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