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Thread: 15 year old poodle on trilostane - frequent dosing increases not helping

  1. #1

    Default 15 year old poodle on trilostane - frequent dosing increases not helping

    Not sure if I should treat. Vet wants to do 8 hr test, ultrasound and then treat with vetroyl sp? Vet agrees age is a factor with treatment and said would understand if I decided not to treat. Dog is drinking, panting and peeing excessively. Currently pn theophylline. Anyone have any experience with treating a senior dog? She is a mini poodle andenjoyed relatively goodhealth until now.

  2. #2
    Join Date
    Apr 2008
    Location
    Tennessee
    Posts
    6,593

    Default Re: 15 year old poodle probably has cushings

    Hi and welcome.

    Most dogs are senior when diagnosed with cushing's so a good deal of us have experience with treating senior dogs. Is your dog in good health otherwise and if so, treatment can be a good option for both you and your dog. I see that you have your dog on theophylline, which is a bronchodilator. Did your vet prescribe it for the panting or is there another problem? Did your vet already do a blood chemistry and urinalysis? If so, can you get copies and post the results here? You need only post the highs and lows on the blood chemistry. A urinalysis, with a culture should have been done to rule out a urinary tract infection and to check urine specific gravity. Dogs with cushing's have low urine specific gravity, dilute urine, and a good number have a urinary tract infection at diagnosis.

    Cushing's is a very graded disease, moving at a snail's pace so there is usually no rush to make the decision to treat, especially if you don't yet have a diagnosis. There is no cure for cushing's so the goal of treatment is to remedy the symptoms that are usually more problematic for the pet owner than the dog. I've treated three cushdogs and know first hand how frustrating it is to have a dog that was once housebroken start to pee in the house. It's also not easy to watch our dogs pant all the time. My first cushdog was only three years old when diagnosed and she sounded like a little freight train chugging up a mountain. Having multiple cushdogs, I am also intimately familiar with the expense of diagnostic tests, the drugs used to treat and the acth stimulation tests that are necessary to monitor treatment. It's not cheap but because I watched these dogs come alive again and live a good quality of life on treatment, I'd do it all over again. Once a dog is stabilized on an effective dose of Vetoryl, the ongoing cost does go down. There are also ways to save money which we can share with you, if you ultimately decide to move forward with a diagnosis.

    If you do decide to move forward with testing, I would suggest that you start with a rather inexpensive urine tests called the urine cortisol creatinine ratio. This is a common screening test that can rule out cushing's if the ratio is within normal range. If the ratio is high, cushing's could be the cause but additional tests, like the eight hour test and abdominal ultrasound should be done. All you have to do is to collect a urine specimen from your dog, preferably the first pee of the morning before a meal and meds. Drop it off at your vets within a few hours of collecting and if you can't get there within that time frame, keep the urine refrigerated. The reason for collecting urine at home is that you want the dog to be relaxed and stress free. The adrenal glands will dump cortisol in response to stress so if your vet tries to collect a urine specimen, the results would be unreliable.

    I'm sorry for the reasons that brought you here but I'm glad you found us. We're here to help you and your dog in any way we can.

    Glynda

  3. #3

    Default Re: 15 year old poodle probably has cushings

    Thanks for your reponse. This is my second dog with cushings so am familiar with all that is involved and the expense. The last dog was under the care of Animal Medical Center in NYC and a specialist in Cushings so received excellent care. Where I live now, is a rural area and the closest vet who is familiar with cushing and has a larger practice with specialized equipment is almost 70 miles away. I got nervous when this local vet said I don't have to test for pituatary or adrenal because the medication is the same. She did xrays, not an ultrasound because she doesn't have an ultrasound machine.

    My little poodle was diagnosed 3 years ago with atypical cushing by U of Tenn and was on lignans and melatonin and Denamarin. She was on this for about a year and then her symptoms (loss of hair) subsided. She didn't have the panting or excessive drinking and urination that she is exhibiting now. Although this vet was familiar with atypical cushings she wasn't familiar with lignans and she never treated a dog with atypical cushings. I don't remember how frequently you need to get blood work done when first on medication. She didn't have a UTI, no infection, I think she said her ACTH was in the 3000 range. I need to know from someone who has treated such a senior pet if it was successful. I kinow this is a strong medication which puts a tremendous burden on the dog's system. My vet told me mini poodles life span in 13-18 but most die within the 15-17 year range. I live in the central coast near Santa Barbara. Anyone have experience with vets in that area that know about cushing?

  4. #4

    Default Re: 15 year old poodle probably has cushings

    Forgot to add that the cardiologist put my mini poodle on Theophylline about 1 year ago for panting issues due to an enlarged heart and mitral valve issues. Helped enormously.

    This latest panting started about a month ago and has gotten worse rapidly along with excessive drinking. Because she was diagnosed with atypical cushings 3 years ago, I worry that just to put her on Veteroyl (which isn't recommended for atypical cushings) would do more harm than good. Need a referral to a "specialist" who knows about both types of cushings. This vet said she didn't need to do any other tests but the 8 hr.

    Anyone have any referrals to vets in and around Santa Barbara, CA

  5. #5
    Join Date
    Jun 2012
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    Canada
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    16,150

    Default Re: 15 year old poodle probably has cushings

    Hello and welcome to the forum.

    That doesn't sound right for an ACTH to be 3000. Maybe the ALKP? Do you have copies of the tests as Glynda mentioned, this would be enormously helpful. You'll need to know if the cortisol is high in addtion to the atypical, which would take her into regular cushings now and normally they recommend lysodren for that, if the ligans and flax isn't controlling.

    I don't know of a vet personally in the Santa Barbara area, but some of our other members might know of someone. If not we have a search tool, you can put in zip code, or city, etc to search.

    http://www.acvim.org/PetOwners/FindaSpecialist.aspx

    Using Vetroyl, you test at the 10 - 14 day mark and then at the 30 day mark to start with. If there is a dose change, then you start over. Always start out low and go up if needed. No more than 1mg/1lb, especially with an older dog I would think.

    They did rule out diabetes and thyroid? Might be worth finding a specialist and having an ultrasound done too if that is feasible for you.
    Sharlene and the late great diva - Molly muffin (always missed and never forgotten)

  6. #6
    Join Date
    Apr 2008
    Location
    Tennessee
    Posts
    6,593

    Default Re: 15 year old poodle probably has cushings

    I did a bit of research and found what appears to be an excellent 24/7 specialty hospital in Santa Barbara. It's called Advanced Veterinary Specialist. Please see link below for contact information. It appears that they will need a referral from your gp vet. I checked them on Yelp too and they are the only five star rated specialist I have ever seen. I've also included the link to reviews on Yelp.

    http://www.avs4pets.com/internal-medicine/
    http://www.yelp.com/biz/advanced-vet...-santa-barbara

  7. #7

    Default Re: 15 year old poodle probably has cushings

    Thanks for checking for me. My vet bill for blood work, 3 xrays (don't know why the vet did xrays to check for cushings??) urine analysis, and a senior exam came to almost $600!!! She said an ACTH test is "very expensive". Will call the office you found and get their fees "upfront". Appreciate your help. The melatonin and lingans seem to be helping with the panting a bit, but not at all with the excessive drinking, peeing and appetite. We shall see what happens next. The other vet said she would put her on trilostane but I read that it is NOT the drug of choice when a dog has atypical Cushings. I understand atypical can progress to typical but seems the drug treatment is different. I do miss my NYC vets!!!

  8. #8
    Join Date
    Dec 2013
    Location
    Alaska
    Posts
    1,176

    Default Re: 15 year old poodle probably has cushings

    In my experience, ACTH tests are rather expensive.. because of the darn cost of the cortrosyn (sp). At my vet, the ACTH is only $100... but, the cost of the cortrosyn is $150, so it totals out to $250 per test. If I was only paying that once, I'd be thinking it was no big deal.. .but, in the beginning, so many of these tests are needed, it adds up quickly!

    $600 for all the work you had done does not sounds out of line to me. Just getting to the cushings diagnosis for my pug was over $1,500.
    Reneé
    Mom to Tobey, Ichiro & Skeeter. Foster mom for Polar Pug Rescue


    “Animals have done us no harm and they have no power of resistance…there is something so very dreadful…in tormenting those who have never harmed us, who cannot defend themselves, who are utterly in our power.”—Cardinal John Henry Newman

  9. #9
    Join Date
    Apr 2009
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    York, PA.
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    11,037

    Default Re: 15 year old poodle probably has cushings

    Those ACTH stimulation tests are expensive but there is a cost saving method if one has a small dog, read this article: How to Extend Your Supply of Cortrosyn and Lower the Cost of ACTH Stimulation Testing

    Hugs, Lori

  10. #10

    Default Re: 15 year old poodle probably has cushings

    Thanks to everyone who responded. The costs for these tests and retests once treatment is started is really beyond me. For now I will keep my little mini on the protocol for atypical cushings which she was diagnosed before -- lignans, melatonin, and denamarin. Her panting seems to have lessened, but not the drinking or urination. She is 15 last month and unless symptoms significantly worse, I will let her enjoy her time here. I don't think the local vets are experienced enough and to drive 45 miles to a vet one way and then possibly have an emergency while on the medication -- I don't think we would make it. My former cush dog went into kidneyfailure within 2 or 3 days on Trilostane. If I had not been close to a vet, he would have died. It's a tough decision, but finances unfortunately do rule when you're retired. Good luck to everyone dealing with this. It's scary not to know how your dog will react to any of the treatments for Cushings and you really need a vet close by and experienced with treatment.

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