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Baileys Butler
10-21-2015, 06:31 PM
Hey everybody. I have been lurking here since our dog Bailey was suspected of having Cushings. Thank you everyone here who contributes and answers questions. It's a big help and was a big comfort to our family that our Cushings dog could live her normal life and it's not a death wish.
Anyway, about Bailey. She is a 10-ish year old Dachshund mix that we rescued 4 years ago. She is 18 lbs. About 2-3 months ago we noticed she was having more accidents in the house. Then noticed a MAJOR increase in her water intake. Took her to the vet who looked at her, heard the symptoms and immediately said "I believe this is Cushings". Of course we had no clue what that meant but between him and this site we got a quick course! He took blood and urine samples that day, which still maintained his Cushings diagnosis. We brought her in for her ACTH test which confirmed it (can't remember exact numbers but I believe after 2hr # was 55(?)). Anyway, he started her on 9mg 1xdaily. We gave it to her in the morning with meals. She seemed to be ok with it other than sleeping more an hour or so after dose. On the fifth day of initial dosing she vomited twice at night (of course). Called the vet and he said stop for 2 days, if she's fine after that give her small dose Prilosec to help nausea and try again. So we did that and all seemed fine. We took her for her 2 week ACTH and #s were great! (6.3 first draw/ 8.1 2hr)Symptoms still remained however. After reading through here and discussing with the vet it seems that is not abnormal and can take a month or more for symptoms to subside.
So now our current problem, he wrote us another 10 day prescription so she could take that while we ordered her month supply online. I gave her her first pill in the morning yesterday and woke up this morning to find she had pooped in the house 4x. Sorry for grossing anyone out here...It was not runny but loose, mucousy, and obviously frequent. Called vet again and he said stop 2 days and try again. He also said he would like to lower dose to 7mg.
Anyone have any advice? Do gastrointestinal issues subside? Should we lower dose? 9mg is low and #s are good, but she still has symptoms. Any help, advice is appreciated. Thank you.

Harley PoMMom
10-22-2015, 05:33 PM
Hi and welcome to you and Bailey!

So glad you have come out of the shadows and created a thread for Bailey! Increased drinking/urinating are symptoms of diabetes, has this been ruled out? An UTI can also cause a dog to drink/urinate more, has Bailey been checked for an UTI with an urine culture and sensitivity test?

Getting copies of all tests that were done on Bailey and posting those results here would be a great help to us. With respect to the blood chemistry and cbc, you need only post the highs and lows and please include the normal reference ranges. Is he taking any other herbs/supplements/medications? I take it that Bailey's Trilostane is compounded. What pharmacy is doing the compounding?

Bailey is getting the Trilostane with food, right? Trilostane can cause gastric upset so giving the Prilosec should of helped. Also it may be that the Prilosec does not work for him and switching to another anti-acid medication is needed, such as Pepcid AC. However, if his post was 55 ug/dl before treatment and decreased to 8.1 ug/dl only after 2 weeks it could be possible that Bailey is going through cortisol withdrawal syndrome. Stopping the Trilostane and restarting at a lower dose is recommended by Dechra, the makers of Vetoryl:
Corticosteroid withdrawal syndrome should respond to cessation of VETORYL Capsules (duration of discontinuation based on the severity of the clinical signs) and restarting at a lower dose. Here's where that excerpt can be found: http://www.dechra-us.com/files//dechraUSA/downloads/Client%20Literature/38965_Technical_Brochure.pdf

Regarding the pu/pd, some dogs have what is known as renal medullary washout. This means that all the stuff (solute) the kidneys need to concentrate their urine has been washed out for a very long time so the kidneys will take a while to recover. And a small number of dogs being treated for Cushing's may never have a resolution of pu/pd.

If you have any questions please do ask them and know we will help in any way we can.

Hugs, Lori

Baileys Butler
10-22-2015, 10:34 PM
Hello, and thank you for the response. Yes diabetes and UTI were ruled out. I will post test numbers next time I go to the vet. I'm always in a hurry to just pay and leave before Bailey pees on the floor:)

Yes she has her Trilostane with food in the morning. Interesting to hear of the cortisone withdrawal syndrome, one reason I love this site. I stopped giving her the 9 mg and will try again with the 7mg when it arrives. The 9mg was compounded at a local pharmacy the vet recommended. I am ordering the 7 mg from online (ThepetPharmacy.com).

Thanks again Lori.

Harley PoMMom
10-24-2015, 04:00 PM
Keeping fingers crossed that Bailey will have a better reaction to the lower dose, let us know how it goes. Another question I have :eek::D Was Bailey's monitoring ACTH stimulation test performed 4-6 hours after his dose of Trilostane was given?

Hugs, Lori

molly muffin
10-26-2015, 09:05 PM
I use ThePetPharmacy also.

That is a big drop so can definitely make him feel crappy. Hopefully the lower dose will do better and then you can gradually increase it if needed.

I find that on the same dose they will usually go lower for at least 30 days.
Pepcid AC is a good option, you'd want to give it I think about an hour prior to the trilostane if I remember correctly.

Baileys Butler
10-29-2015, 03:44 AM
Just wanted to give a quick update. Bailey was given Flagyl for digestive problems which helped quickly. She is now on day 2 of 7mg Trilostane and so far, so good. Finger crossed.

Yes ACTH was done 4 hours after dose.

Yes you are correct on Pepcid AC vet said one hour before dose of Trilostane/food.

Just wanted to thank you all again. This forum is a great support/educational forum. Great job everyone.

Harley PoMMom
10-29-2015, 04:34 PM
Glad to hear that Bailey is tolerating the lower dose!! Please do keep us updated!

Hugs, Lori

molly muffin
11-02-2015, 10:06 PM
yay, good news about Bailey!