Beagle not responding to Trilostane

[tammyl]

Hi! I have not posted before and don't have a lot of information in numbers for my dogs testing; just symptoms she has experienced. Sadie is a 7-1/2 year old female Beagle. We rescued her years ago when she was approx 10 weeks old after a lady tossed her and some others into a dumpster at PepBoys in PA. She may or may not be full bred but is definitely dominate Beagle. About a year ago at one of Sadie's vet appointments; she was diagnosed as having borderline hypothyroidism. At that time she was noticeably overweight at 58lbs. The vet thought it would be a good idea to start her on Standard Process Thyroid Support powder. A short time after we began this, we noticed Sadie was more thirsty than usual and began drinking more. At that time, I called Standard Process and asked if there might be something in the powder that might make her thirsty. They told me there was not. Not too long after this; in early April the vet decided her tests warranted her being on Thyrovet; as well. The thirst became more noticeable throughout the summer and she was tested for diabetes; which was negative. During the summer; Sadie stumbled and hurt her leg. It was not xrayed at that time; she was gived an anti-inflammatory and pain medicine but about two weeks later she hurt it again and began to look like she was walking bow-legged. This time it was xrayed and the vet discovered she had arthritis in he knees. They began giving Sadie a series of Arthritis shots once a week for ten weeks. During this time the drinking and at this point peeing was noticeably increased but the shots worked very well in clearing up the arthritic condition. I continually mentioned to the vet that this all began when we started the Thyroid powder. A few months ago; Sadie began losing weight. She had a full panel done which came back good and she was ok'd to have a tooth removed. This all went well but the drinking and peeing continued. Sadie loves to eat and through all of this never lost her appetite but a few months ago, she began losing weight. She was getting one cup of dry food twice a day. At first, we thought it was the result of getting her thyroid under control; however, she began to lose more and more. The vet said she had all of the symptoms of Cushings except she did not have the pot belly, did not gain the weight but instead had lost weight. At this point she was at 36 lbs. An ultrasound was ordered and for some reason though her kidney function was good; the attending vet said her kidneys appeared to be from a 10 year old dog; instead of a 7 year old. He agreed that she had symptoms of pituitary Cushings and they began her on 30 mg of Trilostane. After two weeks of no change; the vet increased this to 60 mg. We gave her 60 mg for three days and had to go back to 30 mg when the supplier lagged in getting the medicine sent out and I knew I would run out before I received the next box. Currently she has taken 60 mg constant for 12 days with very little change in the drinking and peeing. She wakes several times at night to go out; approx every 2 to 2-1/2 hours. The vet has had me make a 'stew' for her containing beef, oatmeal & a dash of cinnamon and applesauce to help boost her weight. She had been eating 1 cup of dry food and 1/2 cup of the stew for about a month and her weight increased to 38.6. The vet said her target weigh is 40lbs. Last week she got a spot on her belly which the vet said is sometimes attributed to clotting. Thankfully, the spot went away quickly and a clotting test showed she has very fast clotting. She weighed 38.2 at this appt. Her tummy is still hairless from the ultrasound and so at the appointment for this spot last week; the vet had me add a fish oil capsule for her skin/hair and also increase her 'stew to 1 cup along with her 1 cup of dry food twice a day and in addition mix in 1 tsp of coconut oil for an added weigh boost. After a week; her weight was stabilized and she did not gain or lose but remained at 38.2. The vet also gave her the rabies and distemper vaccine today which I was a little concerned about her receiving until the meds are stabilized or til we know what exactly is going on with her. We are concerned that even though the tests are pointing to Cushings; maybe it is something different and we are giving her medicine for this. I mentioned this to the vet who feels it is definitely Cushings but that we do not have 'all of the pieces to the puzzle'. I know it will be difficult to determine without her numbers; but do these symptoms sound like we are on the right track. I will mention also; Sadie runs and plays and seems to feel better than she did when she weighed more and eats very well. I had a lady at the vets office today (another patient) who has a Pug Rescue suggest tome that 7 is really young for Cushings. Any help is appreciated!!

[labblab]

Hello and welcome to you and Sadie! What a blessing to this little girl that you rescued her from that dumpster and that you care so much about trying to give her the best and healthiest life possible.

You have given us a lot of information in your introductory post, which is a very good thing! But it also means that we will probably be addressing bits and pieces over these first few days. One of the things that strikes me as being the most important to talk over is the fact that your vet has started Sadie on trilostane treatment, but it is not clear whether or not either of the two diagnostic blood tests were performed which would give us all greater confidence that Cushing's is truly the source of Sadie's problems. It is true that many aspects of her symptom profile correspond with Cushing's, but as your vet has already noted, a few puzzle pieces do not. For a dog with lots of symptoms typical of Cushing's, it may be tempting to go ahead and start the treatment even in the absence of the testing, especially since the tests can be relatively expensive. But it is not safe to give these drugs to dogs who do not have the disease, and that's why I am hoping we can find out more about the decision to begin the trilostane with Sadie. It may be the case that the blood testing was done, but that will be important for you to find out.

You mention that she has had an ultrasound performed with mention of the appearance of her kidneys. But in terms of a Cushing's diagnosis, we're also very interested to learn whether there were any abnormalities with her adrenal glands. Do you have the ultrasound report with you? If so, can you check and see whether the adrenals are mentioned?


He agreed that she had symptoms of pituitary Cushings and they began her on 30 mg of Trilostane. After two weeks of no change; the vet increased this to 60 mg. We gave her 60 mg for three days and had to go back to 30 mg when the supplier lagged in getting the medicine sent out and I knew I would run out before I received the next box. Currently she has taken 60 mg constant for 12 days with very little change in the drinking and peeing.

Another worry is the decision to increase Sadie's trilostane dose from 30 mg. to 60 mg. after only two weeks on the drug. Assuming she truly has Cushing's, a starting dose of 30 mg. would be appropriate for a 37-pound dog. But the current recommended safe protocol is not to increase that dose for the first month of treatment since cortisol levels can continue to drop even when the dose remains unchanged. Plus, here is another testing issue. One of the same blood tests that is used to diagnose Cushing's is also used to monitor trilostane treatment. It is called the ACTH stimulation test, and it is definitely not safe to double Sadie's initial trilostane dose without performing this blood test in order to determine the effect the drug is having on her cortiol level. Has your vet discussed this monitoring testing with you at all; has one of these tests been scheduled?

I'm sorry to start off with so many questions, but I do worry about your vet's approach to treatment given some of the things you have told us so far. Probably the most helpful thing you can do for us is to request copies of all of Sadie's recent tests from your vet. That way, we can find out exactly what has been done in order to rule in or rule out different diseases that might produce these same symptoms. Mind you, I am not telling you that Sadie does not have Cushing's -- she very well, even perhaps very likely, may have it. But the test results will help us re: suggestions for the best path forward.

Thanks so much in advance, and once again, welcome to you and to Sadie!
Marianne

[molly muffin]

Hello and welcome from me too.

In addition to what Marianne has written, and she hit my concerns too about doubling the dosage without testing, and what the diagnostic tests show, I want to throw in another issue and that is has her BP been checked and is she showing any protein loss in her urine as that can also cause weight loss.

What a horrid thing to do, throw a puppy in a dumpster. So glad you found her.

[tammyl]

Thanks so much for your response. The ACTH test was done; I will have to get the numbers. I am concerned as well about the increase in dosage. Sadie has an appt on Feb 11 to have this re checked if this is the test that requires an hour in between each of two blood tests. The vet wanted me to keep her on this dosage until this test. Another symptom we have noticed that Sadie usually pants a lot mainly in the evening. If I am able to get some numbers sooner; I will post them. Thank you again

[tank&kat]

Thank you for rescuing that precious girl!

I am of course concerned about the dosage being doubled after only two weeks. Trilostane can lower cortisol for up to 30 days. She has been on the 60 mg for 3 days, correct?

Katherine

[tammyl]

Currently Sadie has been taking 60 mg of Trilostane since Jan 15. I did get her last ACTH result from the vet. This was in mid December. Her Cortisol Pre was 5.3 and post was 39.1. She is due to have this repeated on Feb 11. I do have a copy of the radiologist report from her ultrasound. I will post it shortly. Also, we have been noticing that she begins to pant a lot at certain times; usually in the evening; but today she has been doing it off and on all day. Another thing I noticed after seeing a picture of her laying on her side last year; being multi-colored, her tummy skin on this picture last year is multi-colored. Now, as she still has no hair from the ultrasound, the multi-colored skin is mainly pink. Not sure if this is any clues but thought I would mention it. Thank you all for your help. It's nice to have some people who have experienced this to talk to. Though I have confidence in my vet, something tells me that we are on the wrong track and it scares me. I think the mystery lies somewhere in the thyroid medicine because although we do not give her the thyroid support powder now (only Thyrovet); my whole family agrees that her thirst and peeing began when that powder was started. I will post the radiologist report shortly. Thanks again!!

[molly muffin]

I've noticed that my dogs tummy is pretty pink these days too, where as before it was a it more tan and pink. I personally think this has more today with the high cortisol and the changes that come about to hair and skin due to that higher cortisol.

That is strange about the thyroid powder.

[tammyl]

I am new and have only been on a few times. My dog is Sadie and my thread title is Beagle Not Responding to Trilostane. I cannot find my thread!!!

[labblab]

Hi Tammy! Here is your original thread about Sadie. :)

It is located here on our main "Questions and Discussions" forum. I am going to post a "Visitor Message" on your profile page right now with a link to this thread. That way, if you ever have find trouble finding it again, you can just go to your profile page and click on the link.

Marianne

[tammyl]

Thanks Marianne!
Molly; the vet did not mention a problem with her BP. When she had a urinalysis done about 2 weeks ago they said it was not as diluted and that the protein was good.

I noticed she seems to be having more bm's which are occasionally slightly loose. Not so much that she makes additional trips outside, but I did notice her going more than once when she was in the yard with me earlier.

She also had tapeworms which they treated her for about two weeks ago as well.

[molly muffin]

Well this Friday would be 3 weeks, so you could have the test at any time, but remember cortisol drops for 30 days on the same dose. So that is maybe why your vet wanted to wait, but if you see any diarrhea, lethargy, wobbly, not eating, throwing up, get her in sooner and get it checked.

You can try a tad bit of pure pumpkin puree (not pie filling) and not much for loose stools too, also introduce a probilotic when it gets lose . My dog gets gastro upsets and that is what I do for her.

[tammyl]

I have also noticed the last two days that Sadie is having a lot of reverse sneezing spells. She licks the kitchen constantly and has done this for a long time as well as certain spots on the carpet. It seems like when she licks these areas; she gets a reverse sneezing spell. This might not be connected but wanted to share; just in case!

[molly muffin]

Maybe the very act of licking downwards is a trigger for a reverse sneeze. Just guessing, but it could be possible.

[tammyl]

Sharlene;
Sorry it took a while to respond back. After and during the reverse sneezing episode; Sadie also sounded like she was snoring when she was just laying there, not sleeping. I thought she sounded like a person with a sinus infection so I called the vet to see if any of this was coming from the Cushings or the meds. They had me bring her in and sure enough; she had a sinus infection. The vet did not want to rush into an antibiotic so she had me give Sadie 4oz of Sage tea a day until this subsided and run a vaporizer at night. Within a few days; her symptoms were gone. It is difficult to get them to drink the Sage because it is very bitter. However, Sadie is a beagle so food is #1 to her. I dropped a few kibbles of her food into the tea and she managed to drink the tea while trying to get to the kibble. I give her a little now and then just to keep her sinuses in check. Sage tea is an antihistamine and is also good for digestion issues. They also gave her some herbal capsules to take for 5 wks to help support her adrenal glands as she was still having a lot of the drinking/peeing/panting even with the 60mg a day of Trilostane. After 2 weeks, this seems to be helping the drinking/peeing and most of the panting thought she still has spells in the evenings mostly. I just hope when the 5 wks are up she does not revert back without having the additional support. Otherwise, keeping our fingers crossed that she does good with all of this. We will be moving back to our hometown as soon as our house sells and hoping the stress of new surroundings does not cause any setbacks.

[molly muffin]

I hadn't head that about sage tea, but how wonderful that it cleared up (with the vaporizer) the sinus infection. Great news.

Hopefully she will transition fine to her new home. I use to move a lot when I had my golden retriever and I'd spend huge amounts of time with her just doing fun stuff in her new home territory. That seems to really help her adapt and make it her own.

[tammyl]

Does anybody know if it is possible to remove a large tooth (3 roots) from Sadie without anesthesia? Our vet said she is high risk but the tooth should be removed as she broke it off and there is some pulp visible. Sadie does not seem bothered but she is drooling a lot and we are not sure if she is hiding her discomfort from us.

[judymaggie]

Hello to a fellow beagle Mom! I wouldn't think that a tooth with roots can be removed without at least light anesthesia. Dogs can be very stoic about pain -- I suspect that Sadie is experiencing pain. Why does your vet consider her a high risk for anesthesia? Neither her age nor the Cushing's would automatically put her in this category. My Abbie had spinal surgery for a herniated disc a few months ago at the age of 12 -- in addition to Cushing's, she is being treated for high blood pressure and severe proteinuria. I'm sure you know that dental issues can lead to serious health concerns if not treated.

Sharlene mentioned back in February that an ACTH would be due shortly. Was this done? Please post the results if it was. How is Sadie doing with regard to Cushing's symptoms?

Also, my Abbie has frequent reverse sneezing. The first time I heard her I thought she was choking to death -- fortunately, it occurred in a vet's office and he quickly reassured me. Abbie's sneezing is most likely related to allergies.

[Harley PoMMom]

The drooling can be a symptom of pain. My boy, Harley, had 3 teeth extracted when his Cushing's was not controlled and he did fine with the anesthesia. I am curious, too, as to why the vet thinks Sadie is at risk for having that tooth pulled with anesthesia.

Hugs, Lori

[molly muffin]

I do hope that you can have the tooth removed as I think it needs to be with the pulp being visible. Dogs can be very stotic and not show pain, but I think the drooling as Lori mentioned is a sign of discomfort.

How is the Blood Pressure? Do they worry about clotting? Those are the two main issues.
Also ask about if they can do a light anethesia or something that would be less risky.