Zoe-Our journey together

[Crystal&Zoe]

I've been lurking here and the FB page for awhile and thought I would introduce myself and my Zoe to the group and ask a couple of questions. I apologize in advance for the book but just want people to know our history. Perhaps it will give some insight to help you all give us tips, suggestions and advice. Zoe is a Maltese that I got from a byb back before I knew better. She is not the typical Maltese in conformation or temperament. She has always been a high anxiety dog with OCD tendencies. Her food dish must be in the same place. She will only drink out of the water bowl on the right, not the left. She is the reason I've learned that only true positive reinforcement training is best. I feel like I failed her miserably the first couple of years I had her before I did my homework and became a student of all things dog related in behavior, training and holistic health care. However she is the smartest dog that both I and the trainer who did classes at my store have met to date, and has brought me so much joy. Out of my 3, she is the one who wants to please me more than anything and it's frustrating to her and upsets her when she can't figure out what I'm asking of her or she knows what I'm asking and simply can't give it. She will be 11 tomorrow.

Our cushings journey started in the late fall of 2011 when she was 8. My parents were getting older and I was beginning to be called to their house in the evenings after work more and more to help with various things. It was exhausting and draining to try to keep up my place as well as theirs. So I sold my house and theirs and we purchased a house where we could all live with separate areas and I could help out more easily. Zoe did not transition easily to this move. I had a pet supply store (just had to close it the end of 2014) and due to Zoe's temperament she did not do well at the store. So I would take her to my parents home and she would stay with them for the day while I took the other 2 with me to work. The place we moved to is a planned community where we pay a HOA fee and they maintain the outside. So rules are strict here. Zoe went from being able to run free in a 3 acre yard chasing squirrels and chipmunks and exploring adjacent fields and even a creek running through the yard to a place where she had to be leashed when we go outside and we had to implement a 3 bark rule. A huge change for her and one she still to this day struggles with. She has a history of back pain and right after we moved she was in so much pain she would tremble uncontrollably in her bed and would not move. Everything we tried to manage the pain did not help. I was still trying to find a good vet that would work integratively with me. I'm in a small town and most vets here still have the farm animal, pets are pets mentality. It finally became a quality of life issue and she had to be put on Prednisone a few times. She was diagnosed at that time with IVDD. Also at that time she started to drink large volumes of water and having to go outside to pee a lot. Side effect of the Prednisone, right? Well it didn't stop. So I took her to my then vet and we ran a full CBC, Chem Screen and urinalysis and everything was WNL's but her AlkPhos was slightly higher than it had been the previous year and at the high end of normal. Then dad was diagnosed with cancer and died very unexpectedly in February, just 3 months after we moved. Dad was her person and was always in his lap. We had to call the ambulance in the middle of the night and she refused to leave his side. She truly grieved and went into depression. And she continued to drink large volumes of water and pee a lot, as well as lick the kitchen floor incessantly before and after dinner for at least 30 minutes if not more. My then vet was telling me it was all behavioral because she would go drink large amounts of water when she was over excited and didn't know what to do with herself or frustrated. At that time I also noticed she was no longer able to jump up on furniture. It was thought it was due to her IVDD. She has always been a grouchy girl but she was acting grouchier when I would touch her lower back area. So I found a holistic vet a couple of hours away who specializes in movement and does chiropractic and acupuncture in horses as well as small animals. We were doing acupuncture and noticed some areas of thinning hair. He helped me find a really great integrative vet closer to home and we ran a thyroid test and it came back wnl's. Next we ran a Urine Cortisol:Creatinine Ratio. It came back positive. But we did a urine catch there at the vet clinic and she's a high anxiety girl. So we did the Low Dose Dex Suppression test which also came back positive. But her hair was for the most part still thick with only a few areas on the tops of her feet that were thin. And she had no pot belly and her weight was good. She was really in good condition and both my integrative vet and holistic vet said she's the most atypical looking dog they've yet met if she truly has cushings. Neither could really believe she had cushings so we ran the ACTH Stim. Yes, she has cushings. So we treated holistically and managed her cortisol levels well. She would have times where we needed to adjust her TCHM meds and lost most of her hair at one point but it came back in nicely. Then about 5-6 months ago she started to lose her hair again, lost more muscle mass and developed a pot belly. And her grouchiness got worse to the point of aggression. So we started her on Trilostane about 4 1/2 months ago. She was 10 lbs when we started her on 10 mg. once a day. She's also on 3 mg. melatonin twice a day. Her aggressiveness got worse. She lost even more hair to the point of practically being bald. Her skin started to become paper thin where I could see veins and flake. And she was dropping weight and losing her pot belly. She was drinking normal amounts of water again and all peeing accidents stopped. And she was acting like she was feeling better. In her 3rd month of being on the Trilostane she was continuing to lose weight to the point of being too thin. She was under 9 lbs at that point and I couldn't put weight on her and I was increasing her food a lot. And she was beginning to shake uncontrollably when over stimulated. We were trying to spread out the Stim tests a bit for financial purposes but her symptoms were all over the place. Some indicating she was on too high of a dose and others that she was on too low of a dose. We ran another Stim Test a few weeks ago (the same week her symptoms seemed to finally resolve) and her cortisol levels are being very well managed and all of her others levels look good. I'm a firm believer in preventive medicine as well as integrative medicine so I do yearly cbc's and urinalysis on my dogs. We haven't done any flea or tick meds in over 7 years and they've not had fleas or a tick in those 7 years. They get heartworm prevention with no other wormers that is compounded for their sizes every 60 days. They are raw fed with what would be considered 'cold' or 'neutral' meats in TCHM and we rotate often. Zoe is back up to a good weight of 9 lbs and gets in addition to her trilostane and melatonin daily: glucosamine/chondroitin, cold pressed organic coconut oil, fish oil and an immune support blend. I've always given my dogs a 30 day detox with a milk thistle blend every quarter as well as every weekend a homeopathic detox that works on a cellular level. I've also started to give her a preventive dose of an herbal blend for bladder health. So far her liver enzymes have all been wnl's and she's not had a UTI.

So these are my questions:

1) Is her reaction to starting Trilostane typical?

2) I'm reading more and more that it's better to give Trilostane twice a day. She's always been grouchy but I'm noticing in the evenings she's more grouchy than in the mornings. I give her Trilostane at breakfast. Should I ask my vet to compound it and give it to her twice a day?

3) Did the stress/anxiety of our move and the loss of dad trigger this? Again she's always been high anxiety but her adrenal system took a huge hit at that time. And do I try to keep her manners in check even if it causes her stress? The 3 bark rule (not literally 3 barks but I'm ok with them alerting me of something, thank them for it and acknowledge it and then they have to stop) is very hard for her. She can't give it to me at times even though she knows it's what I'm asking of her. I can see she wants to do what I'm asking and just can't. Her barking is getting worse. I'm guessing due to cataracts that are also developing. Do cataracts go hand in hand with cushings or is it that cushings dogs are typically older and so they also have cataracts?

4) Are dogs who are more high anxiety dogs more at risk of developing Cushings?

5) Both vets are skeptical that Zoe will regrow her hair. Any thoughts/experience on this? I'm ok with her being bald but when we go for walks people don't want to touch her or give her attention like they used to; or if I have the other 2 with us, they give them all the attention and that frustrates her.

6) Has anyone been able to successfully lower the dose of Trilostane after a period of time while supplementing holistically?

7) Is there anything more I should be doing? Or is there something I'm doing that raises red flags for those with more experience?

For those that have read our book ::blush::, thank you!

(I wanted to include a photo of Zoe that was taken before she got sick and one that was taken last week. She was begging me to fill up her treat ball again. But I don't think I have permission to do that yet. I did upload a few pics into an album I created for any that would like to meet her.)

[Dixie'sMom]

Hello and welcome to you and Zoe! I loved reading your book(haha) and found it very interesting. You obviously care deeply for your pups and strive to give them the very best care possible. It sounds like they are very well behaved even with Zoe's tendency to be high strung. I'm glad you uploaded pictures and I will go look at them. It is one of my favorite parts of this forum.

Unfortunately, I am a fairly new Cushpup Mom and can't do much to advise you. The gurus on this forum will be along soon to welcome you and offer their support.

The one thing I do know that they will ask of you is copies of Zoe's recent test results (blood work, urine, ACTH or any other test specific to Cushing's) to help them get a clearer picture of Zoe's health. They will be able to give you more meaningful feedback after looking over the labs so if you do not have copies, could you request them from your vet?.

My Cushpup, Dixie, is also very high strung and always has been, so I can relate to your experiences with Zoe. Dixie was the only female in her litter, was the runt and was the bully. LOL.

I look forward to getting to know you and your precious Zoe. Again, welcome!

[labblab]

Welcome from me, too! We're so glad you took the plunge and started posting!

I have to "second" what Suzie has written above -- you sound like a super conscientious and caring mom, and we will do whatever we can to try to be of help to you. Also as Suzie has said, probably the most helpful thing you can do for us is to get your hands on copies of actual test results, especially the diagnostic tests for Cushing's and any/all subsequent monitoring ACTHs. The combination of specifics re: Zoe's trilostane dosing history and the associated ACTH results will really help make sense of the things that have been going both right and wrong for her. Until we get that info, there's a limit to the amount of feedback we can offer. But I'll take a first stab at answering at least some parts of your questions below (my answers will be in blue).

So these are my questions:

1) Is her reaction to starting Trilostane typical?

You need to be a bit more specific as to what "reaction" you are wondering about. It sounds as though Zoe has gone through a range of behaviors/symptoms over time, and I'm not exactly sure as to which things you are associating with trilostane. This is an instance where the dosing history and monitoring test results will be invaluable to us, so that we can better assess where her cortisol level was at a given point in time and in conjunction with specific issues that you are concerned about.

2) I'm reading more and more that it's better to give Trilostane twice a day. She's always been grouchy but I'm noticing in the evenings she's more grouchy than in the mornings. I give her Trilostane at breakfast. Should I ask my vet to compound it and give it to her twice a day?

There is still disagreement among researchers and clinicians as to whether twice daily dosing is preferable for all dogs. Some clinicians prefer to dose twice daily right from the get-go. Others (including the manufacturer of Vetoryl) recommend starting first with once daily dosing and only switching over if symptoms are rebounding at night even though the daytime ACTH level is within therapeutic range. Twice daily dosing is more of a hassle, since it needs to be given at 12-hour intervals and trilostane always needs to be given along with a meal. But it does keep cortisol levels more consistently lower throughout the course of a 24-hour time period. For some dogs this is a good thing; for some, it actually has a greater tendency to drive their cortisol too low. So my personal opinion (and that's all it is, an opinion), is that if my dog was doing well on once daily dosing without noticeable symptom rebounding at night, I'd probably leave well enough alone.

3) Did the stress/anxiety of our move and the loss of dad trigger this? Again she's always been high anxiety but her adrenal system took a huge hit at that time. And do I try to keep her manners in check even if it causes her stress? The 3 bark rule (not literally 3 barks but I'm ok with them alerting me of something, thank them for it and acknowledge it and then they have to stop) is very hard for her. She can't give it to me at times even though she knows it's what I'm asking of her. I can see she wants to do what I'm asking and just can't. Her barking is getting worse. I'm guessing due to cataracts that are also developing. Do cataracts go hand in hand with cushings or is it that cushings dogs are typically older and so they also have cataracts?

I'll start backwards with the cataracts question first. I honestly don't know whether cataracts are more common in Cushpups, so thanks for asking the question because I am interested in looking that up myself! But yes, it does seem logical that cataracts may happen to appear in Cushpups simply since more dogs are diagnosed with Cushing's at a later age.

As far as stress/anxiety causing Cushing's (I'm answering your next question as well), I am not aware of any research that supports this. Cushing's is caused by tumors of either the pituitary gland or adrenal gland. While chronic stress is believed to have unhealthy effects on various aspects of the whole body, I don't think there is any direct relationship between stress and the development of these particular tumors.

4) Are dogs who are more high anxiety dogs more at risk of developing Cushings?

See answer above.

5) Both vets are skeptical that Zoe will regrow her hair. Any thoughts/experience on this? I'm ok with her being bald but when we go for walks people don't want to touch her or give her attention like they used to; or if I have the other 2 with us, they give them all the attention and that frustrates her.

This is an example of why it will really help us to see Zoe's actual monitoring test results. If Cushing's is the cause of her hair loss, once Zoe's cortisol level is truly within the desired therapeutic range, hair regrowth should be one of the general benefits of her treatment. So I am unsure as to why your vets are pessimistic about this improving. What is the status of her thyroid function, however? Low thyroid also commonly affects skin and coat. Low thyroid results often occur hand-in-hand with Cushing's. Sometimes the thyroid levels normalize with effective Cushing's treatment. Sometimes the low thyroid level is a primary problem in its own right and needs to be addressed with supplementation.

6) Has anyone been able to successfully lower the dose of Trilostane after a period of time while supplementing holistically?

Trilostane dosing often requires tweaking over time, both upwards or downwards. That's why the monitoring tests are very important on an ongoing basis, especially if there is a rebound in symptoms or a decline in health. However, I am not aware of any holistic supplementation that can take the place of the physiological activity of trilostane. In other words, we do have dogs for whom dosing is reduced over time, but this is due to their response to the trilostane itself, and not because another drug or supplement is performing the same pharmacological action.

I hope these answers are at least a start to the conversation. Once again, we're really glad you and Zoe have joined us!

Marianne

Edited to add: On rereading your post, I see that Zoe's thyroid level was normal at the time of her initial diagnostics. So that answers one of my questions above. Has her T4 level remained within the normal range subsequent to that time, however?

[Crystal&Zoe]

Hello and welcome to you and Zoe! I loved reading your book(haha) and found it very interesting. You obviously care deeply for your pups and strive to give them the very best care possible. It sounds like they are very well behaved even with Zoe's tendency to be high strung. I'm glad you uploaded pictures and I will go look at them. It is one of my favorite parts of this forum.

Unfortunately, I am a fairly new Cushpup Mom and can't do much to advise you. The gurus on this forum will be along soon to welcome you and offer their support.

The one thing I do know that they will ask of you is copies of Zoe's recent test results (blood work, urine, ACTH or any other test specific to Cushing's) to help them get a clearer picture of Zoe's health. They will be able to give you more meaningful feedback after looking over the labs so if you do not have copies, could you request them from your vet?.

My Cushpup, Dixie, is also very high strung and always has been, so I can relate to your experiences with Zoe. Dixie was the only female in her litter, was the runt and was the bully. LOL.

I look forward to getting to know you and your precious Zoe. Again, welcome!

Thank you! I look forward to getting to know you and your sweet Dixie as well. I just wish it were under better circumstances.

Welcome from me, too! We're so glad you took the plunge and started posting!

I have to "second" what Suzie has written above -- you sound like a super conscientious and caring mom, and we will do whatever we can to try to be of help to you. Also as Suzie has said, probably the most helpful thing you can do for us is to get your hands on copies of actual test results, especially the diagnostic tests for Cushing's and any/all subsequent monitoring ACTHs. The combination of specifics re: Zoe's trilostane dosing history and the associated ACTH results will really help make sense of the things that have been going both right and wrong for her. Until we get that info, there's a limit to the amount of feedback we can offer. But I'll take a first stab at answering at least some parts of your questions below (my answers will be in blue).



I hope these answers are at least a start to the conversation. Once again, we're really glad you and Zoe have joined us!

Marianne

Edited to add: On rereading your post, I see that Zoe's thyroid level was normal at the time of her initial diagnostics. So that answers one of my questions above. Has her T4 level remained within the normal range subsequent to that time, however?

Thank you Marriane. We've tested Zoe's thyroid now on multiple occasions and send it to Dr. Jean Dodds' lab. So far it comes back normal. However the last time we sent it off was when we were struggling to manage her cortisol level holistically and test results were indicating an underlying kidney issue and there were some notes from her lab. I'm sitting her thinking, 'I can't believe I don't remember!'. It was a stressful time and she was not only having many piddle accidents (which she never has, but she had a terrible gastric upset and was having liquid diarrhea every 2 hours for almost a week. I got very little sleep at that time and we were even thinking she may have diabetes insipidus. Thankfully once the cushings was managed again, that went away. But during that time she was not dehydrated but I'm guessing her electrolytes were out of balance because she truly seemed unaware that she was peeing in the middle of the room right in front of me. I will go back and pull records. How far should I go back? I've not received copies of her latest stim test and work up yet. I can have her email me copies but it's usually easier to pick them up when I go to pick up her next supply of Trilostane.

And yeah....I probably just need to admit it. I'm a crazy dog mom. I was never blessed with skin kids so they are truly my kids. I owe so much to Zoe. She really helped me through a very dark time when I realized I would never have children of my own. So please forgive my over the top crazyness.

Edited to add: My understanding is that stress, whether it's good stress or bad stress if her body doesn't know how to deal with it causes major fluctuations in her cortisol levels. I guess I was wondering if having chronic fluctuations could possibly cause tumors either on the pituitary or adrenal gland. We've been thinking Zoe's is pituitary but her last ultrasound did reveal that at this point in time one adrenal gland is slightly larger than the other. No tumors could be seen. Due to her size, I know it really takes an expert to be able to see them and I've not been able to take her to a specialist. My vet is certified and recently took a CE course specifically to help her with ultrasounds for the tiny patients.

And good to know the thought process on once a day vs. twice a day dosing. Thank you!

[Dixie'sMom]

I checked out Zoe's pictures and she is just beautiful! If you want to make one of these pretty pictures your avatar, just go to User CP, Edit Avatar.

I see Marianne has dropped in on you. You are in excellent hands.

[Squirt's Mom]

Edited to add: My understanding is that stress, whether it's good stress or bad stress if her body doesn't know how to deal with it causes major fluctuations in her cortisol levels. I guess I was wondering if having chronic fluctuations could possibly cause tumors either on the pituitary or adrenal gland. We've been thinking Zoe's is pituitary but her last ultrasound did reveal that at this point in time one adrenal gland is slightly larger than the other. No tumors could be seen. Due to her size, I know it really takes an expert to be able to see them and I've not been able to take her to a specialist. My vet is certified and recently took a CE course specifically to help her with ultrasounds for the tiny patients.

Hi and welcome to you and Zoe!

The fluctuation in cortisol levels due to stress is a NORMAL function of the body, canine, human, feline, equine, etc. Cortisol is vital to our survival. It's only in Cushing's where the levels are so very high that this hormone turns on the system.

At this time, no one knows the cause of Cushing's. Studies have been done on feed, environments, genetics and no correlation has been proven. It seems to just be a fluke that some develop this disease. It presents differently in different species, too. In dogs, Cushing's is caused by tumors, either on the pituitary or the adrenal gland(s). What causes those tumors is unknown but stress is not the culprit or we would have proof of that from the scientific community by now.

Stress is MUCH more of a concern for pups with Addison's, a disease the opposite of Cushing's in which the body can no longer produce cortisol or not enough cortisol to deal with any stress. These pups must be supplemented with synthetic cortisol plus electrolytes so they can cope with simple every day stimulus like the mailman. So stress is not as big a concern for our cush pups.

In PDH, the pituitary-based form, the adrenal glands on the ultrasound typically appear larger than normal, both of them. In ADH, the adrenal-based form typically one gland is larger than the other, the other may even be atrophied (shriveled up). The US and LDDS do the best job of helping to determine which form the pup has. This can be very important to know as treating an adrenal tumor can be a bit more difficult and the pituitary tumor may start to grow causing neurological signs. So most vets want to know which form is in play.

The ultrasound is an expensive test and should be done only on a high resolution machine and read by the person who always reads that machine. Otherwise you run the very real risk of not being able to see everything that is needed and not getting accurate, detailed interpretation.

I'm glad you made it here and look forward to following yours and Zoe's journey.
Hugs,
Leslie and the gang

[labblab]

In terms of test results, I'd be most interested in the diagnostic tests for Cushing's (ACTH and abnormal values on blood/urine panels), all the subsequent monitoring ACTH results, and also abnormal values on any recent blood/urine panels. Has Zoe remained on the 10 mg. of trilostane since beginning treatment?

Marianne

[Crystal&Zoe]

Hi and welcome to you and Zoe!

The fluctuation in cortisol levels due to stress is a NORMAL function of the body, canine, human, feline, equine, etc. Cortisol is vital to our survival. It's only in Cushing's where the levels are so very high that this hormone turns on the system.

At this time, no one knows the cause of Cushing's. Studies have been done on feed, environments, genetics and no correlation has been proven. It seems to just be a fluke that some develop this disease. It presents differently in different species, too. In dogs, Cushing's is caused by tumors, either on the pituitary or the adrenal gland(s). What causes those tumors is unknown but stress is not the culprit or we would have proof of that from the scientific community by now.

Stress is MUCH more of a concern for pups with Addison's, a disease the opposite of Cushing's in which the body can no longer produce cortisol or not enough cortisol to deal with any stress. These pups must be supplemented with synthetic cortisol plus electrolytes so they can cope with simple every day stimulus like the mailman. So stress is not as big a concern for our cush pups.

In PDH, the pituitary-based form, the adrenal glands on the ultrasound typically appear larger than normal, both of them. In ADH, the adrenal-based form typically one gland is larger than the other, the other may even be atrophied (shriveled up). The US and LDDS do the best job of helping to determine which form the pup has. This can be very important to know as treating an adrenal tumor can be a bit more difficult and the pituitary tumor may start to grow causing neurological signs. So most vets want to know which form is in play.

The ultrasound is an expensive test and should be done only on a high resolution machine and read by the person who always reads that machine. Otherwise you run the very real risk of not being able to see everything that is needed and not getting accurate, detailed interpretation.

I'm glad you made it here and look forward to following yours and Zoe's journey.
Hugs,
Leslie and the gang

Ok that makes sense about the stress level Leslie. Thank you. So I won't be letting her get away with things I don't my other two. Poor Zoe. I think she thought she had it made there for awhile. lol But we don't want to be asked to move from the community we live in because she may be small but she's got a mighty bark!

I have no idea what type of ultrasound machine my vet has but I do know it's brand new and she said state of the art. How the heck do I ask without causing offense? She is the one to do the ultrasound as well as read it. I believe the Low Dose Dex Suppression test indicated pituitary cushings and I simply cannot afford an MRI. I would have to travel several hours to get one for her. I'm ashamed to have to admit this because honestly, I would do anything for my babies that is within my reach. We've done quite a few ultrasounds. Thankfully my vet and are becoming friends and she seems to like me and has only charged me for the first one. She's wanting to track her progression as much as I do. I've gone through most vets in my area because I simply know more than the average pet owner in general health areas and can give them credible sources as to why I won't vaccinate every year, want titer testing done, and don't even get me started in the area of nutrition. So I want to keep my good relationship with the 2 vets I have for sure. They treat me as an equal when it comes to decision making and allow me to be a part of treatment plans. That didn't happen with any other of the vets I've tried. When treating with TCHVM's, it wasn't truly important what type of cushings she had. And when my integrative vet asked about the MRI and I said I could not swing it financially, she said that with Trilostane it works for both adrenal as well as pituitary cushings. So since her adrenal glands have been the same size all along until just this last time right before we started her on the Trilostane, could possibly the one becoming atrophied? I'm trying to remember but I think this was briefly discussed on the FB page and there is a possibility of adrenal glands doing this and then medication is no longer needed. Am I remembering that right? And am I being neglectful for not finding a way to get an MRI for her?

In terms of test results, I'd be most interested in the diagnostic tests for Cushing's (ACTH and abnormal values on blood/urine panels), all the subsequent monitoring ACTH results, and also abnormal values on any recent blood/urine panels. Has Zoe remained on the 10 mg. of trilostane since beginning treatment?

Marianne

She's only been on the Trilostane now for a little over 4 months. And she's remained on the 10 mg since the beginning. I'll get the results of her latest blood work and and stim test and get the numbers for you. Thank you!

I checked out Zoe's pictures and she is just beautiful! If you want to make one of these pretty pictures your avatar, just go to User CP, Edit Avatar.

I see Marianne has dropped in on you. You are in excellent hands.

Thank you! I was thinking the same thing about using one of the photos for my avatar. Thank you for suggesting it. She really does not look like she used to anymore which is hard for me. But I have to keep telling myself that just because she looks bad physically to people who don't know what's going on with her, she's physically feeling good and that's all that matters.

[Squirt's Mom]

Honestly, I think of the MRI and CT scans as measures when you know things have changed dramatically, as in the appearance of neurological signs that may indicate the pituitary tumor is growing or when considering an adrenelectomy or hypophysectomy. But not as part of the usual diagnostic process. The abdominal ultrasound can tell everything that is needed at this point. So no, you are not being neglectful, just wanting to be as sure as possible that you have covered all the bases.

So since her adrenal glands have been the same size all along until just this last time right before we started her on the Trilostane, could possibly the one becoming atrophied? I'm trying to remember but I think this was briefly discussed on the FB page and there is a possibility of adrenal glands doing this and then medication is no longer needed. Am I remembering that right?

What happens in an overdose from Vetoryl or Lysodren that the pup cannot recover from, is the adrenals are necrosed, or killed off. As time passes, they will shrink and atrophy, as will any living thing that is no longer in use. This is Addison's and not what we are shooting for. Interestingly enough, in some countries they do kill off the adrenal glands on purpose because they feel it is easier to treat Addison's than Cushing's. That is not the prevailing belief elsewhere.

With ADH, the adrenal form of Cushing's, one gland will be large and the other small or atrophied, but not both.

[labblab]

Due to the expense, very few people opt for an MRI of the head, especially in the absence of neurological symptoms that suggest a pituitary tumor is enlarging and placing problematic pressure elsewhere in the brain. So you are definitely not a bad mom for not pursuing an MRI at this time. You are in very good company.

As for the recent ultrasound revealing an increase in size in one of the adrenals, as long as no mass or tumor is noted, my guess is just that both glands are not keeping the exact same pace in terms of enlargement.

Marianne