Angelina has passed away - 15 1/2 year old/7.2 kg Maltese Cross on Trilostane

[John II]

The adventure continues on a new server - once again, thanks to Natalie.

So after 15 days of dosing Angelina once every 24 hours with 30mg of Trilostane – it was testing day.

Four family members plus much loved dog descended on the specialist centre.

Angelina weighed in at 13.04kg – 15 days earlier she was 13.123kg. Every little bit helps :)

The specialist appeared – we had an update chat. I made sure they checked her electrolytes and I handed him a urine sample I collected that morning (not that they asked for one – but after Roxee’s recent experience with a UTI, I wanted to check things out). I also told the specialist that Angelina usually wound up back on the cool bathroom floor by about 4:30pm – around 11 hours after her dose.

Finally he led Angelina away. She was surprisingly agreeable and walked off with him – until he reached the front door – where she stopped when she realised she wasn’t leaving. Then he had to pick her up.

15 minutes later she was back. And we were given the option of waiting with her for 50 minutes until the post-ACTH injection blood sample was to be taken. I was expecting them to wait 2 hours. But I was happy that we could take Angelina outside and she was therefore getting the less stressful option. The nurse appeared after 50 minutes and took her away for another 15 minutes or so.

Then Angelina was back. I questioned the specialist regarding the sound of her heart and lungs – which he said sounded fine. Her blood pressure was still high at 190. The specialist told us he would call with the results the next day.

After we got home Angelina was panting (didn’t help that it was a very warm day for Autumn -28 degrees Celsius – that’s just over 80 degrees Fahrenheit – anything over 25 usually leads to some panting). Her respiration was clocking in at 84 breaths per minute. But her total water intake for the day was only 650mls. All in all she seemed to handle the ordeal well.

At 3pm the next day the specialist rang with a summary. But we Cushings Net people are not summary people :D – so I asked him if I could get the full results emailed to me – and they were – see below my ramblings. Also at the end of the results are the accompanying “General Interpretive Guidelines” which may be helpful to members and visitors.

As expected the specialist has recommended Angelina’s Trilostane dosage be increased to 2 doses of 30mg per day (one every 12 hours) – an excerpt from the report:
"Angie was examined for a recheck of her hyperadrenocorticism. Her blood pressure remained mildly elevated today . Her examination was otherwise unchanged, which is not surprising at present.”

I put it to him that my research (aka Leslie) seemed to indicate that the full effect of a particular dosage of Trilostane didn’t become apparent until at least 30 days after beginning that dose. He didn’t seem concerned – due to the lower dose we started with.

Now I’m feeling about the same way about the 60mg dose as I did about the 30mg – before the first day. Oh the troubled sleep I had last night!

John – what dose is 13lb Roxee on?

Today, I swung by the specialist centre to do some more brain picking (I think I do better in person than on the phone). Turns out it was the specialist’s day off – but I spoke to another one of the doctors who saw Angelina on her first consult (there were three in all). He was similarly unconcerned about the increase in dosage. When I questioned if I should have Prednisone on hand he assured me that by the time I was aware that Angelina was experiencing side effects and gave her the antidote (as I think of it) the Trilostane would already be wearing off.

Since Angelina was due to get her monthly heartworm pill today – I held off starting her second daily dose of Trilostane. I know everyone says you can give them both – and I’ll have to do just that, this time next month – but I’d just as soon keep things as simple as possible on her first 60mg day.

Now, can someone tell me about milk thistle dosage for dogs? And omega 3 (fish oil) capsules? :)

John II

14-04-2009 The Urine Test

URINE COLLECTION METHOD Voided
URINE VOLUME (ml) 50.0
URINE COLOUR Yellow
URINE TRANSPARENCY Opaque
URINE SG 1.019
URINE GLUCOSE Negative
URINE BILIRUBIN Negative
URINE KETONES Negative
URINE HAEMOGLOBIN Negative
URINE pH 6.5
URINE PROTEIN ++ (1 g/L)
URINE UROBILINOGEN Normal (less than 20umol/L)
URINE RBC/HPF Less than 5
URINE WBC/HPF Less than 5
URINE CASTS, NUMBER Negative
URINE BACTERIA Negative
URINE FAT Occasional
URINE EPITHELIAL CELLS, TYPE Squamous
URINE EPITHELIAL CELLS, NUMBER Occasional
URINE EPITHELIAL CELLS, NUMBER Negative
URINE SPERM Negative
URINE CRYSTALS, TYPE Amorphous crystals
URINE CRYSTALS, NUMBER Occasional
URINE CRYSTALS, NUMBER Negative
URINE DEBRIS Negative

Minimally concentrated urine may reflect ongoing hyperA. Mild
proteinuria is unexplained: consider a UPC to further assess.
No evidence of UTI.


14-04-2009 Biochemistry with Electrolytes- Canine

Na 145 mmol/l (139-153) (Sodium)
K 5.9 mmol/l (3.9-5.9) (Potassium)
Cl 107 mmol/l (93-122) (Chloride)
Calcium 2.82 mmol/l (1.9-2.9)
Phosphorus 1.53 mmol/l (0.8-2.1)

Bicarb 20.9 mmol/l (12-26)
Anion Gap 23 mmol/l (14-32)
Urea 13.2 mmol/l (2.5-10.0)
Creatinine 81 umol/l (50-150)
Glucose 5.2 mmol/l (3.3-6.8)
Bilirubin 7.0 umol/l (0-6)
AST 128 U/l (18-80)
ALT 590 U/l (16-90)
AlkPhos 3205 U/l (1-150)
T Protein 77 g/l (52-80)
Albumin 39 g/L (23-40)
Globulin 38 g/l (25-45)
CreatKinase 235 U/l (73-510)
Amylase 727 U/l (333-1500)
Lipase 1495 U/l (77-750)
Cholesterol 10.50 mmol/l (3.5-9.0)


14-04-2009 ACTH Stimulation Test

Cortisol, resting 157 nmol/L (15-170)
Cortsiol, 1 hour 382 nmol/L



General Interpretive Guidelines
Normal dog:
* post-ACTH cortisol 170-470 nmol/L

Hyperadrenocorticism (hyperA):
* post-ACTH cortisol > 600 nmol/L consistent with hyperA
* post-ACTH cortisol 470-600 nmol/L equivocal

* failure of cortisol levels to increase significantly following ACTH
administration in a dog with typical clinical and laboratory features of
hyperA does not exclude the diagnosis. For further assessment a low dose
dexamethasone suppression test may be useful
* adrenal function tests, such as the ACTH stimulation test, may yield
a false positive test result in a sick or stressed dog with non-adrenal
disease
* this test does not differentiate between pituitary and adrenal-
dependent hyperA (an endogenous ACTH assay, abdominal imaging or a high
dose dexamethasone test may be useful for further assessment) For the
endogenous ACTH test, please contact the laboratory for the special
sample collection protocol.

Post-medical therapy for hyperA, results should be interpreted in light
of adequacy of clinical control. Target values depend on the drug used:

Mitotane or ketoconazole:
* baseline cortisol < 100 nmol/L post-ACTH cortisol 28-100 nmol/L

Trilostane:
* baseline cortisol 28-55 nmol/L post-ACTH cortisol 28-55 nmol/L

Iatrogenic hyperA:
* baseline cortisol < 55 nmol/L post-ACTH cortisol < 55 nmol/L

Hypoadrenocorticism:
* baseline cortisol < 55 nmol/L post-ACTH cortisol < 55 nmol/L
* this test will not distinguish between primary (adrenal) and
secondary (pituitary) hypoadrenocorticism

[lulusmom]

Hi John,

For those of us that are used to seeing acth stim results in ug/dl, I've done the conversion:

Pre 5.7
Post 13.8

Was the stim done within 4 to 6 hours of dosing? Did you have an acth stim done before starting treatment? I ask because a post number of 13.8 as compared to a pre treatment post of something like 25 or 30 is a pretty darn significant drop in just 15 days.

Given that Angelina's symptoms seem in increase in the evening, this is a pretty good sign that once daily dosing may not be appropriate. It drives me nuts that you have a drug that is known to have a short half life (12 hrs) and you have studies that have proven that twice daily dosing is more effective yet Dechra still recommends dosing once daily to start. :mad:

I may agree that Angelina would probably do better on twice daily dosing but I absolutely do not agree with the large increase your vet has prescribed. I personally am more comfortable with UC Davis protocol. They have established their own treatment protocol based on their experience with Vetoryl/Trilostane. They found a great disparity in the dosing that Dechra recommends based on weight by following that protocol, they had a great many dogs that had adverse reactions. As a result their dosing protocol is much more conservative and in my opinion, much safer. They prescribe 1mg/kg to start which means in Angelina's case, they probably would have started her anywhere from 10mg to 15mg per day. That's quite a huge difference from Dechra. :eek: They also recommend that when you go from once daily to twice daily dosing, you drop the mg a bit. For instance, if you are giving a dog 30mg once daily, you would drop the mg to say something like 20mg twice daily. This makes perfect sense to me as there is an overlap between the two doses.

One comment on the lab's comment "Mild proteinuria is unexplained: consider a UPC to further assess." The majority of dogs with cushing's have an increase in protein so mild proteinuria is not unusual. I think in Angelina's case, it is explained. My cushdog Lulu also has mild proteinuria.

Glynda

[John II]

Hi Glynda,

Angelina had her Trilostane dose (on testing day) at 06:05 and had her "Cortisol, resting" sample taken at 10am and then her "post-ACTH cortisol" sample taken at 11am.

We didn't have an acth stim done before starting treatment - but we did have an LDDS and a HDDS (what's the number to divide my figures to convert them to your again?).

LOW DOSE DEXAMETHASONE SUPPRESSION TEST
Resting Serum Cortisol : 132 nmol/L
Post-Dexamethasone Serum Cortisol (3-4 hrs) : 337 nmol/L
Post-Dexamethasone Serum Cortisol ( 8 hrs) : 440 nmol/L

HIGH DOSE DEXAMETHASONE SUPPRESSION TEST
Resting Serum Cortisol : 344 nmol/L
Post-Dexamethasone Serum Cortisol (3-4 hrs) : 290 nmol/L
Post-Dexamethasone Serum Cortisol ( 8 hrs) : 148 nmol/L

Where oh where in the world can I find a specialist who will give me good advice and information like the people of this forum do? :mad: The specialist mentioned the Mild proteinuria and suggested the extra test - to which I agreed. Results pending.

Thanks,
John II :(

[labblab]

Given that Angelina's symptoms seem in increase in the evening, this is a pretty good sign that once daily dosing may not be appropriate. It drives me nuts that you have a drug that is known to have a short half life (12 hrs) and you have studies that have proven that twice daily dosing is more effective yet Dechra still recommends dosing once daily to start. :mad:
Glynda
I realize that my thoughts about once vs. twice daily dosing differ somewhat from other members. But I do not see a problem with starting a dog off with a once daily dose, and then later shifting to twice daily dosing if the dog's response warrants it. And even though UC Davis researchers have been among those to publish studies endorsing twice daily dosing, their clinical treatment protocol to which we refer joins Dechra in recommending that dogs first be tried on a once daily regimen. :confused:

I really wish we could get a copy of UC Davis' most current protocol -- the one that we quote here dates to 2007. So perhaps their clinicians are doing things differently now subsequent to additional research studies. But if not, their recommendation doesn't seem unreasonable to me. And that is to first try once daily dosing, but if the symptom pattern and UC:CR test results indicate that once daily dosing is insufficent -- then make a shift.

http://www.k9diabetes.com/forum/showthread.php?t=745

I can imagine that with diabetic dogs, for instance, twice daily dosing might be preferable from the get-go. In that instance, there would be greater benefit from maintaining the most consistent endocrine balance possible. But for dogs without any non-adrenal illness, if the simplest arrangement works, why not "go with it?" At the very least, it may hold down medication costs a bit. Because the majority of dogs that are dosed twice daily seem to end up with a total daily dose that is at least a bit higher.

Having said all that, I totally agree with Glynda that it appears that Angelina is likely a dog who will do better with two daily doses, and also with her preference that Angelina's increase be limited to something like 20 mg. both morning and evening. And based on her ACTH results, I don't think that even Dechra would disagree.

Marianne

[Roxee's Dad]

Hi John and Angelina,
So happy you found your way here. Now if we can find JaneRoper and Lola. I just knew that was you in the members list (JohnII)


John – what dose is 13lb Roxee on?

Roxee started off on 30 mg once per day, after 30 days she was increased to 40 mg once per day.

All the best to you and Angelina
John (roxee's Dad)

[John II]

Well that's annoying. I just wrote a response and when I submitted it for preview - I was requested to log in - again! Which I did - you can't argue with software. After logging in I got a blank screen where my preview should have been. Nothing new there - happens all the time. I backed up a couple of screens thinking I'd find the raw form of the response and try preview or submit again - but it was gone! Aargh.

My post must have been so foolish that the server decided it was better to eat it than post it. :rolleyes:

[lulusmom]

John, you timed out before you submitted your post. When you log in, remember to check the "remember me" box and that won't happen.

Glynda

[John II]

Oh! Is that what that's for? Good to know. Thanks Glynda! :)

[John II]

Hello Forum,

Would anyone have the link for the UC Davis' protocol from 2007? I think all I've ever actually read are articles or threads referring to it. I'd like to have a look at the source material, if possible.

John II

[lulusmom]

Hi John,

You can find that information in reference material Marianne kindly posted for us.

http://www.k9diabetes.com/forum/showthread.php?t=745

Here is a direct link to the article that has the info re UC Davis protocol:

http://veterinarynews.dvm360.com/dvm/article/articleDetail.jsp?id=460965&sk=&date=&pageID=1

Glynda

[labblab]

I sure wish we would acquire a member whose dog is currently being treated with trilostane at Davis! I am REALLY curious as to what their most up-to-date recommendations are in terms of dosing.

And I must confess that some of my thoughts about dosing stem solely from my experience with my own Cushpup. It was five years ago now that we started treatment, and the studies about the advantages of twice daily dosing were just starting to appear. I felt so convinced that twice a day would be a better approach that I prevailed on my specialist to let us go that route, even though it was not "officially" recommended. We ended up having to make a lot of dosing changes along the way, and it always felt doubly complicated to me because of trying to arrive at the best combination of morning and evening doses. So I ended up wishing that we had just started out with once a day, and only increased from that if it seemed as though we needed to.

I just wanted to put my "cards out on the table," so to speak, so you'd know where my bias is coming from. ;)

Marianne

[John II]

Thanks Glynda!

Or I may start calling you "The Oracle" from now on :D

But the thread and the DVM article are the things I've read - I'm wondering where this point you mentioned below came from, that is:

"They also recommend that when you go from once daily to twice daily dosing, you drop the mg a bit."

And Marianne I wish that pesky server issue gets resolved so I can go and read up on your experiences in more detail. What timing!

Thanks for your information, as always,

John II

[Roxee's Dad]

Hi John,
How is Angelina doing? Is she on the 60 mg dose now? Is that once a day or 2 X 30 mg per day?

All the Best.
John (Roxee's Dad)

[Roxee's Dad]

Hi John,
Hope all is well with you and Angelina.
John (Roxee's Dad)

[John II]

Hello All (especially John who watches out for Angelina and me :)),

Sorry to have dropped out for a while - but I was afraid that if you knew what I was up to I might be banished from the group. :o

So - here goes, I started Angelina on 2 X 30 mg per day of Trilostane last Monday. She seemed to tolerate it well and the symptoms that tend to reappear approx 8 hours after her morning dose disappeared after her evening dose.

Monday, Tuesday, Wednesday, she seemed fine.

On Thursday Angelina was moving like she did before we started the Trilostane at 30mg once per day. Walking like an old lady dog. She only went for a very very short walk that morning (only as far as the front yard).

So I held off the Thursday evening dose. Gave her the Friday morning dose, as usual, and called the specialist, Friday afternoon for advice.

Unfortunately, he's on holiday until May 8 :eek:. So I asked for the resident also on the case - he's on holiday until next Tuesday :eek:. I asked the receptionist if there was someone else I could talk to - and she promised to have another specialist call me back.

I should mention that apart from a little geriatric leg action Angelina seemed fine. And I'm wondering if we've just unmasked some arthritis.

6pm Friday evening Angelina, though obviously quite eager for dinner, had turned up her nose at the usual food. I didn't know if that was due to:
1) the Trilostane affecting a dog's taste in food (as I've read in other threads)
2) the inappetance that can also be a warning of low cortisol or
3) the fact that I squeezed the contents of a fish oil capsule into it :)

4 hours after I called the specialist, I got a call back. :mad: Since it was now after 7pm - I'm thinking it was by a doctor whose shift had just started and had discovered my abandoned note.

Well these vets seem to all be cut from the same cloth as far as dosing is concerned. They're all telling me (despite my repeated concerns) that because Angelina's ACTH Stim numbers were quite high, her dose needed to be increased AND they have other maltese sized dogs on double that dose with no side effects. (I could almost hear him say "So there!") They would not recommend reducing her dose without an ACTH stim test. I should continue with the twice daily dose, keep a close eye on her, and bring her in if I have any concerns.

At 10pm Friday night - I offered Angelina her dinner again - which she finally ate - begrudgingly.

So today (Saturday) Angelina got her 6am morning dose with breakfast and her 6pm evening dose with dinner (at 6:41pm - I got home late) and she seems fine. She was VERY interested in the BBQ chicken I brought home. So no appetite problems - she would have eaten the whole thing if she could get to it.

In other news Angelina seems to be developing patches of slightly (so far) darker skin on either side of her abdomen.

I think that's all I have to report.

John II

[lulusmom]

Hi John,

Regarding information on twice daily dosing, check out page two of the monitoring flowchart for dogs whose clinical signs are not controlled for a full day. It say to slowly increase the dose and divide twice a day. In other words, if a dog is getting 60mg a day, you would increase to something like 80mg divided which would be 40mg twice daily. This is also recommended by UC Davis. This information is not really clear in the article included in the Vetoryl/Trilostane information posted by Marianne, I did verify the UC Davis protocol on twice daily dosing via an audio of one of Dr. Edward Feldman's lectures. He used that exact example I mentioned above.

If a post stim number is within the desired range of 1 - 5 but the dog is still showing overt symptoms, this is a pretty good indication that twice daily dosing should be prescribed. Angelina's post stim was definitely well beyond the desired range. The correct way to determine if a dog needs twice daily dosing is to do a urine cortisol creatinine ratio which requires that the pet owner bring in a urine sample collected the morning before the acth and before meds and meal. If the ratio is abnormal, that is a good indication that the once daily dose is not lasting through the night. It looks like your vet made the call to switch to twice daily dosing based solely on unresolved symptoms that could be explained by the high post stim number as opposed to proof that the current once daily dose was not adequately controlling the cortisol overnight. However, I do recall that you mentioned that Angelina's symptoms seem to get worse at night which your felt was a good indication that twice daily dosing may be necessary.

http://www.dechra-us.com/File/vetoryl_Treatment_and_Monitoring_Flowchart.pdf

Every dog responds differently and it could be that Angelina will do just fine on a 100% increase in dose; however, I personally don't think that a post stim number 13 ug/dl after only two weeks of treatment is high enough to make me feel comfortable with that kind of an increase. Just be ever vigilant in watching for signs that cortisol may be too low.

I'm not sure about that Trilostane affects a dog's taste in food. It sure had no effect on either one of my chow hound's taste buds. Their appetite did decrease by they never turned their nose up to food. This is definitely a sign that cortisol can be too low and you should never give Trilostane to a dog that is not eating normally. If either one of mine looked the slightest bit off and wasn't doing their normal head dive into the bowl, they were off Trilo for a few days or until they were back to normal. Try eliminating the fish oil on a meal and see if that makes a difference. If not then you can rule that out as a factor which would make Trilostane the bigger suspect.

I am about as far from a medical professional as you can get but I still respectfully disagree with your vets and don't think that Angelina's numbers were that high after only 15 days of dosing. All dogs respond differently to Trilostane so the fact that another Maltese has done well on the same dosing regimen is irrelevant. A perfect example is my two cushdogs. My 4.5 lb Pom was on 30mg once daily for two years and my then 10 lb Pom was on 15mg twice daily and both were effectively controlled.

You know Angelina best so if you think something is not right, and a cushdog that doesn't eat normally is not right, then don't continue to dose her.

Hope this helps.

Glynda aka The Oracle :p:D:p

[John II]

Glynda to the rescue! :)

So, going by the flowchart you basically stick to the initial dose for a full month, unless there are signs of:
1) Post-ACTH serum cortisol <1.45 μg/dL (<40 nmol/L) and clinically well
2) Corticosteroid withdrawal syndrome
3) Hypoadrenocorticism
(If its points 2 or 3 you discontinue the dose and have an ACTH stim test done to determine the problem).

However if:

Post-ACTH serum cortisol >1.45 μg/dL (>40 nmol/L) and clinically well*

But wait! I see an asterisk on the flowchart - which leads to:

* If the post-ACTH cortisol is >9.1 μg/dL (>250 nmol/L) and the clinical
signs of HAC are marked then you should consider a dose increase
at this stage. Increase dose by smallest increment possible.

So an increase after day 14 is advised? Since this is Dechra's chart the "smallest increment possible" they would be talking about would be 30mg? That's the smallest they are making now (from memory). If that's the case, unless I'm completely confused, then a 30mg to 60mg jump is what they are advising?

Note all the question marks? :confused:

So the problem at this point is not the increase in dose, but the splitting the dose in two? Which should only happen after day 30? Which leads to:

[QUOTE=Lulusmom] In other words, if a dog is getting 60mg a day, you would increase to something like 80mg divided which would be 40mg twice daily. [QUOTE=Lulusmom]

So, eventually the dose is likely to be bigger?

And as far as determining twice daily dosing:

[QUOTE=Lulusmom] The correct way to determine if a dog needs twice daily dosing is to do a urine cortisol creatinine ratio which requires that the pet owner bring in a urine sample collected the morning before the acth and before meds and meal. If the ratio is abnormal, that is a good indication that the once daily dose is not lasting through the night.[QUOTE=Lulusmom]

[QUOTE=Lulusmom] Just be ever vigilant in watching for signs that cortisol may be too low. [QUOTE=Lulusmom]

This morning after breakfast - and her morning dose - I took Angelina out for a short walk. The way she was walking was painful to watch. But I couldn't be sure if it was signs of "Corticosteroid withdrawal syndrome (“relative” cortisol deficiency characterized by weakness, stiff gait)" or Hypoadrenocorticism (e.g.weakness) - I hate the way the symptoms overlap! So. should I discontinue for a few days or rush Angelina off for another ACTH stim test? Or just cut back to the 30mg per day?

Last night's dinner was fish oil free and although Angelina paused to consider it - she did finish every bit of it.

Thanks Glynda for such a thorough response!

John II

[lulusmom]

Hi John,

Here in the US, a lot of vets (including UC Davis) use compounded versions of Trilostane when needing to adjustment a dose that isn't available from Dechra. Lulu was too small for the 30mg available from Dechra so we had no choice but to have her 20mg compounded. We ultimately increased to 30mg which is where she stayed until we switched to Lysodren almost two years later.

I'm glad that you took the time to check out the Dechra flowchart. The chart is meant to be a general guide but as my vet explained to me, you have to look at the big picture. She had never treated with Trilostane but after researching, she decided that it was best to have an acth stim test before starting treatment so that she would have a baseline to compare to the 14 day post stim test. This told her how quickly and how much the cortisol had dropped in a two week period. I hadn't found the cushings forum yet so I hadn't witnessed all the disparities from dog to dog when monitoring treatment so I was very grateful that she was so thorough. Jojo's cortisol continued to drop after the 2 week stim so had she increased his dose right away, his cortisol would undoubtedly have dropped too low. She did a great job considering Jojo was her first Trilostane patient.

Trilostane has a short half life and its enzyme blocking abilities start to diminish after 8 to 12 hours. This is why some dogs will eventually require twice daily dosing if symptoms don't resolve on a single dose. Since every dog is different, you don't know at which hour the Trilostane begins to wane so when you go to twice daily dosing, there are hour(s) in the day that there can be an overlap in dosing. This is why it is recommend that you up the dose a bit and split in two. Like I mentioned before, if a dog was at 30mg once daily, you'd up that to maybe 40mg and split it into 20mg twice daily. In essence you could have an overlap of a total of 40mg. If you simply double the dose like your vet did, a possible overlap would be 60mg. That's a big difference in my opinion.

Jojo was a mess when he first came to us and not only was he extremely weak in the hindquarters, he walked with an incredibly stiff gait. This is a rare symptom of cushing's called pseudomyotonia and sometimes it resolves once the cushing's is controlled and sometimes it doesn't. Jojo still walks like he is on pegged legs but his IM doesn't seem to think it has progressed or will be a problem for him in the future.

I hope all this makes sense but if not, Marianne is excellent in explaining much better than I can and hopefully she can clear the fog I've created in your head. I trip over my own words sometimes, become too verbose, lose my place, need access to spellcheck and eventually put people to sleep or maybe just into a catatonic state. :D

Glynda

[Roxee's Dad]

Hi John,
Glad to see you back. Can't help much with the once or twice a day dosing. I'm still trying to figure out what the best route is for Roxee. Thinking about a UTK panel but will make that decision within the next few weeks.

Regarding her apetite....When the trilo kicked in, Roxee got very, very picky about what she will eat. It has to smell good otherwise she would and still does walk away. Worried me at first but this was a good sign that the trilo was having a positve effect. I have her to 4 meals a day now trying to keep the weight on her. The more and more I read, this (weight loss) seems to be an unspoken side effect of trilo. Oh BTW - her potbelly is completely gone now.



Jojo was a mess when he first came to us and not only was he extremely weak in the hindquarters, he walked with an incredibly stiff gait. This is a rare symptom of cushing's called pseudomyotonia and sometimes it resolves once the cushing's is controlled and sometimes it doesn't. Jojo still walks like he is on pegged legs but his IM doesn't seem to think it has progressed or will be a problem for him in the future.

Glynda just gave me some homework, (pseudomyotonia) this is exactly Roxee's symptoms. Since starting treatment, it has improved somewhat. She doesn't hardly fall over anymore so hoping it continues to improve.

Well, keep up the good work with Angelina and keep us posted.

All the best to you and yours including a belly rub for Angelina (if she'll let you)
John (Roxee's Dad)

[John II]

Hello All,

Even before I read the 2 new posts, I just want to submit my apologies all round for my earlier post because I should not be trying to think this through on 3 hours sleep!

John II :o

[John II]

And now to continue...

I think that if Glynda is "The Oracle" then John must be "The Guardian" :D

This is tricky stuff and I wish I could find one of these "think outside the formula" vets that some of you have been lucky enough to find. Anyone know of one in Sydney?

Anyway - just a update about today. It's cool and windy here - which helps Angelina. Back on a single 30mg dose of trilostane. As the afternoon wore on, the trilostane wore off and the cortisol kicked in, she was walking straighter - still not great, but improved.

Angelina insisted on dinner at 4:30pm. Same stuff as yesterday - and the day before - but she didn't hesitate. And shaved about 15 seconds off yesterday's time.

After which she went for an afternoon stroll down the street and back. Less of an old lady dog than this morning. :)

From Roxee'sDad:
"When the trilo kicked in, Roxee got very, very picky about what she will eat. It has to smell good otherwise she would and still does walk away."

I knew I read that somewhere!

And I'm wondering if there's an Australian version of a UTK panel?

Actually Glynda, here in Australia we're in the same boat - our Trilostane is compounded too. Although I did find (on my wanderings this morning) a submission to the government to import Vetoryl into Australia dated just last February:

www.apvma.gov.au/gazette/0902downloads/page_16.pdf

"The Australian Pesticides and Veterinary Medicines Authority (APVMA) has before it applications from Dermcare-Vet Pty Ltd for approval of the active constituent trilostane and registration of products containing the active constituent trilostane. The products are VETORYL 120 MG CAPSULES, VETORYL 60 MG CAPSULES and VETORYL 30 MG CAPSULES. The products are for use on dogs."

We may be getting access to the name brand soon? Now we just need to convince Dechra to make it in 10mg and 20mg capsules! It also goes on to answer a few of those pesky exposure and environmental questions I had.

And apologies again to Glynda - my earlier sleep deprived brain misunderstood your reference to 60mg and 80mg doses - which I should have realised translated to 30mg SID becomes 20mg BID.:o

Believe me Glynda, as far as I'm concerned - nobody could be too verbose for my liking. Tell me more, tell me more! :D

John II

[BestBuddy]

Hi John,
I was lucky that I was close to the University of Melbourne and the specialists there, surely Sydney has something similar.
Dermcare-Vet was importing Vetoryl early in 2006 when Buddy was first diagnosed but they ran into problems and stopped being reliable so compounding was the only option. It was still possible to order from the UK for a short time but that loophole was soon closed unless you got through all the red tape and imported it yourself.
Jenny

[John II]

Hi Jenny,

Do you mean you got a UTK-type adrenal panel done in Melbourne? Or that the Melbourne University vets are the kind who actually do the right thing without having to be prompted?

John II

[lulusmom]

Hi John,

The University of Tennessee Knoxville (UTK) is the only facility in the world that does the adrenal panel. They also do the panels for patients all over the world. Shipping must be done properly so the cost to you would be higher but your vet can contact UTK and get instructions on what to do. Just remember that Angelina would have to be off of Trilostane for about a month before doing the panel.

Quite honestly, if I lived in Australia and my dog was not doing well on Trilostane for any reason or I suspected that my dog had elevated sex hormones, I think I would forego the expense of a UTK panel and consider switching treatment to Lysodren. Lysodren is very effective in controlling cortisol as well as the other adrenal steroids/hormones. Estradiol is the only sex hormone that can also be found in other bodily tissues outside of the adrenal gland but Lysodren is only effective in controlling this hormone if it is confined to the adrenal glands. I personally wouldn't be too concerned about that as I don't recall any members treating with Lysodren reporting that despite routine acth stim tests showing post cortisol within range, their dogs symptoms remained unresolved for over six months.

If you are still interested in the UTK panel, here is a link to their website and be sure to share this with your vet:

http://www.vet.utk.edu/diagnostic/endocrinology/index.php

If you are using a compounding pharmacy then I am unsure as to why they can't package 20mg capsules. Some pharmacies will also repackage for you so that might be an option if you and your vet decide to lower the twice daily dosing to 20mg. By the way, Dechra manufactures Vetoryl in 10mg, 30mg, 60mg, and 120mg capsules, however, the US has only approved the 30mg and 60mg capsules. I believe they are working on getting the FDA to approve the 10mg and 120mg.

Glynda

[MiniSchnauzerMom]

Hi John,

Although I've been following Angelina's story, this is the first time I've posted to your thread. Basically, I've just stopped by to say, "Hi...how are ya".


I wish I could find one of these "think outside the formula" vets that some of you have been lucky enough to find.

Good luck on your vet quest! I've been searching for 2 years....and I'm still searching for one who doesn't think one dog is an exact clone of all others!!! :(

Glad to hear Angelina was feeling a bit more chipper for her stroll. That's a good sign.

Take care,
Louise

[BestBuddy]

Hi John,
I have nothing but nice things to say about Buddy's treatment and care at Melb Uni and especially the specialist in charge of Buddy. I didn't know anything about the UTK type testing when Buddy was dx so I never asked but my special specialist was silly enough to give me his email address so I am going to ask. I will be back if I can get an answer.
Jenny

[John II]

Hello All,

Glynda,

Isn't it odd that only one place in the world does the UTK type Adrenal panel? If we weren't all losing our life savings paying medical bills :p we might otherwise be able to pool our resources and establish a grant to get more specialist hospitals the funds to incorporate this test into their practices. I'll keep that in mind for when I win the lottery. :)

I'll keep Lysodren on hold as an option - I'm beginning to think I may need a new vet to point me at a new specialist. Time will tell - but after sinking $2000 into this specialist so far (not to mention another $600 to the vet before that) I'm worried about starting over. Especially if you don't know what you're getting. New mantra: lottery lottery lottery lottery lottery lottery. I hate to be thinking about money - but seriously everytime I see a bill it's like the receptionist punched me in the stomach!

I haven't been directly to a compounding pharmacy - the specialist simply handed me a jar of 100 x 30mg capsules of Trilostane. The original label - including handling instructions was obscured by the new printed label for Angelina to take one per day. The only warning on the new label was "Keep Out Of Reach Of Children". :(

Louise,
Thanks for keeping tabs on Angelina's Tale (Angelina's tail keep curling up - so she doesn't seem too unhappy about things :)) and stopping by to say "Hi". As for me - I'm cramming information into my skull, confused, sleep deprived, frustrated, worried, sad, 8 kilos lighter since Christmas (forget the Atkins Diet! The Cush Dog Owners Diet is way more effective! :D)

Jenny,
Thanks for your help as always!

Thankfully Yours,
John and Angelina.

[BestBuddy]

Well I got a reply about something similar to the UTK panel from the best specialist in the world (in my opinion). It is not available in Australia but he did try to have run what he called the "17 OH progesterone" and was messed around by the pathology company and could not get the results. I guess it will be something hopefully that can and will be done here in Australia but it seems like it will be a long way off.
Jenny

[John II]

Well Jenny thanks anyway for checking.

Does it seem to anyone else as though the universe moves in mysterious ways to thwart Cush Pup Parents? Or am I just getting paranoid.
It should be much simpler than this!

John II

[John II]

Hello All,

I think my hair turned grey (greyer :() today.

Angelina was lying next to the fridge. Eventually, I wanted access to the fridge. Angelina tried to get up - but couldn't. She started screaming. Not a sound I EVER want to hear again. I helped her to her feet and the screaming continued. She could not use her front, right leg!!! :(:(:(:(:(

Had she somehow broken her leg? It was that bad! Had her bones become that weak? Had the Cushings advanced to the point where "weak and wobbly" had become much much worse? Had she lost the use of that leg? Was this the beginning of the end?

After a few minutes she settled down. Limped around a little. Went to the loungeroom and assumed the sphinx pose. I lured her forward with some mince meat. The gait was wobbly, but the front right foot was working again.

She had had such a good, quite energetic day last Thursday - I thought I was on the right track - finally. But since then, mostly geriatric again.

Angelina has always loved to rest against something. If you're sitting at a table, you will find ber resting against your foot, or your chair leg, or such. But if you make the slightest move, her self-preservation kicks in, she will over-react, yelp, and make a good attempt at biting your foot. Even if it was only the breeze created by the shifting of your foot, slightly ruffling the hair of her back. Heaven help you if you actually step on her hair! We don't know what would happen if you stepped on her.

It's not surprising - in retrospect - that she would scream the house down upon discovering that her foot had gone to sleep. :o I hope that's all it was.

My specialist is still missing in action - today I learned he's overseas. "Call me if you have any questions" he says! :mad: I'm going to take her in tomorrow, get her electolytes and biochemistry checked out. Probably get an ACTH Stim test done as well if I can. Her liver enzymes have me worried.

The weekend reception can't take appointments - so I'll have to call bright and early tomorrow. Just have to decide if I want to enlist another one of their specialists as well as the resident I've been dealing with.

Since reading Roxee's Dad's thread about good days/bad days on Trilostane, I'm wondering if I jumped the gun by dropping Angelina back to 30mg per day. At 60mg she was good for 3 days - then she was an old dog - now back at 30mg she's become an old dog anyway! Argh!

If I ever meet Mother Nature she will have some explaining to do!

Angelina has developed darkening patches of skin on both sides of her distended lower abdomen (Does anyone know what that might be?) looking like large light bruises.

I was looking at her, once she had calmed down and it seemed as though some of her hair is becoming darker - tanner? Might have been a trick of the light. It only seemed to be happening on the right side of her back.

What a day!

John the Grey

[Roxee's Dad]

Hi John,
Sorry to hear Angelina is in some pain. Hope her leg gets better soon and doesn't turn out to be anything serious. If the acth comes back within the desired range, it could be that the lower cortisol levels have made Angelina start feeling her aches and pains that come with age.:(

Regarding the dosing - I believe the acth stim results should guide you. If you think she is feeling the aches and pain of being a senior, you might want to consider a trial/test run of some pain meds or supplements. I had Roxee on metacam for over 3 weeks but saw no changes or improvements, so I discontinued use. I wanted to see if it was muscle weakness or pain that caused her walking problems. Still can't rule out neurological problems but really can't afford 1500 dollars for an MRI and what would that tell me to do for my almost 14 year old pup? My number one priority is her comfort and quality of life. We are about a week or 2 from our next acth stim test. I didn't want to wait the full 90 days so we are going in a little early. (I am still buying lottery tickets):D Hoping to hire my own full time vet:rolleyes:

The skin pigmentation thing.... I have read this as a side effect of using the meds. Roxee's skin was really pink at one time and has now tuned darker in spots around her sides and belly. The hair regrowth seems to be mostly her white hair but very little regrowth of the black hair:confused: I have also read that some others experience a change in color, and texture of the hair. Around here it is commonly and affectionately called "Cush Fuzz"

I hope that Angelina's test results help your decision and thought process. From the many threads I have read on cc.net, some pups do better on the higher end and some do better on the lower end of the desired results range. So there comes in the tweaking, once a day, BID, how many mg's in the am and how many mg's in the pm??????:confused::confused::confused:

If you have been following "Jesse's thread, this seems to be the million doallar question, I believe we are all waiting to see what updated info that Katherine "Border terrier and Lysodren-UC Davis" can get regarding an updated UC Davis protocol on Trilo dosing.

Keeping good thoughts and Prayers for you and Angelina.
John (Roxee's Dad)

[frijole]

John,

A couple thoughts. Remember that the excess of cortisol in the system BEFORE treating helps to mask pain. (arthritis, old age joint issues etc.) so when you treat the cushings and lower the cortisol level the pain sometimes is revealed. Many of us use glucosamine, fish oil etc. to supplement and aide with pain management. Others have found help with arthritis medication.

Re the skin discoloring - I have been told this is just common old age spots. I didn't notice it til the cushings either however my other dog now has the same thing so I tend to believe that's what it is. They have spots of all shades of dark and sizes. They are schnauzers - white and silver.

Hang in there. My cush dog is nearly blind and deaf now and she likes to stand by my feet at the frig too (piggie she is) and I have hit her with the door and nearly stepped on her a hundred times... so you aren't alone.

Hugs
Kim

[forscooter]

Hi John...

I feel your pain.....and Angelina's pain....and the gray hair....it's a side effect of being a Cush parent ;). I have blonde hair, or used to, so I just call them my "highlights". :cool:

The arthritis thing can be tricky and it sounds like that may be the issue. I used the glucosamine and fish oil supplements and they seemed to help a little. But there were still days....others have used different medications and supplements and it's just a matter of what will work for you. It can take 4-6 weeks to see a difference with the glucosamine route but I think worth it.

On really bad days, I give Bailey a dose of Metacam. Only with a full belly of food though to coat his stomach. It seems to help him a lot. I used to have to do the same with Scooter.

I am not an advocate of doing this....BUT....with Bailey, I do dose him where I think it keeps the Cushing's in the best control we can while helping not bring out the worst of the arthritis. It's been quite rainy here and he has been hurting the past few days. I am not backing off the Lysodren though bc of the Cushing's but rather using the Metacam sparingly.

If you get the ACTH done, and Angelina is at the low end, you may want to discuss the possibility with your vet's input about letting her run a little higher.

Sending my most soothing thoughts to you both!!!
Hugs, Beth, Bailey and always Scoobie

[lucygoo]

Hi John....Sorry to hear Angelina's got some pain. I just wanted to pass along what really helped my dog when she went through a bout of bad arthritis about a year ago, when we were trying to get her trilostane dose worked out. My vet prescribed Cosequin, which is a prescription only heavy dose of glucosamine. They come in chewables as well as regular pills. It took about a month to 6 weeks to work, but it helped her 100 percent. She was like a new dog. If you haven't already tried this, I would check it out. It's a little expensive, but it really worked for my Lucy.

Good luck...
Gina & Lucy

[John II]

Hi Everyone,

Thanks to all for your helpful replies. I'm calmer today, and although Angelina insists on sleeping on her right side - the lameness hasn't recurred (phew) - I've opted for a little more observation, rather than testing just yet. Fingers crossed and knocking on wood. :)

Gina & Beth & Kim & Brother John - thanks for the medication advice. My aim is the best quality of life for Angelina - this just keeps getting trickier and trickier! Lower the cortisol - but not too low! Sheesh! :)

Kim & Brother John - thanks for the reassurance regarding the worrying spots!

Brother John - I like your lottery plans - full time Cushings vet (I'll add in residence to the scheme)! Now there's a plan! :D

Can't wait to see new UC Davis info - hope Katherine can her her hands on it.

Thanks again,

John the Grey

[John II]

Hello All,

Not much to report at the moment.
5 Weeks into treatment, at (except for a brief increase) 30mg of Trilostane a day Angelina:
* Has gone from demanding breakfast at 4:30am to calmly awaiting breakfast at 7am (less calm as 7am approaches).
* Water intake has gone from a litre (plus) per day to around 700mls per day.
*Energy levels are erratic - more one day - less the next.

Took Angelina for an ACTH Stim test today - results hopefully tomorrow.

John the Grey

[Roxee's Dad]

Brother John,

Good to see some positive signs:D:D:D:D

Keeping fingers and 16 paws crossed for good stim results.

John (Roxee's Dad)

[John II]

Hello All,

The Specialist called with the ACTH Stim Test results today:
7 May 2009 results:
Cortisol resting 78 nmol/L (or 2.82 u/L) (normal range is 15-170 nmol/L)
Cortsiol at 1 hour 337 nmol/L (or 12.21 u/L)

Previously on 14 April 2009 the results were:
Cortisol resting 157 nmol/L (or 5.69 u/L)
Cortsiol at 1 hour 382 nmol/L (or 13.84 u/L)

Electrolytes on 7 May 2009 were:
Na (Sodium) 144 mmol/l (139-153)
K (Potassium) 5.6 mmol/l (3.9-5.9)
Cl (Chloride) 108 mmol/l (93-122)

Previously on 14 April 2009 the results were:
Na (Sodium) 145 mmol/l (139-153)
K (Potassium) 5.9 mmol/l (3.9-5.9)
Cl (Chloride) 107 mmol/l (93-122)

So not a lot of difference with the Electrolytes.

Other points during the phone call:

• The Specialist advised going back to the dosing of 30mg of Trilostane every 12 hours. I told him about Angelina’s weakness after 3.5 days of double dosing and said I would prefer us to try 20mg of Trilostane every 12 hours. He replied that would not be his recommendation (and I should have come in for an ACTH test at that time to try to ascertain the cause of the weakness) but if that was my wish – he would order the 20mg capsules for me (they would take a couple of days to come in). So I don’t know if that was a victory or not. A daily increase of Trilostane – but a small increase. Am I going too slow?

He also gave me the option of ordering the Trilostane in liquid form – which would make dosing changes easier – should they be necessary. But, I thought, at least with capsules, I know when Angelina has swallowed them.

• I mentioned her leg problem last Sunday – he said that the disease made them more susceptible to blood clots. BLOOD CLOTS!!! :eek:


I think the 2nd ACTH Stim Test has hit Angelina harder than the first.
Yesterday, Angelina:
• seemed quite weak when she was walking outside to do the necessary.
• Was behaving a little oddly – in that she was trailing me from room to room.
• Panting more than usual – but that’s to be expected with the stim.
• Seemed confused.
Today she:
• Slept in to 06:55am – the latest so far
• Seemed duller – except when food is offered
• Didn’t want to go for a walk (only went as far as the patch of grass in the front yard – which she anointed – twice). I walked on – she stayed put – I walked back and she followed me home.
• Continues to follow me around today - trailing me from room to room. Sleeping next to my foot right now.

Regards,

John the Grey

[Roxee's Dad]

Hi Brother John:)
Have to run and groom some pooches but I wanted to say that I think the conservative approach is good one. Angelina's post acth didn't drop much but at the same time with a slower drop, she won't or shouldn't experience the quick cortisol withdrawl. Just my opinion.

Yeah and Stim days are always rough on Roxee:( but she has did recover quicker on the last stim day.

Check in with you later. Belly rubs to Angelina (if she'll let you):)
John (Roxee's Dad)

[John II]

Hi right back at ya Brother John,

Thanks for stopping by!
You and Roxee are the touchstone for me and Angelina :)

John the Grey

[Squirt's Mom]

Hi John,

I don't post to you much as I don't have much to offer but I do keep up with you and Angelina.

Brother John is right on the mark with starting slow, tho, and I agree with him on that approach. We often see Trilo pups go through the withdrawal of a rapid cortisol drop and by going slow, Angelina may well be spared this.

I did want to let you know that some pups do have problems with the stims the day after or so. The purpose of the test is to stimulate all the things we are trying to control to see how they react under treatment. So, in essence, it is a stress test for the adrenals and they don't always appreciate it! Over simplified, but you get the idea. :rolleyes:;)

You're doing a great job, John. Keep up the good work!
Hugs,
Leslie and the girls

PS. "John the Grey"....I just gotta know; is that a reference to Gandalf the Grey?

[Roxee's Dad]

Hi Brother John II (The Grey) or is it Gray?

Long day today, did a mercy groom today, a 14 year old lab that's never been groomed or had a bath:(. Felt really bad for him, did a shave and removed about a million ticks that have been living in those mats for years. Soon as he got out of my van, he went and rolled around in the grass, I swear he was smiling, gave me a few licks before I left. Guess I made a friend for life:D

Anyway, I was wondering about cushings and the blood clot thing, haven't ever read about that anywhere so was wondering if anyone else has had that experience or knowledge? :confused::confused::confused:

Roxee has become very clingy also, follows me around, cries and moans (blood curldling scream) if we're not in the same room with her. Besides being totally spoiled, I think it just gives her a comfortable feeling to know we are here with her. Probably the same for Angelina, after all, you are her hero. Roxee does like to hang around wherever the food might be:p

How is Angelina's weight, have you noticed any decrease in her belly? We're still trying to keep the weight on Roxee, she get 4 full meals a day:eek: Managed to put a quarter pound on her in the last week. Up to 13.25 pounds now.

I guess you and Angelina are going to be a case study.:eek: I know alot of us will be watching to see how it goes. Starting with 30 mg per day (not enough), going to 30 mg twice a day (too much) and now 20 mg twice a day. Please do keep us up to date on any changes and results.

Hoping Angelina is doing better and continues to do so.
Take care.
John (Roxee's Dad)

PS: Have you heard from Scot and Yanni the other Sidney(ite)?

[AlisonandMia]

Anyway, I was wondering about cushings and the blood clot thing, haven't ever read about that anywhere so was wondering if anyone else has had that experience or knowledge?


You saw that in that power point too. My understanding with the Cushing's and blood clot thing is that it is really quite rare in dogs although just occasionally a Cushing's dog will throw a clot - or it is thought that this is what has happened. However with cats clotting with high cortisol levels (or when on high doses of steroids like prednisone) is quite common and often is the first tip-off to the fact the cat is Cushingoid. I get the impression that cats are a particularly clot-prone species and seem to suffer from clots as a result of quite a few medical conditions, not just Cushing's. They particualry get something horrible and agonizing called "saddle thrombosis". With Cushingoid humans, clots are far more of a risk than they are in dogs but possibly not quite as likely as for cats.

Interestingly humans with high corticosteroid levels are very likely to develop psychiatric disturbances (mania, severe agitation, intense irritability and even rages etc.) whereas, thank goodness, dogs are not particularly prone to that type of symptom - beyond a bit of restlessness in the evenings they almost always remain more or less their usual sweet selves.

Alison

[John II]

Hello All,

Hi Leslie and The Girls :)
Thanks for the information with regards to the stim test. And the hugs - need the hugs! :D The John The Grey is just a reference to my own growing greyness (although I have seen the movies so... maybe it stuck in my head ;))

Hi Brother John The Good,

In Australia I'm John the Grey, if I was visiting the US I'd have to covert that to John the Gray :D

Nice work on the Old Lab! :) You are truly a good man!

I hadn't heard about the blood clot thing either so it was all a bit "What next?" to me. I'm hoping she was just lying on the edge of the rug, it dug into her leg enough to cut circulation and put it to sleep. I'm hoping.

I think I read somewhere that Trilostane can cause behavioural changes - but whichever article it was - they didn't give examples. Of course, since late January, I've been taking over ALL the feedings - so that could be a factor ;)

But then again - it's only been happening since the last testing. (sigh) lots of questions - few answers!

Angelina's weight was almost exactly the same as last time 13.02kg last Thursday versus 13.04kg the time before that. Her belly seems to be the same football it has been.

I'd much rather Angelina was a success story than a case study - but we have to wait and see how this all turns out. It's good to know a lot of fingers and paws are crossed for her. :)

Since Scott and Yanni's first contact, I haven't heard from them - which is a pity because I think Scott has a story to tell.

And Alison,
You are simply amazing with your inter-species cushings knowledge! ;)

John The Grey & Angelina the White
(who is amazed that he managed to write all that before his computer could crash for the 7th time!)

[labblab]

Hi John,

Here's a link to a study that I had seen a while back that discusses the association between Cushing's and blood clots. It is directed towards the implications for humans, but as you will see, the study was performed on dogs with naturally-occuring Cushing's Syndrome. So if you are interested in plowing through it, it may help clarify the linkage between the disorders:

Biochemical Basis for the Hypercoaguable State Seen in Cushing Sydrome (http://archsurg.ama-assn.org/cgi/reprint/136/9/1003.pdf)

I was interested to see that "our" Dr. Feldman (the UC Davis specialist who we so often quote here) was one of the authors.

Marianne

[Roxee's Dad]

Thanks Marianne and Allison,
I learn something new everytime I visit here. I had to read the paper a few times to begin to comprehend :o but managed to get the jist of it.:)


John II AKA The Grey - How about a case study of a success story:D

John (Roxee's Dad)

[AlisonandMia]

The weird thing with both dogs and humans showing the same biochemical changes re being in a hyperchoaguable is that clots are so rare (but not unheard of) in Cushing's dogs whereas in humans it is a very real danger that makes the risks of using heparin worth taking. There must be other factors at work. High cortisol levels seem to affect different species in slightly different ways.

Alison

[John II]

Hello All,

Update Time.

On Monday afternoon, I got a call from The Specialist's Office that the 20mg capsules of Trilostane had arrived. I went to collect them shortly after - and resisted the urge to give her a dose that evening.

Breakfast time Tuesday morning, I started the 12 hour dosing of 20mg.

This morning (Wednesday) Angelina was interested in going for a walk, and walked with some improvement, compared to the last time (on Sunday). She seemed fine all day.

But... 30 minutes ago, after lying on her side for a while (post dinner snooze- and about 2 hours since her second dose of the day) she got up and was walking with difficulty. I'd say with a limp, but I'm unsure which leg to blame a limp on.

I just watched her get up to change position, and the limping continues. Very old lady. :(

This hasn't really happened to date.

Could this be:
* A slight increase in Trilostane?
* Progression of the disease?
* Arthritis being unmasked?
* A clot?
* A reaction to colder weather (currently 15 degrees celsius/ 60 degrees farenheit)?

I didn't want to be hopeful so early after a change in dose - but it's really unfair for things to get worse so quickly! :(

She wanted to go on the couch and I lifted her up and covered her up to keep warm - but a few minutes later she wanted to be lifted down again, and is back to lying on the floor. Seems she can't get comfortable.

John the Greyer and Angelina :(:(

PS: Thanks to Marianne for the clot homework :)

[John II]

An update to my update:

I forgot to mention that Angelina's abdomen seems to have more of a bulge to the left side. Is this familiar to anyone? I initially thought it might be a trick of the light (like when I thought her hair was changing colour) or just the way it appeared when she was moving - but now I'm not so sure.

Angelina has gone to bed now - but keeps changing position as if she can't get comfortable.

And I'm worrying that Trilostane is reacting with a pre-existing condition.

[AlisonandMia]

I forgot to mention that Angelina's abdomen seems to have more of a bulge to the left side. Is this familiar to anyone? I initially thought it might be a trick of the light (like when I thought her hair was changing colour) or just the way it appeared when she was moving - but now I'm not so sure.


I think if you think you are seeing something then it is there - that has been my experience overwhelmingly. Some things are so subtle especially at first that you begin noticing them on an almost subliminal level but almost invariably it becomes clear that there really is something there. If she is sore it could be a result of how she is carrying herself - ie curving slightly to one side so a leg doesn't hurt. Do you notice it more at some times that others such as after meals or whatever? It sounds like something to draw your vet's attention to.

I believe that front-leg lameness (this is what Angelina has isn't it?) can be a result of a neck problem: http://www.dolittler.com/2009/05/12/Collar-safety-in-dog-training-and-in-real-life-A-veterinarian%E2%80%99s-take.html (This is specifically about neck injuries from collars but it mentions symptoms of neck injuries and I'd think the same would apply with arthritic/degenerative neck problems.) Her inability to get comfortable sort of fits with neck pain/discomfort - there is nothing like an uncomfortable neck to make anyone restless.

Hope this helps.

Alison

[Roxee's Dad]

Hi John (The GREY)


Could this be:
* A slight increase in Trilostane?
* Progression of the disease?
* Arthritis being unmasked?
* A clot?
* A reaction to colder weather (currently 15 degrees celsius/ 60 degrees farenheit)?


I wish I could help you but it sounds like it could be any one or more of the above. This is so wierd because Roxee has the same type problems.


ie curving slightly to one side so a leg doesn't hurt. Do you notice it more at some times that others such as after meals or whatever?

Roxee stands with a curve and it seems one side behind her ribs is caved in or one side is a little more plump. Vet took x-rays a few months ago, of her hind leg and pelvis but could find nothing wrong :confused::confused::confused: Bad day yesterday, she could barely stand without falling over. Looked like she hurt her left front leg. We are doing a stim on Thursday and I was afraid we might be changing from stim to crossing the Bridge. She got a good nights rest and is walking better today :)

Regarding covering with a blanket, I've read and also by experience with Rox that cush pups have a hard time dealing with the heat. Roxee prefered to sleep and rest on the coldest part of the floor even in the winter. I was wearing 3 pairs of socks but Roxee just prefered the cold floor to a warm spot or a blanket.

So Roxee is still having good days and I get so hopefull, then she has a bad day and I get depressed but then remember what Leslie said. "On the bad days, remember the good days." and I regain hope.

Now Allison seems to have given me some homework and I need to check out the link she provided.

BTW- has Angelina ever had any leg, more specifically ACL (knee) problem? Roxee blew out her ACL some years ago and it seems this is fairly common in cush pups. She now carries that leg stiff as a board, as Glynda calls it a peg leg.


And I'm worrying that Trilostane is reacting with a pre-existing condition.

Yes, I have been wondering the same thing about Roxee. With the constant struggle to keep her weight on her, 4 meals a day. The struggle to keep her balance and walk, I wonder about the other hormones the adreanal puts out. I've read so much about this and that's why I was and still am considering the UTK panel. The ultrasound was good to have done, but in retrospect, I should have spent the extra dollars to do the UTK panel in addition. I think it's the only way to be absolutely sure. Just my opinion, but I think alot of us get lucky with the standard testing and ultrasound but the UTK results would eliminate alot of the what if's and would most probably give me / us some peace of mind.

Well, sorry I was so long winded, I really hope you see improvements in Angelina. I know you must feel so confused and helpless sometimes as I do but we do the best we can. If only they could talk to us and tell us what hurts.

Keeping good thoughts and prayers for Angelina and You.
John (Roxee's Dad)

[John II]

The following was written about 5 hours ago...

Hello All,

I spent last night in cat-nap mode, alert to any sound, real or dreamt.

Angelina spent the night on the queen-sized bed of another member of the household. I was up every hour or less to check on her. Whenever I did I was worried to see her position on the bed changed and her eyes wide open.

At breakfast time, I skipped the Trilostane dose.

A few hours later, Angelina let it be known that she would be interested in a walk, if anyone was interested in taking her. But she only went about half the distance she did yesterday.

I was out grocery shopping for a couple of hours – all the while worrying what I would find on my return. But – I found her improved. Her lameness seemed to have eased.

Especially when offered her favourite lunch of BBQ chicken. Excitement seems to ease the symptoms.

The downside of giving Angelina her favourite lunch, is her turning up her nose at the dinner of canned food. I tried tempting her with some more chicken bits on top – she ate the chicken, but left (most) of the rest. We skipped the dinnertime Trilostane dose as well.

Oddly, now as day turns to night, it seems as though the lameness is starting up again!

So now I don’t know what to think.

Alison – you’re feeding my paranoia! So far I’ve only noticed the abdominal bulge at random times – just when I happen to be watching her walk – I haven’t found a pattern as yet.

Neck problem? EEK! I can think of three incidents in the last 9 months or so. The dog attack where the vicious (censored) dog had her by the throat – while the other (censored) dog had her by the ribs. And two separate tumbles she took (Angelina is not always the most graceful girl) – one of these falls a foot or so drop onto concrete (she was watching the food – not the ground). Of course the cortisol may have been masking all this until now.

Thanks for the link!

Brother John – sorry to hear that Roxee had a bad day. It just tears your heart out doesn’t it? Hope she has many more good days!

Having read all these Trilostane “the miracle drug” testimonials online, the reality of it is kind of underwhelming. I keep wondering what would have happened if I’d taken the path my Vet suggested and gone with Lysodren in the first place? Would Angelina be better off? Or would she be gone already? Second guessing myself as always!

I don’t think Angelina has an ACL problem – in her early days she would launch herself off the couch or the beds without regard for the consequences. A few years into dog ownership I started using a couple of couch (seat) cushions (wide and rectangular and flat) as Angelina landing zones. She avoided these obstacles at first, but gradually realized it was a softer landing. I hope this means less impact to her joints.

However her other tumble (a few months back) was off these cushions, when I had stacked the two on top of each other – trying to make steps from the floor to the bed (when she was still making the attempt herself). Getting up later that night she hadn’t expected the additional height! Double eek!

So neck problem? Maybe. ACL problem? Maybe.

Thanks for the good thoughts and prayers!

John (the confused and greyer) and Angelina.

[John II]

And now, 5 hours later I'm wondering if I'm onto something.

Angelina's lameness seemed to decrease as the day warmed.
And then it seemed to increase as the day cooled.
Maybe there's no relation to the Trilostane at all?
Maybe it's all just the cold getting into her old bones?

Which, if it's true would be just ironic - I spent all Summer wishing for Winter - now I may just spend all Winter wishing for Summer... or central heating.

John & Angelina

[Patricia ann Wh]

Hi John,

I've been keeping up with your story.

My guy, Jesse is going through the same ups and downs.

When he collapsed on the 5th day of trilostane -(we started at 15 and 15 mg a day when we went to 30 - 30 he collapsed. I stopped and he got better and better.
I restarted about 5 days later ( my notes aren't in front of me) at 15 mg. (he's 85 lbs) a day and the first 3 days he was great, on the 4th day he could barely get up.!!!

So, I thought the 15 mgs was the ticket.
But because he got so weak on day four of the 15 mgs. that also had to be too much.

Now, 2 days off and he is better.

I don't know - I just don't know.

Patti and Jesse:p:)

[Patricia ann Wh]

Have you seen this below - just to add to our confusion:confused:

http://www.justanswer.com/questions/135mx-dog-weight-45lbs-taking-vetoryl


Question
My dog weight 45lbs and taking vetoryl 60mg every 3rd day. His clinal sign is good with the meds. that he is on. Should I lower the dosage to 10mg per day instead for 60mg every 3rd day?

Patti and Jesse

[Patricia ann Wh]

Hi John, I thought this was interesting too. The paragraph is from the link below.

http://www.dcavm.org/04sept.html

Currently, the recommendations of this author are based mainly on those of Dr. Reto Neiger who has the most experience in using this drug.20 Recommendations are to start administration of trilostane (2-10 mg/kg) once daily. If minor side effects are seen, stop the drug for 3-5 days and then restart giving trilostane every other day for one week before continuing with the initial dosing scheme. An ACTH stimulation test should be performed at 10-14 days, 30 days and 90 days after being on a full dose of trilostane. The test should be performed 4-6 hrs post-pill. If the post-ACTH cortisol concentration is <20 nmol/L, stop the trilostane for 48-72 hrs.20 At this point, Dr. Neiger recommends restarting the trilostane at a lower dose20, but given the long-term suppression seen in some cases, I believe that, ideally, an ACTH stimulation test should be performed and trilostane should not be reinstituted until cortisol secretion has recovered. If the post-ACTH cortisol is >200 nmol/L, increase the dose of trilostane. If the post-ACTH serum cortisol concentration obtained is between 20 and 200 nmol/L but the clinical signs are continuing, then twice-daily therapy should be used. The same dose that was given once-daily should be given twice (e.g. if giving 30 mg once daily then double it to 30 mg twice daily). Once the clinical condition of the dog and the dose have stabilized, an ACTH stimulation test should be performed every 3-6 months and serum potassium concentration should be measured to check for hyperkalemia.

RESTART EVERY OTHER DAY FOR ONE WEEK.

HAVE YOU HEARD OF THAT ONE?
Whew - its endless

[Roxee's Dad]

Hi Patti and John,
Hope I'm not hijacking your thread John;) but yes, this can and sometimes is so confusing. Like has been said so many times, every pup is different and maybe just maybe, Jesse and Angelina may need more exact dosing. maybe 10 instead of 15 for example:confused::confused::confused::confused:

Roxee doesn't show any symtoms of overdosing, her or our problem is that she went untreated for over 2 years and was very weak and lethargic before we started treatment. I am just hoping it isn't too late for a decent recovery. We are off to the vet's now for her stim, it's about a month early but I've noticed some increased panting in the evenings and increased thirst. But still, she is better today than she was in Jan.

Will check back later, we are off to the vet for a stim and electrolyte check.

John (Roxee's Dad)

[Squirt's Mom]

Hi John,

You may have missed this info posted by Kathy about Trilo (Vetoryl):

http://www.fda.gov/cvm/CVM_Updates/D...ingDisease.htm

http://www.fda.gov/cvm/FOI/141-291o120508.pdf

These studies are more current than the links posted by Patti and are associated with the approval of Trilo in the US.

I am sorry Angelina is having so much trouble getting on her feet. I hope you see an improvement soon in all areas.

Hugs,
Leslie and the girls

[Patricia ann Wh]

Hi Leslie and Girls and John,

Please don't get me wrong with my info. I just spend every minute it seems reading and trying to understand this whole thing and try to understand more for my guy Jesse. It seems some have such great luck with trilostane.
So - I'm looking at what the possibilities could be when things don't go quite so perfect for us.
So, do you think if the 4th day of trilo and the legs get weak - stay on it??
His legs are weak already - they are definitely more weak after the trilo.
I've read stories where people say their dogs legs are weak before - but after time they do get a little better - but they didn't say if the legs got worse and they stuck with the trilo or if they did not see weakness at the beginning of the trilo. Can anyone understand what I'm talking about?? I'm not sure I'm clear.

Thanks, Patti and Jesse

[Patricia ann Wh]

Hi John,

Jesse and Angelina may need more exact dosing. maybe 10 instead of 15 for example

Have you ever read where a dog Jesse's weight has been on something as low as 10 mg. a day??

Patti and Jesse

[labblab]

Hi John, I thought this was interesting too. The paragraph is from the link below.

http://www.dcavm.org/04sept.html

Currently, the recommendations of this author are based mainly on those of Dr. Reto Neiger who has the most experience in using this drug.20 Recommendations are to start administration of trilostane (2-10 mg/kg) once daily. If minor side effects are seen, stop the drug for 3-5 days and then restart giving trilostane every other day for one week before continuing with the initial dosing scheme. An ACTH stimulation test should be performed at 10-14 days, 30 days and 90 days after being on a full dose of trilostane. The test should be performed 4-6 hrs post-pill. If the post-ACTH cortisol concentration is <20 nmol/L, stop the trilostane for 48-72 hrs.20 At this point, Dr. Neiger recommends restarting the trilostane at a lower dose20, but given the long-term suppression seen in some cases, I believe that, ideally, an ACTH stimulation test should be performed and trilostane should not be reinstituted until cortisol secretion has recovered. If the post-ACTH cortisol is >200 nmol/L, increase the dose of trilostane. If the post-ACTH serum cortisol concentration obtained is between 20 and 200 nmol/L but the clinical signs are continuing, then twice-daily therapy should be used. The same dose that was given once-daily should be given twice (e.g. if giving 30 mg once daily then double it to 30 mg twice daily). Once the clinical condition of the dog and the dose have stabilized, an ACTH stimulation test should be performed every 3-6 months and serum potassium concentration should be measured to check for hyperkalemia.

RESTART EVERY OTHER DAY FOR ONE WEEK.

HAVE YOU HEARD OF THAT ONE?
Whew - its endless
The varying research recommendations regarding trilostane do seem pretty overwhelming, don't they?? And there certainly has been some evolution along the way. The "Dr. Neiger" who is referenced here conducted some of the very first research that was performed at the Royal Vet College in London, and his study results were among those upon which the first Vetoryl dosing recommendations were based. Many of the recommendations contained in the 2004 paragraph that Patti has cited remain part of Dechra's current Vetoryl dosing protocol. But there are some that have been revised as a consequence of subsequent studies.

For instance, you'll see that the 2004 recommendation was that if the decision was made to shift to twice daily dosing, you actually DOUBLED the daily dose (rather than dividing the once daily dose in half). Since my dog started on trilostane right at that time, that is precisely what we did with him. The recommended once daily dose for his weight was 120 mg., so we added another 120 mg. at night (can you believe we were giving a 70 lb. dog 240 mg.?). Even at that whopping dose, he never had an ACTH "post" result that was less than 6 or 7. (But that is a whole other story...). I absolutely CRINGE now when I think that we were giving him that high of dose. But that was the protocol at the time, and he actually did very well on it for several months.

Anyway, that is one of the reasons why we are trying to track down and document for our members the most recent studies and clinical protocols. Because there have been changes along the way, just is the case with any evolving medical treatment.

Marianne

[Patricia ann Wh]

Hi Again,

Did I tell you Jesse is 85 lbs.

Oh - and I once read about a dog that was on 33 1/2 mgs.

Yeah, the article said that 30 was too low and 35 was too high!!!!!!!

But 33 1/2 was perfect!!! It was an article written by a vet. (Have no idea where I read it)

But - I found that amazing. Actually, almost scary. The fact that such a small dose could make such a difference!!!:eek::eek::eek:

Patti and Jesse

[Roxee's Dad]

And now, 5 hours later I'm wondering if I'm onto something.

Angelina's lameness seemed to decrease as the day warmed.
And then it seemed to increase as the day cooled.
Maybe there's no relation to the Trilostane at all?
Maybe it's all just the cold getting into her old bones?

Which, if it's true would be just ironic - I spent all Summer wishing for Winter - now I may just spend all Winter wishing for Summer... or central heating.

John & Angelina

Hi John the Grey,
Sometimes we may over think things. Sometimes we just need to take a day to enjoy our time with our pups. Pretty much what you did with Angelina, I did with all my pups today. They were treated with a trip to Burger King. You would have thought they got the lunch of their lives:D:D:D They enjoyed it and I enjoyed watching them enjoy it.
All the best to you and Angelina, Belly rubs from me if she'll let you:D
John (Roxee's Dad)

[John II]

Hello All,

My, hasn't there been a lot of activity here on Angelina's thread! :)

Patti - Jesse's story of an 85lb dog collapsing on 60mg per day is the stuff my nightmares are made of! :o I see Angelina's numbers still being too high, but I fear the dose increases. Angelina gets wobbly - starts limping... which of several possible reasons is it? On the other hand we have 13lb Roxee on 40mg per day!

So far at the first sign of a negative reaction - I've shut the experiment down! Haven't figured out if I'm cowardly or prudent ;)

I took Angelina to the local vet this afternoon - just to get her leg checked out. After an examination, he suspects an old dog with an old joint. She was so worked up about being in her least favourite place that her limp disappeared :o - I asked the vet about a limp being the sign of a possible neck injury - he said that if that was the case, the limp would persist regardless of her stress levels. He gave her a shot of Meloxicam and suggested I start giving her glucosomine (at a quarter of the human dose).

I asked him about the bulge (I'm not sure I'm seeing) on her left side - he felt her abdomen and reported a very large liver and a very large spleen :(.

I share your confusion Patti - big time!

Leslie - as always thanks for the links and the hugs!

Marianne - I've been thinking about your preference for SID versus BID - and I initially thought that logically, keeping the cortisol levels fairly constant via BID dosing was the better option. But now I'm wondering if upping Angelina's dose to 40mg SID rather than 2 doses of 20mg would actually be easier on her system somehow? She would have the 24 hours for it to wear off...
All I know, is that she handles 30mg once a day well - but both times we've gone to twice a day dosing, whether it was 30mg twice a day or 20mg twice a day - she started getting the wobblies. What do you think?

And Brother John - I hope Roxee's results will be perfect - please let me know.;)
I am the king of overthinking things :D Waking or dreaming I'm thinking about this. You are wise - let us all take the time to enjoy our puppies! And give them special treats whenever possible. Angelina prefers KFC :D

Whatever the outcome I know Angelina has had a good and happy life - I just wish we could have made it to the finish line with a perfect record of happiness. To see her like this breaks my heart. :(

Thanks again one and all,
John the Grey and Angelina.

[Squirt's Mom]

Hi John,

Bless your heart! What is happening to you is your twitcher has gotten stuck wide open! A twitcher is what makes us look at every little thing and say, "What's that?! What does that mean?! What am I supposed to do?!"

When Squirt was first diagnosed and I didn't understand much about this condition, my twitcher was wide open, too. Every little thing she did, or didn't do, made my little mind go into overdrive with worry about the possibilities. "Was that just a normal sneeze, or .....? Why is her nose dry...oh no, what if....? OMG! She's sleeping with one leg curled up....why?!" On and on and on... Poor thing, I drove her nuts the first few months constantly checking on her, looking in her mouth, squeezing her belly, inspecting her skin and coat, waking her up to be sure she was ok. And then they found that tumor, she had surgery and my twitcher went into high gear again!

It's been about 15 months since I first heard the word "Cushing's" and although I am much calmer than I was at first, my twitcher still stays ready to go full steam ahead at the drop of a hat. But having super-active twitchers is a good thing for cush moms and dads as long as we don't let it get out of hand. So twitch away, my friend! That just means you are a watchful, concerned dad. As time passes, you will settle down some and your twitcher will go on stand-by.

I, too, have learned the lesson Brother John spoke of...to enjoy those moments when I see Squirt doing something she used to do, when I see her happy and energetic, when she gives me one of her rare kisses, when she smiles, when I see her little butt sashaying down hall, when she rolls over for me to rub her belly...the little things I used to take for granted are now extra special.

I do hope Angelina gets regulated soon and that you start to see some real improvement. Meantime, remember to enjoy her when you can. You are doing a great job, dad!

Hug from a sister twitcher :p ,
Leslie and the girls

[Roxee's Dad]

Ah Haaaaa!

It's my twitcher that's the problem :eek::eek::eek:. I wonder how I can turn it off from time to time:confused::D

John (Roxee's Dad)

[Squirt's Mom]

Wine, margarita, pina colada,..... :D:D

[Roxee's Dad]

Hi John the Grey,


Is there a recipe section here somewhere?
I've been dabbling with some home cooking for Angelina - but I always worry about it lacking the right ingredients

You might want to check with Angelina's Auntie Leslie:p:). I believe she has some recipies and is studing nutrition.

John (Roxee's Dad)

[John II]

Hello All,

Leslie - so while all the kids are playing with Twitter these days, I wind up with Twitcher? :D
- Also, is there an Auntie Leslie cookbook somewhere? ;)

And Uncle John - thanks for pointing me in the right direction :)

John & Angelina

[John II]

And for my next question :D

I went off to buy some Glucosamine and found a Glucosamine, MSM & Chondroitin powder - which I figured would be easier to measure accurately than tablet cutting. However - looking at the ingredients I'm wondering if there is anything below not suitable for dogs (especially dogs on Trilostane)? The human dose is 5mg (1 teaspoon) twice a day - so quarter of that for Angelina?

Formulation per 5 grams:
Glucosamine Hydrochloride (mg) 250
MSM (mg) 250
Chondroitin Sulphate (mg) 200
Vitamin C (mg) 50
Citrus Bioflavonoids (mg) 50
Zinc (mcg) 400
Manganese (mcg) 200
Copper (mcg) 33.32
Boron(mcg) 50
Sodium (mg) 3.95

Thanks in advance,
John & Angelina

[Squirt's Mom]

Hi John,

We use gluco/condroit w/msm here, too. I don't thing any of the ingredients should be an issue, even with the Trilo on board.

About diet...most of the books and info you find on the web is geared toward healthy dogs and the info that isn't, is often too generic. It is always best when dealing with an ill pup to have a diet designed especially for your pup based on her particulars. Here are two ladies I would recommend:

Catherine Lane
http://www.thepossiblecanine.com/

Monica Segal
http://www.monicasegal.com/

They both have discussion groups, too, which you can join and learn a lot about diet and nutrition in general.

Cat’s discussion group
http://pets.groups.yahoo.com/group/ThePossibleCanine-Nutrition/

Monica’s discussion group
http://www.doggiedietician.com/aboutus/discussions.php

Monica has two books that I would recommend over anything else out there that I have seen so far. They are Optimal Nutrition and The K9 Kitchen.

We had a thread on Diet and Nutrition at the old site and I need to get it started here again. So, thanks for the nudge, guys! :)

I am more than happy to help with diet where I can, but my knowledge is very limited at the moment and the more I learn the more I don't know. Nutrition is a very complicated subject if you want to do it correctly, especially when dealing with pups that have health issues. For example, someone here said their vet told them that all dogs really need is protein and carbs. Wrong. Carbohydrates are not listed as a dietary requirement for dogs by the NRC (National Research Council) which is the unbiased source for canine nutrition. (The AAFCO is an organization that was developed by and reports to the dog food manufacturing industry, so their recommendations are geared to meet the approval of the industry.) In the wild, canids eat the whole prey usually, meaning they eat the stomach and gut of their kill, including the content thereby providing a limited source of carbs. The key nutrients for dogs are protein and fats. Don't get me wrong, carbs are important to the functioning of the body, but it doesn't take much to let the body do what it needs. Carbs are more important to true omnivores, but the dog is not a true omnivore even tho they can eat and digest plant materials to some degree.

Ok, I'm rambling. :o

The supplement you got should be fine. ;)

Hugs,
Leslie and the girls

[John II]

Thanks Leslie!

I'd gone to the pharmacy and bought a jar of Glucosamine tablets first. Then went to the supermarket and checked out their range - finding the multi-supplement powder. It was actually thanks to reading your thread that I thought the Glucosamine, MSM & Chondroitin powder would be a better choice - since you were using something similar. It wasn't until I got home and read all the other things in it and wasn't sure. It was the boron that threw me! :D

And as usual - thanks for the links - got some reading to do! ;)

Angelina had a pretty good day - that pain shot the other day may have made all the difference. She broke into a trot on a few occasions :D

Her water intake has been pretty low the last 2 days only 520mls yesterday and 460mls today... there's still an hour worth of today left - but since she's already gone to bed - that may be it for her today.

Thanks for taking the time to do all the rambling - you can never ramble too much for me!

Hugs for you and the girls :)
John & Angelina

[MiniSchnauzerMom]

Hi John,

I'm glad Angelina had a good day yesterday and that the pain shot has given her some relief.

I'm being a worrywart here but since your vet recommended glucosamine and the powder contains several "extras" I'd recommend checking the product out with your vet for his approval just to be on the safe side.

Give Angelina some extra pets from me!

Louise

[John II]

Hi Louise,

I am also a worrywart (and a twitcher :)) and popped into the Vet's yesterday. Who, after glancing at the container for a second said it should be fine.

I've yet to figure out the Vet roster - I was hoping to talk to the nice one - but got the evil one ;). Well I suppose he's not actually evil. He's just not the nice one. :)

Today I started the 2nd attempt of the 12 hour 20mg dosing of Trilostane. A quarter dose of the Glucosamine, MSM & Chondroitin powder mixed in with food. And the contents of a fish oil capsule mixed in with another meal.

Now I just have to figure out a time to give her some milk thistle!

Thanks for keeping an eye on us,

John & Angelina.

[John II]

I have to admit that I’ve been avoiding reading the updates of forum members who have announced the passing of their Cush Pups. Because I’m trying to keep positive and not think about the eventual outcome of Angelina’s story.

But recently I did look over the list of losses for 2009.

I was saddened to see how many have “crossed the bridge” just this year alone.

But what shocked me most was that among those who have lost so much and so recently, were those who have taken the time in the midst of their grief to lead me by the hand and guide me through my own fear and confusion.

I just find this level of kindness and selflessness amazing. So I just wanted to stop, take a moment and say thank you so much for all of your help! You are all doing so much to help Angelina and me and to restore my faith in humanity. It means more to me than I can say.

I would have been John the Bald without you all :).

[forscooter]

John,

I know what you mean....the people here do restore your faith in humanity! It is the best place on earth!

When I lost Scooter right after Christmas, I wasn't sure what I would do. But then, I still have Bailey who also has Cushing's. But more importantly, if something happens to Bailey, I can't not seem myself being here. We like to think of it as "paying it forward"....we each got help when it was our turn, we still need help, and so we help whoever we can as much as we can.

I found this place, or the old board and now this place, to be a place where there would be meaning for my pups and their stories. I was so upset when they were diagnosed with Cushing's...I questioned "why?"....and this is a way to give meaning and purpose to that question....so maybe I can help someone else who is struggling. That through their battle, and then through me, will their lives and struggles bring even more meaning than the scope to which their lives have brought just to me.

I hope this makes sense. I'm still very tired, LOL. When a pup loses a battle, it upsets us all tremendously...but we go on to help those who come after us as we were helped by all of those who came before us.

Sending lots of hugs....Beth, Bailey and always Scoobie

[John II]

Speaking of one of the devils! :D

[Roxee's Dad]

Hi John the Grey,
Just checking in and see that Angelina is doing better. :) Hope you continue to see improvements.

And Yes, it's great to exchange idea's, information, experiences, stories and sometimes just vent with our frustrations. As I have said before, Roxee wouldn't be here today if I didn't have the help and support of cc.net and Natalie's support through k9diabetes site.

It's good to be able to communicate with "like minded" people.

Belly rubs to Angelina.
John (Roxee's Dad)

[forscooter]

Who?? MOI???? A devil?? :rolleyes:

Naaah...just ask Scott! He'll vouch for me!!! :cool:

Now you keep your hair....I have enough gray hair to cover you though just in case....seems I have earned it over the last year!

Hugs, Beth, Bailey and always Scoobie

[John II]

Hello All,

I need an icon for "frustrated".

Angelina has had her 3rd 12 hourly dose of 20mg of Trilostane and I'm sure she already seems weaker than she has been in recent days (too much Trilostane or too little?). She's been spending a lot of time lying on the cooler floors - including getting up in the middle of the night to do so (too little Trilostane?).

Her water consumption yesterday was only 400mls (too much Trilostane?) (although so far today - to 2pm - she has already drunk 290mls). I just watched her walk from the kitchen to the loungeroom and she was doing the "every foot is an individual" thing (too much Trilostane?) .

Now I'm wondering if I should give her the 7pm dose of 20mg or revert to the 30mg dose at 7am and just continue with the 24 hour dosing? I'm getting a lot of mixed signals from her and she still refuses to tell me how she's feeling. :o How much easier that would be!

John & Angelina

[AlisonandMia]

"every foot is an individual" thing (too much Trilostane?) .

Would you describe it also as walking very carefully, almost as if on eggshells - because that is how my little girl looked when her cortisol was too low. For me it was probably easier to see and easier to sheet home to cortisol as she was younger than Angelina and had no other muscular/skeletal age-related stuff going on - but it was an unmistakable sign with her as she went from bouncing around quite recklessly really to being ultra careful and being weak and would fall over when I was putting her winter coat on her for the night. Mia was on Lysodren and did go just slightly low a couple of times in the course of her treatment and each time a little dose of prednisone perked her up within the hour.

I think that if she is looking like she is too low now that you should probably skip tonight's dose altogether. Possibly (and I'm just thinking out loud here) you could discuss with your vet using a dose that you are pretty sure won't be entirely effective (say 10mg bid) for 10 days and, providing you get no signs of low cortisol, do a stim test at that point and, if the symptoms and the numbers are not right just ever so carefully incrementally increase the dose at 10 - 2 week intervals until you are happy with the symptoms and the numbers - with the symptoms being the main thing and the numbers being a sort double check. Being an oldster Angelina may be rather sensitive to what is called "cortisol withdrawal" which has more or less the same symptoms as low cortisol but is actually caused by a sudden change in a downward direction in previously high cortisol. A dog (or person) can get this even when the cortisol is actually still a little higher than a healthy level but has recently decreased significantly.

I believe Dechra says somewhere (and I'd dig it out but won't be able to because I've got a v-e-e-e-e-ry slow connection at the moment - need that "frustration" emoticon, too!) that with Trilostane treatment the way to discriminate between cortisol withdrawal and absolutely-low cortisol is to take a look at the electrolytes - I'm pretty sure it's in the latest US product info if you want to be look it up for yourself (see Trilo FAQ's). This is because, with Trilostane, if the cortisol really is too low then the aldosterone (the adrenal hormone that balances the electrolytes) will also be too low and this will show up as an electrolyte abnormality.

I think with Angelina trying to sort whether you are seeing cortisol withdrawal or low cortisol might really help you work out what dose suits her best.

Alison

[labblab]

I believe Dechra says somewhere (and I'd dig it out but won't be able to because I've got a v-e-e-e-e-ry slow connection at the moment - need that "frustration" emoticon, too!) that with Trilostane treatment the way to discriminate between cortisol withdrawal and absolutely-low cortisol is to take a look at the electrolytes - I'm pretty sure it's in the latest US product info if you want to be look it up for yourself (see Trilo FAQ's). This is because, with Trilostane, if the cortisol really is too low then the aldosterone (the adrenal hormone that balances the electrolytes) will also be too low and this will show up as an electrolyte abnormality.

I think with Angelina trying to sort whether you are seeing cortisol withdrawal or low cortisol might really help you work out what dose suits her best.

Alison
John, I think these are the Dechra excerpts that Alison is talking about (taken from: http://www.dechra-us.com/File/prod_vetyrol.pdf):


A small percentage of dogs may develop corticosteroid withdrawal syndrome within 10 days of starting treatment. This phenomenon results from acute withdrawal of circulating glucocorticoids; clinical signs include weakness, lethargy, anorexia, and weight loss.1 These clinical signs should be differentiated from an early hypoadrenocortical crisis by measurement of serum electrolyte concentrations and performance of an ACTH stimulation test. Corticosteroid withdrawal syndrome should respond to cessation of VETORYL Capsules (duration of discontinuation based on the severity of the clinical signs) and restarting at a lower dose.

and also:


If the ACTH stimulation test is <1.45 μg/dL (<40 nmol/L) and/or if electrolyte imbalances characteristic of hypoadrenocorticism (hyperkalemia and hyponatremia) are found, VETORYL Capsules should be temporarily discontinued until recurrence of clinical signs consistent with hyperadrenocorticism and test results return to normal (1.45-9.1 μg/dL or 40-250 nmol/L). VETORYL Capsules may then be re-introduced at a lower dose.

Marianne

[Roxee's Dad]

Hi John II, the Grey, and almost bald,

I truely feel your frustration and pain.:(:confused::mad: All we can do is keep the faith and keep working on it.

Hope it get's better with Agelina this evening.
Belly Rubs if she'll let you;)
John (Roxee's Dad)

[John II]

Hello All,

Well it's nice to have a new home - still has that new Webpage smell! :D

Not much to report at the moment. I've scaled Angelina's Trilostane back to 30mg per day (once a day) at the same time introducing supplements such as:
* Contents of an Omega 3 Fish Oil capsule - 1000mg
* Half of a Glucosamine/Chondroitin/MSM tablet - so that would be 187.5mg of Glucosamine Hydrochloride/ 150mg of Chondroitin Sulfate/ 187.5mg of MSM (the human dose is 4 tablets a day - but I thought I'd start smaller just in case)
* Contents of an Cod Liver Oil capsule - 1000mg
* A third of a tablet Milk Thistle - 2333 mg

Haven't slipped those last 2 into her meals as yet today.

A question for the Milk Thistle devotees:
When in your daily feeding/dosing schedule, do you give your pup his or her Milk Thistle?

Nice to be here - thanks to those who made it possible! ;)

John II and Angelina.

[StarDeb55]

John, I buy 100 mg. milk thistle capsules for Harley, open them up, & sprinkle them on his evening meal. Harley weighs about 14 lbs, so he get the whole thing. The IMS told me anything between 100-300 mg. is fine.

Debbie

[John II]

Debbie thanks for stopping by :) - and now you've got me wondering :confused:

The container says:

"Milk Thistle(Silybum marianum) standardised extract equiv to dry fruit(7g) 7000mg equiv to flavanolignins calculated as Silybin 84mg"

So would that be too little or too much?

The information I was working with said a dog Angelina's size should get 30% of a human dose. The human dose is 2 tablets a day (with meals) - so I was thinking a third of one tablet would be a safe place to start.

John II

[Roxee's Dad]

Hi John the Grey.
Welcome from me too. Glad to see you here.

Are you starting to feel like an novice chemist? Did you ever think you would learn so much about vitimins, supplements and meds:D

Amazing what we can learn when when we and our cush pups need help:D

Belly rubs to Angelina:)

[John II]

Hello All,

Oh look my other 8 pages have followed me here! :) Thanks to whoever did that!

I spent some time writing a reply to Alison and Marianne yesterday - but the server ate it - and I was sure I'd ticked the "Remember Me” box at log in time :(

Anyway, yesterday after going back to the 30mg dose Angelina was doing pretty well. Seemed stronger and straighter.

Today seemed a little off in a TWITCH sort of way - maybe the occasional odd step. And a couple of hours ago, I caught her in the laundry staring at the sink. Odd. The kind of odd that makes me wonder is it a neurological sign? Is she going blind? I may have read the old, and now the new Dechra pamphlet too many times - side effects keep popping into my head.

She seems to have gone deaf lately, but not completely, I can still attract her attention with a whistle - but that's about it.

Now here's a question:
If a cushpup develops corticosteroid withdrawal syndrome (which I’m betting is what is happening to Angelina) then how long does it last? It seems to be a barrier we need to push through if we’re to make any progress. I feel like we’re taking a step forward then a hurried step back at the first negative sign. Even though that kind of is what Dechra recommends.

Well it’s late and there is a lot to do tomorrow, so I’ll leave it at that for now. Thanks to Brother John for letting me know the new Cush home is up and running!

Goodnight all,

John the Grey & Angelina.

[StarDeb55]

John, sorry, sorry can 't help you there. As I said, all the IMS told me was to purchase capsules that were between 100-300 mg. She never said anything about the particular concentrations of the contents.

Debbie

[Roxee's Dad]

Hi John the Grey,


Today seemed a little off in a TWITCH sort of way - maybe the occasional odd step. And a couple of hours ago, I caught her in the laundry staring at the sink. Odd. The kind of odd that makes me wonder is it a neurological sign? Is she going blind? I may have read the old, and now the new Dechra pamphlet too many times - side effects keep popping into my head.

She seems to have gone deaf , but not completely, I can still attract her attention with a whistle - but that's about it.

This is exactly what Roxee has been going through over the last 6 months or so. Blindness or nearly, she still see's movements which at times startle her into a barking frenzie.:eek::eek: She can hear a loud noise such as a clap of my hands. Walks off to a room she normally doesn't go to and stares as if she is lost or confused. When laying and resting, she seems to look around in a repeatable pattern from left to right looking for some movement. So I just don't know if the lack of sight and hearing along with her weakness that is confusing her or does she have some neurological issues? Possibly an undetected stroke? Hope our vet get's some advice from Dr Oliver soon.

Keep the faith, on the bad days, remember the good days and give them the love and affection they have given us for so many years:)

Belly Rubs to Angelina (Maybe a pat on the head:))

[Roxee's Dad]

Hi John the Grey


Debbie thanks for stopping by :) - and now you've got me wondering :confused:

The container says:

"Milk Thistle(Silybum marianum) standardised extract equiv to dry fruit(7g) 7000mg equiv to flavanolignins calculated as Silybin 84mg"

So would that be too little or too much?

The information I was working with said a dog Angelina's size should get 30% of a human dose. The human dose is 2 tablets a day (with meals) - so I was thinking a third of one tablet would be a safe place to start.

John II

Might want to check the information in k9cushings, resources. There is some info there referencing liver support products such as sam-e and Milk Thistle. I haven't had a chance to read through it all yet.

Here is a quick link to it.:)

http://www.k9cushings.com/forum/showthread.php?t=192

[John II]

Thanks Brother John,

The link leads to the following info:

Dosages extrapolated from human use range from 50 - 250 mg/kg/day.

So in Angelina's case that would be 650 to 3250mg per day - which means
A third of a tablet Milk Thistle - 2333 mg should be just about right. I hope.

John II & Angelina (who's belly does indeed get rubbed as requested :))

[John II]

Hello All,

Thinking about something Alison wrote (and I responded to but the server ate it :))



Possibly (and I'm just thinking out loud here) you could discuss with your vet using a dose that you are pretty sure won't be entirely effective (say 10mg bid) for 10 days and, providing you get no signs of low cortisol, do a stim test at that point and, if the symptoms and the numbers are not right just ever so carefully incrementally increase the dose at 10 - 2 week intervals until you are happy with the symptoms and the numbers - with the symptoms being the main thing and the numbers being a sort double check.
Alison

The trouble is I already have a ($155) container of Trilostane 30mg and a ($155) container of Trilostane 20mg - I'd really prefer if there was something I could do that didn't involve purchasing a presumably ($155) container of Trilostane 10mg. Funny how the mg go down but the price stays the same.:( I really fear that I'm going to wind up with many jars of capsules - but no dog. :(

2nd trouble is my Vet is a Lysodren fan and won't touch Trilostane. The specialist is the Trilostane fan - and he was already less than pleased about me (a layman) suggesting I try 20mg BID rather than his suggestion of 30mg BID. I fear I'm close to having him wash his hands of me altogether.

Today - and this may have been a bad idea - I tried dosing Angelina with 40mg SID - thinking if she's been able to handle 30mg SID all this time, maybe she could handle the increase. But I think the result of this increase was much the same as the 20mg BID. She seemed off. Had some runny poop - not quite diarhea - but not far off.

Angelina used to go nuts (extremely excited and happy) whenever we have guests. Today, we had three vistors and she was way more subdued than ever in the past.

I'm just getting to the point where I can't think what else to do.

Other thoughts:
With the ACTH stim test do we completely ignore the resting cortisol amount or does it give some indication of improvement? I'm just thing that on Angelina's 2nd stim test the resting result was pretty good (about half that of the first) - the post stim figure didn't drop by such a significant amount, however.

John II and Angelina.

[forscooter]

John.....Just have time for a quick answer...the first number in the ACTH is the "resting" cortisol...with treatment you want to make sure the resting and post aren't the same number or 'flat"...and you also want to make sure the post isn't actually lower. The resting number is simply the amount of cortisol circulating in the blood at that moment....and can be affected by things like stress, etc...it isn't as important as the first except to make sure you aren't getting a flat or "non-stimulatory" response...

My other thought was this....bc this is how I often approached my vet when I felt like maybe he had enough of me....I'd call and just say that whichever dog still didn't seem to be where we wanted, what did HE think of trying blah blah blah....this way, it isn't like you are dictating treatment and still giving the respect of allowing him to have some input....which I do believe in bc they are the docs and they know your pup the best from a medical stance...but if you make it as an open-ended suggestion sometimes the reception is a bit better....just my experience.

I understand about not wanting to spend all this money on all these different dosages. It is tricky not knowing what to do. Can you order a smaller amount of it as a trial so you aren't stuck with such a high bill?

I have to run to work and then meet a judge but I'll check back!

Hugs!!!! Beth and the crew

[forscooter]

OK, so I came back and am going to be reeeallly late but this is bothering me....LOL...

is there a reason you didn't want to go with the Lysodren or would be unwilling to try it? I don't have time to go back and search through everything, but I am wondering if Angelina doesn't have some of the other intermediate sex hormones in play here? In that case, Lysodren may be the better drug for her and worth a try....

just thinking while I am supposed to be getting ready...which I really am going to do this time...:D

Lots of hugs, Beth

[John II]

Hello All,

Thanks Beth, for the vet handling advice :) and the ACTH tutorial!

I must admit to finding it odd that I keep getting handed 100 capsule jars - I guess I was just assuming that was the minimum number the compounding pharmacist would do - when I picked up the last batch I had no interaction with the specialist so didn't have a chance to ask. The receptionist had said that this was the first time someone had gotten this dosage...

...and now slapping my forehead when I remember that the specialist had suggested a liquid form of the drug - which would have made dosing changes easier (but I rejected on the basis that: 1- I couldn't see Angelina taking to it; and 2- isn't there something about Trilostane irritating the throat?)

Beth:
is there a reason you didn't want to go with the Lysodren or would be unwilling to try it? I don't have time to go back and search through everything, but I am wondering if Angelina doesn't have some of the other intermediate sex hormones in play here? In that case, Lysodren may be the better drug for her and worth a try....

I actually was leaning toward the Lysodren - but the specialist recommended using Trilostane based on Angelina's overall condition. Which I meekly went along with - what with the information overload and all.

Thanks for the Hugs!

John and Angelina.

[Roxee's Dad]

Hi John The Grey,

How is Angelina doing these days? Regarding the Trilo, There are many pups doing well on Trilo as well as there are on the Lyso. I think the unknown with the regular known testing is the intermeadiate hormones. This is where the question comes in. Trilo is known to raise some of those hormones so if a pup like Angelina or Roxee already have those hormones in the high range, then the Trilo may raise them even more.

So what is the ending result if those hormones are raised above the normal range? Glynda has some poor experiences with her Lulu. The ACTH and the Ultrasound are really good indicators for a positive dx on pit cushings, but doesn't rule out Atypical or a problem with raised intermediate hormones secreted by the adrenals. It seems that a pup can sometimes have both. Which if is the case, then Lyso seems to be the preffered treatment along with supporting natural remedies like lignans, flaxseed oils and melatonin. (I may stand to be corrected)

So I am really leaning torward a UTK panel to check Roxee's intermediate hormones. The concern I have is the wash out period and her current condition. My thinking has changed over the last few months and believe that with the initial cost of a cushings dx, the extra 135 or so dollars for a UTK panel would have been well worth the investment, not to mention some peace of mind.

Going to check my garden and see if my money tree has started to bloom yet:)

Belly rubs to Angelina.

[lulusmom]

Other thoughts:
With the ACTH stim test do we completely ignore the resting cortisol amount or does it give some indication of improvement? I'm just thing that on Angelina's 2nd stim test the resting result was pretty good (about half that of the first) - the post stim figure didn't drop by such a significant amount, however.

Hi John II,

The resting aka basal reference range is usually between 1 and 6 ug/dl. For the purposes of monitoring treatment, its use is limited to determining if the results are non-stimulatory; however, if the resting number is hugely elevated, that's a good sign that a dog is under a great deal of stress or could possibly have a non-adrenal illness that could greatly impact the accuracy of a stim test. I hope this helps.

Glynda

[Roxee's Dad]

Hi John (The Grey)

How is Angelina doing these days? How are you doing these days?

PS: Belly rubs to Angelina

[Squirt's Mom]

Hi John,

I'm wondering about you and Angelina, too. Let us know how things are going!

Hugs,
Leslie and the girls

[gpgscott]

Hi John,

I have been following but have had no good advice.

And I am not sending belly rubs as I don't want poor Angelina to have a bare tummy:eek:

Hope you get it all worked out soon.

Scott

[forscooter]

Thinking about you all too, John....hoping things are better!!!

I'll send belly rubs...most girls I know don't like having hairy bellies!:eek::cool:

I hope Angelina is doing very well!

Hugs! Beth, Bailey and always Scoobie

[John II]

Hello All,

Sorry to have fallen off the radar - I was trying to avoid jinxing myself and more importantly, Angelina.

Last Tuesday morning (May 26 2009) I started dosing Angelina every 12 hours with 20mg of Trilostane - and although there were a couple of days where she had a little trouble getting started - once she warmed up and worked the kinks out she was fine.

So Angelina's daily schedule has become:
07:00 Breakfast with 20mg of Trilostane
12:00 Small Lunch with half an Osteoeze tablet (Glucosamine /Chondroitin /MSM) & the contents of a fish oil capsule
15:00 Small... er Supper? With a third of a Milk Thistle Tablet & the contents of a cod liver oil capsule
19:00 Small Dinner with 20mg of Trilostane

And so far - knock on wood & fingers crossed - she seems to be tolerating the Trilostane increase. So I'm thinking the previous hiccups might have been the drop in Cortisol unmasking poor old joints and bones.

I don't want to get my hopes up until she's managed to (at least) tolerate a month. Cross your paws for us.

I'm not really seeing any decrease in other symptoms - she's gotten used to her new meals and must be hiding a watch somewhere because she knows when its time for a feed! :) Following each meal, she happily naps - contented.

Overnight she spent a large amount of time panting, licking her chops and swallowing. Which worries me... but might be the dose wearing off? :confused:

Thanks to everyone for checking in! :D

Angelina's hairy belly is getting rubbed, also her ears and chest scratched.

John & Angelina.

[frijole]

Great news. Toe and paws crossed here! Kim

[Squirt's Mom]

Hi John,

Good to hear from you! And good to hear that Angelina seems to be handling the dose change ok.

About the swallowing and licking at nite....that could easily be indigestion causing a bit of nausea. Squirt will exhibit the same behaviors at nite sometimes, and a Pepcid AC or Tagamet will take care of it in no time. Be sure to get the ok from your vet first, of course, but this is my take on it...nite time indigestion. Squirt and I can empathize. :p;):o

The first time I saw Squirt doing that, I just freaked out! :eek: I knew, KNEW, those were neurological signs I was seeing! :eek::eek: That first nite, I just sat watching her and crying, waiting for the grand mal seizure to appear. Called Dr C first thing for an appt. and she said, "Well, it's probably nausea, why don't we try some...." :o:o:o And, of course, it worked like a charm. :rolleyes: My twitcher stays on the ready at all times just for emergencies like that! :p

Hugs,
Leslie and the girls

[forscooter]

John,

I am sooo glad Angelina is doing better!!!!

One little tip we learned around here, when there is a good news, and you are afraid they'll hear us and it will jinx everything...all you have to do is (((((whisper....sshhhhhhhhhh))))):D:D:D

I am very quietly cheering you on....Beth, Bailey and always Scooter

[Roxee's Dad]

Hi John,
Glad to hear things are looking better. I think you may have recvd some good advice regarding the upset tummy.

No jinx'g here.....shhhhhhhhhh.....:D

Fingers and many paws crossed.

[John II]

Hello All,

Leslie, thanks for the advice -
nite time indigestion what's that about? Is it better to treat it of figure out the cause? Honestly, what next?

I do believe Leslie and I have been cut from the same cloth:

The first time I saw Squirt doing that, I just freaked out! I knew, KNEW, those were neurological signs I was seeing! That first nite, I just sat watching her and crying, waiting for the grand mal seizure to appear.

That was me exactly 2 nights ago:o

Thanks for all your good wishes! :) And thanks to Brother John for flushing me out of hiding.

John & Angelina

[Squirt's Mom]

Hey John,

Nite time indigestion...well, it's like my belly...by nite, after food for the day and meds for the day, it's just kinda pissed off and rebels. :o As we age, and pups too, our digestive systems just don't work as well as they used to and it is usually more evident at nite. The Pepcid AC or Tagamet will help shut the pumps in the tummy down, slowing the release of enzymes and acids, relieving the nausea.

If it were me, I would ask the vet about trying one of those OTC remedies and if that doesn't seem to help, then follow up with some testing. But I just bet those meds will do the trick. Since Squirt has been off the Anipryl, she doesn't need help as often but sometimes at nite she still needs a dose. And they work like a charm!

We twitchers gotta stick together! :D If we could just learn to twitch together I bet we could supply a large city with electricity with all the energy we expend vibrating and fretting. :p

You're doing a good job, brother twitcher, so just keep it up!
Hugs,
Leslie and the girls

[John II]

Hello All,

Thanks Sister Twitcher for the advice!:)

And while I remember, I forgot to thank Glynda for the ACTH stim test information. :o

John and Angelina.

[Roxee's Dad]

You know I can't let a whole week go by without checking on our Angelina. AND you too of course :)

[John II]

Hello All and Brother John,

Angelina has made it to her 3rd week of 12 hourly doses of Trilostane 20mg. So far, she seems to be tolerating this dose well.

There are a few things to keep me twitching though:

1. Angelina rarely gets left on her own (maybe once a year, and maybe not that much) – but the Saturday before last, it had to be done. We’d taken her for a walk (to empty her out and tire her out) and had hoped that she would just settle down and snooze until we returned. But alas, on our return, we found her distressed (she looked like she had woofed herself out) and there was a puddle in the carpet. She has never peed inside before. But we were gone for 3 hours, so it was understandable. :(

2. The next day – unfortunately – we had to leave her alone again. Got back just as fast as we could – 70 minutes only, to find her distressed again and another puddle! This was surprising. I did not think 70 minutes would be a problem. :(:(

3. The next day after that – during her morning walk – Angelina was across the road and a couple of houses down when she spotted another dog approaching, her designated walker advised that this dog resembled one of the dogs that attacked her last year. Seeing this dog, Angelina broke away, turned tail and ran all the way home (which unfortunately included running across the street – which is also something she never ever does). :(:(:(

So, in 3 days there were 3 examples of Angelina over-reacting in ways she has never done before. Behavioral changes freak me out!

And just to add that one more thing, her right eye (which already has a small round pink growth inside the lower lid) has gotten a bit weepy. Infection?

I called the Specialist today to schedule an ACTH Stim test – only to find he is on leave until July 1. I may have to get it done at the local Vet’s instead. It’s closer – but the place terrifies Angelina. :(

Thanks for your kind thoughts,
John & Angelina

PS: It's a bit late - but I wanted to say how happy I was to hear about Roxee's waggly tail :)

[Squirt's Mom]

Hi John,

It could be something as simple as Angelina has gotten used to the extra attention that comes along with this condition. It could be separation anxiety or something else unrelated to the Cushing's, but I would check it out just to be sure. Twitchers are frequent visitors at vets offices. :p

Her reaction to the dog that looked like one that attacked her isn't surprising to me. If fear set in, she didn't think one little bit about her training, just about getting where she would be safe - home with you. Just to be on the safe side, I think I would keep her on leash, tho, at least until you can find out what the problem is. Streets are so dangerous for our little ones. :eek:

Keep us in the loop and keep up the good work!
Hugs,
Leslie and the girls

[John II]

Hello All,

Well, this morning I took Angelina off to the local vet for her 3rd ACTH Stim Test, a biochemistry and electrolyte test. Took her in, they took her away for a few minutes, gave her back and we went home for almost an hour. Returned, the Vet took the post stim sample. I braced myself for the bill - which turned out to be half that charged by the Specialist! The Vet also gave me the biochemistry and electrolyte results straight away. At 5pm, the Vet called with the ACTH Stim Test results! So quicker and cheaper! :)

ACTH Stimulation Test Results
===================
14 April 2009 Cortisol resting 157 nmol/L 5.69 ug/dl
Cortisol 1 Hour 382 nmol/L 13.85 ug/dl


11 May 2009 Cortisol resting 78 nmol/L 2.83 ug/dl
Cortisol 1 Hour 337 nmol/L 12.21 ug/dl


26 June 2009 Cortisol resting 91 nmol/L 3.30 ug/dl
Cortisol 1 Hour 174 nmol/L 6.31 ug/dl

Biochemistry and Electrolyte results:
=======================
26-6-2009
Na (Sodium) (139-153) 155 mmol/l
K (Potassium) (3.9-5.9) 6.2 mmol/l
Cl (Chloride) (93-122) 111 mmol/l
Calcium (1.9-2.9) 2.9 mmol/l


Electrolytes on 7 May 2009 were:
Na (Sodium) 144 mmol/l (139-153)
K (Potassium) 5.6 mmol/l (3.9-5.9)
Cl (Chloride) 108 mmol/l (93-122)
Phosphorus (0.8-2.1) ?
Bicarb (12-26) ?
Anion Gap (14-32) ?
Urea (2.5-10.0) 16.2 mmol/l
Creatinine (50-150) 80 umol/l
Glucose (3.3-6.8) 5.13 mmol/l
Bilirubin (0-6) 9 umol/l
AST (18-80) ?
ALT (16-90) 465 U/L
AlkPhos (1-150) 1770 U/L
GGT (liver enz) (0-7) 12 U/L
T Protein (52-80) 74 g/L
Albumin (23-40) 36 g/L
Globulin (25-45) 39 g/L
CreatKinase (73-510) ?
Amylase (333-1500) 839 U/L
Lipase (77-750) 1367 U/L
Cholesterol (3.5-9.0) ?

I did the results for the last 3 tests, inserted the spacing - but in preview all the spacing disappeared - so I removed the older results again.

14-04-2009 Biochemistry with Electrolytes- Canine

Na 145 mmol/l (139-153) (Sodium)
K 5.9 mmol/l (3.9-5.9) (Potassium)
Cl 107 mmol/l (93-122) (Chloride)
Calcium 2.82 mmol/l (1.9-2.9)
Phosphorus 1.53 mmol/l (0.8-2.1)

Bicarb 20.9 mmol/l (12-26)
Anion Gap 23 mmol/l (14-32)
Urea 13.2 mmol/l (2.5-10.0)
Creatinine 81 umol/l (50-150)
Glucose 5.2 mmol/l (3.3-6.8)
Bilirubin 7.0 umol/l (0-6)
AST 128 U/l (18-80)
ALT 590 U/l (16-90)
AlkPhos 3205 U/l (1-150)
T Protein 77 g/l (52-80)
Albumin 39 g/L (23-40)
Globulin 38 g/l (25-45)
CreatKinase 235 U/l (73-510)
Amylase 727 U/l (333-1500)
Lipase 1495 U/l (77-750)
Cholesterol 10.50 mmol/l (3.5-9.0)


Also there seem to be a few holes in the full biochemistry - compared to the Specialist version (which explains the question marks)

Should I be smiling? I was happy to hear that an extra 10mg per day seems to have almost halved her post stim results! And her liver enzymes seem to be improving...

But... why is there always a but? Her urea seems to be on the rise! The Vet said it was unlikely to be cortisol related - early sign of kidney disease??? TWITCH!!! He will send the results off to the Specialist, who returns from vacation on July 1. In the meantime I keep returning to the Dechra advice that Trilostane is not advised for use for dogs with kidney problems. TWITCH!!!

Regards,

John And Angelina

PS: thanks to Leslie for the Angelina behaving strangely advice :)

[Roxee's Dad]

Hi Brother John,

Well the results certainly seem to be improving.

Urea - You may want to check http://dolittler.com/2009/05/03/Blood-work-What-it-means-and-why-your-pet-needs-it-Part-2-Blood-Chemistry.html

It's a good place to go to understand what all these bloodtest's mean. Hopefully your vet finds a good explanation for the rise.

Post Stim is looking better but just be aware, it can continue to drop. Ideal range (textbook) should be 1.45 to 5 ug/dl.


With these improvements in bloodwork, how is Angelina doing with the lowered cortisol?

Should you be smiling? Yes! absolutely, you did good :). You found the cause of Angelina's problems, you learned all you could about cushings and you treated according to your heart and knowledge. (and you saved about 1/2 on the old bill :D)

Smile and enjoy the moment:):):) and give Angelina some very gentle belly rubs.;););) She did good too. :D

[John II]

Hello All and Thanks Brother John de Roxee,

That link is helpful :)


With these improvements in bloodwork, how is Angelina doing with the lowered cortisol?

Well, I don't want to say it too loud, but the supplements seemed to help - Angelina had the occasional "old lady getting up" moments, bit rickety, but it sorted itself out with movement.

Even this latest ACTH Stim test didn't really seem to impact her. (Did they do it right? ;))

What's got me worried (you know, besides everything else ;)) is that in the last week or so her water consumption seems to be increasing (from say 600 to 800mls - now 800 to 1000mls per day) and her hunger as well. Whereas she was quite patient, on occasion, she's now requesting earlier meals. Hmmm... TWITCH!

Now I'm wondering if I should up Angelina's dosage to 30mg in the morning and 20mg at night? Even before I speak to the Specialist. I don't recall if the doses have to be equal?

And thanks for the pep talk :) but I'm feeling like everytime I plug one leak (so to speak) another one starts somewhere else! :(

Thanks,
John & Angelina

[John II]

Hello All,

Well yesterday Angelina finished her 100th 20mg dose of Trilostane. I ordered another 60 of the 20mg capsules and 60 of the 25mg capsules.

Last week, after her latest ACTH test, I had tried upping her dose to 30mg in the morning and she responded with some chocolate fudge sauce looking poop. It may have just been a coincidence - but it's been long established that I'm a worrier - so gently does it. I backed down to the 20mg capsules.

Went to the Specialist centre on July 1 - (our specialist wasn't there - despite my being assured he would be) so I spoke to one of the vets, concerned about Angelina's Liver and Kidneys versus Trilostane - he wasn't terribly worried about Angelina's current urea levels - but advised it was something to keep an eye on with tests maybe every three months.

So as of Monday I'm planning on trialing her on 25mg every 12 hours. If she doesn't do well on those I have the 20mg to fall back on. I suppose now I have the flexibilty to give her 40 - 45 - 50 - 55 or 60mg per day.

As always I get nervous when I have too many capsules on hand - fearing the medication will outlast the dog. :(

The last couple of days her water consumption has risen by about 25%. I'm hoping she only does it because she enjoys worrying me. Despite the cold, last night she got off the bed to lie on the bare floor for 2 hours, before I picked her up and put her back on the bed - where she remained until breakfast time. A little limping when getting up after a rest. This morning I noticed a tremble in her left ear (what's that about?) :confused:

Also, after I returned from grocery shopping yesterday, she was so excited that she didn't look where she was going and shoulder-charged a concrete step - she's given no sign that she's hurt herself - but I could really do without the little surprises! :eek:

[John II]

Hello All,

Well one week later and Angelina seems to have tolerated the shift from 20mg of Trilostane every 12 hours to 25 mg - fairly well. That is no huge warning signs... no vomiting, no diarhea, etc

...but it's the little ones that worry me. I noticed a tremble in her left hind leg yesterday. Is she weaker? Is she more lethargic? Where does cushings begin and old dog leave off? I certainly haven't seen any "fountain of youth" reaction to the drug as yet.

I think I may back off - and take her back down to 20mg doses this week and see if there is a noticable difference.

The information Dr Bruyette gave about compounded Trilostane is haunting the back of my head. Where has the stuff I've been given come from? What's the quality? :confused:

Well, that's my checking in for the moment,

[Roxee's Dad]

Hi John,
Glad you posted as I was ready to send you a PM to check on Angelina.

Other than you twitcher being activated, how is Angelina doing? Weight, pot belly appearance, appetite and water intake, hair growth?

She is over 13 years old, so give her a break ;), even my Rozee is pretty healthy is a little slow to get up and doesn't quite run as fast as she used to.

Can't really help in regards to the compounding, There are alot of vets using compounding pharmacies, wouldn't think they can all be wrong. I know alot of engineers that would faithfully buy a product from the original manufacture bc they feel the originall manufacture put the engineering research dollars into the product and deserve to reap the rewards instead of buying a much cheaper copy of the product. Might be the same for some vets and meds. :confused:

Their are alot of varing opinions to be respected.

Gentle belly rubs to your sweet Angelina :):):)

[BestBuddy]

Hi John,

I understand your situation regarding compounding. Because I am also in Australia I know how hard it is to get Vetoryl and even then dosages for the little ones is a problem.

When I was treating Buddy I started with Vetoryl but there was just at the time the rules were being changed and it was unavailable to me for a while so I went the compounding route. I did ask some questions about the raw trilostane from the compounder and was assured that it was certified 99.9% pure.

The Uni hospital that treated Buddy now only uses compounded trilo and I trust them with all my heart so I know if I was in that situation again I would use the compounded version again.

You are doing what needs to be done but if you are really worried then maybe you could ask some questions of the place that does your compounding as to the source of the raw material and the quality.

Jenny

[lucygoo]

Hi John...

Is it not possible to get Vetoryl in Australia? Can't you get it from Masters Marketing in UK? They do make 10 mg tablets now, but if Angelina is on 25, that might be a problem.

Gina and Lucy

[labblab]

Hi John...

Is it not possible to get Vetoryl in Australia? Can't you get it from Masters Marketing in UK? They do make 10 mg tablets now, but if Angelina is on 25, that might be a problem.

Gina and Lucy
Unfortunately, according to Masters Marketing, a special permit is needed to import Vetoryl into Australia: http://www.masters-uk.com/veterinary/home.php. From what we have heard in the past, the permit process is not an easy one.

John, I do hope that you will take Jenny's words to heart. You are giving Angelina the very best care that is within your power to provide, and you are acting in accordance with your vet's recommendatons. You are a wonderful father and caretaker. But if you are feeling concerned about her response to the trilostane, I also encourage you to talk some more with your vet and /or your pharmacist about the source of her medication. In that way, you will be giving them the opportunity to reassure you regarding the quality of her trilostane so as to put your fears to rest. I do believe that knowledge grants power. So the more you can know about Angelina's medication, the greater your power to either validate or change the direction of her treatment.

Marianne

[John II]

Hello Everyone,

So much advice - thanks! :D

From John:

how is Angelina doing? Weight, pot belly appearance, appetite and water intake, hair growth?

Forgot to check Angelina's weight last time I was at the Vet's - I was so focussed on getting her in and out again that I forgot :o

Pot belly is still there (but then she's happily eating 4 meals a day - so no surprise there) - which answers the appetite question as well.

Water intake fluctuates, the last few days were 975mls -> 885mls -> 605mls -> 665mls -> 880mls

Actually Angelina hasn't had hair growth problems - knock on wood.


She is over 13 years old, so give her a break
Good point :o


Can't really help in regards to the compounding, There are alot of vets using compounding pharmacies, wouldn't think they can all be wrong. I know alot of engineers that would faithfully buy a product from the original manufacture bc they feel the originall manufacture put the engineering research dollars into the product and deserve to reap the rewards instead of buying a much cheaper copy of the product. Might be the same for some vets and meds.

Another good point - but is it cheaper? I doubt it!

Jenny - thanks for the local advice :) I may stop hyperventilating now :o

Gina - as Marianne says - things get tricky down under - what does the goverment have against my dog? :p

And Marianne - thanks for the encouragement and wisdom :)

Today was the warmest July day in Sydney for 18 years - and Angelina's panting kicked right in - of course the warmest part of the day would have been just when her meds were wearing off so... there's that to consider.

Also - I just heard in the background something about a stem-cell treatment for doggy (and people) arthritis!!!
which uses an animal’s own fat to obtain adult stem cells :D I wonder how long that will take to filter down to us folk? AND I heard that it improves liver and kidney function as well!!! :)

Have to put that down on my list of questions for the vet!

Also lottery news - so far this year I've won Lotto or Powerball about 8 times!!! And if I win another 7 times it may pay for a month's worth of Trilostane. I keep getting the cheques in the mail - and they're all around $11 ;)

[BestBuddy]

Hi John,
Just had to comment on the stem cell replacement because there was a story on the news about half an hour ago. It seems that Australia is doing the replacement on dogs with arthritis and have had more than 90% success and one young man is the first person to have this done. I actually think he was from Sydney and had injured his knee years ago in a sporting accident and now he can run and ride a bike that he couldn't do before. I am signing up now.
Jenny

[John II]

Jenny,

I think we watched th same news :D
And I just noticed more info already in the "Everything Else" section.

Gotta go - Angelina insists it's dinner time! ;)

[Roxee's Dad]

Uncle John really needs an update on his beautiful niece Angelina:)

Hope all is going well.

[John II]

Hello All,


Uncle John really needs an update on his beautiful niece Angelina

Angelina continues on her path. Last week I upped her morning dose to 25mg of Trilostane - while keeping her evening dose at 20mg.

And I've added chicken necks to her diet, as both a source of calcium and to help clean her teeth (about 2 a day - when I remember to defrost them in time:)). I was worried about her choking on them - before I gave her the first one - but she manages fine... although the sight is a bit unsettling - a couple of crunches, a swallow and it's gone! :eek:

Angelina got her first (for a long time) bath and trim last week. She came out the other end all tuckered out (always stressful for her - and me :o) but looking like a big fluffy white dandelion :D Quite beautiful.

She's become more insistent on her morning walk - and today managed to go right around the block! Although, once again wound up all tuckered out.

Thanks for checking on us!

[Roxee's Dad]

Hi John II

Haven't heard anything for 2 weeks. So that means no news is good news?? Hope so.


Angelina got her first (for a long time) bath and trim last week. She came out the other end all tuckered out (always stressful for her - and me ) but looking like a big fluffy white dandelion Quite beautiful.

What? No Pics?

[John II]

Hello Brother John and Forum Members,

No, not much to report - after a week of 25mg doses of Trilostane in the morning and 20mg doses of Trilostane in the evening - I got a bit twitchy and backed down to 2 x 20mg doses per day for a week.

Then, seeing the long range weather forecasts were predicting a warm end to our winter, I thought I'd better try returning to the 45mg (total) per day again (to maybe head off the panting).

That was restarted last Friday - Angelina seems OK so far - for an old girl of course. She has the food mania (barks to hurry me along at meal-times and chases me from laundry to dining table to kitchen, as I prepare her raw-meat-wrapped dose, and then give her her meal chaser) - water consumption is all over the place. I've noticed that she goes outside to pee after every meal - but I can't remember if she's always done that - or if this is a new thing. I fear new things.

She likes my home-cooking and lately her poops have been QUITE solid. The rest of the time she lies down and naps.

I could use an at-home MRI machine :) Give her a full body scan and actually know what's going on inside - that would be good.

As I type, she wobbled down to hall to lie down in the doorway near me - and all the usual questions pop up regarding the wobbling :o

Haven't had another ACTH Stim test since the end of June - if she handles the 45mg per day for a couple of weeks straight - we'll have to get that done and see how her numbers look.

OK - I think that's it for now,

Thanks for your concern,
And all your dogs are in my thoughts,

[Roxee's Dad]

Hi Brother John (The Grey)


Haven't had another ACTH Stim test since the end of June - if she handles the 45mg per day for a couple of weeks straight - we'll have to get that done and see how her numbers look.

As I was reading, I was wondering how her numbers were. Glad your planning for the ACTH stim update.

My pups have always gone out to do their business right after they have a meal. Sometimes pee, sometimes poop, sometimes both. :p


I could use an at-home MRI machine Give her a full body scan and actually know what's going on inside - that would be good.

Don't I wish. Totally agree.

Your doing a great job Brother John, keep up the good work. Give Angelina a nice gentle belly rub from me and the rest of the gang here.

[John II]

Dear Brother John,

Thanks for the doggy business advice ;)

I've just uploaded 3 pics of Angelina - I'm a bit worried, the last time I uploaded pics we lost the original site! :D

[Dawn]

Dear John
This is my first time on this site and I have just tried to write a reply to your posts but unfortuanately I believe I pressed the wrong button on the bottom of the page (something advanced) and my whole message has vanished:mad: can you tell me if you have received anything from me or if marianne or the other person you were chatting too las received anything from me - otherwise i will have to redo it all again:(

[StarDeb55]

Dawn, you need to make sure you click on the "submit reply" button, when you're done typing, nothing else. When you click on submit, your reply will post. Also, in the upper right corner of the forum window, make sure you check "remember me", that way you won't time out while your in the middle of typing a response.

Debbie

[labblab]

Hi Dawn. This is Marianne, and no, I'm afraid that I have not received anything from you. It must be so frustrating for you to be losing your replies!! But if you follow Debbie's instructions, I'm hoping that things will straighten out for you.

Marianne

[John II]

Hello Dawn

Sorry to say your words have been lost - but please try again.

It happened to me a few times in the past - I thought it was just the universe editing me :D

Debbie has covered all the points to be aware of (oh and "Back" arrow sometimes works).

Thanks to Debbie & Marianne,

[John II]

Grrrrrrrrrrrrrrrrrrrrrr.................

I was getting down to my last 7 x 20mg Trilostane capsules. So I placed an order on Wednesday. Today the receptionist called to let me know they had arrived - I asked her the price - secure in the knowledge that I had ordered the same amount and the same dosage before - so obviously I had a fair idea of the price. I was wrong.

The prices so far:

March 30 2009 Trilostane 100 x 30mg capsules costs $141 plus GST $14.10 = $155.10 – the capsules were on hand at the practice.

May 11 2009 Trilostane 100 x 20mg capsules costs $142 plus GST $14.20 = $156.20• When I queried why a smaller dosage would mean a (slightly) greater price, I was told because they had to be ordered especially for me as no one had ever ordered that dosage before (1).

July 7 2009 Trilostane 60 x 20mg capsules costs $146 plus GST $14.60 = $160.60
July 7 2009 Trilostane 60 x 25mg capsules costs $146
• When I queried why a smaller number of capsules would mean a (slightly) greater price, I was told because the more you ordered the less it cost (2). If they had the medication on-hand the cost would be less than if it had to be ordered in especially (3).
•
August 28 2009 Trilostane 100 x 20mg capsules costs $244.20 (including GST?) an $88 increase in 3.5 months? Must be $222 plus $22.20 GST
• When I queried why the exact same number of capsules at the exact same dosage as ordered in May would mean a much greater price ($88), I was told that I was in fact paying the same per capsule price as I had already paid for the Trilostane 60 x 20mg capsules in July (4). It seems the more you ordered the less it cost no longer applies. If they had the medication on-hand the cost would be less than if it had to be ordered in especially (3). The receptionist would check with the Compounding Pharmacist – who advised the prices had gone up (5).

If you are going to tell me a story – be consistent. It’s hard to rationalize when the excuses keep changing.

I was thinking of ordering Trilostane 100 x 22.5mg capsules (since I’m currently giving Angelina 25mg in the morning and 20mg at night for a total of 45mg per day). I’m glad I didn’t – I expect if I had I would have gotten excuse number 1 – and I would have accepted it, since I’ve accepted it before.

I’m finding it very difficult to accept this $88 price hike – initially I was trembling with anger – but I’m a little calmer now.

I had a look at the website for the manufacturers of Vetoryl in the UK – to buy a similar amount (that is 180 x 10mg capsules to equate to 90 x 20mg capsules) would cost $249.50 and I couldn’t see if they were talking about Australian dollars (it was strange that it was in dollars for a UK company – was there some feature that picks up where I’m from and automatically calculates the exchange rate price?) but even if it was Australian dollars and if the postage was included and I’d already jumped through the importation hoops – it would still be 10 less capsules (well 20 really) for at least $7.30 more.

Has the local Compounding Pharmacist also checked out the competitor and wondered to himself, why not charge what they charge?

I seem to be operating on 2 emotions this year Angry :mad: or sad :( - lucky there are emoticons for both! :D

[lulusmom]

Hi John,

You are obviously using compounded Trilostane and I can certainly understand your frustration with the fluctuating prices over such a short period of time. When my two were on Trilostane, I never experienced that type of increase...actually in two years, the only increase I saw was in shipping.

Many of us use Diamondback Drugs for our Trilostane and Mitotane/Lysodren. I had to refill Lulu's Mitotane today so I spoke to one of the owners and they do ship to Australia and have never had a problem with the meds reaching their customers. The problem is that shipping is steep but they would still be cheaper than what you are paying. 100 count of 22.5mg capsules would cost $50 plus $50 shipping. That is a total of $100 U.S. dollars which I think converts to $118 Australian dollars. If this is something you might consider, you would need to fax them a script. Their website with contact information is www.diamondbackdrugs.com

Glynda

[BestBuddy]

Hi John,

Do you have the script and send it to the compounding pharmacy? There are several compounders in Melbourne and all over Australia in fact so maybe you need to do some calling around for prices. When I got some compounded trilo (3 years ago) it cost me $272.80 for 100x60mg tablets. The trilo was only done in the 60mg tablets but could easily be cut into half or even quarters so it worked out not too expensive.

Jenny

[John II]

Glynda & Jenny,

Thanks for the advice :) some research needs to be done I think - these random prices are driving me nuts!

[John II]

New test results are in:

ACTH Stimulation Test
==============
14 April 2009 Cortisol resting 157 nmol/L 5.69 ug/dl Coritsol 1 Hour 382 nmol/L 13.85 ug/dl
11 May 2009 Cortisol resting 78 nmol/L 2.83 ug/dl Coritsol 1 Hour 337 nmol/L 12.21 ug/dl
26 June 2009 Cortisol resting 91 nmol/L 3.30 ug/dl Coritsol 1 Hour 174 nmol/L (28-55) 6.31 ug/dl
31 August 2009 Cortisol resting 42 nmol/L 1.52 ug/dl Coritsol 1 Hour 151 nmol/L 5.47 ug/dl

Blood Test 31 August 2009
==================
Na (Sodium) 156 (139-153)
K (Potassium) 6 (3.9-5.9)
Cl (Chloride) 111 (93-122)
Calcium 2.92 (1.9-2.9)
Urea 20.7 (2.5-10.0):eek:
Creatinine 82 (50-150)
Glucose 5.14 (3.3-6.8)
Bilirubin 6 (0-6)
ALT 402 (16-90)
AlkPhos 1678 (1-150)
GGT (liver enz) 9 (0-7)
T Protein 84 (52-80)
Albumin 43 (23-40)
Globulin 41 (25-45)
Amylase 903 (333-1500)
Lipase 1327 (77-750)
Cholesterol 9.99 (3.5-9.0)

Urinalysis 31 August 2009
=================
URINE SG 1.018
Urine PH 7.5

Weight 12.5 - the girl has lost weight! I hope that's a good thing! :)

[BestBuddy]

Hi John,
No idea on the labs but I do like the ACTH numbers and I like the way they are coming down slow.
Jenny

[Harley PoMMom]

Hi John,

Altho I am no expert in these labs, I am going thru issues with my boy Harley right now with elevated BUN (Urea), his IMS told me that his high blood pressure/cushings could be causing this, also since his Creatinine was within normal range that I shouldn't be too worried.

No protein was found in her urine, right?

The ones I would be concerned about are Amylase 903 (333-1500)
Lipase 1327 (77-750), these are pancreas enzymes, you may want to ask your vet to do a specific pancreatitis test called cPLI. This is another issue I am going thru with my boy, and pancreatitis can skew ACTH numbers, I just recently found this out, Harley's IMS told me this and Dr. Oliver confirmed this too. So Angelina's ACTH number's might be higher than what they really are....just a thought...maybe ask your vet about it.

Hugs.
Lori

[Squirt's Mom]

Hi Brother Twitcher!

That ACTH looks great! In good range for a Trilo pup! :D:D

Debbie is the lab expert so I hope she will be able to interpret those for you this evening. I saw a few things that made me gasp!, but since I don't know much at all about labs, they're probably nothing...just me twitchin"! :D

Hugs,
Leslie and the girls

[Roxee's Dad]

Hi John II (The Grey)

The stim results looks good. :D

It would be interesting for me to see a comparison from this blood test to the last one. I have no expertise in this but in Roxee's case her ALT and ALK finally came back into the normal range while she was on her cush meds after years of being very high abnormal. I'm kinda a data and history nut.:o Cause and effect and all that stuff:) If I remember correctly, you are also giving milk thistle and or sam-e?


Urea 20.7 (2.5-10.0)

ALT 402 (16-90)
AlkPhos 1678 (1-150)

Lipase 1327 (77-750)

GGT (liver enz) 9 (0-7)


Weight loss? What was her normal weight in her younger years? How does she look around the ribs and hips?

Give Angelina a gentle scratch behind the ear from us.:)

[AlisonandMia]

Great-looking numbers, John.

Would you be able to post the dosage that Angelina was on against those numbers? The latest drop is relation to a slight daily dose increase, isn't it?

Alison

[John II]

Jenny – as always, thanks for the encouragement :)

Lori – your advice regarding the Urea is reassuring – Angelina’s Creatinine being 82 umol/l with a target between 50-150 umol/l. I don’t have a full copy of the Urinalysis yet – so I’m not sure about protein in her urine – although last time I had the full lot done at the IMS there was a "significant amount" present.

The one thing that I realise I have been doing wrong is not fasting Angelina before her blood chemistry test :(. I keep taking the opportunity to get it done while I’m getting her ACTH STIM test done – but this of course is not giving me a proper reading. I’ll have to delay her breakfast (and Trilostane dose) one day, and take her in to the vet before her meal. Then I’ll know for sure. I’m trying not to think about the possibility of pancreatitis until then. But the “pancreatitis can skew ACTH numbers” keeps creeping in!:eek:

Leslie - Angelina’s labwork often makes me gasp – just as I’m smiling about one level falling, I’m cringing about something else rising! But, at least the Cortisol continues to fall. Although, the resting Cortisol being at 42 nmol/L 1.52 ug/dl makes me twitch! :o

John – over the last few days I’ve been trying to include past results – but I keep losing the spacing in translation (why it took me so long to reply). I finally decided that if spaces disappear – maybe characters won’t. So below are results for the last two blood chemistries.

I’ve got Angelina on a daily dose of milk thistle – I haven’t tried sam-e yet.

When Angelina was younger she was usually between 10 to 11kg – this year she went over 13kg – so I was surprised to see even with the extra meals, she’s lost over 500g in the last few months. I hope it’s a good thing. TWITCH!

Alison – seeing that Angelina was panting due to unseasonably warm weather, I decided to try upping her dose before Spring could set in. So from July 27 Angelina started getting 25mg of Trilostane with her morning meal – and 20mg with her evening meal. That lasted for 11 days before some weakness made me chicken out and back down to 20mg of Trilostane with her morning meal for the following 6 days. From August 14 I tried again - 25mg of Trilostane with her morning meal – and 20mg with her evening meal – for another 10 days. Her water consumption seemed to be spiking (around a litre per day) so I tried increasing her evening dose to 25mg of Trilostane as well. But after 2 days the chicken in me came out again. So, since August 26 Angelina has remained on a total of 45mg (25/20) per day.

ACTH Stimulation Test
==============
14 April 2009 Cortisol resting 157 nmol/L 5.69 ug/dl Coritsol 1 Hour 382 nmol/L 13.85 ug/dl
11 May 2009 Cortisol resting 78 nmol/L 2.83 ug/dl Coritsol 1 Hour 337 nmol/L 12.21 ug/dl
26 June 2009 Cortisol resting 91 nmol/L 3.30 ug/dl Coritsol 1 Hour 174 nmol/L (28-55) 6.31 ug/dl
31 August 2009 Cortisol resting 42 nmol/L 1.52 ug/dl Coritsol 1 Hour 151 nmol/L 5.47 ug/dl

Blood Test:
=========
31 Aug 2009 Na (Sodium) 156 (139-153)= 26-6-2009=155 mmol/l
31 Aug 2009 K (Potassium) 6 (3.9-5.9)= 26-6-2009=6.2 mmol/l
31 Aug 2009 Cl (Chloride) 111 (93-122)= 26-6-2009=111 mmol/l
31 Aug 2009 Calcium 2.92 (1.9-2.9)=26-6-2009=2.9 mmol/l
31 Aug 2009 Urea 20.7 (2.5-10.0)= 26-6-2009=16.2 mmol/l
31 Aug 2009 Creatinine 82 (50-150) =26-6-2009=80 umol/l
31 Aug 2009 Glucose 5.14 (3.3-6.8) =26-6-2009=5.13 mmol/l
31 Aug 2009 TBil 6 (0-6) =26-6-2009=9 umol/l
31 Aug 2009 ALT 402 (16-90) =26-6-2009=465 U/L
31 Aug 2009 AlkPhos 1678 (1-150) =26-6-2009=1770 U/L
31 Aug 2009 GGT (liver enz) 9 (0-7) =26-6-2009=12 U/L
31 Aug 2009 T Protein 84 (52-80) =26-6-2009=74 g/L
31 Aug 2009 Albumin 43 (23-40) =26-6-2009=36 g/L
31 Aug 2009 Globulin 41 (25-45) =26-6-2009=39 g/L
31 Aug 2009 Amylase 903 (333-1500) =26-6-2009=839 U/L
31 Aug 2009 Lipase 1327 (77-750) =26-6-2009=1367 U/L
31 Aug 2009 Cholesterol 9.99 (3.5-9.0) =14-4-2009=10.5


Urinalysis 31 August 2009
=================
URINE SG 1.018
Urine PH 7.5

Weight
=====
31 August 2009 12.5kg (Angelina had been over 13kg last time we checked – but I can’t find the exact numbers at the moment).

Thanks to all, advice, encouragement, hugs and ear scratches are much appreciated!

[Harley PoMMom]

Hi John,

Has Angelina's blood pressure ever been checked? We have been going thru this with my boy, his protein loss from his UPC was 2.3, since he has been on BP meds for just 2 weeks, his protein loss from his UPC is 0.6, normal is 0.5.

John, if Angelina were my pup, I would definitely have a cPLI done on Angelina, just to be sure.

I'm no lab expert here but the other things I looked at on Angelina's labwork is her Na/K ratio is just a little low...26, normal is 27-41, I also see her T Protein and Albumin are creeping up, which would concern me. I believe these three can point to dehydration issues.

John, you are doing a super job and you are a wonderful Daddy to Angelina.

Many hugs and ear scratches are being sent you way.

Love and more hugs.
Lori

[John II]

Hi Lori,

Angelina's blood pressure was checked before treatment, and 3 weeks into treatment, both times hovering around 200 :eek: I keep forgetting to ask the local vet if they can check it there. Unfortunately, with Trilostane, I believe you can't also use ace inhibitors, so I was hoping that if Cushings was the cause of the high blood pressure, then treating Cushings would also treat the BP - I just can't prove that yet.

We got a UPC done (either the 1st or 2nd visit to the IMS) and at that point (April) the level was 1.5.

Na/K ratio? Yikes - just when you think you've read everything... ;)
Going back - over her last 3 biochemistries I have noticed that her Na/K ratio has been on the rise 24 in April, 25 at the end of June and 26 at the end of August.

I've got a longish list of questions for the vet when next we meet.

And John has gone to the trouble of creating a spreadsheet for Angelina - Thanks so much for that! Which can be seen at:

http://spreadsheets.google.com/ccc?key=0ArkKLZtppoejdEdJck9SMUo1QUtMVG45TTFwbjU0O Hc&hl=en

[Harley PoMMom]

Hi John,

I took a look at the Trilostane product insert from our Resource Thread and it says:

"Angiotensin-converting enzyme (ACE) inhibitors should be used with caution with VETORYL Capsules, as both drugs have aldosterone-lowering effects which may be additive, impairing the patient’s ability to maintain normal electrolytes, blood volume and renal perfusion."

So you could you use the BP meds BUT you would have to monitor her electrolytes often. This is something I believe you should ask Angelina's vet about, because I am no expert at this stuff, just going thru this high BP issues with my boy right now and getting him straighten out. His IMS, GP and other forum members did lovenly tell me that high BP can damage the kidney's over time. All I do know is that when we got his BP within normal range/or what his IMS and his vet wanted it to be, his UPC dropped from 2.3 to 0.6 within 3 weeks.


I’ve got Angelina on a daily dose of milk thistle – I haven’t tried sam-e yet.I use Denamarin, it has the best of both, milk thistle and SAM-e, I use the Denamarin in the am (5am) and then at 5pm I give Harley Marin. These were approved by both his IMS and his GP. They have to given 12 hours apart, tho.

Love the spreadsheet, makes it real easy to see the numbers and the increases/decreases...Fantastic job, John. :D

Na/K ratio, just keep an eye on it, both of her numbers are in the high normal, if one should go low normal than the other one, well then twitch.:) My Harley hovers around 27, but he hasn't started his Lysodren yet, I image when he does his Na/K ratio number will fall too...and alas I will join the twitching team. :D

Love and hugs.
Lori

[John II]

Hello All,

I took Angelina to the Vet today to get her Biochemistry and Electrolytes checked - but this time properly fasted. The results are as follows:

Na (Sodium) (139-153) mmol/l 156
K (Potassium) (3.9-5.9) mmol/l 3:eek:
NA:K Ratio (27-40) 52.00
Cl (Chloride) (93-122) mmol/l 113
Calcium (1.9-2.9) mmol/l 3.17
Phosphorus (0.8-2.1) mmol/l 1.47
Urea (2.5-10.0) mmol/l 12.2
Creatinine (50-150) umol/l 79
Glucose (3.3-6.8) mmol/l 6.42
Bilirubin (0-6) umol/l 4
ALT (16-90) U/L 346
AlkPhos (1-150) U/L 1564
T Protein (52-80) g/L 80
Albumin (23-40) g/L 38
Globulin (25-45) g/L 43
Amylase (333-1500) U/L
Lipase (77-750) U/L
Cholesterol (3.5-9.0) mmol/l 9.05
Weight 12.2

I was happy to see her Urea down from 20.7 to 12.2, her ALT down from 402 to 346 and her AlkPhos down from 1678 to 1564.

BUT while her Sodium remained steady at 156 - her Potassium dropped from 6 to 3!!!:eek:

And her Amylase went from 903 to off the chart! :eek: her Lipase wasn't listed.

She seems to have had a rough day today - I don't know why - since we had to wait until after 8am to get the test done (usually gets her morning dose and breakfast at 06:20 ish), I gave her 20mg of Trilostane rather than 25mg. From the day she's had, you would think she'd been given an ACTH stim - but we didn't do that. And last time she had a stim - it didn't seem to bother her.

She struggled with her morning poop - being very solid. Panting throughout the day (it was only about 23 degrees celsius today). Short morning walk, after the Vet and her delayed breakfast.

Following her afternoon meal (3:30pm) she managed a more substantial poop ranging from solid to loose. And just now (8pm) she went out again (and loose again).

I went back to speak to the vet in the afternoon - they use Lysodren, so he wasn't sure if Trilostane might be the cause of the change in results. He suggested I check with the IMS.

I called the IMS and found he doesn't work there anymore :(- the receptionist left a message for another IMS - who didn't call back :(:(- but one of the vets did 2 hours later.

I went through what I was giving Angelina - the Fish Oil, The Cod Liver Oil and just recently (since September 9) a daily Vitamin E capsule (250iu) - the vet suggested I cut back on these additives as they could all be "quite" fatty - just one per day, rather than all 3. Both vets suggested a repeat of the Biochemistry and Electrolytes test tomorrow morning. The vet suggested this might be impacting the Amylase result.

I mentioned the low potassium - she advised that the potassium could alter widely from day to day (especially with the fasting). She was aware of the potential for electrolyte imbalances while on Trilostane - but as long as Angelina wasn't vomiting or having watery diarrhea she wasn't too concerned.

The local vet gave me some Lectade (a rehydration additive for her water) after her latest poop I've mixed it in. I wonder if Angelina will drink it?

I've been wearing my heart in my throat all day. Is today the day?

[Harley PoMMom]

Hi John II,


I've been wearing my heart in my throat all day.Oh, you poor dear...I know exactly how you feel...am there myself with my boy...but we cannot give up on our precious pups as long as they are willing to fight for themselves, ok.

As far as the low potassium...now I don't know if this will even work...ask your vet...but what about giving Angelina bananas, they are loaded with potassium. Put them in a blender or food processor and mix them with her food and maybe she will eat them, Harley does, but Harley eats anything.

I believe some pups have a rough time after fasting, I know my Harley does, or maybe it's just tougher on the elder pups, Harley will be 13 y/o pretty soon.


I went through what I was giving Angelina - the Fish Oil, The Cod Liver Oil and just recently (since September 9) a daily Vitamin E capsule (250iu) - the vet suggested I cut back on these additives as they could all be "quite" fatty - just one per day, rather than all 3. Both vets suggested a repeat of the Biochemistry and Electrolytes test tomorrow morning. The vet suggested this might be impacting the Amylase result.Could be, but John, I know I've said this before the Lipase is pancreas specific, I would run that PLI test, if Angelina is suffering from pancreatitis this is making her feel really yucky and maybe in some pain.


Is today the day?Today is the day when she is going to start to feel better bc now you know her test results from a fasting, are taking steps to correct the things that are in the high ranges and if you repeat them again then we will get a better picture of what is going on with beautiful Angelina....John II, you are doing a wonderful job as her Daddy, don't ever forget that.

Love and many hugs.
Lori

[Buffaloe]

John,

I remember once Shiloh's potassium level was low and thus her Na/K ratio was off. My vet told me to give her some potassium rich foods. You can google it...there's a bunch of them. Bananas and yogurt were on the list and I found some tasty, low fat yogurt with banana at a local health food store. I've been adding the yogurt to Shi's food pretty regularly ever since and she loves it.

I hope Angelina is feeling alot better real soon.

Ken

[John II]

Hmmm... Thanks Lori and Ken, I'll keep a banana at hand just in case,

Angelina took a look at the doggy gatorade, had a very small taste, and gave me an "Are you kidding?" look - I hurriedly replaced it with plain water.

My home-made dog food is usually comprised of... well it's easier if I think of what I cooked today... 250g Turkey mince, half a chicken breast (or often 100g of liver), half a tablespoon of rice (keep forgetting to buy brown rice), half a tablespoon of oats (new addition for cholesterol? or is that just for people?), a carrot, a stick of celery, a tomato (or some capsicum - sweet pepper in the US?), something green (today broccoli - often English Spinach), some pumpkin (but not too much) and a good dollop of yoghurt (although I forgot to add it to Angelina's meal earlier - have since added it to the cooled food before putting it in the fridge - also threw in some peas today. Last time I added some ground eggshell - but seeing Angelina's calcium on the rise today - I might skip that in future. I usually don't add salt, but today I added a pinch. Oh, all the vegetables get minced in the food processor. The broccoli and tomato added at the end to wilt in the last of the heat.

I've had a look at some of the potassium lists and I think that hit a few potassium targets - plus she eats a raw beef breakfast - and a commercial dinner - so what gives?

I raised the pancreatitis concern with both vets today - is she in pain, is she vomiting, is she off her food? They asked. No, I said. And they left it at that. I think a different vet will be on tomorrow.

[Harley PoMMom]

Hi John II,

Sice her Sodium is already high, if I were you, I would not add the salt to her meals, I would also use white rice instead of brown bc it is easier on the kidneys, white rice contains less phosphorus in it. If you are going to use egg shells, I don't know if you are aware of this, you need to bake them in the oven first, grind them after and then use them. Angelina's meals look yummy, Harley is jealous :), is this diet something that was formulated for her? So are her vit., minerals, supplements calculated for her weight?

Even tho Harley doesn't throw up from his pancreatitis, I do know his tummy is so very sensitive to the touch from it. How do I know when he is in pain? He is very restless and he just can't seem to find a comfortable spot and I see him licking anything excessively : the blanket, his paw, the carpet, etc. I give him his Tramadol, and within minutes it seems, he stops that licking and lays on his back, feet in the air and falls asleep...I only have to do this once a day...at night-time.

PS: I am puzzled why your vet gave you Lectade for Angelina, since in it's ingredients are: Glucose 278.75 gr, Sodium Chloride 53.44 gr, Glycine 38.56 gr, Citric Acid Monohydrate 3.28 gr, Potassium Phosphate Monobasic 25.53 gr and Potassium Citrate 0.75 gr. ( In each liter of Lectade Concentrate), her Na (Sodium) (139-153) mmol/l 156 is already high...hmmm.


Love and hugs.
Lori

[gpgscott]

John II,

I understand your concern and cannot offer any useful advice.

I bet Debbie will be along soon though to help you sort out the numbers.

Scott

[Roxee's Dad]

Hi John II (The Grey)

Keep the faith. I hope you and Angelina are having a better day today:)

I updated Angelina's bloodtest and stim test file with the most current results.

http://spreadsheets.google.com/ccc?key=0ArkKLZtppoejdEdJck9SMUo1QUtMVG45TTFwbjU0O Hc&hl=en

Give our Angelina a hiney scratch from her Uncle John:D

[clydetheboosmom]

Hi - I'm hoping for a better day for you today! Please know we are all here for you and thinking of you!

Lynne, Clyde & Bailey

[SaxLady]

Hi John II,
How is Angelina doing today? What a wonderful dad you are, cooking those wonderful meals for her! I know it's difficult when you have to change doctors. I had to do that for Katrina. We always hope we are doing the best possible thing for our babies. Hoping that Angelina is doing much better today! Please keep us posted.
Hugs for you both,
Candy

[mytil]

I am thinking about you two today and am praying things will turn around.

(((((hugs))))) and gentle smoochies to Angelina
Terry

[John II]

Thanks to everyone for your kind support and good wishes :)

We're both doing better today - not much to report (the repeat biochemistry has been delayed until tomorrow morning).

Posted a new picture of Angelina - sporting her new haircut for Spring - just as well, it was 30 degrees celsius in Sydney today - and the A/C died during the last heatwave!:rolleyes:

I ran out of 25mg capsules yesterday - and since I've got 4 vets (and one now MIA IMS) telling me to up her dose, I've gone to 30mg morning/20mg evening as of today - so far so good.

Last couple of days Angelina has been turning up her nose at my homecooking - setting my twitcher to high - she would eat it (reluctantly) for lunch - but flat out rejected it for linner today (breakfast - lunch - linner and dinner :D). After I boiled a piece of liver and mixed some in - problem solved.

Lori - thanks for the advice on the white rice and eggshells (I was wondering if they should be raw or cooked). The diet wasn't formulated for her - I just made note of what nutrients were in what foods (in my general reading and went with that) - the supplement amounts were also picked up from reading (or the vet as far as the osteo support goes) - and fingers crossed!

Lectade - I asked the vet if there was a rehydration drink for dogs - and seeing the ingredients I was a bit if-fy - but in the middle of the night I'd rather have something on hand then nothing - so I took it. Thy were out of Slow-K (have since ordered some in) - but we'll wait on tomorrow's results.

Uncle John thanks again for the spreadsheet - and keeping an eye on us. I'll scratch Angelina for you when she's in an agreeable mood - usually before a meal ;)

Scott & Lynne & Candy - your kind words go a long way to easing my general :eek::(:mad::confused: - what's one word for that? :D

[John II]

Thanks Terry!

You snuck in while I was writing that :D

[Harley PoMMom]

Hi John II,

All the advice I've given to you is just that, John, advice...I have no medical background or training. Everything that I learned I either read about, asked Harley's vet, IMS or Dr. Oliver about, but I really try to not post anything that I cannot reference to with the facts or the article.

I really hope Debbie does come along and take a look at Angelina's numbers since this is her area of expertise.


Last couple of days Angelina has been turning up her nose at my homecooking - setting my twitcher to high...After I boiled a piece of liver and mixed some in - problem solved.
I think she knows how to get her Daddy to cook her what she wants. :) Actually, I think as they get older, they just get alittle fussier with their food.

John II, as I've said before, you are doing a wonderful job taking care of Angelina, our elder pups like to keep us on our toes, my boy Harley has me almost pulling my hair out :eek: So please don't ever doubt the exceptional care you are giving beautiful Angelina.

Love and hugs.
Lori

[Wylie's Mom]

Hi John,

I can't help with much, but about the oils... this is from dogaware.com http://www.dogaware.com/dogfeeding.html#supplements:


Fish Oil or Salmon Oil: An important source of omega-3 essential fatty acids. Omega-3 EFAs are beneficial to the immune system, the nervous system, the heart, and help stop inflammation, such as in arthritis and allergies. They also support brain development of puppies and fetuses. This is probably the most important supplement to give, no matter what you feed, as Omega-3 EFAs are hard to find even in a natural diet, and are highly perishable when exposed to heat, light or air, so they do not survive in commercial foods even if added. Omega-3 EFAs are found in fish body oil, not liver oil. They are also found in flax seed oil, although that form is not as well utilized and some dogs can be allergic to flax. Recommended amount is 1000 mg fish oil (containing 300 mg combined EPA/DHA) per 30 pounds (14 kg) of body weight. Maximum dosage for dogs with health problems would be 1000 mg fish oil (300 mg EPA/DHA) per 10 pounds (4.5 kg) of body weight. You can also use sardines in place of fish oil supplements; one small sardine supplies over 100 mg EPA/DHA. Vitamin E should also be given whenever oils are supplemented (even small amounts are adequate, but highest recommended dosage would be 100 IU per day for small dogs, 200 IU for medium-sized dogs, and 400 IU for large dogs). Note that fish oil is not the same as cod liver oil, which is high in vitamins A and D. Never add cod liver oil to a commercial diet, as they are already high in vitamin D, and too much is harmful.

So, you might want to try cutting out the Cod liver oil completely. I used to give Wylie a doggie supplement for his coat that contained Fish oil & Cod liver oil, but then changed to regular (cheaper) people supplements... I stopped the Cod liver oil completely when I read this article. Haven't noticed too much difference, but it may allow you more room to keep the good Fish Oil & Vit E.

-Susy

[Sabre's Mum]

Hi John

I just saw Susy's last post and just wanted to make a comment with regards to the cod liver oil. We feed a raw diet (BARF) and when we do add the cod liver oil I only give Sabre 1 tsp once a week (he is about 25kg). I haven't been able to find the reference for dosages and frequency in the book I refer to ... "Give You Dog a Bone by Dr Ian Billinghurst" - no index or cross references in the book.

Angela, Sabre and Flynn

[John II]

Hello All,

Went to the vet with Angelina on Friday - this time after giving her her normal breakfast. The vet only retested the electrolytes - giving me a chance to ease up on the various oils for a couple of weeks before trying another biochemistry. Anyway - the results:

Na (Sodium) (139-153) mmol/l 155
K (Potassium) (3.9-5.9) mmol/l 5.7
Cl (Chloride) (93-122) mmol/l 112

Which gives us an NA:K Ratio (27-40) of 27.19 :) - in the zone! (just!)

Why is it that everytime I see a test result the ranges seem to change? The one I got this time had normal levels down as:

Na (Sodium) (144-160) mmol/l
K (Potassium) (3.5-5.8) mmol/l
Cl (Chloride) (109-122) mmol/l

Although that sodium range puts Angelina in the zone as well for that! ;)

Thanks to all my advisers and supporters Lori, Susy & Angela :) Will be cutting back on the Cod liver oil.

[Roxee's Dad]

Hi John II

Glad to see she is "in the zone" :D:) - Have no idea why the "norm ranges" are changing, good question to ask your vet. Maybe it has something to do with re-calibrating the equipment??? Which also makes you wonder if the numbers that are close to range limits really should alarm us. They are numbers and there is some room for error, that is why we also have to keep an eye on our pups and their symptoms.

How is Angelina doing otherwise? Activity, weight, thirst, apetite, mood etc...

We see her B-Day is comming up soon:D:D:D

A nice gentle rub behind the ears to our Angelina:)

[John II]

Hi Brother John,


How is Angelina doing otherwise? Activity, weight, thirst, apetite, mood etc...

Activity - Angelina goes for a short walk down to the end of the street in the morning - and this evening, she supervised taking the garbage bins out to the street.

Weight - I wish those vet scales would stop changing their minds every couple of seconds - but it seems to be around 12.3kg - down from over 13kg back in April.

Thirst - strangely - before her last Stim test her drinking was getting up to about a litre per day - but since the Stim it's reduced - today she drank 750mls (which at a max of 60mls of water per kilo of weight is right at the top of the zone).

Appetite - Angelina loves the things she loves ;)- the last couple of days, not my cooking so much. Perhaps a little too much broccoli or yoghurt? But we finished that batch today - tomorrow's will feature spinach instead of the broccoli.

Mood - how do you tell that one? Dogs hide a lot. She's not the dog she was last year.

We've just completed Day 4 of 30mg morning/20mg evening. There may be a bit of wobbliness in the earlier part of the day. I'm watching her closely.

Yes, the latest of her targets is coming up this Wednesday - and it's making me nervous to be so close. I'm going to have to find out how to alter the heading of this thread - presuming we make it.

Thanks for keeping an eye on us! :)

[Roxee's Dad]

Hi John II

Well, she's eating and drinking... that's very good:) I'm sure you recall so many of us had trouble getting our pups to eat and drink after a while on treatment.

She is still going for short walks and supervising:o that is great.


Mood - how do you tell that one? Dogs hide a lot. She's not the dog she was last year.

Well, if you calculate approx 7 years of dog life to 1 year of human life, I guess we aren't the same men we were 7 years ago :o:p:)


Don't be too nervous that you don't get to enjoy all the small happy moments. The short walks, the supervising and the wagging tail???

You are doing a great job. Enjoy every moment with Angelina.:)

I've updated her link, had to change a few things to accomodate the latest figures.

http://spreadsheets.google.com/ccc?key=0ArkKLZtppoejdEdJck9SMUo1QUtMVG45TTFwbjU0O Hc&hl=en

[labblab]

Yes, the latest of her targets is coming up this Wednesday - and it's making me nervous to be so close. I'm going to have to find out how to alter the heading of this thread - presuming we make it.

Thanks for keeping an eye on us! :)
John, we are all counting the days until we can help you celebrate Angelina's 14th birthday on Wednesday!!!!!! Although you cannot change the heading of this thread yourself, any one of the Moderators or Administrators can do so. So whichever one of us has the privilege of arriving "first on the scene" on Wednesday shall have the honor of revising your title. :) :) :)

Continuing hugs and pats to you both,
Marianne

[StarDeb55]

When it comes to normal ranges, this will vary depending on what lab is doing the testing &/or what type of analyzer is doing test. If your vet has changed the lab they use, or they lab has changed equipment, this is why you are seeing the variation in the normal ranges.

Debbie

[Harley PoMMom]

Hi John II,

So happy to see Angelina's electrolytes are in the "zone" YAAA!!! Great, great job.

Harley and I, with everyone else, are counting the days also, until we can help you celebrate Angelina's 14th birthday!!!

Love and hugs.
Lori

[Wylie's Mom]

Hi John,

Double "YAAAA" :p... Angellina, you go girl:D!!!!

-Susy

[labblab]

HAPPY 14th BIRTHDAY, ANGELINA!!!!!!!!!!! :) :D :) :D :) :D :) :D :)

If I've done my time zone conversions correctly, this should be the dawning of Angelina's birthday in Sydney...:p :p :p :p :p :p :p

All best wishes to "our" special birthday girl and her special dad!!!!
Marianne

[John II]

Excellent time zone conversions Marianne!!! :D

HAPPY 14th BIRTHDAY, ANGELINA!!!!!!!

When she was diagnosed just before Christmas, I didn't think we'd make it, but thanks to the the helpful advice and positive thoughts of The Canine Cushings Crew, here we are!

Thankyou all so very much! :D

[Harley PoMMom]

:D:) Happy 14th Birthday Beautiful Angelina!! :):D

Harley and I send you many hugs and kisses.

[SaxLady]

Angelina---Born on a Friday-She is a 28 degree Virgo with her Venus (love planet) at 7 degrees Libra. A very loving and sweet girl! Happy Birthday sweetie!
Candy, always Katrina, Joe, Heidi and Nixie

[sunimist]

Happy 14th Birthday sweet beautiful girl! May your special day be filled with lots of love, hugs, kisses, goodies and of course PRESENTS!! :D

(((HUGS)))

Shelba and Suni

[MiniSchnauzerMom]

:D:):D Happy 14th Birthday, Angelina!!!!! :D:):D

Sending you birthday scritchies from me and special birthday slurps from Munchie!

Louise & Munchie

[frijole]

Happy 14th! Just a Pup! :D

I'm a virgo too... ;)

Hugs, Kim

[Wylie's Mom]

Happy 14th Birthday, Angelina!!!:p:D:p:D:p:D:p

I wonder what papa John has on the menu for you today:rolleyes:.

-Susy

[Roxee's Dad]

:D:D:D A Special Happy 14th Birthday to our sweet Angelina :D:D:D

[lulusmom]

Happy 14th birthday Angelina!!!!!!

[John II]

Hello and thankyou all for the birthday wishes! :)

I was a little concerned earlier in the day when Angelina wasn't interested in her lunch. She's never been one for anything sweet - so I thought I'd bake her something more to her taste - like a chicken :D

She walked up and down sniffing at the air until it was ready - she got the breast meat (on top of her rejected lunch) and ate both! Then came back for the scraps from my lunch. :rolleyes:

Anyway, thanks for all the hugs and kisses and astrological reports (which is spot on target :)) and scritchies and special birthday slurps.

I'll see if I can upload a picture of the birthday girl before my PC crashes.

[lulusmom]

I just saw Angelina's birthday cake and cracked up. That was really a great idea and Angelina looked pretty anxious to blow out the candle.

[BestBuddy]

I'm sure that Angelina thought it was the best cake ever.:D

Jenny

[mytil]

Whew, I thought I missed this party - A very big HAPPY BIRTHDAY from me too and tons of birthday smoochies.

Wow, John what a cake! (love the idea) I am sure she was very happy. :D

Terry

[John II]

Yes, Angelina seemed very happy with her "cake" and is currently snoozing the snooze of the full belly.:p

[frijole]

Yes, Angelina seemed very happy with her "cake" and is currently snoozing the snooze of the full belly.:p

I bet ! Great idea. Hope my dogs didn't see that cake. ;):p Kim

[John II]

Dear Members of the Forum,

Things that make me go "hmmmmm":

So, late last night I decided to use the power of the internet and shot off enquiry emails to 3 Compounding Pharmacists in the state. I didn't get a chance to check the result this morning - and in mid afternoon my phone rang - it was the closest of the three Pharmacists calling to check if I was satisfied with their response and asking if I had any more questions.

The answers to my questions were as follows:
Price for 25mg x 100 capsules would be $140 (with a Discount of 5% on 200 and a Discount of 10% on 300)
There is no extra cost for clear capsules
They resource the trilostane from "Cleo" in Shanghai China, who they understand to be the biggest supplier of trilostane.
The assay shows 99.32%

I didn't mention the price I was charged last time by the other Compounding Pharmacist - but this one has charged $102 less!

Should I be nervous or should I just jump on it? What do you think?

[BestBuddy]

Hi John,
I always go ewwww when China is mentioned BUT...that isn't very fair as I am sure there are reputable companies in the country. I like the fact that the pharmacy has told you where they source the trilo and also the purity. The fact that the assay shows over 99% pure has to be a good thing and who knows where the others get the trilo, and that includes Dechra. I am sure a lot of the tablets we humans take are made from material sourced from China and elsewhere.
Jenny

[John II]

Thanks for the 2nd opinion Jenny!

Ever since a 60 Minutes expose about counterfeiting in China (including medications :eek:) I've been wary - but, from what I've read China or India are the most likely origins for Trilostane (although I believe the Holy Grail of Trilostane comes from Italy?) - and for all I know all Angelina's medication thus far could be from the same place. This was just the first time I thought to ask.

In other news, I had a look at the dog age conversion chart in the Vet's office while I was waiting - it seems Angelina is 78 :p.

NEWSFLASH! I just received another response - this time from the second closest Pharmacist:

Dear John,

Thanks for your enquiry. The answers for your question are as follow:

1. The cost for Trilostane 25mg Capsules is $115.00
2. The price does come down as the more capsules are ordered
3. The cost of delivery is $8.00 anywhere in Australia
4. Trilostane is 100% pure and each batch comes with a certificate of analysis to confirm the purity
5. Our trilostane came from USA
6. Clear Capsules does not alter the price

Regards,

[Roxee's Dad]

Hi John II,
I keep checking and see no update on our Angelina. :( I hope no news is good news. ;)

[John II]

Well John, you know I get nervous around dosage changes. So it's more like "no news is non-bad news" :o

Let's see:
September 17th I upped Angelina's daily dose to 30mg in the morning and 20mg in the evening. That lasted until I started getting twitchy on September 21st - and cut back to 20/20 until the day after Angelina's birthday (gave her a little birthday break).

I then tried alternating 20/20 then 30/20 dosing for 4 days (hoping it would average out to 25/20 dosing?) before resuming 30/20 dosing on September 28th. And have continued with 30/20 dosing until the present. That's 15 days in a row so far.

Angelina's water intake has been pretty much in the zone (last 2 days have been 640mls) every once in a while it spikes just to make me twitch.

She was looking a bit like a little old lady today - but that disappears at meal time.

Had a close call yesterday, where one of the dogs that savaged her last year got loose from its yard (just when Angelina was supervising the taking of the garbage to the curb) - luckily Angelina's human companion had a stick and literally had to beat the dog back! :eek::(

Angelina was frightened but - this time - unharmed.

That's 3 strikes in my book. I will have to do something about this. :mad:

[Franklin'sMum]

Hi John ll and Angelina

How's your pretty little lady going? And how are you also ;)

Jane and Franklin xx
________
Paxil class action lawsuit (http://www.classactionsettlements.org/lawsuit/paxil/)

[John II]

Hi Jane and Forum,

Well, today Angelina had a fairly rough day, I think. A combination of things, the temperature was warm. Then there were 3 sets of visitors to get all worked up and excited about. And one set of visitors brought their two little dogs! Too much excitement and heat for one day!

Last Thursday I went to the new Compounding Pharmacist to order 100 x 25mg capsules of Trilostane (we should be finished the last of the 30mg capsules on this coming Thursday). The new Pharmacist said they would have the capsules ready in 24 hours for $140 (quicker AND cheaper!). That's $102 LESS than I paid for 100 x 20mg capsules of Trilostane at the old Pharmacist.

Which I suppose I should take as good news - but I'm not used to good news :o - so I'm wondering what the catch is :rolleyes:.

Before we go from 30mg/20mg to 25mg/25mg we should get an ACTH Stim test done - and a biochemistry - and check her electrolytes. Hopefully do that tomorrow.

[Roxee's Dad]

Hi John II


Well, today Angelina had a fairly rough day, I think. A combination of things, the temperature was warm. Then there were 3 sets of visitors to get all worked up and excited about. And one set of visitors brought their two little dogs! Too much excitement and heat for one day!

Sometimes it's the excitement that helps keep them young at heart. :) The good thing is that she still get's excited. ;) I guess with the heat comming, it's getting close to shave down time. :eek:

Hope otherwise, our Angelina is doing well. :):):) Looking forward to very good results from her upcomming testing. :):):) Fingers and paws and everthing else crossed.

Belly rubs to our sweet girl.

[John II]

Fingers and paws and everything else crossed.

May just have done the trick. I took Angelina to the local vet this morning - and the results are in:
ACTH Stimulation Test
Cortisol resting 38 nmol/L (1.38 ug/dl) Cortisol 1 hour 57 nmol/L (2.07 ug/dl)


ACTH Stimulation Test
==============
14 April 2009 Cortisol resting 157 nmol/L 5.69 ug/dl Coritsol 1 Hour 382 nmol/L 13.85 ug/dl
11 May 2009 Cortisol resting 78 nmol/L 2.83 ug/dl Coritsol 1 Hour 337 nmol/L 12.21 ug/dl
26 June 2009 Cortisol resting 91 nmol/L 3.30 ug/dl Coritsol 1 Hour 174 nmol/L 6.31 ug/dl
31 August 2009 Cortisol resting 42 nmol/L 1.52 ug/dl Coritsol 1 Hour 151 nmol/L 5.47 ug/dl

Also her weight is down to 12.1kg! :)

Tomorrow the plan is to return to the vet for a post fasting biochemistry and electrolytes test...

I have to go - I cooked some fresh home-made food for Angelina and she's barking at the stove (with increasing volume :eek:)

[Franklin'sMum]

[I took Angelina to the local vet this morning - and the results are in:] You got the results within 48 hours :eek: I'm impressed :):)
ACTH Stimulation Test
Cortisol resting 38 nmol/L (1.38 ug/dl)
Cortisol 1 hour 57 nmol/L (2.07 ug/dl)
Her numbers look beautiful, John
Also her weight is down to 12.1kg! :)

[Tomorrow the plan is to return to the vet for a post fasting biochemistry and electrolytes test...]
Crossing fingers and paws for great results :)

[I have to go - I cooked some fresh home-made food for Angelina and she's barking at the stove (with increasing volume :eek:)]
There's a good slave!! :p They are such a pleasure to serve though :):):)
Keeping everything crossed, and waiting to learn of the results.

P.S - Franklin has a crush on your little Angelina :D
Jane and Franklin xx
________
LovelyWendie99 (http://www.lovelywendie99.com/)

[John II]

Thanks for checking in on us Jane :)

Yes, her numbers seem to be "in the zone".
She's lost about a kilo since starting on the Trilostane back on the last day of March. Although her pot-belly is still there - so she could stand to lose more... of course that would probably raise the issue of a dosage reduction...
Her water consumption has dropped by about 150-200mls per day, on average, since the most recent dosage change (although it does still fluctuate).

The first time I had the ACTH stim test done at the local vet I was impressed by the speed as well - same day results (and half the price of the IMS) - and this time they suggested emailing me the results too!

I'm happy to slave over a hot stove as long as she's happy to wolf it down :)


P.S - Franklin has a crush on your little Angelina
I'm not surprised - Franklin is only human after all! :D

[Franklin'sMum]

Hi John ll

[Thanks for checking in on us]

You're more than welcome:) I've been checking on you both since the time Angelina's leg fell asleep in front of the fridge :(

[Her water consumption has dropped by about 150-200mls per day, on average, since the most recent dosage change (although it does still fluctuate).]
Of course. No rest for a cushparent!

[I'm happy to slave over a hot stove as long as she's happy to wolf it down :)]
You're a good daddy:)

[I'm not surprised - Franklin is only human after all! :D]
And don't we know it! :D
________
Drug test (http://drugtestingkit.org)

[John II]

Oh - another night owl I see :)

I've been keeping an eye on Franklin's story as well - but my advice would only echo that already given by those with far more Cush knowledge than me.

But, if big beefy Angelina is getting good numbers on 50mg per day - a smaller scale fellow like Franklin getting 60mg per day makes me twitch! 75mg made me gasp!

But - of course all dogs are different - so that's really no guide. He's just so very young - and that makes me twitch as well. But if it's all diagnosed properly and if he's treated correctly - his youth should be an advantage...

Anyway - it's almost 1am and I'm just prattling on :o

[John II]

This morning I took Angelina to the vet again - she was not impressed (going two days in a row) - but the results are in (some of the the measurement units look a bit odd - I'm guessing the translation to email did something):

Test Results (Reference Range)

VetTest (3 November 2009 15:10)

UREA 8.4 mmoi/L (2.5 - 9.6) :)

CREA 67 IJmol/L (44 - 159) :)

PHOS 1.19mmol/L (0.81-2.19) :)

CA 2.98 mmol/L (1.98 - 3.00) :o

TP 82 gIL (52 - 82) :o

ALB 37 giL (22 - 39) :)

GLOB 45 gIL (25 - 45) :o

AL T 297 U/L (10 - 100) HIGH :eek: although down 49 points from last time

ALKP 1596 U/L (23 - 212) HIGH :eek: up 32 points from last time - the first time its risen.

TBIL 4 IJmollL (0 - 15) :)

CHOL 7.88 mmol/L (2.84 - 8.27) :)

AMYL 911 U/L (500 - 1500) :)

GLU 6.28 mmollL (3.89 - 7.94) :)

VetLyte (3 November 2009 07:46)

Na 159 mmollL (144 - 160) :o

K 5.0 mmollL (3.5 - 5.8) :)

For an NA:K Ratio of 31.8 so :)

CI 116 mmollL (109 -122) :)

Otherwise it's a very warm day in Sydney - the old Air Conditioner died last Summer - the new Air Conditioner doesn't arrive until next week - Angelina is hiding in the bathroom - and wasn't insisting on a mid-afternoon meal, so I decided to skip it. Hopefully we'll all make it through the heat.

[Franklin'sMum]

Hi John and Angelina,
Congratulations on mostly great numbers! :D:D
Angelina has been working hard:)
I'm sure her daddy's TLC comes into play, too.

About the heat, you know the things made for human people you put around your neck to keep cool? Filled with non-toxic crystals that you soak in the sink for a few minutes, then the crystals puff up and soften? The last 3 summers I've put one on Franklin, :o he seems to appreciate it. Just thinking Angelina might like it too.
Oh, while I remember, what do you think about Maltese being placed on the NSW dangerous dogs list? :confused:
I don't know whether to laugh or cry
Love to all
Jane and Franklin xx
________
ARIZONA MEDICAL MARIJUANA (http://arizona.dispensaries.org/)

[John II]

Thanks Jane, that sounds like a good idea - where did you get your neck-cooler-thingy? Is it a chemist type of thing or a Target kind of thing?

As far as the Maltese being placed on the NSW dangerous dogs list, well if you knew Angelina, you'd know she's not called a Maltese Cross for nothing! :D :eek::D

[Franklin'sMum]

Hi John and Angelina
[- where did you get your neck-cooler-thingy? Is it a chemist type of thing or a Target kind of thing?]
I've mainly seen them at outdoor markets, although the lady at the RSPCA shelter/shop said she'd try and get some in, too.
I'll keep my eyes peeled :)
BTW- Franklin also has a chiller mat (2 actually). Unless Angelina is a real chewer, they hold up really well. Let me check if I have the paperwork..... "Tail Waggers Cooling Pet Bed" extra strong, puncture proof cooling pet bed with fluid enhanced comfort. I bought that from the warehouse or go-lo or the reject shop.
(They're pretty much all the same :))
, [well if you knew Angelina, you'd know she's not called a Maltese Cross for nothing! :D] :eek::D
I do recall a post where you said
she does try and gobble feet if somebody crosses their legs too close to her hair:D
Jane and Franklin xx
________
Expert Insurance (http://xpertinsurance.com/)

[John II]

Jane,

A cooling mat sounds better still! I think she'd prefer to lie on something cool. Now to go off and find one! :)

How about Franklin, is he also a Maltese-cross or a Maltese-kind? :p

[BestBuddy]

John,
I wish you all the luck in the world with the cooler mat.:rolleyes:
I had one for Buddy but he would not go near it, I think he thought it was toxic. The only time it was used was when we traveled in the car and he was harnessed in and had to sit on it.:D
Jenny

[John II]

Jenny,


Buddy but he would not go near it, I think he thought it was toxic.

I was already thinking Angelina would probably do the same thing. But I'd rather be prepared and fail than be unprepared - and if Angelina doesn't like it - I can always use it myself - I'd better get an extra large - just in case :D

[Franklin'sMum]

Hi again John and friends,

The mats do tend to smell like plastic, but they air out pretty quickly.
If I put a mat where the air con blows, he won't move off of it.

In case you're still thinking of the neck- chiller thingy, Bunnings had them last year, but the lady I just spoke to doesn't think they will get them this year. She recommended to try a sports store because they're popular with tennis players, apparently.
Hope that helps some,
Jane and Franklin xx
________
Moroccan Recipes (http://www.cooking-chef.com/moroccan/)

[John II]

Now that Angelina's cortisol seems to be under control - time to up the liver support supplements. Can't seem to find them in Australia so time to import - just for the information of any other Aussies:


Thank you very much for ordering from 1-800-PetMeds. We appreciate your business.

You have ordered the following items to be shipped via GLOBAL PRIORITY. You will be receiving :
1 DENAMARIN TABS MEDIUM DOG 30CT (1@46.99) $46.99
1 10% OFF COUPON (1@-4.70) $-4.70
Shipping and Handling $29.99
Order TOTAL $72.28

And now we wait... wonder how long this will take?

[Harley PoMMom]

$29.99 for S&H :eek::eek: Is it the same price for a bulk shipment? Like I mean, if you wanted to buy say 5 boxes would they charge you the 29.99 a piece or a flat 29.99?

[John II]

Excellent question - they didn't say :o
At least the exchange rates have improved :)

[Franklin'sMum]

Hi John and Angelina,

How are you all?
I contacted petmeds after Lori posted the link to me ..Thanks Lori :)
You're in luck, John. Their rep emailed back that it's a flat rate shipping.
Do you have a "Chemist Warehouse" near to you? I went shopping today and got "Natures Own" -Liver Health with Milk Thistle... Small print says-

Equiv. to dry milk thistle (8g) 8000mg standardised to contain 96mg Silybin (as flavanolignins)
Schizandra fruit 100mg
Dandelion root 500mg
Globe Artichoke equiv. to fresh leaf 1000mg
Taurine 200mg

Plus I also picked up SAM-e Forte 400 by "Bio organics"
Sam-e 208mg as disulfate tosylate 400mg
Vit B1 5mg, B2 5mg, B3 5mg, B5 5mg, B6 5mg, B12 250mcg, Calcium Abscorbate Dihydrate 25mg, Folic acid 50mcg.
For the life of me I now can't find the docket, but the SAM-e is about $40.ish for 20 tablets.
The milk thistle has 60 tablets and I think it was in the $20s somewhere.
If you run out before your next shipment comes in, there's an alternative.

Hope that helps,and a big kiss for Angelina
Jane and Franklin xx
________
Wendie 99 (http://www.lovelywendie99.com/)

[Squirt's Mom]

Hi John,

Glad to read that your sweet baby is doing so well! :D Does my heart good! :):)

This shipping and handling can be a booger! I order some of the supplements I use in Squirt's food plus her daily supplements from Canada and the shipping is unreal! A bottle of 100 caps that costs $4.00 can end up costing around $35 once S&H is tacked on! I have started searching for suitable substitutes that cost less than ordering from Canada. Crossing borders seems to be very expensive!

I use a milk thistle glycerite from Mountain Rose Herbs and it lasts a long time. She gets 3 drops a day during the spring and fall months, then is off for the summer and winter months. We tried caps before and she started throwing up the contents at nite so we switched to the glycerite form and the on/off schedule; she is doing fine with it.

Hope all is well in your domain!
Hugs,
Leslie and the girls

[John II]

Hi Jane,
Thanks for checking with petmeds! ;)
I've got the Nature's Own Milk Thistle 7000 (which I cut into thirds - more or less)


Schizandra fruit 100mg :confused:
Dandelion root 500mg :confused:
Globe Artichoke equiv. to fresh leaf 1000mg :confused:
Taurine 200mg :confused:

I think I recall mention of a mythical Supplement guide which existed in the Forum 2 generations back. Should we, and when I say we, I mean you the seniors who know this stuff off by heart :D, recreate this wonderful guide to Supplements and dosages? So that we, and when I say we, I mean me, :D have some idea of what's safe, what's poisonous and how much? Cos I keep seeing ingredients and go "Huh?"

From Jane's thread:

I need things dumbed down for me
You and me both sister! :D

I found SAMe in the local pharmacy (for about $20) and was thinking "Yay!" until I looked at the back for contents and strengths and saw "6x". "6x"? What the? Then I went to the local Vitamin/health store and found 3 more types of human SAMe with more ingredients that made me go "Huh?"

Which may be why I ordered the Denamarin with the excessive shipping (especially when the website says orders above $39 are free shipping - without any little *'s anywhere to let you know there's an "unless you're overseas" clause). I want something that's for dogs and of a certain weight - no cutting tablets (meant for people)! :o I need one thing I can be sure of! :o


but the SAM-e is about $40.ish for 20 tablets.
The milk thistle has 60 tablets and I think it was in the $20s somewhere.

So I guess ordering The Denamarin isn't too much more expensive - I'm rationalizing :D if this order is going to take 6-10days or so, I might just run off an get the human SAMe in the meantime :)

Again Jane, thanks for all the information.

From Leslie:

Glad to read that your sweet baby is doing so well!
Actually Angelina had a very rough week - the kind that worries me. I don't know if it was the many visitors, or the many Vet visits (especially the Stim), or the strain of the very HOT Tuesday (39 degrees celsius!!!) or a combination of all three. When we finished off the last 30mg capsule on Thursday, I skipped the morning dose on Friday because Angelina was indifferent to her breakfast.

I restarted dosing Friday evening (she was panting) with 20mg - Monday morning depending on her behaviour, I may start the 25mg - but I may work my way up to 50mg per day again. See how it goes.

From Leslie:
milk thistle glycerite from Mountain Rose Herbs Mountain Rose Herbs? Now you're just making this stuff up! ;)


She gets 3 drops a day during the spring and fall months, then is off for the summer and winter months
Um... what? Seasonal dosing!!! :confused: I'm gonna need that one explained :eek:

[Franklin'sMum]

Hi John,

I'm sorry to hear Angelina's had a rough week :( (and that you've had a rough week also.)

The dandelion is something to do with milk thistle (I think) and taurine is good for heart health.

With the SAM-e, the lady said vitamin B's don't build up in the system.

Big Hugs to you both

Jane and Franklin xx
________
Head Shop (http://headshop.net/)

[John II]

Thanks Jane :)

I've found something that might be helpful and it's pet related:
http://www.lowchensaustralia.com/health/herbs.htm


DANDELION (Taraxacum officinale)
Fresh whole plant as an electrolyte balancer, this is our best diuretic because it doesn't deplete potassium in the cat or dog, it is good for kidney inflammations. Has blood cleansing effects. Kidney and liver tonic. A well known garden weed, dandelion is much valued as a herbal remedy. It is a rich source of vitamins and minerals, including potassium. The root is used to improve digestion as it stimulates the flow of digestive juices, including bile from the liver and gallbladder. This can have beneficial effects on many conditions. The leaves have a diuretic effect.
Uses: Dandelion root is used to treat liver conditions and improve liver function. Both leaves and root can be used to treat arthritis and skin conditions.
Excellent for anaemia because it is high in iron, calcium and other vitamins and minerals. A very good diuretic. - Useful in kidney and bladder problems.
For a horse with bladder infection, give at least five ( three for a pony) cups chopped plants a day for four to five days.

The site covers a whole lot of other herbs for dogs (and ones to avoid) as well... still have to read through the rest.

[Franklin'sMum]

Hey John,

Thanks for that link. I'll check it out when I finish work.

Thanks again,

Jane and Franklin xx
________
DRUG TEST KIT (http://drugtestingkit.org)

[BestBuddy]

Just in case you are still looking for the cooler mat, dealsdirect.com.au have a small one for $25 and the large for $50.
I think I paid about $50 for my small one a couple of years ago.:mad:

Jenny

PD the small one is just under "dogs" and the large is under "pet beds"

[John II]

Thanks Jane and Thanks Jenny,

Angelina was more her old self this morning. Well, not her old old self, more like her new old self - barking for me to hurry up with her food - so I've taken the plunge and given her the first of the 25mg capsules of Trilostane from the new compounding chemist.

Please send prayers, good thoughts, crossed fingers or knocking on wood our way. :o

[MiniSchnauzerMom]

Please send prayers, good thoughts, crossed fingers or knocking on wood our way. :o

Angelina (and you) have all of the above coming your way from me that all goes well for her with the Trilostane from your new compounding pharmacist.

I'm glad that Angelia is back to her "new old self this morning. :D

Louise

[Harley PoMMom]

Hi John II,

You have tons of prayers, very good thoughts and a million of great vibes coming your way from over here in PA! :p:)

I am so happy that beautiful Angelina is back to her "new old self" and is barking orders. :eek::p:)

Love and hugs.
Lori

[Franklin'sMum]

Hi John and Angelina,

Well wishes, good thoughts, knocking on wood and crossing all fingers and toes for you both that all goes well (and also rubbing a buddha belly and a Franklin belly:p)

Jane and Franklin xx
________
Fix Ps3 (http://fixps3.info/)

[Squirt's Mom]

Please send prayers, good thoughts, crossed fingers or knocking on wood our way.

You got 'em, Brother Twitcher!

Hugs,
Leslie and the girls

[AlisonandMia]

Sounds like the heat is really getting to poor little Angelina. Have you considered getting her clipped really close - like a buzz cut - especially on her belly, even to the extent of getting her belly shaved as you would for an ultrasound? I had this done for Mia.

As you can see from my avatar Mia's pre-Cushing's coat was sparse but the combo of Cushing's and then treating it seemed to stimulate her to grow a thick fluffy coat which, although it was only about an inch long, was evidently very, very good at keeping her warm. I had her close-shaved for the warmer months and it really helped. In the first year I had to have her belly re-shaved by the vet late in the summer (regrowth) and that gave her tremendous relief. They lose a lot of heat through their belly. We took long walks which saw her running all the way (she loved it) so keeping her cool was very important.

Alison

[Roxee's Dad]

Hi Brother John,
Sending good thoughts, good vibes and prayers that all goes well. I think Ali idea is a good one :). While you guys are shaving your pups to keep cool, I'm letting mine grow longer to keep them warm. :p Our summer is over. :(

[John II]

Hello Everyone

Thanks for all the good energies.:) So far so good.

We've survived the first dose and for the moment I think I'll stick with 25/20mg dosing. See if I can notice any differences between the medications from the two different sources, by her behaviour.

Thanks Alison & John you remind me that I should have added the 3 hour clipping session on Sunday to all the stressfull things Angelina has had to endure - so that at least has been done and she should feel a little cooler on the bathroom floor.

However, I think I'm going to have go out into the world and track down a cooler mat before Thursday - there's a forecast of a very hot day and whether the heat or the new air conditioner gets here first is anyone's guess.

The following is a small rant that you can all skip if you like:
===========================================
Thanks for the tip Jenny, I would try Deals Direct but 1) I don't have a credit card and 2) in order to... well, order the Denamarin I got a gift Debit Card to place the order online. I had to wait 24 hours for it to activate (from Friday to Saturday) I had hoped to get the order moving before the US weekend. 24 hours later I'm checking it online to make sure it's active. They tell me it's expired. I check the back of the packaging - expired August 09. Which would be annoying enough, but I bought it in the Post Office - and the lady there caught that it had expired and went off to get one that expires next year. Somehow in the end she still gave me the expired one :mad: Today I went back to the Post Office to exchange it - long story short, Visa will send a replacement... sometime... maybe. :mad::mad:

So I called my niece and used her card. :o

Anyway this is why I prefer personal shopping. Go out, get what I need and return, in one day. That's my kind of shopping. Deals Direct would probably take another while.

...and I just had a look - the Canine Cooler Pet Bed 61cm x 91cm
Today’s Deal: $49.95 Shipping: $9.95 the good news is that I don't need a credit or debit card - they have BPay the bad news is:
This product is Out Of Stock :rolleyes:

But having a look online I can see that Deals Direct is way way cheaper (where's the icon for "suspicious"?) :p
===========================================

[John II]

And another thing - what is going on with all these young dogs with Cushings? I mean that's just particularly unfair!:(

[Franklin'sMum]

[QUOTE=John II;18669]

[Deals Direct would probably take another while.]

Hi John,

Dealsdirect and oo.com.au are both surprisingly fast with their shipping, usually 3-4 working days, (just in case you're eyeing off something else in future).

Still keeping everything crossed :)
Jane and Franklin xx
________
SILVER SURFER VAPORIZER FOR SALE (http://vaporizer.org/reviews)

[Squirt's Mom]

From Leslie:
Quote:
milk thistle glycerite from Mountain Rose Herbs

Mountain Rose Herbs? Now you're just making this stuff up!

Quote:
She gets 3 drops a day during the spring and fall months, then is off for the summer and winter months

Um... what? Seasonal dosing!!! I'm gonna need that one explained

Hey John!

Mountain Rose Herbs: http://www.mountainroseherbs.com/. I buy Squirt's milk thistle, Burdock, and astragalus from them, and will probably buy more from them as I learn more. I do trust their products.

The seasonal dosing came about after Squirt started throwing up her capsule of milk thistle...just the contents in capsule shape but no gelatin cap. The lady who designed her diet and under who I am studying recommended switching to a glycerite form and the seasonal dosing. Ideally, she would prefer dosing for 5 days and off 2 days for 6 weeks, then a week off altogether, and start over. Since her liver values went up a little bit in her last blood work-up, I may start that schedule VS the seasonal, tho.

Hope things are looking up for you and sweet - Yes! sweet! - Angelina.

Hugs,
Leslie and the girls

[labblab]

Please send prayers, good thoughts, crossed fingers or knocking on wood our way.

I'm a little late coming on board, but I'm doing ALL the above for you and Angelina!!!!!!!!!!! ;) :) :D

Best wishes always,
Marianne

[John II]

Hello All,

One week into the new 25mg Trilostane capsules and I don't know what's going on. I don't walk Angelina, that's the one thing I leave to another family member, so I don't see the result of the morning poop - but this afternoon it was loose. Found more of a similar consistency, which was probably done yesterday. I think from tomorrow, I'll be doing the walking as well.

Is it the Trilostane? Is it this Trilostane? Is it the filler (lactose)? Is it her food? Is it that she's an old dog and there is no cure for that? Where's my Personal Blood Tester? So I can take a sample and see what's going on. I'm gonna need an in-house IMS and Pharmacist and Lab Tech. The lottery, however is not co-operating.

One day I'll look at her and think she's got a little spring in her step, maybe standing a little straighter, looking a little leaner. Next day I'm back to worrying.

In other news, this week is scheduled to be hell in Sydney, with a forecast of 36 degrees celsius on Monday, and 41 degrees celsius on Thursday & Friday.

I have a general life tip for you - never arrange to get air conditioning installed by a friend of an extended family member. Last Friday became next Tuesday became next Thursday! :mad: I know there's a proverb about not looking a gift horse in the mouth but I need the A/C installed and working NOW!!! :mad::mad::mad:

In a sign that my brain has ceased to function - I had a look at the canine cooler mat on deals direct and seeing the size I wanted wasn't there... I didn't consider buying two of the small ones for about the same price as one of the large ones - duh! (where is that slaps my forehead icon?) :o

Last couple of days Angelina has skipped her mid-afternoon feed, hard to say if that's a sign of anything other than her not liking the homemade chicken, tripe and vegies I cooked yesterday. :o This evening I sprinkled with poached liver and that did the trick - again - but I worry about giving her liver too often.

Thanks to Jane for ongoing mail-order advice; to Leslie for explaining the seasonal dose thing :); and Marianne for her staggered good wishes - may need a good-wish roster, so Angelina gets her good wish dose everyday. :)

PS: I just noticed I'm a Senior Member - when did that happen? :cool:

[SasAndYunah]

Hi John and Angelina :)

I haven't posted before on this thread but have been following it. But now I wanted to add my good wish dose to Angelina for today....from a cold, windy and rainy Holland, perhaps that helps a bit too :)

Best wishes,

Saskia and Yunah,
The Netherlands :)

[John II]

Thankyou Saskia,

Right now I'm thinking of shipping Angelina over to you until it either cools down over here or warms up over there! :D

[littleone1]

Hi John,

I wish I had some answers for you. I also have issues with Corky's stools and his finicky eating. He's suppose to be on a bland, fat free diet. This worked for awhile. Now I also have to put some of his favorite foods on top of his other foods. He then eats everything I feed him. I'm also going to check with his IMS about vitamin supplements.

I know the heat also affected Corky this summer. We had many days when the temps were over 110 degrees. I hope you get your AC unit installed soon.

As far as becoming a senior member, your status deals with the number of your posts. I had a similar question and the answer was explained to me.

I hope all goes well for you and Angela.

Terri and Corky

[Franklin'sMum]

Hi John,

I was wondering how things were going with you both.
Still sending good thoughts your way. :) You're welcome for any info I can provide.
On that note, here's another idea re: chiller mats. Do you have a pet shop (K9 catfish, pet's domain, pet supplies direct) near you? They would probably also sell the mats (most likely at quite a mark-up.) Another thing you might try is soaking a towel and putting that on the tiles where Angelina likes to lay.
If you're still liking the idea of neck chiller thingies (I was also using one last summer) I went to Aussie Disposals (a camping store) and they are sold there for about $15 ish. I also took to wiping Franklin over with a wet face washer.
We hope Angelina is just having a couple of off days, and back to her "new old self" soon.

Take care

Jane and Franklin xx
________
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[Casey's Mom]

Hello John, I have followed your posts for a while with Angelina. We worry so much about our furbabies don't we - just remember that they don't worry and live in the moment. We can learn a lot from dogs!

I know that they do get uncomfortable in the warm weather and wow it sure gets warm in your neck of the woods - my Casey had a hard time this summer and it only rarely gets above 25 here in Northern Ontario. Good luck with the A/C - sending good thoughts your way . . . .

[Roxee's Dad]

Hi John II,
Sorry to hear our Angelina is having a tough time. 41 C is 104 F :eek: I would guess it's the heat that is affecting her apetite and I just looked up your humidity and it's at 86% :eek:.

I was going to suggest an old form of a "swamp cooler" which we used alot in Arizona when I lived there but at 86% humidy, it's won't work. :( If the humidity does drop, you can hang wet sheets with a fan blowing on them, this will create a cool breeze, Sometimes you can even hang them in open windows if it's breezy outside. Just use a spray mist to keep the sheets wet.

Maybe you can take her to one of those big pet stores, put a blanket in the cart (to protect her paws) and push her around the air conditioned store for a bit of relief. She would probably enjoy the change of scenery at the same time. I do this with my Rozee sometimes when I think she is getting bored and we peruse the isle's, I check out new items and she enjoys barking at anybody that comes to close to her cart. :D

Hope your AC comes soon and Angelina enjoys it. :)

All the best to you and Angelina and belly rubs (:)with an ice pack:)) to our sweet little girl.

[Harley PoMMom]

Hi John II,

So sorry to hear that Angelina is having some "off" days. I see in your dinner ingredients for her you have tripe listed, is this something new she was given or has she been given tripe all along? The reason I'm asking is because I tried tripe with my boys already and got very loose stools :eek::eek: and I mean very loose stools. No tripe for my boys. I even started out with the tiniest amount of tripe and I don't know, it just didn't agree with them.

Heat is definitely a factor to consider too. I think Susy mentioned about spraying/spritzing water with a spray bottle on your pups belly and paws to help cool them down, and I've tried this with Harley and this does seem to help.

Sending good thoughts and well wishes your way and give beautiful Angelina a gentle belly rub from Harley and me.

Love and hugs.
Lori

[Squirt's Mom]

Hi John,

Just like us humans, some dogs are lactose intolerant. If this is the same dosage as what she was on before, it could be the lactose filler and not the drug itself that is causing the loose stools. You might contact the pharmacy and see if they can use an different agent...you might even be able to plead allergies and get the lactose-free batch free! Never hurts to wish, huh? :p

Hugs,
Leslie and the girls

[John II]

Hello All,

I had a thought - since April I've been steadily increasing Angelina's dose of Trilostane to a maximum (recently) of 50mg a day. But since April Angelina has been steadily losing weight (down from 13kg plus to 12kg) - so have we passed a point where the increased dose is too much for her decreased weight?

Loose stools, indifference to her breakfast, duller... is this due to low cortisol? It sounds familiar. As of last night I'm holding off giving her any Trilostane until I see some more Cush-like behaviour.

This morning she was still quite indifferent to breakfast - I gave her 3 pieces of meat to try - she took each one in her mouth then put them on the floor - after a moment she ate them. I put the dish with the rest of her breakfast in front of her (and after a bit of agitation from me :o) she ate. I usually give her the Trilostane first and then the rest of the meal - from now on, I'll give her the meal first and depending on her behaviour, give her the Trilostane.

I didn't think we would survive yesterday, the forecast was spot on with a top temp of 36 degrees celsius (I think 96 degrees F) - I tried the fan, the wet towel option, and spraying Angelina with water mist (she was not at all happy about that!). Finally I gave her a cool bath - hoping the stress of the bath wouldn't be too much for her. But we made it through, and I think that helped. By midnight a cool change came through and today the max temp is about 25 degrees celsius. But from this Thursday until next Monday - Sydney will be officially hell. The good news is the A/C was delivered yesterday - not installed - just delivered, but at least that's moving in the right direction.

I've taken Angelina for her morning stroll the last two days, yesterday after a 25mg dose she seemed quite weak. Today after missing two doses, she broke into a trot at one stage. Still tongue hanging out panting on the way back though. Poop report: firmer, breaking off, but poop shaped.

I spoke to one of my nieces on Sunday (the one with the 3 dogs :)) who graciously placed the order for one chiller mat for me with deals direct... it's out there somewhere... heading my way, or her way, either way.

Thanks to Terri & Jane & Casey's Mom for the advice. Obviously it helps to have the behaviour of other dogs to compare with Angelina's :). Jane, you might want to consider starting up your own mail-order business, you have a talent for finding things! :D


Maybe you can take her to one of those big pet stores, put a blanket in the cart (to protect her paws) and push her around the air conditioned store for a bit of relief. She would probably enjoy the change of scenery at the same time. I do this with my Rozee sometimes when I think she is getting bored and we peruse the isle's, I check out new items and she enjoys barking at anybody that comes to close to her cart.

John - over here the shop owners make a point of keeping pets out! :D Which is a shame we could have used their A/C in the meantime. Otherwise a good plan and thanks for the cooling advice.

Lori - problems with tripe huh? When I've used it before, I added a little, I didn't notice any reaction at the time. This time, the packet of tripe froze solid in the fridge, and when sawing it into smaller pieces didn't work, I put the lot in. That might be contributing to the problem.
I made a new lot of chicken and vegies yesterday - but today I was away for the lunch feeding and Angelina was given more of the tripe and chicken. Have to wait and see the result. She's not interested in her mid-afternoon feeding at the moment - will have to save it for dinnertime.

I have to remember perhaps that Angelina PC (pre-cushings) didn't eat her breakfast until after a long morning walk and only had two meals a day. Is her lack of appetite a problem, or is she reverting? :confused:

And Leslie - depending on how things work out with the current plan, I'll have to speak with the compounding pharmacists who make the 20mg and the 25mg capsules and see what the filler used for the 20mg capsules was, and what the alternatives available are.

[littleone1]

Hi John,

Are you going to be speaking with your vet tomorrow? I am no authority about this, but anytime I've noticed anything that was different about Corky, I always called my IMS. After a couple of days on the Trilostane, Corky had seemed to be a little lethargic. When I called her that afternoon, she suggested that I call her in the morning before I gave him his Trilo. He was fine in the morning, so I was advised to give him his normal dosage. That was about a month ago.

I do several things to keep Corky cool when it gets so hot here. I always carry a squirt bottle of water with me on our walks , which Corky will drink from. I don't squirt it down his throat, but I pass it over his tongue.

Depending on how hot it is, I either wet him down with a cold, wet wash cloth, or I put him on the top step of the pool and wet him down. In the summer, I keep a container with ice water and a wash cloth, so I can cool him down.

I hope everything goes better for Angelina, and I hope you get your AC installed soon.

Take care. I know we constantly worry about our babies. You are a very caring and loving person.

[Harley PoMMom]

Hi John II,


Hello All,

I had a thought - since April I've been steadily increasing Angelina's dose of Trilostane to a maximum (recently) of 50mg a day. But since April Angelina has been steadily losing weight (down from 13kg plus to 12kg) - so have we passed a point where the increased dose is too much for her decreased weight?

I really think you are on to something here with the weight-loss, especially with our smaller breeds a reduction of weight of 1kg+, I believe, is significant to her dose.



I didn't think we would survive yesterday, the forecast was spot on with a top temp of 36 degrees celsius (I think 96 degrees F) - I tried the fan, the wet towel option, and spraying Angelina with water mist (she was not at all happy about that!). Finally I gave her a cool bath - hoping the stress of the bath wouldn't be too much for her. But we made it through, and I think that helped. By midnight a cool change came through and today the max temp is about 25 degrees celsius. But from this Thursday until next Monday - Sydney will be officially hell. The good news is the A/C was delivered yesterday - not installed - just delivered, but at least that's moving in the right direction.

Awww...no spritzing/spraying for Angelina...Harley gives me the "eyes" when I'm spritzing/spraying him as if saying "What the heck are you doing to me NOW," and then he realizes that it's just water and he's fine with it. :) Here's hoping your A/C gets installed very soon.




Lori - problems with tripe huh? When I've used it before, I added a little, I didn't notice any reaction at the time. This time, the packet of tripe froze solid in the fridge, and when sawing it into smaller pieces didn't work, I put the lot in. That might be contributing to the problem.
I made a new lot of chicken and vegies yesterday - but today I was away for the lunch feeding and Angelina was given more of the tripe and chicken. Have to wait and see the result. She's not interested in her mid-afternoon feeding at the moment - will have to save it for dinnertime.

I would think if Angelina had tripe before that she would not show any ill effects from it now. My boys only had a tiny bit and had the runs :eek:

Sending more positive thoughts and well wishes for beautiful Angelina and I hope her appetite goes up and the temperture goes down. :D

Love and hugs.
Lori

[AlisonandMia]

I believe we've seen others where weight loss has meant the need for a dose reduction so I too think you are onto something. Also the dose needed/tolerated can change from time to time too. And another thing: it does seem that sometimes as they become real elders some dogs seem to do better with their cortisol running at the higher end of the desired range rather than the lower or in the middle.

Just remembered another cooling method. You fill a 2litre (or bigger) milk bottle with water, freeze it overnight and then run a fan on it. It creates a nice cool breeze which feels like a miniature air con. You'd probably need to have several on hand to get through a hot day, though.

Alison

[Roxee's Dad]

Hi John II,

Sorry Angelina is having a tough time at the moment and do hope she starts feeling better soon.


Loose stools, indifference to her breakfast, duller... is this due to low cortisol? It sounds familiar. As of last night I'm holding off giving her any Trilostane until I see some more Cush-like behaviour.

I think this is a good idea, and as Ali mentioned, some pups do better on the higher range of normal. I've seen and read so many times "treat the pup and symptoms, not the numbers" The numbers are good as a reference but in the end, the purpose of treatment is to keep Angelina comfortable. So I do think your idea is a good one, give her a break to see if she regains her appetite and gains a little kick in her step, which it seems she already has. :)

Your doing a great job brother John, keep it up:D

Belly rubs (with an ice pack) to Angelina.

[Franklin'sMum]

[QUOTE]I didn't think we would survive yesterday, the forecast was spot on with a top temp of 36 degrees celsius (I think 96 degrees F) - I tried the fan, the wet towel option, and spraying Angelina with water mist (she was not at all happy about that!). Finally I gave her a cool bath - hoping the stress of the bath wouldn't be too much for her. But we made it through, and I think that helped. By midnight a cool change came through and today the max temp is about 25 degrees celsius. But from this Thursday until next Monday - Sydney will be officially hell. The good news is the A/C was delivered yesterday - not installed - just delivered, but at least that's moving in the right direction.

Hi John,
Crossing all our assorted limbs that little Angelina feels better soon, and also that your A/C gets installed first thing Thursday morning, if not sooner. Preferably sooner:)



Jane, you might want to consider starting up your own mail-order business, you have a talent for finding things! :D

What can I say, it's a gift. ;)Glad you like the "where to buy" guide!

Good luck,
Jane and Franklin xx
________
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[John II]

Hello All,

A package from Florida arrived today - customs looked it over - but let it through. They said they had xrayed it and the contents looked suspicious.

http://www.k9cushings.com/forum/picture.php?albumid=96&pictureid=1055

Between the tablets and bone-shaped biscuit, I don't think this package had a chance of getting through unchecked ;)

http://www.k9cushings.com/forum/picture.php?albumid=96&pictureid=1057

Now I just have to figure out the best time to dose her:

For optimal absorption, the tablets should be given on an empty stomach, at least one hour before feeding, as the presence of food decreases the absorption of S-Adenosylmethionine.

I initially thought of giving Angelina the Denamarin 1 hour before breakfast - and I probably still will do that, to start - just so I can watch for side effects. But Angelina has her last meal at around 6pm - so if I give her a dose later in the evening... that might be better? What do the Denamarin users think? I know Lori uses Denamarin and Marin with the dosing 12 hours apart, but if you just use the Denamarin once a day?

Still haven't given Angelina any more Trilostane. She was indifferent to breakfast again. A big difference to the mania of say, a month ago. But after giving her a few bits by hand, I placed the dish in front of her, and after looking at me for a while, she ate. Later, she insisted on her morning stroll - as usual. At lunch-time she was barking "hurry up!" orders. A couple of hours later she produced her 3rd poop for the day - which was quite loose (caramel fudge). I'm told the earlier ones were firmer.

At the moment the temperature is 30 degrees celsius and Angelina is in her usual spot in the bathroom.

http://www.k9cushings.com/forum/picture.php?albumid=96&pictureid=1056

Still awaiting the arrival of the cooler mat AND the air conditioning man.

Thanks to everyone for the cooling advice - I have to go freeze some bottles of water ;)

And as a few of you have said now and in the past, I think it would probably be best if Angelina's cortisol hovered around
on the higher range of normal

We've (the forum) had some sad news today:(, and after reading of the losses suffered by our members:(, I went to Angelina to give her the kind of pat you give your pet when you have a fair idea of what the future holds. She lay on the cool kitchen floor, peaceful, angelic. I gently touched her head...

She erupted from the floor ferociously, outraged by my impertinence. If my reflexes weren't better than hers I'd have a lot fewer fingers by now! :eek:

[Casey's Mom]

Hello John, sorry about the heat and here's hoping you get your AC installed soon. Love the photo of Angelina in the bathroom - poor baby trying to keep cool!

I gave Casey Denemarin for quite a few years then switched to Milk Thistle and for both I give to her at lunch time when her stomach is empty. It gives me a reason to give her a treat and I usually wrap it in a small piece of beef.

[John II]

Hi Ellen,

Thanks for the tip :)
But now you've got me wondering, why did you switch to Milk Thistle? Because, Milk Thistle is certainly a lot easier to obtain over here than Denamarin. :confused:
And is Denamarin given once a day and for how long?

[Franklin'sMum]

Hi John,
Angelina looks so beautiful laying on the bathroom floor. I hope your A/C gets installed soon. I was catching up on posts at work and now even more people thing I'm officially insane...:rolleyes:


She lay on the cool kitchen floor, peaceful, angelic. I gently touched her head...

She erupted from the floor ferociously, outraged by my impertinence. If my reflexes weren't better than hers I'd have a lot fewer fingers by now! :eek:

You definitely have a way with words, John. Thank you for brightening my day.:)
Gentle ((hugs)) to Angelina (if you dare!:eek::eek:)
Jane and Franklin xx
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