Recent diagnosis; lab test recheck and dosage change

[Squirt's Mom]

Plain melatonin is fine for our cush pups (NOT diabetic dogs tho) but I would double check with the vet first. He's a little young for dementia to be starting but anxiety is not uncommon at all as they start to age into the senior years. I would talk to the vet about this possibility as well. My little Tilly had to have some help starting a few years back as she developed separation anxiety which has worsened over the years sadly. I now have a carry bag that goes over my shoulder so I can carry her around with me. Yes, I am well trained! LOL

Hugs,
Leslie

[TheBean]

Thank u! Good to know others have tried melatoninwith cushings. Bean's vet has said he could take up to 1/2 mg melatonin in the evening (7.5 lb dog) on anxious days. We are thinking its more cushings related than dementia as he seems anxious about food and water even if he's just eaten on these anxiety occasions - its not over the top anxiety or daily, it's just on an occasional basis. When it happens he's hyped up and stands and barks incessantly, then runs back & forth to food/water bowls. The vet just tweaked his vetoryl dosage recently so hopefully once he's on correct dose we can get a better handle on the occasional anxiety. The phermone spray works well at settling him so he can go to sleep later in the evening whenthis happens. We haven't tried melatonin yet. I guess we're just looking for anecdotal feedback on melatonin and phermone sprays. Thank you so much for your input.

[TheBean]

Is there any resource or even an anecdotal thread on eye conditions and cushings disease? The Bean had a series of corneal issues and dry eye just before his cushings diagnosis and we are curious if the vetoryl and getting his cushings symptoms under control might also possible resolve his dry eye. We have already noted a significant improvement in his eyes since starting the vetoryl. Thank you!

[labblab]

Hello and welcome to you and Bean from me, too! I see I hadn’t had the chance to write to you before this, but I’m so glad that you’ve heard from other folks :-). I’m also glad to hear that you’re now seeing improvement in his eye symptoms. Whether or not his eye problems have been Cushing’s related, I’m afraid I don’t know. Those are not symptoms about which I’ve ever heard a connection. But if you’re seeing improvement now, that’s a gift whether or not there’s genuinely any relationship with his treatment.

I’ll be hoping that you’ll keep seeing improvement in all his symptoms! We’re so glad you’re here, and please keep us updated.

Marianne

[Squirt's Mom]

Hi,

I was surprised to learn a few years ago that Cushing's can impact the eyes. Here are some links that offer information in the avenue:

https://www.dvm360.com/view/ocular-m...se-proceedings

https://pubmed.ncbi.nlm.nih.gov/21575979/

https://veterinaryvisioncenter.com/c...tions-in-dogs/


And then there is SARDS - Sudden Acquired Retinal Degeneration Syndrome.
"Dogs with SARDS appear to go blind very quickly. Some owners report periods where their dog still appears to have some small degree of vision, but most dogs seem to be completely blind.
...
In some cases, dogs with SARDS have a history of clinical signs consistent with Cushing’s disease. These signs include increased thirst, urination, and appetite, excessive panting, weight gain or obesity, and lethargy. It is unknown whether Cushing’s contributes to SARDS or whether this association is coincidental. There may also be an association between SARDS and liver disease, though this is also unconfirmed."
https://vcahospitals.com/know-your-p...syndrome-sards

I hope this helps and that lowering the cortisol will have a beneficial impact on The Bean!
Hugs,
Leslie

[TheBean]

Thank you for this info. It was very interesting and helpful. ��

[TheBean]

Good afternoon.
We had a question regarding the bean and whether any additional blood work should be checked now that he has been on the trilostane Treatment for six months. Other than his initial bloodwork back in October 2023, he has had 4 ACTH stim tests (Results of which are all in my first post) and no other testing. If he should be having some additional bloodwork, what would be the normal blood work values that would be tested so that I can have an informed conversation with my veterinarian about next steps. He is due for another ACTH stim test in about 10 days.
His symptoms have not resolved although some are improved and some are new (like itchy skin). Thank youfor any info or links you might have. Advice always welcomed!
His last acth test was 2/9/24 - results copied below:

2/9/2024: ACTH stim retest after dosage adjustment last month:
"Pre Cort: 6.47 ug/dL range: 1.0-5.0
1 Hr. Cort: 7.5 ug/dL range: 7.8-19.7
Pre-trilostane Cortisol Concentration
> 5 ug/dL (> 140 nmol/L)
Post-ACTH Cortisol Concentration
1.8 – 9.1 ug/dL (50 – 250 nmol/L)

[labblab]

Hello and welcome back to you and Bean! As far as additional bloodwork, we’ve been told it is always a good idea to have a basic blood chemistry panel performed alongside monitoring ACTH tests for dogs taking Vetoryl. This is because, in addition to lowering cortisol, Vetoryl can also lower the production of another adrenal hormone named aldosterone. Aldosterone controls the balance of sodium and potassium in the body. If the aldosterone level gets too out of whack, then the sodium/potassium balance can be thrown off as well. This can cause Addisonian problems. So it’s a good idea to run a basic blood chemistry panel that includes sodium and potassium.

As far as Bean’s February ACTH results, I believe this was after you had increased his dose to 10 mg. in the morning and 5 mg. in the evening. If next week’s results are similar, I do believe you could consider increasing his dose again since he still suffers from some unresolved symptoms.

The desired therapeutic post-ACTh reference range for a dog being treated with Vetoryl is 1.45 ug/dl - 5.4 ug/dl, going as high as 9.1 ug/dl if clinical symptoms are resolved. The range that’s listed on your labsheet is the diagnostic range that’s given for a normal dog without the disease. So in Bean’s case, the goal is different than the numbers on that sheet, and another dosing increase may be reasonable if he’s still having symptoms and his cortisol level remains at the level that it was back in February.

Definitely let us know what you find out next week, OK?
Marianne

[TheBean]

Thanks so much Marianne. That is very helpful. As much as I try to read everything I can on cushings, it is somewhat confusing at times regarding these details. Thank you for taking the time to respond and help!

[TheBean]

The Bean had his bloodwork and I am attaching the results. The chemistry looks out of normal range in several areas. Hematology- less things appear out of normal range. It's still greek to me, and is frustrating as I struggle to help the Bean. As I learn more about cushings, I hope to be able to better understand and recognize what things are most important to understanding this disease and the impacts it (or the trilostane) may be having on his health and well-being. Thanks for your continued input as we move forward. Attaching the bloodwork once i figure out how to upload photos. The ACTH is scheduled for next week. Have a good weekend. And thank you.

Lab results:


https://www.k9cushings.com/forum/att...9&d=1714195277