Down the Cushings Road Again -- Abbie, 15 year old beagle is now at peace

[Harley PoMMom]

Hey Judy,

I came across this study published in 2014, this dog's proteinuria did not respond well to the benazepril/amlodipine treatment, then a drug known as Telmisartan was started along with lowering the doses of the benazepril/amlodipine. After 5 weeks of using the Telmisartan (and adjusting up the dose) the dog's UPC of 4.0ish went down to .33, they then upped the dose of Telmisartan and reduced the benazepril dose, one month later this dog's UPC was .14!

At most recent recheck, 31 weeks after the discontinuation of benazepril and on 10 mg (0.9 mg/kg) of telmisartan once daily, UPC remains reduced (0.33).

Article can be found here: http://onlinelibrary.wiley.com/doi/1...jvim.12471/pdf

[judymaggie]

Lori--really interesting article and dog was even a beagle! I will definitely print out a copy to give to my vet. Sad commentary that I have read so much about proteinuria that I no longer have to look up the meanings of all of the technical terms.

[molly muffin]

Telmisartan is one of the ARB's that we talked about on my thread. It doesn't seem to be as prone to raising potassium as the one my vet had mentioned. (from what I read anyhow, you always have to watch potassium levels with any of these drugs) Abbie's protein is higher than molly's, so might be worth a shot to try and get that down.

We're heading in today for another ACTH and UPC. Cross fingers!

hugs

[judymaggie]

Hi, all! I have spent the last few days posting back and forth on Dr. Peterson's blog and e-mailing Dr. Bruyette. It is so wonderful that these two specialists will take the time to communicate with dog owners. I think I got a reply e-mail from Dr. Bruyette in just a few hours. Here is the link to Dr. Peterson's blog -- scroll all the way down and you will see my first post on the 14th:

http://www.animalendocrine.info/2013...c-dog-for.html

I provided the same initial information to Dr. Bruyette and he responded (even signing his e-mail "Dave" ):

Yes indeed. I would treat with trilostane to see if we can get better control of the proteinuria. I would also use omega 3 fatty acids and low dose aspirin and see if that helps as well.

Most of the articles about proteinuria do mention adding the omega 3 fatty acids but I am very hesitant due to Abbie's tendency to soft stools/diarrhea.

Abbie's requests to go outside and pee have started to increase -- she wants to pee approximately every two hours so, in addition to trying to control the proteinuria, it is definitely time to start Vetoryl. It has been 40 days since her last Lysodren dose. I am going to call my vet tomorrow to discuss starting trilostane -- when we discussed it previously, he had spoken about twice daily dosing and I feel better about that after having received guidance from Dr. Peterson. I did read one of his veterinary blog articles where he suggested doing the ACTH 4-5 hours after the morning dose with the goal of a post of 2-7 ug/dl; I am assuming the higher upper number is due to the dog not receiving a full day's dose before the test.

I am going to order Vetoryl from the California Pet Pharmacy so receipt will take a bit of time. Abbie is scheduled for a BP curve and renal panel on the 30th along with gland expression. Since Abbie is getting increasingly anxious when going to the vet, I will talk with the vet about timing all this with the first ACTH -- she will need a full chem panel then.

Question: since Dr. Peterson said evening dose can be given with a treat as long as it contains fat, I am thinking I will give her a little bit of kibble and canned food followed by the Vetoryl capsule wrapped in either peanut butter or cheese. Does that sound like a good plan?

I would subtract the food from her 3:45 meal. When Abbie was on Lysodren, she had started to spit out the peanut butter but I think the split Lysodren pill probably made it taste bitter.

[molly muffin]

Don't you love the access to specialist that actually will send a reply.
I too posted to Dr. Peterson and emailed Dr. Bruyette about Molly.

I would think your suggestion for administering the evening dose would be good one to go with. If Abbie is tired of the peanut butter try the cream cheese. The whipped cream cheese is easy to manage around pills I find.

As for the higher number that is just his controlled range. You won't or shouldn't be having any spikes with twice a day dosing but a very evenly managed cortisol level.

Huggers

[labblab]

Hi Judy, good for you for pursuing your questions so thoroughly with both these guys!!!

I am a little surprised to see Dr. Peterson say that just a treat (even if it does contain fat) is sufficient for the evening dosing. A couple of us have contacted Dechra in this regard, and they have told us that a full meal is really preferable -- that a treat is not enough for maximal absorption. Plus, this is somewhat contrary to what he has formally written in his blog. But maybe he is just taking the specifics of Abbie's situation into account, and believes that a treat will be fine given the fact that she does get a full meal during the late afternoon. Anyway, I agree with your plan to give her at least a bit of kibble/canned food in addition to the fat-wrapped capsule.

And yes, just as Sharlene says, I think the ACTH monitoring range he's given you is his ideal regardless of whether dosing is once or twice daily. He differs a bit in this regard from Dechra, as well.

Marianne

[judymaggie]

Hi! I just placed an order with California Pet Pharmacy -- my vet is out until Tuesday but one of his associates said she would be happy to help! It will take a few days for meds to arrive so will talk with my vet when he gets back. I did print out Telmisartan study to give to him.

Question: I am aware that first ACTH is to be done 10-14 days after starting. Is the 30 day ACTH done 30 days after starting Vetoryl or 30 days after the first ACTH?

Question (I keep forgetting to ask): Abbie is prone to ear infections, primarily yeast. To try and keep them under control, I flush her ears once a month with ear cleanser followed by Mometamax. I am not sure why it never occurred to me that Mometamax is a steroid drop! What ear drops do you use? I found one on-line -- Zymox Otic Pet Ear Treatment without Hydrocortisone but would prefer to get info re personal use.

[Harley PoMMom]

Question: I am aware that first ACTH is to be done 10-14 days after starting. Is the 30 day ACTH done 30 days after starting Vetoryl or 30 days after the first ACTH?[/quote]

It is performed at the 30 day mark from when the Vetoryl was started.

Question (I keep forgetting to ask): Abbie is prone to ear infections, primarily yeast. To try and keep them under control, I flush her ears once a month with ear cleanser followed by Mometamax. I am not sure why it never occurred to me that Mometamax is a steroid drop! What ear drops do you use? I found one on-line -- Zymox Otic Pet Ear Treatment without Hydrocortisone but would prefer to get info re personal use.[/QUOTE]

I found this post from Glynda with regards to an ear cleaning medication:

I'm a special needs small dog rescuer and many of the dogs I've pulled from shelters have really bad ear infections, among other things. A groomer turned me onto a product that is amazing for dogs with chronic ear infections. It's pretty inexpensive if you purchase it online through Amazon. You can also read over 100 product reviews, most of which reflects the same results I've achieved with it. You may want to put it in the ears outdoors or in the garage. It's pretty purple and if the dog shakes his head, it can stain whatever it lands on. I never really had that problem but my little white pups had a bit of a purple tinge on the hair around their ears for a bit but it's a small price to pay to keep the ears infection free.

http://www.amazon.com/For-Animals-K9...ilver+for+dogs

Also on the dogaware web site they have a list of medications, here's a link to that: http://www.dogaware.com/health/ears.html#yeast

Hugs, Lori

[labblab]

Zymox also makes a couple different versions of ear treatment solutions: one with hydrocortisone and one without. It is an enzymatic treatment, and my vet recommended it to me. I have used the one with hydrocortisone with success with both my girls when they've had inflamed ears (steroids are not an issue for them). But I think other folks here with Cushpups have used the version without the steroid and have also been happy with the results.

http://www.amazon.com/s/ref=nb_sb_no...rds=Zymox+otic

[molly muffin]

Yes the version without the steroid of symbol is what Barbara uses with trixie.

Okay my IMS said that she has two dogs on the ARB now. One in addition to a lower dose of benazepril and one she put on after taking completely off benazepril. In canada we use benazepril rather than enalopril. Same dosage though. The European group who has done the most studies in this day that on humans they see good results with stopping the ace inhibitor and going solo with the ARB. Another IMS in the same group also is using the ARB solo with a dog.

We will probably be moving Molly to this in about 6 weeks