Trilostane Options

[PatsK9z]

I am new here as of today but have been dealing with (or not dealing with) Cushings since July of last year. My baby is a 13.5 year old male Schnoodle named ChaCha. We've been together since he was 12 weeks old and he has always been very healthy and energetic.

We moved in May of 2012 and had to change vets. As of Oct, 2011 he weighed in at 28.8 lbs which was perhaps a couple pounds over but he is a lot of muscle from doing agility for several years. His competition weight at 2-3 years of age was 22 lbs.

In July (at our new vet) he was given a senior panel and Cushings was suspected. It was confirmed with the ACTH test but he was not showing any of the symptoms normally associated. He had however lost nearly 4 lbs down to 24.4 lbs.

I don't know if it is pituitary or adrenal - sorry.

They put him on liquid Trilostane 50 mg/ml #40 ml Chicken. Unfortunately I no longer have the bottle or the directions for how much I was to give him.

In late August they repeated the ACTH and also did Chem 18 #2214 (?). His Cushings numbers were not coming down very much and he lost another pound. They told me to increase the dose of the Trilostane.

By October I was worried enough to consult another vet. By then he was down to 19 1/2 lbs. They said he had pancreatitis. This vet consulted with outside resources and they said to get him off the Trilostane IMMEDIATELY!!

We got the pancreatitis mostly under control altho he still has blood work showing he has it but he is back on a regular high quality diet of highly digestible food with an antioxidant supplement, 1 mg melatonin and an adrenal gland supplement which we are trying out and he is eating fairly well.

Problems are that he continues to lose weight and is down to 17 1/2 lbs and we just re-tested for Cushings and his numbers are going up. About 2 weeks ago he started drinking lots of water, is peeing about every 2-3 hours (even during the night) and our vet is recommending referral to a specialist for an untrasound and going back on Trilostane.

I'm scared to try putting him back on the medication that potentially triggered the pancreatitis (esp since he still has it). I just lost a 10 year old min schnauzer -- Rumba -- to kidney failure and don't want to put ChaCha in any medical crisis or danger. My heart is already in pieces.

SO - is it worth it to pursue the Trilostane again? Are there alternatives? Is an almost 14 year old dog at 1/2 his original weight going to thrive? He as lost about another pound this past month so I don't see how we can resolve anything without medication.

Sign me.... Totally Confused and Afraid
& thanks for help.:(

[labblab]

Hello to you and ChaCha,

I am so sorry your baby is doing poorly right now, but I am very relieved you have found us so that we can offer our support and hopefully some helpful info and suggestions.

First off, I think the idea of consulting with a qualified specialist is a great idea. It sounds to me as though there are lots of "question marks" as to what is the true nature of ChaCha's ill health, and the fresh eyes and fresh brain of a specialist should be a big "plus." In the absence of any overt Cushing's symptoms when he was first diagnosed, I'm assuming that lab abnormalities such as elevated liver enzymes are what prompted the original testing. But without the benefit of specific test results, I really can't give you an opinion as to what may be going wrong now or in the past -- whether it was ever Cushing's, or whether ChaCha has now developed Cushing's. So I think it will be really helpful to see what the specialist thinks now. And yes, I think the idea of an abdominal ultrasound is also a good idea because it can give you a lot of helpful information about all of ChaCha's major organs.

One comment, though: trilostane does not cause pancreatitis. Uncontrolled Cushing's does leave a dog more vulnerable to pancreatic attacks, though. So if anything, perhaps the dose of trilostane was not high enough at that time -- if ChaCha really did have Cushing's. I'm wondering whether the "outside resources" told your vet to discontinue the trilostane at that time because they had questions as to whether or not Cushing's was really the correct diagnosis. I will add that weight loss is not the norm for Cushing's, unless the disease is triggering some other ailment in addition.

Bottom line is, if it were me, I'd definitely opt to see the specialist and get an expert opinion as to what is going on with your baby. If Cushing's remains part of the diagnosis, then it may turn out that ChaCha needs to be dosed very differently with the trilostane than he was previously. But we can address that further down the road.

Marianne

[PatsK9z]

Thanks so much Marianne. We are seeing the endocrinologist on Friday morning so I will update things after that appointment. My biggest concern with him is that he continues to lose weight and no amount of food, encouragement or prayer is putting any back on. So hopefully the appointment Friday will provide some better information.

Thanks again -- so glad I found this forum - we learn so much from each other!! :)

[Harley PoMMom]

Hi and welcome to you and ChaCha from me as well!

Chronic pancreatitis is known to cause Exocrine Pancreatic Insufficiency (EPI). Some of the symptoms of EPI is a dog losing weight and not being able to gain any weight due to the body not being able to break down food and absorb it.

Is ChaCha experiencing diarrhea? Does she seem to be ravenous all the time and eating well?

I agree with Marianne in that seeing a specialist is a really good idea. Please do keep us updated and I am wishing you both the best of luck.

Love and hugs,
Lori

[molly muffin]

Hello and welcome. I completely agree, cushings or not, trilostane or not, the most important thing is to figure out what is causing your baby to lose weight like that. I think that means an ultrasound to look at the internal organs for any abnormalties that might give a clue as to what is really going on.
Crossing my fingers and toes, we'll get the pup to all cross paws to and hope for some answers.
Don't forget to copies of all test results. You need to have your own file so you can see and compare going forward!
(and you know we'll want lab results posted too :) )

Sharlene and Molly Muffin

[Squirt's Mom]

Hi and welcome to you and your baby! :)

You mention an "adrenal gland supplement". Could you tell us the name of this product? There are some out there you can get online that are snake oil. So I want to be sure you haven't been led into believing the hype you can find on the web about these products. ;)

I'm glad you found us and look forward to reading more about ChaCha. Do let us know what you learn from the vet. Whether it turns out that ChaCha has Cushing's or not, ya'll are now family and we will want to hear about your sweet girl...and you. :)

Hugs,
Leslie and the gang

[PatsK9z]

Not that it matters, but Chach is a boy - just FYI. He is my first dog ever so that part is most important :p. We did everything from puppy school, to obedience classes, to agility and finally therapy dog. All 3 of my terriers were therapy dogs to hospice patients :D

Our wonderful vet has been walking this road with us every step of the way.

Anyway - when he had Pancreatitis we put him on fat free ground turkey + white rice. He loved it and ate it up. Of course that's not enough nutrition so when he stabilized, we moved him onto Science Diet Rx I/D with some low-fat canned food mixed it. We tried adding pancrease enzyme but he didn't want it no matter how I disguised it and when we did get it in him, it didn't seem to do any good so we stopped it. He didn't put on any weight at all.

The adrenal support came from our vet- it is made by Standard Process. She got it for us direct from their rep FOR FREE. We've been using it but still no weight gain so not sure if we should continue it or not.

Our vet suggested putting him back on his old food (Natural Balance Ultra) but I thought I would try Nature's Recipe Salmon/ Pumpkin /Sweet Potato grain free/easy to digest mixed with Nature's Recipe canned chicken/rice/barley (easy to digest) and he eats about 95% of what I dish out for him which is about 2/3 cup blended. He eats 2x a day and not much in between meals.

We are adding (per our vet) a 1/2 tablet of Antioxidant Ultra 5000, a 1mg Melatonin (OTC) and 1/8 tsp of the adrenal support supplement.

There's been no diahrrea - loose stools in the beginning but that has stabilized thanks to the Nature's Recipe diet. No vomiting until last night - he up-chucked a little bit in the middle of the night but it was just a tiny amount. Enough to scare me tho :eek:

Biggest concerns are the weight loss, the beginnings of more water consumption and peeing - altho for first time last night he went 5 hours without going outside -- it was typically 2 hours. WOW - 5 hours of uninterrupted sleep!! Who'd have thought it possible? Hee Hee!!

Anyway -- hope I've answered all the questions. Will no more and update you Friday. Thanks again everyone. I am grateful for you.

[PatsK9z]

Just a quick note - I uploaded 3 photos of ChaCha but do not know how to add him as my picture in messages. Can you assist please. I'd love for everyone to see him.

Thanks.

[PatsK9z]

Never mind -- I think I found it :D:D:D

[Squirt's Mom]

awww.... HE :o is a handsome fellow! I just love Terriers! :D

[molly muffin]

At the moment I think a full panel for kidney and any renal issues might be worth a look. Thyroid and Diabetes too.

Was only a ACTH done to confirm cushings or was an LDDS test and ultrasound also done? ACTH ca have false positives if something else is going on causing high cortisol levels. The body will produce cortisol in reaction to just about everything, but it doesn't last long, however, if there is another problem, then it can be high and stay high until that issue is address and it may not be cushings at all. Y
Do you have the lab results that you could post any abnormals high/low with range, including those used to diganose cushings.
This would be very helpful.

Love the albums! I love seeing pictures of our members babies. He's a VERY handsome fellow.

Sharlene and Molly Muffin

[Shabba]

So sorry to hear about your pet. However, Trilostane actually has a lot less side effects than many other medications used to treat Cushing's. my 11 year old Shiba-Inu has been on Trilistane for the last 5 years with virtually no long lasting side effects.

[PatsK9z]

Initial information from ultrasound is "it's still a mystery." Endocrinologist checked all organs and doesn't want to call it Cushing's Disease or consider Trilostane at all.

Everything looks pretty normal except for a little motteling of the liver color and the intestines appear a little thicker than normal. She wants us to have his kidneys rechecked and to try feeding him an extra meal.

Pancrease looks normal on ultrasound too - as well as protstate. Everything is fairly normal for an almost 14 year old dog. We will be in touch with our regular vet to see if any protein loss from kidneys - Lord I hope not -- that's what happened with Rumba.

[Simba's Mom]

Hello and welcome from Simba and me, sending hugs and prayers that your fur baby will gain some weight soon and you get on top of things....

[Harley PoMMom]

Adding carbs to a dog's diet may help in putting weight on. Carbs such as potatoes, pasta, oats, rice...etc

[molly muffin]

Well that was some good information and you can narrow down a few things. I wouldn't go with meds for cushings with that diagnosis from the Endocrinologist. And the pancreas looks clear too.
Definitely get the kidneys checked, but there wasn't anything abnormal in kidneys on the ultrasound right?
So if there is a problem then it might be very early.
Lori has a good idea about the carbs too. Maybe that would work.

Sharlene and Molly Muffin

[PatsK9z]

You all are amazing -- one thing she said in her report was to run another renal panel. We are also going to add a 3rd meal. My can food includes barley and rice but I could add more cooked rice to it for more carbs?. He doesn't seem keen on potatoes.

I'm currently feeding Nature's Recipe grain free salmon, pumpkin and sweet potato dry + Nature's Recipe canned chicken with rice& barley. Both the dry and canned are labeled easy to digest. He's getting 2/3 combined cup 2x per day. We will up that to 3x per day and see if he handles it okay.

I'd be happy to post or forward the report from today if you like- it's a PDF file.

Thanks again for all of your support :-)

[PatsK9z]

I copied the following from the exam yesterday...

"There were some significant changes to the kidneys, which could be consistent with age related change, or could also be consistent with kidney disease (either renal disease or protein loss through the kidneys).

There was some change to the liver texture, which could be consistent with liver disease, possibly cancer, or simply chronic endocrine disease.

The pancreas was very prominent and thickenened, but there was no evidence of an active pancreatitis and no pain was present when we felt Cha Cha's abdomen.

The small intestines measured thickened, which might indicate that there is inflammation or infiltration with something more aggressive such as cancer leading to Cha Cha's weight loss. Sometimes biopsies of the intestines are required
to be able to determine this.

Cha Cha did not have evidence of an adrenal tumor, the adrenal glands measured around 6mm, which is considered relatively normal.

The next steps that we discussed would be to reassess Cha Cha's labwork- focusing on the kidney enzymes and urinalysis and proteinuria, as these have not been evaluated since the urinating and drinking started again.

Following that, we discussed that we could sample the liver and gallbladder to determine if there is something going on in these organs that is contributing to the weight loss.

I would also recommend feeding Cha Cha about 30% more than he is eating right now- so another meal per day would be a starting point, if he is willing to eat.

If he is not eating well, we can consider an appetite stimulant, called Mirtazapine. If we can get Cha Cha eating well, and we can get him to gain some weight, and his labwork does not reveal any issues with his kidneys, we could consider re-starting brand name Trilostane (Vetoryl) in the future, but I am not comfortable with this currently."