Josie-7 Year Old Basenji Just Diagnosed with Cushings :(

[BasenjiMommy]

Hello everyone. My name is Shannon, and my sweet baby Josie was just diagnosed with Cushings today. She is a 7 year old tri-color Basenji. She was diagnosed with Hypothyroidism over a year ago, but she has had a slightly low thyroid since she was about 2 1/2. The vet wanted to wait to retest her when she was a little older due to needing medicine for the rest of her life. She has been taking thyroid medicine twice per day for over a year (I can't remember exactly how long now). I have long suspected that there is something else going on, as her weight seemed to get worse, and her coat never got better. Then last week she lost a TON of hair all at once. It was coming out in clumps. She also has been drinking quite frequently. She has had a stocky build forever, and always been overweight with stick legs, while our other dog eats way more and remains about 21lbs.

I took her on the vet on Saturday and they suggested testing for Cushings. (Before I was about to bring it up as I had briefly saw something previously online how it can be misdiagnosed as thyroid issues). Anyway, she had the LDDS test Monday and the results came back today. First dose 9.6, 4hr dose 2.5, 8 hr dose 3.6. The vet said it should be under 1.5, with most being under 1. She prescribed her 60mg of Vetoryl once per day. She is 34lbs (but breed is usually under 25lbs). The doctor said it is pituitary.

After reading these forums for the last several hours, I terrified to give her this dosage. It sounds too high. However, how do you ask the vet about the dosage without trying to step on their toes? She said I could start tomorrow, and then to bring her back on the 24th to retest, as she explained about possible issues with causing Addison's with too much. My old vet left, so this is a different vet, but she is the head of the practice. Help. I have been on tears all day over this. My sweet baby and our other Basenji (9yrs) are just as important as our son. Thank you for your site, as it is so informative for us newbie Cushings mommies. I wish I had read it before meeting with her. :(

[Trish]

Hi Shannon

I see you are online so thought I would give you a big wave and hello! The experts on cushings will be sound asleep right now, but I will put my 2c worth in until they awake to give you their excellent advice!

My dog had an adrenal tumour but was not positive for cushings but I have picked up a little of the advice they give people new to our site, so I will start you off!! Plus I have a special liking for tri-colour dogs as mine is one too, a fox terrier so a bit different to your Basenji's. :)

Sorry Josie is having these troubles, one thing I first thought of has her thyroid levels been checked lately to make sure they are within normal limits? As often the symptoms of cushings and thyroid problems are similar.

I know if other things are going on in the background like thyroid issues the cushings tests can be skewed and you can get false positives. I will leave the interpretation of your LDDS to the experts here as I would hate to muck that up.

They often do a few different tests, like the urinary cortisol and ACTH to get a real firm diagnosis. We have really good resources the staff here have put together for diagnosis and treatment so I would encourage you to read them here
http://www.k9cushings.com/forum/showthread.php?t=5428
http://www.k9cushings.com/forum/showthread.php?t=5427

Once your baby has been definitively diagnosed the rule of thumb is to start on the lower end of the scale ie 1mg per pound so you are right to be a little concerned about a starting dose of 60mg. It can be easier to go up in dose, but it is not good to make your dog ill. It may well end up needing a higher dose but I think the experiences here have shown it can be dangerous to start so high.

The others will also want to know what other tests have been done, you can list only the abnormals on any blood testing and urine testing you have had done. Also if you have had an ultrasound they will want to know that.

Cush pups drink loads of water, like buckets and they are so hungry they are often cruising the floors looking for any scraps they can scarf down. Is your dog doing this, or does she have other symptoms like pot belly, weak back end. Please let us know, or is it only the hair loss you have noticed recently?

A lot of us have come up against the old problem of having to challenge a vet. I think the easiest way to do this is to say you have concerns about the dosage and you have read that it is best to start at the lower end of the scale and retest after 10 days and not to increase it for a month as the cortisol can continue dropping during that time. I would even print out some of the resources available on our website, quoting the expert endocrinologist vets and their recommendations. You can't argue with science!!! I have done this and most vets worth their salt (and your money) will be pleased to discuss this with you and listen to your concerns and discuss it like adults. So don't be afraid, you can do it and you will with your babies best interests at heart after all you are her best advocate!!

So dry those tears, you have all of us here to help if you have any questions. But if you can supply some of the answers to these questions you will be off to a good start when the experts wake up!!

Trish :)

[Trish]

Haha, I wrote such a novel you have gone offline! Hope it helps when you read it later on! :)

[Squirt's Mom]

Hi and welcome to you and Josie! :)

Vetoryl (Trilostane) is the new kid on the block in Cushing's treatments and we are still learning about it - "we" being not only those of us who have cush pups but also vets, researchers and the manufacturer (Dechra) itself. When this drug was first released the brochure was printed with the recommended starting dose, 3mg per pound - which is what your vet is using. HOWEVER, subsequent research by UC Davis has found that starting at a much lower dose is best...and Dechra usually agrees, depending on who you talk to there.

You can print out the following link and share it with your vet. That way it isn't YOU telling her what needs to be done, but researchers at a highly respected University. ;)

http://veterinarynews.dvm360.com/dvm/article/articleDetail.jsp?id=460965&sk=&date=&pageID=1


The UC-Davis current recommendation is to initiate trilostane therapy at 1 mg/kg once daily. That dose is continued for about one week until a veterinary re-check can be completed.

To find Josie's weight in kilograms (kg) you divide her weight in pounds by 2.2. So at 34 lbs she weighs 15.4 kg (34 / 2.2). So using the UC Davis starting dose, Josie should be getting around 15mg per day to start...if my math is correct. :D

So using this article will allow you to gently lead your vet in the right directions PLUS let her know that you are not going to blindly follow her directions but will be educating yourself to become an active participant in Josie's care from now on. She will either respect you or get an attitude - which will let you know right off if this is the vet you want to stay with for Josie's care. ;)

I'm glad you found us and look forward to following Josie's journey.
Hugs,
Leslie and the gang

[BasenjiMommy]

She was retested in November and her thyroid levels were normal (being controlled with medicine). She does have a larger chest/belly, but I've always just attributes this to her being overweight. :( Now that I've seen pictures of other Cushings dogs, it does seem to be a pot belly, though very firm. She is not ravenous with her food, as we free feed and she eats maybe 1 cup per day. Our smaller, healthy basenji eats more than she does. She does drink quite a bit though, and has had periodic accidents for a while.

[Squirt's Mom]

Many things other than Cushing's can cause a pot belly appearance so I would certainly want an abdominal ultrasound done just to be sure there are no masses or diseases with the internal organs.

I'm glad the thyroid is doing well. That helps rule out one thing. ;)

[goldengirl88]

Welcome to you and Josie. So sorry she is having troubles. I also would urge you to discuss this starting dose with your vet. These are powerful drugs and you are less likely to run into trouble by starting low. This allows the dogs body to adjust to the drug. The correct period for retesting after starting the original dosage is 30 days as the cortisol will continue to drop for that period, after each dosage change you must retest in two weeks not the 10 days mentioned above. Once you start the Trilostane your dog usually starts to show improvement with the drinking. Some quicker than others. The good thing about Trilostane is you can change the dosage easier if you have to as it leaves the dogs body in about 12 hours. You will need to do ACTH testing when changing doses. The cost does go down once you begin maintenance dosing, as most of the diagnostics are done by that time, unless there are other issues. I would make sure you have a vet you can work with, or one very experienced in Cushing's. That alone will save you time, money and heartache.This is probably the hardest disease to diagnose, so you do need to have several of the diagnostic tests mentioned performed to confirm a Cushing's diagnosis. Many diseases have similar symptoms. We are all scared to death when we get this diagn exosis, we have all been where you are and will help and support you in this journey. We all walk this path together. Blessings
Patti

[molly muffin]

Hello and welcome to the forum. The gang here has gotten you started with some excellent questions and information.

Definitely print out the link that Leslie gave you and take that to your vet. Another option that Dechra has followed is the 1mg/1lb start, but by consensus they are all now saying it is better for the dog to start low and build up If needed. It is too risky to start on the high end, not all dogs do well at that level. Some might build up to need it but not all, every dog is different.
My vet wanted to start at 30mg for a 20lb dog and I had to say no. We actually had to ask for an IMS consult and then another test which was negative for cushings and we never did start treatment, but we understand how hard it can be to be in conflict with your vet. However, and this is the most important part, you are the voice for your dog, your baby, no one else can speak for her and she looks to you to make the decisions for her. So, in the end, you have to have that chat and loaded up with reference material will help to explain your concerns.

So glad you found us!
Sharlene and Molly Muffin

[Trish]

Hi Shannon, She does have some symptoms of cushings doesn't she. I hope today was a good day for you, did you talk to your vet about the dosage? What's the plan going forward?

I just want to clear one thing up about the testing after starting treatment. some of our members appear to have different views on the correct testing regime as per this comment below.


The correct period for retesting after starting the original dosage is 30 days as the cortisol will continue to drop for that period, after each dosage change you must retest in two weeks not the 10 days mentioned above.
Patti

I freely admit my dog is not on Vetoryl but I have been here long enough to see the more experienced posters recommend an ACTH test after 10-14 days after the first dose so that any potential problems with the cortisol going to low are picked up early so they can be managed.

If I was you I would carefully read the link that Leslie has given you above and the guidelines from Dechra that also recommend testing after 10-14 days as per this link which is available in our helpful resources section http://www.dechra-us.com/files//dechraUSA/downloads/Client%20Literature/47902_VETORYL_10mg_Treatment_and_Monitoring_Brochu re_Update_3_2_ps.pdf


Hope today is a good day! :)

[goldengirl88]

Hi Everyone:
I just talked to my Vet about this ACTH testing. He told me that after speaking to Dechra he was told to test after 30 days of the starting dose, as she would continue to drop, and every 14 days after dosage changes. So clarification is certainly needed as this is what he did with Tipper . Why would Dechra mis inform my vet? I am calling myself today and find out why and will post when I find out. Is this another change that they did not correct in the instructions?? Blessings
Patti

[Harley PoMMom]

Dechra does state in their U.S. product insert that after the initial treatment has begun that an ACTH stimulation test should be done within 14 days.

However, vets are noticing that the cortisol continues to drop after that 14 day period, so many are adapting the protocol to test at the 30 day mark instead of within 14 days. Vets are witnessing that if an ACTH stimulation test results are still high within that 14 day period and a dosage increase is given that since the cortisol continues to drop an Addison crisis could happen, so as to avert the cortisol dropping too low they are testing at 30 days after treatment has begun.

I do wish Dechra would update their product insert as it can be so confusing that they verbally say one thing which is not consistent to what they have written in their product insert. :mad:

[goldengirl88]

I am glad you knew this too Lori. I don't want anyone to think I would ever give them wrong information. So I guess all of us will have to get onboard with this as I guess Dechra will keep using this outdated insert for eternity, and tell you something else. If you had to do this testing in 10 days lord Tipper would have had 30 ACTH tests by now. Blessings
Patti

[molly muffin]

I have always gone with the 10 - 14 days for first test. Normally we start to see symptoms decrease at the 10 day mark from what I've noticed here on the forum.
So I think there has to be some subjectivity on when to do the test too. For instance seeing a decrease in symptoms, then I would go ahead and test prior to 30 days, but that is just me. I wouldn't risk going too low. If not seeing any changes then I'd be fine to let it ride out to a longer period of time.

That is my thoughts on the initial testing following starting medication.

Sharlene and Molly muffin