Mypuppy:Princess (10 yr. old Lab on Trilostane) - has crossed the rainbow bridge [Archive] - Page 2 - Canine Cushing's Information and Support Forums

mypuppy

11-18-2009, 05:30 PM

Hi Marianne,
Good to hear this is actually the meds taking over and doing it's job. Princess was drinking close to 6 liters per day of water prior to treatment. Yesterday she was down to 3.5 liters. Now that's a big drop if you ask me? And today, I think she will break yesterday's record and have decreased her water intake to 3 liters by the end of the night. This is amazing to witness in merely 3 days. I am just loving it, at least for her sake. In addition, and again, do not know if perhaps it's coincidence or the meds as well, but this afternoon she was wagging her tail (something we have not witnessed in quite some time) and she actually went to her toy basket and brought me her tennis ball to play....How awesome and precious is that! I can't express how happy this has made me today. I know she's not totally out of the woodwork, but it's a better place than we were a month + ago....Hope all is well, and I will continue to report any progress. Luv ya, Jeanette

mypuppy

11-18-2009, 05:34 PM

Terri, I know exactly what you mean. The excessive appetite on Princess at times is very frustrating, specially when she's stealing biscuits from my little one's plate, but I am glad to say she has not pulled that again since the last incident, but she is constantly looking for food, so I am hoping that will taper off soon. For now, I am just enjoying the moment and taking each day at a time with her. I am just happy for any progress, however small, compared to 1 month ago. It's all good for now. Thanks for your post. I always look forward to hearing from you and the others. Hope the Corkster is doing well himself these days. Lots of licks to him and hugs to you...xo Jeanette

gpgscott

11-18-2009, 06:04 PM

Jeanette,

We have never administered Trilo, but I do know that it works quickly.

I am so happy that you are seeing results and that Princess is doing well.

Looking forward to continued improvment for Princess.

Scott

haf549

11-18-2009, 08:17 PM

Jeannette:

I am so happy to hear that the treatment is kicking in so fast. I noticed a change in Kira pretty quickly too. She was drinking almost 5 litres a day and within a week was down to about 1.5 litres. She also stopped wanting out every couple of hours. Trilostane really does work very quickly. The trickiest part is getting the dosage right and it seem that since she isn't having any side effects, the must be right.

It is great to see them playing and showing interest again, isn't it. I'll keep my fingers crossed for both of you, that things continue to go as smoothly. This is really great news.

Congrats.... Heidi & Kira

Casey's Mom

11-18-2009, 09:40 PM

Wonderful news Jeanette! It is so great to see our dogs come back isn't it . . . .

Now the others will chime in and you are using Trilostane which is different with the Lysodren I have Casey on but when Casey's water intake dropped that much I had to stop treatment.

The others will advise you that have more experience but in the end I just want to say well done!

StarDeb55

11-18-2009, 09:49 PM

Just to clarify, with lysodren during the loading phase you are looking for any change in behavior or symptoms that indicate that a pup is loaded. The 2 most common things to watch for are a significant decrease in water consumption or any change in eating habits. With trilostane, you are simply looking for symptoms to ease as a sign that the trilostane is doing its job. The 2 drugs work by totally different methods. With lysodren, the goal is to erode enough of the adrenal tissue to bring the cortisol down to a more healthy level. Trilostane blocks one of the enzymes in the biochemical pathway in the adrenal glands that leads to the production of cortisol. Trilo does no damage to adrenal tissue when given in the correct dose & monitored properly. You stop the trilo for any significant period of time, the adrenals will go right back to overproducing cortisol because that enzyme is no longer blocked by the medication.

Debbie

Casey's Mom

11-18-2009, 09:53 PM

Thanks for clarifying that point Debbie.

MiniSchnauzerMom

11-18-2009, 10:21 PM

Jeanette,

I'm so happy for you and Princess that she is responding so well to the Trilostane. Love those success stories. :D Congratulations!!!

Louise

Franklin'sMum

11-19-2009, 09:54 AM

Hi Jeanette,

Glad Princess is doing so well. You're doing a great job!:):)

Jane and Franklin xx
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littleone1

11-19-2009, 12:43 PM

Hi Jeanette,

Thank you for thinking about Corky. The Corkster is really doing good. In addition to his long morning walks, he is now going for a walk around the block after he eats his dinner. He gets so excited when it's time for his walks. It's so good to see him like this.

I was also glad to hear that Princess is wagging her tail again and that she went to get her ball to play. These "baby steps" mean so much to us.

Corky sends lots of kisses for you and Princess. Extra big hugs from me.

Squirt's Mom

11-19-2009, 12:49 PM

Hi Jeanette,

YIPEE!!! :D:D:D:D

I am so happy for you and for Princess! :D Way to go, Mom!! :cool::cool:

Hugs,
Leslie and the girls

mypuppy

11-19-2009, 02:07 PM

Hi there Leslie, Yippeeeeeee indeed....I feel pretty good right now as I finally start to see signs of my happy pup. I need to ask though, will I eventually see complete progress of all symptoms and have my normal dog again? I know I am enjoying seeing "baby steps" good results as Terri puts it in one of her posts, but I can't help but wanting the whole enchilada. I want it all. I think we all do, but I certainly don't want to set myself up with such high expectations and learn later on other things will arise because of the Cushings? In fact, while I was doing my initial research online when she was first diagnosed I never read anywhere what other problems I should be watching for with a dog suffering with Cushings? I guess my question is, even though she will be on ongoing treatment, will I experience set backs with other health issues. There are always questions and doubts and concerns, etc. I guess for now, one day at a time and I will just try to enjoy each good moment with her... Thanks for the pep post, and luv ya....Best regards, Jeanette

mypuppy

11-19-2009, 02:14 PM

Hi Terri,
That's nice the Corkster is going for walks twice a day. Wow, that is just beautiful! I know what you mean, it's the best feeling to see them all chipper and wanting to engage in what always made them happy. I tell you when Princess brought me that ball to play I almost fell to the ground in awe. And the tail wagging just made my 13 year old's day as well. She's been having a bit of hard time with the "new" Princess. Remember, this is her doggie for 7 years now, and well she was the happiest I've seen her also when Princess let her pet her and wagged her tail for her....I was starting to get worried about her too because 13 is a tough age as it is, and so, at least having her companion reciprocate all the love, makes it all better in her world. Listen, I will keep in touch and keep reporting those "baby steps". Luv ya, and big smooch for Corky. xo Jeanette

mypuppy

11-19-2009, 02:16 PM

Jane, so sweet of you. Thank you, thank you, thank you...I love ya...Jeanette

mypuppy

11-19-2009, 02:18 PM

Hey Louise,
I agree, we love "success stories" around here, and I am happy to report those whenever possible. Thanx for your warm thoughts as always....xo Jeanette

mypuppy

11-19-2009, 02:21 PM

Hi Scott, It's pretty amazing indeed, and as always, thank you for your thoughtful posts....xo Jeanette
ps: how's your chocolate buddy? lol

mypuppy

11-19-2009, 02:27 PM

Heidi, so nice to hear from you. Again, we're only on day 4, and I'm new to this, but I am certainly hoping that her 14 day stim will tell us more as to where we are, and I guess hoping that dose is on target. I wouldn't even mind if they told me it needs to be decreased, but one day at a time here...I am just sooooooo happy that she has not expressed any side effects. Right now I'm thinking this is a "wonder drug". lol.....I hope we stay the path we're on. Again, great to hear from you. How's Kira...She's so beautiful...Always loved the Husky eyes.....they are fascinating.....xo Jeanette and Licks to Kira

StarDeb55

11-19-2009, 02:28 PM

Jeanette, there is absolutely no reason to think that Princess will not return to her "normal" self. My 1st Cushpup, Barkley, was successfully treated with lysodren for almost 8 years, crossing the bridge at 15 from a medical issue not related to his Cushing's at all. Barkley had a wonderful quality of life & had only one instance during those many years where both the vet & I felt he may have suffered an instance of low cortisol, even though testing could never prove it. He rapidly recovered from whatever was.

Debbie

haf549

11-19-2009, 02:32 PM

Jeannette:

You were asking about other possible problems. In the beginning, watch out for the runs, total lack of appetite (not a reduced appetite), lethargy. These are all possible signs of an overdose. It doesn't sound like Princess has the lethargy though, what with the ball playing, etc. Another possible side effect might be signs of arthritis. Princess isn't that old yet, so that may not be an issue for her, unless she had symptoms of arthritis before. Because the trilostane lowers the cortisol, the arthritis symptoms tend to manifest, because the cortisol was controlling these symtoms. If she isn't showing any signs of arthritis, now might be a good time to start her on glucosimine, with chondroiten. You can get this at any pharmacy, in the vitamins aisle. Kira has been on this since she turned 8 (at the doctor's recommendation) and she really wasn't showing any symptoms at that time. It was more a preventative measure. Currently, Kira is on 900mg (450mg glucosomine/450 chondrioten). They come combined in 1 pill. Best to get the capsules, because you can open them and sprinkle the powder into her food.
The most important thing right now is to stabalize Princess on her dosage (what is she getting, btw?). Then wait and see what the stim test says about her results.

I just want to share a piece of advice that my vet gave me when we finally got Kira stablized. Her stim tests show her a bit on the high side of the good results. But the vet told me, 'Trilostane treats the symptoms, not the numbers. The bottom line is that if her symptoms abate and her numbers aren't quite in line with what is recommended, don't rush to increase her dosage. The most important thing is that you are happy with the way she is responding.

Heidi

mypuppy

11-19-2009, 02:33 PM

Hey Ellen, Thank you much. Yes, it's a wonderful, excilirating feeling to see signs of the "old" pup again....I am just thrilled for her. And by the way, I could not have done this without any of you. What a blessing to have found everyone here. Take care and licks to Casey. xo Jeanette ps: I do know that Lyso works differently than the Trilo. It would have been ideal if the Trilo was a maintenance drug as well, but for now, I'll take what I can get if it means "positive" results. Thanks again...

mypuppy

11-19-2009, 02:37 PM

Hi Debbie,
That's great to know and reassuring to say the least. Not to sound negative, but since I am fairly new to this, I always wonder if there will be set-backs. I appreciate your input. Thanks. Best regards. Jeanette

StarDeb55

11-19-2009, 02:40 PM

Heidi said:

I just want to share a piece of advice that my vet gave me when we finally got Kira stablized. Her stim tests show her a bit on the high side of the good results. But the vet told me, 'Trilostane treats the symptoms, not the numbers. The bottom line is that if her symptoms abate and her numbers aren't quite in line with what is recommended, don't rush to increase her dosage. The most important thing is that you are happy with the way she is responding.

I am 100% in agreement with what Heidi has told you. This is exactly how we treat Harley. Since his diagnosis over 18 months ago, I think there is only one time his stims have been within the 1-5 range. His last stim at the end of Oct. was 8.4. He has been doing fine as long as his numbers run between about 7-9. Once he starts creeping over 9, then his symptoms start returning. This is the old adage that in certain cases you have to "treat the pup, not the numbers".

Debbie

mypuppy

11-19-2009, 02:49 PM

ps: Debbie, thank you also for clearing that up. I was once under the impression Princess would eventually be off the trilo once the symptoms would subside, but I learned otherwise now and realize she will be on trilo on-going....Thanks again though....xo Jeanette

mypuppy

11-19-2009, 02:55 PM

So Deb and Heidi, Are you trying to say that even if the stim test comes back a bit high with the cortisol levels but Princesses symptoms are under control, I should not adjust the meds? What if my specialist recommends adjustment based on the stim? Thanks. Jeanette

haf549

11-19-2009, 03:03 PM

Jeannette:

If the symptoms are under control, I would dig my heals in about increasing the dosage. Trilostane will not CURE Cushings, it just controls the symptoms. So if you are happy and Princess is happy, don't mess with perfection. Though you should always be on the look-out for future flare-ups of the symptoms.

Heidi

mypuppy

11-19-2009, 03:06 PM

Heidi,
Perhaps I came across in my last post. What I meant to say is that I'm not sure if there can be any other complications associated with Cushings even if the pup is on trilo. I am not referring to the side effects while on trilo. I have those down pact, trust me. lol....Again, I meant, can any other health problems arise from Cushings itself. Deb says her pup was fine while on treatment and only experienced one problem unrelated to Cushings. Now as for arthritis issues, luckily Princess has never expressed any signs of it. I have heard about the glucosimine and chrondroitin supplements though...In fact, and I do not know the exact measure, but her dry food does have the gluco/chrondroitin in it already, but not sure if it's equivalent to the recommended 900mg. I will most certainly look into it because I'm sure at some point Princess will begin expressing signs of arthritis as well. And I appreciate the tip on getting the capsules so I can just sprinkle it over her food, because right now with the trilo, my smart dog just picked the pills right out of her food bowl and spit them out on the floor, so I have had to hide the pills in one slice of ham---haaa...what a treat for her! I read I shouldn't do this with the trilo though. Oh well, it's ham every single morning for breakfast I guess. lol.... Oh and I'm sorry, I got a little off track here. Princess is on 2 (60mg) pills once a day right now...Her stim is scheduled for the 30th, and I will keep your great advice on hand for that day if Dr. suggest to increase should her levels be a bit off. Thanks again.....Best regards, Jeanette

StarDeb55

11-19-2009, 03:11 PM

Jeanette, I'm not a Trilo parent, so I can't really address dosage changes. The one thing I can tell you is that members have reported that cortisol continues drop within the first month after starting Trilo, so if that first stim is close to being in range, around 6-7, I think?, an increase in dose may not be warranted.

Debbie

PS- I wanted to add that you can never really stop lysodren for any length of time, either. The adrenal cortex tissue where lysodren acts can regenerate fairly easily. Some dogs can regenerate this tissue very quickly, others may take a little time. Bottom line, whatever drug you are using treat a pup's Cushing's, it is lifelong.

haf549

11-19-2009, 03:50 PM

Jeannette:

Where you are, are you able to get that cheese that comes in little cubes. Here it's called 'Party Cubes'. It's a cream cheese cube. The cubes are just big enough to hide a capsule in. If I'm a little slow giving her 'treat', she whines at me now.

Heidi

lulusmom

11-19-2009, 04:18 PM

Hi Jeanette,

I just wanted to validate what Debbie has told you. My dogs have treated with both Trilostane and Lysodren and I can tell you from experience that both of my dogs' cortisol continued to drop in the first 30 days after starting treatment with Trilo. We've had other members report the same type of results and some even report cortisol dropping past the 30 days mark.

If it were me and the first post stim number came back anywhere between 6 and 10, I wouldn't feel comfortable with adjusting the meds until the 30 day stim test. It is always better to go low and adjust upward if necessary. Your choice to dig your heels in if your vet is recommending an increase may cost you a bit in the way of an extra stim test but it's a lot better than Princess getting ill is cortisol were to drop too low.

Not all knowledgable vets subscribe to the "treat the symptoms, not the numbers" protocol. A lot of cushing's savvy vets are going to try to keep the post circulating cortisol level within the range of 1 to 5 so as to allevate symptoms as well as mitigate the impact of excess cortisol on internal organs and the immune system. I wholeheartedly agree with the others that if my dog(s) acted not themselves with their cortisol within range, I'd have no qualms about letting it run a little high, as long as they remained asymptomatic. However, as long as my dogs do well with cortisol within range, I will strive to keep it there. They are both treating with Lysodren now and their last two stims have been perfect. Jojo's bloodwork just came back perfect with zero abnormalities. Lulu had a few mild elevations in some values but none of the ones we normally see in cushing's. Neither Jojo or Lulu are on any type of liver support and both have perfectly normal liver enzymes. Can I prove that these great results are because we've kept their cortisol under total control? No, but I believe it's made a big difference.

I'm a huge Dr. Edward Feldman follower and I quote him more often than most reknown experts because I put a lot of stock in what he has to say. Whether discussing Trilostane or Lysodren, he tells his students that a dog's symptoms may resolve but unless you get the post cortisol with the acceptable range, the dog will never be "normal".

You are doing a great job and we'll all look forward to seeing the results of the acth stim test on the 30th.

Glynda

jrepac

11-19-2009, 05:03 PM

labblab

11-19-2009, 05:59 PM

Hi Jeanette,

If your vet is following the treatment and monitoring guidelines published by Dechra (the manufacturers of Vetoryl), then I doubt that she will be changing the dose for Princess prior to the 30-day mark, as long as the first ACTH results are greater than 1.45 ug/dl, and Princess maintains this degree of improvement in her symptoms. I will give you the link to Dechra's monitoring flowchart below. But when the initial dosing has been based on Dechra's recommendations (which is the case for Princess at 120 mg. once a day), then their biggest concern during those first 30 days seems to be making sure that the ACTH results are not too LOW, and that the dog is not suffering from unwanted side effects. It is only in the event that a dog is still suffering from marked symptoms that they recommend increasing the dose prior to the 30-day mark:

* If the post-ACTH cortisol is >9.1 μg/dL (>250 nmol/L) and the clinical signs of HAC are marked then you should consider a dose increase at this stage. Increase dose by smallest increment possible.

Otherwise, they recommend leaving the dose unchanged during the first 30 days, regardless of the ACTH results (unless, of course, the result is too low).

After the 30-day mark, more significant "tweaking" may begin, based both on the ACTH results and the dog's symptoms. But if a dog's ACTH result is <9.1 ug/dl and symptoms are being consistently controlled throughout a 24-hour period, there is no need to make a dosage change according to Dechra. Here is that link:

http://www.dechra-us.com/File/vetoryl_Treatment_and_Monitoring_Flowchart.pdf

Marianne

lulusmom

11-19-2009, 06:13 PM

I'm a bit puzzled by the commentary as it was my understanding that trilostane actually does "treat the numbers"...in other words, it is highly effective at lowering cortisol levels, since it blocks one of the key enzymes needed. I'm sure others will weigh in....ANIPRYL is the treatment that is often referred to as "treating the symptoms"..

Re: levels, I have heard that some vets are OK w/the cortisol levels running a little high, only because it alleviates things like arthritis and some feel that the risk of going too low is equally bad. Really, that is up to you and your vet to decide.

Jeff, you are absolutely correct on all fronts. If you are referencing my commentary, I was responding to statements from others, who for valid reasons, are treating their dogs symptoms rather than the numbers whether they are treating with Lysodren or Trilostane. My point was that is not a protocol that everyone subscribes to; however, there are extenuating circumstances such as the arthritis you mentioned and a general malais that some dogs experience with lower cortisol. I think Alison has mentioned a number of times that it is her experience that more senior dogs don't always do well with post circulating cortisol levels less than 5. My point was that in the absence of extenuating circumstances and if a dog does well with cortisol within the desired range, that's what you should strive for.

I did forget to mention that the quotes by Dr. Feldman are not in keeping with Dechra's acceptable range of up to 9 ug/dl if a dog is not symptomatic. Of course Dr. Feldman has the power to set protocol at UC Davis and UC Davis does not follow Dechra's dosing protocol either.

Glynda

Franklin'sMum

11-20-2009, 10:35 AM

Hi Jeanette,

my smart dog just picked the pills right out of her food bowl and spit them out on the floor, so I have had to hide the pills in one slice of ham---haaa...what a treat for her! I read I shouldn't do this with the trilo though. Oh well, it's ham every single morning for breakfast I guess.

I give Franklin his meds in a little bit of ham, too. Why shouldn't ham be given with trilo? Is it the risk of pancreatitis? Or is ham just "bad"?
I buy the 97% fat free ham and he gets 2" x 1.5" ish piece wrapped around the tablet. Do you think that's going to cause some kind of damage?

We hope Princess continues to improve.

With Love,
Jane and Franklin xx
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mypuppy

11-20-2009, 11:16 AM

Help me out here Glynda, anyone! I'm a bit confused again after reading the last few mixed opinions on trilo...What should I be looking for at the 14 day stim? Lower cortisol levels or symptoms improvement? And if my specialist is treating the numbers, what is the normal range she should be looking at to not adjust the dose, and what is the range which indicates adjusting? Sorry, but I need to know this for Princesses stim test on the 30th. Thanks all. Best regards. Jeanette

mypuppy

11-20-2009, 11:23 AM

Jane, I must apologize for that post. I think my fingers are typing faster than my brain sometimes. I just re-read it, and I made a huge OOPS on that post....What I meant to say is that I read I should not open the trilo capsules and flake them over Princesses food. I guess I skipped that part altogether, again, these crazy fingers. So, no I didn't mean that about the ham..lol...I have never heard anything on ham being bad for them. I just give Princess one slice a day now with the pills rolled into it, It's the only way she will take the pills, and Heidi had a great idea about putting them in the cubed cheese squares, so I'll try that next also, but for now the ham works great or I can even roll the pills in a slice of cheese as well. So sorry I startled and confused you here. Forgive me? Luv ya....Jeanette

StarDeb55

11-20-2009, 11:37 AM

Jeanette, here's a couple of other options for hiding pills. Harley gets his lysodren in a dollop of peanut butter. It's sticky & the pill can't be spit out. For the rest of the pills that both dogs take, I use Pill Pockets which come in 2 sizes, 2 flavors. Both boys really like them & seem to consider them to be a "treat". You should be able to find them at PetsMart, Petco, & the like. I have ordered them from Amazon, too.

Debbie

haf549

11-20-2009, 11:48 AM

Jeannette:

The aim here is to get Princess' numbers within the accepted guidelines and to have her Cushings symptoms disappear. Most of the time, that is exactly what happens. I merely mentioned that if her numbers are a LITTLE elevated, don't rush to increase the dosage if her symptoms have abated. I am NOT advocating 'treating the symptoms' as a rule of thumb. It is just another consideration. I merely mentioned this because when I first started treating Kira, she was started on 120mg a day, which in her case was too much. the dosage followed the guidelines, but she had the runs, almost stopped eating and was very lethargic. Her numbers were perfect on the first stim test. However, once we settled on the 40mg twice a day, her symptoms were still under control; her energy level went up; her diahrrea went away and her energy level shot up. Her numbers are on the high side of normal; last stim, at 5.9. It's just that in hind-sight (which is always 20/20) I wish I had started her on the lower dosage originally and avoided all the unnecessary worry associated with the higher dosage. Sorry for the confusion.

Heidi

labblab

11-20-2009, 11:50 AM

Hi Jeanette,

I'm sure Glynda will also be by later to offer you her feedback to your question. But here are a few thoughts of mine. I think that a big reason why you are feeling confused is because we are, in fact, giving you different guidelines :o. Trilostane is still a relatively new treatment here in the U.S. (and has been in use for a bit less than 10 years in the U.K.). So there is still a lot of ongoing research -- and disagreement among the professionals -- as to the optimal dosing and monitoring protocol. Dechra themselves are continually revising their recommendations through time -- their dosing protocol now is different from when I treated my boy five years ago.

Through the years, I have tended to more commonly quote Dechra's general recommendations here, largely because their protocol is the one which is followed most widely worldwide. However, I think I'm "OK" in representing that Glynda places a great deal of confidence in the recommendations of Dr. Feldman and the UC Davis vet school. Other folks here (as well as their vets) have differing preferences, as well. The confusion arises because there are some differences between these two protocols (and other specialists may even have their own specific "druthers" based on their own treatment experience). That is why you are getting conflicting information when it comes to the specifics.

With all the protocols, though, the goal is two-fold: both to decrease the amounts of circulating cortisol, and also to relieve symptoms. Everybody agrees that treatment is not successful unless major symptoms are eliminated. One of the differences in the protocols, though, is what the ultimate treatment "target" may be in terms of the numbers: Dechra says it is "OK" to stabilize cortisol at a level that is higher than that preferred by Dr. Feldman, as long as symptoms are relieved.

During these first 30 days when Princess is initially adjusting to the trilostane, neither protocol wants her to drop TOO low, however. And I believe both protocols agree that her cortisol level, even while being maintained on the same dose, may drop even further during the course of that first 30 days. So as long as she is looking and feeling well, both protocols are hesitant to recommend large dosing increases during that time period. After that first 30 days, the test results become more meaningful as far as predicting whether she needs an increase. And at that point, both protocols are aiming to keep cortisol levels consistently reduced to prevent "silent" organ damage (damage that can't be seen by outward symptoms), even though the specific numbers that are desired may vary from one protocol to another. I don't think anybody is in a position right now to say that either protocol is "right" or "wrong." But every vet will probably lean one way or the other, based on their own training and experience.

I've got more I want to say, but I've got to run for now. So I hope I haven't confused you too much already! More later...

Marianne

jrepac

11-20-2009, 12:32 PM

Jeff, you are absolutely correct on all fronts. If you are referencing my commentary, I was responding to statements from others, who for valid reasons, are treating their dogs symptoms rather than the numbers whether they are treating with Lysodren or Trilostane. My point was that is not a protocol that everyone subscribes to; however, there are extenuating circumstances such as the arthritis you mentioned and a general malais that some dogs experience with lower cortisol. I think Alison has mentioned a number of times that it is her experience that more senior dogs don't always do well with post circulating cortisol levels less than 5. My point was that in the absence of extenuating circumstances and if a dog does well with cortisol within the desired range, that's what you should strive for.

I did forget to mention that the quotes by Dr. Feldman are not in keeping with Dechra's acceptable range of up to 9 ug/dl if a dog is not symptomatic. Of course Dr. Feldman has the power to set protocol at UC Davis and UC Davis does not follow Dechra's dosing protocol either.

Glynda

Gotcha! Thanks Glynda. I think that at the end of the day, the pet owner has to decide what is working not working, in conjunction w/the lab results, overall state of the pet, etc. Getting the cortisol "perfect" may be tricky and what may be lab perfect may not be pet perfect in some cases.

Jeff

mypuppy

11-20-2009, 02:35 PM

Debbie, how cool is that! I didn't even think of the gooey, well liked by pups peanut butter....lol....that's a great idea...and the other products also. I will look online tonight....Thanks so much....xo Jeanette ps: she will still get her slice of ham/day...haaaaaaa..

Harley PoMMom

11-20-2009, 02:42 PM

Hi Jeanette,

I give Harley's pills in cream cheese.

lulusmom

11-20-2009, 03:05 PM

Hi Jeannette,

I am so sorry if my post confused you. I don't believe there are any conflicting opinions as to our concerns with making an upward adjustment in dose based on the first acth stim test. I was trying to point out that it is very likely that Trilostane will continue to decrease cortisol well into 30 days so unless the current dose is having little impact on cortisol levels, it is best to wait until the 30 day stim to make an assessment on the need for an adjustment. For instance, if Princess' post stim number came in at 10 ug/dl, the odds are that that number will drop more by the end of 30 days. If a dose was increased after 14 days, there would be a very good possibility that cortisol could drop too low.

Not everybody is lucky enough to start their cushdog on a dose of Trilsotane that will be prove to be the right one and it is not uncommon to have to make multiple adjustments before the right dose does the trick. I was lucky with one of mine who remained at 15mg twice a day and the other required at least one adjustment after the 30 day stim. I'll be keeping my fingers crossed that you and Princess are lucky.

As far as what post stim number is right for any dog, I just wanted to point out that there is more than one opinion on this issue. That doesn't mean that either is wrong. We all do what is best for our dogs because we know them better than anybody in the world. We all have our own opinions and I happen to be of the opinion that trying to maintain post stim cortisol levels within the longstanding accepted range of 1 - 5 is best, unless the dog doesn't do well at those levels. I included Dr. Feldman's thoughts on the matter because yes, I admire him but more importantly, his experience at UC Davis with Trilostane is more reflective and on target with the many members' dogs I've seen here and our prior forum at cc.net.

I do hope that I've helped a bit in undoing the confusion I caused.

Glynda

mypuppy

11-20-2009, 04:47 PM

Glynda, please do not apologize, if anything, I'm still learning each and every time I read anyone's post. Remember, I am still very new to Cushings, therefore, of course, anything I still read outside from what I've learned these past 5 weeks, may still be confusing to me. I just got a little thrown off with Jeff's post when he mentioned he thought trilo does treat the numbers. I will await for Princesses stim on the 30th, and see what it comes back with. In the meantime, I am strictly watching her symptoms. As I mentioned her water intake has decreased dramatically, and there is water in her bowl, something I haven't seen in 5 weeks since she started with symptoms. She is interacting with the family a little more, bringing her ball and toys to us and wagging her tail. We are into day 5 on trilo. I know it's still very early, but as you said, maybe I'll get lucky and hope that this dose she's on will be the correct one for her and may not need to do a single thing. Just the same, I will take everything you said into consideration for the stim test on the 30th. If I notice symptoms are minimized, and she's doing well with no side effects, than I will fight my specialist against increasing her dose should the cortisol levels be off range, and wait for the 30 day stim to decide further. Please do not feel bad in the least. I appreciate everyone's opinions here, and again, this is all a learning process for all of us. I will keep you and everyone posted on EVERYTHING....Thanks again....xo Jeanette

mypuppy

11-20-2009, 04:50 PM

haaa, cream cheese, good one....how about butter? haaaa....thanks....i think she'll get a mixed menu with her trilo each morning.....lol......xo Jeanette

mypuppy

11-20-2009, 04:56 PM

Hi there Heidi, please, do not worry. I got a little thrown off with Jeff's comment, so it just raised a red flag for Princesses stim test on the 30th. I wanted to make sure I clarified what I needed to look for at the time of the test, in order to make the right decision. This stuff seems so complicated at times, and I don't want to make any mistakes along the road that will change Princesses prognosis. I understand now exactly what you and the other meant. Trust me, I will not be rushed to increase anything unless I feel it is absolutely necessary, and I will base my decision on her symptoms and her 14 day stim. Thanks for your input--I do value it...I will keep you and everyone afloat on that. Btw, how is Kira doing these days? Take care. xo Jeanette

haf549

11-20-2009, 07:52 PM

Jeannette:

Take a look at my post about Kira (Update on Kira). She had surgery yesterday to have warts removed from ALL her paws. She looked and acted like a drunk yesterday and early today, but over the course of the day she has improved 1000%. She's almost taking the steps like she did before the surgery.

Heidi

MiniSchnauzerMom

11-20-2009, 08:35 PM

Jeanette,

So........does Princess still have the tail wagging and an interest in playing with the ball going on????

I'll add a couple other food ideas to the list for giving Princess her pill. Since my Munchie was and is on a low fat diet, I used liquid egg whites and would cook a small dollup for him when I was cooking my own breakfast. Then I'd roll the pill up in the cooled egg white and voilà, Munchie had a little egg white burrito (which he definitely relished and gulped right down). Any pills he gets these days are well hidden in a nice hunk of boiled potato and it works well. Maybe Munchie has weird taste buds though. :D

Louise

AlisonandMia

11-20-2009, 08:42 PM

We always used cream cheese. There was (is) a certain brand of cream cheese available here that's perfect for molding around pills with minimum mess. I've used butter in the past for one off pills (like worming) but it is probably too high fat for you to be wanting to be using it on a regular basis.

Carefully softening normal cheese in the microwave and using that to mold around the pill/capsule can work well, too.

I'm so pleased to see that Princess is responding to her treatment so well. It's a wonderful thing to see, isn't it?:)

Alison

Franklin'sMum

11-21-2009, 02:23 AM

So sorry I startled and confused you here. Forgive me? Luv ya....Jeanette

Hi Jeanette,

There's nothing to forgive:) I just started wondering if I was doing him some harm with the ham, that's all. Our compounding chemist makes the trilo in tablet form, not capsules, so sprinkling it on anything isn't an option for us.

Thanks Jeanette, and glad Princess is doing great.

Jane and Franklin xx
________
CREAMPIE ORAL (http://www.fucktube.com/categories/468/oral/videos/1)

mypuppy

11-21-2009, 08:55 AM

Hi Louise, Yes, she is still wagging her tail these last few days, and is playing more with her toys, so it's wonderful! Today is her 7th birthday, so of course, we got her lots of doggie toys and some special treats--she deserves that and so much more. We will sing happy birthday as we have been every year, take pictures and video--both my daughters look forward to this big day, so today it's party time! lol. Now as for Munchie, that is just too funny with the egg white burrito and boiled potato. I was laughing so hard when I read that. I like the egg white idea very much though. Think I will try it also, and I don't think it's bad for them since it's the egg whites. Thanks for the great idea. I know Princess will lap it up with no problem. Take care and Best regards to you and Munchie...xo Jeanette

mypuppy

11-21-2009, 09:00 AM

Jane, it's good you caught my type-o though, and that I cleared things up. I would have done the same thing had I read that, so anytime you or anyone else have any doubts on any of my posts, please do not hesitate to bring it up. I do the same when in doubt. And I wonder why there are two different forms of trilo, capsules and tablets? Is it because it's a compounded form? I find the capsules a lot easier for Princess to ingest against the tablets, and they are not big at all, so that's a plus too. Try asking your pharmacy...Good luck. Best regards....Luv, Jeanette

mypuppy

11-21-2009, 09:03 AM

Hi Alison, Thank you so much, It is wonderful to see my precious puppy play and fetch her ball and not drink water all day long. We are still working on the other symptoms, big appetite and always trying to find a cool spot to lay on. I hope those will subside as the meds continue to do their job. Best regards and Luv. Jeanette

Franklin'sMum

11-21-2009, 09:36 AM

HAPPY 7TH BIRTHDAY, PRINCESS:D:D

Hi again, Jeanette,
We hope Princess and you all have a wonderful day celebrating Princess's birthday, and we're looking forward to seeing some pics:D
Do you put a birthday hat on her?:):o:rolleyes:

And I wonder why there are two different forms of trilo, capsules and tablets? Is it because it's a compounded form? I find the capsules a lot easier for Princess to ingest against the tablets, and they are not big at all, so that's a plus too. Try asking your pharmacy...Good luck. Best regards....Luv, Jeanette

I have absolutely no idea why ours come in tablet form, instead of capsule or even a full liquid like John ll (Angelina's Dad) had the option of. Our new specialist also uses a compounding pharmacist for her pup's trilo, and hers are capsules. I think if Franklin's were a capsule, he'd pierce them as he chewed, and lose half the dose as it squirted out of his mouth!:eek: The tablets aren't big though, and when he does break a bit and spit it out, that just means he gets a bit more ham!:o

Love to you and yours, and big hugs and kisses for the birthday girl :)

Jane and Franklin xx
________
Vaporite Vaporizer Instructions (http://www.vaporshop.com)

haf549

11-21-2009, 09:48 AM

HAPPY BIRTHDAY PRINCESS!!!:D
And my you have many many more.

Heidi & Kira

Casey's Mom

11-21-2009, 09:52 AM

Happy Birthday Princess, sounds like you are going to have a great day with your family!:):):):)

Roxee's Dad

11-21-2009, 09:58 AM

:D:D:D Happy Birthday Princess :D:D:D

we got her lots of doggie toys and some special treats--she deserves that and so much more.

Yes she does, and I know she will enjoy her very special day. :)

Harley PoMMom

11-21-2009, 11:06 AM

:):D:) Happy Birthday Princess :):D:)

Hoping you are having a great time on your birthday day with all your doggie toys and treats, you are a very special girl, and so is your mom...we love you both very much.

With much love and big hugs.
Lori and Harley.

lulusmom

11-21-2009, 11:54 AM

:D:D:D:D:D:D:D:D:D:D:D:D:D:DHappy Birthday, Princess.:D:D:D:D:D:D:D:D:D:D:D:D:D I hope you are enjoying your new toys and are scattering them all over the house. :)

Glynda

Squirt's Mom

11-21-2009, 11:57 AM

Happy 7th Birthday, Princess!!

Make a HUGE mess with all your toys and goodies today, and enjoy every single second of your special day!

Hugs,
Leslie and the girls

PS. Squirt says to hold out for more treats!!! ;)

littleone1

11-21-2009, 12:57 PM

:) HAPPY 7th BIRTHDAY, PRINCESS. I hope you have a wonderful day! Corky sends lots of kisses.

MiniSchnauzerMom

11-21-2009, 08:06 PM

Munchie's birthday serenade to Princess....

Happy Birthday to you....arf!
Happy Birthday to you....woof!
Happy Birthday Dear Princess....aroooooooo!
Happy Birthday to you....arf, woof, arooooo!!!

Hope Princess and her family enjoyed the party and Munchie sends along some extra special "Birthday Slurps" for Princess. :D

Louise

sunimist

11-21-2009, 08:22 PM

Party time! :D :D "HAPPY BIRTHDAY PRINCESS!"

Big (((hugs))) Shelba and Suni

mypuppy

11-22-2009, 03:49 PM

Oh my goodness all! I was ticlked pink by all your lovely birthday wishes for princess. That made our day the more complete....thank you all soooooo very much...you are all the sweetest bunch of people, and i love you every single one of you. We had a very nice birthday celebration yesterday with lots of treats for the precious pooch--i can tell by the look in her eyes she enjoyed herself. Today she is a bit pooped from all the activity, so we are allowing her to rest....thanks, thanks, thanks again to all....we love you.....xo jeanette and princess

mypuppy

11-22-2009, 03:52 PM

Louise, you have no idea how hard my daughter and I laughed with your little serenade for Princess. That was simply hysterical....Thanks for the great laugh, we needed that. We had a blast yesterday just watching her play and eat all her birthday treats...Thanks again for the laugh, I keep singing the tune in my mind.....lol......Love ya....all the best to Munchie.......xo Jeanette and Princess

mypuppy

11-22-2009, 04:01 PM

Jane, My oldest daughter actually made a birthday hat for her, but we had a little bit of a hard time keeping it on her--she wanted no part of it--lol. Had a great time just the same. Now as for a liquid form of trilo? I don't know if Princess would enjoy that unless it comes in a cheese/ham/bacon flavor? lol. The capsules are working great for us, she's not spitting them out because they are rolled into the ham....that's funny that Franklin spits out pieces of his tablets. They are just too smart. Take care and Best Regards, Jeanette

mypuppy

11-24-2009, 03:20 PM

Dear All, I didn't want you all to think I fell off the face of the earth and give you a quick update on Princess. We are into week two already on trilo, and has being doing great. She is down to 2 liters of water per day against 5 - 6 ltrs. prior to trilo. She is more active, but are trying to keep her activity to a minimum after I learned from Debbie she can tear some ligaments and tendons. She goes for her stim test on Monday, so I will be definitely be on the look out for the cortisol numbers at that test. I know a lot of you said a vet normally would not make a dose adjustment at the 14 day stim, so I am hoping my specialist goes by that guideline as well, otherwise, I will have to question any adjustment, specially if it means increasing her dose. I guess I won't jump the gun just yet and wait till the test. In the meantime, I know a few of you have so much more going on with your own pups, and it does make me feel sad while I am here reporting good news and some of you are not so fortunate right now, so for that I am sorry, but I thought you'd want to hear some good news for now. Nevertheless, please know that I will be thinking of you all and your precious pups at Thanksgiving, and thanking God above on that day for each and everyone of you, and praying he will watch over you and your pups and bring them back to a quick healing. I love you all, and I wish you all a very HAPPY THANKSGIVING, GOBBLE, GOBBLE and I'm sure there will be plenty of leftover bird for our pups that day. lol.......xoxoxo Luv, Jeanette and Princess

littleone1

11-24-2009, 03:56 PM

Hi Jeanette,

I'm glad that Princess is doing so well. I hope that you get great results on her tests. I'l l be thinking about both of you and waiting for her test results.

You and your family have a great Thanksgiving. We do have something to be very thankful for.

labblab

11-24-2009, 03:57 PM

Oh Jeanette, it's hearing good news like yours that brings smiles to ALL our faces and raises all of our spirits and hopes!!! So thank you so much for your update and for your happy holiday wishes. Blessings to you and Princess and all of your family there -- and to all of your family, here, as well! :o :) :D :D :D :D :D :D

Tons of hugs,
Marianne

Harley PoMMom

11-24-2009, 05:28 PM

Hi Jeanette,

We absolutely love hearing good news. ;):D and I am so happy to hear that Princess is responding so well to her treatment.

Thanks so much for the Thanksgiving wishes (I hope I don't eat too much this year...yea, right!), and I wish you and your family a wonderful Thanksgiving too.

Love and hugs.
Lori

haf549

11-24-2009, 05:44 PM

Jeannette:

Just wanted to pipe in and say that I am very happy to hear about the great results so far from the meds. Just keep doing what you're doing. I'm sure everything will be great on her stim test as well.

Here in Canada, we already had our Thanksgiving, back in October, but Kira and I want to wish you and yours and Princess of course, a very Happy Thanksgiving. Kira always gets a mini Thanksgiving dinner, mixed in with her regular food. Do you do the same for Princess?

Heidi

mypuppy

11-24-2009, 07:16 PM

Hi Heidi, Thank you so much. And I can't believe you've already celebrated Thanksgiving. In fact, I did not know it was celebrated in Canada. Happy belated. I visited Canada many, many years ago, and I simply loved it. Have you ever visited the U.S.? Who hasn't right? lol. As for mixing Thanksgiving food with Princesses doggie food, you bet your bottom dollar I do that. Thanksgiving would not be complete if I were to skimp out on my precious Princess--they are worthy of that and so much more. Thanks for all your great wishes and I hope Kira is doing a little bit better these days from her surgery. We love you...xo Jeanette and Princess

haf549

11-24-2009, 08:07 PM

Jeannette:

Have you ever visited the U.S.? Who hasn't right? lol.

We mere Canadians probably know more about the U.S. than you guys do about Canada.:rolleyes: Of course I've visited the U.S. I can't think of too many places I haven't been there. Well, OK, the Dakotas and, a regret, New Mexico. I can't count the number of times I've been to California and Las Vegas. Of course Florida; it's a straight drive down the U.S. 75. A couple of years ago we took boat cruise to Alaska, out of Seattle. I really want to go back to Seattle, because the 1/2 day we had there just wasn't enough. Living in Toronto, we're only about 1 1/2 hours from Buffalo. My girlfriends and I make regular visits to Pennsylvania to go to the outlet mall at Grove City. Even Kira has been to the U.S.

Our Thanksgiving is the first Monday in October. I guess ours is earlier, because our harvest ends earlier than yours. You wouldn't know that given the weather we've been having this year. It's the end of November and we're still in the mid teens (celsius).

So, have a great Thanksgiving and give Princess an extra piece of turkey from Kira (with love);).

Heidi

littleone1

11-28-2009, 01:41 PM

Hi Jeanette,

I'm glad Princess was doing so well when we chatted. I appreciated the call. I hope all goes well with Princess's tests on Monday. I'll be waiting to see her results.

The Corkster is still doing great.

Hugs and kisses to Princess from Corky and me.

MiniSchnauzerMom

11-28-2009, 03:48 PM

Hi Jeanette,

I thought you'd want to hear some good news for now

Yes....Good news always welcome!!! :D :D

Glad Princess is still doing well and hope her results are within range when she has her stim test on Monday. I'm sending some positive cyber thoughts for Princess and looking forward to seeing her test results.

Louise.

mypuppy

12-01-2009, 03:13 PM

DEAR ALL,
Sorry I have not posted in a couple days. There was really nothing to report until today actually. Princess had her 14 day stim test yesterday, the 30th. I just got off the phone with her IMS only to inform me her levels were too low, therefore she has recommended I stop the trilo until Sunday and on Sunday begin her again but only on 1 tablet of the 60mg, against the 2 pills of 60mg she has been on. I asked if this is bad, and she was not concerned, but merely asked me to watch and make sure she is eating. I'm just getting a little scared now because as you all well know common nature, we don't like to hear when something is "too high" or "too low"...I get a little skeptical. But those are the doctor's orders, therefore I suppose I must abide by them, and she knows best. I asked her if there was a way for me to know her levels were too low while she began treatment, because in all honesty as I mentioned throughout my earlier posts while she was on the trilo, there were no strange symptoms, and she was eating just fine. Would love to hear anyone's/everyone's take on this. In the meantime, hope you and your pooches find you well these days. Best regards and Luv, Jeanette and Princess

littleone1

12-01-2009, 03:22 PM

Hi Jeanette,

It's good to hear from you. Did your IMS tell you what Princess's levels were and what the reference range was? Did she have any other blood work done yesterday? I'm no authority on this, but I keep on learning. I know I would watch Corky like a hawk, watching for any of the signs that would indicate a problem.

I hope she doesn't have any problems.

The Corkster is doing really good. I'll talk to you soon.

Harley PoMMom

12-01-2009, 03:24 PM

Hi Jeanette,

Honey, we need to see those ACTH numbers, can you call her back and get them for us? And then make sure you get copies of all tests done on Princess, ok?

Love and hugs.
Lori

Squirt's Mom

12-01-2009, 04:50 PM

Hi Jeanette,

I know this is a bit scary...the "too" anything is worrisome! But as long as you are not seeing any signs like vomiting, lethargy, loose stool, loss of appetite, or shaking, I think she will be ok. Do you have pred? If not, when you call for the results insist they give you some - do not take "no" for an answer. Lay your ears back and stomp your foot if you must, but get the pred asap.

As for restarting the Trilo, to me that is quite a bit scarier without another ACTH to see where her levels are at that time. This isn't something that needs to be guessed at - the numbers need to tell the story along with Princess behaviors.

Do let us see those numbers when you can and DO get the pred.

Hang in there! You are doing just fine and will get through this little hiccup. ;)

Hugs,
Leslie and the girls

lucygoo

12-01-2009, 06:10 PM

Hi Jeannette...

When Lucy was first started on trilo, we went thru the same thing in the beginning...after the first two weeks, she was clinically doing great, but the vet said her numbers were too low and we had to stop it and then start again at a lower level. It's really no big deal; just part of the initial tweaking. (We had to adjust Lucy's trilo a few times)
Just keep an eye on her and make sure she's still eating and doesn't start vomiting or anything. I'm quite sure she won't need prednisone, especially if she's not showing any symptoms. They usually don't give prednisone with trilostane because it has such a short half-life and is out of the system fast.
Hang in there and don't worry! This is normal:)

Gina and Lucy

mypuppy

12-01-2009, 07:17 PM

Hi Lori, Thanks. I did call back and they will be sending me a copy of the results in the mail...Unfortunately, I am an hour away from them, so they will be sending a copy out today in the mail. And yes, I do have all of Princesses test results at home, but thanks for calling me on it. In the meantime, I will post the results as soon as I get the report. Thanks again....check back in a day or so. Regards, Jeanette

mypuppy

12-01-2009, 07:23 PM

Hi Gina, such a relief to get your post. Ahhhhhhhhhh...I was thinking here, OMG, what am I going to do now? Is this going to set her back now that she has to go off for a few days? So thanks for the reassurance. I will most definitely continue to keep an eye out for any strange side effects as before. Quick question, once the dosing process was finally resolved did Lucy remain on the same dose permanently or is this something we will be dealing with all the time? If so, is it safe to be increasing/lowering the doses very often? As for the prednisone, I have some mix opinions here. A few people here think I should most definitely have it handy at home, and others don't feel it necessary...???? I guess it doesnt hurt to ask my IMS's opinion on it, but thank you for yours just the same. Regards, Jeanette

mypuppy

12-01-2009, 07:27 PM

Hi Leslie, yes, scary indeed. I do not have predinisone, but I will bring it up to my IMS's attention tomorrow. I requested a copy of her lab work and probably won't have all the nos. until a day or two. I will post them as soon as I get them. I did ask my IMS when she would want to see Princess again based on these results, and she said she will follow up with me next Monday to find out how Princess made out with the new changes. She will determine then if I should bring her back for another stim. So this is it for now. Thanks for your concern and comments. Regards, Jeanette

Annie's Mom

12-02-2009, 02:26 AM

Hi Jeannette, We are fortunate to have so many experienced folks here, to help guide us. It is definitely overwhelming at times, but take a deep breath, and give Princess a big hug :) RE: Pred, my vet insisted on giving me several Pred to have on hand. It is a very inexpensive safety measure. I learned this summer to purchase as many meds as possible at Costco. The cost is extremely less. I get the price from my vet, then I call or check online for Costco's price and have my vet call in the Rx or give me a paper Rx. If it's a human drug, they can fill it for your pet! Prednisone, Tramadol, Gabapentin..... all are extremely inexpensive at Costco. Annie hasn't had any side effects to Trilo other than she has several days of diarrhea beginning on day 22. We don't know what caused it, but I doubt it is Trilo. I call the Veteroyl corp office to inquire and was told I most likely would have seen diarrhea much sooner than day 22. The person I spoke to was very helpful in answering all my questions, so don't hesitate to call the drug co, or ask questions here. I'll be keeping a watch on your posts to see how Princess is doing. Hugs to both of you :) Barb and Annie

haf549

12-02-2009, 10:35 AM

Jeannette:

I'm interested in seeing the actual numbers, like the other folks here. 'Too low' can be a relative term. I wouldn't be too concerned about lowering the dosage. It took 3 tries before we got Kira's right. She's an 80lb puppy and she's on the lowest dosage possible for a dog her size. She started on 120mg/day. Switched to 60mg twice per day and we finally settled on 40mg twice per day. She is now stable. Her numbers are a bit on the 'high normal' side, but her symptoms are under control, so all is well. Hang in there. The beauty of Trilostane is that it doesn't stay in their system all that long. Was Princess on 120mg once a day, or 60mg twice a day? Are you switching her to 60mg once a day?

Heidi

mypuppy

12-02-2009, 11:43 AM

Hi there Heidi, so nice to hear from you. I was actually on your thread earlier this morning and was going to say a quick hello, but got sidetracked with my little one and trying to send her off to school. Thanks for your post. I hope you and Kira are doing well these days, of course, specially her after her wart surgery. I do have to go back to your thread later today and read up on her progress. In the meantime, as for Princesses trilo dose, I knew that the initial process while starting treatment would entail some possible adjustments, so I'm not totally shocked, I was just "hoping" that maybe we had gotten it right the first time, but it's ok. I will deal with it accordingly. Princess began on 2 (60 mg) pills once a day, and her IMS said to get her off for a couple days and start her up again on Sunday with just one (60mg) pill once a day. So we will see if this adjustment works for her best. I'm thinking, and I don't really know all the factors doctors consider in order to warrant an adjustment, but if it goes by weight and Kira is on only 40mg, should Princess be close to the same dose as Kira since Princess is weighing 69 lbs.? Again, I don't know if they only base it on weight or the cortisol levels or both? We shall find out. One other thing I have noticed in the last 2 days is that Princess is not drinking any water, does not touch her water bowl. I asked her IMS if this could be a problem with the trilo and if I should be concerned? She said "not at all". I just think, for me, it is unusual to have seen her drink 6 ltrs. per day prior to trilo, then down to 2 ltrs per day while on trilo and now zero water. I know her food contains water since I do mix dry and canned with water in it, but I always think they should be drinking some water aside from that. At any rate, I am so hoping those stim test results are in today's mail so I can post them soonest. Thanks for your post as always. Best regards to you and Kira. xo Jeanette

labblab

12-02-2009, 11:57 AM

So we will see if this adjustment works for her best. I'm thinking, and I don't really know all the factors doctors consider in order to warrant an adjustment, but if it goes by weight and Kira is on only 40mg, should Princess be close to the same dose as Kira since Princess is weighing 69 lbs.? Again, I don't know if they only base it on weight or the cortisol levels or both?
Hi Jeanette,

The initial trilostane dose is calculated based on weight. But from that point onward, all the dosage adjustments are based solely on the ACTH results as opposed to weight. Every dog metabolizes the drug in its own way, so there can be a wide variation in the doses that dogs of the same weight may end up requiring.

One other thing I have noticed in the last 2 days is that Princess is not drinking any water, does not touch her water bowl. I asked her IMS if this could be a problem with the trilo and if I should be concerned? She said "not at all". I just think, for me, it is unusual to have seen her drink 6 ltrs. per day prior to trilo, then down to 2 ltrs per day while on trilo and now zero water.

On this question, I have to respectfully disagree with your vet. I DO think it is of concern if Princess continues to avoid her water, and I do believe that the trilostane is the cause in the event that her cortisol level and/or electrolytes have dropped too low. You do not want her to become dehydrated now, and I would not feel comfortable starting her back on trilostane as long as she is not drinking any water! Like everybody else, I will be really anxious to see how low her cortisol has actually dropped. But I think you are justified in your concern, and you should continue to monitor Princess closely. It may be that she WILL need some prednisone in order to normalize her system.

Marianne

lucygoo

12-02-2009, 12:46 PM

Hi Jeannette...

We did have to tweak Lucy's dose a few times, but she was on it for two years. She was stabilized for most of the time on either 90 or 120 mg a day, split into morning and evening doses. I got so I noticed subtle changes in her clinically, we would do a stim test, and adjust the dose accordingly. After a while we didn't have to do very many stim tests, and at the end she was on 120 mg a day for a good 6 months or so.

One time I accidently doubled her dose, and I thought I had killed her, but she had absolutely no reaction. We just took her off the trilo for a few days.

You do have to keep an eye on them when they first initiate treatment, or if you increase the dose, but it sounds like Princess is responding well. But like Marianne said, if she continues to avoid water she could get dehydrated.

You're doing great, and I know it's scary....you feel like you have to watch her every move, but it does get much easier:)

Gina and Lucy

Squirt's Mom

12-02-2009, 01:18 PM

Hi Jeanette,

I agree with Marianne on this water issue. Water vital for life and any time a pup stops drinking, there is a PROBLEM that needs to addressed asap - especially one with an existing health issues as serious at Cushing's and on drugs as potentially dangerous as Trilostane.

IMHO, the pred is now a MUST...and there is no way in you-know-where I would resume treatment without having her electrolytes checked and another ACTH done.

Jeanette, I understand that it is hard at times to stand up to someone we see as better educated, more experienced, or whatever...but when we are dealing with Cushing's in our babies we often have to do just that for their benefit. By avoiding her water, Princess is screaming at you that something is wrong and as her voice you must pass that scream on and make them listen to you both.

Please let us know how she progresses today...keep in close contact as I am getting quite worried about Princess. :o:(

Hugs and prayers coming your way,
Leslie and the girls

Casey's Mom

12-02-2009, 01:49 PM

I would be very worried about the water intake if it were me - it doesn't matter that she is getting wet food she needs water and I would be speaking to the vet about giving her pred.

mypuppy

12-02-2009, 03:52 PM

Leslie, I am quite concerned myself. It is my personal opinion that her NOT drinking any water is a warning sign something's not quite right. I have addressed my IMS 3 times about this, and she is not worried about it. I just yet put in another call to her after I read your post because I am getting very frightened now on what to do in the event a crisis arises and I don't have that prednisone handy and I am an hour away to the closests ER vet hospital....Unfortunately, i did not receive copies of her 14 day stim yet. I am awaiting for her to call me so we can address this water issue, but what should I tell her when she calls if we have gone over it 3 times? Either way, I will let everyone know what the outcome is. Question to you or anyone else who would like to reply? What will the prednisone do for Princess? I know it's a form of steroid. Will it increase her cortisol levels since they have dropped according to her IMS? Thanks to all for your concern. I am working on it and trying to get her to drink some water. Will write soon. Jeanette

StarDeb55

12-02-2009, 04:09 PM

Yes, the pred will replace the cortisol. The other thing to worry about if this is the beginning of a low cortisol episode are Princess' electrolyte levels. Low cortisol can wreak havoc on electrolyte levels, & lead to serious problems very quickly.

electrolytes=primarily sodium & potassium

Debbie

Squirt's Mom

12-02-2009, 04:18 PM

Hi Jeanette,

You can simply tell the IMS that whether she is concerned about Princess or not, you are and want her checked out. Ask if her electrolytes were checked and if not, you want them checked asap. Dehydration is a concern as well.

It is my opinion, based on all I have read, researched, and seen happen here, that any dog undergoing pharmaceutical treatment for Cushing's should always, always, always have prednisone on hand. You are absolutely correct - the pred will increase/replace the cortisol if it has become too low which will allow the body to function more normally until the adrenals can once again start production.

I know this is confusing as treatment is geared to LOWER cortisol. But some of this hormone is needed in the body and when it gets too low, or is no longer being produced period, then you have a whole new can of worms to deal with. This is where the pred comes in - to assist the adrenals when they have been over-taxed by the treatment.

As Marianne said, each of these pups is different and no two will react to treatment the same regardless of how many other similarities they may share. A close, team-like relationship with the vet(s) involved will help you and Princess if/when problems do arise and you must all look at her as an individual - not a case study, statistic, etc.

I don't think there is any reason to be really frightened for Princess' life at this point - and didn't mean to make you feel that way. But there is reason to have some real concerns in order to prevent something worse possibly rearing it's ugly head. Look at it as a preemptive strike...you are trying to make sure there is no "enemy" getting any ideas or making any preparations to invade. ;)

Hang in there! You will get through this!

Hugs,
Leslie and the girls

haf549

12-02-2009, 04:35 PM

I'm thinking, and I don't really know all the factors doctors consider in order to warrant an adjustment, but if it goes by weight and Kira is on only 40mg, should Princess be close to the same dose as Kira since Princess is weighing 69 lbs.?

Hi again Jeannette:

No, I don't think it's entirely based on the pups weight. In the beginning, the vet went with the recommended dosage of 120mg. But Kira wasn't responding well to the dosage. In January, her regular vet, who had been on medical leave came back. When I told him all the issues, she took out a calculator and worked out the minimum dosage for a dog her size. So, the 120mg is the max dosage for her, whereas the vet calculated her minimum dosage would be around 75mg per day. Since at that time I had 20mg capsules, we decided to go with the 40/40 regime. He said that if that wasn't enough, we could always do 40/60 and other derivation thereof. Good thing you have the 60mg tablets. It makes it easy for you to decrease her dosage. I spend a lot of money in the beginning, because I had 100mg and 20mg capsules (to make up the 120mg). Then when I went to 60/60, I used up all the 20mg tablets. Since Trilo is basically costed at a per capsule price (at least here in Canada), that got very expensive, since I was giving her 6 a day. When we finally settled on the 40/40, for a couple of months I was still getting the 20mg capsules, in case we needed more tweeking. It wasn't until her stim test in April, that I finally settled on getting 40mg capsules.

The vet also told me that while weight is definitely a factor in determining the dosage, it isn't the only factor. It does concern me a bit though that she isn't drinking ANY water. Can you maybe add a little extra water into her food. It will make it a bit running but at least she'll be getting water. Could you maybe add a little chicken or beef broth to her food? That might work better than water.

Heidi

lulusmom

12-02-2009, 04:57 PM

Hi Jeanette,

Without the benefit of the results of the acth stim test, all we can do is speculate so it would really help if when you talk to your vet, please ask her to give you the pre and post acth stim numbers and post them as soon as you can.

I remember that well before her cushing's diagnosis, my Lulu drank very, very little. She did her heaviest drinking (sounds like she was on a drunken binge :D) right before she was diagnosed with cushing's and oxalate bladder stones. Once surgery was done and she was stabilized on Lysodren, I recall that because I was so used to her sucking up water for so long, I was really concerned about her disinterest in the water bowl. She weighs about 4.5 lbs so hydration was a big concern. Nothing, I repeat, nothing ever affected her appetite so I knew she was getting a good bit of moisture from her food.

Aside from her lack of drinking is Princess acting and eating normal?

Glynda

mypuppy

12-02-2009, 04:57 PM

Heidi, thanks for the info. I already do add water to her dry and wet food, but I will also try to incorporate the beef/chicken broth just to get a little more taste since I think the water somewhat dilutes the taste of the food and then she won't even touch it. I am really concerned myself about this new issue with the water. I am actually going to try to take a turkey baster and see if she'll drink from it. Whatever works just to get her to drink I guess, but I do feel it is not normal her body is not telling her to drink water...I don't want her to end up in a bad place because of this. I wish my IMS can give me a better justification or any for that matter. She didn't discuss it was an issue or thought it could be related to her electrolytes. In fact, she hasn't returned my call, and I'm getting a bit infuriated because it may prevent my chances of getting the prednisone today if I need it. UGH....This is soo emotionally and physically exhausting, to say the least. It's like walking on egg shells every single day with this. Hope the outcome is good and we can get back to life, oh yeah, this is life! ugh.....Take care and thanks again to you and everyone here as always. Jeanette....

lulusmom

12-02-2009, 05:05 PM

Hi Again,

I just saw your last post about adding water to Princess' food. It could be that she is getting enough fluids from eating and doesn't want to drink from her bowl. If you want to add broth to her food, I highly recommend that you make your own by simply boiling skinless chicken part(s) and straining off any fat. Princess might appreciate some of the boiled meat too. My dogs love homemade chicken broth.

Glynda

haf549

12-02-2009, 05:06 PM

Jeannette"

I just thought of another option. You say you're an hour away from an emergency vet. Well, if you want to try and hydrate her I think I read somewhere that you can use pediatlyte, which is available at any pharmacy. Can't remember where I read about the pediatlyte, but it will help with hydration.

Heidi

haf549

12-02-2009, 05:06 PM

lulusmom

12-02-2009, 05:15 PM

Me yet again,

Heidi's last post reminded me that I forgot to mention how to determine if Princess needs more fluids. If Princess is eating, has not been vomiting or suffering with diarrhea, I don't think she is dehydrated; however, you can check by gently pulling the skin up near the middle of her back. If she is dehydrated, the skin won't have its normal elasticity and it will "tent". Having had tiny toys all my life, I've done this a lot.

Glynda

P.S. Here's a link to information on dehydration that should help.
http://petdoc.com/story/dehydration-dogs

littleone1

12-02-2009, 05:22 PM

Hi Jeanette,

Heidi is correct. You can use pedialyte for dehydration. When Corky got so sick from the gel when he had his stim test in January, he had to be rehydrated twice, and his vet also had me giving him the pediayte. At first he wouldn't drink it, but I was given a syringe in case I had to use it to get it in his mouth.

I hope you hear from your IMS soon.

mypuppy

12-02-2009, 05:26 PM

Thanks Heidi, I know pedialyte all too well alright since I have little ones who have required it while sick, but I didn't know you can use it on animals. Guess if its good for humans can't hurt our pups? Thanks again. Jeanette

mypuppy

12-02-2009, 05:33 PM

Glynda, Yes, I know. I wish I had a copy of those results today too so we can go over them. Princess is acting very normal otherwise, eating, even exercising outside, fetching her ball and sticks and playing, so I don't believe she is dehydrated, but I also don't like the fact that she won't drink her water. Will continue to watch her very closely. Thanks for all the great tips too. the chicken broth from boiling chicken sounds like a plan. She will enjoy it....Take care. Regards, Jeanette

labblab

12-02-2009, 05:34 PM

Hi again, Jeanette.

I've just had a chance to catch up on this afternoon's postings on your thread. I did not mean to frighten you unduly with my earlier post, and I agree with the others who have said that we are all just speculating right now, in the absence of Princess' test results. It may turn out to be the case that her cortisol is not ALL that low, and that her electrolytes were all normal, and that is why your vet is not voicing concern at this point. Since I'm thinking that this morning was the first "skipped" dose of trilostane, I'm hoping that her fluid intake will start to pick up again by tomorrow -- once her cortisol level has had the chance to start increasing.

But having said all that, I still wish that your vet would have talked with you in greater detail about the fluid issue. It's one thing for her to not be drinking much for a day or two...it's another if the problem persists. There are ways in which you can physically judge whether or not Princess has become dehydrated, and it would be helpful for your vet to talk with you about that, in order to ease your own mind and be better able to judge whether or not there is a genuine problem. And as I said earlier, I really would be concerned about re-starting the trilostane on Sunday if Princess still hasn't resumed a more normal drinking pattern by then. Here are the recommendations of the makers of Vetoryl re: re-starting trilostane after levels have dipped too low:

At a minimum, this monitoring should include a thorough history and physical examination, ACTH stimulation test (conducted 4-6 hours after VETORYL Capsule administration), and serum biochemical tests (with particular attention to electrolytes, renal and hepatic function). A post-ACTH stimulation test resulting in a cortisol of <1.45 μg/dL (<40 nmol/L), with or without electrolyte abnormalities, may precede the development of clinical signs of hypoadrenocorticism...

If the ACTH stimulation test is <1.45 μg/dL (<40 nmol/L) and/or if electrolyte imbalances characteristic of hypoadrenocorticism (hyperkalemia and hyponatremia) are found, VETORYL Capsules should be temporarily discontinued until recurrence of clinical signs consistent with hyperadrenocorticism and test results return to normal (1.45-9.1 μg/dL or 40-250 nmol/L). VETORYL Capsules may then be re-introduced at a lower dose.

I see that Glynda has already asked you how Princess is doing, aside from not drinking. If Princess is otherwise acting normally, then she is probably OK for right now. But I do think that such a dramatic change in her drinking habits ought to have warranted a more thorough explanation from your vet, and I'm sorry that she's left you "alone" to worry about this.

Marianne

P.S. I see that Glynda has already given you very helpful info about determining whether or not Princess is dehydrated, so many thanks to Glynda!

mypuppy

12-02-2009, 06:46 PM

Marianne, nothing to be sorry about. Believe me, I thought Princess not drinking water was something to post, and knew it would raise concerns, so I wanted to get everyone's valuable inputs on it. I finally heard back from my IMS, and reiterated that she's more concerned about whether Princess is eating or not in the next days or so. She also suggested to add more water to her food bowl. She did say if she did not start drinking water by tomorrow, I can take her to my gp for a procedure called "subcutaneous liquid". I probably totally spelled that incorrectly, but does that ring a bell to anyone? It's not an IV procedure, it's done under her skin. Aside from that, she said to follow up with her on Monday as originally planned. So this is it for now. And I do agree with that my IMS somewhat disregarded to clue me in on a few issues and explain things in more detail. I have to admit she has left me feeling that way many a times now, and may force me to seek someone else's services in the future, but right now I'm not sure would be the best time to switch. Who knows? Thanks again and please do not apologize for your concerns. I value them deeply. Regards. Jeanette

your own mind and be better able to judge whether or not there is a genuine problem. And as I said earlier, I really would be concerned about re-starting the trilostane on Sunday if Princess still hasn't resumed a more normal drinking pattern by then. Here are the recommendations of the makers of Vetoryl re: re-starting trilostane after levels have dipped too low:

littleone1

12-02-2009, 07:04 PM

Hi Jeanette,

That's what Corky had to have done in January. It doesn't take long. They are just injecting fluids. It doesn't cause any problems. They are just rehydrating them.

lulusmom

12-02-2009, 07:09 PM

Hi Jeanette,

The procedure your IM is mentioning is a subcutaneous IV. If Princess were to need fluids, they would lift up skin (scruff) around the middle of the back between the neck and shoulder blades and insert a needle under the skin. It only take a few minutes. I remember being panicked the first time I did this at home because the fluid balls up about the size of a softball which the vet failed to tell me about. This is normal and it gradually goes down as the fluids are absorbed over several hours.

Glynda

AlisonandMia

12-02-2009, 08:27 PM

I have found that in mild or cool weather that Zac (who is a perfectly healthy 3yo Australian Cattle Dog) barely drinks any water. He gets wet food.

Once the weather is hot things change of course and exercise (but only if he pants) or chewing a bone will also increase his water consumption dramatically.

Another thing is that they very often prefer to drink water that is out in the garden (that you may not even know about:eek:) rather than tap water out of their bowls. Could Princess have access to some other source of water, perhaps?

Alison

mypuppy

12-02-2009, 10:25 PM

Hi Heidi, It's 9:20 p.m. and I wanted to post one last msg. before signing off tonight to let you and everyone know that earlier this evening Princess finally drank water out of her bowl. I was so happy to witness her drinking since I hadn't seen her touch her water bowl in a couple of days. Thank you for the pedialyte suggestion. I don't believe Princess is dehydrated at all because she is still active, so I don't feel I need to do anything thus far. I will continue to watch her and hopefully will be fine until I can resume her trilo on Sunday. Anyway, again I was ecstatic to see her drink her water so I can have a good night's sleep. Good night and will post tomorrow with hopefully those stim numbers. Best regards, xo Jeanette

mypuppy

12-02-2009, 10:30 PM

Hi Alison, that could be a factor to consider. I never thought of it that way. I guess I was just highly concerned because she is on treatment and thought possibly it could be related to the meds, but fortunately, she finally drank water this evening. As for Princess having access to other water, that's a no. Reason I know is because I walk out with her each time she is let out to do her business, and when she is playing or exercising outside, I'm right out there with her. We have bears and other wildlife up by me, so I don't leave her out there alone for one second. Hopefully, she will resume her regular schedule again. Thanks for your comments. Regards. Jeanette

mypuppy

12-02-2009, 10:34 PM

Wow Glynda, I tried that and it really works...I knew she wasnt dehydrated to begin with. It was just a concern that she wasn't drinking that could have lead to it though. She finally did drink some water tonight after her dinner, so I am extremely happy. Thanks for the great tip and the link. I love you guys...Jeanette

mypuppy

12-02-2009, 10:46 PM

Yikes! That would have extremely panicked me also had I seen this huge thing bubble up like that. Ugh! Don't these vets take communication 101 in veterinary school? lol...would be nice to know huh! oh well....Now my next question is why did you have to do this yourself at home? I know I would never have the nerve to inject anything into Princess or myself for that matter. I am just terrible when it comes to needles. At any rate, it doesn't seem she will need this done at the present moment as I don't believe she is dehydrated, but at least I know we can act in the event it arises. Btw, great news! Princess did finally drink tonight after her dinner. I was amazed! In fact, Terri, Corky's mom, had just called me and while I was on the phone with her, that's when Princess began to drink. Terri and The Corkster must have sent some good luck vibes. Thank you Terri and little character...lol....Thanks to all of you for your quick replies. You have no idea (well I think you do) how much I rely on all of you during these situations. It is priceless. THANK YOU ALL.....I luv ya and your pooches....xo Jeanette

littleone1

12-02-2009, 11:28 PM

Jeanette, you are so very welcome. I know I was so happy for you and Princess when I heard her drinking her water. I hope we sent good luck vibes, as we were definitely concerned. My little character:D, "The Corkster", :) and I hope everything goes well for Princess. I think that there were other factors involved with her drinking her water, but I do appreciate your kindness.

Extra, extra big hugs to both of you.

Squirt's Mom

12-02-2009, 11:34 PM

It's 9:20 p.m. and I wanted to post one last msg. before signing off tonight to let you and everyone know that earlier this evening Princess finally drank water out of her bowl.

YIPEE!!

This made my night! :D

jrepac

12-03-2009, 12:43 AM

that is good news; I was once queasy about injections many years ago. But once I had a diabetic dog I quickly got over it....and I realized the dog did not really mind it very much either:p

but, as long as I don't have to inject myself...:o

Casey's Mom

12-03-2009, 01:05 AM

Great news Jeanette, now you guys go get a good sleep.:D

mypuppy

12-03-2009, 06:55 PM

Hi Marianne, Oh my gosh! Not sure how to make this request, but I was wondering if it would be a terrible imposition to request an update on my thread like you did the last time reflect perhaps the same as Heidi's thread "update on Princess, on trilostane" or something to that extent. I'm sorry for any inconvenience that may cause you, and I would not take offense if it is not possible. Thanks a bunch....Best regards, Jeanette

StarDeb55

12-03-2009, 07:01 PM

Jeanette, I can do that for you. I just want to make sure that you want the title of the thread to read: Update on Princess (7 yr. old Lab on Trilostane).

Debbie

mypuppy

12-03-2009, 09:16 PM

OMgosh Debbie! Thank you so much. That title is perfect. I think updating the titles is a nice feature for this forum because it makes it easier for everyone to get an idea as to the stage we are in with our pups. Thanks again for handling that so quickly, I didn't know you had the ability to handle this as well. Best regards, Jeanette

mypuppy

12-03-2009, 09:24 PM

ps: Debbie, hi again. I don't quite remember from one of your very earlier posts, perhaps from October if you said, you are a lab technician or if it's Marianne?? I am waiting to receive Princesses last stim test results which indicated her levels were "too low"...If and when I get these, would you be able to look them over for me and give me your feedback. I don't know why the mail is taking so long, and hoping they are in tomorrow's mail the latest. If not, I guess we'll have to wait till next week. I will post those as soon as I do have them. Thanks. xo Jeanette

StarDeb55

12-03-2009, 09:42 PM

Yes, I'm the lab technologist, so I will be on the lookout for those numbers. When it comes to any type of changes like you wanted, any moderator or administrator is able to do that for you. You can either post in your thread, or PM one of us.

Debbie

littleone1

12-04-2009, 08:06 PM

Hi Jeanette,

Just checking to see how Princess has been doing. I hope all is going well.

Corky sends you hugs and kisses and Princess, kisses.

mypuppy

12-04-2009, 09:10 PM

Hi there Debbie, I finally received Princesses stim test results in the mail today..Sorry I didn't get a chance to post those earlier than now--got sidetracked with the kiddies. I will write the results exactly from the report, and I have to be honest, it is rather confusing to me, and not sure what means what. You'd think my IMS would have at least gone over them with me in detail huh! Oh well, just the same, I do kindly appreciate your interpretation or anyone else's here that is familiar with these numbers...Thanks a whole bunch to all...xo Jeanette...Here they are:
=======================================
Cortisol (2 samples) Results

Tube Labeled Pre Acth
Tube Labeled Post 11:50
Cortisol Pre 1.0
Cortisol 2 1.1
========================================
INTERPRETATION OF ACTH STIMULATION TEST:
========================================
NORMAL RESPONSE TO ACTH
CANINE: 5.5 - 20.0 ug/dL Feline: 4.5 - 15.0 ug/dL
Equine: 5.0 - 10 ug/dL

*HYPERADRENOCORTICISM (HAC): Post ACTH cortisol results greater than 20 ug/dL (dog) and greater than 15 ug/dL (cat) suggest HAC.
NOTE:
Approximately 15-20% of dogs with HAC have normal results. False positive results may occur with stress or nonadrenal illness. Because of wide variability, resting (basal) cortisols should not be used to rule out or diagnose HAC.
*IATROGENIC HAC: Resting cortisol is usually between 1-5 ug/dL with little to no increase in the post ACTH cortisol level.
*HYPOADRENOCORTICISM: Resting cortisol is usually subnormal (less than 1 ug/dL) or low normal with no increase after ACTH.
*POST-LYSODERN: Pre and post cortisol levels after Lysodern loading or while on maintenance Lysodern should be between 1-5 ug/dL.

StarDeb55

12-04-2009, 09:17 PM

Jeanette, these results are what is termed a "non-stimulatory" response. I'm sure this is why the vet wants you to lay off the trilo until Sunday. This is when both values are basically equal. On lysodren, this can be a really big deal, but based on a conversation that is going on in the mod forum, this appears to be handled somewhat differently than lysodren. Here's what I'm going to do, I'm going to PM Marianne & Lori to check this, since I'm not a trilo parent, I'm not comfortable making any detailed comments. I know that Franklin has had a similar sort of result on his latest stim & Marianne has already commented to Jane about those results. Hang tight, one of them should be along.

Debbie

AlisonandMia

12-04-2009, 09:22 PM

Wow, I see what your IMS meant by the numbers being too low - particularly for the 14 day stim! (The numbers are usually expected to drop lower over the course of the first month at least so if they are on the low side at 14 days then reducing the dose is certainly necessary. In fact if they are bang on where you'd normally want them then sometimes that is worrying as by 30 days or so they are often too low.)

It is amazing that she was feeling so well with the numbers so low especially early on in treatment - but it just goes to show that all dogs are different.

Is there going to be another stim done before restarting on the lower dose, just to be on the safe side?

Alison

mypuppy

12-04-2009, 09:22 PM

Hi Terri, Princess is doing just fine so far while she's taking a little break from the trilo. She's drinking a little bit of water, not a whole lot, but again, I do mix water in her food bowl as well. I posted her acth stim results a few minutes ago in the hope someone here can gladly help me make more sense of them since all I got from my IMS was "they were too low". UGH, UGH. One day at a time. Thanks for checking up on us. I appreciate your kindness and concern as always. Will keep reporting any news....Best regards, Luv lots and xo to you and Corky.....xo Jeanette

Franklin'sMum

12-04-2009, 09:37 PM

Hi Jeanette,

I'm thinking 1.0 ug/dl equals 27.59 nmol/L, so from info from both the specialist and our vet, they like the numbers higher. Franklin pre-ed at 90 nmol and posted at 94 nmol, Marianne gave what they equal to on Franklin's thread, I can't think of them off the top of my head, but 90 is close to the 100 where the specialist wants him to be. If Franklin scored as low as Princess, I would definitely take him off the trilo.

His previous stim was 40-50, and he wasn't showing symptoms of Addisononian problems.

I was advised to take him off the trilo at that point.

Please check with your GP or specialist about this, as soon as you can.

You're not going to harm Princess if you do stop the trilo.

Jane and Franklin xx
________
AVATAR: THE LAST AIRBENDER DICUSSION (http://www.tv-gossip.com/avatar-last-airbender/)

StarDeb55

12-04-2009, 09:45 PM

Jane is correct, the conversion is to divide by 27.59.

Debbie

gpgscott

12-04-2009, 09:58 PM

OMgosh Debbie! Thank you so much. That title is perfect. I think updating the titles is a nice feature for this forum because it makes it easier for everyone to get an idea as to the stage we are in with our pups.

Jeanette,

Any mod or admin can update your thread title at any time, it is not possible for a member to do so, a function of the vBulletin software which powers our site.

A good reason to leave the title static is so that people recognize it. so if you request a change I do suggest you keep part of the original title. This is why we like to use one thread per pup, all of the information is under an easily found title.

We often change the title when one has passed to mention so. Everytime someone posts to your thread, even you, it is bumped to the top of the list.

Scott

mypuppy

12-04-2009, 10:25 PM

Alison, thanks. I asked Princesses IMS when she would like to see Princess again, and she asked me to call her on Monday to find out how Princess is doing, and take it from there. At her recommendation I am to start her on the trilo again this coming Sunday, however, instead of the 2 pills, I will be giving her 1 pill (60mg). I'm assuming she may want to stim again in another 14 days from Sunday??? I am sure she will instruct me on Monday when I talk to her. In the meantime, I hope Princess is ok internally. I know she's acting and feeling find on the outside, but oh, how to tell what's going on inside? It's what bothers me the most about taking care of these precious pups--they can't tell you what's really going on. I hope my IMS and I are doing the right thing for my Princess. I do feel very helpless at times not knowing more about this condition or being able to read these results myself, but I think as time goes by I will be able to learn more. I will keep you and the others updated on Princess. Thanks again. Regards, Jeanette

mypuppy

12-04-2009, 10:36 PM

Jane, I'm sorry, I am a bit confused at this point because I don't really know too much about interpreting these tests and numbers. Duhhhhh! What exactly do I need to address with my IMS? I am not sure, but I am gathering you feel perhaps Princesses low levels is indicating Addison's???? I heard Addisons can be actually worse than Cushings??? At any rate, as for stopping the trilo, my IMS did ask me to take her off for a few days and start her up again this coming Sunday on only 1 (60mg) pill. I don't know if you meant stop her completely??? However, those were not dr.'s orders. This treatment process started out very smoothly, but feel it's going in another direction, and I am a little frightened to continue and frightened if I go against my IMS's recommendations...What to do here? Just the same, thank you for your concerns and suggestions as well. Regards, Jeanette

Harley PoMMom

12-04-2009, 10:39 PM

Hi Jeanette,

The ACTH stimulation test is a simple and safe screening test in the diagnostic evaluation of dogs with hyperadrenocorticism (Cushing's syndrome). It's also used to monitor dogs on medical therapy (e.g., Lysodren, Trilostane, etc.). Simply put, it's a test of adrenal gland reserve; it checks how the adrenal glands respond to a certain hormone. This hormone is called adrenocorticotrophic hormone, also known as ACTH. ACTH is made in the pituitary gland (pea-sized structure located at the base of the brain) and travels through the bloodstream to the adrenal glands (small paired glands buried in fat in the front of each kidney). ACTH stimulates the adrenal gland to release cortisol. The ACTH stimulation test involves measuring the concentration of cortisol (which is made by the adrenal glands) in a patient's blood before ("pre") and after ("post") an injection of synthetic ACTH.

The ACTH is an ACTH STIMULATION test. One of the main purposes of this test is to make sure your pup can stimulate .Therefore, IMO, that means that your pups post number should be higher than the pre number. With this test you are looking for the dogs ability to stimulate also NOT just that the pre and post numbers are in the desired range. Pre number indicates the base or resting cortisol. Post numbers after injection indicate the dogs ability to stimulate. When post numbers are LOWER or the SAME than pre numbers it means the pup is losing or has lost its ability to stimulate properly post injection. This can either mean the dog is already having an addisonian crisis/episode or possibly heading in that direction. You should always have stimulation on the post numbers-they should be higher than the pre numbers. Now the idea is that you dont want too much stimulation but you must have some stimulation.

Remember Jeanette I am no doctor, but since Princess's numbers are so low I believe you will need to keep a very close eye on her and I do truly believe an ACTH test before starting any Trilostane would be vital.

You are doing a wonderful job, just keep a watchful eye on her and remember we are here if you need us.

Love and hugs,
Lori

StarDeb55

12-04-2009, 10:47 PM

Jeanette, I'm in total agreement with what Lori said about running a stim prior to restarting the trilo. These numbers are quite low as several of us have already indicated. If I were in your position with my Harley & these kind of numbers, I would insist that a stim be done before I restarted any medication. I think the prudent thing to do would be also to have her electrolytes checked.

Debbie

mypuppy

12-04-2009, 11:29 PM

Lori, That explanation was very helpful. I appreciate it. Thanks. But of course more questions. If I do another stim test at this point being that she stopped the trilo for several days should her levels be higher at this point? What if they are still too low? What is the recommendation to bring the levels up again? Do they prescribe prednisone? If so, what comes after that? another stim test? Lastly, when will I be able to re-start her on the trilo? What symptoms do I need to watch out for at this point even though she is off the trilo? And lastly, I thought I read somewhere here that trilo is out of their system rather quickly once it is stopped? I know, these are just a few of sooo many questions, but I think I've bombarded you enough as it is. Thanks. With luv, Jeanette

Harley PoMMom

12-05-2009, 12:29 AM

Lori, That explanation was very helpful. I appreciate it. Thanks. But of course more questions.

If I do another stim test at this point being that she stopped the trilo for several days should her levels be higher at this point?

I would hope that they would be higher since she in not receiving the Trilostane.

What if they are still too low?

Numbers are not the only tools we use to gauge our pups cushings control, the clinical symptoms tell us alot too. But when numbers are so low like Princess's numbers were then we start to get very concerned as your IMS did since she did stop the Trilostane. If Princess's numbers are that low again, which I doubt, but if they are you do not want to start the Trilostane but you do not want to lose control either. I am pretty sure when you have her stimmed again and her electrolytes checked (thanks Debbie) that she will be able to restart the Trilostane at a lower dose, but I would insist that she be restimmed again in 10 days.

What is the recommendation to bring the levels up again?
Do they prescribe prednisone?

Stopping the Trilostane and giving them prednisone, sometimes when their electrolyes are imbalanced then mineralocorticoids and intravenous fluids may be required..

If so, what comes after that? another stim test?

IMO, yes and according to Dechra's, which I included below.

Lastly, when will I be able to re-start her on the trilo?

According to Dechra's U.S. Product Insert: http://www.dechra-us.com/File/prod_vetyrol.pdf

If the ACTH stimulation test is <1.45 μg/dL (<40 nmol/L) and/or if electrolyte imbalances characteristic of hypoadrenocorticism (hyperkalemia and hyponatremia) are found, VETORYL Capsules should be temporarily discontinued until recurrence of clinical signs consistent with hyperadrenocorticism and test results return to normal (1.45-9.1 μg/dL or 40-250 nmol/L). VETORYL Capsules may then be re-introduced at a lower dose.

What symptoms do I need to watch out for at this point even though she is off the trilo?

Clinical signs include weakness, lethargy, anorexia, diarrhea, vomiting, fever, watch for shakiness or trembling.

And lastly, I thought I read somewhere here that trilo is out of their system rather quickly once it is stopped?

PRECAUTIONS:
www.dechra-us.com/File/prod_vetyrol.pdf
Hypoadrenocorticism can develop at any dose of VETORYL Capsules. In some cases, it may take months for adrenal function to return and some dogs never regain adequate adrenal function.

http://www.dechra-us.com/File/prod_vetyrol.pdf

Now I'm not implying that Princess is heading toward an Addisonian crisis here, I'm not trying to frighten you in anyway, just want you to be aware that Trilostane can damage the adrenals.

I know, these are just a few of sooo many questions, but I think I've bombarded you enough as it is. Thanks. With luv, Jeanette

I know this can be a scary, frustrating and confusing disease to deal with but know we are always here for you, ask all the questions you want and we will try to answer them as best we can, ok.

Love and hugs,
Lori

BestBuddy

12-05-2009, 02:24 AM

Hey Jeanette,

There are so many different paths this could take so the best thing is to keep an eye on Princess and make sure she is feeling ok.

So many of our dogs have had different reactions to differing numbers. Buddy couldn't cope being under 2 and then actually went into remission, in other words low enough not to need addison meds and not high enough to start the trilo again.

Some of the pups here cope really well with low numbers and show no signs of distress. So what I am trying to say is that although we can offer suggestions and links it will really be up to Princess as to how this is played out.

Now that you have stopped the trilo (you have haven't you?) she shouldn't get any lower and if you get another ACTH before starting again then it will be fine. I may be wrong but I am sure that if Princess was gong to have a crisis then it would have happened by now.

Hoping for good reports.

Jenny

labblab

12-05-2009, 09:19 AM

Hi Jeanette,

I think that Jenny has just given you some excellent feedback about Princess' situation. The fact that Princess is outwardly behaving normally is reassuring. I personally would bet that her avoidance of water for that two-day time period was a reflection of her cortisol level at its lowest. I am very relieved that she has started drinking again, and I would like to assume that her cortisol level has started to rebound upward. But as everyone else has already said, you can't know that for certain without another ACTH test.

You must feel as though you are in a very awkward position right now, since your specialist has told you to go ahead and resume the trilostane tomorrow and we are warning you about waiting until she has been retested. Here is one other suggestion...even if Princess is not formally retested prior to resuming the trilostane, Dechra additionally advises that you wait until she starts exhibiting Cushing's symptoms again -- greater-than-normal thirst, appetite, etc.

Capsules should be temporarily discontinued until recurrence of clinical signs consistent with hyperadrenocorticism and test results return to normal (1.45-9.1 μg/dL or 40-250 nmol/L). VETORYL Capsules may then be re-introduced at a lower dose.

Due to the manner in which trilostane works to lower cortisol, you are not risking a big treatment setback by waiting for symptoms to reoccur before resuming the medication. Instead, seeing the resumption of symptoms signals the fact that Princess' adrenal function and cortisol level truly HAVE rebounded sufficiently to require the medication once again. So if it were me and I was not going to formally test Princess, I would still hold off on starting back, even at a lowered dose, until she appears to be symptomatic again. That was the reason why I was feeling so nervous about the instructions to begin on Sunday regardless of whether or not she was drinking any water. So with the prospect of giving her the trilostane in the morning, I will be very anxious to know how Princess is behaving by the end of the day today -- whether her Cushing's symptoms have started to increase, or not.

Please keep us updated,
Marianne

mypuppy

12-05-2009, 11:04 AM

Hi Marianne, I think everything you and the others have said makes a ton of sense, and honestly am quite baffled my IMS is not adhering to Dechra's recommendations you posted here in a case like Princesses. I DID NOT know these were their guidelines, however, I would expect my IMS to follow Dechra's recommendations since she made the initial decision to follow their guidelines in the first place when we began her Princesses treatment. I am truly torned about this and how to proceed or not. Is my IMS perhaps concerned we will see a setback with treatment if we wait to see clinical signs to restart? I don't know. I think I am going to hold off either way, and call her on Monday and mention Dechra's guidelines and get her opinion on that. May I ask where exactly you found Dechra's info which stated to no restart treatment until clinical signs begin again? I would like to have it in front of me when I speak to my IMS. In the meantime, Princess is drinking very little water, not excessively in the least, therefore, should that lead me to believe that her levels have not gone up yet? And if they have not increased, I know Jenny said if she was heading for an Addison's crisis if would have happened already, but should I still be a little concerned if I don't see Cushings clinical signs soon? Thanks again, and I will most definitely keep you informed. Best regards, Jeanette

mypuppy

12-05-2009, 11:19 AM

Lori, I will get through this with the help of everyone. One day at a time. On another note, I hope Harley is doing better these days. All our love. Jeanette and Princess

labblab

12-05-2009, 11:55 AM

Jeanette, if you click on the link below, you will be taken to the official Dechra Product Insert that is included with boxes of Vetoryl capsules that are sold in the U.S.:

http://www.dechra-us.com/File/prod_vetyrol.pdf

The paragraph about withholding trilostane until Cushing's symptoms reappear and cortisol levels rebound above 1.45 ug/dl can be found in the second column, under "Long-Term Monitoring" (it is the second paragraph under that heading).

Here is another link, this time to the portion of Dechra's U.S. website that is intended specifically for veterinarians (the Product Insert above is included there). There is lots of helpful info here for pet owners, as well. And if you or your vet click on the "Contact Us" button at the top of the page, you'll be given a telephone number and email address for Dechra's office in Kansas. There are veteranarians on site there who are available to field any general questions about Dechra's treatment and monitoring protocol.

http://www.dechra-us.com/page/veterinarians

Hope this helps!
Marianne

mypuppy

12-05-2009, 12:26 PM

Dear All, The anticipation has just been building up too much for me to wait till Monday to talk to my IMS, so I put in a call a few minutes ago to gladly find she is in the office today. I left a message for her. In the meantime, I printed out the Dechra product insert to discuss with her. I hope she returns my call today. Will let you all know the outcome of our conversation. Jeanette

mypuppy

12-05-2009, 03:54 PM

littleone1

12-05-2009, 04:33 PM

Hi Jeanette,

I'm so glad that your IMS has seen the light. You are definitely doing the right thing by having Princess's electrolytes checked and having a stim test done before you start her back on the Trilo.

Hugs and kisses for both of you from the Corkster and me.

Harley PoMMom

12-05-2009, 04:37 PM

Hi EVERYONE, After careful consideration of all your comments, suggestions and phone conversation with Princesses IMS today, we have decided to delay restarting treatment tomorrow and proceed with another stim test as well as checking Princesses electrolytes. The thought of giving her any tiny bit of meds without knowing if those levels came up at all after her last stim had me on edge. I feel a lot more at ease for now. I have scheduled her test for this coming Tuesday. I am hoping by Tuesday's test, it will bring me a bit more peace of mind to continue with treatment soon at the lower dose. Thanks to all...Best regards, Jeanette

Hi Jeanette,

I truly believe this is the best thing to do for Princess too...Good job!! Believe me when I tell you I know how you feel...this cushings disease is so frustrating at times...to know what exactly to do, I am at that time with my boy Harley...do I load him with Lysodren or do I just do a maintenance dose..ugh.

Two things I have learned tho, always listen to your gut, your instincts will always steer you in the right direction, and you know your pup best.

Will be watching for Princess's test results, and give her some belly rubs from Harley and me.

Love and hugs,
Lori

mypuppy

12-08-2009, 02:18 PM

Hi everyone, Just got back from Princesses stim test and her Nova State profile. Great news! Her electrolytes were normal. They also checked her blood sugar and those were normal as well. I don't have stim results yet. Will have those by tomorrow, and I will post the actual numbers for you as soon as I have them. Princess is doing fine off the trilo with no recurrence of any Cushings clinical signs, so I am curious to find out when I can restart her on the trilo? Thanks again to all of you for pushing me to do this. I feel so much better knowing she's doing alright after learning her numbers were very low. Post soon. Hope everyone and there pups are well also. Luv and licks. Jeanette and Princess

haf549

12-08-2009, 02:33 PM

Great news about the electroytes. Hope the stim test is equally good. You know, I think I'd hold off on restarting the trilo until you see a re-occurance of the symptoms. I wouldn't let them get really bad, but may-be hold off a little longer since Princess is doing so well right now. Looking forward to the stim results.

Heidi

Squirt's Mom

12-08-2009, 02:41 PM

Hi Jeanette,

I have been following along and was so happy to hear you had stopped the Trilo. Like Marianne, I feel her sudden disinterest in drinking was an early sign of the cortisol dropping too low. I would keep that in mind for the future in case she ever does that again...you will know that this is one way Princess' body reacts and one indication of a looming problem.

As for restarting the Trilo...as has been pointed out, this should NOT be done until an ACTH tells you her cortisol has reached higher levels again AND her behavior returns to a pre-treated state - i.e. her signs are strong. Until you have these factors in place indicating the cortisol is out of control, restarting the Trilo could be very dangerous.

I know you feel better with her on treatment, completely understandable. But don't forget that the treatment itself can be hard and cause problems if not handled properly. Let Princess and the ACTH guide you in making the decision as to when to restart the meds.

Keep your chin up!
Hugs,
Leslie and the girls

mypuppy

12-08-2009, 02:43 PM

Hi there Heidi, I think you are right and I had actually thought the same thing, so I may just do that until I at least see one or two of her symtoms recur. It gives the pup a little break from those terrible meds they have to take. Ugh....Thank you, and I hope Kira is doing well these days. Tune in tomorrow or next day for stim results. I am so anxious to get them already....Lots of luv, Jeanette

littleone1

12-08-2009, 06:04 PM

Hi Jeanette,

I'm so glad that Princess's electrolytes are good, and that her other blood work results were in the normal range. :D I know that's one less thing to worry about. I'll be watching for her stim test results.

I was also glad to hear that Princess is doing so well. It's great to see them being their normal selves again.

Take care.

mypuppy

12-09-2009, 03:31 PM

Hi there everyone,
Just heard back from Princesses IMS with her stim results:
Pre cortisol: 2.5
Post cortisol: 6.7
=====================================
Her 14 day stim results after starting trilo were:
Pre cortisol: 1.0
Post cortisol: 1.1
=====================================
As such, her IMS has recommended to wait until this coming Saturday to restart her on 1 (60mg) tablet once a day. She also mentioned Dechra's recommendation is to restart at a 90mg once a day, but she wants to be conservative at this point and go with the 60mg, and stim her again in 2 weeks. OUCH for my precious Princess and OUCH for us both emotionally and financially at $250.00 a pop...Wow! It really is an expensive condition to treat, but it's amazing how financially and emotionally draining it can be. Nevertheless, I wouldn't see it any other way for my precious friend. "Where's that money tree" as someone here put it once. LOL. We will do what it takes. In the meantime, if anyone would like to comment on her stim results or anything else, you know I welcome anyone's input. Thanks and Luv ya all...xo Jeanette

littleone1

12-09-2009, 03:44 PM

Hi Jeanette,

I'm glad you got the results of the stim test today. I can't comment on the results, as I'm still learning how to interpret the test results.

I am glad that your IMS is taking a more conservative approach and is starting Princess back on a lower dosage when she starts taking the Trilo again.

Hugs and kisses to both of you.

labblab

12-09-2009, 07:03 PM

Hi Jeanette,

I'm so relieved that Princess' ACTH results show that she has rebounded from her "low." And I am glad that you specialist is still advising a couple more days before resuming the medication.

I'm puzzled by her statement that Dechra would recommend 90 mg. at this point, unless she actually contacted them for a specific recommendation? All that Dechra states in writing is that remedicating should begin at a "lower" dose. And if I'm remembering Princess' weight correctly (I think she's around 70 pounds?), 60 mg. daily corresponds more directly with the low end of Dechra's dosing range for a dog of Princess' size (1 mg/lb). But the important thing is that she is rebounding, and that you'll be starting back at a reduced dose. Yay! And hopefully after the NEXT test, you'll get to hold off on testing for a bit longer).

How is she doing in terms of symptoms?

Marianne

Squirt's Mom

12-09-2009, 07:24 PM

Hey Jeanette,

Oh so good to see that post come up a bit! ~~whew~~ Unless there have been some changes, that is right in line with a pup on Trilo. The desired post number for a Trilo pup is a bit higher than that for a Lyso pup, so it looks really good to me! :D

I am glad you will be waiting til Sat. to restart and very glad that the dose won't be increased to 90mg. Based on her weight, the 60mg is as much as I would want to go with, especially after being so low recently. Maybe I won't worry quite as much now. :o

Ya know...I have been planting coins in the back yard for nearly 2 years now and the only ones getting any richer are the gophers! :D I have told our vet if they come in one day and see a big cardboard box on their parking lot, that will be me and my girls. Gotta be close no matter what, ya know?! :D:p

Keep up the good work!
Hugs,
Leslie and the girls

mypuppy

12-09-2009, 07:31 PM

Thanks Marianne. I am a bit more relieved with the new results and knowing she will start off with the lower dose. As for my IMS statement, I don't know, but those were her exact words, and she did not really elaborate on whether she contacted Dechra directly or read it somewhere. I didn't really catch on, I was just happy to hear we would be doing the 60mg against the 90mg. Maybe something to ask her next time we speak. As for symptoms, Princess has not demonstrated any cushings symptoms since we started her on trilo and even now that she's been off the trilo for several days. She is engaging, is eating normally and seems happy, so it's very strange, but should I even question this behavior? Would you suggest holding off on restarting trilo until at least I see some recurrence? Hope all is well on your end, and thanks again for your post. Regards, Jeanette

Franklin'sMum

12-09-2009, 07:34 PM

Hi Jeanette,

Yippee!!! Princess's cortisol came up! She's no longer low! :D Oh Jeanette, you must be so relieved.

How's Princess seem to be feeling?

Jane and Franklin xx
________
Kitchen Measures (http://kitchenmeasures.com/)

mypuppy

12-09-2009, 07:42 PM

Hi there Leslie, long time no post, LOL....Thanks for your post. I feel I am in a good place right now with Princess after this last stim, and feel much better about restarting her trilo on Saturday at the lower dose. I am so hoping this will be the final dose for her so we don't have to over stim her and stress her more than she needs to be. I feel awful dragging her to these tests so close together, but I accept they are necessary for this purpose to go without a hitch. And yes, I hear you about the coins......LOL....These are days when I wish fairy tales were real, just like Jack and Beanstalk--Oh how I'd love to have some of those magic beans right now......haaaaaaa......Hope all is well with you and the pups, and thanks again for motivating me to do my best....Luv ya, xo Jeanette

mypuppy

12-09-2009, 08:39 PM

Hey Jane, great to hear from you. Yes, I am quite relieved for now, and honestly Princess has been doing great ever since we started treatment. Her water intake has decreased dramatically, however, I highly believe it has much to do with the change of weather now and less outdoor activity. Although we just had our 2nd snow storm of the season and she has been having tons of fun out in the snow, and have noticed her going straight for her water bowl when she comes inside from playing. So again, I think definitely the drastic drop in temperature is a contributing factor to her less water intake lately. Other than that, I can't complaint. She is happy, and so am I, and the one thing I am enjoying most about her these days is that she sleeps in my bedroom right next to my bed all through the night. It is just such a great feeling to know she's there by my side and not feeling uncomfortable in any way as when she was first diagnosed with this condition. I know you can relate to this wonderful feeling. How is little Franklin himself these days? Hope all is well with him. Take care and Best regards, xo Jeanette

haf549

12-09-2009, 08:44 PM

Jeannette:

Glad to hear about the great results of the stim test. You must be verrrrrry relieved, specially since Princess is acting normal again.

Personally, I would hold off giving the trilo until Cushings symptoms re-occur but then again, I don't know how stopping the symptoms and then letting them re-start and the stopping them again affects the overall health of the dog. What a tough call!!!:(

At least your vet is starting Princess on 60mg which is great. For a 70lb dog, that is on the low end of the dosage recommendation, so that's great. I know you'll be watching her very closely once she re-starts.

Great news though:D:D:D

Heidi

mypuppy

12-10-2009, 12:17 PM

Hi Heidi,
Thanks, and yes, extremely relieved. I thought the same thing and holding her out even longer than this Saturday, however, her specialist did say based on her stim, she's on her way to being cushingnoid soon, so she thought Saturday would be a good restarting point. And as you mentioned I feel if I prolong it she may have a big setback, and we would have to start this process all over again with extra stims, etc. We have done so many already, so I don't want to risk that dilemma. I am hoping that the 60mg will finally be the right dose for her so we can move on with this. I will definitely let you and everyone know her status. Thanks for your post. How is Kira these days? Best regards, xo Jeanette

mypuppy

12-10-2009, 01:00 PM

Dear All, As relieved as I was to find out Princesses cortisol levels came up after stopping her trilo, part of me felt compelled to contact Dechra directly in order to get their guidelines as to how to proceed, despite what my IMS instructed me to do. Interestingly enough, the person I spoke to highly recommended I restart Princess on the 60mg once a day, and even further strongly recommend to wait for clinical signs to reappear. Taking all that into consideration I have made the decision to hold off from restarting the trilo this coming Saturday, unless I see some signs in the next couple of days. Somehow I feel the chances of that are pretty slim considering I came to the conclusion today she was oversuppressed in the first place at the 120mg per days. My poor baby! This is the point where I get bent out of shape with the differences of opinions and recommendations. Dechra's product insert does recommend to begin a dog of Princesses weight at the 120mg, however, the person I spoke to today mentioned if a person were to contact them directly, as I did today, they would recommended starting at the 60mg once a day. I questioned this and explained it poses a great conflict of interest for both doctor and patient relationship. In Princesses case, I would have preferred her starting at the 60mg, but my IMS thought otherwise. At any rate, I just wanted to share this bit of info with everyone here who uses trilo for future reference. It is probably best to contact them directly with any questions or concerns. Thanks Marianne for the earlier link in order for me to receive all this info. Best regards to all. xo Jeanette

Roxee's Dad

12-10-2009, 01:05 PM

Hi Heidi,

Thank you so much for that update and information. I am glad you contacted them and have a safe and conservative plan in place for Precious Princess :)

Good job!

labblab

12-10-2009, 01:22 PM

Dear Jeanette,

I am so glad that you spoke directly with the Dechra folks! The dosing information you received corresponds with info that I have heard as well -- that they are verbally encouraging people and vets to begin initial dosing at the low end of their recommended range, which is 1 mg. per pound. Princess seems to be a classic case that starting lower would have been better. I, too, wish that there would be revision to the written chart. But in the meantime, I'll also do what I can to help "get out the word," and to encourage owners and vets to contact Dechra directly if they need clarification about this.

I do feel confident that Princess will do much better on the lower dose. And I don't think you will be losing ground by delaying the medication until you see an increase in symptoms. That will just mean that her cortisol has rebounded to the point where she truly needs to be treated once again. I'm guessing it won't take too long for her to get there, and maybe it will even be by Saturday.

Good work, Jeanette!
Marianne

littleone1

12-10-2009, 01:30 PM

labblab

12-10-2009, 01:50 PM

Hi Jeanette,

A few weeks ago, Dr. Renee, on CCAC, went to a Vetoryl presentation by Tim Allen, who is an IMS that works for Dechra. During the presentation, he told everyone there to change the dosage from 1-3 mg/lb to 1 mg/kg across the board. It seems that Dechra is now changing their dosage to that of UC Davis. This is probably why the lady you spoke with gave you the information that she did. I really don't know if this information has been released yet for publication. This is the information I got on CCAC.
Hmmmm....Terri, I am thinking that there is some misunderstanding about this. As it turns out, I too have had occasion to talk to Dr. Allen recently. I had some general questions that I wanted to ask him, and initial dosing was one of them. He told me that he is personally recommending that people start at the lowest end of the Dechra range, which is 1 mg. per pound (and not 1 mg. per kg.). I don't think I misheard him, because we went on to discuss the differences in Dechra's recommendation from UC Davis.

He stressed that they are in no way challenging any vet's decision to follow Davis' guidelines if that is their preference. But the dosing protocols are not identical. I really wish that there would be written revision to Dechra's chart, in order to clarify this revised recommendation. But barring that, I will encourage people to contact Dechra directly in order to get the information first-hand in the event that they want more info. Here's contact info for Dechra's U.S. office: "Contact Us" (http://www.dechra-us.com/page/contact-us)

Marianne

littleone1

12-10-2009, 02:38 PM

mypuppy

12-10-2009, 03:25 PM

Hi Marianne, That gutt feeling again kicking in and telling me to pursue this further...again, do not like to leave any stone unturned at Princesses expense. And I agree, I too wish Dechra would revise that product insert ASAP and adhere to the lower dosing guidelines for future cushpups and whose owners may not be inclined to second guess their vets and/or the makers of these meds. And you are doing a great thing by offering your knowledge and encouragement to everyone here. This is why we are all here to reach our greatest and proper potential in treating our pups. Thanks a bunch once again. Lots of luv, Jeanette

mypuppy

12-10-2009, 03:30 PM

Terri, absolutely right! When we are dealing with the potential high risk side effects of these meds, I do feel the makers need to be as conservative as possible and take the proper measures to inform people of such. Regards to you and Corky....Jeanette

mypuppy

12-10-2009, 03:36 PM

Terri, thanks for the info. I think it's great Dechra decided to rethink their dosing guidelines, but there has to be a better way for them to spread the word on this new change. I wonder if that change took place prior to Princess starting her trilo treatment, and wish I would have known prior to starting so that I would have avoided her being oversuppressed...Nevertheless, we can't look back now, just have to move forward, but I am so glad my gutt told me today to call them. Thanks again and I'm sure we will speak soon. It's nice talking to you...all our love to you and Corky, Jeanette

mypuppy

12-10-2009, 03:43 PM

Thanks John, I wouldn't see it any other way for mypuppy. We always feel we have to go the extra mile for them. Regards, Jeanette

labblab

12-10-2009, 04:09 PM

Thanks, Marianne.

This is what was posted on CCAC by Dr. Renee. I agree with you that it is important to see this in writing. Sometimes I think that there might be too much information out there that can be misconstrude (spelling?)
Terri, I have no doubts whatsoever that you have reported this posting accurately. I am guessing that the confusion is somehow between Dr. Renee and Dr. Allen -- maybe he misspoke himself at the conference or she somehow misunderstood what he said (because, of course, I have to believe that I wasn't the one to misunderstand what he said to me :o ;)). And you're right, it would be so much better if the chart itself were to be revised.

Marianne

mypuppy

12-10-2009, 04:29 PM

Dear Everyone AGAIN! - LOL! I disregarded to mentioned one other important source of info given to me by the Dechra rep. I spoke to today relating to restarting treatment. Dechra recommends restarting treatment only when the dog's cortisol levels reach over 9.1 and is demonstrating clinical signs. Another reason not to start Princess on Saturday since her post cortisol on Tuesday's stim was 6.7. Just and FYI for all of you....Jeanette

Harley PoMMom

12-10-2009, 04:43 PM

Hi Jeanette,

Good job on getting that info!! I am so happy that Princess is doing so well too.

Don't you feel like a yo-yo sometimes? One minute you're up...happy and the next...ughhh!! :eek::D:eek::D The life of a cushings parent!

You're doing a great job.

Love and hugs,
Lori

haf549

12-10-2009, 04:59 PM

Jeannette:

I'm glad you contacted Dechra and got all that info from them. Kira too was started at the high end of the dosage scale (120mg/day). She didn't have quite the crisis that Princess did, but she was acting weird for a good long time, before her vet decided to recalculate the dosage and came up with the 80mg she's now getting each day. I spent 3 months trying different things before we got the dosage right. She's now getting 40mg twice a day. She's an 80 pounder.

I'm also glad that you decided to hold off starting the trilo until the symptoms return. My gut feeling is that this makes sense.

Keep up the good work

Heidi

mypuppy

12-10-2009, 05:23 PM

Oh Lori, you are not kidding! Geez, when did we sign ourselves up for this "crazy" ride? All part of life I guess--gotta take the good with the bad, but double UGHHH UGHHH to all of it alright. I'm sure we can all readily go back to how life used to be prior to Cushings. AMEN! Thanks for writing...Luv ya too. Jeanette ps: How are you doing with Harley these days?

mypuppy

12-10-2009, 05:33 PM

Heidi, now I can breath a little again knowing I took an extra step to confirm what my IMS recommended or at least partial of what she instructed me to do. I have no problem at this point going against her orders and holding off on the trilo. She will just have to get over it...LOL! Go figure, they get paid the big bucks to figure out this stuff, and we're doing all the work....haaaaaa....Anyway, this Cushings stuff is extremely draining. At times, I feel as if I don't have enough hours in the day to dedicate even more of my time to this new challenge. My girls at this point everytime they see me on the laptop, automatically blurt out "on K9 cushings again"....LOL. They know, even the little one (5 years old). It's funny, but at the same time, I know they have been missing me a lot ever since this condition entered our lives. It's really tough to swing everything at times, but I am managing as best as I can and with the help of everyone here. I send you all my love and licks to Kira....xo Jeanette

UOTE=haf549;20656]Jeannette:

I'm glad you contacted Dechra and got all that info from them. Kira too was started at the high end of the dosage scale (120mg/day). She didn't have quite the crisis that Princess did, but she was acting weird for a good long time, before her vet decided to recalculate the dosage and came up with the 80mg she's now getting each day. I spent 3 months trying different things before we got the dosage right. She's now getting 40mg twice a day. She's an 80 pounder.

I'm also glad that you decided to hold off starting the trilo until the symptoms return. My gut feeling is that this makes sense.

Keep up the good work

Heidi[/QUOTE]

haf549

12-10-2009, 08:25 PM

Jeannette:

Yes, Cushings is verrrrry draining, emotionally and physically. Kira has been stable since January (that's almost a year now) but I'm still recovering from it. I'm still tired a lot of the time and don't sleep very well. That's from getting up every 2 hours back last fall. I don't think my sleep pattern has ever recovered. I'm just really glad that Kira is doing so well, even with the surgery last month. The hair is starting to come back in on her legs and she's finally stopped licking at the scars. She was still wearing her leg warmers up until early this week. I'm still doing the hydrogen peroxide and polysporin on her legs. Right now she's absolutely loving the weather; snow, below zero temps, high, cold winds, etc. Ah huskies!!:p

I'm glad you've decided to hold of on re-starting the trilo. I think you're doing the right thing. When I was going through this last year, I wish I had held firm to my resolve to start her on the lower dosage. It would have saved a lot of worry. It's hard to question the vet, who you attribute to knowing more than you. However, my vet even suggested that I research Cushings and has absolutely no problem with my questioning his every move. I have a lot of confidence in Kira's clinic and vet(s).

Heidi

Squirt's Mom

12-11-2009, 02:08 PM

Hey Jeanette

I just gotta tell you how very proud I am of you! :) You are becoming a fierce advocate for your precious baby and I know how difficult it can be to step into that arena with all those "experts" but you did it and did a GREAT job of it! You deserve a huge
Atta Girl!!!

Keep up this good, good work, sweetie!

Hugs,
Leslie and the girls

mypuppy

12-11-2009, 05:49 PM

Hi everyone,
Latest development: I wanted to keep the lines of communication open with my IMS, therefore, I popped her an email advising her I would not be restarting Princesses trilo tomorrow, Saturday, based on the verbal communication received by Dechra. I just received her reply saying the only problem she has with holding Princess off is that her cortisol levels may go sky high again and the lower, conservative dose (60mg once a day) may not be enough for her at that point. So here I am stuck again between a rock and a hard place as to how to proceed now taking my IMS's point into consideration. UGH, UGH....Who signed me up for this again?????? YIKESSSSSSSSS. Anyone like to comment on this? Thanks. Luv, "going out of her mind" Jeanette

labblab

12-11-2009, 06:33 PM

I just received her reply saying the only problem she has with holding Princess off is that her cortisol levels may go sky high again and the lower, conservative dose (60mg once a day) may not be enough for her at that point... Anyone like to comment on this?

Hi Jeanette,

As you've discovered, I'm always happy to comment on stuff :p, so here goes...

Of course, I am not a vet, and I have had no veterinary training whatsoever. So you can take my thoughts with a grain of salt. But I'm not seeing any particular risk with holding off on the trilostane until Princess becomes symptomatic again. Your specialist's comment would make more sense to me if you were treating with Lysodren rather than trilostane. Due to the way in which Lysodren physically acts upon the adrenal glands, a dog that "escapes" control on a too-low dose of Lysodren typically needs to go through a specific "loading" process all over again. However, trilostane is very short-lived and acts in an entirely different manner. If it turns out on your next ACTH test that Princess' cortisol is not being lowered sufficiently on 60 mg., then you'll just increase the daily dose a bit. If 60 mg. is not a high enough dose for her, her cortisol level will not be adequately controlled at the time of testing, regardless of what the level is when you resume treatment. And if it IS a high enough dose, you'll be just fine -- again, regardless of whether that initial level is really elevated. That's the whole point -- when given at a therapeutic dose, trilostane works quickly to lower the cortisol.

So there's my thoughts, for whatever they are worth. ;)

Marianne

mypuppy

12-11-2009, 09:43 PM

Marianne, you are too funny! I always look forward to reading all your comments, so don't ever hold back on those because I do take them seriously. I knew lyso and trilo work differently, but I wasn't aware how until you just clarified it for me. One other question, which perhaps you may not be able to answer, but I was wondering how long do you think it will take for Princess to become symtomatic again? I mean what if she doesnt show symptoms in a long while from now? Is it ok to still not treat? And there you have it, more questions for you to happily comment on. LOL....Thanks a bunch. xo Luv, Jeanette

forscooter

12-11-2009, 10:17 PM

Hi Jeanette,

I am just going to jump in here and admit I haven't had a chance to read through all the latest goings-on....but, to answer your question, most Cushing's dogs are not treated unless they both have positive tests (which I know you have long done) and in the presence of clinical symptoms. So although I know Princess is positive for Cushing's, and she did have symptoms before, I would be hesitant to treat in the absence of those symptoms if you are stopping dosing now until the symptoms start to return. The reasoning being it is hard to determine what is working and not working without the presence of symptoms. As long as she is not showing symptoms, most likely the cortisol is not high enough to cause as much of a concern.

I am suffering from a mild cold and brain fatigue, so I hope this makes sense.

Many hugs, Beth, Bailey, always Scoobie, Allo and Baby Pallie

Oh I should add we used Lysodren....so someone may have something different to say...;)

Franklin'sMum

12-12-2009, 09:12 AM

Hi Jeanette,

One of the things to look for when using trilo and figuring out when to take Princess in for a stim test during the first couple of weeks is a reduction in symptoms, (excessive thirst, urination, eating habits, and if arthritis/allergies are issues, whether symptoms lessen when not on meds, versus becoming more pronounced when on meds as the cortisol lowers.)

If symptoms have not resumed and the meds are restarted, it would be very hard to try to tell if she is responding well to the treatment.

Hope this helps,

Jane and Franklin xx
________
Magic Flight Launch Box (http://mflbvaporizer.com)

lulusmom

12-12-2009, 09:44 AM

One other question, which perhaps you may not be able to answer, but I was wondering how long do you think it will take for Princess to become symtomatic again? I mean what if she doesnt show symptoms in a long while from now? Is it ok to still not treat?

Hi Jeanette,

Unfortunately, there is no way to predict when Princess might become symptomatic again. All dogs are different and some dogs may become symptomatic in weeks while others take months. When I switched my Lulu from Trilostane to Lysodren, we had to go through a 30 day washout period. After 30 days she was still not symptomatic and her post acth stim was 20 ug/dl so we waited until she became symptomatic before starting the Lysodren. It took a good two months before she was symptomatic and it was pretty nice for both of us to have a little vacation from the pills.

Glynda

littleone1

12-12-2009, 09:57 AM

Hi Jeanette,

Before Corky started taking Trilo, his clinical signs were in remission for seven months. I know Corky's IMS told me that the signs could come back in a week, a month, 6 months, etc.

You might also want to look at Spiceymum's thread. Spicey's symptoms were in remission for quite a long time.

Squirt's Mom

12-12-2009, 11:47 AM

Hi Jeanette,

Throwing my 2 cents in...everyone is right about how long before you see signs again. I have noticed that with Trilo pups there sometimes seem to be periods of remission...some lasting a good long while. There is even a remote possibility that she will remain in remission and not need the meds any more...but that IS remote.

The key for you now is to continue to watch her closely...as I know you do anyway. ;) If you notice the signs coming back and they become rather strong, then it is time for that ACTH and electrolyte check again to see exactly where the cortisol and electrolytes are then. Those two - signs and cortisol levels - will dictate what needs to be done, if anything right then.

Soooooo....enjoy the break, pray it lasts a loooong time, BUT don't you dare stop checking in! :)

Hugs,
Leslie and the girls

mypuppy

12-12-2009, 05:28 PM

Hi Leslie, goodness in the midst of your own puppy troubles you still manage to give the rest of us sheer encouragement--I truly believe this is your "calling"--and I thank you for your selfless acts each and every time. On another note, I am totally enjoying the fact that Princess is on "break" from these meds and not exposing any symptoms whatsoever. I won't question it any longer and just go with the flow so long as all is well. You did implant one bit of doubt with your post when you said "there may be a remote possibility Princess may remain in remission and need not take her meds anymore". I learned on this forum that with trilo, unfortunately it is "for life". Princess's IMS confirmed that as well, so I am very curious to learn where you learned that. It in fact there is some validity to that, oh, that would be so ideal, but geez, that would be the same odds as winning the lottery, no? At any rate, I hope you and the girls are holding up ok, and remember you are in my constant thoughts and prayers. BTW, if Princess goes into remission "for life", you'd still not get rid of me that easy, so nice try...haaaaaa..... I love ya and sending you and the pups comforting, tight hugs and lots of wet licks from the Princess...xo Jeanette

mypuppy

12-12-2009, 05:39 PM

Hi Terri, Wow, 7 months is a nice, long vacation away from this Cushings $*&$*%&*#$%*# (for a lack of better words--lol).....But I know I can't compare Princess with Corky or anyone else, but it would be heavenly to say the least. She's doing great still and showing no symptoms. I guess her over suppression on the high dose really did a number on her, good thing we had that stim, otherwise, would have never known until perhaps it was too late. UGH, UGH. These meds are definitely a double edge sword. Thanks for the info on spiceysmum, I will try to go there when the girls are finally in bed for the night....In the meantime, best regards to you and the meatloaf eating Corkster.....lol......Luv ya, xo Jeanette

mypuppy

12-12-2009, 05:42 PM

Hey Glynda, nice to hear from you. I hope I am not prying but I would love to know why you switched Lulu from trilo to lyso? Did she have a bad reaction to trilo, did your vet recommend the switch or was it your own decision and why? Again, sorry for sounding nosy, but would really love to know. Thanks for your post. Luv ya. Jeanette

mypuppy

12-12-2009, 05:49 PM

Hi Beth, sorry about your cold and brain fatigue...hopefully your brain cells are recovering by now, but I can assure you, you always make sense no matter what the weather--lol. I did decide to hold off on Princess's trilo a while longer and until I see at least one symptom return. According to her IMS, she thinks it may be rather soon since her last post stim was 6.7, and when I spoke to Dechra, they said they warrant restarting treatment only when a pup's post cortisol is 9.1 or over, so it's so weird that Princess may already be at that level or above, who knows, but not showing the symptoms. That is what amazes me about this "dratted disease" (quoting Lori, as usual)--love the term because it is "dratted indeed"....Anyway, will continue to watch for one lousy symptom to continue. Take care and all the best to you and the pups....xo Jeanette

StarDeb55

12-12-2009, 05:52 PM

Jeanette, I don't want to put words in Glynda's mouth, but since she doesn't appear to be on-line, I can pretty much answer this for her. She will add anything that I miss. Lulu has Atypical Cushing's, along with PDH. Glynda will explain exactly what happened, but for whatever reason one of Lulu's initial treating vets put her on trilo even though she had numbers on the associated hormones that were sky high. Trilo will pretty much always raise some of the intermediate hormones which is what happened with Lulu. This made these levels worse to the extreme, & Lulu really never had a clear resolution of symptoms because of these worsening intermediates.

Debbie

mypuppy

12-12-2009, 05:55 PM

Hi Jane,
I'm thinking with the dose Princess started on, which was obviously too much because of her very low stim, who knows if she may not expose any symptoms in quite a while from what I am learning here lately. Don't get me wrong, that would be ideal for mostly Princess and me both, but I also reflect on what her IMS told me if we wait for symptoms to recur, the lower conservative dose may not be adequate enough at that point if her cortisol levels are sky high, and risk having her go to a higher dose again?? I don't know. For now, I am waiting it out as long as Princess seems fine and not showing any symptoms. If and when I see at least one, I will restart her immediately on the 60mg once a day and take it from there. Hope little Franklin is doing well these days. I luv ya both, xo Jeanette

Franklin'sMum

12-12-2009, 11:48 PM

but I also reflect on what her IMS told me if we wait for symptoms to recur, the lower conservative dose may not be adequate enough at that point if her cortisol levels are sky high, and risk having her go to a higher dose again?? I don't know.

Hi Jeanette,
Trilostane should lower the cortisol somewhat, regardless of a lower dose being used. If after the stim test, symptoms still aren't controlled and her levels are still too high, the trilo dose can then be increased slightly.

Because trilo doesn't have a loading phase, she really should not "escape control." If however her cortisol levels are too high, and symptoms have not resolved, from what I've read, the dose just gets adjusted a little at a time, until she's showing no/ less severe symptoms. You don't have to re-load, because there is no loading with trilo.

Hope Princess continues to do very well, end enjoys the break from no meds :)

Jane and Franklin xx
________
Justin bieber (http://justinbieberfan.info/)

Squirt's Mom

12-13-2009, 10:28 AM

Hi Jeanette,

Maybe this will help you understand....no matter how many or how strong Princess' signs may become, that has no bearing on the dose of Trilo she would need. The dose is based on one thing and one thing only - her weight. The same is true of Lysodren - the drug isn't administered based on the severity of the signs but on the dogs weight. The Trilo should be administered at the same dose and will have the same effect no matter how strong Princess' signs become.

I don't recall but is Princess your vet's first Trilo patient?

Hugs,
Leslie and the girls

labblab

12-13-2009, 10:55 AM

Hi Jeanette,

Maybe this will help you understand....no matter how many or how strong Princess' signs may become, that has no bearing on the dose of Trilo she would need. The dose is based on one thing and one thing only - her weight.
Leslie and the girls
Just to offer one bit of clarification which I'm thinking Leslie will agree with...the INITIAL dose of trilostane is based solely upon weight. After treatment has begun, all subsequent trilostane adjustments are based solely upon ACTH results (coupled with the dog outwardly appearing to be healthy). This is because dogs metabolize the drug differently, and dogs of the same weight may ultimately end up requiring widely ranging doses as they stabilize on the medication.

However, in Princess' case, we have both her weight and the results of her first ACTH test to indicate that 60 mg. will be a better starting place. The 60 mg. corresponds most closely to Dechra's conservative 1 mg/lb initial dosing recommendation. And from the ACTH results, we know that 120 mg. was clearly too much for her.

Marianne

Squirt's Mom

12-13-2009, 11:00 AM

Absolutely agree with, Marianne, and thanks for making that clarification!

mypuppy

12-13-2009, 07:30 PM

Marianne, Thanks for that clarification. That is exactly what I learned a while ago on the forum and from my IMS...The initial dose goes by her weight based on Dechra's guidelines and then her stim numbers somewhat decide the rest of her dosing adjustments....Again, thank you for clearing it up for all of us here....xo Jeanette

mypuppy

12-13-2009, 07:39 PM

Hi Leslie, Thanks for your post. And to answer your question; no, Princess is not my IMS's first Cushings patient. In fact, thanks to her we were able to find the Cushings diagnosis versus my GP who said it was a behavioral problem. She also confirmed having treated many Cushings cases successfully with the trilostane against the lysodern. Hope all is well with you and will keep in touch....xo Love ya lots, Jeanette

mypuppy

12-13-2009, 07:42 PM

Dear all, i know some of you asked a while back you'd like to see some more pictures of princess, so i finally added some new ones to my profile. Hope you all enjoy them as much as i enjoyed taking them....i love you...xo jeanette and licks princess

haf549

12-13-2009, 07:56 PM

Great pictures of Princess, Jeannette.

Heidi

MiniSchnauzerMom

12-13-2009, 08:15 PM

Jeanette,

Loved the pictures! Thanks for posting them. How is Princess doing?

Louise

mypuppy

12-13-2009, 09:20 PM

Oh thanks so much Heidi....I think all pups are so beautiful in pics...Best regards....Jeanette

mypuppy

12-13-2009, 09:26 PM

Hi Louise, Not sure if you have been peeking in on my thread, but long story short, stopped the trilo for a while since she was oversupressed with her initial dose--waiting to see some symptoms reappear so we can restart. Other than that, Princess is doing great, thanks for asking, and we are both enjoying the break from the meds..Take care and Best regards,,,xo Jeanette.

littleone1

12-13-2009, 09:30 PM

Good pictures of Princess, Jeanette. I think my favorite is the one of her laying down on the floor.

How is she doing today?

Give Princess hugs from me and kisses from the Corkster. He's still taking his Trilo with meatloaf.:D

mypuppy

12-13-2009, 09:38 PM

Good evening Terri, How are you? I was just about to sign out for the night and saw your post. Princess is still doing great. It's been raining all day so she didn't get out much, but hopefully the "sun will come out tomorrow" so she can play in the snow a bit if it doesn't wash out. Enjoy the rest of your day and night. Talk soon. And the same wishes to you and Corky. We love ya....xo Jeanette

MiniSchnauzerMom

12-14-2009, 12:20 AM

Hi Jeanette,

Although I may not always post, I do regularly peek in to see how your girl is doing. :D I'm glad that Princess is feeling well and I do think waiting until symptoms reappear before starting the Trilo again is a good choice.

Give Princess some extra petting from me.

Louise

mypuppy

12-17-2009, 07:05 PM

Hi there everyone, Didn't want you to think I've forgotten about all of you now. Wanted to let everyone know Princess is doing great these days and is still off the trilo and not showing any symptoms yet. I hope you and your pups are doing well, and for those who need some extra TLC lately, I send you all lots of tight hugs and kisses and licks from Princess. I love ya all....xo Jeanette

]

mypuppy

12-19-2009, 06:41 PM

Hi Debbie, I see you've been cleaning house....lol...thanks so much and I can see what a huge difference. Sorry and thanks for handling that--same to you Glynda....Much love and regards, xo Jeanette

Annie's Mom

12-22-2009, 03:41 AM

Jeannette,
So glad to read that Princess continues to do well being off of Trilo! We cherish all the good days :)

Barb - Annie's mom

mypuppy

12-22-2009, 07:18 PM

Hi there Barb, Yes, indeed we do cherish the good days with our cushpups, and her being off the meds for a little while is certainly a dream we are both enjoying to the fullest. Ahhhhhhhh! Wish I can say the same for all our pups here. Thanks for posting, and I hope you, Annie and your family have a wonderful and healthy holiday season. All the best to you, xo, licks, Jeanette and Princess

mypuppy

12-30-2009, 10:21 PM

Dearest friends, wanted to send my very best wishes to everyone for a Happy New Year with your precious pups...May you and they be blessed with love and lots of good health in the New Year. We love you, xo Jeanette and Princess ps: check out my new family album with my 3 little Princesses.. lol.....

haf549

12-31-2009, 10:00 AM

Great pictures Jeannette. Looks like everyone had a great Christmas

Heidi

lulusmom

12-31-2009, 11:18 AM

Hi Jeanette,

Just saw the new pictures and loved them!!! You have three very beautiful princesses. Thanks for sharing and Happy New Year to you and yours.

Glynda

jrepac

12-31-2009, 02:54 PM

very cute pix:)

mypuppy

12-31-2009, 03:33 PM

Awwwww! Thanks everyone. Glad you enjoyed the new pics of Princess and her two sisters...lol.....Love you all, healthy New Year....xo Jeanette

haf549

01-02-2010, 10:16 AM

Jeanette:

Just wondering... is Princess still off the trilo?

Heidi

Squirt's Mom

01-02-2010, 11:48 AM

Great pics, Jeanette! and a beautiful family!

Harley PoMMom

01-02-2010, 12:10 PM

I loved, loved the pics too. And I agree with everyone else, what a beautiful family you have, my friend.

Love and hugs,
Lori

mypuppy

01-02-2010, 05:50 PM

Hi Heidi,
Yes, Princess is still off the trilo and symptom free. In fact, today is exactly 1 month she's been off the meds. It's wonderful yet at the same time I am somewhat scared if there's any damage being done internally and if her Cushings is progressing while she is off, but I will continue to do as I'm doing until anything unusual develops. How is Kira doing on her trilo and with the Cushings and her warts? Take care....Best regards, xo Jeanette

mypuppy

01-02-2010, 05:59 PM

Dear Leslie and Lori,
Thanks to both of you for such nice compliments, but I can only be honest when I say my 4 legged daughter is more well behaved than my two legged ones.....she doesn't back talk....haaaaaaaaaaaaaaaaaaaaa......All kidding aside, they are all very precious...Thanks again, I love you both. Tight xo's, Jeanette

labblab

01-02-2010, 08:04 PM

Hi Jeanette,

I apologize for being late with my New Year's greetings! But here they are, regardless, and I absolutely agree that your three girls are precious -- what GREAT photos! :)

Lots of hugs and best wishes for this New Year,
Marianne

Harley PoMMom

01-02-2010, 08:14 PM

Hi Heidi,
Yes, Princess is still off the trilo and symptom free. In fact, today is exactly 1 month she's been off the meds. It's wonderful yet at the same time I am somewhat scared if there's any damage being done internally and if her Cushings is progressing while she is off, but I will continue to do as I'm doing until anything unusual develops. Best regards, xo Jeanette

Hi Jeanette,

No damage is being done unless her cortisol is elevated, and when her cortisol is elevated Princess will begin to show the clinical signs...so you can just relax...breathe...deep soothing breathes, ok. ;):)

Love and hugs,
Lori

mypuppy

01-02-2010, 09:30 PM

Hi Lori, ahhhhh, I needed to hear that little bit of reassurance. Thanks for that as always. xo Jeanette

mypuppy

01-02-2010, 09:32 PM

Hey Marianne, so glad to get your post and New Year's wishes. Same to you....Glad you enjoyed the pictures of the girls. Hope all is well on your end. Luv ya, xo Jeanette

clydetheboosmom

01-03-2010, 11:12 AM

Just getting caught up on your thread. It's true that the cortisol does damage when elevated - so no worries there. Bailey, my trilo dog, has gone Addisonian three times on trilo and taken "breaks" from the medicine...when her cortisol goes back up, you'll know! :)

Awesome pictures! :)

Love to you -

Lynne, Clyde & Bailey

haf549

01-03-2010, 02:03 PM

Jeanette:

Good to hear that Princess is still off the meds. The longer the better (emotionally and financially). As everyone has said, you'll know when she needs to start again. If she does show symptoms again, be sure to get the ACTH test done before re-starting the medication.

Kira is doing great. It's snowing today, so she's in her element. It's been a year now since she's been stabalized on the trilostane. Her paws have healed up and she's even growing back her fur; soft peach fuzz where she was shaved. I was worried, being a cushpup that the fur might not grow back, but....

Let's hope things stay on an even keel for all of us this year.

Heidi

Casey's Mom

01-04-2010, 04:39 PM

Just wanted to chime in - beautiful photos and wonderful news that Princess is still off meds and doing well.

mypuppy

01-05-2010, 05:46 PM

Dear All,
I dreaded to be the bearer of bad news, but of course, as always, I felt the need to keep everyone afloat on Princesses status. Yesterday while I was playing with her, Princess shook and a pretty huge clump of hair fell right out of her. So here I'm looking at this humungous fur ball, and needless to say I was shocked and very frightened. This has never happened to Princess before so I knew it was not normal and right then there I knew deep down this was a result of the "dreaded" Cushings taking over. UGH, UGH. I can't help but feel a bit yipped since here I was thinking, WOW! maybe she'll be in remission indefinitely or at least a little longer. Wishful thinking on all our parts when it comes to our babies huh? I hope I'm not judged here too harshly because I was so taken off guard here by this and I had never experienced this hair loss issue and just took matters into my own hands and immediately restarted her on the trilo just today without calling her IMS or getting her stimmed. All that was running through my mind was "have to start her before her entire hair falls off". It was also that gutt feeling taking over at the same time to just go ahead with this, dr. or no dr. I have scheduled her 14 day stim accordingly so we will see where her cortisol levels take her on this lower dose (60mg) once a day. I'm sorry I didn't post earlier, I guess part of me feels guilty for not going through the appropriate channels first. I hope you all understand my position regardless. For now, I hope I made the right decision for her as it was made solely in her best interest. Hope you all find yourselves in a happier place, and I will most definitely keep you posted as always on the latest developments. Luv you all....xo Jeanette

AlisonandMia

01-05-2010, 06:23 PM

Don't worry Jeanette!:) This is a very normal thing to have happen once the cortisol is being controlled effectively. It seems that when the cortisol is high the normal shedding cycle just stops but when the cortisol is back to a more healthy level the shedding cycle starts up again and you get this massive shedding of the old "sick" coat and they regrow a new one. Often this new coat is a strange, fluffy "puppy coat" and might even be a slightly different color. And don't be surprised if you start to see a lot of dry, dandruffy skin flaking off too in the near future - again that seems to be normal and it does eventually stop.

This happens with trilostane and Lysodren so it isn't related to the treatment itself but seems to be caused by the return of cortisol to a more healthy level.

Hope your vacuum cleaner is a good one!

Alison

Squirt's Mom

01-05-2010, 06:25 PM

Hi Jeanette,

Bless your heart. That must have scared you to pieces! It's easy to understand your panic and the drive to start Princess on the Trilo again right off.

But take a deep breath and think if you have seen any other signs coming back or strengthening? Drinking more or longer? Peeing more or longer? Appetite increasing? Pot belly developing? Panting for no reason? Lethargic? Weakness in the hind quarters? Any other changes you have seen lately?

The good thing about Trilo is its short half-life. Unlike Lyso, it acts quickly and leaves the system quickly so even if you have jumped the gun, there should be no major problems with one dose.

I personally would like to see her have an ACTH now VS in two weeks just so you know where her cortisol level actually is instead of guessing based on hair loss. Others may feel differently, so stay tuned. ;)

We can't undo what has been done, so keep a close watch as always on her and give the pred if needed. The cortisol getting too low is much more dangerous than letting it get a little too high, k?

Hang in there,
Hugs,
Leslie and the girls - always

labblab

01-05-2010, 06:43 PM

But take a deep breath and think if you have seen any other signs coming back or strengthening? Drinking more or longer? Peeing more or longer? Appetite increasing? Pot belly developing? Panting for no reason? Lethargic? Weakness in the hind quarters? Any other changes you have seen lately?

I "second" what both Alison and Leslie have written ;). Princess' hair loss may actually be a result of her cortisol being normalized again, as opposed to running too high. I doubt that one dose of trilostane is going to cause her any problems, but before you start back with consistent dosing, I'm thinking it would be a good idea to either hold off and wait to see additional symptoms return or instead perform another ACTH test.

Marianne

littleone1

01-05-2010, 06:46 PM

Hi Jeanette,

You've gotten some very good advice. I know you'll feel better now.

Extra big hugs.

mypuppy

01-05-2010, 06:51 PM

Hi there Alison,
I wanted to thank you for your recent reply to my post, however, I was a bit confused with the info you wrote. Do you mean to say that Princess had developed this sudden excessive hair loss because went off the trilo (1 month). I came to the conclusion it was the other way around, she is experiencing the hair loss because of not being treated. When I last spoke to her IMS, her last stim showed her post cortisol at 6.7, and her IMS stated Princess was pretty much on her way to being Cushingnoid again, so I am thinking her levels must be way up there at this point from what they were a month ago. Princess never experienced the hair loss symptom prior to starting the initial treatment, this is something she just developed yesterday out of the blue. As for the dry dandruffy, flaky skin, you nailed it, she has developed that as well all of a sudden. From what I am gathering is that you seem to think this is the aftermath result of her initially being on the trilo and not a result of her being off? I'm sorry, but I would greatly appreciate your clarification just to make me feel more at ease. Thanks for your input nonetheless, and again, sorry if I'm not totally getting it. Regards, Jeanette

Don't worry Jeanette!:) This is a very normal thing to have happen once the cortisol is being controlled effectively. It seems that when the cortisol is high the normal shedding cycle just stops but when the cortisol is back to a more healthy level the shedding cycle starts up again and you get this massive shedding of the old "sick" coat and they regrow a new one. Often this new coat is a strange, fluffy "puppy coat" and might even be a slightly different color. And don't be surprised if you start to see a lot of dry, dandruffy skin flaking off too in the near future - again that seems to be normal and it does eventually stop.

This happens with trilostane and Lysodren so it isn't related to the treatment itself but seems to be caused by the return of cortisol to a more healthy level.

Hope your vacuum cleaner is a good one!

Alison

gpgscott

01-05-2010, 07:17 PM

Hi Jeanette,

We have never treated with trilo, but as concerns the hair loss, it can be very disconcerting.

The hair does not respond at once but when it does, you will hear the word 'blow' associated with the loss.

It usually occurs with nordic breeds, but I suspect it can happen to any of them.

Do you have a shedding blade? I will place a link. I like these as they do no scratch the skin.

Scott

http://www.drsfostersmith.com/dog-supplies/shed-control/ps/c/3307/3289?ref=3928&subref=AA&mkwid=Sq2TApCkf|pcrid|3691400121&cmpid=PPC-_-G-_-3928

AlisonandMia

01-05-2010, 07:27 PM

It is a result of her body getting back to normal as regards the cortisol level. My personal theory is that the "hair loss" that many see with Cushing's is most often not shedding as such but the hairs breaking off due to wear and tear when the normal shedding cycle stops and because the old, worn hairs are not being replaced balding appears.

My Mia was a dog who had always left a few hairs on you when she was picked up. When she developed Cushing's this shedding stopped completely although she did eventually develop some balding between her hind legs and on her belly. Once her cortisol returned to a more healthy level (Lysodren in our case) she absolutely blew her coat and was engulfed in a cloud of dandruff for a few weeks. She then regrew a strange, thick, fluffy puppy coat. She had never done anything like blowing her coat before but had previously just shed a little bit all the time.

What you are seeing with Princess is most likely a result of having been on the trilostane and, even though she isn't on it now, her cortisol is still at a healthy level so she has started to get rid of her old "sick" coat (and skin). If she had stayed on the trilostane this would happening just as it is now.

Alison

labblab

01-05-2010, 07:34 PM

Jeanette, it is totally understandable that this info seems confusing since we are telling you that the same symptom -- hair loss -- can result both from cortisol being normalized in a treated Cushdog and also from uncontrolled Cushing's. But here's the deal. Even though Princess has been off her trilostane for a month now, it may be the case that her cortisol level still hasn't increased all that much. I checked back and found that her pre-treatment diagnostic post-ACTH level was 50. That is REALLY high in comparison to 6.7! So if her cortisol level has remained down in that lower range, even while off the trilostane, her body may be responding to what is a much more normal level of cortisol. And what we've seen in our Cushpups is that one of those responses can be the massive shedding of old hunks of fur. My own Lab did that after he had been treated with trilostane. Literally chunks of fur came pulling off him. He also suffered hair loss PRIOR to treatment, and he had bald areas on his flanks and haunches. But that hair thinning was much more gradual, and occured over a longer period of time. What you are describing is more consistent with what happened after his cortisol had been stabilized at a more normal range following trilostane treatment.

Of course, in the absence of current ACTH results, we can only speculate as to what is going on. But if Princess' cortisol level was highly elevated again, we'd be guessing that she'd be showing a return of her previous Cushing's symptoms (thirst, urination, hunger, etc.). So that is why some of us are wondering whether her cortisol level may not still be at that lower level. And unfortunately, the only way to know for sure is have her tested. But in the absence of testing, that is why I am thinking that you still may want to hold off on reintroducing the trilostane until you see other symptoms re-emerge.

Marianne

Casey's Mom

01-06-2010, 12:34 AM

Jeanette this is also happening with Casey's coat now that her cortisol is at a normal level for the past 3 or 4 months. Thanks to you I have an explanation!

Don't worry, its all good.

Love and hugs,

Annie's Mom

01-06-2010, 01:47 AM

Hi Jeanette,
We are so lucky to have all these amazing caring and knowledgeable folks to turn to! I was worried for you when I read your earlier post; I am now relieved to hear that this is normal. You are a fabulous mom--doing everything in Princess' best interest. It is stressful and confusing at times, but we'll get through this with the help of our friends here! Annie has been on 60 mg/day of trilo for 2 months and the past couple weeks she has had terrible excessive dandruff. Annie has never had dandruff. I associated it with the dry air in the house with running the furnace so much this winter. Glad to know this is normal. I finally gave her a bath this weekend (80 degrees in sunny Calif!) and her coat looks better. I'll keep watching your posts and hope for good reports.
hugs and scratches from Barb and Annie

mypuppy

01-06-2010, 01:20 PM

Dear ALL, Thanks for all your replies. I understand to some extent what everyone is trying to confirm, however, somehow something within me does not seem to add up. Reason being is because at Princesses last stim after we stopped the trilo, her IMS clearly stated her cortisol levels were consistent with her being Cushinoid (SP?) pretty soon. If I'm not mistaken that post cortisol no. was 6.7. Therefore, taking that into consideration, I can only rationalize that her levels at this point are even higher to warrant restarting treatment and based on her new symptom (hair loss). I know everyone here is stating that the hair loss is a result of treatment and cortisol levels getting back to a normal level, but again, how can that be possible if I was told she was heading toward Cushings again??? I know everyone highly recommends a stim again at this point, but the way I look at it, her IMS was willing to restart Princess on the trilo without having her stimmed, so I think in my opinion it may be unnecessary at this point only to have her stimmed again in 14 days. BTW, I recently spoke to another person I was recently introduced to whose pup was just diagnosed with Cushings, and is experiencing the same hair loss and flaky skin as Princess and she has not been treated yet. So, one would assume those symptoms are Cushings related and not the after results of being on treatment since the dog has never been treated??? I certainly hope everyone here understands my position and my doubts when it comes to this new symptom. Just the same, as alway, you know I highly respect and look forward to all your opinions. Keep them coming...xo Jeanette

I "second" what both Alison and Leslie have written ;). Princess' hair loss may actually be a result of her cortisol being normalized again, as opposed to running too high. I doubt that one dose of trilostane is going to cause her any problems, but before you start back with consistent dosing, I'm thinking it would be a good idea to either hold off and wait to see additional symptoms return or instead perform another ACTH test.

Marianne

haf549

01-06-2010, 03:02 PM

Jeanette:

Go with your gut. Only you can know how Princess is doing. It's only 2 weeks until her scheduled stim test so it will be interesting to see the results then. Just keep a very vigilant eye on her now that she's started the tril again (like you wouldn't :rolleyes::rolleyes:).

Keep us posted on how she's doing on the meds.

Heidi

mypuppy

01-06-2010, 03:16 PM

Yes Heidi, that gut feeling as always taking over. I am most definitely watching my Princess like a hawk. Her next stim can't come fast enough, and I too, am curious what her levels will be at that point, and also hoping that one 60mg pill will be sufficient for her continue her treatment. I will of course keep everyone informed. Thanks. How is Kira doing these days also? Warts all gone bye bye? lol. Hope so...Take care and post soon....xo hugs, Jeanette

labblab

01-06-2010, 06:06 PM

... however, somehow something within me does not seem to add up. Reason being is because at Princesses last stim after we stopped the trilo, her IMS clearly stated her cortisol levels were consistent with her being Cushinoid (SP?) pretty soon. If I'm not mistaken that post cortisol no. was 6.7. Therefore, taking that into consideration, I can only rationalize that her levels at this point are even higher to warrant restarting treatment and based on her new symptom (hair loss).
Hi Jeanette,

Please know that I am not trying to tell you what you should do, but instead I'm hoping to explain my earlier reply more clearly. As far as what your vet was telling you, this is my guess. When Princess had her first diagnostic ACTH test, her "post" result was 50 ug/dl. The normal range for a dog without Cushing's is a "post" result between approx. 6 - 18 ug/dl (the norms vary slightly from lab to lab). So as you already know, her ACTH result prior to any treatment was really high. After two weeks of 120 mg. trilostane daily, her "post" result dropped clear down to 1.1 ug/dl. That is a big drop in a relatively short amount of time, which suggests that she is pretty sensitive to the trilostane. After you had stopped the trilostane and she was tested about ten days later, her "post" result had increased up to 6.7 ug/dl. Dechra recommends that a Cushing's dog being treated with trilostane should be stabilized within a range of 1.45 - 9 ug/dl. So at the point of that ACTH "recheck," Princess' results were within that desired range.

However, I am guessing that your vet expects that without the medication, Princess' cortisol level won't stay in that range for very long, but instead will keep on rising until it gets back up up a level that once again results in Cushing's symptoms. And for the majority of dogs, that would definitely be the case. However, for a few dogs, it takes a longer time for the cortisol to elevate again after it has dipped too low on trilostane. For a very few dogs, it may take a very long time. Without performing an ACTH test, it's impossible to know for certain. And my own thinking is that I would expect that Princess would start showing some of her original symptoms again if her cortisol was really elevated once again, rather than just sprouting a new symptom like sudden hair loss.

But I am not a vet, and so I am not trying to tell you to ignore your own instincts or your vet's advice. Since you have decided to start up with the trilostane once again, I really urge you to watch Princess very closely (which I know you will do anyway). Outwardly, she previously was looking good even when her cortisol had dropped too low after the first two weeks of treatment. So even though you are starting back at half the dose, I'd still really keep my eye on her and I'd again stop the trilostane if she starts acting "off."

Marianne

Squirt's Mom

01-06-2010, 06:23 PM

Hi Jeanette,

Another thing...it really isn't feasible to compare a pup that has never been treated to one that has been treated, whether that treatment is currently in use or not. Because of the drug, Princess' system has undergone changes the untreated pup's has not. So be sure you are always comparing apples to apples, and that is very, very difficult to do even between pups who are the same breed, same age, same weight, same initial signs, same gender and sexual state, being treated with the same dose of the same cush med on the same schedules.

Do you still have pred on hand? If not, get a refill so you have it, but hopefully you won't need it. :)

I listened to my gut when Squirt was first diagnosed but in the opposite direction from you...I refused to start either Trilo or Lyso when she was first diagnosed even tho I was strongly urged to do so. I am glad I didn't start treatment on her, or I may well have killed her because she didn't need it then and still doesn't. We always say "you know your baby best" so we, and Princess, have no choice but to trust you trusting your gut. ;)

You know we are here for you any time so don't ever, ever hesitate to ask anything, k?

Hugs
Leslie and the girls

mypuppy

01-06-2010, 07:26 PM

Gosh you all! First, I must start by extending my sincerest apologies to anyone for perhaps coming across a bit defensive in any way, shape or form in my earlier post. In fact, it was more out of confusion if anything since obviously I don't understand every issue that comes along with this condition. Gosh, this condition is a lot more complicated than I ever imagined, and because of my lack of understanding and still learning to this very day, I probably "panicked" as Leslie stated, and thought restarting Princess on her trilo was the best decision for her at the moment. After speaking to Lori earlier today, she pretty much knocked some sense into me, which geared me to the opposite direction, and as such, have decided not to continue the trilo until Princess begins exhibiting her excessive thirst and appetite. Hopefully, the two unnecessary doses given to her did not make any impact on her well-being. In the meantime, I have said it many a times, I respect everyone's opinions here and you all mean the world to me, so do keep them coming whether at times we get too wrapped up in conflict and differences in opinions. Thank you all for your continued support and for sharing your hands on information. Allison, I never would have reached my decision today without you bringing forward this information onto the forum on the "blowing of the coat". Thank you immensely for that since I just assumed that it was a Cushings symptom. Thank you Marianne for trying to spell the entire process out for me in details and thank you once again Lori for being so firm yet sooooo "sweet" with me about this. I luv you all sincerely.....xo Jeanette

mypuppy

01-06-2010, 07:32 PM

Hi Barb, I thought too at first it could have been related to the bitter cold and dry heat inside the house, but thank Alison mostly for elaborating on it some more to make us feel a bit at ease. Glad a few people aside from myself were able to learn some new information on more Cushings related issues. Hope all is well. Best regards, xo Jeanette

Hi Jeanette,
We are so lucky to have all these amazing caring and knowledgeable folks to turn to! I was worried for you when I read your earlier post; I am now relieved to hear that this is normal. You are a fabulous mom--doing everything in Princess' best interest. It is stressful and confusing at times, but we'll get through this with the help of our friends here! Annie has been on 60 mg/day of trilo for 2 months and the past couple weeks she has had terrible excessive dandruff. Annie has never had dandruff. I associated it with the dry air in the house with running the furnace so much this winter. Glad to know this is normal. I finally gave her a bath this weekend (80 degrees in sunny Calif!) and her coat looks better. I'll keep watching your posts and hope for good reports.
hugs and scratches from Barb and Annie

Harley PoMMom

01-06-2010, 07:59 PM

Hi Jeanette,

Jeanette, honey, you are family here, so no apologies are necessary. We love you and we know how confusing and frustrating this Disease can be. We all have been there and we all still get confused and frustrated, but that's the beauty of this forum...one can come here, post a question about cushings and it gets answered.

And do you realize your post answered the question of "blowing the coat" of 2 other members...Ellen (Casey's Mom) and Barb (Annie's Mom). Isn't that amazing, I think it is.
So never be afraid to post a question bc someone else might be wondering the same thing, huh!

You mean the world to us, we love you and you will always have our support. We only want what is best for Princess and we know that is what you want too.

With much love and big, big hugs,
Lori