Spencer, Chihuahua just starting treatment

[Melsteele]

Well when we changed his dose and he seemed to be doing well with the amount and his bladder issues were improving, my vet said just keep doing what we were doing and she didn’t do the test again. Other than the weight gain and being a little more mopey than normal, he seems to be doing ok. Not really depressed acting but just a little out of it sometimes. His diet hasn’t changed. Still feeding him the same amount everyday (like 1/2 cup). He doesn’t drink excessively like he was doing at one point. The only thing different I’m doing is..the vet told me to give his medicine with food (it’s liquid)... the only thing I can get him to eat it in is baby food (chicken). I only give him about a teaspoon to a teaspoon and a half each time I give it, which is twice a day. It takes several days to use up one very small jar of baby food. Other than that, that is the only thing I’m doing different.

[Squirt's Mom]

Since the vet has not been following protocol, he needs an ACTH pretty soon to see where he is now. Signs can certainly help us know if the cortisol is getting off but the labs are critical. It is nice when the vets try to give us a $$ break but our babies depend on those labs so they do need to be performed any time we see a change. So I would be calling his vet this afternoon for an ACTH.

[Harley PoMMom]

The only thing different I’m doing is..the vet told me to give his medicine with food (it’s liquid)... the only thing I can get him to eat it in is baby food (chicken). I only give him about a teaspoon to a teaspoon and a half each time I give it, which is twice a day. It takes several days to use up one very small jar of baby food. Other than that, that is the only thing I’m doing different.

So prior to this Spencer wasn't getting his Trilostane with a meal?

[Melsteele]

No. That’s what I’ve been doing ever since he’s been on his medication. That’s just the only change in his diet since the very beginning (of being on new medication).

I spoke with my vet. She wanted to increase his dose a little before we do any further testing. She seems to think his dose was too small to be seeing any difference. We’ve increased it to .3 ml twice a day for now. So far so good! I believe we’ll increase it again in a week or two if he keeps doing well. He may have perked up a little since we’ve increased it.

[Melsteele]

any thoughts on not treating for Cushings? Spencer’s bladder issues are somewhat better but ever since he’s been on the Trilostane he just hasn’t been himself. He’s always in a daze almost like he’s depressed. Sometimes he would perk up but but it doesn’t last long. Now he does wag his tail when I come home so he gets happy for a minute, but then it’s gone. My vet has not tested him anymore be we have slowly been increasing his doses trying to get to .5ml. We are at .45 now. I really don’t feel he has improved as much as I thought he would and it’s been since the end of March that we started his medication. He’s gaining weight. He’s up to 12.3 lbs now. Sometimes I think he’d just be happier and better off without it. Any thoughts?

[labblab]

I am really, really, really worried that your vet thinks it’s OK to keep increasing Spencer’s trilostane dose without doing any of the monitoring testing. It is not OK to do this. It is not safe to do this. It sounds like she’s arbitrarily trying to increase him to .5 ml without knowing whether his cortisol level supports any of theses increases. I am baffled as to why she’s doing this. Spencer may seem so “blah” to you simply because he’s overmedicated.

Of the two options, stopping the trilostane vs. overdosing him, stopping is actually the safer alternative. But I’m hoping you can tell us why your vet is not doing the proper testing. Spencer might be doing much better if he was actually taking the dose that’s appropriate for him.

Marianne

[Melsteele]

Well the only answer I have is that originally, in the very beginning, she said that .5ml twice a day was the appropriate dose for his size. He didn’t do well taking it with his heart medication so we stopped the heart pill and decreased his dose of Trilostane. She said we’d start low and work back up to the appropriate dose. (.5ml) so every few weeks we increased it slightly. A few weeks ago we weighed him. She said some of his weight gain was because he was on too low of a dose. She just said to slowly increase it, till we reached the original dose. I really feel like he would be much happier without it. Everything I’ve read states that Cushings will not make them suffer, and in most cases the cause of death ends up being something else. I want to do whatever it takes to prolong his life but I want him to feel better the rest of his life too. He’ll be 15 Wednesday. If I do stop it, is it ok to stop it cold turkey, or do I have to wean him off of it? In the beginning we stopped it while we were on vacation but he had not been on it very long at the time.

[Joan2517]

He doesn't need to be weaned off...just stop it.

[Melsteele]

Ok good! Thanks! How long should it take to get out of his system? Just wondering how long it should take to notice a difference in how he’s acting.

[labblab]

Well the only answer I have is that originally, in the very beginning, she said that .5ml twice a day was the appropriate dose for his size. He didn’t do well taking it with his heart medication so we stopped the heart pill and decreased his dose of Trilostane. She said we’d start low and work back up to the appropriate dose. (.5ml) so every few weeks we increased it slightly. A few weeks ago we weighed him. She said some of his weight gain was because he was on too low of a dose. She just said to slowly increase it, till we reached the original dose.

Joan is correct, you can just stop the trilostane without weaning. And that may be your best option right now. But I just want to explain why I’m worried about your vet’s approach to all this, especially for other readers who are new to treatment. The initial starting dose for trilostane is indeed based upon weight. However, the only way to know whether or not that is truly the “appropriate” dose is through subsequent monitoring blood testing. There is wide variability in how individual dogs metabolize the drug, so the notion of dosing by weight is only the starting point. Some dogs end up always needing a lower dose than they started out on; other dogs need a bigger dose. The way you find this out is by observing symptom improvement or symptom rebound, and by blood testing. Official recommendations are to conduct this blood testing first after two weeks of treatment, or at one month at the latest. If doses are changed, the blood testing should be repeated at the same intervals. As far as I can tell, your vet hasn’t conducted any of this monitoring testing, so we have no way to know whether Spencer’s current trilostane dose is still too low for him, or instead way too high.

So to go full circle, if your vet is not going to test Spencer’s cortisol level, it is safest to stop the medication. At his age, there may be more pluses than minuses to discontinuing treatment. But I’m afraid your vet is really missing the boat in terms of the way she’s handled his dosage increases, and that leaves me worried about other Cushing’s dogs in her care.

Marianne