Franklin, 4½ yo maltese, trilostane (updates)

[mypuppy]

hi there Jane,
You are right, it has been a long while since we've heard from you, but so happy to hear the little sweet face is doing well. I am sorry to hear about your family emergency and hope that it is nothing serious.

Please give that little boy Franklin a belly rub from aunt Jeanette and some licks from cousin Princess, and please take some very tight hugs for yourself, and please say a small prayer for your sweet and missed Bailey at his Memorial.

We love you both dearly.

Xo Jeanette and Princess

[Franklin'sMum]

Hi everyone!

It's been a long time since we've checked in, and a lot has happened in that time. There's been a few family situations, which are currently under control (for the most part.)

As you might remember, Franklin stopped taking the trilostane a couple of years ago, after having his diagnosis changed to atypical cushing's. He's been on melatonin and lignans since.

His proteinuria became sky high earlier this year, a up:c of 9 EEK! After a change of diet, and increasing the fish oil frequency, his up:c is now down to 4.1.

In February this year, Franklin started having grand mal seizures, and in late February had 6 in one day. He started on phenobarbitone, and didn't have any more seizures. The MRI was clear of anything that could cause them. At the time, we were using a monthly flea tablet called "Comfortis" and about 6 weeks after beginning the phenobarb, the sales rep was at our vet's, and mentioned as an aside that it can lower the seizure threshold. Due to Franklin's liver enzymes being more elevated than usual, the vet agreed that we could discontinue the phenobarb.
Since then, he's had a few more seizures, and another cluster, so now is back on the phenobarb.

His cortisol has risen, (241 / 478 nmol or 8.7 /17.3 ugdl on 16 Feb) and our vet wants Franklin to begin on traditional treatment. So we will shortly begin the Lysodren journey. HELP! I've been through the files again, and would someone mind clarifying for me, please?

One article (textbook vet internal medicine) says to get the stim done as soon as he seems to be loaded, another says to wait a couple of days without giving any more lysodren.
Which is the more common protocol? My vet isn't familiar with the waiting. I won't be starting him on it as soon as I pick it up, I'm going to wait til his appetite has returned to normal, the phenobarb has increased it.

Is either ok, as long as he's been stimmed, and his numbers are ok to start the maintenance dose, and there's a couple of days between the last loading dose and the first maintenance dose?

Franklin is drinking about 750ml per day, it's our winter, I'm on night shift and we haven't been walking this week. The appetite monitoring will be more difficult, we all eat a bit more when it's cold, and he usually looks at me a few times as he eats. Although there have been times when he's tried to snatch my food out of my hand, while it's on it's way to my mouth.

Are there any tips, tricks or something you can share with me?

Thank you all so much,
Biggest love and hugs,
Jane, Franklin and Angel Bailey xxx

[frijole]

Jane, Welcome back!

I am off to work in a few so will be brief. It is common see atypical cushings turn into regular cushings. (cortisol elevated)

My biggest concern is the use of pheno and hopefully another member can provide greater details but it can be tricky if I recall. (sorry I don't have time to search the site for other cases)

You are wise to wait until the appetite has returned as it is hard to monitor lysodren. The reason it is recommended that acth testing be done 48 hrs after the last dose is because it continues to work for that long after ingested. That is why you never give a pill if you think your dog is loaded... you can't take it back and it will continue to lower cortisol/erode the adrenals.

Here is a link to loading instructions that helped me greatly. I'll check in later. Kim
http://www.k9cushings.com/forum/showthread.php?t=181

[lulusmom]

Hi Jane,

When did Franklin go back on phenobarbital and did he have cushing's symptoms prior to phenobarbital and did cushing's symptoms continue after you took him off? Unfortunately, the side effects associated with phenobarbital are identical to the most common symptoms associated with cushing's, being excessive drinking and peeing and voracious appetite. For not having been on treatment for a year, Franklin's last stim test isn't that high so if Franklin's appetite returns to normal before starting Lysodren, I would question whether he needs to be back on cushing's treatment. Additionally, Lysodren and Phenobarbital are not a good combination as the Phenobarbital greatly effects Lysodren's absorption, requiring that larger doses be given. Please discuss this very important information with your vet before you start loading Franklin.

With respect to timing for the acth stim test, lysodren has a cumulative effect so the optimum time for testing is 48 hours after the last loading dose. I hope this helps.

Glynda

[addy]

Hi Jane,

I cant help with advice but I can say: hugs and love" and that I am here for you and Franklin.

I thought Glynda had wonderful input and I am sorry to hear about Franklin's seizures. I hope and pray you get things straightened out and I just know it will all turn out okay.

[Harley PoMMom]

Hi Jane!

It is good to hear from you but sorry to hear this news about sweet Franklin.

I agree with Glynda that his post stim number does not suggest starting any Cushing's treatment. Here is a link to IDEXX with a chart that shows the normal ranges for a dog (post between 6-18 ug/dl is normal): http://www.idexx.com/pubwebresources...n-protocol.pdf

So hoping those seizures settle down and give our precious boy some gentle hugs and kisses.

Please do keep us updated, and again, so nice to hear from you!

Love and hugs,
Lori

[Squirt's Mom]

Hi Jane!

Don't know how I missed this post yesterday but it is really good to see you again!

I, too, think the post is within normal range and I wouldn't start treatment just yet, especially with all the rest that he has been facing lately. The stress could be the cause of the elevation in cortisol. If I were you, I would keep an eye on him and when, if, his signs become strong and he hasn't had any extra stress on his system, then you know it's time to start the Lyso.

From what I know and how we do it, Squirt is tested 36-48 hours after her last dose of Lyso. She is on maintenance twice a week. When the time comes to start Franklin on the Lyso, you will do just fine, honey. I know you will. We will be right by your side the whole time.

Hugs,
Leslie and the gang

[mypuppy]

Sweet Jane,

How nice to hear from you, but not under these circumstances. I truly wish I can help your precious little boy, but I know someone here will give you something very valuable soon.

For now, I'm praying the button nose little guy feels better real soon.

Always thinking of you both with much love.

xo and those tight hugs coming your way.

Jeanette and my girl Princess

[Franklin'sMum]

Hi again and thank you for all of your valuable input.

After Franklin's appetite levelled out 2 weeks after re starting the phenobarb, he was still drinking about 800ml per day. He started back on it 30 May. Our vet thinks that mitotane could help to reduce the proteinuria, which from what I've read is a possibility.

So the mitotane was ordered and compounded to 375mg. To be given half twice daily. At this point he weighed 7.4kg. I seem to have misplaced his stim results but the post before beginning treatment was 600+mmol and his blood glucose was 17, with no glucose in his uh urine.
He was on the mitotane from 29 June till 2nd July. Went in for another stim test on 4 July and the results were pre 118 post 584mmol (4.27- 21.1)ug /dl.
Blood glucose was 28 and 29mmol and urine glucose was 4+ Eek! The couple of days before this, his water intake had gone up to 1 litre and a little more. His weight was down to 7.0kg and he was feeling bony.

So on Thursday Franklin went in fora glucose curve.
Fasting time 08.50 24.4
Breakfast then 10.50 25.1
3.5iu insulin given 11.00
12.50 15.8
14.50 13.2
16.50 12.1

So, needless to say, cushing's is on the back burner while we try to regulate his diabetes. Argh! I really think Franklin is feeling a lot better, water is 400-600ml, he doesn't have to stand on icy grass for 90 seconds to pee, and he's not feeling so bony. Plus he stays still to be injected.
He'll be having another curve done on Wednesday to see if any adjustments need to be made.
We will keep you updated as to how he's going,

Love and hugs to all,
Jane, Franklin and Angel Bailey
xxx

[addy]

Oh Jane, I am glad to hear Franklin is feeling better. I hope the upward trend continues.

I was trying to picture your "icy" grass as we have been having such a heat wave!!!!!

hugs and love to you and yours