Dad of Lulu - sweet Lulu has crossed The Bridge

[Squirt's Mom]

Hi,

The reference range is incorrect for a dog on Trilostane (Vetoryl). The range for these pups is 1.45 to 5.4 ug/dl and can go up to 9.1 ug/dl if all signs are under control. The post number of 1.8 ug/dl is getting down there so keep an eye on her for any signs that her cortisol is lower than is comfortable for her.

The optimal time to test a pup on Vetoryl is 4-6 hours after the last dose and the dog should NOT be fasted.

Keep up the good work!
Hugs,
Leslie and the gang

[LabDad]

Hi,

The post number of 1.8 ug/dl is getting down there so keep an eye on her for any signs that her cortisol is lower than is comfortable for her.

The optimal time to test a pup on Vetoryl is 4-6 hours after the last dose and the dog should NOT be fasted.

Keep up the good work!
Hugs,
Leslie and the gang

We have our new pills, and I believe by Sunday or Monday I will have started her on these pills. Will keep an eye on. The vet, Dr. Booth wants to wait a month to redo the 2 hour ACTH test.

I do notice some periods of increased appetite and increased water intake. But much better than before.

Her legs, especially the hind legs are weak, but getting better. Some of this is psychology. As I have been transporting her up and down the basement via the walkin sliding door, thank goodness we don't have a Michigan basement! But she surprises me by coming upstairs to the second floor by herself, though her method of operation is to stay on a single floor for longer periods, usually she stays on the first floor while I'm at work, if I'm not at home working.

[molly muffin]

So glad she is doing better. Slow walks, getting longer, to build the leg muscles back up.

Hugs,
Sharlene

[LabDad]

Slow walks, getting longer, to build the leg muscles back up.

Hugs,
Sharlene

That is what I am finding. It's been two weeks on the new pharmacy compounded Trilostane. I am wondering if perhaps this pharmacy's preparation is not as strong as the more expensive local place we got the first 50 days!

I have noticed that Lulu does still pant at night, though a bit less with the cooler weather. She owns the room fan and I always keep it on at least low speed directed toward her.

Too, I notice that she is a lighter sleeper. She could be dead to the world a year ago the senior citizen dog she is. But since being positive for Cushing's Disease again, could that be a symptom of or perhaps a side affect of the drug?

Her left rear leg is a bit weaker, so I keep up the glucosamine, occasionally give her Duramax for pain. and massage her leg. The back legs were operated on for ACL 7 years ago successfully. I am thinking I may have Dr. Wilson, same place that Dr. Booth is at treating her Cushing's now examine her legs. That and just plain old arthritis of an older dog can make it harder to walk.

A year ago she would still be able to walk 2 miles or a bit more, but now I am keeping it under 1/2 a mile, and sometimes less. She does have a harder time eliminating and has to squat a couple times or so to get it all out. LOL

[labblab]

Hi, and I'm sorry that I have not had a chance to reply to you earlier about Lulu's first monitoring ACTH results:

Really quickly now, at a job site, but Lulu pre ACTH test was 3.3 ug/dl and Post-ACTH 1.8 ug/dl.

As Addy mentioned earlier, Lulu's post-ACTH result was right at the very low end of what is acceptable for a dog being treated with trilostane. According to the manufacturer of brandname Vetoryl, the drug should actually be temporarily discontinued and then the dose lowered if the post-ACTH result drops any lower than 1.45 ug/dl. Since Lulu's test result was this low after only one month of treatment, I do worry that it may continue to drift downward even further in the coming month.

Please do watch her very, very closely. If she exhibits any symptoms of low cortisol (lethargy, loss of appetitie, vomiting, diarrhea), I would stop the trilostane immediately and take her in for testing right away.

Marianne

[LabDad]

I am going to call Dr. Booth and let him know her walking problems. I am a bit confused. So if the dosage were reduced or stopped even she might improve. I thought that the dosage would be started low and then to see how she is doing. I have a call in to Dr. Booth to express my concerns. Lulu is not throwing up. Her appetite is more normal and not as ravenous as it had been.

[labblab]

Sorry I was gone yesterday afternoon and didn't see your reply until this morning. I want to clarify that Lulu may be doing just fine on this dose of trilostane, and her rear-leg weakness may only be from arthritis that has been "unmasked" by her decrease in cortisol. But her 30-day post-ACTH result is low enough that you really do not want it to drop any further. Individual dogs metabolize the drug at different rates, so what may be a "low" dose for one dog may turn out to be a "high" dose for a dog of the very same weight. That is why the monitoring ACTH tests are so important in terms of making dosing adjustments. The initial dose is indeed calculated on the basis of weight (the makers of brandname Vetoryl recommend a formula of 1 mg. per pound). But that is just a starting point, and the dog's appearance, behavior and subsequent blood testing all guide the subsequent dosing.

I think it's great that you are seeing so many improvements in Lulu. And as I say, this dose and ACTH level may prove to be just fine for her. But I wanted you to be aware that you do not want her cortisol level to drop any further. If it does, you will need to decrease her dose. Here's a link to the U.S. Product Insert for brandname Vetoryl. It contains a lot of helpful info re: monitoring and potential side effects to watch out for:

http://www.dechra-us.com/files/dechr...ts/Vetoryl.pdf

Marianne

[LabDad]

Thanks Labblab,

Thanks for the link. Lulu is scheduled for her ACTH test next Thursday morning. They said they want her from 9 am to 1 pm. So will work out good for me, as my project I am working on is 3 miles away.

I am thinking that most of the weakness in her back left leg is due to muscle weakness from Cushing's Disease. This happened a year and a half ago and got better when she went into remission. These back legs were operated on for ACLU 7 years ago which helps to complicate plus the fact that the vet then said she would get some arthritis too. I am thinking that massaging her back legs may be therapeutic to her. I help an guide her to go upstairs at night and also downstairs. There is a mid-landing so I make her stop there, even though she wants to do it in one fling. She can do the steps but now mostly waits for me. Even if it's just two steps sometimes!

[LabDad]

Lulu has been having trouble eliminating and tends to get in position, but doesn't hold still when she poohs. She tends to walk it out. But lately she has been a bit constipated, and her stools tend to be a bit looser. I don't know if this is because of the trilostane, or just her muscles are weak yet from Cushings. She is going? Is there a good stool softener or something like Metamucil to give? I don't think she is having a blockage though I am watching just in case.

[Harley PoMMom]

Metamucil or canned pumpkin (not the kind with spices for pies) can be used for constipation/diarrhea in dogs.

Here are two links that provide the dosages: Metamucil: http://www.vetinfo.com/dogmed.html

We usually recommend using 1/4th teaspoonful of Metamucil per 20 lbs of body weight twice a day but there is a wide variation in recommended dosages and it is probably safe to use slightly more than this.

Pumpkin: http://www.earthclinic.com/Pets/constipation.html

Pets who weigh less than 15 pounds = 1 - 2 teaspoons
Pets who weigh 15 - 35 pounds = 1 - 2 tablespoons
Pets who weigh 35 pounds and up = 2 - 5 tablespoons depending on size

Hope Lulu feels better real soon...keep us posted!

Love and hugs,
Lori