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Kathy
06-03-2012, 09:31 PM
Hi Everyone, I'm Kathy, and I live in Portland, OR with my nearly 12-year-old Australian Shepherd named Maggie. I would post her photo as you all have done, but I have not figured out how to do that yet.

Maggie was recently diagnosed with Cushing's after quite a long period of time. My vet thought it was hypothyroidism, and we took about a year to get that under control. She takes Soloxine three times every day to stay in the normal range Trouble is, the soloxine did not take care of the hair loss, and in the meantime, she developed excessive thirst and hunger. Then she had a non-healing wound on her hip that would not clear after a couple of rounds of antibiotic. Our vet did some surgery, trimmed the border and sewed her up. Two weeks later when the sutures came out, the wound opened up again. Our vet sent us to a specialist who I like very much, and after an ultrasound and the low-dex test, they confirmed Cushing's. Maggie started on Trilostane on May 14, and the ATCH test on May 23 showed her at 5.4 which the specialist said was good. Last night, 10 days later, Maggie vomited frothy clear liquid with some blood mixed in. Not a lot, but enough to scare me. Of course, it is Saturday night, so I can't talk with the vet until Monday morning. I had been given prednisone with the instructions that if vomiting, diarrhea, weakness or collapse is noted during non-vet hours, I should give her two 5 mg. tabs of prednisone. I called the local vet emergency hospital, and the doctor agreed I should do that. Maggie improved today, and she ate and drank and walked and peed. She is a little subdued, but she was before this happened as well. Here is my question: The instructions from the vet say that if I start Maggie on prednisone that I should contact a vet for advice on how to continue the medication. The emergency hospital wouldn't give me that advice unless I brought her in. Maggie is doing well right now, and my gut says to let it go. If she starts to feel bad again, I could give her one more 5 mg. prednisone. I just want to keep this simple until we can get to see the specialist tomorrow morning. Does this sound like I am doing the right thing? Kathy

labblab
06-03-2012, 09:58 PM
Hi Kathy, and welcome to you and Maggie.

I only have a moment to post right now, but I wanted to let you know that I took the liberty of moving your reply in order to create a new thread for you and Maggie. This way, our members can talk with you directly.

It does sound to me as though you are doing the right thing in terms of the prednisone. If Maggie looks as though she needs it during the night, you can always give her the additional pred. But if she is doing better now, hopefully she'll continue to do fine until you see the specialist tomorrow. When prednisone is given over a longer time, it can be very important to taper down on the dosage slowly rather than stopping abruptly. But if you've only given a single daily dose, you should be fine to hold off now for the time being -- unless, of course, Maggie should worsen again during the night.

Marianne

Kathy
06-03-2012, 10:32 PM
I want to add that I have had an extremely emotional experience with Maggie's diagnosis of Cushing's. While the vets have been helpful, I didn't even know what questions to ask at first. I have now done a ton of reading, and this site is a blessing for me. I am thankful that my friend Chandra pointed me in your direction. I already feel more confident that I will be able to take care of Maggie in a quality manner. I want to understand what is going on with her, not just follow what the vet says and then fall into a panic when things don't go smoothly like last night. Because she has severe arthritis and some other issues, I like that you are discussing multiple problems. Thank you all for doing this. Kathy

frijole
06-03-2012, 10:39 PM
Hi Kathy! I agree with Marianne you are doing just fine. You will know if you need to give it - probably won't based on what you said.

Make sure when you talk to the specialist that you describe the vomit as frothy and with blood as it may not be related to the cushings. Why does this always happen on weekends? :confused:;)

I am glad you went to the specialist because your dog was screaming cushings symptoms while you worked on the thyroid. The acth test on May 23 was a good reading. I didn't use trilostane but my understanding is that there is a cumulative effect and perhaps she krept low. Or it could be something else.

I will share that my cush dog developed a real intolerance for any fatty foods. I knew to only let her have treats like white chicken but over time she couldn't even tolerate a bite of white meat. She would vomit up... I share this to make sure you are aware that cush dogs can't tolerate fatty foods.

Hoping for a peaceful night for you and dear Maggie. Kim

Kathy
06-04-2012, 02:34 PM
Today is day 21 of Trilostane, and I am nervous and feel that I have so much to learn. Since Maggie vomited on Sunday night and I had to administer the prednisone, I feel like we are in limbo while I wait for our very busy specialist vet to return my call.

I feel like Maggie is taking too many medications: Soloxine three times a day for hypothyroidism. She cannot eat 2 hours before a dose and 1 hour after. Maggie has had diarrhea for three months and is currently taking Tylan twice a day and is still on a bland diet. Maggie's arthritis has gotten worse again after starting the Trilostane, so she is taking Metacam and continuing with Tramadol and Gabapentin.

The Trilostane instructions say it should be taken with food. Maggie struggles with a low appetite in the morning, and I'm wondering what is the least amount of food I can give her with it? I just have so many questions. I hope this will get easier. Your comments give me hope and a feeling that we are doing the right thing. Thank you, Kathy

marie adams
06-04-2012, 04:03 PM
Hi Kathy--welcome to you and Maggie. She is beautiful!! :)

I am so glad you found us. Everyone here were so helpful when my Aussie Maddie (a black tri) was diagnosed. I had already started her on Lysodren when I found this site, but they guided me through the process with flying colors when the vet couldn't. :)

Have you tried giving Maggie some canned pumpkin to help with the diarrhea? It helped Maddie and it helps my new Aussie Ella. I never had a problem with Maddie eating so I am no help on the appetite issue. I ended up giving Maddie a no grain dry diet along with a frozen raw chicken product. She didn't take any additional medicine other than vitamin supplements.

Please keep asking questions as the experts will answer them or research till they find something. The journey does get better once you have Maggie's numbers under control.

You are not alone in the journey--you are now part of the family. :)

Sage
06-04-2012, 06:14 PM
How much Soloxine does your dog get a day?
How much does your dog weigh?
Has there been a recent Thyroid test?

lulusmom
06-04-2012, 06:32 PM
Hi Kathy and a belated welcome to you and Maggie.

I realize that you are probably at the specialist’s office today but wanted to give you my thoughts and probably ask too many questions. :D Please see my comments in blue text below.


My vet thought it was hypothyroidism, and we took about a year to get that under control. She takes Soloxine three times every day to stay in the normal range. Trouble is, the soloxine did not take care of the hair loss, and in the meantime, she developed excessive thirst and hunger.

Has your specialist mentioned that it’s possible Maggie may not have primary hypothyroidism but rather euthyroid, which is secondary to cushing’s. Thyroid hormones usually normalize once cortisol is effectively controlled.

Maggie started on Trilostane on May 14, and the ATCH test on May 23 showed her at 5.4 which the specialist said was good.

How much does Maggie weigh and what dose of Trilostane is she getting? I assume the 5.4 was the post stimulated cortisol? If so, I would agree with your specialist that it is a good result. However, this is only after nine days of treatment and because it is very typical to see cortisol continue to drop for at least the first 30 days of treatment, Maggie doesn’t have a lot of wiggle room here. Based on our experience here, that concerns me.

Last night, 10 days later, Maggie vomited frothy clear liquid with some blood mixed in. Not a lot, but enough to scare me.

That would scare me too given that her post cortisol was 5.4 after nine days of treatment. It would not surprise me if her cortisol dropped too low 10 days later.

Of course, it is Saturday night, so I can't talk with the vet until Monday morning. I had been given prednisone with the instructions that if vomiting, diarrhea, weakness or collapse is noted during non-vet hours, I should give her two 5 mg. tabs of prednisone. I called the local vet emergency hospital, and the doctor agreed I should do that. Maggie improved today, and she ate and drank and walked and peed. She is a little subdued, but she was before this happened as well.

The fact that Maggie perked up after prednisone is a good indication that her current dose of Vetoryl may be too high.

Here is my question: The instructions from the vet say that if I start Maggie on prednisone that I should contact a vet for advice on how to continue the medication. The emergency hospital wouldn't give me that advice unless I brought her in. Maggie is doing well right now, and my gut says to let it go. If she starts to feel bad again, I could give her one more 5 mg. prednisone. I just want to keep this simple until we can get to see the specialist tomorrow morning. Does this sound like I am doing the right thing? Kathy

I realize you have probably already seen the specialist but for what it’s worth, I agree with Marianne and think your plan of action is the right one.


I want to add that I have had an extremely emotional experience with Maggie's diagnosis of Cushing's. While the vets have been helpful, I didn't even know what questions to ask at first.

Welcome to the club, Kathy. I think I speak for all of us when I say that there are few things in life that invoke the depth of emotions than the dreaded canine cushing’s diagnosis. Every hair standing straight up, the nausea, the lump in your throat, the fear in your heart, feeling ignorant and the frustrations of trying to wrap your head around what is happening inside our dogs precious body are all very normal reactions. The good news is that all of these things will subside with knowledge and experience.

I have now done a ton of reading, and this site is a blessing for me. I am thankful that my friend Chandra pointed me in your direction. I already feel more confident that I will be able to take care of Maggie in a quality manner. I want to understand what is going on with her, not just follow what the vet says and then fall into a panic when things don't go smoothly like last night. Because she has severe arthritis and some other issues, I like that you are discussing multiple problems. Thank you all for doing this. Kathy

Good for you. The more you learn, the easier it will be on you and Maggie. Have you ever noticed how Maggie is tuned into your moods? Most dogs are very intuitive and can sense when their human is one big ball of raw nerves. That’s how I described myself when I got the first diagnosis. When my second one was diagnosed over two years later, my head was in a much better place but oy vey, two dogs with cushing’s! That’s when I decided that I needed to find somebody who understood. I landed here and it was the best thing that ever happened to me…..well almost. I may be biased but I think you are very lucky to have found us and we’re glad you did. Thank you, Chandra.


Today is day 21 of Trilostane, and I am nervous and feel that I have so much to learn. Since Maggie vomited on Sunday night and I had to administer the prednisone, I feel like we are in limbo while I wait for our very busy specialist vet to return my call.

You have every reason to be nervous and your specialist needs to get off the dime and return your calls. There is no excuse for him/her to ignore your messages, given the seriousness of the drug and it’s possible adverse effects. Honestly, I don’t understand the nonchalant attitude.

I feel like Maggie is taking too many medications: Soloxine three times a day for hypothyroidism. She cannot eat 2 hours before a dose and 1 hour after.

It’s only too many if she doesn’t need them. It is quite possible that she may not need the Soloxine once she’s stabilized on the Vetoryl. I’ve never heard of a dog getting thrice daily doses of Soloxine. My dog is on twice a day and I wish we could get her down to once a day. It really is a pain to have to get up earlier in the morning to give meds one or two hours before a meal. I have four dogs on multiple meds and two of them have meds that must be given on an empty stomach. What was your vet’s explanation as to why Maggie needs Soloxine three times a day? When was the last time you had Maggie’s thyroid values checked?

Maggie has had diarrhea for three months and is currently taking Tylan twice a day and is still on a bland diet.

Was Maggie experiencing stomach problems when the cushing’s testing was done?

Maggie's arthritis has gotten worse again after starting the Trilostane, so she is taking Metacam and continuing with Tramadol and Gabapentin.

The Trilostane instructions say it should be taken with food. Maggie struggles with a low appetite in the morning, and I'm wondering what is the least amount of food I can give her with it?

You aren’t the first person who has had trouble with the morning appetite. You mentioned that increased hunger was one of the symptoms leading up to testing for cushing’s. Was Maggie’s morning appetite voracious before starting treatment? If Maggie eats well in the evening, have you thought about skipping the evening meal and feed her in the mornings. If she is hungry enough, she’ll eat.

I just have so many questions. I hope this will get easier. Your comments give me hope and a feeling that we are doing the right thing. Thank you, Kathy

Ask any question you may have and we'll do our best to provide a meaningful response. I promise that it will get easier. We’ll be here to prop you up, help you learn, cry with you, scream with you and help you be the best advocate possible for your precious Maggie.

Looking forward to hearing more about your sweet Maggie and an update on your appointment with the specialist.

Glynda

Sage
06-04-2012, 06:54 PM
Here are a few quotes on soloxine from online product information: (Just FYI...I am hardly an expert but I do have a few miles logged on the Endocrine Highway. You adjust one thing and two others change, meanwhile new independent events or conditions are seen as "side effects" for the situation which has our focus. Some dogs give great tests numbers, while others just fingerpaint a snap shot of the hormonal opera within. The pred over the weekend was a good move, in my opinion, that is what it is for.)

“Soloxine should not be used if your pet has ever had thyrotoxicosis, or an uncontrolled adrenal gland problem. Tell your veterinarian if your pet has heart disease, anemia, diabetes, or problems with the pituitary or adrenal glands. If you give your pet insulin or diabetes medication by mouth, dose adjustments may need to be made.”

”The usual dose in dogs is 0.1mg per 10 pounds. The usual dose in cats is 0.05mg to 0.1mg per cat. The dose of Soloxine may require adjustment based on periodic blood tests to determine the animal's T4 level. There are many medications that can affect Soloxine. Tell your veterinarian about all the prescription and over the counter medications you give your pet, including vitamins, minerals, herbal products, and drugs prescribed by other veterinarians.”

“Symptoms of Soloxine overdose may include dizziness and fainting, increased thirst, urination and hunger, and panting.”
....

I'm also wondering...did you take your dog in today or just call the specialist/vet?
If your dog was taken in what tests did they perform?

Kathy
06-04-2012, 08:31 PM
My gosh, you have all raised such incredibly good questions for me to consider and find the answers to. The whole Soloxine situation has been troubling to me. I will relate that sequence in my next post. Thank you so much. What luck to have found you. I'll be back on later. Kathy

Kathy
06-06-2012, 11:36 AM
Hi Everyone, I'm back with some new information about Maggie. Your posts back to me after her vomiting incident were very helpful, both emotionally and educationally.

I did not take Maggie to the specialist's office this week. I talked extensively with Maggie's regular vet who knows Maggie very well, and she is the one who worked with me on the hypothyroidism, but when M. still presented with issues, she referred me to the internal medicine specialist who is considered the expert in Portland, OR where I live. I also talked extensively with the specialist on the phone. More in a bit about this.

Some history: M's regular vet worked with Maggie and me for many months, reluctant to say it was Cushing's before she felt certain. Maggie is a very sensitive Aussie--to drugs, to sounds, a very good herder who sometimes has a hard time with city life. Maggie had the full range of tests UCC, ATCH stim, ultrasound, low dex. I don't have her numbers, but I don't have qualms about her diagnosis. Both M's regular vet and the specialist have worked together every step of the way.

One of the things that was muddying the waters for the vets was Maggie's inability to absorb thyroid medications. Even on .6 of Soloxine twice a day, she was in the low range, and her trough measurement was close to nothing. We tried .8 twice a day, and that was clearly too much, so we dropped back to .6 while they explored further. Finally, they put Maggie on .6 three times a day, the first time the specialist had done that with a dog in many years of practice, and M's numbers moved into the normal range.

What put Cushing's back on the front burner was a non-healing sore that she had had since September which I spoke about in an earlier post. Both vets agreed that M. should have the ultrasound which showed that both adrenals were enlarged, although her liver looked good. The low-dex test was the final test.

Here are the observable symptoms that Maggie has shown since September and before, until she was "officially" diagnosed in early May:
loss of hair in specific areas (torso sides, back of legs, around neck, plus hair not growing back on two shaved spots for incisions), muscle weakness in rear area (M. has arthritis and a spine issue, and has worked with a physical therapy vet since Sept.), paper thin skin, non-healing sore, excessive thirst which eventually resulted in incontinence during periods of sleep, excessive hunger. I think that is the complete list. She never had a pot belly, her liver enzymes have been good and the liver looked good on the ultrasound, she has always been on the thin side (she is extremely fit--has rarely had less than an hour of walking/running per day her entire life and in her prime it was more)

Now, back to the present. Because of four doses of antibiotics over three months (Jan-March) for the non-healing sore that resulted in two surgeries to get and keep it closed, M. has had diarrhea. She came off of a low dose of Metacam (20) in mid-April that she has taken for arthritis and the vet upped her Tramadol. We finally have the diarrhea stopped, and the specialist said she thought it was fine to put Maggie back on the Metacam, because since about a week after she started the Trilostane, she was limping again.

Off Metacam in mid-April
Official diagnosis of Cushing's in early May
Started Trilostane on May 14 - 35 mg. twice daily
ATCH stim on 5/23 - 5.4
Started Metacam 5/25 at 40 (just to start & I was ready to cut it down to 35 and then lower if she was good)
Vomited clear frothy liquid with some streaks of blood on 6/3

In conversation with the specialist on Monday, she feels that the vomiting was brought on by stomach irritation from the Metacam. She has never seen blood in the vomit from a Cushing's overdose. Maggie never did really appear ill on Sunday after vomiting. I gave her the two prenisone, and she ate and seemed to feel fine. The specialist said to stop Metacam, wait until today (Wednesday) to start back on the same dosage of Trilostane and watch her. She is schedule for the next ATCH stim on July 2.

Based on Sage's comments regarding the Soloxine, I was able to ask some direct questions about M. taking it three times a day now. The specialist did know reduction in cortisol/absorption, and we have cut M. back to .6 twice daily with a T-4 scheduled for July 2.

This is way too long, but I think you now know what I know. I want to be able to relax and start living with Maggie on Trilostane. From what I saw in the first 20 days, she was greatly improved in terms of water intake back to normal and more spark in her eyes. Her appetite dropped more than I would like, because she was thin to start, at 45 pounds right now. Her normal healthy weight was 50. I was warned that the lowered cortisol levels from Trilostane would probably exacerbate the arthritis pain, and that did happen. Your posts have given me more hope that dogs can lead fairly normal lives with Cushing's. I feel hopeful, and I feel so lucky to have found this forum and to have all of you helping me watch over my beloved Maggie. Kathy

marie adams
06-06-2012, 01:49 PM
Hi Kathy,

Maddie had the hair loss in all of Maggie's spots--lost all her underfur and lost a lot of her belly fur. Once she was on a maintenance for awhile she got her fur back--it was a different color--more tan and black fur and it seemed more coarse. I ended up giving her yogurt and flax seed oil to help with the dry skin and fur. She also had sores on her elbows--I ended up using Bag Balm and got infant socks--cut out the toes and cushioned the inside with thin sanitary liners I cut in half & suck them to the inside of the socks--I got the socks and liners at the 99 cent store. The elbows did heal up. I was surprised she let me do this, but I know she knew it was helping her.:)

Maddie had the hind leg weakness and the arthritis showed up when the cortisol levels came down. Maddie ended up a little over weight because she slowed down (I didn't realize soon enough she has Cushings). She ran miles each day with my husband on the bike and I walked her in the mornings about a mile and half.

It sounds like Aussie have the same issues with their symptoms. You will see even more improvement along the way. Maddie didn't get the muscle back in her hind legs, but she was a trooper till the end.:)

It was great all the info you wrote--never think it is too long--all the info helps with giving you advice.:)

Take care!!!

Kathy
06-06-2012, 02:17 PM
Oops, now I see that my first post did go through, but it was on a second page. So, now you all have two versions of Maggie's tale. Sorry about that, but I have not used forums like this before. Kathy

Kathy
06-07-2012, 11:43 AM
Two questions:

I am looking for some suggestions for getting Maggie to take her pills. I wrap them in something tasty, but she is getting pickier and pickier, and I hope to continue to have her eat them rather than me using the manual pill popper. I have tried the Greenie's Pill Pockets, her favorite canned dog food, liverwurst, cream cheese. If anyone has other ideas, please share. I need to keep the tastes novel, I think.

Also, the vet is saying that maybe Maggie should go on Adequon to help arthritis pain. She seems to have had a stomach reaction to the Metacam last weekend, and the vet doesn't want to use that anymore. I think I saw Adequon referred to on this site, and I think it is injectible which would help re. the problem I related in the last paragraph. Any pros and cons that you could share? Thanks so much for any recommendations, Kathy

MODERATOR NOTE: Kathy, I merged your latest post about appetite and Adequon with Maggie's orginal thread. We like to keep all the info about each pup in one place; that way it is much easier to look back through the history if needed. I also deleted the duplicate post. Thanks!

marie adams
06-09-2012, 06:30 PM
Hi Kathy,

I just put the pills in with Maddie's food and she ate them. I never tried to put pills down her throat. She would just eat the Sentinel (heartworm pill) out of my hand. I gave her benedryl by putting it in lunch meat. So I would say I didn't have a problem with pills. The fish oil I would cut in half and pour out the oil. Capsules I would open up.

Ella is the same way she just eats them in her food. Some pills I smash into a powder, but most the pills she has taken in her short life go in her dry food with a little pumpkin. She also will eat the Comfortis from my hand.

I wish I had another idea, but I don't. Good luck!!!

Harley PoMMom
06-10-2012, 01:06 AM
You might want to look into a product called Flavor-Doh. It comes in a pail and you just pinch out what you need...here's a link: http://www.entirelypets.com/flavordoh.html

Concerning the adequan shots, I never personally used them but we have several members that have...here are some posts from them: http://www.k9cushings.com/forum/showpost.php?p=62231&postcount=550 and http://www.k9cushings.com/forum/showpost.php?p=62253&postcount=554

Hope this helps.

Love and hugs,
Lori

frijole
06-10-2012, 10:24 AM
Haley lived to be 16 1/2 and towards the end she took adequan for her joint pain and it seemed to help her. The way it works is you give a series of them (to jump start its effectiveness) and then you set up a regular schedule (in my case it was every 2 weeks). You can give the injections yourself to save money. Ask to see the needles though before you try it (mine were huge!) Kim

Kathy
06-10-2012, 11:30 AM
Thanks Kim, Lori and Marie for your replies. I am still very nervous about this new trip we are on with Cushing's. Maggie is eating well again after our little 3-day break from the Trilostane, but before that she was on for 20 days and she wasn't wanting to take pills, even wrapped in her most favorite treats. I am getting more comfortable as the days go by. She is definitely feeling better on the Trilostane than before she started it, and that is such a relief. I so appreciate all of you on this forum who so lovingly help those of us starting out. I think Maggie's vets are good, but you all have been through it, and you are all so willing to give the day-to-day support that makes all the difference. I am extremely grateful, Kathy

frijole
06-10-2012, 01:53 PM
Kathy, We were all frightened at first and yes this group helps fill in a whole lot of gaps. Unless a vet has actually been there with their own dog they have no way of knowing how stressful the experience is.

My cush dog passed over 2 yrs ago and I now know it really wasn't that tough of a disease to treat. Once you get going the rough part is over and you just maintain and test periodically.

So don't fear and you are always welcome to ask questions - another good thing about this site is that we all have had elderly sick dogs so we share info about alot of other ailments and meds as well. :p Kim

marie adams
06-14-2012, 01:41 PM
Hi Kathy,

I hope Maggie is still doing well with the Trilo. I was a mess at first starting treatment, but like Kim said when you look back it really wasn't that bad. You are always watching them for anything out of the ordinary. Maddie was just so healthy I never thought anything until she slowed down and started panting--we thought it was she was getting older, but it just came on faster than we thought and then more symptoms and said this cannot just be getting older. :o

You are doing a great job with Maggie, the vet, and asking questions. Keep up the good work!! :D

You wanted to know how to see pictures--Click on the person's name or Thread user name--mine is Marie Adams, go to View Profile and you will see pictures of Miss Ella as she has grown up. She is a completely different Aussie than Maddie. Maddie was sensitive, but Ella could care less what trouble she is getting into. With Maddie you couldn't even say the word BAD without her looking like - what did I do. She was a great dog just like Maggie. They are amazing companions--like having another human in the house. :)

Take care!!!

Kathy
07-08-2012, 11:13 AM
Hi Everyone, Here's an update on Maggie on day 53 of Trilostane. I think I should use Trilostane, because it is compounded in liquid form rather than the vetoryl pills. Maggie's ACTH stim last week was 5.0, down from 5.4 on May 23. The IM specialist that she sees was happy with the results and wants another test in three months. Maggie is doing well: excessive thirst is gone; appetite is good but not excessive; no panting; coat is growing. The only issue, which we were told to expect, is that her arthritis has flared up, and I am going to start her on Metacam again tomorrow, having used only Tramadol for pain control.

One very positive outcome from the Trilostane is M's reduced fear with thunder and fireworks. Her response to both was about a 9 on a 1-10 scale in the past, but this year I think it is half that or less. She still has some reaction, but it is greatly reduced. Is that something others have experienced?

I am thankful that I decided to move ahead with treatment. Maggie's regular vet had reservations, but the specialist was encouraging after treating hundreds of dogs. Maggie's quality of life is so much better right now, and will get better if we can control the arthritis pain. Thanks to everyone for the loving and caring responses. I get on the site every day even though Maggie is doing well. This is where I have gotten the encouragement and tons of information about Cushing's. Your experiences in living with a Cushing's dog have given me so much help. Thanks, Kathy

jmac
07-08-2012, 11:26 AM
Hi Kathy,

Thanks for the update. I am so glad to hear Maggie is doing so well! It is great to hear about wonderful improvements like this, especially for people who are debating treatment. I am glad you went with the specialist and began treatment. I hope Maggie continues to do well! Keep us updated and let us know if you have any questions.

Julie & Hannah

Kathy
07-24-2012, 11:57 PM
Here is a poem about Maggie and Cushing's that I wrote and read to my writing group. They liked it, but they didn't really get it. I think you all will get it. Please let me know if this is not appropriate to post on this site. Kathy

HOPE

Cortisol creeps uninhibited through her veins,
Revving her body like high-octane gasoline,
Life supporting yet potentially deadly,
Necessity turned curse,
Simple hormone, harmless in moderation, now poison with a punch.

Cortisol torments her body,
Turning glossy fur coat dull and thin,
Sapping energy and wasting muscle.
Turning kibble to caviar and water to nectar,
Bringing unrestrained hunger and thirst.

Pituitary tumor,
Adrenals enlarged
Compromised body systems
Ruled by this demon called Cortisol,
A madman with vast and unlimited power.

A figure appears on the horizon,
White knight called Trilostane stands bigger than life.
His arrogance stirs the air; handsome face split by a cruel mouth.
Hero or villain? Too soon to tell.
Hope or despair? Trilostane offers hope.

They meet to do battle inside my dog's body,
Her life hangs in the balance.
Trilostane is merciless but cautious. If he kills his foe, she dies too.
Cortisol's retreat is imperative, but
both must live, and Trilostane shall rule.

Flickers of light in her eyes, missing for months.
Lapping water from her bowl, gulping long gone.
Sleeping through the night to wake on dry bed.
Muscle building to support a stronger body.
Trilostane 1/Cortisol 0. Hope is alive.

lulusmom
07-25-2012, 02:16 AM
That was awesome. I love it!!!

Squirt's Mom
07-25-2012, 08:22 AM
Oh, Kathy! That is awesome! Great job! You need to post that in the Everything Else section so we can all refer to it when we need a glimpse of that Hope. Yes, we fully understand because we live it; in a way, it is good your writing group doesn't understand fully, huh? ;)

You have a talent and I sincerely hope you pursue it relentlessly.

Hugs,
Leslie and the gang

marie adams
07-26-2012, 03:06 PM
Hey Kathy,

That is a great poem!!!

I remember Maddie ended up having a great fear of the fireworks the last couple of years. In fact that was why we went to the vet to see if we could give her something and asking about the panting--we ended up giving her Benedryl. I think the last 4th of July she was alive she had been on Lysodren since February of that year--we gave her the benedryl anyway, but she did seem a lot calmer.

I am so happy for Maggie and you that everything is going so well!!!:)

Kathy
09-11-2012, 10:20 PM
Hope to get some feedback on Maggie's latest ATCH-stim from some of you wonderful experts. Maggie started Trilostane on May 14. We are using a liquid suspension of 75 ml using 37 ml in a.m. and 37 in p.m. On May 23 her ATCH cortisol level was 5.4, on July 2 it was 5.0, and on September 10 (yesterday) it was 2.0.

Our IM vet specialist wants me to reduce the dosage to 30 ml twice a day. She told me originally that Maggie's ideal level would be between 2.0 and 5.0. Seems like a big drop in three months. Is that common? She says she would like another ATCH in 4 months? Doesn't that seem a long time from now? This info was relayed to me by a tech assistant, and I asked that the vet call me, since I have some questions.

Here they are:
Maggie has spinal arthritis which has really flared up since she started the trilostane. I understand that losing all that cortisol which was "treating" the arthritis upped the pain a lot. She has been on 75 mg. of Tramadol three times a day (we are also working with a fabulous vet specialist who is overseeing the arthritis.) I just started taking her swimming and I am using TENS treatments at home. I have been concerned about Maggie's lethargy, thinking it was the Tramadol. Now I am thinking it was this big drop in her cortisol level. She does not have any vomiting, is eating fairly well, no diarrhea, so if lethargy is all I have to go on, I'm a little concerned that I wouldn't know if her cortisol level goes too low or if it's just the tramadol. I'm guessing that she would start vomiting in that case, right, but I would hope to avoid that kind of crisis.

Wouldn't it be best to keep the cortisol level higher, like at 4.0 or above, particularly for a dog with arthritis? Maybe the reduction of Trilostane to 30 will take care of that. Am I overreacting to this?

Over time, is Trilostane going to affect her organs. Should I be getting a full blood count regularly, and if so, how often. What else should I be concerned about over time with Trilostane.

I do have confidence in this specialist, and I don't want to be a pain, but I also would like to take every precaution so that we don't get to a crisis level. In four months, I thought we were doing really well. Is this just part of this disease--you never know????? Thanks for any advice. Kathy

frijole
09-11-2012, 11:20 PM
Let me preface my comments by saying I have never used trilostane but am only relaying what I have read about it over the years here. It is common to see drops over time even though the dosage remains constant. That said - that was a fairly large drop. I would absolutely NOT wait 4 months for another acth.

2.0 is a very good level on paper. But as you said, not all dogs are comfortable at that level and perhaps having more cortisol would make Maggie more comfortable. Sometimes we focus too much on the 'numbers' instead of how each dog reacts so I think it's OK to let the cortisol creep up a bit. This is another reason to do acth testing - to see how the dosage change affects her cortisol - you don't want it creeping up too high either. I'll let others comment on whether they think decreasing it by 1/2 makes sense.


Having used a TENS machine I know it feels great so I am sure that helps. And the swimming is great too. Did the vet say anything about reducing the dosage of tramadol as the cortisol rises? Other alternatives for pain you could look into would be duralactin or adequan shots. A 2.0 cortisol level is not low enough (in most cases) to be lethargic to the point of worry. I think the tramadol is probably the culprit - perhaps with the lowered cortisol making it more noticeable? You could always experiment by slightly lowering the tramadol levels to see if you notice a change.

BTW I used all 3 (tramadol, duralactin and adequan) as well as acupuncture to treat my ailing girls.

You mentioned concern that you would not know if she goes low - there are some dogs that have without any warning signs but most dogs are not lethargic - they are so weak they cannot stand or lift their heads when cortisol goes low. So without a doubt it is obvious.

I think you are doing a great job and asking great questions. Hopefully experienced trilo users will add to my response. Kim

lulusmom
09-12-2012, 12:20 AM
I'm an experienced Trilostane pet owner and I think your specialist is on the right track. I am assuming that you have 100mg liquid suspension and that you were giving .37ml on the syringe am and pm. That would be 37mg and by dropping that down to .30ml (30mg) BID, you are reducing the dose by a total of 14mg. That might be enough or it might not be and I personally wouldn't wait four months to find out. I'd do a stim test at 30 days or sooner if Maggie should start to show more overt signs of having low cortisol. I was lucky with my two cushdogs who were treated with Trilostane and had them stabilized on an appropriate dose within the first 30 to 45 days. Others, like Maggie, do end up having to make a few adjustments. The issues you are dealing with are not so much part of the disease but rather how a dog responds to the drug. We'll be keeping fingers and paws crossed that this latest change will do the trick.

Glynda

Kathy
09-12-2012, 12:29 AM
Kim, Thank you so much for your prompt reply. That was good feedback for me. I have been coasting along feeling very good about the treatment, and this felt like a blow today to get such a large drop. I guess I just need to lower the dose of Trilostane like the vet recommended and continue to keep a close watch over Maggie's behavior. I will get another ATCH-stim before four months though. Kathy

Kathy
09-12-2012, 10:46 AM
Thanks Glynda and Kim, Over the last four months since Maggie was diagnosed and started treatment I think I got lulled into thinking that this Cushing's thing wasn't so bad, but I got a wake-up call yesterday, and I'm thankful that you two were there to soothe my fears a bit.
I appreciate you and the others on this site so much even though I have not had serious need of advice since May. When I got the news about her cortisol drop yesterday, I came directly to the computer to ask what you thought. I would appreciate any other comments if others have something to offer. Thank you, thank you. Kathy

addy
09-12-2012, 02:14 PM
My Zoe was just on Tramdaol, twice. The first time for an eye ulcer. It knocked her out, a very low dose and she slept most of the time.

The second time was after surgery for a growth removal. At that same time I also had to increase her Trilostane dosage as her cortisol was pushing almost post 10 ug/dl. She really had trouble walking durring that time. Once I stopped the Tramadol, her walking improved.

The hormones do flucuate. I had Zoe on 20 mgs last year and she had a post of a bit over 11 ug/dl. I did not change her dose at all and she drifted down to a post a bit over 9 three months later, then drifted back up to 12 after that.:o:o:o I never had changed her dose durring that time.

Having said that, some dogs are sensitive to the drug and you may find you need less of it to control Maggie's cortisol. Glynda has a good point.

Kathy
11-23-2012, 02:50 PM
Does anyone have experience with dog hiccups and why they occur? Maggie never had them before Trilostane. Since May she has had several occurrences. I can get them stopped with food, but they often come back a little later. It's not constant, but each episode could last one day or even into the second day, very sporadic during that time and then they may be gone for a few weeks.

I have checked the internet, and overall they seem harmless. The vet does not seem worried. Any thoughts or suggestions? Is it possible that they are related to cortisol level? Kathy