New Diagnosis and 7 day update

[my2sons]

Hello and before I begin, let me say "thanks" to the administrators and all that contribute to this site. While I assume many if not all are not doctors, the information and observations provided are extremely valuable as we, the mom's and dad's of our four legged friends are most in tune with them.

Macie, our soon to be 10 yr old female Shih Tzu has been remarkably healthy her entire life. Just recently, she had been showing signs of weakness in her back legs (not able to jump up on chairs, etc.) as well as a few other things such as thinning hair, panting, increased water intake and a more robust, aggressive appetite. These symptoms began about 2 months ago. Fast forward to February 24 when the vet did her annual senior blood work and suspected Cushings. After a STIM test was conducted, Cushings was confirmed. While not conclusive to be pituitary dependent, the vet was fairly confident it was in fact pituitary. I will be inquiring about having an ultrasound performed to rule out adrenal dependent. I immediately went into research mode and I found this site. In the last three weeks, I have learned a great deal from this site among many others. I ask a lot of questions and have no hesitation in questioning any diagnosis and treatment protocol. Fortunately, we have a vet that encourages this relationship and she has been wonderful in answering questions.

Macie was started on Vetoryl 7 days ago and will have her 2 week follow up on the 4th of April. She takes 15 mg in the morning. Her weight is just shy of 12 lbs. Just in these 7 days, we have noticed a decrease in water intake, less demonstrative about food and maybe slight improvement in hind leg strength/mobility. She still seems to be a bit lethargic, but I am not sure it is any more than pre-Cushings diagnosis. Her "normal" behavior (say 6 months ago) was very frisky, almost puppy like in many ways, although being a senior she does sleep a bit more. We are hoping for a return to that puppy-like condition and are fully committed to her treatment and follow up.

I am providing the results of her blood work and STIM test and would welcome anyone's insight and feedback.

Platelet - 591, 143-448
ALT - 185, 18-121
ALP - 501, 5-150
GGT - 17, 0-13
Cholesterol - 401, 131-345
Total T4 - .8, 1-4

STIM Test:
Baseline was >10, 1 hour post was >30. Vet is aiming for Baseline 2-5 and 1 hour post 4-7

Crazy thing is she had the senior blood panel done in Jan 2017 and all values were great, in the "normal" range. I guess things can change quickly.

From a diet perspective, on the recommendation of our vet, we have not changed anything except in the morning with the medication she is getting a very small amount of Freshpet Vital Grain Free Beef and Bison Adult Dog Food with her dry kibble (Nutro Small Bites Lamb and Rice). No signs of problems with food or Vetoryl tolerance. She has no diarrhea, vomiting or anything else, however we are hearing some burping or gas since all this started.

Thanks again for taking the time to read ad if you chose to comment, it is sincerely appreciated.

[labblab]

Hello, and welcome to you and Macie — we’re really glad you’ve joined us! You are correct in guessing that none of us are vets, but instead we are dedicated pet parents ;-). But the truth is that, over the years that this forum has existed, we’ve encountered more Cushpups than many vets see in a lifetime. So that’s certainly not to say that we share the same medical expertise as a vet, but we’ve witnessed many, many treatment journeys that guide our suggestions and feedback. Above all, we offer our support!

Turning to little Macie, she certainly exhibits a number of laboratory and behavioral abnormalities that are consistent with Cushing’s, and we’ll surely be hoping that you’ll see continued improvement with the Vetoryl. Everything about your treatment protocol sounds very reasonable to me, with one small exception. As you’ve probably seen us write elsewhere, the most widely recommended starting formula for trilostane dosing is 1 mg. per pound. So with a weight of less than 12 pounds and a daily dose of 15 mg., you guys are rounding “up,” if you will, as opposed to rounding “down.” Given the available Vetoryl capsule strengths, my personal preference would have been to start at 10 mg. and work up as needed over time, rather than vice versa. But she’ll soon be having her monitoring testing, and you’ll have a better idea as to the appropriateness of that dose. It’s clear that you are watching her very closely, and will notice any issues that might arise beforehand.

So all in all, we’ll be hoping for smooth sailing for your little girl, and we’ll remain anxious for further updates. And once again, welcome!

Marianne

[my2sons]

Thank you Marianne. In your opinion, how did the blood work and other numbers look to you? Our vet thinks we caught this early and we are hoping that the Vetoryl will be effective given the early stage of Cushings and her overall excellent health otherwise. Regarding the dosage, I too thought that 10 mg would be a better starting point, but we are now in day 9 so I figured let's let it go the full course before the next ACTH test and see what we get. She has been tolerating the medicine and is showing small signs of improvement such as decreased water intake, decreased urination and is less aggressive regarding food. Again, thank you.

[labblab]

Hello again! Macie’s labwork abnormalities are pretty classic in terms of Cushing’s: significantly elevated ALP; mild or moderate elevations in other liver markers, cholesterol, and platelets; decreased thyroid. And yup, that ACTH result is also consistent with a “positive” Cushing’s diagnosis. So taken in conjunction with her overt symptoms, I’m on board re: your treatment plan. The 15 mg. Vetoryl dose may end up being perfect for Macie, and I don’t want to worry you unduly with my comments about that since she’s taking only a little bit more than I’d normally suggest. For the benefit of all our readers, we just tend to harp on that 1 mg. per pound initial dosing formula. In earlier years, dosing ranges were much higher and we do encounter vets who persist in starting off with some whopping big doses.

I’m so glad Macie is doing well at this point, and we’ll be rooting for even more improvement in the coming days!

Marianne

[my2sons]

Hello again. One additional observation I would appreciate some insight on. Not sure this is Vetoryl related, but about an hour after giving her the medicine, she appears very lethargic, but not totally unresponsive. About an hour or two later, she appears to be back to normal. What makes this difficult to connect with the Vetoryl is she usually takes a good nap around this time of day, but she just seems to be a little more "sleepy" than usual. Her eyes may be open but she doesn't really follow your hand movement. I have a call into the vet and am waiting a response. It may be nothing, but I want to be sure.

Thanks

[labblab]

It may be the case that Macie is responding to what may be a pretty dramatic drop in cortisol for her. The manufacturer of Vetoryl tells us that the medication reaches maximal level in the bloodstream by about 1.5 hours after administration, so that would correlate fairly well with the timing you’re noticing. If this is the cause, the reaction may just be temporary as her body adjusts to the med. But if it persists, it might justify lowering her dose for at least a few days in order to allow for a more gradual transition to a consistently lower cortisol level.

Marianne

[my2sons]

Thank you - I read that same thing about the 1.5 hr maximum level. Vet just got back with me and she said basically the same thing, so all is well so far. Have a great Easter!

Keith

[molly muffin]

Hello and welcome from me too. So, the 4th has passed, i assume you did the follow up blood work. Where did her cortisol numbers come in at? How is she doing, does she still have that very sleep time about 1.5 hours in?

[my2sons]

Hello, thank you for the note and apologies for my delay in responding. Macie had her 14 day follow up and the Dr. said all her numbers looked great. I will get a copy and post the numbers this week. Overall, she seems to be doing really well. Energy level is up, drinking is down although appetite still seems stronger than usual . We have not changed her food but are watching her daily food intake and have added green beans to her evening meal. She loves them and it seems to satisfy evening hunger. Her energy level seems to have smoothed out a bit, even after taking the Vetoryl. We are back to going on walks which is really encouraging. She has continued to lose some hair but I have read that will taper off with regrowth in about 6-9 months.

She will have another ACTH test in about a week and we are hoping she continues to do well. Thank you again for your message and I will continue to provide updates as we work through this.

[Harley PoMMom]

Hello, thank you for the note and apologies for my delay in responding. Macie had her 14 day follow up and the Dr. said all her numbers looked great. I will get a copy and post the numbers this week.

Are those numbers coming from a Chemistry blood panel or an ACTH stim test?


Overall, she seems to be doing really well. Energy level is up, drinking is down although appetite still seems stronger than usual . We have not changed her food but are watching her daily food intake and have added green beans to her evening meal. She loves them and it seems to satisfy evening hunger. Her energy level seems to have smoothed out a bit, even after taking the Vetoryl. We are back to going on walks which is really encouraging. She has continued to lose some hair but I have read that will taper off with regrowth in about 6-9 months.

She will have another ACTH test in about a week and we are hoping she continues to do well. Thank you again for your message and I will continue to provide updates as we work through this.

Glad to hear that Macie is improving with treatment, it's a happy time when one starts to see their dog return to their "ole self" please do keep us updated!

[molly muffin]

Very glad to hear that Macie is doing better. We'll be interested to see what the numbers are now.

[my2sons]

OK - she has now completed two rounds of ACTH Stim testing since starting Vetoryl. The first, on April 3rd: Baseline 5.5, Therapeutic Monitoring 6.0. Second testing completed on April 17th: Baseline 5.3, Therapeutic Monitoring 7.0.
Next testing is scheduled for July 17th so no changes are prescribed at this time based on her numbers and overall appearance. She is on 15mg Vetoryl 1X daily and seems to be doing really well. Energy levels are coming back as is rear leg strength. Dr is very pleased with how she has responded to the medicine and will be doing another full blood panel in July just to keep an eye on all other pertinent levels.

[Harley PoMMom]

Seeing that her symptoms are still improving those ACTH numbers are great!!! Crossing fingers that this trend continues!!

Lori

[molly muffin]

Glad to hear Macie is doing well. Considering that is the case, the numbers are very good and she is maintaining well.

[my2sons]

Hello everyone. Just wanted to provide another update. Macie has been on Vetoryl since March 20th and she is doing really well. We have also added a daily treat of Dasuquin. Her appetite has leveled some, drinking is way down and her energy level is much improved. We have added Vital Pet Fresh dog food to her dry kibble which she seems to love. She still struggles with jumping up onto chairs, etc. but seems to be very content for us to "give her a lift" when she wants up! Her walks have become a little more regular and she shows great excitement and enthusiasm when family and friends visit. Except for the thinned hair, you would not know she has anything wrong.

While I do not know the long term prognosis, for now, we are pleased with her progress. I share this for one main reason - if your pup is diagnosed with Cushing's don't fret, there is help. While the medicine will not cure Cushing's, it can definitely make the disease tolerable and give your little one a renewed lease on life. It is not a death sentence if you catch it early, have a proactive vet and are committed to the treatment.

I will update after her July doctor visit. Good luck to all that are working through this and those that will eventually find this site looking for answers.

[Harley PoMMom]

What a great update and thanks for coming back and letting us know how Macie is doing!

[my2sons]

Hello all - hope this message finds you all well and progressing through life with Cushing's. We have been at this now for almost five months. All in all, Macie is doing really well. I have been trying to move her to a more natural diet, but she seems to just really love her dry kibble mixed with a bit of wet. We did try Fresh Pet Select refrigerated food but she just didn't seem to care for it. Anyway, she will get what she likes with as much natural as she will tolerate. Her hair is still thin, but I suppose I should not expect a great deal of growth this time of the year. Her energy level is back to normal and daily walks have resumed which she just loves. We have noticed her skin is definitely darker in places and is flaky. Does anyone have any recommendations for the flaking skin? Medicated shampoo or other diet related ideas? I hear fish oil is good for this. Anyway, just wanted to give a quick update. She goes back in for her 6 month ACTH test in July and I will provide an update at that time.

Happy 4th of July to all and thank you for your thoughts, time, recommendations and support. As my vet said, we got this!

[Joan2517]

Another great update! Happy 4th to you and Macie!

[Harley PoMMom]

Hair and skin issues related to Cushing's can take a long while to improve but I see no problem with adding a fish oil supplement, however I would definitely confer with the vet about this first.

Lori

[my2sons]

Thanks Lori - just a bit more information one more question. So before the diagnosis and as late as 4 weeks ago, Macie showed no signs of skin issues except for some dark patches. I was surprised to see skin issues appearing after being on Vetoryl for 4 full months. She now has a lot of flaking skin and some small, what appear to be, pimples or blisters. Any thoughts or experience with skin issues appearing AFTER being on the medication for a while? FWIW, I moved her 6 month Cushing's treatment vet appointment up a week as I don't want the skin issues to get worse if we can stop it. Thanks in advance!

[labblab]

Hello again from, too! I do think it’s a good idea that you’ve advanced Macie’s monitoring testing, because it may be the case that her cortisol level is not being controlled sufficiently right now, and a Vetoryl dosage increase may be in order. In looking back at her April ACTH results, they were in a range that would be considered OK as long as symptoms are being adequately controlled. However, her cortisol may have drifted upward during these past three months, or even the previous post-ACTH level of 6-7 may just not have been low enough to keep symptoms from rebounding. Some dogs need to keep their post-ACTH level consistently within a lower range of 2-5 ug/dL in order to keep all symptoms under control.

Another thought relates to Macie’s thyroid level. It is not uncommon for Cushpups to suffer from low thyroid, as well, and hypothyroidism can cause significant problems with coat and skin issues. For some dogs, low thyroid readings are actually secondary to the Cushing’s, and resolve once effective Cushing’s treatment is underway. However, other dogs may develop genuine hypothyroidism in its own right. This is easy to treat with simple, inexpensive medication. Since it seems to me as though it may be a possibility, I’d want to make sure that a blood chemistry panel including thyroid analysis is performed alongside the ACTH.

Please do let us know what you find out with her testing, and continue to update us re: her progress, OK?

Marianne

[my2sons]

Thanks Marianne. She is getting a full blood panel screening done tomorrow in addition to the ACTH testing so I expect they will have a good idea of what's going on. Will definitely discuss the thyroid concern. I appreciate your input.

More tomorrow after we have results.

[my2sons]

Macie did well at her vet visit and through the ACTH test. I don’t have all the test numbers but her post number was 6.8 and the vet was happy with her progress and response to the 15mg Vetoryl dosage. Her blood panel will be in next week and we will be meeting to review those results as well. Nothing definitive on the flaking skin and small blister like spots on her underside. She was given antibiotics for 10’days to help with the skin issues. She seems to be responding well. More later but she is a happy little girl and for that we are grateful.

[Joan2517]

Sounds great! Happy is just the best, isn't it!

[labblab]

Thanks so much for the update, and we’ll sure be watching for those other results next week. It’s wonderful that Macie is basically doing so well. I do want to point out once again, though, that her cortisol level can safely be brought lower than 6.8 if all her Cushing’s symptoms are not being well controlled. If nothing is amiss other than the skin issues, then perhaps you don’t want to rock the boat in terms of her dosage. But one warning in that regard: there’s a particular condition called Calcinosis Cutis to which Cushpups are vulnerable. It involves calcium deposits that first form under the skin and then work their way to the surface, causing weeping and blistering lesions. This condition can get out of hand quite quickly and create genuine quality of life issues for afflicted dogs. You can Google the condition and view images to compare to what you’re seeing with Macie, but for your reference, here’s some samples from a photo album of one of our members:

http://www.k9cushings.com/forum/album.php?albumid=805

This certainly may not be what’s going on with Macie, but I do want to just mention it for your vet’s consideration in the event that Macie’s skin worsens over time rather than improving. For dogs who suffer from this condition (or other unresolved Cushing’s symptoms, for that matter), the general recommendation is to lower post-ACTH cortisol levels to a range between about 2.0 - 5.0.

That being said, hoping you guys have a great weekend, and we’ll definitely watch for those other results next week.

Marianne

[my2sons]

Hello everyone. We completed the 6 month ACTH testing and had a full blood panel done just to gauge any changes from her last blood work which was done in February when Cushing's was suspected. For those of you that have been following our journey, you will recall that Macie had recently (last 30 days) began to exhibit some skin issues, mainly flaking with small little dark areas and some pustules. The vet put her on a 10 day course of antibiotics which has seemed to do a good job of clearing the skin condition. In addition to the skin improvement, a great surprise is all her hair is growing back and quickly! Her beautiful brown undertones came back in a week's time and her little boney tail is returning to normal. According to the vet, this is probably due to getting the skin issues under control and the natural progression of Cushing's when treated with Vetoryl. Her pre and post ACTH test numbers from a couple of weeks ago were 2.8 and 6.8. based on her appearance and overall demeanor, we are keeping with the 15 mg 1X daily of Vetoryl. Her blood panel numbers were terrific. Just about everything was in the range that the doc was looking for. Even her liver values were improved since the initial diagnosis so all in all, we are on the right track and she is doing really well. We are back to daily walks of nearly a mile and she has regained her rear leg strength.

I know I have said this in a previous post, but if you are new to Cushing's, it can be confusing, worrisome and scary. We have no guarantees and regardless of the progress that is being made, once diagnosed, unless you have the tumor removed causing the excess cortisol production, it is a condition for life. That is just the reality. However, with a good doctor, a generally healthy pet and the commitment and diligence to treat with the prescribed medications, you can beat this and return to a sense of normality and happiness for your four legged friend. So don't despair, find a good vet that understands this condition and give your pup the chance to return to his/her pre Cushing's condition.

So for now, we will continue with the daily medicine in the morning, walks in the afternoon, dinner in the evening and general happiness and contentment that life with a pup is supposed to be. Next update is in 6 months unless something changes.

Take care all and may your journeys with your four legged friends be full of wonder, excitement and happiness.

Thanks!

[Harley PoMMom]

Thanks so much for the update and what a wonderful update it is! So glad that Macie is doing well and that her skin/hair have improved!!

[my2sons]

Hello, we're back! So another 6 month update. Macie has been doing fantastic. Changed her food to Honest Kitchen dehydrated lamb/chicken topped with Northwest Naturals dehydrated lamb back in October to minimize carbs and she just devours this food. We still give her a bit of Nutro small bites kibble but she is mainly on the Honest Kitchen. Her weight has been maintaining right around 12.5 lbs. We did run into a bout with a UTI late last fall that we finally have gotten under control with the use of 60 days of antibiotics. She also takes Cranberry Bites 1X daily to help with UTI's.

She went in for her annual wellness exam and 6 month STIM test at the end of January. We have noticed just a bit of panting late in the day which we noticed at the onset of Cushing's. Overall blood panel results were good. Cortisol results were just outside the acceptable range: pre 6.3 post 7.8. The doc wants the post to be under 7 so she made a change to 20mg/day of a compounded chewable version of trilostane. After two weeks on this, she was tested again and the numbers did not change much: pre 4.4 post 8.2. So, we are back to Vetoryl capsules 20 mg/day. We will run with this for 30 days and check her again. However, overall, she is doing just great. All the energy level has returned as has rear leg strength. Her coat is just beautiful. Appetite is very good, normal in all other aspects. We are back to long walks - anywhere from 1-2 miles/day. She will come find me everyday around 3:30 to let me know its time for her outdoor adventure. It has been a personally rewarding time for us as this is "our" time to just be. I let her smell every tree, rock and anything she finds interesting. I have a new appreciation for the joy a pet brings to us.

As I have been doing, I will post her next STIM test numbers in 30 days. Take care!

[Squirt's Mom]

A great update! I am so glad you are enjoying each other again and pray that trend continues for a very long time to come!
Hugs,
Leslie

[my2sons]

Macie has been on 20 mg 1X daily of Vetoryl for about a month. We had her STIM test last week and results are in. Cortisol Pre ACTH was 1.3 and post was 4.2. Doctor seems pleased and wants to check her again in 3 months to ensure we are not over suppressing her cortisol. I'm glad I insisted on going from 15 mg to 20 mg and not the 30 mg the vet had suggested. So, onward we go on this journey. She is still taking her long walks, eating well, very playful and seems normal in all ways.

Again, for anyone just now reading this or have recently received a Cushings diagnosis, I encourage you to read and learn as much as you can and pay close attention to your pet. You know them best and will know if something just doesn't seem right. With excellent veterinary care and you staying on top of the meds, etc., this is definitely a disease which can be treated and can be managed. It's not cheap, but in my opinion, it is worth every penny for the joy we get in return.

Next update in three months. Take care.

[Joan2517]

Wonderful update! Looking forward to the next one.

[my2sons]

Quick update: about 60 days since last test. Still on 20 mg Vetoryl 1X daily. Last STIM test done this week - results were great (pre 3.5, post 3.8). Vet is very pleased but Macie is having some hair loss again exactly like what we first experienced when Cushing's symptoms first developed. Vet said maybe thyroid and we are having her annual senior care including full blood panel tested now. Will have results in a couple of weeks and I will provide update then.

All in all she is doing great still taking long walks and is playful for an 11 yr old!

Any thoughts on Honest Kitchen dehydrated food? She has been on this for about three months and loves it but the vet is not a fan.

Thanks for reading.

[labblab]

Thanks so much for the update! It’s great that, overall, Macie is doing so well :-). It’ll be good to check her general bloodwork, though, just to make sure there’s nothing amiss.

I’m afraid I can’t offer an opinion about Honest Kitchen. I think a couple of our members have used it through the years, but I really don’t know much about it.

Thanks again for returning to us, and please give Macie a big hug for us. And definitely do let us know if anything interesting shows up on her lab panels.

Marianne

[Squirt's Mom]

What a great update! Those numbers are perfect and I am so glad she is feeling good. The hair loss could easily be the thyroid...mine falls out at an alarming rate when my meds need an increase and for an old broad that ain't good! :o:D

As for Honest Kitchen....I've used it off and on for several years now and love it as do the dogs who've eaten it. If not for the expense, all of mine would be on it daily. As for what the vet said....unless things have changed dramatically over the last decade vets get little to no education on nutrition or brands of dog food. When my Squirt was first diagnosed in 2007 I asked her vet about the diet she needed to be on because the web has SO MUCH info and most of it contradictory. She showed me a text from her vet school that had one paragraph on nutrition - the message was basically "good nutrition is important". And that was it. She told me they got a one hour lecture from Hill's Science Diet and that was all the education they got on diet. All but one vet that we have used sells Science Diet and most have pushed it...but I refuse to feed it. The one vet that did not have SD had Royal Canin - just as bad in my book. Every vet who has been willing to talk to me about diets for dogs has told me basically the same thing - little to no education on the subject/they rely on what the sales reps for SD have to say/all dog foods are about the same. Dog Food Advisor is a pretty good place to look into the various brands of food and see what they are made of and how they rate on a scale of 1-5 stars. https://www.dogfoodadvisor.com/best-dog-foods/

Hugs,
Leslie

[my2sons]

We got her bloodwork results back and her thyroid was fine. Overall blood results were all in line with maybe one or two values being borderline. The vet has no explanation for the hair loss and suggested we put her on 3mg of melatonin twice daily. Except for the hair loss she is doing just great. Appreciate any thoughts or advice on the hair loss issue.

[Harley PoMMom]

It can take a long while to see improvement in their hair. The melatonin may help, I believe the type on melatonin you want is the regular kind not the fast acting or rapid releasing.

[Squirt's Mom]

So I'm confused...nothing unusual unfortunately! You say the vet recommended 3mg of Vetoryl twice a day....is that in addition to the 20 mg once a day you posted earlier (5/19) or has that 20 mg been stopped and she's not been on any Vetoryl for a bit? OR is the 3mg a typo and supposed to be 30mg twice a day?

[my2sons]

So I'm confused...nothing unusual unfortunately! You say the vet recommended 3mg of Vetoryl twice a day....is that in addition to the 20 mg once a day you posted earlier (5/19) or has that 20 mg been stopped and she's not been on any Vetoryl for a bit? OR is the 3mg a typo and supposed to be 30mg twice a day?

Thanks for the replies. The 3mg is for melatonin. She is still taking 20mg of Vetoryl daily.

[my2sons]

I'm back with another encouraging update. Macie had her Stim test done yesterday. Pre was 2.7, post was 2.3. Weight down to 11 lbs and except for the hair loss, she is doing great. Doctor is suspecting allergies so she is on Apoquel for 14 days at which time we will make a decision if the allergies are a contributing factor to hair loss and scratching. All in all, the vet is extremely pleased with her health, appearance and overall management of Cushing's. We march onward!

[Squirt's Mom]

We always love to hear great updates so thanks for letting us know Macie is doing so well. Keep up the good work!

[my2sons]

Happy New Year! So here we are closing in on two years living with Cushing's. Overall, I think my girl Macie has done very well. We have had a few ups and downs and I have learned that is to be expected. She has had a couple of UTI's along the way and a flaking skin incident that was quickly resolved with meds. At the start of 2019, we upped her Vetoryl from 15 to 20 mg/day to lower her cortisol values as determined by the ACTH testing. In early May, Macie started losing her hair again. This got progressively worse throughout 2019. Her thyroid levels were checked and all are in order. We had her cortisol levels checked again today and they came back great (pre 4.4, post 4.0). So the vet is strongly suspecting food allergies and we have started her on a strict diet of Purina HA that limits the animal proteins which is the suspect allergen resulting in hair loss.

I really don't have any questions for the message board as this is just an 2 year update on our journey. If anyone has any thoughts on the hair loss or results with Purina HA, feel free to comment and as always thanks for reading. Good luck on your journey and remember, with dedication, discipline and the help of a good vet, you and your pup can get through this.

[labblab]

Happy New Year to you and Macie, too!! I’m so glad to know the Cushing’s treatment is remaining stable for you guys. I know the hair loss has been an ongoing issue for you, and I wish I had some brilliant suggestions to make — but unfortunately, I don’t. I’ll keep my fingers crossed for you that the new Rx food may finally help. In the meantime, I can’t tell you how much we appreciate hearing back from you with updates. The Cushing’s journey is definitely one that can proceed along many different paths, and as time goes on, we all learn together. So please do let us know whether or not the dietary change makes any difference, OK? And in the meantime, please give Macie a big pat from her family here :-)))).

Marianne

[Squirt's Mom]

Good to hear from you and so glad to hear Macie is doing well! Keep up the good work and do let us hear from you when you can!

[my2sons]

Hello everyone. So we endured 11 weeks on Purina HA as a diet trial to isolate any potential food allergies. Macie tolerated the food and we were diligent on restricting her diet as recommended. In the end, we did not see any difference in hair loss or re-growth and she has developed two very small sebaceous cysts on her head. We were then referred to a veterinary dermatologist. We had that visit yesterday and they do not suspect food allergies or any type of allergies. Their thought is an imbalance in hormone levels. Also, there is a suspicion that her cortisol levels may be spiking only to be brought under control with the morning dosing so a new stimulation test conducted in the morning before her Vetoryl dosing will give us an indication of what her cortisol levels are doing. If this is the case, we may be changing her to 10 mg of Vetoryl twice daily. Lastly, the use of lignans were recommended but I will hold off on that until we test the cortisol levels pre Vetoryl. One change at a time!

In spite of her thinning hair, she is still normal in all ways. Good appetite, very playful with good energy levels and still looking forward to the 1 mile walk every evening. BTW, we have switched back to The Honest Kitchen Grain Free Chicken which she loves! Will report more as things develop and we hopefully get some answers.

Stay safe out there everyone.

[labblab]

Thanks so much for this update. It sounds as though the food trial was a major pain, but at least now you know you can finally rule out food allergies as being the culprit. Under the circumstances, I agree that checking Macie’s cortisol level prior to her morning dose may provide some useful information, and a shift to twice daily dosing may indeed be helpful. We’ll definitely be curious as to how that testing turns out. In the meantime, we’re so glad to hear that your little girl is otherwise doing so well!

Marianne

[my2sons]

Thanks Marianne. Any thoughts or history from board members on dosing 2X daily? It seems like that would be the standard as Trilostane does not stay in their system too long.

[Harley PoMMom]

With diabetic dogs, it is strongly recommended that the Vetoryl be given twice a day so as to keep the cortisol on a more even level. When starting treatment with a dog that does not have diabetes, once a day dosing is endorsed because it is felt that this is easier to do.

[labblab]

Lori is exactly right. Twice daily dosing is indeed recommended for diabetic dogs in the effort to keep both cortisol and glucose levels controlled as consistently as possible at all times.

For nondiabetic dogs, several research studied throughout the years have compared the effects of once vs. twice daily dosing. For some dogs, it does seem as though twice daily dosing aids in symptom relief. However, other dogs show significant improvement with just one dose each morning. Since trilostane must be given along with a meal in order to be metabolized properly, it’s easier for many owners to dose only in the morning, along with breakfast. So as long as a dog is doing well clinically on a single daily dose, the manufacturer of Vetoryl still recommends starting off in that manner. If symptoms do rebound later in the day, however, then the shift to including an evening dose can certainly be considered.

Marianne

[my2sons]

Thanks for the responses. Macie has always only been given the Vetoryl with her morning meal. The only symptoms she currently has is the thinning hair/bald spots. The veterinary dermatologist drew a blood sample today before she had her Vetoryl at breakfast and will be checking her resting cortisol levels just to be sure they are not climbing abnormally throughout the day. I will share more when we have answers. Stay safe out there.

[my2sons]

Hello, we're back for a quick update. The results came back from the blood drawn at the dermatologist. She was just checking the resting cortisol level and to my surprise, the level was well within the "controlled" range at 2.9. I was really expecting her level to be much higher but it appears that the Vetoryl is doing its job. So at this point, the dermatologist is thinking her hair loss is a result of hormones. She has suggested we put her on 40 mg/day of lignans which we have started. If anyone has any experience with the use of lignans, I would be interested in hearing the results you may or may not have had. After 60 days, we will re-visit the dermatologist if there is no improvement in her hair loss.

Fortunately, the hair loss is only an appearance issue and there is no danger or medical concern.

Stay safe everyone.

[Squirt's Mom]

I would add melatonin to the lignans if it were me. Melatonin is known to promote hair growth plus the Atypical form of Cushing's is treated by that combination - melatonin plus lignnans. Atypical Cushing's a form in which the cortisol is normal but 2 or more of the intermediate, or sex, hormones are elevated. One of those hormones is estradiol. Unlike the other hormones involved in Atypical, estradiol can be produced outside the adrenal glands and this combination can reach outside the adrenal glands. It is believed that conventional Cushing's with elevated cortisol also includes elevations in the intermediate hormones. So I would add the melatonin. You want plain melatonin - not extended release, rapid release, etc.....just plain ole melatonin. The dosage for melatonin is 3mg/2x/day for dogs under 30 lbs and 6mg/2x/day for dogs over 30 lbs.

There are two types of lignans used to treat these hormones - from flax (SDG) and from spruce (HMR). The dose for SDG lignans is 1mg/lb/day; for HMR lignans the dose is 10-40mg/day...for smaller dogs you want closer to 10mg, for larger dogs the dose is higher. Lignans can cause diarrhea so you want to start with a lower dose and increase gradually.

This combination takes at least 4 months to work so I wouldn't expect much to have changed in 60 days. ;)

I'm glad everything else seems to be good for Macie!

[labblab]

Thanks so much for this update. That’s reassuring that Macie’s cortisol level is within the desired range. And yes, it’ll be interesting to see whether the lignans helps. Our experience here has been variable in that regard. Some dogs with hormonal imbalance gain some degree of symptom relief, but definitely not all. And it can take quite some time to see improvement even when it occurs. One question: did the dermatologist discuss treating with melatonin in addition to the lignans? Most dogs here have been prescribed those two supplements in combination. I’ll come back later and add a link that will discuss the dual treatment in more detail.

Marianne

P.S. Aha! I see that Leslie and I were posting at the same time. I’m really glad she’s stepped in because she is much more experienced than I am with the lignans/melatonin combo ;-).

[my2sons]

Thank you both for your input. Macie was on melatonin for about 10 months prior to starting the lignans. We did not see any change in hair growth or loss. She has not been on the combination of the two at the same time. BTW, she is taking 40mg HMR lignans once a day and still on 20 mg Vetoryl once daily.

[my2sons]

Hello all after nearly a year! Sorry for the long absence, but I am hear to report that little Ms Macie is doing just great. She had her last STIM test on 3/18 and her pre and post numbers were 2.2 and 1.9 respectively. Also worth noting is her hair growth has re-started and I am pretty sure it is due to the addition of Dr Mercola Hormone Support given twice daily. Even though her cortisol levels have been totally under control, I was still concerned about the hair loss so I took her to a veterinary dermatologist who suspected a hormone imbalance. After doing some research, I came across the Dr Mercola Hormone Support and it has made a very noticeable difference. I believe that any help you can give to dogs with Cushing's to strengthen their adrenal and hormone system is a plus. I have also include Dinovite into her daily feeding as well as fish oil. Not sure if this is doing anything but her coat is definitely softer. So, all in all, we are now three years into this journey and I can happily say she is doing great. You would never think she is 13! Hope everyone is doing well and your pups are enjoying another spring season. Take care!

[Harley PoMMom]

Thanks so much for the wonderful update!! I'm very happy to hear that Macie is doing so well!!!! You're doing a great job with Ms Macie!!!

[Joan2517]

Great update!

[Squirt's Mom]

How wonderful to hear from you and Macie and especially with such good news! :):):) I hope the next three years continue along this same line....tho I hope we get to hear from you before those 3 years are behind us! :D I always love to hear about pups who are having an easy time with treatment...it does the heart good. So thank you so much for stopping by to update us.

Hugs,
Leslie

[my2sons]

Hello again all. Hope your summer has been going well. While I do not have a medical update or a new STIM test to provide the results of, I thought I would just check in and let everyone know that Macie is doing great and has retained all the hair growth I reported in my last post. I am 100% convinced it is due to the Dr Mercola Hormone Support that we have been giving her twice a day since March. She is as spritely as ever and just a happy girl. Hope this brightens your day and gives you encouragement if you are new to the Cushing"s journey.

[labblab]

Welcome back, and thanks so much for this great update on Macie! Absolutely it cheers us all to read such happy and hopeful news. I am not familiar with the hormone support supplement that you’re using, but upon Googling it, I see that it contains melatonin, lignans, and another active ingredient. At any rate and no matter what the cause, we’re delighted to hear that Macie is doing so well! Keep up the good work, and we’ll look forward to your next report.

Continued best wishes,
Marianne

[jenner1026]

Thank you for posting about the supplement!! I am going to try it for my dog Jet. He is on the Vetoryl but I figured this can't hurt. I will of course check with my vet.
Many thanks for posting this!!

[my2sons]

Happy new year everyone! Quick update on little Macie. First, she will be 14 in about three months so she is definitely a senior. We are four years into the Cushing's journey.

She sleeps A LOT! probably 6-7 hours a day. She did have a STIM test completed in September of 2021 and I failed to provide that update. Recently, over the last 3 weeks, we noticed a few behavioral changes however, these were not consistent meaning not everyday.

1. Not going on her normal walks - cutting them short. She often comes to get me to tell me its time to go but not recently.
2. I have to prompt her to eat sometimes and top her food with something interesting to her. However, she does eat all her food and both meals everyday.
3. Most recently (last week or so, we have had some anxiety episodes with trembling in the evening leading to sleepless nights. Trazodone works but not my preferred approach.
4. Interesting to note that the evening behavior has been accompanied with low energy level and minimal interaction. However, the mornings are just the opposite. She is full of energy and very aware.

So off to the vet we went. Blood work seemed to be pretty good. There were a few things slightly elevated and doc thought there may be a pancreatitis flareup but she showed none of the symptoms. We also discussed the possibility of Canine Cognitive Dysfunction. Another potential reason for her behavior was cortisol being too suppressed leading to the "off behavior" later in the day only to normalize after a night's sleep. So today we ran a STIM test, but just the pre. Her result was 2.3. Clearly within the acceptable range but the possibility of her body not reacting to the 1X 20 mg dose evenly throughout a 24 hr period does exist. So at this point, the decision was made to split her dosing of Vetoryl into 10mg in the morning and 10mg in the evening. I would be interested to hear of anyone's experience splitting the dosing, Lastly, the doctor also noticed a slight heart murmur that they didn't hear just a week ago - go figure. So she is scheduled for a EKG next week.

So that's about it for now. We still have an overall happy girl that just may be slowing down a bit but we are doing all we can to keep her healthy and happy. Take care everyone.

[jenner1026]

Good luck to Macie! It's funny you re-posted because I finally bought the supplement you suggested and passed it by my vet who said it can't hurt to try so I will start it soon and see what happens! Jet just turned 11 and the summer will be 3 years since his diagnosis.

In terms of splitting the dose, Jet has been on a split dose for almost 2 years. In fact, my vet recommends it for most dogs. He takes 60 in the am and 30 in the pm and has been on this dose for a while now. Of course I am not a vet but if Macie is only on 20mg I can't see it being a problem to split that.


Best,
Jennifer

[my2sons]

Hi Jennifer. Thanks for your reply. I hope your Jet responds well to the supplement. We started the split dosing of Vetoryl today so we will see what happens. So far, she has slept most of the day.

[Squirt's Mom]

Hi Keith,

Thanks for the update! It sounds like Macie is doing pretty good for a frosty faced gal!

As you were describing the changes you have seen the cognitive issue is what came to my mind. My Squirt developed dementia starting around the age of 15. The first thing I remember seeing that made me start to think this was happening to her was the fact that she went to the wrong side of the door to go out or in. Not every time but from time to time, like she momentarily forgot which side opened. Slowly more and more things became apparent. Sadly there aren't many things that can help but one thing you can try is SAMe. At the time Squirt got sick with this there was a supplement called Novafit that was a miracle for her. It was a stable SAMe product, meaning it didn't have to be taken with food. But the FDA made them stop making it for some reason and it has not be put back on the market yet. But SAMe is worth a shot. Anipryl is a drug that can sometimes help but you would want to use this with caution as it can also lower the cortisol in some pups. Just something to keep in mind should you need it.

Twice a day dosing is how this drug should always be given in my opinion simply because of the short life in the body. Vetoryl is leaving the system in 2-12 hours so expecting any sort of level control over a 24-hour period with one dose is illogical. Hopefully you will see a difference in the split dose. BTW...make sure it IS a split dose and not a doubled dose. Twice a day dosing doesn't mean doubling the dose....it means dividing the dose. So 30mg once a day becomes 15mg twice a day. I've seen too many vets double so I had to say something. ;)

Stay in touch and let us know what the EKG finds.
Hugs,
Leslie