Rudy: New diagnosis, on Trilostane/Vetoryl, lethargic

[MyRudy]

Hi, I am new here, been reading all day and just wanted you to know I feel so much better after reading this. Apollo has almost identical symptoms to what my dog has.

Rudy was diagnosed with Cushings July 22 and started on Vetoryl that day. I saw vast improvement in the water drinking, panting and peeing within a few days. But about a week later, my poor puppy looked half dead. He was lethargic, not eating and his hind legs suddenly seemed to give out on him. He no longer wanted to go for walks more than a few feet.

I called my vet and he was surprised because he said Rudy's cortisol was 'super high' according to the ACTH test we had done. He gave me a script for prednisone in case Rudy got 'shocky'. Rudy weighed about 45 lbs at the time he was diagnosed, so he was prescribed the 60 mg capsules once a day.

I quit giving Vetoryl to him since Monday. He has improved every day since, finally eating a little bit and today he actually made it to the park for a shorter walk, but did not appear to have as much trouble as he had even yesterday.

My vet said to give him the Vetoryl every other day, since it is in capsule form and I can't just half the pill. He also said I could open up the capsules and sprinkle half on his food every day if I wanted to, but I have read not to do that.

My question is: since he is almost back to normal and has been off Vetoryl for 3 days now, when should I start him back on every other day? It is obvious to me that the dosage was too high even though it is correct for his size. We are supposed to have a follow-up ACTH on Aug 21st and I believe I read in here that he needs to be taking his meds for 2 weeks prior to that time in order to get an accurate reading?

I hope there is more good news on Apollo from the Vet today!

[StarDeb55]

I want to welcome both you & Rudy! I must warn you that we tend to ask a lot of questions of new members, but that just helps us to give you the most appropriate feedback possible from the group's collective experience. Can you tell us a little more about Rudy's history? What symptoms led you to take Rudy to the vet? What tests were done to diagnose Cushing's? Some of these tests may include an ACTH, low dose dex test, or even an abdominal ultrasound. If you could post the actual results for us, that would be great. We are not trying to second guess your vet, but we have seen too many pups mis-diagnosed due to lack of sufficient diagnostic testing, a vet who is inexperience in treating Cushing's, or both. Did your vet rule out diabetes & thyroid problems? I ask about these 2 problems as their symptoms can overlap with Cushing's.

I'm very concerned about your vet's experience in using trilostane & treating Cushing's. Trilostane only has a half life in the body of about 12 hours, so every other day dosing is a complete waste of time. Most members who use trilo, dose once daily, some members have to dose twice daily. We do have many members using trilo, so I'm sure some of them will be along to offer their input.

Looking forward to hearing more.

Debbie

[MyRudy]

I'm very concerned about your vet's experience in using trilostane & treating Cushing's. Trilostane only has a half life in the body of about 12 hours, so every other day dosing is a complete waste of time. Most members who use trilo, dose once daily, some members have to dose twice daily. We do have many members using trilo, so I'm sure some of them will be along to offer their input.

Looking forward to hearing more.

Debbie

Yes, this is exactly what I was concerned about! Thank you so much. I fear my vet is not very experienced as well.

Rudy went to the vet first in June for his 6 month check-up since he is a senior dog (12 1/2). I had recently noticed excess drinking and peeing and some coughing as well as one of his hind legs giving out at the end of our walks. I described these symptoms to the vet and he did a urine test and blood test that day, but I have no idea what kind and I never got the numbers on any of the tests I've had done on him.

He said his urine was very watery and that his blood levels were in normal ranges, he had been worried about kidney disease. So next we had a urine bile acids test as he was afraid of liver disease. That came back with numbers a little high but he said still not too far from normal.

An ultrasound was performed a few days later and it showed all organs normal except the adrenal glands were both enlarged. So then they performed the ACTH and all I was told is that the cortisol levels were super high. I will need to call the vet's office tomorrow to get the actual numbers.

[frijole]

Welcome from me as well! I question the dx as well as the experience level... hard to know without those reports. If I were you and it isn't too big of a deal I would go in person and get copies of the reports.

I just went thru an ordeal with my vet and there were several times when I'd get a verbal report that didn't quite have all the info in it that was in the reports. So if you can - go get copies of all blood tests, etc that have been done. Then post the results here and it will help us understand the situation a bit better and help guide you thru the process.

Cushings is a serious disease but it isn't imperative you start treating right away so I'd cease with the trilostane until I had a greater comfort level that the dx is right. Frankly the regime you are on is a waste of time - as Deb said - the drug doesn't last long enough in the system to be effective with every other day dosing.

Hang in there and keep us posted. Glad you found us. Kim

[littleone1]

Corky and I also want to welcome you and Rudy.

I know you have gotten some very good information, but I just want to mention that you can get Trilostane compounded in other doses than Vetoryl. Corky is taking Trilostane, and is doing very well on it. His IMS started him on the lower dose, and then increased it as it was necessary. Corky started with his dosage once a day, and is now dosing twice daily.

I hope everything goes well with Rudy's treatment.

Terri

[MyRudy]

Thanks for everyone's advice, I feel better already.

I had another vet at this same clinic for many years and then I guess he quit working on Saturdays (which is the only day I can take Rudy in since I work and am single) so I got switched over to this new vet. My other vet was much older and more experienced and he explained things much better than the new guy. I may ask for him back and just take time off work if necessary.

I am going to call them tomorrow and ask them to fax the test results, is that okay? What reason do I give for wanting them?

There were a few days this week when I thought I was going to lose Rudy. I don't understand why he is worse now than he was before I gave him any pills at all. His hind leg weakness is the most difficult to deal with - I felt just like Apollo's mom did, it was like Rudy aged 30 yrs in a matter of days!

I gave him a total of 11 pills and the last few I wish I had not given him. I have paid close to $1,000 already with all the tests and $100 for a month's supply of vetoryl which the vet told me I would have to keep Rudy on for life.

[MyRudy]

I should also mention that Rudy does not have any hair loss or skin problems that I can see, his symptoms are excess water intake and urination, including accidents in the house which he never had before, coughing and panting heavily. He is a Chow/Husky mix and I have had him since he was 8 weeks old. He is my fur-kid since I have no human kids and I would spend anything to make his quality of life better.

I assumed from the little the vet did tell me that Rudy has the pituitary cushings.

[StarDeb55]

I would just tell them that you would like to keep a file on Rudy at home, in case you might ever end up at a strange vet, especially an ER clinic. When you ask for the fax, please make sure you get not only the Cushing's testing, but any general labwork that might have been done such as a senior wellness panel or super chemistry panel. There are common elevations in liver function tests on our pups that will frequently point a vet toward Cushing's. On the general labwork, please post only the abnormals, along with normal range & reporting units. Just to let you know, I'm a medical lab tech with 30+ years experience, so I can help you sort those results out.

Debbie

[frijole]

My first dog was diagnosed with cushings over 4 yrs ago and I had never asked for records before unless I moved. Well... with cushings you really want to be more actively involved and frankly check everything that is done. You want to make sure you have all the facts and understand what is going on because you are Rudy's voice.

You don't have to explain why you want the copies. You paid for the tests and legally if you ask they are to give them to you. If you feel you need to offer something, just tell them you'd like to read them over. You can get a fax but they are often hard to read because the print is so fine. Perhaps they could scan them into documents and email them to you?

My last request had so many pages that when I went in on Saturday (same thing single and working) they were busy and I just said - make copies and mail them to me which they did. It just will delay things if they are mailed.

My 2nd dog was diagnosed with cushings and ended up having a nasty bacteria in her stomach that resulted in bleeding ulcers. I ended up going to 3 different vets on this one (and remember I have experience w/ cushings :confused::eek:;)) and after all this they think she was misdiagnosed and might not even have it. (She had 5 different tests indicating high cortisol/cushings)

So when we say it can be misdiagnosed it is because we've been there and seen it alot. Perhaps Rudy does have it but the reaction to the drug isn't making sense.

Hang in there - you already are doing the right thing by getting up to speed on the disease and asking questions. Rudy will be just fine. Kim

[StarDeb55]

I went back & rechecked what you had posted for Rudy's weight & the daily dosage your vet initially recommended. Dechra's recommended dosage range is 1-3 mg./lb. which does work out to 60 mg. Univ. of Cal. at Davis has a little different protocol as they have found that starting at a lower dose & working up, if needed, seems to be a little safer. UC Davis starts at 1 mg/kg, which for Rudy would be a starting dose of 20 mg. daily. Rudy's problems may simply be due to the fact that his initial dosage may be a bit too high. Has he had an ACTH done since he started trilo, especially recently since he has been feeling bad? Dechra protocol states that the first ACTH needs to be done within 10-14 days after starting treatment, then, again at 1 month. We have frequently seen in this group that pup's who start vetoryl whose initial stim (ACTH), may still be mildly elevated, or even within range will continue to drop their cortisol during the first 30 days. It is very important that with each stim test, that Rudy's electrolytes be checked. Were Rudy's electrolytes check during this period where he was feeling so bad?

Here's a link from our important information section which will give you tons of information about trilostane including Dechra's & UC Davis dosing protocols.

http://www.k9cushings.com/forum/showthread.php?t=185

Debbie

[MyRudy]

Wow, Kim, I guess it really could be something other than Cushings? Funny because the Vet originally ruled out Cushings due to the fact Rudy had not gained weight and he was not eating any more than normal, plus he does not have the distended stomach so many describe. He gave us an antibiotic for the cough and it did not make any difference whatsoever.

I appreciate all your great advice! I will call them tomorrow and ask them to make copies and pick them up on Saturday! Then maybe we can figure this out:D

I am under the assumption right now that his dosage was too high. Since he went several days w/o eating at all, I assume he is probably closer to 40 lbs now. He looks really skinny to me all of a sudden! He's never been overweight, but always very healthy looking and muscular. When I pet him now I feel bones:(

[frijole]

My biggest worry would be the cough. That can be a sign of heart issues. Did the vet mention this or question you about it? How long has the coughing been going on and how frequent is it? Coughing not sneezing right?

When you get the records, find out if he's lost weight. I had NO idea my dog had lost weight but she did/does have the cushings round belly so it hid it for a while.

[Squirt's Mom]

Hi and welcome to you and Rudy, :)

My Squirt's story is similar to Kim's Annie's in that she was first diagnosed with PDH (pituitary form) but then a tumor was found on her spleen. Once the tumor was removed, her cortisol returned to normal and has remained within normal ranged since. She will be tested again the 30th of this month, and if it is still normal, she will be considered to have been misdiagnosed concerning the PDH, but she does have a form of Cushing's called Atypical in which cortisol is not involved.

When she was first diagnosed, I didn't want to start her on either Lyso or Trilo until she was thoroughly tested and we knew exactly what we were dealing with. She had the LDDS, HDDS, ultrasound, ACTH, and UTK panel, and all of those tests were positive for PDH...yet it looks as if all those tests may well have been wrong. It was the tumor causing her cortisol to be elevated. Cortisol is a fight or flight hormone and it is normal for it to rise in response to stress of any kind, internal or external.

Because of cases like Squirt's and Annie's as well as the number of other conditions that share signs with Cushing's, IMHO it is best to take it slow and make as sure as you possibly can that you are dealing with Cushing's, which form, and what the options are for treating it. Having a cush savvy vet is really nice, but if you have one that is willing to listen and learn, that is much better than a vet who refuses to hear your concerns or is too arrogant to admit they might be doing things a bit odd, if not downright wrong. Most of the cases we have seen here of a pup not doing well with treatment boils down to a vet who isn't following established protocols for diagnosing, treating or monitoring the patient nor educating the parent on what to expect and what their part will be.

You are off to a good start in learning what you can about this condition and the drug your baby has been prescribed. Continue to read and ask questions and we will do our best to help you understand. You and Rudy are no longer alone; we will be with you every step of the way.

Looking forward to learning more about you and your baby in the future.

Hugs,
Leslie and the girls - always

[apollo6]

Welcome to you and Rudy
Don't give up. Apollo is my fur ball child also, never had children.
I am going through the muscle wasting in his hind legs. First you need to define which cushing it is , read up, on it. There are three kinds, atypical ( no signs in blood test, but physical signs, and related to sex hormones) ADRENAL( one gland is larger then the other-found in an ultrasound) or Pituitary/PDH( when both adrenal glands are equally enlarged) that is what Apollo has. He has been on Trilostane since July 23rd. I did a lot of research, finally went to an Internal medicine specialist experienced with cushing's, Had a full blood panel, an ultrasound, an urinalysis, before it was determined if Apollo had cushing's, then I had an ACH STIM TEST (shows if cortisone levels are extremely elevated) it took me almost a year before I saw an increase in symptoms. Only then was treatment decided. And in my case when I read about company's Decha recommendations and even called their veterinarian specialist, found out what the dosage should be for Apollo's weight 10 lbs, 10 mg,the vet wanted me to start on 30 mg, I felt it was too high after input from the forum. So we started on 10 mg, at his first retest his cortisol levels were fine. Now we will see what the next test will show. His weakness started about a month ago. Hard to know if it is the cushing or not, but my gut feeling is it is. Like you I am pretty new at this. If Rudy is lethargic it could be a possible side effect of the Trilostane.
We are here for you and Rudy.

[MyRudy]

I am so glad I found this forum, you all are so knowledgable about Cushings. I just can't tell you how relieved I feel now, whereas before I was going round and round in my head debating whether or not to put Rudy back on the medication.

I just called the vet's office and they will have copies of all tests done on Rudy since June of this year ready for me to pick up tomorrow. I also requested the older more experienced vet going forward. AND I cancelled the Aug 21st appointment for his follow-up ACTH test.

Rudy has only had the one ACTH test so far, the vet told me his cortisol levels were so high that he did not need to test again until a month later!!!! He also told me that they recommend a follow-up test after 2 weeks but he felt it was a waste to do it at that time because in his opinion Rudy's cortisol levels would not be down in just 2 weeks. Yet, in reality, it appears Rudy's cortisol levels dropped dramatically in just 1 week.

[MyRudy]

My biggest worry would be the cough. That can be a sign of heart issues. Did the vet mention this or question you about it? How long has the coughing been going on and how frequent is it? Coughing not sneezing right?

When you get the records, find out if he's lost weight. I had NO idea my dog had lost weight but she did/does have the cushings round belly so it hid it for a while.

I too was initially very worried about the cough because I had a cocker spaniel years ago with a cough and it was diagnosed as heart disease. She died young because of that, and also because she was overweight due to UNDIAGNOSED thyroid conditions. It seems I have not had great luck with good veterinary care over the years! That was a totally different Vet and Clinic than the one I am going to now.

I mentioned that to the Vet when we went for his check-up in June and he told me Rudy did not have heart disease. That is when he prescribed an antibiotic which did not clear up the cough. Rudy still coughs.

Rudy has lost some weight over the years, I do know that. He used to weigh 50+ lbs several years ago and was down to 44 lbs this past June. But he also weighed that much at his Jan 2010 checkup, so his weight has been consistent this year.

Looking back, I can recall a time about 3 yrs ago (maybe 4?) that he no longer wanted to jump into the SUV I had at the time, and I just attributed that to aging. Also, I was living with my fiance at the time and he had a yellow lab and they shared a water bowl so I recall thinking that I was filling the bowl up a lot more than normal but it was hard to tell if it was because of Rudy or because of 2 dogs drinking from the same bowl.

In hindsight, I do believe Rudy has had Cushings for several years.

[StarDeb55]

I wanted to expand on what Sonja had mentioned about Atypical Cushing's. Sonja had described Atypical in the following sentence:


There are three kinds, atypical ( no signs in blood test, but physical signs, and related to sex hormones)

When she said no signs in blood test, if you are dealing strictly with Atypical, the normal tests such as an ACTH or low dose dex test will appear to be normal because Atypical will not have an elevated cortisol. With Atypical Cushing's, you will have an elevation in one or more of the associated sex hormones, with or without a concurrent elevation of cortisol. Atypical can only be diagnosed by the full adrenal panel which is done only at the Univ. of Tenn., Knoxville. As far as we know, this is the only lab that is doing this type of testing. For example, my Harley, at his diagnosis, not only had a severely elevated cortisol, but an across the board elevation in the other 5 associated hormones.


Looking back, I can recall a time about 3 yrs ago (maybe 4?) that he no longer wanted to jump into the SUV I had at the time, and I just attributed that to aging. Also, I was living with my fiance at the time and he had a yellow lab and they shared a water bowl so I recall thinking that I was filling the bowl up a lot more than normal but it was hard to tell if it was because of Rudy or because of 2 dogs drinking from the same bowl.

In hindsight, I do believe Rudy has had Cushings for several years.


Don't beat yourself up about this, as what you describe is frequently what happens with an undiagnosed pup. The owner assumes that all of these symptoms can be attributed to simple aging. A lot of vets will make the same assumption. Frequently, what will happen is that as the symptoms continue to worsen, the owner will start pushing the vet that something is truly wrong with their pup which needs to be investigated. A large number of general practice vets simply do not have the background to know that much about Cushing's as it is the most difficult endocrine disorder to diagnose in our canine companions.

Debboe

[MyRudy]

Thanks so much for explaining things and being so understanding, Debbie. I can't wait to get the copies tomorrow so I can get your opinions on what to do next.

I told the receptionist at the Vet that I wanted the test results so that I could get a 2nd opinion. I am also prepared to take Rudy to a new vet if need be. I had him at one Vet up until 5 years ago when I switched to this Vet.

I understand it must be hard for Vets to diagnose since the animals can't talk and tell them what hurts. But it seems you have to be pretty aggressive with them just to get testing done!

[StarDeb55]

Actually, I was pretty lucky with my Harley. He has regular dentals, & my GP vet alerted me to the fact that his alkaline phosphatase enzyme had been consistently elevated for about 2 years. This enzyme is found in the liver & an elevation is what frequently points a vet towards Cushing's. The vet wanted to recheck liver function in 6 months, if it's still elevated, then start the Cushing's workup. After thinking about it, especially since Harley was 13 at that time, I told him to go ahead & let's take a look at Cushing's. Fortunately, my vet had also switched to doing the full adrenal panel for diagnostic purposes, so all Harley had done for his diagnosis was the full panel & an abdominal ultrasound. If you are considering changing vets, you may want to seriously consider going to an internal medicine specialist as these vets are the ones who have the specialized training/knowledge in endocrine disorders, & much better a diagnosing Cushing's.

Debbie

[MyRudy]

I will definitely look into that if I change Vets. I guess you get a referral for a specialist from your regular vet?

Debbie, I was just reading your thread (OMG!!!! at what you went through trying to get Harley to eat) and came across this:

DUH! I just thought of something. Chewy is on antibiotics, both orally & eardrops for the next 10 days, so he has no business having a UTK panel done until all of his antibiotics are done.

That got me to thinking about things....when I first took Rudy in at the end of June for his semi-annual checkup the Vet prescribed antibiotics for the coughing so I was giving him those for several weeks leading up to the subsequent bile acids testing and ACTH. Do you think that would that have any effect on his test results or does it only affect the UTK panel you referred to?

I so very much appreciate your help;)

[StarDeb55]

If Rudy had an active infection present, it's possible. The 2 main diagnostic tests are the ACTH & low dose dex test. The low dose is considered to be the gold standard when diagnosing Cushing's, but it has one huge drawback, the test may yield a false positive in the presence of any non-adrenal illness. I pretty sure that the ACTH is less likely to yield a false positive, although, my understanding is that an ACTH may yield a false negative. When trying to get a confirmed diagnosis of this disease, it's always best to confirm any positive result on either of the above 2 tests with a second test, frequently, an abdominal ultrasound to take a look at the adrenal glands & other internal organs. Confirming with a 2nd test is especially important with the low dose because of the false positive problem. If you might consider doing the ultrasound, you really get more "bang for the buck" as all of Rudy's internal organs will be checked, & you will have a better idea of his overall health. You want to make sure that the ultrasound is done on a high resolution machine, & read by an experienced vet.

Debbie

PS- When it comes to a referral, it will depend on the specialist. I will say that the majority will probably require a referral. We do have a link in the important information section about how to find a specialist in the US, if you need some help.

[MyRudy]

I had the ultrasound done already, it showed both adrenal glands were enlarged, which is why I deduced Rudy as PDH instead of the other 2 types of Cushings. And luckily my current vet was off that day, so my former vet, the older more experienced guy, is the one who read the results to me and explained things.

After that is when they did the ACTH and his cortisol levels came back 'super high'. I don't know if they did the other test you mentioned.

[StarDeb55]

With an elevated ACTH & bilaterally enlarged adrenals, IMO, you have a confirmed diagnosis.

Debbie

[MyRudy]

Just found this in another thread and I think it is exactly what happened to Rudy:

A small percentage of dogs may develop corticosteroid withdrawal syndrome within 10 days of starting treatment. This phenomenon results from acute withdrawal of circulating glucocorticoids; clinical signs include weakness, lethargy, anorexia, and weight loss. These clinical signs should be differentiated from an early hypoadrenocortical crisis by measurement of serum electrolyte concentrations and performance of an ACTH stimulation test. Corticosteroid withdrawal syndrome should respond to cessation of Vetroyl Capsules (duration of discontinuation based on the severity of the clinical signs) and restarting at a lower dose.

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

[StarDeb55]

This is a possibility. There can be such a rapid decline in cortisol levels with both drugs that the pup can start feeling kind "yucky" without the cortisol actually having gone so low that you may dealing with a low cortisol emergency. Cortisol is a sort of "feel good" hormone as it is a natural anti-inflammatory, & the pup is used to higher levels that are present. The only way to know for sure what might have happened with Rudy is to have run an ACTH or electrolyte check at a minimum. If that wasn't done, all we can say is likely, but we can't prove it.

One other thing to point out is cortisol normal ranges are completely different for our pups as opposed to a normal, healthy pup. Our normal range is 1-5 ug/dl. We have vets who get the normal ranges mixed up on a fairly regular basis.

Debbie

[MyRudy]

Just got back from the vet and going through the reports. I took Rudy with me so I could weigh him and he is down to 33 lbs:mad:

I think my first concern is putting weight back on, am I correct? He weighed 44 lbs just a few weeks ago when all this started.

Looking through the 6/27/10 test results on his Senior Screen, Chem 25 test, the following were flagged as high:

ALT (SGPT) 111 (5-107 U/L)
GGT 21 (0-14 U/L)
Cholesterol 345 (112-328 mg/dL)

and the following were flagged as low:

WBC 4.1 (5.7-16.3 THOUS./uL)
Eosinophil 1 (2-10%)
Absolute Neutrophil SEG 2911 (3000-11500/uL)
Absolute Lymphocyte 984 (1000-4800/uL)
Absolute Eosinophil 41 (100-1250/uL)

7/18/10 Bile Acids Test:

Bile Acids 21.0 (0.0-6.9 umol/L)
Bile Acids Post Prandial 18.0 (0.0-14.9 umol/L)

7/21/10 Ultrasound:

The ultrasonographic findings are strongly suggestive of pituitary dependant hyperadrenoocorticism (PDH). Adrenal function testing is recommended. (As I mentioned before, bilateral enlargement of adrenal glands was found, along with a generally enlarged liver and bladder; pancreas, spleen and kidneys were normal; gall bladder was moderately distended with inspissated bile. The gall bladder wall was normal in thickness).

7/21/10 ACTH Stim test:

Pre-ACTH 35.1 ug/dL
Post-ACTH 42.5 ug/dL

If there are other numbers you guys need to know, I will try to find them in these reports.

Thanks!
Donna

[frijole]

Donna, Was the ALK PHOSPHATE normal? If so that would not be indicative of cushings. The ALT sometimes is elevated in cushings. Did your vet discuss all of the other abnormal readings and what might be causing them to be off? I ask because most of the abnormal readings are not things we typically see with cushings.

Since there were things going on at the time of the acth test - I am not sure I could feel comfortable that it is a true positive result. The ultrasound sure looks like cushings.

Forgive me for not reading back - I just spent 2 hrs working the yard and am bushed. I am sure Deb will check in and give her more professional opinion.

Thanks for getting all of that info and posting. It will be a great help. I will check in after I get cleaned up. Kim

[MyRudy]

Kim:

Yes the ALK Phosphate was 116 and they list 10-150 U/L as normal range. The ALT (SGPT) was 111 with a 5-107 U/L listed as normal.

I am sure he has Cushings, but I suppose there could be something else going on that the vet might have missed? He did not discuss the flagged readings with me and I have no idea what they are (except cholesterol).

The stim test numbers really threw me, they were so darned high! Rudy is a very sensitive dog and scares easily, he normally shakes like a leaf when we are at the vet. At the time the stim test was done he had been at the vet's office all day and gone through an ultrasound already, so I am pretty sure his cortisol numbers were inflated due to that.

Thanks for your response!
Donna

[frijole]

I don't remember a single dog ever being diagnosed with normal liver enzymes. And when we are talking elevated -- my dog's ALK Phos was 2000+. Most vets won't even test if its under 250 because the likelihood is that it is something else.

Even if cushings is involved - it appears something else is going on which would explain the weight loss.

I am really glad you got those numbers.... now I reallly am going to go shower! :p:D:)

[MyRudy]

Kim, I edited the numbers for ALK and ALT above, I was looking at the test from 2009 instead of this year's test. The edited numbers are a bit higher, but still not all that high compared to your poor dog's!

Just to be clear, Rudy has only lost 11 lbs since the Vetoryl, which lasted only 11 days before I stopped giving them to him. After I stopped and got the prednisone, I gave him one of those and he perked up a bit the next day and has been slowly improving, but still not eating normally. I am having to supplement his food just to get him to eat at all.

The last day I gave him Vetoryl was Aug 2nd. He got one prednisone on Aug 3rd. Since then, no pills at all. He is back to walking more normally but he is still not eating like he was.

And the panting/drinking/peeing symptoms have returned in full.

[StarDeb55]

I agree with Kim. It's extremely unusual that a pup has near normal or normal liver enzymes, especially the alk phos. We have seen pups in this group who have alk phos values in the several thousands. My Harley's alk phos can run around 650. There are a lot of other things that can cause enlargement of the adrenal glands besides Cushing's. To give you one example, Leslie's Squirt had just about every known diagnostic test for Cushing's & they all came up positive. The one thing that was not mentioned when her first ultrasound was done was the presence of a tumor on her spleen. Squirt had that splenic tumor surgically removed, & her cortisol has been normal ever since. It now looks like the Cushing's was misdiagnosed.

In one of my initial posts to you, I asked whether or not your vet ruled out diabetes & thyroid problems for Rudy? I don't see where you told us, after reviewing your thread. I believe weight loss is way more common with diabetes, than Cushing's. Weight gain, a ravenous appetite, along with a pot-bellied appearance are more common in our pups. If the vet did not specifically rule out diabetes, there is a quick check you can do at home. You want to purchase what are called "ketodiastix" at a drugstore, about any drugstore will have them. These strips check the urine for the presence of glucose, & ketones. The presence of either one or both is a pretty good indication that diabetes may be the problem

Based on Rudy's near normal general labwork, I do have my doubts about Cushing's. I suppose it's possible that you caught it in the very early stages. The other thing is that if Rudy does not have Cushing's, it can be extremely dangerous to administer either drug to a normal, healthy pup. This may be why Rudy became so ill on the few doses of trilo that you gave him. IMO, it's time to look for a new vet, preferably an IMS.

Debbie

[MyRudy]

Thanks for your input, Debbie. I probably didn't answer those questions because I did not know the answers! He did originally think it could be kidney or liver problems and ruled both of those out. I recall him mentioning Cushings at the first check-up because of the symptoms I described and at that time he did not believe Rudy had Cushings for those same reasons you mentioned, he was not gaining weight. Rudy has steadily lost a few pounds each year as he has gotten older, but this recent drop of 11 pounds was all due to the Trilo.

I did not post the urinalysis results, also from his Senior Screen on 6/27/10:

Color Yellow
Clarity Clear
Specific Gravity 1.004
Glucose Negative
Bilirubin Negative
Ketones Negative
PH 7.0
Protein Negative
WBC 0-2
RBC 0-2
Bacteria None Seen
EPI Cell Rare
Mucus None Seen
Casts None Seen
Crystals None Seen
Urobilinogen Normal

I also just noticed a line I missed earlier with his T4 at 1.3 (0.9-3.9 ug/dL)

So it seems he did rule out diabetes, right? Thyroid, I am not sure about.

[StarDeb55]

A very low specific gravity may be an indication of cushing's. You still can't totally rule out diabetes with the negative on the glucose & ketones on the UA results. Do you have results of a recent blood glucose anywhere? The T4 is low normal. When it comes to thyroid testing in our pups there is a concurrent syndrome called "sick euthyroid syndrome" that may show as hypothyroid in routine testing. This is because of the effects of the Cushing's on the thyroid. Once the Cushing's is under control, the thyroid tests should normalize. The only way to confirm hypothyroid in one of our pups is to have a free T4 by equilibrium dialysis to verify the initial low result. Has the vet said anything about the abnormal bile acid result, with most of the liver enzymes being near normal or normal?

One other thing, could you check that senior panel that was done, & please post the BUn & creatinine results?

Debbie

[MyRudy]

Bun 21 (7-27mg/dL)
Creatinine 1.0 (0.4-1.8 mg/dL)

Gosh, this all sounds so very complicated!

I have read the results of the ultrasound and there was no mention of any spots or suspected tumors or anything, everything was normal except that I posted earlier.

Rudy did great on his walk tonight, and he is eating again, so he seems to be recovering, whew! He is still panting, peeing and drinking excessive amounts of water, however.

His hind leg weakness seems to have resolved as well, I guess all the cortisol has made that better? He is going up and down the stairs like he used to!

Is there a website to find a local internal medicine vet for my area? I am not that far from Texas A&M Veterinary School, but I have to think there has to be someone in a city this size!

[StarDeb55]

BUN & creatinine are the 2 main kidney function tests. They are nice & normal.

Cortisol is a natural anti-inflammatory, so if the pup has any arthritic issues, the higher cortisol will help.

Here's the link from our important information section on how to locate an IMS. I do want to tell you that we have had several members take their pups to A&M for treatment, & they have always given the vets & students glowing reports for their care of the pup & the parent.

http://www.k9cushings.com/forum/showthread.php?t=182

Debbie

[MyRudy]

I went to school at A&M and know they have an excellent reputation! It is just that I volunteer at the SPCA on Saturday afternoons, so I only have limited time for Vet visits on Saturday mornings unless I take time off work....I am working a temp job so that isn't always possible, but if I find a specialist who can't accommodate my schedule I will take time off from work.

Thanks so much for all your help, I really appreciate it as I don't know enough about all the different numbers and tests to even know what to ask :rolleyes:

Donna

[frijole]

You are lucky to be in an area with a selection of specialists and a teaching university. A&M is wonderful.

There are ZERO specialists in my state and I drove Annie to Kansas State and was thrilled with the service and knowledge. If it isn't too far I would opt for A&M ... alot of the time teaching schools charge less for the tests. I had a 2nd ultrasound done and it was $100 less and way more detailed. Also I think you get faster answers because they can get you the test results usually right away vs waiting. Plus there is more than one person on the case. If they need another type of specialist they bring them over and review the case. Food for thought.

[MyRudy]

I am lucky, you're right! I will see about one of the IMS in my city and if they concur with the prior diagnosis of Cushings, there really isn't much point driving to A&M. If it becomes complicated, then I would not hesitate to drive to A&M to let them figure it out.

[frijole]

Save yourself some money. Bring copies for them to look at of every test done including the bloodwork.

Type up a summary sheet for them in chronological order including symptoms, tests, results, meds taken etc. That will save them time and give you peace of mind that they get the whole picture.

[apollo6]

Just checking on how you and Rudy are doing.
Like I said before I had a lot of test done before I started on Trilostane, and had an confirmed diagnose
This is a web site on Internal medicine vets , you can check if yours in there it also gives what their speciality is
http://www.acvim.org/websites/acvim/index.php?p=3

all you have to do is look up specialty, your state.
Hope this helps.
Glad to hear Rudy is doing better.

[lulusmom]

Hi and a belated welcome to you and Rudy

You've gotten some great feedback from members but I wanted to weigh in and share my totally unsolicited two cents. :D

I’ve seen some high acth stim results but I think Rudy’s pre/basal number of 35 is about the highest I’ve seen and the post stim number is also quite high. As you said, stress was probably a factor but I think the abdominal ultrasound showed that there is a pretty fair amount of hyperadrenal activity going on. I also think that the hyperadrenal activity is the reason that Rudy was so sensitive to Vetoryl as opposed to the possibility that he doesn’t have cushing’s. It is known that dogs with cushing’s are definitely far more sensitive to the drug than healthy dogs. There have been a few studies done, one of which was done by Dechra, the manufacture of Vetoryl, wherein they dosed 32 six month old healthy Beagles with 6.7 mg/kg twice daily for 90 days and they tolerated it well. This is a pretty healthy dose considering Rudy was getting a bit less than 3mg/kg once daily. Dechra pushed the envelope and found that healthy dogs have severe reactions, including death, when given huge doses well in excess of 20mg/kg twice a day. As a frame of reference, a dog Rudy’s size would have gotten no less than 400mg twice a day. :eek:

I'm not a highly experienced lab tech like Debbie but from a layman's point of view, the results of the bloodwork you posted sure looks like cushing’s to me. Mild elevation in cholesterol, very, very mild elevation in ALT and GGT, low absolute lymphocytes and absolute eosinophil…..these are all common abnormalities associated with cushing’s, or at least they are in the textbooks and papers I’ve read. With such mild elevations, I am a bit surprised that your vet was concerned with primary liver disease. The results of the bile acid test is not typical of primary liver disease but it is very common in cushing’s. Most dogs with cushing's have increased bile acids, some as high as 50 to 75 so Rudy's results are pretty tame in comparison.

It is rather strange to see normal ALK in a cushdog but it happens. Dogs are the only species that have a steroid induced isoenzyme ALK. Most dogs have a gene that turns on this isoenzyme in the face of excess steroids; however, a small number of dogs are missing that gene. My dog, Lulu, is one of them. The only time she has had elevated ALK was when she had severe dental issues and bladder stones.

Again, I’m no expert but I personally think Rudy probably has cushing’s and it might just be a matter of finding a dose that works for him, keeping in mind that all dogs are different and size doesn’t always correlate with the dose. However, the weight loss definitely concerns me and like Kim, I can’t help but think there is something else going on....so I’m happy to hear that you are contemplating consulting with a internal medicine specialist. In the meantime, you might consider calling Dechra, the manufacturer of Vetoryl. They have a vet on staff, Dr. Tim Allen, who has been really wonderful in answering members’ questions. You have nothing to lose by calling him and discussing Rudy’s rapid weight loss since starting treatment with Vetoryl. I am wondering if Dechra considers this side affect to be the result of simply no eating or does Vetoryl have some type of impact on the metabolism or digestive function. Their contact number is (913) 327-0015.

Glynda

P.S. How old is Rudy and what is his breeding?

[StarDeb55]

Thanks, Glynda, for weighing on Rudy's situation. I will admit that I was somewhat confused by the extremely mild elevations on the liver function tests. In answer to your question about Rudy's breed, I think this will do it.


He is a Chow/Husky mix and I have had him since he was 8 weeks old.

Debbie

[MyRudy]

My sincere thanks to everyone!

Rudy is a chow-husky mix and he is 12.5 years old. He weighed as much as 65 lbs when he was a young pup, and has lost a few pounds every year. I don't know if that is normal? In Feb 2009 he weighed 53 lbs, in January 2010 he weighed 47 lbs and before all this started he was at 44 lbs....none of that was alarming to me or mentioned by the Vet.

What is alarming to me is that I started him on Vetoryl on 7/22/10 and gave him 11 pills before I stopped completely, and on 8/7/10 he had dropped from 44 lbs to 33 lbs. That is alot of weight to lose in just 2 weeks for anyone! That is 1/4 of his total weight.

Although he is now eating, he is not eating as much as he used to. Maybe it is just going to take time, I don't know, but I am very concerned about this.

I do believe he has Cushings but agree it won't hurt to get a 2nd opinion. I guess part of the problem with Vetoryl is that it has only been used in the U.S. since 2009 so there isn't a whole lot of history and experience with it (except in the U.K.).

I do believe his dosage was too high. I think he should be given 30mg to start with and see if that works. If not, I would go to a 30 mg dose in the morning and add a 10 mg dose in the evenings, assuming he gets back to his pre-vetoryl weight.

I will bring copies of all his tests with me when I see an IMS. I hope if they want to perform more tests it will be different tests to rule out anything else they might suspect.

Is there any possibility that the ACTH was done incorrectly?

I think there has been a gradual increase in drinking water and peeing over the past few months, but it wasn't until June that he started having accidents in the house while I was at work. This did not happen before except on rare occasions. Now he has accidents every night and it is getting really old!!! I get up every few hours to let him out, but that doesn't seem to help. He goes outside and pees with his leg lifted for what seems like 5 minutes, comes in and drinks half a bowl of water, then goes out and pees again!

[frijole]

Glynda has made some great points...

You asked: Is there any possibility that the ACTH was done incorrectly?

It can be done incorrectly and also - if something else is going on in the body (infection, bacteria, other illness) then that can certainly affect the test result as well. (this is what happened to me)

So seeing a specialist should help confirm the cushings diagnosis AND determine what else is going on causing the weight loss. Kim

[zoesmom]

Hi - Just browsed quickly thru your thread but with that pronounced weight loss, I think I'd get Rudy to an IMS (lots of red flags on your regular vets) and first off, have them recheck for diabetes, if it hasn't been done recently. Doesn't mean this isn't cushings - it may or may not be, but diabetes could possibly have thrown off the diagnostics for cushings. Or, the two diseases can sometimes appear around the same time and that can make controlling both of them a trickier process. Many of the symptoms are the same. Sue

PS - On the vetoryl being used in the US - actually it has been used for canine cushings several years longer - maybe since 2001 or 2002 (not sure). Owners were able to import it from the UK for those years before it was approved here in the States. Once it became available here, I began ordering a compounded trilostane dose from an online pharmacy (pethealthpharmacy.com in AZ - so much cheaper than what I'd been paying to order the vetoryl from the UK.)

[MyRudy]

I've read so many threads here that I can't remember anymore (Debbie maybe?), but whoever mentioned the Ceasar's dog food, yes!!! I got some at the store today and Rudy seems to love it....I mixed it w/his dry food and he ate the whole bowl. This is the first time he has eaten all of the food in his bowl since this whole mess started and recently he was just eating the supplements off the top and not eating his kibble with it, so I am much encouraged about getting that weight back on him.

I used to just free feed him with kibble always in his bowl and thinking back, I don't think he ate much of that after the first several days on Vetoryl. I did not know that I was supposed to give the medication with food, so that may also have been part of his problem. Dumb mama!

[MyRudy]

AND......we just had normal length walk and he was walking like he used to, with a spring in his step, not like the 90 yr old he acted like the past week or so, yay! His stool was a bit loose, not diarrhea, but that must be due to him eating the Ceasar food - before all he ate was kibble. I did mix it together so his system should get used to it soon and I expect that to stabilize.

I feel better than I have in a week as far as his prognosis now. This past Mon and Tues I really did think I was going to lose him.

Mission for tomorrow is to find an IMS that has experience w/Cushings and make an appointment. :)

[frijole]

Wow... where can I find some of that food?!!! :D:D:D:D:D Seriously though - that is great news. Glad Rudy had a great day. I found that keeping a diary really helped me remember and track things. If you haven't, start today because it was a great one. ;) Kim

[frijole]

Just got back from the vet and going through the reports. I took Rudy with me so I could weigh him and he is down to 33 lbs:mad:

I think my first concern is putting weight back on, am I correct? He weighed 44 lbs just a few weeks ago when all this started.

Looking through the 6/27/10 test results on his Senior Screen, Chem 25 test, the following were flagged as high:

ALT (SGPT) 111 (5-107 U/L)
GGT 21 (0-14 U/L)
Cholesterol 345 (112-328 mg/dL)

and the following were flagged as low:

WBC 4.1 (5.7-16.3 THOUS./uL)
Eosinophil 1 (2-10%)
Absolute Neutrophil SEG 2911 (3000-11500/uL)
Absolute Lymphocyte 984 (1000-4800/uL)
Absolute Eosinophil 41 (100-1250/uL)

7/18/10 Bile Acids Test:

Bile Acids 21.0 (0.0-6.9 umol/L)
Bile Acids Post Prandial 18.0 (0.0-14.9 umol/L)

7/21/10 Ultrasound:

The ultrasonographic findings are strongly suggestive of pituitary dependant hyperadrenoocorticism (PDH). Adrenal function testing is recommended. (As I mentioned before, bilateral enlargement of adrenal glands was found, along with a generally enlarged liver and bladder; pancreas, spleen and kidneys were normal; gall bladder was moderately distended with inspissated bile. The gall bladder wall was normal in thickness).

7/21/10 ACTH Stim test:

Pre-ACTH 35.1 ug/dL
Post-ACTH 42.5 ug/dL

If there are other numbers you guys need to know, I will try to find them in these reports.

Thanks!
Donna

Donna - Great job on getting this all together. Do you mind posting the other items as well just so we have a complete picture? I appreciate it! Thanks Kim

[StarDeb55]

Donna, I know we said that we were only interested in the abnormals on the general labwork, but based on the discussion between you, me, Kim, & Glynda, I would like to see all of the CBC (complete blood count) results. I am specifically interested in the RBC count, hemoglobin, hematocrit, & platelet count.

Thanks,
Debbie

[MyRudy]

Sure, no problem, here they are, in order:

ALK Phos 116 (10-150U/L)
ALT (SGPT) 111 (5-107U/L)
AST (SGOT) 30 (5-55U/L)
CK 70 (10-200 U/L)
GGT 21 (0-14 U/L)
Albumin 3.5 (2.5-4.0 g/dL)
Total Protein 6.6 (5.1-7.8 g/dL)
Globulin 3.1 (2.1-4.5 g/dL)
Total Bilirubin 0.1 (0.0-0.4 mg/dL)
Direct Bilirubin 0.1 (0.0-0.2 mg/dL)
Bun 21 (7-27 mg/dL)
Creatinine 1.0 (0.4-1.8 mg/dL)
Cholesterol 345 (112-328 mg/dL)
Glucose 97 (60-125 mg/dL)
Calcium 9.7 (8.2-12.4 mg/dL)
Phosphorus 4.3 (2.1-6.3 mg/dL)
TCO2(Bicarbonate) 17 (17-24 mEq/L)
Chloride 113 (105-115 mEq/L)
Potassium 4.9 (4.0-5.6 mEq/L)
Sodium 146 (141-156 mEq/L)
A/G Ratio 1.1 (0.6-1.6)
B/C Raio 21.0
Indirect Bilirubin 0.1 (0-0.3 mg/dL)
NA/K Ratio 30 (27-40)
Hemolysis Index N
Lipemia Index N
Anion Gap 21 (12-24 mEq/L)

T4 1.3 (0.9-3.9 ug/dL)

WBC 4.1 (5.7-16.3 Thous/uL)
RBC 7.59 (5.5-8.5 Million/uL)
HGB 17.4 (12-18 g/dL)
HCT 51.3 (37-55%)
MCV 68 (60-77 fL)
MCH 22.9 (19.5-26.0 pg)
MCHC 33.9 (32-36 g/dL)
Neutrophil Seg 71 (60-77%)
Lymphocytes 24 (12-30%)
Monocytes 4 (3-10%)
Eosinophil 1 (2-10%)
Basophil 0 (0-1%)

[MyRudy]

Rudy and I have an appointment with an IMS tomorrow at 9 am!

I asked if this guy had experience with Cushings disease and Trilostane/Vetoryl and she assured me that he does.

[MyRudy]

This may be a dumb question, but I am wondering if it could be related to a tooth infection possibly? I guess the antibiotics would have cleared that up, though. I have never had his teeth cleaned and the vet did mention that one of them was in bad shape a year or so ago.

I have noticed that when I pull his harness off over his head after our walk that he cries out like it hurts him.....he did not do this before. So it got me to thinking maybe he has an ear problem or the tumor in his head is getting big and causing pressure in there or something else head-related?

Also, a few times when I was petting him, if I pet him down the sides of his snout he would cry out too.:confused:

[frijole]

What I do is write all those little things down that pop into the head so when you meet with the vet you won't forget. I always think more is better regarding communication so be sure to mention this. It might not make sense right away but when the pieces start to fall into place it could be meaningful. I'm doing the same thing right now with Annie.

Good luck with your appt. Keep us posted and give Rudy a hug. Kim

[MyRudy]

Good idea, I will make notes to bring up when we go to the IMS tomorrow. And thanks, I will give Rudy a hug and a kiss from all the wonderful forum members :o

And you and Annie have a safe trip tonight and keep us up to date whenever possible on what happens tomorrow at KState, of course wishing and hoping and praying for the best!

[StarDeb55]

Thanks for posting the remainder of the CBC results, I do not see anything that raises a red flag, so that's good. Hope all goes well with the IMS, & please keep us posted.

Debbie

[MyRudy]

Rudy is with the new IMS Vet. He is going to run another ACTH and a new blood panel just to see where we are at right now. I agree with this because to further treat Rudy we need to know what we are starting from.

He said that my prior vet should have done an ACTH when Rudy was showing signs of crashing after 11 doses of Vetoryl. He did ask if I had been given Prednisone and I told him yes, I had gotten some after I reported Rudy's symptoms on Aug 2nd when he was half-dead.

He reviewed the ultrasound and said he is fully confident in those results, he knows the ultrasonographer and said he is highly competent.

He said he has seen cortisol numbers that high before, but also said they could be that high because of something else going on. He therefore wants to take xrays of Rudy's chest and back to see if something else could be bothering Rudy to produce such high numbers of cortisol. He believes Rudy has arthritis as well and I intend to ask him if we can treat for that at the same time.

He also said most dogs GAIN weight as they get older, not lose it. He wanted to make very sure with me that Rudy's rapid weight loss was only a result of treating with Vetoryl.

He told me he actually prefers lysodren. I don't know yet if he is going to recommend that or not. When Rudy was first diagnosed and I read about the treatment options on the internet, I was adamantly against anything that would destroy part of his adrenal glands, but after reading about all the experiences here, I have changed my mind.

Oh! He also told me that Dechra's dosing recommendations are too large and Rudy should not have been started out on 60 mgs per day!

I will go pick up Rudy later on today after they complete the testing and see what else he has to say, but other than xray results I don't think we will have a clear picture until the blood panel and stim results come back, probably tomorrow (if it is the same as w/other vet).

I must say I do feel Rudy is in capable hands now and I am glad you all gave me the advice to take this step. Thanks so much from both of us!:D

[frijole]

Thanks for the update.. sounds like you found a keeper vet! I am at a coffee bistro in Kansas... So glad Rudy is in competant hands now. Kim

[lulusmom]

Just wanted to say that I think you found a great IMS! We'll be looking forward to the results of the stim test.

Glynda

[Squirt's Mom]

I agree with Kim...sound like you have found a good IMS! And I personally are tickled pink to hear him say he prefers Lyso to Trilo...Trilo scares me much more than Lyso.

Just to clear something up for you....Trilo has just as much ability to destroy the adrenals as Lyso does. That is my big problem with Trilo - it is touted as "safer" but that is not what I have seen over the last few years I have been involved with Cushing's. Trilo was the way I initially wanted to go but the more I learned the more I leaned toward Lyso.

I am so glad he is checking for some other cause for the elevated cortisol! :) Non-adrenal illnesses can and do cause Cushing's-like signs and positive results on cush specific tests so this is great. Your IMS is being very thorough! :)

Let us know what you learn!
Keep your chin up!
Hugs,
Leslie and the girls - always

[MyRudy]

You guys are the best! Thanks so much for the good wishes.

Did not know that Trilo can also kill off part of the adrenal. Wow. If this guy recommends Lyso I have no problem with that - he has the experience to do it right I believe. He is being extremely thorough, and while I hate the idea of the paying for more of the same tests I just had done, I do understand that it is necessary if we are going to treat Rudy effectively. For all we know his cortisol could have dropped but judging from the water drinking and peeing in the house accidents, I do not believe so.

About 5 yrs ago I was told he had a mild case of hip dysplasia and that could possibly have progressed, I suppose, along with arthritis, to perhaps contributing to those high cortisol numbers. I just want Rudy to be in as little pain as possible during the whole process.

On a side note, the IMS reviewed Rudy's test results before we saw him and when he came into the examining room he said, whoa, that is not what I expected of a chow/husky mix, he is more husky/chow mix! He seemed to think it a strange combination, and wanted to know where I got him from. Whenever I walk Rudy people are always asking me 'what kind of dog is that?' and they can't believe it when I say he is a mutt. Lots of people think he is part collie or st bernard, I guess because of his coloring and markings.

I WANTED a mutt when I got him after my 2nd pure bred Cocker Spaniels died young.

[MyRudy]

Rudy is back at home now and none worse for the wear, it appears. We will get blood test results tomorrow but ACTH will take 3 days, he said.

Good news, nothing showed up on Xrays other than he is old.....but I knew that!

Best news is that prior vet's scale must have been out of whack as Rudy weighs 42 lbs on IMS's scale - and he said he weighed Rudy five times and checked his scale with a 40 lb bag of dog food just to be sure! He is thorough and I like that alot :)

He said if nothing is noticeably out of whack on the test results he recommends starting Rudy at 30 mg Vetoryl once daily with an ACTH in 10-14 days and adjust from that point. MUSIC TO MY EARS!!!!

I found some Rimadyl prior vet had given me in Feb when I was moving to a 2 story house because Rudy had already shown he did not do stairs.....so I asked if it was okay to give that to Rudy to help with the hind leg weakness I saw in him during our prior Vetoryl experience. He told me not to give at same time (because if there was a problem we wouldn't know which drug was causing it) and then he looked at the dosage prior vet had prescribed and said to only give half of that. He said he believes starting out small and increasing rather than the other way around, MORE MUSIC TO MY EARS!!!!

Rudy is home and resting now, he ate and drank and peed first, of course.

I am so relieved that his weight is near normal range. I guess it figures that prior vet's scale was off, just like his dosage recommendations!

Donna

[jrepac]

all sounds like good news; just to be clear, Trilo's method of action is not intended to kill off any part of the adrenal glands. Nonetheless, some cases of "necrotic" (dead) adrenals have occurred, but they are supposedly rare. Re: dosage, many people on this board have had good success w/just half the recommended dosage...every case responds differently. Comparatively, lyso's method of action is by killing off/suppressing the adrenal glands directly...both drugs have risks associated with them, even if Trilo is marketed as "safer".

good luck

Jeff

[MyRudy]

Yes, IMS said pretty much the same thing about Trilo claiming to be safer and he does not agree because he actually prefers lysodren.

I think I would choose Lysodren if I had it do over, but at the time I thought I was picking the less risky treatment method. Since Rudy already started on Trilo I guess it only makes sense to continue with it and I sure don't want to wait for the 30 days washout period with the number of accidents he has in the house at night!

The taking a pill every day for life vs being on maintenance pills 2 or 3 times per week has merit that I did not even consider at the time I made the choice: I was totally blinded by the destruction of adrenal glands idea.

Anyway, with prior Vet's tendency to over-prescribe dosages, I am glad I did not go with Lyso with him! I'd probably have an Addisonian dog now if I did.

[addy]

Hi Donna,

So glad to hear you may be getting to the bottom of the problem and Rudy has a competent IMS. That is always such a relief. Thank goodness his scale gave us good news!!!!!

Just a tad concerned about giving him the Rimadyl but if IMS said it was okay------. Zoe had such a bad experience with that drug I get the heebe jeebes when I hear the name.:eek:

I think we all freak out about lysodren and we tend to think Trilostane is so much safer but UC Davis has been having diffferent experiences with the drug than the Europeans have. We need to respect that drug as well, it is a serious drug. Gosh, so many problems when we end up in the hands of an inexperienced vet or a gung ho one for that matter, too.:mad:

My first vet wanted to put Zoe on Trilostane and was figuring it out based on a UC:CR test. Se said she had never treated a dog with Triolstane. Glad Zoe wasn't the guinea pig!

Thinking of you and hoping things get better.

Addy and Zoe

[littleone1]

Hi Donna,

I know there are differences of opinion about using Trilostane. Corky has been taking it for 9 months now, and hasn't had any problems with it. His IMS started him on the lower dosage, and adjusted the dosage as was needed. His IMS felt that this would be easier on him due to his medical conditions.

I know both meds can cause problems, but as long as you have a vet/IMS with experience in treating Cushings with these meds, the treatment should work.

Terri

[MyRudy]

With regard to the Rimadyl, I am only going to give it to Rudy if he has the same hind leg weakness where he could barely stand up again. With the lower dosage, maybe that won't happen, I don't know. Anyway, last time it did not happen for about a week, so he will be on Vetoryl only for at least a week before I introduce Rimadyl.

Rudy took it once before and he was puking that yellowish stuff up (bile?) but I didn't know if he was just upset because I was also packing to move at the time and he gets upset anytime he sees the suitcases come out.

[apollo6]

the problems you are describing are side effects of Trilostane:anorexia-lose of weight, loss of appetite, throwing up. In my case I read information from UCDAVIS and the manufacturer-DeCha, about proper dosage. Apollo has hind leg weakness also, but I don't know if the Rimadyl could maybe not be good for cushing's dogs. Apollo was on Rimadyl, etc, for back pain and allergies which could have contributed to the cushing. I sent you a private email on looking for a specialist in your area.

[QUOTE=MyRudy;37602]With regard to the Rimadyl, I am only going to give it to Rudy if he has the same hind leg weakness where he could barely stand up again. With the lower dosage, maybe that won't happen, I don't know. Anyway, last time it did not happen for about a week, so he will be on Vetoryl only for at least a week before I introduce Rimadyl.
Maybe someone else can give input. But I think he is on the wrong dosage of Vetoryl too high can also be very dangerous and I don't know if adding Rimadyl to the mix is a good thing.

[MyRudy]

I have been reading other threads re: arthritis and intend to ask the Vet about that once a month shot (Adequan?) some other dogs got that seemed to help. From what I have read, Rimadyl does not seem like a good idea for a dog w/a sensitive stomach like Rudy appears to be.

I am very happy to report that in the past 2 days Rudy appears to be eating normally again. I am still supplementing his food and feeding him twice a day but now instead of just eating the 'good stuff' off the top, he is eating his kibble as well. And when he leaves some kibble, he will go back and eat it later :D

The past 2 nights I have given him melatonin (3mg) in his evening meal and he has slept much better, therefore I have slept much better as well! I was getting up about 4x a night to let him out. He had one accident on the carpet last night but none the night before. Prior to this, he was having at least 3 accidents a night :(

Still waiting on the Vet to call w/test results.

[Squirt's Mom]

An alternative to Rimadyl is Previcox. It is still and INSAID but is not supposed to have the same detrimental affects on our babies. Squirt's ortho surgeon used to give Rimadyl after surgeries but has switched to Previcox because it has had less adverse effects on his patients.

Tho, Adequan is the pharmaceutical way I would prefer to go first. ;) If it works, so much the better as it is not an INSAID. Those are always available if the shots don't provide enough relief.

There are also several herbs/supplements that can help like Boswellia, Bromian, Papin, Omega 3's, glucosamine, condroitin, to name a few. Avoid feeding white potatoes, tomatoes or peppers as these foods, the nightshade family, can aggravate arthritis.

Cortisol is a natural anti-inflammatory and once it is lowered to a more normal level, it isn't uncommon for arthritis to become evident or worsen.

Hugs,
Leslie and the girls - always

[addy]

Hi Donna,

Glad you got some sleep. Hoping your tests results are good.:)

I give Zoe her 3mgs of melatonin at 9:00pm and within 15 minutes, she is zonked out!!!!

Hope you and Rudy have a wonderful day!!!!

Addy

[Roxee's Dad]

Hi Donna,

I have been reading other threads re: arthritis and intend to ask the Vet about that once a month shot (Adequan?) some other dogs got that seemed to help. From what I have read, Rimadyl does not seem like a good idea for a dog w/a sensitive stomach like Rudy appears to be.

I am one of quite a few that uses Adequan for my 15 year old, 30 lb. Wheaton mix. He has arthritis in his right shoulder and elbow. It has really helped him a lot :D I've read where it is successful about 40% of the time and from what I've been told that is a pretty good success rate.

Started with one shot a week for a month then went on to once a month injections. If Mickee is having a bad day, we supplement with Metacam (anti-inflammatory) Since we have moved into a house with no steps, he has been doing great and doesn't need the shots as often. We are going to 1 every 6 weeks.

Some vets have different protocols. Mine was once a week for a month some seem to prefer twice a week for a month then on to once a month injections.

Certainly is worth discussing with your vet. :)

[caroleh]

I can understand what you are going through. I had a vet that I thought was the best and it turned out to be a horrendous situation. If you keep checking on this website you will learn so much and have so much support as you have already seen. These are wonderful people helping in any way they can. I am so happy to have found them.

[MyRudy]

Just got Rudy's ACTH numbers on the Stim test he had Aug 10th and they are much better - IMS Vet said obviously there had been some effect by the Trilo to have these numbers 10 days after no Trilo had been given - he said we have no idea how low he actually got, but it must have been pretty low. He recommends trying the 30 mg once a day and I will start him on that tomorrow.

Pre 4.63
Post 22.8

What do you all think?

[apollo6]

What is Rudy's weight that is important as to the dosage, he is getting.30mg is for dog between ≥ 10 to < 22lbs
With Apollo I started at 10mg for a dog 10lbs. So if first was to high, needs to be less. Not sure what Rudy started out with.
But glad he is doing better and hope you have a good vet.

[Harley PoMMom]

Hi Donna,

How are his clinical symptoms?

[MyRudy]

Rudy weighed 42 lbs on Aug 10th, so the 30 mg dose is low for his size but considering how bad he got on the 60 mg dose, both IMS and I believe it best to start low and then add to that if his next stim test shows the need.

His clinical signs are accidents in the house every night even though I get up to let him out every 2-3 hrs. He also pants and drinks water excessively. I am hoping these signs abate shortly.

I went ahead and started him yesterday evening, fed him at 5 pm and gave him dosage at 6 pm rolled up in ham. It is very important to me to get this started over the weekend where I can watch him closely, because during the week I am gone 10 hrs per day. I am going to transition to morning dosing over the weekend.

I got copies of his tests when I went to the vet to get the Vetoryl and his superchem blood test results came back normal except GGT and Platelet Counts were both high.

[Harley PoMMom]

I believe the 30mg will be adequate to control his cortisol. When is his next ACTH stim test scheduled? If it is in 10-14 days and the results are still high I don't think I would increase his dosage because Vetoryl/Trilostane is known to decrease a pups cortisol over a period of time. I would give Rudy at least a good month on this 30mg dosage and see where his cortisol levels are before adjusting his dosage. JMO.

Alot of us give our pups Pepcid AC 20-30 minutes before their Cushing's meds. It really helps with the gastric upset that the meds can have on the tummy. Ask your vet/IMS about using this first.

Best of luck to you and Rudy.

Love and hugs,
Lori

[MyRudy]

I have not scheduled his ACTH yet, kinda playing it by ear at this point since I don't know how he is going to react to the lowered dosage yet. He seemed fine on the 60 mg for the first week, too.

I did ask the receptionist how hard it would be to get an appointment on short notice and she told me not to worry, they would get him in on short notice if necessary. I also asked her which emergency vet they preferred in case something happened over the weekend, so I have done my homework. AND I do have prednisone just in case.:D

[zoesmom]

Sounds like it was time to get back on the trilostane. I completely agree with Lori on the dosing. Give it at least thirty days before making any adjustments (even if the numbers aren't quite down to the ideal level at 10-14 days.) All dogs needs are different with these meds. My 80 lb. Zoe could only tolerate 45 mg. when she first began trilostane (after several bad starts at higher dosages). For some dogs, I think they need to gradually build up to an effective dose. We took about 2 - 3 months after that, to increase her dosage step by step until her cortisol was under good control. Doing it that way, we avoided any more crises. She eventually went on to take the same dose (180 mg) that originally made her so sick. In fact, she took that dose twice a day later on. But don't worry about what is 'normal'. That might not be 'normal' for Rudy!! I've seen some BIG dogs who required much less than norm for their weight and some smaller guys who needed more than you'd expect. Just depends. But given Rudy's problems on 60 mg., I'd say go slow with any changes. Of course, if any signs of low cortisol redevelop on 30 mg, you would want to stop it and retest sooner.

The only other thing is the timing of the pills. Giving the trilostane one hour after the meal may be ok (depending on how fast his stomach empties) but it might be a little safer to give it immediately after he eats to make sure there's adequate food in his stomach (better than before meals, simply because sometimes they fool us and then refuse to eat after they've taken their pill.) Have our fingers and paws crossed that all goes smoothly this time around!! Sue

[MyRudy]

I will give it right after he eats once I transition to mornings - don't have time on work mornings to do it any other way! Thanks for the great advice :)

[Harley PoMMom]

7/18/10 Bile Acids Test:

Bile Acids 21.0 (0.0-6.9 umol/L)
Bile Acids Post Prandial 18.0 (0.0-14.9 umol/L)





I got copies of his tests when I went to the vet to get the Vetoryl and his superchem blood test results came back normal except GGT and Platelet Counts were both high.Could you post these values for us please.

Did your IMS say anything about the elevated bile acid test? Since Rudy's GGT is still high, this has me just a little concerned.


Increased serum GGT activity is associated with impaired bile flow in the dog
http://veterinarycalendar.dvm360.com/avhc/article/articleDetail.jsp?id=610974&sk=&date=&pageID=2

Hopefully Debbie and/or the others will be along to offer their opinions on this as well.

Love and hugs,
Lori

[MyRudy]

No, the IMS said nothing about the bile acids test that was done by prior vet.

Aug 10th HIGH test results:

GGT 16 (1-12 IUL)
Platelet Count 419 (170-400 10.3/uL)

Neither one is that high off normal and IMS was not worried, so I'm not either. Was good to see his cholesterol is back to normal, it was high on prior test.

[O'Riley]

Lori, I was wondering why you are concerned about Rudy's GGT and Platelet Count?

One of my dogs (not Riley) recently had bloodwork and her GGT is 19(ref range 1-12), and platelet count 480 (ref range 170-400). Monocytes 870 (ref range 0-840). Just like with Rudy, the vet in our case wasn't worried either, and in fact the vet's handwritten notation next to GGT says "mild".

I don't want to hijack Rudy's thread, but I don't want to start a thread here about a non-Cushing's dog. If you could expand on why Rudy's values are worrisome it might also help me figure out what's wrong with my dog (she makes a low, painful sounding moan, and I'm sure she has pain somewhere, just can't figure out where). She's a Basenji who ordinarily makes NO noise, so this sound is unusual for her.

MyRudy, is your dog experiencing any pain?

Thanks,
~Rosey

[MyRudy]

I think Rudy's pain is related to arthritis, although sometimes I can just walk close to where he is laying and he'll cry as if I stepped on him.....and every so often when I take his harness off over his ears he cries. But he has pretty much ALWAYS done that off and on for years and years and years, so I don't put much stock in it.

Rudy is often times very afraid of things, and sometimes it can be a sudden fear that appears out of nowhere. I attribute this to his experience as a puppy - the lady who I got him from said she had a fire at her house and at that time she was staying with her mother. Unfortunately, I didn't think to ask if he was in the house at the time, but when I first got him he would run and hide under the bed when I lit a candle or the fireplace, so my guess is he saw the house fire. He grew out of that over time.

[O'Riley]

I'm also on the K9Diabetes board where CarolW pointed out a forum focused on "reactive" dogs. My Riley is always ready to take on the world, just name the time and place. He will plant his little body between me and anything he sees as a danger to me. He got the worst end of it once while protecting me during a pit bull attack. Come to think of it, shortly after that was when his Cushing's type symptoms began. Could there be one major trigger in a dog's life that sends them on the path towards Cushing's? I've always had a vague notion that his fight or flight mechanism is stuck in overdrive, and now that I've learned more here about the adrenals and the cortisol hormone, I'd be curious how many dogs with Cushing's are also dogs that stress out a lot, or maybe even had one major stressful event in their lives (like your Rudy's house fire?). Glad to hear your dog is better now about fire.

The source of pain is soooo tough to narrow down. I have a Rat Terrier rescue who does the same as your dog does with his harness, but my dog does it with his side. Sometimes he yelps when I pet him on his side when he's half asleep. Makes me wonder if he might have been kicked earlier in his life, and the yelp comes from a memory of fear rather than from pain. I've learned to only pet him when he's fully awake so he knows there's no threat.

~Rosey

[MyRudy]

Very interesting theory Rosey! Rudy is definitely a stressed out dog during storms, loud noises, fireworks, etc.

Day 2: I am happy that Rudy is still eating well, appears to be alert and so far no hind leg weakness. BM's a little soft, but not worried about that since he has recently started eating canned food in addition to his kibble. I am already noticing a slight decrease in water consumption. I fed him and gave him his Vetoryl at the same time today, about 3.5 hrs earlier than yesterday's meal, since I need to transition to morning dosage.

I am still giving him melatonin and flax seed oil w/his evening meal and the melatonin continues to works wonders :)

The only difference I have noted is that he does not want to walk far, but I am okay with that for now since he isn't hobbling and acting like every step is gonna be his last.

[apollo6]

Apollo doesn't want to walk much either. He is 11.5 years old and could have some arthritis in his hip, besides the muscle weakness from cushing.
Apollo has his Trilostane in the morning with his food (I wrap turkey around it and he eats it with his meal)
It sounds like Rudy is as sensitive as my Apollo, I am concerned that too many of these vets are starting our fur balls on such high dosages and the after math on them is bad.
Like I said I fought my Vet on starting Apollo low after reading and consulting Dr Allen-Decha/Vetoryl 1-866-933-2472 (toll free/1-913-748-4836
Please note what it says below about twice daily if you go that route:
it means an increase of 1/3 to 1/2 of the original eg. 30mg. +10=40
which means 20mg in morning and 20mg (12 hours later) not 30 and 30mg.

15. Individual dose adjustments and close monitoring are essential. Re-examine and conduct an ACTH stimulation test 10-14 days after every dose alteration. Care must be taken during dose increases to monitor the dog's clinical signs and serum electrolyte concentrations. Once daily administration is recommended. However, if clinical signs are not controlled for the full day, twice daily dosing may be needed. To switch from once daily to twice daily dosing, increase the total daily dose by 1/3 to 1/2 and divide the total amount into two doses given 12 hours apart.
Hope this helps. Remember it took a long time to get hear and it will take awhile to improve, don't rush it.
Hugs from Sonja and Apollo

[addy]

Hi,

Zoe is reactive too, afraid of strangers, thunderstorms, wants to protect me, too. Maybe they do get stuck in overdrive, intersting theory, for sure.

Just wondering what benefits you see from melatonin. Zoe has just been on it for about a month but I had to inch up the dose slowly for her and we now are at 3 mgs at night and started 1mg durring the day, will slowly get to 3mgs durring the day. It zonks her out at night, and made her alittle spacey yesterday. She has only been on the lignans for 2 weeks.

Just wanted to compare notes!!!:) her platlet count was alittle high too, I think it was from her diahrrea flare up so I did not worry about it. IMS did not either.

Thanks,
Addy

[MyRudy]

I just meant that he sleeps well after the melatonin - he zonks out for several hours whereas before he seemed very restless at night. I give him 3 mg. Somewhere on one of these threads I was reading there was a discussion about how dogs metabolize melatonin differently than humans do. Sorry I can't remember which thread, I've read sooooo many!

[Squirt's Mom]

One note I wanted to make...since you have started adding canned food to Rudy's meals his water consumption will come down as canned feeds have a great deal more moisture than the kibble. So if you are measuring water intake, don't forget to take this into account. A pup on kibble will drink much more water than a pup on canned or home prepared diets.

Hugs,
Leslie and the girls - always

[MyRudy]

Thanks Leslie, that is a good point!

Day 3 on 30 mg Vetoryl and nothing to report except today I noticed Rudy licking the carpet and I've never seen him do that before....I remember several other members here commenting on their dogs doing that, too. He has always had a spot on his front foreleg that he licks at, but the carpet thing is new.

[frijole]

Weird. I knew dogs on lysodren did it but don't remember a trilo dog doing it. But then my memory has lapses. :o;):D Sounds like Rudy is doing well so far. Great news. You deserve it! Hugs, Kim

[addy]

Zoe is just on melatonin and lignans and she licks everything, the floor, my husband, me if I let her. IMS said it might be a way of her comforting herself.

Rudy never licked before? My thought might be tummy may not feel good. I know Lysodren can cause tummy upset, not sure about the trilo. You give it with food, right?

Glad to hear things are good so far other than the licking:)

I love your avatar and have been meaning to telll you that:)

Addy

[apollo6]

Don't know if this helps,
Apollo starting licking his right paw, very red, lost most of his fur there, spots, this started a few months ago.

[O'Riley]

This is what I've read about licking -- licking carpet and furniture means stomach upset; licking legs/paws means yeast infection (overgrowth?), or allergy to an ingredient in their food or some other allergen; licking the air (Riley does this)...Dr. Mike Richards wrote that dogs with liver disease appear to be licking the air to get rid of the bad taste in their mouth when nasty tasting toxins from liver disease work their way up and out through the mouth.

With Cushing's dogs, could the licking be due to allergies that have been held at bay because of the excess cortisol in their systems, and once they begin treatment to lower the cortisol levels, the allergy symptoms appear? I understand that prednisone is commonly prescribed for allergies. This could be along the same lines as arthritis symptoms reappearing after starting treatment for Cushings.

~Rosey

[MyRudy]

Rudy did not repeat the carpet licking so it may have been an insolated incident....weird thing is he did it upstairs in my bedroom and I don't ever take food up there, so I can't imagine what may have gotten on the carpet. He does lick my legs when I put lotion on, so perhaps a spot of lotion got on the carpet? That's really all I can think of offhand.

Day 4 and he seemed to be doing fine this morning. Still drinking lots of water but only one very tiny accident in the house overnight, so that is an improvement, yay! BM's are back to normal. He still does not want to walk far. Am giving him glucosamine and condrointin jerky chews to help with the arthritis.

[apollo6]

Good to hear Rudy is doing better. Hang in there.
Hugs from Sonja and Apollo

[MyRudy]

Day 5....Rudy is still eating and going up the stairs, so that is a plus over our last experience. And no accidents last night, yay!!!!

He is still drinking too much water and peeing and panting too much. I know that by this point he had stopped that when he was on the 60 mg so I guess it is just going to take a bit longer on the 30 mg.

This morning he did show signs of lethargy, I usually let him out right before I leave for work and he just laid on the floor looking at me....so I gave him a jerky chew and he kinda looked at it for a minute or two, then he got up to get it and then he went outside.

I sure hope I do not go home to a lethargic dog!

[MyRudy]

Day 6 and not much to report. Rudy is still doing well on the 30 mg of Vetoryl but his clinical signs are not abating at all.

On a positive note, he must have gained some weight back because when I pet him he no longer feels like skin and bones!!!

Another positive sign is last night he went for a normal walk after not wanting to go far at all the past few days since he got back on medication.

I will give this the full 14 days and see what the ACTH stim test shows for his cortisol levels. I am thinking we may have to bump up the dosage, but not back to 60 mg hopefully! Since they only come in 10 mg w/o being compounded, I would guess we'd bump it up to 40 mg total and see if that does the trick.

[frijole]

Keep the good news coming! Go Rudy go! Kim

[lulusmom]

I like your strategy. Good job!!!

[apollo6]

keep up the good work. Be patient, notice if there are changes, and let us know how each day goes.

[MyRudy]

Day 7 and good news, I think! No accidents last night and when I got home from work today, he had not finished his bowl of water like he usually does and there were no wet spots on the kitchen floor.

Took him for a walk and I noticed some mis-steps due to some hind leg weakness, but he is still very alert and bright-eyed, which is good.

Also, he ate his dinner and did not immediately go slurping down half a bowl of water.

I am hoping his cortisol levels are coming down to normal.

He really does look like a different dog, I can see it in the way he looks at me. Like I said, bright-eyed, not dull.

I will be so happy to see him back to normal and no longer suffering from this awful disease.

[frijole]

Wonderful news. Nothing like seeing the glimmer back in their eyes. So happy for you. Kim

[Casey's Mom]

Great news Kim and Rudy :):):)

Love and hugs,

[addy]

Hi,

Glad to hear your good news and I hope the sparkle in Rudy's eyes continue!!!!!!

Addy and Zoe

[MyRudy]

I may have spoken too soon, he had 3 accidents in the house last night, one right in front of me!!! I was apalled he would hike his leg in front of me.

Then, this morning, he slipped coming down the stairs and slid the whole way down. He landed at the bottom with a THUD and I could tell it scared him more than anything. I hugged and kissed on him for awhile afterwards to make sure he was okay. Needless to say, he did not go back up the stairs after he went outside even though he usually does come up there while I am getting ready for work.

[addy]

well now, ups and downs, a good day, a bad day, you are still early into this treatment.

Trying to keep your spirits up!!!!! Our pups love to contradict us:)

Addy

[MyRudy]

Ain't that the truth!!!!

[MyRudy]

Rudy fell again yesterday coming down the stairs....this time he did not get up quite as quickly. I was so scared! He appears to be ok though. I was more than surprised when he ventured back upstairs last night (I sleep up there). This a.m. I could not get him to come back down the stairs so I finally carried all of his 45 lbs down. He is still eating and pooping normally but the hind leg weakness just seems to be getting worse.

I am going to ask my vet about adequan shots, don't care how much they cost!!! He isn't going far on walks either.

[frijole]

I am just now seeing this post. That is scary. I used adequan and loved it. It takes a while and at first you get them more frequently. I paid $15 a shot - the vet did them. If you are happy with the results you can purchase the adequan and do your own injections.

You might want to put a baby gate up to keep Rudy up or down in the meantime. If you were there to see him go up and down (alongside him) that might help. He is lucky he hasn't torn an acl or broke a bone. Poor guy! Aging sucks.. and that I can attest to personally. :D

Hugs, Kim

[StarDeb55]

Please take Kim's advice about putting up a baby gate. Our pups seem to be very prone to cruciate ligament ruptures, & trust me, you do not want to go through it. My 1st boy, Barkley, blew an ACL which led to his Cushing's diagnosis due to abnormal pre-op labwork. It took 2 surgeries to finally get his knee fixed. My "healthy" pup, Chewbacca, blew his right cruciate ligament jumping off the bed about 3 weeks ago, had his surgery about 12 days ago. This surgery involved realigning his femur & tibia at the knee joint, then pinning & plating everything together across the knee, He is on restricted activity until the end of October.

Debbie

[MyRudy]

Oh gosh, that sounds horrible! Poor Rudy can't even manage going from street to curb w/o his hind legs failing him at times. I feel so bad for him, and I, too, know what it feels like, Kim! Sometimes my knees creak when I go up the stairs.

I will take precautions to make sure it does not happen again.

[Franklin'sMum]

Hi,
Haven't read you whole thread yet, but have you tried using a towel under his belly while going up or down the stairs? With you there beside him, and holding the towel which (I think) would take a fair bit of the weight of Rudy's back end, he might gain more confidence and not become scared of the stairs after having fallen a few times.
And absolutely look into a baby gate, great idea :)
Jane, Franklin and Bailey xxx

[MyRudy]

Okay, most recent problem taken care of. I put a baby gate up at the top of the stairs once we retire for the night so that he can't attempt to go down w/o me.

I also tried putting his leash on him and walking right next to him as he goes down and he seems okay with that, at least for now! He almost slipped twice but I had a good hold on him from above and he was able to right himself and continue down (he wears a harness so I am not choking him!).

He is back to hardly eating and looking half-dead again, totally lethargic. UGH! Does it ever end/get better?

We are going in for Stim test on Thursday to see where his levels are.

This is really getting old - I can only imagine how poor Rudy feels riding this roller coaster.:mad:

[zoesmom]

So sounds like the ACTH is about 14 days in?? If he's still having accidents, he may end up needing a boost in his dose. My Zoe would lick the carpet when she left little pee dribbles. Trying to get rid of the evidence maybe? Since the weak legs haven't improved, that may be another indication that a dose increase is in Rudy's future, although symptoms like that can take longer to show improvement. Then again, the hardly eating might be a sign his cortisol is down. All dogs respond differently and all symptoms don't disappear at the same time. If his cortisol numbers have come down but aren't quite 'perfect' yet, it is usually wise to continue at the current dose until after the second ACTH - at around 30 days. I will be anxious to see what his ACTH test shows. Given his trouble on 60 mg, 40 or 45 mg would be the logical choice. Where are you getting the trilostane? And is there a reason you don't want to try compounded version? 'Cause that way, you can get the exact dose you need in one capsule. Just wondering?

I understand the getting old part. With these cush pups, there can be good days and bad days. Seems like it's always something with them. Weak legs, skin issues, infections of various sorts. Poor babies. But hopefully, the good outweigh the bad, overall. I can tell you that the four years Zoe spent on tx were challenging but well worth the effort, given the improvement in her quality of life. I'm not gonna lie, though . . . .there can be setbacks. But you and Rudy are early in the tx process so first, the ACTH - and then you should have a better idea of where things are going with his dose. Chin up. I would not have done anything differently with my Zo as it gave us four more years with her - despite the ups and downs and she enjoyed most of those days!!!! Hugs to Rudy. Sue

PS - We had to resort to the baby gates, too. And sometimes using the leash to walk her down the stairs. Towards the end, stairs were absolutely forbidden, except for the two to go out to the front. We changed our routine accordingly. Still, whenever she'd beat me into the house, she'd always make a beeline for the stairway, just to see if the gate was up. If I slipped up and forgot it, she'd start down and I'd cringe (and then kick myself for the memory lapse!) Scary thing to watch when you are afraid they'll fall.

[MyRudy]

LOL @ Zoe making a beeline to see if the gate was up!

Rudy acts like he just doesn't care anymore.....he just lays there in the kitchen and gets up to go out and then wants to come right back inside and lay down again, as if he does not have enough energy for anything else. I just hate to see him like that! He did not even try to come upstairs last night. He is barely eating, no kibble, just the 'extra' stuff I put in his bowl. He will eat treats at least, dog bones and chews and cheese.

I hope he is just adjusting to lower cortisol levels but honestly, if this is how he is going to be I can't see that he has much quality of life. I lay down on the floor next to him and pet him and talk to him, and he will wag his tail, but he just seems so uninterested in everything. Ugh, I really hate this!

Tomorrow is the 14 day stim test, so once we get those results back, we should know better.

[addy]

Hi,

I am thinking of you and Rudy, hoping that all is well and sorry to hear he is under the weather. Let us know on the stim test tomorrow.

You are doing a great job and I don't know if I could be as calm as you have been.:) I think if Zoe ends up getting loaded with lysodren, I will be going crazy trying to figure out is it, low cortisol, the drug, a huge problem, WHAT!??!! :eek:

Hang in there, tomorrow will come soon!!

Addy

[apollo6]

Hang in there.
A side effect of Trilostane is lethargic, lose if appetite. Please mention all to your vet. It may be too high a dosage?:confused:
My Apollo is not the same anymore either, he will be 12 in October, but as long as he can wag, lick me, walk a little, enjoys a treat , I will fight for him. :mad:Be patient, give it sometime. I have been told it can take a few months. Apollo started June 23rd and I have noticed some improvements.

[MyRudy]

Don't see how it could be too high a dose, but I guess we will know soon. It is the exact same as the last time he was on Trilo, he did fine for the first week, then really started to go downhill acting lethargic and not eating and walking 'drunk'.

I wonder if he just can't tolerate Trilo at all?

He is back to drinking water normally and not panting, so the peeing is the only thing left that is not normal and it is ALMOST back to normal. He never did have excessive appetite or hair or skin problems or distended belly.

[MyRudy]

He did go on a shortened version of his walk tonight, and I am very pleased with that! Still barely ate his dinner, but at least he wanted to get out and walk.

[addy]

that is good news! wish you look with stim test!!!

You are doing really well. You should be proud of yourself:)

Hugs to you and Rudy,

Addy

[frijole]

Wanting to walk is great news. Getting him out is a good way to fight the lethargy and doggy depression. Plus it helps us out as well. :D I am reading and cheering you and Rudy on. Hang in there - you are doing great. Deep breaths. (from experience) xoxo, Kim

[StarDeb55]

I am not sure that anyone has mentioned this, but it bears repeating, if it has. Cortisol is a "feel good" hormone, so when a dog first starts treatment with either drug, they can go through a cortisol withdrawal phase where they can feel pretty yucky. This may be what Rudy is going through right now. If it is, once he gets used to the lower levels of cortisol in his system, he should start perking up.

Debbie

[MyRudy]

I am just astounded - this morning Rudy shook the whole way to the vet's office in the car, but once we got there, he charged right up to the front door, could not wait to go inside and wagged his tail at everyone in there! He has never done this before at a vet's office, he has always HATED both vets he has had up to this point and would sit in the waiting room shaking and cowering under my legs.

[Marlene]

That IS a puzzling reaction! Maybe he just wanted to impress the vet!:) I have been following your posts. Lacey is going to start on Trilostane and I am certainly nervous about it. I hope Rudy continues to come out of his lethargy and shows that enthusiasm more and more as days go by.
Marlene and Lacey

[MyRudy]

Good luck Marlene, I hope Lacey does well on Trilo. I have read your posts as well ;)

When I talk to the vet again on Tuesday to get the test results, I am going to ask him what they do to make Rudy like them so much, it is the most amazing thing I have ever seen. Rudy is typically fearful of everything and I was just in shock this morning the way he was acting at the vet's office....they must give him the doggy equivalent of catnip or something!

He is home now and acting just fine, still not eating much but at least he is eating some food. He looks alert again, yay!

Last night I put the baby gate at my bedroom door so he could not get out and would have to wake me up if he needed to potty....which he did at 5:30 am! I like this arrangement so much better, no surprises downstairs in the a.m.

I think he is going to be fine, can't wait to see results of the stim test.

[frijole]

Wonderful news!!! I always figured that if my dogs are all shaky when going to the vet or groomers they are sending me a message. ;) And if they are happy or even normal acting... thats a great message.

[addy]

Oh, this is good news!!!!! Sigh of relief!

Go figure, they never cease to keep us guessing! One minute they have to muzzle Zoe at the vet's, the next minute, she is as cool as a cucumber:cool:

Never a dull moment with our pups. ;)

Maybe they had new doggie treats out;for whatever reason he was so happy, all I can say is Go Rudy, Go Rudy!!!!!!

Addy

[apollo6]

Hang in there.
Progress not perfection. Need to remind myself. Good that you are doing little walks. I am doing the same with Apollo. A little is better then nothing at all.

[Marlene]

Positive vibes from Rudy. Yayyyyy!!!!

[MyRudy]

Vet told me yesterday it was okay to give Rudy 1/4 tab of Rimadyl to see if that will help with the hind leg weakness....prior vet prescribed 1/2 tab but current Vet said it needed to be lowered to 1/4 tab.

Gave to Rudy last night and I can already see such a difference in his hind legs! I just hope this continues, I almost have my dog back!!!

I know many on here are not fans of Rimadyl and I was a bit scared to try it again after Rudy puked the first time I gave it to him (in Feb). But so far, so good, I am keeping my fingers crossed:D

[MyRudy]

Update: Rudy had a normal walk last night, so the Rimadyl really is helping him, yay! He is also starting to eat a little tiny bit more and I am very encouraged!!!!!

We have our telethon at the SPCA today so I will be volunteering at that this afternoon.

[MyRudy]

Results of Rudy's ACTH:

Resting 1.22 (low normal)
One Hour 3.97 (mid normal)

Vet says he is happy with the stim test results and says we should keep Rudy on the 30 mg dose until further notice. YAY!!!

[labblab]

I think those ACTH results are GREAT (and I'm so glad that Rudy is walking and eating better, too!). What super news, all the way around! :) :D

Big congratulatory hugs to you both :p :p
Marianne

[MyRudy]

Thanks Marianne, I just cannot express how HAPPY and RELIEVED I am that we finally seem to have this horrific disease under control.

I know that some posters here have gone much longer and I tip my hat to them because this experience has pushed me to the brink several times.....

[addy]

We are all thrilled with the great news!!! Way to go Rudy!!

You have done such a good job with it all. Be proud, Mom!!!:D

Addy

[apollo6]

Way to go. It is always nice to hear about the good stuff.
Hugs Sonja and Apollo.

[littleone1]

I'm glad that Rudy's test results are so good, and that you are now seeing a normal Rudy again.:) It makes a world of difference to us.

Terri

[MyRudy]

Just popped in to update on Rudy....he is almost normal again, yay! It is so nice and I am going to enjoy it while it lasts. He has days when he eats pretty well and days when he barely eats at all, but I am getting kind of used to it now.

He is doing so well on the arthritis medication (Rimadyl) and is no longer having problems negotiating the stairs.

Back in March I had bought Rudy new food and water bowls that are high off the ground so that he wouldn't have to bend down low to eat and drink and I am so glad I did! His water bowl outside is on the patio and he seems to have trouble getting low enough to drink out of it, but he has no problems with the inside dishes.

His hair/fur looks great and I think his double coat is coming in now for the winter because it looks so thick!

I need to catch up on some other threads to see how the other cush dogs are getting along:D

[addy]

It is always so great to hear about a pup doing well!!! I am so glad:) Go Rudy Go!!!:D:D:D

I know what you mean about enjoying it while it lasts. I have a hard time with that sometimes:(

Just love it and enjoy as much as you can. Your Rudy is so beautiful and his Mom is pretty special too

Hugs and BIG SMILES

Addy

[Franklin'sMum]

YAY!!! So glad to hear Rudy is doing better, fantastic news! :D You're doing so good (both of you :))

Jane, Franklin and Bailey xxx

[apollo6]

:D
Sorry haven't kept up with you. So glad to hear Rudy is doing better.
Keep up the good work.
Hugs Sonja and Apollo

[MyRudy]

Update on Rudy....he now appears to be fully deaf. I have no idea if that is related to the pituitary tumor or if it is just old age, but nonetheless I see it as one more sign that he won't be with me much longer and I am trying to make our remaining time together THE BEST EVER.

He is eating even less now, but otherwise appears to be fine. Still on 30 mg of Vetoryl daily and 25 mg of Rimadyl 2x per day. He still enjoys his walks, so as long as that continues I remain hopeful that his quality of life is not that impaired.

Donna

[littleone1]

Hi Donna,

Corky's hearing is just about totally gone. He can't hear me anymore. I've been using motions, along with a few different whistles for different things. Some of the whistles he still hears.

Don't give up hope, even though Rudy is eating less. He seems to be doing good other than that.

Terri

[MyRudy]

Thanks Terri, it is just one more little thing that I worry about!

I would rather him lose his hearing than his eyesight, that's for sure, so I should be grateful I guess.

Just so hard because I know that his life is almost over and I am not prepared to let him go yet. I guess we never really are though. I am so saddened to read about the others who have passed over the bridge.

I will try to keep the faith.

Donna

[apollo6]

Dear Donna,
I am so sorry to here about Rudy. If he is losing more weight it could be the trilostane. Have you asked the vet-this is a side effect of it. I am going to ask if I can take Apollo off the Trilostane for awhile to see if it might help with his legs. I am on a very low dosage, 12.5 mg for 10-11lbs. I am sorry about Rudy's hearing lose.
It is hard. Apollo turned 12 today, and I wonder how much longer I have him.
Look at the good things that have come out of this for now. Cushing's can take a toll on us also, with the fears and anguish.
My prayers are with you and Rudy.
Hugs Sonja and Apollo.

[addy]

Hi Donna,

Sorry to hear of Rudy's hearing loss. They are resiliant though, sometimes we mind things more than they do.

If we could all learn to live in the moment like our pups do----- it is so hard sometimes. I struggle with it.

I am hoping that you and Rudy have a great deal more time with each other and I know I don't have to remind you to hug and kiss and love your beautiful Rudy every minute that you can.

Hugs always,
Addy

P.S. On a side note for some research I am doing, did you have a full adrena panel done with UTK? If so- did it show high estradiol for Rudy? Or any other elevated intermediates?

[MyRudy]

Addy - no I did not do a panel with UTK.

[MyRudy]

Sonja - It has only been a few days now that Rudy has turned his nose up at dog food. He will still eat cheese and chicken and ham thankfully, because that is what I hide his pills in! I am going to watch him the rest of the week and see if his appetite comes back and if not, I suppose we will go back to the vet.

Reading about Debbie's little guy and the tumor in the mouth has me really worried.

Rudy turned 12 in March, so I know he has had a good long life no matter what happens.

Donna

[frijole]

Donna, I had the same thoughts and fears that you did with my girl Haley. She lost her hearing (most of it) very suddenly. And then her eyesight slowly went. But you know what? My little bundle of joy still managed to run around the house like normal with a smile on her face and she never met a meal she didn't like. ;):p So keep the faith and don't count Rudy out yet. Hang in there. xoxo Kim

[Harley PoMMom]

Rimadyl is a NSAID and one that we usually really try not giving to our cush-pups.


Signs of Rimadyl intolerance may include appetite loss

http://www.rimadyl.com/display.aspx?drug=RC&species=CN&sec=000

Has your vet been monitoring Rudy's liver values while on Rimadyl?


Blood work however should be done prior to beginning treatment and one or two weeks into treatment to monitor liver values.

http://www.vetinfo.com/drimdyl.html

Big hugs to you and Rudy.

Love and hugs,
Lori

[Squirt's Mom]

Hi Donna,

Has Rudy had an ACTH since Aug.? Trilo often needs tweaking before the optimal dose is reached so it's possible Rudy may need an adjustment and that is why you are seeing these signs in him such as a loss of appetite.

Another thought...as dogs age they start to lose their sense of taste and smell so may lose interest in feed they have always liked. So you might try to "spice" up the smell and taste of Rudy's meals with something like green tripe. Dogs usually love it and it is good for them! Fair warning...it stinks to most of us lowly humans! :eek::p

As Addy said, we tend to react much more negatively and helplessly to a loss of one of our senses like hearing or sight. However, when this happens, other senses step up and become more sensitive. This is especially true in animals, who already have heightened senses compared to us. I have been owned by deaf and blind animals, both cats and dogs, including a Great Dane who was both. Not a one of them approached, or is approaching ;), their life with fear, frustration, anger, depression, or confusion. Nor did/do any of them act as if their lives had/have no value. Rather they all enjoyed, and are enjoying, their lives to the fullest - loving, playing, and living happily. I have a friend who has a horse who went blind due to an infection but he tears around his pasture at full gallop, never hitting a fence or tree! When Trinket's new vet saw her for the first time Mon., he thought she could see even tho her eyeballs have been recently removed - she was handling herself so well in the waiting room roaming around he forgot I had told him that. So while Rudy's deafness is understandably upsetting to you, it doesn't bother him nearly as much. ;) Most dogs adjust quickly.

Keep your chin up, honey. Have a vet check Rudy out to be sure there is nothing going on, try to entice him to eat with some new stinky things, and remember he is letting you carry the grief over his hearing loss. We are here anytime you need to talk; sometimes just talking about our fears helps a great deal and trust me we all understand yours.

Hugs,
Leslie and the girls :D - always

[apollo6]

Dear Donna
Just watch your precious Rudy, loss of appetite is something you need to tell the vet. Apollo just turned 12 , Oct 11th. Like you I am trying to be in the now , which is so hard with this disease. It seems like just when you think everything is under control, something new pops up. But on the positive, Apollo is still happy and tries to walk.
Praying for you and your beautiful Rudy.
Hugs Sonja and Apollo.

[KRAM3732]

Dear Donna & everyone:
I just stumbled upon this website and my dog Sadie girl is approx 15 yrs old and so far is a survivor of bladder cancer (via piroxicam) and now she has cushings disease. She has been on vetoryl for 1-2 months and so far we are deciding to STOP giving it to her now because her back legs are trembling and she can no longer seem to walk (due to lethargy). This is very scary to see. She will be having her hair trimmed tomorrow so that it is extremely short as to not trigger frequent panting and we'll see what happens over the next 2-4 days to see if she gains her leg strength back again. We are deciding to just deal with her excess thirst, hunger, panting (fortunately, cushings has not induced hair loss) so that we AVOID the side effects of these lethal meds. We may change our mind. I'll send an update in a few days to keep you all informed, but we just can't see other problems happen to her due to these pills! Best of luck everyone and talk to you soon...

Monica (Sadie's mom)

Administrator's Note: A new thread has been started for Monica. So anyone who wishes to reply directly to Monica about Sadie can find them here: http://www.k9cushings.com/forum/showthread.php?t=2735.

[KRAM3732]

I forgot to mention that we have already tried reducing her 30 mg per day to only 15 mg per day (half powder)- 10 mg capsule per day does not help, but 15 mg seems to be enough does, BUT starting to cause the dangerous lethargy side effect. So we've tried adjusting the dose. In a few days, we might try 10-12 mg and see....but we are going to see if shaving most of her hair short and giving her NO vetoryl, if she will be just "ok". We're trying not to add to her list of problems by introducing new side effect problems....

Monica