Chip

[Julco]

Hello! My sweet Chip was diagnosed Atypical Cushings last Thursday. Chip is a Pomeranian, he will be10 in March. Chip has been diabetic for almost3 years. 3 months after his diagnosis he went into a honeymoon phase and was taken off of his insulin. 3 months later he was back on insulin and we couldn't get control. He became very sick, didn't want to eat, lost10lbs ( he weighed20-- was very overweight) we thought he tore his acls but couldn't do surgery because his diabetes was out of control I had to do physical therapy on his legs so he could walk again. With an appetite stimulant he started eating again, we got some control and then the vet said he might have food allergies so he was put on ketoconazole We then got good diabetes control. After a food trial, Chip does not have allergies During the food trial, Chip's sugar shot up, he was over600 in the mornings, he should be around100-200The vet said not to worry is probably dawn phenomena, which is where hormones are active at night and blood sugar elevates. 600 is pretty high answer can cause damage. I went for a second opinion.

The new vet suggested Cushings and we tested and also did an ultrasound. I should mention we did an ultrasound2 years ago-- his liver was enlarged, his intestinal wall was slightly thickened and they thought he might have lymphoma or IBD. He was too sick for exploratory surgery and the symptoms never developed. These results are the same in the second ultrasound The vet sent the Cushings test to University of Tennessee and we got the atypical diagnosis. His medicine was delivered today, compounded trilostane from Roadrunner Pharmacy in Arizona. Im going to start it Saturday, I'll be off for2weeks.

When Chip was diagnosed diabetic, the vet actually thought he had Cushings, but the ACTH was negative. I now question if he was atypical all the time. Chip has always been a big eater. He would eat his food and go after the other2 dog's food. He was a20 lb Pom !

So I am here to learn as much as possible. I am a bit intimidated by this medicine. I learned about canine diabetes from Facebook groups. I am so glad this group is here and appreciate your knowledge and experience .

[Roxee's Dad]

Hi and welcome to you and Chip,
Seems that you and Chip have been through the mill. We have a few members that have been diagnosed with Atypical Cushings. I was wondering if you got a copy of the test results from the UTK? If so, usually at the end, they give a recommendation for treatment.

We also have a few members dealing with both cushings and diabetes. We have a sister site for K9diabetes which I think would be quite helpful.

http://k9diabetes.com/

Many more will stop by to welcome you and Chip and share their knowledge and experiences.


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[Roxee's Dad]

I also wanted to ask what the dosage of Trilostane was prescribed? and how much does Chip weigh now? Still 10 pounds? Did your vet recommend Lignans and or Melatonin?

[Julco]

Thank you for the welcome! I don't have the paperwork, but will get it from the vet. I made the mistake with the last vet of not getting a copy of everything. It is so important to have it for reference. I will check out K9 diabetes.

Chip hasbeen through alot. He is so precious to me. When we got this diagnosis I had to come home and just hold him. He let me know it would be okay.

[Harley PoMMom]

Hi and welcome to you and Chip from me as well! I have only a moment to post but wanted to let you know that I have manually aproved your membership so just ignore the email conformation that was sent to you from us.

I am sure others will be by to welcome you and Chip, and offer their advice and knowledge.

Hugs, Lori

[Julco]

Chip weighs11.8 lbs. The dosage is 30 mg1x per day. Does that seem like a high starting dose?

[Roxee's Dad]

Yes, that is at the higher end of the range. Vetoryl, (Trilostane) recommends to start at about 1 to 3 mg per pound and recommends starting at the lower end. I think most here will agree that starting at 1 mg per pound would be ideal starting point.

Many that have Atypical cushings are using Lignans and Melatonin, both of which can be purchased at a health food store. If after a few months no improvement is seen, they add a low maintenance dose of Lysodren. I am a bit surprised at starting at such a high dose of Trilo for such a small pup. I think many here will be concerned at that starting dosage.

Actually trilostane is recommended to lower the cortisol levels and since Chip's Cortisol is normal (via the ACTH test), I wonder what the intent is here? Well we do have a few members dealing with Atypical that I am sure stop by to help you and Chip through this. Hang in there, they will probably be by tomorrow.

[Julco]

Thank you Harley PoMMoM. Roxee's Dad the vet didn't recommend anything else. He said we would get started and go from there He mentioned a food change in the future

I forgot to mention that I had Chip in a lion cut and his hair wouldn't grow back until I added enzymes, probiotics, and coconut oil to hism eals. I now wonder if I should stop the coconut oil.

Oh. He also takes soloxine for thyroid.

[Roxee's Dad]

It would be a good idea to get a complete copy of the UTK test results including the recommendation for treatment.

I am sure Leslie and Addy and a few others that are dealing with Atypical will be by tomorrow.

[Julco]

Thank you I have been confused by this whole thing and am afraid to give him this medicine. I will call the vet tomorrow and get copies ofg his paperwork He said he consulted with Univ of Georgia

[Roxee's Dad]

We also have some very good information in our resources section... here is a link to the Atypical information section.

http://www.k9cushings.com/forum/showthread.php?t=198

Treatment options and recommendations
http://www.k9cushings.com/forum/attachment.php?attachmentid=618&d=1307715594

[labblab]

Hello and welcome from me, too! I have to agree that if Chip were my dog, I would feel more comfortable starting him off on a trilostane dose that corresponded more closely to the lower end of Dechra's initial dosing range: 1 mg. per pound. However, as far as using trilostane for treatment of Atypical Cushing's (normal cortisol level; other elevated adrenal hormones), apparently this is becoming a more common practice than was earlier the case. Here's a reply that one of our Administrators recently posted on another member's thread. Interestingly enough, I believe this dog's care was also being overseen by Univ. of GA. (SARDS is a poorly understood form of acquired blindness that is often accompanied by adrenal hormone elevations.)


Hi and a belated welcome to you and Sassy.

As Marianne mentioned previously, dogs with SARDS most often do experience an increase in intermediate hormones, with accompanying symptoms much like typical cushing's, before or after diagnosis but these increases quite often normalize within several months. As for treating this condition with Vetoryl (Trilostane), internal medicine specialists seem to be prescribing this more frequently to alleviate symptoms. Dr. Mark Peterson, a world renown endocrine specialist, lists Trilostane as an option for atypical cushing's and explains it's effects on the intermediate hormones in his paper entitled Cushing's Disease in Dogs: Recommended Diagnostic Protocols and Treatment Options. I'm not sure we have this paper in our Helpful Resources Section yet but I'll check. In the meantime, I have attached a copy below.

794

There have been a few studies I've read where dogs with normal cortisol have received some pretty high doses, of Trilostane with no ill effects. That doesn't mean one should not be concerned about giving a dog with normal cortisol any dose of Trilostane, it means you have to be that much more vigilant in monitoring the dog for adverse reactions. Having had a bald Pomeranian, one of the studies I am very familiar with involved Pomeranians and Poodles with alopecia. These two breeds are at the top of the list of breeds that seem to be genetically predisposed to alopecia. Most have elevated intermediate hormones but are usually asymptomatic, which is why another renown specialist, Dr. David Bruyette, prescribes sweaters for his alopecic patients. :D The results of the alopecia study showed that Trilostane grows hair in most dogs and it's believed that's because of "down-regulation of adrenal steroids and/or of the noncompetitive inhibition of the oestrogen receptors at the hair follicle level." You can read an abstract of that study using the URL below:

http://www.ncbi.nlm.nih.gov/pubmed/15500480

I have a great deal of respect for Dr. Jack Oliver, who developed the recommended treatment for atypical cushing's at UTK and think he was one of the most compassionate man in the world. He passed away and is sorely missed by a lot of us. He was an amazing human being and helped so many of us on this site. For many years I steadfastly supported many of Dr. Oliver's theories but after doing much research, observing my dog and those of hundreds of others on this site, I no longer subscribe to all of his theories. I once spoke personally with Dr. Oliver about my bald Pomeranian and took the opportunity to ask him why so many in the veterinary community are skeptical of his opinion of Trilostane and it's effects on the intermediate hormones. His response was that veterinary dermatologists are hard sells. Apparently some internal medicine specialists are too. Unfortunately, UTK has done no peer reviewed studies/clinical trials and that certainly puts a damper on UTK's credibility with many vets (and me).

I hope this helps.

Glynda

We will be interested to hear what you learn from your conversation with the vet today.

Marianne