MrsJune
01-25-2015, 03:05 PM
Hi Everyone,
My 10.5 year old dachshund was diagnosed a little over 2 years ago with Pituitary Canine Cushings and has been on 5mg of Trilostane BID during that time. I purchase his medication through a compound pharmacy. He has been well controlled since we began treatment.
He has another issue such as every now and then he injures his neck either by climbing a step or chewing too aggressively on a toy. This has happened maybe 1-2 times a year for the past few years. His vet prescribed pain killers, NSAIDs, and muscle relaxers when he has an episode.
About 3 weeks ago he was climbing up a step and hit his throat on it. Later that morning he was limping and developed this strange throat clearing noise. It was not stridor but more like a low grunting sound. This was on 1/7/2015. I had started a new batch of Trilostane 2 days before. I also gave him the painkillers, NSAIDS, and muscle relaxers.
He had his routine ACTH testing on 1/15 and I decided to wait until then to mention to his Vet what had happened. He had just had a wellness checkup the month before. We didn't do the ACTH at that time because there was a mix up with scheduling and the Vet didn't have the Cortrosyn available that day. The injury happened after that visit.
I wasn't present during the exam but when his Vet called to give me his results (which were controlled), I asked her about the throat issue and she said she applied direct pressure to his trachea area since she drew from the jugular vein. She said she didn't notice anything wrong with his throat at the time.
They also did a regular lab panel and potassium was checked but not sodium. (I don't know why this wasn't done) We found out he had hypothyroidism and she ordered 0.1mg Soloxine BID and 100mg of Gabapentin BID to control his possible nerve pain. She wanted me to stop the Carprofen because his liver Alk Phospatase came back elevated at 477 U/L.
The next few days he became extremely lethargic. The cough worsened. He wouldn't get up from bed. He was constipated, didn't want to walk, and looked horrible. I thought I was going to lose him. I stopped giving him all meds that day except the Soloxine and Gabapentin. His Vet called me that night and I told her what was going on. She asked me to get an electrolyte panel the next day. She also said to reduce the Gabapentin by dividing the capsule and said I could give him his Tramadol. I asked her if I should stop the Trilostane and she said, "No". (I had only skipped one dose at this point). I asked her by allowing the cortisol back in his bloodstream would it help his pain? She told me it didn't work like that. I have read everything I could get my hands on regarding canine Cushing's and it can work like that! I stopped the Trilostane completely anyway against her advice.
Well, he improved immediately. The next morning he got out of bed and wanted to go outside on his own without being lifted of carried. I did not take him to have his electrolytes tested as I no longer have any trust in this Vet. I don't understand why a full electrolyte panel wasn't ordered when she drew his lab work. I gave him his Soloxine and Tramadol and skipped the Gabapentin. He is back to himself the last 2 days. He has a slight issue still with his throat. Very slight compared to the days before. Just a little throat clearing now and then.
The issue I have with this Vet is extensive. I won't go into further detail as I don't think it is relevant to this immediate situation. I just don't think she is competent in treating Cushing's. From my experiences, only certain Vets have expertise in this area of treatment. I do not think she has this.
The downside is that his Cushing's symptoms are already returning. His increased thirst and appetite have come back almost immediately.
I need a new Vet. I also have concerns about the compounded medication. I want to have it tested for potency. I am going to call tomorrow to see if I can do this as a consumer. If the medication is potency is correct, I want to start using it again under the supervision of a new Vet. I would purchase Vetoryl but he has done so well with the 5mg BID Trilostane. I can't purchase that strength in the Vetoryl.
I am interested in treating the Cushing's with Selegiline if the Trilostane is failing.
I don't have any concrete proof that the Trilostane failed other than he improved after stopping it. The ACTH pre and post showed optimal control. I know I should've done an electrolyte panel but I was angry with her and my trust was gone. I thought it would've been useless at the time since I thought he was dying. I was looking for comfort for him and not more needle pokes. I think if I had more trust in her I would've had the electrolyte panel done. I have wanted to fire her long ago but kept putting it off. Now a crisis has happened and I am beating myself up over not doing it sooner.
His labs: 1/15/15
Post-Trilostane
Cortisol Sample 1/results 2.2 ug/dl ref. range
Cortisol Sample 2/results 8.4 ug/dl ref. range
(Pre and Post cortisol levels between 1.5-9.1 ug/dL)
Reference Range
Alk Phosphatase 477 U/L (high) 5-131 U/L
Glucose 110 70-138 mg/dL
Potassium 4.6 3.6-5.5 mg/dL
BUN/creatinine Ratio 27 4-27 mg/dL
Creatinine 0.3 (low) 0.5-1.6 mg/dL
Hemoglobin 14.2 12.4-20.3 g/dL
Platelet count 451 (high) 170-400 10/uL
Monocytes 1053 (high) 0-840 /uL
T4 0.7 (low) 0.8-3.5 ug/dL
Has anyone experienced a poor outcome with compounded medications? Has anyone tested the potency or quality of a compounded medication?
I am ok with not treating the Cushing's but I would prefer not to for his comfort. I don't like to see him hungry all the time.
Any suggestions would be helpful.
Thank you for taking the time to read this.
My 10.5 year old dachshund was diagnosed a little over 2 years ago with Pituitary Canine Cushings and has been on 5mg of Trilostane BID during that time. I purchase his medication through a compound pharmacy. He has been well controlled since we began treatment.
He has another issue such as every now and then he injures his neck either by climbing a step or chewing too aggressively on a toy. This has happened maybe 1-2 times a year for the past few years. His vet prescribed pain killers, NSAIDs, and muscle relaxers when he has an episode.
About 3 weeks ago he was climbing up a step and hit his throat on it. Later that morning he was limping and developed this strange throat clearing noise. It was not stridor but more like a low grunting sound. This was on 1/7/2015. I had started a new batch of Trilostane 2 days before. I also gave him the painkillers, NSAIDS, and muscle relaxers.
He had his routine ACTH testing on 1/15 and I decided to wait until then to mention to his Vet what had happened. He had just had a wellness checkup the month before. We didn't do the ACTH at that time because there was a mix up with scheduling and the Vet didn't have the Cortrosyn available that day. The injury happened after that visit.
I wasn't present during the exam but when his Vet called to give me his results (which were controlled), I asked her about the throat issue and she said she applied direct pressure to his trachea area since she drew from the jugular vein. She said she didn't notice anything wrong with his throat at the time.
They also did a regular lab panel and potassium was checked but not sodium. (I don't know why this wasn't done) We found out he had hypothyroidism and she ordered 0.1mg Soloxine BID and 100mg of Gabapentin BID to control his possible nerve pain. She wanted me to stop the Carprofen because his liver Alk Phospatase came back elevated at 477 U/L.
The next few days he became extremely lethargic. The cough worsened. He wouldn't get up from bed. He was constipated, didn't want to walk, and looked horrible. I thought I was going to lose him. I stopped giving him all meds that day except the Soloxine and Gabapentin. His Vet called me that night and I told her what was going on. She asked me to get an electrolyte panel the next day. She also said to reduce the Gabapentin by dividing the capsule and said I could give him his Tramadol. I asked her if I should stop the Trilostane and she said, "No". (I had only skipped one dose at this point). I asked her by allowing the cortisol back in his bloodstream would it help his pain? She told me it didn't work like that. I have read everything I could get my hands on regarding canine Cushing's and it can work like that! I stopped the Trilostane completely anyway against her advice.
Well, he improved immediately. The next morning he got out of bed and wanted to go outside on his own without being lifted of carried. I did not take him to have his electrolytes tested as I no longer have any trust in this Vet. I don't understand why a full electrolyte panel wasn't ordered when she drew his lab work. I gave him his Soloxine and Tramadol and skipped the Gabapentin. He is back to himself the last 2 days. He has a slight issue still with his throat. Very slight compared to the days before. Just a little throat clearing now and then.
The issue I have with this Vet is extensive. I won't go into further detail as I don't think it is relevant to this immediate situation. I just don't think she is competent in treating Cushing's. From my experiences, only certain Vets have expertise in this area of treatment. I do not think she has this.
The downside is that his Cushing's symptoms are already returning. His increased thirst and appetite have come back almost immediately.
I need a new Vet. I also have concerns about the compounded medication. I want to have it tested for potency. I am going to call tomorrow to see if I can do this as a consumer. If the medication is potency is correct, I want to start using it again under the supervision of a new Vet. I would purchase Vetoryl but he has done so well with the 5mg BID Trilostane. I can't purchase that strength in the Vetoryl.
I am interested in treating the Cushing's with Selegiline if the Trilostane is failing.
I don't have any concrete proof that the Trilostane failed other than he improved after stopping it. The ACTH pre and post showed optimal control. I know I should've done an electrolyte panel but I was angry with her and my trust was gone. I thought it would've been useless at the time since I thought he was dying. I was looking for comfort for him and not more needle pokes. I think if I had more trust in her I would've had the electrolyte panel done. I have wanted to fire her long ago but kept putting it off. Now a crisis has happened and I am beating myself up over not doing it sooner.
His labs: 1/15/15
Post-Trilostane
Cortisol Sample 1/results 2.2 ug/dl ref. range
Cortisol Sample 2/results 8.4 ug/dl ref. range
(Pre and Post cortisol levels between 1.5-9.1 ug/dL)
Reference Range
Alk Phosphatase 477 U/L (high) 5-131 U/L
Glucose 110 70-138 mg/dL
Potassium 4.6 3.6-5.5 mg/dL
BUN/creatinine Ratio 27 4-27 mg/dL
Creatinine 0.3 (low) 0.5-1.6 mg/dL
Hemoglobin 14.2 12.4-20.3 g/dL
Platelet count 451 (high) 170-400 10/uL
Monocytes 1053 (high) 0-840 /uL
T4 0.7 (low) 0.8-3.5 ug/dL
Has anyone experienced a poor outcome with compounded medications? Has anyone tested the potency or quality of a compounded medication?
I am ok with not treating the Cushing's but I would prefer not to for his comfort. I don't like to see him hungry all the time.
Any suggestions would be helpful.
Thank you for taking the time to read this.