Tipper - adrenal tumor/breathing issues

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Originally Posted by addy

I have not yet found anything from Dr. P about twice day dosing being the better alternative for adrenal tumors though we know that it may be hard to control their cortisol so that could lead to twice day dosing. Zoe has always struggled with her evening dose.

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Dr. Peterson discusses UC Davis' study on twice daily dosing and comments on SID, BID and TID dosing on his blog. I have provided an excerpt from that blog as well as the URL to his site below:

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SID, BID, or TID administration?
Whether to start with once- or twice-daily trilostane administration is controversial (1,2). Although most dogs are controlled clinically with once-daily dosing, trilostane may begin to lose its effectiveness 8-10 hours after administration, so twice daily dosing may be necessary in a subset of dogs (1,4).

In addition, it is very possible that the efficacy of twice-daily dosing might be more effective than once-daily dosing in controlling the complications of Cushing’s syndrome (e.g., proteinuria or hypertension). However, the answer that question remains unclear (15), and additional studies are needed to resolve that issue.

So what do I recommend? Until it is proven that SID or BID treatment is better, I prefer to start with a twice-daily regimen —if feasible and the owner agrees —because controlling cortisol concentrations throughout as much of the day as possible makes sense to me. In diabetic dogs with concurrent Cushing’s disease, twice-daily administration is essential in avoiding large fluctuations in serum cortisol concentrations during the day (1,2). With once-daily trilostane administration, adequate diabetic control will be next to impossible in many dogs with concurrent Cushing's syndrome.

What about TID administration? In this study, 9 (24%) of the 38 dogs with PDH were eventually switched to a regime of trilostane, administered every 8 hours. In my practice, I have not found it necessary to use TID dosing, and I do not find that dose schedule very practical or realistic for most owners. If I can't remember to "take a pill" every 8 hours (and I can't!), how can we really expect the owners to give their dog a medication three times a day for the rest of their dog's life?

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http://endocrinevet.blogspot.com/201...rilostane.html

Thank you Glynda but he does not really say that specifically it is better to do BID for adrenal tumor based Cushings does he? Maybe I am missing something in that article. I was looking for a specific reference to it, which I have not found.

I took that as a general statement on his thoughts but not specifically addressing how BID dosing may affect an adrenal tumor except we know it may be harder to control their cortisol so in that regard, BID would perhaps do a better job with more consistent control throughout the day. I think I posted his blog statement about adrenal tumors on my thread as to why he thought Trilostane would be preferred over mitotane.

Hi Addy,

We know that adrenal tumors are highly resistant to Lysodren which requires much larger doses but to my knowledge that doesn't apply to Trilostane. You are the second or third person who has mentioned larger doses of Trilostane for adrenal tumors and it's possible I've read that but I sure don't remember. The modes of action are completely different and I believe dogs with adrenal tumors are usually prescribed standard doses of Trilostane, just like those with PDH. I would think the same considerations for switching to BID dosing would be the same as those considerations given dogs with PDH. Adrenal tumors have random secretory patterns, independent of the pituitary gland, so they don't constantly dump cortisol like PDH dogs, so the need for BID dosing may actually be less in ADH dogs. It just depends.....

There is only one condition that I'm aware of that BID dosing is usually recommended from the getgo and that is cushdogs with diabetes. Dr. Cook doesn't just recommend it, she states that it is absolutely necessary in order to sustain consistent control of cortisol throughout the day.

Glynda

Hi Patti,
Oh boy...Tipper and Lucky...that must have really been frightening! I'm so glad neither one was hurt in any way. Poor Lucky, still not 100% feeling well and lost a bit of fur. Tipper means business doesn't she...I guess you're right, don't mess with Tipper!

Hoping you have an easy and safe ride tomorrow. From the forecast I just heard you should be just fine on your drive tomorrow...watch out on Tuesday and Wednesday though..looks like the snow moves East.

Glad Tipper has been having good nights...hope it keeps up!!
I see the Steelers did win the game!!

Barbara

Have a safe trip tomorrow. I hope the roads aren't going to be too awful

hugs,
Sharlene and Molly Muffin

Thinking about you and the trip today. Keep safe and let us know when you are back.

Hi Everyone:
We are back form the dreaded trip. It was really bad around the country roads here this morning as we had snow last nite. It was 12 degrees when we started out. the first hour of driving was in the dark. When we got about 45 minutes out of here there were clear roads. On the way back basically the same thing. So here is the eye report:
Mild iris atrophy, lens sclerosis, stable tear film, no retinal hemorrhages, calcium deposits the same on the right eye, decreased in the left eye.
From all medical reports it is very likely her spleen reaction to the storms caused this hemorrhaging. Advised by client that Reticulocytes will be tested in about a month. No visit needed until April. He said this dog has better vision than he does. So I am very pleased with all that. Now if I can just get over the next 2 hurdles in January I can calm down a bit. I carry Tipper every where I go and never put her on a floor anywhere because of germs and her legs in the back. An older lady had a big grey dog you could see it was old, she held the door for us. Her dog wanted to get close and smell Tipper the Ripper, so she smelled Tipper's foot and Tipper growled and tried to lunge at her and showed her teeth. The old lady said "boy for a little dog she is brave going at this big lug!" We were all laughing. She was so tired of riding in the car and so was I, it is a long trip back and forth. She walked a short walk at home as it is too cold out. I just wanted to get her legs moving after she lay in the car for 5 hours. We were both up a lot last nite. I kept worrying I would sleep in and be late. I don't know if Tipper sensed that or she is not controlled. I am so tired and just going to do what I have to today. I had to run up to the bank after we got home, I saw some unauthorized charges on my debit card, so I had to cancel it and get a new one. My old man neighbor came over and told me his daughter had 3 turkeys given to her, and she does not like turkey so he was going to give me one. I know he wants me to cook it and send some over, I am no dummy to this, but that's ok. It said we are in for really heavy snow and bad weather tomorrow thru the rest of the week. Blessings
Patti

The eye report sounds good, Patti and I am so glad you are back home safe and sound.

My 20 minute commute turned in to 45 minutes this morning and we hardly had any snow.:rolleyes:

Stay warm and safe and inside:):):)

Glad you had a safe trip there and back. Eye report sounds pretty good.
Now maybe you can relax for a bit. :) Well after you cook turkey for your neighbor that is. :)
He sounds pretty lonely and I bet he is very grateful for all you do for him. What a wonderful person you are Patti.

hugs,
Sharlene and Molly Muffin

WTG Tipper glad to hear all went well today at the appointment. Now maybe you can chill out a little bit Patti. I hope you got your meds and are looking after yourself. :)