Cushing's Disease Monitoring Questionnaire "*" indicates required fields Pet's Name:*Client's Name*Preferred Phone Number*Is this a mobile number?* Yes No Preferred E-mail*What dose of trilostane does your dog receive?*How many times per day is this dose of trilostane given?*When your dog was diagnosed with Cushing’s syndrome, how much was he/she drinking compared to 1 year prior to diagnosis?* Less About the same A little more A LOT more How much is your dog drinking now, compared to when he/she first started taking trilostane?* A lot less A little less Same More How much is your dog urinating now, compared to when he/she first started taking trilostane?* A lot less A little less Same More Has your dog had any urinary accidents/leakage within the past month?* No Yes, but less than before Yes, same as before How active is your dog compared to when he/she started taking trilostane?* Less active The same A little more active A lot more active/back to normal Rate your dog’s appetite change since the beginning of treatment.* A lot less A little less Same Increased Rate your dog’s panting since the beginning of treatment.* A lot less A little less Same Increased How does your dog’s haircoat look?* Less hair Slight improvement No change Hair improved/normal Overall, how do you think your dog is responding to treatment for Cushing’s syndrome?* Now worse No difference Some improvement Nearly normal low Completely normal Have you had to use the dexamethasone tablets provided at previous visit? Yes No Has your dog had any:* Vomiting Diarrhea Trembling Other signs of illness None of the above Please explain:*
