My girl pug (confirmed Cushings & confirmed calcinosis cutis) / Tobey has passed

[Renee]

Hi everyone,

My name is Renee. I have three pugs, a female and two males. I am also heavily involved in running pug rescue up here in Alaska (with another amazing animal lover).

My girl Tobey is my first pug. I got her as a puppy from a backyard breeder (before I knew better), and she is 10 years old now. Things have been quite baffling with her these last few years, although looking back, it seems that she has many symptoms that indicate possible cushings. Unfortunately, at the moment, she is unable to be tested for cushings due to being on prednisone (we are tapering her off right now).

About 2 years ago, she started getting UTI's. They were wicked too, and I was sending out culture & sensitivities every month for a long time. For a few months she even had MRSP bacteria (related to MRSA). It was a long road to get these infections under control, but eventually we did. She did have surgery earlier this year for bladder stones, which turned out to be very untypical looking struvites (they appeared to be oxalate, but they were confirmed as struvites from the lab). Before the surgery, the ultra sound showed her kidneys to be 'dark' and containing possible stones / tumors as well, however, her kidney function has never been out of the normal range. After the surgery, she started having incontinence in her sleep. She 'wets the bed' a few times a month.

Starting in October of this year, she began drinking a lot of water and having accidents in the house. She was also very gassy. I thought she may have another UTI, so we went to the vet for testing. She tested negative for a UTI, but given the possibility of early kidney disease (based on the ultrasound), we thought it was just a progression. We decided not to treat the gassiness and just wait and see how it progressed.

About three weeks later, I took her back because she was unable to jump up on chairs / beds, etc that she had previously been able to jump on. In addition, her stomach seemed very bloated, and the gas was continuing. She was still drinking an excessive amount of water as well. We did a complete blood panel and xrays. The organ function and all other levels on the blood panel were within normal range, except for her phosphorus levels, which were in the normal-high range. At this point, given the xrays, my vet suspected some type of blockage. The xrays were taken 10 hours after her morning meal, and yet, her stomach appeared completely full, but it was not recognizable as food.

She went back in the next day for a barium xray series. She had been fasted since the previous morning, and thankfully, her stomach was empty, so no blockage concerns. To help with digestion, I began home cooking for Tobey (which I still continue to do).

Thus began the task of figuring out what could be going on with this random set of symptoms. We tested for thyroid. That was negative. We tested for diabetes. We tested kidney function again. I brought up the possibility of cushings, but my vet didn't think it was possible since her liver functions have always been within normal range. I am kicking myself for not pushing harder for the testing, but frankly, I love and adore my vet. Not only is she amazing with my pets, she is beyond amazing with our rescue dogs. I had no reason to doubt her, and I certainly don't blame her.

Anyway, while we were still trying to figure stuff out, up pops these lesions on Tobey's back. We decided to try a week of abx to see how that affected them. The lesions got worse. My vet thought it was cancer. We did a biopsy last friday on five of the lesions, and proactively started a huge dose of pred. Of course, then the results came back this week that the lesions are calcinosis cutis. Not only has my vet never seen them, but she never even saw them in vet school, and in hundreds of rescue dogs, we have never seen them. She called and apologized and said that it is much more likely that it is cushings, although she is still baffled as to why the liver function is normal.

We are now tapering off the pred so we can take the next step into the cushings testing.

My poor girl seems miserable. Her lesions are painful, she's drinking so much water, and peeing a lot. She hates wearing diapers, but that is my only option for her at night. I hate to see her like this. Her digestion is better since I started cooking for her, which is an improvement. Since she is a pug, her appetite has always been good.

If you've made it this far, bless you. I have read through many other threads, and I know that not only am I not alone, but that everyone has been at this beginning stage before as well. I will post test results, etc, as soon as they are available. We are done with the pred next Monday, then we have to wait before the cushings test can be done, so it may be a while.

[Roxee's Dad]

Hi and welcome to you and Tobey,

First I just wanted to thank you for all your rescue work.

We have a few members dealing with calcinosis cutis and I am sure they will stop by not only to welcome you but to share their experiences. We will all stay tuned for the cushings testing results.



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[frijole]

Glad you found us! It is a shame you started a huge dose of prednisone because prednisone is essentially cortisol. If your dog has cushings it is from too much cortisol so the prednisone added to the problem. You really do need to wean her off of it. Please tell us what you mean by a huge dose of prednisone.

Specifically tell us how long she's been on prednisone, what dose and how much does she weigh?

What is the weaning plan? Note that you must wait at least 24 hrs from the last dose of prednisone before doing a cushings test to make sure it is all out of her system and so that the test results aren't skewed.

Thanks, Kim

[Renee]

Hi Kim,

Thank you for the questions. She is18 pounds, and the dose is 20mg per day. My understanding is that is a fairly large dose for her size (as opposed to a past foster with a brain tumor that was on 10mg per day). We just started it last Friday, after her biopsies. I have already begun weening her off, and she should be completely done by next monday. My vet wants to wait a week before doing the cushings test to make sure the pred is completely out of her system.

I should add that she has never, up until last week, been on prednisone or any steroid for that matter.

[Renee]

Hi John, thank you for the welcome. Rescue is amazing. It frustrates me, breaks my heart, and makes me want to quit all the time... but, every time a dog is saved, I know something is right in the world. I've been doing pug rescue the last 5-6 years. Learned so much, but in all that time, I have not had a cushings dog!

[frijole]

Yikes that is a very large dose. Sounds like your vet has it under control. We have had many members deal with calcinosis cutis and hopefully some can give you their input re meds and shampoos that have helped. In the meantime you can do a forum search and find threads to read as there is a ton of experience here. Kim

[molly muffin]

Hello and welcome to the forum.

It seems like you have had a long journey to get to the point with poor Tobey going through so much.

What a sweetheart you are. We have others on here that do rescues too, it is heart breaking at times and heart warming always. :)

Yep, once the prednisone is out of the system and luckily she hasn't been on it for a really long time. (my golden was on pred since she was 2 years old and never could go off it completely) But once that is through and a suitable time has passed then you can start testing for cushings. It is strange that the liver enzymes aren't raised, as that is a general clinical sign, but it is not true for all cushings dogs. In fact it is great that they aren't. There are two tests, and because cushings is so hard to diagnose and because you definitely don't want to give cushings meds to a dog that doesn't have it, many of our members have both tests done to confirm. They are an ACTH test, which will be high if there is anything else going on too, and an LDDS, which determines their ability to suppress cortisol.

It sounds like you have already done a lot of research which is good. We also have a very good research section that you can browse through. Knowledge is key with cushings and since your vet doesn't have a lot of experience with it, um, or any, then you will have to work as a team to get this right. You can print out any studies or recommendations to take in to her, to help her to get up to speed.

One thing that we are real sticklers on, is protocols. Protocols for dosing and for testings. Following the most current recommendations for treatment, will produce the best results and be the safest. In conjunction with the protocols though is the knowledge that every dog is different and what they need might be different too. Some dogs do a bit better with higher levels of cortisol, some with much lower. Symptoms is the key to determining that. With the cc though, it can get worse before it gets better and is one of the last things to usually clear up.
Just a thought to keep her comfortable is tea compresses. Camomille, green tea is currently helping to keep one of our forum boxers comfortable. Onsies is another thing you can try to put on her to keep her from messing with the cc. (they also work pretty well to keep diapers on)

Wow, that is probably enough for now. I don't want to overwhelm you all in one post. LOL

Welcome again
Sharlene and Molly Muffin

[Renee]

Hi Sharlene,

Thank you for the welcome and the information. I did check out the resources forum. Lots of useful stuff in there! I've been slowly reading throughout the last few days.

I have already spoken to my vet about doing both the ACTH & LDDS testing. She said that she would like to start with the ACTH first, then the LDDS. She does not have a lot of experience with cushings, but she is also very open to working with other vets, and we do have a veterinary internist up here. I don't care much for the internist, so I'd rather try and stick with my vet and work in conjunction with the internist. That being said, I will of course put my personal feeling aside regarding the internist, and go to her whenever I need to.

[molly muffin]

It is good to have a team to work with, the internist and your vet. Does the internist have experience with cushings? I see both, my specialist for ultrasound and consultation and my vet for tests, etc.

Sharlene and Molly Muffin

[Harley PoMMom]

Hi Renee,

Welcome to you and Tobey, so sorry for the reasons that brought you here but sure glad you found us.

Cushing's is one of the most difficult canine diseases to diagnose, which makes it one of the most misdiagnosed diseases. Many of the symptoms Tobey is showing can be attributed to prednisone, Calcinosis cutis included.

When it comes to canine kidney disease, 50%-75% of kidney function is lost before increases in the creatinine are seen. If this were me, since the ultrasound did show abnormalities with Tobey's kidneys I would have this issue checked out further...just my opinion, and I am sure others will be along to share theirs. ;)

If you have any questions please do ask them, and know we are here to help in any way we can.

Hugs, Lori

[Renee]

Hi Lori, Tobey has only been on prednisone the last six days, so it's definitely not the cause of her symptoms. She's never been on it before either.

We definitely will be exploring her kidneys more when we do an ultrasound.

[Renee]

Just updating here and asking for advice.

My girl finishes her pred this week, and we are scheduled for a vet appt on Friday to discuss the next steps.

We will most likely start with the ACTH test, but I was wondering if anyone had any recommendations on exploring the possible kidney disease, other than just an ultrasound? Bloodwork comes back normal, but as someone said, the disease has to be pretty far progressed before the bloodwork will reflect any abnormality.

Is it possible kidney disease could account for her issues? I don't understand how it could cause the calcinosis cutis?

I am also concerned that her liver function is normal, even though elevated liver function appears to be a cushings indicator.

Thank you everyone!

[molly muffin]

Well cc, is normally the result of high cortisol from what I understand as to cause and effect.

You could have a thorough urinalysis, to check protein, etc levels. Other than an ultrasound, if the blood work is not showing any problems yet, I don't know what else you would do. Maybe some of the others have some thoughts as we do have some pups on here that are being watched closely for kidney issues. Addy's Zoe, Tina's Jasper and Trish's Flynn, just off the top of my head.

I would do the ACTH and ultrasound if it was within my means to do so I think.

Sharlene and Molly Muffin

[Dawn Anderson]

Hello Renee,
Welcome to our family, and god bless you for all your hard work as a rescuer. I'm sorry that your baby is ill I can totally relate to the CC, my girl Buttercup has a sever case of it. She was diag with the CC on 11/02/13 her vet went straight to the LDDS test first due to her having experience with Cushing's and it came back positive.
What I have been using on Buttercups CC is hibistat wipes to keep the areas that are weepy with blood or clear fluids clean and since the real bad spots she can not reach to lick at I use neosporin on them as well , which her vet did approve of. I can only find the Hibistat at walgreens. They have been working well to keep the open areas from getting infected.
If your little one scratches her self up and makes a bloody mess of her self(hopefully she won't) like Buttercup did, of course clean as best as possible with clean cool water then apply the neosporin and put a cold wet compress on the area, do not use anything warm, then put a ice pack on it, wrap a bag of frozen peas or corn and put it on top of the wet compress then place a towel over her, the cold pack will cool the skin and reduce the pain and inflammation,
for the other areas chamomile and green tea compresses are good for the skin.
Butters likes the warmth of the compresses and hopefully your girl will to.

You are on the right track, keep up the good work and know that you are a part of a very special family, we are here to help in any way we can, I do not know what I would have done with out all these wonderful people the last 30 days.

Dawn & Buttercup

[Renee]

Dawn, thank you so much for the great tips on the CC!! So far, the lesions are isolated to her back, so she cannot reach them to scratch, but it seems like they do itch, because I catch her trying to run along the couch sometimes. I will try the cool compresses to help sooth them.

[goldengirl88]

Thank God that is one problem Tipper does not have. I thought it would be too from her allergic past. It must be awful for these babies to have CC. Do you wear a T shirt on her? Tipper does have the small hard lumps like calcium deposits. She has chewed the one at times, but has mostly left it alone as it is on her foot. Hope you find something that works as I know many on here have that problem, and I see how many things they try to get rid of it. Blessings
Patti

[Renee]

Thank God that is one problem Tipper does not have. I thought it would be too from her allergic past. It must be awful for these babies to have CC. Do you wear a T shirt on her? Tipper does have the small hard lumps like calcium deposits. She has chewed the one at times, but has mostly left it alone as it is on her foot. Hope you find something that works as I know many on here have that problem, and I see how many things they try to get rid of it. Blessings
Patti

Thanks Patti. Fortunately, she cannot get to the lesions, as they are on her back. No tshirts yet. I have been using DMSO on them and it seems like some parts are starting to peel up? It's weird. My kids think she's turning into a zombie, lol.

[thecoz]

Renee: we've been using the DMSO on Cosmo's CC as well. It does seem to go through many gross stages along the way.
KJ & Cosmo

[Renee]

Renee: we've been using the DMSO on Cosmo's CC as well. It does seem to go through many gross stages along the way.
KJ & Cosmo

Could this stuff smell any worse?? Ughhhh. We've been putting the DMSO on daily.

A huge part of one of her CC lesions peeled off today. The skin underneath looks like burn patient skin. :( I am hoping maybe with the big hard scab off that it feels better though.

[thecoz]

yes, that stuff is very strong and we aren't supposed to let our other dogs near Cosmo for an hour after applying...because you can't let them touch it. When Cosmo's lesion peeled, the skin underneath looked very pink. I wouldn't say it looked burnt though. Our vet suggested dividing Cosmo's body into thirds, so each day only one-third of his cc area is getting an application of the DMSO. Therefore, each area/spot is getting the med only once every three days. It's slow going, but it's working.

[goldengirl88]

I feel so bad for anyone having to deal with this CC it is surely a horrible thing to try and get rid of. Blessings
Patti

[Renee]

yes, that stuff is very strong and we aren't supposed to let our other dogs near Cosmo for an hour after applying...because you can't let them touch it. When Cosmo's lesion peeled, the skin underneath looked very pink. I wouldn't say it looked burnt though. Our vet suggested dividing Cosmo's body into thirds, so each day only one-third of his cc area is getting an application of the DMSO. Therefore, each area/spot is getting the med only once every three days. It's slow going, but it's working.

Yes, the skin is very pink and raw looking, like it had been burned and now peeling away. I think exactly what you are describing.

I have been putting the DMSO on daily, not every three days... hmm... It smells so horrible, none of the other pugs come near it. And, every time I let them sniff part of her lesions, they take a sniff and back away from it. Its like they know its bad.

[goldengirl88]

Renee:
This CC is certainly such a terrible thing to try and cure. I am sure your other babies can smell the flesh disintegrating. This has to one of the more wretched things this Cushings does. I am so sorry you and your baby have to go thru this. It hurts me just thinking about it. Blessings
Patti

[Renee]

Thanks Patti. It is really hard, almost worse than any other symptom at the moment. It sounds gross, but you know how dogs are, my Ichiro would eat any scab (barf), but he won't go near these lesions. I keep wondering how many layers of skin the CC will go through?

[thecoz]

Renee: I have a few pics of Cosmo in my album on here if you want to see them. But I think you have to be in my "contacts" list, unless I make the album public.
KJ & Cosmo

[thecoz]

oh, and my other two dogs treat Cosmo like he has leprosy, lol.

[Renee]

oh, and my other two dogs treat Cosmo like he has leprosy, lol.

Awww, poor baby! lol.

I'll see if I can access your album. Still figuring out all the navigation.

[thecoz]

you should be able to access it. Pics #1 & #2 were recently added. #3, #4 & #5 were from a few weeks ago.

[Renee]

Just updating.

Just got off the phone with the vet and we are scheduled to run the ACTH and LDDS test next week.

Symptoms continue to persist. I will be so glad when we get this diagnosis behind us and can start treatment.

[molly muffin]

I think Cosmos cc looks a little better in the later pictures.

Next week is going to be a busy one it sounds like Renee.

hugs,
Sharlene and Molly Muffin

[Renee]

Met with my vet yesterday to make a plan for next week.

Tuesday is the ACTH and Wednesday is the LDDS. Assuming the results confirm cushings, we will start vetoryl on Friday. This will be my vet's first time using vetoryl for a patient.

Two more lesions of the CC busted open last night, so it's spreading. :(

[frijole]

OK so if its the first time - did he/she share what dosage and frequency? Please let us know that as well as weight of your girl so we can make sure it is ok prior to you ordering pills.

There are many schools of thought on dosing and trust me - from reading on this board since the drug was released you want to start LOW and tweak upwards slowly over time.

Kim

[Renee]

OK so if its the first time - did he/she share what dosage and frequency? Please let us know that as well as weight of your girl so we can make sure it is ok prior to you ordering pills.

There are many schools of thought on dosing and trust me - from reading on this board since the drug was released you want to start LOW and tweak upwards slowly over time.

Kim

My pug is 18.4 pounds. We ordered one bottle of the 10mg vetoryl to start. We have not committed to one or two pills a day, as we are still comparing the UC Davis to Dechra protocols. I wish the two weren't so different. It makes it much more confusing to try and decide what is the right amount to start with.

That said, my vet is so awesome about listening and making a plan WITH me, not FOR me. I know we will do what is right and not jump right into something bad. The minimum we talked about was 10mg once per day (following UC Davis) or 10mg x2 per day (Dechra).

I will say, I was expecting the medicine to be a lot more expensive, based on what other people have expressed, but the one bottle of 30 10mg is only $66 through my vet. Not bad at all!

[Freckles#3/Louise]

From my experience starting Freckles on vetoryl, please do the minimum dose once a day and observe. Freckles weighed 29 pounds and was started on 10 mg once a day. After 3 weeks, her ACTH came down from 19 to 8.6.

The dosage was doubled and trouble started. There were other factors, such as other medications for other issues, but my IMS agrees that we keep her off for a month and then restart at the 10 mg per day.

It can cause tummy upset so be prepared.

Getting the dose right is a trial and error process that can be challenging. Read up on the symptoms of too much and too little medicine so you can catch it when it happens.

Good luck with the tests and keep us posted.

Louise

[goldengirl88]

Renee:
I can tell you that low is the way to go. You may have to have more testing and more dose changes but the chances of something happening are really minimized by this approach. I have inched Tipper up every step of the way to ensure her safety. You dogs safety has to be the paramount concern here. The lower you start the least amount of trouble you will encounter from my experience. I know you will get it right, and everything will be ok. Blessings
Patti

[Renee]

Just updating.

The ACTH stim test was today (delayed a day). Results should be in tomorrow, hopefully, and the LDDS test is tomorrow too, with results from that coming in Friday.

I was planning to go with the UC Davis protocol, but after talking with my vet and my husband, we are leaning towards the Dechra protocol.

Of course, once I was all ready with my decision, I started reading other threads and came across the commentary in regards to the use of vetoryl and CC. Tobey's CC is fairly bad, and getting worse. Some spots look like they are clearing up / drying out, but new spots are popping up and busting open. I am usually pretty stoic about stuff (years in rescue will do that), but I am starting to get very discouraged on the CC and how to treat it. I definitely do not want it to get worse.

It's hard to decide what is right. I am not the type to question myself very much, but my head is getting so full from so much reading, that I am having trouble making decisions. I just want my poor girl to be happy again, and not have these painful lesions all over her back.

[molly muffin]

hmmm, I do understand your concern about the trilostane and the cc. Yes, Cosmo is getting better it looks like while on trilostane and Zoe got better too while on trilostane. I think that again, we are at the same point of every dog is different, and while some do better, in some it doesn't work as well.

I think though that since cc is one of the last symptoms to clear up and can get worse before it gets better, that you don't know until you try it. I've heard of it taking up to 6 months to clear up some cc, it can be real tough to get through that time.

I've sent messages to a couple of our other members who haven't updated in awhile to see how their cc is doing on the trilostane, so cross fingers that they'll get the message and reply.

hugs,
Sharlene and Molly Muffin

[Renee]

Thanks Sharlene. I had myself pretty upset last night, but today is a new day, and I am trying to stay positive. I am still going to try the vetoryl first. I went and visited Cosmo's thread and took a look at his pictures. It is encouraging to see his CC getting better.

[molly muffin]

Now remember, it's a long haul recovery with cc! So, set the expectation meter lower and don't get discouraged. Okay, we're right here with you and great at pep talks. :) We're also realistic so we'll call it as we see it, okay?
Just hang in there and remember our motto, baby steps. :)

hugs,
Sharlene and Molly Muffin

[thecoz]

I think that once we got Cosmo on the vetoryl (even his small dose) the cc stopped progressing. It didn't take too long to notice it was starting to help. Hang in there!

[Renee]

ACTH Results:

Pre 2.7 ug/dL, range 0.0-10
Post 24 ug/dL, range 8.0-22

LDDS test is today. I should have results tomorrow.

[Renee]

I spent some time last night trying to understand these test results. My vet was disappointed in them as well.

The range for this lab seems to be quite broad, and using their ranges indicates that Tobey's cushings results are borderline (potentially not cushings). However, based on her pre number to the post number, the cortisol increased nearly 10 fold - which seems very high to me!

Does anyone have any thoughts on this?

I am very glad we are getting the LDDS test results today.

[Renee]

LDDS Results:

Pre 3.5 ug/dL, range 0-10
4 hr 2.9 ug/dL, no range provided
8 hr 3.3 ug/dL, range 0-1.4

Cushings is confirmed. :(

She starts vetoryl tomorrow morning.

[Renee]

I feel like I am replying to myself a lot... lol .. but, this is a good way to document as well. :)

At the last minute, we decided to follow the Dechra protocol on the vetoryl, so we are doing 10mg x2 daily. She had her first last pill night, and then one this morning. So far, everything is going good. No upset belly, which I am very grateful for. I have the next 10 days off from work, so I will be home with her the entire time.

[thecoz]

I would guess all should go well, especially with you right there able to keep a close eye on her.

[molly muffin]

Hi Renee, you are NOT replying to yourself. Believe me, we read all the posts. Sometimes we might miss one here and there as we are going through, but we catch it on the next one usually. LOL You are Never alone on this forum. :) :) My problem is answering on the cell phone, man that keyboard is small and I've had some doozy autocorrected replies show up on the forum. LOL I try to wait till I'm either at my desktop or laptop computer. safer for all of us believe me!!

Yes, the ACTH was close, but it was over and in addition to the LDDS test and the cc that Tobey is displaying I think you are right about cushings being the culprit.

Now, you know, we all say every dog is different, but in general, give it a bit, I tend to say that you should start noticing a difference in symptoms in 10 days (approximate, give or take a day or two). Depends on, one how much they need to come down in cortisol, and how they react to the vetroyl. 10x2 is a fine place to start, you might go up or down depending on how Tobey reacts to the medicine, sensitivity wise.

You'll be fine and hopefully in a month (because I live on optimism and positivity) we'll start to see something in the cc too, just like Cosmo has. :) :)

Hang in there!!!
hugs,
Sharlene and Molly muffin

[Renee]

Thanks so much Sharlene! It feels so good to finally be doing something. And, I am sure I am reading into it too quickly... but, today for the first time in a very long time, she went down the stairs off our porch and sniffed around the yard. :) She hasn't done that in a long time. She usually pees right on the porch and comes quickly back inside.

[Roxee's Dad]

LOL.. No you are never alone. We do our best to stay up with our cush family and although we may not always reply..... we are here ;)

BTW, our Roxee starting showing improvement by the 3rd day, her excessive thirst diminished :-) Took a few months for her hair to get healthy again and even started growing hair on her "Rat tail" .... every pup is different.

[molly muffin]

Nope, not reading too much into it. If it is something that she hasn't done in a long time, then it is likely that her cortisol is already starting to lower and she is feeling better.
Too high of cortisol can make them feel awful and so can too low of cortisol, so you want that balance. Optimally with the cc, if it were me, I'd be aiming for a control just under 5.0, that is my thought though, we'll see where she responds best at.
Just keep an eye out. :)

hugs,
Sharlene and Molly Muffin

[molly muffin]

Btw, very good progression pictures of the cc, which Was confirmed by testing. (I just want everyone to be aware that this is confirmed and not a guess).

Sharlene and Molly Muffin

[Renee]

Btw, very good progression pictures of the cc, which Was confirmed by testing. (I just want everyone to be aware that this is confirmed and not a guess).

Sharlene and Molly Muffin

yes, the CC was definitely confirmed. We did punch biopsies on five separate lesions to be absolutely sure.

[Renee]

I have a question on the dosing for Vetoryl.

I know it is supposed to be given with food... and I am trying to get as close as possible to exact 12 hour dosing. I don't always feed her every 12 hours though. This morning I gave her the vetoryl with some peanut butter, then she had her breakfast about an hour later. Is a small amount of food enough, or do I need to make sure she gets a full meal with the vetoryl? This won't happen often, but I want to make sure I am doing it correctly.

[molly muffin]

That is fine Renee. The key is that you just want to give the medicine with a bit of food, something like peanut butter, cream cheese, etc works fine. It needs the food for maximum absorption, then give her breakfast/dinner at normal times.

hugs,
Sharlene and Molly Muffin

[labblab]

Renee, to be honest with you, I'm not sure exactly how much food needs to be given so as to insure full absorption, but I'm thinking it may be more than just a little dab of peanut butter surrounding the capsule. When I've asked Dechra in the past, they've told me at least a small "meal." To be certain as to their current recommendation, I'd advise you to directly contact a technical representative at Dechra. If you do, we'll be really interested as to what they tell you.

http://www.dechra-us.com/Default.aspx?ID=365

Marianne

[addy]

I dont think a dab of peanut butter is enough food. Dechra tells us to give the pill with a small meal the day of ACTH testing. I think most of us give it with a regular meal or small meal.

[molly muffin]

Sorry, my bad, I thought you could give it with a some peanut butter or wrapped in cream cheese. Sorry Renee. How much do you give Zoe's with Addy?

Sharlene and Molly Muffin

[labblab]

Sharlene, I'm thinking the peanut butter or cream cheese suggestion is coming more from our Lysodren users since that drug is best metabolized in the presence of some fat.

Marianne

[Junior's Mom]

Renee, another reason for giving with food, lack of appetite can be a sign of too low of cortisol. If you feed, then give medicine, you still have a chance to withhold it. If you give medicine, and then they don't want to eat, it's too late to take it back.

[Renee]

Hmm, okay. Thanks for the feedback. I was trying to get her meds in exact 12 hours dosage intervals, which didn't coincide with her breakfast time this morning.... so I did the peanut butter. Then she had her full meal about an hour afterwards. Since I cook for her, it's not as easy as kibble to just scoop out her breakfast real quick.

I'll just make sure to give her a full breakfast / dinner when she gets the vetoryl.

I just emailed Dechra using the link provided by Marianne. Thank you so much! I will definitely post their answer here for everyone.

[molly muffin]

ACK! Of course Marianne! Lsyodren needs to be taken with a bit of something that has some fat content. That could be where my brain was.
Sharlene and Molly muffin

[lulusmom]

I agree with Marianne that the cream cheese and peanut butter is advisable for Lysodren as it is much more readily absorbed with fat. My dogs eat twice a day and I never gave Lulu or Jojo any less food on the day they had their stim tests.

Glynda

P.S. Here is a url to Dr. Peterson blog where he tells you how the acth stim test needs to be done and he has never mentioned small meals. http://endocrinevet.blogspot.com/2013/11/protocol-for-acth-stimulation-testing.html

[Renee]

Just wanted to let anyone know that may be following my thread, that I have updated Tobey's photo album with more pictures documenting the CC.

[goldengirl88]

Renee:
You are doing a fabulous job of documentation on the CC, I am sure that people that come on here after us will find it very helpful in diagnosing and treating their dogs. Blessings
Patti

[Renee]

Here is the email from Dechra:

Renee,



Thank you for contacting Dechra Veterinary Technical Services with your question about Vetoryl.



When administering Vetoryl we do recommend to give a full meal. Food does help absorption.



If you have any further questions, please don’t hesitate contacting us.



Kind regards,



Dosha Atwell, RVT

Technical Services



Dechra Veterinary Products

7015 College Blvd. Suite 525

Overland Park, KS 66211



Office: (913)748-4838

Fax: (913)327-0016

dosha.atwell@dechra.com

www.dechra-us.com

Technical Services: (866)933-2472

[goldengirl88]

Renee:

Have a Merry Christmas. Blessings
Patti

[Renee]

Thank you Patti - merry christmas to you and Tipper too. I hope her leg is healing up.

[molly muffin]

So they want a full meal with vetroyl. Well, then that is what you need to do. What about cooking the night before? Or doing the vetroyl a tad bit later with the meal time? something like that.

How is Tobey doing anyway?

OH and cannot forget, Happy Holidays, merry christmas eve. :)

hugs,
Sharlene and Molly Muffin

[doxiesrock912]

Daisy has her meds with breakfast and again 11—12 hours later. We give her a mini meal tohold her over in between.

Merry Christmas!

[Renee]

Well, almost a week on the vetoryl.

Tobey has her first ACTH post vetoryl scheduled for tomorrow, which is exactly one week after starting the meds.

My vet has requested to do the ACTH tests after one week, three weeks, six weeks, and then every three months. Of course, if the dosage is adjusted, we will change that schedule.

I haven't seen much improvement, other than a bit more sass. She has been going down the stairs into the yard about half the time this week, whereas before, she would not go down them at all. She got snippy with her brother the other night too (we all cheered for her!).

No decrease in water intake, hunger, or pot belly. Of course, the CC us worsening. It seems that she is holding her pee longer though, but I let her out so often, I'm not really certain on that.

I hope everyone had a wonderful holiday yesterday. We stayed home and hosted the family. It was really nice, and the puggies enjoyed a bit of prime beef in their dinners. :)

[goldengirl88]

Renee:
It takes a while for some of the dogs to show improvement. Tipper is not the norm, but she showed improvement within hours after taking the first dosage. I was amazed, and very thankful as her symptoms were so severe. Just give it a little time, maybe the dosage will get tweaked after the ACTH testing and then maybe you will see some change. Prime Rib Huh? Tipper says we're coming over to your house! Blessings
Patti

[Renee]

Just got back from the vet. The cleaned up the CC a bit, drained one part that kept weeping blood, and sent us home with abx. The larger sore is infected. :(

Results from the ACTH should be in tomorrow though!

[goldengirl88]

Renee:
I am so sorry to hear your Tobey has an infection. This CC is the worst stuff ever. I am so sorry you have to deal with this and poor baby Tobey. Hope it gets better soon. Blessings
Patti

[molly muffin]

Oh dear, poor thing, an infection too. Cushings dogs are definitely prone to infections and slow healing. Hopefully this will start to clear up soon as the cortisol comes down. They are all different, so some seem to clear up faster than others.

Hang in there!!
hugs,
Sharlene and Molly Muffin

[Renee]

Thanks girls. Yes, this CC is just horrible. One part kept cracking open and bleeding for the last three days, so I guess I should have expected it was getting infected.

Other than that, Tobey is handling the vetoryl well. Up a pound on her weight, so I'll need to cut back a bit on the food / treats. I'm sure she will not like that!

[Renee]

Shoot! I just realized we did the ACTH test 3 hours post dosing today, not 4 hours. She had her pill at 7, then the stim test was at 10.

Am I screwed?

[doxiesrock912]

Awwww. That stinks. Poor Tobey!

A good healthy treat that we give Daisy are string beans. You can even give them frozen.

[Dawn Anderson]

Oh man , poor little fella, did they give you any topical ointments to put on the infection.? Let me know if they did and how well it is working for Tobey.

Your doing a great job, I know how hard CC can be to handle. Just take things 1day at a time. Did they give Tobey any pain me s to help keep him comfortable?

Today was a rough day for our Butters, the whole shower thing took it toll on her, between her head aches and then the skin issue from the showering last night, she was really down today:( wishing I had a magic wand but they don't exist so the only thing I can do is try to comfort her with love , and I am sure you are doing the same for your baby.

You guys are in our prayers for a speedy recovery!

Dawn and Butters

[labblab]

Shoot! I just realized we did the ACTH test 3 hours post dosing today, not 4 hours. She had her pill at 7, then the stim test was at 10.

Am I screwed?
Renee, you should still be OK since trilostane typically reaches its highest level in the blood about 1 1/2 hours after dosing (meaning you were testing when the cortisol level was at its lowest). Some clinicians actually prefer a testing window that begins around the 2-3 hour mark. But you do want to try to have all the monitoring ACTH tests performed within the same time frame so that you are comparing apples-to-apples with the numbers. So going forward, try to pick a single time frame and ask the vet to stick to it.

Marianne

[Renee]

Thanks for the reply Marianne. I just don't want a test that is invalid. The darn things are expensive enough! And, I hate for Tobey to get poked anymore than she has to. She has started to dread whenever we even get her harness out, because she expects a trip to the vet.

[molly muffin]

Oh poor thing, to dread her harness. :(

When do you get the results back?

hugs,
Sharlene and Molly Muffin

[Dawn Anderson]

Opps my bad, Tobey is a girl, I apologize to little Miss Tobey for my error, no
No excuses should pay much closer attention:D

Hoping today is a better day for both of you:D

[Renee]

Haha, Dawn, no worries on Tobey's name. My kids named her when they were younger, without thinking she'd be mistaken for a boy. We actually never call her Tobey anyways. You know how dogs acquire a million nicknames? :) Her most common nickname is Woba, something my daughter made up when she was 5.

[Renee]

I have a question for those in the know.

I never did get an ultrasound done, and the LDDS test was inconclusive in regards to pituitary vs adrenal tumor. Now that Tobey is on the vetoryl, would that affect the results of an ultrasound?

Honestly, ultrasounds up here are quite expensive ($800+, because there is ONE vet in the whole state that does them), and with all the money I have been spending on the tests, monitoring, and now the vetoryl (not to mention the holidays), I just could not prioritize the US. I am thinking about getting one done now though, sometime in the next month.

Thoughts?

[addy]

Well, would you consider surgery if it was an adrenal tumor? Over time, Vetoryl will make the adrenal glands larger. It may be possible then to make a tumor harder to see, I am not really sure.

I guess my point is, if surgery is not an option if your girl had an adrenal tumor, I dont know that you need to have an ultra sound right now to determine that if money is tight;) Just my two cents:)

[labblab]

Trilostane treatment itself can spur enlargement of the adrenals, so you couldn't know for certain whether bilateral enlargement (diagnostic of pituitary Cushing's), if revealed on ultrasound, preceded the medication. If you're instead looking to see whether an adrenal tumor or mass is present, then I don't think the trilostane would confound the imaging. However, unless you would consider surgery upon discovery of an adrenal tumor, you still might want to hold off on the expense of the ultrasound right now during the time period when the initial medication monitoring costs are highest (unless you are suspecting there may be something else also going on with Tobey right now?).

Marianne

[Renee]

I've been thinking about the US, simply because I don't like leaving any stone unturned, and I would rather know which type of cushings she has. That said, I don't know if I would do surgery or not. She's not that old (just 10), and I think she could handle surgery well... but, I am not ready to go there just yet. If I knew for certain she had an adrenal tumor, then I could spend the time considering the surgery. If I knew she had PDH, then I would not have to worry about considering surgery.

I think I'll just get through this initial monitoring stage and then do the US.

[Renee]

Just got the results of yesterday's ACTH test. I'm a little confused.

Pre 2.0
Post 7.3

She's only been on the meds (10mg x2 daily) for a week, and I have seen no abatement in symptoms. Yet, her post figure dropped from 24 to 7.3. Could the lab have made an error? This is the verbal result, I am waiting for her to email the actual lab report.

The vet suggested we could increase the dosage to 30mg per day, but given her cortisol dropped so much in just one week, I don't feel good about an increase yet. We have the next ACTH scheduled for Jan 10th.

[goldengirl88]

Renee:
You are smart to question the jump to 30mg. With her cortisol dropping like that and it may continue to do so for about a month, I would not do it if it were my dog. Tipper dropped all through her first month. Better safe than sorry is how I do it. Blessings
Patti

[molly muffin]

I wouldn't change the dosage either, since that is a big change from just a week ago. Cortisol levels can continue to drop for sometimes even over 30 days on the same dose. I'd stay right where you are and see if post goes down to maybe about 4 or so on this dosage.

Does she seem better through the day? Or is the drinking/peeing, hunger, all day long? What you want to look and see is if there is any time during the day when she seems better controlled than at other times. She is already on twice a day dosing right?

You're doing good. These are good numbers actually for the first week. Want to watch that pre number as it's at a 2. already too. Yea, definitely no increase at this point.

See I just re-convinced myself you shouldn't up it yet. :)

hugs,
Sharlene and Molly Muffin

[labblab]

No, I would not increase the dose either at this point. Just as Patti has said, the cortisol level can continue to drop on this same dose and Dechra's own official recommendation is to largely leave the dose unchanged for the first 30 days as long as the cortisol has not dropped too low.

Even though you are not seeing overt improvement yet, those numbers are definitely a drop from baseline and I would guess that you will soon see some changes in thirst and urination. Skin and coat issues take a significantly longer time to improve. Most folks do not perform the first test until the 10-14 day mark, so you are ahead of the curve by testing after just one week. Those numbers are actually very good right where they are (you really don't want the"pre" to drop much more), so you're right in not wanting to risk accelerating the cortisol drop by increasing the dose right now.

Marianne

[Renee]

We are definitely not changing the dose until I get another ACTH in a few weeks.

Her symptoms are still the same for the most part. Very hungry, still drinking waters and peeing a lot, the CC is worsening, pot belly is the same, her fur is getting rougher. And, still hot all the time. She showed some sass a few days after starting vetoryl, but that has not remained, and she's still quite standoffish.

I was expecting a big improvement with such a drop in cortisol, but maybe it takes a while for that decrease to present itself?

[thecoz]

I would definitely not up the dose.
KJ & Cosmo

[Zoogirl]

Renee,

So many of the things you are describing about Tobey match my Willie too. You mentioned that she usually doesn't want to leave the porch to do her business. That Willie too....he just goes right up on the deck, only willing to climb down the steps those 1-2 times a day for when he needs to poop. Of course your Alaskan and my Minnesota winters is probably not giving either dog and inspiration to want to be out any longer than needed!

You also said she is a bit "standoffish" Willie also is more "moody" and seems to tire of his brother and I. He starts the night in the bed with us, but get annoyed and leaves.

It is helpful to hear that descriptions of similar behaviors.

Thank you for you great welcome and supportive comments and my thread, and the rescue work you do.

Steph

[lulusmom]

Hi Rene,

Just remember that Tobey has probably had high levels of cortisol circulating in her blood for a quite a long time so she's become accustomed to it. Her cortisol has now dropped like a rock in only seven days and she probably feels like she's been hit by a Mack truck. Some dogs experience cortisol withdrawal and will feel pretty crappy for a few days. I agree with Marianne that there's not a lot of wiggle room with a resting cortisol of 2ug/dl after only seven days, so keep a close eye on her.

Glynda

[Renee]

I've been watching her closely for any crisis. She is still very hungry and interested in food, no diarrhea or upset belly, no vomiting. She is rather lethargic... but, she has always been like that. I swear pugs sleep about 22 hours out of the day. It's hard to know if her sleepiness is normal, or a sign of too low cortisol?

Of course, I am psyching myself out now about how quickly her cortisol dropped, and wondering if I should reduce the dose to 10mg once per day?

[frijole]

Hang in there and don't panic. Stay the course but you can always stop at any time if the appetite goes away. Remember that the lower cortisol will help cure the CC! Keep posting updates and we'll all throw out our opinion! :) You are doing great. Kim

[molly muffin]

The key is knowing Tobey and what would be "off" for her. If you see anything off, you simply call the vet and get an ACTH test done.

It is a hairy position to be in, because you want it to come down to a range where the cc will start to clear up specifically and yet not go to low. So you do need to come down some more it sounds like but not too much.

I don't know if she dropped so quickly because she is sensitive to the medicine or if she will just stabilize right at this dosage. We never know as every dog is different in how they react to medications.

Normally you have the first ACTH test at around the 12 - 14 day mark, from what I have noticed on the forum, you'll see a change at around day 10, that can give or take a day or so either way, but that just seems to be a very generalized time frame. We always have the one or two that see results immediately same as the ones who don't see anything a few weeks. Usually if the dogs seem to be outside of this pattern, earlier then the dosage ends up being dropped a bit or split, and later seem to end up upping the dosage.

Like I said this is just in general from what I've noticed via the forum.

hugs,
Sharlene and Molly Muffin

[labblab]

We are all assuming that this is a really "quick" cortisol drop for Tobey, but in honesty, we really don't have a big reference range because very few members have tested as early as one week after beginning treatment. Dechra's recommended range is 10-14 days, and so that is far more common. It may typically be the case that the cortisol drops fairly quickly within the first week, but we just wouldn't know it. Plus, Tobey's pre-treatment stimulated cortisol level was "only" 24, so the drop down to 7 was not actually as dramatic as would have been the case had she started out at a much higher level (we've seen dogs who have tested as high as in the 50s).

Having said that, research has demonstrated that dogs being dosed twice daily often end up requiring smaller daily drug totals than do dogs dosed only in the morning. So a dosing decrease may in fact end up to be necessary. But right at the moment, so long as Tobey doesn't exhibit any issues consistent with low cortisol, I believe I would stay the course. As Kim and Sharlene say, it also seems to me that the calcinosis cutis really is a game-changer as far as wanting to initiate tight control of the cortisol as quickly as possible.

Marianne

[Renee]

Well, it's a new day, and some improvements are emerging! Last night, I did not get up to take Tobey outside, and she did not have an accident! She does seem to be more comfortable this past day or so too, and this morning was especially an improvement as far as her attitude.

Thanks everyone for the words of encouragement and support. I feel really good about sticking at the 10mg 2x per day and rechecking her cortisol in 2 more weeks.

[goldengirl88]

Renee:
You are definitely doing the right thing by erring on the side of caution. This is the best approach as far as I am concerned. I sat at the park across from the vets office for hours after Tipper had her first dose of Vetoryl so if anything happened, I could take her right over. I think when you are really vigilant like you,then the dog stands a good chance of doing well on this drug. I am so glad you are seeing improvements however small they may be they are really huge steps in the management of this disease. Blessings
Patti

[Renee]

SHE BARKED AND PLAYED FOR A FEW MINUTES

Seriously, she did. My husband and I about fell over! My other pug was playing with his ball, and Tobey got excited, barked (which she rarely does), and ran around a bit. OMG, I think we almost cried! She wouldn't chase the ball, but she engaged.

:D

[goldengirl88]

Renee:
Take all the little precious moments that come your way and treasure them. It is wonderful to see your dog start to act normal again isn't it?? Blessings
Patti

[molly muffin]

That is fabulous! Put that together with her not having an accident or waking you up over night and I bet she is in a good spot right now with her cortisol level.
Hang in there!!!
hugs,
Sharlene and Molly Muffin

[addy]

Rejoice in every victory, no matter how small.

Happy Dancing

[doxiesrock912]

Sounds like she's improving!

[frijole]

Great news! Enjoy the moment! Celebrate! Kim

[Renee]

It's really amazing... on Friday I was sure the vetoryl was not working, in spite of the lower cortisol levels. I was feeling so discouraged.

A world of difference in just 2 days. She was more active, engaged, less water consumption and less peeing this last 36 hours!!

We are on the upswing!

[molly muffin]

Just keep an eye on her and I'm beyond thrilled that she is doing so well. Day 10, I'm telling you, it's the swing day for many. :)

hugs,
Sharlene and Molly Muffin

[labblab]

This is such great news, Renee. What a swell way to ring in the new year! ;) :)

Marianne

[goldengirl88]

Renee:
I could not be happier for you. This is really great news that you both needed. Hopefully it will be smooth sailing for your sweet baby now. Blessings
Patti

[thecoz]

Yeah!!! for both you and Tobey!!!

[Budsters Mom]

YAY! What a great way to launch the New Year! Love it!:p xxxx

[goldengirl88]

Renee:
I have a feeling you all are in for a good New Year!! I am so happy things are going well. Blessings
Patti

[Dawn Anderson]

Renee,
That is awesome to hear, what a wonderful sight that was for your family to see. Way to go Tobey, YEAH!!!!!:D

[Trish]

We'll take all the good news we can get Renee!! Great to hear :)

[molly muffin]

Happy New Year Renee and Tobey and family

May you continue to see improvements in the new year and the cc go away completely. wishing you all the best.

hugs,
Sharlene and Molly Muffin

[Renee]

Whew!

My thread was buried on page 3, lol.

Just updating on Tobey. Tomorrow is officially two weeks on vetoryl. So far, I would say it's been up and down. She rallied on Saturday and Sunday, really surprising me, but I have not seen as much animation since then. Last night she did have an accident in the house (first time in about 5 days), because I didn't get up with her. The appetite is still ravenous, but her drinking has dropped off somewhat, although not all the time. It comes and goes in peaks.

The abx are really helping the CC. It's not cracking open as much, although more sores are popping up. They don't seem as angry though, which is a good improvement in my book.

She has her next ACTH on January 10th. I can't wait to see where things are at.

[goldengirl88]

Hi Renee:
I am sorry you got lost on page 3. I am glad however that you found something that is working for your baby. I think the CC has to be one of the hardest things to deal with from Cushings. The pain it must cause is terrible. I hope your baby gets fixed up soon. Blessings
Patti

[molly muffin]

Hi Renee, it could be that the cortisol is sort of up and down right now too, or not stable for the entire day. Keep track of when she might have some control slippage, like is it more evening, or early morning or mid day. This way you'll know going forward, if anything needs to be tweaked, where to do so. Maybe you need, 10mg am and 15 mg pm, or something, but it's really too soon to say till after the next test.

You're doing great though and hopefully Tobey's cc will get better too.

hugs,
Sharlene and molly muffin

[Renee]

Tracking is a good idea. Thanks Sharlene for that suggestion. Her next ACTH is not until Jan 10, which will be three weeks on her current dose of 10/10.

I was wondering.... has anyone ever heard of dosing three times a day? I am disappointed about the vetoryl having such a short half-life. It seems like she rallies for a few hours after dosing, then slides back down.

[molly muffin]

I think there were some studies that looked at three times a day, and if I remember correctly a member here who tried it. Usually it is too hard for the owners to keep up that kind of schedule dosing and meals, etc.

This is a link to Dr. Petersons blog where Dr. Feldman did a study on the various dosing options and Dr. Peterson's discussion of that option:

http://endocrinevet.blogspot.ca/2012/12/low-dose-twice-daily-trilostane.html

hugs,
Sharlene and Molly Muffin

[Renee]

Back on page 3 again, lol!!

So, today is Tobey's third ACTH test. This is the first one where they are using the gel, instead of the injectible cortrosyn, which was used for the last 2 tests.

We discussed increasing the dose to 30 (from 10/10). I don't want to go with one 30mg in the morning, so I'll probably do 20/10, even though its not as cost effective.

Right now, her symptoms seem to peak in the afternoon. The heavy water drinking is between 3-7. She is not peeing at night nearly as much, which has been nice for us, and her I am sure. The CC is another whole matter, and the vet did comment that she can see how it's spreading more.

Her weight is up another pound. :( She hasn't been up to 20 pounds in years. I know it's because 1. I am home-cooking, and 2. I can't keep the family from giving her treats all the time because they feel sorry for her. I cut her food back from 7.5 ounces to 7 ounces, but I'll need to cut it back a bit more to try and bring her weight down. This will be a challenge for sure!

[Renee]

Well, her cortisol levels are up. :(

Pre 2.9
Post 8.6

We are upping her dosage to 20mg am and 10mg pm. I'll be flying through these vetoryl capsules!

I figured her cortisol was up because her symptoms have been coming back more.

[Harley PoMMom]

Well, her cortisol levels are up. :(

Pre 2.9
Post 8.6

We are upping her dosage to 20mg am and 10mg pm. I'll be flying through these vetoryl capsules!

I figured her cortisol was up because her symptoms have been coming back more.

Well phewy :( sorry that Tobey's numbers are up, and hoping the increase in her Vetoryl dosage will do the trick. Has Tobey's next ACTH stimulation test been scheduled to see if the increase dose adjustment is adequate?

Hugs, Lori

[labblab]

Renee, I'm a little worried that you may be comparing apples to oranges since the testing agent was switched this time around. There must have been good reason why your vets opted for the gel this time around, but it looks as though there are reasons why at least one specialist is not keen on it (Dr. Mark Peterson). Plus, according to Dr. Peterson, apparently the testing time frame should be different when using the gel.

http://endocrinevet.blogspot.com/2013/11/protocol-for-acth-stimulation-testing.html

Since you have been seeing symptom rebound, these results may indeed be accurate. But I just wanted to point out some additional thoughts to factor into the big picture.

Marianne

[molly muffin]

Hi Renee,

Did the vet say if this is something they would be using going forward or a one off on the gel?

Drat that the numbers are going up, but maybe it doesn't signify as much in light of what Marianne mentioned and the link provided.

The symptoms though can often tell the story too, so raising is probably what you'd want to do anyway, but you know the drill, keep an eye on Tobey, just in case. :)
You do have a bunch of worry warts around here :)

hugs,
Sharlene and Molly muffin

[Renee]

The last test was using the injectible, and it was 3 hours after dosing, with the post check an hour after the injection (four hours after dosing).

This time, with the gel, the test was 3 hours after dosing, and the post check 2 hours after the gel. So I guess that would be 5 hours after dosing.

I guess we do have a discrepancy in the amount of time between the dosing and the post draw. The reason the gel was used is because 1. the gel was initially what she had planned to use, but could not get before we needed it when all this first started, and 2. it is less expensive than the injectible (which was her initial plan).

When we first planned the ACTH tests, she couldn't get the gel in time, and so she ordered the injectible which arrives next day. Then the gel arrived a week or two later, and now she has to use up the gel since it expires much quicker. I probably won't get the gel again... but, she ordered it for me, and I can't see wasting it.

That said, I do believe the results are accurate enough to warrant the increase. Tobey's symptoms have been coming back, especially mid-day. I have been tracking them, as was suggested, and can definitely see them peak around 3. Since the increase was from 8 to 8.6 between the two tests, I feel that it is more likely correct. If there was a huge swing one way or the other, I would want to redo the test just to be sure.

Recheck in two weeks. I'll have to work on how to adjust the testing time frame to match up with her initial ACTH test. I need to use up the gel before going back to the injectible.

[goldengirl88]

Renee:
Sounds like you are keeping track of things and have a good plan. Hope this dosage is the right one for a while as I know it is a lot to keep putting them thru this all the time. Tipper has had so many, I cringe every time she has to get another one. Blessings
Patti

[molly muffin]

Thank god you are the organized one Renee! :)

Tracking is one of the only ways I can keep things straight when so much is going on and needs to be figured out. It just makes sense to me and I agree that because you Do know when she seems to be slipping during the day, then it is more likely that the test results are going to match what you are seeing, so in this case the increase does make sense.

yes, I see what you mean about the gel and not wasting what was ordered for you.

hugs,
Sharlene and Molly Muffin

[Renee]

Just a quick update:

So far, no real difference one way or the other with the 20/10 dosing. I am still seeing a big peak in water intake and hunger in the afternoon, but it hasn't been a week yet on the new dose, so I am being patient. Boy, do I wish they made an extended release!

I am taking her in today for her rabies vaccination, so I really hope she does not have a reaction to that.

And, little funny from my vet: I am also taking in my rescue pug Skeeter for his vaccination. We always joke he is the last healthy pug I have, and they asked if I was sure I wanted to risk bringing him in! Hahahaha.

[Renee]

Very frustrated right now!!

The vetoryl from the vet is running about $88 per box (more than they initially quoted :( ), so I am trying to switch to an online pharmacy.

I followed the links provided for a Vet-VIPPS pharmacy, and ended up choosing allvetmed.com. I just set this account up over the weekend and have not placed an order yet.

I just found out this morning they were hacked. They didn't even bother to inform me! WTH!! No email, no phone call, nothing. :mad:

I cancelled my account immediately, because I don't trust a company that is not forthcoming when there is a security breach (especially after Target).

Back at square one.

[molly muffin]

Did you check out Diamondback? They are in Arizona, but some of our members use them and have had good experience.

I know the vetroyl from the vets always seem to cost more. :( 30mg vetroyl here in canada from my vet was 125.00 (approx, I can't remember the exact figure but between 125. - 129. CAD, which exchange rate is close to 1CAD/1US) horrible pricing.

hugs,
Sharlene and Molly Muffin

[doxiesrock912]

I use Diamondback without a problem.

[Dawn Anderson]

Do you have a VMTH any where up there ? I have compared bills from my vet to bills from Davis and vets are higher then Davis , meds are much less then at the vet. Not sure how much the trilo is that they sent me, they did not include a billing invoice for them or the AB, hoping her IMS is cutting me a break knowing that I have spent close to 13k on all her testing and treatments their. ( she made a comment while I was there about how vested I was with Buttercup and did not ask for a deposit stating that "we know your good for it".

Hey I just had an idea. Wonder if the forum host/admins could create a page for people that have had their beloved cross over and that still have meds for those beloveds that passed available to pass along to other cushpups in need. We are a family here and need to help each other out any way we can, just.an idea.

How's the CC coming along, hope it is not getting worse. That skin conditioner spray they gave me is really helping also backing off the wet compresses also are helping, dryness is working well for her, very minor skin cracks are healing very quickly with the ointment.

Dawn and Butters

[molly muffin]

I saw this site:

http://www.heartlandvetsupply.com/p-2836-vetoryl-capsules-for-dogs.aspx?gclid=CLP3k8WkhLwCFa9aMgodVC8AVA

10mg - 30 ct Price: $42.95

Foster and Smith are $47.70

I know Patti uses another one and swears by their pricing.

Unfortunately we are prohibited by US law that we can't publish medications to give away or transfer in any way, so we have to be very careful about anything like on the forum.

hugs
Sharlene and Molly Muffin

[Dawn Anderson]

Dang, its not like its a narcotic/addictive mind altering drugs. It was just an idea anyways.

[Renee]

Thanks for the ideas everyone. I think I found a reputable online pharmacy. I have to look at the cost of shipping, on top of the cost of medicine, since I live in Alaska. A lot of places don't ship here, or they charge extra.

Since we just upped Tobey's dose, she goes through a box of vetoryl every 10 days. I don't mind the expense, but it adds up quickly, and I don't see why I should not get it cheaper somewhere else. I wish my vet would price match!

Other than that, things are moving along. Trying to work on being patient.

[goldengirl88]

Renee:
I got mine at Lambert veterinary Supply and ask for Nancy, she will help you , and if you get 100.00 at a time no shipping cost. Blessings
Patti

[Renee]

Tobey is a little sick tonight... she was dry heaving, and some foam / bile came up. :( I don't believe she got into anything, but I don't know what could cause her dry heaves. I'm going to withhold her vetoryl tonight, just in case. I wonder if it is just from hunger? I worked late today, so no afternoon snack for her.

[doxiesrock912]

You just increased the dose, right?
If so, watch her closely for signs of Addisons and call the vet asap.

[goldengirl88]

Hi Renee:
I am hoping Tobey is ok this morning and not having any problems with the new dosage making her go low. Sending hug to you and Tobey from Tipper and I. Blessings
Patti

[Renee]

She seemed absolutely fine this morning, and was fine last night too, after her little dry heaving episode. I really think she just had a cranky belly from being hungry. With the weight she's put on, I've been reducing her calories.

We just increased her dosage on 1/12/14, so far it has been fine. She should be getting another ACTH friday, so I'll see how she does between now and then.

[goldengirl88]

Renee:
Just wanting to know how things are this morning?? Hope everything is working out ok for sweet Tobey. Blessings
patti

[Renee]

She's doing much better. I don't know what that little episode was. I've been making sure to give a mid-day snack so her belly doesn't get so empty.

She did something weird the other day: she jumped right up on my husbands chair (which she has not been able to do in months), and then peed on it. I didn't see this happen, but my hubby swears it did.

Sometimes I think she may be having personality changes.

[goldengirl88]

Renee:
When Tipper first started on Vetoryl two different vets told me it can cause personality changes, so you could be right.

[Renee]

Renee:
When Tipper first started on Vetoryl two different vets told me it can cause personality changes, so you could be right.


That's good to know Patti. I've been doubting myself about her personality.. but, she does seem different sometimes.

[molly muffin]

I wonder if the peeing was in reaction to the jump, something Tobey hasn't been able to do for a long time. Maybe the landing hurt when she didn't expect it to, or jarred her or something?


hugs,
Sharlene and molly muffin

[Renee]

I thought that too Sharlene. It's just hard to know. I wish she could talk to me.. but, I am sure all she would say is to tell me to feed her more! Hahaha. I haven't seen her jump on anything else since then, so it must have taken a big effort for her to even make that jump.

ACTH is Friday, so I'll talk with the vet about it.

[goldengirl88]

Renee:
Please check my post and the one to Dawn. I am wondering if your dogs would be helped by cold laser therapy???? Blessings
Patti

[Renee]

Thanks Patti for thinking of me. I will ask my vet about it. Not sure if any of the vets do cold laser therapy up here? I know I've had warm laser light therapy on one of my other dogs.

How does the cold laser therapy work to help skin conditions?

ACTH is happening right now, so results should be in tomorrow. We are having more positive changes in symptoms too, and the CC appears to be in a new, unseen stage. It is less angry, and not cracking as much, although still covers the same area. I need to get pictures! I hope this means the CC is mending, not sure.

[molly muffin]

oh yes, it could be that the cc is moving to what it does before scabs all come off and skin becomes pink and new hair starts to grow. It takes time, it's a long process, but it's a very good sign I think that it doesn't look so angry. Angry cc is bad cc. :)
Will be good to see the numbers that correspond with this change too.

hugs,
Sharlene and Molly Muffin

[Dawn Anderson]

Hello Renee

We are hoping that things are going well with the CC, i know its a very slow process, yet if you are staring to see any type of small improvements, then all your hard work is starting to pay off. I just wish that Radiation treatment was more widely available for all dogs with Pituitary tumors. Butters was very luck to have access to it and it is working so well for her at this point. If only I could win the Lottery I would create a foundation for the treatment of Pituitay tumors for all theses beloved dogs and there families, I would run it like St. Jude childrens hospital, no cost to families would include transportation and logging while being treated!!!!!!!!!!!!!!!!!!!!!! Come on Power Ball the dogs need our help!!!!!!!!!!!!!

Dawn & Butters

[Renee]

Darn. I have a little problem. I have run out of vetoryl. :( Bad planning on my part. I just switched to an online pharmacy, and they have shipped the meds, but of course, I have run out before it got here. Took them a week just to get everything worked out with my vet.

My vet does not stock this medication either. They would have to order it too, but they can get it next day. If they ordered it tomorrow, it would not come until Tuesday. So, Tobey would be going without the meds for 2 days.

Will this reverse all her progress?

[goldengirl88]

Renee:
It won't reverse her process, but depending how strong her symptoms are some may return. Tipper has really strong symptoms when she is off she starts the 1st day showing signs. If Tobey's symptoms were not that pronounced then you may not even notice it. I have had to stop Tipper several times now when her pre number went too low the last time and that is how I know what happens. Hope it comes soon. Blessings
Patti

[Renee]

Thanks Patti. I was thinking that might be the case. I just checked the tracking information on her meds, and it says they should arrive Tuesday... so I will just wait on them.

I hope this doesn't happen again!

[molly muffin]

Should be okay, but yes, like Patti said, you might notice some symptoms coming back. If so they'll go away once you get back on the medication.
This kind of thing happens sometimes. Don't let it worry you.

hugs,
Sharlene and Molly Muffin

[Renee]

Results of Friday's ACTH:

Pre 2.1
Post 9

This is a decrease in the pre number, but an increase on her post number.

I am unsure about changing her dose at this point. For reference, she is on 20mg am and 10mg pm. Her current weight is 19lbs.

The CC is changing somewhat, but I cannot tell if it is healing, or just going through a new stage. Other symptoms are much less, but still peaking in the mid-afternoon / evening time. She still remains very hungry all the time.

We just upped her dose 2 weeks ago, so I am inclined to wait another 2 weeks and retest again. My vet wants to increase the dose, but of course, she will let me call the shots on that decision. I'm just not sure which way to go.

I'm really cranky at Dechra right now for not making these dosages easier either! If I went 20/20 am & pm, I'd be flying through the 10mg boxes!

[Harley PoMMom]

We just upped her dose 2 weeks ago, so I am inclined to wait another 2 weeks and retest again.

If this were me, I would wait another 2 weeks and retest. In 2 more weeks the Vetoryl could lower her cortisol even more.

Hugs, Lori

[molly muffin]

I would wait too since the pre number is coming down and see how that works out for another couple weeks. It could continue to drop and we have seen that happen even up to and past 30 day mark.
Yes Dechra doesn't make it easy for owners. That is why some end up doing party vetroyl and part compounded trilostane at some point, so they can fiddle with the dosages a bit easier.

I wouldn't want the dosage to be upped and then the pre number to drop even further. So it would be good to see what it does over the month.

hugs,
Sharlene and Molly Muffin

[Renee]

Thanks for the replies. I am in agreement. I don't want that pre number to drop any lower. I am concerned about the post number going up the last two tests though. :(

I'll wait another two weeks and retest, then see where we are at.

What a balancing game this is!

[Arizona Boston]

Renee,
I am sending you a private message. Also, I posted some new pics of Lucys CC today.
Shelly

[Renee]

I've been slacking on updating the CC album, but I need to get some newer pictures uploaded.

I spoke with the vet this morning about Tobey's ACTH results and where to go from here. We have agreed to retest in 2 weeks, and make a decision then. Tobey's symptoms are not bad enough for me to jump right into an increase yet, so I am happy to wait a few more weeks. In fact, were I not trying to control the CC, I would probably choose to stay at this dose for a longer period of time.

I just need to say how very much I love my vet through all of this. She may not be an IMS, and she may be learning along the way in some respects -- but, she has just been so amazing and spent so much of her time researching on this for Tobey and supporting every decision we have made. It makes such a huge difference.

[Harley PoMMom]

I just need to say how very much I love my vet through all of this. She may not be an IMS, and she may be learning along the way in some respects -- but, she has just been so amazing and spent so much of her time researching on this for Tobey and supporting every decision we have made. It makes such a huge difference.

Kudo's to Tobey's vet!!! It does make it easier when you have a vet that will work with you as a team player. Sound like Tobey's vet is a keeper.

[molly muffin]

I agree, it's great when you work together as a team and it will all benefit Tobey greatly I am sure.

hugs
Sharlene and Molly Muffin

[Dawn Anderson]

Wow that's so great to hear. Wish more vets were like her, so open and willing to do what it takes to help her patients , not only will Tobey benifit from it so will any other cush pup that comes her way during her career.. its a win win for everyone.
Butters had a nickle size piece of plaque fall off today and under neath it was normal healthy skin, I am so happy for her, hoping that you are starting to see some of the same with Tobeys CC.

[goldengirl88]

Renee:
That is a wonderful thing that you have a vet willing to go the xtra mile and learn all this. It really makes you feel good about going there. Thank God you have her. Blessings
Patti

[Renee]

Day 2 of no vetoryl, and the symptoms are very much back. Wow, unbelievable how fast that is! The tracking update on her meds say they have arrived and should be delivered today, thank goodness!

[molly muffin]

That's good they'll be here soon!

hugs,
Sharlene and molly muffin

[Dawn Anderson]

Just popping in to see how you all are doing, hoping that things are improving!

Dawn and Butters

[doxiesrock912]

Oh I know Renee, the same thing happens when Daisy's meds aren't delivered before we run out.

Normal healthy skin, YEAH!!!!

[goldengirl88]

Renee:
I guess all dogs are different and show their clinical signs at a different rate. Tipper's are so bad you can tell within hours of her not having Vetoryl. Hope you got the meds and all is well. Blessings
Patti

[Renee]

Hey everyone. I haven't check in on Tobey's thread, because not much has been happening. I definitely feel that her CC is improving somewhat, especially one of the first lesions is looking much better. They are all very dried up now, and rarely bleed. None are fully gone though.

What has come up in the past few weeks is a lot of hair loss. Her skin is very dry and flaky and the hair is coming out in clumps, with little dandruff / skin flakes attached to it. Her fur in general is much drier. The hair loss is mostly on her sides, stomach, legs and stomach.

I have her on a fish oil supplement, probiotics, and a good quality food. I stopped cooking for her, as she has been tolerating The Honest Kitchen very well the past 6 weeks.

It's almost like she needs lotion rubbed into her skin? I don't understand the hair loss though.

As for her cortisol levels, we have an ACTH scheduled for Wednesday, and we will see where she is at. Her pu/pd is virtually gone, with a small peak mid-afternoon/evening. The panting is gone. She still has a pot belly, but I feel like she may always have that.

[molly muffin]

Hi Renee,

What about that spray lotion that University of Davis recommended for Butters CC? That might help. trizchlor spray

hugs,
Sharlene and Molly Muffin

[addy]

Renee, that is how I describe Zoe's skin problems last Spring when she had yeast, dandruff and bacteria on her skin. I had to use ketochlor shampoo and the hair loss got worse before getting better because the hair follicles have to go through a cycle so they die off and then regrow and that can take maybe 3 months to cycle. But the hair follicle had white dandruff attached to the base. It was when all that started, I had the skin scraping done.

I would have to recheck on DVM 360 but I thought the case study I read they used a medicated shampoo with calcinoisis cutis. In Zoe's case, I had to start at smaller increments and work my way up, so the first time I used it, I did not use as much, only allowed to stay on for 3-4 minutes, we did that twice a week for a few weeks, then built up to eight minutes twice a week for a few weeks and then cut back to once a week for a few weeks, then continued to cut back.

So it would be a matter of treating the secondary skin issues besides the calcinosis cutis. Could you discuss with your vet?

[Renee]

Addy, thanks for the suggestion on the skip scrape and shampoo. Tobey sees the vet on Wednesday of this week, so I'll have the vet check it out. I am taking her today to be groomed by a very good friend of mine. We are going to hopefully just pull out all these clumps of hair, because everywhere she goes, hair clumps are just falling off her.

Her hunger is getting more pronounced again. She woke me up last night twice to eat. I gave her a small treat, but I can tell she wanted a lot more.

I feel so confused, because a lot of her symptoms are manageable, but at the same time, I feel like she could still go lower on her cortisol, because she's still not as happy as she used to be. I guess cushings is like this. I think she's fine overall, but then there are moments where I think it's not fine and I wonder what it must be like for her. :confused:

[Dawn Anderson]

Morning, dry clumps are really a good thing, its a sign that the underside is calming down and slowly entering a new growth stage, as frustrating as it is this process, as long as you are seeing fewer and fewer new spot , you are both heading in the right direction. Cycling is a good discription, the damage to the folicals started long before we could see it. Butter has now lost almost all of her fur on her top side, the fur that she left is mostly in bedded into the cc plaque.
As long as you can control the hormone and it sounds like you are getting it in check, then the CC will slowly subside, it just seems to take forever to really see any major changes in that area. The spray is helping the condition of her skin, cleans and conditions it.
We just entered the medication faze & keeping my fingers crossed that we have minimal issues. If we do I will be asking for advice.

[Renee]

Thanks Dawn, for the pep talk. Yes, we are seeing fewer spots for sure, just her hair growth has thinned out so much. We are back from her grooming, and it's sad to see how thinned out her hair is. This is my girl that has a double coat. But, I am hopeful on the progress of the CC.

[Renee]

I have a question for the experts:

Tobey's pre number has continued to drop (last ACTH was 2.1), while the post number has continued to creep back up.

Is there an explanation for why the pre would drop, but the post would not?

Her next ACTH is this Wednesday, and while I feel she could do with a dose increase, I worry about her pre number getting too low, without being able to get that post number into therapeutic range.

[Dawn Anderson]

Yes that is a good ??, would like to see what our forum experts have to say. I will be keeping a close eye on your posts, butters is on day 3 of Vetyrol, will have first acth post meds on 02-22.. Little nerves here.

Dawn & Butters

[addy]

Renee, I know you are hoping one of the administrators stop by to discuss your question about why would the pre go down and the post go up on an ACTH test.

When I first found this forum four years ago, we didnt really pay much attention to the pre number on an acth test. We usuall saw stress show up on the pre number and really concentrated on the post. Lately, the pre number has become more of a discussion with Dechra not wanting the pre or post below 1.45 ug/dl. I cant find much written about the "pre" number on an ACTH test.

When debating whether or not to change a dose for your dog, my opin ion is to take everything into account. I dont have time right now to go back through your thread so maybe could you post all ther ACTH stim results on your thread? That would help the discussion as history and symptoms play a huge role in deciding whether to change a dose, it cant just be about chasing numbers.

Thanks

[goldengirl88]

Renee:
All I basically know about the pre number being lower is that Dechra told me when the pre number goes low the post will soon follow to keep close watch. So on this ACTH the post may be lower. Tipper had now gone low on her pre again and the post is fine. What a balancing act this is ! Blessings
Patti

[labblab]

Renee, I just want to "ditto" what Addy has already said so well. We never used to pay much attention at all to the "pre" number, and I've not seen any formal written explanation as to when and when not to consider it a problem now. Like addy says, I would think that context is a big part of the picture. If both the pre and post are relatively low, I can see where there could be cause for concern. But if a dog has a significantly high post number, it's hard to imagine that the adrenal function is really oversuppressed, regardless of the pre number.

The best advice I can give you is to call Dechra and ask them directly about the issue, citing your specific ACTH results. Maybe we can also see if one of our members who is currently consulting with Dr. Bruyette can ask him this question on our behalf. I sure wish he was still participating on the forum! :o

Marianne

[goldengirl88]

I will be contacting Dr. Bruyette later today with a progress report on Tipper so I indeed will ask him that question, as I need to know too.

[labblab]

Thanks Patti!!

[Renee]

Thanks Patti! That would be wonderful to get his opinion.

As for the history of her results, here they are:

12/19/13, pre 2.7, post 24 (before starting vetoryl)

12/28/13, pre 2.0, post 7.3 (10mg am / 10mg pm, started 12/20/13)

1/11/14, pre 2.9, post 8.6 (started 20mg am / 10mg pm)

1/25/14, pre 2.1, post 9.0 (still 20mg am / 10mg pm)

As you can see, the post number took a big dip right after starting vetoryl, but it has been creeping back up ever since, even with the dosage increase.

I know the symptoms play a big part. A lot of her symptoms are resolved to a good extent, but overall, I do feel a dosage increase may be called for. She still has a big spike in symptoms in the mid-afternoon / evening time. And, just this past week, her hunger has really increased again. She is waking me up at night to eat.

[goldengirl88]

Renee:
I just sent Dr. Bruyette a rather lengthy email so we shall see if he can help with this. Blessings
Patti

[Renee]

Renee:
I just sent Dr. Bruyette a rather lengthy email so we shall see if he can help with this. Blessings
Patti

YAY! Thank you so much Patti!

[goldengirl88]

Renee:
Nothing from Dr. Bruyette yet, he must be busy. I did ask a lot of questions too so maybe that is why. Blessings
Patti

[Renee]

Wow, last night was the worst night in a very long time. Tobey kept waking me up all night. I let her out a few times, but she still managed to have an accident inside too. And she was waking me up to eat too, not just go outside. Her hunger is back in a big way.

Her cortisol must have taken a big spike, because she has not been like this for at least 5-6 weeks. One of her CC lesions cracked open and started to bleed too, which hasn't happened in a few weeks either.

Thank goodness I'll be getting the results of her ACTH today.

[addy]

Her post has been inching upward, regardless of her pre. Let's see what her results are but especially because of the CC you may need to bring that post number down regardless of her pre (which Dechra seems to keep changing their mind about anyway):(.

I know it is hard to figure it all out. You should see all the crazy stims Zoe has:rolleyes::rolleyes:

What is the dose history to go with the stims you listed? Or did I miss that? I may have.:o:o

[Renee]

Thanks Addy. I will edit my post above to include the dosing.

Her pre is low, but not as low as Tipper's has gone, so I still feel like I have good wiggle room.

[Renee]

Results are in from yesterday's stim test.

Pre 3.9
Post 8.8

Fairly big increase on the pre number, and a very minimal decrease on the post.

Since she's been on 20mg am and 10mg pm for the last month, and her symptoms are rebounding, I am going to increase to 20/20. This will put her at 2mg per lb.

[goldengirl88]

Renee:
I am mystified I have not heard form Dr. Bruyette yet this is so unlike him. Could you try 35 instead of going to 40? 30 Vetoryl and 5mg trilostane? Just throwing some stuff out there. Blessings
Patti

[Renee]

Patti, thanks for checking in about Dr Bruyette. I'll be very interested to hear what he has to say!

I'm actually not too worried about increasing by 10mg. Each increase has resulted in initial improvement, followed by rebounding symptoms 3-4 weeks later. I have not been able to get her below 8 since that first stim when she started the vetoryl. With her CC and the rebound on the symptoms, I am really hoping to get her post down to 5 or so.

[molly muffin]

drat! well that explains the bad night last night I suppose. Plus some dogs have a like 48 hour reaction to the ACTH because the cortisol rises during it. That usually goes away though and you're back to the normal levels which for Tobey have gone up. :(

hugs,
Sharlene and Molly muffin

[Renee]

Sharlene, thanks for pointing that out about the reaction to the ACTH. It was a rough night.

[doxiesrock912]

Renee,
Daisy is terrible for a few days after the ACTH.

[addy]

Renee, I think your approach is reasonable since you thought there was some rebounding prior to the ACTH test - what does your vet say?

[Renee]

Addy, my vet is totally on board. She said we could stay at the current dose if I wanted to wait, or add the 10mg in the evening. We agreed to do the increase, and will retest in a few weeks. I hope this is the right combination, although bumping up to the 30mg vetoryl would be much less expensive. :(

Last night was better, but still up a few times.

[molly muffin]

And a very happy valentines day

hugs,
Sharlene and Molly Muffin

[goldengirl88]

Renee:
The first 2 ACTH's Tipper had she was crazy for the rest of the day, so that may be what Tobey had like Sharlene said. I hope things get better for you both. This is rocky road sometimes but it will get better. Blessings
Patti

[Renee]

Well, no vetoryl this morning. Tobey has been sick throwing up. This last stim test seemed to really affect her. I gave her some rice this morning, and she has been holding it down so far. I think she threw up last night too, but I didn't know it was her, so she got 10mg of vetoryl last night at dinner.

This is the first time she's been sick since starting the medication, so I don't know if it is just a coincidence or what.

[doxiesrock912]

Awww poor girl,
that's no fun. Feel better soon Tobey!

[goldengirl88]

Renee:
So sorry to hear Tobey got sick. Tipper seems to not get to bad now as she has had like 14. I am hoping this is temporary. Did you do the increase yet? I thought
It might be that?? Hope she is better today. Blessings
Patti

[addy]

Hi Renee,

I was going back through your thread and saw Tobey had the dry heaves one time after her last dose increase to 20/10 but then was fine. How many times did she vomit, one time last night and this morning? Had you given her the increased evening dose?

Zoe has had so many stims, she threw up from the test one time but that was the same day.

Let us know how you both are, ok?

[Renee]

Addy, thanks for reminding me about the dry heaves. I forgot about that.

I did not increase her dose, as I do not have enough vetoryl on hand to do the increase yet. My next order comes Tuesday, so that is when I planned to increase.

She threw up once last night (which I now believe it was her), but then a few times this morning. Since she had the rice this morning, she has not thrown up or dry heaved at all. If she does okay the rest of the day, I will give her the regular 10mg tonight and see how she does. Luckily, the vet is very close and I have her cell phone number to call after hours.

[goldengirl88]

Renee:
Hoping Tobey is doing much better today. Have you given her anything to eat today? Blessings
Patti

[molly muffin]

Checking in to see how Tobey is doing. I hope much better and no more vomiting.

hugs,
Sharlene and Molly muffin

[Renee]

Thanks for checking in everyone! Tobey is doing better, she ate rice again last night and her regular food this morning. No vomiting! I think something was just off for 24 hours, because she's back to herself.

[molly muffin]

Really good to hear!
hugs,
Sharlene and molly muffin

[goldengirl88]

This is a good thing! I hope it keeps going up hill! Blessings
Patti

[doxiesrock912]

Maybe she got into something? Or a bit of a doggy bug?
Glad she's feeling better now.

[Renee]

Valerie, that is what I was thinking. It just seems like a coincidence, but I'll be watching very close when we up the dose. She has been acting fine today and had a full breakfast, with vetoryl.

[goldengirl88]

Renee:
Hope all is well in Tobey's world today. Tipper is fit to be tied with this weather she wants out and is making a point of letting me know it. Blessings
Patti

[Renee]

So, last night I decided to do the dosage increase, and gave her 20mg (usually she gets 10mg). She was acting just fine, but this morning, she didn't want her breakfast. She ate about half. I withheld her morning dose, since she didn't eat. But, she was very interested in having treats / other food, just not her breakfast. I don't understand. :( She has not usually ever been picky like this. I don't know if it is the dose increase, or if she just doesn't want regular food anymore and is holding out for the goodies.

[goldengirl88]

Renee:
I would be scared to keep giving her the Vetoryl if it were me until this passes whatever it may be. Hope she gets thru this and goes up hill. Blessings
Patti

[addy]

Hi Renee,

I think if it were me I would wait on that dose increase until I was sure Tobey was eating 100% as she has previously for at least a few more days. That way you wont have to wonder if it is a relapse back to whatever was bothering her or the dose increase.

have you ever tried Pepcid?

[Renee]

Addy, that's a good idea. She is still acting quite hungry a lot of the time and will beg for treats / people food, but has been showing some disinterest in her dog food. I may go back to homecooking for her for a bit, but I hate to add another variable. :confused:

I am going to switch back to her 20/10 dosing schedule for the next week and just see how she does. Her dosing has been so up and down the last 5 days since her ACTH that I am not sure where she's at or what could be affecting her.

[Renee]

Just spoke with the vet and we agreed to scratch the dose increase for at least a week and wait to see how Tobey is doing. We talked about signs for low cortisol, etc, and my vet said to bring her in if she shows any of those signs so we can do a stim test.

I did call home to check on Tobey, and she's being her usual bratty self, begging for food and acting super hungry... so, I am beginning to think she has figured that if she rejects her dog food, she can have something better. Little stinker.

[molly muffin]

Tobey is obviously pretty smart. :)

Molly after her first gastro intestinal attack decided that's it she doesn't want her kibble. (oh yea, she'd love to have good home cooked stuff all the time) We started to give her a bit of wet food in the morning (or she won't eat at all) on top of the kibble. Often she'll leave the kibble or just have a tiny bit with breakfast and then at night to get her to eat some of the dry kibble I'll add a bit of wet, we're talking less than a teaspoon and this is like a gravy texture. I also have a couple different ones that I add in with the SO, which is her main dry and she has to have that to get her to drink enough.

Anyway, wow digress much there, the idea might be that you can try to add a bit of something into the kibble to get her to eat it.

hugs
Sharlene and Molly muffin

[doxiesrock912]

Daisy will also avoid food and taking her pills when she isn't feeling well so it is obvious even if there aren't clear symptoms.

Sometimes this happens when we change doses and then after skipping a meal of two, she's fine. So far, we haven't had a crisis thank God. I just think that it takes her time to adjust to the new dose.

[goldengirl88]

Renee:
Just checking in to see how Tobey is this morning? Hope all is well. How is she eating now? It is so hard to figure out why they do these things sometimes. Blessings
Patti

[Renee]

Thanks for checking in Patti. She is doing just fine. Ate all her dinner last night, had her regular 10mg vetoryl, and did fine.

This morning, she ate all her breakfast, so I gave her the regular 20mg vetoryl. She was acting like her regular self.

I don't know what was going on, but I have informed the house that Tobey gets NO people food, until I am certain she is better. I can't have her holding out on eating her regular food, just so she can have the goodies that she wants. My husband has been guilty of giving her a little too much of whatever she wants, because he feels bad for her.

[molly muffin]

And then they bat those big brown eyes. :) It's hard to hold out against "the eyes" and the oh woe is me looks. :)

I know, molly uses it to her advantage as much as possible.

Glad Tobey is doing better

hugs,
Sharlene and Molly muffin

[Renee]

Just an update on Tobey's progress.

Eating and everything else has been absolutely normal. Her appetite is good, her mood / personality is good, peeing & drinking are normal (for her, more than my other pugs, but lower than her pre-medication levels). Her CC is looking better, with the oldest lesions showing dramatic improvement, but the newer ones still bleeding and very hard right now. Hair loss has dropped off somewhat.

So, now I am in a conundrum. Her last stim had her post cortisol at 8.8. This is not exactly low enough, but I am afraid to increase her dose again without another stim test to see if its come down anymore, especially with her getting sick last weekend.

[molly muffin]

I'd give it some time on this dose and see where she is. Partly you will know from her symptoms. I mean, she does show you when her cortisol goes up. Hopefully it will continue to go down, but I think some time would be fine. You can get a stim and check if you start to notice symptoms, or at a regular schedule test.

hugs,
Sharlene and Molly muffin

[goldengirl88]

Renee:
Hoping you and Tobey are having a good day and that she is still improving. Blessings
patti

[doxiesrock912]

Renee,
there is still improvement so there is no rush to increase.

[Arizona Boston]

I wish it was cheaper and easier to know that cortisol level. Lucy is eating like mad lately and I think she is drinking more also. But as long as her CC is clearing I think we're for OK for a little while longer. What a balancing act.
Shelly

[Renee]

I wish it was cheaper and easier to know that cortisol level. Lucy is eating like mad lately and I think she is drinking more also. But as long as her CC is clearing I think we're for OK for a little while longer. What a balancing act.
Shelly

I was thinking the same thing Shelly. I am just going to ride this out. She's back acting to the way she was before this last ACTH, and I don't want to mess things up anymore.

It's so hard to find the right answer, as some days her symptoms are more pronounced than others. So, one day I think she needs an increase, then the next day, she doesn't. :confused:

I guess I'll wait a while and do another ACTH to see where she's at.

[scoora]

Renee,
I just sent you a message before I read this. Glad to hear Tobey's eating is better. I'm glad to hear she is doing good.

[Renee]

Well, last night was another up and down, up and down. She is waking me up to go outside and to eat. I think the eating is more on her mind than going outside. I have been giving her a treat after she goes potty outside, which I think makes her want to go out more, hence waking me up more.

Then, this morning, she was kinda slow eating her breakfast, even though she was waking me up to eat. I took her bowl and added some cottage cheese, then she ate it right up. The little brat. She has gotten to where she expects her food to have some goodies added in.

[molly muffin]

oh my gosh, that sounds exhausting! Tobey!! nighty night time girlfriend.

I know, molly doesn't want to just eat her plain ole kibble any more. Nope, she thinks she is being deprived if she doesn't have a little something extra on it. (started when she was sick and wouldn't eat at all)

They do know how to work us don't they. Do you think her cortisol is bouncing up at night more?

hugs,
Sharlene and Molly muffin

[Renee]

Sharlene, I am certain her cortisol increases at night, which is why I wanted to increase her dose to 20mg evening, rather than 10mg... but, then she got sick at the same time the one time I did that, and I could never tell if she was sick because of something else, or because of the dose increase. She only ever got one dose increase, then I backed off because I got nervous.

I just don't know.

[goldengirl88]

Renee:
I think Tobey is having the same issues as Tipper. Tipper also is having problems from high cortisol at nite. I am giving her 10mg at note, but feel I can tell early in the morning when cortisol starts to rise she starts moving every few seconds. I also am considering that since things move around in them that something is making her uncomfortable so she keeps moving around. Do you think Tobey can be having this problem? In know what you mean about her getting you up and thinking if she goes out she will get treats. Everything you do with food becomes a habit and they expect it. Their whole life revolves around food. Blessings
Patti

[Dawn Anderson]

Not sure if this will help, but I have only been giving Butters her pain meds at night to help her sleep, her skin is still bad, during the day she seems to be good,but nights she twitches and shifts alot as if she is uncomfortable. I started doing that and saw an improvement of her sleeping patterns ( watching over her like a HAWK) Or maybe Tobey is a night owl now if sleeping a lot during the day HOOT HOOT.

Dawn & Butters

[Renee]

Up and down again last night. Its the food thing. She is so hungry she's waking me up. I let her out every time, but she doesn't really need to go. She goes out and then runs right back in and runs around for food.

Then, of course, another pug was up last night making the pukey sound. He never did throw up, but I was on high alert waiting for it to happen.

Operating on no sleep....

[doxiesrock912]

Oh no Renee!
You're sure having a time of it.

One thing that I do is coat the bottom of Daisy's bowl with canned pumpkin or since we have cats, everyone gets fed together and so I mix water into the cat food can when it's mostly empty and pour that over Daisy's food like a gravy.

It works and I'm not giving her anything fattening by doing either.

[molly muffin]

Oh geez Renee. I think you will have to increase the evening dosage at some point. A person can only go on so long with no sleep.
Hope your other pug is feeling better today too.

hugs,
Sharlene and molly muffin

[goldengirl88]

Renee:
I know first hand how you are feeling. I remember at one point in time Tipper getting up at 3:30 or 4:00 am for food. It went on for a while until I thought I was going to go crazy from no sleep. I think we tweaked her dosage at that time. I know what you are going thru. Tipper is persistent and will not stop when she wants food. You will have no peace until she gets food. I am hoping maybe a dosage tweaking will help Tobey. Blessings
Patti

[thecoz]

I, too, think maybe just a bit more adjusting. You'll get there!!

[goldengirl88]

Renee:
Just checking in to see how Tobey is doing ?? I am hoping she did not keep you awake last nite again. That has to be one of the hardest things to manage is the constant hunger. It has to get better from here! Blessings
Patti

[Renee]

Just some updates.

Tobey has some new CC lesions popping up lower on her back, so I think her cortisol may be on the rise. Her hair is continuing to fall out and is very brittle/dry. :(

I never did increase her dose after her strange reaction after her last ACTH, so I'm not comfortable increasing, until I do another stim test. Almost makes me feel like I wasted the last stim test.. but, I guess it is what it is.

Her digestion has been really, really bad too, and her belly feels very hard / bloated a lot of the time. And she has been very gassy. She went through this last fall and I started home cooking for her. After being on the vetoryl for about 6 weeks, I transitioned her back to the regular food (The Honest Kitchen). Well, her digestion has gotten bad again and now I am thinking I'll have to home cook for her once again.

What I am baffled by is how her cortisol could be affecting her ability to digest food? Is this just random or related?

[molly muffin]

I know gastrointestinal upset is one of the side effects of vetroyl, so that might be part of the culprit. Have you tried adding in some florifora or other probiotic just in case there is an inbalance? It could be of course that you will need to go back to home cooking, or even just for a few days, try limiting to the mushy rice/boiled chicken combo with some probiotic and see if that settles things down.
It might have even been the start of an upset that cause the reaction after the ACTH test, and not the test itself, just timing.
It does sound like the cortisol is on the rice if you are seeing new cc breakouts though. :( poor Tobey.
Poor you. I know a new breakout is discouraging.

hugs,
Sharlene and molly muffin

[addy]

Hey Renee,

What you also have to think, about, not just a side effect of the Vetoryl which it could be, or have you lowered her cortisol enough to uncover something else that the high cortisol was helping.

When was her last blood panel done? When your vet does the acth test does she do any blood work?

[grapey]

Tobey is so lucky to have a mama who will cook for her! You are awesome. Sorry to hear about this new development.

[Renee]

She has been on probiotics for the last 2+ years and has either had home cooked meals or eats The Honest Kitchen. I don't think it is the vetoryl causing her stomach issues, as she had this symptom right before we nailed down the cushings diagnosis last fall. It seems like it takes her body hours and hours to digest the food. And her stomach is hard and bloated.

I really want to know what is causing her digestion issues. It does not seem normal that food would be in her stomach for 8+ hours before it is finally digested. Last fall when this was happening, we were convinced it was a blockage. The only thing I can find online is that this could be a condition known as stomach stasis (common in rabbits, of all things). What I don't understand is what could be causing it for Tobey and why it seems to come and go?

I believe the last blood panel was run in December, but I would have to check on that. All her values were within the normal range, as far as I can remember. But, I think it may be a good idea to run another panel soon.

[addy]

I use Honest Kitchen too. Was the only food Zoe could ever eat besides her commercial raw turkey patties from Nature's Menu. I still feed Embark to Koko. How often do you switch the probiotics? I wonder if you tried a prebiotic?

It sounds then like this was an issue prior to starting treatment so I would be inclined to agree it is not the Vetoryl and not necessarily a new issue from lower cortisol.

You would probably have to scope her to get to the bottom of it. There is a part leading from the stomach and I'm at work so cant look at Zoe's tests to remember the name of that part of her stomach but anyway, she had scar tissue on it and the opening was small yet food could get through and they thought it was from helicobacter infection. Zoe also had inflammatory bowel disease. When her IBD was well controlled her tummy did not get bloated and hard. Zoe never had the vomiting associated with IBD or Helicobacter. Of course, she never read the manual on anything;)

[goldengirl88]

Renee:
Have you ever tried Manuka honey? Tipper had very bad problems with her tummy for a long time. She also gets acid reflux. Manuka honey has wonderful healing and antibacterial properties. The IMS said it saved Tipper from lesions on her esophagus from the acid erosion. In give her about 1/4 teaspoon before meals, sometimes on a small piece of bread. I buy it on Amazon, the higher the number the better the honey. It works so well it is used on burn victims. Blessings
Patti

[goldengirl88]

Renee:
Checking in to see what is going on with Tobey? Hope all is better. Blessings
Patti