Kirby, Boston Terrier with PDH on Trilostane (Kirby has passed)

[kapohotricia]

Aloha,
My almost 11yr old BT was diagnosed with PDH on 4/14/11. My vet did an LDDS test for Cushings when blood tests showed elevated liver enzymes and I described excessive drinking/urinating and chronic lethargy. He weighed 21lbs and is almost 11years old. He is 20.8lbs today.
We are in a very rural area on an outer Hawaiian island but we are blessed with a very good general vet 20 miles away who has cared for my goats, dogs, cats, etc for 30+ years. She has treated Cushings only once, with Lysodren, without good results but agreed to try to treat Kirby with Trilostane now it is available. She started him on 5/4/11 with 60mg but he trembled so badly all day I could see it was too high a dose. So I persuaded her to try the UC Davis protocol and she restarted him on 5/6/11 with 10mg.
The drinking/peeing problem disappeared and I was encouraged. The first stim test a month ago wasn't bad for Trilostane (pre-draw 3.7, post draw 7.8) so we continued the low dose. But a week ago a patch of hair came out of his back and a red patch appeared below his nose. Today the red on his face is almost better and the bald spot on his back was no longer red and scab has gone (used Vit E oil).
However, today we went in for our second ACTH stim test and checkup. His liver enzymes continue to go up (I think she said 158?) and, when we got home a bigger patch of hair, red and sore underneath came off next to the original one so he now has a bald spot about 1" x 1 1/2".
In my inexperience (and that of my vet) how do we know, apart from the results of the stim test, if this dose is going to work in the long run? Is it to be expected that symptoms will continue to appear and get worse after treatment is started for a while and then things will get better or is it likely that these symptoms indicate that the dose is too low?
Also, the vet wants another ACTH stim test in another month. These vet visits entail long, hot drives there and back, stressful blood draws and 2 hours between draws waiting in the truck while I run errands. It's so stressful for him and he has come home exhausted. I would rather wait 3 months before I put him through the next stim test if I could feel that we are on the right track at 10mg and I just have to be patient for Cushings symptoms to clear and observe him carefully for any adverse reactions to the Trilostane. Perhaps the stress of the day caused his hair to fall out?
While I wait for the results of the second stim test, any advice would be appreciated. Is there anything other than Vit E that can help stop and treat hair loss? Is there anything more than the milk thistle I am giving him to help his liver?
Thank you,

Tricia

[Harley PoMMom]

Hi Tricia,

Welcome to you and Kirby!


Aloha,

She started him on 5/4/11 with 60mg but he trembled so badly all day I could see it was too high a dose. So I persuaded her to try the UC Davis protocol and she restarted him on 5/6/11 with 10mg.

Good for you that you have been educating yourself about Cushing's and the treatment plans. The 60mg, to me, is a little high for a starting dose.

Many members have contacted Dr Tim Allen, a vet tech from Dechra's Kansas office. He verbally recommends a starting dose of Vetoryl at 1mg per pound.



The drinking/peeing problem disappeared and I was encouraged. The first stim test a month ago wasn't bad for Trilostane (pre-draw 3.7, post draw 7.8) so we continued the low dose. But a week ago a patch of hair came out of his back and a red patch appeared below his nose. Today the red on his face is almost better and the bald spot on his back was no longer red and scab has gone (used Vit E oil).
However, today we went in for our second ACTH stim test and checkup. His liver enzymes continue to go up (I think she said 158?) and, when we got home a bigger patch of hair, red and sore underneath came off next to the original one so he now has a bald spot about 1" x 1 1/2".

This could be calcinosis cutis or a thyroid problem. Has thyroid issues been ruled out?



In my inexperience (and that of my vet) how do we know, apart from the results of the stim test, if this dose is going to work in the long run? Is it to be expected that symptoms will continue to appear and get worse after treatment is started for a while and then things will get better or is it likely that these symptoms indicate that the dose is too low?

If Kirby's symptoms of drinking/urinating excessively have abated then I believe the dosage is adequate at this time. If the skin problem is calcinosis cutis, this condition takes a while to get better.



Also, the vet wants another ACTH stim test in another month. These vet visits entail long, hot drives there and back, stressful blood draws and 2 hours between draws waiting in the truck while I run errands. It's so stressful for him and he has come home exhausted. I would rather wait 3 months before I put him through the next stim test if I could feel that we are on the right track at 10mg and I just have to be patient for Cushings symptoms to clear and observe him carefully for any adverse reactions to the Trilostane. Perhaps the stress of the day caused his hair to fall out?

Any dose of Trilostane can cause Hypoadrenocorticism, so I believe a stim test in a month is important. According to Dechra's Product Insert the electrolytes should be checked also.



While I wait for the results of the second stim test, any advice would be appreciated. Is there anything other than Vit E that can help stop and treat hair loss? Is there anything more than the milk thistle I am giving him to help his liver?
Thank you,

Tricia

Many dogs with Cushing's have a very elevated ALP and will take some time to improve. The ALT is more specific to the liver, so could you tell us if this liver enzyme is high.

Many members do give their furbabies a liver supplement such as milk thistle or denamarin.

I was wondering if you could post Kirby's LDDS test results. Also could you post the results of the CBC/Chemistry blood panel that was done, we only need what is marked abnormal with the reference ranges and units of measurements. Is/was Kirby taking any other herbs/supplements/medicines?

You see, the more information we have about Kirby the better our feedback can be, ok? Please know we will help you and Kirby in any way we can so don't hesitate to ask us any questions. ;):)

Here are some links which I hope will be useful:Trilostane/Vetoryl Information and Resources. (http://www.k9cushings.com/forum/showthread.php?t=185
) and Links to Cushings Websites (especially helpful for new members!). ( http://www.k9cushings.com/forum/showthread.php?t=180)

Love and hugs,
Lori

[kapohotricia]

Hi Lori,

Thank you so much for your helpful reply. I will have to read to find out what calcinosis cutis is. I think the vet checked the thyroid initially but I will fax her both to clarify this, ask if she checked electrolytes and ask for those test results and numbers you asked me to post. Regarding the liver, yes the ALT was high. I will have to check that number tomorrow. I didn't hear her clearly.
In the meantime, I can tell you about supplements: when the vet told me his liver enzymes were high I looked locally for milk thistle. I found 1000mg capsules. That seemed more than a little dog needs so I pierce the capsule and squeeze a little into his breakfast. One capsule lasts about 5 days but I don't measure exactly. He also gets 1000mg of fish oil daily. He's been getting that for 5 years along with a home made mix of good stuff with some added anti-oxidants mixed into his NaturalLife kibble. I improved his diet then because he had stage 2 mast cell cancer and a very large tumor removed from his chest.
Thanks so much for the information and support. I'll post again when I get the stim test results and include the other test numbers.

Aloha,
Tricia

[littleone1]

Hi Tricia,

Corky and I are so glad to see you and Kirby here. Our members have a great deal of experience in dealing with cushings, and are so supportive and caring.

I hope everything goes well for Kirby with his treatment. Corky is sending Boston lickies to Kirby.

[kapohotricia]

Thanks, Terri,

More hair is peeling off his skin tonight, poor lamb. I'm wondering if the ATCH stim injection could have caused a reaction. It looks so sore and a little bloody. I don't know if I should put anything on it or if that will just make it worse. The patch is 2" x 2" now. I think we'll be back at the vet tomorrow and I hope she can do something for him. I read about the calcinosis cutis but it doesn't look anything like the photos of that. Just hair peeling off and bare, red skin with a few bloody spots.

Aloha and Boston lickies to Corky,

Tricia

[lulusmom]

Hi Tricia and welcome.

I only have a minute but wanted to comment on Kirby's skin problems. Did your vet do a skin scraping to check for mites or a punch biopsy? The hair and skin peeling off sounds like it could be demodectic mange, which is easily treated. Adult dogs don't get demodectic mange unless there is an underlying condition, like cushing's, that is compromising the immune system, so mites are a likely suspect. Don't panic about demodex mites getting on you or being contagious. This type of mange is not contagious and we all have demodex mites but our immune system keeps the population in check. When our immune system is compromised, the little buggers multiply by the millions and things get out of control. The condition isn't usually itchy at first but left untreated it will get uncomfortable for the dog and secondary yeast infections are not uncommon.

Glynda

[kapohotricia]

Thanks everyone,

Now I have a good list of possibilities to ask the vet about. I will try to get an appointment after work this week so she can check him out.

Aloha,
Tricia

[littleone1]

Hi Tricia,

I just want to see how Kirby's doing. Were you able to get an appointment with your vet?

[kapohotricia]

Hi Terri and Corky,

Thank you so much for the support. I have to wait until end of today to see the vet. She is always fully booked except for emergencies. This is good because it is cooler to drive then and I don't have AC in my old truck. I looked at images on the 'net of the various suggestions posted and have been reading about skin problems other Cushings dogs have been having and Kirby's sounds like the staph symptoms. Staph infections are common in humans here in hot, humid Hawaii so I won't be surprised if that's what he has. That was so sudden and scary to see that patch just come right away, but no more has come out since Tuesday evening. He has been kept cool and relaxed and has had lots of soothing cuddles and a few Greenies :) I haven't put anything on the spot for fear of even Vit E aggravating it. The vet might even have the ACTH stim test results by the time I go in after work so I might be able to post all those results too when I get back with a diagnosis of the skin problem.
Boston lickies to Corky from Kirby! Aloha,
Tricia

[kapohotricia]

We're just home from the vet's and hubby is waiting for dinner so I'll make this brief. I have all the test results and will post them tomorrow. This is just to let you know that Kirby is now on antibiotics for a probable staph infection. She wasn't unduly concerned with his skin right now but rather with the other clinical signs and with the ACTH Stim results she got back today. Briefly, his cortisol levels are down already on just 10mg for 6 weeks (he weighs 20.5 lbs right now). He is to take a 3 day break and then resume at 5mg until the next stim test in a month. I brought home copies of his tests and, when I post them, and current clinical signs, I would very much appreciate any feedback.

Thanks so much. Hugs to everyone's furkids!

Aloha,
Tricia

[littleone1]

Hi Tricia,

Hopefully the antibiotic will help Kirby. Posting his test results would be helpful. After Corky was on Trilo for 10 days, his cortisol level dropped to 2.1.

Corky is sending Boston lickies back to Kirby.

[kapohotricia]

Aloha!

The vet thinks that Kirby's bare patch is the result of rough-housing from Winston. She said his skin is very delicate because of the Cushings and she pointed out possible tooth scrapes. So, strong, boisterous, young Winston is not allowed to "play" with Kirby for the time being, at all! Kirby is on 250mg of Cephalexin for 7 days and continuation of Vit E oil on the patch.
Now, for stim test results from Idexx labs:

The first test (after 2 weeks on 10mg Trilostane):
pre-injection -3.7 ug/dl
2 hours post -7.8 ug/dl

Second test (after 6 weeks on 10mg Trilostane):
pre-injection - 1.4 ug/dl
2 hours post - 6.7 ug/dl

Lori asked for LDDS results. This was done on 4/13/11 and the vet confirmed the PDH from this results:
pre-dexamethasone -5.1 ug/dl
4 hour post dex - 3.1
8 hour post dex - 1.9

As a result of this week's test, the vet says she is so glad that we stopped the 60mg dose recommended in the Dechra lit for Kirby's weight after the first day's reaction. I was warned that Boston Terriers are extra-sensitive to the meds and Kirby's response shows that to be true in his case.
Kirby is getting three days off Trilostane and I am to call the vet on Monday. All being well, she is planning on resuming Trilostane treatment at 5mg and then giving him another stim test on July 6th. Kirby has lost a little weight since this started -now 20.5 lbs -but he still has a great appetite and normal stools.

For the past week I have noticed Kirby trembling a little when I take him outside before bed. I thought it was the Cushings because he's had trembling legs for months but now I wonder if it was low cortisol because he does not seem to be trembling at all today. I really need to do a better job of recognising adverse effects of the meds -I am so very new to this.

Any thoughts on the proposed new course of meds?

Thanks so much,

Tricia

[littleone1]

Hi Tricia,

You never can tell what causes things with our furbabies.

I'm not quite sure why your vet is going to have Kirby off the Trilo, and then drop it to 5mg. A post of 6.7 is not quite in the reference range for a stim test. Usually the lab posts the range as 8-17, but that is for a healthy dog not being treated for cushings. The normal range when being treated with Trilo is about 1.5-5.5. However, there are some dogs that do better when the cortisol level is slightly higher than that.

At one time, Dechra was recommending 1-3mg per pound, but they are now sugggesting starting with a lower dose. Corky's IMS started him at 20mg, which was about 1mg per pound.

I hope everything goes well.

Boston lickies to Kirby from Corky.

[kapohotricia]

Hi Terri,

I don't quite understand what you explained about what "normal" should be with Cushings dogs. The vet explained the change of plan because she felt the pre-injection of 1.4 was low and she didn't want him to come down too fast. Does that make sense? He still is trembling just a little when I pick him up to take him out at night to pee. I don't know what that means -too low or too high. Other than that, he seems okay.

Aloha,
Tricia

[kapohotricia]

Terri and Lori,

I have to call the vet tonight before we restart Kirby at 5mg. Both of you had expressed concern that she responded to the ACTH stim results by taking him off all Trilostane for 3 days then re-starting at 5mg. I don't understand why that might cause concern. Can you please help me understand if that is not a good idea?

Thanks so much.
Aloha,
tricia

[littleone1]

Hi Tricia,

I'm sorry I didn't respond sooner, but I've had a nasty pipe leak,and my mind has been on other things.

The reason I was concerned about this is that the post stim is usually the best indication of the cortisol level. Corky's pre stim has been below 1 on several occasions. I know I was concerned about it at first, but it was the post stim that was used to determine if Corky's dosage had to be increased. The post stim results were definitely the right ones for Corky.

[kapohotricia]

Thank you so much for explaining that, Terri. I was wondering if the low pre-stim might be the cause of Kirby's trembling but now I understand that is not the case.
Sorry to hear about the pipe leak: I hope it's behind you now.

Hugs to you and Boston lickies to Corky from Kirby,

Tricia

[Harley PoMMom]

Although the ACTH stim test is a very good tool for monitoring dogs while on the Cushing medicines, I believe another indicator of how a dog is responding to the Cush-meds is their reaction to the meds. So, how are Kirby's symptoms of excessive drinking/urinating, have they subsided?

I truly believe that one can not go by the numbers alone, how a dog feels and if the clinical signs have abated are very important also in monitoring a dog while being treated with Trilostane or Lysodren.

[kapohotricia]

You know, Kirby's drinking/peeing problem stopped after only a few days on the Trilostane. He is still begging for more food but both of my dogs are greedy boys and the healthy one, Winston, is right there with him asking for food whenever it's around. It must be a Boston Terrier thing.
Energy-wise, Kirby has been a couch potato for years and is nearly 11 so I don't expect him to run marathons. But he has been extra lethargic for 6 months or more, not wanting to go for walks or play with Winston any more, and that hasn't changed yet. He has been off Trilostane since Friday and actually seems more energetic today than when he was on it. His legs are still shaky.

Aloha,
Tricia

[kapohotricia]

I have a question for those of you who, like me, make food for their dogs. I started 4 years ago with a formula for dogs with cancer because Kirby had stage 2 mast cell cancer. I haven't changed the diet much at all since then and he has done well. I just added fresh grated coconut because I was advised that the medium chain fatty acids are very good for our furkids and because it is plentiful in my yard, i.e. free :).
Now I read that Cushings dogs need high quality protein and less fat. I have switched to superlean meats and now am looking at using comfrey instead of the mixed greens (mostly parsley, arugula and chard) I pick from my garden for the green part of the recipe. Comfrey is high in protein and I fed it to my milking goats for 12 years but I don't know if it is safe for dogs. Can anyone tell me?

Thanks,

Tricia and Kirby, Boston Terrier, 20 lbs, now on 5mg of Trilostane.

Moderator's Note: Tricia, I have moved your latest post concerning Kirby's diet into Kirby's original thread. We, normally, like to keep all posts on a pup in a single thread as it makes it easier for other members to refer back to the pup's history when needed.

[frijole]

I googled it and it appears that it can cause liver toxicity... I'd stay away from it to be safe. Here's one link but there were more. Kim

http://webcache.googleusercontent.com/search?q=cache:63oo0GLuQIIJ:www.ehow.com/facts_5519463_herbs-toxic-dogs.html+comfrey+safe+for+dogs&cd=2&hl=en&ct=clnk&gl=us&client=firefox-a&source=www.google.com

[kapohotricia]

Thanks so much, Kim, for such a fast reply. His liver levels are still rising despite the Trilostane so I don't want to make things worse. You've got me thinking now: I'm going to google all the ingredients I'm currently using to make sure none of them are hard on the liver.

Aloha,
Tricia and Kirby.

[Squirt's Mom]

http://www.lowchensaustralia.com/health/herbs.htm


COMFREY (Symphytum officinale)
Broken and fractured bones, sprains and damaged tendons; it will stimulate respiratory organs and eliminates expectoration; helpful in arthritis, stomach problems, ulcerated tonsils, abscesses, and wounds; makes an excellent mouthwash for bleeding gums; good for anaemia and diarrhoea. With extended use, it may irritate the liver. Also known as knit bone, comfrey has a good reputation as a wound healer. It is soothing, healing and anti-inflammatory.
Uses: Comfrey is used to treat fractures, wounds, sprains, psoriasis and eczema. Internally it has been used to treat gastrointestinal problems It has been a woman's all-healer for thousands of years. Because it works, the FDA has banned its sale. You will need to grow your own.
Comfrey is a wonderful herb, used internally and externally speeds the healing of bruises, tissue and ligament tears, and broken bones non-unions. ..... One of our dogs eats straight off the plant whenever he needs this herb for soothing digestive discomfort.

Comfrey also rids the Bacteria of Streptococcus and Staphylococcus bacteria, heals urinary tract infections with blood in the urine, heals the lungs and respiratory problems, and heals skin wounds, bites and itching (externally). It is a nutrient, detoxifier, blood cleanser, infection/inflammation fighter.
*Can chop fresh leaves and roots as a poultice, for sprains, splints, shin soreness, bone fractures with horses.
Comfrey is also rich in Vitamin B12 so feed a small handful of shopped leaves to a horse that needs a pick-me-up.
Cautions: Comfrey contains compounds which have caused liver damage only IF given in larges doses for a long period in animals. Otherwise is safe and very effective for healing animals and humans. We often use the Comfrey in Homeopathic formulations for small animals (Symphytum Off 30C) for easer application as tasteless drops on head or orally.

[littleone1]

Hi Tricia,

I saw that you were on line, and I wanted to see how Kirby is doing. I hope everything is going well.

Corky's sending lickies to Kirby.

[kapohotricia]

Hi Terri,

Thanks for caring, bless you, with all you have going on. Kirby is doing okay, thanks. His dose has gone from starting at 10mg to 6mg after the first month to 7mg after the second month and now, with this third month's ACTH results, which we got yesterday, he is to increase to 9mg.
The only symptom which seems to really improve with the Trilostane is that he isn't excessively thirsty or peeing in the house when he has a high enough dose. On 7mg that symptom returned so I could tell it wasn't enough even before we got the test results.
The vet, new to this, is giving him an ACTH test once a month. Yesterday, the results from being on 7mg were Pre-stim 2.2 and post-stim 7.3 and he was having "accidents" in the house almost daily.
I hope the 9mg works and we can go a few months without another test. But he is really not having fun. He sleeps most of the time, still doesn't have the energy to walk, seems in a bit of a fog much of the time and slowly circles about in the yard in an indecisive way when I take him out to do his business. Perhaps 3 months of Trilostane is not long enough for these other symptoms to decrease but I was hoping he'd start playing just a little with Winston again.

He is still the best cuddler in the world, though, and has a good appetite. He just had his 11th birthday and we're very grateful for that.

Aloha and hugs to you and Corky,

Tricia

[Squirt's Mom]

Hi Tricia,

The signs are very important to know if Trilo is working or not at the current dose...regardless of what the numbers are. With Trilo, a pup can run as high as 9.1 on the post number as long as signs are not present. Since you are still seeing signs at a post of 7.3, increasing his dose was the right thing to do. Hopefully, you will start to see Kirby perking up a bit more on this dose.

He's doing alright otherwise?

Hugs,
Leslie and the gang

[kapohotricia]

Thanks for letting my know that, Leslie. the vet is keeping the numbers low to be safe but we do want to go high enough to give him a better quality of life. As I said, he is not really enjoying life much. He is always so tired and acts a little dazed. I just don't know if it's realistic to expect him to perk up a little and start playing again.

Aloha,

Tricia

[Squirt's Mom]

Hi Tricia,

The norm for cush pups once their cortisol is under control = a return to a perkier, friskier, happier, more attentive, and more interactive self. Most cush moms and dads have a day when the tears that fall are not out of fear or grief or worry but rather are out of pure simple joy because that baby did something it hasn't done in ages. For me, it was when Squirt, 13, grabbed a toy and tossed it in the air - she played for the first time in years and I bawled like a baby. :)

So, yes, it is realistic to have hope, always have hope. ;)

Hugs,
Leslie and the gang

[littleone1]

Hi Tricia,

I hope the increase in Kirby's dosage helps. The dosage does have to be tweaked until the right one is attained. Corky started at 20mg a day almost 2 years ago, and now he's up to 72mg a day. His cortisol level is harder to get under control due to his adrenal tumor.

As Leslie mentioned, the symptoms do clear up in time. Some take longer than others. Corky was use to walking up to 3 miles a day, but when he had the cushings symptoms, he would only walk around the block. In a short amount of time after being treated with Trilo, he started going for his long walks again.

Take care. Corky is sending lots of Boston Terrier lickies for Kirby and Winston.

[kapohotricia]

Those of you that take the time to give me this feedback are more appreciated than I can say! I won't give up hope, then, that we can get his meds to a level where we see our little Kirby attacking the vacuum again: now you know how he got his name :) I have a favorite video clip of him and Winston face wrestling a few years ago and it reminds me how much fun they used to have. This affects Winston so much too.
We have taken the "go low and slow" approach to be safe but, if his numbers are within safe limits on the next ACTH test, I will ask the vet if she'll support me raising the dose a little to see if it will help him regain some energy.

Thanks, Leslie and Terri. Bless you both today.

Aloha,
Tricia

[kapohotricia]

Kirby isn't doing well this weekend. He has been trembling since Friday evening and just wants to be cuddled. To review, he has been increased to 9mg a week ago and it did stop his peeing but the trembling is worse. I don't know if this means his dose is too low or too high.
He has a great appetite and good stools. He is just breathing a little hard and trembling and seems exhausted.
What to do?

Aloha,

Tricia

[frijole]

I have never used trilo but it sounds like the dose might be too high. Hopefully others will chime in. I would call your vet and report this. Trembling could also be from pain. Is it non-stop? Certain time of day? Does it lessen as the dosage wears off? (I'm assuming you dose once daily)

The trembling combined with the breathing concerns me. Call the vet please. Poor thing. Sending hugs and positive vibes your way. Kim

[littleone1]

Hi Tricia,

I'm so sorry that Kirby is having problems. Corky hasn't had these problems with Trilostane. The only time he had issues with trembling was when his thyroid level was too low. I would definitely call your vet in the morning. I would also have his electrolytes checked, as they could be off.

I'm sending lots of hugs and positive healing prayers that Kirby will be okay.

[kapohotricia]

Thanks so much for the responses. Just after I posted I noticed he had urinated in the house. Poor little guy. He seems so tired and confused much of the time. I noticed his circling is always anti-clockwise. Perhaps he has something else going on too.
My neighbor will take good care of him while I'm at work and I'll see if the vet can see him after I get off to check out his thyroid and electrolytes.
We haven't noticed him trembling after he has his Trilostane in the morning. It seems to come on in the afternoon and evening. He was trembling on Saturday morning when we woke, before his dose, but not this morning. He wants to sleep more and more.
Aloha,
Tricia

[littleone1]

Hi Tricia,

You're very welcome. I'm just trying to think of anything else that might be causing problems for Kirby. One of my friends also had her furbaby circling, and it was due to something with the liver enzymes. I am hoping your vet will be able to see Kirby and find out what is going on with him.

You are both in my thoughts and prayers. I'm ao glad you have someone to watch Kirby while you're at work.

[Squirt's Mom]

Hi Tricia,

Please let us know what the vet says about Kirby. One thought is that Kirby may need to be on twice a day dosing since he trembles before the dose and later after the dose is losing its effectiveness. The accident in the house could also be an indicator that once a day dosing isn't holding for Kirby.

Another thought, one I truly hate to put out here, is a macro. The circling is classic for these larger pituitary tumors, as is the confusion you mentioned. The only way to be sure this is the reason would be an MRI or cat scan of Kirby's head. Pups with the brachycephalic heads like Boxers, Pugs, etc. seem to be more prone to developing these macros. One of our members had to deal with a macro in her baby, Macy, and has started a thread in the Everything Else section where she shared her experiences and invites others to share theirs. As a result, we have a growing "data base" for macros...one we hope grows very, very slowly. ;) You can read about Macy at - http://www.k9cushings.com/forum/showthread.php?t=3567

Keep in touch and know we are with you both.

Hugs,
Leslie and the gang

[kapohotricia]

Lesley,

Your concern about the macro confirms what my gut instinct tells me is happening to little Kirby. He seems so confused in so many ways and he exhibits the same refusal to walk and desire to get home that is described in that macro link. There are other small indicators too, but I didn't want to make my message earlier too long with a long list of changes in behaviors I'm seeing.
We are in a rural area on a rural island. I would have to fly him to Honolulu to get any treatment other than the palliative care a very small country vet's office could give and that's not possible. I think the vet suspects it too because she told me, on the last visit, that we don't have long with him. The video is a good idea to help the vet figure it out. Kirby is totally passive at the vet so she doesn't see some of these behaviors.
He is not trembling today, at least, not yet. I gave him his Trilostane and will see how he is when I get home from work.
Thanks so much for the support. It means so much.

Aloha,
Tricia

[kapohotricia]

Hi Terri,

Testing did show that Kirby's liver enzymes are somewhat high but not alarmingly so and I have been giving him daily milk thistle. Thanks for the suggestion.

Our love and hugs to you and dear Corky today. We have to make each day count with our furkids and treasure up the memories in our hearts.

Much aloha,
Tricia

[littleone1]

Hi Tricia,

You and Kirby are in my thoughts and prayers. We do have to treasure everyday we have with our furbabies. I hope that Kirby's issues aren't due to a macro, and that there is something minor that can be taken care of.

I have one other thought. Corky started to exhibit strange behavior awhile ago. One of the things he was doing was wandering aimlessly. He started pawing at things, which he had never done before. He was diagnosed with Canine Cognitive Dysfunction. He was put on SAM-e for a month, which really helped him. If he starts exhibiting these behaviors again, he will be back on the SAM-e. At that time, I didn't realize that there were different kinds of SAM-e.

I'm sending lots of love and hugs.

[Squirt's Mom]

Hi Tricia,

Something else that helps with CCD is Anipryl, or the generic, Selegiline. It wouldn't hurt to talk to your vet about this possibility and try these meds to see if that helps Kirby.

Hugs,
Leslie and the gang

[kapohotricia]

I'm going to have to wait to see the vet but that's okay because she has already given him all the tests that she has the equipment for and I doubt she could help any more. Kirby is not trembling much this week and I am reading about macros as it seems to be the best fit with his symptoms.
He had a happy moment when I got home from work just now and ran a short distance across the little lawn and up the two steps. He stumbled on the steps because his little legs are so weak but picked himself up and enjoyed his treat and a nice cuddle :) He's so precious! I am just treasuring every day we have with him and finding ways to give Winston more playtime with us so he's happy too.
Aloha,
Tricia and Kirby

[littleone1]

Hi Tricia,

You and Kirby are in my thoughts and prayers. Enjoy and treasure every moment you can with Kirby. (((HUGS)))

[kapohotricia]

We are off to the vet on Wednesday for the next ACTH test. The 10mg dose of Trilostane really isn't working any more. The poor little guy is having almost daily "accidents" in the house (tile floor, luckily!) and sleeping most of the time. I have to carry him to get him out to do his business. That, combined with the disorientation, circling and trembling means he doesn't have much fun any more. Of course, he gets tons of cuddles and loving, and loves his food so he probably doesn't realise anything's amiss. We'll see what the test results are and I won't be surprised if the vet wants to double the dose to 20mg. I'll post the results when I get them and the dosage recommendations.
Aloha,
Tricia

[addy]

Hi Tricia,

Good luck with your stim. I hope you get a dose that helps Kirby.

Hugs,
Addy

[kapohotricia]

Hi everyone,

I need your advice. Kirby's last Stim tests results were Pre 2.6 and Post 4.6 so the vet has decided he should continue with 10mg of Trilostane (he is 20 lbs).
However, I have been reading your posts about how others of you are treating cognitive symptoms with Anipryl (generic is selegiline) and shared all that info with the vet. She started Kirby on 5mg today. It was $100.00 here locally, gulp, but I have found it cheaper online if it works.
I am wondering if Kirby should continue on 10mg of Trilostane now that he is also taking Anipryl or if is it likely that he won't need as much Trilostane. So, my question is, have those of you with dogs on Anipryl had their Trilostane doses reduced?
Thanks so much for any advice you can give.
Aloha,
Tricia and Kirby

[frijole]

Whoa. I'll try to research this but I am pretty sure that you should NOT be giving both of those drugs at the same time! Please call and have your vet check into this. Meanwhile I will see if I can find any info online. I'm glad you asked the question because it is a good one. I don't think I've ever seen a dog use both. KIm

[Harley PoMMom]

According to Dr. Mark Peterson's blog they can be used together: Q & A: Pacing and Circling in a Cushing's Dog Treated with Trilostane (http://endocrinevet.blogspot.com/search?q=Anipryl)
An excerpt from his blog:
If you believe that Rigby has canine cognitive dysfunction, you can certainly use the drug selegiline hydrochloride, also known as L-deprenyl (veterinary trade name, Anipryl) along with the trilostane that the dog's already getting.

[frijole]

Thank you Lori! I wasn't having any luck getting an answer online! Kim

[kapohotricia]

Thanks, I had shared Dr. Mark Peterson's comment to my vet (she and I are learning together about this) when I read it on the Q & A excerpt. However, it doesn't explain HOW to use them together. I still don't know whether there should be a reduction in Trilostane when L-deprenyl is added. I'm anxious about this as my vet does not have prior experience of this.
What has been the experience of any other members whose dogs are on both?Is there some way I can ask that question of Dr Peterson?
Thanks!
Tricia

[Harley PoMMom]

For treatment of clinical signs of Cushing's:


Other treatments have zeroed in on affecting the adrenal glands to inhibit production of cortisol. Anipryl, however, goes straight for the pituitary functions. Anipryl prevents Dopamine in the brain from breaking down. By doing this, the Dopamine (which inhibits the creation of ACTH in the pituitary—thus, in a chain reaction, inhibiting the creation of cortisol in the adrenal glands) sticks around to keep the pituitary from over-producing.

While a majority of Cushing's cases in dogs are due to pituitary tumors, only about 20% of those cases have tumors on the part of the pituitary that is dependant on Dopamine. Any dogs outside of this 20% will not see a significant improvement when given Anipryl.http://www.vetinfo.com/managing-cushings-syndrome-in-dogs-with-anipryl.html

For CDS:
Researchers say that deposits of beta-amyloid plaques in brain tissues are likely to play a role in CDS. These plaques build up and eventually inhibit transmission of the brain's neural signals. Researchers speculate that Anipryl works by increasing levels of dopamine, a neurotransmitter. This info can be found here:Doggie Dementia (http://www.sciencentral.com/articles/view.php3?type=article&article_id=218391360)

Dosage:
The recommended dosage for oral administration for the control of clinical signs
associated with cognitive dysfunction is 0.5 -1.0 mg/kg once daily, preferably
administered in the morning.
http://www.fda.gov/ohrms/dockets/98fr/141080Fi.pdf

Anipryl works differently than Trilostane. I really do not think that there will be a problem using them together. The dosage for CDS is lower than if one was using Anipryl for controlling the clinical signs of Cushing's.

Hope this helps.

Love and hugs,
Lori

[Cyn719]

Tricia - hopefull I will find out it that is what is wrong with penny - she was on trilo now off trilo - she got very sick for a week??? we put her back on her Rimadyl meds and she was wonderful for two weeks and we changed nothing and then very sick again????? So macro or just pain for legs muscles lumbar??? She pants alot - gets up and down alot like not sure how to get comfy - groans - and sometimes she digs? Does not do circling - but not steady on her legs - yup so frustrating!! I wil pray for our little fur babies and hope we both can get some answers and some relief

[kapohotricia]

Thanks, Lori and Cindy.

He had a restless night but has had a good breakfast with the selegiline and trilostane and is sleeping comfortably now. He will be watched 24/7 until Nov 3rd, when my visiting friend who loves him like a second mother returns home. I will hope that he is showing some improvement by then. I'm still hoping someone else has tried this and found out if the trilostane dose should be adjusted once the dog is also taking selegiline for CCD. It would be really sad to have his cortisol levels drop too low now the numbers are looking good. I haven't scheduled the next ACTH test yet. Those test days exhaust him and cause him such stress. His veins are so hard to draw blood from and it is such a long day because of the distance and waiting times between blood draws.
I just don't want him to be suffering in any way. I can't tell if his head is hurting. He has always made little groany noises when I pick him up and stuck out his big ole' tongue when he sleeps so there are no signs if he has a headache.

Aloha and hugs you your furkids,

Tricia and Kirby

[Cyn719]

Yes Tricia - I know - wish they could tell us how they feel - you are doing a great job with Kirby - I know its alot - Ive been doing it since last December - jope wed answers some more questions - hopefull a member can give you some info on the selegiline - sending alot of hugs support and strength!!

[labblab]

Tricia, re: your concern about trilostane dosing upon having added Anipryl -- you or your vet could call or email Dr. Tim Allen, one of the veterinarians who serves as a technical rep for Dechra (manufacturer of brandname Vetoryl) in their Kansas headquarters. He is a very nice man and has been extremely helpful to many of our members. If he doesn't know the dosing answer himself, I feel certain he'd be able to find it out quickly. Here's the contact info:

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

Marianne

[kapohotricia]

Marianne,

What a good idea! I didn't think of asking them. Thank you so much for Dr Allen's contact info. I'll email him right away and post his advice should others find themselves in a similar situation some time.

Aloha,

Tricia and Kirby

[kapohotricia]

Wow! Dr Allen replied right away! What a lovely man. Here is his response -good information should anyone else have a PDH dog with CCD considering these treatment options:

I'm glad your Boston's cortisol concentration is under control. Because Vetoryl and Anipryl work by completely different mechanisms it's unlikely that the two drugs together will cause over suppression of adrenal gland function (Addisonian crisis). Furthermore, the Anipryl dose used to treat Cushing's is two to three times higher than the dose used to treat cognitive dysfunction. My advice in this situation is be certain to follow the recommended Vetoryl protocol of re-checks every 3 months and if your Boston shows signs of appetite loss, vomiting or diarrhea stop Vetoryl immediately and contact Dr. Verluys.

Regards,

Tim

Timothy A. Allen, DVM (SAIM)
Technical Services Veterinarian
Dechra Veterinary Products
Toll free: 866.933.2472
Fax: 913.327.0016

[Cyn719]

Tricia -

I was just going to give you Dr Allens toll free number but he got back to you and now you have it - Isnt he the best!!!!! I called him like 5 times already and he picks right up and he is so pleasant to speak with!! I am glad he answered your questions - I think I should be asking the new IMS Wed about Anipryl for Penny??? How is Kibry feeling today??? Sending you both HUGSSSSS!!!!!!!!

[kapohotricia]

Hi Cindy,

Yes, he is so kind and prompt. I am so relieved. Of course, Anipryl can't stop the tumor growing but I am hoping Kirby is one of those that will have better quality of life with this drug. He is on day 3 and tolerating it just fine with the Trilostane at breakfast and fish oil and milk thistle, bless him. He has always been a good eater, thank goodness. I am told it could be a month or even 2 before I really know if it will help.
Hugs for you and a kiss on the head for dear Penny. You are blessed to have an IMS available. It will be interesting to hear what she thinks.

Aloha,
Tricia and Kirby

[Cyn719]

Tricia- Thanks for the thoughts and Kiss for Penny - I will let you know how it goes - I pray the med will help Kibys quality of life - that went on my question list for the vet!!! Hugs and a HUGE SLOPPY lick to Kirby from Penny:D

[kapohotricia]

Hi everyone,

I haven't updated for a while because nothing has really changed in Kirby's condition these past few months except that he is very gradually getting a little weaker. His right legs fail on him when he circles for too long so, when I am home, I pick him up and settle him on the couch. He does need some exercise so I don't stop him walking around at all -he just doesn't go straight much at all. He is generally content with his quiet life -he gets lots of cuddles and enjoys his food and can still see and hear but, I'm writing today to ask for advice with one thing. When I am home I take him outside when he wakes after a nap or signals that he wants to go out. He goes after circling for a few minutes and he is always so proud he actually runs across the little lawn afterward. But, now I am back at work after the holidays I can only come home at lunchtime to check on him and he can no longer wait 4 hours between going out. I've tried pee pads but he isn't used to them and pees on the tile by the front door instead. He has obviously wanted to go out and there is a pattern of circling paw marks around the area over the puddle, poor thing. I tried a towel on the floor but he goes to the nearest tile by the front door.
Has anyone found a way to train an incontinent older dog not used to going inside?
Thanks for any advice you might have.
Aloha,
Tricia

[Harley PoMMom]

Hi Tricia,

My suggestion would be to get him peeing on the pee pads while he is urinating outside...meaning, slip the pee pad under him while he is peeing then bring this already soiled pee pad inside for him to go on.

My thinking is if he smells an urine odor on the pee pad it might entice him to use it again.

Hope this helps.

Love and hugs,
Lori

[Squirt's Mom]

Hi Tricia,

Good to hear from you again and to know Kirby is holding his own, and still content with his life.

You are on the right track by putting something where he is already used to going - tho I can understand not wanting it right in the front entrance. :eek:;):D Like Lori said, get some of his scent on a pad then place that pad down for him. I would also go ahead and put enough pads by the front door covering the tiles. Once he is used to the pads, you can SLOWLY start moving them over a bit so that hopefully he will follow the pad and not insist on the tiles. :D You can expect to go through quite a few pads this way but in time he may catch on.

When he does use the pad, you will praise and reward him just as you did when you were house breaking him. I had a friend once who tried putting treats on the pads to encourage the use of them....all her dog learned from that was that she ate there... and never did learn to use pads. :rolleyes:

Some older dogs won't learn to use pads so you might want to look into a belly band for him while you are away.

Hugs,
Leslie and the gang

EDITED TO ADD:

I just read on another thread where a member put grass on a peepee pad to encourage her babies to use one. You might try that!

[kapohotricia]

Thanks, Lori and Lesley,

Those are some good suggestions I hadn't thought of. We'll give these suggestions a try and I'll report back in case it can help someone else.

Aloha,
tricia

[kapohotricia]

Hi again,

We settled on the belly band type "diapers" from Drs Foster and Smith because I couldn't get him to use the pads no matter what I tried. But he pees such volume he soaks through several liners and the wrap and I still have a little to clean up on the floor and wash Kirby. Ah well, I'd rather have him with us having accidents than not have him any more, that's for sure!
He had his 3 month ACTH test on Monday and I got the results today. Pre is down to 1.1 and post is down to 3.9 (from 2.6 and 4.6). He is still only on 10mg of Trilostane but has lost weight. He's down to 18 lbs now so the vet says to reduce the dose a little. I'm supposed to try 8mg and see how he does. Do those numbers seem low to you all?
Cognitively and in other ways, Kirby is aging fast. The vet commented on the difference since she last saw him 3 months ago. I suppose the tumor keeps growing and pressing up into the brain. But he is quite content, enjoys his food and cuddles, sleeps pretty well at night and still has happy moments when he runs on the lawn. I feel more sorry for Winston because he is still very active and energetic and he really misses all the chasing and roughhousing and playing they used to do together.
Aloha,
Tricia

[labblab]

Tricia, thanks for this update about Kirby, although I wish the little guy was feeling better. :o

If nothing else was involved, I would not say that his most recent ACTH numbers were too low. But since you have other issues going on -- the inappetance, weight loss, and likelihood of an expanding tumor -- I can't disagree with your vet's advice. His numbers have drifted downward a bit while remaining on the same dose, and you probably don't want to risk them dropping much lower. You are trying to balance several variables, and I would hope that the dosage change may help stimulate Kirby's appetite a bit more.

Please give your sweetie-pie a special hug for me,
Marianne

[Squirt's Mom]

Hi Trish,

Thanks for the update on sweet Kirby. That he still enjoys his food and cuddles is a great thing. I can just imagine how much your heart swells when he feels like running and playing in the yard for a minute. We learn to treasure the most seemingly insignificant things, folding them up and tucking them away where we can find them again.

Letting his numbers run a bit higher might be best for Kirby all things considered. Marianne has explained the whys and wherefores much better than I ever could but, for what it's worth, I agree with her assessment.

Know we are here any time, sweetie.

Hugs,
Leslie and the gang

[kapohotricia]

Thank you so much, Lesley and Marianne. Kirby enjoyed the extra hugs. He just loves to be cuddled and nestles in with a big, contented sigh :)
My country vet is as inexperienced as I with Cushings and I do appreciate her being willing to give him these tests and prescribe the Trilostane. But we are both concerned that the numbers don't get lower. If this were your dog, how much would you reduce the dose? Would you even consider giving the 10mg only on alternate days?
I appreciate any thoughts anyone might have on this dose question. I am very concerned not to let the numbers get dangerously low, especially since my vet will be out of the country from the end of Feb for a month and I have no one else to take him to in her absence.
Thank you so much for being there!

Aloha,
Tricia

[Cyn719]

Hi Trish

Just wanted to stop by to say hello!!:) Leslie and Marianne gave you good advice and I have to say when Penny was on trilo she always did better when her numbers were higher - when they were low she didnt want to eat and was very tired - give it a try and if you can get the numbers up alittle Kirby might feel better and eat better like they said-that would be great:)

hugsss xo

[labblab]

I'm being lazy and not looking back through your thread:o :o, but can you remind us of any previous ACTH results? If Kirby has been pretty much stable since starting treatment, then I think dropping to 8 mg. daily sounds reasonable. Is the trilo in a liquid form so that you can make that teensy a dosing change?

Just remember, you can always stop the trilo at any time if Kirby seems to be reacting poorly. So if he seems to decline even more while your vet is gone, you can temporarily discontinue it altogether. Also, just make sure that you have some prednisone on hand while your vet is away. That way, you'd be prepared to give him supplemental steroid in the event of a serious cortisol drop.

Marianne

[kapohotricia]

Hi Marianne,

Kirby's previous ACTH results at 10mg were Pre 2.6 and Post: 4.6. That was 3 months ago. The vet said that was perfect so he has continued on 10mg since but has lost another lb in weight.
I have compounding solution and mix the dose from 60mg caps in a 10 ml syringe through a luerloc, following my pharmacist's instructions. It makes it easy to adjust the dose. I do have prednizone on hand but it is hard to tell if he is oversupressed because he has had trembling and lethargy symptoms since last April even when his cortisol levels were good, and the incontinence seems to be caused by CCD. I do stop dosing on the days he doesn't want to eat and resume a few days later once he is back to enjoying his food.
So, I am back to wondering how low a dose I should be giving him now, based on this week's numbers.
Aloha,
Tricia

[labblab]

It is with a heavy heart that I tell our family that Tricia lost her dear Kirby on August 13. When she is ready, Tricia will return to post herself. But in the meantime, I know we will all be holding Tricia and Kirby in our thoughts and prayers. Fare thee well, sweet Kirby, fare thee well.

Marianne

[addy]

I am so sorry, Tricia. Thank you, Marianne for letting us all know.

Godspeed, Kirby. Tricia, we are all here for you if you need us.

[molly muffin]

I am so sorry to hear of Kirby's passing. :( I know your heart is heavy Tricia. We're all here if you want to talk.

hugs,
Sharlene

[Squirt's Mom]

Dear Tricia,

I was so sorry to hear about Kirby. I know you worked very hard to make his life the best possible and did a great job of it. There is no doubt in my mind that Kirby is grateful for all you did on his behalf.

Please know we are all here for you whenever you are ready to talk. We know your pain and are here to help any time.

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



A Dogs Message from Heaven

I am sending you this message as I can see you are still having struggles with coping each day since my passing.

You may walk in darkness and your heart is broken with my absence. I haven't left you as you hold me in your heart. Please don't be sad as the light will come shinning through for you. For each day of sunshine, think of it as reminder of me beaming down on you. Be happy that I am no longer in pain from sickness or injury. I don't want you grieving for me for long as it makes me sad to see you in so much hurt. Don't dwell on the guilt you feel for making decisions we both know you had to do and I thank you for releasing me of my sickness.

Cry if you need to miss me if you must, but don't worry about me, I'm in a place I love.

Yesterday I talked with the Creator and he said you'd come one day. I wanted you to know this. So you see I'm happy and I am free. There's nothing to worry me. Dry your eyes and make plans to see me again. I will look for you and when you get here, you will see what a wonderful place this is.

Let me tell you what it's like here in this wonderful place. There are no clouds or dreary rain…Just lot of blue sky and sunshine casted on us from His most gracious presence. There are miles of green grassy fields and meadows of beautiful flowers.

There are no cruel humans to hurt us, just the keepers who have been specially chosen to care for us...

We all get along here large and small. Some of us had a pretty rough life while others were very spoiled. We run and play tag or chase balls. We can be lazy as we want and take long naps. The Creator checks on us each day.

I have met many of your friend’s fur kids here.

It's been neat to see my brothers and sisters again that came here before me. There is never a sad moment. Just so much to keep busy....We get a lot of new kids arriving daily and is fun to show them the ropes here.

We are here waiting here for you when your purpose on Earth is complete. My wish for you is to be happy for me and not sad. It will be the most happiest of reunions and I will lick away all your tears. There will be nothing but good times for ever and ever.

I will let you feel my presence if you will just have faith and allow it to happen.

When the time is right and it will come, I want you to take in another fur kid to care for just as you cared for me and protected me from all harm and gave me the security that I needed all those years. They deserve the life I had with you. Don't think of it as replacing me but giving another the love you have inside you to bring joy to another. I felt honored to a part of your life and you gave me so much of yourself.... That will always be special.

You were my life and I will always love you for that.

I am not that far away and I will be close to you in spirit and will remain in your heart. That is the bond that connects us. Do not think of me when I was at my worst but all the great memories we shared together. I hate to see you cry. I am happy here so be glad for me.

I want to be remembered for all the silly things I did and things we did together. We had some great times together.... So cherish those memories.

So my best friend, until your task on Earth is finished, take care of yourself and help another less fortunate kid to know the love I shared with you and you will be forever rewarded. You will know when the time is right.

Love you Forever,
Your 4 legged soul-mate.

Author...Kay Faulkner

[3bostons]

Tricia, Im so sorry to hear about Kirby, our thoughts are with you.
Hugs, Kona and Deb

[Maya]

May God comfort you during this difficult time....so sorry to hear of your heartache....
Hugs from Leah and Maya

[Bo's Mom]

I am so terribly sorry to hear about Kirby. Our prayers are with you and your family at this most difficult time.

[Boriss McCall]

So sorry to read about your baby Kirby. You are in my thoughts & prayers.

big hugs

[Kodasmom]

I am so very sorry for your loss of Kirby. My thoughts and prayers be with you. It's been 2 months today for me since Koda passed. My heart goes out to you and your family.

[goldengirl88]

I am so sorry for your loss, and hope you have the strength to get you through this. I can feel your pain and know that I too will be there in your shoes some day. God Bless You, and all the others that go on the very difficult journey because of the love of their wonderful furbabies. I will be thinking of you and your precious Kirby.

[Jenny & Judi in MN]

I am so sorry for your loss. He looks like he was quite the character and I know you are hurting. hugs, Judi

[kapohotricia]

Thank you, everyone, for your kind words. Those of you who have lost a furkid will know how hard it is for a little while after they go on. I just couldn't write about it. I still call his name every day yet I know we did the right thing to let him go to a perfect place where he is free of the poor sick body and mind that he never quit trying to function with. We'll be united with him and our other loved furkids one day. The trilostane gave him many more happy times with us until the tumor got too big and we are grateful both for the treatment and the kindnesses of those of you who took the time to write with support and advice.
God bless you all: those who are presently in the middle of the Cushings battle with your furkid and those who stay on to comfort and help. You all make the world a better place.

Aloha,
Tricia