Riley's frustrated owners need help

[barbaraabaker]

I am new to this site, just joined yesterday so “Hi” and now for my situation. My dogs name is Riley, an English spaniel. He is 10 (almost 11 - birthday in July). We adopted him as a rescue animal. He was used as a bait dog for fighting dogs so needless to say his puppyhood was pretty stressful. Since he came to our home, he has been pretty much a pampered dog.

Anyway, we noticed that the hair on his back had virtually stopped growing and the skin was reddening. He has always been a water drinker and consumes a fair quantity every day. He showed some signs of a bigger belly and his back legs were not as strong as they once were. He used to jump into our truck cab for rides and now we need to help him up. He has always panted more than we liked and for some reason he likes to lick the carpets. Both issues got worse in November of last year along with the hair and skin so we took him to our vet. He said that the initial blood work indicated a problem but further tests were needed so we returned for a second time for a more extensive test. The vet then brought up the possibility of Cushing’s but wanted another test to confirm. Since we were going into the holidays, he said we could wait until after the first of the year to pursue it. Since that time, Riley has started losing control of his bladder and leaving puddles on the carpets and linoleum in the house. He was well house trained and has his own doggie door to go outside with free roam of our back yard and is still going outside like usual. We thought it might be a bladder infection so we went back to the vet and he ran a test, said it was negative, charged us another $100 and then said that the incontinence was probably a result of the Cushing’s and urged running the definitive test so we agreed. After that test he said it was probably Cushing’s but he could not tell if it was pituitary or adrenal so ANOTHER test was needed.

Now we are four visits, four tests and hundreds of dollars down the road and the vet still has not definitively diagnosed Cushing’s disease. He said it probably is but wants to conduct more tests – a sonogram? – before saying anything or prescribing any medications. He wants to determine if an adrenal tumor should be removed surgically (more money?).

Are we getting a run around here? Can’t we start Riley on one of the medications to get this under control? Do we really need this next test? Are we financing the vet’s next boat payment? Sorry, probably unfair but we are just a bit frustrated here. I am retired and this is costing a lot of money. Even if we start the medication I know it is very expensive. I guess that some knowledgeable guidance is requested here. I have tried to get as many test results in here as I can. They did not copy too well from the vet's email. I don't really know what I am looking at. Thanks.

11/13/14 Test results
In Range Out of Range Reference Range Units
Glucose 102 65-130 mg/dL
BUN 39 H 6-29 mg/dL
Creatinine 0.6 0.6-1.6 mg/dL
Potassium 5.8 H 4.0-5.7 mEq/L
Phosphorus 5.4 3.0-7.0 mg/dL
ALP 385 H 10-84 U/L
ALT 69 H 5-65 U/L
T4 RIA 8 L

11/19/14 Test results

CBC
In Range Out of Range Reference Range Units
WBC 11.7 6.0-17.0 K/uL
RBC 6.57 5.50-8.50 M/uL
HGB 16.2 12.0-18.0 g/dL
HCT 49.1 37.0-55.0 %
MCV 74.7 60.0-77.0 fL
MCH 24.7 19.0-25.0 pg
MCHC 33.0 32.0-36.0 %
PLT 424 200-500 K/uL

Differential
In Range Out of Range Reference Range Units
Poly # 9690 3600-11500 /uL
Lymph # 1180 1000-4800 /uL
Mono # 490 150-1350 /uL
Eos # 280 0-1250 /uL
Baso # 20 0-500 /uL
% Poly 83.1 %
% Lymph 10.2 %
% Mono 4.2 %
% Eos 2.4 %
% Baso 0.2 %

Total Body Chem Screen
In Range Out of Range Reference Range Units
Glucose 66 65-130 mg/dL
BUN 17 6-29 mg/dL
Creatinine 0.6 0.6-1.6 mg/dL
Sodium 149 140-158 mEq/L
Potassium 5.5 4.0-5.7 mEq/L
Na/K Ratio 27 27-40
Chloride 106 100-118 mEq/L
CO2 21 18-26 meq/L
Anion Gap 28 H 13-25
Calcium 10.4 8.0-12.0 mg/dL
Phosphorus 6.2 3.0-7.0 mg/dL
Osmolality Calc 296 270-310
Total Protein 6.3 5.4-7.6 g/dL
Albumin 3.0 2.3-4.0 g/dL
Globulin 3.3 2.4-4.4 g/dL
A/G Ratio 0.9 0.6-1.2
Tot Bilirubin 0.2 0.0-0.5 mg/dL
ALP 392 H 10-84 U/L
GGT 10 0-10 U/L
ALT 68 H 5-65 U/L
AST 27 16-60 U/L
CK 191 50-300 U/L
Cholesterol 518 H 150-275 mg/dL
Amylase 587 300-1500 U/L
Lipase 1011 H 0-425 U/L
Lipase verified by repeat analysis.

Urinalysis
In Range Out of Range Reference Range Units
Urine Source UrineCatheterization
Color Pale
Appearance Clear
pH 5 5.0-9.5
Urine Sp. Gravity 1.014 1.005-1.055
Protein 30 A Negative mg/dL
Glucose Negative Negative
Ketone Negative Negative
Bilirubin Negative Negative
Blood Small A Negative
Casts Mod Granular
Bacteria None seen
Mucus None seen
WBCs 0-4
RBCs 0-4
Epithelials Few
Crystals None seen

3/2/15 Test results

Urinalysis
In Range Out of Range Reference Range Units
Urine Source Urine-Catheterization
Color Pale
Appearance Slightly Cloudy
pH 5 5.0-9.5
Urine Sp. Gravity 1.011 1.005-1.055
Protein 300 A Negative mg/dL
Glucose Negative Negative
Ketone Negative Negative
Bilirubin Negative Negative
Blood Small A Negative
Casts None seen
Bacteria None seen
Mucus None seen
WBCs None seen
RBCs None seen
Epithelials Few
Crystals Amorphous Urate
Crystal Quant Few
Presence of protein has been verified by Sulfosalicylic Acid(SSA)

3/5/15 Test Results

Test Reading Reference range Units
Cortisol, 0 hr 5.3 1.0-10-.0 ug/dL
Cortisol, 4 hr 3.1 ug/dL
Cortisol, 8 hr 3.4 (out of range) 0.0 -1.4 ug/dL

[Harley PoMMom]

Hi and welcome to you and Riley,

Aww, I am glad Riley found such wonderful pet parents as you, and Bless you for giving Riley a loving forever home.

Cushing's is one of the most difficult canine diseases to diagnose, which makes it one of the most misdiagnosed. There isn't one test that is 100% accurate at diagnosing Cushing's so a vet/IMS does need to perform multiple tests to validate a Cushing's diagnosis. So, no, I don't believe you're getting a run around with your vet.

Ultrasounds can be a very useful diagnostic tool, they may be able to find abnormalities on the internal organs, such as gallbladder mucocele, kidney issues, pancreatitis...etc. Ultrasounds also have the capability to differentiate between the pituitary or adrenal form of Cushing's IF the adrenal glands are visualized. Our motto here is you get a lot of bang for your buck with an ultrasound. However not ultrasounds are created equal. A good quality ultrasound/interpretation depends on a few things; the tool used, the technician performing it, and the physician interpreting it.

With Cushing's the initial expense is during the diagnostic phase, once a dog is on treatment and the dose is stabilized the cost does go down significantly. Having the medication for Cushing's compounded will also save some money, many of our members use Diamondback pharmacy, here's a link to their website: http://www.diamondbackdrugs.com/

How much does Riley weigh? Is he taking any other herbs/supplements/medications? I see that he does have diluted urine, when a dog has diluted urine a regular urinalysis is not sensitive enough to pick up bacteria so in that case an urine culture and sensitivity test is needed.

Those low dose dexamethasone suppression test results
0 hr 5.3 1.0-10-.0 ug/dL
Cortisol, 4 hr 3.1 ug/dL
Cortisol, 8 hr 3.4 (out of range) 0.0 -1.4 ug/dL


are indicative to Cushing's, and as your vet did say, they don't show if the Cushing's is adrenal or the pituitary type.

We are here to help in any way we can, and do not hesitate to ask all the questions you want. ;)

Hugs, Lori

[barbaraabaker]

First, thanks for your prompt response.

Riley is a healthy 32 pounds and is not receiving any medications at all.

So I take it from your post that we should go ahead with the ultrasound but also ask for a urine culture and sensitivity test? Or just the ultrasound? And what is a ballpark cost figure for the ultrasound?

If that test shows a pituitary then medication is the answer (and I think I read that about 85% of Cushing's is in this category)? if it shows an adrenal tumor then surgery and that would solve the problem with no medication needed? Can the medication work even if it is an adrenal tumor without surgery?

[barbaraabaker]

By the way, I looked at Diamondback drugs and it looks like they only supply veterinarians.

[molly muffin]

Diamondback does provide services to patients. You just need a prescription which comes from your vet. They often just call the vet or the vet calls them and then you pay and it is mailed to your home address. As Lori said, many of our members use Diamondback or other online pharmacies. You just want one with a good reputation for compounding and Diamondback has a good reputations, as does California pet pharmacy, Lamberts, etc.

Say for you are using vetroyl, you can get any amount compounding that the manufacturer of vetroyl doesn't make, and since you start at 1mg/1lb with that medication, then you could get 32 or you could get 29 or 28, just not 30mg as Dechra manufactures that amount of vetroyl It can save hundreds of dollars over time.

With test results unless it is LDDS or ACTH and urinalysis, which we would want to see the whole thing, the main thing is any numbers out of range.

Ultrasound can give you a lot of bang for the buck but they are expensive. You'll need to ask your vet what they charge and make sure it is a high resolution machine so they get a good view. I would guess it would be in the 300 - 500. range. We've seen them fall in that range anyhow. With the average being around 350. (ish).

I think you would want a good view of adrenals, liver, kidneys, pancrease, spleen, gall bladder as main areas based on symptoms.

Welcome to the forum.

[Harley PoMMom]

So I take it from your post that we should go ahead with the ultrasound but also ask for a urine culture and sensitivity test? Or just the ultrasound? And what is a ballpark cost figure for the ultrasound?

If this were me, I would have the urine culture and sensitivity test done to make sure that Riley does not have an UTI which could be the culprit for the bladder issues. Another reason I would want this ruled out is because if any other non-adrenal illness, such as an UTI, diabetes etc... is present at the time of testing a false positive result could occur.

Ultrasounds are expensive, it's been a while since I had to pay for one, but I'm pretty sure it was around $400.


If that test shows a pituitary then medication is the answer (and I think I read that about 85% of Cushing's is in this category)? if it shows an adrenal tumor then surgery and that would solve the problem with no medication needed? Can the medication work even if it is an adrenal tumor without surgery?

If the dog has a functional adrenal tumor and is a good surgical candidate, an adrenalectomy could be a complete cure. However, this type of surgery requires a very skilled and experienced board certified surgeon.

The two medications generally prescribed for Cushing's are Mitotane/Lysodren and Vetoryl/Trilostane, both can be used for the adrenal or pituitary type of Cushing's.

Hugs, Lori

[Mile and Ann]

Just wanted to interject that Mile just had an abdominal ultrasound and the cost was 278.00. I learned a lot. I did not know he had an enlarged adrenal gland and enlarged prostrate. It is worth having this test done. I could even be with Mile while he had the ultrasound.

[Wrighton]

Our ultrasound in January was $50 at our reg. vet who found the mucoscele but was low definition so she sent us to specialist who confirmed it. That was $425 but much more defined.
Gail

[Squirt's Mom]

An ultrasound for $50?! That sounds more like the cost of an xray! Lucky you!

[Renee]

Ultrasound in my area is $600-$700. I opted for a CT instead, because I thought it would be more useful to me. That was $1200.

[molly muffin]

I'm in Canada and my initial ultrasound was more expensive but I go back to the same place for follow up ultrasounds and the recheck is only 70.

[barbaraabaker]

I think my wife and I have decided to bypass the ultrasound and to rely on the medication to control the disease. It seems that the benefit to the ultrasound is knowing if it is an operable adrenal tumor or not. If it is, then the surgery would address the situation without lifelong medication. But replies seem to indicate that medication is effective in either adrenal or microscopic pituitary tumors.
My question now would be, in general, how long after starting the medications can you usually see reduced symptoms - panting disappears, belly not bulging out, hopefully the leaking in the house disappears. Basically, when can we expect Riley to be his normal self again?

[lalosmom]

Orlando has been on Vetoryl for 11 days and I am seeing less urination, reasonable appetite, and more energy. He has resumed barking when he needs to alert me, and before starting the med he was more or less too exhausted to care.

I did not do an ultrasound either, but that was strictly my decision based on past experience. My vet told me that if the test for Cushings was negative, we would do an ultrasound to check for liver tumors. I probably would have allowed that.....and here in LA they are at least $500...but would not have opted for surgery for either adrenal tumors or any other type.

[idalit]

Hi Riley, As I read your description of your dog condition. reminds me so much of what my dog symptoms were. I noticed his was losing hair in his tail. he drinks a lot of water. He gained a lot of weight and mainly around his belly. We controlled his food though.

He was just diagnosed with cushing deseases after was taking to the emergency Hospital where he remains. We found out about it due to a clot on his rear legs that had him with a lot of pain and cannot walk. I am still waiting for signs of recovery.

I am amazed I never heard of this illness. My dog has regular checks. I took him 3 times to the vet to find out his issue with his limping and suddenly he couldnt walk.

I hope you dog get undercontrol this conditions. The last few days in the hospital + medical visits has been extremely expensive. I dont know how much more I can borrow to keep him alive.

I wish you luck and hopefully the medicine keep him under control

[barbaraabaker]

idalit, I thank you for your comment. You have my prayers that your dog gets back into good health. I have owned dogs for about 35 years and this is the first I have known about Cushings disease. So I am learning a lot in a very short time. I can appreciate your issue with finances. That is why we are opting to start meds rather than chase ultrasounds and further surgery for Riley.

Thanks again and good luck with your doggie.

[molly muffin]

Are you starting vetroyl/trilostane or lysodren? If starting vetroyl, remember, 1mg/1lb starting dose is safest.

We certainly understand $$ around here and an ultrasound is not always feasible for people to do.

Let us know how things are progressing. We are here for you.

[barbaraabaker]

Well our vet finally agreed to dispense vetoryl to address the situation. I have a couple of things that bother me though. First he does not want to run stim tests to check the dosage from checking ACTH levels. He just wants us to observe and check that the Cushings symptoms abate and that there are no reactions to the drug - diahrea vomiting lethargy etc. Then he just wants to do a look see check one week from now as a follow-up. Second, he started Riley at 60mg every other day increasing to 60mg per day after 7 days. This seems to be high based on what you all have written but he feels that Dechra says to use 1 to 3 mg per pound per day for a 33 pound dog and that 2mg puts it at 60mg per day. We gave his first dose yesterday and have not seen any adverse affects yet. We will keep watching.

[Squirt's Mom]

I'm gonna be real blunt - Riley needs a new vet NOW. ;) What this one is trying to do is risky - he is putting Riley's life in danger by not testing, pure and simple. You must protect Riley at all costs. If he were mine, he would go without treatment before following this vet's direction. ;) This vet's willful ignorance and arrogance is unforgivable in my book.

[molly muffin]

Wow. That vet is totally dangerous. He can't read simple directions I hope he isn't putting dogs on vetroyl regularly.

Let's be clear. Dechra says. Start on low end of scale. This was a recent update due to so many problems at the higher dose to start with. It is not safe. So 1 mg/ 1 lb. no where do they say double the dose to start give it every other day and then once a day.

Not all vets are created equal. Some graduated I the top 10 percent of their class. Some where in the bottom 10 percent.

So sorry. I'd never step foot in his door again other than to pick up a complete copy of my pets records. I think the vet isn't safe frankly. This is of course my opinion but it's based on seeing how wrong things can go and how fast :(

My dog is 18 pounds. We are just now getting up to 15 mg

[labblab]

Oh dear, I'm afraid I have to join in the choir, too. :( :(

There is really nothing about your vet's recommendations that I can feel good about :o. First and foremost is the risk associated with foregoing any of the monitoring blood-testing. Not only can cortisol levels drop too low for dogs taking trilostane, but aldosterone levels (another adrenal hormone) can be affected, too. Aldosterone controls the safe balance of sodium and potassium levels in the body. If those chemicals become unbalanced, dire consequences can occur. It is very, very important that both cortisol levels and blood chemistries are regularly monitored so that the medication dose can be readjusted BEFORE you see serious signs of imbalance such as vomiting, diarrhea, lethargy, collapse. You may not see outward signs until the situation has become very serious. I do realize that the expense of blood testing can be a great burden, so there may be ways in which the testing can be spaced out, or even baseline cortisol levels can be substituted at times for complete ACTH stimulation tests. But you simply cannot go without any testing or all or it is not safe to use the drug. Period.

This is especially true since your vet is opting to start at the 60 mg. dose -- a higher dose makes unwanted side effects even more likely. There really is no need nor reason to start that high. Dechra makes both 10 mg. and 30 mg. capsules of Vetoryl, as well. So the 30 mg. dose would have been the safer (and less expensive) option to begin on. Yes, Dechra does have a published dosing range of 1-3 mg. per pound. But on their newest Product Insert, the range is immediately followed by the instruction to "Start at the lowest possible dose, based upon available capsule size." Here is a link to a reply on our Trilostane FAQs thread that discusses the preference for lower dosing in great detail:

http://www.k9cushings.com/forum/showthread.php?p=1251#post1251

If you wish, you can even print this out and give it to your vet to read.

Last but not least, starting out by dosing Riley every other day makes absolutely no sense. Trilostane exits the dog's body in a time period of 12-18 hours. So by giving a 60 mg. dose every other day, Riley's cortisol is getting lowered significantly one day, and then it is allowed to balloon back up again on the next day. All this does is create a roller-coaster effect on his endocrinological system. The goal is to maintain cortisol levels at as consistent a level as possible. So at a minimum, you want to dose once daily. Some dogs actually end up taking 1/2 the daily dose both morning and evening in order to even out the cortisol level even further.

It sounds as though your vet is trying to "break him in" by initially giving Riley a dose every other day. But there is no logical reason why this dosing pattern is actually any easier on Riley's body. The better option would have been to give 30 mg. every day.

To better arm you with specifics for all this information, here is a link to Dechra's most recently updated U.S. Product Insert for Vetoryl.

http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf

Marianne

[Renee]

Second, third, and fourth what has been said. Your vet is dangerously ill-informed and not equipped to handle such a complex disease.

[Squirt's Mom]

Honey, we are not ganging up on you either and I hope we haven't made you feel that way. But we are here for one reason - to do the best we can for the dogs that come here by guiding their parents. We don't really care if the vets like us, tho that would be nice, nor are we here to make friends, tho that does certainly happen and we are very happy when it does - our number one priority is the dog. And Riley is simply not safe under this vet's "care". Please, please find another one. We have Canadian members here who can help you I'm sure.

[molly muffin]

I am in canada. Mississauga Ontario. If you are in my area let me know.

[barbaraabaker]

OK so I hear you all and I am now extremely reluctant to even give Riley a second pill. But to change vets - where do I find a qualified one that is knowledgeable in treatment of Cushings? We live in the Federal Way, Washington area so thanks Canadians, but it's a bit too much of a commute. :) I am talking to relatives and friends and will then call their recommendations but what questions do I ask? And will changing now put us back to ground zero and force us to have to pay another $280 for a complete exam? And of course this happens on a holiday weekend so another delay in getting the proper treatment for my pup. :( And oh yeah, I now own a useless 29 pills of 60 mg vetoryl that cost me $93.00!

[StarDeb55]

I have been reading Riley's story, but have not posted to you before. I can't offer a whole lot of help with the vetoryl as I have never used it. The one thing I can suggest is that your 60 mg. capsules may not be a waste. If you can find a pharmacy that would be willing to repackage the 60 mgs. into a smaller dose that Riley can use, such as 30 mgs., it would save you some money. There is usually a small charge to do this, but nothing compared to buying a brand order of vetoryl.

Debbie

[molly muffin]

Debbie has made a good point about getting them compounded to smaller dosage. Just google compounding pharmacy for your area.

The closest specialist I found was at the critical care in Renton.
http://www.criticalcarevets.com/service/internal-medicine

They have an internal med group. You could get copies of all test from your vet. For your own files. The. Take those with you to whomever you see. So you don't repeat.
Option 2 is to start calling vets in your area. Asking what experience they have with Cushing. How many patients. Success rate. Drug they use. Etc.

It isn't always easy. Even if they don't know Cushing's well they need to be a team with you. Did you print out the instructions from dechra to give your vet? Maybe that would help him to learn. He can also call the drug manufacturer directly for input. They have an 800 number in the US.

Hang in there.

[labblab]

It isn't always easy. Even if they don't know Cushing's well they need to be a team with you. Did you print out the instructions from dechra to give your vet? Maybe that would help him to learn. He can also call the drug manufacturer directly for input. They have an 800 number in the US.
Yes, I agree with Sharlene. If you don't have good alternative options, you may still be able to work with your current vet if he is open to additional education about appropriate treatment. Have you been happy with him in the past? Is he a good team player?

If so, hopefully he can learn more from this experience. In his defense, the 1-3 mg. per pound dosing range does still appear in Dechra's published info. So he may have felt as though he was doing the right thing by picking a dose in the middle of the range. The lack of testing is an entirely different issue, though, because nobody advises dispensing with testing. So the question is, why does he think this is acceptable in Riley's case? Was he just trying to save you guys money, or is the ACTH testing something he is not equipped or willing to perform? If it is the latter, then you really have no choice but to look elsewhere. If it is the former, then you can tell him that you know the testing is essential for Riley's safety, and you will pay for what needs to be done.

Sticking with this vet does place much greater responsibility on your own shoulders to ensure that things are being done correctly, though. So I guess that's what your decision will come down to as far as weighing your alternatives. If you do decide to switch, you don't necessarily need a specialist, though. A GP vet with Cushing's experience should also be fine, asking them the questions that Sharlene mentioned above.

Marianne

[barbaraabaker]

OK so I found another vet - Animal Critical Care and Emergency Services - and I am fairly confident that the new vet actually knows something about Cushings. After initial exam he recommended that we do an Endrogenous ACTH test and a pre post stim test. The results:

PRE POST ACTH Stim test
Pre-ACTH cortisol 5.8 ug/dL
Post-ACTH cortisol 37.6 ug/dL
reference range
2 - 6 pre-acth resting
6 - 18 post acth cortisol
18 - 22 equivocal post acth cortisol
>22 consistent with hyperadrenocoricism

Endrogenous ACTH test
<5 pg/mL

< 10 result consistent with Adrenal dependent disease
10 - 15 equivocal result
> 15 consistent with Pituitary dependent disease

So now he is recommending an ultrasound to confirm the adrenal tumor and to see if there is any invasion into adjacent structures especially vascular invasion. This to be followed by surgery. To get to here was almost a $600 trip bringing investment so far to about $1600.

In a perfect world where Riley was young and I had tons and tons of money I could see continuing this course of action. But am I a terrible owner by saying that enough is enough? I don't want to put Riley through a surgery and the cost of the ultrasound alone is $400 and I hate to think about the charge for surgery.

The vet says that he "could" consider treatment with Vetoryl but "some patients with adrenal tumors are resistant to the standard dose of Lysodren but do seem to respond to higher dosages".

Is it unfair of me to ask you folks - What do I do??????

[Harley PoMMom]

OK so I found another vet - Animal Critical Care and Emergency Services - and I am fairly confident that the new vet actually knows something about Cushings. After initial exam he recommended that we do an Endrogenous ACTH test and a pre post stim test. The results:

PRE POST ACTH Stim test
Pre-ACTH cortisol 5.8 ug/dL
Post-ACTH cortisol 37.6 ug/dL
reference range
2 - 6 pre-acth resting
6 - 18 post acth cortisol
18 - 22 equivocal post acth cortisol
>22 consistent with hyperadrenocoricism

Endrogenous ACTH test
<5 pg/mL

< 10 result consistent with Adrenal dependent disease
10 - 15 equivocal result
> 15 consistent with Pituitary dependent disease

It does sound like this vet is pretty knowledgeable, and yes, that endogenous ACTH result does point to the adrenal type of Cushing's.


So now he is recommending an ultrasound to confirm the adrenal tumor and to see if there is any invasion into adjacent structures especially vascular invasion. This to be followed by surgery. To get to here was almost a $600 trip bringing investment so far to about $1600.

In a perfect world where Riley was young and I had tons and tons of money I could see continuing this course of action. But am I a terrible owner by saying that enough is enough? I don't want to put Riley through a surgery and the cost of the ultrasound alone is $400 and I hate to think about the charge for surgery.

You are not a terrible owner at all, and just get that thought out of your head. An adrenalectomy is a very serious surgery, and in your shoes, I probably wouldn't consider it either.

One advantage with an ultrasound is that it may show abnormalities with other organs, however, ultrasounds are expensive, and I too wish we lived in an ideal world where money doesn't need to be a factor. :(


The vet says that he "could" consider treatment with Vetoryl but "some patients with adrenal tumors are resistant to the standard dose of Lysodren but do seem to respond to higher dosages".

Is it unfair of me to ask you folks - What do I do??????

The vet is correct in regarding adrenal tumors needing higher than normal loading doses with Lysodren. Trilostane treatment is a option that can be used when a dog has an adrenal tumor, and this would be the course of action I would take if Riley were my dog. These decisions are never easy or cut and dried, I think you need to listen to your gut when making decisions for Riley because nobody knows him better than you.

Hugs, Lori

[labblab]

I just want to say that I "second" everything that Lori has written above. I know this brings us back full circle again, as far as resuming trilostane treatment once again. But hopefully, this time, the treatment will be monitored and dosed daily at a lower level. As we had discussed back when Riley first took the med, at his weight, he should start on a dose no larger than 30 mg.

http://www.k9cushings.com/forum/showthread.php?p=1251#post1251

Out of curiosity, I looked back at his original LDDS and his result on that test could have been consistent with adrenal Cushing's, too. So it may well be the case that he has an adrenal tumor. But Vetoryl is FDA approved for treatment of adrenal Cushing's, so it should be an option the specialist will consider.

Do let us know, OK?

Marianne

[LtlBtyRam]

I am very close to you, at least for finding someone randomly on a fourm. I too live in the Puget Sound area. I take my dog to the The Animal Emergency Clinic (http://www.theaec.com/directions.aspx) I know you say you have already found somewhere, but more information can't hurt. They have a wonderful Internal Medical Specialist, his name is Dr. Walton. If you want to stay where you are I totally understand.

I also get the fears to go with this process, as my pup and our family has been at it for about 2 years and 4 months. If I can be of any help I can privately message you my personal contact information, or we can just private message back and forth here if you are more comfortable. This is not to replace putting posts in your thread, as there are folks around here way more knowledgeable than I, but just to give some moral support if you need it from more than words on a computer.

Angela & Shasta & Family

[barbaraabaker]

Well there is good news on Riley's treatment. The vet understood our reluctance to pursue ultrasound and surgery on the adrenal tumor. We started 30mg Vetoryl on Wednesday so today is day 3. No problems so far. We are cautiously optimistic about not seeing any peeing problems for almost 2 days. The vet said to schedule a follow-up stim test at 30 days but I might shorten that a bit (I think the recommendation is 14 days). I also found a compounding pharmacy right here in Federal Way (about 7 minutes from by house) and will contact them about re-formulating those 60mg caps that we have left over into a dose that is useable. So - now we wait and watch and love him up.:)

[molly muffin]

Oh good, glad you found a local compounding pharmacy. Hopefully they can get those bigger pills sorted out.

Glad to hear that he is doing good and no recent accidents.

[LtlBtyRam]

So happy to here things are getting better. Here is one to them keeping on the same track.