Buddy has Cushings [Archive] - Canine Cushing's Information and Support Forums

BuddysPapa

03-26-2015, 12:53 AM

Hello everyone. Im Chet from Rapid City, SD. My dog Buddy was just diagnosed with Cushings yesterday. He is a mix breed about 70lbs. I am pretty sure Boxer and Catahoula but not positive. What tipped me off was the excessive thirst and urination. Two gallons plus every two days or less. I thought he was getting a little chunky in the tummy too, but didnt ever cross my mind it was anything else. He is 7 years old best guess, as he is a rescue dog. Here are his labs.....
GLU 116
BUN 17
CREA 1.2
BUN/CREA 14
PHOS 5.4
CA 10.4
TP 7.5
ALB 3.3
GLOB 4.2
ALB/GLOB 0.8
ALT 350
ALKP 1565
GGT 15
TBIL 0.5
CHOL 320
AMYL 817
LIPA 1093

Before the diagnosis was known, there were these labs and a ultrasound done. The sonogram showed a liver 1 1/2 times normal size. He also is Hypothyroid and we are treating for a UTI. He does some panting but nothing to worry about as of yet. He does show more of an appetite too. I dont have the meds near me right now, but will post what he is on for the liver and the thyroid. They also put him on two antibiotics for the infection.
I am scared. Im a 51 year old man divorced 5 years ago and Buddy has been with me through everything all those 5 years. I want to do what is right for him, mostly avoid any pain or discomfort. At the same time, I want to keep him around as long as is ok for him. Docs want to treat with 60mg of Vetoryl daily. Not too keen on putting poison into him, but I know me and there is no way I would be able to make up meals and concoctions/supplements and keep up with it. The biggest problem is the expense of all this but that is my issue. What I would like to know is are there things I shouldnt do or feed that might speed up the process of Cushings? We walk a mile a day now, used to be two. It makes him panty and thirsty of course, but I hate to take away his only fun time, reading pee mail. I am overwhelmed and scared about this and am so glad there is a place for communication for the disease. Thanks for your advice and for listening. Buddy is a very loving, kind and gentle soul. Chet

Harley PoMMom

03-26-2015, 03:58 AM

Hi Chet,

Welcome to you and Buddy! So glad you found us and we will help in any way we can. And bless you for giving Buddy such a loving forever home.

Thank you for your detailed post and including his lab values, however, we do need to see the reference ranges and the units of measurement for those numbers, as an example....ALT 150 U/L (5-50) Could you also post the results of the test/s that were performed to diagnose Buddy's Cushing's.

Cushing's is one of the most difficult disease to diagnose, and unfortunatey, it is often misdiagnosed. Cushing's is challenging to diagnose because there's not one test that has the ability to accurately identify it, and other non-adrenal illnesses can skew the test results for Cushing's.

We certainly understand that you are scared but I want you to know that Cushing's is a treatable disease, however, success in treatment does depend on a few things; keen owner observation, a pet parent willing to educate themselves about Cushing's, and a vet/IMS that has experience treating Cushing's and is knowledgeable about the protocols for this disease.

Yes, the medications that are prescribed to treat Cushing's are serious drugs but they are also live savers for our cushpups. An educated pet owner and an experienced vet are equally effective in facilitating safe and efficacious treatment with few to no side effects.

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, but you need to purchase through a trusted compounding pharmacy. Many of our members use Diamondback pharmacy, here's a link to their website: http://www.diamondbackdrugs.com/home-mobile/ One of the ways that helped me with the expense was applying for Care Credit. It's a revolving credit line that allows you to pay large bills same as cash for a year.

Concerning the diet, there really isn't a "set" diet for a cushdog, it should be tailored to that individual dog. However, because of the effects of excess steroid on protein and fat metabolism, a good quality, moderate to high protein, low fat diet is recommended.

I am including a link to our Resource thread where you will find a wealth of information regarding Cushing's: Helpful Resources for Owners of Cushing's Dogs (http://www.k9cushings.com/forum/forumdisplay.php?f=10)

And remember we are for you and Buddy, if you have any questions at all please do not hesitate to ask them.

Hugs, Lori

molly muffin

03-26-2015, 09:39 PM

Hello and welcome from me too.

Definitely edit your post to give the ranges as that would be enormously helpful to us (every lab is different).

The starting dose of vetroyl, 60mg for a 70lb dog is a good starting dose. One way you can cut the cost, once you see how he is going to respond to the vetroyl (need more, need less or just right) is to move the compounded version, trilostane and have your vet call the perscription in to a compounding pharmacy, such as diamondback, that can save a lot of money for you.

Denamarin is a liver supplement and might be what your vet put it on already, and it is good for the liver. Omega 3 can be good for kidney, liver, over all function too.

Moderate fat is best, you don't want to much fat in their diets as they can be prone to pancreatis.

Now the good thing as Lori said is this is treatable. Learn as much as you can about the disease, medication, treatment and testing (we'll help) and get on medication to control the cortisol and hopefully he'll live out his normal lifespan.

Welcome again. :)

BuddysPapa

03-28-2015, 06:15 PM

Ok.....so here is everything they could/would send to me. I hope this makes sense. It would take me a long time to re-type everything so I copied/pasted from an email they sent to me.

Catalyst_Dx
Buddy's Low High
GLU 116 74 143 mg/dL
BUN 17 7 27 mg/dL
CREA 1.2 0.5 1.8 mg/dL
BUN/CREA 14
PHOS 5.4 2.5 6.8 mg/dL
CA 10.4 7.9 12.0 mg/dL
TP 7.5 5.2 8.2 g/dL
ALB 3.3 2.3 4.0 g/dL
GLOB 4.2 2.5 4.5 g/dL
ALB/GLOB 0.8
ALT 350 10-125 U/L High
ALKP 1565 23-212 U/L High
GGT 15 0-7 U/L High
TBIL 0.5 0.0 0.9 mg/dL
CHOL 320 110 320 mg/dL
AMYL 817 500 1500 U/L
LIPA 1093 200 1800 U/L

SNAPshot_Dx 03-20-15 10:06a
TT4 0.8 µg/dL

Leukocytes Positive
Nitrate Negative
Urobilinogine 0.2
Protein Positive
pH 6.0
Blood Positive
Spec. Grav. 1.006
Ketone Negative
Bilirubin Inconclusive
Glucose Negative

OBJECTIVE SECTION
ABNORMALITIES
General Appearance
BAR
Musculoskeletal - abdomen is sprung behind the ribcage - dog appears bloated and firm on palpation of abdomen - no pain can be illicit.
Digestive - moderate tartar
Urogenital - Occult urinary tract infection found on cytology and u/a from cystocentesis
Normal Systems: Integumentary, Circulatory, Respiratory, Eyes, Ears, Neural System, Lymph Nodes, Mucous membranes

ASSESSMENT SECTION
NOTES
Thyroid 0.8 - LOW - discussed low due to euthyroid sick from chronic disease vs actual hypothyroidism.
u/a cysto - occult urinary tract infection
Chem 17 - ALT 350 GGT 15 and ALKP 1565 ELEVATED
Sent home on amoxicillin 500mg 2 tab PO BID for 10 days. Sent home on metronidazole 500mg 1 tab
PO BID for 10 days and denamarin 425mg 1 tab PO SID for 30 days.
DDX cushings vs liver disease vs other endocrine ( hypothyroid) vs other
Discussed with owner that cushing test (LLDST) and bila acid testing and liver ultrasound could be
indicated.
Owner would like to consider options over the weekend and scheduled a lab tech appointment for
Monday and we will decide then what testing we would like to do.
DIAGNOSES:
HYPERADRENOCORTICISM
HYPOTHYROIDISM
URINARY TRACT INFECTION
POLYURIA
POLYDIPSIA

I have Vetoryl on the way from ValleyVet Supply for $64...60mg 30 pills. One of my main worries is him seizing while I am gone. Has anyone had this happen? Also, he is beginning to breath more quickly and I was told this is another sign of the disease. Does this subside after treatment has been underway and the same with the bloating and thirst/appetite? We did a mile walk today and that was an hour ago. Temp right around 80 degrees so maybe I am just too worried about this. How do Cushing's dogs deal with hot temperatures?

I hope this all makes sense. This is overwhelming. Thanks for your time. Chet

Bonnie0420

03-28-2015, 06:42 PM

Hi Chet, we too just found out about our Aggie and like you are scared to death, just found this forum last night. I havent a clue what we are dealing with as of yet since her appt for her ultrasound is not until Wednesday and then we will learn more. But in just a couple of posts, I already feel like this is a great place to be, hadnt a clue about questions to ask etc and BAM!!! they were posted right away....this forum while scary in reading everything is also very comforting to know that we are NOT alone....
Prayers for your Pup and You!!

Harley PoMMom

03-28-2015, 10:12 PM

Hi Chet!

Ok.....so here is everything they could/would send to me. I hope this makes sense. It would take me a long time to re-type everything so I copied/pasted from an email they sent to me.

Catalyst_Dx
Buddy's Low High
GLU 116 74 143 mg/dL
BUN 17 7 27 mg/dL
CREA 1.2 0.5 1.8 mg/dL
BUN/CREA 14
PHOS 5.4 2.5 6.8 mg/dL
CA 10.4 7.9 12.0 mg/dL
TP 7.5 5.2 8.2 g/dL
ALB 3.3 2.3 4.0 g/dL
GLOB 4.2 2.5 4.5 g/dL
ALB/GLOB 0.8
ALT 350 10-125 U/L High
ALKP 1565 23-212 U/L High
GGT 15 0-7 U/L High
TBIL 0.5 0.0 0.9 mg/dL
CHOL 320 110 320 mg/dL
AMYL 817 500 1500 U/L
LIPA 1093 200 1800 U/L

Looks like only the ALT and ALKP are elevated. ALT is an enzyme that is specific to the liver, mild elevations are seen in dogs with Cushing's. The ALKP is a enzyme that is secreted from the liver, bones, placenta, intestinal lining and the kidney. Also 80% or 90% of dogs have a steroid induced isoenzyme of ALKP so if one of those dogs has cushing's, you are gonna see anywhere from a mild to severe increase in ALKP. We have seen cushdogs on the forum have ALKP numbers over 2000!

Dogs with Cushing's generally have high elevations in the ALP, mild increases in the ALT, mildly increased blood glucose concentration, and high blood cholesterol concentration can be seen.

On the complete blood count (CBC) dogs with Cushing's syndrome have what is called a "stress leukogram," which refers to a specific white blood cell distribution in the blood. This includes a high total white blood cell count with increased numbers of neutrophils and monocytes and decreased numbers of lymphocytes and eosinophils.

Now, on Buddy's blood work panel it sure seems he doesn't follow the usual Cushing's abnormalities, and since all dogs are different some just do not follow these same rules!

SNAPshot_Dx 03-20-15 10:06a
TT4 0.8 µg/dL

This might be FT4, could ya check, and if so this is a marker for the thyroid.

Leukocytes Positive
Nitrate Negative
Urobilinogine 0.2
Protein Positive
pH 6.0
Blood Positive
Spec. Grav. 1.006
Ketone Negative
Bilirubin Inconclusive
Glucose Negative

These results are from an urinalysis, which shows a low specific gravity (Spec. Grav. 1.006 = means diluted urine), blood was found so I am thinking this is the reason for the urinary tract infection diagnosis, usually the WBC' (white blood count) is high.

Now, I see NO test results for Cushing's and at this time you want to wait until that urinary tract infection is completely gone to have any done.

ASSESSMENT SECTION
NOTES
Thyroid 0.8 - LOW - discussed low due to euthyroid sick from chronic disease vs actual hypothyroidism.
u/a cysto - occult urinary tract infection
Chem 17 - ALT 350 GGT 15 and ALKP 1565 ELEVATED
Sent home on amoxicillin 500mg 2 tab PO BID for 10 days. Sent home on metronidazole 500mg 1 tab
PO BID for 10 days and denamarin 425mg 1 tab PO SID for 30 days.
DDX cushings vs liver disease vs other endocrine ( hypothyroid) vs other
Discussed with owner that cushing test (LLDST) and bila acid testing and liver ultrasound could be
indicated.
Owner would like to consider options over the weekend and scheduled a lab tech appointment for
Monday and we will decide then what testing we would like to do.
DIAGNOSES:
HYPERADRENOCORTICISM
HYPOTHYROIDISM
URINARY TRACT INFECTION
POLYURIA
POLYDIPSIA

It seems that the vet would like to perform a LDDS (low dose dexamethasone suppression) test, which is used to help diagnose Cushing's; and they also want Buddy to have a bile acid test, which is ordered to see if the liver is functioning properly.

I have Vetoryl on the way from ValleyVet Supply for $64...60mg 30 pills. One of my main worries is him seizing while I am gone. Has anyone had this happen? Also, he is beginning to breath more quickly and I was told this is another sign of the disease. Does this subside after treatment has been underway and the same with the bloating and thirst/appetite? We did a mile walk today and that was an hour ago. Temp right around 80 degrees so maybe I am just too worried about this. How do Cushing's dogs deal with hot temperatures?

I hope this all makes sense. This is overwhelming. Thanks for your time. Chet

Cush dogs do seem to run a hotter temperature, I used to spritz water on my boy's belly and the bottom of his feet to help keep him cool.

Is Buddy overweight at all? I ask because dogs that are even slightly overweight can have excessive fat in the thorax area which can labor the breathing. Also when dogs have Cushing's they have an enlarged liver and this can put pressure on the diaphragm, redistribution of fat to the abdominal area and the muscle loss in the abdominal area are factors that can cause a dog with Cushing's to pant more.

I think you may be putting the cart in front of the horse in buying the Vetoryl because Buddy does not have a confirmed diagnosis for Cushing's. So, lets take some deep breaths...in...out...in...out...now, one more question :eek: can you tell us the symptoms that Buddy is displaying?

Hugs, Lori

BuddysPapa

03-29-2015, 04:45 AM

Lori,
They did do the bile acid test and if I am not mistaken, the LDDS. Those were done on Monday this past week. I thought those levels were part of what I had posted here.

Symptoms are.....bloated tummy, excessive thirst and urination, excessive hunger, they did an ultrasound and saw that his liver is 1 1/2 times normal size. They said he is Hypothyroid and that he has an Occult UTI. I am confused...you say they want to wait until after the uti is gone to test for Cushings and yet they tell me they tested for it. I dont have the money to pay for all the testing to be done over again. The doctor said she consulted with a pathologist on all these results and was very confident he has Cushings. Doctor said he is overweight but I am not sure how much since he is a mixed breed. In November she said he should be at 50lbs but he is 71. He has two doses left of antibiotics for the uti.

What should I be looking for in the Cushings test results? I wouldnt know where to begin. I had them email me all his latest information/results and everything that looked like measurements is what I posted. Thanks for checking on Buddy and me.

lalosmom

03-29-2015, 04:45 PM

Chet
Orlando definitely gained a lot of weight and it affected our walks as well. It was our prime form of exercise and togetherness and I did not want to cut back on them, but I have started to let him make the "decision" about whether or not he is able to go further. We stop and wait, and then if he seems tired, he will turn back on his own and reverse us.
I am with Lori on the LDDS test because your vet has put that you will consider the LDDST; the wording in a couple of places seems as if they have not done it, but it could be that their printouts are not synced with what is going on in the office. i would just ask them flat out if they did that test by name and what the specific result showed.
Orlando is my second Cushings dog, maybe third if I count the possibly false negatives that another dog received on the testing. Once you get over the initial expense, Buddy should be on a regular protocol of the meds which should work indefinitely. Also, Diamondback may be able to beat your price on the meds a little if you have to continue to administer trilostane.

BuddysPapa

03-30-2015, 12:07 AM

Buddy.....since being put on meds for thyroid and liver and antibiotics for UTI, is beginning to pant and breath heavier a good portion of the time. In addition, he is constantly searching for something to eat. I take him to an off leash dog park for walks and he has now begun searching for food on the ground or wherever he can find it, including dead animals. He never used to do this. It is heartwrenching to see this happen, and to have him look at me the way he does for help or food or water or whatever. The panting is really bothering me cause I don't know if it is from pain, hunger, thirst, or something else bothering him like anxiety. I guess I am just a worrier but I feel helpless for him. Chet:(

molly muffin

03-30-2015, 12:32 AM

Hmm I don't see the bile acid and LDDS test results here. The LDDS especially would be 3 results. Pre. 4 hou. 8 hour. If you could see if that result is on the papers they sent you would be helpful. I assume you amd your vet discussed the results. What did the vet say about the liver amd the Cushing's rest result?

You are at the beginning of the journey and the symptoms will improve as you get the cortisol down.

Does Buddy have a history of seizures? There is no reason to suspect he would seize while you are at work. This is a decent starting dose for Buddy. So let's see how he does ona month of this dose.

Hang in there

BuddysPapa

03-30-2015, 09:11 AM

I dont know how to make sense of all this. I copied and pasted as best I could. It doesnt transfer from PDF to here correctly.

Low High
SNAPshot_Dx 03-23-15 9:01a CORT baseline corti 5.1 µg/dL

SNAPshot_Dx 03-23-15 1:23p CORT 4 hour post lo 1.5 µg/dL

SNAPshot_Dx 03-23-15 4:40p CORT acth stim (cus10.0 µg/dL

SNAPshot_Dx 03-23-15 5:09p CORT 8 hour post lo 7.5 µg/dL

03-23-15 LM DEXINJ Dexamethasone 2 Mg/Ml by Ml 0.20
L372 Snapshot Cortisol 3
03-23-15 IVLSO Requisition 44076-1170585

SNAPshot_Dx 03-23-15 8:50a Bile acids Preprandi 16

SNAPshot_Dx 03-23-15 10:46a
Bile acids Postprand 22 µmol/L
03-23-15 LM L356 * Bile Acid - Snap Test - Pre & Post
03-23-15 CHECKIN Patient check-in LB: 03-20-15 at 10:54a: Bile Acid Test - LM

Harley PoMMom

03-30-2015, 04:28 PM

Hi Chet,

You did an excellent job!

I dont know how to make sense of all this. I copied and pasted as best I could. It doesnt transfer from PDF to here correctly.

Low High
SNAPshot_Dx 03-23-15 9:01a CORT baseline corti 5.1 µg/dL

SNAPshot_Dx 03-23-15 1:23p CORT 4 hour post lo 1.5 µg/dL

SNAPshot_Dx 03-23-15 4:40p CORT acth stim (cus10.0 µg/dL

SNAPshot_Dx 03-23-15 5:09p CORT 8 hour post lo 7.5 µg/dL

03-23-15 LM DEXINJ Dexamethasone 2 Mg/Ml by Ml 0.20
L372 Snapshot Cortisol 3

What is confusing to me is that "SNAPshot_Dx 03-23-15 4:40p CORT acth stim (cus10.0 µg/dL" result stuck in the middle of what looks like LDDS test results. Also, when an ACTH stimulation test is performed there is a pre number and a post number, I only see that 1 number (cus10.0 ug/dl) Could you ask your vet for clarification of this for me...thanks

BuddysPapa

03-31-2015, 12:13 AM

Second night in a row Buddy is laying next to me on the loveseat and is just panting/breathing heavily with no physical exertion. He is continually panting and asking for food. Paws feel warm. We finished the run of antibiotics last night for the UTI. I am having trouble determining just exactly what the vet ran for tests with regard to the Cushings, as a couple of you have seen, and am working 10 hour days all week so cant get in to talk to her. I dont understand or process things well (a bit learning disabled), so intend to take information and email I have received to try to get questions answered so that I am able to convey on here what is going on. I am concerned that we may be getting on a drug he may not need, but based on his signs/symptoms, I feel pretty certain there is something seriously wrong with him. My biggest issue right now is me. I have trouble dealing with the panting and the begging. I want to do what is best for Buddy, but dont want to give him treats etc every time he begins to pant. How do you others deal with this? Thanks for all your responses.

labblab

03-31-2015, 08:16 AM

Hello Chet, and welcome from me, too!

First of all, you are doing a great job of taking care of Buddy and of trying to make sense of all this lab testing that can be very confusing to us all! But for what it is worth, after looking through all that you have written here, a Cushing's diagnosis seems likely to me and if he were my dog, I would start treating Buddy with the Vetoryl as soon as you receive it.

It seems to me that your vet has taken a reasonable approach to following up on different diagnostic tests, and Cushing's is the diagnosis that is consistent with the majority of the symptoms and laboratory abnormalities. I agree with Lori that I am curious about the reference to the "ACTH stimulation" in the midst of the LDDS test results. But regardless of whether or not an ACTH stimulation was run (and actually, regardless of the results), the LDDS numbers that you have posted are consistent with the pituitary form of Cushing's.

Given the elevations in three of Buddy's liver enzymes on his blood chemistry panel, as your vet had noted, another question mark would be whether Buddy's problems are due to a primary liver issue rather than Cushing's. So to help answer that, an abdominal ultrasound was ordered along with a bile acid test. It looks as though Buddy's liver was enlarged on ultrasound, but no other worrisome abnormalities were noted such as evidence of a mass or tumor. And even though you have not posted the exact "normal" range for the bile acid test, my guess (from looking at some laboratory websites) is that Buddy's results fell in a "gray" area of moderate elevation, but nothing high enough to confirm serious liver dysfunction. So I am guessing that your vet now assumes that the liver issues are the result of something other than primary liver disease. Also, as your vet has already explained, Cushing's can also account for Buddy's low thyroid reading.

It is true that, ideally, you would hope that the diagnostic blood tests for Cushing's like the LDDS could be performed in the absence of any known ongoing illnesses, such as a UTI. But dogs with untreated Cushing's can be particularly vulnerable to persistent, chronic UTIs, so sometimes you have to proceed with testing, regardless. Plus, in Buddy's case, he suffers from several abnormalities that are consistent with Cushing's but would not be caused by a UTI. So even though excessive thirst and urination could be "explained away" by a UTI, the overall picture looks as though there is something else that is also involved.

So all in all, I think a reasonable diagnostic path has been followed, and I would move forward with giving the Vetoryl a try. That is a good starting dose for him, and I am hoping that you will see some improvements sooner rather than later!

As for any remaining questions for your vet, these are the two I would ask:

1) Like Lori, I am wondering whether Buddy had an ACTH stimulation test performed in addition to the LDDS test.

2) What is your vet's interpretation of the bile acid test -- in other words, did Buddy's results fall outside of the normal range and/or what would be expected for a dog with Cushing's?

Marianne

Harley PoMMom

03-31-2015, 03:30 PM

Marianne has given you some very good advice and I agree with her 100%.

As for the panting, which is common with our cushdogs, it is due to the increased fat deposition over the thorax, and also the fat distribution to the abdomen which increases pressure on the diaphragm. It also seems that our cushpups run at a higher temperature. My Harley panted a lot and I would spritz water on his belly and on his pads which seemed to help. With treatment the panting usually does lessen.

Hugs, Lori

BuddysPapa

03-31-2015, 05:41 PM

Thank you for your responses. I greatly appreciate it. Buddy has never had seizures. I just am a worrier and would be really torn up if he had/has to suffer through one alone.

The Vetoryl arrived yesterday and I have hesitated starting it, mainly because of timing and some out of anxiety. I will likely start it tonite so that I will be here in case there is a reaction, rather than wait till morning to administer and then leave and be gone all day to work. Bad idea in my thinking. I will keep you posted on our journey and thank you again for your support. Chet

PS.....Buddy does not like water spray so not sure how to approach the higher temps.

labblab

03-31-2015, 05:53 PM

I surely do understand your worry (I am a worry wart myself!!), but it is most likely that Buddy is going to do just fine.

As far as the timing of the dose, I think it is OK to start him out at night for the first few doses, just long enough to make you feel comfortable as to how he is reacting. But in terms of the long-term treatment plan, you will quickly want to switch to dosing him in the morning along with his breakfast. This is because the monitoring blood testing (ACTH stimulation test) needs to be performed 4-6 hours after taking his medication. So for most everybody, this is not possible to be done at night. In that vein, the first test is typically done around two weeks after beginning the Vetoryl. Has your vet talked with you about this yet?

If you do start Buddy off with a few evening doses, do make sure that he is given food to eat at the same time. Vetoryl is not metabolized efficiently on an empty stomach.

Good luck, and just let us know of any more questions -- and also how you two boys are doing!

Marianne

BuddysPapa

03-31-2015, 08:12 PM

I cant express to you all enough just how much it means to me to have this site to turn to, and moreso, to have you respond with such kindness. I just gave Buddy his first dose of Vetoryl (with dinner) and thank you for the tip about the need to have it given in the morning. Question.....He doesnt do well with meds. I sometimes struggle to get him to keep them in his mouth (tricky little devil) and so have been wrapping a pill's width of cheese around it and he just swallows it whole. Any better suggestions for a more healthy way to do this? I can do as the vet does and get it on the back of his tongue but he is somehow getting it over to the side of his mouth and then out it comes. Suggestions? Thank you again. Chet

labblab

03-31-2015, 08:31 PM

If Buddy is happy with taking the pill in cheese, I say don't mess with success! :)

That is exactly how I pill my two Labs, too. I buy processed American cheese squares and rip off enough of the slice to totally mush around the pill. I love the processed cheese because usually it is soft enough to completely mold around the pill. Then it always goes down the hatch in one gulp. I immediately follow with a kibble or little piece of deli turkey -- anything I know they like. Because if they've swallowed that, too, I know the pill didn't get spit out.

I figure that little bit of cheese won't do any harm, and actually, since Vetoryl is fat-soluble, wrapping it in a little cheese may actually aid the absorption.

Good job, Dad!!! Just let us know if you have any problems this evening (but I'm betting you won't). ;)

Marianne

molly muffin

03-31-2015, 09:06 PM

What ever works is good in my opinion. Some of these dogs ( most) are tricky to get pills down.

Harley PoMMom

03-31-2015, 09:41 PM

Yep, just as Sharlene said, whatever works :) I have used cream cheese and peanut butter in the past.

They make these cooling bandanas for dogs: http://www.drsfostersmith.com/product/prod_display.cfm?pcatid=18850 do you think that would work?

BuddysPapa

04-02-2015, 10:22 PM

I just read a post regarding food. I have Buddy on Science Diet. Someone posted that it is not a good food but if have started treatment already, not to change diets as it may mess with testing etc. Do I need to put him on a better food and, if so, what would you recommend? I have heard so many (and read) so many differing opinions on dog food brands to avoid or to feed that it gets confusing. Maybe someone in here who has the same situation could give me a little insight toward good vs. bad brands. I would appreciate it. Also, Buddy has had 3 doses of Vetoryl to date. Would it be early enough in his treatment's 1st 14 days to change foods now, or would you recommend sticking with what he is on till it runs out? Thanks to all. Chet

labblab

04-02-2015, 10:41 PM

I honestly would not change Buddy's food until he has been stabilized on his optimal dose of Vetoryl. You won't know what that dose is until at least a month into treatment (the dosing will depend on symptom improvement and the results of ACTH blood testing). The problem with changing food before then is that if he has any GI upset (diarrhea, vomiting), you won't know whether it's the new food or whether it's medication overdosing that is causing the problem. ACTH tests are pretty darn expensive, so you don't want to be checking Buddy's cortisol level any more often than you have to. :o

Even if Science Diet isn't the greatest food, it won't hurt him to stay on it a while longer. And in that same vein, you don't want to be adding in any new treats, either, or anything else that could upset his stomach. You want to limit the variables as much as possible.

How is Buddy doing after these first doses?

Marianne

BuddysPapa

04-02-2015, 11:16 PM

Marianne....He seems to be doing ok. I have been trying to watch his BMs and they dont seem to be any different than usual. No vomiting and no other adverse reactions. He gets panty in the evenings for some reason, but could be just excitement of me being home too, but he used to calm down quicker. No accidents in his kennel, but have been trying to make it home more often to let him out too. I have a fairly flexible job or at least am out and about often so can do a quick stop to let him out. His appetite is probably the biggest thing. Constantly wanting food. Thirst is still high but I dont expect much change for awhile with those symptoms. Going to try catching up with the vet tomorrow to get clarification on their reports so I can convey the correct info here with the hope that you who have experience with cushings can assist us in keeping Buddy around a few more years. I pray about this daily. Chet

BuddysPapa

04-04-2015, 01:23 AM

I ordered my first prescription of Vetoryl from Valley Vet Supply out of Marysville KS. It was the least expensive supplier I could find at $67 for a month, reduced about $40. I have seen you all mention compounding pharmacies and wonder how that works and if the cost for Vetoryl would increase significantly if ordered that way. Also, I spoke to my vet today briefly and she told me that she wanted to wait to do the ACTH test after two months of Vetoryl. The Cushings diagnosis was done by a pathologist who read the results, and he also determined and was satisfied that the liver was not in failure. She was busy and didnt have much time to visit so I got whatever info I could from her. She said she was happy to visit and was glad to help and see owners who take an active role in their dog's well being. Being from a small town (70,000) there arent many vets well versed in things such as Cushings, thus farming out the lab results becomes a common practice. The nearest small animal internal specialist is in Colorado. Not much change in Buddy to date. I am not able to check all his stools but seems they arent as firm as they were lets say a 10 days ago. He had an accident last night in my room two hours after I had let him out before bedtime. I treated him to grooming today at PetSmart. He is such a loving and wonderful companion.

labblab

04-04-2015, 07:39 AM

Hi again, Chet. I love the photos of Buddy in your album :). He looks like such a sweet boy -- it is easy to see why you love him so!

Waiting for two months to test is neither safe nor a good idea, and this is something you will want to discuss further with your vet so that you can agree on a different schedule. Regardless of whether Buddy's dosage is too high or too low, you don't want to wait that long to find out. Dechra's official protocol is perform a full ACTH stimulation test (as well as basic blood chemistries) after two weeks, and then again at the 30-day mark. They do not recommend any dosing increases until after the 30-day testing; dosing should be decreased at any time if the dog's cortisol is dropping too low.

As long as a dog does not appear unwell in any way, there are now a fair number of vets who are dispensing with the 14-day test and waiting until the 30-day mark to test the ACTH and chemistries. But you do not want to wait any longer than that to assess the appropriateness of the current dose. And if a dog exhibits any indicators of low cortisol, you definitely need to test even sooner. Since you are the one paying for the test, I can think of no reason why your vet should object.

As far as compounded trilostane, it is definitely much cheaper than brandname Vetoryl, but depending upon the source, there are some concerns that the product may not be as consistently effctive. Once you get Buddy stabilized on any given dose of Vetoryl, though, you may want to try switching to a compounded drug and seeing if it works just as well for him. Many of our members have been very satisfied using Diamondback Drugs in Arizona.

Marianne

BuddysPapa

04-04-2015, 10:21 AM

I will admit that I am not too keen on waiting that long either and that I also have some reservations about my vet's level of experience. As I mentioned in my last post, this is a small area and it is difficult to find a vet with much experience in this area. I dont have the financial resources to go hunting, nor does Buddy have the time. I guess I am in a bit of a crunch as to what to do now. I may try to contact a vet out of state who does have experience, but wouldnt be able to travel to take Buddy to their clinic. This is disappointing. As if it isnt enough to have him get sick this way, but to not have the veterinary resources nearby to get proper treatment/care. Getting frustrated with this and with my ability to comprehend things.

BuddysPapa

04-23-2015, 09:11 PM

Hi everyone. I hope all is well for you. I havent posted for awhile so I thought I would share something. Buddy has been doing ok with everything. His thirst is still pretty strong, frequency or amount of urination still pretty strong, and his appetite is still a bit much. He has been on Vetoryl since March 31st and today we went in to the vet for ACTH stim testing. Here is my quandry:
Fed him at 6:30am and gave Vetoryl with meal. Took him in to vet at about 7:30am and left him for the testing. The tech asked when he ate last so I told her. She told me it was to be a 12 hour fasting lab. I responded that in what reading I had done, the lab was not to be a fasting lab as Vetoryl is fat soluble and absorbs better that way. Read on Mark Peterson's blog site. My vet was busy but she talked to 2 other vets who said, "well, it should be ok still." So I left expecting to pick him up on my lunch break. The big issue though, is the protocol they did or did not follow. The are supposed to draw baseline, inject, wait one hour and draw post. I didnt see this on the paper when I picked him up, but they drew baseline at 10:23am and then post injection at 10:43am. Wouldn't this skew the results or am I just being paranoid or too worried? The results of the lab show him within normal range of cortisol level which is fabulous if it was done correctly. Worried I am dealing with some docs who are not well versed in this disease. I appreciate and thank you in advance for your responses. Chet and Buddy.

LtlBtyRam

04-23-2015, 10:11 PM

The are supposed to draw baseline, inject, wait one hour and draw post. I didnt see this on the paper when I picked him up, but they drew baseline at 10:23am and then post injection at 10:43am. Wouldn't this skew the results or am I just being paranoid or too worried? The results of the lab show him within normal range of cortisol level which is fabulous if it was done correctly. Worried I am dealing with some docs who are not well versed in this disease. I appreciate and thank you in advance for your responses. Chet and Buddy.

The way this is worded is subject to suspicion. If the pre draw was at 10:23 and they did the Cortrosyn injection at 10:43 then what time was the post blood draw? Or are they saying they did the Pre draw at 10:23 gave the Cortrosyn injection and took the post blood draw at 10:43. If the pre was and post were done only 20 minutes apart then I think there may be a problem. Please don't take my word as gospel as there are others way more versed than I, but I have been at this for a couple of years and learned a thing or two.

I don't know if it would help but you may want to request your vet contact Dechra about protocols. Another choice may be to contact Dechra again yourself and see if you can get literature from them to give to your vet to help give your concerns a stronger voice in the opinion of your vet.

I will be keeping up with you and Buddy. This is definitely a treatable disease as others have stated.

molly muffin

04-23-2015, 10:29 PM

The key is as previously mentioned. What time was the 2nd blood draw. If an hour after the first blood draw then that was fine. I am more concerned that they thought an ACTH was a 12 hour fasting test. Not even close and good of you for insisting otherwise. I agree they need to contact dechra if they are that off about protocols. Or even the lab would probably know better. This one though should give you the correct results. If an hour later.

As long as they are willing to learn, read up on the disease. Testing. Dosage. Then it might work out still. Just stick to what you know and if you have a question. Let us know and we will try to answer and direct you to documentation if needed and wanted.

labblab

04-24-2015, 07:46 AM

Hi Chet, as the others have noted, there are multiple issues here. Since the times of the blood draws are specifically noted and they are only 20 minutes apart, I do think that is a problem that would affect the validity of the results. I am only speculating here, but I would assume the cortisol level would have been higher had the stimulating agent had the full hour to "work." I have never seen a laboratory protocol anywhere in the world that specifies any time period less than one hour between the two draws.

Also, with a report that the cortisol was in the "normal" range, I have to wonder what is meant by that. The desired therapeutic goal for dogs treated with trilostane is lower than the normal range for dogs who do not have the disease. Can you please get the actual numbers for the test results?

Given the fact that Buddy is still quite symptomatic, I have to question whether his cortisol level is really where it needs to be. If the ACTH was indeed run within that shortened time frame, I believe the vet owes you a repeat, free of charge. You need a result that is accurate, and that is interpreted properly. And even though the ACTH can be a fasting test for initial diagnostic purposes, the trilo does need to be given with food for all subsequent monitoring tests.

I am so sorry this is turning out to be such a struggle for you to get proper monitoring for Buddy. I have to agree that it does not seem as though your vet is well versed in treating Cushpups. It would be great if they would call Dechra and get themselves squared away!

I am very proud of you for sticking to your guns about needing to test after the trilo is given with food. Good job, Dad!!! It may be a challenge, but hopefully we can get them straightened out about these other issues, too. If they will just run the test correctly, we can supply you with the information about the desired results.

Marianne

BuddysPapa

04-24-2015, 10:01 AM

The base level of cortisol was 9.3ug/dl, taken at 10:23am. Then they show the post cortrosyn draw taken at 10:43am at a level of 7.8ug/dl. This information was provided through IDEXX laboratories.

I dont do well speaking in person to people. I lose track of my train of thought. So, I contacted the clinic I use via an email with my concerns and also put a link to Dr. Mark Peterson's page regarding the protocol for ACTH Stim testing in that email. I pointed out that I felt the testing was done incorrectly, that I felt uncomfortable with and lacked confidence with the treatment Buddy is getting. I also told them I cannot afford to have to pay for these tests over and over. I also said that I wouldnt hesitate to find another vet if we cannot get this figured out. I was fairly pointed in my remarks, so hopefully this will change and yes, I agree that I should get a retest at no charge to me.

I dont know how long I should wait though, for them to get this squared away as the longer Buddy is on Vetoryl, the more damage the medication can do to him if the wrong dosage is being given. Chet

labblab

04-24-2015, 10:38 AM

Chet, I think you are doing a great job with a difficult situation. I think your decision to send an email was an excellent one. I often get overwhelmed and sidetracked when I am talking to a vet or doctor, too, and even making a list of questions in advance doesn't always save me. When I am stressed, my brain usually just blanks out altogether :o. I really wish my vets would communicate via email, too, but they do not.

ANYWAY, given those ACTH results, I don't think there is any worry about Buddy's cortisol dropping too low on this dose of trilostane. So that is a relief. But the jury is definitely still out regarding the benefit of a dosing increase. The test results are goofy, in that the second number should have been higher than the first. So either this is evidence that the stimulating agent did not have enough time to do its job, or perhaps the two blood samples were mistakenly reversed and mislabeled prior to the analysis. Either way, neither result is too low. But also, since Buddy is still having strong symptoms, neither result is low enough to show that Buddy's cortisol is being optimally controlled. So the odds are that he needs a dosing increase, but you want to have an accurate ACTH result before deciding how much more of the drug to give.

For dogs being treated with trilostane, the therapeutic post-ACTH range is approx. 1.5 - 9.1, so long as all symptoms are resolved. If symptoms remain, you would want the cortisol level to be lower than 9.1. Some specialists prefer that the post-ACTH result be no higher than 5.0.

So let's see how your vet responds. Hopefully she will pick up the ball and do what's right to correct these problems.

Marianne

BuddysPapa

04-24-2015, 08:54 PM

I spoke with the vet today. She indicated that the baseline draw was at 9:20, then the injection was given. The second draw was done at 10:20. The times that I read were the times where they did the spinout process on the SNAPshot machine. She did say however, that at their clinic they prefer to do a 12 hour fast because she says they find that cushings dogs usually high fat (lipids) which make the whole test difficult to run and spin out. She indicated too, that Buddy does not have a high level of lipids so she preferred the fasting lab. I guess this is all mumbo jumbo to me as I just look at what the protocol dictates you do and didnt think there was to be any variation on the theme. Still confused.

LtlBtyRam

04-25-2015, 12:27 AM

Actual draw times of 9:20 and 10:20 great. Nothing I know supports giving the test being given with a 12 hour fast while on Trilostane. Perhaps someone else knows something of this? I just don't know enough to say with 100% certainty.

You are doing great keep up the good work. People here are great and will help as much as we can ;) The best anyone can do is monitor their animal, educate themselves, and work with the vet as much as possible.

BuddysPapa

04-25-2015, 11:47 AM

I just want to tell you all thank you for being willing and taking the time to respond to my posting here. I know we are all on the same page when it comes to caring for our animals, but to do what you do and to offer your advice so freely is truly special to me and I wanted to tell you how much this dog lover appreciates what that means.

labblab

04-25-2015, 04:39 PM

Hi again, Chet. Thank you so much for your kind words. But once again, I want you to know how much we also appreciate your love and concern and care for Buddy! It touches all our hearts when we witness this special bond between a parent and their dog. :)

Sooo...let's get back to work re: charting the best path forward. I'm really glad to know that your vet responded to your questions, and especially glad that the ACTH was performed within the proper timeframe. But unfortunately, we are still left with some big question marks.

First, the effect of lipemia (elevated fat level) on the test results. I understand what your vet is saying about problems that are created when trying to analyze blood samples that contain a lot of fat. When the ACTH is used diagnostically to help determine whether a dog has Cushing's in the first place, there is no reason not to fast the dog beforehand, especially when other tests are going to be run on the same sample. Some blood panels really do need to be run on a fasted sample. But using the ACTH to monitor trilostane and Lysodren therapy is a special circumstance. Given what Dr. Peterson has written, I really don't know how to get around the need for dogs to be given their morning medication, WITH a meal, on the day of testing. I think you really need to stick to your guns on this on all subsequent tests. Otherwise, you will be comparing apples to oranges in terms of the results. If your vet balks, I would tell her that she needs to call Dechra directly (manufacturer of brandname Vetoryl). The Dechra technical representatives tell us all, both in writing and also verbally in phone conversations, that trilostane must be given with a meal on the morning of the monitoring test in order to convey accurate results. Your vet can contact Dechra directly and find this out for herself:

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

And here's a second problem. It remains the case that Buddy's ACTH results were goofy in that the "post" result was lower than the "pre." This is not what you'd normally expect to see, and returning again to Dr. Peterson, this is what he has to say in response to a question about this situation:

Question: I recently rechecked a dog on Vetoryl. The post-ACTH stimulated cortisol concentration was lower than the pre-value. What does this mean?

Answer: There are several explanations for discordant results, i.e., those in which the baseline cortisol is greater than the post-ACTH value. These include laboratory error, mislabeling of samples in the clinic, interference by exogenous steroids, and use of an ineffective ACTH product...

As you can see, the answer never seems to be that the result is an accurate one :o; somehow an error has been made or an ineffective product has been used. For the sake of argument, let's assume the samples somehow were reversed, such that Buddy's true results were:

Pre: 7.8
Post: 9.3

I know you are one week shy of the 30-day mark with Buddy's testing, so it is possible that his cortisol will still drift downward a bit more over the next couple of weeks or so. So you do have the option of leaving things just as they are and waiting a bit longer to see whether you still see any additional improvement both in his symptoms and his numbers. But given the fact that he remains significantly symptomatic, I do think you might go ahead and consider increasing his dose a bit now. In looking back through your thread, I think Buddy weighs about 70 pounds and you are currently giving him 60 mg. of Vetoryl daily? If so, you might consider buying some 10 mg. capsules and adding one to each daily dose for a total of 70 mg.

Of course, you will need to discuss this with your vet if you wish to increase his dose at this stage. What is she recommending at this point in time, given Buddy's continuing symptoms?

Marianne