12-yo Cairn with Cushing

[Sally in SC]

Hello! I found you by Google when our 12-yo Cairn was diagnosed with Cushing in Aug. The first sign was excessive water consumption & urination accidents inside. Hoping for UTI diagnosis, took urine sample to Vet. After correct testing protocol, including an ultrasound, Cushing was diagnosis.

Trilostane 20mg was prescribed from compounding pharmacy in AZ. Sept ACTH test inconclusive due to incomplete instructions. Meds doubled to 40mg following Oct test. Just yesterday, meds increased to 60mg as a result of Nov test.

That sounds like a big dose to me. She weighs 18-lbs. She is also on Tramadol for arthritis, and Prion and Marin.

Thoughts? I look forward to your comments. Thank you!

[Harley PoMMom]

Hi and welcome to you and your girl!

Yep, that sounds like a hefty dose for your girl, however we need to see the results of all those ACTH stimulation monitoring tests to provide more accurate information regarding her Trilostane dose. Could you get copies of all tests that were done on your furbaby and post any thing that is marked abnormal with the references ranges and normal reporting units? Also, could you post the ultrasound findings for us? Does your girl have the pituitary or adrenal form of Cushing's? Besides the increased drinking/urinating is she displaying any other symptoms? How is your girl acting now, any change in her appetite, drinking, or bowel movements? Is she getting her Trilostane with food? And are her ACTH monitoring tests being performed 4-6 hours after her dose of Trilostane is given?

I'm sorry this is so short and I will try to get back later. Looking forward to hearing more about your sweet girl.

Hugs, Lori

[Sally in SC]

Thanks! I don't currently have copies of testing results but could ask vet. As fate would have it, his last call with results was a voice mail & we are playing phone tag. I do recall, first value was 4.8 & second value was in 9 range. He said, ideally, both below 5?!?! No results from specialist on ultrasound either, except pituitary Cushing's. They wouldn't even let me go back for test. Picked her up in Lobby & returned her to me in Lobby. Other symptoms are weak hind quarters, which seems to be normal?!?! Yes, ACTH tests are performed 4-6 hrs following Trilostane with food.

[Harley PoMMom]

With Trilostane the therapeutic ranges are between 1.5 ug/dl - 5.5 ug/dl, also if all clinical symptoms are controlled that post number can go as high as 9.1 ug/dl. Is she still displaying all her Cushing's symptoms? Are you using brand-name Vetoryl or getting the Trilostane compounded?

As soon as you get those ACTH stimulation results please do post them for us, ok?

Hugs, Lori

[Sally in SC]

She has been on 60mg (yes, compounded) for 5-days now & I see slight improvement in symptoms. I believe last night was the first time without overnight accident since diagnosis in Aug. Next ACTH not for 3-wks but I will try to call vet tomorrow for last results a week ago. Thanks!

[molly muffin]

I think you said you are using compounded trilostane from AZ pharmacy? Diamondback? If so it is a good one that many of our members use.

As Lori mentioned, they like post cortisol to be between 1.5 - 5.0ug, however, can be up to 9.0ug with control of symptoms.

That is a hefty dose and remember that cortisol will continue to decrease for 30 days on the same dose. Also, you don't always want to double the dose on an increase. If you don't need to come down too much, then going up 5 or 10mg could be enough.

You mentioned arthritis and on pain med, so I am thinking that in your case, the cortisol being a bit on the higher up to 9.0 might not be such a bad thing, as she will feel better, especially those back legs with a bit higher cortisol in her.

[Sally in SC]

Our AZ compounding pharmacy is Roadrunner. Is that another name for Diamondback, perhaps?

I called vet today. Her last ACTH stim test was Nov 16, after 3-wks on 40mg Trilostane. The info given to me was, pre 4.8 & post 9.4 (hopefully that makes sense). Vet bumped to 60mg then. Next ACTH stim in another 3-wks.

I think I read, hind quarters last to respond? Poor gal can't (won't) even use her pet door any longer, as her hind legs won't boost her up one normal step.

Based on experience here, what timeframe is reasonable for our gal to return to somewhat normal? Six months from diagnosis? One year?

Thanks much! Y'all are wonderful!

[molly muffin]

Nope, Roadrunner is a different pharmacy than Diamondback.

Um, bumping up 20mg when the post cortisol level is at 9.4ug seems like a lot to me. You only need to come down a few points. I'd be more comfortable with a lower increase. So, since I'm a worrier, make sure you are vigilant about the eating, drinking, urinating, vomiting, lethargy as possible issues.

Leg weakness can improve but not always. It depends on the dog, what is actually causing the weakness, etc. High cortisol weakens tendons and ligaments, the longer it is high without treatment, the more damage done.

My dog walks okay but won't do stairs, she'll do one step or small steps up to her window seat, but not the ones on the deck. It's just so many variables.

[Harley PoMMom]

Yep, I agree with Sharlene, that jump from 40 mg to 60 mg is a bit too much seeing that her post ACTH was just outside the therapeutic range of 9.1 ug/dl. Has her eating and drinking changed? Any diarrhea?

Hugs, Lori

[Sally in SC]

She still eats good. Water consumption and urination has decreased a bit, thankfully. No diarrhea.

Current dilemma is, treating vet closed early for T'giving today & just got notification of next meds shipment from AZ (5 biz days). With weekend factored in, she will run out of meds Mon.

Which is worse scenario, dropping back to 40mg to stretch pills, or letting her run out completely? Help. Many thanks!

[labblab]

If it was me, I'd bump back to the 40 mg. rather than running out completely. I'd think that would be an easier transition on her system than going from 60 mg. to nothing back to 60 mg. again. If you do that (go back to 40 mg. for a few days), you may want to back off on the next ACTH test for a few days, too, accordingly.

Marianne

[Sally in SC]

That was my gut instinct, so your thoughts are appreciated. Happy Thanksgiving!

[Harley PoMMom]

Totally agree with Marianne :)

[Sally in SC]

Thank you!

[frdough]

Just to let you know Dechra makers of Vetoral is now reducing the initial dose rate to 2 mg from 10mg which will reduce the side effects. I am hearing some very high doses out there that has been prescribed. You may want to check this out.

[Harley PoMMom]

Just to let you know Dechra makers of Vetoral is now reducing the initial dose rate to 2 mg from 10mg which will reduce the side effects. I am hearing some very high doses out there that has been prescribed. You may want to check this out.

Dechra is now advising to start Vetoryl at 2mg/kg which is 1mg per pound of a dog's weight, here's the link to the article where this is stated: http://www.vettimes.co.uk/news/new-lower-starting-dose-for-vetoryl/

[Sally in SC]

Great info. I will research. Thanks so much.

[Sally in SC]

Hi friends!

Haven't been here in awhile. No changes since 60mg per day, Thanksgiving. Her next ACTH stim test is Mon, 12/21.

The news today? She went out her pet door, first time since Aug diagnosis! Yay!

Hoping we are on right track. Will keep you updated! Thanks much!

[molly muffin]

Whooo hoooo, sounds like a good sign that she used the pet door!!! Hoping for a good ACTH test tomorrow!

[Sally in SC]

Sadly, today's news on yesterday's ACTH stim test results is disappointing. Values are considerably higher this month over last! Results of Nov 18 @ 40mg of compounded Trilostane were 4.8 pre & 9.4 post. Results of yesterday, Dec 21, @ 60mg of same soared to 9 pre & 11.1 post. Consultant at Roadrunner tells my vet, common to see variability in potency in compounding & now recommends switching her to name brand, Vetoryl, which is considerably more expensive. Thoughts? My questions are: (1) Switch to Diamondback & keep compounding; or, (2) Switch to Vetoryl with lower dose to start? I am very confused here on how to proceed, and look forward to your comments. Thanks much!

[molly muffin]

You could try Diamondback first, as it will remain more cost efficient for you. We've had several members use them with good results. If that does not work, then you could try going name brand and see how that works. That is probably what I would do if cost is a big factor.

You also can probably find the name brand online at a cheaper price than the vets supply it for too.

[Sally in SC]

Thanks much! We have had to make decisions, so went straight to name brand 30mg to start. I did find at Dr Fosters & Smith for $60 / 30 days. Reasonable, as cost is always a factor. Cushing is an expensive diagnosis, as you all know. Hopefully start new protocol this Thurs. Will keep y'all updated.

[Sally in SC]

Friends, started her today on 30mg of Vetoryl, AM only. Tonight, she is exhibiting worrisome symptoms. Won't eat dinner. Won't eat treats. Won't eat deli sliced bologna. Won't eat green beans from table. I am very concerned, as this is totally out of character. Thoughts? Advice? Opinions? Thanks, all.

[molly muffin]

Eeek! I thought I had answered your post and now I don't see it. drat

okay, how is she doing now? Sometimes they have a reaction to when the cortisol starts to drop. Did she eat the next morning? If so I'd say she is probably okay then, but if not I'd not give her the pill of vetroyl and get her checked out (cbc, checking for things like pancreastis, electrolytes)
Pancreatis is always a worry with cushing dogs it seems.

So, let us know how are things now?

[Sally in SC]

Behavior was temporary & probably a fluke. She seems to be doing great on 30mg Vetoryl. Next ACTH stim test is Mon, Jan 25. Thanks all!

[molly muffin]

Awesome to hear! Good job. Yea flukes are just there to keep us on our toes I think. :).