Angelina 13.5 year old/13kg Maltese Cross on Trilostane

[AlisonandMia]

"every foot is an individual" thing (too much Trilostane?) .

Would you describe it also as walking very carefully, almost as if on eggshells - because that is how my little girl looked when her cortisol was too low. For me it was probably easier to see and easier to sheet home to cortisol as she was younger than Angelina and had no other muscular/skeletal age-related stuff going on - but it was an unmistakable sign with her as she went from bouncing around quite recklessly really to being ultra careful and being weak and would fall over when I was putting her winter coat on her for the night. Mia was on Lysodren and did go just slightly low a couple of times in the course of her treatment and each time a little dose of prednisone perked her up within the hour.

I think that if she is looking like she is too low now that you should probably skip tonight's dose altogether. Possibly (and I'm just thinking out loud here) you could discuss with your vet using a dose that you are pretty sure won't be entirely effective (say 10mg bid) for 10 days and, providing you get no signs of low cortisol, do a stim test at that point and, if the symptoms and the numbers are not right just ever so carefully incrementally increase the dose at 10 - 2 week intervals until you are happy with the symptoms and the numbers - with the symptoms being the main thing and the numbers being a sort double check. Being an oldster Angelina may be rather sensitive to what is called "cortisol withdrawal" which has more or less the same symptoms as low cortisol but is actually caused by a sudden change in a downward direction in previously high cortisol. A dog (or person) can get this even when the cortisol is actually still a little higher than a healthy level but has recently decreased significantly.

I believe Dechra says somewhere (and I'd dig it out but won't be able to because I've got a v-e-e-e-e-ry slow connection at the moment - need that "frustration" emoticon, too!) that with Trilostane treatment the way to discriminate between cortisol withdrawal and absolutely-low cortisol is to take a look at the electrolytes - I'm pretty sure it's in the latest US product info if you want to be look it up for yourself (see Trilo FAQ's). This is because, with Trilostane, if the cortisol really is too low then the aldosterone (the adrenal hormone that balances the electrolytes) will also be too low and this will show up as an electrolyte abnormality.

I think with Angelina trying to sort whether you are seeing cortisol withdrawal or low cortisol might really help you work out what dose suits her best.

Alison

[labblab]

Originally Posted by AlisonandMia

I believe Dechra says somewhere (and I'd dig it out but won't be able to because I've got a v-e-e-e-e-ry slow connection at the moment - need that "frustration" emoticon, too!) that with Trilostane treatment the way to discriminate between cortisol withdrawal and absolutely-low cortisol is to take a look at the electrolytes - I'm pretty sure it's in the latest US product info if you want to be look it up for yourself (see Trilo FAQ's). This is because, with Trilostane, if the cortisol really is too low then the aldosterone (the adrenal hormone that balances the electrolytes) will also be too low and this will show up as an electrolyte abnormality.

I think with Angelina trying to sort whether you are seeing cortisol withdrawal or low cortisol might really help you work out what dose suits her best.

Alison

John, I think these are the Dechra excerpts that Alison is talking about (taken from: http://www.dechra-us.com/File/prod_vetyrol.pdf):

A small percentage of dogs may develop corticosteroid withdrawal syndrome within 10 days of starting treatment. This phenomenon results from acute withdrawal of circulating glucocorticoids; clinical signs include weakness, lethargy, anorexia, and weight loss.1 These clinical signs should be differentiated from an early hypoadrenocortical crisis by measurement of serum electrolyte concentrations and performance of an ACTH stimulation test. Corticosteroid withdrawal syndrome should respond to cessation of VETORYL Capsules (duration of discontinuation based on the severity of the clinical signs) and restarting at a lower dose.

and also:

If the ACTH stimulation test is <1.45 μg/dL (<40 nmol/L) and/or if electrolyte imbalances characteristic of hypoadrenocorticism (hyperkalemia and hyponatremia) are found, VETORYL Capsules should be temporarily discontinued until recurrence of clinical signs consistent with hyperadrenocorticism and test results return to normal (1.45-9.1 μg/dL or 40-250 nmol/L). VETORYL Capsules may then be re-introduced at a lower dose.

Marianne

[Roxee'sDad]

Hi John II, the Grey, and almost bald,

I truely feel your frustration and pain. All we can do is keep the faith and keep working on it.

Hope it get's better with Agelina this evening.
Belly Rubs if she'll let you
John (Roxee's Dad)