Boomer, 13 year old Jack Russell mix - Trilostane side effects?

[lindal]

Hi, my 13 year old Jack Russell mix was diagnosed last week with PDH. He pants almost constantly, can't jump on furniture anymore, was constantly wanting to eat/drink/urinate, more aggressive towards males, so I had him checked out. Yeap, I thought it was old age!

His results of the low dex test were: resting sample 6.3; 4 hour sample 1.1; and 8 hour sample 2.3.

He started Trilostane 60mg daily yesterday, has had 2 doses so far. He now isn't interested in food and has terrible diarrhea.

My question is, how long do these side effects last? I am trying to help him, not hurt him, by giving him the med. I noticed a few days ago that he is also coughing alot, his lungs are clear tho, so I don't think congestive heart failure has started.

Thanks for any info!

[AlisonandMia]

Hi and welcome.

It doesn't sound like side effects so much as an overdose of trilostane resulting in too low a cortisol level. How long ago did he have his last dose? Do you have access to emergency vet care?

How much does he weigh?

Alison

[lindal]

He weighs 15 pounds, I gave him a dose about 1 1/2 hours ago.
Linda

[AlisonandMia]

It looks like your little guy has had a pretty significant overdose of trilostane - 60mg for a 15lb dog is way too much! I think you need to get him to an emergency vet asap for urgent treatment!

Alison

[lindal]

What is the determination for dosage vs weight?
Linda

[AlisonandMia]

A dog the size of your guy would usually be started on 30mg - and a lot of vets would want to start him on an even lower dose, maybe 10 or 20mg. So you can see 60mg is a whopping big dose - which is why he is in need of emergency care.

The OD of trilostane has dropped his cortisol too low and has probably also affected his ability to regulate sodium and potassium (electrolytes) and that is really, really dangerous as it can cause the heart to stop beating which is why he needs to bet to a vet right now.

Trilostane usually peaks in its effectiveness 4 - 6 hours after a dose is given so if he only had a dose about 1 1/2 hours ago his levels are going to go much lower soon - so it is really important that he gets care ASAP.

Alison

[lindal]

Thanks so much, luckily my vet is open late tonight!
Linda

[AlisonandMia]

When you take him in, insist that his electrolytes be checked - that is probably the most critical thing.

Good luck and keep us posted!

Alison

[acushdogsmom]

Only have a moment, but thought you might want to have the references for the dosing guidelines that Alison mentioned in her reply.

There is more than one protocol for dosing, but from what I can see, 60 mg for a 15 lb dog is indeed much too much, especially as a starting dose.

Here are the references for the two most frequently used dosing protocols:

Dechra (manufacturer of Vetoryl) says:

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


Ideally, the starting dose to aim for is 1.0 to 3.0 mg/lb (2.2 to 6.7 mg/kg) once a day based on body weight and capsule size. When calculating dosage, it is suggested to round down. Start at the low end of this range.

So according to Dechra, at a recommendation of 1-3 mg per lb, a 15 lb dog should be getting about 15 mg to 45 mg per day. And they recommend starting at the lower end of the range (which would be 15 mg per day for a 15 lb dog)

UC Davis recommends starting at an even lower dose than Dechra does and then working your way up if necessary:

http://veterinarynews.dvm360.com/dvm/article/articleDetail.jsp?id=460965&sk=&date=&pageID=3


The UC-Davis current recommendation is to initiate trilostane therapy at 1 mg/kg once daily. That dose is continued for about one week until a veterinary re-check can be completed.

Owners are instructed to collect a small urine sample from their dog before leaving home the morning of the scheduled re-check prior to trilostane administration. Trilostane should then be given and the dog should be seen by the veterinarian two to three hours later.

The goal of therapy is an owner who is completely pleased with the response. As aids in achieving this goal, both urine and blood tests are indicated. The urine should be checked, at a minimum, for specific gravity, glucose and urine cortisol-to-creatinine ratio (UCCR). An ACTH stimulation test should be started at the time the dog is seen, again about two to three hours after trilostane administration.

The UCCR result should be within the reference interval and the post-ACTH serum cortisol concentration should be between 1.5 and 5.5 mcg/dl.

If the serum-cortisol concentration is within that goal and the UCCR is abnormal, the medication should be given BID. If the serum-cortisol concentration is too high, the trilostane dose should be increased. But if the serum-cortisol concentration is too low, the dose should be decreased.

This approach should be used at each re-check until the dog is doing well.

And P.S. I agree with Alison about getting your dog to the Vet ASAP and about having the electrolytes checked!

Another P.S. I wonder ... is it possible that your Vet got confused somehow between kg and lb and possibly prescribed the wrong dose? Although it does seem pretty clear - even on Dechra's dosing chart where it doesn't really say to start at the lower end of the range (see link above that I gave you) - that 60 mg per day is way too much for a 15 lb dog!

[Buffaloe]

I am really glad Alison was around to advise you on your dog.

He has had way, way too much Trilostane. U.C. Davis (whom I totally trust) recommends a starting dose of 1 mg. of Trilostane for each kg. of body weight once daily. To find your dog's weight in kg. you divide his weight by 2.2, hence 15 lbs. divided by 2.2 is about 7 kilograms. Dechra (manuf. of Trilo.) recommends a higher starting dose than U.C. Davis but even at their highest recommended dosage, your pup is getting way too much.

At the very least, he needs a "rescue" dose of prednisone. Without question, your vet has him on a very excessive dose of Trilostane. I hope you take him somewhere, right now. Good luck.

Ken

[lindal]

Thanks everyone! I am going to call my vet now, will keep you posted!
Linda

[acushdogsmom]

Thanks everyone! I am going to call my vet now, will keep you posted!
Linda

Will be looking for your updates!

P.S. I'm no expert on trilostane (my dog was actually treated successfully for more than 6 years with Lysodren, not trilostane) but I'm really glad that Alison was here and saw your post and that Ken also saw your thread and replied and that all three of us realised immediately that the dose seems really high!

You should really also always have some prednisone at home, just in case you ever need to use it. As Ken mentioned, pred can be given as a rescue med if cortisol does go too low. You may never need to use the pred at home, but you never know if/when it might come in handy to have pred on hand (overnight/when Vet is closed etc) - and better safe than sorry, I always say!

[zoesmom]

Linda -
I saw the 60 mg dose in your first post, and then when I went further down and read that he weighs only 15 lbs., I thought YIKES!!!!

His reaction, like the others already said, is a sign that his cortisol has most likely gone too low. It looks like you are already kicking into action, so hope he gets some pred and an electrolyte check asap. My only concern is that it sounds like you will have to see the same vet who overprescribed the trilo. Hope he/she knows what to do in this situation. So glad you came here right away and didn't wait and wonder as time is of the essence. Will be waiting and watching for an update. Sue

[lulusmom]

Hi Linda,

Just wanted to echo what you've already heard from other members. Holy cow, that was a huge dose for your little one. I'll be waiting with everyone else for an update.

Glynda

[MiniSchnauzerMom]

Linda,

Thinking positive thoughts for your little guy. I'll be waiting for your update also. I totally agree with Cushy and Ken - do have some prednisone on hand.

Louise

[zoesmom]

Hey Linda -

Everyone, myself included, is worried about your doggy and hoping for an update. Hope all is ok? Sue

[lindal]

Update on Boomer. Everything is fine, I pushed the panic button too soon! I talked with my vet about the dosing and she assured me that 60mg a day is a normal dose for a 15 pound dog. She gave me the run down how she calculates it, but now I can't find the paper with the notes on it! His lytes came back all normal, no more diarrhea since the 23rd. He has had 5 doses of trilostane and already he is a bit more active, not coughing anymore, and is panting less. But still gets up every 1 1/2-2 hours at night :(
Thanks so much for all of your concern and advice!
Linda

[Harley PoMMom]

Hi Linda,

Thanks so much for keeping us updated as we were getting so worried.

Now I am no vet and have no medical background and I am not here to bad-mouth your vet but I still truly believe 60mg of Trilostane is too much for a 15lb dog to start out on. So please, please keep a very watchful eye on Boomer for any ill side-effects from the Trilostane, which I know being the wonderful and loving mom that you are, you will.

And please, please keep us updated. ;):)

Love and hugs,
Lori

PS...Do you have prednisone on hand?

[acushdogsmom]

So glad to see your update and to hear that Boomer is okay! I was getting really worried!

And I love your avatar picture! Boomer is adorable! :D

I'm still concerned, though, with that 60 mg/day dose of trilostane for a 15 lb dog! Boomer may seem okay now, but his cortisol could still be falling too low without showing the usual signs of overdose and even with normal electrolytes.

Can you ask your Vet to clarify how the dose is being calculated? Because every piece of veterinary literature on trilostane (Vetoryl) that I've seen says that 60 mg per day is at least twice as much as a 15 lb dog should be getting, especially as starting dose.

Here again are the links to the veterinary literature that I gave you before and one more which will confirm that 60 mg/day is too much trilo for a 15 lb dog.

Dechra (the manufacturer of Vetoryl) says on their USA website:

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


Ideally, the starting dose to aim for is 1.0 to 3.0 mg/lb (2.2 to 6.7 mg/kg) once a day based on body weight and capsule size. When calculating dosage, it is suggested to round down. Start at the low end of this range.

So according to Dechra, at a recommendation of 1-3 mg per lb, a 15 lb dog should be getting about 15 mg to 45 mg per day. And they recommend starting at the lower end of the range (which would be 15 mg per day for a 15 lb dog)

And their dosing chart (same link) says that dogs who weigh between 10 and 22 lbs should be started at no more than 30 mg per day.

They recommend 60 mg per day for dogs weighing 22 to 44 lbs!

Also here's a link to the official package insert that comes with Vetoryl, and where you will see the same dosing info. Look under the heading "Dosage and Administration".

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

As I also mentioned before, UC Davis recommends starting at an even lower dose than Dechra does and then working your way up if necessary:

http://veterinarynews.dvm360.com/dvm/article/articleDetail.jsp?id=460965&sk=&date=&pageID=3


The UC-Davis current recommendation is to initiate trilostane therapy at 1 mg/kg once daily. That dose is continued for about one week until a veterinary re-check can be completed.

Owners are instructed to collect a small urine sample from their dog before leaving home the morning of the scheduled re-check prior to trilostane administration. Trilostane should then be given and the dog should be seen by the veterinarian two to three hours later.

The goal of therapy is an owner who is completely pleased with the response. As aids in achieving this goal, both urine and blood tests are indicated. The urine should be checked, at a minimum, for specific gravity, glucose and urine cortisol-to-creatinine ratio (UCCR). An ACTH stimulation test should be started at the time the dog is seen, again about two to three hours after trilostane administration.

The UCCR result should be within the reference interval and the post-ACTH serum cortisol concentration should be between 1.5 and 5.5 mcg/dl.

If the serum-cortisol concentration is within that goal and the UCCR is abnormal, the medication should be given BID. If the serum-cortisol concentration is too high, the trilostane dose should be increased. But if the serum-cortisol concentration is too low, the dose should be decreased.

This approach should be used at each re-check until the dog is doing well.

I don't mean to sound like a broken record, but my motto is always "Better safe than sorry". :) And I'm glad your Vet explained the calculations for dosing to you - but I really can't figure out what protocols he/she is following that say that 60 mg per day is recommended dose for a 15 lb dog. Can you try to find your notes and tell us what the Vet said, specifically? Especially in light of all the veterinary literature and manufacturer recommendations which do not agree with the dose your Vet is recommending, it just doesn't make sense to me .....

[lindal]

Thanks for the compliments on Boomers pic!
I found the notes on the dosage! < 5kg is 30mg/day, 5-20 kg is 60mg/day. I don't know where she got this calculation, because what I have read and researched is different. Yeap, I have prednisone on hand - I am a nurse and I think that is why I was getting panicky re: side effects.
I will ask her where she found the calculation.
Linda :)

[acushdogsmom]

Thanks for the compliments on Boomers pic!
I found the notes on the dosage! < 5kg is 30mg/day, 5-20 kg is 60mg/day. I don't know where she got this calculation, because what I have read and researched is different. Yeap, I have prednisone on hand - I am a nurse and I think that is why I was getting panicky re: side effects.
I will ask her where she found the calculation.
Linda :)Please do ask her where the heck she found that calculation, Linda. Because everything else I've read (from the veterinary literature and manufacturer/distributor inserts etc) states to the contrary. :confused:

I'm relieved to know that you are a nurse, but if I were you, I think I'd rather be erring on the side of caution and go with the lower (recommended everywhere credible that I can find) dosage.

We really have had more than a few dogs here whose cortisol dipped way too low and yet who showed no outward clinical signs and with normal lytes, too. They just "crashed", with no warning.

PS When is the next stim scheduled for?

[acushdogsmom]

Just noticed on the Vetoryl dosing chart that they recommend a dose of 60 mg/day for dogs who weigh >10 to <20 kg (more than 10 but less than 20 kg)

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

http://www.dechra-us.com/images/10mg-dosechart.gif

And the same chart is here, too, on the Vetoryl data/product insert sheet:
http://www.dechra-us.com/File/prod_vetyrol.pdf

So maybe your Vet is looking at where it says >10 to <20 kg and is mistaking the kg for lb??? And maybe that's where the error in dosing is coming from???

For dogs who weigh 15 lbs, the starting dose is clearly 30 mg per day, not 60 mg/day

[lindal]

Please do ask her where the heck she found that calculation, Linda. Because everything else I've read (from the veterinary literature and manufacturer/distributor inserts etc) states to the contrary. :confused:

I'm relieved to some extent to know that you are a nurse, but if I were you, I think I'd rather be erring on the side of caution and go with the lower (recommended everywhere I can find) dosage.

We really have had more than a few dogs here whose cortisol dipped way too low and yet who showed no outward clinical signs and with normal lytes, too. They just "crashed", with no warning.

PS When is the next stim scheduled for?

The next stim test is this Thursday. Do you think the dosage has to do with how high his cortisol level was?

[Harley PoMMom]

Starting dose is always determined by a dogs weight.

[AlisonandMia]

No the dosage has nothing to do with the cortisol level. Some dogs with a very high cortisol level can be very sensitive to the drugs and some with a relatively low (but still high) cortisol level can be not so sensitive so cortisol level is never a factor in dosing - it is done by weight only especially at the outset and most vets these days are erring on the conservative side with trilostane, too.

I'm really thinking that this is a kg/lb issue - we have seen it it before!

I think you need to bring this up with your vet on an urgent basis (before giving another dose!) and sit down with her and look at the actual literature she is using (actual dosing charts) and compare them with yours, with special attention to the units of measurement for weight.

I really feel that Boomer is very, very likely heading for big trouble on this dose. Trilostane typically really kicks in around the 3rd - 5th day of dosing that is why we are so worried about Boomer now.


Alison

[lindal]

Here is where she got the calculation info: http://www.newmanveterinary.com/CushingTx.html


Treatment Protocol:
The initial dose and frequency is somewhat variable. Early studies suggested starting (once daily) doses, depending on the weight of the animal, as follows:
< 5 kg 30 mg/24 hr
5-20 kg dogs, 60 mg/24h
20-40 kg dogs, 120 mg/24h
>40 kg dogs, 240 mg/24h

[AlisonandMia]

That is kg not lbs. There are 2.2lbs to a kg so if you dose lbs as kg you are double dosing.

Boomer is 6.8kg which does put him right at the bottom of 5 - 20kg range thoguh. As Acushdogsmom says, those are very old recommendations and have been updated several times since. The dosing has got steadily more conservative as adverse reactions cropped up quite frequently at the higher doses, and the way in which the drug actually works in dogs (as opposed to theoretically how it should work) became more apparent as it went into clinical use. I see that on the website does actually say "Early studies suggested starting ..."

I really think you need to question your vet on this. In your position I'd be asking that Boomer be treated with the most up-to-date dosing protocol provided by Dechra, the manufacturer of Vetoryl. Trilostane is turning out to be one of those drugs where it is really best to "start low and go slow". In the early days it was perceived as "safe" and the initial dosing was pretty bold as a result. As use increased and severe adverse events (some even fatal) became more apparent the protocols have become more conservative.

Alison

[acushdogsmom]

Here is where she got the calculation info: http://www.newmanveterinary.com/CushingTx.html

Treatment Protocol:
The initial dose and frequency is somewhat variable. Early studies suggested starting (once daily) doses, depending on the weight of the animal, as follows:
< 5 kg 30 mg/24 hr
5-20 kg dogs, 60 mg/24h
20-40 kg dogs, 120 mg/24h
>40 kg dogs, 240 mg/24hAnd I know that site. I think those "dosing recommendations" are pretty old - maybe from when Vetoryl was first out on the market in the UK. Back then, Vetoryl only came in 30 mg and 60 mg capsules, if I recall correctly. Nowadays, with more clinical experience to go on, Dechra has changed the dosing guidelines. And Vetoryl is now available in 10 mg and in 120 mg capsules too, in some countires, as well as the 30 and 60 mg capsules, so that the different needs of the smaller and larger breeds can be acommodated. I don't think that newmanveterinary website is updated very often, either.

And why in the world would your vet get her dosing information from the website of one particular veterinary practice (Newman Veterinary is, I believe, the website of a Vet named Chick Newman - and Dr. Newman is just a General Practice Vet in Seattle, not even a Specialist as far as I know) instead of using the recommended dosing protocols from the manufacturer of Vetoryl, who has a division right there in the USA and who can be reached if she has any questions at all about dosing and monitoring the drug? Or from UC Davis, also a very credible source of information (and dosing protocol recommendations)

:confused:

[acushdogsmom]

That is kg not lbs. There are 2.2lbs to a kg so if you dose lbs as kg you are double dosing.

AlisonWell, a 15 lb dog = 6.8 kg so I suppose that weight would fit at the very lowest end of that 5-20 kg range, I guess. But still, the manufacturer of Vetoryl and UC Davis would be much more credible for proper dosing recommendations, in my opinion. And per both of those, 60 mg/day for a 15 lb dog is at least double the dose that they recommend.

[AlisonandMia]

I edited my reply.:o

Alison

[Harley PoMMom]

This is a post by Marianne to another member: Now Dr. Tim Allen is an IMS (Veterinary Internal Medicine Specialist) who works for Dechra.


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]

Hi,

After getting this message from Marianne, I also spoke with Dr. Tim Allen. He did tell me that Dechra is now recommending starting at the lower dose, which is 1mg per pound. Corky's IMS started him on 20mg once a day, as he was just over 20 pounds.

Terri

[BestBuddy]

Hi and welcome.

I am really worried for Boomer. Those dosing guidelines your vet is using must be so far out of date. Even the current Dechra guidelines state 30mg once per day should be the starting dose for 10-22 lbs.

I know it is really hard to question our so called medical professionals but doctors, vets, dentists etc have been proven wrong before.

If you continue with the 60mg per day then please be watching very carefully because bad reactions can come on swiftly. I really hope I am wrong but I have an awful feeling that Boomer is going to get into trouble on such a high dose.

Jenny

[zoesmom]

So glad all is good with Boomer so far. But like the others, I'm really worried that he may be headed for problems, based on that dosing. I remember the old formula that your vet is using. I came across it when we first started the trilo journey with our Zoe . . . who was just under 40 kg. That was in early 2006 and that particular formula was already on its way out back then, in favor of the newer, more conservative ones that are now being used.

My Zoe, too, was put on a very 'ambitious' starting dose as she was my vet's first trilo patient. Her dose was based on another older formula that was also in use back then (it recommended a range of 2 - 10 mg of trilo/kg of body weight) So Zoe, at 40 kgs (or 84 lbs), was put on 180 mg per day which worked out to be right in the middle of that range (i.e. somewhere between 4 and 5 mg/kg of her weight). BUT, right away, she fell into serious trouble. After several stops, breaks, and restarts at lower and lower and lower doses, she finally was able to tolerate just 40 mg.

Eventually, over the course of many, many weeks, we were able to work her dosage back up without seeing any more bad reactions. But time and again, we've seen dogs here get off to a rough start and it's usually when they are started off on a higher rather than a lower dose. IMO, starting low and going slow IS the safest way to go. You can always increase the trilo down the road, if need be. Sue

[ladysmom06]

Hi,

I agree with the others that the dose is high. My Lady was a Jack Russell Terrier who weighed 13 lbs. when she first started trilostane. She started on 60mgs also and after the second dose started vomiting. Took her to the vet and had her electrolytes checked and they were fine but vet had us stop the trilo. Can't remember if we waited a week or two before starting the trilo again at 30 mgs. and she did fine with that dose - no problems at all and then we were able to gradually increase the trilo over time. We eventually had to decrease it back to 30 mgs. Starting low and going slow is the way to go.

[mypuppy]

Hi Linda,
My IMS started Princess at 120mg per day weighing 69-70 lbs, and had it not been for the 14 day stim, I would have never known she was heading for a crisis since her levels dropped dramatically at that high dose. I stopped trilo and she was symptom free and off treatment for 5 months. I just recently restarted her treatment at the 60mg per day, and even though I have not seen great results so far, I feel more comfortable knowing its a lower dose and we can increase need be. I know it's hard to challenge your dr., he's suppose to know better, but that doesn't ultimately mean he does. I hope Boomer does well regardless. Looking forward to some positive updates soon. Best regards, xo Jeanette

[Casey's Mom]

Hi Linda, just wondering how Boomer was doing?

Keep us posted.

Love and hugs,

[lindal]

I have an update on Boomer. He had his first ACTH test Wednesday, my vet's collegue called this am and his level is within normal range :D
We are keeping him on the current dose of trilostane, 60mg/day and my vet is going to call me Monday to set up the next ACTH test.
Linda

[frijole]

Linda, Great news. Just to be on the cautious side... did the vet give you any numbers? I'd like to be sure that Normal is Normal for a cush dog and not a regular dog because the numbers are different. Sometimes vets/labs make this mistake and I just wanted to be 100% sure what that no. is. If he didn't give it to you - just call the office. They can pull out the test and read it to you. There are 2 numbers - get them both. Then next time you visit you might want a copy for your files at home... Those of us with terrible memories find it helpful to keep a file so we can track over time.

Again - great news that things seem to be working! Kim

[lindal]

My vet will be calling me Monday and I will get the numbers then. She is the head vet at her facility, so her colleague only told me that the lab was normal. I will get much more info on Monday. She is great at giving out as much info as possible, she has always mailed me copies of everything from the past 10 years.
Linda

[SavingSimon]

My vet will be calling me Monday and I will get the numbers then. She is the head vet at her facility, so her colleague only told me that the lab was normal. I will get much more info on Monday. She is great at giving out as much info as possible, she has always mailed me copies of everything from the past 10 years.
Linda

Hi from me and Simon, Linda - just searching the forums for other JRT owners, and saw your beautiful Boomer. I hope things are going well, as it looks like you haven't posted for a while. I know this disease is so confusing and frustrating ... if you ever want to vent, we are here for you.
Love,
Dena and Simon

[lindal]

Hi Dena and Simon,
Boomer is doing great! His levels are normal, he has his energy back. Sometimes I threaten to withhold his trilostane because he is too energetic (just kidding) ;)
We go back in a couple of months for one more ACTH stim test, and if it is normal, the vet said we won't have to recheck it unless he is symptomatic. Simon looks like a relaxed JRT :)
Thanks for your concern and support!
Linda and Boomer

[apollo6]

Hi, I'm Sonja , my Apollo is 11 year dachshund, I just started Apollo on Trioslane on June 26th, 10mg. Glad to here your little guy is doing well.

[lindal]

Thanks Sonja! How is Apollo doing now?
Linda

[lindal]

Hi everyone,
Boomer has been on Trilostane since May, and he has loose stools. I started putting his trilostane in wet dog food at that time, and he stopped eating his dry food. He has had loose stools ever since, I don't know how to get him to start eating his dry food again. I have tried putting gravy on it, and only giving him enough wet food for his meds, but he won't touch his dry food. Are the loose stools a result of his Cushings, wet food or maybe the trilostane? Any ideas?
Thanks!
Linda and Boomer

[lulusmom]

Hi Linda,

I have merged your last post with your original thread so we can keep Boomer's information in one place.

As far as Boomer not wanting to eat his dry food, he may simply not like it anymore. My four kids haven't been on dry food for over two years and have done much better, healthwise, on canned or commercially prepared raw food. I think most people prefer kibble for convenience as well as to keep the teeth cleaner but honestly, canned food isn't that inconvenient and there's always a toothbrush. Is there any reason why Boomer has to eat kibble? Trilostane can taste pretty awful so you may consider giving Boomer his capsule in peanut butter or cream cheese after he eats. Taking the capsules apart is not a good idea at all.

Glynda

[lindal]

Hi Glynda,
The only reason for the dry food is for firmer stools - as per my vet :)
I brush his teeth, so that isn't a problem. His tummy makes gurgling noises and he has loose stools 2-3 times a day, but he is otherwise healthy and energetic. The vet mentioned possibly putting him on a med for the loose stools, but I don't want to do that.
Linda

[lulusmom]

I am not a nutritionist by any stretch of the imagination but I've had great luck with grainless foods. One of noncushdogs had chronic colitis which required at least one trip every two three months to the emergency clinic. Since I took all of them off of grains, everybody's stool firmed up and their allergies improved greatly. Another reason I took them off of kibble is because none of them were drinking enough water and two had highly concentrated urine which landed them in surgery for bladder stones. The poop firmed up, they poop less and their urine has normalized with no sign of stones since taking them off of kibble over two years ago and putting them on Primal, a commercially prepared raw food diet.

[StarDeb55]

Linda, I don't believe I've posted to you before, but I have a thought on Boomer's refusal to eat kibble. Is there any possibility he may have a dental problem or something going on in his mouth that the kibble is painful for him to try to chew up?

Debbie

[lindal]

Glynda,
Thanks for the info ~ I am going to give Primal a try.
Linda

[lindal]

Hi Debbie,
Boomer has gingivitis, always has, but no other dental problems. He chews on his bones without difficulty. I think he is just getting picky in his old age :)
Linda

[apollo6]

Well. Apollo has been on Trilostane since June 18th, so we are new to all this, his last ACHT STIM had good readings. My concern is with the weakness in his hind legs and the skin sores. But I know I have to be patient.
Thanks for asking.

[lindal]

Boomer's strength in his hind legs came back slowly - he still can't jump up on the bed tho. It's hard to be patient tho when it involves a loved one

[lindal]

I know it has been awhile, but Boomer has been doing pretty well. His blood levels are within normal limits and he remains very active. I am in desperate need of help tho. For the past 3 months or so, he only sleeps 1 1/2 - 2 hours at a time during the night. He wakes me up to eat, drink and go out. I am trying to avoid prescription "sleeping pills", and I have tried natural remedies to no avail. I have tried "Petalive" and currently "NHV Lesstress" with absolutely no help! I really need to get a good nights sleep :)
I have tried withholding water and food, but he will scratch on the bed and whine until I get up. Any suggestions?
Thanks!
Linda

[Harley PoMMom]

Please DO NOT ever withhold water. Ask your vet about giving Boomer melatonin. Alot of our members are giving melatonin to their pups that have elevated intermediate/sex hormones.

Melatonin seems to have a calming effect on many of our pups and some even get real sleepy from it.

The melatonin we use is the regular melatonin...not the fast-acting or rapid-releasing kind.

Here is some info about it:


Melatonin. Often used as a first treatment, especially if alopecia is present, since it is cheap, has few side effects and is available in health food stores or via nutrient suppliers on the Internet. Typically, a dose of 3 mg is given q12hrs (BID) for dogs <30 lbs; a dose of 6 mg is given q12hrs (BID) for dogs > 30 lbs. Regular melatonin is usually used rather than rapid release or extended release products.
http://www.vet.utk.edu/diagnostic/endocrinology/pdf/TreatmentInfoAtypicalCushings201005.pdf

Love and hugs,
Lori

[lindal]

My vet is the one who suggested holding his food and water, I was not thrilled when she said that! Is melatonin a prescription? I am willing to give anything a try right now.
Thanks for your help!
Linda

[frijole]

I have used melatonin on two schnauzers and it worked great for both of them! I gave them 1/2 of a 3 mg pill. Kim

[labblab]

Hi Linda,

I'm wondering when Boomer last had an ACTH performed? I just looked back through your thread, and during July you said that he was due for another one in a couple of months?

The reason why I ask is because if he is wanting to eat, drink, and pee every couple of hours during the night -- I have to wonder whether his cortisol level is being controlled adequately throughout an entire 24-hour time period. Boomer might be a Cushpup who would do better with twice daily dosing. How are his Cushing's symptoms earlier in the day?

I don't believe we've ever had the chance to see the actual numbers for any of his monitoring ACTH tests. Do you think you could find those and post them for us?

Thanks so much,
Marianne

[lindal]

Marianne,
Here are the ACTH results:
4-29-10: pre 3.9; post 9.5. We lowered his dose to 45mg daily
5-24-10: pre 4.2; post 4.7
6-21-10: pre 6.1; post 7.6
9-8-10: pre:6.8; post 7.9

[labblab]

Linda, are Boomer's Cushing's symptoms well-controlled during the day, or are you seeing any back-sliding? His ACTH results are trending upwards again since the lower reading in May. That one reading fell within the ideal therapeutic range given by Dechra, the manufacturer of brandname trilostane (1.45 - 5.4 ug/dl). The subsequent readings would be considered "OK" (up to 9.1), as long as symptoms are well-controlled. But if Boomer is starting to exhibit more symptoms during the day, his once-daily dose might need to be increased. If his symptoms truly remain well-controlled during the day, he might instead benefit from switching to twice-daily dosing in order to keep his cortisol under control throughout the night, as well (maybe switching to something like 30 mg. both morning and evening). Here's a link to Dechra's "Treatment and Monitoring Flowchart" that outlines their dosing recommendations in situations where symptoms are rebounding (it may be easier to read if you actually print it out):

http://www.dechra-us.com/files//dechraUSA/downloads/Client%20Literature/47902_VETORYL_10mg_Treatment_and_Monitoring_Brochu re_Update_3_2_ps.pdf

I'm also curious as to why his dose was lowered to 45 mg. at the point that his ACTH "post" result was still hanging up there at 9.5. Was there something going on with him that made your vet decide to lower his dose at that time? His May result makes it look like as though it initially turned out to be a good decision, since his "post" result of 4.7 was within the ideal treatment range. But as I say, his last two tests since that time are headed upward again...

Marianne

[lindal]

Marianne,
The dose was lowered to 45mg, but to keep costs lower, I get the 90mg tabs and give him 1/4 tab twice a day per the vets instructions. So he is getting 22.5mg BID, morning and evening. He was having symptoms of too much trilostane, that's why the dose was lowered at that time. As far as during the day, it is hard to tell because noone is home. My husband comes home at noon to let Boomer out, and my husband says Boomer is usually sleeping. If I am home, Boomer is calm. It just seems to be at night that he is doing this. To add to my stress, I have sleep apnea and I am constantly taking my CPAP mask on and off all night :(
I guess I will give the vet a call and get another ACTH test done and go from there.
Linda

[labblab]

Linda, what symptoms of overdose was Boomer exhibiting at the time that his trilostane was decreased? I am just curious, since his ACTH result was still high at that time. As I say, in hind-sight it appears as though it was the right decision, at least intially, since his cortisol was cut by half even on the reduced dose. But it just seems odd that he would exhibit symptoms of overdose with an ACTH that high...:confused:

If you are already dosing him twice-daily, perhaps your vet might think it OK to go ahead and increase his trilostane a bit now, even without performing yet another ACTH beforehand. Both the June and September results are within the range where Dechra would recommend a dosing increase if symptoms are not being well-managed. So with your vet's permission, you might want to go ahead and try an increase, and save your money on retesting until Boomer has been on the increased dose for at least a couple of weeks. At least it may be something to talk over with your vet. Unfortunately, I'm guessing it would be difficult to divide the 90 mg. tablets into thirds, because that might be the logical increase -- to 30 mg. twice daily.

Marianne

[labblab]

I am still puzzling over Boomer's situation. Because if you're already dosing him twice-daily and his overall dose is too low, you'd think he would also be having accidents or other issues during the day in addition to his night-time issues. I know you're not at home during the day, but does he have access to water all during the day, and if so, how much is he drinking? Is it a normal amount or is it excessive? How about his appetite at mealtimes when you feed him?

If daytime thirst and appetite are normal, maybe you truly do want to give the melatonin a quick try. If it solves the night-time problem, great! If not, then you could go ahead and pose the question of a dosing increase.

Marianne

[lindal]

Marianne,
Boomer was having some vomiting and was lethargic, so the dose was lowered at that time. During the day, his drinking is normal. His appetite isn't over the top either. I am going to give my vet a call and see what she thinks about trying the melatonin first.
Thanks so much for your help!
Linda

[lindal]

Update:
I talked to my vet yesterday regarding Boomer's symptoms, and she said that since his ACTH level in September was within normal limits, she didn't think it was necessary to repeat one now. She said to give him melatonin 3mg every evening. Boomer is due for vaccinations in December, so I will see how it goes til then.
I do have a question tho, that I didn't think about asking my vet at the time. Does melatonin have to build up in the blood before it starts to take effect? I have given it the past 3 nights and it has not helped at all.
Linda

[jackrussell]

Hi -
I just happened upon your post from over a year ago. I read just the first few responses and then your final post. I hope your boy is doing well.
My Jack was 12 when he was diagnosed with Cushings - and he too was 15 lbs. Through much research and much monitoring I will say I did a great job managing his Cushings. He eventually passed away at 15 from Lymphoma. I do not know if there was a relationship between the Lymphoma & Cushings.
Researching Cushings & Trilostane I learned that the dosage should be split in half with half given in the AM & half in the PM. I gave it with food. Spliting the dosage also allows you to reduce the total amount given thus lessening any potential side effects and complications. I kept a detailed log of when I gave him the drug, how much, what foods he ate and when, his sleep patterns, his energy levels... everything. In the end he was on twice daily trilostane and smaller more frequent meals. You will come to learn that there is commonly a delayed response of about 2 to 3 days to the dosing. I believe in the end I had him on about 7 mg twice a day down from an original prescribed dose of 30mg. There are immediate effects but it's the 2-3 day response on which you need to focus.
If he had never gotten Lymphoma I am sure he would be alive today going on his 16th birthday soon. I feared what Cushings would do but in the end I believe we could have worked all the angles and he would have made it to a healthy 17.

[lindal]

Hi jackrussell,
Sorry about your loss. Boomer is doing very well, just as energetic as ever! He is on 22.5mg twice a day of trilostane. He eats small meals about every 2-3 hours, and gets up every 2-3 hours during the night to pee. So for the past year or so, I haven't slept thru the night :(
I can't believe how well he is doing, considering his blood work shows a very high BUN.
Thanks for your post,
Linda

[lulusmom]

Hi Linda,

There are some cushdogs who don't see resolution of the excessiving drinking an peeing. UC Davis has conducted their own studies based on their extensive experience with Trilostane and they report that pu/pd never resolves in a small percentage of dogs, despite confirmation that cortisol is being controlled around the clock.

Dechra, the manufacturer of Vetoryl, reported in one of their studies submitted to the FDA for approval that approximately 10% of the dogs in that study had elevated BUN values (≥40 mg/dL) in the absence of concurrent creatinine elevations. Like Boomer, these dogs were clinically normal despite the elevated BUN.

In your prior post back in November, you mentioned that your vet said the stim was within normal range. We have seen a good number of gp vets who are unaware that the normal range as provided by the lab is not to be used for purposes of monitoring treatment with Lysodren or Trilsotane. The goal of treatment is to get the stimulated cortisol down to within a therapeutic range of 1.5 to 5.5 ug. With trilostane, the post stimulated cortisol can be as high as 9 ug/dl if the dog is symptom free. Can you please post the results of that stim test you were referring to in November as well as the results of any others that have been done since then?

Glynda

[lindal]

Hi Glynda,
The last ACTH stim test was in Dec 2010. Pre was 2.7 and post was 2.8. Sept 2010 was pre 1.9, post 3.0
Linda

[lulusmom]

Those numbers look great to me! Thanks for posting them. Do you know if Boomer is concentrating his urine? If he is, he may be like me and has developed a weak bladder over the years. :D

[lindal]

Glynda,
It wouldn't surprise me if he had a weak bladder, he has gone deaf, and has some dementia. He will just stand and stare at a wall for a few seconds, or just stand in the middle of the floor as if he doesn't know what he was going to do.
But, he is still active, eating well and has no arthritis. So as long as he isn't suffering, he will be around for quite awhile yet :)
Linda

[lulusmom]

Well, I wish you both much, much love and happiness for whatever time you have left together here on earth. Boomer's a very lucky guy, indeed, to have you for a mom and no doubt, you consider yourself lucky to have been able to share your life with such a great little guy.

Please continue to let us know how both of you are doing and until next time, I'll be sending positive thoughts your way and saying a prayer here and there for you and Boomer.

Hugs,
Glynda

[lindal]

Thanks Glynda!
Linda