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

Opps my bad, Tobey is a girl, I apologize to little Miss Tobey for my error, no
No excuses should pay much closer attention:D

Hoping today is a better day for both of you:D

Haha, Dawn, no worries on Tobey's name. My kids named her when they were younger, without thinking she'd be mistaken for a boy. We actually never call her Tobey anyways. You know how dogs acquire a million nicknames? :) Her most common nickname is Woba, something my daughter made up when she was 5.

I have a question for those in the know.

I never did get an ultrasound done, and the LDDS test was inconclusive in regards to pituitary vs adrenal tumor. Now that Tobey is on the vetoryl, would that affect the results of an ultrasound?

Honestly, ultrasounds up here are quite expensive ($800+, because there is ONE vet in the whole state that does them), and with all the money I have been spending on the tests, monitoring, and now the vetoryl (not to mention the holidays), I just could not prioritize the US. I am thinking about getting one done now though, sometime in the next month.

Thoughts?

Well, would you consider surgery if it was an adrenal tumor? Over time, Vetoryl will make the adrenal glands larger. It may be possible then to make a tumor harder to see, I am not really sure.

I guess my point is, if surgery is not an option if your girl had an adrenal tumor, I dont know that you need to have an ultra sound right now to determine that if money is tight;) Just my two cents:)

Trilostane treatment itself can spur enlargement of the adrenals, so you couldn't know for certain whether bilateral enlargement (diagnostic of pituitary Cushing's), if revealed on ultrasound, preceded the medication. If you're instead looking to see whether an adrenal tumor or mass is present, then I don't think the trilostane would confound the imaging. However, unless you would consider surgery upon discovery of an adrenal tumor, you still might want to hold off on the expense of the ultrasound right now during the time period when the initial medication monitoring costs are highest (unless you are suspecting there may be something else also going on with Tobey right now?).

Marianne

I've been thinking about the US, simply because I don't like leaving any stone unturned, and I would rather know which type of cushings she has. That said, I don't know if I would do surgery or not. She's not that old (just 10), and I think she could handle surgery well... but, I am not ready to go there just yet. If I knew for certain she had an adrenal tumor, then I could spend the time considering the surgery. If I knew she had PDH, then I would not have to worry about considering surgery.

I think I'll just get through this initial monitoring stage and then do the US.

Just got the results of yesterday's ACTH test. I'm a little confused.

Pre 2.0
Post 7.3

She's only been on the meds (10mg x2 daily) for a week, and I have seen no abatement in symptoms. Yet, her post figure dropped from 24 to 7.3. Could the lab have made an error? This is the verbal result, I am waiting for her to email the actual lab report.

The vet suggested we could increase the dosage to 30mg per day, but given her cortisol dropped so much in just one week, I don't feel good about an increase yet. We have the next ACTH scheduled for Jan 10th.

Renee:
You are smart to question the jump to 30mg. With her cortisol dropping like that and it may continue to do so for about a month, I would not do it if it were my dog. Tipper dropped all through her first month. Better safe than sorry is how I do it. Blessings
Patti

I wouldn't change the dosage either, since that is a big change from just a week ago. Cortisol levels can continue to drop for sometimes even over 30 days on the same dose. I'd stay right where you are and see if post goes down to maybe about 4 or so on this dosage.

Does she seem better through the day? Or is the drinking/peeing, hunger, all day long? What you want to look and see is if there is any time during the day when she seems better controlled than at other times. She is already on twice a day dosing right?

You're doing good. These are good numbers actually for the first week. Want to watch that pre number as it's at a 2. already too. Yea, definitely no increase at this point.

See I just re-convinced myself you shouldn't up it yet. :)

hugs,
Sharlene and Molly Muffin

No, I would not increase the dose either at this point. Just as Patti has said, the cortisol level can continue to drop on this same dose and Dechra's own official recommendation is to largely leave the dose unchanged for the first 30 days as long as the cortisol has not dropped too low.

Even though you are not seeing overt improvement yet, those numbers are definitely a drop from baseline and I would guess that you will soon see some changes in thirst and urination. Skin and coat issues take a significantly longer time to improve. Most folks do not perform the first test until the 10-14 day mark, so you are ahead of the curve by testing after just one week. Those numbers are actually very good right where they are (you really don't want the"pre" to drop much more), so you're right in not wanting to risk accelerating the cortisol drop by increasing the dose right now.

Marianne

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

SHE BARKED AND PLAYED FOR A FEW MINUTES

Seriously, she did. My husband and I about fell over! My other pug was playing with his ball, and Tobey got excited, barked (which she rarely does), and ran around a bit. OMG, I think we almost cried! She wouldn't chase the ball, but she engaged.

:D

Renee:
Take all the little precious moments that come your way and treasure them. It is wonderful to see your dog start to act normal again isn't it?? Blessings
Patti

That is fabulous! Put that together with her not having an accident or waking you up over night and I bet she is in a good spot right now with her cortisol level.
Hang in there!!!
hugs,
Sharlene and Molly Muffin

Rejoice in every victory, no matter how small.

Happy Dancing

Sounds like she's improving!

Great news! Enjoy the moment! Celebrate! Kim

It's really amazing... on Friday I was sure the vetoryl was not working, in spite of the lower cortisol levels. I was feeling so discouraged.

A world of difference in just 2 days. She was more active, engaged, less water consumption and less peeing this last 36 hours!!

We are on the upswing!

Just keep an eye on her and I'm beyond thrilled that she is doing so well. Day 10, I'm telling you, it's the swing day for many. :)

hugs,
Sharlene and Molly Muffin

This is such great news, Renee. What a swell way to ring in the new year! ;) :)

Marianne

Renee:
I could not be happier for you. This is really great news that you both needed. Hopefully it will be smooth sailing for your sweet baby now. Blessings
Patti

Yeah!!! for both you and Tobey!!!

YAY! What a great way to launch the New Year! Love it!:p xxxx

Renee:
I have a feeling you all are in for a good New Year!! I am so happy things are going well. Blessings
Patti

Renee,
That is awesome to hear, what a wonderful sight that was for your family to see. Way to go Tobey, YEAH!!!!!:D

We'll take all the good news we can get Renee!! Great to hear :)

Happy New Year Renee and Tobey and family

May you continue to see improvements in the new year and the cc go away completely. wishing you all the best.

hugs,
Sharlene and Molly Muffin

Whew!

My thread was buried on page 3, lol.

Just updating on Tobey. Tomorrow is officially two weeks on vetoryl. So far, I would say it's been up and down. She rallied on Saturday and Sunday, really surprising me, but I have not seen as much animation since then. Last night she did have an accident in the house (first time in about 5 days), because I didn't get up with her. The appetite is still ravenous, but her drinking has dropped off somewhat, although not all the time. It comes and goes in peaks.

The abx are really helping the CC. It's not cracking open as much, although more sores are popping up. They don't seem as angry though, which is a good improvement in my book.

She has her next ACTH on January 10th. I can't wait to see where things are at.

Hi Renee:
I am sorry you got lost on page 3. I am glad however that you found something that is working for your baby. I think the CC has to be one of the hardest things to deal with from Cushings. The pain it must cause is terrible. I hope your baby gets fixed up soon. Blessings
Patti

Hi Renee, it could be that the cortisol is sort of up and down right now too, or not stable for the entire day. Keep track of when she might have some control slippage, like is it more evening, or early morning or mid day. This way you'll know going forward, if anything needs to be tweaked, where to do so. Maybe you need, 10mg am and 15 mg pm, or something, but it's really too soon to say till after the next test.

You're doing great though and hopefully Tobey's cc will get better too.

hugs,
Sharlene and molly muffin

Tracking is a good idea. Thanks Sharlene for that suggestion. Her next ACTH is not until Jan 10, which will be three weeks on her current dose of 10/10.

I was wondering.... has anyone ever heard of dosing three times a day? I am disappointed about the vetoryl having such a short half-life. It seems like she rallies for a few hours after dosing, then slides back down.