Cocker Spaniel Bailey with Cushings and low thyroid - Bailey has crossed

[Help4Bailey]

Hi, I am Lynette and Bailey is my 11 year old, spayed, female cocker spaniel who was diagnosed with Cushing's on March 1, 2016. She presented with several peeing accidents, drinking lots of water, and has always been a voracious eater. Last year I had her tested for diabetes but that was and is still negative. She was originally brought to the vet because she was soaked in urine one morning which she never had accidents in the kennel she slept in. The vet thought that she may have a bladder infection so they did a urinalysis and blood work. The blood work showed low thyroid, <0.5, range 0.8-3.5ug/dL.
The urinalysis and culture came back negative. Vet placed Bailey on 0.2mg of Thyrosine two times a day. I wasn't given the actual full report until I brought Bailey back in two weeks later as she was barking to let her out 3 to 4 times a night, sometimes to pee, sometimes for water. I told the vet that something else must be wrong with her. She mentioned an ultrasound so we proceeded with the ultrasound that showed enlarged liver and adrenal glands. The radiologist suggested to vet that Bailey was likely to have Cushings so we proceeded with the ACTH Stim test. Bailey's results from the Stim test were Pre-Cortysn 26.9, range 1.0-5.0ug/dL and Post-Cortysn 39.5, range 8.0-17.0ug/dL. Her lab report also showed Alk Phosphatase 188(High), range 5-131 IU/L, Cholesterol 426(High), range 92-324 mg/dL, BUN 39(High), range 6-31 IU/L, as well as, PrecisionPSL 516(High), range 24-140 U/L. From this Bailey was diagnosed with Cushings and placed on 30mg of Trilostane once a day for a 24.3 lb dog. According to the vet, package dosing recommended 60mg once daily. I was uncomfortable starting out that high so I agreed to the 30mg once daily. Bailey started her Trilostane on March 2nd and took the meds for 4 days before I stopped the meds due to seeing her back legs shaking early in the day and after her collapsing on the floor later that night when she got me up. I was very scared as I thought she was going to die or had died! I lifted her paws and they were very limp and I tried to arouse her but nothing worked. I finally was able to get her up to stand but she looked mentally out of it. I moved her to another room where I could lay on the floor with her. She appeared to be breathing normally but still very groggy. I thought I was going to have to take her to an emergency vet but as I was getting ready to do that I opened the front door and she slowly got up and went to the front door. Since she had responded by getting up I postponed going to the emergency vet. I watched and listened to her all night long as she slept and got up and moved several times throughout the night. I did not give her the Trilostane that morning. After reading several posts from this forum, I contacted my vet this morning to tell her what happened to Bailey. She mentioned that about 63% of dogs will have Cortisol withdrawal and that I could give her 30mg of Trilostane every other day. I told the vet about the UC Davis recommendation that I read about later of 1mg/kg and she agreed that we could then give her 10mg capsules once daily but that she will still be Cushinoid. I am hoping that by reducing the level of Trilostane that it will be better for her to reduce her Cortisol levels more slowly. I don't know if she'll eventually have to go to back to 30mg but I would be very reluctant based on what happened to her earlier. Is it more likely that if Bailey shows some sign of improvement on her next ACTH Stim test but not enough to show that she is within the correct range that she could be given 10 mg twice daily rather than increasing back to 30mg? Bailey will be going back for another thyroid and ACTH Stim test on March 22. I was told to make sure she eats, takes her meds and then the ACTH Stim test would be performed within the 2-3 hour window from the time she eats. This wasn't the case when she was first tested as they had her fast when she had the ultrasound done an then they proceeded with the Stim test. Could her really high pre-Cortysn results been because she had no food or does that not matter until they start taking Trilostane? Is it likely that if and when the Trilostane corrects her Cortisol levels than she may not have to take Thyroid meds anymore? Sorry for such a long post and thank you in advance for any information you can provide. Lynette

[labblab]

Hello and welcome to you and Bailey! I am so glad you've found us, and thank you so much for already providing such helpful information. I regret that I only have time to post a couple of thoughts right now, but I certainly do want to welcome you to our family. I also want to tell you that I've shifted your thread here, to our main discussion forum, where more people are likely to see it and respond. ;)

First of all, I do not know exactly what to make of Bailey's episode of extreme lethargy. But no matter what caused it, I applaud you for sticking to your guns and asking that Bailey's daily trilostane dose be lowered. Your vet is relying on outdated information (Dechra's current insert recommends starting as closely to 1 mg. per pound as is possible using available capsule strengths) and I am hoping that Bailey's experience will end up to be a "teachable moment" for your vet. There is no way that your vet can know in advance whether 10 mg. will turn out to be an insufficient dose -- different dogs of the very same weight can end up requiring widely variable dosages. Only time will tell. And in answer to your question, yes, increasing Bailey's dose to either 20 mg. once daily or 10 mg. twice daily will certainly be a doable option if she needs an increase.

As far as the ACTH testing, it is fine that Bailey was fasted at the time of the first, diagnostic test. The fasting only becomes an issue once the dog starts taking trilostane. This is because the drug must be taken along with food in order to be metabolized properly, which is very important on the day of the test.

I do want to point out that the testing timeframe that you have planned (2-3 hours after dosing) differs somewhat from the timing officially recommended by Dechra, maker of brandname Vetoryl (4-6 hours after dosing). We are aware that some clinicians prefer the shorter timeframe, and it should also be OK since trilostane supposedly reaches optimal effectiveness by 1.5 hours after dosing. But if that's the timeframe you are picking, you should stick to it consistently for all subsequent tests. That way, you are directly comparing apples-to-apples each time.

Oh, and yes, it is possible that Bailey's natural thyroid results will normalize once her Cushing's is well-controlled.

OK, I've got to close for now. But once again, I'm very glad you've found us and I hope that Bailey is doing much better today.

Marianne

[Help4Bailey]

Thanks Marianne for getting back so quickly!

No, I did not pick the 2-3 hour window from the time that Bailey eats, takes her Trilostane and then gets the ACTH test. I thought I read somewhere that testing was 4-6 hrs. I will make sure that each ACTH test is done exactly within the same timeframe. I do know that the vet said that subsequent tests will be about 1/5 the costs as they don't have to use the large amount of Cortysn.

I started Bailey on her new lower dose of 10mg Trilostane yesterday afternoon and she did very well last night with only getting up once! She did have to rush out to pee after she got up but she also ate better this morning.

I am wondering if it's better to have Bailey take her Trilostane in the afternoon with a small meal as it seemed to work well yesterday. Don't know if her appetite has come back because her dosing is less or because her stomach feels better after having been on a round of antibiotics. They first suspected she had a bladder infection before all the urinalysis and blood work testing came back.

I have been reading on different websites that a frozen raw diet is good for a dog with Cushing's. However, my vet is very much against a raw diet. She says that with Cushing's comes a weakened immune system and that all the bad bacteria would not be good for her and that I would be setting her up for more problems down the road. Bailey used to be on Natural Balance Salmon/Sweet Potato but now refuses to eat it. Does anyone have their dog on a frozen raw diet? If not, is there any food that is better recommended for dogs with Cushing's or ingredients to stay away from? Bailey is currently eating a bland diet of cooked chicken and rice as that was the only thing I can get her to eat on a consistent basis since the antibiotics.

Thanks, Lynette

[labblab]

Hi again, Lynette. I'm really glad to hear that Bailey seems to be feeling better! As far as the timing of the trilostane, it may be OK to stick with what you're doing for a few days if it seems to be agreeing with Bailey. But in the long run, Dechra's strong recommendation is that dogs who are dosed only once daily should be given their trilostane in the morning along with a full breakfast. There are a couple of reasons for this: the drug is metabolized best when given with a full meal, morning dosing allows the dog to receive the greatest benefit from the decrease in cortisol during the waking day when the dog is most active, and it also allows for the ACTH testing to be performed during most vets' normal office hours. Although there is variation among individual dogs, trilostane's effectiveness generally wears off after 12-18 hours. That's why some dogs seem to experience better symptom resolution if they are dosed every 12 hours instead of only once a day. But if you are dosing only once in the afternoon, her cortisol level will be peaking again throughout the morning hours.

As far as food suggestions, in honesty, I can't say that in my years on the forum, I have felt as though any particular style seems more suitable or more helpful for Cushpups. I am not a fan of raw feeding myself, but we do have some folks who feed raw food. Other folks feed the whole range of commercial wet, commercial dry, and homecooked. The general recommendation I often make is to serve a food that has a moderate level of good quality protein, and also lower levels of fat. Cushings can affect the kidneys in such a way that protein gets spilled into the urine. If a dog experiences significant urinary protein loss, then it's probably best not to include high levels of protein in the diet. The rationale for the lower fat is to due to the fact that Cushpups may have a higher vulnerability for developing pancreatitis, and higher fat diets may heighten this risk for some dogs. But as I say, these are just general recommendations. So any food with good quality ingredients that tempt Bailey is probably a fine option for you to choose.

I really hope the 10 mg. will do the trick for Bailey, and that she'll continue to feel better with each passing day.

Marianne

[molly muffin]

Welcome. I'm really glad you stuck to your guns and had her dosage lowered. There is no way to say for sure how any dog will react to any drug, but a complete collapse like that is more than cortisol withdrawal I'd think.

When do you do the follow up ACTH test to see how the levels are?

[Help4Bailey]

Hi again Marianne,

I wanted to give you an update on Bailey at the 10mg dosing level vs 30mg that she had serious reactions to and the reason why I was giving her Trilostane in the afternoon instead of the morning. Her next ACTH Stim test will be at 4:00pm with a 2-3 hour window from the time she is fed and given the Trilostane.

It took Bailey about a day and a half to recover and start to show symptoms of Cushing's after being off the 30mg dose.

The first night after the 10mg dosing level with a meal in the afternoon Bailey was able to sleep for 6 1/2 hours without waking us up with the need to pee. Of course when she did get up she peed a flood. She drank a moderate amount of water throughout the day, but not excessive. She had one accident in the house during the first day but otherwise jingled her bell to go outside.

During the 2nd day she was mellow in the morning, did a downward dog stretch that I hadn't seen her do in a long time. She was still alert but not overly active. She is always given her dosing of Thyroid meds with a smaller meal in the morning and in the evening. For most of this day she was very alert and followed us around during the day. She received her afternoon meal which I have made her largest meal along with the Trilostane at about 1:00-2:00pm. She was acting more like herself and even started to bark at her Kong and brought it to us. At about 9:30pm I put her to bed but she did wake me up at Midnight to go out and pee and get a drink. She went back to bed and didn't get back up until 8:00am!!! Yay! We were able to get some desperately needed sleep!

Day 3, so far continues to go well. She definitely drank and peed less today. When she goes in and out to pee I have noticed that her back legs don't whack on the threshold like they used to. She also tried to get up on the couch tonight but didn't make it. I hope that this is a sign that her muscle strength is coming back versus having more out of control cortisol like before. She was able to make a smaller jump up on our deck. What I have noticed is that when I give her the night time Thyroid med she seems to be a little more restless and pants some, but then it goes away. I plan to continue to watch this to see if it's a pattern. She won't have her thyroid checked until March 22 along with her ACTH testing. Maybe she won't need as much thyroid med if the Trilostane helps to improve things. I am hoping that Bailey will be able to sleep again tonight for 6-8 hours!! Keeping my fingers crossed!

I'll explain my thinking or questions about food pertaining to Cushing's in another post. Thanks for listening and your advice. Lynette

[Help4Bailey]

Need advice!!

Bailey is starting to show signs of back leg tremor. I noticed a little when I took her for a short, slow walk yesterday. It subsided after the walk. She had some loose stools on Thursday/Friday when I added some pumpkin to her meals. That seems to have helped.

She has been able to sleep and not get up and pee for 6 to 8 hours at a time at night. Her drinking and peeing during the day have dropped off as well, which is a good thing, I think. She continues to be interested in food and gets up when she thinks we are preparing food in the kitchen and eats her chicken/rice/pumpkin well.

She is on 10mg of Trilostane after having collapsed on 30mg. It was her 6th day of the 10mg that I noticed the tremors, now this morning after she went out to pee I noticed when she came in that her back legs were tremoring. The tremors dissipated after she rested. I also gave her the thyroid medicine this morning when she ate. She mostly rests during the day but gets up and follows us around or gets up when someone comes to the door. She's starting to act more like herself other than the off and on tremors.

Bailey is due to receive her dosing of Trilostane around 1:00-2:00pm with her largest meal and I am debating on whether I should give it to her. I'm not sure what to do? I don't want her to collapse again but so far she has never made it to the 10-14 days to get another ACTH Stim test to know where things stand! Do some dogs just have tremor as a side effect and are OK? Could it be a combo or her thyroid med and Trilostane, too much thyroid (shaking/tremor is a side effect in humans, but couldn't find anything for dogs). Bailey's thyroid levels haven't been re-checked yet as they were going to do them together when she gets the ACTH test. ACTH test to be done on March 22.
Please advise, Thanks, Lynette

[labblab]

Gosh, I know it feels like a hard call, given what you went through with her before. Tremoring is listed as a possible side effect of trilostane, though, so perhaps that is what this is about and it won't get worse. If Bailey is otherwise acting fine, I guess I'd be inclined to go ahead and dose her today in the hope that it is just a temporary issue. But you certainly know her best and if you are worried you can hold off for a day to see what happens.

Marianne

[Help4Bailey]

Thanks Marianne. I did go ahead and give her the Trilostane today. She has been eating and drinking and peeing normally throughout the day and I didn't see the tremors anymore before I gave her the dose.

I'm hoping for the best. March 22nd can't come soon enough so I can get some updated test results.

Lynette

[molly muffin]

My molly gets tremors sometimes. They sort of come and go and it hasn't seemed to affect her energy levels on her walks.

I'd just keep a close eye on her and as long as everything else is fine, then I'd continue with the dosage. If not, then I'd just call the vet and say, she has the tremors again and you want an ACTH done to check levels.
I say this based on her prior reaction.

Levels will continue to drop on the same dose for around 30 days normally.

[DoxieMama]

Hi Lynette,

I don't have advice to offer, but wanted to say I'm happy to hear that Bailey seems to be doing well on the new, loser dose. Thinking positive thoughts for you both!

Shana

[Help4Bailey]

Thank you Sharlene. I will definitely call the vet if I see more tremors and get her ACTH levels checked.

I haven't seen anymore tremors today. Bailey is starting to act more like her old self but at the same time she got me up last night to pee after about 4 1/2 hours, went back to sleep, and was able to go another 5 hours. Last night was the first night she didn't sleep through since a week ago Monday, so I hope her cortisol levels aren't going back up. Maybe her cortisol levels were really low from the previous 30mg and her body is now adjusting to the 10mg.

Shana - Thank you for your positive thoughts!

Lynette

[Help4Bailey]

Hi all!

Good news!
Bailey's 2nd ACTH after being on 10mg of Trilostane came way down!

Originally ACTH Stim test - Pre 26.9 and Post 39.5

Today - March 23,2016
Pre 9.2
Post 8.4
Optimal range 1.5 - 9.1

Her Thyroid level is also good at 4.5 with a range for a dog on thyroid meds of 3 - 5.

Vet is keeping her on 10mg once daily. She didn't mention anything about another ACTH Stim test in her voice message or any other testing.

Should I be requesting another ACTH Stim test at the end of the 30 days on the 10mg as well as another blood panel to see if the ALKP, Cholesterol, PrecisionPSL, Platelet count, and BUN levels have decreased? Should I also be requesting another Urinalysis since her Specific Gravity was 1.015, pH 8.0, Protein 3+, and Occult Blood 2+?

Bailey is eating well, tries to get on couch but can't yet, is drinking less water and peeing less. Although the night time peeing during our sleeping hours vary. Sometimes she gets up 1 time, 2 times, or sometimes she sleeps all the way through. Yesterday before she had the ACTH Stim test I noticed a new hot spot. Am I to assume that this is something that Cushpups have to deal with. Bailey also has a prescription of Gentamicin that also has Betamethasone Valerate that is a cortisone. Do I have to be concerned about this topical spray being it has cortisone in it for itching?

Thanks,
Lynette

[molly muffin]

On the day they get the ACTH test, the excess cortisol is dumped into their body (the post measurement) So I call the ACTH bounce or spaz. It usually goes away in around 48 hours.

You could opt to retest in about another few weeks. If she continues even after a month or so on medicine to peeing at night, then you might want to consider a split 5mg am and 5mg pm.

[Help4Bailey]

Thanks Sharlene!

With the post ACTH reading of 8.4 which is less than Bailey's pre of 9.2, does that mean that after they give her the Cortisol injection that the Trilostane pill is working correctly and acting on the excess Cortisol? I was surprised to see that the post reading was lower than the pre reading. I assumed that it would still be higher due to the injection.

I will continue to monitor how often Bailey gets up at night and then address the issue of whether we will need to split the dose.

Lynette

[Harley PoMMom]

With Cushing's that pre number isn't look at with real importance unless Addison's is suspected. Now, the post number is very important, this tells how the adrenal glands are working and if they are producing enough or too much cortisol.

If this were me I would definitely want an ACTH stimulation test performed at that 30 day mark.

Hugs, Lori

[Help4Bailey]

Hi Lori and all,

I just read on another person's post that if the post numbers on an ACTH test are lower than the pre numbers that it could be that the adrenal glands can't produce reserve cortisol due to an overdose of trilostane.

Originally Bailey was on 30mg of Trilostane for 4 days and had to be removed because she collapsed. Before she started Trilostane her ACTH results were pre 26.9, post 39.5. It took Bailey a day and a half for her Cushing symptoms to reappear after removing the 30mg Trilostane. She then started on 10mg and had her 2nd ACTH test with pre 9.2, post 8.4.

What I thought were good numbers may not actually be??? Could the adrenal glands have been permanently damaged by the higher dose for her to now have lower post numbers than her pre numbers?

Hope to hear from you or someone.
Lynette

[labblab]

Hi Lynette!

You are asking some very good questions, but no, I don't think you need to worry about permanent damage in conjunction with Bailey's ACTH results. It is true that sometimes a lower "post" may be a cause for worry, but like so many things in life, it all depends on context. If the "pre" and "post" results are both very low and flat (or a lower "post") and a dog is acting ill, there may be cause to worry that the adrenal glands have been oversuppressed and are not reacting normally to ACTH stimulation. And in the past, the expectation was that the "post" would/should always be higher than the "pre" under normal circumstances. However, with additional years of clinical experience with trilostane, it has been found that it is actually not uncommon for some dogs with therapeutic results to show the same testing pattern as does Bailey. We have at least a couple of other dogs here who have done well taking trilostane but who consistently have higher "pres" than "posts." So with cortisol levels as robust as Bailey's right now, I personally would not worry that the "post" is lower.

So I think you guys are on the right track, and I would stick with the 10 mg. throughout the first month of treatment, too. However, I totally agree with Lori that I would want the ACTH repeated after 30 days. If some of Bailey's symptoms still remain at that time and her "post" result is higher than 5-6 ug/dL, you may consider a dosing increase or a split dose as Sharlene has mentioned.

Also, as far as your earlier question about the spray, you do need to be careful about introducing additional steroids in the form of topical drops, sprays, and ointments. However, if you are using only a little bit of spray for a limited time on a localized hotspot, I wouldn't think that it would have a significant negative effect.

Marianne

[Help4Bailey]

Hi everyone,

Marianne, Thank you for the explanation of the pre/post figures. That helps to ease my mind. I will definitely request another ACTH test at the end of 30 days to see if her cortisol levels continue to drop and to see if Bailey normally/consistently presents with a lower post number than the pre number. I was thinking the same thing about the dosing if some of Bailey's symptoms continues after a month.

On the day that Bailey was having her 2nd ACTH test, I remember asking the vet about when then next ACTH test and blood work would be and she mentioned a year!! At the time I thought that was highly extreme but figured I would address the ACTH testing after her 2nd results came in. So thank you again!

I was concerned about the topical spray also as it says to drench the area 3 times a day for 7 days. Is there any over the counter sprays that don't have any cortisone in them that people have used? Or a different prescription topical antibiotic without cortisone? Until Bailey was diagnosed with Cushing's this month she never had any hot spots/sores on her body. This is now the 2nd one.

Lastly, I have "How the forum question/reply works". Is there anyway to reply to a specific individual other than replying to a last reply? I think I have missed replying to other people and thanking them for their advice/information or being able to extend a conversation in regards to their response directly.

Lynette

[labblab]

I'm actually using a similar antibiotic/antifungal/steroidal spray on a hotspot on one of my nonCushpup Labs right now. It may even be the same one as you are using! Anyway, yes, there are other sprays or ointments that don't include steroids. And if Bailey ends up needing something for longer than the week, you can definitely talk to your vet about a nonsteroidal alternative. However, the benefit of the steroid is that it is an anti-inflammatory and, as you know, it helps control itchiness, redness, and irritation. So it becomes a bit of a trade-off, in that you don't want to be adding a lot of additional steroids, but if a short course of the steroid will resolve the hotspot more quickly and efficiently, that is a benefit in and of itself. How many days do you have left of the spray? Honestly, if it was me, I believe I'd just go ahead and finish this course of it. Even though some of the steroid is absorbed into the system, it's typically far less than if it was being given orally or by injection.

Also, if you want to reply to something specific that's been written to you earlier in your thread, you can go back to that reply and select the little blue "Quote" button at the bottom right-hand corner of the reply. By doing so, the text of that reply will show up inside a new window wherein you can also add your own new text, as well. Once you post it, this new reply will automatically be added at the end of your thread chain. Don't know whether I've explained this very clearly, but hopefully it will make sense to you! Good luck!

[labblab]

Lastly, I have "How the forum question/reply works". Is there anyway to reply to a specific individual other than replying to a last reply? I think I have missed replying to other people and thanking them for their advice/information or being able to extend a conversation in regards to their response directly.

Lynette
Here's an example of what I was talking about above. ;)

[Help4Bailey]

Oh! I see the Quote button and the message with a "Quote" now! Thanks!

Bailey has 4 days left and will finish her 7th day on Monday. I'll go ahead and finish up with the Gentamicin and Betamethasone Valerate spray. It is helping and if she continues to get re-occuring hot spots and I notice that she seems to exhibit more symptoms of higher cortisone then I will ask the vet if there is something else we can use.

Thanks again and have a great day!
Lynette

[molly muffin]

We've had other dogs whose pre is usually higher than the post. Unless it is very low, I wouldn't be overly concerned about.

A year!! Oh no, I wouldn't wait that long, I'd have a nervous break down!!! LOL :)

Usually once you get stable you can test every 3 months and if that stays okay and in the same range, you can go to every 6 months. 3 months is about the longest I can go without testing as I start to worry that something is going on that I might miss and sure enough we've had a few things crop up, like her cortisol going up unexpectedly and we have to increase the dose, etc.

[Help4Bailey]

Sharlene,

Ya, I couldn't go a year either! I don't know what she is thinking unless I misinterpreted her and she only meant other blood work, but I think that is important also. I will be talking with the vet on Monday so I will get everything clarified with her then.

Lynette

[molly muffin]

Did you get everything clarified with the vet?

[Help4Bailey]

Hi Sharlene and all,

I went into the office to pick up Bailey's prescriptions for Trilostane and Thyrosyn so that I could research where to get her meds at instead of the vets office which are too expensive. Does anyone have any recommendations? She is on 10mg Trilostane once daily. Thyrosyn .2mg twice daily.

Bailey's 30 day mark is next week so I was waiting to see how she did to see if I had to address a split dose of 5mg/5mg and at the same time address another ACTH Stim test. Bailey's next Senior checkup is in late June but I don't want to wait that long. I want to also get complete blood work done as well as another urinalysis to be able to compare the most recent results to see if any of the figures have improved.

I hadn't mentioned in my first post that just before Bailey was diagnosed with Cushing's she went temporarily blind. I did the cotton ball test on her and she reacted to nothing, the cotton balls just kept hitting her in the face with no reaction. She was walking into things and getting lost. I mentioned this to the vet after the Cushing's confirmation but they were stumped as to why this would have happened. At the time she was on Clavamox and I had given her her Trifexis for the month. I thought it was due to one of these drugs. However, after reading some other posts her blindness might have been due to high blood pressure. The vets have never said anything about her blood pressure. One had mentioned a heart murmur in the past but nothing about blood pressure. Since this temporary blindness occurred and rectified itself (all which occurred within a 5 day period of time) and after her blood work showed really low T4 thyroid levels and they placed her on Thyroid meds could the blindness have been attributed to having such a low T4 or should I be requesting that they check her blood pressure?

Bailey is doing well on 10mg once daily. No accidents in the house at all! She has been sleeping through the night for about 6-7 hrs without having to get up to pee. She was even able to go for a walk and jumped on the couch! We took it slow on the walk and she set the pace. We have been monitoring her water and she is currently drinking her weight in water not much more. She seems much happier and more like her old self minus the peeing/accidents/water consumption. She still likes to eat but isn't as ravenous as before although she will still come and stare at me when it's time to eat!

Thanks in advance for advice!
Lynette

[judymaggie]

Hi, Lynette! I wanted to let you know that I purchase 10 mg. Vetoryl tablets from California Pet Pharmacy. 30 tablets cost $41.95. Here is a link to their page that shows how to order:

http://www.californiapetpharmacy.com/how-to-order-rx.html

My vet is very willing to work with me to find the least expensive medications for my dog. Hopefully, yours will do the same.

Are you going to have an ACTH at the 30 day mark? As Sharleen posted, typically the next ACTH, after the one at the 30 days, would be at the 3 month mark if everything is going well. Like Sharleen, I am uncomfortable going longer than that. Each time I have the ACTH run I also have a super chem panel run to make sure electrolytes and other measures are okay.

[Harley PoMMom]

When sudden blindness is mentioned SARDS comes to my mind so I wanted to share this post from Marianne:
Hello and welcome to you and your sweet boy. I'm surely sorry for the problems that have brought you to us, but also really glad that you've found us.

As soon as you mentioned sudden blindness, my mind turns to the possible diagnosis of SARDS. It is a syndrome of unknown origin that causes sudden blindness in dogs, along with certain other symptoms that overlap with (and can be confused for) Cushing's, including excessive thirst, urination and hunger. One thing I am uncertain about is whether or not the dog's pupils become totally nonreactive to light with SARDS. However, if SARDS is suspected for Leo, it is possible that he does indeed also have Cushing's, but it is also possible that the diagnostic blood tests for conventional Cushing's may be negative. Of course, it is also possible that his blindness has not been caused by SARDS, but instead by some other issue which may or may not be Cushing's-related (e.g., high blood pressure leading to retinal bleeding, etc.).

Can you tell us more about the other symptoms that are leading you to test Leo for Cushing's? Also, SARDS can be ruled in or out by an eye examination conducted by a vision specialist. So I don't know how extensive Leo's eye diagnostics have been so far.

Regardless of the cause of blindness, I surely understand why you are feeling so worried and protective of your little boy. We do have members with dogs who have gone blind for a variety of reasons, and I'm hopeful they will be stopping by to give you some tips. Also, in the event that Leo might indeed have SARDS, here's a reply that I posted some time ago to another member. I'm hopeful it will make you feel better about Leo's future, regardless.


Also, I just came across this 2013 article from the Journal of the American Veterinary Association that I found to be very interesting, and you may, too.

Long-term outcome of sudden acquired retinal degeneration syndrome in dogs (http://avmajournals.avma.org/doi/abs/10.2460/javma.243.10.1426)

100 dogs with SARDS were examined at five different vet schools between 2005 and 2010, and these were the main results.


Results—Age at diagnosis was significantly correlated with positive outcome measures; dogs in which SARDS was diagnosed at a younger age were more likely to have alleged partial vision and higher owner-perceived quality of life. Polyphagia was the only associated systemic sign found to increase in severity over time. Medical treatment was attempted in 22% of dogs; visual improvement was not detected in any. Thirty-seven percent of respondents reported an improved relationship with their dog after diagnosis, and 95% indicated they would discourage euthanasia of dogs with SARDS.
Although some pieces were discouraging: medical treatment did not improve vision for any dogs, and the other overt symptoms did tend to persist over time. But excessive hunger was the only systemic symptom that increased, and I found it very interesting that so many owners reported an improved relationship with their dogs afterwards, and the overwhelming majority -- 95% -- did not perceive SARDS to be a reason for euthanasia. I found that to be a very positive indicator of quality of life after diagnosis.

Here is another article that summarizes this research in much greater detail. Once again, I felt as though the overall conclusions were quite positive.

http://speakingforspot.com/blog/2014/07/13/sudden-acquired-retinal-degeneration-syndrome-sards/




I see I've already written a book here, so I'll stop for now! But once again, welcome to you and Leo, and we'll be very interested to read any additional info you care to share with us.

Marianne

Hugs, Lori

[DoxieMama]

Hi Lynette,

We got our Trilostane from Diamondback Pharmacy in AZ. $37.95 for 10mg dose (plus shipping).

How is Bailey doing now? Did you have the 30 day ACTH test done?

Shana

[Help4Bailey]

Hi Shana,

I spoke with the vet about the 30 day, 90 day protocol from Dechra and she said that she was happy with Bailey's results from her 14 day ACTH Stim Test. The results from Antech stated that if pre & post cortisol levels between 1.5-9.1 ug/dL indicate optimal control. Bailey's pre was 9.2 with post of 8.4. She thought that the pre of 9.2 was close to the 9.1 and since Bailey was doing well they would keep her on the 10mg which they keep telling me is a low dose. The most I could get out of her was that if Bailey started having accidents or began to get up in the middle of the night to pee then I could request another ACTH Stim test.

Since her first ACTH Stim test was scheduled for very late in the day I had her on 3 meals a day giving her the Trilostane in the afternoon. I now have her back on 2 meals a day with the Trilostane given with her morning meal after about an 1 1/2 hours after she takes her thyroid medication. So far, Bailey has had one accident in the house which we didn't get to her in time to let her out, sleeps 8 hours at night, eats more calmly and drinks less water which I have been monitoring by measuring her water.

With the one accident I did notice that her pee smelled like pee now.
I called and had the vet run another urinalysis but this time from a first morning urine draw to see if there was still protein and blood in her urine and to check the specific gravity to compare to her prior results. The protein went from 3+ to 2+ and blood from 2+ to 1+ and specific gravity from 1.015 to 1.017 range 1.015 - 1.050. Vet still says her urine is dilute even though within range. They like to see it about 1.025 or so. I asked if the blood and protein in the urine had to do with Bailey's kidneys, which I always thought it did, but the vet said it was due to the Cushing's. Since I told her about changing Bailey's time from afternoon to morning for her Trilostane and during that time, two nights she had to get up to pee, that she said that if that continued, which it hasn't, that she would put Bailey back on 30mg! I'm NOT doing that after her bad reaction to 30mg. She didn't even say she would do a Stim test before changing and primarily was using the urinalysis report of protein in the urine to dictate that the 30mg would take care of the protein! I have noticed recently that Bailey has some mild tremors in her hind leg although she jumps on the couch and deck now with no problems. If the tremors continue I will have to force the issue to get another T4 done and/or ACTH Stim test. Bailey's Microalbuminuria was still also HIGH >30 with range <2.5 mg/dL. Should the vet be checking her urine protein : creatinine ratio?

I called and spoke with Diamondback and the representative told me that they couldn't make up 10mg of Trilostane but if it was 9mg or 11mg they could. I wasn't quoted the price of $31 for 10mg of Vetoryl/Trilostane, I was quoted more than the $52 total that I am paying through VetRxDirect, so I went with VetRxDirect. My vet originally gave me some other compounding company that I could use that they recommended but they had an F rating with BBB, so I stayed clear of that company. If Bailey continues to do well on the 10mg and to reduce my cost further since I'm on a fixed income, maybe the vet would prescribe 9 or 11mg for compounding and I could use Diamondback which I was hoping I would be able to do.

Lynette

[DoxieMama]

Lynette,

Thanks for the update!

Sorry, I misspoke above. The price I was quoted was for 11mg. Not sure why I typed 10.

My vet essentially has the same viewpoint; since the 14 day result is good, then we don't need to test again for 90 days. I will request another at the 30 day mark anyway. From what I've been told, cortisol continues to decrease for the first 30 days on a new or lower dose, which is why the manufacturer recommends the 14, 30, 90 day protocol.

I would do the 30 day test to see what her levels are at that time, and if those are good and symptoms are resolved, then you're golden.

Shana

[Help4Bailey]

Hi, Lynette! I wanted to let you know that I purchase 10 mg. Vetoryl tablets from California Pet Pharmacy. 30 tablets cost $41.95. Here is a link to their page that shows how to order:

http://www.californiapetpharmacy.com/how-to-order-rx.html

My vet is very willing to work with me to find the least expensive medications for my dog. Hopefully, yours will do the same.

Are you going to have an ACTH at the 30 day mark? As Sharleen posted, typically the next ACTH, after the one at the 30 days, would be at the 3 month mark if everything is going well. Like Sharleen, I am uncomfortable going longer than that. Each time I have the ACTH run I also have a super chem panel run to make sure electrolytes and other measures are okay.

Hi Judy,

Sorry I didn't get back to your response earlier, but thank you for your input about California Pet Pharmacy. I had researched them earlier and was going to use them as their price was cheaper and they were located in California but I checked them out on Better Business Bureau and they had an F rating, so I went with VetRxDirect who had an A+ as well as good reviews.

Unfortunately, my vet is not very helpful when it comes to ordering drugs through online pharmacies as she won't fax or speak with them regarding prescriptions. I have to mail the original prescription, so I didn't want to take a chance on a company that didn't have a good rating. However, both of these companies are on the Vet-VIPPS list from the National Association Boards of Pharmacy.

Have you had any problems with product/delivery? That seems to be where all the negative posts were.

Lynette

[judymaggie]

Lynette -- interesting about the "F" rating. I have not had any issues with California Pet Pharmacy. They respond promptly and orders are shipped expeditiously. My vet prescribed several refills so that has helped. I am sorry that your vet is not more cooperative with regard to on-line pharmacies. My vet's only concern with California Pet Pharmacy was that they did not repackage the Vetoryl (he thought they might since their price was so low) -- he called them and was reassured that their Vetoryl comes directly from Dechra. Between Abbie and my last beagle, Maggie, I have paid my vet thousands of dollars --- he does try to save me money whenever he can.

[Help4Bailey]

Did you get everything clarified with the vet?

Hi Sharlene,

I spoke with the vet about the 30 day, 90 day protocol from Dechra and she said that she was happy with Bailey's results from her 14 day ACTH Stim Test. The results from Antech stated that if pre & post cortisol levels between 1.5-9.1 ug/dL indicate optimal control. Bailey's pre was 9.2 with post of 8.4. She thought that the pre of 9.2 was close to the 9.1 and since Bailey was doing well they would keep her on the 10mg which they keep telling me is a low dose. The most I could get out of her was that if Bailey started having accidents or began to get up in the middle of the night to pee then I could request another ACTH Stim test.

Since her first ACTH Stim test was scheduled for very late in the day I had her on 3 meals a day giving her the Trilostane in the afternoon. I now have her back on 2 meals a day with the Trilostane given with her morning meal after about an 1 1/2 hours after she takes her thyroid medication. So far, Bailey has had one accident in the house which we didn't get to her in time to let her out, sleeps 8 hours at night, eats more calmly and drinks less water which I have been monitoring by measuring her water.

With the one accident I did notice that her pee smelled like pee now.
I called and had the vet run another urinalysis but this time from a first morning urine draw to see if there was still protein and blood in her urine and to check the specific gravity to compare to her prior results. The protein went from 3+ to 2+ and blood from 2+ to 1+ and specific gravity from 1.015 to 1.017 range 1.015 - 1.050. Vet still says her urine is dilute even though within range. They like to see it about 1.025 or so. I asked if the blood and protein in the urine had to do with Bailey's kidneys, which I always thought it did, but the vet said it was due to the Cushing's. Since I told her about changing Bailey's time from afternoon to morning for her Trilostane and during that time, two nights she had to get up to pee, that she said that if that continued, which it hasn't, that she would put Bailey back on 30mg! I'm NOT doing that after her bad reaction to 30mg. She didn't even say she would do a Stim test before changing and primarily was using the urinalysis report of protein in the urine to dictate that the 30mg would take care of the protein! I have noticed recently that Bailey has some mild tremors in her hind leg although she jumps on the couch and deck now with no problems. If the tremors continue I will have to force the issue to get another T4 done and/or ACTH Stim test. Bailey's Microalbuminuria was still also HIGH >30 with range <2.5 mg/dL. Should the vet be checking her urine protein : creatinine ratio?

Lynette

[molly muffin]

Cushings, high cortisol, can affect the kidneys. But it is the cushings that can cause it, as they pee, they drink, they pee, they drink, so much. They drink to stay hydrated because they are peeing so much, so the kidneys are working over time.
In some dogs under treatment this will clear up, in others it won't, it will stay the same in some it will develop into kidney problems.
I do think that it looks like there is good response as far as specific gravity and a lower of protein loss, so hopefully that will get even better going forward.

[Help4Bailey]

Hi Sharlene,

I spoke with the vet about the 30 day, 90 day protocol from Dechra and she said that she was happy with Bailey's results from her 14 day ACTH Stim Test. The results from Antech stated that if pre & post cortisol levels between 1.5-9.1 ug/dL indicate optimal control. Bailey's pre was 9.2 with post of 8.4. She thought that the pre of 9.2 was close to the 9.1 and since Bailey was doing well they would keep her on the 10mg which they keep telling me is a low dose. The most I could get out of her was that if Bailey started having accidents or began to get up in the middle of the night to pee then I could request another ACTH Stim test.

Since her first ACTH Stim test was scheduled for very late in the day I had her on 3 meals a day giving her the Trilostane in the afternoon. I now have her back on 2 meals a day with the Trilostane given with her morning meal after about an 1 1/2 hours after she takes her thyroid medication. So far, Bailey has had one accident in the house which we didn't get to her in time to let her out, sleeps 8 hours at night, eats more calmly and drinks less water which I have been monitoring by measuring her water.

With the one accident I did notice that her pee smelled like pee now.
I called and had the vet run another urinalysis but this time from a first morning urine draw to see if there was still protein and blood in her urine and to check the specific gravity to compare to her prior results. The protein went from 3+ to 2+ and blood from 2+ to 1+ and specific gravity from 1.015 to 1.017 range 1.015 - 1.050. Vet still says her urine is dilute even though within range. They like to see it about 1.025 or so. I asked if the blood and protein in the urine had to do with Bailey's kidneys, which I always thought it did, but the vet said it was due to the Cushing's. Since I told her about changing Bailey's time from afternoon to morning for her Trilostane and during that time, two nights she had to get up to pee, that she said that if that continued, which it hasn't, that she would put Bailey back on 30mg! I'm NOT doing that after her bad reaction to 30mg. She didn't even say she would do a Stim test before changing and primarily was using the urinalysis report of protein in the urine to dictate that the 30mg would take care of the protein! I have noticed recently that Bailey has some mild tremors in her hind leg although she jumps on the couch and deck now with no problems. If the tremors continue I will have to force the issue to get another T4 done and/or ACTH Stim test. Bailey's Microalbuminuria was still also HIGH >30 with range <2.5 mg/dL. Should the vet be checking her urine protein : creatinine ratio?

Lynette


Hi Sharlene and all,

My vet wants me to increase Bailey's Trilostane from 10mg to 20mg once daily without a 30 day Stim test or additional testing other than the urinalysis results from April 8 above that I requested. Bailey has been on Trilostane 10mg for 51 days with one Stim test at 14 days. Above quote message shows results. Vet wants me to put her on 20mg for 5 days. I have an appointment with her and Bailey on Monday, May 2 but not for any planned testing. I am torn on what to do. Should I just wait for the appointment on May 2 and explain to her in person why I am requesting these tests and not increase the dosage? I don't know if she'll do a Stim test at 14 days, 30, or not at all if I do increase the dosage.

My reasoning why I called the vet today:
We have noticed that over the last week Bailey has had a few more accidents during the day and I noticed that she shakes or has some tremors like she did when she was on 30mg Trilostane when she crashed. She generally sleeps at night 7-8 hours without having to get up to pee. She is currently on 10mg Trilostane and now weighs 22.4 lbs down from 26.8 since starting Thyroid meds on Feb 15. I realize that Bailey is on a low dose of 1mg/kg versus the 1mg/lb of Trilostane and that 20mg would be appropriate dosing. But do I do the increase without any additional testing?

I wanted to find out whether the Thyroid meds could be causing the shakes/tremors by getting another T4 test and at the same time get a complete blood panel work up to see if the 10mg Trilostane has improved any of her ALK, BUN, Cholesterol, PrescisionPSL, Albumin, A/G Ratio, etc. I am also cooking/preparing Bailey's food from fixed recipes from Dr. Becker's, DVM Real Food Book and including bone meal and appropriate minerals based on food serving size. Also, since the vet previously said that if Bailey was to continue to have any accidents beyond that one that she had previously that I could request another Stim test which I did along with blood work and T4 through her staff. The staff set me up for an appointment on Monday to get me on the schedule to get an appointment with the vet to see what to do. Staff spoke with the vet and I got a call back stating that before anymore tests the vet wanted me to increase her Trilostane dosage to 20mg for 5 days then go from there.

How am I to know if her current dosage has changed any blood work for the better or worse as well as whether the current Trilostane dosage has affected the levels of her thyroid? How am I to know if she is truly getting the correct amount of necessary bone meal and minerals with her food without any testing? What would you do if you were me? Thanks in advance. Lynette

[DoxieMama]

Lynette,

I'm no expert, not even close. But I agree with your thoughts. If you've only had the one Stim test at 14 days then I would absolutely request another one be done now. Even if the vet weren't requesting a change in the dose, I'd want one done, especially since you're seeing return of some of Bailey's symptoms. Without a doubt, I would test before changing the dose... and then if a dose change is warranted, you have to restart the testing schedule at 14 days again.

We had an ACTH test done at 11 days and my vet said that we wouldn't need another for 3 months. But I called in and requested another one anyway, which we are doing today at 24 days. I don't want to refill Visuddha's prescription unless I am certain the dose is right, and the only way to be certain is to test.

Shana

[Harley PoMMom]

With a dosage adjustment I would definitely want an ACTH stimulation test performed within 10-14 days, and this is the protocol that Dechra states in their product insert. They also recommend having a chemistry blood panel done with paying particular attention to the electrolyte levels.

I'm including a link to Dechra's product insert: Dechra's U.S. Product Insert (http://www.dechra-us.com/Admin/Public/Download.aspx?file=Files%2fFiles%2fProductDownload s%2fus%2fvetoryl-5mg-pack-insert.pdf)

Hugs, Lori

[molly muffin]

Your vet wants to increase dosage of trilostane based on the amount of protein in the urine?
There is no way I would do that without an ACTH to know what is going on with her and a repeat urinalysis and culture and then if it warranted an increase based on ACTH results, I would go up slowly. She is on 10mg now, I wouldn't go to 30mg based on the last reaction either. So, I'd see what the tests show and then decide, making an informed decision rather than an uninformed guess.

[Renee]

Hi there - I haven't contributed to your thread yet, but I just spent some time reading through it.

I'm not sure if there are other vets in your area that you can try out, but your vet scares me with her treatment. When a dog starts vetoryl, they should be tested at the 14 day mark, then again at 30 days, then every 3 months, assuming proper range and control of symptoms. If you are seeing a recurrence of symptoms, the best idea is to run a stim test, assess where the cortisol is, then make a dosing decision. And, start the testing protocols over again. Now, the 14 day mark has been sidelined by many vets, and I can understand why (I have skipped it more than once), but after so long on the dose your pup is on, I cannot fathom blindly increasing the dose, nor judging her needs based on a urine test. I believe your vet is being careless and I'm really unsure why.

Incidentally, I have been using California Pet Pharmacy for the last 2 years. Never once have I had an issue. It was a bit of work to get the initial set up done (calling the vet, ect), but it's been smooth sailing since then. My vet just sent them authorization for unlimited refills, so I never have to bother her.

[Help4Bailey]

Your vet wants to increase dosage of trilostane based on the amount of protein in the urine?
There is no way I would do that without an ACTH to know what is going on with her and a repeat urinalysis and culture and then if it warranted an increase based on ACTH results, I would go up slowly. She is on 10mg now, I wouldn't go to 30mg based on the last reaction either. So, I'd see what the tests show and then decide, making an informed decision rather than an uninformed guess.

Sharlene,

Basically, the answer to your question is Yes.

I requested a urinalysis be done after Bailey had a couple pee accidents. When I wiped it up I noticed that it smelled like pee which it hadn't in a long time.

I already knew that the vet was not open/receptive to having a 2nd Stim test (since she originally said in a year) and I wanted to check to see if her protein and blood in her urine had gone down and to check on the specific gravity. The results on April 8 showed both the protein and blood in the urine had gone down and the specific gravity went up to 1.017 which was within the range but the vet said the urine was still dilute and likes it to be more in the 1.025 range.

I asked if this was due to her kidneys and she said no it was due to Cushings and to correct it would be to have Bailey take 30mg every other day. I told her that I didn't think that was a good idea since I thought that would make the cortisol levels too inconsistent from day to day. I let the idea of 30mg drop from the conversation, but asked if Bailey were to continue with her accidents if I could get another Stim test and at that time she said yes. She also said I could do another urinalysis if I was still concerned about the protein and blood in her urine.

Bailey stopped with her accidents and didn't have anymore until late last week that's why I called the vet this week. I didn't get to speak directly to the vet as she was with a patient. The staff talked with her and relayed my requests for Superchem, T4, Stim Test, and urinalysis. When the office called back they said the vet wanted me to give Bailey 20mg of Trilostane for 5 days and then we'd go from there. No mention of any tests. I asked the staff member, so the vet wants me to up her meds with no testing, and she said yes. The staff member relaying the information could tell I wasn't too pleased so I don't know if she relayed that to the vet or not. I did not say that I would or wouldn't be giving her the increase but was keeping the May 2nd appointment.

I have not given her the increase as I felt this wasn't a good idea without doing any testing to see where Bailey was at even though 20mg would be an appropriate dose based on her weight of 22.4 lbs.
I am being very cautious due to the vet starting her out on an initial dose of 30mg. I am just very frustrated that I can't get tests that I want and maybe it's time to move to a different office/vet.

Lynette

[Help4Bailey]

Hi there - I haven't contributed to your thread yet, but I just spent some time reading through it.

I'm not sure if there are other vets in your area that you can try out, but your vet scares me with her treatment. When a dog starts vetoryl, they should be tested at the 14 day mark, then again at 30 days, then every 3 months, assuming proper range and control of symptoms. If you are seeing a recurrence of symptoms, the best idea is to run a stim test, assess where the cortisol is, then make a dosing decision. And, start the testing protocols over again. Now, the 14 day mark has been sidelined by many vets, and I can understand why (I have skipped it more than once), but after so long on the dose your pup is on, I cannot fathom blindly increasing the dose, nor judging her needs based on a urine test. I believe your vet is being careless and I'm really unsure why.

Incidentally, I have been using California Pet Pharmacy for the last 2 years. Never once have I had an issue. It was a bit of work to get the initial set up done (calling the vet, ect), but it's been smooth sailing since then. My vet just sent them authorization for unlimited refills, so I never have to bother her.

Hi Renee,

Thank you for responding regarding the dosing and the testing. I agree. I am very frustrated with the vet. I gave a detailed explanation to Sharlene in a previous post today about dosing and testing, so I won't repeat it again here.

The vet that is currently seeing Bailey is not her normal vet due to her original vet had a baby when all the Cushing tests started and won't be returning for awhile. I was told by the office staff and the vet that they will not fax nor speak to any online pharmacy so I figured if I had any problems I wouldn't get any support from the vet or vets office. I am glad that you have not had any problems with California Pet Pharmacy. I had wanted to use them since I am in California and they were cheaper and figuring I could get the meds quicker, but because of the vet/office and their policy I didn't want to take the risk based on the BBB rating.

Lynette

[Help4Bailey]

Sorry it's been so long since I have posted, but I have been busy with an IMS in Endocrinology that Bailey has been seeing since the middle of May. I am glad that I learned about Sage Centers here in California.
Thank you so much for the advice of getting an IMS versus Bailey's general vet!

Bailey has had several STIM tests that have showed that she was overmedicated on 20mg (10mg x 2 daily) and 10mg (5mg x 2 daily).
She actually was off the Trilostane for over 3 weeks when symptoms started returning along with a new hot spot this past Sunday.

She has also been diagnosed with kidney disease and we having been working with a nutritionist from Cornell University using a home cooked diet. Her thyroid med has also been reduced as she was overmedicated. Her blood pressure was checked and was originally 200 but after having me in the room it dropped to normal levels, but the IMS is still watching this closely. Her eyes were checked by the IMS with regards to her temporary blindness that occurred in Feb when everything first started with no retinal bleeds or detachment. So far so good with no recurring blindness.

Her last STIM test 6-28-16: Pre: 10.6 Post: 26.5
Normal Range Pre: 2-6, Post: 6-18

Bailey is back on 5mg Trilostane, but once daily. She now weighs 21.34 lbs (9.7kg) down from 26.9 lbs. May possibly have to compound at 2.5mg twice daily, but IMS suspects over time Bailey will probably have to increase but watching kidneys as well.

Bailey's BUN levels have come down from 111 to 61 to 52.
Normal range: 10-26 using in-house from IMS.
Creatinine 1.0, Normal range: 0.5 - 1.3.

Before Bailey originally started 30mg Trilostane in March her BUN level was 39, Normal range: 6-31 using ANTECH from general vet.

Bailey will be having additional STIM tests as well as Chem panels to check electrolytes, BUN levels, etc., over the next week and months. I'm hoping we can find a happy medium here with the Trilostane, diet, and testing as it's very expensive.

Sharlene - I believe I read where your Cush pup also has kidney disease and has experienced blindness or is blind due to high blood pressure. How are you balancing kidney disease with Cushing's?

Lynette

[molly muffin]

We are balancing with some difficulty in that her Kidney disease is probably more important at this point than the cushings, but I actually think that if we can keep trying to balance both, that one helps the other. It is delicate though and food is something we have some difficulty with. I currently cook a ground protein, to top off her kidney perscription food, to get her to eat enough and it is still a trial.

Molly's cortisol is currently controlled, although a bit higher than we'd like ultimately but she gets the shakes bad if we go lower. Now I'm trying to see if the kidney values went up with the cortisol lower and if they will go down a bit with cortisol a bit higher. Although then I expect her UPC that came down with better cortisol control will go up again.
As I said a balancing act, and I have found having an IMS to be invaluable.
Actually the BP might be more important than the kidney as her has been staying too high, even though we've increased BP med, but it has made new retinal bleeds occur which has increased her blindness.
ARGHHH It is frustrating isn't it. But we do the best we can.

I would any day of the week just like to be dealing with only cushings. It is in the end much easier than adding kidneys into the mix. :)

Keep us posted as to how things are going.

[Help4Bailey]

Our dear sweet Bailey crossed over the Rainbow Bridge yesterday. We are devastated by her loss but know in our hearts that she is now in a better place.

Her body just couldn't withstand the devastation of Cushing's and kidney disease. Even though she was on Mirtazapine, Metronidazole, Amlodipine, Cerenia, Pepcid, supplements and subcutaneous fluids, it wasn't enough. Due to her worsened kidney function we couldn't put her back on the 2.5 mg Trilostane. She still couldn't eat enough and she suffered two seizures and possibly more that we don't know about. Her body seemed to quiver all the time but worst while at rest and after the second seizure struggled to maintain her balance. She was very confused, uncomfortable and would wander the house aimlessly while trying to move from place to place.

We knew that we had to release her from her struggling body. She is now free to run and play. We miss her deeply.
Lynette and family.

[molly muffin]

I am so sorry for the lost of your sweet Bailey. It's very hard to see them struggle with the effects of cushings and kidney disease.
My sincerest condolences.

[molly muffin]

I've added Bailey to our In Loving Memory Thread located here:
http://www.k9cushings.com/forum/showthread.php?t=7676

[Harley PoMMom]

Oh Lynette,

I am so sorry for the loss of your beloved Bailey and my heart goes out to you and your family. Please know we are here for you and always will be.

With Heartfelt Sympathy,
Lori

[Renee]

I am so very sorry. :( Sail on fast and free Bailey.

[Joan2517]

Oh, I'm so sorry, Lynette...Bailey is at peace, but it is so hard on those of us left behind. Condolences to you and your family.

[Squirt's Mom]

Dear Lynette,

I am so sorry to hear about your precious Bailey. There are no words that will take away the agony you feel today but I hope knowing many here understand and can empathize with you helps in a small way to lighten your heart.

You are a good mom and I am sure Bailey flew from this life with so much love and gratitude in her heart. Today she is free of all pain and fear. She is as she was when a puppy - full of vim and vinegar, whole, strong, and happy. From now until the day your job here is done, she will be watching over you...then when your day comes to cross the Divide, your sweet baby girl will be there to greet you.

Our deepest sympathies,
Leslie, Trinket, Sophie, Fox, and all our Angels



A Special Gift

They're a very special gift, to be cherished and loved;
You're chosen for each other by God Himself above.
It's a match made in heaven so it can't be wrong;
You're tied together by a bond that's oh so strong.

All they'll ever ask from you is to be loved and fed,
And at night make sure they have fresh water and a bed.
In return, for so little, the rewards are so great!
You'll get a companion for life with some very special traits.

When you are lost and the end seems so far away
They'll walk by your side, they'll help you find your way.
When life gets you down they can put a smile on your face
As they run you in circles with their fast pace.

You'll share the good with the bad, you'll be happy and sad;
And through it all you have a friend, the best you ever had.
You're time together will be special and unique;
It will be as priceless to you as a rare antique.

Then, before you know it, the day will arrive
When suddenly your life takes a steep dive.
The furry friend who's been with you for all of these years
Has now passed on and left you in tears.

As you sit and wonder what did I do?
Why is this all happening to you?
Into each of our lives a little rain must fall,
And you must be strong to answer the call.

Your little one's spirit has flown home on the wings of a dove,
To a special place that awaits them in heaven above.
St. Francis will meet them; when they get home
He will take them to a meadow where they're free to roam.

There in the meadows, down by the pond,
Your furry friend will remember his loving bond.
He'll look into the water, then you appear;
He can see you're frightened, he can feel your fear.

Through the bond that still ties you from heaven above
He looks down upon you, he sends you his love.
Because you loved him and because you care
Whenever you need him, he'll always be there.

There, in the meadows, they patiently wait for the day
When you will celebrate your life together, each and every day.
Waiting for that day; when you come walking back home
When together for an eternity through the meadows you'll roam.

Author Unknown

[judymaggie]

Lynette -- my condolences to you and your family on the loss of your precious Bailey. You did the hardest thing a pet parent has to do -- let our loved one go before they suffer too much. Hopefully, there will come a day soon that you will be able to focus on all the good times you had with Bailey and the tough times will fade into the background.

[DoxieMama]

I'm so sorry to hear of your loss. Sending many hugs your way.

[Allison]

Lynette, hugs.

I'm so sorry for your loss of Bailey. Our own Gizmo, who passed in May 2015, struggled with Cushings and pancreatisis. I think the one he could have handled; the two combined caused too much stress on his body. He too spent a lot of time being restless and confused. I know the heartache.


Our dear sweet Bailey crossed over the Rainbow Bridge yesterday. We are devastated by her loss but know in our hearts that she is now in a better place.

[Help4Bailey]

Thank you all for your heartfelt thoughts. We miss Bailey terribly but my only solace is that she is no longer suffering. I picked up her ashes/urn today. Was difficult but made it through it.

Hoping that everyone else's Cushpups are doing OK. Cushing's is a roller coaster without adding kidney disease and macro adenoma into the mix. Bless all of you and your pups. Lynette & Angel Bailey

[molly muffin]

{{{HUGS}}}

Them not being sick any longer really is the solace in a heart breaking time. I am dreading the pickup and just all of it and totally understand how hard it is.
You aren't alone.

[SandyH]

I am so sorry to hear about Bailey. From one cocker mom to another.