Zoe By My Side- Our Journey with Cushings

day two of 30/10 after skipping one evening dose- she investigated the closet (has not happened in more than a month, mini trot to the dining table ( has not happened in a month) for two days she was drinking water like crazy and panting- not today and hubby did not have to help her up off her bed today.

I wonder if I should keep the test going for a week before I try to put her back to 30/20.

Oh and she finished all her food without leaving some in the bowl and taking forever to eat it and spitting it out all over.

Now the worry is will her cortisol go too high?

October 15th, I cut her back to 30/10 for five days and it was not until 11/8 she got worse again with the head tremors and falling over.

Then she just kept getting slower and slower. I guess only time will tell but my spirited girl seems to have rebounded and her large personality is back:):) Not sure for how long but tonight I will take it.

Quote:

---

Originally Posted by addy

unless she has a macro causing neuro problems my main goal is to keep Zoe with a quality of life, which has always been my goal.
:

---

Hi Addy,

Saying the "M" word is taboo!:eek::eek: We don't want to even think about going there!! Yes, it's about quality of life.

I hope you mom has settled and is doing okay for now. xxxxx

Hi Addy

I so hope the tweaking does the trick, it is such a fine line between the good and bad. Her Mom knows her best though! Must do your heart good to see her more perky! I wish I knew more about the intricacies of dosing but I do not, but I am thinking if you are seeing improvement you are doing something right so trust your gut, I have learnt to do that and it is usually right :)

Thank you for being there for me through this last traumatic week, you are a great friend to have Addy and I always feel you have our backs and for that I am very thankful I have met you xxxxxxxxxxxxxxx

Hi Addy... you know I can't help or give advice on anything, but wanted you to know Zoe and you are constantly on my mind.

With the gamut I've been through for months, I totally agree with you in regard to quality of life. That's all I can do right now for Keesh.

Each day they are feeling great to me is a blessing.. a day at a time.

Glad Zoe is enjoying each day.

Addy, re: the studies comparing once vs. twice-daily dosing, here's some of the info you may be looking for. This is a 2012 retrospective comparison of the results of trilostane testing during 2001-2002 performed at the Royal Vet College in conjunction with the original licensing of Vetoryl in the U.K. by Arnolds (the company that ended up being bought by Dechra). The first study involved once daily dosing. The subsequent study involved twice daily dosing, and although it's always been known the twice-daily study was done, to my knowledge this is the first time the results have ever been published.

When we started Barkis on trilostane in 2003, there was some other preliminary research that suggested twice daily dosing might be preferable. I was so anxious to find out any recommendations from the U.K. study that I even tried to contact Dr. Neiger myself (but with no luck). At my urging, our IMS was willing to go ahead anyway and we dosed Barkis twice daily, although in retrospect I wish we had not, since the general thought at that time was to double the once daily dose rather than halve it. Anyway, after all these years, finally we see the original study results. And it seems to confirm what I'd eventually ended up suspecting -- that those original researchers did not find a significant advantage to dosing twice daily. And I presume that's why Arnolds/Dechra did not originally publish the data or alter their recommendation to begin with dosing only once daily.

I haven't had time to read through the article in any detail, but it does seem as though there are some interesting tidbits that mirror the results of other studies. For instance, dogs dosed twice daily seemed to achieve faster and more effective control than those dosed with the same amount once daily. However, in a departure from what Dr. Feldman has anticipated, dogs who were able to remain on once daily dosing (some dropped out of the study) did not exhibit any more unwanted ill effects than those dosed twice daily. But you need to read through the whole discussion to understand the various study limitations, and I do have remaining questions. For instance, I don't understand why Dechra recommends increasing the total daily dose when switching from once to twice-daily dosing, since that seems to run counter to the study results. But anyway, here's the bottom line:

Quote:

---

Objective: This retrospective study describes the use of trilostane given once versus twice daily in dogs with hyperadrenocorticism (SID vs. BID group)in separate clinical trials. Material and methods: The groups were compared over a six month period using laboratory findings, dose required to suppress post-ACTH cortisol, and clinical scores from owner and clinician questionnaires. Results: Ninety-three dogs enrolled the trials but for analysis of the final visit results only 56 dogs filled the inclusion criteria: 30 dogs in the SID-group and 26 dogs in the BID group. Both treatment groups showed an improvement in clinical scores with time and no significant difference between them. In the BID-group post-ACTH cortisol concentrations went below 250 nmol/l sooner and in a higher proportion of dogs than in the SID-group. Twice-daily administration of trilostane also achieved a faster and more effective control for comparable daily doses. A higher individual tolerability (based on clinical scores) was found in the SID-group but there were no supporting laboratory findings. No dogs developed serious side-effects. Conclusion: This study reveals only small practical differences between once and twice daily trilostane administrations in treating hyperadrenocorticism. And the overall benefits of twice daily dosing have to be considered against the effect on the owners and their compliance with treatment.

---

Here's a link to the German veterinary journal in which the article is published (note that you can download the full study for free):

http://tpk.schattauer.de/en/contents...ipt/19145.html

And then, for comparison purposes, here's the link to Dr. Feldman's 2012 twice-daily dosing study and the summary of the results and conclusions drawn by the Davis team:

http://www.k9cushings.com/forum/showthread.php?t=4442

And here's one more new comparison study that I just now located:

http://onlinelibrary.wiley.com/doi/1...12207/abstract


Marianne

Thanks guys, there were a couple evenings last week when she was laying down, she tried to lift her head and could not, she just dropped it back down.:eek::eek:

and the food thing was like her mouth did not work right

this morning her bark is strong, she is active and curious, she seems more like she was in August and September. Even the hard panting has eased up.

I wont jump to any conclusions yet, I know each day can change and bring something new but she this morning she seems so much better and is walking so much better.

I would rather have her bald and walking then how she was. Last week we would go out for her chicken walk and she would just stand there and not walk, she would just take a few steps and stop and theat head thing and falling over freaks me out.

sorry guys, I am getting emotional now and starting to cry.

Have a great Saturday we are off to find a turkey

Addy, it looks like we were posting at the same time. I just want to make sure you see those links re: the dosing studies I think you were wanting to revisit. ;)

Addy:
My heart just breaks reading your post. I hope you get some resolution to this soon as I know how you are feeling, and it is not good to be under so much stress, I know that all too well. It is a shame how this disease can make your life so unbearable at times. Blessings
Patti

What a life saver you are Marianne, thank you so much for finding the studies for me.

I have been printing and googling my heart out this week so thank you so much.:):):):)

Hubby has flashing lights in his eyes now so we have to find a opthalmologist and watch to make sure he does not develop signs of a retina tear.:eek::eek:

He is usually pretty patient about me bouncing things off him but right now he is worried about his eye so I need to bounce things off on my thread right now:):)

I did recheck pricing for 20/20 and hubby finally caved in if we decide that route. I just am not sure that is the right way to go yet.:confused:

oh my gosh, your poor hubby, first the shoulder now his eyes. Well, I hope you can find a good ophamalogist and get him in today to get it checked out. Mine is currently at a physio appt for his shoulder. I swear if he doesn't get this shoulder thing fixed it is going to drive us both nuts.
I hope it isn't anything too serious causing the flashing lights. :(

Do you keep a journal on how Zoe reacted for each medication change? I'm wondering where she feels best at. I know you've made a few changes over the years, but I agree, it is heart breaking when she won't do the chicken walk, you know she doesn't feel good or right. The falling over would scare the bejeebes out of me too, so whatever it takes to get rid of that, would be worth it. I'm with you rather a balder zoe, but a happy zoe.
Now what is the thinking of going 20/20 vs 30/10? More evenly spread out? Do you notice the bad issues after the first dose of 30 rather than in the evening on the 10?
hugs,
Sharlene and Molly Muffin