Just diagnosed -- problem with Vetroyl

[JacksMom22]

First of all, I apologize for the very long post. Thank you for taking the time to read it.

My dog was just diagnosed with Cushings. His main symptoms are excess panting (made worse by his collapsed trachea), lots of water drinking, anxiety, muscle weakness. Based on his blood tests, ultrasound and xray, they diagnosed. The doctor put him on Vetoryl 30 mg. He is about 47 pounds.

He's only had two doses, but both times, several days apart, he became hyper anxious -- freaking out kind of anxious -- at about 5-1/2 hours after the dose. The anxiety last about 12 hours.

After the first dose, his doctor gave him a prescription for xanax. It really didn't help when used with the 2nd dose. I've searched online and could not find anyone else who reacted with hyper anxiety.

He also has kidney issues, thyroid issues, and a mass in his liver. She doesn't want to do a biopsy of the liver mass until his anxiety and cushings is under control. But I don't see how that's going to happen.

Jack is 11. I believe he was abused before we got him at 10 months old. He has always been extremely sensitive and easily stressed.

2-1/2 years ago he had a complete physical, blood tests, xray, and ultrasound. They only found the thyroid issue -- and his collapsed trachea. He had the physical because our dog Holly got sick and passed away. Though she was 15, she got some kind of mass in her intestines and because we didn't know what it was, we had him looked at too. He's never been the same since Holly passed (he was with her from the time he was 10 months), he just keeps having health issues.

My heart is breaking for him because I can't help him and his quality of life really stinks right now. He's constantly anxious, breathing hard, panting, drinking and rarely wags his tail anymore. He has moments of happiness, but not often. He just can't get comfortable, and doesn't enjoy his life the way he used to. He's so anxious all the time that he can't even rest.

I'm waiting for his doctor to call me back. She thought the first reaction was a fluke and not related to the Vetoryl, but now it's happened twice.

Have you ever heard of a dog reacting to Vetoryl like this? Do you have any suggestions?

[goldengirl88]

Hello and welcome to the forum. I am so sorry your baby is having troubles. First I just wanted to say there are some dogs that cannot take Vetoryl, there have been some that have had reactions to it. I would do this if it were my dog. I would do no dosing until you show us the abnormal test results. starting dose is 1 mg per pound which your vet abided by. That being said your dog still had a reaction. This is what I would do with my dog. Even though your dog weighs 47 lbs it could still be sensitive to this drug. You say he has only had 2 doses. I s he on 30 mg per day or is this twice a day? When you gave the first dose and he acted real hyper how long did you wait to give the second dose? I would wait until he settles down for now. I would call Dechra Tuesday at 866-307-0789 There are vets on staff there. They will also start a file on your dog. They are very helpful. Ask them if they have seen this type of reaction before and what you should do. My honest to God opinion is that I would not tart this dog at higher than 10mg and see if he is able to adjust to that, but wait to see what Dechra says they are the experts. If you start low and build up to the dose that controls his cortisol it will be a safer way in light of what happened. I would not give any more trilostane without calling and discussing this with Dechra. Ask them if they feel a low starting dose would be better. You may eventually reach 30mg, but that would be down the road after your dog adjusts. Secondly if that is not a good idea per Dechra you may ask about Lysodren when talking to your vet. If he is unfamiliar with it there are many on here with the experience to help you. My dog has tracheal issues also and Cushings can cause or make the situation worse. My dog gets Adequan shots for hers every two weeks. Adequan comes from cow tracheas. It is safe when used correctly and goes by your dogs weight. It is an intramuscular shot that will leave their leg a little sore. It has helped my dog a great deal. The trachea has rings of cartilage and it is damaged by high cortisol and will collapse sometimes drinking water makes it worse. Your dog will start honking if it is collapsing. My dog also has thyroid problems and is on Soloxine. Is your dog being treated for this? If not you need to talk to the vet about treatment. We will be wanting to see your dogs test results so could you get a copy and post the abnormal numbers along with the normal reference given by the lab as they are all different. We want to see what is going on with your dog in order to help you. Also we want to make sure your dog does have Cushings if you are treating him. There are many vets that are unfamiliar with this disease and it's treatment. How was the mass found on the liver with an Ultra Sound? Were the other organs looked at and if so any problems? What exactly do you mean by kidney problems, could you be more detailed and how was it diagnosed? As far as the mass on the liver it alone could be the cause of your dogs high cortisol, so we need to make sure your dog has Cushings before you start treatment again. We will help you get this worked out. I would stay away from the Xanax until you get help figuring this out. I just don't want you to be treating a dog for Cushings that has high cortisol because of a liver mass. It will all be ok so just take a deep breath,and wait as the Sr. forum members will have some questions and comments for you. So I would just wait, talk to the members, and get your results posted, call Dechra and we will help you and give you support to get thru this. Blessings
Patti

[jxeno13]

Hi and welcome to the forum! I'm sorry your baby is sick. I know it's always hard for any of us. I think Patti said all for now. I don't know enough to add. And, I'm surely NOT one of the senior members Patti is talking about, but I'm sure they'll be along soon. They have a world of information, experience and yes, LOTS of questions. :D

Welcome! Jo Ann and Eli

[JacksMom22]

Thank you so much, Patti! I appreciate the help.

He is supposed to take the Vetoryl once a day. I gave it to him on 5/21 and tried again on 5/25. Bad reactions both times.

They found the mass through an ultrasound. It was not there 2-1/2 years ago. Also found his heart is enlarged -- and that was also fine 2-1/2 years ago.

He is on soloxine for his thyroid. He also takes Benezepril for his kidneys -- because he loses too much protein through his kidneys. Although he is not taking it at the moment because it may cause high potassium along with the Vetoryl. They wanted to get him settled on the Vetoryl first and then put him back on the Benezepril and check his potassium levels after a week to see if it was making it higher or not.

He also takes Hepato Support for his liver because his liver enzymes are too high. But since they discovered the mass, it could be the mass causing it.

I will ask my vet for all the test results tomorrow so that I can share the information with you.

I'm just so sad for him because he's not happy and doesn't feel well.

Thank you so very much for your help.

[JacksMom22]

Hi and welcome to the forum! I'm sorry your baby is sick. I know it's always hard for any of us. I think Patti said all for now. I don't know enough to add. And, I'm surely NOT one of the senior members Patti is talking about, but I'm sure they'll be along soon. They have a world of information, experience and yes, LOTS of questions. :D

Welcome! Jo Ann and Eli

Thank you Jo Ann. I just really appreciate the support!

[jxeno13]

Thank you Jo Ann. I just really appreciate the support!

That's what we're all here for! Oh! And, don't worry about the long post...my fingers run long posts all the time just to say "hi"! :D You'll get used to it. :D

[goldengirl88]

I do know that Cushings can cause problems with the heart as it is a muscle and Cushings does affect muscle. With the potassium I would definitely be monitoring that as it can cause heart problems if it goes too high and that is why they want him to get settled down probably because he is already having heart issues. I use Hawthorn for my Tipper's heart as she developed a murmur from all this. It is an herb and you can get it in liquid form online, I get the one with no alcohol. It will regulate their blood pressure too and help the heart work more efficiently. I also give her COQ10 which is good for the her heart support and the cardiologist told me fatty acid are very important in her diet. Hoping all goes well we will look for your results to be posted. Blessings
Patti

[Harley PoMMom]

Hi and welcome to you and Jack!

Sorry for the reasons that brought you here but glad you found us.

Cushing's is one of the most difficult diseases to diagnose and unfortunately, it is also one of the most misdiagnosed. There isn't just one test that is conclusive, so a vet has to rely on more than one diagnostic and validation test.

Strong symptoms, as Jack is displaying, do play a huge part in a Cushing's diagnosis, but a lot of these same symptoms are shared by other non-adrenal health issues such as diabetes, hypothyroidism, and/or liver problems. Since Jack does have a liver mass the increased drinking/urinating could be attributed to that and not Cushing's.

There are certain blood and urine abnormalities that are common in cushing's, and blood chemistry, cbc and urinalysis are routinely done as screening tests before doing the diagnostic tests like the acth stimulation test, ldds and abdominal ultrasoiund. It would help us a great deal if you could get copies of all test/s that were done on Jack and post any abnormal values here, we are especially interested in all diagnostic and monitoring tests for the Cushing's.

When were Jack's thyroid levels checked?

It is true that Trilostane/Vetoryl is contraindicated in dogs that have liver and/or kidney problems. Angiotensin-converting enzyme (ACE) inhibitors, such as enalapril and or benazepril , should be used with caution with Vetoryl since both drugs have aldosterone-lowering effects. It is also true that ACE medications may cause elevations in the potassium and creatinine but over time these values should level out. Is Jack's creatinine or potassium elevated?

We have a informative Resource Thread that I hope you will find useful, here's a link: Helpful Resources for Owners of Cushing's Dogs (http://www.k9cushings.com/forum/forumdisplay.php?f=10) Please feel free to print anything out, and if you have any questions do ask, ok?

Hugs, Lori

[JacksMom22]

Thanks, Lori.

Jack's thyroid was last checked 6 months ago. He's been treated for his thyroid for the last 2-1/2 years.

I have 13 pages of results from my vet -- and I have absolutely no idea on what to post.

Can we upload documents? I couldn't find anything in that in the how to section.

[Harley PoMMom]

We need the abnormal values only, as an example...ALT 100U/L (5-50) With the tests for Cushing's the ACTH stimulation tests will have 2 numbers, a pre and a post, such as pre = 5 ug/dl, post = 11 ug/dl. The LDDS test will show 3 blood draws and will look like this... baseline/resting = 6 ug/dl, 4 hour = 1.8 ug/dl, and 8 hour = 3.5 ug/dl.

[JacksMom22]

Pre 9:30: 3.9 (1.0-5.0)
Sample 2: 6.3 (0.0-1.4)
Sample 3: 4.9 (0.0-1.4)

[Harley PoMMom]

Pre 9:30: 3.9 (1.0-5.0)
Sample 2: 6.3 (0.0-1.4)
Sample 3: 4.9 (0.0-1.4)

These results look like they are from a LDDS test, right? And could you add the units of measurement for us, they might look like ug/dl or nmol/L...thanks!!

[JacksMom22]

Here is the text of the entire sheet:

It was called a Cortisol Serial 3 (DEX) Test

Time1 Pre 9:30 am
TIme 2 Post #1
Time 3 Post #2
Reference Range Units
Cortisol Sample 1 3.9 1.0-5.0 ug/dl
Cortisol Sample 2 DEX 6.3 (High) 0.0-1.4 ug/dl
Cortisol Sample 3 DEX 4.9 (High) 0.0-1.4 ug/dl

Interpretation of the Dexamethosone Suppression Tests:

Normal: Cortisol Level elss than 1.4 ug/dl 8 hours post-dex
Hyperadrenocorticism: Cortisol level greater than 1.4 ug/kl 8 hours post-dex.

If the 8hr post dex cortisol level is greater than 1.4 ug/dl, the following can be used to differentiate pituitary dependent hyperadrenocoricism (PDH) from an adrenal tumor:

1. Cortisol level less than 1.4 ug/dl 4 hours post-dex is consistent with PDH.

2. Cortisol level less than half the baseline level at either 4 or 8 hours post-dex is consistent with PDH.
(Samples taken at 2 or 6hrs are interpreted the same way as a 4hr sample)

If neither of these criteria is met, further testing is needed to differentiate PDH from adrenal tumor Cushings.

Note: Approx. 5% of dogs with PDH have normal results.
False positives may occur with stress/nonadrenal illness.

High-dose dexamethasone suppression test. Use this test after hyperadrenocorticim has been diagnosed.
PDH or AT: Cortisol level suppressed by less than 50% 8hrs post-dex.
PDH ONLY: Cortisol level suppressed by > 50% 8hrs post-dex.


FYI, he is a super-sensitive, easily stressed dog. I have no doubt he was stressed just being at the vet all day by himself.

[JacksMom22]

Do the test results look normal for Cushings? Could a highly stressed dog create results that look like Cushings, but is really just stress?

[lulusmom]

Yes those results are consistent with cushing's. Often times the results will tell you if a dog has pituitary cushing's but unfortunately your pup didn't suppress very much on the 4 and 8 hour blood draw. Since your vet did an abdominal ultrasound, s/he probably determined which form Jack has. Do you remember what the vet said? Severe stress can cause false positive results but since we haven't seen any other test results, it is difficult to say if stress was the problem. Lori already requested that you round up all of the labwork that was done to diagnose Jack. That would include blood chemistry and complete blood count (cbc). It would also be great if you could get a copy of the ultrasound interpretation and share those with us. With respect to the blood labs, we need only see the highs and lows, and please include the normal reference ranges. It does sound as though your vet did a pretty thorough job of testing which is great. Once you post the additional information, we will be in a much better position to provide you with meaningful feedback.

Glynda

[doxiesrock912]

Our Daisy didn't do well at all on dosing once a day so asking the vet to prescribe Jack's dose into 2 given 12 hours apart is also an option.

I've never heard of hyperactivity with this drug, quite the opposite.

[JacksMom22]

Thank you Glynda and Doxiesrock. I have lots and lots of blood test results. Should I just put them all here? Or look for something specific?

They did both an ultrasound and an xray. Said that one adrenal gland is swollen, so they think it's the pituitary tumor.

They have now put him on Prozac and want to try a lower dose of the Vetoryl in a couple of weeks when he's calmer. I will ask about a lower dose and splitting it up.

It's hard to see him so anxious and clingy because it is not his personality. Also, the last couple of months he has the WORST gas in the world. Is that some kind of side effect?

[Harley PoMMom]

Thank you Glynda and Doxiesrock. I have lots and lots of blood test results. Should I just put them all here? Or look for something specific?



Yep, you can post them here in Jack's thread, as an example: ALT 150 U/L (5-50)...the U/L is the units of measurement and the (5-50) are the reference ranges for that particular element which is ALT.

Hugs, Lori

[goldengirl88]

My dog on the other hand has proven over and over throughout her dosage changes that she must have one dose in the morning to know the cortisol down, she struggles on the split dose. Every dog is going to be different. Your dog being so nervous could cause a false positive, and sometimes when they are really nervous it shows on certain values in their blood work. Blessings
Patti

[JacksMom22]

Which is better? Once or twice a day? My dog, Jack, is very sensitive to medications.

He tried two doses of 30mg and both times had a severe anxious/panic reaction.

Then has since been taking 10 mg once a day in the morning, but his doctor wants him to take 2 pills a day. I've been afraid to try it, but the 10 mg alone does not seem to be alleviating his panting or leg weakness.

Suggestions? I would appreciate the help.

As you can see I've merged your last post into Jack's original thread so all information regarding Jack is in one place which makes it easier for us to reflect back on his history.

[Harley PoMMom]

If a dog is diabetic than twice a day dosing is required. Once a day Vetoryl/Trilostane dosing is usually tried first. If a dog's symptoms seem to increase in the evening than twice a day dosing could be beneficial, an UC:CR could provide that answer. Are Jack's symptoms increasing toward the evening?

Hugs, Lori

[JacksMom22]

If a dog is diabetic than twice a day dosing is required. Once a day Vetoryl/Trilostane dosing is usually tried first. If a dog's symptoms seem to increase in the evening than twice a day dosing could be beneficial, an UC:CR could provide that answer. Are Jack's symptoms increasing toward the evening?

Hugs, Lori

Thanks, Lori.

His symptoms do increase in the evening. He is not diabetic. What is a UC:CR?

[molly muffin]

It might be that 10mg, once in the morning and once in the evening might help him to stay at a stable level throughout the day. It is a preferred dosing by many vets.

A UC:CR is a urine test to check cortisol levels. For instance you could see if it cortisol is higher in the evening, but is likely that if the symptoms occur at night now that he slips after th 12 hours and the cortisol comes up. It would be worth trying the twice a day dosage. What you're looking for is a stable cortisol level with no spiking.

Sharlene and molly muffin

[JacksMom22]

It might be that 10mg, once in the morning and once in the evening might help him to stay at a stable level throughout the day. It is a preferred dosing by many vets.

A UC:CR is a urine test to check cortisol levels. For instance you could see if it cortisol is higher in the evening, but is likely that if the symptoms occur at night now that he slips after th 12 hours and the cortisol comes up. It would be worth trying the twice a day dosage. What you're looking for is a stable cortisol level with no spiking.

Sharlene and molly muffin


It might be that 10mg, once in the morning and once in the evening might help him to stay at a stable level throughout the day. It is a preferred dosing by many vets.

A UC:CR is a urine test to check cortisol levels. For instance you could see if it cortisol is higher in the evening, but is likely that if the symptoms occur at night now that he slips after th 12 hours and the cortisol comes up. It would be worth trying the twice a day dosage. What you're looking for is a stable cortisol level with no spiking.

Sharlene and molly muffin

Thank you Sharlene and Molly Muffin :)

I tried twice a day once before for 4 days, and then he got so much worse. When I told my doctor about it, she seemed very unhappy that I split the dose to begin with, so he's only been taking one a day in the morning. But since he always seems to be worse at night, I wanted to try it again -- but his doctor gave me doubts about it. Seems like she isn't aware of anyone else doing it.

Jack is hyper sensitive to some medications, so I try to always start lower than they think. I wish I had done that when they gave him 30mg to start. He took it twice (different days) and freaked out both times.

He's been taking Ace which is a sedative to help him through the rough times. Came in handy over the 4th. They said he could take one or two. I started with 1/2 which knocked him out. Even 1/4 is a lot for him. I've been trying to cut them into 1/8 which isn't easy, but he does well with it.

Thank you for posting. I thought he was done about a month ago. Literally one day away from making arrangements with the doctor and then he started to rally. I'm so grateful he's still here, but I want to make sure I can keep him happy and comfortable.

[JacksMom22]

As you can see I've merged your last post into Jack's original thread so all information regarding Jack is in one place which makes it easier for us to reflect back on his history.



Thanks for putting my post in the right place!

[molly muffin]

Have you tried 10mg in am and 10mg in pm? You can always try 10mg am and 5mg pm if you think that would be better.

You don't want to split the pill yourself. Get trilostane from a compounding pharmacy such as Diambondback, California Pet Pharmacy, Lamberts, etc online with a prescription if you need one that isn't the standard dosage's.

Sharlene and molly muffin

[JacksMom22]

Have you tried 10mg in am and 10mg in pm? You can always try 10mg am and 5mg pm if you think that would be better.

You don't want to split the pill yourself. Get trilostane from a compounding pharmacy such as Diambondback, California Pet Pharmacy, Lamberts, etc online with a prescription if you need one that isn't the standard dosage's.

Sharlene and molly muffin

Several weeks ago after a week on the 10mg in the morning, I tried the 10mg in the morning and evening. After 4 nights he seemed so much worse I stopped the evening pill. Yesterday I tried the am & evening dose again. He did wake me up at 12:30 pretty anxious so I gave him a little sedative. I'll give it at least another 4 or 5 days trial unless he completely freaks out.

I know his vet is frustrated that I want to try splitting the dose again, but he's worse at night so it seems logical it's because his cortisol is going to high.

Will the ACTH stimulation test still work if I am splitting his dose?

[molly muffin]

Yes the ACTH works with the split dose, many vets do this. You test after the morning dose giving with food within 4 - 6 hours just as normal.

Sharlene and molly muffin

[Harley PoMMom]

Several weeks ago after a week on the 10mg in the morning, I tried the 10mg in the morning and evening. After 4 nights he seemed so much worse I stopped the evening pill.

I'm not sure what you mean when you say Jack gets worse, could you explain what Jack does? Thanks!

Hugs, Lori

[Renee]

If you can stabilize him at 10mg am for awhile (get comfortable with his acclimation to the dose), then start the twice daily dosing, with 10mg am and then 10mg pm, that would be my suggestion.

In reading back through your thread, it looks like he's had a lot of up and down. When the cortisol plummets, then spikes, it can be very tough on the dog. I just wonder how much of his anxiety is being caused by that initial adjustment to a much lower cortisol level?

I am concerned that so many dose changes here and there could be making his reactions unclear. The general protocol is to go at least 2 weeks between dose changes, but longer (especially in the beginning) is even better. I don't think I ever went less than 30 days between a dose change.

Like Lori asked, it would be very helpful to get more information on what symptoms he displays at night when things are much worse.

Also, I want to make sure you are not actually splitting the pills, correct? Vetoryl capsules cannot be split.

[JacksMom22]

Yes the ACTH works with the split dose, many vets do this. You test after the morning dose giving with food within 4 - 6 hours just as normal.

Sharlene and molly muffin

Thank you!

[JacksMom22]

Hi Rene and Lori,

Forgive the long post, I just want to give you more detail on where he is with medication.

He had a 30 mg Vetoryl on 5/21 and 5/25. Both times his anxiety was through the roof. He literally would try to sit on my head in bed. He always had to be on top of me. His panting got worse. His eyes looked absolutely panicked. Then he would go in the other direction and be lethargic. It was really scary.

In the meantime, his doctor was switching pain meds around, trying xanax, nothing would calm him.

On 5/31 he started tramadol to go along with his rimadyl for pain. They also gave me ACE (sedative) to try.

For the record, he also takes Hepato support for his liver, thyroid pills, and colitis medication. And more often than not, he's on an antibiotic for a chronic ear infection, and last week he started a different antibiotic for what she thinks is a respiratory infection because his nose is so stuffed up it clogs up one side (crusts over so he can't breathe through his nose). He also has a collapsed trachea, which is unusual for his size dog (45 pounds), so we are used to his panting a lot, but not to the extent he does with the Cushings.

6/14 he started 10mg Vetoryl in the am.

6/27 he started 10mg in the pm as well.
After 5 days of Vetoryl twice a day, he started drinking twice as much water, panting more, anxiety, clinginess, starving, so we stopped the evening dose again, continued the am dose until he calmed down again.

7/7 he started the pm dose again. He's still clingy and anxious, but not to the extent of the previous freakouts. I think the Ace helps even though he's taking really tiny doses. He only takes 1/4 of a 25 mg tablet when the dose for his weight is 1 to 2 pills. He has always been super sensitive to medications.

He's 11. He is losing strength in his back legs -- though he's always been a little shaky in the back legs when he was over-exerting himself.

He also has a liver mass which they discovered at the same time of the Cushings diagnosis. He's kind of a mess.

It breaks my heart to look in his eyes and see that he is tired and doesn't feel well, and I can't make it better. He's not the happy boy that he's always been. He's happy when I get home from work, and happy at bedtime (because he gets a little snack bowl and he loves bedtime). But the happy times are so much less and the in between is filled with anxiety.

Thank you so much for your help. I can't tell you how much I appreciate it. It's comforting to know that others know what I'm going through with my baby.

[JacksMom22]

Jack has had 4 full days of 10mg in the am and 10mg in the pm and he seems to be doing better with it this time around. I get to work from home today so I did not give him the ACE this morning so I can see how he's doing.

The other weird thing going on with him since the Cushings Diagnosis, is he doesn't seem to like to go in the backyard anymore. Sometimes I can get him to walk out there with me a little ways, but he goes right back inside. He used to love to play in his kiddie pool, but won't go near it anymore. Or play in the hose. He just seems very timid when he never was before. Does this seem normal or related to the cortisol issue?

[Harley PoMMom]

High cortisol levels can change a dog's behavior, a dog may seem more antsy or agitated and even restless.

Glad to read that this time around Jack has had a better response to his Vetoryl!!

Hugs, Lori

[JacksMom22]

High cortisol levels can change a dog's behavior, a dog may seem more antsy or agitated and even restless.

Glad to read that this time around Jack has had a better response to his Vetoryl!!

Hugs, Lori

Thanks, Lori! One of his vets mentioned that Cushings can slow healing. Should this be a big concern? At some point they want him to have a biopsy of his liver, but I'm concerned about the stress that will put him under.

[molly muffin]

Glad to hear that Jack is doing better now. Yes, we've had other dogs who had behavioral changes like that too, where they don't want to do things they use to do. I hope he gets back into enjoying those things in his backyard playground.

Yes cushings can slow healing. My IMS has so far opted not to do a liver biopsy for that reason, high cortisol slows healing, so she said she'd rather be cautious and not do that unless really needed.

Sharlene and molly muffin

[Renee]

I saw personality changes in Tobey when we started treatment as well. Mostly, they have stabilized, but I would say she is still somewhat different in temperament than she used to be.

[JacksMom22]

Glad to hear that Jack is doing better now. Yes, we've had other dogs who had behavioral changes like that too, where they don't want to do things they use to do. I hope he gets back into enjoying those things in his backyard playground.

Yes cushings can slow healing. My IMS has so far opted not to do a liver biopsy for that reason, high cortisol slows healing, so she said she'd rather be cautious and not do that unless really needed.

Sharlene and molly muffin

Why does Molly need a liver biopsy? Jack has a mass in his liver. It makes me nervous because the vet said that livers can bleed a lot which would mean going in surgically to stop it. I really don't like the idea of putting him through that at his age with everything else going on with him.



I saw personality changes in Tobey when we started treatment as well. Mostly, they have stabilized, but I would say she is still somewhat different in temperament than she used to be.

I'm glad to hear that is normal. Jack has become very timid -- which is really the opposite of what he used to be. Timid and clingy and he startles very easily now.

[molly muffin]

It was mentioned as a possibility if we couldn't figure out why the high cortisol by one IMS. I have since switched IMS and this one said she wouldn't do a biopsy for exactly the reason you mentioned. High risk of bleed and causing more problems than we currently have.

We don't have a mass to deal with but I understand the concern. We monitor by ultrasound and recheck ultrasounds are luckily cheaper than the first diagnostic one.
Sharlene and Molly muffin

[JacksMom22]

It was mentioned as a possibility if we couldn't figure out why the high cortisol by one IMS. I have since switched IMS and this one said she wouldn't do a biopsy for exactly the reason you mentioned. High risk of bleed and causing more problems than we currently have.

We don't have a mass to deal with but I understand the concern. We monitor by ultrasound and recheck ultrasounds are luckily cheaper than the first diagnostic one.
Sharlene and Molly muffin

Thank you. That makes me feel better. It's not that I wouldn't do anything in the world to help him, but I also don't want to put him through unnecessary stress and discomfort at this point of his life. He had a tumor removed 2-1/2 years ago, and the recovery was really, really hard on him -- and that was before all the medical issues he has now.

What does IMS stand for?

[molly muffin]

Internal Medicine Specialist. I opted to have both my gp vet and a specialist for ultrasounds and just more specialized knowledge.

Sharlene and Molly muffin

[doxiesrock912]

I did the same. The IMS for Cushings treatments and gp vet for everything else. Both shared all records of visits etc with each other.