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

Wow Sharlene, You now officially know more than most vets!! ;)

Since Molly's shivering has stopped since stopping the Trilo, that could certainly indicate a side effect of the Trilo itself, or her cortisol dropping a little too low. Both have been noted previously. So maybe the shivering isn't a sign or pain. It's so hard to know.

Stomach upset is common with Trilo. It used to irritate Buddy's stomach something awful. So bad that he couldn't settle to sleep at night. Pepcid did nothing. SEB was the only thing that I found that helped.

Happy to hear that Molly is still happily running around enjoying life. As long as she is able to do that, she can't be hurting too much.;)

Big hugs,

Hmmmmm...I totally agree with you, Sharlene, those ACTH results surely do seem backwards. I don't know exactly what to make of them, either, or whether your musing may be right (about her cortisol running higher all the time due to pain).

I know you'd rather not see the creatinine increasing. It occurs to me that if her renal filtering function is becoming more impaired, the trilostane may not be exiting her body as efficiently. I think that's why Dechra warns about giving trilo alongside kydney dysfunction. So I guess that's a question I would want to ask your IMS: at what point would Dechra advise stopping the trilo altogether in the face of rising creatinine?

Aside from the stomach issues, though, I'm so glad that outwardly she is still a happy girl. I think we reach a stage where that's the most important barometer of all. I know, though, that it's awfully hard to keep the dang numbers out of our heads. :o

I certainly will ask her that. I did make a mention of what Glynda found as far as when impairment is involved along side cushings, that cushings meds should be stopped if the animals appetite is being adversely affected by the lower cortisol and the kidney issue. Higher cortisol increases their appetite. We didn't come to any consensus on that during our discussion that this is the time to move away from treatment, but I will bring up the issue of whether or not the trilostane is being filtered out enough.
I know Lori mentioned on our thread that they stopped the cushing treatment and focused on the kidneys.
I've ordered one of the new forumula for dry and wet renal today so hopefully will have those by end of week and I'm going to move her onto it slowly and even though I know it isn't HER preference, will try to keep her solely on renal food and see if that makes a difference.
She really does appear to be okay. No increase in drinking without the trilostane and her appetite seems to be okay for her. We haven't had any more of those really horrible, refusing to eat episodes since she drove us all crazy that time 2 months ago. Maybe she had some serious gastro issues at that point.

She does keep me on my toes and I guess I'm adding kidney issues to the cushings issues that I'm learning about. (no my choice at all)

oh I was going to say too, Marianne, that since we are rechecking in 2 weeks I'm not concerned about letting the cortisol levels come up for her and I am guessing that the next test will tell us what is going on. (I'm still betting on an switch of the pre/post results) We have seen enough cushing tests on this forum to know that is the most obvious answer as to why so high a pre and often times, the obvious is the right answer. But since molly has been known to be her own dictionary with cushings, I can't say positively. The repeated negative ldds comes to mind, never over drinking water, no ravenous appetite, perfect coat until recently and only after she was on medication for over a year did it go bonkers. argghhh

:)

Marianne, I had sent that email to the internal medicine department asking about the possibility of the vials being mislabeled or the lab switching the results.

Today even though my specialist isn't into the office till tomorrow she emailed me and this is what she had to say about the high pre and low post:

Quote:

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I saw your email about Molly and just wanted to touch base. I think it’s unlikely that the tubes were mixed up but we can’t completely rule that out. I have seen that before in other cases. One theory that I’ve read to explain it is that more trilostane has been absorbed from the intestinal tract since the pre so there is greater inhibition of cortisol production at the time the second sample is pulled. I am back in the clinic tomorrow if you want to call me to discuss further.

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That is an interesting possibility that I hadn't seen mentioned before so I wanted it on here as something to consider. I am going to mention your thoughts on renal filtration too and see what she thinks.

Have I mentioned how much I adore my specialist and love how much she loves molly. :)

Hang on to that specialist! You've got a real winner!
Love,
Sus

Yes I do love her. I didn't get a chance to get back to her on Friday as it's the May long weekend in Canada and we have been away.

I took molly off all trilostane for 4 days and started back in at the lower dose on last Wednesday. At this point, all shaking has stopped. That makes me wonder if that post number wasn't the main factor after all. Of course it is also warmer, but it didn't stop until I took her off trilostane for a few days.

We've been transitioning to complete kidney specific diet and today is her first day with this without any mix of the old food in there. Cross my fingers that she doesn't get tummy upset or diarrhea from the switch over.

Hey Sharlene.... just wondering how our Diva is doing and of course you too.

Hi Judi. Great to hear from you. Just been working and more working.

Molly goes back Wednesday for her follow up ACTH. I expect it will be higher. No more shaking episodes forma couple weeks now! She seems to be walking better. Not as many episodes of her leg giving out. Eyes worse. You can tell because she uses her hearing to tell where in the house someone is. You can tell she will be looking one way and unless you make a sound that you are I. A different direction she doesnt know. Even if yiunar waving your arms madly in the air. She needs that sound. So another area we are working on to get her more comfortable.

Big hugs. Hope things are going well for you.

Near the end as Keesh's eyes and mostly his hearing went... I started to clap loudly to get his attention. Only needed to do it once. He responded well and I was glad it worked. Of course I used hand signals all his life, but the single clap was new. Seems that sound wave traveled much differently then my voice. 2 claps meant "no" meaning he could not trot across the street.. LOL