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

Hi, all! Just got 30 day ACTH test results for Abbie and am pleased that her numbers are continuing to come down:

Pre: 2.4
Post: 9.7

(compared to 5.6 and 11.5 at 14 day mark).

Although below 9.0 would be ideal, we are going to keep Abbie's dosage the same because of her arthritis (... and my pocketbook!)

Hi, all! An update on BP and UPC -- unfortunately, Abbie's blood pressure average on 9/1/15 was 190 (up from 160 on 7/30). She was very relaxed at the hospital so stress not a contributing factor. This is very concerning to both me and my vet. We increased the telmisartan dose to 10 mg. in the morning and 5 mg. in the evening. Her UPC has gone down slightly to 4.6 (from 4.8 on 7/6/15).

We agreed that it would be good to schedule a follow-up appointment and ultrasound with Abbie's internist rather than wait until mid-October. That appointment is on 9/28/15.

Abbie's affect has been very dull the last few days. The arthritis in her right back leg has definitely been bothering her -- she is dragging that leg more often. I'm sure our high humidity and hot temps are contributing to this -- hopefully, only a few more weeks of it! Today, for the first time ever, Abbie didn't get off the bed when I was leaving the house. As many of us have noted before, it is so hard to determine causes, i.e., lowered cortisol, medications, cognitive changes, etc.

Good grief, I thought I'd completed and sent my reply 2 days ago and just found it, still sitting here where I'd started writing it.
I swear Judy I am losing my mind work and stuff is so busy right now. My apologies.

So, here is what I was writing..
Hi Judy,
Darn, don't like to see that BP go up. I know you don't either. We too struggle with Molly's jumping up sometimes.
Maybe the internist will have another idea on how to get her UPC down? How long is it suppose to take to see results on telmisartan?

I did like to see her cortisol levels where much better last time so that is a plus, not just the UPC and BP, same things that we are working on with molly, although Abbie's UPC is higher, so seems like there is plenty of room for that to come down.

I notice that when Molly's cortisol came down we have a lot more problems with the back legs than we do when it is higher, but if it is higher then more problems with the other stuff :( It's such a fine wire balancing act we are doing with these cushpups sometimes.

Hugs

Hi, folks! Update on Miss Abbie – we saw the internist on 9/28. Ultrasound didn’t show significant changes from a year ago which was good news. Her BP average was 180. We discussed Abbie’s cognitive changes. The internist believes that it is more likely that changes are due to an increase in tumor size rather than canine cognitive dysfunction. To try and control both blood pressure and proteinuria, he recommended that a 10 mg. Vetoryl increase be started to try and lower the ACTH post to the 6-7 range.

An ACTH was conducted at my vet’s office on 10/1/15 and, to our surprise, the post had dropped to 8.5 from 9.6 a month ago (pre of 4.0). Because of the drop, my vet and I agreed that a once a day 5 mg. increase was the best choice. My vet faxed a prescription to Diamondback and the 5 mg. capsules arrived today.

I have read that, with twice daily dosing, the larger dose would typically be given in the morning if day time symptoms are more pronounced and the evening if symptoms are greater in that time frame. Since we are targeting blood pressure and proteinuria, I am trying to decide whether to give extra 5 mg. in the a.m. or p.m. My vet thinks the p.m. in order to avoid any negative effects while Abbie is awake. I am leaning towards a.m. so that future ACTH tests would be based on the increased dose and, hopefully, increase might perk her up a bit during the day. Abbie is increasingly uninterested in going for walks in spite of cooler weather or getting off of bed to greet visitors or when I leave the house. I have submitted a question on Dr. Peterson’s blog to see what his thoughts are but I haven’t received a response yet. Your input would be greatly appreciated.

Hi Judy, I don't know what Dr. Peterson will say, but Dechra recommends that the larger of two unequal doses be given in the morning. I suspect this is for the reason you've already noted: for safety's sake, in order to make sure the monitoring ACTH is always catching the cortisol at its lowest point. This is from the U.S. Product Insert for Vetoryl:

Quote:

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Once daily administration is recommended. However, if clinical signs are not controlled for the full day, twice daily dosing may be needed.

To switch from a once daily dose to a twice daily dose, the total daily dose should be divided into 2 portions given 12 hours apart. It is not necessary for the portions to be equal. If applicable, the larger dose should be administered in the morning and the smaller dose in the evening. For example, a dog receiving 90 mg would receive 60 mg in the morning, and 30 mg in evening.

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Marianne -- thanks so much for your quick reply! :D I never even thought to go back to the Dechra insert for guidance.

Marianne,

Disregard my private message asking about Abbie, I'm caught up now after finding your recent post. Abbie's success with treatment is encouraging news to me. I wish I knew more about dosage and giving advise, the best I can do until I get more educated is provide moral support and prayers. What did you decide about dosage?

I will be starting Jenna's compounded treatment tomorrow or Thursday. I did another blood test yesterday to see if her Liver enzymes came down and they did not. Besides the very elevated enzymes Jenna seems pretty normal. Vet is concerned about getting her going on treatment to bring the Liver enzymes down to avoid kidney problems.

I'll post her update on her thread

Tammy -- thanks for checking on Abbie! I decided to give her the larger dose in the morning so she is getting 15 mg. in the a.m. and 10 mg. in the p.m. She has had two days of the increased dose and has had more energy. I am keeping fingers crossed that this is due to the increased dose rather than slightly cooler weather (which ended today ...) but I'll take it either way! :D

Hi Judy

Glad to hear that Abbie is getting more energy. Did you say you are giving her the liquid form or capsule?
Jenna's medicine will arrive tomorrow, vet want to start her on 10mg AM & PM, Jenna weighs about 25 lbs. it on the lower side which I am more comfortable with, what do you think?

BTW we live in Michigan but have a townhouse in West Palm Beach, Fl. My dogs don't like the heat, and they get frisky with the cooler weather.

Kisses to Abbie
Tammy (Jenna, Charlie, Sandie)

Tammy--I am giving Abbie the capsules. "Low and slow" is what I learned from folks here with regard to trilostane dosing. You may end up having more ACTHs if dose adjustments are necessary but you lessen the risk of a negative reaction. Abbie weighs 24 lbs. and I started her on 10 mg. twice a day. The only reason I started her on twice a day dosing was to try and regulate her high blood pressure and proteinuria. Being her beagley self, she certainly doesn't mind having an evening meal!