New Member/New Diagnosis/Need Help

[dalzy2]

My dog Mickey was just diagnosed with Cushings and we are not seeing improvement with the Trilostane that was prescribed to him. I think he is actually getting worse. One thing that has changed is that for the last 4 days he has had diareah. We are finding blood in his stool. I have not seen this in any of the other forums so my question is whether or not this seems to be related to the cushings? I don't know what to do and I feel the vet is not keeping us informed of how to deal with it. He is currently out of the medication, but the diareah started when he was on the meds. :confused:

[lulusmom]

Hi and welcome to the forum.

Do not, I repeat, do not give Mickey any more Trilostane. Diarrhea is an absolute sign that cortisol is too low so you need to contact your vet right away. Did your vet give you any prednisone? If so, give him a dose now. Trilostane has a short half life and most dogs start to come around rather quickly after withholding the dosing. Can you tell us how much Mickey weighs and what dose of Trilostane he is on. Is it once or twice daily?

I want to get this info to you asap so I'm going to send this post and will post additional questions and comments on another post.

Hang in there. We're with you and Mickey no so we'll do whatever we can to get you both through this safely.

Glynda

[lulusmom]

Hi again.

Here's what we need you to do for us so that we can provide meaningful feedback. The more we know about Mickey's history, the better and don't worry about long posts because it's impossible to provide too much information.

To make it easy for you to go down a checklist, I've listed my requestions and questions below:

1. How old is Mickey and what is his breeding?
2. What led your vet to suspect that Mickey may have cushing's. Was it symptoms and if so, which symptoms does Mickey have? Or perhaps it may have been abnormal blood values.
3. Does Mickey have any other medical conditions?
4. Is he taking any other medications or supplements?
5. Can you round up all of the testing that was done to diagnose Mickey and post the results here? With respect to bloodwork, you need only post the high and low values and please include the normal reference ranges.
6. What form of cushing's did your vet diagnose. Pituitary or Adrenal?
7. In addition to diarrhea is Mickey showing any other symptoms like vomiting, no appetite, trembling, weakness an/or extreme lethargy

Sorry for all the questions but as I said, it will help us help you and Mickey.

Glynda

[marie adams]

Hi and welcome to you and Mickey,

I see Glynda has been asking questions and giving advice. As soon as you can post the information she asked for the better so everyone on the forum can help.

You are in good hands with the experts here because they know a lot about everything even beyond Cushings.

You are part of the family so keep posting any questions you may have.

Take care and hang in there!!!:)

[Squirt's Mom]

Hi and welcome,

How is Micky this morning? Please let us hear from you when you can.

Hugs,
Leslie and the gang

[Skye]

Hello! and welcome! I hope your darling is feeling better, looking forward to hearing updates. You have found a place that so many of us are so grateful for. Sharing loads of experiences and learnings. Hope today is finding you and your baby well!

[molly muffin]

Hello and welcome. How is Micky doing today? Did you get him to the vet? Did you give prednisone?

hoping for the best.

Sharlene

[dalzy2]

Hi everyone thank you for your quick reply. I'm sorry it took me so long to respond but I was having a hard time getting on the computer. Let me start by saying that Mickey was out of the trilostane so I had him off it for a week and he just started taking it again. The diareah ended the same day I posted because out of frustration I tried fixing it myself with pumpkin and it worked beautifully. I don't have all the answers, because I didn't know the correct questions to ask. I had no idea that there were two differnt kinds of Cushings. Anyway, here is all the information that I can give:

1. Mickey is a 10 year old black lab. His age is an estimate because we rescued him off death row. The vet thinks purebreed but my husband thinks he might be mixed.
2. We took Mickey to the vet about 10 months ago because he appeared to be loosing weight. His back and legs looked boney. The vet said he had only lost a pound since his last visit and that he was just "showing sings of age" redistributing his weight from his muscle mass to a big belly. Then we took him back about a month ago because he was showing way more signs of aging and my mother-in-law (a dog person) thought that this wasn't right. Mickey was urinating frequently in the house and was panting a lot. He has always been a begger, but was getting worse. He was also very slow to get up and was shaking in his hind legs. The vet immediately said it was cushings and we did a couple different tests to confirm. He said the blood test came back a 26 for cortisol levels and that he should be a 5. This is when he perscribed the trilostane.
3. To the best of my knowledge Mickey does not have any other conditions.
4. We were giving him glucosamine for his "old joints" before we knew that was related to the cushings. He hasn't had them for a couple of months.
5. I don't have any of the test results. I will request them.
6. Like I said before, I had no idea that there were two different kinds, so I have no idea.
7. He is still showing the aging type symptoms that caused us to go to the vet in the first place, frequent urination, loss of hair, loss of muscle mass, shakey legs, panting, begging and excessive water consumption.
8. We didn't get a perscription of prednisone.

I have not been happy with the front office staff at the vet office and am beginning to have doubts about the vet also. I think I will be changing offices withing the next week. If anyone out there knows a good vet or how to pic the right vet I would love to hear from you.

Also, I noticed that a lot of people use lysodren instead of trilostane. Which is better?

Thank you all for your help and kind thoughts.

Mickey's mom!

[mytil]

How much trilostane are you giving at this point? And how much does your boy weigh?


.....The vet immediately said it was cushings and we did a couple different tests to confirm. He said the blood test came back a 26 for cortisol levels and that he should be a 5. This is when he perscribed the trilostane.

I wanted to make sure of this result in particular....especially since it was a DIAGNOSTIC test and not monitoring. So am looking forward to seeing whether this was an ACTH (should be two numbers: pre and post) or a LDDS (should be three numbers: baseline, 4 hour draw and 8 hour draw) and all the numbers.

The front staff should be able to pull your chart and tell you - do not take no for an answer.

Keep us posted
Terry

[Squirt's Mom]

Hi Dalzy and welcome to you and Mickey! :)

Until we can see the test results, please don't give any more Trilostane. I am very concerned that he will have another negative reaction if he is on the same dose as before.

For future reference, it is a "rule" that you never ever give Trilostane or Lysodren to a sick dog. If they start acting ill, stop the med immediately. One of the good points about Trilostane is that it can be stopped and restarted without losing ground. So never hesitate to withhold the med when Mickey isn't feeling well. ;)

If that was an ACTH that your vet is basing the diagnosis on, he read the results wrong. At 26 that is high but the number of 5 he told you about doesn't apply until the treatment is started. The normal ranges for the ACTH are different for an untreated pup, for a pup on Trilo, and for a pup on Lyso. Three different norms for three different situations. So it would be HUGE help if you can get copies of all the testing done to date and post the actual results along with the normal ranges for each value and the units of measurement (ug/dl/ Mnol/L, etc).

I'm glad you found us and look forward to learning more as time passes. You and Mickey are no longer alone. We will be right by your side the whole way.

Hugs,
Leslie and the gang

[lulusmom]

If you can let us know where you are located, members may be able to provide a name of an experienced vet or specialist.

[lulusmom]

Okay, now that I have more time, I wanted to come back and thank you for doing a great job of answering my earlier questions. After rereading your original post, I have a question or two left for you. Since you and I kept our Q & A's so organized by numbering them, I've number my new questions below. Some of these questions may have already been asked by other members so sorry if I duplicated anything.

1. How much does Mickey weigh and what dose of Trilostane was he receiving?
2. You mentioned that you ran out of medication which says to me that he's been on treatment for at least two to four weeks. Has he been back to the vet for an acth stimulation test in that time? If so, when and what were the results?
3. It does not sound like Mickey had any of the other symptoms of low cortisol, such as vomiting, not eating and extreme lethargy. Can you confirm this?

Glynda

[molly muffin]

How is Mickey doing?

Sharlene and Molly Muffin

[dalzy2]

Thank you everyone. We have changed vets and had an ultrasound done. Mickey has pituitary Cushings not adrenal. Yes it was an ACTH blood test that was done where his cortisol levels were 26 the first time we took him in before any medication. The second ACTH test showed a cortisol level of 8. That was doing the blood test after 12 hours of fasting and then waiting the 4 hours after the dose was given. Mickey weighs 72 pounds and takes two 35mg capsules of Trilostane a day. I give him one in the morning and one at night, usually around 7AM and 7PM. He tends to have more problems from the meds at night then he does during the day. He usually pees at least once a night that i have to get up and clean. My husband leaves for work at 5:30 AM and lets him out before he leaves. Usually before 7:00 AM when I get out to the kitchen to feed him he has urinated again. I feel as though I am constantly mopping. He hasn't had any more diarrhea but he did vomit this morning. The new vet wants me to bring him in for another ACTH test and about 4 other blood tests. I feel bad because I really don't have the money to do all of these tests, but I want to do what’s best for Mickey. I think that he acts kind of crazy when he is on the Trilostane. He begs more and pees more and acts hyperactive anytime that we are in the kitchen with him because he thinks he will get to eat. We have baby gates up and he stands at the gate and won't move enough for me to get into the kitchen to take care of him because he is so excited that I'm coming. I am curious as to whether or not this is the best medication for him. The new vet said that Trilostane is safer than the Lysodren, but it seems that more dogs are put on the Lysodren.

[mytil]

Hi,

I have just a second, but wanted to make a few comments:

-On the dosage and the symptoms that are not being checked - he still pees and is hungry constantly. The recommended dosage for his weight should be 120 mgs (split into 2 doses) and I am wondering if what you are giving now (70 mgs) is too low of a dose for him.

-Actually Trilostane is no more or no less safer than Lysodren.

-the ACTH test that registered 8 - was that several weeks after you starting the Trilostane? And this number 8, was this pre or post?

-what did your vet say about his vomiting?

Terry

[labblab]

Hello from me, and I am so sorry that Mickey is still having problems -- that makes life so much more difficult for you all!

Just as Terry has said, though, it is possible that Mickey needs a dosing change. And unfortunately the only way for your new vet to know for sure is by proceeding with another ACTH test. The other blood tests can also help identify whether there are any other imabalances that may account for any of Mickey's continuing problems.

One really important thing for you to know and discuss with your vet beforehand, though, is that a dog taking trilostane should NOT be fasted before the ACTH. The morning dose should be given along with at least a small meal so that the drug will be metabolized properly. Otherwise, the test result may be inaccurately high, and the decision made to increase the trilostane when it really should not be increased. The other blood tests may require fasting, though, and so perhaps should be done at a different time from the ACTH. This will be very important for you to talk over with your vet in advance so you will know exactly how to prepare Mickey for the testing.

Hang in there, OK? And please keep us updated as to how he's doing. Of course, if he continues to have any problems with vomiting or diarrhea, then it is best to at least temporarily stop the trilostane altogether and consult the vet. As far as which drug is better -- trilostane or Lysodren -- many dogs do fine on either, but some may respond better to one than the other. Trilostane is probably being prescribed more frequently now, especially by younger vets who do not have the previous history with Lysodren. It is possible that Mickey might do better with Lysodren, but the first step really will be to see how he does with trilostane once the dose is effectively controlling his cortisol level. If his last "post" result was 8, it is still too high given the problems with his symptoms. However, that "8" was after having been fasted, so the result after having been metabolized properly could have been lower. That's why it will be important to go forward with at least one more test having been conducted properly -- with the trilostane being given along with food.

Please do keep us updated.
Marianne