New Member, Chloe (approx 7yrs old), Shih Tzu mix, trilostane

[Yasmin]

:)Hi everyone,:) My name is Yasmin and my dogs' name is Chloe and we live in Sydney, Australia. Chloe is/was a rescue dog so nothing is known about her early life or her true age but we guess she's around 7yr & I've had her for 4yrs. She is Chiauchua x was finally diagnosed with cushings last Sept/Oct. At first she had these black, scaby lesions appearing on her body, a pot belly, and we realised that she had stopped jumping into the car and on the bed etc., she also had this ravenous appetiate (prior to that she was a bit of a picky eater and would eat when I ate), and her coat was getting thin in places. The first bloody test for cushings came back negative so after a couple of weeks on antibiotics she underwent the more comprehensive test which confirmed the vets suspicions. She was put on Trilostane 60mgs daily (she weighs 6.5kg), within 3days she had stopped eating completely and was dry retching so I took her straight back to the vets, this time I saw another partner who at first was rather sceptical at her re-acting so dramatically in such a short time but he say to stop trilo. When her appetiate had still not returned after 5days he put her a low dose (5mgs twice daily) of prednisone until she was eating normally again - this took about a week. Then prednisone was reduced to 1 pd for 15 days, after 7 days we started a lower dose of trilo (30mgs - has that been fun dividing up the capusles) and as she tolerated the trilo we finally weaned her off the prednisone totally. She due to back now for her first retest - she should have gone at the beginnig of March but as we had a holiday booked starting Mar 22 we didn't think it was fair to our wonderful 'dogsitter' just incase the doseage was changed and we have problems. Soon after she was completely diagnosed she lost most of her lovely silkly coat - she ended up looking like a x between a hairless Mexican and a Chinese crested dog. However since she got settled on trilo her coat has started to regrow (fortunately as autumn is just starting for us here). Just one other thing since she been on trilo she has 'peti-mals' (approx 1 per month)- not full blown seizures that I've seen other members mention but when I've mentioned this to the vet he seems to imply they're not connected and says there nothing in the literature. Anyone wish to comment? :)

[labblab]

Hi Yasmin, and welcome to you and Chloe!

Poor little Chloe -- it sounds as though she has had quite a time of it. I'm really glad that for the most part, it seems as if she is doing better. But wow! I am so surprised that your vet started her off at 60 mg. of trilostane, and I am not surprised that she had problems. That is a whopping high dose for a dog weighing only 6.5 kg. :eek:!! According to the most recent U.S. Product Sheet published by Dechra (manufacturers of the brandname version of trilostane, Vetoryl), their recommendation is that dogs be started at the LOW end of a range between 2.2 - 6.7 mg./kg. So Chloe may end up needing a dose even lower than 30 mg.

Can you tell us how long she has been taking the 30 mg. without any prednisone? And when and what were the results of any ACTH tests along the way? I do think you will be wise to take her in for a repeat test just as soon as possible to make sure that her cortisol level is not trending too low on this dose, as well.

Are you using brandname Vetoryl, or a compounded form of trilostane? I know there are great hurdles to be jumped in order to import Vetoryl into Australia. So if you are using Vetoryl, it may be the case that 60 mg. is all that your vet has on hand. But just so you'll know, Vetoryl is also manufactured in 10 mg. and 30 mg. capsules. And if your vet feels comfortable prescribing a compounded form of trilostane, you should be able to get that in any dosage strength that you need. The manufacturers do strongly warn against opening and dividing the capsules. It is not good for you to be handling the raw powder, plus it is difficult to divide the powder equally. Plus, it may be irritating to the dog's throat and stomach if it is being ingested as a raw powder instead of in capsule form. If your vet wants you to keep using Vetoryl, you can try to find a local pharmacy that will "repackage" your existing capsules into smaller doses.

It sounds as if Chloe's coat is improving. How about her other symptoms? Is she eating and drinking more normally now? And can you describe her seizures in a little more detail -- how long do they last, and what happens to Chloe when they occur?

I apologize for asking so many questions, but your answers will help us to give you the best feedback and support that we can.

Once again, welcome...
Marianne

[labblab]

P.S. Here is a link to a thread on our "Helpful Resources" forum that contains a lot of helpful information about trilostane treatment and monitoring. Do take a look, and check out the "Product Insert" that I mentioned above, as well as the "Treatment and Monitoring Flowchart."

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

Marianne

[Yasmin]

Hi,
Sorry for not replying sooner but Chloe & I took advantage of some Indian Summer weather and went to our holiday house some 160kms south of Sydney. Chloe loves there as she gets to go on a dog-friendly beach and gets to meet lot of 'locals' and visitors - human and doggies!
One real change we have seen in Chloe since she has been on Trilostane is a change in her behaviour towards other dogs - previously she was quite aggressive (we had put this down to the fact that she was a 'rescue' dog) but now she is so freindly and will go up to any dog.

She's going well on her treatment and just before we went away we had her re-tested. Our vet rang us to say her levels are still above 250 (?) and has suggested we put her back on to the higher dose (60mg). We gave her the dose morning and night for a week and she has tolerated that ok so now she is back on the full dose once a day and seems to be ok on that after 4 days.

I'm not sure if we have brandname Vetoryl, or a compounded form of trilostane, but I believe we will be able to get different strengths. The vet had given me smaller capusle cases so that I could split the originals. he wasn't too worried that it wasn't exactly 30mgs per day.

Chloe is drinking is back to normal - approx 250/300mls per day. In a way her eating has improved - prior to the ravenous appetiate she tended to be a'fussy eater' she would virtually only eat cooked chicken, raw wings and necks. I tried with so many different tins, sausage type meats and other fresh meats but always ended up throwing out. Until last year I also had a couple of cats and occasionally she would steal their food but if I tried ti give to her she wouldn;t touch it! She still prefers chicken but will the sausage type meat and some of the inned commercial foods. I"m also getting her eat a dried food that when hot water is added it makes a gravy - I mix it with her meat and whilst she pick the meat out she getting know that I won't give her anymore food until she has cleaned her bowl. She likes to eat when I eat so she has 3 a day - i.e approx 100grms per meal. She's very thin/bony but hasn't lost any weight - once we got back to eating ok so I guess she ok as my brother (who is as thin as rake) says 'you don't see a fat thoroughbred'.

As for her seizures as I said they are 'peti-mals' 'they only last for 1-2minutes - it's as if her legs give away and then they shake abit (nothing alarming) she doesn't lose conciousness just seems abit dazed. Once it's over she's fine and on a couple of occasions has gone to her bowl and eaten. I guess my own feelings are that maybe she has a pitituary tumour - I've not had any scans or ultrasounds done - I'm on a disability pension so funds are limited. The vet is very good in that he lets me pay off the bill gradually.
Yasmin & Chloe

[StarDeb55]

Yasmin, I want to offer you & Chloe a late welcome. I'm in total agreement with Marianne that 60mg. is a huge, huge dose for such a little one. The other thing I notice in your posts is that you say that you have been opening the capsules. Please stop opening the capsules as handling vetoryl directly can be dangerous. This is a quote from the product information sheets that are posted on the Trilostane link in our important information section.


• Do not open capsules and do not attempt to split or divide capsules.

When you say that the vet said Chloe's last ACTH was still high, was that test done within 24 hours of giving any prednisone. I ask because prednisone will read just like cortisol on the test & will give you a falsely elevated result.

Debbie

[EllyAugie]

Hi Yasmin, welcome to you and Chloe.
Sounds like Chloe had a rough time of it and I am sure this has not been easy on you either seeing your baby go through such a hard time of things. Augie and I wishing Chloe the best, you will receive some very helpful advice here on this forum with caring and knowledgeable people. I know it is hard at first taking everything in but you have great support here and have come to the right place.

Elly and Augie

[Yasmin]

Just checking in - Chloe is tolerating the increased dosage of Trilostane with no problems. I see people seem to be concerned about her dosage of 60mgs daily (she weighs 6kgs). I've quized my vets and they are adament that it is correct.

My main worry at present is that she is very skinny - her spine and ribs are very prominent. She is eating well 3x a day! I give her approx 100gms per meal, this satisfies her (occassionly she leaves some so I guess I'm feeding her the right amount) but she's ready for her next meal. This has been a big improvement on her previous eating (prior to diagnosis). Because she's so skinny she feels the cold (it's coming up to our winter) so she gathering quite a wardrobe!!!:)

[StarDeb55]

Yasmin, I have moved your update post to Chloe's original thread. We normally like to have all posts on a pup in one thread as it helps members, if they would like to review the pup's history.

Debbie

[Yasmin]

Hi, just posting an update on Chloe (Shi-tzu X). Since Chloe's diagnosis (Oct/Nov 2009) and getting her to tolerate Trilostane not much has changed apart from that she has lost most of her fur and its not regrowing. Is there any safe supplement I can give her to stimulate hair growth? My vet is talking about her having some hormonal problem. Her last ACTH test showed that her cortisal level had risen 2000 (whatever that means), so they have increased her dosage to 120mg daily (previously 60mg daily). Because she had an extreme reaction when she first went on Trilostane I give her 60mg twice daily and she has tolerated that well. Most of her other symptoms have abated -, no excessive drinking, no pot belly, no ravenous appetiate, I'm not sure about muscle weakness as she constantly demands to be lifted onto the couch/bed but when it suits her (like tonight when I was out, according to my housemate) she can do it easily! I have joined a walking group and we walk 5kms Chloe manages that very well and now hassles me for more walks!:)
The other thing that seems to be unexplained is that since her diagnosis she has 'peti-mals' - the only thing the older vet said recently was that it points to a pituarity tumour. She appears to be having on average to having 2 seizures a month very close together with second much milder that the first and they are usually preceded by her trying to cough (as if she had phelgm in her throat).
Would be intersted in anyones comments on anything I've mentioned as I'm still struggling with the diagnosis, treatment and the future.

Moderator's Note: Yasmin, I have merged your update on Chloe into her original thread. We normally like to keep all posts on a pup in a single thread as it allows other members to refer back to the pup's history, if needed.

[AlisonandMia]

Hi,

I am confused by the vet saying that her "cortisol has risen 2000" - that doesn't seem to be a cortisol number (in any unit of measurement) but sounds more like a liver enzyme number, maybe.:confused:.

Unless you have had an ACTH stim test done (2 - 6 hours after dosing with trilostane - the timing is very, very important) which has definitely indicated that her cortisol is nothing like controlled by her present dose then I'd be very, very wary of increasing the dose - especially doubling it - if I was in your situation.

The fact that all her symptoms except hair growth have improved and she is tolerating and asking for so much exercise suggests to me that her cortisol is being well controlled - which means that doubling the dose will almost certainly lead to big problems, sooner or later - and probably sooner.

Coat and skin problems are notorious for being the problems that are hardest to resolve with treatment and to take the longest - and sometimes they never resolve completely. My feeling is that if the dog is otherwise well and happy then coat problems are not a huge issue (after all dogs don't care what they look like!) and chasing possible improvements in the coat isn't worth risking the dog's health in other ways. It is quite common for a the coat/skin problems to seem to get worse before they get better after starting treatment too. It is very usual for a newly treated Cushing's dog to shed copiously and even to develop some dreadful-looking dandruff for a while too - it seems to be a part of the healing process.

It is possible that she has high estradiol levels which may be what you vet is thinking of when he/she mentions "hormonal problems". Increasing the trilostane will not help with this - there are other things that can be done to try to help with high estradiol levels - but estradiol is the hardest hormone to manage so it can be tricky. Is Chloe at all overweight? Being overweight is a big cause of high estradiol levels as fat can produce estradiol in significant quantities, I believe (certainly is the case in humans). If she is still carrying any excess weight then losing that weight would be a priority I think.

Good luck and keep us posted.

Alison

[Yasmin]

Chloes weighs 5.2kgs and basically her weight has stayed stable apart from when she obviously lost at the beginning when she was unable to tolerate the trilostane.:)