11 year old cocker spaniel just diagnosed with Cushings

[MurphysMommy]

Hello everyone, Am glad I found this site. I sit here literally staring at my 11(ish) year old cocker spaniel as he was just diagnosed this week with Cushings and began his first dose of Trilostane this morning. I read the insert of possible side effects and like many on here, it freaked me out, but I know there has been success with this drug. Like so many dogs, his symptoms were excessive thirst, peeing and panting. Test results came back with the pituitary type of Cushings.

So far, so good, but don't want to jinx anything. I know it's only the first day. Just wanted to say hello and thank you for an informative site.

Best,
Laura (Nashville, TN)

[Spencersmom]

Hi Laura and welcome to the best forum you'll ever join!

You will receive immeasurable advice and information that will not only help guide you along this path, but give you the support needed as you work your way thru symptoms and any changes in your baby's health that may come along!

Be prepared with test results, cause they're gonna ask for them! Lol

Trust in their posts, this is a group of the most wonderful people around!!

[LauraA]

Welcome Laura :)
I found the first two weeks of starting the Vetoryl the most stressful. Poor old girl couldn't even go to the toilet in peace lol. After that first stim test though I was much more relaxed as her numbers while still on the high side had come down. I think they continued to decrease over a period of 6-8 weeks.

Oh and you have such a lovely name :D:D:D
Laura

[molly muffin]

Hi and welcome to the forum.

How much does your cocker weigh and what dose did they give you to start him on?

Next do you have the test results used to diagnose him? ACTH or LDDS or both? If so could you post them for is? Also any blood work and urinalysis. Just the abnormal one with unit of measure like ug or nmol and the range. That will help us to give you better feed back.

We are all nervous when starting on this journey. It does get better once you have been on it a while and know what to look for.
Basically sart low and go slow works best. 1mg/1lb is best starting dosage.
Watch for diarrhea, not eating, vomiting, lethargy, wobbly when standing/ walking. If those happen. Stop meds and go get ACTH checked.

Welcome to the forum

[MurphysMommy]

Thanks all for the welcomes! And yes, Laura, you have a great name!

I have a call into the vet for those test results so that I can share here. Stay tuned for that.

Murphy had an ACTH test and a DST test… It was determined he has the pituitary gland type of Cushings. He's 35 pounds, but they put him on the 60mg. I didn't read the warnings here on this site (about 1lb/1mg) until after I'd given him his first dose, but a friend of mine has had success with her cocker (same size) being on that dose, but I WILL be talking to my vet about it. All that to say, he is doing great, and is not as restless, he's drinking a normal amount of water, and we only had to go out once in the middle of the night last night (usually it was 3-5 times). His personality is the same, but I am keeping a close eye on him. My vet said it might take a week or so to see any improvement, but I've been pleased so far. (and fingers crossed). I'll be taking him back for a re-check in 10-14 days.

My question is - What do y'all think about compounding? As many here have talked about, Trilostane is expensive (but Murphy is my baby so if that's the best route, I'll definitely stick with that…) Sounds like from what I read on this site it's not a good drug to compound?

Thanks, all!!

[molly muffin]

Many use compounded trilostane vs the name brand vetroyl. Most of it depends on making sure you use a good compounding pharmacy.

Yes, just keep a close eye and if you see any of the worry symptoms, stop and do the ACTH test.

Every dog has the ability to react differently to any drug, so you never know and what is good for one, may not be the best option for another. That is why the more conservative dosage is often a good starting point.

Hopfully though it will all be a moot point and you'll be just fine on the 60mg.

[LauraA]

I was using Vetoryl but then changed to the generic form - Trilostane. Being a paranoid Cush parent I was worried about changing in case it wasn't as effective as the Vetoryl and it would upset her progress. Happy to say we have been using it successfully for nearly 6 months. I know I get 100 tablets of Trilostane for the same cost as what 30 Vetoryl tablets were costing me. Hubby is now happy and so is the bank balance ;)

It took about 10 days before we really noticed her symptoms decreasing when we first started. That first night when I slept all night without having to clean her up (she had no bladder control by this stage) or take her outside was pure bliss for us all. Her numbers kept decreasing for about 6 weeks and even though they were still high at the 10-14 day stim test we left her on the same dose as the vet said it would probably keep decreasing and we didn't want to end up with her cortisol going too low. While she still pants occasionally she has done really well for over a year now - with some annoying skin problems that we hopefully have more or less controlled now.

[MurphysMommy]

Evening all, I received the test results from the vet, but there's a lot of info there so I'll post here tomorrow as I've got bleary eyes right now. :-) Murphy is doing good after being on Trilostane since last Saturday. He's a bit restless tonight though so I'm keeping a close eye on him.

But in the meantime, Murphy is constipated… But I don't see that as a side effect for Trilostane so it might just be his system. Anyone have any natural remedies for this? He's a little booger and can sniff out anything he doesn't like or is unfamiliar to him.. He's not a fan of green beans or pumpkin, which I've read is good… I see here someone had success with olive oil so might try that. Or are there any good supplements I can get that might help him?

[molly muffin]

denamarin, liver supplements are always good for dogs with cushings.

Hope you and Murphy are doing good. Wishing you both a merry christmas and safe holiday season.

[MurphysMommy]

Thanks for the liver supplement recommendation, Sharlene! Murphy is doing MUCH better. Water intake and peeing is back to normal. No panting. He does seem lethargic at times, but then he'll be tossing around his toys at other times. Here are his test results below. I'm not real sure what I'm looking at, but he goes back for his 10-14 day follow up next week….

I THINK I'm posting the correct info that you guys want to see:
Cortisol - Pre-Dex - 3.0 / 4 hr Post Dex - 1.4/ 8 hr Post Dex - 2.8

There's a bunch of other info on the report, but let me know if you need more…
Thanks, and I hope you all are having a good holiday season!
Laura and Murphy

[MurphysMommy]

Hi all,

Looking for tips on how to get your dog to take Trilostane. My 11-year old cocker, Murphy, can sniff out medicine out of any treat I try to use… Pill pockets, cheese, peanut butter, etc… I end up having to just pop the capsule down his throat, which I hate to do - and he doesn't like it. (Sometimes I'll find it in his gums, so I have to try again…) Any tips?

Thanks!
Laura

[Squirt's Mom]

MODERATOR NOTE: I have merged your post about giving pill into Murphy’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!

[Renee]

My pugs eat food so fast they don't even notice the pills.

But I have had fosters that could sniff out anything. The best I've done is to get something like lunch meat and tear it into about 4-5 pieces. Give one or two pieces without the pill, then wrap the pill in the third piece and immediately follow that third piece with two more pieces of lunch meat. Usually the dog is focusing on getting the next few treats as quickly as possible that they swallow the pill piece right away. This doesn't work with sticky treats, like peanut butter, but more with something your dog can swallow very fast. Maybe pieces of hotdog, turkey, etc. Make sure your dog can't choke on it, because you'll be trying to get them to eat in quick succession.

[Squirt's Mom]

My Squirt because IMPOSSIBLE to give any meds to that I couldn't get into her feed so I can empathize! Try putting the pill in something he really really likes. Have 3 pieces of that goodie ready. Give the first piece without the med holding the rest so Murphy can see there are more treats to come. Give the second after the first is gone and follow immediately with the third piece. You want to fool him into thinking he has 3 goodies with no meds. ;) Only you (and we :D) know the pill is in the second bite! This worked with Squirt for a while. ;)

[Dixie'sMom]

I hide Dixie's in food. Its pretty easy to poke the capsule into a small piece of hotdog and she usually swallows it whole. I've also wrapped it in a small piece of light bread. Its pretty easy to mold the bread around the pill, and like Squirt's mom, I start with a small bite without the medicine and follow it with the pilled bite, and then another without the pill. Dixie always thinks its treat time. :)

[MurphysMommy]

Thanks, ya'll! I just bought some hot dogs… Murphy loves them so am hoping those will do the trick. Wish me luck! :-)

Btw, 10-14 day ACTH follow-up came back on Monday with good ranges. He goes back in 30 days for another follow up… He still wants to get up and pee several times in the middle of the night, but his panting has gone away. He's still drinking a lot of water, but not as much. Not peeing in the house anymore (knock on wood), but I do hope the middle-of-the-night bathroom visits subside… I've read on here that Trilostane can take some time, so I'm trying to be patient… :-)

[Renee]

Hi there,

So glad to hear things are in range. Can you please post the actual lab results for the ACTH?

[steiny]

Hi Laura,
Just wanted to wish you continued good luck with treating Murphy's Cushings disease! There are many success stories and I hope you and Murphy are included. And...as a owner of a dog that fishes out any and all medications we try to sneak in...I thought all the advice you got from other members was spot on. We wrap his meds in small strips canned chicken dog food (he loves Weruva Chicken & Gravy..only ingredients are chicken and potato starch)...he has allergies to beef and wheat so he has never had the experience of having a delicious hot dog or lunch meat!
Kelly

[molly muffin]

I use wet dog food and shape it around the pill with my fingers, then I shape another one (maybe around a smaller pill or just a ball of food) As I give her the first one (with the pill) I make sure she sees the second one. Normally she'll take the first one very fast in order to get the second. I always give things like there omega 3 or eye supplement in the first one as it is bigger, then the trilostane in the second along with her kidney meds that is very small.

Good luck!!! They can be real tricky to get pills into.

[MurphysMommy]

Hi all, I have a concern about Murphy. He has been on Trilostane for almost 1.5 months and done fine on it. His 10 day test came back that it's working and the range is good. However, last night he had diarrhea and again today. He vomited this morning and wouldn't eat breakfast so I held off on giving him his dosage since nothing was in his tummy. He finally ate some bland chicken and rice for dinner, but he has just vomited about 6 times in a row. Mostly water… He has settled down now and I will take him to the vet first thing in the morning if it keeps occurring… My question is could this be Trilostane-related or just an upset tummy/bug? I'm visiting my parents this weekend and will have to take him to their vet. He goes back to his vet on Monday for his 30-day test. I understand I shouldn't give him his dosage if it's not taken in the morning, so I skipped it today. Will re-evaluate in the am…. Thank you!

[LauraA]

He could have pancreatitis, it is common in Cush pups. If he continues vomiting I would go to the vet. Boil him up some chicken and/or some mushy bland rice if he wants to eat and feed him a spoonful every few hours if he is keen. Keep him off the trilostane while he is unwell.

[My sweet Ginger]

Hi,
Please don't give him any more trilostane until he gets ACTH test done to be safe as I'm concerned his cortisol might be going too low as all those symptoms are usually the results of low cortisol. In the meantime watch him very closely and if he gets worse he needs to be seen by a vet and perform an ACTH test.
My understanding has been that you run ACTH tests at 10-14 day mark and then another one at 30day mark, two weeks after the first ACTH and not 30days. :rolleyes:
Please, someone correct me if I'm wrong on this as my pup was on Lysodren.

I hope skipping trilostane will make him feel better.

Would you please post the results of his 10day ACTH test?

[Squirt's Mom]

I would certainly get him to the vet asap and no more Trilo for now at all. If he is not markedly better this morning, I would give him some pred and be on my way to have an ACTH done asap as well as the pancreas checked out closely. Let us know how he's doing when you can!

[Harley PoMMom]

We would really like to see those ACTH stim results if you could post them here for us that would great.

I saw in an earlier post that Murphy weighs 35 lbs and his starting dose of Trilostane was 60 mg, is this right? If this correct, with those symptoms Murphy is displaying it does sound like his cortisol may have dropped too low.

During the first 1-2 months of treatment a dog's cortisol can continue to drift downward so if Murphy is still not feeling/doing better than an ACTH stim test should be done.

Please do keep us updated. ;)

Hugs, Lori

[labblab]

Just wanted to add that if you are going to be taking him in to the vet shortly, I would hold off on giving any prednisone beforehand. If you do give it, they will have to hold off on any cortisol testing because the results will not be accurate. If they think he needs the pred, they can give it to him there after they've drawn blood.

Marianne

[Dixie'sMom]

How is Murphy feeling this morning? Please let us know what the vet had to say about him. I'm praying its nothing too serious.

[MurphysMommy]

Hi everyone,

Thank you for your concerns and prayers for my fur baby…. Murphy was diagnosed with gastroenteritis.. They did a fecal, ultrasound to check his pancreas, bloodwork, anti-nausea meds (and anti-diarrhea meds) and gave him fluids. He is feeling much better - I can tell in his eyes and spunkiness. Bloodwork came back normal. Pancreas looked good, but when they did the fecal, that's why they diagnosed the gastroenteritis. The vet said it was textbook.

A cortisol test was done but results won't be back until Monday. I will let y'all know what it says. In the meantime, he's been given a prescription for Metronidazole (says give until gone) and Diawin (give until stools look better). She also prescribed a few cans of EN Gastroenteric food (Purina). I'm not normally a fan of Purina, but the reviews I read are really good. She said no Trilostane until further notice. I asked about doing an ACTH test today, but she said that shouldn't be done while he is feeling bad. (Reminder - this is not my regular vet, but my parents' vet in Atlanta because I'm visiting). I really liked her and she said the Cortisol test results would give valuable info of what's going on. Again, he was due for his follow up ACTH test on Monday anyway, so I'll call my vet first thing Monday morning.

I will post the previous results of the ACTH tests… But to answer the above question about previous ones, I had the original one that diagnosed him with pituitary gland Cushings (or heck, was that the Dex test? -I get so confused…) Then after he started Trilostane, we went back for the ACTH stim test at 14 days. That came back good, so my vet said another one should be done in 30 days. She didn't say anything about doing one before than… :-/ Perhaps we should have?

Well, he's sleeping peacefully now, and so I wait until Monday to see what the cortisol test results are and what my vet says about the ACTH stim test…. If he's feeling back to normal, I'm sure they'll go ahead and go forth with it….

Btw, what is the Prednisone for? I see several of you talking about having some on-hand, but that subject has not come up in any of my conversations, but I am going to ask about it…

Thanks again for your support and prayers!!
Laura

[MurphysMommy]

An additional note - I just read about reasons for Prednisone… Not sure why my vet did not bring this up, but they also do their own emergencies 24/7, so perhaps they figure their clients will call if something comes up and they can immediately do what they need to do. But still, I'm going to mention it...

[Harley PoMMom]

Hi everyone,

A cortisol test was done but results won't be back until Monday. I will let y'all know what it says. In the meantime, he's been given a prescription for Metronidazole (says give until gone) and Diawin (give until stools look better). She also prescribed a few cans of EN Gastroenteric food (Purina). I'm not normally a fan of Purina, but the reviews I read are really good. She said no Trilostane until further notice. I asked about doing an ACTH test today, but she said that shouldn't be done while he is feeling bad. (Reminder - this is not my regular vet, but my parents' vet in Atlanta because I'm visiting). I really liked her and she said the Cortisol test results would give valuable info of what's going on. Again, he was due for his follow up ACTH test on Monday anyway, so I'll call my vet first thing Monday morning.

I'm a bit confused here, has a full ACTH stimulation test been performed on Murphy while he was at the vets?




Btw, what is the Prednisone for? I see several of you talking about having some on-hand, but that subject has not come up in any of my conversations, but I am going to ask about it…

Thanks again for your support and prayers!!
Laura

Prednisone mimics cortisol in a dog's system. When a dog's cortisol drops too low, which means their adrenal glands are not producing enough cortisol on their own, prednisone is given to supplement for that lack of cortisol.

Cortisol is vital for the body to work correctly and when not enough is being produced this can be life threatening. Trilostane has a short half-life and leaves a dog's system rather quickly, so usually just stopping the Trilostane is enough when a dog is displaying symptoms of cortisol dropping too low, but not always.

Hugs, Lori

[MurphysMommy]

Lori, no full ACTH stim test was done today. That's the part when I asked if we should do that, she said not while he's feeling bad. She took blood for a Cortisol test.

And thanks for the Pred info. Yeah, am def going to ask my own vet about that on Monday!

[labblab]

My guess is that the vet drew blood for a resting cortisol level, the rationale probably being that if Murphy's resting cortisol level is higher than 2.0, it is pretty unlikely that his issues today were caused by an Addisonian drop. If the resting cortisol is lower than 2.0, then you probaby do need to proceed with an ACTH sooner rather than later in order to make sure that his cortisol production is indeed adequate right now. However, if the resting cortisol is 2.0 or higher, you may want to hold off on the ACTH until Murphy has stabilized and has been returned to his regular trilostane dosing. Otherwise, after several days without the medication, the ACTH will not be able to give you accurate information about the efficacy of this dose for him.

It's true that illness or severe stress can artificially elevate the results of an ACTH. So in conjunction with the other blood panel results, if the vet's overall assessment is that the diarrhea most likely is not being caused by low cortisol, then I understand delaying the ACTH. But that can be a hard call to make -- whether the GI distress is due to low cortisol or not. In this case, perhaps the baseline cortisol was a reasonable compromise to tide you over until Monday.

I can't remember whether Murphy is taking many other medications, but regarding the diawin -- you need to wait an hour before or after the diawin to give other meds because it can affect the absorption of other drugs. My dogs have been given both metronidazole and diawin, also, during episodes of diarrhea.

As far as the exact timing of monitoring ACTH tests, different clinicians do tweak the scheduling a bit. I believe Dechra does recommend that the second monitoring test be performed 30 days after commencing treatment. But we have seen vets here who do extend that time to 30 days after the first monitoring test. I think it partly just depends on how the patient is doing, in terms of either moving the testing up or pushing it back a bit.

Marianne

[MurphysMommy]

Thank you, Marianne! And good to know about Diawin. He does not take other meds, but per your instructions, will keep an hour between… Thank you!

[MurphysMommy]

Hi everyone - Here's an update:

Murphy's cortisol test came back this morning as normal. Vet says it should be in range from 1-5 and it was 3.8. So, it appears his gastroenteritis over the weekend was not related to Cushings. Murphy will start back on Trilostane tomorrow and then she said in 30 days we should come back for an ACTH stim test. (He has not been on Trilostane since Friday because it was thought it could be Cushings related. She said if we did an ACTH test now, his levels would be all wonky.)

And I know some of you have asked for his ACTH test results. This is after being on Trilostane for 14 days. The test was done on Jan. 9th:
Pre-ACTH - 0.9
Post ACTH - 1.9

And just so you have this handy, his PRE-Dex test done in December was 3.0.
Post Dex 4 hr - 1.4
Post Dex 8 hr - 2.8

Murphy is back to his spunky, flirty self. His stool is still kind of loose, but definitely better than it was. And his appetite is back.

[Harley PoMMom]

And I know some of you have asked for his ACTH test results. This is after being on Trilostane for 14 days. The test was done on Jan. 9th:
Pre-ACTH - 0.9
Post ACTH - 1.9


Those numbers are a bit on the low side, is Murphy still on the 60mg of Trilostane?

A renown canine Cushing's expert, Dr Peterson states that a post lower than 2 ug/dl is too low, here is an excerpt from his blog:
I recommend stopping the drug in all dogs that develop a ACTH-stimulated cortisol values less than 2.0 μg/dl, and repeating the ACTH stimulation test in 1- to 2-weeks in those dogs. Some of these dogs will require that the drug be restarted at a lower dosage, but others will maintain low to normal serum cortisol concentrations for prolonged periods of time. And a subset of these dogs, presumably because of mild adrenal necrosis, will never need any further trilostane treatment to control the signs of Cushing's syndrome.

http://endocrinevet.blogspot.com/2012/12/low-dose-twice-daily-trilostane.html

Dr Peterson is also a contributor to Dechra's continuing education site.

And if this were me, I would not wait 30 days to have another ACTH stim test done, I would follow Dr Peterson's advice in having one done in 2 weeks along with lowering Murphy's Trilostane dose.

[molly muffin]

hmm, yes those numbers cannot drop any further that's for sure. So keep an eye on him.

Glad he is feeling perky now though.

[MurphysMommy]

Thanks for the feedback, everyone. I went to the Dechra site and looked at their charts. Murphy's weight is 35 pounds, and it recommends 60 mg. dosage. Then on the post-ACTH chart (on the site) after 10-14 days it says that if the results are in the 1.45-5.4, keep on same dosage. Murphy's was a 1.9, so I'm guessing that's why the vet is keeping him on the same dosage. Considering he's done really well with it, I'm going to keep him on it, but will certainly keep a close eye on him. And to your point, HarleyPoMMom, I will schedule him sooner than 30 days for his follow up.

However, since Dr. Peterson says otherwise, is the chart on the Dechra site out of date?

[labblab]

However, since Dr. Peterson says otherwise, is the chart on the Dechra site out of date?

Yes and no, as far as the chart being out of date. It is definitely out of date in terms of the initial dosing recommendations. Per this notification released last summer, Dechra has revised their initial dosing recommendations to a formula that does not exceed 1 mg. per pound. They are in the process of rapidly revising the printed info that accompanies Vetoryl in Europe, and are trying to jump through the FDA hoops to accomplish the same task here in the U.S. In the meantime, here is the associated press release from last year. Of course, this formula relates to initial dosing recommendations. Subsequent dosing changes remain guided by monitoring ACTH results and symptom resolution.

http://www.vetsonline.com/news/product-news/140722-new-lower-starting-dose-for-vetoryl.html

As for the desired therapeutic range, I am not aware of any other clinician who has expressed the same concern as Dr. Peterson re: a drop below 2.0, and I believe Dechra still lists 1.45 as their "basement." This doesn't mean he is wrong, but just that apparently his personal experiences with his patients apparently differs somewhat from the research studies upon which Dechra has based its recommendations.

Marianne

[addy]

Could we clarify that those test results were after the initial fourteen days of starting treatment or am I mixed up?:o


Because if that is the case, that is pretty darn low for only 14 days when we know they could drop further during the next two weeks as we approach the 30 day mark.

Would that not be the bigger picture?

Just wondering :)

[labblab]

If I am understanding things correctly, Murphy started on the trilo in mid-December and those ACTH results date from early in January. He continued on the same dose, was outwardly doing well, and was due for his subsequent 30-day test when the GI issues appeared. The full ACTH was deferred last week, but his resting cortisol came back at 3.8. So under the assumption that his cortisol is not currently too low, the decision has been made to continue at the same trilo dose for the time being. I agree with the others, however, in that I would proceed with another ACTH earlier than 30 days from now. That seems to me like too long a time to wait after that sole first monitoring test in early January, especially given these intervening GI problems.

Marianne

[addy]

Ok, thanks Marianne, for explaining about the resting cortisol between then and now but, wow, I'm still shaking my head at those numbers after only 14 days.

I don't mean to worry Murphy's mom:o:o It just grabbed my attention.

[labblab]

Yup, I agree with you Addy -- at that first 14-day mark, I would have wanted to be backing off a bit, too. But now, I really don't know what to make of that 3.8 baseline. I'll really be interested to see what this next full ACTH shows!

Marianne

[MurphysMommy]

I know, it is very worrisome, but am grateful to have found this group. So, an update… I started Murphy back on Trilostane yesterday, and he vomited about 3 times throughout the day (yesterday). He doesn't retch - It's more of a projectile vomit - mostly watery. So, I don't know if his tummy needs a little bit more time to recover from his gastroenteritis, but I am waiting on a call back from the vet. And I am going to INSIST that they decrease his dosage to 30mg. Could the higher dosage of 60mg be causing him the upset tummy? He's been doing so well, but it seems with Cushings, there can be all kinds of surprises…. :-(

[addy]

I'm sorry to hear that. It could be the dose is bothering him, the drug is just bothering him or something else is going on.
My own dog had inflammatory bowel disease. I got that under control before treating her Cushings. Even with starting at a very low dose, her IBD flared and continued to act up every time we raised her dose. She eventually got used to the drug and tolerated it.

Has anyone suggested giving Pepcid 30 -60 minutes prior to the dose of Vetoryl? I have been back through your thread but will check the history again.

Honestly, that first ACTH test is a worry, that the numbers would be that low after only 14 days. It is not the results are under two or which specialist says what range is acceptable. It is the fact the numbers were that low after only 14 days that is concerning as you know.
Forgot to ask if Murphy has any history of gastro problems? I don't think I saw it mentioned in your thread.


If it were me, I would start over at a lower dose. The question remains, we know the resting cortisol from the last test but we don't know where the cortisol is now, especially after being off the drug for a short period of time and the on and off again dosing due to the gastro problems. One of the benefits of Vetoryl is that you can start and stop it, but that also means more money for testing.

[Harley PoMMom]

If this were me, since Murphy is vomiting on the Trilostane I would stop it and either wait until his Cushing's symptoms rebound again or have an full ACTH stimulation test done, or even do both, before starting the Trilostane back up.

[addy]

I agree Lori, you said exactly what I meant by starting over. Stop the drug, let symptoms rebound, retest and start at a lower dosei when warranted.

[MurphysMommy]

In y'alls' experience, how long before symptoms normally rebound?

[addy]

Depends on the dog, could be a few days, a few weeks or a few months.

[MurphysMommy]

So here's the latest - Just talked to my vet and she's open to putting him on the 30mg. to see how he does on that dosage. So, my plan is to watch him to see when he rebounds, then start him on the 30mg. then re-test after 10-14 days. So basically, starting over. But I will feel better and my vet was good with that.

Btw, I don't know if I made it clear in my previous posts, but I do give Trilostane with food, so his vomiting is not from an empty stomach. (My vet wanted to make sure of that and I wanted to make sure I was clear here on this forum too.) :-) I read that some folks give Pepcid about 30 min. before Trilostane… If he ends up with GI issues even on the lower dose, perhaps I can investigate Pepcid or some other anti-nausea meds… (?)

Thanks all - and Murphy thanks you too! To be continued….

[MurphysMommy]

UPDATE! Murphy just had his 14 day ACTH test after re-starting him on 30mg. Trilostane (after a break from the 60 mg. when he got gastroenteritis) and POST results were 3.6. (as a reminder, he's 30 pounds)… That's good results, right? The vet was happy and he will go back in 30 days.

[ShibaMom]

Yay!! 3.6 is beautiful!! So happy to hear that, go Murphy!!

Do you also have the pre-results? It's important to also be sure that number isn't going to low.

Thrilled at the positive news.

Regards,
Samantha

[molly muffin]

3.6 is excellent. Expect it to drop even more though. The number at 30 days on the same dose is usually lower than the 14 day one, so keep an eye on him still. And as Samantha said you don't want that pre number to go too low either. This might be a good dose for him though. The 60mg would have been way too much. You're right where you want him to stay in that range. 2 - 5

Congratulations!

[MurphysMommy]

Ahh, thank you! He still gets up to pee once or twice in the middle of the night (sometimes I get lucky and he sleeps through the night), but certainly not as much as before. I wonder if that's just something I might have to live with for the rest of his life? I am wondering if, since he's an older dog, it's just a natural thing that is happening as he ages. Or if it's a Cushings symptom that will never completely go away… I'll def keep an eye on him. Thank you for the feedback!!

[MurphysMommy]

Also, I have asked the vet to email the results so as soon as I do, I'll report back on the pre-results… Thanks so much to this group for the encouragement and for being there!

[molly muffin]

Give the peeing a bit more time. It can take a bit for it to totally go away. For some it doesn't clear up but since he is going out less often at night now, there is a good chance that once he is controlled for awhile, then he might get through the night.

:)