Angelina 13.5 year old/13kg Maltese Cross on Trilostane

[Roxee'sDad]

Re: Angelina 13.5 year old/13kg Maltese Cross on Trilostane

Thanks Marianne and Allison,
I learn something new everytime I visit here. I had to read the paper a few times to begin to comprehend but managed to get the jist of it.


John II AKA The Grey - How about a case study of a success story

John (Roxee's Dad)

[AlisonandMia]

Re: Angelina 13.5 year old/13kg Maltese Cross on Trilostane

The weird thing with both dogs and humans showing the same biochemical changes re being in a hyperchoaguable is that clots are so rare (but not unheard of) in Cushing's dogs whereas in humans it is a very real danger that makes the risks of using heparin worth taking. There must be other factors at work. High cortisol levels seem to affect different species in slightly different ways.

Alison

[John II]

Re: Angelina 13.5 year old/13kg Maltese Cross on Trilostane

Hello All,

Update Time.

On Monday afternoon, I got a call from The Specialist's Office that the 20mg capsules of Trilostane had arrived. I went to collect them shortly after - and resisted the urge to give her a dose that evening.

Breakfast time Tuesday morning, I started the 12 hour dosing of 20mg.

This morning (Wednesday) Angelina was interested in going for a walk, and walked with some improvement, compared to the last time (on Sunday). She seemed fine all day.

But... 30 minutes ago, after lying on her side for a while (post dinner snooze- and about 2 hours since her second dose of the day) she got up and was walking with difficulty. I'd say with a limp, but I'm unsure which leg to blame a limp on.

I just watched her get up to change position, and the limping continues. Very old lady.

This hasn't really happened to date.

Could this be:
* A slight increase in Trilostane?
* Progression of the disease?
* Arthritis being unmasked?
* A clot?
* A reaction to colder weather (currently 15 degrees celsius/ 60 degrees farenheit)?

I didn't want to be hopeful so early after a change in dose - but it's really unfair for things to get worse so quickly!

She wanted to go on the couch and I lifted her up and covered her up to keep warm - but a few minutes later she wanted to be lifted down again, and is back to lying on the floor. Seems she can't get comfortable.

John the Greyer and Angelina

PS: Thanks to Marianne for the clot homework

[John II]

Re: Angelina 13.5 year old/13kg Maltese Cross on Trilostane

An update to my update:

I forgot to mention that Angelina's abdomen seems to have more of a bulge to the left side. Is this familiar to anyone? I initially thought it might be a trick of the light (like when I thought her hair was changing colour) or just the way it appeared when she was moving - but now I'm not so sure.

Angelina has gone to bed now - but keeps changing position as if she can't get comfortable.

And I'm worrying that Trilostane is reacting with a pre-existing condition.

[AlisonandMia]

Re: Angelina 13.5 year old/13kg Maltese Cross on Trilostane

I forgot to mention that Angelina's abdomen seems to have more of a bulge to the left side. Is this familiar to anyone? I initially thought it might be a trick of the light (like when I thought her hair was changing colour) or just the way it appeared when she was moving - but now I'm not so sure.

I think if you think you are seeing something then it is there - that has been my experience overwhelmingly. Some things are so subtle especially at first that you begin noticing them on an almost subliminal level but almost invariably it becomes clear that there really is something there. If she is sore it could be a result of how she is carrying herself - ie curving slightly to one side so a leg doesn't hurt. Do you notice it more at some times that others such as after meals or whatever? It sounds like something to draw your vet's attention to.

I believe that front-leg lameness (this is what Angelina has isn't it?) can be a result of a neck problem: http://www.dolittler.com/2009/05/12/...%99s-take.html (This is specifically about neck injuries from collars but it mentions symptoms of neck injuries and I'd think the same would apply with arthritic/degenerative neck problems.) Her inability to get comfortable sort of fits with neck pain/discomfort - there is nothing like an uncomfortable neck to make anyone restless.

Hope this helps.

Alison

[Roxee'sDad]

Re: Angelina 13.5 year old/13kg Maltese Cross on Trilostane

Hi John (The GREY)

Could this be:
* A slight increase in Trilostane?
* Progression of the disease?
* Arthritis being unmasked?
* A clot?
* A reaction to colder weather (currently 15 degrees celsius/ 60 degrees farenheit)?

I wish I could help you but it sounds like it could be any one or more of the above. This is so wierd because Roxee has the same type problems.

ie curving slightly to one side so a leg doesn't hurt. Do you notice it more at some times that others such as after meals or whatever?

Roxee stands with a curve and it seems one side behind her ribs is caved in or one side is a little more plump. Vet took x-rays a few months ago, of her hind leg and pelvis but could find nothing wrong Bad day yesterday, she could barely stand without falling over. Looked like she hurt her left front leg. We are doing a stim on Thursday and I was afraid we might be changing from stim to crossing the Bridge. She got a good nights rest and is walking better today

Regarding covering with a blanket, I've read and also by experience with Rox that cush pups have a hard time dealing with the heat. Roxee prefered to sleep and rest on the coldest part of the floor even in the winter. I was wearing 3 pairs of socks but Roxee just prefered the cold floor to a warm spot or a blanket.

So Roxee is still having good days and I get so hopefull, then she has a bad day and I get depressed but then remember what Leslie said. "On the bad days, remember the good days." and I regain hope.

Now Allison seems to have given me some homework and I need to check out the link she provided.

BTW- has Angelina ever had any leg, more specifically ACL (knee) problem? Roxee blew out her ACL some years ago and it seems this is fairly common in cush pups. She now carries that leg stiff as a board, as Glynda calls it a peg leg.

And I'm worrying that Trilostane is reacting with a pre-existing condition.

Yes, I have been wondering the same thing about Roxee. With the constant struggle to keep her weight on her, 4 meals a day. The struggle to keep her balance and walk, I wonder about the other hormones the adreanal puts out. I've read so much about this and that's why I was and still am considering the UTK panel. The ultrasound was good to have done, but in retrospect, I should have spent the extra dollars to do the UTK panel in addition. I think it's the only way to be absolutely sure. Just my opinion, but I think alot of us get lucky with the standard testing and ultrasound but the UTK results would eliminate alot of the what if's and would most probably give me / us some peace of mind.

Well, sorry I was so long winded, I really hope you see improvements in Angelina. I know you must feel so confused and helpless sometimes as I do but we do the best we can. If only they could talk to us and tell us what hurts.

Keeping good thoughts and prayers for Angelina and You.
John (Roxee's Dad)

[John II]

Re: Angelina 13.5 year old/13kg Maltese Cross on Trilostane

The following was written about 5 hours ago...

Hello All,

I spent last night in cat-nap mode, alert to any sound, real or dreamt.

Angelina spent the night on the queen-sized bed of another member of the household. I was up every hour or less to check on her. Whenever I did I was worried to see her position on the bed changed and her eyes wide open.

At breakfast time, I skipped the Trilostane dose.

A few hours later, Angelina let it be known that she would be interested in a walk, if anyone was interested in taking her. But she only went about half the distance she did yesterday.

I was out grocery shopping for a couple of hours – all the while worrying what I would find on my return. But – I found her improved. Her lameness seemed to have eased.

Especially when offered her favourite lunch of BBQ chicken. Excitement seems to ease the symptoms.

The downside of giving Angelina her favourite lunch, is her turning up her nose at the dinner of canned food. I tried tempting her with some more chicken bits on top – she ate the chicken, but left (most) of the rest. We skipped the dinnertime Trilostane dose as well.

Oddly, now as day turns to night, it seems as though the lameness is starting up again!

So now I don’t know what to think.

Alison – you’re feeding my paranoia! So far I’ve only noticed the abdominal bulge at random times – just when I happen to be watching her walk – I haven’t found a pattern as yet.

Neck problem? EEK! I can think of three incidents in the last 9 months or so. The dog attack where the vicious (censored) dog had her by the throat – while the other (censored) dog had her by the ribs. And two separate tumbles she took (Angelina is not always the most graceful girl) – one of these falls a foot or so drop onto concrete (she was watching the food – not the ground). Of course the cortisol may have been masking all this until now.

Thanks for the link!

Brother John – sorry to hear that Roxee had a bad day. It just tears your heart out doesn’t it? Hope she has many more good days!

Having read all these Trilostane “the miracle drug” testimonials online, the reality of it is kind of underwhelming. I keep wondering what would have happened if I’d taken the path my Vet suggested and gone with Lysodren in the first place? Would Angelina be better off? Or would she be gone already? Second guessing myself as always!

I don’t think Angelina has an ACL problem – in her early days she would launch herself off the couch or the beds without regard for the consequences. A few years into dog ownership I started using a couple of couch (seat) cushions (wide and rectangular and flat) as Angelina landing zones. She avoided these obstacles at first, but gradually realized it was a softer landing. I hope this means less impact to her joints.

However her other tumble (a few months back) was off these cushions, when I had stacked the two on top of each other – trying to make steps from the floor to the bed (when she was still making the attempt herself). Getting up later that night she hadn’t expected the additional height! Double eek!

So neck problem? Maybe. ACL problem? Maybe.

Thanks for the good thoughts and prayers!

John (the confused and greyer) and Angelina.

[John II]

Re: Angelina 13.5 year old/13kg Maltese Cross on Trilostane

And now, 5 hours later I'm wondering if I'm onto something.

Angelina's lameness seemed to decrease as the day warmed.
And then it seemed to increase as the day cooled.
Maybe there's no relation to the Trilostane at all?
Maybe it's all just the cold getting into her old bones?

Which, if it's true would be just ironic - I spent all Summer wishing for Winter - now I may just spend all Winter wishing for Summer... or central heating.

John & Angelina

[Patricia ann Wh]

Re: Angelina 13.5 year old/13kg Maltese Cross on Trilostane

Hi John,

I've been keeping up with your story.

My guy, Jesse is going through the same ups and downs.

When he collapsed on the 5th day of trilostane -(we started at 15 and 15 mg a day when we went to 30 - 30 he collapsed. I stopped and he got better and better.
I restarted about 5 days later ( my notes aren't in front of me) at 15 mg. (he's 85 lbs) a day and the first 3 days he was great, on the 4th day he could barely get up.!!!

So, I thought the 15 mgs was the ticket.
But because he got so weak on day four of the 15 mgs. that also had to be too much.

Now, 2 days off and he is better.

I don't know - I just don't know.

Patti and Jesse

[Patricia ann Wh]

Re: Angelina 13.5 year old/13kg Maltese Cross on Trilostane

Have you seen this below - just to add to our confusion

http://www.justanswer.com/questions/...taking-vetoryl


Question
My dog weight 45lbs and taking vetoryl 60mg every 3rd day. His clinal sign is good with the meds. that he is on. Should I lower the dosage to 10mg per day instead for 60mg every 3rd day?

Patti and Jesse

[Patricia ann Wh]

Re: Angelina 13.5 year old/13kg Maltese Cross on Trilostane

Hi John, I thought this was interesting too. The paragraph is from the link below.

http://www.dcavm.org/04sept.html

Currently, the recommendations of this author are based mainly on those of Dr. Reto Neiger who has the most experience in using this drug.20 Recommendations are to start administration of trilostane (2-10 mg/kg) once daily. If minor side effects are seen, stop the drug for 3-5 days and then restart giving trilostane every other day for one week before continuing with the initial dosing scheme. An ACTH stimulation test should be performed at 10-14 days, 30 days and 90 days after being on a full dose of trilostane. The test should be performed 4-6 hrs post-pill. If the post-ACTH cortisol concentration is <20 nmol/L, stop the trilostane for 48-72 hrs.20 At this point, Dr. Neiger recommends restarting the trilostane at a lower dose20, but given the long-term suppression seen in some cases, I believe that, ideally, an ACTH stimulation test should be performed and trilostane should not be reinstituted until cortisol secretion has recovered. If the post-ACTH cortisol is >200 nmol/L, increase the dose of trilostane. If the post-ACTH serum cortisol concentration obtained is between 20 and 200 nmol/L but the clinical signs are continuing, then twice-daily therapy should be used. The same dose that was given once-daily should be given twice (e.g. if giving 30 mg once daily then double it to 30 mg twice daily). Once the clinical condition of the dog and the dose have stabilized, an ACTH stimulation test should be performed every 3-6 months and serum potassium concentration should be measured to check for hyperkalemia.

RESTART EVERY OTHER DAY FOR ONE WEEK.

HAVE YOU HEARD OF THAT ONE?
Whew - its endless

[Roxee'sDad]

Re: Angelina 13.5 year old/13kg Maltese Cross on Trilostane

Hi Patti and John,
Hope I'm not hijacking your thread John but yes, this can and sometimes is so confusing. Like has been said so many times, every pup is different and maybe just maybe, Jesse and Angelina may need more exact dosing. maybe 10 instead of 15 for example

Roxee doesn't show any symtoms of overdosing, her or our problem is that she went untreated for over 2 years and was very weak and lethargic before we started treatment. I am just hoping it isn't too late for a decent recovery. We are off to the vet's now for her stim, it's about a month early but I've noticed some increased panting in the evenings and increased thirst. But still, she is better today than she was in Jan.

Will check back later, we are off to the vet for a stim and electrolyte check.

John (Roxee's Dad)

[Squirt's Mom]

Re: Angelina 13.5 year old/13kg Maltese Cross on Trilostane

Hi John,

You may have missed this info posted by Kathy about Trilo (Vetoryl):

http://www.fda.gov/cvm/CVM_Updates/D...ingDisease.htm

http://www.fda.gov/cvm/FOI/141-291o120508.pdf

These studies are more current than the links posted by Patti and are associated with the approval of Trilo in the US.

I am sorry Angelina is having so much trouble getting on her feet. I hope you see an improvement soon in all areas.

Hugs,
Leslie and the girls

[Patricia ann Wh]

Re: Angelina 13.5 year old/13kg Maltese Cross on Trilostane

Hi Leslie and Girls and John,

Please don't get me wrong with my info. I just spend every minute it seems reading and trying to understand this whole thing and try to understand more for my guy Jesse. It seems some have such great luck with trilostane.
So - I'm looking at what the possibilities could be when things don't go quite so perfect for us.
So, do you think if the 4th day of trilo and the legs get weak - stay on it??
His legs are weak already - they are definitely more weak after the trilo.
I've read stories where people say their dogs legs are weak before - but after time they do get a little better - but they didn't say if the legs got worse and they stuck with the trilo or if they did not see weakness at the beginning of the trilo. Can anyone understand what I'm talking about?? I'm not sure I'm clear.

Thanks, Patti and Jesse

[Patricia ann Wh]

Re: Angelina 13.5 year old/13kg Maltese Cross on Trilostane

Hi John,

Jesse and Angelina may need more exact dosing. maybe 10 instead of 15 for example

Have you ever read where a dog Jesse's weight has been on something as low as 10 mg. a day??

Patti and Jesse