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Thread: Yogi has crossed the Bridge - questions about Trilostane

  1. #21
    Join Date
    Apr 2009
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    Default Re: Newly Diagnosed: Yogi - Initial question about recommended vet care partner

    I fortunate that my vet and the IMS had a good communication line between themselves and they both didn't have a issue with keeping me in the loop, which I demanded they do.

    Since Yogi's dosage is being increased, is an ACTH stimulation test already scheduled for a recheck? This should be performed within 10-14 days.

    Lori

  2. #22

    Default Re: Newly Diagnosed: Yogi - Initial question about recommended vet care partner

    Hi Lori,

    Yes, his recheck has been scheduled 13 days after his dosage change, along with another test to see if his platelets remain low. Then he will see the ICM after those test results come back. Yogi appears to be going longer in between bathroom breaks, and actually brought a ball to me to play fetch yesterday. That is the first time since all of this started. I'm hoping the increased dosage is starting to have a positive effect.

    Angie

  3. #23

    Default Re: Newly Diagnosed: Yogi - Initial question about recommended vet care partner

    Yogi's Rx for Vetoryl has been increased several times followed by ACTH Stim tests. The latest Vetoryl dosage has been: 50 mg AM and 50 mg PM. Yogi is 60 lbs. This is the ACTH test result from last week:

    Pre ACTH Cortisol 5.6
    Post ACTH Cortisol 9.7

    The note on the IDXX report says Per the manufacturer, pre-and post-ACTH cortisol levels of 6-9 ug/dL may be sufficient for some animals if clinical signs are well controlled.

    I have sent the results to NCSU Internal Medicine for their advice on whether to increase the dosage or stay as is. Except for 2 urination accidents this month, his symptoms are very well controlled and he seems good.

    Please feel free to share any thoughts. I will update when I get their response.

  4. #24
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    Default Re: Newly Diagnosed: Yogi - Initial question about recommended vet care partner

    In your December 13th post I see that you were having Yogi's urine cultured, did it show that the UTI was completely gone? Are those most recent ACTH stimulation test results (Pre ACTH Cortisol 5.6 ~ Post ACTH Cortisol 9.7) from the 50 mg dosage increase or the 40mg?

  5. #25
    Join Date
    Jun 2012
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    Canada
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    Default Re: Newly Diagnosed: Yogi - Initial question about recommended vet care partner

    So Yogi seems to be doing well? Symptom wise, other than a couple accidents, he seems more himself?

    And what of his platelets and other test results that were off? Have those resolved?

    He's such a lovely boy. I like his avatar picture.
    Sharlene and the late great diva - Molly muffin (always missed and never forgotten)

  6. #26

    Default Re: Newly Diagnosed: Yogi - Initial question about recommended vet care partner

    Hi, yes Yogi is doing much better and seems more like himself! The vet specialist recommended we stay at the current Vetoryl Rx for the next month and assess if he continues to do well before increasing the dosage. The platelets and other test results that were off have resolved based on the last full blood screen. So fingers crossed that the next month is good.

    I am curious how to search on this forum to see what to expect if he does well on Vetoryl for a while - and what the path or progression when things start to deteriorate. I am hoping he does well for a long time - and also want to educate myself on what happens when it no longer works. Is there a way to search for that without reading all the individual stories?

    Thank you!

  7. #27
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    Default Re: Newly Diagnosed: Yogi - Initial question about recommended vet care partner

    I'm glad Yogi is doing better and pray the trend continues! You can learn a great deal about Cushing's, the drugs used to treat, and many other things in this section of our forum, the Helpful Resource section - http://www.k9cushings.com/forum/foru...Cushing-s-Dogs

    For something specific you want to read about, use the Search feature at the top right of the page. You can use the box or go to the Advanced Search for more options.
    "May you know that absence is full of tender presence and that nothing is ever lost or forgotten." John O'Donahue, "Eternal Echoes"

    Death is not a changing of worlds as most imagine, as much as the walls of this world infinitely expanding.

  8. #28
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    Default Re: Newly Diagnosed: Yogi - Initial question about recommended vet care partner

    Yay glad he is himself again and his platelets are back where they should be.

    It will always be necessary to stay on top of what his adrenal glands are doing using the ACTH test. It isn't uncommon that after a dog has been on a dose for awhile for them to need an adjustment, often downwards and not needing as much. This can happen at any time, but especially I have noticed after being on the same dose for a year. Thats just a personal observation on my part and we are talking long time going forward on a stabilized dose.

    I would also say that you want to do cbc's regularly. I did them every 6 months even when things were going well, as you have to watch things like kidneys and pancrease and other organs, as they are often the ones that end up causing problems later on. (this is true of any animal as it gets older though)

    So just some thoughts I had when reading your post.
    Sharlene and the late great diva - Molly muffin (always missed and never forgotten)

  9. #29

    Default Seeking input - Trilostane no longer working

    Hello,

    My dog, Yogi (11 y.o. 60 lb flat-coated retriever) presented symptoms last year and was initially treated by my vet. In Jan 2018, he moved to NCSU Vet Internal Medicine and was diagnosed with pituatary dependent Cushing's. He presented some data that is a bit out of line with Cushing's diagnosis (ALP not elevated), but they decided to treat using Trilostane (Vetoryl). Since January, the vet has adjusted the dosage of Trilostane several times in response to symptoms (see below). Blood work and ACTH tests were completed throughout this period. Recently, because the ACTH tests were so low, the vet requested I stop Trilostane dosage for 1 time, then restart, and finally requested I stop dosage to reevaluate. The vet has indicated they are not sure how to proceed given his response and proposed four potential options at this point, including restarting Trilostane.

    I would greatly appreciate any input on what questions to ask the vet, and also steps to take.


    12/12/17 ACTH Pre 4.1 Post 12.5 - vet increased dosage from 30 mg twice a day to 40 mg twice a day
    12/27/18 ACTH Pre 3.6 Post 8.0 - dosage remained at 40 mg twice a day
    1/12/18 - no ACTH test - dosage increased from 40 mg twice a day to 50 mg twice a day
    1/16/18 ACTH Pre 5.6 Post 9.7 - dosage remained at 50 mg twice a day
    2/15/18 ACTH Pre 2.4 Post 3.0 - dosage remained at 50 mg twice a day
    3/15/18 ACTH Pre 2.0 Post 4.8 - dosage remained at 50 mg twice a day
    5/3/18 ACTH Pre <1 Post 2.3 - dosage reduced from 50 mg twice a day to 40 mg twice a day
    5/21/18 ACTH Pre 1.1 Post 2.5 - dosage remained at 40 mg twice a day
    6/11/18 ACTH Pre 1.9 Post 4.1 - dosage remained at 40 mg twice a day
    7/26/18 ACTH Pre <1 Post 1.6 - Yogi was EXTREMELY lethargic, dosage stopped for 1 dose, restarted at 35 mg twice a day to reset
    8/8/18 ACTH Pre 1.3 Post 1.4 - revised to 35 mg twice a day
    8/9/18 dosage stopped to reassess

    8/8/18 Bloodwork, electrolytes tested, all normal except: Anion Gap (High 26.2 - range 11.2 - 19.9) and HA / K Ratio (Slightly high 37.1 - range 27.7 - 35.9)

    Yogi has been off Trilostane since 8/9/18. He is alert, however, his symptoms of frequent drinking and urination have resumes (he has to go out ever 3 hours). Bloodwork has been done, and appears normal (I'm requesting the latest).

    The vet at NCSU states they are perplexed. They have done a lab and determined that the enzymes have not been negatively impacted. They do believe Trilostane is having a positive impact to his symptoms. The vet provided the following 4 options with #1 as recommended:

    1) try 40 mg one time per day and move to testing via the cortisol test instead of the ACTH test (i.e.,cortisol test at 8 AM, dose at 9 or 10 AM w/food). This Rx to start now, then first cortisol lab in 2 weeks
    2) Try Mitodane/Lysodane. The vet states they have never seen a dog come off this b/c of bad effects, requires >intensive monitoring
    3) MRI to look for micro adenoma tumor not visible
    4) do not medicate - Vet has a concern over quality of life, potential UTI, pancreatitis

    I have mapped the tests, bloodwork, results and dosage. To me, the dosage increase to 50 mg was ok at first, but I suspect it was too high. I am concerned about continuing to medicate him with Trilostane when his ACTH tests show cortisol so low. I am concerned that there is a continual disclaimer about his diagnosis as Cushing's - as if there may be something else going on. Do I need to seek an endocrinologist?

    Any help or suggestions would be greatly appreciated. Note that I posted earlier when I was trying to find a specialist.

    Angie
    Last edited by AngieB; 08-20-2018 at 01:12 PM. Reason: add test results from last bloodwork

  10. #30
    Join Date
    Mar 2009
    Location
    rural central ARK
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    Default Re: Seeking input - Trilostane no longer working

    I have merged your latest post concerning the 4 options the vets have offered for Yogi into his original thread. We like to keep all info about each dog in one thread. That way it is easier to look back thru the history.
    "May you know that absence is full of tender presence and that nothing is ever lost or forgotten." John O'Donahue, "Eternal Echoes"

    Death is not a changing of worlds as most imagine, as much as the walls of this world infinitely expanding.

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