Molly, 13 yr, shih tzu - lhasa aspo - Molly has passed

Sharlene -- Not sure how to correlate the results between the two different tests but Molly definitely has a history of continuing to drop the longer she is on a particular dose. That said, since the trilostane has such a short life and you definitely know what to look for with regard to negative effects, you would be able to stop the trilostane immediately if need be. Would it be more expensive if your vet orders a week's worth at a time? I would hate for you to have to pay for 40 pills and then have to go change doses before you use them all.

I've decided to do a test in two weeks as yes her history shows she willcontinue to drop. I have enough of the 15mg to get through that time period and a bit past so we can decide if it is safe to keep her at 15 mg or not.

With Molly's lack of symptoms that are typical of Cushing's. She shows no different at this cortisol level than previous higher levels I worry that she would have to go very low before we caught her using symptoms. Even diarrhea is in her history so not a true indicator. She doesn't drink as much as she should and never has. So that too is a problem area. And food she has never been a big dry food eater either. Sigh.

There is nothing typical about Molly and her diagnosis.

I will only do the ACTH test in two weeks so cost shouldn't be too bad. Cross fingers.

It is definitely a balancing act and fine line with her. If I could know she would stay where she is I'd be very happy indeed.

Sharlene -- your plan sounds like the most sensible (albeit, expensive) thing to do. Hopefully, Molly can maintain the good numbers and not go any lower!

(I think Molly and Abbie conspire together somehow to keep us on our toes! :rolleyes:)

I didn't want to have to spend the money right away but I've seen how quickly things can go wrong. A drop of 200nmol or 0ver 7ug in two weeks. Knowing she has continued to go down without a change has me wary. Better safe than sorry. I hope.

I think that even after all these years and the knowledge I've gained. ( never enough). I still am afraid of the what ifs.

WOW, in only 2 weeks with the 15mg and she dropped that much. I believe your plan to test in 2 weeks in a very good idea, glad to hear that Miss Molly :) is doing well with her Trilostane.

Sending positive energy along with love to you and Molly, Lori

You know, one more variable in all this is that the stimulating agent had changed for this most recent test. I know that, theoretically, that should not make any difference in the results. But perhaps that introduced some change in Molly's test numbers in addition to the change in dosage. I agree, it will be really interesting to see if there is any further variation in two weeks.

Marianne

I wondered about that too Marianne. The other variable is that I had changed pharmacies. I just don't know but it is worrying.

We went up 4 mg on the increase and I was hoping to be around 200 or 180 nmol when the results came back. Dropping that much definitely is more than I think either myself or the IMS expected.

Hmmm...the pharmacy change raises even a few more questions, then. Are you going to be sticking with this pharmacy from now on? You know I always worry when we see unexpected results with compounded meds. Especially when dealing with dosing totals and changes that are incrementally rather small, I always wonder how accurate the changes really are from batch to batch, even using the same compounder. But now I'm really wondering whether the pharmacy change may account for a difference in absorption or actual accuracy/comparability of dose. :o :o

I don't know. It depends on what the next test shows I guess. I did cancel the order for more of the 15 mg pills today and we will see how things go till next week.

If she continues to drop a lot them will probably go back to getting from the vet school pharmacy. I just don't know why she dropped so much.

I know what you mean. Is it the stimulating agent. Is it the pills. Is it just Molly. Argh. So frustrating.

Sharlene, why did you decide to change pharmacies? One probably very goofy thought that occurs to me is that you could order some 15 mg. capsules from the vet school and give them for two weeks before retesting. It would be interesting to compare the results between the two sources. But that would only really make sense if you wanted to return to them, anyway, which you may not.

If you want to stick with the new compounder, we'll just figure this is a baseline for the way in which their dosage affects Molly and judge future changes accordingly. Plus, we're kind of overlooking the fact that she is finally in well-controlled therapeutic range -- and that is really a good thing! :) :)