Kona, 13 y/o Border Collie - Starting on Trilostane

[kona]

Hello. This is my first time here, so please excuse if I am in the wrong place or out of turn.

My 13 yr old border collie has been diagnosed (after lots of tests) with mod to severe cushings. I have just started kona on 60mg day of trilostane. I am scared and hope to god I am doing the right thing. I dont know what else to say. I have heard so many bad things about the meds, but she needs help. So do I!

Sorry, I forgot.....my name is Phyllie...Kona is 13 and the best dog ever. I love her with all my heart. She started symptoms around 2 years ago but no vet ever ind icated a problem like cushings. I hope I didnt waste precious time.

I welcome any advice and comments. Thanks

[labblab]

Hello Phyllie! Welcome to you and Kona!

I only have a moment to type right now, but wanted to tell you that I have moved your post so as to create a thread that is your very own. This way, it will be much easier for our members to reply to you directly. ;) :)

Marianne

[goldengirl88]

Hi Phyllis:
Welcome to you and your Kona. I just want to say don't worry about wasting precious time as Cushing's is a very slow progressing disease, and you can't go back and change things now. It would be great if you could get all the test reports and post the abnormal ones with the scale from the lab on normals as all are different. This will give us a better idea of what all is going on. Many other diseases have similar symptoms that is why Cushing's is one of the most difficult disease to diagnose. Were there any other issues going on when Kona was tested for Cushing's? This can skew test numbers if so. Also please give us a brief history of Kona including weight. Is the dosage you are on once a day or twice? Has Kona had ACTH tests to monitor her cortisol since starting it? If so pleas show the results from them and the done. We are here to help and support you through this journey, so please know we are here anytime you need help. I hope things go well and Kona does well on his treatment. Blessings
Patti

[kona]

Thank you so much. I will put together all the info I can and share. Appreciate the quick responses.

[Squirt's Mom]

How much does this gorgeous girl weigh?

[kona]

I saw the first sign of something wrong in March of 2012 - a small patch of hair was coming off on her back, about the size of a golf ball.* Then I saw dark blackish spots on her belly. I went to the vet and he gave antibiotics - for what I dont know.* She did keep getting bad ear infections (and now she is about 80% deaf).

*Over the course of about 14 months, Kona began gaining weight and being sluggish.* Her appetite became ravenous (she had never been much of a chow hound). Her normal weight was around 53-55, but now was getting to mid 60s. Her skin and coat became very dry and sparse - and one thing she always had was a very beautiful coat !!* Then the "pee-ing" started; drips on the floor, or wet underneath her when she was laying down. It became bad enough that I had to put a toddler diaper on her in the house - hard to do for a dog with so much dignity and pride - I swear she knew it was a problem and was embarrassed by it.

*Anyway, she really lost her zest, and her coat, and the eating and pee-ing was really out of control.* I changed her diet (all natural and organic) and she lost some weight and was able to move around better.* But nothing else improved. And now her muscles were really shrinking - hard for her to jump to her favorite spot on the sofa - legs really spindly.* Her skin was breaking in some spots and almost coming off. She looks so frail !!**She was tested for thyroid and it was low so they put her on*a low does of thy med.* Still no improvement.* Over time I stopped the thyroid med because I wasn't sure what it was doing.

*In March 2014 I found another vet that came highly recommenced - she tested allot right off the bat: sonograms, xrays, blood work, etc - came back very low thyroid and said the dose she was getting was not nearly enough. so back on thy med.* Then she did an ACTH test - said cushings was indicated, but wanted to do another test that would be more definitive (stim?) - came back positive for cushings. I do not have those results myself, but can get them I guess.* The vet prescribed trilostane - 30mg 2x day.* I just gave her the first dose last night.* I read so much about the side effects that I worried that the med might make her more sick than the sickness would.

*That's the backstory in a nutshell*- I am sure I left things out, but my head is swimming.* Important to note that Kona walks to the park, is very bright eyed on most days, and does not appear to be in pain at anytime (other than trouble getting in the car, and she wont run).*she now weighs appx 45lbs. I dont know what to expect from the trilostane - I am praying she reacts well to it.* I am grateful for any experiences you all can share.

[goldengirl88]

First off Kona does have a lot of the symptoms of Cushing's, but we need to see all the results I asked you about first. It is a real good idea to always ask for copies of anything done to your dog. You need to have your own file, and it is also good to make a daily journal of your dog. You said he had many ear infections, that also goes along with Cushing's. You must be careful that their ear drum is intact before medicating them, or it can cause serious problems. Also the type of ear medication you use is important. Some can cause deafness! The vet you have seems to be testing your dog and has done an ACTH, but has there been an LDDS? Has your dog had an ultra sound on a high definition machine? This is important to check the adrenal glands and any other suspicious problems involving other organs, or seeing if any thing has spread. If your dog had any other issues going on it can skew the test results. Did the ear med contain steroids? That can really mess up the testing, although your dog does have many symptoms other dise1ases have similar symptoms too. The last thing before I forget is the dosage you are worried about. The starting dosage is 1 mg per pound. Your dog weighs 45 lbs. I myself would not have started in this dog out on more than 30 mgs. You are looking for trouble starting a dog off on a higher dose. I the first thirty days it's cortisol can really plummet. You do not want a dog having to little cortisol or an Addisons crisis, as that can be life threatening. Were you given a rescue dose of prednisone in the event that happens, and did the vet explain this. The best thing you can do in my opinion is to give one dose in the morning with some food and tiny amount of fat. Vetoryl is fat soluble. I would be giving this dog one dose in the morning of 30 mg and have an ACTH done in 14 days to see where the cortisol is. If it is still high do not increase the dose until after 30 days or you risk overdosing the dog.mif the cortisol has really dropped in 14 days you can reduce the dose if necessary. So in 14 days get the ACTH done, it must be completed within 4-6 hours of the dose given. It is to be given with food, do not let the vet tell you different. If you do not give food it will not be absorbed properly, and you risk skewing the test results which can in turn overdose the dog. You are the only advocate for your dog, do not put blind faith in a vet. Most of them know little or nothing about Cushings, don't let you know this fact, and this is where big trouble can start. We will help you thru this. This forum has a lot of experience, and will not steer you wrong. So p!ease do not give the second dose today of Vetoryl. We are here if you need us, or have questions. Blessings
Patti

[labblab]

Thank you so much for this additional information. On the face of it, Kona certainly does sound as though she has a set of symptoms that are consistent with Cushing's. One question I have relates to her current weight, however. You mentioned that originally you were consciously attempting to reduce her weight. However, she is now about ten pounds underweight, and I am wondering whether your vet is concerned/surprised about this much of a turnaround. I would not think that you would want her to be losing any more weight, so I am wondering whether you are making any dietary changes in addition to starting the medication. Unexplained weight loss is a more consistent symptom of diabetes rather than Cushing's. But I am assuming that diabetes was long ago ruled out, and that the weight loss is a result of your conscious effort?

Having said that, 60 mg. of trilostane is a bit higher initial dose than would be recommended by many clinicians, based on Kona's current weight of 45 pounds. Although the published initial dosing range of Dechra (manufacturer of Vetoryl) ranges from 1-3 mg. per pound, recent experience with the drug has led many specialists to begin at the lowest end of that range. So Kona's dose of 30 mg. twice daily puts her at a formula of 1.33 mg. per pound. This is not a huge dose, but I just mention the possibility that she may ultimately end up with a decrease depending upon how she tolerates the drug. The proof will be in her behavioral reaction as well as monitoring blood testing. Kona should be scheduled for a monitoring ACTH stim test at some point within the first month of treatment (Dechra's published recommendation is at the two-week mark; some clinicians wait until closer to the 30-day mark). What instructions has your vet given you re: follow-up testing?

Also, I hope you've been instructed to always administer the Vetoryl along with food in order for Kona to metabolize the drug most efficiently. I'm betting she'll do just fine! But any time you have questions, please do no hesitate to talk them over here, OK?

Marianne

[Iraklis]

Hello and welcome!

Any ultrasound or MRI results?
I'd suggest a 1*30mg per day too...at least for a month...

If you see something strange like vomit or circling or empty gaze or pacing ,anything out of the ordinary do not be afraid to post it or even better take a video of it and post it!

[kona]

I dont have the test results myself yet, only what the vet told me. She is now on her second full day and has had no bad reaction so far (no vomit, diarhea, etc). I guess I was expecting the worse. Wondering when I will know if this med is working.

[molly muffin]

Hello and welcome to the forum.

Quite often I've noticed that you'll see some results in about 10 days or so. Like a lessening of urinating/drinking can be one of the first.

You just want to keep an eye on Kona. Any vomiting, diarrhea or lethargy, not eating, stop the meds and get an ACTH to check levels. Just because it is a bit more than the 1mg/1lb ratio and you never know how a dog will react to any medication. Some end up needing more, some need less, some are just right.
Sort of like the three bears. :)

Sharlene and molly muffin

[kona]

Kona is doing well. Trilostane has not made her sick. She has been on it 10 days, so today we re test to check levels.

[goldengirl88]

Beautiful girl you have keep watching her closely. Could you get us those test result numbers? I am glad to hear that she is doing well. Blessings
Patti

[kona]

Kona is doing great, thank goodness. Vet called last night and said test from friday shows her levels are right on target. This is day 13 on the trilostane and there have been no bad effects. She is very alert - almost frisky!! I will post her status in another few days. I think this is working.

[goldengirl88]

Way to go Kona!!! Keep it up!!!

[addy]

That is great news! I wonder if you could do us a favor though- if you did not receive the actual tests results from your vet could you ask they be sent to you and post them here? It is always a good idea to have a copy of any test results. You may never know when you need them.:)

Also, it is just a way of double checking what the actual cortisol numbers are:):):):):)

Good job!!

[Trixie]

Great news on Kona! :) My 10yr old dog has been on the medication for one year and doing great. Sounds like you're really seeing good improvement with Kona. I can see by her photo that she's a beauty. I hope she continues to do well. Ever since my dog was diagnosed I started to go back to my vet and request from the desk copies of every test..blood work, acth tests..whatever. I just tell them I am keeping a folder so I can be on top of my dog's progress. It has been so helpful to post the numbers here and have everyone help me understand what everything means and how my dog is doing. It's really good to have all the information at your fingertips...you never know when you might need it.
Even though my dog is back to normal I am still constantly watching her for any adverse reactions or a change in her routine. You have to be vigilant with this medication, but it has made all the difference in getting my dog back to her old self.

Barbara