Midge - Cushings + other problems - help please

[AlisonandMia]

Re: Midge - Cushings + other problems - help please

Sometimes we do see dogs on Trilostane being dosed on alternate days and similar arrangements but it isn't done very often and doesn't seem to be a successful regime long-term - and I've never seen it recommended or even discussed in any research or dosing information.

Vetoryl is available in 10mg capsules and these may be useful in allowing you to use a lower daily dose which would have to be preferable to giving what looks like a too-big dose every few days and hoping it works out ok. I've heard someone in the UK say that their vet didn't want to stock it (10mg size), possibly for commercial reasons. The 10mg dose hasn't been on the market that long and some vets may not be aware that it is available, either and thus believe they are stuck with trying to work something out using 30 mg caps. I don't know how the prescription/supply system for veterinary meds in the UK works but I'm pretty sure that even if your vet doesn't want to carry 10mg Vetoryl caps you should be able to obtain them somehow (with a script, of course.)

Here's a link to Dechra's info on the 10mg cap: http://www.dechra-eu.com/downloadfil...tDataSheet.pdf

And a link to the Vetoryl product info page on Dechra's site: http://www.dechra-eu.com/viewproductdetails.asp?ID=89

Alison

[BestBuddy]

Re: Midge - Cushings + other problems - help please

Hi,

One of the last resort options for my Buddy when he was having problems with trilo was to consider dosing every two days. This is definitley not normal but I do believe there have been at least one of our members do it this way.

My specialist said that he had at least two dogs on strange trilo dosing, I think one was every 48hours and one was every 36hrs. I trusted the doc. and would have given this a try because the worst (in my mind) that could happen was that it wouldn't control the cortisol and the next ACTH would have told us so.

I do think that with trilo being newer that there is a lot to learn about but like all newish drugs it takes many years before we can truly understand how it works.

Jenny

[Mel B]

Re: Midge - Cushings + other problems - help please

Hi again

Midge is still doing well and feeling a lot better, he's drinking but not excessively now, and he's eating like it's going out of fashion! He's much more alert, his hearing has improved no-end and his feet are almost back to normal - his pads look like pads again, and his legs, despite still being very blotchy/black hardly have any yeasty stuff on them at all. His tummy is a lot better and gets very little yeasty stuff on now, even when he sweats. He does get warm though. He's happy to get up out of his bed without encouragement, pottering from room to room if he thinks there's a chance of a 'treat'. The problem is that I don't know if this renewed interest in food is a good or bad thing.

We're still in a quandary of what to do next ... has anyone got any experience of giving Vetoryl (Trilo.) once every couple of days, rather than daily? It would be great to hear if this has helped or caused problems. He weighs around 9kgs at the moment and was prescribed 30mg a day but after the way he was zonked out, lethargic and unwilling to eat I'm very reluctant to put him back on it daily in case he declines and/or gets anaemic again. I've partly got my 'little boy' back now and I don't want to 'lose; him again if I can help it.

[Mel B]

Re: Midge - Cushings + other problems - help please

Hi Glynda

Some more info:

Midge had the classic symptoms/appearance: excessive drinking and urination, voracious appetite, panting, pot bellied appearance (he'd always been 'rotund'). He had always been a nibbler of his legs too. He had the ACTH stim tests done around 4-5 hours after his dosing each time (as recommended). He didn't have an ultrasound performed, not sure about the Dex test ... At the time he was having loads of testing done he was an extremely unhappy chappy, in a lot of discomfort with his foot infection, so the vet kept it to the minimum to prevent stressing him out too much.

He was only tested for Cushings after many different types of antibiotic were tried to sort out the problem. Once he was diagnosed he was put on Vetoryl 30mg from the off and the dose was never altered as we were told the lab said it had 'excellent control' at that dosage.

Anaemia - The vet and I suspect the cause of this is due to his immune system being under strain with the infection and suspected liver failure, plus his lack of appetite which therefore meant he wasn't getting the nutrients he needed, it was a downward spiral which we had to stop, hence our current removal of the Vetoryl. I don't have any more test results info so I'll have to go back to the vet for that.

Midge is better than he was on the Vetoryl but obviously he's not 'cured'. He's eating normally, pottering a little more, and seems more content generally. His skin lesions are not as angry and are much much drier, his sweating has lessened, he's quite relaxed. He's not getting the horrible ear infections now which were pretty constant. He's happier and that is what matters, whether he's got a week, a month, or a year, so long as he's feeling better that it what is important, quality rather than quantity of life.

The question is - does anyone have any ideas on where we go from here/what to do? If he continues to get better should we consider putting him back on the Vetoryl?

[Lulusmom]

Re: Midge - Cushings + other problems - help please

Hi Mel,

I just took a quick look at your posts to refamiliarize myself with Midge's history and realized that you never answered some of our questions. The more information we have, the better able we can provide you with meaningful feedback. Sooo, let's backtrack a bit. I see that you have posted the blood chem results but is it possible for your to post the results of the diagnostic tests that your vet did to confirm a cushing's diagnosis. Those would be acth stimulation tests prior to treatment, low dose dex suppression test (LDDS) and abdominal ultrasound findings.

Aside from Midge's skin and coat issues, did he have any other symptoms associated with cushing's such as excessive drinking and urination, voracious appetite, panting, pot bellied appearance? Can you also give us the history of treatment. For instance, can you list the date you started treatment and the mg dosage and the dates of amount of any adjustment to the dosage. Please include the dates and results of the acth stim tests that were done after starting treatment and let us know if those tests were done within 3 to 6 hours after dosing? I realize that your memory may be a bit sketchy but your vet should be able to give you copies of all testing which has the dates and results.

Does your vet have any idea what is causing the anemia. If not, will s/he be doing additional testing to make this determination? I think Midge has a lot going on that is more urgent than cushing's at the moment so I agree that you made a wise decision to discontinue the Vetoryl. Actually, Vetoryl should never be given to a sick dog and when it comes to cushing's, any dog that is not eating is to be considered a sick dog.

Here is a link to info on anemia in dogs that might help you understand how it is diagnosed. It also touches on the bloodwork results. Debbie (Stardeb) is a long time lab technician and I am sure that she'll be by to give you her educated opinion on Midge's bloodwork.

http://www.sniksnak.com/doghealth/anemia.html

We'll all look forward to receiving more of Midge's history.

Glynda

P.S. Midge is adorable...his smile is contagious for sure.

[Harley PoMMom]

Re: Midge - Cushings + other problems - help please

OOOHHHH Mel,
Midge has an absolute BEAUTIFUL smile that goes with that absolute BEAUTIFUL face.

Harley and Lori

[Mel B]

Re: Midge - Cushings + other problems - help please

Thought you all might like to see a photo of Midge so I've put him 'smiling' as my avatar, and a full photo of him in my profile.

[Mel B]

Re: Midge - Cushings + other problems - help please

Hi Patti

In a nut-shell: Midge was not well on Vetoryl, he was getting weaker and weaker and not eating properly, in fact it was getting harder to get him to eat much at all. When he had his last lot of tests done on 30 April, we found that the levels were raised again and that he was anaemic too. After weighing up the way he was and the problem with trying to sort out the anaemia in a dog that doesn't really want to eat, we decided to stop the Vetoryl, which can apparently cause lethargy, anorexia etc to see if we could sort out the anaemia and then decide where we went from there once (hopefully) he was stronger again. After all, if we couldn't sort that out then he was just going to continue to get weaker and eventually he definitely wouldn't have the reserves to fight the illness and would probably have faded away. We weren't prepared to let that happen. He's been off Vetoryl for a week now (last 30mg dose was on 1 May 2009).

Hi Leslie:

Midge kept getting ear/eye infections around January a time and was not a happy lad at all. He was also very picky about his food and getting him to eat was more and more difficult, we had been trying to give him a better diet but when he wouldn't eat it was to some extent a case of just getting food down him. He had been on Vetoryl continually since November 2008. When we got the 'bad' results we then tried to change his diet to a purely chicken/fish, potato/white rice one, with just odd bits of other food (such as hot-dogs to get his tablets down him). He was also on antibiotics to try to see if they helped with his skin infection so these may have added to the levels, I'm not sure but since he's been off the antibiotics his levels have reduced - may just be coincidence?

Midge was on Antirobe from 29 Dec to early January but after the course had finished he went back on his original ones (can't remember the name) as the Antirobe didn't appear to be having having any effect. Later in January he got much more of the yeast/infection back on his feet, more than ever before so he was put back on the Antirobe for a second time to see if that helped this time. He was also extremely fed up at the time - having really good 'whinging' sessions and beating seven bells out of his beanbag, he also kept waking in the night having whinging sessions too and getting himself into a right old tiz.

In early Feb we had to do a lot more 'washing/bathing' of his feet, Midge didn't like but we didn't know what else to do. I suspect this increase in 'care' (he didn't do baths at the best of times!) and the ever spreading 'gunk' didn't help. The Antirobe finished around this time and he then stayed off it, it didn't have any effect at all, in fact I suspect it made things worse by killing off the good bacteria in his tummy and making him feel even more grotty.

By 22 Feb the infection on his feet had remained pretty static but the yeasty stuff had started to spread more to his legs etc and he'd started to develop more of the 'lesions', up till then he'd only had a few patches but then they were spreading like mad. I assume the horrible progression of the disease is what was 'reflected' in the Feb test with the raised levels? He was extremely fed up during this time and getting himself into a right stew too which won't have helped either.

Back to now - he's much more content and calmer, which is why I assume his results have improved a little since February.

(I've tried to get the 'dates' etc right - fortunately I was putting postings on my Motorhome forum's 'chatterbox' section so can at least refer to that for some of the info as my memory is totally addled!)

Mel

[Squirt's Mom]

Re: Midge - Cushings + other problems - help please

Hi Mel,

Thanks for the kisses, Midge!

I'm no good at reading lab results like these but others like Glynda and Debbie are and I am sure they will be along to give their input.

In looking at the results, tho, did something happen between the Jan and Feb tests? The ALKP numbers were going down until the Feb reading then nearly doubled. Was Midge sick at that time, or was he under some sort of extra stress then? New med? That seems to be a big jump to me, but as I said I'm no pro at this at all, so it could just be my funny mind doing it's funny stuff.

7 Jan 09:
ALKP - 860 U/L (high)
ALT - 292 U/L (high)
UREA - 13.1 mmol/L (high)

23 Feb 09:
ALKP - 1629 U/L (high)
ALT - 253 U/L (high)

Well now, I was a lot of help, huh?

I am really glad to hear that Midge is doing better and better as the days pass. Sounds like stopping the Trilo was the right move for now. His skin sounds like it is improving as well and I'm sure that makes all of you more comfortable. I hope he continues to improve all around!

Hugs,
Leslie and the girls

[Patricia ann Wh]

Re: Midge - Cushings + other problems - help please

Hi,

I'm not up to date on your story. Could you fill me in a little bit.

Why is your dog "off" vetoryl.

How long and why??

I'm so glad so so glad he's feeling better

Thanks, Patti and Jesse

[Mel B]

Re: Midge - Cushings + other problems - help please

Hi all (licks from Midge)

Midge is definitely feeling better, he's actually getting up from his bed more and more now and is happily standing to eat his food, he's drinking but now at least he stops himself when he's had enough, rather than us having to stop him, which is a good sign I think. His lesions are definitely not as crusty and the yeasty stuff on his tummy isn't coming back anything like as fast or as much as it was and he's gone 'flaky' ... in the sense that the crusty stuff on his body etc is coming away much more easily now. We've had a few goes at his feet and whereas normally he would be sore, its actually not really bothering him now.

I've now got the test results from the vets, not sure exactly what you need to see but here goes, I've just included the bits which are either high or low to save space (omitting other items given on the test result sheets which were normal):

19 Nov 08:
ALKP - 1168 U/L (high)
ALT - 507 U/L (high)
UREA - 4.3 mmol/L (normal)
CREA - 39 umol/L (low)

5 Dec 08:
ALKP - 1100 U/L (high)
ALT - 355 U/L (high)
UREA - 18.9 mmol/L (high)
CREA - 75 umol/L (normal)

7 Jan 09:
ALKP - 860 U/L (high)
ALT - 292 U/L (high)
UREA - 13.1 mmol/L (high)

23 Feb 09:
ALKP - 1629 U/L (high)
ALT - 253 U/L (high)

30 Mar 09:
ALKP - 1503 U/L (high)
ALT - 141 U/L (high)

30 April 09:
ALKP - 1569 U/L (high)
ALT - 159 U/L (high)
HCT - 17.6% (low)
HGB - 5.9 g/dL (low) (I assume this shows he's anaemic? )
GRANS 13.8 x109/L (high)
%GRANS - 88%
NEUT 13.3 x109/L (high)
EOS - 0.5 x109/L (Low/normal borderline)

All comments/views gratefully received!

[Mel B]

Re: Midge - Cushings + other problems - help please

Hi all

Update on Midge. He's still off the Vetoryl. The good news is that he's now eating properly again and generally appears to be much happier. He's more alert and when we went away for a couple of days he had a little potter on the beach and 'sniffed' the rocks etc, same when he had a little potter on the field - he hasn't really done this for ages! Today he actually got out of his bed to come over to us to say hello without us even asking him and we actually got licks!!! I feel like my little 'boy' is coming back again ... yes I know I shouldn't get too excited by all this, we don't know how long he will go on for but we feel it is better for him to have a quality to his life rather than be fed up and like a zombie.

Tonight he's eaten his hot dogs for breakfast with his vitamin tablets, plus some complete food biscuits (Bakers Complete), at lunch time he had more of the Bakers, and at tea-time he had an egg, 4oz of white fish, a little drop of very thin gravy and some potato, and he's just had a small jacket potato!

He's had his nightly bath and whilst my hubby was getting it ready, Midge went and laid in his favourite spot in there ... something he hasn't done for months.

I can't be sure but I think his skin is a little better, very difficult to say for sure as its only been a few days, but I don't think it's quite as 'angry' looking, possibly because the Vetoryl isn't supressing his immune system? he has't had a skin culture done but it's pretty certain it's his own system that's causing the problem ... the yeasty type stuff that's on his tummy every day is yucky and when we clean it off there's nothing else there, but it just comes back again. He's having some pro-biotic yoghurt daily to try to boost his 'good bacteria' and immune system.

The vet is aware of what we are doing and doesn't have a problem with it, we just have to watch out to see if he develops any liver problems due to the excess cortisol in his system again. He's putting some of the weight back on that he gradually lost and once we feel he's back to a better 'size' and hopefully his anaemia is not so bad, we'll look to getting him on a better diet again so that his liver isn't so stressed.

Tests - we've asked the vet for the results and she's going to get them together for us so we should have them in a day or 2 and I'll then post them on here for you to see.

Thanks for all your suggestions/help so far, much appreciated.

[rhodesian46]

Re: Midge - Cushings + other problems - help please

Has a culture been done on his skin? Also it is extremely important that you have a vet that is knowledgeable on Cushings. I would see an Internal Medicine Specialist as they have more expertise

[forscooter]

Re: Midge - Cushings + other problems - help please

Hi,

I probably missed you at the other board but am so glad to see your post here. The scales, the infections, it all reminds me so much of what my Scooter had. Same thing...the yeast, then it would ooze and scale over and get infected. The only thing that helped him with that would be a weekly bath with a colloidal oatmeal rinse. I would trim the fur back the best I could without hurting him to allow the oatmeal rinse to get as close to the skin as possible. You don't rinse that off....leave it on. Aveeno sells it in packets and I would just pour and pour it over him for at least 15 minutes at a time. Then, the rest of the week, I would take a mild shampoo, usually oatmeal and put a little on washcloth and pat it on and gently wash the infected areas only. And then rinse it off using the same technique. My fear was by giving an actual bath daily it made him worse...his skin got very dry and even more likely to get infected. I used the antimicrobial shampoos and for whatever reason I swore they made things worse....again almost too drying.

The other thing we added was a strong broad spectrum antibiotic. It took about a week but I did see some improvement.

As for the liver enzymes, I see you have been given great advice already. Scooter's enzymes were in perfect control so we felt it was more an allergen. I see you are feeding fish and potatoes which is excellent. I am wondering if you aren't dealing with allergies and the chicken and rice could be lending to the problem? A strict hypoallergenic diet may help things out too. Nothing but the fish and potatoes for a few weeks at least until you can see if it helps.

I know someone, I think Leslie (Squirt's Mom) told me that her vet mentioned that sometimes an older dog's immune system just can't handle things any longer....I am not quite sure what exactly she said now (sorry Leslie) as it was shortly after I lost Scooter. But, I do know she reassured me that I did everything I could and sometimes there just isn't anything else you can do.

But I do think these other things are worth trying out. I hope this helps some bc my heart truly goes out to you and Midge! I feel your pain and am so very sorry!!!!

Sending my very best healing wishes!!! Beth, Bailey and always Scooter

[LuvMyMunchie]

Re: Midge - Cushings + other problems - help please

Hi Mel,

I, too, am glad you found us and wanted to add my "welcome back" to you and Midge. As Glynda has said, the more information you can provide from the questions that were previously asked the more it will enable us to give you feedback.

Sounds like you are feeling a tad unfortable about asking your vet for copies of Midge's labs and test results. I can certainly understand that feeling. In the past, asking for copies of tests was nothing that ever even crossed my mind. However, I soon learned the importance of having copies of all the testing on hand and have been keeping a file ever since for all of my animals (and myself too!) I urge you to ask your vet to provide you with copies of Midge's test results. As John (Roxee's Dad) said:

Your vet or assitant would be glad to make copies for you.

Will be watching for your next post and update. Give Midge some extra pettin' from me!!

Louise