11 year old Doxie with tumor on Adrenal - Bondo has crossed the rainbow bridge

[infoviewer]

Hi Trese: I have not posted before. I cannot believe how similar our stories are. My CoCo will be 12 in September. He is on 20 mg of Vetoryl. We travel in a motor home. My husband has prostate cancer. Had radiation treatments in 2004 and has done well. He also has breathing problems. CoCo is also doing well. He has lost hair on his head and back and the hair has not grown back where he was shaved for an ultrasound. He also has hypothyroidism. Has 4 calcium deposits on his tail, but he has not noticed them at all. Your doxie seems to be doing so well. CoCo is due for another ACTH. I am wondering if he would do better on a little higher dose of Vetoryl. He still cannot jump like before, which is probably a blessing. CoCo only weighs between 11 and 12 pounds. I hope you have a wonderful trip. Take care. JoAnne

[Trese]

Hi JoAnne.
Just read your post as we have been traveling....getting ready for the summer at our home, etc.
Hope your little Coco is doing well. Yes, we seem to run somewhat parrell lives. Small world, isn't it?

Update on Bondo. He did so well on our trip to Moab. He LOVES all the new smells in all of the campgrounds we stayed in along the way. I am a little concerned about a few things and I have a Vet appointment in the morning. He is on the 30 mg of Trilo and has been doing so GOOD but about 3 weeks ago he started losing his hair again. One spot is on his back and I was petting him and a big clump of hair fell out. A few more of the cutis calitinos (sic) sores on his belly and one front paw. His thirst is very high again, also. No accidents in the house but we are very good about making sure he goes outside. We, also, have a doggy dog so he is free to go in and out when he wants to.

I was wondering if anyone gives their furry child a dosage in the morning and evening????? I will post results I get from the Vet tomorrow. Bondo has been on the Trilo for 7 1/2 months.

Thanks for listening........

[molly muffin]

Hi Trese,

Yes, sometimes it works better if they do morning and evening dosage. You split the dose, instead of one 30mg for instance, you would give 15/15. However, having said that, it is awhile since you have had a regular ACTH test with both pre and post and it sounds like his post number has risen causing the cc symptoms and the loss of hair to come back. I would have a complete ACTH test done to see what that post number is as that is the one that is important in this case.
Glad that you have been having a good time. My mom and dad traveled by motor home for years and loved it. They ended up doing it full time till it got to where they couldn't any longer.

hugs,
Sharlene and Molly Muffin

[Trese]

Well, the "little money pit" is asleep right now on the floor near the swamp cooler. We will get some really hot weather this weekend so we are heading up to Mammoth where it should be cooler. Ok, the vet did the complete blood panel and all is well. With Cushings he says other organs are sometimes affected and it is good to keep an eye on things. Bondo's resting cortisol was 4.5 with a range of 1.0 - 5.0. 3 months ago it was 1.1.

Other tests were done as Bondo was licking near his tail. Yep. he has a yeast infection so home I went with a salve and antiboctics (oral). He will go back in to get his urine tested in about a week to see if the infection has cleared up. Vet says the excess thirst he was having might be due to yeast infection. Bondo has been on meds for about a week and no more thirst. Vet does not want to raise his Trilo unless he really has to and I agree. Bondo weighs 20 lbs and we are on a 30mg. a day. No other Cutis Cal sores have appeared. He will be 12 years old in August so I take one day at a time. He , still, runs and greets us at the door and loves to eat.

Wishing all of you a very happy, not too hot and safe 4th of July. God Bless our troops who protect us.

[labblab]

Hi again, Trese.

It is so good to hear back from you and to read your update. I am sorry, though, that Bondo had a rebound in some of his Cushing's symptoms earlier in June, especially the calcinosis cutis. As we've discussed before, this is a condition that has the potential to really blow up quickly and if so, can really raise havoc with a dog's quality of life and become very difficult to contain. Dogs with elevated cortisol are also more vulnerable to a range of infections.

I know we've had the following conversation many times. But under these circumstances, I feel as though I really need to repeat a reply that I first posted during the winter. I still do not understand why your vet chooses not to perform a full ACTH monitoring test on Bondo since this is the only way to accurately assess whether or not he needs an increase in his trilostane dose. Now if both you and your vet have reasons why you do not want to increase the trilostane dose even in the event that his cortisol is too high, then it's true that there is no point in ACTH testing. But since you are indeed treating Bondo with trilostane, I would think you would want to be giving him the dose that offers proper control of his cortisol. Is there some reason why that is not the case?

That "resting cortisol" range of approx. 1-5 (or 2-6 for some labs) is the laboratory "norm" that is given for a dog who does not have Cushing's. Historically, the baseline cortisol reading has not had significance for monitoring a dog being treated with trilostane. However, a researcher at Texas A & M who is also a consultant to Dechra, Dr. Audrey Cook, has recently performed a study aimed at investigating whether or not baseline cortisols may have predictive value in assessing whether a dog is being overdosed or underdosed on trilostane. Dr. Cook freely admits that more research is necessary to decide the true clinical significance of this study, but her initial findings suggest that baseline cortisols between 1.3 and 2.9 were associated with good cortisol control for the dogs she tested. She recommended full ACTH tests for dogs with baseline cortisols outside that range in order to insure that their post-ACTH results fell within parameters that were safe and effective. Here's a link to Dr. Cook's study:

Evaluation of the use of baseline cortisol concentration as a monitoring tool for dogs receiving trilostane as a treatment for hyperadrenocorticism

As I say, this is new research, so if your vet is legitimately trying to rely on Bondo's baseline cortisol as an indicator of appropriate dosing, this would be the most current guide. And as you will see, Bondo's baseline cortisol of 4.5 places him above Dr. Cook's "acceptable" range and within the category of dogs requiring a full ACTH stimulation test in order to assess whether their adrenal function is being controlled adequately.

Marianne

Based on this most recent baseline cortisol, Bondo again is exhibiting a level that places him above Dr. Cook's "acceptable" range for a dog being treated with trilostane. So we really can't have any confidence right now that this is the correct trilostane dose for him. Given his symptom rebound, the best guess is that he needs an increase. But he needs to have a full ACTH test to know for sure.

I know you must feel as though I keep repeating myself over and over again (and that's because I am ). And I do not want anything I say to keep you from returning and updating us because we are always anxious to know how you guys are doing. But in clear conscience, I feel as though I have to continue to comment on Bondo's situation and the reasons why I'm so hopeful that someday your vet will evaluate Bondo's status using standard testing protocol.

Marianne

[molly muffin]

Hi, glad to hear that you discovered what the problem has been with the licking. (the yeast infection) You can bet if his resting cortisol has risen to 5.4 from 1.1 then his reserve (post number) is quite a bit higher and that could cause the cc to get potentially worse. Keep an eye if the drinking and peeing start to get out of wack again, or the cc starts to get worse, that is a clear sign that his cortisol has slipped out of control, which can happen.
It's sweltering here too right now. Mammoth I am sure will be cooler.

hugs,
Sharlene and Molly Muffin

[Trese]

Happy Summer to all.
Well, this is Bondo's birthday month. On August 12th he will be 12 years old. He is doing fine. The (Calcut) has come back but no excess panting, drinking of the water or peeing. No excess hunger, either. You know, his pattern changes. In the morning he is like a puppy, running around, barking at me to feed him his breakfast then as soon as he eats he sleeps which is most of the day.

When I say, "Let's go outside" he will gladly get up and go outside to survey his kingdom. No accidents in the house.

He is on the Trilo 30 mg and I know alot of you are concerned that I should have an ACTH test but I am going with my heart and I do the blood work every 4-6 months with a test of his cortisol. I just hate to load his system up of more meds which I know may create other problems that he does not have now. However, I do value your concerns and true interest in Bondo's well being. All of you are so caring. Thank you.

[Budsters Mom]

Happy 12th birthday Bondo! I am glad that he's doing so well. Love the puppy like antics in the mornings!

[Squirt's Mom]

Happy 12th Birthday, Bondo!

[molly muffin]

Happy Birthday Bondo!!!!! Still cute as can be!!

Glad to hear from you Trese and that things are going well. He sounds like he is doing fine.

hugs,
Sharlene and Molly Muffin