My girl pug (confirmed Cushings & confirmed calcinosis cutis) / Tobey has passed

We are definitely not changing the dose until I get another ACTH in a few weeks.

Her symptoms are still the same for the most part. Very hungry, still drinking waters and peeing a lot, the CC is worsening, pot belly is the same, her fur is getting rougher. And, still hot all the time. She showed some sass a few days after starting vetoryl, but that has not remained, and she's still quite standoffish.

I was expecting a big improvement with such a drop in cortisol, but maybe it takes a while for that decrease to present itself?

I would definitely not up the dose.
KJ & Cosmo

Renee,

So many of the things you are describing about Tobey match my Willie too. You mentioned that she usually doesn't want to leave the porch to do her business. That Willie too....he just goes right up on the deck, only willing to climb down the steps those 1-2 times a day for when he needs to poop. Of course your Alaskan and my Minnesota winters is probably not giving either dog and inspiration to want to be out any longer than needed!

You also said she is a bit "standoffish" Willie also is more "moody" and seems to tire of his brother and I. He starts the night in the bed with us, but get annoyed and leaves.

It is helpful to hear that descriptions of similar behaviors.

Thank you for you great welcome and supportive comments and my thread, and the rescue work you do.

Steph

Hi Rene,

Just remember that Tobey has probably had high levels of cortisol circulating in her blood for a quite a long time so she's become accustomed to it. Her cortisol has now dropped like a rock in only seven days and she probably feels like she's been hit by a Mack truck. Some dogs experience cortisol withdrawal and will feel pretty crappy for a few days. I agree with Marianne that there's not a lot of wiggle room with a resting cortisol of 2ug/dl after only seven days, so keep a close eye on her.

Glynda

I've been watching her closely for any crisis. She is still very hungry and interested in food, no diarrhea or upset belly, no vomiting. She is rather lethargic... but, she has always been like that. I swear pugs sleep about 22 hours out of the day. It's hard to know if her sleepiness is normal, or a sign of too low cortisol?

Of course, I am psyching myself out now about how quickly her cortisol dropped, and wondering if I should reduce the dose to 10mg once per day?

Hang in there and don't panic. Stay the course but you can always stop at any time if the appetite goes away. Remember that the lower cortisol will help cure the CC! Keep posting updates and we'll all throw out our opinion! :) You are doing great. Kim

The key is knowing Tobey and what would be "off" for her. If you see anything off, you simply call the vet and get an ACTH test done.

It is a hairy position to be in, because you want it to come down to a range where the cc will start to clear up specifically and yet not go to low. So you do need to come down some more it sounds like but not too much.

I don't know if she dropped so quickly because she is sensitive to the medicine or if she will just stabilize right at this dosage. We never know as every dog is different in how they react to medications.

Normally you have the first ACTH test at around the 12 - 14 day mark, from what I have noticed on the forum, you'll see a change at around day 10, that can give or take a day or so either way, but that just seems to be a very generalized time frame. We always have the one or two that see results immediately same as the ones who don't see anything a few weeks. Usually if the dogs seem to be outside of this pattern, earlier then the dosage ends up being dropped a bit or split, and later seem to end up upping the dosage.

Like I said this is just in general from what I've noticed via the forum.

hugs,
Sharlene and Molly Muffin

We are all assuming that this is a really "quick" cortisol drop for Tobey, but in honesty, we really don't have a big reference range because very few members have tested as early as one week after beginning treatment. Dechra's recommended range is 10-14 days, and so that is far more common. It may typically be the case that the cortisol drops fairly quickly within the first week, but we just wouldn't know it. Plus, Tobey's pre-treatment stimulated cortisol level was "only" 24, so the drop down to 7 was not actually as dramatic as would have been the case had she started out at a much higher level (we've seen dogs who have tested as high as in the 50s).

Having said that, research has demonstrated that dogs being dosed twice daily often end up requiring smaller daily drug totals than do dogs dosed only in the morning. So a dosing decrease may in fact end up to be necessary. But right at the moment, so long as Tobey doesn't exhibit any issues consistent with low cortisol, I believe I would stay the course. As Kim and Sharlene say, it also seems to me that the calcinosis cutis really is a game-changer as far as wanting to initiate tight control of the cortisol as quickly as possible.

Marianne

Well, it's a new day, and some improvements are emerging! Last night, I did not get up to take Tobey outside, and she did not have an accident! She does seem to be more comfortable this past day or so too, and this morning was especially an improvement as far as her attitude.

Thanks everyone for the words of encouragement and support. I feel really good about sticking at the 10mg 2x per day and rechecking her cortisol in 2 more weeks.

Renee:
You are definitely doing the right thing by erring on the side of caution. This is the best approach as far as I am concerned. I sat at the park across from the vets office for hours after Tipper had her first dose of Vetoryl so if anything happened, I could take her right over. I think when you are really vigilant like you,then the dog stands a good chance of doing well on this drug. I am so glad you are seeing improvements however small they may be they are really huge steps in the management of this disease. Blessings
Patti