Apollo fought with grace and dignity to the end, My little angel warrior

[marie adams]

Hi everyone,

Leslie that is so true that we are more in touch with our trusted buddies than we ever imagined. This is a way for the next time we take this journey we start out knowing so much more to make them healthy and happier---not that we aren't doing it this time around. We are now giving them the best we can give and sharing the most precious time we have together.

Sonja, keep up the good work, stop the worrying, and enjoy Apollo. I know the feeling of the gasp when they stumble, but they are still trying and I think the letting them continue to keep to a regular routine is good for them mentally and physically---we just watch out for them a little more and like our own children---you are there when they fall to help them up again--I am still doing that with my 25 yr. old daughter--it is just she can do it herself now, but always like a little help here and now.

[apollo6]

Thanks all of you.Maria Adams, Jeannette, Andy. I try to walk with Apollo and when he gets tired, I put him in the carriage. He seems quite content to look out. The bond between us is so special. When I am out in public, people comment that when I talk to him he really is listening to me. When we were at the ocean on Sunday on a bench, he was beside me, and decided he wanted to sit on my lap. I told him that is were I want him. He meet to very pretty Shih Tzu sisters. I think Zoe is cuter. They were in love with him. But being the Apollo he is, he hardly noticed them. Stuck up Apollo thinks he is a Greek god and I love it. He was sitting on the bench holding his head up high. :D Need to have a little humor sometimes. Well August 5th is the day I go in with Apollo for a retest and blood panel, will have to address the lump in his tail. I watch Apollo like a hawk, just waiting for another sore, or something to pop up. Need to focus on the good stuff more.

[addy]

we are counting the days with you and we will all be there for you when you get back from your appointment. I am saying a special prayer every night. It will be fine.

Gee, thanks for thinking Zoe is cuter:D:D:D you won't get any arguments from me about that!

All our love and hugs and kisses,

Addy and Zoe

[addy]

Hi Sonja,

One more day to go. I am counting down to the vet visit with you:)

Zoe and I are sending positive thoughts and all our love for a good outcome.

Hope you have a beautiful day today with Apollo.

Love,
Cindy and Zoe, Koko, too

[MyRudy]

Hi, I am new here, been reading all day and just wanted you to know I feel so much better after reading this. Apollo has almost identical symptoms to what my dog has.

Rudy was diagnosed with Cushings July 22 and started on Vetoryl that day. I saw vast improvement in the water drinking, panting and peeing within a few days. But about a week later, my poor puppy looked half dead. He was lethargic, not eating and his hind legs suddenly seemed to give out on him. He no longer wanted to go for walks more than a few feet.

I called my vet and he was surprised because he said Rudy's cortisol was 'super high' according to the ACTH test we had done. He gave me a script for prednisone in case Rudy got 'shocky'. Rudy weighed about 45 lbs at the time he was diagnosed, so he was prescribed the 60 mg capsules once a day.

I quit giving Vetoryl to him since Monday. He has improved every day since, finally eating a little bit and today he actually made it to the park for a shorter walk, but did not appear to have as much trouble as he had even yesterday.

My vet said to give him the Vetoryl every other day, since it is in capsule form and I can't just half the pill. He also said I could open up the capsules and sprinkle half on his food every day if I wanted to, but I have read not to do that.

My question is: since he is almost back to normal and has been off Vetoryl for 3 days now, when should I start him back on every other day? It is obvious to me that the dosage was too high even though it is correct for his size. We are supposed to have a follow-up ACTH on Aug 21st and I believe I read in here that he needs to be taking his meds for 2 weeks prior to that time in order to get an accurate reading?

I hope there is more good news on Apollo from the Vet today!

[apollo6]

Thanks , today was a little tough. The IM0 said he felt Apollo was looking pretty good, until he noticed Apollo stiff walking. He had a neurologist check out says it it muscle atrophy, could be from the cushing. Apollo's skin is somewhat improved, still has a great appetite, hair loss has stopped , some hair has grown back-but very little, still lump in tail (told cystic inflammation and to leave alone-which I have not done)Test done"CBC and Chemistry Profile, Urinalysis, Cystocentesis( to get the urine-go figure?) ACHT Stimulation Test w/o Cort/Antech.
Vet said maybe the good effect of the Trilostane doesn't stay in his system long enough, and maybe will need to give twice a day. Sometimes muscle strength comes back, sometimes no. My husband was so sweet, said if we have to Apollo will get race wheels, we are not giving up on the little guy.
Will get results tomorrow. Nervous.

[Casey's Mom]

Just so you know it probably took a good 6 months or so for Casey to get the strength back in her back legs. 6 months of carrying my 40 lb dog up the stairs to bed every night and down in the morning! She now goes up and down with ease - well for a 14 1/2 year old . . . I know that someday I will be back to carrying her up and down because of her age.

Once the excess cortisol levels are resolved with Trilo or Lysodren the muscle weakness is the last thing to resolve come back so don't give up hope.

Love and hugs,

[addy]

Hi Sonja,

Well, the visit wasn't bad.

Maybe twice a day dosing will help. I think other Trilostane members are doing that. In a way, it makes sense, if it only lasts for 12 hours.

Maybe others will chime in on that.

Try to relax while you wait for the test results, I know that is easier said than done.

Apollo will improve, I just know it:)

Have a wonderful weekend girlfriend!

Addy

[marie adams]

Good Morning Sonja,

Maddie is on lyso so it is a little different, but now that the maintenance has been going on now for 2 months I am seeing the slow changes such as her fur growing yeah--I thought she would be bald in all the fur loss areas. I keep telling her how cute her belly fur is and soooo soft. Of course, I know she thinks I am crazy...:D:D

Maddie's weakness in the hind legs seems about the same, but she still climbs the stairs multiple times a day, sometimes there is a little trip, but we make her start again so she isn't afraid of them. She started back in running a little more with my husband (he is on the bike) she goes a good distance and my husband says you can tell she loves it--her gate isn't what it use to be but we feel you still have to keep them moving or they will lose what muscle they have and hopefully built up some.:;)

Keep up the good work, Apollo couldn't ask for a better best friend!!:)

[littleone1]

Hi Sonja,

Corky is on twice a day dosing. He was on once a day dosing for 5 months, but his cortisol level kept going up, and his dosage was increased. A little over 3 months ago, Corky was started on twice a day dosing. After one month with the twice a day dosing, his cortisol level dropped a little. His IMS told me that some dogs do better on twice a day dosing.

Terri

[apollo6]

thank you all-Ellen, Addy(finally spelled it right) Maria and Terry.
will keep you posted.

[Harley PoMMom]

Maybe twice a day dosing will help. I think other Trilostane members are doing that. In a way, it makes sense, if it only lasts for 12 hours.

Maybe others will chime in on that.Addy


Dr. Bruyette, you have no idea how excited I am to be able to ask you my accumulation of trilostane questions! People who know me here know that I have a LOT of them. So I'm going to keep on firing away (and anybody else who has a question -- please join in!).


This is not a "trilostane question" per se, but I did want to ask a follow-up regarding the validity of urine cortisols. Is it the case that when the UC:CR is being used as an initial general Cushing's diagnostic, the testing should involve the pooled 3-day sample that you have described above? (And to get down to specifics, would the owner "pool" and refrigerate the daily samples as gathered at home, and then take the combined result in to the vet for analysis?).

And one more follow-up trilostane question: Even though it is ideal to obtain a 24-hour ACTH when making the decision to switch to twice daily dosing, as a practical matter, do you ever recommend making the switch solely on the basis of recurrent symptoms later in the day? Assuming, of course, that the 4-hour ACTH is within the desired therapeutic range and symptoms have been effectively controlled during the early hours after once daily dosing.
Marianne


Yes. The same would apply when looking at urine cortisols in the initial diagnosis of Cushings. Ideally 3 morning pooled urine samples collected by the owner at home and refrigerated.

With regards to trilostane we have done as you described and made the switch to BID dosing when the 4 hour post ACTH is controlled and the symptoms return at night.
Dave



Hope this helps,
Lori

[apollo6]

Dear Lori
thanks, got the results will post later, good and bad, and have questions for IMO. Will read what you said about Trilostane.
Thanks

[apollo6]

Test results and comments
8/5/10 7/7/10
ACHT SAMPLE 1 2.9 WAS 1.6 GOING UP
SAMPLE 2 5.1 WAS 2.1 (GOING UP- IMO said still within range)
Worried about number going up:(
Urinalysis
urine clear
specific gravity 1.015 was 1.017 not much change in other reading
but
Urine Blood 1+ should be neg- ( none last time)

Apollo has an extremely large bruise where the urine was extracted by his little manhood. Didn't have that when it was done last time.
Also bruise on his neck where blood was taken. Is this a cushing thing?

Epithelial cells - rare range should be -none( why?)

On blood panel
I will only list certain one

C02 27 H RANGE 17-26( DIDN'T TEST LAST TIME-CORITSONE PART OF bicarbonate AND DIURETIC THERAPY_DON'T KNOW WHAT THIS MEANS-DIDN'T TEST LAST TIME)

CA/PO4 1.6 RANGE 1.2-3.8 ( I don't know what this reading means wasn't done last time ?)

BUN 35H WAS 31 RANGE 7-31

BUN/CRE RATIO 50.0H WAS 62 RANGE 9-33

CK(CREATINE KINASE) 243 RANGE 54-380 ( DIDN'T TEST LAST TIME-MAY BE INDICATION OF MUSCLE DISORDER? DUE TO CUSHING)

AST(SGOT) 64 H WAS 88 RANGE 6-62( HAS GONE DOWN)

ALK PHOSPHATASE 369 H WAS 827 RANGE 9-140(HAS GONE DOWN)

ALT (SGPT) 448 H WAS 854 RANGE 15-84 ( HAS GONE DOWN)

GGT 40H WAS 131 RANGE 0-6(HAS GONE DOWN)

MAGNESIUM 2.1 WAS 1.91 RANGE 1.5-2.7 ( NOT MUCH CHANGE)

TRIGLYCERIDE 179 WAS 75 RANGE 18-248(CONCERN ABOUT SUCH AN INCREASE

DID NOT TEST AMYLASE And lipase for pancreas will ask IMO WHY NOT DONE?

Trying to remember what IMO said. liver readings are getting better.
something about toxic levels from Kidney 31? :confused:within normal range

If Apollo did not have muscle weakness would continue with same dosage, but concern about muscle weakness (alopecia caused by hyperadrenocorticism)

want me to bring in urine sample when Apollo is relaxed in morning to see if get different reading .

Also could have neurologist test muscle reflexes with machine that test for it( some kind of needle- I had a test my self for nerve damage same sort of instrument).

My dear Apollo can walk and almost run when I mention treats, dinner -any thing that involves food.:D I get to see the old Apollo once in awhile.
Then the stiffness acts up in his hind legs and he can fall so easily. I held him tight and said we will fight on. I make him walk a little each day , like you said try to keep up his normal routine.
But I am a little worried about some of the readings, surfing the Internet is not always a good thing when looking for information. Information overload in the hands of a crazed cushing Mom is not a good thing.:(
trying to interrupt the reading is difficult.
On the lighter side, I have a built in alarm clock, I get a few licks, jumped on , paw raised if I try to sleep in and I love it.:D

[addy]

Hi Sonja,

Sorry I can't comment on the labs, I am sure the others will. I do know that bruising can be common in Cush pups, their skin gets thin and papery sometimes. Zoe's skin on her tummy is that way and was something the IMS commented on, as a clue toward Cushings.

From what I have been reading about muscle wasting, it seems you are doing the right things, quality protein diet, continue excercise. If Apollo's numbers are going up, you may have to adjust his dose? I know the other trilostane members will guide you in that.

Since it may be one of the last symptoms to improve, maybe once Apollo's dosage is tweaked, you will see an improvement in a few months.

I know that seems forever.:(

What is the current plan?

Hugs,
Addy and Zoe

[frijole]

Deb is our expert but I took the liberty of copying only those things that were out of line to make it easier...

I would say it looks like the readings have mostly improved and the ones for cushings - liver enzymes all went down so this is very very good.

I dont know what GGT is so won't comment.

The only thing standing out is the Bun and Bun/Creatine ratios which could be simply from muscle wasting caused by old age or cushings, the amount of cortisol in the system.

What did the vet tell you? Agree that with the increase in the cortisol reading on the acth test that you need to adjust the dosage. What did the vet recommend?

Correct me if I am wrong - your concern is the problem with the hind legs and weakness. You have seen this get worse and not better using trilo right? Sorry... I sometimes get confused. ;)

Kim

[lulusmom]

Just an observation and a few comments:

Unless the last two stim tests were done under identical circumstances, meaning same food in the morning and test done at the same time, these types of variances can happen and it doesn't necessarily mean that a dose has become ineffective. Are all of Apollo's symptoms under control? If so, I personally would not contemplate an increase in dose right now as your IMS is correct, he is still within the desired range. As for the muscle wasting, that is one of the last symptoms to resolve because it does take some time to build the muscle mass. My cushdog, Jojo, had incredible weakness in his hind quarters and it took forever to notice an improvement after starting treatment. I do recall thinking that there were days when he was worse and the vet attributed this to arthritis. Metacam was prescribed and it did seem to help him; however, he hasn't needed Metacam for two years so I'm not sure that it really was arthritis. :confused:

Cushdogs definitely bruise more easily than other dogs. My Lulu doesn't have any hair on mosts of her body so I can see the extent of the bruising whenever she is stuck with a needle. She always has a really large and ugly bruise every time they take blood from her neck for a stim and it doesn't go away all that quickly either.

Like Kim said, Debbie is the expert so hopefully she'll be by to give you her take on the labwork.

Glynda

[apollo6]

thanks for all the input will wait for other's to comment on readings.
For bruising I apply arnica gel or cream just like I do for myself, I bruise very easy due to poor circulation.( can get at any health food grocery store-I use for Apollo and me.)
I have to take a urine sample in the morning when Apollo is not stressed am to see if difference in results.
Now I am going to but cushing in the drawer until Monday.
Wish me luck in trying to get Apollo's urine in a container. That should be a sight.:p

[Casey's Mom]

For catching urine the vet gave me a good trick - use a soup ladle under his manhood when he goes - works great and you don't have to get anything on your hands!

Love and hugs,

[apollo6]

Thanks Glynda,Kim , Ellen and Addy
I handed in the new urine sample today. Will call vet with all the questions I have.
I did a trial run on Sunday night to catch the urine, did good, but Monday morning had a little of overspill on my hand. I survived.
Worried, seems like Apollo is drinking more water, don't know if attributed to warmer weather. He is having soft stool today( not quite diarrhea)But today he was just gulping in the car when I gave him water. The weakness in the hind legs is there, once in awhile he seems to better, but only for a second.
His skin has improved, his coat is looking better, still flaky in places.
I really don't want to increase his dosage, but will get answers in the next two days.

[Squirt's Mom]

Hi Sonja,

Can't help with the labs but wanted you to know Squirt and I are still hanging with you and hoping you start to see more improvement soon.

Keep you chin up!
Hugs,
Leslie and the girls - always

[MyRudy]

Just chiming in to say I hope Apollo's numbers are good ;)

[marie adams]

Hi Sonja,

Just to let you know Maddie is just now getting her fur starting to grow back. She still is weak in the hind legs with the shakes, but I am starting to see a little improvement in her muscle tone--it is a slow process and I know how much you want more instant results---they will come have faith!!:)

Take care!!

[apollo6]

thanks for all the support and encouragement. Need all the help, I can get.

[addy]

Dear Girlfriend,

I was just thinking, it took our pups along time to develop symptoms, so maybe some of the harder symptoms will take more time before resolving. Zoe's IMS explained the hair cycle to me. She said you have to "clean out" the hair folicals before new growth can begin so alot of times the hair will look worse before it gets better and it takes usually three months becuase that is the hair cycle, I thought is how she explained it but I am brain dead at the moment, and I can't spell again either:mad:

The muscle weakness, gosh that we know takes awhile. You love Apollo so much, I don't blame you for wanting things to speed up a bit.

Hey, the saying goes, good things come to those who wait. I believe with all my heart Apollo will be better soon, just alittle bit longer, girlfriend, just alittle bit longer.:)

Hugs to you and the pups,
Addy

PS, you are going to have to start giving me spelling lessons, I can't believe how bad I have gotten at it since relying on spell check all the time. And when I don't have it to depend on YIKES!!!!!!!!!!!!!

[apollo6]

I will call the IMO on the second urine test to see if results changed and have a lot of questions to ask. :confused::(
As far as spelling, since I turned a certain age, I feel brain dead a lot and with all the stresses we have with family,husbands, pets, parents, business, it's a wonder we can keep our heads on straight .:eek:
If it weren't for spell check you would think I am writing in a foreign language.:D

[apollo6]

:(I got the results on Apollo's urine cortisol/creatinine ratio
urine cortisol/creatinine Ratio is 76 ratio >13:eek:
IMO says this shows good effect of Trilostane is not lasting all day.
should dose twice daily-12 hour increment 8a.m then at 8p.m.
All other signs would say keep dosage same, but because of Apollo's stiff gait means needs more medication? :confused:says muscle weakness is normal but Apollo's stiff gait is not normal for cushing, more severe?:eek:
He still can walk, still climbs his step and the ramp and sometimes runs, so I am very mixed about increasing from 10mg to twice 10mg a 100 % increase? Says Apollo has old age kidney disease? :( Other then the weakness in the hind legs he is doing well. So what do I do.
I copied this from the Vetoryl instructions on twice dosing and it doesn't say double the dose but:
However, if clinical signs are not controlled for the full day, twice daily dosing may be needed. To switch from a once daily dose to a twice daily dose, increase the total daily dose by 1/3 to 1/2 and divide the total amount into two doses given 12 hours apart.
Am I reading this wrong or does it say only increase by 1/3.
Also now I should go to a neurologist and get electrodiagnostics needle test to check for muscle weakness, wasting. Then call in one week on the increase dosage see how Apollo is doing. Then two weeks after increase another ACHT STIM TEST, another urinalysis.
I don't feel comfortable about increasing his dosage. Would appreciate input. I am very stressed and overwhelmed right now.:(
Input : What if I break the pill in half or get it compounded.

[littleone1]

Corky's on twice a day dosing. When his dosage had to be increased for the second time, his IMS recommended this. Since I had many 20mg capsules left, I got 11mg capsules to get to the 31mg. Corky takes 20mg in the A.M., and the 11mg in the P.M. This has really worked for him. He actually made it for the 3 month stim test, which is really good since he was getting a stim every 30 to 60 days due to clinical signs returning.

If your IMO doesn't feel that the dosage should be increased but split between two doses, you wouldn't have to increase the dosage.

Terri

[labblab]

Dear Sonja,

You are interpreting the Vetoryl instructions correctly: when the shift is made to twice-daily dosing, Dechra does NOT recommend doubling the dose. Instead, the daily total may be increased by a smaller amount and is then ideally divided evenly between the morning and evening doses. If your vet has questions about this, perhaps he'd be willing to talk directly to Dechra's U.S. technical representative, Dr. Tim Allen:

http://www.dechra-us.com/Default.aspx?ID=365

Unfortunately, since the smallest Vetoryl capsule is 10 mg. and you are not supposed to open it and split the contents yourself, this does put you in the situation of needing to alter your current med supply if you opt for a smaller dosing increase. You can check to see if there is a local compounding pharmacy in your area that would "repackage" the capsules that you already have on hand. Or else the other option would be to contact an internet compounding pharmacy. Typically, you can order compounded trilostane in virtually any dose that you need.

Marianne

[apollo6]

Thank you both.
It really makes me question the IMO. This is the second time I have disagreed with him on dosage.

[addy]

Hi Sonja,

Should we look to see what UC Davis says? I thought their protocol was a bit different than the manufacturer. Maybe I am remembering wrong.

Don't freak out yet. Remember to breath.:)

Love you and Apollo,

Addy

[labblab]

Unfortunately, I don't think the info that we currently have re: the UC Davis protocol specifies how much (or whether) the total daily dose should be increased in the event that a switch is made to BID (twice daily) dosing. Here's the related excerpt from the article on our Trilostane Info and Resources (http://www.k9cushings.com/forum/showthread.php?t=185)thread to which we typically refer:


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.

Unfortunately, this article dates back to 2007. We have been trying without success to get more updated info from UC Davis. So if anyone out there has a dog on trilostane who is being treated at UC Davis, we would be grateful for any additional feedback!

Marianne

[addy]

Me Again,

I just keep reading the twice daily dose is half of the daily dose. Or I read the total daily dose may be smaller in dogs with twice daily dosing.

If you don't yet want to increase, I guess that means compounding so you could give the current dose bid.

Maybe you feel better trying that before increasing?

Oh dearest friend, we'll all keep trying to help figure it out.

Sure wish I could hop a plane to say hi!!!!!:)

Hugs,
Addy

[apollo6]

Dear Addy
wish you could also.
I left word with the IMO. I know he doesn't like when I question him, but the last time I stuck to my gut feeling, I was right.

Thanks Marianne. And Terri.

[lulusmom]

I have an audio of Dr. Edward Feldman and I think he has a great deal of influence in setting protocol at UC Davis. In his lecture, he said you want to bump up the total daily dose a bit and divide by two. For instance, if a dog is getting 60mg once daily, you would increase the daily dose to 80mg and give 40mg every 12 hours. I hope this helps.

[apollo6]

Dear Lulas Mom you are right.
I am posting in point form what has happened in the past two days,
my notes.
16. Dr. Hart wants me to start tonight with extra dosage, once in morning 8a.m, twelve hours later8p.m with food.( wants me to do 10mg morning and 10mg night-that is not what manufactor says)
17. Should call within week, how Apollo doing
18. Then in two weeks another ACHT STIM TEST, and bring in Urine sample from first thing in morning.
19. See Neurologist, Lepwiski- to get Diagnosis of myotonia consists of electromyography (EMG) analysis electro diagnostics needle electrode test to check for muscle weakness, wasting. Let Dr. Hart know when so can talk to Dr. Robin Levitski-Osgood prior to Apt.
24. Dr Allen-Decha/Vetyroyl 1-866-933-2472 (toll free/1-913-748-4836-If arthritis keep Vetroyl at same dosage-treat the arthritis/stiff gait (cortisone may have covered up this). If Muscle weakness-Cushing-increase dosage.

25. Urine Cort/Creat level of 76 is not unusual for Cushing dog-after 18 hours Vetroyl wears off, and cortisone increases.

26. Muscle weakness may warrant and increase in dosage.

27. Twice daily means increase dosage by 1/3 or ½ only > Which would be 10 +5=15mg divide in two, would be 7.5 mg in morning and 7.5 mg in evening(18hr difference) Dr. Allen said I could do 10mg in morning and 5mg. in evening (compounded) because Apollo is so little would not want to go any higher.

28. Could wait a few weeks to see if improvement in muscles, since it can take that long to see.

29. August 13, 2010-Dr. Weingardt says if improving why not wait a few weeks wait see if muscle weakness gets better and stiff gait then go from there. Gait stiffness more on right side, hip could be onset of arthritis, Apollo does have back problems for years- doing natural supplements to deal with this, do not want to bump more drugs into Apollo. (Rimyl? not sure of spelling)
30. Still not sure if should do nerve test , he has been probed enough lately, not sure if should do (test if nerve or muscle damage)
Goodnight all, I am exhausted today.

[lulusmom]

Hi Sonja,

Please see my comments below in blue:



Dear Lulas Mom you are right.
I am posting in point form what has happened in the past two days,
my notes.
16. Dr. Hart wants me to start tonight with extra dosage, once in morning 8a.m, twelve hours later8p.m with food.( wants me to do 10mg morning and 10mg night-that is not what manufactor says)

I see that Dr. Allen at Dechra recommended a 5mg dose in the evening. Are you going with his recommendation or Dr. Hart's?

17. Should call within week, how Apollo doing
18. Then in two weeks another ACHT STIM TEST, and bring in Urine sample from first thing in morning.
19. See Neurologist, Lepwiski- to get Diagnosis of myotonia consists of electromyography (EMG) analysis electro diagnostics needle electrode test to check for muscle weakness, wasting. Let Dr. Hart know when so can talk to Dr. Robin Levitski-Osgood prior to Apt.

I think I mentioned this to you before but my Jojo had severe muscle wasting and it did take a lot longer than two months for the to resolve. He also had psuedomyotonia that was dianosed by his IMS based on physical presentation. I did not have a the diagnosis confirmed by a neurologist because I did not have the funds. I figured the condition would either improve with treatment or it wouldn't. In Jojo's case, he regained his muscle tone but still walks with a stiff gait that does not cause him any discomfort.

http://www.vmsg.com/files/Case_Report_Canine_Hyuperadrenocorticism_and_Pseud omyotonia.pdf

24. Dr Allen-Decha/Vetyroyl 1-866-933-2472 (toll free/1-913-748-4836-If arthritis keep Vetroyl at same dosage-treat the arthritis/stiff gait (cortisone may have covered up this). If Muscle weakness-Cushing-increase dosage.

Increasing the dose is fine as long as you have some room but I certainly would not increase the dose if the post stim is within 1 - 5 ug/dl because to do so could throw a dog into an addisonian state. If twice daily dosing is providing good 24 hour control and all but the hindquarter weakness and stiff gait have resolved, it could be a matter of allowing a bit more time to regain the muscle mass or it could be arthritis. An arbitrary increase in dose should not be prescribed based solely on non resolution of these two symptoms.

25. Urine Cort/Creat level of 76 is not unusual for Cushing dog-after 18 hours Vetroyl wears off, and cortisone increases.

I totally agree.

26. Muscle weakness may warrant and increase in dosage.

See my comments for 24 above.

27. Twice daily means increase dosage by 1/3 or ½ only > Which would be 10 +5=15mg divide in two, would be 7.5 mg in morning and 7.5 mg in evening(18hr difference) Dr. Allen said I could do 10mg in morning and 5mg. in evening (compounded) because Apollo is so little would not want to go any higher.

I hope your IMS listens to Dr. Allen.

28. Could wait a few weeks to see if improvement in muscles, since it can take that long to see.

You've been treating since the end of June and if Apollo's weakness issues are strictly associated with muscle wasting, I personally would wait at least a minimum of two weeks to see if the twice daily dosing helps.

29. August 13, 2010-Dr. Weingardt says if improving why not wait a few weeks wait see if muscle weakness gets better and stiff gait then go from there. Gait stiffness more on right side, hip could be onset of arthritis, Apollo does have back problems for years- doing natural supplements to deal with this, do not want to bump more drugs into Apollo. (Rimyl? not sure of spelling)

The drug is Rimadyl and it is a nonsteroidal anti-inflammatory drug. I personaly wouldn't want to give this to my dogs unless I knew for sure my dog had arthritis and/or couldn't alleviate their pain with other treatment..i.e. adequan injections.

30. Still not sure if should do nerve test , he has been probed enough lately, not sure if should do (test if nerve or muscle damage)
Goodnight all, I am exhausted today.

As I mentioned previously, if it were my dog, I would wait at least a few weeks to see if the twice daily dosing makes a difference.

It may not be worth it but you now have my two cents worth of stuff for the day. :D

[addy]

Dear Sonja,

Glynda knows her stuff!!!!!!!!! She is giving you good advise. Go with your gut. That is what you have been doing and it has taken you this far but what Glynda points out sounds really right to me.

Hugs,
Addy

[apollo6]

Dear Glynda
Thank you so much for your input. I am going with your recommendations. I am upset with the IMO at this point. He did give me the options of waiting a few weeks to see how Apollo is doing.
I went to my vet who does acupuncture for Apollo's back, and said why not wait a few weeks to see if the weakness gets better, might be some arthritis in his hip, it usually takes some while. He thought Apollo is looking better, coat, skin.
I am not eager to pump Apollo or myself with more drugs. Once again the IMO did not read the manufacturer's guidelines.
Thanks Addy
Always a challenge.

[marie adams]

Hi Sonja,

Be patient, Ellen has said the muscles/hind leg weakness were the last to come back and it took about 6 months. Maddie started lyso towards the end of February and has been on her first true maintenance period for a couple of months. I am just seeing the improvement in getting muscle back; she still walks stiff legged, but enjoys the running again:D. I am not sure if she has arthritis because she doesn't complain like she hurts; she does get up slower, but not sure if that is because of the weakness in the hind legs.

Keep the faith, you are doing a great job!!:)

[apollo6]

Dear Maria
Thanks for the encouraging words.

[MyRudy]

I'm confused:confused:

Are you staying at the same dose or did you increase it? If you increased it, by how much?

[apollo6]

I am keeping Apollo on the same dosage until I talk to the specialist. I want to give it some more time to see if Apollo's weakness in his hind legs improve. I will ask when he should get his next ACH STIM test. If I notice any changes in Apollo, I will call the specialist right away. After the next Ach stim test or before , the only increase I would do would be twice daily, which means an increase of only 1/3 or 1/2.
example: Apollo gets 10mg., I would add 1/3 or 1/2 which would be 10+3 or 10 +5.
That means you would feed half of 13 or half of 15 in morning(6.5 or 7.5) then 12 hours later 6.5 or 7.5 . I do a lot of analysing figures, so don't even worry about all this for now. Wait until you get all your test backs, get the vets recommendation and we can help you from there. This can be very overwhelming.

[apollo6]

Talked to the specialist today, said if Apollo is doing good, wait 6 weeks to recheck, but call in 3 weeks for an update, or if there are other changes. Still concerned about the hind leg stiffness, sometimes he seems a little better. Walks very slowly now.
Any input?

[addy]

Hopefuly, other trilostane users will be able to tell us if they have experienced muscle weakness as a side effect of the drug. Sonja, you are saying Apollo had muscle weakness before starting the trilostane and now it seems worse?

Addy

[littleone1]

Corky didn't experience additional muscle weakness because of the Trilo. Once his cortisol level dropped, it affected his arthritis. When his level was higher, his arthritis didn't bother him. Some dogs might also have undiagnosed arthritis which could be masked by the cortisol level. Once the level gets lower, arthritis can show up.

I hope this helps, Sonja.

Terri

[lulusmom]

Hi Sonja,

Unless I missed something, which is always a possibility, it looks like you have not put Apollo on twice daily dosing yet. I think the last acth stim test and the UC:CR confirmed the need for twice daily dosing and I'm wondering why you are hesitant to do so using the dosing formula you have so carefully calculated based on proper protocol.

I realize that Apollo's stiff gait is worrying you but honestly, if this problem is due to muscle wasting and/or pseudomyotonia, these symptom will not improve until you have Apollo stabilized on a dosing regimen that effectively controls the cortisol throughout the day. Once you accomplish this, you should be patient because you may not see improvements for a few months.

I think that it's highly likely that until you get Apollo on twice daily dosing, you are going to get identical or similar results on all subsequent acth stim tests and UC:CR's, so I'm not sure that's very cost effective for you. In your shoes, I'd get Apollo on twice daily dosing and have a stim test done 10 to 14 days later.

Just my two cents, again.

Glynda

[apollo6]

Addy, Terri and Glynn
I did talk to both my vets and they said since all other signs are okay to continue same dosage 10mg. Thanks Glynn, but the specialist said to call by end of this week and then next check up and ACHT STIM test around Sept 9th, 2010.
I know Apollo did not have the stiff gait until about a month ago. Could it be the trilostane?:confused:
I still have a hard time accepting my little guy has this disease/condition.
His coat has improved a lot, skin lesion are gone, still bump on tail, appetite normal for Apollo. And I was shocked that he refused extra water when we were on an outing. Never ends, now my other dachie, Karma has a weird lump on her side and some kind of sore on the side of her nose.

[addy]

Additional adverse reactions were observed in 93 dogs. The most common of these included diarrhea (31 dogs), lethargy (30 dogs), inappetence/anorexia (27 dogs), vomiting (28 dogs), musculoskeletal signs (lameness, worsening of degenerative joint disease) (25 dogs), urinary tract infection (UTI)/hematuria (17 dogs), shaking/shivering (10 dogs), otitis externa (8 dogs),

I found this on a VetRx website. So I guess the question is, how do you know if the lameness is from the drug or because of the drug reducing the cortisol which in turn makes any arthritis worse? :confused:

The above study did not remark on that. :mad:

I had a friend that used to tell me 'You know dogs, always something!!!"

But they are so darn cute, we have to love them!!!!:D

Hoping the next test is really great!!!!!!!

Hugs,
Addy

[apollo6]

Dear Addy
thanks for the input , I am calling IMO to report on Apollo's progress, but I will state what you just said.
Hugs Sonja

[apollo6]

Well today was a bad one for me. :( I lost it.:eek:
A lot of stresses today , with my Mom's health, business decisions, disputing a health bill. But what pushed me over the edge , was a neighbor telling me , that my other neighbor put her 13 year old border collie, Wizard , to sleep after he was ill for a few hours. I just started crying so hard, the flood gates opened. When I got home I picked up Apollo , held him, sat on the couch and couldn't stop crying. Apollo will be 12 in October and I am realizing my time with him is precious. I am supposed to call the IMO on Apollo's progress and am fearful. Don't know why. Just so much lately, doesn't take much for me to cry.

[frijole]

I understand completely and send hugs. I started out the year with a dog that was over 16 and one about to hit 14. Haley's passing hit hard however she led a long and happy life. I always thought I'd have several years of happiness to spoil Annie as she always cowered around Haley and so missed out on attention. When Annie was diagnosed with cushings and after mos without answers as to what is going on... lots of tears, lots of stress... I am forcing myself to make life fun for both her and myself. It is really hard some days. But knowing that we all have a limited time on this earth... we need to take advantage of it.

It is easy for all of us to focus on the illness but we must remember to smell the roses and notice that the sun is shining. I remind myself of this every day. Good luck and do continue to give Apollo lots of love and laughs. That is the greatest gift. Kim

[addy]

Dearest Friend,

I had the same reaction when my neighbor put her very ill shephard down. I think it just hits a little too close to home.

The important thing to remember is Apollo is here right now today and you can hug him and kiss him all you want.

I now declare today to be National Hug Your Dog Day!!!!!!!:D

So, let's all give our pups extra hugs!!!!!:)

I think you need a trip to the ocean with your cool red stroller so Apollo can turn heads!!!

Sorry I have to run to work, talk to you later,

Love,
Addy

[MyRudy]

That would probably send me over the edge, too (to hear about a neighbor's dog being put down).

Love National Hug your Dog Day and I will do so when I pick him up at the Vet's office today!

[Marlene]

Sonja,
You are not alone in those feelings. I teared up reading your post. I can completely empathize. I'm having trouble sleeping because when I lie down I start to think. I teared up at the vet's office. It's embarrassing for me that I can't keep it under control sometimes. You have the other added stresses in your life and I can't imagine how difficult this is for you right now. I wish I were there next to you to help. I hope knowing that we care and are here to listen and offer whatever comfort we can will help.
I went to lunch with an acquaintance last week and I was telling her about Lacey and how upset I am. She offered, "Well, you know, she can't live forever!" I was so upset at that remark. There are lots of people who can't understand the closeness and the love we feel for our babies. But we here on this forum are thinking of you and sending our love and we certainly feel what you are feeling.
Love and hugs to you and Apollo from Marlene and Lacey!!

[apollo6]

My angels:Kim, Addy, and Marlene
without all your support , I would really have a tough time. I am going to hug Apollo a lot today. People just don't understand, our fur balls are living breathing beings, not things. I can't believe how cruel people can be. I have such a bond with Apollo, it scares me.
On the lighter side, Sunday we took the whole family, husband, mom, me , Apollo and Karma to Hotel Coronado for a stroll in Apollo's stroller.:) Both Apollo and Karma were sitting in it heads in front looking out. A young girl and her mother from France, eyed us.
The little girl was so sweet and asked to make a picture with my pups, said sure. My husband the Scot said if we retire we could make money having people make pictures of our pups in the stroller.:D
Well I call the IMO today. Wish me luck.
Hugs from Sonja and Apollo

[addy]

I have not slept more than 4 hours at night since I was first told Zoe had Cushings back in April. I was considering trying out Zoe's melatonin:o but then read it may affect my asthma:eek:

My husband is wondering if he tries melatonin and lignans will he grow hair on his bald spot?:rolleyes:

I am trying really hard to get you guys to laugh!!!!!! Help me out!!!

I guess tomorrow is going to have to be National Laugh Out Loud Day!!;)

Dearest Sonja- I think Apollo will have good results on stim and is going to be around much longer.:)

Sweetie Marlene- It will get easier, just takes awhile. Did you try putting Cushings in the drawer yet? It really helps.

Hugs to all,

Addy

[apollo6]

So right Addy,
We need to remember to laugh with each other once and a while.

[Marlene]

Addy,
You did get a giggle on your husband's idea of growing hair!:D
I got my copies of Lacey's testing from CSU just now and I immediately thought, "I'll post those and see what others think of them." Then, I read your post and thought again, "No, I'll do what you say. Give it a break for a while and go do something that will take my mind elsewhere." Thank you, Abby, for trying to make life better.
Love and hugs from Marlene and Lacey.

[apollo6]

called IMO, go in Sept 7th for next ACH STIM TEST. Made appointment at same time with Robin Levitski-Osgood, DVM, DACVIM (Neurology) to check if stiffness, lameness due to cushing or arthritis? :confused:
Apollo does have a herniated back disc.

[Squirt's Mom]

Having a herniated disk myself, I can tell you that my hind legs will go numb from time to time especially when I overdo so that could be playing a role in Apollo I would think.

Hugs,
Leslie and the girls - always

[addy]

Hi Sonja,

A herniated disk could be affecting your sweet baby. I think you will feel better after his appointments.

I loved hearing about the French people taking pictures. I have to check your album. Did you add pix of Apollo in the stroller?

I hope you have a really good weekend and I hope your Mom is better. Mine is a widow, 86 and live 30 minutes from me. It is a challenge juggling it all. I don't know how you do it!!!:)

You are so lucky your pups fit in the cabin of the plane. Wish mine did!!! We would be gone------ I think France doesn't quarantine, or maybe an island, just not near Bermuda, I heard catagory 4 hurricane is approaching!!:eek:

Love to you and the pups,

Addy

[littleone1]

Hi Sonja,

I just read your response to Addy about Apollo's last stim results. The 8-17 range is the normal reference range for a dog that is not being treated for Cushings. For a dog being treated with Trilo, Apollo's 5.1 would actually be in range. Dechra doesn't recommend increasing the Trilo dose until the cortisol level gets to 5.4. For a dog being treated with Lysodren, the range is 1-5. I hope this helps.

[apollo6]

Thank you.
So far Apollo is still on same dosage. Next Stim test is Sept 7th.

[Franklin'sMum]

Having a herniated disk myself, I can tell you that my hind legs will go numb from time to time

:D:D:D:D:D Gotta love 'laugh out loud' day!!! ;)

Hi Sonja,
One of my friends has greyhounds, and he gets them seen by a animal chiropractor or physiotherapist sometimes. Not sure if that would help Apollo with his herniated disc, but figured I'd mention it.
Jane, Franklin and Bailey xxx

[apollo6]

Thanks
open to suggestions. Have a herniated disk in my neck.
Apollo does acupuncture for his back. Are cushing babies more heat intolerant. Apollo did not do good with the heat today, even in an air conditioned car.

[apollo6]

Need to express my self. Like Corky's mom says, I wonder sometimes if I am doing the right thing having Apollo on Trilostane. It seems the stiffness was something Apollo did not have until June, and he seems to fall easily now.:( It breaks my heart. :(Am I doing the right thing by him having him on medication?:confused:
It was just today seemed like a hard one for my little boy.

[littleone1]

Hi Sonja,

I just want to clarify that Corky had arthritis prior to his Cushings because of the pins in both of his hind legs. When his cortisol level was higher, his arthritis wasn't bothering him, but there was muscle weakness. There is the possibility that our cushpups have undetected arthritis because of higher cortisol levels. I personally would rather have Corky on Trilo and give him other meds for his arthritis than not to treat his Cushings, especially with his adrenal tumor infringing on his major blood vessels.

I totally understand how you feel. Corky has been missing steps in his walking recently, and I know his dosage is most likely going to have to be increased due to muscle weakness, which is not the same as his arthritis symptoms. I hope this helps to clarify what I posted before.

[Roxee's Dad]

Hi Sonja,



called IMO, go in Sept 7th for next ACH STIM TEST. Made appointment at same time with Robin Levitski-Osgood, DVM, DACVIM (Neurology) to check if stiffness, lameness due to cushing or arthritis? :confused:
Apollo does have a herniated back disc.

I think getting a Neurologist is a great idea :) Sometimes it's difficult to know if it's arthritis or a neurology problem. I hope he is able to offer you some answers. Keeping fingers and paws crossed that all turns out good.

Give little Apollo some belly rubs from me. :)

[addy]

Hi dear friend!

Zoe has a hard time in the heat, even going into the air conditioned car seems to be hard for her when it is hot and humid. This morning we stayed in the yard and did not walk, just praticed stuff outside for ten minutes, i know she can't do heat.

I have a question, when you give Apollo his trilo, does his gait improve or get worse? As the trilo wears off, does his gait improve or get worse? Or is it stiff all the time? Is there a pattern? Does it seem worse with certain weather?

I think, too, that seeing the neurologist will help get to the bottom of things.

Sorry you had such a bad day. I hope today is better. Hey, I can't go out in the heat either so that is not so bad:)

Bottom line is, you could always stop the trilo for a few days and see what happens. If your gut is telling you something is wrong with the drug, then maybe you should do a test for a few days. I don't know if that would matter, ask you vet what he thinks, could you do that. Just remember, as always with our dogs, there are always soooooo many possibilities, hard to know what is accurate picture. I get a sense that in your gut, you feel there is something wrong with Apollo's reaction to the trilostane. Is that how you feel?

Love you and many hugs to Apollo,
Addy

[apollo6]

Addy, Terri , John
Thank you all for the input. I am monitoring his gait. The little guy is still determined to try his best. On the brighter side, yesterday, we took a day trip, and Apollo was in his glory in his red stroller. Second time a person asked to make a picture of him in the stroller. Maybe we could make extra money asking people to pay for the privilege of making his picture.:D
I am so proud of myself, I was able to download the picture of my pups in the stroller from my phone. Will download.
Without you all, I don't know if I could make it.

[addy]

we should write a children's book with water color pictures about Apollo and his red stroller!!!!!!!!!


he could be famous and have his own line of pup gear!!!!

Addy

[MyRudy]

Oh, I wanna see the Apollo in his red stroller pics - where are they?

[apollo6]

You go an idea there Addy.
I downloaded the stroller in my picture album.
Apollo in his red stroller picks up Zoe for a drive to the country side for a picnik.:D

[addy]

Oh Sonja,

I love the dogs in the red stroller. I also saw your beautiful drawing.

You never mentioned what a talented artist you are:)

Keeping fingers and toes crossed for upcoming vet check.

Saying a prayer too!

Love,
Addy

[apollo6]

Dear Addy
Thanks for the encouragement. I was an art major way back when then switched to business administration. I feel like all I do is go to doctors with Apollo, Sept 7 another ACHT STIM test, then same day neurologist check if stiff gait is from muscle loss or hip problems arthritis.:(
Sept 10th acupuncture for his back(he likes that) then Sept 24th yearly check up, titer test to check if vaccines still working. Stopped 2 years ago with vaccines.
When I read how many of our cushing babies get overdosed starting too high a dosage, I just don't want to increase Apollo's if I don't need to. This is so difficult at times to take. :(

[addy]

it will get better and hopefully calm down soon. On my thread I mentioned you should turn to your art for stress therapy, your talent should be nutured, don't let it fall by the wayside.

I hope you have a great Labor Day weekend.

Hugs,
Addy

[addy]

Hey Girlfriend!!!

I hope you are enjoying a good Labor Day weekend!

Thinking of you and your up coming vet visits and saying a prayer for you and Apollo that everything is great!!!

Zoe thinks Apollo is pretty darn good looking too!!!:) and is hoping for that ride in the stroller for a country picnic:D:D:D

Love,

Addy

[apollo6]

Thanks
They would make a cute couple. Are we trying to play cupid.:p:D

[MyRudy]

Awww, Apollo in the red stroller is cute beyond words ;)

Hoping for good test results for him today!

[addy]

Hi Sonja,

My overprotective genes are kicking in.:o

Hoping everything is okay with my dear friend and our precious Apollo.

Hugs,

Addy

[apollo6]

Thank you for worrying:eek:, I have been overwhelmed lately.:( Will post what doctor said. and neurologist , had ACHT STIM TEST AND URINYLASIS CORTISOL . WILL POST WHAT DOCTORS SAID.
Thanks for caring.

I am copying from notes I do.
34. ___September 7TH 2010 APT WITH DR. LIPSKY NEUROLOGIST-DIAGNOS-NEUROMUSCULAR VS MYELOPATHY( L4,5,6 disks in vertebra
) CUSHING MYOPATHY, DEGENERATIVE NEUROPATY AFFECTING FEMORAL NERVES, VASCULAR EVENT, NEOPLASIA (could wait and see if improvement or do electromyography(EMg) or take a biopsy of muscle. NO way Apollo has been through enough already.
My vet who does acupuncture stated in simple terms-you know this started in June with the cushing , so why waste money with further tests-you know it is from the cushing, since other symptoms have improved.

35. Sept 9th results of ACHT STIM 1-3.3 2 POST 6.2 URINE CORTISOL/CREEATININE RATION 61

36. September 10, 2010- DISCUSSION WITH Dr. Hart, if not for muscular weakness in hind legs would keep same dosage, but because of this would like to make a minor increase to 12.5 mg from 10mg. and do ACHT STIM TEST WITHIN 10 DAYS to see if change in weakness, have noticed seems to urinate more and drink more lately.

37. NOTE Throw UP Sept 4 and on Sept 9th (green slimy liquid)

38. Lump on tail is doing better, reduced.:)
Any input would be appreciated. My assistant was on vacation 2 weeks, so trying to do her work also.
JUst been running in all directions lately.
It is so good to know you all care.:o
Love Sonja and licks from Apollo.

[addy]

You have been busy my friend!

It would seem a dose adjustment may be the best way to go especially if other symptoms seem to be increasing.

If Apollo had disk problems before you started Trilostane and the muscle weakness started since he was put on Trilostane is it possible the drop in his cortisol has affected his back problem since the high cortisol possibly masked some of it? Just wondered how that works.

How are you feeling about all of this?

I understand about assistants and vacations only too well and you have my sympathy:)

Glad to hear you been busy and it wasn't something else:eek:

Hugs and licks back at you and Apollo.

Addy

[apollo6]

At times I just get overwhelmed and question is the hind leg weakness from the Vetoryl, didn't have before, or was the high cortisone covering it up. Just don't know what is right.
Not happy about the increase, but it is very small, so I guess I can accept it. Was 10mg now going to 12.5mg.(compounded formula)
EXPENSIVE.:eek::mad:

[addy]

I hear you, it is so hard to know which is it? Look at Denise and Bonnie (the twiglets) for example, she too was backwards, forward and sideways.

Trial and error, I guess, as long as the error part does not get critical. It is a modest bump. I guess if you really think it could be side effect you could stop the drug for a bit then you may get your answer. If we look at it, on the surface it seems like the thought that high cortisol was masking some of it could be high possibility. Not that Cushings is logical:mad:

Guess what? I finally noticed I have a spell check button on my tool bar and it works while I am typing here. Man oh man, do I feel stupid!!!:eek::o:rolleyes:

Try to get some down time in!!!

Hugs,
Addy

[apollo6]

My dear friend
I couldn't type without spell check, that's how bad I am at spelling.
:D:eek:
Get some rest my friend.

[addy]

Hi Sonja,

I was rereading the June 2010 article- the interview with Dr. Feldman regarding Cushings


Feldman: Trilostane is my first choice in dogs with an adrenal tumor. My first choice for dogs with pituitary-dependent hyperadrenocorticism is mitotane. However, trilostane at an initial dose of 0.5 mg/kg given twice daily is an excellent second choice. No veterinarian should consider the use of trilostane before thoroughly reading the insert provided with the drug — not the insert for pet owners, the insert for veterinarians.

What I thought was interesting was that he is saying twice daily dosing. I did not remember this from the interview, thought you might be interested in it. Was wishing this was an option for Zoe for when I need it but with her other hormones so high, I don't think we can use it.:(

Have a great week!!!

Addy

[apollo6]

Thanks
Today was bitter sweet.
Apollo tripped a few times and I feel the gait is worse. Am I doing the right thing with Trilostane. Went to lawn show from Puerto Rica-love latin music. Afterwards took Apollo with my Mom to the dachshunds meet. When I saw all these healthy dachshunds running around and Apollo stumbling and wobbling I had to hold back the tears.:(
On the up side, embarrassing side, a 8 month old boy dachie was smitten with Apollo, the two of them were trying to hump each other in a race who could be on top:eek:. Every one at the park was laughing and making jokes. This is a family park, is there something Apollo is not telling me about his preference , then to top it off an 8 month old bull dog decided to try and hump the back of a young lady sitting down.:eek: This was indeed an x rated event. When we left someone gave the thumps up to Apollo and said, you still got it. I told Apollo he was a dirty old man.
Will need your support to increase Apollo to 12.5mg. Trilostane.

[Squirt's Mom]

Hi Sonja,

Sounds like a fun day was had by all! :p Maybe there was something in the air today!:p

Isn't it funny...Apollo's limitations didn't bother him in the least, he had fun in spite of everything. But, as mom, it breaks your heart to see what he can't do as well as he once could. Our babies are blessed in that they do not worry about things...they leave that allll up to us! ;) And some of us, Sister Twitcher ;), are very good at that! ;):D

You will do just fine with the increase in dosage. It is small, and you now know what to look for in the event it is too much. For Apollo's sake, it is worth the try. Wouldn't it be wonderful if his legs improved?! We have many Trilo moms and dads who can help you with any questions you have. Most importantly, you watch Apollo like a hawk and that is what it takes with Cushing's. Apollo couldn't be in better hands!

Hang in there!
Hugs,
Leslie and the girls :D - always

[addy]

Hi Sonja,

All I can say is Leslie nailed it. dead on. I understand how hard it is to watch darling Apollo and remember when----- but he did have fun and he can still have fun. so he has a quality of life, it is just different than before. It breaks our hearts and we feel sad because we fear what else the future may bring and we look back. We can't look back, dear friend, I do it too, we have to stay in the now somehow. Focus on the positive which is very hard to find sometimes because we want it like it was, we don't like the new life.

I am having that with my Mom. It is hard to see the changes that are not always good.:(

It is a slight bump, the dose increase, and if it doesn't work out, you can change it or try twice a day or stop the drug. You know your baby best. I was suprised when I reread the interview with Dr. Feldman about the twice daily dosing. I thought it would make you feel better, reassure you, if you have to go that route:)

Our little Apollo is the hit of the dog park and the boardwalk!!! We better start on that book:D

I will be here and so will eveyone else, every single day when you bump the dose so we will cheer you on!!!!!!!!

Love you,

Addy

[apollo6]

thanks Leslie, the girls, Addy and Zoe
Needed to read what you both said.
We need to post their little adventures to lighten up a little.

[apollo6]

My sweet little Apollo is having a harder time walking. Doesn't want to walk at all. I force him everyday to walk a little. He seems to fall more. I just don't know what to do.
I got the new medication Vetoryl compounded liquid 12.5 mg/1.25 ml
and I just look at it and question could this be causing the weakness in his hind legs. I pick him up when he falls and whisper we are not giving up. God this this hard.:(

His coat is growing in, the pot belly is almost gone, he eats fine, but something as changed, it's like he looks at me and I wonder what he is feeling.

[gpgscott]

Hi Sonja,

The unwillingness to walk and the clumsiness could be pain as much as muscle wasting. While I would not want to have my pup on a chronic dose of pain meds for and extended period it might be useful to suggest constant pain meds like tramadol for two or three days and see if that has a significant affect on mobility. If it does that would lead me to suspect degenerative joints and might lead to to a long term treatment.

Scott

[addy]

Hi Girlfriend,

I am so sorry to hear Apollo's leg problem is worse. Dena seems to be reporting similar issues if you read her recent post. I thought Scott had a good suggestion, maybe discuss with your IMS. I know how nervous you are about uping the dose. I am crossing my fingers and saying prayers all goes well.

Zoe did something to her back leg, she won't jump on the bed and when I try to pull on her leg gently to stretch it, she stiffens it up. We are on rest this weekend, no walks and may have to go see IMS if not better in a few days. Their hind legs sure end up being problems, poor things. So many of us have one issue or another with them.

It is always something!!!:)

Love you and Apollo, give that "dirty ole man" a kiss for me:D

Addy

[SavingSimon]

I have to tell you it is the first encouraging thing I noticed (for me) in your thread that Apollo's pot belly is gone - because I think that is a good sign about muscle. I might be wrong, but I have read that part of why they get a pot belly is because of the abdominal muscles becoming dystrophied, so I want to tell you hang in there. I am so scared too - have lots of questions about muscle and trilostane - but this seems to be an IMPROVEMENT in that area, so maybe we just have to be patient, like you said, and not give up. Apollo reminds me so much of Simon in his face, and eyes, those soulful eyes really get me - I will keep you both in our prayers. Hang in there - hopefully someone knows something to help with their legs, because I have the same exact concern as you.
Know you are doing everything you can, and God bless and watch over you and your sweet boy. May He give us all strength! Literally.
Love,
Dena and Simon
PS. Simon still has his pot belly, so maybe I haven't been patient enough? Maybe legs just take a little longer than their bellies? I'm sure someone knows more than me. :)

My sweet little Apollo is having a harder time walking. Doesn't want to walk at all. I force him everyday to walk a little. He seems to fall more. I just don't know what to do.
I got the new medication Vetoryl compounded liquid 12.5 mg/1.25 ml
and I just look at it and question could this be causing the weakness in his hind legs. I pick him up when he falls and whisper we are not giving up. God this this hard.:(

His coat is growing in, the pot belly is almost gone, he eats fine, but something as changed, it's like he looks at me and I wonder what he is feeling.

[apollo6]

Thanks Scott, Addy and Dena
Apollo is having problems with one leg more then the other. When he sits he leans more to one side then the other. I am watching him like a hawk, I mean guardian angel.
Yesterday was a good one, when I was working in my office, Apollo managed to get himself on the couch and on the back rest all by himself. I was so proud , I gave him a hug and a treat.:p Some people don't want their pets on the furniture. Well in my house , my pets have free range of everything(well not quite everything):D
He did a pretty good walk yesterday.
Will wait another day before I up is dosage. I just want him to have a good weekend.

[apollo6]

Sunday
Today was not a good day for my little guy. Had a harder time walking, fell down once. I keep wondering is it the Trilostane or is it degenerate joint disease or arthritis. All I know is it just came up overnight in June when I started the Trilostane. I am thinking of calling the IMO to ask. I should start the new increase 10mg old , new is 12.5mg compounded liquid.
On the lighter side. Apollo does not like getting bathes. As soon as he sees me bringing out his shampoo and towels, he hides under my guest bed. :p Well the little rascal found a new hiding place . I searched for over an hour in the house, found him hiding behind my bed in between a head stand. Well he was stuck so he couldn't get out. End of story. He still got a bath.

[addy]

Awwwww, cute story, I can picture him stuck:D Koko does not like bathing, brushing, face washed, Apollo reminded me of my Koko hiding.:) Maybe it is a guy thing:D:D:D

Hope today is better for you and sweet Apollo. I still think Scott had a good suggestion about asking to try some pain med for a few days to see what happens.

I have to try to get Zoe in for a urine culture and I'm sick again and on antibiotics for sinus infection. Ugh

Hope you have a good week:) When do you go back for test?

Love,
Addy

[Squirt's Mom]

Squirt hates baths! She's been known to walk by the bath tub, glare and growl at it! :D The Queen keeping things in line! :rolleyes::p

I hope Apollo has a better day today....and you, too, Mom.

Hugs,
Leslie and the girls :D - always

[apollo6]

Leslie and Andy
Thanks for the fun stories.:D
Sorry you are not feeling better Andy.:(
Like Scott and Leslie said may talk to vet about the stiff gait and if it is pain. It gets hard at times to figure out what is going on with the fur balls. Wish they could somehow let us know.

[littleone1]

Hi Sonja,

I hope Apollo will soon do better. I'm sorry to hear that he had a bad day yesterday.

I can relate to how he hates getting baths. Corky does, too. He normally follows me everywhere. As soon as I open the bathroom door where he gets his baths, he takes off down the hallway.

I hope that everything goes well with the increased dosage.

[apollo6]

Thanks Terri
Tomorrow I start the new dosage. Kind of nervous.

[addy]

Hi Sonja,

Just wanted to wish you luck with New Dose Day!

Hoping all goes well:)

Hugs,
Addy

[apollo6]

thanks Terri and Andy.
Today was the first day on 12.5mg/compound.

[addy]

Day 2 of New Dose Day!:)

Hi Sonja,

How are you and Apollo doing? Just want to make sure my dearest friend is hanging in there and our babycakes is doing well:D

Love and Hugs,

Addy

[Rebelsmom]

Sonja, have you always used a compound or did you just start? if so have you noticed any difference between the 2? I'm thinking of switching Rebel to a compounded dose and I want all the info I can get.

Thanks and I hope Apollo is doing well.

[MyRudy]

Hope Apollo tolerates the new dosage and those back legs start working better!

I just wanted to add that Rudy had the same problems with his hind legs and since I had some Rimadyl on hand, I tried it one day and could not believe how much better he was at walking! So I started him off slowly, and he is up to 50 mgs (taken twice a day @ 25 mgs each). He is back to normal walks again!

He still does not eat like he did before all this started, but he seems fine.

It has been weeks since he had any accidents in the house and I have removed the baby gates and give him free rein of the house while I am at work again.

He does not come upstairs, however. I think those few times that he fell have him completely scared about the stairs. Although if it gets stormy outside while I am sleeping, he will get brave enough to come upstairs.

He is so funny.

Best of luck w/Apollo.

[littleone1]

Hi Sonja,

I hope Apollo is doing well on the new dosage and that it will help his hind legs. Keep us posted.

[apollo6]

What would I do without you all: Addy, Melissa, Rudy's mom and Terri. I am thankful for all of you.:p
Today is Apollo's third day on the new dosage. Going for his annual check up. will point out the hind leg weakness. On the positive the lump on his tail is almost gone. Maybe the Trilostane?
Does any one have input about if cushing effects the teeth. When I brush Apollo's teeth, the front ones bleed? An now he has this awful foul breath which I don't remember him having before.:confused: I have been lazy about brushing his teeth, though.
Speaking of bop, sometimes Apollo has watery bop, then it is real light yellow, sometimes firm , but never know what to expect. :confused:I must be a nut for watching this.:eek: That is how exciting my life is right now.

[addy]

My Life with Poo, oh I could write that book for sure!!!! Poop Patrol was my life for 2 years and still is:eek:

I have not seen anything written about how trilostane affects the gastro system other than it can cause diahrrea. If you know it is not from any kind of dietary indescretion then parasites, worms, bacteria, food intolerance, the list goes on. In Zoe's case IMS thinks Cushings is causing bacterial infections so that was causing her colitis so she thought treat the Cushings and it will improve but then we shocked her when we got control of it with the melatonin which is totally weird and makes no sense, but Zoe has never made medical sense:rolleyes:

Do you use probiotics or enzymes? Probiotics help Zoe. Also for Zoe metronidazole saves us but we don't use it as per traditional vets prescribe. We use longer and wean off of it slowly.

When I would get accidents in the house or squirty diahrrea then I knew it was time for metronidazole.

In Apollo's case, could be side effect of Trilostane but maybe mention to the vet next week.

Hugs,
Addy

[apollo6]

Take care Addy. How did open house go?
Apollo seems to be gaining weight. Is this a side effect of Trilostane.
For me the concern to keep Apollo lean and slim is he has back/disk problems and I need to keep him slim to not aggravate his condition.

Apollo had another bad day with walking, but it was hot outside. We did a short walk and when we got home he was just whipped.
Vet said before treatment , Apollo's weight loose could have been the cushing? And weight gain could be getting back some of his muscle back? Any input would be appreciated.

[addy]

Someone else suggested that on another thread, that weight gain could be from muscle mass. I think Glynda posted something about it.

I did not remember that Apollo lost weight with his Cushings, I thought they usually gained weight before treatment.

Good luck with your stim this week.

Open House was a complete zoo and I went in to work and didn't even get to eat an empanada:mad::mad: Well, at least I have some extra time off due me. now I can take Zoe in for her urine culture;)

Hang in there girlfriend and I really think you should ask your vet about Apollos' bops.

[apollo6]

Dear Addy,
Hope you got a retrieve from the weekend. Apollo was losing weight before he started treatment. I couldn't understand why, before got the cushing diagnose. But now he has bad breath. :eek: My regular vet said because of the cushing I have to watch his teeth even more for any signs of infections. He has one chipped tooth that is been like that a year, but so far good. Never ends.:eek:
I give Apollo a probiotic supplement to help with his immune system.
Going for next ACHT STIM test Friday, to see how new dosage doing.
Should I get a blood panel also? Any input from anyone, please.

[littleone1]

Hi Sonja,

I always have a blood chemistry panel done when Corky gets his stim tests. Trilo does effect some of the immediate hormones, which could throw the electrolytes out of whack. So far, Corky's electrolytes have been good, and he's been taking Trilo for just about a year now.

I hope everything goes well with Apollo's stim on Friday. I'll be thinking about you and Apollo.

[apollo6]

Terri
Thanks for the input. Will ask Vet.

[addy]

Hi Sonja,

Did you have your stim? Could not remember what day it was scheduled for.

Hoping you have good numbers.

Love,
Addy

[apollo6]

sounds like you have a full plate. Take a breath.
Tomorrow I go for a blood panel and a new STIM test. Won't know results until Monday maybe.
Apollo's lump on his tail has gone down and is almost gone, but he has this lump on his little butt , hoping that will heal. Always something.
His gait is still stiff, sometimes he seems to be walking a little better, then not.

[addy]

Guess you have to hit the beach with the red stroller then this weekend!!!!!

I thought your test was earlier:o I will be crossing everything I can for our little guy.:)

Sonja, how did you know Apollo had an accident in the house and that it wasn't your other pup? Did you see him do it? They never want to do it if you're watching:rolleyes:

Did you see the pictures of Leslie's Trinket? Too cute. I still have a lump in my throat.

Hugs and more hugs,
Addy

[apollo6]

It seems with a boy, there is more urine. Karma did it front of us.
With Apollo's cushing , he did on the front inside brick entrance, trying to get outside, and it was a lot.
I starting going out side with him more then I used to , especially just before bedtime and would praise him and sometime give him a treat to associate going outside is a good thing. But where you live it can be awful cold in the evening.:eek: My brother went graduate school in Madison, now teaches at the University of Ohio State.
Hugs Sonja and Apollo

[littleone1]

Hi Sonja,

Corky and I are keeping everything crossed that Apollo's stim and blood work results are all good.

[frijole]

Sonja, just read your post on Deana's thread and wanted to ask if you have had xrays done? I ask because you just described my Annie's leg and butt. Walks stiff, no meat on the butt etc. I just had xrays and discovered she has spondylosis in her spine. They are bone spurs and very painful. Read up on it and they cause muscle wasting in the hind end. Just sharing... it might not be the cushings.

http://en.wikipedia.org/wiki/Spondylosis

[apollo6]

Appreciate the input.
Need to check and ask for xray.
Sonja and Apollo

[apollo6]

got results from test and managed to erase when posting.
Specialist wants to talk with me on Monday. Said was pleased with the results. But I still have concerns about some readings, also the hind leg stiffness. Suggested I get xray. Maybe I should?

ACH STIM
CORTISOL SAMPLE 1 1.1 RANGE 1.-5
CORTISOL SAMPLE 2 2.8(LOW) RANGE 8-17. SHOULD I be alarmed?

Sodium 148 ( 139-152) last time 148

Potassium 4.8 ( 4.- 5.6) last time 4.8

chloride 111 (105-120) last time 107

C02 27 H RANGE 17-26 last time 27H hasn't changed
( -CORITSONE PART OF bicarbonate AND DIURETIC THERAPY_DON'T KNOW WHAT THIS MEANS-DIDN'T TEST LAST TIME)

NA/K RATIO 30.8 (26-37) last time 31.5

Anion Gap 10. (.0-25) last time 14.

Glucose 83 (70-120) last time 89

BUN 32H (7-31) last time 35H going down (kidney function?)

Creatinine .7 ( .7-1.7 ) last time .7


BUN/CREA RATIO 45.7H (9-33) last time 50H still very high



Calcium 10.5 ( 9.1-11) last time 10.3

Phosphorus 5.5 ( 3.2 -6.3) last time 6.3



CA/PO4 1.9 RANGE 1.2-3.8 last time 1.6 ( I don't know what this reading means wasn't done last time ?)

Protein 6.2 ( 4.7-6.9) last time 5.7


A/G RATIO 1.07 9 .6-1.3) WAS 1.28

CK(CREATINE KINASE) 270 RANGE 54-380 LAST TIME 243 ( DIDN'T TEST LAST TIME-MAY BE INDICATION OF MUSCLE DISORDER? DUE TO CUSHING) GOING UP?

AST(SGOT) 50 RANGE 6-62 WAS 64H WAS 88 HAS GONE DOWN) LIVER

ALK PHOSPHATASE 137 RANGE 9-140 WAS 369 H WAS 827 (HAS GONE DOWN) STILL HIGH

ALT (SGPT) 219H RANGE 15-84 WAS 448 H WAS 854( HAS GONE DOWN) STILL HIGH

GGT 14H RANGE 0-6 WAS 40H WAS 131(HAS GONE DOWN) STILL HIGH

BILIRUBIN .4 RANGE .1-.6 WAS .1 GOING UP

CHOLESTEROL 178 RANGE 114-250 WAS 205

MAGNESIUM 2.2 RANGE 1.5-2.7 WAS 2.1 WAS 1.91( NOT MUCH CHANGE)

TRIGLYCERIDE 252H RANGE 18-248 WAS 179 WAS 75 (CONCERN ABOUT SUCH AN INCREASE

Input would greatly be appreciated on the readings.
Thank you

[littleone1]

Hi Sonja,

Apollo's test results do look good to me. The range given for the post stim test are actually those that are in the normal range for a healthy dog who is is not being treated for Cushings. Corky's
1st post test stim result was 2.1, after being on the Trilo for 10 days, which was in the normal range for a dog being treated for Cushings. I remember how concerned I was, but this is a good, desired result. Corky's Triglyceride result also fluctuates between the normal and high range. One time it's in the reference range, and another time, it isn't. The BUN is very close to the normal range, and I personally don't think this is anything to be concerned about. The test results do fluctuate depending on what is going on with our furbabies.

I know that I was always concerned about any deviation in Corksters results, but as long as his IMS didn't feel there was a problem, I trusted her, as she knows alot more than I do.

X-rays might be good, as they could very well help to get a better idea of what is going on with Apollo's leg weakness.

Hang in there, you're doing a great job.

[Franklin'sMum]

Hi Sonja,

How's Apollo feeling lately? B/c these results look pretty darn good :) I've tried to answer your questions below in blue, and I hope it helps

ACTH STIM
CORTISOL SAMPLE 1 1.1 RANGE 1.-5
CORTISOL SAMPLE 2 2.8(LOW) RANGE 8-17. SHOULD I be alarmed? No Sonja don't be alarmed, as Terri said, the 8-17 is for a non cush pup :)
The dechra flowchart lists 1.45-5.4 ug/dl (40-150 nmol) (post stim)with significant improvement as "to continue on current dose" and 5.41-91 (150-250) as acceptable if symptoms are controlled
http://www.dechra-us.com/files//dechraUSA/downloads/Client%20Literature/47902_VETORYL_10mg_Treatment_and_Monitoring_Brochu re_Update_3_2_ps.pdf

BUN 32H (7-31) last time 35H going down (kidney function?) Was this a 12 hour fast?
Blood urea nitrogen (BUN) is typically measured to assess kidney function; however, there are many different metabolic processes and diseases that alter BUN concentration. that's from http://www.vet.uga.edu/VPP/clerk/mckee/index.php and goes on to give these as some possibillities
Increased protein intake, Upper gastrointestinal hemorrhage, Increased catabolism of protein, Starvation, Infection, Fever, Prolonged exercise, Drug administration, Glucocorticoids, Azothioprine, Hypovolemia, Shock so please don't automatically think kidney disease. Also, dehydration can sometimes elevate BUN. Test results can change from one day to the next (says a greyhound breeder/racer friend), and he suggests to think of them as a snapshot in time, not a complete be-all and end-all. If Apollo had a recent meal, or excercise before the test, that can also elevate BUN, but as you note- it's coming down, and in kidney disease it would be elevating, and much more than this.
To my knowledge, creatinine is more of an indicator for kidney function, and Apollo's looks beautiful :D
Creatinine .7 ( .7-1.7 ) last time .7
BUN/CREA RATIO 45.7H (9-33) last time 50H still very high
CK(CREATINE KINASE) 270 RANGE 54-380 LAST TIME 243 ( DIDN'T TEST LAST TIME-MAY BE INDICATION OF MUSCLE DISORDER? DUE TO CUSHING) GOING UP? Creatinine kinase (CK) is released into the blood from damaged muscle. Elevation of creatinine kinase therefore suggests damage to muscle including heart muscle from http://www.vetmed.wsu.edu/cliented/lab.aspx so I would suggest asking your vet if this may be related to Apollo's hind end weakness

ALK PHOSPHATASE 137 RANGE 9-140 WAS 369 H WAS 827 (HAS GONE DOWN) STILL HIGH Please tell me your secret, Sonja, how did you get the alk phos down so far and so quickly?? I would love for Franklin's to look half this good. :) To me, it looks like it's within your lab ref ranges, now.

TRIGLYCERIDE 252H RANGE 18-248 WAS 179 WAS 75 (CONCERN ABOUT SUCH AN INCREASE May be explained if Apollo wasn't fasted for 12 hours. And sometimes they do vary from one test to the next as Terri mentioned. Cholesterol was in range, and I didn't see anything for lipase, so personally I wouldn't worry too much about this, yet. If it skyrockets up, or stays up through repeated tests, then I'd be speaking with the IMS.

Input would greatly be appreciated on the readings.
Thank you

Hope some of that helps, Sonja :)

Jane, Franklin and Bailey xxx

[gpgscott]

Hi Sonja,

The numbers are OK but I would be concerned that the cortisol is too low. At 2 there is really no buffer should it go lower for some reason, I would be much more comfortable with a post in the range of 5. The September 09 post was 6.9 if I am reading right and this was before an increase in dose.

Changing dosing is not like salting to taste, the response of the pup is delayed and varies. I really think you have to be very alert to symptoms of low cortisol and be prepared to administer cortisol if these symptoms occur. As long as appetiete and thirst are controlled I think most pups, especially those with joint/muscle issues are better served by a post cortisol in the higher rather than lower range.

An x-ray can give you an idea as to hip damage and arthritis and they don't take long. I think it would be a good idea. Glad he is better and hoping his hindquarters issues improve also.

Scott

[labblab]

Hi Sonja,

If I'm reading your test results correctly, Apollo's ACTH "post" result was 2.8 and not 2.0, and therefore I'm feeling much more comfortable about the result than is Scott (which I'm sure he won't mind, since that's what this forum is all about -- tossing all of our different ideas out there for consideration :p). But as Jane has written, Dechra's ideal therapeutic treatment range is between 1.45 and 5.2 ug/dl. So at 2.8, Apollo's reading is right in the midst of that ideal range. And since you're now seeing healthy declines in several unwanted lab elevations, it looks to me as though you've gotten a great result from the dosing increase, at least from that standpoint.

I do agree with Scott that you always have to remain vigilant about any negative changes in Apollo, because his cortisol level can continue to change over time. And that some pups do feel better with cortisols that run "higher" rather than "lower" within the range. But for right now, I'm thinking that some x-rays would be a good idea for Apollo -- in order to explore whether there might be something entirely different going on that is causing the hind-end issues. Because in terms of laboratory improvements, I think Apollo's response to this dosing increase has been good.

Marianne

[addy]

Dearest Friend,

It seems you are getting good feedback regarding your tests. The important questions exactly is how is Apollo feeling?

I need to run to work but wanted you to know I am thinking of you and so glad I checked in to see if you had the results.

All seems good:D:D:D

Big sigh of relief, dear friend.

Love,
Addy

[AlisonandMia]

Here's a link to an interesting talk regarding reliability/consistency/variability of lab tests and their interpretation. It is about humans but would undoubtedly be no different for dogs and other animals. Click on "show transcript" or you can download it in MP3 format.

http://www.abc.net.au/rn/healthreport/stories/2009/2577209.htm

Alison

[Franklin'sMum]

Thanks, Alison, that was interesting reading :)

[apollo6]

Thank you all for your input.
Terri and Corky for the support.
Jane,Franklin and Bailey, for the input on the labs. Apollo did not fast before the lab test. Don't know how the Al Phos went down so much. Thanks for the link
Scott thanks for the input, I was also concerned about the second cortisone low reading.
Maria yes the second reading is 2.8. will keep a watchful eye on him. I think he thinks I smother him too much. Because it is like he is saying give me space.:eek:
Addy thank you for the support. Hang in there. Got to have faith and hope.
Thanks Alison for the site on lab readings. It gets so confusing.
The vet said other then the leg weakness happy with progress.
I asked the IMS if the Trilostane could be causing the hind leg weakness, said no?
Wants me to keep close watch if any changes in Apollo , to call him. Wants another ACHT STIM test in 6 weeks unless any changes.
I go Friday to the vet how has treated Apollo for his back/spinal issues for years and will bring up the hind leg weakness and about doing an x-ray.
Need to go back to work. Will update after Friday appointment.
Still worry a lot.
Hugs Sonja and Apollo.

[marie adams]

Hi Sonja,

Keep up the good thoughts. You are there for Apollo and will do the right thing. I think Maddie just has the arthritis showing up more now that her cortisol levels are maintained. She walks slower, but doesn't give up. Apollo sounds like a trooper; so you hang in there also.

Best Always!!

[gpgscott]

.
The vet said other then the leg weakness happy with progress.
I asked the IMS if the Trilostane could be causing the hind leg weakness, said no?
Hugs Sonja and Apollo.

I get it that the Trilo is not 'causing' the hindquarters issue but it is clearly a quality of life issue and in my view should be treated with the same concern as elevated cortisol. I would be pressing the Dr. for some answer as to the source and a treatment to give Apollo better mobility with less pain.

I remain concerned about the post cortisol number. In only one month you have reduced circulating cortisol by over 1/2. I think there is a real danger in treating Cushing's in dismissing the need of the pup for adequate cortisol. 2.8 is an abnormally low level. I get the reason when treating with Lysodren to maintain a level of 5 or less due to the physiological aspects of how the adrenals react. I see no reason to force a pup under treatment with Trilostane to live on such a low level of cortisol unless it is necessary to keep PU/PD or other overt symptoms of Cushing's under control.

Scott

[labblab]

II remain concerned about the post cortisol number. In only one month you have reduced circulating cortisol by over 1/2. I think there is a real danger in treating Cushing's in dismissing the need of the pup for adequate cortisol. 2.8 is an abnormally low level. I get the reason when treating with Lysodren to maintain a level of 5 or less due to the physiological aspects of how the adrenals react. I see no reason to force a pup under treatment with Trilostane to live on such a low level of cortisol unless it is necessary to keep PU/PD or other overt symptoms of Cushing's under control.

I wondered exactly the same thing when Barkis started trilostane treatment -- given the differences between the way in which trilostane and Lysodren work, why are you shooting for the same treatment range? And over time, it is true that Dechra is allowing some upward flexibility in the target range as long as symptoms are being well controlled (although it looks as though UC Davis still wants trilo pups to have treatment ACTH cortisols under 5 ug/dl, and less than 5.2 still remains the ideal for Dechra). I wish I could remember and repeat the explanation that I was given, but it had somethng to do with the fact that, regardless of the manner in which the two drugs work, your goal is still to limit the amount of cortisol that is generated and is freely circulating at ALL times to bombard Cushpups (as opposed to normal pups for whom cortisol spikes are transient).

And I think the other issue is the importance of curtailing the unseen, internal damage that Cushing's causes. On this increased trilo dose, we're seeing a very welcome decrease in Apollo's unhealthy lab values over previous testing. So in addition to curtailing the overt symptoms, I think you're seeking a treatment dose that is also normalizing hidden organ damage. For sure, this all involves a delicate balance and quality of life issues are probably paramount. So if it does turn out that Apollo's mobility issues ARE cortisol-related, then I agree that you'd want to revisit the treatment goals. But if he otherwise is doing well, then I'd think you'd want to keep his cortisol within that target range. I'm really glad that he'll be retested again in six weeks, though. As Scott says, it is really important to keep up with his levels to make sure that they aren't going much lower.

Marianne

[gpgscott]

Hi Sonja,

I just want to make sure that I am not confusing the issue. I have never treated with Trilo and Marianne is much better informed concerning the literature and treatment recommendations that I am.

I am just looking at the whole situation and in particular your complaints about hindquarter issues and making discussion. And there are ways other than his own cortisol to address the joint/muscle issues. Looking forward to the report after Friday's appointment.

Scott

[Carol G]

I admit that I know far less about this than lots of forum members, so I could be wrong.

Anyhow, doesn't the timing of the trilo ACTH stim test represent about the lowest cortisol levels of the day (if you are doing once a day dosing). So then wouldn't the daily average cortisol level be higher than the stim test shows.

Carol

[littleone1]

Sorry for posting on your thread, Sonja.

Carol, the stim test is done 4-6 hours after the Trilo dose, whether it is once a day dosing or BID. Therefore, this wouldn't be done at the lowest cortisol level of the day.

Terri

[labblab]

Just to add to what Terri has said, here's a quote from Dechra's U.S Product Insert:


Trilostane absorption is enhanced by administration with food. In healthy dogs, maximal plasma levels of trilostane occur within 1.5 hours, returning to baseline levels within twelve hours, although large inter-dog variation occurs.

So it sounds as though the lowest cortisol level would also generally be reached within 1.5 hours, with an increase back upwards to baseline by the twelve hour mark.

Marianne

[apollo6]

Thank you all for your input. I am overwhelmed by all of this. I am concerned about the second reading but my vet said in a cushing dog this is okay? Need to research more. Feel frustrated.
Will go over Friday with other vet-who has been dealing with Apollo's back issues, etc. For now Apollo seems fine.
Do cushing babies tire easily. It seems like Apollo's energy level is low. As to walking, well he never enjoyed it so hard to say if it was his back issues or what. Now dealing with a weird lump on his bottom, could be a calcinosis cutis.:eek: I am at fault for not leaving it alone.:eek: I just want that ugly thing off his but. Will show vet Friday.
I can't say the leg weakness has improved much.:(
Off to an appointment will check in soon.
Hugs Sonja and Apollo.

[addy]

Dear Friend,

I hope your Friday appointment with Apollo's vet gives you some insight. I know the feeling of being overwhelmed:eek: You always pull through even in crisis mode:D

Busy day for me tomorrow too, will check with you on Saturday to see if any news.

Take care and give Apollo hugs from Zoe, she has a crush on him;)

Love,
Addy

[apollo6]

will post in a day or so.
A lot on my mind about Apollo , effects of Trilostane, good and bad.
Torn apart about hearing about Debbie's, Harley passing.:(

[SavingSimon]

Dear Sonja and Apollo,
I just want you to know that I really know how you feel. Apollo and Simon are doing very much the same. You and I have similar questions and worries. I understand your frustrations and your fears. I wish I had answers for you as much as I wish I had them for us. The muscle atrophy is terrifying for me, and I see it is for you too. No one has answered yet if if can be the Trilostane, but I will do my best to get to the bottom of that question and find some kind of an answer, even if it is just one of those frustrating answers, like "maybe, maybe not".
I HATE this disease with a passion! It is sucking the life out of both of us.
I had to laugh a little when I read about Apollo "needing his space" - Simon has been acting that way too. He gets kind of grouchy with me sometimes and has even nipped at my nose once when I was "smothering him" with hugs and kisses. I remember his breeders telling me when his father got older he would just lay under the covers and growl at anything, or nothing. When he get's that way I ask him "who's your daddy?" I have no idea if it is a Cushing's thing, because he has lately had kind of an attitude, like "I will cuddle with you when I want to - I will touch you before you touch me - there are rules and they are mine about when you are allowed to love on me" and I am sure he thinks I am a disturbingly over loving Mom lately. I drive him crazy sometimes, he will go under the bed or in a closet rather than hang out with me - I feel "snubbed" by him often and it didn't used to be that way.
Yes, I believe Cushings can make them tired - or the medication does - don't know which one. I also think I read Trilostane can cause some skin growths, Simon has more weird bumps and knots than he had before Trilostane, and I also think that they get overheated easily because of the high levels of estradiol and female hormones that Trilostane raises.
Anyway, I want you to know I think of you and Apollo often, and whenever I think of you I pray for you and your boy. There is this awful pit of depression, confusion, and feeling helpless that trying to fight this disease has dragged me into time and time again. Try to enjoy every moment with your boy, even if he does feel over smothered and I hope and pray you can stay far from that pit, or if you are there that God will reach down where you are and pull you out and give you joyful, and ABUJNDANT time with your sweet Apollo. God bless you both.
Love,
Dena and dogs
SORRY I MESSED UP THE QUOTATION HERE SOMEHOW.
,Franklin and Bailey, for the input on the labs. Apollo did not fast before the lab test. Don't know how the Al Phos went down so much. Thanks for the link
Scott thanks for the input, I was also concerned about the second cortisone low reading.
Maria yes the second reading is 2.8. will keep a watchful eye on him. I think he thinks I smother him too much. Because it is like he is saying give me space.:eek:
Addy thank you for the support. Hang in there. Got to have faith and hope.
Thanks Alison for the site on lab readings. It gets so confusing.
The vet said other then the leg weakness happy with progress.
I asked the IMS if the Trilostane could be causing the hind leg weakness, said no?
Wants me to keep close watch if any changes in Apollo , to call him. Wants another ACHT STIM test in 6 weeks unless any changes.
I go Friday to the vet how has treated Apollo for his back/spinal issues for years and will bring up the hind leg weakness and about doing an x-ray.
Need to go back to work. Will update after Friday appointment.
Still worry a lot.
Hugs Sonja and Apollo.[/QUOTE]

[apollo6]

Dear Dena and Simon
Hang in there. We will figure this out.
Thanks for all the input.
Love Sonja and Apollo.
Tuesday will be a big day for Apollo , he will be 12, and yes I will post his birthday.

[addy]

Oh Boy! I can't wait, someone is about to have a birthday!!!!!!!!

Is it Tuesday yet?

Addy

[MyRudy]

Happy B-day to Apollo!

Just checking in to see how your baby is doing, sorry to hear he is not much better w/the hind leg weakness. I know some said it takes up to 6 months, I guess I was lucky that the Rimadyl helped Rudy so much.

Hang in there!

Donna

[addy]

It is Tuesday!!!!!

We get to sing Happy Birthday

Happy Birthday Dear Apollo

HAPPY BIRTHDAY TO YOU

I hope this is a wonderful day for you and Apollo, Sonja:D:D:D

Lock up the dratted Cushings and have a really, really great day

Love you,
Addy

[apollo6]

Thanks Addy,
Will do so, per your orders.
Hugs Sonja and Apollo.

[apollo6]

Not much to say.
Trying to get courage to call IMS about stopping the trilostane for 2 weeks or more to see if this is relating to the hind leg stiff gait and falling easily. Apollo had a few minor infections on his rear end-ingrown hairs . I am a little worried if this is the cushing coming back or if his body is trying to get rid of the cushing old skin? His little belly is peeling , don't know why?
Think I need to take a break from the constant worry.

[Franklin'sMum]

Hi Sonja,

I think we all need a break from the worry every now and then. Easier said than done, I know. The infections on Apollo's rear/tail from the ingrown hairs... have you stopped picking and squeezing at them? That might make a difference with how fast they heal up :)

Hugs,
Jane, Franklin and Bailey xxx

[loshie]

happy belated birthday apollo :)

luv,
melanie & mila

[addy]

Hey Girlfriend,

Zoe's skin is thin and crepe papery on her tummy too, though it is not yet peeling. Could it be the skin goes through a growth cycle like the hair does? Could be:)

I understand your worry- typical day at my house:

Zoe goes to get a drink after chewing her Kong

My reaction- "OH NO, she is drinking WATER" as I throw my hands in the air:eek::eek::eek:

Hubby's reaction- "What's wrong with that? Why can't she get a drink?" as he calmly goes back to the newspaper.

Must be in our make up:D

You will get the courage to make the call ----or not. Something will push you along.:)

I think about you and Apollo all the time. You are in my thoughts and prayers everyday, dearest friend.

Love ya,

Addy

[apollo6]

I have stopped picking on the growth on Apollo's behind.
I will try email Decha about Apollo's leg problem tomorrow before I ask IMS. Need all the ammunition I can get to listen to my hunches.
Thank you all for your input and birthday wishes for Apollo.

[labblab]

Sonja, I'm glad you'll be contacting Dechra re: Apollo's leg problem. Like you, I'm still wondering about that listed "paresis" side effect. Please let us know whatever you find out.

Marianne

[apollo6]

Dear Marianne and Addy
will email decha about the leg weakness today.
This is what I emailed to them:
Apollo started on 10mg in June, then went up to 12.5 compounded liquid beginning September 21,to see if hind leg weakness would improve. So far no. Read a side effect of Trilostane can be hind leg paresis.
He did not have this hind leg weakness before starting the Trilostane.
The neurologist I went to diagnosed as follows.
Cushing myopathy, degenerative neuropathy affecting femoral nerves, vascular event, neoplasia
Would it be okay to stop the Trilostane for 2-4 weeks to see if there is any improvement in the legs. I know of another pet owner who went through the same thing after 4 years on Trilostane. When stopped was able to walk. Please advise.
Will keep you posted.

[addy]

That sounds really good!!! I knew you could do it;)

I will be anxious to hear what they say. Good work, girlfriend:D

Thanks for all your help with Zoe's sweaters and for sending me sunshine:D

I hope you get some good information for little Apollo.

Hugs,

Addy

[marie adams]

Hi Sonja,

I sure hope you get the right answers. You are are good at getting to bottom of the problem. Cannot wait to hear what they have to say. :):)

Maybe Lysodren might be better if they say the Trilo is the cause. Maddie has weakness in the hind legs, but she can still use them--I think it is more arthritis, but I think I was reading that a thyroid problem can cause hind leg weakness and also being lethargic. I was thinking Maddie might have a problem with her thyroid, but the heavy panting wasn't listed as a symptom. I thought this because one of my working buddies is pregnant and is having thyroid problems and she is short of breath and her heart seems to race. All her other Cushing symptoms seems to be fine, but the heavy panting has started up again. I need to have her tested, but work is crazy right now and I tried to have it done for last Saturday, but they had to order the acth stuff; so maybe this Saturday I can take her.

Good Luck!!

[Isnthebeautiful]

hi
i will be very interested too to see what dechra says!
my Bob has that hind leg stiffness too and its come on pretty rapidly,been on the trilo since May.
He has been diagnosed with pseudomyotonia as well! And I want to know of anything that may affect his mobility,its a horrid thing to witness your dog becoming disabled.I noticed in your posts you say that Apollo has falls,so does Bob. Does Apollo just fall because of the back legs? Or does he stumble in the front too? Does he have physio? Its expensive but my physio showed me what to do so i do some on Bob everyday.
Jo

[littleone1]

Hi Sonja,

I hope you can get some positive answers about what could be causing Apollo's leg weakness. I, too, am glad you contacted Dechra. I have spoken with them twice. They are very quick to respond. I'll be waiting to hear what they said.

[apollo6]

Thanks Addy, Marie and Maddie girl, Jo, and Terry and Corky.

Jo- yes Apollo stumbles in the front sometimes and his back legs are stiff and stretched out. No I don't have a Physio?

My little Apollo throw up his food yesterday and this morning I found his dinner from last night on the kitchen floor. I just broke down and balled my eyes out.
My little sweet heart went in the kitchen to throw up. I am waiting one more day. If he throws up again, I will be at the vets, again. This could mean problems with the new dosage. He still has an appetite. It never ends.
Still waiting for reply from Decha, will keep you posted.

[addy]

Oh Sonja, it will be okay. It is always something, isn't it?

If it is the new dose, maybe it is meant to be that you are supposed to stop the Trilostane for awhile. We will make lemonade out of whatever it may be;) Okay, that probably sounds confusing, I was trying to refer back to when life hands you lemons------:rolleyes:

Dearest Friend, if I could come to help I would.

Love ya,

Addy

[apollo6]

Thanks Addy
Sometimes we need a reality check. The little guy just yelped at me for attention. That's a good sign.:p

[happydogs]

Hello Sonja, just found your thread about Apollo. Sounds like you've had quite a journey with him. He is a lucky boy to have such an attentive mom!

Just wanted to add my 2 cents about physio. We have another dog (also 15 years old) who has been regularly seeing a doggy physiotherapist. It has made a huge difference in his mobility. Mind you, he's NOT a Cushings dog. We asked the physiotherapist about working on our Cushings dog and she said that whether or not it would help depends on what's causing the weakness. Maybe it would help little Apollo? The other thing we do regularly for our Cushings pup is acupuncture, just another thing to think about...

[Harley PoMMom]

My little Apollo throw up his food yesterday and this morning I found his dinner from last night on the kitchen floor. I just broke down and balled my eyes out.
My little sweet heart went in the kitchen to throw up. I am waiting one more day. If he throws up again, I will be at the vets, again. This could mean problems with the new dosage. He still has an appetite. It never ends.
Still waiting for reply from Decha, will keep you posted.

Hi Sonja,

If this were me, I would hold off giving the Trilostane. Since Apollo has vomited twice and his last post was 2.8 ug/dl...this could be a sign that his cortisol is a bit low.

Love and hugs,
Lori

[mypuppy]

Hi Sonja,
I don't post on your thread too often but wanted you to know I am pulling for your little boy here behind the scenes. I wish for a small, happy miracle for the little guy. You are so very loving, so keep the faith. Tight hugs for you and some licks for Apollo from my Princess. Luv ya, Jeanette

[apollo6]

On the brighter side, Apollo has been able to keep his food down and is eating well. :) Will still monitor if changes. The IMS said Apollo might just have an upset stomach, told me to try bland diet and pepto bismol-I already did. Said if not improve bring in for ACHT STIM test. Will keep you posted if changes.

On the hind leg weakness, Dr. Allen sent me email , see below:


Ms. Honeyman, Sorry for the delay in responding to your inquiry. I was traveling Tuesday and Wednesday. I think your veterinarian or the neurologist who examined Apollo should be involved in the decision. But from my perspective, yes I think it is reasonable to stop trilostane for several weeks to see if Apollo’s hind leg weakness improves. The rationale for that is that trilostane has a short duration of effect so that if it is causing his weakness you should see improvement quickly. An additional point is that if the weakness does not improve you can re-start trilostane and you have not lost anything in terms of long-term control of his hyperadrenocorticism. As you and your vets decide what is the best thing to do for Apollo be aware that just because hind leg weakness is listed as an adverse event that doesn’t necessarily mean that trilostane causes weakness. The FDA requires that we report everything that happens during clinical trials. Thus if a dog developed weakness related to the underlying Cushing’s syndrome during the clinical trial, it is listed as a side effect. Another point about trilostane, is that unlike the FDA approved product (Vetoryl) the stability and purity of compounded liquid trilostane is not been reviewed and approved by outside experts like the FDA. Contact me if you have further questions. Tim
Next ACHT STIM test, is November 3rd. Will wait till then to decide, if no change in Apollo.
Thank you Happy Dog about input physiotherapist.
Lori, thanks and Jeanette also.
Sonja and Apollo

[Isnthebeautiful]

would defo get him checked over by a physio - thats who spotted Bobs problems with his muscles
jo

[littleone1]

Hi Sonja,

I'm glad you got a response from Dr. Allen. He's been very helpful to me when I've spoken with him. I like the fact that he's an IMS.

Hopefully you will be able to get Apollo's muscle weakness resolved.

I'm glad that Apollo is feeling better.

[addy]

Me too, Sonja, glad our little boy feels better. November 3rd is right around the corner. It is amazing how fast time is going. It is good to hear Dr. Allen say no problem if you want to stop the trilostane for a bit and I was glad to hear that if it was from the Trilostane you would seen an improvement rather quickly.

How do you feel about all this?

Hugs,
Addy

[apollo6]

I am thinking of waiting for his next ACHT STIM test , see what the results are and then maybe stop the Trilostane for a week or two after going over with vet and IMO. I am not one to jump into anything. I like to research, get the facts before I make a decision. It drives my impatient husband crazy.:eek:

[addy]

I think that is a good trait to have;) I do the same thing and it drives my family nuts as well. :rolleyes:

Dr. Allen does not seem to think you would lose much ground by stopping for a few weeks so that was positive.

Have a great day, I am off for my riding lesson. Hope I can get these old bones up on the dang horse. They will probably give me a "kiddie" mount:rolleyes:

Love,
Cowgirl Addy

[SavingSimon]

Dear Sonja and Apollo,
With Simon, I am in exactly the same place as you are with Apollo. Although it sounds like Apollo at least does not have front leg muscle atrophy like Simon does. His neurologist attributed the muscle loss to Cushings, said that is not his area of specialty, but truly believes all of the other tests he could do (like what you posted on our thread) are not really necessary. I want to wish Apollo a happy belated birthday, and I want to thank you so much for being our friend. I do not know of a case here more similar to Simon's than Apollo. You probably can't see it as much because I only have one picture up of my boy, but Simon and Apollo have such similar faces, and eyes, it amazes me. I fell in love with Apollo the first time I heard of him, and you are in our prayers, as are all the people and dogs struggling with this terrible disease.
Love,
Dena and dogs
PS. I tried to get an answer about the amino-acid HMR that comes from leucin (sp?) and if it could help the muscle problem. When I read about it on the Internet it sounds like it would work, but I have no idea if it would help a Cushing's dog or would be counterindicated. Maybe you have someone that could answe r that for us. Also, the pharmacist suggested something called stanazolol but also does not know if it would be counterindicated, and I haven't read about that one yet. HMR might be a problem because of the liver enlargment, but that is so slight compared to the muscle loss - I'm just not sure. I just thought I would bring them up to you, since the only one who called me back about HMR was the neurologist who said that it would not be bad neurologically, but he does not know otherwise, I should ask the IMS - which I did, but he does not answer my questions.

I am thinking of waiting for his next ACHT STIM test , see what the results are and then maybe stop the Trilostane for a week or two after going over with vet and IMO. I am not one to jump into anything. I like to research, get the facts before I make a decision. It drives my impatient husband crazy.:eek:

[apollo6]

Well found Apollo throw up again. Found yellow liquid in kitchen in the morning. I don't know if he throw up or urinated. Keep him on cottage cheese for the day and seems alright now. But I will have to watch. It never ends.:mad:

[littleone1]

Hi Sonja,

Something might be upsetting Apollo's stomach. Have you tried Pepcid AC? Corky takes 1/2 a 10mg pill every morning.

I hope you start seeing improvement in Apollo.

[addy]

Hi Girlfriend,

Sorry to hear Apollo had another tummy upset. Did he have an occassional tummy upset prior to the Trilostane? Just wondered. Zoe never vomits so if she does I know it is a big problem. Koko, on the other hand, is more apt to.

I know Marianne was worried about him going too low last week. Hoping everything is okay.

Hugs,
Addy

[apollo6]

Well ,Apollo has thrown up in the past. He has always had a weak stomach. I am trying not to worry. :( I have been a little down about the progression of this disease. No improvement on the legs. He has this weird stiff walk, wobbly hind legs, seems to bend his hind legs.:confused: His bones still show on his hind. :(I am at a lose as to what to do. The newest thing is Apollo jaw trembles sometimes for no reason? Has anyone else had this with their cushing baby? He doesn't shack his head, just the jaw quivering.
I go for the next ACHT STIM test on Wednesday, on Friday we go for acupuncture. I will ask the vet if maybe get an x ray of his hind legs if that would show anything. Now I am obsessing if I should find out if the tumor is getting bigger. I am thinking maybe Apollo could get the surgery Lucy had. Help me calm down.:eek:
On the positive, some symptoms have disappeared-thirst, pot belly, hair loss. Still has some skin problems.
On the up side. :Sunday we had a dachshund Halloween costume picnic. I dressed Apollo up as a wizard- black pointed hat, with a Halloween scarf. I strolled him around in his stroller. He got a lot of attention. Did a little walk with him afterwards. Saw some of the cutest costumes.

[littleone1]

Hi Sonja,

Corky had quivering in his mouth when his thyroid level got on the low side and his Soloxine dosage had to be increased. I know there could be other causes of this.

You might want to read Millie's thread about the hind end and leg issue. I've seen pictures of Millie before and after the Pred was given. She also has a pituitary tumor. There was a big difference in her hind leg area. This is something you might want to ask your vet about.

I'm keeping you and Apollo in my thoughts and prayers that you will soon get some answers as to what is going on with Apollo.

[addy]

Hi Girlfriend,

Don't panic. Wait to get the stim results and see where you are. Do you feel Apollo is healthier today with his treatment or do you feel he is worse? I guess that would be the bottom line for me. You are about four months into treatment and just upped his dose.

We get so super sensitive, we notice every little tick, twitch, you name it. Things that we might have not given a second thought to now scream at us. I am exactly the same way.

Try to breathe and lets wait for your stim results. if he is stimmed tomorrow, when do you get the results?

Hang in there sweetie,

Love,
Addy

[apollo6]

Thanks Terry/Corky
Will look into.
Thanks Addy
I can get so rapped up with this disease and watching Apollo to excess that I think I suffocate him with checking him all the time.. :eek: He'll give me this look like, what are you looking for on me now.stop it.:eek:
Sonja and Apollo

[addy]

Hi Sonja,

Hope everything went okay with Apollo's stim yesterday. Waiting anxiously for the results as I am sure you are.

Sending positive vibes your way;)

Give our sweet boy a big hug from me and Zoe.

Addy

[apollo6]

Apollo's results:
ACHT RESPONSE
CORTISOL SAMPLES 1-2.5 WAS 1.1 last time
Cortisol Samples 2- 3.3(low) last time was 2.8

Go to other vet , Friday- accupuncture for his joints, will ask about hind legs and now the jaw trembling.
Sonja

[addy]

Hi Sonja,

Not an expert on the numbers but he did not go lower than last time so that has to be a good thing. I am sure you looked up your results and others will comment.

I don't understand the jaw trembling either. Could he have a bad tooth?

Our never ending issues.:rolleyes:

Take care dear friend,

Love ya,
Addy

[littleone1]

Hi Sonja,

Just a quick comment on Apollo's post stim results. The 3.3 is actually in the normal range for dogs being treated with Trilo/Vetoryl. If the reference range that was given was 8-17, that is the range for dogs who are not being treated for Cushings. The range comes from the lab. Please let us know if this is the range that was given.

I'm still hoping that you will be able to get some answers regarding Apollo's leg weakness.

[apollo6]

thanks Addy and Terri
Still dealing with the hind leg weakness and now the jaw trembling.
The holistic vet said it could be from muscle wasting in the face, not sure. Still trying to decide if I should stop the trilostane for 2 weeks or more to see if legs improve. Trying to get hold of IMS about stopping for awhile.
My little guy sometimes falls now in the front. :( I haven't been on the site as much lately. I get so obsessed with wanting a cure and for the cushing to go away, that I have to watch myself. And every time we lose another little warrior I get real down.:(
Sonja

[addy]

I know the feeling girlfriend. I really do.

Miss you,

Addy

[apollo6]

Well talked to IMS said didn't see a problem with stopping the TRilostane for 2 weeks or so, wouldn't hurt progress. But he does not feel it will make a difference.
Will be starting Duralactin -anti-inflammatory alternative for stiffness in legs if arthritis.
Holistic vet wants me to start Standard Process-Caine Musculoskeletal Support -for neuromuscular disorders.
So still deciding on stopping the TRilostane. Will try the holistic products.
Not much else to say at this time.
So many new members, so many have passed away in the past week. It hurts.:(
I am so grateful for the moderators keeping this site going. Thank you.:)
Sonja and Apollo

[Casey's Mom]

Yes it is a bit overwhelming at times but we are here to help each other so hang in there Sonja. Love to you and Apollo,

[frijole]

Sonja, Keep the faith! I just sent you a PM about the Duralactin and then I read your post saying you would be starting it. I really hope it gives dear Apollo some relief. Keep us posted. Yes.. it seems like things happen in spurts and it can be very sad. Hang in there and know we are thinking of you and sending you best wishes too!! Kim

[jrepac]

I've never heard of jaw trembling...that is new to me. This damn disease can be confounding, for sure. Re: hind leg problems, it is a real dilemma, particularly if there is arthritis (or similar conditions) involved. Lower cortisol reveals arthritic problems previously hidden. And, high cortisol can cause muscle weakness/wasting. No easy solutions as many of us know. But, sometimes supplements do help w/joint related problems. I hope the natural/holistic approach brings Apollo some relief. Crossing my fingers for you.

Jeff & Angel Mandy

[addy]

Hi Girlfriend,

Just wanted to say, hi and send hugs and moral support. Hoping the new plan helps our little guy and helps you feel better too.

Life can get topsy turvy, busy and very sad indeed but we all have to keep on going somehow, as hard as it is sometimes. When you need a break, take one, you need to do whatever you can to keep you strength.:)

Love you and the pups and hope you have a calm weekend.

Did I tell you I ordered sweaters? You really should check out the Etsy sight. It will perk you up and the pups can get some really cool sweaters in their Christmas stockings;)

Love you bunches,

Addy, Zoe and Koko

[littleone1]

Hi Sonja,

I'm keeping everything crossed here that you will see improvement with the new meds.

Hang in there. You're doing a great job of taking care of Apollo.

[apollo6]

You all are the greatest.
Will keep you posted.
Hugs Sonja and reserved lick from Apollo
What do you expect from a dog named Apollo:p

[Rebelsmom]

Hi Sonja, just wanted to let you know we are thinking of you and I hope you can find some resolution for Apollo. I have never heard of the jaw trembling related to Cushings, but I know sometimes Rebel gets fascinated with Sadie's rear end or where se just urinated. When he sticks his nose to far (ie licks it) his jaw trembles a little. I just call him a dirty old man and after a few mins it goes away.

Is there no way they can tell if it's arthritis for sure?

Take care,
Melissa

[apollo6]

Dear Melissa, Rebel & Sadie
I am at a loss about the jaw trembling it can happen at any time.
I haven't posted as much as I would like. It hurts to see the changes in my little Apollo. I worry how long I will have my little angel. I get overwhelmed at how do I keep him healthy.

I am trying to attack Cushing with a better attitude.

There is a saying Yesterday is gone, Tomorrow is unknown, and Today is all we have. Apollo teaches me to be in the present. Try to be grateful for the moments I have with Apollo.
I am still in a turmoil as to stopping the Trilostane for 2 weeks to see if the stiff hind leg weakness improves. Both my vet , IMS and DEcha say I can try but don't feel it will improve.:confused:
Sending my thanks to all of you for your support.
Sonja and Apollo

[Rebelsmom]

I know it's so frustrating when you can't get a straight answer from the people you trust with your pups care. Maybe it wouldn't hurt to stop it for a couple of weeks. It won't hurt him right? He might have a return of some of the symptoms, but from what I hear that takes some time. Maybe it's worth a shot to see if that helps his legs. Maybe if it does then that gives you a better indication of arthritis that maybe the cushings was covering up. I wish I had more advice for you, but I'm still a newbie with all this also. Sending love and hugs your way.

[apollo6]

Melisa
Thanks for the input. I am almost finished with the liquid.
Like you said, it can't hurt.
We are always new when it comes to cushing. There is always something new that props up.
Sonja

[addy]

Oh Sonja, something new indeed always pops up:mad:

The hind leg weakness seems to be something quite a few pups are dealing with. I hope other than the leg weakness, Apollos is doing well. How are his bumps?

It has been a hard month on the forum. The present is truly just that "a present" so I guess we all need to live in the moment.

Hugs,

Addy, Zoe and Koko

[frijole]

Sonja, Have you ever taken a short video of Apollo's jaw shivering? Sometimes a picture is worth a thousand words and if your vets could see it perhaps it would help them understand your concern. If you do one post it here as well please.

I am continuing to have luck with the Duralactin. I think you started it by now.

Continued warm thoughts and love sent to you both. Kim

[littleone1]

Hi Sonja,

I just wanted you to know that Corky and I are really hoping that everything will improve. I know it's as hard on us as it is for our precious furbabies.

You have been doing a wonderful job of taking care of Apollo.

[apollo6]

You guys are the best.Addy-Zoe and Koko, Kim and Terry and Corky.
I like your idea about the video on Apollo's jaw.
Just one problem. I am lousy at taking video's. The last one I took you saw my legs and the ground for a long time till I realized what I was taping. :D:eek:
Apollo's jaw trembling can happen at any time and it is just a second when it happens. The lump on his tail is gone, but the back of his tail as spots of hair and no hair.
It has been a tough month on the forum , we lost a lot of sweet hearts. May they rest in peace.
On the lighter side. Sometimes my husband will call me, say he and Karma( my other dachie) have decided to fly to Hawaii for the day and take a walk along the beach. I 'll say is Karma going to wear her Hawaiian dress , he'll say no she wants to go bare chested on the beach and just wear a grass skirt.:D:p
Sonja, Apollo and my girl Karma

[addy]

now that would be a picture;)

maybe the second of trembling is just a tooth bothering him. When Koko gets excited about a squirrel outside he will sometimes get a slight tremble in his leg, like a quiver.

I probably should not compare Zoe to Koko but I find I do. Do you do that with your two? This afternoon I was trying to see if Koko's but was the same size as Zoe's just more hair:p

I gotta get a life;)

Have a wonderful Sunday girlfriend!

Addy

[apollo6]

Dear Addy
I compare Apollo with Karma all the time. Which just makes things worse for me. Karma has a beautiful coat, no hind leg weakness.
I try to hide my pain from Apollo when I cry and I do that a lot.
I found out a friend I hadn't seen for a while put her 14 year old Yorkie down last Sunday. :(I hurt inside and think how Apollo is 12 already. :(But it is so important for us to be in the present like our little fur balls are.
MY husband and mother say I am just looking for things to go wrong with Apollo. I check his coat, tail and paws always.
I have got to get a life.

Apollo throw up on the bed yesterday morning just vial. But my alarms are up. He has always had stomach issue.
His hind leg weakness is not getting better. All I can say is it started around June. Since starting the Trilostane his coat has grown, his tail is scatter with hair and bold here and there. I started the Duraclin yesterday and keeping a log on to any changes. I will stop the Trilostane when I finish the liquid . Which should be by Monday.

On the lighter side, while walking yesterday, a man came up to us and said"Dogs are angels with paws". I gave him the thumbs up.
Apollo has quite a collection of coats and sweaters. I wonder if it is because his mom likes clothes.:eek:
Thanksgiving we went to Hotel Coronado to walk by the ocean. People loved Apollo's green and red sweater and his bright red stroller.
It made me smile to see people smile at Apollo. We only have moments.
Sonja and Apollo

[littleone1]

Hi Sonja,

I am so hoping that Apollo's hind leg weakness improves. It would be so nice if we had answers and solutions to all of our questions and issues with our furbabies.

I was always aware of what was going on with Corky. The slightest difference in anything he would do would bring up a red flag. Once he was diagnosed with Cushings, I was constantly watching him. I got very over protective. I'm much better about it now, but I still watch him very carefully.

You are doing an excellent job of taking care of Apollo. Hang in there my friend. I'm sending healing thoughts and prayers that Apollo's legs will improve.

[addy]

Hi Girlfriend,

I think we are in the exact same frame of mind, dear friend, we are so alike in our thought process;)

Zoe just came and fished a toy out of her toy box. She is very happy and I am sitting here taking deep breathes with a fake smile plastered to my face:rolleyes:]

I hope Apollo's leg weakness gets better. We'll see what happens when you stop the Trilostane. At least you will possibly get some answers one way or another.

Take care sweet friend, thinking about you and hoping for the best as always:)

Love,
Addy

[apollo6]

Dear Addy, Terri and Corky and Zoe.
Thanks.
I will post picture took of my Mom with Apollo at thanksgiving at Hotel Coronodo. We were going to do one of me but it was so crowded in the lobby.
Hugs Sonja and Apollo

[addy]

Hey Girlfriend,

How are thing is San Diego? How is our little Mister Apollo doing? I am hoping you are seeing some progress with the Duralactin. I have been reading about it since Kim has had success and I have been reading good things. I am trying to talk my boss into putting his South Africian Mastif on it, he has a rear leg problem and I hate to see him in pain. He spends alot of time in my office. The dog, not my boss:rolleyes::p

I am going to check out your albums to see if the Thanksgiving photos are there:D

Hugs,
Addy, Zoe and Koko

[apollo6]

Dear Addy
Thanks for asking. Apollo's legs are getting worse. :( I am trying to build up the courage to stop the Trilostane to see if it helps. It seems his hind legs are getting thinner and his muscles in his head. But I am so paranoid that maybe nothing has changed but my anxiety about this disease is getting the better of me. :eek:I go to the holistic vet for his accupuncture next week and will ask if he sees a change in Apollo. He doesn't want to walk at all. I force him every day to move and walk a little. He falls very easily. Last night when we came into the house he could barely jump up the entrance door.:(
Last night I just started crying at Walmart when I dropped a little money in the Salvation Army charity pot. The gentleman said thank you so much and God bless you. Every day I don't know if our business will make it through the day. The stress is getting to me plus my worry for Apollo and my mother's issues.
Hugs Sonja and Apollo

[frijole]

Sonja - Sorry to hear this and I send big hugs to you. How much duralactin are you giving? Half a pill morning and half at night? If so - since Apollo is in such pain - try upping it a bit - even doubling it. I read that others had done this in severe cases. It helped 'control' things and then they went down to the recommended dosing. Just a thought. The muscle wasting you are describing is very much like what Annie has. She has nothing but bones left. Silly comparison but her hind legs are like when you get a chicken wing and it is all bones with no meat on it. So I know what you are talking about. Hang in there and I send positive vibes your way. xoxox Kim

[addy]

Oh Sonja,

I was hoping the Duralactin helped Apollo as it did Annie. I know what you mean about the muscle loss, Zoe's head and face is getting skeletal like and her hind legs are so thin and stiff now.

Girlfriend, if you stop the Trilostane for two weeks Dechra thought it would not be a problem if I remember right.

I think of wee Bonnie and how we thought she was under controlled but turned out she was over controlled and Denise stopped the Trilostane and she was better. I know every dog is different but maybe you should stop the drug for 2 weeks. If anything, if there is no difference, then you know finally.

I know what you mean about business. It stinks:mad: I am in the same sort of boat with my work and my Mom.

That was why little things like waiting for Zoe's beautiful sweater helped. I lost the cord to my camera so have to wait until I can borrow works uSB port so you can see her in her new dudes;)

Sending all the love in the world to you and little Apollo.

Addy, Zoe and Koko

[littleone1]

Hi Sonja,

I'm so sorry to hear about Apollo. I was also hoping that there would be improvement with the duralactin.

I'm sending positive healing thoughts and prayers that Apollo will improve.

((HUGS))

[apollo6]

Dear Kim,Addy & Zoe and Terry and Corky
Thank you all for your support.
I will up the Durclain? was only giving Apollo half a table a day. I stopped the Trilostane this morning. Apollo throw up this morning, orange vile(maybe the pumpkin from last night) he throw up again got him to the sink for this one, was orange with little red dots. :eek:My alarms go off is this blood. He ate his breakfast after I gave him pep to bismol in his food. Was okay all day and was able to hop from outside garage door into house. He is in good spirits. But his Mom is a basket case. I took my Mom to an outside Christmas event, listened to the Rock church choir( and boy did they rock!):p
Another dance performance was playing Kattie Perry's "Fireworks" in the middle of the walk way I started singing and dancing to it.:D
Apollo got a lot of attention in his red racer stroller wearing a red hat my Mom knit him.:p:D
I will mointer him being off the Trilostane each day, will call IMS on Monday to let him know. I thought things would go smooth finally. Not to be.
Each day is a gift from God. Dogs are angels with paws. Need to try and do a gratitude list to keep balanced.
Hugs Sonja and Apollo.

[frijole]

Sonja, Please do try giving Apollo the recommended dosage which is 1/2 pill am and 1/2 pill pm. If you read the testimonials there were lots of dogs that are same breed as Apollo and that is the dosage they were on. Please give it a try before giving up on it. I truly hope it works for you. My girl still has some weakness but it is so much improved I truly hope the same for Apollo. Big hugs, Kim

[HarrysMom]

Sonja,
I started my Harry on Trilostane exactly two weeks ago. After 2 days of Trilostane, Harry's rear end just collapsed. The internist thought it was the treatment of Cushing's revealing the underlying arthritis, but his rear end collapse was not like any arthritis we've seen. Harry did not seem to be in pain - just lost control of his rear end.
Until starting Trilostane, Harry had been a trail running dog - running 1+ hour on steep trails of California.
Harry's Trilostane dosage was 1mg/kg. Nothing unusual.
His ACTH test came back 1 and 4 - showing very quick and tight control over cortisol.
I tool Harry to his regular vet yesterday to get his electrolyte levels checked because his rear end collapse was becoming worse and episodes more frequent.
His had a collapse at the vet's office, and our regular vet became a bit alarmed. She did not think it was arthritis.
She called the internist's office. The regular internist was out, but our regular vet spoke with another internist at the clinic. They both agreed that we should stop Trilostane for a few days and see if there is any improvement.
I also belong to Yahoo CCAC group, and members there have seen rather frequent rear end collapse following Trilostane treatment. Apparently, these symptoms do disappear after the drug is stopped or dosage reduced.
I will let you know how Harry does, but also keep me updated.

Yunhee

[apollo6]

Dear Addy, Terry, Kim and Yunhee
Thank you all for your input. Sorry have not been on line lately. Had a bad week. My 79 year old mother's apartment had a water leak, took days for maintenance crew to find source, dug up cement in her closet, holes in different rooms, another leak. Short story, was over there every day this week helping. Due to all the stress, financial also, had a minor car fender bender accident. My work got piled up.
Dear Yunhee, Apollo's hind leg weakness started around the time I started the Trilostane. It has helped with so many other cushing aliments so a catch 22. I did stop the Trilostane on Dec 4th. Holistic vet said give it a few weeks to see if any improvement. I will up the Duraclin as you said Kim.
Apollo is in good spirits. Between you and me he gets whip cream on the weekends when I treat myself to whip cream in my coffee. I know he has stomach issues, but he enjoys it so much with a little bit of Apple sauce. He gets very demanding about it.:p:eek:
I pray for all my cushing parents and their fur balls every night.
God bless all of you.
Sonja and Apollo
P.s Got to go. Apollo is demanding more whip cream. Have to run, got to go over to my mothers to help her put her apartment in some kind of order since the leak dry up, etc.

[addy]

Hi Best Friend,

How is Apollo doing on his Trilo holiday? Hoping you are able to draw some conclusions from it.

Time is flying by. Hard to believ it is the middle of December:)

I'm betting there are lots of presents for your babies. I got the cutest ecard I wanted to post and could not figure out how:eek:
Oh Sonja, it's cute factor was in the thousands!!!!

Love you,
Addy

[apollo6]

this is copies from journal I keep on Apollo:
50. Apollo still has minor skin issues-tail ingrown hairs with pus, also belly has ingrown hairs, skin is peeling and still has calcutis cutis. Growing some hair on ears, tail and belly.

52. December 4th threw up and day before was orange (pumpkin sauce?) some tiny red dots in vial.

53. December 4th stopped Trilostane as of December 14, 2010, no improvement in muscle weakness, losing weight? Jaw trembling still going on.

54. December 7th, Dr. Weingardt says no change in muscle weakness, stable. Not getting worse. Need to give it three to 4weeks to see if symptoms do not improve or get worse.

55. December 13th, Dr Hart called said does’t think Trilostane cause of Apollo’s hind leg weakness. Says would see difference within 12-16 days. Notify him immediately if any changes in Apollo. Start Trilostane on Dec 20th, to see results by January 6th Acht Stim, and blood panel. Mixed messages.
So that's were I am at. It just doesn't seem to end. Praying for a blessed Christmas and a better new year for you and yours. Would be nice to read some success stories on the thread. It takes so much out of me , every time I read about another loss. Sometimes we need to take a break. My husband says I am obsessing on Apollo. It is so hard to see his weakness in the hind legs and now the front legs. I keep praying for a miracle.

Apollo isn't much for toys anymore, just treats. But I do so love to buy him coats and sweaters. He has quiet a wardrobe, including a July 4th red hat.
Apollo seems a little thinner. Don't know if it is withdrawl from Trilostane or a crazy week I had under a lot of stress and irregular feedings for Apollo.

Love Sonja and Apollo.

[apollo6]

No improvement in Apollo's hind legs. :( I think he has a little more muscle wasting in his hind legs. He is having more of a difficult time with hind legs stretch. Now has ingrown hairs around noise and lips.
Feel helpless. To restart Trilostane on Monday. He has flaky skin, almost a dark grey. Skin is peeling on his belly. A strange side effect of the Trilostane is hair growth on his neck and upper belly. Never had hair there before.His coat is looking better, still bald patches on his tail. Worry about long term effects of Trilostane down the road. It never ends. I examine Apollo almost every day for any new growths. Found red swollen area around mouth, squeezed out ingrown hairs.
Could sure use some input and support. I try to see the positive but worry about the changes Cushing has done to my baby.
On the brighter side, taking my Mom to a Christmas concert Sunday and will be sneaking Apollo in under my coat.:eek::D
Sonja and Apollo

[Sabre's Mum]

Hi Sonja

Sorry to hear about the hing leg weakness continuing with Apollo. I can't comment here with regards to the rear hind weakness .. With regards to the hair growth and skin ... we found that hair grew in places where Sabre barely had any hair - he was a Hungarian Vizsla and they barely had anything on their tummy but with treatment he was more like a labrador. There were areas on his tail that never did grow back ... probably where there still was some calcinosis cutis. The skin was something that would fluctuate ... at the start of the treatment his skin was actually drier and would peel. I believe that these hair and skin scenarios is something that happens with both Lysodren and trilostane treatment.

Have a great time at the Christmas concert.

Angela and Flynn

[addy]

Hi Sonja,

Well, at the least, you now have closure that it is not the Trilostane. I am really sorry to hear he seems worse. Maybe we think it is going to be a "cure" but it can't solve all the Cushing problems. The drugs, I mean.

I am resigned to that now. I know Zoe will never be the same as she was a year ago but if I can alleivate some of her discomfort well---- I guess that is what we have to hope for.

I am hoping our little guy still has a gleam in his eye, Sonja.

It might be that if the trilostane increases his estradiol you will continue to see skin and hair problems. All those hormones affect them somehow. Lower one and another goes up, I think.

It is so darn hard, dear friend.

Hoping you have a wonderful time at the concert. Sure wish I could watch you sneak him in;)

Love,
Addy

[littleone1]

Hi Sonja,

I really wish I had an answer for you about the hind leg weakness and muscle wasting. Some of the other issues that you are seeing are some of the ones that Corky had when his cortisol level was too high. I hope the Trilo will help these issues. I'll be keeping everything crossed that restarting the Trilo will really help.

[apollo6]

Thank you all
Angela & Flynn for your input , it helps.
Addy for your support and humor.
Terry and Corky for your caring.
I did sneak Apollo in. He sat between my Mom and I . I kind of panicked when my mother started eating a snack. Apollo popped his head up.:eek: Thank God the people sitting next to us where dog lovers and were happy to see him. He got to hot under my coat and Mom saved the day with water to cool him down. He gave the concert an A rating.:D
I am waiting one more week and will start the Trilostane on Dec 27th. Mom said she thought he was walking better since she saw him a week ago. Will keep you posted. So confused as to what to do. I know I will have to start him back on the TRilostane . Will have full blood panel ,Acht stim test on January 14th. Feel 3 weeks no Trilostane will show if the muscle weakness is due to drug or muscle atrophy and arthritis.
On the lighter side, my neighbor who lost her dog about a month ago, got a four week old chitsu-black and white, named her Leia. She is cute as a button.
Sonja and Apollo

[addy]

Dearest Friend,

Sometimes others who are not with our pups every day see things differently. I am hoping Mom may be right about Apollo's walking :) My mom had not since Zoe in a few weeks and she freaked about how bad her coat looks:eek: I guess it works both ways.

I wish I could have been at the concert to see him pop his head out. How cute is that? I have a picture of it in my mind;)

I'm glad you are giving the trilo holiday another week. Your vet appointment is right after ours. I changed Zoe's to January 6th.
Lots of notes to compare.


Hope you have the very best Christmas!!!

Love,
Addy

[apollo6]

Dear Addy
Sorry off line for awhile. I get so overwhelmed by it all that sometimes I need a break.
Apollo had lost about a half pound also, don't know if stress of what we are going through or just out of his normal feeding routine. I watch every pop he does looking for color, if any blood, if firm or loss. Think we could write a book " A day in the life of cushing pop"
Apollo has been off the Trilostane since Dec 4th. Other then the weakness in his hind legs he is in good spirits, appetite. I am watching for signs of cushing's symptoms. So far not bad. So what do I do start on the Trilostane again. So I am more worried as to what to do. Know Apollo needs medication but do I watch him even more on the Trilostane?
Left word with both my vet and IMS about restarting Trilostane or get ACht stim test before restart to see how Apollo's readings are.

On the lighter side. Apollo and Karma enjoyed their Christmas gifts.:p Problem was they thought every gift was for them and wanted to help open them. Apollo got to carried away opening up his Christmas bag that he got the handle around his neck and was running around the family room with the bag behind his head. :D We couldn't stop laughing.:p I made a video but I don't know how to do the You tube thing so if any one can give me instructions will down load for you to see. Apollo still has a lot of life in him and is trying his hardest to walk.
Have a great New Years. I may be off line until the first, end of month, quarter, year end reports, payroll, etc. to do.
Hugs my dear friend Sonja and Apollo, and Karma

[addy]

Oh, I want to see the video.:D

Zoe and Koko ignored the tree until I put presents down. I put their presents to the back, behind others but they somehow knew those were their presents and were determined to crawl through the other presents to get them. They sniffed every present and then just KNEW, theirs were in the back:D:rolleyes: So funny!!!!

Hoping you have a good New Year! Just keep hoping things will get better.

Love ya,
Addy

[apollo6]

Dear Addy
May try to download video if can figure out how to do so.


Apollo was on the lowest dosage of TRilostane. He has been off it since December 4th. He is walking a little bit better, but he will no longer be the same old Apollo. The stiffness is a little better, but he still has the hind leg weakness. I know I will have to go back to the medication since some issues are starting up again-his stomach problems (gurgling in intestines)and skin issues. I hate this disease.
Thinking of having acht stim TEST to see how Apollo is doing before restarting. Waiting for IMS to call back-4 days now. Maybe out due to holidays. Open to feed back from the forum.
Sonja and Apollo

It is a game of roulette with the drugs and disease.

[addy]

Yup, sure is a game of roulette and I never was good at gambling:rolleyes:

Dr. Allen was very nice to me Sonja, so thanks for his email, etc.

I hate all that year end stuff too. Am facing a pile of it tomorrow.:eek:

ACTH test may not be such a bad idea. When was your last one? Not too long ago, if I remember right.


Give our Apollo a hug from me and Zoe is sending New Year's kisses to Apollo. She is such a flirt:rolleyes:


Love,
Addy

[apollo6]

Apollo is doing okay. The IMS did finally call back, could have been out for the holidays. Said wants to actually see Apollo and do some blood work to see how he is doing before do another ACHT STIM and decide when to restart Trilostane.
Today Apollo did a very little walk. He walks a little better then before , but not much improvement.He labors to walk, legs seem wobbly, falls easily if I don't watch him. He still has a good spirits. But his stomach is starting to gurgle again and he seems to urinate more. TRilostane has improved many things: coat, skin issues. But can't resolve the leg issues. When we walk he stops and gives me this sad look, like he doesn't want to keep going. I look back and say we are not giving up , we are going to fight as long as we can.
Realistically when I compare him to my Karma , he is my struggling little angel. His legs are not what they were. I look back at the 12 years we have spent together , his and my joys, health issues, struggles. Apollo is the first dog that I have ever had. I love him so much. I will do what ever I can to improve his quality of life. I am not ready to lose my baby.
Going to IMS Wednesday will let you know his blood results. Pray for me and my Apollo.
Sonja and Apollo.

[littleone1]

I'm sending positive thoughts and prayers, Sonja. I really think it's a good idea to have blood work done.

I totally understand how you feel about Apollo. Corky is the only furbaby I've ever had.

You are doing everything you can possibly do for Apollo. Apollo knows his limitations, as did Corky when he was first diagnosed with Cushings. If Apollo only wants to take a very short walk, that's okay.

[mypuppy]

Hi Sonja,
Your poor little Apollo. I'm so sorry he is having all those issues with leg weakness. And I know exactly what you mean when they give you that sad look as if saying "help me"--it breaks our hearts indeed. I wish there was something I can add to help your little boy, but I definitely have those prayers going out to both of you. Try to take one day at time for now and just soak up every single second with the little guy. Just enjoy each other to the fullest. Take care of you and hang in there. Sending you both some tight hugs. Xo Jeanette and Princess

[Squirt's Mom]

Hi Sonja,

I, too, am glad the IMS will see Apollo soon and hope they have a better idea of what could be causing his weakness and how to approach it to help him.

Those eyes can be compelling, can't they? I have seen a sadness in Squirt's eyes from time to time this last year and it just breaks my heart. It never lasts long but it always makes me wonder what she is thinking or feeling or knows. She will be 13 in Feb. but I simply cannot fathom a day without her. I tell myself it is because of all the changes we have been through since spring and, at times, I almost believe myself.

Please let us know what you learn at the IMS'. Sending healing white light and belly rubs!

Hugs,
Leslie and the girls - always

[clydetheboosmom]

Hi - I'm sorry I have not chimed in before, but I wanted to share something with you.

My Bailey is 14 now, and she started Trilostane at the age of 11, I believe...anyway, she has gobe Addisonian a minimum of 4 times n the Trilo, and now she is on an occasional dose of 30 mgs Trilo. It was to be every third day, but I kind of go more on how she is feeling and acting than on the clock -

The reason I mention this is that since her last Addisonian crisis, she has had trouble with some weakness in one of her back legs. She drags it getting up sometimes and it wobbles after she has been laying on it. Eventually, she gets outside and does a pretty good run for a girl her age, but the weakness was checked by my IMS at Tufts and she didn't feel it was neurological, just maybe from the crisis itself - this last one seems to have really slowed the Cushings down.

I'm wondering if there is a correlation between the Trilo-induced Addisons and the weakness for Apollo?

Lynne, Clyde & Bailey

[addy]

Dearest Friend,

I am saying countless prayers for you today and hope you have some good news. I think the IMS has a good plan.

I saw a sparkle in Apollo's eye on his Christmas photo and something tells me he is not willing to give up either.:) Zoe gives me that look when her paws freeze and she cannot walk, she knows Mommy will carry her home. OMG maybe I need a pretty red stroller too.;)

Sonja, neither of us is done with the battle, we will both carry on. And when it gets hard we are all here for each other through the ups and downs, scary moments and hard decisions. We don't have to walk alone. Your heart has steered you well so far. Continue to listen to it. Heed it well.:)

Love,
Addy

[HarrysMom]

Dear Sonja,
I am sending good thoughts your way and Apollo. Hope his tests went well today. You two deserve some reprieve.

Yunhee

[apollo6]

Dear Addy
Your words mean so much too me. Thanks . It took me a long time to decide on a stroller . I am glad I finally decided to do so. Apollo tires very easily now. If you do decide I have given you the link of the one I got Apollo. I am able to put both dogs in it and it folds real easily in the car. When Apollo can no longer walk, I put him in it and he gets to still enjoy the outdoors. And a plus is it isn't real expensive.:p
Amazon seems the most reasonable on strollers.
http://www.amazon.com/gp/product/B000ZJC2D4/ref=oss_product
Yunhee thanks also.
Well here is were I am at.
January 5, 2011-Dr. Hart appointment-observe Apollo looks great-skin, coat. Concerned about weight loss from 10.9 to 10.4 lbs. Request TLI, FOLATE, COBALAMIN (check internal organs intestine, pancreas, liver, kidney for any deficiencies, lacking vitamins) from TEXAS) URINALYSIS, CHEMISTRY PROFILE W/O CBC. Maybe start higher calorie Halo food slowly to diet. Watch water consumption, appetite and any changes in behavior. Neurologist did quick check on Apollo observe hind leg weakness has not gotten worse, feels not related to Cushing. Dr. Hart will call with blood panel results tomorrow. Will need to wait a week for results on Texas test. Once in will decide on medication. If Apollo is doing well will decide when to restart Trilostane.
Off to get tires for Mom's car, take her to seminar on pain management( need for self also have a lot of pain in my hands(carpel tunnel, arthritisyears of accounting and computer work), look up new Employee tax rates, etc.-multitasking:eek:
Will post results when get.
Sonja and Apollo

[Squirt's Mom]

Hi Sonja,

Waiting with you on the results and hoping they come back all good!

I like that the neurologist thinks Apollo's legs are no worse! :) That is good news! Now, if they can just figure out what is causing his weakness if not the Cushing's or Trilo and get a plan in place to help him.

Thanks for posting that link on the strollers, too! I have decided Squirt will have no more surgeries on her legs and I know the day is coming when walking will be a huge struggle for her so a stroller would come in very handy! Hers would have to be all-terrain, tho, as most of our movements are on the 3 acres around here and seldom on paved or concrete surfaces. So I will have to do some studying before I get one for her and your link gives me a good place to do that!

Hugs,
Leslie and the girls - always

[addy]

Hi Best Friend!

Looks like we are waiting for some of the same tests. We did the Texas gastro panel on Zoe too. We will probably get the results at the same time, we went to IMS on the 6th, you went on the 5th:D

Hope things are okay with you and your family. Hope Apollo is doing well. Hope the end of the year business stuff is not too time consuming. I am trying to do my W-2's. :mad: Did you do yours yet?

I love the stroller link, definetely thinking about getting one for Zoe. Only thing is Koko will probably want a ride too. He is being very naughty from being house bound and chewed up Zoe's harness while I was out shoveling snow:eek: I tell ya, those babies, always into something!!!!!

Love ya,
Addy

[apollo6]

Dear Leslie and the girls
and Addy
Thanks. Rushing out the door will post results, not good.
Addy, what ever you decide on the stroller, the one I have , both my dogs sit in it very comfortable. I think most strollers if not to small can hold two small dogs.I am praying for you and Zoe.
Our accountant does all the taxes, w-2 for us.
IMS Says maybe Apollo has inflammatory bowel disease , but doesn't have symptoms of diarrhea and vomiting.Wants do to do ultrasound on Apollo's abdominal cavity, then depending on results a G.I. FUNCTION, some kind of endoscopic tool to look inside Apollo's intestines to see what is going. Then says maybe weekly injections of Vit B12, once a week if need be. Apollo has lost some weight also. And financially we put some of our own savings into the business. We are on our last leg. Can't pay our bills. If I didn't have all these other stresses in my life I would be coping better with Apollo's health issues. I don't want to put my little angel through more tests. I am going to holistic vet next week and will go over with him. He is the one I go for accupuncture and nutritional advice. I will post his results on my thread.
Wish I had better news.
I need to stop and breath and regroup about what to do next for Apollo. He still is off the Trilostane and his numbers are going up again.

I will post Cobalamin and Folate results sent to Texas A &M UNIVERSITY -shows both levels are subnormal not absorbing nutrients and will post CHEMICAL BLOOD panel and urinalysis later.
Sonja and Apollo

[addy]

Sonja I don't blame you, I don't want to do endescope on Zoe either.
Maybe holistic vet is better for this for Apollo. Standard Process may have a supplement for you. Usually when one is off, B12 or folate that is SIBO. I thought when the B12 is low.

Seems odd that he would not be vomiting or having bad poos. The vets lump alot into "IBD". Is he still losing weight since off the Trilostane?

I do know my neighbor's pup was thin and she had low folate and she just gave her a supplement. Doing that also took away her bad poos. But Apollo does not have bad poos.:confused:

Take care, dear friend. We'll compare notes when I get Zoe's Texas gastro panel back.

Love ya,
Addy

[apollo6]

Dear Addy
We think so alike. Wish we lived closer. I will post results and vets comments tomorrow. Pretty worn out. I am such a bad speller. Focus on the little things, time with your family , the outdoors, seeing your fur balls love you. Sometimes that is all we got.
Sonja and Apollo my little trooper

[apollo6]

will post Apollo's results from Chemical panel showing liver enzymes are elevated. And Serum Coblalamin(Vitamin B120 and Folate test tomorrow. Not good news.
Sonja and Apollo

[marie adams]

Hi Sonja

Hang in there you are doing a great job!!

[littleone1]

I hope you will get some good news, Sonja. It's so hard when we don't know exactly what is wrong with our furbabies. You are such a great mom. You are doing everything you possibly can to help Apollo.

[apollo6]

Dear Addy and Marie and MaddieGirl and Terry and Corky thanks for the support.

I feel like I am in a box and more stuff keeps being dumped into the box and I am having a harder time breathing because of it.
I am so overwhelmed right now.:eek:
We are on our last leg in the business, can't pay our bills, now the computer has some kind of cliche when I input the 2011 employee fed tax rates didn't apply to employee records, my personal computer has all sorts of software issues going on, so I might not be able to post to the forum. Apollo's front legs are now acting up also, he has a harder time walking, seems to fall very easily, his muscle wasting in the head seems more, I can feel the bones on the side of his eye sockets, he fell a few days ago because I wasn't watching him and scraped a small part of skin off his nose. The bloating is starting up again and the gurgling in his intestines. On the positive his coat looks great, he has a good appetite, is still popping alright(never know what color it will be-light yellow, sometimes darker, sometimes watery, sometimes great. He has not thrown up so far. He has lost weight was 10.6 lbs now down to 10.4 lbs. He is feeling a lot of my stress. I will post from my notes what IMS said and test results.


55. December 13th, Dr Hart called said doesn't’t think Trilostane cause of Apollo’s hind leg weakness. Says would see difference within 12-16 days. Notify him immediately if any changes in Apollo. Start Trilostane on Dec 20th, to see results by January 6th Acht Stim, and blood panel. Did not start Trilostane.

56. JANUARY 3, 2011-Dr. Hart called, let’s look at Apollo first, do blood test before decide to restart Trilostane.

57. January 5, 2011-Dr. Hart appointment-observe Apollo looks great-skin, coat. Concerned about weight loss from 10.9 to 10.4 lbs. Request TLI, FOLATE, COBALAMIN (check internal organs intestine, pancreas, liver, kidney for any deficiencies, lacking vitamins) from TEXAS) URINALYSIS, CHEMIISTRY PROFILE W/O CBC. Maybe start higher calorie Halo food slowly to diet. Watch water consumption, appetite and any changes in behavior. Neurologist did quick check on Apollo observe hind leg weakness has not gotten worse, feels not related to Cushing. Dr. Hart will call with blood panel results tomorrow. Will need to wait a week for results on Texas test. Once in will decide on medication. If Apollo is doing well will decide when to restart Trilostane

58. January 13, 2011- DR. Hart review of tests: liver enzymes up again 50 %, compelling changes, kidney value normal, a muscle enzyme is elevated (muscle atrophy)
G.I. TRACT- 2 COMPUNDS –folate bacterial-small intestines , Vitamin b 12 deficiency? Back parts of the intestines, both folate levels are subnormal- intent not absorbing nutrients, diagnose maybe be inflammatory bowel disease- no symptoms of vomiting or diarrhea. Interpretation: consistent with distal small intestinal disease, EP1 or small intestinal bacterial overgrowth. Check TLI to rule out EPI. Consider cobalamin supplementation. Second reading consistent with disease affecting the proximal small intestine. Could be allergies, infection, or cancer –bottom of list. Pancreas in normal range. Problem in small intestine-observation suggest ultrasound of abdominal cavity, check liver, etc. G.I. Functions -to give VIT B12 INJECTIONS IN SERIES ONCE A WEEK, THEN MONTHLY INJECTIONS. Also do FIBSCOPE (endoscope) of small intestines.
59. I feel could be irritable bowel syndrome due to stress I am under.
Test results
Gastrointestinal function test:
TLI,FOLATE,COBALAMIN TEST from Texas A & M University
Cobalamin Fasting
Interpretation: Consistent with distal small intestinal disease, EPI or small intestinal bacterial overgrowth. Check canine TLI to rule out EPI. Consider cobalamin supplementation.
Http://www.cvm.tamu.edu/gilab/research/cobalamin.stml
<150 ng/l control range is 25-908
Folate Fasting
Interpretation: consistnet with disease affecting the proximal small intestine.
reading 5ug/l control range is 7.7-24.4
TLI Fasting
Interpretation: Result is within the normal range.( if in normal range doesn't that rule out EPI?)

URINALYSIS
COLOR PALE YELLOW
URINE APPEARANCE CLEAR
SPECIFIC GRAVITY 1.018(PRIOR 1.015) RANGE 1.008-1.060
ph 6.0 range 5.0-7.0
urine protein -Neg
all readings-neg
urine blood 2+( used needle to get urine?) last time was 1+

Chemistry panel
sodium 149 ( previous 148) range 139-152
potassium 5.1 (previous 4.8) range 4.0-5.6
chloride 112(previous111) range 105-120
CO2 27H(SAME) RANGE 17-26
NA/K RATIO 29.2( WAS 30.8) RANGE 26.0-37.0
ANION GAP 10.0 RANGE .0-25.0
GLUCOSE 107(WAS 83) RANGE 70-120 CAN BE ELEVATED DUE TO CUSHING
BUN(KIDNEY) 28(WAS 32) RANGE 7-31
CREATININE .5L (WAS .7) RANGE .7-1.7
BUN/CREA RATION(KIDNEY) 56.0 H(WAS 45.7) RANGE 9-33 ELEVATED
CALCIUM 10.1 (WAS 10.5) RANGE 9.1-11.0
PHOSPHORUS 6.1( WAS 5.5) RANGE 3.2-6.3
TOTAL PROTEIN 6.0(WAS 6.2) RANGE 4.7-6.9
CA/PO4 1.7 (WAS .9) RANGE 1.2-3.8
ALBUMIN 3.4 (was 3.3) range 2.6-3.5
globulin 2.6 (was 3.2) range 2.5-4.5
liver enzymes going up
a/g ratio 1.31H( was 1.07) range .6-1.3
CK 506H( WAS 270) RANGE 54-380( MUSCLE DISORDER WORSE)
AST(SGOT) 67H( WAS 50) RANGE 6-62
ALK PHOSPHATASE 577H( WAS 137) 9-140( MOST COMMON CAUSE ARE LIVER DISEASE, BONE DISEASE OR BLOOD CORTISOL CUSHING DISEASE- I FEEL NEEDS TO GO BACK ON TRILOSTANE)
ALT(SGPT) 328H( WAS 210) RANGE 15-84
GGT 39H(WAS .4) RANGE 0-6
TOTAL B ILIRUBIN .4(WAS .4) RANGE .1-.6
CHOLESTEROL 194( WAS 178) RANGE 114-250(GIVING SOME RICHER FOOD HALO AND MORE COOKIE TREATS?)INCREASE CAN BE CASUED BY CUSHING DISEASE , DIABETES AND KIDNEY DISEASE
MAGNESIUM 2.4 ( WAS 2.2) RANGE 1.5 -2.7
Triglyceride 36(WAS 252) RANGE 18-248

I put in my own notes to understand the readings. I feel Apollo needs to go back on the Trilostane and then see if the intestinal issues improve. So confused as to what I should do next for my Apollo. Right now he is laying on my lap with his little head. The best part of the day.
Would appreciate input. I will see my holistic vet on Tuesday to go over all the tests and get his input on the additional tests-ultrasound( will not do an endscope on his little intestines where does it stop him being a ginnepig being promped ) Did you know accupuncture helps with cushing. I will also talk to Ims about restarting the Trilostane maybe restart at the lower dose again. I wish he didn't need to take this medication. I just know I am not going to jump into something without a lot of consideration.
Sonja and Apollo.

[addy]

Gosh Sonja, don't know where to start. I think it rules out EPI, I just finished reading about EPI, SIBO, IBD, colitis, etc. From the sound of his poos, seems like something is going on there, maybe SIBO if his folate and B12 are both low but I just read sometimes the EPI is sub clinical so------

Sweetie I am so sorry you have so much on your plate, How you function is a wonder to me, all that stress and you remain so coherent:) I'm a babbling idiot!!!!!

Check out the links on Dogaware. I was just there reading before I take out my volumes of printed articles:eek:

Sounds like you need to go back on the Trilostane but maybe at the original dose as you said.

I am sure the others will be along to comment on your test results. I still don't have mine.:mad:

I don't know if stress would lower his folate and B12. Hubby and I discussed endoscope for Zoe. He feels what's the point putting her through that. We' ll see.

I am here for you best friend.

Love ya,
Addy

[Squirt's Mom]

Hi Sonja,

It sounds to me like Apollo has several things going on at once - Cushing's, an intestinal disorder/disease, and a muscular disorder/disease for sure, possibly other things as well. The digestive issue and the muscular issue are probably not related to the Cushing's. I say this so you don't get to thinking that restarting the Trilo will help these issues.

If I were you, I would tackle these things one at a time as finances, etc. allow. The intestinal problem would be my first step. If Apollo isn't able to absorb nutrients, then the cause needs to be determined and steps taken to correct this if possible. I would have to question the availability of the meds if he is having absorption problems. Availability meaning what he is able to use once it is ingested. But this is JMHO.

How long has Apollo been off the Trilo? Is there a reason you or your vets don't want to try the Lyso?

Sue's Zoe had SIBO and I think she was on Trilo but I'm not sure. I will try to find their thread and post it for you so you can read their story.

Keep your chin up!
Hugs,
Leslie and the girls - always

[apollo6]

Dear Addy and Leslie
The reason I took Apollo off the Trilostane was I thought it was the cause of his leg problems. I am so worried. Right now my little angel is sleeping go the bed behind my chair. I love him so much. I will see what my other vet says. I don't want to lose him. It would put me over the edge with everything I am dealing with.
Will try to check in later. Having a lot of computer issues.
Sonja and Apollo

[Squirt's Mom]

Sue and Zoe's story of the SIBO doesn't seem to be on this list...that must have happened when we had the old site. :(

Keep the faith, Sonja. When times are tough, everything seems so much worse. I am hoping and believing that Apollo is ok for the most part, and that you will figure out what is wrong and what to do in no time. I think the acupuncture is a great idea! A good place to start!

Keep your chin up!
Hugs,
Leslie and the girls - always

[apollo6]

Dear Addy and Leslie
Thanks for the support.
Today is a good one. Apollo actually climbed some stairs.:p
And he was pretty loud about demanding his treats. He actually ran to me.:D

Each day is a gift. Has nay one heard from Dena on Simon. I was given her phone number but haven't called yet.
Sonja and Apollo

[Isnthebeautiful]

hi sonja
i am sorry to hear about Apollos extra problems - and yours.Its hard working and caring for such a special boy.Me and Bob have similar trials! I havnt been on here regular lately as we have been too busy running our business,trying to make money to pay for all the vet bills! I think the trilostan has been blamed for hind leg weakness (it says so on their site).I emailed them about this but they didnt get back to me........
I can only say hang on in there and fingers crossed things get better
Jo and Bob
PS i forgot to say Bob had 3 courses of acupuncture and we think it did help with his legs....he started on a new drug around the same time so it was hard to tell at the time - we took him off the new drug (for his pseudo myotonia) pretty quick cos it worked too well! his muscles went to jelly so his back legs wouldnt support him at all. But the physio therapist who has treated Bob a lot reckons there is some improvement.So maybe you could try it......it costs us £210 for 3 sessions! Next sessions at the end of this month.

[frijole]

Sonja - In May Annie was diagnosed with SIBO. They wanted to treat with an antibiotic that is hard on the stomach - can't remember which but I opted to go with Tylan instead. You can buy it off the internet in powder form and put it into capsules. I did alot of research and alot of people who had dogs with sensitive stomachs were preferring it over the other antibiotics. In our case she didn't even have SIBO but instead a bleeding ulcer in her stomach caused by the helicobacter but I just wanted to share that this is very treatable. Did your vet mention trying to treat the SIBO? I understand it is difficult when you are dealing with more than one thing... I am sooooo with you sister. ;) Big hugs from our house to yours. Kim

[Spiceysmum]

Hi Sonja,

Sorry you have so many things going on with Apollo, it must be hard to know where to start. Brin, my 14 year old non-cushings dog had SIBO about 18 months ago. He lost so much weight and before he was diagnosed he had antibiotics but they did nothing. Blood tests showed his B12 levels were very low and the first vet I spoke to said it was probably caused by small tumours in his intestines and wanted to take a look inside to be sure. I decided to try the easier route first as he had a bad reaction to anaesthetic a year before. So he had the weekly B12 injections, another course of antibiotics and a change of diet to Royal Canin Vetinerary Sensitivity Control (Blue Whiting and Tapioca). The improvement after the first injection was amazing and he was so well he just had 6 in total. I have kept him on the same diet ever since and he hasn't had any problems. I know he didn't have Cushings to deal with but I think they will never be well while the B12 levels are low. Good Luck.

Linda