Hello! New Here...

[Jme42077]

Hi. My name is Jaime and I have an 8 year old Corgi, Cooper, that was just diagnosed with Cushing's. We do not have all the details yet because we meet with the specialist in a week.

I have been reading a lot online about this disease. One thing that I haven't seen in reading about this is about how a dog walks. My Cooper walks completely stiff and has problems getting up from laying down. When he walks it is a weird swagger from side to side and his back legs do not move.

Also, I would like to know if this is painful for him. I know he must be uncomfortable since he is so stiff but is this disease painful to dogs?

Sorry if these questions have been answered a million times on here. I am just a bit overwhelmed by all that has been read and what this means for my poor little guy.

Thanks! :D

[Harley PoMMom]

Hi Jaime and Cooper,

Welcome to you both, so sorry for the circumstances that brought you here but so glad you found us.

If you could get copies of all test/s that were done on Cooper and post the results here that would help us to provide you with more meaningful feedback.

It sounds like Cooper may have an uncommon/rare complication of Cushing's called pseudomyotonia. Here's an excerpt from the article Canine Hyuperadrenocorticism and Pseudomyotonia (http://www.vmsg.com/canine-hyuperadrenocorticism-and-pseudomyotonia):
In rare cases of hyperadrenocorticism (<1%), dogs develop a myotonia (pseudomyotonia) coincident with the onset of Cushing’s disease.2 This syndrome is characterized by muscular hypertrophy and a stiff disabling gait (particularly of the pelvic limbs), in contrast to the typical clinical signs of muscular atrophy and weakness. The muscular rigidity may be so pronounced that the dog is non-ambulatory, and flexion of the hindlimbs may not be possible even under general anesthesia.3 In addition to the pelvic limbs, myotonia of the epaxial and thoracic limbs may also be apparent. Generally these animals are nonpainful and have an otherwise unremarkable neurologic examination. Percussion of the muscles may also produce a characteristic “myotonic dimple.”3


Here's another link from Dr. Mark Peterson's blog about this condition: Q & A: Pseudomyotonia in Dogs with Cushing's Syndrome? (http://endocrinevet.blogspot.com/2011/02/q-pseudomyotonia-in-dogs-with-cushings.html)

Please do not hesitate to ask any and all questions, we are here for you and Cooper and will help in any way we can.

Love and hugs,
Lori

[Jme42077]

Hi Lori! Thank you for the information!! This is exactly what my boy has, unfortunately. I am happy it says he isn't in pain! I am looking forward to meeting with the specialist soon to find out more and will try to get the results to post.

I am so happy that I found this site and can talk with others that are going through this!

Thanks again!
Jaime

[addy]

Hi Jaime,

I want to welcome you also. We are a supportive group that will try to help any way we can as you can see with Lori's quick reponse to your question.

Being overwhelmed is something we are all familar with so don't you worry about that.:D:D The more you learn, the more that feeling will come and go.

Glad you found us and we will wait for more information from your vet meeting.

Hugs,
Addy

[Squirt's Mom]

Hi Jamie,

Welcome to you and Cooper! :)

One thing you might want to look into for Cooper is acupuncture. I am not sure it will help but it is worth looking into. ;) I bet the specialist will be able to give you the name of someone who practices this approach along with a bunch more info that is gonna really overwhelm you. :p One thing you can always count on with Cushing's is adventure and opportunities for learning - learning more than you ever dreamed possible. :D

Something else you can look forward to are a few roller coaster rides. I, personally, have a season ticket to this particular ride. :p When these times come up, just know you are not alone, that we are here with you always, walking every step with you and Cooper. Don't hesitate to ask questions; we will do all we can to help you.

Hugs,
Leslie and the gang

[Jme42077]

Thank you for the welcome Addy and Leslie and Gang! I tried accupuncture for a month with Cooper and the vet decided it was no help. It was obvious he didn't respond. It seems he also has pseudomyotonia so that won't let his poor muscles loosen up. I am trying to read up on that and hope we can find something that will help with that. :(

[Jme42077]

Hello All! I am a bit ahead of myself since I have not met with the specialist yet regarding what type of medicine my Cooper will be prescribed but I wanted to try and be as prepared as possible. I have been reading how the medicine for Cushing's can get costly so I wonder if anyone has found an online pet meds place that they think is less expensive than getting the meds from the vet

Thanks!
Jaime and Cooper :)

Moderator note - I have merged your latest post about which med to choose with Cooper's original thread. We like to keep all the info about each pup in one thread. That way it is easier to look back at the history when needed.

[frijole]

There are alternatives that are cheaper either online or thru compounding companies. So don't worry about that - we'll help you there once your IMS tells you what they recommend. Keep us posted! Kim

[Jme42077]

Hi all! The vet prescribed Vetoryl 60 mg for Cooper once a day. I also have a copy of his test results. It looks like a jumbled mess to me so how can I tell which info would be helpful to post??

Thanks! :D
Jaime

[Harley PoMMom]

If the results are from an ACTH stimulation test then a pre number and a post number are what we would like to see. If the results are from a LDDS (low-dose dexamethasone suppression) test, there should be 3 blood draws taken which are a baseline/resting number, a 4 hour, and a 8 hour number.

Any abnormalities (lows or highs) that are shown in a CBC/Chemistry panel can be posted here with the reference ranges and units of measurements, as an example: ALT 140 (5-107U/L.)

Just curious, how much does Cooper weigh? And what symptoms does Cooper display?

Love and hugs,
Lori

[Skye]

Hello, wanted to check and see how all was going and let you know I was thinking of you and cooper.

[Jme42077]

Hi! Cooper weighs 26.5 lbs. We have had him checked out for muscle stiffness and he urinates for a long time. He had also started having accidents in the house. He was starting to drink a lot of water too. The vets had him on pain meds and at first we didn't think he had an issue with drinking too much but I took him off pain meds and he gets up to drink a lot! He was having seizures for a couple years too but those seemed to stop with the onset of this.

I found results that say cortisol sample 1 = 3.0 and cortisol sample 2 = 21.2. I hope this is what you are looking for. Is there a way to scan the results and post? There are more results about T3, T4, etc. I don't know if this would be helpful to post too.

Thanks!
Jaime

[Jme42077]

Thanks Skye! He is doing good. We just gave him his first dose of the medicine and I am nervous! I hope he does well on it since while reading the insert in the medicine I started to cry! My husband and I are lucky to work from home so we will be able to watch him all day and if anything seems funny I am taking him over to the vet!

Jaime

[lulusmom]

Hi Jaime,

I am a bit concerned about two things; 1) the dose your vet has prescribed is too high for a dog weighing 26.5 lbs. and 2) the results of the acth stimulation test is borderline for cushing's and unless there are other diagnostics that are consistent with cushing's, a diagnosis cannot be confirmed. I've read the symptoms you have posted and Cooper doesn't seem to have the overt symptoms we are used to seeing in a cushdog. Did your vet do a urinalysis and confirm that urine specific gravity was low and did he do a urine culture to make absolutely certain that there is no urinary tract infection. Dogs with cushing's lose their ability to concentrate their urine. It is usually clear and almost odorless.

The acth stimulation test results you posted are one of many tests that should have been done. Did your vet tell you whether Cooper has pituitary or adrenal dependent cushing's. The acth stimulation test cannot provide this information so additional tests such as an abdominal ultrasound should have been done to differentiate.

Have to run but will check back later. Before giving Cooper another dose, I would heartily recommend that you or your vet contact Dr. Tim Allen at Dechra, the manufacturer of Vetoryl (Trilostane) to discuss an appropriate dose as well as confirm what testing was done to diagnose Cooper. Dr. Allen is an internal medicine specialist, highly experienced with Cushing's and few have more knowledge of Vetoryl (Trilostane).

Timothy A. Allen, DVM (SAIM)
Technical Services Veterinarian
Dechra Veterinary Products
Toll free: 866.933.2472
Fax: 913.327.0016
Glynda

[Jme42077]

Thanks for that info! I contacted my vet and I am waiting for a reply!

My husband says that urine tests were run to rule out any infection. Actually Cooper's urine is diluted. The specialist that I saw who suggested this could be Cushing's did suggest to me an abdonimal ultrasound so I don't know why last night on the phone with my husband the vet didn't suggest getting that done. I brought this up to him in my message today though. I also passed on the contact info for the vet at Dechra.

I did forget to mention that Cooper has the thinning hair, strange patches on his skin and a potbelly look. Sorry, all this is so overwhelming I forgot to mention really important info! :)

Will post info when I hear back from the vet! Thanks for getting back to me so fast with this info!

Jaime

[lulusmom]

The specialist that I saw who suggested this could be Cushing's did suggest to me an abdonimal ultrasound so I don't know why last night on the phone with my husband the vet didn't suggest getting that done.

The short answer is that internal medicine specialists (IMS) are highly experienced and educated on cushing's as well as all other endocrine disorders. That is why both of my cushdogs, both having additional conditions, treat with an IMS. Unfortunately, too many gp vets do not follow diagnostic or treatment protocol which places the dog at risk. Cushing's is the most difficult canine disease to diagnose which makes it the most misdiagnosed condition. Even if a dog has overt symptoms, one acth stimulation test, with borderline results, is woefully inadequate testing to confirm a diagnosis.

If there were no other diagnostic tests done, then I would recommend that before you give Cooper another dose, you have an abdominal ultrasound done as well as insure that Dr. Allen has been contacted. The abdominal ultrasound will give the vet a good look at the adrenal glands and surrounding organs. If Cooper has cushing's, chances are both adrenal glands will be enlarged as will the liver. If Cooper were to have an adrenal tumor, one adrenal gland would be enlarged and the other smaller, shrunken or atrophied. Any or all of these abnormalities will help confirm a diagnosis.

A good number of dogs with cushings have a urinary tract infection at the time of diagnosis. Because the urine is diluted out, it is difficult to detect white blood cells in the urine which would confirm an infection. For this reason, a normal urinalysis will not pick this up so a urine culture must be done. Does your husband know if a culture was done and if the urine specific gravity was checked as well? Rounding up the results of all testing and posting the results here would really help us see the total picture.

Glynda

P.S. I forgot to mention that Dr. Allen does not charge for his time or guidance. Please let us know how your vet's conversation with him goes.

[Jme42077]

Hi Glynda!

I talked to my vet and we are going to have the ultrasound done this Friday. Also, we are cutting Cooper's dose to 30 mg. We are not giving him any more though until after the ultrasound results.

As far as urine testing goes we have only had him checked for infection, no urine specific gravity test was done.

My vet was happy to look into the questions you raised and I thank you and everyone on here for guiding me in the right direction!

Will keep you posted about Friday's results!

Jaime

[Skye]

Way to go Pet Parents!!!! whootwhoot! your being a great advocate for your pet child! Yes this is all over whelming, and alot of information to take in and understand what stand for what. It helped me to type it all out. Tests I had ran, CBC, cysto, UP/C, USG, double cavity ultra sound, diabetes (DM), Chem Pan, dipstick urinaliyst, SSA, B/CR ( i think that is what it was called), UCCR, what was found, adrenal turmor on left. We are scheduled for surgery 28th of November. Each of this amazing people helped me so greatly, and I trust them completely. they have smiled with me, shed tears with me, and allowed me rant and rave, snot, babble, and remind me this all okay, because bottom line, it will bring you around to get yourself together to be strong and speak up for what cant. You got this....hands down....you got this.....you got all of us. Take notes, write questions out......and if your not comfortable with something, jump on here, you will most likely have one of the beautiful cush angels fluttering by. Seriously, fall into their arms, you will not fall through. They are right here to help. I am so happy you found this site, it is the most amazing and has helped litterally save pet babies. (((((hugs))))) your doing great.

[Cyn719]

Jamie - just was checking in on your little one - glad you have the test on Friday - I had to get an IMS for Penny also - her vet did not know how to treat the Cushings or know what dose to give her and as I found out its important to have a vet that is very knowledgeable when it comes to Cushings - Like Skye said this forum is wonderful - they are the reason Penny is still with us today - they knew way more than my regular vet knew!!! One crisis after another and their advice was always the right advice - Good Luck on friday - its alot to keep up on but you both are doing a great job of it!! keeping your little one in my thoughts!! Will check back -

[Jme42077]

Thanks Cynthia, Penny & Skye! This site is so wonderful and I really would feel lost had I not found it!!

Jaime

[lulusmom]

Hi Jaime,

I just read a post in another member's thread and apparently, Dr. Allen has retired from Dechra. I'm sure that was a surprise and a disappoint for many of us. I hope his successer is as gracious with their time and knowledge as Dr. Allen was with all of us and our vets.

Since you will not be starting treatment again until after the ultrasound, why not take the opportunity to bone up on Vetoryl (Trilostane) and even share some excellent information with your vet. The more your vet knows about the drug he has prescribed to Cooper the safer it will be for Cooper and any other future cushdogs your vet may choose to treat. Believe me, you won't be the first member who has contributed greatly to their vet's continuing education.

I am attaching a paper (PDF) written by Dr. Mark E Peterson, entited Vetoryl (Trilostane) - Another Choice for Treating Dogs with Hyperadrenocorticism. This paper was written for veterinarians so this is perfect for your vet. This paper covers almost any question, including but not limited to how the drug works, how often to dose, how much to dose, timing of dosing on the day of acth stimulations tests, what instructions should be related to the client (petowner) and how to properly monitor treatment and make appropriate adjustments to dosing. There is additional recommended reading that your vet would have access to as a veterinary professional.

626

When you read this paper, you'll see that vets with lots of experience with Vetoryl start their patients on the low end of the dosing range. The low end of the range per the manufacture is 2.2 mg/kg. That is equal to 1 mg per pound so that would be 26mg for Cooper. Should you round down to 20mg or up to 30mg? I'm conservative but I think the 30mg your vet is suggesting would be fine, with the caveat that your vet properly diagnose Cooper before starting any treatment again.

Now I'm going to give you some information to share with your vet that can save you a ton of money on acth stimulation tests. When you take Cooper in for an acth stimulation test, your vet or vet tech will take a baseline blood draw, then inject a stimulating agent called Cortrosyn. We call this liquid gold because it is the reason these test are so darn expensive. Cortrosyn comes in a .25mg vial with instructions to administer the entire vial, regardless of the size of the dog. Studies have shown, however, that accurate readings can be obtained by using only 5mcg per kilogram of body weight. There are 250mcg per vial so those of us with smaller dogs can save some big bucks.

Coopers weight in pounds equates to 12 kg so your vet could do four acth stimulation tests with one vial. I think it is safe to say that most gp vets are not aware of this cost saving information so by all means, talk to your vet about this. You can refer him to Dr. Peterson's blog for information on how to dilute and store any remaining Cortrosyn. It can be stored in the refrigerator for 30 days or in the freezer for up to six months. This particular blog is for veterinarians so either print out the blog or give your vet this link:

http://endocrinevet.blogspot.com/2011/03/how-to-extend-your-supply-of-cortrosyn.html

I'm looking forward to hearing about the abdominal ultrasound findings. Please make sure you get a copy from your vet so you can post them here.

Glynda

[Jme42077]

Thank you for all this info! I will certainly pass it on! I am eager to read it myself! :)

I have a couple questions...

When should the ACTH test be given again in the event that he is 100% diagnosed with Cushing's and is going to continue the medicine?

What does the testing usually cost on average?

Thanks!
Jaime

[lulusmom]

Jaime, you will find the treatment monitoring information in the PDF file I attached but for ready reference, here it is:

10-14 days after starting therapy
14 days after any dose adjustment
Day 30 after stable dose is achieved
Every 3-4 months thereafter
ANY time the patient is unwell (consider just a baseline cortisol first)
If signs of HAC (Cushing's) are noted

You have already paid for one acth stimulation test so check your receipt. Ask your vet how much of that was for the stimulating agent. If it was $100 or $150, you can save 75% of that charge if your vet uses the 5mcg per kg instructions. So if your total charge for the acth stimulation test was $300 and $150 was the stimulating agent, you would save about $112.

[Jme42077]

Hi! Cooper had his ultrasound this morning and the vet told my husband that the adrenal glands were swollen with no masses on them so it pituitary. I don't have the results right now to share, just this little bit of info. Not sure what all this means yet but I am going to try and read up this afternoon. :(

Jaime

[lulusmom]

Hi Jaime,

Approximately 85% of dogs with cushings have a lesion on the pituitary gland. The other 15% have an adrenal tumor. In most cases, dogs with pituitary dependent disease have bilateral enlargement of adrenal glands on imaging. Unless there are bilateral tumors, dogs with an adrenal tumor will have one enlarged adrenal gland and the other will be much smaller or completely atrophied. It sounds like your Cooper is in the majority; however, Trilostane is known to enlarge the adrenal glands. I'm not sure if this would be the case in short term treatment like Cooper's but it's worth asking about, especially if there are no other abnormalities consistent with cushing's. I'll be interested to see if the liver was enlarged as well so please post the findings when you get a copy.

Glynda

[Jme42077]

Hi Glynda!

I do know that it has been mentioned before that he does have a slightly enlarged liver. The doc that did acupuncture mentioned it to me when he looked at an x-ray we had done. I believe my husband said both adrenal glands were equally enlarged.

Will post the results hopefully tonight or tomorrow.

Thanks!

[lulusmom]

Aaawwww, Cooper is adorable!

[Jme42077]

I finally got Cooper's results. I took a few days off so I could enjoy my daughter's first Halloween. Cooper's condition has been quite depressing for me. Sometimes I cry just looking at him and thinking about it.

Here are the results. Please let me know what you think! Thanks!

U/S Abdomen With Sedation
CONCLUSIONS: Consistent with pituitary dependent
hyperadrenocorticism and steroid hepatopathy. Suspect hepatic
nodular regeneration
REFERRING VETERINARIAN: Dr. Lee
DATE: 10/28/11
NAME OF CLIENT WHO BROUGHT PET: Mike
BREED: Corgi
SEX (MN/M/FS/F): M
RADIOGRAPHS TAKEN: no
SEDATION USED: torb/ace
0.25 mls torb (2mg/kg) iv
hub of ace iv
REASON FOR SCAN: Evaluate adrenals
LIVER: hyperechoic, multiple >1cm hypoechoic nodules, protrudes
beyond costal arch
GALLBLADDER: 30% filled with suspended echogenic material, but no
sign of mucocoele formation
SPLEEN: Normal
KIDNEY (RIGHT): Normal
KIDNEY (LEFT): Normal
URINARY BLADDER: Normal
ADRENAL GLAND (RIGHT): 0.8 cm (transverse) hypoechoic
ADRENAL GLAND (LEFT): 0.8 cm (transverse) hypoechoic
STOMACH: Normal
SMALL INTESTINE: Normal
COLON: Normal
PANCREAS: Normal
LYMPH NODES: Normal
PROSTATE/UTERUS: Normal

[Cyn719]

Jamie - just had to say that Cooper is so cute!!!!!!!!!!!! I will be checking back just had a quick minute:)

[Jme42077]

Thanks Cyndy and Glynda! He is my sweet, super cute guy! :)

[Skye]

hello
i understand your tears that fall...............trust me on that.....there are no words honey, its a pet mommas heart you have, its okay to have them tears fall....it will help you get your strength.
so lets try and look at this one item at a time......digest this all slowly ok? I am sure one of the other members will be along and help you get a much better understanding of everything.....but let me see if I can pick at the results and see if i am understanding..........and please others who are more familiar.....please please correct me on each error......
okay so they did a u/s on the stomach area. how did they see the pituary gland? that is at base of brain and u/s will not show that. I think you have to have MRI for that (?)
and you had mentioned he had a slightly enlarged liver.........and this shows something with his adrenal glands. Did they explain any of this to you??

[Jme42077]

Hi Skye. Thanks for the reply!

They did an ultrasound on the abdonmen only. They never took a look at the pituitary gland. I assume that they diagnosed it based on the adrenal gland condition, blood work and the symptoms??

Nothing was really explained to me except that they were diagnosing him with Cushing's and starting medicine. I hope to get more info on this site. The vet seemed to think the results were cut and dry and Cushing's it is.

:) Jaime

[Squirt's Mom]

Hi Jamie,

The pituitary is located in the head and cannot be seen by Xray or ultrasound. An MRI or cat scan is required tho this is not usually pursued in the diagnostic phase as they are very expensive. Plus the abdominal ultrasound will tell the docs whether it is pituitary or adrenal based Cushing's by the look of the adrenal glands. As Glynda explained, with PDH both glands are usually bilaterally enlarged (meaning two sides or, in this case, two organs side by side) while with ADH one gland will be very large and the other much smaller or even shriveled up.

Cooper's U/S results look pretty good to me! All those "normals" are delightful to see! :) The two things I would pursue further are the liver and gall bladder findings. These could be the result of Cushing's or could be an unrelated issue(s). An enlarged liver is expected with Cushing's but I am not sure about this - "multiple >1cm hypoechoic nodules, protrudes beyond costal arch". I would want that explained in detail. ;) Sludge, or the suspended echogenic material mentioned, is not uncommon. I give Squirt an herb called Burdock to help with this but there are many other things to use as well. But you want to be sure this is all it is and not a "mal-function" of the organ itself so that is why I would ask for more info about both the liver and gall bladder before starting treatment.

Keep up the good work!
Hugs,
Leslie and the gang

PS. I agree...Cooper is a very handsome fellow!

[Jme42077]

Thanks for the reply and compliment Leslie and Gang!

I also wonder why nothing was mentioned about the liver and gallbladder. I have started Cooper on his treatment already but plan on bringing this up at his appointment in 2 weeks. I will post what I find out. I was concerned when I started looking up what the liver results said. Could be liver disease or little tumors possibly? I will get to the bottom of it!

Jaime :)

[Jme42077]

Hi! It has been a long time! Cooper has been on medicine and we have been waiting and waiting and waiting for it to make a difference. His blood work at 2 weeks after starting the vetoryl showed that is was working. But, all his symptoms are still there.

He has been on this medicine since November. What do I do now? I am so frustrated and feel horrible for him. He is also dealing with a strange muscle problem where he can't bend his legs too. He is so stiff and medicine doesn't help.

I just don't know what else to do. Any info would be greatly appreciated!

Jaime

[labblab]

Hi Jaime,

I'm so sorry that you don't have better news to report! :(

Can you find out what the actual numerical results were for Cooper's November ACTH test? Also, has he had any subsequent ACTH tests (or tests of any kind) since November?

Even if his initial ACTH was within the desired therapeutic range, it is entirely possible that his cortisol has not remained low enough to provide ongoing relief for his symptoms. There can be a fair amount of fluctuation when dogs first begin trilostane treatment, and that's why the manufacturer of Vetoryl recommends routine ACTH testing again at the 30-day mark, and also at any time that the dog appears unwell or symptoms rebound.

I am so sorry that Cooper's pseudomyotonia has not improved at all. But that may be another indication that his cortisol level is not staying as low as you would wish, and a dosing increase may be in order.

Please do let us know about any of those testing results, OK? And have there already been any trilostane dosing changes, or has he remained on the 30 mg. once daily?

Marianne

[Jme42077]

Thank you for the response, Marianne!

Cooper has stayed at 30 mg once a day. The vet said that his levels were still good at that dose. I don't have the numbers but will e-mail the vet to get them and post it on here. We had him tested after 2 weeks then after 30 days and the vet said his dosage should stay where it is. His last test was on January 3rd. Should we get him tested again this soon?

I feel so bad for him.

[labblab]

Let's first see what his test results actually were. Even if both tests were within the desired range, another possibility is that Cooper might benefit from a switch to twice-daily dosing. Although there can be a great deal of individual varation, the drug loses effectiveness for most dogs after approx. twelve hours. In many cases, this is long enough to keep the Cushing's symptoms at bay. But some dogs require a second daily dose in order to avoid symptom rebound. Here's a quote from the U.S. Product Insert of Dechra (http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf)(manufacturer of brand name Vetoryl):


Once daily administration is recommended. However, if clinical signs are not controlled for the full day, twice daily dosing may be needed. To switch from once daily to twice daily dosing, increase the total daily dose by 1/3 to 1/2 and divide the total amount into two doses given 12 hours apart.

But first things first -- let's see what the results were for those two ACTH tests.

Marianne

[Jme42077]

Thanks! I will post results as soon as I can get them.

I am so thankful to have found this site! I don't know what I would do without the help and support I receive on here! :D

Jaime

[Jme42077]

The vet just e-mailed this to me from the 30 day test...

Pre sample of 2.8 and a post of 5.0

[labblab]

The vet just e-mailed this to me from the 30 day test...

Pre sample of 2.8 and a post of 5.0

Well, that really is a good result so I understand why your vet did not want to increase the dose at that time. So that leads me to wonder whether a shift to twice-daily dosing might help.

Please tell us more specifically about Cooper's symptoms and whether or not you are seeing any change at all -- and at any time of day?

Marianne

[Jme42077]

I thought after a few weeks his panting at night got better, he didn't have a big pot belly, his flaky skin on his belly seemed to go away and he didn't drink as much.

But now it seems his panting at night is out of control unless I keep it almost unbearable cold in my room. He can't stand any heat. His belly seems to be coming back, his skin is flaky, he drinks a lot when he can get up to get water. He has always urinated for really long periods of time when he goes out and it is diluted.

His worst symptom is the panting at night. He prefers to lay on the cold ceramic tile all day and it keeps him comfy. We give him his vetoryl with his breakfast.

Jaime

[labblab]

If the worst symptom is the panting at night, then it really may be the case that Cooper would benefit from getting an evening dose of trilostane. Per that quote from Dechra, their recommendation in this situation would probably be to increase his total daily dose to 40-45 mg., but divided evenly in half and given every twelve hours. If you are using brandname Vetoryl, though, I know your prepackaged options are limited at Cooper's dosage strength (10 mg. and 30 mg.). If you are instead using a compounding phamacy, they will be able to supply any strength you need. Or they can even take brandname Vetoryl and repackage it for you.

Have you talked with your vet yet about the return of Cooper's panting and the fact that he is still really thirsty? I would definitely let him know, and ask him about trying twice-daily dosing. Even though the ideal would be to split the increased dose evenly, if you are using Vetoryl and it would be easier for you right now, your vet might think it would be OK to just stick with the 30 mg. in the morning but to add an additional 10 mg. at night (rather than having to buy so many 10 mg. capsules so as to arrive at 20 mg. twice daily). Keep in mind that each dose, no matter what the strength, should be given along with some food so that the drug will be metabolized properly.

Marianne

[Jme42077]

I haven't talked to the vet yet about the return of his symptoms. I have been trying to deal with his muscle issue lately. After reading everything it seems that all I can do is try a couple different over the counter medicines like CoQ10 and physical therapy. His physical therapy consult is on 3/27 so hopefully we can get his legs moving enough to where he can at least walk himself outside to potty or even get up from laying down. He is so stiff!

I will talk to the vet about adding a dose at night. We have used a compounding pharmacy before so that is no problem.

Thanks for your help Marianne! I hope next time I post it will be better news!

Jaime

[lulusmom]

Hi Jaime,

I just wanted to mention that 1) I agree with Marianne that Cooper appears to fit the profile of a dog that can benefit from twice daily dosing and 2) with cortisol not being adequately controlled throughout the day and night, this could be a major contributing, factor in the nonresolution or improvement of the pseudomyotonia. Given Cooper's this additonal and rare symptom of cushing's, I personally would choose to up the dose and split into two equal 12 hour doses so as to insure more consistent control throughout the day and night. My cushdog, Jojo, was diagnosed with pseudomyotonia which improved greatly with twice daily dosing of Trilostane. He still walks with a wide stance and stiff gait but definitely improved with treatment.

Glynda

[Jme42077]

Thanks Glynda! I am taking this info to the vet and will ask to up the meds a tad and divide it to take 2x a day. Did you try physical therapy with Jojo?

I was pretty down, stressed and confused but now after the help on this site I am feeling better! Thanks so much for helping!

[addy]

When you get down or depressed, just come here and talk about it. We are all really good at moral support:D:D:D:D:D

Patience is hard to come by sometimes, we want our pups better right away. It is hard sometimes to have to try different things and then wait to see which option works. I struggle with that ALL the time:D:D;);););)

You are doing great.:D:D:D

hugs,
addy

[Jme42077]

Thank you so much Addy!

[Jme42077]

Hello all! I took the advice to the vet and this is the response I got. Thoughts? Does this seem right?

My vet -
You can have his vetoryl compounded into 15mg capsules at Nora Apothecary and administer them morning and evening. However, i would not increase his dose without repeating an ACTH stimulation test to see if that is appropriate.

[labblab]

Trilostane treatment protocols are still evolving, and so different clinicians do have different recommendations. Here is a link to Dechra's published recommendations re: Vetoryl treatment and monitoring: http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf

This is where I obtained the info I gave you earlier about increasing the daily total dose somewhat in conjunction with the switch.


However, if clinical signs are not controlled for the full day, a switch to twice daily dosing may be needed. To switch from once daily to twice daily dosing, increase the total daily dose by 1/3 to 1/2 and divide the total amount into two doses given 12 hours apart.

However, some other endocrinologists have reported their experience that dogs being dosed twice daily may end up needing a SMALLER overall daily total, and that there actually may be a greater risk for oversuppression to occur with twice daily dosing. So go figure. :o

It sounds as though your vet is taking this more conservative approach, probably because Cooper's earlier ACTH result was where he wanted it to be, and he doesn't want to risk it going a lot lower right now. So yes, it does sound reasonable. The only downside, of course, will be the need for additional ACTH testing if Cooper's symptoms still don't resolve.

Marianne

[Jme42077]

Thanks Marianne! I feel better running this by you guys on here! After our vacation next week I am going to start him on the 2x a day dose and hope that helps! I would start immediately but with grandma taking care of 3 corgis, 1 cat and a 1 year old baby I don't want to add to the craziness! :)

[Jme42077]

Cooper Update! :D

My boy has been to 6 physical therapy sessions since he also has pseudomyotonia with the cushings . He would lay by himself in our sunroom day and night and never get up to come around the family. He wouldn't get up to go outside or hardly even to get a drink of water. He was in bad shape and so depressed!

After 6 sessions I am SO happy to report that he is acting like his old self again!! He will never walk like a normal dog but he is up and alert and happy. He is by my side all the time, is happy to get up and go outside, he jumped up on the couch 2x yesterday and his attitude is so much better. We can tell he is so happy and feeling better. We have our little guy back!!

It took weeks to start seeing any results but it was worth the wait since he is doing so well. We just signed him up for 6 more sessions and look forward to him getting even stronger!

[addy]

Thats is a pretty darn good update!!!!! I am sooooo happy that the physical therapy is helping Cooper. That is just awesome!!!!

What do they do at physcial therapy?

Keep up the good work,
addy

[Jme42077]

Thanks Addy!

Cooper is walking on the underwater treadmill. He is up to 10 minutes and doing great. His goal is 30 minutes. I know he can do it! After that he will just come in once or twice a month for a workout.

We are so glad and amazed he is doing so well!! :D