Tia, 12 yo JRT - update: Tia has passed away

[trazeee]

Hi, Just wondering if any of you out there know of any respiratory side effects with trilostane? My JRT was just diagnosed(ACTH test) last Friday with cushings,most likely of iatrogenic nature, and was given one dose of trilostane (one half of a 20 mg capsule) Friday. However, her breathing went crazy following this, very fast, shallow, sporadic rythms for about 5 hours, before, calming down....she has also been taking t ramadol twice a day and metacam(NSAID) once a day for past 8 days...in addition was given a injection of convenia antibiotic for calcinosis cutis lesions which apparently lasts a month....does anybody know of any wierd respiratory side effects from trilostane???? Much appreciated.......her breathing has been out of whack since....almost like if given too much prednisone.....

[StarDeb55]

When you say your pup's diagnosis was iatrogenic Cushing's, I need to double check that. Iatrogenic Cushing's only happens when the pup has been on steroid therapy for an extended period of time, & the only way to cure it is to wean the pup off the steroids. You do not give trilostane to a pup with iatrogenic. Are you sure the diagnosis wasn't either pituitary or adrenal dependent Cushing's?

Debbie

[lulusmom]

Hi and welcome to the forum.

I'm sorry that your guy is having a rough time of it at the moment. Iatrogenic Cushing's is due to topical or oral steroids (prednisone). Are you currently giving your dog prednisone and if so for how long? Iatrogenic cushing's does not require treatment as the remedy is to simply wean the dog off of whatever steroid is being administered.

In order for us to provide you with meaningful feedback we'd like to know more about your dogs history. I'll start the standard grilling with a few questions of my own. :D

1. Can you please tell us why your vet thinks iatrogenic cushing's is involved.
2. What medication aside from the ones you've listed already was your dog taking.
3. What cushing's like symptoms did your dog have that lead you and/or your vet to suspect cushing's.
4. What tests were done to diagnose your dog and can you please get your hands on those tests and post the results here?
5. How much does your dog weigh.
6. Why is your dog on Metacam? This drug should not be given with prednisone nor to a dog that has uncontrolled cushing's.

To my knowledge the respiratory distress you noted isn't something that I recall being listed as a side effect of Vetoryl(Trilostane), however, I'm going to go have a look at the information we have available in our Helpful Resources section and will report back. You can access this information too by clicking on the following link:

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

Looking forward to getting more information on your little JRT.

Glynda

P.S. I see that Debbie posted while I was typing so please excuse any duplication.

[lulusmom]

Respiratory signs, such as coughing and congestion were noted in 8 dogs in one of the studies done by Dechra, the manufacturer of Vetoryl (Trilostane). I don't recall any members reporting this side effect though but perhaps other members may remember.

I also wanted to touch on the calcinosis cutis. We've had a number of members with dogs who've suffered with calcinosis cutis and it is not a condition that is easily remedied. It is not uncommon for a pet owner to deal with this, sometimes heartbreaking condition, for months before seeing any improvements so I'm unsure whether you meant that your dog will be on antibiotics for a month or that you expect the calcinosis cutis to be cured in one month. I also wanted to mention that Dr. David Bruyette, a reknown endocrinologist that regularly lectures on cushings and it's various treatments, admits that while Trilostane is his hospital's drug of choice, they have not had good luck with calcinosis cutis. One of our member's vets recently contacted Dr. Bruyette and it was Dr. Bruyette's recommendation to switch to Lysodren.

[ventilate]

Hi and welcome;
I hope you are not breaking the caps yourself. If so please stop, it is almost impossible to judge exactly how much you need and you may be giving your dog to much or not enough. It is also can be dangerous to you. You can take your caps to a compounding pharm and they can safely give you caps of the dosage you need, without you having to break open the caps.
Sharon

[trazeee]

Hi, Thanks for your quick reply to my question...my JRT has several health problems.....I'll try to sum it all up in short.....I got her when she was 5 yrs. as a rescue.....she always presented with heavy panting, was over weight with pot belly appearance, and despite all efforts couldn't loose weight....was tested around 6 yrs old for cushings based on those symptoms but came back negative....began having regular episodes of pancreatitis, and colitis....ultrasound results showed that she had lesions on pancreas and was tested for food allergies....once diet was modified, pancreatitis calmed down. However, then displayed respiratory symptoms and was diagnosed with asthma ......a year later, had an episode of acute respiratory distress(was on a ventillator twice) and was diagnosed with allergic airways disease....further testing showed that she had bladder and kidney crystals.....was administered prednisone at this time along with flovent inhalers and after approx. 3 months her alkaline phosphate levels were elevated...however no Dr. questioned Cushings. I took her off all steroids at this time and her health/breathing seemed to stabilize for a while....however. have been dealing with breathing issues ever since...generally with homeopathic medicine. Unfortunately Tia was dx with a mammary gland tumor in January, it was an adenocarinoma....and since then the calcinosis cutaneous lesions have appeared along suture line and upper body of that left side(tumor was in the 3rd gland in left mammary chain) Since then, the dog has had several ultrasounds, echocardiograms, bloodwork, x-rays, etc.....only thing new is that the dog had a gallbladder stone and liver enlargement, and phosphate deposition in her kidneys, and her alkaline phos is extremely elevated.

The dog's breathing and restlessness have worsened over the past two months, had an asthma attack March 29th, the vet gave her an injection of depo-medryl and her symptoms have continually worsened.....

Finally, a veterinarian suggested she be tested for cushings, was administered the acth test: I'm not sure of the exact lab values only to say that her baseline indicated that she was only slightly over the norm, and the post test read that she was approximately 50% above normal values....

Tia is approximately 12 years old, she has lost about 2 pounds since the beginning of April.(she currently weights 10.5 kg) Since she was administered the one dose of Trilostane last Friday, her appetite is insatiable, and her breathing much heavier and irratic , and she is very restless.....the poor thing hasn't had much sleep for weeks....

We are feeling very hopeless at this moment, I was so hoping that with the cushings diagnosis that we would be able to treat the symptoms to bring her some relief, however, since I gave that single dose of Trilostane her symptoms have seemed to escalate....she has been currently taking tramadol twice a day, medicam once a day, she was given an injection of convenia 12 days ago, so I don't know if there's been some kind of drug reaction or just worsening of Cushings disease(She is not on any prednisone or steroids).....I have since ceased all medications, however, the calcinosis cutis lesions need to be addressed with some pain relief....I have made an app. with the internist for Wednesday to address these issues....however, I would greatly appreatiate any advice, knowledge, or ideas.....I know there must be something I can do for my poor little dog, we don't wan't to give up our fight to help her feel better! Thanks to all who respond
________________________________________

Moderator's Note: I have merged your new thread with the original thread. We normally like to keep all post on a pup in a single thread, that way it is easier for other members to review a pup's history.

[trazeee]

Hi, Have posted once before, and thanks to those who responded, however, the dogs condition hasn't improved.....she has a long health history.....

I've had her since she was 5yrs. old. - presented then with heavy breathing/panting, was overweight..almost 20 pounds then....began have series of pancreatic attacks which have been ongoing since, was tested for cushings but negative, however ,ultrasound showed some lesions on pancreas and diet was modified (due to confirmed food allergies) and her condition imrove...more energy and lessening of pancreatic/colitis issues....not long after was diagnosed with asthma... this was controlled at the time until a severe acute respiratory attack in 2007, was exposed to a mudslide in the mountains..lots of dust etc, and ended up in critical care-on a ventillator twice, was diagnosed with allergic airways disease.

Started on intermittent prednisone and flovent daily, however, alk phostphatase level rising within a few month....these drugs were discontinued at this time as they weren't effective anyways. Further allergy treatments were homoepathic at this time.

Four months later, the dog presented with acute colitis/ pancreatitis....blood work showed extremely elevated liver enzymes and panreatic enzyme levels....she started on milk thistle, zentonil, and white fish diet, next blood work showed marked improvement. Follow up ultrasound showed that in addition to bladder/kidney crystals she had a gallbladder stone. Health was for the most part stabilized with exception to allergies....

last December I discovered a lump in the left mammary chain, it was removed in January(3rd in the mammary chain) and diagnosed as an adenocarcinoma....one month following this she developed calcinosis cutis lesions on the left side from incison site up the dorsal left side.

She has had several ultrasound,xrays, echocardiograms, bloodwork and urinalysis....all which came back o.k. Unfortunately, her breathing issues presented again and was finally tested for cushings last Thursday. She was confirmed, ACTH test, pretest showed her cortisol levels were just above normal range, however, post test showed that they were elevated approx. by a50%.

One dose of Tylostane 20mg capsule divided given and she had a very strange respiratory reaction....she was currently taking tramadol twice a day, medicam once/day, and had been given an injection of convenia 12 days ago...as well had been taking famitodine for stomache. All medications were ceased after her respiratory reaction-very elevated heart rate, elevated and irregular repirations. excessive panting and extremely elevated resting heart rate/breathing. DOES ANYONE KNOW OF ANY OF THESE STRANGE EFFECTS TO TRILOSTANE??????

My poor dog (12yrs) is suffering, hasn't been able to rest for weeks, but we don't want to give up on her.....she is 10.5kg, lost 1kg since April, appetite has accually increased since given the trilostane....what's wierd is that the med reaction was like that of too much prednisone.....my dog is not currently on any steroids, however last steroid injections was given March 29th due to severe asthma attack...since then her health has steadily declined....does anyone have any advice re cushings treatment, similar stories, or info in general that might help us.....Much appreciated......

[zoesmom]

Hi and welcome to you and 'did you say your dog's name?' ;):) -

Splitting the capsule into two is NOT recommended. I don't recall the exact details, but I think I read somewhere that as it goes down, if it comes in direct contact, the trilo can irritate the espophagus (and no doubt the trachea, too.) Since your pup already has asthma-related problems, if any loose trilo powder was on the outside of the 'new' capsule (I assume that's what you did, and didn't try to mix the trilo powder itself with food or something), that may have possibly caused the reaction. You haven't given any more trilo since that first dose, right?

Other than that, I don't remember ever hearing of that kind of reaction from trilostane. But that said, if any dog has a predisposition to allergies, I suppose that almost any drug could produce an allergic reaction in that dog.

It would be really helpful to have your pup's diagnostic ACTH results - the specific numbers. You said that everything else was 'normal'
except for the ACTH? Could you please ask for and post any notes on her ultrasound and x-rays and the general labwork results - if anything at all was out of range (either high or low). Think you mentioned AlkPh was high. One other thing of concern. A dog with cushings - especially uncontrolled cushings - should not be on metacam. Even when my girl Zo had her cushings under control, her IMS was extremely reluctant to put her on that drug and only finally prescribed her half the usual dose. Also, she would no longer give me prednisone (which cush parents like to have on hand during tx) when we started using the cautious dose of meloxicam. Steroids (or in cush pups, excess cortisol) and NSAIDS - bad and possibly dangerous combo. Can cause stomach/intestinal bleeding. Hope you can get ahold of the pertinent records and post them for us soon. And in the meantime, I'd hold off on any more trilostane. Sue

PS - iatrogenic cushings wouldn't be treated with a cushings drugs. The oral steroids would simply be withdrawn slowly. So if that's what your vet is saying, my question in that regard is: exactly how long was your pup on steroids and how long ago were they stopped?

[trazeee]

Hi , Thank you to all that responded with all your advice and wisdom....sadly Tia passed away this morning before ever having the chance to start her Trilostane therapy...my advice to all is that even if your dog doesn't have all the classical cushings symptoms ie/ increased thirst and urination that you persist with your veterinarian and continue testing for cushings....my dog was in the advanced last stages and did not have increased urination and thirst...so be vigilant and an active advicate for your dog...unfortunately my dog had may other chronic problems, however, it was the advanced cushings that was her demise.......Good Luck to all of you!

[Roxee's Dad]

I am so sorry for your loss of Tia. I am sure she will be watching over you with love.

Rest in Peace sweet girl.

[Casey's Mom]

I am so sorry to hear that Tia has passed - you tried and gave her your very best love and care.

When you feel up to it please share some of your memories on our In Loving Memory Forum. We would like to hear some of your special stories about your girl.

Love and many hugs,

[Harley PoMMom]

I am so sorry for the loss of your beloved girl, Tia. My heart goes out to you at this most difficult and painful time. Although words are just not adequate enough at this tragic time, I do hope you find some comfort in knowing that we do understand your pain and are here for you whenever you need us.

Peace sweet Tia

With Heartfelt Sympathy
Lori

[Carol G]

I am so sorry to hear of your loss. My thoughts are with you.

Carol

[Dawn]

so sorry to hear of your loss we are thinking of you RIP
Dawn caspers mum

[Spiceysmum]

So Sorry to hear about Tia. Thinking of you.

Linda and Spicey

[Mrs. J]

Im so very sorry, this is so so sad for me to read...{{{Hugs}}}

Karen

[zoesmom]

My heart goes out to you on your loss. Godspeed, sweet Tia. Sue

[sunimist]

I am so sorry to read about Tia. My thoughts and prayers are with you at this very difficult time. R.I.P. sweet Tia.

(((HUGS)))
Shelba and Suni

[Bichonluver3]

Sometimes God needs 1 more dog and he only chooses the best. Little Tia can now run free of pain and discomfort with all her friends in doggie heaven. She will watch over her special mom for always. Bless you and Tia. Remember the funny, good times. They are the ones that last. Please come back and let us know how you are doing.
Our love and thoughts are with you,
Carrol & Chloe