Shadow 9 yr. old Shepard/Chow

[Shadow's Mom]

Hi Everyone,

Let me start by saying I'm glad I found you all. This forum has been a great help to me and I was beginning to think I was going to have to go it alone. Thanks Nat for making room!!

I got Shadow's 1 month ACTH results back Wed. Her pre-draw was 1.2 and post 1.4. Does anyone think that is getting a little low?? She was on Veteroyl 120 mg once a day and the last 4 days before the test she began taking Trilostane but only 118mg once a day. We ordered from Diamondback drugs because the price was much better but for some reason we could only get either 59mg or 61mg capsules. Our vet decided to go with the lower dosage and said that she is not going to change anything right now to just keep an eye on her to make sure it doesn't get to low.

Anyway Shadow seems to be doing better than she was one month ago. She's getting little tufts of hair growing and water consumption is down but she still eats alot. Not sure if this is just a habit now or she's really hungry. If anyone has any thoughts please let me know.

Thanks,
Karen

[labblab]

Re: Shadow 9 yr. old Shepard/Chow

Hi Karen!!

We're so glad to have you and Shadow back with us. I'm also really glad to hear that Shadow is showing improvements since beginning treatment.

However, I'm afraid I do worry that Shadow is at risk of going too low if you keep her on her current dose. According to the treatment and monitoring guidelines of Dechra (manufacturer of Vetoryl), their trilostane treatment goal is an ACTH "post" result greater than 1.45. Per their published flowchart, even if a dog appears clinically well, a result lower than that ought to result in a brief break from the trilostane and resumption at a lower dose.

Here is a copy of Dechra's treatment flowchart: http://www.dechra-us.com/File/vetory..._Flowchart.pdf

After taking a look at it, I'd encourage you to print it out and discuss Shadow's results further with your vet. The awkward part is that, if you only have 58 mg. capsules on hand, there is not an easy way to "tweak" her current dose a little bit lower. You may want to bite the bullet and order some capsules in a lower dosage strength so that you will always have them on hand in order to make gradual dosing changes as needed.

Oh, and the reason why Diamondback is not supplying 60 mg. capsules (or 30 mg. capsules) is because those are the Vetoryl dosage strengths that have received FDA approval. Due to marketing legalities, compounding pharmacies are not selling a product that directly competes with the FDA-approved brand. Therefore, once the FDA approves 10 mg. and 120 mg. capsules later this years, compounders will no longer offer those dosage strengths, either.

Marianne

[BestBuddy]

Re: Shadow 9 yr. old Shepard/Chow

Hi Karen,
I am so glad Shadow is doing well but like Marianne I am a little concerned that those ACTH numbers are getting too low. If you continue with the same dose be watchful and stop the trilo if you have any little sign that shadow is not well.
Jenny

[Squirt's Mom]

Re: Shadow 9 yr. old Shepard/Chow

Hi Karen,

Glad to hear that Shadow is showing some improvements and hope you see many more! Let us know how things are going when you can.

Hugs,
Leslie and the girls

[Shadow's Mom]

Re: Shadow 9 yr. old Shepard/Chow

Hi All,
Thanks everyone for the advice. I too thought it was getting a little low but for some reason our vet wants her to stay with that dose and have her tested in another 2 weeks. I think she feels that since the dosage is 118mg instead of 120mg a day that her numbers will be up some when we go back next time. We have been taking Shadow there ever since she was a pup but I've been thinking maybe it's time to start looking for another vet. Someone more experienced with Cushings.
Shadow seems to be a little tired (nothing to out of the ordinary) but her appetite is good and her bowel movements are solid and she hasn't been nauseated but I'm a little worried that if these symptoms start it will be to late so we are watching her very closely.
We're all going camping Saturday for a couple of days and will be out of the state and that is making us a little nervous. We bought a motor home when Shadow was just a pup because we couldn't NOT have her with us always! This pup loves to go camping, especially all the walks we go on. We're going to start out slow because I know she hasn't gotten all of her strength back but I'm sure some exercise will do her good.Maybe build some of the muscle back up.
Is there anything else I should be looking for besides the symptoms mentioned above? Also I have noticed that there seems to be some darkening on her stomach, it almost looks like some kind of bruising. Could this be from the medication? I'll wait to hear from you all. Any suggestions or opinions are all greatly appreciated. God knows I can use all the help I can get!
Thanks Again!
Karen

[Roxee'sDad]

Re: Shadow 9 yr. old Shepard/Chow

Hi Karen,

You have a lot of good advice from the others. I would look on line for an emergency vet somewhere close to where you will be camping just in case.

We're all going camping Saturday for a couple of days and will be out of the state and that is making us a little nervous. We bought a motor home when Shadow was just a pup because we couldn't NOT have her with us always!

Now this made me laugh, now I know my wife and I aern't the only ones that are nuts and purchased a motorhome for our pups. We never had the heart to leave them in a kennel. They just love it and the 2 little ones sit on the dashboard and look out at the world at least until the windshield wipers come on then they scramble for cover.

Have fun and enjoy your time with Shadow on your camping trip, hope all goes well.
John (Roxee's Dad)

[Lulusmom]

Re: Shadow 9 yr. old Shepard/Chow

Hi Karen,

I'm a Lysodren mom now but both of my cushdogs treated with Trilostane previously. I personally don't think 2mg per day is going to make a marked difference one way or the other. Unlike Lysodren which has a cummulative effect for up to 48 hours, Trilostane has a short half life, meaning that it's enzyme blocking abilities start to diminish any time after 8 hours. This is a good thing because if Shadow starts to show signs that her cortisol is too low, she should bounce back rather quickly after withholding the dose. This is why most cushing's savvy vets don't feel it necessary to prescribe Prednisone. Of course, that doesn't mean that you can't overdose a dog so you should stay ever vigilant.

Stop the Trilostane if Shadow loses her appetite, vomits, has diarrhea, starts trembling or is acting extremely lethargic. When either one of my pups acted the least bit sick, I withheld the Trilostane for a few days or until they were back to normal...whatever that is in this house.

Pigment change is common in cushdogs and those with hypothyroidism. You are not the first member to mention darker pigmentation on your dog's stomach. I think the pigmentation is probably occurring elsewhere on the body but because the stomach is void of hair/fur, that's usually the first place people notice it.

You and John are very lucky to be able to hit the road in your RV with your furbabies. I've always fallen in love with defective units so I've made it possible for my vets to buy RV's but alas, it's a little cramped in the Yugo for me and my five furkids.

Glynda

[Roxee'sDad]

Re: Shadow 9 yr. old Shepard/Chow

Hi Karen,

Just checking to see how Shadow is doing, hope he had a nice camping trip.

John (Roxee's Dad)

[Shadow's Mom]

Re: Shadow 9 yr. old Shepard/Chow

Hi All,
I know it's been a while. We've been emptying out a college dorm room so that we can bring home our baby WITHOUT fur and with her all the drama that follows.
The camping trip went surprisingly well, thanks for asking John. Although our walks were much shorter than before this disease got her , Shadow enjoyed heself very much. She would have walked her legs off if we let her but as you all know her energy gets zapped pretty fast these days.
We just passed the 2 month mark for Trilostane and she is so much better than she was. This last month we haven't seen much more improvement but we are greatful for what we have gotten so far.
Shadow is still on 118mg once a day, her drinking is back to normal, panting is gone, appetite is still very healthy and her hair is making slow progress. She seems to be better in the morning before taking her medication. We dose her at noon and shortly after she seems to be grow more tired as the day wears on and by 9pm she is exhausted. I know this seems backwards and she should be perking up by 9pm since the Trilostane should be wearing off. We were considering dosing her twice a day to see if that helps. Maybe a steady 59mg dose would be better.
Shadow turns 10 years old next month and we have been so blessed to have had her this long but the truth is she is getting older and she will never be that pup we had before she got sick. We are greatful for every day we are given with her and pray that she keeps improving. ACTH test scheduled in 3 weeks. Hope the numbers are good!
Sorry I've been so long winded today, I'm pretty sure that I shouldn't have watched that movie Marley & Me last night, it really broke my heart. I think I cried for about an hour afterwards just holding onto my pup. Well I guess I'll close for now.
Hope eveyone had a great weekend!
Karen

[LuvMyMunchie]

Re: Shadow 9 yr. old Shepard/Chow

Hi Karen,

Glad to hear that Shadow has successfully passed the two month mark on her Trilostane treatment. With her drinking back to normal, panting gone and the progress with her hair, well those are some pretty positive results. Congratulations!

Will be interested in knowing the outcome of her ACTH testing in three weeks. Hope you had a great weekend too!

Louise