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So after 15 days of dosing Angelina once every 24 hours with 30mg of Trilostane – it was testing day.
Four family members plus much loved dog descended on the specialist centre.
Angelina weighed in at 13.04kg – 15 days earlier she was 13.123kg. Every little bit helps
The specialist appeared – we had an update chat. I made sure they checked her electrolytes and I handed him a urine sample I collected that morning (not that they asked for one – but after Roxee’s recent experience with a UTI, I wanted to check things out). I also told the specialist that Angelina usually wound up back on the cool bathroom floor by about 4:30pm – around 11 hours after her dose.
Finally he led Angelina away. She was surprisingly agreeable and walked off with him – until he reached the front door – where she stopped when she realised she wasn’t leaving. Then he had to pick her up.
15 minutes later she was back. And we were given the option of waiting with her for 50 minutes until the post-ACTH injection blood sample was to be taken. I was expecting them to wait 2 hours. But I was happy that we could take Angelina outside and she was therefore getting the less stressful option. The nurse appeared after 50 minutes and took her away for another 15 minutes or so.
Then Angelina was back. I questioned the specialist regarding the sound of her heart and lungs – which he said sounded fine. Her blood pressure was still high at 190. The specialist told us he would call with the results the next day.
After we got home Angelina was panting (didn’t help that it was a very warm day for Autumn -28 degrees Celsius – that’s just over 80 degrees Fahrenheit – anything over 25 usually leads to some panting). Her respiration was clocking in at 84 breaths per minute. But her total water intake for the day was only 650mls. All in all she seemed to handle the ordeal well.
At 3pm the next day the specialist rang with a summary. But we Cushings Net people are not summary people
– so I asked him if I could get the full results emailed to me – and they were – see below my ramblings. Also at the end of the results are the accompanying “General Interpretive Guidelines” which may be helpful to members and visitors.
As expected the specialist has recommended Angelina’s Trilostane dosage be increased to 2 doses of 30mg per day (one every 12 hours) – an excerpt from the report:
"Angie was examined for a recheck of her hyperadrenocorticism. Her blood pressure remained mildly elevated today . Her examination was otherwise unchanged, which is not surprising at present.”
I put it to him that my research (aka Leslie) seemed to indicate that the full effect of a particular dosage of Trilostane didn’t become apparent until at least 30 days after beginning that dose. He didn’t seem concerned – due to the lower dose we started with.
Now I’m feeling about the same way about the 60mg dose as I did about the 30mg – before the first day. Oh the troubled sleep I had last night!
John – what dose is 13lb Roxee on?
Today, I swung by the specialist centre to do some more brain picking (I think I do better in person than on the phone). Turns out it was the specialist’s day off – but I spoke to another one of the doctors who saw Angelina on her first consult (there were three in all). He was similarly unconcerned about the increase in dosage. When I questioned if I should have Prednisone on hand he assured me that by the time I was aware that Angelina was experiencing side effects and gave her the antidote (as I think of it) the Trilostane would already be wearing off.
Since Angelina was due to get her monthly heartworm pill today – I held off starting her second daily dose of Trilostane. I know everyone says you can give them both – and I’ll have to do just that, this time next month – but I’d just as soon keep things as simple as possible on her first 60mg day.
Now, can someone tell me about milk thistle dosage for dogs? And omega 3 (fish oil) capsules?
John II
14-04-2009 The Urine Test
URINE COLLECTION METHOD Voided
URINE VOLUME (ml) 50.0
URINE COLOUR Yellow
URINE TRANSPARENCY Opaque
URINE SG 1.019
URINE GLUCOSE Negative
URINE BILIRUBIN Negative
URINE KETONES Negative
URINE HAEMOGLOBIN Negative
URINE pH 6.5
URINE PROTEIN ++ (1 g/L)
URINE UROBILINOGEN Normal (less than 20umol/L)
URINE RBC/HPF Less than 5
URINE WBC/HPF Less than 5
URINE CASTS, NUMBER Negative
URINE BACTERIA Negative
URINE FAT Occasional
URINE EPITHELIAL CELLS, TYPE Squamous
URINE EPITHELIAL CELLS, NUMBER Occasional
URINE EPITHELIAL CELLS, NUMBER Negative
URINE SPERM Negative
URINE CRYSTALS, TYPE Amorphous crystals
URINE CRYSTALS, NUMBER Occasional
URINE CRYSTALS, NUMBER Negative
URINE DEBRIS Negative
Minimally concentrated urine may reflect ongoing hyperA. Mild
proteinuria is unexplained: consider a UPC to further assess.
No evidence of UTI.
14-04-2009 Biochemistry with Electrolytes- Canine
Na 145 mmol/l (139-153) (Sodium)
K 5.9 mmol/l (3.9-5.9) (Potassium)
Cl 107 mmol/l (93-122) (Chloride)
Calcium 2.82 mmol/l (1.9-2.9)
Phosphorus 1.53 mmol/l (0.8-2.1)
Bicarb 20.9 mmol/l (12-26)
Anion Gap 23 mmol/l (14-32)
Urea 13.2 mmol/l (2.5-10.0)
Creatinine 81 umol/l (50-150)
Glucose 5.2 mmol/l (3.3-6.8)
Bilirubin 7.0 umol/l (0-6)
AST 128 U/l (18-80)
ALT 590 U/l (16-90)
AlkPhos 3205 U/l (1-150)
T Protein 77 g/l (52-80)
Albumin 39 g/L (23-40)
Globulin 38 g/l (25-45)
CreatKinase 235 U/l (73-510)
Amylase 727 U/l (333-1500)
Lipase 1495 U/l (77-750)
Cholesterol 10.50 mmol/l (3.5-9.0)
14-04-2009 ACTH Stimulation Test
Cortisol, resting 157 nmol/L (15-170)
Cortsiol, 1 hour 382 nmol/L
General Interpretive Guidelines
Normal dog:
* post-ACTH cortisol 170-470 nmol/L
Hyperadrenocorticism (hyperA):
* post-ACTH cortisol > 600 nmol/L consistent with hyperA
* post-ACTH cortisol 470-600 nmol/L equivocal
* failure of cortisol levels to increase significantly following ACTH
administration in a dog with typical clinical and laboratory features of
hyperA does not exclude the diagnosis. For further assessment a low dose
dexamethasone suppression test may be useful
* adrenal function tests, such as the ACTH stimulation test, may yield
a false positive test result in a sick or stressed dog with non-adrenal
disease
* this test does not differentiate between pituitary and adrenal-
dependent hyperA (an endogenous ACTH assay, abdominal imaging or a high
dose dexamethasone test may be useful for further assessment) For the
endogenous ACTH test, please contact the laboratory for the special
sample collection protocol.
Post-medical therapy for hyperA, results should be interpreted in light
of adequacy of clinical control. Target values depend on the drug used:
Mitotane or ketoconazole:
* baseline cortisol < 100 nmol/L post-ACTH cortisol 28-100 nmol/L
Trilostane:
* baseline cortisol 28-55 nmol/L post-ACTH cortisol 28-55 nmol/L
Iatrogenic hyperA:
* baseline cortisol < 55 nmol/L post-ACTH cortisol < 55 nmol/L
Hypoadrenocorticism:
* baseline cortisol < 55 nmol/L post-ACTH cortisol < 55 nmol/L
* this test will not distinguish between primary (adrenal) and
secondary (pituitary) hypoadrenocorticism
So after 15 days of dosing Angelina once every 24 hours with 30mg of Trilostane – it was testing day.
Four family members plus much loved dog descended on the specialist centre.
Angelina weighed in at 13.04kg – 15 days earlier she was 13.123kg. Every little bit helps
The specialist appeared – we had an update chat. I made sure they checked her electrolytes and I handed him a urine sample I collected that morning (not that they asked for one – but after Roxee’s recent experience with a UTI, I wanted to check things out). I also told the specialist that Angelina usually wound up back on the cool bathroom floor by about 4:30pm – around 11 hours after her dose.
Finally he led Angelina away. She was surprisingly agreeable and walked off with him – until he reached the front door – where she stopped when she realised she wasn’t leaving. Then he had to pick her up.
15 minutes later she was back. And we were given the option of waiting with her for 50 minutes until the post-ACTH injection blood sample was to be taken. I was expecting them to wait 2 hours. But I was happy that we could take Angelina outside and she was therefore getting the less stressful option. The nurse appeared after 50 minutes and took her away for another 15 minutes or so.
Then Angelina was back. I questioned the specialist regarding the sound of her heart and lungs – which he said sounded fine. Her blood pressure was still high at 190. The specialist told us he would call with the results the next day.
After we got home Angelina was panting (didn’t help that it was a very warm day for Autumn -28 degrees Celsius – that’s just over 80 degrees Fahrenheit – anything over 25 usually leads to some panting). Her respiration was clocking in at 84 breaths per minute. But her total water intake for the day was only 650mls. All in all she seemed to handle the ordeal well.
At 3pm the next day the specialist rang with a summary. But we Cushings Net people are not summary people
– so I asked him if I could get the full results emailed to me – and they were – see below my ramblings. Also at the end of the results are the accompanying “General Interpretive Guidelines” which may be helpful to members and visitors.As expected the specialist has recommended Angelina’s Trilostane dosage be increased to 2 doses of 30mg per day (one every 12 hours) – an excerpt from the report:
"Angie was examined for a recheck of her hyperadrenocorticism. Her blood pressure remained mildly elevated today . Her examination was otherwise unchanged, which is not surprising at present.”
I put it to him that my research (aka Leslie) seemed to indicate that the full effect of a particular dosage of Trilostane didn’t become apparent until at least 30 days after beginning that dose. He didn’t seem concerned – due to the lower dose we started with.
Now I’m feeling about the same way about the 60mg dose as I did about the 30mg – before the first day. Oh the troubled sleep I had last night!
John – what dose is 13lb Roxee on?
Today, I swung by the specialist centre to do some more brain picking (I think I do better in person than on the phone). Turns out it was the specialist’s day off – but I spoke to another one of the doctors who saw Angelina on her first consult (there were three in all). He was similarly unconcerned about the increase in dosage. When I questioned if I should have Prednisone on hand he assured me that by the time I was aware that Angelina was experiencing side effects and gave her the antidote (as I think of it) the Trilostane would already be wearing off.
Since Angelina was due to get her monthly heartworm pill today – I held off starting her second daily dose of Trilostane. I know everyone says you can give them both – and I’ll have to do just that, this time next month – but I’d just as soon keep things as simple as possible on her first 60mg day.
Now, can someone tell me about milk thistle dosage for dogs? And omega 3 (fish oil) capsules?
John II
14-04-2009 The Urine Test
URINE COLLECTION METHOD Voided
URINE VOLUME (ml) 50.0
URINE COLOUR Yellow
URINE TRANSPARENCY Opaque
URINE SG 1.019
URINE GLUCOSE Negative
URINE BILIRUBIN Negative
URINE KETONES Negative
URINE HAEMOGLOBIN Negative
URINE pH 6.5
URINE PROTEIN ++ (1 g/L)
URINE UROBILINOGEN Normal (less than 20umol/L)
URINE RBC/HPF Less than 5
URINE WBC/HPF Less than 5
URINE CASTS, NUMBER Negative
URINE BACTERIA Negative
URINE FAT Occasional
URINE EPITHELIAL CELLS, TYPE Squamous
URINE EPITHELIAL CELLS, NUMBER Occasional
URINE EPITHELIAL CELLS, NUMBER Negative
URINE SPERM Negative
URINE CRYSTALS, TYPE Amorphous crystals
URINE CRYSTALS, NUMBER Occasional
URINE CRYSTALS, NUMBER Negative
URINE DEBRIS Negative
Minimally concentrated urine may reflect ongoing hyperA. Mild
proteinuria is unexplained: consider a UPC to further assess.
No evidence of UTI.
14-04-2009 Biochemistry with Electrolytes- Canine
Na 145 mmol/l (139-153) (Sodium)
K 5.9 mmol/l (3.9-5.9) (Potassium)
Cl 107 mmol/l (93-122) (Chloride)
Calcium 2.82 mmol/l (1.9-2.9)
Phosphorus 1.53 mmol/l (0.8-2.1)
Bicarb 20.9 mmol/l (12-26)
Anion Gap 23 mmol/l (14-32)
Urea 13.2 mmol/l (2.5-10.0)
Creatinine 81 umol/l (50-150)
Glucose 5.2 mmol/l (3.3-6.8)
Bilirubin 7.0 umol/l (0-6)
AST 128 U/l (18-80)
ALT 590 U/l (16-90)
AlkPhos 3205 U/l (1-150)
T Protein 77 g/l (52-80)
Albumin 39 g/L (23-40)
Globulin 38 g/l (25-45)
CreatKinase 235 U/l (73-510)
Amylase 727 U/l (333-1500)
Lipase 1495 U/l (77-750)
Cholesterol 10.50 mmol/l (3.5-9.0)
14-04-2009 ACTH Stimulation Test
Cortisol, resting 157 nmol/L (15-170)
Cortsiol, 1 hour 382 nmol/L
General Interpretive Guidelines
Normal dog:
* post-ACTH cortisol 170-470 nmol/L
Hyperadrenocorticism (hyperA):
* post-ACTH cortisol > 600 nmol/L consistent with hyperA
* post-ACTH cortisol 470-600 nmol/L equivocal
* failure of cortisol levels to increase significantly following ACTH
administration in a dog with typical clinical and laboratory features of
hyperA does not exclude the diagnosis. For further assessment a low dose
dexamethasone suppression test may be useful
* adrenal function tests, such as the ACTH stimulation test, may yield
a false positive test result in a sick or stressed dog with non-adrenal
disease
* this test does not differentiate between pituitary and adrenal-
dependent hyperA (an endogenous ACTH assay, abdominal imaging or a high
dose dexamethasone test may be useful for further assessment) For the
endogenous ACTH test, please contact the laboratory for the special
sample collection protocol.
Post-medical therapy for hyperA, results should be interpreted in light
of adequacy of clinical control. Target values depend on the drug used:
Mitotane or ketoconazole:
* baseline cortisol < 100 nmol/L post-ACTH cortisol 28-100 nmol/L
Trilostane:
* baseline cortisol 28-55 nmol/L post-ACTH cortisol 28-55 nmol/L
Iatrogenic hyperA:
* baseline cortisol < 55 nmol/L post-ACTH cortisol < 55 nmol/L
Hypoadrenocorticism:
* baseline cortisol < 55 nmol/L post-ACTH cortisol < 55 nmol/L
* this test will not distinguish between primary (adrenal) and
secondary (pituitary) hypoadrenocorticism
They also recommend that when you go from once daily to twice daily dosing, you drop the mg a bit. For instance, if you are giving a dog 30mg once daily, you would drop the mg to say something like 20mg twice daily. This makes perfect sense to me as there is an overlap between the two doses. 
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