New Member - Jenna 11 yr old beagle getting Cushing's test tomorrow!

[Beaglelover]

Hello some of my old friends who pulled me through treatment and losing my beagle Sparky years ago, and Wow, here I am again. Another beagle who may have Cushing's Jenna is 11 yr old beagle. Her signs that leaded us to test for Cushing's; threw up 3 times in the past 3 weeks, and she begs for food. Went for blood work results shocking, ALKP > 993 U/1 ; ALT > 1000 U/1 ; CHOL > 450 mg/do ; TBIL 1.4 mg/do H. No other typical Cushing's symptoms. Otherwise happy and sassy girl. Went back to vet for Ultrasound and xRay only showed slightly enlarged Liver, no tumor or cancer as far as they can see.
Going in tomorrow for the Low Dose Dex. Suppression 8 hr test. They will do 3 blood draws 4 hrs apart with steroid injection. My question is should Jenna fast?
My vet says no, but what I've read she should fast. I know not feeding Jenna in the morning will really stress her out... But I don't want to jeopardize messing up the test.
Thanks for your feedback. Tammy

[Squirt's Mom]

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[Squirt's Mom]

Hi Tammy and welcome back! :)

Tho I guess being welcomed back for the second possible cush baby isn't the welcome most of us want :D, we are glad to see you and Jenna here.

Was the liver looked at beyond the usual labs and ultrasound? How did that organ look on the ultrasound - any comment other than slightly enlarged? That ALT is attention getting. ;) The ALKP is rather mild compared to some we have seen tho it is certainly elevated. Has she been on any medication recently?

As far as the LDDS goes, I don't think fasting is necessary. Some vets will have the pup fasted because they are going to run other tests on the blood that do require fasting and some labs may require it while others don't. Others will be along to give their input on this soon I'm sure.

The sudden vomiting is not one of the usual cush signs but the increased appetite is for sure. You are seeing no other cush signs, tho? No panting for unknown reason, seeking cool places to lay, peeing more, drinking more, thin bruised looking skin, sores on the skin.....anything else at all different with Jenna?

As always the more you can tell us about Jenna the better. We still love details! :D

Glad to have you and Jenna with us!
Hugs,
Leslie and the gang

[labblab]

Hello Tammy, and of course we remember you and Sparky! As Leslie says, I'm so sorry you have need of us again, but also so glad you've found us. Of course there have been some changes through these past years, but you will still see some familiar faces! ;)

As far as the fasting, as best as I can tell, many labs do request that the LDDS be performed using fasted samples, but some do not care. So we will hope that your vet truly does know the specific preference of the lab you all will be using. Overall, probably you could never go wrong by fasting, but you also want to hold Jenna's stress to a minimum, too, on the day of an LDDS. So I guess it will need to be your judgement call on that one.

As Les has already asked, are there any other overt symptoms at all other than hunger? Even if the LDDS is positive, it is always a bit of a quandary as to whether or not to start treatment with a dog who exhibits lab abnormalities alone. So the more you can tell us about Jenna's overall health history, the better.

Thanks so much in advance, and good luck with today's vet visit!
Marianne

[judymaggie]

Hi, Tammy & Jenna! As I recall, we were both on the board at the same time the last go-round, me with my beagle, Maggie, you with Sparky. You are not the only repeat member -- I am back with my second Cushing's beagle, Abbie, who is now 12 1/2! Our in-house experts have gotten you started with guidance and questions. I hope Jenna isn't too stressed out with today's test. Curious what the ultrasound showed with Jenna's adrenal glands ...

[Beaglelover]

Hello Leslie, Marianne and Judy,

Ultrasound show adrenal glands slightly enlarged, but overall vet said Ultrasound and x-ray showed nothing terrible. Liver slightly enlarged.

No other symptoms !! NO excessive thirst, hair loss, sores, skin lesions, panting, non-stop appetite. Jenna is a beagle and she begs for treats and at feeding time (AM/PM) she barks a lot when you are preparing her food. She has always done that, maybe she is barking more now? She does not appear to be overly obsessive about food, she's calm, wags her tail, eats with no problem, otherwise seems happy. Weight is good, coat is shiny and healthy.
Jenna threw up 3 time in 2.5 weeks, we thought maybe stress because my husband Joe was gone for 17 days and she's daddy's girl and then we were both gone for a week. Stress? Vet says no way would the blood work be what it is due to stress...

History: Jenna has had 2 bladder infections before and twice an infected anal glad. She has had upset stomach in the past and would hesitate to eat when it's upset (maybe twice?). Jenna takes a daily dose of Cimetidine 100mg (AM/PM) to keep her acid down, recommended by vet. She's never needed to be on steroids for any length of time.

I have on hand Flagyl 250mg and Centrine 20mg that I would give Jenna or my other beagle if they got diarrhea or upset stomach. (I have 3 rescue beagles now). I had Jenna on it for a total of 10 days - since that time she's been perfect? To combat the Liver disease? I've started Jenna on SamE last week and Milk Thistle, Tumeric, and low protein home cooked food this week. I will try to introduce Fish oil too but want to be careful not to upset her stomach.

(Judy, yes of course I remember you and Maggie!, and nice to meet Abbie)

Tammy

[molly muffin]

My molly never had the typical symptoms. In fact hasn't had them at all till recently, when her cortisol slipped control and we had to increase her dose, so I don't think all cushing dogs necessarily show every symptom.

Is the plan to start her on medication? If vetroyl, start at 1mg/1lb that has been a recent adjusted starting dose by the manufacturer.

[Beaglelover]

Molly,

I was going to post an update tonight, vet confirmed yesterday that Jenna has Cushing's, they said its the non cancerous tumor and that we caught it early, since she has mild symptoms ( blood work, slight increased appetite).

Vet wants to start Jenna on (liquid) Trilostane as soon as possible.
I really want to get feedback from others about the liquid form, if they used it etc. My vet prefers the liquid because it's easier to adjust, where you can't adjust the pills so easily. I was thinking to reach out to the other senior member (Leslie, Marianne, and Judy, and others like yourself). I really need some reassurance and guidance about using the liquid form.

Tammy (Charlie, Jenna and Sandy's mommy)

[Beaglelover]

Jenna's low dose Dex. test confirmed Jenna 11 yr old beagle (25 lbs.) has Cushing's. Pituitary, Non cancerous tumor. Vet thinks we caught it early because Jenna's symptoms are very mild. Her blood work was what lead us to test for Cushings.

Vet wants to start Jenna on compounded liquid Trilostane ASAP. (VTrilostane 40 mg/ml Susp 60 ml Unflavored, I believe 2 X day). Vet said liquid form is easier to adjust. Pharmacy is Wedgwood. I've read mixed reviews about the compound treatment and now I'm scared and wonder if I should cancel the order and request to try capsules. Jenna is a 25 lb beagle.

Thanks for your help
Tammy (Jenna, Charlie, Sandy's mommy)

[molly muffin]

I've never used the liquid form, although others have said that yes it is easier to adjust dosage.

[Squirt's Mom]

MODERATOR NOTE: I have merged your post about compounded Trilostane into Jenna's original thread. We like to keep all posts about each pup in a single thread as it makes it easier for members, and parents, to refer back to the pup's history when needed. Thanks!

[labblab]

Hi Tammy,

There is no question but that it would be easier to tweak doses using a liquid, and for dogs who are difficult to pill, liquid formulations can be a godsend. Having said that, changing the researched delivery form of a medication may affect its efficacy. Whether or not that is an issue with liquid trilostane, I do not know. We have had members who have used liquid trilostane with apparent success; others have had issues keeping their dogs' cortisol under consistent control. But the same has been true even of folks using brandname Vetoryl capsules, so it is impossible to know whether the liquid formulation contributed to the problem or not.

I am a person who likes to try to control as many variables as possible, though. For that reason, I would personally prefer to begin my own dog's treatment with brandname Vetoryl capsules if my dog was easy to pill and appropriate Vetoryl dosing strength was available. However, Vetoryl is definitely much more expensive than compounded trilostane and much more limited in terms of available doses. If Vetoryl didn't work for me, I'd next pick a compounded capsule in a small enough unit that I could more easily combine or subtract capsules if the dose needed to be changed. For me personally, I would use a liquid suspension as a last resort.

And just to add insult to injury, I would also have reservations about using Wedgewood :o. I know they are a huge operation and I'm assuming your vet has had good experiences with them, but they pretty miserably failed an FDA inspection back in 2013, to an extent that I really found to be worrisome. Here is the FDA's actual report for Wedgewood issued last February of 2013 (based on inspections conducted during the preceding three months). Several infractions are quite worrisome. Here is one example that seems especially troubling to me:



Raw materials such as bulk active ingredients are not routinely tested for identity, and raw materials being used in sterile compounded drugs are not evaluated for routine bioburden [microbial contamination]. Although quality agreements are maintained with suppliers of active ingredients, sampling and testing has never been performed for any active or inactive ingredients. There are no identity tests performed for any materials.

http://www.fda.gov/downloads/AboutFDA/CentersOffices/OfficeofGlobalRegulatoryOperationsandPolicy/ORA/ORAElectronicReadingRoom/UCM342543.pdf

Presumably they have since rectified all the noted deficiencies, but you may want to ask your vet whether she is aware of this report. I have never used a compounding pharmacy for Cushing's meds myself, but a number of our members are extremely satisfied with Diamondback Drugs in Arizona, and to my knowledge, they have never encountered the same type of inspection issues. I believe they do now prepare liquid formulations of trilostane in addition to the more traditional capsules, so they might be another pharmacy for you to consider if you want a compounded product. Their pharmacists have been very happy to consult with our members through the years, so you may even want to give them a call just to get their "take" on plusses or minuses of a liquid formulation.

Marianne

[judymaggie]

Tammy -- Marianne has given you great guidance regarding the pros and cons of liquid trilostane. Since you sent me a private message, I wanted to respond and add another thought. If you decide to start treatment with a compounded medication and Jenna does not respond as hoped, you will be left with the question as to whether the non-response is due to the use of the compounded med or if the dose itself is an issue. Like Marianne, I prefer to keep treatment as simple as possible. I am unable to just stick pills down my Abbie's throat but she loves her "cheese balls" with the pill inside. She usually chews them a little bit which makes me nervous that the capsule may open up but she hasn't had any issues.

A big ar-o-o-o-o to Jenna from Abbie!

[Beaglelover]

Thank you Marianne and Judy for your replies, and thanks Leslie for merging my posts. Well, it's too late to change my order with Wedgwood to brand name capsules, I'm stuck with getting the liquid sometime next week. I did call the pharmacy to question their status with the FDA and safety protocols etc. related to the 2013 violation and I was told they have since had several re-inspections and we're never out do compliance for compounding. I'm still nervous but at the is point need to give it a try. My vet uses this pharmacy for 5-6 other patients and have had good results.

I've read that the LDDS can be false positive and that's the test Jenna was confirmed with having Cushing's. Her symptoms were she threw up 3 times in 2.5 weeks, lost a little weight, goes crazy begging for food at feeding time and begs for treats, I forgot to mention in my original post occasionally her hind legs shake a little?

BTW our vet is starting a very low does, 12ml and Jenna is 24-25 lbs, so I'm not worried about over dose. After reading on the forum I specifically asked for low and slow dosage. Please check in on me and Jenna, this is all very scary for us.
Hugs to all of you

Tammy

[labblab]

BTW our vet is starting a very low does, 12ml and Jenna is 24-25 lbs, so I'm not worried about over dose.

Vet wants to start Jenna on compounded liquid Trilostane ASAP. (VTrilostane 40 mg/ml Susp 60 ml Unflavored, I believe 2 X day)

Hi again, I just want to double check your dosing info. Did you mean to say that Jenna will be getting 12 mg. as opposed to 12 ml.? And will that be twice a day for a daily total of 24 mg.? That would make sense according to her weight, but in terms of actually administering the dose, if my math is correct, that would be a tiny bit more than 1/4 a ml. (since 25% of 40 mg. would be 10 mg.). Is that the dose you are planning to give her?

That just seems like really an awkward calculation to start you off on and impossible to administer precisely, so I want to make sure we're all on the same page. I would have thought the concentration of the trilostane in the solution would have been different, given that starting dose. (In honesty, this is one reason why I'm leery about liquids because I am no math whiz myself and it seems so easy to miscalculate the dosages!)

Marianne

[Beaglelover]

Marianne, I may have been off on what the pharmacy told me on the phone as far as dosage. I will post the dosage once I receive it. The vet called in the prescription and instructions to Wedgwood directly.

I'm thinking about doing another complete blood work to check Jenna's liver enzymes before starting the Cushing's medicine. I guess I'm still not convinced its Cushing's because Jenna is acting totally normal. My vet said the Lose Dose test is very accurate in diagnosing Cushing's and is convinced Jenna has it based on her blood work and the test.

Tammy

[molly muffin]

Okay so I just saw that you wrote you'll be doing trilostane 10mg twice a day.

With trilostane it isn't really a load, like with lysodren. You are looking for the correct dosage for your baby to keep the levels even of cortisol.

I know you said she doesn't have many symptoms if any, so you are worried.

What you want to look for that would mean she is getting too much is if she doesn't want to eat, if she vomits, gets diarrhea, wobbly, etc. Those are sign of too much and you want to at that point, not give any more and get an acth done. Normally this doesn't happen, unless too high of a dosage is started (you are in a fine range of 20mg a day for a 25lb dog) But since any dog can react in any way to a new medication when it's introduced, you just have to watch and be aware of any changes and what it might mean.

We are always around, someone anyhow, so if you have any concerns never be afraid to ask.

I follow everyones threads, even if I don't get to post as often as I'd like sometimes, but I do read and jump in if any crisis shows up, as most of us do.

Just take deep breaths and we'll get through this.

Hugs

[Beaglelover]

Sharlene

Thank you for responding and your reassurance. I feel better. I will defiantly keep everyone posted on Jenna. I hope Molly is doing well.

Hugs
Tammy

[Squirt's Mom]

I am copying and pasting your comment on Abbie's thread so we can have all Jenna's info in her thread. That way we can keep up with her and not be confused between the two pups. ;)


Sharlene and Judy

I received Jenna liquid medicine, we start tomorrow 10mg x 2 day.
My concern is Jenna is almost symptom free, except her beagle appetite I'm worried how to know she's loaded. I am nervous, I will post on my thread please follow me as I will need your support. I hope your fur babies are doing well

Hugs
Tammy (Jenna, Charlie and Sandie)

One thing I want to point out - with Vetoryl (Trilostane) there is no loading phase. The pup simply takes the med every day. The dose may change but that is not a load, it is just the dog's body changing requiring a different dose. With Lysodren there IS a loading phase but not with Vetoryl. Easy to get them confused in the beginning when you are reading the stories of other pups.

What you do NOT want to see are these signs that indicate a problem - loose stools/diarrhea, nausea/vomiting, loss of appetite, lethargy. If you see ANY of those things, stop giving the med and call her vet to let them know what you are seeing.

What you DO want to see is a reduction in urination, a reduction in water consumption, a reduction in appetite (tho that may not happen if her appetite has not increased with the elevated cortisol), a return to her former self ie more interactive and playful.

Keep talking to us especially any time you are worried about something. You won't be alone on this journey, we are with you all the way.

Hugs,
Leslie and the gang

[judymaggie]

Tammy -- sending good thoughts to you and Jenna as you start on the trilostane road! :D

[molly muffin]

Hope all is going well!!

[judymaggie]

Thinking of you and hoping all is going well!

[Beaglelover]

Hi Judy, Leslie, Sharlene and the gang,

Wanted to give you an update on Jenna, we are day 6 into giving her trilostane 10mg x 2 day. She is acting fine, absolutely no side effects, a couple times her stool was soft but firm this morning. Jenna is happy, active, love bug, great appetite and begs for treats. Although her was really symptom free for having Cushing's I do think maybe she is not begging as much? Or it could be my mind playing tricks to believe there's a difference this early. Day 14 we will do blood work to see where we are at.

Our beagle Charlie (we have 3) is declining, he does not have Cushing's but has a neroligical disorder of some kind, he can hardly walk and when he does it's in circles. He's a happy boy, wags his tail, but our hearts are broken because he doesn't really have any quality of life. His hind legs give out all the time, his eyesight is bad, and he's slowed down on drinking water. We have to work with him for about 45 mins in the morning to get him to eat, poop and pee. We think he will go to rainbow bridge in the coming weeks, we don't think it's fair to keep him going for our sake. This is going to be tough.

I do hope your fur babies are doing well, I'll look for an update on you threads.
Hugs
Tammy (Jenna, Sandie, Charlie's mommy)

[judymaggie]

Sending loving thoughts and gentle hugs to Charlie! I am so glad that Jenna is doing well--at least that lets you focus on Charlie.

[lulusmom]

Hi and very belated welcome to you and Jenna.

In looking at the results of Jenna's abnormal blood values you posted, I am quite alarmed with the diagnosis. Dogs with cushing's can have severe elevation in ALKP but increase in ALT is usually negligible. Jenna's ALT is greater than 1000 u/L which is a huge red flag that there is a lot more than cushing's going on. Her total bilirubin is also greatly elevated which we don't see in cushing's. Can you please gather copies of all of the testing that was done by your vet and repost all abnormal values, including the normal reference ranges? Prior to doing the LDDS, especially on a dog who isn't really presenting as being cushingoid, your vet should have done a complete senior screening which includes the blood chemistry, complete blood count and a urinalysis.

Based on what you have posted, Jenna has no real symptoms associated with cushing's, no abnormalities in adrenal glands noted on abdominal ultrasound and her blood values are not consistent with what we see in cushing's. How soon after the bloodwork was the LDDS test done and can you please post the results of that test? Beagles are a breed that seem to be over represented in cushing's but in my experience, the ones who are correctly diagnosed have a lot more symptoms. Beagles are also a breed that seems to have a genetic predisposition to gluttony so it is important, especially since this is the only real symptom you've posted, that what you are seeing is not normal for Jenna. Is begging for food at times normal for her or have you seen a definite increase in her appetite. There is no mistaking this in a dog with cushing's, even a Beagle. It is constant whining, foraging and begging to the point of making you want to rip your hair out.

Is your vet a general practitioner and if so, how much experience does s/he have with cushing's? I seem to be the odd person out on this thread in that my concern with the diagnosis is much greater than any concern over doses of compunded vs brand name Vetoryl. With the ALT and TBIL results you posted, I think it's much more likely there was something other than cushing's going on, which could have caused a false positive LDDS.

I'll be looking forward to learning a lot more about the numbers and circumstances behind Jenna's cushing's diagnosis.

Glynda

[Beaglelover]

Glynda

I have struggled if Jenna has Cushing's or not? But our vet is convinced based on the blood work. We started her on compound liquid treatment for Cushing's 9 days ago and there have been no changes, she's acting normal with exception to a little loose stool. Her appetite is not abnormal, she a beagle and loves food. She's not drinking excessively. She does have a little belly but she always has.
We are scheduled for a ACTH test this Friday, what should I do? I'll have my husband pick up the records tomorrow and I'll send you the results. I like my vet but it brothers me They don't give me copies of the test results, I have to practically beg for them. I can scan the records if you have an email? Or I can post.

My vet is a general vet, large practice, he specializes in some surgeries like knee etc. I questioned how many patients they have with Cushing's and was told 4 patients, but I don't think he specializes in it.

We had a dog Sparky with Cushing's and he had almost every clinical sign, Jenna's totally different that's why I'm struggling with the diagnosis.

Tammy (Jenna's mommy)

[Beaglelover]

Glynda

I forgot to elaborate on Jenna's appetite, she eats twice a day, and she begs for food when we eat, but not constantly and she's not begging all the time. She usually begs around 830p for some food and then lays around otherwise. She's persistent but she's always been that way. I don't see anything alarming going on.

One thing recently is she has been licking her pee pee, and I originally thought bladder infection but vet said test was inconclusive, I'll send you those numbers too tomorrow night.

Now I'm concerned about continuing the treatment 10mg x day, she's not showing any difficulties with the medicine? And maybe I should take the results to another vet? I had a second appt. but cancelled because I thought I was over worrying.


Tammy

[Tassysmom]

Tammy, I hope you get a 2nd opinion (from a vet with more Cushing's experience) for Jenna. I have learned to take the concerns of the ladies on this blog very seriously. They really know their stuff.

Tassy's early symptoms (torn ACL and lameness, excess drinking and urination in the house, panting, hair-loss, pot-belly, etc.) were very marked. It took 6-8 months AFTER beginning 30mg Vetoryl daily before they resolved. The first thing to come under control was the drinking and urination. The last thing was her hair grew back. The increased panting and continued muscle-deterioration never resolved but that was due to the Pseudomyotonia.

If Jenna is not actually Cushingoid, then Vetoryl could push her into Addison's disease which is (if possible) worse than Cushings. Please have Jenna's test results re-checked. As Glynda noted...some of the test results are abnormal; need to get to the bottom of it.

Hope to hear the result of this. Please post!

Linda

[Beaglelover]

Linda thank you for the advice.

Glynda,

Here are the recent tests results in order by date, earliest to latest;

8/25/15 Urine In-house test:
Ketones = neg
Blood = trace:confused:
pH = 6
Glucose = neg
Bilirubin = neg
Protein = 10
S.G. = 1.027
Culture = negative
Sediment = NSF

9/21/15 Blood Test:
Test Result Ref Range
ALB 3.4 g/dl 2.5-4.0
ALKP > 993 U/l 0-140
ALT > 1000 U/l 0-120
AMYL 818 U/l 100-1500
Ca 11.3mg/dl 9.0-12.2
Chloride 101mEq/l L 102-120
CHOL >450mg/dl 120-310
CREA 0.9mg/dl 0.4-1.4
GLU 95 mg/dl 75-125
LIPA 120 U/l 0-225
PHOS 4.6 mg/dl 1.9-5.0
Pottassium 4.6 mEq/l 3.8-5.3
Sodium 145 mEq/l 141-152
TBIL 1.5 mg/dl H 0.0-0.5
TP 7.4 g/dl 5.5-7.6
GLOB 4.0 g/dl H 2.0-3.6
BUN 23.0 mg/dl 9.0-29.0

9/21/15 CBC Results from CBC In-house
Test Result Ref Range
HCT 52.2% 37.0-55.0
HGB 22.4 g/dl H 12.0-18.0
MCHC 43.0 g/dl H 32.0-38.5
WBC 7.2 10^3/ul 6.0-17.0
GRANS 5.3 10^3/ul 3.5-12.0
%GRANS 73.9% 0.0-99.9
PLT 498 10^3/ul 200-500
RBC 7.73 10^6/ul 5.50-8.50
MCV 67.6fl 60.0-72.0
MCH 29.0 pg H 19.5-25.5
RDW 19.3% H 12.0-17.5
MPV 7.9 fl 5.5-10.5
%LUMPS 19.5% 0.0-99.9
%MPNOS 6.6% 0.0-99.9
ASPT 0.7 sec
LYMPS 1.4 10^3/ul 0.9-5.0
MONOS 0.5 10^3/ul 0.3-1.5
RBC CT 13.3 sec
RDWA 53.8 fl H 35.0-53.0
WBC CT 9.8 sec
Manually entered.

9/24/15 Ultrasound Notes:
Ultrasound shows bilat prominent adrenal glands w/normal shape. Liver normal except hyperechoic. R/O pituitary dependent Cushings disease. Radiographs of chest normal.

10/1/15 Dex Suppression Test confirms Cushing's disease.
Cortisol, Baseline Cle Vet 5.6 ug/dL
Cortisol 4hr. Cle Vet <1.0 ug/dL
Cortisol 8hr. Cle Vet 2.5 ug/dL

10/5/15 Blood work:
Test Results Ref Range
ALKP >993 U/L 0-140
ALT >1000 U/L 0-120
TBIL 1.5 mg/dl H 0.00-0.5
Manually entered.

10/10/15 started Trilostane medication 10mg twice daily.

10/23/15 First ACTH test scheduled

10/26 2nd Opinion Appointment with vet who has Cushing's experience and more of an internist vet.

I appreciate your thoughts.
Jenna is in good sprits, she's eating well and acting her typical beagle self, except she's got diarrhea. Her stool was getting soft and then full blown diarrhea today (she did get into the garbage can earlier today when the pet sitter visited her). There wasn't much is the trash can, so not sure if the diarrhea is from the garbage dive or the Trilostane - I am thinking to stop the Trilostane until the diarrhea stops. What do you think?

Hugs - Tammy (Jenna's mom)

[labblab]

Well, phooey, the timing of the diarrhea certainly sucks in relation to the scheduled ACTH testing :o. At this late hour, I'm assuming there's no way you could move it up to tomorrow morning...

The thing is, no, you don't want to continue giving trilostane if her cortisol is truly dropping too low. But if you discontinue the trilo two days before testing, then you won't have an accurate assessment of the effect of this dose of medication on her adrenal function. Safety is paramount, so I do think you need to notify your vet as to the diarrhea in the morning. As long as Jenna otherwise remains OK, you may want to just halt the trilo altogether and call off the ACTH until you've had the chance to meet with the other vet next Monday. After you obtain the second opinion, you can then make the decision as to whether or not to resume treatment at that time and set a new ACTH date.

Of course, if Jenna worsens before now and then, you'd want to go ahead and proceed with the ACTH for safety's sake -- to make sure her adrenal function has not been oversuppressed.

Marianne

[Beaglelover]

Hi Marianne

Jenna seems normal other wise. Eating great, no issues there. I'm really torn what to do, one idea my husband had was to give her 1 x day treatment, not 2, but that would probably mess up the test. Gosh this is stressful. I'm looking forward to the second opinion Monday.

I will call vet in AM

Tammy

[Beaglelover]

Marianne

Jenna was fine this morning so we continued her medicine and plan to do ACTH Friday, and second opinion Monday.

Tammy

[judymaggie]

Tammy--I am so glad that Jenna is doing better and you are back on track with your plan of action!

[labblab]

Oh, I'm so glad to hear this, too! Go Jenna! :)

[molly muffin]

Yay, glad to hear things are still on track.

You know molly has been known to get gastro upsets and have diarrhea. Sometimes for a day or two, a few times for longer. I usually discontinue the trilostane till she is back to normal and then carry on, but that being said, I already know that she is prone to those gastro attacks, so can't use it to gauge the trilostane.

Let us know how things are going.

[Beaglelover]

Hi Sharlene

Jenna's poop is good now. Well, we took Jenna to another vet yesterday for a second opinion, and vet dr. Gorbea consulted with an endocrinologist and the both are not convinced that Jenna has Cushing's and recommend us to stop the medicine and get an ultrasound on Jenna's Liver and look for what else may be causing the Liver enzymes to be so high. We haven't stopped medicine because she's on such a low does and we are thoroughly confused. Thank God Jenna is acting perfectly fine.

Dr. Gorbea said that starting medicine without the clinical signs of Cushing's is not usually recommended. Jenna does not drink much, doesn't urinate much, no panting, no skin issues. She does beg like crazy at feeding time and begs for treats but not constantly. She does lick her paws sometimes? Really I don't see the typical clinical signs, no smoking gun. Jenna has lost some weight but gained some back and maintains her weight at 26 lbs. she's playful, happy, etc. NO vomiting, diarrhea, loss of appetite, etc.

We are going to talk to our vet again, I hope Dr. Lisner is not upset we got another opinion. I hope Molly is doing well. What were her symptoms?

Hugs
Tammy:confused::confused:

[labblab]

Hi Tammy! Just wanted to check back in with you and Jenna, and to see where things stand with you two. Surely hope all is well!

Marianne

[molly muffin]

Molly didn't have the typical symptoms either. A bit of a pot belly and the hair eventually started to get thinner, but we never experienced the hunger, drinking issues.
Really we waited, but then she went from everything other than liver enzymes being high, to getting high BP, renal scarring from the high BP and protein in the urine, so we started treatment for cushings.

Not every dog has every symptom and for years we where told if no symptoms don't treat, now there is a lot of discussion about treating if the tests show high cortisol with no other chronic illness.

An ultrasound is always I think, good value and gives you a lot of information about how their internal organs look and anything else that might be going on, or what affect the high cortisol is having on the organs.