Zowi new treatment plan acth results for cushing's
 

this is a link to zowi's previous thread....
http://www.yorkietalk.com/forums/sic...overnight.html

i just got home with zowi after meeting with her dogtor regarding her latest acth results from u of tenn. we have decided to start her on trilostane (12mg once daily with food.) her dr says that she feels trilostane is safer than lysodren because trilostane is an enzyme blocker, lysodren eats away adrenal tissues and sometimes there is no going back if it becomes overcontrolled. she told me that the cortisol is much more detrimental to zowi's system than the sex steriods that are elevated, so we should be most concerned about treating the cortisol. her dr also said that 90% of her patients on trilostane are doing very well with no bad reactions. she will also continue l-thyroxine (.1 mg every 12 hours) for her low thyroid, denamarin for her enlarged liver, and hmr lignans (10mg once a day). we will consider adding in oral melatonin after the recheck of her next acth test in 4 weeks from today, but for now she wants to see what the trilostane does without melatonin.
i was also told today that when she was hospitalized a couple weeks ago, her triglycerides were greater than 500 and her cholesterol was at 450. if her cholesterol went up to 500 she would begin to have seizures.

this acth test showed her cortisol to be high, the previous acth did not. here are the results from u of tenn endocrinology lab....
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cortisol baseline 49.6 (normal range 2.1-58.8) result post acth 185.5* (normal range 65.0-174.6)
androstenedione baseline 0.36 (normal range 0.05-0.57) result post acth 2.66 (normal range 0.27-3.97)
estradiol baseline 144.8* (normal range 30.8-69.9) result post acth 122.7* (normal range 27.9-69.2)
progesterone baseline 0.25 (normal range 0.03-0.49) result post acth 1.67* (normal range 0.10-1.50)
17 oh progesterone baseline 0.42 (normal range 0.08-0.77) result post acth 2.07* (normal range 0.40-1.62)
aldosterone baseline 257.9* (normal range 11-139.9) result post acth 492.1* (normal range 72.9-398.5)

* above or below reference range

These results indicate presence of increased adrenal activity. moderate-significant.
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Wylie has Atypical Cushings - and it is def stressful at first. As you know, the diagnosis can take months - then you have to titrate the meds, which can truly take up to a year. U of Tenn is the best in the U.S. for canine Cushings - you're in great hands; they're very good about communicating w/ your regular vet too.

Wylie is on Lysodren 3x a week, and is on Melatonin 2x a day. He does amazing on these meds, no discernible side effects. Oh, he also has hypothyroid, which is pretty common w/ adrenal diseases.

I just want you to know that it does get easier, once you get the proper diagnosis (as you have) and get going on the med titration; the worst part is really the wondering during the diagnosis stage. There are lots and lots of dogs who live full lives w/ this diagnosis.

Let me know if there is any way I can help. I have a ton of bookmarks about Cushings if you need them :).

So glad you got the results and a meeting with your Doctor. Now, let the medications work their magic and get her feeling better. SHe is in great hands with you Carrie.

How is she feeling today?

I hope the meds will help control her Cushing's. My pom had it and it is a difficult disease.

I am first reading now that Zowi was hospitalized. I hope you both have recovered from it. I agree with Steve that Zowi could not be in more loving hands than you and that you will do everything in your power to keep your little girl healthy. I hope this new treatment plans helps your baby. My thoughts and prayers are with you, Carrie.

hello ann, it's very nice to have you back on the forum and glad you are doing much better! :) a while back (probably around may) you did share some fantastic bookmarks with me around the time of zowi's diagnosis, and they really did help me understand cushing's. plus, i joined the yahoo group you suggested and have posted there a couple times, received some great information. and thanks for the encouragement. i am so glad that wylie is doing so well with his treatments. thanks for your help, i really appreciate it!

i have been so concerned with zowi starting these meds! i was told to wait 4 weeks after starting her on trilostane before her next acth, but i'm thinking i will only wait 3 weeks at the longest, then there is the 2 weeks waiting for results. but so far... so good...

hi steve... today we are on day 4 of trilostane... last night, i saw zowi do something i have not seen her do in a long time - she had pixie's racoon squeaker toy and was growling at it, playing with it, and shaking it in her mouth for about 15 minutes straight! i have not seen her play in months! last week tuesday we took her to the little dog park by us and she just sat with her water dish drinking like crazy, so after 15 minutes we had to leave.

the main things to watch are her appetite and energy level. if those things go downhill or she vomits or has diarrhea, we will have go to off the meds, wait a month and try a different one, most likely lysodren. zowi's blood will be going to u of tenn at minimum every 4 weeks until we find the perfect "maintainence" dose. her dr said i could see positive improvements in her symptoms in as soon as a week. for now, i'm watching her every move and hoping that all turns out well for my baby girl!

lisa, thank you so much for the thoughts and prayers. i have been so busy since her hospitalization, watching her like a hawk and spoiling her, i haven't had much time for anything else! i do plan on doing everything it takes to keep her healthy and happy and so far she is doing wonderful on the trilostane, lets hope this continues. thanks again so much for the well wishes and prayers, they really do help!
i've been thinking of you!!! i hope all is well with you and your dh. i am sure you're once again a busy woman now that school is back in! sending you a big hug and will keep you updated!

thank you patti, yes it really is. so much trial and wondering if you're doing the right thing.

update
 

zowi has been on trilostane 3 weeks as of today. so far, she has done very well on the med with no bad side effects. however, it doesn't seem that any of her symptoms of cushing's are going away. (ravenous appetite, panting, seeking cool spots to lay, excersize intolerance, increased water consumption/potty breaks) her dr said to wait 4 weeks and recheck her acth, but after discussion with her we have decided to only wait 3 weeks. also, it has been a little over 4 weeks on her thyroid med (l-thyroxine.)

so today she will be spending a few hours at the vet's office getting her acth stimulation test, thyroid panel, and a blood pressure test. i am requesting her blood pressure to be checked as it can also cause panting and i would like to rule that out so we do know that the panting is being caused by cushing's. of course, i also have a list of new questions for the dr too. we will also discuss getting zowi on oral melatonin, the melatonin implant she received in june only lasts 4 months and her dr wants to see if we get better results with giving it in pill form.

then its a waiting game again to see the results from u of tenn within 10-14 days. from there, we will adjust her trilostane dosage up or down, or maybe even opt for a different med, depending on her results.

zowi is a very happy go lucky girl that goes along with everything, so i'm happy for that, but it's always so sad for me leaving her there, even for a few hours. zowi doesn't seem to mind though and she loves all the attention she gets there. fingers crossed all goes well and we get some good news this time! no matter what, zowi's best interest will always always be what is most important!

Wow it sounds like you are definitely in the midst of an ordeal but you have gotten Zowie the best care available. Just to give you a ray of hope, Kelsie, our fox terrier mix, was diagnosed with addisons in 2005 and is still going strong! She gets prednisone every day and ACTH once a month. In 6 years, she's only had one episode of Addison's crisis but when she was diagnosed, we didn't think she'd have this long and she has surpassed everyone's expectations!

Sending up prayers for you and your baby - she's lucky to have such a dedicated Mommy!

Hope it goes well for you guys, and that further fine tuning will help little Zowi. Hang tough my friend.

Glad you know what you are dealing with and have a treatment plan.
I am curious, there is a youngish woman who walks in the evenings. She always stops to say hi if we are in the yard. She said her mom took her Yorkie to Tenn. and that she had Cushing disease. I was wondering if this is your daughter ?

I hope they find the right med and dosage soon for Zowi. You're a good mom! She is so lucky to have you! :)

You're a great mom, Carrie. Thoughts of you always bring such warm feelings to my heart and mind. I think of you and your babies so often, and I always wish you and your family the best of health and happiness, a great deal of love, and beautiful memories always.

thank you so much for sharing your story of kelsie, it does offer some hope. i am very happy that her addisons has been under control for so long! from my understanding, addisons is more critical than cushing's, so it is truly amazing that she has done so well for 6 years! great job! you must be a very good mom to her, she's lucky to have you! i will also send up prayers for you & your kelsie to continue to do so well with her treatment!

thank you steve, i am doing my best to hang tough for my girl!

hi there! sorry it's taken me a few days to get back on here. no, the woman in your neighborhood is not my daughter... would've been a real coincidence if it was though! i'm sure she was referring to u of tenn though. it's the only place in the country that does the complete acth panel for cushing's dogs that includes not just cortisol, but several other sex steroids that are elevated with the atypical form of cushing's. i have never actually taken zowi to tenn, our vet sends her blood samples there for evaluation and they consult with zowi's dr and recommend treatment based on the results. they're expert engocrinologists and considered #1 in the country, especially for atypicals.

thank you linda, it means a lot, especially coming from an angel of yorkies like yourself! :)

thank you lisa. having met you here means so much to me because you're so thoughtful and sincere. i am so proud to have you as a friend. thanks for all the well wishes and positive thoughts, i know they work more than we will ever know. you always have a way of comforting with your words. sending you a hug and hoping all is well!!! thinking of you often!!!

update
 

still waiting on results from u of tenn to see if trilostane is helping to control zowi's cushing's..... will continue same dose until results are in. all clinical signs are still present, but her energy level has improved somewhat.

zowi had her cholesterol and triglycerides rechecked as both were very high (especially cholesterol) during her hospitalization. her cholesterol was at 450 (normal is 324 or lower) and triglycerides were in the 500's (normal is 291 or lower.) we changed her to a very low fat (6% maximum) diet a little over a month ago. her cholesterol has lowered to 330 which is almost back to normal range, but her triglycerides have raised to 673. we are instructed to continue same food she is on and no treats, and recheck in a couple weeks to see if there's any improvement. this is a concern i will be discussing with her dr when i get u of tenn results. it is a possibility the trilostane is increasing triglycerides and it is not diet related. does anyone have any experience with high triglycerides?

zowi's thyroid panel showed a great deal of improvement (3.4 normal is 1-4) from when she was hospitalized, so we will continue the same dose of thyroxine twice a day for her hypothyroid condition. dr recommends rechecking every 6 months to be sure that the dosage is still correct, but knowing how i worry about giving her meds, we will probably recheck in 3 months and her dr said that would be fine.

her dr said the blood pressure test is probably unnecessary because usually there would be some changes in vision or with the eyes occurring with a blood pressure problem, but agreed to do it for my own peace of mind and that came back normal with no blood pressure problems. she said that she is sure the panting is a clinical sign of elevated steroids from cushing's.

will continue to update as i find out more info. zowi and i really appreciate everyone sharing their stories and sending positive thoughts our way. maybe this info can help someone with their own baby someday too. cushing's is very often overlooked as normal aging process by owners and veterinarians alike. zowi started having some symptoms a year before her diagnosis and every test run on her came back normal then. we also were unable to see our regular dr for those tests over a year ago. zowi got a uti and was seen by our regular doc and that was the first cushing's was ever even mentioned. sending ((hugs)) and well wishes to all of you and your babies!

Thanks for the update! Keeping you and Zowi in my thoughts and prayers.

update
 

zowi's u of tenn results 11/3 came back a little lower than we wanted so her trilostane dose was decreased to 10mg once daily from 12mg once daily. she is due for another endocrine panel to tennessee in a couple weeks to see how everything looks on the new dose. she's a little more energetic and panting a little bit less but she continues to have symptoms of cushing's even though her numbers are pretty close to where they should be. this makes me and her dr agree that some adjustments still need to be made in the future, but we must give things time to work and see what we have for an outcome. i have noticed her shaking/shivering during times of excitement over the last week and her dr says that is a side effect of the trilostane and to watch her closely. so i am waiting and hoping for more improvements and watching her very closely....
cushing's is caused by a tumor in the pituitary gland 85-90% of the time or from a tumor in one (or both) of the adrenal glands 10-15% of the time. (a very small percentage can have tumors in both though.) the adrenal tumor type is usually operable but very risky (25-30% mortality rate within first 24 hours) and expensive ($6,000-$8,000), the pituitary is not operable because it is located at the base of the brain. we decided to opt for surgery if possible because it's the only way cushing's can possibly be cured, the rest of the time it is not curable and can only be controlled. zowi had an ultrasound 11/10 to determine which it is and unfortunately she has the pituitary dependant type, so medical management is our only option. good news is that everything looked great with the exception of an enlarged liver and both adrenal glands. her dr took the time to let me see the ultrasound images myself and explain everything to me which was great.

i am so grateful that even with all this going on, zowi is in great spirits and overall doing great! she's such a little trooper and such a good little patient. she still keeps her happy healthy 18 month old little sister pixie in check and knows she will always be the queen!!! we will stop at nothing to keep zowi happy and healthy as long as we can!!!

thank you to all of our wonderful yorkie talk friends and family for your well wishes and positive thoughts and keep them coming - they really do work!!!

That is real good news, and hopefully fine tuning the dosage will yeild positive results. Glad she is more active and feeling better. You are doing everything you can for her! She will be the Belle of the next Chicago River Boat Ride.

The Meet-up group will most likely have an Easter Time meeting and hopring you are all there.