Skippy has passed; 12 y/o Yorkie with likely pituitary tumor (Trilostane)

[Carole Alexander]

I spoke with the student at Purdue again today and she tried to answer my questions. She said that they recommended the Atypical Cushings test; they could offer no opinion as to whether the tumor will or will not return when removed but the cost is now 1 to 3,500k and that they hope the increased dosage to 15/10 will improve Skippy's response. They had no opinion on herbal treatments and no idea of what other conditions might arise if Skippy has Atypical Cushings and Cushing's. Just shoot me.

[labblab]

Omigoodness Carole, I feel your pain! I wish I had more time to post right now, but I'll have to wait and come back at a later time to add some thoughts. Hang in there, but I totally get your frustration.

Marianne

[Carole Alexander]

Skippy continues on the Cushings Merry go round; today I took him back to the local vet for a consultation and a look at the adenoma on his butt. The vet is of the opinion that the Trilostane dosage is still too low at 15/10 for the past four days; she said to at least increase to 15/15 which would be in accord with the current Drecha guidelines as Skippy remains at 29lbs. So today I will up the dosage. Overall, she would be inclined to increase the dose even more. The vet did not think Skippy needs a sex steroids test - yet. And, she thought we should try to get the Cortisol under control before addressing the adenoma. I feel a little like I am vet opinion shopping right now and I don't mean to do that. But, I am looking for some symptomatic relief for Skippy. After nearly two months, Skippy's cortisol on the 1/23 stim test was higher than the two week stim test (pre 2.2 and post 10.8), i.e., pre - 6.3 and post - 16. He remains quite shaky,belly still bloated, no hair growth, lethargic, does not want to be outside, runs back in after pooping, no interest in playing, appears fearful and is still ravenous. I did order Melatonin and Flax and will start that soon but his butt problem aside, I am at a loss. Oh, yes peeing and drinking has lessened. Please let me know if you think I'm being too demanding or unrealistic. Thanks everyone.

[molly muffin]

Of course you are not being too demanding or unrealistic. You are trying to find answers. With the post number continuing to increase, the increase in medication seems to be warranted.
I do wish that he seemed to be feeling more like his usual self. Maybe the melatonin and flax will help.

[Carole Alexander]

Four days ago, we upped Skippy's Vectoryl from 15/10 to 15/15. Today for the first time in over four months, Skippy is beginning to return to his previous self. He is alert, interacting and sleeping less. No, no hair regrowth; yes, he's still very hungry, but the trembling is mostly gone and he's a little sphinx arising from his own ashes. I am so relieved and very happy that he may actually live with this awful disease. I thought that such a day would never come and I have learned so much from all of your experience, experiences and knowledge and am truly grateful.

[molly muffin]

Wow, cross fingers that this is the right dose and Skippy continues to get better and better.

[Carole Alexander]

Sharlene,
I should have know better than to speak too soon; Skippy had a diarrhea attack on his walk this morning - not a horrible one but definitely very soft stool. Called the vet who said that she couldn't imagine that a 5mg bump caused this. She put him on Imodium 3X a day and a bland diet for the week end. He seems to feel fine and I just took him for a good walk but no poops. I hope this is the right decision as I really don't want to stop the Vectoryl after he's finally responding. I will watch him like a hawk. This vet's opinion of dosing is much more risk taking than Purdue (She told me that their practice just put a 12lb dog on 30mg of Vectoryl.) I'm not sure that is a good thing after all I've read on here about low and slow. But, if I can't get the diarrhea stopped soon, I will stop the drug. Anyway Skippy will be ACTH tested next Wednesday.

The final thing: Skippy's high numbers on the last test on 1/23 (pre - 6.3 & post -16) may be incorrect since Purdue told me to fast him for the test. I challenged that and they said to just feed him enough to ingest the Vectoryl. I fed him a little more than that because I didn't know any better. But, now I wonder if the drug was absorbed? Maybe you all could put together the latest research, Drecha's new recommendations, etc. and we all could start leaving the info with vets as we come into contact with them. Or you could get a grant and create an e-book! Just a thought and thanks again.

[DoxieMama]

Hi Carole,

First of all, you absolutely need to feed Skippy a full meal when you give him his Vetoryl. This includes the day of the ACTH test. You also want to be consistent about the timing of the test, so you can compare apples to apples so to speak. Do you know how many hours after you gave Skippy his Vetoryl they started each of the tests?

Shana

After nearly two months, Skippy's cortisol on the 1/23 stim test was higher than the two week stim test (pre 2.2 and post 10.8), i.e., pre - 6.3 and post - 16.

The final thing: Skippy's high numbers on the last test on 1/23 (pre - 6.3 & post -16) may be incorrect since Purdue told me to fast him for the test. I challenged that and they said to just feed him enough to ingest the Vectoryl. I fed him a little more than that because I didn't know any better. But, now I wonder if the drug was absorbed?

[Harley PoMMom]

As Shana has mentioned, it is critical that the Vetoryl be given with a meal to be properly absorbed.

We have a wealth of information regarding Cushing's; the medications used and the treatment protocols, that can be found in our Helpful Resource Forum and it also includes articles written by some of the most renown veterinarians that specialize in endocrinology such as David Bruyette, Mark Peterson, and Edward Feldman. In this forum you will find a thread that pertains to Vetoryl/Trilostane so please utilize it and if you have any questions do not hesitate to ask them.

Here's a link to our Helpful Resource Forum Helpful Resources for Owners of Cushing's Dogs

And to the Vetoryl/Trilostane thread: Trilostane/Vetoryl Information and Resources

Hugs, Lori

[Carole Alexander]

Shana, I believe that Skippy was tested (at least he was taken back) approximately 4 1/2 hours after I fed and gave him the Vectoryl dose. The food was a big bite of chicken breast with the pill enclosed and a very small handful of kibble. If the Vectoryl wasn't properly absorbed, am I correct in thinking that his cortisol level would be higher (as it was)? In our two visits to Purdue he has been tested, as Drecha and researchers recommend, at 4 to 6 hours after dosing. The mistake was in telling me explicitly not to feed.

Lori, I agree that there is a wealth of information on this web site and I applaud you all for bundling the research. Certainly, I could have done more reading at the outset, but I am not the doctor. And, the devil is in the details. For example, I read that there are two different products used for ACTH testing. I recall that one is a synthetic liquid and the other a gel. Should a dog be tested with the same product each time? Does it matter? If I take him to my local vet for testing, will they use the same product as Purdue? Another example, Purdue thinks Skippy's sex steroids should be tested; the local vet says not to bother. I ask each one "why" but got no answers. I could offer additional examples but my point in my earlier post was that vets and their staff need to be better informed about Cushing's and best practices in diagnosis, treatment and testing. Recommendations from the researchers seem to be clear, compelling and most importantly, evidence-based. And yet...