Border Terrier Vera (17 y/o) - Vera has crossed the Bridge

[BettyF]

Hi everyone, I'm Betty from the UK and although I joined this group quite a time ago, this is my first post.

My Border Terrier Vera was diagnosed with Cushings in March 2012 at the age of 14, she is now 17 and is doing quite well for her age.

However, I find the main problem is that my vet seems pretty clueless when it comes to treating Cushings.

When she was first diagnosed he wanted to start her on 30 mg Vetoryl once daily (she weighed 16 pounds at the time). I had already joined a Yahoo group and was aware that it was better to 'start low, go slow' so I politely told this to the vet and since then it has been left up to me to decide the dosage.

I started her on 10mg once daily, then guided by her regular ACTH results I increased it to 7.5mg twice daily, then 10mg twice daily and now to 15mg twice daily.

I don't know of a compounding pharmacy here in the UK, so I bought some mg scales and empty capsules and split the Vetoryl myself. I know it isn't 100% accurate but it is better than not doing it.

Her last ACTH a week ago was pre - 2.2 and post - 6.7.

For her age, Vera is good. She enjoys her walk in the park every morning, her appetite is reasonable and her weeing and drinking is more or less normal.

I hope that anyone who has a newly-diagnosed dog will be encouraged by Vera's story. Cushings is quite scary to begin with but it is possible to manage it and for the dog to have a good quality of life.

[mytil]

Way to go Vera and Betty!!!!

I surely am glad you posted. As you can see I have copied your post from the Checking in section to here.

Her post number does look good.

Keep up the great work and keep us posted
Terry

[camval1]

It makes me feel better that others are questioning their vets when it comes to dosing our pups with trilostane.

My vet wants to start my 58 lb Airedale on the 120mg capsules.
I'm not comfortable with that amount. I told her I wasn't and she told me "let me do my job".

I then contacted the maker of trilostane (Dechra) and they said they would advise to start at the 1mg/lb dosage and adjusting from there.
They're in the process of changing the inserts for the UK and they will probably do the same in the States.

When I talk to her again tomorrow, I will reiterate that I do NOT want to start him with the 120mg dose. If she balks, then I will make an appt with an internist in my area.

It's VERY critical that the dosage is not too high.
I wish Dechra would do a better job educating vets about their product.

[BettyF]

Thank you for moving my post Terry!

Mark, I felt a bit embarrassed telling my vet that I would not be giving Vera the 30mg, but then I thought it was better to be embarrassed than to push Vera into a possible bad reaction to the Vetoryl.

In a way, I suppose I am lucky that the vet lets me get on with it. On the other hand, it would be brilliant to have a vet who really understood Cushings. It seems that I am just using the vet to prescribe Vetoryl and do blood tests.

The 120 mg your vet prescribed seems way too much and you were right to tell her you were not comfortable with it. Good luck with the internist.

Betty and Vera in the UK

[camval1]

Hi Betty,
For me, it's less about being embarrassed and more about trying to avoid conflict.
I've a gut feeling that she will get angry with me and basically tell me to find another vet.
Which is sad, because I really like my vet & the folks in the practice.

I've been going to them for almost 11 years now and they've never steered me wrong so far.

And I'm not sure vets don't understand Cushing's (maybe some don't). It's more that they seem to be working from some outdated data. Particularly when it comes to Cushing's medicine dosing. Don't know why that is.

My vet picked up on it pretty quickly when she heard that Brick was drinking a lot, peeing a lot, and couldn't get enough to eat. She went right to Cushing's.

[BettyF]

Hi Mark,

I first took Vera to the vet about her increased drinking and peeing in December 2011 and it took from then till March 2012 for her to be diagnosed. It was only because someone on a Border Terrier facebook group I belong to mentioned that her dog had the same symptoms that I realised that Vera might have Cushings. The vet had not considered it, but had been testing her for diabetes and infections. Once I asked him to test her for Cushings he did the tests and it was confirmed.

I am fortunate that he is willing to do whatever I ask, but it shouldn't be up to me!

[BettyF]

Is it common for dogs with Cushings to have urine low specific gravity?

Vera's was 1.020 at her last urine test last week and if I remember correctly, her previous one was about the same.

Is low specific gravity something I should be concerned about?

[camval1]

I think I've read that low specific gravity (dilute urine) is a symptom of Cushing's.

[camval1]

Hi Mark,but it shouldn't be up to me!

I get that, and I would agree for the most part.

But when it comes to something like this, I don't think it hurts to question the vet.

[molly muffin]

Welcome to the forum, officially, now that you have posted. :)

yes, low urine specific gravity is common with cushings.

I really find it frustrating that the UK has so few options when it comes to compounding medication. Canada has much the same problem. The only place I am able to get compounded is going through the Specialists and they use a compounding pharmacy at the Vet School. I know they have some schools in the UK would they perhaps have a compounding pharmacy that your vet could call in dosage to for you? Just a thought.

So glad to see you and to hear that Vera is doing so well. Good job!!

[BettyF]

Thank you for the welcome Sharlene.

After Vera's urine was tested last week and there was low specific gravity (1.020) the vet phoned me and said that I should increase her Vetoryl to 20 mg once daily, instead of the 15 mg twice daily that I was giving her. I told him I was reluctant to do this as her ACTH a few days previously had been so good (2.2 & 6.7) He said that by giving her 20 mg it would 'kick start' the adrenal glands into working better.

This did not make sense to me so I have carried on with the 15 mg twice daily.

The vet has never mentioned that low specific gravity is common in Cushings. I think that Vera might be his only Cushings patient and that he doesn't really know much about the disease.

I think that low specific gravity means that the kidneys are unable to concentrate the urine, does this mean she is in the early stages of kidney failure? The vet did say that her urine test showed that protein and creatinine were normal.

Thank you for taking the time to read this, and for any advice you can give.

[camval1]

He said that by giving her 20 mg it would 'kick start' the adrenal glands into working better.

This doesn't make sense to me. Vetoryl (trilostane) is used to throttle back the adrenal glands, not to jump start them.
You're giving 30 mg per day and he want to decrease that to 20 mg per day? Do the tests show that your pup is heading over to the Addison's side of cortisol levels?



The vet did say that her urine test showed that protein and creatinine were normal.

That info is probably important to know for Cush pups, but I would think that the urine cortisol/creatinine ratio is more important. And of course along with the ACTH measurements.


The experts here can chime in and correct me if I'm wrong.
I'm new to all this, so...........

[BettyF]

It didn't make any sense to me either Mark.

Although I am giving her 30mg a day (in two doses of 15mg each), this is not the same as giving her 30mg all in one go. Because trilostane does not stay in the system for longer than 10 - 12 hours it gives better control to give it twice a day. (the experts will correct me if I'm wrong on this)

She is generally in good health, eating fairly well, no sickness or diahorrea so I would not say she was heading towards Addisons.

Thanks for your comments.

[Harley PoMMom]

Hi Betty,

A belated welcome to you and Vera from me as well!



After Vera's urine was tested last week and there was low specific gravity (1.020)...

As Sharlene has mentioned a low urine specific gravity (USG) is very common in dogs with Cushing's which is generally caused by the increase in drinking/urinating (PU/PD). With Cushing's a dog's system is producing excessive amounts of cortisol. This upsurge in cortisol production increases the blood flow to the kidneys which in turn causes the PU/PD.


The vet has never mentioned that low specific gravity is common in Cushings. I think that Vera might be his only Cushings patient and that he doesn't really know much about the disease.

I think that low specific gravity means that the kidneys are unable to concentrate the urine, does this mean she is in the early stages of kidney failure? The vet did say that her urine test showed that protein and creatinine were normal.

Thank you for taking the time to read this, and for any advice you can give.

You are correct, a low USG does mean that the kidneys are unable to concentrate the urine but does not mean that the dog is in the early stages of kidney failure, especially since Vera's creatinine was normal. Actually Vera's USG of 1.020 is not that bad, my boy, Harley, had a low USG that hung around 1.009.

Some cushddogs have had PU/PD for so long that the kidneys have lost what they need to concentrate the urine again. This is called medullary washout and sometimes it takes a while to get things jump started.

You are doing a wonderful job at being Vera's advocate!

Hugs, Lori

[BettyF]

Thank you Lori,
You have given me a much better understanding of USG than my vet ever has!

[BettyF]

Vera's last ACTH on November 19th showed that her urea was high - 11.6 (ref.range mmol/L 3.1 - 10.1) so the vet did a urine test. It was following this urine test that he phoned me and told me to increase her Vetoryl to 30mg once daily (I said 20mg in my post above, sorry, my mistake) instead of 15mg twice daily. I did not increase her dose and she remains on 15mg twice daily.

I have been asking for a copy of the lab report to be emailed to me and finally got it yesterday. Would someone mind having a look and letting me know their thoughts please?

Urine protein 70 g/L 0 - 1000
Urine creatinine 5626 umol/L
Urine protein:Creatinine ratio 0.11

She seems to be doing well, eating ok, quite lively and still willing to go for her morning walk in the park.

Many thanks

[labblab]

I apologize that I have only a moment to post right now, but here is an article that can help make better sense of the urine test that your vet performed: the urinary protein:creatinine ratio:

http://www.vcahospitals.com/main/pet-health-information/article/animal-health/urine-protein-creatinine-ratios/442

I am guessing that the elevated urea you are referring to is what our labs in the U.S. label as BUN. As you will see in this article, elevated BUN in the blood may be cause to perform the UPC urinary test in order to examine how much protein is being passed in the urine -- this can be a marker of certain kidney issues (of which Cushing's can be one cause).

So everything makes sense to me up to a point. In other words, if the UPC showed significant protein loss, you might want to increase the total daily trilostane dose in hopes of gaining better control of the underlying disease. However, it looks as though your dog's UPC result was not abnormally elevated at all (unless I am somehow misreading it or the units in which they are reported). Please take a look at this article, yourself, and see what you think.

As far as changing the trilostane dose now, am I correct that all your vet is asking you to do is to consolidate the 15 mg. twice daily into a single 30 mg. dose in the morning? Did he explain why (aside from the notion of "kick starting" which really doesn't make much sense)? Is it perhaps because he does not want you splitting the capsules yourself? As long as Vera's symptoms are being well-controlled right now and it is not inconvenient for you to dose twice daily, I am not sure why he us asking you to make the change.

Marianne

[BettyF]

Hi Marianne, thank you for the link, I will take time to read it this afternoon.

Yes, the vet wanted me to give Vera a single 30mg dose in the morning. The only reason he gave was the 'kick-start' one. I told him I was reluctant to do it because her last ACTH was so good. He knows I split the capsules myself but didn't comment when I told him. I don't think he is at all interested.

It is no problem at all for me to dose her twice daily, or to split the capsules.

Just a thought, I wonder why Vetoryl made as tablets rather than capsules? It would be so much easier to adjust the dose.

[Squirt's Mom]

It is no problem at all for me to dose her twice daily, or to split the capsules.

Actually, this is a rather big problem. The capsules should never be opened. They should never be divided. There are many reasons for this - one big one is that you can't know how much actual Trilostane (the active part of the capsule) is actually in each half and how much is filler. If you have any plans to get pregnant, you do not want to touch the powder. *I* would not want the loose, unprotected powder to hit my baby's tummy with a coating (capsule) designed to help the drug breakdown correctly.

In EU, you have access to a 5mg dose that we do not in the US so I would start using that along with a 10mg dose to make up the 15mg dose. ;)

[BettyF]

Actually, this is a rather big problem. The capsules should never be opened. They should never be divided. There are many reasons for this - one big one is that you can't know how much actual Trilostane (the active part of the capsule) is actually in each half and how much is filler. If you have any plans to get pregnant, you do not want to touch the powder. *I* would not want the loose, unprotected powder to hit my baby's tummy with a coating (capsule) designed to help the drug breakdown correctly.

In EU, you have access to a 5mg dose that we do not in the US so I would start using that along with a 10mg dose to make up the 15mg dose. ;)

I didn't realise we could get 5mg capsules here! I will definitely look into that.
I understand about the filler and Trilostane and do try to mix the powder once it is out of the capsule. I also wear gloves. I know it's not going to be exact but until you mentioned the 5mg capsules I didn't think there was an alternative.

As for me getting pregnant - a year ago I became a great-grandmother so as you can imagine, my days of having babies are long gone!

[labblab]

I don't believe the 5 mg. dose is available for general sale in the U.K. Instead, vets must make special request to Dechra on the grounds that a 10 mg. dose is too large to be safely administered to a specific dog. In Vera's case, I don't know whether she would be eligible for the special 5 mg. dose since she could, indeed, simply be shifted to a 30 mg. capsule once daily.

Normally, I would never recommend splitting and repackaging the capsules yourself, either. But since Vera seems to be doing so well on this regimen, I'm just going along with the theory of "don't mess with success..." :o

Marianne

[BettyF]

I haven't written for a while, but I just wanted to let you know that my little Vera was put to sleep on July 2nd, she would have been 18 in August. Eventually, dementia caught up with her and her quality of life became poor. We decided that the kindest thing to do was to let her go.

She had Cushings for just over 3 years and coped with it very well. I will continue to be a member of this group because my other dog Graham also has Cushings.

Betty
Birmingham UK
with
Graham, Border Terrier aged 16.2
diagnosed with Cushings in May 2015

[Squirt's Mom]

Dear Betty,

I am so sorry to hear about your sweet girl. :( She was doing so well last we heard she was doing pretty well so it was a shock to read your post. Losing their mental faculties can be so very hard on both pup and parent. Today she is restored to her full self, mind clear, body as it was in her young days thanks to your final gift to her.

Our deepest sympathies,
Leslie,Trinket, Brick, Sophie, Fox, Redd, and all our Angels


A Parting Prayer

Dear Lord, please open your gates
and call St. Francis
to come escort this beloved companion
across the Rainbow Bridge.

Assign her to a place of honor,
for she has been a faithful servant
and has always done her best to please me.

Bless the hands that send her to you,
for they are doing so in love and compassion,
freeing her from pain and suffering.

Grant me the strength not to dwell on my loss.
Help me remember the details of her life
with the love she has shown me.
And grant me the courage to honor her
by sharing those memories with others.

Let her remember me as well
and let her know that I will always love her.
And when it's my time to pass over into your paradise,
please allow her to accompany those
who will bring me home.

Thank you, Lord,
for the gift of her companionship
and for the time we've had together.

And thank you, Lord,
for granting me the strength
to give her to you now.

Amen.

- © Brandy Duckworth, 1998

[BettyF]

Thank you for those lovely words Leslie, they are a great comfort.

In her younger days Vera was probably one of the naughtiest dogs that ever lived. Before I had her I used to think that all dogs should be off lead in the park so for the first two years of her life, she was.

During those two years she chased police horses, jumped into the river to get to a man she liked who was at the other side, got through the park fence and into someone's garden and climbed onto the roof of an extension they were having built, got through a fence and onto a railway line and stole things like gloves from people and ran off with them and refused to come back.

She wasn't much better at home. Soft toys had the stuffing ripped out, towels were shredded, if a chair was left pulled out near the table she was on it and ate whatever she found, she climbed a wall in the garden which had a sheer drop of about 6 feet the other side and sat in flower tubs on the wall.

When she was almost two years old we decided to have another Border Terrier. Everyone thought we were mad. However, Graham was totally different to her and didn't learn any of her bad ways.

She was diagnosed with Cushings disease when she was 14 and coped really well with all the blood tests and treatment.

Although she was so naughty, she had the sweetest temperament and never, ever growled at anyone. The vet could do anything with her.

Now she has gone and I still can't quite believe she is no longer in this world......

[Harley PoMMom]

Dearest Betty,

I am so sorry for your loss of sweet Vera and my heart goes out to you at this difficult time. Please know we do understand the pain you are feeling and we are here for you.

With Heartfelt Sympathy, Lori

[BettyF]

Dearest Betty,

I am so sorry for your loss of sweet Vera and my heart goes out to you at this difficult time. Please know we do understand the pain you are feeling and we are here for you.

With Heartfelt Sympathy, Lori

Thank you so much Lori, that is very kind of you.

[Robert]

So sorry for your loss. She sounded a real little character.

[BettyF]

So sorry for your loss. She sounded a real little character.

Thank you Robert, she certainly was!

[molly muffin]

Dang. I am so sorry to hear that Vera has passed. I know you will miss her so very much.

My condolences

[BettyF]

Dang. I am so sorry to hear that Vera has passed. I know you will miss her so very much.

My condolences

Thank you so much Sharlene, life seems very strange without her.