Sparky, new member, trilostane question

[JayBee]

I would like to introduce myself. Sparky, my 9 yr old mini schnauzer has PDC. I have been reading alot of posts and will try to answer all the questions you usually ask but for right now I have a quick question. After much research, panic, and reading your threads, I started Spark on trilostane 8 days ago. He was started on 2mg/kg on a twice a day schedule. I am happy to say he has had no side effects so far and is doing well. He is due for his first post medicine ACTH stim test next week.

I understand that the blood draw has to be done about 4 hours post pill. Is this correct? I have also read that a urine sample needs to be taken on the morning of the test prior to giving meds. What I can't seem to find is what is the reason for the urine sample in addition to the stim test and what we are looking for as far as specific values in the urine.

My vet didn't ask me to bring in urine and I would like to go over it with him before the test and sound like I know what I am talking about but, of course, I can't find the info on the urine test that I know is out there. If someone could point me in the right direction I would really appreciate it. I know the urinalisis is important but I don't know why and I want my Spark to get the best care I can give him. My vet is good, but he doesn't have alot of experience with trilostane though he has been in contact with several vets in the area that do.

Thank you for being here. I am so happy I found you. This is the first time I've posted but your support and advice to others has already been invaluable to me in this frightening time.

Jean

[Harley PoMMom]

Hi Jean,

Welcome to you and Sparky from me and my boy Harley.

Here are some quick answers:

After approximately 10-14 days at this dose, re-examine the dog and conduct a 4-6 hour post-dosing ACTH stimulation test. Re-examine and conduct an ACTH stimulation test 10-14 days after every dose alteration. Care must be taken during dose increases to monitor the dog’s clinical signs and serum electrolyte concentrations.

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

As far as the urine sample, this is for the UC:CR test and this is check and see if your dog needs twice a day dosing instead of once a day dosing.

http://www.k9cushings.com/forum/showthread.php?t=543&page=3

Now I will come back and ask you them questions then. :eek::p:D

Hugs.
Lori

[labblab]

Hi Jean, and welcome! :)

I have only a moment to post, and I know that others will soon be welcoming you. So I will just quickly address the specific question that you are asking right now. If I am understanding you correctly, Sparky is already receiving his trilostane both morning and evening. If that is the case, then there is probably no great value to taking in that morning urine sample. The morning sample is recommended by UC Davis to evaluate the effectiveness of the medication for dogs who are receiving the medicine only in the morning. Since triostane's peak effectiveness is relatively short-acting, some dogs need to receive the medication twice daily in order to keep symptoms well-controlled throughout a 24-hour time period. The point of the morning urine sample is so that a specific urine test (UC:CR) can be performed which helps to guage whether the dog's cortisol is rising too high at the tail end of the 24-hour period. Since Sparky is already being dosed twice daily, this test would not be particularly helpful.

If you go to this link on our Important Information forum, scroll to the bottom of the first post and you will see written monitoring guidelines followed by UC Davis. Within those guidelines, you'll see the morning urine sample discussed. The guidelines also talk about testing the urine for specific gravity and glucose. And perhaps your vet will want that information. You can certainly always ask. But in terms of the UC:CR test of the urine sample, Davis is recommending it for evaluation of the effectiveness of once vs. twice-daily dosing.

http://www.k9cushings.com/forum/showthread.php?t=185

Marianne

[lulusmom]

Hi Jean and welcome to you and Sparky.

I am sorry for the circumstances that brought you here but I'm tickled pink that you found us. Going through the diagnostics is enough to unnerve any normal person but getting the confirmed diagnosis of cushing's is the worst kind of sucker punch. Being scared to death is the norm so just know that we've all been there, done that and it will get better, I promise. I have two cushdogs and I was alone when my first one was diagnosed. I found this wonderful group when my second one was diagnosed and I can tell you from experience, that it makes a huge difference to have a support group. We'll do everything we can to help you and Sparky through this and lucky you, you've come to the best place in the whole world for some serious hand holding.

Now, to answer your questions. Yes, it is recommended that you have the acth stim test done within 4 to 6 hours of the last dose. When my two were being treated with Trilostane, they would get their capsules with their breakfast at about 6:00 am and I had them at the vets by 10:00. It is not necessary to fast Sparky and as a matter of fact, Trilostane is much better absorbed with food so feed as usual.

Because of Trilostane's short half life, meaning it's enzyme blocking ability starts to diminish any time after 8 to 10 hours, some dogs never see a resolution of symptoms. This is where the UC:CR comes in. If the post acth cortisol is within the desired range but symptoms have not improved, then a vet will often ask the pet owner to bring in a urine sample taken before meals and dosing for purposes of a UC:CR. If the results are high, then that's an indication that the Trilostane has not effectively controlled cortisol through the night and twice daily dosing is probably going to be necessary. I was very fortunate that one of my dogs did great on once daily dosing. It is easier to only have to give one morning dose and in the long run, I think it's more cost effective. My other dog was started on twice daily dosing as his then gp vet had read a recent study indicating that twice daily dosing is advantageous for a lot of dogs.

Now about those questions Lori mentioned. It would be terrific if you could tell us what were the circumstances leading up to the diagnosis, such as symptoms, abnormal bloodwork, etc. What tests were done to diagnose Sparky and can you post the results of those tests? The ones we are particularly interested in are the acth stimulation test, LDDS test, HDDS test and/or abdominal ultrasound findings. The LDDS and the HDDS are an 8 hour ordeal so I'm sure you would remember if these were done.

We always recommend to members to keep a folder of all medical records, tests, vaccine certs, etc. This information comes in real handy if you ever have to go to an after hours clinic. The vets on call appreciate having a dog's complete history at their fingertips and if you are anything like me, you'll be happy that you can just hand them something as opposed to putting two sentences together at what can be an emotional time. Having the info in one place will also come in handy when we but you relentlessly to post test results. :D

I hope I've been of help but if not, I can guarantee that others will be by to welcome you and share their experiences and knowledge.

Glynda

P.S. I see that Marianne has posted while my boss was so rudely interrupting me. I hate it when work gets in the way of really important stuff. :D Anyway, excuse the duplication.

[MiniSchnauzerMom]

Hi Jean,

From one MiniSchnauzer lover to another...just wanted to say "Hi and Welcome" to you and Sparky. Hope Sparky has a successful ACTH test next week and please do post again and share the results with us.

Would love to see some pictures of Sparky. :D

Louise

[Franklin'sMum]

Hi Jean & Sparky,

Welcome from me and my little boy too.

Jane and Franklin xx
________
NEW JERSEY MARIJUANA DISPENSARY (http://newjersey.dispensaries.org/)

[Squirt's Mom]

Hi Jean and welcome to you and Sparky! :)

I am so glad you came out of "hiding" and decided to join in! :p You have been doing a great job while behind the scenes of reading and learning, tho, and you are to be commended for that! :cool:

I hope you will stick close from now on and let us really get to know you and Sparky. This can all be so scary and I want you to know that you will have a whole crowd of folks with ya'll from now on!

Keep reading and asking all the questions you may have and we will do our best to help you understand.

Hugs,
Leslie and the girls

[littleone1]

Hi Jean and welcome. I'm glad Sparky is doing well on the Trilostane. I hope he continues to do well.