Paddington (6 y/o shih tzu) - Paddington Bear has passed

[janemin]

I have two Shi tzus.One 3 years old & Paddington who will be 6 years old this year.Paddington was recently diagnosed with cushings.He is on 30 mil trylastane .this is his second month of taking this .My vet tested him at the end of the first month .I had to leave him there for 4 hours.She said that his blood work was a little better but that it was not under control yet.He seems to be acting a little better in himself.not drinking quite as much & will play every once in a while,even back to jumping on the chair.I think she is hesitant to in crease the dosage unless she has too.I was wondering what the maximum dosage for a 20 lb shih tzu would be.He still seeks out cold spots to lay .But doesn't seem to mind going for his walks.

[Squirt's Mom]

Hi Janemin, and welcome to you and Paddington! :)

Here is a link to info on Trilostane (Vetoryl) from our Helpful Resource section:

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

It would help us a great deal if we could see the actual results of the tests Paddington has had, both to diagnose Cushing's and the subsequent ACTH monitoring since he has been on Trilo, including the scheduling of the monitoring tests (ie - how long after he had his meds were the tests given?). The more info we have, the more meaningful feedback we can provide. We have many Trilo parents here and I am sure they will be along to share their experiences and ask their own questions.

Trilo can take quite a bit of tweaking to get the dose just right sometimes, so don't get discouraged.

Can you tell us what signs you are still seeing and how strong they are compared to the time before treatment started?

Is Paddington neutered?

I am glad you found us and look forward to learning more about you both in the future. You have found a wonderful group of folks who are more than happy to share their knowledge, experience and hope with you. Don't hesitate to ask questions and we will do our best to help you understand.

Keep your chin up!
Hugs,
Leslie and the gang

[addy]

Hi and Welcome !!!

We are so glad you found us. When I first came to this forum, I was so glad to know I would no longer be alone. Our members are both caring and smart:)

As Leslie has already posted, the more information you can provide about Paddington the better the moderators can discuss options.

Some of our members have found Dr. Allen at Dechra(Vetoryl manufacturer) is willing to give advise on dosing, etc. Our Vetoryl/Trilostane members will all be along soon to weigh in. They ask a ton of questions so don't get put off by that. My Zoe will be starting Trilostane this month. She is 18 1/2 pounds and we will be starting at 15mgs. She has colitis, so that figured into the equation for us.

Hugs,
Addy

I love shih tzus. They are so sweet. My Koko is a shih tzu, pekingese, cocker spaniel:rolleyes::rolleyes: We call him a shi-p-kok:D

[littleone1]

Corky and I also want to welcome the both of you.

You have found a wonderful group of very caring, supportive and knowledgeable people. As Leslie said it would really help everyone if you could post the test results.

Corky has been taking Trilo for 19 1/2 months now. He's doing very well on it. Leslie mentioned that the dosage will most likely have to be tweaked. Corky now weighs 18.1 pounds. He started with 20mg once a day. During the time he has been on Trilo, his dosage has been increased several times. He's now taking 60mg TID, which is broken up into 20mg 3 times a day. There are many fur babies that don't require too many increases, and sometimes the dosage can be decreased.

I'm glad you found us. I would have been totally lost if I hadn't found this group.

Terri

[janemin]

Hi,I haven't been back in a while but Paddington recently had his blood work redone after 7 months of being on trylostane.He has been doing very well.The frequent urinating & excessive thirst had abated,His blood work was done yesterday.& the Vet was very pleased.I have to get copies of his blood work for myself.My problem is he's been drinking & peeing a lot in the past three days.The Vet wants to wait & see before she increases his trylostane.He's on 60 mil right now.He was doing so good ,I hate to see him taking a step back The Vet seems very satisfied with his blood work & she said it was such an improvement from the last test.Has anyone had similar experiences with recurring symptoms & is it temporary.

Moderator's Note: I have merged your update on Paddington into Paddington's original thread. We, normally, like to keep all post on a pup limited to a single thread as it makes it easier for other members to refer back to the pup's history, if needed.

[lulusmom]

Hi and welcome back.

It would be very helpful if you would please get a copy of the acth stimulation test and post the results here. I Paddington on once or twice daily dosing? When you have the acth stimulation tests done, are you and your vet making sure that the test is done well within 4 to 6 hours after the morning dose? Are you noticing that Paddington's symptoms are worse at any particular time of day? Sorry for all of the question but your answers will help us try to figure out what is going on with Paddington.

Glynda

[labblab]

It's possible that Paddington might have developed a urinary tract infection that would account for the increased thirst and urination. You might want to ask your vet about analyzing a urine sample in order to check.

Marianne

[janemin]

Hi and welcome back.

It would be very helpful if you would please get a copy of the acth stimulation test and post the results here. I Paddington on once or twice daily dosing? When you have the acth stimulation tests done, are you and your vet making sure that the test is done well within 4 to 6 hours after the morning dose? Are you noticing that Paddington's symptoms are worse at any particular time of day? Sorry for all of the question but your answers will help us try to figure out what is going on with Paddington.

Glynda

I am going to get copies of his bloodwork today hopefully.He;s on one a day 60 mill.taken at 5 00pm .He does sleep all night .Cant really pinpoint if his symptoms are worse any particuler time.I do know he heads for the outside, first thing when he gets up & also his water jug

[labblab]

Is there a particular reason why you are giving the medication in the evening instead of the morning? For dogs getting the medication once a day, morning dosing is recommended by the drug's manufacturer and most vets, for a couple of important reasons. First, as Glynda said above, the monitoring ACTH testing should be performed between 4-6 hours after dosing. Theoretically, trilostane only remains active in the body for about 12-18 hours after dosing, and the peak effect occurs during those earlier hours soon after taking the medication. Dechra's dosing protocol (advising whether to raise or lower a dose) is based on a comparison of peak testing results. So unless you are having Paddington's ACTH test performed between 9-11 p.m., the rsults are not meaningful in relation to Dechra's dosing recommendations.

Secondly, if Paddington is getting his medication at 5:00, he is getting the peak benefit in the evening and overnight, while he is asleep. By the time he wakes up in the morning, the drug is already starting to exit his system. So it would not be at all surprising for you to see a return of Cushing's symptoms during the day.

So in addition to the possibilitiy of his simply having developed a urinary tract infection, you may see significant improvement in his thirst and urination if you switch to dosing him in the morning (along with some food). Plus, that way his ACTH results will be much more meaningful.

Here's a link to Dechra's U.S. Product Insert for Vetoryl (trilostane). It will give you a lot of helpful info in relation to dosing and testing:

http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf

Marianne

[janemin]

I will be switching Paddingtons meds to morning,starting tomorrow.Vet said to skip tonights dose,also will be taking a urine sample .She said once again that she didnt want to mess with his dosage as his test results were so good.but if he still continued to drink a lot & urinate ,then she would see.I will pick up all of his blood tests results when I go over.& will post all of them.Thanks for being so helpfull.

[janemin]

Well, I switched Paddingtons Trilo to morning ,this is his second morning dose.He is more restless at night & had an accident in the middle of the night.
Hoping to take sample of urine to Vet in the AM & see if there is a UTI.Plus get copies of ATCH tests

[labblab]

That will be great to get the ACTH test results. Also, the timing that the tests were run will also be a help to us (meaning, how long after Paddington had his trilostane was the test done).

It may turn out that Paddington is a dog who would do better if he is dosed twice daily, at twelve hour intervals. It may be the case that the drug is leaving his system so quickly that it allows for symptoms to rebound before he gets his next daily dose. Depending on the numbers and the timing of his last ACTH test, that would help with making the decision as to how to alter his dosing. For dogs switching to twice daily dosing, Dechra recommends increasing the daily total by a bit, and dividing that amount in half. But once again, whether or not an increase is warranted will depend upon his most recent results. You can find more info about this in that Dechra link that I gave you.

Marianne

[janemin]

I have some bloodwork on paddington but cant seem to post them.I did have his urine tested.Allclear.

[Squirt's Mom]

Just type out all the abnormal values, too low or too high, along with the units of measurement and normal ranges for each value.

EXAMPLE -

ALKP 1250 ug/dl 125-500 ug/dl

[Skye]

depending on what all they are going to do with the urine, a cysto might be better.
make sure the urine is sent out to lab...they need to know what bacteria if any is present so they give the correct antibotic and not guess. This is very important.
Has anything in your babies diet changed??? and change of any treats? some things can cause dehydration. so just checking!

[janemin]

Just type out all the abnormal values, too low or too high, along with the units of measurement and normal ranges for each value.

EXAMPLE -

ALKP 1250 ug/dl 125-500 ug/dl
ALB =4.1g/dl H 2.3-4
ALKP=89U/L H 23-212
ALT=76U/L 10-100
AMYL=376U/L L 500-1500
BUN/UREA =8mg/dl 7.27
Ca = 10.8mg/dl 7.9 12
CHloride = 108mmol/L
CHOL =184mg/dl
CREA =0.7mg/dl
GGT =5U/L
GLU =129 mg/dl
LIPA =967 U/L
PHOS =4.7mg/dL
Potassium--- -- mmol/l
TBIL =0.2mg/dl
TP =6.8g/dL
Sodium =148mmol/L
GLOB =2.7g/dl
ALB/GLOB =1.5
BUN/CREA =11
This is 1 page

[janemin]

ALB =4.1g/dl H
ALKP=89U/L H 2.3-4
ALT=76U/L
AMYL=376U/L L 500-1500
BUN/UREA =8mg/dl
Ca = 10.8mg/dl
CHloride = 108mmol/L
CHOL =184mg/dl 109-122
CREA =0.7mg/dl
GGT =5U/L
GLU =129 mg/dl
LIPA =967 U/L
PHOS =4.7mg/dL
Potassium--- -- mmol/l
TBIL =0.2mg/dl
TP =6.8g/dL
Sodium =148mmol/L
GLOB =2.7g/dl
ALB/GLOB =1.5
BUN/CREA =11
This is 1 page
Page 2.I think I have the hang of this now.Just the high & lows
HCT =60.7% H 37-55
HGB =18.6g/dl H 12-18
RBC =9.24M/uL H 5.5 -8.5
WBC =20.26K/uL H 5.5-16.9
NEUT =16.65K/uL H 2-12
PLT = 801K/ul 175-500
Taken 11/16 2011 09.31 04


Immunoassay

CORT01 =10ug/dl baseline cortisol

[labblab]

Hi again, I only have a moment to post right now, so I'm going to focus on the last test result of the baseline cortisol of 10 ug/dl. Is there a second number to the test result that you may have overlooked posting? An ACTH stim test should have two numbers, the resting baseline cortisol, and then a second cortisol reading taken 1-2 hours later after a stimulating agent has been administered.

Also, can you tell how many hours had passed after Paddington's trilostane dose before the cortisol testing was performed?

I'm afraid that if only a baseline cortisol reading was taken a lot longer than 4-6 hours after Paddington's trilostane dose, it is really impossible to know whether or not a dosing increase is warranted on the basis of the testing...

Marianne

[janemin]

Update.Paddington is going to have the ACTH test done again on Wednesday. 2.1/2 hours after I have given his medicine.I will post his results .I feel relieved that finaly I will get correct results.Thank you so much.I never would have known .You guys are so helpfull

[lulusmom]

I'll be looking forward to seeing the results of a meaningful acth stimulation test. We can only share our experience and provide you with reading material but it is you who has to take that information and make it work for you and Paddington. I'm glad to see that you are off to a great start. Paddington is blessed to have such a great advocate speaking for him.

Glynda

[janemin]

Thanks,I am so anxious to get those results.I will post them as
soon as I get them

[janemin]

Could someone please tell me.When i give Paddingtons trylostane in the morning.I have always given it with his food.But my Vet has always had me fast Paddington the day of his ACTH Test.Of course that was when he was taking it in the evening.I guess I could try & reach her first thing in the morning.Cant believe I didnt ask this question when I was talking to the vet.

[labblab]

It is now recommended that dogs receive food along with their trilostane dose on the day of ACTH testing. Here's a link to a reply with more information in this regard:

http://www.k9cushings.com/forum/showthread.php?p=65220#post65220

Marianne

[janemin]

Took my boy over for his ACTH Test & just got a call from Vet who said his cuushings was well controlled she gave me two figures.One was4.3 & the other was 6.3.They are going to send me the full reportwith all the numbers,so I will post as soon as I get them.Also did another urine Test this morning & Paddington has a UTI.So hes on clavomax .The vet thinks that the urine & drinking problem has everything to do with the UTI.so we shall see after he has taken this medicane.

[lulusmom]

Hi and thank you for posting the results of the acth stimulation test.

Just to make sure, was the test done within 3 to 6 hours after Paddington's morning dose of Vetoryl (Trilostane)? As long as Paddington's current symptoms are not cushing's related, then the numbers you posted are great. Please keep us posted on how things go with the antibiotic treatment for the UTI. Keeping fingers and paws crossed that it does the trick.

Glynda

[janemin]

Yes Paddington had his trylostane at 7.30 am & I too him in at 10 15 am for test .I believe the test was done at 10.30am

[janemin]

Paddingtons on his4th day of clavamox & still is peeing & drinking a lot.Hope this starts to work pretty soon.Maybe I am too impatient.He still has quite a few pills to take,but i thought the medicine would start to work by now.

[addy]

Sometimes the UTIs can be really stubborn and take a while to resolve.
Hopefully the antibiotic will kick in soon. Also remember sometimes, it may be the wrong antibiotic for the uti. Did the vet do a culture?

hang in there,
addy

[Skye]

Good question Addy, that is what i was going to ask.....
that is where they send it out to labs and it takes few days to get report back....
keep us posted!
love and paw hugs

[Squirt's Mom]

How is Paddington doing today? I hope you are seeing some resolution of his signs.

Hugs,
Leslie and the gang

[Skye]

Sunshine hugs to you all today, popping by to see if you ever heard if the urine was sent out for culture to what bacteria was causing this
and seeing how all is feeling?
big hugs

[janemin]

Good morning,Sorry I've been so long posting ,but its been a very frustrating time.Well as you know Paddy had a uti & was on Clavamox.It didnt seem to make much difference in the peeing & thirst.Anyway after taking all the medicane.I took him back & asked for another urine test.Came back neg.So vet decided to up his dosage of trilostane.So he has been on 60 mil in the morning & 30 in the evening.He's been on this dosage for about a week .Dont see a whole lot of difference yet.Vet wants to give it another week or two.
I am looking at my Paddington right now & wondering what a difference a few months has made.He''s gone from 21 00lbs ,which probably wasnt good for him,down to 17lbs which i think makes him look gaunt .The Vet is not at all concerned with his weight.He sleeps a good share of the time & the only time he shows any real emotion is when we come in from being out or if we have company.He still goes for walks twice daily.Oh & when he sleeps he has tremors.My hubby thinks he is cold ,but i think it is the meds.I am going to wait untill after Christmas & if I dont see any improvement I think I will have to seek another opinion..Thanks for letting me go on,Any opinions would be greatly appreciated.Oh & by the way has anyone noticed Trylostane going up in price.The vets office told me it has gone up $10 00.So I just got charged $75 00 for 30 mil .Am going to get it from online pharmacy next month Has anyone dealt with Diamond Head.I understand its a compound pharmacy that will mix med to required dosage.

[Squirt's Mom]

Hi,

How is Paddington's appetite? Has he lost weight because he has lost interest in eating? How are his stools?...solid and well formed or a bit mushy, watery? Has he had any nausea or vomiting?

Is the vet absolutely sure the UTI has cleared up? Testing with an active infection can affect the results of the ACTH. ;)

Did the vet raise his Trilo dose based solely on the urine test that was done to see if the infection was gone? His cortisol level was not checked right before this increase, if I am reading you right? If the increase was not based on an ACTH or urine, keep a close eye on Paddington and if you see any signs of the cortisol going too low - diarrhea, nausea/vomiting, loss of appetite, lethargy - stop the Trilo, give pred and call the vet asap.

Could you give the normal ranges for these values from the lab report, please, thanks -

GLU =129 mg/dl
TP =6.8g/dL

Weight loss is more typical of diabetes than Cushing's...tho it does happen with cush pups. The form of diabetes that is checked via blood, like those above, is called Diabetes Mellitus, often called DM. There is another type that is not tested via blood called Diabetes Insipidus, or DI. DM is a disease of sugar and insulin imbalance but DI is a disease of water imbalance. Excessive drinking and urination are the main signs of this form of diabetes. Here is a link or two so you can see if anything seems to fit Paddy -

http://www.vetinfo.com/dencyclopedia/dedibetinsp.html

http://www.petplace.com/dogs/diabetes-insipidus/page1.aspx

http://www.vcahospitals.com/main/pet-health-information/article/animal-health/diabetes-insipidus-in-dogs/743

Has Paddy had an abdominal ultrasound? If not, I highly recommend he have that done. This test saved my Squirt's life by finding a tumor on her spleen. As one of our other mods says, you get the biggest bang for the buck with the U/S. Not only will they be able to see the adrenals, which is very helpful in Cushing's, they can also see the spleen, stomach, kidneys, liver, gall bladder, bladder and other organs.

We have several folks who use Diamond Back and I'm sure they will be along to share with you as will our Trilo moms and dads.

Well, as you can see, most of what I have to offer is questions. :o But it helps to have as clear a picture as possible when our babies decide to throw us a curve! ;)

Honey, you can "go on" any time! We are always glad to hear from you and Paddy!

Hugs,
Leslie and the gang

[janemin]

Hi everyone,Its been a few days but its been hectic to say the least.
Well,I decided it was time for a fresh opinion,so I took Paddington to a different Vet.She is not comfortable with the weight loss.Paddington is weighing in at 16 lbs now.A loss of 5 lbs since last April.I have to take him in Thursday morning for yet another ACTH test.She gave him a blood test & informed me that his cushings was not under control.Will let you know the outcome on friday.She is also talking of doing an ultra sound.Oh & by the way ,his Urine test came back normal,although she said his urine was so diluted it wasjust like water,due to him drinking so much.will keep you posted

[janemin]

What a day,we took Paddington to the vet today for yet another ACTH test.She called me tonight .Paddingtons cort level is 8.6.so his cushings is not under controll.But she wants to drop his dosage from 90 to 60 as she feels it is a high dosage for him.She is concerned with his weight.Also he is going for an ultra sound next week & also a sterile urine test.She definately believes something is going on apart from the cushings.I feel I will get some answers soon.Will keep you posted.

[janemin]

I just wanted to say Paddington has an appointment on Friday Jan 6 at Peak Animal Referral Center for an Ultra Sound.Located in Burlington Vt.I have checked & it is supposed to be a great place.Hopefully Paddington will get a break bless him.I really think they will be able to find out how to treat his cushings,& find out if anything else is going on.

[Squirt's Mom]

Let us know what you learn at Peak. I hope you find out what his problem is for sure and directions on how to help him.

Hugs,
Leslie and the gang

[Skye]

so glad you took him in for another opinion.....i was reading your post and felt uncomfortable about what other doctor was doing.
holding you and your baby close and wishing you all the best. will be looking forward to hearing back on results. ((((((((((((hugs)))))))))))))

[janemin]

Visit to the Peak referral center.Paddington had his Ultra sound & Vet said there was nothing to indicate anything else going on with Paddington.She also did aIdexx Urine Culture MIC Susceptible.Will get results on Tuesday .Still cant figure out why he is losing weight but my Vet thinks maybe we should think about trying him on Lysodren..Anyway,we are going to wait until the results of the urine comes back.If it comes back positive.Vet indicated another ACTH test might be in order as it could have given false results last time.If this sounds a little confusing ,it matches my mind right now.Will let you know about the urine culture.

[Squirt's Mom]

If this sounds a little confusing ,it matches my mind right now.

Welcome to the wonderful world of Cushing's! :p Confusion is a natural condition here! :D

Sounds like Peak is trying to help find what is going on with sweet Paddy and I sure hope a definitive answer is on its way.

You are doing a great job of ruling out all you can!
Hugs,
Leslie and the gang

[janemin]

Just got the results of Paddingtons Urine Culture.All clear.The vet at Peak thinks the next step is an internist .She thinks we might want to try Paddington on Lysodryn.Just got a call from Paddingtons newest vet & she just talked to Peak..She will also be talking to someone from Cornell for some additional ouput.Hopefully we will have something positive soon.Will keep you posted..

[janemin]

Update on Paddington.If this is a little confusing its because I am confused myself.As you know Paddington is not doing well on trylostane. The medication is not working on him.The worry is him losing weight so much & the cortisoil level still being so highOur options are a possible ct scan.but the Vet wants to try him on lysodren & see if that will work.She has had good results with it.But she says according to the people she has talked with ,including a Mark Peterson who was at this conference in Fl she just attended ,seems to think that if the trylostane didnt work,there might be other issues involving the adrenenal gland.Anyway we will probably start Lysodren tomorrow.I really really hope this works.If it wasnt for the drinking & peeing i would wonder about treating him at all as he doesnt seem to be in any pain .

[Rebelsmom]

Has he been off the trilo? Typically there is at least a 30 day wash before switching to the other med.

[addy]

Hi,

Have you done the 30 day wash out period? I'm sorry, I didn't have time to recheck your thread. Usually a 30 day wash out period is done before switching from Trilostane to Lysodren.
I just wanted to make sure that was done.

Hang in there, you are doing a good job as advocate for Paddington.

Hugs,
addy

[Squirt's Mom]

Has Paddy been off the Trilo or has he been taking it as usual? Melissa is right - you need a wash-out period when you switch treatments tho it isn't quite as critical when going from Trilo to Lyso since the Trilo has such a short life in the body. However, to be safe, it is best to wait before starting the Lyso to absolutely sure there is no Trilo still working on the body. They work in different manners - Trilo works to interupt the signal to release cortisol while Lyso works to prevent the adrenals from "hearing" those signals.

I'm glad you had the ultrasound and that nothing else was found! :)

Hugs,
Leslie and the gang

[Harley PoMMom]

Lysodren should not be used in a dog that is not eating properly/poor appetite. Losing weight is uncommon in a dog with Cushing's disease.

Cortisol will be elevated when a dog has a non-adrenal illness, so if this were me, I would try finding out what other illness might be causing the cortisol to be high.

[janemin]

Lysodren should not be used in a dog that is not eating properly/poor appetite. Losing weight is uncommon in a dog with Cushing's disease.

Cortisol will be elevated when a dog has a non-adrenal illness, so if this were me, I would try finding out what other illness might be causing the cortisol to be high.

They have done thyroid,lime disease,diabetis,plus ultra sound.
Could you tell me what other diseases would produce high cortisol levels.I would really like to find out if it really is Cushings.But my Vet said everything points to cushings.What about doing the original test for cushings again.I cant remember what it was called.I dont mean the ACTH test.I think that was to determine the cortisol level.I do believe she was planning to start the Lyso tomorrow as she said there was no waiting period.But I am going to ask to wait a while.
It is good to here feedback as I wouldnt know what to ask.By the way this Vet did not do the original test to diagnose cushings.That was done by another.

[lulusmom]

Hi Jane,

The rule of thumb is never switch from Trilostane to Lysodren before 1) a 30 day washout period or 2) there is evidence of hyperadrenal activity. As I recall, Paddington's last acth stim test was a bit over 8. In my opinion, that's not high enough to constitute hyperadrenal activity and unless another acth stim test has been done showing otherwise, I would absolutely not start Paddington on Lysodren yet. You mentioned that Peak felt it was time to see an internal medicine specialist. I think that's a great idea. You may want to do just that before you make the switch to Lysodren.

Glynda

[janemin]

Well we took Paddington off Trylostane three days ago .My Vet suggested I might want to try Meletonin.I gave him 3mil at 10 00pm.& I only had to get up once during the night.instead of the usual three or four times.He seems pretty good & has been eating much better.Not sure what direction we are headed as far as treatment.I thinkour Vet iwants to try lysodren next.I have mixed feelings over this.I did so want the Trylostane to work.I guess I am a little afraid of the Lysodren.Will keep you posted .

[Cyn719]

Jane

I know how scarey it is to go from one medicine to another - Penny is off trilo and they said when she needs to go back on the meds its going to be Lyso - I and kinda nervous too -- I know alot of dogs do have good luck with it -

sending you love support and hugssss xo

[Squirt's Mom]

Hi Jane,

When Squirt was first diagnosed and I was learning about Cushing's and the treatments, I was also afraid of Lyso and not Trilo. As time has passed, that fear of Lysodren has completely gone away and it is the drug I am most comfortable using. What I learned over the time is that Trilo is NOT safer than Lyso; that both drugs are life-savers; that both drugs have the same potential for harsh side effects; that neither drug is guaranteed to work for all dogs. Some pups just respond better to one over the other but the only way to know is to try one and see how it does. ;)

The melatonin will help Paddy calm down and get him in more of a natural wake/sleep pattern if his has been off. It does have the potential to lower cortisol, but that is negligible in the face of the amount of cortisol rushing around in a cush pup's body...ie, not very effective. However, it can help him relax while he is off the Trilo and ya'll are deciding the next step.

I have a couple of questions that I really need answers to -

1) Were all of Paddy's ACTHs (since starting the Trilo) given within 4-6 hours of his last Trilo dose?

2) Were all of those ACTHs (since starting the Trilo) given at about the same time - example, all of them about 5 hours after the last dose?

3) What cush signs are you still seeing in Paddy?

4) Have there been any changes since starting the Trilo? - example, new medications (other than those for the UTI), herbs, supplements; new diet; signs that don't fit with Cushing's; odd/different behaviors

5) Is he still losing weight?

6) Does he have a strong appetite?

7) Would you please post exactly what they said on the ultrasound report? There should be notes about each organ seen.

8) What date did Paddy take his last Trilo dose?

Take a break from worrying about all of this while Paddy is off the Trilo for a bit. As said before, you have to wait at least 30 days from the last Trilostane dose to the first Lysodren dose so you have time to just enjoy your sweet boy and try to learn as much as you can.

I can only imagine how stressed you must be from the last few months but you need to know that you are doing all you can to help your boy. You are doing a good job for him, Mom. Some pups are just a bit more difficult to get on the right path toward controlling the Cushing's. I think the winner so far for pups who read the cush rule book then do everything they possibly can the exact opposite is Glynda's little Jojo. So don't feel too discouraged if Paddy needs to switch treatments - just don't let him talk to Jojo! :p

Hang in there sweetie!
Hugs,
Leslie and the gang

[janemin]

Thanks for your encouragement .To answer your questions No not all of his tests were done within the 4 to 6 hour period.I have since changed Vets & The test was done accurately.Paddingtons current symptoms are peeing & excessive thirst.He also went off his food after starting trylostane.He did have tremors & lost his beautifull tail .& his coat thinned out quite a lot.There was a bare patch on the front but it has grown back.I am giving him just about anything his little heart desires in way of food.My Vet said just stay away from pork & beef.although he does love a little hamburgher mixed with Pasta.Like she said ,He needs to put on some weight .So its chicken & pasta mixed with a little canned food or kibble.I dont know if he'll ever go back to his regular food after trying this menu.He is eating better since he has been off trylostane.His last dose was on 1/22/12.I do not have his ultra sound results but next time I am in Plattsburgh I will stop by & pick them up.I hate to call her as she just called me & discussed Paddingtons options.On Feb 8 she is going to do the dextro test herself & then go with the lyso.There is a possibility of getting him in for an MRI before he goes on the Lyso.

[Squirt's Mom]

Sounds like a good plan, Jane. Since Paddy's last Trilo dose was 1/22 you don't want to start the Lysodren before Feb. 23. ;) That gives the Trilo plenty of time to be out of his system before you start the Lyso.

[janemin]

I was just wondering if anyone has used Satin balls.Its a home made supplement to feed your dog to help them gain weight.Someone mentioned this to me & i wasn't sure if this would be OK for Paddington.I am using melatonin & I have ordered some flax signan ,I know thats not the correct word but hey its close.I swear my vocabulary has increased ten fold since Paddington became ill.Anyway, I would appreciate your input.

[janemin]

Update on Paddington.since being off the trylostane Paddington is doing well.Appetite is coming back.Melatonin & flax lignan really seem to be helping him.last night he slept all night.Seems to be more at ease.I am a happy Mom.Am anxious for his appointment on the 8th.

[Harley PoMMom]

So glad to hear that Paddington's appetite is improving. Is he displaying any symptoms while not on the Trilostane?

I was also wondering if the dosage of Trilostane you were giving was in a liquid or capsule form.

Please keep us posted, ok?

Love and hugs,
Lori

[Cyn719]

Have been reading up on Paddington. Glad he's eating better and so happy you are happy!:)

Hugs xo

[Squirt's Mom]

Hi Jane,

I missed your last couple of updates. :eek::o

Did you try the satin balls? I have a recipe if you are still interested in trying them. Are there any foods Paddy shouldn't have that you are aware of? I'll go find that recipe and post it here for you just in case. I'm glad he is eating better so the balls may not be needed. But you will have a recipe if you ever need it again. ;) I've been thinking about making some to give Squirt SAMe since she has gotten extremely pill-wise in her old age. :p

I am so glad he is doing better with just the melatonin and lignans. When did he have his last ACTH or UTK panel? I hope he continues to do improve.

Keep in touch!
Hugs,
Leslie and the gang

[janemin]

Lori,To answer your question ,The only thing I can tell as far as symptoms go are the excessive thirst & drinking.But it isnt quite so bad since he's been taking Flax & Melatonin.He was taking the trylostane capsule before.
CYN Thanks for the hugs.Paddington & I love to get & give them
Leslie,I would love to have the recipe for the Satin Balls.There are so many of them out there I dont know which one to use.As far as his eating.I never had any trouble with giving paddington any kind of food.I have changed his food numerous times & never has he had any problems with his tummy.His problem used to be ,he ate too much.I would give anything for that little 21lb tubby back again.I suggested my new vet give Paddington the Dextro test on Wednesday.My current Vet thinks it is a good idea.That way all of the tests will have been done by her.I did tell her i wanted to wait a month untill Paddington started Lysodren.Also we havnt ruled out the MRI.althhough that might be a last resort as we would have to travel to Montreal .as that is more reasonable than Vermont or Ny .I think Montral quoted 15 or 16 hundred dollers & Vermont wants $1795.
I dont suppose I could just keep giving him the flax & Melatonin & see if he could get by on that.I still cant figure out why the trylo stopped working.

[Harley PoMMom]

If Paddington weighs 17 lbs then a starting dose of Trilostane should of been initiated at around 20 mg.

I see that Paddington started out at 60 mg, which to me seems like a way too high of a starting dose and this could be the reason why he had some adverse reactions.

UC-Davis protocol is to initiate a starting dose of 1mg per kg of a dog's weight. Dr. Tim Allen, who was a technical services veterinarian for Dechra Veterinary, was verbally recommending 1 mg per pound of a dog's weight.

If symptoms of excessive thirst and urinating plus a ravenous appetite are being seen, although I am not a vet, I would suggest starting the Trilostane again but at a lower dose such as 20 mg once a day.

You are doing a great job!! Please keep us posted.

Love and hugs,
Lori

[Cyn719]

Just checking in. I agree with Lori 60 mg is a lot..... My Penny was 85 lbs when she started trilo and they started her at 60 mg......my new vet said what Lori said.....always start at a low dose.... You can always add to it if needed....but yes the test will tell you if you do need to restart for sure

Sending more love, hugs and kisses. Xoxoxoxoxoxo

[Squirt's Mom]

Hi Jane,

I haven't forgotten you...my computer has crashed a couple of times and I have lost some files - apparently this recipe among them. :rolleyes: I have been reading others online today and am asking my nutrition group if they have a healthy one to share. I'll let you know when I have something for you!

Hugs,
Leslie and the gang

[Squirt's Mom]

Hi Jane,

Ok - Satin Ball recipes. I want to preface these with some thoughts.

First, these are very high in fat content. Satin balls are designed to help pups either gain weight or gain quick extra energy (they are often used in dogs shows or with working dogs like sled dogs who require extra energy). Since the fat content is so high, this is a concern for our cush pups since they are prone to pancreatitis. So use them sparingly...or we can work to cut some of the fat out. ;)

Second, only one of these is cooked. I am not a fan of raw feeding even for healthy dogs and am downright against it for pups with health issues...except as the last resort. ;) So the first version is the only one I have personally used...and Ruby loved them!


TO ADD WEIGHT

20 pounds ground 70/30 beef or lamb
2 pounds beef or chicken livers pureed in the blender (gross I know)
12 eggs pureed in the blender
1-pound bag of cranberries pureed in the blender with the eggs
2 containers high fat ricotta cheese
2 cans jack mackerel or Salmon - drained
2 big cans spinach drained
1 box total cereal
1 jar wheat germ
1 big round box oatmeal
1 can of pumpkin
2 cups unsweetened applesauce
Bake at 350 like a meatloaf.


The raw versions -


CLASSIC VERSION

1 lb ground beef
1 8 oz pkg cream cheese
1 small jar all natural peanut butter
1 jar (smaller of the sizes) wheat germ
1 doz egg yolks
1 cup or so of flaked cooked oats soaked in heavy cream

Mix up, form balls, freeze, feed as treats or food supplement



OUR NUTRITIONAL CONSULTANT'S VERSION:

1 lb ground lamb, turkey or venison (or combination)

1 8 oz package of ricotta cheese

2 ounces almond butter

2 ounces coconut oil

4 ounces ground flaxseed

1 dozen egg yolks

2 cups rice cereal cooked


Other things she can try include green tripe, sardines(canned in water and
drianed) scrambled eggs, novelty meats like ostrich and rabbit, and certian
types of babyfood. Baked treats can be good too, if the meat content is high
enough to get them interested. If there is nausea, let me know, I can suggest some herbs as well.

I hope these will help if needed again.

Hugs,
Leslie and the gang

[janemin]

Thanks for the recipe Leslie.I will keep it on hand in case i need it.Paddington went to the Vet on the 8th,& lo & behold he had gained 1lb 3ozs.Granted it wasn't what i would normally feed him but Desperate times called for anything I could get into him.He has gone completely off chicken.& seems to have become a junk food doggy.His favorite at the moment is Little Cesar,I have tried literally everything ,Home cooked dog food used to be his favorite,but he will not touch it.Anyway he had his dexto test again & the Vet said it was definitely cushings,She gave me the numbers over the phone but i was in the car & didn't have a pen .I will get them soon.But she is really anxious to start him on Lyso.This Sunday 12th.I told her i would like to wait the month ,but she thinks going from the trylo to the lyso will be fine.He also had a chest xray & liver.I saw the xrays & his liver is quite enlarged.She noticed quite a change in him from the last time he was in .........she said he was quite feisty & they actually had to muzzle him .She said he got tired of them poking & prodding him.Usually he is an angel ,but cant say as I blame him.He's been through so many tests poor baby.If this doesn't work the vet thinks there is a tumor which is fast growing,then we will have to think about MRI & radiation.We will just have to wait & see.

[Squirt's Mom]

Hi Jane,

It really doesn't matter how "anxious" your vet is to start the Lyso, the recommendations from the experts, world renowned endocrine specialists, are to wait a minimum of 30 days between the two drugs. It isn't her dog, it is your dog and you do what you are most comfortable with. If she pushes you into starting the Lyso before the wash out has passed and Paddy goes into crisis, it will be you who is panicked, out more money, up all nite, and Paddy's body that will suffer the results of her rush. Just my four grumpy cents worth. ;)

Hugs,
Leslie and the gang

[Harley PoMMom]

Regarding the 30 day washout period; This excerpt comes from Dr. Feldman, a renown Cushing's expert:
DVM: So has trilostane become your first choice in the treatment of hyperadrenocorticism, or do you continue to use mitotane (o,p'-DDD)? Is there a particular protocol you use if you switch between the two medications to avoid possible complications, in light of a couple of reported cases of acute adrenocortical necrosis following a switch?

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. Any dog switched from one to the other should receive no medication for at least six weeks.

You can find this info here: Cushing's disease and other adrenal gland disorders (http://veterinarynews.dvm360.com/dvm/Internal+medicine/Cushings-disease-and-other-adrenal-gland-disorders/ArticleStandard/Article/detail/672663?contextCategoryId=40534)

Please feel free to print this out and give a copy to your vet.

Love and hugs,
Lori

[janemin]

Just fowarded a copy by Dr Feldman to my Vet.
I have been thinking about this all night & am going to wait .Paddingtons last dose of Trylo was Sun Jan 22,so Feb 20th will be 30 days.Thanks again for your four grumpy cents worth Leslie.I'll take your advice any day.& thank you Lori for the info.

[janemin]

Paddington started his Lysodren on Sunday.So far so good.No major problems except the first day he seemed to have a lot of gas.He is eating really well & we are watching closely for the first sign of turning away from eating.& water consumtion going down.So far not a big change although he is sleeping till 5.00am in the morning,which is great for him.We take him out to go to the bathroom about 11 00pm.so I consider that sleeping through the night.I am starting to calm down a little & not follow him around all the time.He also seems to be acting more alert.I am praying that the Lyso will work.My Vet has been great & I am in touch with her daily,so that makes me feel better.will keep you posted on his progress.

[janemin]

Friday ,We took Paddington for a ACTH test to see how he is progressing.His cortisol is still very high & he is to continue to take the loading dose.It will be his 7th day today.
His ACTH numbers were cort baseline 9.3ug/dl 11 24am
cort 20.4ug/dl 12.14pm

There wasnt hardly any change in him except he did turn away from his food at breakfast friday.Plus we were in for a huge snow storm & my Vet was worried I would be stranded without a way to get Paddington in for a Acth test if i needed to..I live about 45 miles from Plattsburgh so I am glad i took him in on Friday.We really got dumped on .I will be in touch with her on Tuesday to see how things are progressing.I was really hoping to see somewhat of an improvement.He is sleeping better at night.Thats a good thing .But hopefully things will get better.

[frijole]

Hi. I am curious what dose of lysodren you are on. It could be that it is not high enough and that is why you saw no change in a week. Also please give us Paddington's weight so we can calculate the dosage based on weight. Hang in there. My dog did great on lysodren. Kim

[janemin]

Hi. I am curious what dose of lysodren you are on. It could be that it is not high enough and that is why you saw no change in a week. Also please give us Paddington's weight so we can calculate the dosage based on weight. Hang in there. My dog did great on lysodren. Kim

Paddington is on 250 mi a day .Its a 500 mi tablet cut in four.Paddington has one in the a.m with breakfast & one in p.m with dinner.He presently weighs about 16 lbs.

[frijole]

That dosage is within the desired range but could be increased to 3/4 of a pill a day (you'd just give 1/4 once a day and 1/2 a pill once a day)

Some dogs just require more - my Haley did. If the cortisol has not decreased after the next acth test you most certainly will want to try increasing it.

I see you tried trilostane and it did not work. Could you please refresh my memory and tell us every single test that was done to diagnose cushings? If so, providing the actual results (numbers) would also be helpful.

Hang in there - Kim

[janemin]

That dosage is within the desired range but could be increased to 3/4 of a pill a day (you'd just give 1/4 once a day and 1/2 a pill once a day)

Some dogs just require more - my Haley did. If the cortisol has not decreased after the next acth test you most certainly will want to try increasing it.

I see you tried trilostane and it did not work. Could you please refresh my memory and tell us every single test that was done to diagnose cushings? If so, providing the actual results (numbers) would also be helpful.

Hang in there - Kim

Kim.I will be glad to put paddingtons tests up,but they are at my daughters.She is an RN & she wanted to look at them .I can tell you that he has had all of the tests for cushings,plus a complete blood panel ,an ultra sound.Thyroid,The only thing he hasnt had. is MRI.& I really dont see us going down that road.I did want to mention one thing.On friday when I took paddington for his ACTH. I had already given him his morning meal with his lysodren,I didnt think of it at the time,but I didnt mention this to my vet.Was wondering if this would have given false reading.I have emailed my vet to tell her.

[janemin]

Had to share the news.Paddington went down for yet another Acth test today.He was lethargic & at breakfast turned his nose up at chicken,steak & hamburgher ,ate just a little chicken, I gave him his pill anyway.Down we go another 45 miles to the vet,but Hooray his bloodwork was good.Cortizol had come down a lot.My vet emailed me this afternoon & he starts on his maintenance twice a week.I feel so relieved,I did not have a good feeling when I took him down,I didnt figure his numbers would come down that quick from friday to monday.Anyway I hope thinks are on an even keel for a while.

[Harley PoMMom]

When using either Lysodren or Trilostane, if a dog is ill or not acting like him/herself stopping the medication is vital. When using Lysodren, the usual protocol is to give the dosage and 36-48 hours later to have an ACTH stimulation test done. Lysodren has a cumulative effect and having an ACTH stim test done earlier than 36-48 hours will not show the full results for cortisol and can lead to the cortisol being too low.

[janemin]

When using either Lysodren or Trilostane, if a dog is ill or not acting like him/herself stopping the medication is vital. When using Lysodren, the usual protocol is to give the dosage and 36-48 hours later to have an ACTH stimulation test done. Lysodren has a cumulative effect and having an ACTH stim test done earlier than 36-48 hours will not show the full results for cortisol and can lead to the cortisol being too low.

Isnt the lethargy & refusing food an indication that the loading phase has been accomplished.This was what I was told to watch for very closely.This was Paddingtons 8th day of loading.

[labblab]

I think the concern here is that Paddington was already showing signs of being loaded this morning, prior to your going ahead and giving him yet another dose. Since the ACTH test was performed within just a few hours later, there is a great likelihood that his cortisol will still fall even lower during the next 48 hours, perhaps even lower than is comfortable for him. So depending upon how high or low his test results were today, your vet may want to take today's "extra" dose into consideration when deciding how soon you should start in with the maintenance dosing. And if Paddington looks or acts unwell within the next couple of days, he may need some does of prednisone to help perk him up until his cortisol starts to rebound again. You will want to continue to watch him closely.

Marianne

[janemin]

I think the concern here is that Paddington was already showing signs of being loaded this morning, prior to your going ahead and giving him yet another dose. Since the ACTH test was performed within just a few hours later, there is a great likelihood that his cortisol will still fall even lower during the next 48 hours, perhaps even lower than is comfortable for him. So depending upon how high or low his test results were today, your vet may want to take today's "extra" dose into consideration when deciding how soon you should start in with the maintenance dosing. And if Paddington looks or acts unwell within the next couple of days, he may need some does of prednisone to help perk him up until his cortisol starts to rebound again. You will want to continue to watch him closely.

Marianne

Oh I am sorry,I understand, I am not giving him any more Trylo untill I talk to my Vet tomorrow.I will continue to watch him very closely.I do have Prednisone on hand .I think what confused me was when i took him down Friday for his acth test his cortisol was very high ,I was not prepared for it coming down that quick.He did eat his dinner tonight so maybe he will be ok.
Aye what a lot to know.I'm seventy four & I still have so much to learn.

[Harley PoMMom]

Oh I am sorry,I understand, I am not giving him any more Trylo untill I talk to my Vet tomorrow.

I'm a bit confused, which doesn't take much :eek: as to what Cushing medicine you are giving Paddington.

Lysodren, unless compounded, comes in 500mg white tablets. Trilostane/Vetoryl are capsules.

With Lysodren there is an induction or loading phase and when the dog is loaded is followed by a maintenance plan.

Trilostane/Vetoryl has no loading/induction phase, it is given every day.





I'm seventy four & I still have so much to learn.

We all keep learning!!! at any age! Your doing a great job at advocating for Paddington!

[janemin]

I'm a bit confused, which doesn't take much :eek: as to what Cushing medicine you are giving Paddington.

Lysodren, unless compounded, comes in 500mg white tablets. Trilostane/Vetoryl are capsules.

With Lysodren there is an induction or loading phase and when the dog is loaded is followed by a maintenance plan.

Trilostane/Vetoryl has no loading/induction phase, it is given every day.






We all keep learning!!! at any age! Your doing a great job at advocating for Paddington!

Here I go,confusing my friends as well,I meant to say I was not going to give him anymore lysodren,untill further notice from my Vet.

[janemin]

I don't know where to put this .I already have a thread on Paddington.But this is to tell you that we put Paddington to sleep today.He has been in the hospital & was home for a few days,but his condition deteriorated rapidly.I find it so hard to talk about him right now,but I did want to thank your forum for a wealth of good advice you gave me.I wished i found you a year ago.My heart is heavy,but now I know he is no longer in pain.

[Jenny & Judi in MN]

I am so so sorry for your loss. I know Paddington was only 6 years old. hugs to you and for your boy who is no longer hurting. Judi

[Squirt's Mom]

Dear Jane,

I am so sorry to hear about sweet Paddington. There is no doubt in my mind that you did all you could to make his life the best possible for as long a possible. When that was no longer viable, you gave him the greatest gift of all.

Today, he is running free with the wind in his hair, romping with all our babies who have gone before. He knows that one day he will be in your arms again never to be parted. Until then, he will watch over you just as you did him for so long - with all the love and gratitude in his heart.

Our deepest sympathies,
Leslie, Squirt, Trinket, Brick and our Angels, Ruby and Crystal

[Squirt's Mom]

Paddington has been added to our 2012 In Loving Memory album. He will always be remembered and honored by his family here at k9cushings.

http://www.k9cushings.com/forum/showthread.php?t=3918

[Leena]

I am so very sorry for your loss...I know how heavy your heart is...You gave Paddington the ultimate gift of love, and someday you will be together again..

[Harley PoMMom]

Dear Jane,

I am so sorry to hear about the loss of your beloved Paddington. We do understand the loss and pain you feel, so please remember we are here for you.

Godspeed sweet Paddington.

With Heartfelt Sympathy,
Lori

[jmac]

Jane-
I am so very sorry to hear of your loss of your little Paddington. My heart aches for you. It is such a difficult thing to do. I dread that day with my Hannah. But you did what you had to do for him, and relieved him of pain and the struggle he was having. Please know that we are here to support you during this difficult time.

Julie & Hannah

[Cyn719]

Jane

I am so so sorry for the loss of Paddington...my heart breaks for you...but you we're a wonderful mom and you did everything you could....no words right now can make things better but try to focus on all the beautiful memories you have.

Love, hugs, strength, support and prayers xoxo

Xoxoxoxoxo to you Sweet Angel Paddington

[k9diabetes]

Oh no... I'm so sorry to learn of Paddington's passing.

From what you wrote, I believe the vets' intuitions that there was something else going on with him were likely true. And I know from our experiences with our dog that sometimes you can exhaust every diagnostic tool available and still not be able to find it. Paddington's refusal to eat is one of those frustrating things that tells you something is wrong but gives no indication of what.

I am very sorry for your loss. He was obviously a cherished member of your family. He was deeply loved, which I know was everything to him.

Natalie

[Sabre's Mum]

Jane

I am so sorry for your loss of dear Paddington. My thoughts are with you.

Hugs
Angela and Flynn

[janemin]

Thank you so much for your kind words & oh such wonderful encouragement & advice you gave to me & Paddington.
Penny, my other little shi tzu is wandering around the house today a little lost,probably wondering whats happened to her PaddingtonBear. Paddy was the quieter of the two.Penny is the michiefull one.But today Penny seems to be a little quieter.Paddington is coming home today.He was cremated yesterday & I am going to pick him up later.But right now,Penny & I are going for a long walk in this beautifull sunny afternoon.

[Altira]

It's amazing what a walk does at a time like this. You feel so in tune with the world and so lost all at the same time. It all seems to spin. Fear not, you are not alone, we have all been there and our spirits walk right beside you. 8::::

[bgdavis]

I'm so sorry to read of your loss of Paddington. He was adorable and the name matched. He will always be there, taking a walk with Penny and you.

Bonnie and Angel Criss

[mypuppy]

I'm so saddened for your deep loss. May God bless your little Paddington and you always

Lots of tight hugs.

Jeanette

[jrepac]

So sorry to hear of your loss...

Jeff & the Girls

[Sugar]

I am so sorry you lost your dear little Paddington Bear. Cushings is such a dreadful disease. My heart saddens so to learn of more precious babies that are being lost to it. Please find comfort knowing that we are all in the same place and share your loss as if it were our own.