Shelby girl ~ pituitary cushings (Shelby has passed on)

[Shelby01]

Hello All,

I am new here ~ my 13 year old lab mix, Shelby, has just been diagnosed with pituitary cushings disease.

She has a list of symptoms, including: loss of muscle mass, increased appetite, panting, issues with nervous system, skin issues. We just finished antibiotics to clear a urinary tract infection too.

I need to decide between using lysodren or trilostane for treatment. I know the risks are slightly lower with trilostane, but I also know that lysodren is chemotherapeutic and may kill tumor cells.

My veterinarian(s) usually recommend starting with trilostane first.

Any thoughts/suggestions? I know each case is unique... I have been overwhelmed with literature!

Thanks,
Hillary ~ Shelby's mom

[ScottieBoo]

Hello Shelby's Mom

I can understand exactly what you are going through. I just joined this website today. My Scottie 6 year old Chihuaha / Dacshound mix was just also recently diagnosed. I am also between deciding on going with either Lysodren or Trilostane. As of right now I am hearing Trilostane has given good results with less side effects. However I sill keep reading up on things and feel like it information overload. Not to mention the financial stress this has brought on.
I hope Shelby does well soon!

Gino - Scottie's Dad
:)

[LauraA]

Welcome to you both :) I am sure that you will be asked for the results of any testing that has been soon, that way the Cushing experts can tell you what is going on :D I just wanted to say that both drugs are great and that I would go with whatever your vet has had more experience in using. Hope Shelby is bounding around very soon!

[Shelby01]

Thank you Laura :) My vet has looked at the blood work results and has basically told me I have a choice between the two drugs. So I have been reading about both and asking for other opinions.
I just lost my boy, Wrangell, in November to lymph node cancer. It was very fast and unexpected. He was almost 11. Now to have issues with Shelby, is gut wrenching. I know this disease is manageable. But she is older and I am worried.
I am so thankful for the support <3

[LauraA]

I have only ever used the vetoryl which we swapped to the compounded version - trilostane - after about 7 months, it is much cheaper!! I have had no problems with it but we went the low and slow route so as to try and avoid any side effects. I can't comment on the lysodren but I am sure those that prefer it will be along shortly to give you some info. Either drug is truly a life saver. And started with either one is full of anxiety and fear of what if's - or maybe that was just me hehe.

[Shelby01]

Thank you Scottie's dad :)
My big concern is that tumor. With her being older, I know cancer is probably more likely. If she was younger, I may opt for the less aggressive path. I just don't know Which to choose. One thing is for sure, my time with her is limited. Poor sweet girl. I don't want her to be miserable either.
Has Scottie started his treatment yet? I hope it works for him.

[samba7282]

Hello and Welcome Shelby's Mom! :) I am new to Cushings too, our little girl Daisy was diagnosed 12/5... She is taking Trilostane, and is doing wonderful...she had her ACTH checked two weeks after starting treatment and our vet was very pleased with how her cortisol levels are responding! She has a very enlarged liver, (2x normal size) and he also put her on Denamarin, after her ACTH recheck, to help with her liver function, and also with her gall bladder, since the two rely on each other so to speak...This has helped too. exactly three weeks after starting treatment, she started to go blind. We noticed Christmas day she couldn't see us throw pieces of food to her(this was like a game for her ;) and I called our vet the next morning. he said her blood pressure may be high, and to bring her right in. We did, and sure enough, it was around 200. Unfortunately, high bp is one of the things that can come with cushings. On the upside, the Enalapril she is on for BP also helps aid against UTIs, as Molly's mom let me know! Thank God for our friends on this site! I learn new things all the time! If your vet has not checked bp, I recommend doing so ASAP. I feel that if our vet had checked Daisy's bp when she was diagnosed, she would not have lost her vision, as this resulted from her having the high bp... I hope this helps you, and I will be praying for ya'll on your journey through this!! :) We are all here for you!

[Shelby01]

Thank you! I appreciate your insight on the blood pressure. I am taking Shelby in today to have her blood pressure checked and get her started on trilostane.
My boy, Wrangell, who I lost in November, had hemorrhage in his eyes which caused him to loose his sight. This was our first indicator something was wrong. I know how hard it is to see your pup have to deal with the sudden, uncomfortable change. Keeping walkways clear and not moving around furniture can be a big help for Daisy. Thank you so much for the support ~ I will be praying for Daisy too.

[labblab]

Hi again from me, here on Shelby's thread this time! ;)

Just wanted to tell you that the vast majority of pituitary tumors causing Cushing's are not cancerous, and also I don't believe that Lysodren is believed to hold any advantage over trilostane in relation to actually reducing pituitary tumor cells -- neither drug does that. A few adrenal tumors may exhibit cell destruction in conjunction with Lysodren, but I believe this is basically related to the overall erosion of adrenal cortex cells that forms Lysodren's mode of therapeutic action.

Both Lysodren and trilostane can be very effective drugs. The key lies in a good partnership between a knowledgeable vet and a vigilant owner -- and I can easily tell you totally fill the bill in that regard!

Marianne

[Shelby01]

Thank you Marianne - You are confirming new information I recently came across to help me make my decision towards trilostane.
Fingers crossed we get off on a good start. I know this is going to be a balancing act!

[Renee]

Hello my fellow Alaskan. :D I'm down in Anchorage!

Once you get your vetoryl dosage worked out, you can switch to ordering it from an online pharmacy. I order from California Pet Pharmacy, and it's free shipping for spending over $75, and the vetoryl is half the cost of what my vet would charge.

Can you tell us what dose you are starting with and how much your Shelby weighs?

[Shelby01]

Hello in Anchorage! Thanks for the ordering tip!

My Shelby weighs 70 pounds and we are starting a dose of 60mg one dose a day. Any thoughts?

[Renee]

Perfect dose based on weight. Excellent, excellent.

If you vet is willing to price match.. then, that could be a win too. I bought the first month or so from my vet, then switched to online ordering. She just wrote me a script for unlimited orders for a year. It really makes it easy because I usually order 6 boxes at a time. We go through a box a week... so it adds up fast! I use the 10mg though, so dose increases were easy because I just added 10 more mg each increase.

[Shelby01]

Awesome! I am feeling good that I've made the right choice for her. I just bought my first box of 30 from my vet for $99. I will wait and see how this goes. I hope we can get a good dosage figured out somewhat quickly, then I will look into purchasing options :)
Thanks again - so much.

Hillary ~ Shelby & Wrangell's mom

[Shelby01]

Shelby blood pressure was boarder line. But we know she was stressed when it was being taken so figure she's fine.

I was able to get a copy of Shelby's blood work.

Cortisol baseline 147 (normal range 15-110)

Cortisol low dose dex 6h 49 (normal range 0-30)

Cortisol low dose dex 8h 52 (normal range o-30)

Total thyroxine (tt4) .7 (normal .8-2.1)


Everything else looked good. I am wondering the difference between the 6h and 8h? If it matters? Something more to know?

Thanks
Hillary ~ Shelby & Wrangell's mom

[Shelby01]

We are on day 3 of trilostane. So far, Shelby is doing okay. We go in on the 24th to be rechecked.

Thank you everyone for your guidance and support. It has been so helpful to read other experiences and learn from others' extensive knowledge so I can try and make the best decisions for my baby girl :)

[Renee]

Sounds like you are following all the proper protocols. Good job mom, and good job to the vet too!

Don't get discouraged if you don't see any symptom improvement. It took about 10 days for me to see anything that I could call improvement.

[Shelby01]

Thank you Renee! That is good to know - part of me feels like I'm sitting here watching her, expecting something to happen, but not really knowing what I'm supposed to see.

Just thankful there's no crazy vomiting or diarrhea at this point - so I don't feel even more guilty about having to go to work tomorrow!

[Harley PoMMom]

Shelby blood pressure was boarder line. But we know she was stressed when it was being taken so figure she's fine.

I was able to get a copy of Shelby's blood work.

Cortisol baseline 147 (normal range 15-110)

Cortisol low dose dex 6h 49 (normal range 0-30)

Cortisol low dose dex 8h 52 (normal range o-30)

Total thyroxine (tt4) .7 (normal .8-2.1)


Everything else looked good. I am wondering the difference between the 6h and 8h? If it matters? Something more to know?

Thanks
Hillary ~ Shelby & Wrangell's mom

Those results look like they're from a LDDS test, and generally with the LDDS test you have a baseline/resting number, a 4 hour number, and an 8 hour number.

When interpreting the LDDS test results one always looks at the 8 hour number first and if it is over that lab's reference range, which is usually 1.4, than the dog probably has Cushing's. If the 8 hour number is above the reference range, then evaluate the baseline and four-hour results to see whether cortisol suppression occurred during the eight hours. If at least 50% cortisol concentration suppression is present at the four- or eight-hour time points, the definitive diagnosis is PDH and additional adrenal function tests are not needed.

This info can be found here: http://veterinarymedicine.dvm360.com/clinquiz-interpreting-low-dose-dexamethasone-suppression-test-results

So I am not really sure if that 6 hour reading matters or not because at the 8 hour mark Shelby's number was over the lab's reference range of 30, and since both at the 6 & 8 hour mark 50% cortisol concentration suppression was seen, so it looks like PDH to me.

Now for those adverse symptoms, if you see: vomiting, diarrhea, loss of appetite, lethargy, or Shelby just not acting herself, if any one of these signs are seen than the Trilostane needs to be stopped and a visit to the vet might be needed.

Keeping all fingers crossed that Shelby will do fine, keep us updated, ok?

Hugs, Lori

[Dixie'sMom]

I just wanted to pop in and say "hello" and "welcome" to you and Shelby since I had not done so. Your dogs are beautiful! :) It sounds like Shelby is off to a great start. i look foward to getting to know you and your precious babies. :)

[ScottieBoo]

So it looks like your Shelby and my Scottie both go in on the 24th for their follow up tests. I wish you all the best and of course we will keep each other posted on the results.

Also, thank you for the all the support and conversations throughout the weekend.

[Renee]

Hey there Hillary! Just checking in. I hope things are going well.

Did your vet ever run an ACTH, or just the LDDS?

[Shelby01]

Those results look like they're from a LDDS test, and generally with the LDDS test you have a baseline/resting number, a 4 hour number, and an 8 hour number.

When interpreting the LDDS test results one always looks at the 8 hour number first and if it is over that lab's reference range, which is usually 1.4, than the dog probably has Cushing's. If the 8 hour number is above the reference range, then evaluate the baseline and four-hour results to see whether cortisol suppression occurred during the eight hours. If at least 50% cortisol concentration suppression is present at the four- or eight-hour time points, the definitive diagnosis is PDH and additional adrenal function tests are not needed.

This info can be found here: http://veterinarymedicine.dvm360.com/clinquiz-interpreting-low-dose-dexamethasone-suppression-test-results

So I am not really sure if that 6 hour reading matters or not because at the 8 hour mark Shelby's number was over the lab's reference range of 30, and since both at the 6 & 8 hour mark 50% cortisol concentration suppression was seen, so it looks like PDH to me.

Now for those adverse symptoms, if you see: vomiting, diarrhea, loss of appetite, lethargy, or Shelby just not acting herself, if any one of these signs are seen than the Trilostane needs to be stopped and a visit to the vet might be needed.

Keeping all fingers crossed that Shelby will do fine, keep us updated, ok?

Hugs, Lori



Thank you Lori!! This makes much more sense to me now, knowing we did the 6 hour and 8 hour tests. I did not make the connection.

So far I've administered 3 dosages to Shelby, and I am not seeing any of the symptoms you mentioned. She seems to be acting like her normal Shelby self :)

I will definitely keep you posted -- thank you SO much!

[Shelby01]

Hey there Hillary! Just checking in. I hope things are going well.

Did your vet ever run an ACTH, or just the LDDS?


So as far as I can tell, just the LDDS test was run.

But according to what Lori posted above, the levels don't indicate further tests are needed - that these levels do indicate pituitary cushings (sorry, still trying to keep all the abbreviations straight!)

[Renee]

You are correct - an LDDS is the preferred test for diagnosing cushings.

A lot of vets don't think to recommend it, but doing an ACTH before treatment does help to establish a 'baseline' before dosing. We have another member, Mark, that didn't realize he had no baseline before beginning dosing, and it was quite upsetting to him to get the first post-treatment ACTH test and not have the benefit of a test before treatment.

As they say, hindsight is 20/20. No big deal, please don't think you or your vet did anything wrong or out of the ordinary. I was just asking. I did both tests during the diagnostic phase, but most people don't.

[Shelby01]

Okay, so something my husband and have noticed the past month or so is that Shelby is having what we are calling face tremors or twitches. My husband almost wondered if they were mini seizures. At first she didn't seem to notice. Only a few seconds long. But I think there have been a few that she has noticed.

My vet says it's probably just another Cushing symptom. However, I wonder if it may be connected to the pituitary gland.

I don't know if she actually has a tumor, but I know that's the primary cause of pituitary Cushing. I also know there is another question: is the tumor micro or macro. From what I understand the macro will not respond to treatment and has the likelyhood to grow and cause more issues, one being seizures.

We are on day 5 of trilostane. Not seeing too much change in behavior. She's always been a little pouty at times and the recent loss of our other pup (her inseparable buddy) is also a big adjustment for her.

Am I reading too much into these facial twitches? Paranoid mama?

[Squirt's Mom]

Vetoryl itself causes tremors in some pups so it could be the med. Pituitary based Cushing's **always** means there is a tumor on the pituitary gland. ;) Most of these tumors remain microscopic, causing no more problems than the cush signs. Some start to grow into the larger, or macro, tumors which do cause numerous neurological signs. Unfortunately, the treatments themselves can help these tumors grow if they are of a mind to do so. Even so, the majority of treated pups do NOT experience the macros. ;)

Just keep a close eye on your sweet girl and don't hesitate to ask if you are concerned about something. Odds are, she is just adjusting to the lowering cortisol.
Hugs,
Leslie and the gang

[Shelby01]

Thanks Leslie for the insight - that would make total sense, Shelby adjusting to the cortisol. However, we noticed these tremors way before we started medication.
The vet said it's probably just a symptom of Cushing -- but I really worried its a bigger sign about that tumor.
I am watching her like a hawk! So worried for my girl ~

[Manny]

Hi,

My little guy is taking Vetoryl 20 mg a day. He, like your dog, has a pituitary tumour. My vet reassures me that 99% of the time these are not cancer. All sites say 2 year life span. Don't believe them, my vet, who I must say is wonderful, tells me that a lot of his patients have lived a full life, years, not 2 years. So let's stay positive, love our fur kids and just enjoy them.

[molly muffin]

Molly gets the shivers since starting on trilostane. It is listed as a side effect. One of our admins said her dog had these and then they just stopped after a few months.

huggers

[molly muffin]

Manny you are absolutely correct, many, many dogs live out their normal life spans with cushings.
Welcome to the forum. Maybe you'd like to start a thread and tell us about your furbaby.

[Shelby01]

Tomorrow I take in my Shelby to be re-tested at day 14. She has been taking the 60mg dose once a day of trilostane.

I think I have seen an improvement in her panting less -- but she is still ravenous for food.

She has thrown me for a loop today. She has been very consistent for a while now at wanting to get up at 6AM (no matter what day it is) so she can have her breakfast. Yesterday she woke up at 5:30. Today she was trying to get me up at 4:45. I think her inner clock may be off. Then this morning she was circling my feet and very eager -- this is how she normally acts on weekends when she gets to hang with me all day. It broke my heart to tell her it was Friday and I had one more day of work :(

Wondering if this may be a senior moment for her. I am nervous to see what tomorrow's blood work shows.

[Renee]

Hey Hillary, the hunger may never go away completely, especially if she's always been a healthy eater. My girl still acts hungry all the time, but I can tell it's less than it was, because she no longer wakes me up at night to eat.

14 days in is still very soon, the symptoms generally resolve over a few weeks or months.

Remember, this acth is only to verify she's not too low. You won't want to increase her dose until another few weeks have passed and you re-test.

[ScottieBoo]

Hillary

Thinking of you and Shelby! I hope things go well with tomorrows Visit.:)
I will be eagerly awaiting for you to post us on the updates. Just remember we are all in the same situation with our Fur Babies / CushPups!

Gino

[Shelby01]

Thank you for the support ~ I know we are all in the same boat together

Gino ~ I have been thinking of Scottie, I hope you are seeing improvements :)

[Shelby01]

We are home from our 14 day check.

Our first visit this morning showed her cortisol level to be 3.5 (supposed to be between 1-5) the vet said she was surprised because the chemistry panel showed slight elevation in potassium and the BUN (one of the kidney tests).

BUN 31mg. Supposed to be 7-27

K 6.1 mmol. Supposed to be 3.5-5.8

Also high: ALKP 402 U/L. Supposed to be 23-212

So I'm waiting for vet to call me about the test done after 2 hours.

But regardless, the vet says she wants to reduce the vetoryl dose to 30mg instead of 60mg.

[Renee]

Hmm, can't wait to get the post results. That baseline figure can be difficult to predict and is not always an indicator of high or low cortisol.

A conservative vet is better than one that is too aggressive!

[labblab]

Hmmmm...from me, too. In the absence of the post-ACTH result, I'm not understanding why your vet has already decided to cut the Vetoryl dose in half. The initial "pre" result of 3.5 is not too low by any means. And slight increases in potassium and BUN (listed as "Urea" in the U.K. and Europe) are expected when treating with trilostane. You prefer that these values remain within the normal range, of course, but without Shelby's previous labs for comparison, I don't know how great a departure those two values represent from her previous readings. If you look at this Technical Brochure of Dechra's, you'll find a chart on page 5 listing these and other expected biochemical changes associated with trilostane treatment.

http://www.dechra-us.com/files//dechraUSA/downloads/Client%20Literature/38965_Technical_Brochure.pdf

I'm just thinking it's premature for her to decide on such a large dosing decrease without even having the benefit of yet seeing the post-ACTH result...:confused:

Marianne

[Harley PoMMom]

We are home from our 14 day check.

Our first visit this morning showed her cortisol level to be 3.5 (supposed to be between 1-5) the vet said she was surprised because the chemistry panel showed slight elevation in potassium and the BUN (one of the kidney tests).

Is that 3.5 a pre or post number?

Those 1ug/dl-5ug/dl reference ranges are for a dog being treated with Lysodren and NOT Trilostane. For Trilostane/Vetoryl Dechra states the therapeutic ranges are 1.5ug/dl - 5.5ug/dl and as long as the clinical signs are controlled that post number can go as high as 9.1 ug/dl. However on Dr Peterson's blog with Trilostane he doesn't want a dog's post cortisol to be lower than 2ug/dl. Here's a excerpt from that blog:
For my cases, I recommend maintaining a post-ACTH cortisol concentration between 2-7 μg/dl when tested 4-5 hours after the morning dose...

When using trilostane, it has become increasing clear that we do not want the cortisol values to drop too low, because that may indicate early or mild adrenal necrosis (1,11,12). In contrast to the protocol used in this reported study, I recommend stopping the drug in all dogs that develop a ACTH-stimulated cortisol values less than 2.0 μg/dl, and repeating the ACTH stimulation test in 1- to 2-weeks in those dogs. Some of these dogs will require that the drug be restarted at a lower dosage, but others will maintain low to normal serum cortisol concentrations for prolonged periods of time. And a subset of these dogs, presumably because of mild adrenal necrosis, will never need any further trilostane treatment to control the signs of Cushing's syndrome.


BUN 31mg. Supposed to be 7-27

K 6.1 mmol. Supposed to be 3.5-5.8

Also high: ALKP 402 U/L. Supposed to be 23-212

So I'm waiting for vet to call me about the test done after 2 hours.

But regardless, the vet says she wants to reduce the vetoryl dose to 30mg instead of 60mg.

Was the creatinine level normal on that chemistry blood panel? According to an abstract I found it seems that potassium levels do increase in dog's with PDH and that are being treated with Trilostane.


Median potassium concentrations increased slightly after initiation of treatment with trilostane http://www.ncbi.nlm.nih.gov/pubmed/15478772

Hugs, Lori

[labblab]

FWIW, according to that chart of Dechra's, creatinine is also expected to increase slightly with trilostane treatment.

Marianne

[Shelby01]

Ok! Just spoke to my vet. The post cortisol level was 9.5 !!

Which means the dose is not working.... But vet is concerned we are seeing other side effects in the kidney BUN and the ALKP.

She wants to go down to 30 dose in hopes to see those levels readjust.

December panel before meds showed:
BUN 20
ALKP 280
K 6.1

So today's panel of
BUN 31
ALKP 402
K 6.1
Is all major jump since we started meds.
Vet said even though the med may cause the potassium to go up, she would still want to see it in normal range.

Vet said if things go back to normal after 2 weeks like they were then we will look to readjust vetoryl again. However if there is no change back to normal on these then try lysodren.

Everything else was normal range, including CREA of 1.5

[labblab]

Hillary, I would strongly encourage your vet to call Dechra's U.S. office in order to discuss these results before you all panic and discard trilostane as a treatment.

http://www.dechra-us.com/Default.aspx?ID=365

First, a post-ACTH result of 9.5 after two weeks of treatment is a good result. Since you did not have a diagnostic ACTH done prior to starting the Vetoryl, we don't know how much her cortisol has come down. But it is now only a tiny bit above the upper limit of the potential therapeutic range. It is definitely not too low. But it may not yet be low enough to resolve all symptoms, and certainly not low enough for long enough to expect to see improvement in the ALKP, or perhaps even to yet limit the increase in ALKP caused by the elevated cortisol. That number may seem high to you, but we have dogs here whose ALKP is in the thousands! By cutting the Vetoryl dose in half, I am afraid you are guaranteeing that the ALKP will only go even higher.

As for the potassium level, that is unchanged from December so I don't understand why that is an issue. And BUN can be elevated by something as innocent as dehydration at the time of testing. As long as creatinine is in normal range, I think that blunts some of the concern over the BUN.

Truly, I think it would be a big help for your vet to talk to one of Dechra's technical specialists. If you cut Shelby's dose in half now, I'm afraid you will only see the ALKP rise even higher, which will make your vet more nervous, but for the wrong reason. If Dechra agrees that these are truly worrisome results, then obviously I would defer to their judgement. But I am thinking that they may be able to give your vet some better context for these abnormalities.

Marianne

[flynnandian]

so pre 3.5, post 9.5 after only 2 weeks on 60 mg of vetoryl is not bad at all.
the cortisol levels will drop on the same dosage for 2 weeks at least, so give it some time.
after that you may have to increase the dosage a bit.
how are the symptoms like water intake and appetite?
did they decrease?
oops posted the same time as marianne.

[Shelby01]

Hillary, I would strongly encourage your vet to call Dechra's U.S. office in order to discuss these results before you all panic and discard trilostane as a treatment. http://www.dechra-us.com/Default.aspx?ID=365 First, a post-ACTH result of 9.5 after two weeks of treatment is a good result. Since you did not have a diagnostic ACTH done prior to starting the Vetoryl, we don't know how much her cortisol has come down. But it is now only a tiny bit above the upper limit of the potential therapeutic range. It is definitely not too low. But it may not yet be low enough to resolve all symptoms, and certainly not low enough for long enough to expect to see improvement in the ALKP, or perhaps even to yet limit the increase in ALKP. That number may seem high to you, but we have dogs here whose ALKP is in the thousands! By cutting the Vetoryl dose in half, I am afraid you are guaranteeing that that ALKP will only go even higher. As for the potassium level, that is unchanged from December so I don't understand why that is an issue. And BUN can be elevated by something as innocent as dehydration at the time of testing. As long as creatinine is in normal range, I think that blunts some of the concern over the BUN. Truly, I think it would be a big help for your vet to talk to one of Dechra's technical specialists. If you cut Shelby's dose in half now, I'm afraid you will only see the ALKP rise even higher, which will make your vet more nervous, but for the wrong reason. If Dechra agrees that these are truly worrisome results, then obviously I would defer to their judgement. But I am thinking that they may be able to give your vet some better context for these abnormalities. Marianne

Thank you Marianne! I will take your advice. I just realized my typo -- the potassium level in December was 5.5 so it did go up to the 6.1

Also, her cortisol level in December before treatment was 147 mmol/L which to my understanding converts to 5.3 ug

[labblab]

Also, her cortisol level in December before treatment was 147 mmol/L which to my understanding converts to 5.3 ug
Hillary, that was Shelby's baseline cortisol prior to proceeding with her LDDS test. So her baseline cortisol today was lower at 3.5 and may reflect the benefit of the medication. However, as Renee has pointed out, baseline cortisols can fluctuate a great deal just from hour-to-hour, day-to-day. So we cannot use that original baseline to speculate what a pretreatment post-ACTH result might have been for Shelby (to compare to the 9.5).

Thanks for correcting the potassium number and showing that increase. Still, I'd be really interested in hearing whether or not Dechra would find that increase to be a significant concern.

Marianne

[Shelby01]

so pre 3.5, post 9.5 after only 2 weeks on 60 mg of vetoryl is not bad at all. the cortisol levels will drop on the same dosage for 2 weeks at least, so give it some time. after that you may have to increase the dosage a bit. how are the symptoms like water intake and appetite? did they decrease? oops posted the same time as marianne.

Her water intake did decrease. But she still has heavy appetite.

I know the cortisol results weren't bad. It's the change in chemistry panel that has my vet concerned. I know she is definitely trying a conservative approach so as not to throw Shelby out of whack.
She is thinking if we can get the new high levels to lower then we can go back to adjusting vetoryl for the cortisol levels.

So you all are thinking she should stay on 60mg based on these results ?

[labblab]

Based on cortisol and ALKP alone, yes, I would leave her on the 60 mg.

What I am not capable of doing, though, is evaluating whether the degree of elevation in Shelby's potassium and BUN are genuinely worrisome. As I say, I would defer to Dechra's staff vets on that judgement call. They know the research results and have followed the case studies of a multitude of dogs, so I believe they will know better whether or not a dosing change is in order.

[Shelby01]

Based on cortisol and ALKP alone, yes, I would leave her on the 60 mg. What I am not capable of doing, though, is evaluating whether the degree of elevation in Shelby's potassium and BUN are genuinely worrisome. As I say, I would defer to Dechra's staff vets on that judgement call. They know the research results and have followed the case studies of a multitude of dogs, so I believe they will know better whether or not a dosing change is in order.

Thank you so much, Marianne. I just emailed my vet (we've corresponded this way on several questions and she sent me the lab results) I asked her about the ALKP going higher on the lower dose and about consulting with Dechra.

[Shelby01]

Update on Shelby!!

I heard back from my vet! She did confer with Dechra. In fact she thanked me for directing her to them, as she had not consulted with them before and said they were quick and helpful! So thank YOU for the suggestion!!

The Dechra specialist agreed that my Shelby does not play by the rules!! But most importantly, agreed with my vet's concern about the high BUN and Potassium. The specialist also agreed with the decision to lower the dosage to 30mg for two weeks and retest.

Shelby did have a significant UTI in December that cleared after antibiotics. The specialist suggested checking urine again. Considering all of her blood work, The specialist wondered if possibly Shelby could have a low grade underlying kidney issue that potentially the excess cortisol from her Cushings was helping to manage.

So we are taking a urine sample tomorrow.

Well... At least I feel like things are making more sense and we are in a good track ;)

[Renee]

way to go Hillary, and way to go on your vet for calling Dechra directly!

How is your girl doing?

[Shelby01]

way to go Hillary, and way to go on your vet for calling Dechra directly! How is your girl doing?

Thank you, Renee!

Shelby seems to be doing well, besides the fact that her clock seems off - her morning wake up call keeps getting earlier! Eager for breakfast :)

No outward signs of UTI, but again, that's my Shelby. In December I had no clue. The vet was in shock she wasn't having accidents and I was even reminding her to go outside to potty.

Such a rule breaker she is!!

[ShibaMom]

Hi Hillary!

Hurray that Shelby seems to be doing well! That clock change would about kill me! LOL

Hopefully once things get evened out she'll go back to a schedule you're more accustomed to.

Cheers,
Samantha

[Shelby01]

Well it's seems Shelby has another UTI and they are sending it out to be cultured... Another $200!

Anyone ever feel like they are draining money wise?? If it's needed, I will absolutely pay. But sometimes I feel all the vet sees is deep pockets. Like the vetoryl... I pay $99 for an entire box of 60mg I use for 10 days, then I have to spend $75 on another full box of 30 mg while the first box just sits... And who knows how long that one will be used...

We test again for her cortisol levels Saturday, which will be $300. Most likely they will want to adjust and then another two weeks and test again - that's $800 in a month. Not including antibiotics for the infection..

I love my sweet pea Shelby, and want what is best for her. I will pay what is needed.

Pet owners should be advised when they first adopt - just as they might set up college fund for a kid, they need to save every month starting as a puppy for a medical fund!!

[Harley PoMMom]

Well it's seems Shelby has another UTI and they are sending it out to be cultured... Another $200!

Those darn UTI's, hopefully once the bacteria is known that the antibiotic will be able to get rid of it.


Anyone ever feel like they are draining money wise?? If it's needed, I will absolutely pay. But sometimes I feel all the vet sees is deep pockets. Like the vetoryl... I pay $99 for an entire box of 60mg I use for 10 days, then I have to spend $75 on another full box of 30 mg while the first box just sits... And who knows how long that one will be used...


We surely can relate, Cushing's is an expensive disease to get diagnosed and to treat. Once Shelby normalizes on a dose that cost should come down.

Another thought I had was those 60mg Vetoryl capsules, you may be able to take them to a compounding pharmacy and get those repackaged into other strengths.

Hugs, Lori

[Renee]

I can certainly relate!

Here is how I have cut some costs:

1. Order the vetoryl from an online pharmacy. I use California Pet Pharmacy and get the box of 10mg for $42. Free shipping over $150, so I order 6 boxes at a time (we use a box every 7 days).

2. See if your vet is diluting the cortrosyn. They should be able to get about 5 doses from one bottle. Then, purchase the entire bottle for your pup. I do this. I bought the entire bottle from my vet for $320, she diluted it down into 5 doses, and now all I pay is the cost of the testing itself, which is $110 per test. This means the cortrosyn is approx $63. per dose. A huge savings. Once I use up my five doses, then I will purchase them again.

3. Unfortunately, I don't think there is a way to cut the cost of running the cultures, because they are so necessary. I've certainly been there myself. Are you adding probiotics to Shelby's food? I suggest you do that.

[Harley PoMMom]

2. See if your vet is diluting the cortrosyn. They should be able to get about 5 doses from one bottle. Then, purchase the entire bottle for your pup. I do this. I bought the entire bottle from my vet for $320, she diluted it down into 5 doses, and now all I pay is the cost of the testing itself, which is $110 per test. This means the cortrosyn is approx $63. per dose. A huge savings. Once I use up my five doses, then I will purchase them again.



When it is for a small dog, say weighing 10 kg (22 lbs) and since each vial contains (250 μg), which only 5 μg/kg is needed for an ACTH stim test, one can get 5 stim tests out of a vial. I'm not sure how much it would save because Shelby weighs 70 lbs.

[Shelby01]

Thank you, Lori and Renee!

I needed that reminder that we are in the most expensive stage and once we get a dosage things will level out.

Once we have a more permanent dose, I will look into ordering online.

I am also going to at least bring the topic of diluting for the blood test. I have a feeling Lori is right about it not helping much because Shelby is a big dog.

Shelby is on a vitamin called NuvetPlus, which has prebiotics that helps support the healthy growth of probiotics. The vitamin is high quality, all natural, human grade products. It was recommended to me by a friend who is a vet-tech and husband retired vet. She is also a breeder and all of her dogs take them.

We are still waiting to hear results of the urine culture.

Thanks for your support ladies!

[ShibaMom]

I sure hope they'll be able to get that UTI knocked out quickly. Zanya's been plagued with them over the past 9 months, it's so hard! Crossing fingers the Clavamox takes care of this current one!

Thanks for sharing about NuvetPlus, I'm going to look in to that after she finishes the Proviable-DC the vet gave us!

Regards,
Samantha
and Zanya, Chip, Kappa, Tux, Gingus and Weasley
(whew that's a mouthful!)

[Shelby01]

Thanks for sharing about NuvetPlus, I'm going to look in to that after she finishes the Proviable-DC the vet gave us! Regards, Samantha and Zanya, Chip, Kappa, Tux, Gingus and Weasley (whew that's a mouthful!)

Good luck with the NuvetPlus! It's an excellent supplement.

Well The rest of her UTI test came back. She has an E. Coli infection. We are going on two weeks of clavamox. (Spelling?)
Of course it won't respond to the cheaper antibiotics!

Hoping for good news Saturday when we check cortisol levels again.

[molly muffin]

ugh, e-coli, we've seen quite a bit of that lately it seems. It can be a real dickens to get rid of unfortunately and it isn't unheard of for it to take a month or so for it totally clear up. Sometimes even when you think it's gone, it will come back. I just want you to be aware of that, because it is hard to get rid of.

Hoping everything is going well.

[ShibaMom]

Sorry to hear Shelby's got an e. coli infection, but your vet's treatment sounds good. How many days did she prescribe? For Zanya's most recent UTI, the first vet prescribed 15 days, but the main vet who is now in charge of Zanya's treatment added another 15, since she said these Cushpups can require the longer treatment to make sure it's eradicated. Just thought I'd share that. We'll then be re-testing before she takes her last dose.

Poor Shelby. These UTI's are brutal on them! Hopefully with improved cortisol levels, both our girls will be UTI-free!!!

I completely relate about being in the expensive phase! It's been a rough past year... Zanya got in to something while with the dogsitter, some old food my daughter left in the basement, we think, and had a $1,000 bill at the emergency vet (thank goodness she was ok!), and during the same visit, my boy Chip jumped the baby gate and hurt his back and neck (wanting to get to the sitter's dog - she had only gone downstairs to do laundry!!) and needed care. Then the many UTI's of Zanya's, as well as skin infections (vet seemed to think Staph, which the lesions sure looked like to me). Also vision issues for Chip, and both of them had dentals, with extractions and antibiotics due to infection. OY VEI!!!

Sorry, didn't mean to write a book in your thread! These babies sure can dig deep into our wallets ... and I thought my two young-adult daughters were bad enough! Ha!

Take care,
Samantha

[Shelby01]

So I'm feeling quite frustrated with my Vet. We went in on Saturday for blood work. I had to call Monday afternoon because I still had not heard results. The Vet told me a few over the phone and said she would get back to me on the "new plan" for meds. I called and left another message yesterday. I am still waiting...


So we had started Shelby on 60mg Vetoryl and at 2 weeks, the cortisol looked good, but her liver, phosphate, and potassium were up. After consulting with some specialists, we decided to go down to 30 mg. Hoping to see some change in those other 3 elevations.

Well, according to what the Vet told me on Monday, we did not see the change we wanted to.
Her cortisol is back up -- which I had figured because her panting was back.
Her BUN (kidney) was at 31 and only dropped to 29
Her alkaline phosphate only dropped from 402 to 377

The big concern is that her potassium actually went farther up! From 6.1 to a 6.9

The Vet was wanting to consult with the specialist again, which I understand. But obviously my Shelby is not on a good dosage and we need to make a change... how long am I expected to wait?? We had that conversation Monday and it's now Thursday.

GRR :(

[Renee]

I'm not sure what to say in regards to the potassium... but, those other values (ALK and BUN) can take a while to come down. Treatment is definitely not overnight. Some dogs on here have taken over a year to get the alkphos into range.

How is the UTI?

What were the actual acth results?

[Shelby01]

I'm not sure what to say in regards to the potassium... but, those other values (ALK and BUN) can take a while to come down. Treatment is definitely not overnight. Some dogs on here have taken over a year to get the alkphos into range.

How is the UTI?

What were the actual acth results?


We are still on antibiotics for the UTI

I requested the blood work to be emailed to me, but I'm still waiting for that too.... all I know is what she told me over the phone on Monday.

I know things take time, I'm just feeling frustrated that my Vet is not getting back to me quicker. I don't think I should have to wait a week for blood results -- there is obviously a need to change something, I feel helpless not being able to make that change.

[Renee]

Oh yes, I absolutely agree with you about waiting! It should not take a week to get back to you, unless it truly took her a week to receive the results herself. I have an understanding with my vet that she emails the results to me when she receives them, then we talk. I sure hope you can work this out with your vet.

The UTI does present some problems, as it may influence some of the results, but with the BUN being elevated, there may be more going on than cushings.

More questions than answers I am afraid! Keeping hanging in there, you are doing good. I hope some experts stop by with their feedback too.

[Shelby01]

RESULTS!!

Okay! I finally heard back from the Vet!

The Dechra specialist is very concerned about the potassium level being so high, 6.9, so close to 7. (this can cause other issues like musculoskeletal issues and cardiac issues)

Specialist said that trilostane can inhibit production of a hormone called aldosterone - and Shelby may be having an exaggerated aldosterone response.

The specialist wants to take her OFF the trilostane for 1 week and recheck potassium level.

If it returns normal, then she's having a reaction to trilostane and want to switch her to mitotane.

If it does not return to normal, then the concern turns to her aldosterone regulation and they would want to do other blood tests.

[Renee]

YAY for Dechra and your vet for checking in with them!

Excellent plan!

[Shelby01]

YAY for Dechra and your vet for checking in with them!

Excellent plan!

Thank you Renee! I appreciate your support SO much :D

[labblab]

Hi again, Hillary. I'm so glad that Dechra has been helpful to y'all! And I have to agree that this sounds like a reasonable gameplan. Please keep us updated.

Marianne

[Shelby01]

Hi again, Hillary. I'm so glad that Dechra has been helpful to y'all! And I have to agree that this sounds like a reasonable gameplan. Please keep us updated.

Marianne

Excellent. I must say, it is reassuring to hear you all agree with the game plan. It helps put me at ease a bit, knowing we are on the right track.

Thank you :D

[Shelby01]

What a relief.... We had Shelby's potassium level checked after being off the vetoryl for a week. Thank goodness her potassium level went down! Yay! Which means she was definitely reacting to the meds.

Unfortunately the clavamox did not get rid of the bladder infection, so we are trying a new one.

Her kidney and liver levels are on the line for being slightly high. Otherwise, things look decent.

I must say, Shelby has been happier off the meds. Her appetite is not near as intense and she isn't obsessed with water. She has occasional spells of panting but nothing out of control.

With her being 13 and a half, and seeing how trilostane really messed with her system, I am hesitant to try her on milotane, the more aggressive drug.

[Renee]

Hillary, I am so glad to hear she has improved so much!

Did you vet do a culture and sensitivity for her UTI? If not, then I encourage you to have that done. Also, it can take much more than the standard 10 days of abx to clear a UTI in a cush dog.

As for the reaction to the trilostane - what about doing a compounded dose, a very small compounded dose? Or is using trilostane completely off the table? I'm not an expert on the reactions for the intermediaries and use of trilostane, so I hope some others chime in.

Also, just a though - as long as she is not displaying hard symptoms at the moment, I'm not sure I'd worry about starting up any treatment again, until the symptoms return. Are you planning to run another stim test to see how she's rebounded?

[Shelby01]

Hillary, I am so glad to hear she has improved so much! Did you vet do a culture and sensitivity for her UTI? If not, then I encourage you to have that done. Also, it can take much more than the standard 10 days of abx to clear a UTI in a cush dog. As for the reaction to the trilostane - what about doing a compounded dose, a very small compounded dose? Or is using trilostane completely off the table? I'm not an expert on the reactions for the intermediaries and use of trilostane, so I hope some others chime in. Also, just a though - as long as she is not displaying hard symptoms at the moment, I'm not sure I'd worry about starting up any treatment again, until the symptoms return. Are you planning to run another stim test to see how she's rebounded?

Thank you Renee! And thank you for your suggestions, too.

Yes, we had the urine cultured. There was only one drug it showed resistance too. We had her on clavamox for two weeks. Since this is our second time on clavamox, Vet wonders if it has developed resistance to it now.

Even with dropping the 60mg of vertoryl down to 30mg, the potassium continued to go up. So, I don't think I'm comfortable trying it anymore.

I agree, I think we will sit tight for now in terms of treatment. Just going to focus on the UTI for the moment. I don't have another stim test planned at the moment. Her cortisol levels did go back up when we tested at the end of two weeks on the 30mg. But if the specialist is right, this cortisol may be helping to manage an underlying kidney issue.

[molly muffin]

How is Shelby doing?

[Shelby01]

How is Shelby doing?

Hi! Shelby is doing well. We are still taking our antibiotic for the UTI - bavtril. I hope it works!

We have been off vetoryl for two weeks now. At this point, unless things get bad, something changes, I don't have plans to try her on lysodren anytime soon.

On another note, Shelby has always kept to herself and never really liked other dogs, except her "brother" who passed in November. Of course the past three months have been tough on all of us.
Well, with our many trips to the vet, she has shown interest in other adult yellow dogs (like my boy was). I know she misses him.
Well, we are fostering a 6 year old golden for a rescue I volunteer with. So far so good - besides a tiff about a ball - Shelby has really perked up. I hope it will be a good fit, but ultimately is Shelby's decision.

Keeping her comfy and happy is my goal of course. :)

[Squirt's Mom]

That's funny that she is attracted to other yellow dogs like herself and her brother. :p I guess in Dogdom PC doesn't carry much weight. :D:D:p:D:D

[Renee]

I'm so glad to hear she is doing well, and YAY for fostering! :)

[Shelby01]

Yay! We finished meds for the UTI on Monday. Today we checked and Shelby is infection free!! Woohoo! Now let's hope it lasts!

On another positive note, we have decided to adopt our foster pup, Josie. She has been wonderful for Shelby :)

[Squirt's Mom]

YAY! on all accounts! :cool::cool::cool:

[pansywags]

Congratulations on your foster fail!

[judymaggie]

Great news all around! I' m so glad that Shelby has a new companion.