New cushings diagnosis

[Deuces mom]

First, thank you for this forum. My baby Deuce was diagnosed in July. He is a 12yr. Old neutered male mastiff/pit bull mix. I am also sure he has CC. But it has not been confirmed. At the moment, I don't have copies of all lab work.
We started him on trilostane at 30mg twice a day. Two weeks later he had blood work and cortisol was 8.5, the vet raised it to 45mg twice daily. Three weeks later New blood work and cortisol still 8.5. Last blood work was Tuesday, cortisol is still 8.5. The vet wants to increase trilostane to 90mg twice daily. I forgot to add that Deuce weighs 101lbs. Next blood work will be done Dec. 26th.
Deuce is doing well on the meds. He is finally showing a little spunk. He is still drinking lots of water and peeing quite a bit. The ugly sores on his shoulders and butt look better. Dry and brown and starting to come off. I feel we are on the right track but still worry.
Thank you for listening.
Julie and deuce.

[tank&kat]

Hi Julie,

I only have a minute to respond right now but can you verify the amount that the vet wants to increase to? Can you also provide the dates of the ACTH tests that have been done and the date Deuce began taking trilostane? I would strongly recommend against an increase from 30 mg bid (twice a day) to 90 mg bid. Generally, increases should not exceed 25-50%. I am hoping the vet meant 45 mg twice daily.

An ACTH test should be done 10-14 days after any dose adjustment. Is he getting a full meal with each pill?

~Kat

[DoxieMama]

Hi Julie, welcome to you and Deuce! If you can get copies of the tests done on him and post the abnormalities found, that would help us with his history. And as Kat commented, I too am concerned about the increase from a total of 90mg per day to twice that... and then no blood work for 3 months.

If you could, also clarify the results of the tests showing his cortisol. Were those ACTH tests with a pre and post number - or just a baseline cortisol result?

I'm so glad you're here, and look forward to getting to know Deuce better!

Shana

[labblab]

If I am reading things correctly, there has already been a jump to 45 mg. twice daily, and that's where you've been for at least three weeks. However, the post-ACTH cortisol level has remained constant at 8.5 throughout the dosing increase thus far? As Kat has said, exact testing dates will help us a great deal, as well as confirmation that the cortisol readings you're giving us are indeed post-ACTH values and not baseline cortisols.

If I'm accurate in my understanding of things, I would not feel at all comfortable with such a big dosing increase (from a daily total of 60 mg., to 90 mg., suddenly to 180 mg.). That is a huge increase, especially given the fact that Deuce's cortisol is already within a range that would be deemed therapeutic if you were seeing significant symptom relief. I understand that, in terms of symptoms, you still have a ways to go. And especially if he truly suffers from C.C., you may well want to hold that post-ACTH to a level below 5.0. But this flat-out doubling of his dose seems quite extreme and frankly dangerous to me, especially since your vet does not want to retest until December. I would not agree to such a large increase if Deuce were my own dog. Far more reasonable would be a jump to 60 mg. twice daily, for a daily total of 120 mg.

I agree it's odd that Deuce's post-ACTH has consistently hung at 8.5 thus far, regardless of dosing level. But since you are seeing at least some improvement, and most especially with his skin, I repeat that I would not feel comfortable with such a large increase. May I ask what form the trilostane is in (liquid vs. capsules vs. chewables)?

Marianne

[labblab]

Hi again! Just wanted to let you know I've moved your thread to our main Questions/Discussion forum. This way, more of our members are likely to see it and respond. ;)

Marianne

[judymaggie]

Welcome, Julie, to you and Deuce! Hopefully, you have had a chance to digest the excellent information you have already received. Your feedback will help us guide you in taking care of Deuce. Cushing's can be a complicated disease. We often say that the best outcome comes from having an educated pet parent and a vet who is knowledgeable or who is willing to learn. Here is a link to our Resources forum where you can find a lot of helpful articles:

http://www.k9cushings.com/forum/forumdisplay.php?f=10

Looking forward to learning more about Deuce!

[Deuces mom]

Deuce is on chewable trilostane.

[labblab]

I wondered if that was the case -- whether Deuce has been taking a compounded version of trilostane. I truly understand that the cost of brandname Vetoryl can put treatment out of reach for many people, especially those who have dogs requiring larger doses. But unfortunately, research studies have shown that some compounded versions of trilostane are inconsistent in terms of the actual dosage of the medication and/or the efficacy with which it is absorbed. I do think it is very odd that Deuce's post-ACTH has come out with the identical value, regardless of the supposed dosing increase. So, unfortunately, it makes me wonder about the quality of the compounded trilostane he is receiving.

What I'm going to suggest now would be a big shift for you and your vet. But if you could afford to give $140 a try, you could buy a month's worth (total of 60 capsules) of 60 mg. brandname Vetoryl capsules from a reliable internet veterinary pharmacy. I would be really interested to see where Deuce's cortisol level would fall at the end of a month of treatment with Vetoryl, as compared to the compounded chewables.

If his level after that month is still hanging higher than you'd like, then I'd feel a whole lot more comfortable about an even greater increase than I do, right now :o. So perhaps this is a suggestion you might want to talk over with your vet. At least, it is a thought.

Marianne

[Deuces mom]

I am going to start at the very beginning. Last March, Deuce cut his nose and it got infected. We took him to a vet in Norco where we were living at the time. He had never been sick or injured before. We had noticed his fur was getting thinner and ask said vet about it. He said it might be cushings disease. We also ask about the sores on his back. Vet put Deuce on antibiotics for the infection, gave us an ointment to put on the sores, and BPO 3 shampoo to bathe him. We made an appointment to have him tested for Cushings and did so after he finished his antibiotics. I don't know what test was done but it was negative for cushings. We again asked about the rash on his shoulders and butt and vet said he had never seen anything like it and attributed it to old age. I had a hard time swallowing that.
In July, we took him to a different vet as we were getting ready to move to Arizona. This vet tested him for cushings and it was positive and they also told us the sores were from the Cushings.
We moved to Arizona on the 29 of July. I found a vet here and made Deuce an appointment. They called and obtained Deuces records and test. I am sure by this time Deuce's stress level was pretty high as we moved him from the home he lived in for 12 years. We had to stay at our son's house for 2 weeks until escrow closed in Az. Deuce and his sister Venus were both stressed out an then my son also has 5 dogs. More stress. Then we moved them to Az.
The new vet. Dr. William Dean went over Duece's records and test, at this time he started him on 30 mg. of chewable Trilostane twice daily.
Then, 10 days later they did a Snap test and raised Deuce's medication to 60mg twice daily.
After 3 weeks vet ran another Snap test and raised meds. to 90mg. twice daily. At this visit Cortisol was 8.5.
Looking at the paperwork I see Deuce lost 8lbs.
Patient vitals:
Temp, 101.8
Pulse 124
Respiration, Pant
Cortcotropin: Gave 2.3 mls im
Level is 8.5
Recommend increase Trilostane to 90mg. (Wedgewood Gourmeds Chewable) PO BID and recheck in 3 months.
Will take me some time to get all of Deuce's test records as I need to get in touch with the first vet in Norco.
Now, I have a question. Is Cushings hereditary? Deuce and Venus Mom had Cushings. Do you think I should have Venus tested? She is his sister but 18 months younger. I don't see any signs but feel like better safe than sorry.
On the up side, Deuce is looking and feeling better. For the last few nights he has wanted to play ball. His stamina is not so good so he will bring back ball 2 times and then quit. His back end is getting stronger as he lost a lot of muscle.
He seems his happy loving self with the exception of drinking and peeing. Rash is healing, dry, brown, and falling off.
Thank you for your support. Will get all records soon and let you know what they say.
Bless you all,
Julie, Deuce and Venus

[molly muffin]

So 8.5 is the consistent post ACTH result and the vet wants to double from 45mg twice a day to 90mg twice a day. I don't think I would want to go up that high and wait 3 months for a retest, especially if the calicinosis cutis (the sores on his back) are clearing up nicely. However, since the urinating accidents is still an issue, he isn't considered to be under control. You are looking for a post result of the ACTH between 1.5 and 5ug. So he doesn't have much to come down, and it can be a post results up to 9mg if the symptoms are controlled. He isn't quite controlled yet so I would look at a smaller increase.
Perhaps something like 50mg twice a day or 55mg twice a day would do the trick.
There is another option and that is to try name brand vetroyl, although it can be more expensive. Another good pharmacy to get trilostane from is there in Arizona and is called Diamondback, but I don't think they do chewable tablets.

They haven't been able to determine either a cause for cushings or a proof of hereditary in cushings.

I'd just keep an eye on Venus and make sure to get blood work regularly to make sure she is okay and then perhaps if you are very concerned you could do a cortisol urine test. If no cortisol (or within acceptable range) then there shouldn't be a concern of cushings. Due to the family history though I think it would be worth keeping an eye with the urine testing, as that could give you an early warning if things start to develop.

[Deuces mom]

Deuce is doing well. My husband opted to give him 90mg trilostane twice daily. He seems to be doing good. His personality is back to normal, wants to play with his sister, Venus, wants to play ball. The other day he had a bath and the whole time he kept his ball in his mouth. We went to the vet last Friday. Physical was good and he had a rabies vaccine. I have decided on no other vaccinations. His blood will be tested again on Dec. 26th. We will be having Venus tested the 1st of the year as we are fairly certain she has Cushings also.
I asked the vet if cushings is hereditary and she seems to think it is possible. Deuce and Venus' mother had cushings. I don't think it has been studied.
I hope you all have a Happy Thanksgiving.
Love and Hugs, Julie, Deuce, and Venus

[Squirt's Mom]

Yes, genetics have been studied in canine Cushing's and unless something has changed over the last couple of years, there is no known connection to genetics with this disease. To date, there is no known cause, nothing we can change to prevent it. It just happens, sadly.

I'm glad Dueces is doing well and pray that trend continues.
Hugs,
Leslie and the gang

[molly muffin]

Very good to hear that Dueces is doing good. Long may it continue.
:)