Two dogs with Cushings

[justadreamer1021]

Hi. we have 2 dogs diagnosed with Cushings. Leia is a white shepherd. She developed hair loss. Her tail is hairless and her undercoat has disappeared. She has a low thyroid which she takes medicine for. The other dog is a chocolate lab Teagan. She pants excessively, drinks lots of water, hungry all the time, and had occasional accidents in the house. she also takes thyroid meds. She is SUPER sensitive to steroids. Both are now on trilostane 8 mg. Leia seems to drink a bit less but we see no change in Teagan. Both had their urine tested and both came back on the very high side (Corticol:Creatinine Ratio ). The vet trying to save us money believes both have Cushings. She has not done any other testing, as we have lots of pets and expenses. My question is: should we be seeing results by now? They have been on meds for about 2 months. Also, we are finding the trilostane to be super expensive. We get it in liquid form 200 mg/ml, compounded. We have 1 cat on chemo, a diabetic dog, 1 cat with asthma, etc... so it is getting very expensive. Can anyone recommend ideas to keep cost down? Any help would be appreciated.

[Squirt's Mom]

Hi and welcome to you and your babies!

Goodness, two at the same time plus all the other sick babies in your care. I know you are stretched to the limit on all fronts.

Some things just JUMP out at me in your post. First you are talking about large dogs, shepherd and lab, but they are on a dose size that would work for a Chihuahua. No wonder you aren't seeing any improvement. So if I am reading the info correctly, your babies might as well not be on any treatment with such small doses (8mg). The starting dose is Img per POUND and I just haven't seen that many 8 lb labs or shepherds. LOL Most vets want to overdose them right off the bat - yours is just teasing them with treatment. :D

Second, and MOST dangerous - it seems treatment was started based solely on the UC:CR? If that is the case, STOP giving this drug now, even tho it isn't doing much at all at such a low dose for big dogs. These are NOT drugs you give out willy nilly but their use must be supported by a diagnosis based on cushing's tests - and the UC:CR is not a test to diagnose Cushing's. It can rule it out but cannot diagnose it. So were any other tests given to diagnose Cushing's in either of your babies?

Third, and equally as dangerous, no testing while on this very powerful drug.

I am not at all impressed with your vet so far and pray I am misreading most of your post concerning the care your babies have been getting. So please fill in the gaps for me and change my impression - tell us all you can about each of these baby's health history, testing, etc in depth. It might be best to start a separate thread for one of them so we, and you, can keep each of their histories apart and not confuse them. No two dogs will have the same cush journey. ;)

Looking forward to hearing more from you soon!
Hugs,
Leslie and the gang

[molly muffin]

Hello and welcome to the forum. Leslie makes some good points. You did need testing with cushings meds to know that it is working, how they are reacting and that they aren't being overdosed.
I am guessing that because these aren't tests you can afford to have done with some many animals all having issues that your vet went very conservative with dosing but I don't think the 8mg will do the trick.

Most get compounded trilostane from an online pharmacy like diamondback. Maybe a pill form would be better for big dogs and cost less. Liquid works well with small dogs, who need a ver small dose, but not so sure it is cost effective for large dogs.

[justadreamer1021]

Okay I figured out that using liquid compounded trilostane at 200 mg/ml - they are actually taking .8 ml per day which equates to 160 mg per day. Sounds much better, doesn't it? Our vet is pretty good. She ran the one tests (urine: creatine)and both dogs were off the charts so she said rather than us spending $200+ per dog she would go ahead and treat them for Cushings. She went with the liquid because she said the amount would need to be adjusted. Lea is the white shepherd weighs close to 80 lbs. and Teagan the lab weighs about 70. They have been pretty healthy overall. Leia for some odd reason stopped shedding completely. She then had a cancer removed off her thigh. After the operation she started losing hair bad. Her tail is now hairless and spots on the truck of her body. They tested her for all sorts but found nothing. She also was having hind leg weakness. Leia does have low thyroid and takes thyroid meds. Teagan, our choc lab kept having weird reactions to steroids. She would have accidents inside. They would check her for a urinary infection but it showed nothing - just very diluted urine. She also pants ALOT and drinks a lot of water. She was tested for diabetes but was neg. She does have low thyroid also and takes meds. She has gained weight but is on the same amount of food. With 3 dogs and 17 cats (all rescued) we have a busy house. Like I said our black lab has diabetes and is on insulin. One cat had a cancer on her larynx - they removed it but she is on chemo. It was an aggressive cancer so it may return. Another cat, they found cancer in her mouth (bone cancer) and they thought it may had spread to her tail, but she is doing good (almost 2 yrs now). We lost 1 cat to lung cancer (a real sweetheart), 1 to heart trouble, and another to some sort of sinus problem (caused her to stop eating). All our pets are fixed, all indoor. We live our lives for them. I was hoping to locate somewhere that has trilostane cheaper. We have another cat on asthma medication. Transdermal gels that you rub on her ears daily. Most of our pets are geriatric now so you expect more cost.

[Squirt's Mom]

She ran the one tests (urine: creatine)and both dogs were off the charts so she said rather than us spending $200+ per dog she would go ahead and treat them for Cushings.

:eek::eek::eek::eek::eek::eek::eek::eek::eek::eek: :eek::eek::eek::eek:

[Harley PoMMom]

Cushing's can not be diagnosed with the UC:CR (urine cortisol:creatinine ratio) test, this is only a screening test to rule out Cushing's as it can not diagnose it, other diagnostic tests are needed to validate a Cushing's diagnosis.

Also, it is recommended that the starting dose of Vetoryl/Trilostane should be 1mg per pound of the dog's weight, so for Lea of 80 lbs that equals out to no more than 80 mg, and for Teagan's weight of 70 lbs a dose no higher than 70 mg, so I am a bit worried. It also has been documented that larger dogs tend to require a lower dose than small dogs.

I'm including a link to a published article from Dechra noting the revised starting dose: http://www.vetsonline.com/news/product-news/140722-new-lower-starting-dose-for-vetoryl.html

Hugs, Lori

[justadreamer1021]

Looking at the trilostane site it reads:
Ideally, the starting dose to aim for is 1.0 to 3.0 mg/lb (2.2 to 6.7 mg/kg) once a day based on body weight and capsule size.

If you look at that and figure Leia is 80 lbs. x 2.0 = 160 mg. I don't think she is over the amount. Maybe too, I am reading the amount wrong. It is 200 mg/ml and she gets .8 ml. I asked the pharmacist and he said it was 160 mg.

Teagan would be higher for her body weight. She is between 65-70 lbs. and gets the same dose.
When we asked the vet what she would do if they were hers and she said she would go ahead and treat since their numbers were so high and monitor. They have been on the medicine for approx. 2 months now. The vet service has more than 1 vet and they both agreed. Not sure what to think. How soon would one see a difference? Leia is nearly 11 yrs old and Teagan is 8.

[My sweet Ginger]

' the starting dose to aim for is 1.0 to 3.0 mg/lb (2.2 to 6.7 mg/kg) once a day based on body weight and capsule size. '

That's the old recommendation by Dechra and they now recommend 1mg per pound.
Here's the link.
http://www.vetsonline.com/news/product-news/140722-new-lower-starting-dose-for-vetoryl.html

Hmm, I don't know what to think either. :rolleyes:
They've been on trilostane 2mg per pound for about 2 months and you see almost no change in them? From that fact alone I'd be inclined to think that maybe something else is going on.?
I certainly can imagine that your money is very tight with so many pets :eek::eek: but at this point you really want to do ACTH tests on both pups to see what the two months of trilostane has done to their may or may not be Cushings bodies and reevaluate the course of their treatments all together. Song.

[Squirt's Mom]

To my mind the starting dose doesn't matter since the disease has NOT be diagnosed and therefore the drug should NOT be used at any dose. ;) Your vet is risking your baby's lives, pure and simple. There is no other way to say it, no way to explain it, no way to excuse it. :(

[justadreamer1021]

Since there is no way to absolutely prove a dogs has Cushings (no matter what tests) - then everyone that treats a dog for it takes a risk. I know our vet - she is very good at what she does. What is the use of going to a doctor or vet if one doesn't follow their advice or trust what they have studied long and hard to learn. Yes, I am concerned that they have not had all the test available, but I also know we have given a good life to many pets over the course of 11 yrs. We continue to do the best we can and have been complimented on doing such a fine job.
Our vet and her partner vet has provided us with around the clock care for our pets so I fail to believe they would endanger them unnecessarily. What I do think is that they have looked at all the tests they have run and at all the evidence they have seen and went with a solution they feel will help the animals and us, while keeping cost under control.

[molly muffin]

What is your vet suggesting at this point?

The tests for cushings specifically can do a couple things, ACTH tells you what the resting cortisol is and how much cortisol the adrenal glands are production.

The LDDS tests you if the dog is able to suppress at 4 hour and 8 hour after having the pituitary gland tell the adrenal gland that there is enough cortisol in the body and to stop making more. A dog without cushings will suppress at 4 and 8 hour, a dog with an adrenal tumor will not suppress at either 4 or 8 hour and a dog with a pituitary tumor will usually suppress at 4 hour some but lost more control at 8 hour.

The ultrasound can show if there is an adrenal tumor or not or if there is something going on with another organ that is causing the cortisol to raise.

A CT/MRI can show you if there is a pituitary tumor.

All of these tests are expensive. That is a fact. I think your vet has taken that into consideration and is trying to do the best for the dogs that they can with limited resources. What you have to remember is that if you are doing this, then you have to be very conservative with treatment, enough to be effective but not enough to risk an overdose of the medication. The problem is that dogs can react differently to the medication, one may be more sensitive than another, need a larger or small dose.

If your vet needs guidance at all, then they can call Dechra the manufacture of vetroyl and I'm sure they would be able to help out. (not sure if your vet knows they can be contacted or not)

It is true that just recently Dechra has lowered the recommended starting dose to 1mg/1lb due to the problems encountered with starting at larger doses.

I think that about covers testings, what they are meant to show.

[justadreamer1021]

Our vet ran the creatine:urine ratio. One dog was 73, the other was even higher. The vet believes that since it was not just a "borderline" reading that the odds are VERY likely Cushings - also since we have witnessed drinking excessive amounts of water, heavy panting, and Leia (white shepherd) has unexplained hair loss (skin turning dark in spots and end of tail is rat like). She started them both at .4 ml. They were on the trilostane for about 1 1/2 months with no noticeable changes, so she has increased them both slowly. They are now both on .8 ml of 200mg liquid. (160 mg each). I think they are drinking less, but Teagan still pants ALOT. We go back to the vet in 1 week and will discuss results. We would love to be able to get all the tests you mentioned but we have other pets requiring treatment a diabetic, asthma, chemo, etc... Both the dogs are also treated for thyroid. They get tested on a regular basis and are due now for that. Just wish I knew the best place to buy trilostane - right now we get it from Pet Health - it was the most reasonable. The cat gets transdermal medicine for asthma which runs $29 each (x2), the lab gets insulin (2 bottles a month - $22 ea.), the other cat gets chemo ($49 for 5 pills), plus we get thyroid meds, gabapentin, glucosamine, cholodin, and duralactin. Oh and the Raven (cancer cat) gets liquid prednisolone. Then of course we have frontline and anything else they may need on the spur of the moment. Our income is approx. $40,000./ yr gross so money is tight. No Iphones, no newer cars, no eating out, etc... Our lives are our pets. My husband is retired and I work full time. Any links to prescription saving sites, etc.. would be greatly appreciated.

[Jenny & Judi in MN]

your list made me tired. go you! Holly from the diabetes forum got some type of membership card at Walgreens that saved her some money on some of the medicine for her dog I think.

[Renee]

I'll just say what you're not supposed to say in this situation - if your income is as limited as you say and you have so many special needs pets, you may need to consider reaching out to a local rescue or animal shelter to help relieve some of the burden.

Your vet may have given you exceptional care in the past, but if they are setting aside professional protocols with such a serious drug so they can save you money, then they are not doing their due diligence by your dogs or you. There are certain things in medicine that just should not be shortcut.

Even if you choose not to run the diagnostic testing to confirm a cushings diagnosis, it is unconscionable for your vet not to run the standard monitoring testing while establishing a proper dose. There is no dose that is low enough to be considered 'safe'.

Everyone on this board, myself included, has been where you are, facing the cost of such an expensive disease to treat. We absolutely understand where you are coming from. Please understand, I am not trying to personally attack you.