Tipper - adrenal tumor/breathing issues

I don't know if the thyroid can have any effect on the pre number in an ACTH or not, but if I were you, I would focus on that organ for now. I would give her enough time on the new thyroid med to give it time to work and see how her signs, which both conditions share, are after her thyroid is regulated. The post number does NOT indicate Tipper is in any danger of an Addisonian crisis so I wouldn't waste a great deal of time worrying about that happening right now. The pre has come up and Dechra didn't seem overly concerned when you talked to them about it.

I don't understand Vetoryl (Trilostane) as much as I try but I have to wonder if even division of the dosing might not have a positive effect on the pre number - if she were given an even dose am and pm if that number might not come back in better range? :confused:

If thyroid has the same symptoms as cushings and we know it does, then it might be that the hunger and definitely the aggression is due to the thyroid being off and not the cushings. This would mean that you could safely lower the dosage of vetroyl and if the thyroid is controlled, then those symptoms could go away.

I really wonder if that 5. isn't due to the adrenal tumor, and the .9 due to the suppression during the day by vetroyl.

It certainly can be a very tricky situation to be in.

hugs,
Sharlene and Molly Muffin

Just my two cents worth, but I would not add yet another variable of twice daily dosing into the mix when you have so much else going on. We have been told by Dr. Bruyette that there seems to be a greater risk of oversuppression with twice daily dosing, and that is exactly what you are trying to avoid. I am only speculating as to the physiology of that, but perhaps it is because the cortisol never has the opportunity to rebound very greatly at any time during the daily cycle with twice daily dosing. At any rate, this is what he's told us:

Quote:

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While twice a day dosing may result in a lower amount of trilostane being used per day it will require closer monitoring as the ACTH stimulation tests tend to be lower so we have to look for both hypocortisolemia and electrolyte abnormalities.

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Since this last test was done with once daily dosing, I would stick with that for the time being so you will have some head-to-head comparison with the next test. I agree with Leslie that since Dechra wasn't too worried about these recent results, I wouldn't worry unduly right now, either. I would want to change only one variable at a time, and right now that would be adding the thyroid supplementation.

Just wanted to add that we have been told all along by the experts that ACTH stim testing may not be the ideal gauge for monitoring optimal trilostane dosing, but it's the best thing we've got right now. (I'll try to find a quote that better explains why, and come back later to add it). These kinds of weird discrepancies between low "pre" and higher "post" numbers may be a reflection of an inherent problem with using the test for trilo dosing decision-making. But so far, nobody has come up with a better alternative. So there you have it...

Thank you Marianne that does make sense to me and like you said don' add another variable to the mix. I am hoping to get this thyroid thing sorted out this week. Tipper seems to be doing a little better on this drug but do not want to jinx things! She was lethargic, dull coat, panting, restless, drinking, sensitive to cold and weight gain. She has all the classic symptoms and she lets me know for the past few weeks something is off and she is not feeling well. It's enough to make your crazy all this stuff! Blessings
I am waiting for a return call from the cat expert!!
Patti

Hi Everyone:
I have some not so great news. Gracie must go to another home. After consulting with the cat expert he confirmed what I have already known. Since my cat Chance is 13 years old, he could have a compromised immune system. Therefor putting him at risk for picking up this virus and having it mutate into FIP. The first sign of them having the corona virus would be severe diarrhea. I have spent enough money trying to turn Graces' situation around, but in all god conscience I cannot knowingly make my boys sick, and have the expense of that yet! I am crushed as her and I have become quite close and she never has acted up trying to get out of this one room God Bless her. This is devastating to me as she has suffered enough in her lifetime. I wish I could change all this, but the illusive magic wand is no where to be found. I must kick this into high gear and find her a forever home. This is making me cry as I type these words. I am sad for her and for me. I am waiting to talk to Jean Dodds and get Tipper squared away. Blessings
Patti

Oh Patti, I am So sorry. I know we were all praying for a miracle. Maybe try some other rescues and put notices up at various places.

Sending you big hugs and hoping for the best
Sharlene and Molly Muffin

Patti, I am so sad and sorry, too. This is so not fair for either Grace or for you. What I will turn my hope towards is that you can find somebody out of your own circle of acquaintances so that at least you can still visit her from time to time...

I really am so sorry.

Patti,
I'm so sorry.
I would try other rescue groups and whoever finds Grace a home first gets to place her. The place that you mentioned was concerned about getting a lot of money concerns me and I wouldn't trust them to screen candidates properly.

hi patti, i will catch up with your thread tomorrow. sleep well!