Doc begins Trilostane tomorrow! -11-1/2 y/o yellow lab

[puddyjan]

I spent hours last week before the site went down reading posts, preparing myself for the diagnosis of Cushing's which was confirmed yesterday with the LDDS test. We begin the Trilostane tomorrow morning! Any suggestions are welcome! I have done extensive reading of the Vetoryl brochure along with lots of articles including Audrey Cook's on Trilostane therapy. I admit I am a little nervous but was glad to get a diagnosis we can treat. Doc is an 11-1/2 year old yellow lab we adopted from Canine Companions for Independence 10 years ago. Doc had too high a prey drive to continue in the program after 15 months of training! Boy were we lucky to get him. He is the best dog and goes everywhere with us. We will do whatever is necessary to make sure the rest of his days are the best ever!
Thanks for this forum and I look forward to keeping you posted with Doc's progress.

Jan
Doc's proud mom

[BestBuddy]

Hi Jan
Welcome to you and Doc. Tell us some more about how you got your diagnosis and test numbers if you have them. How much does Doc weigh and what is your dosage of trilo. Has your vet treated many cushing dogs and does he/she know that you need to test at 10 days to see how things are going. Wow, sorry for all the questions.
Jenny

[Squirt's Mom]

Hi Jan and welcome to you and Doc! :)

I am really glad you found us here! :cool:

Well, to add to Jenny's questions ;) , does Doc have any other medical conditions; is he on any other meds, supplements, or herbs at the moment? Has you vet used Trilo before? or is Doc her first patient to use it? What tests has he had done, and, in particular, has he had the UTK full adrenal panel and an ultrasound? Do you know if Doc had the pituitary form or the adrenal form?

I ask about the UTK full adrenal panel in particular because Trilo always elevates one or more of the intermediate or sex hormones and if these are already elevated in Doc, the Trilo has the potential to make things worse instead of better. The elevated intermediate and sex hormones cause a form of Cushing's called Atypical Cushing's and many vets are not aware of this form or the testing for it. We always strongly recommend having the UTK panel run when a pup is going to use Trilo. I will give you some links about Atypical and the UTK panel, as well as some on Cushing's in general.

For over a year now I have been telling new members that we will be here for them no matter what, and then the site went down and so many are left floundering that I am a bit cautious to say that now! :( But the sentiment holds true in all our hearts and we will do our best to hold your hand the whole way!

I am so glad that you found us! :cool:

Keep your chin up!
Hugs,
Leslie and the girls

:eek::eek: the links :D:D

Kate Connick*
http://www.kateconnick.com/library/cushingsdisease.html

Long Beach Animal Hospital*
http://www.lbah.com/canine/cushings.htm

Drs. Foster and Smith*
http://www.peteducation.com/article.cfm?c=2+2097&aid=416

Newman Veterinary*
http://www.newmanveterinary.com/CushingDiag.html

Cushing’s signs and pics*
http://www.newmanveterinary.com/CushSignFrame.html

BMD Health Library*
http://www.bestbeau.ca/bmd_health_links_4.htm
(scroll down to see Endocrine Diseases)

Vetstream*
http://www.vetstreamcanis.com/ACI/February08/VMD2/FactSheet052.asp

Atypical Cushing’s*
http://veterinarynews.dvm360.com/dvm/article/articleDetail.jsp?id=485128&sk=&date=&pageID=1

http://www.vetcontact.com/en/art.php?a=132&t=

UT Panel
http://www.vet.utk.edu/diagnostic/endocrinology/treatment.php

[MiniSchnauzerMom]

Hi Jan,

Wanted to extend my welcome to you and Doc.

Since you've been studying the Vetoryl brochure (good job, by the way!!) you are probably already aware of this, but just in case......Doc's electrolytes also need to be tested when the ACTH stimulation test is done.


Thanks for this forum and I look forward to keeping you posted with Doc's progress.

We look forward to reading your posts about Doc's progress and helping in whatever way we are able!!!

Louise

[puddyjan]

Let me recap Doc's diagnosis:
3/13/09
presented with diarrhea x 2 days, vet drew blood and treated with antibiotics
blood panel revealed elevated liver enzymes:
ALKP 1152
ALT 301

put on Denamarin along with the antibiotics and rechecked at 3 weeks:
4/2/09
ALKP 2000
ALT 428

due to other symptoms (heavy panting, slight weakness in rear legs, increased appetite, two hard lesions on inside of rear leg) we tested for Cushing's.

4/13/09
Low-dose Dexamethasone Suppression Test
baseline cortisol 4.2 ug/dL
4 hr. post low dose dex 0.8 ug/dL
8 hr. post low dose dex 2.1 ug/dL
It is my understanding these numbers are suggestive of PDH, not atypical hyperadrenocorticism.

I am fortunate that my vet has extensive experience with Cushing's. He has quite a few patients on Lysodren and others on Trilostane. We both agreed that we prefered to treat Doc with trilo. Doc is 84 lbs. so we will begin with 120 mg/day with food.

We have scheduled an appt. 12 days out for ACTH stim test (4 hrs. post trilostane), electrolytes and serum chemistry and a physical exam.

Thank all of you for your response. I am hoping Doc will respond well and won't have many side effects.

Will keep you posted and hopefully I can figure out how to get a picture of Doc up here on the post!

Jan
Doc's proud mom

[StarDeb55]

It is my understanding these numbers are suggestive of PDH, not atypical hyperadrenocorticism.

Jan, you can't diagnose Atypical Cushing's based on the LDDS result. A LDDS & ACTH look at ONLY cortisol levels. Atypical is when one or more of the associated sex hormone produced by the adrenal glands is elevated with or without a concurrent elevation of cortisol. As Leslie has already mentioned, the only way to get Atypical diagnosed is to have the full adrenal panel done at the Univ. of Tenn., Knoxville. I would, also, like to emphasize that Trilo is know to elevate some these intermediate hormones, so it may not be an appropriate treatment for an Atypical pup.

Was any other testing done to confirm the positive LDDS result? Even though the low dose is considered to be the "gold standard" for Cushing's diagnostic testing, it has one problem as it can generate a false positive result in the presence of non-adrenal illness. You can either confirm a postivie Low Dose result with an abdominal ultrasound or the High dose dex. The abdominal US is usually the better value as you can get a look at all of Doc's internal organs to get an overall idea about his health.

Debbie

[rhodesian46]

Hi and Welcome. I had a dog named Pebbles She had cushings,diabetes and hypothyroidism. It sounds to me like your vet is following protocol on redoing the ACTH stim in 10 days or so. But you did not mention if an abdominal ultrasound was done to confirm pituitary cushings.
Just to add that an electrolyte check should be done every time you redo the ACTH stim. It is very important that you have a vet that has extensive knowledge on this subject. Really important that you know what to look for when starting trilo . Having pred if needed. Looking for you dog walking away from food,diarrhea,lethargy,depression etc. These could be signs that your dog is not producing enough cortisol( Addisons Disease) This can be dangerous for a dog if you are not instructed what to look for. You should be instructed to stop the trilo give pred then redo the ACTH stim immediately.

Also Trilostane should be given in the morning with food so that the ACTH stim tests could be done 4-6 hours post pill. This is a must to only do the testing within this timeframe in order to have the correct results.

[Squirt's Mom]

Hi Jan,

Just dropping in to see how Doc did on his first day with treatment. Hope all is well with you both.

Hugs,
Leslie and the girls

[Squirt's Mom]

Hi Jan,

How are things going with you and Doc?

Hugs,
Leslie and the girls