Callie: Potential Cushing's Diagnosis / Sensitivity to Trilostane [Archive] - Canine Cushing's Information and Support Forums

CalliesMom

08-25-2015, 01:26 AM

Hi everyone. I've been reading these boards for 3 weeks while we have been testing my girl, Callie, to figure out what was wrong with her. She was drinking excessively (8+ cups a day) and urinating excessively (9-12 times a day). She was having accidents in the house, which NEVER used to happen and she used to only go potty 3-4 times a day. She had blood in her urine, so she was originally treated for an UTI. Meds did not help, so we did blood work, which showed raised ALP levels. This led to doing an ultrasound and low dose dex test, which finally confirmed (pituitary) cushings.
Reading everyone's stories on here has helped me through this so much!
Callie is a 32 pound, 8 and 1/2 year old beagle mix. The vet put her on a 40 mg dosage of Trilostane. I was instructed to start her on 1 pill every other day for 2 weeks and then give 1 pill daily after that. I would love to hear your experiences with Trilostane (side effects, dosages, effectiveness, how soon for results).
I wanted to do a very in depth post, but I have a concern that just happened. At 11:30 tonight, Monday 8/24, Callie vomited all her food from dinner (5:30). She has only been given two Trilostane pills: 1 on Friday 8/21 and 1 on Sunday 8/23. She has been lethargic for weeks now, so that is a tough indicator for her. Do you think this was Trilostane related? Her water intake has also decreased from 8 cups to 3 and 1/2 in just a matter of 2 pills of Trilostane. I thought this was an awesome sign, since that's what she used to drink daily. But now with one time vomit, I'm getting a little paranoid. Any thoughts/advice? Should Trilostane be helping so soon or is this a bad sign? Her symptoms have been mild in comparison to some of the dogs I've read about and we caught it super early. She is also currently on a second round of antibiotics to knock out the stubborn uti. Thanks in advance.

Harley PoMMom

08-25-2015, 02:10 AM

Hi and welcome to you and Callie!

Trilostane/Vetoryl should never be given when a dog is presenting signs of not feeling well, so in Callie's case I would withhold giving her any more doses of the Trilostane. Trilostane has a short half-life and leaves a dog's system quickly so I am hoping that withholding her Trilostane will make her feel better. If the situation should get worse...e.g...having more vomiting episodes and/or diarrhea, I recommend that she be seen right away.

So if I am understanding this right, Callie's UTI never resolved? If this is so, having an urine culture and sensitivity test is needed, this test will tell exactly what bacteria she has and than the proper antibiotic can be prescribed.

I am a bit concerned about her diagnosis of Cushing's, with the low-dose dexamethasone suppression test a false positive result can be created if a non-adrenal illness, such as an UTI, is present at the time of testing. I am also bit worried that her vet may not be well versed with the protocols in treating Cushing's. Every-other-day dosing is generally not a good option. Since the medication remains active in the body for no longer than 24 hours, skipping a day only sets up a roller-coaster of higher cortisol one day, lower cortisol the next.

This is especially troublesome in terms of trying to interpret the results of an ACTH stimulation test. If the test is performed on an "off" day, the results will be higher; if the test is done on a day with the med, the cortisol level might even be lower.

I am including a link to information about Trilostane/Vetoryl: http://www.k9cushings.com/forum/showthread.php?t=185

We do have many members that are experiencing success with their dog's treatment with Trilostane/Vetoryl. 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. An educated pet owner and an experienced vet are equally effective in facilitating safe and efficacious treatment with few to no side effects.

The best advice I can give you is to do your research on Cushing's, the treatment protocols, and how it is diagnosed. I am providing a link to our Resource forum which has a wealth of information regarding Cushing's and also includes articles written by some of the most renown veterinarians that specialize in endocrinology http://www.k9cushings.com/forum/forumdisplay.php?f=10

Please know we are here to help in any way we can, and remember you are not alone on this journey.

Hugs, Lori

mytil

08-25-2015, 08:23 AM

CalliesMom

08-25-2015, 11:31 AM

I appreciate all the feedback and will definitely call her vet today.
Sorry, that post was a little brief, I was panicking last night.
When all of her symptoms started (almost 1 month ago), she was originally treated for a UTI that did not respond to antibiotics (cefpodoxime). On that day her urine showed a small amount of blood, but was too diluted to pick up much of anything else. Later that week after not getting any better, she had bloodwork done that showed high alkaline phosphatase levels. Kidney and liver functions were normal. X-rays were clear, no tumors, no bladder stones, no crystals. Organs look normal.
Ultrasound showed mild bilateral adrenal gland enlargement. All other organs were normal, just some age-related changes. Ultrasound showed undigested food in her stomach, which they thought was a bit odd since she was fasted since the evening before. Urine was tested again, still too dilute. I finally took water away around 10 PM, and tried another collection in the morning (and then gave her water). This time urinalysis showed protein, gram negative bacteria and a higher specific gravity, No glucose.
I do not have a copy of the results from her low dose dexamethasone suppression test, but that was positive. Like I said she is now on the 40 mg of Trilostane and Enrofloxacin for the bacteria in her urine.
She tends to vomit after she is given her heartworm pill (the big chunky tablet) because she doesn't chew. I have to cut it into slices. I thought POSSIBLY the Enrofloxacin tablet (now I'm cutting that into pieces) caused the vomiting because she did not have the Triolstane since the day before at 7 AM. She's not having any other symptoms this morning. She's been lethargic/not her happy self since the polydipsia/polyuria and house accidents started a month ago. She actually seems happier in the past few days.

Is it possible to see a reduction in the polydipsia and polyuria in less than a week on Trilostane?
Also, generally when dogs do have vomiting/diarrhea from Trilostane is it often or can it just be a one time thing? Like I said, I'll call her vet today and keep a close eye on her. She's my everything!

CalliesMom

08-25-2015, 03:50 PM

Callie threw up again today sometime between 12 and 2:00.
I called the vet, she said do not give any more meds and call her on Friday to discuss how Callie is feeling to see if I should restart the Trilostane. Callie is still eating and drinking and eliminating normally.
I asked the vet about a lower daily dosage instead of every other day. She said she's already on a pretty low dosage and that the days may need to be spaced out more if she's sensitive to it.
It's going to be a long road..

Harley PoMMom

08-25-2015, 03:50 PM

It generally takes about 2 weeks to see a decrease in the polydipsia and polyuria, however, all dogs different and can react differently to the Trilostane. We usually only see adverse side effects when the dose is too high, Dechra the makers of Vetoryl (Trilostane), have revised their initial Vetoryl (Trilostane) dosing recommendations, they now state that a dog should be started on Vetoryl at a dose of 1mg per pound of the dog's weight. So with Callie weighing 32 pounds her dose should be 32 mg, but since the 40 mg is just a hair over I would think that her dose is reasonable, but like I mentioned before...all dogs are different :eek:

Is her Trilostane being given with food?It is very important to give the Trilostane with food because if given on an empty stomach it will not be absorbed properly and could cause nausea.

Keep us updated, ok?

I can't stress enough that every-other-day dosing is not a good option. If it is feasible I recommend having an ACTH stim test done just to be sure that her cortisol is not too low, hypoadrenocorticism can develop at any dose of Vetoryl. If this were me, if the ACTH stim results show that her cortisol is fine than I would start her at a much lower dose, say 10 mg, and give it once a day.

Hugs, Lori

CalliesMom

08-25-2015, 03:58 PM

I'll definitely keep you updated. She's had a total of 3 pills so far and they are given with food at the same time each day. Hoping to get this under control so she can live a happy life as long as possible. We are both exhausted! I've been thrilled that she's slept through the night the last 3 nights. It's like having a newborn!
The every other day thing doesn't make sense to me either ��

labblab

08-25-2015, 06:39 PM

Welcome from me, too! I also agree that the every-other-day dosing does not make sense, plus I would have preferred starting at 30 mg. once daily. BUT.....having said all that, yes, it is possible to see such quick improvement in thirst and urination. My own Cushpup was better after only a couple of doses, too. So keep us updated, and we'll all be hoping that Callie continues to do well, especially once she is indeed changed over to daily dosing.

I have to agree with you that I wonder whether it's actually the antibiotic that's the culprit in terms of upsetting her stomach.

Marianne

labblab

08-25-2015, 07:31 PM

Out of curiosity, how are you arriving at the 40 mg. total? Are you giving her a combination of brandname Vetoryl capsules (30 mg. and 10 mg. capsules), or are you giving a compounded trilostane product that exactly equals 40 mg.? Either way, she certainly could be given a lower dose than what she is currently receiving, so I'm puzzled as to why your vet would think it would be difficult to alter the amount of medication if this seems to be too high for Callie, especially on a daily basis.

Here's a reply on our Trilostane FAQs thread in our Resources Forum that discusses in greater detail the most recent recommendations to begin daily dosing at an amount that does not exceed 1 mg. per pound. Once again, given Callie's weight, that would not be a difficult dose to obtain. She could either take one 30 mg. capsule of Vetoryl, or she could even have a compounded dose of trilostane specially prepared for her at 32 mg. Or, if she needs even a lower dose, Vetoryl comes in 10 mg. capsules and compounded trilo can be custom prepared at any dose other than those in which Vetoryl is already sold.

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

Marianne

CalliesMom

08-25-2015, 08:09 PM

Hi there,
Callie is taking a compound 40 mg Trilostane capsule. Not sure why the vet decided on that dosage.. I spoke to the vet briefly today and I asked about a lower dose, given daily, but she kind of just replied that "she's already on a pretty low dose." I'll be following up with her via phone on Friday night. I am getting pretty nervous about finding the right dosage, that's for sure. Callie adores this vet and has been to some previously she's been terrified of, so I'd hate to change places. But this one is far away and if she's not getting the best treatment for cushings I'd consider changing to somewhere closer to my house.

CalliesMom

08-26-2015, 12:40 AM

Just to clarify. If a vet is doing the acth tests appropriately, it means 2 weeks, 30 days, 90 days, every 3 months, in addition to running it each time there's a dosage change? I feel like I will go broke. I've already spent so much just for the diagnosis.
I really feel like crying because i would definitely find a way to pay for all of this, if needed.. But it's going to be such a strain at $200+ per test. I'm so overwhelmed right now with Callie not taking to the Trilostane. And then with possibly needing to find a different vet for proper treatment.. I'm Just venting :(

Renee

08-26-2015, 01:03 AM

Callie's mom - the cost can be reduced greatly if you 1. follow Dr Peterson's dilution method, and 2. buy the entire bottle of cortrosyn upfront, then you only pay for the lab work while you use up your bottle of cortrosyn. You should be able to get 4-5 doses out of a single bottle.

Harley PoMMom

08-26-2015, 02:09 AM

As you can see I have copied your post as well as Renee's reply from "What do you pay for an ACTH stimulation test? U.S. Dollars" poll and placed it here in Callie's original thread, that way all information regarding Callie is in one place.

I second Renee's suggestion of following Dr. Peterson's advice on how to save on those ACTH tests. The cost of those ACTH stimulating tests are driven by the high cost of Cortrosyn, the stimulating agent. Normallly the entire vial of Cortrosyn is injected but studies have shown that just a fraction is needed to obtain accurate results. A vet can split the vials and freeze the remaining agent for future tests. It is well worth your while to ask your vet if she is aware that you do not need to use the entire vial of cortrosyn. If your vet is unfamiliar with how to split and store Cortrosyn, you can print out instructions that can be found on Dr. Mark Peterson's blog. He is a renown expert who provides educational information to veterinarians as well as to pet owners. You can either provide your vet with the URL to the correct page on his blog or you can print it out and take it with you when you discuss it with her. The URL is http://endocrinevet.blogspot.com/2011/03/how-to-extend-your-supply-of-cortrosyn.html

Hugs, Lori

mytil

08-26-2015, 07:12 AM

I know it can be maddening when your vet says one thing and you hear and read another, especially when your dog is very comfortable around them. I am glad your vet did mention to stop the Trilostane.

How much dose your girl weigh?

I would encourage you and/or your vet to contact the manufacturer (Dechra) and talk more about the every other day dosing.

Terry

Squirt's Mom

08-26-2015, 07:57 AM

Just reading along here and I am VERY concerned your vet doesn't understand this disease nor this powerful drug they are giving your dog - incorrectly and refusing to discuss their mistake. Huge red flag for this cush mom. We need vets who will listen to us and work WITH us, not against us. ;) And if they simply are not capable of listening, at least be willing to read the literature that goes with the drugs they dispense.

labblab

08-26-2015, 08:17 AM

Please try not to feel too downhearted right now! I think there are actually several positives that we can all focus on.

First of all, I think it's entirely possible that it's the antibiotic that is causing the GI upset for Callie, and not the trilostane. And since you've already seen improvement in her thirst and urination after just a few doses, it does seem as though she is responding to the drug in terms of symptom relief. Of course, however, the other possibility is the that the thirst/urination was actually the result of the unresolved UTI and this new antibiotic is finally taking aim at the infection. If Callie remains "off" the trilostane for a while and the thirst/urination continues to improve, then that might be further indication that the UTI really was at the root of those symptoms.

Assuming that Cushing's is truly at play, however, Renee's suggestion about dividing the ACTH stimulating agent is a great one. I've just done calculations per Dr. Peterson's article using Callie's weight, and you ought to be able to get three tests out of a singe bottle of agent, so that can definitely help with the testing costs. Also, it is possible that for a few of the testings, you might be able to get by with only performing a baseline cortisol reading instead of a full ACTH. You can never safely increase a trilostane dose based upon resting cortisol alone, but some of the interim tests (like two weeks after a dosing change, for instance) are mainly performed for safety's sake -- to make sure cortisol is not dropping too low. And for that, resting cortisol levels may sometimes be sufficient as long as a dog is outwardly doing well.

Last but not least, it's great that Callie gets along well with this vet. She (the vet) may just not have had a huge amount of experience with this drug, but that doesn't mean she can't find out additional helpful information. As Terry has suggested, it would be great if she would be willing to call Dechra (maker of brandname Vetoryl) and bounce her questions/concerns off of them. Many of our members and their vets contact Dechra's technical reps, who are very eager and willing to help. The initial dose your vet has put Callie on is not hugely high, it's true, and she was indeed planning to switch to daily dosing after the first two weeks. But what your vet may not realize is that optimal dosing really does turn out to be hugely variable, and some dogs ending up only needing much less (or much more) of the drug than the initial dose that they are started on. If your vet calls Dechra, they can help guide her regarding dosing, and also about possibly substituting some baseline cortisol testing as I discussed above. So here's the contact info for Dechra, and I'm really hoping your vet will give them a call. You can even call them yourself to make initial contact and to get a file started on Callie:

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

So please don't despair! Callie may be much easier to get under control than you are thinking right now. :)

Marianne

CalliesMom

08-26-2015, 12:07 PM

Thanks for the support. Terry - she's 32 pounds. I go back and forth from feeling hopeful and thinking Callie can live a fairly normal life, to thinking she'll never get back to her normal self. She's not even 9 years old!
It's been a long month and this is the THIRD vet she's been to. Vet #1 wanted to put her under anesthesia for x-rays and ultrasound. That is ridiculous because she is the most mild mannered dog I've ever met. (and I work with dogs, so I've met a LOT) Vet #2 did an ultrasound and couldn't see her adrenal glands. Then they told me to "wait it out" 2 MORE weeks before they did any tests. They had no idea what was causing her symptoms, but they suggested cushings or diabetes insipidus. Vet #3 did a REAL ultrasound, xrays, ran the low dose dex test, and a urine culture. So she was, up until treatment, a godsend.
While it is possible Callie is sensitive to the antibiotic, I would think it's most likely the Trilostane. She's never had an issue with antibiotics or medications before. Except for Benadryl, which makes her violently ill (vomiting nonstop). The amount of urine is unlike anything I've ever seen. At the worst of it, I could put 5-6 heavy duty wee pads down and it still rolled right off. I do feel she's making progress with the wee-wee pads and feeling less guilty about going potty inside. She always uses them at home, but can't seem to get the hang of them when were at someone else's house though.. so I wouldn't say she's actually trained.
I'll decide what to do with the vet on Friday when I speak with her again. The other thing that concerned me is that she didn't ask to see Callie back until 5 weeks after medication. So.. I'm open to suggestion to vets in North Jersey that have dealt with a lot of Cushings patients.
Sorry for the ramblings, but thank you so much for "listening" and giving advice.

~Catie

mytil

08-27-2015, 08:26 AM

Hi again Catie,

How is she this morning with being off Trilostane for a day or two?

I do not know of any vets in your area but here is a link to specialists throughout your state. http://www.acvim.org/AnimalOwners/FindaSpecialist.aspx

Keep us posted
Terry

CalliesMom

08-27-2015, 01:54 PM

Hi terry - Callie seems to be doing a little better. No more vomiting (so it was just twice) She seems to be awake more, so I think the Trilostane was making her lethargic. It's so hard to tell lethargy when you have a lazy hound dog to start lol. Her appetite has been great all along (also a beagle trait) and she's always been eager when asking if she wants to go for a walk. Thanks for checking!

CalliesMom

08-27-2015, 10:04 PM

Well forget that. She threw up tonight around 8:45 pm. I'm at a loss.

mytil

08-28-2015, 08:35 AM

This sure is a conundrum. Being a hound dog did she get into something she should not have? What about the food ---- maybe try something different or milder on her tummy for a bit like rice and plain boiled chicken. She is up to date on vaccines right? Has she been checked for Lyme disease or heartworm?

I know this sounds gross, but what did the vomit look like? Was it dark, yellow bile looking or clear liquid?

Keep us posted
Terry

Harley PoMMom

08-28-2015, 12:30 PM

Pancreatitis comes to my mind when vomiting is involved, there is one test that is specific for diagnosing pancreatitis and it is the spec cPL test.

Hugs, Lori

mytil

09-02-2015, 06:45 AM

Just checking to see how Callie is doing.
Terry

molly muffin

09-05-2015, 10:26 PM

Just checking in here too. How is Callie?

CalliesMom

09-08-2015, 10:46 PM

Thanks for checking in!
I stopped Callie's trilostane. I think she may have been misdiagnosed. Her last pill was 8/26 and by 8/28 she had returned to regular urination (3-5x a day) and water consumption. I was actually concerned that her water consumption was a little low, she tends to drink about 1 and 3/4 cups a day now. She never did drink a whole lot before all of this started.
Randomly, today she has thrown up food 4x today! (between 7:30 and 2:30) She is not one to vomit like this. Round 1 had a little food, a few blades of grass and bile. Rounds 2 and 3 had food, I THINK (she tends to eat it if I'm not home) and round 4 had food. She did not get into anything strange or have different foods. I withheld her dinner tonight and no more vomiting, but she also hasn't drank anymore.
I'm really hesitant to think it's Cushings at this point, which is why I haven't posted on here. I truly appreciate all the support I've had here, but didn't want to bother anyone, since it's a board for cushings. I'm still a little concerned but she was absolutely normal for a week and a half!

*edit* and yes she's current on vaccinations and heartworm treatment. Lyme's vax is expired, but I use Frontline monthly.

molly muffin

09-08-2015, 11:41 PM

Oh don't sorry we adopt one and all once you come here. Like a big family. Not all end up with Cushing's. Could always be something else.

Don't like that vomiting. Are you trying the chicken and mushy rice? Several smaller meals a day. That might help with the digestion.

My dog has never been a big drinker either.

mytil

09-09-2015, 08:08 AM

Thanks so much for the update!!!! And am glad you stopped the Trilostane.

I agree please do not think you have to leave because your Callie may not have Cushing's and you are not bothering anyone at all. It could be she just cannot tolerate Trilostane - some dogs are sensitive to it.

She is still in distress with the vomiting and there is something going on. You can certainly give her some chicken broth (better freshly made - just boil a chicken and skim the fat) for nutrients, easy on the tummy and hydrates her. Has the vet given any advice?

Please keep us posted!
Terry

Squirt's Mom

09-09-2015, 08:46 AM

uhhhh NO! you don't just get to leave! You and Callie are family now so you are stuck with us! :p

I am quite concerned about the vomiting especially since it has continued off the Trilo. Has she been seen by an IMS? If not, I think that would be my next step if at all possible. Fresh eyes that have more training, education, and experience than our GP vets. It can make a world of difference. One of my babies was diagnosed with heart disease recently, her heart showing up on xrays almost twice it's normal size (I saw the films myself so I know that is what the vet saw) BUT the IMS found her heart to be in perfect working order and only slightly enlarged. However my baby does have lung disease - which the GP vet wasn't equipped to diagnose - he literally didn't have the equipment needed to do the specific testing. So taking her to an IMS saved her life. ;)

I hope she had a better night!

CalliesMom

09-10-2015, 11:02 PM

Thank you everyone - cushings or not, she's having serious issues and I'm very confused. I have a vet appt on Saturday. I live in New Jersey and her vet is in Pennsylvania (I used to live there and my family still does) I am going to ask for ALL her test results and then thank my vet and let her know that I need to find someone closer to home, so that when these things pop up, I can just go that day.
Callie was perfect on Wednesday... Today I came home from work to diarrhea in the house, 3 piles! :( she has never ever ever ever pooped in the house. There was also a puddle of urine! This is so not normal for her. I just made chicken and rice and will try that out tomorrow. No more diarrhea since 5:30 tonight. I will let you all know how the vet appt goes. I have two options from here.. I can switch to an expert vet (which may send me to the poor house lol) or take advantage of a free wellness plan at Banfield (I work in Petsmart). One of the vet's there is still good, but if this is cushings, I might go with the other vet that specializes in Oncology.
She seemed perfectly normal from 8/28 through 9/7 but now it's too obvious that there's something going on.

Harley PoMMom

09-11-2015, 04:25 PM

Hey! here's a link from our Resource thread where one can search for an IMS in their area: http://www.k9cushings.com/forum/showpost.php?p=1246&postcount=1

Hugs, Lori

CalliesMom

09-13-2015, 09:56 PM

I just wanted to make a quick post with Callie's low dose dex test results. Test was done on August 14th:
Sample 1 - 3.8
Sample 2 - 2.8
Sample 3 - 2.8
Went to the vet yesterday and she STILL has traces of blood in her urine. She's getting a urine culture done and a resting cortisol test, just to see if things look the same. I should have those results on Monday. The vet still thinks she has cushings due to the raised ALP and mild adrenal enlargement. Although she is a bit puzzled about why the excessive thirst/urination has stopped.
Trying to figure out what is causing "retention of ingesta" aka food still being seen in her stomach after fasting. That may explain why she's vomiting (several hours) after eating, occasionally.

Squirt's Mom

09-14-2015, 08:26 AM

I wouldn't put any stock at all in that LDDS since it was given while she was actively ill with something else. The LDDS is notorious for giving false-positives in the face of non-adrenal illnesses like the UTI so your vet probably just wasted your money and put Callie thru a stressful blood draw for nothing. :(

molly muffin

09-14-2015, 11:09 PM

If the food isn't being digested then that could cause stomach upset and it's important to find out why that is happening.

We've had several dogs who had gastro problems/UTI's even recently that got better after their gastro problems where taken care of. Several have been caused food issues and a change has made a difference. So again, something to investigate.

CalliesMom

09-17-2015, 12:44 PM

Callie's urine culture came back today. She has a difficult strain of bacteria - pseudomonas aeruginosa /putida. This strain doesn't typically respond to oral medications and she is most likely going to need an injectable medication to clear it up.
We did another resting cortisol test to see if he results would be any different after her sensitivity to the Triolstane - it actually went up to a 6.4 (first test was 3.8 resting)
I understand the bacteria/UTI could be throwing off her test results, the vet still feels she may have cushings due to the other symptoms, but she isn't ruling out a false positive either. There has been no more vomiting or diarrhea (knock on wood) but yesterday was her first day back on normal food. But that had been very intermittent and no schedule to it. So, I guess the next step is to clear up this bacteria for good and go from there.
Her water intake has increased again. I can't find any medical proof that the Baytril/Enrofloxain causes increased thirst, but many people claim their dog was drinking more while taking this antibiotic. She is not drinking the 8 cups/day like she was initially, but is between 3 1/2 - 5.

mytil

09-18-2015, 08:43 AM

Hi again,
Thanks for the update. Sorry to hear about the bacterial infection in Callie. And I hope her vomiting does not reoccur. IMO I would wait until the infection is cleared up before testing again. I know the symptoms may come back (excessive drinking/peeing etc).

While it looks like the LDDS test is positive for Cushing's, I wanted to pass this on just as an FYI --- there is another type of condition called Atypical "Cushing's" (http://www.k9cushings.com/forum/showthread.php?t=198). We have a lot of members here with this.....Although not actually Cushing's, dogs with these conditions often have many of the same clinical symptoms as Cushing's dogs do and the treatment protocol is different.

Not saying this is the case for Callie, but this could be one explanation she reacted to the Trilostane.

Keep us posted
Terry

CalliesMom

09-21-2015, 10:56 AM

Thanks for the links on atypical cushings. I'm not sure I fully understand the difference but I'll keep researching it.

The vet did find one oral pill that should cure this nasty bacteria in her urine. It is called Marbofloxacin - anyone ever hear of it? She has to take it for 6 weeks!! And it's pricey. The alternative was an injectable which would be hard on her liver/kidneys which would require monitoring those, which would be almost as expensive. At this point, the vet is unsure if this bacteria is causing Cushing results or if the bacteria is caused by Cushings disease since cushings can cause nasty Utis. So no more testing until after another urine culture in 6 weeks.
Callie has had another accident in the house (when we're not home). She needs to pee very frequently, especially in the evening. She can hold it 7 hours overnight. She's drinking about 5 cups/day.

Has anyone heard of dogs having such a severe/rare reaction to Trilostane that it can make them "normal" in terms of pu/pd for a few weeks? Say, if the dosage was too high? She only had 3 or 4 Trilostane pills when this thread started. We are still working on this mystery and won't get any more updates in at least 7 weeks

Squirt's Mom

09-21-2015, 11:59 AM

Atypical is a form of Cushing's that has nothing to do with cortisol. Rather five intermediate, or sex, hormones are involved. Elevations in those hormones can cause many of the same signs as conventional Cushing's (with elevated cortisol) but an Atypical pup will not test as positive on the usual cush tests because those tests look ONLY at cortisol levels. An Atypical pup has normal cortisol levels.

The five hormones involved in Atypical are Estradiol, Androstenedione, 17-Hydroxyprogesterone, Progesterone and Aldosterone. I believe in order to be diagnosed with Atypical the pup must show elevations in at least two of these hormones. An expanded ACTH is performed to test these hormones and the only lab we know of in the world that does this test is the University of Tennessee in Knoxville.

If the cortisol is elevated, the pup does NOT have Atypical even if all of these five hormones are also elevated. The key is the cortisol. Elevations in these hormones along with an elevation in cortisol is not at all uncommon. It is when ONLY 2 or more of those five hormones are elevated and the cortisol is *normal* that the pup is considered Atypical.

Squirt's Mom

09-21-2015, 12:00 PM

As for remissions for pups on Vetoryl (Trilostane), read the story of our Princess.

http://www.k9cushings.com/forum/showthread.php?t=1324&highlight=Princess

CalliesMom

09-21-2015, 12:32 PM

Thanks for clearing that up!! I would love to read about Princess. I see that there's over 100 pages, so on my next day off I will dive into her story.

apollo6

09-21-2015, 01:27 PM

Hello.
If Callie is not feeling well and throwing up that means trilostane more than likely is causing it. It is important to base it on her weight. My Apollo who weighed 10 lbs was prescribed 20mg which in reading dechra (not sure of spelling, company that makes ) was to much, I started him on 10mg and he did better. Every time the vet tried to increase it he did not feel good. The dosage may be to high for the furball. Bottom line is if your baby is not doing well, this is not good. My baby was on Trilostane . If you have the time you could read about our experience with it. Also as Squirt mom said, there are three types of Cushing-pituitary gland(Apollo had) adrenal gland and Atypical. This determines the kind of treatment . And what kind of a vet you have, if knowledgeable in Cushing. Cushing is a very complicated disease. We are here for you, there is a lot of knowledge and experience on the forum to guide you.
If. Callie is dealing with other issues, they should be addressed before going on Trilostane.

Sonja,Angel Apollo and Karma,Ariel

molly muffin

09-21-2015, 09:22 PM

Yikes, hope this medication works to clear up the infection.

How is she doing? Still throwing up?

CalliesMom

09-21-2015, 11:59 PM

Callie has not had any vomiting for almost 2 weeks. All things cushings-testing-medications are on hold until she finishes her 6 week course of Marbofloxacin. We should have the pills by Wednesday. After stopping the Trilostane she had a week and a half of normal drinking/urinating. Now the PU/PD has kicked in again and she's having accidents in the house.

Im praying its just the nasty bacteria making her sick, but in my heart, I feel like there's more to it. It's going to be a long 6 weeks.

CalliesMom

09-23-2015, 08:15 PM

Still no more diarrhea/vomiting. Callie started the 6 week mega dose of Marbofloxacin/Zeniquin this evening. Dealing with her vet being 2 hours away is not ideal. The vet feels her PU/PD is cushings flaring up again. I'm still hesitant/don't want to believe it's cushings, but everything else, other than this bacteria, has been ruled out.
The vet suggested I start her back on a 15 mg dose of Trilostane (the 40 mg made her lethargic and possibly caused the vomiting).
I know the importance of testing every time before starting a new dose, but her vet hasn't mentioned it. (I know this concerns everyone here) We are taking a beach trip this weekend, so I'm not going to start the Trilostane yet.

I've been reading Princess' story. She and her mom had such a tough time figuring out dosing. And she was also dealing with the astronomical vet costs in New Jersey (which is why Callie's vet is in Pennsylvania).
What is the difference between a remission and going into Addison's temporarily? It's so weird that Callie's pu/pd stopped completely for almost 2 weeks off meds.
Also can you do a low dose dex test between doses to monitor levels or does it have to be the ACTH test?
I know I should wait until the bacteria in her urine clears, but that's another 6 weeks away and I've been dealing with this since the beginning of August. Not knowing and worrying causes me so much anxiety!

Harley PoMMom

09-23-2015, 09:25 PM

Only the ACTH stimulation test can be used to monitor a dog being treated for Cushing's.

Glad to hear that she has stopped vomiting, boy that is so worrisome when they are sick like that.

I really do urge you to wait until that bacteria is gone for good before treatment for Cushing's is started.

The biggest difference between remission and going into Addison's temporarily is that with an Addison dog you may need to give supplemental mineralocorticoids and/or glucocorticoids for either a short or long period of time because the dog's body is not producing these on their own.

Sometimes with treatment a dog may have their cortisol drop too low and the Cushing's medication is withheld for a period of time. During this cease of treatment (remission) their system is still able to produce enough of cortisol that is necessary instead of the overproduction of cortisol when treatment was started.

Hugs, Lori

Squirt's Mom

09-24-2015, 08:36 AM

Please do not rush to put her back on treatment. It is better to NOT treat at all than to give these very powerful drugs to a dog who does not actually have Cushing's or when we have no idea what the cortisol level is - which you do not and CANNOT without another ACTH. So take your trip, enjoy, and let Callie get over all this other stuff first. ;) Then we can look at Cushing's again.

apollo6

09-25-2015, 02:29 PM

I agree with Squirts mom. I had Apollo on and off Trilostane many times to give him a break. Let Callie recover before even thinking of putting her back on Trilostane.
Also it would benefit you to find an internal specialist near you ,who specializes in Cushing for a consul. These medication are very potent. My baby also throw up and had to be on a very low dosage. Ask neighbors,etc. look on Yelp , also the American veterinarian internal medicine assoc.(not sure of actual site) I would think you would have a few to choose from.
Sonja,Angel Apollo

mypuppy

09-26-2015, 08:54 AM

Hi Catie,
I am so sorry you are so frustrated with trying to help your precious Callie and not truly understanding all this cushings stuff and its treatments. IT IS EXTREMELY FRUSTRATING. I think every member here has been in the same position at one point or another with their babies :(. I sent you a private message over one week ago and not sure if you have read It yet, but I would be more than happy to answer any questions you may have related to Princess's trilostane treatment and I can gladly refer you to a lovely internal medicine specialist in the Paramus, New Jersey area. In the meantime, these folks here (my very cherished family), are right in that withholding treatment with no final dx is the best and safest way to proceed with Callie. Enjoy your mini vaca with Callie, and please do not hesitate to reach out.

Tight hugs.

Xo Jeanette

CalliesMom

02-17-2016, 11:19 PM

Well, we are back again :( Callie was doing so well from October 24th until about January 20th. NO pu/pd!!! We slowly noticed that she was starting to drink/urinate more frequently mid January. On January 27th, she had an accident in the house and her water intake was still increasing. Went through a few more tests Bloodwork, Urinalysis, Bile Acid Test. Her alkaline phosphatase was into the 1,000s (previously only 300-500). She did have some struvite crystals in her urine on this urinalysis. Her liver functions are near perfect. I'm at a loss! She has not been on any trilostane since the original posts. I feel like everything has been ruled out, besides cushings. I'm crushed again and really believed she had been misdiagnosed. Callie's only cushings signs are pu/pd, raised ALKP levels and scrounging for things to eat. I think it's time we get to a Specialist... I'd love to hear your thoughts - please and thank you.

labblab

02-18-2016, 07:58 AM

Hello again to you and Callie, although I'm sorry for the reasons that have brought you back :o. I've just gone back to re-read your thread and refresh my memory. I'm hoping that Callie's GI issues are well behind you -- no more vomiting or diarrhea recently?

There certainly are several question marks about Callie's reaction to the trilostane the first time around, and the reasons for her apparent remission if Cushing's is indeed the culprit. But since she's once again back to exhibiting some classic Cushing's symptoms, I do think I'd opt to specifically test for Cushing's once again. This time, you might choose the ACTH instead of a repeat LDDS, although the case could be made for either. You might want to repeat the LDDS for comparative purposes. However, I don't believe you've ever had an ACTH done and since it is the monitoring test for trilo treatment, it would be nice to have a baseline reading in hand if you do start up with the trilo again. Also, it is less likely than the LDDS to give a false positive if a disease/illness other than Cushing's is at play.

I know a specialist is an extra expense, but given the question marks associated with Callie's history, it may be worth the money to consult with a specialist during this initial disgnostic process. Your regular vet can always jump back into the driver's seat once a treatment plan is in place. At least, that's my thought right now.

Marianne

CalliesMom

02-23-2016, 05:56 PM

Thanks Marianne!
We have an appointment booked on March 8th. It's the place where Jeanette took her Princess.
Callie has not had any more vomiting, very thankful for that. I never did an ACTH test, so that's probably the next step. Since all her symptoms went away for so long, I didn't pursue anything else.
I would have had Callie to a specialist sooner. but I had a surprise appendectomy done and just went back to work after 3 weeks. Life is never dull! I'll keep everyone posted after March 8th.

CalliesMom

07-25-2016, 12:03 PM

Harley PoMMom

07-25-2016, 12:11 PM

Welcome back! I have only a minute to post but wanted to let you know that I have taken the liberty and moved your new post into your original thread about Callie. This way, we will be able to keep track of her entire health and treatment history all in one place.

I will try to stop back later and post but in the meantime I am sure the others will drop by and share their thoughts with you.

Hugs, Lori

CalliesMom

07-25-2016, 12:45 PM

Thanks Lori,
Would it be possible to change the subject? To "Potential Cushing's Diagnosis / Sensitivity to Trilostane"? If not, it's not big deal.

~ Catie

DoxieMama

07-25-2016, 04:16 PM

Hi Catie,

Welcome back! I'm sure one of the admins will be able to change the subject of the thread when they see your post.

As for your question, I am not the most knowledgeable and only have very little experience with Trilostane. My pup was diagnosed this year and started on 1mg per pound (11mg in his case), which was reduced twice. Shortly after the second reduction, he had an issue of unknown source, though "dietary indiscretion" is suspected as the x-rays showed small bones/rocks. His Cushing's symptoms have not returned and his bloodwork has not gone back to "normal" so he is still not taking Trilostane.

All that said, as far as I understand, the only potential issue with starting on a smaller dose is that it may take longer to lower the cortisol and get symptoms under control. That means potentially more testing - and more money for you.

I'm sure others will be by to provide their experience and insights as well.

Shana

Harley PoMMom

07-25-2016, 04:47 PM

Thanks Lori,
Would it be possible to change the subject? To "Potential Cushing's Diagnosis / Sensitivity to Trilostane"? If not, it's not big deal.

~ Catie

I'd be happy to do that for you!!! ;)

Help4Bailey

07-26-2016, 08:49 PM

So it has been one year since Callie's initial cushings diagnosis. I had hopped around vets for a while, which probably didn't help. Her symptoms were just excessive thirst/urination and high alkaline phosphotase levels. She has only ever taken 3 capsules of meds.

Callie has been going to a specialist since March 2016 and we are now going to try Vetoryl again. Callie had been started on 40 mgs of Triloastane compound in August of 2015, by a different vet. It made her violently ill after 2 doses (diarrhea, vomiting, lethargy), so I stopped doses. She had intermittent diarrhea and vomiting for 2 weeks after stopping the Trilostane compound.

THEN we started doing urine cultures and found out she had bacteria. After Callie would run a course of antibiotics, she would be symptom free for 3 months. The UTI-like symptoms would come back after 3 moths and we would run another culture. We did this two or three times over the course of a year and it worked like a charm.. so we thought maybe it was not cushings. Her symptoms have started up again, but the last two cultures have been negative, no bacteria, so Cushings has been determined. We've ruled out everything else in the process, as well. We tested organs and they all have normal functions. One adrenal gland was slightly enlarged (no tumor) and liver is slightly enlarged.

Her vet wants to start her on Vetoryl (two 10mg capsules a day). I am EXTREMELY nervous about starting her back on this medication. Last time was a nightmare and I don't want to see her go through this again (my rugs didn't love it either). Throughout the last few months her vet told us that if we go back to the cushings diagnosis, I could start on 10mg and work our way up slowly, if we decided to start her on it. Callie had an ACTH test last week and now the vet says we need to do 20mg, because she thinks 10 would be useless. I'm tempted to start her on 10 despite the vet's plans... Callie is a 9.5 year old beagle/staffy mix and is 32 pounds.

Callie's 1 hour ACTH results were:
Pre: 5.3
Post: 34.1

I'd love to hear some opinions of people who have had problems with Vetoryl and/or the Trilostane compound. I know there's a lot of knowledgeable people on this board :)

Hi Catie,

I had similar problems with my dog Bailey who weighed 26 lbs and was started on 30mg Trilostane once daily. She crashed after 4 days,
and I spoke with the vet and I had her placed on 10mg once daily which she was on about 45 days and started to show more signs of Cushings. She later develop problems which we found out that she had kidney issues besides Cushing's.

I took her to an endocrinologist and she was placed on 10 mg twice daily but she was too suppressed (ACTCH stim test). We went down to 5mg twice daily and she was still over suppressed (ACTH stim test). We stopped Trilostane for a month. Another ACTH stim test was done and showed results of Cushing's and symptoms had returned. She was again placed on 5mg once daily with another stim test, then increased to 5mg twice daily, but had to remove Trilostane again. She will now be on compounded Trilostane 2.5 mg twice daily after she recovers from a bout of diarrhea and vet rechecks her kidneys. Keep in mind that she has lost weight and is down to 20 lbs so I would have expected a reduction in the amount of Trilostane. She seems to be very sensitive to Trilostane or perhaps its complications related to her kidney issues.

So with all that said, I would start out on the low side of 10 mg once daily and then have an ACTH stim test done within 10-14 days. This will cost you more money in the long run but will make you feel more comfortable. You can always go up if your pups symptoms still persist. You can also increase by 5mg Vetory/Trilostane that is now available if you're not comfortable with going up 10mg at a time. Of course, you will need to get your vet on board with going up slowly, but I wish my first vet would have listened to my concerns from the beginning.

Wishing you and your pup all the best,
Lynette

Harley PoMMom

07-26-2016, 09:32 PM

Some dogs are more sensitive to Trilostane and if Callie is one that is, I agree with your decision to start her at 10 mg and would hold my ground on this one. No harm can be done with starting at that 10 mg dose, we have seen many dogs get into trouble when they are started out at a too high of dose, so starting low and going slow is, IMO, the best move for your dear girl.

When dogs are first treated with Trilostane their dosage strength is dependent on their weight, and sensitivity to medications is taken in account too. When the ACTH stimulation test is used for diagnostic purposes those results do not have any bearing on the initial starting dose. So for the vet to say that the 10 mg dose would be useless, I believe, is incorrect, as it just may be the dose that is perfect for her, ya just never know ;)

Hugs, Lori

molly muffin

07-27-2016, 08:46 PM

Based on what happened last time, I would start at the lower dose too.

Every dog is different and you already know that Callie reacts strongly to the vetroyl.

CalliesMom

07-31-2016, 11:58 PM

Thank you all for responding. With your help, I decided to go with my gut instinct and start at 10mg. By day four Callie's water intake decreased to 3 cups (down from 6-7 cups) and only needs to pee 6x a day (down from 8 or 9). Pre cushings she would drink just under 2 cups a day and pee 3 or 4 times a day. If her next Acth test is still high, then we can increase.

I'm terrified to continue on this cushing's journey. I read all these stories on here and it breaks my heart. I'm hoping this low dosage is an easy solution, but it's so early on.

In general, what is the best food for a dog with cushings? Raw food is out of the question for us. I had her on blue buffalo for the last two years, but her stool became way too mushy after about 18 months. I switched her back to Purina One (garbage, I know) but her stool has been normal since.

Do any of you wear gloves when handling Vetoryl?? My vet was adamant that we do. What are the risks from handling it without gloves?

I have so many questions and thoughts in my head. I'm glad to have this board to vent and get information.

Harley PoMMom

08-01-2016, 01:40 AM

I am so glad to hear that you listened to your instincts and started Callie at that 10 mg dose, Great job, Mom!!!

We certainly understand your fears of the disease and the treatment. Please remember we are here for you and are at your side walking this journey with you.

Regarding the diet; there really isn't a "set" diet, a diet needs to be tailored to that individual dog's needs and health issues. However, dogs with Cushing's do lose muscle mass so their feed should have a high quality protein. If Callie is doing well on the Purina One then I really see no reason to switch.

I must admit that I didn't wear gloves when handling the Vetoryl capsules but what I did do was wash my hands well after dosing. A person that is pregnant or wanting to conceive should not be handling the Vetoryl. Also you do not want to open them capsules up and try to split the powder. And if gloves make you feel more comfortable using it, then by all means use them. ;)

Hugs, Lori

CalliesMom

08-01-2016, 08:02 PM

So yesterday I thought maybe Callie was limping a bit. Sometimes she tweaks her back. Her back legs seemed slow/hunched getting up, but seemed normal during walks. Today my husband is home with her and he said it seems like her front legs are weak. Is this the kind of "weakness" that can happen with Vetoryl? Almost like a limp. Ugh... She has no pain to the touch.

*edit* I'm home now and it seems like she is stiff. It does seem to be just her front left leg tonight. She seems happy, she's eating, going potty. No lethargy, no upset stomach. Still a little concerned that it may have some connection to the Vetoryl, since she's never done anything like this before. But otherwise, she's great. I'll leave a message for her specialist tomorrow.

judymaggie

08-01-2016, 08:19 PM

Hi -- it could be that Callie had some arthritis that had been masked by the high cortisol. With Vetoryl bringing down the cortisol, many of us have seen signs of arthritis that we didn't even know was present previously. If the weakness gets really bad, then it is possible that it will be necessary to keep the cortisol levels a bit higher than the recommended levels.

CalliesMom

08-02-2016, 07:22 PM

1. Corticosteroid withdrawal syndrome (“relative” cortisol deficiency characterized by weakness, lethargy, stiff gait, anorexia, fever during first 10 days of therapy)

Could anyone tell me more about this?? Callie is definitely stiff and has never been like this. She almost fell getting out of her bed on the ground. She is sleeping all day, but not completely lethargic like last time. Water intake yesterday was only one cup. I left a message for her specialist, but it's a busy facility so she may not get back to me as soon as I'd like. Should I stop the Vetoryl or do I need to get in for an ACTH test before stopping it??

labblab

08-02-2016, 07:49 PM

Certainly, if you ever have worries about how Callie is behaving, you can and should withhold the trilostane until you can contact your vet. You can always restart it again at any time, so there is no problem in holding a dose or two until you can consult with the vet about what is going on.

Here's a couple quick questions for you, though. Do you already have a date established for a monitoring ACTH test? And how long has she been taking the medication? I apologize for not having the time to read back through your thread.

Since she is taking a relatively small dose for her weight, though, and if stiffness is the primary problem you are seeing, it may just be the case that a lowering of her cortisol is unmasking an existing problem, just as Judy has said above. If that's the case, then it just puts Callie in the circumstance of a non-Cushing's dog for whom arthritic pain relief must be addressed. As long as she is otherwise behaving normally, I would guess that the lowered cortisol is not affecting her adversely in other ways. So the challenge may be figuring out the best way to manage arthritic changes that had been buffered previously by the abnormally high levels of cortisol.

Marianne

CalliesMom

08-02-2016, 08:04 PM

Marianne,
Callie started Vetoryl on July 26th. Her acth test is scheduled for August 10th. My other concern is her low water intake.
Hoping the vet gets back to me tonight. Would stopping and restarting Vetoryl affect the upcoming ACTH test?

labblab

08-02-2016, 09:18 PM

Just withholding tomorrow morning's dose should not skew the test scheduled for August 10. If you are worried about dosing her until you've spoken to your vet tomorrow, I think you can safely wait.

Marianne

CalliesMom

08-02-2016, 10:53 PM

Whiskey's Mom

08-02-2016, 11:48 PM

Thank you! I get "panicky" very quickly when it comes to my baby. Especially with how sick she was last time. Her IMS got back to me and she doesn't feel as though it's from the Vetoryl. She said the same thing as everyone here, that it may be something that her high cortisol has been masking.. Anywhere from arthritis, to the gait cushings dogs get or even lymes. I'm going to have to trust everyone and try to relax until the 10th. :cool:

Hi! Just curious as to what your vet meant by "the gait Cushings dogs get". I've never heard that before. My boy walks a bit different since his ACL tear last year but maybe there's something else I'm missing. ( sooo afraid of missing something! :()
Also good luck relaxing til the 10th! The suspense and worry is just awful, right?? Hang in there!!:)

CalliesMom

08-03-2016, 11:33 PM

Hi Whiskey's mom,
I didn't ask her what she meant.. I assume the way they walk from their bloated bellies, like a sway?
ACL tears are no fun :-( hope he's feeling better.

I work with dogs, so I've seen all kinds of limps, arthritis etc. I haven't see any like Callie has. It's only her front legs. She stretches every time she gets up, which is good! And she's super eager to go for longer walks, but I've been limiting her to 10 minute sessions. She tries to drag me to the park. Once she's up and moving, She kind of hobbles while she walks. I've checked paws, toes, limbs etc and she doesn't show any pain, just stiffness. Doesn't seem to be getting worse, so I'll wait it out until next week.

Whiskey's Mom

08-04-2016, 12:38 AM

Thanks for the explanation! I'm glad Your sweet Callie is eager to go for walks, I'm sure that's a sign that she's feeling ok! Whiskey & I used to go for at least a mile, him dragging me most of the way. Now our walks are really short. I'm so afraid of reinjuring the leg and he's satisfied with them so it's good.
Lucky you-working with dogs! Must be wonderful. :)

Scoovale

09-24-2016, 11:53 AM

Hi and welcome to our site.

I would stop the Trilostane. Never give Trilostane to a dog that is ill (even with a UTI). Her being lethargic for some time could indicate another condition that is present.

Did your vet check for other conditions that may present (diabetes, thyroid, kidney, liver problems or even pancreatitis) as this has some of the same symptoms.

I also agree with Lori on the every other day dosing - it is not recommended by the manufacturer or vets experienced with Cushing's.

When you get the chance post the results of the LDDS test and the elevated number of the ALP levels.

Some dogs are sensitive to Trilostane and starting with 40 mgs anyway could be too much for your Callie.

Please keep us posted
Terry

Hello terry,
I was Reading your answer and it could be helpful for my dog too. He is very sensitive to Vetoryl. The doctor wanted to start him with 60 mg (55ibs) but I insisted to start on 30mg. That has proved to be too much after only 12 days. In one month he went from 30 mg to 10 and now he doctor wants to give him 10mg each 2 days. He is not as good as he was with 30mg though. I find the solution of 10mg each two days not good but here in Germany we have no 5mg Vetoryl. I am unsure what to do and it is a urgent decision. Do you maybe have experience in cases like this?

Thank you!
Valentina

Scoovale

09-24-2016, 12:53 PM

Hello Callie,
What are the dosis at the moment? Still 10mg a day? My dog is very sensitive to trilostane too. What are her levels at the moment?

CalliesMom

11-20-2016, 08:59 PM

Harley PoMMom

11-21-2016, 04:20 PM

I'm sorry to hear that Callie's UTIs keep returning. I wonder if she is picking up some sediment when she is relieving herself? And if so, maybe wiping her when she is done would help?

molly muffin

11-23-2016, 12:01 AM

When the urine is dilute then it is always good to just have them run a culture as soon as you notice that increase of urination cycle and licking begin. Molly had the blood in her urine and straining only once. It was due to crystals in her urine that time, and that caused the increase of UTI's for her.

CalliesMom

12-18-2016, 11:07 PM

I may be getting ahead of myself, but I'm predicting another possible UTI sneaking up on Callie. Increased water, urination. She had an ACTH test last week but the vet was off this weekend so we haven't gotten results.
Has anyone's dog had these recurrent UTIs while on Vetoryl? Maybe her dosage is too low and I should try to get her ranges between 2 and 5??

We are also in the process of moving (we just bought a house). Could stress trigger he PU/PD? This is so frustrating. I feel like I'm not reaching any sort of resolution. :(

Scoovale

12-20-2016, 09:00 AM

Hi, my Scooter is also very sensitive against Vetoryl. I havs managed to find the right dosis for himbut I had to go agsinst his veterinarian suggested dosis. The Best thing to do would be quit the vetoryl for two weeks (decra germany suggests two weeks to get the levels back to the original state) than started at low dosage.
From what I have experienced, is much better to go from low to high dosis. Of course that means more blood tests. Try doctors outside the city, maybe where farms are. They have better prices and know their job.
It will probably not be necessary to reach 40 mg. The cortisol drops quickly and more on hypersensitive dogs. Forget the veterinarian to decide against the general official vetoeyl policy. They will not and cannot do it. My doctor got a complaint from a decra's doctor for having suggested a different application of vetoryl (which by the way, was not good for me either). Anyway, if you decide and make clear that you hold the responsibility then they will help you.
The veterinarian/decra dosis for Scooter were between 120 and 60 mg!! He is now fine with 5mg a day!
If I would have listened to the doctor, he would be long dead.
I even make a pause from vetoryl two days once a month. At the beginning, he got 5mg each other day, for safety, then blood test and then every day 5mg.

Scoovale

12-20-2016, 09:23 AM

Scoovale: last ACTH stim was in September, she is due again in December. She just got over another UTI, but not sure if it was caused by her cortisol possibly being high again?? After she's done the Antibiotic we will do another ACTH stim test. Right now she is still on 10mg of Vetoryl.

SO we are back.. and are so are Callie's UTI's. Since starting her 10mg of Vetoryl, her ACTH stim tests have been good, her alkaline phosphatase levels are normal, but the UTI's keep coming back every 3 months. :confused::confused:

Test Results:
July 21 - pre 5.3/post 34.1 (no vetoryl)

Sorry if I replied this late.
I would keep her on
August 10 - pre 1.2/post 6.1 (after vetoryl)
September 22 - pre 2.6/post 7.2

Steadily increasing cortisol, but still normal

She had a urine culture 11/8 because I noticed she was drinking and peeing a lot again. It came back clean (but urine was very dilute). By 11/12 she was urinating blood/straining to pee. This UTI was the first time she showed blood in urine/frequent urges to urinate, with just drops coming out. And she was in extreme pain, which broke my heart. The others just show PU/PD. She is currently on amoxicillin, which has made all PU/PD disappear.

Her vet would like to try to increase her to 15 mg Vetoryl, but I am hesitant due to her sensitivity to it and her PU/PD has disappeared with the antibiotics! Shes on antibiotics for another 10 days.
Her 3 month ACTH test is December 16thish. If her Cortisol levels keep increasing, then I'll have to increase the Vetoryl, right?

Can anyone help with the UTis?!?! They're so frustrating and this last one was extremely painful for Callie and it was awful. They happen every 3 months like clockwork.

Hi, sorry for replying tho late. Generally I personally think that if the values are only a bit too high and the sympthoms are contained, there is no need to risk by increasing the dosis.
If you check the decra table and see that the current values are only a bit too high, I would wait. 15 mg maybe divided morning and evening,could be ok. You could try and observe.
I don' t know about the blood, it can have many causes. Are you sure that she has pituitary Cushing? Have you done a kidney ultrasound? Have your do to excluded any possibility of tumors, urinary tract cancer? Because any tumor can cause cortisol to rise...and other problems.

Look, in my opinion the problem is that generally dogs with cushing have a very weak immunsystem. So wherever they are the weakest the infection comes. In case of my dog that is the skin. I do everything possible but I think it will always be like this. Do you give her something extra for the immunsystem? Scooter gets from Cdvet Senior ....herbs that I have checked through and are also very good for Cushing. He also gets minerals extra, also by Cdvet, fleaxseed, honey, sometimes also phostatydilserine, extra pills for his liver, natural. I added a lot of veggies to his diet to help him with electrolites. He gets food from Wokfsblut, with veggies and turkeg breast meat. His values are now almost perfect. But he still gets skin infections. Even if I wash him with special shampooo regularly.
Sometimes he also gets antibiotic.
You can give her some natural tee to drink. Check which one is good for dogs, I can ask my doctor but you should search because plants can help Cushing dogs really a lot.

CalliesMom

12-21-2016, 08:53 AM

I woke up to pee in the house this morning. So her PU/PD is in full effect. Her last ACTH stim was December 15th with a one hour post result of 6.2.
She's on 10mg of Vetoryl now, but I gave her an extra 5mg this AM. If the 15 mg doesn't stop the PU/PD I don't know what to do next. Last urine culture was a waste of $300 dollars. It came back negative and then 4 days later she had a terrible uti with blood. Another culture and of course that one came back positive.
Really struggling with utis and PU/PD even though cortisol levels are within normal range. Advice would be greatly appreciated!

labblab

12-21-2016, 09:11 AM

I'm so sorry you guys are having such a tough time! I know you've spent a ton of money on urine cultures, but have sensitivities also been done in conjunction with the cultures? I just have to wonder whether the underlying infection is being accurately identified so that a truly effective antibiotic is being prescribed. Due to the persistence of the UTIs, I have to think there is more of an issue here than just trying to lower the cortisol further -- that an infection is being harbored in her kidneys or elsewhere in her urinary tract that is never being fully eradicated. Maybe it's even just that she needs to stay on an antibiotic for a much longer course than she has to date?

Marianne

CalliesMom

12-21-2016, 12:27 PM

Hi Marianne, how would I be sure about sensitivities being run? They always tell me which Bacteria they've found. It's been e. Coli everytime but the first one. The last course of antibiotics was 3 weeks and the PU/pd is back again already. She's been seeing an internal specialist for the last year or so. She's had an ultrasound a year ago and one about a year and half ago. Organs always look good. I'm stumped and feel helpless. Thank you for your response

judymaggie

12-21-2016, 05:14 PM

Hi! One thought in conjunction with Marianne's thought that Callie may need to be on the antibiotics for a longer period of time -- whenever my beagles have had severe UTIs, my vet has run another urinalysis/culture done a few days before the end of the antibiotics. That way, if there is still an infection present, there is no gap between the end of the antibiotics and starting them again.

With regard to the sensitivities, it is my understanding that a culture would include these. It would show which antibiotics would be best for the particular type of infection. You could just confirm with your vet that he is receiving this type of information.

labblab

12-21-2016, 05:41 PM

Yes, I agree with Judy that probably Callie's urine cultures (especially since they've been recurrent) have also included sensitivity testing as well. But I do think it's worth it to ask since it does involve a second step in terms of analysis of the cultured urine sample. I may be wrong, but I think the last time my Peg was cultured for a UTI, my vet asked me if I wanted to also pay for a sensitivity as well. Peg's culture was also positive for e. Coli which is typically responsive to a number of antibiotics, so I think he gave me the choice as to just directly proceeding with treatment rather than waiting the additional time for the sensitivity to be run on the sample.

If Callie is having repeated e. Coli infections that appear to respond to a particular antibiotic, then your vet may not be asking the lab to go that extra step and added expense of performing the sensitivity assessment every time, as well. If the antibiotic has apparently been working, why bother, right? But I'm just wondering whether some amount of bacteria are still remaining even though her overt symptoms are temporarily clearing. But I am definitely not an expert at UTIs by any means, and if you are seeing an internist, he ought to be better versed than I am about all this. What a explanation does he give for the recurring problem? Does he say Callie is just especially vulnerable due to her Cushing's?

Marianne

CalliesMom

12-21-2016, 08:56 PM

We are currently at the ER vet due to blood in urine...

**update**
We went to a different Vet (not her internist) because we have moved out of state. Based on the history of E. coli and antibiotics working, they are just treating With Amoxicillin. They did a urinalysis but we did not do a culture this time. They found blood and bacteria. (Duh) We are home and I am trying to convince Callie that she doesn't need to go outside to "pee" every ten minutes. (So I can sleep) This vet suggested possibly doing a scope of her urethra in the future if this continues just to rule out anything that cannot be seen on ultrasounds. Previous ultrasounds did not show any signs of stones or bladder tumors. Callie's not having any actual pain this time, just discomfort. Still no answers as to why she's getting so many Utis. I appreciate the response I've gotten here. This has been a stressful journey for us and I think everyone else in my life is tired of hearing about it.

Harley PoMMom

12-21-2016, 09:53 PM

Keeping you both in my thoughts and prayers, let us know how things are as soon as you can.

Hugs, Lori

CalliesMom

12-22-2016, 01:15 AM

Yes Marianne, Callie's Internist has been under the impression that the cushings and utis go hand in hand. "The chicken or the egg"
I think she's stumped and Callie has been deemed an interesting case all around with sensitivies to everything. I believe she would have come up with more solutions if this keeps happening and her stim tests are normal. .. unfortunately we are moving from New Jersey to Maryland.. but are currently staying in Pennsylvania with family until the new year. Confusing enough? Lol what a mess!

Harley PoMMom

12-22-2016, 12:08 PM

This has been a stressful journey for us and I think everyone else in my life is tired of hearing about it.

Thanks so much for the update. I just wanted you to know that we are here for you always, and if you ever feel like talking, venting, etc. you just come here and talk to us, ok? ;)

One thought I had with Callie, I wonder if wiping her girlie parts with a baby wipe after she relieves herself would help???

Hugs, Lori

dsbailey

12-22-2016, 01:58 PM

Based on the history of E. coli and antibiotics working, they are just treating With Amoxicillin.

My girl also suffered from recurring UTI's and looking at a culture report from April showed the bacteria as E. Coli and that Ampicillin / Amoxicillin was "R" (resistant ?). We finally whipped it with Enrofloxacin "S" and getting her cortisol levels below 5. I think it was a combination of both because while still symptomatic, drinking and peeing a lot she was leaking urine and licking a lot, the whole area and reinfecting her urinary tract by doing so. We also vigilantly shut down the universal watering bowl in the bathroom. :rolleyes: I hope this helps.

Darrell and Lolita

CalliesMom

12-23-2016, 01:19 AM

Darrell and Lolita - sorry to hear you've been through the uti struggle! I am going to continue with the extra 5mg of Vetoryl to try to get her under the 5 range in hopes that it helps. My vet did verify that E. coli is sensitive to amoxicillin and it has worked in the past. I've tried prescription urinay food and crananidin, to no avail. How long has it been since your pup's last uti and how often were they happening before? It's so frustrating :confused: and yes, Callie is always trying to lick herself after she pees and before bed. I try to stop her but she will literally go to another room to do it lol

Thanks for your support Lori. I have considered getting baby wipes for Callie, but I have this irrational fear of causing more harm than good. I might buy some soon and give them a chance.

dsbailey

12-23-2016, 01:16 PM

How long has it been since your pup's last uti and how often were they happening before? It's so frustrating :confused: and yes, Callie is always trying to lick herself after she pees and before bed. I try to stop her but she will literally go to another room to do it lol.

It's been about 2 months now which is the longest in years. It was recurring about every two weeks after the antibiotics ended regardless of how long she was taking them.

One thing that seemed to help is I would catch her on her way in the house from peeing with a damp warm washcloth. I'd push on her vulva and wipe everything down so there was no urine on her skin to irritate things. TMI? :D

Happy Holidays

Darrell, Shannan, Lolita, Chulo, Mr. Bohannan, Ophelia, Jack, and Chloe

judymaggie

12-23-2016, 05:14 PM

Hi! Just wanted to throw out something re frequent UTIs. My first Cush pup, Maggie, was born with a recessed vulva where it is almost completely covered with skin folds. The vet treated her with antibiotics for a few years but they never totally cleared up and I made the hard decision for her to have an episiotomy which involves cutting away all the skin folds. I was horrified when I saw her after the surgery as she had a horseshoe of staples on her backside. She recovered without issue (well, except when she pulled some staples out and had to be re-stapled ...) and never had another UTI. Here is an article about the issue and surgery:

http://veterinarynews.dvm360.com/recessed-vulva-overlooked-cause-chronic-uti-dogs

This may be totally out of left field but just thought I would mention it.

I do use baby wipes to keep Abbie clean when she is having issues. Don't bother buying the expensive "dog wipes" -- a lot more expensive and there is no advantage over using regular baby wipes.

CalliesMom

12-26-2016, 06:38 PM

dsbailey - 2 months has been the longest for you? :( I thought every 3 months was too much! This one came on 3 weeks after she finished her last antibiotics and I was not expecting it at all. I was very disappointed and I've been extremely stressed out by it. She has been on the amoxicillin 5 days and she is still drinking and peeing too much - every 2-4 hours during the day and 4-5 at night. No more blood or visible pain though, which is great. I'm just exhausted and I just want a resolution after a year and a half of this. I think wiping may be my next attempt. I hope your baby gets some relief from her UTIs, too! Please keep more posted, because you're the only one that seems to be having this problem! Have you ever gotten a negative culture, only to be followed by blood in urine 4 days later and a positive culture?

Judy - Did Maggie always have problems with her recessed vulva and UTIS? Callie's vet did say she has a slightly recessed vulva, but shes almost 10 years old and it's never been an issue before Cushing's. I didn't even notice. The vet said it's not a bad case at all, but the episioyomy might help reduce utis. I would get the surgery in a heartbeat if I knew it would cut down UTIS significantly. BUT, I would feel awful and be so mad at myself if I had the surgery done and it didn't help her. It's wonderful if it works, but I feel it would be cruel if it doesn't. I just don't think I can have it done unless I know it will help.

I have a question about Crananidin. When I got it from my vet the pill was square and tan, like Rimadyl. The next few bottles I bought from Amazon and they were a circular cranberry colored pill. Do you think it makes a different between ordering them on amazon vs buying form vet? They were much cheaper online, but they looked different.

And yes, in the past sensitivities have been done with her cultures. I regret not asking for a culture done on 12/21. It wasn't her regular vet and I wasn't thinking clearly. They didn't really offer one either. The PU/PD usually reduces a lot after 3 days of antibiotics, but it hasn't this time.

I hope you all had a wonderful Holiday with your families!

CalliesMom

12-26-2016, 07:33 PM

Has anyone tried homeopathic remedies for UTI's? My aunt is into all natural products and recommended this:http://www.newtonlabs.net/Pets-BladderKidney/productinfo/P010/
I might give it a try!

molly muffin

12-28-2016, 05:37 PM

We never had the chronic problem with UTI's that some face, so I can't say anything about that, but I do know that sometimes you have to adjust antibiotic according to the bacteria results in the culture and then do it long term to make sure it is really gone.

Maybe some of the others have tried natural remedies for the UTI.

CalliesMom

01-04-2017, 02:56 PM

Ms. Callie had her appt and stim with her new vet today. We recently increased her from 10mg Vetoryl to 15 mg in hopes of getting her cortisol under 5, as supposed to 6-7. Hopefully helping with preventing utis.
Her new vet also feels that an Episioplasty would cut back on utis since urine could be "pooling" in there. She said that Cushings dogs are susceptible to infections (weakened immune system) and this may be why her recessed Vulva never bothered her pre cushings diagnosis. This may be a surgery to consider once she's "stable".

Her current uti symptoms have decreased and are manageable, but she's not normal in terms of PU/pd yet. Callie has finished her amoxicillin and will get a urine culture in a few days.

ACTH stim results - pre levels were "almost undetectable" post was 5.4
Needless to say the extra 5mg was too much and we'll just stick to 10mg of Vetoryl.

molly muffin

01-05-2017, 03:09 PM

Well, pffftt. I know a lot of vets don't pay attention to the pre number so much as long as the post number is fine, but I admit it always made me a bit nervous if the pre was super low.

CalliesMom

01-05-2017, 03:17 PM

Molly muffin - I didn't want to question her because she seemed adamant that we should cut her back. Callie didn't haven't any problems on the 10mg, so I guess there's no harm. She also seems to think the surgery for recessed Vulva will be a huge help in preventing utis.

judymaggie

01-05-2017, 03:27 PM

Judy - Did Maggie always have problems with her recessed vulva and UTIS? Callie's vet did say she has a slightly recessed vulva, but shes almost 10 years old and it's never been an issue before Cushing's. I didn't even notice. The vet said it's not a bad case at all, but the episioyomy might help reduce utis. I would get the surgery in a heartbeat if I knew it would cut down UTIS significantly. BUT, I would feel awful and be so mad at myself if I had the surgery done and it didn't help her. It's wonderful if it works, but I feel it would be cruel if it doesn't. I just don't think I can have it done unless I know it will help.

Hi -- to give you a bit more info about Maggie's issues -- she was younger than Callie and was "pre-Cushing's" when she had the episiotomy. She had had UTIs for several years and we had gotten to the point that meds, including steroids, were no longer effective. The episiotomy was definitely a last resort -- it is a very serious surgery. Maggie's vulva was completely recessed. I cannot remember if she never had another UTI but they were certainly few and far between. From what you are describing, Callie's situation does not seem to rise to the occasion of putting her through this surgery. I think you ought to concentrate on keeping Callie clean after every urination -- this will go a long way towards helping to ward off UTIs.

molly muffin

01-09-2017, 10:14 PM

How is Callie doing with the cleaning after potty?

CalliesMom

01-10-2017, 10:58 AM

Hi Sharlene - thanks for checking on Callie. She is not loving the wipes and tries to sit down as soon as we get inside lol. I do usually notice a drop of urine on the wipes. She still has PU/PD and she just had a culture done yesterday, so we are awaiting results. Need to get her back to normal before I see if the wipes help. She still insists on trying to clean herself, even after I wipe. Callie is still going out to pee every 2-3 hours during the day and can hold it about 6 hours at night.

Her new vet mentioned some more ideas just in case the culture comes back negative. She asked if I had the test done at university of Tennessee. I said no, but I would be interested since Callie's case has been so strange.

She also mentioned something as a possibility if her culture didn't show bacteria. Eye drops used for dogs with diabetes insipidus (to control pu/pd). I think the name was Desmopressin, but don't quote me. Vet said it was just a thought and obviously we need to wait for results of the culture. Thoughts on the eye drops? Her PU/Pd isn't caused by high cortisol and we can't up her Vetoryl or she goes too low.

molly muffin

01-10-2017, 03:21 PM

I use to have to hold molly with her back legs in the air so she wouldn't sit down on me.

yes the drops could be tried and see if they make a difference. It is a possibility and normally they just try the drops and see if they work, as the testing for inspidus is a water deprivation test and it is hard on the dogs. (I wouldn't do it, just try the drops)

hmm, the Univ of Tennessee test is for the other hormones and it is possible they are elevated. They give lignans and melatonin to treat. Also another benign treatment that can be tried.

CalliesMom

02-16-2017, 04:26 PM

So, now Callie is on a break from her Vetoryl all together. Her last culture February 7th, was clean. Pu/Pd decreased fully about a week after she finished her Cefpodoxime.

Results from Her ACTH stim test on February 9th:
(pre) sample 1: less than 0.5
(post) Sample 2: 4.7

Although she is still stimming after the injection, they fear she is headed towards an Addisonian crash if she stays on the vetoryl. She goes for another stim on the 28th. So confusing.. and beyond expensive at this point.

Squirt's Mom

02-16-2017, 04:49 PM

If that post # is 4.7ug/dl there is NO reason to stop the Vetoryl at all. That is an almost perfect post #. So I'm very confused. :confused::confused::confused: Could you tell us what the little letters are after the numbers?

CalliesMom

02-16-2017, 04:58 PM

They were stopping it because of her PRE levels being almost undetectable for her last two stims. I don't have a copy of the test results, just verbal results from the vet.

CalliesMom

03-26-2017, 05:29 PM

I really really need some advice! We moved away from Callie's internist in December. When we last saw her, we upped Callie to 15 mg of Vetoryl from 10 mg. Callie's new vet wants to stop Callie from the Vetoryl all together again. Callie still has pu/pd but her current water level is 3-4 cups a day. When she goes off Vetoryl her intake goes to 6-7+ cups a day. Callie's current vet does not like see her Pre ACTH levels as low as they are. She fears Callie may go into an Addison crisis. She wants her off Vetoryl again, but as you can see from the Feb 28th test, her post ACTH levels creep UP when she's off Vetoryl and so does her water consumption.

Recent test results:
January 4 (15 mg vetoryl) pre: less than 0.5 post: 5.4
February 9 (10 mg vetoryl) pre: less than 0.5 post: 4.7
(Stopped Vetoryl for 2 weeks)

February 28 (no vetoryl) pre: 4.7 post: 19.7
(Re Started 5 mg Vetoryl March 1st)

March 22 pre: less than 0.5 post: 4.8

Basically, she is still drinking and urinating too frequently. She hasn't been "normal" since the beginning of December. She used to have a pre ACTH number somewhere in the 1 range, now it's hardly there. Her vet wants her off Vetoryl all together, but I feel she needs SOME! Callie's vet has been playing phone tag with her old Internist... I need some thoughts on this super low "pre" number

Unrelated, Callie also has periodontal disease and has lost two teeth, but no one wants to put her under anesthesia!! I've been trying to get her teeth cleaned for two years now. I really hate Cushing's Disease.