Jenny, 8 y/o Maltese - Stop the meds - sweet Jen Jen has passed

[1DebbieJo]

Hi, my first post. My 8 year old female Maltese Jenny has recently been confirmed via blood tests etc. with Cushings. I'm devastated in that this special dog is my best friend and has gotten me through the last four years of a horrific contested divorce. My angst today is that she's been symptomatic of now what I know are THE symptoms of Cushing's disease but I did not know. I feel horrible to know that she's been suffering without me taking her in to the vet. I did for a few issues, but we did not suspect Cushing's then. Her first symptom was the pot belly. The next excessive panting. What got me to get her formally tested was these skin lesions/irritations on her underbelly, hind end and top of her back near her tail.

I know I don't have to tell you all about how special my dog is. She's the most amazing dog I've ever owned and loved. She's like Kenny's dog in that everyone that meets her loves her immediately. She's got a gentle soul and I just love her so much.

I've been offered meds to control the sypmptoms, but after hearing that the meds are so strong that they work, but the patients suffer more or die, I came here to find out WHAT to do.

I'm devastated that I read that from diagnosis to passing that there's about a year or so window. But, my baby's had these symptoms for about a year, but have progressed now to where I'm really trying to find a cure for her. So does that mean that she's going to pass from this disease? I thought it was NOT life threatening. But I do get from reading that it's "other" complications that I now need to watch for.

As a young puppy, she did suffer from bouts of pancreatitis, although mild. But I'm here to ask what NOT to do for her.

I want to learn from others mistakes and make my baby's life the most rewarding for as long as she's got.

I'm sick over this that I've missed her suffering while I was going through the divorce and distracted. I would DO ANYTHING to help her.

Debbie Jo

[labblab]

Hi Debbie Jo, welcome to you and to Jenny! I noticed you had originally posted this reply to Kenny's thread about his little girl, but I have taken the liberty of moving it so as to create this brand new thread for you and Jenny. This way, it will be easier for our members to talk with you directly.

I am so glad you've found us!
Marianne

[Chloe's Mom]

Debbie Jo,

I understand your angst at your baby's diagnosis. I have also just recently gotten the diagnosis for my JRT, Chloe. And like you, she saw me through a horrible divorce (also contentious), so she is very special to me.

After reading a lot on this forum and talking to my vet, I figured the ONLY chance for Chloe was to begin treatment. My vet had lots of good things to say about Vetoryl, and that she had several dogs in treatment that had done very well.

I'm one week (today!) into Chloe's treatment, and I can already see improvement and ZERO problems with the drug. I think the key is to have a vet that is experienced with Cushing's and understands the proper dosing protocols. Chloe is on a very low dose (5 mg.), and while the manufacturer originally recommended 1 mg/LB, the better dose is 1 mg./KG of dog's weight. Chloe weighs 14.5 lbs, so technically, she should be on 6 mg/kg for her weight, but she gained a few lbs. before her diagnosis. She should weigh about 12.5 lbs, so the 5 mg. dose is a very good place to start.

If your Jenny doesn't have other problematic conditions, I would certainly begin Cushing's treatment. Sure, we may lose our babies in a year, two, or five - but, we will definitely lose them a lot sooner without treatment. Like you, I was terrified, but the wonderful people here have held my hand and encouraged me every step of the way. I guess I'm trying to "pay it forward" by offering the same to you.

Hang in there, and keep posting. The Senior people here with TONS of knowledge will be along soon.

[goldengirl88]

Debbie:
So sorry your Jenny is having troubles, but glad you found us. All of us have been where you are and scared to death. First just let me say that my Tipper will be on Vetoryl 2 years in August. We have had our ups and downs, but my girl is still here and has a good quality of life. Please do not fault yourself for not knowing what your Jenny had. We are not vets, so we all do the best we can. Please get copies of the testing done on Jenny as we need to see the abnormal numbers and the reference scale given by the lab as all are different. We can get a better picture of what is going on then. You said she has had bouts of pancreatitis. Was she having any issues during the time she was tested? If so this can skew her numbers, and give a false positive. Tell us a brief history of her health, meds, supplements etc. How much does Jenny weigh? Cushing's is one of the hardest diseases to diagnose. Many vets do not know the proper protocol for testing, and are not familiar with management of this disease. Please remember this, do not put blind faith in anyone. The members of this forum have extensive experience with this disease, you can trust them, as I am a testament to. I know you heard bad things about the drugs used to manage this disease, but there is no cure. If in fact your dog does have Cushing's, that means high cortisol is surging thru her system. If left uncontrolled it damages organs, just so you know. If you choose to treat her she could live out her natural life. If not I have stated the consequences. Either way we are here to support and help empower you so you can be a good advocate for your dog. You have heard the saying knowledge is power, well that is very true in this situation. Please do not feel alone as we are one big family you joined. We are hear for for anything you need help with, even if you just want to talk or vent. You will get thru this, and it will get easier. This is not a death sentence for your dog as long as you are a vigilant owner. When people are not watchful of their pets, or mindful of proper procedures to follow, that's when things go wrong. Once you post her numbers everyone will post on your thread and help you thru this with correct dosing etc. Looking forward to having you post your questions and concerns. Blessings
Patti

[1DebbieJo]

Please get copies of the testing done on Jenny as we need to see the abnormal numbers and the reference scale given by the lab as all are different. Ok, I will. We can get a better picture of what is going on then. You said she has had bouts of pancreatitis. As a pup and when she was pregnant at 1.6 years, I thought she had morning sickness (don't laugh! lol) but it was pancreatitis. FF six years and she occasionally has a pure bile throw up. I'm a dental hygienist so I do know to look up certain meds and things, but I'm NO VET! Was she having any issues during the time she was tested? No pancreatititis during testing. If so this can skew her numbers, and give a false positive. Tell us a brief history of her health, meds, supplements etc. How much does Jenny weigh? Jen Jen weighs 14 pounds and has had great health up until the last two years. I saw in her little face that she just didn't feel well and her nose was dry. She has bouts where she doesn't eat, then suddenly eats. She's been on glucosamine/creatine soft chews for her joints, but if you know if this exacerbates her symptoms, I'll take her off. It was preventative. Cushing's is one of the hardest diseases to diagnose. Many vets do not know the proper protocol for testing, and are not familiar with management of this disease. Please remember this, do not put blind faith in anyone. The members of this forum have extensive experience with this disease, you can trust them, as I am a testament to. I know you heard bad things about the drugs used to manage this disease, but there is no cure. If in fact your dog does have Cushing's, that means high cortisol is surging thru her system. If left uncontrolled it damages organs, just so you know. If you choose to treat her she could live out her natural life. If not I have stated the consequences. Yes, the vet, a former patient of mine is very learned in this disease and has taken a very special interest in my Jenny. I she has had all kinds of tests but recently was an 8 hour fasting test where blood was drawn every four hours. I do trust my vet, but I really need to find meds cheaper than $3 dollars a day. The divorce has left me with huge legal bills but her needs now will come first, but if there's an on-line pharmacy, my vet was good with that. He also said that he didn't want me to buy too much of one thing at once because of the "monitoring" for results. He said we may have to switch up or change meds and with my funds so limited I have to be very cautious. Either way we are here to support and help empower you so you can be a good advocate for your dog. You have heard the saying knowledge is power, well that is very true in this situation. Please do not feel alone as we are one big family you joined. We are hear for for anything you need help with, even if you just want to talk or vent. You will get thru this, and it will get easier. This is not a death sentence for your dog as long as you are a vigilant owner. When people are not watchful of their pets, or mindful of proper procedures to follow, that's when things go wrong. Once you post her numbers everyone will post on your thread and help you thru this with correct dosing etc. Looking forward to having you post your questions and concerns. Blessings
Patti
Thank you all. I am leaving the state for a week (death in the family) and will want to start her meds when I return. Is there a preferred on line RX place to trust?

[goldengirl88]

You want to look for a VIPPS approved pharmacy so you know what you are getting. Lambert Veterinary Supply. or California Pet Pharmacy. They are about the cheapest. The recommended starting dose from Dechra is 1 mg per pound. If it were me I would be starting Jenny at 10mg. There may be adjustments later. Have an ACTH in 10-14 days after starting. Do not fast the dog for this test or she could be over dosed!!! When you get the ACTH results if she still has high cortisol do not change her dose. The cortisol continues to drop for 30days and sometimes longer. You will need an ACTH for every dose change. If you start low you dog is safer. It takes their body a while to adjust to the cortisol dropping, and
to this drug. Your dogs safety is paramount to anything else. This minimizes risks. Blessings
Patti

[molly muffin]

Hello and welcome from me too. You've gotten some good information so far, so you should be on track. Knowledge is the key to cushings, the more you know, the better you can work with your vet as a team to get Jenny on track. The lab results showing high/low abnormals and the cushing testing are a good start too.
No problem giving joint supplements with cushing meds, it is in fact preferable as often when cortisol drops, they start to feel any aching joints even more. (the cortisol acts as a feel good in their bodies) Also you might want to consider a liver supplement if it is her liver enzymes that are high. (ALT, ALP, etc)

I agree starting low and working your way up, If needed, is the best way to go to get her body to adapt to the medication better. You just don't know how any dog will react with medication.
The two online pharmacies that Patti mentioned are both good and are used by members, as is Diamondback. So that gives you some options to check out. I don't know if you might want to start with the name brand and then seeing how things go at say 10mg, later switch her to trilostane, or do a compound if you need to go to say 12 or 14mg or if you split the dosage later. Just a thought.

Sorry to hear you have lost a family member. :(

Welcome again,
Sharlene and molly muffin

[goldengirl88]

I hope you let us know how things go when you get back. Blessings
Patti

[1DebbieJo]

Hi, I'm back and found my own thread. Jenny started her first pill of Vetoryl 30 mg yesterday. I also picked up a copy of her lab results for someone here who asked me to get them. I am a dental hygienist, but don't understand vet stuff. So, I'd appreciate the guidance.

Because of finances, the vet (a former dental hygiene patient of mine) is helping to cut costs with office visits etc. In two weeks after being on the meds, she'll have another, but different 8 hour blood test. ACSH stim (or something like that) for about $500 and then we'll go from there. She did vomit six hours after her first pill, but I don't know if that was from the Cushing's (and she's had a tendency in the past for pancreatitis) or the meds. He warned me to look for weakening in her hips.

[labblab]

Hi Debbie Jo,

I'm so glad you've come back to us again :). I am sorry to hear that Jenny vomited after receiving her first Vetoryl capsule. If that happens again, here is some additional information for you to consider. Even though Dechra, the manufacturer of Vetoryl, has a published dosing chart that lists 30 mg. as the proper initial dose for a dog of Jenny's size, they themselves as well as many clinicians now prefer to start a dog at a dose no greater than 10 mg. per lb. So in Jenny's case since she weighs 14 pounds, that would be a dose no greater than approx. 15 mg. If your vet wants to stick with brandname Vetoryl to begin with, their 10 mg. capsule would probably be a safer starting point than the 30 mg. that she is taking now. We've just had a similar conversation on the thread of another member with a dog of Jenny's size. So I'll go ahead and repeat of quote of mine from that thread:


However, in the meantime, just to elaborate a bit more on the dosing info... I am guessing that your vets may be relying on the dosing chart that is included with Dechra's U.S. Product Insert for brandname Vetoryl. For a dog weighing 10-22 pounds, the chart does indeed list an initial starting dose of 30 mg. Your vet would rightfully think that the chart could be relied upon as the best dosage indicator. But as it turns out, the chart is based on initial clinical trials performed a decade ago. More recent experience has led most specialists and even Dechra themselves to encourage vets to start dogs off at the lowest end of a dosing range of 1-3 mg. per pound. So in your dog's case, that would be 10 mg. rather than 30 mg. That is not to say that it is impossible nor even unlikely for Maya to ultimately end up needing a larger dose, but there is less danger of side effects and cortisol dropping too low when beginning with a smaller dose and working up, rather than vice versa.

Also, as additional support for this lower dosing formula, here is a recent publication from Dechra themselves (more recent than the dosing chart that lists the 30 mg. for a dog of Jenny's size):


Ideally, the starting dose to aim for is 1.0 to 3.0 mg/lb (2.2 to 6.7 mg/kg) once a day based on body weight and capsule size. When calculating dosage, it is suggested to round down. Start at the low end of this range. If you have any questions on dosing, contact Dechra Technical Support at 866-933-2472 or support@dechra.com.

http://www.dechra-us.com/Cushings-Syndrome/Veterinarians/Prescribing-VETORYL-1.aspx
So if Jenny again vomits, or has diarrhea, or otherwise does not seem to be herself -- I would really worry that her dose needs to be dropped to a lower level immediately.

Last but not least, the ACTH monitoring test that your vet is talking about should only take 1-2 hours to perform. The diagnostic LDDS is the test that takes 8 hours, but the LDDS is not used for monitoring purposes after treatment has begun. As far as the cost of the ACTH, here is some really good information for you to share with your vet. For a dog of Jenny's size, it is possible to get multiple tests out of a single vial of the stimulating agent, thus greatly reducing the cost for each individual test. Here is a quote that one of our other staffers, Glynda, offered to another member:


Since you have a tiny dog, I wanted to provide you with another link to Dr. Mark Peterson's blog on how to extend a vial of cortrosyn, which is the stimulating agent used in the acth stimulation test. Stim tests are expensive because the cost of Cortrosyn is ridiculous. What most gp vets don't know is that even though the instructions for cortrosyn call for injecting the entire vial, only a fraction is required for an accurate reading in small dogs. Your vet could get at least five stim tests out of one vial, which will save you hundreds of dollars. Hopefully your vet will be willing to learn how to reconstitute and store remaining Cortrosyn for future stim tests for Sandy. Please print out Dr. Peterson's blog and give to your vet. It will be well worth your while to discuss this and twist an arm, if need be.

http://endocrinevet.blogspot.com/2012/03/how-to-dilute-and-store-cortrosyn-for.html

I would definitely print out this article and share it with your vet in advance of Jenny's first monitoring ACTH test. Hopefully, it will really help with your costs. Please do keep us updated

Marianne

[goldengirl88]

I just need ask how much your dog weighs? Please read the success stories of dogs using Vetoryl and starting on a low dose. I still think the 30 mg. dosage is way to high to start this dog on and that is the reason for the vomiting. Please do not give her any more of this 30 mg dosage. I would stop the Vetoryl altogether for right now. She could have had her cortisol plummet like a rock from this, and may be too low right now. I would be getting her an ACTH test, & checking her Electrolytes immediately. I feel you are playing with fire here. These are very powerful drugs. Please call Dechra and they will advise you to stop, I don't want anything to happen to your baby. 866-933-2472. You never, ever give trilostane to a sick dog. Please read Chloe's thread and see how well the low dosing goes. Blessings
Patti

[labblab]

Hi again, Debbie Jo, I see that we've now started a second page in your thread, and I just want to make sure that you go back to the first page to read the reply that I just added at the bottom. Sometimes it is easy to miss replies that have been posted on previous pages. :o

From what you had written before, I think I can answer one of Patti's questions: Jenny weighs around 14 pounds, right?

Also, just to clarify, I believe Jenny only had one dose of Vetoryl before she vomited yesterday. If so, and if she does OK today, then I would not rush to perform an ACTH or other blood testing myself, after only one dose of the drug. But as I wrote in my earlier reply, if she continues to act unwell today, I would definitely stop giving her any Vetoryl at all for the time being and regroup. Assuming she normalizes, and only after she normalizes, I would then start back at that lower 10 mg. dose in hopes that she can better tolerate it.

Also, signs of overdose typically include loss of appetite, vomiting, diarrhea, and unusual lethargy. I am not sure what your vet meant when he told you to watch for weakness in the hips. GI issues and general lethargy are much more common signs of dosing problems.

Marianne

[goldengirl88]

She only had one dose? I would also see if she normalizes before giving her anything else. Thanks for putting the thread together Marianne I see her weight.

[1DebbieJo]

Thank you so much! I just copy and pasted the article to print for my vet. He's been helpful as I've said because he knows that since I've been going through this divorce for four years, my funds are extremely limited.
Jenny appeared fine this afternoon, even playful. She and I played chase for the first time in over a year! So, I don't know what to think of it.

She's been off the Rx for her skin for only four days, and the rash/lesions are returning. So frustrating, but I hope that the new meds help to control this too.

I guess we'll see if she pants less too, right? She did not have the excessive thirst/urination symptom, but was very lethargic and looked like she just didn't feel well. So when I read the part about the cortisol damaging her organs, my alarm bells went off like she was already too far gone. But, I am encouraged today.
Thanks everyone. I'll post her update tomorrow.
DebbieJo

[goldengirl88]

I am glad you are going to a lower dose. I was scared when you posted that 30mg dosage. I hope Jenny is ok and will do fine on a much smaller dose. Blessings
Patti

[1DebbieJo]

I forgot to add that the vet said that since my funds are restricted he was not going to do "a" test which determines pituitary vrs. adrenal and even if it was determined that she had an "operable" tumor, a surgeon would be cost prohibitive for me. So, he began her treatments based upon the test results from the first 8 hour span testing done a few weeks ago where her Cushing's was confirmed.

I have printed that info out about using that vial for more than one test and will fax it to my vet later today. Does the info I've just shared make a difference for her testing and treatment?

[goldengirl88]

I am not sure what you are asking. It will make a difference financially, as it all cost less for you. As far as treatment goes if it is stored and used correctly according to Dr. Peterson's instructions there should be no problems. Blessings
Patti

[labblab]

Trilostane is used to treat both pituitary and adrenal Cushing's, so you should be good to go regardless of which form Jenny has. ;)

Marianne

[goldengirl88]

You can also buy they Vetoryl and Trilostane cheaper online usually than from your vet. For Vetoryl go to Lambert Veterinary Products of California Pet Pharmacy, and for Trilostane got to Diamondback Drugs. You can it is much cheaper that way, unless like my vet your vet will match the best online price? Hoping Jenny is doing well this morning. Blessings
Patti

[1DebbieJo]

Thanks for the pharmacy info. My vet said we'd wait to buy a large amount until we're sure this drug is the right one and dosage for Jenny.
The med does seem to make her not feel well. I'm watching her. I think it makes her nauseous. "(

[labblab]

Thanks for the pharmacy info. My vet said we'd wait to buy a large amount until we're sure this drug is the right one and dosage for Jenny.
The med does seem to make her not feel well. I'm watching her. I think it makes her nauseous. "(
If that is the case, I really would ask your vet to lower her dose. You have much more to lose by overdosing than you do by starting lower and taking some additional time to work upward if a higher dose is warranted. Cushing's is a slow moving disease, and taking some extra time to gain optimal control is preferable to the possibility of serious side effects from overdosing.

Marianne

[goldengirl88]

I just wondered if you are giving the Vetoryl with food? It has to be given with food that has a tiny bit of fat as it is fat soluble. You may have to lower the dose to be safe like Marianne said. I use Slippery Elm Bark for Tipper if she gets a tummy ache, but you must be careful that it is given an hour or more away from meds as it will affect absorption. Hope Jenny feels better. Blessings
Patti

[goldengirl88]

How are things going today? Hope the tummy issues have settled down. Blessings
Patti

[1DebbieJo]

Well, today, Jenny's skin condition has returned. While on antibiotics, it went away, but now one week later, it's back. I was hoping her new meds would control this symptom. What exactly is the skin blotches and lesions/rash? Anyone?

[goldengirl88]

I am not sure what it is without seeing it. Cushings dogs do get lesions called Calnisosis Cutis where calcium deposits in their soft tissue. It can be very hard to control if that is what she has. A number of people on here have dogs with that condition. Blessings
Patti

[1DebbieJo]

Ok, I just did see your replies on the top of the new page. Jenny only vomited that one time. The dosage she's on is in capsule form and I cannot cut this in half. She's not lethargic, eating, has not runs, or vomiting. Her panting is less. She was playful even I think I mentioned in the earlier post. But, her skin condition is returning as I just posted after 8 days off her Rx.

We just got back from a trip to the car wash and she's resting, but was happy to get to go. I don't know if she's ill, but her dry nose is gone. But, her general look has not quite returned, but that's just me I suppose worrying to death.

She sees the vet in a week for the 8 hour test or whatever the test he said he was going to do. I faxed the data on storing the expensive stuff to the vet and asked for further clarification. I'm sure we'll discuss it in a week.

I cannot believe that at only 8 she's got this horrible disease.
She's gotten closer to me in the last two weeks, but I've been really doting on her when I think she needs some extra loving.

") One day at a time.

[goldengirl88]

When you take her to the vet for her testing why don't you have them do a skin scraping to see what this really is? Blessings
Patti

[1DebbieJo]

It looks like diaper rash and she licks the areas continuously. It's on her abdomen and near her rectum and vulva. Lesions first started on her back and looked like dry skin. Then became circular lesions. But now, they appear to be localized on her under-belly.

She'll be seen again in a week and I'll ask him to do a definitive diagnosis on her lesions.

Her panting is better at times. She sleeps with me and she does not pant while she's sleeping or resting with me on the bed. But, first thing this morning, after we got up, she started panting as we walked to go outside.

And, this is weird, but the male Maltese, Jenny's six year old son, has now become a regular lift his leg in the house dog. He did this as a puppy, and off and on for a few years, but now it's almost a daily thing. I'm going crazy with him baptizing our furniture.

[goldengirl88]

Are these lesions raised? What you are describing sounds a little like ringworm to me as it is circular. I would want a skin scraping if it is not ringworm so you know how to treat it. It could be early CC, but without seeing it just guessing. There is something else I think Addy's dog Zoe may have had with her vulva, but I am not sure what it was called. I know the dogs can make it sore and keep licking it. Are you able to put an E collar on her to stop the licking? Blessings
Patti

[Renee]

Circular lesions - check for ringworm. Your description does not sound like CC. It does not come on as a 'diaper rash'. There are many pictures in some of our albums that document CC. My album has some really good, up close pictures.

CC is generally along the spine, back of the head, trunk, and sometimes down the legs. If she has CC, I do believe you'll need a biopsy to confirm, although I have heard of some vets diagnosing it by scraping. I just hesitate with that type of diagnosis. My vet did a scraping too, and could not tell at all what the lesions were. Most scrapings are looking for bacteria, viruses, etc. CC is not a virus, bacteria, fungus, or any of the things normally looked for under a microscope, which is why I don't understand how it could be diagnosed just by scraping.

Although it seems that CC is more prevalent than once thought, it is still rare enough that most vets will never see it, or maybe see it once in their career. My pug was diagnosed with CC by doing 4 punch biopsies.

[goldengirl88]

Has you dog ever had allergies?

[1DebbieJo]

I forwarded the info on the ACTH testing/cortrosyn to the vet as you know. Yesterday, I received a letter from him stating that because Jenny is not "voraciously drinking water" that the test she needs on monday is the only wat to determine "clinical efficacy" and he would "feel less confident if I was using an aliquot of cortrosyn after it had been frozen for five months"....

He suggests I take her to a specialist if I disagree with her testing. I cannot afford a specialist.

"(

[1DebbieJo]

It's not ring worm, and initially the vet prescribed an ointment that helped and flat, diffuse areas of redness subsided. It's not blisters, but looks like red scaly areas that are made red I believe by her licking.

I posted about my vets response, but don't know if I hit delete by mistake. Did anyone see the post about the vet not being comfortable using 5 month old frozen stuff?

[molly muffin]

Hi Debbie, Yes we saw your post about him not being comfortable with the freezing option. That is too bad, as Dr. Peterson, who is the one that wrote the article you sent him, is a leading authority world wide on cushings disease, including as a contributor to Dechra the makers of vetroyl.

He can do a skin scraping to verify exactly what it causing the skin problems. One thing that comes to mind is a yeast infection, or other type of infection in which case, knowing exactly what it is will enable him to prescribe something specific for that problem.

The only test that can be done once medication is started is called an ACTH, and is done 4 - 6 hours after the morning dose is given with food. They do an initial draw at around the 4 hour mark and then an hour to 2 hours later, depending on which agent is used for the test, the second draw is done and that is it. She shouldn't be there any longer than an hour or two at most.

Sharlene and molly muffin

[1DebbieJo]

My vet said that Jenny will be there all day for 8 hours of testing?

Is he mistaken?

[goldengirl88]

That is correct, your dog needs to be there that long to complete the test. Blessings
Patti

[molly muffin]

Since Jenny is on Trilostane currently, then the follow up testing should be an ACTH, not an LDDS. I know your vet said he wanted to do an LDDS to confirm pituitary vs adrenal, but normally that test is not done once treatment has started. I'm not sure that the results would be valid after starting treatment. (that is the 8 hour test). Maybe one of the admins will know if an LDDS will still return valid results after treatment with trilostane is ongoing to determine if it is an adrenal or pituitary problem.

Sharlene and molly muffin

[labblab]

To my knowledge, the LDDS cannot be used for monitoring purposes, and diagnostic results would be skewed by trilostane treatment. And the longest time an ACTH should take is two hours. So I am thoroughly confused by your vet's statement. Can you please ask him specifically which test he is planning to perform? If it is not the ACTH, then I am afraid you do need to look elsewhere for this testing. And honestly, a specialist may not be any more expensive if he/she is willing to divide the stimulating agent as Dr. Peterson suggests in his blog. :o

Marianne

[Harley PoMMom]

My vet said that Jenny will be there all day for 8 hours of testing?

Is he mistaken?

I agree with Sharlene and Marianne, only the ACTH stimulation test is used for monitoring treatment. With the ACTH stimulation test the time it takes is dependent on the stimulating agent used, if cortrosyn is used the ACTH stim test takes only a hour; with ACTHAR gel the ACTH stim test takes 2 hours.

Having a LDDS test performed, which does take 8 hours, at this time would be pointless.

Hugs, Lori

[goldengirl88]

That is what your vet had planned was the LDDS test right? It does take 8 hours. Not sure what your vet is doing this for though??

[1DebbieJo]

My concern is that the vet doesn't know the difference between ACTH and the other??? If normally the 8 hour test is not done after meds are started, why doesn't the vet know that? How do I broach this subject on Monday morning when I take her in?

And maybe this is a coincidence, but since Jenny started her meds, her symptoms have increased as in last night, she woke me to use the rest room and get down from the bed to get water. She's panting all night now where she had intermittent panting before.

I'm frightened that I didn't catch this sooner. But neither did the vet when she presented with a pot belly and skin issues. My first visit was a year ago for her panting...

My vet is ready to retire, but, he's a former patient as I've said and gives me a break on the office visits, but,....

[goldengirl88]

This is what I think is happening. You said your vet is ready to retire. My vet is not close to retirement and he knew nothing about Cushings when I started with him. I must be on top of, and guide him every step of the way, and double check all he suggests doing because of this. Your vet probably did not have this in school. Many young vets today seldom know anything about it or have treated it, so the older vets are lost a lot of the time. This is a situation where he or she cannot fake it till they make it. They must know what they are doing or harm can come to your dog, which is not worth any discount if you know what I mean. I appreciate the fact you need to save money, as I do too. Everyone is correct with the information you have been given. The LDDS is an 8 hour test and it is not done after the dog has been on medication to monitor the situation. The ACTH test is what monitors the cortisol once the dog has been on medication for 10-14 days, then at the end of thirty days. If you are using the gel corticotrophin it takes two hours for the test to complete, the cortrosyn test takes 1 hour to complete. Whenever you change a dose on your dog you need to get another ACTH test performed within 10-14 days again. You need to stand firm and be an advocate for your dog that has no voice ,and tell the vet this is not how it is done with LDDS. You can even put him in touch with Dechra and they will tell him it is ACTH that is needed. Here is the phone number and there are vets there for him to talk to 866-933-2472. I know you do not want to upset the apple cart, but your dogs safety is paramount to anything, and the correct protocols must be followed in order to get accurate results that you can use to manage your dog. I feel for you in this situation, but the vet is wasting your time and money with this LDDS stuff. Blessings
Patti

[1DebbieJo]

Got it and will be diligent.
Thank you!!

[Harley PoMMom]

How do I broach this subject on Monday morning when I take her in?



I would tell him that you have been educating yourself about Cushing's and the protocols for treatment. I would mention that you were directed to an article written by Dr. Mark Peterson, who is a renown Cushing's expert and also is a contributor to Dechra's continuing education site, how the ACTH stimulation test is the only test used to monitor dogs on treatment for Cushing's.

Here's a link to that article and an excerpt from it:
Are there any clinical situations where we should use the ACTH stimulation test?

Best test to use for monitoring and adjusting mitotane or trilostane therapy. Again, this is the only pituitary-adrenal function test that can be used in this situation; none of the other pituitary-adrenal function are useful in monitoring drug treatment.

Diagnosing Canine Cushing's Disease: Should the ACTH Stimulation Test Ever Be Used? (http://endocrinevet.blogspot.com/2011/02/diagnosing-canine-cushings-disease.html)

Hugs, Lori

[1DebbieJo]

I took Jenny in today for THE ACTH (stim) test. I was mistaken in what the vet (and his associate said...where the confusion came in) about which test was which.

Jenny had the test and in two hours I picked her up. She's been better. Skin has improved by almost 95%. Her thirst appears to may be a bit more, but perhaps that's because I'm cognoscente of it.

Her results will be in tomorrow. The vet sold me four more pills to hold me over for the results and allow for me to get on line meds at the places you folks have suggested. The vet is aware of the cost problems with the high price of the meds, but does not want to write a script for the meds until the tests come back. The assistant also said that these online pharmacies will contact the vets to confirm Rxs. so I'm not to worry about a hand held RX like for humans.

The ONLY concern was my vets opinion on storing the testing medium in a freezer that is not a frost free freezer, which theirs at the office is NOT. He said that the outcome of the test is so critical to the dogs health, that he did NOT feel comfortable storing the vial. I offered to store it in MY frost free freezer and he again stated that the results are critical and the medium must be fresh.

So I wait. What should her results be after being on the vetoryl for 14 days. I'm please with her return of play and spunk. Frisky even and not the lethargic lying around acting if she's in pain or uncomfortable.

") It's a start.

[molly muffin]

I'm super pleased that Jenny is doing well and some frisky is returning. It is hard to say what the results will be of the ACTH. I don't think we had an ACTH for Jenny prior to starting vetroyl did we?
In general, if symptoms are controlled the post number can be up to 9.0ug. If not, then you would likely want it under 5.0ug.
However, keep in mind that you don't really want to change the dosage right now, as those numbers can continue to drop even at 30 days on the same dose. So what you are looking for is to see how she is doing and that she isn't going too low. Now if she is ridiculously high, then it could be that you might make a small adjustment, but in general most vets don't as they know that they can continue to go down.

Hang in there, you're doing great. It's a good sign that her skin problems are clearing up!

hugs
Sharlene and molly muffin

[1DebbieJo]

Ok, vet just called. Jenny's ACTH test results are in and her second level cortisol was 1.3 and the doctor was not pleased. He's immediately reducing her dose to 10 mg. from 30 although she's had physical improvement.

He did agree to use the NEXT vial of ACTH meds and store it over time.
He ONLY agreed after I told him the alternative was her not being able to be properly tested or treated due to excessive costs for these meds. He is a former patient and gave in a bit. I wished he'd given in a bit yesterday when he COULD HAVE stored the stuff.

I took Jenny for a walk today. 3.2 mile walk and she's resting. I didn't think to ask if it was okay to even take her for a long walk. She was feeling so much better I just wanted to make her happy.

Debbie

[molly muffin]

yes, 1.3ug would be okay on the post if she had been on it for awhile but it's only been a couple weeks, so you don't want it to go any lower. I am sure that is why the vet decreased the amount now. At the same dose it could continue to go lower and you will still want to keep an eye on her for signs of it continuing to go low. Vomiting, diarrhea, not eating, lethargic are all things to watch out for. If you see these symptoms, you with hold the medication and get her tested again.

I'm glad that he has agreed to do the freezing as that can help, but I understand his concerns about fresh and appropriate for the testing. Hoping that works out!

Sharlene and molly muffin

[labblab]

You know, I bet Dr. Peterson would be happy to directly field a question from your vet re: the issue of using a frost-free freezer. That way, you both could have greater peace of mind about the freezing procedure. Dr. Peterson gives contact info on that blog page, I believe.

Also, I am very nervous about that 1.3 post-ACTH result. Do you know what the pre-ACTH number was? Like Sharlene says, you sure don't want it to drop any lower, and 1.3 is actually too low for any point in time. If Jenny seems "off" to you in any way, I am confident that Dechra would advise temporarily discontinuing the trilostane before starting back at a lower dose. This is what they say on their Product Insert:


If the ACTH stimulation test is < 1.45 μg/dL (< 40 nmol/L) and/or if electrolyte imbalances characteristic of hypoadrenocorticism (hyperkalemia and hyponatremia) are found, VETORYL Capsules should be temporarily discontinued until recurrence of clinical signs consistent with hyperadrenocorticism and test results return to normal (1.45-9.1 μg/dL or 40-250 nmol/L). VETORYL Capsules may then be re-introduced at a lower dose.

I understand that the expense of yet another ACTH right away is daunting, so to be on the safe side, you might want to ask your vet about holding off on the new dose for at least a couple of days so as to allow Jenny's cortisol reserves a bit of time to rebound.

Marianne

[1DebbieJo]

By the time I arrived at the vets to pick up the new rx, he'd already changed his mind and put Jenny on 20 mg's a day, not 10. So, he'd done some home work about her numbers.

Thanks for all who've commented. She's not experiencing anything but positive things thus far. She's feeling better.

XO
Jen's mom.

[My sweet Ginger]

Hi Debbie,

We are a Lysodren family but I've read a lot of stories on our pups that are on Vetoryl so I know how important it is to start low and slow with this potent drug. If I were you I'd still be nervous about Jenny's new dosage of Vetoryl especially without any break from it. 20mg is still higher than the recommended starting dosage on top of her very low ACTH numbers assuming she had a low pre number too. Can you post her pre number, please?
I don't know if you've had a chance to read Eli's thread and I hope you read it if you haven't. You will see how quickly a seemingly very well doing dog will go into a life threatening crisis the next day from a Vetoryl overdose if they were on higher than recommended starting dose. The title of his thread is ' Eli and me'.

[1DebbieJo]

Jenny woke up with nausea. I'm not going to give her her meds today and give her a break as you folks have suggested.

I'm not good at finding old threads since I'm not very computer saavy like many of you. Perhaps someone could cut and past the pertinent part that I need to know or read?

I'm struggling today with worry and angst over not doing the right thing for Jenny or now having the resources to pay for everything that she's going to need.

"(Debbie

[1DebbieJo]

Oh, Jenny's cortisol
Cortisol serial 3 (DEX)
sample one was 2.0
Sample two <1.0
Cortisol sample 3 dex 5.3 (high)

I don't know if I'm giving you the numbers you were asking for, but this is from her lab work I got copied when you folks first asked for it.

Let me know if there are other numbers you need.
And, I have her RX for the new 20mg. which I was going to fill at the pharmacy you recommended, but want to wait until I hear from you folks.

I have enough for seven days at 20 mg per day, or two weeks at 10 mg per day.

Debbie

[labblab]

Hi again, Debbie, and I'm so sorry you girls are having a bad morning. Try not to be too downhearted, though, because I think there is very good news in that before this downturn, Jenny seemed to be responding well to the trilostane :). So I do believe it will just be a matter of adjusting the dosage to the level that is optimal for her.

Since she is nauseated this morning, I definitely agree with withholding the trilostane. Since we are not vets, however, it is best to notify your own vet of any medication changes. And especially if Jenny is sick this morning, I think it is very important for your vet to know this is the case. This is the type of symptom that can signal an overdose, and so he needs to be informed so as to factor this into future dosing decisions. Most often, simply discontinuing the trilostane for a while will permit the dog to normalize. But if Jenny worsens, temporarily she may need some supplemental prednisone to bolster her low cortisol levels.

Thanks for the diagnostic LDDS test which is what you have given us above. That test result is consistent with the pituitary form of Cushing's. What we are now asking for is the other half of the monitoring ACTH that was just performed: the number for the first baseline cortisol reading that was taken before the stimulating agent was given. We are just interested in iknowing that number, although we don't have to see it because we already know that the post-ACTH number was too low. I am assuming the baseline number was below normal, as well.

Last but not least, under these circumstances (the low cortisol reading and today's nausea), if Jenny were my own dog, once I started dosing again I would prefer starting her back on only 10 mg. daily to begin with. This is on the low side of the 1 mg./lb. formula, but I do think the risk of unwanted side effects is lessened when you start low and work up as needed. So if it were me, I'd give the 10 mg. a try for a month, and then retest and go from there. You can always increase the dose later on down the road if her symptoms and test results indicate an increase is warranted. But this is all based first on making sure that she has first rebounded from having her cortisol drop too low right now. Hopefully, she will be feeling better by tomorrow. Please keep us updated OK?

Marianne

[1DebbieJo]

Thank you sweet Marianne!
"the number for the first baseline cortisol reading that was taken before the stimulating agent was given." I just called the vet. Her number before the stimulating agent was given was 1.9.

The vet is faxing me the test results from Monday's ACTH test in a second.

Jen's vet does not work on Wednesdays, but I'm on hold with their office waiting for the other vet to answer my concerns.

Ok, vet just said for Jenny to skip the dosage today, but that she should go back on 20 mg tomorrow. But, if she actually vomits up STUFF and more than once, she needs to be immediately be seen.

So, please advise. Do I give her 10 or 20mg for the next month?

"(

[labblab]

Debbie, thanks for getting that first baseline number. It is interesting that it is somewhat higher than the post-ACTH number. It actually makes me wonder whether the two blood samples may have been accidentally reversed when the analysis was performed! Sorry to introduce yet another question mark into things, but it would be better if that was the case -- it would mean that Jenny's result was not as low as we were initially thinking. I believe I can hunt up yet another quote from our now-famous Dr. Peterson re: ACTH results when the first number is higher than the second, and I'll post it here when I find it. :o

In the meantime, here's something else you can try. You can call Dechra, the manufacturer of brandname Vetoryl, directly at their Kansas headquarters. Tell them you have just started treating your dog with Vetoryl and you want to talk with a technical representative (it will be either a vet or a vet tech). You can tell them exactly what is going on: Jenny's weight, her test results after two weeks on 30 mg. daily, the fact that she is nauseated this morning, and the instruction to continue with 20 mg. starting tomorrow. They may tell you that they need to speak to your vet with any feedback, but on the other hand, they may offer you some direct guidance re: dosing. You've got nothing to lose by trying!

Here's contact info for Dechra: http://www.dechra-us.com/Default.aspx?ID=365

And in the meantime, I'll look up that quote from Dr. Peterson...

Marianne

[My sweet Ginger]

Hi Debbie,

I totally understand your angst and worries with this journey you and Jenny have just started. We all have been there and a lot of us are still going through it. The angels on this forum will guide and help you every step of the way as they have been with me and I became a member of this wonderful family since last October.

Thank you for the numbers but we are looking for 2 numbers, a pre & a post number for the ACTH stimulation test and not LDDST numbers which have 3 numbers like the one you just posted.

Please hold off on Vetoryl for now. Did your vet give you therapeutic dose of prednisone for an emergency use and do not place an online order for Vetoryl just yet as she may have to go lower than 20mg.

You can find Eli's thread on page 2 right now and you will need to read at least a few pages to see how the crisis started and dealt with.

You can apply for Care Credit which you don't have to interests for 6, 12 or 18 months depends on the provider. This comes in very handy and a good thing to have to fall back on when in need. You can apply online I think.

One other thing I've learned from all this is that having a wonderful relationship with your vet means 0 meaning when treating cushings and to never put a blind faith in your vet. Knowledge, experience and team work are far more important with this complex disease.

By holding Vetoryl I hope he will get better. Have you let your vet know of this yet?

So glad to see your posts, Marianne. You are in wonderful hands now.

[labblab]

OK, here's the quote from Dr. Peterson:


Question: I recently rechecked a dog on VetorylR. The post-ACTH stimulated cortisol concentration was lower than the pre-value. What does this mean?

Answer: There are several explanations for discordant results, i.e., those in which the baseline cortisol is greater than the post-ACTH value. These include laboratory error, mislabeling of samples in the clinic, interference by exogenous steroids, and use of an ineffective ACTH product.

If the patient is clinically well and both results are between 2 - 7.5 µg/dl, it is appropriate to continue VetorylR at the present dose and recheck as usual. If both values are below 2 µg/dl or above 7.5 µg/dl, or if the dog is not clinically normal, the test should be repeated as a dose adjustment may be necessary.

http://animalhospitalofmtpocono.com/NEPVMA/docs/1c%20Vetoryl%20FAQ-troubleshootingMP.pdf

So, unfortunately, now we are left with a bit more of a question mark... Were Jenny's samples mislabeled so that her "pre" value was actually 1.3 and the "post" was actually 1.9? Or maybe was the stimulating agent ineffective and her "post" result would have been even higher? Dunno....:confused:

Either way, first things first. And that is to see whether she straightens out as the day goes on, or whether she looks worse to you. That is really the first and most important thing at the moment.

Marianne

[labblab]

Awww, Song, thank you for the kind words (and thank you so much for all the help you've been giving!!).

Debbie, here's a direct link to Eli's thread: http://www.k9cushings.com/forum/showthread.php?t=6162

[molly muffin]

I'd call Dechra, as Marianne suggested and tell them what is going on.

I wouldn't based on those values, continue with a 20mg, at most 10mg and not right away. See what Dechra says, they can be very helpful!

hugs
Sharlene and molly muffin

[addy]

Just chiming in that my girl had more than a few ACTH tests where her pre was higher than her post. I researched extensively and never could find much written about it. It happened enough that it could not have been a lab error that many times. One IMS mentioned it as well when he reviewed her history and could not explain it either.

[1DebbieJo]

Jenny is definitely not feeling well. She looks like she's sick. A little warm to touch and a bit of a dry nose.

I'll read Eli's post (thanks for the help!!) and catch up with what Jenny could be facing, but I am frightened and a bit of a hypochondriac dog mom because I know that the patients can't talk!

Ugggh

[Harley PoMMom]

Sorry to hear that Jenny is still feeling unwell. How is her appetite? Has her water consumption changed? Did the vet prescribe you any prednisone to have on hand in case Jenny's cortisol dropped too low?

[1DebbieJo]

Jenny's better, ate well, water intake unchanged. Slept well. Loving.

I'll give her 10 mg in a sec. The on-call vet never called back regarding the possible mix up in vials or testing at the lab.

Thanks for the info everyone. I'm going to order her meds in the 10 mg amounts and plan for a healthy month on the 10mg.

Debbie

[Harley PoMMom]

Glad to hear Jenny is feeling much better and has eaten!!! YAA!!!! Please do keep us updated! ;)

Hugs, Lori

[1DebbieJo]

I ordered Jenny's 10 mg of Vetoryl from one of the on-line RX stores and after verification from the vet, they'll send it. I paid $41.95 for 30, times two, and 5.50 shipping and 7.75 tax.

Does that sound about right?

Jenny is feeling much better every day and her tummy does not looking so bloated. Her skin has cleared, but she's still panting, but perhaps not as much. She went through the night without wanting water so that's good. She did not eat dinner last night, but she had a good breakfast.

All is good for now. I think.
Oh,after questioning the backwards test results, my vet has not called me back...

Oh well.

[addy]

I hope Jenny continues to improve and the 10 mgs will be a good starting dose for her.

I used to pay about $55.00 for name brand Vetoryl from our pet pharmacy which is located near my house

[molly muffin]

Hopefully the vet will get back to you, I mean what the lab does or doesn't do might not have anything to do with him. Hard to say.

Glad to hear that Jenny seems to be doing okay. That is good news

Sharlene and molly muffin

[1DebbieJo]

Jenny appears to be better every day on this lower dosage.
Now it's taking notes for the next month to document her progress.

Vet never called...Egos, huh?

[1DebbieJo]

Jenny did not eat her breakfast. We're only back on meds two days. Do I worry that the meds are too strong (10mg) or not strong enough.

At least on the 30 mg. she acted better. The vet wanted her on 20 mg for the next month.

I don't know what to do. She did eat a bite of ham when I offered it to her by hand.

Should I up her dosage? She only was off the 30 mg. for one day then I resumed two days ago the 10 mg. dosage.

Debbie

[labblab]

If Jenny's appetite is off, it is much more likely that she is overdosed rather than underdosed. Ultimately, 10 mg. may be fine for her or even too low. But in the short run, if her cortisol had not yet had the chance to fully rebound from a level that was too low, even 10 mg. may be too much for her to handle and it may be keeping her cortisol overly suppressed. Whenever a dog acts "off" while taking trilostane, the conservative approach is to hold the medication. Per those written recommendations of Dechra, if Jenny was my dog, I would not resume the trilostane dosing so quickly. I would await signals that her cortisol was rebounding such as increased appetite, thirst, and/or urination.

Marianne

[1DebbieJo]

Got it. Thank you. Is one day of her not acting normal not enough time for the good effects of the meds to kick back in?

[My sweet Ginger]

Exactly what I was thinking Marianne.:) I thought Jenny was put back on Vetoryl too soon after her low pre and post numbers even on much lower 10mg.

[molly muffin]

I agree completely with Marianne's assessment. Once jenny shows signs of the cortisol going up, that is when to start here back on the meds.

It really isn't a problem with trilostane to start and stop.

Sharlene and Molly muffin

[1DebbieJo]

So I'm really confused on what to do here. Meds were because her cortisol was off and causing her to be sick. She acts sick without her meds too. She appeared fine on the 30 milligrams as it appeared to me that she had improvement.

Now, day two, she's only eating when I hand feed her. Is her illness causing her to feel bad, or the meds that she had? If I don't keep her on the meds, then her test results after another ACTH test will be worthless right?

Isn't the whole idea of those meds to control symptoms? Her symptoms of high cortisol are what are making her sick.

So do I give her meds to make her feel better, or not? Isn't the side effect of loss of appetite and her lethargy side effects of the meds, yet the medicine needs time to do its thing?

I feel in my guy she should be on the meds because her skin condition etc., was really bad. At least on the meds she seemed better.

I don't know what to do here.
Debbie

[labblab]

Dear Debbie,

Extremes of cortisol levels in either direction -- high (as in Cushing's) or low (as in Addison's) -- can make dogs sick. Some syptoms can be the same with either extreme. For instance, excessive thirst and urination can be associated both with very high and also very low cortisol. But loss of appetite is more typically associated with a cortisol level that has dropped too low, whereas excessive hunger is associated with a cortisol level that is too high. The fact that Jenny's appetite was initially OK but she subsequently exhibited nausea and a loss of appetite while taking the trilostane points the finger towards a cortisol level that has dropped too low, at least for the time being. The fact that her first monitoring ACTH was too low is further confirmation that this was most likely the cause of her nausea and loss of appetite. The fact that her appetite rebounded while off the medication for that one day and then immediately worsened again, even at the 10 mg. dose, suggests that her cortisol level is still too low to withstand the further lowering effect of the medication at any dose.

In looking back through your thread, the only Cushing's symptoms that you've mentioned are panting, pot belly, and skin issues. Have thirst and urination always remained normal? If so, her appetite may be our best indicator as to the immediate effect of the trilostane on her system since panting, pot belly, and skin issues can take a much longer time to resolve even when the dosing level is optimal.

After cortisol levels are known to have dropped too low, ideally, you would wait to restart the trilostane until a repeat ACTH has demonstrated that cortisol levels have naturally rebounded back up to a healthier level. This is because, even though it is uncommon and for reasons that are unknown, some dogs who are once overdosed with trilostane do not EVER regain abnormally high or even normal adrenal function again. We know that the ACTH testing is a huge burden to you, however. So in the absence of a repeat test now, that is why I have suggested that the most conservative (and in my mind, safest) path forward for Jenny is to hold off on any trilostane at all until she has been consistently eating normally again for a period of several days up to a week. Once she has normalized to that extent, we would hope this means that her adrenal reserves have recovered from the overdosing and you can start the medication again at the lowered dose. In the short run, of the two dangers, it is much more dangerous to risk overdosing the adrenal glands than it is to allow the cortisol level to temporarily rise.

Marianne

[1DebbieJo]

Thank you Maryann.
And to answer your question, excessive thirst and or urination didn't appear to be one of her symptoms. But on the meds, she wanted water in the middle of the night (never asked to go outside though) and wanted off the bed to get to the water in her bowl.

I'll keep her off as you suggest to see how she does over the next week. She's just not herself and I know she's not feeling well.

Thanks again,
Debbie

[1DebbieJo]

Oh, and while on the medication her belly did appear to be smaller and not so pronounced pot belly.

I just fear the cure is worse than the illness.
I just don't want her to suffer one way or the other.

I just get so frightened because of the length of time she was not diagnosed or receiving treatment.

Thanks for listening.
Debbie

[labblab]

If her appetite does not rebound or she acts increasingly ill (vomiting, diarrhea, lethargy), at a minimum, I do think you will need to have her blood drawn to check her basic blood chemistries, and also perhaps a resting cortisol level. As well as lowering cortisol, an overdose of trilostane can also lower the production of another adrenal hormone, aldosterone. Aldosterone is responsible for coordinating the healthy balance of sodium and potassium in the body ("electrolytes"). If these levels are "off," a person or a dog can become seriously ill. As long as Jenny's electrolytes are normal and a resting cortisol level is higher than 2.0, you can more safely assume that Jenny has not become Addisonian from oversuppression of her adrenal glands, and that the problem lies elsewhere.

Marianne

[labblab]

Hi Debbie, we were typing at the same time. If Jenny's pot belly is truly a product of Cushing's, then it is not likely that you were seeing a genuine improvement within just a couple of days of dosing. The pot belly is caused by fat redistribution and atrophy of the stomach muscles, and this is not something that can be cured or changed overnight. Like hind end muscle weakness, this is something that takes time (weeks to months) to improve.

And please don't despair!! In the midst of all my dire talk, the most likely scenario is that Jenny will soon start eating normally and perking up again. And by this time next week, she'll be starting off on the 10 mg. with no problem. ;) :)

Marianne

[1DebbieJo]

Well what I think I was noticing after two weeks of the 30 mg meds were a decrease in her abdomen. Perhaps my expectations of it, but it did appear to be less distended. When I took her in for initial testing, her belly was taught and distended. I could clearly see all the veins in her tummy.

I thought maybe bloating. I wonder if Jenny could be further along in the disease than we suspect. What are the cumulative and progressive symptoms as the disease advances?

Debbie

[1DebbieJo]

And sorry for misspelling your name Marianne! "(

[Budsters Mom]

Hi Debbie,

We love Marianne and have referred to her by many pet names. Rest assured that a misspelt name isn't going to upset her. ;)

Kathy

[1DebbieJo]

Well, Jenny's back on meds 10 mg. after about five days off. While off, she had not much of an appetite, and her skin problem started to return if only the itchies and nibbles to it. Her nose was dry and she still acted like she does not feel good.

So day two back on meds, and she's hungry, playful, and seems to feel better. She's not panting (but she wasn't off meds this time either), or drinking excessive water (but wasn't off meds this time either), but I think we may have a good level and balance.

My vet never called back... egos, sheesh!

Debbie and Jen Jen

[molly muffin]

Well i'm happy to hear that Jenny is being playful again.

arrgggh, I know, vets that don't return calls, that's a tough one. Time to knock on the door if you want to chat I guess. :) :)

Sharlene and molly muffin

[1DebbieJo]

Jenny continues to do well on 10mg. The vet had suggested 20 for the month, your thoughts? What if after the month he wants to try 20 mg after learning I did not do the other dosage and wants to run more of those 400 dollar tests. I can't afford to keep doing these over and over again. The vet did say he'd discuss the storing of the expensive vial of stuff, and, giving me a discount on it to boot.

Your thoughts?

[Harley PoMMom]

How are Jenny's symptoms? Also, how does Jenny seem to be feeling?

[molly muffin]

Yes, Lori asked the pertinent questions, how are her symptoms on the 10mg? If they are improved, fine, etc, then I'd probably leave her on 10mg. She only weighs 14lbs and it might be a month or so that the levels keep dropping.

Sharlene and molly muffin

[1DebbieJo]

Her "lesions" returned on her belly hence me switching her to 20 mg. But, the vet warned me to watch for any rear leg immobility of stiffness. On 20 mg., (only a couple of days) I did notice her not wanting to walk very far upon rising. She usually bolts down the stairs to use the rest room. Not today.

She also had "bouts" of panting last night.

So today, I titrated her dosage back down to 10 mg. since I'm afraid.

She barely ate her breakfast, but ate a bunch (she begged me for more dinner) of fresh ground and baked chicken last night so she could be full.

??? am I doing okay with this?

[Harley PoMMom]

The only way to really know if Jenny's increased production of cortisol is being controlled is with an ACTH stimulation test, which I do realize is expensive.


Ok, vet just called. Jenny's ACTH test results are in and her second level cortisol was 1.3 and the doctor was not pleased. He's immediately reducing her dose to 10 mg. from 30 although she's had physical improvement.

Another reason I would have the ACTH stimulation test done is because her post dropped a bit too low on this ACTH stim test.

Does the vet know what is attributing to her skin issue?

Hugs, Lori

[1DebbieJo]

The vet wants her on meds for 30 days. At the end of that period I will of course get her the next ACTH test. I'm just being vigilent by watching how she does and acts. With only 10 mgs, as suggested here and to watch for symptoms to return, she seemed fine, with a few appetite deviations, but when the lesions returned, I have increased her dosage to 20 mg. She is 8, so maybe has morning stiffness. Her appetite is fine, she's not over drinking water, is not asking to go out at night, plays, is MORE affectionate than usual, and is doing ok. What I noted the other day as her not looking like she was feeling good, was now what I see was that she did not eat her breakfast as I thought and had the pill on en empty stomach.

SO I have to listen to you guys and but not try to diagnose her but let you guys be my guide during these 30 days.

Any input is always welcome. You guys are the best!!
Debbie and Jennie

[Harley PoMMom]

I'm thinking that since we do not know for certain that Jenny's skin issue is caused by the Cushing's and along with her cortisol dropping too low on the 30mg, that the Vetoryl dose of 10mg would be a better option especially with her clinical symptoms being controlled with the 10mg dose. Just my thoughts here and I am sure others will be along to share theirs.

Hugs, Lori

[molly muffin]

I like the 10mg option right now better than the 30mg.

I can't remember if you said if they did a skin scrapping to figure out exactly what it is?

hugs
Sharlene and molly muffin

[1DebbieJo]

Thanks for your swift replies. I was told that her skin condition is a symptom of Cushings. Surely someone here with a baby with cushings has had a skin rash? It looks almost like ring worm, but it's not. It's random and has only reappeared on her belly. Was on her hiney, and back here and there.

Did I jump the gun with the 20 mg? She's better in every regard on the meds but the rash reappeared on only 10 mg. Folks here advised to reduce the dosage from 30 to 10 until symptoms reappeared. She did have some waves of panting and thirst, but all seems to be well. It's only been hummmm two days of 20 mg.

Please advise. I'm leaving for a few days and my grown sons are caring for their beloved Jennie and would want to help and do the right thing.

THANK YOU!!
Debbie

[Harley PoMMom]

Dogs with Cushing's can get a skin problem known as Calcinosis Cutis, I believe a biospy of the infected area is needed to confirm a diagnosis. A few of our members are dealing with Calcinosis Cutis, here are links to some of their threads:

new to Cushing searching for advise for Buttercup (Calcinosis cutis) (http://www.k9cushings.com/forum/showthread.php?t=5850&highlight=Calcinosis+Cutis)

My girl pug (confirmed Cushings & confirmed calcinosis cutis) / Introduction (http://www.k cushings.com/forum/showthread.php?t=5908&highlight=Calcinosis+Cutis) Renee, the owner of this thread, does have an album with pictures of her girl, Tobey, in varying stages of Calcinosis cutis: Calcinosis Cutis (http://www.k9cushings.com/forum/album.php?albumid=805)

It might be that Jenny does need the 20mg of Vetoryl to control her symptoms, however, since you are leaving for a few days I do believe I would have your sons only give Jenny 10mg of Vetroyl, and when you return I would revisit raising her dose to 20mg. This is just my opinion, I am always such a worry wart. :o

Hugs, Lori

[addy]

Dogs with Cushings are prone to skin issues, demotopic mites can cause problems, yeast with bacterial infections can cause issues, calcinocis cutis as Lori already mentioned. Their skin gets thinner and papery. They can be prone to dandruff, black heads, etc.

They can also have allergy problems that were masked with high cortisol as they self medicated themselves; we drop the cortisol, allergies show up.

My advice would be to stick with one dose, don't keep going back and forth between 10 and 20. What I mean is don't do a few days at 10, then switch to 20 for a few days, get nervous and go back down to 10. You wont know what is going on.

What dose does your vet want her on for 30 days?

[molly muffin]

I can see Addy's point of not jumping back and forth, but because she did go low on the 30mg, and you are going to be leaving, it's probably going to be less nerve wrecking to be on 10mg for awhile and hope that her skin issues don't come back.

I'd do the skin scrapping to find out for sure what it is. Cushings dogs immune systems are suppressed so anything that gets started is real hard to get cleared up.

Sharlene and molly muffin

[addy]

I totally agree it would not hurt Jenny to have 10 mgs for two days. I think my point was more in line with not wanting to keep changing her dose week to week and I was curious as to the dose the vet wants.:):):) Maybe I read the thread wrong - sounded like Jenny's dose has been up and down between 10 and 20mgs since she went low. :confused::confused::confused:

I sure changed Zoe's dose when I needed to if she was having an issue but in this case we don't even know what dose is going to keep Jenny's cortisol at an acceptable level which is why if it were me, I would not want to keep changing it until she was established consistently for a few weeks at least on one dose and then tested. I am just thinking back to how easily I messed up Zoe's cortisol by changing her dose last November:o:o:o

So that is just my rambling this morning.:):):):):):) Thanks for listening:D:D:D:D:D

[molly muffin]

Just checking on on you and Jenny. If you are gone, you'll see all this when you get back and hope things continue to go well and no skin issue recurrences.

hugs
Sharlene and molly muffin

[1DebbieJo]

I arrived home last night and Jenny's skin lesions were large and worse, but, my son did not get the "memo" (written on a paper) about dropping Jenny to 10 mg. for the total four days I was gone. So, on 20 mg, her lesions came back.

I'm a bit confused. Don't we have them on Vetoryl because Jen's cortisol is too high?

My vet had prescribed 20 mg. for 30 days.

Other than the skin issues, my sons say she ate well, played, slept, and seemed generally happy. I'll leave Jen on the 20 mg for the next two weeks and go from there.

But the cutis issue, I'll be looking into in a sec. I'll see what the link shows as visuals and see if it's the same.

XOXO and wet nose kisses to you all for your help.
Debbie

[Harley PoMMom]

Cushing's is when a dog's system produces excessive amounts of cortisol, treatment is started to lower the elevated cortisol level and to control Cushing's symptoms.

If Jenny is diagnosed with Calcinosis Cutis it can take a while to see any improvement, and sometimes it gets worse before it gets better. :(

When is Jenny's next ACTH stimulation test scheduled?

Hugs, Lori

[addy]

Hi,

I can only speak from experience with my pup. When her cortisol was over 7 the small hard cc bumps would appear and get bigger, when her cortisol was under 7, they got smaller and eventually went away completely when I also treated her skin. Zoe also had yeast and bacteria so we used Keto Chlor. That really worked wonders for her but she really got worse before she got better.

Zoe had a very mild case of CC but the thin skin, dandruff, oily to dry patches of hair and the yeast and bacteria really became a problem after a surgery. The Keto Chlor really helped her.

Are Jenny's lesions oozing?

[molly muffin]

Everyone who has cc, if this is that it is, always says it gets worse before better and is one of the things that take the longest to clear up.

Did you check out the other pictures of cc yet? Do you think that is what it is? They can tell for sure with a skin scraping test.

Sharlene and molly muffin

[1DebbieJo]

Yup, I saw the photos. And yes, I believe this is what she has but, Jenny has lesions that have a red line or circumference to them with the grey crusty and flaky stuff in the middle. The photos I saw were extreme cases.

I'm going to keep her on the 20 mg for the next two weeks and see if she improves. I agree that going back and forth is not working. So, in two weeks she'll get another test and we'll go from there.

In the interim, I'll watch her lesions that come and go. She never formed pustules that I could see, but I sure hope that these lesions or skin conditions are not painful.

Does anyone know if these little babies are in pain?

"(

[molly muffin]

I don't think so Debbie. We've had some pretty severe cases, and it doesn't seem to be a bother so much to the animal. I would absolutely though get some Keto Chlor from the vet or at least ask if that would help with the skin area. Quite a few here have used it.

hugs
Sharlene and molly muffin

[1DebbieJo]

Thank you!!!
Even on meds though, Jenny seems to wax and wane with her energy.
I guess I'm going to over-worry things til she gets re-tested.

Deb

[addy]

It comes with the territory, the worry before each ACTH test.

It will get easier.

[molly muffin]

Yep, worry is a natural state of being around this place. :)

Sharlene and molly muffin

[1DebbieJo]

Weird night. I was awaken to her very rapid breathing. Not panting like usual, just rapid breathing during her sleep. I woke her to make sure she was okay, offered her water, but she just licked my face and wanted to go back to sleep.

I take her tomorrow for her test.
"(

[Budsters Mom]

We are all a bunch of worry wart aunties. You are in good company.:p

[addy]

It will get easier, it just takes awhile to get used to all of this.

Make sure you post the test results, ok?

[1DebbieJo]

Tomorrow is the test. The vet said she has to have her blood drawn within four hours of getting the pill. So, if I get up early and give it to her four hours before vet visit, she theoretically won't have to stay, right?

[lulusmom]

She will have to stay an hour or two, depending on the stimulating agent. They will do one blood draw as soon as you get Jenny there. They'll then inject her with a stimulating agent and do a second draw one hour later. If the vet is using cortrosyn as the stimulating agent, it's one hour. Other agents call for a two hour draw.

I see that Marianne has already provided you with a link to Dr. Mark Peterson's blog on how to dilute and store cortrosyn. I'm posting it again below because if your vet uses cortrosyn, it is so worth your while to ask hum/her to do this for you. It can literally save you hundreds and hundreds of dollars.

http://endocrinevet.blogspot.com/2012/03/how-to-dilute-and-store-cortrosyn-for.html

[1DebbieJo]

Yes, thank you all. I've printed this again, just in case.

")

[addy]

Good luck today:):):):):):)

[1DebbieJo]

Vet just called.
As I said, I got up at 4:30 to give Jen Jen her 20mg of Vetoryl. We were at the vet at 8:30 (remember vet said she had to be tested four hours after morning dose, so to minimize her time there, I got up early)

Her results were 1.1 pre injection, and 1.4 post and vet said that since this dosage has reduced her symptoms dramatically (not panting as much, no excessive thirst or urination, eating, playing, attentive) that he feels this is a good dosage to keep her on.

He said "optimal control" is 1.5-9.1 but Jen was only a tenth of a point behind optimal so this is where he wants her.

She's currently on an rX for her skin condition, which the vet said is NOT that cutosis condition, but a skin infection since she's susceptible.(Does this mean that she cannot go to the doggie park because she could catch something else?) But other than that, she seems to be better.

I just ordered the meds (2 batches of 10mg for $95.00 a month) which still seems high to me, but the vet said that at 10 mg, we can go up or down with her meds IF we needed to.

Does this all seem right to you folks?

[1DebbieJo]

correction. Her pre tests were 1.1. Her pre injection was 1.4 and that's with her 20mg Vetoryl on board.

Did I write this down right and explain it right from the doc?

[labblab]

correction. Her pre tests were 1.1. Her pre injection was 1.4 and that's with her 20mg Vetoryl on board.

Can you clarify which was the "pre" number and which was the "post" number?

Thanks!
Marianne

[lulusmom]

Regardless of which number is pre or post, both numbers are too low for my comfort, as well as the comfort of some renown specialists. Per Dr. Mark Peterson:


When using trilostane, it has become increasing clear that we do not want the cortisol values to drop too low, because that may indicate early or mild adrenal necrosis. I recommend stopping the drug in all dogs that develop a ACTH-stimulated cortisol values less than 2.0 μg/dl, and repeating the ACTH stimulation test in 1- to 2-weeks in those dogs. Some of these dogs will require that the drug be restarted at a lower dosage, but others will maintain low to normal serum cortisol concentrations for prolonged periods of time. And a subset of these dogs, presumably because of mild adrenal necrosis, will never need any further trilostane treatment to control the signs of Cushing's syndrome.

You can find these excerpts at http://endocrinevet.blogspot.com/2012/12/low-dose-twice-daily-trilostane.html

Dr. Mark Peterson has immense experience with Vetoryl and is a frequent contributor to the manufacturer's (Dechra) Continuing Education courses for veterinarians. You may want to share this information with your vet.

Per Dr. David Bruyette, also a very experienced Vetoryl (Trilostane) prescriber and frequent contributor to Dechra's veterinary CE courses:


If the post-ACTH cortisol concentration is < 1.45 µg/dl, I will discontinue treatment until post-ACTH cortisol concentrations are > 9.1 µg/dl. At that point I would decrease the initial dose of trilostane by 50% and repeat the ACTH stimulation test in seven to 10 days.

You can find this quote at http://veterinarymedicine.dvm360.com/just-ask-expert-could-you-be-using-lower-doses-trilostane-big-dogs?rel=canonical

[labblab]

I agree with Glynda, and am glad that she has posted this info. The dosing issue that may seem difficult for you is that while 20 mg. seems to be too high, 10 mg. may be too low. Your "sweet spot" may ultimately turn out to be something like a total of 15 mg. for a daily total. In that event, though, since you will have plenty of 10 mg. capsules on hand, you may opt to have a compounding pharmacy custom-dose you with 5 mg. capsules that can be used in conjunction with the 10 mg. capsules you have already ordered.

Marianne

[1DebbieJo]

Or, what if I gave Jenny dosage of 10 mg every other day?
We had a little development today. While attempting to walk around the Rose Bowl, Jenny stopped and laid down. Never has she ever suspended her walk like this.

But, she did not get her 20 mg dosage this a.m. because I ran out of the meds before the meds could arrive from the on line rx.

So if I'm reading this all right, Jen's numbers which are low, suggest that 20 mg. is too much.

She's not her normal self in that she is lethargic for the most part of the day, but excited around meal time, and when she sees me putting on my walking shoes.

Today, I carried her for half of the 3.2 mile walk around the Rose Bowl. And, only because what was once her favorite past time became an obvious exertion.

Please advise.

[labblab]

I have only a moment to post but, yes, I am very concerned that Jenny's cortisol has dropped too low. As you saw from the quotes that Glynda provided earlier, at the time of the testing, she was already too low in the opinion of those noted specialists, and also per Dechra's own treatment guidelines. According to Dechra, any time a post-ACTH result drops lower than 1.45, the medication should be temporarily stopped and the dosage subsequently lowered when restarted. Given this behavioral change, I am concerned that Jenny's cortisol has dropped even lower. If she were my dog, I would not give any more trilostane at all for the time being and I would call the vet right away to inform him of her lethargy. If she worsens -- starts vomiting or has diarrhea -- she needs to be seen and evaluated ASAP because she may be in need of prednisone or other supplemental meds to normalize a cortisol level or blood chemistries that have been affected by a drug dose that was too high.

Marianne

[Harley PoMMom]

I totally agree with Glynda and Marianne, Jenny's ACTH stimulation numbers are too low, so please stop giving her the Vetoryl. How is she doing? Any vomiting or diarrhea?

[1DebbieJo]

Ok, here's the numbers just faxed to me from the vet.
Cortisol sample 1: 1.1
Cortisol sample 2: 1.4

Jenny's lethargy is wax and wane. She walked with me around the Rose Bowl yesterday and the day before, and only had trouble the second day in a row, so I know not to let her get too much exercise.

So, you guys agree to take her off the vetoryl all together, but until when? I just ordered 10 mg.s so that I could alter the dosage. I did not see not giving it to her at all. I'll have the meds here.

Isn't the point of meds to treat the symptoms? On the level she was on panting almost stopped and she seemed better, but the lethargy could be just bored. But that look on their faces tells me it was a bit more. She does not have the runs at all. Eats well, plays well and loves well.

Her skin condition is what concerns me more. She just finished a 10 day rx and it cleared up nicely.

Please advise.
Debbie

[Harley PoMMom]

Yes, the treatment for Cushing's is to control the symptoms, however if the cortisol drops too low this can create a life threatening situation if not addressed promptly.

Jenny numbers are too low and the Vetoryl needs to be stopped and should only be restarted when Jenny displays strong symptoms and an ACTH stimulation tests validates that her cortisol is elevated. Please be aware that when a dog's cortisol has dropped too low (Addison's), increased drinking and urinating are symptoms attributed to Addison's. Other symptoms of too low cortisol are: vomiting, diarrhea, lethargy, or the dog just not acting them-self. If any one of these signs are noted a call to the vet is needed.

Hugs, Lori

[molly muffin]

I agree, stop the trilostane and wait for symptoms to come back, verified by an ACTH and then start at a lower dose.
Some dogs take awhile weeks to months to rebound others can take even longer.

Sharlene and molly muffin

[labblab]

Normally, I would be advising exactly the same thing as Lori and Sharlene, but I know you've had a dickens of a time getting the skin infection cleared and would hate to see that flaring again. So I understand why waiting for a return to uncontrolled symptoms/cortisol is probably not a very attractive option to you. :o

However, I am hoping there might be a middle-ground whereby you could resume dosing at the lowered 10 mg. dose before strong overt symptoms have re-emerged. I do heartily agree, though, that you will need to have evidence that her cortisol has safely rebounded at least to some degree before starting back. Of course, the gold standard for this is would be another ACTH test in a week or two. Another option that is less desirable but perhaps better than nothing might be a baseline cortisol alone. Once the baseline has risen safely above 2.0, you may have some added assurance that the overall adrenal function is rebounding. Plus, behaviorally, before starting back you will definitely want to see Jenny acting well and resuming her previous level of energy/activity. But awaiting a desirable elevation in the ACTH is definitely the safest way to go.

Also, you had asked earlier about every-other-day dosing. This is generally not a good option, at any dose. Since the medication remains active in the body for no longer than 24 hours, skipping a day only sets up a rollercoaster of higher cortisol one day, lower cortisol the next. Your ideal is to keep the cortisol controlled more consistently during each day.

Marianne

[1DebbieJo]

Great advice, thanks. Today was her first real day without any meds anyway since the new 10mg has yet to arrive.

I'll wait as you all advise to restart. However, her skin condition flared while she was already on the 20 mg. of vetoryl. So her skin flared up in spite of treatment.

D

[1DebbieJo]

Last night was rough on Jenny. She projectile vomited out of the blue in bed. I took her out and she was sick. She's only been off meds two days and now this.

I took her in today and my regular vet (not the guy who read her test results) did not like her numbers and with the vomiting and a bit of the runs put her on Prednisone 5 mg tabs. Sig: One tab once a day for three days, then 1/2 tab once a day til gone. Total of six tabs.

Then Jennny's son Beamer, developed Pancreatitis in the night. So I had my hands full. I have no idea what caused this in him as the dogs get pet ID gastrointestinal health kibble, and fresh rice and roasted turkey, beef or chicken.

I've had two ours sleep between the two dogs. And, I think I posted that the other maltese, Amelia, had blood in her stool ONCE two days ago. Still bright red blood is alarming. The vet said that she's had a history of constipation so felt that it was most likely anal fissures, but she was fine the next day and not a drop since.

Sheesh....

I don't understand why Jenny would throw up AFTER we stopped the meds. Actually, I ran out if you recall and you all piped in that her numbers were too low. So, what caused the vomiting? Is that a symptom that her cortisol had just fallen below where we want the levels and it was just coincidental timing?

Please advise.
XO

[molly muffin]

The cortisol shouldn't have continued to drop after the last pill was given, up till that point it would drop.
If her vomiting is due to the low cortisol then the prednison should make her feel better and you'll notice that in a day or two. If she continues to throw up on the prednison or act off, then is probably due to another reason and this is a coincidence.

You certainly do have your hands full right now. I feel for you as even one dog being off can be enough worry for any one person.

hugs
Sharlene and molly muffin

[labblab]

Wow, you sure do have your hands full! :( :( :(

You mention a bit of diarrhea in addition to vomiting? When did the diarrhea happen?

The thing is, when adrenal function is oversuppressed by trilostane, it may take quite a while for hormone production to normalize again even in the absence of redosing with the drug. So Jenny's cortisol may be no higher now than it was when you stopped -- which was too low. Not every symptom of low cortisol will necessarily be seen on the same day, but so far you've seen exercise intolerance and now vomiting and perhaps also diarrhea? I am glad this other vet is taking things seriously. As Sharlene says, if the prednisone improves things, that can be evidence that Jenny's cortisol had not yet rebounded sufficiently. If she doesn't improve on the pred, I'd encourage you to have a panel of basic blood chemistries run because overdosing on the trilostane can also affect the balance of potassium and sodium in her bloodstream. It requires treatment other than pred to normalize that balance.

Marianne

[1DebbieJo]

Thank you! Jenny had one loose stool which I'd classify as the runs.
She's not better today, but she's only had one pill. Today makes her second dosage.

Beamer is still uncomfortable, but is better. His meds are working.

Amelia is fine and adorable.

All will be well soon! ")

[1DebbieJo]

well, Jenny's symptoms have returned. Panting and thirst. We did walk today and she panted the entire way. We stopped every half mile and I had her travel bowl for water. I carried her because I wanted to and not because she stopped.

I'll call the vet tomorrow. She's got two more days of the prednisone. So then when will I start her on the lesser dosage of 10mg vetoryl?

[labblab]

You will want to make sure that Jenny's natural cortisol has rebounded and that the effects you are seeing now are not being produced by the prednisone or some other problem. As of Saturday, you told us she was no better. I don't know how she was yesterday, but she sounds unwell again today even though in a different way. Since we really don't know the true cause of her problems right now, my personal opinion is that it is dangerous to resume trilostane dosing at any dose until Jenny either behaves consistently normally for several days after having stopped the prednisone and/or you perform another ACTH test to find put exactly what the status is of her native cortisol production. The thirst and panting you are seeing could be triggered by a prednisone dose that was higher than what she needed for supplementation of a low cortisol level, or from a rebounding cortisol level, or it could be triggered by blood chemistries that are still off, or it could be something even unrelated to Cushing's.

One of our oft-repeated sayings here is that you do not give trilostane to a dog who is unwell. I do think you need to tell the vet tomorrow what is going on with her and go from there. If you continue and finish the last two days of prednisone, it will be important to see whether or not she normalizes on her own after that and if not, what her symptoms are at that time.

Marianne

[1DebbieJo]

Got it. She's definitely not herself, but is eating normally, but still laying around the house.

[1DebbieJo]

Jenny was better today. Wanted to go for a walk when she saw me put my walking shoes on, but, I know better just yet.

I did give her a bath today and she seemed to welcome it. It's been warm.

Vet will be in tomorrow and we'll talk. Her panting is back as I reported, but not constant without cause.

I have hope that she'll be fine.
Thanks to everyone here.
XO
Debbie and Jenny

[1DebbieJo]

So 20 mg vitoryl proved to be too high a dosage for Jenny, but, 10 mg. although has deminished her symptoms appears not to be quite enough.

She's more restless at night on only 10 mg. She's playful, as in feeling better, eating very well, eliminating just fine, but at 10mg her symptoms are as I said or less controlled at her 20 mg. levels.

So is that the compromise?
I don't see 5 mg of vetoryl available on that one online pharmacy.

Debbie

[molly muffin]

5 mg you can get as compounded trilostane. Your vet can write a prescription for that and you can get via an online pharmacy.

You can give the 5 mg perhaps in the evening if symptoms aren't controlled all day. Another option would be to give 7 mg in the morning 7 mg at night. These would need to be a compounded prescription also.
Or get 5 mg and give in the morning with the 10 mg of vetroyl.

Sharlene and Molly muffin

[1DebbieJo]

Thanks MM. My question today is that since 10mg does not control the panting, how bad is the panting on her if the alternative is her cortisol levels still being off.

She's playful now and back to normal. No skin issues today or in the week or so often the rX. But the panting is disturbing her sleep.

I'll call the vet in a sec to see about getting that rx for 5mg. That sounds like the answer until next testing.

Thanks,
Debbie and Jen Jen

[molly muffin]

Usually a cushing dog pants because they can't regulate their body temperatures as well with the cortisol. Normally and I say normally because there are always exceptions to everything, as the cortisol becomes controlled levels the panting will level off.
It isn't hurting her, she is cooling down by panting, but it isn't comfortable I'm sure. So, hopefully that will regulate itself more. In the mean time, cool floors, next to cool windows, open a window to cool breeze even, to keep her cool.

Sharlene and molly muffin

[jillmst]

After my dog, Charlie, started taking meds for Cushing's (he's on Trilostane), his constant panting was lessened immensely. But he still pants that same way now and then, that Cushing's panting that's fast and hard. When it happens now, it's usually at night. I have a little fan that I turn on beside him when he starts panting hard, and he stops after a few minutes, seems much more comfortable, and sleeps soundly. :)

[1DebbieJo]

Jenny gets down on the cool tile when she's over-heating. I keep the ceiling fan on for her/us all night.

Thanks for the input.

[1DebbieJo]

OMG, Jenny having trouble with walking this morning. I'm dressing for the vet now. She's only on 10mg. of Vetoryl.

HELP!! What does this mean?

[molly muffin]

Get her an ACTH test.

I just saw this. Have you been to the vet? What did they say?

Hang in there!
sharlene and molly muffin

[1DebbieJo]

The vet said that her temp was normal, but her anal glands were severely impacted (don't know how that could be when she was groomed two weeks ago and they're supposed to take care of that), but she did not act weird about her hind legs there. She walked around like normal.

Yet, today, same thing, she didn't want to come to me. I call her and she squirmed a bit then immediately went to lick her hiney, or try.

I don't know what to make of it. She's got a dry nose today. She didn't eat her breakfast right away yesterday which was not like her and why I rushed her in. Her regular vet was out yesterday but the other guy does know of her case.

She's on a very low dosage of the Vetoryl so I'm confused as what's happening to/with her. She also was shaking her head a lot last night so I wonder if she's getting an ear infection. That's happened (not to her) but my other dogs after a grooming.

Doctor wanted to keep her on the 10 mg because it is apparently controlling her symptoms.

[1DebbieJo]

But she did not want to walk down the stairs. I carried her, then she ran out the front door like normal.

[lulusmom]

Based on a cursory scan of your posts, it appears that you restarted Vetoryl treatment 30+ days ago, which dictates that you should have had at an acth stimulation test a few weeks ago and are probably due for another one now. If an acth stim test has been done, can you please post the results? If one has not been done, I highly recommend that you schedule one as soon as you can get Jenny in. Without appropriate testing, it is impossible to know if some of Jenny's current problems may be due to low cortisol. I'll be looking forward to your response.

Glynda

[molly muffin]

That is strange that the anal glands would be impacted, but I agree with Glynda that an ACTH should have been done by now. You want to know what effect the medication is having on her body.

If you have had one can you post the results?

Sharlene and molly muffin

[1DebbieJo]

I did reply and her cortisol levels were .1 which were borderline of too low you all said. Then her her disease symptoms came back full force, but her cortisol was too low.

That was on 20 mg. She's been on 10 for the last 30 days. Her only real symptom now is the impacted anal glands. I'm adding a little olive oil to her food in the morning, per the vet. We've also began alternating every other day of two ten mg instead of one every other day, with 10 mg. daily.

I cannot afford the constant acth tests so the vet is using symptom return as a barometer. She's apparently under control, but the impacted anal glands explained it to the vet about her not wanting to run out the door in the morning, but turning to nibble at her hind end. With olive oil and having her glands cleaned out, that symptom has gone away.

My question is does the cushings' cause constipation?

[molly muffin]

Yes I knew you posted the results in August, I was wondering if they had done even a baseline cortisol level since then to see what her cortisol is doing. A baseline they don't administer the agent and take a second draw, it is a regular blood draw and will only give the pre number, but since Jenny's had a low pre before, it would at least give you a bit of help in knowing what it is doing now.

No constipation isn't something I think of with cushings, but it can happen with any dog, cushings or not. Omega 3's might help with that too. Not sure if she gets any now or not.

Hugs
Sharlene and molly muffin

[labblab]

I'm afraid I'm confused. Are you alternating between 10 and 20 mg. as far as a daily dose? If so, what increasing symptoms have led you to "up" the dose again? I don't believe that impacted anal glands or constipation have anything to do with Cushing's. So those would not be reasons to increase her dose at all. If you are indeed increasing the dose without the benefit of an ACTH test, this makes me feel very worried on her behalf.

Marianne

[1DebbieJo]

At 20 her level of cortisol was too low. So we adjusted to 10, then symptoms returned. Vet wanted to adjust to 15, daily, but for now is doing 10 mg every other day and 20 mg ever other day.

Will test at the end of the month. She is better on this dosage.
I was worried that the constipation was yet another symptom of Cushings. The vet is monitoring her and I feel ok for now about that.

Debbie and Jenny

[molly muffin]

Has the constipation gotten any better? Hope so. I know it is worrying when they are uncomfortable.

Sharlene and molly muffin

[1DebbieJo]

Well it has gotten better. Thanks!

[1DebbieJo]

Jenny weighs 18 pounds. 10 mg. was not enough and symptoms returned, but on 20mg daily, her cortisol fell to borderline too low.
She's almost nine now. And, when flipping through this segment of the pet forum, I see a lot of Maltese dogs with this affliction of Cushings. Any stats on the type(s) of dogs most afflicted with this disease?

I don't understand how this drug works. I thought it was based upon how much she weighs.

She's not been herself for almost two years. Partly my fault because I did not know what was wrong with her. But now, her skin condition has cleared up. She's eating, playing and loving, it just seems that she has difficulty breathing when at rest (more than pants) but like grunts with her exhales. ??

I'm giving her a little olive oil on her food for constipation per the vet. Other than following her outside every time to check, her constipation seems better. I've cut out the rice I was including in her freshly ground chicken and turkey which I add to her Pet ID intestinal health dry food.

I guess I'm just a worry wort. She has her act testing at the end of this month.

Thanks for all of the support.
Debbie and Jenny

[molly muffin]

Hi Debbie! Checking in on you and little Jenny.

How is she doing? Is she acting more like herself? I do hope so.

hugs
Sharlene and molly muffin

[1DebbieJo]

She's hit and miss. I can tell she's not feeling well, but wonder how much is being 8 and residual damage to her insides before I knew what was wrong with her and got her on meds.

Now, her 6.6 year old son is developing the same signs. I've looked through this site and there appears to be a lot of Maltese dogs who get Cushings. Any research about a breed more susceptible to this?

[Renee]

Actually, I believe the flat faced breeds, especially boxers and boston terriers, appear to be more likely to get cushings.

Are you splitting her dose by giving her 10mg in the morning and then 10mg in the evening? 20mg all at once may have been too much, but a steady amount of 10mg twice a day may agree with her more.

The 10mg was not lowering the cortisol enough?

[1DebbieJo]

OMG, just came in from dinner to find my Jenny having a seizure.
I just came in as her head hit the hard wood floor, feet in the air, and she'd peed all over the floor. I came in at the tale end of it, but she got up, was confused then wanted to go outside.

She's breathing rather hard, but has been doing SO WELL on 20 mg. of Vetoryl.

What do I do? I hope someone is up and reading this.
"(

[molly muffin]

Some dogs have seizures. It is listed as a possible side effect of vetroyl on manufacturer material. I think you will want to tell your vet though because you'll want to find out what is causing the seizure.
When was her last ACTH?
I wouldn't give next dose till you chat with vet about it. Normally they are okay once the seizure passes. There are big ones and what they call mini ones. ( focal) The reaction sounds like this was a large one. (Grand mal).
So definitely talk to vet about it.
Hugs

[1DebbieJo]

Thank you MM. In the past four days, Jenny's needed to go out to the bathroom in the middle of the night rather urgently. Then last night the seizure where she had what I've also ascertained from things I read on the internet as a grand mal.

After her seizure, about ten minutes later, you'd never have known she'd had one. She slept on the bed with me. Her breathing sounded rattled, which frightened me, but she acted like her old self. Today, playful, HUNGRY, loving, etc.

I will not give her another Vetoryl until she can see the vet in the morning. She's only on 20 mg, but had such great results finally on that dosage. But, from the literature I just pulled out that recently came with her pills, 60 mg is the required dosage for her weight as a starting dosage. So maybe she's not on ENOUGH Vetoryl and that's why the tumor is growing??? Causing pressure on the brain ??

She has NOT had an ACTH test in about two months. Cannot afford the monthly ones, but the vet was fine with it because she'd shown 100% improvement of all of her symptoms.

What a precious baby. She's right here as I type a licking my ankles to go for her walk. But, I do not want to exhaust her right now.

[flynnandian]

the starting dosage of vetoryl is 1mg/pound max.
your jenny is 18 pounds, so 20 mg is the recommended dosage for her.
not 60 mg!
she was low for a long time, so more vetoryl is not an option for her.

[labblab]

That is right, the 60 mg. dosage is outdated. Here are the current dosing recommendations:

http://www.vetsonline.com/news/product-news/140722-new-lower-starting-dose-for-vetoryl.html

I am so sorry Jenny had the seizure. I know how scary they are to see -- my nonCushpup Peg has epilepsy with a history of grand mal seizures.

But no, this is not a likely indication that the trilostane needs to be increased.

Marianne

[1DebbieJo]

That's good to know all. Thanks! She went with me today on a walk after all. She was insistent and did very well. She just kept staring at me the entire time. So sweet and her eyes were thankful.

Love, love that dog.
Tomorrow we'll be going to the vet.
:)

[labblab]

One quick thought occurs to me that you may want to discuss with the vet today -- what has been the status of Jenny's thyroid level? Seizures can definitely be caused by low thyroid, and it is not uncommon for dogs to suffer from both Cushing's and hypothyroidism. Sometimes low thyroid levels are secondary to the Cushing's and end up correcting on their own once the Cushng's is under control. But other times, the hypothyroidism is a primary disease in its own right. You can check this by starting off with a simple T4 reading on a standard blood panel. If that T4 reading is too low, then you can proceed with more detailed analysis that can better gauge whether the thyroid problem needs to be addressed independently. If so, it is very easy and inexpensive to treat with daily medication. Just a thought...

Marianne

[molly muffin]

Merry Christmas Debbie and Jenny.
Hope things are going okay and Jenny feeling well.

hugs

[1DebbieJo]

Jenny is continuing to do well and has not had another seizure. Vet said that seizures are often times symptoms of advanced cushings.

I'll mention to him the thyroid when we see him again. I'm on fumes for a budget and vet is trying to help me out. I could not afford another acth test this month so, we're treating as issues come up. Not ideal, and I would give anything to help my dog, but I have no more room on my credit card. :(

Thanks,
Debbie and Jenny

[molly muffin]

There is Never enough room on the credit card when it comes to our furbabies. That's a given it seems.
I space stuff out too, trying to make it all work out in the end. You do what you can, as you can. We all know and understand that.

[1DebbieJo]

Jenny just had another seizure. The second that I'm aware of. This one was not quite as bad in that she did not lose her bladder. I heard her coughing, then it sounded like wheezing. I ran to her only to observe her on her back, eyes rolled back and that wheezing sound. She seemed to fight to come out of it. Then, when it was over, she got up and was obviously shaken. The first time, she got up and ran and played. Not this time. I held her, quieted her down and then covered her up in her little bed.

I read that seizures is a sign of advanced Cushings. Does this mean she's going to die soon? I feel so horrible that I only got her treatment seven months ago. I wished my vet had done tests a year ago when I brought her in several times for her skin condition, or, that he'd recognized her pot belly, lethargy, etc., for what it was.

Heart breaking day.
I can take the truth if you all know that she's near the end. I will stay close to home if I know this is the case.

[labblab]

I am so sorry for your scare, but there are many other things besides Cushing's that can cause seizures. So right at the moment, there is really no way to know what all this will mean in terms of Jenny's treatment.

I have a 10-year-old nonCushpup who started having grand mal seizures over three years ago. We did a bunch a blood testing but never did figure out the cause. Our good news is that she has not had another seizure in all this time after starting on medication to control them. I remember clearly how scared I felt during those seizures, though, so my heart goes out to you.

One quick thought/question...has Jenny's thyroid level been checked lately? Low thyroid can trigger seizures, and the two conditions -- Cushing's and hypothyroidism -- occur together rather frequently. Hypothyroidism is one of the easiest conditions there is to treat, so I was really hoping it might be the explanation for my Peg's seizures. It was not, but I just thought I would mention it to you as a possibility.

In terms of Cushing's and seizures, it is true that seizures sometimes accompany an expanding pituitary tumor. But I would not immediately assume that is the cause for Jenny. It may be something else entirely, and something that can be controlled. So don't give up hope yet!

Marianne

[molly muffin]

Oh gosh, so sorry that she had another seizure and had to fight to come out of it.

Marrianne is right though, it might or might not be related to cushings. I wouldn't give up hope right now.

[1DebbieJo]

Well today was a sad day at the vet. Dr. detected a heart murmur and doesn't think Jenny is having seizures at all. Thinks that she's fainting from lack of blood to her brain. Said the "seizures" I've described sound like petite mal, if that, because seizures start with coughing and as if she's choking on something. Then, she only twitches for about a minute, but is stiff straight and not flipping all around. Yesterday's "seizure" only lasted 40 seconds. She got up, was a bit disoriented, wanted to be held a bit, then went off to play. She did lose her bladder like the other two times however.

The vet did xrays of her lungs and heart, blood tests, etc. Said to call him in the morning with the results and that he was going to do more research on Cushing's to see if murmur caused by Cushings. Vet did say as you all did here that seizures are often seen in advanced Cushing's.

He said to continue the Vetoryl same dosage (20 mg daily) until we get the labs back in the morning. She was doing so well on the meds. Eats well, plays, no longer panting all the time, water intake back to more normal and her skin condition is totally cleared up.

She can no longer go on our 3.2 mile walks. I haven't taken her in about a month because the last time I took her she just stopped and didn't want to walk any further after about 1.5, so I carried her.

So any Cushing's veterans here that had heart murmur develop?

"(

[My sweet Ginger]

I'm sorry I'm not a veteran but my pup also has grade 2 heart murmur for some time now and not on any meds for it. Did he say what grade hers is?

[1DebbieJo]

They did tests for blood and xrays. He said he'd tell me more in the morning when the other test results come back. Mentioned diuretics, etc. I'm just heart broken. I know that a murmur can be life threatening.

:(

[Squirt's Mom]

Squirt had a grade 3 for ages, before she had Cushing's I believe, and never needed meds for hers either.

[flynnandian]

i used to compete in agility contests for years with a grade 2 murmur dog, won 1st prizes and no meds.
died at age 14 with no problems at all from her murmur!

[LauraA]

My cushings girl also has had a heart murmur for many years, way before she showed any symptoms of cushings.

[1DebbieJo]

So, does anyone know if the Vetroyl causes or contributes to seizures? What is it about the end stage of Cushings that causes the seizures.

Vet doesn't think so as I said, but she lost her bladder control when she passed out, so, ???

I'm just anxious tonight waiting for all of her test results. Oh, and thanks for the heads up on the thyroid ck. I asked the doctor to run that too since they were drawing blood.

Thanks everyone!

[1DebbieJo]

Vet called and said Jenny's test confirmed central nervous system activity, aka, seizures. He wants to put her on Phenobarbital for two weeks and see how she does.

She also has a very enlarged heart. Her maximum normal if 10 and hers is a 11.5. Don't quite understand that part.

She breathes rapidly but is not panting. I was concerned with the number of respirations per minute, but its kind of like inside panting?

Vet said he didn't want to put her on diuretics unless she starts to cough a lot.

[Harley PoMMom]

According to Dechra's product insert, seizures are listed as an adverse effect.


In two UK field studies with 75 dogs, the most common adverse reactions seen were vomiting, lethargy, diarrhea/loose stools, and anorexia. Other adverse reactions included: nocturia, corneal ulcer, cough, persistent estrus, vaginal discharge and vulvar swelling in a spayed female, hypoadrenocorticism, electrolyte imbalance (elevated potassium with or without decreased sodium), collapse and seizure, shaking, muscle tremors, constipation, scratching, weight gain, and weight loss.

http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf

Hoping the phenobarbital works, and keep us updated.

Hugs, Lori

[1DebbieJo]

Day two of her anti-seizure meds and no seizure.
Thanks for the update on side effects. Luckily, she only had the seizure. The other stuff sounds just as bad too.

Day to day. But, she's playful, loving, HUNGRY, and attentive.
")

[Harley PoMMom]

Glad to hear that she has had no more seizures and hopefully this trend will continue.


Other adverse reactions included: nocturia, corneal ulcer, cough, persistent estrus, vaginal discharge and vulvar swelling in a spayed female, hypoadrenocorticism, electrolyte imbalance (elevated potassium with or without decreased sodium), collapse and seizure, shaking, muscle tremors, constipation, scratching, weight gain, and weight loss.

Not all dogs will have these adverse side effects, in that study if only one dog that was being treated with Vetoryl had a seizure than they have to list it as an adverse side effect.

Also happy that she is doing well with her treatment.

Hugs, Lori

[1DebbieJo]

I took her for a mini walk with her two 7 year old babies, Beamer and Amelia. We came across a Bobcat. Funny, when it's little critters and such they bark and growl like pit bulls, but when it's a BIG KITTY, they instinctively knew to be quiet.

[Harley PoMMom]

Our furbabies can be so smart, huh!!

[Squirt's Mom]

I've had a few Chihuahuas who had no idea they were teeny dogs weighing around 5 lbs and they would have looked at that bobcat as a snack! In their teeny brains, they were 10' tall, made of solid steel, with jaws like bear traps! :p:D:p

[1DebbieJo]

Jenny had a seizure at 4 a.m. Could not get back up. My sons and I at her side comforted her.

911 call to her vet who said she's very sick (from all the tests last week) and to keep her calm. He said if she has another seizure, to bring her to the ER since it's probably life threatening.

Only two days ago, she was still playing.
She did eat this morning, but only all chicken and not her kibble with it. We're keeping her calm, but I know it's the end. She freaks out in the vets, so if it's that close, we're keeping her home.

Her breathing was so rapid as in 130 respirations per minute last night. The vet did tell me that it takes about 7 days for phenobarbitol to kick in. It's only been five days.

Her panting is awful. We're keeping her cool with ice thingys you put on wine.

I'm beside myself with grief. The vet said "had we caught this sooner"...HE should have caught this sooner, not me. I took her in for her swollen belly, her skin infections, her panting...

She'll be 9 April Fool's day if she makes it.
The boys and I discussed rushing her to the vet this a.m. We know how freaked she gets at the vet, so we decided for today, to keep her home with us where she's comfortable.

Still eating I guess and peeing a good sign. This a.m., she'd take a few steps, cough as if she was going to have another seizure, then didn't. Twice she laid down and tried to cough. I haven't let her out of my sight.

If only I knew she was in pain or not.

[labblab]

Oh, I am so terribly sorry that sweet little Jenny is having such a tough time. My heart goes out to you all, and I truly hope that somehow she will rally and make her way though this.

Sending all my hugs of strength and comfort to sweet Jenny and to all of you who love her so dearly.

Marianne

[Dixie'sMom]

Oh no! I'm so sorry Jenny is feeling so bad. I certainly hope she can get thru this. Is there another vet in your area that you may trust more? A specialist? A teaching center or an ER?

I'm praying for you and your sweet Jenny. Please keep us posted on how she is doing.

[Squirt's Mom]

Our thoughts and prayers are with you. Please let us know how things are when you can.

[1DebbieJo]

Jenny's miracle. After the most brutal of days yesterday for poor "Jen Jen" (the family nick name for Jenny), and visits from many who came to say good bye including her own mother. My dear friend Cindy Morales called and we spoke. Her words tried to console my grief and uncontrollable tears, but nothing worked. She asked to pray for a miracle and I sobbed as she prayed. Me and Jen spent the evening on the couch together just making sure I kept her hydrated, and she nibbled on her little "tricky treats", all little pieces of chicken hot dog where I hide her meds and she takes them that way. I'm just keeping her calm and loved per the doctor's orders. My BFF came by with food for me and the boys and tried to make me eat. I just could not.

At 10:00 p.m., I brought Jenny up to bed with me to let her pass in my arms and hopefully in her sleep. The boys all said their last good byes. She could barely breathe; labored, irregular... and was coughing, then would pee,but no grand mal seizure. It was just the most horrible thing to watch our little friend go through. Each coughing episode brought with her rear legs collapse.

I tended to her every hour giving her water when she would take it, and dribbling it into her mouth with my finger tips when she refused. I laid next to her the entire time. On occasion she still would lick my face and give me that special Jen Jen love. I've never seen anything like this dog. I took her outside to do her business, twice, and each time she did, her rear legs collapsed and I had to carry her back in.

She felt like she had a substantial fever. Jordan helped bring alternate ice packs for her to lay on to keep her cool and help with the hyper painting, and when those ran out, we used packages of frozen Otter Pops. I wiped her head with wet compresses.

Every moment with her labored and irregular breathing I stroked her head and laid there staring into her eyes letting her know I was right there. She could no longer lift her head off of her special blankey. At one point she lifted her paw and laid it across my forearm. It was just heart wrenching.

At 3:09, when things were at there worst, I cried out to Jesus in response to Cindy's powerful prayer and said, "Please Lord, save my little baby if you've got that miracle for our beloved dog Jenny, please give it to her now she's only 8." Still nothing. Her struggles continued.

I felt like each breath would be her last. I cursed myself for listening to my vet earlier in the morning and "just keep her calm" instead of taking her into the ER vet and putting her down. I could not take her struggled breathing or that "look" that everyone said she'd give when it was time. I got up and decided we could not wait until 7:30 a.m.for her appointment with the rainbow bridge. I dressed and went down stairs for a sedative for Jenny.

In the fridge I've always kept syringes full of RX grade Benadryl to administer to the dogs in case they got bit by rattlesnakes, which when used after a bite, calms the animal while you make the trip to the ER vet.

This is a sedative of sorts and I made the decision that to calm her on her one-way trip, that I would administer it to her via this injection. I decided to take Jenny to the all night emergency clinic and end this suffering; for both of us. I injected the solution between her shoulder blades as trained by her vet. I laid down waiting for the meds to kick in, and knew that I would take her when I felt she'd be sedated. With each minute however, her breathing eased, but only a bit. 45 minutes into "resting 'til time" she fell asleep and she was breathing in a much calmer rhythm. It's now 4:50.

I must of dosed off for a bit for the next thing I remember was being startled awake by Jenny's mild whimpering. I opened my eyes and she was standing over me, licking me face to get me up. I jump to my feet and see that she wants to go out. It's ten to seven and we have a 7:30 appointment. Her panting was there, as it has been for almost two years with this Cushing's disease, but the horrific labored, death rattle breathing was gone. I carried her outside, she does her business and comes back to where I'm standing watching her. She wants back inside. I offer her water and she laps it all gone, as well as nibbles on her left over dinner from the night before. I can see that she's actually hungry and better. I give her some fresh deli roast beef and she gobbles it down. I'm in shock that she has an appetite, but I feed her and she licked my face.

I still haven't forgotten the task at hand and knowing this could just be the calm before the final storm. I gather my wallet and take her on her one way trip to the vet, who was waiting for us.

He examines Jenny. He can see that she's panting, but not struggling. He listens with his stethoscope and kept saying "Hummmmm". He shares that temperature is normal. He listens to her heart and excuses himself with her. He returns with her licking his arms after using an ultrasound on her lungs. He states that although her lungs are seriously congested, the breathing problems are from fluid build up in her lungs caused by her heart and not the Cushing's disease.

He says he does not feel she's ready to be put down and gives her an injection of Lasik. I'm wiping away my tears with half laughter in her Lazarus reprieve, but I say, she barely made it through the night. I explained the injection of Benadryl and he says it was the right call for more than one reason. The anti-histimine affect of the meds, also dilated her little veins and arteries allowing more blood flow and oxygen to her brain and lungs. I said I cannot stand another night of watching her suffer.

He said let's put her on this Lasik twice a day for a week and go from there. I'm texting Jordan and Andy as fast I can that I have a surprise and a miracle to report for now.

I collect Jenny in my arms and we head home. Both exhausted we laid on the couch and take a nice long nap. She's got her bed, food and water by the couch. I just awoke about an hour ago to find her food and water gone. I take her outside again, she does her business, no coughing, no collapsing, but she's walking on her own.

There's no other explanation for her surviving the night of filled lungs, but a miracle. I know, the Benadryl calmed her, but it did not remove the fluid from her lungs. We're home now together. She's lying by my feet here as I type. I know she's still not perfect, weak from the night, but the anti-seizure meds are finally working, the Lasik is working and in one week, we'll return to the vet and she'll start heart meds to help with her enlarged heart producing the fluids.
We're stopping the Vetoryl for now until next week when the doc will run another ACTH test again and we'll go from there. My boys are going to help with the costs.

Miracle is all I can say. I had my mind set that her one way trip to the vet was the end for her suffering. But, apparently God had other plans.

God answers our prayers on His time, not ours.
Debbie and Jenny.

[Harley PoMMom]

OMGoodness Debbie, I am so happy for you and dear Jenny!!!

[Renee]

What an amazing story from your night! I am so sorry for the painful moments --- but, what a miracle! Wow!

[My sweet Ginger]

I'm so happy and relieved for you and your little Jenny. I will pray for her continued improvement. Hugs, Song.

[labblab]

Oh my goodness!!!! I was scared to click on your thread, Debbie, but what a joy to read this news! Sending tons of hugs to you and to Jenny, with hopes of many more better days to come!

Marianne

[Dixie'sMom]

wow, Wow, WOW! I am so happy to read this! I had cold chills and started crying a little, Sometimes the miracle comes in ways in which we don't expect it. Like a little voice whispering in your head, "Give Jen Jen some Benadryl."

XOXOXO for you and your sweet baby. I'll continue to pray for her, and I know others join me. Wow.

[Squirt's Mom]

What a great story and how wonderful to read the outcome for our sweet girl! :cool:

[1DebbieJo]

Thank you all. However, she's still breathing rapidly (panting from the inside out is all I can explain), and you can tell is exhausted. From the night's events? I don't know. She's very slow on her feet. Wants to just lay around and as I said breathing rapidly but not with great difficulty like last night. Yesterday she had two normal bowl movements and was able to go in and out of her doggie door without assistance. Then the horrible night progressed.

She's eating, drinking plenty of water, going potty outside but now with help. Doesn't want to go too far, she gets pooped. She did have a "gooey poo" all over her rear end, but I don't know if that's the Lasik, the Benadryl, or what. I did call vet and he says it still could be just the advancing problems/symptoms of Cushing's.

As I type, I know that there's no cure, and that at most I've post poned the inevitable, but do believe with God's will and guidance, we've bought more quality time. She did run to the door when my son came home from school and greated him. But laid down right after. Then, when his tutor arrived soon thereafter, she ran to the door a second time to greet the door bell.

I'm watching her as we speak as I said, and she prefers the coolness of the hardwood floor over my arms or on the sofa with me.

I did call the vet about the dark black gooey poop and he said let's talk again tomorrow.

Prayers for my Jen Jen, but, I know that she's weak and won't get better over night.

Please pray that I made the right call in not trusting her, who clearly last night looked like she was not going to make it. Imagine my surprise to see her little eyes first light.

XO

[Dixie'sMom]

You made the right call. Your instincts and love and devotion and prayer got her thru last nights episode. No, she is not cured and is in a fragile state and weak, but now you can focus on how to help her get stronger. I'm so happy you have more time together.

[Harley PoMMom]

I will be keeping you both in my thoughts and prayers.

Hugs, Lori

[Squirt's Mom]

I can't tell you how many times I thought "the end" had come for Squirt. I even went so far as to make arrangements with the vet once and she rallied just before. There were times I just knew were her last morning/afternoon/evening but she would fool me over and over and over. I kept giving up on her when she had lots more fight left. I think I carry more guilt over that than anything else except her last few minutes. I gave up on her. But she told me in no uncertain terms each time - "I am NOT ready, back off!" So I stopped trying to figure things out, stopped trying to second guess what was going on, and simply listened to my baby girl. So you listen to your baby girl and let her guide you. She may simply have a few more things to do and tell just yet. ;)

We are here with you all, every step of the way.
Hugs,
Leslie and the gang

[1DebbieJo]

So after a very long night of her panting, coughing sporadically, and lasik working, in and out the doggie door, I could tell she was just not doing well.

I gave her a little more benadryl and promised her I'd do the "right thing" first light. On the way to the vet, she was breathing very poorly, but still wanting to hold her head out the window. Once there, her life long vet said she's still aware and very viable. Knowing my finances he said of course a cardiologist and neurologist (since she had 3 seizures) are in order, but would like to try her on heart meds for 24 hours to see if in tandem they would help Jenny.

Her vitals were norm and except for the fluid in her lungs, she was aware, full of kisses and wanted OUT OF THERE. Option 4, not first was putting her down. I opted to do as many as you have said and trust the dog. I brought her home, but she won't eat today.

She's got the meds on board, and now it's another wait and see. Neither of us have had but winks of sleep in the past 48 hours.

I pray that I'm doing the right thing. Vet said, best case scenario, we do buy her time, worst case, we know we tried everything.

So, one more day folks. She's got the runs now, but after all the meds, who wouldn't huh?

XO for your support.

[Squirt's Mom]

Not sure which heart med she is trying first but Vetmedin gave Grace horrid diarrhea. It is a superb drug but she simply couldn't take it. So don't give up if the med could be making things seem worse.

[molly muffin]

I just want you to know that even not not posting right now (out of the country) I am following what is going on with you and jenny and my heart goes out to you.

I know and you know that you are giving her every possibility you can.

Big hugs

[1DebbieJo]

Well after four hours of heart meds, Jenny ate her turkey. Then this afternoon we went out front and she went down our little hill to her favorite #2 spot, went AND was able to make it back up the hill.

Just yesterday (before I stopped letting her go out there) she went down and laid down. I hurried down, yep, in the rain and carried her up.

She's napped all afternoon and hasn't left my side, or me hers. but, she's drinking water, eating (had more turkey and a little rice for lunch) and is breathing more comfortably than she has in over a week.

Her heart meds are: Enalapril 2.5 mg. 1 1/2 tab twice daily
Vetmedin 1.25 mg. 1 1/2 tab twice a day.

Other meds:
Phenobarbit 16.2 mg. one tab twice a day. (low dosage but stopped the seizures)
Furosemide 20mg (Lasik) 1 tab, twice a day.

Doc wants to re-do ACTH test next week when she's stable to determine if and how much he's going to put her back on Vetoryl.

It's in my mind, but if stable, would anyone risk surgery to remove the CONFIRMED pituitary gland tumor at almost 9 years of age? She'll be 9 on April 1. I have a friend who would loan me the money (take my wedding ring as collateral) for the dog's surgery.

Your thoughts? Should I just be happy that we're buying her quality time, or should I go for it once we have her stable?

Her improvement after just two heart pills is dramatic.

Your thoughts?

[1DebbieJo]

Oh, and all night she just went in and out of our same floor doggie door. Today, I let her lead. I was ready to go fetch her from her favorite "spot", but she showed me SHE was a fighter.

Thank GOD, she made it through Sunday night, which was her most critical night. Her rattled lungs made me think pneumonia. But it was the fluids in her lungs from her heart condition.
Oh, the vet said something about normal range is up to ten, (heart size?) but Jen's is an 11.5. Don't know what that number is about but it IS an enlarged heart, which tells me she's been breathing hard (panting as we know) for a long time fighting this disease.

I'm not going to let Jenny go down her "little hill" again until I see marked improvement. But today, I ALMOST put her down in error because I expected immediate results from the medication.

I also need to thank everyone on this board for their constant love and support. I WISHED I'd understood the power of Vetoryl and listened better about getting her ACTH tests done more often AT ANY COST and perhaps could have spared this? I dunno, but I'm using my wedding ring as collateral (yes, I'm divorced) to pay for her continued care. I wish I'd heard you all more clearly back then (last June) to how serious putting a dog on this med is, and how SERIOUS it is that we all listen to the advice here about regular monitoring. I fear that Jenny's suffering is a response to me not "getting it" about how strong and powerful this medication truly is.

I thank you all from me and Jenny.
Stay tuned, she's a fighter. I only wish I knew how to put a photo on this site so that you all could see the amazing dog we're all praying for and fighting for.

Hugs and wet nose kisses,
Debbie and Jen Jen.

[molly muffin]

I will be honest and say no I wouldn't do the pituitary surgery on jenny. With the heart condition and seizures I think the risk be too great for My peace of mind. I think I would stabilize her on what she is on for as long as possible and if the symptoms of Cushing's come back strongly Then I would do an ACTH but not before. Right now the goal for me would be getting her healthy and strong. That takes time. Those are my initial thoughts. Hugs

[labblab]

Debbie, I am wondering whether you are perhaps confusing the more common adrenal gland surgery (where the entire gland containing a tumor is removed) with surgery on enlarged pituitary macrotumors which remains very cutting-edge and actually, in some ways, probably still experimental. The dog of one of our members was actually the first candidate for this surgery orchestrated by Dr. David Bruyette at UCLA Medical Center. But there would be a lot involved in being a candidate for this surgery, starting with expensive initial imaging of the tumor to see whether it fulfilled the criteria for the surgery, as well as establishing that the dog is healthy enough to undergo the surgery. When dealing with a pituitary macrotumor, the far more common treatment is radiation to reduce the tumor size, so perhaps that is what you are really thinking about. But that is a very expensive undertaking, as well. And at this stage, I don't believe we even yet have proof that it is an enlarging tumor that is causing these new problems for Jenny.

So that is a long-winded way of saying that I agree with Sharlene. I think that Jenny's health remains very fragile right now, and the first priority is stabilizing the seizures and the heart issues.

Marianne

P.S. Take a look at these forum FAQs, and you will find instructions for creating a photo album and also uploading a little picture of Jenny, or "Avatar" to appear alongside your username:

http://www.k9cushings.com/forum/faq.php

[1DebbieJo]

She ate her supper! She was excited then pooped after my college age son came home to see her. What an amazing dog who can put her "illness" aside to greet her favorite man in this world.

What a dog. What a family member and best friend.

Wow.

[Squirt's Mom]

Sounds like Jenny still has things to say and do for a bit yet. ;)

[Dixie'sMom]

Go Jen Jen! She isn't giving up. :D

I'm praying she will continue to improve on her new meds. Hugs to you both!

[1DebbieJo]

Jenny slept through the night without having to go out for potty.
She's been off her Vetoryl since Sunday and I think she's feeling the effects of her Cushings, or, the meds she's on are making her a little sluggish today. After all, she's had a "ruff" week.

I combined her meds in baby food as my cousin with Maltese suggested since Jenny's figured out that the "tricky treats" as I call them which are just cut up chicken hot dogs, have pills in them.

She just finished her little plate and is looking up at me for more, so that's a good sign. She only went a few steps this a.m. for her potty routine, again another sign from her that I see that she's taking it easy.

I'm going to take her in the car later for a ride so I can show her that her rides don't always yield a trip to the vet.

I'll try to have a son help me post a photo of Jenny. She's a doll.

Oh, does anyone have any input on when to start Jenny back on the vetoryl? The vet wants to do another ACTH test first, which as we all know is very expensive, but I just have to find a way.

Again thank you all for helping me get through a rough week.
Hugs and wet nose kisses.
Debbie and Jenny

[1DebbieJo]

Well something new. About 15 minutes or so after her meds, Jenny began to wheeze a bit. I got her to adjust her position and that helped, but I guess with only two days of the meds I can't expect 100% better.

I never asked the vet what caused all the fluids in her lungs in the first place. Anyone know how and why she was getting pneumonia like problems?

[1DebbieJo]

Just spoke to the vet. He said Jenny has a stage 4+ heart murmur and this was the cause of her fluids in her lungs.

Before the Cushings she did not have a heart murmur and was see regularly by our vet.

Now up upset because he wants her to see a $800 cardiologist.
I don't have that. And because I'm getting the severity of what's going on with her and realize that she can't go on walks any more, and that her heart will give out before the Cushing's finishes her off.

She's one sick pup. "(

[1DebbieJo]

I also remember getting her teeth cleaned last year. IF she had a murmur that was undetected before, she could have gotten bacterioendocarditis.

I'm going to go look up symptoms from that right now.

She's a smidge better. Vet put her back on her Vetoryl TODAY since she was feeling so poorly.

Whatta day for Jen

[Squirt's Mom]

"Feeling poorly" how? Are you seeing increased Cushing's signs? You NEVER EVER give these drugs to a pup who is not well for any reason.

[1DebbieJo]

Yes, panting, just lethargic and that look from when she was NOT on meds.

Her Cushing's is very advanced said the vet. He's trying to control all of her issues a bit at a time. Saving her heart was of course first. She's responding well and no more wet breathing sounds. Her murmur is 4.6 and bad too.

Vet put her back on Vetoryl yesterday 20 mg and she's feeling better after two dosages... or, the other meds are working too.

She slept through the night, is already acting improved today. Ate a great breakfast.

Her respirations without Vetoryl went up to 130 per minute. But, that was also fluids, etc in her lungs when she was critically ill on Sunday night. Five days later, I'm amazed that she's still here and is looking much better look wise too so I know she's feeling better.

Last night at "rest" her respirations were down to 55 per minute. Still 20 over max normal for her size, but I don't know if that's normal for her weight. 19.1 pounds. (she's lost .7 ounces since being weighed in October.

I'm just thankful she's here five more days than I thought.

[Squirt's Mom]

It sounds like something is bringing a little relief and that is great news! I hope the trend continues and our sweet Jenny is feeling much more like her old self soon.

[1DebbieJo]

Yes, but now you've got me frightened about giving her the Vetoryl.

Heart issues are foremost, of course, but her symptoms from the Cushing's comes back fast. Five days off and she was not well.

PLEASE advise. I have to go to the vets to pick up more vetoryl in an hour. :(

Yes or no on giving it to her.

[labblab]

I think you need to follow your vet's instructions re: the medication, especially if Jenny has been doing better since starting back on the Vetoryl.

Marianne

[Squirt's Mom]

Since you said "feeling poorly" meant increased cush signs, then yes she needs the med if your vet so directs. "Feeling poorly" could have meant vomiting, or disoriented, or any number of things and that is why I asked. ;)

[1DebbieJo]

The vet was in the foyer when I arrived to get the meds. I said, Please, I want you to make a life saving decision here. If Jen should not be back on Vetoryl right now and is NOT out of the woods yet, please tell me. He said, He wants her on the Vetoryl.

So, I bought another two week supply.
The phenobarbitol does sedate her a bit and that's some of the lethargy I see about 30 mins after her meds. But, I'd rather see that then those BLASTED seizures!

My precious baby. Thank you all for your support.
D and Jenny

[1DebbieJo]

She's really lethargic today. Wouldn't come to me in bed and wake me. Very thirsty (I gave her water in the night when I heard her panting again). I had to carry her down stairs. Can carry her outside to pee.

She's moving very slowly today. Perhaps just a bad day? I can tell she's not feeling well. I gave her her meds in the baby food, and, fresh turkey, so she's eating and drinking. Just barely moving today.

"(

[Squirt's Mom]

Hopefully it's just the meds and she will perk up again soon!

[1DebbieJo]

She's still eating. Went to the rest room on her own. Took a drive with me to get a sandwich, but she's just a bit off. I had to hand feed her until she determined she liked the food. I read the phenobarbitol has a sedative affect to it, but she's on a really low dosage the vet said.

I'm just frightened tonight. This is the most lethargic I've seen her since last Monday night. And, I DID NOT give her the VEtoryl today. Too scared with so many meds on board and given her current actions.

This morning when she woke up, she did not saunter over to my side of the bed to wake me with kisses.

I don't think she's going to make it. I'm very sad. But I won't leave her side and I hope that this was just a bad day, but my gut is anxious and I hope I'm wrong.

"( Debbie

[ShibaMom]

Oh Debbie, I'm so sorry to hear that Jen Jen is having such a rough day.
I've been thinking about you two!

I'm new here, and my cushpup has only been on trilostane for a week, but I definitely would have done the same as you, and not given the med (Vetoryl) today. I think that was a very good call, based on what I've learned so far.

How are her respirations?

Hugs!
Samantha and Zanya

[Dixie'sMom]

Oh, I'm so sorry to hear shes not feeling good. Hopefully she is just having a bad day. Just watch her and make sure she is eating and drinking and peeing and pooping. I also would have stopped the Vetoryl, so I think that is a good call. She's got alot going on in that little body right now. Let us know how she feels in the morning. Hopefully she will feel much better. Praying for your little sweetie!

[Squirt's Mom]

How was the night for you two?

[1DebbieJo]

She was up at 3:30 for an urgent trip to the rest room. I've been feeding her chicken (baked and ground) with a little rice and her pancreatic health PET ID kibble. Yesterday she would have not of that. Last week I started giving her deli sliced chicken and she loved that. I've also been giving her her new meds in the chicken baby food. She loves that. Last night I gave her a little roast beef and believe that maybe that's why she's got a little of the runs in the night.

We slept down stairs for the rest of the night so that she could go in and out of the doggie door. She attempted to go but appeared to be a little constipated? It was dark and I could not see, and with two other dogs not sure.

She's better today. Eager to go out front with the other two little dogs her kids, even participated in a little run down the slope and bark at the neighbors dog. She came back up on her own.

Question is the dark greenish runs. Meds or roast beef? She had this earlier last week too when first on meds, but I thought it was the meds. I was giving her chicken, turkey and a little roast beef. Anything to get her back on her feet.

Anyone have an ideas about the greenish number two and what can I safely give her for the constipation?

She's better, but stable I'd say. Of course I'm watching every move.
Debbie and Jen

[Squirt's Mom]

I think I would lay off the roast beef and see if that wasn't the culprit. You might try a little but of plain pumpkin, not the kind for pies with the spices, just plain. Give her a teeny bite - too much will work the opposite way. ;)

[My sweet Ginger]

I'm very happy that Jenny is doing better today and hope she will continue to improve each day.

I don't know anything about the color green but have been told a tsp of pure canned pumpkin will usually take care of either diarrhea or constipation. Funny, huh? Only a tea spoon, no more than that. I'd go flat on her. Hope that helps.

My Flora is 8 and she's a cross between Maltese and Chi who looks like Maltese only smaller. My Flora is still a baby to me so I pray that Jenny recovers from this and enjoys many more happy years with you and her babies. Hugs.

[1DebbieJo]

Well, she's definitely having an up day. I gave her a soothing bath and let her dry in the sunshine (yes mid 70's in So. CA) with her son and daughter in the outdoor mini fence.

I combed her out, and took a few photos. Her eyes tell me what I needed to see.

Oh, I'll definitely not give her any more RB.

[ShibaMom]

Yay! I'm so relieved Jenny's doing better!

What I've read, for human poop and I'd imagine this may apply to dogs, is that when it's green, or bright green, it's an indication that it's passed through the GI tract quickly, and thus didn't have time to be broken down/digested more and turned brown. That's the super layman's summary. So something made it all go through her quickly.

Safest bet when their tummies/guts are upset is keeping as simple and bland as possible. Poultry, rice (though not too much rice if constipated!), that sort of stuff that you've been giving, just without the RB. As others mentioned, plain pumpkin (not "pie filling"), but just a teensy bit.

Hopefully it will resolve shortly!

Thanks,
Samantha

[1DebbieJo]

Sticking to roasted turkey, her new fave for eating. Chicken baby food for meds.

She's quiet and respiration down to 50 per minute.
(130 a week ago if you recall) So, meds, food, quiet intensive care love and treatment working. Had to bathe her this a.m. because of the green "runs", which have subsided.

Every moment with this blessed critter of love is worth all the effort.
She's never left my side during this last five years of the divorce from hell, nor will I leave her side during her illness from hell.

As it should be.
")

[ShibaMom]

That's great!!

Ugh, sorry to hear about divorce from hell - I'm so glad you've had her to stick by you and see you through!

:)

Cheers,
Samantha

[1DebbieJo]

Second good day in a row thus far. She's still having trouble with "gooey" #2s and it doesn't seem like much is coming out.

I'll get that pumpkin in her this morning.

Everyone keep praying for our miracle girl. Thank you!!

[molly muffin]

So glad that Jenny is having some good day(s) now. Just a tad of pumpkin should do the trick. Maybe on your finger?

hugs

[1DebbieJo]

She's doing well and I'm going to ask the doc to perhaps cut back on the phenobarbitol that sedates her too much...in my opinion. But if that's what it takes to control the seizures, then...

Her blood tests showed her seizures were the result of central nervous system issues (i.e. Cushing's) so what to do.

And, her boy son dog threw up five or six times tonight. Pancreatitis again and all he gets is pancreatic health dog food and fresh baked chicken.

I'm pooped from doggie health issues, but it is so a labor of love.

[ShibaMom]

Oh no about Jenny's son! I hope he'll recover from it quickly. Does your vet have any other ideas for how to help him? Any natural supplements or perhaps a different brand's prescription diet to try?

Regarding the seizures and as result of a CNS issue, I didn't realize Cushing's was a central nervous system issue. I thought endocrine issues weren't CNS. I maybe mistaken, though - learn something new every day! Can someone else clarify?

Sorry to hear you're having so many pet struggles... labor of love, indeed!!!

Regards,
Samantha and Zanya and crew

[labblab]

Debbie, I was puzzled, too, when you posted your vet's information about Jenny's bloodwork showing that her seizures are being caused by a CNS issue. As for a CNS connection with Cushing's, I am guessing he was talking about the possibility that her pituitary tumor is maybe expanding and placing pressure elsewhere in her brain? So in that sense, the culprit would be the expansion of the tumor as opposed to production of excess cortisol. But I was also confused as to how her bloodwork could be used to diagnose a CNS problem. I ask because I have a nonCushpup with seizure disorder of unknown origin, and I'm not aware of any blood panels that would identify a CNS issue as the seizure source. I would think you would need neurological testing in order to make that type of determination?

As far as the phenobarb dosing, is your vet still planning to check her phenobarb level soon? I'm thinking you are around the two-week mark since starting the drug, so technically it is about time. Jenny has so many issues going on right now that drawing blood to check that level may seem awfully burdensome. But that would give you the best guidance as to whether this dose is adequate to prevent seizures, or whether you could drop the dose and still get protection. I know my girl remained pretty sedated throughout the first month of phenobarb treatment, even when the phenobarb level was perfect in her bloodstream. But after that first month, she totally normalized and has done great on the phenobarb ever since. If you can suffer through those first few weeks of sedation and other side effects, they often do drop away or at least significantly decrease.

But as I say, with so much going on for her, I know your primary concern right now is her comfort and whatever will best provide it.

Marianne

[1DebbieJo]

Yes, Jenny has a check up a week from tomorrow making it two weeks "stable"... I hope to report. They are going to do blood work, acth test.

and this: "Jenny's bloodwork showing that her seizures are being caused by a CNS issue. As for a CNS connection with Cushing's, I am guessing he was talking about the possibility that her pituitary tumor is maybe expanding and placing pressure elsewhere in her brain? So in that sense, the culprit would be the expansion of the tumor as opposed to production of excess cortisol.

That's the extrapolation I got from what he said too. However, he also said seizures are a side effect from the Vetoryl too. So I asked for clarification after talking with you folks here. He stated that the blood tests suggest that Jenny's seizures are from a CNS issue, and not a side effect of the Vetoryl. That's all I got guys.

He does have a pituitary gland tumor.

I'm just thankful that she appears to be "normalizing" on her phenobarbitol too in that today, she was actually frisky a bit and wanted to play.

")

[ShibaMom]

That's terrific that Jenny seems to be "normalizing" on the pheno now! Great news!

[1DebbieJo]

Another great night. She slept all the way through. Very, very comfortable breathing at a more normal rate. Didn't have to go out.

I do offer her water (I keep on my nightstand)if she wakes and wants down, and she always takes it. But, she's not needing the potty for either 1 or 2 in the night. (Never did until first on meds 10 days ago).

She sat outside with her two babies now 7. Beamer, the boy dog, is getting 1/2 Pepsid AC in the morning now. And, vet put him on Cerrana (sp) for stomach upset. What a busy month.

And now, I just got the bill.

But, we'll cut back in other ways.
Debbie and Jenny and Beamer and Amelia.

[Dixie'sMom]

You really have your hands full. I'm so glad Jenny is feeling better. Hugs for you both and continued prayers for you and all 3 of your babies.

[1DebbieJo]

One wag of her tail and a wet kiss and it's all worth it.
Unconditional love...works both ways.

[1DebbieJo]

Well, she had a less comfy night last night. Respirations were back up at 84 per minute. She drank four times as much water as her norm, then of course had to go out for a long visit.

Appears fine today however.

I wonder if they adjust the Vetoryl upwards as the disease progresses to control her symptoms.

Debbie

[Dixie'sMom]

Debbie, they adjust the Vetoryl depending on her ACTH stim test results. If the next test shows she needs better control, they will increase her dosage and vice versa. I hope she is feeling good today. :)

[Harley PoMMom]

How a dog is feeling, doing, are as much a guide in adjusting the Trilostane dosage as those ACTH stimulation results. ;) Trilostane is given to control bothersome symptoms, and unfortunately is not a cure for that dratted disease. :(

[labblab]

I wonder if they adjust the Vetoryl upwards as the disease progresses to control her symptoms.

Hi again, Debbie. I am not exactly sure what you mean in terms of "the disease progressing." The systemic damage that is caused by chronically elevated cortisol should be slowed or even halted when cortisol levels are effectively controlled by medication. Cushing's is not cured, meaning the medication can never be discontinued without risking the return to uncontrolled cortisol. But the ill effects on the body are hopefully minimized via treatment. Vetoryl dosage levels frequently do require tweaking along the way, but this is not necessarily due to the Cushing's "worsening," but instead simply due to changes in the way the drug is metabolized. If anything, I think we more typically see Vetoryl dosage decreases over time, rather than increases. But if symptoms are worsening and ACTH results show a loss of control, then yes, the dosage would be increased.

One way in which Cushing's could indeed be seen to be worsening would be through the growth of the tumor on the pituitary gland or adrenal gland, and associated damage to surrounding tissue. In terms of growth of the pituitary tumor -- which I think is what you are suspecting with Jenny -- what you would see would be an increase in neurological problems as opposed to the classic symptoms of Cushing's. In the face of an enlarging pituitary tumor, the trilostane might actually be decreased or halted altogether in order to allow the dog to benefit from the anti-inflammatory properties of higher levels of circulating steroids.

So in relation to Jenny's specific situation, exactly which symptoms of Cushing's are you thinking are worsening, or you are worried about worsening?

Marianne

[1DebbieJo]

Thank you Marianne, wow. The panting was my big concern as is the 4x icrease in her thirst. I just assumed that these are from the Cushings. But over the weekend I read many articles on symptoms (increase in number of breaths per minute) of the heart murmur grade 4.5 and think that maybe these are the symptoms I get confused. She could have actually merely fainted from the unmedicated heart issue and fluid that was building up in her lungs causing her to cough. From what I'd read here, I immediately went into panic mode fearing that her meds were causing the cough.

Here nor there, she goes in this Wednesday for her two week check. She had a little more difficulty last night in breathing, but is okay to day.

Thank you so much for helping me keep all this straight and sort out symptoms vrs. reactions, vrs. worsening conditions and growth of the pituitary condition, which is what the vet suspected by her labs and CNS "symptoms,... or was that the heart. It's just a lot and I'm trying to absorb it all without over-reacting. I'm going to print your explanation above so I can reference when I get confused with all this, which is often.

Hugs and wet nose kisses, Jen

[ShibaMom]

Debbie,

It can be challenging enough keeping everything straight when dealing with JUST Cushing's, not to mention everything Jen Jen has been through and is dealing with! I'm sure it's easy to mix things up and get overwhelmed, anyone would, gosh.

Just off the top of my head, what if you get some large index cards, and have one for each condition, with symptoms, things to watch for, meds, etc? Just an idea... to make it handy to reference.

Hugs!
Samantha