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

ACTH Results:

Pre 2.7 ug/dL, range 0.0-10
Post 24 ug/dL, range 8.0-22

LDDS test is today. I should have results tomorrow.

I spent some time last night trying to understand these test results. My vet was disappointed in them as well.

The range for this lab seems to be quite broad, and using their ranges indicates that Tobey's cushings results are borderline (potentially not cushings). However, based on her pre number to the post number, the cortisol increased nearly 10 fold - which seems very high to me!

Does anyone have any thoughts on this?

I am very glad we are getting the LDDS test results today.

LDDS Results:

Pre 3.5 ug/dL, range 0-10
4 hr 2.9 ug/dL, no range provided
8 hr 3.3 ug/dL, range 0-1.4

Cushings is confirmed. :(

She starts vetoryl tomorrow morning.

I feel like I am replying to myself a lot... lol .. but, this is a good way to document as well. :)

At the last minute, we decided to follow the Dechra protocol on the vetoryl, so we are doing 10mg x2 daily. She had her first last pill night, and then one this morning. So far, everything is going good. No upset belly, which I am very grateful for. I have the next 10 days off from work, so I will be home with her the entire time.

I would guess all should go well, especially with you right there able to keep a close eye on her.

Hi Renee, you are NOT replying to yourself. Believe me, we read all the posts. Sometimes we might miss one here and there as we are going through, but we catch it on the next one usually. LOL You are Never alone on this forum. :) :) My problem is answering on the cell phone, man that keyboard is small and I've had some doozy autocorrected replies show up on the forum. LOL I try to wait till I'm either at my desktop or laptop computer. safer for all of us believe me!!

Yes, the ACTH was close, but it was over and in addition to the LDDS test and the cc that Tobey is displaying I think you are right about cushings being the culprit.

Now, you know, we all say every dog is different, but in general, give it a bit, I tend to say that you should start noticing a difference in symptoms in 10 days (approximate, give or take a day or two). Depends on, one how much they need to come down in cortisol, and how they react to the vetroyl. 10x2 is a fine place to start, you might go up or down depending on how Tobey reacts to the medicine, sensitivity wise.

You'll be fine and hopefully in a month (because I live on optimism and positivity) we'll start to see something in the cc too, just like Cosmo has. :) :)

Hang in there!!!
hugs,
Sharlene and Molly muffin

Thanks so much Sharlene! It feels so good to finally be doing something. And, I am sure I am reading into it too quickly... but, today for the first time in a very long time, she went down the stairs off our porch and sniffed around the yard. :) She hasn't done that in a long time. She usually pees right on the porch and comes quickly back inside.

LOL.. No you are never alone. We do our best to stay up with our cush family and although we may not always reply..... we are here ;)

BTW, our Roxee starting showing improvement by the 3rd day, her excessive thirst diminished :-) Took a few months for her hair to get healthy again and even started growing hair on her "Rat tail" .... every pup is different.

Nope, not reading too much into it. If it is something that she hasn't done in a long time, then it is likely that her cortisol is already starting to lower and she is feeling better.
Too high of cortisol can make them feel awful and so can too low of cortisol, so you want that balance. Optimally with the cc, if it were me, I'd be aiming for a control just under 5.0, that is my thought though, we'll see where she responds best at.
Just keep an eye out. :)

hugs,
Sharlene and Molly Muffin

Btw, very good progression pictures of the cc, which Was confirmed by testing. (I just want everyone to be aware that this is confirmed and not a guess).

Sharlene and Molly Muffin

Quote:

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Originally Posted by molly muffin

Btw, very good progression pictures of the cc, which Was confirmed by testing. (I just want everyone to be aware that this is confirmed and not a guess).

Sharlene and Molly Muffin

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yes, the CC was definitely confirmed. We did punch biopsies on five separate lesions to be absolutely sure.

I have a question on the dosing for Vetoryl.

I know it is supposed to be given with food... and I am trying to get as close as possible to exact 12 hour dosing. I don't always feed her every 12 hours though. This morning I gave her the vetoryl with some peanut butter, then she had her breakfast about an hour later. Is a small amount of food enough, or do I need to make sure she gets a full meal with the vetoryl? This won't happen often, but I want to make sure I am doing it correctly.

That is fine Renee. The key is that you just want to give the medicine with a bit of food, something like peanut butter, cream cheese, etc works fine. It needs the food for maximum absorption, then give her breakfast/dinner at normal times.

hugs,
Sharlene and Molly Muffin

Renee, to be honest with you, I'm not sure exactly how much food needs to be given so as to insure full absorption, but I'm thinking it may be more than just a little dab of peanut butter surrounding the capsule. When I've asked Dechra in the past, they've told me at least a small "meal." To be certain as to their current recommendation, I'd advise you to directly contact a technical representative at Dechra. If you do, we'll be really interested as to what they tell you.

http://www.dechra-us.com/Default.aspx?ID=365

Marianne

I dont think a dab of peanut butter is enough food. Dechra tells us to give the pill with a small meal the day of ACTH testing. I think most of us give it with a regular meal or small meal.

Sorry, my bad, I thought you could give it with a some peanut butter or wrapped in cream cheese. Sorry Renee. How much do you give Zoe's with Addy?

Sharlene and Molly Muffin

Sharlene, I'm thinking the peanut butter or cream cheese suggestion is coming more from our Lysodren users since that drug is best metabolized in the presence of some fat.

Marianne

Renee, another reason for giving with food, lack of appetite can be a sign of too low of cortisol. If you feed, then give medicine, you still have a chance to withhold it. If you give medicine, and then they don't want to eat, it's too late to take it back.

Hmm, okay. Thanks for the feedback. I was trying to get her meds in exact 12 hours dosage intervals, which didn't coincide with her breakfast time this morning.... so I did the peanut butter. Then she had her full meal about an hour afterwards. Since I cook for her, it's not as easy as kibble to just scoop out her breakfast real quick.

I'll just make sure to give her a full breakfast / dinner when she gets the vetoryl.

I just emailed Dechra using the link provided by Marianne. Thank you so much! I will definitely post their answer here for everyone.

ACK! Of course Marianne! Lsyodren needs to be taken with a bit of something that has some fat content. That could be where my brain was.
Sharlene and Molly muffin

I agree with Marianne that the cream cheese and peanut butter is advisable for Lysodren as it is much more readily absorbed with fat. My dogs eat twice a day and I never gave Lulu or Jojo any less food on the day they had their stim tests.

Glynda

P.S. Here is a url to Dr. Peterson blog where he tells you how the acth stim test needs to be done and he has never mentioned small meals. http://endocrinevet.blogspot.com/201...n-testing.html

Just wanted to let anyone know that may be following my thread, that I have updated Tobey's photo album with more pictures documenting the CC.

Renee:
You are doing a fabulous job of documentation on the CC, I am sure that people that come on here after us will find it very helpful in diagnosing and treating their dogs. Blessings
Patti

Here is the email from Dechra:

Renee,



Thank you for contacting Dechra Veterinary Technical Services with your question about Vetoryl.



When administering Vetoryl we do recommend to give a full meal. Food does help absorption.



If you have any further questions, please don’t hesitate contacting us.



Kind regards,



Dosha Atwell, RVT

Technical Services



Dechra Veterinary Products

7015 College Blvd. Suite 525

Overland Park, KS 66211



Office: (913)748-4838

Fax: (913)327-0016

dosha.atwell@dechra.com

www.dechra-us.com

Technical Services: (866)933-2472

Renee:

Have a Merry Christmas. Blessings
Patti

Thank you Patti - merry christmas to you and Tipper too. I hope her leg is healing up.

So they want a full meal with vetroyl. Well, then that is what you need to do. What about cooking the night before? Or doing the vetroyl a tad bit later with the meal time? something like that.

How is Tobey doing anyway?

OH and cannot forget, Happy Holidays, merry christmas eve. :)

hugs,
Sharlene and Molly Muffin

Daisy has her meds with breakfast and again 11—12 hours later. We give her a mini meal tohold her over in between.

Merry Christmas!

Well, almost a week on the vetoryl.

Tobey has her first ACTH post vetoryl scheduled for tomorrow, which is exactly one week after starting the meds.

My vet has requested to do the ACTH tests after one week, three weeks, six weeks, and then every three months. Of course, if the dosage is adjusted, we will change that schedule.

I haven't seen much improvement, other than a bit more sass. She has been going down the stairs into the yard about half the time this week, whereas before, she would not go down them at all. She got snippy with her brother the other night too (we all cheered for her!).

No decrease in water intake, hunger, or pot belly. Of course, the CC us worsening. It seems that she is holding her pee longer though, but I let her out so often, I'm not really certain on that.

I hope everyone had a wonderful holiday yesterday. We stayed home and hosted the family. It was really nice, and the puggies enjoyed a bit of prime beef in their dinners. :)

Renee:
It takes a while for some of the dogs to show improvement. Tipper is not the norm, but she showed improvement within hours after taking the first dosage. I was amazed, and very thankful as her symptoms were so severe. Just give it a little time, maybe the dosage will get tweaked after the ACTH testing and then maybe you will see some change. Prime Rib Huh? Tipper says we're coming over to your house! Blessings
Patti

Just got back from the vet. The cleaned up the CC a bit, drained one part that kept weeping blood, and sent us home with abx. The larger sore is infected. :(

Results from the ACTH should be in tomorrow though!

Renee:
I am so sorry to hear your Tobey has an infection. This CC is the worst stuff ever. I am so sorry you have to deal with this and poor baby Tobey. Hope it gets better soon. Blessings
Patti

Oh dear, poor thing, an infection too. Cushings dogs are definitely prone to infections and slow healing. Hopefully this will start to clear up soon as the cortisol comes down. They are all different, so some seem to clear up faster than others.

Hang in there!!
hugs,
Sharlene and Molly Muffin

Thanks girls. Yes, this CC is just horrible. One part kept cracking open and bleeding for the last three days, so I guess I should have expected it was getting infected.

Other than that, Tobey is handling the vetoryl well. Up a pound on her weight, so I'll need to cut back a bit on the food / treats. I'm sure she will not like that!

Shoot! I just realized we did the ACTH test 3 hours post dosing today, not 4 hours. She had her pill at 7, then the stim test was at 10.

Am I screwed?

Awwww. That stinks. Poor Tobey!

A good healthy treat that we give Daisy are string beans. You can even give them frozen.

Oh man , poor little fella, did they give you any topical ointments to put on the infection.? Let me know if they did and how well it is working for Tobey.

Your doing a great job, I know how hard CC can be to handle. Just take things 1day at a time. Did they give Tobey any pain me s to help keep him comfortable?

Today was a rough day for our Butters, the whole shower thing took it toll on her, between her head aches and then the skin issue from the showering last night, she was really down today:( wishing I had a magic wand but they don't exist so the only thing I can do is try to comfort her with love , and I am sure you are doing the same for your baby.

You guys are in our prayers for a speedy recovery!

Dawn and Butters

Quote:

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Originally Posted by Renee

Shoot! I just realized we did the ACTH test 3 hours post dosing today, not 4 hours. She had her pill at 7, then the stim test was at 10.

Am I screwed?

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Renee, you should still be OK since trilostane typically reaches its highest level in the blood about 1 1/2 hours after dosing (meaning you were testing when the cortisol level was at its lowest). Some clinicians actually prefer a testing window that begins around the 2-3 hour mark. But you do want to try to have all the monitoring ACTH tests performed within the same time frame so that you are comparing apples-to-apples with the numbers. So going forward, try to pick a single time frame and ask the vet to stick to it.

Marianne

Thanks for the reply Marianne. I just don't want a test that is invalid. The darn things are expensive enough! And, I hate for Tobey to get poked anymore than she has to. She has started to dread whenever we even get her harness out, because she expects a trip to the vet.

Oh poor thing, to dread her harness. :(

When do you get the results back?

hugs,
Sharlene and Molly Muffin