REMY diagnosed last week

Hello Again, I used to be here as “Amanda’s Mom”. She had an adrenal tumor which was successfully removed and she lived another year of so before passing away from CHF. This time it appears to be the pituitary form. We adopted Remy four years ago. He is just now turning 11, a rescued Bichon and came from a backyard breeder after the man passed away. His teeth were beyond deplorable and he was never socialized. Even four years later he has only bonded with my husband and remains afraid of pretty much everything. I have wondered if the stress he lives with might even contribute to his Cushings. Remy always had high liver enzymes and we had an extensive work up in Feb 2018 including a liver biopsy, cortisol levels, bile tests, copper storage disease and liver shunt testing. The internist felt since he wasn’t having any clinical symptoms it was likely some chronic form of inflammation. Treated with prednisone for awhile then eventually discontinued. Never reached ‘normal’ liver enzymes levels. He was always a picky eater, a grazer and not at all food motivated. We would throw so much food away as it would sit all day untouched. In December I noticed he was actually looking for his food and eating it all up. Sometimes he’s looking to see if Angel has left him anything in her bowl. He isn’t ravenous, but definitely eating like most normal hungry dogs do. He has developed a pot belly and I feel his coat is a bit thinner. It was always horrific to get a clipper thru and I noticed at his last grooming it doesn’t seem as thick. He seeks out cool places such as the tile floors but he’s always done that. At night even with our bedroom chilled to around 66 and a fan over him he puffs and pants much of the night. He is sluggish and not at all active but he’s always been that way. He refuses to take walks or show any signs of being interested in activity. Favorite thing is a car ride or to go to bed. We have not had any increased drinking or peeing (yet!). But I felt there were enough changes to warrant asking about Cushings when he had his semi annual senior blood work. The vet ran a comprehensive panel plus urinalysis 2/7/20.
Liver Enzymes were more elevated than ever ALT 714, ALP 772, AST 58, GGT 60, TP 7.6, Cholesterol 443, Glucose 143, platelets 617, T4 1.8, urine protein 1+. He also did another ultrasound and both adrenal glands seemed slightly enlarged. The liver is also somewhat enlarged and hyperechoic (as it has been for several years).
ACTH performed 2/14/20, precortisol 7.8 and post cortisol 24. PIcked up trilostane yesterday with recommend dose 20 mg. Per day either as one dose or two 10 mg doses. Remy is right at 18 pounds. Do you think the two doses is preferable? As long as he’s eating we’re fine. But if he reverts to the old grazing and picky behavior that may complicate things.

I feel he is early stage with mild symptoms so I certainly don’t want to overdo the trilostane. You are a very smart group so I welcome your suggestions. My past experience with Cushings was 23 years ago and more recently Amanda a few years ago but removal of her Adrenal tumor effected a cure and she never did have any clinical symptoms. Remy’s liver situation has always been a concern but the internist felt until he actually exhibited clinical symptoms of something we were throwing money away to continue testing.

We have one other dog, our 14 year old rescue toy poodle Angel. She also has highly increased liver enzymes and TP and pretty much always has. She is missing a lobe to her liver and she is on chemo for Transitional Cell Carcinoma. We are just about at the one year mark and on our second chemo protocol but so far so good. Just started seeing some blood in her urine once in a while but as of 3 weeks ago there was no progression of her disease. We caught it exceptionally early and she has done well with no ill effects from the chemo. I know that isn’t going to last however so I am figuring out the next steps for her as well as for Remy.

I am aware of the team at Washington State University who has been successful with pituitary tumor surgery and it wouldn’t be out of the question but there are many factors including his ever present liver inflammation, his age and the risks of this yet rare surgery. Needless to say, life is consumed with my furry kid’s issues and I welcome your suggestions, comments, etc. Thanks so much to everyone here!! Claire

Hi Claire! It's so nice to see you again, but sad for the reason. I am also going through Cushing's again with my big guy, Gable. I don't have any answers for you, but just wanted to say hello. Joan

Hi Joan so nice to hear from you too!! So sorry to hear you are ‘at it again’. Sometimes it seems we are simply given those who need help the most sometimes repeatedly. This is my third Cushings, second with Transitional Cell Carcinoma and lost two boys to resistant kidney infections in the past few years. I hope things go well for Gable. It’s such a frustrating disease for sure!! Claire

Welcome home again, Claire! I want everybody to know that Claire deserves a standing ovation for her patience and perseverance in returning to us. Due to some weird glitch with our forum software, she’s been unable to log back in under her original username of “Amanda’s Mom.” But thankfully, we’ve finally gotten her re-registered in conjunction with Remy. In case anyone wishes to revisit Claire’s postings re: Amanda and her successful adrenalectomy, here’s a link to Claire’s original thread:

https://www.k9cushings.com/forum/sho...da-is-free-now

Also, in looking back, I’m remembering that Claire had also started a different thread about Remy and his socialization challenges back when he was first adopted. So here’s also a link to that thread, too, with a lot of very valuable suggestions and experiences related to behavioral shaping:

https://www.k9cushings.com/forum/sho...lter-Dog/page6

Reading through both those threads highlights Claire and her husband’s incredible ongoing devotion to their rescued babies. A huge “Thank you” to both of you for your love and your grace and your kindness to animals in need!

Finally, circling back around to Remy’s current situation, I can’t disagree with any of your internist’s suggestions thus far. I think you’ve been on the right track, and I also would have been cautious about leaping into treatment earlier. Now that you’re going to begin, I guess my only “different” suggestion would be to start off even lower than the 20 mg. Since you have 10 mg. capsules, you have the luxury of being able to introduce Remy’s body to the effects of the medication even a bit more gradually. If Remy were my own, I’d talk with the internist about starting with one 10 mg. capsule each morning for at least the first week. If all goes well, you then can consider adding the additional 10 mg. Or, if you might even wait until the first monitoring blood test before doubling the dose. Remy may well need the extra dosage, but time after time here, we’ve seen that dogs tend to exhibit fewer unwanted side effects when they start at a relatively low dose and work upward only as needed, rather than vice versa.

If and when you do increase to 20 mg., I’d suggest going whichever dosing route best suits your own schedule and Remy’s eating habits. Trilostane needs to be taken along with food to be metabolized properly. So if you choose to dose twice daily, then you need to arrange food intake alongside each dose. Different studies supply pros-and-cons for both once and twice-daily dosing. If one dosing pattern initially better suits Remy’s routine, though, I’d start with that. Once again, you can always make adjustments as you go along. For instance, if you start out dosing only once a day but it appears as though symptoms are rebounding before the day is over, you can always try switching to twice daily dosing.

OK, I’ll go ahead and post this much of a reply for now. But I’ll definitely be checking back to add more thoughts as they arise!

Best wishes to you and all your family, Claire ;-)
Marianne

Marianne thank you so much for your help getting back on the forum and also for the very warm welcome!! I especially appreciate your comments on starting with the lowest dose (10mg). This vet is not an internist (the one who worked Remy up previously moved away sadly) but this Dr was working along side him during that time. Still, internal med and especially endocrinology is a complex specialty and I may take him to LSU for a consult. Thought I’d see how this goes though. Especially since the ACTH wasn’t all that high and his ‘clinical symptoms’ are very minor at this point I like the idea of 10 mg once a day to start.

I had forgotten I had gotten into Remy’s socialization issues and sadly, they haven’t improved much although he barks and growls at me a bit less :). I often wonder if the fear he lives with might contribute to overproduction of cortisol simply because he is so nervous. It’s like he’s always ‘on guard’ and fearful that someone or something is going to harm him. So sad but I really don’t want to try any more drugs since they run the risk of increasing is already elevated liver enzymes.

I miss my sweet Amanda but I’m so thankful I was able to have her for a couple of years. Her adrenal surgery which I agonized over was a complete success and saved her one less complication in her precious little life. Being blind and with heart failure was quite enough.

We lost Pork Chop last January, my second with a resistant UTI which turned into kidney infection. I keep asking WHY? Why does this happen to these boys?? With Pork Chop it was. Klebsiella, Peyton had Pseudomonas. And then a month after Pork Chop, there’s Angel with Transitional cell carcinoma. UGH, sometimes the stress of wondering if I am attentive enough, making the right decisions, catching things quickly enough becomes a bit overwhelming. The support one finds here is so amazing and the kindness of all of you who have been down this path is such a blessing!! Love you all!!

Hi Claire!

So glad to have you with us again tho I am sorry it is with another cush pup! However, you know you are in the very best place for Remy. ;)

I can't add anything to what Marianne said but I did want to address a comment you made. You said -

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UGH, sometimes the stress of wondering if I am attentive enough, making the right decisions, catching things quickly enough becomes a bit overwhelming.

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I think guilt is part and parcel for those like us who seem to be magnets for these little souls who need so much more than the usual level of attention. Especially if they have been with us for a while before they get sick. I always find myself asking "what was it that caused my baby to get sick this time?" or "what early signs did I miss?" or "what could I have done different?" But the very fact that we ask these questions of ourselves simply means that we are the right ones for the job, we are the ones who will go that extra mile to learn and do what we can to help them live the best life possible. Coming back to us with Remy says the same things. I also believe that is why we end up with more than one cush pup or more than one dog with cancer or _________ - the dogs know that we will do our utmost on their behalf. Remy knew you were meant for him. All of your babies have been ever so lucky to have landed in your home and they all knew they would be loved thru everything that came along by two wonderful humans. So remember this when you start wondering if you _________ and don't let the what-ifs or maybes get under your skin (and I know how hard that can be at times! :o ).

Hugs,
Leslie

I”m not sure I’m doing the replies right Leslie but hopefully you get this. I very much appreciate your thoughts. It is terribly difficult at times, an awesome responsibility to be on top of things and be attentive. Dogs can be such stoic creatures they don’t always make it easy for us.Life gets in the way too when we become overwhelmed by other responsibilities such as family or children. I do truly understand how important it is to be vigilant and not to simply trust that our veterinarian will ‘catch’ things. This is not a knock on veterinarians at all. Like most medical professionals they have many patients and not nearly enough time to devote to them. They too have their lives to live and other responsibilities. I know most do the best they can. I do wonder why I have so many repeat issues, is it simply coincidence or am I doing something wrong? This is #3 with Cushings. I’ve had 3 blind poodles and Angel’s vision is deteriorating fast too. Two males with life ending UTIs despite getting them in for treatment very early on. I have learned and cannot reiterate enough how important early detection is. So many things have similar symptoms and it is very easy at times to mistake one for another. So hard not to become overwhelmed, even consumed by trying to figure things out and keep everything straight.A forum such as this is such a Godsend and I thank all of you from my heart for the time you volunteer to help us benefit from your wealth of knowledge, compassion and support. Bless you all for your service, and it IS a huge service to us and our beloved fur kids!!

Claire, just wanted to reassure you that you’re replying exactly correctly! :-)))

So just keep on keepin’ on ;-).

Marianne

Thanks Marianne. Remy is on day 2 of the Vetoryl and I’m sticking to the 10 mg for now until we see how he does. So far he seems just fine. I did realize I don’t have any prednisone here apparently. I think I should ask for some just in case of a crisis. I would rather have it and never need it. Since Remy didn’t have much in the way of clinical symptoms it may be a bit tricky to know how he is doing until we retest.

I sure wish there was a similar forum for canine cancer. I have yet to find anyone as knowledgeable and supportive as all of you here!!

Day 4 and no problems at 10 mg. Can’t say I’ve noticed any changes in Remy’s behavior either. He was panting quite a bit last night so I turned the overhead fan on and that seemed to help. Water consumption and peeing haven’t been an issue with him so nothing to report there. I think I will continue at this dose until Friday which will be a full week and see where we’re at. I will be open to advice as to whether or not to go up to the prescribed 20 mg dose. Thanks to everyone!

Hi Claire,

Certainly glad that Remy hasn’t shown any ill effects! How about his appetite — have you had any new problems with getting him to eat? Also, when is your vet wanting you to schedule the first monitoring blood test?

Marianne

No change in appetite. He’s still eating happily. We are going to retest after two weeks.

I think as long as Remy seems okay, I would leave him on the 10mg until you test. Gable was doing so well, I thought, on 30mg and then started drinking and panting more and I almost raised it back to the 40mg because we all thought he had room. Turned out it was just the opposite, he had dropped to .4 or .5 because of too much thyroid medication. It's a good thing I didn't raise it without testing.

He's been on 5mg now for a few months (he's 75 lbs) and even though he still drinks loads and pees like a racehorse, he's doing good. The panting has finally subsided, he's still got a good appetite and in the last few days he's been going 5 - 6 hours without having to go out at night. His fur has come back beautifully and I feel like he's doing better. I will test him again in the next couple of weeks to make sure.

After that scare with the drop in cortisol, I won't make any changes without testing. I think the key is how well we know our dogs. We watch for those little signs that only we would know are off. If something doesn't seem right, I'm off to the vet. I did that with Lena, but wasn't as aware then as I am now, that they don't always know as much about Cushings as they like to think. I don't think that Gable would still be alive if it wasn't for this forum. I'm sure they would've started him at a huge dose and I wouldn't have known better and gone along with it.

Remy’s actual dose was supposed to be 20 mg but I started with 10mg on my own until we see how he does. What makes it hard is he has very minor symptoms. No drinking or peeing at all beyond the normal. He was always a very picky eater and started to eat normally which is what concerned us. A little pot belly and somewhat thinner coat and night time panting is about it for symptoms. And really, he has done the panting at night for a long time. He insists on cuddling up to a faux fur blanket and gets too hot I think. But still, even a slight change was enough for me to consider Cushings and I’m glad we tested. I think since he has such mild symptoms, it isn’t going to hurt him to wait another week and retest and see where we’re at. My biggest concern is his liver enzymes which were pretty high but he’s always had elevated liver enzymes without clinical signs. So I think as long as they are retesting the ACTH we will do liver enzymes as well and see if there is any change. I’m glad Gable is doing pretty well now. Good thing you followed your instincts! For me, it’s bizarre to have a Cushings positive dog that doesn’t pee much. Remy can sleep 11-12 hours go outside and just lay on the porch. We have to prod him to ‘go potty’. I also want to be sure this IS Cushings and not just some minor bump in the ACTH. I am going to pick up some prednisone to have on hand in the event of a crisis and I think keep him on the lower dose until we know for sure where he’s at. You are absolutely right, they don’t know as much about Cushings as we would like.

Hi again, Claire. I very much agree with Joan’s suggestion to just leave Remy’s dose “as is” until your first monitoring ACTH. Even though the general recommendation is to leave an initial dose unchanged for the first 30 days (cortisol levels can continue to drift downward during that time), if his cortisol level is still extremely high next week, you may decide to go ahead and increase since he started at a rather low dose to begin with. Here’s some related info that you might find helpful — I just added this reply to another new member’s thread, so I’ll go ahead and repost it here, too ;).

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Originally Posted by labblab

Also, if Rex is being given an ACTH stimulation test next week to monitor his cortisol level, it’s important that he be given his morning dose of trilostane along with breakfast, as usual. He should not be fasted before taking the test. This is because trilostane needs to be given along with food in order to be metabolized properly. If not, the monitoring test may falsely indicate that his cortisol is running higher than usual. As Leslie has written, dosing increases are usually not made until after 30 days, regardless. But with every monitoring test, we want the results to be as accurate as possible.

Here’s a link to a publication printed by Dechra, maker of brand name Vetoryl. At the bottom, you’ll see a flowchart that shows you how dosing decisions are made based on monitoring ACTH tests. I think this info may be helpful.

http://www.dechra.us/Admin/Public/Do...US-046-TEC.pdf
Marianne

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As far as Remy’s liver values, this is probably way too soon to expect to see any change. It can take quite some time to see a significant impact with those, and some Cushpups never have their liver values completely return to normal range even while being treated. So don’t get discouraged if you don’t see quick improvement there, OK? I think you guys are doing great for right now.

Marianne

Remy’s ACTHwas 7.8 and 24 so not too terrible so I’m comfortable sticking with the 10 mg. Don’t know what his vet will say but I believe the thinking here is sound. He is virtually asymptomatic and I see no harm in giving the trilostane at the lower dose for a bit. I appreciate the information regarding the liver enzymes. His ALT and ALP were both in the 700’s. I know Angel’s can go up and down like a roller coaster but when hers are medication driven it can take weeks for them to decrease. With her we found one drop of neopolydex eye drops was enough to keep her liver values elevated for weeks. I know changes to his liver and gallbladder are very mild and we do an ultrasound at least every six months. In the four years we have had Remy he has never had normal liver values so I won’t panic. :). Thanks so much! Such a wealth of information here!!

We just got the test results from Remy’s first follow up ACTH. Pre 6.1 and Post 7.6. Prior to Vetoryl he was 7.8 and 24. So we will stick with the 10 mg dose once a day for the time being as it seems to be controlling his disease. VERY glad we started with the 10 mg dose!! Other than maybe a slight decrease in his panting I don’t see any changes but his ‘symptoms’ were really marginal to begin with. I’m hoping he will keep his appetite and not return to being Mr. Picky Eater!! Will keep you posted!! As always, a big thanks to everyone for the help and support!!!

I think this is a great report, and yes, I’d definitely stick with the same dose for now.

Thanks so much for letting us know!
Marianne

Wonderful, Claire!

I was very pleased to see him respond so well on a minimal dose. Hopefully he will do well at 10 mg per day. Doctor did up his amlodipine to control his blood pressure though. Also, Angel had a good report from her oncologist Monday. Her bladder cancer remains stable!! It was a year ago on March 1 that we first suspected TCC and she has had a fantastic year! Now if I can just keep Remy doing well too!! Hugs to you and your fur babies. Hope Gable is doing well!!

An update on Remy. He went in for ACTH test yesterday. Result: Pre 6.0, post 6.6. His doctor feels he is very well managed and doing great! He’s back to being a picky eater and no issues with excessive water consumption or urination so everything looks good!! So glad we caught this early and 10 mg once a day is doing the trick.

Meanwhile toy poodle Angel is at LSU for ‘possible’ pancreatitis. She has always had liver issues and also has transitional cell carcinoma but had been doing very well until the past few weeks when inappetence set in. Everything looks good on ultrasound but test for pancreatitis showed a slight elevation (430) even though pancreas appears quite normal. They may keep her for a couple of days of fluids and IV meds. I hate the thought of that but we will do whatever is best for her. She has been on chlorambucil for seven months (metronomic chemotherapy) so we may also give her a brief break from her medication to some if the inappetence has improved. There has been no progression of the TCC since last September and if it is pancreatitis the hospital is the best place. At least Remy is doing great and hopefully my little fur family will be back together soon!

Glad to hear our Remy is doing so well and pray the trend continues! I will also keep Angel in my prayers for a swift recovery so that she is soon back home where she belongs. You have your hands full, Mom, and are doing a great job!

Thank you so much! Prayers are always appreciated!! Little Angel is home. She wouldn’t eat at the hospital but I got some GI diet food down her at home. Granted she looked at me with disgust when I offered but I am holding firm! We will schedule an Internal Medicine consult for her to see if we can figure out what’s going on. Things are up in the air with the Covid-19 situation affection the veterinary schools. The good news is her problem does not seem related to her cancer which is great news!

I just put out a new note on Angel and the pancreatitis. I’ve never dealt with it before and searching for suggestions and advice. Kind of an emotional wreck tonight I guess. ��

Remy has had Cushings for almost 4 years. Pretty much same dose of Vetoryl, 10mg morning and 5 mg night. He developed diabetes almost 3 years ago and we have never been able to get it regulated. Lately he has developed tremors. Primary care says it’s common in old dogs which I understand. Could it be due to organ damage from the diabetes? Now I started wondering about his Cushings and if he could be moving to Addisons? Louisiana State University Small Animal now has an internist who is an endocrine specialist so I am going to get an appointment with her to see if she can figure this out. So far his primary care and internist have been unable to come up with a solution to the difficulties in regulating Remy’s glucose levels. The only consistent thing is his inconsistency.Any thoughts and suggestions would be much appreciated. Thanks so much,
Claire

Hello Remy’s Mom, and welcome back. I’m surely sorry Remy is having this problem with tremors, and I’ll come back tomorrow to write more. But in the meantime, I’ve added your new question to Remy’s original thread so that we can have the chance to refresh our memories regarding his overall history. So as I say, I’lll be back again later to add some more thoughts.

Until then, once again, welcome back.
Marianne

Hi Claire,

Reading back on your posts I saw that Remy was taking 10 mg once a day, when was the 5 mg added in and why was his dose increased? Can you share his most recent monitoring ACTH stimulation test results? How is his appetite, and is he displaying any Cushing's symptoms? Sorry for all these questions but the more we know the better our advice can be...thanks!

Hugs, Lori

I’ll have to check back further as to exactly when they added in the 5 mg. But it’s been well over a year. His last Cushings test was 4/23/23 at LSU. They use a different reference scale I think. He was 42.5 no l/L at 1 hr and 55.2nmol/L at 5 hrs. 40-140 is normal. Prior to that 5/27/22 pre 1.3 and post 1.9. His Cushings gets forgotten because of all his problems with diabetes. He eats because we feed him with a spoon. We’ve done that for over a year and a half because otherwise he just picks and grazes which doesn’t work with a diabetic dog. He never begs for food at all and if I weren’t hand feeding I don’t think he would eat much. We’ve kept his weight stable by doing the spoon feeding. He only drinks excessively when his glucose is high. Other than that he’s normal. His coat isn’t too bad for his age and living in a super hot climate. Not much undercoat but what he has grows very fast. No potbelly, panting or other Cushings symptoms. The tremors started back in the early summer and seem to be increasing in frequency. Due to his inactivity he does have some muscle wasting. We also learned his hip joints are extremely bad so no doubt his discomfort is one reason he is inactive. The diabetes has been a constant problem and we have not been able to regulate it. I think his doctors truly don’t know what to do with him. I started looking for things that might cause the tremor and saw Addisons so I wondered if maybe he’s on too much Vetoryl now. Of course there are many things that can cause tremor in old dogs including organ damage from diabetes. His most recent blood work was last week but they did not test Cushings. I think everyone is so wrapped up in the diabetes the Cushings goes by the wayside.

Vetoryl increased from 10mg to 10mg am and 5 mg pm 1/4/21. Will try to find earlier records. He was having syncope events at that time which turned out to be hypertension. Cardiologist increased his amlodipine and also discovered small heart murmur of grade 1-2 which has been stable. Right after that in early February was when he was diagnosed with diabetes.

Thanks so much for this additional information. Given the fact that Remy’s cortisol level was at the low end of the desired therapeutic range back in April, I definitely encourage you to have it rechecked as soon as you can arrange it. Various problems could account for both tremors and a lack of appetite, but low cortisol is indeed one possible explanation that could cause even more serious problems if it continues.

I think it will be great if you can get an appointment with the new LSU endocrine specialist ASAP. I know how hard it can be to deal with both Cushing’s and diabetes at the same time. So the input of a specialist would be such a gift. Please do let us know how things develop, OK?

Marianne

I thought I replied to this but can’t find it so I just wanted to thank you for your response and advice. I will definitely let you know what I find out. There are so many things that can cause tremor but I sure want to rule out low cortisol. Thanks again!
Claire

Hello Marianne and everyone. We had a consultation Tuesday with the new endocrinologist at Louisiana State University regarding Remy’s tremors and poorly regulated diabetes. I asked about possible low cortisol causing tremor since Remy has been on Vetoryl for nearly four years. I received the ACTH test results today and his cortisol is indeed low. 25.1 baseline and 27.3 post therapy. This is substantially lower than his April test. So she recommends a two day holiday from the Vetoryl and then tre start at 5 mg morning and evening with a retest in two weeks. I will continue monitoring his tremors. His body score was 4 which is very good and she said he actually looks really good. I think they were all surprised that he’s had Cushings for nearly four years and is doing so well. She discussed switching him to Degludec after Christmas but I think now they will reevaluate after we get his cortisol levels figured out. She spent a lot of time with us Tuesday and we were very happy to have a good consultation. I think we were there four hours. I will keep you updated but I am hopeful that we can help our little guy feel better!! Best to everyone and as always, thank you so much for your advice!

I’m so glad you got to see the specialist, and thanks so much for this update! Overall, it sounds as though the results were reassuring, although you will definitely want to see a rebound in Remy’s cortisol level. For sure, I encourage you to follow through with the retest in two weeks in order to make sure he doesn’t need even a longer break from the medication before restarting at the lower dose.

I’ll keep my fingers crossed that indeed all goes well for you guys. And please let us know how his follow-up testing does turn out. Continued best wishes to you both!

Marianne

A day and a half vacation from the Vetoryl doesn’t seem like much to me but that’s what the doctor ordered so we will resume this morning with a 5mg dose and again tonight. He did not seem to have tremors yesterday which was certainly encouraging. We have an appointment scheduled with the specialist on Dec.27 for a recheck and recheck ACTH so we’ll see how he is doing at that point. If, in the meantime the tremors seem to return even on the lower dose I will contact LSU and see about either cutting back again to only 5 mg per day or extending his ‘vacation’ from the drug.
Thank you SO very much for the advice!! Will keep you posted!!

Oh I hope you are seeing improvement in our sweet boy! If not, I would stop the med and keep him off until I saw cush signs coming back and an ACTH proved the cortisol was indeed again high. Then I would want to start even lower...max of 5mg per DAY. If he needs the split dose then a compounded Trilostane would be the way to go. I am so glad you had a good visit with the specialist and left feeling good! It makes it all seem easier and better when we have a good vet by our side.

Hugs,
Leslie

Thank you so much to everyone who has responded. I always value your opinions so much especially considering the first recommendation for trilostane nearly four years ago was 10 mg twice a day!! I suggested we start with 10 mg per day because of your suggestions. SO….Wednesday we went for the retest visit and Remy is still low cortisol. 28.5 pre and 33.2 post. They called Friday afternoon with test results so no trilostane last night and we will not give it until after another retest January 3rd. I did notice last night for the first time a return of the tremor for a brief time. Other than that I only see it when he is put up on the table for his evening meds and feeding. I suspect that is stress related. And I agree Leslie, 5 mg should be enough to start treatment with IF we can get back to a healthy level. His diabetes certainly complicates things but we have to get the cortisol levels straightened out first and then we can deal with the diabetes. I do with the Canine Diabetes Forum was still active because I could sure use advice there! If anyone wants to jump in on that issue I’m listening!! Remy never had too many symptoms of Cushings because we caught it very early. The last visit we saw a Resident and I don’t feel she was really ‘listening’ to me so much as the Endocrinologist. Believe me, I have learned how important it is to make sure they do listen. No one knows their dog better than their own family and sometimes the vets have tunnel vision. Anyway, that’s my update for now. I will be keeping a very close watch on Remy over the holiday weekend. HAPPY NEW YEAR to everyone and again thank you so very much for your support and advice!! Claire

I am so glad the Trilo has been stopped. Now he has a chance to level out a bit and start over and hopefully with better results. It is difficult when diabetes is concurrent but it can be done. I admit....I am a colossal wuss when it comes to diabetes alone. Combined? someone would find me is a corner with my eyes rolled back and drool running down my chin! Those of you who handle this with such grace astound me. You have my utmost admiration.
Keep up the good work, Mom!
Hugs,
Leslie

I am a ‘wuss’ too when it comes to diabetes. The possibility of Remy becoming hypoglycemic scares me to death especially since we have had little success in regulating him. That said, he has never been clinically hypoglycemic because we always catch it in time. I couldn’t do this without his Libre continuous glucose monitor. And I don’t go more than 10-15 minutes away from Remy just in case he starts to go too low. My phone will sound an alarm at 85 which gives me time to rush home. I also have a “FURBO” which is a wifi enabled gadget with camera and microphone so I can watch him. I can have it shoot little treats to him (I use a type that has some cane molasses in them) so I can start getting some glucose in him while I’m away from home. It’s restrictive for me staying close by but I wouldn’t have it any other way. We are coming up on 8 years with Remy in a couple of weeks and we love him dearly! I am hoping we can get his cortisol levels back into a safe range and then work on the diabetes again. Having you all to bounce things off helps me so much!!

Happy New Year to you all and thank you again!!
Claire

Hi Claire!

My cat was just recently diagnosed with diabetes and has the Freestyle Libre, that sensor is really nice to have, although I did have one that stopped working after only a week, and that was a bit frightening. Fortunately, the pharmacy had one in stock and the vet got him in that day to put a new one in.

Wishing you and Remy best wishes!

The Libres will conk out once in a while but the majority of ours (and this is three years worth!) have gone right to the last minute. We usually change it out within an hour or two that. And they are not always accurate either. But for an unregulated diabetic like Remy they have been a God send and made all the difference. I change his out myself. It’s not difficult to do and only takes a few minutes. I usually buy four at a time. I would suggest you always have at least one on hand!

Best to you and Kitty!!