11 year old Doxie with tumor on Adrenal - Bondo has crossed the rainbow bridge

[lulusmom]

I've had a few hours to mull this over in my head and I've looked back at Dr. Moore's proactive and ethical approach to my two cushdogs' treatment. Dr. Moore is the Director of Internal Medicine for VCA All Care and very well respected. My first dog was diagnosed there and my second dog started treating there shortly after diagnosis. At no time did Dr. Moore, or any of his staff, ignore proper protocol as your vet has done. As a matter of fact, it was almost a year before I was given the okay to extend the stim tests to every six months.....and neither of my dog had active calcinosis cutis like Bondo.

Our primary concern here is our precious pups and we place their welfare above a vet's certification and most certainly above ego. We frown upon vet bashing on the forum; however, when a vet is so blatantly ignorant so as to place a dog at risk, you have to call a spade a spade. Based solely on the information you have provided, the only conclusion I can come to is that your vet is completely incompetent and a danger to any dog with cushing's. Honestly, I know Dr. Moore and he would never be that wreckless with the welfare of a dog nor that ignorant to think a petowner should dictate when an acth stimulation test is done. That is simply absurd and if your vet told you that Dr. Moore agreed with his woeful standard of care, I wouldn't believe him for one minute.....and neither should you.

There is a very easy way to insure that your vet is acting in Bondo's best interest and telling you the truth. Simply call Dr. Moore and explain to him that Bondo has chronic calcinosis cutis that is not resolving with treatment. Tell him that you started treatment seven weeks ago and that neither you or your vet have any idea if Bondo's cortisol is being adequately controlled because he has never had the recommended acth stimulation tests since starting treatment. Be sure to tell him that Bondo hasn't had those acth stim tests because your vet thinks it's okay to forget about them unless you insist on them. He may ask you to come in so he can check Bondo's calcinosis cutis and if he does, I heartily recommend that you do exactly that.

I'll be anxiously awaiting your update. In the meantime, I'm hoping that Bondo continues to do well and the calcinosis cutis can be remedied. It's a bugger of a problem to get under control and requires a lot of patience.

Glynda

[apollo6]

Dear Tersa
Not sure if I have posted on your thread before. I am Angel Apollo's mom. My Apollo , was almost 14 when he died. He started on Trilostane when he was almost 11, he weighed 10lbs. How much a dog weighs is very important as to dosage. Also I agree with everyone else. It is very important to monitor the cortisol level, it can go either way too low if the dosage is high which is serious also. as to the skin issues they should start clearing up with a few months if not, the immune system maybe compromised. Cushing Dogs have a weak immune system,so it is even harder for them to fight infections, etc. You should have had an ultrasound to see if it is pituitary or adrenal, or a symetric(forgot the spelling) hormone based involving the sex hormones. a full blood panel to see if other organs have elevated readings-the kidney,liver,thyroid. and the ACHT stim test to see if the cortisol level is elevated. there is an acceptable range the cortisol should be in can find on Trilostane,DEchra website as to right dosage of Trilostane. Hope this helps. We have the knowledge and experience with this disease. we are not vets but our experience can guide you.
Hugs Sonja and Angel Apollo.

[Trese]

Thank you all for your advice and words. Bondo has had an ultra sound done at VCA hospital.. He started on the Trilo on Oct. 31st and has had several blood panels done and two "resting cortisal" tests done. His last numbers for the "resting cortisal" were 4.5 and that range is 1.0 - 5.0. My vet has explained to me that with the blood panel and the resting cortisal done that would be all that is needed. He told me his Calcinosis Cutis may take months to go away if even then.

Because all of you have traveled this road before me I tend to believe you so now what do I do???? We leave in the morning for 3 weeks.....so we will not be near our vet. I am sick to my stomach because all I really want is Bondo to have the best treatment.

[molly muffin]

Hi,

Since you are leaving, you make sure you have a copy of his medical tests in a folder and take it with you. Just because it is better to have it than not. Then you keep an eye on him and make sure that he continues as he has been. Then when you get back, you tell the vet that you would like to have an ACTH done to make sure of where his levels are really at because it will make you feel more assure that you are on the right track. By this time Bondo will have been on Vetroyl for about 10 weeks. If anything starts to look wonky while you are away, and you know all the things to watch for, diarrhea, not eating, too lethargic, then you take him to an Vet ER and get an ACTH done. If not, wait till you get back.

Normal protocol from Dechra would have an ACTH at 12 - 14 days and then at 30 days if everything is normal. So normally, 2 ACTH tests in 4 weeks. After which is things are going okay, then you'd space the tests out for longer intervals. I think at the outside at 10 weeks, even if he is doing fine, you will want to check that out just to be sure. Within the first 30 days cortisol can continue to drop, that is why the tests are recommended.

It doesn't Sound like Bondo has gone too low, so your vacation away should be okay. I assume you are taking Bondo with you? Now stop feeling sick to your stomach, go back, get everything together and just keep an eye on Bondo as I'm sure you have been doing this entire time.

Oh one other thing. Have a Merry Christmas and a Happy New Year

Hugs,
Sharlene and Molly Muffin

[labblab]

Trese, I think Sharlene has given you some great advice. Take your vacation as planned, have a great holiday, and then you can pursue additional testing when you get back. Since Bondo's most recent resting cortisol level was 4.5, the risk of him going too low seems unlikely. Instead, it is the reverse -- it is more likely that his cortisol level is not being controlled adequately right now.

I'm sure you have a million things to do tonight, so you can leave this until you return home. But here's some additional information for you to have on hand when you get back. That "resting cortisol" range of approx. 1-5 (or 2-6 for some labs) is the laboratory "norm" that is given for a dog who does not have Cushing's. Historically, the baseline cortisol reading has not had significance for monitoring a dog being treated with trilostane. However, a researcher at Texas A & M who is also a consultant to Dechra, Dr. Audrey Cook, has recently performed a study aimed at investigating whether or not baseline cortisols may have predictive value in assessing whether a dog is being overdosed or underdosed on trilostane. Dr. Cook freely admits that more research is necessary to decide the true clinical significance of this study, but her initial findings suggest that baseline cortisols between 1.3 and 2.9 were associated with good cortisol control for the dogs she tested. She recommended full ACTH tests for dogs with baseline cortisols outside that range in order to insure that their post-ACTH results fell within parameters that were safe and effective. Here's a link to Dr. Cook's study:

Evaluation of the use of baseline cortisol concentration as a monitoring tool for dogs receiving trilostane as a treatment for hyperadrenocorticism

As I say, this is new research, so if your vet is legitimately trying to rely on Bondo's baseline cortisol as an indicator of appropriate dosing, this would be the most current guide. And as you will see, Bondo's baseline cortisol of 4.5 places him above Dr. Cook's "acceptable" range and within the category of dogs requiring a full ACTH stimulation test in order to assess whether their adrenal function is being controlled adequately.

Since Bondo has already been seen at VCA, if he were my dog, when I got home from vacation I'd request a consultation with Dr. Moore just as Glynda has suggested. I think you're "good to go" on your holiday without worrying about Bondo crashing. But I'm very doubtful that he's receiving the correct dose of trilostane for appropriate long-term control of his disease. For reasons that I truly don't understand, it sounds as though your vet is giving you the run-around. In honesty, I would not trust him to perform a full ACTH test at this point since he has been so inexplicably resistant to the need for it. I would prefer to have the testing done at VCA.

Marianne

[molly muffin]

I know you are on on vacation and hope you are having a good time.

Merry Christmas.
Have a safe and wonderful holiday.

hugs,
Sharlene and Molly Muffin

[molly muffin]

Hi!! Are you guys back from vacation yet? If so how is Bondo doing?
Just checking in on you.

hugs,
Sharlene and Molly Muffin

[Trese]

Hello everyone.
I have not posted for awhile but all is well. I realize that most of you really recomenned the ACTH test but I have not had the test for my little Bondo. He is doing SO WELL that I cannot seem to justify it. I give him 30mg of Trilo each morning. No drinking tons of water, no excess urination. Every morning he is like a puppy, running around, playing with his squeeky toys, etc.

His Cutis (sores) are not as bad as they used to be. They are, still, there but I have been giving him a bath with medicated shampoo (from vet) and his coat is really looking so much better.

I have read and read everything about this dreaded disease and I do know that most vets do the ACTH test (especially if other medical things are wrong) but the way Bondo is right now I don't think that the test results would sway me for doing exactly what I am doing right now. Keep him on the 30 mg of Trilo and watch him for any side effects, etc. I do have a bottle of Predisone pills on hand if needed. I keep a journal and so far, the entries are "doing great" on all of the days.

All of you have been so kind with your thoughts and words....I don't want you to think that I have not taken your advice about the ACTH test seriously but I don't think at this time it would serve a purpose. If I did have Bondo tested and they said, drop the dosage or up the dosage and he got worse I would never forgive myself. He just seems to be doing so well, I don't want to change anything. I hope all of you understand.

[molly muffin]

Hi! Remember that you do know Bondo better than anyone, so assume that if something came up, then you'd have him in for the ACTH complete test to find out what the Post number is.
Glad that the symptoms are controlled and he is a happy guy. It is of course always your decision to make. We do of course know that.
You do know that we are all pretty much constant worry warts here right?!!! LOL
I'm so glad that you posted and I hope you had good holidays.

hugs,
Sharlene and Molly Muffin

[Trese]

Hi Sharlene and little Molly Muffin.
Thank you SO much for your post. I did not want anyone thinking that I did not value all of your opinions. In March, Bondo will have another full blood panel as well as a "resting cortisol" blood test.

OK...vacation Well, on the 26th of December I had to take Husband into ER as he could not breathe. Everything checked out A-OK but the doctor told us to get out of the high elevation (8900 ft) so home we came. We leave on Thursday to try it again. He, actually, works at a Ski area. We will be up at the mountain for 5 days this time. Bondo loves the snow and sleeping up on the couch under all of his warm blankets. It has been -2. Yikes. Ok, off to bed and Sweet Dreams to you.