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Old 04-21-2009, 07:17 PM
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4Mikeydog 4Mikeydog is offline
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Join Date: Apr 2009
Location: New Jersey
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Default Re: Mikey no longer doing well on Trilostane

Thank You so much for your kind words of support and encouragement....and especially for sharing your knowledge. Glynda, my heart breaks when I hear about your dear Lulu. I can wholeheartedly relate to your pain.
My dear sweet dogboy is fading away to nothing. He is skin and bones
We have tried different diets and all kinds of testing throughout the past 4 months....
Mikey presented at his initial diagnosis of cushings weighing 20 lbs!
He was quite overweight, as his usual weight was between 15 and 16 lbs.
So when he reached 16 lbs again after 5 months of Trilostane, we certainly were not alarmed. However, his weight loss has drastically continued.

Of particular interest was how an intestinal manifestation presented itself immediately after an ACTH stim test administered 11/21/08.
Up until that point, Mikey had only 1 issue with diarrhea in the past, was medicated with metronidazole and made a complete recovery. He had never had a reaction to an ACTH stim test in the past.

After this particular Acth test in Nov, within 1 hr of returning home, Mikey began to vomit recurrently. He could not hold down water and had absolutely no interest in food, as he was probably nauseus. He vomited 5 times within 2 hrs and went back to the vet's office, where he was administered subcutaneous fluids, injectable prednesone , and injectable anti-emedics.
Within 3 hrs, Mikey was back to himself...supposedly.
Two days later, continuous diarrhea began.
Mikey, ultimately, was put on a diet of boiled chicken breast and brown rice as well as metronidizole 50 mg BID.
Mikey remains on this dose of metronidizole until presently because each time the medication is stopped, the diarrhea returns within 3 days.

He has been tested for parasites twice and the results have been negative.
He has been prophylactically dewormed with Pancur.
He is only able to tolerate the boiled chicken breast, brown rice, and the switch from science diet to...Nutro dog food with chicken meal, brown rice, and oatmeal for sensitive stomachs...(uh oh, I read about the FDA investigation of this company yesterday and now will change this)
His bowel movements are fully formed but soft on this regiment.
This is much better than the yellow soup he has had in the past.

I wondered why this seemed to happen directly after this particular ACTH test. It didn't seem like a coincidence. He has had so many of these tests uneventfully in the past.

Exocrine Pancreatic Insufficency was suspected and tested for in 12/08.
A nutritional panel was run at this time as well.
B12 and Folate levels were normal and Exocrine Pancreatic Insufficiency was ruled out as well.

Mikey has had 2 additional ultrasounds as well as an x-ray of his heart since that time. All showed no changes, thankfully.
Protein Losing Enteropathy was suspected subsequently.
Blood tests showed normal levels of albumin and lymphocytes.
Endoscopic biopsies need to be done to rule out Protein Losing Enteropathy,
but Mikey is certainly not a candidate for this at this time.

Our regular vet an IM specialist both felt that, perhaps, Mikey has an inflammatory bowel condition due to a food sensitivity which he had been able to mediate in the past with his own overproduction of cortisol.
However, once the cortisol production was suppressed with the Trilostane, perhaps, the symptoms of Inflammatory Bowel Disease ran amuck and are now creating a Protein Losing Enteropathy or a nutritional absorption problem.
Tylan powder 1/16th tsp sprinkled on food 2x per day was added to his regimen.
They recommended a consultation with a veterinary nutritional specialist and, perhaps, the introduction of a novel protein (hypoallergenic) diet.
Have any of you been down this road?

We met with the nutritional specialist yesterday and she does not necessarily concur with this theory because of the fact that the gas and diarrhea return when the metronidizole is stopped.
Therefore, she believes the problem may be bacterial (such as SIBO) rather than food sensitivty.
A Pro-Biotic treatment approach was recommended and commenced today.
He absolutely hated the taste of this supplement sprinkled on his food and refused to eat his chicken for the first time ever Now What?

I am somewhat enlightened to hear that Dr Oliver has stated that some dogs with excess sex steroids lose weight. Every time I have ever inquired as to the possibility of this phenomenon, I am told that this cannot be!

I truly believe that the Trilostane could be behind this awful weght loss due to it's ability to increase the adrenal sex steroid levels and I cautiously think the time has absolutely come for a change!
I intend to contact Dr Oliver and get his input.
I also wonder if, somehow, the fact that Mikey's aldosterone and andostedidone levels were lowered after the stim could be responsible for the nausea and vomiting he experienced. His androstenedione level was high initially and then went below normal.
Has anyone had any experience with this?
He only vomited once after his 3/30/09 ACTH stim, but, perhaps in November his levels of those hormones went even lower....Just a thought...
I love my boy and I just want to find a way to help him....

Thank you so much for your input!

Love and best wishes..
Dorothy and Mikey