# THIRD FOLLOWUP Ellie diagnosed with IBD and Cushings



## mlg (Feb 23, 2020)

Because of certain blood tests that were way off, my concern that she was constantly hungry beyond her norm and combined with enlarged adrenals seen in the ultrsound all day blood tests were drawn for Cushings Disease. They came back positive. Vet told me the diagnosis is definitive but the testing showed a mild degree of disease. Vet (this is the good vet) wants her to take the Brand Vetoryl Capsules (Trilostane) 30 mg and then 1 1/2 hr test in two weeks to check levels. The brand comes in a small capsule and because vet wants to be very sure of exactly how much Ellie is getting, she doesn't want me to break open the capsules. Started two days ago and have had two "brawls" but eventually she swallowed. 

Scrounging for food has already decreased almost to her normal levels. Although the vet said this would only effect her extreme hunger, I am seeing behavioral changes which seem positive: she's more cuddly, didn't bark as demandingly on two occasions and seems to have stopped licking her front paws.

Although still on Biome her stools are again soft. I'm thinking this could be attributed to the two antibiotics she's on (for ears and infected anal glands) and perhaps to the Trilostane?

Does this treatment plan sound wise and does anyone know the pros/cons of Trilostane? Ellie is 18 pounds - is 30 mg a common dose for this size dog? And...how is this likely to go? What should I expect and what should I watch for?

Thank you to everyone who encouraged me to ask the vet more questions - it was my persistence that led to the second set of blood tests and the diagnosis. High cortisol makes sense to me: Ellie has always been hyper-vigilant and somewhat overly alert, although charming Her incessantly demanding barking has become worse over the last few years as well and that, I must acknowledge, has not been charming. I am concerned however, that she be on the lowest efficacious dose so that she maintains her life energy.

Thank you all once again.


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## krandall (Jun 11, 2009)

I’m so glad that tou persisted when you knew things “weren’t right”. I have absolutely no experience with this, so am interested to hear about your progress! ❤


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## mudpuppymama (Mar 24, 2012)

So happy your persistence is paying off. Loose stools are not surprising given antibiotics and all that is going on. Perhaps that will improve as she gets better and gets off the antibiotics. My Yorkie recently took some antibiotics and it took a little while for his gut to normalize.


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## krandall (Jun 11, 2009)

mudpuppymama said:


> So happy your persistence is paying off. Loose stools are not surprising given antibiotics and all that is going on. Perhaps that will improve as she gets better and gets off the antibiotics. My Yorkie recently took some antibiotics and it took a little while for his gut to normalize.


I agree. My vet gives us a super-duper pre/pro biotic paste to be given with antibiotics that helps a LOT with diarrhea/loose stools. Maybe ask about it?


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## LWalks (Feb 7, 2021)

So glad your persistence paid off! Ellie is lucky to have such a dedicated advocate!!


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## mudpuppymama (Mar 24, 2012)

krandall said:


> I agree. My vet gives us a super-duper pre/pro biotic paste to be given with antibiotics that helps a LOT with diarrhea/loose stools. Maybe ask about it?


Thank you. He is actually completely back to normal now, however I will definitely consider this if antibiotics are required again.


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## Sheri (Oct 11, 2008)

I'm very glad that your "good vet" seems to be on top of this. It would be a huge relief to have Ellie's hunger returning to more of her norm, and wonderful that you are seeing other little beneficial signs in other areas, too!

I have no knowledge of the new med. You could always go to FB and find a group for canine cushings to ask there.


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## mlg (Feb 23, 2020)

Sheri said:


> I'm very glad that your "good vet" seems to be on top of this. It would be a huge relief to have Ellie's hunger returning to more of her norm, and wonderful that you are seeing other little beneficial signs in other areas, too!
> 
> I have no knowledge of the new med. You could always go to FB and find a group for canine cushings to ask there.


Thanks - I'll look on FB.


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## EvaE1izabeth (Nov 14, 2017)

There is a particular strain of probiotics that was studied for use with antibiotics (and I think one that was studied specifically in dogs with ibd or some kind of digestive disorder). It was difficult for me to find the information on this in the first place when I was comparing probiotics a while back because the names of the strains are similar and I had to search for each individually and then sift through scholarly articles. But this is exactly the kind of thing a good vet will be able to help with, especially because there are some unreliable brands and weird information on probiotics out there, too. After all of that work, which I hoped would lead me to a less expensive option, I ended up finding that the probiotic the vet recommended in the first place was probably the best choice for Sundance, but at least I felt better about the cost.


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## mlg (Feb 23, 2020)

Thanks - I'll ask.


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## mlg (Feb 23, 2020)

mlg said:


> Thanks - I'll look on FB.


I found a Cushings Disease group on FB and the moderator seems very knowledgeable. She has helped me make sense of things the vet was too rushed to explain.


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## Sdeek (Nov 27, 2021)

mlg said:


> Because of certain blood tests that were way off, my concern that she was constantly hungry beyond her norm and combined with enlarged adrenals seen in the ultrsound all day blood tests were drawn for Cushings Disease. They came back positive. Vet told me the diagnosis is definitive but the testing showed a mild degree of disease. Vet (this is the good vet) wants her to take the Brand Vetoryl Capsules (Trilostane) 30 mg and then 1 1/2 hr test in two weeks to check levels. The brand comes in a small capsule and because vet wants to be very sure of exactly how much Ellie is getting, she doesn't want me to break open the capsules. Started two days ago and have had two "brawls" but eventually she swallowed.
> 
> Scrounging for food has already decreased almost to her normal levels. Although the vet said this would only effect her extreme hunger, I am seeing behavioral changes which seem positive: she's more cuddly, didn't bark as demandingly on two occasions and seems to have stopped licking her front paws.
> 
> ...


Dusty has had Cushings for about five years now. He’ll be 14 in January. He weighs 15 lbs and is on 10 mg. of Vetoryl in am and 5 mg at night. His Cushings has been under control almost since the beginning. He has the lab work done every six months to make sure he’s on the right dose. My boy also has diabetes. I’ve been extremely lucky as it is also under control. He just had his yearly physical and for the first time the vet heard a small heart murmur. He said that it’s very common for a dog in his teens to get a heart murmur and would take years to become heart disease. Does anyone have experience with a heart murmur? I have been extremely lucky with Dusty having most of his illnesses under control. He also has dry eyes due to the diabetes. He had cataract surgery in one eye as he went blind within two weeks of being diagnosed with diabetes. What are other people doing for dry eyes? He’s on Tacrolimus ointment 0.03% twice a day and Optixcare eye Lube at least 3x day.


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## krandall (Jun 11, 2009)

Kodi has auto-immune dry eye, which, of course, is not the same as what you are dealing with. He is also on Tacrolimus 2x daily, and has just been increased to .05% which must be compounded for him, antibiotic and steroid drops 2x daily, and artificial tears as often as possible through the day. He still is producing no tears. We are HOPING that with the increase of Tacolimus he might have some improvement, but the opthamologist is afraid he might be one of the rare non-responders, considering that we have been treating him since May, with NO improvement at all.


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## Sdeek (Nov 27, 2021)

I’m so sorry Kodi has that problem. I didn’t know they could make the Tacrolimus stronger than 0.03%. Perhaps Dusty’s eye dr. will increase the strength. What kind of artificial tears do you use?


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## krandall (Jun 11, 2009)

Sdeek said:


> I’m so sorry Kodi has that problem. I didn’t know they could make the Tacrolimus stronger than 0.03%. Perhaps Dusty’s eye dr. will increase the strength. What kind of artificial tears do you use?


As I said, the stronger Tacrolimus has to be made by a compounding pharmacy.

The artificial tears we are using are I-Drop vet gel, with no preservative.


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## Sdeek (Nov 27, 2021)

I’m also getting the .03% from a compounding pharmacy, Meds for Vets. What pharmacy do you use? I’ve tried one other but they put it in a plastic tube tat was difficult to use and wasted some of it. Meds for vets puts it in a metal foil type of tube.


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## krandall (Jun 11, 2009)

Sdeek said:


> I’m also getting the .03% from a compounding pharmacy, Meds for Vets. What pharmacy do you use? I’ve tried one other but they put it in a plastic tube tat was difficult to use and wasted some of it. Meds for vets puts it in a metal foil type of tube.


I’m not sure yet. We only saw the opthamologist Friday, and the new compounding pharmacy hasn’t contacted me yet. Wedgewood was the one we used before, when he was on Optimune, because we had to increase the dose of that too. (But that didn’t work, so we moved to the Tacrolimus). All the ones I’ve used (except for the original Optimune) have been drops, though, not ointment.


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## LWalks (Feb 7, 2021)

Sdeek said:


> Dusty has had Cushings for about five years now. He’ll be 14 in January. He weighs 15 lbs and is on 10 mg. of Vetoryl in am and 5 mg at night. His Cushings has been under control almost since the beginning. He has the lab work done every six months to make sure he’s on the right dose. My boy also has diabetes. I’ve been extremely lucky as it is also under control. He just had his yearly physical and for the first time the vet heard a small heart murmur. He said that it’s very common for a dog in his teens to get a heart murmur and would take years to become heart disease. Does anyone have experience with a heart murmur? I have been extremely lucky with Dusty having most of his illnesses under control. He also has dry eyes due to the diabetes. He had cataract surgery in one eye as he went blind within two weeks of being diagnosed with diabetes. What are other people doing for dry eyes? He’s on Tacrolimus ointment 0.03% twice a day and Optixcare eye Lube at least 3x day.


My 10 yo was diagnosed with a murmur when he was 8. We took him to a cardiologist for an echocardiogram to get a baseline (and formal diagnosis of mitral valve disease) and repeat the echo yearly. So far, no changes in his heart or signs of breathing issues, so no meds needed. If/when we do see any enlargement or he starts coughing, we will start him on a medication that the vet said is very well tolerated w few side effects, and that there’s a very good chance it will never lead to CHF if we keep a close eye on any changes.


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## krandall (Jun 11, 2009)

Good news!!!


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## Melissa Brill (Feb 22, 2017)

krandall said:


> I’m not sure yet. We only saw the opthamologist Friday, and the new compounding pharmacy hasn’t contacted me yet. Wedgewood was the one we used before, when he was on Optimune, because we had to increase the dose of that too. (But that didn’t work, so we moved to the Tacrolimus). All the ones I’ve used (except for the original Optimune) have been drops, though, not ointment.


Not drops or ointments but we use Wedgewood for Perry's prescriptions - the great thing about them and some of the pills is that they have a "tiny tab" option which is a very small pill (about 1/4" across) - perfect for the prescription sizes for our little guys! AND if anyone needs to do gabapentin, they actually will compound both the 25mg and 50mg in tiny tabs - so no need to cut pills for them. The size makes them super easy to push into a small training treat to give them. 

The negative/ annoying part of Wedgewood is that they require your vet to send the prescription to them to get a price quote - makes it harder to shop around because if you do decide to go with someone else you then have to get your vet to send a second prescription to the other place.


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## krandall (Jun 11, 2009)

Just found out the name of the compounding pharmacy that the ophthalmologist is using for Kodi is Sokes Pharmacy. And the strength of Tacrolimus she's upped him to is .5% NOT .05% It should be arriving within the next few days.


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## BoosDad (Mar 8, 2020)

Boo gets his medications from Valley Drug and Compounding in Encino, California. The service is very good, though they may be a little pricier than other places


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## krandall (Jun 11, 2009)

BoosDad said:


> Boo gets his medications from Valley Drug and Compounding in Encino, California. The service is very good, though they may be a little pricier than other places


I figure that in this case, when we only use one, it's just as well to use the one that the ophthalmologist is used to working with.


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