Extreme sensitivity to Trilostane?

[Sadie's Mom]

My 11 yr old golden was just diagnosed with pituatary-dependent Cushing's. She also has non diet-related chronic, mild pancreatitis, and a small liver mass. The problematic -- and only -- symptoms we are trying to address are excessive panting/exercise intolerance/back leg weakness with dragging of rear paws and knuckling. She was initially started on digestive enzymes and Traumeel for the pancreatitis and was improving -- she could walk up the wood stairs and take a short walk. Then came the Triolstane. She was started on Triolstane 60 mg twice a day. After 3 days, she was listless, had back leg weakness, anorexic, depressed -- a zombie. We stopped it, and she improved. Then, we restarted at 60 mg once a day, and the weakness has returned. Took her back off of it. She's becoming worse on Trilostane and at her age, every good day matters. I don't see the benefit of trying it again. Am I missing something here?

Moderator's Note: I have moved your post to the main forum, where other members are more likely to see it & respond to your questions. The main forum is the primary forum for discussing getting a pup diagnosed, treatments, problems, & anything else related to the pup's Cushing's treatment & health.

[Harley PoMMom]

Hi and Welcome!

Cushing's is one of the most difficult diseases to get a confirmed diagnosis and strong symptoms are a huge part of the diagnosis. The symptoms that you are describing really do not fit the usual clinical signs displayed by a dog with Cushing's.

Since not one test is 100% accurate at diagnosing Cushing's multiple tests are usually performed. Could you get copies of all tesing that was done to confirm the diagnosis of Cushing's and post the results here, this would really enable us to give you more meaningful feedback.

I was also wondering if you could tell us more about your furbaby such as how much she weighs and if she is on any other medicines/supplements/ herbs.

Although I am not a vet, it sounds like to me that the dose she is on is too high, has an ACTH stimulation test been done recently and have her electrolytes been checked? Do you have any prednisone on hand?

Please know we will help you in any way we can so do not hesitate to ask us any and all questions.

Love and hugs,
Lori

[addy]

Hi and Welcome,

I am sorry to hear of your pups problems with Trilostane. I echo Lori in asking for tests results and weight, other health problems, medicines, etc. While some dogs may go through a period of feeling off until they get used to the lower cortisol, not eating and lathargic behavior can be a sign cortisol being too low.

It is also possible some dogs just do not do well on this drug. Cushings can be a puzzle and sometimes it takes a bit to make all the pieces fit.

Glad you found your way here and hope we can help shed some light on things.

Hugs,
Addy

[Squirt's Mom]

Hi and welcome to you and your baby! :)

First, please do not give any more Trilo to your baby - none! ;) You have done a good job of knowing something wasn't right. :)

Based on the signs you have mentioned so far, I have serious concerns about the Cushing's diagnosis. Cushing's is extremely difficult to pin down because the signs are shared by so many other conditions (including liver issues ;)), PLUS cortisol is the body's normal response to stress. So with other conditions, the Cushing's tests can bring back false positives. For these reasons, it is best to do as much diagnostic testing as you can before starting any treatment. Many vets will see elevated cortisol and leap to Cushing's without doing the testing needed to confirm this suspicion. ;)

Since we don't know what your babies cortisol levels are yet, it is difficult to tell you whether your baby actually could have Cushing's or not so I really look forward to seeing those results! Seeing her test results will allow us to give you more meaningful feedback. Your vet should be happy to give you copies of the results. Trilostane should never, ever be given to a pup with normal cortisol so those test results are very important. The more details you can give us about her, the better. We LOVE details! :D

The knuckling could be neurological. Has she seen a neurologist or has your vet said anything about this possibility? Or spine issues as the cause for this?

I'm glad you found us and look forward to learning more about you as time passes. You and your baby are no longer alone - we will be with you every step of the way.

Hugs,
Leslie and the gang

[Sadie's Mom]

Thanks for all your input into this. Sadie is 76 lbs now -- her normal weight is 78 to 82 lbs. She was being evaluated for surgery for possible laryngeal paralysis when the Cushing's dx came up. It was first suspected last year after she had an abdominal ultrasound to investigate high lipase and amalyse levels, despite a low fat diet. Her adrenal glands were found to be abnormal and most consistent with Cushings. The vet did a Cushing's urinalysis that came back negative. No further investigation was done because she didn't have any symptoms. Her CBC in July, in addition to off the chart Lipase and high amalyse, showed high liver enzymes: AlkP at 388 u/l and Alt at 188 u/L. Then we did a repeat abdominal ultrasound which revealed the same abnormal adrenal findings, the chronic, mild pancreatitis, and an enlarged liver with a small mass in it. Then came the low dose dex test. Her pre level was 6.0 ug/dl; at 4 hours post, it was 2.7 ug/dl; at 8 hours post it was 3.5 ug/dl. Both her very experienced and her new vet (who offers holostic therapies) concurred in the Cushings dx. She is hypothyroid, and has been taking Soloxine for 2 years. That's the only med she takes. The supplements she takes are "Dasquin with MSM," "Prozme", "Okra Pepsin," "Canine Adrenal Support," and "Traumeel." She was doing her best after 3 days of the digestive enzymes and before the Trilo. She has tried Trilo 60 mg. twice: First for 5 days at 2 times a day. Then we stopped for a couple of days. We restarted at once a day and stopped after 3 days.

[Squirt's Mom]

When the Trilo was stopped, were any ACTHs done? Were her electrolytes checked? These are the first things that need to be done when an overdose or treatment crisis is suspected. Without the ACTH, there is no way to know what the cortisol levels were, tho based on your description I bet they were too low. The protocols to follow with Trilo that can be found here -

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

While those liver enzymes were judged high (not sure what the normal ranges are tho), we have seen them much, much higher - in the 5000's ug/dl! With the liver mass that was seen, that could easily account for Sadie's elevations, as could chronic pancreatitis and laryngeal issue. What were the comments on this mass from the ultrasound?

What were the comments about the adrenals from the ultrasound? Are the adrenals both enlarged, or one much smaller, even atrophied?

Has her thyroid function been checked recently? Has diabetes been ruled out?

Cushing's is one of, if not THE, most difficult condition to diagnose and when you throw chronic conditions into the mix, it gets even more difficult. My Squirt was diagnosed based on five tests - LDDS, HDDS, ACTH, ultrasound (2), and UTK panel - four vets in the clinic, her IMS and researchers at UTK (University of TN in Knoxville) all agreed. ;) However, when we had the second ultrasound, I was told about a tumor on her spleen. Once it was removed, her cortisol returned to normal. The stress of that tumor was causing her cortisol to elevate and cause false positives on the tests. This is a very difficult disease to diagnose and treatment shouldn't be rushed until all other causes for the elevation in cortisol have been ruled out. So, from my own experience, I would have the mass on the liver checked out before I started Sadie on anything else - Trilo or Lyso - and have at least the ACTH done. Perhaps even starting with repeating the UC:CR that was negative. ;)

There are pups who are sensitive to one drug or the other and simply cannot take it. Sadie could be sensitive to Trilo but I would feel more comfortable with looking at that mass and some more testing before making that assumption. As I said before, pups who do not have elevated cortisol do not need to take Trilo. Lysodren can be given to pups who do not have Cushing's with no ill effect but that is NOT the case with Trilostane so it is especially important to know what you are dealing with when using this drug for treatment.

I'm not familiar with the herbs you are using, other than the Traumeel, but will do some research and see what I can learn about them. The Dasquin is used by some of our other members, I think.

I am sure others will be along to ask questions and share their experience with you, too. Keep talking, sharing and asking your questions! You're doing a great job!

Hugs,
Leslie and the gang

[Sadie's Mom]

You are so thorough. I really appreciate your input into all of this decision-making!! It kinda reminds me of one of my favorite TV shows -- "House." To answer your questions, Sadie never had any ACTH test of electrolyte test after we stopped the Triolo. Her original vet suggested that we could biopsy the mass in the liver. We nixed that idea after we all determined that she wasn't a good candidate for gen'l anesthesia. On the nite before her low dose dex test, she "overdosed" one a tranquilizer (25 mg of Acepromazine). The comments re the adrenal glands in the ultrasound report are as follows: "There are still bilaterally enlarged nodular shaped adrenal glands. The left adrenal measures 1.1 cm compared to prior measurements of 1 cm and the right adrenal gland measures 1.2 cm compared to prior measurements of 1.1 c.m." Sadie had a thyroid function test within the last 6 months. After getting the results of the ultrasound and low dose dex test, we went to the holostic vet to see what he could recommend. His first comment was: "These dogs usually get cancer." Indeed, Sadie lost both parents at age 10 due to cancer. My husband and I do not want to subject her to further testing at this point because of the cost (over $1,000 so far) and the psychological effects it has on her. We kinda of did that last year with respect to the idiopathic pancreatitis, and got nowhere with it. She is a pure people dog, and detests being crated and treated like a dog. She enjoys going places in the car, having company over, and being outside in the fresh air with people. We want to maximize our dollars on treatment. You are all helping me see things a little better through the fog. Since she also started licking her paws this year, we're also wondering whether she might have arthritis or disc disease that could be causing the weakness in the hind quarters. At this point, even though the Trilo did seem to decrease her panting at nite, we all need to take a breather and continue with the supplements and activities that improve her psyche.

[Leena]

Hi...Just to chime in a little bit...You sound like a great dog parent.! You are trying your best to help your baby with her physical problems, and you also see how the testing, etc, is affecting her Quality of life :) It's good to take a small step back to reassess the best path for her. To treat, not to treat..and is it better to just let her live happy for her remaining days and not put her through the meds and testing, etc...Whatever choice you make, it is done with a great love! Your dog will know that too! I wish you luck with this. I understand as I am currently fighting my own battle with Cushing dx and treatment. hang in there !:)

[Sadie's Mom]

Thank you Leena, Leslie and the gang, Lori & Addy: Such kind words, and such great advice. My furbaby Sadie has been such a blessing in my life!! I think the wisest advise you gave, and have given to others is to not rush into making a decision regarding the medication. I wish I had found your website before I rushed into the decision, because it might not be the right thing for her risk-benefit wise. I love learning from other great dog-moms like you, and thanks for being there for me. Hugs back to you! Sadie's Mom :)