Cairo, 8 year old staffordshire bull terrier just diagnosed

[spdd]

I'm going to jump in here and give my 2 cents worth. My dog was 65 lbs. We started him once a day at 58 mg and over a period of time there was no change ( 3 weeks) . We bumped it up to 68 mg and again no change for awhile then suddenly we had a couple of good ones. Peeing and thirst were the main issues. Then there was some weakness in his back end so the dose got reduced to 65 mg, still once a day. My dog crashed and at the time I had no idea about prednisone as the vet never mentioned it. He was literally minutes away from being euthanized and the vet said it was time.
Well "mah boy" is still here cause I brought him home and paid no attention to this vet. She also as a sidenote did NOT do the ACTH test at the proper times, again I found out later all thanks to this forum.
I have been to 5 different vets which include a teaching veterinary college and an IMS. All vets have had different comments and diagnosis. My point is that being an average size dog the dose my dog got was too much for him. Please do NOT give a large dose to your dog. Start out at the 1mg and build up if need be. I was told just last week that it can literally take months for a dog to respond to treatment. Every dog is different.
I come here now for all my advice and this is coming from someone that has no faith AT ALL in forums, until I came to this one. They know what they are talking about.
My dog is still a mystery, after now 4 months of problems and I'm no expert at all on here, however I've learned a few things, and I almost had my dog put down until I listened to what was being said to me here.
Hope this helps you in your decision about the dosage.

[goldengirl88]

Alison:
Please start him on a lower dose and work up from there. We are all here to help you, and make sure nothing happens to your baby. The people on here have a lot of experience with this, more than most vets do, so please trust in them. Blessings
Patti

[Alison]

Lord, now I'm worried.

She didn't do an ACTH stim test - just the LDDS test. He's to get the Stim test on 17th September after 2 weeks on the meds. Boy were they expensive.

I'll try and type out his lab reports as they appear in the hope they make sense.

[Alison]

Oh and we weren't given any prednisolone but I do have 1mg, 2.5mg and 5mg tablets in the house, along with hydrocortisone (the joys of a family with Addison's and ulcerative colitis!!) Are human prednisolone OK to use if necessary?

[Alison]

Here are the lab results - hope I've typed them out correctly. There are three pages:

Page 1

SNAPshot Dx

CORT 83nmol/L

8 hour post low dose dex
...Both 4 and 8 hour <27.6nmol/L - Normal
...Both 4 and 8 hour = 27.6 - 41.4 nmol/L - Inconclusive, consider repeating in 6-8 weeks
...Both 4 and 8 hour > 41.4 nmol/L and >50% of baseline -
.......Consistent with Cushing's syndrome; consider HDDST to rule out adrenal tumour
4 hour <41.4nmol/L or <50% of baseline and 8 hour >41.4nmol/L and >50% of baseline -
.......Consistent with PDH
4 hour <41.4nmol/L or <50% of baseline and 8 hour >41.4nmol/L and <50% of baseline -
.......Consistent with PDH
4 hour >41.4nmol/L or >50% of baseline and 8 hour >41.4nmol/L and <50% of baseline -
.......Consistent with PDH


Page 2

SNAPshot Dx

CORT 101 nmol/L
baseline cortisol


Page 3

SNAPshot Dx

CORT <14 nmol/L
4 hour post low dose dex
Await 8 hour post result for interpretive comments

[Harley PoMMom]

Oh and we weren't given any prednisolone but I do have 1mg, 2.5mg and 5mg tablets in the house, along with hydrocortisone (the joys of a family with Addison's and ulcerative colitis!!) Are human prednisolone OK to use if necessary?

I believe that would be ok. The standard rescue dose of pred is 0.25mg/kg.

So for Cairo's weight of 28kg, from my calculations the rescue dose would be 7 mg.

If I am reading those LDDS results correctly they are :

• Baseline = 101 nmol/L

• 4 hour = <14 nmol/L

• 8 hour = 83 nmol/L

Converted to ug/dl, which is the units we are used to seeing:

• Baseline = 3.66 ug/dl

• 4 hour = <0.51 ug/dl

• 8 hour = 3.01 ug/dl

Most times the cut off value is 1.4 ug/dl, so I believe those LDDS test results are indicative for PDH. However, I am in agreement with the others that the starting dose for Cairo is too high.

UC Davis protocol advises a starting dose of 1mg/kg which in Cairo's case would be 28mg. Dechra verbally recommends starting at the low end of their dosing scale which is 1mg/lb, so for Cairo's weight in lbs that would be 61.6lbs and a starting dose of 60mg.

We have seen dogs that do well with no adverse side effects when started at an initial low dose. If Cairo was my dog I would start him at 30mg...just my 2 cents worth.

Love and hugs, Lori

[Alison]

I did say to the vet that the dose was higher than I'd thought he'd be on but she said that it was smack bang in the middle of the recommended treatment regime and was fine for him.

I'm terrified I kill him!

Would giving him 120mg every second day work? There's no way of splitting the capsules and I don't think the vet would agree to reducing the dose if she believes him to be on the right dose.

[Roxee's Dad]

Trilostane only remains in the system for about 12 hours. a little less or a little more. Part of the reason that twice a day dosing is seen more and more. Every other day would cause a roller coaster ride.

You are Cairo only voice and advocate. I would at least ask if we could start at a lower dose as you are not comfortable starting so high.

as Lori indicated...

UC Davis protocol advises a starting dose of 1mg/kg which in Cairo's case would be 28mg. Dechra verbally recommends starting at the low end of their dosing scale which is 1mg/lb, so for Cairo's weight in lbs that would be 61.6lbs and a starting dose of 60mg.

You may want to print out the links and send them to your vet. UC Davis is world renown in the treatment of canine cushings and testing, monitoring protocol.

[Alison]

I'll speak to the vet tomorrow. The last thing I want to do is cause him more problems.

Just spoken to someone else who is in the UK and her dog (roughly same weight) was started on 120mg too but he was reduced down to 30mg daily. Sounds like over here they do start them on the higher end of the scale.

[Roxee's Dad]

That's why Veterinary medicine is still called a practice.... just don't practice on my dog..right? LOL

You are his only voice and advocate... You will be fine after all the vet works for you.