Me, my dog and Cushing

[Scoovale]

Hi everybody,
I am Valentina and my Dog Scooter has been diagnosed with Cushing. First of all I wish to thank You all for creating and maintaining this forum. It has been very helpful to me in many different ways! I know that being from Europe might not be the est option, maybe I will not be able to help you as the European reality is probably different than the American, but I will try. Scooter is the love of my life, we have been through so much together and it breaks my heart to see him suffer. I am doing my best to help him and it seems to work too. He is 12 years old, a dalmata mix, 55 ibs. I found him abandoned twelve years ago in the central station of Neaples, Italy. Since than we have been inseparable. One year ago I had the impression that he was not well and I asked his doctor about Cushing. She laughed at me and did not test him. But since than he had always various problems with his eyes, with his skin and hair. He started to drink a lot...A couple of months ago I decided to get rid of all this city doctors and went for a veterinary near Berlin, in the countryside. I have been reading about it. There is an old doctor with his staff and they treat different problems which makes it easier to get a complete picture of the animal's health condition. They told me almost immediately that my dog very likely had Cushing. I knew almost nothing about it. They have cured his skin infection with antibiocs and later, they tested him for Cushing. Now, one month later I know much more about it. I have been studying natural remedies, I compared various treatments, especially natural ones, and their components in order to find a good natural way to help him. I have searched Western nature medicine and I finally landed on the tRaditional Asian medicine. I am still having a bit of trouble understanding all the various medical terms and amounts, but I am learning still. Scooter started Vetoryl five days ago. I was so scared ad I feld I was poisoning my dog. When I gave him his first pill I started to cry and could not stop. I wanted him to start low so I told the doctor that I wanted 30 mg a day and not 60. She said that 60 is even too low for him. I said that probably is too low but I want him to get slowly used to it. She said that he needs 120 mg a day and I think that she did not really believe in this thing of getting the dog so slow in it. I actually wanted to give him the vetoryl in the morning and in the evening but the 30 mg capsule is difficult to share as you must open it. The pharmacy does not do that and I did not feel sure enough to do it myself. After few days of Vetoryl Scooter is doing much better. He drinks less (against urinary pressure he gets also pumpkin pills), he is more awake wants to go out and stay out, he plays, he is in a good mood. Still he gets tired very quickly but the difference is big. I give him daily an herbs mix, flaxseed, minerals, fish oil. In the evening he gets mostly 1 mg melatonin with Melissa (lemon balm), which helps him relax (really great). On Monday we will test the cortisol. I am very curios as the sympthoms seem so mild now. Actually I am searching for people who had experience with the TCM Rehmannia 14 formula. It seems to be extremely good for Cushing. Some dogs (and horses) can even quit the trilostane after a while. I searched some books of traditional Chinese medicine and I have found out that Rehmannia 14 or 11 are usually used together with Ophiopogon Formula (against thirst and drinking). I could convince my veterinary to try the Rehmannia. Have you any experience with it? Sorry for writing so much! I need somebody to share this huge thing...it is really blowing my mind;) thanks valentina PS sorry for the grammatic!

[DoxieMama]

Hi Valentina,

Welcome to you and Scooter! I only have a moment but wanted to reply and say I am very happy you convinced your vet to start with the low 30 mg per day dosage. Sometimes dogs need lower doses so it may be that Scooter will never need more Vetoryl to control his cortisol.

Do you have any of the test results that were used to diagnose him? The more details you provide, the better we can help you to support Scooter!

No need to apologize for writing so much. We love details!! :)

Hugs,
Shana

[Harley PoMMom]

Hi Valentina,

Welcome to you and Scooter from me as well! Bless you for giving Scooter a forever home, he is a lucky boy to have a pet parent so loving. I, like Shana, am so relieved that you listened to your intuition and started Scooter out at a lower dose. Dechra, the makers of Vetoryl, recommend a starting dose of 1 mg per pound of a dog's weight, so for Scooter's weight of 55 lbs that 120 mg would have been double of what's recommended, which is way too high.

Regarding daily dosing; the majority of dogs do fine on just a daily dose given in the morning with a meal, an exception to that rule is if the dog has diabetes than twice a day is required. Is the test on Monday the ACTH stimulation test? If so, than this test needs to be performed 4-6 hours after Scooter has had his dose of Vetoryl with a meal...I can't stress enough that the Vetoryl has to be given with a meal as it is not absorbed properly on an empty stomach. A dog's cortisol can continue to drift downward during the first 30 days of treatment so many vets are not increasing the Vetoryl dose at that 10-14 day test mark especially if there are any improvements in symptoms.

If you could get copies of all the tests that were done on Scooter and post those values that are abnormal with their reference ranges that would be great. We also are really interested in all test results that was done that diagnosed his Cushing's.

I'm not familiar with Chinese herbs so I can't offer any advice there, sorry. :(

We have a wealth of information regarding Cushing's; the medications used, and treatment protocols, which can be found in our Resource thread and it also includes articles written by some of the most renown veterinarians that specialize in endocrinology such as David Bruyette, Mark Peterson, and Edward Feldman. So please utilize it to educate yourself and if you have any questions do not hesitate to ask them. We all eventually figured out that safe and effective treatment is much easier facilitated if the vet is experienced and the pet owner is educated. Here's a link to our Resource thread: Helpful Resources for Owners of Cushing's Dogs (http://www.k9cushings.com/forum/forumdisplay.php?f=10)

I am sorry for the reasons that brought you here but so glad you found us and we will help in any way we can.

Hugs, Lori

[Allison]

Valentia, hi.

Welcome to the forum! Bless you for rescuing Scooter twelve years ago. Also, thank you for being so diligent with his care.

My experience with Cushings is limited. Our adopted dog only had it for a few years, before he developed other ailments.

There are many here with plenty of experience will be able to help! As others have suggested, posting test results will give ones the ability to give the best advice. Hang in there!

[Scoovale]

Hi guys, thank you for your replies. These are the results that we have got the first time we tested for Cushing:
Dexamethason screening test:

Cortisol basalwert (base value): 53,7 von (of) 5 bis (to) 65;
Cortisol supp. Wert:
50,8 ◀ 10 ng/ml
Cortisol 2 supp. Wert:
60◀ 10 ng/ml

Hope it makes sense, because is in German.

Scooter got half of the starting dose proposed by the doctor, 30 mg instead of 60. She aims to 120 mg but I do not think that I will ever give him so much. I have the impression that he needs a little bit more to be completely well. He is already good. He wants to play.
I am checking out this Rehmannia 14 trying to get more info's. But I guess I will make a post specifically about it.

See you later,
Valentina

[Harley PoMMom]

Hi Valentina,

Looks like a LDDS (low dose dexamethasone suppression) test was performed, which includes 3 blood draws, and I'm going to convert Scooter's results into the units more commonly used here in the U.S:

baseline ~ 5.37 ug/dl
Cortisol supp. ~ 5.08 ug/dl
Cortisol 2 supp. ~ 6.0 ug/dl

Those results are indicative for Cushing's but they do not differentiate between the adrenal or pituitary form and that can be very helpful to know.

I'm happy to hear that he is improving so much on the 30 mg dose and will be anxious to see those ACTH stimulation results, just a reminder; their cortisol levels often continue to drift downward during the first 30 days of treatment so even if Scooter's results are not within the therapeutic ranges you may want to hold off on increasing his dose especially since his symptoms have improved.

Hugs, Lori

[dsbailey]

Welcome to the group,

Please read my thread "Lolita" our stories are similar. My 57 lb girl started on 60 and that was way to strong. She finally stabilized on 30 mg. If she would have continued on 60 mg things would have turned out badly. It would also be helpful to determing if this is Adrenal or Pituitary based Cushings. I feel the next step after the ACTH test should be an abdominal ultrasound. That should provide you with the type of Cushings and a lot of other useful information.

Darrell and Lolita

[Scoovale]

Hi guys, so much thanks for the datas translation.
the doctor said that even with the ultrasound we night not be able to find out. She said that he most likely has an adrenal malignant tumor. As far as I have understood, pituitary tumor is more common however, that is especially for smaller dogs. Bigger dogs has often adrenal tumor. As soon as I have paid these bills I will make an ultrasound. I am so glad that I have found tho doctors. Also, in Berlin city, the same tests would cost double and I could have never afford that much so often. What I like of this veterinary staff is that because they live on the countryside, they are much more in contact with animals and have a wider experience.

Which test do you usually do in the Usa to find Cushing?

My question is, is it possible that a dog that basing on test needs 120mg, actually gets better with 30 or less than 60 mg? How is that possible?

Could I apply 30 mg in a long time period obtaining the same effect only in longer time span, but with less risk?

[labblab]

Hello and welcome from me, too. First of all, you are doing a wonderful job of writing in English! I would never be able to write so clearly in a different language, myself!

Secondly, in answer to your question about dosing -- every dog processes the medication differently. The manufacturer suggests a starting dose based on weight alone, using a formula of 1 mg. per pound, or 2 mg. per kilogram. But the true test is then to see how the body responds to the medication. This is judged by how well symptoms improve and also by testing of the cortisol level. I am very glad to hear that Scooter seems to be feeling better, and I am assuming he will have an ACTH stimulation test tomorrow to check his cortisol? At that point you will have a much better idea as to how well this dose is working. And it is entirely possible that the 30 mg. daily dose is all that Scooter will ever need. We have seen large dogs who only needed small doses to control their disease, and small dogs who needed much larger doses. It all depends on the individual dog.

Also, overall it is true that pituitary tumors are far more common than adrenal tumors. In our experience here, we have not seen any correlation between a dog's size and whether they develop a pituitary or adrenal tumor. That part really seems to be random. Here is the U.S., the LDDS is also used as a diagnostic blood test for Cushing's. The ACTH stimulation test can also be used for diagnosing in addition to monitoring treatment. Trilostane is a recommended treatment for both types of tumors, so regardless of whether Scooter's tumor is pituitary or adrenal, it is a reasonable choice.

I need to go and walk my own dog right now ;), but once again, welcome!

Marianne

[judymaggie]

Hi, Valentina! I just wanted to add my "welcome" to you and Scooter. I also think you are doing a fantastic job posting in English. Not only is it a hard language to master, you are adding in medical terms as well! Looking forward to learning more about Scooter!

[Scoovale]

Hi guys, an update about our Cushing Problem. I just spoke with his doctor and it seems like he cortisol is bit too low. We will go to 10 mg in a couple of days. Luckily I had decided to start low! The doctor was amazed. Me too actually. I have not got the written results yet, but from what I have understood his basal value is 3.3 nl and it should be above 5, the cortisol is 24. Does it make sense to you? I go there on Thursday and get the papers. His liver value is a bit higher to high, we will do a cure with milkthistle, that works very well every time. The doctor said that they use it too, especially with Cushing patients.
Do you think we do the right thing giving him 10 mg? We would recheck it in 10 days.

Thank you again for your support and precious help!
Valentina

[Harley PoMMom]

I have not got the written results yet, but from what I have understood his basal value is 3.3 nl and it should be above 5, the cortisol is 24.

Can you please check and see what the reporting units are for those values? I know his LDDS test results were ng/ml and I'm wondering if the ACTH stim test, that Scooter just had, are in the same units....if so than his base or pre number, in ug/dl units, is .3 ug/dl and his post is 2.4 ug/dl.

How does he seem to feel? Does he have an appetite? Any loose stools or vomiting?



Do you think we do the right thing giving him 10 mg? We would recheck it in 10 days.
Valentina

Yes, I believe decreasing his dose was the right thing to do especially since he has only been on the Vetoryl for about 10 days. Will be anxious to see what that next ACTH stim test shows.

Hugs, Lori

[Scoovale]

It should be nanomilligramm, that is what she said at the telephone, I believe she means µg/dl. She said that it should be above 5. I am afraid that even 10 mg vetoryl is going to be too much in time. Shall we wait a week for that? I am not feeling comfortable in switching to 10 mg immediately and wait 10 days for the next test. I would wait five days at least and that go 10 mg and test after a week. Could it be ok?

I guess maybe, in Scooter case it would be safer to go natural, with Rehmannia for instance. It seems otherwise dangerous with such low values.

He is very fine, in a very good mood, hungry, alive, cuddly, very relaxed but not lethargic, Just relaxed. His red eye bothers him a bit, but that problem is another story. Stool is fine too.
Yesterday evening he was tired but I was too as we had a very loooong day.

Wish everybody goodnight! lthough maybe there is morning already?

Valentina

[Squirt's Mom]

The optimal range for a pup on Vetoryl is 1.45 - 5.4 ug/dl on the post, or second, number. So if she is talking 5 ug/dl then that is just about perfect and no change in meds would be needed. I am wondering if 1) the units of measurement is different from ug/dl or 2) like many vets she is looking at the range for an untreated pup which is what is often listed on lab work (in the US anyway)?

[Scoovale]

Scooter is now 3.3 but he should be above 5.
I will let her send me the results per email tomorrow and check it out.

[Harley PoMMom]

Glad to hear that Scooter is feeling well. Hopefully tomorrow the vet will get back to you and we can see exactly what those units are in, I'm still thinking they are ng/ml but we shall see ;)

Vetoryl does come in 5 mg capsules, so if the 10 mg seems too much maybe the 5 mg will be just right.

Hugs, Lori

[Scoovale]

Ok, I got the results. It is ng/ml. Base value 3.3 of 5. The 5 mg is a good idea, I did not know but I will ask!

[labblab]

I am thinking your vet may be confused about interpreting ACTH test results for a dog taking trilostane. This test is also used to diagnose Cushing's, and when used in that way, the normal reference range is very different. The unfortunate thing is that many labs only include the diagnostic reference range in their report and not the treatment range, so it can be very confusing for vets and owners.

Here is a link that gives you a lot of helpful information about trilostane treatment. At the bottom, it has a chart that tells you what the desired ACTH range is for a dog taking trilostane. It is lower than the range for a normal dog who does not have Cushing's. You will also see that the chart is concerned only with the second, or "post" testing number. This is the number that plays the greatest role in determining dosing. For a dog taking trilostane, the first resting number will often be lower than the range for a normal dog as well. One note: the chart lists numbers in two measurements, neither of which are the measurements your lab gave. But to convert from "your" ng/ml to the chart's ug/dL, you just move the decimal point one space to the left. So as Lori has said, Scooter's results in ug/dL would be .3 and 2.4 ug/dL. Here's the link:

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

So, this is what I see. Per the chart, Scooter's "post" number of 2.4 ug/dL is right in the middle of the range where you would leave the trilostane dose unchanged. However, since it is possible and even likely that his cortisol will drop even lower during the first full month of treatment, I would probably want to lower his dose a bit as well, especially combined with the .3 resting level which is indeed low even for a dog taking trilostane. So I think it would be fine to drop back to the 10 mg. and see where that puts his cortisol level. It may be that he will actually end up needing a dose in between the two, however -- something like 15 or 20 mg -- in order to keep his "post" cortisol level under good control.

I hope this monitoring chart will help make more sense of things. Just let us know about additional questions.

Marianne

[Scoovale]

Hi Marianne,
thank you, you have been very helpful. Sometimes is so confusing. Also because german is not my mother language, as I come from Italy, and the doctors here talk so fast and take so much for granted. Especially at the telephone. It is so frustrating to have to keep up with so much and learn so much, all at the same time.
The only two datas related to cortisol that I have are these two, basal and stimulation value, which you call Post. Shall i ask for more next time? Can it be more detailed?

In the Vetoryl Brochure, seems like I should stop it for 7 days, which I wanted to do anyway. And then start with a lower dose. Then test after 10 days. The doctor wanted to make us start in a couple of days with 10 mg, but I will follow the brochure and my heart.

to say the truth, I feel like I cannot keep anything in my head anymore, I am so exhausted because I do not sleeping properly. I worry all the time and can´t seem to enjoy anything else. Scooter always checks on me to see how I am feeling, so I try to look relaxed and look happy. but you know, because you had it too, I am very scared.

[Squirt's Mom]

What Marianne is thinking is what I was also thinking - you vet doesn't know how to interpret the results which is not all that unusual. ;)

On the lab results the labs will list a range after the results so that it looks something like this -

Post (or stimulation value) 2.5 ng/ml 5 ng/ml-20 ng/m (EXAMPLE)

That 5 ng/ml-20ng/ml is a normal range for a dog that does NOT have Cushing's or is NOT being treated for Cushing's. The range for dogs on treatment is different but labs usually do not put that range on their lab reports - it is not their job to know if the dog is being treated or not. It IS the vet's job to know the difference but sadly many do not. So in looking at the 2.5, the vet thinks the cortisol is too low when it is not.

[labblab]

The only two datas related to cortisol that I have are these two, basal and stimulation value, which you call Post. Shall i ask for more next time? Can it be more detailed?

Hi again, Valentina. I think you're doing a great job with Scooter, especially since you are handling all of this in two languages that are not native to you! But in answer to your first question, there are only two values for the ACTH stimulation test, so you have them both in these results and there is nothing more to ask for.

The basal value is also sometimes called the "pre" or resting value. This first value measures the amount of cortisol in the dog's bloodstream before the stimulating agent is injected. The second value is called the stimuated or "post" value. It has this name because the blood is drawn an hour after the stimulating agent has been injected (which causes the adrenal glands to release all their stored cortisol). For dogs with Cushing's, their adrenal glands are overactive and typically have much more stored cortisol than do normal dogs. The point of the trilostane is to reduce the amount of cortisol that the adrenal glands are producing and storing -- even to the point of reducing the reserve to a point lower than would be the case for a normal dog who does not have Cushing's.


In the Vetoryl Brochure, seems like I should stop it for 7 days, which I wanted to do anyway. And then start with a lower dose. Then test after 10 days. The doctor wanted to make us start in a couple of days with 10 mg, but I will follow the brochure and my heart.


The monitoring chart in the Vetoryl Brochure gives you dosing guidelines based on the second of the two cortisol values: the stimluated or "post" value. In Scooter's case, his stimulated value was equal to 2.4 ug/dL. So actually, this is the part of the chart where his result would fall. According to the chart, you would not be stopping the Vetoryl for seven days; instead you would leave it at the same level.


Post-ACTHserum cortisol:

1.45-5.4 µg/dL(40-150 nmol/L) - Continue treatment at current dose

I think the confusing part is that you are comparing Scooter's basal level to the chart instead of his post-stimulation value. The chart is dealing with the post-stimulation value alone. However, as I wrote in my earlier reply, I do understand that Scooter's basal value is quite low and it is also the case that his post-stimulation value may drop even lower if you keep him on the 30 mg. dose. So if he were my dog, I would also probably lower the dose a bit, and even maybe down to the 10 mg. level in order to see where that puts his cortisol overall. But unless Scooter were to start looking ill (vomiting, diarrhea, lethargy), I don't think you need to stop giving him the medication altogether for the seven days.

This is just my own opinion, however. If you feel more comfortable stopping the Vetoryl for a week, then you can certainly do that. But overall, I am just hoping to help make more sense of Scooter's test results in relation to that chart, and in contrast to the results that would be expected for a normal dog who does not have Cushing's at all.

Marianne

[Scoovale]

oh sorry, you were writing already. Ok, now I got it;) finally!


OK, I think I have made a mistake and interpreted the chart wrong. He would be in the second option: >1,45 ug/dL. Than he should stay on 30 mg, after the chart.

So I should not interrupt but just switch to the lower dose.

ok!
you guys are so good!

[labblab]

Yes, that is exactly what I meant. ;)

If Scooter's basal level was a bit higher and if his post-stimulated level was still at 2.4 ug/dL after a full month on the medication, then I would be following the chart's recommendation to leave the 30 mg. dose unchanged. The reason why I am agreeing with the idea of lowering it a bit is because Scooter had only been taking the Vetoryl for about 10 days when this test was run, correct? We have seen cortisol continue to drop lower during the first month of treatment, even when the dose is left unchanged. In his case, you really do not want his cortisol to drop much lower at all. So that is why I would lower the dose a bit now, even though the chart says it is OK to leave it unchanged.

I know how frustrating this all is. It is so much information to try to understand in such a short time! But you may want to double-check and make sure your vet has seen this dosing chart, too. That way, she will also know that there is a difference in the ACTH testing norms for dogs being treated with Vetoryl vs. dogs without Cushing's.

Marianne

[molly muffin]

I definitely agree with Marianne, cortisol will drop normally for at least 30 days on the same dose. He doesn't need to drop any more at all, as that is a good value already.

[Scoovale]

Hello everybody,
How are you? So scooter is taking 10mg Vetoryl since a couple of days and his symptoms came back, not in full power but still...he drinks a lot, he has to go to the toilet often. Hungry like a wolf and serious. His eye also gets worse. The usual medicines are not working. I wonder if I should wait or rise the dose to 15mg already.

I don' t like to see him back on this road...what do you think? Shall I wait until one week has passed?

I wish you a nice day! Valentina

[labblab]

Hi Valentina, if Scooter was mine, I believe I would go ahead and increase now (and of course let your vet know about this). I had suspected that a drop clear back to 10 mg. from 30 mg. might be too much to keep control of his cortisol. Since his symptoms are reappearing so quickly, I do think I'd go ahead and increase now.

Marianne

[Scoovale]

I would call his doctor tomorrow. I just wonder if I would go to 15 or to 20 mg now. I could give him 10 in the morning and ten in the evening. or divide the capsule and do 5 mg.

I am also kind of worrying because of his eyes. Chinese Medicine believes that curing the liver helps the eyes as well. in fact he has very high liver values and he is now taking a cure for 30 days. I am wondering whether it might have to do with the cushing. the drops we usually use are not doing any good. I tried everything that would normally work for his eye problems.

I know that some ophtalminc issues come with cushing. indeed he has the dry eyes problems. I am wondering how other owners deal with it. I went to a very expensive veterinary doctor, specialized in eyes but the problems are still there.

it is frustrating!

thanks for the help!

valentina

[labblab]

Valentina, you should not try to open and divide the capsules yourself. The maker of Vetoryl gives a specific warning about this. You should either wait until you can buy some 5 mg. capsules, or yes, increasing to 20 mg. is another option. I would wait until tomorrow and talk to your vet, though, before doing that. I think it would be OK, but I would first want your vet's approval.

As for the eye, I would worry that Scooter might now have an infection that is different from what has been troubling him before. Cushpups are more vulnerable to infections of all sorts. You just may need to return to the eye doctor. :o

Marianne

[Scoovale]

Hi,
I have a maybe silly question, but how can I know precisely when the Estradiol is high?

Thanks!

[Harley PoMMom]

Nope, not a silly question at all, please feel free to ask any question that you have. ;)

If a dog has Cushing's than more than likely the estradiol is elevated too. However, there was a study done on estradiol levels in normal dogs and it was found that this hormone amount varies from dog to dog.

The only way, that I know of, to see if estradiol is high is to have it measured via a blood sample.

Hugs, Lori

PS: As you can see I have taken the liberty and moved your new post into your original thread about Scooter. This way, we will be able to keep track of his entire health and treatment history all in one place. ;)

[Scoovale]

Hi guys,
the doctor told me that estradiol is not high if the dog is castrated. Scooter is (since one year).
Yesterday he was very tired in the morning and much better in the afternoon. He slept in his bed instead of looking for the floor as usual. I found it strange but then eh went on the floor again.
I gave ihm a phosphatydilserine later and he got all lively. He is generally better in the evening, which is strange as he gets his pill in the morning. It is difficult to say if is the cushing that makes him a bit tired, the weather is incredibly hot here and it makes it hard to move at all. However, I wanted to check him a couple of days longer with the 10 mg. Of course he looks better that when he got no Vetoryl at all. He is awake and not weared out as before. Still he is a bit tired and loses lot of hair. That did not stop happening. I wonder why. I will check how tomorrow goes and than maybe call the doctor. our appointment is next week, so we actually do not have to wait that long.
After Molly has left us, I am so scared. Scared of making mistakes.

[dsbailey]

Hey,

Lolita started shedding terribly / losing hair soon after starting Vetoroyl but after her cortisol levels were brought down she grew back thicker curlier hair. She was never hairless just shed horribly, I was afraid she was going to lose her coat. It took about 3 months to get her dosage right and another 2 months before her hair regrew. Give it time.

Darrell and Lolita

[Harley PoMMom]

the doctor told me that estradiol is not high if the dog is castrated. Scooter is (since one year).


Castration/spaying can not stop the production of estradiol. The adrenal glands make estradiol and it is also formed in other places, like fat cells, hair follicles and the liver.

My boy, Harley was neutered and his estradiol was very elevated it measured 96.6 pg/ml (23.3-69.4).

Lori

[Scoovale]

Hi everybody, on my way to the eye veterinary for scooter. Totally unplanned visit. I was treatinv his eyes with eye drops from the doctor. His eyes seemed to have improved a lot but this morning i checked them and his right eye's tear canal showed a black surface. I don' t know how to call it really. It looks like a small tumor to me, but yesterday it was not there!
So now we go the eye doctor. Problem, she is the hell expensive and we need already so much for the Cushing. I hope at least she finds out what he has. We know that he has this dry eye problem, but usually the other eye, the white one and the dry eye looks very different. Operations are no go with him, he is too old, and he is curing his liver so no surgery and no antibiotics in pills. I am so worried. Anybody haveseen something similar before?

Probably, reading my notes i have confused estradiol and testosteron!
I am glad to hear that the hair problem is not unusual! I have been reading that with the rehmannia 14 the coat comes back very fast. I have actually found it in a Chinese farmacy, in Holland. The doctor is very helpful and the price better than in the other online farmacy. As rehamannia 14 is difficult to find, I am very happy. For dogs which take very low dosus of vetoryl and are always at the limit with Addison risk, it could be particularly helpful. J am waiting to see where scooter stabylizes.

Thank you for listening! And helping!
Keep u posted

V.

[molly muffin]

Oh my goodness! Do let us know what the vet says the problem is.
I hope its something minor.

[Scoovale]

Hi everybody, Scooter has a minor infection on The backside of eye that is making pressure but is not as bad as it seems. After The visit he had troubles walking and standing. I had to wait at the doctor and later I took him home with a wet towel on his shoulders. His blood pressure was not low but not that high either. In the past it has happened that he would be tired or walking very slow. Since I know that he has Cushing I thought that was the reason but this docgor said that it should not be. I am not sure, when he got the 30mg vetoryl he was super energetic but still his energy did not last very long. It never happened like this time that he was kind of dizzy and did not want to walk, but it it has happened in similar way. Is the Cushing causing low pressure problems? I have been reading of other dogs that were so tired, how is it I your experience?

The hair problems is also getting worse, his hair is coming down with the skin and he has a lot of spots, soon he will have not many hair left! He has this paper dry skin. What could I use to help him against it? After the antibiotics cure his skin was ok. I don t want to give him antibiotics and Vetoryl! Poor baby!
On wednesday we have the acth test. We will see what it brings.

Have a good day

! Valentina

[Harley PoMMom]

It is common in dog's with Cushing's to have high blood pressure not low.

When dogs have elevated cortisol over a period of time it can do damage to the hair follicles. Hair follicles have to go through a cycle so they die off and then regrow and that can take a long while to see any regrowth. We have had some dogs on the forum that when their new hair grew in it was a totally different texture/color.

Hugs, Lori

[Scoovale]

Ok, so I have to worry. I will talk about it with his doctor. His electrolytes were ok.
Concerning the skin, is not just that hair are falling, the skin comes out with the hair. A little bit like those fake gardens:o

[Scoovale]

Hello everybody, we have our new Acth test. After 14 days 10 mg, the result are now: Basal 8.8 ng/ml, Stim.value/post: 32.8 ng/ml.
Look forward to hear your opinions. At the beginning, after stopping with 30mg, he had one day without vetoryl and he was back on the bad pattern. After we started 10mg. The first six days as you maybe also remember, I thought I was going to change to 20mg, but the he got better and better. He is lively, drinks much less. His eyes is better, the other one we are curing. Unfortunately his skin looks bad. We thought it was a calcium problem but is not, is an infection. He has some spots where you can see his skin. Poor guy. We are treating him with a shampoo and a special oil for the skin.
One thing I have noticed, is that he gets tired very suddenly. Once, after the visit at the eye see doctor, he was dizzy and could not walk. We had to cool him down, it was very hot outside. When is hot he gets so tired. Now the weather is much colder and he is so much better. His blood pressure is fine.

Tomorrow I will talk to his doctor!

I wish you a nice day!
Valentina

[Scoovale]

Valentina, you should not try to open and divide the capsules yourself. The maker of Vetoryl gives a specific warning about this. You should either wait until you can buy some 5 mg. capsules, or yes, increasing to 20 mg. is another option. I would wait until tomorrow and talk to your vet, though, before doing that. I think it would be OK, but I would first want your vet's approval.

As for the eye, I would worry that Scooter might now have an infection that is different from what has been troubling him before. Cushpups are more vulnerable to infections of all sorts. You just may need to return to the eye doctor. :o

Marianne


It seems that we now have to go down to 5mg Vetoryl per day! Apparently in Germany is difficult to get the capsules for 5 mg. Scooter doctor has proposed to give him 10mg every 2 days. I am thinking that maybe is not very good for his body to jump from 10 to nothing each two days. The other option is to divided them myself. I know that should be done only in the pharmacy. The pharmacist showed how to do it myself. I am still unsure whether is a good idea. After the Dechra tab he should remain on 10 mg a day but the doctor is afraid as Scooter values go down so fast.
I am really not sure what to do. Yesterday he was drinking and peeing again very much, at the same time he was quite lively and keen to walk. today he is tired.
I am sorry for bothering you all the time! you all have much more experience than me. I wonder what you think about it.

thanks valentina

[Scoovale]

Hi everybody, I wish to share some information regarding the treatment for Cushing disease in the Traditional Chinese Medicine. I was researching for my dog and I have been reading of some dogs (USA) and horses (Germany), which had been successfully treated with Traditional Chinese Medicine (they started in combination with Trilostane and some of them could later stop it). Through articles and books I could focuse on what is seen as the main Cushing treatment in animals, consisting in a TCM formula called Rehmannia 14, often used in combination with Ophiopogon and Rehmannia 11 (depending from the sympthoms). These are each one a combination of many different herbs that has been developed during centuries of chinese medicine practice. They are not be underestimated as they are strong real medicines. Professor Ronald Koh of the Lousiana University had published a very good article about TCM teraphy for Cushing in dogs

(https://www.tcvm.com/Portals/0/SummerFall2015.pdf)

and, because I wanted to know more about it, I have contacted him. He was so nice to answer my email (which I have would have never thought!)

and,because I believe that we need to have so many options as possible, I wish to share his answer with you. He wrote:

"TCVM which consist of acupuncture, herbal medicine and food therapy, could replace Trilostane and Mitotane to my experience. However, in some cases that with severe Cushing’s disease, the combination of western and TCVM medicine is needed.

TCVM mainly addresses clinical signs from Cushing’s disease, but it also regulate the cortisol production. I have great results in using TCVM to get the cortisol level back to normal in 6-9 months.

The ingredients are as follow:
1) Ophiopogon Formula : Glehnia Lophatherum Pueraria Scutellaria Phragmites Ophiopogon Crataegus Massa Trichosanthes Mume Prunus Anemarrhena
2) Rehmannia 11: Poria Rubus Astragalus Rosa Moutan Cinnamomum Mantidis Dioscorea Cornus Rehmannia Alisma
3) Rehmannia 14: Poria Aconite Moutan Cinnamomum Dioscorea Cornus Rehmannia Alisma

The dosage: 0.5g per 10 pounds twice daily. For any dog that are more than 60lbs, you may give 3g twice daily.

The therapy may take up to 6-9 months or longer.

My herbals are usually from www.tcvmherbal.com

I strongly recommend that the patients be assessed by veterinarian whom are certified in acupuncture and/or herbal medicine. You may find a TCVM vet near you on this website: www.tcvm.com

Please let me know if you have any question.

Ron


Ronald B. Koh, DVM, MS, CVA, CVCH, CVFT, CCRP
Assistant Professor & Service Chief
Integrative Medicine and Rehabilitation
Louisiana State University
"
---

I could find two companies who sell these formulas and they both reside in Holland. One of them I find particularly good, they are very helpful and the prices are a bit better.
Sanjiao: http://www.sanjiao.de/

the other company is called Euroherbs but they sell only with medical prescription (or veterinarian) while at Sanjiao you get it with or withouth prescription but with is cheaper. Both generally use to deal with doctors and not with private clients, therefore is always good to underline that you are working together with your veterinarian (which is the best to do anyway).
Sanjiao proposes to give for a dog 25 kilos, Rehmannia 14 2 times a day, with food but at least 2 or 3 hours away from Trilostane. Never take it at the same time. He offers granulates. I can see a difference between the proposed dosage but I am thinking that Sanjiao wishes not to recommend higher dosis for security reasons. That should be ideally decided with a TCM doctor.

I believe that the option offered by the traditional chinese medicine is good whenever there is an Addison risk or an intolerace. For instance my dog, Scooter, has his cortisol running down very fast and he is now taking 5 mg a day (55ibs dog). I will try Rehmannia 14 if I see that is cortisol in not stabilizing yet.

I hope I could give you some good hints. I am still in contact with professor Koh, if you wish to ask him something I would be glad to help.

Valentina

[labblab]

Hi again, Valentina! Before we discuss things further, can you please verify for certain what reporting units are being used for Scooter's ACTH test? In looking back through your thread, I see that there's been some question as to whether the results are in the form of ug/dL or instead a different unit. If you can look at the lab report and write down the unit exactly as it appears, that will help us a great deal.

For example, if Scooter's results are in the form of ng/ml instead of ug/dL, that makes a big different in terms of how we'd recommend moving forward.

Thanks so much!
Marianne

[Squirt's Mom]

MODERATOR NOTE: I have merged your post about TCM for Cushing's into Scooter’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.

I merged this post into this thread on the assumption you intend to try this approach with Scooter. If that is not the case and this is for information purposes only, let me know and I will move it to the Everything Else section for you.

Thanks!

[Scoovale]

Hi again, Valentina! Before we discuss things further, can you please verify for certain what reporting units are being used for Scooter's ACTH test? In looking back through your thread, I see that there's been some question as to whether the results are in the form of ug/dL or instead a different unit. If you can look at the lab report and write down the unit exactly as it appears, that will help us a great deal.

For example, if Scooter's results are in the form of ng/ml instead of ug/dL, that makes a big different in terms of how we'd recommend moving forward.

Thanks so much!
Marianne



Hi there, it is definately ng/ml. I have translated the last test results into nmol/L and it looks like this:

ng/ml post: 32,8 (and basal: 8,8)
nmol/L post: 104.304

I have used an online converter so I am hoping that is correct...

[Scoovale]

MODERATOR NOTE: I have merged your post about TCM for Cushing's into Scooter’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.

I merged this post into this thread on the assumption you intend to try this approach with Scooter. If that is not the case and this is for information purposes only, let me know and I will move it to the Everything Else section for you.

Thanks!




HI! Well, my hope was to make it available to everybody and spread what I am learning. I mean to try it with scooter but this specific post was meant to inform the others about new ways to cure cushing. maybe in my thread is going to be a little hidden, as only few people will read it. I am not yet acquainted with how the forum works, therefore I cannot really say...but it was for open knowledge;)

[labblab]

OK, I am going to make a copy of that post and move it to create a new thread on our "Everything Else" forum as Leslie suggested. This way, the info will be here on Scooter's thread as well as on a thread that may be viewed by more people. ;)

[labblab]

Hi there, it is definately ng/ml. I have translated the last test results into nmol/L and it looks like this:

ng/ml post: 32,8 (and basal: 8,8)
nmol/L post: 104.304

I have used an online converter so I am hoping that is correct...
And now back to Scooter's test results. Thank so much for the info and the conversion. And here's one more conversion for our American readers:

Basal: .88 ug/dL
Post: 3.28 ug/dL

Previous results on 30 mg. daily:
Basal: .30 ug/dL
Post: 2.40 ug/dL

So yes, like your vet, I am very surprised that Scooter's numbers turned out this way after the two-week drop from 30 mg. daily to 10 mg. I really expected to see more of an increase in his cortisol level, and it is a good thing that you did not go higher than the 10 mg. after all!

I'm really not sure what I would do now if you cannot get the 5 mg. capsules. Neither option is ideal -- 10 mg. every other day or dividing the capsules yourself. All I can tell you is what I would do in your situation. I think I would try the 10 mg. every other day to begin with, and see how Scooter does with that. My reasoning is that at least you'll know with certainty exactly what dose he's getting, whereas there may be a fair amount of variability from day to day if you try to divide the capsules yourself. But if the pharmacy has instructed you on how to divide the dose, that may be an option, too.

What is your vet's preference?

Marianne

[Scoovale]

Hi, the doctor wants us to give him 10mg each two days. I am here discussing it with my husband because it seems to me that, as his values have increased since last time, he should stay on 10 mg a day. Why does the doctor mean that 3.28 ug "still" too low is?

do you guys think is too low? Last time we stopped vetoryl for 1 days and all the sympthoms were immediately back, plus his skin problem won´t profit of the two days/10 mg solution.

...

[dsbailey]

IMO (haven't read the other 48 posts) 3.28 ul/dl is ideal if he is showing no negative clinical signs (Loss of appetite, diarrhea, arthritis, itchy from allergies). If I've misspoke I'm sure others will let me know. :o

3.28 is too low for my girl because she has arthritic problems.

[labblab]

Darryl is right that, generally speaking, 3.28 ug/dL is right in the middle of the ideal therapeutic range for trilostane treatment (and I'm still not sure whether or not your vet yet realizes that the target range for Cushpups is lower than the range for normal dogs without the disease :rolleyes:).

However, the thing about Scooter's situation that gives me pause is the fact that his adrenal hormone production seems to be extremely sensitive to the effects of the medication. After only two weeks on 30 mg., his baseline cortisol level was indeed quite low and his post-ACTH level was at a point where you would not want it to go any lower. Since we anticipate that cortisol levels will continue to drift lower during the first 30 days on any given dose, I was concerned about him continuing on that same dose. However, I had expected that lowering his dose clear down to only 10 mg. would result in a significantly higher cortisol level after another two weeks.

However, that is not the case. Taking only 1/3 of his previous dose, his levels have rebounded only a very small amount. This is very surprising to me. So even though his post-ACTH cortisol level is good according to the Dechra chart, I remain concerned that he's going to keep on dropping throughout the next few weeks if he remains on the 10 mg. daily dose.

I'm really not sure what the best strategy is going forward. I really would like to see your vet contact Dechra directly, so as to ask one of their technical representatives exactly what they would recommend in this situation. Scooter's reaction to the medication is somewhat unusual.

Here's a link to Dechra's website page for German patients. I'm assuming/hoping they have contact info there:

http://www.dechra.de/

Marianne

[Scoovale]

Darryl is right that, generally speaking, 3.28 ug/dL is right in the middle of the ideal therapeutic range for trilostane treatment (and I'm still not sure whether or not your vet yet realizes that the target range for Cushpups is lower than the range for normal dogs without the disease :rolleyes:).

However, the thing about Scooter's situation that gives me pause is the fact that his adrenal hormone production seems to be extremely sensitive to the effects of the medication. After only two weeks on 30 mg., his baseline cortisol level was indeed quite low and his post-ACTH level was at a point where you would not want it to go any lower. Since we anticipate that cortisol levels will continue to drift lower during the first 30 days on any given dose, I was concerned about him continuing on that same dose. However, I had expected that lowering his dose clear down to only 10 mg. would result in a significantly higher cortisol level after another two weeks.

However, that is not the case. Taking only 1/3 of his previous dose, his levels have rebounded only a very small amount. This is very surprising to me. So even though his post-ACTH cortisol level is good according to the Dechra chart, I remain concerned that he's going to keep on dropping throughout the next few weeks if he remains on the 10 mg. daily dose.

I'm really not sure what the best strategy is going forward. I really would like to see your vet contact Dechra directly, so as to ask one of their technical representatives exactly what they would recommend in this situation. Scooter's reaction to the medication is somewhat unusual.

Here's a link to Dechra's website page for German patients. I'm assuming/hoping they have contact info there:

http://www.dechra.de/

Marianne



Hi Marianne, thank you for your answer. It is a difficult situation indeed, if scooter would look fine I would even try what the doctor proposed but his skin looks very bad, he is a bit more hungrier and drinks a bit more. He is a bit more tired. Generally he looked much healthier with 30mg. However 10 is not that bad but I cannot imagine lowering that.
I am for sure starting the traditional chinese medicine treatment as soon as I have the products. But in the meantime? I will write Dechra and check it out but, I mean, after their tab for scooter values 30mg or10mg made no difference. They write to keep it up for 30 days but they do not evaluate single cases.

To me it seems that the Dechra system is , is to stop the medication for one week whenever the level is too low, to restart than with lower dosage. I believe that that seven days time is needed to reach a level, and I truly do not believe that the doctor solution is safe or meaningful...
At the same time I am afraid of being too pushy or too seem arrogant in the doctor eyes (Germans are particularly sensitive!) but I have taken the right decision two times in a row...so...

[Scoovale]

Hi guys, I am freaking out at the moment because Scooter had something like an hallucination and I do not know how to decipher that at all. He went all tired suddendly he looked like a crazy, scared and trying to get up as he had seen something, looking all around in the room but everything was quiet. I was there with him, we were just "talking" as usual.
I thought of Addison but I cannot recognize the symptoms...now he is in his bed a wants to sleep. I called him for food and he jumped up very lively.
I am thinking that he might have some other problem which could explain also why he gets tired so quickly. Maybe diabetes. However, I still cannot explain hallucinations! the only explanation I know, is a possible pituitary tumor pressing on the brain.

I am so scared!

[labblab]

Gosh, Valentina, I understand why you're very worried! :(

I'm really not sure what might have caused this reaction in Scooter. I guess the only thing you can do right now is to watch and see if it happens again. If so, can you take a video using your phone or a tablet? If so, that might help your vet in terms of interpreting what is going on with him.

Do let us know how he's doing!
Marianne

[Scoovale]

Thank you Marianne, you are very nice. It means a lot.

[Scoovale]

Gosh, Valentina, I understand why you're very worried! :(

I'm really not sure what might have caused this reaction in Scooter. I guess the only thing you can do right now is to watch and see if it happens again. If so, can you take a video using your phone or a tablet? If so, that might help your vet in terms of interpreting what is going on with him.

Do let us know how he's doing!
Marianne



Hello, I have researched a bit and it resembled very much a focal seizure, I guess. His eyes where looking around but not seeing me. He saw other things. That was very short but intense. He tried to run away but his legs were weak as usual when he stands up. Later, he had moments in which he just starred, eyes not blinking. It is neurological for sure. I will give him something to relax in the evening and keep observing him.
Was there a dog called Spencer with a similar problem?

Have a nice day,
Valentina

[judymaggie]

Valentina -- I did think of the possibility of a seizure when I read your description of Scooter's behavior. My go-to web site for information about seizures is the Epi Guardian Angels -- here is their link:

http://www.canine-epilepsy-guardian-angels.com/site_map.htm

There is a ton of info. My first Cush pup, Maggie, had seizures and I found that, just like with Cushing's, the more information I had, the better I was able to help Maggie.

We did have another member talk recently about their dog who she thought was having "fly snapping". I will try to find that post.

[judymaggie]

Valentina -- here is a link to the member's post -- dog's name is Cedar.

http://www.k9cushings.com/forum/showthread.php?t=8158&highlight=snapping

[molly muffin]

How is he doing now Valentina? Any more episodes?

[Scoovale]

Hi guys, thanks for asking. I had found the guardian angel site! it was very helpful!
I thought I saw him a couple of times starring strangely in the emptiness and every time I tried to wake him up. that worked. I am observing him at the moment. he looks awake, a bit worser when he gets no vetoryl. my older dog attila, when he was already quite old use to do something similar. sometimes he was jut starring at the wall. no crazy hallucination though. I have seen the Cedar video but I cannot compare Scooter seizure with his. I think with Scooter he was also in panick. not walking in circles, not snapping.

I am very mad at the moment actually...
as mentioned, Germans are delicate, especially when things do not follow the regular paths, is really painful sometimes. Honestly, please correct me if I am wrong, I believe that with a disease like cushing, you must be able to think outside the box.
I was not happy with her solution of 10 mg vetoryl each other day but she did not give me another option. she said like this or I do not know. I was very un impatient and I wrote dechra to ask their opinion. a day later I thought I tell the doctor and ask her to write them, to be sure that they reply and reply properly. dechra contacted her (or she contacted them, I did not understand) and she got angry at me because I have contacted them without telling her. she said that she had to answer many questions and go through a hell of a process with dechra. I am not sure why actually. dechra told her to stop vetoryl for 14 days and restart at low dose. which is a classical dechra approach, only they usually stop for 7 days.
a solution that goes against what she had proposed. this is again something...as she wanted to give scooter high dosis vetoryl at the very beginning, and the second time as well, and if i would have done it my dog would be probably long gone. she does not even mention that.
I am sorry for her but I am fighting for Scooter life. I do everything for him. it was my proposal to her to call dechra, she did not think about it. which is also a thing. i understand that they have other patients, but if you have something like this, you should work on it. it can also help future cushing dogs. i think she should be happy that problems have been prevented (again) and be happy that I am so stubborn.
I guess that if we keep on with vetoryl, it will be always like this: with pauses in between to make the cortisol rise again. I do not think that this will be a good solution for him.
now he has this terrible skin infection and loses hair on his back, like big spots. his other hair had start regrow but if we stop vetoryl his hairloss and his skin infection are likely to get worse again.

I am not sure what to do. is there a good immunsystem booster? could it help?

when he stops vetoryl, how long does it take to the cortisol to rise? is that a bit every day? dechra thinks that it will take two weeks.
what should I be careful for with addison`drinking and urinating are also symptoms. i feel a bit scared, do not want to miss any sign....


thanks
vale

[molly muffin]

It depends on the dog as for how long it takes cortisol levels to come back up. Usually you wait till you see symptoms of high cortisol before restarting at a lower dose.