Katy Girl diagnosed with Cushing's - Katygirl has passed

[KatyGirl]

Today we got the final blood test back from the Vet and Katy definitely has Cushing's. Katy Girl is a 10 and half year old Jack Russell which my husband and I love. We have had her for six years since her first human mother had a stroke. Needless to say I am crushed. The Vet doesn't think we should treat her Cushing's disease since she has seen some bad treatment results and Katy's age. Also we travel a lot in our RV and Katy doesn't take pills well. We have to make a decision next week on medication. Another issue is that I think we should do sonograms but my husband doesn't and the Vet doesn't care. Appreciate anyone's thoughts.

[Renee]

Hello and welcome!

Some of the more experienced people here will be along soon to welcome you and ask a whole slew of questions. :p

I just wanted to chime in and tell you that in no way is 10 years old too old to treat for cushings. Your vet is quite mistaken about cushings treatments as well - yes, there are always bad cases (as with anything), but by far, there are more good cases! I am currently treating my pug, who is 10 1/2, and she is doing very well.

[KatyGirl]

Thanks Reene, what med is your baby on? I live in a small town but the Vet is very smart. I do wonder if I should get a second opinion. Katy's blood counts were way above average on all three tests. Katy hasn't been herself the last two months. She doesn't jump on the sofa anymore, has little interest in the critters outside, and wants to eat all the time. However, she will take on the chase of a good cat. I thought she was just slowing down with old age like her retired parents.

[doxiesrock912]

Welcome KatyGirl,

if you can, find and IMS vet in your area. They often have a higher level of knowledge than a general vet does. Our Daisy Mae is 10 1/2 and we've been treating her with Trilostane for a year tomorrow. So far, with a few tweaks here and there, she's doing well.

Many of us have mistaken the symptoms of Cushings for old age until they get out of hand.

[StarDeb55]

Welcome to you & Katy! Pups run into trouble during treatment when their care is being managed by a vet who has little to no experience in treating Cushing's. What usually happens is an inexperienced vet will not follow protocol for dosage & monitoring testing when using either drug that is used to treat, lysodren or trilostane. Cushing's treatment
also requires a knowledgable, well-informed owner that works as a team with the treating vet.

I have treated 2 Cushpups. My first boy was diagnosed at about 7, survived 8 years with treatment. He had a great quality of life. My second boy was 13 1/2 at diagnosis, so he was a little senior gentleman as it is. He was doing well on treatment for 2 years before passing due to causes unrelated to his Cushing's. This is to show you that your pup is not too old to be treated.

When it comes to an ultrasound, this will help you to determine which kind of Cushing's Katy has, pituitary or adrenal. If she would happen to have adrenal, surgery offers the hope of a complete cure, assuming that she would be a good surgical candidate.

What will help us tremendously is if you can gather up copies of all testing that has been done to make the diagnosis. With routine blood work such as a chemistry panel, you will need to post only the abnormals, along with the normal range & reporting units. We would really like to see the results of the Cushing's diagnostic tests. In this group, we love numbers. It just helps us to give you more specific feed back.

Some of the other questions we normally ask include some of the following:

What symptoms were you seeing that led you to take Katy to the vet?
Does Katy have any other health problems or is she on any medications, including supplements?
Did your vet rule out diabetes & thyroid problems? This is important as the symptoms for these 2 things can overlap with Cushing's.

Cushing's is a very slow graded disease, literally taking years to due the damage to the pup's internal organs. You have plenty of time to make a decision as to what you want to do for Katy, and to get yourself up to speed. One or two other things. An ultrasound is really a good idea as not only do the adrenals get examined, but they will look at all of Katy's internal organs, so you will have a better idea of her overall health. I don't want to get your head spinning any worse than it already is, so I'll stop for now.

Welcome, again! We are here to help in any way we can.

Debbie

[LauraA]

Hi KatyGirl :) Just want to say my girl is was diagnosed at 10 years and put on Vetoryl. Her initial number were off the charts as my vet put it. I am glad to say nearly 6 months down the track she is doing great. Her quality of life has improved so much it is hard to believe. Many older dogs thrive on the Cushings meds. I seriously am not sure my girl would still be around if she wasn't diagnosed and treated :)

My girl doesn't like pills either and has a sneaky habit of hiding them in her throat till she thinks I can't see her gagging them up lol. I have found that if I just put a little peanut butter on the pill she will just swallow it and I don't have to force it down her throat. A win for us a both.

[goldengirl88]

Welcome to you and Katy. I too have a Jack Russell Tipper. I can tell you they are very sensitive to drugs, so be careful with dosing. Tipper will be on Vetoryl for 2 years in August. She will be 13 years old, and would not be here without this drug. That being said she did have such strong clinical symptoms, that the first dosage made a major change in her the first day within hours of her taking it. You must be very vigilant when using this drug, as long as you are you should
have no problems. I put Tippers pills in chicken. She wants the chicken so bad she just swallows it without chewing it. Hope all goes well. Blessings
Patti

[Squirt's Mom]

Hi and welcome to you and Katy Girl! :)

The first thing you need to do is find another vet. Based on what your vet told you, I would not be at all comfortable with them handing my babies Cushing's. They all but told you they don't know what they are doing so they would pose a risk to Katy in my opinion. So your first job is to find another vet. It doesn't have to be an IMS - they are more experienced, true, but they are also more expensive. Most of us use an IMS as a back up or support for our GP vets....UNLESS the pup is a complicated case with other things going on in addition to the Cushing's. ;)

Your second job is to start educating yourself on Cushing's and the treatments for it so you can be a strong advocate for Katy. We are their only voice so we need to learn the language of Cushing's. I will give you some links that will help in this endeavor and of course we will be here to answer any questions we can that you may have.

Your third job is to get copies of the testing done so far and post the results here. We only need to see the results that are abnormal, too high or too low, on the blood work that shows things like ALP, ALT, BUN, etc. We need to see all of the ACTH and / or LDDS results as well as all comments from any ultrasounds that have been done.

Your fourth job is to relax, take a deep breath, and enjoy Katy Girl. Cushing's is NOT necessarily a death sentence. Many cush babies live out their normal life span and beyond, passing from things unrelated to Cushing's. With a proper diagnosis and proper treatment and monitoring, Cushing's can be well controlled allowing our babies to return to their usual selves. I first heard the word Cushing's when my Squirt was 9 and she was officially diagnosed at 10. She has had 2 surgeries, one quite major, a seizure from an incontinence med, and other ongoing issues since then. Squirt was 16 this past Feb. Had I been told not to treat her and simply accepted that, she would not be her today because I would not have learned how to help her through these past years. She has surprised me twice this past year, thinking her time had come. But she rebounded and came back to me both times. Never give up hope. Never stop learning and fighting. Never take the word of anyone for anything without researching for yourself what is best for Katy. Remember - YOU know her better than anyone. ;)

I'm glad you found and look forward to learning more as time passes. You and Katy Girl are now part of our family - and it's a pretty dang amazing family!
Hugs,
Leslie and the gang

[KatyGirl]

Thanks for all your posts. I have read them to my husband. We live 70 plus miles from any kind of experienced Vet for Cushing's, either here in Texas or our summer home in Colorado. There are two Vets in this local clinic. We made a decision to talk with the other Vet first thing next week. Our regular Vet told us that she and him had differing opinions about treating. I will try and get her blood count numbers next week too for posting to the forum. Also, I will try to get an opinion on how long she has had this disease since she gets a wellness checkup every six months. A tech implied yesterday that they only draw blood once a year. Looking back at her eating and drinking habits, they seemed to change about nine months ago. We noticed her pot belly at Christmas and joked that she looked pregnant. She quit jumping on furniture shortly there after. It hurts to watch her go downhill, but being retired we see it in ourselves. Again, thanks for posting. Appreciate all advice.

[Squirt's Mom]

I forgot the links! :p Feeble minded old broad that I am! :p

K9C Resource section:
http://www.k9cushings.com/forum/forumdisplay.php?f=10

Kate Connick*
http://www.kateconnick.com/library/cushingsdisease.html

Long Beach Animal Hospital*
http://www.lbah.com/canine/cushings.htm

Newman Veterinary*
http://www.newmanveterinary.com/CushingDiag.html

Cushing’s signs and pics*
http://www.newmanveterinary.com/CushSignFrame.html

BMD Health Library*
http://www.bestbeau.ca/bmd_health_links_4.htm
(scroll down to see Endocrine Diseases)

Mar Vista Animal Medical Center*
http://www.marvistavet.com/html/cushing_s_disease.html

Washington State Uni. – College of Veterinary Medicine
http://www.vetmed.wsu.edu/cliented/cushings.aspx

Complications from untreated Cushing’s –
http://www.k9cushings.com/forum/showthread.php?t=195

[Renee]

Thanks for all your posts. I have read them to my husband. We live 70 plus miles from any kind of experienced Vet for Cushing's, either here in Texas or our summer home in Colorado. There are two Vets in this local clinic. We made a decision to talk with the other Vet first thing next week. Our regular Vet told us that she and him had differing opinions about treating. I will try and get her blood count numbers next week too for posting to the forum. Also, I will try to get an opinion on how long she has had this disease since she gets a wellness checkup every six months. A tech implied yesterday that they only draw blood once a year. Looking back at her eating and drinking habits, they seemed to change about nine months ago. We noticed her pot belly at Christmas and joked that she looked pregnant. She quit jumping on furniture shortly there after. It hurts to watch her go downhill, but being retired we see it in ourselves. Again, thanks for posting. Appreciate all advice.

Don't feel bad that you didn't pick up on stuff right away, or that your vet didn't. Cushings is quite sneaky that way. Many of us think the symptoms are just aging, until they become too much, and we start wondering what is really going on. I would speculate that my pug had cushings for at least a year, or more, before we finally put everything together.

Talking to the other vet is a great idea. When you live somewhere with limited options, the best defense against that is to be as educated as possible, so you can work with your vet to make the right choices. My vet is rather inexperienced, but we've worked together every step of the way, and it has been going very well.

[Spencersmom]

Katy Girl...where are you located in Texas? Depending on where, there are lots of good vets there....even A&M is an option if you are close enough!

[doxiesrock912]

After Daisy was diagnosed and I learned more about Cushings, I realized that she probably has had this disease for at least a year and we all, including her general vet, attributed her symptoms to old age and IBD. Also. the changes happen so gradually so again we think that it's age related.

[Trixie]

My dog was diagnosed a year ago at age 9. She's been on medication for about a year. She had all the common Cushings symptoms just as you described with your dog and also my dog had off the charts liver numbers. I'm happy to tell you treatment can work wonders and now a year later my dog is doing just fine.
She walks at least a mile almost everyday and is playing like a puppy again. Your dog can do very well too with proper treatment. Maybe your vet just doesn't know enough dogs who have been treated successfully..there really are many! I hope you can work out a treatment plan for Katy Girl with a vet who knows that Cushings is not a death sentence.

Barbara

[KatyGirl]

We live 75 miles north of Dallas and in the summer 35 miles from Montrose and Gunnison Colorado ( an hours drive when including going down the mountain). My husband corrected me that the other vet has treated Cushing's. We are going to consult with him this week. I noticed a real change in Katy about nine months ago when their tech suggested that we switch Katy to dry food for her teeth. It was right after her last blood work. I read today that you never give Cushing's dogs dry food. Anyone have food suggestions?

[Squirt's Mom]

Absolutely nothing wrong with feeding kibble (dry food) to a cush pup. Where ever you read that, it is wrong. ;) The diet for a cush pup needs to be low fat and moderate proteins. Kibble, canned, cooked or raw - those are the guidelines we need to look for - low fat and moderate proteins. ;) You do not want to feed low quality feeds at any time whether the pup is healthy or not. Higher quality feed are always the best bet. ;) If you can get the feed in your grocery store, WalMart or other such places, the odds are it is a low quality feed. Places like PetCo (not Pet Smart surprisingly) carry higher quality feeds. This site has a fairly good guide and rating system on commercial feeds -

http://www.dogfoodadvisor.com/recent-updates/

Another site on feeds -

http://forums.dogfoodproject.com/viewforum.php?f=1

[Renee]

I think it is always a good idea to add water to any dry food, just to get some hydration in it.

Also, the act of chewing kibble to clean teeth is a myth. Dogs almost never, ever really chew their food. They gulp it down. It takes a good long chew to do anything to clean teeth, such as chewing on a marrow bone.

[KatyGirl]

Went to see the other vet at our clinic. He said we didn't have a choice but to treat and are starting treatment this week. He gives her a two to three year outlook once they get her numbers right. Failed to say that he said the meds would run about $40 a month. He doesn't plan to do a sonogram unless the meds don't work. If they don't work, he expects a short time left for her. He is very positive and they have seen her all her life.

[molly muffin]

Which med are you using. Since you are not going to be near vets, start on the low side of the recommended, either 1mg/2kg or 1mg/1lb if using vetroyl. If Lysodren, then let us know and we'll give your our watch list for using it during loading phase.

Sharlene and molly muffin

[KatyGirl]

We are not going to leave Texas until we have Katy regulated; however, her Vet thinks it will be done by June. We are only 5 miles from his office. I will post the med name once he gets it in stock and she is on it, either Wednesday or Thursday. He said it was the newest med that was not the cancer type treatment. He also said it had a percent of the drug which keeps them from over reacting. The only problem is keeping them taking the meds and eating/drinking. My husband corrected me, the med will be Trilostane.

[KatyGirl]

Not sure what I did to post twice, so I deleted the text. Go to go Katy wants to be feed. LOL. I can't see her not wanting to eat.

[Renee]

I am glad you have decided to treat your girl. Many of us (myself included) use Vetoryl/trilostane.

Please read up as much as you can on the medicine before starting it. It is very important to follow proper protocol when using this drug, in order to minimize risk.

Please tell us Katy's weight and the dose you plan to start on.

[molly muffin]

Yep, keep the dose low to start with. There should be no risk to her not wanting to eat or drink at all, as long as the dosage is proper. Don't start her on too high of a dosage. You never know how a dog will be on any drug and signs of over dose are, lethargic, wobbly, diarrhea, vomiting, etc. If you start on a low dose and go up as needed, you will likely Never have these problems, but we see it all the time when a vet gives too much to start out with.
I'm sure if your vet is up on proper protocol and dosing then things will be fine and by June you should be in a good spot with Katy girl. What a great name.

:)
Sharlene and molly muffin

[KatyGirl]

Thanks for the advice on dosage and what to look for in side effects. I will try to post often during her initial treatment.

[Squirt's Mom]

He also said it had a percent of the drug which keeps them from over reacting....
My husband corrected me, the med will be Trilostane.

I don't know what your vet meant by this statement but I want to make sure you are aware that Trilostane has the same risk factors as Lysodren - it has nothing that I know of in it to keep the pup from "over reacting". A pup on Vetoryl, brand name of Trilostane (same drug), can become Addison's just as a pup on Lysodren can. The ONLY thing that keeps a pup from "over reacting" is the knowledge and experience of the vet, and the diligence of the parent(s). Please do not go into treatment with the idea that Trilostane is "safe" as it was originally touted to be - and that many vets continue to believe. Mishandled, even aspirin is deadly. ;)

There is a very specific protocol to follow with Trilostane. Please take some time to read the following link so can be a good advocate for Katy -

Trilostane/Vetoryl Information and Resources -
http://www.k9cushings.com/forum/showthread.php?t=185

[goldengirl88]

If you get a chance you can even contact Dechra and start a file on Katy. As Leslie said there is nothing that will substitute in this journey for good old fashioned knowledge. I have a Jack Russell as I mentioned earlier. They are sensitive to medications. I started my Tipper on 10mg. Slow and low is better, you have less of a chance of any life threatening problems if you follow that. You may have to do dosage adjustments dependent on the next set of numbers form the ACTH. You must always do an ACTH before and after dosage changes. The protocol for testing in the Dechra literature has become outdated according to Dechra. They used to want you to retest in 14 days. Now they are saying that because the cortisol continues to drop during the 30 day period, that checking in 2 weeks can result in a vet upping the dosage which could lead to problems. I called Dechra and they advised me on this. If you feel better testing in 2 weeks do it, but I would not let anyone up the dosage until checked in 30 days. The dosage is 1mg per pound. Dechra's number is 866-933-2472 and it is a good idea to have a file there on your dog, they are very helpful if you have questions. Blessings
Patti

[KatyGirl]

Thanks so much for this advice on Vetoryl. I would swear that our vet said that her meds would include a small dose of the med used if they went into shock from overdose, but this has been a lot for me to absorb. Still I appreciate our Vet taking the decision making of whether to treat or not out of our hands. Katy Girl is way overweight at 26 pounds for the short breed Jack Russell. We noticed changes in her muscle strength, not being able to jump on the sofa, at Christmas. We attributed it to old age since she had just seen the doctor for her six month and they had her on a weight loss dried food diet. She keep wanting more and more food. We were wintering in South Texas so I decided to take her back in to her Vet early once we got home which we did. I am getting together a list of questions for our consultation which will happen Wednesday or Thursday. Any suggestions for that list would be appreciated.

[Renee]

So, if she is 26 pounds, then you'll want to start out at a max of 20mg per day, in my opinion. Some would recommend even starting out lower, at 10mg.

If your vet truly does believe there 'is a small dose of the med they use if they go into shock from overdose', then I am very afraid for you, as this indicates your vet knows NOTHING about vetoryl/trilostane. It is no safer than lysodren - just different.

I cannot encourage you enough to get as educated as possible about vetoryl, including contacting Dechra, in order to make sure you can manage this for Katy. It's fine if you want to stay with your vet, but it would be beyond catastrophic if you were to blindly put your faith in him.

A few questions to consider asking:

1. Has he ever used vetoryl for other patients?
2. How many cushings dog is he actively managing?
3. Who does he consult with, if he is unsure about something (such as dosing, etc)?
4. What are his monitoring protocols when using vetoryl?

[Squirt's Mom]

You will also want to know how successful his cushing's treatments have been. If he has treated 20 pups with Cushing's, how many of those had problems?

Is he willing to give you prednisone to have on hand just in case?

Will he be available 24/7 should something go wrong? (Plan for what you will do if he is not.)

Does he know NOT to fast before giving the ACTH for monitoring?

As you ask your questions, pay attention to the vet's response, not only the words but the attitude. You need a vet that will work with you as a team, not one so arrogant they refuse to listen to you. ;) So if your questions make them angry or snippy, that would raise a red flag for me.

[Trixie]

I'm sure your vet is very nice and it seems like you trust him/her, but the decision to treat has always been in your hands, not the vet. If my vet said not to treat I would have immediately gone somewhere else for a 2nd opinion unless my dog was needlessly suffering.
Most of us here came to this just as you did. We see some strange things with the dog but chalk it up to the dog getting older until we find out otherwise at a check-up, but this disease is treatable. Many have posted to attest to this fact. Many dogs with Cushings can live out their natural life span so any vet who tells you the dog only has a couple years to live is possibly one I would not want to work with.
Good luck with Katy Girl, if all goes well you will be surprised and relieved when she starts getting back to normal, and I hope this happens quickly for you though it often takes some time.
You should be vigilant in watching her while she's on her medication for any adverse reactions-diarrhea, bad appetite, weakness.. and question your vet about the dosage if it is any higher than 20mg a day because at her weight the starting dose should be no more than that. Playing it safe is the best way to start off.
My dog had all the same symptoms your dog had and she is now on the medication for one year...she's doing great. No more Cushings symptoms...but I am always careful to watch her water intake, her eating and all the things that can easily change with this disease.
It's sometimes hard to question a vet/doctor but I have learned over the last year that it is vital to do so and your right to do it. Not all vets are created equal, even if up til now you have been satisfied with the care your dog has gotten, this disease needs an experienced vet . Please don't be afraid to say you have been researching and you know certain things about this disease and the medication now. The vet should be impressed, not annoyed that you care enough to know how to help your dog.
Hope Katy Girl feels better real soon!! She's so cute and she deserves to get back to her usual self. :)

Barbara

[Harley PoMMom]

Thanks so much for this advice on Vetoryl. I would swear that our vet said that her meds would include a small dose of the med used if they went into shock from overdose, but this has been a lot for me to absorb.

I am wondering if your vet was referring to Lysodren and giving a small dose of prednisone along with the Lysodren?? Lysodren has a induction phase and if the vet is contemplating this protocol, it is not recommened because the prednisone can mask the signs of a dog being loaded.

Cushing's is a treatable disease but success in treatment depends on keen owner observation and a vet/IMS that is knowledgeable and experienced in treating dogs with Cushing's. Lysodren/Mitotane and Vetoryl/Trilostane are generally the two medications used to treat Cushing's. Both can have adverse side effects and one is no safer than the other. Lysodren has been around for many, many years and for decades it has been used, off label, for Cushing's and still is. Trilostane/Vetoryl was FDA approved for the treatment for Canine Cushing's in 2008.

We have a Resource Thread which has a wealth of information regarding Cushing's and protocols that need to be followed with either Lysodren or Trilostane, here's some handy links: Helpful Resources for Owners of Cushing's Dogs (http://www.k9cushings.com/forum/forumdisplay.php?f=10)

Trilostane/Vetoryl Information and Resources (http://www.k9cushings.com/forum/showthread.php?t=185)

Lysodren loading Instructions and related tips (http://www.k9cushings.com/forum/showthread.php?t=181)

If you have any questions at all please do not hesitate to ask them.

Hugs, Lori

[KatyGirl]

No he talked about Trilostane. He said he wouldn't use the chemo type. I probably just misunderstood. I asked about leaving her with them for a week or two in their hospital but they don't have anyone there at night and what might happen if she went into overdose shock. He said that would not happen because of the med they used had a portion of the drug used to bring them out of shock. The problem would be if she locked up and refused to eat. Anyway, I am bad about interrupting medical advise. I think he has a handle on a good treatment. Both Vets are in their thirties and up on the latest. He also said that some doctors in Europe would force them into Atkinson because it was easier to treat, but he would never do that.

[Renee]

No he talked about Trilostane. He said he wouldn't use the chemo type. I probably just misunderstood. I asked about leaving her with them for a week or two in their hospital but they don't have anyone there at night and what might happen if she went into overdose shock. He said that would not happen because of the med they used had a portion of the drug used to bring them out of shock. The problem would be if she locked up and refused to eat. Anyway, I am bad about interrupting medical advise. I think he has a handle on a good treatment. Both Vets are in their thirties and up on the latest. He also said that some doctors in Europe would force them into Atkinson because it was easier to treat, but he would never do that.

I must disagree with you here. I do not believe he has a good handle on treatment... based on the blatantly incorrect statements he has made. If he thinks that it is common for the dogs 'to lock up and refuse to eat', then this tells me he has a history of overdosing his patients, and expects it. This is incredibly dangerous.

Yes, there is some controversy about some vets purposely inducing addison's disease, because it *can* be easier to manage in some respects. I don't think I know of anyone on this forum that has purposely gone that route.

[KatyGirl]

Thanks, I think I misspoke. He didn't say it was common. He expects no problems. He was saying that over a period of time it would be bad. I was worried about leaving her unattended at night thinking I was giving her better care for a week or two. He was reassuring me that she would be Ok, but he thinks she would be better off at home.

[Trixie]

Your dog does not need to be in the hospital with this treatment, that would be a little stressful on the dog and unnecessary. You give the dog the pill and most likely the dog goes on to have a fairly normal day, which is why starting with a low dose is key.
You should not have a problem with Trilostane if used conservatively, but you just have to keep a close eye on your dog to make sure there are no adverse reactions. If you see any, you call the vet and you don't give any more pills until the situation is evaluated.

My dog had no reactions at all, but we started low and built up the dosage strength slowly. Some dogs can have some upset after the initial dose but that is why starting low is important. Most problems come from the dose being too high.
The protocol is for 1mg per pound of dog. Your dog is 26 pounds, so a good starting place is 20mg a day, or 10 mg twice a day. If you want to play it super safe you can ask the vet to prescribe a lower dose. In my opinion you should start somewhere between 15mg- 20mg a day. If you do twice a day dosing your dog will get less at one time which is also a safe bet. Some dogs do well on twice a day and some on once...that is something that will be decided as you work with your vet.
You want the medication to be effective but you want it safe. Also-Trilostane should always be taken with food at the same time every day.
After you get the medication worked out the next step will be the ACTH Test which will come 10-14 days after you begin giving your dog the pills. That test is very important as it will show how your dog is doing on the medication-if it is enough, too much, or just right.
You will get used to all of this. The beginning part is the hardest...then, hopefully things settle in.

Barbara

[Squirt's Mom]

Since there is some confusion about what the vet has said and what he meant, before you give a single dose post here and tell us exactly what you are supposed to do - how much you give, how often, when. And when Katy is supposed to go back for the first ACTH. Do this before she takes one dose, ok?

[KatyGirl]

Ok, you all are very helpful. The meds are in and our appointment is at 2:30. My husband will always be with me at the appointments. He seems to better understand the situation. I will post the meds after we get them. Also I will tell you when the blood work is due. I know our vet expects to do this often to start. This is a nervous thing for us to do but we will be diligent and get through it. Also, I will try to be more technical and exact about drugs in the future. You ladies are really experts and I am still trying to learn how to spell Cushing's. By the way, thanks for doing the math for me on her dosage. I will make sure and talk that through with the vet.

[Trixie]

Good Luck at the vet! :D Don't worry, you'll get used to all this! Glad your husband will be there too...two are better than one! :D:D

Barbara

[KatyGirl]

Questions for the Vet today as we pickup Katy's meds:


Diet of wet food, Little Cesar, with some lean meats from the table, chicken, beef, lean ham, and occasional salmon. Lean meats will be how we give her meds. Try to ease in higher quality wet dog food later. Katy loves Little Cesar.

Trilostane dosage and once or twice daily. If over 20mg once a day or 10mg twice a day, will question based on her 26 pound weight. Also will ask if should start lower than 20mg. Understand it needs to be taken with food at the same time each day.

Makeup of med so I can better understand if there is an additive to the Trilostane.

Side effects to look for. How to tell if Pancreatic attack. Looking for diarrhea, vomiting, shakes, seizures.

Discuss going to Dallas in two weeks would he like a sonogram setup.

The Vets home and cell number if we cannot get the Vet on call and Katy is in emergency condition

Blood test frequency and when next? Expect an ACTH test within two weeks.

Katy is very droopy, not wanting to go out. Her water intake is more normal but often gags when drinking. Probably because she over drinks when she does go for water.

[goldengirl88]

When you say Katy is gagging when drinking, are you sure it is not her trachea? You need to watch out for that with Cushing's. Tipper has tracheal issues now too. Blessings
Patti

[KatyGirl]

Thanks, no I am not sure why she gags. Also I want a copy of her blood tests from last week.

[Iraklis]

Sorry if i missed it ,but have you done an ultrasound to check if it is caused by the adrenals or the pituitary?

[KatyGirl]

No, they haven't done a ultra sound. There is not one local. I mentioned that we were going to Dallas in two weeks and he is going to decided if he wants one done then. There is a traveling doctor who may come by and do a couple of his Cushing's dogs.

Ok, back from the doctor. He is starting Katy at one tablet 30mg once a day of Vetoryl with follow up blood work in two weeks.

Had an upset husband with me for my asking so many questions and doubting why 30 instead of 20 mg dosage. So I got a copy of the initial lab work but don't know how to read it. There are three numbers 39.4 urine cortisol, 59.6 urine creatinine, 206 urine cortisol/creat ratio. Then there is a sheet with graphs and she is high on retic 115.1 , NEU 12.20 , BUN. 30 mg/do. , ALT 161 U/L , and 1455 U/L. Then there is a page with Snapshot Dx. Cort > 30 which supports a diaognsis of Cushing's.

I also got a Prednisone 5 mg with directions to take 1/2 tablet by mouth once a day if she had direaha, vomiting, or refused to eat over a 24 period. At that point I am to stop the Vetoryl.

So tomorrow we start the Vetoryl at noon since that is the best time for me to doctor.

[goldengirl88]

If it were my dog I hate to say this again, but I would never start with 30 mg. Never ever. Also a traveling vet who can do the ultra sound is not what you want and it may waste your money. You need a high definition ultra sound, trust me ai know this. My dog had an adrenal tumor that was never picked up on the vets ultra sound, but was clear as anything on the high definition. You husband is 100% correct on the Vetoryl. If it were me I would take it back and get 10 mg. You are looking for problems with 30 mg to start off with. Blessings
Patti

[KatyGirl]

Sorry, you misunderstood, hubby thinks whatever the doctor says goes and I am stupid for asking questions. I have a choice to drive an hour and half and hope to find a new Vet which I know nothing about to treat Katy, or use the one who had treated her all her life. Also, what if she has a reaction to the Cushing's meds? I plan to watch her carefully for symptoms of illness. If she gets really sick someone will treat her ASAP or regret it. I think the thing I dislike most was the Vet telling me to call whichever Vet was on call on the weekend for an emergency. You got to remember out in the country the Vets treat cows and horses. She will be OK.

[molly muffin]

Katy weighs 26 -27 lbs. I'd normally say 25mg to start for her or even 20mg.

However, you do have prednizone. I think that with that on hand you have a plan in place at least. I do agree about the ultrasound. If you Do want to get one, go to a place with a good high res machine. No point in wasting money.

If you have any questions, if you notice any signs of problems, let us know asap. Someone will usually be around.

I know you said you were going to give her meds around noon? Does that mean that the vet will be able to do the testing between 4 - 6pm?

Sharlene and molly muffin

[KatyGirl]

Thanks, I do have Prednisone 5mg to take 1/2 a tablet a day and drop the Vetoryl if she gets sick. I am giving her the Vetoryl because my husband would just put it in a bowl and hope she takes it. He feeds her a 7 am before I get up. So I want her hungry. The Vet knows ii am giving it to her at noon but the test starts at 9 am. Can you make any sense out of the numbers I posted?

[molly muffin]

Okay, that won't work. It would be better for your hubby to feed her at 7 am with her breakfast and give her the pill then.

The reason is because you HAVE to test within 4 - 6 hours when the drug is at it's peak to know what the actual cortisol level is. Otherwise you don't get an accurate reading. Or give it to here when you Do get up. But the test Must be done in that time frame or you are throwing money out the window.

Sharlene and molly muffin

[molly muffin]

What time do you get up? Just give it to her in the morning, like 9 and you can have the test then in the afternoon. On the day of the test you give her the med with her meal as normal. It's not a fasting test.

Sharlene and molly muffin

[addy]

Please note that the acth stimulation test to check your dog's cortisol while being dosed with Vetoryl must be started appx 4 hours after the pill has been given with a meal. Otherwise the results are pretty much useless. This is mandatory, in my opinion, no negotiation. Don't let anyone tell you differently (including yourself) and dont let anyone give excuses as to why it cant be done. Please make sure this is done appxromiately 10-14 days after starting your dog on the drug and then again, about two week later so at the 30 day mark from starting Vetoryl.

If your pup is almost 30 pounds than go ahead with the thirty mgs. Just monitor closely, come here everyday and tell us what is going on and make sure that first acth test is done correctly.

When in doubt, withhold the pill. Never forget that.

You will be fine as long as you educate yourself and be a strong voice for your dog who is depending on you.

You will be fine.:):):)

[KatyGirl]

I see a problem with the testing. I will get in touch with the Vet about when to take her pill on the day before and the day of. Thanks you guys for this information.

[Renee]

Quick question - because I may be misreading....

Are you giving the prednisone daily, or only if you see a reaction?

Also, the vetoryl must be given with a meal. So, if hubby is up and feeding her at 7am, then that is when she needs the pill.

[KatyGirl]

I go to bed at midnight to 2 am and hubby at 9:39. That is my alone time and his in the morning. Retired people need that. I get up at 9 am or there about but the Vet wants her feed w pill together at the same time daily, and hubby doesn't want to give the pill at his 5:30 am rise or 7 am breakfast. It will work.

[molly muffin]

It would work for you to give the pill when you get up at 9:30am with her meal. Hubby just won't feed her, you will in the mornings. Then the test can be scheduled at 1:30pm in the afternoon. That would work.

Believe me, through the years we have worked these times out hundreds if not thousands of times. :) So, we got it and you tell the vet, this is the plan. :)

LOL

This way you still each get your alone time, Katy gets her meds as protocol says and the test is scheduled when it needs to be.

Oh and Renee, she is just to give the pred if there is any problem, not daily with the vetroyl.

Ta Da!
Sharlene and molly muffin

[KatyGirl]

Yes, you only give the Pred if sick after 24 hours of being sick by itself. Also stop the Cushing's med until you see the Vet.

[Iraklis]

Not trying to scare you or anything ,
just keep in the back of your mind,
that if later on you observe signs of aimless pacing ,headpressing or circling...
contact your vet immediately!!!...(i'd also give at least double the prednisone if that occurred).

Don't know how your funds are but if the ultrasound comes clear, try to get an mri...it'll probably save you tons of money in the long run and maybe Katy life!

[KatyGirl]

Not scared. Thanks so much for all the advice. I get the impression that the Vet doesn't want a sonogram as long as the meds work.

[Renee]

Sorry..... am I being dense? Why can't your hubby give her the pill when he feeds her at 7am?

If he really cannot do it, then you'll want to change her feeding time to 9am, when you get up, then you'll feed and give her the vetoryl.

I must have misread something you typed earlier about the pred, because I got a little worried that you were giving it daily (which would be wrong!). It's all good!

[KatyGirl]

I don't trust him to give her meds. He doesn't get how important it is and will just put it in her bowl with her food. She is great about eating around pills, even hiding them. Also he does all the other doctoring so we agreed that I would give her this pill. I will make sure he doesn't feed her until 9 when I get up. I probably can move that up to 8 am. Hope I never have to give the Pred.

[My sweet Ginger]

Hi. Your post #43 scared me and I was thinking why is she talking about my husband?:eek: :p
My husband can't stand me when I ask questions to anybody as he thinks those are all stupid questions, period. He shuts me up right then and there so we come home with no information what so ever and we later have to deal with each question as the problem arises:mad:

The reason I'm telling you this is I was in between a rock and a hard place myself just a few months ago with my baby Ginger but as incredibly hard as it was once I'd realized (or was educated by reading and urgings (advice) from all the angels on this forum) enough to know what was best for my baby it became crystal clear which way I needed to go. The rock was our GP vet and the hard place was my hubby who thought I went TOTALLY insane going against our vet like that and wouldn't speak to me for weeks.:rolleyes: The vet who with her damaged ego is still shunning me by her actions; NEVER once called to check on Ginger and gave me an impression that she didn't want to deal with us anymore regarding Ginger (tried to refuse to check her BP a couple of times) and she didn't even acknowledge us when she passed RIGHT by us in their tiny waiting rm/front desk when we were there for an ACTH test which I had to insist to be cost strategic because it was going to cost us more than a double with our IMS.:eek:

It's been a long and winding road and a very, very lonely journey for Ginger and I with many, many tears since late Sept. of last year. I feel I'm wiser and stronger now that I am willing to fight anything or anybody to give my Ginger the comfort and peace she so deserves and I truly know I'm ALL she's got when it come down to speaking on her behalf. Not the vets nor my husband. They can help us along the way but no one is going to intimidate me waving their professional hats anymore because I've learned never to put blind faith in any professional and follow them. Try to educate yourself as much as you can and ASK questions until you are satisfied with their answers. I know some vets don't like that and get annoyed but it's your baby and not theirs we are dealing with here.
Don't give up and stay strong and be proactive. I really pray your journey with Katy girl will be a smooth one and it could well be.
Lastly, welcome to the forum. You've landed in a wonderful place.:)
Song.

[doxiesrock912]

To hell with hubbies!
Ask those questions. You'll be glad that you did and as for vets egos, poop. We're paying them! They work for us.

[KatyGirl]

Sorry, I should not have mentioned the tension at the Vets yesterday. I should have waited until I cooled off before posting. I just knew you all would not like the dosage and I felt helpless, and I value your experienced opinions.

Good news today. Katy will get her pill at 8 am each day by one of us. I gave it to her this morning wrapped in a little turkey. It went down smooth and she is hard to give meds to. Pleasantly surprised at how small the pill is since it looks large in the container.

[doxiesrock912]

I give peanut butter with Daisy's pill and there never is a problem.

[Renee]

I give peanut butter with Daisy's pill and there never is a problem.

I do PB too. :)

[pansywags]

Pansy was extremely fussy about pills and would find and spit them out much of the time. Peanut butter was soft enough for her to detect and eject a pill so I switched to cream cheese which worked better for us.

Song, what a tough road you have had, I admire your strength and dedication to advocating for your Ginger. She is so lucky to have you.

[KatyGirl]

Question, Katy is eating well and goes outside In the fenced yard. But she is also laying around, as usual; but she usually loves to go on a walk and didn't want to today. Guess it takes a day or two to adjust. I am not expecting her to have more energy, but it seems she has a little less. Probably a little ill feeling. Not throwing up or anything like that.

[Junior's Mom]

Welcome to the forum. Their cortisol can drop drastically when you first start the meds, it can make them feel icky, as their bodies have to adjust. As long as she is otherwise behaving normally, it shouldn't be a worry.
You said she gets her pill with some turkey? Does she also get a full meal before it? Vetoryl has to be given with a meal to aid in the absorption. It is always a good idea to feed first, and give the pill after. A sign of cortisol going to low, is lack of appetite. You wouldn't want to medicate if that was happening, so it's best to feed first.
On a side note, my dog weights 50lbs, and I insisted he start on just 20mg, to lessen the stress on his system. We have been increasing ever since. It is more expensive going low and slow, but in my opinion, a good idea.
You are doing a great job.

[Renee]

Yep, the first few days can cause a sort of 'coming down' period, because the cortisol can drop quite dramatically. Think about all that cortisol pumping and pumping throughout the body, and then, all of a sudden, you stop it. My girl pug went through the same thing.

Watch for all other signs of overdose, but I think you are good!

[KatyGirl]

No, I medicated her immediately before the meal. But she still has a very good appetite.

[goldengirl88]

I am still concerned to have Katy started at 30 mg. With that being said you have to feed Vetoryl with some fat. It is fat soluble and needs to be done this way for proper absorption. Blessings
Patti

[KatyGirl]

I know, I am still concerned about the dosage too. Lean turkey and Senior Cesar is what she has had today. Do I need to give her some roasted chicken skin now or something else with fat now?

Wait up, she is acting much better now moving around to get her share of our afternoon yogurt. Funny how we are changing our schedules around for the next few weeks so that someone is with her at home.

Also just went on a short walk with us. Enjoyed it and popped looks fine.

[KatyGirl]

Addy, thanks so much for the advice on when to take the pill before the next blood tests in ten days. We are giving her pill to 8 am daily. She took it easily this morning. Also, I called her Vet and made sure what time to bring her in. They changed the scheduled time to four hours after she takes her pill. Great advise that you caught our error.

[molly muffin]

Just give her the pill with whatever kind of food works for her and then give her a normal meal right away. One of them needs to have a tiny bit of fat in it, but not too much as we don't want her too get too much fat. Senior ceasar Should be okay for that.
That is great that you have worked out a time.
Oh believe me, we have all posted when we are hot about something. Hubbies and vets and who knows what all can get us riled up. It's good to have a place to vent when you need to.
This is not just a journey that affects our pets, it affects us and those around us too. :)

hugs
Sharlene and molly muffin

[KatyGirl]

Katy easily took her second pill today. She is doing fine. Wanting a little less food and more interested in what is gaping on outside our home. My main concern from yesterday was her gaging on her water, which she does often, in the middle of the night as she went outside. She gaged up some clear water with white foam. I woke hubby up to see it. He agreed that it wasn't med related. She doesn't gag every time she drinks but usually if she drinks hard. I told the vet about her gaging at the end of our consult this week. He seemed perplexed and said he wanted to address the Cushing's first.

[goldengirl88]

The Cesar you are feeding is a commercial food that is wet? If so most all of them are sprayed with fat to make them appeal to the animal. I think that is sufficient to get the Vetoryl absorbed. Blessings
Patti

[Trixie]

Sounds like you're doing a great job and that Katy is doing fine. You just keep observing as you are doing. The good news about this drug is if you were to see some adverse signs along the way you just stop the medication and assess the situation with the help of your vet.
You have emergency prednisone which most likely you will not need to use but you have it just in case. So you're in good shape!
Hope Katy continues to do fine in these first few days of treatment. The beginning of this is the hardest part, it does get easier! :D:D

Barbara

[KatyGirl]

Thank you all. Katy is doing great today after her second pill. She even thought seriously about jumping on my footstool. I may be premature but she has more spark. I will try and post her numbers on the 16th.

[addy]

The gagging while drinking water- my Koko has a partially collapsing trachea. I stopped using a regular water bowl and changed to a food bowl, not as deep, more shallow and larger diameter. I only fill the bowl with water a bit less than half way and he has totally stopped gagging when he drinks because he can't gulp as fast.;);)

[KatyGirl]

Thank you Addy. I read that can happen with Cushing's. I will try changing her water bowl

[goldengirl88]

The reason I brought the tracheal issues up to you before is that my Tipper has these problems and drinking exacerbates this condition. She too cannot gulp fast or this happens. Blessing.
Patti

[KatyGirl]

Tipper's Mom, I have learned so much and I am moving on her gagging issue because you initially brought it up. Thanks so much. The Vet is now aware and I will follow up with him at her blood test. I cut the amount of water in her dog food bowls, family room, study, and bedroom. I haven't heard her gag yet. I also took the collar off her neck and we bought her a new harness that puts pressure on her chest instead. She is doing great on her third day of treatment.

[goldengirl88]

Good job. I used to have a collar on Tipper all the time because I could not find a harness that was comfortable for her or not made out of nylon as she is allergic to it. The leather ones cut her. Now she can wear some with a little nylon. She has not worn a collar for two years now, but the damage is already done from that and Cushings so all I can do is get her Adequan shots. Good Luck!
Patti

[molly muffin]

I stopped using collars with molly years and years ago. It can also put pressure on nerves that you don't want damaged along with the trachea. We use a harness too.

Sharlene and molly muffin

[KatyGirl]

Started to ask a question but I think I know the answer.

[molly muffin]

You can ask anyway. Questions are free. hahahaha

Sharlene and molly muffin

[KatyGirl]

Thanks, but I don't want to over ask. Well, Katy gaged or threw up clear liquid with white foam the first night on meds. She did it again a couple of hours ago. Her stomach is growling a little too much. It is maybe because I switched her a week ago to wet food. Also, she had a kennel cough shot last week. She seems fine otherwise. Just over worrying here on my part.

[Trish]

You can NEVER overask here... someone knows the answer to most things!! Ask away :)

[goldengirl88]

If your dog is throwing up stop the Vetoryl. Never medicate a sick dog. As I said before this dosage is too high for me. Her cortisol may be really dropping quickly. If anything else happens, more vomiting, diarrhea, can't get up, won't eat take he to the vets asap. Her electrolytes can go out of balance if her cortisol drops too far and that can be a life threatening situation. Blessings
Patti

[addy]

Rule number one- always do one thing at a time so you know cause and effect- Katy Girl had a Bortetella shot, food changed and started Vetoryl all within a few weeks?

Rule number two- when in doubt withhold the pill

Does Katy seem ill in any other way? Is she eating, active, alert?

Vetoryl can also make some dogs sick to their tummies and we sometimes have to give them Pepcid.

Since it is Saturday night, is your vet available?

[KatyGirl]

Right, I should not have changed her diet. The shot was given before the diagnosis and almost overdue. If she gags up water/white foam again, I will stop the meds. We also are budding out pollen everywhere here which gives her allergies. She is up moving around looking for a share of people food, which isn't happening, and no diarrhea.

[molly muffin]

It doesn't sound like Katy is sick, as in overdose, it does sound like vetroyl Might upset her tummy, sometimes. She has had 3 pills, only in the am, and then on 2 of those days, she has barfed up white foamy, after drinking and gulping water? Everything else is entirely fine, active, no diarrhea, eating fine.

Could be she needs some pepcid ac about 30 minutes before the vetroyl. It might give her upset tummy, which it does for some dogs.

You're doing fine :)

Sharlene and molly muffin

[Tina]

Does she throw up the water and white foam right after gulping water and drinking too fast? Jasper will do that from time to time also if he drinks too much water too fast.

Are you giving her the vetoryl after a meal? I think I might have read that you were giving her the pill first followed immediately by the meal. I think it is better to have her eat first then give the pill. Also, this way if she is showing a decreased or poor appetite, you will know it before you have medicated her and can hold the pill if needed.

Tina and Jasper

[KatyGirl]

I will switch to giving the pill after she eats, but I have been feeding her immediately. Bill reminded me that she was gaging up liquid before meds. The thing that got to me was the addition of a growling stomach today. Monday I will call the Vet. I don't think it is an overdose but a weaker stomach to something.

[molly muffin]

I think giving it after the meal is a good idea then there will be something in there to coat the stomach and help with the digestion. Hopefully no more tummy growls.

Sharlene and molly muffin

[Trixie]

I give my dog 1 half of a 10mg Pepcid A/C to keep her stomach in check, especially if I hear all those gurgling noises. You should ask your vet though before trying it. It works well for us, but not for everyone.

My dog had really bad stomach noises for many months before her diagnosis and they got better once her Cushings was controlled, though some dogs can get mild stomach upset because of the pill.

If Katy is still hungry, eating normally, no diarrhea and is not too lethargic then she is probably not having any adverse reactions. Sounds like you're keeping a good eye on her.

Barbara

[doxiesrock912]

Daisy takes Trilostane twice a day. She wasn't to tolerate it all at once.

[LauraA]

I know that Bulger had a lot of tummy trouble because of all the testing she had done to find out if she had cushings. After her 10 day test it got worse and she had a bleeding ulcer. Now before her tests we give her a Losec 3 days before and 3 days after, has worked a treat. Maybe btw all the tests she has had and the Vetoryl her tummy isn't too happy. She was coughing up a lot of watery bubbly stuff as well.

Also my vet has said we are not worrying about vaccinations and kennel cough shots anymore since she has Cushings. They only needle they are looking at giving her is a heartworm one. My poor girl isn't having a good week this week, hoping next week is better for her.

[KatyGirl]

My iPad seems to be squirrelly today. Thank's for the replies. Katy had a good night last night being her old prowling self. Getting us up three or more times smelling around the house for critters and jumping up and down to go out. First time this Spring she has done that. Feed her before her pill today. Glad to know others have a little stomach issue too. Hope everyone is feeling good today.

Have a grandson's birthday to attend Friday in Dallas so we will be dropping Katy off at PetSmart hotel for a few hours Friday night. Little apprehensive about that but we have to go on with our lives.

[molly muffin]

So katy has Always gotten you up during the night to go in and out? You mentioned she is a prowler.

You'll be able to give her meds Friday morning and Saturday morning right? So, a few hours friday night shouldn't be a problem. I'm sure they will have your phone number if they need to contact you. :)

hugs
Sharlene and molly muffin

[KatyGirl]

We don't intend to leave her overnight. She will be there about five hours starting at 3 pm. More worried about explaining her meds to them but the Vet doesn't see a problem leaving her unattended overnight at their place, not doing that yet.

[molly muffin]

hmm, well, if you are only leaving her for 5 hours and not overnight, will she have any meds that need to be given?
She should be fine. I know though that it makes a person nervous.
I get nervous all the time when I leave my molly. I've been known to have consults with the vet over the phone while I am away from home. LOL My vet has a doggie day care, stay over, extra play time, walks, etc, but I still stay in touch if I have to be away more than a day or two.

hugs
Sharlene and molly muffin

[goldengirl88]

I don't know that I would be leaving my dog that just started on Vetoryl somewhere. That's just me though as I would be a nervous wreck. Hope all goes well. Blessings
Patti

[KatyGirl]

I agree that it is hard to think of leaving Katy at a boarding place. My biggest concern was to whether bring the Prednisone with me to give to the attendant at Petsmart.

I decided that when we leave home on a lengthy journey with Katy to always take some Prednisone with me. Also I will take a a Vetoryl capsule with me Friday just in case we can't make it back to the store before it closes. I will keep both meds with me and make sure Petsmart has our cell numbers so they can call us.

We had to leave her at the Vets today to travel to Dallas for my yearly breast cancer checkup. I am now 14 years cancer free. Yeah! Katy did fine at the Vets and actually acts like she feels much better.

[Harley PoMMom]

I am now 14 years cancer free. Yeah! Katy did fine at the Vets and actually acts like she feels much better.

14 years cancer free! Oh my that is great news!

Regarding Katy, you can always skip a dose of Vetoryl the day of your trip and I'm pretty sure it wouldn't hurt.

Hugs, Lori

[Trixie]

Congratulations for being cancer-free for 14 years. That's fantastic!! :D

You are only leaving Katy for 5 hours....that should not be a problem. You give her the pill in the morning...you are not leaving her until 3pm, by that time you will see how she's been all day.
If you are leaving medication with the doggie daycare I would make it clear they are not to give Katy anything without contacting you first.

She will most likely not need any medication while she is there but I wouldn't want them to "wonder" if she's supposed to have any or not. It's a short stay for her there..she should be just fine. Better than staying home alone too.

Barbara

[KatyGirl]

That is the other option to leave her in her kennel alone at my daughter's house.

[doxiesrock912]

Congratulations of being cancer free!!!!
Has Katy stayed at Petsmart before?

[KatyGirl]

Yes, we have used PetSmart hotels a number of times and this particular one twice.

[doxiesrock912]

Ok, skipping one episode won't hurt if you don't trust Petsmart to give it at the right time. Just resume your schedule the next day.

[goldengirl88]

Congratulations on being cancer free, that is a major accomplishment!!! If you do not trust Pet smart to give the pill, I would just skip it one time. I hope all goes well with Katy. Blessings
Patti

[KatyGirl]

Thanks for the congrats on my mammogram. It is true that they do save lives. I think I have my problem solved with Katy. Her vet said not to skip a pill but for me to check and see if a vet would not be in attendance at PetSmart, sure enough there is one until 7 pm. I think I have asked about every question available on newbie Cushing's. Appreciate your help.

[molly muffin]

Congratulations on being cancer free for 14 years! What a great accomplishment and no small feat.

I think you have no need to worry. Katy will be fine at Pet Smart hotel

hugs
Sharlene and molly muffin

[Trixie]

I thought Katy got her Cushings medication in the morning. Why do you need to give her any medication at PetSmart? Just curious.

Barbara

[KatyGirl]

Barbara, I was worrying about what if she crashed at PetSmart being new on meds and not understanding that process. Everything will be Ok. I just had some questions which were answered.

Rebecca

[goldengirl88]

Just explain the signs to them and tell them to watch her closely as she just started on these meds. Make sure they understand why to do and that everyone on that shift knows about her situation, don't leave it up to someone there to explain this to everyone that may be watching her, do it yourself. Blessings
Patti

[KatyGirl]

Back from our trip to Dallas for our grandson's birthday. Had a great time together. Katy did great at the PetSmart. The attendant's were very familiar with how to treat Cushing's dogs. There was a Vet on premises until 7 pm and they have an emergency clinic for night health issues down the road.

[molly muffin]

Yay for Katy. I hope you had a wonderful time at you grand sons bday. Now you know too about how they would be with Katy and the meds etc too so less of a worry there.

Hugs
Sharlene and Molly muffin

[goldengirl88]

I was very glad to hear Katy did well while you were away. It seems they know the drill at Pet smart. Blessings
Patti

[KatyGirl]

Katy has her first blood test Wednesday. We are giving her pill with food at 7:30 am and dropping her off for the day at 8:30 am. We have an appointment in Dallas at 11. I will make sure the a Vet has that information. Would like to know more about what the test involves.

[Trixie]

If Katy had her morning pill at 7:30 then the test should begin somewhere around 11:30am and not before. The fiist draw should be 4 hours after her morning dose. They will draw blood and get her "pre" number. Then they will inject her with a cortisol stimulating agent and after that they will wait a bit and then draw blood again to see how well she suppresses the cortisol agent and then they get her "post" number. The numbers they get will show where her level is with her current dose of Trilostane.
There will be a range of normal numbers on the test and then a comparison will be made with the normal range and Katy's numbers. Those results and your observations on her symptoms will decide if the dose is on target or in need of any adjustments.
Sometimes after the dog has the test you may notice a little more drinking or jumpiness from the injection though it should go away after awhile.
Hope Katy's results are showing good progress. How are her symptoms lately??

Barbara

[KatyGirl]

Katy is doing well with no negative drug reaction. Her wanting to eat all the time is not as bad as before meds. Also she doesn't seem to be drinking as much water. She seldom wants to go outside for potty, which bothers me a little. She jumped up on the sofa the other day which is more muscle than she has used this year. She is up roaming around during the night again smelling for action outside. She still lays around a lot during the day and doesn't want a very long walk. Overall, I don't think she is as miserable as before meds and gradually improving which would seem normal.

Thanks for asking,

Rebecca

[Renee]

yes, it takes time, and sometimes it seems you take a few steps forward, then a few back.

Sounds like things are going well though, so don't get down!

[goldengirl88]

It is much like a chess game all the time, little victories and little set backs. That is pretty much how it goes with my Tipper. Blessings
Patti

[molly muffin]

Everything going okay with Katy girl?

When is her test? I know you said this week.

hugs
Sharlene and molly muffin

[goldengirl88]

When do you take Katy in to be tested? I hope everything is going along alright with her. Blessings
Patti

[KatyGirl]

Katy got tested yesterday. The vet said her numbers were much better, almost down to normal on one of the values. He is going to leave her on 30 mg once a day. She had a little upset stomach last night and a little dreary today but doing well overall. We noticed a sore on her right back at her leg, assume that is where they inserted the solution for the test. She goes back in a month for another set of tests.

[molly muffin]

Hi, glad to hear that Katy is doing well. Did you get the actual numbers from the vet? We'd like to see them if possible.
Cortisol can continue to drop on the same dose for up to and past 30 days, so if you notice anything off, get her in for another test. :) Sounds like she is doing very well though. Super pleased to hear that.

hugs
Sharlene and molly muffin

[KatyGirl]

I didn't get the numbers but will try to. He wanted to raise her dose to 40 mg a day but decided not to after reading the second test. That scared me a bit. She has some kind of sore now on her back and I called the vets office to find out where they injected her and drew blood. It was not in that area. That was my third call today. First because her leg was twitching like chasing rabbits in her sleep, but she was awake. Second for test results. Third on the sore. They said call anytime. I said I would and they laughed.

[KatyGirl]

Ok, I got some test result numbers today from Katy's first blood test after starting Vertoryl. Baseline cortisol was 6.7. After injection, actg stim (Cush selected) was 10.0. That puts her in the normal range of 6-18. Hope that makes sense. Oh, I took her in to see the Vet and the sore on her back is an old age wart that got infected.

[Harley PoMMom]

Ok, I got some test result numbers today from Katy's first blood test after starting Vertoryl. Baseline cortisol was 6.7. After injection, actg stim (Cush selected) was 10.0. That puts her in the normal range of 6-18. Hope that makes sense. Oh, I took her in to see the Vet and the sore on her back is an old age wart that got infected.

Unfortunately it does not put her in the therapeutic reange for a dog being treated with Vetoryl. Those reference ranges of 6-18 are for a normal healthy dog. Dechra's, the makers of Vetoryl, state that a dog's cortisol should be within 1.5 ug/dl - 5.4 ug/dl and as high as 9.1 ug/dl if Cushing's symptoms are controlled.

Could you refresh my memory and tell me what dose of Vetoryl Katy is on? And is this being given once or twice a day?

Hugs, Lori

[Renee]

If she's at 10.0 for the post, then she's getting close, but she's not quite there.

Lori is correct - the normal range that you referenced is only a normal range for a 'normal' dog, meaning no cushings at all. Since Katy has cushings, you'll want to get her post number lower than that.

Did you discuss increasing the dose?

[labblab]

The girls are right about the desired therapeutic range for a dog being treated with trilostane. But if I'm not mistaken, this first monitoring test was done two weeks after starting the drug? If so, you really do not want to increase the dose at this stage since Katy's cortisol level will likely continue to drift downward during the next couple of weeks. After the first month, you will be in a better position to judge whether a dosing increase will be helpful.

For right now, I think you guys are doing good! :)

Marianne

[goldengirl88]

I agree with Marianne. That is why Dechra changed the testing protocol to 30 days. Too many vets were seeing the numbers after 14 days and upping the dose and the dogs get in trouble. I was told by Dechra you never increase the dose before 30 days as it will continue to drop for that time frame and some times a little longer. Raising a dosage after two weeks of starting Vetoryl can overdose the dog. You made sure to feed him before the testing right? Blessings
Patti

[KatyGirl]

Katy has been on Vetoryl for two weeks at 30 mg once a day. I know you don't want her to go on 40 mg. The vet is leaving her on it for one more month. She is doing fine and acting like she feels better. I would be uncomfortable with a higher dosage right now based on feedback from the forum.

[Harley PoMMom]

I believe the plan you and your vet have of not increasing the dose and waiting a month to recheck with an ACTH stim test is a great one. ;)

Hugs, Lori

[labblab]

I agree with Marianne. That is why Dechra changed the testing protocol to 30 days. Too many vets were seeing the numbers after 14 days and upping the dose and the dogs get in trouble. I was told by Dechra you never increase the dose before 30 days as it will continue to drop for that time frame and some times a little longer. Raising a dosage after two weeks of starting Vetoryl can overdose the dog. You made sure to feed him before the testing right? Blessings
Patti
Hey Patti, I don't doubt for a moment that somebody at Dechra told you to hold off on testing for 30 days. But I just wanted to let you know that I was puzzled upon hearing that and so called myself a couple of weeks ago for more clarification. The tech with whom I spoke told me that nothing has changed -- they are still recommending the standard published protocol of testing first at the 10-14 day mark :rolleyes:. Not the first time that we have gotten conflicting info, but there you have it.

So based on my own conversation, I have to keep telling people that Dechra's testing protocol has not changed. But perhaps even more importantly -- and where I think we all agree -- is that it is best to hold off on any dosing increase until after the first 30 days have passed. That is really an important recommendation that has developed out of clinical experience during recent years. And on that, it seems as though almost everybody is now on the same page. :)

Marianne

[goldengirl88]

Marianne:
We had this same dilemma a few weeks ago. Lori will tell you she was told the very same thing. It was a problem then and still is. So where do we go with this. I tell people if they want to test in 14 go ahead but don't raise the dosage until 30 days or later, but you can decrease. My vet was told the same information as I checked with him.
Patti

[My sweet Ginger]

Well, here is my 2 cents worth from who has no first hand knowledge with trilostane yet. If I were to start Ginger with trilostane at some point once her cortisol starts to creep up, from what I have learned through all these conversations I'd definitely DEMAND the 14 day mark ACTH test and here is why. That's not because for a dosage increasing purpose but exactly for the opposite purpose in case the starting dosage turns out to be too high and you need to decrease the dosage RIGHT AWAY if the ACTH results come back alarmingly low at that point before your pup reach the point of crashing. That would be my take on Dechra's position they still recommending an ACTH testing at 14 day mark and I think that's a very important one.
Yeah, the cost is a bummer but I'd like to know whether she's downward bound or upward.

[labblab]

Personally, I don't think there is any definite right or wrong as to the initial testing window. There has always been a degree of flexibility depending upon a dog's actual behavior. For instance, you wouldn't want to wait for even two weeks if your dog seems to be doing poorly. On the other hand, for quite some time, a few specialists have opted to wait for 30 days if a dog seems to be doing fine. On some other threads, I've noted an alternative twist of performing a baseline cortisol at the two-week mark for some assurance that cortisol is not dropping too low.

I don't think there's anything at all wrong with continuing to test at the two-week mark, but it does add to the already hefty monitoring expense. So if it were me and my own dog was starting all over at the beginning, this is probably what I'd prefer as long as he was outwardly doing well: begin dosing at 1 mg. per pound, do a baseline cortisol at the two-week mark (and decrease the trilo dose if the baseline seemed low), and a full ACTH at 30 days (and increase the trilo if cortisol remains too high). I suspect that as time goes by, more vets will opt to defer until 30 days for the full ACTH, whether or not Dechra revises their published protocol.

Marianne

[goldengirl88]

I think if it were me starting on a new drug I would also want the 2 week ACTH or baseline to make sure the dog was not going too low. I would never increase my dogs dosage at the two week mark as I feel that is compromising the safety of my dog. I would however go down on the dosage if the numbers showed she was going down too fast or too low for my comfort. You can always go back up after the 30 day or so mark. I think this is an all around safer way for the dog and that is what is paramount in my mind. the problem lies with people who do not know how this goes and trust their vet who in turn at the two week mark says lets raise the dosage as it is not where we want it. that is the danger in my mind. too many of these vets are doing this and it is dangerous. I can tell you that if my vet would not have used the 30 day mark, he would have upped the dose at two weeks and Tipper would have been overdosed as he knows nothing about Cushings. Me being new to all of this may have let him do it and we would have been in trouble. That's all I am saying, I don't want to see anyone's dog harmed by this. I can see the point of if the dog is showing no danger signs and you have to make a decision based on what you can afford going to the 30 day mark as Dechra said .So I guess the admins. need to tell us a way of stating this so that we don't keep saying different things, or setting an inexperienced person up for increasing their dog after 2 weeks.

[Renee]

Well, here is my 2 cents worth from who has no first hand knowledge with trilostane yet. If I were to start Ginger with trilostane at some point once her cortisol starts to creep up, from what I have learned through all these conversations I'd definitely DEMAND the 14 day mark ACTH test and here is why. That's not because for a dosage increasing purpose but exactly for the opposite purpose in case the starting dosage turns out to be too high and you need to decrease the dosage RIGHT AWAY if the ACTH results come back alarmingly low at that point before your pup reach the point of crashing. That would be my take on Dechra's position they still recommending an ACTH testing at 14 day mark and I think that's a very important one.
Yeah, the cost is a bummer but I'd like to know whether she's downward bound or upward.

I was thinking this exact thing myself. If you tested after 2 weeks and the post was already quite low (say 5), it would give you something to think about in terms of continuing on that dose for another 2 weeks, in which case the cortisol could come down too much.

My vet tested after 1 week and in that first week Tobey's cortisol dropped quite dramatically, but as time went on, it actually began to creep back up.

[KatyGirl]

Thanks for the advise. I will continue to watch her every day.

[goldengirl88]

Hope Katy is still doing well?? When is she supposed to get tested next? Hope you are both fine. Blessings
Patti

[KatyGirl]

Have a problem. Katy got up sick. She has stinky farts and threw up. I changed her diet four days ago to a five star food Merrick. She has had more stinky farts since then but loves it. So I think it is food related. The problem is that my husband gave her her Vetoryl this morning. I missed it by fifteen minutes. She is just laying on her bed. What do I watch for or do next?

[lulusmom]

Changing a dog's food, especially if not transitioned over a period of days, will give a dog diarrhea for a few days but vomiting would be an extreme reaction. Does Katy have diarrhea too? Keep a close eye on her and if she continues to be sick, I personally would get her in to see a vet. In any event, no more Vetoryl until Katy is completely well.

[Squirt's Mom]

Since we really don't know if it's the food or the med, personally I would want an ACTH asap and have the electrolytes checked. The Trilo parents may disagree with me on the ACTH but that is what I would do. ;) How was she acting yesterday? Has she improved any since you posted?

This is why we say stick with the current diet when first starting treatment and don't change feeds unless absolutely necessary as we can't always tell which is the problem. If it is just the food, no problem....but if it's the drug, could be big problem. ;)

Let us know how she is doing! and hang in there! You are doing a fine job, Mom.
Hugs,
Leslie and the gang

[KatyGirl]

Actually she has improved. I may have panic'd. She hasn't thrown up again and ate her food. Her poop is soft but solid. She is moving around good. I waited a month to put her on the better dog food from when she started meds. Hubby feeds her and won't mix the old with the new. I possibly caused this by letting her have one of my small pigs in a blanket. I have to learn to ignore the scratching on my leg.

[Squirt's Mom]

You tell hubby he is doing Katie a HUGE disservice by not transitioning slowly to the new food - especially with a new drug in her system. ;)

[Squirt's Mom]

But I am glad she seems better and hope it continues. I'm with Glynda and would not give any more Trilo until this is completely resolved.

[goldengirl88]

Sometimes dogs cannot handle certain foods especially if they are high in protein. This may not be the food for Katy. I would definitely skip the table food or you could be inviting pancreatitis which can be really bad. These dogs are prone to it. I would not be giving any more trilostane until this is all cleared up. When is the last time Katy had an ACTH?? Have you had her electrolyte checked? Those are two things I would be doing asap. She is too new to the trilostane to be switching her food. You are making too many variables for yourself, so when she gets sick you don't know what it is from. Limit the variablles to trilostane for a good period of time until she gets at her maintenance dose. Then later down the road if you want a better food for her transition very slowly. Cush dogs need a medium protein, low density food. Hope you get Katy back to feeling better. Blessings
Patti

[KatyGirl]

Thanks for the response. I was about to panic over Bill giving her a pill and she was not eating. She has been fine all day since the initial throw up. She finally ate her breakfast. Merrick has a five star rating and I assumed that was better than Cesar which has a two star rating from the same chart. I have to stop letting her have people food but she has had it all her life. Merrick is almost people food, you can see the vegetables.

[Renee]

Tobey has had a few episodes of random sickness too. I am so glad to her that Katy is doing much better.

I love how the Merrick canned foods have such variety. And, it is a step up from the Ceasars. I am sure Katy loves it!

[Squirt's Mom]

People food per se isn't a problem, it's the KIND of people food. Never give them anything you have seasoned to your taste, including simple butter, salt or pepper nor the fatty trims from pork chops, etc. Unseasoned meats, fruits and veggies are fine for dogs - it's the things we humans do to the food to change the taste that can cause problems most of the time. Of course, if the pup is overweight you also want to watch to make sure you aren't adding weight by what you allow them to have. Fresh (NOT canned) veggies and fruits are usually the best options - things like green beans, carrots, apples, bananas, etc can help our cush babies feel full longer yet not pack on the pounds.

Good move, Mom, to get away from the Cesars!

[molly muffin]

Hi Rebecca, I am very sorry to hear on the facebook page that kaygirl has passed. My sincerest condolences on your loss. I have changed your title thread to reflect her passing.

hugs and love sent your way.
Sharlene and molly muffin

[Trish]

My condolences on Katygirls passing. Lots of hugs for you and your family.