Just diagnosed – Luna, 6 y/o beagle

[lunabird]

Hi everyone,

Luna is a 6 y/o lemon beagle who was diagnosed with Cushing's about three weeks ago. A little history:

I've known Luna for about four years. Some friends of mine brought her to me in 2011 after they found her wandering around in a snowstorm. She had heartworm, an embedded collar scar, and showed signs of being abused.

I got her fixed up and rehomed with a nice family, who gave her back after about a year because she was "escaping" from their yard (turns out their fence was actually broken). She stayed with my mom out in the country and was enjoying life, but wasn't getting a lot of one-on-one attention, so I took her back this summer to find her a new family. I found her a great one — and then she was diagnosed with Cushing's. My vet says her lifespan is about 1 to 2 years at this point, and the new family doesn't want to take on a Cushing's dog, which I understand. This is all to say that Luna is my dog now. She's a very sweet girl and I'm just hoping to keep her happy for the time she has left.

We're starting trilostane treatment next week –*40 mg once a day, and then a STIM test in 10 days (unless one is needed sooner). I don't have any specific questions right now. I'm just reaching out for any advice or tips you might have. My vet has warned me that the treatment can be really hard on them and things might get ugly. I'd appreciate any knowledge you all have learned from experience. It also seems that Luna's been diagnosed pretty early in her life, and I'm wondering if that will have any effect on things.

Thank you!
Eliza and Luna

[My sweet Ginger]

Dear Eliza,

First of all, I'd like to thank your for being her guardian angel by trying to do right by her while others were not or couldn't and I'm really glad for Luna now that she came to you for good.:) You two will have many happy years together.

Secondly, I know others will chime in on this with passion in that your vet is plainly wrong going with the notion that the life expectancy of Cushings pups is 1-2 years. Just plain wrong. With proper treatments and your love and devotion she has a very good chance of living out her maximum life span. So don't pay any attention to that and channel all your energy into her treatment as it greatly requires owners participation aside from having an experienced vet who doesn't mind being a team player.


In order for us to tell you more sounding advice we need to know more about how she was diagnosed for Cushings. Please, post all the results of the diagnostic tests that were performed on her including the exact numbers along with their reference ranges right next to them. Also we need to know her weight.

Now, my pup was diagnosed in Oct. of 2013. She was already very weak then but still hanging in there today and she will be 16:eek: coming Dec.! She had the symptoms going on probably more than a year prior to her diagnosis. So yea, I don't agree with your vet telling you those scary things as a vet of all people. Song.

[Squirt's Mom]

Hi Eliza and welcome to you and Luna! :)

Bless you for trying so hard to find her a good and for realizing she is best off with you.

Song has asked the questions I would have - her weight and test results - so I won't repeat. I will add that anything you can tell us about her health history will be good.

As for that 2 yr thing - pooh. We have had pups here who lived 8 years and more after diagnosis - no telling how long the pup had lived with the disease prior to diagnosis since it can be sneaky. My own baby was diagnosed with Atypical at the age of 10 which progressed into true Cushing's around 13 and she lived til she was 16 and a few months, passing from old age, not Cushing's. In fact, I had stopped her treatment, Lysodren in our case, when she was 15 after she had a stroke. Vets are taught in school that cish dogs don't live long and that owners won't treat but that is because those books were written before parents like us rose up by the 10's of 1000's and got deeply involved in our pet's care, demanding our vets keep up and provide the best, most current medical attention. ;) In times past this disease wasn't recognized until the dog was usually elderly already and many today don't develop it until their senior years so that in itself has a bearing on the life span. But more and more dogs are being diagnosed sooner which means younger so that view has to change to consider these younger pups who are diagnosed with the disease. ;)

A few tips -
Always give the Trilostane with a meal. Vetoryl (Trilostane) is a fat soluble drug which means it must have fats in order to be absorbed and used by the body. Some vets will tell their clients to fast before the ACTHs to monitor treatment and this is wrong. So I want you to know now that food is required with this drug even on ACTH test days.

The ACTH should be given 4-6 hours after the dose and meal, tho one of the endocrinologists, Dr. Mark Peterson, says 2-4 hours. The literature from Dechra, the manufacturer, says 4-6 hours.

The literature in the US is INCORRECT however on what is shown as the recommended starting dose. The current starting dose is 1mg/lb (or 2mg/kg). The literature says 3mg/lb (or 6mg/kg). This is why it is important to know luna's weight. Dechra has corrected the literature in EU and will get around to the US soon we hope.

I'm glad you found us and look forward to learning more soon!
Hugs,
Leslie and the gang

[tyry]

Hi Eliza,

We've been treating our Corgi for less than and year but the one thing we learned and adhered to (until now at least) was go low and slow. We started with just under 1mg per pound and have had to increase her, but (knock on wood) have had none of the bad side effects that scared me so. It's meant a lot of testing and it is looking like ours will eventually be a over 1mg twice a day, but it has improved her symptoms. She is even growing hair for the first time in three years!

Good luck to you and Luna! This board is full if extremely knowledgeable folks who can get you through almost anything that comes up.

Tracy and Jen

[judymaggie]

Welcome to you and Luna! Thank you so much for providing Luna with her forever home. :D My beagle, Abbie, is my second Cushing's beagle and the folks here have been invaluable to me. Absorb as much as you can--even though I have a very caring vet, he was not following the proper treatment protocol for Vetoryl/trilostane. Armed with info gained from members and the resource articles, my Abbie is being treated properly.

[lunabird]

Thank you everyone! I so appreciate finding some help as we navigate our way through this.

I have requested Luna's records and will post that information when I receive it. At the moment, she weighs about 35 lbs. Yes, she is quite overweight for a beagle! She was over 40 lbs. when she came to me in June, so we've been slowly working that off. I suppose that might affect her dosage, if she's losing weight as we're treating.

I had actually been on this discussion board before we received the Cushing's diagnosis, and was hopeful because everyone was talking about long, normal lifespans. So I was very surprised when two vets told me she'd only have 1-2 years. I passed this information on to her prospective family, and I feel bad about that now because maybe she has a lot longer and I gave them erroneous information. That's OK though, it's clear this loading process is going to take awhile and I feel more comfortable doing it myself since I know her and her habits well.

[molly muffin]

When it comes to lifespan, once you have cushing control, much depends on if there are any other ailments going on with Luna. If just cushings, then yes, she can live a long time with cushings and being on treatment.

You only told them what the vet told you, so don't beat yourself up over it. Many people don't want to take on a pet that has medical problems, and dealing with the vet visits and medications. Good on you for saving Luna and giving her a 2nd, third, 4th chance at a happy home. It's what every dog wants and deserves. :) A belly rub, a smile, some play time. You're awesome.

Let us know when yuo get those records and what they say.

[Beaglelover]

You are truly Luna's guardian angel, bless your heart for the love and compassion you've given Luna. I agree with everyone else that Lina could live much longer if her issues are just Cushing's related. Key is making sure she gets properly diagnosed and treated carefully. We are going through a diagnosis with our 11 yr old beagle Jenna, we will know tomorrow if Cushing's. Sometimes vets give you gloom and doom information and they may not be the case at all. Absorb the information and advise from this forum, these people weather new or a senior member are very knowledgable, compassionate and helpful.
Good luck
Tammy z(Jenna's mommy)

[lunabird]

Luna has a weird new habit: she's become excessive about licking the carpet. If you don't stop her, she'll do it for hours. I'm looking around online and seeing different things — sign of liver failure, or just an upset stomach from the Cushing's. Has anyone experienced this or had luck treating the symptom?

Luna is a 6 y/o beagle diagnosed a couple of months ago. She's on trilostane. I had an older thread going but haven't gotten the vet records to post yet... she has a followup appointment on Friday to check levels, so I'll try to get then.

Thanks everyone! I appreciate having a group to turn to.

[mytil]

Hi Eliza,

I have merged your two threads together so we can see the history of your Luna and maybe find some clues as to why she has started this behavior.

You already mentioned an upset stomach, but it could be an electrolyte imbalance too or just plain anxiety. Is she loosing weight even though she eats a lot?

Keep us posted
Terry

[lunabird]

Thanks Terry!

Luna did lose a pound in the past four weeks, but she's on a diet. She was 38 lbs. when she came to me over the summer, which is obviously overweight for a beagle. The vet wants her to be at 28 lbs. At first, after her Cushing's diagnosis — and when they told me lifespan would be 1 to 2 years — I didn't see the point in putting her on a diet. But then we discovered she's got a bit of arthritis in one leg, so trying to work off the weight to alleviate that pressure. She's now at 34 lbs.

She has "loaded" on her trilostane treatment (40 mg once a day). The vet recommended I try Luna on some peptoid because the meds might be giving her an upset stomach. I've been attributing her puking episodes to drinking too much water too fast (it's always just water that she throws up), but I realized she does sporadically gag every once in awhile, whether or not she's had water recently. I was lumping that in with the other behavior, but perhaps she does just have an upset stomach and the peptoid will even things out.

[Harley PoMMom]

Hi Eliza,

A belated welcome to you and Luna!!

I just wanted to clarify that with Trilostane there is not a "loading" period, only with Lysodren does a dog go through what is known as a "loading" phase. I didn't want members using the Trilostane/Vetoryl treatment to get confused or worried that their dog didn't go through a "loading" phase. ;)

Yep, Trilostane can cause gastric upset and Pepcid AC is one medication that a vet will recommend.

Was an ACTH stimulation test done 10-14 days after she was on the Trilostane? And from reading your thread I see that Luna has been on the Trilostane for over a month, has an ACTH stimulation test been performed recently?

Hugs, Lori

[molly muffin]

yes I am curious about what the ACTH test result was, as Luna is 34 pounds now and she was started on 40mg? of trilostane a day? is this once a day?
and the results of the stim can tell you how her body is reacting to the medication. In order for us to give you better feedback it would be good if you could post those results.

As Terry mention, electrolyte imbalance can be a trigger for licking, especially sodium/potassium and the most likely cause of electrolyte imbalance is an incorrect dosage of the trilsotane. So many things are connected. This is just one possibility but one of the first that you want to rule out.

So, we'll be looking forward to seeing those results.

[lunabird]

Oops, thanks Lori! It's been such a confusing process.

Yes, Luna had her first STIM test 10 days after starting on the trilostane, and the vet was happy with her numbers. She then did one 30 days later (which was Friday), and the vet said she's still in a good range. She was 35 lbs. when she started, she's 34 now. I hadn't considered how her losing weight will affect her dosage, something else to throw us off. :confused:

And yes, 40 mg once a day (I give it to her in the morning with breakfast). There hasn't been a huge change in symptoms, though she's starting to actually leave some water in the bowl, which is an improvement. She seems happy and comfortable (minus the licking). We started the peptoid two days ago, and that seems to be going down now.

I'll see if I can get those results from my vet. When/how would we check electrolyte imbalance? My vet seemed to want to rule out the upset stomach with the peptoid first. I mentioned reading about electrolytes online, and she gave me that look like I'd been WebMD-ing too much. :o

[lunabird]

Rec'd records from my vet, here are numbers:

Sept. 9 (before trilostane): 2.3 (cortisol pre-ACTH), 22.5 (cortisol post-ACTH)
10/10 (10 days on trilostane): 2.9 / 3.2
11/7 (30 days later): 4.7 / 3.8

Does that help? Thanks!

[Harley PoMMom]

The electrolytes are included in the chemistry panel which are checked with a blood draw.


Rec'd records from my vet, here are numbers:

Sept. 9 (before trilostane): 2.3 (cortisol pre-ACTH), 22.5 (cortisol post-ACTH)
10/10 (10 days on trilostane): 2.9 / 3.2
11/7 (30 days later): 4.7 / 3.8

Does that help? Thanks!

Yes! that helps a lot, thank you! And yep, her ACTH stimulation results are very good!

Hugs, Lori

[My sweet Ginger]

Sept. 9 (before trilostane): 2.3 (cortisol pre-ACTH), 22.5 (cortisol post-ACTH)
10/10 (10 days on trilostane): 2.9 / 3.2
11/7 (30 days later): 4.7 / 3.8

Eliza, could the results from 11/07 be backward by any chance? If not it is worrisome to me. Normally we wouldn't want to see a post number from 22.5 to all the way down to 3.2 in just 10 days after Vetoryl was started. Too low too fast. We'd normally like to see numbers like 3.2 after 30 days, not 10 days as Vetoryl works for 30days.
If you look at the results from 11/07, the pre number of 4.7 is actually higher than the post number of 3.8 and these backwards looking numbers usually mean the dosage is too high for the pup and will cause a great danger if not corrected swiftly.
I understand that 11/7 for both pre and post numbers are not alarmingly low but still it bothers me if those numbers are correct numbers for the fact that the post is lower than the pre and that is not ideal on a pup on Vetoryl treatment.
We'd like to see a post number higher than the pre number.
So if they are indeed correct numbers I'd have a talk with the vet regarding this matter and check her electrolytes ASAP since she also has developed a licking problem.

Is she showing any other adverse side effects other than the stomach problem such as diarrhea, lethargy, wobbliness, hind leg weakness?
I hope those numbers are backward.

[Harley PoMMom]

I still say those numbers are fine, I used to believe the same regarding the higher pre than post however we now have been told differently: ;)

One peculiarity to Ebon's results are the fact that his "pre" value (15.5) was so much higher than his "post" value (7.9). Typically, the second, stimulated value should be higher than the initial baseline value. Previously, we had been told that a result such as this one was probably the result of an error: either the samples were mistakenly reversed or the stimulating agent was ineffective. However, just this week, we have been told by a Cushing's expert that results such as this -- higher "pre" than "post" -- are not necessarily a mistake and perhaps occur more common than previously thought.

Hugs, Lori
Marianne

[My sweet Ginger]

I see but I'm still concerned about her results on day 30 when you factor that with the rapid drop on her post number from 22.5 down to 3.2 in just 10 days. I'd monitor her very closely.

[Harley PoMMom]

I agree that drop in 2 weeks does look concerning, however, since the post cortisol has risen from 3.2 ug/dl to 3.8 ug/dl in a month, I feel good about those ACTH results. :)

[My sweet Ginger]

I hope I'm overreacting and I probably am.
All I want is no other pups have to go through what my pup had to go through under a vet who was not very versed on Cushings.
Because of that I will probably never be able to overlook at ACTH numbers that look anything but the way they are supposed to look.:o

[lunabird]

Hi everyone, checking in for advice with Luna, my 6 y/o lemon beagle, diagnosed last year.

Has anyone else experienced shaking as a symptom? She just seems to vibrate sometimes, she's shaking so bad. I don't know if it's the cold, arthritic pain, or the Cushing's.

She has her six month follow-up on the 29th. We might need to adjust meds. Her hunger has not subsided, I think it is actually worse. She's licking the carpet again (peptoid helped that for awhile), and now the shaking. She's currently doing 40 mg of Trilostane once a day. Anyway, I just wanted to reach out and see if anyone has any advice so I can be a little more informed before the follow-up. Thank you!

[Harley PoMMom]

Hi! As you can see, I've merged your new post into your original thread about Luna. This way, Luna's entire health and treatment history are all in one place.

I have seen other members mention that their dog was having these tremor and/or shaking episodes while taking Trilostane. Is Luna drinking/urinating at a normal level now? Is there any diarrhea?

Hugs, Lori

[lunabird]

Thank you Lori!

Also, a correction: this will be a follow up after three months, not six.

No diarrhea. She is still pretty thirsty, but she actually leaves water in the water bowl sometimes, which is an improvement. I don't believe there's been a change in urinating, although I do feel like we go out pretty frequently. I can start keeping track of that to see if it's an unusual amount.

[Harley PoMMom]

Is her urine diluted? If so you may want to take in a fresh urine sample and have a urine culture and sensitivity test performed to see if an UTI is the culprit for the increased drinking.

[molly muffin]

My dog has the tremors and shakes sometimes. It can be pretty extreme at times, others just a small amount of movement and it isn't consistent.

This is listed as a possible side affect of vetroyl. I don't know if that is the cause of ours or not.

[lunabird]

Hi everyone, seeking more advice for Luna.

She went in for her three month check on Tuesday. The vet said her numbers are still good — pre-level was 2.2 and post was 4.8. But I'm still concerned with the rise in symptoms (more hunger, shaking, licking, and peeing in the house), so the vet suggested breaking her once a day 40 mg of trilostane into two smaller doses, morning and evening.

Of course, this will mean another round of stim tests, which will be very expensive. If it will help ease some of her symptoms, I will gladly do it, but maybe all Cushing's dogs have some form of these symptoms and this is just our reality now? I'm trying to keep her quality of life as high as possible. The vet says her appetite is typical of beagles, but I really think it's gotten worse, and I hate to see her like that.

Anyway, I know it's all a guessing game, but have any of you switched from once a day to twice a day treatment and seen improvement?

We'll be going back for a UTI test... I'm almost certain she has one, but they didn't test when she was there on Tuesday.

Thanks for any input!

[labblab]

Hi again, and yes, some folks definitely do see improvement upon switching to twice daily dosing. For some dogs, keeping the cortisol generally lower throughout an entire 24-hour time period results in better symptom management than dropping the cortisol in the morning, only to have it increase again later on in the day.

Is your vet suggesting you give 20 mg. both morning and evening? Or instead perhaps giving it as 30 mg. in the morning and 10 mg. in the evening? Given her excellent ACTH results on the 40 mg. once daily, I don't think you want to increase Luna's overall daily dose at this stage -- just divide it. It used to be that Dechra recommended giving equal doses both morning and evening, but they've recently altered the recommendation to allow for unequal doses. But if so, the larger dose should be given in the morning so the subsequent monitoring ACTH tests will still capture the cortisol at its lowest level during the day.

Marianne

[lunabird]

Thank you Marianne, that was very helpful!

I haven't had a chance to talk with the vet yet to determine dosage. When we talked about going twice a day earlier in this process, she mentioned that we would go above 40 mg, because when you split the dosage you need to go a little higher on the two smaller doses (so rather than 20 and 20, more like 30 and 30). But that made me really nervous since she's done so well on 40 mg, so I'll ask if she can look into that. She doesn't seem to have a ton of Cushing's experience, but she looks into the research when I have questions.

[labblab]

Your vet is indeed correct that when switching to twice daily dosing, slightly increasing the dose used to be the recommendation. However, as long as the post-ACTH result is within desired therapeutic range (which Luna's is), Dechra's revised and most current guideline is to divide the existing daily total into subunits rather than increasing the daily total in conjunction with the split.


Once daily administration is recommended. However, if clinical signs are not controlled for the full day, twice daily dosing may be needed.

To switch from a once daily dose to a twice daily dose, the total daily dose should be divided into 2 portions given 12 hours apart. It is not necessary for the portions to be equal. If applicable, the larger dose should be administered in the morning and the smaller dose in the evening. For example, a dog receiving 90 mg would receive 60 mg in the morning, and 30 mg in evening.


Also:


To change to twice daily dosing, use combinations of capsule sizes to split the current daily dose into two doses. If Post-ACTH serum cortisol >9.1 μg/dL (>250 nmol/L), total daily dose can be slowly increased and split into two doses.
Here's a great new, very thorough, technical .pdf that Dechra makes available to vets and these quotes are embedded within the brochure. I hope this link works for you, and if it does, you may want to pass it on to your vet. I'm sure Dechra will also be happy to confirm this recommendation directly should your vet wish to consult with them.

http://www.dechrace.com/pdfs/vetoryl/VETORYLTechnicalBrochure.pdf

If anything, I think the accumulated experience over time has been that dogs who are shifted to twice daily dosing may ultimately end needing even a lower overall total than dogs who remain on once daily regimens. I can only suppose this is because cortisol levels never elevate quite as highly at any time during the day when twice daily dosing occurs.

Anyway, good luck!!!!! And let me know if you can't view that .pdf and I'll try to find another viewing option for you.

Marianne

[lunabird]

Thank you so much! I was able to open the pdf and will be sure to share it with my vet. I really appreciate the help.

[Harley PoMMom]

I still would want to rule out an UTI before any upward adjustment of Vetoryl is started.

Hugs, Lori

[lunabird]

Hi everyone,

For those of you who have switched to twice a day dosing, how important is it that those doses be 12 hours apart?

My vet did recommend going to twice a day to try to alleviate some lingering symptoms. We're doing equal doses of 20 mg each, and checking her levels in 14 days. She said I need to stick to as close as 12 hours apart as possible, but I'm having some trouble with that.

Luna's original feeding times were 8 a.m. and 6 p.m. It's just too much to make her wait for dinner until 8 p.m., I can tell it's hard on her. I switched to 7 and 7, but that's still a stretch. (Neither of us are morning "people," but there's no getting her off the couch before 7 a.m.) The vet said I can give her meds within an hour of eating, so technically I could give her dinner at 6 and her meds at 7, but I'm afraid if I don't do it with her food, I'll get busy and forget. (I realize this is a pretty flimsy excuse, so perhaps that's just the route to go.)

There's also the issue of sometimes I'm just not home at 7 in the evening — if I have dinner plans, etc. I'm hitting it as close as possible, but was just wondering what other people have done in this situation.

(Also, we checked, and no UTI. I was very surprised. The vet said it was just another reason to switch to twice a day dosing.)

Thanks for your help!

[labblab]

My personal opinion is that it is more important to give the medication along with a meal than it is to hit the 12-hour mark exactly. If the drug is not given directly in conjunction with a meal, then it will not be metabolized properly. So I would think that convenient mealtime takes precedence over a strict 12-hour dosing interval. Just my opinion, though...;)

Marianne

[judymaggie]

Hi--I agree with Marianne in that I don't think it is advisable to wait an hour after a meal before giving Luna her trilostane. I give Abbie her meds twice a day and I am glad that I am retired so I am able to be pretty flexible. What works for me is to give Abbie her first meal at 7:30 followed by her Vetoryl. Abbie was used to getting her second meal at 4:00 so what I have done is split that meal, giving her half at 3:30 and the second half at 7:30 p.m. followed by her second dose of Vetoryl. This schedule does mean that I don't have evening plans unless I can bring Abbie with me. Obviously, this wouldn't work for a lot of folks and I think that is why the experts in the field don't recommend twice daily dosing unless absolutely necessary.

Curious why your vet thinks it is necessary to do another ACTH in 14 days--you are not changing total daily dose and last numbers were excellent. If you are trying to get better symptom control, you can discern that without incurring the cost of another ACTH. Maybe others will have some additional thoughts about this.

[molly muffin]

One wouldn't think that splitting the same dose into twice daily instead of once would need a 14 day retest. Would she be okay with waiting 3 weeks or 30 days do you think?

[lunabird]

Hi everyone, Luna has hit another roadblock and I was hoping for some advice.

We switched to twice a day dosing of the trilostane, splitting her 40 mg into two 20 mg treatments. We did ACTH tests 2 weeks out and 4 weeks out. I don't have the exact numbers (I can request them from the vet), but it basically made no difference. Her levels were still considered good and the vet didn't want to change the dosage at all.

However, Luna is still peeing frequently and seems to have an increase in thirst. We tested again for a UTI (negative) and sent the sample off for a culture (also negative). The vet spoke to an endocrinologist, who is recommending another chemistry panel to check kidney/liver levels, etc. The last time we did this was when we were first diagnosing, and her kidney levels were fine. Only her liver and cholesterol levels were problematic, per the Cushing's.

The endocrinologist said that sometimes the high steroid levels from the Cushing's can mask other diseases, and once you get the steroids down to a normal level, those crop up. I told the vet I was afraid I was maybe "making it up" (the severity of the drinking/peeing) and wanted to log her water intake/bathroom breaks for a week, but she said she doesn't think I'm exaggerating due to Luna's urine gravity levels. They have always been in 1.005 to 1.009 range, which is in the "kidneys aren't functioning well range." (Yet her kidney levels looked perfectly fine on the first chem panel. Maybe that was the steroids masking things?)

Sorry for the overload of information! I'm just wondering if anyone else has had other problems crop up like this and how they handled them. I can do the chem panel just to rule out anything else (but good grief this whole thing has been a HUGE strain on my finances), but if everything is fine, the vet is recommending we go to 3x/day on trilostane, which I just absolutely can't do with my work schedule, or switch to lysodren, which will mean another round of ACTH tests. Starting to feel a little discouraged here. Whatever input you might have would be appreciated!

Thanks,
Eliza & Luna

[labblab]

Hi again, Eliza. I'm sure sorry that issues are remaining for Luna. However, in looking back through your thread, it looks as though she was diagnosed back in September. So if it has been that long since a chemistry panel has been performed, yes, I definitely think you need to bite the bullet and have one done. As the specialist has said, there may be some kidney or liver problems emerging. Or, it may also be the case that there are imbalances in her electrolytes -- most specifically, her potassium and her sodium. In addition to lowering cortisol, trilostane can also lower aldosterone (another adrenal hormone). Aldosterone controls the balance of potassium and sodium in the body, and if those electrolytes get out of whack, problems can emerge. Dechra (manufacturer of Vetoryl) actually recommends that basic blood chemistries be run alongside every monitoring ACTH. Not many people do test that frequently, but Luna is definitely overdue now for a chem panel to be run, and I would want to have that done before considering another dosing change.

Also, if you can get us the results of these most recent ACTH tests, that will be very helpful as well.

Marianne

[Renee]

I'm wondering if it could be diabetes insipidis?

[lunabird]

Thank you! That's very good to know. I'll go ahead and schedule that chem panel for next week, and get the latest ACTH results as well.

[molly muffin]

I can definitely say that kidney values can change rather quickly (in a matter of months) as it happened with my dog. In 3 months, she developed kidney problems, high blood pressure and eye problems).
Now with controlled cortisol I think it should be more gradual if at all, but I'd have a chemistry panel done just to be sure.

[lunabird]

Hi everyone,

No luck with figuring out what's up with Luna. First, I have her last two STIM results. These were after splitting her trilostane to two treatments per day:

Feb. 16: 2.3 (pre-ACTH), 7.6
March 1: 2.9 / 4.2

On March 25 we did a chem panel. The only thing the vet said was mildly abnormal was her calcium level, which was on the high end (11.7, the highest normal level is 11.8). So she recommended an ionized calcium test, suspecting Hypercalcemia. I checked it out on PetMD, and the symptoms all seemed to match what we're seeing, so I was hopeful we had finally found the cause. But I heard back today and her ionized Calcium was only slightly elevated (1.49, high normal is 1.45).

The vet said she's skeptical about that slight of a bump causing the increased thirst and urination Luna's been having. She said she'll be in touch with the endocrinologist and get back to me in the next few days, and will probably recommend switching to Lysodren (which will mean several more STIM tests).

I want to get Luna fixed up, but I feel a little bit like I'm getting yanked around and pouring thousands of dollars down the drain. I'm not sure if I should start seeking second opinions or if this is just how Cushing's goes. Any words of wisdom would be appreciated.

Thanks,
Eliza and Luna

[molly muffin]

How about an SDMA kidney test?
If it is kidneys and the cortisol is controlled, which is it, there is no reason to switch to lysodren.

In fact, I really don't see a reason to switch with such good control. I'm more concerned about the kidneys frankly.
BUN/CREATININE ratio and SDMA kidney test would be my choice.

[lunabird]

Thanks for responding!

Those tests were included in her chem panel, and all was normal.

BUN: 12 (healthy range: 9-21 mg/dL)
Creatinine: .7 (.5 - 1.5 mg/dL)
SDMA: 7 (0-14)

[molly muffin]

well, hmmm, not kidneys then.

I just don't know, and maybe someone else does, why if the cortisol is controlled, switching to lysodren would make a difference.

[Harley PoMMom]

It is quite possible that she has what is called renal medullary washout. To simplify things, it means all the stuff (solute) her kidneys need to concentrate her urine has been washed out for a very long time so the kidneys will take some time to recover. There is a small number of dogs that never have a resolution of pu/pd despite having their Cushing's controlled.

[lunabird]

Hi all,

I'm really struggling with Luna's next phase of treatment and was hoping to get some advice.

We had her on UTI meds for four weeks hoping to treat an "invisible UTI." Things actually did seem to improve (urinating less frequently, less thirst), but when she went in for a urinalysis, the vet was concerned that her specific gravity is still lowering. It's at a 1.005 (very dilute). She's been around 1.008/1.009. Normal concentrated urine is around 1.030.

The vet has been speaking with an endocrinologist and is recommending an estrogen supplement. She's recommending Diethylstilbestrol, which is $21 for a 30 ct bottle, be given daily for one week and then decreased to once a week.

I guess in the big scheme of things, that is not a terribly expensive treatment option. I'm just feeling overwhelmed at this point. We've put Luna through so many tests (for a while there we were at the vet at least once a week), and we've spent thousands of dollars to get to here. Her cortisol levels are controlled. I've asked the vet if this specific gravity thing is affecting Luna's quality of life, and that's my big question. I don't know at what point to switch to palliative care because no one knows what a Cushing's dog life span will be. I just don't want to put Luna through the ringer if we're not actively improving her quality of life, and am wondering if others have had to make similar decisions.

Thanks,
Eliza and Luna

[DoxieMama]

Hi Eliza,

I'm sorry you and Luna are having such a rough time figuring out what's going on with her.

Renee previously mentioned diabetes insipidus as a possibility. Was this ruled out?

[molly muffin]

I don't have any suggestions in regards to an estrogen supplement. I guess that if I was considering going down that path, then I would have all the sex hormones tested by University of Tenn and see what they suggest.

[lunabird]

Hi, thanks for responding. I asked about diabetes insipidus, the vet said it was a legitimate question but she didn't think it was likely because she hasn't seen changes in electrolytes, an elevated BUN, or abnormal blood glucose levels.

She said to be sure, we'd have to run more tests, and I just don't feel comfortable doing that at this time.

I think I am also going to pass on the estrogen and cranberry supplements for now. The vet said it's really only to control potty breaks at this point, and I feel OK with where we're at so far. I appreciate everyone's help! Hopefully Luna will continue to do well. I think the medullary washout is a pretty likely culprit for her current issues, but she seems happy and comfortable, so we'll stay the course.

[Harley PoMMom]

Abnormal glucose numbers are associated with diabetes not diabetes insipidus (DI). And although increased drinking/urination are symptoms of both, they are two entirely different diseases. DI is a disorder with the hypothalamus, which is located in the brain.

Glad to hear she is a happy girl, that is always such good news ;)

Hugs, Lori

[dsbailey]

Hello Lunabird,

My dog Lolita has been taking Diethylstilbestrol (DES) for about two years for spay incontinence which seems to be amplified by Cushings. She takes DES 1mg every three of four days since the loading phase. I dose according to her having breakthrough. I'll give you a hypothesis I have about my girl.

Here's the pattern: She fills up on water causing excessive urination(cushings). She urinates and then when cleaning herself which a normal dog does for a few seconds, but she continues licking her vulva which then turns into what I can only describe as the tip of a Gerbil water bottle. The more she licks, the more she leaks. I'm also guessing that while down in that area she licks her other business area that she has and presto the magical never ending UTI (Hers is always eColi). Now after the return of the UTI which is usually a week or so after antibiotic treatment the irritation makes her lick more and so on and so forth. The pattern has emerged into a never ending cycle.

When she takes DES it keeps her from leaking, licking, and the UTI. Google spay incontenence some of your problem may completely independent of Cushings but amplified by it.

I hope this information helps you make the best decision before jumping off the Trilostane boat.

Darrell (Lotlita's Dad)