REMY diagnosed last week

[labblab]

Hi Claire,

Certainly glad that Remy hasn’t shown any ill effects! How about his appetite — have you had any new problems with getting him to eat? Also, when is your vet wanting you to schedule the first monitoring blood test?

Marianne

[Remy’s Mom]

No change in appetite. He’s still eating happily. We are going to retest after two weeks.

[Joan2517]

I think as long as Remy seems okay, I would leave him on the 10mg until you test. Gable was doing so well, I thought, on 30mg and then started drinking and panting more and I almost raised it back to the 40mg because we all thought he had room. Turned out it was just the opposite, he had dropped to .4 or .5 because of too much thyroid medication. It's a good thing I didn't raise it without testing.

He's been on 5mg now for a few months (he's 75 lbs) and even though he still drinks loads and pees like a racehorse, he's doing good. The panting has finally subsided, he's still got a good appetite and in the last few days he's been going 5 - 6 hours without having to go out at night. His fur has come back beautifully and I feel like he's doing better. I will test him again in the next couple of weeks to make sure.

After that scare with the drop in cortisol, I won't make any changes without testing. I think the key is how well we know our dogs. We watch for those little signs that only we would know are off. If something doesn't seem right, I'm off to the vet. I did that with Lena, but wasn't as aware then as I am now, that they don't always know as much about Cushings as they like to think. I don't think that Gable would still be alive if it wasn't for this forum. I'm sure they would've started him at a huge dose and I wouldn't have known better and gone along with it.

[Remy’s Mom]

Remy’s actual dose was supposed to be 20 mg but I started with 10mg on my own until we see how he does. What makes it hard is he has very minor symptoms. No drinking or peeing at all beyond the normal. He was always a very picky eater and started to eat normally which is what concerned us. A little pot belly and somewhat thinner coat and night time panting is about it for symptoms. And really, he has done the panting at night for a long time. He insists on cuddling up to a faux fur blanket and gets too hot I think. But still, even a slight change was enough for me to consider Cushings and I’m glad we tested. I think since he has such mild symptoms, it isn’t going to hurt him to wait another week and retest and see where we’re at. My biggest concern is his liver enzymes which were pretty high but he’s always had elevated liver enzymes without clinical signs. So I think as long as they are retesting the ACTH we will do liver enzymes as well and see if there is any change. I’m glad Gable is doing pretty well now. Good thing you followed your instincts! For me, it’s bizarre to have a Cushings positive dog that doesn’t pee much. Remy can sleep 11-12 hours go outside and just lay on the porch. We have to prod him to ‘go potty’. I also want to be sure this IS Cushings and not just some minor bump in the ACTH. I am going to pick up some prednisone to have on hand in the event of a crisis and I think keep him on the lower dose until we know for sure where he’s at. You are absolutely right, they don’t know as much about Cushings as we would like.

[labblab]

Hi again, Claire. I very much agree with Joan’s suggestion to just leave Remy’s dose “as is” until your first monitoring ACTH. Even though the general recommendation is to leave an initial dose unchanged for the first 30 days (cortisol levels can continue to drift downward during that time), if his cortisol level is still extremely high next week, you may decide to go ahead and increase since he started at a rather low dose to begin with. Here’s some related info that you might find helpful — I just added this reply to another new member’s thread, so I’ll go ahead and repost it here, too .

Also, if Rex is being given an ACTH stimulation test next week to monitor his cortisol level, it’s important that he be given his morning dose of trilostane along with breakfast, as usual. He should not be fasted before taking the test. This is because trilostane needs to be given along with food in order to be metabolized properly. If not, the monitoring test may falsely indicate that his cortisol is running higher than usual. As Leslie has written, dosing increases are usually not made until after 30 days, regardless. But with every monitoring test, we want the results to be as accurate as possible.

Here’s a link to a publication printed by Dechra, maker of brand name Vetoryl. At the bottom, you’ll see a flowchart that shows you how dosing decisions are made based on monitoring ACTH tests. I think this info may be helpful.

http://www.dechra.us/Admin/Public/Do...US-046-TEC.pdf
Marianne

As far as Remy’s liver values, this is probably way too soon to expect to see any change. It can take quite some time to see a significant impact with those, and some Cushpups never have their liver values completely return to normal range even while being treated. So don’t get discouraged if you don’t see quick improvement there, OK? I think you guys are doing great for right now.

Marianne

[Remy’s Mom]

Remy’s ACTHwas 7.8 and 24 so not too terrible so I’m comfortable sticking with the 10 mg. Don’t know what his vet will say but I believe the thinking here is sound. He is virtually asymptomatic and I see no harm in giving the trilostane at the lower dose for a bit. I appreciate the information regarding the liver enzymes. His ALT and ALP were both in the 700’s. I know Angel’s can go up and down like a roller coaster but when hers are medication driven it can take weeks for them to decrease. With her we found one drop of neopolydex eye drops was enough to keep her liver values elevated for weeks. I know changes to his liver and gallbladder are very mild and we do an ultrasound at least every six months. In the four years we have had Remy he has never had normal liver values so I won’t panic. . Thanks so much! Such a wealth of information here!!

[Remy’s Mom]

We just got the test results from Remy’s first follow up ACTH. Pre 6.1 and Post 7.6. Prior to Vetoryl he was 7.8 and 24. So we will stick with the 10 mg dose once a day for the time being as it seems to be controlling his disease. VERY glad we started with the 10 mg dose!! Other than maybe a slight decrease in his panting I don’t see any changes but his ‘symptoms’ were really marginal to begin with. I’m hoping he will keep his appetite and not return to being Mr. Picky Eater!! Will keep you posted!! As always, a big thanks to everyone for the help and support!!!

[labblab]

I think this is a great report, and yes, I’d definitely stick with the same dose for now.

Thanks so much for letting us know!
Marianne

[Joan2517]

Wonderful, Claire!

[Remy’s Mom]

I was very pleased to see him respond so well on a minimal dose. Hopefully he will do well at 10 mg per day. Doctor did up his amlodipine to control his blood pressure though. Also, Angel had a good report from her oncologist Monday. Her bladder cancer remains stable!! It was a year ago on March 1 that we first suspected TCC and she has had a fantastic year! Now if I can just keep Remy doing well too!! Hugs to you and your fur babies. Hope Gable is doing well!!