New Cushing's diagnosis in older pet (liquid trilostane)

[Lisa]

Hi, I am new to the site but what a huge comfort it has been. I have a small 10lb dog that was diagnosed with cushings and one of her liver enzymes was at 3000 the vet just kind of said that's too bad so I started asking other questions about trilostane and denamarin and he said that's a great idea lets try it. When she is hydrated she feels great but after a week she has stopped eating again and is looking droopy. I am still waiting after a week for the vet to get this trilostane in and he says the compounding pharm is calif just has him on hold so he keeps hanging up. I read your posts on diamondback. My question is has anyone else had a dog with levels that high and they came back using liquid trilostane?

[labblab]

Hi Lisa, and welcome!

I saw that you had posted this reply on another member's thread, and I have taken the liberty of moving it to create a new thread of your very own. This way, our members will be able to talk with you directly in terms of offering feedback and suggestions. :)

I apologize by starting off by asking some questions rather than answering the one that you have asked. But it will help us a lot if you can tell us more about your dog and her health history. Aside from the liver enzyme elevation, were there other symptoms that led you and your vet to suspect Cushing's? Can you tell us what testing was done to diagnose the disease? Any specific test results that you can give us would be great. Also, does your dog have any other health problems of which you are aware?

Thanks in advance for this additional information!
Marianne

[Lisa]

She is a small pom sheltie mix who was put on steroids for about 2 years which we now know gave her cushings. She has been in perfect health though she is older and when I asked about her hair they said she needed vitamins. She is now with a different vet after my first post and they have her hydrated and awaiting liquid trilostane. The big issue seems to be that she had been waking us up in the night to feed her and about 1 week ago she stopped eating and that is what has the vet concerned. She is very alert and giving them a lot of trouble but he thinks we need to keep her well hydrated until he can get her started on the medicine. She will eat at home but only for a day or two until her liver enzymes get too high again and she stops. I just wondered if anyone elses dogs had got to that point and recovered and how long it took them too eat again. My vet said her levels were not to high that she could not recover from them.
I feel like one day I have great hope and the next is horrible.

Thanks so much for your help,

Lisa

[frijole]

Lisa, Maybe I am just having an off day :rolleyes: but I'm not following your story... can you please start at the beginning and fill in the blanks? I'm asking because this hunger coming and going doesn't sound like cushings.... could be something else. I'd like to also know what tests you did to diagnose cushings and the results of them.

So even if you think we won't read your whole story - trust me - we will and it will better help us help you. Hang in there.

My dog Annie was diagnosed with cushings and all of a sudden her appetite went away. Turned out she did not have it. I still have appetite issues and I know it is the toughest thing in the world. I would focus on the appetite and not worry about trilostane right now because you never give it to a dog that won't eat... and like I said... I want to read your whole story because I'm not sold on the fact your dog has cushings. Kim

[StarDeb55]

Lisa, I'm not sure either Marianne or Kim have asked specifically about the prednisone usage. You say that your pup was on pred for 2 years & that she developed iatrogenic Cushing's. I'm assuming she was weaned off the pred? How long was she off the pred when the diagnostic testing was done that now says you are dealing with Cushing's? What was the problem that the vet treated with pred?

Debbie

[frijole]

:D Deb good job... I just asked for the story but you asked the specific questions I wanted answered. Thanks. Kim

[labblab]

When she is hydrated she feels great but after a week she has stopped eating again and is looking droopy.
Hi again, Lisa.

I, too, am feeling very concerned about the accuracy of the Cushing's diagnosis and the decision to begin treating with trilostane. I am very worried about giving trilostane to a dog who is not eating or who has hydration issues. Most Cushpups have ravenous appetites and excessive thirst, so one of the desired treatment effects of trilostane is to lower cortisol so as to curb the appetite and thirst -- seemingly the exact opposite result that you are hoping for with your little girl at the moment.

In fact, from your description, I am wondering whether your girl may be suffering from some sort of primary liver disease, gall bladder disease, pancreatitis, or instead even Addison's Disease, which is the opposite of Cushing's. Long-term steroid use can result in either Cushing's or Addison's. Addison's is rare and seems very unlikely given the time-frame that you have described for your dog's problems. But Addison's can result when prolonged use of steroids has damaged the adrenal glands to the extent that they are no longer able to properly supply the body with needed hormones. Here's a description:

http://www.vetinfo.com/canine-addisons-disease-symptoms.html

Note these symptoms:


Symptoms of Addison's disease include:

•Repeated episodes of vomiting and diarrhea;
•Appetite loss;
•Dehydration;
•Rapid weight loss;
•General poor health.

Has your vet performed an ACTH test as part of the diagostic process? This is the one test that can actually help with diagnosing both diseases, Cushing's or Addison's. How about other lab results -- have they all been normal except for the liver enzymes? Once again, the more info you can give us will be really helpful.

Marianne

[Lisa]

She has been off the steroids (Alba Plex) about 2 years. They did the ACTH test and it showed cushing's not addisons. As a human believe it or not I have addisons. (: Anyway she had a voracious appetite for quite some time and then literally the last week or two she lost it. That is my concern. When she is hydrated she is her old self eating and all. The vet had her on Trilostane, denamarin and fluids and she is doing well. I think his theory is to keep her healthy while the trilostane starts to work and when the liver isn't so overwhelmed it will fix itself. The vet had a liver problem in college and said he felt like he had the flu and could hardly eat until it was corrected. What I was wondering is does anyone else have a dog that lost their appetite at the end and regained it.

Thanks,

Lisa

[labblab]

Lisa, thanks so much for this additional info. I'm still confused, though, as to the sequence of events. How long ago was the ACTH performed? Was it prior to your girl's sudden loss of appetite? Is she not drinking, either? And once again, can you tell us whether there are any other lab results that are abnormal for her? Last but not least, exactly how long has your girl been taking the trilostane and at what dosage?

While awaiting this additional information, I must tell you once again that I don't believe this acute episode that you are describing -- severe enough to require artifical hydration -- corresponds with Cushing's, per se. It is true that Cushing's can cause chronic changes in the liver over time that result in elevated enzyme readings. But what you are describing right now sounds more like an acute illness or episode that may be altogether unrelated to Cushing's and require alternative diagnostics or treatment. There can be lots of other causes for elevated liver enzymes besides Cushing's. And the sudden loss of hunger is not consistent with the typical profile of a Cushpup.

I'm sorry to keep responding to your questions with more questions of my own :o. But without more answers, I still feel worried about your girl being started off on trilostane right now.

Marianne

[Lisa]

The first ACTH was administered by another vet wednesday (march 2), the most recent one was by a new vet this last monday (march 7) there were no other problems. She had been shoveling food until 2 weeks ago and it just started tapering off. Thank goodness that happened or we would not have taken her in. This is her second day on trilostane I don't know what the mg is yet. The vet thinks the fluids are keeping her liver a little more cleaned out and less toxic and that's why she feels better when she has it and less nauseated.

[labblab]

Lisa, you are going to want to shoot me for continuing to question the trilostane treatment :o. But this is my new concern based on the timing of the ACTH tests: both of the widely used Cushing's screening blood tests (the ACTH and the LDDS) can be skewed in the presence of other, nonadrenal illness. In other words, if a dog is suffering from a different disorder such as severe liver disease, the ACTH may turn out "positive" even though the dog may not have Cushing's.

Aside from the hearty appetite, did you previously suspect Cushing's prior to seeing the vet during the past two weeks? It is true that ravenous appetite is one typical Cushing's symptom. But has she been exhibiting any others over time? Excessive thirst and urination, hair loss, pot belly, panting, muscle wasting? Have the vets suggested an abdominal ultrasound so as to actually visualize her liver to see whether there may be an unrelated tumor present or if there are any other abnormalities with her liver or other organs that could account for her sudden loss of appetite?

I know I'm repeatedly harping on the same concerns, so I'll keep quiet now and let others offer their thoughts. And I'll keep my fingers crossed for you that the trilostane really does help. But I'd personally remain worried about both the diagnosis and administering trilostane to a dog that appears to be acutely ill.

Marianne

[Harley PoMMom]

If keeping your girl hydrated is making her feel better, please be advised that Trilostane/Vetoryl can unmask kidney issues in one's pup, that is what happened to my boy Harley.

Has a Chemistry panel been done after starting the Trilostane?

Lori

[Lisa]

She had all the symptoms the pot belly, the no hair, muscle weakness but when we mentioned it to the first vet he said to give her vitamins. She has had those symptoms about a year. On another note the new vet is giving her 10 mg of Trilostane, Denamarin, and a wee dose of thyroid. She is on day 6 of her Trilostane and is back to demanding food and running the house. It's like yesterday she just woke up. Though I'm relieved, it's a little scary. She won't be retested until day 10.