11 year old shih tzu - Bella - with recent cushing's diagnosis

[Brooke]

Hi to everyone, I've been reading posts to the forum for about a week now and wanted to introduce myself and my Bella and also ask some questions since everyone here is very familiar with cushing's. My Bella is 11 years old and recently was diagnosed with cushing's after an acth test. She had originally went in for a dental cleaning a few months ago and had some blood work come back with high liver enzymes. I'll post all blood work results shortly when I get everything organized. We thought it could possibly be from the Temaril - p, so we gave her about six weeks off of the temaril and also gave her sam-e. Bloodwork after all that showed the alkp coming down, but not enough for my vets satisfaction, so we were sent to a small animal specialist for acth test. She came back positive for cushing's. About a month ago, she began to have problems with excess bile in her stomach at night which she has had in the past. She licks and swallows alot during the night. She's not throwing up, but I know if I didn't feed her really early in the morning, she would throw up the bile. I know that the Cushing's causes increase appetite (she definitely has this symptom), and this might be causing the excess stomach bile. So I'm wondering if the disease is progressing and maybe if any of you have had a problem with excess stomach bile and vomiting with your cushing's babies prior to any treatment. For now, I am opting to hold off on the teeth cleaning and meet with my vet on Friday to discuss his suggestions for what to treat first, we've got the bile issue now, along with a desperate need for a teeth cleaning and also how/when to start treatment for cushing's. Any insight or advice you all can give would be greatly appreciated. :) I want to do everything I can to get her healthy and happy .. i know with treatment, she can live with this disease and even can improve her quality of life. By the way, the outward symptoms she is showing of cushing's are increased appetite, pot belly, and some skin issues. She never has increased her water consumption, the specialist that confirmed her cushing's says that 15% of dogs with cushing's do not have excessive thirst. She was very sure that she definitely has cushing's based on symptoms and the acth test and she has had lots of experience with cushing's, so I'm pretty confident she is right. Ok, I'll stop there for now and check back in later. Thanks in advance for any information.

[Squirt's Mom]

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[lulusmom]

Hi Brooke and welcome to you and Bella.

So sorry for the circumstances that brought you here but I'm glad you found us. In order for us to provide you with more meaningful feedback, we'll need more information and/or clarification from you. Asking a bunch of questions of new members almost makes it seem like an initiation but I assure you it's all necessary to help you become the best advocate you can be for Bella.

Can you please round up copies of all tests that were done to diagnose Bella? With respect to the blood chemistry and complete blood count (CBC), you need only post the highs and lows and please include the normal reference ranges. The results of the acth stim test will be easy to post as it has just two numbers, a pre cortisol and a post cortisol.

An acth stimulation test does not tell you what form of cushing's a dog has so a differentiation test is normally done to determine this. With Bella's bile problem, I would think an abdominal ultrasound would be an excellent idea before you start treatment for cushing's. This would give the vet a good view of the adrenals to determine which form of the disease Bella has and it would also give the vet a good look at the internal organs for the common abnormalities associated with cushing's as well as organ problems not associated with cushing's that may be contributing to Bella's symptoms and stomach problems. With respect to determining the form of cushing's, the majority of dogs have pituitary dependent disease but there is 15% to 20% chance she has an adrenal tumor in which case surgery could be a complete cure if Bella is a good candidate. If my dog had an adrenal tumor, I would want to know as these can be extremely invasive and malignant.

Licking the air and the floor does seem to be something a lot of members report; however, vomiting bile is not a symptom of cushing's but it is indicative of a dog who is not well, and dogs who are not well should not be given Vetoryl (Trilostane) or any other treatment for cushing's. Dogs with severe dental disease can have bacterial infections that can cause myriad problems so if Bella were my dog, I'd consider having an ultrasound done directly after a teeth cleaning as Bella would already be sedated. Of course that depends on whether your vet has a high quality ultrasound machine in her office. Most gp vets refer patients out to specialty facilities. By the way, dental disease and anything going on in the gut can increase ALKP.

Looking forward to hearing a lot more about your precious Bella.

Glynda

[Brooke]

I too am also leaning towards an ultrasound to confirm which type of cushing's and also if there are other issues going on that may even be related to her teeth. I am at work but will post blood work results this evening when I get home... i do not have the acth results with me but can get them maybe today, if not I will pick them up at the Friday appointment. She said her acth number was not off the chart but it was a high number. Thanks again for any input or recommendations, I will be checking in often.

[Brooke]

I am waiting on the specific numbers from the acth test, doctor is supposed to call me back with them in the morning. I will then post all blood results at one time. Thanks again!:)

[lulusmom]

Thanks for checking in. We'll be here waiting for your next update.

[Brooke]

Ok, I have her numbers. She has had 3 different blood tests and the acth test. I will only list numbers that are high.

- pre dental bloodwork on 4/4/14

BUN 30 mg/dl Range (7-27 mg/dl) HIGH
ALT 109 U/L Range (10 - 100 U/L) HIGH
ALKP 586 U/L Range (23 - 212 U/L) HIGH

- bloodwork on 6/6/14 ( I opted for the larger panel)

HCT 59.6% Range (37-55%) HIGH
HGB 18.6 g/dl Range (12.0 - 18.0 g/dl) HIGH

BUN 39 mg/dl Range (7-27 mg/dl) HIGH
ALB 4.0 g/dl Range (2.2 - 3.9 g/dl) HIGH
ALKP 1861 U/L Range (23 - 212 U/L) HIGH

**ALT went back to high end of normal range

- bloodwork on 8/1/14 ( I went back to smaller panel, so no HCT or HGB, also she was taking SAM-e daily)

BUN 30 mg/dl Range (7-27 mg/dl) HIGH
ALT 124 U/L Range (10 - 100 U/L) HIGH
ALKP 1342 U/L Range (23 - 212 U/L) HIGH


Ok, for the ACTH stim test, the doctor this morning did not give me units, but I am assuming ug/dl since I am in the US. ( See I already learned something from you guys! :)

Pre test : 2.4 ug/dl
Post test: 46.6 ug/dl (YIKES)




Ok, the doctor who did the stim test said this is a high number but not way super "off in the stratosphere" high, she has seen higher. But a definite Cushings positive. Also, she did say it is ideal if I am willing to pay for it, to do an ultrasound to rule out an adrenal tumor (wish she would've of said that to me first because obviously I'm looking for ideal here). My question to you all is, being that she is a smaller breed and also that her post number is so high, would you all say there is a higher than 85% chance she is a pituitary cushing's dog? I'm still doing the ultrasounds, but I'm just curious your thoughts.


Ok, about her licking and being somewhat nauseous at night, she hasn't thrown up bile recently, but I can tell she has more bile in her stomach during the night and I can head off the vomiting with a snack. This is something that just showed up again about a month ago when these bloodwork numbers were also looking funny. It's also like she as a thick slimy clear spit or mucus in her mouth during the night, causing her to swallow.

She used to be real queasy in the morning when she was a puppy up until about the age of 7 and might throw up a little bile if she didn't eat, so that's why I recognize the symptoms. I'm wondering if the cushing's is increasing her appetite so much that she is becoming hungry during the night and producing the bile as a result of increased hunger. Or I thought it might just simply be her bad teeth causing the saliva issue, but if so, I don't understand why just at night time. The stim test doctor did not seemed concerned with it and said it is a common thing that can be controlled with some Pepcid. I will talk with my GP vet more on Friday, I have an appointment with him to review what he thinks is the best sequence of events. We are dealing with an ultrasound, teeth and then treatment of cushings so far... yikes!

So any input is appreciated, I am curious to know what you all make of the numbers. Thank you so much again, talking this out is definitely helping my anxiety! Also, I will try to post a pic of my little Bella!

[molly muffin]

Hello and welcome to the forum from me and molly.

Being hungry could be the reason she produces bile at night. We've had several people mention the licking, swallowing, with cush pups and the increased appetite could make them have upset tummys. It isn't uncommon for cush pups to display gastro issues off and on.

It looks like the BUN is coming down which is good. Uncontrolled high cortisol can have an effect on the kidneys and protein processing. It appears that the sam-e, liver support is working on the liver enzymes, which is what you want them to do.

Unfortunately, the ACTH while it does show accurate cortisol levels and reserve held within the adrenal glands tells us nothing as to whether it would be pituitary or adrenal cushings. The majority of dogs have a very small pituitary tumor. A few have active adrenal tumor masses, which is one thing that the ultrasound can tell you. If an adrenal tumor is the cause, usually you will have one adrenal gland larger than the other. If both are normal size or bilaterally enlarged, then it is most likely due to a pituitary tumor. A good reason to get the ultrasound and in general have a look at liver, gall bladder, spleen, kidneys, etc. I'm glad you are doing that.

It is always a bit scary when you first get the diagnosis of cushings, but the more you learn about it the better advocate you will be on this journey. Knowledge is key, as is a good vet team.

We'll be here with you the entire journey.

Sharlene and molly muffin

Sharlene and molly muffin

[Brooke]

Thank you for the reply Sharlene,

I have been reading different threads after I posted the blood results and noticed that your baby Molly had a positive acth test but a negative LDDS, is that correct? One thing I have been wondering, and even more so after reading your story, is that Bella does not seem overtly ill in any way. Her main symptom for Cushing's is an increased appetite with a pot belly to match ha. No increased water or urination. She does occasionally have issues with her skin, she has sebaceous cysts come up on occasion and she is also an allergy dog on a weekly allergy shot (not a steroid but a hyposensitizing regimen). The shots greatly improved her skin issues a couple of years back when we started them.

My question is I'm wondering if I should wait to treat her for Cushings when she shows more outward symptoms. She does seem healthy to me (other than the teeth issues I'm trying to address) and I really hate giving high powered drugs to her, but the alkp increase scared me (and her gp vet). I am doing like most of you and really taking my time here with the Cushing's. We will see what the ultrasound brings. I probably will get to take her in sometime next week for the ultrasound.

Also, to Squirt's mom, I read your thread on your little Squirt and wanted to send my condolences on the loss of your baby.

I am also in the central Arkansas area which is what drew my attention to your thread, what a small world.

Thanks again to everyone,
Brooke and Bella

[Dixie'sMom]

Hi Brooke! I'm Suzie and am new here. I just wanted to introduce myself since we are both beginning this journey with Cushings in our little ones at about the same time. I'll hold your hand if you'll hold mine. :)

[molly muffin]

Brooke, I didn't make any decisions regarding molly until after the ultrasound, but she has had I think it is 4 negative LDDS tests so far and 2 positive ACTH test, one of which was the university of tennessee panel, which also showed high sex hormones.
The reason I didn't proceed with any treatment for molly at that time was because she still to this day, leaves food in her bowl, doesn't even drink a dish of water a day, her urine is very concentrated, and other than the pot belly, that is about her only symptom. I still have to get her groomed at the normal times because her coat grows out quickly and she has no skin issues. It's a mystery as my IMS says about why she doesn't show any of the typical cushing symptoms. I don't know, but there is a rather good chance that we will at some point have to move on from the lignans and melatonine to more traditional medicines simply to get the cortisol down, even if she doesn't have symptoms. It's a literally day by day evaluation for us, along with the insight of all the great members here. While I am okay knowledge wise with cushings, having been on this road now for a number of years, there are others with even more knowledge and to be frank, I am never as good at looking at my own molly solely in a clinical manner as I would need to be, so I need others eyes and input.

I think you'll know more after the ultrasound, but if molly was displaying ravenous appetite and the pot belly along with the high ACTH, then yes, I would probably have started treatment with a very low dose as I am pretty conservative with the meds. I'd rather go up slowly if need be and avoid any problems, or even be able to keep her on the lowest dose possible to manage the cortisol. That is my opinion and what I would do.

Hope that helps some. Suzie, nice to see you popping in on some threads. :) good job finding your way around the site. :)

Sharlene and molly muffin

[Brooke]

Ok, ultrasound is scheduled for the 28th, and we will also be seeing the gp vet tomorrow to get his initial input on things and for him to have a good look at her teeth to see if anything pressing needs to be addressed. The good news is that my specialist vet likes to go low and slow on the cushing meds, she uses lysodren and says she has had good response with it as long as puppy parents pay attention. Geez what a roller coaster ride! I hope we can find some relief once we make it to maintenance phase. And I'm really hoping the ultrasound is good, sounds like from some threads I've read that alot of times bad things come up in the ultrasound with cushing's... :( I'll try not to over think it! I'll check back when I have more to tell, as far as little Bella goes, she doesn't know anything is wrong. But she is one of those pups that are very hard to read when it comes to pain, she will never complain, never whine, (unless she wants a treat ha). She is so strong willed, i hope that will serve us well through this. But like i said, all is well for today, and that's something, so I'll try and focus on that.

Brooke and Bella

[Harley PoMMom]

Low and slow is the motto when treating with Vetoryl/Trilostane but when using Lysodren it is usually a differnt story. Generally the Lysodren dose used for loading is 50mg per kg of a dog's weight a day being split and given twice a day. To calculate a dog's weight in kg, divide the weight in lbs by 2.2, so if a dog weighs 20 lbs then in kg that is 9.09 kg. Taking that 9.09kg and multiplying that by 50 mg = 455mg of Lysodren, now it has to be divided and given twice a day which comes out to 227 mg, this can be rounded down to 225 mg or could be rounded up to 250 mg of Lysodren, Lysodren comes in 500 mg pills so that would be 1/2 a pill. You can also have it compounded into 227 mg doses, which is known by the name of Mitotane.

I'm providing you with a link to our Resource Thread with info regarding Lysodren: Lysodren loading Instructions and related tips (http://www.k9cushings.com/forum/showthread.php?t=181)

Please do feel free to print anything out. ;)

Hugs, Lori

[Brooke]

Thanks for the info, very helpful. I'll be ready when my vet is ready to talk dosage. We're going to get the ultrasound out of the way first. Based on all of your collective experience's here, would you all say that this treatment of cushing's with medication is usually successful? Or like do I have more like a 50/50 shot at controlling her disease? I just want to be prepared for what is most likely to occur I guess. ....that's the anxiety creeping in! I'm terrified I'm going to hurt her. I will continue reading and calculate her dosage. Thanks again.

[Dixie'sMom]

Hey Brooke! Yes, right there with you with the anxiety and fear. Hopefully we will both get more adjusted once all of the initial testing is done and our girls start showing some improvement, right? In the meantime, Bella and Dixie will probably stay mad at us for hovering over them and inspecting them every 5 minutes. LOL! Well ya gotta laugh... better than crying. I'm sure we've both done plenty of that. Now we'll have to put on our big girl panties and be brave for our furbabies. We've got this. We can do this.

XOXO
Suzie

[Harley PoMMom]

Dogs with Cushing's are usually elder ones, and older dogs can generally have other health issues. The majority of our babies here have passed from things completely unrelated to Cushing's.

Cushing's is not a death sentence and is a treatable disease but success in treatment does depend on keen owner observation, a pet owner who takes an active role in their dog's treatment, and also having a vet/IMS that has experience treating dogs with Cushing's and that is knoweldgeable about Cushing's and the treatment protocols is a huge plus, many of us have had to educate our vets regarding Cushing's.

Vets have been using Lysodren for decades with great success, and usually adverse effects are only seen when a vet doesn't follow the proper protocols.

Knowledge is power, so I do recommend that you take a look at our Resource Forum, pull up a comfy chair and make a nice drink and tackle through our articles. I am confident that you and Bella will do fine, and remember, we are always here. ;)

Link: Helpful Resources for Owners of Cushing's Dogs (http://www.k9cushings.com/forum/forumdisplay.php?f=10)

Hugs, Lori

[molly muffin]

I agree with Lori, knowledge is power and with vigilance, a good vet team and medication, cushings Can be controlled. Other factors associated with an older dog can come into play of course, and a growing pituitary tumor can change things. Most dogs don't end up with a macro tumor, but some do.

We have seen dogs be on treatment for many years successfully. So, it is possible.

Sharlene and molly muffin

[Brooke]

Thanks to all for the encouraging words! Big girl panties are on now, right Suzie?! :) By the I found the pic I was looking for of Bella from last fall (the avatar photo), her groomer gave me bows and Bella let me put them on her just long enough to get a picture of her amongst the mums and pumpkins on our porch. I'm hoping we can get another good one this coming Fall, it's our favorite time of year!

[Harley PoMMom]

What a beautiful picture of your sweet girl!

[molly muffin]

She is beautiful. I love both the pictures you had of her on your avatar.

Sharlene and molly muffin

[Dixie'sMom]

Ahhh... Bella is adorable! I love looking at all the sweet faces of these babies in the group. I'm just sorry they have to go thru this. Brooke, oddly enough, Dixie's ultrasound is scheduled for the 28th too, so we are doing this thing more in tandum that I realized. haha! I will be thinking of you and Bella on that day and know you will be sending good vibes our way.

XOXO
Suzie (and Dixie too!)

[Brooke]

Hi all, just checking in, we're still scheduled.for the ultrasound on the 28th so I'll be sure and post updates.

Suzie, I will also be sending positive energy your way on the 28th, I'm hoping for good news and no surprises, for us both!

Your little Dixie is pretty darn cute too, she has a mischievous look in her eye!

Oh by the way, our gp vet recommended formatidine (pepcid ac) for her tummy and she seems to be alot less nauseous. And we went ahead and scheduled her teeth cleaning for Sept 5, and if all goes as planned, start cushing's meds a couple of weeks after that. .whew!

Talk to you all soon and thanks again for the support.

[Trixie]

Awww..Bella is so adorable. I've been absent from the board for awhile but trying to read through some new posts tonight. Just for a little encouragement-- my 10 year old schnauzer is now on medication (vetoryl/trilostane) for almost a year and half. She has had no adverse effects and Cushings completely controlled. It did take awhile, months of dose tweaking and finally symptoms began to fade away. She is pretty much back to normal...playing like a puppy and acting like her usual self.
She did not have all the Cushings symptoms..but she had enough-- drank like crazy, had a huge appetite, super high liver numbers, and panting. Thankfully today that is all gone...the liver numbers took the longest to head back toward normal range. I hope once your dog has the ultrasound you will be able along with your vet to figure out a treatment plan.
My dog also had a lot of gastro upset--even before her diagnosis and we used Pepcid a/c every night. I gave her a half tab (10mg), she weighs about 15-16 pounds. Make sure you get the regular strength tabs. I bought the generic at Target..a big box is pretty inexpensive.
Hoping all goes well with Bella, I hope you have the same success treating her that I have had with my dog.
Barbara

[Brooke]

Just a quick question, has anyone had any problems with teeth cleanings or anesthesia after their cushing's diagnosis? I know I'm being over paranoid, but Bella did have kind of a hard time after her last teeth cleaning with some wheezing, and that was about 4 years ago. She's scheduled for this teeth cleaning next Friday if all goes well tomorrow with the ultrasound. Our vet said he is going to use a special anesthesia for older dogs that's easier for her to come out of... but im more worried about her wind pipe being irritated from intubation. ..i know sometimes cushing's can affect the cartilage in their windpipe so that kinda has me extra worried... any suggestions for her after wards? Thanks in advance...

[Harley PoMMom]

Is the vet doing a mini pre-op blood panel? When my furbabies have to have surgery/dentals my vet always does a pre-op chemistry panel to check if any levels are high (mainly liver and kidneys).

I didn't have a problem with dentals with Harley, just as your vet mentioned they used an anesthesia that wasn't as hard on a senior dog, also they kept him well hydrated (IV's), on one occasion Harley even had to have a few teeth extracted.

Hugs, Lori

[Brooke]

Hi Lori,

I'm not sure if he is planning for pre-op blood work since we have had recent blood work, but I will ask and might request. I expect her alkp will still be high and possibly elevated alt. She desperately needs her teeth cleaned and I know she has to have a couple teeth pulled. I'm just concerned about her breathing afterwards.... I guess I was just wondering if anyone has had any complications with anesthesia with their cush babies. I'm not really sure what I could do about the irritation and raspy breathing she experiences, the vet techs sorta looked at me funny when I expressed some concern, ha....I guess I am an overly worried mother! :) Thanks again

[Dixie'sMom]

Hey Brooke! I can't help with with the anesthesia stuff. I just wanted to say good luck to you and Bella tomorrow and we will be thinking about you. Let us know what they said about her when you can. Hugs and prayers going up for a great report.

[Brooke]

Good luck to you too Suzie! I will check back with you tomorrow, I will be anxious to hear your results as well. Positive thoughts to you and Miss Dixie! Our appointment is at 8 am and I hope to be back by noon, I will check in asap.

[molly muffin]

We are all going to be waiting to hear from you and Suzie tomorrow. :) These ultrasounds can be nerve wrecking going in, but such a relief to know whats going on.

Now they know that you have concerns hopefully they will be careful with her when putting the tube in.

hugs
Sharlene and molly muffin

[Tina]

Hi Brooke,
I have been following along and wanted to let you know that I am thinking about you and Bella today and hope all goes well with the ultrasound. I will check back later for an update. (From both you and Suzie!)

Hugs,
Tina and Jasper

[Brooke]

Well, we didn't get to do the ultrasound today. The vet who is the adrenal ultrasound guru decided he wasn't going to be there today so there was some kind of mix up. The lady I have been working with does not do the adrenal ultrasound and apparently some of the staff thought she did... She apologized and is giving me a discount on the next ultrasound scheduled, and didn't charge me for today, so it all worked out I guess.

She suggested going ahead and starting meds whenever I am comfortable after Bella's teeth cleaning. Then doing an ultrasound and a stim test on the same day after she is through the loading phase, since treatment would be the same for pituitary or adrenal tumor. It would also save me a trip to the vet which is a little ways away and we can combine the two into one visit. I picked up the Lysodren, but haven't decided when to start it exactly and if I like that set up. But she assured me that the treatment would be the same for either diagnosis.

I'm kinda iffy about it and still rolling around the information. Any input or concerns is appreciated from you all, I will get to the lysodren later. I'm not going to start it right now, oh and she did also give me an emergency prednisone dose.

Really no new info, :( but I'm going to focus on her teeth for next week and think about how I want to handle the ultrasound stim test combo visit...my gut says do the ultrasound then start meds....

[labblab]

I apologize for not having the chance to welcome you before this, but after reading your post today, I do have a couple of thoughts I want to add. If it were me, I would not want to start the Lysodren treatment prior to performing the ultrasound. Even though your vets feel confident that Cushing's is the correct diagnosis, I would think that one of the two primary values of the ultrasound is to see whether there are adrenal abnormalities present that are consistent with Cushing's in any form. It is remotely possible that the ultrasound could reveal some other abnormality that could account for the elevated cortisol/lab values in its own right. Also, I do not know whether this is also true of Lysodren, but trilostane treatment actually affects the physical appearance of the adrenals. Trilostane causes bilateral adrenal enlargement, just as does pituitary Cushing's. So trilostane treatment prior to a diagnostic ultrasound can "muddy" the interpretation of the image in the absence of an adrenal tumor that makes the diagnosis more obvious.

Secondly, some specialists are now favoring the use of trilostane for treatment of adrenal Cushing's. This seems to be because control of hormonal overstimulation caused by adrenal tumors sometimes requires higher doses of Lysodren, which in turn can lead to more side effects. Since your specialist is telling you that he/she would opt for Lysodren, regardless, she must have had generally positive results with treating adrenal Cushing's in this way. But I did want to mention to you that trilostane might turn out to be an option to be considered if adrenal Cushing's ends up being the diagnosis and Bella does not respond well to the Lysodren.

Glynda had asked earlier if there was any chance to combine the ultrasound with the dental cleaning (and prior to beginning treatment). If you are going to "piggyback" procedures, that sounds like a much better combination to me.

Marianne

[Brooke]

Marianne,

Thank you for the information. I am also leaning towards an ultrasound before the lysodren. If nothing else to have more information going forward, she even said herself that there was no hurry in treating the cushing's, I have some time for her to heal from her teeth cleaning before continuing with treatment for cushing's.

I think she was just trying to save me a trip, she was kind of embarrassed, especially after I told her I had to take off work since they do not do ultrasounds on Fridays.

I forgot to mention also that my gp vet is doing the teeth cleaning and that the lady I saw today was her specialist vet. My gp does not do ultrasounds or stim tests, but he suspected cushing's so he sent us to this other clinic. So the teeth cleaning is being done at our gp vet while the cushing's is being treated with the specialist. I wish I could do them at the same time! But honestly its not that big of a deal for me to make the trip again and I certainly want to do what's best for Bella, not what's best for my schedule, so we'll make the best of it!

Whew! I feel a little bit clearer headed after I had a nap, so plan of action is to get through the teeth cleaning/extractions and then do an ultrasound, then proceed with meds.

Now my new question, Bella has loose stool, I suspect from her bad teeth, I have read that you all use canned pumpkin for diarrhea in your pups, do you just mix it with their regular food or do you give it separately? Thank you all so much for your input, I so much appreciate it!

Brooke and Bella :o

[addy]

Hello,

You want to use plain pumpkin, not pumpkin pie filling, start with maybe a teaspoon as too much can give loose stools, Bella may need anywhere between a teaspoon and a tablespoon perhaps. I always feed it without food if she will eat it. If not mix in some food.

She sure is a cutie!!!

[Brooke]

Thanks addy!


Is your baby in your avatar a shih Tzu also? So pretty :p I love the shih Tzu's, I will always have one in my life. I have this thing in my head that Bella will reincarnate as another shih Tzu and come back to me after she finishes this life so we can always be companions! She's my little side kick and has been through so much with me, she's the first and only dog I've ever had.

I will get some pumpkin first thing in the morning, thanks again!

[Dixie'sMom]

Awwww... that is so sweet that Bella is your first and only dog. No wonder she is so special to you. And I hope that when she gets to the bridge at a happy, ripe old age, her spirit will somehow find a way to come back to your side to remain until you can both cross the bridge. I love seeing your love for her and I'm sure if she could talk she would say the same thing about you. A dog's love is like no other.

I hate you didn't get to do the ultrasound today and get it over with. Rats! Everything turned out fine with Dixie's except for a slightly enlarged liver and 2 enlarged adrenals . The vet said Classic Pituitary Cushing's. So I am relieved. I am starting on Vetoryl tomorrow.

Brooke, follow your gut. Do what is comfortable and makes sense to you. You know how much Bella can take and what is overload, so you fix her schedule in a way that you feel is right for her. I know you will do the right thing.

Hugs and thanks for being my friend. ;)

Suzie (& Dixie too!)

[Brooke]

Hi all,

Just checking in, the pumpkin worked great for her tummy. The vet also gave me an antibiotic (clindamycin) to get any bacteria in her mouth under control. I still think that what was causing the loose stools. So we are staying on the antibiotic until her teeth cleaning Friday.

As for the Cushing's, I'm definitely going to do the ultrasound before starting the Lysodren. So it's going to be a few weeks before we go down that road.

I'll check back later!

Thanks as always,
Brooke and Bella

[molly muffin]

Good idea to have her on antibiotics prior to the teeth cleaning. Might even be a good idea for afterwards too, to make sure no infection spreads during the procedure.

I am fan of the ultrasound if one can afford it definitely. I find it is informative and gives a person a better idea of what they are dealing with.

hugs
Sharlene and molly muffin

[Dixie'sMom]

Hey Brooke. I'm just popping in on you to see how you and Bella are. Has she had her teeth done yet? Is she doing ok?

[Brooke]

Hi again,

Yay! Bella's teeth are finally clean! We had them done about a week ago. She had quite a few teeth pulled and seems to be feeling much better with them out. Her ultrasound is on Wednesday (hopefully), then I'm going to start treatment about a week after that if all turns out well. She is still on clindamycin for any bacteria from her teeth so I want to give her about a week off of the antibiotic meds before starting Lysodren. I'm still not crazy about the idea of giving her the Lysodren, she really does look healthy to me, especially now with the teeth out. I hope that the ultrasound shows classic signs of Cushing's in a way, so I feel more comfortable treating with medication. She really does not appear sick at all.

But for now, I'm enjoying her being healthy and happy! I'll post ultrasound results and will definitely be talking dosage with you all before I start any medication.

Thanks to all of you.

Dixie's Mom, thanks for checking in, and I am so glad to hear that Dixie is doing great! Woo hoo!

[molly muffin]

I know we have talked about this before, but now that the teeth are out and cleaned, and after the antibiotics are over, it is possible that she may not have cushings?

While the adrenal glands may be bilaterally enlarged if the tooth infections and problems contributed to the cortisol rising. Cortisol will rise in response to any chronic conditions. The adrenals could look enlarged even on the ultrasound, because they are from chronic tooth problems, but then they would go back to normal if this isn't a true cushings case. If that is the case and we don't know really at this point, then starting lysodren would not be a good option.

If for instance, once the antibiotics are over with, if she has no symptoms of cushings, starving, drinking huge amounts, peeing a lot, skin thinness and hair loss. I'd wait and monitor. That is my thoughts at this time.

hugs
Sharlene and molly muffin

[lulusmom]

For what it's worth, I wholeheartedly agree with Sharlene.

Glynda

[Squirt's Mom]

And I third that. Give her time after this dental to fully recover THEN think about Cushing's if needed but not until. ;)

[Brooke]

Ok I thought it was just my anxiety about giving meds. I like the idea of waiting, it seems if she has cushings, the symptoms will stick around so it seems better to wait. Especially if pain from her bad teeth could raise cortisol and generate a false positive on all tests, even an ultrasound. She does still have the voracious appetite, but I did notice a slight change this week where she just seems more calm, but she is definitely still begging for food. So I'm not sure. I'll know more after Wednesday and check back in. I will definitely hold off on meds for a little while at least to observe her appetite and see if I notice any changes.

With her personality, she will power on through any pain, so i really have no idea how bad her teeth were bothering her. Even our gp vet who did the cleaning said he noticed a difference in her when we took her in for her allergy shot last weekend. I know the specialist vet is still going to want to do treatment since her stim test was highly positive, but I don't think there is any harm in waiting a little while and observing her symptoms. How long do you think it would take for her alkp number to come down if it was the teeth causing the problem? I could do a future blood test before treatment...

Also if/ when she starts meds, her prescrip is for 1/4 of a pill per day, it's a 500 mg pill, so that's 125 mg per day. Let me know if that sounds about right...i will do some more dosage research before starting also if we proceed.

Thanks again to you all.

Brooke and Bella

[lulusmom]

Hi Brooke. How much does Bella weigh? Once I know that, I can tell you if your vet's dosing is according to protocol. If and when you start treatment, make sure you read the Lysodren Loading Instructions in our Helpful Resources subforum first. Lori provided you a link to it back in August. Reread her post as well.

Did your vet give you prednisone to use in case of emergency and did he provide verbal and written instructions?

[Brooke]

She weighs in between 15-16 lbs. She did give me emergency prednisone after I asked for it. I have some verbal instruction to watch her for any changes, especially in eating since that is her only symptom. Call her and stop treatment if there are appetite/behavior changes, then we will discuss a time for her next stim test. If after I think it was 10 days she shows no signs of change, I'm supposed to call anyways and discuss dosage/testing. I'll review all of this with her vet again before starting treatment. I can call her anytime. Thanks for your advice/input on this lulu's mom!

[lulusmom]

The daily loading dose should be split in half and given am and pm. Loading doses are 25mg to 50mg per kg of weight. Bella's weight in pounds converts to 7.3 kg. The prescribed daily dose of 125mg (1/4 pill) equates to 17mg/kg, which is woefully inadequate and I suspect Bella will never load at that dose. It would make more sense if you were giving 125mg twice a day, which would be a more appropriate 34mg/kg dose. Please recheck your vet's instructions. You should only dose for 8 days and then have an acth stimulation test done a day or two after that to see where cortisol levels are. Based on the dose prescribed and the fact that you had to ask for prednisone, I have to question your vet's experience with Lysodren. A vet should never, ever load a dog without giving the pet owner prednisone. If I were you and I felt that Bella needed to start treatment at some point in the future, I would seek out a specialist to reconfirm the diagnosis and direct the treatment.

Glynda

[Brooke]

Glynda,

Thanks for your response. This vet is our specialist and says she has lots of experience with Lysodren, I will double check the dosing and see if it was twice a day.. I'm not sure I can get another specialist in this state... but if needed, I will try. I better double check that dosage before I jump ship though, I could've looked at it wrong. I'm going off of memory from the bottle I glanced at this morning early, so i could be mistaken.

Thanks again for the info.

Brooke

[molly muffin]

You'll probably want to ask the vet, as we've had things typed incorrectly onto labels before.

Are you giving her any supplements like milk thistle and sam-e? They are wonderful for the liver and any time a dogs values start to go up or if they reach that age of hello I'm a senior, I think it is a good time to start them on liver and joint supplements. I remember being shocked when they told me molly would be having as senior wellness check, when to me she is always our bouncy baby girl, in permanent puppy hood. It wasn't long after that we started with the supplements. We recently added in the sam-e and have seen the alkp start to go down.

Sharlene and molly muffin

[Brooke]

I definitely will talk to her on wednesday. I'll bring the bottle with me. I do have her on sam-e with milk thistle. And her alkp did come down significantly on her second blood test but it was still high. I'm continuing with it though since it was helping. II'm still looking for some good joint support supplements. Going to do some more research on that.

Thanks :)

[Squirt's Mom]

A joint supplement I like is called GlycoFlex. It comes in 3 strengths.

http://www.vetriscience.com/index.php?l=page_view&p=glyco_flex

[Brooke]

Ok I'm back after a crazy weekend. So Bella's ultrasound showed both adrenals enlarged and her liver, kidneys, gallbladder looked good. So, I'm opting to wait and observe her symptoms for awhile and see if they dissipate. Our specialist vet said it would be ok to wait since she is not showing major outward symptoms, but still thinks it's definitely pituitary cushing's. So that's where we stand , I'm thinking about giving it until November, and then do another blood work up on her to see where she is at on her liver enzymes, unless her symptoms are obviously progressing before that time. Do you think that's too long to wait?

[Brooke]

Another question.. so you all have seen pups in the past misdiagnosed with cushing's, when they really had infection or pain going on somewhere else in the body?where all tests pointed to cushing's but it turned out that the pain/infection was causing the increased cortisol?

Ha, I work in a scientific field and and am wired for statistics...im thinking about how statistically possible that would be...In other words, what are the odds that it was her teeth, is it slim, or does this kind of misdiagnosis happen often. I don't want to prolong this for her if it's a slim chance it was her teeth causing the problem..

Thanks to all for your advice and input. On a positive note, I'm thankful her ultrasound was otherwise good! :)

[Squirt's Mom]

My Squirt was diagnosed with PDH via 5 tests - LDDS, HDDS, ACTH, UTK panel and two ultrasounds. After the second US I was told about a tumor on her spleen. Once the tumor and half her spleen were removed, her cortisol returned to normal. Her intermediates remained elevated but were controlled via melatonin and lignans for several years after the surgery. Her cortisol did start to rise about 3 years after the surgery.

[Brooke]

Thanks for the reply squirt's mom, what made you decide to do the second ultrasound and did the same vet perform the second ultrasound?

[molly muffin]

No, waiting till November isn't too long. Then you can redo the blood test and the ACTH test and see where she is at.

We're still on the, is she or isn't she cushinoid with my dog. No symptoms, acth positive, repeated ldds negative. It's been a few years of doing this.

Sharlene and molly muffin

[Squirt's Mom]

The same hospital did both US but different IMS' read them and talked to me. The reason we did the second one is because UTK recommended she have another one after they ran their panel. There was some question if she had an adrenal tumor or not.

The really rotten thing about this is the tumor was clearly evident on the first US, even I could see it and I have no training at all. But the IMS who ran that first one was on her way out the door of this hospital and on to a new one so she just didn't bother to note it. That tumor had 4 months to grow on her spleen. :eek::mad:

[Brooke]

Ok I'm feeling better about the decision then, we shall wait and see...my gut is screaming at me to wait, and from what I've learned on here, it's best to listen to that gut feeling.

[Brooke]

Squirt's mom, just remembered, you are from central arkansas, so am I, sheridan area. Would you mind telling me who your ims is? We can talk through another way so as not to air names on here... just wondering if we are using the same clinic.

[Dixie'sMom]

Hey Brooke! I'm so glad Bella had a good ultrasound report. I know all of this is confusing for you and I can't be of any help, but you know your girl so if your gut is saying wait, then I'd wait. I have always lived by the saying, "when in doubt, do nothing." Because things will either change or they won't. And you'll react appropriately. Hugs! :)

[Squirt's Mom]

Sheridan! Cool! :cool: I'm just up the hiway from you outside Bauxite! I do believe you are the first Arkie I've met here! :cool::cool:

The IMS and hospital that did Squirt's spleen surgery was in Cordova, TN. where we were living at the time. The IMS there, the good one that is, was Dr. Sessions, her surgeon Dr. Royal. Her IMS in ARK was Dr. Larry Nafe in LR - and he is one of the best in the area as far as I am concerned. Dr. Gary in LR is also supposed to be a really good vet but I don't have any personal experience with him, he has just been recommended several times. Another great Arkie doc is Dr. Terry Dew in Russellville, also a surgeon and all around great guy tho be prepared when you see him the first time - he looks like one of the ZZ Top members! :p Dr. Dew wears a multicolored clown wig during surgeries to give you a clue to his personality. :D

And I'm happy to air these names - they are all good vets. The IMS who would have let Squirt die from that tumor I do not name in public however...tho I would really, really, really like to advertise to the whole country what she did to my Sweet Bebe. Her bedside manner was horrid but she was supposed to be the best diagnostician in the area so I put up with it....and look what she nearly did to my baby! :mad: And I think Dr. Sessions would have been glad to help me spread the word - he was livid when he saw that first film. ;)

[Brooke]

Squirt's Mom- Awesome, Dr. Nafe performed Bella's ultrasound so I feel better now! Our local sheridan vet gave us a referral so i really wasn't familiar with the Hillcrest clinic. Dr. Lavergne, not sure of spelling, from Hillcrest is the one working with me on the treatment plan for Bella. She's really nice and Bella seems really calm when she's there.

So cool to meet another Arkansan on here! I know exactly where Bauxite is, been through there many times :).

Dixie's Mom - Yes having the ultrasound come back clean was great! I was stressing! And for now I'm listening to my gut :). How's your little Dixie? I'm going to head over to your thread and catch up on some reading.

Everyone have a great week!

[Dixie'sMom]

Thanks for asking about Dixie, Brooke. She is doing good. Has been on Vetoryl for almost a month now and I'm pleased with her progress so far. I just ordered compounded Trilostane from Diamondback so I'm hoping it works as good as the Vetoryl. Hugs to you and your girlie! :)

[Brooke]

Hi everyone! Well, we're back! Bella is showing more outward signs of Cushing's (mainly increased apatite) and her liver enzymes are still elevated ( i will post numbers soon). So I've decided to see an IMS in Memphis tomorrow to start treatment. I've been told she uses Vetoryl. I wanted to check in here so I can consult with the experts during treatment. :)

I will leave it at that for now and post blood work numbers and more info after our vet visit.

Thanks again for all of the awesome work you all do with this forum. There is such a wealth of information here and such a huge comfort to know I can come here for guidance.

[molly muffin]

How did the visit to the IMS go? What did they say?

[Brooke]

Hello all,

Just now getting a chance to post info from her latest visits. Bella had her annual vaccinations last week and we also had bloodwork checked again. Here are her numbers from that visit compared with her previous numbers from August 2014 (I will only post numbers that were out of range (HIGH):

-BUN- Ref. Interval (7-27 mg/dL)
Results:
Aug 1st, 2014 = 30 mg/dL
March 18th, 2016 = 50 mg/dL

-ALT- Ref. Interval (10 - 100 U/L)
Results:
Aug 1st, 2014 = 124 U/L
March 18th, 2016 = 119 U/L

-ALKP- Ref. Interval (23 - 212 U/L)
Results:
Aug 1st, 2014 = 1342 U/L
March 18th, 2016 = >2000 U/L (off the chart)

All other numbers were good.

Some more history, we did have a positive ACTH stimulation test in 2014 and an ultrasound also in 2014 that showed both adrenal glands enlarged - so we are pretty sure pituitary dependent.

Her apatite has increased in the last few months which is the main reason I'm going ahead with treatment. She still does not drink that much water, maybe a slight increase over the past few months. But she does have a pot belly and does over heat and pant pretty quickly in the heat. Also, her hair is thinning and slow growing, especially on her tail.

This past Friday, we went to see another IMS. She did some tests while we were there: tested for UTI, proteins in urine, and also an endogenous ACTH (apparently to further confirm that it is Pituitary Dependent). We will know these results either this Monday or Tuesday. She also checked her blood pressure and she said it was good.

She prescribed her 10 mg of Vetoryl every 12 hours. I decided not to start treatment until I get all her lab results back and also wanted to consult with you all before starting.

Bella weighs 14.2 lbs. So I am thinking, just to be extra cautious, to start her on 10 mg once a day. Let me know what you all think. Bella generally is sensitive to meds, so that is why I'm thinking this.

I'll stop there for now - thanks in advance for your help. :)

[molly muffin]

So the endogenous ACTH is the resting cortisol only correct?

I think that starting at 10mg is a good place, but make sure you do a follow up full ACTH test to see how her glands are reacting to the medication a couple weeks into treatment.

Give with a full breakfast if giving once a day. Plan for the ACTH to be 4 - 6 hours after the morning medication with a meal when you do it.

The only result that is very concerning is the ALKP. At over 2000. I might consider redoing an ultrasound to see what the gallbladder and liver look like now.

[labblab]

Hey Sharlene, we seldom see endogenous ACTH test results here, but it is not a cortisol test. It instead measures the dog's natural ACTH level, and it is a test that can help differentiate between pituitary and adrenal Cushing's. The blood sample has to be handled very carefully according to a strict protocol, so we don't see many vets ordering that test. But once in a while, it does pop up.

Also, I agree that I would feel much more comfortable starting with the 10 mg. rather than a daily total of 20 mg.

Marianne

[molly muffin]

Interesting. I wasn't sure what it was.
So will be very interesting to see results.

[Brooke]

Ok sounds good, I am going to do 10 mg once a day until we do the first stim test at 14 days and see where we are. I haven't heard back yet on Fridays test results.

Another note on her liver, she mentioned that she could feel that her liver was enlarged as part of her physical exam notes. I'll ask about a second ultrasound when I talk to them hopefully tomorrow. I'm still going to wait until after I get the results back to start treatment. She also mentioned she could have an underlying thyroid problem that we should look into after we get further down the road with cushing's treatment.

Have you all seen liver numbers come back down after treatment that were that high to begin with?

I will update when I get numbers in hopefully tomorrow.

thanks everyone for your input

[molly muffin]

We've seen both when it comes to the liver numbers. Many go down, but some go up and even others that hover around the same range.

My dogs liver numbers have gone down, only to come back up and then back down. We haven't been in a normal range for years. So I think it depends on how her liver reacts. As long as they don't sky rocket up, which would indicate something else is going on, then I probably wouldn't over worry it, just test regularly to be sure.

[Brooke]

Ok, we got results back from last week's test. I do not have the paperwork yet, just her interpretation over the phone, so no numbers. She said the endogenous acth did confirm pituitary dependent cushing's. She does not have a uti. And also she said that she does have protein in her urine.

I don't know if protein in the urine is common with cushing's dogs. Her BUN was high on her latest bloodwork if that coincides with protein in urine (not sure if they are related). She said it may indicate a problem with the kidneys, however I told the doctor when we were at the appointment that she does eat a natural diet that consists of cooked lean ground beef (she's allergic to poultry) along with cooked from frozen veggies like peas and carrots and potatoes, rice. The doc said that may be why her BUN is high, from eating a high protein diet . She also said something about her lack of drinking water (not typical cushing's) might be increasing protein in blood/urine. I'm thinking she said this because a typical cushing's dog drinks alot of water, thus flushing proteins, and normally you would see low BUN and proteins in urine? I'm guessing here...

So, my plan is to start vetoryl tomorrow at 10 mg once a day with breakfast.

Also, what are you all's thoughts on letting my regular vet do the acth stim test and send bloodwork off, this is what the IMS suggested instead of driving a long distance each time for blood work. The IMS will interpret results and consult with me but my general vet here in town would do bloodwork part....another option would be to let a different IMS that's nearby just do the test....I'm not sure if they would though.

Thanks in advance :)

[molly muffin]

Okay, so high protein can cause the BUN to be a bit higher. It is the creatinine with the BUN high that is a concern with the kidneys,
My dog, also a shihtzu has protein loss, kidneys, which causes high blood pressure too and this cause retinal bleeds in the eyes. So what I'd do is keep an eye on Blood Pressure, and do 3 consecutive UPC tests to see if she is having true protein loss in urine or if this is a one off, and lowering the protein just a tad (add in more veggies to meat ratio) and see if that doesn't also help bring down the protein in urine. This can all be done by your vet and a couple to several weeks in between UPC tests, as you need 3 consecutive High results on UPC to say that it is definitely protein loss kidney disease.

My shihtzu also was also never a big water drinker, definitely not a typical cushings dog.

Yes, your local vet can do the ACTH test and send results for interpretation to the IMS. It might just cause a bit of a slower turn around in your getting result determination of any medication change, etc, but is certainly doable and my IMS lets me do the same thing if I want and use my local vet. Since they are technically a team working together for Bella this should all work out alright.

[Brooke]

Hi all, so have a question, this is day 5 on vetoryl 10 mg once a day for bella (she weighs 14lbs). She had breakfast this morning and her pill around 730 am. She usually gets three small meals a day, so my dad asked her around noon if she wanted something to eat she was semi interested and did eat, then she threw it up around 2pm. She's a little puny acting but otherwise ok, moving around etc.. went outside afterwards and had a normal poop and pee..

I called our ims, she is supposed to be getting back to me this afternoon sometime. Any thoughts? She has been asking for food, but maybe with less and less enthusiam over the last few days. Also, my mom said the throw up smelled very medicinal....I definitely won't give her any more meds until I talk to doc. Im curious to see if she asks for dinner.I'm at work now, but on my way home shortly.


Thanks in advance for any advice..so grateful for you all, especially in moments of panic! :)

[molly muffin]

I'd see how she does with dinner, if she is interested and what the vet says.

They might opt to go ahead and do a stim, or you might need to just withhold the vetroyl for a day or so and see she does okay, no vomiting. It could be a stomach bug.

Vetroyl given in the morning with her breakfast should have been absorbed well before her lunch time and so wouldn't have a medicinal smell.
Does she get any other medications?

My shihtzu/llhaso gets stomach upsets very easily. Not throwing up, hers shows up more in diarrhea when her tummy is upset.

[Brooke]

Thanks for the speedy reply, she threw up again more food left over from her lunch - talked to the vet and they want to stop treatment and get her eating. tonight they want me to give her a 5mg prednisone and 2.5 mg in the morning. Then go from there, they said if she still doesn't eat - might be addisonian (spelling?) and need iv fluids - I'm not sure if we are addisonian yet - she actually looks a little more perky after she threw up this last time - she got a good drink of water. But I will give her prednisone just in case. Shouldn't this medicine kick out of her system within 12 hours? She had her dose at 0730 this morning.

Bella throws up antibiotics very easy which is why I was hesitant to go with too high of a dose (i.e. 10 mg TWICE a day).

Going to get meds and hanging tight for the moment - poor baby :(

[Brooke]

Question - should I still give her prednisone even if she eats? she took a small bite out of my hand - but reluctantly.

[lulusmom]

It appears that she is still not well and eating very little, so I would continue to give the prednisone as instructed by your vet.

[wendyweneki]

Hi Brooke,

Curious, I see this was the 5th day on the meds. Was this the first time you saw an issue? We are on day 1 on the meds. My impression was that if there was going to be a reaction, it would happen in the first few days. My own assumption that maybe I should not make. How has she been up until this point (while on the meds)?

Wendy

[Brooke]

Ok, yeah I guess prednisone could not hurt at this point- I will give her some and talk with doc again in the morning.

Wendy - Bella was doing pretty good up until today. She was acting a little bit calmer maybe, not so insistent about eating - which to me was not a bad thing - I'm not thinking we have gone overboard and are now in an Addisonian crisis - I think Bella's tummy may have just had enough of the meds and she urped it up. Fingers crossed.

What breed of dog is your little baby? I will try and pop over and read your thread - this is a great group and we can all help each other out. Good luck and I'll be glad to answer any questions I can.

[wendyweneki]

Panda Bear is a Shih Tsu (Sorry, don't know how to spell). Panda Bear is my Grandbaby. My 30 yr old daughter and myself share a residence. They are 'our' babies (Scruffy and Panda Bear).

Just as I am responding to you, I notice that Panda Bear is going outside and sitting in the backyard. Something she normally does not do. She has her tail tucked between her legs. She's just sitting there...... I can't tell if she is 'enjoying' it outside or if something is wrong.

It's so hard to tell.... :confused::confused:

How is Bella doing now? How does she look to you?

[Brooke]

That's kind of my scenario, my parents and I share a house and Bella is their grandpup :)

I gave Bella the prednisone and she is sleeping now in my lap. She ate a tiny bit of peanut butter. Hopefully the morning will bring her apatite back.

I understand how you feel, starting the meds is really nerve wrecking. Bella is super sensitive and I suspect this is a little out of the ordinary, she was on a low dose for her weight. I'm used to her being a little out of the ordinary ha.

I feel like you can't go wrong with asking questions and bugging your vet if you have too. It never hurts to ask. My vet told me to stop treatment if she stops eating, so that's kinda where we are at.

Remember you are the one who knows your pup best, my case is a good example, I'm glad I went with my gut and opted to go with 10 mg once a day instead of twice like the vet recommended. I'm not saying you shouldn't listen to the vet, but educating yourself through this website can help you out alot. Plus, i always feel better when i am armed with knowledge! Alot of people on here have had success with vetoryl. Lots of smart people here to help also. I'll check in with you on your thread soon to see how your pup is progressing. :)

[Harley PoMMom]

Gastric upset is listed as one of the side effects from Vetoryl, my vet had me give my Harley 5 mg of Pepcid AC 20-30 minutes before the Vetoryl was given with his meal.

Hope sweet Bella's appetite perks up.

Hugs, Lori

[Brooke]

Hi Lori,

Did Harley throw up while on vetoryl? If so, did his appetite disappear during that time and then come back later? Bella just doesn't want to eat, and she wants to sleep. She does drink a little water though. It will be a long night :(

[Brooke]

Good news, bella perked up last night and ate a little, then woke me up and wanted to eat a little more around 1 am, and then also ate a good breakfast. Yay! She had a little bit of loose stool this morning, not diarrhea though and she is drinking water and peeing normal.

So, here's my plan. The vet did say she is for ordering a 5 mg tablet and doing that twice a day when she gets over this episode (which I think she is fine now). I will go ahead and order the 5 mg, but will try at once a day for the first few days and based upon how she acts then I will increase to twice a day.

I've seen several times throughout this forum where the vet does not seem overly concerned when the animal gets sick from the drug. I was catching a little attitude from some of the people at her ims clinic yesterday when I told them I was only giving her once a day 10 mg instead of the prescribed twice a day - and she still threw up. Luckily my vet agreed with lowering the dose after they gave her all the info. The nurses there were kinda suggesting I continue treatment - um no, I'm not dosing a sick dog with the drug that made her sick.

Ok rant over :)

Do you all know if i go through a compounding pharmacy if they can make a dose smaller than 5mg? Just curious, might need a small dose. After reading through these posts, I know one thing is for sure, each dog is very individual when it comes to dosage. It really is up to us as pet parents to make the call on the dosage - feels a little weird going against the doctors recommendations, but sometimes moma knows best :)

[wendyweneki]

I'm SO HAPPY to hear that Bella is feeling better. :):):)

Panda Bear has not pooped since we started her on the meds - but I think it's because we have been feeding her treats like crazy because we feel bad that she has cushings and making sure she has a full tummy when she takes her pills.

No more treats for Panda Bear - but I am making some chicken for her this morning to take with her pills. I can't tell if Panda is not doing well or not. I don't know what is my own paranoia and just Panda being Panda Bear.

Keep us up to date on Bella. I'm following your journey to learn from it since Bella has been on meds 4 days more than Panda.

[Brooke]

Thanks wendy! Me too...i was super worried about the little stinker. She's still doing well, eating and napping, grandmom is watching her today :)

P.s. I left a post on your thread so i can keep up with how Panda Bear is doing.

[DoxieMama]

Hi Brooke,

My Visuddha (mini dachshund) just started on Trilostane Monday. I'm happy to have found your thread and will be following along. I want to go back to the beginning of the thread but am at work so that will have to wait.

For now though, I did want to let you know that I've read of others getting compounded doses less than 5mg, so I believe it's possible. (Someone mentioned they gave a dose of 2.5mg twice per day to their little one.... can't remember who it was. Might have been on the Facebook group, if not here.)

Anyway, I'll check back in tonight and catch up on the history. Hope Bella has a good day, today!

Shana

[Brooke]

Thanks Shana that's good to hear about the compounded smaller dose. I may need it. For now I'm just glad she's eating, one day at a time with this Cushings stuff.

I will hop over to your thread later as well and check out how your baby is progressing.

Thanks,
Brooke

[Harley PoMMom]

My Harley had chronic pancreatitis and that pancreas can be such a fickle organ, so as to try to eliminate any potential stomach upset we started him on the pepcid ac which did work. However after a while he started to get nauseated on the pepcid ac :eek: so I then stopped the pepcid ac and switched to slippery elm bark (SEB).

And yes, a compounding pharmacy can make any Trilostane strength except for the ones that Dechra already manufactures. Diamondback is one that our members use.

Hugs, Lori

[Brooke]

Hi everyone again! I wanted to consult with you all on some things that are going on with Bella. Let me give a quick update - she started vetoryl 10 mg once a day back in april - she got sick and we took her down to 5 mg once a day. We are having her stim tests performed by a vet close to home and then they are sending the results to her IMS who is working with me over the phone.

Her ACTH stim results after 21 days on once a day 5 mg were as follows:

Date: 05/21/16

Pre: 3.1 ug/dl
Post: 17.1 ug/dl

So as that post number was still too high, she wanted me to bump it up to twice a day 5 mg. Her ACTH stim results after approximately 21 days on the twice a day were as follows:

Date 06/24/16

Pre: 1.4 ug/dl
Post: 18.2 ug/dl


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Here are the reference ranges listed on her first results sheet, with units in ug/dL:

2-6 Pre-ACTH (resting) cortisol

6-18 Post-ACTH cortisol

18-22 Equivocal post-ACTH cortisol

>22 Post-ACTH cortisol consistent with
hyperadrenocorticism

<2 Post-ACTH cortisol consistent with
hypoadrenocorticism

1.5-6 Desired pre- and post-ACTH cortisol on
trilostane* therapy

*Recommendations for target cortisol levels on trilostane (Vetoryl*) therapy vary. Per the manufacturer, pre- and post-ACTH cortisol levels of 6-9 ug/dL (testing performed 4 hours post-trilostane) may be sufficient for some animals if clinical signs are well controlled.
__________________________________________________ ____


So, the next step here is to speak with or IMS vet. Now - she has already told me she is not a fan of the compounded trilostane, she thinks it simply does not work. I'm concerned because I do not feel comfortable giving her a 10mg dose (the next available size) again since she got pretty sick, she was vomiting and lethargic, not eating. I had to give her a prednisone and she came back around. So ideally, what I think is the best here is to bump her up maybe to 7 mg twice a day? Which is of course compounded.

My question to you all is - have any of you had any success (or problems) with compounded trilostane? The IMS vet tech I spoke with previously about the compounded trilostane - and who relayed to me that our Dr. did not like the compounded version - said it comes in a liquid form and is really not a good option. Something about this sounds a little off to me. :confused:

*Sigh*

I do know some of you on here have used or are using compounded trilostane. I think the vet who is doing the stim test would be willing to write me a prescription for compounded, but I hate to step on the IMS's toes and over ride her suggestions. The local vet ( who I expressed these concerns too also) said lets wait and see what the IMS actually suggests, then talk about it. So I'm jumping the gun a little here, but I wanted to be as informed as possible before talking with the IMS, I'm expecting an argument I guess. Any input and/or advice from you all would be greatly appreciated as always.

Brooke

[lulusmom]

Hi Brooke. I only have a moment but wanted you to know that I just noticed that your last post seems to have been missed by us. I am sorry about that. I have to run out to an appointment and don't have time to reply right now but wanted to bump this up so that others can see your posts and share their thoughts. I will share my own later today or this evening.

Glynda

[molly muffin]

I use the compounded trilostane and it is what my IMS prefers due to being able to control the dosage.
It does come in both liquid and capsule form. I prefer the capsule personally but many prefer the liquid.
If you want to you can do the 5mg vertroly am and pm and get a 2.0mg compounded trilostane. to add to it.

The reference ranges that you quoted are for a normal dogs being tested for cushings initially and NOT for a dog on treatment. There is often a note on the results that say a dog under treatment with trilostane or lysodren is different.
The post result you are looking for on a dog on medication is 1.5ug to 5.0ug POST ACTH. It Can go up to 9.0ug if symptoms are controlled, but you don't want 18.

This should be helpful for you:

http://www.dechra.us/Admin/Public/Download.aspx?file=Files%2FFiles%2FSupportMaterial Downloads%2Fus%2FUS-046-TEC.pdf

[Brooke]

Thanks guys - wanted to give an update. Today my IMS ok'd the compounded trilostane - yay! So we are going with a 15 mg chewable that is scored so I can half it, so 7.5mg morning and evening.

I'm not sure why she was so adamant about not using it before.

Also, I was looking at those numbers again from her last stim test - should I be concerned about that " pre" number of 1.4 being on the low end of the desirable range? The IMS didn't mention it, but just curious.

As far as Bella's current symptoms, hunger is still not controlled (which I would expect based on the test results). She is not one that would drink too much water, so the only outward symptoms I have to go on are her eating and her pot belly. Her belly has gone down some.

[molly muffin]

They don't seem to put much worry into the pre number as that goes up and down throughout the day. It is what is stored in her adrenal glands they worry about as that is how much is available to be dumped into her body.

Good you got a resolution from the IMS about trilostane compound

[Brooke]

Hi everyone! I wanted to drop in and ask for some advice. Bella is now currently on 8.5 mg of vetoryl in the morning and 10 mg at night.

She had a stim test performed last week, results were 1.8 pre and 6.7 post.

Her ims says she is at a good number, (within range if symptoms are controlled).

Now, her symptoms are controlled during the day up until around 5pm. I give her the 10 mg dose around that time and it doesn't even really phase her - she acts like she is starving all throughout the evening, she might calm down a little after several snacks of veggies and a little beef, but eventually she wakes me up around 2 or 3 am asking for food. And this is all after she has had her full meal at 5pm with her 10mg vetoryl.

The IMS wants to do a stim to test her evening cortisol after the 10 mg dose. She has asked me to schedule a stim test 8-12 hours after her evening dose.

I wanted to say also that when we adjusted her meds before this last stim test - we went from a 8.5mg at night dose to a 10mg dose at night (keeping morning dose at 8.mg) - her post stim number dropped from 9.4 to 6.7.

I think she is concerned that if we up the night time dose much more ...we may drop her morning cortisol too low.

Has anyone had any experience with increased symptoms throughout the night and if so should I try something else to calm her down? I don't understand how it's getting that high at night and she's super calm during the day. It's almost like she has her days and nights mixed up...

Thanks in advance for any thoughts and advice :)

[molly muffin]

You have some wiggle room if her ACTH was done after the morning dose. You could do an increase in the evening. The idea is to have it level throughout the day but it isn't unheard of for them to lose control in the evenings.