Mini Dachshund just diagnosed with Cushings.

[Sophies Mom]

Hi. My 10 year old doxie just diagnosed with Cushings last week. She has never been sick and I'm so upset. Been crying all week. Brought her to a vet internal specialist after vet ran ACTH blood work coming back positive for pituitary Cushings. He's starting her on vetoryl 10 mg 2x a day. Waiting for it to be delivered today . Hope I can start tonite. I've been reading this forum all week and it has given me so much information. I have been so depressed, we have no children and Sophie and our other doxie are our babies.

[Roxee's Dad]

Hi and welcome to you and Sophie,
Please tell us more about what led up to the cushings diagnosis. Were their other test performed other than the ACTH? I assume that since the vet said it was Pit based, there was also an LDDS performed? How much does Sophie weigh?

I know a lot of questions :o and their will probably be more as many more stop by to welcome you and Sophie and help you along this journey.

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[goldengirl88]

Welcome to the forum. I am sorry your Sophie is having problems. Just try not to get yourself so upset as she needs you now, and we will help you through this. You are not alone in this now. We have all been there and cried, just know that with proper management and vigilant watching you dog could live out it's natural life time. The first thing I would ask is if you could get all the test copies and post the abnormal numbers on here, and the range that the lab gives as normal, as all labs are different. There are a number of tests used as it is a very hard disease to diagnose. Did you have an LDDS, ACTH, Urine, Blood Panel and Ultra Sound? We will need the weight of your dog, because you do not want to start the dog on too high of a dose or you could have problems. The recommended starting dose is 1mg per lb. Do not go higher or you are asking for trouble. Low and slow is the way to go. That way your dogs body can adjust to the drug. You will want to make a daily diary on you dog, how much water drinking , or anything else note worthy as you will refer back to it many times. Were you given prednisone by the vet in the event your dogs cortisol goes too low? You should be watching for lethargy, vomiting, diarrhea, can't get up, won't eat. If you are unsure of symptoms it is best to withhold Vetoryl if that is what you are giving. You so not want to give it to a sick dog ever. If you are unsure of something we are here to help you just log on and tell us what is going on. It will be ok once you get the hang of this. Please make sure to educate yourself as much as you can on this disease. You are the only advocate for your dog, and she needs you to understand all of this. Never put blind faith in anyone, and that includes your vet. Try to empower yourself with as much knowledge as possible as it will benefit your dog. We will be on this journey with you so don't be afraid we will help you. Blessings
Patti

[Sophies Mom]

Thank you so much for all the support. I'm going to pick up her labs tomorrow. I know she had blood work at pet smart in April and October. She's on a wellness plan there and gets bloods drawn 2x a year. Labs in April were normal. In Oct her alk phos was 2000 and I complained of her drinking and urinating more. They never said anything to me. So I went back to The vet and asked them to look at her labs again and they said the alk phos was elevated and suggested a ACTH test. I was so annoyed that they didn't tell me this last month. They called me the next morning and said the test was positive for cushings. So I asked to be recommended to a specialist and saw him Tuesday. He spent an hour giving me a lot of information. I seem to like him, he has a lot of experience with this disease. He said he likes to start low, and suggested 10 mg 2x a day. Sophie weighs 19 pounds. She really isn't a mini doxie. More of a tweenie . He called in the medication to Wedgewood pharmacy. Very expensive. $120 for 60 pills. I called the other pharmacies suggested on this forum and found one for $31 a month,but it has to 9 or 11 mg.He also did an ultrasound and said adrenals were slightly enlarged. Meanwhile she is having a lot of accidents which isn't like her. Going back to vet in 3 weeks for repeat labs. Gave her the first pill tonight. I just pray this medication works. He didn't say anything about prednisone. This all started last Friday. I am a nurse so I have heard of cushings disease. I did a lot of reading and some of it very depressing. I'm so happy I came across this website.

[goldengirl88]

You can get 20mg name brand Vetoryl from Lambert Veterinary online for 41.95. It would save you substantial money. If you want to use trilostane DiamonBack drug is widely used by many members on here and are cheaper than others. It sounds like you have a good match up with you Dr. With this disease you do need to start low as he recommended and you do need experience to treat and manage it properly, so it sounds good. Blessings
Patti

[molly muffin]

Hi and welcome to the forum. :)

We're so glad you found us. It's really good to have a support network in place when going through this.
Now I know that it sounds scary and some of the things you read will just not be all that accurate. We like to start out low here too and recommend it as the dogs seem to adapt better to having it in their bodies.
Either 1mg/1lb or 1mg/1kg (Davis recommendation)
Just remember, with proper treatment a knowledge vet and vigilant owner, a dog can live our their normal lifespans.
The good news is that one of the first things to clear up is usually hunger, and the drinking/urinating issues. You should see a difference within the first 10 - 12 days. You will then want to have a follow up ACTH to check those levels between 10 - 14 days of starting vetroyl. That will be done after the morning dose of vetroyl, given with a bit of food, (no fasting for the on treatment ACTH testing).
What you are going to be looking for is the Pre and Post numbers.

Dechra the manufacture recommends a Post of up to 9.0 if symptoms are controlled and if not controlled, then bring it down to under 5.0. You never want the pre or the post number to go lower than 1.45 as this can get you into trouble, they need to maintain a certain level of cortisol in their bodies.

Make a note of those numbers, as not all labs and vets know the numbers they need off the top of their heads. You'll want to start your own file for her, keeping all blood tests in it. So make sure that they know you want copies of everything.

Welcome to the forum :)
Sharlene and Molly Muffin

[Sophies Mom]

Thank you for all those numbers I need to look for. I'm going to start a file, good idea. I got quotes from Diamondback, they were the cheapest so far. Does it matter if I use Vetoryl name brand or Trilostane from a compound pharmacy?
I just gave her her second dose of Vetoryl. If she was going to have reactions to the drug, when would it start?
So happy for all your info and support.

[molly muffin]

It is not normally so much a reaction, like an allergy or something to the drug, but the sensitivity they have to it, and I'd think if she was going to show being very sensitive it would be in the first week. You are just watching to see if the cortisol drops too fast. What you would see is, the not eating, wobbly, lethargic, not drinking.

But just pop in here and check if you ever have a case of the nerves, which is quite common. We all get nervous with anything to do with our "furbabies". It's perfectly natural and everyone here understand that. :)

Some people and vets prefer to use the name brand vetroyl as you are guaranteed to get the correct dosage in every pill. Some use compounded as the cost is a big difference and if you are on a dosage that doesn't match to what the brand name comes in. Some use both, a combination of vetroyl and trilostane.
If you have a good compounding pharmacy, Diamondback has a good reputation, then I'd think trilostane should be fine. Everyone can have different opinions on trilostane vs vetroyl. I think it's a matter of cost and of dosage. Sometimes you need an inbetween dose that vetroyl doesn't come in, plain and simple, so need to add in a compound or switch completely. Others is that some just can't afford the higher cost, especially long term of vetroyl.

Hope that helps.
Sharlene and Molly Muffin

[goldengirl88]

I try to use Vetoryl because the dosage is more accurately relied upon. I have to use some trilostane because Vetoryl does not make small mgs and my dog ins on 27mg so I use 20 Vetoryl and 7 trilo. It is true a lot of vets only want you to use the name brand. It is up to you and your vet to decide. Blessings
Patti

[addy]

Hi and welcome,

You have gotten much good advice and I just want to add that ACTH stim test to check the cortisol after starting the drug should ideally be done sooner than 3 weeks. 10-14 days would be best from the start date and make sure you give the am dose with food and have the test started 4 hours after giving the dose in the morning.

I am so glad you found us.

[Sophies Mom]

I picked up Sophie's labs today from PetSmart. In oct the only thing elevated was the Alk Phos 2000. ACTH sample 1 post 5.3 Normal(1.0-5.0). Sample 2 post 32.2 Normal (8.0-17.0).
I just look at her and hope nothing is bothering her, or she is not suffering in any way. The tears are falling on my ipad as I write.
Anyway off to the bed to watch a movie with Sophie, hubby and my other doxie Sammie.
Thanks everyone.

[Roxee's Dad]

Alk Phos 2000. ACTH sample 1 post 5.3 Normal(1.0-5.0). Sample 2 post 32.2 Normal (8.0-17.0)

Just just wanted to note that the normal numbers given here are for a pup that is not on Cushings medication, which at the time of this test, she was not. Now that Sophie is on Vetoryl (Trilostane) her ideal numbers should be somewhere very close to this range on her ACTH post ( 1.45 µ/dL and 9.1 µ/dL)

Besides the excessive water drinking (Polydipsia), and excessive urination (Polyuria) often referred to as PU/ PD , does Sophie have an excessive appetite? Always hungry?

You will probably notice a decrease in the thirst in about 3 to 10 days, sometimes it may take a little longer.

It looks like you caught it early enough that she is not really suffering, just bothered by being thirsty all the time and hungry. Relax and enjoy each others company and like has been said before, watch for signs that the cortisol is going too low. Did the vet explain what to watch for?

[Sophies Mom]

Thanks John. I will write those numbers down. I am keeping a file. I was trying to think back this whole week. And it seems the first symptom she had was a few months ago. She always acts like she's hungry, but she started crying for her food. Then a couple of months ago she started with the drinking/urinating. Those were the only symptoms. The vet said we caught it early.
He did tell me to look for GI symptoms from the drug.
Just gave her 4th dose of Vetoryl. She seems ok, thank god.
Thanks for your support.

[Sophies Mom]

What were the signs again of cortisol going to low? Want to write them down. This has been a crazy week with a lot of information.
Thanks.

[goldengirl88]

Barbara:
You are doing a great job, everything will be ok just keep watching closely. It takes a while to get the hang of this, but you are on your way. Blessings
Patti

[goldengirl88]

Barbara:
Watch for vomiting, diarrhea, lethargy, not eating, can't get up or stand. You can do it!
Patti

[Sophies Mom]

Sophie just started making small spots of urine everywhere. And nothing is coming out now. Is that a side effect of something? Should I bring her to the vet?

[goldengirl88]

Barbara:
Don't know what you mean small spots, but nothing coming out is not making sense to my brain right now?? I have not heard anyone else ever mention this. Do you think she is trying to go and can't?? Has she been checked for a UTI as of late? Blessings
Patti

[goldengirl88]

Barbara:
Is everything ok, I don't think the urine spotting is something you need to take her to the vet for unless she cannot go and that could mean an infection.

[Sophies Mom]

Patti, she was just walking around spotting on the deck and on the kitchen floor. Little spots were coming out until eventually she had nothing else left. I've only seen her do this when I take her to a place where there has been a lot of dogs.
It's just just everything is making me so nervous right now. I don't know what's normal and what's not at this point.
Right now she's on the bed resting.
Thanks so much Patti, you are so sweet!

[addy]

Deep breath, it will get easier. If it helps to write down her behavior every day for awhile, a journal is good. We are all nervous when we first start. You will be just fine.:)

[goldengirl88]

Glad everything is ok. It will get easier I promise you. I was such a nervous wreck when I started Tipper on her Vetoryl it's a wonder I didn't have a stroke. Every little thing she did I was right there in her face. Addy is right I always journal Tippers day . It is good to reference when you cannot remember something that happened in the past. I call it my doggie diary. You are going to get thru this, but don't hesitate to post as there are no dumb questions on here, and we all need help that's why we are here. Hope you two have a quiet evening. Blessings
Patti

[Roxee's Dad]

I think you will do just fine and if any questions we are here to help. Here is a great information pdf put out by Vetoryl (Trilostane) easy to read and full of good information to print out and keep handy. These are the basic rules we pretty much all abide by. It's only a 10 minute read but well worth it. :)

http://www.dechrace.com/pdfs/vetoryl/vetoryl_client_brochure_english.pdf

BTW, their is a lot of good information in our "Helpful Resources for Owners of Cushing's Dogs" section. You will get used to the terminology pretty quickly ;):)

[molly muffin]

Checking in to see if she is doing better with the pee spotting? I wonder if as the cortisol is lowering, if she feels different and makes her nervous. If it does continue, then what the heck give the vet a call and tell them what she is doing, just in case to cover all your bases.
A journal is a good idea, as Addy mentioned. It can be helpful to go back and look and see what her reactions are every day or anything you notice.
Addy has been at this for 2.5 years with her Zoe and I know she has consulted that journal for information from time to time :)

hugs,
Sharlene and Molly Muffin

[Sophies Mom]

Sophie is better now. I have no idea what that was. I was thinking the same thing about the cortisol lowering, maybe she feels a little weird. But she's acting ok. I'm going to mention it to the vet.
Thank you all so much for the concerns. It makes me feel so much better.

[goldengirl88]

Just checking in on Sophie today to see how she is doing? Blessings
Patti

[addy]

Any time you have a question or feel anxious just come and talk to us, okay? Any time you are really concerned, withhold the pill. Sometimes they can feel icky as the cortisol drops, as Sharlene already mentioned. My Zoe was first diagnosed in April 2010. We started Vetoryl in June 2011. It will get easier for you.:):)

[Sophies Mom]

Addy, why did you wait so long to start the meds?
I'm at work today. I'm a nurse so I have a long day. Hubby is home with Sophie. So far everythings good. I left him all the notes, signs and symptoms and vet number.
Let you know later how the day went.

[Sophies Mom]

Hi everyone. Just want to give you an update on Sophie. Day 6 on Vetoryl. The drinking/peeing seems to be a little better. She even seems to have a little more spunk. You forget the little silly things they used to do, and then they start doing it again. We go for ACTH test Dec 17th.
I just want to thank everyone for their support. It makes me feel better that I always know I can come here for support and information.

[molly muffin]

Really glad to hear that Sophie is doing well on the vetroyl and the drinking and peeing are getting a bit better. That is good news indeed! :) whoo hooo Sophie girl.

hugs,
Sharlene and Molly Muffin

[doxiesrock912]

Symptoms are improving which means that Sophie is either at the right dose or just needs a little tweaking. Daisy always has a day or a few when she's not herself whenever they change her dose. That's normal for her.

As long as Sophie is eating, not lethargic, no vomiting or diarrhea, you're doing fine.

[goldengirl88]

Great to hear that Sophie is improving every day. That is great for them and us when the symptoms subside. Blessings
Patti

[apollo6]

Dear Sophie's Mom
Welcome. What you are feeling is normal. It can get pretty overwhelming. The love you have for Sophie is very strong. I am going to post a few websites for resources as to specialists, internal medicine specialists have more insight about cushings. also websites that explain the 3 types of cushings, you have not said which one Sophie has(pituitary gland, adrenal, atypical) Also the test for cushing are full blood panel which would show elevated readings( usually the liver, kidneys) and an ACH stim test which show the cortisone readings( cause of cushing)
Keep copies of all test results,labs from vet.,ask questions about reports, drugs any thing that confuses you. Try to keep a journal on her progress so you can look back to compare. Signs of cushing is hair loss on both sides of body, pot belly, and excess drinking causes more urinating.

http://www.kateconnick.com/library/cushingsdisease.html

http://www.peteducation.com/article.cfm?c=2+1597&aid=416

http://www.acvim.org/PetOwners/FindaSpecialist.aspx
this is the company Dechra for TRilostane/Vetroyl, with information on cushing, the drug it self and you can even email any questions you have.
http://www.dechra-us.com/Default.aspx?ID=38&pcatid=PRIMARY4&catid=PROPGRP14&fid=PROPFIELD107&ProductID=PROD123
My sweet doxie, Apollo was on 10 mg. of Vetroyl, and weighed 10 lbs. He was one month short of 14 when he died. Never give up hope, faith. I would recommend a specialist if you can afford.
Also it is less expensive to order medications online from a reputable animal pharmacy, ask us. I have used Diamondback, also Dr. Foster and Smith.
Ask questions, never feel you have to make a decision on the spot, research, use this forum for support. there is a lot of knowledge here.
Hugs Sonja and Angel Apollo

[Sophies Mom]

Hi everyone. Took Sophie in for her first Stim test yesterday after being on Vetoryl 10mg 2x a day for 2 1/2 weeks.
The Vet just called with the numbers.
Pre 5. 2 Post 11.2 He was very pleased. She went down from pre 5.3 and post was 32.2.
She has much improved, but I told him she still has a little too much drinking/urinating. So he is raising her to 15mg 2x a day. We will repeat the blood work in 3 weeks. But he he thinks that this is most likely going to be her maintenance dose.
He mentioned that as the tumor gets bigger the maintenance dose sometimes has to be increased, which I wasn't crazy about hearing. Gives me something else to worry about.
I asked him if I could use Trilostane instead of Vetoryl, and he said that was fine. So I had them call Diamond Back.
Hope everyone is well and not getting too much snow. Here in New York we are in a deep freeze. Was suppose to go into the city today to see the tree, but just too cold.

[goldengirl88]

I am glad things are working out for Sophie. It seems your Dr. is really on top of things. I am hoping you can get her to the dosage that works for her soon. It is hard, but the babies are worth it. Blessings
Patti

[molly muffin]

So glad to hear that Sophie is doing well. A drop of 20 points post in 2 1/2 weeks, I'm not sure if she would have needed to go up or not, as cortisol levels sometimes don't level out for 30 days or more. So, just keep an eye out in case it's too much. We've seen it happen. Baby steps. You can always walk back the dosage if she starts to get diarhea, lethargy, etc.

You're doing good!
Sharlene and Molly Muffin

[doxiesrock912]

That's awesome news! It often takes longer to find the right dose. You're one of the lucky ones :)

[Sophies Mom]

Why is Sophie's Alk Phos still so high? It only went down to 1600 from 2000. I'm concerned.

Barbara and Sophie, (New York, USA), canine, 10 YO, F, Spayed, Dx PDH 11/24/13, started 10 of Vetoryl x one month, now going up to 15mg 2x a day, no other medicines or supplements, diet chicken organics by Nature, Last Stim 12/17/13 Pre 5.0. Post 11.2, Alk Phos still high 1600 down from 2000. Weight 19 lbs.

[labblab]

It can take quite a long time for the liver values to react to treatment, and for some dogs they do not ever return to baseline levels again. But this need not be a cause for undue worry since even with the lab elevations, the dog's actual liver function may not be compromised nor damaged.

Marianne

[addy]

Zoe's liver values did not return to normal until she was down to 1.9 ug/dl.

[Trixie]

Hi, I'm a Barbara too...and also from NY. My dog has been treated since last March. It took us awhile-many months of dose tweaking to get my dogs symptoms to subside. Her liver numbers are still high, hoping our next blood work will she improvement. That drop your Sophie had from 2000 to 1600 is pretty good actually since you've only just started...it's definitely headed in the right direction!!
Sounds like you're doing a great job. :)

Barbara

[Sophies Mom]

Thanks for the encouragement everyone. Got the 15 mg of triolostane today from Diamondback. Will start in AM. A little nervous about that.

[Sophies Mom]

Sophie and I wish everyone a Merry Christmas and a happy and healthy New Year for 2014!
Thank you everyone for your wisdom and support!

[doxiesrock912]

Merry Christmas!
Be sure to give the Trilostane with food. Canned pumpkin from the baking aisle can help if Sophie 's stomach is sensitive. Daisy's was at first.

[molly muffin]

Merry Christmas :) I hope you have a wonderful holiday

hugs,
Sharlene and Molly Muffin

[Sophies Mom]

Hi everyone. Hope everyone had a good holiday. Just wanted to post Sophie's 3rd Stim test done yesterday. Came back pre 6.0 post 13. That went up even though we raised her trilostsane the month before from 10mg 2x a day to 15 mg 2x a day. Now the vet wants to raise her to 20 mg 2x a day. Her symptoms have improved.
Is that normal for the cortisol to go up even though her dosage was raised?
Barbara and Sophie, (New York, USA), canine, 10 YO, F, Spayed, Weight 19 lbs, Dx PDH 11/24/13, started 10mg 2x a day of Vetoryl x one month, now going up to 15mg 2x a day, no other medicines or supplements, diet chicken organics by Nature, Last Stim 12/17/13 Pre 5.0. Post 11.2.

[doxiesrock912]

Barbara,
In the helpful resources part of this forum you'll find a lot of useful information. Since you are concerned about increasing Sophie's dose, please pay particular attention to the posts discussing Addison's. Important to know just in case.

Daisy, a black and tan mini dachshund, also as symptom improvement but our IMS wasn't satisfied so she's increased her dose from 12mg twice a day to 15mg twice a day. We started tonight.

If Sophie has any infections or other health problems in addition to Cushings, the tests results could be off.
Please address these issues with your vet before increasing the dose.

[labblab]

Hi everyone. Hope everyone had a good holiday. Just wanted to post Sophie's 3rd Stim test done yesterday. Came back pre 6.0 post 13. That went up even though we raised her trilostsane the month before from 10mg 2x a day to 15 mg 2x a day. Now the vet wants to raise her to 20 mg 2x a day. Her symptoms have improved.
Is that normal for the cortisol to go up even though her dosage was raised?
Barbara and Sophie, (New York, USA), canine, 10 YO, F, Spayed, Weight 19 lbs, Dx PDH 11/24/13, started 10mg 2x a day of Vetoryl x one month, now going up to 15mg 2x a day, no other medicines or supplements, diet chicken organics by Nature, Last Stim 12/17/13 Pre 5.0. Post 11.2.
It is somewhat odd for the cortisol to have increased subsequent to upping the dose of medication. I am wondering if you may have switched from brandname Vetoryl to a compounded product since 15 mg. is not available in Vetoryl? If so, there may be some dosing or absorption inconsistency between the two types of product. Just a thought.

Marianne

[Sophies Mom]

It is somewhat odd for the cortisol to have increased subsequent to upping the dose of medication. I am wondering if you may have switched from brandname Vetoryl to a compounded product since 15 mg. is not available in Vetoryl? If so, there may be some dosing or absorption inconsistency between the two types of product. Just a thought.

Marianne

That's exactly what I was thinking! Can there be that much of a difference? Is that a bad thing? Of course I can't get a hold of the vet until Monday to go over it with him. I'm so frustrated with these vets. What I'm paying him, he should be available 24/7!

[labblab]

Yes, unfortunately it appears there can be a significant difference in the efficacy of compounded products. Here are the results of a recent study conducted by Dr. Audrey Cook of Texas A & M University. This study was funded by Dechra, so that may raise the eyebrows of those who are cynical. But Dr. Cook is highly respected internationally both as a researcher and a clinician. And these are the study results:


Compounded trilostane capsules (15 mg, 45 mg, or 100 mg) were purchased from eight pharmacies and assayed for content and dissolution characteristics. Capsules made in-house containing either inert material or 15 mg of the licensed product and proprietary capsules (30 mg and 60 mg) served as controls. Findings were compared with regulatory specifications for the licensed product. Altogether, 96 batches of compounded trilostane and 16 control batches underwent analysis. In total, 36 of 96 (38%) compounded batches were below the acceptance criteria for content. The average percentage label claim (% LC) for each batch ranged from 39% to 152.6% (mean, 97.0%). The range of average % LC for the controls was 96.1–99.6% (mean, 97.7%). The variance in content of the purchased compounded products was substantially greater than for the controls (234.65 versus 1.27; P<0.0001). All control batches exceeded the acceptance criteria for dissolution, but 19 of 96 batches (20%) of purchased compounded products did not. Mean percent dissolution for the purchased compounded products was lower than for controls (75.96% versus 85.12%; P=0.013). These findings indicate that trilostane content of compounded capsules may vary from the prescribed strength, and dissolution characteristics may not match those of the licensed product. The use of compounded trilostane products may therefore negatively impact the management of dogs with hyperadrenocorticism.

Here's the link for the abstract of this article published in the Journal of the American Animal Hospital Association:

http://www.jaaha.org/content/early/2012/05/18/JAAHA-MS-5763.abstract

The compounding pharmacies that were sampled in the study were not named. So on the face of it, there's no way to know from this study whether a specific compounding pharmacy has been problematic in the past, or will be in the future. In reading back through your thread, it looks as though you were planning to use Diamondback. Many of our other members have been using them to their satisfaction, so I have no reason to question the efficacy of Sophie's compounded trilo other than these odd ACTH results. But when I see testing irregularities like this, it always makes me wonder...

In Sophie's case, you had no choice but to move to compounding when her dose was increased to 15 mg. And now, moving to 20 mg. twice daily, the cost of four boxes of Vetoryl monthly would be really prohibitive. But in order to eliminate these kinds of question marks, in situations in which the dosing and cost do make it possible, my own personal preference would be to try to stick with the brand product at least during the first couple of months or so, until a dog has been stabilized on a given dose.

After having spent all this time talking about compounding, though, just to double-check: both of these monitoring ACTH tests were conducted within the same time frame after Sophie was dosed along with food? Otherwise, that would be the most likely reason for the irregularity in the test results.

Marianne

[Sophies Mom]

Yes, unfortunately it appears there can be a significant difference in the efficacy of compounded products. Here are the results of a recent study conducted by Dr. Audrey Cook of Texas A & M University. This study was funded by Dechra, so that may raise the eyebrows of those who are cynical. But Dr. Cook is highly respected internationally both as a researcher and a clinician. And these are the study results:


Here's the link for the abstract of this article published in the Journal of the American Animal Hospital Association:

http://www.jaaha.org/content/early/2012/05/18/JAAHA-MS-5763.abstract

The compounding pharmacies that were sampled in the study were not named. So on the face of it, there's no way to know from this study whether a specific compounding pharmacy has been problematic in the past, or will be in the future. In reading back through your thread, it looks as though you were planning to use Diamondback. Many of our other members have been using them to their satisfaction, so I have no reason to question the efficacy of Sophie's compounded trilo other than these odd ACTH results. But when I see testing irregularities like this, it always makes me wonder...

In Sophie's case, you had no choice but to move to compounding when her dose was increased to 15 mg. And now, moving to 20 mg. twice daily, the cost of four boxes of Vetoryl monthly would be really prohibitive. But in order to eliminate these kinds of question marks, in situations in which the dosing and cost do make it possible, my own personal preference would be to try to stick with the brand product at least during the first couple of months or so, until a dog has been stabilized on a given dose.

After having spent all this time talking about compounding, though, just to double-check: both of these monitoring ACTH tests were conducted within the same time frame after Sophie was dosed along with food? Otherwise, that would be the most likely reason for the irregularity in the test results.

Marianne
Thank you so much for the info Marianne. We feed Sophie at 9am that Morning and we had a 1pm appt. So maybe they did the test at about 130. I'll have to be more aware of the time we feed her. It's 4 to 5 hours after taking medication? I guess we will just have to wait another 3 weeks to see what happens. Very Stressful!

[labblab]

If Sophie had her trilo along with breakfast at 9:00, then the 1:00-1:30 testing time frame should be good (Dechra says to test 4-6 hours after dosing along with a meal). You'll just want to make sure that you remain consistent with that same schedule for all the subsequent tests, as well, so that you are comparing apples to apples.

[Sophies Mom]

I'll keep you updated. I'm always nervous when I raise the dose. Thanks for all your info.

[Budsters Mom]

We are all nervous when dosage are raised. We are here to help make sure they are done as accurately and safely as possible. :p xxxx

[Sophies Mom]

I am just sitting here at 1am in the morning after working a 12 hour shift and of course worrying about my beautiful Sophie. Not being able to sleep, I'm reading some of the posts and wondering if I should be giving Sophie any supplements as I see some members do. Is that something I should be discussing with the IMS?
Thanks everyone! So happy I have all your support! Barbara and Sophie, (New York, USA), canine, 10 YO, F, Spayed, Weight 19 lbs, Dx PDH 11/24/13, started 10mg 2x a day of Vetoryl x one month, now going up to 15mg 2x a day, no other medicines or supplements, diet chicken organics by Nature, Last Stim 1/16/14 pre 6 post 13. Going up to 20 mg of trilo 2x/day.

[Budsters Mom]

We've all sat up many nights and worried about our babies. The good news is that you never sit up alone. There is usually a few of us coming or going. :p

I just noticed that you commented on my "Never had a Cush Dog" poem. We know what your are going through because many of us have been there or are going through it now.

Your journey with us has just begun. Keep reading and asking questions. The more you know, the more in control you will feel.

Hugs,
Kathy

[molly muffin]

It's pretty natural to be awake worrying. :)
A lot of us give liver supplements of some form.
I give Heppato Support, some use Denamarin, or milk thistle. You could certainly
ask your IMS if she thinks they would be beneficial for Sophie.

Sharlene and Molly Muffin

[Sophies Mom]

We've all sat up many nights and worried about our babies. The good news is that you never sit up alone. There is usually a few of us coming or going. :p

I just noticed that you commented on my "Never had a Cush Dog" poem. We know what your are going through because many of us have been there or are going through it now.

Your journey with us has just begun. Keep reading and asking questions. The more you know, the more in control you will feel.

Hugs,
Kathy

Thanks Kathy! :)

[Sophies Mom]

Hi everyone. Wanted to get your feedback on Sophie's Stim test this month after going up to 20mg 2x a day last month. IMS just called.
Pre 4. 8. Post 11.2. So it didn't go down that much, he says he prefers it to be under 10 but he doesn't always go by the numbers. Her symptoms are improved and it's pretty close. He says as the disease progresses we will have to go up to 25 or 30mg 2x a day. But right now he's happy with these numbers. I should come back for repeat Stim in 3 to 4 months. This her 3rd Stim since December.
What do you think? I don't know! Should I look for another IMS?
It sounds kind of depressing!

Barbara and Sophie, (New York, USA), canine, 10 YO, F, Spayed, Weight 19 lbs, Dx PDH 11/24/13, started 10mg 2x a day of Vetoryl x one month, now going up to 15mg 2x a day, no other medicines or supplements, diet chicken organics by Nature. Original Stim in Dec 5.3,32.2. Stim in Jan 6.4,13.7 Trilo up to 20mg 2x a day.

[molly muffin]

I don't know if I'd raise it right now. She just seems to be all over the place with her reaction (stim results). How are her symptoms?

To recap:
ultrasound showed bilaterally enlarged adrenal glands

pre medication (diagnositic acth)
pre 5.3 post 32.2

12/17/2013
pre 5.2 post 11.2 (vetoryl 10 x 2)

01/16/2014
pre 6.0 post 13.0 (vetroyl 15 x 2)

02/19/2014
pre 4.8 post 11.2 (vetroyl 20 x 2)

So she is coming down and if symptoms are okay, even though that post number is high, I'd maybe just wait and see how she does over a longer period on the same dose.
Now if the symptoms aren't clearing up, then I might up it a bit but not much. You can use vetroyl and trilostane to get a dosage you are comfortable with if need be.
Did you put her on any liver supplements yet? If you, you should consider that too.
Sharlene and Molly muffin

[Harley PoMMom]

I agree with Sharlene with not increasing Sophie's Vetoryl dose as of yet because we have seen some dog's cortisol levels drop while being treated with the same dosage over a period of time.

Hugs, Lori

[apollo6]

dear Barbara

Sophie and Sophie's Mom
I agree with your gut feeling. Please realize only you know what is best for your sweet Sophie. Any Cushing drug is serious business and you just don't up it drastically. I can not tell you what to do, but if you do not feel confident with your vet it does not hurt to get a second opinion. My sweet Apollo was one month short of 14 when he died and I think we have a Cushing baby that lived to 16. So keep asking us and questioning your vet get all the info you can get.
hUG Sonja and Angel Apollo

[Sophies Mom]

I don't know if I'd raise it right now. She just seems to be all over the place with her reaction (stim results). How are her symptoms?

To recap:
ultrasound showed bilaterally enlarged adrenal glands

pre medication (diagnositic acth)
pre 5.3 post 32.2

12/17/2013
pre 5.2 post 11.2 (vetoryl 10 x 2)

01/16/2014
pre 6.0 post 13.0 (vetroyl 15 x 2)

02/19/2014
pre 4.8 post 11.2 (vetroyl 20 x 2)

So she is coming down and if symptoms are okay, even though that post number is high, I'd maybe just wait and see how she does over a longer period on the same dose.
Now if the symptoms aren't clearing up, then I might up it a bit but not much. You can use vetroyl and trilostane to get a dosage you are comfortable with if need be.
Did you put her on any liver supplements yet? If you, you should consider that too.
Sharlene and Molly muffin

Sharlene, I asked him about liver supplements and he said they don't do anything, keeping the cortisol level down is the best treatment.

[Sophies Mom]

Thanks Sonja, you are so sweet. I hope you are ok. I read in your posts how much you miss your Apollo.

[Sophies Mom]

Sharlene, I asked him about liver supplements and he said they don't do anything, keeping the cortisol level down is the best treatment.

Sharlene, I was just thinking. Maybe I should just try liver supplements. My doctor told me to try Red yeast rice to bring down my cholesterol and it worked. Which one should I try and where do I buy it?
By the way, I'm very impressed , you got Sophie's history down pat from the beginning.
Thank you for all your feedback. I always feel better when I hear all your comments.

[molly muffin]

Denmarin is used by many. I use one called Heppato support, but not sure it is working any longer, so might need to change that.
milk thistle is good.

Glad I got the labs correct. I like to have them in one spot and see them, it's easier then to see exactly what is going and helps to make decisions easier I think.

hugs,
Sharlene and molly muffin

[Sophies Mom]

Hi. I'm a pretty new member with a 10 year dachshund just diagnosed 3 months ago. And I noticed the last couple of weeks she doesn't jump on the couches anymore. She runs and walks well. Why do you think they suddenly stop jumping ?

Barbara and Sophie, (New York, USA), canine, 10 YO, F, Spayed, Weight 19 lbs, Dx PDH 11/24/13, started 10mg 2x a day of Vetoryl x one month, now going up to 15mg 2x a day, no other medicines or supplements, diet chicken organics by Nature.
Original Stim in Dec 5.3,32.2. Stim in Jan 6.4,13.7 Trilo up to 20mg 2x a day.

[goldengirl88]

It could be any number of things making your dog not want to jump anymore. Cushing's affects the leg muscles by wasting them away. It could be your dogs back legs are weakened. Also this affects the musculoskeletal system, and that could be the problem. Also Cushing's mobilizes fat through their bodies which often settles in the abdomen shifting things around there that can put pressure on other organs. It could be any of these, or any combination there of. Blessings
Patti

[Sophies Mom]

Hi everyone . I'm not sure what to do about Sophie. Her lasts Stim was February 17. On Trilo 20mg 2x a day. Pre was 4.8, post was 11. IMS said he likes it under 10. But was comfortable with that dosage for now. Come back in 3 to 4 months for another Stim. Her urinating all day seems fine but at night after 8pm is off. She always goes on the pads, sometimes she misses a little. But like tonite she went on the floor when you walk into the kitchen. Before that she went under the kitchen chair. I can't figure out if she can't make it to the pad or what. Maybe the trilo isn't the right drug for her. I know I'm going to have to make another appt with the IMS. Maybe her cortisol went up again. I'm just so confused.

[Harley PoMMom]

Is she drinking a lot of water? If so, than I believe her post of 11 is probably the cause of her increased urine output. What did Sophie's IMS say about her increased urination?

Dechra states in their product insert that a dog can have a post as high as 9.1 ug/dl as long as clinical signs are controlled.

Does it seem that she is straining to pee, and/or is she trying to urinate and only a small amount comes out? An UTI can cause a dog to drink and urinate more.

Hugs, Lori

[goldengirl88]

I am with Lori. My Tipper cannot go as high as 9 on her post as she exhibits clinical signs a lot. The drinking and peeing a lot mostly. The problem could be the dog is not controlled enough at her current post number. It will continue until the cortisol is controlled enough to stop it. This has been the case with my Tipper. You will need to discuss raising her dosage with the IMS as the current dose is not managing the cortisol enough. Blessings
Patti

[Harley PoMMom]

I also wanted to add that dogs with Cushing's almost always have diluted urine and a regular urinalysis is not sensitive enough to pick up any bacteria so I would recommend having an urine culture and sensitivity test performed.

[Sophies Mom]

That's what I'm thinking. Made an appt to see IMS Wed. But she's a 19 lb dog on 40mg a day. Isn't that high already.
Could it be this drug is not working for her?

[addy]

Zoe was 17-17.5 pounds; her weight went up and down. She was on 50mgs for over a year. There is no maximum dose and we have had some dogs end up on what some would consider hefty doses. But they worked their way up to them.

Its better to gauge symptoms rather than chase numbers. Having said that theraputic range of 1-5 for Zoe brought normal blood work, though she struggled when she went down to 2 and under because of problems with her front leg, etc. She felt better with a bit higher cortisol.

It all depends on the dog. Each one is different.

[Sophies Mom]

Thanks for your response Addy. I'll let you know what the IMS says 2 Moro.

[Harley PoMMom]

But she's a 19 lb dog on 40mg a day. Isn't that high already.
Could it be this drug is not working for her?


Zoe was 17-17.5 pounds; her weight went up and down. She was on 50mgs for over a year. There is no maximum dose and we have had some dogs end up on what some would consider hefty doses. But they worked their way up to them.

Its better to gauge symptoms rather than chase numbers. Having said that theraputic range of 1-5 for Zoe brought normal blood work, though she struggled when she went down to 2 and under because of problems with her front leg, etc. She felt better with a bit higher cortisol.

It all depends on the dog. Each one is different.

Addy has said it perfectly and I agree 100% ;)

[Sophies Mom]

Hi all, hope everyone had a nice holiday. Haven't posted for a while, but every nite I read all the new posts. Sophie has been doing well since we went up to 25 of trilo 2x a day about 3 weeks ago. Her Drinking and peeing is about normal. She always wants food, but she was always a chow hound. We thought we were going to get really good numbers with her ACTH and we were shocked that they went up from 4.8 pre /11.1 post to 6.5 pre/13 .5 post. We had to see a different IMS because our usually one was on vacation and I didn't want to wait. He asked me about her blood pressure being high and spilling protein in the urine which the IMS we have been seeing since December never mentioned BP or protein in the urine. When this all started I got copies of all her labs and her urine didn't have any protein. Sophie has an appt to have her dental next month and we will have them ck her BP and urine. Pending that he wants me to go up on the trilo. I just can't believe that Stim was right because her symptons are so controlled. Maybe because I had 20 mg pills of trilo and then added 5 mg pills to that. Or maybe Diamondback is not consistent with their dosages. I'm just so confused right now with everything. Anybody ever have this happen to them?

Barbara and Sophie, (New York, USA), canine, 10 YO, F, Spayed, Weight 19 lbs, Dx PDH 11/24/13, started 10mg 2x a day of Vetoryl x one month, now going up to 15mg 2x a day. Last Stim on jan 18. Pre 4.8. Post 11. Remaining on trilo 20mg 2x a day.PD/PU increased, went up to 25mg of trilo 2x a day in March.

[Harley PoMMom]

Since Sophie's symptoms are well controlled, I too, would be hesitate to increase her Trilostane dose. If this were me, I would wait a month and have another ACTH stim test done and see what those results show. For me, it's about how the dog is feeling along with the symptoms rather than chasing numbers.

Hugs, Lori

[Sophies Mom]

I forgot to mention, that I kinda picked this new IMS brain by asking a lot of the same questions to see if they are all on the same page.
I told him about her making snorting sounds mostly when she breathes in and he said cushings dogs sometimes get extra skin growth in the back of their throats that can make this noise. It's usually harmless. The other IMS said she had rhinitis which is common in doxies and told me to give her Little noses nasel spray. So which one is right? Has anyone ever heard of this?
This disease is just so frustrating, and everyone gives you different answers. I think you guys are the most knowledgeable with this disease!

[doxiesrock912]

Daisy's symptoms are very well controlled but her numbers also went up recently and we increased to 19mg twice a day. Daisy weighs 11 lbs.

Our IMS is very familiar with Diamondback as she used them when she lived in CA.

We seem to be in the same situation and both with mini dachshunds.

I was under the impression that the numbers aren't quite so important as controlling the symptoms, but our IMS says that at some point you worry about what Cushings is doing to the liver and I think that is why she increased.

This might be worth asking your IMS.

[goldengirl88]

There are some studies online if you look them up. Some say there is a high percent of these compounded drugs that do not contain the right mg., so you may be right about the compounded trilostane. Blessings
Patti

[Harley PoMMom]

Dog's with Cushing's will usually have an enlarged liver which presses up on the diaphragm and can cause breathing issues.

Hugs, Lori

[Sophies Mom]

Since Sophie's symptoms are well controlled, I too, would be hesitate to increase her Trilostane dose. If this were me, I would wait a month and have another ACTH stim test done and see what those results show. For me, it's about how the dog is feeling along with the symptoms rather than chasing numbers.

Hugs, Lori

I agree with you Lori. I'm going to wait a month and then do another Stim. I always feel better when I get all of the forums feedback.
Thanks everyone.

[Sophies Mom]

Hi everyone. I haven't posted for a while. I read the posts every few days. I'm sending my thoughts and prayers to Patti and Tipper, I noticed she hasn't been posting for a while which is unlike her. I wanted to update everyone on Sophie.
Sophie's last Stim was in April 6.5/13.6 after upping her Trilo to 25mg 2x a day. IMS wanted me to raise her trilo, but I felt her symptoms were perfect. So I had the Stim repeated yesterday, 3 months later and it came back pre 3.0/post 5.0. The lowest she's ever been.
I'm just not understanding why we raised her 4 months ago and her levels went up, now 3 months later on same dose, went down so much. IMS says we should repeat in a month to see if maybe one of the Stims had a glitch(as she called it). Appreciate your feedback as always.


Barbara and Sophie, (New York, USA), canine, 10 YO, F, Spayed, Weight 19 lbs, Dx PDH 11/24/13, started 10mg 2x a day of Vetoryl x one month, now going up to 15mg 2x a day. Last Stim on jan 18. Pre 4.8. Post 11. Remaining on trilo 20mg 2x a day.PD/PU increased, went up to 25mg of trilo 2x a day in March.Stim came back after one month on 25mg 2x a day,pre 6.5, Post 13.6. Symptoms have improved. No protein in urine, BP normal.

[addy]

The hormones including cortisol fluctuate which is why we have a range to use. It could be we caught your pup on a low day, something else was going on before, added stress,who knows on the previous test maybe bumped it up a bit.

They can also drift lower on a dose which is why we have to watch them. Now it could be this dose holds these numbers for another 3-4 months. It does seem like a pretty big drop though. Sometimes they get sensitive to the drug and we end up lowering their dose. That happened to my girl and Dechra advised us about the possibility of that happening. If you or your vet has questions, you can call Dechra.

How are Sophie's symptoms? Are they controlled? Are you seeing any new symptoms?

[Sophies Mom]

Thanks for your response Addy. No, there are no new symptoms, thank god. The only thing is the food obsession which she always had to some degree.
I thought that was a big drop also. So we will do another Stim in about a month.

[molly muffin]

Glad there are no new symptoms, that is a good sign, but yes, the results can get squirrely. Any time that there is a large drop up or down, I think a rest at an appropriate time frame is in order. I'd do a month too. You just want to know if this is trending or a fluke or what.

Sharlene and molly muffin

[Sophies Mom]

Hi everyone. I haven't posted for a while. But I go on occasionally and read what's going on. Sophie had her last stim last month. She is still within the controlled range. She is still on 25 of trilo 2 times a day. Everything is going pretty well except she has picked up this disgusting habit of eating her own poop, if we don't get there in time to pick it up. And she is so sneaky about it. Typical Doxie behavior. Has anyone had this problem? Is this from the Cushing ?
Appreciate any feedback. Happy Father's Day to all the fathers out there!