15 yr old Maltese just diagnosed. So overwhelmed! Vetoryl questions

[Maggiemoo1]

Hi everyone!

My 15 year old Maltese Maggie was diagnosed via the LDDS test yesterday. Numbers were

5.3 (1-6 ug/dL)

2.1

3.7


IM specialist started her on 5 mg vetoryl twice daily. She’s about 4kg Does this sound ok? Vet will NOT compound due to potential variances in bioavailability. She’s being rechecked in 14 days and I believe will follow the standard re check protocol in the US.

Maggie’s symptoms mainly are back leg muscle weekness that has gotten progressively worse. She also has consistently elevated cholesterol and alk phosphatase. Her tail hair is also very thinned out. She doesn’t really drink excessively (only about 1 cup water per day). No consistent potty accidents. A few but more my fault!

I noticed her back legs trembling about 3 yrs ago but all her vets attributed it to arthritis. When I thought she started drinking more (but not excessively) excessively panting and just generally not being able to rest I suggested cushings. Still none of our local vets thought it was! Most recently when her back legs began to give out I saw the IM specialist at one of the largest hospitals in NYC and he took one look at her and said I agree! FINALLY!

Most recently her

Cholesterol is 515. (92-324 mg/dL)(goes up every time we test)
Alk phosphatase is 368 (5-131 iu/l) (also increasing)

Before testing we tried flax lignans and melatonin but I don’t think it had any effect.

Any overall thoughts? Recommendations?

EVERYONE’s input and advice is welcome and appreciated. I’m just so terrified of all this!!

[fkhan]

Hello,

My dog has Cushing's as well and am considering treatment on Trilostane/Vetoryl. Do you know if yours is Pituitary based or Adrenal? My dog named Pookie is suspected as being Pituitary based and has had ACTH stimulation test, which didn't reflect cushings. The Low dose did reflect cushings, but not which one. The high dose is supposed to help differentiate the two, but Pookie fell in that population range that failed to suppress. Also had an MRI and Ultrasound. Pookie has had Cushing's for a year and am just now thinking of treating her, because Cushing's causes all sorts of problems. She started with Panting, than eating more, and now her back legs are giving out. I heard that thyroid problems could cause back leg weakness too, bec the nerve signal travels longer to get to the back legs or something like that. I'm not a doctor. I'm hearing so many different opinions on treating with western drugs. I have tried home remedies and am considering Trilostane now, bec I'm running out of options. If you do start, I would start with a low dose, bec that's what I'm going to do. Also having a steroid injection on hand may be advised for an Addisonian crisis.

[Maggiemoo1]

The test results say the numbers are suggestive of pituitary based cushings and the IM specialist said the same.

Hmmm I’m not certain her thyroid has ever been tested. I will ask

It sounds like looking and Maggie have similar symptoms. What breed?

I am against treating bc I’m so terrified of the drug but natural remedies didn’t work and the weakness is progressing. It’s heartbreakimg to watch especially bc she’s otherwise so healthy.

Anyone have any thoughts on the dose? We have the first this am and I’m watching her like a hawk! Every little thing I automatically think addisons!! I’m driving myself crazy.

[fkhan]

The test results say the numbers are suggestive of pituitary based cushings and the IM specialist said the same.

Hmmm I’m not certain her thyroid has ever been tested. I will ask

It sounds like looking and Maggie have similar symptoms. What breed?

I am against treating bc I’m so terrified of the drug but natural remedies didn’t work and the weakness is progressing. It’s heartbreakimg to watch especially bc she’s otherwise so healthy.

Anyone have any thoughts on the dose? We have the first this am and I’m watching her like a hawk! Every little thing I automatically think addisons!! I’m driving myself crazy.

I have a 15 1/2 year old Pekingese and understand your concern and emotions. If you look at my other post on here for "dog not eating and has cushings," you will see I have been through alot over the last month($9,000 in one month). Have you checked your dogs Kidney values? Cushings makes our dogs more prone to all sorts of things. Before all of my problems this past month, I was using HRM lignans, Melatonin, Adrenal Harmony Gold, and started using a little Tumeric and Ginkgo Biloba. This helped her back legs, but she is not using this now, bec her Kidneys were high and possibly was dealing with Pancreatitis. I would verify your dogs liver is ok too, because Pookie is on Advanced Denamrin, which is most likely from Cushings. The back leg weakness could be from a number of things, arthritis, back problems, nerve/thyroid problems, cushings, kidneys/ataxia, etc. It's exhausting financially, physically, and mentally to deal with Cushings. At least from my experience. I heard they changed the dosing on Vetoryl/Trilostane to a low dose, but you would have to confirm with your vet. After Pookie went through all this the past month, her panting has diminished, her appetite and water intake have gone done. I thought it was Addisons, but the vet doesn't think so. Currently, I am starting B12 shots today and Pookie is on Azodyl for her kidneys, Denamarin Advanced for her liver, and I add HMR lignans, Fishoil, Kidney Gold by PetWellBeing, VitC, 1/2 tablet of Pepcid, and 100mg of SubQ fluid 3 times a week to play it safe with her Kidneys. Pookie lost over 10% of her body weight this past month, but is eating and walking again. Her legs give out around the house, but can still run outside. I'm still not sure what is causing her leg weakness, but I will say that when I treated her with all the stuff mentioned above, it helped her leg weakness. I just had to stop, bec her Kidney values got high and I don't know if it was from Ginkgo or something else. Have you had an ultrasound done on her kidneys, liver, etc? If you haven't had an ultrasound done on her kidneys, I would highly advise it.

[Squirt's Mom]

Hi and welcome to you and Maggie!

I understand very well how terrified this diagnosis can be. When I first heard that word in connection with my Squirt in 2007 I thought my world was ending. I spent countless hours scouring the internet trying to learn all I could about this disease and what I needed to do to help my Sweet Bebe deal with it. I rarely slept, had a hard time choking down food, and basically withdrew from everyone and everything except my computer and dog. I joined several other online forums and what were called "lists" back in those days hoping to find support and knowledge. They all failed on both points. One woman told me I might as well put a bullet in Squirt's head if I did what her vet was recommending which was to start treating with ligans and melatonin. By the time I made it to this forum I was a complete basket case. A dear friend here said I reminded her of a woman with her finger in a light socket - sputtering gibberish and hair standing on end. She kindly left out the parts about wild eyes and flying slobber! :D:D:D In short order the kind folk that were here had me calmed down and almost to the point where I could breath a bit so I could start to learn in earnest. They taught me then and continue to teach me to this day.

My Squirt was 7 when she was first diagnosed and lived to be a little over 16. Cushing's is NOT a death sentence. So take a deep breath, roll your shoulders, shake your head, and try to start relaxing. When you can, take some time to start reading in the Helpful Resource section of the forum found here:

https://www.k9cushings.com/forum/forumdisplay.php?10-Helpful-Resources-for-Owners-of-Cushing-s-Dogs

Not everything you find there will apply to Maggie and her journey. It is rare for any 2 dogs to follow the same path with this disease but the more we know about Cushing's and it's treatments the better off our babies will be regardless of their own path.

The starting dose for Vetoryl is 1mg/lb so at 4kg Maggie weighs 8.8kg (4 x 2.2 = 8.8). So the starting dose of 5mg is a great place to start for your baby girl. Her vet is supposed to follow up with an ACTH in two weeks after she starts. If all looks good then meaning her signs are no worse and the post number is good (between 1.45 - 5.4 ug/dl) then things stay the same. IF the post, or second number, is below 2.0 then the dose will be lowered. The dose is NEVER raised in the first 30 days because the cortisol will continue to fall on the starting dose. 30 days later another ACTH will be given. If the post number is within optimal range things will stay the same. Her vet should discuss what if any signs you are still seeing and if they are stronger or weakening. That second or post number can go as high as 9.1ug/dl if ALL signs are well controlled.

The most common signs for Cushing's which indicate the cortisol is too high are:

Increased thirst and urination (polydipsia and polyuria, respectively)
Urinating at night or having accidents
Increased hunger
Increased panting
Pot-bellied abdomen
Obesity
Fat pads on the neck and shoulders
Loss of hair
Lack of energy
Muscle weakness
Infertility
Darkening of the skin
Thin skin
Bruising
Hard, white scaly patches on the skin, elbows, etc. (associated with the disease calcinosis cutis)

Not all pups have all these signs but we almost always see a huge appetite and thirst, excess peeing, panting and hair loss or failure of the hair to regrow after being shaved. A word of caution - our pups are not peeing so much because they are drinking so much. It is the exact opposite. They are GOING to pee and have to drink a lot to keep themselves hydrated. So never withhold water. Always make sure Maggie has plenty of fresh water so she doesn't dehydrate.

Once treatment starts you also need to know the signs that the cortisol is too low. Those signs are:

Nausea/vomiting
loose stool/diarrhea
lethargy
loss of appetite

If you see ANY of these signs do not give any more Vetoryl and contact her vet to let them know what you are seeing. The good thing about Vetoryl is that it has a very short life in the body and if the cortisol does go to low most of the time simply stopping treatment for a bit will set things right. Her vet may want to check the cortisol via an ACTH and run a test to look at electrolytes just to make sure she doesn't need a little help getting that cortisol up. Of the two sets of signs the set that indicates the cortisol is too LOW is the most crucial because low cortisol can be life threatening very quickly while high levels are not life threatening until they have been present a very long time. A lot of cush pups have had the disease for many years before they are diagnosed which proves the point that high cortisol is rarely life threatening.

Well that should have your head spinning! :D But it is what you need to know today. Well most of what you need to know. You also need to know that you are not alone. You and Maggie are part of our little family here at K9C and we will walk every step of this journey with you. Never hesitate to ask questions, we will do our best to help you understand. If you simply need to chat, have at it! This thread will serve as a sort of diary of Maggie's journey so you can look back at any time to reread something someone else has said or to refresh yourself on something concerning her journey like when testing was done or doses changed. So come back to this thread and talk away!

I am glad you found us and look forward to learning more as time passes!
Hugs,
Leslie

[Maggiemoo1]

HI again!

Thank you so much for the kind words! I am a bit calmer today.

The vetoryl dose is 5 mg 2x daily so 10 mg in total. Is this too high? I am scheduled for her recheck in 13 days when they will do the stim test and check bloodwork.

She gets regular bloodwork every 6 mos, had a liver panel in the beginning of aug and had her urine checked. The IM vet also did an ultrasound of her belly. Other than adrenals being slightly enlarged all looked ok.

She is in great health besides the elevated alk phosphatase and cholesterol. All else is normal. That’s why this is so frustrating!!!

We gave two doses of vetoryl yesterday and one today. So far all is ok!

[Maggiemoo1]

Oh my. Pookie (and his mom) have been through so much. I’m happy he’s doing better. I will keep him and you in my thoughts. I know what’s it’s like to be depleted physically mentally and financially over our little ones. Maggie has had cancer twice and a whole host of other bizarre health problems. Multiple surgeries. More than any animal or person should have to ever endure. She’s such a trooper!

Would you consider treating with western meds if his kidneys and liver are strong enough? I NEVER did before but the hind leg weakness and falling were terrible. Just broke my heart.

We’ve seen a neurologist multiple times, orthopedist and rehab specialists. All have agreed it could be from disc disease in her spine but it was the rehab vet(who is also an Eastern Chinese medicine specialist) who agreed with me a lost the cushings and thinks her weakness could be from it. I love this vet and trust her instincts. Maggie is being treated at the AMC in NYC. They have all sorts of specialists there and see cushings all the time so I feel like they know what they are doing but I’m still terrified!

[fkhan]

Oh my. Pookie (and his mom) have been through so much. I’m happy he’s doing better. I will keep him and you in my thoughts. I know what’s it’s like to be depleted physically mentally and financially over our little ones. Maggie has had cancer twice and a whole host of other bizarre health problems. Multiple surgeries. More than any animal or person should have to ever endure. She’s such a trooper!

Would you consider treating with western meds if his kidneys and liver are strong enough? I NEVER did before but the hind leg weakness and falling were terrible. Just broke my heart.

We’ve seen a neurologist multiple times, orthopedist and rehab specialists. All have agreed it could be from disc disease in her spine but it was the rehab vet(who is also an Eastern Chinese medicine specialist) who agreed with me a lost the cushings and thinks her weakness could be from it. I love this vet and trust her instincts. Maggie is being treated at the AMC in NYC. They have all sorts of specialists there and see cushings all the time so I feel like they know what they are doing but I’m still terrified!

Pookie is a tomboy and her sister is a princess. Both half sisters. I'm the daddy... I am considering Trilostane treatment as well. Before this past month, I had an ACTH test done that doesn't show Cushings, but we know she has/had it from the low dose dex test. The strange thing is her clinical signs changing, but she does have back leg weakness and falls down sometimes. This is why I'm considering treatment, because she has been dealing with it for a year and its just gotten worse. I'm going to speak with my Vet on Wednesday to see if we can start. I'm afraid of causing Pookie harm, but many people have success with treatment. My Vet initially said not to treat unless Pookie is eating and drinking excessively. Pookie never did, but her hair loss, skin changes, back leg weakness, and now prone to infections makes me think she needs treatment. In the past, Pookie would pant alot, but now not. Very strange, because I'm wondering if her Adrenal glands have been overworked for so long that she may have had Adrenal fatigue/Addisons, but it doesn't appear to be the case. Her last ACTH base was 181 and post was 494. I don't know how this stuff converts and what is considered normal, but treatment is probably in Pookie's future, because I almost had to put her down recently and baby feed her with a syringe for 2 weeks. Just glad I was able to get a 0% intro Credit Card balance transfer done, because the stress from Finances just adds to the exhaustion.

[Maggiemoo1]

So sorry!! I thought pookie was a boy and you were a mom. I got it all wrong!

Our regular vet said not to treat also because she’s not drinking and peeing excessively. Sad thing is I’d almost prefer that over the hind leg weakness lethargy and anxiety. She doesn’t want to walk 10 feet and when she does she’s panting so excessively. Her tail is almost bald. She’s always wandering about and restless. Some vets told me she had a touch of dementia but I knew it wasn’t that! Poor little thing. It took me almost 3 years to have someone see what I saw. I’m furious but the past is the past. I’m hopeful we will get this taken care of.

I miss the walks and playfulness. I know she’s got a lot of life in her. I just hope this helps without causing damage.

Don’t give up! Pookie and Maggie are in this together. Two troopers! And they are lucky to have us by their side every step of the way.

[Squirt's Mom]

10mg is not too high for Maggie. Just keep an eye out for those signs I gave you that would indicate the cortisol is too low. That doesn't mean I am worried because I am not - her starting dose is good but we cush parent always need to keep an eye out for those signs once treatment starts. The schedule for the stim is perfect as well. You are off to a good start!

[fkhan]

No worries. They are troopers for sure. Does Maggie have high blood pressure? When Pookie had an MRI, it showed she had a stroke. I'm not sure if it was during Cushing's or not, but the MRI revealed it. Hypertension appears to be another thing that can occur with Cushing's. I'm hoping the meds work for you, because Pookie may be on them soon. The other thing I always wonder about is the ACTH stim test. I'm not a vet and I know that it's standard to test, but I wish we had another way to measure cortisol. When I think about being stressed, I would think adding more stress/acth would be dangerous.

[Maggiemoo1]

Thanks Squirt’s mom!

I’m was worried it was too high because it’s over 1mg/lb but it’s close so I wasn’t sure!

I’m so nervous I need to calm down! When does it get easier if ever!?!

How long did it take to get Squirt’s cortisol under control?

[Maggiemoo1]

Maggie’s blood pressure was not high. I’m sure mine is though......

Why did they do an MRI? I asked the IM VET but he said it’s not necessary at this point

[Harley PoMMom]

Hi and a belated welcome to you and Maggie from me as well!



Our regular vet said not to treat also because she’s not drinking and peeing excessively. Sad thing is I’d almost prefer that over the hind leg weakness lethargy and anxiety.

It is recommended that if a dog doesn't have the most common Cushing's symptoms, such as a ravenous appetite and increased drinking/urinating, that treatment is not started because the goal of therapy is to improve those symptoms, it makes it harder to judge how a dog is doing if the symptoms are not present, so I do understand why the vet did not want to start treatment.



She doesn’t want to walk 10 feet and when she does she’s panting so excessively. Her tail is almost bald. She’s always wandering about and restless.


The lethargy, panting, and hair loss are symptoms associated to hypothyroidism, has her thyroid function been tested?

Unfortunately Cushing's is one of the most difficult canine diseases to diagnose and is often misdiagnosed. Other non-adrenal illnesses should be ruled out before a diagnosis of Cushing's is sought, so I recommend having a Free T4 test done to rule out a thyroid problem.

We sure do understand how worried you are about your sweet girl and are here to help in any way we can.

Lori

[Maggiemoo1]

Thanks Lori!

Now I’m really concerned. Do you think we should stop the vetoryl?

Could the thyroid actually case a false positive on the LDDST? And her adrenals are both slightly enlarged. Ugh. I’m so frustrated!

Not sure why an IM specialist at one of the very best hospitals didn’t test her thyroid!!!

[fkhan]

If it's that good of a hospital, they might have and didn't see anything on the test. You should double check, because I have to ask for test to be run after my own research and concerns. The MRI was done, because Pookie has Cushing's and stopped eating. The vet brought another vet tech in and told me a story about another dog with Cushing's that had to be put down, because that dog stopped eating. The reason being was from a Macroadenoma, which is an enlarged tumor on the pituitary gland. I was crying that day and thought I would have to put Pookie down. The MRI showed she doesn't, and she is suspected to have been dealing with Pancreatitis for 2-3 weeks. Pookie had a CPL test that showed a light positive, hence the IV's and antibiotics. It was an awful experience, but I'm glad I still have my Pookie.

[Maggiemoo1]

Who knows at this point! I’ve emailed the vet to ask. I don’t believe it was checked because I think I would recall.

Maggie wasn’t interested in her food this am. She did eat treats and carrots but she turned her nose up at food so now I’m freaking out. Did Pookie stop eating altogether?

This is so frustrating. I’m not sure how long I can go on like this.

[Maggiemoo1]

Well so much for well tolerated. Maggie just had massive runny stool. Call is into the vet IM service. Waiting for a call back.

She’s fine otherwise but I’m definitely NOT giving the next dose!

Wondering if this with no other symptom is just gastrointestinal upset from the medication and nothing else.

[Squirt's Mom]

Good for you! You are absolutely correct in stopping the Vetoryl. WAY TO GO, MOM!

Do contact her vet and let us know how Maggie is doing!
Hugs,
Leslie

[fkhan]

Found this at: https://www.drugs.com/pro/vetoryl.html

Side effects generally involve an over suppression of the adrenal glands (hypoadrenocorticism, also known as Addison's Disease). Look for the following side effects that may indicate your dog is having a problem with Vetoryl Capsules or may have another medical problem:

Depression, lethargy or decrease in activity.
Change in bowel movements (such as diarrhea or loose stools).
Vomiting.
Stops eating or loses all interest in food.

[fkhan]

Pookie slowly stopped eating, which they think was from Pancreatits. Hope all is well with Maggie. I agree to stop and check with your vet, because a lower dose may be needed, stopped all together, another cortisol suppression med, or something else. Now I'm worried to start Pookie on this stuff too. Just to add to it, Pookie's sister is 16 today and slowing down. It is very depressing when our dogs get older, but caring for them in their old age is my first priority. I understand your frustration and you are trying to help your baby just like I am.

[fkhan]

I'm wondering if those meds should be done with a change in diet or probiotic stuff? Not sure, but just a thought.

[Maggiemoo1]

The terribleness has stopped for now. I hope it’s over. Maggie ate all her food tonight and still wanted her after dinner Kong! Wow what a rebound.

Funny. The vet who called me back said she didn’t think the events were from the vetoryl!!! Crazy!

Now I don’t know what to do! Restart tomorrow? Abandon treatment completely? Has anyone else experienced these gastro issues?!? Please help!

[Maggiemoo1]

Has anyone had experience with gastrointestinal issues from vetoryl? If so please reply!!!

Thanks!
Maggie’s very scared mom

[Budsters Mom]

Absolutely! Trilostane (Vetoryl) tore up my Buddy's stomach. Pepcid AC and Slippery Elm bark ( made into a slurry) helped ease those symptoms tremendously. SEB coats the stomach lining, similar to Pepto Bismol for people. It can interfere with other meds, preventing their proper absorption. For that reason, it should be dosed two to three hours before/after meds. It can be used up to 4 times a day, but that is difficult to acheive while dosing around other medications. Even once or twice a day can help. At least, aim for bedtime. It can calm rumbly tummies throughout the night, so everyone can get more rest.

To sum it up.... Stomach upset is common with dogs taking Vetoryl.

[Maggiemoo1]

Oh thank you thank you for answering! What is strange is that she was fine for two days (4doses) and the third day all went crazy! I am afraid to give her a dose tomorrow.

She ate fantastically tonight so I think she’s feeling better. Do you give the Pepcid before the vetoryl? Where do you find slippery elm bark?

[fkhan]

I would ask the vet if you should start with a lower dose. I wish I had more insight to give, but I don't have any experience with this drug. I'm still waiting on Pookie's thyroid test to come back.

[Maggiemoo1]

I would ask the vet if you should start with a lower dose. I wish I had more insight to give, but I don't have any experience with this drug. I'm still waiting on Pookie's thyroid test to come back.

I’m going to ask as soon as her treating vet gets back to me. I spoke with someone from the internal medicine service last night who infuriated me by claiming it wasn’t the vetoryl. Even the manufacturers help line said it could be from the vetoryl!!! I want to speak to the dr who actually gave her this medication to see what he says.

My local vet (who is an absolutely amazing person) said wait until the loose stools resolve and then discuss a lower dose. She says it’s absolutely a side effect of these meds.



How’s your gals today? Happy belated birthday!!

[fkhan]

I’m going to ask as soon as her treating vet gets back to me. I spoke with someone from the internal medicine service last night who infuriated me by claiming it wasn’t the vetoryl. Even the manufacturers help line said it could be from the vetoryl!!! I want to speak to the dr who actually gave her this medication to see what he says.

My local vet (who is an absolutely amazing person) said wait until the loose stools resolve and then discuss a lower dose. She says it’s absolutely a side effect of these meds.



How’s your gals today? Happy belated birthday!!

My little rascals are doing pretty good. Peaches is now 16, and if Pookie makes it to January, she will be 16 as well. It's hard to see my babies get old, but I'm doing everything I can to take care of them. Having them for so long has created a huge attachment to them, but I also stress myself out, because now that they are old, I'm always worrying about them and watching them like a hawk. I wish I won the lottery so I don't have to work and just spend time with them and take care of them.

[fkhan]

Have you tried Adrenal Harmony? I used this with Pookie for 6 months, but have stopped, because she got sick and her kidney values were high. Not sure if this caused it, but thought you could think it over. My Pookie doesn't have the heavy panting anymore, doesn't drink or eat like crazy, but her back leg weakness and skin/hair is screaming for treatment. This is the only reason I'm thinking about Vetoryl/Trilostane, but I'm scared to try it. I've read reviews where Vetoryl and Adrenal Harmony has worked miracles for their pets, and I have heard that they were awful... It's scary, but every dog is different. I guess we do the best we can with blood tests, scans, and clinical signs.

https://www.amazon.com/gp/customer-reviews/R3EVP3QHJS05K8/ref=cm_cr_arp_d_viewpnt?ie=UTF8&ASIN=B00BCQQPDC#R3EVP3QHJS05K8

[fkhan]

I also signed up here for suggestions: https://www.justanswer.com/help/. 2 vets on here says I should start treatment with Vetoryl... Still don't know. You could sign up and get answers as well. Just more opinions, but it's up to us to make decisions.

[Harley PoMMom]

Thanks Lori!

Now I’m really concerned. Do you think we should stop the vetoryl?

I believe stopping the Vetoryl is a good idea right now, and I did see that you have done this, great job!


Could the thyroid actually case a false positive on the LDDST? And her adrenals are both slightly enlarged. Ugh. I’m so frustrated!



Any non-adrenal illness and even stress can cause false positive results on all tests for Cushing's which is why strong obvious symptoms play a huge part in the diagnosis of Cushing's. The adrenal glands can be enlarged due to any chronic illness, so yes, a thyroid issue could be a cause of those adrenal glands being enlarged.

Lori

[Harley PoMMom]

Pepcid should be given 20-30 minutes before the Vetoryl is given, also you want the regular Pepcid AC not the fast acting or slow releasing kind.

I purchased my Slippery elm bark online, I'm including this post from one of our Moderators, Leslie, with info on SEB:
About that diarrhea. My little Trinket had colitis and it is SCARY when it comes on bad. All that blood! :eek::( But we started using herbs called Slippery Elm Bark and Marshmallow. SEB is the one most well known and the one most here have used but Marshmallow has the same properties and has worked just about as well as SEB when I have used it. I will say for the really stubborn cases the SEB is what I use. These herbs work as a sort of bandaid throughout the digestive system, seeking out, finding, and healing that whole track from mouth to rectum. Here are some links about SEB and one where you can purchase safe herbs of any kind (Mountain Rose Herbs).

https://www.whole-dog-journal.com/issues/5_5/features/5455-1.html

https://vcahospitals.com/know-your-pet/slippery-elm

https://healthypets.mercola.com/sites/healthypets/archive/2012/03/26/dealing-with-dog-diarrhea.aspx

https://www.thepossiblecanine.com/slippery-elm-marshmallow-little-differential

https://www.mountainroseherbs.com/products/slippery-elm-bark-powder/profile

I always use the powder from with my animals because you can so easily make anything from a thin soup to a thick gruel - what the case calls for. ;) You MUST give the SEB/Marshmallow 2 hours before or 2 hours after all other meds, supplement, herbs, etc because these herbs will prevent the absorption of other meds. Just in case you weren't aware - diarrhea is one of the side effect of the Zonisamide so that may be having a bearing on this issue too. I think the SEB/Marshmallow is worth a shot for your precious baby boy. Be patient and give the herb time to work in his body.

Hugs,
Leslie

Lori

[Maggiemoo1]

Update
Maggie saw the vet. Electrolytes checked all ok. He suggested a reduction to 5 mg per day and gave metronidazole just in case.

Checked her thyroid with the MOST EXPENSIVE panel ever. Normal

First dose of vetoryl today and she had soft stool again.

Wondering if she just shouldn’t take this medication. Scary bc she needs treatment. Her blood pressure was so high vet put her on meds.

Is there anyone who had the same GI experience after beginning vetoryl? Did it stop? How long after begging? Please!!! Any suggestions would be appreciated

[Maggiemoo1]

Update
Maggie saw the vet. Electrolytes checked all ok. He suggested a reduction to 5 mg per day and gave metronidazole just in case.

Checked her thyroid with the MOST EXPENSIVE panel ever. Normal

First dose of vetoryl today and she had soft stool again.

Wondering if she just shouldn’t take this medication. Scary bc she needs treatment. Her blood pressure was so high vet put her on meds.

Is there anyone who had the same GI experience after beginning vetoryl? Did it stop? How long after begging? Please!!! Any suggestions would be appreciated

[fkhan]

Did you try the Pepcid and Elm Bark as suggested before? I'm still waiting to here back on Pookie's thyroid. It has been over a week and now her hair/skin is peeling away from the middle of her back. I hope your pup will be ok. I'm also wondering about Probiotics or something else to help the GI. Wish I had some experience with this med, but I haven't used it yet.

[Harley PoMMom]

Update
Maggie saw the vet. Electrolytes checked all ok. He suggested a reduction to 5 mg per day and gave metronidazole just in case.

Checked her thyroid with the MOST EXPENSIVE panel ever. Normal

First dose of vetoryl today and she had soft stool again.

Wondering if she just shouldn’t take this medication. Scary bc she needs treatment. Her blood pressure was so high vet put her on meds.

Is there anyone who had the same GI experience after beginning vetoryl? Did it stop? How long after begging? Please!!! Any suggestions would be appreciated

I took the liberty and copied your updated post and placed it in Maggie's original thread so that all of her information is in one place.

Besides the soft stool, is Maggie experiencing any other GI issue, such as nausea or vomiting?

[Maggiemoo1]

I took the liberty and copied your updated post and placed it in Maggie's original thread so that all of her information is in one place.

Besides the soft stool, is Maggie experiencing any other GI issue, such as nausea or vomiting?


Thanks!
No other issues at all! Vet and manufacturer think it may subside after her body gets used it it. She has had two doses of metronidazole and she’s much better. I just don’t want to keep her on it! I also know she’s going to need a higher dose and that scares me.

Any thoughts?

[Maggiemoo1]

Vet said probiotics may help. Also gave us RX clay. It didn’t really help so we used the metronidazole

I haven’t found the slippery elm yet.

Pepcid usually works for vomiting for Maggie. I think this is more of an intestinal inflammation.

[fkhan]

I hope the meds work for your baby, because I may have to start Pookie on them. I'm still waiting on her Thyroid test to come back, which was over a week ago. Given the immune suppression of cortisol in our dogs, I'm supplementing Pookie with Vit C twice a day. Since Cushing's has effected her liver and her kidneys were failing last month, I have her on Azodyl, SubQ's, Denamarin Advanced, and Vit B12 shots once a week. I also give Pookie fishoil, Pepcid, HMR lignans, Kidney Gold, and just started alternating Kidney Gold and Adrenal Harmony, and a little Ginkgo Biloba again. Since my vet hasn't recommended Trilostane, I have to be my own vet and see what works and doesn't work for Pookie. It's dangerous to experiment with our own dogs, but I feel leaving Cushing's untreated is not a good idea. At the least, I think VitC is needed if their immune system is being suppressed. Since Pookie is suspected of have been dealing with Pancreatitis, her CLP still shows a light positive, but the Vet said it could take time for that to resolve.

[Squirt's Mom]

I have merged your latest post into Maggie's original thread. Please keep all posts concerning Maggie in this one thread. Thanks!

[Maggiemoo1]

I have merged your latest post into Maggie's original thread. Please keep all posts concerning Maggie in this one thread. Thanks!

Well I’m considering taking Maggie off the vetoryl. She’s sleeping all day and her stool is still soft despite the metronidazole I’m wondering whether it’s worth it.

Her back leg weakness is getting worse and she’s now on high blood pressure meds because of cushings. I’m wondering if there’s a way to control the effects of cortisol on her little body without the vetoryl which just seems to make her feel terrible. I hate to cause more harm than good.

Anyone have any ideas? When is enough enough!?! I’m suffering because she’s suffering. I could really use some help please!

[fkhan]

Well I’m considering taking Maggie off the vetoryl. She’s sleeping all day and her stool is still soft despite the metronidazole I’m wondering whether it’s worth it.

Her back leg weakness is getting worse and she’s now on high blood pressure meds because of cushings. I’m wondering if there’s a way to control the effects of cortisol on her little body without the vetoryl which just seems to make her feel terrible. I hate to cause more harm than good.

Anyone have any ideas? When is enough enough!?! I’m suffering because she’s suffering. I could really use some help please!

I'm sorry to hear about your dog. I have not started on the Vetoryl yet and may not. Can you ask the vet about a lower dose? Also, my little Pookie is eating again, but her hair has gotten worse is is falling out all over her back. She does seem comfortable though and goes for walks. Her muscle weakness is not as bad as it was. I feed her home cooked food and give her Azodyl for her kidneys, Denamarin Advanced for her liver, Adrenal Harmony for her Cushings, HMR lignans for her cushings, SubQ's for her kidneys, VitB12 shot, Ginkgo Biloba for her Cushings, VitC for her immune system, fish oil for Cushings and just being old, Pepcid for acidity/cushings. At this point in time, the only reason why I would consider vetoryl is because her skin/hair appear to be screaming for treatment. Since the skin is another organ, I'm still waiting for the blood tests to see if she has a thyroid problem or cushings problem.

[fkhan]

Why is she on an antibiotic? Is it because of her stools? If her stools were fine before the Vetoryl, I would think the Vetoryl could cause it and maybe diet and probiotics would be better. I know when Pookie was on antibiotics, she was listless and lethargic.

[Maggiemoo1]

Why is she on an antibiotic? Is it because of her stools? If her stools were fine before the Vetoryl, I would think the Vetoryl could cause it and maybe diet and probiotics would be better. I know when Pookie was on antibiotics, she was listless and lethargic.

The internist put her on it because of the diarrhea. Yes I’m sure the drug is causing the diarrhea because her stool was fine before starting.

I’m taking to vet tomorrow. This can’t go on.

[fkhan]

What is her blood pressure reading? Also, what are you doing about the elevated alk phosphatase? Is her liver and gallbladder ok?

[Harley PoMMom]

There are other novel therapies being looked at for Cushing's, however, these new treatments can be costly and there is still much more to learn about them. This link that I'm providing has information regarding these new medications: https://www.k9cushings.com/forum/showthread.php?8551-Cabergoline-Retinoic-Acid-and-other-novel-pituitary-Cushing-s-treatments&highlight=Cabergoline AND https://www.k9cushings.com/forum/showthread.php?8022-Canine-pituitary-dependent-hyperadrenocorticism-(PDH)&p=189827#post189827

Lori

[fkhan]

Hope all is well. What did your vet recommend?

[Maggiemoo1]

Hope all is well. What did your vet recommend?

Hi
We are keeping at her 5 mg once a day and will test next Tuesday. I am stripping the metronidazole tomorrow. Her stool has been quite normal the last two days! Thank goodness for small things!

I consulted with Dr Bruyette who is an amazing human being. He said we are in great hands at our animal hospital and he agrees with the strategy.

I suspect we will need to increase her dose and that could again open the floodgates but for now she seems to be doing much better


How are your little ones. Did the thyroid panel come back?

[Budsters Mom]

Dr. B. Is amazing! He has helped many of us! Did he advise you to stop the metronidazole, or was that your decision?
Just wondering because two days of a normal stool isn't very long. My dog was on a course of metronidazole for 10 days. The diarrahea stopped on the second day of treatment, but I was told to continue it for the entire 10 days. 5 days after finishing treatment with the met, the diarrhea started again. We followed up with another 10 day round of met. Finished the second round 17 days ago. Infection has finally cleared. So, again two days of normal stools aren't very long. Yes, it could be caused by the Vetoryl, or could be an infection, or both. If Dr. B. Advised you to stop the Met, I would absolutely follow his advice. If he didn't, I'd Think twice about it. Did your regular vet suggest that it be stopped? If I was going to the vet on Tuesday, I would probably keep my dog on the Met until that appointment, at least. Then again, I am overly cautious.

[Maggiemoo1]

Dr. B. Is amazing! He has helped many of us! Did he advise you to stop the metronidazole, or was that your decision?
Just wondering because two days of a normal stool isn't very long. My dog was on a course of metronidazole for 10 days. The diarrahea stopped on the second day of treatment, but I was told to continue it for the entire 10 days. 5 days after finishing treatment with the met, the diarrhea started again. We followed up with another 10 day round of met. Finished the second round 17 days ago. Infection has finally cleared. So, again two days of normal stools aren't very long. Yes, it could be caused by the Vetoryl, or could be an infection, or both. If Dr. B. Advised you to stop the Met, I would absolutely follow his advice. If he didn't, I'd Think twice about it. Did your regular vet suggest that it be stopped? If I was going to the vet on Tuesday, I would probably keep my dog on the Met until that appointment, at least. Then again, I am overly cautious.

Thanks

The metronidazole was solely given to help with the diarrhea caused by vetoryl. She didn’t have an infection

Dr B said we shouldn’t have to give metro in order to treat with vetoryl and she may be intolerant to vetoryl. I stopped the metro to see if that’s the case. If she can’t take it there’s no point in increasing the dose.

Anyone have experience with anipryl. Vet will NOT give Lysodren.

I’m so sad. I just can’t believe she’s intolerant to potentially the only thing that can help.

[fkhan]

Thanks

The metronidazole was solely given to help with the diarrhea caused by vetoryl. She didn’t have an infection

Dr B said we shouldn’t have to give metro in order to treat with vetoryl and she may be intolerant to vetoryl. I stopped the metro to see if that’s the case. If she can’t take it there’s no point in increasing the dose.

Anyone have experience with anipryl. Vet will NOT give Lysodren.

I’m so sad. I just can’t believe she’s intolerant to potentially the only thing that can help.

I'm so sorry she is intolerent to it. I think they make a generic to it which you may want to ask about. Also, I'm going to start Vetoryl with Pookie next week and I hope it helps. You can try the supplements and VitB12 shots I mentioned before and see how she does.

[labblab]

Hello, and welcome to you and Maggie from me, as well! I’m sorry this has been my first chance to write, but I’ve been out of town and away from the forum for awhile. I surely understand how frustrating the diarrhea has been for you girls. But hopefully it was only a temporary problem that will resolve after Maggie’s system becomes accustomed to the Vetoryl. This is indeed a possibility, so I do believe there’s still reason to hope that the treatment will remain a viable option. However, if not, Dr. Bruyette would be a great resource for you in terms of giving Anipryl a try. He is very knowledgeable about its use and efficacy. Apparently only a minority of Cushpups respond with symptom resolution, depending upon the exact location of the tumor within the pituitary gland. But we have seen a few success stories here, so it may indeed be worth a try if both Vetoryl and Lysodren are ruled out.

Just to clarify, there is no true generic form of Vetoryl available for sale at this time. In the U.S., generic medications are mass manufactured by pharmaceutical companies under the same FDA regulations as brand name meds, and must conform to the same efficacy requirements. No generic form of Vetoryl is currently being marketed here. However, “compounded” versions of trilostane (the active chemical in Vetoryl) can be created by individual compounding pharmacies when an owner needs a dose or form of the drug that is not commercially available in the form of Vetoryl. Theoretically, a compounded version of trilostane probably shouldn’t be any easier for Maggie to tolerate since the active ingredient remains the same. But I suppose the inactive “fillers” might differ somewhat. That I wouldn’t know. But, in general, unless a dog’s specific dosing needs require a compounded substitution, some clinicians look less favorably on compounded products because they are not subject to the same safety and efficacy testing as are mass produced meds.

In looking back through your thread, it seems as though Maggie’s loss of hind end mobility is her most troubling external issue. As you already know, Cushing’s can certainly cause muscle weakness. However, just as a warning, that is one of the symptoms that can take a longer time to improve even with effective Rx treatment. Also, given Maggie’s age, there may be arthritic or orthopedic changes that are not directly related to Cushing’s. If she cannot tolerate the Vetoryl, I’m wondering whether your specialist might consider a trial of a pain-killer or anti-inflammatory in order to see whether that improves her mobility at all. I’ve been the lucky owner of three beloved Labs, now. My first was my Cushpup, and he definitely exhibited the associated muscle weakness. However, my subsequent two non-Cush girls have suffered from equally debilitating hind end mobility issues that did show improvement with painkillers. I know the combination of uncontrolled high levels of circulating cortisol are not a good combination with traditional NSAIDS. But I believe there are some newer, safer versions that might be considered appropriate to try with Maggie. Certainly you don’t want to confound the issue or present any new GI challenges right now. But again, if the Vetoryl is ruled out, perhaps her mobility might still be amenable to some improvement through alternative treatment.

OK, I guess that’s all I can think of to write at the moment. Hopefully, Maggie’s tummy has settled down and you’ll have a better update for us very soon!

Best wishes,
Marianne

[Maggiemoo1]

Thanks Marianne! I’m Marianne too!

I’ve added pumpkin to her diet. She eats freeze dried raw and it doesn’t have a ton of fiber so vet suggested adding some fiber. We took her off the metronidazole completely if you have any helpful dietary suggestions they would be much appreciated!

Her stim test is Tuesday. I’m hoping the vetoryl is doing something!

I understand about the muscle weakness being the hardest to correct. She also has high cholesterol triglycerides and blood pressure so I’m hoping treating the cushings brings these down. If vetoryl isn’t tolerable I will ask Dr B about the efficacy of anipryl. He was so kind to us. What an amazing human.

Maggie is on a CBD chew for her arthritis. It’s one that was tested by Cornell vet school and works great for her aches and pains. I’m beginning to think the hind leg weakness may not be all cushings related and is neurological but we will not MRI her bc we wouldn’t treat at this point in life. I just want her to be comfortable and feel ok. It’s so terrible that she has to spend whatever time she has left with runny poops and stim tests I guess if things don’t subside I will decide not to continue but I want to make a good faith effort.

Your labs are very lucky to have such a great knowledgeable mom!

[Maggiemoo1]

I'm so sorry she is intolerent to it. I think they make a generic to it which you may want to ask about. Also, I'm going to start Vetoryl with Pookie next week and I hope it helps. You can try the supplements and VitB12 shots I mentioned before and see how she does.

I hope Pookie tolerates it well! What dose will you begin at?

[labblab]

How great to meet another member of the Marianne sisterhood — there aren’t a whole bunch of us around! ;-)))))))))))

We’ll certainly be wishing you girls well on your stim test tomorrow, and we’ll be watching for your update. I wish I could give you some great dietary advice, but our experience here throughout the years has been that there doesn’t seem to be any one particular type or style of food that works better or worse with Cushpups — it all comes down to individual health profiles and tolerances.

I do want to offer one cautionary note about the pumpkin. Paradoxically — and again, depending upon individual tolerances — fiber can help with both diarrhea and constipation. With some dogs, it helps firm up stools, but it can make stools even runnier for some dogs. I have irritable bowel episodes myself, and a high-fiber diet is helpful to me. However, my own dogs have never responded well to pumpkin during episodes of diarrhea, and if anything, it’s made things worse for them. I am not a vet, so I don’t mean to challenge your vet’s recommendation. However, if Maggie’s stools were A-OK prior to the Vetoryl, I don’t know that I would want to introduce any new dietary variables right now when you’re attempting to determine whether or not Vetoryl will be an ongoing culprit. In other words, if she starts having diarrhea again after starting back with the Vetoryl and also beginning the pumpkin, how do you sort out the genuine cause? If it was me, in terms of dietary additions, I believe I’d try to stick it out with the Vetoryl alone for at least a week or so, in order to see whether or not her system adjusts on its own. Just a thought for you to consider...

One question for you, though. Can you tell us more about her CBD chews? I’d love to find a CBD option with some firm research backing for my own arthritic girl.

Marianne

[fkhan]

I hope Pookie tolerates it well! What dose will you begin at?

Pookie is in a good place right now and her only clinical sign is her hair loss all along her back, which includes plenty of black pigmentation changes. The only reason I'm going to treat is to try and keep her organs and immune system from being harmed by non treatment. It was an awful experience to deal with, but I'm glad she survived it and is doing pretty good right now. I am really scared to start the Vetoryl, but I'm afraid what would be the next infection or organ to be the victim of cushings. Since her hair and skin are screaming for treatment, I'm thinking she needs treatment. She has been dealing with cushings for over a year. I'm waiting on her base level cortisol today, but we will start with a low dose of 5mg once or twice a day. Before I start, I wanted to know her base cortisol, because last time the base was 181 and post was 494. When that stim test was done to get those numbers, she crashed and I thought it was adrenal fatigue or addisons. The really strange thing is that her clinical sign for a year of dealing with cushing's was panting and hair loss/pigmentation. After Pookie crashed, she does not have the panting clinical sign anymore, but her hair loss continued to get worse. Really strange.

[fkhan]

Just got a call from my vet and said her base cortisol level is now under the normal range at 1.7. Pookie was given a trazadone the day her blood was drawn. I don't know if Trazadone could be the cause or not. Now that her cortisol is low, we were thinking of waiting to start Vetoryl. Her clinical sign of Cushings for the past year have been panting and hair loss/skin pigmentation, back leg weakness/loss of balance, increased appetite with a little thirst increase. Now after Pookie crashed/Pancreatitis over a month ago, her only clinical sign is hair loss/skin pigmentation with a little weakness/balance issues. We decided to wait a week or two and run another ACTH stim test. I'm concerned now, because her cortisol level is low. All tests in the past year have shown High cortisol and the vet said it could just be a fluctuation that occured. Pookie has had consistent high levels over 3-4 tests and now low, which has me putting on the brakes.

[Maggiemoo1]

How great to meet another member of the Marianne sisterhood — there aren’t a whole bunch of us around! ;-)))))))))))

We’ll certainly be wishing you girls well on your stim test tomorrow, and we’ll be watching for your update. I wish I could give you some great dietary advice, but our experience here throughout the years has been that there doesn’t seem to be any one particular type or style of food that works better or worse with Cushpups — it all comes down to individual health profiles and tolerances.

I do want to offer one cautionary note about the pumpkin. Paradoxically — and again, depending upon individual tolerances — fiber can help with both diarrhea and constipation. With some dogs, it helps firm up stools, but it can make stools even runnier for some dogs. I have irritable bowel episodes myself, and a high-fiber diet is helpful to me. However, my own dogs have never responded well to pumpkin during episodes of diarrhea, and if anything, it’s made things worse for them. I am not a vet, so I don’t mean to challenge your vet’s recommendation. However, if Maggie’s stools were A-OK prior to the Vetoryl, I don’t know that I would want to introduce any new dietary variables right now when you’re attempting to determine whether or not Vetoryl will be an ongoing culprit. In other words, if she starts having diarrhea again after starting back with the Vetoryl and also beginning the pumpkin, how do you sort out the genuine cause? If it was me, in terms of dietary additions, I believe I’d try to stick it out with the Vetoryl alone for at least a week or so, in order to see whether or not her system adjusts on its own. Just a thought for you to consider...

One question for you, though. Can you tell us more about her CBD chews? I’d love to find a CBD option with some firm research backing for my own arthritic girl.

Marianne

Ohhhhhh Marianne, how I wish I read your post before giving the pumpkin!! Maggie was up all night with diarrhea and while we were at work had an accident again. I’m so stupid!! The vet didn’t suggest it I just thought it would be a good idea and now I made her suffer more.

I’m going with your recommendation. Only vetoryl and blood pressure med. nothing else. We need to see if her stools get better or if the vetoryl is the problem. My hope is she will adjust to it. Any idea how long that could take?

Im worried for the stim. I hope she doesn’t have a bad reaction. Is this possible? I haven’t discussed any specifics with the vet regarding the stim. What is it? Can she get sick!?!

The cbd chews are from Ellevet. Ellevet and Cornell vet school did a clinical study together which was the study that established that cbd helps osteoarthritis in dogs. You can read the study online which was published and widely discussed. The chews are great. Maggie has very bad arthritis in her elbows and woul limp all the time. Since giving the chews she hardly limps! They also have the oil but I prefer the chews.

Several vets I have spoken with know the product and the study and think they are a great choice. Maggie loves them! They are expensive but in my opinion well worth the money. Btw for a larger dog the oil may be more economical.

[Maggiemoo1]

https://ellevetsciences.com

The website. I’m not affiliated employed or anything else!! I just did a bunch of research and this was the only cbd product backed by firm research performed by a leading vet school.

[Harley PoMMom]

Im worried for the stim. I hope she doesn’t have a bad reaction. Is this possible? I haven’t discussed any specifics with the vet regarding the stim. What is it? Can she get sick!?!



The "stim" is the ACTH stimulation test and is used to monitor dogs taking medication for Cushing's (it is also performed for other diagnostic purposes). An ACTH stim test contains synthetic forms of ACTH (Adrenocorticotrophic Hormone) such as Cortrosyn, ACTHAR gel, or another agent called Synacthen, ACTH and the synthetic forms of ACTH stimulates the adrenal glands to release Cortisol.

In an ACTH stim test a sample of blood is taken from an animal (the "pre-level"); then the animal is injected with a small amount of the synthetic form of ACTH, a second blood test is taken an hour later (the "post-level") to measure the change in circulating cortisol. The results of the two blood tests are then compared.

Some dogs do have a reaction to the ACTH stim test, they may become restless or agitated.

Lori

[Maggiemoo1]

Well the 5 mg is not sufficient. The results from the stim are

Pre 2.4 ug dL
Post 15 ug dl

Vet wants to start another 5 mg at night for total of 10 mg day

The diarrhea finally stopped! I’m not sure if it was the pumpkin or her little body getting used to the vetoryl. We are going to increase her dose on Friday just in case the diarrhea starts again so we can be around with her all weekend.

Any thoughts?!?

[labblab]

The standard recommendation is *not* to increase a Vetoryl dose until the first month of treatment has been completed. This is because cortisol levels can continue to drift downward during that time, even when the medication dose is unchanged. Thus, you can more accurately judge whether, and how much, the medication should be increased by waiting until the 30-day test results are in.

If I’m calculating correcting, this first monitoring ACTH test was performed after 2-3 weeks of treatment. So the general recommendation would be to hold off on an increase for a bit longer. However, your internist may feel that an earlier increase is warranted since Maggie’s initial dose was reduced due to the diarrhea, and her post-ACTH number is still relatively high. His decision is not crazy, by any means. However, in honesty, due to the diarrhea issues, I personally would prefer waiting a while longer to institute the increase. That’s great that the diarrhea has stopped, and I would want to give her a bit longer to stabilize further before upping the dose. This is just my laypersons opinion, but I don’t think you have a lot to lose by allowing her to plateau for a couple more weeks, and much to gain if this eases her GI system. I would repeat the ACTH in a couple more weeks, and wait until then to increase the dose if her GI system remains stable and the test results still suggest that fully doubling her dose seems appropriate.

And BTW, thanks so much for the info re: the CBD chews!

Marianne

[fkhan]

Well the 5 mg is not sufficient. The results from the stim are

Pre 2.4 ug dL
Post 15 ug dl

Vet wants to start another 5 mg at night for total of 10 mg day

The diarrhea finally stopped! I’m not sure if it was the pumpkin or her little body getting used to the vetoryl. We are going to increase her dose on Friday just in case the diarrhea starts again so we can be around with her all weekend.

Any thoughts?!?

I'm not licensed or a pro, but the post seems really high for sure. Pookie's post only doubled, which my vet said didn't mean she had Cushing's. Your post is over 6 times, which seems like alot. My vet also was going to start Pookie at 10mg and her tests were not as high as yours. I agree with the waiting period, but given the post number and your vets recommendation, I would probably follow their orders. It would also depend on your dogs clinical signs. I would take that into account with what your vet is saying, before increasing the dose. I hope it works out whichever way you choose, because I'm right around the corner from where you are. I would also inquire about keeping a steroid injection on hand and ask your vet what signs to look for during an Addisonian crisis if god forbid one did occur. Just so you are ready to help your pooch if need be.

[fkhan]

I'm not licensed or a pro, but the post seems really high for sure. Pookie's post only doubled, which my vet said didn't mean she had Cushing's. Your post is over 6 times, which seems like alot. My vet also was going to start Pookie at 10mg and her tests were not as high as yours. I agree with the waiting period, but given the post number and your vets recommendation, I would probably follow their orders. It would also depend on your dogs clinical signs. I would take that into account with what your vet is saying, before increasing the dose. I hope it works out whichever way you choose, because I'm right around the corner from where you are. I would also inquire about keeping a steroid injection on hand and ask your vet what signs to look for during an Addisonian crisis if god forbid one did occur. Just so you are ready to help your pooch if need be.

I was also curious on what your dogs diet is? I am just starting to try this:
https://www.drharveys.com/products/dogs/450-paradigm-a-green-superfood-pre-mix for Pookie. They appear to have a great response with helping you with diet considerations to consider for your pet. I'm going to take their advice and try it.

[labblab]

Evaluating the results of an ACTH stimulation test can be very confusing, that’s for sure. This is especially true because the test can be used either for diagnostic purposes prior to beginning Cushing’s treatment, and also for monitoring purposes subsequent to starting either Vetoryl or Lysodren. Depending upon the purpose of the test — diagnostic vs. monitoring — the desired reference ranges for the post-ACTH results are very different. For diagnostic purposes, you have to check the actual printed “normal” range for the lab that has performed the analysis. But even though 15 ug/dL may seem high, for most labs that value generally still falls within the normal diagnostic range for a dog that does not have Cushing’s.

In Maggie’s case, though, the test is instead being used quite differently to monitor the appropriateness of the Vetoryl dose once treatment has begun. In this situation, a post-ACTH result as high as around 9 ug/dL is considered acceptable as long as symptoms appear to be well-controlled. If symptoms persist, a lower post-ACTH result is recommended. So as we can see, after 2-3 weeks of Vetoryl treatment, Maggie’s cortisol is higher than the “cut-off” of 9. However, it may still drop lower over the next couple of weeks even if the dose is unchanged.

Also, just as a side note, in terms of Cushing’s, laboratories don’t make a diagnosis based on how much higher the post-ACTH result is than the initial baseline cortisol level. Instead, when diagnosing Cushing's, they compare the post-ACTH result to an expected range for that result alone. Baseline cortisol levels can be highly variable for any given dog, and therefore don’t have as much value as part of a diagnostic ACTH stimulation test for Cushing’s. Baseline cortisol does have a more prominent role in the ACTH when Addison’s is suspected, and also when interpreting the results of a diagnostic LDDS test. But not so much for a diagnostic ACTH test for Cushing’s.

[fkhan]

Well the 5 mg is not sufficient. The results from the stim are

Pre 2.4 ug dL
Post 15 ug dl

Vet wants to start another 5 mg at night for total of 10 mg day

The diarrhea finally stopped! I’m not sure if it was the pumpkin or her little body getting used to the vetoryl. We are going to increase her dose on Friday just in case the diarrhea starts again so we can be around with her all weekend.

Any thoughts?!?

Did you get the lab results as to what is normal for the post? If not, I would ask for it. I wish all labs used the same standard. It just makes us cush parents more confused and stressed.

[labblab]

In Maggie’s case, since the ACTH is being used for monitoring purposes rather than diagnostic purposes, the lab’s printed norms may or may not be relevant to her situation. Many times, the printed lab norms only reflect test results when the ACTH is initially being used to diagnose whether or not a dog suffers from Cushing’s (or Addison’s Disease). The printout may not list the desired range after treatment has begun.

In Maggie’s case, we are instead guided by the therapeutic recommendations published by Dechra, the company that manufactures brand name Vetoryl. Here’s a link to a Dechra publication that offers a testing/monitoring/dosing flowchart that is applicable to dogs being treated with Vetoryl (trilostane). This flowchart reflects the post-ACTH testing norms that we all refer to after trilostane treatment has begun:

http://www.dechra.us/Admin/Public/Download.aspx?file=Files%2FFiles%2FSupportMaterial Downloads%2Fus%2FUS-046-TEC.pdf

[Maggiemoo1]

Thank you everyone for your thoughts and suggestions!

The internist said a dose increase is usually not made until the second check but he felt (and dr b agreed) that in this instance her initial dose was just too low. As you pointed out we did that because of the GI issues.

I initially wanted to keep her at this dose but given her blood pressure is still very high I’m concerned about the other damage this terrible disorder is causing. I want to get this under control and I know that I’m going to have to increase at some point so we bit the bullet and did it today. Fingers crossed no GI issues.

We will retest in 30 days. Just to be sure is it 30 days from today or from her last stim?

[labblab]

The internist said a dose increase is usually not made until the second check but he felt (and dr b agreed) that in this instance her initial dose was just too low. As you pointed out we did that because of the GI issues.

I initially wanted to keep her at this dose but given her blood pressure is still very high I’m concerned about the other damage this terrible disorder is causing. I want to get this under control and I know that I’m going to have to increase at some point so we bit the bullet and did it today. Fingers crossed no GI issues.

We will retest in 30 days. Just to be sure is it 30 days from today or from her last stim?
That’s pretty much what I had guessed — that the internist is basing this increase on Maggie’s extenuating circumstances. I can’t argue with that, especially since Dr. B agrees ;-). It’s very good to know, though, that he’s explained his reasoning to you.

As far as the retesting, usually the 30-days are counted from the very first day of dosing. So the first test is done 10-14 days after starting treatment, and the second test is done 30 days after starting treatment. In Maggie’s case and considering the dosage change, I’m not sure exactly what the internist has in mind. But don’t be surprised if he does want to proceed with another test as soon as two weeks from now. If not, I wouldn’t think he’d want to wait beyond 30 days from the last test, but I’d contact him to find out for sure.

Marianne

[Maggiemoo1]

Thanks Marianne!

I’m contacting him Monday to confirm. Today is day 2 of higher dose. So far all is quiet......!

Hoping for the best for my little girl. I can see she doesn’t feel great though. When do you actually see a difference? I would imagine going from having all that cortisol to reduced cortisol probably makes them feel off.

This has to be the most frustrating disorder. Boooooo cushings :mad:

[Squirt's Mom]

How is our Maggie girl doing today?

[Maggiemoo1]

How is our Maggie girl doing today?

Hi!
Thanks for checking in!

She’s doing great! No more GI issues and we are on the twice daily 5 mg. She’s due for her stim next week. Here’s hoping we continue on this course. It’s amazing how much better she’s doing now.

Although it could be wishful thinking I feel like she has a bit more energy and she’s panting less. She just seems more vibrant. I know it’s early though.

I’m wondering when you really start to see a difference clinically. I hope quickly because her blood pressure is very high (vet put her on meds for now) and cholesterol is high too. Any thoughts on this?

[fkhan]

I am glad to hear she appears to be getting better. Wish I had some insight on her blood pressure, but I don't have any experience in that area. I'm not sure if Omega 3's would help, but may.

[Maggiemoo1]

I am glad to hear she appears to be getting better. Wish I had some insight on her blood pressure, but I don't have any experience in that area. I'm not sure if Omega 3's would help, but may.

Thanks. She was on fish oil but the vet said to take her off and just give the vetoryl and blood pressure medication for now. I hope it will go down with the cushings treatment

How’s pookie?

[Harley PoMMom]

Hi!
I’m wondering when you really start to see a difference clinically. I hope quickly because her blood pressure is very high (vet put her on meds for now) and cholesterol is high too. Any thoughts on this?

Clinical symptoms such as increased drinking/urinating, ravenous appetite usually improve within 2 weeks of treatment. Panting is very common with cush dogs and this is due to a few things: the increased fat deposition over the thorax, and also the fat distribution to the abdomen which increases pressure on the diaphragm, both can take a while to improve.

You definitely want to keep an eye on Maggie's blood pressure, getting it checked at least every week is ideal until it normalizes. Unfortunately even with treatment for the Cushing's Maggie may need to continue the blood pressure medication.

Lori

[fkhan]

Thanks. She was on fish oil but the vet said to take her off and just give the vetoryl and blood pressure medication for now. I hope it will go down with the cushings treatment

How’s pookie?

Pookie is doing so much better now. I don't know what miracle occured, or if this is the calm before the storm, but I'm happy she is doing well. I'm going to have another blood check in a week or so to check her kidneys again. Her clinical signs for cushings have been less and less for some reason. I can't make sense of it, but am happy where she is right now. She can go for longer walks, gets up on the couch, and her hair appears to be growing back. She does however have a small lump on her leg or a cyst that I'm going to the vet look at. This is the leg where she had the most IV work done on as well. Ever since I started using an antiseptic shampoo on her, her hair appears to be growing back. I'm not sure if she had a skin condition/infection or if it was from cushings. I was thinking it was from cushings, bec she looked like other cush pups with cushings. Right now, I'm holding off treatment until something changes. She is on a special diet and supplements which may be helping her too. I hope your little one continues to improve!!

Thank you,

[Maggiemoo1]

Hi everyone
We had our second stim. Pre was 5.4 post was 9. Blood pressure went down thank goodness!!! Keeping her on the 5 mg twice a day and will restest in 2 months. Vet didn’t want to raise dose just yet.

There’s another development unfortunately. Large amount of protein in her urine. Anyone have experience with this cushings side effect? Vet put her on semintra which is a newer drug. Ugh. Now she’s on blood pressure meds vetoryl and this. She has NEVER. Taken meds!!!

I’m afraid we will never outrun this freight train

[Harley PoMMom]

Unfortunately, proteinuria (protein in the urine) is commonly found in dogs with Cushing's. I do remember one of our staff members, Judy, giving Telmisartan (which is the active ingredient in Semintra) to her dog Abbie with positive results...here is a link to their thread: https://www.k9cushings.com/forum/showthread.php?6675-Down-the-Cushings-Road-Again-Abbie-15-year-old-beagle-is-now-at-peace Crossing fingers that Semintra helps with Maggie's proteinuria. Was an urine protein to creatinine ratio (UP:UC) test performed to determine how much protein is being lost through the kidneys?

Lori

[Maggiemoo1]

Thanks! Sorry I’ve bren away for a bit.

Yes the test was done and results say u pro/crea 6.8.

She’s on the meds and we will recheck in a month to see if it’s helping. Maggie seems to have more energy but I still think we are not at the right dose yet. Retest is in December. Fingers crossed things get better

[Maggiemoo1]

Hi everyone

I have a question. Maggie is on 5 mg twice a day. In the evening her panting drinking doesn’t seem well controlled as it does with the first dose. Her numbers at her last stim were also still above the ideal range but the vet wanted to keep her on the same dose for a few months.

I suspect we will need an increase but I hate to go up a full 5 for a total of 15. Does anyone use vetoryl and compounded trilostane for doses that are not available (eg 2.5)

Thanks!

[Squirt's Mom]

Would you mind sharing those ACTH results that were "above the ideal range but the vet wanted to keep her on the same dose" with us? Proper protocol says that if signs are not controlled then an increase should be considered. What were the vet's reasons for wanting to keep her on this dose? If my math is right, Maggie weighs about 9lbs (4kg x 2.2 = 8.8lbs). Recent studies are showing that smaller dogs often need higher doses than one would think. Here is a link to that info:


The recent report on effectiveness of lower dose trilostane treatment, given 2 or 3 times daily, for NOH prompted questions regarding dose relative to body weight.Specifically, it was suggested that smaller dogs (<15 kg)might require larger doses of trilostane/kg of body weight and are relatively resistant to trilostane as com-pared with larger dogs (>15 kg), who might require smaller doses/kg and are relatively sensitive to the drug.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1939-1676.2012.00956.x

You can share this info with your vet if you wish. Hopefully they will be open to you letting them in on some more up to date info about Vetoryl (Trilostane).

As for a 2.5mg dose - you would have to get the drug compounded as Trilostane to get that dose. Dechra, the manufacturer of Vetoryl only makes certain doses and the capsules should not be opened and divided. So compounding is the only way to get doses other than what Dechra makes. 15mg is not a high dose for a dog Maggie's size especially if the signs are not controlled. Are the panting and drinking the only signs you are still seeing? Is it possible there is another reason for those such as warm temperatures in the house or outside, pain, an unrelated illness, etc.?

[labblab]

Hello again from me. Leslie has given you some excellent info, and I just have a couple of thoughts to add. First, in looking back, here are the results of Maggie’s recent ACTH that you posted on 10-6:


We had our second stim. Pre was 5.4 post was 9.

That was her second monitoring ACTH, and was performed about one week after increasing her dose from 5 mg. once daily to 5 mg. twice daily. Prior to that, her first monitoring ACTH was performed about 2-3 weeks after starting treatment, and these were the results:


Pre 2.4 ug dL
Post 15 ug dl

So if I’m remembering things correctly, Maggie has now been taking Vetoryl for about two months. She started out on 10 mg. total, but experienced diarrhea. Cut back to 5 mg., and performed the first test which was higher than desired. Increased her dose and performed the second test around one week later (which was around three weeks ago). Does that all sound about right?

If so, and given the continuation of her symptoms, I’m guessing you’re right that a dosing increase will be appropriate. However, one more ACTH may be warranted at this point in order to best judge the size of the increase. As Leslie says, adding another 5 mg. may actually be the better route to go, both in terms of cortisol control and also consistency of the product she’s receiving. You can certainly obtain a compounded form of trilostane, if necessary. But Maggie may actually benefit from another full 5 mg. in order to achieve better symptom control.

If she were mine, I believe I’d wait another week or so, and then schedule one more ACTH. That would give her a full month since her last test, and around five weeks on the 10 mg. dose. That should allow you to accurately judge the full effect of the current dose, and the size and appropriateness of an increase.

Are you still in touch with Dr. Bruyette, or another internist? If so, you can always ask their opinion about all this. But if Maggie were mine, that’s probably the route I would go.

Marianne

[Maggiemoo1]

thanks for the replies!

We are rechecking STIM first week in December. The internist wanted her on the 10 mg dose for longer before rechecking and Dr B agreed.

She’s now having kidney issues. Protein in urine. Was put on semintra and rechecked this week because she was drinking uncontrollably. The semintra worked too well. Protein in urine improved to normal range but bun creat went up. Internist took her off semintra for a week to see if excessive drinking resolves. One day off and it has! She will restart semintra in one week at half the dose. He believes we just need to find the right balance.

On a positive side, Her bloodwork is looking better already (except the kidney issue). Liver enzymes down, cholesterol down. We just need to figure out the kidneys which is obviously a HUGE item. she’s still on blood pressure meds but her BP is down from a whopping 210 to about 140. How this little trooper keeps going is just a miracle. She’s my little fighter! Keep fighting Maggie!!!

[labblab]

Thanks so much for your update! I surely understand why the kidney issues are worrisome, but overall, I agree with you that Maggie is a super-brave little miracle girl. Semintra is not a drug test I have experience with, but I’ll be hoping that things will improve once you establish the optimal dose. In the meantime, please give Maggie a big pat from her family here! And please continue to let us know how things proceed.

Best wishes to you both,
Marianne

[anotherk9lover]

I have to say you're so lucky that your maltese was only diagnosed at 15 years of age! That's a long life! My maltese is 8 and she was diagnosed this summer with diabetes and cushings. She won't have as long of a life unfortunately with all of these issues :(( My vet started her on only 5mg Vetoryl once a day, and she's 12lb. The first lab draw a couple weeks after starting was within normal limits, we will be redrawing acth this week to see where she's at.

[Maggiemoo1]

I have to say you're so lucky that your maltese was only diagnosed at 15 years of age! That's a long life! My maltese is 8 and she was diagnosed this summer with diabetes and cushings. She won't have as long of a life unfortunately with all of these issues :(( My vet started her on only 5mg Vetoryl once a day, and she's 12lb. The first lab draw a couple weeks after starting was within normal limits, we will be redrawing acth this week to see where she's at.

Well I think Maggie had cushings at 12 or 13 but it wasn’t diagnosed because our vet didn’t believe she had it.

Much has happened over the last month. We almost lost Maggie to kidney failure. The telmisartian which was given for the protein in her urine was causing a massive increase in her BUN and creatinine Right before thanksgiving she was so sick we almost put her to sleep. Dr took her off all meds (including vetoryl) and one week later her kidneys were recovering!!!

We were so blessed to have Maggie for another Christmas! She’s back on vetoryl (5mg in am 10 in pm) and I suspect she will go up to 10 in am. Dr increased pm dose because she was having accidents over night.

We are still struggling watching her age but that’s one thing we can’t control. She’s slowing down, sleeping more and not as spunky but there are moments when we get a glimpse of her younger self and it’s so rewarding!

Please don’t lose hope for your little 8 yr old Maltese. Find an amazing internal medicine specialist and be her advocate. She can live a long life even with cushings and diabetes. You just need to properly get them under control.

We are still trying to figure out the right doses of vetoryl!

Best of luck to you and your little girl. How I wish Maggie could be 8 again!

[Squirt's Mom]

Good to hear from you again but I am so sorry to hear both that Maggie got so sick. I am very glad she pulled thru.

Now I'm gonna be real blunt - I also VERY sorry that the Vetoryl continues to be given to her. Dechra is very clear - Vetoryl should not be used in dogs with kidney disease. I think I am only repeating what has already been said but since her vet continues to mistreat her by giving her a drug that will cause the kidney disease to progress faster I feel the need to repeat this message again. I would not give Maggie another dose of Vetoryl ever, for any reason, in any dose. Protecting her kidneys would be my main focus and I would tell this vet who is insistent on causing further damage to them to go jump in a lake. Her vet is hastening her death by continuing to tell you to give this drug to her. I hate to be so blunt but if I didn't care I would keep silent and let Maggie suffer. But I DO care and I want her to be with you for as long as possible...which will not happen if she continues to take Vetoryl. Please, I'm begging you, stop the Vetoryl and concentrate on keeping her kidneys as healthy as possible.

Hugs,
Leslie

[Maggiemoo1]

Good to hear from you again but I am so sorry to hear both that Maggie got so sick. I am very glad she pulled thru.

Now I'm gonna be real blunt - I also VERY sorry that the Vetoryl continues to be given to her. Dechra is very clear - Vetoryl should not be used in dogs with kidney disease. I think I am only repeating what has already been said but since her vet continues to mistreat her by giving her a drug that will cause the kidney disease to progress faster I feel the need to repeat this message again. I would not give Maggie another dose of Vetoryl ever, for any reason, in any dose. Protecting her kidneys would be my main focus and I would tell this vet who is insistent on causing further damage to them to go jump in a lake. Her vet is hastening her death by continuing to tell you to give this drug to her. I hate to be so blunt but if I didn't care I would keep silent and let Maggie suffer. But I DO care and I want her to be with you for as long as possible...which will not happen if she continues to take Vetoryl. Please, I'm begging you, stop the Vetoryl and concentrate on keeping her kidneys as healthy as possible.

Hugs,
Leslie

Thanks Leslie. I truly appreciate your concern. We have discussed this issue with the vet because like you I was wondering why he would give vetoryl to her if she has kidney issues. My understanding from our discussions is that the cushings can cause protein in urine which in Maggie’s case it was. She didn’t otherwise have an independent kidney problem or failure. To try to control the Proteinuria she was put on telmisartian which worked like a charm but caused the increase in bun and creatinine. Once we stopped the telmisartian her kidney problems went away.

If I thought for a second that the vet was wrong I would stop and find someone else but I trust him, he’s a very reputable IM specialist and I’ve also consulted with Dr B who tells me we are in excellent hands. Our hospital is a leading vet teaching hospital in NYC. THAT BEING SAID I am forever grateful for your concern and directness You are such an asset to all of us Cush parents!