Hi - I'm Dixie's Mom

[Dixie'sMom]

Hi all. My name is Suzie and I am the mother of a doxie/beagle mix named Buttons and a mini doxie named Dixie. Dixie is 6 y/o and is at the vets today getting the low dose Dex test for Cushings. She has been showing symptoms for quite some time but I failed to realize it was a sign of disease.

Dixie has all of the classic symptoms of Cushings. Unbelievable appetite, pot belly and weight gain. I put her on a diet and she started losing weight everywhere but the pot belly so thats when I realized something was wrong. After cutting back on her food she begin drinking huge amounts of water, and of course was a peeing/pooping machine. Last week at her vet visit, he walked through the lobby while we were checking in and turned all the way around and stopped when her saw her. He looked at me and said "Thats a big belly". I think he knew/suspected immediately just by her appearance. Her blood work at that time was consistent with Cushings with the values being off that would indicate Cushings. I can't remember exactly which ones but I think it was liver and kidney and I do remember him saying her urine was dilute due to the excessive water intake. I will be getting a copy of her labs today and I will share those with you. She is supposed to weigh about 8 lbs and she weighed over 19, and as I said, that was after some weight loss.

I'm so very sad and feel so guilty that I didn't get her to the vet sooner. I'm also concerned about treatment. I have an autoimmune disease myself and am disabled and am very aware that the "cure" sometimes is worse than the disease itself. I myself am on daily steroids and immunosupressants,as well as other meds for the side effects of my treatment or disease that the medicines have caused. I just hate that she has to go thru this. Other than her obvious health problems, she is basically a happy, loving little girl and I hate to see her "messed up". Does that make sense?

Thank you all for what you do in supporting others and helping us to educate ourselves about this disease. Please say a little prayer for my baby girl.

Suzie

[Harley PoMMom]

Hi Suzie,

Welcome to you and your sweet furbabies! One thing I want you to know is that Cushing's is a treatable disease but success in treatment does depend on keen owner observation along with a vet/IMS that is experienced with treating Cushing's and knowledgeable about the proper protocols for Cushing's.

The two medications usually prescribed for Cushing's are Lysodren/Mitotane and Vetoryl/Trilostane. They are both strong drugs but are life savers for our pups that have Cushing's. Treatment is started to abate Cushing's symptoms as the medications do not cure Cushing's.

If you could get copies of all tests that were done on Dixie and post any abnormalities that are listed with the references ranges and units of measurement that would be great we are especially interested in the results of any tests done to diagnose Dixie's Cushing's. Does Dixie have any other health issues? Is she taking any other herbs/supplements/medications?

Please know we are here for you, and if you have any questions at all do ask them, ok?

Hugs, Lori

[Dixie'sMom]

Thank you for responding Lori. Dixie is not on any meds or supplements. If she is indeed diagnosed with Cushing's (which I'm pretty sure she will be), I will be very interested in things I can do to help her overall health. Natural diet? Supplements? etc. I do plan on treating her, but as I've read here, starting with a low dose seems to be important, so I will definately discuss that with my vet. I should have a copy of her last weeks blood work today and will post the abnormal values with the range. According to the tech, I will not get the results of the 8 hr test being done today until Friday or Monday. I guess they have to send it off?

[Harley PoMMom]

When a dog has Cushing's a diet that contains a high quality protein/s is recommended, however, if Dixie is doing well on the food she is eating now I see no reason to change it.

Regarding giving supplements, they should be dependent on a dog's own health issues.

We have a wealth of information about Canine Cushing's in our Resource Forum, here is a link: Helpful Resources for Owners of Cushing's Dogs (http://www.k9cushings.com/forum/forumdisplay.php?f=10) Feel free to print anything out and to ask all the questions you want. ;)

Hugs, Lori

[Dixie'sMom]

Well I still don't have all of the information I need but I did talk to the vet this morning who had Dixie's test results back. He said her LD dex test did show Cushing's. Her values were:
baseline cortisone 6.4 with normal range at 6
4 hr at 5.3 with normal range <1
8 hr at 3.7 with normal range <1

He said her values are not outrageous so he thinks we caught it early and that she will do well with treatment. He wants to put her on Vetoryl 30 mg/day with follow up testing in 2-4 wks. I still don't have her regular lab work from her first visit. They were supposed to send them home with my son the day he picked her up but they didn't send them. Then I called to have them mailed to me which I haven't received. *sigh* So when I go to pick her her meds, I will stand at the counter while they copy them for me and I will post the abnormals for you.. Honestly, the only way to get things done properly these days is to push, push, push.... but thats another story. ha! (I am disabled and cannot drive or I would have already gone up there)

I'm uncomfortable with starting her at 30 mg and would have preferred to start lower, but I'll try it and if it makes her sick I will stop immediately and insist on a lower dose.

I'm interested in hearing your impressions. Any thoughts, anyone?

[Squirt's Mom]

Hi and welcome to you and Dixie!

Could you tell us how much she weighs? That will help us see how her dose fits since it is based on weight.

You should know that you do not have to use the dose the vet is recommending if you are not comfortable with it...but after we know her weight and can chat with you a bit, our Vetoryl parents will be able to help you with that. The current recommended dose is lower than what is stated in the drug's brochure but I will leave that to the Vetoryl parents, too. We were a Lysodren house. ;)

The main thing I want you to know is that there is no reason to feel guilty. Cushing's is a sneaky disease, often confused with signs of simple aging. It is also one of, if not THE, most difficult canine condition to correctly diagnose because so many other things share the same signs so vets are often confused themselves. You are a good mom. How do I know this? Because once you knew what you and Dixie were dealing with, you started searching to learn all you could in order to help your sweet girl. And in the process you found us - your new family. You and Dixie will never walk alone on this amazing journey; we will be by your side every step of the way. Never hesitate to ask questions and we will do all we can to help you understand. We are here to learn together, support each other, and encourage each other. ;)

Hugs,
Leslie and the gang

[labblab]

Welcome back, and thanks for posting those LDDS results. They are definitely consistent with Cushing's. Depending upon the pattern of the results, sometimes it is possible to make the assumption that they are caused by pituitary rather than adrenal Cushing's. In Dixie's case, the test results could be produced by either form of the disease, so it would require additional testing to make that determination (for instance, an abdominal ultrasound or additional blood testing).

Vetoryl (trilostane) is used to treat both forms of the disease, so the expense of additional testing may not be worth it to you. But just so you'll know, surgery can offer a permanent cure for dogs suffering from adrenal Cushing's. For many dogs, surgery is not considered an option due to the expense and complexity of the surgery. But I just wanted you to know about the option and the possible value of additional testing.

At a weight of 19 pounds, I too would feel more comfortable if Dixie were starting out at 20 mg. rather than 30 mg. You will be dosing at a formula of 1.5 mg. per pound rather than 1.0 mg. per pound, so it is somewhat higher than the beginning dose that is now more generally preferred by specialists and researchers. You will indeed want to watch her closely for any symptoms of overdosing and you will want to return to the vet after 10-14 days for monitoring bloodwork to make sure that her cortisol is not being overly suppressed by that dose (at least a baseline cortisol level at that time if not a full ACTH stimulation test). Also, do ask your vet to supply you with some supplemental prednisone to have on hand in the event that she becomes ill at a time when it is difficult for you to get her in to the vet on an emergency basis.

Good luck, and we will be anxious to see your updates!
Marianne

[Squirt's Mom]

:o Missed the weight you have posted.

[Dixie'sMom]

LabLab and Squirt's Mom - thank you so much for responding and helping to alleviate my "guilt". During the time Dixie's symptoms started (overeating and drinking and potbelly beginning) I was going thru a period of time when my own income had ended from my previous employers disability policy and my Social Security Disability had not been approved yet. It was a struggle to keep things going at home and although I knew she was "off", everyone I talked to kept saying "Oh yeah, Dachshund's do that." (food aggression, overeating, etc). So as soon as my situation got resolved, I put her on a higher quality food but a weight control formula which seemed to help at first and she did lose weight. But then the water gorging began and the potbelly didn't shrink any. Luckily I am at home with her all day and can meet her potty demands, but nights are a problem. She goes to the door which luckily isn't a carpeted area and I have stacks of what I call "Dixie's Pee Towels". So thats our night time solution. I wash alot of towels, but I can deal with that, right? Her normal weight is supposed to be 8 lbs so I am also very concerned that the 30 mg dose will be too strong for her "8 lb" organs. My brother is a pharmacist and I may get him to split the dose for me and re capsule it. I don't want to offend my vet but her life is more important to me than his approval. He mentioned a high dose dex test as well as another "expensive" test, so I'm assuming the 2 week test will be the high dose test in order to determine if its a pituitary or adrenal tumor... then the ACTH stim? Thank you again so much for standing by me and not letting me walk alone thru this. I'm terrified for her, but we will get thru this. I have wonderful supportive friends but no one with experience, so I'm especially grateful for your knowledge and kindness. I think I will also request a thyroid and diabetes test at her next visit just to be safe.

[labblab]

I think I can give you some peace of mind as far as the dosing in relation to Dixie's organs. It doesn't matter that she "ought" to weigh a lot less -- the drug is dosed on the basis of the actual overall weight of the dog, so the physical size of the internal organs shouldn't matter. In fact, dogs of the very same weight can end up metabolizing the drug differently and require very different doses for optimal symptom control. That's why the monitoring testing is very important, paired with your own observations as to how Dixie responds.

The HDDS is one of the diagnostic blood tests that can help distinguish between pituitary and adrenal Cushing's. It would need to be performed prior to beginning treatment, though, because the trilostane will skew the results. So if that is a path you would want to explore, you would need to do that now. I am assuming the expensive test to which your vet is referring is the ACTH stimulation test. That is the gold standard for monitoring treatment. At a minimum, it should be performed for the first time at the 30-day mark. Ideally, and if money is not an issue, that is also the test that is first performed at the two week mark. But as long as a dog appears clinically well, a less expensive option at two weeks is a baseline, or resting, cortisol level alone. I can talk about that a bit more later on.

As far as the dosing, yes, that could perhaps be an option to let your brother repackage the capsules. If your vet prefers that you begin with brandname Vetoryl, it would be more expensive to buy two boxes of 10 mg. capsules than a single box of 30 mg. capsules, so splitting would be cheaper if your brother will do it for free. If that is what you decide to do, though -- split the 30 mg. capsules -- you do need to tell your vet so he's aware of the actual dose that Dixie is getting. In my own mind, it is a bit of a hard call. This is just my own opinion, but I might be inclined to go ahead and start off with the 30 mg. capsules intact so that you know the drug is being delivered exactly as intended. In honesty, it really is a craps shoot as far as what dose any dog will end up needing. We have had dogs here who were undersuppressed on relatively small doses. My own dog was dosed at what seems like a very large dose of 4 mg. per pound and he never came anywhere near to dropping his cortisol too low. So that's why the monitoring testing is so important as a follow-up. Starting at a very low dose can certainly decrease the risk of side effects. But it can also increase the expense and frustration associated with a prolonged period of dosage increases, multiple monitoring tests, and delayed symptom resolution.

Also, once Dixie is stabilized on a given dose, a less expensive option may be to switch to a compounded version of trilostane which can be prepared to any specific dosage amount that is required. Your brother can explain more as to the pros-and-cons of compounding, and your vet would also need to be consulted. But this is just another thought for further down the road.

Marianne

[Dixie'sMom]

Thanks ladies. There's some very good advice and information in your posts and I appreciate it more than you will ever know. There's alot of fear involved in getting this diagnosis and alot of anxiety with regard to the meds and treatment. And since I am on a fixed income, cost is important, although I will do all that's in my power to see that she gets good care. The bottom line is that I'm just afraid I'll lose her. And I guess that's what brings us all here.

I did get the lab results from her first visit last week. These were the abnormal values:
MONO range 0.30-2.00 HIGH at 2.10
PLT range 175-500 HIGH at 639
BUN range 7-27 LOW at 3
CREAT range 0.5-1.8 LOW AT 0.3
ALT range 10-100 HIGH at 307
ALKP range 23-212 HIGH 431
GGT range 0-7 HIGH 48
CHOL range 110-320 HIGH at 437
AMYL range 500-1500 LOW at 241

Thoughts? Impressions? The labs look bad to me but I just don't know how bad. Please be honest.

I look forward to getting to know all of you and your story.

Suzie

[Budsters Mom]

Hello, welcome from me too. :)

Someone will be along shortly to help you decipher the lab results. Do not worry. They will be honest.;)

We do understand how expensive it is to treat for Cushing's. Many of us are on a fixed incomes and we do all we can. You are not alone in this.

Cushings is a crappy disease. We are all afraid of losing our babies. And yes, that is what brings us all here together. The more you learn, The more empowered you feel and the fear starts to ease up a bit, but never goes away.

We will help in anyway we can.
Kathy


since I am on a fixed income, cost is important, although I will do all that's in my power to see that she gets good care. The bottom line is that I'm just afraid I'll lose her. And I guess that's what brings us all here.

[Dixie'sMom]

Thank you Kathy. I'm catching up on my reading. I don't know if I will make it thru everyone's story, but wow. What y'all as a group have been thru with your pups is amazing. All of you and your furbabies will be in my prayers, always.

[Budsters Mom]

You may not want to start with reading about my Buddy (Buddy, the mighty lizard Hunter). His story has more than 1500 posts!!! I would suggest starting small to avoid feeling overwhelmed by it all. Please remember, we didn't do any of this alone. We had each other's support and love. You are one if us now. No one does this alone.

[Dixie'sMom]

1500 posts?? Holy cow! Yes, please do forgive me for not starting with his thread. But I do look forward to hearing about his lizard escapades. He sounds like a fun little guy!

[addy]

Hi and welcome to our forum,

I'm going to bump this up so one of our administrators can look at Dixie's labs. I don't want to take a stab at advising on the results but the bun and creatinine is low not high and the alkp isn't as high as some. Some of the reading could be attributed to Cushings but I would rather someone else with a better ability to look at the numbers.:)

Was this a fasting blood test?

Someone will be around soon.

[lulusmom]

Hi Suzie and a belated welcome to you and Dixie.

With respect to the test results you posted, the only thing that jumped out at me is the level of increase in ALT and GGT in relation to ALKP. We usually see moderate to severe elevations in ALKP and very mild increases in ALT and GGT. Dixie's results do not follow this pattern. I realize that you are on a fixed income but if there is any way you could possibly work out a payment plan with your vet for an abdominal ultrasound, I would strongly recommend you consider doing so. This would allow your vet to determine whether Dixie has pituitary or adrenal dependent cushing's and it would also allow him to look at the liver as well as the gall bladder to see if there are any abnormalities that are not associated with cushing's. Gall bladder stones or mucoceles would be something that would show up that could account for the high ALT and GGT.

If you can't swing an ultrasound, then I would suggest that you have your vet do a recheck of the liver values in 30 to 45 days to see if ALT and GGT have changed. Most vets can do a mini chemistry inhouse so it wouldn't be expensive. In the meantime, I recommend that you talk to your vet about getting Dixie on liver support just in case she has more than excessive amounts of steroids affecting the liver.

Is Dixie spayed and is she currently on any medication?

Glynda

[Dixie'sMom]

Thanks Addy and Glynda. Your comments raise a new question for me. If a cushing's pup is under good control with medication, does the blood values normalize or stay abnormal? And if they normalize, any abnormal values could indicate disease, yes or no? I also noticed the GGT as I did not remember seeing abnormal values discussed on other posts. We are early in this process and you've given me very good information in regard to getting a game plan together. I believe my vet was looking specifically for cushings and breezed over the fact that there were other values that were indicative of other conditions or disease. I will pin him down and get some answers. In my reading last nite I did find the link to search for specialists in my area and actually found 2 in my town. If an ultrasound is in order or specialist consult, that is available to me which is a relief. Oh, and to answer a question, Dixie is a whole female. She hasn't been spayed and is on no medications or supplements. She is fed Blue Buffalo Weight Control kibble and has an occasional pig ear as a treat. She doesn't get table scraps unless it is the left over bites of meat or veggies or bread - something known to be safe. (No onions, grapes, raisins, chocolate, etc) However, both of my girls would chew off their own legs for french fries from McDonald's :)

[molly muffin]

I would probably start a liver supplement to, something like denamarin, which is a combination of both sam-e and milk thistle. Both are good liver supplements and denamarin has them both in it.

Sharlene and molly muffin

[Brooke]

Hi, wanted to give a hello and welcome to you and Dixie as well since, like you said on my thread, we are beginning this journey together! I wanted to say too that my Bella is on sam-e to help bring her liver enzymes down, it might be something for you to try. Bella's alkp enzyme came down by about 500 points within around six weeks time so it did seem to help. I buy mine from amazon, it was cheaper than from my vet. It's listed as s-adenosyl for small dogs and cats (100 mg) and is 36$ for 60 tabs. He tried bella on a higher dose and she threw the pill up, but it was too much for her weight so the lower milligram (100mg) worked fine. Anywho, I'll be checking your thread and watching for your updates! All the best to you and Dixie.

Brooke and Bella

[Dixie'sMom]

Charlene and Brooke. I have put the liver supplement on my "To Do list to discuss with the Vet. I'm assuming you need a prescription for them?

I've been doing alot of reading and am exhausted before I even get good and started on this journey. I need someone to point me toward some success stories! Have a blessed day ladies and thank you for being here for me.

Suzie

[addy]

In response to the abnormal blood work. It took along time for my Zoe to have normal blood work. It was not until her cortisol was down to a post 2ug/dl for a while that everything was normal. Having said that, her levels were not hugely elevated as some we see.

Some pups may have other issues so, we might not see a return to normal levels on all the bloodwork - if perhaps the liver values are sky high, but they can come down.

Dixie's bun and creatinine being low can also indicate liver issues so yes, discuss this with your vet.

Also, I wanted to mention keep in mind, a lot of times our success stories move on and may come back only occasionally to report in.

[Brooke]

I did not need a prescription for the sam-e...

Like you I am also overwhelmed with information and some of these stories on here break my heart. I've been in tears every night the past couple of nights, but I have run across many success stories. What a blessing to have people on this forum who truly care and listen to what we have to say about our pups. Often times I feel like people think I'm crazy for putting so much energy into what they call, "just a dog". For us our little ones are so much more, and I'm glad to be amongst people who get it!

Hang in there,

Brooke

[molly muffin]

Love Dixie's photo. She is so cute in her little pink harness.

Sharlene and molly muffin

[Dixie'sMom]

Thank you Addy. I think I was under the impression that the BUN and creatinine were low because of the water gorging. I will pin down my vet to explain the labs to me discuss her possibly having liver issues beyond the Cushings. What I seem to be getting from all of you is that an ultrasound may be in order because of the possibility of adrenal cushings/tumor or another issue with her liver or gallbladder (elevated GGT, ALT, low BUN Creat). I hope I'm getting this right.

Brooke, We are lucky we found this forum and these folks. Although its scary, I do feel less alone. We'll get thru this together.

Sharlene, this picture of Dixie was before her disease started. It was taken Easter 2 years ago. I get tickled everytime I look at it because of the classic Doxie eye roll or stink eye. haha! She quickly outgrew that pink halter as well as another larger sized one once the overeating began. *sigh*

[molly muffin]

Well Dixie is very cute.

It's true, many success stories move on and don't come back to update very often. We have also had those whose pets have passed now but were successfully treated for many years. You have already heard from some of them, Leslie, Glynda, Marianne, Lori, they all treated for many many years and are still here helping others even though their own cushing pups have passed on. Cushings is not cured it is managed and quite often successfully for years.

Hang in there!
hugs
Sharlene and molly muffin

[Dixie'sMom]

Thanks Sharlene. I'm hanging in there and getting less panicky. I just need to remember one day at a time... one test at a time and to stop saying "what if...." I'm glad to know that many on the board have successfully treated their pups and with all of the combined knowledge here, our pups will get the best care with the least mistakes (IF our vets will be open to some possible changes). Dixie's meds should be in this week but I believe I'm going to see if I can get an ultrasound before she starts them. And she does have light colored stools. I had my daughter check her eyes, gums and belly when she came by today and no hint of yellow anywhere. I'm losing my sight due to my autoimmune disease so I cannot distinguish colors unless they are high contrast. (I would not be able to distinguish yellow from white) Another concern... I'm afraid I will miss something important going on with her due to my low vision. However, I CAN make my screen large enough to see your avatar whom I assume is your Molly girl. She's a doll baby! :)

I hope to get around to everyone's stories. There's a LOT of reading to do here haha! Thanks again.

[Trixie]

Hi to you and Dixie. She is super cute!! Sorry she had to get this diagnosis. Don't feel guilty, almost everyone chalks up various symptoms to the dog getting older or other various reasons.
My dog was diagnosed March of 2013. Until she had a senior blood panel done I didn't realize anything was wrong. She had very high liver numbers so she started on Denamarin supplements. Then after a few weeks some symptoms of Cushings began to show, though not all of them. Excessive drinking/urinating and panting were the most obvious for Trixie..and a big appetite but that was not unusual for her at all! Testing came next, ultrasound and positive diagnosis...and we decided to start treatment before things got any worse.
It took awhile of dose tweaking her vetoryl/trilostane, a number of months before we saw big improvement, but she is doing great now...controlled and pretty much back to normal. (knocking wood!) Her liver numbers slowly...very slowly came back into normal range. That took almost a full year and the alkp still comes in a tad high, and might always be like that.
One suggestion is do not give 30mg to your small dog!! I really believe that starting low and gradually moving up in small increments-if needed- is the best way to go. If you start too high your dog will have troubles. My dog weighed about 16 pounds when we started out and we began with a dose of just 12mg a day. We dosed her 6mg in the morning and 6mg in the evening...and we slowly moved up from that dose after periodic testing of her levels. After months she settled into a dose of 28mg...and now is at 24mg. I use a combo of brand name and generic compounded to get the exact dose that works best for her.

The best and safest way is to get control on the lowest dose possible and you can't know that a lower dose can do the trick if you start high. It worked very successfully with my dog...she never had any, not one, adverse effect from this medication. I know you don't want to offend or question your vet but that 30mg could cause your dog harm.
I hope Dixie does well with treatment, it's a relief when they begin to improve. I'm so grateful that my dog is doing well after almost a year and a half. The experts on this board helped me beyond measure as I knew nothing about Cushings when we faced the diagnosis.

Barbara

[Dixie'sMom]

Barbara, thank you for your reply. It has given me a huge sense of relief that despite the difficulty of managing this disease, things CAN go very well. I have taken your suggestion (as well as everyone else's) to heart and am not going to start her on the 30 mg. If the medicine comes in tabs, I will break it in half and start her at 15. If it is capsules, I will have the vet order 10 mg (or give me a script) and start her at 20 mg/day.

I'm so glad to hear that your Trixie is doing so well. She's such a cutie! I will go read her story and I'm looking forward to getting to know you.

[molly muffin]

The pills come usually in capsule form and they tell you not to open and split it. So, that wouldn't be a good idea. Have him order you some 10mg and return the 30mg box to him. :)

Sharlene and molly muffin

[FemaleK9]

I guess I'm one of the "success stories" that doesn't post very often, but I'd like to chime in here.

My beagle, Rosie, has been on 20mg (10mg twice daily) since she was diagnosed, and she is still at that dosage more than a year later. Her symptoms are still well controlled, and she hasn't developed any complications or additional health problems. We've been very lucky. I know not all dogs are the same, but if I were you, I wouldn't want to start Dixie any higher than this, and I do believe that splitting the dose helps to maintain a more even level of medication.

Don't be afraid to express your concerns to your vet. It doesn't come easy to most of us to stand up to them when we disagree, but this is very important. One reason I stopped coming here so often is because of the people who refused to go against their vets and gave their dogs massive doses of Vetoryl/trilostane in spite of the excellent advice given to them here. And several of these dogs died, and it tore me up so bad to see this happen that I just drop in once in a while now. The admins here can give you chapter and verse for you to arm yourself with references if you feel the need. A discussion with your vet doesn't have to be an argument, I was lucky and my vet was open to new information and willing to work with me.

As to expense, I get trilostane Gourmeds from Wedgewood Pharmacy (http://www.wedgewoodpetrx.com/items/trilostane-gourmeds-chewable-tablets.html) and they are much less expensive than brand name Vetoryl, plus I just drop them in food and Rosie eats them with no fuss. So much nicer than poking pills down her throat! I get (200) 10mg tablets (a 100-day supply for us) for $109 including Fedex shipping. If you are in the US, you might want to check them out - just give them a call, they are very helpful.

[Dixie'sMom]

OMG. I hope that is Rosie in your avatar. That is the cutest thing ever! I am an absolute food for the hound dogs. I can find the beauty in all dogs - big and small, furry, fluffy or not, but the hound dogs absolutely touch my heart in a way I can't describe. My Buttons is a doxie/ beagle mix and of course Dixie is a full blooded Doxie. Ok enough of that.(one more thing - I had a friend with bloodhounds! they were amazing!)

Thank you so much for stopping in. It helps my spirits to hear the success stories and know that there are pups that are doing very well. I am taking everything very seriously and I will discuss it with my vet and I will not give her the 30 mg. That decision is made. I will also not try to half any capsules, I will have him order 10 mg and discuss twice daily dosing at 10 mg per dose. She weighs a little over 19 lbs so hopefully that is in the safe range. Now I just have to find a way to tactfully discuss this with him. He is a great vet, very kind and has an amazing way with animals. They instictively trust him, even tho they make not like what he is doing to them. But I have worked with doctors of all kinds (except vets) throughout most of my life and know that things get overlooked and mistakes are made, especially in a busy practice. And I have no clue how knowledgeable about this disease he is or how many cush dogs he has treated. We do live in a small town, so its possible that he is great at everything but Cushings. I'll just have to play it by ear.

It sounds like you have also found a good cost saving way to getting your baby's meds. I'll be very interested in speaking with them as soon as we can get Dixie's maintenance dosage figured out. I know that will be a while yet.

I'm so glad your Rosie is doing well. I love, love, love that picture. I'm going to see if you have more! haha! :)

Thanks again!

[FemaleK9]

Yup, that's my Rosie in my avatar. It was taken when I first got her at 6 weeks old, waiting for me to help her up onto the patio. She's 12 years old now, but she's still cute as a button.

I took a look at your picture of Dixie, and she's adorable - the side eye made me laugh! The hounds have so much attitude, don't they?

[labblab]

Hello again from me, and I'm really glad that you are going to be able to talk things over in more detail with your vet, especially the dosing.

I just thought I'd add one more note in advance. Karen is definitely right that some dogs do better with twice-daily dosing, and some specialists prefer to start out that way right from the beginning. But the jury still seems to be out as to whether that is always the preferable dosing schedule for all dogs. I think virtually all specialists prefer twice-daily dosing for dogs who also suffer from diabetes because there seems to be a clear benefit to keeping their endocrinological systems as consistently stabilized as possible throughout an entire 24-hour time period. However, when nothing else is involved, many dogs seem to do just fine being dosed only once daily in the morning. And since trilostane should be given with food in order to maximize its effectiveness, it can be a pain for owners to space out dosing every 12 hours along with a meal. Sometimes there is a clear need for this, such as when symptoms start to rebound later in the day after a single morning dose. But otherwise, if a dog does fine with a single morning dose, it can be easier to administer the drug more consistently that way along with a meal. Plus, ironically, there seem to be some dogs who feel better when their cortisol is allowed to increase a bit during a 24-hour time period rather than being consistently suppressed.

Partly why I mention this is because my nonCushpup suffers from seizures and I have to dose her twice daily with her seizure medication. I try to be obsessively compliant and give it to her exactly at 12-hour intervals, and I know how difficult it can sometimes be to maintain that schedule. So this is a long-winded way of saying that if it seems easier to you to start out with once-daily dosing, you may want to first give that a try to see whether the results are satisfactory. If so, it is an easier regimen for most folks to maintain day-in, day-out.

Marianne

[Dixie'sMom]

Thanks for your input Marianne. That makes perfect sense. Once a day would be easier for me to do, but if twice daily seems to help her then of course I will do that. I guess we will wait and see. I have an ultrasound scheduled for next Thursday so I'm not going to start any treatment until I see what that reveals. Keeping my fingers crossed that she doesn't have any other problems. Since I don't know yet her type of Cushing's (adrenal vs pituitary), is there any indication that once daily vs twice daily works best depending on the type of Cushing's they have? That would be interesting to know.

BTW, your lab is gorgeous.

[labblab]

Definitely good luck with the ultrasound, and we'll be awaiting the results right alongside you! And no, I'm not aware of differential dosing recommendations depending on adrenal vs. pituitary Cushing's, but possibly someone else here has.

Thanks so much for complimenting my boy! He is Barkis, my Cushpup, who passed away several years ago. But he is my reason for first finding, and still remaining here with, our wonderful family. Even though he is no longer physically beside me, it warms my own heart, every day, to see his photo pop up every time I log in. So thank you very much for your kind words on his behalf. :)

Marianne

[Dixie'sMom]

Marianne, I got chills reading your words about Barkis. That tells me that y'all must have had a very special bond. Such a cute name too. He looks like a very happy boy. Its so kind of you to hang around to help others when at times it must bring back painful memories. I am working on reading everyone's story and look forward to reading about your beautiful boy. Thanks again for your support. It means so much.

[Elsie's Mom]

Hi Dixie's Mom! I recognize that stink eye! I too have a doxie, and get that look from her sometimes! Elsie is a 12 pound mini, and has been on Trilostane for 10 months! Between this forum and their Facebook page, I felt pretty knowledgable when the vet and I first discussed dosing. Elsie started on 10mg once a day, and now, after much tweaking is on 10 mg am and 8 mg pm, and is doing great! She still drinks more water than I'd like, but my vet said that he has seen that in other Cush pups-their water consumption never gets back to a "normal" amount. Thankfully she's always been able to hold it through the night! Anyway, welcome! I wish you and Dixie great success! Sounds like you're off to a good start!

[Dixie'sMom]

It's good to hear from you Elsie's Mom! I'm so glad to hear Elsie is doing well with her treatment. Every bit of positive feedback gives me hope that Dixie will tolerate the treatment and may be with me for many more years. This forum has been very helpful and I don't feel quite so alone anymore, thanks to people like you. I look forward to getting to know you and your Elsie girl! Hugs.

[Trixie]

What's the latest on sweet little Dixie? Have you worked out dosing with your vet? Hope Dixie is doing well. :)

Barbara

[Dixie'sMom]

Hey Barbara and thanks for asking about Dixie. She is still an eating/peeing machine. We are waiting for an ultrasound this Thursday to get more information. I am not starting any meds until after the ultrasound and when we start, I'm not starting at 30 mg as the vet recommended. I am just not comfortable with that and I'm just not going to do it. Please say a little prayer or send healing vibes our way Thursday. I'm a little nervous at what they may find with her high ALT and GGT. Also, I guess I will learn then what type she has. I think I read that Trixie is doing good right now so I'm really happy your little one is well. Thanks again for checking in on us. :)

[molly muffin]

I think we are all nervous before the ultrasounds but I have come to think it is just better to know what I am dealing with, what to expect and the best way to take care of them that it is to not know for sure and just wing it.
It doesn't make it any less nerve wrecking but you gear yourself up for it and go I'm prepared to have a lengthy discussion if needed and get your questions answered.
I always have a medical test history in one hand and a list of questions in the other :).

It will be okay and you go I. With all of there with you in spirit.
I take my smart phone and have been know to text forum from waiting room for opinions.

You'll both be just fine

Hugs
Sharlene and Molly muffin

[Dixie'sMom]

Hey Sharlene. My imagination tends to run wild and go to worst case scenario, so hopefully the reality won't be as bad as my imagination has made it. I've got copies of Dixie's test results, filled out some history forms and written a quick summary for the vet and have my list of questions ready. The vet doesn't know it, but she will also be very discretely interviewed and if she appears more knowledgeable about Cushing's and more in line with recommended treatment and testing protocol than my own vet, I'll have no problem moving Dixie to her.

One thing that has really bothered me is that my vet's office has not even called me to tell me Dixie's medicine is there. It was ordered on the 11th of August. And since I'm not starting her at 30 anyway, I've just not called them to ask. If they are already dropping the ball, what the heck am I gonna do if Dixie runs into trouble? So, as much as I like my vet, some alarms are going off and I'm just not sure that he is the right person to manage her disease.

Thanks for checking in on us, and I will continue to follow Molly and see how things transpire. I sure hope that little girl will be ok and this will just be a bump in the road and not anything permanent for her. Hugs

Suzie

[molly muffin]

Good lord! They do call me the queen of auto correct and when I go back and see some post I've made from phone or tablet, I am amazed anyone can make heads or tales out of it!!

I hope it's a bump only too. We'll know but not till the end of September it looks like :( I'll post about it on my thread, but I wasn't able to get an appointment for quicker. *sigh*

Hang in there, only a bit more time now
hugs
Sharlene and molly muffin

[Dixie'sMom]

haha! It was just 1 wacky sentence, Sharlene, and I knew what you meant. I hate you have to wait so long for Molly's appointment. Uhhh... the waiting stinks.

[Dixie'sMom]

In light of Dixie's upcoming ultrasound, I'm in need of some comic relief.

http://www.k9cushings.com/forum/album.php?albumid=906&pictureid=6995

[Squirt's Mom]

Oh my! Is that appropriate in my house! :p

[molly muffin]

Oh very funny!!

I hate having to wait to, I can't stand the thought that it might get even worse. I am trying not to dwell on it though.

Other things are going on, Dixie has her test tomorrow! Now it will be okay and when it is all done, we'll want to know everything! :)

hugs
Sharlene and molly muffin

[Tina]

Hi Suzie,
I have been following along on your thread and just wanted to pop in to wish you all the best with Dixie's ultrasound today. I am thinking about you guys, and will check back later for any updates.

Hugs,
Tina and Jasper

[Dixie'sMom]

Hi Tina and thanks for stopping in. Is that Jasper in your avatar? He is so cute and looks like such a sweet little guy. I will have to go and read your story.

TA-DA! Ultrasound is overwith. It was a long day. I had to drop her off at 8:10 and we didn't get to pick her up until 4:30 but had quite a lengthy conversation with the vet. The ultrasound showed "Classic, Classic, Classic Cushing's" is what she said. Both adrenals enlarged with no masses so type is pituitary. Slightly enlarged liver with some white spots which probably indicate a fatty liver. Also classic and no other masses or abnormalities found in any other organs. I liked this vet. She took her time and explained everything to me and even went so far as the Lysodren vs Vetoral. She didn't really tell me anything I hadn't already learned from this forum (haha) but I did appreciate being able to see that her recommendations as far as managing the disease were following protocol and in line with what I was expecting. She completely understood my feelings regarding Dixie at 30 mg and proposed that we start her at 10 mg/day for 4 days, then 10 mg/twice a day until testing at around day 15. She will call me at days 4 and 8 to see how Dixie is doing. She understood my fears about needing someone very accessible and willing to take my calls in the event questions or problems crop up and she said with her Diabetic and Cushing's patients that was a given and she would be expecting to hear from me often especially until Dixie was stabilized. She offered me the rescue Prednisone (which my other vet never mentioned) and gave me the meds with instructions. So all in all, so far, so good. I'm so grateful for all of your well wishes and prayers Things went better than I expected. So tomorrow is Day 1, 10 mg Vetoryl... and I'm not a bit scared. :)

Hoping and praying all of you have had a good day with your sweet ones.

Suzie (& Dixie too!)

[molly muffin]

oh wow, that sounds like a good vet. The only thing I haven't heard of is the 4 days at 10mg and then 10mg twice a day. So, I'd like to hear what the others on here who have been on this journey even longer think about that. I've always heard of keeping them at 10mg once a day till you do the rest, at day 10 and day 30.

Still I like that she is accessible to you and giving you the prednisone too. Nice that you have confirmation on what the suspicions were and don't have to worry about an adrenal tumor.

hugs
Sharlene and molly muffin

[Dixie'sMom]

Sharlene, I think the 10 mg for 4 days is strictly to alleviate my fear that Dixie may get sick from the medicine and to just introduce the med to Dixie's system. I don't think she expects any great results from that - its just to give Dixie a few days to adjust before going to 20mg/day. And again, I think the twice day dosing is to possibly alleviate any side effects. I fully expect her to go to 1x daily when we get to the correct dosage. I think all of this is for ME to tell you the truth. I didn't ask her to do it this way, but I did tell her that I would not start at 30 mg./day which is what she recommended. We settled on 20 and she suggested the easing in to it. I think she's decided Dixie will be fine, but I may be another story. haha!

[molly muffin]

Ok. That makes sense then. Twice a day dosing has always made sense to me. But it is really what works best for Dixie.

Thanks for explaining for me. Lol

Hugs
Sharlene and Molly muffin

[labblab]

Hello from me!

I think the dosing regimen sounds fine, and will indeed give Dixie a chance to adjust to the medication a bit more gradually over those first few days. Your vet's intention may be to always remain with the twice-daily dosing, though, if Dixie responds well and it suits your schedule. I realize Dixie is not diabetic, but twice-daily dosing is always recommended for diabetic dogs, so your vet may have had a great deal of success with that dosing pattern if she treats a number of diabetic dogs. There are a number of specialists and researchers who prefer twice-daily dosing across the board. From our experience here, I don't know that the actual result is so much that it eases side effects, but it does keep cortisol levels suppressed more consistently across a 24-hour time period which may offer systemic benefits to the dog.

One thing that newer research has revealed is that dogs dosed twice daily may end up needing a smaller overall daily total of trilostane. So as always, the regular monitoring testing will be very important in determining the need for dosing changes down the road. This will also be the case if Dixie ends up shedding some extra pounds. ;)

It sounds as though the new vet has been very thorough and you three are off to a good start together! Just remember that you do need to give both doses of trilostane along with at least a small meal, though, since food in the stomach is required for the drug to be metabolized efficiently.

Marianne

[Dixie'sMom]

Hey Marianne. I feed twice a day so dosing twice a day is fine with me. I will just have to be more diligent about the timing. I'm not sure Miss Dixie would go for waiting 12 hrs between meals so I may have to go to feeding smaller amounts 3x per day. Luckily I don't work so I'm home all of the time so I can make whatever adjustments are needed. I was wondering yesterday what happens to the tiny 5 lb Yorkie or Chi's with Cushing's. Do the vets just grab the 10 mg off the shelf and go for it? Wonder why Dechra doesn't make a 5 mg tab? It looks like folks are almost forced to go to compounding in order to get the dosage adjusted. I imagine they save money manufacturing, but at the expense of possibly the pet's life since there have to be loads of animals that are over or under managed. Just musing....

[labblab]

Yes, doses smaller than 10 mg. must be compounded here in the USA. Dechra does produce a 5 m.g. capsule in the U.K. that isn't available for general purchase but can be supplied to vets there upon special request. But that dosage has not yet been submitted to the FDA for approval here.

Apparently compounding is not legal in the U.K. so without that special 5mg. capsule there would be no dosing alternative over there.

Marianne

[Brooke]

Hi Suzie,

I wanted to drop in on your thread and say congrats on a good, informative ultrasound! I know that is a big relief to have no surprises. I will be checking in to see how Dixie is doing with her meds, lots of positive energy to you and Miss Dixie. :)

Brooke and Bella

[Dixie'sMom]

Thanks for checking on us Brooke. Its day 4 of 10 mg Vetoryl for Miss Dixie. She is having no issues. We go to 20 mg tomorrow so I'm keeping my fingers crossed she will tolerate that ok. Hugs to you and Bella.

[molly muffin]

Crossing fingers and paws for you and Dixie!

hugs
Sharlene and molly muffin

[FemaleK9]

One thing that newer research has revealed is that dogs dosed twice daily may end up needing a smaller overall daily total of trilostane.

That is very interesting. I think it may at least in part explain why my Rosie has done so well with such a low dose.

It has always just made sense to me, since the drug doesn't last beyond even 12 hrs, that two smaller doses would keep the drug level more nearly constant than a high dose (possibly too high) once a day, which would give a very high level and drop to nothing for hours before repeating the cycle of overdose/underdose every day, which can't be a good thing.

Rosie's meals are at 12 noon and 6 pm. I give her first dose of Trilostane with the noon meal. I just save about 3 tablespoons of her food from her meals to give her at midnight with her second dose of trilostane. So you don't have to completely disrupt Dixie's feeding schedule, just save some of her food to give at the 12 hour mark.

[Dixie'sMom]

Hey Karen! Its good to hear from you. I smile everytime I see your avatar of Rosie. Just makes me happy. I'm glad she's still doing good.

It also makes sense to me that their cortisol would stay more steady with the twice a day dose. It sounds like you feed about like I do - 12 and 6, so I could easily do midnight as well. I'm a night owl. I hate to go to bed and I hate to get up. haha.

Maybe you ladies can help me figure out a problem. I'm going to Hatteras Sept 11 for a few days and my son and daughter will have to take care of the dogs. My son lives with me but works erratic hours. My daughter can stay the weekend but not on school nights because she has a daughter in school. I'm wondering if the once a day dosing would be better during those few days because I just don't know if anyone will be here to get the twice a day in her at exactly the 12 hr. mark. Will it hurt anything to go to once a day for a few days, then back to twice a day? Or should I should put her on 20 mg once a day until I get back to do the twice a day? Any thoughts??

[labblab]

I think it should be fine to shift to the once daily dosing for just those few days. I would not schedule another ACTH, though, until you've consistently returned to the twice daily dosing again for at least several days.

Marianne

[FemaleK9]

Yup, I'm a night owl, too! All my life, I've found it hard to get to sleep and hard to wake up.

It doesn't seem to cause any problems if they miss a dose every once in a while. Sometimes when we have had thunderstorms and I had to sedate Rosie, she has missed her midnight dose, or I have withheld a dose when she has a stomach upset or diarrhea, until the problem resolves and I'm sure it's not a problem with the trilostane.

If I were you, I would stick as close as possible to the twice a day regimen, but not worry too much if a dose is missed. Don't try to make up the missed dose, just resume as usual with the next dose.

I wouldn't try to to go to the one 20 mg dose. I believe it's always better to go too low than too high. The worst that can happen with underdosing is a return of symptoms, overdosing can have dire consequences, although it would probably not be a threat at the dosage you are at.

ETA: I agree about postponing the ACTH until the twice a day regime has been maintained consistently, I would say for a couple of weeks to a month, unless there are signs that the dosage is wrong (Cushings symptoms not abating, or symptoms of overdose arising, although I wouldn't expect this last at the low dosage you are starting with).

[labblab]

Paradoxically since the overall daily dosing total may end up being less, at least one expert (Dr. David Bruyette) tells us that twice-daily dosing actually tends to have a greater risk of oversuppression/overdosing than does once-daily dosing:


With regards to once vs twice a day dosing if we look at all the studies throughout the world you will see that about 80% of dogs do well with once daily dosing. One huge advantage of once daily dosing is owner compliance which goes up substantially when owners only have to dose once a day. While twice a day dosing may result in a lower amount of trilostane being used per day it will require closer monitoring as the ACTH stimulation tests tend to be lower so we have to look for both hypocortisolemia and electrolyte abnormalities.

This is pure speculation on my part, but maybe it's because the twice-daily dosing keeps the cortisol from rebounding as it normally would in the early hours of a 24-hour circadian cycle. I'm not sure how it works with dogs, but with humans, I think cortisol level normally peaks in the early morning/morning hours and then lowers during the course of the day into the evening.

At any rate, whatever the reason for this effect, I don't think you can assume that twice-daily dosing is necessarily safer if what you are worried about is oversuppression. At a weight of 20 pounds, theoretically 20 mg. once daily should not be an unreasonable dose for Dixie and based on what Dr. Bruyette has written, might actually have a less overall suppressive effect than 10 mg. twice daily. So if she has been doing OK on 10 mg. twice daily before your trip, she ought to be fine on 20 mg. once daily while you are gone. Actually, though, probably the best thing is to check directly with your vet and see what her preference is in terms of dosing during the time period you are gone since we are talking about a few days and not just a single missed or altered dose. Especially since I am thinking that your trip may fall within the time period that you were originally planning to perform the first ACTH?

Marianne

[FemaleK9]

Marianne has much more experience here than I do, so you should go with her recommendations.

I shouldn't have spoken of thunderstorms, one just hit here and Rosie is panicking. I just gave her a sedative and we're waiting for it to kick in so she can stop trying to claw her way up to my head.

[labblab]

Hey Karen, I think your point is very well taken -- that when in doubt, it is better to underdose than overdose. And especially when a parent is going to be away, the conservative route is usually the best route. So your thoughts and suggestions are very valuable, and I did not mean to write anything that seemed otherwise. Dixie's vet may well think that 10 mg. once daily is the safer route while mom is away.

I mainly just wanted to add these additional comments because I think there is still uncertainty as to the "best" dosing regimen for trilostane. There is no question but that different specialists have different preferences, but it seems to me that there are still pluses-and-minuses to both dosing routes and it still comes down to the likelihood that there is no one-size-fits-all that is best for every dog. And that even with the lower doses that may be associated with a twice-daily regimen, parents still have to be vilgilant about monitoring and the risk of oversuppression.

Marianne

[FemaleK9]

No worries, Marianne, I know what you meant! I know that you have been involved here with many dogs and are much more up to date with research than I am. My only experience has been with my own dog, and I wouldn't want anyone to take my observations as anything more than that. Rosie has done very well, but that's just because we've had really good luck, not because I know any better than anyone else!

[molly muffin]

I'll just chip in with observations with our own dogs and experience of the others on here are sometimes all we have to go on.

I'd probably do lower rather than higher dosages when I am away and haven't a reliable alternative to monitor constantly. That is because I am a worrier and wouldn't want to be freaking out the entire time I was away. (which I know I would do) LOL

I always smile at Rosies avatar too. She is just too cute!

hugs
Sharlene and molly muffin

[Dixie'sMom]

I think you all make very good points and its an interesting discussion. Her first ACTH is actually falling the day before I leave which will be 14 days since beginning treatment. But this raises another question in my mind. If she goes for the test 4 hrs after her meds at 10mg twice a day, then she would only have the 10 mg in her system at the time of the ACTH vs 20 mg at once a day dosing. So even tho both ways she would be getting 20mg/day, could the ACTH show different results depending on once vs twice day dosing? hmmmm...

I'm really not too worried about her being overdosed on either method as 20 should be pretty safe for her. But yes, Sharlene, I will be worried about her. I will torment my children via cell phone the whole time I am gone. They are adult children (35 and 21) so they can take it.

[molly muffin]

That is fine. If you are on twice a day dosing then that is accurate to do it 4 hours after the morning dose of 10 mg. it shows what her cortisol is doing and the test will reflect her current cortisol levels.
Note that some dogs after the ACTH test can have up yo 48 hours of the symptoms acting up. More hunger. More drinking. More peeing etc. It is from cortisol dumping into their body.

[Dixie'sMom]

Thanks y'all. I can over analyze things sometimes to the point of making myself massively confused. ha!

We have a new development today. Dixie is able to walk past her water bowl without drinking. :D :D :D

[Brooke]

Yay for Dixie! So glad to hear things are going good :)

[molly muffin]

Whoo hoo Dixie! That is great.
Lol. We can all over analyze around here. I know I do too.

Hugs
Sharlene and Molly muffin.

[Dixie'sMom]

Hello all. Tomorrow is Dixie's first ACTH stim test. I'm very anxious to see the results. Dixie is doing well on the 20 mg Vetoryl. Her stools are soft but not runny. Her water consumption has decreased by 2-3 cups a day but still having some long drinks at the water bowl. What is a normal amount of water? Buttons has always drank and ate very little and Dixie over does everything so I have no clue what normal is anymore.

Not as much change in appetite as with the water. She still has the appetite of a horse, but is less frantic about eating and sometimes even chews her food before swallowing. :) Other than that, she appears to be less anxious and appears somewhat more content. I feel like an increase in meds will probably be in order, but I'm so thankful she is tolerating the medicine. Thanks to all of you for your support and help. I'm ready for tomorrow.

Meds with meal - check
Be at vets 4 hrs after meds - check
Anything I've forgotten?

I hope all the furbabies are doing well and enjoying the somewhat cooler temps... at least we're having them here anyway. It makes my doggies more frisky and that makes me smile. :)

[Harley PoMMom]

Approximately 1 ounce of water per pound of body weight is considered normal for a dog.

So happy to hear that Dixie is doing well on her treatment and we will be waiting anxiously with you for those ACTH results!



Meds with meal - check
Be at vets 4 hrs after meds - check
Anything I've forgotten?

Looks like you have it covered!! Good job!!!

Hugs, Lori

[FemaleK9]

Sounds like you're well prepared!

Some people have reported some effects from the test itself, but I'm not sure exactly what side effects to expect, if any. Can someone speak to this?

How long has Dixie been on the Vetoryl/trilostane now? It's my understanding that it can take up to 30 days to take full effect, and since Dixie's symptoms seems to be responding well, I would be reluctant to increase dosage yet. I think the 1st ACTH is primarily to make sure there is no need to decrease the dose, ie, overdose. A safety precaution, as it were.

I'm sorry if I seem overly cautious, but we have seen several dogs overdosed here on the forum; some were rescued, and, sadly, some were not. The worst that can happen if the dose is too low is that it will take little longer to completely control symptoms and you will incur the cost and inconvenience of more ACTH tests.

[labblab]

Good luck tomorrow! And Karen is right on the mark re: holding off on a dosage increase until after the first 30 days. :)

I never experienced this with my own dog, but some owners have reported that their pups have reverted back to excessive drinking and restlessness for a day or so after an ACTH test. We speculate that perhaps it is an effect of dumping the adrenal reserve of cortisol into the system as a result of the stimulating agent.

Marianne

[Dixie'sMom]

Hey ladies! No matter what the results of tomorrow's test are, we will stay the course at 20 mg until 30 days is up, unless she is too low and I doubt she will be. She still has a ways to go before her symptoms are under good control. And that pot belly hasn't gone down much either. The good and bad news is that my trip to Hatteras fell thru so I won't be going anywhere so the whole once day/twice day issue is a non issue at this point. . The bad news is that I am really missing the big water and was looking so forward to spending some time at the coast. Oh well... I can plan a trip when my girlie is more settled. Thanks for the warning about some possible increase in symptoms after the test. I'll keep you posted on what happens. Hope all the babies are doing well and happy.

[molly muffin]

Oh fiddles. I am sorry that your trip won't happen now. I hope you get to the coast soon. We all need those reenergizing breaks. On the other ha nod you will be around for this tine period to get things sorted out with your little girl.

Hugs
Sharlene and Molly muffin

[FemaleK9]

Sorry about your trip, but maybe it's for the best, so you can be around during this early treatment period while Dixie gets good control of her symptoms.

We'll be watching for you to post the ACTH results!

[Dixie'sMom]

Yes its for the best and I would have been worried sick about her anyway. I will be back with results as soon as I get them.

Karen, give Rosie a cuddle for me! (I could just eat her!) (Thats a southern saying, just in case you didn't know.. haha)

[Dixie'sMom]

Honestly... its like pulling teeth to get things done right ANYWHERE anymore. Is it just my town or does anyone else have to go thru an act of congress to get things done right?? ... and it seems to be never get done right the first time. Sorry for the rant but I get so frustrated. I've been on the phone today doing "business" that I've already taken care of before and it.. again... wasn't put in the computer. (medical stuff of course) grrrrr. And I've been given misinformation from another source which wasted my time on another matter. And then everyone at the vet's office looked at me like I had 2 heads today when I got there with Dixie.

When the vet tech called a few weeks ago to check on Dixie and set up the appt for the ACTH stim, she told me to drop her off. I told her I would not drop her off but would bring her in 4 hrs after her meds which would be early afternoon. She said ok and set the date. I then get an email reminder showing that I am going to drop her off at 8:10 a.m. *sigh* So today we go in about 15 minutes before the 4 hrs is up and they said they expected me to drop her off. I told them no, that I had told the tech that I would not drop her off at 8:10 a.m. because I would have had to give her her meds at 4:00 a.m. in order for the testing to be done properly. That I had told her I would be there 4 hrs after her meds which would be early afternoon. They replied that her vet wasn't there. So I asked them "Then why did y'all schedule my appt. for a day when her vet wasn't going to be here?" They looked at each other kinda dumbfounded. They said they would get another doctor to do it and I could leave her. I said no. I will just wait with her until its over. So then a tech came out and told me which vet was going to do it and I could pick her up in 2 hrs. I told her I would just wait while the test was done and asked if I could talk to him and she left again. She then came back and said again that he would do the test and I could take her after they did the test if I had her back in exactly 2 hours. So obviously, he wasn't going to talk to me. I have no clue whether this test was done properly or not because nobody but me seemed to know that it had to be done at a precise time. I think the vet must have explained it to them, but once again it made me wonder that if they had many Cushing's patients, wouldn't the staff know the procedure? So. I have no clue whether the test was done right or not. I am supposed to get the results Friday and I will ask that her doctor call me. I'm not a happy camper today. Do y'all run into this kind of stuff? And if so, how do you handle these kinds of situations?

[FemaleK9]

If the vet understands the protocol, you're lucky, never mind the staff.

For my first experience with the ACTH, see this post in Rosie's thread (http://www.k9cushings.com/forum/showpost.php?p=114493&postcount=49).

[Dixie'sMom]

I read the post and it's awesome that you were able to turn a bad situation into something good for everyone. So I guess this means that I'm not alone, huh? Thanks Karen... you are a jewel.

And on another subject I think you were asking about, I can definately tell Dixie had some steroid today. She has been panting (she rarely pants), hanging out at the water and food bowl, peeing like a racehorse and barking and growling at imaginary things in the grass. haha! poor baby.

[Elsie's Mom]

Hi Dixie's Mom! I think testing day is stressful on its own, and it certainly doesn't help when someone at the vets office doesn't know what's going on! But now that is behind you! I hope the test results show improvement!

My Elsie goes in for an ACTH Stim test on Friday! She's been on Trilostane since last October, and w/ all the tweaking we've done she's had plenty of ACTH Stim tests, but this is the first time we've been able to go 3 months between tests! I'm anxious to see the results! She had been doing well up to the last couple weeks. Now She seems more anxious to me, slightly higher water consumption, and definitely hungrier. Oh how I hate to start the tweaking and testing all over again! I was so enjoying having more money in my pocket:)

[Dixie'sMom]

Ok. I'm feeling better now. I just read a thread where LuLu's Mom was thanking Marianne for providing the documentation for Steiny's mom to beat her Vet over the head with. :D :D :D

[Dixie'sMom]

Elsie's Mom, thanks for checking in on us. Yes, it will be nice to get to the place where you are. I really hope Elsie is responding to something else (cooler temps, better appetite?) instead of a rise in her cortisol. But you know her best, so hopefully it won't take much tweaking. I'll have to go read Elsie's story. Do you have pictures? I love to look at the pictures of the furbabies. Such sweet faces to be going thru all they have to go thru. I will say a prayer for you and Elsie Friday and please let me know how things go. I will be keeping my fingers crossed (or as they say here, paws too!) for good results for your baby girl.

[FemaleK9]

Yup, that's how we roll!

[doxiesrock912]

Too many of us have had to beat vets over the head. You definitely aren't alone.

[Elsie's Mom]

Thanks Dixie's Mom for the prayers and the crossed paws! I really believe she'll need an increase, and hoping we can get the dosage right the first time. When I went home to pick her up and take her to the vet, she had peed twice on the floor (in less than 3 hours!), and was hyper and panting like crazy in the car on the way to the vet - firming up my belief that she needs an increase. Hope you get good news from your vet! Enjoy the weekend!

[jillmst]

I think you all make very good points and its an interesting discussion. Her first ACTH is actually falling the day before I leave which will be 14 days since beginning treatment. But this raises another question in my mind. If she goes for the test 4 hrs after her meds at 10mg twice a day, then she would only have the 10 mg in her system at the time of the ACTH vs 20 mg at once a day dosing. So even tho both ways she would be getting 20mg/day, could the ACTH show different results depending on once vs twice day dosing? hmmmm...

I'm really not too worried about her being overdosed on either method as 20 should be pretty safe for her. But yes, Sharlene, I will be worried about her. I will torment my children via cell phone the whole time I am gone. They are adult children (35 and 21) so they can take it.
I was wondering the same thing! I was giving Charlie 20mg at midnight every day just because it fit best with our work schedules, but after doing some research I was thinking of maybe giving 10mg in the day and 10mg at night instead... but would that construe the next ACTH test?

Sorry guys, I should introduce myself -- I'm Jill and I'm new to the site and have been reading this thread, thanks to everyone for all of the great advice and information!

Last time my pup Charlie had an ACTH test he was doing the 10mg at midnight, and because of the times that the clinic is open we did the ACTH at 8am in the morning, which seems too late after his dosage, but there didn't seem to be any other way. Afterwards, the vet upped his dosage to 20mg a day. How can I be sure that the next ACTH results are as accurate as possible?

[jillmst]

p.s. Susie you sound like a great mom and Dixie is lucky to have you looking after her so well! :)

[Dixie'sMom]

WOW. I want to thank everyone who has listened to me, encouraged me, educated me, befriended me, and in general been there for Dixie and me for the last month or so. Her ACTH results came back pre 3.5 and post 6.4 with normal being between 1 and 8. Two different vets wanted to start her on 30 mg Vetoryl but because of you guys I insisted on 20mg since she weighs 19 lbs. That appears to have been the perfect dose for her. I am so pleased and relieved. And I think my vet was absolutely stunned. haha! :D I will never be able to thank you enough.

So if there is anyone reading my thread who is still blindly following all their vet's advice even when the members here can prove that it is bad practice, STOP now if you love your pet. Real life experience beats book learning every single time.

Elsie's Mom, poor Elsie. She's having a bad day. I wonder if she picked up on something and knew something was going to happen today. I know my dogs can pick up on my "vibes" and sometimes they will act out. I bet she is having a rough night too. I said a little prayer for her and will say another that she settles down and has a much better today tomorrow. Please let me know when you get the results of her test. I care! I looked for a thread for her but couldn't find one. :( And I want to see a picture too.

Hey to Jill and Charlie! I'm so glad to meet you both. I'm sure not the best one to answer your questions, so hopefully someone will check my thread and be able to give you some helpful info. I will check out Charlie's thread so I can learn all about him. :) Thank you for saying I'm a good mom. I try to be and know that I will be much better when I have that experience under my belt. Not that I ever wanted that experience but sometimes we don't get to choose do we? I think everyone here is exceptional where their pets are concerned. I've read about what some of the others have gone thru and I'm not sure I would have had the strength to make it as long as they did -- broke, sleep deprived, exhausted, juggling work, family and a sick pup. So thank you again even tho I have not done anything but seek out the best way to care for my little girl. I'll go visit your thread now. :)

I hope everyone has a happy weekend and all the cushbabies get some sort of special treat to celebrate the weekend. :D

[Harley PoMMom]

Her ACTH results came back pre 3.5 and post 6.4 with normal being between 1 and 8.

Those look like good numbers to me!! Good job, Mom!! How are Dixie's symptoms?

Hugs, Lori

[Dixie'sMom]

Thanks Lori. Dixie's symptoms are much better, although I wouldn't call them "normal". She is drinking about 2-3 cups of water less per day, so peeing less. She actually left a little bit of kibble in her bowl this morning, so this is a new development. Her potbelly has gone down slightly. But its only been 17 days since she started treatment so I'm hoping things will continue to improve. She does appear less anxious and more content, and with the cooler temps outside, she is more active and playful. I'm very pleased with how she is doing so far. :)

[jillmst]

That's awesome that you found the right dose for Dixie, and glad to hear her symptoms are easing a little!

[molly muffin]

There is every possibility that her cortisol will continue to drop and you'll see a continued decrease in the water consumption and food intake in the days ahead.

This is a very good test results and right where we want her to be right now. I think that 20mg is a good dose for her and you did an excellent job with the vet in getting it right for your girl.

Awesome job!
hugs
Sharlene and molly muffing

[FemaleK9]

Congratulations on Dixie's excellent results on the ACTH test! You can take the credit for that, coming here and finding out so much information about Cushings and medications, and standing up to the vets for Dixie's sake! Yay for you!

[Dixie'sMom]

Dixie is still doing well on the 20mg trilostane. I am watching that pot belly closely for more improvement but it is sure slow in coming. In fact, the slight decrease is actually enhancing the appearance of the huge swelling in the right side of the belly. I am assuming this is her liver since it was significantly enlarged on ultrasound. She also had the elevated liver values on 7/31. She will go for another ACTH in a few weeks and I plan to make sure she has blood work done to see if her values are coming down any.

My question. It was recommended at the start of her diagnosis by all of you to put her on a liver supplement. I spoke to the vet about this and she said that it has not been shown that they improve anything so she didn't recommend them. I didn't argue with her, but I have not forgotten your recommendations. I can't forget because I think about it every time I see her belly. The left side is obviously enlarged but the right is noticeably larger.

I am considering putting her on sam-e and milk thistle OTC since I can't get a prescription. I'm also considering just not telling my vet. I need your opinions, and recommendations for a source and dosage if you agree Dixie could benefit from the supplements. As always, Thanks a million!

[molly muffin]

I would check amazon.com for denamarin or something with milk thistle and sam-e (S-Adnysol) (that might be spelled wrong). I don't think it hurts to support the liver with these supplements and I know my vet and my IMS both said it would be okay to use them. Some vets advocate for them.

It will usually say on the bottle, how many to give based on weight.

Glad Dixie is doing so well.

hugs
Sharlene and molly muffin

[Harley PoMMom]

In our Resource Forum we have a thread that has links to articles regarding liver supplements, here's a handy link to that thread: Milk Thistle/Sam-e and more (for liver "support") (http://www.k9cushings.com/forum/showthread.php?t=192)

Hugs, Lori

[Dixie'sMom]

Thanks Ladies! I keep forgetting about the other forums and all the info there.... Or maybe I just miss y'all and need to see a post from you. hahaha! <3 :)

[molly muffin]

Oh we are here definitely. :) :)

Did you check amazon.com? You can order liver supplments, like denamarin there.

hugs
Sharlene and molly muffin

[Dixie'sMom]

I did check Sharlene and am going to order tomorrow when I get online to pay bills. *sigh* Watch that money fly out of that bank! lol.

[molly muffin]

I hear ya Susie we have been to the IMS twice this month. The bank is getting lower. Luckily for now I am getting decent hours at work.
Glad you found something.

Hugs
Sharlene and Molly muffin

[molly muffin]

Hey Suzie, how are things going with Dixie? How are you doing? Checking up on you two. :)

hugs
Sharlene and molly muffin

[Dixie'sMom]

Hey Sharlene! Thanks for checking up on us. I've had some head and chest crud so I've been feeling kinda lousy. I've felt better today so I hope the worse of it is over. Dixie is her normal bossy self--fat and sassy as ever. She's still doing well on the trilo. She's due for a follow up ACTH. I'll probably do it the first week in Nov and have her blood work done to see if those liver values have come down any. I still haven't started her on any liver supplements but did see several options on Amazon so I plan to start that after the blood draw.

I hope you and Molly and the hubby are doing good. I need to check your thread to see what is next on the calendar for y'all. I remember hubby has surgery in Nov, but can't remember what's next for Miss Molly. I know you have been searching out foods for her kidney health. I don't know what you decided tho.

Thanks again for checking on us! Hugs and Love!

[jas77450]

Just popping in to say hi and see how your doing.

[Dixie'sMom]

Cosmo's Mom, thanks for stopping in to check on us. We are all doing fine. Dixie will go in for an ACTH and blood chemistries the second week in November. The vet called yesterday to check on her which I thought was very sweet of her. One interesting thing is going on with Dixie which I discussed with the vet. She appears to be having a false pregnancy. She is carrying "her baby" (a hot pink mesh fish) around everywhere (even out to potty) and her nipples have enlarged quite a bit. I had heard the others here talk about how once the cortisol is suppressed, sometimes the other hormones increase. I wondered if that's what was causing it. The vet said it was probably unrelated to the Cushings, but it did sound like she was having a false pregnancy and not to be surprised if she got milk. Lord have Mercy! Its actually kinda cute to watch her. If you try to play with her baby and throw it, she gets upset and hides it. haha!

I hope you are doing ok. I think about you every time I see Cosmo's picture on your avatar. He is such a cute fellow. (I say "is" instead of "was" because I believe their spirits live on.) I know you miss him so much. Hopefully one day when the loss isn't so fresh and the grief isn't so bad, you can give your love to another furbaby who needs a great Mom like you. Until then, hugs and prayers and we're always here for you.

[molly muffin]

Well, isn't that interesting. A false pregnancy. Maybe some of the others will know if that happens with the hormone change. I don't recall it myself but who knows. It can change the sex hormones, so anything might be possible.
That is so cute carrying the pink fish around though, but milk! oh my.

Hang in there. If that happens to molly I might have a heart attack!

hugs

[Dixie'sMom]

LOL @ Sharlene! Hopefully Molly won't do anything quite so crazy. I've always said living with Dixie was like having a cartoon dog. Maybe it's a dachshund thing... who knows. But I really hope she doesn't go so far as leaky teats!

[jas77450]

Suzie,
Couldn't help but laugh at the visual of Dixie carrying around her baby...that's too cute. Then hiding it.
Thanks for asking about me...having a better day today, it's up and down. I like you believe their spirits live on and someday we will unite with them forever where there will be no more pain, suffering or goodbyes. Won't that be wonderful!
Hugs and love to you and silly Dixie!!!

[molly muffin]

Saw you had popped online earlier, so do tell... milk? still carrying her baby fish around?
Inquiring minds want to know!!!

hugs!

[Elsie's Mom]

Hi Dixie's Mom! I glanced at your post because my Elsie is a doxie, and I had to laugh because Elsie has a couple "puppies" that she carries around when she gets nervous! But, when we're gone and Elsie is home alone, she hides her "puppies" under the bed in the guest room! Then when we come home she races in there and gets them out from under the bed! She's always carried them around, but this hiding them under the bed is relatively new! Doxies are fun!

[Dixie'sMom]

Hey Sharlene and Elsie's Mom. Thanks for stopping by to see us. Dixie, thankfully, has not gotten any milk. Her fish has lost all its fins and most of its tail now so we bought her an identical new hot pink fish and Buttons a new dolphin. Dixie, of course, claimed them both and took them to her hoarding cave right up under my bed. So after a few days she was pretty much dividing her time between the new and old baby. The dolphin and Owl are Buttons, as well as some other toys, but they all have to live in the hoarders cave too. *sigh* Yes, the doxie's are so comical. And poor Buttons is just resigned to the fact that she'll never get to keep her new toys, so she just jumps on the couch or bed with mama for revenge because Dixie still can't jump.

I was thinking about Molly today and wondering if she was still doing ok on the trilo. Elsie's Mom, I wish you would start a thread on Elsie even if you don't need any help so I can pop in on you and see Elsie's picture. I love the pictures of the pups. I hope Elsie is doing ok and all is well at your house. Does she like to tunnel up under covers to sleep? Dixie does and it can get really amusing to watch at times. Especially when someone comes and she can't get out from under there so the blanket goes racing across the floor barking. haha!

We go for an ACTH and bloodwork next Wednesday. I'm still really concerned about Dixie's big pot belly, but realistically she has only been on meds since September so I guess maybe I'm being impatient. I just worry about that enlarged liver. I do have supplements that she will start after the blood draw. I want to see what those numbers look like first to have something to compare it to after starting the liver support. That's all thats happening in our world. You two ladies fill me in on your girls.

[jas77450]

Wishing you the best on the upcoming labs...you girls are so funny.

[Dixie'sMom]

Well I'm thoroughly confused. I thought I had a grip on all of this but I've realized that I don't know how to handle the curveballs. Dixie had her ACTH and some blood work done yesterday. The vet called this morning and gave me the results and then emailed me a copy at my request. The results look weird to me. It's still IDEXX but the lab and ACTH results are together. She said that Dixie is actually a little low and that we definitely did not want to increase the dosage of trilo. To watch for any signs of vomiting, diarrhea, loss of appetite, etc. That if she continued to do well then bring her back in 6 months for repeat stim. She said that her labs were still abnormal. One had come down a little and one was up a little, but she wasn't too worried about it. Said that her glucose was up and she was prediabetic and to get some weight off of her. Give her green beans and low calorie stuff and cut back on the kibble. This vet isn't the one that did her bloodwork in Sept so I don't know if the values changed or what, but I remember it was an IDEXXX lab. I'm guessing the ranges may be different. She has written different numbers beside of the typed numbers. :confused:

At the Top it says CHEM11
Abnormal values:
ALP 412 (5-160) U/L She has written beside of it 431
ALT 318 (18-121) U/L She has written beside of it 307
Creatinine 0.4 (0.5-1.5) mg/dL
Glucose 121 (63-114) mg/dL She has written beside of it 125

ACTH STIMULATION
PRE ACTH CORTISOL 1.9 ug/dL range 2-6
POST ACTH CORTISOL 5.2 u/dl range 6-18

<2 consistent with hypoadrenocorticism
1-5 Desired pre and post ACTH cortisol on lysodren therapy

Dixie takes trilo and not lysodren so are the ranges the same for both drugs?

Do I need to stop her meds?

She was not fasting during this blood work because I was more concerned with the stim test being accurate than the blood work. She had her trilo with food as usual.

She's eating BBuffalo Weight control formula now. Anyone know o a lower calorie weight control food?

Other ideas for low cal snacks besides green beans?

I'm concerned with the stim results as well as the glucose. If she gets diabetes both Dixie and I are going to be in a world of a mess. I cannot see well enough to fill a syringe with insulin, so I have got to get this number down.

I hope this makes sense to someone. Your thoughts please??? and thanks in advance. I'm not a happy camper. :(

[Harley PoMMom]

Dixie's ACTH stim numbers are fine, her pre number is a bit low but her post number is fantastic, if this were me I would be pleased with those results, so, I don't know why the vet is concerned.

Ranges are different between Lysodren and Trilostane, with Trilostane the range is 1.5 ug/dl - 5.4 ug/dl and the post can be as high as 9.1 ug/dl as long as the symptoms are controlled. Now, with Lysodren one wants to see the pre/post between 1 ug/dl - 5 ug/dl.

And you were absolutely correct with giving her Trilostane with food on the day of her ACTH stimulation test, Trilostane always has to be given with food to be properly absorbed.

You are doing a wonderful job!! Congrats on those ACTH numbers!!

Hugs, Lori

PS, I wouldn't worry about her glucose as of yet. ;)

[Dixie'sMom]

Thank you for the quick reply Lori! That took 1/2 my worry away. I think this vet is actually more used to working with Lysodren that Trilo. But that blurb on the lab results sure makes it confusing to the pet owner.

Now to get the weight off of my chubby girl!

[Harley PoMMom]

In my post I wanted to include a link to Dechra's product insert, that way you can see those reference ranges for yourself, so here it is: Dechra's U.S. Product Insert
(http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf)

And again, GREAT JOB, MOM!!!

[molly muffin]

Hi Suzie, glad that Lori was able to get you are reply right away. :) I wonder if the numbers written beside the typed numbers aren't the numbers from Sept, so you could see the comparison. (you can call and ask her about that if you want, but that is my guess)

The blurb you are talking about is for testing of a dog that is not on medication, usually as part of a diagnosis. Some labs will then have an extra blurb portion that says range for a dog being treated with trilostane and range for a dog being treated with lysodren.

I don't remember, but think you started Dixie on liver supplements? Does that include sam-e? I hope that eventually her liver numbers will come down some. I was just reminded today that with one of our members, the liver numbers went up before they finally almost 8 months later they came back down, so it can take awhile.

You're doing good and so is Miss Dixie. :)

hugs

[Dixie'sMom]

THANKS LORI! I'll print out the reference and try not to panic next time. I also just saw your comment about the glucose. I feel better now. WHEW! :D:D:D

[labblab]

She said that Dixie is actually a little low and that we definitely did not want to increase the dosage of trilo.
Suzie, it concerns me quite a bit that your vet would say this in view of Dixie's post-ACTH result of 5.2. Because as you will see from that Dechra monitoring spreadsheet, a dog who remains symptomatic with a post-ACTH greater than 5.4 would be a candidate for an increase. So Dixie is actually at the high end of the ideal therapeutic range and not the low end. If her symptoms remain well-controlled, then there is no issue. But if her symptoms start rebounding down the road, then a small increase in her dose may indeed be in order if her cortisol starts creeping even higher. Your vet's comment makes me worry that she is not familiar with the desired monitoring ranges for trilostane -- or Lysodren either, for that matter, since the ideal post-ACTH result for a dog on Lysodren should not exceed 5.0.

Marianne

[judymaggie]

Suzie--I am glad that the experienced folks here could reassure you about Dixie's test results! You are doing a great job taking care of Dixie. :D I had the same thought that Sharlene did about the hand-written numbers because that is what I always do in order to compare results.
Re trying to cut back on calories--do you give Dixie any non-veggie treats in between meals? If you are, you could gradually reduce those. If Dixie is anything like Abbie re food, you don't want to withhold food suddenly. If Dixie is doing good on the Blue Buffalo in terms of digestion, I think you ought to stick with that for now. Changes in food can have all sorts of repercussions. In addition to green beans, you could try carrots or pieces of apple.

[Dixie'sMom]

Sharlene - I went back and checked the old lab results and she did write in the old numbers, but it doesn't even make good sense to me because the ranges were different so you would have to do some math. And maybe she did do the math. I think I glazed over when she said "a little low" and "prediabetic".

I have sam-e with milk thistle (s-adenosol) but didn't start her on it until last nite. I wanted to get yesterdays testing done first so I could compare results after she has been on it for a few months.

Marianne - what you are saying makes much more sense to me than what she said because I actually felt/feel like Dixie needs about 5 more mg of trilostane. She is slowly creeping back up on her water consumption and her appetite has only been slighty better with treatment. I'm happy with how she is doing overall but have felt from the beginning that she could be a little better controlled. She is just unsatisfied and still hungry and you all know what it's like with dog that is begging. Its just sad and I feel bad for her. Also, the results of the stim weren't flagged as High or Low by the lab so I questioned that because it should have been flagged if she was low.

I think I will send the vets office an email with Dechra's info attached and tell her that I am confused and see what she says. I think she is going by the ranges on the bottom of the lab work which has a reference citation of Feldman, 2004. I wonder if their lab software has been updated in the last 10 years? Holy Cow. I need to pull my head together. In the meantime, y'all just keep me straight and I'll try to keep her straight. There is one more vets office nearby, but I really wanted to stay with this one since they do have an ultrasound machine in case we need something done quickly. Thanks ladies. You're the best!

[Dixie'sMom]

Thank you Judy for the diet suggestions. Yes, Dixie actually does well on the Blue Buffalo as far as digestion and poops. No issues there. She does like apples and carrots, and she likes the green beans. My whole family spoils both dogs so they get entirely too many other kinds of treats. She currently eats 1/2c kibble twice a day. I think I will try to cut her back to 1/2-3/4 cup and supplement with your suggestions and see if that helps. Thank you sweetie! I hope Miss Abbie is feeling good today! :)

[My sweet Ginger]

Could it be that she was going with the reference ranges for normal, untreated dogs of 6-18? Then Dixie's 5.2 could be considered as low but how could she not know that, right? But then what she said just doesn't make a lot of sense does it? :rolleyes::rolleyes::rolleyes:

[judymaggie]

Suzi--how much does Dixie weigh? Reason I ask is that Abbie who weghs 26lbs. also gets 1/2 cup of dry food in the a.m. and again in the evening. I do mix in a tablespoon of canned Royal Canin low fat food. I also wrap Abbie's pills in the canned food and she a piece of a biscuit when I leave the house. Now that is on so many pills I am trying to use less canned food. I wish I could just stick them down her throat like I did with my last dog. Anyhoo, when Abbie starts to get chunky, I cut back on the treats and canned food. If I am consistent with that, I usually see changes pretty quickly. Maybe you can tell your family members that the treats are preventing her from getting better--a bit of a stretch but they might buy it.
Abbie is doing good--a little blip this morning after her morning Lysodren. I think it briefly upset her stomach--she actually refused a treat when I was leaving the house. I was anxious about her the whole time I was out but she was absolutely fine when I got home and we had a worm-free evening walk!

[Dixie'sMom]

LOL@ MySweetGinger - I don't think I trust any of these vets. If it weren't for y'all they would have already killed my dog via Vetoryl OD. In her defense I will say that I was awakened by her call and may not have heard everything clearly and that's why I was relying on the copy of the results to clarify things... which It didn't 'cause it looks like it came from 1000BC.

[Dixie'sMom]

No worms today - Go Maggie! haha!

Well now its confession time. Dixie is a mini so she is supposed to weigh 8-10 lbs. She weighs 20.6. And I wrap her meds in a hotdog.

*sigh* Now I get to figure out how to stuff them in a greenbean.

[labblab]

Hi Suzie, actually, the lab's notations about the ACTH results are current, as far as they go. The only problem is that they don't contain a reference guide for trilo users which is a bit odd. But aside from that, they are accurate and reflect the fact that the ACTH is used both as a diagnostic test prior to treatment, and also as a monitoring test after treatment has begun.


ACTH STIMULATION
PRE ACTH CORTISOL 1.9 ug/dL range 2-6
POST ACTH CORTISOL 5.2 u/dl range 6-18

<2 consistent with hypoadrenocorticism
1-5 Desired pre and post ACTH cortisol on lysodren therapy

The posted "ranges" are the norms for dogs without Cushing's and reflect the use of the ACTH as a diagnostic test for both Cushing's and for Addison's disease. This was the original primary use of the test, and is typical for all labs that analyze ACTH results.

The <2 notation relates to diagnosing naturally-occurring Addison's, again when compared to a population of normal dogs without either disease.

The 1-5 range is self-explanatory: it is the desired range when the test is not being used diagnostically, but instead is being used to monitor treatment for a dog taking Lysodren.

So the only thing missing is the therapeutic monitoring range for a dog taking trilo, which I agree is surprising since so many dogs in the U.S. are now treated with trilo. However, all the other info is accurate, and your vet ought to be aware of the differential use of the ACTH as a diagnostic and also a montoring test, and what these different ranges mean depending upon the context within which the test was ordered. :o

And you can still use hot dogs for pills -- just get the fat-free low-cal chicken or turkey franks (that's what I buy to fight my own battle against the bulge ;) :D).

Marianne

[My sweet Ginger]

That's the big worry I have for the pups, some vets are not careful enough to differentiate ACTH results between the diagnostic and the monitoring purposes when they read the lab references. I remember reading this happening from time to time on here.:(:(
Although the lab's references could've written a little clearer if I had it my way ;) we all assume your vet must know what they all mean 'cus they are the Drs.. I used to have a blind faith in them but no more and it is the vet's carelessness or lack of accurate info that worries me when they are dealing with a possible danger as a result.

[Dixie'sMom]

Well I thought I would check in since it's been awhile. I've been exhausted and busy and the holiday's just make me ache, but I have tried to read a little on the forum each day. I had to go back to reread some of the last posts to remember what we were doing the last time I posted. Uh... and embarrassingly enough I caused quite a bit of confusion. I went back to my answering machine at some point in time and listened to the beginning of the vet's message before I picked up and the vet did say normal is 1-9. *sigh* Don't rely on your memory when you are mostly asleep.

Ok so Dixie is doing well. She is still acting more hungry than I think she should but we are still working on her weight loss so hopefully as her weight continues to decrease, her appetite will too. I started her on S-adenosol and it makes her hyper! Oh Dear Lord! Her potbelly began going down almost immediatey, but she barks continuously and pants and acts like her cortisol is up after giving her the pill. I'm trying to remember to pick up a pill spliter and see if 1/2 of the 100 mg dose works better for her. As it is, I am only giving it to her about 3 times a week instead of daily. But I have noticed less belly swelling so I do feel like this is helping her.

That's it for us. Just busy like everyone else and still trying to muster up some holiday cheer. HO, HO, HO! :D:rolleyes:

[FemaleK9]

Your memory is probably correct. Rosie's ACTH test results included this note:

"Post Trilostane: Pre and post cortisol levels between 1.5 – 9.1 ug/dL indicate optimal control"

- to which we on this forum have added "... if clinical symptoms are well resolved" especially when results are on the high side of that range.

[judymaggie]

Hi! Good to hear from you and great to hear that Dixie is doing well! I'd have to go back and read to find out if you were giving Dixie Denamarin before the S-Adenosyl. I have been giving Abbie the Denamarin daily for a few weeks now and haven't seen any negative side effects. I also don't think Abbie's pot belly has reduced at all. :( Just now awaiting a bottle of S-Adenosyl -- switching due to a better price for the latter. A big hug to Dixie!

[Dixie'sMom]

Hey Judy and Karen! I've missed y'all. :) Karen, my confusion came into play when the copy of Dixie's stim results listed the values for dogs without Cushings which was different from dogs being treated for Cushing's and those values weren't listed like your results. Marianne so kindly got that straight for me and I was part of the problem in that I didn't interpret the vets statement correctly because I was asleep when she called. So I think all is well now. I hope Miss Rosie is doing good. I did read that you have surgery coming up, so I will be checking your thread as much as I can to check on you.

Judy, this is the first supplement that I have tried Dixie on. I chose it because it has the Sam-e as well as the milk thistle and it was so much cheaper than Denamarin. I'm not sure what to do now. Be sure to let me know if Abbie gets hyper. LOL. Dixie gets restless and all crazy eyed and barks and pants and just acts all unsettled. I had not noticed Dixie's potbelly improving with Trilistane either until I added the S-Adenosol so I feel sure it is the supplement that is causing the belly to look better. Don't get me wrong, it's still big, but it is going down. I've checked in on Abbie a couple of times but haven't posted. Most of the time these days, I'm almost brain dead. I'm better today because I slept 13 hours last nite. whoops....

[judymaggie]

Susie--just read about side effects associated with sam-e and there was a comment that caution should be used when treating hyperexcitable dogs as sam-e can heighten moods. Nothing along that line related to milk thistle so it is probably the sam-e that is affecting Dixie. Maybe think about just giving her plain milk thistle?

Enjoy the sleep when you can get it! I got a Prolia shot today so am achy tonight. So glad I am retired so I don't have to get up early.

[molly muffin]

Merry Christmas Susan, Dixie and Buttons.

I hope you are having a Merry Christmas and have a good holiday season!

hugs and love

[molly muffin]

Happy new yea Susan, Dixie and Buttons

Hope you have a wonderful new year.

Hugs

[Dixie'sMom]

Thank you Sharlene and same to you and yours!

[molly muffin]

Hey Susie, just popping in to say hello and give Dixie some belly rubs. Hope all is well with you and the gang. :)

hugs

[Dixie'sMom]

Thanks for checking on us Sharlene. We are all doing fine. I plan to schedule Dixie for some fasting blood work this month to see how her liver numbers look and come to think of it, she's probably about due for another stim test. (If so, I won't do those on the same day)

We have had some really cold temps here and a few snow episodes and some sleet. The girls love the fluffy stuff but none of us enjoy the sleet and freezing rain. Next week should be a warm up for us so I'm looking forward to that.

Dixie thanks you for the belly rubs. Buttons said its her turn next time. :D I hope you and Miss Molly, the hubby and the BIL are all doing ok. I need to check your thread! :)

[molly muffin]

Hey Suzie :) How are you and Dixie doing & Buttons too of course. :) You can give them both belly rubs from me and molly.

hugs

[Dixie'sMom]

Hey Sharlene! Thanks for checking on us, and the girls thank you for the belly rubs. :) We are all doing just fine. Dixie and Buttons are both well and happy to have green grass to roll in. :D They have found more than a few jelly beans from Easter outside which either get wolfed down (Dixie) or buried (Buttons).

I've had quite a bit going on in my personal life lately Lots of friends with serious illnesses, more than a few deaths, and other things which has caused me to stay off of the internet more lately and seek escape in a good book or sitting in the yard with the girlies (no, I cant see books, but I can read them electronically) I think of all of you every day and will be around more often when my mental health allows. Thank you again for checking on us. Prayers and XOXO's to you all!

[molly muffin]

Oh no Suzie. Sorry to hear of so many sad issues going on for you.
There is not much I enjoy more than sitting outside with a good book. I can totally escape into a books world.
Glad to hear Dixie and Buttons are doing well.

Take care. Hugs

[judymaggie]

Suzie--I'm sorry there is so much sadness surrounding you. When I am feeling down, a long snuggle with Abbie comforts me. I'm sure Dixie and Buttons will enjoy the extra attention!