What's more stubborn than an Airedale??

Mum belongs to many canine health related forums on Yahoo. Whenever she thinks I may have a health problem, she signs up for a new group and starts reading. (mum: and the list keeps on growing...)

Lists she is currently on:

• Yahoo Orthodogs
• Yahoo K9KIDNEYS
• Yahoo K9KidneyDiet
• Yahoo Deaf_Dogs
• Yahoo Canine_Cancer
• Yahoo Canine Cushings Autoimmune Care

Mum has been writing to the Cushing's group because we are in the midst of starting the scary drug and adjusting dosage. A typical message looks like the one below:

Subject Title: [CCAC] Help with Sunshade's lab results please....


Hello group,

Sunshade had an ACTH stim test + CBC done yesterday and I would really appreciate it if you could help me understand what is going on here. My vet has faxed all the results to the internist, and we're waiting to hear back.

We started Sunshade (70 lbs) on 30mg Trilostane BID last Wednesday (December 8th). So far, I have not seen any reduction of the Cushingnoid symptoms. We have never had a regular ACTH Stim done before. We've always done the U of Tenn panel as we thought Sunshade was Atypical. Prior to seeing the internist, we had an LDDS test done that showed inadequate adrenal suppression in response to dexamethasone - is supportive of hyperadrenalism.

(lab results....)

I think our ACTH Stim units are international units, so I'm not quite sure how it compares to the US values. However, it looks like pre and post are both normal? So shouldn't her symptoms be better? Is Trilostane the wrong drug for her due to her being a true Atypical dog?


Thank you in advance,
Elaine & Sunshade

(11 yr old, F/S, Airedale Terrier, 70 lbs)

(right ED dx 2001, kidney insufficiency 2003, bilateral TPLO's 2003, Vet-Stem Procedure April 2010, PDH Atypical turned Typical Cushing's June 2010, Grade 1 Soft Tissue Sarcoma November 2010)

(12/08/10 - 30 mg Trilostane BID. Denamarin, PolyMVA, IP6, Fish oil, Vit-C,E,B, probiotics, Syn-flex, CoQ10, Selenium, digestive enzymes.

Raw meat/bone diet with pulped veggies, Budwig Diet)

All the extra information below the signature line is required so the list members can get a clear picture of the health concerns, diet, weight of the dog, and all the medications and supplements the dog is currently on. It allows members to get the general info and better them to help one another.

Last night, mum posted the message below to the Cushing's group. You can see the subsequent responses below.

(FYI: Pot belly and constant hunger are two of the hallmark symptoms of Cushing's disease. Trilostane and Lysodren are the two scary drugs that work at destruction of layers of the adrenal glands to suppress over production of cortisol and other hormones.)

10:33 PM

Title: [CCAC] URGENT: Trilostane safe for stupid human?

My boyfriend ate Sunshade's Trilostane (45mg) by accident and he refuses to go to the ER no matter what. He told me he'd go if he starts having diarrhea, vomiting, lethargy, inappetance. Basically not taking it seriously and reciting to me everything I had asked him to keep an eye on Sunshade for. Any doctors on the list? I called local animal ER and they told me they weren't sure and to just go to the ER.

I usually take all his supplements out and put them on a plate. Tonight I prepared all of Sunshade's pills and put them on a different plate. He ate Sunshade's plate. I have no idea why, the pills look completely different and Sunshade has more pills.

He's 31 with no known health issues, although he does have a Cushingnoid belly and insatiable appetite.

Thanks,

Elaine, Sunshade & stupid boyfriend

(31 yr old, un-neutered, 200+ lbs, 45 mg Trilostane, pot belly, huge appetite, knuckle head. Diet consists of cooked meat, veggie, raw fish supplemented with Heineken)

RESPONSES:

10:45 PM

Goodness I don't know whether to laugh or be serious...!!!!! But one thing I do know a Dr's opinion and evaluation are in order immediately...I dont think it is anything to play around with..

Judy
A Nurse

USA
Missoula Montana

10:54 PM

I agree with you Judy, I just don't know how to get him to GO. He thinks Sunshade is only 70 lbs, so he should be fine. I saw the below info when I googled and showed it to him and he still wouldn't go. Said those side effects were ok. I am so frustrated (and a little bit worried..). I need a tranquilizer and a moving company.

Side Effects

Taking Trilostane is proven to result in unwanted, adverse side effects which is why it should never be used in humans. Some common side effects associated with Trilostane use were: stomach pain, cramps, diarrhea, achy muscles, bloating, dizziness, fever, flushing, nausea, headache and watery eyes. In rare cases, some patients experienced darkening of the skin, drowsiness, loss of appetite, depression, vomiting or skin rashes. Treatment for canines resulted in reductions of cortisol and aldosterone. Use also commonly results in polydypsia, polyuria, panting, polyphagia, improved skin conditions and coat quality.

Elaine, Sunshade & stupid boyfriend

(31 yr old, un-neutered, 200+ lbs, 45 mg Trilostane, pot belly, huge appetite, knuckle head. Diet consists of cooked meat, veggie, raw fish supplemented with Heineken)

11:03 pm

Hi

I'm a GP.

As a disclaimer, this isn't medical advice for your boyfriend.

However he is unlikely to suffer any ill-effects from one Trilostane tablet regardless of dose. If he makes a habit of it I would suggest behavioural training!

Regards

Elizabeth Christie

11:16 PM

Oh thank you thank you!! I'll consider taking him to Cesar and putting him in with the pack.

Elaine, Sunshade & stupid boyfriend

(31 yr old, un-neutered, 200+ lbs, 45 mg Trilostane, pot belly, huge appetite, knuckle head. Diet consists of cooked meat, veggie, raw fish supplemented with Heineken)

11:28 PM

Well now there you go, everyone can have a good nights sleep, With the GP's comment, however I do think she hit it right on the mark of doing some Behavioral training, and I would get and appt with Caesar as soon as possible...if he doesn't want to go, get one of the pronged choker collars and the leash and do some correcting..

Judy
Montana

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Then we all went to bed.......

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6:24 AM

Hi Elaine,

I just want to ease you remind about a couple things since boyfriend is reluctant to go to ER.

Although the package insert reads not for human use, Trilostane was originally a human medication, used for Cushing's as a bridge therapy until surgery was or other treatment corrected the condition. It was withdrawn from the (US) human market in 1994. From the bowels of archived drug info- For humans, an initial starting dose was 30mg,4x daily; adult prescribing limits Up to 480 mg per day.

This is not a substitute for medical advice but I agree, one dose probably won't hurt him

Carol C. (Fl, USA)
WELCOME HOST Canine Cushing's- Autoimmune Care

Oliver : 13yr-11mo, CKCS, dx 9/06, rx w/ Trilostane, flax lignans; also on benazepril, pimobendan, L-thyroxine, (forever in my heart)
Winston: 13 yo, CKCS, dx 12/07, atypical, previously rx w/ Trilostane-> elev secondary hormones, now rx w/ Lysodren; 11/09 dx degenerative MVD, on Benazepril, Pimobendan, Furosemide; also on Ursodiol, Melatonin, flax lignan extracts, SamE, milk thistle, ASA, monthly testosterone inj for hormone-responsive incontinence.

8:32 AM

Gotta say, as I read the list this a.m., I have been roaring with
laughter!!! Elaine, I had a circumstance where my poodle counter surfed
and ate some of Milo's trilostane. Two things...apparently healthy
adrenals are more resistant to the effects than are ones that are
running amuck. Also, a single dose at theraputic levels or below won't
hurt a poodle.

I suspect your boyfriend is just fine this morning. And this is going to
continue to make a FABULOUS tale to trot out when he needs putting in
his place. "Honey, remember the time you ate the dog's medicine?"

Mary Ainsworth (CA, USA)
WELCOME HOST-Canine Cushings Autoimmune Care (CCAC)

Milo, Canine, Border Terrier, 13 y/o, M/N, 20 lbs., PDH since 11/08,
Trilostane started 1/09, loaded on Lysodren (6/14), maintenance program
(62.25 mg every 2-1/2 days begun around 9/15/10), .2 mg Soloxine SID,
IBD controlled by diet, mix of fish-based kibble, canned pumpkin,
Glycoflex II

8:39 AM

Management is very important in preventing counter surfing, so perhaps you could gate off kitchen from boyfriend, until after Sunshade has taken meds. Or alternatively, you could teach him a go-to-couch cue to keep him out of the kitchen.

Jacky

9:39 AM

Hi Ladies,

While Trilostane or Lysodren may help my pot belly, thinning hair and frequent urination, it is not on my list of things to do today, yet I want to say in Elaine's Boyfriends defense that things happen. There is no such thing as a stupid human, just one that is ill informed...perhaps even ill trained, but just the same, I have come close to making the same mistake myself, mostly during holidays when I feed Gremlin from a plate instead of her bowl. Get distracted from a phone call or a knock on a door...it is easy to make a mistake. Gremlin has her own plates because last Christmas I couldn't remember what dish I put the phenylpropanalopene in and her antibiotics. I had to toss some food. Good thing there was no Eggnog that day!

I'm not a supporter of prong collars as they don't work and for counter surfers, the logical thing is to keep things off the counter. Clicker Training works well and I would suggest beef jerky cut in small pieces or pigs in a blanket for men...not when they are watching the GAME. There are too many distractions and you can't positively reinforce the behavior you want.:)

Gremlin and Denis

11:50 AM

I wouldn't be concerned unless he starts scratching behind his ear and turning around three times before he sits down.

Toni
Bwahahaha

11:53 AM

Mum's response to all those helpful hoomans.

Hi Everyone,

Thanks for all your support and input regarding the issue at hand. Boyfriend DID wake up this morning, and he is fine. He did pull the "hmm.... I don't want breakfast, I'm not hungry......" trick on me, but managed to finish 4 pancakes and some scrambled eggs in about 5 minutes.

Now that I know he is going to be ok, I will put some of your training suggestions in practice. A friend of mine suggested neutering as that made her male dog obey better. I think that is a little extreme for now, but will keep it in mind as last resort.

We have started training this morning. The lesson was how to tell the difference between the plate of pills that's left on the left hand side of the sink from the other plate left on the right hand side of the sink. (Refer to picture attachment). He paid attention, but I think it's going to take a lot of practice before he masters it. I will also work on the Go-To-Your-Couch command as I can see that being quite useful in many circumstances.



@ Denis: LOL! I understand accidents happen, the "stupid human" part was for the fact that he refused to go to the ER with me in situations like this. He was busy playing World of Warcraft online. I did disconnect his computer, and he saw that I was really mad, so he went and made me TEA and SNACK and offered to give me a massage but still refused to go to the ER!!!!!!

Again, thank you to all that responded.

Elaine, Sunshade & stupid boyfriend

(31 yr old, un-neutered, 200+ lbs, 45 mg Trilostane, pot belly, huge appetite, knuckle head. Diet consists of cooked meat, veggie, raw fish supplemented with Heineken)

12:30 PM

I pray there is still some hope for us man-creatures!;)

Gremlin and Denis

PS gremlin comes first in the signature as she seems to be the one that keeps me on track.

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That's about it for now, hope you guys had a great weekend!!

(mum: so what's more stubborn than an Airedale??)