Meera, 10-12 Years Old, Start on Trilostane Not Going Well (Meera has passed)

[Meerabum]

Hello to all and I hope life is treating you and your multi-species families well!

My pooch Meera was diagnosed with Cushings a few weeks ago - most of the classic signs - excessive drinking, peeing and eating; muscle loss, mild hair loss, flaky skin, slowing down. She was still going for brisk walks but never ran any more.

She was diagnosed after an ACTH and started on 40mg of Trilostane once daily - she's a 19.5kg Staffie cross. On day two she was a little more wobbly than usual but drinking less. We went for a walk, she was fine but then on the way back began to slow down, got increasingly unsteady and crouched continually like she was undecided whether she needed to go number one or two. She squeezed out a tiny amount of the latter then once we were home she slept on and off until midnight. Her appetite was intact but I stopped the meds the following day and consulted the vet. I was advised to restart at a dose of 30mg a few days later once she had returned to normal. Exactly the same situation arose, day two of treatment on the return leg of a walk. This time she was even more wobbly on her back legs. I was advised to try again on a dose of 20mg which I did.

This is day 4 of the 20mg dose. Up until now she had been okay - kind of sleepy, a bit weak in the back legs but drinking less with a good appetite. I noticed her getting very warm today then, as I typed this, she threw up and had a severe dose of diarrhoea. Trilostane is, I think, her only treatment option and I desperately want it to work for her. I will need to stop the meds again and get back in touch with the vet but they were intimating during our last phone call that if this dose didn't agree with her then we may need to just let the Cushing's run its course.

Is this a common experience starting out on Trilostane for others or does this seem like a particularly adverse reaction? I was thinking, based on studies, that splitting the dose into twice daily 10mg instalments might be worth a shot but my vet didn't seem to know much about that.

Any thoughts or comments welcome. We live in hope!

[labblab]

Hello and welcome to you and Meera, although I'm surely sorry she's having such a tough time right now. We are really glad you're found us, and we will do our best in offering thoughts and suggestions.

First of all, it will help us a lot if you can tell us a bit more about her overall health history and also the diagnostic process that led to her Cushing's treatment. Does she have any other known illnesses, and for how long a time has she been exhibiting the symptoms you've listed? We'd love to find out the exact numbers for her ACTH test, and also any other abnormal values on recent regular blood or urine panels.

As far as her response to the trilostane, dogs can be highly variable in terms of the way in which they metabolize the medication. So even though you have been lowering the dose, it may still be the case that it is merely too much for her, and she needs yet a lower dose. May I ask what form of trilostane you are giving -- is is brand name Vetoryl or instead a compounded product? If it is compounded, in what form (capsule, tablet, chewable, liquid)?

Thanks in advance for any additional info you can share about your girl and her health history!

Marianne

[Joan2517]

Hi and welcome from me too. You must be so worried. I'm sorry Meera is having such a rough time. Please post the results of her blood work, only the highs and lows with the reference ranges. Members more knowledgeable than I am will need to see the results and they are wonderful.

We are all here to help you through this!

[molly muffin]

Hello and welcome from me too. I have the same concerns that she is sensitive to the drug and will need a lower dose.

I think if it were me, I'd have her off meds for at least a week or so before trying maybe 10mg.

Where any other abnormal values found on her blood and urine tests? If so could you post anything that is high or low and the range here? This would help us to give you better feedback.

[Carole Alexander]

How is Meera? Is she again off the Triolostane?

[Meerabum]

Thank you to everyone who took the time to reply and my sincerest apologies for disappearing - it's been a horrible couple of weeks.

I said goodbye to Meera yesterday after things took a severe turn for the worse. The day after I posted I took her to see the vet for a chat before I decided whether to give the Trilostane another try. After the vet had a look at her last blood test results (she was my fourth different vet within the same practice during this experience) she referred Meera to have her bloods redone. She was surprised by the extremely high ALT count >1000. The vet I had seen for the first ACTH and ultrasound had found 'holes' in Meera's liver but was taking the chance that they were caused by the Cushing's and may improve with the Trilostane.

The second blood test did not go well. After seeing even higher ALT in the initial test the vet (yet another different one) performed another scan and found the liver was in even worse condition. She advised that Meera may only have a few weeks to live. She was walking around fine, albeit sometimes slowing a little, her appetite was ridiculously good and all of her ablutions were perfect. I couldn't believe it. Over the next week Meera just got worse and worse. Her breathing began to suffer, she lost her appetite and all of her strength. She was dying of liver cancer which seemed to be spreading to her lungs. The vet came to our home yesterday to ease her passing and it was not a moment too soon. She went downhill so fast.

I would urge anybody whose dog is starting Trilostane with very high liver read-outs to be extra, extra careful. The high cortisol caused by the Cushings was part of what was keeping Meera stable - taking that away and putting stress on her liver with the medication probably pushed her down a little faster.

I'm so proud of how she handled it all, she was so calm and strong. I'll miss her every day for the rest of my life. It was just me and her for so long that I don't know how to even start coping!

Thank you again to the people who replied, shared and showed concern. I wish I had found you all weeks ago - the effort you put in for other's pets is beautiful.x

[labblab]

Oh my, I'm so deeply sorry about your loss of sweet Meera. Thank you so much, though, for returning to let us know what happened. This allows us to always honor Meera on our special memorial thread, amidst our other precious babies who have preceded her.

http://www.k9cushings.com/forum/showthread.php?t=8383

We surely understand how much you will miss her. So please do feel free to return to us at any time to talk, to share stories, or just to tell us how you're doing. Sweet Meera is now at peace, and I hope you'll be able to find a bit of comfort in knowing that she will never suffer again. But we are here for you whenever you may have hard times yourself.

Always in loving memory of your brave, sweet girl.
Marianne

[Joan2517]

Such sad news...I'm so sorry for the loss of your sweet Meera.

[molly muffin]

oh i am very sorry to hear of your loss of your Meera.
My sincerest condolences.

[Carole Alexander]

I too am so sorry for your loss. I can imagine how sudden, shocking and tragic this must all have been for you. Thank you for your follow-up post; I know that you did everything that you could and hope that you can find comfort and healing as time passes. My best to you,
Carole