American Bulldog 7yrs PDH Tremors at rest (Vetoryl)

[doodlebug]

Hi,
i'm new here so apologies if this has been covered in other threads.
I have a 7yr old Am. Bulldog who has recently been diagnosed with PDH Cushing's as well as polycystic kidneys (large stone in one) & a discoloured liver...(poor sausage.)..
He has been taking 60mg am & 30mg pm vetoryl daily for 3 months now & from the beginning he was shivery after meds. He responded really well to the treatment with the thirst, ravenous appetite etc.
My concern is the tremors are getting worse. He shakes when he is resting, lying down..I wonder how he can rest like that? I cover him & that sometimes helps.
He had a little bit of a head shake before starting treatment but its not known whether the pit tumour is large or small...although i suspect it to be on the larger side because of the shaking.
He has also started to get some green bogies :eek:in his nose which makes him sound nasally/wheezy.
Many thanks in advance

[labblab]

Hi and welcome!

Boy, what a timely question...I just now added a reply to another member's thread in which I talk a bit about tremoring/shivering episodes. Here's a link to Elizabeth's reply in which she asks about tremoring, and if you continue to scroll down that page, you'll see my reply at the bottom:

http://www.k9cushings.com/forum/showthread.php?p=30357#post30357

I'll come back and talk some about the tremoring later on (I've gotta take my dogs for their morning walk! :o). But here's a quick question in the meantime. When was an ACTH test last performed on your dog? Because I think the first issue here is making sure that his cortisol level has not dropped too low on the trilostane.

Also, as a side note, I believe that green nasal "gunk" can signal a sinus or respiratory infection. I'm thinking your vet should take a look at that so as to possibly prescribe some antibiotics...

I'll be back a bit later on...
Marianne

[doodlebug]

Hi Marianne,
thanks for the speedy reply.
After reading you Elizabeth reply it seems my dog has the same type of shivering as your dog, from the shoulders.
His last ACTH test was in feb & he is due one soon.

[labblab]

OK, I'm back again now. :)

It's lucky that your boy is due for an ACTH test anyway. Because I really do think that is the best place for you to start, including having his electrolytes (blood chemistries) checked, as well. Plus, that way your vet can take a look at his nasal discharge. Do you know what his ACTH results were in February? Aside from the tremoring, does he otherwise seem to be doing well?

If his cortisol is OK, here's a couple other thoughts. Tremoring is listed as a side effect of trilostane itself on Dechra's Product Description Insert for Vetoryl (brandname trilostane). However, I have never read any detailed discussions of tremoring as a side effect, so I really can't tell you much more than that. However, it is possible to speak with a U.S. technical representative for Dechra at their U.S. office in Kansas. I have spoken with Dr. Allen in the past, and I'm certain he'd be happy to also talk with you or your vet about the incidence of tremoring as a medication side effect. Here's a link to Dechra's "Contact Us" webpage:

http://www.dechra-us.com/page/contact-us

Also, as you've already seen in my reply to Elizabeth, we have had other occasions of unexplained tremoring among our membership over the years. Just to elaborate a little more on my own experience…I first noticed a bit of "shivering" in my Cushpup during the month of our diagnosis process. Then, right after starting trilostane treatment, the shivering became even more pronounced. It happened most often when he was lying down, or even asleep. It looked as though he was shivering across his shoulder blades. At its worst, he would even jerk himself awake with the force of the shivering. However, he never seemed to be in any pain, and it definitely seemed to upset me more than it did him. The episodes kept happening for a couple of months, and just as we were trying to videotape an episode to show to a neurologist, they ended. We never did get an explanation, although I often wondered whether it just somehow resulted from the rapid changes in his cortisol level (both up and down).

Now, not to worry you unduly, but we did later come to believe that our boy suffered from enlargement of his pituitary tumor. A few months after the tremoring stopped, he developed other neurological problems (wouldn't eat, was confused and lethargic, etc.). And as luck would have it, Elizabeth is also worrying that her little dog may also have an expanding tumor. However, I truly don't know that there was any relationship whatsoever among my boy's symptoms. I have not seen tremoring specifically identified as a symptom of an enlarging tumor. And as I say, we've also had other members who have complained of strange tremoring -- and not in conjuction with macrotumors.

So to come back full circle, I really do think your best "first step" is to take him in for his ACTH/electrolyte check. And then, depending upon any other feedback from your vet, we can talk about additional diagnostics -- including maybe seeing a neurologist if there is one available to you.

Marianne

[lucygoo]

Hi...

Just wanted to put in my two cents about the tremors. I don't think it has anything to do with a macrotumor. Lucy had increasing tremors when she was treated with trilostane for 2 years. When we stopped it a couple weeks before her surgery, the tremors completely stopped (And as many of you know she had a huge macrotumor)

I think it's just a transient side effect of the trilo, and doesn't seem to have any ill effects.

Hope this puts you at ease a little:)

Gina

[zoesmom]

Well, I can report that my Zoe also had tremors .... across her shoulder area ..... early on in her treatment with trilostane. Like Marianne said, it didn't seem to bother her as much as it did me. And it didn't go on for too long. I tend to agree with Gina - that it's probably a side effect of trilo - or perhaps the dog's reaction to their changing levels of cortisol. Not everybody here using trilo has noted that effect but I know that at least a few have. It is probably time to schedule that next ACTH & electrolyte check tho - just to rule out low cortisol as a possible cause. Sue

[doodlebug]

Thank you for all your replies & yes, you have put my mind at ease regarding the tremors...& yes, they are distressing to watch.
He is doing well apart from the tremors, his pendulous stomach has tucked up somewhat, he is not so wobbly on his hind legs, his head has filled in somewhat from being skeletal, his thirst & hunger have subsided.
He is due the end of the month for an ACTH but i'll maybe delay till next month as i have so many bills this month & i am struggling badly.
I love him so much & my stomach is in knots with worry..i wake up in the night to shake him to see if he is still breathing..I know he wont live forever but he is my family & i cant bear the thought...
Thanks again to all who answered

[jrepac]

I would not get too worried about the tremors, but just keep an eye on him. they can get tremors when cortisol is too high OR too low....

[doodlebug]

Im taking him for an ACTH test tomorrow & will post results.
Tremors have lessened since the recent hot spell..although he does still get them.
He seems to have become agressive, has anybody observed this in their dog?

[Harley PoMMom]

I have read where dogs that have hypothyroidism and that are not being treated can get agressive, has his thyroid levels ever been checked?

Love and hugs,
Lori

[doodlebug]

Hi Lori,
I dont think they tested him for thyroid levels.
I'll mention it tomorrow...well i think they'll notice all on their own...
I'm hypothyroid myself & i think the levothyroxine i take makes me tense sometimes..anyhow, thanks for the reply & wish me or should i say the vets luck tomorrow!

[doodlebug]

Got his ACTH results today & they are fine. He also got a kidney function test, which also was fine & antibiotics for his snotty nose.
The vet seemed to think the new aggression was because he was feeling under the weather...so she didnt check his thyroid function.