Marusca 12 years Cushing Diagnosed

[JJorge]

Hello. I´m new here, found this great message board through google, while searching for info and help about Cushing´s. My best friend is Marusca a 12 year old female dog who has been diagnosed with Cushing´s about 2 weeks ago. She is not a large dog but she is fat, always had a big appetite and weighs about 40 kilos or 88 lbs. Anyway we took her to the vet and her liver values were through the roof and then the vet did another test and diagnosed her with Cushing. She precribed Vetoryl in 60 mg pills. She ordered one pill on the first day and another on the second and on the third we started her on 2 pills a day, so 120mg in the morning. Everything was going fine until on the 5th day she lost all strength on her rear legs. She could hardly stand, hardly walk at all. The vet ordered us to stop for a few days and go to the office. She conducted new tests, the liver values were even higher and she ordered us to give her a pill, 60 mg every two days. However the weakness remained and the vet asked us to stop the Vetoryl to see if she´d improve. Its been about a week, without any medication and she has now started to be stronger, even though she cant climb stairs on go up on the couch or on the bed yet as before. Still she seems to be walking much better and doesnt have as much trouble getting up as before.

So my question is: is it the Vetoryl that´s responsible for her weakness? I know its also a symptom of the decease but could the Vetoryl worsen it even more? I´m affraid to give her more pills and dont know what to do. I also dont want her without any medication, so i really dont know what to do. She seems sad, cries alot until her favorite owner gets home at night but she still eats well and other than her weakess seems not to be in pain.

Has anyone had a similar situation? Sorry for my english but i´m from Portugal so its not my native language.

Thank you!

[Harley PoMMom]

Hi and welcome to you and Marusca from me and my boy Harley. So sorry for the circumstances that brought you here but glad you found this forum and we will help you in any way we can.

The more information we know about Marusca the better our feedback will be, so usually with our new members we ask alot of questions, ok?

Were any ACTH stim tests done? If so, could you post the results here for us, usually there are two numbers, a pre or baseline and a post number.

What symptoms led you or your vet to test Marusca for Cushing's in the first place? Has non-adrenal illnesses like diabetes and hypothyroidism been ruled out?

According to Dechra's protocol one should keep one's dog on a dose for at least 10-14 days and then complete an ACTH stim test before adjusting the dose. We have seen dogs go lower on the same dose in 30 days.

A small percentage of dogs may develop corticosteroid withdrawal syndrome within 10 days of starting treatment.

Please ask all the questions you want and we will help you in any way we can, in the mean time here are some links that I hope will be useful.

Trilostane/Vetoryl Information and Resources
http://www.k9cushings.com/forum/showthread.php?t=185

Dechra's U.S. Product Insert
http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf

Love and hugs,
Lori

[JJorge]

Thank you for your response. Unfortunately i dont really know the names of the tests performed.

Marusca was drinking lots and lots of water and eating even more than usual. She also started urinating alot, she had two or three "accidents" on my bed, which she never had in her life, so we knew something was wrong and took her to the vet.

At first the vet did the usual blood tests and found that there was a value relating to the liver which was very high.
She prescribed a liver protector and some other liver meds and waited a week to repeat the blood work. The level was still high. The vet then did a test where she took a blood sample, injected some sort of substance on Marusca and then waited an hour and took another blood sample. The sent it to the lab and it came back the cortisone levels had gone through the roof within that hour. The vet kept the test results, she did tell me the numbers but honestly i dont remember them exactly because by then i was pretty nervous and out of it!

Please ask anything you want. Today has been a good day. She seems much stronger on her back legs and seems much less sad. Also her favorite person in the world is home today with her so she is really happy!

Thanks again!

[Harley PoMMom]

Sounds like Marusca had an ACTH stim test. The ACTH stimulation test is a simple and safe screening test in the diagnostic evaluation of dogs with hyperadrenocorticism (Cushing's syndrome). It's also used to monitor dogs on medical therapy (e.g., Lysodren, Trilostane, etc.).

Simply put, it's a test of adrenal gland reserve; it checks how the adrenal glands respond to a certain hormone. This hormone is called adrenocorticotrophic hormone, also known as ACTH. ACTH is made in the pituitary gland (pea-sized structure located at the base of the brain) and travels through the bloodstream to the adrenal glands (small paired glands buried in fat in the front of each kidney). ACTH stimulates the adrenal gland to release cortisol. The ACTH stimulation test involves measuring the concentration of cortisol (which is made by the adrenal glands) in a patient's blood before ("pre") and after ("post") an injection of synthetic ACTH.

If you could get those ACTH stim numbers for us it would help a lot.

What breed is Marusca? And am I correct, Marusca is NOT taking any Vetoryl now?

Love and hugs,
Lori

[JJorge]

I can try and get the numbers but the Vet is away on a mini vacation because of the new year so i have to wait for her to get back! Right now she hasnt taken any medication for about a week except a liver protector that she´s been taking ever since the first visit to the vet!

EDIT: Forgot about the breed. She really doesnt have a pure breed, her mother was a dog we adopted from the street, but she is close to a labrador and we´ve always suspected her father was one. Her mother got away when she was in heat so we never really knew but Marusca is like a mini-labrador :D

[Harley PoMMom]

What is this liver supplement? Is it milk thistle or denamarin? Also what breed is Marusca?

Is Marusca on any other herbs or supplements?

[JJorge]

Forgot about the breed. She really doesnt have a pure breed, her mother was a dog we adopted from the street, but she is close to a labrador and we´ve always suspected her father was one. Her mother got away when she was in heat so we never really knew but Marusca is like a mini-labrador :D

The liver medicine she is taking is called Denosyl. She takes two pills a day! No herbs, nothing else, just that. She stopped the Vetoryl about a week ago but now that she´s better from her real legs i might start her again! I dont know, im just affraid she´ll stop walking at all!

[Harley PoMMom]

The most recent recommendation of Dechra, the company that makes Vetoryl, is to start dogs off using a formula of 1 mg. per pound. So in Marusca's case of 88lbs, that would be about 90mg. of Vetoryl instead of 120mg. Many members found this out by talking directly to one of their technical representatives. He is a vet, and his name is Dr. Allen. Either you or your vet can call him directly, as well, to get this updated information:

http://www.dechra-us.com/Default.aspx?ID=365

Don't know if this is possible or not, but if your vet would be willing to call Dr. Allen at Dechra, they could talk about Dechra's revised recommendation. And Vetoryl is sold in 10mg and 30mg capsules, so obtaining it in other doses will not be a problem. Plus, if it does turn out that Marusca needs a higher dose, it will be easy to keep adding on additional 10mg or 30mg increments.

I know it may not feel too comfortable "questioning" your vet about the dosing. But hopefully he will also think it is a good idea to call the Dechra rep in order to have a direct conversation about their new dosing recommendations. I have never talked to Dr. Allen myslef but the other members who have, said, that Dr. Allen is really nice and happy to discuss questions with both owners and vets.

We would really like to see those ACTH stim numbers and any other tests that were done on Marusca. If you could get copies of all tests that were done and post only the abnormal findings with their reference ranges and units of measurements (ug/dl), this would really help us a lot.

Love and hugs,
Lori

[Squirt's Mom]

Hi and welcome to you and Maursca! :)

What a pretty name! I bet she is as pretty as her name, too. ;)

First, please do not give Marusca any more Trilostane (Vetoryl) until she has another ACTH that shows the cortisol level high again and she is showing strong signs again. I am afraid that the dose is much too high for Marusca plus not being given according to protocol, and these factors put your baby at great risk. The collapse you describe is indicative of an overdose of Trilo.

Your vet should be happy to give you copies of all her testing pertaining to the Cushing's diagnosis. You did pay for them. ;) When you get them, post the results along with the units of measurement and norms for that lab (different labs use different normal values) and that will help us a great deal to help you and Marusca.

Do your have predisone on hand? If the time comes when you do restart the Trilo, insist your vet give you some prednisone in case this happens again. If I were in your shoes, I would insist they give me some today! :p But I can be a rude old broad! :D

If you have some plain, unflavored Pedialyte, you might put a little in her drinking water to help with her electrolytes....which become dangerously low with an overdose of Trilostane or Lsyodren. The electrolytes need to be checked when she has the next ACTH - ideally soon.

Please keep in touch and let us know how she is doing. Don't hesitate to ask questions any time - someone is almost always on 24/7.

Hugs,
Leslie and the girls - always

[JJorge]

Thank you so much for your kind words and advices. As soon as i can get a hold of the vet i will try to get the "specific" test results! This is a tough time and it really helps to talk to someone who is going / has gone through the same situation! Again, thank you so much!