Suni

[sunimist]

Hello everyone! I just had a feeling a few years ago that I would be back someday looking for information and support from this special group, and sure enough, here I am!

Suni's story is a long one, so I will just cut to the chase and fill in details later. She is 12 years old and the beat of my heart. She is unofficially diagnosed with cushings. I say unofficially, I mean I have been in denial and not pursued a diagnosis because I was certain I couldn't subject her to the treatment, however, my vet said she is almost certain she has it. She has a collapsing trachea and difficulty breathing sometime; she has a bad cataract in one eye that is going to cause her the loss of that eye; she has cherry eye in the other one that has been corrected, but wasn't successful, so we keep drops in it to keep down infection; she has the onset of arthritis; persistent gallbladder sludge; is overweight and is very cautious about her surroundings, naturally. That's pretty much an outline of my sweet girl, but she is still happy and all functions are great! Labs have been good except a high steadily increasing Alph. I am totally freaked out about her and am trying to, in the end, do what is best for her, not me. Would love to hear your opinions, advice and comments and most certainly, your support. I am looking forward to getting re-acquainted and meeting everyone. Thanks to all and thank you Marianne for being so gracious in helping me find my way back!

[labblab]

Shelba, YAY, you made it back again today! I don’t know what’s been going wacky with your log-in, but I’m very grateful that you’re here again now.

I’ll come back later on to add my thoughts about sweet Suni’s situation, but first I wanted to quickly re-introduce you to our membership. Folks, Shelba is one of the founders of the original message board that, over the years, ended up being reborn into K9C here. Without Shelba and our other founders, there would be no K9C today. It was her sweet girl, Misty, who bravely battled Cushing’s and who helped blaze the trail for all our Cushpups to follow. I’m so sorry to hear that Suni is having so many problems right now, but I know we’ll all do our best to repay the support that we were given by our original founders, and that has been continued by our K9C family throughout the years.

Thank you, Shelba, and now let’s put our heads together and see what we can figure out in order to help Miss Suni!

Bye for now, but I shall return ;-).
Marianne

[labblab]

OK, here I am back again :-). Once again, I’m so sorry that little Suni is struggling at all right now, but let’s go ahead and leap right into the Cushing’s question. After my years on the forum, I’ve really come to believe that a treatment decision for older dogs probably depends more on immediate quality of life as opposed to minimizing risks of slow systemic damage developing over time. In other words, is Cushing’s causing enough discomfort in an older dog to warrant beginning a medication regimen that requires close vet monitoring, frequent vet visits, and the possibility of medication side effects (not to minimize significant expense)?

So let’s take a look at Suni’s situation. You really haven’t mentioned her being bothered by any of the classic observable uncomfortable Cushing’s symptoms such as excessive thirst and urination, ravenous appetite, panting, skin problems and hair loss, seeking out cool places, inability to jump up or climb steps, general lethargy, etc. Overall, you describe her as being a happy girl who is functioning pretty well. So in terms of observable comfort, it doesn’t sound as though you’d be gaining much in terms of treatment, even if Suni does actually have Cushing’s.

Digging a bit deeper, though, we know that Cushing’s does leave dogs more vulnerable to infections, generally (her Cherry eye?), to the development of gallbladder mucoceles, and to tracheal collapse due to weakening of cartilage. So in Suni’s case, if she does have Cushing’s, I’m thinking that a decision to treat would depend less upon observable symptoms and more upon whether or not these internal problems could be reversed or improved — and how important that would or would not be given her age. One “negative” to treatment might be the worsening of her arthritis once a high level of circulating cortisol is lowered.

Is your vet encouraging you to test Suni for Cushing’s and to pursue treatment? Having lived through treatment with Misty, what are your own thoughts or reservations? Although I don’t remember for certain, I’m guessing you were using Lysodren since Vetoryl was largely experimental back then. As you’ll see here, Vetoryl (Trilostane) is now being prescribed pretty much exclusively. But Lysodren would still remain an option, as well.

Since Suni *doesn’t* seem to be exhibiting any of the classic observable Cushing’s symptoms, I’m not sure how likely it is that she actually does have the disease. Of course, one option is to go ahead and test, just to gain the information. But if you wouldn’t choose to treat, regardless, then testing does become much less important. So do let us know what you’re thinking right now, OK? And do feel free to ask us any current testing or treatment questions that come to your mind.

Marianne

[sunimist]

Thanks Marianne!

I will try and fill in all the blanks. Suni does have cushings symptoms....drinking more water, big appetite, weight gain, high alp, heat sensitive. To be thorough, she has always, since a puppy, peed a lot and often so didn't think much of that, has always had a good appetite, but the heat sensitive came after she accidently slipped out the door unknowingly while my husband was talking to someone. It was one of the hottest days we had and she was left out a couple hours before we missed her.
When I started looking for her I realized she might be outside because she didn't come when called. I flung the door open and she was just standing there panting hard and looking like she was about to pass out. I rushed her in and started washing her down with cool water and put her in front of a fan. Kept this up for several minutes until she started breathing better. She slowly came around but has never been the same since. I spoke with the vet about it and she said she had heat exhaustion and if quick action hadn't been taken, she might have died. Scared the bejeebers out of us! it took a toll on her little body. She still gets hot and stressed real easy and pants hard when she gets stressed.

This alone is hard on her collapsing trachea. Long story I know, but a major reason why I am reluctant to treat if she tests to have cushings. She has had regular ultrasounds because of her trachea and gall bladder and the adrenal glands have always looked normal, so another reason I haven't pursued testing. She is having more trouble jumping, but I believe it is due to arthritis. She has injured her legs over the years by jumping and has had to have medicine and bedrest several times.
My vet has suggested cushings in the past, but I would shy away from pursuing it.

The last visit 2 months ago, which was a check on her little eye to check pressure and how close enucleation was. Another reason. I am wondering if the eye drops she uses (different drops for each eye) could have an effect on her symptoms. Both have steroids in them. She has been using the one for cherry eye a long time, but the other one only a couple months. Need to ask about this. Should have already addressed that with the vet!.

Let me interject right here so you won't think I am a really horrible mom, that the past 2 years have taken its toll on this old gal! Fell and broke a hip, doing well with therapy and developed blood clots in my lungs. Had to spend an additional 10 days in the hospital under pulmonologist care, then in January of this year, both my husband and I had Covid and it hit me pretty hard. After the appropriate waiting period, the dang first shot made me sick as a mule! I am still trying to recoup from all of the mess, so I hope you will cut me some slack when trying to read and understand my messy and unprofessional post! UGH!! I will be more than happy to answer anymore questions if there are any and will try to make sense of it. I'll do better, maybe....I think you probably understand though. Thanks!

[Squirt's Mom]

Heavens! We all understand how life can get in the way at times so need to worry about being judged! :)

At first I was going to disagree with Marianne about testing in spite of no signs but your second post has listed enough cush signs that testing would be warranted. As you know Cushing's is a sign-driven disease meaning the signs are important both for diagnosing and during treatment. HOWEVER, with the steroids on board that changes everything. Since she has been on one of them for a long time and just added a second drop with steroids that is more than likely where the cush signs are coming from.....the drops are causing Iatrogenic Cushing's caused by exposure to steroids. ;) The first line of treatment for this form is to slowly wean the pup off of the steroids IF possible. Should you decide to test Suni you will want to use the ACTH VS the LDDS because Iatrogenic Cushing's can cause the adrenals to atrophy and not respond as expected on a suppression test. Here is a link from DMV360 that talks a bit about this form of Cushing's and testing for it:

https://www.dvm360.com/view/hyperadrenocorticism-proceedings

I would discuss whether another form of treatment for her eyes is available that is non-steroidal. That may not be an option but would be the first step in my book. I have asked about studies on treating Iatrogenic while keeping the dog on the steroids so hopefully someone will supply some more info for you soon.

Hugs,
Leslie

[sunimist]

Thanks Leslie. It just came to mind that maybe the eyedrops could come into play. The older I get, the slower my mind works, if at all!! So I will speak with the vet and we will get the drops changed and see if that makes a diffrence. I checked and she has been using the eyedrops for cherry since 2018. They have dexamethasone in them. I can get the same thing with antibiotic Bacitracin that I think would be ok. I will definitely check with the vet.

Just noodlin', but wonder if they would cause some of her other issues like with the high alp.

[labblab]

Bingo! At least some of Suni’s problems could indeed be the result of the longterm dexamethasone, I think including elevated ALP:

https://vcahospitals.com/know-your-pet/dexamethasone

https://www.sciencedirect.com/science/article/abs/pii/S0034528801905417

I totally agree with Leslie that my first step now would be to try weaning Suni off the steroidal drops.

(And omigish there’s nothing messy or unprofessional about your posts! I’m just so sorry you’ve been through such a wringer with health issues! But you’re doing a great job of describing what’s going on with Suni.)

[Squirt's Mom]

Here's a link Glynda shared with me:

https://pubmed.ncbi.nlm.nih.gov/6497127/

So it seems that most if not all of what you are seeing both in terms of signs and lab work could be attributed to the eye drops.

[sunimist]

OMG! Why didn't I think of this before!!? It is not being used now every day, but every 2-3 days. Would it still warrant a gradual withdrawal?

[Squirt's Mom]

Yes since she has been on the steroid drops for long term. The adrenal glands can atrophy on steroid use and you want to give them time to regenerate so a s.l.o.w. wean is best. I would want to include her vet in this process too.

[sunimist]

Just talked to the vet and she said by all means wean her off the eye drops. She said since I had only been using them every other day or so to use them every three days for a week and then twice a week. She said there's a chance that it was playing a big part in her elevated alp and contributed to some of the cushings symptoms. She said the neo/poly/bacitracin would be a good fit for both eyes, so bam!!

Y'all are the best!!! 2 or 3 heads are always better than one old wore out one!! Thank y'all so much for being there to help. Love you both!

[lulusmom]

Shelba, I am so sorry to hear that you have had so many health issues. Holy cow, you really have been through the wringer with very serious conditions so I'm happy you are still with us. To answer your question about the ALP liver enzyme, I believe long term use of dexamethasone, even if eye drops, can cause an increase in ALP. Dexamethasone is 30 times stronger than our body's natural cortisol so you can expect to see the same lab abnormalities and symptoms as you would see in a dog with naturally occurring cushing's. Poodles are a breed you see in the textbooks as being over represented in cushing's but I really don't see that many Poodles in the facebook groups. I agree with Leslie and Marianne that you try to get Suni off of the steroidal eye drops. If that's the problem, you should see symptoms resolve on their own. If they persist, then you may be hanging around here for a while. :) Did your general practice vet prescribe the eye drops or did you see an opthalmologist? I think it's strange that your vet has prescribed long term use of a steroidal eye drop for cherry eye. I've had dogs with cherry eye and it was not pretty but it wasn't life threatening nor did it require short or long term treatment with steroids. I don't trust any gp vet when it comes to my dogs' eyes so if Suni has not seen an opthalmologist, you may want to consider asking your vet for a referral. I've taken a few rescue dogs to an opthalmologist after gp vets misdiagnosed the problem and prescribed eye drops with steroids which exacerbated the problem. Since your vet was sure Suni has naturally occurring cushing's, he doesn't seem to be familiar with iatrogenic cushing's caused by long term exogenous steroid use. He may therefore not know how to properly wean Suni off of the eye drops. He may need some help from an internal medicine specialist. By the way, dexamethasone is not good for Suni's collapsing trachea and it is also the likely culprit for the heat intolerance, panting, inability to jump on on things and the the usual increase in thirst, urination and appetite. How is her skin and coat?

[sunimist]

Hey Glynda!

Suni's coat and skin is ok so far.

Our vet offered to send her to an ophthalmologist but at the time it was out of the question. It still could happen. The eyedrops were originally prescribed "as needed' but she had difficulty with the eye and it bothered her, so I am the one that gave her the eyedrops more than prescribed. For the past year she has had them every 2-3 days, depending on how the eye looked.

[lulusmom]

You know Suni best and if you think she has a chronic issue with her eyes, I would strongly recommend you have her seen by an opthalmologist. They ain't cheap but they can sure get to the bottom of a problem and solve it with appropriate treatment(s). The dex eye drops are definitely the first suspect that has to be ruled out so if after weaning her off and symptoms don't go away, then it's highly possible she has naturally occurring cushing's. She's a senior Poodle so that would not be a surprise.

[sunimist]

You are very right and I agree 100 percent, and I will. Meanwhile, I hope to get this steroid issue resolved. Have already got the meds without steroids so I can start the weaning immediately. Thanks for your help my friend!

[lulusmom]

We all love you, Shelba, and everybody has done a great job of identifying the problem. Please keep us posted and I'll be keeping hoping and praying that all of the symptoms go away after weaning off of the dex eye drops. (((HUGE HUGS)))

[sunimist]

Well, I certainly love all of y'all too!! That's the way families roll, right? I want to introduce you all to our sweet Mandi a little later on. Suni's little sister.

[sunimist]

Is Lysodren the preferred treatment? I am hoping something far less harsh has been developed. I see a vast majority are using vetoryl. Where is Anipryl ranked now? And also, is the stim test still relied on for testing and maintaining? I would do the ultrasound first, but need a little guidance otherwise since i have forgot most of what I knew about this mean old disease! Thanks.

[Squirt's Mom]

Most vets are using Vetoryl these days (compound name Trilostane). It has the same risk factors as Lysodren but has a much shorter life in the body than Lyso so if, IF, there is a problem with the cortisol dropping too low it is leaving the system more quickly. This means simply stopped the drug for a week or so will usually take care of the issue, rarely needing Prednisone to support the adrenal glands. The flip side is that Vetoryl is given daily (no loading phase as with Lyso), it is not as stable as Lysodren so the cortisol can suddenly drop or rise even if the dog has been on the same dose for a while, and it can take a while to get the correct dose....all of this means there is a great deal more testing with Vetoryl than with Lysodren because with every dose change the testing schedule starts all over at the 2 week mark. ACTH testing schedule for Vetoryl is 10-14 days after starting, another at 30 days after starting, then every 3 months as long as the cortisol is controlled. If the dose has to be adjusted, and most dogs have several adjustments, this schedule starts all over. So while each Vetoryl pill is less expensive than the Lsyodren pills the testing makes it more expensive to use in most cases. I am the oddball and much prefer Lysodren to Vetoryl for these reasons and others but most feel the opposite because of the short life in the body in cases of overdose. Anipryl is not in favor for most dogs because it is rarely effective and even when it is, it doesn't work very long. For Anipryl to be effective the dog must have the pituitary form and the tumor must be on the pars intermedia portion of that gland. Most pups do have PDH but only about 20% of them have the tumor on that portion of the pituitary gland.

For dogs with the adrenal based form Vetoryl is the preferred treatment because ADH requires higher and higher doses over time and Lysodren is very hard on the stomach making increasing doses tough for the pup. Vetoryl is also preferred for diabetic pups if memory serves.

If Suni does have naturally occurring Cushing's VS Iatrogenic we can help you with the starting dose for either drug so don't let the vet convince you that you have to use what they prescribe. Sadly many vets still don't understand these drugs and often overdose from the beginning, especially with Vetoryl. Also, Dechra refuses to update their literature so vets are operating on outdated info for starting and increasing Vetoryl doses. So come talk to us before accepting treatment. ;)

As for testing, the LDDS is notorious for false positives if any other health issue is present but is still considered the gold standard for diagnosing Cushing's. The ACTH is the test that should be used in diabetic dogs for this reason. If it is feasibly possible it is always best to have both tests done along with the ultrasound. Establishing a base with the ACTH before starting allows us to see how far the cortisol has dropped at that first ACTH monitoring test.

One thing to keep in mind....for a pup who has been on long term steroid use the adrenal glands can become inactive, even atrophied, because they haven't been having to do their job...the steroid has been doing it for them. So for this reason you want to give the pup long enough off the steroids for the adrenal to fully recoup. When you are seeing strong cush signs you know they are functioning again. Some adrenals never recover if the steroid use has been high enough and used long enough, putting the pup in an Addison's state, but this is not typical. For Suni, I wouldn't rush into any testing right now but rather give her time to get all the effects of the steroids out of her system. I would wait for those cush signs to show up the test. If you don't remember those signs I can give you a list to watch for.

Remember to get copies of all the test results so you can play 20 Questions with us. :D

I hope she is doing well and you too....you've all been through enough for a while!

Hugs,
Leslie

[sunimist]

Thank you Leslie! So much information I had forgotten and you gave me some valuable reminders! One more question...Suni has the cushings symptoms now, so how long will it be before they start resolving if she does in fact have Iatrogenic cushings? When will I be able to tell? And if they do start to resolve, that means she doesn't have the regular form of cushings? See how dumb I have become not keeping up with this important part of my past. Regrets! Yes, I have always, and still do, get copies of all lab work ever since Misty started this hateful journey! Thanks for the reminder though.

[Squirt's Mom]

As she comes off of the steroids those signs should start to go away IF this is only Iatrogenic. Right now the steroids are causing the signs, not because the adrenals are over-producing cortisol. So hopefully you will see those signs disappear the longer she is off of the steroids. I would give her at least a month before testing UNLESS the signs start to get stronger instead of lessening. And yes, if those signs go away and don't come back then she was dealing with Iatrogenic only and not naturally occurring Cushing's....which is what we all are hoping for!

You're not dumb....just rusty. :D All of this will come back and you'll be an old pro again in no time!

[labblab]

Hey Shelba, just stopping by to see how things are going for you and Miss Suni — hopefully well!! Also, I love seeing your photos of Suni and Mandi. What a pair of sweeties :):)! Thanks for sharing ;).

Marianne

[sunimist]

Sadly, so far, I can't tell much difference. Seems she is drinking a little less, but appetite is still humungous! Still hasn't lost any weight. How long does it take for definite noticeable changes provided we are on the right track? No change in the eye.

Thanks for asking. Hope you have a wonderful and safe holiday.

[labblab]

Hi Shelba. I would hope that you’d start seeing some improvements sooner rather than later, but as Leslie suggested, I think I’d wait for at least a month before I started trying to draw any big conclusions. So I’ll continue to keep my fingers crossed for both you girls.

Best wishes as always, Marianne

[sunimist]

I agree, and thank y'all for giving me a guiding hand. I was hoping for an immediate change, but I should have known better. Patience is not my virtue.
I have been trying to re-educate myself on cushings, but my mind keeps having out of body experiences!!! Love ya!

[mytil]

Hey Shelba and sweetie pie Suni!
I too would look hard at the eye drops --- and the long term use of this steroid based product.
Without any test numbers for Cushings and you mentioned her organs look fine I would talk to my vet about this.
Hang in there girl!
Terry

[sunimist]

Hey Terry! Thanks!!

[sunimist]

Will try and put her February 2021 lab values in prospective....

Glu 147 (70-143)
ALKP 2000 We have had a high reading starting in 2014 here for a few years with several ultrasounds and nothing to contribute it to except trouble with her gallbladder. Takes Ursodiol for GB.
Baso 0.14 (0.00-0.10)
PCT 54 (0.14-0.46)
LYM 0.87 ((1.05-5.10)
She was prescribed POLY/NEO/Dex drops for her cherry eye when the surgery failed.
Everything else was in the normal range.

Thought this might help.

[labblab]

Hi again, Shelba. Thanks for posting those values. I’m afraid I don’t know enough about blood counts to judge whether the variations in basophils and lymphocytes are enough to be of any significance, and I’m totally unfamiliar with PCT (although it sounds as though it can be some sort of infection marker). Dogs with Cushing’s do often exhibit irregularities in certain white blood counts that are collectively labeled as a “stress leukogram.” This involves high counts of neutrophils and low counts of lymphocytes and eosinophils. Cushpups also often have elevations in platelet and cholesterol counts. It does look as though Suni’s lymphocytes were a bit low in February. But I don’t know that they’re significantly low, and she didn’t have any of those other common blood count abnormalities.

So we’re left with her elevated ALKP, which definitely is typically found with Cushing’s. However, other conditions can elevate ALKP, apparently including gallbladder issues. So I don’t think her February labwork was screaming out Cushing’s in terms of a diagnosis. But it is still very helpful for us to know how things stood at that time, and as a basis for future comparison.

Marianne

[sunimist]

It's complicated, but I do see a bit of improvement. She has lost a few ounces, her peeing has slowed down, water intake near normal. Those are huge to me! I may be getting ahead of myself, but I feel a little optimistic now. Her appetite is still over the top though. Wish my Mandi had an appetite like hers. Don't know how I am going to get my little picky girl to eat. Any hints?

Marianne, I hit edit on your post by accident. Sorry.

[labblab]

Shelba, no problem at all about the “edit” ;-). And I’m glad to hear that you’re seeing even a little bit of improvement with Suni — let’s hope it continues!!

As far as little Mandi, here’s a link to a thread here where a few feeding suggestions have been given when dogs are reluctant to eat:

https://www.k9cushings.com/forum/showthread.php?8565-Inappetence-in-dogs

Has Mandi always been a picky eater, or is this a new development? I’m afraid I don’t personally have any great suggestions, because my three Labs generally had hearty appetites. Ever since Christmas, though, Luna has had episodes of inappetence, probably associated with some sort of chronic GI upset. Right now she’s doing good, though, thank goodness. At the moment, I’m warming up some ground turkey crumbles in a little water to add to her kibble. It kind of turns it into a warm bowl of stew, and she really seems to like that. On that thread I gave you, a couple other people also mention that warming the food seems to help perk up appetites. Anyway, do take a look at that thread and see if any other suggestions make sense to you. And good luck!!

[sunimist]

I sure will Marianne, and thank you. She has been a picky eater since I got her at 8 weeks old. She will be a year old this coming Friday and I have tried several good dog foods, both kibble and wet. Some she will eat a time or two and that's it. Others she just turns her nose up at. The only kibble she tolerates at all is Suni's weight management Fromms. Geez!! A puppy doesn't need that! I add boiled chicken to it just to make me feel better!! Very frustrating. Never had a picky eater before so it's a learning experience for me.

[Jonathan]

First thing first... you guys are AWESOME!
- I know there are many lurkers/readers who feel the same, and yet havent spoke up, like myself.
(shame on me, for not letting you know I appreciated you, in the midst of my frantic searching for answers!!)

[Jonathan]

I agree, and thank y'all for giving me a guiding hand. I was hoping for an immediate change, but I should have known better. Patience is not my virtue.
I have been trying to re-educate myself on cushings, but my mind keeps having out of body experiences!!! Love ya!

Thats the trick, focusing on the day to day, but look back at the week (for example) as a gage.
Meaning, you know the daily routine, and it might just take a little while to see changes in the patters.

(hope that made sense)

[Harley PoMMom]

Hi Shelba!

Just wanted to let you know that I have been following your thread about sweet Suni and with the excellent advice you've been getting I don't have anything to add.

My Jax isn't what I say a picky eater, he does eat his food eventually, I've tried several different brands but nothing really arks his appetite except for the cat's food grrrr!!!

Hugs, Lori

[sunimist]

Hi Lori! Great to hear from you!! Glad to see there is hope for my sweet picky eater! The struggle is real.

[mytil]

Hey again,
Glad to see there is some improvement!!! It will take a bit of time and the improvement will be gradual.
Since you mentioned Mandi has always been a picky eater, well I have one too and have 3 types of dry food along with 2 wet and give her a few kibbles in the dish at a time and a scoop of wet to see which one she wants. I do very little at a time (in the past I have to waste so much food until I started doing this). I do find some chicken broth can help. There have been times I just leave the kibble in the dish (plain) and after a long while she will eat it. Cailey Bear has always been uninterested in food since we found her so no health issues; just not a big eater.
Keep us posted!
T.

[sunimist]

Hi Terry! Happy Thursday! I ended up having to take Mandi to the vet today. She stopped eating completely and just wasn't up to par this morning. I tried everything to get her interested in just a bite or two of something...anything, and she wasn't having it. My gut told me something was wrong, so I kinda begged the vet to take her today knowing they were completely booked, and they felt sorry for me, I guess. Anyhow, did x-rays of her abdomen and blood work. Nothing outstanding revealed, but her temp spiked at 104 while we were there. The Doc gave her a steroid shot with antibiotics and nausea meds to give a few days. She said it was some kind of infection but wasn't
showing up. What??? She is home, ate some chicken and rice with gusto, babying her sore hip from shot and getting lots of TLC right now from her daddy.

Terry, sounds like a good idea you have feeding your picky eater. I will have to give your scenario a try.

A noodling thought....A question for you guys unrelated to cushings, can allergies cause those symptoms described above?

Meanwhile, back at girls camp, my little cushings acting girl is doing great and seems to be feeling better. That makes me smile. We gonna make it somehow!!! She is due a dental in another month, so we need to hurry!

[Squirt's Mom]

As far as I know allergies wouldn't cause what you were seeing in Suni....but I could be wrong. LOL

How is Suni feeling today?

[sunimist]

So far, both girls are good right now. We just take it one day at a time. Still hoping Suni's cushings symptoms subside. She does seem to be doing better.

[sunimist]

Just a quick update on my girls. Suni is a challenge!! Her peeing and drinking is normal, she gets around with a skip in her gait, acting like the boss she is. But...she is still eating everything in sight, even stealing Mandi's food when she can. Being badly overweight, her trachea collapse and her eye are my concerns now. Am making an appointment this month for a dental and complete ultrasound from head to toe, and see where we stand with the eye. That is providing she can be intubated with her trachea. Do you know of anything to help her with her coughing due to the trachea? We give her cough pills and have given, twice, pills for collapsing trachea. Don't know what they were. Failed to ask and I no longer have the empty bottle. May have something else the doctor can try. UGH!! Bless her. I feel so sorry for her having such deep raspy cough and breathing difficulty when she has an episode. I stick her in front of a fan, which is what I was told to do, by the vet.

Mandi is still testing me on her eating. I am just about to throw in the towel and see if she wants some Ol Roy or some other yucky food! Being the brat she is, she would probably eat that!! Have put her on some good probiotic chews for her tummy. Her eye stays red from pawing at it. They tell me it is allergies so we are doing an allergy chew also. I also give her some Benadryl too! Other than that, she is the sweetest most loving little thing I have ever seen. She is my baby girl! I am exhausted and frustrated with their problems, but by the Grace of God, we will find some answers to make it all better.

Hope everyone is healthy, happy and doing well and having a wonderful, blessed and safe 4th of July!

[labblab]

Shelba, thanks so much for your update, but I’m sorry to hear that things are still pretty stressful for you. I sure wish I knew something that would help with Suni’s cough, but that’s one challenge that I haven’t had to face myself. Hopefully you’ll learn more when you take her in for her work up. I’ll be keeping my fingers crossed that you only find out answers instead of any new problems.

And yep, I can easily imagine your exhaustion with Madi’s appetite issues! We’ve just been through another GI upset with Luna — they really come and go with no rhyme or reason. But at least she’s doing better again, and I hope Madi will soon settle down, too.

Thanks so much for your holiday well wishes. It was a quiet weekend around our house except for the evening neighborhood fireworks. But thankfully Luna never pays any attention at all. She must be descended from a line of gun dogs because those loud booms have never bothered her or even awakened her from snoozing on the couch ;-).

Hang in there, girl, and do let us know what you find out after Suni’s appointment.
Marianne

[sunimist]

Thanks Marianne. I am searching for simple but healthy, with necessary vitamin and nutrient efficient ingredients, in home cooked meal recipes for Mandi. The girl has got my goat!! She loves her supplements but balks at the food. Brat!!

What do you feed Luna, and what supplements do you give her, if you don't mind?

Anyone have any home cooked recipes for a one year old problem child you might share?

[labblab]

Aside from preparing bland chicken and white rice during GI upsets, I have never home cooked for my dogs. So unfortunately I have no tips in that regard — hopefully some other folks will have ideas to share. Labs are notorious for being chowhounds, so for the most part, I’ve been spared issues of inappetance. It’s only now in her old-age that Luna has been having these GI issues, and I think it’s on days that her stomach is upset that she just doesn’t want to eat anything.

I’ve always fed my dogs kibble because it’s so easy to store and serve, and they’ve always been happy with it. Up until the last few years with Luna, I had rotated among high-end grainfree products. But then I got nervous reading about the possible association between grainfree food and dilated cardiomyopathy in dogs. In honesty, I didn’t see why peas and lentils and potatoes are any more a part of a natural diet for a dog than grains, anyway, so I switched to grain-containing. And, for what it’s worth, she was starting to have the GI problems while still on the grainfree, so I don’t think grain is the source of her current issues. She’s now eating Purina Pro Plan Senior Bright Mind Chicken and Rice. It shares a lot of the same ingredients as the prescription I/D food she’s been on during her GI upsets, and she seems to really like it in between episodes. To make it even more enticing, I cook ground turkey and add some crumbles with a bit of warmed water to make her meal more like a stew.

Her only medication now is Previcox for her arthritis, and Denamarin (milk thistle and SAM-e) to support her liver from possible irritation from the Previcox. I had also been giving her CBD oil for her arthritis and some Omega oil capsules for general health. But since the GI upsets started, I’ve discontinued all the oils in order to limit any possible triggers. I also have some Rx probiotics to give her during her upsets. But that’s it. For now, we’re trying to limit the things that she’s taking by mouth, and her food is allegedly nutritionally complete.

I surely do hope you can find something that makes mealtimes with Madi a lot easier. As I say, food has largely been an isolated issue for me. It was only when Barkis was so sick with his Cushing’s and now these intermittent episodes with Luna that it’s been a problem for me. But it has been *so* stressful during these few times that my heart goes out to you and anybody else who is struggling on a regular basis. As I say, hopefully some other folks will soon be by with tips to share.

Marianne

[sunimist]

Interesting you should share the grain and grain-free kibble. FWIW, I too have recently been pondering the difference it might make. Suni has been on grain-free all her life, so I may have ignorantly contributed to some of her issues. I am going to introduce some grain kibble along with her grain-free and see if she does better. I have her on a weight control kibble, but honestly, I doubt there is very little difference in it and others.

As for Mandi, I tried her on Purina Pro Plan Focus Puppy and she liked it a while... I can't count right off how many quality brands we have tried with that girl, but one or two meals and she is finished with it. She prefers Suni's weight control food over all others! Even tried some of that they fix tailored to a dogs profile!! Go figure! I am not giving up on her just yet!! That's why I am trying to get a home cooked recipe lined up for her needs, just in case all else fails! I am exhausted!!!

I am very curious about CBD oil for cushings treatment. I would love some pros and cons about it please, and especially from experienced users.

[sunimist]

I took Suni for her followup/workup today and I am pretty frustrated and in a dilemma as to what to do! Help!! First, she is having an eye enucleation the 9th of September on the right eye and the other eye that has cherry eye has now developed a cataract. The pressure was not high in the bad eye. Surprised me because i figured it would be really high.

Her ultrasound showed she has an impressively enlarged liver, but no fluid around heart or lungs. X-rays showed a very serious narrowing in the lower trachea. Coughing is getting worse.

Ultrasound showed adrenals normal size (?) with one only a tiny bit larger than the other. She said almost unnoticeable. Looked healthy with no other issues involving them. She now tends to believe the elevated ALPH is liver related rather than cushings. (?) Sludge, or whatever is in her gallbladder is worse also. Bloodwork looked great except for the high ALPH.

For right now she is letting me make most decisions regarding how aggressively we want to tackle these problems, and I am horrified I will have the wrong influence on how to treat and what to treat. The girl is happy and loving life except for the vision loss and not getting around as well as she once was. So please help me decide.
What and how to proceed. I will now say that I think the eye removal is the least of the concerns.

No dental for now. She said we wanted to see how the trachea handled the intubation on a much lesser time of anesthesia with the eye removal since it was a much shorter surgery. Sorry for the rambling, but that's my brain in overdrive working!!

Be kind and blunt....how does all this sound to you guys?

[labblab]

The girl is happy and loving life except for the vision loss and not getting around as well as she once was.

Hey there Shelba. I went ahead and quoted what you had written above, because if it was me, I think that statement would hold a lot of weight in terms of how aggressively I would want to be about intervening at this point. There’s that old saying, “If it ain’t broke, don’t fix it.” Of course you don’t want to miss being proactive about treating something that can end up turning sinister. But at this point, it does seem as though the jury’s still very much out about the possibility of Cushing’s. The normally appearing adrenals on the ultrasound do nothing to *support* the diagnosis. On the flip side, liver changes and gallbladder issues and “tracheal collapse” (is that the same as narrowing?) could be affected if Cushing’s was actually present.

However, if I’m not mistaken, Suni has suffered from the tracheal issues for years now, theoretically predating the possible appearance of Cushing’s. If what she suffers from is indeed “tracheal collapse,” this article states that liver problems can often accompany the tracheal problems. But as I say, tracheal collapse may not be the same thing as tracheal narrowing. Maybe you can clarify that for us. Anyway, here’s the article:


A study indicated that a high percentage of dogs with collapsing trachea also had concurrent liver disease. Therefore, all dogs with collapsing trachea should have their liver function monitored closely. Your veterinarian will provide specific treatment advice to help with your dog's condition.

https://vcahospitals.com/know-your-pet/tracheal-collapse-in-dogs

Regardless of cause, I’m thinking there are two liver tests you might consider having done in the hope of identifying more accurately what’s going on with her liver. One is a totally noninvasive blood test — a “bile acid test.” This test can show whether or not the liver is functioning normally. If so, that could relieve some worry about the importance of the enlargement regardless of the source.

https://vcahospitals.com/know-your-pet/bile-acid-test

The other thing you might discuss with your vet is having a liver biopsy done at the time she’s knocked out for her eye procedure. I think biopsies can be more or less invasive, but I think they can be as simple as inserting a needle and extracting some tissue. If your vet doesn’t think that would be too risky, that might be a diagnostic that could better identify the true nature of her liver enlargement. However, if the bile acid test shows that her liver is functioning normally, you might not want to even consider a biopsy at all.

So those are my own thoughts right now. Also, I see that I missed seeing your earlier question about CBD oil. I don’t know a whole lot about it, but I had decided to add it alongside Luna’s daily NSAID for added relief from her arthritic pain. There have been at least a couple veterinary studies that have indicated that CBD oil can be helpful in that regard. I do think it was somewhat helpful for her, but after the development of GI issues last winter, I’ve discontinued all her supplements aside from Denamarin for her liver. In that vein, I don’t know that CBD has the potential to actually harm the liver, but I do believe it can elevate test results for ALT, another liver enzyme. So right now while you’re trying to pinpoint Suni’s liver issues, it might not be a great time to introduce CBD and risk muddying the test results.

OK, gotta close for now. But definitely do get back to us with your own thoughts about all this.

[sunimist]

She has been diagnosed with tracheal collapse. The trachea is collapsing worse at the bottom according to the x-rays. Yes, you are correct Marianne. She has had trachea issues for several years now and have gradually gotten worse to the point of where they are now. And get this!! You know what would alleviate the symptoms most? Prednisone! It may come to that, but not right now. GEEZ!! We are doing the bronchial drugs now plus a cough suppressant. She has done better today.

I am almost certain I am not going to pursue any cushings testing right now. I am beginning to believe from all indications that the liver might be the problem and we need to get her weight down for one thing. That's going to be a challenge since the girl loves to eat (and always has)! Exercise is also problematic because of her leg. Oh Lawd!!

The doctor would not elaborate on CBD oil, as I expected. She said in Texas that it was against the law to prescribe it. No problem, I was just curious. I am setting it aside for time being, but may get back to it later.

We will probably do a bile acids test and maybe even a biopsy when and if she has her dental. That all depends on how she manages with the anesthesia during eye surgery.

Thank you dear friend for helping me sort some things out. You are such a blessing!

[sunimist]

Marianne, if you need to move my post to another topic since cushings isn't at the forefront any longer, please feel free to do so. I realize she could still have, and probably does, cushings, but we are having to address other problems before we get to cushings. Thank you mam!

[labblab]

Hey Shelba, I think we’re fine if we leave Suni’s thread right here for the time being. Even though other issues are now at the forefront, Cushing’s may still end up reappearing in the mix. As long as it remains a possibility, even in the background, I think it makes sense to keep our discussion about Suni here on the main forum.

So do keep us updated as things progress, OK?

[sunimist]

You know best my dear!

I will certainly keep you updated and will reach for your hand to hold when she has her surgery the 9th of September.

[sunimist]

Well, this is it! Tomorrow my sweetheart will have only one big black adoring eye. I am so sad, but just pray all her other issues can handle the surgery alright. Prayers would be so very much appreciated and I will let you know how everything goes.

[labblab]

Omigoodness, prayers are flowing for our dear girl (and for her mom)!

We’ll be anxiously awaiting any and all reports….

(((((((HUGS!)))))))

[Squirt's Mom]

Prayers rising, Shelba! Let us know how things went when you can.
Hugs,
Leslie

[sunimist]

As of 4:30 this afternoon she was awake off and on, pain meds taking care of pain and making her rest. She made it through surgery just fine (they said). Going after her in the morning. Mandi is so sad her sister is not here. She loves her so much that I don't know what she would do without her.
I have only cried once today, but there is a long night ahead. She doesn't deserve this!
Thanks so much for y'all's prayers, thoughts and concern. l Will post again after I get her home unless I hear something before then. Love you!

[labblab]

I’m so relieved to log in this morning and read last night’s report! All fingers and toes crossed that I’ll also soon be reading that Suni girl is safely home once again.

Prayers and healing wishes continuing to flow!

[sunimist]

Suni is home, doing well and acting like nothing is wrong. Bless her heart, she looks pitiful but I am not going to tell her. She's still beautiful to me!
Came home with pain meds and some antibiotics.

Mandi was beside herself when Suni got home. She had been so sad and depressed. Now that child (Mandi) won't eat a bite of anything I offer her. Have no idea why. How long will she do that? Checked her temp..ok, felt around in her mouth..nothing, stomach seems soft, but I couldn't tell if something was amiss in there because I don't know how and what to check for obstruction. Now I am worried sick about her. She did her crazy and wild runs during her evening romp in the yard. Doesn't make sense to me. Could it have anything to do with the way Suni's eye looks? Hair shaved on one side, eye red, stitched and swollen. Any ideas or something you can think of that is a sure fire appetizer? I'm stumped!

[labblab]

Such good news that Suni is home!! And I wonder if maybe Mandi may just be temporarily reacting to the changes and anxiety in the house related to Suni’s surgery. Of the three dogs we’ve had so far, Luna is by far the most sensitive to my own moods. Especially if she thinks I’m worried about *her* in any way (like if I’ve physically examined her or even if I’m just watching her), she’ll go run to her crate and hide inside. And that usually means she won’t eat, either. Hopefully by today, everything will be more normal all the way around for you girls. If not, let us know and we can try to come up with some food ideas that will help.

Sending high hopes for a better day today!

[sunimist]

It has been a better day. Suni is coping with and without her collar really well. As long as she gets food, she is a happy camper! Incision looks great and the doc said in about 10 days it would be healed. Just have to watch for accidents and Mandi's tail swishing in her face!!!

Mandi finally ate some and has done better today. I agree that it was the trauma of dealing with Suni and then seeing her face all messed up scared her. She still eases up and smells of her face and head, but she is accepting it more now. She sure adores her Suni! Hoping things continue to normalize in our household, and they will I am sure.

Now to begin deciding what to do about other issues! Geez! Can't seem to be able to buy a break!

Thanks again for the love and kindness shown. Means the world to me!

[Joan2517]

I've been keeping up with Suni's progress and am so happy that she seems to be adjusting. It is hard on the others when they don't understand what has happened.

[sunimist]

Yes it is, Joan especially with the one who is so attached.

[sunimist]

Just popping in to see how everyone is doing and report that Suni is doing so much better. Appetite has slowed, lost a few ounces, drinking near normal and she is more active. Still her sassy self. Her eye healed wonderfully and she gets around great. However though, she has become more attached to me and wants to be right with me at all times.? On the flip side, her trachea has become much worse and she coughs a lot. We are trying to control it with meds and they seem to help considerably.

I pray for all those here who are having a difficult time with their babies. It's a dreadful ordeal to go through, but we must do what we have to, and what's best, for our precious little ones. God bless you all, and my love to all the special folks on this forum sacrificing their valuable time for those in need as they travel the cushings road.

[labblab]

Oh Shelba, how great to hear from you! I’m so sorry that Suni’s still troubled by her cough, but it sounds as though everything else is on the upswing right now — WHEW! :D:D:D

Thanks so much for checking in, and we’ll surely be keeping our fingers crossed for you and your girls!

Love, Marianne

[sunimist]

I started my 12 pound poodle, Suni, on Adequan injections a week and half ago to try and strengthen the cartilage in her trachea. She has had a total of three injections. This morning her appetite was way down and this afternoon she has vomitted a big amount of food with clear to yellow liquid. Doesn't want anythinjg to eat. I understand this can be a side effect of Adequan.

She also has the collapsing trachea along with cushings.

My question is: how much liquid pepto can I give my 12 pound precious baby to settle her stomach, or is there something better? I went through her medicine cabinet and she has no anti-nausea meds. I am trying to wait until tomorrow to reach out to her doctor. Thank you in advance.

[labblab]

Shelba, I’m so sorry I just now saw your Pepto question this morning after you’ve probably been worrying all night! I’m afraid I don’t know the answer, though, so contacting your vet is really your best bet. I’ve been given Rx Cerenia in the past to administer for nausea, but I don’t know about other over-the-counter options. I’m so hoping that Suni’s little stomach has settled down since you wrote last night. Please let us know what the vet says, and how she’s doing today, OK?

Sending big hugs to you, and healing hugs to sweet Suni.
Marianne

[Squirt's Mom]

I wasn't on either, Shelba, and didn't see you post til just now. How is Suni this morning? My little Tilly was just diagnosed with collapsing trachea. She was put on an antibiotic who's name I can't remember and a narcotic for cough called Lonox. She stopped hacking and coughing and gagging within 1 day after starting these. She finished the AB this weekend, Fri nite was her last dose, and Sat night had one episode of hacking. BUT I had also put a little pressure on her throat that evening trying to keep a neighbor's happy-to-see-someone Pit from jumping all over us and I'm sure that had something to do with it as well. The narcotic she was taking twice a day along with the AB but I took it down to once a day when that was finished because doc said to use these "as needed". She got one last nite with her supper but not this morning and if she does ok all day I don't plan to give her one this evening. Adequan is in the plan tho if needed. I hope you sweet girl is feeling better and that her treatments help.
Hugs,
Leslie

[mytil]

Hoping her little tummy is doing better. I would contact my vet too about he dosage --- I am currently giving Cailey Pepcid (through the vets and not over the counter and also giving Cerenia to Cailey ---- have been going through a ton of stuff with her these past months. It takes at least a few days to show some relief but they both do work well with her.
Hugs,
T.

[sunimist]

I am so sorry girls, I am just now getting back here. Life stinks sometime and certainly gets in the way!!!
Suni is doing better with her stomach issue. I did contact the vet and she said she believed the antibiotic was causing her problem, so we stopped it and she did not have another vomiting episode. She said she had never had an Adequan patient present with that side effect. So with my girl, the doc knows best.

She is currently taking Theophylline, cough tabs, Hydrocodone, a throat soother, and Valium as needed. And Terry, Dr. P. did prescribe Pepcid for her.. What all is wrong with your little Cailey?

Leslie, I am so sorry Tilly has been diagnosed with collapsing trachea. It is a gut-wrenching thing to not be able to help your baby. Suni has such terrible anxiety since she can't see and she panics if i get away from her. That alone is so stressful because she just follows me around coughing. We have done all we can do for her unless she has the surgery and that is just not an option with her and her health problems. So we are hoping and praying the Adequan helps her. This is the last week for twice a week injections.
We start the once a week next week!! Relief!!

It just hurts! The radiographs spoke for themselves. She barely has any air passage in her trachea.

Also, her cushings keeps rearing it's ugly head.

Mandi is so sweet trying to take care of her. She sure loves her Suni.

So we are just here taking one day at a time, doing the best we can, praying a lot and crying a lot when Suni is not looking.

Thank y'all for caring. Means so much to me and I love all of you dearly.

[sunimist]

Good day all. Hope you are having an enjoyable sunshiny Sunday. Well, here at least!
I have something Iam going to throw out to y'all for debate, be it negative or positive, I value your knowledge more than anyone I know, and my trust in you is unmeasurable, so here goes.

I have spent several sleepless nights thinking and praying about my decision. My intentions are to start Suni on a low maintenance dose of Vetoryl without testing. I promised her no more traumatizing and unnecessary vet visits and tests and I intend to keep my promise. Everything that can be done short of surgery has been done, or is being done, for her collapsing trachea, and her eyes have been taken care of, so we are going to try for a way to alleviate some of her cushings symptoms to make breathing a little easier for her. May help, may not, but what do we have to lose? If there is something else worthy of a try, my mind is open to other options, but right now I am void of other options. I would just like to give her a more comfortable and less stressful time with what time she has left, and if I can lessen some of those cushings symptoms, I would be over the moon happy for her! I pray something grabs hold and works, but can't see it right now.

I haven't come to this conclusion lightly. My brain hurts from stressing over it, and I haven't approached the vet with this yet, but plan to tomorrow. She may fire me or she may agree. We will see!

Do y'all know anyone else that has started the drug without testing? This may be a common thing, but I have not heard of it before.

I ask your prayers that I am doing the right thing for my precious little girl and that she will benefit from it. Thank you all for listening and I do hope you will respond with your views and advice. I need it!!!

Thank you!

[labblab]

Hey Shelba, I’m so sorry that you and Suni have so many ongoing issues to be dealing with! I surely understand the toll that those sleepless nights take on both your head and your heart :-((((. I’ll be happy to give you my thoughts about the situation, but predictably (knowing me!) I have a couple of questions for you first.

I know that Cushing’s has been a huge question mark for some time now, so I went back and reread your thread again to remind myself of the presence and absence of consistent symptoms. At this point, which symptoms are present that seem most troubling for Suni, especially in terms of her trachea? In other words, what would be your most important goal with treatment?

Also, in terms of testing, are you referring to doing away with diagnostic testing, monitoring testing, or both? In terms of diagnostic testing, an ACTH stimulation test would likely be the preferred blood test since Suni has a number of physiological stressors (the ACTH is less likely than the LDDS to deliver a “false positive” in the face of nonadrenal illness). The ACTH only requires one hour between two blood draws, so that would not be an excessively long time for her to be at the vet. Some vets will actually let owners take their dogs out of the office for that intervening hour in order to reduce stress on them. Another preliminary test that wouldn’t involve a vet visit at all would be to collect urine at home to take in for analysis via a UC:CR urine test (Urine Cortisol to Creatinine Ratio). An elevated UC:CR means Cushing’s is a possibility but without being definitive. However, a normal UC:CR is virtually a guarantee that Cushing’s is not at play. So that might be a home diagnostic that you would consider.

Ongoing vet visits for continuing treatment monitoring is a different story. But as far as diagnostic testing, that should be much more limited and circumscribed. It sounds as if you have concerns about any further testing at all, though, so hopefully you can tell us a bit more about that. And as I say, let’s find out more about the symptoms you’re hoping to ease.

We’re here to talk, girl, so let’s get started!
Marianne

[sunimist]

Thank you Marianne for responding.

Symptoms: She has them all full blown! Pot belly, panting, heat sensitivity, excessive drinking, overweight, enlarged liver, high liver enzymes, anxiety and enormous appetite and excessive peeing.
There is no doubt she has cushings.

If we could slow the panting, anxiety, heat sensitivity, the enlarged liver and get the appetite under control, it would be wonderful, because they all play a part in her being able to breathe without such labored gasping.

As far as her trauma on going for testing. She gasps, coughs and cries all the way to vet and then back, and while there. That's 120+ miles taking a huge toll on her breathing. Not up for that at all. So yes, as I promised her, no more testing, ultrasounds, or intubations. If being able to breath, if only a little, is not addressed and preserved, she won't be with me long. So this is a chance I am willing to take for her sake. My feelings are being buried for now I think.

Am I being too unrealistic? I can't think of anything else to do.

[labblab]

Thanks so much for this additional info, Shelba, because now I better understand what you’re struggling with. Of course, normally we always stress the importance of testing here, both for diagnostic and monitoring purposes. But in sweet Suni’s case, it seems to me that you’ve entered into sort of a hospice phase where all the usual bets are off. Her immediate comfort is the sole issue, and if I were in your shoes, I’d probably be considering the same option. I’m kind of in the same place with my Luna. I’m no longer worried about long-term ramifications of doing this or that. If I can try to make make the present day better for her, then that’s the choice I pick because I’m aware every morning that this may be the last day that we’re gifted to be together. So if your vet is willing, then I understand the experiment that you want to try.

I’ll be very anxious to hear how things go and surely hoping for a good result, my friend. Lots of love to you and sweet little Suni, always.

Marianne

[sunimist]

Thank you, Marianne for understanding more of where I am coming from. Like I said, this is not a spur of the moment decision, and it has caused me a lot of anguish to arrive at where I am now. I understand that it would not be a right decision for most, but for me it is the only hope I have for my sunshiny girl. I have shed many tears trying to arrive at a decision and I am sure I will shed a lot more. However, in the end, I truly feel a little relieved and am at peace with this. If it fails, it's all on me and I will have to live with it.

I love you girl, and so appreciate your loving and caring input. I hope and pray you find an answer that will help your precious Luna. It sucks, don't it??!!

FYI, Dr. just called and will call back. She wants to make sure there is nothing else out there that we have missed to try. Bless her, she is so darn special!

[sunimist]

Quick update on Suni. The vet wants to do a UC:CR test and a thorough ultrasound to take a good look at the adrenals, hoping to get the answer one way or the other. We are still contemplating what route to take. What would you do? I just want to do what's best for my baby, that's all.

[labblab]

I don’t think there’s any downside at all to doing a UC:CR since you would be collecting the urine samples yourself, at home. As a reminder, in order for that test to be accurate, the process should be as stress-free as possible for Suni. That’s why the urine should be collected at home and not at the vet’s. We’ve been told that, ideally, the test would be performed on a pooled sample — collecting the first urine of the day on three successive mornings, pooling it and refrigerating it until the pooled sample is taken to the vet for analysis. An elevated UC:CR cannot confirm Cushing’s (there can be other causes including simply feeling stressed), but a normal result definitively rules out Cushing’s.


Urinary Cortisol:Creatinine Ratio
Creatinine is excreted in the urine at a constant rate; cortisol is not. The UCCR is a sensitive test to detect cortisol hypersecretion. It is imperative the dog is not stressed for the urine sample collection. To minimize stress, the owner should collect free-catch samples for 1-3 days at home and bring to the practice; first morning samples are ideal. Samples can be pooled to increase chances of observing an elevated cortisol due to daily variation. Stress and non-adrenal illness can cause increases in urine cortisol levels. False positives are common (specificity is as low as 20-25%), but a normal ratio is considered truly negative, and HAC can be ruled out.

So if it was me, I’d go ahead and perform a UC:CR first, since it shouldn’t be stressful for Suni. If that result is elevated, then you can shift to making a decision about the ultrasound or any other testing.

Marianne

[Squirt's Mom]

I would definitely do the ultrasound. It was the ultrasound that saved Squirt's life the first time she was diagnosed with cushing's because it was a tumor on her spleen that caused ALLLLLL her cush tests (LDDS, HDDS, ACTH, and UTK panel) to come back positive even tho she didn't have the disease at that point. Had I started treatment based on those tests it could have easily killed her 1) when the tumor ruptured or 2) from an overdose because she didn't need the drug to start with. So please do get the US for sure.

[sunimist]

Thanks, y'all! Yes, she is going to do both the uc:cr and ultrasound, at least. I will give Suni some valium for the trip as it won't affect either of those tests and maybe she can travel better. Will be making the appointment Monday.

Oh my! Thank you Leslie for that information! I did not know, or either forgot, about angel Squirt's ordeal. Sure did love that baby!
,
And thank you Marianne for reminding me about the pooling samples. Ideally, I guess it should be done 3 days before the test? I can do that after I get an appointment date.

I am so embarrassed! It's sinful how much I have forgotten about all this. I am trying to catch up though, and my gratitude to you girls for helping me do that! XXOO

[labblab]

Thanks, y'all! Yes, she is going to do both the uc:cr and ultrasound, at least. I will give Suni some valium for the trip as it won't affect either of those tests and maybe she can travel better. Will be making the appointment Monday.
Yep, I’m so glad Leslie had the chance to reply to you, too! And just to reconfirm, Valium *would* skew the results of a UC:CR, but since you’ll be collecting the urine at home it will be a non-issue for Suni during her vet trip.

And there’s absolutely no cause for embarrassment, girl! It’s been a very long time since you had to deal with Cushing’s, and it’s no surprise at all that it wouldn’t be in the top drawer of your memory bank ;-).

[Squirt's Mom]

Goodness....I deal with this stuff every day and still can't remember what's what a great deal of the time! :o I'm sure my age has NO part to play in that tho. :D

[sunimist]

So the valium would not affect her test results if taken after I collect the samples. And hoping the samples would be stable enough for testing? I am wondering about other meds she takes. Will have to remember to ask about that. Thanks for pointing that out Marianne.

No, of course age would not play a part in what we forget, Leslie!!:o
!

[labblab]

For the results of the UC:CR to be accurate, you don’t want the dog to be either unusually agitated or sedated when the urine samples are being collected — you want an accurate reflection of the typical amount of cortisol that the dog is producing on a daily basis. So you’ll want to collect the last batch of urine first thing in the morning of the day you’re taking Suni in, *before* you give her any Valium. We’ve been advised that the pooled urine sample should stay refrigerated prior to analysis. So depending on how long the drive is to the vet, taking it in a cooler would likely be a good idea. You can double check all this with your vet to make sure you’re following the protocol that she wants. But this is what we’ve generally been told.

[sunimist]

Update on Suni. I caved, and did exactly what I said I wouldn't do. She has been diagnosed with pituitary cushings. We will start Trilostane treatment in a couple weeks or so. She just spent 4 days in the hospital on an IV with a stomach infection, so treatment won't be until she gets her strength and weight back. I am still reluctant, but must do all I can to make her golden years as happy and healthy as possible.

I am asking for experience in Trilo users for feed back. What is the lowest dose I can start her on? I know nothing about the med as Misty was treated with Lysodren. Just so you know.... I will be asking a lot of questions because I trust this group completely when it comes to advice. Doctors know a lot, but experience is worth its weight in gold.

On a brighter note. Adequan injections are helping her collapsing trachea so much. She coughs very rarely and that's the only thing I can contribute the success to. As the Doc said, "It's time something went right for her"!!

Hope all you furmoms and furbabes are doing well and keeping safe. It's fast becoming a very uncertain future for all of us. God Bless. XXOO

[labblab]

Hi again, Shelba! That’s great news that Suni’s cough is responding well to the Adequan — that has to be a huge relief to you!! As far as the trilostane treatment, we’ll surely do all we can to be helpful to you. I’m going to start by giving you links to two threads on our Resources forum that contain a lot of helpful info. I encourage you to take a look at them now, in advance of starting treatment. This way, you’ll have the chance to address many potential questions ahead of time. Taken together, the two threads address treatment and monitoring considerations, as well as suggesting ways in which costs may possibly be lessened. So do take a look and we can discuss any aspects that you’re still wondering about.

https://www.k9cushings.com/forum/showthread.php?8925-GENERAL-GUIDELINES-for-Vetoryl-(trilostane)-Dosing-amp-Monitoring-with-ACTH-Stimulation

https://www.k9cushings.com/forum/showthread.php?9066-Cost-Savings-for-Owners-of-Cushingoid-Dogs&p=211096#post211096

To address your specific question about dosing, the generally accepted formula for calculating the initial dose for a dog weighing less than 40 pounds is to prescribe 1 mg. per pound of the dog’s weight. I believe you’ve told us that Suni weighs 10 pounds, so theoretically that would place her starting dose at 10 mg. and Dechra, the manufacturer of brandname Vetoryl, does produce a 10 mg. capsule. However, they also manufacture 5 mg. capsules, as well. In your situation, I’m thinking you’d prefer to be cautious re: the size of her starting dose and therefore the 5 mg. capsule may be the best place to start.

When you read the second link I’m giving you about cost-cutting methods, you’ll see that compounded Rx’s of trilostane can be prepared at any dose other than the capsules manufactured by Dechra. So you could start even lower if you wanted to have a compounded dose prepared for Suni. All things being equal, I personally recommend that folks start off with brandname Vetoryl if they can afford it and if a capsule is available in the dose that they are needing. I feel more comfortable with making the switch to a compounded product once the dog has been stabilized on the brandname Vetoryl (for reasons that are discussed in that link). But especially with smaller dogs who need a dose that’s not available via Vetoryl, compounding provides the answer.

OK, I’m gonna leave things right here for the moment. As I say, this way you can do some initial research on your own and then return to us with any additional questions. I sure hope our little girl bounces back quickly from her infection!

Marianne

[sunimist]

Thank you so much for the links Marianne, and I will most definitely dive in reading and studying them. I plan on knowing a lot more when we start treatment than I do right now, thanks to you and the folks here. The way the doctor talked, she doesn't want to start anything until Suni gets back to her initial weight and health. So maybe a month or so. I was glad to hear the info on the lowest dose to start with. That was my first request.

On a positive note, she is doing really well and bouncing back rather fast. Much relief there! I will be checking in often and I appreciate you more than you will ever know.

[sunimist]

So Vetoryl is more effective than Trilostane? For some reason, my low IQ thought they were the same.

[Squirt's Mom]

Not necessarily. Trilostane is the active ingredient in Vetoryl. When a dose or form of medication, like a liquid, is needed that Dechra doesn't supply then Vetoryl is compounded and is then referred to by the active ingredient, Trilostane. Dechra only produces capsules and only in 5, 10, 30, 60, and 120mg doses. So if a pup needs 6mg and can't swallow pills, the Vetoryl can be compounded into a liquid with which 6mg can be given easily. So Vetoryl is the brand name unaltered from Dechra, the manufacturer, and Trilostane is the compounded form of Vetoryl.

Not all compounding pharmacies are equal so you want do some research if using compounded medications of any kind. We used to relied on Diamondback out of AZ but sadly they sold out to Wedgewood Pharmacy and the quality dropped quickly. There is a pharmacy out of New Jersey called CareFirst Specialty Pharmacy that the admins of the Facebook groups researched and talked with and now recommend most of the time. Here is a link to their information:
https://www.cfspharmacy.pharmacy/

I'm glad to hear Suni is already feeling better and pray this trend continues!
Hugs,
Leslie

[labblab]

Hey girl, this is definitely *not* a low IQ issue — this stuff is just plain confusing for everyone!

But here’s the crux of things. Trilostane is the chemical name for the active ingredient in Vetoryl. So from a chemical standpoint, they are the same thing. However, Vetoryl refers to the brandname veterinary version that was initially researched, patented, manufactured and marketed by a pharmaceutical company named Dechra. To this day and to my knowledge, I believe Dechra still holds exclusive right to the large-scale pharmaceutical manufacture of an FDA-approved veterinary version of the medication. Through the years, I had assumed that generic versions would be made, once Dechra’s original patent expired. But I’m not aware of this happening yet. Generic versions of medications are also made by large-scale pharmaceutical companies, and generics sold in the U.S. must also meet FDA standards. But as we know from our experience with human meds, generics can be a whole lot more affordable! But I guess nobody has felt that a generic version of trilostane would be enough of a money-maker to launch into formal manufacture.

So that leaves us with compounded versions of trilostane as being the only alternative to Vetoryl. Compounded trilostane products are put together by individual compounding pharmacies, theoretically customized to each patient via the Rx written by the dog’s vet. Legally, compounded products cannot duplicate brandname products. There is supposed to be a reason why the compounded product is necessary — either a dose or delivery system that is not available in the brand. Compounded medications can certainly be a life-saver when a dose or form (e.g., liquid instead of a capsule) is not available in the brand. Compounded trilostane is typically far less expensive than Vetoryl, as well. However, there can be a downside to compounding, too. Since the meds are being prepared by individual pharmacists, they are not FDA-approved and at least one study has shown greater variability in the dose and effectiveness of some compounded products as compared to Vetoryl. However, due to individual dosing needs and even just the exorbitant expense of brandname Vetoryl, compounded versions of trilostane can offer some owners the best and even only viable option for treatment.

You can read more about these issues on the “Cost-saving” link that I gave you above. If folks want to consider compounded trilostane, there are also tips in that thread to help owners identify reliable compounders who conform to some established professional standards. This can offer greater peace of mind re: the purchase of a compounded product.

So the long and the short of it is that we often do get sloppy and use “trilostane” here in our answers to refer to both Vetoryl and compounded alternatives. But basically we’re just generally referring to treatment using that particular chemical (like “mitotane” and Lysodren). Usually the owner will tell us at the outset which version they’re actually using. As I said earlier earlier, though, my personal preference is to start dogs off on Vetoryl if it is affordable and available in the desired dose. This is because of the study results showing greater variability among compounded versions. I’d like to make sure my dog can tolerate the approved version of the med first. Once stabilized on a certain dose, that would be the point that I’d consider switching to a compounded version if Vetoryl is too expensive to handle longterm. But that’s just my own opinion. As I say, you’ll see more about this all in the resource thread above.

Marianne

[labblab]

I see that Leslie and I were writing at the same time, and I’m so glad she had a chance to add her additional info, including the link to CareFirst Pharmacy. I do want to add one more thing to what she and I have both already written. And that’s to say that even though trilostane is the active ingredient in Vetoryl, compounders typically are not actually starting with Vetoryl as the basis for their own product. Instead, they are buying raw trilostane from their own chemical suppliers to incorporate in their preparations. This may be one reason why there might be more variability in the strength or effectiveness of some compounded products. And this is why it’s important that folks select a reputable compounder to prepare medications for their pups (or for themselves, for that matter!). You’re wanting to use a compounder who sources their base chemicals from a reputable supplier, as well.

[sunimist]

So, if I start Suni on Vetoryl, would the 5 mgs be considered a low dose for her? 12 Pounds? My head is spinning!! Thanks guys. I will make if with y'all's help!!

[labblab]

Yep, I believe 5 mg. would be considered a lower dose by many clinicians. If Suni were my own dog, that’s probably the starting dose I’d be advocating for.

[Squirt's Mom]

I agree.....5mg is the most I would want to start with.

Be prepared....Vetoryl/Trilostane is NOTHING like Lysodren. It works differently, the protocol is VERY different, and the dog's response is different....and the impact on your pocketbook can be dramatic because of the frequency of testing often required. So please don't hesitate to ask questions anytime something seems "off" or different or anything. It can be hard to wrap your head around the differences when you are used to using one or the other and need to switch. But I have full faith you will do just fine!

[sunimist]

Leslie, you bring me to a question I want to ask and have put off for obvious reasons. What is your opinion of using Lysodren rather than vetoryl? Would it be
easier on Suni? Is the loading phase the same as 13 years ago? I don't think I would have these questions if she was in otherwise good health. Scares the bejeebers out of me. What would you guys do given my circumstances, please!

[labblab]

Hi Shelba, obviously I’m not Leslie ;-), but I’ll go ahead and leap in with some of my own thoughts, as well. Leslie is indeed a strong supporter of Lysodren, and it will be good for her to tell you why. However, I’m going to go the opposite route and tell you why I’d be opting for Vetoryl in your situation. This way, you’ll have a greater reservoir of information about the treatment path ahead, and that’s always a good thing.

In full disclosure, I only have personal experience with trilostane. Back in 2003 when Barkis was diagnosed, Vetoryl was not yet available in the U.S. and we were importing a human version of the medication, Modrenal. However, the active ingredient was also trilostane, so that’s how I’ll refer to the drug going forward. Anyway, the veterinary use of trilostane was first researched in the early 2000s, came into wider use worldwide around 2002-3, and received formal FDA approval here in the U.S. in 2009. So it’s now been in general use for 20 years and thus I would no longer consider it a “new” medication. Somewhat surprisingly, as Leslie notes, there are some question marks that still remain about the actual therapeutic mechanism and physiological effects on the adrenal glands, as well as the best way to monitor effectiveness via blood tests. That being said, it has overwhelmingly replaced Lysodren as being the medication of choice for most clinicians worldwide.

I honestly cannot remember when we last had a member come to us with a dog being treated with Lysodren. I don’t even know whether brandname Lysodren is even readily available anymore, or whether compounded mitotane would be the likely option. So what accounts for the shift? I believe it’s the following. Both trilostane and Lysodren carry a risk for causing longterm adrenal dysfunction resulting in an Addison’s condition. However, I believe permanent Addison’s occurs more often in dogs being treated with Lysodren because its effectiveness hinges on actual erosion of adrenal tissue, and the degree of erosion can be hard for some owners to recognize and regulate. From your own experience with Misty, you know what’s involved with Lysodren loading. So you will know how easy or hard it may be to judge when the loading process is complete. With trilostane, there is no loading phase — you just start dosing daily and then monitor the results both visually and via blood testing. Just like with Lysodren, dogs taking trilostane can also be overdosed with too much suppression of adrenal function. However, the condition is generally more quickly and easily reversed with trilostane, simply by stopping the med for a time. Lysodren overdosing requires actual regeneration of adrenal tissue, and this may take longer time and for some dogs may never occur, resulting in permanent Addison’s. Permanent Addison’s can also result from trilostane, and unfortunately for reasons that are not clearly understood. But apparently it simply doesn’t occur as frequently. Thus, I believe trilostane is perceived by vets to be the safer of the two meds and the easier for novice Cushing’s owners to manipulate simply by raising or lowering the dose minus any loading phase.

It’s true that trilostane users do commonly need to make dosage changes over time with associated testing, However, I’m less inclined than Leslie to think that Lysodren users are all that much better off in that regard. Historically, I think we had a number of members who had to reload their dogs over time or who had to go through multiple monitoring tests during lengthy loads or during recoveries from overloads. We’ve had folks using both treatments who’ve had easy times and those who’ve had harder times. Unfortunately, you just don’t know in advance how things will turn out for your own dog.

For sure, trilostane is far from perfect. It is indeed bothersome that questions still remain about its affect on the adrenal glands and also the best course of monitoring. However, even with those questions remaining, it is now the treatment of choice for most clinicians worldwide because it is thought to be less likely to result in permanent Addison’s and is easier to manipulate quickly via dosing changes. Honestly, I think you’d have a hard time even finding a vet now who is experienced with using Lysodren.

In Suni’s case, specifically, I’d prefer trilostane anyway due to her fragile state. I’d think it might be harder to evaluate the subtle changes associated with Lysodren loading and I’d want to lessen the risk of throwing her into lengthy or permanent Addison’s. Again, I’m not saying this can’t happen with trilostane. It can, and at any point in time and at any dose. But apparently it happens less frequently, and especially if lower initial dosing protocols are followed. By using trilostane, I’d feel more comfortable thinking I had a greater likelihood of reversing any ill effects more rapidly simply by lowering the dose or temporarily halting it altogether. So that’s my two cents worth. And as I say, it’ll be good to get Leslie’s alternative perspective, as well, so that you can gather as much info as possible beforehand. Plus — and perhaps most importantly — you have your own Lysodren experience to remember and evaluate.

[Squirt's Mom]

Yes, I much prefer Lysodren to Vetoryl and have for years. When Squirt was first diagnosed, Vetoryl (or Trilostane as that was the only form that was available here in the US then) had just hit the market in the UK and I had watched dogs on cc.net get sick, very very sick, and worse over and over on Lysodren. So when my Sweet Bebe was diagnosed and ready to start treatment, I wanted her on Trilo not Lyso because Trilo was touted as safe.

And that is one of my main problems with Vetoryl/Trilostane. It is touted as a safe, or sometimes more honestly a “safer”, alternative to Lysodren. This has lead to vets, and parents, becoming lackadaisical when it comes to dosing and monitoring treatment. Vets often completely ignore the very specific protocol that comes with Vetoryl and fly by the seat of their pants because this drug “can’t hurt the dog”….and yes, more than one person has reported this or similar from the vet treating their dog with Vetoryl. The nightmares I was seeing years ago with Lysodren when Squirt first started her journey are now magnified with Vetoryl because 1) the sheer number of dogs taking Vetoryl and 2) too many see it as “safe” or “safer” when Vetoryl has the exact same risk factors as Lysodren up to and including death.

My next huge issue is with the company itself. When Vetoryl first hit the market the starting dose range was very high, MUCH higher than it is today, and dogs were getting sick and dying left and right. Dechra knew this but refused to change their literature for years. When they finally did lower the starting range, it was still too high and a great many dogs were still getting sick and worse. Dechra finally lowered that recommendation a little more….but not enough to keep dogs from getting sick. And this is the range at which the starting dose is presented today. The most current independent research has shown that larger dogs are typically more sensitive to Vetoryl for some reason and need a much smaller starting dose than the drug’s literature recommends. Dechra knows this. They do.not.care. They refuse to change their literature continuing to let vets use outdated information with which to treat their patients. Which means dogs are still getting very sick. Over the years, I have come to despise Dechra. In my opinion, and this is ONLY MY opinion, Dechra has been using our cush babies as a research project for over a decade now. This drug should never have been released when it was because too little was, and remains, unknown. Dechra does not give one single crap about any dog...they simply want to sell more and more Vetoryl, hence the reluctance to lower starting doses which would result in fewer sales. And they fight tooth and nail against Trilostane (compounded forms) because they lose money when we use Trilostane...NOT because Trilostane isn’t effective, but for money, period. THAT is all Dechra cares about. Yes, a company is supposed to make money but they are also supposed to be responsible especially when lives are at risk and in my opinion Dechra is anything but.

With Lysodren we know exactly where it is working and exactly what it is doing in the body. It works on the adrenal glands, period. Vetoryl works on the HPA (hypothalamus, pituitary, adrenal) axis and a great many things happen on this loop, or axis, other than instructions for cortisol production and release.

Studies have shown that Vetoryl/Trilostane causes increases in the intermediate, or sex, hormones that are involved in Atypical Cushing’s, (which has normal cortisol but elevations in 2 or more of the intermediate hormones). Lysodren is used to lower these same hormones and is very effective at that job with the possible exception of estradiol which can be produced outside the adrenal (and Lyso works only on the adrenal glands ;) ). Those intermediates can cause some of the same signs as elevated cortisol. So while Vetoryl is lowering the cortisol it is often raising those intermediate hormones at the same time.

Lysodren is a more stable drug than Vetoryl meaning once a pup is on maintenance they typically remain on that dose for the duration. Some Lyso pups do need increases over time but that is the exception, not the rule as it is with Vetoryl. With Vetoryl the cortisol can suddenly drop or increase even if the pup has been doing well on the same dose for some time...and I do mean suddenly. And it is often difficult to find the optimal dose when first starting out which means there is frequent testing…sometimes every 2 weeks for months at a time while the correct dose is found. And even then the level can change so much so fast that the testing protocol for Vetoryl is more frequent that with Lysodren. On Vetoryl the pup must have the ACTH test 2 weeks after starting treatment; the second test 30 days after starting treatment; and IF the cortisol level is good AND all signs are well controlled at this point, then every 3 months for the rest of the time the pup is on treatment. With every dose change, increase or decrease, this schedule is supposed to start all over at the 2 week mark. With Lyso there may be 2 or 3 tests during the loading phase to make sure the load has been achieved and again in 30 days and 90 days. Then if the dog is doing well testing can be stretched out to twice a year. Of course, the testing starts over with any dose change with Lysodren as well but that does not happen as often as it does with Vetoryl.

There are a couple of positives in my mind about Vetoryl. It does have a very short life in the body, which is both a positive and a negative. The negative is this results in frequency dosing, daily or twice daily, so not only is the dog having to take more pills we have to buy more pills; the positive is - this means if something does go wrong Vetoryl is leaving the body much sooner than Lysodren can. Usually simply stopping the Vetoryl for a little while and then restarting on a lower dose will do the trick...no pred or other intervention needed with Vetoryl MOST of the time. Not always tho. With Lysodren it can take up to 48 hours for the drug to clear the body meaning Prednisone is a necessity when using Lyso should a problem arise. With either drug, any sign the cortisol is going too low is critical and requires immediate attention...but especially so with Lyso. Another positive is the availability of Vetoryl compared to Lysodren currently. From time to time it has become difficult to find Lysodren but Mitotane, the compounded form, is readily available. Another positive is that due to Dechra’s marketing of Vetoryl, more vets are familiar with Vetoryl than they are Lysodren these days and this is often the deciding factor as to which drug to choose…which one does your vet have the most experience with and the most success with?

Bear in mind, much of my feelings about Vetoryl VS Lysodren stem from working on the FB groups. There are over 30,000 combined members and the vast majority of them are using Vetoryl…and I see dogs on Vetoryl dying every single day primarily for the exact same reasons dogs were dying from Lysodren all those years ago…arrogant vets who think they know everything, refusing to listen or learn, and uneducated parents. My personal experience is limited to Lysodren. Thankfully, Squirt's vet had never heard of Trilostane and I wasn't too keen on possible issues with getting it in from the UK so we went with Lysodren. For me, I will always choose Lysodren over Vetoryl UNLESS the dog has adrenal based Cushing’s then Vetoryl is usually the best choice simply because of the increasing doses needed to keep control with ADH.

You must do what you are most comfortable with. You know your precious girl best of all and know her vet best of all. I have no doubt that you will be a great mom just as you always have been regardless of the treatment path Suni is traveling.

Hugs,
Leslie

[sunimist]

Oh my word!! you two are the most informative folks I have the honor of knowing!! This information is so valuable for me to sort through. If we indeed do decide to go forward with treatment, I do believe with these two posts alone, I can make the best possible choice for Suni.

One more question, if we do choose Vetoryl, can I start off at half of the lowest dose available? Is compounding terribly expensive? I am no longer working
and on a fixed income, so finances would or could be an issue.

Throw any advice and info you have at me. I need it!!!!

[labblab]

If you do opt to treat with the chemical, trilostane, the smallest available brandname Vetoryl capsule is 5 mg. Since Suni weighs 12 pounds, that dose given once daily would represent less than .5 mg. per pound. The lowest generally recommended formula is 1 mg. per pound, although some specialists feel even more comfortable with a formula of .5 mg. per pound. So either way, the 5 mg. capsule would already be less than half of the more commonly recommended formula, and also would conform with the advice of those specialists who prefer to start even lower.

If you want to start even lower than that, though, you would need to have a custom dose compounded. In that event, the good news is that compounded trilostane products are typically significantly less expensive than Vetoryl. So financially, compounding should not present a problem for you if that's the route you and your vet decide to go.

[Squirt's Mom]

I agree...the 5mg Vetoryl capsule would be half the lowest starting dose so this would be a good place to start. Liquid Trilostane has several advantages tho....it is very easy to give as all you have to do is drop the med into the food, and it is very easy to adjust any dose changes without having to purchase a new 'script. For example, a liquid Trilo might say 50mg per ml so you can easily calculate any dose changes, up or down, using that 50mg/ml. If you need 10mg you would give 1/5 of a ml or 0.5cc, 5mg would be 0.25cc and so on. The liquid Trilostane is the easiest for the dog and the most cost efficient way to go in my mind.

[sunimist]

I like the liquid idea better for a few reasons. Suni has taken so much medicine the past year that she is beginning to be a pain giving pills. She always, before, would take anything I gave her, but has become a bit rebellious for a few months. I am afraid the capsule would be a bigger challenge than I could successfully manage. And even if we started at the 5 mgs, it could still be compounded, right? So, I am really glad to learn all this. Thanks again ladies.

[labblab]

Theoretically, here in the U.S. it is illegal for compounders to duplicate products that are available in a brand form. This means that compounded trilostane capsules in dosage strengths of 5, 10, 30, 60, and 120 mg. are not permitted in the U.S. since those are the Vetoryl doses manufactured by Dechra. I’m not sure if this extends to compounded trilostane in other “solid” forms such as pills or chewable tablets (which also exist). You’d have to check with the compounder about that. So in other words, you could get a compounded trilostane capsule in 4 or 6 mg., but not in 5 mg. Other countries may not have the same prohibition, but this is the case in the U.S. You’re right, though, that with a liquid suspension, there’s no problem at all in this regard because you get the whole bottle of liquid and then just parcel it out in whatever amount your vet prescribes.

I do want to again voice a personal caution, though, about compounded formulations and especially liquid suspensions. I certainly understand the attractiveness of a liquid. However, 5 mg. of trilostane that’s ingested via a liquid that’s syringed or chewed after being added to food may be metabolized differently than a powder that reaches the stomach intact within a capsule. All of the original clinical trials that went into FDA authorization were based on medication delivery via capsule, and 5 mg. via liquid (or compounded chewable pill) may be metabolized differently (with different effectiveness) than 5 mg. protected by capsule en route to the stomach. In reality, this may not actually present any problem at all in the case of trilostane. But this is why I personally would feel more comfortable starting my dog on a genuine Vetoryl capsule if I could afford it and my dog would swallow it. I would like to know whether my dog improved without side effects taking the established researched product. If so, and then if there were immediately problems after switching to a compound, I’d be more suspicious that there was some sort of a problem with the specific compounded formulation I was using as opposed to trilostane itself just not working well for my dog.

For instance, back in the old days when we were much busier here, it seemed to me that we encountered more issues with dogs who were using liquid formulations — cortisol levels that were more erratic and difficult to control. This is solely my personal impression and not based on any actual comparative studies or anything. But I always wondered whether maybe the trilostane wasn’t evenly distributed throughout the suspension, or consistently measuring out the liquid was hard, or the suspension itself had gone bad, or the chemical just wasn’t as effective if absorption started out in the mouth or throat. I can’t argue with Leslie about many of her criticisms of Dechra, but I figure (perhaps naively…) that if the Vetoryl box is marked 5 mg. per capsule, at least that’s the exact dose my dog is getting. And also without any absorption occurring until the powder is released in the stomach.

Now if Suni (or any other dog) can’t or won’t swallow a capsule, then all bets are off, and we’re very grateful that a liquid formulation exists as a possibility. Or again, if a dog needs a customized dosage for a solid pill or capsule, then compounding is the solution. But I just wanted to explain more fully why I personally continue to advocate for the use of Vetoryl when first starting off if it’s a viable option. And now that I’ve *fully* beaten that dead horse, I’ll shut up about it ;-))))). Whatever you and your vet decide is the best route to go, I’ll be supporting you 100%!

[Joan2517]

Lena got very suspicious of anything I fed her after she started Vetoryl and I had to get creative, but Gabe was so easy. He ate anything and never noticed a pill or two or three in it. I was very lucky with him.

[sunimist]

Hi Joan! Indeed you were lucky. Suni has been an angel taking meds all her life up until the past year when she had to take so many. She just plain got fed up with it
and drew the line in the sand. I truly do not know if I could dose the meds in capsule form or not, but I lean to "not". So that would really present a problem with having
such an iffy schedule of dosing. I'm so lost and stressed over all this. My girl has such a hard time in some other ways with other issues that I just hate to add to her stress.

Marianne, I certainly do understand where you are coming from and It opens a whole new thought for me. I had not thought about that aspect of it. Thanks for always
giving such informative details.

P.S.
I do remember trying liquid Lysodren on Misty and it didn't seem to be as effective as the pill form, so I went back to the pill.