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Hi Marianne,
Datsun's most recent STIM was performed on Wednesday, February 8th. The STIM was performed at 4 1/2 hours after his morning dosage as were his 6 other STIM's since October 2016 all tests were performed at the same Veterinary Hospital, UF in Gainesville, FL.
Thanks So Much For the Quick Reply!
Mitchell
And yes both dosages are given with food.
Did Datsun eat breakfast alongside his trilostane on the day of the test (as well as on other days, as well)? If so, the results should indeed be accurate. However, one possibility I might suggest is talking with UF about perhaps moving up the timing of his ACTH the next time around. Dechra acknowledges that there is a fair degree of variability in the manner that individual dogs metabolize trilostane, and perhaps Datsun's cortisol is "bottoming out" and then rebounding more quickly than is the norm. It might be interesting to see where his cortisol level is at that 1.5 hour timeframe, especially if his myopathy is otherwise much improved since starting treatment.
Have you reported the wobbliness to the vets at UF? If so, do they have any thoughts about it?
Marianne
Whoops, we were posting at the same time! Thanks for the info about the food.
I did mention to UF about the wobbliness following his dosages, the Doctor feels that it may or should (not sure or definite) resolve once he is "stimming" in the recommended range. Due in part to his wobbliness, the Doctor wants to see if his upcoming blood chemistry will be a better indication of Datsun's symptoms resolving rather than solely relying on the STIM since he is so close to optimum treatment reference range. I'm concerned about raising dosage. Testing him at 1 1/2 hours would be very interesting to see the results. I will ask him about the variability in the rate at which the Trilostane effects Datsun. Interestingly, I did ask the Doctor about 3X dosing early on when the treatment was begun. The Doctor was not in favor of this due to concerns over being able to consistently measure stims. I also asked if obtaining the treatment range was the main measure, than why not single dose until treatment range was obtained.
Anyway, once his blood chemistry shows improvement the Doctor thinks the Myopathy should improve. I'm wondering if anyone has noted Myopathy improvement once their dog is within treatment range and how long before improvement was noticeable? And is there anything else that I can do for Datsun to increase the chances of improvement of the Myopathy. I do massage his hind leg quads to the point where he will relax his leg muscles enough to allow the knee to bend and relieve the stiffness temporarily.
Perhaps water therapy could be tried?
Datsun's blood chemistry has significantly improved, in September 2016, before Trilostane Therapy,
His numbers:
ALP 617 5 - 160 U/L HIGH
ALT 202 18 - 121 U/L HIGH
AST 77 16 - 55 U/L HIGH
CREATINE KINASE 640 10 - 200 U/L HIGH
GGT 63 1 0 - 13 U/L HIGH
BUN 33 9 - 31 mg/dL
Trilostane Began October 31st, 2016.
After Trilostane Therapy, March 9th, 2017
ALK PHOS 127 U/L H 8 - 114
ALT P-5-P 80 U/L H 18 - 64
AST P-5-P 72 U/L H 15 - 52
T BILIRUBI <0.1 mg/dL 0.1 - 0.4
CREATININE 0.7 mg/dL 0.6 - 1.7
BUN 27 mg/dL H 8 - 25
Unfortunately his Cushing's Myopathy has gotten worse, he no longer walks. My Vet thinks this may be permanent. Very little information available, does anyone one know someone who is an expert with Cushing's Myopathy?
It sounds as though Datsun may be in the very miniscule number of dogs with cushing's who have a condition known as pseudomyotonia. Unlike the usual muscle wasting that is commonly seen in cushing's pseudomyotonia can be quite devastating. If this is what you are dealing with, your vet is correct that it does not always improve with treatment. The specialist you would need to consult for this rare symptom would be a board certified veterinary neurologist who would run a number of test to determine if Datsun does have pseudomyotonia. Has your vet ruled out other possibilities such as degenerative myelopathy, IVDD, etc.?
Hi Mitchell,
In my ongoing Cushing's research I stumbled on these two articles, one written by Dr. Mark Peterson, an endocrinologist.
http://www.vmsg.com/wp-content/uploa...domyotonia.pdf
http://www.endocrinevet.info/2011/02...-cushings.html
Another thought is to email Dr. Bruyette in CA and ask if he could recommend anyone in your area, including your IMS, with whom he could consult to treat Datsun. I don't have his email but I am certain others here do.
Also, if you search this forum for myotonia, there are or were other folks whose pups were diagnosed. I'm really sorry as it seemed that Datsun was doing well before this condition emerged. This disease truly sucks and I'm thinking of you and Datsun.
Thank you for the information. The article written by Dr. Peterson was very interesting, but apparently there is no known treatment. Datsun has a follow-up appointment tomorrow with the neurologist at UF. He has been on a steady decline with regard to his mobility over the past 8 months. His myopathy symptoms worsened last week. In August, Datsun was able to jump up onto the couch or bed and would occasionally run after a squirrel. It's been such a short time that his condition has worsened to the point where now he will not walk. I still wonder if the Trilostane treatment which began the end of October is involved. I still wonder if I should change course and treat with the Retinoic Acid... I am going to try and decide if we should temporarily stop the Trilostane to see if it will make a difference. Possible revert to micromanaging each of Datsun's Cushing's symptoms. After his neurological exam tomorrow I'll relate any new information...