Adverse effects to Trilostane. How common? (Sweet Lily has passed)

[Lilypily]

Hi everyone, this is my first post. My little Mini Foxie Lily has recently been diagnosed with Cushings.

She turns 11 on the 1st of December. She has had a rough past 4 months, she ruptured her ACL Ligament, so she underwent surgery to repair it.

For quite a while now she has had the odd accident overnight, i'd say once a week at the most i'd get up to find a puddle on the kitchen floor. It didn't worry me, old age I thought.

Straight after her ACL surgery she starting urinating overnight about 3 times everynight. So we went back to the vets with a urine sample which came back clear, but my vet still prescribed a 10 day course of Clavulox just incase she had mild cystitis.

The antibiotics didn't help, so back to the vet and he said it must be age, so he prescribed Propalin and said within 2 days she will stop the overnight urinating. At 10 days I gave up, it wasn't helping at all.

So while waiting for our next vet appointment I jumped online and did a lot of reading. A lot of things clicked such as her fur has not grown back after her surgery, i'v had people comment 'gee she's gained weight, look at how round her tummy is'.

Ok, so back at vets we had full bloods taken. There were a few things out of whack and vet suggested Cushings so we did the 8hr LDDS test and it came back very high.

Tuesday she started Trilostane 30mg. She became lethargic and vommited her dinner. Wednesday I gave her another capsule and she crashed really badly and really quickly. She was vommiting, diahreah, not drinking and not eating and not responding properly to us.

So quick dash to the vets. They did a electrolyte test and the good news is they are all in the normal range. Vet was worried that there could be secondary liver problems, so I had a nervous wait for those results, and they came back that her ALT has decreased. YAY.

They kept her in and put her on a drip as she was dehydrated and gave her a shot of Cortisone to see if that would perk her up (it hasn't)

I picked her up this morning, they wanted to keep her in over the weekend but I said no (i'v got the vet on call's mobile number)

Vet says that hopefully by tomorrow afternoon she will start to pick up and hopefully make a full recovery. Hopefully??????? All she had was two 30mg capsules.

Right now she has no interest in food, is beyond lethargic, she is flat as a tack. She has been drinking and I know she's been well hydrated as she's peed A LOT today. She still has diahroea, i'v boiled up a chicken breast and some rice.

She is officially off Trilostane. Vet says now not to treat and to just love and spoil her, she won't live as long, but she'll be happier.

Sorry for the essay. Has anyone else had a dog suffer a severe reaction to Trilostane?

Lily is 5.5kg. We go back to the vets on Monday (please cross fingers that we don't have to go back over the weekend) I'll get copies of all her bloodwork and tests.

[doxiesrock912]

Welcome to you and Lily.
30mg for a 5.5kg dog is much too high.
The symptoms that you're describing suggests this as well.

For example, our 11lb mini dachshund Daisy Mae takes 9mg of Trilo twice a day.

It is best to start low regardless of what the numbers say because every dog reacts differently. You can always increase later.

[mytil]

Hi and welcome from me as well.

Yes, this can be common although it is not the rule. There are some dogs who are hyper sensitive to a drug more so than others....or, your Lily does not actually have Cushing's and her cortisol levels dropped to a very low level with the Trilo.

Did your vet discuss with you the possibility of diabetes or thyroid conditions and any testing to rule these out?

I would say that 30 mgs is what is listed in the products dosing recommendations, but....a lot start at a much lower dose and work up. From the sound of it your poor Lily has experienced a very sensitive reaction to Trilo. And it would be great if your vet would give you the actual numeric results of the ACTH test performed when you took her in for the crisis she was having.

IMO I would not give her any more Trilo until she has completely recovered from this as well.

Can you let us know all the tests performed to diagnose Cushing's. You mentioned only elevated levels in the blood panel and a LDDS.

Keep us posted
Terry

[Lilypily]

Thanks guys.

The elevated bloods and LDDS test were the only tests done to confirm Cushings. No there was no talk of Diabetes or Thyroid problems.

The vet did not do a ACTH test when I took her in yesterday, he said as she had only had 2 capsules it wasn't enough to get a reliable result. He said he actually erred and gave her 30mg that he was thinking of giving her 60mg (I shudder to think how she would be if he had of).

He said as her electrolytes are all in the normal range that means she isn't suffering from a Addissons crisis.

He also said the injection of cortisone should of perked her up, but it hasn't.

Her original bloods, her ALT was two hundred and something (as I said on Monday i'll get copies of all her tests). Yesterday he rechecked her ALT saying he was concerned that if it had continued to rise we would be looking at a secondary liver problem. The test came back that her ALT has actually decreased.

He did say to that she is presenting as a odd case. Originally yesterday he said we'd still do the 30mg but every second day. Then he changed his mind and said we'd do 10mg. Today when I picked her up I had to see another vet as my vet was away for the day. This vet said 'No more Trilo'. Based on my limited knowledge of Cushings I agree. My little girl has never been so sick and I don't want to risk her being unwell again.

She has eaten some chicken and rice and kept it down. YAY! She is still very lethargic and keeping to herself. She hasn't regained any interest in us or her surroundings.

[frijole]

My guess is that your dog doesn't have cushings - to crash on a single dose which is what happened makes me very suspect. The ldds test you had done is a good test but it is known to have false positives when other illnesses are present.

And as others have mentioned that is too high of a dosage to start on for a dog that size. Sounds like that vet was all over the map. You might have to find one that has more experience. If they did bloodwork you can see if they checked glucose levels so you can rule in or out diabetes. Thanks Kim

[labblab]

I, too, am very surprised by Lily's extreme reaction to just two doses. It is unusual. As Terry has mentioned, 30 mg. is the correct dosage for a dog of Lily's weight per the manufacturer's published chart. However, in the intervening years since the chart was first published, many vets (and the manufacturers themselves) are generally recommending a lower starting formula of 1 mg/lb or 2.2 mg/kg. So yes, we would have wished to see a lower starting dose, but Lily's response still seems surprising.

In my own mind, I'm not so much questioning the Cushing's diagnosis itself, but instead puzzling over Lily's extreme sensitivity to the medication. In addition to the electrolyte check, I would have wished that your vet had performed at least a resting cortisol test. The electrolytes are only half the picture when it comes to Addisonian issues. If Lily's cortisol was too low, you would have expected the cortisone shot to help. But she may still be at need for supplemental oral prednisone after the effects of the shot wear off. So if she doesn't start perking up soon, I would want to know the status of her resting cortisol level, at least, even if a full ACTH is not performed.

Bottom line, I guess, is that the manufacturers do warn that dogs can experience adverse reactions to trilostane at any time, and I guess Lily is the living proof of that :(. I, too, would be very wary of considering giving the drug to her ever again -- and certainly only at a very low dose and not until she has made a full and complete recovery, proven by complete testing including a diagnostically high ACTH result indicating a complete cortisol rebound. Please keep us updated, OK?

Marianne

[goldengirl88]

Welcome to you and Lily:
I just wanted to add a few things that I think are vitally important here. You said you had an LDDS test done. Is this all the testing you had done to confirm Cushings? If so I would urge you to rethink that. Cushings is one of the hardest diseases to diagnose. These are powerful drugs you do not want to be giving if your dog does not have Cushings, the outcome could be bad. You said your vet thought Lily might be having liver problems. I don't understand the guessing on your vets part. Did you have a full blood panel done to see if there are liver problems? The last and most important thing I have to add. Even though the dosage is correct for Lily's weight, it is way too much to start out with. You need to give her time and let her recuperate. If in fact she does have Cushings and you get the proper testing done, and your vet follows the proper protocol, I would start her on no more than 10mg. I am speaking to you from experience. My Jack Russell Tipper has Cushings. The vet wanted to start her on 30mg. I refused thank God, and started on 10mg. The dogs body needs time to adjust to this drug. After she has been on the 10mg you need to get an ACTH test. You can then tweak her dose little by little until she is controlled. You always get an ACTH test when changing doses. DO NOT FAST YOUR DOG BEFORE THIS TEST no matter what your vet says. If you do you run the risk of an invalid test and overdosing your dog. Also do not ever split these capsules per the drug manufacturer. If your dog needs a dose that Dechra does not sell you need to go to a compounding pharmacy. Vetoryl comes in 10mg, and 30 mg for your size dog. Anything in between you need to get compounded. I am trying to get you on track here without having to sound controlling, but you are your dogs best and only advocate, so you need to get educated with as much material as you can. The people on here have more experience with this disease than most vets. Most vets have never treated, or diagnosed this disease, so you need to be careful and know what your vet needs to do so you can over see things. Never leave your dogs fate solely up to anyone else but you. That means if someone tells you to do something with your dog, come on here and ask questions first before letting anyone do anything, this is your safety net. You may also want an Ultra Sound of the adrenals to find out what type of Cushings your dog has. I would suggest you start a doggy diary and add to it daily. You will need it to refer back to. Because you have a terrier breed I am going to go out on a limb and say the reaction your dog had was too high of a dose to start. Terriers are really touchy when it comes to drugs, vaccinations, etc. They can have bad reactions. Terries don't do well with Leptospirosis shots, mine almost died from one, the vet told me she should never have one again as it is a terrier thing. So what I am trying to say is it is inherent in the breed somehow that they can experience reactions to things other breeds would not. So with that and the higher starting dosage I think that is the problem. I am hoping you get Lily straightened out, tested and on a lower dosage to start. This should help you out. We are all in the same boat, so when you need help we are here for you. It will be ok once you get Lily straightened out. Just be vigilant and watch for signs of trouble. Blessings
Patti

[Lilypily]

Thankyou so much guys, your advice is really appreciated!!

I'll back up a bit. Originally I was concerned her problems may have been from a chicken jerky treat I was feeding her every day "VitaPet JerHigh Chicken Tenders". It was while doing internet reading I came across all the issues with these products, and I looked at the packet and yep they are made in Thailand.

I freaked out and mentioned this to my vet, he was suspicious himself, but when he did the bloods and LDDS test he said cushings. One last test to rule out the jerky product he said was a glucose test. We did that and it came back fine.

I threw out the remaining product and I now make my own jerky with fresh chicken breast. Since stopping the product she got better. She went over a week without a overnight accident (coming from atleast 3 everynight for several months).

Well that only lasted the one week and she went back to her accidents.

Yep Goldengirl a full blood panel was done. Her ALT was two hundred and something and another liver enzyme was up. Vet said he wasn't concerned with that one as cushings dogs have that parlicular enzyme elevated (as I said i'll get a copy of all results Monday, will be much easier then). Yep just the LDDS was performed.

My girl is a fussy little thing and I said to my vet 'I won't be able to get a capsule into her, I crush her meds and mix with food'. He said 'no worries, just break the capsule and mix the powder with her food'. Now i'v read that is a bad thing to do??.

Frijole, i'm guessing the dipstick urine test for glucose would of shown any problems re: diabetes?

She is a touch brighter this morning, she's snuggled in her bed (she shared my toast, that's how I know she is on the mend, lol)Also interestingly she never had a accident overnight.

Also from my reading is this something to think about or not - she was having her overnight accidents well before she ruptured her cruciate. If it's cushings, could that be why her cruciate ruptured? Also with her fur not growing back after the surgery, that would suggest to me that the problem was there well before her knee 'went'.

Thanks so much again guys for your advice and time:)

[molly muffin]

Hello and welcome to the forum.

It sounds like she possibly has cushings, but Yikes, several things that your vet has said make me completely question, his experience with cushings and in particular his experience with this drug. No way, you do not ever break open to split the capsules. It worries me that your vet would even suggest that and then the 30mg, no maybe we should start at 60mg, wait what about 10mg, just sort of seems like he is doing trial and error with no real knowledge of what the drug is or how it works.

So, yes you can have problems if you overdose a dog and some dogs can be very sensitive and not need as much, others need a much higher dose than one would think, but the rule of thumb is start small and work up as needed. Always stop medicating if the symptoms you saw show up and don't restart unless symptoms come back and then only at a lower dose.

That vet that said no more trilo. Might want to get his number. :) Sounds like he has some idea of what this drug is all about.

Have you ever had an ultrasound done to see what the adrenal glands look like, and the pancrease and gallbladder, kidneys etc. If that is even a possibility, some places charge astronomical fees, other places are more reasonable, so that is a factor of course. But something to think about any way.

Hopefully she will continue to perk up. If not, ask for an ACTH, or at least as suggested a resting cortisol, then if it is low try oral prednisone, not much, it's a very low dose and then she would have to weaned off of it, so not something for long term.

So glad you found us and hoping for a good next report.

hugs,
Sharlene and Molly Muffin

[Budsters Mom]

Also interestingly she never had a accident overnight

Cush pups don't always have accidents in the house or at night. Mine certainly didn't. He would Pee a river and hold his urine until he was dancing in pain, but he NEVER had an accident in the house. I would have much preferred dealing with the accidents, as he would not use Pee pads and could no longer get out the doggy door.

You also mentioned opening up Trilostane capsules.:eek::eek: They should NEVER be opened! They should be dosed whole. The product insert advises handling the capsules with gloves or washing hands thoroughly after handling them. I am concerned about your vet's lack of knowledge in this area.

So again welcome to you and Miss Lily. I hope you get her sorted out soon and she starts to feel better.

[Lilypily]

Thanks. She has her appetite back and is drinking. She is still lethargic though and still has diaroeah.

It's her tummy that is my biggest concern at the moment. I'm aware of the 'pot belly' and she has that for a while, but it's getting bigger and it's firm. Is a really big misshaped belly common?

[Squirt's Mom]

I think if it were me, I would be asking for an abdominal ultrasound asap to get a look at the internal organs. This test saved my Squirt's life by finding a tumor on her spleen. You want this performed on a high resolution machine by someone skilled in this test and in reading what they see. Rarely is a GP vet qualified so you will probably need a referral to an IMS. ;)

I'm really glad she is feeling well enough to eat again and hope the trend continues.
Hugs,
Leslie and the gang

[goldengirl88]

You are still not giving the trilostane right? As long as she has diarrhea you should not be giving it. Hopefully she will turn around in the next couple days. I would go for the ultra sound also. Blessings
Patti

[molly muffin]

Hi, how is Lily doing? Is she still lethargic? Is the diarrhea gone? Just want to make sure that things are going okay.

Sharlene and Molly Muffin

[Lilypily]

Hi guys, sorry for the very late reply.

After a second opinion we have chosen not to try the Trilostane again, it's just to risky for her.

Lil had a ultrasound and all her organs are perfect:) Her Gall Bladder is enlarged and sludgy, the vet said this is completely normal for her age. Her right Adrenal Gland is cystic, but the vet said if the Cushings was Adrenal based the glands would show up huge on the ultrasound.

So we are loving and enjoying every minute with her. She currently has a urinary infection which she's on antibiotics for. Her abdomen is HUGE. If she wasn't desexed i'd be sure she's just about to drop a litter, lol.

[Lilypily]

Hi guys. My Lil is being untreated for her cushings. She is suffering from constant UTI's. It seems we just finish a course of antibiotics, and off we go again:(

Does anyone know of a natural product/drink that is safe to give to dogs, that might help put things in balance a bit for her?

TIA

Also what is a good product for dry skin? I'm thinking of trying Sorbaline????

[goldengirl88]

I believe the way you started out with the Trilostane too high is what caused most of the problems. You dog will continue to get UTI's. If it were me, and the dog was feeling better, and the electrolytes are all in balance, I would start on a low dose of Trilostane 10mg. It will lower some of the cortisol in your dog's system and maybe start the UTI situation getting better. I am sure you read the consequences of not treating your dog? As long as you understand that and still choose not to treat that is your decision, and we will respect it. I just wish you had not started the dog off so high. I hope it all works out for you. Blessings
Patti

[Squirt's Mom]

So is the vet thinking the Cushing's diagnosis was in error from the beginning?

Or is the vet thinking she really does have Cushing's, that Trilostane is the only choice to treat and since she didn't handle that HUGE dose well, you just don't do anything even tho there is another drug out there that she might handle better?

If I were in your shoes, I would be seeking a second opinion asap if at all possible. I would let the new vet with fresh eyes, and hopefully more experience and understanding of Cushing's, look at her. I would want an in depth explanation of what a "cystic" adrenal gland means. Your vet is right in a small way in that with the pituitary form of Cushing's BOTH adrenals are typically enlarged - but not always. In the adrenal based form, one gland is typically large while the other is very small, or even atrophied. So what does it mean that one is "cystic"? Would that effect the cortisol level possibly causing a false-positive on the LDDS? Is that indicative of some other disease / condition?

I hope she is feeling alright today and you, too!
Hugs,
Leslie and the gang

[Harley PoMMom]

Was an urine culture and sensitivity test performed? This is the only reliable way to determine the bacteria that is causing the UTI, and to know which antibiotic will be effective against that particular bacteria.

Hugs, Lori

[Jan W.]

I was reading this run and one thing I thought about was the LDDS was run when she had a urinary infection - this might have given a false positive as some else mentioned. I just went through all this am just started my girl on trilostane today but I had lots of tests done and waited to make sure her bowel infection was clear before I had the last tests done on Thursday.
Someone mentioned getting a urine culture and being a nurse, I know that it can be difficult to determine the bacteria that is the causative agent without a culture and sensitivity. If you have continual infections, get a culture urine sent. If you are feeding your dog kibble (dry) this can increase your dogs pH which in turn helps along bacteria. If you changed to less processed food like canned for awhile or maybe give a little Vitamin C with the kibble and see if the UTI's settle down. The urine culture in the meantime can tell you what antibiotic will be best. The antibiotic you were given is a very common one currently given for UTI's and covers E Coli well. Sometimes a takes more than one round also.
Listen to what these people have to say as I (with this forum's friends) have been working on this whole cushings thing for a few months and impatiently wanting to get started, but just started today. And I'm hoping my dog's tests were not false positives, but we can find no infections at present and tests (note that I said tests)are still positive and my dog has a lot more cushings symptoms than your dog seems to have.
I agree with holding back on the trilostane until you have more ammunition. Someone on this site made me take a deep breath and slow down - the Cushings is slow going. A urinary tract infection is not.
I also am worried about the higher dose and made my vet start us on a very low dose and I still am apprehensive. Here again - being a nurse, I always felt that I could increase something if it was not enough, but it is hard to take it back. I realize this will cost me more money in the beginning for tests, but at least any adverse reactions should be lessened I HOPE!!
Give you little critter a big hug. Jan W.

[Lilypily]

Lori, no, no tests were performed re: the UTI. The vet just gave me the antibiotics.

Leslie, the vet is definate it is Cushings. He wanted to re try her on 15mg but I said no. The day I picked her up from the vets after her crash I saw a different vet, as mine was away (this vet I also know quite well and trust). He had a quiet word with me and said 'don't put her through this anymore, just love and enjoy her. She won't live as long, but she'll be happy'.

His words and Lilys response to Trilostane has scared me off the drug.

I feel just rotten (I'm not after any sympathy at all, nor do I want to be disliked here). I can't afford much more vet treatment. I can't work due to medical reasons. I'm divorced with 2 children on my own.

Lil is my third child, she is my baby. I'm already living on reduced groceries and I have many unpaid bills because all my money has and is going to the vets. I'm really starting to struggle big time.

I feel like the worst dog owner ever. Things wern't always like this. I used to have a great job with a great income, then I got sick.

Sorry, this isn't woe is me, just frustration that I can't afford the darn drugs!!!!!

[doxiesrock912]

I've been unemployed for 4 years.
Lily will continue to get UTIs if the Cushings remains untreated.

Daisy also has the gallbladder sludge and IBD.

She weighs 13lbs and takes 12mg of Trilostane twice a day, 1/16th tablespoon of Tylan (Tylosin) powder sprinkled on her meals, and 62.5mg of Urisidol for the gallbladder once a day.

Others on the forum have directed me to Diamondback pharmacy for pet meds. They can't make the same dosage that is sold commercially by law (10mg, 20mg) but if your vet chooses an odd dosage that is not made by Dechra already, this saves you a ton of money.

Also, the Tylan powder made huge improvements in Daisy's IBD and reaction to the Trilo. You can find this on Amazon for approx $50 and it last months. Just be sure that it is food grade. See below for the brand that we use. http://www.drsfostersmith.com/product/prod_display.cfm?pcatid=10935

[Squirt's Mom]

Sweetie, we all do the best we can with what we have. I understand the financial woes very well. One reason I am glad we went with Lysodren over Trilostane - it is less expensive to use. ;)

My old girl is not getting any more drastic medical intervention. She had a seizure in March from a drug for incontinence and almost didn't make it. She has since been diagnosed with CCD (doggy Alzhiemer's) and that is all I am treating other than trying to keep her as pain free as possible. Even if I had all the money in the world, she has had enough and deserves the remainder of her days to be as stress free as I can make them....whether that is a few more weeks or the gods willing a few more years. My job now is to make her happy and keep her comfortable. Some days that is very hard for me - I know what is going on in her body, I know what is coming. However, SHE doesn't. She only knows that she is loved, safe and gets good things to eat - and that is all that really matters. That is all that really matters to Lily, too. ;) To hear your voice, to see your face, to feel your touch, to know your love - those are the most important to Lily. So don't feel guilty if you can't treat for whatever reason - we all do the best we can with what we have and our best is ALL we can do.

Any time you want to talk or to ask questions feel free. You and Lily are family and we want to hear from you even if you aren't on the Cushing's Treatment Train. :)
Hugs,
Leslie and the gang

[Lilypily]

Lily also has IBD. I just carefully monitor her diet (make sure the kids don't slip her any of there uneaten food) She hasn't had a problem with it for about 4-5yrs now.

Thanks for the info and links:)

[molly muffin]

Oh gosh, we don't hate around here. Don't even think that!!

Everyone does the best they can with what they have to work with. We know that. It's super hard sometimes and vet bill doesn't make it any easier.

HUGS,
Sharlene and Molly Muffin

[Budsters Mom]

Hi,
The money thing is difficult for many of us. You are by no means alone in this. I lost my fur baby four months ago and I'm just now getting his vet bills paid off. We understand your predicament and know that you would do more if you could, but we all do what we are able. That is the way it is. Lilly is loved and cherished. That means more to her than all the money in the world.

Whether you treat or not, please keep us posted on how sweet Lilly is doing. Xxxxx

[Lilypily]

Oh Leslie my thoughts are with you and your girl. *Hugs*

With Lil I have just started to relax a bit food wise re: her Inflammatory Bowel Disease. As I just said, strict monitoring of her diet has kept symptoms at bay. Now I think, you poor girl, bugger being on such a strict diet, enjoy life. I give her very small tidbits and see how she copes, so far so good, and she is LOVIN it. She inhaled a small piece of cake yesterday:)

In 2010 she was having seizure like episodes regulary. The vet said not epilepsy as she's to old. I was left with 'if they increase, we are looking at a brain tumour'. Well 2010 they were regular but not increasing, 2011 they dramatically reduced, 2012, she only had a few. Her last eposide was July 27th 2012.

So what the heck was causing them i'll never know:confused: and I pray they never return, they were very distressing for her, and me.

I wonder if I should enquire about the Lysodren? Yes I have been scared off the Trilo - she was very sick. It's certainly not that I don't want to treat, it sucks that it comes down to the almighty dollar.

I'v had a few people say to me 'you're crazy, it's just a dog, you don't go spending over $2,500 on a dog, i'd never risk my utilities being cut off for a dog'.
I think they are silly people:p

[Jan W.]

Never feel guilty or let people put you down for what you can or cannot do. They aren't in your shoes!!! Squirt's Mom really hit it home and those that followed. I tell people who feel they are being bad parents, Where would your dog be now if you hadn't taken them home?? You may have saved them from a fate much worse than we can imagine or want to imagine. They have a warm home/bed, and people that care for them and every now and then special treats. Although mine get special treats mostly now and often. I was involved in AKC agility and obedience for years and one of my instructors said they don't care about the title you are trying to get, all they care about is being with you and having fun with you. They don't know if you are rich or poor = all they know is that they are rich in love.
I'm not going to recommend this but there are places you can get antibiotics without prescriptions - As someone said Tylan for the bowels is RX free from Drs. Foster and Smith and other places. Worked well for my dog. A company called Fish Mox has RX free antibiotics that many use for pet and humans. I used one of theirs once without problems and it worked. Please don't throw tomatoes at me, but if people are hurting for money ----- I don't have an answer for the Trilostane as I also am new here. But Cushings moves slow so you might have time to do more research. Jan W.

[Budsters Mom]

Don't get me started with the "it's just a dog" thing. I have been told that several times myself. It makes me furious!:mad::o If our babies are just dogs, then these people are just idiots and can't help themselves. I feel sorry for people like that. No one here believes that our babies are just dogs. They are our children and we love them as family members. In fact, more than some!;):D xxxxx

[Concernedmom]

It sounds to me like you've already done a lot of testing when you noticed she got sick. That's being a good Mom. You shouldn't feel bad about not treating cushings because it sounds to me that you don't know for sure that she has it. I'm not saying this to make you feel bad but you've not had enough testing to confirm it. It also doesn't sound like she has enough clinical signs to even test for it.
If you feel more comfortable testing though I would find a different vet for a second opinion and do an ACTH test. I would never start any cushing meds without confirming it first. If you can't afford to do the testing that you need to do while on these cushings meds then I wouldn't treat. That's a decision you make for yourself and your dog and your family. It sounds to me like you take really good care of her and love her to death. T

[Lilypily]

Jan W, your post was beautiful. I used to be a vet nurse many years ago and did obedience and agility with Lil. Good days!

I'v put 3 photos of her up on my profile (i can't figure out how to make her my avatar, duh, lol.

Thanks so much for your support everyone. You are all so lovely and i'm lucky to have found this forum:)

[Trixie]

Saw your photos of Lily...she is so cute!!!...I love fox terriers!!
The drugs and testing are crazy expensive, it's true.
I do think your dog just had too high a dose of Trilostane and that's why she had such a bad reaction. My dog started so low only 12 mg. for her 16 pounds and that was split in two doses of only 6mgs twice a day. That 30mg was probably way too much for your Lily.
Compounded Trilostane can be a lot cheaper online from Diamondback should you change your mind on treatment, just google them if you want to check it out, the price will vary based on the dose.
Barbara

[goldengirl88]

I am a sucker for a terrier. What a cute baby she is. My Tipper is a Jack Russell Terrier, I am always drawn to the terriers I just love them. Maybe you could get your Trilostane from Diamondback Drugs which is cheaper than the Vetoryl and that would help. I wish you and your baby well no matter what you decide. Blessings
Patti

[Jan W.]

Maybe I don't know how to work things on the computer, but the pictures were sideways for me, but what I saw your girl has pretty coloring. I love little dogs, but I have decided I will never have one as I would step on them and break a leg or something. Plus we live out in the country and I won't let my son's dog out without being on a leash. We have too much wildlife out here.
I am scared right now to give trilostane, and we had our second dose today, but we are starting at a much lower dose for a much bigger dog than you did so I hope to get a slower response. Plus the cost of monitoring will be more involved as we will need it done more frequently until we reach a good level.
I got my compounded trilostane from diamondback and I think it was a little over $30 for 60 -22 mg capsules. Which I feel isn't too bad as compared to the cost of what I thought I was going to have to pay. Of course as we increase the dose, the cost will go up. The monitoring of trilostane is very expensive. But someone mentioned that Lysodren was cheaper to monitor. Both drugs have big side effects. And as you probably know, medications can react so differently with different individuals.
I had an internal medicine vet known nationally tell me that he felt my dog did not have cushings until we started having tests coming back positive. Then he turned me over to another internal med vet that specialized in endocrinology and she was uncertain also at first and worked very carefully and thoughtfully. I was still unsure myself after researching it all and being on this site so when I was pretty sure I had no infection processes going on, I had a urine cortisol:creatinine ratio run - a pretty cheap way (it wasn't all that cheap - $90) to see if your dog does not have Cushings. If you get a negative response then you can feel fairly certain you are not dealing with Cushings, however, I did not get a negative response there so felt certain that I needed to test further again- then I got another ACTH test and it was elevated again. A urine Cortisol:Creatinine is easy to get also. Just get a first thing in the morning urine in a cup and keep it cool until you get it to the vet in the morning.
My dog probably has had this disease for several years, but I thought I was dealing with thyroid problems and I had her put on thyroid medications and for 1 year she was wonderful. She perked up and ran an agility course like she never had before, then the bottom fell out and that's when I felt something else was going on. My point is that there is no rush in this. Slow down and regroup -- make sure you have no infections first.
I purchased urine pH strips many years ago and checked on my dogs pH finding that the kibble (dry) food gave my one dog a great medium for urinary infections. That's when I changed food and if I use kibble I use Vitamin C (my vet offered this way of changing the urine pH). I know you are worried about IBD but you might want to check your dogs pH to see if the food may be contributing to the incorrect acid/base level in the urine no to mention stones.
I am rambling --- Jan W.

[Harley PoMMom]

I'v put 3 photos of her up on my profile (i can't figure out how to make her my avatar, duh, lol.



Here's a link that should help: Signatures, Avatars and Profile Pictures (http://www.k9cushings.com/forum/faq.php?faq=vb3_user_profile#faq_vb3_signatures_av atars)

If you have any difficulties, please do not hesitate to ask for our help, ok?

Hugs, Lori

[Lilypily]

Maybe I don't know how to work things on the computer, but the pictures were sideways for me, but what I saw your girl has pretty coloring. I love little dogs, but I have decided I will never have one as I would step on them and break a leg or something. Plus we live out in the country and I won't let my son's dog out without being on a leash. We have too much wildlife out here.
I am scared right now to give trilostane, and we had our second dose today, but we are starting at a much lower dose for a much bigger dog than you did so I hope to get a slower response. Plus the cost of monitoring will be more involved as we will need it done more frequently until we reach a good level.
I got my compounded trilostane from diamondback and I think it was a little over $30 for 60 -22 mg capsules. Which I feel isn't too bad as compared to the cost of what I thought I was going to have to pay. Of course as we increase the dose, the cost will go up. The monitoring of trilostane is very expensive. But someone mentioned that Lysodren was cheaper to monitor. Both drugs have big side effects. And as you probably know, medications can react so differently with different individuals.
I had an internal medicine vet known nationally tell me that he felt my dog did not have cushings until we started having tests coming back positive. Then he turned me over to another internal med vet that specialized in endocrinology and she was uncertain also at first and worked very carefully and thoughtfully. I was still unsure myself after researching it all and being on this site so when I was pretty sure I had no infection processes going on, I had a urine cortisol:creatinine ratio run - a pretty cheap way (it wasn't all that cheap - $90) to see if your dog does not have Cushings. If you get a negative response then you can feel fairly certain you are not dealing with Cushings, however, I did not get a negative response there so felt certain that I needed to test further again- then I got another ACTH test and it was elevated again. A urine Cortisol:Creatinine is easy to get also. Just get a first thing in the morning urine in a cup and keep it cool until you get it to the vet in the morning.
My dog probably has had this disease for several years, but I thought I was dealing with thyroid problems and I had her put on thyroid medications and for 1 year she was wonderful. She perked up and ran an agility course like she never had before, then the bottom fell out and that's when I felt something else was going on. My point is that there is no rush in this. Slow down and regroup -- make sure you have no infections first.
I purchased urine pH strips many years ago and checked on my dogs pH finding that the kibble (dry) food gave my one dog a great medium for urinary infections. That's when I changed food and if I use kibble I use Vitamin C (my vet offered this way of changing the urine pH). I know you are worried about IBD but you might want to check your dogs pH to see if the food may be contributing to the incorrect acid/base level in the urine no to mention stones.
I am rambling --- Jan W.

Yes i'm unsure what I did wrong, but the pics turned out sideways:p the only way I manage with my little girl is having a mini (pink) cows bell on her collar. She is constantly under my feet and atleast by hearing the 'jingle' I know where she is.

[Lilypily]

Hi everyone:) I hope everyone's babies are doing well. I need some more advice please.

Lily isn't doing very well:( What are the 'end stages' of untreated Cushings?

Her worringing symptoms are~

The distended belly is getting bigger and bigger.
She is taking herself away from us, going in to my bedroom to sleep.
Snoring, when asleep and awake (She has never snored before)
I have air con but she still doesn't cope in the heat (yay, summer is just starting)
Lethargic, looking sad and keeping to herself.
Her belly always feels hot to the touch.

New symptoms of untreated Cushings that she is also developing (the not so worrying ones)

Dry flaky skin.
Skin on ears have sores on them.
I thought she was already drinking a lot, but man she is near emptying the water bowl.
Licking her paws.
Refusal to jump on couch, I have to lift her.

Plus the original symptoms.


I think what has me really worried is her now disinterest and taking herself away and looking miserable. Also this snoring/respiratory sounds.


Ofcourse I will be making a vet appointment (it's Sunday here). I just have myself in a real tizz:(

[Roxee's Dad]

I am so very sorry to read that Lily isn't doing well.

Our cush pups if left untreated can develop diabetes, kidney and Liver failure, congestive heart disease and chronic infections of the eyes, ears, skin, gums and bladder. The licking could very well be a result of skin irritation or infection.

[Renee]

I find that excessive licking can also be from stress.

[flynnandian]

my dog flynn didn't react good on trilostane either [low dose]. his arthritis has gone worse. his joints are inflamed now. i don't think i can ever put him on this drug again. he gets pills for his [secundary] thyroidproblem though, and he feels a lot better with those pills. observe your dog and if there is no good quality of life anymore, you have to make the descision to put her to sleep. i will have to face this descision too.
when licking her paws it can also mean arthritis. it hurts and they can start licking and biting their paws
you can try if painkillers can make any difference.
i think she is not refusing to jump on the couch, but due to weakness of her hindlegs she is not able anymore. i have to lift my dog in the car too.
hope your vet can give her something to keep her comfortable.

[Trish]

Awww I just looked at her pictures, so cute... but I am biased as my Flynn is a foxy too! I hope your vet helps you out and runs some tests, hopefully there are some clues there for you to work on and get her mojo back. Flynn licks his paws a lot too, I think just due to environmental allergies so it could be something as simple as that. I am in NZ, so it is getting hot here too and they don't do so well in the heat do they. My a/c is running just about 24/7 lately. Wait and see what the vet says, hope you have a good one :)

[Lilypily]

What a handsome man Flynn is. They are just the best little dogs hey.

Lily, while still looking miserable has decided to join us tonight:D i'm very happy as she is a real mummy's girl and is always with me and under my feet. This past week has been very 'not right' without my girl basically glued to me.

[Lilypily]

Lil has a respiratory infection. The vet said her lungs sound crackly. She has had a antibiotic injection and her blood sugars were checked. They were 9 and the vet said that's fine for a stressed out dog (Lil hates the vets)

My vet said his medical opinion is it's not 'that time' yet and we shall press on. The only problems he can foresee for the moment is if the respiratory infection keeps reoccuring and how she copes with the heat of summer.

[molly muffin]

Hopefully that antibiotic shot will knock the respiratory infection on it's heels and Lil will get back to being herself. Good catch mum!
hugs,
Sharlene and Molly Muffin

[Lilypily]

Hi guys:) Is there a product out there that helps with the dry/ flaky/thining/crusty skin issues that our babies suffer?

Well before my Lily was diagnosed she had dry skin, most noticible after a bath, while drying there was always a tonne of white flakes. I thought she had dandfruff. I went to the vets and got her linseed oil to add to her food. It didn't work, now I know why.

Since her belly was shaved for the ultrasound, only a little fuzz has grown back so her dry flaky skin is very noticable. I was using Sorbaline cream on her, but it's just to greasy.

Now i'm using Vitamin E oil. The vet also said to apply it to the crusty sores on her ears.

Is there actually a product out there that will help? Or is a matter of this is just another part of the disease that we can't control.

She's not bothered at all by the dry skin.

[doxiesrock912]

Our vet gave us a special shampoo for Daisy. Be careful with vitamin E as it is possible to easily use too much and have a bad reaction.

[Squirt's Mom]

MODERATOR NOTE: I have merged your post about dry skin into Lily’s original thread. We normally like to keep all posts about each pup in a single thread as it makes it easier for members to refer back to the pup's history when needed. Thanks!

[Squirt's Mom]

What is Lily eating? External things like the creams and oils can help but the real healing is an "inside job" so addressing the diet is a good start.

You can add some good salmon oil to her diet and that should help. Nordic Naturals makes a good oil for dogs (Omega-3 Pet, link below). Give her some of the Vit E along with the salmon oil, but don't use more than is recommended for her weight or it can cause some loose stools. If she likes sardines, give her a little bit of water packed sardines with her food (drain the water ;)). Fish contains good Omegas and the Omegas are good for the skin and coat among other things.

Unless there is a medical reason that requires frequent bathing, don't bath her very often especially during the winter months. When she is bathed, use a mild, gentle shampoo - not human shampoos either. Bathing washes away the natural oils that help the skin and coat. Brushing helps distribute these oils and stimulates the glands to produce more, helping the dry skin, too.

Hope these ideas help!
Hugs,
Leslie and the gang

You can shop the price for the oil to see who has the best bargain but here is Nordic's site so you can see the product you are looking for -
http://www.nordicnaturals.com/petRet/nnpet_collection.php

[Lilypily]

I'm sorry to keep posting, I don't want to be a nuisance.

Lily had the Convenia injection 6 days ago and she is getting worse. Her breathing is so noisy whether awake or asleep and her tummy really sucks in with every breath. She is still mostly keeping to herself. She looks quite miserable.

I'll be back to the vet on Monday.

Please tell me i'm overreacting. I'm terrified i'm losing her.

[doxiesrock912]

I'd be concerned with no improvement too. You're not overreacting. I have a friend who uses coconut oil on her dogs ears. It seems to be helping.

[Trish]

I would take her back too, so it was just a one-off injection, no tablets to take? I would take her to emergency vet if I was real worried rather than wait till Monday.

I don't think you are over reacting, if there is one thing I have learnt is trust your gut instinct, if you are worried take her earlier

[doxiesrock912]

I agree. Sucking in air is not normal.
Daisy was doing that before Cushings was confirmed. She had a bacterial infection. They gave her a shot and antibiotics to take for a week at home.

Don't wait.

[Lilypily]

Thanks guys. Yes she was just given the injection. Unfortunately there are no emergency vet centres near where I live and a local clinic would just pop her in a cage and leave her overnight, which would only stress her more.

I have coconut oil, i'll try that. Thanks.

Her gums are nice and pink, not pale or blueish. I'm taking my phone to bed tonight. She was making some very strange sounds last night, so if it she does it again i'll record her.

[doxiesrock912]

Good idea recording her. Hope that you get some rest too.

[Trish]

Yes it is a good idea to get it on video, so much easier for the vets to see and hear exactly what is going on as sure as anything once you take her in she will stop making the noise.

Can you sit her up slightly, or prop her up with pillows when she is sleeping, rather than her lying flat.. that can help a bit too. Do the local clincs not have an urgent vet on call? It would be good for them to see her and listen to her chest and make sure there is no fluid there that could be treated or even restart the antibiotics so at least she gets a headstart on some treatment before seeing your vet on Monday. Hope she has a better night the poor little poppet. :D

[addy]

If it is dry in your house can you run a vaporizer or let the shower run and put her in the steamy bathroom for ten minutes?

[Trish]

How is Lily feeling today, hope she got to rest a bit more comfortably last night. Hopefully you can find an urgent vet on today to see her, let us know how she gets on today :)

[flynnandian]

in my country convenia is only allowed as no other ab. works anymore. it is the last in the line of ab. they told me. the vet has to ask for permission from the health department to use it. after 6 days, you should see an improvement already. if this ab does not work they told me no one will. maybe they will give her another shot?

[lulusmom]

I am just seeing that Lily is not doing better after the Convenia injection. This is a great drug as long as a dog has no adverse reactions. It is a long acting antibiotic which is really convenient for us pet owners but you can't take the injection back, which makes adverse reaction difficult to deal with and nothing to fool around with. You need to know that despite its use for upper respiratory infections, one of the less common adverse reactions for this drug is acute pulmonary edema. If Lily appears to be struggling to breath and has worsened since she got the injection, please don't wait until Monday to see your vet. If I were you, I would contact the vet immediately and tell him/her what is going on. If you can't reach your vet, get her to an er so they can do imaging to see what is going on. Fluid build up in the lungs is serious and can be fatal.

Glynda

[Trish]

in my country convenia is only allowed as no other ab. works anymore. it is the last in the line of ab. they told me. the vet has to ask for permission from the health department to use it. after 6 days, you should see an improvement already. if this ab does not work they told me no one will. maybe they will give her another shot?

Hi, I have no idea of what antibiotic resistance rates you have in your country but this statement from your vet is not true, especially this bit "if this ab does not work they told me no one will". :eek: Convenia is a cephlorsporin which is a type of antibiotic that is broad spectrum. There are many, many other different antibiotics that can be effective depending on what bacteria is causing the problem. This is the important part of giving antibiotics, Lily has been presumed to have a chest infection, I presume from xray, coughing, examination etc but it could be difficult to treat if they do not have anything cultured to match the correct antibiotic to the bug. Those symptoms could also be due to other problems like heart, pulmonary oedema and as Glynda said the concern is with side effects. They may be rare but they can happen. The extra effort Lily is having to use by using her abdominal muscles to breathe concerns me and I agree it would be best if she was checked out today.

[molly muffin]

Oh dear this does not sound good. :( Very worried to not hear from you about Lily too. :(

It could be she is having an adverse reaction to the medication but they will need to see her I'm sure.

I don't think they have an emergency vet hospital near them, is that correct?

hugs,
Sharlene and Molly muffin

[Trish]

They are in Australia so it would still be fairly early there Sunday morning, like 9.30am so maybe she is just not up and about yet, hopefully we hear later :o

[Trish]

How is Lily doing? Hope her breathing has settled down and you got her to the vet ok. :)

[goldengirl88]

Tipper and I are praying that everything is ok with the breathing. We are hoping all turns out well for you and your baby. Blessings
Patti

[Lilypily]

Hi everyone, thankyou so much for your thoughts and advice. It's been 8 days since the convenia injection and Lil is no better:( She still has noisy breathing with her abdomen sucking in.

The vet said (sorry if i'm repeating myself here) that it's her enlarged liver pressing on her diaphram which is then pressing on her lungs.

She still has bright moments. Right now she's sitting at my feet scabbing food.

I think I know what has to be done. I just keep procrastinating on making that call to the vets:(

[Trish]

I am sorry to hear this news, so she hasn't got a chest infection after all? What is the matter with her liver? Pleased to hear Lily is still having good days, sounds like you are loving her lots and giving her everything she wants which makes her a happy little doggie :)

[molly muffin]

Oh sorry to hear this. :( I did hope it was something that the antibiotics could fix.

My thoughts are with you.
hugs,
Sharlene and Molly Muffin

[lulusmom]

If the convenia is clearing up the fluids and her only problem is an enlarged liver caused by the effects of cushing's, then please don't do anything drastic. Almost all dogs with cushing's have enlarged livers. This, plus weight gain for some dogs, and the redeposition of fat to the thoracic area puts pressure on the diaphragm, making them pant, snort and snore. With proper control of the disease, iiver support and weight loss, these symptoms improve greatly. Has your vet put Lily on liver support? If not, please talk to him or her about it.

[Lilypily]

Thanks guys. Lily is pretty miserable. Her breathing is very laboured and her chest/abdo area is really sucking in with each breath. It's a struggle for her.

After a long phone conversation with my vet, he is coming to my home this afternoon to put her to sleep.

It hasn't really hit me yet, even though i'v been crying all morning.

[Budsters Mom]

I am so very sorry. My thoughts and prayers are with you and your sweet girl during this very difficult time. I trust your judgement. You know Lily better than anyone. Many of our fur angels will be waiting at the rainbow bridge to welcome Sweet Lily. I know how difficult and painful this is for you. I had to do it myself. Please keep us posted on how you are doing. Xxxxxx

[molly muffin]

Sending you lots of love, hugs and strength. We are all with you in spirit. These decisions are not easy ones to make. I'm very sorry.
hugs,
Sharlene and Molly Muffin

[Renee]

I am so sorry it has come to this. :(

[frijole]

I am so sorry. Thinking of you and sending strength. Kim

[Concernedmom]

I am so sorry you need to make this decision for Lily. It is the one none of us ever want to make but in the end only you know when it's the right time. I know your heart is breaking. My thoughts are with you in this most difficult time.

[Cooper is missed]

I'm so sorry you are going through this. It's the hardest decision we have to make but you know your baby best and if she is suffering you will know when the time is right. I never thought I would be able to live with my decision to let Cooper go but time has helped heal the wounds. My heart goes out to you, this will be difficult for some time but please know that it will get better with time. We will always love them and they will hold a special place in our hearts. They are never forgotten, that's for sure.

[doxiesrock912]

I am so sorry.
This is one of the most difficult and dreaded decisions that we'll ever have to make.
My sincere condolences.

[Lilypily]

Thankyou for all your thoughts ladies.

My girl is gone. Even though i'v cried all day it still hasn't hit me yet..

I'm not really with it at the moment. Lily was my 'daughter'.

I'd just like to say thankyou to everyone here for your advice and help since I joined this forum. It has been immensly appreciated.

[doxiesrock912]

Oh honey, I'm so very sorry.
Please know that Lily is no longer sick, She's meeting many others on the other side of the rainbow bridge.

HUGS.

[Trish]

I am so sorry Lily had to leave you, but you made the best decision for her to put her out of her suffering. How unselfish of you and I see you felt like absolute shite doing it. I have often read on here that making this ultimate sacrifice you end their suffering by taking it on yourself. So true, she is running free and fast while you experience the awful grief of losing your baby. Big hugs for you and please take care of yourself, sleep, eat and try not to get sick because that just makes you feel worse. Come in and talk to us because we all understand how you are feeling now x

[molly muffin]

My sincerest condolences on the loss of your sweet girl.

hugs,
Sharlene

[gatorgirl_bama]

I'm so sorry to hear about sweet Lily. I know it's hard and God know I wish I could tell you it gets better. I just lost Tia in August and now my sweet Tippi in December so it's still a fresh hell for me too.

I just know everyone here will help you get through the sad times and the heartache. It has been my go to where I can sit and cry and not be judged by anyone.

Sending much love to you.
Donna and my angels, Tippi and Tia

[labblab]

My heart is also heavy upon reading your news. What a hard way to start off this new year, with such a huge hole in your heart and in your home. We hope it may bring you a tiny bit of comfort to know that Lily will be forever honored here amongst our family:

http://www.k9cushings.com/forum/showthread.php?t=5973

You will see that Lily is our first angel of this new year. But there are a multitude of our angels who instantly welcomed her at the moment she passed. There is nothing dividing nor separating her from all our Cushpups who preceded her, nor will there be any divisions from those who follow. They are all together now, and will remain so always.

We hope you will stay with us and permit us to walk alongside you. We cannot change your pain, but we will make sure you are never alone.

Sending many hugs, always in loving memory of your sweet little girl.
Marianne

[goldengirl88]

I am so sorry your sweet Lily has passed, I am sure the others were at the bridge to help her over. God Bless you and sweet Lily in heaven. Blessings
Patti

[BostonLover]

I'm so sorry you lost your sweet Lily.:(

[Budsters Mom]

I am so sorry for the loss of your sweet girl.:( Run free with the others, run free!

[Lilypily]

Thankyou so much everyone. It's like it's not real. Last night I didn't sleep well and when I did I had several dreams of her 'waking up' and being back with us. I'v been completely out of it today, tried to keep myself as busy as possible trying not to think. I mucked up my lunch order, forgot my grocery list etc: just on another planet. I thought I heard her before (obviously not) I'm just Gah at the moment.

[Trish]

I bet you will be feeling off for quite some time, she has only been gone a day so your mind is still reeling so don't plan to much till your over the shock a bit more. I bet Lily is letting you know she is not too far away and is watching over you right now so you can know she is feeling much better since you released her which no matter how awful for you was the best thing you could do for her, so you keep telling yourself that! x

[Spiceysmum]

So sorry to hear that your sweet Lily has passed. My thoughts are with you.
Linda

[Roxee's Dad]

I am so very sorry for the loss of your sweet Lily girl. I am sure she knows how much she is loved....

Rest in peace sweet Lily.... You are our newest and brightest star in the night sky....

[Mel-Tia]

So sorry to read that you lost your little Lily

Roam free sweet Lily

Mel
Xxx