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[kmsteward]

Good morning. I am new here. My thirteen year old dog "Wiggles" was just diagnosed with Cushings. She has started on Trilosane. I would appreciate any feedback on the medication and Cushings in general. Thank you.:)

[Harley PoMMom]

Hi and welcome to you and Wiggles,

Sorry for the circumstances that brought you here but so glad you found us.

It would help us out a lot if you could round up copies of all tests that were done on Wiggles and post any abnormalities listed. Also what dose of Trilostane is your vet rx'ing and how much does Wiggles weigh? Is Wiggles on any other herbs/supplements/medicines? Does she have any other health issues? What symptoms does she display? I am sorry for all of these questions but the more information we know about Wiggles the more meaningful our feedback will be, ok?

I am providing a link with information about Trilostane from our Helpful Resource Thread: http://www.k9cushings.com/forum/showthread.php?t=185 I believe you will find a wealth of data pertaining to Trilostane/Vetoryl and hopefully this will help. Please do not hesitate to ask any and all questions and know we are here to help in any way we can.

Love and hugs,
Lori

[kmsteward]

Thanks so much Lori for your welcome and the informational link.

Here are answers to your questions:
Trilostane dose is 10 mg per day for two weeks then retest (ACTH)
Wiggles weighs 10 pounds now but her normal weight is 7 pounds
Her symptoms are ravenous appetite, weight gain (without eating more food than normal), excessive thirst and urination, hair loss, dull coat, unable to jump up on furniture, does not want to go on walks, hearing loss (not sure this is related to cushings), she also has developed several warts (also not sure this is related to cushings)

As far as other health issues - she had a benign growth removed from her liver 6 years ago. She gets occasional bladder infections.

Her blood work showed the following abnormalties:
AST (SGOT) 78 High 15-66 Ref Range
Alk Phosphatase 158 High 5-131
GGT 38 High 1-12
Creatinine 0.4 Low 0.5-1.6
Glucose 51 Low 70-138
Magnesium 2.8 High 1.5-2.5
Chloride 99 Low 102-120
Cholesterol 808 High 92-324
Triglyceride 1596 High 29-291
Platelet Count 405 High 170-400
Urine
Specific Gravity 1.012 Low 1.015-1.050
Protein 2+ High Negative
Occult Blood 1+ High Negative

ACTH Stimulation/Response
Sample 1 4.1
Sample 2 24.8 High

Again, thank you.

Hugs
Kathy

[Bo's Mom]

Welcome Wiggles...from your friends here in Texas.

[molly muffin]

Hi Wiggles!

I'm sure you'll learn all kinds of pertinent information on this forum. Everyone is quite wonderful and compassionate.
I've not been here very long and am slowly learning more and more.

Welcome and belly rubs,

Sharlene (and Molly too)

[Harley PoMMom]

Hi Kathy,

It sure does seem that Wiggles is displaying many of the classical Cushing's symptoms and with an ACTH post stim of 24.8 ug/dl, I would feel pretty confident in treating.

The Trilostane dosage of 10 mg seems very adequate for a starting dose and having an ACTH stim test with-in 10-14 days of treatment is ideal...sounds like you're getting off to a great start! Although your vet is starting a the low end of Dechra's recommended starting dose, I always want to caution new members that any dose of Trilostane may cause adverse effects, so keep an eye out for any vomiting, diarrhea, lethargy, or Wiggles not acting herself. If you feel Wiggles is not acting right, just stop the Trilostane and see the vet ASAP.

With Trilostane it is important that the acth stimulation test be done within 4 to 6 hours of dosing and the Trilostane should be given with food for maxium absorption.

If you have any questions at all, please do not hesitate to ask us, ok? ;)

Please do keep us posted.

Love and hugs,
Lori

[lulusmom]

Hi and welcome to you and Wiggles.

It would be very helpful if you would please post the normal reference ranges for each of the abnormal values you have provided. Wiggles has some liver enzyme abnormalities that we don't normally see with cushing's so I'm just wondering how high those abnormalities are. Was the ALT normal?

Wiggles triglycerides appear to be very elevated. Did your vet mention anything about that? Was Wiggles fasted and is she on a low fat diet? A lot of dogs with cushing's will have elevated triglycerides and cholesterol but most are much lower than Wiggles'. It will be interesting to see if treatment will bring those levels down below the usual trigger for a diagnosis of hyperlipidemia. Those fasted levels are usually triglycerides no greater than 500mg/dl and cholesterol no greater than 300mg/dl.

Did your vet discuss an abdominal ultrasound in order to validate the acth stimulation test and determine which form of cushing's Wiggles has? Most dogs have pituitary dependent disease and the odds are great that this is probably what Wiggles; however, if it is an adrenal tumor, surgery could be a permanent cure, if she is a good candidate.

Glynda

[kmsteward]

Thank you Bo's Mom, Molly Muffin, Harley PomMom and lulusmom for your warm welcomes and information about Cushings.

lulusmom - yes, ALT was normal. Wiggles was not fasted for blood work. She was fasted for the ACTH. My vet and I did discuss an abdominal ultrasound, however, we agreed that Wiggles at her age would not be a good candidate for surgery so the ultrasound seemed unnecessary. Wiggles had an extremely difficult recovery from surgery at age 6 so surgery at 13 does not seem like a reasonable option to me.

I have a couple of questions - How long does it usually take to see improvement from medication? Also - Do side effects such as vomiting, diarrhea etc. occur soon after starting medication? She started Trilostane four days ago and so far so good.

Thank you everyone.

Hugs..................

[kmsteward]

One more thing - I added reference ranges to my previous post with blood test results

[Harley PoMMom]

I have a couple of questions - How long does it usually take to see improvement from medication? Also - Do side effects such as vomiting, diarrhea etc. occur soon after starting medication? She started Trilostane four days ago and so far so good.

Thank you everyone.

Hugs..................

Clinical signs such as excessive drinking/urinating and ravenous appetite usually subside with in 2 weeks, hair-loss and rear-end weakness can take much longer to see improvements.

Since Trilostane reaches peak concentrations at 1.5-2 hours post dose, adverse side-effects could be seen with in this time frame but with Wiggles starting at the low end of the dosing scale for her weight I really do not anticipate that you will see any of these ill effects, however all dogs are different and can react differently. Just keep an eye on her as I know you already are. ;):)

Love and hugs,
Lori

[kmsteward]

Clinical signs such as excessive drinking/urinating and ravenous appetite usually subside with in 2 weeks, hair-loss and rear-end weakness can take much longer to see improvements.

Since Trilostane reaches peak concentrations at 1.5-2 hours post dose, adverse side-effects could be soon with in this time frame but with Wiggles starting at the low end of the dosing scale for her weight I really do not anticipate that you will see any of these ill effects, however all dogs are different and can react differently. Just keep an eye on her as I know you already are. ;):)

Love and hugs,
Lori
Thank you!!

[kmsteward]

Wiggles has been on Trilostane for 14 days. She was definitely improving. Her appetite was more normal, she was not drinking as much water, not urinating as much (no accidents), her energy level was up and she was starting to enjoy her walks again.

Then yesterday she wouldn't eat and is very lethargic. She has been drinking some water. I did not give her the Trilostane yesterday or today. I am going to call the vet as soon as the office opens.

Does anyone have some insight? I am very worried.

[lulusmom]

You did the right thing by withholding the Trilostane as not eating and lethargy are symptoms of low cortisol. If she is not better today, your vet should want to check her electrolytes at the very least.

[Squirt's Mom]

You are taking the correct action by stopping the Trilo and taking Wiggles in asap. She will probably need an ACTH and her electrolytes checked. Don't panic just yet...tiny set backs aren't all that uncommon and Trilo often needs adjusting at first to get the dose dialed in just right. So hang in there and know you are doing the right thing by taking her in. Let us know what you learn.

Hugs,
Leslie and the gang

[kmsteward]

You did the right thing by withholding the Trilostane as not eating and lethargy are symptoms of low cortisol. If she is not better today, your vet should want to check her electrolytes at the very least.

Thank you!!

[kmsteward]

You are taking the correct action by stopping the Trilo and taking Wiggles in asap. She will probably need an ACTH and her electrolytes checked. Don't panic just yet...tiny set backs aren't all that uncommon and Trilo often needs adjusting at first to get the dose dialed in just right. So hang in there and know you are doing the right thing by taking her in. Let us know what you learn.

Hugs,
Leslie and the gang

Thank you!!

[molly muffin]

Hang in there! Sounds like you have done exactly what you should and hopefully the test will show the answers you need.
Scary and nerve wrecking thing to go through. Hopefully Wiggles will perk up as her cortisol level comes back up.
HUGS!
Sharlene

[Squirt's Mom]

How is Wiggles doing?

[kmsteward]

Wiggles Update
This is the third day that Wiggles is not eating. Fortunately she is drinking water.
I have not given her Trilostane since she stopped eating three days ago. She is still lethargic.
She had a very dark poop yesterday. It was the consistency of yogurt.
She has pooped small amounts (about a teaspoon) of watery blood tinged mucus twice since last night.
The vet wants to do the ACTH test. My question is - will the results be of any use since she has not eaten or taken Trilostane for three days. I am going to call the vet again today and try to get some answers. Thanks to all of you for any suggestions.
Hugs....................

[Squirt's Mom]

Oh, honey, Wiggles needs an ACTH immediately! That and her electrolytes checked. Get her in TODAY if possible. The sooner the better.

The signs you are seeing are indicative of the cortisol being much to low and that can be fatal. Do not wait any longer to get her in to be tested. Did the vet give you any prednisone? If so, give her a dose NOW. If you need help with the dosage, we can help but let us know real soon so you can get that into her.

I don't mean to frighten you but this could be very serious. Let us hear from you, ok?
Hugs,
Leslie and the gang

[labblab]

I totally agree with Leslie and your vet that Wiggles needs an ACTH test and electrolytes checked ASAP. Since Wiggles has been off the trilostane for three days, you are correct that the test now will undoubtedly have a different result than a test given three days ago. But if the ACTH is still too low today, that is a guarantee that Wiggles is being overdosed on the medication. The sooner she can be tested, the better! Low cortisol and low aldosterone (another adrenal hormone affected by trilostane) can become an emergency situation quickly.

If you are able to take her in immediately, then I would hold off on the prednisone even if you have it. Because the prednisone will skew the results of the ACTH test for at least 24 hours -- it will make the test results higher than they would otherwise be. But if you do have prednisone and must wait before being able to test, then the prednisone may be critical to maintaining the stability of her blood chemistries during the meantime. You should discuss both the testing and the possibility of giving prednisone with your vet just as soon as you can.

Good luck!
Marianne

[kmsteward]

Oh, honey, Wiggles needs an ACTH immediately! That and her electrolytes checked. Get her in TODAY if possible. The sooner the better.

The signs you are seeing are indicative of the cortisol being much to low and that can be fatal. Do not wait any longer to get her in to be tested. Did the vet give you any prednisone? If so, give her a dose NOW. If you need help with the dosage, we can help but let us know real soon so you can get that into her.

I don't mean to frighten you but this could be very serious. Let us hear from you, ok?
Hugs,
Leslie and the gang


Thank you. She is scheduled for the ACTH test this morning. I will talk to vet about testing electrolytes and also ask about giving her prednisone. Thank you very much for the information!
As a side note - when I called my vet yesterday, she did not talk to me personally, she simply had receptionist tell me to bring her in for ACTH. There did not seem to be any sense of urgency or concern. That makes me wonder if it is time to change vets.

[Squirt's Mom]

Oh, I am so glad she is going in this morning! Please let us know what you learn.

Hugs,
Leslie and the gang

[labblab]

I'm also so glad you're taking Wiggles in this morning! Just to repeat what I wrote earlier, though, giving her prednisone before the ACTH will skew the results. Since you're getting her in so quickly, I'd hold off on the prednisone until afterwards.

Marianne

[molly muffin]

On pins and needles waiting to see how Wiggles is doing.

Sharlene

[kmsteward]

Update

ACTH done this morning - results should be back in a day or two.

CBC/General Health Profile also done - Per vet, results were good - better than last test done before Wiggles started taking Trilostane

Also given subcutaneous fluids, Famotidine injection and penicillin G Procaine injection
Prescribed 1cc twice a day of Metronidizole

So far Wiggles has not improved at all. Very lethargic, walks like a sick dog with tail down and back hunched. She still won't eat anything at all. Drinking water.

Any insight as to how long until I should see some improvement? Also, how long can she go without eating? When I asked my vet, she said Wiggles should be ok for now and should start eating soon.

Does this seem like appropriate treatment? I just keep feeling more confused about what to do.

I am so distressed. Wiggles is such a dear, sweet girl.

Thank you all so much for all the wonderful information!!!!

PS - If this is a duplicate reply, I apologize. When I wrote this the first time it seemed to disappear when I hit "submit"

[molly muffin]

Hugs! I know this is very worrying. Was there any suggestion that prednisone should be given now in case of low cortisol?
Hopefully some of the peeps that have been through this for years will have some input soon.

Poor little Wiggles. She is so adorable. I love her pictures. Those perky ears. :) I hope she pulls out of this soon and gets back to her normal behavior. And eats! I'd be freaky too.

Hugs,
Sharlene

[frijole]

Wow. How long since your baby has eaten? :( I assume you are still off the meds. Please say yes and stay off of them til we tell you it's ok. ;)

Have you given any prednisone? It mimics cortisol and within hours your dog is given relief (assuming the cortisol was too low). If your vet didn't give you any I would be DEMANDING IT and I'd personally go get some first thing in the a.m. so Wiggles gets relief.


I am perplexed because your vet gave an antibiotic, an injection for upset stomach and Metronidizole which is an appetite stimulant. These are drugs I'd prescribe to a dog with an upset stomach. Is this what your vet is thinking?

I think all of us were suspect that Wiggle's cortisol had dropped too low as a result of the treatment for cushings. This happens. And when it does any vet that knows anything about treating cushings immediately tells you to give prednisone which you should have been given at the time you were given trilostane in case of emergencies.

You went in and had an acth test and no prednisone? :(:(:( I am shocked. I don't mean to scare you but if your dog hasn't eaten still and is lethargic still I am very worried. Please get prednisone.

Because electrolytes can be affected I would go out and purchase Pedialyte (baby section) at Walmart or wherever and put some in Wiggle's water asap. It can help in the event that electrolytes went low (common with overdose).

Sorry to write a book... just worried. Kim

[kmsteward]

Hugs! I know this is very worrying. Was there any suggestion that prednisone should be given now in case of low cortisol?
Hopefully some of the peeps that have been through this for years will have some input soon.

Poor little Wiggles. She is so adorable. I love her pictures. Those perky ears. :) I hope she pulls out of this soon and gets back to her normal behavior. And eats! I'd be freaky too.

Hugs,
Sharlene

Thank you!!

[kmsteward]

Wow. How long since your baby has eaten? :( I assume you are still off the meds. Please say yes and stay off of them til we tell you it's ok. ;)

Have you given any prednisone? It mimics cortisol and within hours your dog is given relief (assuming the cortisol was too low). If your vet didn't give you any I would be DEMANDING IT and I'd personally go get some first thing in the a.m. so Wiggles gets relief.


I am perplexed because your vet gave an antibiotic, an injection for upset stomach and Metronidizole which is an appetite stimulant. These are drugs I'd prescribe to a dog with an upset stomach. Is this what your vet is thinking?

I think all of us were suspect that Wiggle's cortisol had dropped too low as a result of the treatment for cushings. This happens. And when it does any vet that knows anything about treating cushings immediately tells you to give prednisone which you should have been given at the time you were given trilostane in case of emergencies.

You went in and had an acth test and no prednisone? :(:(:( I am shocked. I don't mean to scare you but if your dog hasn't eaten still and is lethargic still I am very worried. Please get prednisone.

Because electrolytes can be affected I would go out and purchase Pedialyte (baby section) at Walmart or wherever and put some in Wiggle's water asap. It can help in the event that electrolytes went low (common with overdose).

Sorry to write a book... just worried. Kim

I have not given Wiggles Trilostane since Monday.

I mentioned prednisone but vet said she didn't want to give her any just yet - don't remember if she gave a reason - there was information overload.

I am going to call again in the morning. I do not know anything about all of this so it's hard to discuss with vet when I don't know what I am talking about.

Vet said electrolytes were fine but I am going to buy and use pedialyte anyway.

Also - Wiggles stomach has been gurgling ever since the day before she stopped eating on Tuesday.

One more thing - The day before she stopped eating and became lethargic she was doing very well. She did not become gradually sick. She went from feeling very good to very sick in 24 hours. Is that normal?

Is it possible that she could be ill from something other than Trilostane? Or are her symptoms typically of Trilostane side effects?

Sorry to go on and on but I am so confused and anxious.

Thank you so much.

[Harley PoMMom]

So far Wiggles has not improved at all. Very lethargic, walks like a sick dog with tail down and back hunched. She still won't eat anything at all. Drinking water.



Pancreatitis might be a culprit here, has Wiggles been checked for this? A dog that is suffering from a pancreatic episode can walk with a hunched back.

Keeping you both in my thoughts and prayers...Lori

[labblab]

As soon as you mentioned the hunched back, pancreatitis jumped into my mind, as well. Pancreatitis can cause severe abdominal pain, loss of appetite, diarrhea and vomiting. It can also come on quite quickly, and Cushpups may have a special vulnerability to it.

Even though Wiggles' initial bloodwork looked OK, it is still possible that pancreatitis might be involved. Sometimes only a special blood test, the "Spec cPL" test, will reveal the abnormality. One of my two dogs had an acute episode of pancreatitis last spring, and nothing was out of line with her standard labwork including her pancreatic enzymes. Sort of as a last resort, my vet and I decided to perform a cPL test, and it came back HIGHLY elevated! We were shocked, but able to move forward with her treatment which involved major dietary changes and the addition of some supplements.

When you call your vet this morning, I'd ask about special testing for pancreatitis. Also, under these circumstances, I would not give Wiggles any pedialyte without first consulting your vet. Since her electrololytes were normal and she already received supplemental fluids in the office, it may be better to only offer her plain water right now.

Please let us know what you find out this morning, OK?
Marianne

[Squirt's Mom]

Hi sweetie,

I'm with Lori and Marianne - based on the hunch-back walk and other signs, pancreatitis is a real possibility. I wouldn't ask that she be tested for this, I would insist and if they aren't willing, find a vet asap who will test for pancreatitis. This is another condition that can cause some serious organ damage if not treated.

It simply blows my mind that the vet wasn't more concerned with the signs Wiggles presented with. :confused: Just in case the pancreas is inflamed, which is what happens with pancreatitis...I was told nothing by mouth via the vets when Squirt had an acute attack following surgery - no water, no food, no meds - because substances in the mouth trigger the pancreas to go to work, releasing enzymes, and the organ needs to rest to heal.

Do let us know what they say when you call this morning. We are right by your side, sweetie, lending you our strength and hope. Anytime you need to talk or ask a question, we will be right here.

Hugs,
Leslie and the gang

[kmsteward]

ACTH results came in this morning

Sample 1 0.7 Low Range 1.0-5.0
Sample 2 0.7 Low Range 8.0-17.0

Vet gave Wiggles Dexamethasone injection
and Prednisone tablets to be taken in gradually decreasing amounts over the next 9 days.

The vet on duty today was wonderful. He took the time to go over everything that is going on with Wiggles and explained the disease so much better. I felt that he was much more well informed about Cushings. I am going to request him from now on. He eased much of my anxiety.

Thanks again everyone for all your support. Keep your fingers crossed for Wiggles.

Hugs......................

[frijole]

Thank you so much for the update. Your description sounded just like a dog with low cortisol and now we know that is what was going on. The prednisone and shot are what Wiggles needed.

I assume they told you that you were not to give any more trilostane until tests show that the adrenal glands are producing cortisol and symptoms return (acth test).

I am so relieved that Wiggles got the prednisone and yes this vet obviously knew what to do. Get his direct number! ;) Kim

[kmsteward]

Thank you so much for the update. Your description sounded just like a dog with low cortisol and now we know that is what was going on. The prednisone and shot are what Wiggles needed.

I assume they told you that you were not to give any more trilostane until tests show that the adrenal glands are producing cortisol and symptoms return (acth test).

I am so relieved that Wiggles got the prednisone and yes this vet obviously knew what to do. Get his direct number! ;) Kim

Thank you for your reply. Yes, Vet said no more trilostane for now. We will wait and see what happens after the prednisone.

I forgot to mention that the vet said Wiggles could also have an underlying intestinal issue as her white blood count was a bit high (something the other vet did not mention). I tried giving her baby food via syringe earlier today before I got in touch with vet and she could not keep it down. So I am to continue the other medication (metro.... something) if she continues to vomit after eating.

He felt that the prednisone should kick in fairly quickly. Hope he is correct.

Again - thanks

[molly muffin]

Well Yay! This vet sounds like they are more on top of what could be going on with Wiggles. Hope that prednisone kicks in quickly and the appetite and ability to keep food down clears up soon. Poor little thing.

I'm just sure that once the cortisol level's come back up that Wiggles will feel better. Positive reinforcement here. :)

HUGS,
Sharlene

[kmsteward]

Well Yay! This vet sounds like they are more on top of what could be going on with Wiggles. Hope that prednisone kicks in quickly and the appetite and ability to keep food down clears up soon. Poor little thing.

I'm just sure that once the cortisol level's come back up that Wiggles will feel better. Positive reinforcement here. :)

HUGS,
Sharlene

Thanks so much for your support and encouragement.

Hooray - Wiggles just ate and she looks and acts soooo much better. Wow - I am so relieved. Wiggles and I will sleep better tonight.

[frijole]

She ate?!!!!!!!!!!!!!!!!!!!!! Yeah. And that is why everyone must have prednisone on hand - whether it be trilostane or lysodren they are using. I am posting this for any lurkers or newbies that could learn a lesson... Hurray is right!!! You must be so relieved. Keep us posted. Kim

[Squirt's Mom]

Oh, this is the best news! :) I am so glad she has eaten and hope you see nothing but improvement from here on.

Hugs,
Leslie and the gang

[kmsteward]

Good morning. Wiggles slept soundly and ate well this morning. She is acting like her normal happy self.

I sincerely want to thank all of you for your support, encouragement and sound advice. I am so grateful.

This is a wonderful site for those of us struggling to understand and deal with this terrible disease.

Hugs and Kisses ! !

[jmac]

That is WONDERFUL news! I am so glad Wiggles is doing so well and that you followed your instinct not to give the drug, and that you saw a vet who knew exactly what to do. I'm so happy for you and Wiggles!

Julie & Hannah

[molly muffin]

Every seen so many people getting excited about a cushings dog eating. :) You bet!
This is great news!

Happy Dancing!

Sharlene and molly muffin

[kmsteward]

An update on Wiggles. It has been 2 1/2 months since Wiggles had her terrible episode with Trilostane and I am so happy tell you that she is doing great. I did not put her back on Trilostane and amazingly, she has not displayed any of the cushings symptoms. Her eating, drinking and urination is normal. Her weight is back to normal and there is no more bloating. She loves her walks again and she can jump up on the sofa. Even her hair seems to be thickening. The only thing that remains is the darkened skin pigment. It is absolutely astonishing to me that she is doing so well!! Thanks again to everyone for all the advice andsupport!!!!

[Steph n' Ella]

Yay for Wiggles!

[Squirt's Mom]

What a great update on Wiggles! :) I am so happy for the both of you and hope it continues like this!

[addy]

Very good news that we love to hear:D:D:D:D:D

[molly muffin]

Just love the happy updates! Go Wiggles!

hugs,
Sharlene and Molly muffin

[kmsteward]

Good morning. Wiggles is still doing great. It's wonderful to see her so bouncy again. I have a question - Wiggles hair was very thin on her back, almost bald in some areas. It has grown back and is much thicker but the hair is now black (it used to be silver) and very soft and fuzzy like puppy hair. I am not worried about this, I just think it is interesting and wonder if anyone else has experienced this?
Again I want to thank everyone for their support!!
Happy Thanksgiving!!

[Squirt's Mom]

Good to hear from you and especially good to hear that Wiggles is doing so well! :):cool:

It isn't uncommon for a Trilo pup to regrow a coat that is different from their original one. Some will even go through a stage of just about completely blowing the old coat as the new one comes in. It seems to be one of those little things that is inherent with treatment but that causes no problems...unless the pup is a show dog then things might matter more. ;)

Hugs,
Leslie and the gang

[molly muffin]

yay, glad that Wiggles continues to do well. :)

Happy Thanksgiving

hugs,
Sharlene and Molly Muffin