Jesse just diagnosed with Cushings

[Patricia ann Wh]

Re: Jesse just diagnosed with Cushings

Hi Glynda,

If the dose is too high.........then wouldn't the cortisol withdrawal be too quick??
I'm confused.
Can you explain a little more.

Without having an acth stim test done the day a dog shows symptoms of overdose, it's almost impossible to tell if the adverse reactions are due to cortisol withdrawal or if the dose is too high.

I did send your response and the site to Sebatians parents.
I know they are extremely concerned.

Thanks so much Glynda
Yes, Jesse was on the 15 / 15 for 4 days with no problems.
I'm sure that's when the water went way down - so something positive was going on.

[Patricia ann Wh]

Re: Jesse just diagnosed with Cushings

Hi All,

Another question.

If trilostane is such a short acting drug, why is it recommended to wait 5 - 7 days before restarting ?? AGAIN

Patti and Jesse

[Squirt's Mom]

Re: Jesse just diagnosed with Cushings

Hi Patti,

This is my understanding....even tho the active effectiveness of the Trilo stops after a few hours, it still remains in the system in a lessened or, perhaps, altered less effective form. While this lessor form remains in the system, it is not wise to add another drug that could very well kick the remainder of the Trilo into action, or interact in some other negative way. Remember, medicines are chemicals and each chemical has unique properties. These individual properties work as intended until mixed with some other chemical, and then they interact producing consequences neither chemical alone could.

Think of it like using bleach to clean. We know that it is very unwise to mix any other cleaner with bleach as they will react and can cause a gas that is quite harmful. You make sure the bleach residue has been wiped up good before using anything else. The same with Lyso and Trilo. We want to make sure the first drug (bleach) is completely out of the system (wiped up good) before putting something else (Pine Sol) in the system. Unfortunately, it takes a bit longer to wash drugs out of the system than it does to wash bleach off.

This washout period (which I would feel more comfortable at 30 days) gives you a good opportunity to learn as much as you can about Cushing's and the various tests/treatments. It is obvious that you are doing a great deal of thinking about all this stuff and doing a good job of asking questions. Questions are one of the best ways to learn!

I hope Jesse is doing ok today and that you are feeling a bit calmer about things now.

Hugs,
Leslie and the girls

[Patricia ann Wh]

Re: Jesse just diagnosed with Cushings

Hi, Its been a few days. Here's the update:

Jesse has been on just "15" mg of trilostane for 4 days now (this is day 4).
I know - its a very small dose - Jesse is 85 lbs.
He is sleeping and resting the best he has in a long time. Sleeping normally at night now - not wide awake till the wee hours of the morning.
He is walking much better (stronger) and he is just acting more like himself.

I'm going to keep him on 15 for one more day and then go to 15 am 15 pm.
I just do not want to risk making him weak again - it took too long for him to recover. (maybe 3 - 4 days)
The vet said that sounded good. (don't forget - he's never used trilostane)
Anyway, so far so good, I like what I'm seeing.
Thanks again everybody.

Patti and Jesse

[Squirt's Mom]

Re: Jesse just diagnosed with Cushings

Hi Patti,

I saw your post on John the Grey's thread and wanted to give these links to you, too. They are more current than the one you posted on the lecture notes, tho that link has some valid info still for sure. These studies are the ones done in the US and the UK plus some other places and were apparently used to help get Trilo approved in the US. Kathy (We Hope) posted these a little while back:

http://www.fda.gov/cvm/CVM_Updates/D...ingDisease.htm

http://www.fda.gov/cvm/FOI/141-291o120508.pdf

How is Jesse doing? I hope you are seeing some improvement.

Hugs,
Leslie and the girls

[Roxee'sDad]

Re: Jesse just diagnosed with Cushings

Hi Patti,
I hope Jesse is doing good today.

So, do you think if the 4th day of trilo and the legs get weak - stay on it??
His legs are weak already - they are definitely more weak after the trilo.
I've read stories where people say their dogs legs are weak before - but after time they do get a little better - but they didn't say if the legs got worse and they stuck with the trilo or if they did not see weakness at the beginning of the trilo. Can anyone understand what I'm talking about?? I'm not sure I'm clear.

This is just my opinion, If Jesse's legs were weak before starting meds, then became weaker after, then it might be that he is feeling aches and pains that were masked by the higher cortisol levels. If this is the case, you and your vet may want to consider a trial run of a compatable medication to treat the aches and pains and see if it makes any difference. I tried Metacam for 2 weeks on Roxee but saw no improvement. I will be speaking with our vet again Friday and ask him if I can try Tramadal just to see if it helps her at all. We are in that experimental stage, is her (Roxee) hind end weakness still because of all the muscle wasting or aches and pains or both? hmmmm.

Please let us know how Jesse is doing today. I really hope he is doing better.

John (Roxee's Dad)

[Patricia ann Wh]

Re: Jesse just diagnosed with Cushings

Thank you John,
You could very well be right about the pain. I will take care of that tomorrow - the best I can.

I have another question.
How soon does trilostane take effect.
If you restart - can it work immediately - like the next day??
When I stopped after day 5 of the first try with trilostane (when he collapsed day 5) I started back up 5 days later and immediately his limping stopped.
He did not limp again till yesterday (that was day 3 OFF of trilostane) I stopped the second time because he was getting really weak again.

One more question (for this moment)
It seems like most people rely on the testing to see how their pups are doing - what about WATCHING for effects (good or bad) they seem to change dosages when the results come back high or low, I don't feel as though I read as many stories about just "noticing" if the dosing is off.

Do vets ever change dosages because the owner "sees" ups or downs or do vets only change dosages due to test results.

I called my vet to get the 15's made into 5's, he hasn't called back yet.

Thank you for asking about Jesse - he hadn't had a trilostane (15 mg) since Tuesday am. He was much much better yesterday, barking, more himself. But -- last night he started limping again, which he hadn't done at all since last Sunday -( He restarted the tilostane on Saturday - 15 mg. a day)
NO limping at all - until last night

I don't know - maybe 10 mg a day or maybe 15 every other day.

Thank you so much Leslie and your girls - yes all the info is extremely helpful.

Patti and Jesse There has to be an answer - there has to be!!!!
We won't give up!!

[labblab]

Re: Jesse just diagnosed with Cushings

One more question (for this moment)
It seems like most people rely on the testing to see how their pups are doing - what about WATCHING for effects (good or bad) they seem to change dosages when the results come back high or low, I don't feel as though I read as many stories about just "noticing" if the dosing is off.

Do vets ever change dosages because the owner "sees" ups or downs or do vets only change dosages due to test results.

Patti, the monitoring protocols for both Dechra and UC Davis state that dosing changes should be based on BOTH test results and also behavioral reports from the owners. Neither piece is adequate in isolation. Relying on test results alone makes no sense, because the goal is to see improvement in the well being of the dog. Unless symptoms are adequately resolved and the dog is feeling well, the "job" is unfinished regardless of test results. But on the other hand, test results are also critical in helping to establish whether any given symptom is likely the result of too much or too little medication. Many different causes can result in the appearance of the "same" symptom. For instance, dogs with both very high and very low cortisol may all exhibit lethargy. But a dog may also be lethargic due to a condition unrelated to Cushing's altogether. Weakness and exercise intolerance are other similar examples. So the objective test results can help identify the most likely cause of any given symptom or issue. In summary, whether or not they are explicitly saying so, I think you'll find that most people and vets here use both pieces in assessing the need for dosing changes: the dog's test results, and also the dog's appearance and behavior.

Marianne

[Roxee'sDad]

Re: Jesse just diagnosed with Cushings

Hi Patti,
One more thought, I believe I read some months ago that one of the cc.net members cush pup was having a real problem with an additive that a compounding pharmacy was using. I think the additive was just for color. (not sure) but seems when the member asked the pharmacy not to use the additive, the adverse affects with her cushpup went away. I think she went thru alot to figure that one out.

Hope one of the other members remembers the details of that from the old cc.net.

All the best to you and Jesse.
John (Roxee's Dad)

[John II]

Re: Jesse just diagnosed with Cushings

OMG! We have to worry about additives as well?

[nikkismom]

Re: Jesse just diagnosed with Cushings

Hi, all, I'm the one with the additive story. The compounding pharmacy was using lactose and orange powder to mix with the mitotane, and it did make Nikki very sick, although it is probably rare for this to happen. The pharmacy told me it was impossible.I have switched to Diamondback and my vet requests" no additives" and Nikki tolerates it fine.I think cushpups have especially sensitive stomachs and digestive systems. I have been making Nikki's food because every canned dog food I gave her gave her diarrhea. They put so many supplements and unknown things in it! She has not had stomach problems since I've been cooking her food.

[John II]

Re: Jesse just diagnosed with Cushings

Is there a recipe section here somewhere?
I've been dabbling with some home cooking for Angelina - but I always worry about it lacking the right ingredients

[nikkismom]

Re: Jesse just diagnosed with Cushings

I think there are recipes on line, but my vet says they really only need a protein and a carb. I stay away from grains like corn and wheat and mix ground chicken, turkey or beef with brown rice. Then I add some kind of vegie like beans, squash or broccoli, but Nikki seems to eat around all the vegies that I put in. I think I'll try grinding them up instead of chopping. I also give her a teaspoon of coconut oil and fish oil in one of her two daily meals.She won't take her glucosomine anymore, so I put that in her food and sometimes she doesn't notice. Some dogs like fruit which would also be good, but Nikki hates all fruit. I do think they need some fiber, ie the fruits and vegies. I also put some ground rosemary just to make it smell better, and she likes that. If I'm pressed for time, I use Wellness 95% meat mixed with the rice etc. It doesn't have the additives that other commercial foods have. Nikki will be 15 in July, so I doubt I could give her much that would do harm.If her digestion is better, it has to be good.

[Patricia ann Wh]

Re: Jesse just diagnosed with Cushings

Thank you Marianne and John for clarifying those things.
Whew!! It all makes my head spin.

The vet called me back and he wants to try 15 mgs. every other day.
From the beginning - logically - it seemed to me that dosing every 12 hours made the most "logical" sense.
At this point - I'm beginning to wonder where the logic lies.

I could cry - and I do - believe me. I've always been able to "make Jesse feel better" - always, the frustration I'm feeling is - well - you probably all know the feeling. Unbearable.

I will try the 15 mgs. every other day and I am "sure" it will work.
I must - I must think positive at this point.
THE POWER OF POSITIVE THINKING

So, I will let you all know how this progresses. - Which - will be PERFECT!!

Thank you all so much - you are all so wonderful - really - Thank You.

Patti and Jesse

[Roxee'sDad]

Re: Jesse just diagnosed with Cushings

Hi Patti,
Just checking to see how Jesse is doing. Hope Jesse is feeling better.
John (Roxee's Dad)