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

[molly muffin]

We all just do the best we can with what our options are. These tests are very expensive and you have to weigh benefit vs quality of life too when they reach seniors age.
We are still here any time you want to have a chat or talk about anything.

[mitsua]

Here's here #s from her blood work. Posted all the out of normal range #s

platelet count 577
ALT 120
ALK Phosphalase 3375
BUN/Creatine 32
Cholesterol 337
Tryglyceride 667

T4 1.0

Urinalysis
ph 7.0
Protein 2+

RBC 11-20
Occult Blood 3+

My mini poodle just had her LDDS test done today -- results next week.

the note on the test results said "urine protein creatinine ratio testing is recommended to determine clinical significance of proteinuria."

When I asked the vet about this, she said she wasn't famliar with this test and never did it and suggested I go to an endocrinologist. Problem is that the closest endo is 47 miles away. So am waiting for the test results from LDDS.

Any comments, insights, greatly appreciated.

[lulusmom]

I've merged your two threads so that we can keep all of your girl's history in one place. Sometimes our threads get buried on back pages so I'll PM you a link that you can use whenever you want to get to your thread.

I would really help if you could edit your post and provide the normal reference ranges for the blood results you just posted. With respect to the proteinuria, it is not uncommon for cushdogs, especially an uncontrolled one, to have a +1 or +2 urine protein. My little Lulu's urine protein was +2 consistently and she did not have kidney disease. Can you check your papers and see if there are results for BUN and creatinine? If so, can you please post those results with the normal reference ranges? When cushing's is suspected, a vet should check the urine specific gravity. That is usually a component of a urinalysis. Can you please check to see if you have USG results and post the result for us? It is not unusual for a dog with cushing's to have a high BUN, due to the increased urine output. If the BUN is high with a normal creatinine, that will yield a high BUN/Creatinine ratio. Normal range for this ratio is usually 4 to 27 so I would assume that the result posted is high, which is usually consistent with cushing's.

I'm more than surprised that your vet has never done or ordered a urine P:C ratio, as this is a common tests most vets do if they suspect kidney dysfunction. Most vets are set up to do P:C ratios inhouse but if not, a urine specimen is collected and sent to an outside lab. I'd be very concerned about a vet who has to send patients to internal medicine specialists for a urine P:C ratio. If I had to drive 40 miles and pay specialist prices to run a test that another gp down the street could do, I'd probably print out lab instructions and walk her through it. For this test to be abnormal, 70% of kidney function is usually gone, and based on the results you've posted so far, I don't think you're dealing with kidney disease. I think you're probably dealing with cushing's, but we'll have a much better idea when you post the results of the LDDS test.

Glynda

[mitsua]

Here's all the #s out of range and what the normal #s are. THis vet was HIGHLY recommended. I've been through several of the local vets here and most of them said the same thing -- your poodle is at or near the end of her life expectancy. I would do nothing. This vet said that with all the urination my poodle does, it wouldn't be the "first' urine in the morning as she has a door to go outside in the night. She would have to send the test out. I have to work with what's here. THe closest board certified endo vet is 70 miles away. The vet in santa barbara is an internal medicine; not endo.


BUN 19 6-31 normal
Creatine 0.6 0.5 - 1.6 normal

platelet count 577 170-400 normal
ALT 120 12-118 normal

ALK Phosphalase 3375 5- 131 normal

BUN/Creatine Ratio 32 4-27 normal
Cholesterol 337 92-324 normal

Tryglyceride 667 29-291 normal

T4 1.0 0.8-3.5 normal

Urinalysis
ph 7.0 5.5-7.0 normal

Protein 2+ Negative normal


RBC 11-20 0-3
Occult Blood 3+ Negative

Specific gravity 1.033 1.015-1.050 normal

THanks for the pm and link.

[Trish]

Hi, while I am certainly no cushings expert I have had a bit of experience with renal problems. I too am surprised your vet has such a lack of knowledge with UPC ratio testing and they wants to send you to an endocrinologist for the test , that is not even the right specialist!! My vet cannot get real accurate tests for the UPC ratio and sends them out to an external lab. But an endo is not even the right specialty for renal tests, cushings sure but not kidneys that belongs with IMS or renal specialist. Usually the IMS are qualified to look at both cushings and the renal side of things so it might be a good idea even with the drive, to visit them if your vet is worrying you like they are worrying me!

I'm more than surprised that your vet has never done or ordered a urine P:C ratio, as this is a common tests most vets do if they suspect kidney dysfunction. Most vets are set up to do P:C ratios inhouse but if not, a urine specimen is collected and sent to an outside lab. I'd be very concerned about a vet who has to send patients to internal medicine specialists for a urine P:C ratio. If I had to drive 40 miles and pay specialist prices to run a test that another gp down the street could do, I'd probably print out lab instructions and walk her through it. For this test to be abnormal, 70% of kidney function is usually gone, and based on the results you've posted so far, I don't think you're dealing with kidney disease.

Glynda, I have always been told it is once the serum creatinine and BUN start rising (when other issues such as dehydration are ruled out) that 75% of renal function has been lost, but I have not seen that figure applied to an abnormal UPC test. So I would be real interested in any articles related to that. As it worries me with my dogs previously eleveated UPC. Thanks.

In both cushings and renal failure the urinary specific gravity is low and your pup's urine is concentrating nicely at 1033, you have not mentioned creatinine in your list so I presume that is normal, so that is good to see!

[Tina]

Glynda, I have always been told it is once the serum creatinine and BUN start rising (when other issues such as dehydration are ruled out) that 75% of renal function has been lost, but I have not seen that figure applied to an abnormal UPC test. So I would be real interested in any articles related to that. As it worries me with my dogs previously eleveated UPC. Thanks.

Trish, thanks so much for posting this, as this is what I have also been told regarding the serum BUN and creatinine rather than the UPC. I am quite worried now also as my pup has been struggling with elevated UPC too, and it seems to be on the rise again. Glynda, any additional information that you can provide will be greatly appreciated so I can discuss with my vet. Thank you.

Sorry for the thread hijack.

Tina

[addy]

For others reading this, I just want to add, my Cush pup suddenly started throwing protein in her urine. It is not always just from Cushings and sometimes there is something we can do about it. Dogs can start throwing protein from anywhere. In our case, it was from Zoe's GI tract- she has inflammatory bowel disease and was on a high protein diet. Once I lowered the amount of protein she was eating, better controlled her IBD and kept her cortisol within theraputic range- her UPC lowered until it was normal.

I just wanted to share our experience for any memebers reading this.

[mitsua]

Here's the creatine #, again.

Creatine 0.6 0.5 - 1.6 normal

I concur with all the comments about the seemingly lack of knowledge with the vets, but as I said, I have to work with who is here. I am worried that if she should have a crises on any medication, if Im not working with the vets, they won't treat her. Yes, its' true. There are only 2 or 3 vets local to me. So although I have more knowledge re cushings I am trying to work with her and "encourage" her to confer with a IM specialist. Im waiting on the results from the LDDS.

Re the protein in the food --- Missy has been on Low Fat/Low Digestive Royal Canin for many years and does well on it. She gets a supplemental tablespoon or so with cooked hamburger or turkey or , pasta or rice as she won't eat just the dry food. Prior to this year's blood work, all her #s have been within normal range. THis panting and thirst came on about 2 or 3 months ago. I posted the #s to see if this are #s for a cushionoid dog and will the LDDS give me (or the vet) a conclusive diagnosis for cushings.

Missy weighs 15 pounds and I know the veteroyl comes in 10mg. This vet also was not familiar with the 2x a day dosing at a lower amount. She said she just prescribes the 1x a day at the closest dosage available. I read the UC Davis (where she graduated) now suggests the 2x a day dosage. Anyone familiar with that? So Im thinking should Missy be put on 10mg 1x a day to see how she's doing with the f/u blood work (which she tells me is $250 each ACTH test). YIKES!!

Also was hoping to hear from anyone who has treated a 15 year old poodle for Cushings. Thanks for reading this long post.

[labblab]

Missy weighs 15 pounds and I know the veteroyl comes in 10mg. This vet also was not familiar with the 2x a day dosing at a lower amount. She said she just prescribes the 1x a day at the closest dosage available. I read the UC Davis (where she graduated) now suggests the 2x a day dosage. Anyone familiar with that? So Im thinking should Missy be put on 10mg 1x a day to see how she's doing with the f/u blood work (which she tells me is $250 each ACTH test). YIKES!!

There are pros-and-cons to dosing once v. twice daily, and different clinicians have different preferences. The manufacturer of brandname Vetoryl still recommends starting with once daily dosing and only moving to twice daily dosing if it appears as though the effects of the morning dose are wearing off too quickly and symptoms are rebounding later in the day or overnight. From the standpoint of owner convenience, once daily dosing is probably easier, especially because every dose needs to be given along with a meal in order to assure maximum absorption. Plus, it may be less expensive since only half as many capsules are needed (regardless of the fact that the single dose is larger in strength). But some dogs do end up with more consistent symptom control when dosed every 12 hours.

Having said that, I think a single daily dose of 10 mg. would be a reasonable place for you to start if you do begin treatment. Adjustments can be made later down the line depending upon your dog's response to the medication.

Marianne

[goldengirl88]

I have done both dosings and say I prefer the once a day. The higher dosage once a day seems to blast the cortisol level down enough so it does not climb back up by nite if you are on the right dose. Also if you think your baby is having renal issues that would fall under a specialist in urology, I don't think you would be looking towards an endocrinologist as that would be more about the Cushings itself or thyroid, hormones etc. Blessings
Patti