Loss of muscle mass, please help

[Sirismatte]

Dear Someone,

Please if someone could get me an input or advice on how to help my precious one. I have a 13 year old miniature poodle, Siri. She was diagnosed with Cushings four months ago. She has been on 15 mg Vetoryl a day since December 28th and the latest tests showed that her levels are back to normal.

She has never been drinking extreme amounts of water and therefore no problems with urination. Her problems were that she gained weight, from 4.8 kg in August to 6.3 kg in December, her fur looked dull, she got a couple of crusted spots on different parts of her body and she got those dark spots on her skin. She has also been coughing. She had arthritis looking problems in her back a year and a half ago. We used conservative treatment and kept her still for 8 weeks. 6 month ago she got the same kind of problem in her neck and we started giving her Carthrophen injections. She had a dose of 4given once a week and now gets them every 4 to 6 weeks now depending on when she needs them.

After taking Vetoryl she is no longer coughing, her fur and skin is getting better, but she has not lost weight. The big problem now is that she seems to be getting weaker faster and I can see the difference weekly. She seems to be losing muscle mass. She has started to tremble when walking and is walking really slow.

Now to my question, could it be the Vetoryl that is causing her to be weaker? Anyone had the same problem? How long should it take before she should start lose weight? I keep her on a strict diet.
Grateful for any answer.
Anette

[labblab]

Hello Anette and welcome!

Although I am very sorry that your sweet girl is having problems, I'm really glad you've found us. I only have a few moments to post right now, but I do have a question to ask. Can you please tell us the specific dates and test results for your dog's monitoring ACTH tests since starting on the Vetoryl? It has been our experience here that dosage requirements may change rather abruptly, and any time a Vetoryl pup starts acting weak or lethargic, I worry that cortisol levels may have dropped too low.

Since your dog has arthritic issues, another possibility for the weakness and trembling may be a worsening of arthritic pain as a result of the lowering of her cortisol. Steroids naturally act as anti-inflammatory and "feel-good" agents, so when cortisol levels drop as a result of treatment, other ailments may be unmasked in the process.

I'm sorry to greet your question with questions of my own, but your additional information will allow us to provide more accurate feedback. Also, if you can fill us in on the diagnostic testing that was involved in determining that she is a Cushpup, that would be great!

Looking forward to reading more about your girl!
Marianne

[Sirismatte]

Dear Marianne,

Thank you for reading and answering.

They started to suspect Cushings early last spring when Siri had some skin problems, she has always had allergies, nibbling and licking her paws. They took a Low Dose Suppression test wich I unfurtunatly I don´t have the result from with me here. I will try to get it if you think it might be of any help. They told me then that it showed her beeing borderline Cushing and wanted us to come back and take new tests after 6 months. We lived in Sweden at that time and moved to China in August of 2010. Below are the test results from our vet in China. The samples were send to Germany for testing. Siri started on Vetoryl on December 28. We started gradually, 3.75 mg for a couple of days then 7,5 mg for a week and then 15 mg and that is what I still give her every morning. Siri has had one test taken since starting on Vetoryl.

She had started to get weaker, one could feel that she had lost muscle mass before we started her on Vetoryl. But now it´s noticable that she is getting weaker every week. She has started to tremble when walking and she is now walking up the two steps between the living room and kitchen using one leg at a time. At least she does not seem to be in any pain.


2010 Sept 30 ACTH-Stimulation test
Cortisol (pre-ACTH: basal value) 1.9 µg/dl reference value 1.0-6.0 µg/dl
Cortisol (post-ACTH) 24.9 µg/dl reference value 6.0-18.0 µg/dl
>24.0 µg/dl = strongly suggestive of spontaneous hyperadrenocorticism

2010 Oct 26 Low dose suppression test
Low dose Dexamethasone
Cortisol (Basal) 323.0 nmol/L reference range 25.0-125.0
Cortisol (3h) 212.0 nmol/L
Cortisol (8h) 91.6 nmol/L reference range <=40.0

2011 Jan 19
ACTH-Stimulation test
Cortisol (pre-ACTH basal) 18.2 ng/ml reference value 5-65 ng/ml
Cortisol (post- ACTH) 29.4 ng/ml reference value < 150 ng/ml
Therapy control: Vetoryl stimulation level between 15 and 55 ng/ml

Our vet has also run some other blood tests and all the values on those have come out within reference range except for

2010 Sept 21
Al P 154 ref 20-154
Al T 173 ref 10-118

2010 Dec 28
Al P 160
Al T 148

2011 Jan 19
Al P 133
Al T 158

Kind Regards,
Anette

[labblab]

Anette, I believe that you should immediately schedule another ACTH test for Siri, along with a check of her blood chemistries (electrolytes). It looks as though she only has had only one monitoring test performed since beginning the Vetoryl, and that was three weeks after beginning treatment and two months ago. The manufacturers of Vetoryl recommend more frequent monitoring than that when a dog is started on the medication, and also after any dosing change. Not only do you want to make sure that the dose is high enough to be therapeutic, but of much more immediate concern to the health of the dog is to make sure that the dog is not being overdosed so as to cause potentially life-threatening abnormalities in the blood chemistries ("Addisonian crisis"). And even if the initial monitoring test showed that the level was OK, there can be a cumulative effect over time such that the dosage needs to be lowered. That is why Dechra recommends testing at the 10-14 day mark, and then at the 30 day mark, and also at any time that a dog appears to be unwell, which is definitely the case for Siri right now. (For our members in the U.S., Siri's January ACTH results convert to 1.82 ug/dl pre-ACTH, and 2.94 ug/dl post-ACTH).

Have you talked with your vet about Siri's weakness? I would call him/her immediately and schedule the testing for as quickly as possible. If the testing cannot be done right away, I would talk with your vet about at least temporarily stopping the trilostane and perhaps even administering some prednisone in order to see whether Siri improves. If she does, that would be a strong indication that her cortisol has dropped too low on this dose of Vetoryl. Is she still eating and drinking OK? If not, or if she starts having diarrhea or vomiting, that is definitely cause for immediate attention. Please keep up updated. And here is a link to the U.S. Product Insert for Vetoryl. It will give you a lot more information regarding treatment and monitoring guidelines and issues:

http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf

Marianne

[Sirismatte]

Thank´s again for your answer. Our vet is out of town this week but we have been in contact via mail. After him hearing that I think she is weaker, he too said that we might think about take her off the medication for some time. I will be out of town from tomorrow until Thursday next week. I have a very trustable lady staying in our house taking care of Siri when we are away. After reading your answer I have decided to take her off the medication from tomorrow and schedule a new test as soon as I get back. When we started the treatment our vet gave me some Prednisolone to have at home just in case. He told me about the signs to be looking for, about eating, drinking, vomiting and diarrhea. Siri has not shown any signs for any of those. That´s why I have thought and hoped everything was going well until now. I will keep you posted on what´s happening. Thank you for being there and caring.
Anette

[Squirt's Mom]

Hi Anette,

Welcome to you and Siri! :)

It sounds to me as if Siri could be experiencing a drop in cortisol that is too low, as well. I think you are wise to stop the Trilostane (Vetoryl) for now. If she does not perk up today being off the Trilo, I would think seriously about giving her some pred. Since your vet is not available to do an ACTH until next week, is there anywhere else you could get one done before then? It would be very beneficial to see where her cortisol is right now because by the time your vet returns, it will not be the same.

Please let us know how Siri is doing. Know we are here to help you in any way we can.

Hugs,
Leslie and the gang

[Sirismatte]

Unfortuantly I can´t take your advice on having Siri taking the test today. I will be leaving for six days today. Since we live in China and my chinese is no good I only have one vet that I trust and he is out of town this week. I have taken her off the Vetoryl for now.
Anette

[Squirt's Mom]

Hi Anette,

Ah, ok.....then you have done the best thing for her by stopping the Trilo. If her behavior is due to the cortisol dropping too low, she should rebound in a day or two and you can start over when your vet gets back. That is one of the good things about Trilo - it leaves the body fairly quickly while you don't lose ground if you need to stop like you can with Lysodren.

I hope your trip is enjoyable, your travels safe!

Hugs,
Leslie and the gang

[apollo6]

Dear Anette
Welcome. My Apollo, 12 year old dachie, is on Trilostane. And the nice thing about Trilostane/Vetoryl is you can stop it without any problem. Apollo was on it for 6 months, and was doing well accept the muscle weakness. I stopped it in December 2010and restarted in March 2011, when I realized the weakness was not getting better and his symptoms were coming back. Apollo has the muscle wasting in his hind legs and now starting in his front legs.

In my case the vet said maybe Apollo has hyperthyroidism which can also cause similar symptoms and muscle wasting. But for now I don't know.
Taking her off the Trilostane until you contact the vet was smart. It can take a few months to see improvement with the muscles. Each case is different.
We will be praying for you.
Hugs Sonja and Apollo