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Thread: Potential Cushings diagnosis

  1. #11
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    Sep 2018
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    Default Re: Potential Cushings diagnosis

    Also, if anyone out there has any experience with HAC and incurin, I'd be interested in knowing if you've seen similar effects. there's not a lot of info out there, but my theory is that since estriol is a form of estrogen (which is also produced by the adrenal glands), somehow this gives a similar effect to dexamethasone, essentially suppressing (some) of the effects of HAC, assuming its pituitary-caused. I'm no expert, but that makes sense to me, given what I've seen, but I'm curious if anyone else has a similar experience.

  2. #12
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    Mar 2009
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    Default Re: Potential Cushings diagnosis

    It's good to hear from you again and to hear that Bella is doing well for the most part. However anytime I see that someone is using Proin it scares the crap outta me because of what that drug did to my Sweet Bebe, Squirt. Not only does it cause side effects that are the same as some of the signs for Cushing's I have no doubt it caused her stroke which changed her for the remainder of her life. You can read our experiences at the following link to her thread. It starts at post #532 where she is prescribed Proin. One of the links to the FDA report no longer works but you can search the FDA website using the word "Phenylpropanolamine". You will find several articles concerning the dangers of this drug, the FDA's efforts to remove it from the market, and their success in removing it from all human drugs. Sadly it remains in veterinary use. You can also google "Proin death", "Proin side effects", "Proin dangers" and learn more. Here is Squirt's thread to get you started - (post #532 starts the conversations on Proin in her life) -

    https://www.k9cushings.com/forum/sho...-Bridge/page54
    "May you know that absence is full of tender presence and that nothing is ever lost or forgotten." John O'Donahue, "Eternal Echoes"

    Death is not a changing of worlds as most imagine, as much as the walls of this world infinitely expanding.

  3. #13
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    Apr 2009
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    York, PA.
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    Default Re: Potential Cushings diagnosis

    Are you getting the Trilostane (active ingredient in Vetoryl) compounded? And is your vet testing the cortisol using the pre pill method or the regular full ACTH stimulation test? Also, it is very important to give the Trilostane with a meal as it needs food to be properly absorbed. Here are a couple links to information from our Resource Thread that I believe you'll find useful: Cost Savings for Owners of Cushingoid Dogs AND Trilostane/Vetoryl Information and Resources

    Please keep us updated!

    Lori

  4. #14
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    Sep 2018
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    14

    Default Re: Potential Cushings diagnosis

    No, we're getting Vetoryl at one of the existing dosages (she's a ~22 kg dog, so at .5 mg/kg, they want to start her on a 10 mg dose 1x/day). For checking the cortisol, the plan is to do a full ACTH stim test is my understanding. They are going to do an addition electrolytes check at the 1 week mark which is just a blood draw, but I think the 2 week check is a full ACTH stim.

    SquirtsMom,
    So sorry to hear about your awful experience with Proin, and thanks for the warning. So far Bella is tolerating it very well (no real side effects), and the vet is monitoring her blood pressure regularly. Part of the reason I'm interested in trying to start the Cushings treatment is I'm hoping that will improve some of her incontinence/PU/PD issues, since without the Proin she is leaking urine about 5-10+ times/day, and it was making her miserable, not to mention the toll it was taking on us trying to keep her and our house clean. The cushings symptoms all pre-date her starting Proin, so I'm hoping once we get that under control we won't need to have her on so many incontinence meds.

  5. #15
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    Default Re: Potential Cushings diagnosis

    Hi David,

    Has Bella started the Vetoryl?

  6. #16
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    Sep 2018
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    14

    Default Re: Potential Cushings diagnosis

    Yes!
    She's been on it for about 20 days now. She had an electrolytes check at 7 days (everything normal) and an ACTH Stim test at 14 days. The ACTH test came back with values of 3.9 (pre) and 9.7 (post). Our vet called today about the results (just came in over the weekend) and said it all looked good, keep the current dose. I'm a little confused by this, since while her PU/PD has improved slightly, it's definitely still not normal, and overall behavior is mostly unchanged. She's only on .5 mg/kg dose right now, and according to the flowchart that came with the Vetoryl, over 5.4 and symptoms not controlled means the dosing should be increased. Am I misreading this? I understand we're supposed to wait a full 30 days before any dosing changes, which makes sense, but I was going to make an appointment to talk to the vet about upping the dose when I need to buy more vetoryl (which will be at 30 days, she's taking 10mg doses right now).

  7. #17
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    Sep 2018
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    Default Re: Potential Cushings diagnosis

    Also, just as information, the ACTH stim was done 4 hours after her morning meal and pill.

  8. #18
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    Default Re: Potential Cushings diagnosis

    Quote Originally Posted by Doggy_David View Post
    Yes!
    She's been on it for about 20 days now. She had an electrolytes check at 7 days (everything normal) and an ACTH Stim test at 14 days. The ACTH test came back with values of 3.9 (pre) and 9.7 (post).
    Very happy to hear that her electrolytes were checked and they were normal. As for her ACTH stim test results, for right now I think those are good too...GREAT job!!!

    Quote Originally Posted by Doggy_David View Post
    Our vet called today about the results (just came in over the weekend) and said it all looked good, keep the current dose. I'm a little confused by this, since while her PU/PD has improved slightly, it's definitely still not normal, and overall behavior is mostly unchanged. She's only on .5 mg/kg dose right now, and according to the flowchart that came with the Vetoryl, over 5.4 and symptoms not controlled means the dosing should be increased. Am I misreading this? I understand we're supposed to wait a full 30 days before any dosing changes, which makes sense, but I was going to make an appointment to talk to the vet about upping the dose when I need to buy more vetoryl (which will be at 30 days, she's taking 10mg doses right now).
    Nope, you not misreading it, however, cortisol can continue to drift downward during the first 30 days of treatment so a dosage increase is not recommended at this time. Will you be getting another full ACTH stimulation test performed at the 30 day mark? If so, and her cortisol is still over 5.4 ug/dl and she is still exhibiting symptoms a dosage increase would be justified but I wouldn't increase it more than 5 mg. Vetoryl does come in 5 mg capsules so if this were me, I would purchase 5 mg capsules in addition to the 10 mg capsules so that dosage adjustments could be made in 5 mg increments.

    Lori

  9. #19
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    Sep 2018
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    Default Re: Potential Cushings diagnosis

    Thanks. Glad to know I'm not misreading. I think I need to have a talk with the vet closer to the 30 day mark. Not sure if the plan is to do another ACTH test at 30 days or not. The big thing for me is the clinical signs haven't improved. It seemed like they were improving slightly for a bit (drinking less, spending more time hanging out with us versus sleeping on the cold tile all day, etc), but since the ACTH test things seem to have regressed back to before we started the vetoryl in terms of the PU/PD levels and the activity levels. Is this normal?

  10. #20
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    Apr 2009
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    York, PA.
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    Default Re: Potential Cushings diagnosis

    The PU/PD shouldn't be getting worse, however, it could be that an UTI is brewing as cushdogs are notorious for getting them, since their urine is so dilute the best way to check for an UTI is to have an urine culture and sensitivity test done.

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