Introducing Pheobe- 14 year old Bichon Frise with Cushings-Trilostane?

[Pheobe]

Hello everyone.
I would like to introduce my 14 year old Bichon Frise, Pheobe who was officiall diagnosed with Cushings in September of 2015. I chose not to medicate with my Vet's approval at that time. Since then, Pheobe's ALT liver enzymes have gone up expotantially and are now at 2000. Her other liver enzymes have gone up too.

Pheobe has had 2 ultrasounds which are normal with no discovery of adrenal tumors. Just an enlarged liver which is typical of Cushings.
My Vet now highly recommends that we start medicating. We started with Lysodren and after over 30 days of induction with 3 ACTH test in between, the drug has shown that it is not working. Her pre test is about 3 and post at 17. We are now trying Trilostane at 5 mg 2x per day. I would like some feedback from members who are using this drug or have tried it. I am leary because I understand in 1% of dogs, this drug can kill the adreanal glands. Please let me know if your pet has had a negative reaction and was treated and is fine. Also please let me know about your successes. Thank you!

[Harley PoMMom]

Hi and welcome to you and Pheobe!

I have only a minute to post but wanted to make sure that you were aware that when switching from Lysodren to Trilostane there has to be a 30 day washout period, was this done?

Hugs, Lori

[molly muffin]

Hello and welcome to the forum.

The key with starting trilsotane dosage is that you be at 1mg/1lb. I'm assuming Phoebe is over 10lbs so you should be in a safe zone in that regard.

We've had many members who did fine on trilostane for years. Test at 2 weeks after starting and see how she is reacting to the medication.

What where her symptoms of cushings? Was she only tested due to the high liver enzymes?
Which test was done to diagnose cushings, the ACTH or the LDDS and what where those initial results?
Was the ultrasounds done after the liver enzymes went up? Was the gall bladder seen? (wondering about sludge)
Where any other blood results abnormal other than ALKP (liver)?

[DoxieMama]

Welcome to you and Pheobe from me, too. I am also curious to know the answers to Lori and Sharlene's questions. The more information we have, the better to support you and Pheobe.

[rainiebo]

Hi, my dog Bobo (12 year old Chinese Shar-pei) was diagnosed with Cushings in June. He began the Vetoryl (trilostane) and after a few weeks of tweaking the dosage and several ACTH tests - his numbers are within the good range. I won't need to do another ACTH for about 3 months. Also have noticed his pot belly has gone down quit a bit, and the hair is coming back (especially noticed on his tummy, since he had none there.) He's not up all night panting and wanting out. He had swollen dog nipples (go figure) and the swelling is gone. He still has some panting, very light during the day (if at all) and beginning around 7PM the panting starts but not anything like it was. Two of our members suggested putting a fan turned on him at night, but that worked so well, that I have the fan in front of him pretty much all the time. Very little or no lip smacking anymore. I don't know anything about adrenals except what I've read. To be honest my vet, bless his heart, doesn't seem to know much about Cushings. I have an endocrinologist that has been the most help. It has been a very scary, frustrating and trying process to get Bobo a working program, but the outcome has been worth it. He's on supplements now for arthritis along with Vetoryl. The cosequin, etc. is beginning to kick in and he seems to be walking better. I've been able to pull him off his prescribed medications for arthritis, but every dog is different. Right now this seems to be working for us. Hang in there - this website has been a real source of information and encouragement. I'm sure you'll find it true as well.

[rainiebo]

P.S. to my first message. If you do decide to use Vetoryl (trilostane) - you might want to look into the PetCareRx.com website. I bought my first box of trilostane from my vet for $110. I joined PetCareRx for $50 a year because Bobo had so many health issues. The vetoryl only costs $45 a box. Good luck with your pup.

[Pheobe]

About 3 weeks before starting Trilostane.

[Pheobe]

Her symptoms are heavy panting, drinking lots, increased appetite and swollen belly along with elevated liver enzymes. All other blood tests normal. Didn't do the stym test to diagnose. We did a urine test which had a high content of cortisol. Yes her entire belly was ultra sounded. Only the liver showed enlargement (with a bit of swelling of adreanals this last time). Pheobe has been on the Trilostane for 6 days and I really don't notice improvement yet except for less panting. Still drinking lots of water, still has barking for food. She seems subdued which is making me nervous. She is being tested on Thursday. Does this sound normal or should I be seeing improvement by this time?

[Pheobe]

Thank you. Pheobe is on liquid right now from compound pharmacy. About $65 for 30 days.

[Squirt's Mom]

Didn't do the stym test to diagnose. We did a urine test which had a high content of cortisol.

This comment caused a huge red flag to go up for me. Can you please tell us what urine test was used?

Are you saying Pheobe has not had an ACTH or LDDS?

[Pheobe]

Hi Squirt's Mom,
Pheobe had a urine- cortisol/creatinine ratio test in September of 2015 plus an ultrasound of her liver, abdomen and adreanals and was diagnosed with low grade Cushings at that time with a recommendation not to medicate except for 1/4 baby aspirin every other day and milk thistle for liver support.
She has now had 3 ACTH tests while she was on Lysodren. Couldn't get her cortisol level below 16. It was determined that Lysodren was ineffective for her and now she is on trilostane. 9 days tomorrow and she get's another ACTH test. I will keep you posted. Thank you.

[molly muffin]

I do hope that she is responding to the vetroyl.

Did they show her gallbladder on the ultrasound? I always wonder about sludge in the gallbladder too with high liver numbers.

[Pheobe]

Yes I think they did the gallbladder last year. My other bichon had sludge and was medicated for it and is fine now.
Pheobe is responding to the vertoryl, thank God!. She just had her stym test on Thursday and she showed quite an improvement. My vet was very pleased. Overall she is seems much better. Brighter, calmer, much less panting and less ravenous. Still drinking lots though. Vet is keeping her on the same dose- .5 ml. We will test her again in 3 months. Her liver was swollen and has gone down too. Thank you!

[Harley PoMMom]

She just had her stym test on Thursday and she showed quite an improvement.

Was this an ACTH stim test to check cortisol? And if so, could you get a copy of that and post the results here for us...Thanks!

Hugs, Lori

[molly muffin]

That is excellent that the size of the liver has gone down. (you'll notice the belly looking smaller once that happens too) and that she is responding so well.
Do you have the results of the ACTH?
I always used my mollys thread to track what was happening when with her and referred back to it often. I also kept copies of all test results in a file folder with her picture on it. (yea, a bit OCD there :) )