Britches 9 - pituitary tumour.

[Little Britches]

Hi, I'm new to the form and I have a Chihuahua x Yorkie, spayed bitch who was diagnosed with Cushings two years ago. She has been taking Trilostane (Vetoryl) since diagnosis, with a 10mg dose every other day - they don't market a 5mg capsule here in the UK which is unfortunate.
She has regular ACTH bloods and is usually kept on the same dose, occasionally it being reduced to 10mgs every two days when she goes above desired levels. Britches is my daughters dog and both live with me, Britches has done since an eight week old pup, so although I'm just her Nana I mostly look after her, while my daughter is at work.

She's recently (last two days) had diarrhoea plus two sickness episodes, so I have changed her dose to one tablet every two day as I'm worried she could be heading to Addisons if her dose is too high. I'm phoning my vet tomorrow to arrange bloodwork and a full blood count in case there are any underlying problems. Her diarrhoea has now stopped, stools firm once again and no sickness since the first day when she vomited twice.

My main query is - Britches has lost 2 kilos in weight in the past three months, we had reduced her food but only slightly and she has gone from 10.5kgs to 8.5kgs (sorry I really should do it in pounds/ounces but its 2am and am on my phone, which I can't navigate without losing the thread to convert) and I'm a little concerned there may be something sinister going on. I have five other dogs, three Malamutes and two other terrier crosses and although I had dieted a couple of them in the past they have never lost weight this rapidly. I'm having a full blood count but wondered if this kind of weight loss could be the beginning of the end, so to speak - I sincerely hope not. :(
She has even lost her 'pot belly' but has no bones that can be felt, in fact she looks and is very fit, apart from the episode of the past two days, she has not had any other illness in the past two years. Is this something that happens with Cushings in later stages? Please be open as I need to know if this is a bad sign, for Britches mostly but also for my daughter and I to prepare.

Thanks for any replies
Freda :)

[frijole]

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[Little Britches]

Thank you :) I have checked my emails on my phone but there isn't a spam folder unless on my PC, which I will check in the morning. Nothing in my inbox so I expect it will be in spam.
Thanks again
Freda

[frijole]

Hi Freda,

You did the right thing by stopping the drug. Diarrhea and vomiting are signs that cortisol have gone too low. Here's what is going on... the dose of 10 mgs is too high and giving it every other day is NOT the way to do it and here is why...

vetoryl/trilostane only stays in the system for hours - not days. It reduces cortisol. It does it IMMEDIATELY. it doesn't hang around - it goes out of the blood stream. So what you are doing is giving too much one day and then letting the body rest and then too much and then none... it is creating havoc with your dog.

You can have the drug compounded into 5 mg pills and your vet should know this. Doing what you are doing will harm your dog. I wouldn't waste money on a blood panel because it is obvious what was going on - and you are right you were sending your dog Addisonian at that high dose... but the days off are when he recovered. But do NOT give that dose again.

Please get copies of the acth tests that have been done so that we can see what your vet is calling 'normal'. There is 'normal' for regular dogs and 'normal' for cushings dogs... I want to make sure the numbers are valid. We see this error frequently.

Here is info on trilostane and cushings that might help. Kim
http://www.k9cushings.com/forum/showthread.php?t=185

[labblab]

Just a quick note to tell you that your registration has now been "manually" approved so you don't need to search in your spam folder for the confirmation. ;)

[goldengirl88]

Great job on stopping the trilostane when the diarrhea started. Has your dog ever been checked for diabetes? Hope all goes well. Blessings
Patti

[Squirt's Mom]

Hi Freda and welcome to you and Britches, and your daughter! :)

We are a Lysodren house so I will let those who use Trilo talk to you about it - tho Kim is right on the mark about the every other /every third day dosing. I don't know if compounding is available where you are but that is what Britches needs; a compounded Trilo can be made into any size dose required, ie - it can be made in the dose she needs instead of assaulting her system with a big dose on occasion. There are many online pharmacies who will compound and many folk here use Diamondback Drugs out of Arizona but there are others. I hope someone in your area can let us know if this is available to you there or not. And I would be checking with some of the online pharmacies to see if they can ship to you from the US.

Another thing to look into asap is diabetes. Diabetes can come on very fast and weight loss is a classic sign so I would want to have that checked today if possible if it hasn't been checked very, very recently. It isn't uncommon for a cush pup to develop diabetes along with the Cushing's.

We are glad you found us and I look forward to reading more of Britches story.
Hugs,
Leslie and the gang

[Little Britches]

Thank you all so much for the welcome and the advice and thank you too labblab for confirming my registration, have been searching high and low, lol. :o

I have asked my vet for a clinical history of Britches (a girl btw :D) and they are doing that for me as I type. I had contacted Dechra via their site but received and email back saying they don't deal with the owner, only the vet - why they have a 'pet owners' option then is confusing!

Britches hasn't been recently tested for diabetes and I will phone my vet as soon as I have finished this post, it's something that never occurred to me and the vet has not suggested it but in all fairness the weight loss is fairly recent and I haven't seen Nick (vet) since it began. We had wondered if it were due to the dieting but, like I said, worried that the loss was too rapid for that. The vet does not ask for a urine sample at every testing, in fact I believe I have only ever given him one since she was diagnosed and that was at the initial testing, so I will get that sorted too. I have a BM testing kit here that I bought for use on a daughter who sometimes has low levels (not diabetic though) so I could do a test right now if anyone knows what a normal/abnormal reading would be.

I know a few people here in the UK with Cushings dogs and they too are dosing on a sporadic basis, due to Dechra being our only supply and not making a lower than 10mg capsule. I will certainly look into the on line pharmacies to see if I can get a supply as I didn't realise that was possible - I really hope it is.

As I was typing Britches has become very loose again, her stools are like water so I am going to get her to the vet. I thought she was getting better but since feeding she has began with diarrhoea again. It's very worrying and I won't be giving her Vetoryl for a few days and only when I have the okay from people on here. Vets here seem to have very little idea of how to deal with Cushings, from my experience anyway.

Here is Britches today, taken just a few mins a ago.
http://i41.tinypic.com/1zwcbx0.jpg
As you can see, she doesn't have the 'pot belly' that she used to have.

I will be back later and thanks again.
Freda xx

[Squirt's Mom]

Oh, she's a DOLL! :):):)

[spdd]

What a sweetie!! I can't help you with anything, I'm still trying to figure out my pup... but I have definitely learned so much on this forum. I take their word for gospel as they have far more experience then all 6- yup count em 6 vets I've been too.

So... welcome to the forum and with the guidance of those on here, you'll get Britches sorted out.. cute name too.

[Little Britches]

Thanks spdd :)

The vet wants Britches in tomorrow to do an ACTH stim test and full blood count because she has a temp of 39.2, which shows something is going on. However she said Britches isn't showing signs of dehydration or anything shock related and to keep her in overnight would most probably stress her out more, she hates being away from home - what pooch doesn't? :(

She did a thorough physical exam and spent some time in the lung area (hope that's not the problem) but she didn't want to start her on meds until she has the bloods and the test. I took in a urine sample and that will be tested, plus possibly a BM test - we did our own BM and it came back as 4.8mmol, which I believe is at the lower end of the scale - not sure about that though as my daughter is an accident & emergency nurse with human patients and we're both not too good on animal levels.
For now I can still give her small amounts of boiled chicken and keep giving her a 5ml syringe of rehydration fluid every now and then, which I started her on Saturday to help maintain her electrolytes.

Roll on tomorrow and at least we have our little one with us tonight instead of her being lonely and upset in hospital. :)

Brithces is now sound asleep and sleeps in my bedroom so will be closely observed throughout the night in case of any change.

[molly muffin]

Hello and welcome to the forum. :)

We have often heard of the every other day dosing, but usually only in the UK for some reason. It makes no sense, other than if you absolutely HAVE to use Dechra's 10mg dose, which I made a note of just recently, you do not have to use only Dechra (but they sure do want you to) in the UK, as one of our members in Italy's family vet is in London and he told her that they could do a compounded trilostane. So, there you have it. There is no logical reason to only have to use a 10mg vetroyl pill. Now not Wanting to use a compounding pharmacy is something else, but the option is available and your vet should be able to find out about it. I'd suggest maybe a 7 or 8mg, or even 5mg once a day.
However, the temperature being raised does raise concerns about an infection somewhere, maybe an intestinal bacteria (I've been fighting that with my dog recently, and it took 2 weeks to clear with florifora probiotic and an antibiotic).
So that or a UTI maybe. Never hurts to check the blood glucose though because we do see that come on very quickly when it hits. Get that check pretty regularly.
I have to tell ya, Britches is just adorable! That belly just begs for tummy rubs. hahaha
Hope things go well at the vets. Looking forward to hearing more.

Sharlene and Molly Muffin

[labblab]

Hello again. I am very glad that you are taking Britches in for a work-up because I have to agree with you that I wonder whether or not there is something else going on aside from the Cushing's. It is always a wise idea to hold off on giving trilostane to a dog that is experiencing vomiting or diarrhea. But on the face of it, Britches' current dose is actually quite conservative even if the 10 mg. is given once daily. Since a weight of 8.5 kg. translates to approx. 19 pounds, for the benefit of our U.S. readers, even if dosed daily she would be receiving only 0.5 kg. per pound. Of course, she may be very sensitive to the drug and the past monitoring ACTH tests would be the proof of the pudding in that regard. Would you be able to find out the actual numerical results for her previous monitoring tests?

However, the combination of the weight loss and the GI issues may signal some unrelated issue. So we will all be very anxious to hear the results of all her blood testing and your vet's impressions.

Marianne

[molly muffin]

Oh Marianne is right I was thinking 8.5lbs
At 19 lbs 10mg per day would be a conservative dose and definitely make me suspect something else
The temperature issue too points to another culprit
sharlene and molly muffin

[Little Britches]

Hi again everyone :)
I'm happy to say the Britches is bright this morning (7.40am here) she's had breakfast of boiled chicken and not pooped since last night which was not watery but soft, an improvement. She will not be happy to be left at the vets but needs must eh?
My vet originally wanted Britches on a 5mg daily dose and I would love to see her on 2.5mg twice daily, just to see how she faired on that. I will post today's and other test results later today, I forgot to collect them yesterday as was in a bit of a panic thinking something awful may be happening with our little babe, today I feel much more confident and also much more informed.

I have e mailed Diamondback pharmaceutical to ask about shipping Trilostane over here, or if they know somewhere closer that I could get a lower dose from and hopefully will have a reply in the near future. The more I think of how we in the UK are dosing our dogs in sporadic fashion, the more annoyed I become - its like Dechra are the only option here and I've always been told that is the case, very bad really isn't it?

One of my Mals has hypothyroidism and he is dosed twice daily on an empty stomach, again I was never told soloxine had to be given without food and it was only because I contacted wonderful Dr Jean Dodds that I knew that too. Vets here said to give Martys medication once daily but Jean said otherwise and of course that made perfect sense, which I now understand with Trilostane too. Why our vets are so uninformed is beyond me, we tend to trust their judgement and follow blindly but thankfully now I have better advice from you guys. Thank you. :)

I have to start the morning walks now and finish in time for our vet visit at 11.30, at least the sun is out and before it gets too warm I have to get these Mals out at least. I will update later and wish you all a lovely day.

[Little Britches]

Wow! You guys are fantastic, because of this forum I have, after two years, found a drug company that can supply me with a correct, specific dose of Trilostane. :) Diamondback Drugs got back to me and do ship to the UK. In just 48 hours I have learned more from you than I have in two years surfing the net. You have to excuse my ignorance with Cushings as I have not really had much to do with it tbh, my daughter mostly dealt with the vet side of things and we both listened to him too much - I've now learned. Perhaps we can teach him that Dechra aren't the be all and end all as far as Trilostane is concerned too.
Britches stool is now solid, her FBC showed no abnormalities other than slightly raised white cells and ALT, which is apparently quite normal in Cushings. Hope they got that right!

Busy day today, walking five dogs, six including Britches small romp at the field, tending my dear 90 year old next door neighbour, vet trips and general chores that I didn't have time to collect the print outs from their other practice but will do so soon and post them in another thread.
Waiting for the results of today's ACTH test, be another day or two and will post them.

I am a very happy 'Nana' tonight and am looking forward to learning more about this condition from you wonderful people on here.
Will be back soon.
Freda x

[molly muffin]

That is wonderful news! I guess it was a gastro upset and her body is fighting it off on her own. If it comes back, then the antibiotic that most end up taking is metronidazole, or maybe even a little probiotic like florifora would help at times.
It sounds like things are fine for now though and that you are one busy Nana :)

hugs,
Sharlene and Molly Muffin

[Harley PoMMom]

I am a very happy 'Nana' tonight and am looking forward to learning more about this condition from you wonderful people on here.
Will be back soon.
Freda x

You are doing a fantastic job, Freda!! Much can be learned from our Resource Thread: Helpful Resources for Owners of Cushing's Dogs (http://www.k9cushings.com/forum/forumdisplay.php?f=10) Feel free to print any thing out!!! ;)

[Little Britches]

Thanks for the link Harley PoMMoM :) I have read through some of it and its very helpful. Still no test result, its usually here on the same day so I don't know why this one is taking longer, have to be patient I suppose.

Britches still hasn't had any Trilostane because I'm waiting to find what dosage you all recommend after the results are in and then talk to Nick (vet) about a prescription to send to Diamondback. Britches is full of beans and back to eating her usual raw diet. I had put her on boiled chicken while not well but I'm glad to have her back to her usual diet.

Thanks again
Freda x

[Little Britches]

I read in a post that Metacam is not good for Cushings dogs and wondered why. Britches had a limp a few months ago and I had to see a locum vet who then prescribed Metacam, she was on it for about a month. I personally hate NSAID's and in the past have opted for Tramadol instead - my own vet knows this and always gives my guys Tramadol if needed.
Mind you this locum vet was pretty useless and I left the surgery feeling so angry that he seemed to think I was talking nonsense. I had mentioned Cushings and that her ligaments and muscles may make her limp more of a problem, he said Cushings doesn't affect those tissues - I corrected him there! He also said her weight/body shape wouldn't be affected by Cushings and that she was simply fat - I corrected him there too and his response was: "I see it every day!" :mad:
Needless to say I won't ever see him again but anyway I just wondered why NSAID's are not a good idea with a Cushings dog, don't want her to ever have it in the future but in case I have to explain why (to a clueless vet) I'd like some info please.

Thanks
Freda x

[labblab]

Long-term steroid exposure of any form tends to irritate the upper GI tract and leaves both people and dogs at a greater risk for developing ulcers or GI bleeding. This is true whether the steroid is taken orally (prednisone, for instance), or whether the steroid comes from the high levels of circulating natural cortisol associated with untreated Cushing's. Aspirin and other NSAIDS aggravate this problem and this risk.

Here is a quote from the website of the American College of Gastroenterology (http://www.gi.org/patients/gibleeding/index.asp#nsaid2) that discusses the increased risk for humans:


Patients taking NSAIDs who also are taking a prescription corticosteroid, medications like prednisone (in doses over 10 mg), have been found to have a seven fold increased risk of having GI bleeding.

Here's a related quote from a pretty detailed veterinary article I found that may help make more sense as to the warnings about combining NSAIDS with steroids (such as higher levels of circulating cortisol).


It is very difficult to predict which corticosteroid/NSAID combinations(drug formulation, dose, dosing frequency, treatment duration) will result in adverse effects in any individual patient.Therefore, concurrent therapy should only be done when medically necessary and with close and careful patient monitoring...

Treatment of GI toxicity is intensive and mainly symptomatic. Anorexia and/or vomiting are frequently the first indication of GI ulceration and perforation. Any dog or cat that becomes anorectic or vomits while on combination NSAID and corticosteroid therapy should be promptly evaluated by a veterinarian.

http://www.cliniciansbrief.com/sites/default/files/sites/cliniciansbrief.com/files/Complications.pdf

An additional issue is that NSAIDS can also be associated with liver toxicity and therefore (I would think) have the potential to further aggravate the liver abnormalities experienced by the majority of Cushpups. I don't have an article citation right at the moment, but I'll bet you can quickly find additional info in this regard if you Google it.

Hope this info helps!

Marianne

[Squirt's Mom]

MODERATOR NOTE: I have merged your post about NSAIDs into Britches’s original thread. We normally like to keep all posts about each pup in a single thread as it makes it easier for members to refer back to the pup's history when needed. Thanks!

[Trixie]

So glad to hear little Britches is doing better and getting back to normal. Just looked at her photo and she is adorable! Hope she continues to do well.

Barbara

[molly muffin]

It seems that any time we see cushings, high cortisol in general and metacam that it is not good. It can cause damage to the liver and GI tract. The combination can be very bad.
This in addition to the studies that Marianne has posted for you. One of our members who has gone through several vets, and whose dog was on metacam, had her vet say, the other vet should Know better than to prescribe metacam if there is a cortisol elevation or on cushings medication.

I just think over all that tramadol if it is needed is better than the NSAIDs options.

hugs,
Sharlene and Molly Muffin

[Little Britches]

Thanks for that very detailed explanation labblab and those links, very informative and now I understand why the risk is higher. I'm not a fan as I've said and experienced a duodenal ulcer myself by using aspirin to treat migraine for many years. Wish I had known that when the vet prescribed Metacam - would have been something else we disagreed on, lol. :)

Thanks Squirt's Mom, I thought I'd said something undesirable when I saw it had been moved but it makes sense, of course.

Going to pick up the print outs later and hope they have the recent results too. Will post on this thread now, am so interested in what you guys think.

Back soon
Freda x

[LtlBtyRam]

I hope you get things straightened out soon. Welcome to the forums, and as you have found out the folks around here are PAWSOME!
Angela

[Little Britches]

I like pawsome, lol. :D

I haven't got all of Britches past results at the mo, the nurse who was dealing with it wasn't there this morning and the others couldn't find what she had done with them. Honestly though, how long does it take to look on the computer and click print? Anyway, they are being polite so I will be too and they should be at the surgery on Monday.

For now though, Britches ACTH result from last Tuesday are in, still something else to follow so I haven't the full results :rolleyes: her levels are 205 - the vet said the range for a Cushings dog would be between 20 - 250, so she wants her to continue on the 10mg every other day dose. As you know I am going to source her Trilostane from Diamond back but am grateful for any input as regards these levels.

Will post full results and past ones on Monday - hopefully! :)

Thanks
Freda x

[molly muffin]

Do you know if that is the pre or the post result?

205nmol divided by 27.50 = 7.4ug

If it is the pre, you can expect the post to be a bit higher, but maybe they only gave you the post in which if symptoms are controlled, that is fine (it can be up to 9.0ug) if not, then you want to get her down under 5.4ug.

I agree, pawsome is cute, another one is paws up. :)
hugs,
Sharlene and Molly Muffin

[Little Britches]

Thank you molly muffin. :)

I believe this is the post test because that's the one they always state when giving a phone result, due to deciding how much Trilostane I need to give Britches. However I'm not very good with understanding results (sorry) so does this mean that her 10mgs every other day is most likely correct and if so should I be asking for a specific prescription of 2.5mg tablets in order to give her 5mgs in two divided doses daily?

I know you need to see all the results and before asking for a prescription I will post them in their entirety.

Freda x

[FemaleK9]

Freda, we will also need to know how the tests were done. Was Teddy fasted before the test? How long after a dose was the test done? Was the dose given with food?

[Little Britches]

I will speak to the vet on Monday about the fasting etc. She did have a palm full of boiled chicken at 7am and was tested at about noon, or so I think but I will find out definitely. Thanks for asking so as I know what details you need.

Freda x

[Little Britches]

Since I last posted on the forum and I just wanted to update you about Little Britches.
As she is my daughters dog she moved to her new home just over one year ago, where she is an only dog - as opposed to living in my six dog household. In that time her Cushings has completely disappeared. She has lost her pot belly shape, her weight is now back to her adolescent dog weight, her appetite has reduced and she has been off of Vetoryl for almost one year.
Vets can only assume that living in my multi dog household put stress on her, raising her cortisol levels and bringing on kind of false Cushings symptoms. They eventually decided the Vetoryl dose was so low that she may as well not be having it and remarkably she is now completely symptom free. She never outwardly showed signs of stress but moving home has definitely changed her condition.

I wondered if you have ever heard of this happening, it is fantastic to have our little girl back to her normal self, she is eleven at the beginning of next year and super fit now - has lovely long walks too.

[doxiesrock912]

I have seen one article from holistic vet Dr. Karen Becker about stress playing a huge role in Cushings. Aside from Dr. Becker, I haven't heard of it.

Congratulations to Little Britches!!!!!!

[addy]

Great news Britches is doing well!!!! I have not read any articles about the role of stress and Cushings for dogs but I think if we think in human terms- we know that when humans live under constant stress, it raises our cortisol and causes all kinds of health problems for us, weight gain, lethargy, etc. Symptoms similar to Cushings.

I know last year when I was under so much stress in my life, I used to tell my husband I had Cushings right along with my Zoe.

It could be possible.

Whatever the reason, I am so glad Britches is doing well!!!!

[Squirt's Mom]

PLEASE do not look to Dr. Karen Becker as the voice of Cushing's! Take every word she says with a healthy grain of salt and many hours of research on your own. ;)

[molly muffin]

I think that is wonderful that Little Britches is doing so well and has no symptoms of cushings. Awesome. :)