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Thread: 13 year old dog with "Cushings Light" (words the vet used)- Jackson gained his wings

  1. #11
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    Default Re: 13 year old dog with "Cushings Light" (words the vet used)

    Hi, Julie. You are correct in your understanding that for dogs being treated with trilostane, the monitoring ACTH test ought to be completed within a time frame of 4-6 hours after dosing with breakfast. So I see no reason for Jackson to be stuck at the vet’s office all day. Just to clarify, though, the test only takes one hour to perform in the U.S. In Canada, readings are taken at both the 1-hour and 2-hour marks. But here in the U.S., there is only one hour between the baseline cortisol blood draw and the second blood draw subsequent to the injection of the stimulating agent.

    Since you seem to be getting questionable information from the vet tech, this is a situation where I would insist on talking directly with your vet prior to the test. This test is too expensive and too important to be performed incorrectly. And there’s also no need to put Jackson through unnecessary stress by extending his length of stay at the vet’s.

    Karen, I think what you’re referring to is an initial diagnostic LDDS test. That test does indeed take eight hours to perform and involves a full day at the vet’s. However, once treatment has begun with either Lysodren or trilostane, the monitoring test is the ACTH stimulation test. So when Annie is tested, it will also only involve a one-hour test for her, as well. However, since she’s taking twice-weekly maintenance Lysodren as opposed to ongoing daily doses of trilostane, that 4-6 hour testing window after dosing is not applicable. With Lysodren, I think you can test at any time of any day that suits your schedule.

    Marianne

  2. #12
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    Feb 2019
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    Default Re: 13 year old dog with "Cushings Light" (words the vet used)

    Hi Marianne, Thanks for providing Julie with the correct information for her pup. I always learn from my mistakes and one of these days, I’ll learn to keep my thoughts to myself especially when I keep realizing just how much I DON’T know about this disease.

    Sorry Julie if I made your anxiety worse! My own anxiety tends to trigger the ‘over-zealous’ part of my personality. I know you are doing everything you can for Jax and these great people here willl guide you in the right direction. I told you I was a worrier and over-thinker. I promise from now on, I’ll just worry and over-think about my own little baby. Karen

  3. #13
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    Default Re: 13 year old dog with "Cushings Light" (words the vet used)

    Karen, there’s no need at all for you to just stick to talking about Annie — the mutual support we get from joining other members’ conversations is what makes a forum like this so helpful! We all have the chance to expand upon or clarify info in replies. Trust me, I’ve had to come back and correct or update plenty of information of my own. Truly. But there’s always mutual learning that comes out of the process. And for another member, just knowing that you cared enough to take the time to add a reply can mean the world. So don’t “clam up” on us, girl! We welcome your replies everywhere ;-).

    Marianne

  4. #14
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    Jun 2018
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    Default Re: 13 year old dog with "Cushings Light" (words the vet used)

    Hello wonderful K9C friends. Just sharing an update on Jackson because it helps me process everything. He has had six doses of Trilostane so far. It does seem like he is drinking less - is it too soon for that to be happening? That is my stress, wondering if the dose is too high. His poop was bit soft today but not diarrhea. He is scheduled for his ACTH on Friday so I am just praying he stays stable until then. I’m sure it is wishful thinking but it would be great if this was his right dose and we don’t need to play around with it.

    Have a great week everyone.

  5. #15
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    Apr 2008
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    Tennessee
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    Default Re: 13 year old dog with "Cushings Light" (words the vet used)

    Hi, Julie, and a belated welcome to you and Jackson.

    I just wanted to mention that a peer reviewed study and the vast experience of renowned veterinary teaching institutions across the globe suggests that larger dogs (>44 lbs) can be more sensitive to the drug and require much smaller doses to effectively control cortisol. For instance, UC Davis California, Zurich University and University of Utrecht would have prescribed much lower starting doses for Jackson, none of which would exceed 30 mg. Most general practice vets are unaware of this and unfortunately Dechra US confirmed that they have no active submissions to FDA to revise their dosing recommendations, despite this science based evidence. My concern for Jackson is that you are noticing mushy stool and this could be a sign that 50 mg may be too much for him and cortisol could be dropping too low. Please keep a close eye on your boy and if his stool gets worse or he starts to show any disinterest in food, I recommend you stop treatment and contact your vet. Hopefully he just had a bad one off bowel movement and things will go smoothly until the acth stimulation test on Friday.

    Glynda

  6. #16
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    Jun 2018
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    Default Re: 13 year old dog with "Cushings Light" (words the vet used)

    Hi Glynda. Thanks for expressing your concern. I did read somewhere about the lower dose in bigger dogs but I thought it was a weigh range higher than Jackson’s but I’m sure I am misremembering. Today on his AM walk and his PM walk his stool was perfectly normal. He still has a very hearty appetite. My husband and I have always said that when he doesn’t eat we will know something is very wrong. Counting the days until Friday.

    Thanks again! Julie

  7. #17
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    Feb 2019
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    Default Re: 13 year old dog with "Cushings Light" (words the vet used)

    Hi Julie, Annie and I will be thinking of you guys the rest of this week. Annie gets a much needed groom in the morning, and I'm stressing about that! I've also been doing the poop check on a regular basis with her. I just feel so paranoid most of the time! Good luck, well wishes and good thoughts are coming your way. Let us all know how it goes on Friday. Karen

  8. #18
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    Default Re: 13 year old dog with "Cushings Light" (words the vet used)

    Hi Julie! I’m really glad to hear that Jackson returned to normal again, and I surely hope that remains the case. We’ll all be anxious to see how the testing turns out on Friday, and I’m hoping you’ve been able to straighten out the testing protocol with your vet: testing to be completed 4-6 hours after dosing with breakfast. One other advance comment about the testing — unless Jackson’s dose seems to be too high and needs to be lowered, current recommendations are to leave the trilostane dose unchanged for the remainder of the first month of treatment. This is because cortisol levels often continue to drift downward during that first month, even on the same dose. Therefore, it’s usually better to hold off on any dosing increases until the second monitoring ACTH is performed and there’s greater confidence that the cortisol level has truly stabilized.

    I do want to comment on the issue of larger dogs often needing smaller doses of trilostane to maintain effective control. Like you, my reading had led me to believe that the weight “cut-off” that was cited in the research study is heavier than Jackson’s weight. I had seen >66 pounds cited, which is why I felt comfortable with Jackson starting off at the 1 mg. per pound formula. But Glynda’s point remains very well taken, that any time an adverse reaction is seen in a dog taking any dose of trilostane, there is cause for caution. And I’m reaching out to her to see whether perhaps the >44 pound guideline represents a newer revision in the research findings.

    In the meantime, I hope that all is going well for you guys, and that you may even be seeing increasing improvement in Jackson’s symptoms. You had asked earlier whether six days was too early to see improvement in his drinking, and the answer is “no.” Improvements in thirst, urination, and hunger can be the earliest symptoms to show improvement. So we’ll hope the trend continues. Do let us know!

    Marianne

  9. #19
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    Jun 2018
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    Default Re: 13 year old dog with "Cushings Light" (words the vet used)

    Hello and Happy Monday! The first ten business days of every month are my super busy time at work so I haven't had time to be on-line for anything not work related.

    So Jackson had his ACTH back on 3/29. That morning started out traumatic for both of us. I was dropping him off by myself in the AM and my husband was picking him up in the afternoon. Well, Jackson did not want to get out of the car. If I opened the door on one side he would go to the other side of the car. Then he managed to jump from the back seat to the front seat (remember he is part Corgi so he is vertically challenged) and when I opened the front passenger side door he jumped over the console to the drivers side seat. He has never responded this way to getting out of the car. I went into the vet and got some treats and I eventually got him out of the car but it was upsetting to both of us.

    The test was on a Friday and the vet called on Saturday when I was in the car driving so I wasn't able to write down his results. They were supposed to be e-mailed to me and I have yet to see them. The vet dropped his dose from 50mg to 40mg and asked us to monitor his water intake again that weekend and call with the results on Monday. His consumption was definitely down from before he started the meds. I am a bit frustrated as I have yet to talk to the vet since providing her with the water results (a week ago). I played phone tag with a tech last week and in one of the messages she indicated that the vet had reached out to a specialist and would call me after she was able to speak with the specialist. I am a bit frustrated right now.

    Jackson seems to be doing ok. He still has his appetite and is drinking less but we've noticed some whimpering that we can't relate to anything specific.

    Sorry if I am rambling but honestly I feel like this is my first opportunity to collect my thoughts around this since the morning of the ACTH.
    Last edited by jaxr0806; 04-08-2019 at 10:40 AM.

  10. #20
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    Default Re: 13 year old dog with "Cushings Light" (words the vet used)

    Please get those test results and post them, the fact that the vet dropped his Vetoryl dose has me worried that his cortisol has dropped too low.

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