New and Recently Diagnosed :(

[ZoeysMom]

Hi,

This is my first time here because, unfortunately, my precious Zoey was recently diagnosed with Cushing's. I have been completely distraught and find myself crying many times throughout the day. I guess I am here because I'm looking to hear that it's going to be ok.

Zoey is my adorable 8-year-old long-haired chihuahua. About a year ago, I made an appointment with my very reputable vet, because I noticed Zoey begging more frequently. My vet did bloodwork and a urine test. All tests were normal. She said that Zoey looks great and her physical was perfect. She basically said she was just being a spoiled little girl. As time went on, I noticed that her begging got worse and now she wasn't satisfied with her treats anymore. She wanted more food and was drinking more. Again, I brought her to the vet and she did another urine test, but said she didn't want to do bloodwork again so soon. She said her coat looked beautiful, everything looked great and her urine test came back normal. She again told me that, from what it seems, it looks like a learned behavior. I still wasn't convinced because she was always licking her bowl, even if I wasn't in the room, so it wasn't being spoiled. I began to give her smaller meals throughout the day, and some more treats, because I couldn't stand seeing her little eyes looking at me. My husband and I started googling and separately,we both were wondering if it could possibly be Cushing's Disease. We decided at that point to make another appointment. We got the appointment for a few weeks away, since it was time for her physical anyway. A couple of days later, my husband noticed a tiny bit of bright red blood in her stool. In complete panic, I called a vet that I had heard great things about, since mine was closed. My husband and I were already thinking about a second opinion. This vet checked her out, said everything looks and feels good, but she wanted to do a blood test and urine cortisol test to check for Cushing's, because of her ravenous appetite and her excessive drinking. Tests came back pointing toward Cushing's. She ordered an abdominal ultra sound and the low dose dexamethasone test and it was confirmed. :( She prescribed Vetoryl and also checked her blood pressure and since it was pretty high and because her urine test showed that she has proteinuria, she wanted her on a blood pressure medication, as well. So far she's been on both for 5 days and although she's still ravenous and drinking a lot, she is not showing any side effects of the medication.
I cannot begin to tell you the guilt I am having about my little girl begging and how we thought it was her just playing us and being spoiled, when she truly was starving and had this disease. I did call my previous vet and asked why they did not consider Cushing's as a possibility (unless, of course, she thought it but didn't mention it until she had the blood work) and they said that everything was completely normal and there wasn't a reason to suspect that. I told my new vet how I was feeling and she reassured me that she would not have suspected that either since the previous results of the bloodwork and urine were normal. She said, because I was so persistent, they were able to diagnose her early. She does not have a pot belly, and her skin and coat are perfect. We contacted my old vet and she agreed 100% with what this vet is doing. They both said that constant monitoring with the tests and bloodwork are vital. We wouldn't have it any other way. I really don't know what to do with myself at this point. I worry 24/7 and Google and question everything. My vet is wonderful and calls me and explains everything in detail, but I made an appointment with an endocrine specialist anyway. We have to wait until October 5th to see her.
I haven't read many other posts on here because, in all honesty, I'm afraid of what I'll read. But I have to remember, that if I want to stay on top of everything, I need to read personal experiences in order to become more aware. Although I know this isn't true, I feel like I'm the only "crazy, nut" mom out there. I've tried googling when the medication will start to tasked effect, because this begging seems to have gotten worse since we started the testing. I can't stand to watch her being so hungry. My husband is just as bad as I am, so you can just imagine what it's like living in this house. I really don't know what I'm looking for, but I guess just typing this out and knowing I've taken the first step in reaching out to others, makes me feel a teeny bit better. Thanks for "listening".

[labblab]

Hello and welcome to you and little Zoey! If you are a "crazy nut mom," you are in good company, because we are pretty much all obsessed with our furpups here!! ;) :)

It sounds as though you have done a wonderful job of advocating for your little girl, and hopefully you will soon be seeing some positive results from the Vetoryl. How quickly that happens will depend on exactly how Zoey metabolizes the medication. As you probably know, she may end up needing a dosing increase in order to arrive at a therapeutic level in her bloodstream. But the monitoring testing will help guide that decision. Can you tell us how much she currently weighs? Also, when you have the chance to gather the actual numbers for her diagnostic testing (the LDDS and any abnormal values on other labwork), it will help us to see them.

In the meantime, it sounds as though the new vet has taken very appropriate steps as far as diagnosing the Cushing's. Do you already have a testing date scheduled for Zoey's first monitoring ACTH stimulation test? The maker of Vetoryl recommends testing at the 10-14 day mark. Some vets now wait until 30 days, but no longer than that.

Definitely do start reading here. Of course, you will find both happy and sad stories along the way. But bear in mind that many, many dogs are treated successfully for their Cushing's and they go on to live out their normal lifespans. You may actually see an over-representation of dogs who experience road bumps here on the forum. This is because owners who experience smooth sailing tend to come and go rather quickly. They find us when their dogs are first diagnosed, but then also leave us when things are well under control. So folks who remain here for a lengthy time may be a combo of people with ongoing questions, or people who just grow to love this family and never want to leave (like me -- my own Cushpup passed away 12 years ago now!).

I promise you will learn a lot from our family, though, and you and your husband and Zoey will receive tons of support. So once again, welcome.

Marianne

[DoxieMama]

I want to echo everything Marianne has said. Welcome to you and Zoey! I believe you have found the best place on the net for "crazy nut moms" (and dads!). ;)

When my own dog was diagnosed, I also Googled and questioned everything. It wasn't enough to read about the medication on one site, I needed to read the same thing on multiple sites, cross check and verify it all. I'm so grateful for the support of this forum, who cheered me on and stood behind me while advocating for my boy with the vet.

It sounds to me like you and your husband are doing a fantastic job of caring for Zoey. The best possible outcomes happen when both the owner and the vet are educated about Cushing's and its treatment, and attentive to the needs and responses of their pup.

In addition to the questions Marianne has posed, I'm curious what dose of Vetoryl Zoey is taking now?

I'm so glad you're here and look forward to learning more about your precious girl.

Hugs,
Shana

[Squirt's Mom]

Hi and welcome to you and Zoey! :)

Oh, honey, does your post bring back memories. I think I had already crossed the line over to the insanity side by the time I found this wonderful, amazing family here. I had spent the prior several weeks bawling and in total panic - my Sweet Bebe was sick and it felt like my world was ending. Everything I read was in Greek and the little I could comprehend seemed to be saying she wouldn't live much longer. I had found a few other groups for this disease and they only made me feel worse. more confused, overwhelmed, and scared....and one made me livid with their calloused comments. So by the time I got here, I was a real mess. One of the members, who has become a cherished friend, told me that when I first posted she envisioned a woman with her hair standing on end, as if she had her finger in a light socket. She kindly left out the parts about bulging eyes and flying slobber. ;):D

After a few weeks I could breath again, my mind wasn't going 900mph, and I wasn't crying ALL the time. Then I started to learn what these gentle folk had to teach. They shared their stories, their experiences, their knowledge, their compassion....and soon I no longer felt so lost and scared but believed for the first time there was hope. I initially heard the word "Cushing's" in late 2007 and my beloved Squirt lived to be 16 years and a few months - passing in 2014 from old age complications, not Cushing's related. I'm not sure if she or I would have survived if not for our family here at K9C. They kept me sane and taught me what I needed to know to make the best possible life for Squirt.

You are right where you are supposed to be and it won't be long until you start to feel a bit calmer and stronger. Then one day you find yourself sharing your Zoey's story and the things you have learned with someone else.

Take your time, do lots of reading here, the threads and our Helpful Resource section found in the Index - lots of good info there! Never hesitate to ask questions you may have - if we don't have the answer we will help you search and learn together.

The most important thing I have to tell you this morning is that you, your hubby, and Zoey are no longer alone on this journey. We will be with you every step of the way.

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

[Harley PoMMom]

Hi and welcome to you and Zoey from me as well!

As Shana asked, what dose of Vetoryl is Zoey taking and how much does she weigh? Dechra, the makers of Vetoryl recommend a starting dose of 1 mg per pound of the dog's weight so the answer to both of those questions is very important because we want to be sure that she is taking the appropriate dose for her weight.

There are two critical guidelines that need to followed, the first one is that the Vetoryl has to be given with a meal to be properly absorbed; the second one pertains to those monitoring ACTH stimulation tests that are performed to see where her cortisol is, they have to done 4-6 hours after her morning Vetoryl dose is given with her meal.

What is the blood pressure medication that she is taking? Angiotensin converting enzyme (ACE) inhibitors, BP medications such benazepril (Lotensin), and enalapril, need to be used with caution when treating with Vetoryl because both of these drugs lower aldosterone levels, so monitoring the electrolytes for an imbalance is highly recommended.

The chances of adverse effects are minimal if the proper protocols are adhered to. Safe and effective treatment requires an experienced vet and an educated pet owner and it is when one or both is missing that dogs get into trouble. We have many members that are treating their cushdog with Vetoryl/Trilostane and are experiencing success.

We have a wealth of information regarding Cushing's; the medications used, and treatment protocols, which can be found in our Helpful 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. Here's a link to our Helpful Resource thread: Helpful Resources for Owners of Cushing's Dogs (http://www.k9cushings.com/forum/forumdisplay.php?f=10) I am also including a link to articles that pertain to Vetoryl/Trilostane: Trilostane/Vetoryl Information and Resources (http://www.k9cushings.com/forum/showthread.php?t=185)

We certainly understand your fears but you are not alone and we will walk this journey with you. If you have any questions please do not hesitate to ask them.

Hugs, Lori

[molly muffin]

Hello the others have already covered everything I would be able to think of so I'll just say welcome to the forum. You are in good company here. :)

[ZoeysMom]

Thank you all so much. I'm emotional just reading your responses. I truly appreciate it. I have so many supportive friends in my life and I am grateful for each one of them, but no one truly understands, except you, what I am feeling, especially my heartache💔.
Zoey is 15.6 pounds and is taking 20mg of Vetoryl. Her test is on the 22nd, at which time my vet said that they may increase the dose depending on the results. She explained starting out at a lower dose and then possibly increasing after 14 days (after the test). I already knew this from my research, so I honestly wasn't expecting to see results from the medication so soon. It really is important to be on top of things, as you said. When my husband made the 14-day appt, the tech told him not to feed Zoey on the day of the test. When my vet called to check on Zoey, I was sure to ask her why we were told no food, when she is supposed to take her medication 4 hours prior to the test, with food. She immediately told me that YES, she is to take the medication with food 4 hours before bringing her in and that's why when she initially prescribed it, she told us to make sure we administer it during breakfast. That's not the first time I questioned something that I was told by receptionists or techs, that I made sure to question to the vet. So, yes, being informed is extremely important. I emailed my husband a list of questions to ask her, and since she was with a patient at the time, he decided to fax the actual email with the attached questions, to the vet, so she would have them before she called us back. So if she didn't think I was insane before, I'm convinced that my husband's actions in sending the questions that were intended for HIM to see and not her, erased any doubts she may have had! 😩😁.
I do have a question: Does the medication curb the appetite symptom in most cases? As I previously stated, Zoey's appetite is still out of control. After begging all night (to which I give in), she wakes me up at 4:30 on the dot, and starts begging. I feed her around 5. I have completely changed my schedule and have been going to bed very early, because Ive noticed that if I put her in bed with me, she doesn't beg and falls asleep until morning. I do this because I can't stand watching her beg, not only because of the stress it might be causing her even though that I give into it, but also because I worry about her weight and my other pup's weight (since I can't give something to her and not him). I was also wondering how I will know if her begging becomes a learned behavior since she has me programmed.
Thanks again! 😘

[Harley PoMMom]

We certainly understand the worry that comes with being told that your furbaby has Cushing's, I still remember how scared I was. :eek: Thankfully I found this forum and the wonderful people here kept me from being a total basket-case and were so willingly to share their knowledge with me. We will help you and Zoey get through this. ;)

I am so glad to hear that you question what people tell you when it concerns your sweet girl's health. So many of us have put blind faith in our vets and our poor pups are the ones that suffered for that mistake. :( Educating yourself with regards to Cushing's is the best help you can do for Zoey, so kudos to you for being such an awesome advocate for your precious girl.

Oh man, that ravenous appetite that comes with Cushing's, and it is difficult to watch them going through that. It does get better, that hunger usually eases up around 2 weeks after treatment has started but in the meantime you can try giving her green beans or carrots to help sate that appetite.

Concerning the dosage increase at that 10-14 day ACTH stimulation test, many vets are taking the practice of not increasing the dose because a dog's cortisol can continue to drift downward during the first month of treatment, this is a protocol that Dechra now recommends too.

One thing this dratted disease does require is patience :eek::eek: And I know how hard that is ;) so if the time ever comes that you feel the need to vent, scream..etc just come here, you can always do that here. ;)

Hugs, Lori

[ZoeysMom]

Thanks, Lori, so what you're saying is that it's better to wait a month after initial treatment before increasing, if necessary? So Zoey should go the her 14-day appointment and then again after a month, before making that determination, eve if my vet recommends an increase? I know my vet said she has to be tested after 2 weeks and the again after a month, then 3 months after that. Does that sound correct? Zoey is on 20mg now, and like I said, the vet said after this next test, she may have to increase, depending on the results. Her appointment is the 22nd and I am also taking her to the endocrine specialist on October 5th. I can wait until I go to the specialist before changing anything, since she specializes in endocrine diseases, such as Cushing's. I've heard great things about her and we had to wait a month for an appointment, since she was booked solid.

Thank you!

[labblab]

The timing of the testing protocol that your vet is recommending is exactly consistent with the recommendation of Dechra (maker of Vetoryl). But as Lori says, for most dogs, Dechra is now advising vets to wait for the results of the first month's testing to make an increase. By that time, you will have a better idea as to the true effect the initial dose is having on the cortisol level, and therefore it is easier to judge exactly how much of an increase is warranted going forward. Hopefully, this will result in less need for dosage "tweaking" down the line.

One exception, however, might be if the cortisol level is still remaining at a very high level and the owner is seeing absolutely no symptom improvement at the 14 day mark. In that situation, a small increase may be justified, and that may be what your vet is referring to.

So let's wait and see how the first monitoring ACTH turns out, and then we can go from there. ;)

By the way, here's a link to a brochure published by Dechra that gives you a wealth of information about Cushing's and Vetoryl. If you scroll most of the way down, you'll find a "Treatment and Monitoring" flowchart that contains the recommendation to generally leave the starting dose unchanged throughout the first 30 days (unless cortisol has dropped too low).

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

Marianne

[DoxieMama]

I just saw your profile picture - assuming that's Zoey? She's adorable!!

You mentioned you can't give something to Zoey and not to your other pup. I have to feed Visuddha 5 times a day, but my other dog Jackson only eats twice a day so I get that! My vet recommended giving Jack a couple baby carrots, which are his treats. He usually sits and waits for them as I get Visuddha's food ready. Sometimes he isn't interested at all though.

[Joan2517]

My boys were so confused when Lena used to get a breakfast and dinner and they just had to have kibble, but they got used to it. I just had to stand guard, not that she would have let them get any of it. She was only 6lbs and even my 70lb boy, Gable, wouldn't dare cross her!

[ZoeysMom]

Hi,

Thank you all for responding!! This forum is great and so are all of you. I only have a minute to read these last couple of posts, but i did see that it's misunderstood about my other pup, Jake. He DOES get the treats when Zoey does. I can't give to her and not to him, so they both get them. I will respond more later, but I wanted to clarify.

Thanks again for taking the time to respond! I appreciate it.

[ZoeysMom]

Yes, that's my Zoey. Thank you. :) I think she's adorable too, but i am biased. ;) She's such a sweet girl and is friendly to everyone. Your baby is cute too! How old? Is there a place to post pictures?
By the way, my appointment is on the 22nd. Should I post her levels from that test or the first test that confirmed her diagnosis?

XO,
Darlene

[Joan2517]

She sure is adorable! We have an 11 year old teacup Chihuahua named Doree...very pretty, but a real barker (and not so friendly to everyone).

[Harley PoMMom]

Is there a place to post pictures?

Awww, she is such a cutie pie!! Pictures can be uploaded to an album that you can create, and I'm including a link to those instructions: ;) http://www.k9cushings.com/forum/faq.php?faq=vb3_user_profile#faq_vb3_albums


By the way, my appointment is on the 22nd. Should I post her levels from that test or the first test that confirmed her diagnosis?

XO,
Darlene

If you could post the results from all tests that were done on Zoey that would be great. With respect to the blood chemistry and complete blood count (CBC), you need only post the highs and lows and please include the normal reference ranges. And we are very interested in results of the tests that were performed that diagnosed her Cushing's.

Hugs, Lori

[Squirt's Mom]

awwww Zoey's face reminds me of one of my fosters. Josie wasn't able to stay with us long - sadly she had a tumor growing between her heart and trachea - but she made a big impact on me and my youngest grandson. Josie did NOT like very many people and the first few times I touched her, she chewed my arms and hands up pretty bad. But I knew she was just scared. After a short while she would still put her mouth on me as if biting but she didn't apply any pressure - she just needed a valve for all her fear. The itty bitty ones have a special place in my heart, especially the sick and scared ones. I have 2 itty bitties and one small baby of my own....and one BIG foster who is stealing everyone's heart! :rolleyes:;):)

Oh, and yes, it would be nice to see all the lab results from both diagnostic tests and monitoring tests. We like details! :D

Hugs,
Leslie and the gang

[labblab]

Hi again! I just want to make sure you had the chance to see my reply that ended up at the very bottom of the first page of your thread. Not because what I wrote is so brilliant :rolleyes:, but instead I want to make sure you get that link to Dechra's publication ;). It should help answer many questions for you :).


The timing of the testing protocol that your vet is recommending is exactly consistent with the recommendation of Dechra (maker of Vetoryl). But as Lori says, for most dogs, Dechra is now advising vets to wait for the results of the first month's testing to make an increase. By that time, you will have a better idea as to the true effect the initial dose is having on the cortisol level, and therefore it is easier to judge exactly how much of an increase is warranted going forward. Hopefully, this will result in less need for dosage "tweaking" down the line.

One exception, however, might be if the cortisol level is still remaining at a very high level and the owner is seeing absolutely no symptom improvement at the 14 day mark. In that situation, a small increase may be justified, and that may be what your vet is referring to.

So let's wait and see how the first monitoring ACTH turns out, and then we can go from there. ;)

By the way, here's a link to a brochure published by Dechra that gives you a wealth of information about Cushing's and Vetoryl. If you scroll most of the way down, you'll find a "Treatment and Monitoring" flowchart that contains the recommendation to generally leave the starting dose unchanged throughout the first 30 days (unless cortisol has dropped too low).

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

Marianne

[ZoeysMom]

awwww Zoey's face reminds me of one of my fosters. Josie wasn't able to stay with us long - sadly she had a tumor growing between her heart and trachea - but she made a big impact on me and my youngest grandson. Josie did NOT like very many people and the first few times I touched her, she chewed my arms and hands up pretty bad. But I knew she was just scared. After a short while she would still put her mouth on me as if biting but she didn't apply any pressure - she just needed a valve for all her fear. The itty bitty ones have a special place in my heart, especially the sick and scared ones. I have 2 itty bitties and one small baby of my own....and one BIG foster who is stealing everyone's heart! :rolleyes:;):)
Oh, and yes, it would be nice to see all the lab results
Leslie and the gang

I am so sorry to hear about Josie.Poor little girl. :(
God bless you for being a foster parent. It takes a special kind of person to do that. I, without a doubt, would be a foster failure. I would keep them all and be devastated at hearing the stories that landed some of them there. I admire you and your heart. I tried to adopt a foster, but Jake, my other little chihuahua, wouldn't have it. He was terrified at the meet and greet and I was fearful he would hurt her. She was a teeny little thing (5 lbs.) and Jake and Zoey are over 14 pounds. I was heartbroken but, besides the fear of hurting her, his happiness had to come first. She was adopted the very next day by a loving family, so it all worked out, thankfully.

[ZoeysMom]

Hi again! I just want to make sure you had the chance to see my reply that ended up at the very bottom of the first page of your thread. Not because what I wrote is so brilliant :rolleyes:, but instead I want to make sure you get that link to Dechra's publication ;). It should help answer many questions for you :).

Thank you! I will read it now. I have the results from the abdominal ultra sound, but in all honesty, when she asked if I wanted a copy of the other results, I told her to just forward them to the endocrine specialist and to my other vet. I was afraid that I would try analyzing them myself and freak myself out. Now that I know that you know what they mean, I will post them here. Doing this on my own, without being able to reach out to someone immediately with questions that I may have, would have put me over the edge. I'm teetering right now. When my husband gets them on the 22nd, I'll post all results and then hopefully, you can answer any questions or concerns that I may have. I am so grateful to have found this site and at the risk of repeating myself (a million times), I truly appreciate all of you!

[ZoeysMom]

Ugh!! So I just typed this long post just now and lost it. I'm a wreck right now. After posting that last post, I was skimming a few threads and I came across conversations about adrenal panels and how it's important not to start medication until you have the results because of intermediate hormones (something like that). Well, I'm not sure that was done on Zoey! Like I previously posted, I didn't ask for the results because I wanted my vet to send them to the endocrine specialist who specializes in Cushing's so she would have them at our October 5th appointment. I was afraid to google things on levels, etc. Although I asked a million questions and googled my sanity away on symptoms and Cushing's, I chose not to get those results unless I knew I would get immediate answers. Should I be in a panic that she's on medication without being certain that she had that test?! I do know that her ultra sound showed both adrenal glands slightly enlarged (no tumors) and that her urine showed high levels of cortisol and she's eliminating protein, and her bloodwork showed high cholesterol and higher levels of liver something (sorry, I don't know). After all of that, her first low dose dexamethasone test confirmed Cushing's. She also told me that these new blood test results showed a significant change since her previous bloodwork that was done in November when I had brought her in for a second time to my first vet, for her symptoms of extreme hunger and thirst. This vet said back in November there was no reason for my other vet to suspect Cushing's since she showed no other signs and her urine and bloodwork were normal at that time - in November.
I also questioned my new vet about the proteinuria to make sure there was no chance that she has kidney disease since Vetoryl states not to administer to dogs with kidney disease. She reassured me that her kidneys levels were fine. Again, Zoey is about 15.7 pounds and on 20mg of Vetoryl in the morning. She is also taking .5 mg of Benazepril due to high blood pressure. Her 14-day appointment is on Thursday and at that time, they will also redo her blood pressure. I am really hoping that I'm making sense here because I am in a complete panic. Please advise me if I should contact my vet tomorrow about continuing the medication if she hasn't had the adrenal panel. I know that conversation that I read was from 2009, so I'm not sure if things have changed. Help! :(

Thanks !!!!

[Squirt's Mom]

No, honey, don't worry about that at all. That test comes in when the dog has signs of Cushing's but the tests all come back negative. Often that means the intermediate,, or sex, hormones are elevated causing a form of Cushing's called Atypical. In Atypical the cortisol is normal but other hormones are elevated. Since Zoey has elevated cortisol that test won't help you. Most pups with elevated cortisol do have elevated intermediates....it's just when the cortisol is normal that this test has value. ;)

This post will help prevent losing those long posts. I've done many times myself and understand how upsetting that can be. http://www.k9cushings.com/forum/showthread.php?t=1329

You're doing a good job of trying to learn, mom! Keep up the good work!
Hugs,
Leslie and the gang

[ZoeysMom]

Thank you!! I was so worried! Ok, so now on to the next...it never ends with me. Sorry. My husband is taking Zoey on Thursday for her 14-day test. As a teacher, it is difficult for me to take time off, especially since I took the day off for her first test because I didn't want her to be there for 8 hours (so I drove he back and forth). Anyway, my husband said that they are doing the ACTH test 4 hours after she takes her medication and then again an hour after that. Does that sound correct? Just checking.
The first time I took her (for the low dose dexamethasone test), they never told me not to feed her, so they did the baseline and on my way home, I happened to call and ask if she could eat after the initial baseline (since it killed me to not feed her) and they said no and to bring her back in exactly 4 hours. So I happened to ask if she was supposed to eat in the morning prior to the test, and they said no! They never told me And I had fed her, so there was a chance the test was invalid. They checked it out and it was fine since it was a while since I had fed her. Things like that make me crazy! It happened again with Thursday's test, as I posted above. Had I not questioned it, we would not have given Zoey her medication. The vet knows, but it's the others who aregiving me wrong information. Everyone there is so kind and have been so good with Zoey (and me), but I have to question everything and trust me, I do!

Thanks again for getting back to me!

[judymaggie]

Hi, Darlene! The instructions your husband relayed to you sound accurate. Zoey should get a full breakfast followed by her dose of Vetoryl. Four hours later your vet will take a blood sample to get a baseline cortisol level (the "pre" in the test results) followed by an injection of synthetic ACTH. An hour later another blood sample will be taken (the "post" in the test results). Then Zoey will be ready to go home! Many of us notice that our pups are a "bit" hyper after the ACTH. My Abbie gets what I call the "zoomies". Zoey may also drink more water afterward. These post test symptoms will abate after a while and are due to the extra cortisol in her system.

Just a note that it is important to follow the same timing in all subsequent ACTH tests so that results are comparable.

Please don't ever feel like you are asking too many questions!

[ZoeysMom]

Thanks! So next time it will be 2 weeks after that, correct? That's what my vet said.

Zoey is completely out of control with her begging tonight. I fed her a few more morsels of food and a teeny biscuit after her dinner. As soon as she finished, she began begging and crying. I gave her a carrot. She ate that and immediately begged more. I tried to ignore for a little bit and she began crying and begging some more. We ignored her for a little while and then I gave in. This is ongoing. I don't know if this is because she's still so ravenous or because she now has me trained.
From the day I realized that it had to be more than just being spoiled (as they once suspected), I gave into her more often. She's been on the 20mg for 10 days now and I don't see much of a change. Any advice? Suggestions? I feel awful because she's hungry and I also don't want her in distress for crying and begging. :(

[judymaggie]

Darlene -- correct, your next ACTH will be in two weeks. At that time you (with our help :D) and your vet will decide if Zoey's dose needs to be adjusted. Since you have not seen any change in her hunger yet, it may well be that her dose needs to be increased slightly. It is important that no increase be made until that 30 day mark as cortisol can continue to decrease over the next two weeks. Be sure get the "pre" and "post" numbers from tomorrow's ACTH test and post them here.

I did want to mention that I always have a chem panel done at the same time as the ACTH to make certain that electrolytes are at good levels. If you don't have one done tomorrow, I think it would be a good idea to do that at the 30 day mark.

Have you tried green beans as an alternative to the carrots? Only advantage is that you can make Zoey think she is getting more of them!

I did want to mention one thing in connection to the protein showing up in Zoey's urine. If protein is high in the next two urinalysis, then it would be good for your vet to run a UPC (urine protein creatinine ratio). This is done to determine if the kidneys are filtering properly. My Abbie has both high blood pressure and significant proteinuria and, from reading other members' stories, it seems as though these often go hand-in-hand. The proteinuria is not considered kidney disease but rather can be a pre-cursor to that down the road. Abbie is on Vetoryl and takes both benazapril and amlodipine. The caution about taking Vetoryl and ACE inhibitors such as benazapril is primarily due to evidence that the ACE inhibitors can lower aldosterone. As long as regular blood tests are conducted, this can be monitored.

[ZoeysMom]

Once again, thank you! I just took notes on the questions I will be asking. My vet did say that after this test, they can see if they need to increase. So I tell her that we should wait for the next test? And that means ravenous appetite for 2 more weeks?? My poor baby! I have not tried green beans, but I will be getting them tomorrow! How many can you give? Did Abbie have a ravenous appetite? If so, has it gotten better? Did you constantly feed her? I don't know what to do. I'm telling you, I can't sit down for more than a minute and she's pawing at me, crying and barking. If she's not doing it to me, she's doing it to my husband. She truly does not stop until we go to bed. :(

[labblab]

Normally, yes, the most recent recommendation is to hold off on increasing the Vetoryl dose until the effects of the first month of treatment can be assessed. However, as I mentioned earlier, exceptions may sometimes be made if the cortisol level is still hanging at quite a high level at the 10-14 day mark, and the owner is not seeing improvement in any symptoms whatsoever. So whether or not a small increase is warranted at the time of the first testing will depend upon these variables.

Marianne

[judymaggie]

Darlene--I'm glad Marianne posted about the possibility of increasing after the first ACTH.

When I gave Abbie green beans, I would buy the canned ones that had no added salt and kept them in the frig. For some reason, Abbie preferred cold ones. Of course, you could buy fresh beans and blanch them (without salt). Abbie would eat two or three at a time. Fortunately, Abbie responded to Vetoryl very quickly in terms of hunger.

[ZoeysMom]

Thank you both. I am trying the green beans tomorrow. I know I keep asking about her appetite, but I'm just worried that I'm constantly giving her food. I can't say no because I feel awful for her. It breaks my heart into a million pieces.

[Squirt's Mom]

I don't think I will ever forget that awful all-consuming hunger when my Squirt's cortisol started to rise. It was absolutely gut-wrenching. Her eyes were always asking me why I was starving her. :( She would gulp her food, try to take her sibling's food, try to get my food, scrounge constantly for crumbs, searching inside and out for something, anything, to eat. She could barely rest she was so driven by her hunger. Thankfully I understood what was happening or I think I would have lost my wee little mind and she would have ended up so fat she couldn't walk because it was never easy for me to tell her no about anything. :o;):) When her treatment started working and her cortisol came back down, I think she slept for 3 days because she was so tired by the never-ending efforts to find something to eat. It is pitiful to watch but know in your heart she is not really hungry - it is the cortisol making her feel that way. And it won't be long and that will go away - then you both will get a bit of relief. ;)

Hugs,
Leslie and the gang

[labblab]

I wanted to stop back by this morning to ask whether you are seeing any improvement at all in any other Cushing's symptoms, like excessive thirst or urination? I just want to warn that, in Zoey's case, her begging behavior may not be the best indicator of cortisol reduction (and therefore the need for a dosing increase). As you already know, you are reinforcing the begging by constantly feeding her :o :o. I do not mean this as a criticism, but just a fact. I truly do understand how heart-wrenching the hunger can seem. But this means there are two "prongs" to the begging: actual hunger and also an established behavioral routine. So other symptoms may actually be a better gauge of the effectiveness of the medication right now. Are you seeing any other improvements at all?

Marianne

[ZoeysMom]

I absolutely agree with you. No offense taken at all! Earlier I had asked about the possibility of her "training me" (I also asked the vet that question) - about it becoming a learned behavior. It's so hard to tell! As far as other symptoms, while we are at work, we noticed that the water bowl is still pretty full when we get home and both dogs drink from it. At night, when she's eating more food and treats, she drinks a lot, therefore, urinating quite a bit. My doctor already stated that the test results will determine the dose increase, not her eating habits (because again, I'm thinking some of this may be a learned behavior). This is so tough. She went from a pup who sometimes didn't even eat her food right away, to grabbing Jake's food within a second of one of us looking away and always begging and crying. Thank you again! I was flooded with tears as I read your response knowing that you know exactly what I'm going through watching this. They're just so helpless and dependent.

[ZoeysMom]

Hi,
Quick question: Does the vet do another urinalysis at the 14-day mark? I am calling today to find out, but I wanted to check with you first, in case they tell me no and she's supposed to have it done.

Thanks.

[Squirt's Mom]

The vet may run one if there is any question about infection but usually just the ACTH is run at the 2 week mark.

[ZoeysMom]

Help!

Zoey is supposed not have her 14-day test today at 9:30. She ate at 5am and I gave her the pills at that time. However, somehow she managed to quickly eat Jake's stool just now - because of this hunger apparently!!! I apologize - I know that disgusting, but now what?! Can she still have the test in an hour and a half?! I will call the vet, but I wanted to know your opinions!!

Thanks :(

[Squirt's Mom]

Sure, that will be fine. :)

[ZoeysMom]

Thank you! That's what the vet said - but I wanted to check here also! I appreciate it.

[ZoeysMom]

Tomorrow I will ne getting the test results and posting them here. I got the results from previous tests today. Vet said that Zoey's blood pressure is now good and she will call us with the results tomorrow. Thanks again!

[ZoeysMom]

Hi,

The vet just called with the results from yesterday. She is going to fax over them to my husband. She told me that Zoey's cortisol levels have improved, but not where they should be. She called the drug company and they suggested that we give 10mg in the morning and 10mg at night, for now, and test her again in 2 weeks as scheduled. I had actually clicked on the link that you sent to me for the Dechra site and it had mentioned that as a possibly in the flow chart. I've noticed that Zoey begs a lot more at night. I'm hoping this will help. Does this all sound right to you? I will post results later. As always, thank you!!!

[labblab]

Hi,

The vet just called with the results from yesterday. She is going to fax over them to my husband. She told me that Zoey's cortisol levels have improved, but not where they should be. She called the drug company and they suggested that we give 10mg in the morning and 10mg at night, for now, and test her again in 2 weeks as scheduled. I had actually clicked on the link that you sent to me for the Dechra site and it had mentioned that as a possibly in the flow chart. I've noticed that Zoey begs a lot more at night. I'm hoping this will help. Does this all sound right to you? I will post results later. As always, thank you!!!

Once we see Zoey's actual test numbers, it'll be easier for us to comment. But if your vet called Dechra and this is what they've suggested, then it should be a good plan. As I wrote earlier, usually they don't recommend increasing the dose at the 14-day mark, but there are exceptions and it sounds as though Zoey may be a dog who will benefit from more medication. And yes, shifting to twice daily dosing may end up helping with that ravenous evening appetite.

So do let us know the test numbers, and then we'll go from there. Thanks!

Marianne

[ZoeysMom]

Hi,

The dose wasn't increased. It's just 10mg in the morning and 10mg at night. She was on 20mg in the morning before.
Which numbers do you need? I have the results from all the tests and will type it all out tomorrow. Please let me know what numbers and from which tests - thanks!
Question: Zoey has had a bit of blood in her stool for a while now - not consistently. It's bright red and only on the surface. The vet had us bring in a stool sample and everything was normal - no parasites. Abdominal ultra sound didn't show anything either. I asked if it is possible that, since she eats so much more now, that it has something to do with straining. She said absolutely and perhaps she'll put her on a high fiber food, but didn't want to make another change yet since she just started all this medication. When the bloodwork came back today, she noticed higher levels of, I think it was eosinophil, so she is going to deworm her (even though stool showed no parasites) and prescribed Panacur granules. Zoey does not like being outside, so when she does goes out, we walk her on the pavers, around the pool and back inside, since she pulls toward the house all the time. It's very unlikely that she would have had a parasite in the first place. Anyway, I tried to google if there is an interaction with that medication and Vetoryl. I'm sure my vet would not have prescribed it if there were, but wanted to ask you if you know of anything.
Thanks!

[ZoeysMom]

Hi,

Not sure if anyone is see in my posts, but I'll ask anyway in the chance that someone comes across this. As previously posted, Zoey took the Pancur, but she still has blood, since she didn't have worms. They think she needs a change in food with more fiber, so they prescribed Prescription Diet Digestive Care food. I read on the back that it is enriched with prebiotic fiber and ginger, high levels of omega-3 fatty acids, controlled minerals, and clinically proven antioxidants. I was wondering is this will interfere at all with her Vetoryl.

Thank you!

[molly muffin]

Hi. I'm sorry no one replied to your previous post. :(

No the food shouldn't interfere with her vetroyl. Just remember to introduce food gradually so as not to upset her tummy.

As far as test results, the ACTH should have two values, a pre and a post.
For example: pre cortisol 3.5 1 hour or post cortisol 2.5

Any other blood or urine work that shows something out of range, either high or low.
For example. ALKP - 550ug (normal range 50 - 150ug)

Would be how you would type it out. Only anything that is out of range.

It could be the blood is from straining and since it's a bright red it does suggest that it is something like that. Internal bleeding would be almost black in color.

[ZoeysMom]

Hi,

Thanks again to all who have responded with my questions and concerns.

I would like to update all of you on Zoey. On September 22nd, Zoey had her first 2-week appt for her ACTH stim test. At that time, Zoey was on 20mg of Vetoryl in the morning. My vet reviewed the results with Dechra, in which time it was recommended that we keep the dose the same, however, split it into 10mg in the morning and 10 mg at dinner. Zoey has shown slight improvement as far as her thirst, but her appetite is still ravenous. The doctor has also changed her food last week, due to the blood on her stool, to a high fiber food. We are able to give her more of this than the food she was taking, so that helps a bit (since she gets more to eat throughout the evening).

Tomorrow afternoon is our appt with the edocrine specialist. We have waited 5 weeks for the first available appt. My husband and I were willing to go at any time on any day, and this was the 1st appt we could get with this particular specialist, since she has rave reviews. Tomorrow morning is also the 14-day mark, after splitting up her medication, so we need to go in again for another ACTH test. In the afternoon tomorrow, is the appt with the specialist. My regular vet is out of the country for a conference and wont be back until Monday. So this is my dilemma: Should I reschedule the ACTH test for Monday since my vet will be back by then and also, that will be after the consultation with the specialist, in case she recommends something else or in case she wants to do the test at her office. My concern is that if I cancel tomorrow and wait for an appt on Monday, is too long of a wait? I would need to get the medication refilled since she only prescribed it for 14 days. I'm hoping this makes sense and you can give me some advice!

THANKS!!! Zoey and I appreciate you!

[labblab]

I personally think it would be fine to wait until Monday for the ACTH, and that's probably what I would do under these circumstances. I would not expect the specialist to perform the ACTH tomorrow afternoon because the timing would likely be "off" (needs to be 4-6 hours after dosing with a meal). But you're right, the specialist may want to schedule it herself for another day, or alongside some additional tests that can be run at the same time. So I believe I'd continue as you are doing until after the consultation tomorrow.

Marianne

[molly muffin]

I too would wait for the reasons Marrianne mentioned. Once I saw a specialist that IMS became my primary care giver for all things internal and did the testing for ACTH.

[ZoeysMom]

I just got back from the specialist and she agreed with everything my vet has been doing so far. She was very thorough and spent a lot of time with us. Since Zoey's dose decreased since she first went on Vetoryl (from 20mg in the morning to 10mg twice a day), she was scheduled to have the 14-day test, which I was going to wait until Monday to do. Anyway, the dose now is considered a decrease since it usually lasts only about 9 hours and she went from 20 to 10mg, so I asked if she is supposed to be tested on the 14th day again or wait until the month mark, which is in 2 weeks. She agreed to waiting until the month mark since her last acth test was on 9/22, at which time it was decreased. Opinions on this? She did say several times that it takes a while for the cortisol to stabilize and you have to be careful.

Also, she did recommend plavix every morning as a preventive for blood clotting. Again, thoughts? She said that's what she would do, but it was entirely up to us. We got the prescription since we would rather be safe than take a chance. Any experience with this at all?

Thanks!

[Harley PoMMom]

Since Zoey's dose decreased since she first went on Vetoryl (from 20mg in the morning to 10mg twice a day), she was scheduled to have the 14-day test, which I was going to wait until Monday to do. Anyway, the dose now is considered a decrease since it usually lasts only about 9 hours and she went from 20 to 10mg, so I asked if she is supposed to be tested on the 14th day again or wait until the month mark, which is in 2 weeks. She agreed to waiting until the month mark since her last acth test was on 9/22, at which time it was decreased. Opinions on this? She did say several times that it takes a while for the cortisol to stabilize and you have to be careful.

I really do not consider her dose as a decrease as she is still getting 20 mg of Vetoryl it's just split (10 mg) and given twice a day. The reasoning behind splitting the total daily dose is if symptoms seem to rebound in the evening or if the dog has diabetes.

I do believe it is a good idea to have her cortisol tested in 2 weeks because when splitting the daily dose there is a chance that the cortisol can drop too low. One of the top renown veterinarians that specializes in endocrinology, Dr. Bruyette, states that:
While twice a day dosing may result in a lower amount of trilostane being used pre day it will require closer monitoring as the ACTH stimulation tests tend to be lower so we have to look for both hypocortisolemia and electrolyte abnormalities.

http://www.k9cushings.com/forum/showthread.php?p=5051


Also, she did recommend plavix every morning as a preventive for blood clotting. Again, thoughts? She said that's what she would do, but it was entirely up to us. We got the prescription since we would rather be safe than take a chance. Any experience with this at all?

Thanks!

Personally, I prefer a low dose of buffered aspirin (not Enteric-Coated) in place of the plavix. Although both aspirin and previx are associated with haemorrhage a study has shown that the chances are higher with plavix: http://www.medsci.org/v09p0441.htm

Lori

[ZoeysMom]

Thanks for your response. The specialist told me yesterday that the medication only lasts about 9 hours, therefore it's considered a lower dose, but twice per day. I will keep Monday's appt then, if you're saying something different. I can't take a chance.

[molly muffin]

For myself it depends on what her last ACTH numbers were and if she was in range, needed to come down a little or a lot as to whether or not I'd test now or wait. For instance if you have a big range to drop, then I would probably wait, unless I noticed a marked difference in symptoms. If she only needs to come down a little then I'd probably do the test sooner at the 2 week mark.
I don't see where you posted the results of the last ACTH but maybe I missed it.
I think Dechra says it last 12 hours in body, but the cortisol drops to it's lowest point and then starts to come up again throughout the day.

[ZoeysMom]

Hi,

Hope this finds everyone ( and their precious pups) well.
Here is an update since my last post. We just had her ACTH test on Saturday. This test was done after they changed Zoey's Vetoryl from 20mg in the morning, to 10 mg in the morning and 10 mg at night. It was the 30-day mark. My vet called today with the results and said that she called Dechra and normally they would leave the dosage alone, however, since Zoey is still showing signs of hunger and thirst, they are now (because she is still symptomatic) going to increase from 10 to 20mg in the morning and leave 10mg at night. Here is my concern: I have seen some improvement in her begging and thirst levels during the day (on weekends when we are home with her all day), but at night it is back to being out of control. They changed her food, as well, so she has lost some weight and her belly went down. So, I worry that they are increasing the dose because of the symptoms - what if she is playing us now? It's hard to tell. I have her results from all the tests she's had and I would like to post them for someone to review, however, I don't know exactly what results you need. Just cortisol levels? Please let me know and I will post results with dates and hopefully you can help me out! Thanks so much!

[DoxieMama]

Hi Darlene,

For the ACTH results, post the cortisol levels (as well as the units used). Post all the results - both pre and post numbers. For bloodwork, you need only post those values which are high or low, as well as the range listed.

Hope that helps!

Shana

[ZoeysMom]

Thanks.

Here are the results:

**9/22/16 (after taking 20 mg of Vetoryl in the morning for 2 weeks)

ACTH Results:
Pre ACTH Cortisol .4
Post ACTH Cortisol 3.9

Blood Test Results:
The following were labeled as just High and the rest of the levels fell in average - some high average and some low average:
ALP 191
ALT 153
Cholesterol 560

**10/23/16 (one month after changing Vetoryl from 20 mg morning only, to 10mg morning and 10mg night):
ACTH Results:
Pre ACTH Cortisol .6
Post ACTH Cortisol 9.4

When I received the copy today of the results, I didn't notice that I hadn't received the blood test results.

So, from these results, they are now changing morning to 20mg and night leaving it at 10mg. She told me that Dechra recommended this because she's still symptomatic.

My vet also said she is calling the endocrine specialist that we had gone to, and running everything by her as well. I am supposed to start the 10mg morning increase tomorrow, but I wanted to wait until she speaks to the specialist and also I wanted to post on here.

Thoughts? Recommendations?

Thank you!!

[Harley PoMMom]

So, from these results, they are now changing morning to 20mg and night leaving it at 10mg. She told me that Dechra recommended this because she's still symptomatic.

My vet also said she is calling the endocrine specialist that we had gone to, and running everything by her as well. I am supposed to start the 10mg morning increase tomorrow, but I wanted to wait until she speaks to the specialist and also I wanted to post on here.

Thoughts? Recommendations?

Thank you!!

I think that the dosage increase in the morning is reasonable since she is still having Cushing's symptoms. And since the vet is going to confer with the specialist, which I believe is a great idea, I would also wait to do the increase until you hear what specialist has in mind.

Hugs, Lori

[molly muffin]

Strange the cortisol levels post actually went up on the 10/10 split. from 3.9 to 9.4 3.9 is actually a good result and right where you want to be at.

You could also do a 5mg add, 15mg/15mg, they do make 5mg now of vetroyl, and you could do trilostane for the 5mg if they can't get it in vetroyl.

It will be interesting to see what the specialist thinks too.

[ZoeysMom]

Hi,

I asked my vet about possibly doing the 15mg morning and 15 mg night, since I knew about the 5 mg Vetoryl. She wanted to check with the specialist and the specialist actually recommended that. She said that she hasn't seen much success with the 20mg morning and 10 at night, so 15/15 would be better.

So, you said the Cortisol level is where we want it to be. That's what concerns me about increasing. I am worried that she is "playing me". She does drink a lot, but not as much and her belly looks smaller, but then again, they changed her food to low fat and she lost a pound. I just worry that the dose increase is only because she symptomatic, as I stated earlier.

One more question. Do you think that the 10/10 split results were better because of the month wait since it takes about 30 days? Just curious. The first test was done after 2 weeks.

Thank you all again. I am trying to understand all of this, and I have to say, thanks to all of you, the specialist said she was impressed at how much I knew about Cushing's and thought I had some good and valid questions. So, Kudos to all of you! :)

[molly muffin]

With the result of 9.4 I don't think she is playing you. She might have had an initial drop at the 2 week mark and then went back up.

The 3.9 was perfect, but as you can see by October, she was having increased cortisol production.

Think of the adrenal glands as a sponge, and the ACTH post result is after the sponge is rung out, how much liquid was produced. Right now there is enough being produced that she is still hungry and needing to go out more frequently.

So yes I would try the 15mg/15mg. You want her post to be after a month in that 3.9 range, or under 5.0. Post can be up to 9.0ug but that is with symptom control.

It's strange but we have seen some small dogs on pretty large dosages, and some big dogs on smaller doses.

[ZoeysMom]

Gotcha! I thought you were saying that the 9.4 was good. I understand now. Thanks so much!

[ZoeysMom]

One more question. Zoey has been licking us a lot. She will sit and lick our legs or arms for a long time. Does this have anything to do with Cushing's?

[labblab]

I've never read about licking being a side effect, but my own Cushpup licked our legs (and his own paws) obsessively until we got his cortisol down low enough until his other symptoms were well controlled. At that point, he stopped the licking, as well. This is only a wild guess on my part, but maybe he was liking the saltiness of our skin during the time period that he was drinking and peeing so excessively -- kind of like when atheletes drink sports drinks like Gatorade when they get dehydrated. They need to keep the electrolytes (sodium and potassium) balanced when they are dehydrated. Just a thought...

Marianne

[ZoeysMom]

Hi,

I hope this finds everyone and their pups doing well. I'm writing because I am very concerned. Zoey went back for her monthly ACTH test last week and her levels were still elevated and she's still having some symptoms (worst one being the appetite). My vet called Dechra and also the endocrine specialist and they both agreed on increasing her dose to 20mg morning and 20mg evening. Again, Zoey is a 15-pound chihuahua. My concern is that in the past week and a half, Zoey's appetite has increased quite a bit and her drinking has increased slightly. She was always hungry throughout all of her treatments, but she was begging a little less frequently and not drinking as much. Now, she is back to what is was - constantly begging and ravenous. Can anyone help me to answer why this is happening now!? My nerves are completely shot. I worry all the time! We go back on December 22nd for the next ACTH test. Thank you!!

[Squirt's Mom]

Hi Darlene,

Over the years we have seen an odd thing with Vetoryl - many times the smaller dogs take a much larger dose that would seem right for their weight while larger dogs take a much smaller dose than their weight would demand - and both do fine. With the increasing dose tho always keep a close eye for any sign it may be too much. Did you try the 15/15 or is this a jump to 20/20? If you haven't tried the lowest increase possible that is where I would start myself. ;)

Hugs,
Leslie and the gang

[ZoeysMom]

This is an increase from the 15/15. We tried that for a month and she was a teeny bit better, however, the last week of 15/15, she regressed. We started her on 20/20 last Monday and she's worse now. I know it's been only a week, but she's worse.

[ZoeysMom]

Hi,

I just wanted to continue my previous post by privding you with an example of some of the ways we have noticed that she's worse.. Besides drinking more, Zoey had stopped waking us up as early as 4-4:30am and started getting up between 5-5:30, for breakfast in the past 6 weeks or so. Now, she is back to going crazy at 4:00am and on a few days, a little earlier. She hasn't done that in over a month or so. And she is also begging and barking and pawing at us immediately after being fed. Do you know the reason she is regressing with an increase in medication? Like I stated previously, she's only been on the increased dose for about a week and a half now, and I know it takes about a month or so, however, why would she go backwards from the previous dose that was showing slight improvements?

[molly muffin]

I just went back through and reread your thread. She was at 9.4ug so dosage was increased.
What is the level now that caused the new increae?
It is strange that she is more hungry on the increased dose. Is all other blood work fine?
How is her thyroid? Glucose?

[labblab]

Gosh, I can sure sympathize with your frustration! However, I think it will be helpful to give it a bit more time to see you whether or not Zoey's other symptoms are better or less controlled, as well. When our dogs are diagnosed with Cushing's, the natural reaction is to assume that any and all behavioral changes are a direct result of the disease. But the early awakening and begging may be continuing for other reasons. I say this because I'm experiencing the same problem with my nonCushpup!

Prior to the death of our older girl in June, both our dogs always slept together and away from us, downstairs. But when Peg died, we worried that Luna would be lonely and we are letting her sleep in our bedroom. The problem is we've discovered she is a very early riser :eek:. Anytime after 4:00 she will get up and walk around, flap her ears, roll on the floor -- generally make noise. Some mornings it's 5:00, some mornings earlier. If I go ahead and get up, take her out and feed her, she settles down and we both can go back to sleep again. So I do get to go back to bed, but my sleep is still disrupted and with each day that passes I am reinforcing the early awakening more and more. Overall, I know this is not a good thing. I don't think she really needs to go out badly because she usually sniffs and explores before peeing. But she loves getting her breakfast! For the last couple of days I am trying to just ignore her until 6:00 when I do need to get up. I'm not sleeping well, but I'm hoping it will break the cycle. We'll see.

Anyway, the point of this saga is that begging behavior may not be the most accurate gauge of Zoey's actual cortisol level. She may just be a dog who likes to eat (like my girl) and when you reinforce the begging behavior by feeding her early in the morning (like I'm doing :o), it will never really stop. As far as Cushing's treatment success, other indicators may be better guides for Zoey. You note that she also seems to be drinking more, too, though. Does that genuinely seem to be a change or is it more the begging that's the issue?

Marianne

[ZoeysMom]

Hi,

I will post Zoey's latest results shortly. The symptoms that have shown regression are the drinking and the begging and appetite. Honestly, it looks like her belly looks bigger too. She did gain a little weight back this week, after the weight loss she had last month. It's most likely because we seem to be feeding her more because she seems like she's in distress when she begs. It's so difficult to ignore. Sometimes I think it can be a learned behavior, however, there are times when we are in another room and we can hear her banging on her dish and licking it and crying. :(. It's heartbreaking.

[molly muffin]

Yes that begging can definitely break your heart. Have you tried giving green beans or something low cal for a treat when she begs?

[ZoeysMom]

Yes, I have. Someone here mentioned green beans so we tried that - and carrots. We have also been just giving her a few morsels of food here and there, but I don't understand why everything is back to the way it's been since before she was diagnosed in August. Nothing satisfies her. She seemed to be getting a bit better so I'm very confused. Between the medication and all the ACTH tests and the high blood pressure medication, plavix, probiotics, antibiotics, and a few other things for blood in her stool (she's had that since August, as well), and the ultra sound, blood pressure monitoring and the second opinion with the endocrine specialist, we are at about 6k. I'll do/pay anything for her, but I don't understand what's going on, why nothing is working, and it's tearing me up. Again, besides the ravenous appetite and the constant barking and begging, she's completely her normal self. She plays, cuddles and rolls over to be rubbed. She's an absolute love bug! I realize it takes a while to get the vetoryl at the exact dose, but it seems like for her it's been a nightmare. She's only 8, too. Sorry, I'm just so upset about this.

[ZoeysMom]

I have a question. Is adrenal Cushing's also treated with vetoryl and if not, is it possible that Zoey has adrenal Cushing's? How do they diagnose adrenal, besides an ultra sound? Zoey did conduct an ultra sound, but I guess I'm just grasping at anything at this point because it seems like nothing is working in the over 4 months that we've been treating this.

[molly muffin]

I understand completely. We think I spent more time at various vets offices than I did at home sometimes. It can be very frustrating, but that is why I was wondering about the thyroid, glucose etc. Those might have been okay 4 months ago but might have changed since.
Her behaviour is certainly confusing for dosage, treatment, etc.
As for adrenal that is normally discovered on the ultrasound by viewing the adrenal gland. Sometimes it is discovered via the odds during diagnosis phase.

[ZoeysMom]

Hi,

I will post results shortly, but I was told everything was in normal range. Cortisol levels were still high and that's why they increased the dose (which, by the way, has not helped at all).

My question: Is radiation or surgery an option? I remember asking the vet in the beginng when she was first diagnosed, and was told that surgery is an option for adrenal Cushing's. I'm just wondering if there's anything else since Zoey is now at 20mg twice a day and we have seen no improvement at all. This is so upsetting. I am waiting for the vet to call me back, but I figured I would ask here as well.

As always, thank you!

[Harley PoMMom]

We have also been just giving her a few morsels of food here and there, but I don't understand why everything is back to the way it's been since before she was diagnosed in August. Nothing satisfies her. Again, besides the ravenous appetite and the constant barking and begging, she's completely her normal self.

Is the increased hunger where there has not been any improvement? Is her drinking and urinating still normal?


Hi,

I will post results shortly, but I was told everything was in normal range. Cortisol levels were still high and that's why they increased the dose (which, by the way, has not helped at all).

Has it been 10-14 days since her dosage increase of 20 mg BID? And if so, has an ACTH stimulation test been performed to see where her cortisol level is at?


My question: Is radiation or surgery an option? I remember asking the vet in the beginng when she was first diagnosed, and was told that surgery is an option for adrenal Cushing's. I'm just wondering if there's anything else since Zoey is now at 20mg twice a day and we have seen no improvement at all. This is so upsetting. I am waiting for the vet to call me back, but I figured I would ask here as well.

As always, thank you!

Unfortunately surgery for the pituitary type of Cushing's, at least here in the U.S., is rarely performed. Radiation can be done and I believe some centers offer shorter-term radiation options where before it involved many sessions. We've had members who have had great success with radiation therapy but it is expensive.

Hugs, Lori

[ZoeysMom]

Drinking and urination had decreased for a short time as well, but it's all back up.
She's been on 20mg for 3 weeks now. It sounds crazy but she was on 15mg for a month prior to the ACTH test which increased her to 20mg, and she actually seemed a bit better. After 3 weeks on 20mg,we see no improvement and she seems worse. Her next test is on Tuesday.
It's truly upsetting to hear that radiation is an option. On every website I went to, it was never recommended - all websites talked about Vetoryl. I also don't understand why my vet or the specialist didn't recommend it (or suggest it as an option). We are already at about 7 thousand -not sure how much radiation is.

[ZoeysMom]

One more question about the radiation. I typed radiation in the search here and didn't see anything. Do you know where they do it or have a number I can call? 8 tried googling but I'm finding nothing. Thanks!

[ZoeysMom]

Not sure if I mentioned, she's 20mg twice a day and my vet usually waits 4 weeks lately for the next ACTH test (Dechra recommended that the last time).

[labblab]

Hi again from me. I just want to clarify that radiation is typically only a treatment option to reduce the size of a pituitary tumor when it has enlarged to a size that is causing neurological symptoms due to pressure placed on other areas of the dog's brain. These are problems such as seizures, loss of coordination, aimless pacing, loss of appetite, etc. Radiation does not eliminate the tumor completely, it just reduces the size. So it is not actually a cure for Cushing's itself, but rather a treatment to halt or slow the development of these additional problems. Some dogs who have been treated with radiation do get at least a temporary break from needing to take Vetoryl or Lysodren, but most have to restart the medication eventually and some always need to continue it without a break. So I'm afraid that is probably not a treatment option that would be helpful to you right now. And yes, it is very expensive to boot, like thousands of dollars.

I cannot tell you how anxious I am to actually see the history of ACTH monitoring results for Zoey -- the actual numbers. I really think that's where we need to start in terms of sorting things out.

Marianne

[ZoeysMom]

Thank you for clarifying!

Here are the cortisol levels from the ACTH results from 11/19/16:

Pre 4.2
Post 9.0

I apologize. I thought I had posted them. This test was administered after a month on the 15mg twice a day dose. After calling Dechra and the endocrine specialist and per their advice, my vet increased Zoey's dose to 20mg twice per day (where she is now).

[ZoeysMom]

Also, I was reviewing the previous levels over the past 5 months and I was wondering if you could explain exactly what the pre and post mean and what they should be at? I want to make sure I am understanding this all correctly (or can you send me a link on where it is explained, so you don't have to type it out again). I hate to bother you on this, but according to the specialist and my vet, I am pretty versed on Cushing's (thanks to all of you), but I want to be certain I understand it completely. Thanks!

[DoxieMama]

Hi,

I only have a minute (am at work) but wanted to share the link Marianne posted http://www.dechrace.com/pdfs/vetoryl/VETORYLTechnicalBrochure.pdf. Take a look at the page titled "Treatment and Monitoring of Hyperadrenocorticism" (page 11 of the PDF). That is where it talks about the specific POST ACTH numbers you want to see, and how to respond to each with an increase/decrease of Vetoryl.

They don't mention the PRE number all too often...

Hope this helps!
Shana

[Harley PoMMom]

In the ACTH the "pre" number is the value which represents the cortisol before any stimulate is injected, it is also referenced as the baseline or resting cortisol number. The post number is the value after the stimulating agent is injected, it shows how much cortisol was reserved in the adrenal gland.

Sharlene posted this response to a member describing the post number: "Think of the adrenal glands as a sponge, and the ACTH post result is after the sponge is rung out, how much liquid was produced."

With Cushing's the post is the main important number because you don't want that post to drop too low. The Pre number is mainly looked at if Addison's is suspected.

When treating with Vetoryl/Trilostane Dr. Peterson, who is one of the top canine endocrinologist, recommends a post of between 2 ug/dl - 5.4 ug/dl and if all clinical symptoms are controlled that post number can be as high as 9.1 ug/dl.

Hope this helps, if not please do let us know, we want to help you understand not confuse you.

Hugs, Lori

[ZoeysMom]

Thank you! So basically, she's still high since she was 9.0 post and is still symptomatic. We will see what results next week show.

[ZoeysMom]

Hi,
Zoey's results from Wednesday's ACTH:

Pre 1.3
Post 2.4

They're keeping her at 20mg/twice per day.

Here's my next concern. Our other dog, Jake, went in for routine bloodwork and there are some levels that were high.
Hemoglobin: 21.9
Hematocrit: 61.8
MCH: 26.5
Reticulocyte: 124
ALP: 272

Doctor is recommending an abdominal ultrasound. Could it be possible from these numbers that they're starting the check for Cushing's?!? She emailed my husband the results, but I had missed the call. I called back, but because of the holiday, she wasn't in until today. I will be calling shortly, but I wanted to know if you had any idea of what could be going on. I'm losing my mind here.

Thank you!

[labblab]

Hi Darlene,

Thanks for posting those ACTH results. If I'm remembering correctly, Zoey has been taking the 20 mg. twice daily for about a month now. If so, then yes, we can assume that her cortisol level has pretty much stabilized and this is a good level for her to be maintained in the hope that you'll finally start seeing the symptom resolution you're hoping for. How is she doing in that regard?

As far as Jake's situation, I'm afraid we'll have to wait to see exactly what your vet is considering. But no, I don't think it's likely that it's Cushing's that she is wondering about. I would guess it's more likely that it is Jake's spleen or liver that she is wanting to look at in the face of those elevated red blood cell counts. The spleen is an integral organ when it comes to blood cell "stuff," so maybe that's what she's wanting to view. Totally just a guess, though, and please update us as soon as you have more info yourself.

Marianne

[ZoeysMom]

Yes, Zoey has been on 20/20 since November 22nd. She doesn't drink as often, is less hungry (but still begs a lot and tries to take Jake's treats when she can), and licks us a lot. But, from what the levels show, and what you and the vet and specialist are all saying, she's at a stabile level now.

The reason I was asking about Jake was because I had googled the liver levels and Cushing's was a possibility. But then I saw the other blood levels, so I thought I would ask. Vet usually calls me back at lunch or after 5.

Thank you again!

[labblab]

Hopefully you'll soon get to talk to the vet about Jake and you can find out what she's thinking. I do need to back up to say that Cushpups do sometimes exhibit some mild elevations in platelets and red blood cells, but without the reference ranges for Jake's cell counts, I don't know how highly elevated these results are. And I also don't know whether Cushing's would account for all these cell count elevations across the board. So I guess we'll just have to wait and see what your vet has to say.

Marianne

[molly muffin]

What did your vet have to say about Jake? Now I'm curious too. :)

[ZoeysMom]

Hi,

Me again. :( For some reason, I stopped getting email notifications, so I didn't see that you had written back. Jake had his ultra sound and it was completely normal (thank God), so they will check his liver levels in another 3 months.

As far as Zoey goes, she has been on 20/20 since November 22nd and levels appeared to stabilize after her test in December showed her levels were good. They wanted to check again in one more month (which was this past Saturday) and her post level was 1.9. Because my vet and the endrocrine specialist said it was too low, they reduced her medication back to 15/15. Since the day we changed it, she's back to drinking a lot and begging like crazy!!! Please help! I need advice. She's been going back and forth to the vet and the specialist since August. Starting out with ACTH test every 2 weeks for the first month and then monthly after that and they still haven't figured out the correct dosage. it has been 3 days on 15/15 and my poor baby is going nuts again with the hunger! Thank you!!!

[Carole Alexander]

I am sure that others will reply who are far more knowledgeable than I am, but I would hang on and see if the hunger diminishes. Will she eat vegetables and fruits? I know how frustrating this dosage issue is but you sure don't want to send her into Addison's and have a new and potentially more serious problem. Hang tight and wait I think.

[molly muffin]

Oh poor zoey. Her cortisol probably did go up a bit on the lower dose but a 1.5 post acth is a bit low. You'd be better to see like a 3.5 as it is eay to tip over into life threatening territory if she where to continue to drop for any reason.
I'd see if the hunger doesn't abate on this dose. When do they want to retest?

I understand completely the running back and forth to the vets. We did it for years and it is exhausting. On the other hand Molly made great friends of all the staff and got very good care.

I'm saying this a lot today but deep breathes. That's great that jake had a good clear ultrasound. Yay

[labblab]

I would contact your vet and let him/her know how badly Zoey's symptoms immediately rebounded. Perhaps a better dosage adjustment would be to shift to 20/15 rather than 15/15. After her first month on 20/20, she tested at 2.4, which was fine. After a second month on the same dose, she had drifted further down to 1.9. Technically, that 1.9 would still be OK according to Dechra (they don't want levels to drop lower than 1.45). However, I understand why the vets do not want to risk continued lowering on the 20/20. But given Zoey's clinical response to the lowered dose -- immediately worsening symptoms -- I'd see if the vets would consider a smaller dosing decrease.

According to Dechra, twice daily doses don't have to be perfectly evenly split. But if not, the larger dose should be given in the morning. So again, I'd tell your vet about Zoey's worsening behavior and see whether 20/15 might be a reasonable compromise to try.

Marianne

[ZoeysMom]

Thank you all. I will call tomorrow and speak to my vet. Don't get me wrong, my reaction is because of my heartache for Zoey, not the vet. She's absolutely wonderful. After each ACTH test, she calls our endocrine specialist and Dechra, then she calls us, even if it's 7:30 at night. I was also frustrated that they went back to a dose that didn't help her before. I completely understand not wanting it to drop and not taking any chances, however, I was looking for perhaps another alternative, as the one you just suggested.

Thank you again!

[molly muffin]

checking in for an update on Zoey. :) Is she still having strong hunger drive on the lower dose?

[ZoeysMom]

Yes, and it's very bad. She's waking us up at 3am now. I contacted the endocrine specialist and she mentioned perhaps it was behavioral since her weight is stable. That did not make sense to me at all since one of the symptoms of Cushing's is a ravenous appetite - regardless of the weight. I wrote back stating that it's been a huge increase since we went back to 15mg 2x per day. She stated that we couldn't take a chance since her cortisol level dropped and it was dangerous. I understand that, and I would never want to put Zoey in any dangee so or at any risk, but something has to be done. She is in complete distress all the time. This is what brought us to the vet in the 1st place over 2 years ago.

[molly muffin]

I wonder if you can add in like a 1 mg or 2 mg trilostane. Not enough to go up to her previous dose but more than her current dose.
I do know someone who used a combination to get the right dose for her dog.

[Carole Alexander]

You also might try adding melatonin to Zoey's diet; of course, I can't say for certain as five days ago we increased Skippy's dosage 5mg at night, but he's been on melatonin for a week too and now he is sleeping through the night and is not nearly as thirsty and ravenous. They will test Skippy again next Wednesday. I understand your frustration and desperation and Sharlene's thought of adding one or two mg of Vectoryl seems like a great idea if they can compound it. One day at a time.

[ZoeysMom]

Hi,

An update and a question. Zoey just had her monthly ACTH test after being back on the 15mg 2x per day. Her post was 3.2. Here last test, which was after taking 20mg 2x per day, was 1.9, which was too low according to both my vet and the endocrine specialist. Although the levels are good now, my concern is her appetite. I do understand that some of this is behavioral(like both vets said), however, I do think that part of it is hunger. When I am downstairs and she is upstairs (she can't go down the stairs on her own), many times we can hear her licking Jake's and her own bowl. This is constant. When we are with her, which is most of the time, she is pawing, scratching, barking and crying for food. She sits in the begging position and continually gets on top of us and barks and cries. Zoey was never a dog that barked. Because she can only eat her special food, due to an inflamed colon, we just give her some niblets of her food throughout the day. We also bought some of the puzzle toys that release food, to keep her distracted (as recommended), but she gets the food out of there immediately. Any suggestions would be great! It is heartbreaking to watch. This is such a sad way for her to live her life. Breaks our hearts. :(

As always, thank you.

[ZoeysMom]

One more thing. When Zoey was on 20mg 2x per day, we did see less of these behaviors. She did beg at times, but it was constant. This also makes me believe that it is not all behavioral.

[Harley PoMMom]

I believe I would ask the vet about the 20/15 split that Marianne suggested. I know how upsetting it is to see them constantly searching and begging for food :( some of our members give their dogs green beans or carrots in between meals.

Hugs, Lori

[molly muffin]

I think we also had a member give blueberries as a treat too.

I'd try the 20/15 maybe too as marianne suggested.

[ZoeysMom]

Hello,

I hope that this finds everyone and their pups well. Unfortunately, I am back because I have devastating news. Zoey was just diagnosed with a very aggressive type of cancer. My world has crashed. She’s my life. We are totally distraught and devastated. Chemo is not an option. Initially we brought her in because she wasn’t eating and I was afraid her levels were too low. My vet did an ACTH Stim test and bloodwork and everything was good. She then did an X-ray and found nodules in her lungs and a tumor next to her kidney. We immediately went to the ER so that they would get her in for an ultrasound and we would be able to meet with the oncologist on that same day. It was confirmed and my heart completely shattered. We have seen 5 vets. She is not in pain. My question is this: the oncologist took her off of her vetoryl. I’m thinking it’s because she wasn’t eating (but now is) and because she said that her normal corstisol levels will help with inflammation because the tumor is pressing up against her kidney. I am concerned, however, that now she is back in a Cushing’s state, which makes her a sick pup, on top of the cancer. The reason I am questioning this is because I met a vet the other day and he questioned taking her off vetoryl. I am going to ask my oncologist, but I was wondering if anyone here has come across the same thing and if you know if this is an ok thing to do.

Thank you from the bottom of my heart, Darlene

[Joan2517]

How terrible for you, Darlene, and poor little Zoey. My heart goes out to you.

[Squirt's Mom]

Letting the cortisol run high will help her now even tho the cush signs will become stronger. They will not harm her. Lowering the cortisol will allow the tumors to grow faster while letting it run high will help them stay smaller longer. Not how we are used to thinking about our nemesis, cortisol, but there are times when it is actually a friend....and this would be one of them in my mind.

Enjoy every moment with your precious girl. Talk about all the things you have done together, the places you have been, the people who love her. Make new memories you both can carry with you always. Let her eat anything she wants anytime she wants. Take her to her favorite places for as long as she enjoys going there. Take her to see her favorite people. Touch her every chance you get. Talk her so she hears the love and strength in your voice. And always remember we are here for you anytime.

Hugs,
Leslie

[molly muffin]

Oh no, I am very sorry to hear the news about cancer.

As leslie explained, having the cortisol run a bit higher might help to keep the tumors smaller for longer, and prevent inflammation. I'm pretty sure that is what the vet was thinking. The other vet was probably thinking in terms of cushings, but this is one of those trade off situations.