Intro to Lady, my mom's Yorkie

[LadyBug12]

Good evening all. I just recently came across this forum and am so thankful to have so much info in one place. 11 years ago in April, I bought an all blonde Yorkie for my dad. My parents were in love at first sight. She was a tiny rollie pollie. Needless to say, she bonded with my mom. When my mom passed away four years ago this February, I brought her home to Texas with me. She weighed roughly 14 lbs. When I took her to my vet for her shots, my vet took one look at her and asked if she had Cushing's Disease. I knew about it as my horse of 20+ years had it. We tested her and sure enough she had it. We tried her on Anipryl first which didn't work but made her a more agreeable dog. We started her on Trilostane and she has done amazing on it ever since to the point that I only give it to her every other day and our vet is very pleased with her levels, which I am not sure of the numbers. On top of that, she now weighs 9.6 lbs and acts like a spring chicken and goes up stairs when she couldn't before. My mom always said Lady had anxiety attacks but when I started witnessing them, I knew she was having seizures. Her seizures were infrequent until last month. We have had 5 in less than a month. She had a mild one yesterday brought on by someone ringing my doorbell and both Yorkies barking. My vet said it was time to start her on phenobarbital. We are now in new territory. I know it will be okay but it is scary.

[frijole]

Welcome! Glady Lady is doing great on trilostane. Please tell us more about the seizures. FYI they are common with cush dogs but tend to be infrequent. That said we have had the discussion of phenobarbitol on multiple occasions... I went ahead and found another thread where this was discussed in hopes that it helps you.

Our admin Marianne contacted the manufacturer of Trilo (Dechra) and here is her thoughts after talking to them about the use of trilo and pheobarbitol (the concern is the liver) Note Marianne has a NON CUSH dog that has seizures so she uses phenobarb:


OK, I just spoke with one of Dechra's technical reps, and what he told me pretty much coincides with what you were already thinking. Even though there is no documented interaction between trilostane and phenobarb (he is unaware of any clinical trials that specifically addressed that drug combination), dogs who are being treated with both drugs need to be monotored very diligently both in terms of liver function and also trilostane efficacy. He is aware of dogs that are currently being treated with both drugs, and no particular problems have surfaced thus far. But theoretically, phenobarb's effect on the liver could alter the way in which trilostane is metabolized by any given dog, leading to the potential for trilostane overdosing in the absence of appropriate dosing adjustments. Everything being equal, potassium bromide would probably be a preferable treatment choice for a dog suffering from both conditions. I'm sorry, but I forgot to ask about gabapentin .

This is just my own opinion, but if my own sweet "seizure-girl" were to now develop Cushing's, I might be inclined to leave her on the phenobarb because she has done amazingly well with it (knock on my wooden head!!). But if I had a Cushpup on trilostane who was newly diagnosed with seizures (like you guys), I'd also be looking at alternatives such as potassium bromide. Oh, in that regard, I also asked whether there would be a preference in a Cushpup between potassium bromide and sodium bromide (due to potential effects on electrolytes), and he said it was a good question but one for which he is unaware of an answer. He suggested asking a neurologist about that one.

Marianne


I recall other discussions as well and it seems like most cases they elected to go with potassium bromide vs phenobarbitol.

Here's a link to the entire thread:
http://www.k9cushings.com/forum/showthread.php?t=3876&highlight=phenobarbitol+trilostane

If I see another thread that might help I'll link it too.

Kim

[mytil]

Welcome to you and your Lady.

I do have a few questions here.

Firstly, what were the results of the most recent ACTH stim test? Your vet should have run one about 14 days after the start of Trilostane treatment. You can call your vet to obtain these numbers.

I would also be interested in the initial testing performed to come to the diagnosis of Cushing's. Again, you can get all of this information from your vets.

How much Trilostane you are giving?

I know some vets opt for every other day in treating, but this does not follow the recommended protocol in successful treatment.

I certainly would look into other issues that may be causing these seizure type episodes before giving her any meds for this. Thyroid issues can cause these symptoms as well as vitamin deficiencies and low calcium levels.

Terry

[LadyBug12]

When I brought Lady home, she looked like a pot bellied pig. She was on a prescribed food from the vet for overweight dogs and was only given 1/4 cup a day which she almost never ate but was always ravenous. She was always thirsty and we had problems with her urinating while asleep. She is good about letting you know when she needs to go out but we had accidents once in a while while she was awake. She pants a lot and sounds like a freight train. Her hair was thin with thin skin and pigmentation spots. Since she has lost weight, she does sound better except when she gets congested from allergies. Mucinex takes care of this.
She has had quite a few ACTH stim tests. Her liver function has always be elevated until her last test when everything was right on target. My vet has performed ultrasound of her liver and it is not enlarged. Her last ACTH stim test was March 2011 with a pre level of 10 and post of 5.7. For some reason, I thought it was last year. She takes 10 mg of trilostane compounded. Now that it is available in 10 mg doses, we are ordering the pills/capsules. My vet checked her liver and electrolytes yesterday and her liver was slightly elevated but since I haven't been too consistent with the trilostane, her functions could be within normal levels. I have a 21 month old at home.
As for her seizures, she has had them all of her life as far as I know. My mom used to call them her panic attacks. Since she has been with me, anything can trigger her seizures. Falling of the bed, doorbell ringing, getting stuck on her back (before she lost weight), two other dogs in the house when family visits, or no reason at all. Sometimes I can tell when one is coming as she will act like a crotchety old woman. Others, I have no clue. They used to be very infrequent but this last year they have been coming at least once a month. Since December 18, she has had 5 seizures - two within 24 hours with the last one Monday when our doorbell rang. There is no pattern. My vet discussed her liver functions and that Cushing's and pheno will elevate her levels and that we will need to monitor her closely. I have not looked into alternative treatment for them as it was a tough decision about pheno. I have not yet given it to her and it is sitting on my counter.
I have her on blue buffalo freedom food with limited treats. I have started making my own dog treats at home. I call my two dogs the tag team as BudBud will get up on the furniture to get whatever smells good and take it to Lady who will tear it open. She can't jump. Sorry for being long winded. I hope I have covered everything.

[addy]

Her last ACTH stim test was March 2011 with a pre level of 10 and post of 5.7. For some reason, I thought it was last year. She takes 10 mg of trilostane compounded.

Hi,

Is there anyway you can check your records? Is your vet not monitoring her Trilostane with reguar ACTH tests?

Thanks for checking.:)

[LadyBug12]

Her last stim test was March 2011. I had my son April 2011. She had liver panels done Dec 2011, June 2012 and yesterday. My vet has been telling me about doing the stim test but it has been a struggle here. My hubby came home from deployment June 2012. On top of that, I have been slacking her giving her meds to her. It was a rough year last year for us. In about 4 to 6 weeks, I am taking her in for a stim test as I am going to make sure she gets her meds on time.