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Angelina 13.5 year old/13kg Maltese Cross on Trilostane

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  • #61
    Re: Angelina 13.5 year old/13kg Maltese Cross on Trilostane

    Originally posted by Patricia ann Wh View Post
    Hi John, I thought this was interesting too. The paragraph is from the link below.

    Currently, the recommendations of this author are based mainly on those of Dr. Reto Neiger who has the most experience in using this drug.20 Recommendations are to start administration of trilostane (2-10 mg/kg) once daily. If minor side effects are seen, stop the drug for 3-5 days and then restart giving trilostane every other day for one week before continuing with the initial dosing scheme. An ACTH stimulation test should be performed at 10-14 days, 30 days and 90 days after being on a full dose of trilostane. The test should be performed 4-6 hrs post-pill. If the post-ACTH cortisol concentration is <20 nmol/L, stop the trilostane for 48-72 hrs.20 At this point, Dr. Neiger recommends restarting the trilostane at a lower dose20, but given the long-term suppression seen in some cases, I believe that, ideally, an ACTH stimulation test should be performed and trilostane should not be reinstituted until cortisol secretion has recovered. If the post-ACTH cortisol is >200 nmol/L, increase the dose of trilostane. If the post-ACTH serum cortisol concentration obtained is between 20 and 200 nmol/L but the clinical signs are continuing, then twice-daily therapy should be used. The same dose that was given once-daily should be given twice (e.g. if giving 30 mg once daily then double it to 30 mg twice daily). Once the clinical condition of the dog and the dose have stabilized, an ACTH stimulation test should be performed every 3-6 months and serum potassium concentration should be measured to check for hyperkalemia.


    Whew - its endless
    The varying research recommendations regarding trilostane do seem pretty overwhelming, don't they?? And there certainly has been some evolution along the way. The "Dr. Neiger" who is referenced here conducted some of the very first research that was performed at the Royal Vet College in London, and his study results were among those upon which the first Vetoryl dosing recommendations were based. Many of the recommendations contained in the 2004 paragraph that Patti has cited remain part of Dechra's current Vetoryl dosing protocol. But there are some that have been revised as a consequence of subsequent studies.

    For instance, you'll see that the 2004 recommendation was that if the decision was made to shift to twice daily dosing, you actually DOUBLED the daily dose (rather than dividing the once daily dose in half). Since my dog started on trilostane right at that time, that is precisely what we did with him. The recommended once daily dose for his weight was 120 mg., so we added another 120 mg. at night (can you believe we were giving a 70 lb. dog 240 mg.?). Even at that whopping dose, he never had an ACTH "post" result that was less than 6 or 7. (But that is a whole other story...). I absolutely CRINGE now when I think that we were giving him that high of dose. But that was the protocol at the time, and he actually did very well on it for several months.

    Anyway, that is one of the reasons why we are trying to track down and document for our members the most recent studies and clinical protocols. Because there have been changes along the way, just is the case with any evolving medical treatment.



    • #62
      Re: Angelina 13.5 year old/13kg Maltese Cross on Trilostane

      Hi Again,

      Did I tell you Jesse is 85 lbs.

      Oh - and I once read about a dog that was on 33 1/2 mgs.

      Yeah, the article said that 30 was too low and 35 was too high!!!!!!!

      But 33 1/2 was perfect!!! It was an article written by a vet. (Have no idea where I read it)

      But - I found that amazing. Actually, almost scary. The fact that such a small dose could make such a difference!!!

      Patti and Jesse


      • #63
        Re: Angelina 13.5 year old/13kg Maltese Cross on Trilostane

        Originally posted by John II View Post
        And now, 5 hours later I'm wondering if I'm onto something.

        Angelina's lameness seemed to decrease as the day warmed.
        And then it seemed to increase as the day cooled.
        Maybe there's no relation to the Trilostane at all?
        Maybe it's all just the cold getting into her old bones?

        Which, if it's true would be just ironic - I spent all Summer wishing for Winter - now I may just spend all Winter wishing for Summer... or central heating.

        John & Angelina
        Hi John the Grey,
        Sometimes we may over think things. Sometimes we just need to take a day to enjoy our time with our pups. Pretty much what you did with Angelina, I did with all my pups today. They were treated with a trip to Burger King. You would have thought they got the lunch of their lives They enjoyed it and I enjoyed watching them enjoy it.
        All the best to you and Angelina, Belly rubs from me if she'll let you
        John (Roxee's Dad)


        • #64
          Re: Angelina 13.5 year old/13kg Maltese Cross on Trilostane

          Hello All,

          My, hasn't there been a lot of activity here on Angelina's thread!

          Patti - Jesse's story of an 85lb dog collapsing on 60mg per day is the stuff my nightmares are made of! I see Angelina's numbers still being too high, but I fear the dose increases. Angelina gets wobbly - starts limping... which of several possible reasons is it? On the other hand we have 13lb Roxee on 40mg per day!

          So far at the first sign of a negative reaction - I've shut the experiment down! Haven't figured out if I'm cowardly or prudent

          I took Angelina to the local vet this afternoon - just to get her leg checked out. After an examination, he suspects an old dog with an old joint. She was so worked up about being in her least favourite place that her limp disappeared - I asked the vet about a limp being the sign of a possible neck injury - he said that if that was the case, the limp would persist regardless of her stress levels. He gave her a shot of Meloxicam and suggested I start giving her glucosomine (at a quarter of the human dose).

          I asked him about the bulge (I'm not sure I'm seeing) on her left side - he felt her abdomen and reported a very large liver and a very large spleen .

          I share your confusion Patti - big time!

          Leslie - as always thanks for the links and the hugs!

          Marianne - I've been thinking about your preference for SID versus BID - and I initially thought that logically, keeping the cortisol levels fairly constant via BID dosing was the better option. But now I'm wondering if upping Angelina's dose to 40mg SID rather than 2 doses of 20mg would actually be easier on her system somehow? She would have the 24 hours for it to wear off...
          All I know, is that she handles 30mg once a day well - but both times we've gone to twice a day dosing, whether it was 30mg twice a day or 20mg twice a day - she started getting the wobblies. What do you think?

          And Brother John - I hope Roxee's results will be perfect - please let me know.
          I am the king of overthinking things Waking or dreaming I'm thinking about this. You are wise - let us all take the time to enjoy our puppies! And give them special treats whenever possible. Angelina prefers KFC

          Whatever the outcome I know Angelina has had a good and happy life - I just wish we could have made it to the finish line with a perfect record of happiness. To see her like this breaks my heart.

          Thanks again one and all,
          John the Grey and Angelina.


          • #65
            Re: Angelina 13.5 year old/13kg Maltese Cross on Trilostane

            Hi John,

            Bless your heart! What is happening to you is your twitcher has gotten stuck wide open! A twitcher is what makes us look at every little thing and say, "What's that?! What does that mean?! What am I supposed to do?!"

            When Squirt was first diagnosed and I didn't understand much about this condition, my twitcher was wide open, too. Every little thing she did, or didn't do, made my little mind go into overdrive with worry about the possibilities. "Was that just a normal sneeze, or .....? Why is her nose dry...oh no, what if....? OMG! She's sleeping with one leg curled up....why?!" On and on and on... Poor thing, I drove her nuts the first few months constantly checking on her, looking in her mouth, squeezing her belly, inspecting her skin and coat, waking her up to be sure she was ok. And then they found that tumor, she had surgery and my twitcher went into high gear again!

            It's been about 15 months since I first heard the word "Cushing's" and although I am much calmer than I was at first, my twitcher still stays ready to go full steam ahead at the drop of a hat. But having super-active twitchers is a good thing for cush moms and dads as long as we don't let it get out of hand. So twitch away, my friend! That just means you are a watchful, concerned dad. As time passes, you will settle down some and your twitcher will go on stand-by.

            I, too, have learned the lesson Brother John spoke enjoy those moments when I see Squirt doing something she used to do, when I see her happy and energetic, when she gives me one of her rare kisses, when she smiles, when I see her little butt sashaying down hall, when she rolls over for me to rub her belly...the little things I used to take for granted are now extra special.

            I do hope Angelina gets regulated soon and that you start to see some real improvement. Meantime, remember to enjoy her when you can. You are doing a great job, dad!

            Hug from a sister twitcher ,
            Leslie and the girls
            "May you know that absence is full of tender presence
            and that nothing is ever lost or forgotten." Anne, a Corgi mom


            • #66
              Re: Angelina 13.5 year old/13kg Maltese Cross on Trilostane

              Ah Haaaaa!

              It's my twitcher that's the problem . I wonder how I can turn it off from time to time

              John (Roxee's Dad)


              • #67
                Re: Angelina 13.5 year old/13kg Maltese Cross on Trilostane

                Wine, margarita, pina colada,.....
                "May you know that absence is full of tender presence
                and that nothing is ever lost or forgotten." Anne, a Corgi mom


                • #68
                  Re: Angelina 13.5 year old/13kg Maltese Cross on Trilostane

                  Hi John the Grey,

                  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
                  You might want to check with Angelina's Auntie Leslie. I believe she has some recipies and is studing nutrition.

                  John (Roxee's Dad)


                  • #69
                    Re: Angelina 13.5 year old/13kg Maltese Cross on Trilostane

                    Hello All,

                    Leslie - so while all the kids are playing with Twitter these days, I wind up with Twitcher?
                    - Also, is there an Auntie Leslie cookbook somewhere?

                    And Uncle John - thanks for pointing me in the right direction

                    John & Angelina


                    • #70
                      Re: Angelina 13.5 year old/13kg Maltese Cross on Trilostane

                      And for my next question

                      I went off to buy some Glucosamine and found a Glucosamine, MSM & Chondroitin powder - which I figured would be easier to measure accurately than tablet cutting. However - looking at the ingredients I'm wondering if there is anything below not suitable for dogs (especially dogs on Trilostane)? The human dose is 5mg (1 teaspoon) twice a day - so quarter of that for Angelina?

                      Formulation per 5 grams:
                      Glucosamine Hydrochloride (mg) 250
                      MSM (mg) 250
                      Chondroitin Sulphate (mg) 200
                      Vitamin C (mg) 50
                      Citrus Bioflavonoids (mg) 50
                      Zinc (mcg) 400
                      Manganese (mcg) 200
                      Copper (mcg) 33.32
                      Boron(mcg) 50
                      Sodium (mg) 3.95

                      Thanks in advance,
                      John & Angelina


                      • #71
                        Re: Angelina 13.5 year old/13kg Maltese Cross on Trilostane

                        Hi John,

                        We use gluco/condroit w/msm here, too. I don't thing any of the ingredients should be an issue, even with the Trilo on board.

                        About diet...most of the books and info you find on the web is geared toward healthy dogs and the info that isn't, is often too generic. It is always best when dealing with an ill pup to have a diet designed especially for your pup based on her particulars. Here are two ladies I would recommend:

                        Catherine Lane

                        Monica Segal

                        They both have discussion groups, too, which you can join and learn a lot about diet and nutrition in general.

                        Cat’s discussion group

                        Monica’s discussion group

                        Monica has two books that I would recommend over anything else out there that I have seen so far. They are Optimal Nutrition and The K9 Kitchen.

                        We had a thread on Diet and Nutrition at the old site and I need to get it started here again. So, thanks for the nudge, guys!

                        I am more than happy to help with diet where I can, but my knowledge is very limited at the moment and the more I learn the more I don't know. Nutrition is a very complicated subject if you want to do it correctly, especially when dealing with pups that have health issues. For example, someone here said their vet told them that all dogs really need is protein and carbs. Wrong. Carbohydrates are not listed as a dietary requirement for dogs by the NRC (National Research Council) which is the unbiased source for canine nutrition. (The AAFCO is an organization that was developed by and reports to the dog food manufacturing industry, so their recommendations are geared to meet the approval of the industry.) In the wild, canids eat the whole prey usually, meaning they eat the stomach and gut of their kill, including the content thereby providing a limited source of carbs. The key nutrients for dogs are protein and fats. Don't get me wrong, carbs are important to the functioning of the body, but it doesn't take much to let the body do what it needs. Carbs are more important to true omnivores, but the dog is not a true omnivore even tho they can eat and digest plant materials to some degree.

                        Ok, I'm rambling.

                        The supplement you got should be fine.

                        Leslie and the girls
                        "May you know that absence is full of tender presence
                        and that nothing is ever lost or forgotten." Anne, a Corgi mom


                        • #72
                          Re: Angelina 13.5 year old/13kg Maltese Cross on Trilostane

                          Thanks Leslie!

                          I'd gone to the pharmacy and bought a jar of Glucosamine tablets first. Then went to the supermarket and checked out their range - finding the multi-supplement powder. It was actually thanks to reading your thread that I thought the Glucosamine, MSM & Chondroitin powder would be a better choice - since you were using something similar. It wasn't until I got home and read all the other things in it and wasn't sure. It was the boron that threw me!

                          And as usual - thanks for the links - got some reading to do!

                          Angelina had a pretty good day - that pain shot the other day may have made all the difference. She broke into a trot on a few occasions

                          Her water intake has been pretty low the last 2 days only 520mls yesterday and 460mls today... there's still an hour worth of today left - but since she's already gone to bed - that may be it for her today.

                          Thanks for taking the time to do all the rambling - you can never ramble too much for me!

                          Hugs for you and the girls
                          John & Angelina


                          • #73
                            Re: Angelina 13.5 year old/13kg Maltese Cross on Trilostane

                            Hi John,

                            I'm glad Angelina had a good day yesterday and that the pain shot has given her some relief.

                            I'm being a worrywart here but since your vet recommended glucosamine and the powder contains several "extras" I'd recommend checking the product out with your vet for his approval just to be on the safe side.

                            Give Angelina some extra pets from me!

                            Munchie, 11 yr. old Mini-Schnauzer, 23.2 lbs., diabetes 10/24/12. 8 units Novolin N 2xdaily.


                            • #74
                              Re: Angelina 13.5 year old/13kg Maltese Cross on Trilostane

                              Hi Louise,

                              I am also a worrywart (and a twitcher ) and popped into the Vet's yesterday. Who, after glancing at the container for a second said it should be fine.

                              I've yet to figure out the Vet roster - I was hoping to talk to the nice one - but got the evil one . Well I suppose he's not actually evil. He's just not the nice one.

                              Today I started the 2nd attempt of the 12 hour 20mg dosing of Trilostane. A quarter dose of the Glucosamine, MSM & Chondroitin powder mixed in with food. And the contents of a fish oil capsule mixed in with another meal.

                              Now I just have to figure out a time to give her some milk thistle!

                              Thanks for keeping an eye on us,

                              John & Angelina.


                              • #75
                                Re: Angelina 13.5 year old/13kg Maltese Cross on Trilostane

                                I have to admit that I’ve been avoiding reading the updates of forum members who have announced the passing of their Cush Pups. Because I’m trying to keep positive and not think about the eventual outcome of Angelina’s story.

                                But recently I did look over the list of losses for 2009.

                                I was saddened to see how many have “crossed the bridge” just this year alone.

                                But what shocked me most was that among those who have lost so much and so recently, were those who have taken the time in the midst of their grief to lead me by the hand and guide me through my own fear and confusion.

                                I just find this level of kindness and selflessness amazing. So I just wanted to stop, take a moment and say thank you so much for all of your help! You are all doing so much to help Angelina and me and to restore my faith in humanity. It means more to me than I can say.

                                I would have been John the Bald without you all .