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Thread: Dealing with Cushings in a third world country

  1. #11
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    Default Re: Dealing with Cushings in a third world country

    Quote Originally Posted by M&Inu View Post
    I have so many questions still:

    Could you recommend a starter pack to treat Cushings blind? I know this is a lot to ask, but as I have stated my vet and I would be going about this by clinical signs not tests.
    There really isn't a way to treat a cushdog safely without the proper monitoring ACTH stimulation test but since this is not an option for you, starting Inu out at a much lower dose of Trilostane would be something you could try. The results of one study indicated that larger dogs require smaller doses so it is entirely possible that a low dose would be adequate for Inu. Keen owner observation is one factor that is needed when treating a dog for Cushing's so you would want to watch out for any ill effects from the Trilostane.

    Trilostane does have a short half-life and leaves a dog's system rather quickly, so usually just stopping the Trilostane is enough when a dog is displaying symptoms of cortisol dropping too low, but not always.

    Quote Originally Posted by M&Inu View Post
    Since I currently only have 60mg capsules. I will start Inu on one capsule daily. If I am successful buying this compounded Trilostane (while holding still the hope to get Vetoryl, since I have heard the dosage and strength of Vetoryl is more reliable) should I buy certain range of MG capsules?
    Like maybe 5mg, 10mg, 30mg, 60mg to make combinations and adjustments on the way depending how Inu reacts to the dosages?
    Trilostane cannot be compounded in the same exact dose as Vetoryl capsules so the dose cannot be exactly 5, 10, 30, 60, or 120 mg. However you can have them made into doses of 4 or 6 instead of 5, 9 or 11 instead of 10...etc. Having doses of 4 mg or even lower such as 2 mg, I think, would be better since monitoring with the ACTH stimulation tests can not be performed.

    Quote Originally Posted by M&Inu View Post
    Also I wanted to know how much prednisone I have to have at hand for a 89 pound dog, as an emergency help if she displays the side effects? Should I have it as tablets at hand or since vomiting is a side effect, as is injection too? Is the injection subcutaneous or intramuscular?
    The oral rescue dose of Prednisone is .25 mg/kg so to convert Inu's weight of 89 pounds in kg you just divide 89 by 2.2 which = 40.45 then times that by .25 which = 10.1, so the Prednisone recommended is 10 mg. I'm not sure if prednisone can be injected subcutaneous. My vet gave me dexamethasone shots to keep on hand in case my dog needed them. Dexamethasone is a much stronger steroid so the dosage strength needed is a lot lower than prednisone .

    Quote Originally Posted by M&Inu View Post
    I have been trying to read all there is. And taking the medication in the morning with food is what I am going to do. But are there any other newbie and "how to treat where there is no doctor" recommendations?
    I don't know of any, maybe someone else will.

    Quote Originally Posted by M&Inu View Post
    She is also getting ear drops for a mild ear infection.
    Are any steroids in the drops?

    Quote Originally Posted by M&Inu View Post
    What can I keep giving her? What should I stop? Are there better alternatives natives for supporting her brain, liver and joints when on Trilostane?
    I have used Denamarin in the past but did switch over to Milk thistle as it was much cheaper.

    Quote Originally Posted by M&Inu View Post
    Also I know this is a long stretch but I was reading sometimes people have been able to correspond with Dr. Bruyett or that he can look at a forum thread when asked? It would mean a lot to me to be able to get a second opinion on my case. Just to go over the very basic blood test results I have and advise on dosage and drug interactions.

    Dr Bruyette's email address is David.Bruyette@vca.com. Another renown endocrine expert is Dr. Mark Peterson and he has a blog that you or the vet could respond to: https://endocrinevet.blogspot.com/20...s-disease.html his email address: info@animalendocrine.com

    Lori

  2. #12

    Default Re: Dealing with Cushings in a third world country

    Hi Lori,

    So many thanks for answering my questions.

    I know I am risking it big with treating Cushing, like this, blind, without test, but I want to do something, just exhaust my possibilities, and I hope that if I am very careful and vigilant on her reactions I could maybe get a right dosage, to at least slow down symptoms like hipertension, panting, polydipsia and polyphagia?

    I need to read up more on how compunded medicine works, to even know how to order it in Diamondback. I have already emailed them and they got back to me saying they will ask their compliance department. I am being hopeful they will agree.

    Thank you, I have ordered in the human pharmacy prednisone in that dosage, just to have at hand. I will ask my vet about dexamethasone injections.

    The ear drops contain: Ivermectina20mg, Prednilosona40mg, Gluconato de Clorhexidina50mg, Ketoconazole200mg and Gentamicina300mg. These drops were prescribed for one week of usage, and her last dose is tonight.

    Could you tell me what brand of milk thistle tablets you buy and what dosage you give? Thank you.

    I wrote to Dr Bruyettes email but the address is getting rejected. I send it one time to David.Bruyette@vca.com and the second time to david.Bruyette@vca.com (lower case D), both times I got the message of address not found.

    Thank you so much for answering and being so supportive.

    I hope you are having a nice day.

  3. #13
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    Default Re: Dealing with Cushings in a third world country

    Glad to offer some ideas for TCM approaches. In no particular order as to how well they work -


    Men Dong Tang (Ophiopogon Decoction Formula) - http://franklintnvet.com/cushings-disease-in-dogs/

    Si Miao San (Four Marvels Powder) - http://www.gfcherbs.com/Images/Four%...0Monograph.pdf

    Long Dan Xie Gan Tang (Gentiana Longdancao Decoction to Drain the Liver) - http://franklintnvet.com/conjunctivitis-in-dogs/



    Some general info on treating canine Cushing's Holistically -

    http://ivcjournal.com/integrative-ap...hings-disease/

    https://www.tcvm.com/Portals/0/SummerFall2015.pdf


    From our archive on some of this info:
    http://www.k9cushings.com/forum/show...ne-and-Cushing


    In case you aren't aware, TCM does not approach medical conditions by disease but rather is a "... unique paradigm of medicine (that) grew out of penetrating observation of how everything in our reality functions at the deepest, invisible levels and interacts with the surface or visible physical levels. It’s a medicine of extraordinary relationships. Every TCM principle, theory, and healing practice reflects and harmonizes with the relationships that exist within natural law."** All of which means they do not look at the disease "Cushing's" but rather things like dampness, heat, blood deficiency and so on. And I am NO expert by any means....I use Western Herbal approaches but do trust and respect the very ancient approach to medicine offered by TCM.
    ** https://www.tcmworld.org/what-is-tcm/


    A formula found using both western herbs plus a Chinese herb called Rehmannia from Veterinary Herbal Medicine -

    1 part Ginkgo (Ginkgo biloba)
    1 part Milk Thistle seed (Silybum marianum)
    1 part Dandelion root (Taraxacum officinale)
    1 part Rehmannia root (Rehmannia glutinosa)
    1 part Astragalus root (Astragalus membranaceus)

    "Part" means any measurement. So if you use 1 teaspoon of Ginkgo then you will also use 1 teaspoon for each of the other. If you use 1 tablespoon for Ginkgo, you use 1 tablespoon for the others and so on. There is no set amount - you determine that with the first ingredient in this formula. Buy actual herbs if possible not herbs that come in capsules etc. A good place to get high quality herbs is Mountain Rose Herbs and if you contact them they can tell you if they can ship direct to you where they are. If they can't and you wish to try this, again I can help with shipping if need be. I order from them all the time. The names in italics are the bi-nomial or Latin names which fully differentiate herbs. Often common names, like Dandelion or Milk Thistle, are used to talk about completely different plants depending on area, culture, traditions passed down, etc. so always refer to the bi-nomial/Latin name when researching or ordering herbs.

    I hope you find something of benefit in this info!

    Hugs,
    Leslie

    Sources referenced in addition to websites listed above:
    Manual of Natural Veterinary Medicine: Science ad Tradition by Dr. Susan G. Wynn and Dr. Steve Marsden
    Veterinary Herbal Medicine by Dr. Susan G. Wynne and Dr. Barbara Fougere
    Last edited by Squirt's Mom; 12-26-2017 at 04:18 PM.
    "May you know that absence is full of tender presence and that nothing is ever lost or forgotten." John O'Donahue, "Eternal Echoes"

    Death is not a changing of worlds as most imagine, as much as the walls of this world infinitely expanding.

  4. #14
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    Default Re: Dealing with Cushings in a third world country

    Just a quick note regarding the ear drops: Prednilosona, I believe, is a steroid, and even though she's only been on it for a week it will cause increased drinking, urinating, and appetite. So I would probably wait for at least a few days before starting the Trilostane, my reasoning behind this is because those symptoms may lessen a bit and since you are needing to watch for changes in her clinical symptoms to judge how the Trilostane is working, it may cause this judgement call harder to make.

  5. #15
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    Default Re: Dealing with Cushings in a third world country

    Quote Originally Posted by M&Inu View Post
    Hi Lori,

    I wrote to Dr Bruyettes email but the address is getting rejected. I send it one time to David.Bruyette@vca.com and the second time to david.Bruyette@vca.com (lower case D), both times I got the message of address not found.
    Another one of our members is corresponding with him by email right now so I'm going to ask them for his email address, but in the mean time try this one: david@anivive.com

  6. #16
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    Default Re: Dealing with Cushings in a third world country

    This is Dr. Bruyette’s new email address: DaveBruyette@veterinarydiagnosticinvestigation.com.

    He is no longer at the VCA Hospital, and is a co-founder of this new consulting service.

    https://www.veterinarydiagnosticinvestigation.com/

    Marianne

  7. #17

    Default Re: Dealing with Cushings in a third world country

    Hi Leslie!

    Thank you so much for all the articles and information about the options of complementing Cushing treatment with Chinese herbs. I am definitely ordering, since I can get that as soon as possible. Only I wanted to keep on asking:

    I searched in The Mountain Rose Herbs website, but I would have to buy each individual herb and make my combinations myself.

    So I read through the thread in this same forum, you were so kind to link me to, and they said they buy from www.tcvmherbal.com where I could buy the combined formulas cited in this article: (https://www.tcvm.com/Portals/0/SummerFall2015.pdf)
    But when I clicked on that website it only says they sell their herbs to veterinarians, you can do a zip code search to see what veterinarian in your area has their products, but I am sure I will encounter yet again the same problem: nobody wants to sell me any Cushing medicine without a prescription, or without seeing the dog themselves.

    So I googled the author of the other article you linked me to: http://ivcjournal.com/integrative-ap...hings-disease/
    And I found they have an etsy store where they sell their herbal combinations:
    Si Miao San (Four Marvels Powder) https://www.etsy.com/listing/2156692...op_home_feat_1
    But they dont have the Men Dong Tang (Ophiopogon Decoction Formula) I would have loved to try out.

    I wanted to know what you would recommend. Would I be able to cobble together my own formulas buying each individual herb in Mountain Rose Hebrs? It would be so much easier to be able to buy https://store.tcvmherbal.com products, since they are listed by name in the articles and I could use the help finding similar case studies to buy those combinations, for example:

    Snowflake was treated with acupuncture once every 2 weeks, was given a cooling diet and daily Chinese herbal medicine with Zhi Bai Di Huang and Four Gentlemen for 2 months initially. 2 weeks later, Snowflake showed significant improvement. She had normal appetite and seemed to be calmer, panting less, and slept better at night. Herbal medicine was switched to Ophiopogon Formula and acupuncture sessions were then tapered to once a month. 4 months after the initiation of TCVM, Snowflake had normal appetite, water intake and urination. Her skin coat was normal and she continued to sleep well at night. Trilostane was successfully weaned off over a 2-month period without any signs of relapse of the disease. Snowflake continued receiving acupuncture every 3 months for maintenance, as well as daily herbal therapy based on pattern diagnosis. (https://www.tcvm.com/Portals/0/SummerFall2015.pdf)

    Thank you so much for all the information! Hugs!

    Quote Originally Posted by Harley PoMMom View Post
    Just a quick note regarding the ear drops: Prednilosona, I believe, is a steroid, and even though she's only been on it for a week it will cause increased drinking, urinating, and appetite. So I would probably wait for at least a few days before starting the Trilostane, my reasoning behind this is because those symptoms may lessen a bit and since you are needing to watch for changes in her clinical symptoms to judge how the Trilostane is working, it may cause this judgement call harder to make.
    Thank you for your recommendation! And thank you for the other address for Dr Bruyette you gave me.

    Quote Originally Posted by labblab View Post
    This is Dr. Bruyette’s new email address: DaveBruyette@veterinarydiagnosticinvestigation.com.

    He is no longer at the VCA Hospital, and is a co-founder of this new consulting service.

    https://www.veterinarydiagnosticinvestigation.com/

    Marianne
    Hi Marianne! Thank you very much, I wrote to him on this address you gave me, he already answered back I! I had not expected that, its amazing. Thank you so much.

  8. #18
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    Default Re: Dealing with Cushings in a third world country

    I make most of my own herbal meds using the individual herbs like those from Mt. Rose Herbs and the folk method of preparation. Teas are easy to make but don't last long nor are they as strong as tinctures using alcohol. It's easy to make them (tinctures) using the folk method and I'd be glad to direct you to sites explaining how they are made or explain to you myself. As for the TCM formulas...they are not easy to make and I have never tried because the ingredients that are used are not readily available here. If I were you I would keep searching for the formula(s) you want to try - humans use these same formulas. Use google to find sites where the formula(s) are being sold and see what they require for purchasing. A friend of mine used an animal herbalist in Australia....let me see if I can find that info and I will share it with you. She may have some products already made that may help.
    "May you know that absence is full of tender presence and that nothing is ever lost or forgotten." John O'Donahue, "Eternal Echoes"

    Death is not a changing of worlds as most imagine, as much as the walls of this world infinitely expanding.

  9. #19

    Default Re: Dealing with Cushings in a third world country

    Thank you Leslie, sorry I did not answer sooner.

    I went ahead and have given her Trilostane three days in a row, each day in the morning 60mg capsule with her food. I felt great yesterday, because she was perking up, drank less and looked better than in weeks. She even got up without problem, really amazing, I was over the moon and we all celebrated yesterday.

    Then today she woke up with severe rear end weakness, like she goes into her knees when standing and needs help getting up. I am discontinuing the Trilostane, I bought prednisone, but haven’t given her any, because she is drinking water, eating and going to do her business outside as always, but needs help to not drop her rear end.

    I don’t need to tell you all how bad I feel seeing her like this. I now feel guilty for giving her the Trilostane, even if prescribed by a veterinarian. I really have been crying for hours and feel even more helpless than before. I don’t know what to do and if I just made everything worse.
    Also since many talk about electrolytes imbalance I have been given her oral serum to drink.

    I don’t know what to do. How to really help her. I am simply lost.
    Last edited by M&Inu; 12-29-2017 at 01:11 AM. Reason: Trilostane was missing in one sentence

  10. #20
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    Default Re: Dealing with Cushings in a third world country

    I am so sorry for such a worrisome day, after having first enjoyed improvement. However, please do not feel guilty about giving the trilostane, because that may not be causing the problem at all. Especially if Inu was being more active than usual for a couple of days, it may be that she has strained some ligaments or muscles that have been under-used lately. I have a torn cartilage in my own knee, and I’ve learned that I can easily pay the price for “overdoing” on days when my knee has felt better. And that sends it back to hurting again. So I am hoping that perhaps this acute weakness will improve again with a bit more time.

    If Inu is otherwise acting normally (for her) in terms of eating, drinking, bowel movements, etc., then I would not worry so much that the trilostane has excessively lowered her cortisol. Also, in the absence of test results or other evidence that her electrolytes are actually “off,” I caution you about giving her a solution to alter her electrolytes. You may unintentionally actually cause an imbalance when there was not one originally.

    As hard as it is to see her having trouble standing right now, I’m really hoping this is a temporary setback. If is indeed being caused by pain, perhaps your vet could provide a prescription for medication such as tramadol. This is a type of painkiller that can be effective for animals and humans alike, but it is not in the class of drugs, the NSAIDS, that can be dangerous to give to dogs who suffer from the elevated cortisol levels associated with uncontrolled Cushing’s. Just a thought you might want to discuss with your vet.

    Marianne

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