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! :) :)

Hi Marianne. One factor as always was cost. To get it through the vets compounder was more expensive and I have to go to the IMS to pick it up. Not the closest option by any means. And I had no contact with the compounding pharmacy myself. This was recommended by someone else who uses them for trilostane for their dog. It's a human pharmacy who has a pet pharmacy section too. So I like the options available and they send it straight to my door.
Since my IMS is not in till Wednesday I think, I haven't been able to discuss any of this with her yet. So couldn't get the vets pharmacy to make pills to compare till the end of the week. Then under a time crunch of when I can get the testing done.
I love that she is controlled now and hope it makes a difference with the kidney and bp issues. I really just want her to stay right where she is now. My fear is that she won't and will drop some more. Not tons of wiggle room.

I am probably being a worrier is all. I do tend to do that. Lol. Last year was a real kick in the pants. Things just changed and went downhill so fast. Good one minute and not the next. It makes me gun shy for sure.

You want to be between 42 and 152, right? I would keep her on dose she is at longer and retest. I think that's what you decided to do. I'm not sure if our IMS is being conservative or not with Kaibo but she wanted him to stay on 5mg twice a day for another month because she said he may still drop...and that was after a month being on that dose. I guess we will see in a couple of weeks. Im not sure if I posted on our page but Kaibo's down to one insulin instead of two! He's doing really well 😃

Yes. They can go put to 250 nmol. That would be 9 ug. That she dropped so much so fast and because she usually continues to drop for even copper 30 days worried me. We have an appt for next Thursday to retest. I am a worrier I know. But we have seen it happen so easily on the forum where things can go low quickly. I like nice and slow.

That is great about kaibos insulin. Congratulations.

Hmmm well it is past Thursday.... we need an update!! I now you're a worrier, we all are... that's why we here :D dog worrier's united! Hopefully the IMS calls to let you (and us) know all is well!

Nothing yet and whatever the verdict we won't be able to order till Monday, and so I will run out of 15mg on Tuesday and will have to use some 11mg I had left to carry her through. ARgggghhhh

Usually have a call next day at around 5pm. Guessing there must have been emergencies today and they take priority, which is understandable, it is a VET ER hospital first and foremost where her specialist is.

Stink! I still have hope she will call!! **fingers crossed**

So I was right, emergencies all over the place today and my IMS was the only internal medicine specialist on duty. She called me around 9pm.

I don't even begin to know what to think about these results. Molly continues to be... well molly.

On the same dosage of 15mg:

Pre 29 = 1.05 ug
post 243 = 8.8 ug

She said she wasn't worried about the pre being that low, as that can fluctuate during the day due to different factors that if the post had also been low then we'd worry, but instead, mollys post went up by 140 nmol points.

She dropped 234 points from her post of 334 nmol I think it was in the previous test in April initially on the 15mg and now back up.

If I hadn't just had an ultrasound 2 weeks ago, I'd think she had an adrenal tumor, but then this is the dog who tested negative on every LDDS test too.

So what the heck molly! You are confounding me.

If any of you have any thoughts I'd love to hear because I swear this dog is absolutely one of the most confounding cases I have seen and just figures she is mine.

She is doing everything normal molly. Eating, drinking, playing. No diarrhea, poops have in fact been great.

sigh


2 weeks ago, she was on 15mg and results were:

pre 44
post 103

We talked about was it the compounding pharmacy, was is the test..what.

I think it is higher though, this past week, she has had less problems with the back left leg than the previous 2 weeks and here is the kicker, she hasn't had the tremors for the past week.

The ultrasound showed no change in the adrenal glands, still enlarged bilaterally. The nodule hasn't changed a bit. The liver is still enlarged and the only thing we noted on the tests is that her liver values have increases (ALT and ALKP) GGT fine. Which is also baffeling a bit as we'd hoped those would either come down or stabilize.

I asked if we should try going back to the other pharmacy but she said, no since I am on lock down at work, and can't get off for a test, then we'll keep her on the same pharmacy's compound and she'll order 8 weeks worth of trilostane 15mg and we'll retest when I can and see how she is.

Ah, Molly, Molly ... you sure do keep your Mom's brain cells on high alert! Sharlene, since Molly is feeling so good, maybe just shift focus away from test results/patterns. The improved leg and lack of tremors are definitely good signs. I know how hard it is to just accept what is and not wait for the "other shoe to drop". Give Molly and yourself hugs from Abbie and I!

That is the idea just accept and go with the flow for a bit.

Today though is not a good Molly day. Started last night with her very jumpy on a late night walk. Them stopped and wouldn't go up the step. Fine this Morning. Then this afternoon was behind couch and had diarrhea on her walk around 4pm. Is still jumpy but did the step okay. Not sure is this is cortisol or eyesight.

Since Molly often has diarrhea I can't say that it is related to cortisol levels which should be fine as the test Thursday was higher anyhow.

Maybe just am off day for her. Hard to,say. I don't like it though.

And now she just ate all her dinner and is bopping around like no problem. We will see how she does on her walk later on. Still think she has lost more sight I. The right eye especially

Another day when we wish our dogs could talk!! I was thinking that it was more than likely Molly's vision issues. Abbie has cysts almost completely covering her corneas and she startles often.

I tend to think it is eye issues too.

Hello,was reading a little about your baby Molly.I have also read about others on the site.All these sweet babies.But I noticed they all are lucky they have such loving mommies.

Quote:

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Originally Posted by molly muffin

Maybe just am off day for her. Hard to,say. I don't like it though.

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Yes, I somehow managed to handle the continuing problems as they arose, but the off days now and then were tough. I totally get it. For me, it was that knawing feeling that something wasn't quite right, but not knowing what it was or how to fix it.:o

I had a dog as a child who went deaf and blind as he aged. He was my little brother who grew up with me. We were inseparable for 15 years. It was a minor detail that he actually happened to be a dog. He started as my protector, but toward the end, I ended up having to protect him. He managed very well for a long time in his sound and sightless world. He was truly loved and that was all he needed. Molly may be losing her sight, but she has all she needs too! She is dearly loved!

Hugs,
Kathy

Hey Sharlene,

Were the 03/18/2015 ACTH stim numbers (1 hr post - 326 (11.8 ug/dl)); 2 hr post - 356 (12.9 ug/dl)) from the former compounding pharmacy, and were her recent ACTH stim results 05/07/2015 (Pre 44 (1.5 ug/dl); Post 103 (3.7 ug/dl)) from the other compounding pharmacy that you switched to? If so, then what Marianne has mentioned before with regard to the pharmacy change, could be the culprit for those conflicting stim results. :confused: How is she doing now?

Hugs, Lori

Only these last two where from the new compounding pharmacy.

I mentioned that I want to go back to the other pharmacy and compare but the IMS said she didn't want any change while I wasn't in a position to do a test.

So this next batch of meds will be from the new compounding pharmacy and then when we test next the order will go to the other compounding pharmacy from at the vet university. That is the long term plan.

She is sleeping now. Was okay last night but not as playful.

Dawn. Yes we all try so very hard to do the best we can for our much loved furbabies.

Kathy you are right we know when they are off. I am sure Molly can adapt if she does end up blind. I worry more about figuring out the medical issues she has going on and trying to keep those stable. Cortisol liver kidneys and bp.
They said her liver just keeps going up and there is no reason they can see for it to be doing so and are hoping that is she is controlled maybe that too may adjust with time just as they hope the kidney and bp will adjust. We are putting am awful lot of hope I to this one area helping all the others.

Molly is doing okay this evening. She seems to bounce back and forth i. How she reacts on Any give day or even hour.

Oh Dear Sharlene,

We love our little muffin too and know how worried you are.:o They have our hearts wrapped around those furry little paws of theirs and we desperately want to fix everything for them and make them okay forever. It's the feeling of helplessness that sucks!:o :( Okay, not the best choice of words but they work. Molly has always been somewhat of an enigma. She loves to keep you guessing and on your toes.

It finally got to the point with Buddy that I had to Face the fact that I could not fix him anymore. Although that was devastatingly difficult to face, it was also freeing because my focus had to change to enjoying every precious moment I had left with him and letting the rest go because nothing else mattered anymore. I pray that you are still a long way from that point with our little muffin and she will once again bounce back from all these little setbacks. It's really easy to get so wrapped up in all the diagnostics and lose sight of the precious little baby right in front of your eyes. I spent way too much time frantically googling, searching for a miracle cure that could save Buddy, when I could have doing belly rubs and butt scratches. Try not to make the same mistake I did.

Breathe Sharlene, you'll get it all figured out.
Hugs,
Kathy

Hi Sharlene, I just skimmed a few posts and sure hope Molly is having a break and a better day. I need to go back in your thread, I remember the last updates I read, her numbers had come down but sounds like her eyes are troubling?

Thinking of you as we cleaned our pool this morning, water is still cold, we have not had the heater on much as the pool has only been open for a week.

I hope you and Molly are ok

Love
Addy

Dear sweet Sharlene.
Will be praying for our sweet little Molly. Hope she feels better.
Love Sonja ,Apollo

Addy, Sonja, so great to see you both here. :)

What a busy spring you have had Addy. I can't even imagine doing all you have done while also not feeling the best in the world.

Sonja dear, so good to see you. I know things are very hectic for you too these days. Hope that little Ariel is keeping you smiling though. That's important through all the rough times.

Molly is being molly. a bit demanding and seems to be feeling better than she has for the last couple weeks. Lower cortisol might not make her feel so good, but who knows.

She'll be going a bit higher in her cortisol as i ran out of the 15mg and playing phone tag with the pharmaist since monday. It will be sent out tomorrow and hopefully I'll have it friday (if the post feels like it) or if not will be next week.
Since I'm out of 15mg pills, she'll have the pills I have left, not sure if they are 11mg or 8mg, but better than nothing. Then we'll have about 6 or so weeks on 15mg till her next test.

She is currently barking at me because she wants her veggie treat. She pulled a toy out of her box last night to play, which she hasn't done for a couple weeks at least. When she does that I know she is feeling good.

Also continues to NOT have the tremors and leg is acting better too. No slipping out causing the hop. Gads. What a twist this girl is.

hugs all!

I don't post much anymore, but you can bet I check up on "our" Molly almost every day. Glad to see she is feeling better. My stomach still flips when I do come here, and I find it still very hard, but all the pups I knew get a regular visit on their threads just so I know how everyone is doing. So... sweet Molly, you just keep your momma happy and continue to feel well.

Go Molly!!!!!!

How is our little muffin doing today?

Sounds like she's feeling better! Kaibo has been getting toys out too so it looks like lower cortisol is good for both of them! Yay.

I haven't posted because I don't really have anything to offer but I am following Molly's journey and thinking of you all throughout. I was so pleased to read that she's playing with toys - that's always a good sign :)

Where is that update on our little muffin?

Molly is doing good. Which is always nice to say. Her leg is holding up fine, I don't think she has dropped down any in her cortisol as she has trouble with her leg when she does, plus a couple other things I know now to watch for. (not that she ever went too low, she didn't, but when she is around that 100nmol range, I should know it)

She is playing and active, all normal molly things. Probably not as happy with me as she could be as I am working so much these days that she doesn't get that extra time we normally have had. Just been a rough year for that.

And my home computer has been contrary, so not been around as much. It freezes so much it makes typing a post a real painful experience. Tonight it seems to be (at the moment) on it's best behavior. LOL I do read on my ipad but I find typing on that a real trial and I'm just not great at the voice stuff, although I know you tried to teach me Kathy. I keep forgetting to say period, comma, etc.

Anyway, molly is okay.

One thing. I haven't started her on her heartworm, tick, flea med this year. She has been on revolution for years with no problem, but then I was looking into it some more and they where talking about it affecting the liver and that made me a bit wary as molly's liver enzymes keep going up, and I hate to think I might be doing something to make it worse on her liver. So not sure what I'm going to do about that.

That is my latest thing I guess and really the only thing going on. :) so can't complain.

Thanks for checking in on us!

So pleased to hear Miss Molly is feeling good at the moment, although sounds like Mom needs a rest ;)

but I'm horrified to read about Revolution affecting the liver. There are so many nasties we have to protect our pups from here (rabies, ticks, ...) and I do worry about the effects of all of the chemicals :(

Sharlene, had to stop by to check on Molly, glad things are stable and also to say

TRIPLE CROWN. OMG, can't believe it:D