Angelina 13.5 year old/13kg Maltese Cross on Trilostane

[Roxee'sDad]

Hi John,
Sorry to hear Angelina is in some pain. Hope her leg gets better soon and doesn't turn out to be anything serious. If the acth comes back within the desired range, it could be that the lower cortisol levels have made Angelina start feeling her aches and pains that come with age.

Regarding the dosing - I believe the acth stim results should guide you. If you think she is feeling the aches and pain of being a senior, you might want to consider a trial/test run of some pain meds or supplements. I had Roxee on metacam for over 3 weeks but saw no changes or improvements, so I discontinued use. I wanted to see if it was muscle weakness or pain that caused her walking problems. Still can't rule out neurological problems but really can't afford 1500 dollars for an MRI and what would that tell me to do for my almost 14 year old pup? My number one priority is her comfort and quality of life. We are about a week or 2 from our next acth stim test. I didn't want to wait the full 90 days so we are going in a little early. (I am still buying lottery tickets) Hoping to hire my own full time vet

The skin pigmentation thing.... I have read this as a side effect of using the meds. Roxee's skin was really pink at one time and has now tuned darker in spots around her sides and belly. The hair regrowth seems to be mostly her white hair but very little regrowth of the black hair I have also read that some others experience a change in color, and texture of the hair. Around here it is commonly and affectionately called "Cush Fuzz"

I hope that Angelina's test results help your decision and thought process. From the many threads I have read on cc.net, some pups do better on the higher end and some do better on the lower end of the desired results range. So there comes in the tweaking, once a day, BID, how many mg's in the am and how many mg's in the pm??????

If you have been following "Jesse's thread, this seems to be the million doallar question, I believe we are all waiting to see what updated info that Katherine "Border terrier and Lysodren-UC Davis" can get regarding an updated UC Davis protocol on Trilo dosing.

Keeping good thoughts and Prayers for you and Angelina.
John (Roxee's Dad)

[frijole]

John,

A couple thoughts. Remember that the excess of cortisol in the system BEFORE treating helps to mask pain. (arthritis, old age joint issues etc.) so when you treat the cushings and lower the cortisol level the pain sometimes is revealed. Many of us use glucosamine, fish oil etc. to supplement and aide with pain management. Others have found help with arthritis medication.

Re the skin discoloring - I have been told this is just common old age spots. I didn't notice it til the cushings either however my other dog now has the same thing so I tend to believe that's what it is. They have spots of all shades of dark and sizes. They are schnauzers - white and silver.

Hang in there. My cush dog is nearly blind and deaf now and she likes to stand by my feet at the frig too (piggie she is) and I have hit her with the door and nearly stepped on her a hundred times... so you aren't alone.

Hugs
Kim

[forscooter]

Hi John...

I feel your pain.....and Angelina's pain....and the gray hair....it's a side effect of being a Cush parent . I have blonde hair, or used to, so I just call them my "highlights".

The arthritis thing can be tricky and it sounds like that may be the issue. I used the glucosamine and fish oil supplements and they seemed to help a little. But there were still days....others have used different medications and supplements and it's just a matter of what will work for you. It can take 4-6 weeks to see a difference with the glucosamine route but I think worth it.

On really bad days, I give Bailey a dose of Metacam. Only with a full belly of food though to coat his stomach. It seems to help him a lot. I used to have to do the same with Scooter.

I am not an advocate of doing this....BUT....with Bailey, I do dose him where I think it keeps the Cushing's in the best control we can while helping not bring out the worst of the arthritis. It's been quite rainy here and he has been hurting the past few days. I am not backing off the Lysodren though bc of the Cushing's but rather using the Metacam sparingly.

If you get the ACTH done, and Angelina is at the low end, you may want to discuss the possibility with your vet's input about letting her run a little higher.

Sending my most soothing thoughts to you both!!!
Hugs, Beth, Bailey and always Scoobie

[Lucygoo]

Hi John....Sorry to hear Angelina's got some pain. I just wanted to pass along what really helped my dog when she went through a bout of bad arthritis about a year ago, when we were trying to get her trilostane dose worked out. My vet prescribed Cosequin, which is a prescription only heavy dose of glucosamine. They come in chewables as well as regular pills. It took about a month to 6 weeks to work, but it helped her 100 percent. She was like a new dog. If you haven't already tried this, I would check it out. It's a little expensive, but it really worked for my Lucy.

Good luck...
Gina & Lucy

[John II]

Hi Everyone,

Thanks to all for your helpful replies. I'm calmer today, and although Angelina insists on sleeping on her right side - the lameness hasn't recurred (phew) - I've opted for a little more observation, rather than testing just yet. Fingers crossed and knocking on wood.

Gina & Beth & Kim & Brother John - thanks for the medication advice. My aim is the best quality of life for Angelina - this just keeps getting trickier and trickier! Lower the cortisol - but not too low! Sheesh!

Kim & Brother John - thanks for the reassurance regarding the worrying spots!

Brother John - I like your lottery plans - full time Cushings vet (I'll add in residence to the scheme)! Now there's a plan!

Can't wait to see new UC Davis info - hope Katherine can her her hands on it.

Thanks again,

John the Grey

[John II]

Hello All,

Not much to report at the moment.
5 Weeks into treatment, at (except for a brief increase) 30mg of Trilostane a day Angelina:
* Has gone from demanding breakfast at 4:30am to calmly awaiting breakfast at 7am (less calm as 7am approaches).
* Water intake has gone from a litre (plus) per day to around 700mls per day.
*Energy levels are erratic - more one day - less the next.

Took Angelina for an ACTH Stim test today - results hopefully tomorrow.

John the Grey

[Roxee'sDad]

Brother John,

Good to see some positive signs

Keeping fingers and 16 paws crossed for good stim results.

John (Roxee's Dad)

[John II]

Hello All,

The Specialist called with the ACTH Stim Test results today:
7 May 2009 results:
Cortisol resting 78 nmol/L (or 2.82 u/L) (normal range is 15-170 nmol/L)
Cortsiol at 1 hour 337 nmol/L (or 12.21 u/L)

Previously on 14 April 2009 the results were:
Cortisol resting 157 nmol/L (or 5.69 u/L)
Cortsiol at 1 hour 382 nmol/L (or 13.84 u/L)

Electrolytes on 7 May 2009 were:
Na (Sodium) 144 mmol/l (139-153)
K (Potassium) 5.6 mmol/l (3.9-5.9)
Cl (Chloride) 108 mmol/l (93-122)

Previously on 14 April 2009 the results were:
Na (Sodium) 145 mmol/l (139-153)
K (Potassium) 5.9 mmol/l (3.9-5.9)
Cl (Chloride) 107 mmol/l (93-122)

So not a lot of difference with the Electrolytes.

Other points during the phone call:

• The Specialist advised going back to the dosing of 30mg of Trilostane every 12 hours. I told him about Angelina’s weakness after 3.5 days of double dosing and said I would prefer us to try 20mg of Trilostane every 12 hours. He replied that would not be his recommendation (and I should have come in for an ACTH test at that time to try to ascertain the cause of the weakness) but if that was my wish – he would order the 20mg capsules for me (they would take a couple of days to come in). So I don’t know if that was a victory or not. A daily increase of Trilostane – but a small increase. Am I going too slow?

He also gave me the option of ordering the Trilostane in liquid form – which would make dosing changes easier – should they be necessary. But, I thought, at least with capsules, I know when Angelina has swallowed them.

• I mentioned her leg problem last Sunday – he said that the disease made them more susceptible to blood clots. BLOOD CLOTS!!!


I think the 2nd ACTH Stim Test has hit Angelina harder than the first.
Yesterday, Angelina:
• seemed quite weak when she was walking outside to do the necessary.
• Was behaving a little oddly – in that she was trailing me from room to room.
• Panting more than usual – but that’s to be expected with the stim.
• Seemed confused.
Today she:
• Slept in to 06:55am – the latest so far
• Seemed duller – except when food is offered
• Didn’t want to go for a walk (only went as far as the patch of grass in the front yard – which she anointed – twice). I walked on – she stayed put – I walked back and she followed me home.
• Continues to follow me around today - trailing me from room to room. Sleeping next to my foot right now.

Regards,

John the Grey

[Roxee'sDad]

Hi Brother John
Have to run and groom some pooches but I wanted to say that I think the conservative approach is good one. Angelina's post acth didn't drop much but at the same time with a slower drop, she won't or shouldn't experience the quick cortisol withdrawl. Just my opinion.

Yeah and Stim days are always rough on Roxee but she has did recover quicker on the last stim day.

Check in with you later. Belly rubs to Angelina (if she'll let you)
John (Roxee's Dad)

[John II]

Hi right back at ya Brother John,

Thanks for stopping by!
You and Roxee are the touchstone for me and Angelina

John the Grey