Tomato - 16 y/o Shi Tzu (Trilostane)

[Tomato]

My dog, (Shi Tzu), Tomato is also 16 years old. He is newly diagnosed to have Cushing's disease. In fact, he just survived from a deadly condition of pancreatitis + hemorrhagic gastroenteritis that I almost lost him just before his birthday. His body weight dropped from 5.8kg to 4.4kg within about 2 weeks of hospitalization.

He started the 10mg Trilostane treatment (once daily) about a week ago, but the 2nd ACTH stimulation test showed that the post-stim level was still about 500 something. The vet said his condition is not very well controlled and the dosage has to be increased to 15mg. However, after Tomato started the Trilostane 10mg last week, I noticed that his appetite was decreased, and he started to pass soft stool.

I have two questions:

1) Should the dosage of Trilostane be increased to 15mg for Tomato’s condition especially given that he has signs of GI upset side-effects? However, the Vetoryl capsule only provides 10, 30 & 60mg dosage form. It won’t be a good idea to divide the capsule, right?

2) The cost of Vetoryl is quite expensive in Hong Kong. Does anyone know if there is any economical route to buy Vetoryl (in Hong Kong) or get it ship to Hong Kong? I searched some online pet pharmacies, however, it seems that they don’t accept overseas order nor prescriptions from non-UK registered Vet.

[labblab]

Hello and welcome to you and Tomato! I noticed that you originally posted this introduction as a reply on another member's thread ("Mavis"). I have left a copy of your reply there, since Mavis also resides in Hong Kong and was asking similar questions as to availability of Vetoryl/trilostane in Hong Kong. Hopefully, she may return to her thread, see your reply, and have some additional information for you in that regard (http://www.k9cushings.com/forum/showthread.php?p=46355#post46355).

But in the meantime, I also want you and Tomato to have a thread of your own in which you can discuss your other questions about Tomato's treatment. I have only a moment now to write, but I'm first going to start off with a few questions of my own. Can you tell us some more about Tomato's health history, the symptoms that led to her being tested for Cushing's, and if possible -- the exact diagnostic test results? Also, how much does Tomato weigh? I apologize for asking you questions rather than answering your own questions, but this additional info will help us to give you the most accurate feedback that we can.

Thanks in advance, and I'm looking forward to learning more about Tomato!
Marianne

[Tomato]

Thanks Marianne!! 

Below is Tomato's medical history.

He had 6 levels of disc prolapsed at thoracolumbar region and resulted in Grade IV paraplegia about 3 years ago, and he had 4 levels hemi-laminectomy done at that time. He could walk again after the surgery, yet with some residual spasticity and weakness over his rear legs.

However, he fell from sofa about a month ago and resulted in Grade II paralysis of his rear legs that he couldn't stand or walk. He was admitted for rest and pain treatment (Baytril; Nerontin 100mg; Robaxin Tab 700mg; Tramadol 50mg Tab; Acupunture). During the second day of his hospitalization, the vet said he developed mild diarrhea with blood stained stool, and she prescribed Lomotil for symptomatic relief. Tomato was then discharged after few days of hospitalization as he could walk again although unsteady.

After discharged home, he seemed fine despite the wobbling gait. However, after three days, he suddenly vomited moderate amount of whitish liquid (about 5 – 6 times) at night and refused to eat the next morning. Then he suddenly developed bloody diarrhea in the afternoon and passed out large amount blood, he was so dehydrated and almost became unconscious when we rushed to the hospital.

The vet put him on IVs and performed the abdominal ultrasound. She found that Tomato’s intestines were not moving, and there was abnormal whitish signal at his pancreas. She also noted that Tomato has bilateral adrenal gland enlargement.
Some of his blood tests results were:
UREA 14.4 mmol/L
ALKP 254U/L
PCV 52%
K 3.3 mmol/L
cPL Abnormal
Giardia Negative

The diagnosis was “Acute pancreatitis” + hemorrhagic gastroenteritis. He was put on IV with plasma infusions + loads of other medications (Ampicillin Na, Cloxacillin Na; Temgesic; Promeran; Metronidazole; Zofran; Zantac; KCl)

After his pancreatitis was stabilized, the vet advised that we should also tackle his adrenal gland hypertrophy as Cushing’s might predispose Tomato to have relapse pancreatitis. Therefore, Tomato was being tested for ACTH STIM and confirmed he has Cushing’s disease, probably pituitary dependent.

The 1st ACTH STIM done on 12 Feb 11
Baseline cortisol was 179nmol/L; Post-ACTH STIM was >828nmol/L
He started 1 week of Vetoryl 10mg (once daily) since then

The 2nd ACTH STIM done on 20 Feb 11
Baseline cortisol was 235nmol/L; Post-ACTH STIM was 571nmol/L

So that’s about the long history of my poor Tomato.

After the 2nd ACTH STIM test, the vet said Tomato’s Cushing’s condition is not very well controlled and the dosage needed to be increased. However, I am very concerned about further increasing the dosage as Tomato has very poor appetite + pass out soft stool since the start of Vetoryl, and the change of his diet to Royal Cainn “low fat” diet. His weight dropped from 5.8kg (before pancreatitis) to about 4.3 – 4.4kg now. The problem is I don’t know whether it’s because of he just simply doesn’t like the “low fat” food or it’s because of the Vetoryl / it’s a combination effects. I am so worried that if his loss of appetite continues, his conditions and especially his rear legs will be even weaker.

I have to syringe feed him these days just to supplement his diet…..

[Mavis]

Hi, Tomato's parent. I'm Mavis & sorry to see your history so late. Pls kindly see my reply under my thread...

[Squirt's Mom]

How is Tomato doing? We would love an update!

Hugs,
Leslie and the gang