Dr. Booth called and he was convinced :) with you all, and I will wait until the new reduced dosage pills come in. Thank you all.
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Dr. Booth called and he was convinced :) with you all, and I will wait until the new reduced dosage pills come in. Thank you all.
I'm sorry -- I missed seeing your earlier post with the test results. In this case, you really do need to stop the trilostane entirely for the moment. Here's the related portion of Dechra's dosing instructions:
So simply lowering the dose is not enough right now -- Lulu should first have a "break" from the medication in order to allow her adrenal reserves to regenerate. Also, if she continues to act "off," she really should have a blood sample drawn to check her "electrolytes" (the blood chemistries that relate to the ratio of potassium, sodium, etc.,) since steroid levels that are too low can throw off this balance.Quote:
If the ACTH stimulation test is <1.45 μg/dL (<40 nmol/L) and/or if electrolyte imbalances characteristic of hypoadrenocorticism (hyperkalemia and hyponatremia) are found, VETORYL Capsules should be temporarily discontinued until recurrence of clinical signs consistent with hyperadrenocorticism and test results return to normal (1.45-9.1 μg/dL or 40-250 nmol/L). VETORYL Capsules may then be re-introduced at a lower dose.
Marianne
P.S. We were posting at the same time. I'm really glad that Dr. Booth has agreed to hold off on the trilostane for the time being.
I want to be absolutely sure you understand -
DO NOT restart the lower dose Trilo when you get it. Lulu needs to be showing strong signs and have an ACTH that shows the cortisol is rising beyond the acceptable level BEFORE starting the new lower dose. ;)
Vets often approach Trilo (Vetoryl) thinking it is safe - it is NOT safe. It has the exact same potential risks as Lysodren and must be treated accordingly. Playing willy nilly with dosing and testing can lead to serious, permanent issues with both drugs. ;)
My Jenny went Addisonian from too much Lysodren. She hasn't had any Cushings meds since April 2012 and was on prednisone until August 2012.
Her cortisol is slowly increasing and her specialist said he doesn't want us to let it get out of control making her uncomfortable, but he wouldn't even consider giving her any cushings meds until her post #'s are over 2.0 (I'm thinking higher but we'll cross that bridge when we come to it)
glad your vet agreed to stop the trilo. I have to say it's been a nice mental break not worrying about the cushings meds for awhile.
Thanks all. I have printed some of this. And I will print the PDF too on Vetoryl.
I am thinking of calling where Dr. Booth is today, since I could just swing by the satellite office with Lulu and have her electrolytes tested. But maybe it's best to just wait and see how she does. She is peeing okay, and her stool on this morning's walk was firm.
Whew... checked in to make sure all was ok... I had to run this am. Thanks everyone for helping out where I left off. I didn't have time to search for the Dechra acth recommendations. Good job.
Dad - you are doing great. Like Leslie said - it isn't just a matter of waiting 4 days. We need to wait until the cortisol has risen to a certain level and that will require another acth test and some time. Glad Lulu is doing well. Kim
Well Lulu made it through the day. I took her with me, had to go the bank branch and then decided to go main branch, long story so will spare the details. Foggy, but went to where I completed a work project to get some money, and the owner asked if he could pay me part. I said okay as long as I could cash at his bank. Then he asked if I was going to tidy up the project like I said I could. I did for two hours, and went and walked Lulu after an hour. She peed a couple of times and went back in truck. I have water in the truck for her and stopped at convenience store to get some cheese nips for her to tide her over till home.
Now she is a bit hungrier this evening, seems more alive. She does get this way in the evenings though.
I don't know if they shipped the reduced dosage pills as they needed a new payment card and I hadn't given it to them. I might get it with a bill, but want to discuss with Dr. Booth what you all on the forum have suggested. It does make sense, I just don't want her to be ravenous again, but maybe that is her nature at times?
Whew! I am so glad the gang was here to help with LuLu's results yesterday and today. No idea How I missed yesterdays post but I swear I almost had heart failure :eek: while catching up on the goings on this evening! (we probably need a fanning yourself while swooning icon)
Worry warts indeed. :) Definitely have a chat with your vet, but I wouldn't start anything until you see that POST number come up a bit. It might even be that if she has more symptoms at night that you would consider going to a twice a day dosing, but that again, is something to talk with your vet about.
So glad that today was okay. (now no more near miss heart attacks on the forum. I'm getting older you know!) :eek: :D
Sharlene and Molly Muffin
Let us know how things are going when you can:)
Hi Addy and others. Lulu is doing fine today. She shows her hunger at the meal table. She has us trained. She is pretty good, but reminds us that she is allowed a bit of table food.
This has been day two without her trilostane. I don't know how long we should wait before she is retested, but we are taking this just one day at a time.
I am not certain of weather conditions in your area.....but i feel i need to at least mention couple of things that caught my attention......cheese nips contain quite alot of salt which can really throw things off balance and the other is leaving her in car unattended. For many reasons and all being for her safety.....including safety from other people. I so hope all is well, and she is doing okay.
No worries, it wasn't hot. I came out after an hour and walked her around and then worked another hour. Could have stayed longer but didn't. The mixture a bit salty. She likes some salt, but she doesn't get an over abudance. I just didn't want her starving.
I am going to put a call in today to Dr. Booth, not sure where he's at today. But I will tell him that the general (wise) consensus is to wait until her levels go above normal.
Is 30 days a good time period to wait for a retest?
If Lulu were my dog, I think I'd let her symptoms determine how soon you retest. If her Cushing's symptoms start really kicking in again quickly, I would want to go ahead and recheck her so that you can resume dosing if her cortisol is rising again rapidly. But on the other hand, I wouldn't rush to recheck if her symptoms seem to stay under control for a lengthy time period. This is one situation where I'd let her symptoms really "call the shots" in terms of testing/treating.
Marianne
when Jenny saw the specialist after becoming Addisonian, he recommended a few weeks at a minimum but like Marianne said, he was most concerned with her symptoms. He doesn't want her to have raging cushings again.Quote:
Originally Posted by LabDad
That was last April. I tested her in August and will be partially testing her tomorrow. She hasn't had any symptoms.
So yes, at least a month pending any symptoms.
Thanks, Jenny, Judi & Marianne,
Sounds good. I will just monitor Lulu's symptoms.
Just got the notice that the reduced 75 mg pills have been sent, though I hadn't authorized payment. I had to change credit cards, so the one they tried to charge was closed. But I told the Kentucky company to call me first telling them that I would have to give them another card.
I told them I might send the pills back, because they are 88 dollars. They said they would keep for a year, so I wonder if I should just hang on to them and if so keep them in the refrigerator or just room temperature. I am thinking that Lulu's cortisol levels will eventually go up?
you just don't know
in April 2012 Jenny's pre and post were .2 & .3
In August 2012 they were .8 & 1.0
Here it is January 2013 and she hasn't had any cushings meds for 9 months
But I don't think Belinda's Bo's levels ever came up. $88 is a lot of money. I'd cancel if I were you. You can always place an order later.
Judi
I agree... you don't know so I'd have them cancel the order if you still can. You can always order again. And the dose might be even lower... let the symptoms determine the next step. Kim
Hi,
You sure are getting lots of good advice.:D:D I hope Lulu is ok so far. Have you talked to Dr. Booth at all? Just wondered. Sometimes the pups bounce back faster from going to low from Trilostane compared to Lysodren, but you just never know.
Give Lulu a big hug from me:D:D:D
Hi all,
I greatly appreciate all the help. I told Dr. Booth I would see that he gets the website address, plus I know at least one other veterinarian that I am going to send this site too. You see many of the vets with high volume practices only see a handful of Cushing's cases. And the info is out there, but they can't possibly know it all. Dr. Booth seemed eager to get the site, he said give it to the office and they will put it in his notebook.
Yes, Dr. Booth agreed, and said let's check her in a couple of weeks. Another doc. we know suggested a month.
Lulu is doing well. For a bit she didn't seem interested in food about half an hour ago. But then she did eat a biscuit that was by her foot, and I gave her a small bit of chicken which she gladly ate.
She can be funny, and I have noticed that when dogs get older their personalities can change just like people. She seems to be doing well.
I want her to gain a bit of weight, though my wife likes her weight. You can feel her back with and the bone above her head with her skinnier physique. But I think some weight should come back if she is a bit hungrier. Now I did notice that she was pretty hungry late afternoon.
Lulu seems to be not as hungry tonight. She did eat a treat and she doesn't turn down chicken or ham. She did try to get up the stairs by herself and fell back a step, so she might have hurt herself a bit. She has been able to get around, but I think she is tired tonight. Will keep an eye on her.
Will keep an eye on her through the night as I usually do. But she was pretty active this evening so it may just be that she wanted to go to bed early and occasionally will go up early. I don't usually help her up till close to 11, since she likes to be where the family is.
Going to get her a small piece of ham and then retire.
Lulu doesn't feel as well today. She did fall on the steps going up to bed, early last night. I had to help her up. I think she may have slid down a couple of steps. They are carpeted.
This morning she did come down the stairs with my help, but she was bit hesitant. She went outside but after a while she lied down. She does this when she's tired. And she has a bit more trouble lying down, though she can get up.
I got her to eat only some soft food, like chicken, rice, ham and some canned dog food. She wouldn't touch her dry food, her treats or her pills. Now she did eat one meaty bone treat.
I think I will call the vet. I don't know if this would be a sign of Addison's or just that she hurt herself?
She was fairly active yesterday afternoon, and wanting food from us, which is typically normal for her.
So I thought I would post this. She does appear to be comfortable.
Morning,
Yes, I would have her checked out asap. She may have hurt her legs in the fall and / or the cortisol may be too low still. Be sure they check her electrolytes, not just the cortisol. And do NOT let them tell you she needs back on the Trilo - with this behavior, the med would have been stopped for a bit anyway. ;)
Please let us know what you learn and remember that not everything that happens with a cush pup is related to Cushing's so don't let the vets get tunnel vision. ;)
Hugs,
Leslie and the gang
We have decided to go to vet at about 3 pm, five hours from now, or earlier. Dr. Booth will be the ER doctor at 5:30 pm and they expect a couple hour wait then. So we figure we would get there at 4:30 pm and then just wait until he comes on staff.
Lulu is resting well, she can get up and did so when my wife, Linda (a.k.a. Moo) gave her some chicken and rice. She just perked up when Moo came down. So I think she will be okay and we can see the doctor of our choice, even though it will cost us 12 dollars more for the ER charge.
I agree with Squirt's mom on this one. The lack of interest in food, overall tiredness, trouble with stairs - these are all things that happened to my dog when he was very very sick. He would perk up a bit and I'd think I was over reacting, but then he'd feel bad again. So now I'm of the opinion that it's better to be safe than sorry.
You know, I used to worry about Baxter's weight a lot with the cushings, but once he got cancer I was so grateful for the little bit of chub. And thank goodness for cushings that keep our doggies with a healthy appetite even when they are going through some rough times.
Lulu seems to holding her own. I have her in the basement and going to use the treadmill, she loves the basement. She is alert and can get up and walk outside and pee. I think she did either pull a muscle or otherwise hurt her leg. She will be fine till we leave this afternoon. It has been hectic, as I mentioned bank before, we had a serious break-in and of course the other stressful things.
We will do a short bit of shopping, most for Lulu and stop at my contract job, for money they owe and to touch base.
Lulu comes first for us, but it's been a struggle and I think one of my quotes shows that I am up to it. At least I hope so.
So see you on the other side of the treadmill!
Okay, I am glad she seems better. Let us know what happens with Dr. Booth. I wonder if you should have some prednisone on hand just in case. Some vets will give it to us, some refuse. Maybe ask to see what his feelings are about it.
I am going to ask Dr. Booth about prednisone. I should have some. It saved my life 30 years ago.
Yes, Lulu ate my wife's rice, spinach and something else, a very yummy and low-calorie soup. She added some chicken for Lulu, Moo is a vegetarian. Great recipe
Lulu seems in better spirits, she sat outside while I treadmilled, and then I brought her in with me, and then we both walked out the basement door up the hill to the kitchen for lunch. Now I am back in the basement to shower and get ready to take her to the vet.
Checking in on Lulu, glad she had something to eat. Low cortisol just makes them feel rough around the edges and so I hope that is all it is, but just in case, stick with the chicken and low fat food, don't want to get her pancreas upset.
hugs,
Sharlene and Molly Muffin
Lulu has regained some of her spunk. Dr. Booth thinks she just had a fall which caused her some stress. He ran some labs. The electrolytes are okay. Her AlkP is high, but that is typical with Cushings. But the number was pretty high. I had a very high value when I had Ulcerative Colitits years ago, but it has been normal since.
http://www.k9cushings.com/forum/albu...pictureid=4519
Lulu is glad to be home and her appetite has improved.
BIG SIGH OF RELIEF ICON:D:D:D:D:D
Sometimes we see that number in the thousands. Glad to hear Lulu has improved.
Very glad to hear that Lulu has regained some of her spunk. I wonder if the higher number on the AKLP might have something to do with the cortisol dropping low.
Sharlene and molly muffin
Sharlene,
I am going to see if I can't get all of Lulu's lab results from the past years. Her liver enzymes have been up before, and I believe the first time was back in 2006 or 2007. This would have been after her ACL surgeries as I believe the Romeo Vet Clinic did the tests. We started using them more after the surgery because their lab costs were surprisingly cheaper than our closer Port Huron vet. Her liver enzyme values then came down. She may have had the start of Cushing's Disease then!
Since our Port Huron vet retired we have pretty much moved her care to them.
Lulu has been fine today. She walked a bit, but was reluctant to even meet her neighbor dog Bella, a cute Jack Russell Terrier. They became great friends over two years ago, when Bella was still under a year old. Those two would play tug-a-war. If I find the short videos I will post them. I do have a video of Lulu opening one of her Christmas gifts. I will post the link. I have uploaded the files so I will just have to create a webpage to point to them.
Hi,
I was poking around DVM 360 and I came across an article which discussed low cortsiol concentrations with Trilostane. I thought I would post the link for you. I have always thought this to be a trustworthy source but if it is not I am hoping one of our administrators will tell us.
http://veterinarymedicine.dvm360.com...date=&pageID=3
Perhaps Lulu will only need half of her 100mgs which would mean only 50mgs.Quote:
If the cortisol concentration is below 0.7 μg/dl, withhold trilostane until signs of hyperadrenocorticism recur, and closely monitor the patient for signs of hypocortisolemia. If the post-ACTH stimulation cortisol concentration is 0.7 to 1.5 μg/dl, suspend therapy for 48 hours, and then restart it with a 50% dose reduction.
Interesting study, Addy. Thanks. I am at the point now to wait and retest in the next couple of weeks or so. But to watch Lulu. Too bad it takes time to get the trilostane if it's mailed, since I try to keep the costs down too.
Just wanted to pop in with my two cents worth. Addy, I also rely on that publication -- DVM360 -- for lots of excellent resource info. And Dr. Audrey Cook is a distinguished veterinary endocrinologist who is a faculty member at Texas A & M and also a consultant to Dechra. She is the researcher who has been studying possible use of baseline cortisol as a monitoring tool for trilostane treatment.
Having said all that, my only reservation about this article is that it was printed in 2008. There has been a lot of water under the bridge, so to speak, during the intervening years re: trilostane dosing and monitoring. So even though the source of this info is highly credible, I'd want to see whether Dr. Cook has updated her recommendations in recent years. At the time of that article, I think the general initial dosing recommendations were higher and also there was less awareness of trilostane's potential for more lasting impact on adrenal function.
It may be the case that Dr. Cook is still making this same recommendation. To our frustration, it is definitely the case that different researchers and specialists have different preferences regarding trilostane treatment. But in terms of this specific recommendation, I'd feel more comfortable if I saw it in a more current publication.
Marianne
Thanks Marianne.
I gave Dr. Booth the URL of this forum, too. I plan to give a Dr. Geiger this address, he is a country vet that we take our cats to. He was very interested in Lulu's Cushing. He said he is treating about 4 or 5 dogs now. His clients don't have a lot of money, so until recently I don't think people treated the disease in his area.
Thanks Marianne, I did think about the date but then it also seemed to correspond to how Dr. Peterson handled Cindy's Penny when she went too low but perhaps my memory is faulty on that;)
I'm glad to know the site is valid. I have used it quite a bit over the years.
Addy, you may very well be right in your memory about Dr. Peterson. You know, since there do seem to be differing recommendations, it would be great if we could find the time to hunt up and consolidate everybody's advice in one spot. That wouldn't necessarily give us the "definitive" answer, but it would be interesting to see how the opinions overlap (or not). Maybe a good project for us to tackle at some point!