concerned about diet - (12 y/o Lab) Liberty (Trilostane)

[flyagain]

Hello.. My 12yo Lab Liberty has been diagnosed with Cushings for three months now. She is on Trilostane and we have had to up her dose the l 2 previous visits after the acth was high. The last one drawn last week was finally in a good range. I would like to be sure that she is on a good diet for Cushings. does anyone have any suggestions or have any good or bad recommendations

[Harley PoMMom]

Hi and welcome to you and Liberty,

I was wondering if you could tell us more about your furbaby such as the dose of Trilostane she is on and her weight. Also could you post the results of the ACTH stim tests that were done with their timelines. What symptoms did Liberty display that led you or your vet to test for Cushing's in the first place and how are the symptoms now? Is she on any other herbs/supplements/medicines?

A diet that provides a high quality protein, moderate fiber, and lower in fat is usually recommended but it truly depends on any health issues that the dog has.

Please know we are here to help in any way we can so do not hesitate to ask any and all questions.

Looking forward to hearing more about your sweet girl.

Love and hugs,
Lori

[marie adams]

Welcome to you and Liberty,

We are so glad you found us because now you have a sounding board to ask all sorts of questions concerning Liberty and Cushing's.

When my Maddie was diagnosed I start all sorts of research. I had at one time found something that said take them off of grains. I also had read beef was not a good choice for their protein source, but as Lori said it does depend on Liberty.

Take care and as Lori said please post as much testing info as you can because it helps the experts know how to answer your questions more thoroughly.

[flyagain]

Thanks for answering my post.. Liberty was diagnosed after an episode of eating alot of chocolate. She got into a chocolate basket I was holding for an auction. I took her to the Doggie ER and she spent the night there. her Liver function test were sky high but that was thought to be because of the Chocolate
It was scary cuz i thought i might lose her but she came through OK
then I had my Vet recheck her Liver test about 3 weeks after.. the Alkaline phoshate was still high and they said she had cushings.. Being a nurse i felt that they were stopping to conclusions too quickly so we repeated the Liver test in about a month.. It had doubled
I was still not sure because she really has not had any episodes of freq urinating or incontinence. She is a food hound but always has been
She did start being reluctant to jump into the car and starting panting heavily with just a little activity..
They did the ACTH level and it was what they called borderline at 13.
Just some other background on Liberty. She has had 4 knee surgeries 2 for ACL repair and 2 for menisectomy.. So she has weakness in her legs which is also one of the symptoms I guess
We didnt do an Ultrasound which I am maybe double thinking
She weighs 83 lbs and she was started on 120mg of trilostane 2x day.. Her ACTH after that came back 3.. So we kept her on that dose.. the next one jumped up to 18.. I thought that might have been related to her starting on meloxicam but they said no.. All the same i waited to make any dose changes and her next one came down to 5.. Now she is on !30 mg 2x day.. I have noticed very little changes and am still a little unsure of the diagnosis
Any info you can give would be appreciated .. thanks

[frijole]

Please go to your vet's office and get copies of the acth tests that were done. The numbers for normal vary from lab to lab but I guarantee you that a reading of 13 on the acth test is NORMAL and not cushings. A reading of 18 is also NORMAL from most labs.

I am very very very concerned that your dog does not have cushings and you are giving trilostane unnecessarily. I would bet money that Liberty does not have cushings. Kim

http://www.idexx.com/pubwebresources/pdf/en_us/smallanimal/snap/cortisol/cortisol-acth-stimulation-protocol.pdf

[flyagain]

Thank you for your reply
I have had doubts from the beginning as well.. Would the fact that the ACTH levels came down into a more normal range now that she is on trilostane indicate she might be positive for cushings?..When they got an initial reading that they thought was borderline on Liberty I asked about why we would put her on this drug and they indicated her symptoms were the reason.. She isnt having the frequency or incontinence but is exhibit the food focus and she has a ppot bellied like physique. The panting came on a little before the Cushings diagnosis and hasnt made any improvement since the Trilostane
I will confirm the ACTH numbers I sent in a previous post and let you know Thanks for watching out for Liberty!!

[frijole]

I had a dog that was misdiagnosed. She had elevated cortisol from something else. She was put on lysodren and her readings went down a bit so we upped the dose and the levels went up. This is when I knew something was not right. (and I had already treated a dog successfully with cushings!)

My vet was at a loss and was way over his head. I took my dog (after much deliberation) to the closest internal med specialist who happened to be 5 hours away. That is how I figured out what was wrong.

If the numbers you posted are correct, the cortisol levels were normal and therefore it was never cushings. The trilostane just lowered the cortisol as it is designed to do. But it isn't a good thing to lower cortisol in a dog that does not have cushings for obvious reasons.

Please keep us posted! Kim

[Squirt's Mom]

Hi and welcome to you an Liberty! :)

I agree with Kim and will go a step further and recommend you stop the Trilo for now. If, IF, Liberty does indeed have Cushing's, you can restart the med without losing any ground like we who use Lyso can if we stop. So, until the diagnosis is confirmed, and it hasn't been, no more Trilo. ;)

The ultrasound is one test I highly recommend - it saved my Squirt's life in 2008 by finding tumor on her spleen that was the true cause of her elevated cortisol. Once it was removed, her cortisol returned to normal and has remained within range, tho it started creeping up last summer prompting us to add the Lyso.

Which brings me to another point I wanted to make. You called Liberty a "chow hound". I can relate! One of Squirt's nicknames is Miss Piggy because she has always been one! :p As a result, I felt the appetite talked about with Cushing's would never be good indicator for us - MAN! was I wrong! :eek: Chow hounds and Miss Piggy's are pure amateurs, trust me. When Squirt's cortisol started going up last summer, it was pitiful to watch. She literally felt as if she were starving 24/7. She would wolf her food down, try to run the others off their plates, then look at me with eyes that were pleading with me to feed her or she was going to die. Every waking minute was spent searching for something, anything, to eat - whether it was actually edible or not didn't matter. When she found something, it went down so fast there was no way she could have tasted it...and she immediately started looking for more. The look in her eyes was haunting and heart-breaking. When, if, that cush appetite ever dose show up in Liberty, I think you will notice a dramatic change just as I did. ;)

Another point is this - as a medical professional you are probably used to working under more of an evidence based approach to medical issues. You have probably been trained to count on proven science only. However, there is in all of us a little voice that tells us when something is not right even tho the science may not support our little voice. This little voice is one of your best friends when it comes to treating Liberty, or any baby, for Cushing's. No surprise, but we here call that little voice your "gut" and we tell everyone to listen to their gut every time. No one knows Liberty better than you; no one sees the things that happen at home other than those who live with him; no one else will notice the tiny changes that might indicate a big problem. So always, always, listen to your gut. I believe it may well have been telling you the truth about his diagnosis all along. ;)

So today your job is easy - put the Trilo up and forget about it for now; go get all the recent testing that has been done on Liberty and post the abnormal values along with units of measurement (ug/dl, mnol/l, ect) and normal reference ranges for each value listed on the blood work but post all the results from the Cushing's specific testing he has had; love on your sweet boy, play, snuggle and simply enjoy his company. And keep talking to us. You and Liberty are now family and you will never walk alone again.

I'm glad you found us and look forward to learning more about the both of you.
Hugs,
Leslie and the gang

[flyagain]

Thank you for the reply
I asked the Vet for copies of the tests that Liberty(Libby) has had but worked a late shift so didnt get to pick them up. I will get them posted tomorrow i hope
Thank you for your suggestion about stopping the Trilo for now.. I have been wondering because i dont want to head her in the other direction.. So I will stop for now and then go from there
Thanks again:)

[flyagain]

How do I keep this from Logging me out when I am posting a long Post? I tried a minute ago and it said I wasnt logged in?
Thanks

[lulusmom]

This happens to a lot of people so we actually have a sticky thread with instructions. Please click on this link:

http://www.k9cushings.com/forum/showthread.php?t=1329

[flyagain]

Okay so I think I figured out the logging out issue
I will try to post again
So in a previous post I talked about Libbys ACTH results and was unsure of the values.. I have those now so here they are
Initial Alk Phos after eating Chocolate.. 600
Other labs at same time were as follows: No other abnormals
Glucose 126
Bun 23
Creat 1.1
TP 6.6
ALT 57
Chol 243
Amylase 784

After this high Alk Phos they starting talking about Cushings. I asked for a repeat Alk Phos in a month.. That came back at 1255( normal range: 23-212)
So we did these 1/6/12
Pre-ACTH..14.6 Range 2-6
Post-ACTH 22.9 Range 6-18

Started her on 120mg Trilostane

2/15/12
Pre-ACTH 3.1
Post-ACTH 4.0 Kept dose the same

2/29/12
Pre-ACTH 13.4
Post-ACTH 16.1.. They wanted to increase the dose but they couldnt explain why the results went up so I asked for a repeat and it came back the same.. I still wanted to wait and repeat in 2 weeks cuz no change in her symptoms
I also stopped her meloxicam which I had newly started in the weeks between those test results

3/13/12 Pre-7.4
Post 5.9
Increased her dose to 130mg

4/13/112 Pre 4.7
Post 5.4

When we started Liberty on Trilostane really the only symptoms were the huge appetite and some panting with exercise.. No hair loss , no incontinence or thirst increase
the Panting she had previously and was placed on Vetmedin for suspected Heart failure
My question is now that I know the initial beginning Post ACTH was 22 does that confirm Cushings?.. I really want to just stop the Trilostane and keep up with the Heart meds.. her Panting and Exercise tolerance have gotten worse since this whole thing..
Oh She does have reluctance to jump up but has has 4 knee surgeries and has extensive Arthritis in her knees
I am planning on having a sit down with my Vet next week to discuss all this.. any suggestions would be appreciated.. thanks

[labblab]

Thanks so much for posting this additional information. In answer to your question about the initial diagnostic ACTH testing, if the "normal" lab range was 6-18, then it is true that a result of 22.9 was consistent with Cushing's. But "consistent" is not the same thing as "proving" Cushing's. Both the LDDS and the ACTH can render elevated results in the face of other conditions beside Cushing's. So that's why both the overall symptom profile and associated testing/history are so important when trying to determine whether or not Cushing's is at play.

Even if we assume that Liberty does have Cushing's, I cannot explain that "blip" where her monitoring ACTH testing went so high. But additionally, if she is actually looking worse to you after having been treated with the trilostane -- then I'm with you, I do believe I would want to stop it altogether for a while and see what happens. You can always start back again at any time. But I think there are still enough question marks about her diagnosis to warrant a break for observation and perhaps additional diagnostics.

Marianne

[flyagain]

Is Trilostane a medication that needs to be tapered off or can I just stop it all at once?
What has your experience been with the length of time symptoms like panting and ravenous hunger start to subside?:)

[Squirt's Mom]

Trilostane can simply be stopped with no tapering needed. I think Marianne has a good idea - stop and see how Liberty is then.

Let us know how things are going!
Hugs,
Leslie and the gang

[CJandTucker]

I had the same problem. I think that when you log in there is a box you can check to keep you logged in. I haven't had any trouble since.--oops I didn't see page 2