Cocker w/Cushing's on Trilostane Severe Weight Loss Please Help

[TheFonz31]

Hi all,

Great little board and community we have here, I feel lucky for finding it.

I have a 16 year old Cocker Spaniel, Fonzee who was diagnosed with Cushing's Disease a little over 3 years ago. I believe my vet used the ACTH test, I can't recall exactly since it was a while ago, but from my understanding that's the only test that can completely confirm it.

Prior to the diagnosis Fonzee had all the typical Cushing's symptoms:

-excessive thirst
-constant panting
-pot-belly
-muscle loss
-hair loss on back, falling off in clumps
-frequent urination


After testing my vet got him on Mitotane, which quickly put his symptoms at bay. Within a couple months of Fonzee being on mitotane my vet mentioned that Trilostane seems to be a better option and safer for Cushing's.

We switched him over to Trilostane at a dosage of 120 mg, which was 2 60 mg pills given twice a day.

After a few months on Trilostane, Fonzee's Cushing's symptoms were doing very well, so the doctor after more testing reduced his dosage to 60mg once a day. That is the dosage he has been on ever since.

While his Cushing's symptoms are doing very well for the most part, I have become increasingly concerned with some new symptoms, which I presume is due to the medication.

The main one being severe weight loss. Fonzee was always a chubby dog, especially for a Cocker Spaniel, always hovering around 32-35 lbs. At the time he started the Cushing's medication he was around 28 lbs. He has dwindled away over the past couple years all the way down to 18 lbs!!! He looks so skinny and I'm very worried. His spine is sticking out, the bone in his skull is sticking out, his pelvic bones are protruding.

Some other symptoms he has are occasional trembling, lethargic throughout most the day (this is partly due to the medication and partly due to being home alone sometimes). And he barks a lot in the middle of the night.

I mentioned to my vet some time last year at a check up that I was concerned about Fonzee's weight loss. He said it was due to old age and nothing to worry about.

Well as I've started researching Cushing's and specifically Trilostane I feel strongly that the medication is causing this and I want to fix it.

My questions are:

1) Is the Trilostane causing the severe weight loss? And if so what do I do about this???

2) When I take Fonzee to the vet should I demand a new ACTH test? Are there any other tests he should get?

3) Based on the results of the test, should I expect Fonzee's dosage to be reduced? I see some on only 4mg and feel like perhaps the over-dose of medication is why he's losing weight?

4) I started giving him the medication once every 3 days last month just to see how he would react and he started having lots of accidents inside the house, so I put him back on his regular dosage of 60mg once a day.

5) If my vet passes this off to old age again I want to take him to a new vet. Does anyone know anyone in the Orange County Ca area who has experience with Cushing's?


Fonzee is a very happy dog, he has lots of energy, runs around and has no other health issues that I'm aware of....his stools are healthy and normal, he has a strong appetite which might be partly due to the medication.

I'm going to continue reading, but would love for this awesome community to give me any advice prior to me speaking with my vet.


Thank you so much!


Sunny and Fonzee

[Harley PoMMom]

Hi Sunny and Fonzee,

Welcome to our family. I do have some concerns, when your vet switched Fonzee from mitotane to trilostane did your vet recommend a wash-out period? Dr Feldman, who is a renown Cushing's expert recommends:
Any dog switched from one to the other should receive no medication for at least six weeks. http://veterinarynews.dvm360.com/dvm/Internal+medicine/Cushings-disease-and-other-adrenal-gland-disorders/ArticleStandard/Article/detail/672663?contextCategoryId=40534

If it were me I definitely would have an ACTH stim test done and have Fonzee's electrolytes checked.

Although I am not a vet, 60mg of trilostane for a 18lb dog seems too high to me. Is Fonzee experiencing any diarrhea or vomiting?

Please keep us posted and know we are here for you.

Love and hugs,
Lori

[frijole]

The symptoms you described could be due to a dosage that is too high. Even though you have been using trilostane for some time it is recommended that at the very least you have annual acth testing done to test the cortisol levels.

What happens in some cases is that the dose no longer works - and you have to adjust it. The only way to know is by the test. Yes the acth test.

I am surprised given a loss of 10 lbs the vet didn't at least do a blood panel to see if something is going on.

If I were going to experiment I would LOWER the dosage and give it daily like you have been. Try cutting it in half. As Lori mentioned, if the dose is too high I would also think that the appetite would be reduced. Have you noticed that?

Anyway, I would do a blood panel and an acth test. I am sure we have members with vets in Orange County so hang in there and someone will give you a shout out.

Kim

[ktzndgs]

I have a Newfoundland who lost 10 pounds on trilostane (Vetoryl). We haven't gotten it all straightened out yet but I'd definitely do an acth stim. 60mgs is a high dose of medication for such a small dog. My Newf will restart Wednesday on 40mg divided into two daily doses and we'll work our way up from there. She started out at 97 pounds and went down to 87.

I found a link to some interesting info about trilostane in the files. I think it went to dvm.com. I'll look for the link that's here tomorrow and will post that and the link I found later. Very interesting stuff!

Kathy

[Franklin'sMum]

Hi Sunny and welcome to you and Fonzee,

When was the last time an acth was performed? The trembling could be due to the cushing's or the trilostane. Back end weakness is common in our pups.
The accidents and the barking during the night may be the beginning of canine cognitive dysfunction (doggie alzheimer's), there are others here with more experience with that.
I am also concerned about the dosage. It's recommended these days to start low and raise the dose if necessary, and 60mg is a lot for one who weighs 18lbs. I know you said these symptoms have only re-started recently, and it could be that Fonzee was fine before, but now needs a change. Do you have prednisolone on hand? I would call the vet and run the idea passed them of giving a small dose of pred to see if Fonzee perks up, but I would definitely get some blood work done.

Jane, Franklin and Angel Bailey xxx

[labblab]

I just want to "second" what the others have already suggested: I think it is definitely time for lab work to be performed on Fonzee. Given his unexplained weight loss, I would want an ACTH monitoring test performed along with panels measuring his blood chemistries ("electrolytes") and organ functions (kidney and liver profiles, blood counts).

Trilostane should not be associated with severe weight loss unless appetite is being oversuppressed by a dose that is too high. Is Fonzee eating and drinking normally? The manufacturers of Vetoryl (brandname trilostane) recommend that monitoring ACTH tests be performed every four months throughout treatment because dosing requirements do change over time. Once a dog seems to be stabilized and continues to to well on a given dose, some vets may feel it is OK to back off a bit from that frequent a testing schedule. But any time a dog is unwell for reasons that could be associated with over-dosage or under-dosage, a new monitoring test should be performed. Even if Fonzee's weight loss is not associated with an overdose, per se, ACTH testing should still have been performed to ensure that he still required the same trilostane dose (since dosing requirements are associated with weight). And I believe that alternative reasons for the weight loss should be explored.

I do believe a second opinion could be very helpful for you. One of our other administrators also lives in southern California, and I'm hoping she'll have the chance to stop by today in order to give some referral suggestions. One testing note: unless Fonzee were to be in a crisis situation, you do not want to give him prednisone during the day or two prior to an ACTH test because the prednisone will alter the accuracy of the test results.

Here's a link to Dechra's U.S. Product Insert for Vetoryl which will give you a lot more helpful information about treatment and monitoring:

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

I'm really glad you've joined us here!
Marianne

[lulusmom]

Hi and welcome from me too.

You are lucky to live in Orange County because you have two excellent facilities there to chose from. My cushdogs treat with VCA All Care in Fountain Valley which is 50 miles away for me. Commuting is a small price to pay to sleep easy knowing that my dogs are in the best of hands. There is also a great facility in Tustin called ACCIM. I don't think you can go wrong with either. You do not need a referral from your vet to go to VCA but you will need a referral for ACCIM. Both hospitals are open 24/7 so it makes it really easy to have the acth stim tests done. I just had stims done for both of my dogs on Sunday.

http://www.vcaspecialtyvets.com/all-care
http://www.accim.net/

[TheFonz31]

Thanks for the replies guys, means a lot to me and of course Fonzee!

Spoke with my vet this morning and he completely agreed with me and all of you. He cleared his scheduled and has asked me to bring Fonzee in today for a updated ACTH test and a check up.

As far as Fonzee's appetite, he's always been a free feeder. Nibbling throughout the day, then eating late at night when I'm up with him. I have dabbled in raw feeding and he absolutely loves it. So I'm looking to switch him over to that 100%.

We didn't give him his dose of Trilostane last night. If I do the ACTH test today will it be inaccurate? I asked my vet about this and he said since Fonzee took his dosage on Monday the test will still be accurate? Just want to confirm so I don't get a false reading.

Harley: I can't recall if there was a wash out period, I'm pretty sure there was, but I will ask my vet today to confirm.

Also it seems like the consensus is that splitting up the dose into two smaller doses is optimal compared to once a day?

Franklin'smom: Thanks for the tips, yes Fonzee was doing fine when he started on the Trilostane, I would say these symptoms popped up over the past several months. However the weight loss has been a concern for a while and since my vet told me prior to this that it as due to age, I didn't worry about it. But after I got him groomed over the weekend, I knew something wasn't right.

Lori: Thanks for the reply and that interview, very helpful! Fonzee is not experiencing any vomiting or stool abnormalities. When he initially was on mitotane, he had runny stools, watery stools etc. Never any vomiting. As he has got on the Trilostane and been eating some raw food, his stool looks very normal.

Thanks for all the other replies, I really do feel lucky to have found this great board. I am taking Fonzee to the vet in about an hour and he is doing the ACTH stim test and possible another test.

Will post when I get back.



Sunny and Fonzee

[labblab]

Sunny, I don't want to screw up your plans for your appointment with the vet, but per Dechra's established protocol (given in that Product Insert link above), all monitoring ACTH tests should be performed 4-6 hours after the dog is dosed. This is also why they recommend that dogs who are dosed once daily get their trilostane in the morning rather than the evening -- so that the monitoring test can be performed during the time period when the medication is peaking in their system and the cortisol level is at the lowest. Theoretically, trilostane has a relatively short half-live, so its effect and level in the body has tapered off dramatically within 12 to 18 hours after dosing.

This is a long way of saying that if Fonzee has not had any trilostane now for a day and a half -- then no, I don't think you will be getting an accurate reading as to the true effect that this dose is having on him. :(

Have you had any prior monitoring ACTH test performed beyond those first few months of treatment? If so, what was the timing of those tests?

Marianne

[TheFonz31]

Sunny, I don't want to screw up your plans for your appointment with the vet, but per Dechra's established protocol (given in that Product Insert link above), all monitoring ACTH tests should be performed 4-6 hours after the dog is dosed. This is also why they recommend that dogs who are dosed once daily get their trilostane in the morning rather than the evening -- so that the monitoring test can be performed during the time period when the medication is peaking in their system and the cortisol level is at the lowest. Theoretically, trilostane has a relatively short half-live, so its effect and level in the body has tapered off dramatically within 12 to 18 hours after dosing.

This is a long way of saying that if Fonzee has not had any trilostane now for a day and a half -- then no, I don't think you will be getting an accurate reading as to the true effect that this dose is having on him. :(

Have you had any prior monitoring ACTH test performed beyond those first few months of treatment? If so, what was the timing of those tests?

Marianne


Thank you Marianne, I'm glad I read and read and read some more yesterday because that was sticking out in my head.

We usually give him his once daily dose in the night, anywhere between 8-10. Perhaps if I give it to him right now and re-schedule the doctor's appt for the evening than it would be accurate?

We did two ACTH stim tests, one at the original diagnosis and one a couple months after he was on Trilostane. Since then, its been a little over a year and half we have not had any tests done. Realizing how important monitoring this all is, I feel terrible, because too much is just as bad as Cushing's itself.

We plan on closely monitoring him from here on out, likely getting ACTH testing done every 4 months to be safe.


Edit: I just gave him his dose right now, and re-scheduled the appointment for 2pm. By the time the test is done is should over 4 hours since the dose was done. Thank you, I would be lost without this board. Most likely will be switching vets to one of the two mentioned above since it seems like my vet, as caring as he is, isn't up to speed on Cushing's protocol's.





Sunny and Fonzee

[lulusmom]

Hi Sunny,

I've just now had time to read your entire thread and I have some real concerns about your vet's experience with cushing's, and most certainly vetoryl. As Marianne has mentioned. Unless cortisol is so low as to debilitate a dog, chances are that doing acth stim test more than six hours past the last dose is going to be a waste of money. The electrolytes can still be checked; however, if Fonzee is acting okay now, I would probably opt out of that too. I personally feel that all of that money would be better spent on a consultation with a specialist.

Severe weight loss is not normal for a dog of any age so I would have to agree with you that your vet shouldn't have another pass at writing Fonzee's weight loss off to old age. Fonzie could very well have more than cushing's going on, which is another reason to see a specialist. My two cushdogs have multiple conditions, which is why I drive 50 miles to have them seen by a specialist. Most gp vets, including my own, are woefully inexperienced in diagnosing and treating cushing's so add another condition in there and you really need someone that deals with endocrine disorders day in and day out. That's not a slam on any gp vet, it's simply a fact that internal medicine specialists go to school a lot longer, are highly trained and board certified.

Glynda

P.S. I see that you posted while I was typing and have mentioned consulting with a specialist. That's a great idea and in my opinion, I'd wait to have a stim test done after seeing a specialist who will direct the treatment with an appropriate dose. You don't have to desert your vet, he can easily work in cooperation with a specialist. Stim tests are usually cheaper if your vet does them too.

[labblab]

Sunny, I usually try to give every vet the benefit of the doubt, because I realize that there may be a lot of behind-the-scenes activity and conversation going on between an owner and a vet of which we are unaware. In other words, we may not always have the "big picture" in terms of what a vet is thinking or basing his/her decisions upon.

However, prior to any more testing, I am going to be bold here and encourage you to first consult with another vet who is seemingly more experienced with Cushing's treatment. From what you've told us, your current vet has not been following traditional protocol in terms of safely administering or accurately monitoring the trilostane that you've been giving to your dog.

The ACTH is both a very important and a relatively expensive test, so you want to make sure that it is being administered correctly and interpreted accurately. If a dog is not in crisis such that a test result is needed immediately, you want the dosing to have been administered in a consistent manner over a period of several days so that you have the best chance of obtaining a stable and predictable result. So if it were me, I would not want to test Fonzee today after giving him a dose now at what is an odd time of day for him, and also after a previous day and a half without any medication.

Sunny, I just read your edit while in the midst of typing this. So I see that you have gone ahead and given Fonzee his trilostane and rescheduled his test. I will leave it up to you as to whether you want to go ahead and proceed with the testing today. If so, depending upon the results, I would just bear in mind that another vet may end up wanting to repeat the testing under more consistent circumstances...:o

Marianne

[TheFonz31]

Sunny, I usually try to give every vet the benefit of the doubt, because I realize that there may be a lot of behind-the-scenes activity and conversation going on between an owner and a vet of which we are unaware. In other words, we may not always have the "big picture" in terms of what a vet is thinking or basing his/her decisions upon.

However, prior to any more testing, I am going to be bold here and encourage you to first consult with another vet who is seemingly more experienced with Cushing's treatment. From what you've told us, your current vet has not been following traditional protocol in terms of safely administering or accurately monitoring the trilostane that you've been giving to your dog.

The ACTH is both a very important and a relatively expensive test, so you want to make sure that it is being administered correctly and interpreted accurately. If a dog is not in crisis such that a test result is needed immediately, you want the dosing to have been administered in a consistent manner over a period of several days so that you have the best chance of obtaining a stable and predictable result. So if it were me, I would not want to test Fonzee today after giving him a dose now at what is an odd time of day for him, and also after a previous day and a half without any medication.

Sunny, I just read your edit while in the midst of typing this. So I see that you have gone ahead and given Fonzee his trilostane and rescheduled his test. I will leave it up to you as to whether you want to go ahead and proceed with the testing today. If so, depending upon the results, I would just bear in mind that another vet may end up wanting to repeat the testing under more consistent circumstances...:o

Marianne


Marianne,

Thank you for the quick replies.

I did give Fonzee his dosage of Trilostane, but I canceled the vet appt after reading these last few posts from you and Lulu'smom. Thank you.

I re-scheduled the appt for Saturday at 11am. The plan is to give Fonzee his dose at 7am for the rest of the week, so that once Saturday comes around the test should be done a little over 4 hours after he takes his dose.

I plan on getting the ATCH stim test done with my gp vet on Saturday, waiting for the results and then posting them here to get all your advice. If my vet seems to be on point with all your thinking then I will see how Fonzee does on the adjusted dose and most importantly if he gains weight.

If I feel like my vet is still clueless, then I plan on taking him to the specialist in Tustin, since its pretty close to me.

Lulu: Fonzee had a full blood panel run at the end of last year to look for any cancers, other diseases and they all came back negative. However, it might be time to do them again.

I'm certain that right now he is on too high a dose, hoping to get this corrected after the test on Saturday.

Thank you again, will post results right when I get them back.


Sunny and Fonzee

I

[labblab]

I re-scheduled the appt for Saturday at 11am. The plan is to give Fonzee his dose at 7am for the rest of the week, so that once Saturday comes around the test should be done a little over 4 hours after he takes his dose.

Sunny, I'm really glad that you've set up this revised scedule for Fonzee's medication and testing. I think it should give you a much better chance for meaningful results.

Like you, I'm fully expecting that his trilostane dose will need to be lowered. If so, just a reminder that trilostane capsules should not be opened up nor the contents divided by the owner (this is another warning that is in that Vetoryl Product Insert). So unless you have compounded trilostane tablets that can be safely cut into pieces, your vet will need to write you a new prescription if Fonzee needs a dosing change.

Also, you had asked earlier about twice daily dosing. Even though there have been several research studies that have advocated for dosing dogs twice each day so as to keep the cortisol level more consistently lowered, many vets in practice believe that the majority of the dogs they treat do just fine on a single daily dose. And that is what Dechra's published guidelines still recommend as their initial dosing instruction. A once daily dose is much easier for an owner to coordinate, so I guess the thinking is, "why rock the boat if the sailing is smooth." Due to the short half-life of the drug, some dogs do experience a rebound in symptoms later in the day, and for them, twice daily dosing would be preferred. Diabetic dogs also are often placed on a twice daily regimen. Some experts and specialists prefer twice daily dosing from the get-go, and we've also had members here whose dogs just experienced better control and did better on a twice daily dose. But having started out dosing my own Cushpup twice daily without first having seen if he would have done fine on a single daily dose -- I'd start out once a day, myself, and only shift to twice a day if my dog wasn't responding well. It would just make life a little bit easier.

Marianne

[TheFonz31]

Thanks for the advice Marianne, you f-in rock! haha

Fonzee did start out on a twice daily dosage of 60 mg in the morning and 60 mg in the evening and after I said a few months and re-testing was reduced to 60mg once a day.

At its worst prior to getting on the meds he would refuse to go on a walk, presumably due to the pain in his body. Even now I gave him the medicine and it just knocks him out and he sleeps for 3-4 hours.

I called a specialist and they said if I brought him in they would test from scratch even if I got the ACTH test done by my vet, so it looks like its going to be quite costly if I go that route.

I'm going to stick to this plan and see how he does on a lower dose, mainly if he gains weight back.

Any idea how to control the barking at night?? Part of it I believe is lack of exercise, I mean I play with him since I work from home and occasionally take him for a short walk. I notice on the days where I stay up late and let him hang with me he doesn't bark much. He is an indoor dog, but restricted to the downstairs area, so I think that's part of it. He wants attention.....

Thanks again and I look forward to keeping you posted!

[labblab]

I called a specialist and they said if I brought him in they would test from scratch even if I got the ACTH test done by my vet, so it looks like its going to be quite costly if I go that route.

Yeah, I kinda figured that they might want to do the testing themselves in order to ensure the accuracy. But in honesty, you still may want to consider that as an option -- taking Fonzee to them for the ACTH and the other simple basic blood panels. You can check to see if they would charge more than your GP vet. But if not (or if not much more), it may end up saving you money in the long run. Right now, we're assuming that Fonzee's trilostane dose should be lowered. But that may or may not be true. And if it has nothing to do with his weight loss, then you may be ahead of the curve by letting the specialist take a look at Fonzee and offer his/her opinion as to what is going on. If you go to a specialist, you don't have to agree to any testing that you don't think is necessary or appropriate. But having them perform the ACTH and simple blood panels may end up giving you a lot of helpful insight as to what may be going on with your boy.

You've still got a couple of days to think things over, so I just wanted to offer the suggestion out for your consideration.

Marianne

[Squirt's Mom]

Hi Sunny,

I would strongly recommend you also have an abdominal ultrasound done. This test will tell you very much about the condition of organs such as the liver, kidneys, gall bladder, intestines, stomach, bladder, spleen as well as the adrenal glands, that play such a huge role in Cushing's, to name a few. The weight loss is quite concerning to me and I would want a look at the liver especially.

Having computer issues but will keep an eye out as much as possible. Always sending you hope, strength, and support.

Hugs,
Leslie and the gang

[TheFonz31]

Hi Sunny,

I would strongly recommend you also have an abdominal ultrasound done. This test will tell you very much about the condition of organs such as the liver, kidneys, gall bladder, intestines, stomach, bladder, spleen as well as the adrenal glands, that play such a huge role in Cushing's, to name a few. The weight loss is quite concerning to me and I would want a look at the liver especially.

Having computer issues but will keep an eye out as much as possible. Always sending you hope, strength, and support.

Hugs,
Leslie and the gang



Thanks for the support and advice. For now im going to keep the appt with my gp for the ACTH test on Sat. If i feel like hes not in tune with what i feel and what all ya'll are suggesting i will take him to the specialist. Most likely will take him in either case since thats their forte....


Thanks all i'm recovering from shoulder surgery....crazy week for me!

Will keep u all*posted!

[BestBuddy]

Hi,

Just wondering if Fonzee had been tested for diabetes? It is very easy to test for and diagnose but for some reason a lot of vets don't think of it. I just hear ringing bells regarding the weight loss.

Jenny

[TheFonz31]

Hi,

Just wondering if Fonzee had been tested for diabetes? It is very easy to test for and diagnose but for some reason a lot of vets don't think of it. I just hear ringing bells regarding the weight loss.

Jenny

Hi Jenny,

I don't believe Fonzee has been tested for diabetes, but I do have an update and maybe this will be the tip of the iceberg.


So I took Fonzee in for his ACTH stim test on Saturday; he had been on his normal 60mg dose of Trilo for 4 consecutive days and the test was done 4.5 hours after the dose was given.

His post cortisol levels came back at 5, which the doctor said is completely normal and indicates that the medicine is working and the 60mg dosage is good for him.

He also tested his liver and kidney enzymes and said that the liver enzymes came back very very high. I don't remember the exact numbers, but he said one was suppose to be around 105-120 and Fonzee was at 540! And that a second one was suppose to be in the fifties but was over double that. I will try and get a copy of the exam report.

My doctor said that his liver is not breaking down the dry food he eats and that he feels that changing the diet to lean meats, and some carbs like potatoes, rice etc will help reduce the stress on Fonzee's liver, help him break down his food better and gain some weight.

He also mentioned that there are treatments for the high liver enzymes, but that with his age (16) there can be some risk.

So in summary my vet feels like his weight loss is due to the stress of Cushing's on his liver, which makes sense.

If anyone has any advice, input, thoughts I would love to hear it. We have bought a bunch of chicken and lean beef and plan on making him different meals every night and hopefully he can put on 3-5 lbs.


I look forward to your replies.


Thank you,

[lulusmom]

Hi Sunny,

I just want to caution you that if after only 4 days, Fonzee's post stimulated number is 5, you should be very concerned that the cortisol will continue to fall. Trilostane will definitely continue to drop cortisol in the first week or two and we've seen it continue to drop cortisol well into 30 days so I am very concerned about Fonzee. When did your vet schedule the next stim test?

[Harley PoMMom]

Weight-loss is very unusual for a Cush-pup as they usually have a ravenous appetite. If diabetes has not be ruled out, IMO, it should be.

As far as his liver, my boy Harley had an enlarged liver with his liver enzymes very, very elevated and still ate very well. Like most members here I did have Harley on a liver support supplement. Milk thistle and Denamarin are the liver support supplements that are used most.

Fonzee's ACTH test results do look very good but as we have seen with dogs taking Vetoryl/Trilostane over a period of time with the same dosage that their cortisol can drop lower. I would keep a eye out for low cortisol symptoms such as diarrhea, vomiting and/or lethargy.

Keep up the great work and please do keep us posted.

Love and hugs,
Lori

[TheFonz31]

Hi Sunny,

I just want to caution you that if after only 4 days, Fonzee's post stimulated number is 5, you should be very concerned that the cortisol will continue to fall. Trilostane will definitely continue to drop cortisol in the first week or two and we've seen it continue to drop cortisol well into 30 days so I am very concerned about Fonzee. When did your vet schedule the next stim test?

Hi Lulu,

Thanks for the reply. Fonzee has been on the same dosage of Trilostane for almost 2 years or so. It was just that prior to scheduling this ACTH stim test we were giving him the dosage at different times in the day. So after reading up here I wanted to get him on a set schedule to help ensure a more accurate reading on the test itself.

The doctor said changing the diet should help the liver enzymes to return to a closer to normal range, he feels like Fonzee is having trouble breaking down the dry food and it makes sense.

However I guess I'm not sure now if he has diabetes because of the Cushing's or if simply switching his diet will do the trick?

[TheFonz31]

Weight-loss is very unusual for a Cush-pup as they usually have a ravenous appetite. If diabetes has not be ruled out, IMO, it should be.

As far as his liver, my boy Harley had an enlarged liver with his liver enzymes very, very elevated and still ate very well. Like most members here I did have Harley on a liver support supplement. Milk thistle and Denamarin are the liver support supplements that are used most.

Fonzee's ACTH test results do look very good but as we have seen with dogs taking Vetoryl/Trilostane over a period of time with the same dosage that their cortisol can drop lower. I would keep a eye out for low cortisol symptoms such as diarrhea, vomiting and/or lethargy.

Keep up the great work and please do keep us posted.

Love and hugs,
Lori


Thanks Lori!

Fonzee has no vomiting or diarrhea, stools look very well formed. He does get lethargic from time to time and obviously has the noticeable weight loss.

He also has a very strong appetite, its just that he doesn't like or won't eat his dry food. He's always trying to grab table scraps though. If I feed him anything its always lean meat, some veggies and on occasion some rice or fruit.

Any tips on what diet is best? I will also look into the liver support supplements.

I am starting to think he is showing signs of diabetes based on the liver enzyme results.

However from what I'm reading diabetes is common with Cushing's?

Also it should be noted that his kidney enzymes were normal

Any thoughts on his Trilostane dosage, which is currently 60 mg once a day. The vet feels this is the right dosage for him and to continue at this once a day.

[Harley PoMMom]

Any tips on what diet is best? I will also look into the liver support supplements.

I am starting to think he is showing signs of diabetes based on the liver enzyme results.

For the liver, white fish such as tilapia or cod are very good sources of protein as are eggs. Skinless, boneless chicken is also very good.



However from what I'm reading diabetes is common with Cushing's?

Diabetes and a whole host of other diseases can be associated with dog's that have Cushing's. Like I mentioned before I would have diabetes ruled out.





Any thoughts on his Trilostane dosage, which is currently 60 mg once a day. The vet feels this is the right dosage for him and to continue at this once a day.

How much does Fonzee weigh? All dogs are different and react differently to the Cushing medicines. I would watch Fonzee for any adverse reactions. When is the next ACTH stim test scheduled for?

Love and hugs,
Lori

[labblab]

Hi again, Sunny.

Were Fonzee's liver enzymes part of a broader blood panel? I would assume so, and typically such a panel would also include testing of Fonzee's blood glucose level (this could appear as "glucose" or several other abbreviations such as "Gl" or "Glu" or even "BG"). If Fonzee's blood glucose level was normal, then diabetes is an unlikely culprit. So it may already have been ruled out without you knowing it. Aside from the elevated liver enzymes, were there any other abnormal results on Fonzee's bloodwork?

And as for the liver elevations, the numbers that you are quoting are not at all unusual for a Cushpup.


He also tested his liver and kidney enzymes and said that the liver enzymes came back very very high. I don't remember the exact numbers, but he said one was suppose to be around 105-120 and Fonzee was at 540! And that a second one was suppose to be in the fifties but was over double that. I will try and get a copy of the exam report.
We have many dogs here with elevations that are far greater than Fonzee's. Sometimes effective Cushing's treatment does lower liver enzymes back to a normal range. But my own IMS cautioned me that sometimes they always remain chronically elevated for Cushing's dogs, regardless of treatment for the high cortisol.

So even though it is a good idea to do whatever is possible to ease Fonzee's liver, I would not be convinced that it is the cause of his weight loss. I do agree that the post-ACTH result of 5 falls within the desired therapeutic range, and therefore the trilostane doesn't seem to be the immediate cause, either. Your current dosing of 60 mg. in the morning seems to be effective (earlier in the week, he had only gone for a day and a half without the medication, correct?).

I'm still a little confused about his appetite. When you say that he doesn't like his dry food, is he not eating the full amount that would be recommended for him during the course of the day (although he will readily eat "human" food)? Has he been on this same food throughout the duration of his weight loss? And the weight loss has been chronic rather than acute -- stretching out over a year or more? Maybe the food really has been inadequate in nutrition for him.

But if a feeding change does not result in a pretty quick turn-around, I'd still worry that there is another cause of his weight loss. Depending upon how comprehensive Fonzee's blood panels were this time around, if it were me, I'd might want some additional lab testing performed now. And again, if the dietary change doesn't quickly help, I'd then want to pursue an abdominal ultrasound to look at his internal organs (performed by a specialist). Once again, I think the input from an internist could be very valuable for a number of reasons since your vet seems to be at the end of his diagnostics.

Marianne

[TheFonz31]

For the liver, white fish such as tilapia or cod are very good sources of protein as are eggs. Skinless, boneless chicken is also very good.

Thanks so much this is exactly what I was looking for!

Diabetes and a whole host of other diseases can be associated with dog's that have Cushing's. Like I mentioned before I would have diabetes ruled out.

Just curious, would weight loss be associated with diabetes? Because he's def underweight, which is where my main concern is coming from.

How much does Fonzee weigh? All dogs are different and react differently to the Cushing medicines. I would watch Fonzee for any adverse reactions. When is the next ACTH stim test scheduled for?

At his recent doctor's visit he weighed 17.5 lbs. Keep in mind he was around 33-35 before he had Cushing's, which was about 6 years ago now. He is old, just turned 16, but I feel certain that he shouldn't have lost so much weight.

Furthermore, I have been giving him a mixed diet of lean meats, (beef, chicken, eggs) rice, potatoes some mixed veggies and he gulps it right down. When he was eating the dry food, he really had to be forced to eat it. I know Cushing's can make them gain weight from a voracious appetite, but I'd say his is holding steady.

Love and hugs,
Lori



Thanks so much Lori.

My apologies for being MIA for the past couple weeks. I had shoulder surgery (doing well) and was out of town on business. My vet said holding Fonzee at 60mg was the right choice since his numbers are showing up positive on the ACTH stim test. His post cortisol level was 5, which I understand it good, but not always indicative that things are peachy.

Another thing I'm concerned about is his left hind leg. He clearly is having muscle wasting in that leg (he did have surgery on that leg years ago from a fall). He is not putting much weight on that leg, however he runs and walks around fine. I know that's most likely another Cushing's symptom.

I've had him on a whole foods diet now for about 2 weeks, he is eating well, mood is great, energy is good. But it doesn't look like he's gaining any weight.

Do you guys think it would be a good idea to feed him a small portion in the morning and a good sized dinner? I feel so bad when I see him so skinny and I don't want people to think I neglect him, he's my world.


Thanks so much

[TheFonz31]

Hi again, Sunny.

Were Fonzee's liver enzymes part of a broader blood panel? I would assume so, and typically such a panel would also include testing of Fonzee's blood glucose level (this could appear as "glucose" or several other abbreviations such as "Gl" or "Glu" or even "BG"). If Fonzee's blood glucose level was normal, then diabetes is an unlikely culprit. So it may already have been ruled out without you knowing it. Aside from the elevated liver enzymes, were there any other abnormal results on Fonzee's bloodwork?

Yes I believe it was part of a broader blood panel, I didn't ask the doctor. Unless of course they test liver enzymes on the standard stim test? My doc is usually pretty through, he didn't mention anything about blood glucose levels, but I will be asking him shortly since I'm still concerned about Fonzee. No other abnormal results aside from the liver enzymes.

And as for the liver elevations, the numbers that you are quoting are not at all unusual for a Cushpup.

Thanks for letting me know that, I realize it due to the Cushing's but was alarmed at the way he made it seem.


We have many dogs here with elevations that are far greater than Fonzee's. Sometimes effective Cushing's treatment does lower liver enzymes back to a normal range. But my own IMS cautioned me that sometimes they always remain chronically elevated for Cushing's dogs, regardless of treatment for the high cortisol.

Interesting and something I will remember, thanks again for this tidbit.

So even though it is a good idea to do whatever is possible to ease Fonzee's liver, I would not be convinced that it is the cause of his weight loss. I do agree that the post-ACTH result of 5 falls within the desired therapeutic range, and therefore the trilostane doesn't seem to be the immediate cause, either. Your current dosing of 60 mg. in the morning seems to be effective (earlier in the week, he had only gone for a day and a half without the medication, correct?).

Yes only a day and half without it and prior to that he was consistently on 60mg for the past couple of years. But I've steadily watched him lose weight, part of that I now believe was to the fact that he couldn't properly digest the dry food and also likely that he was sick of it. He has always had a healthy appetite, there were times where he wasn't eating his dry food and would jump up and grab food off my plate and become very defensive because he was hungry.

I'm still a little confused about his appetite. When you say that he doesn't like his dry food, is he not eating the full amount that would be recommended for him during the course of the day (although he will readily eat "human" food)?

Yes that's exactly it. He's always been a free feeder, nibbling here and there throughout the day and then eating a hearty portion at night. We fill his bowl up (pretty big bowl) and that would usually last 2 days max. Prior to switching up his diet, there were days when his food would sit there for 4-5 days barely touched. But he would always want my food, so I know he's hungry and possibly just not digesting his dry food well?

Has he been on this same food throughout the duration of his weight loss? And the weight loss has been chronic rather than acute -- stretching out over a year or more? Maybe the food really has been inadequate in nutrition for him.

Yes he's been on the same food, he did well with it for years, but yes your correct. I've steadily watched him lose weight over the past 3 years. From 28 lbs, to 25 lbs, to 22 lbs to 19 and now 17lbs. Granted he's 16 and part of it I'm sure is age, but its a lot. He's a tall cocker and therefore looks skinny at 22 lbs, now he looks anorexic.

But if a feeding change does not result in a pretty quick turn-around, I'd still worry that there is another cause of his weight loss. Depending upon how comprehensive Fonzee's blood panels were this time around, if it were me, I'd might want some additional lab testing performed now. And again, if the dietary change doesn't quickly help, I'd then want to pursue an abdominal ultrasound to look at his internal organs (performed by a specialist). Once again, I think the input from an internist could be very valuable for a number of reasons since your vet seems to be at the end of his diagnostics.

I agree with your thoughts here. I think perhaps I'm not feeding him enough and was asking Lori that maybe adding a morning meal would help?


Marianne



You guys are awesome, thanks for the support.


Look forward to your replies.

[labblab]

Hi Sunny,

It's great to see you and Fonzee back here! I'm also really glad to hear about the good result on his ACTH test, and also that he seems to be feeling so well. :)

I'm not very knowledgeable about dietary specifics, but I would see no reason why you can't give Fonzee two meals daily. I've always fed my dogs twice daily (I figure it gives them double the pleasure ;)). Just be sure that you continue to give him food at the same time that he receives his trilostane, since the medication is absorbed most efficiently when given along with at least a small meal.

I'll be hoping that he does gain some weight before long. But at this point, I'm guessing that you're also happy just as long as he isn't losing any more. Please continue to update us (and good luck on your shoulder recovery!).

Marianne

[Harley PoMMom]

Thanks so much Lori.

My apologies for being MIA for the past couple weeks. I had shoulder surgery (doing well) and was out of town on business. My vet said holding Fonzee at 60mg was the right choice since his numbers are showing up positive on the ACTH stim test. His post cortisol level was 5, which I understand it good, but not always indicative that things are peachy.

I am so sorry to hear about your surgery but very happy you are doing well!

According to Dechra a pup's cortisol can be as high as 9.1 ug/dl as long as the pup's clinical symptoms are controlled. I do believe that how a pup is feeling/acting is just as important as the ACTH stim numbers.



Do you guys think it would be a good idea to feed him a small portion in the morning and a good sized dinner? I feel so bad when I see him so skinny and I don't want people to think I neglect him, he's my world.



If it is convenient and since you want to put weight on him, I would try to spread his meals throughout the day, split his meals into 3-4 smaller portions. Maybe adding some carbs like rice, pasta or potatoes will help him gain weight.

Hope this helps.

Love and hugs,
Lori

[TheFonz31]

Hey gang,

So a couple of things I've noticed about Fonzee and wanted your input.

Since I have switched him away from his dry food to a meat and veggies with some starches (rice, potatoes) type diet, he isn't drinking water. I mean like maybe a couple sips throughout the day and that's it! We use to fill up his huge water bowl once every couple days, now its been 4 days and its still not even half way?

Secondly, I know this is common with older dogs and Cushing's dogs, but he has been regularly having accidents in the house. Sometimes he will bark to let me know he needs to go out, other times I will go down to the kitchen (where he sleeps) and see an accident. This has been happening for about 6-8 months now. Keep in mind he just turned 16.

As a result of the lack of water, his urine really stinks....like I'm talking you can smell it from several feet away! LOL

Are these possible signs that his dosage is too high? I know you guys mentioned symptoms are sometimes our best indicator.

Other than the weak back left leg, he seems to be doing very well. He runs around, goes on short walks, is playful and looks to be in good spirits.


Thanks for your thoughts and any help.


Sunny

[Squirt's Mom]

Hi Sunny,

A pup eating kibble, dry feed, will drink quite a bit more water than one eating any other form of feed. So the decrease in water intake is not alarming in and of itself since he is no longer eating kibble. However, the concentration of the urine and the odor shouldn't be that much stronger. If it is really dark and strong smelling, then you may be looking at signs of a UTI.

Hugs,
Leslie and the gang

[lulusmom]

As Leslie mentioned, Fonzee could have a UTI. The color and odor as well as accidents in the house are all signs of a UTI so you may want to have Fonzee checked out by the vet.

I have two dogs, one a cushdog, who don't drink enough water and unless I make sure they get more water, their urine will be highly concentrated and smelly. Both have had bladder stones as well so I try hard to get plenty of water in them. They are already on a moist diet but I add water or broth from boiled boneless and skinless chicken breasts to their food.

[TheFonz31]

Thanks for the replies, I'll try adding a broth and see how it likes it. I use to re-fill his water bowl every couple days, now it sits there barely touched for 4 days! I have resorted to putting water in my hand and making him drink it.

The second thing I'm worried about is his left eye and left rear leg. His left eye gets very dry and looks very irritated most of the time. The right eye seems fine. He does have the early signs of cataracts in the left eye, but the "cherry eye" is common in Cocker's. I have a Neosporin like ointment that the vet prescribed that helps, but within a few hours it gets dry again. Any ideas on that?

And for the leg, I know that their rear legs get weak when they have Cushing's, but is there anything we can do for it? He's on a joint supplement, but nothing more. He still walks and runs, but there's a noticeable little limp to it when he walks. He did tear some ligaments in that knee years ago, but had surgery and was fine.

Man all this is so overwhelming, just seems like one thing after another with these Cushing's dogs. I feel so bad for him and want to make sure I'm doing everything possible.

I plan on taking him back to the vet next month if he doesn't gain any weight on this new diet.



Sunny

[frijole]

Heh Sunny... Hang in there.. know it can be tough but you are doing just fine. My 15 yr old schnauzer just had to go to an eye doctor and that is a first for me... lord knows I have been to every other type of vet. :) Anyway.. the neosporin like gel is probably liquid tears which is used to keep the eye moist. There could be an infection of some sort, allergies, or what happened to me is my dog must have walked into something and ruptured her cornea. It takes a while to heal and sometimes you need to have it tested - they use a dye. Not sure if you have had this done or not but just in case.

Re the hind legs... had two dogs with those issues.. glucosamine chondrontin for starters - you can get treats with the daily dose already in it or you can get capsules and pour into food. Fish oil is good and I also have been using a 'holistic anti inflammatory' that the head of the vet hospital at Kansas State recommended. It is called Duralactin. It is all natural and it really helps her. Chewable tablets. You can buy online without prescription.

Take care! Kim

[StarDeb55]

Sunny, I have not posted to you before, but have been following. I notice your comments about the left eye dryness, & am wondering if Fonzee has ever has a test for dry eye. It's very simply, doesn't require any injections or medication, & it may provide the answer for what is going on with that eye. If it is dry eye, there are several medications which will encourage the eye to make tears, but these drops will be life long. It's very important to determine if this is dry eye because chronic dry eye can lead to permanent corneal damage & blindness.

Debbie

[Squirt's Mom]

Hi Sunny,

It isn't uncommon for problems like arthritis and other inflammatory conditions to become more obvious once the cortisol is lowered since cortisol is a natural anti-inflammatory.

You say Fonze is on a supplement for his joints. What supplement is he taking? My Squirt has had both knees done, and one re-done this past July when the pin came out so we have tried many different supplements. The best source I have found for glucosamine is GlycoFlex. A good Omega-3 oil will help, too, and there are several good ones available. Currently, I am using one from Only Natural Pet called Pure Salmon Oil that I really like. When shopping for fish oils, look for the highest EPA and DHA you can find. Kronch makes a good oil, too. You will need to add Vitamin E along with the fish oil to prevent oxidation in the body which causes free radicals. NOW Foods makes a Vit E oil in liquid form that is much easier to give than the capsules for me. Fonze may swallow the Vit E caps just fine but I was having to puncture the little boogers and that is a pain so I was glad to find a liquid form that can be used internally. Plus, I'm basically lazy! ;)

You might also try MSM, SAM-e, or Cetyl Myristoleate. I have used CM for myself with good results but you have to give it time to build up in the system before you see any results.

There are herbs that can help like Boswellia, Devils' Claw, Yucca root, Feverfew to name a few. Also Vit C can help. You will take Fonze up on dosage to bowel tolerance - ie until he develops loose stools - then drop back to the dosage before that did NOT cause loose stools and maintain that level. Use an ascorbate form of vitamin C, such as Calcium Ascorbate or Ester C, rather than Ascorbic Acid, which is more likely to cause stomach upset.

Acupuncture, massage and low-impact exercise like swimming can also help.

I hope this helps and gives you some ideas....and also lets you know there are things you can do to help Fonze.

I'm glad Debbie talked to you about dry eye. I have two blind babies but they were blind when I got them so I didn't go through the process of trying to save their vision. I can tell you that both of my blind babies are happy, healthy, and NOT handicapped at all. In fact, the first time our vet saw Trinket, he thought she could see a little bit until I told him she didn't have any eyeballs to see with! :D Trinket lost her vision due to glaucoma and Brick from Hydrocephalus. I hope Fonzie's eye does well with the ointment (and there is no reason the believe it won't) but wanted you to know that if the worst should happen, it will more than likely be much harder for you to adjust than it would be for him. ;)

Keep in touch!
Hugs,
Leslie and the gang

[TheFonz31]

Thanks for the advice and replies guys, really helps!

Fonzee is on a Gluco/Chond formula and has been doing well with it. I do incorporate some Vit E as well, I'm not a big fan of fish oil since I believe many of the over the counter ones are of very low quality, esp by the time it sits on the shelf at the store, oxidation to the max.

I do believe what he has is chronic dry eye, it might be caused by an allergy because I notice it acts up when the weather warms up. In the meantime I've been using the ointment several times a day and it def helps. I was curious about whether I could use artificial tear drops on him? I had lasik done a while back and have tons of those drops...

I do believe Fonzee had an eye test a while back which showed he had dry eye syndrome, the whites of his eye on the irritated one is very red, while the other side is perfectly healthy. Perhaps the cataracts started due to this and his age?

I've been feeding him twice a day, he gobbles his food up, is looking a little better, but not sure if he's gained any weight. Will weigh him and report back.


Thanks for the help, will keep you all posted!



Sunny

[StarDeb55]

The only 2 effective meds for dry eye are tacrolimus or cyclosporin. They do come in either drops or ointment. If the ointment you have isn't one of the above, I'm afraid it's not going to be that effective. Dry eye is actually an immune system problem where the tear glands/ducts are being damaged. These meds are normally used twice a day, I, personally have not heard of another dosing schedule, & am now on my 3rd pup with dry eye. These meds help to slow that down, along with promoting the tear glands to produce tears. You can use over the counter drops for temporary relief, but they must be only artificial tears with nothing else such as drops to help control itching or burning.

Debbie

[jani]

Hi,

You must keep the numbers in check with a ACTH test to make sure the Cushing's does not turn into Addison's disease. Which is the opposite of Cushing's. Addison's will make a dog lose weight. I'm with you...get another vet. You should be with a specialist in this field. You live down there in OC....you will find a good one.

the best of luck.

jani

[TheFonz31]

Hey guys,

Been about a month since I posted, so i wanted to update you all on Fonzee and of course ask some questions.

First of all, the main reason I started posting here was due to his weight, he was looking extremely thin, to the point where I get looks from people when i take him out even though he eats.

For the past 6 weeks or so I have been feeding him twice a day and he def has a healthy appetite, he eats all the food up as fast as he can. Sadly though he's only gained a little over a pound. So he started at 18lbs and now is just over 19. I see the Jani mentioned Addison's which is something I will have to look into now because I'm obviously concerned.

Second issue.... last night I was up late watching TV, Fonzee woke up and came by the couch and proceeded to walk in circles for a while. At least a solid 5-7 minutes. I had noticed over the past several months that he would walk in circles, but it was only for a few seconds as he was about to sit down. Yesterday was the first time I noticed him just constantly walking in circles for that long continuously. As I started researching the first thing that came to mind was macroadenoma. Of course I'm not sure and I'm going to take him to the vet, but he's been living with Cushing's now for over 5 years.

As I was looking at other posts here from members, I then also remembered about 3 months ago how he seemed really disoriented one day. I was sitting down stairs and he was bummed into the wall a couple times, looked a little disoriented and I was puzzled as to what was going on. I feel horrible as I research as see that he might have been having a seizure??? For the record he has never done that before or since that day, but it def was weird to say the least.

Lastly as I mentioned before, he has the weak left rear leg presumably from the Cushing's. He bumps into stuff on occasion, will fall sometimes due to the rear leg and it really sucks seeing him go through so much.

I know we talked about getting him to a specialist, but money is def a concern right now. I think I'm going to take him to our vet, describe the symptoms and see if he refers me to a specialist. I'll have to find a way to get some money for him because I don't want him to suffer. That's always been my #1 rule, I won't allow my selfishness to keep him around if he's suffering.


This morning he looks completely fine, high energy, smiling and walking around like normal.


Any input on the repeated circles? Also the one episode where he seemed disoriented, bumming into the walls? So far I'm also looking at Epilepsy, along with all other possible causes.



Thx all,


Sunny

[littleone1]

Hi Sunny,

Corky had seizures years before he had any cushings symptoms. He would actually thrash into the walls. As time went on, they became less frequent and were shorter in duration. His wasn't epilepsy, but his vet didn't know the cause of it. He hasn't had one in over two years.

I don't know what causes the circling, but one of our members experienced this with her furbaby. Her IMS told her that it was related to something with the liver. When I talk to her again, I'll see if she can tell me what it actually was.

Terri

[Squirt's Mom]

Hi Sunny,

Another possibility is CCS, Canine Cognitive Syndrome. At Fonzee's age this is certainly a consideration. It can be treated with Anipryl or other meds to help him. Here are some links about CCS -

CCS info

http://www.thepetcenter.com/imtop/cds.html
http://www.cpvh.com/Articles/4.html
http://www.lbah.com/cds.htm *
http://www.cdsindogs.com
http://www.veterinarypartner.com/Content.plx?P=A&A=2549


And a couple on seizures -

Petit Mal or focal seizures

http://www.thepetcenter.com/gen/epilepsy.html
http://www.canine-epilepsy.net/basics/basics_index.html

Hang in there!

Hugs,
Leslie and the gang

[TheFonz31]

Hi Sunny,

Corky had seizures years before he had any cushings symptoms. He would actually thrash into the walls. As time went on, they became less frequent and were shorter in duration. His wasn't epilepsy, but his vet didn't know the cause of it. He hasn't had one in over two years.

I don't know what causes the circling, but one of our members experienced this with her furbaby. Her IMS told her that it was related to something with the liver. When I talk to her again, I'll see if she can tell me what it actually was.

Terri


Hey Terri,

I've read some of your posts about your pooch and def appreciate your response.

That's interesting that you mention the liver since Fonzee's enzymes are high, like most due to the Cushing's. However he has been living with Cushing's for 5 years now, so I highly suspect that the tumor has grown since it was first diagnosed.

My sister has a little Yorkie that has liver shunts. Before we knew one day he was running into walls, his eyes were glassed over, foaming at the mouth, wimpering etc and we found out it was due to the shunts cycling the ammonia into his system instead of getting rid of it.

I just feel so bad for Fonzee, I know he's not in pain, but I also know he can tell something feels off and I just want to fix it. Gonna take him to the vet this week and see what's up.

Thx!


Sunny

[TheFonz31]

Hi Sunny,

Another possibility is CCS, Canine Cognitive Syndrome. At Fonzee's age this is certainly a consideration. It can be treated with Anipryl or other meds to help him. Here are some links about CCS -

CCS info

http://www.thepetcenter.com/imtop/cds.html
http://www.cpvh.com/Articles/4.html
http://www.lbah.com/cds.htm *
http://www.cdsindogs.com
http://www.veterinarypartner.com/Content.plx?P=A&A=2549


And a couple on seizures -

Petit Mal or focal seizures

http://www.thepetcenter.com/gen/epilepsy.html
http://www.canine-epilepsy.net/basics/basics_index.html

Hang in there!

Hugs,
Leslie and the gang


Thx Leslie! I haven't read any of the links yet, so perhaps it mentions it in there, but do you know off hand if there is any interaction between those drugs if he needs them and Trilostane? Just don't want to overwhelm him since his immune system is already surpressed. Also going to look into Addison's since he's still not really gaining any weight other than the pound he put on when I switched him off his dry food.

Its strange because I love dogs so much and this past year or so has really made me wonder whether I will ever get another one since it just sucks so bad to watch this happen to someone you care about so much.


Thx for the advice!


Sunny

[TheFonz31]

Update:

Well i took Fonzee to the vet today and sadly its not looking good. This morning when we gave him his dose of Trilostane he immediately threw it back up and there was a lot of thick bile in his throw up.

Based on all his symptoms our vet highly suspects he's showing early signs of liver failure.

We are feeding more than he has ever got in the past and yet, he lost another 2 pounds! He's now down to a little over 16 pounds, truly skin and bones.

Our last ditch effort is to try a special liver diet and Denosyl once a day to help give his liver some relief.

If this doesn't help at all, the vet has recommended that we put Fonzee down. At this point I can't say I disagree with him, although it doesn't appear he is suffering, I know mentally he's probably exhausted:

-his rear leg is so weak
-he walks in circles a lot
-he has toxins running through his system that cause him to lose his balance, run into walls etc
-has accidents in the house several times a day
-he's now sleeping for most of the day

However with all that said, he still wags his tail, has a smile on his face when he see's me and has an incredible will to live.

As an owner I don't want to ever let him suffer, but at the same time I want him to live as long as possible. I'm sure many of you have been in my spot.

If anyone can offer an insight, I'm open to hearing it. Pretty bummed out right now, hopefully he starts showing improvement.




Sunny

[addy]

In addition to treating the liver disease, it is important to control and prevent complications, particularly hepatic encephalopathy and bleeding. This may involve feeding a special diet that is low in protein, lowering blood ammonia levels, maintaining blood-clotting factors, preventing seizures, correcting electrolyte abnormalities, and administering antacids to prevent stomach and duodenal ulcers. Supplements such as SAM-e and milk thistle are useful in both restoring and maintaining normal liver function.

Hepatic encephalopathy can affect the brain (ammonia levels are too high) and cause walking into walls, circles, leg weakness.

I am hoping the diet change helps your pup.

hugs,
Addy

[littleone1]

Hi Sunny,

I'm sending positive thoughts and prayers that a change in diet and the Denosyl will help Fonzee.

[kapohotricia]

Hi Sunny,

I agree about that seeming like a high dose. My 21 lb Boston Terrier, Kirby, was started on 60mg Trilostane but it was too high and he was immediately switched to 10 mg. A stim test one month later showed his cortisol levels coming way down, even on only 10mg, and he did lose a pound. He was then lowered to 5mg a month ago and has stopped losing weight. He is rather lethargic and his legs do tremble a little but he is old too. Older dogs can have arthritis and many other things that can cause similar symptoms so thorough checkups are important. My otherwise healthy 15 year old girl slept most of the time in her last year and she could hardly walk her legs got so weak.

Kirby had another stim test today, one month later, because the vet isn't sure she has the dose right yet. If the results show his cortisol levels are now within the guidelines and stable, she will do a maintenance checkup and stim test every three months while he is doing well.

Keep us posted and lots of aloha from us,

Tricia and Kirby

[TheFonz31]

Hey guys,

Thanks for the replies, really appreciate it.

I do have good news; switching the diet made an over-night improvement; dramatic. He was much more alert, not lethargic at all, didn't walk in circles and was easily able to recognize me putting little bits of food on the ground.

So it looks like the amount of protein we were giving him was waaaaaay too much, creating the influx of ammonia in his system.

Hopefully this diet switch and the Denosyl will help him improve even more.


Tricia: I tend to agree with you on the dosage for Fonzee being too high. But I specifically asked my vet about this and he said he felt it was the right dose since Fonzee is showing continued improvement on his stim tests at that dosage. However, he's a GP not a specialist so he could be interpreting some of the values in the wrong manner. For example, when he first got diagnosed with Cushing's, his liver enzymes were out of the roof high (1000 plus). Now they are down to 500 something, still high but much better. Is it possible that these numbers are lower because his liver is shutting down?

I think this has been asked before, but would giving Fonzee half the dose of Trilostane be a smart idea? Based on the Trilostane instructions, its based on weight and his weight keeps dipping lower and lower. I think somewhere between 20-30mg which still might be too high, might be best for him and help him gain weight.

Thx again,


Sunny

[Harley PoMMom]

Hi Sunny,

You may want to ask your vet about Ursodiol. Ursodiol has been used in the treatment of chronic diseases of the liver. Has a bile acid test been done on Fonzee? A bile acid test is a highly sensitive and specific test of liver function.

Keeping you both in my thoughts and prayers.

Love and hugs,
Lori

[MarikaZoll]

HI. My dog an this dog sound like one and the same. Extreme weight loss and trembling. Although my dog does not want to eat. ACTH says he is on the right dose. 20mg twice daily. He is a french bulldog. Weighed 37 pounds and now is 24 pounds. I recommend anyone call Dechtra. They were amazing on the phone and recommended stopping! the half life of this drug is about 18 hours. After stopping they are back to zero. Hence, I was told he could restart another drug if necessary soon. I wonder if anyone can elaborate on this. Which other drug? After reading here I wonder if I should just try doing really small doses if you all think that too much would decrease appetite, alhtough even dechtra does not say this. Is is simply a side effect for some dogs. ACTH was good only 1 month ago, already into the weight loss and severe lethargy. I am stumped. What drug. any ideas.:mad: