Newly Diagnosed 11.5lb Shih Tzu

[JennyGump]

Hi all, I'm very pleased to have found this forum.

My 12 year old female Shih Tzu, Jenny was recently diagnosed after exhibiting symptoms (weight loss, hair thinning, drinking a lot, front legs bowling out and collapsing, waking at night to go outside, tiredness).

We began her treatment on 02/05/16 with 3mg Trilostane every 12 hours. She weighed 11.5 lbs at start of treatment and I should probably weigh her again since she is eating well and hopefully has gained a little (in June of 2014, she weighed 13.8 lbs). I give her the pill with food twice a day in hopes that the food in her belly will help with nausea.

I'm a bit concerned after reading some of the posts here that the dosage is too high. She seems to be lethargic during the day, although she is drinking a bit less water now. Before treatment, she would need to go outside once a night about four times a week. Now since she started treatment, she needs to go out every night and is very restless all night long - tossing and turning. Last night she vomited a little too.

The vet told me that we should start seeing improvement after about a week, but it seems to me that it isn't doing anything but making me concerned. He wants to test her again at 30 days but I'm thinking that maybe we should test her sooner?

I plan to contact my vet tomorrow, but would also appreciate comments/advice here as well.

Thank you.

[judymaggie]

Welcome to you and Jenny! I am sorry for the reasons that brought you to us but everyone here will try to guide and support you as you traverse the Cushing's road.

We would really appreciate it if you could tell us some more about Jenny's medical history as, in this way, we can provide you with better feedback.

If you could please get copies of the testing that was done on Jenny and post the results here that would be great. With respect to the blood chemistry and CBC, you need only post the highs and lows and please include the normal reference ranges. We are also interested in the specific Cushing's test results (ACTH, LDDS, ultrasound). If Jennfy has any underlying illness for which she is taking herbs/supplements/medications, please tell us about that as well.

Based on the current dosing recommendations, with a weight of 11.5 lbs. a reasonable starting dose would be 10 mgs. of trilostane so 6 mg. a day would not be considered a high dose. That said, every dog reacts differently and symptoms are important.

Dechra, the manufacturer of Vetoryl (trilostane), recommends the first ACTH after dosing begins at the 10-14 day mark. With Jenny's lethargy, if I were in your shoes, I would ask the vet to do an ACTH this week. Concurrently, it is important to do a chem panel to evaluate sodium and potassium levels. Our "Helpful Resources" forum has very good information about all aspects of Cushing's.
Here is a link to the Dechra technical brochure -- page 11 has an
excellent flow chart:

http://www.dechrace.com/pdfs/vetoryl/VETORYLTechnicalBrochure.pdf

It is recommended that the trilostane be given after a meal in some sort of fatty food. Many use peanut butter or cream cheese. I put my Abbie's in American cheese. This helps the trilostane to be absorbed into the dog's system. I give Abbie pepcid original before the meals she gets trilostane in order to ward off any nausea.

Others will be along to offer their insights and suggestions but I wanted to get you started!

[molly muffin]

Hello and welcome to the forum. No the starting dose isn't too high and is considered a safe dosage to start with.

Are any other lab values high or low in her lab work?

When a dog is vomiting, diarrhea then trilostane should be stopped and an ACTH done to evaluate her cortisol levels.

Trilostane should always be given with a meal as you are doing. I too am concerned though that she isn't feeling very well and hopefully she would be feeling better not worse.
I'd do the ACTH test for sure. That should be done 4 - 6 hours after the morning dose. But if she is vomiting you might want to go straight to doing the ACTH.

[JennyGump]

Oh, I stand corrected! My hubby just mentioned that we started her on the Trilostane on Feb 11th. I suppose it just feels like I have been giving her meds for longer. Too soon to do any testing. I.must.have.more.patience!

I will request copies of her previous test results tomorrow and post them.

A little history on Jenny: she has been very healthy up til the last 2 or so years...it started with very bad breath - she had her teeth cleaned, 8 pulled and 1 abscessed tooth treated. It was the vet dentist that noticed her elevated liver enzymes so the family vet started her on Denamarin and then later Dasuquin for limping. Last fall the bad breath returned so we had her teeth cleaned again and a couple of more teeth pulled. The vet has been very diligent in doing blood work on her and in January, her liver, pancreatic, and kidney tests shot up and she really started exhibiting Cushing symptoms.

Thank you so much for the suggestion to give her the trilostane with a fatty food. She had it with peanut butter this eve! :)

[molly muffin]

Her pancrease numbers went up? In that case make sure that over all she is having a lower fat food as pancreatic can be a problem with Cushing dogs. (I'm speaking of over all lower fat not like peanut butter with her trilostane).
Let's see what the numbers are in the lab tests that you get tomorrow.

[JennyGump]

I'm taking Jenny back to the vet on Monday. It seemed like she was starting to improve but I'm not sure. Her appetite has gone down and it's a struggle to get her to eat. She seems weak and tired. She doesn't have to get up in the middle of the night to go outside anymore and she isn't drinking as much water so I guess that's good. I haven't requested her lab work yet - I'll get that on Monday. I'm very worried about her.

[Renee]

If you are at all worried, stop the trilostane. She may be dropping too low. There is no harm in stopping, but plenty of harm can happen with giving a sick dog these medications.

Any vomiting or diarrhea?

[JennyGump]

If you are at all worried, stop the trilostane. She may be dropping too low. There is no harm in stopping, but plenty of harm can happen with giving a sick dog these medications.

Any vomiting or diarrhea?

No vomiting or diarrhea that I can tell.

[labblab]

Sometimes dogs just feel crummy from the rapid drop in cortisol that results from the medication. This can occur even when cortisol levels have not actually dropped too low. But if she started the trilo on 2-5, she is now due for a monitoring ACTH test, especially since she is dragging. Was the testing already planned for Monday? In order for the ACTH test on Monday to accurately reflect the effect of her current trilostane dose, Jenny will need to continue taking the drug through the weekend. So this is where it becomes a judgement call on your part. Renee is certainly correct that if there is any doubt as to whether Jenny is getting into serious trouble, it is best to halt the trilo for the time being. If it is just that she is sleeping more and has less of an appetite, I'd be inclined to go ahead and keep giving the drug until she is tested on Monday. But if she does worsen, such as vomiting, diarrhea, more significant lethargy -- then yes, the safe thing is to stop the drug.

Remember that on Monday, she should be given the trilostane along with breakfast, and the ACTH should be performed 4-6 hours later.

Marianne

[JennyGump]

Sometimes dogs just feel crummy from the rapid drop in cortisol that results from the medication. This can occur even when cortisol levels have not actually dropped too low. But if she started the trilo on 2-5, she is now due for a monitoring ACTH test, especially since she is dragging. Was the testing already planned for Monday? In order for the ACTH test on Monday to accurately reflect the effect of her current trilostane dose, Jenny will need to continue taking the drug through the weekend. So this is where it becomes a judgement call on your part. Renee is certainly correct that if there is any doubt as to whether Jenny is getting into serious trouble, it is best to halt the trilo for the time being. If it is just that she is sleeping more and has less of an appetite, I'd be inclined to go ahead and keep giving the drug until she is tested on Monday. But if she does worsen, such as vomiting, diarrhea, more significant lethargy -- then yes, the safe thing is to stop the drug.

Remember that on Monday, she should be given the trilostane along with breakfast, and the ACTH should be performed 4-6 hours later.

Marianne


The vet had not planned to see her back until she had completed a 30 day course of the drug. The appointment on Monday is 2 weeks early so no ACTH test is scheduled. Hopefully, he will be willing to to do the test when I take her in.

Thanks to all of you for the great advice/feedback! It is very much appreciated!

[molly muffin]

Maybe see about doing some blood work and urinalysis to see how she is doing over all. I know you had some done earlier that showed pancrease numbers up. When was that test done?

[JennyGump]

After Jenny's 2nd ACTH test (11 days after initial test), my vet consulted with a specialist and the decision was made to give her the Trilostane once a day (in the evenings) instead of twice a day to see if her lethargy decreases. He said the treatment is working, but not as well as expected.

[labblab]

So Jenny had an ACTH done while seeing the vet yesterday? Can you find out the exact test results for us as soon as they are available? Did Jenny have her regular trilostane doses (along with food) prior to the test?

Thanks so much, in advance, for this additional info.
Marianne

[JennyGump]

After Jenny's 2nd ACTH test (11 days after initial test), my vet consulted with a specialist and the decision was made to give her the Trilostane once a day (in the evenings) instead of twice a day to see if her lethargy decreases. He said the treatment is working, but not as well as expected.

One other thing...he stopped the treatment yesterday. She will start back up on Friday night (taking it once a day, instead of twice).