13 Year Old Jack Russell

[Phonecenter]

Hi my name is Shanna. My 13 year old jack russell "Jack" has cushings. We started trylistane 11mcg 1-2 times a day per rx. We did 1 time for 10 days. The first few days he did well. The 7 day he started to act like his back half wouldn't function first thing in the am. He finally by day 10 was so lathargic I cut it off. I thought I would try every other day? His water intake and urine output in my floor has decreased. However I think it is partially due to him being stoned out of his mind. Any suggestions?

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[addy]

Hi Shana,

Welcome, I am so glad you found us. We asked quite a few questions, so dont get put off by that. Could you let us know what tests your pup has had and how Cushings was diagnosed? Could you tell us what your pup weighs?

You cannot really just change doses without proper testing; there are important protocols to be followed. I am concerned your pup needs help and I think you should not give any more trilostane but others will be along soon if they are not already typing away:D

Hang in there so they can try to help sort things out.

hugs,
addy

[marie adams]

Welcome Shanna and Jack!!:)

As Addy said you will be asked lots of questions along the way. So gather up all the test results and start typing away.

I agree with Addy about stopping the dosing. I know the experts always ask if the vet prescribed Predisone along with the trilostane. You might want to call the vet just to make sure.

I know I was over joyed to find this site when I was starting the Cushing's journey--everyone is so helpful and knowledgeable. Please ask any questions or share your thoughts.

You are now family!!!:)

[Phonecenter]

Hi again. Jack weighs about 25 lbs. We had a low dex test (neg) about a year ago. This all kind of started by him having his throat cut by a crazy person. A long story. He recovered well from that. BUT he started on steriods. thats why we had the low dex test to see if he was cushionoid. He was on meds 5 months. He had yeast so bad. We thought he was loosing his hair from yeast. He tested positive for woods. I don't know but his toenails glowed under a light. He is losing them. They grow back but lose another. His ears are disgusting with yeast. We have had antibiotics as well as internal and topical steroids. We have tried mange dip you name it. He has been at the vet at least every 2 weeks for a year. Finally htc stem test gave a positive for cushings. An ultra sound showed enlarged liver. Did a liver function test. Livers still good. His glands are enlarged but no tumor. Wiating on the numbers from the vet will post asap. Oh by the way he is not diabetic yet. But is on thyroid.
Thanks SO MUCH

[Phonecenter]

march 1 9:00 am
bile acids 13 umol/l
preprandial
preprandial Fasting
<12 umol/l hepatic dysfunction unlikely, await postprandial results
12-25 umol/l await postprandial result
>25 umol/l consistent with decreased heptic function or gail bladder contraction
March 1 11:49 am
Bile acids 6 umol/l
postprandial
<12 umol/l normal ; consistent with suffcient hepatic function
12-25 umol/l equivocal;retest at a later time if hepatic dysfunction is still a concern
> 25 umol/l consistent with decreased hepatic function

[Squirt's Mom]

Hi Shana and welcome to you and Jack! :)

Is Jack still on steroids? If so, none of the testing for Cushing's is going to be accurate as steroids read like cortisol on these tests. So you can easily get a false positive. There is absolutely no point in you wasting money or putting Jack through the tests as long as he is taking steroids. ;)

Also, the use of steroids causes a form of Cushing's called Iatrogenic, which is treated by slowly weaning the pup off of the steriod(s) if at all possible.

Could you tell us the relationship between his taking the steroids and the testing for Cushing's that has been done? In other words, he was still on it/them when this test was done, but had been off for X number of days when that test was done.

Others will be along soon to chat with you as well and probably have many more questions for you. Bear with us as we try to learn as much as possible about Jack's journey so we can offer the most meaningful feedback.

Hugs,
Leslie and the gang

[Phonecenter]

He was off of steroids about 5 months. He had the low dex. test then started the steroids. Stopped because we were afraid we were causing more damage than good.

[Phonecenter]

Hey,
I haven't heard anything. Am I posting correctly?

[labblab]

Hi Shanna,

Yes, you are posting EXACTLY right and I am so sorry that we've overlooking responding to you! :o

Before I try to post more, I just want to clarify Jack's trilostane dosing history. Are you sure he is taking 11 mcg. rather than 11 mg.? A microgram is a different and much smaller unit than a milligram. So we need to know for certain about his dose. Also, you wrote that he was prescribed the medication 1-2 times per day. But it sounds as though you've been giving it to him just once a day up until now? How many days, in total, has he now been on the medication? Also, is he taking the trilostane in a pill, capsule, or liquid form?

Also, has your vet scheduled a monitoring ACTH test in order to check Jack's cortisol level while taking this dose of trilostane?

I apologize for so many questions, but your answers will really help us to sort through what may be going on with Jack.

Thanks so much,
Marianne

[Squirt's Mom]

Hi,

You are posting just fine! :) I guess no one has had a reply for you yet but be patient.

Is the bile acid test the only one he has had? You did mention the low dose dex (LDDS). Do you have those result to share with us? Did he have a UC:CR, HDDS, ACTH, or ultrasound before starting the Trilostane?

I don't know much about the bile acid test or what it implies, but some here do and hopefully they will be along to talk to you about it soon. What did your vet(s) say about it?

Have you pursued the nail issue to find out what is causing this?

I am still confused about the steroid usage, tho. If I understand, he was on them and the Trilostane at the same time? But he's not on either one now, correct?

Is he taking any meds, supplements, or herbs? If so, what, how much, and what for?

I know we ask lots of questions but it really helps if we can establish a timeline for events, tests, meds and reactions as well as have a good general health background. Cushing's is one of, if not THE, most difficult diseases to diagnose so it is important that we have as much info as possible so that we can respond in ways that will help ya'll. This is also why it is important to rule out all other possibilities before starting treatment - like diabetes, thyroid problems, kidney and liver issues as well as things like problems with bile ducts, gall bladders and unknown conditions like the nails as causes for what we are seeing in our babies.

So, let's start at the top - what led you take him in to see the vet in the first place when Cushing's was first mentioned as a possibility?

What signs were you seeing before diagnosis?

Were the bile duct and nails an issue for Jack at this time?

What tests were done to diagnose the Cushing's and what were the actual results of each test along with normal ranges and units of measurement (ug/dl, mnol/l, etc.)?

How much did Jack weight when the Trilostane was first started?

What dose did he start on?

Was it given once or twice a day and at what time of the day?

Did he have follow-up monitoring at 2 weeks after starting the Trilo? What were those results?

Were there any dose changes? If so, when and to what amount? Did he have follow-up monitoring at two weeks after each change? What were those results?

After starting the Trilo, when did you first notice something didn't seem quite right? Did you call the vet? What did they say to do?

Enough for now? :p

Hang in there - we are trying to learn as much as possible about Jack's situation. ;)

Hugs,
Leslie and the gang

PS. If you are still giving the Trilo, I would stop for now.

[Phonecenter]

march 1 9:00 am
bile acids 13 umol/l
preprandial
preprandial Fasting
<12 umol/l hepatic dysfunction unlikely, await postprandial results
12-25 umol/l await postprandial result
>25 umol/l consistent with decreased heptic function or gail bladder contraction
March 1 11:49 am
Bile acids 6 umol/l
postprandial
<12 umol/l normal ; consistent with suffcient hepatic function
12-25 umol/l equivocal;retest at a later time if hepatic dysfunction is still a concern
> 25 umol/l consistent with decreased hepatic function
Jack was fine. We had a caretakers husband slit his throat. He almost died. He started to drink huge amounts of water and pee in the house. We did have low dose dex test prior to steroids. We were on antibiotics and steroids for 5 months with this cut. He became pot gutted. Big appetite. Lost his hair. I don't know where the yeast came fro but full of yeast. Ears are awful. Smells terrible. He was off of steroids for 5 monts before we did hct test. He was taking 11.5 mg 1-2 times a day. We started 1 tie a day. By the 6 th day he was loosing control of his hinde quarters. My vet was closed. We were told that we would know when he looked like he was back to normal. To go about 30 days. So we decided to do his med every other day. Our other vet said cut the dose in half. It is a capsule. He said every other day was the same as in half.

[Squirt's Mom]

Ok...the test you have posted is not for Cushing's. If this was the only test Jack had done, then he has never been tested for Cushing's.

If the signs you saw came on after he started the steroids, then they are more than likely the cause of those signs.

I am not sure Jack has ever had Cushing's to start with and if that is the case he should never have been taking Trilostane.

Again, if the test you have posted twice is the only test Jack has had done, then he has NOT been tested for Cushing's so there is no way to know if he has it.

Hugs,
Leslie and the gang

[Squirt's Mom]

In looking back through Jack's thread, I see no one has told you the name of tests used to look for Cushing's. They are the UC:CR, LDDS, HDDS, ACTH, and ultrasound. He may have had one or more of these if he was tested for Cushing's. If is has not had at least either the LDDS or the HDDS or the ACTH or the ultrasound then he has not been tested for Cushing's. The test you have posted looks like a bile acid test which has no bearing on Cushing's but looks at the bile ducts in the digestive system.

Hope that helps! :o
Hugs,
Leslie and the gang

[Phonecenter]

He did have acth test. The levels were more than 30. He said he could not believe he didn't have diabetis. We were sent to an endocronoligst. An ultrasound showed He has enlarged glands but no tumor. In the begining he had low dose dex test (they said it was for cushions) It was neg a year ago.

[labblab]

How long has Jack been getting the trilostane every other day? Does he seem to be feeling better overall? How about his drinking and peeing?

Dosing every other day really isn't the same thing as giving half as much every day. For most dogs, trilostane only stays active in the body for about 12 hours. So this way, he is getting a bigger dose one day, and then probably not getting much of a benefit on the second day. My layperson's opinion is that he'd be getting a more consistent benefit from the medication if he was getting a smaller amount of the trilostane every day.

Given Jack's weight, it is a bit surprising that only 11.5 mg. a day has produced such strong side effects. Is he taking any other medication as well? Also, given the dosage of the 11.5 mg. capsules, I'm guessing you must be getting the trilostane from a compounding pharmacy. Is this a pharmacy that you or your vet has used in the past?

Last but not least, has your vet spoken about the need for another ACTH test in order to monitor Jack's cortisol level while taking the trilostane? Standard protocol is to test approx. two weeks after treatment is started or at any time that a dog appears to be unwell.

Thanks again for providing this additional information,
Marianne

[Phonecenter]

I had to stop every other day too. It's like it is loading up in his system. I finally got the vet. The senior vet I think was confused about the trilostene and the mysomething. That's why he told me we could play around with the dose. His vet seems to think it may be an electrolite problem. So I have cut the meds off. He was doing much better not peeing. I'm not sure his water consumption was less. He still drank alot. He was able to make it outside. I am not sure his peeing less wasn't due to the fact that he was never waking up. When he first went on the meds he was getting frisky and playing and growling like his old self for the first few days. Then he just crashed. Untill he all but lost his rear end. His legs were sliding out from under him. He could not stand or walk. He fell down and up our steps. I tried every other day. That did good for the first 2 doses. 4 days then by the 3rd dose he was going down again. After being off for several days I can already see his pee increasing as well as his girth size.

[MBK]

Hi, Shanna -

I'll let the others more qualified than me answer your questions. I'm better at offering moral support. I just wanted to welcome you. I have 2 JRTs and they are tough little buggers! My Alivia is 14 years old. She was diagnosed with Cushing's due to an adrenal tumor. Initially, we went through a lot of issues caused by the Cushing's and some very serious medical problems, but inexplicably, she is no longer exhibiting any symptoms. Maxwell is 12 and, fortunately, has always been healthy.

The people here offer a wealth of information and support. I was terrified when Ali was first diagnosed and they helped me through some pretty bad times. Hang in there. Jack is fortunate to have you and I am sure you feel the same about him.

[lulusmom]

Hi Shanna.

I apologize in advance for the really long post and any duplication but I had lots of questions and the best way for you to follow my train of thought is to include my comments within the body of your various posts. This post pretty much has all of Jack's history right here so it will be easier for me and others to refer back to this post rather than rereading the entire thread. Please see my comments and questions in blue below:


Hi my name is Shanna. My 13 year old jack russell "Jack" has cushings. We started trylistane 11mcg 1-2 times a day per rx. We did 1 time for 10 days. The first few days he did well. The 7 day he started to act like his back half wouldn't function first thing in the am. He finally by day 10 was so lathargic I cut it off. I thought I would try every other day? His water intake and urine output in my floor has decreased.

When Jack started to show adverse reactions to the Trilostane did your vet do an acth stimulation test or check his electrolytes?

However I think it is partially due to him being stoned out of his mind.

Trilostane does not drug up a dog so when you say stoned, are you talking about Jack's hind end weakness?



JHe had yeast so bad. We thought he was loosing his hair from yeast. He tested positive for woods.

When you said he tested positive for wood, do you mean he had a wood's (ultraviolet) lamp test to determine if a fungus is present? As a dog rescuer, we've had that test done on a lot of dogs suspected of having ringworm. If fungus is present the area of skin being examined will be florescent (glow/light up).

I don't know but his toenails glowed under a light. He is losing them. They grow back but lose another. His ears are disgusting with yeast. We have had antibiotics as well as internal and topical steroids. We have tried mange dip you name it. He has been at the vet at least every 2 weeks for a year. Finally htc stem test gave a positive for cushings. An ultra sound showed enlarged liver. Did a liver function test. Livers still good. His glands are enlarged but no tumor. Wiating on the numbers from the vet will post asap. Oh by the way he is not diabetic yet. But is on thyroid.

At what point was Jack diagnosed as being hypothyroid? What drug is he taking for this and how much?


march 1 9:00 am
bile acids 13 umol/l
preprandial
preprandial Fasting
<12 umol/l hepatic dysfunction unlikely, await postprandial results
12-25 umol/l await postprandial result
>25 umol/l consistent with decreased heptic function or gail bladder contraction
March 1 11:49 am
Bile acids 6 umol/l
postprandial
<12 umol/l normal ; consistent with suffcient hepatic function
12-25 umol/l equivocal;retest at a later time if hepatic dysfunction is still a concern
> 25 umol/l consistent with decreased hepatic function

Why did your vet do a bile acid test? Did he suspect primary liver disease?

Jack was fine. We had a caretakers husband slit his throat. He almost died.

Oh my gosh, I would be hard pressed not to hunt down that horrible person and make him pay for doing such a horrific thing. How awful that must have been for, not only Jack, but you too. I am so sorry you both had to go through such a traumatic experience.

He started to drink huge amounts of water and pee in the house. We did have low dose dex test prior to steroids. We were on antibiotics and steroids for 5 months with this cut. He became pot gutted. Big appetite. Lost his hair. I don't know where the yeast came fro but full of yeast. Ears are awful. Smells terrible.

Did all of the symptoms you describe begin after the steroid treatment? Once you discontinued the steroids, did any of the symptoms improve? Steroids, whether synthetic or produced by the adrenals suppress the immune sytem, leaving a dog open to infection. Bacterial and fungal are common with long term use of steroids. More commonly yeast infections are due to high levels of bacteria in the gut and/or allergies. Did your vet recommend giving Jack probiotics and/or trying a single source protein diet?

He was off of steroids for 5 monts before we did hct test.

During that five months did any of the symptoms improve?

He was taking 11.5 mg 1-2 times a day. We started 1 tie a day. By the 6 th day he was loosing control of his hinde quarters. My vet was closed. We were told that we would know when he looked like he was back to normal. To go about 30 days. So we decided to do his med every other day. Our other vet said cut the dose in half. It is a capsule. He said every other day was the same as in half.

Did you wait 30 days before trying the every other day dosing? Was it your vet's idea to try every other day dosing? I believe Marianne has already mentioned this but because Trilostane has a short half life, every other day dosing is ineffective in controlling cortisol throughout the day. I also agree with Marianne that a dose of 11mg is not that much for a dog of Jack's weight but we do know that some dogs are extremely sensitive to it. I'm going to repeat myself but did your vet do an acth stim test to determine if Jack's cortisol was low?


I had to stop every other day too. It's like it is loading up in his system.

If a dose is too high, the results will be the same, whether you give it once a day or every other day. Your vet needs to determine if 11mg is simply too much for Jack. It would help if you could post the results of the last acth stimulation test that was done by your vet.

I finally got the vet. The senior vet I think was confused about the trilostene and the mysomething. That's why he told me we could play around with the dose. His vet seems to think it may be an electrolite problem.

Electrolyte problems can be life threatening so if your vet thought that Jack's electrolytes were off, he should have had you take him immediately for a test. Was this done?

So I have cut the meds off. He was doing much better not peeing. I'm not sure his water consumption was less. He still drank alot. He was able to make it outside. I am not sure his peeing less wasn't due to the fact that he was never waking up. When he first went on the meds he was getting frisky and playing and growling like his old self for the first few days. Then he just crashed. Untill he all but lost his rear end. His legs were sliding out from under him. He could not stand or walk. He fell down and up our steps. I tried every other day. That did good for the first 2 doses. 4 days then by the 3rd dose he was going down again.

When did you actually begin giving Jack Trilostane and has the dose always been 11mg? Is the med in capsule form or liquid? I believe Marianne has already asked this question but is the Trilostane compounded?

Leslie has asked some of the same questions but because I was unable to find your answers, I've asked them again.

It's possible that Jack is one of those dogs who can't tolerate Trilostane but before that determination can be made, your vet needs to determine if the current dose of 11mg is just too much for him. A reduction of dose may be all that is needed. I must tell you I am concerned that your vet told you to experiment with Jack's Trilostane dosing. Trilostane is a serious drug and proper protocol must be followed to insure a dog's safety. Perhaps your vet did an acth stimulation test within 4 to 6 hours after a dose and determined that the dose was not too much for Jack, yes?

Sorry for all of the questions but we can't really offer any meaningful feedback with so many unanswered questions. I know it can be overwhelming and difficult to keep track of everything but please try to go down the list of questions and do your best to answer them. The more information you can give us on Jack's treatment history, the better we can try to help you figure out why he seems to be unable to tolerate Trilostane. We're here to help in any way we can so if I've confused you, please let me know.