Angelina 13.5 year old/13kg Maltese Cross on Trilostane

[Roxee'sDad]

Re: Angelina 13.5 year old/13kg Maltese Cross on Trilostane

Hi John,
Sorry to hear Angelina is in some pain. Hope her leg gets better soon and doesn't turn out to be anything serious. If the acth comes back within the desired range, it could be that the lower cortisol levels have made Angelina start feeling her aches and pains that come with age.

Regarding the dosing - I believe the acth stim results should guide you. If you think she is feeling the aches and pain of being a senior, you might want to consider a trial/test run of some pain meds or supplements. I had Roxee on metacam for over 3 weeks but saw no changes or improvements, so I discontinued use. I wanted to see if it was muscle weakness or pain that caused her walking problems. Still can't rule out neurological problems but really can't afford 1500 dollars for an MRI and what would that tell me to do for my almost 14 year old pup? My number one priority is her comfort and quality of life. We are about a week or 2 from our next acth stim test. I didn't want to wait the full 90 days so we are going in a little early. (I am still buying lottery tickets) Hoping to hire my own full time vet

The skin pigmentation thing.... I have read this as a side effect of using the meds. Roxee's skin was really pink at one time and has now tuned darker in spots around her sides and belly. The hair regrowth seems to be mostly her white hair but very little regrowth of the black hair I have also read that some others experience a change in color, and texture of the hair. Around here it is commonly and affectionately called "Cush Fuzz"

I hope that Angelina's test results help your decision and thought process. From the many threads I have read on cc.net, some pups do better on the higher end and some do better on the lower end of the desired results range. So there comes in the tweaking, once a day, BID, how many mg's in the am and how many mg's in the pm??????

If you have been following "Jesse's thread, this seems to be the million doallar question, I believe we are all waiting to see what updated info that Katherine "Border terrier and Lysodren-UC Davis" can get regarding an updated UC Davis protocol on Trilo dosing.

Keeping good thoughts and Prayers for you and Angelina.
John (Roxee's Dad)

[frijole]

Re: Angelina 13.5 year old/13kg Maltese Cross on Trilostane

John,

A couple thoughts. Remember that the excess of cortisol in the system BEFORE treating helps to mask pain. (arthritis, old age joint issues etc.) so when you treat the cushings and lower the cortisol level the pain sometimes is revealed. Many of us use glucosamine, fish oil etc. to supplement and aide with pain management. Others have found help with arthritis medication.

Re the skin discoloring - I have been told this is just common old age spots. I didn't notice it til the cushings either however my other dog now has the same thing so I tend to believe that's what it is. They have spots of all shades of dark and sizes. They are schnauzers - white and silver.

Hang in there. My cush dog is nearly blind and deaf now and she likes to stand by my feet at the frig too (piggie she is) and I have hit her with the door and nearly stepped on her a hundred times... so you aren't alone.

Hugs
Kim

[forscooter]

Re: Angelina 13.5 year old/13kg Maltese Cross on Trilostane

Hi John...

I feel your pain.....and Angelina's pain....and the gray hair....it's a side effect of being a Cush parent . I have blonde hair, or used to, so I just call them my "highlights".

The arthritis thing can be tricky and it sounds like that may be the issue. I used the glucosamine and fish oil supplements and they seemed to help a little. But there were still days....others have used different medications and supplements and it's just a matter of what will work for you. It can take 4-6 weeks to see a difference with the glucosamine route but I think worth it.

On really bad days, I give Bailey a dose of Metacam. Only with a full belly of food though to coat his stomach. It seems to help him a lot. I used to have to do the same with Scooter.

I am not an advocate of doing this....BUT....with Bailey, I do dose him where I think it keeps the Cushing's in the best control we can while helping not bring out the worst of the arthritis. It's been quite rainy here and he has been hurting the past few days. I am not backing off the Lysodren though bc of the Cushing's but rather using the Metacam sparingly.

If you get the ACTH done, and Angelina is at the low end, you may want to discuss the possibility with your vet's input about letting her run a little higher.

Sending my most soothing thoughts to you both!!!
Hugs, Beth, Bailey and always Scoobie

[Lucygoo]

Re: Angelina 13.5 year old/13kg Maltese Cross on Trilostane

Hi John....Sorry to hear Angelina's got some pain. I just wanted to pass along what really helped my dog when she went through a bout of bad arthritis about a year ago, when we were trying to get her trilostane dose worked out. My vet prescribed Cosequin, which is a prescription only heavy dose of glucosamine. They come in chewables as well as regular pills. It took about a month to 6 weeks to work, but it helped her 100 percent. She was like a new dog. If you haven't already tried this, I would check it out. It's a little expensive, but it really worked for my Lucy.

Good luck...
Gina & Lucy

[John II]

Re: Angelina 13.5 year old/13kg Maltese Cross on Trilostane

Hi Everyone,

Thanks to all for your helpful replies. I'm calmer today, and although Angelina insists on sleeping on her right side - the lameness hasn't recurred (phew) - I've opted for a little more observation, rather than testing just yet. Fingers crossed and knocking on wood.

Gina & Beth & Kim & Brother John - thanks for the medication advice. My aim is the best quality of life for Angelina - this just keeps getting trickier and trickier! Lower the cortisol - but not too low! Sheesh!

Kim & Brother John - thanks for the reassurance regarding the worrying spots!

Brother John - I like your lottery plans - full time Cushings vet (I'll add in residence to the scheme)! Now there's a plan!

Can't wait to see new UC Davis info - hope Katherine can her her hands on it.

Thanks again,

John the Grey

[John II]

Re: Angelina 13.5 year old/13kg Maltese Cross on Trilostane

Hello All,

Not much to report at the moment.
5 Weeks into treatment, at (except for a brief increase) 30mg of Trilostane a day Angelina:
* Has gone from demanding breakfast at 4:30am to calmly awaiting breakfast at 7am (less calm as 7am approaches).
* Water intake has gone from a litre (plus) per day to around 700mls per day.
*Energy levels are erratic - more one day - less the next.

Took Angelina for an ACTH Stim test today - results hopefully tomorrow.

John the Grey

[Roxee'sDad]

Re: Angelina 13.5 year old/13kg Maltese Cross on Trilostane

Brother John,

Good to see some positive signs

Keeping fingers and 16 paws crossed for good stim results.

John (Roxee's Dad)

[John II]

Re: Angelina 13.5 year old/13kg Maltese Cross on Trilostane

Hello All,

The Specialist called with the ACTH Stim Test results today:
7 May 2009 results:
Cortisol resting 78 nmol/L (or 2.82 u/L) (normal range is 15-170 nmol/L)
Cortsiol at 1 hour 337 nmol/L (or 12.21 u/L)

Previously on 14 April 2009 the results were:
Cortisol resting 157 nmol/L (or 5.69 u/L)
Cortsiol at 1 hour 382 nmol/L (or 13.84 u/L)

Electrolytes on 7 May 2009 were:
Na (Sodium) 144 mmol/l (139-153)
K (Potassium) 5.6 mmol/l (3.9-5.9)
Cl (Chloride) 108 mmol/l (93-122)

Previously on 14 April 2009 the results were:
Na (Sodium) 145 mmol/l (139-153)
K (Potassium) 5.9 mmol/l (3.9-5.9)
Cl (Chloride) 107 mmol/l (93-122)

So not a lot of difference with the Electrolytes.

Other points during the phone call:

• The Specialist advised going back to the dosing of 30mg of Trilostane every 12 hours. I told him about Angelina’s weakness after 3.5 days of double dosing and said I would prefer us to try 20mg of Trilostane every 12 hours. He replied that would not be his recommendation (and I should have come in for an ACTH test at that time to try to ascertain the cause of the weakness) but if that was my wish – he would order the 20mg capsules for me (they would take a couple of days to come in). So I don’t know if that was a victory or not. A daily increase of Trilostane – but a small increase. Am I going too slow?

He also gave me the option of ordering the Trilostane in liquid form – which would make dosing changes easier – should they be necessary. But, I thought, at least with capsules, I know when Angelina has swallowed them.

• I mentioned her leg problem last Sunday – he said that the disease made them more susceptible to blood clots. BLOOD CLOTS!!!


I think the 2nd ACTH Stim Test has hit Angelina harder than the first.
Yesterday, Angelina:
• seemed quite weak when she was walking outside to do the necessary.
• Was behaving a little oddly – in that she was trailing me from room to room.
• Panting more than usual – but that’s to be expected with the stim.
• Seemed confused.
Today she:
• Slept in to 06:55am – the latest so far
• Seemed duller – except when food is offered
• Didn’t want to go for a walk (only went as far as the patch of grass in the front yard – which she anointed – twice). I walked on – she stayed put – I walked back and she followed me home.
• Continues to follow me around today - trailing me from room to room. Sleeping next to my foot right now.

Regards,

John the Grey

[Roxee'sDad]

Re: Angelina 13.5 year old/13kg Maltese Cross on Trilostane

Hi Brother John
Have to run and groom some pooches but I wanted to say that I think the conservative approach is good one. Angelina's post acth didn't drop much but at the same time with a slower drop, she won't or shouldn't experience the quick cortisol withdrawl. Just my opinion.

Yeah and Stim days are always rough on Roxee but she has did recover quicker on the last stim day.

Check in with you later. Belly rubs to Angelina (if she'll let you)
John (Roxee's Dad)

[John II]

Re: Angelina 13.5 year old/13kg Maltese Cross on Trilostane

Hi right back at ya Brother John,

Thanks for stopping by!
You and Roxee are the touchstone for me and Angelina

John the Grey

[Squirt's Mom]

Re: Angelina 13.5 year old/13kg Maltese Cross on Trilostane

Hi John,

I don't post to you much as I don't have much to offer but I do keep up with you and Angelina.

Brother John is right on the mark with starting slow, tho, and I agree with him on that approach. We often see Trilo pups go through the withdrawal of a rapid cortisol drop and by going slow, Angelina may well be spared this.

I did want to let you know that some pups do have problems with the stims the day after or so. The purpose of the test is to stimulate all the things we are trying to control to see how they react under treatment. So, in essence, it is a stress test for the adrenals and they don't always appreciate it! Over simplified, but you get the idea.

You're doing a great job, John. Keep up the good work!
Hugs,
Leslie and the girls

PS. "John the Grey"....I just gotta know; is that a reference to Gandalf the Grey?

[Roxee'sDad]

Re: Angelina 13.5 year old/13kg Maltese Cross on Trilostane

Hi Brother John II (The Grey) or is it Gray?

Long day today, did a mercy groom today, a 14 year old lab that's never been groomed or had a bath. Felt really bad for him, did a shave and removed about a million ticks that have been living in those mats for years. Soon as he got out of my van, he went and rolled around in the grass, I swear he was smiling, gave me a few licks before I left. Guess I made a friend for life

Anyway, I was wondering about cushings and the blood clot thing, haven't ever read about that anywhere so was wondering if anyone else has had that experience or knowledge?

Roxee has become very clingy also, follows me around, cries and moans (blood curldling scream) if we're not in the same room with her. Besides being totally spoiled, I think it just gives her a comfortable feeling to know we are here with her. Probably the same for Angelina, after all, you are her hero. Roxee does like to hang around wherever the food might be

How is Angelina's weight, have you noticed any decrease in her belly? We're still trying to keep the weight on Roxee, she get 4 full meals a day Managed to put a quarter pound on her in the last week. Up to 13.25 pounds now.

I guess you and Angelina are going to be a case study. I know alot of us will be watching to see how it goes. Starting with 30 mg per day (not enough), going to 30 mg twice a day (too much) and now 20 mg twice a day. Please do keep us up to date on any changes and results.

Hoping Angelina is doing better and continues to do so.
Take care.
John (Roxee's Dad)

PS: Have you heard from Scot and Yanni the other Sidney(ite)?

[AlisonandMia]

Re: Angelina 13.5 year old/13kg Maltese Cross on Trilostane

Anyway, I was wondering about cushings and the blood clot thing, haven't ever read about that anywhere so was wondering if anyone else has had that experience or knowledge?

You saw that in that power point too. My understanding with the Cushing's and blood clot thing is that it is really quite rare in dogs although just occasionally a Cushing's dog will throw a clot - or it is thought that this is what has happened. However with cats clotting with high cortisol levels (or when on high doses of steroids like prednisone) is quite common and often is the first tip-off to the fact the cat is Cushingoid. I get the impression that cats are a particularly clot-prone species and seem to suffer from clots as a result of quite a few medical conditions, not just Cushing's. They particualry get something horrible and agonizing called "saddle thrombosis". With Cushingoid humans, clots are far more of a risk than they are in dogs but possibly not quite as likely as for cats.

Interestingly humans with high corticosteroid levels are very likely to develop psychiatric disturbances (mania, severe agitation, intense irritability and even rages etc.) whereas, thank goodness, dogs are not particularly prone to that type of symptom - beyond a bit of restlessness in the evenings they almost always remain more or less their usual sweet selves.

Alison

[John II]

Re: Angelina 13.5 year old/13kg Maltese Cross on Trilostane

Hello All,

Hi Leslie and The Girls
Thanks for the information with regards to the stim test. And the hugs - need the hugs! The John The Grey is just a reference to my own growing greyness (although I have seen the movies so... maybe it stuck in my head )

Hi Brother John The Good,

In Australia I'm John the Grey, if I was visiting the US I'd have to covert that to John the Gray

Nice work on the Old Lab! You are truly a good man!

I hadn't heard about the blood clot thing either so it was all a bit "What next?" to me. I'm hoping she was just lying on the edge of the rug, it dug into her leg enough to cut circulation and put it to sleep. I'm hoping.

I think I read somewhere that Trilostane can cause behavioural changes - but whichever article it was - they didn't give examples. Of course, since late January, I've been taking over ALL the feedings - so that could be a factor

But then again - it's only been happening since the last testing. (sigh) lots of questions - few answers!

Angelina's weight was almost exactly the same as last time 13.02kg last Thursday versus 13.04kg the time before that. Her belly seems to be the same football it has been.

I'd much rather Angelina was a success story than a case study - but we have to wait and see how this all turns out. It's good to know a lot of fingers and paws are crossed for her.

Since Scott and Yanni's first contact, I haven't heard from them - which is a pity because I think Scott has a story to tell.

And Alison,
You are simply amazing with your inter-species cushings knowledge!

John The Grey & Angelina the White
(who is amazed that he managed to write all that before his computer could crash for the 7th time!)

[labblab]

Re: Angelina 13.5 year old/13kg Maltese Cross on Trilostane

Hi John,

Here's a link to a study that I had seen a while back that discusses the association between Cushing's and blood clots. It is directed towards the implications for humans, but as you will see, the study was performed on dogs with naturally-occuring Cushing's Syndrome. So if you are interested in plowing through it, it may help clarify the linkage between the disorders:

Biochemical Basis for the Hypercoaguable State Seen in Cushing Sydrome

I was interested to see that "our" Dr. Feldman (the UC Davis specialist who we so often quote here) was one of the authors.

Marianne