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View Full Version : Good Afternoon - Puffy (10½ y/o male Shih-Tzu) on Trilostane



PuffysMom
02-07-2010, 03:33 PM
I have a 10 1/2 year old male Shih-Tzu, Puffy, who was diagnosed with Cushing's a little over 2 years ago. He is taking 50 mgs of Trilostane once daily for his Cushing’s, and he is also on 0.25 mgs of Soloxine (Levothyroxine) because he has hypothyroidism as well.

His Cushing’s symptoms are fairly well controlled with the Trilostane, however; he occasionally has problems with panting, getting up at night, and wanting to sleep on the cool tile in the closet. During the day he seems fine, it’s at night when I notice the panting and wondering to find cool dark places. In addition, he also has large cyst type bumps under his skin, which occasionally break open.

His ACTH is always in the normal range when he has blood work, however; his liver values are really high > 2000. Last summer, because of the high liver values, we had an ultrasound performed on Puffy. During the ultrasound our vet found a large growth on his spleen, which was removed that same day. Fortunately, the tumor was not a hemangiosarcoma as we originally feared, but a benign hemangioma. My vet has suggested he may have a cancerous adrenal tumor rather than a benign tumor, but nothing was seen on the ultrasound last year. My thoughts are that if it was a cancerous adrenal tumor, it would have grown and spread in the past 2+ years, and would have caused other problems.

I was wondering if anyone else has had the same or similar problems with their dogs, especially smaller breeds, and if so, do you have any suggestions? Is the adrenal carcinoma a possibility because they may be slow growing, or could something else be going on? Any thoughts or ideas would be appreciated.

Thank you,
Tanya

frijole
02-07-2010, 03:59 PM
Tanya - welcome!

I have a schnauzer who is over 16 now and has been on lysodren for over 3 yrs. The panting, restlessness, lying on tile and bumps ARE all very common in cush dogs. So don't fret.

You said that Puffy's cortisol levels are within normal range. Just to make sure we are on the same page - do you know what the result of the last test was? I ask because normal for normal dogs is different than for cush dogs. Sometimes labs and vets overlook this so just wanted to make sure. Normal dogs have levels over 20 but cush dogs need to be maintained between a 1 and a 5 (sometimes a bit higher is deemed ok).

Many of us have found that melatonin helps calm dogs down at night. I give my schnauzer 1/2 of a 3 mg tablet before bed when needed. It is not like a sleeping pill (droggy etc) but just relaxes her to the point she falls asleep.

Re the liver values - dogs react different to treatment and some have values that go down while others do not. Mine did not. I have been using milk thistle (I just put 1/2 capsule powder in her food and mix it up daily). I don't know if any scientific studies have been done but my dogs values DID go down quite a bit after using it. It could have been luck but I continue to give it assuming it has helped.

Both of these can be found at health stores - I get mine from GNC.

Please do check on the ACTH levels and get back to us. If the "normal" readings are above a 5 it could be that some tweeking of the trilostane could be in order. Obviously don't do anything without checking with your vet.

Glad you found us. Let us know how its going and ask questions! Kim

labblab
02-07-2010, 04:07 PM
Hi Tanya,

Welcome to you and Puffy! I'm so glad that you have found us. In order for us to be able to give you our most accurate feedback, it will help us a great deal if we can find out more about Puffy's history. You mention that he was diagnosed with Cushing's two years ago -- can you tell us what led to the testing, and also what testing was performed? Specific test results would be great!

I'd also really be interested in his monitoring ACTH testing history. For instance, can you tell us the actual results of his most recent ACTH test? Since his symptoms are not totally controlled, two thoughts come to mind. Since the treatment target for a Cushpup is an ACTH result even LOWER than the "normal" range for a dog without the illness, perhaps he is just not on a high enough dose of trilostane. Another possibility is that he might do better being dosed twice a day rather than once daily -- especially since it sounds as if his symptoms are rebounding in the evening after being better controlled earlier during the day. Here's a link to a Treatment and Monitoring flowchart prepared by Dechra, the manufacturers of Vetoryl (brandname veterinary trilostane):

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

If you take a look at this flowchart, you'll get a much better sense of the recommended goals for cortisol levels in a Cushpup being treated with trilostane.

I'm sure that others will also be by shortly to greet you (and also armed with additional questions for you!). In the meantime, thanks in advance for telling us more about Puffy's situation.

Marianne

P.S. I see that Kim was "quicker on the draw" than I in asking you about Puffy's ACTH results :p. So I apologize for the duplication of questions...

gpgscott
02-07-2010, 04:12 PM
Welcome from us as well,

Looking forward to hearing about testing and results. Thanks very much for joining, we all look forward to helping were we can.

Scott

littleone1
02-07-2010, 09:15 PM
Hi Tanya,

Corky and I would also like to welcome you and Puffy.

Corky has been on Trilo for 4 months, and so far, he hasn't shown any of the signs that you mentioned that Puffy is showing. He also has hypothyroidism and is taking 0.1mg in two daily doses.

I hope you will be able to get your questions answered. Everyone here is very caring and supportive. There are many members here that have much more experience than I do.

Terri