Please help - bad reaction with Trilo - don't know what to do next?

[k9diabetes]

Re: Please help - bad reaction with Trilo - don't know what to do next?

It would be very very important given the symptoms you see of Cushings to test Melly for Atypical Cushings, which is done with the University of Tennessee Panel.

Cortisol is not the only hormone that, when elevated, can cause Cushings symptoms. These other hormones are the cause of atypical Cushings. And as some have mentioned, Trilostane is contraindicated when some of these hormones are the cause of Cushings symptoms.

If it isn't truly cortisol that's elevated, then the Trilostane could be taking her cortisol too low AND increasing the hormone that is causing her symptoms so making the Cushings symptoms worse while also giving her Addison's disease (too low cortisol) which is far more miserable to live with than Cushings .

I can hear your frustration as I imagine you feel like finally you know what's going on with your dog and now we are telling you to hold off treating it.

The thing is... no damage will come to Melly from typical or atypical Cushings disease if you wait a week or two to do more testing so you're sure.

I know you love Melly deeply and want what's best for her - why not KNOW it's Cushings disease instead of being even 99% sure it is. And also KNOW what hormones are causing it so you know how best to treat it?

Is Melly still taking pred?

How is she doing?

If she's still on pred and she's doing well, almost certainly her own cortisol production remains suppressed - the opposite of Cushings.

If she's still on pred and she's starving and thirsty and panting worse than ever before, she most likely has normal or excess cortisol production of her own.

I'm sorry if we seem pushy or critical or skeptical of your vet or you... none of which is intentional. It's just that after you've been on a forum like this for a few years, you have seen a lot of misdiagnosed dogs who never ever had Cushings and who were sent into Addison's disease by being treated for something they didn't have.

Your vet should be more than happy to run the UTK panel to be sure about Melly.

Hope you have a very productive meeting and I hope you will forgive us if we are ranting a bit - it is only out of concern...

Natalie

[LuvMyMunchie]

Re: Please help - bad reaction with Trilo - don't know what to do next?

Hi!

I hope Melly is doing better today and that when you check to see whether she has had additional testing other than the UCCR to confirm a Cushings diagnosis (and also rule out a thyroid or diabetes problem) that this will be the case.

My Munchie suffered because of a misdiagnosis and being put on Trilostane when he didn't have Cushings. He was very unwell. Thanks to this forum I was able to educated myself about the disease, gain the ability to become an advocate and voice for my Munchie and receive a lot of help and support from the many concerned people here. It's been over a year now since that nightmare but I'll never forget it.

Looking forward to your update.

Louise

[matea]

Re: Please help - bad reaction with Trilo - don't know what to do next?

Just a quick update.

Melly was weaning off the prednisone, and not doing great. For the past few days we've had her on one a day, per our vet's instructions. She eats and is hungry when she takes it at night, but vomits every morning. She's also really weak in her back legs, and when the prednisone wears off not hungry at all, though she still drinks water thankfully.

She's going to the vet this morning for an ACTH test plus some more bloodwork to see where she's at, and test her electrolytes etc.

At this point we feel we shouldn't have given her any Trilo at all, she's much worse now than she was before.

Regardless, we'll know more after the tests. If she's become adissonian what's the next step? How does one treat addisons?

[gpgscott]

Re: Please help - bad reaction with Trilo - don't know what to do next?

Good idea to withold Cushing's meds, I can't see yet that you have a confirmed diagnosis, and it is said by the suppliers of both Trilo and Lysodren that you suspend treatment if the animal exhibits any of the symptoms you are describing.

I think it is too early to contemplate Addison's.

Please let us know about test results.

Best to you and Melly. Scott

[Lulusmom]

Re: Please help - bad reaction with Trilo - don't know what to do next?

Hi,

I just read your thread and it appears that your vet diagnosed Melly based on an abnormal UC:CR. As many members already told you, the UC:CR is a screening test, not a diagnostic test and regardless of how high the urine cortisol creatinine ratio is, you cannot assume that the adrenal steroid, cortisol, common in typical cushing's is the driving factor. That is why additional testing is always necessary in order to reach a confirmed diagnosis.

It is known that excess amounts of adrenal hormones/steroids, other than cortisol, can also be responsible for an abnormal UC:CR. Your vet, at the very least, should have done an acth stimulation test to determine if excess cortisol production was responsible for the abnormal ratio. Did your vet do any further testing after the UC:CR or did s/he base the diagnosis solely on the UC:CR?

Glynda

[frijole]

Re: Please help - bad reaction with Trilo - don't know what to do next?

I agree with the others. I am not convinced your dog has cushings and I wonder whether the trilo has caused the problems. I base my opinion on the fact that protocol testing was not done to confirm the dx.

Dogs that have been pushed into Addisons are usually very distressed - to the point owners are afraid they are dying and prednisone is given to mimic the loss of cortisol.

I am not a vet but if it were my dog I would not give any more trilostane. Please post the test results when you get them so we can better help you help your baby.

Hang in there. Cushings is not easy to diagnose and some vets have more experience than others. We'll help you through this.

Kim

[Squirt's Mom]

Re: Please help - bad reaction with Trilo - don't know what to do next?

Hi Matea,

Based on your last post, I really, really believe Melly was misdiagnosed, that the Trilo has caused damage to her adrenals and they are having a hard time regenerating or the weaning off of the pred wouldn't effect her as it has. Her reaction to the lessening of the pred indicates an overdose and that she still needs the pred. I am really looking forward to seeing the results of her ACTH.

I do hope you will post the results, the numbers, and not just "normal" or "just fine" or "low" or "high", etc. We are not vets and are not trying to usurp your vet but we have been living with Cushing's and know what to look for in most circumstances since we have "been there, done that". I would be hard pressed to believe any one vet, regardless of how good, has seen as much as we have or experienced first-hand all that we have with our pups. That is one of the big advantages of groups like this. You get a wealth of experiences and the knowledge learned from those experiences from those who live with Cushing's day in and day out, hour after hour. No vet has the time to devote themselves entirely to one sick pup and few actually live with a cush pup. Most know about Cushing's from their textbooks and schooling, and those who do treat Cushing's only see those pups intermittently for a brief time. Without our vets, many of us would be lost, but they cannot take the place of the combined knowledge and experience found here. We ask for the actual results so we help you by using the knowledge and experiences we have gained. That is our only motivation in asking for them. We may not agree with what the vet has determined or plans to do, but we will always stand beside you no matter what you decide to do...unless it's inhumane, which I don't see happening. The bottom line is, we just want to help Tigger feel better and help you cope by teaching you all we know so you can stand up for Tigger with confidence.

If it turns out Melly is Addison's now, we can help you find sources for support. With Addison's the adrenals are basically dead, cannot and will not function ever again. An Addison's pup has to be on meds for life just as a cush pup does. My hope is that she is simply having an Addisonian crisis from the Trilo and with the pred will recover soon. The adrenals will need time to regenerate if they have been seriously damaged (Addisonain crisis) but in time they will start to function again.

Let us know what the vet said! and hang in there!

Hugs,
Leslie and the girls