Down the Cushings Road Again -- Abbie, 15 year old beagle is now at peace

Hi, folks! I posed a question to Dr. Peterson about the use of Mometamax:

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Question: Abbie is prone to yeast flare-ups in both ears. To keep this under control, I flush her ears with Vet Solutions Ear Cleansing Solution followed by Mometamax every couple of weeks. If the yeast is widespread, there have been periods when Mometamax is applied daily for a week to ten days with flushing every few days. Is the amount of mometasone in the Mometamax significant enough to affect cortisol levels?

Dr. Peterson: Possible, but unlikely to make a difference for a dog on Vetoryl.

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I received the Vetoryl yesterday and Abbie will start it on 7/29 (10 mg. twice a day) with an ACTH (along with superchem panel and UPC) scheduled for 8/11 assuming all goes well until then. We already had an appointment on 7/30 for a BP curve along with glands and nails -- I wanted to give Abbie at least a two week break before heading back to the vet, thus the reason for waiting to start until the 29th. My vet made some comments about adjusting the dose if necessary after the 14 day ACTH -- I pretty much ignored him and went on to talk about something else. Unfortunately, he still doesn't have a clue about the use of Vetoryl but he is willing to go along with what I want to do.

Hi, all! Abbie had her blood pressure tested yesterday and, unfortunately, the average has increased from 124 to 160 (back to where it was two months ago). :( Abbie has a UPC scheduled for 8/11 (along with ACTH and chem panel) so we are holding off adjusting any meds until we see the UPC results. Since her BP meds had been increased after the last UPC, I am discouraged that her BP has risen.

I did start Vetoryl on Wednesday. Abbie absolutely dislikes peanut butter!! She touched it with her tongue and walked away so I ended up putting the capsule in her canned food just to get it down her. I then gave her some whole milk ricotta and she loved it -- well, until I wrapped her evening dose in it! She put the whole thing in her mouth, ate the ricotta and spit out the capsule. So ... I bought sliced cheese yesterday and she gobbled up yesterday's doses as well as this morning. So far, so good with the Vetoryl -- no apparent side effects. Sure hope that it works to get down the cortisol and, in turn, the BP and UPC.

I have been giving Abbie a small amount of pumpkin in her morning meals and, after just four days, her poop has firmed up. Simultaneously, I have cut her metronidazole dose in half. Has anyone tried this product:

Diggin' Your Dog Firm Up Pumpkin Super Supplement

http://www.amazon.com/gp/product/B00...=ATVPDKIKX0DER

I am giving Abbie so little pumpkin that I doubt I will get very far down in the can before it spoils. The Amazon product is dehydrated pumpkin. My vet had not heard of it but said it would be worth a try.

Hmmmm...I've never seen that supplement before, but it really looks interesting, Judy! Thanks for pointing it out. If you end up buying some, we'll definitely want to know how it works. Gosh, it would be so much easier than messing with canned pumpkin!

I'm sure sorry about the darn blood pressure reading, but at least I'm glad the cheese slices are working for the meds. That's what I always use for my girls, too, and they will actually go and stand at the fridge when it's time for them to be dosed -- they must have an internal clock, they are sometimes so precise about the the timing!!! They love that soft cheese, and I love that I can mold it so easily. :)

Marianne

Molly too has decided she doesn't want to take her meds in canned food from my hand. If I just put it in her bowl, she will eat it, but I noticed this morning she left the omega 3 on the floor next to her bowl. I think it is just too big. So far she is getting the trilostane though. Whew. It can be a real trick finding something to disguise those pills in that they will like.

That is an interesting idea with the pumpkin. I too wouldn't mind knowing how that works for you.

Molly's BP was back up to 180 last time, although they put that down to her being excitable, still I don't like it, so know what you mean about Abbie's BP.

Hi, all! (Apologize in advance for long post …) Abbie’s latest round of tests were this past Tuesday. Tests included ACTH (at day 14 of Vetoryl, 10 mg. 2x/day), super chem panel and UPC. Results are below:

ACTH: Pre of 5.6 and post of 11.5 (range of optimal control between 1.5-9.1)

Post down from 15.6 on 6/10 when Lysodren was stopped – I expect her cortisol continued to climb up during the 30 day wash-out so probably was even higher by the time Vetoryl was started. I am very pleased that the Vetoryl seems to be working.

SUPER CHEM:

ALK: 141 (H)(range 5-131)

Although still technically high I am thrilled that it dropped from 401 on last test on 6/17! I have been giving Abbie S-Adenosyl pills for a while now and expect that has helped.

BUN/Creatinine Ratio: 28 (H)(range 4-27) (up from 22 on last test)

Potassium: 6.0 (H)(range 3.6-5.5)(up from 5.6 on last test)

Cholesterol: 691 (H)(range 92-324)(up from 661 on last test)(most likely related to protein loss in urine)

Triglycerides: 1065 (H)(range 29-291)(considerably higher than 595 on last test--non-fasting test probably contributed somewhat to increase but it is still really high)

UPC: 5.6 (range <=0.5)(up from 4.8 on last test on 7/6)

Major concern is Abbie’s kidneys – she is definitely what is considered a “non-responder” to typical treatment of amlodipine and enalapril. In spite of the cortisol coming down, her kidneys are not filtering proteins. The increased BUN/Creatinine ratio is very concerning as this usually only increases when there is significant kidney dysfunction.

I shared the telmisartan study with my vet – he had not seen it before and said he definitely wants to switch Abbie from enalapril to telmisartan. He wants to follow the same dosing and evaluation methods outlined in the study. He even helped me call pharmacies to find out the cost. It is very expensive at most pharmacies but our local compounding pharmacy had the best price and Target is willing to match their price. They had to order it so won’t be able to start Abbie on it until Wednesday morning. Over the next two weeks the enalapril will be lowered while the telmisartan is increased. After 7 days of telmisartan twice a day, the vet will run another super chem and her BP will be checked at the hospital (vet’s machine still not working). A week later another UPC will be run. The vet wants to continue the amlodipine which is aimed towards helping to lower the BP.

I am glad to report that my vet has definitely been reading up on the use of Vetoryl. Abbie has the next ACTH scheduled for day 30 and my vet agreed that, if we have to raise the dose, a 5 mg. increase from a compounding pharmacy would be the best route. Because Abbie’s arthritis has become troublesome with the drop in cortisol, we agreed that a post at the upper end of the range would be preferable.

Added into the mix are yeast infections in both ears! I am glad that Dr. Peterson said that mometamax should not affect cortisol levels while on Vetoryl as she is on it for two weeks with Triz-Ultra+Keto rinse once a day (and every third day also a cleansing solution rinse). Sure am glad that I am retired – her medication/eating schedule is definitely a full-time job!

Well I'm glad the vetroyl is hopefully working and maybe it will help to get the other things under control too. One can hope anyway right.

Oh I hate ear infections. Molly runs if she sees the bottle of ear drops. She doesn't fool around either, she is like, I'm outta here. LOL

I hope that the telmisartan works and gets that UPC down some. That might help with the Bun/Crea too? It is the Creatanine that is worrying in the ratio usually, so I would get that retested.

You know and I was thinking of this the other day, if there is any kind of upset tummy, gastro, that makes the UPC usually higher too. I was wondering about that with Abbie and I wondered about it with molly too, because molly's was higher last test and within a day she was having that bad diarrhea and not eating. I remember Trish and Tina both saying that it takes weeks for the UPC to be right after any kind of gastric issues.

Yea their schedules can be real doozies eh. :)

Folks: I think Abbie's last super chem results were distorted because she was not fasting. I asked Dr. Peterson via his blog:

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With Vetoryl being given at 7:30 am after morning meal, how do we schedule a fasting blood test? Should a morning dose be skipped the day after the ACTH so that she is fasting? Or is the lack of fasting not a significant factor in test results?

Due to adding telmisartan, my vet wants to do a super chem 7 days after she has been on a twice daily dosing without the enalapril. This will be a week after her 30 day ACTH but would still have same issue of fasting.

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He answered back:

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The fasting sample should be collected on a separate day from when you are doing an ACTH stimulation test.

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Unfortunately, this does not answer my question about skipping a dose of trilostane in order to do fasting blood draw. What do you all do when a fasting blood draw is needed?

I think you could either skip her morning dose or opt in giving her a very lite meal with her morning Vetoryl. Wish Dr. Peterson would have been more specific with his answer to you. :(

Hugs, Lori

Perhaps I am not understanding your question, Judy, but on the day that you schedule the chem panel (as opposed to the day you are doing the ACTH), I would think you would just go ahead and give the trilostane but just without the breakfast. The trilo won't be metabolized as efficiently that way, but it's just one dose that would be compromised and some drug benefit is better than none at all.

In other words, it won't hurt her to get the trilo on an empty stomach that morning. That particular dose just won't be as effective in terms of lowering her cortisol. But you are not measuring cortisol on the chem panel, anyway.

Marianne

Marianne -- never even thought of that option! Since Abbie is on twice daily dosing, one less effective dose would be even less significant.You guys are so smart. :D

Maybe Dr. Peterson was confused by my inquiry although his response is good to know with regard to future ACTH tests. I try to do as few vet trips as possible as Abbie does get stressed but I definitely want accurate test results.

Since my vet is a newbie with regard to trilostane, I so appreciate your input.