11 Year Old Boston with cushings

[brandonscottbr]

Hello everyone! We have a 11 year old boston who about 2 months ago was diagnosed with cushings after months and months of trying to figure out what was going on with her. It all started with her sleeping alot, drinking alot, losing weight, finally losing hair and her skin is patchy. She also is so disoriented, walking in circles, wondering the house, getting lost in corners, she has lost 8lbs in the last year. However she eats good but at this point drinks little water.

We have her on trilostane at 30mg a day and it doesn't seem to be making a dent. I am wondering how soon we should be seeing progress?

[Skye]

Hello! popping by welcome you! i am certain others will be popping by as well. I hope your dear little Boston is feeling good today and you will be so glad you found this site. People here are so supportive and friendly and there is lots of knowledge here. How much does your boston weigh now? and how long have is actually been on the trilo? any lab results you can post will be very helpful. Thank you again for joining us!

[kapohotricia]

Welcome to this wonderful support group. I'm so sorry you are having to take this Cushings journey too. I'm not sure I can answer your question because each dog is an individual case but I will gladly share our experience so far. We, too, have an 11 year old Boston, Kirby. His symptoms were very similar except for the weight loss and his Cushings is pituitary caused. Kirby has lost only 1 lb but a lot of muscle mass and doesn't have the strength to go for walks longer than 10 mins any more. Kirby weighs 20 lbs and has been on 10mg of Trilostane for 6 months now. He had been drinking and peeing a lot and that went away in three days. That dose has been sufficient to safely and slowly bring down his cortisol levels to acceptable levels after about 3 months but the circling (always anti-clockwise) and constant sleeping continue. The vet feels that the Trilostane cannot help that because the growing pituitary tumor may be impacting other brain functions and these may just be the resulting cognitive symptoms. We have begun a 5mg daily dose of selegiline to see if that will help a little. It's too early to tell yet. The good thing is that Kirby does not seem at all unhappy and is not in pain and we are hoping for more years with him yet.
What is your girl's name, and yours? Is her Cushings pituitary or adrenal caused? What is her weight?
Sending Boston lickies to your sweet girl from Kirby and his brother Winston
Aloha,
Tricia

[littleone1]

Hi and welcome from (Angel) Corky and me.

I just lost my Boston Terrier recently. He was on Trilostane for over 2+ years. He had cushings for over 3 years. When he started wandering aimlessly, he was diagnosed with Canine Cognitive Dysfunction. Corky lost alot of weight in the last few months, but it wasn't due to cushings or the Trilo. From what you've posted, it seems that there is something else going on with your furbaby. There is something with the liver that can cause this. I personally would have other testing done.

Terri

[labblab]

Welcome from me, too. Can you please give us the results of any monitoring ACTH tests that have been performed since starting your dog on trilostane? If the ACTH testing is all within therapeutic range for a Cushpup, then it is doubtful that the problems are the result of a dosing issue and you will need to look elswhere as the others have already suggested.

Also, did the diagnostic Cushing's testing point towards the pituitary or the adrenal form of the disease? Unfortunately, if it was pituitary, I have to "second" Tricia as far as wondering whether your dog's pituitary tumor may be large enough to place pressure on surrounding areas of the brain. If so, this would account for the neurological problems of disorientation, walking in circles, getting lost in corners, not wanting to drink water, etc. Also unfortunately, the only way to diagnose an expanding tumor is through relatiavely expensive imaging such as a CT scan or MRI of the head.

So if the ACTH testing has been good, I would follow Terri's advice and first ask your vet about any other preliminary testing that could help identify a cause for these problems. Has your dog had an abdominal ultrasound? Has her other blood testing been normal?

Marianne

[brandonscottbr]

Chloe has pituitary Cushings. From what I understand it is the tumor causing some of her disorientation. She was 22 lbs and now she is barely 14lbs. It has taken me over a year to get a correct diagnosis. Up until the last few months 3 different vets told me it was her thyroid and had been treating her for that. At the time she had the common symptoms of drinking a lot, eating a lot, pot belly, lethargic. Now after being misdiagnosed for so long she is very underweight, she hardly eats or drinks. Her skin is horrible with calcium deposits and hardly any hair and she is very disoriented all the time.

Just talked to the vet, making an appointment to check her liver enzymes and we are taking her off the Trilostane since we haven't seen any improvements. She said that her form of atypical cushings is fairly resistant. So now we are starting from scratch on a new treatment.... Very frustrating.

[Cyn719]

Hi do you take Chole to a Internal Medicine Specialist??? My problem was I was letting my reg vet take care of her and she needed to be with a specialist -- my girl also has pituitary cushings - this disease is a handful and needs to be handled by a IMS - I learned the hard way - I thought my vet knew what she was doing - that was not the case -- keep us posted --- hugssss

[kapohotricia]

I'm so sorry to hear about all the frustration you have been through with Chloe. I was so blessed that my general vet (there is no IMS on my side of this rural Hawaiian outer island) guessed Cushings on Kirby's first visit for the symptoms I'd noticed and had the test given immediately. Kirby's cortisol levels have come down with the Trilostane but his liver enzymes remain highly elevated. I am giving him milk thistle and have been told that it helps. Perhaps the levels would have been higher without it. So, if Chloe's levels are high, ask about giving her milk thistle. My vet said it can take a very long time to bring those levels down.
I do hope you can get help for the other symptoms, poor dear girl ! Give her a big kiss from us,

Tricia and Kirby

[labblab]

At the time she had the common symptoms of drinking a lot, eating a lot, pot belly, lethargic. Now after being misdiagnosed for so long she is very underweight, she hardly eats or drinks. Her skin is horrible with calcium deposits and hardly any hair and she is very disoriented all the time.

Just talked to the vet, making an appointment to check her liver enzymes and we are taking her off the Trilostane since we haven't seen any improvements. She said that her form of atypical cushings is fairly resistant. So now we are starting from scratch on a new treatment.... Very frustrating.
Do you know the name of the new treatment? And once again, has your vet performed any ACTH monitoring to confirm whether or not Chloe has been placed on a therapeutic dose of trilostane? If you don't know whether or not her cortisol level has been appropriately lowered on the current trilostane dose, you really have no idea as to whether or not trilostane can be a successful treatment for her. Also, dogs who are overdosed on trilostane may stop eating and drinking normally. Dosing requirements for individual dogs can vary widely, and the only way to know for certain whether the dose is appropriate (neither too high nor too low) is to perform an ACTH stimulation test.

Also, I just want to clarify that some of the symptoms you have described are classic Cushing's symptoms for which you can expect to see improvement once you've arrived at the appropriate dose of medication. These would be the original symptoms of excessive thirst and urination, pot belly and lethargy. Calcium deposits ("calcinosis cutis") may also improve once cortisol levels are lowered -- but often very slowly and over an extended time period.

However, lack of hunger and thirst are not typical of high cortisol and can result from trilosane overdosing. Or they can instead be caused by an enlarging pituitary tumor. If the other neurological symptoms that you are describing are also truly caused by an enlarging pituitary tumor (the circling, confusion, getting lost in corners), unfortunately no treatment aimed at lowering cortisol is going to help. Improvement would require invasive treatment aimed at shrinking the tumor such as surgery or radiation. I just want you to be clear about your expectations about treatment outcomes, and to realize that Chloe's symptom profile is not typical for a pup suffering solely from high cortisol.

Given Chloe's symptoms and behavior, it does sound as though this is a complicated situation with the potential for several serious issues going on. So I'd have to agree with the recommendation that you might be well served to seek a consultation with an internal medicine specialist, if possible. Especially if your vet is now planning to shift Chloe from trilostane to Lysodren without having first performed any ACTH monitoring testing. A word of warning: a dog should not be immediately switched from one of these medications to another without first going through a "wash-out" period in between.

Marianne

[kapohotricia]

I have read that Bostons and other Brachy dogs are more susceptible to neurological problems from enlarging pituitary tumors because of the shape of their heads. It does sound like Chloe has similar symptoms to Kirby except that we were so fortunate to start the Trilostane early enough to stop the other typical Cushings symptoms you describe getting so far along. He lost a little hair early on but it has grown back now and the coat is, once again, good. With appropriate treatment, Chloe can regain her skin and coat health too.
I just want to "second" Marianne in making sure you get an ACTH test done to find out what Chloe's cortisol levels are now before making a decision about how she is responding to the Trilostane. She could, indeed, be off her food because of overcontrol. That is one of the things I was told to watch out for. Kirby got an ACTH test every month when he first started treatment and now gets one every two months or if his symptoms/behavior change. Chloe really hasn't been on Trilostane long enough for the vet to know if it is going to help some of those other symptoms. As we are finding out, no treatment for Cushings (the overproduction of cortisol) is going to stop the tumor from slowly growing and causing neurological problems.
Do all the reading about this as you can and then don't be afraid to ask lots of questions of your vet. My vet is learning along with me as we both study this disease. Keeping a daily log of behaviors I notice (good advice I was given early on) is very helpful to her.
Hang in there!

Tricia and Kirby

[kapohotricia]

Hi Brandon,

What did you find out from the liver enzymes test? How is Chloe doing? We've been thinking about you.

Boston lickies from Kirby, and aloha from me,
Tricia

[Skye]

dropping by to see how you and your baby are doing
have you thought of getting an ultrasound done? or even a ct scan or mri? one of the later might prove more helpful as they would show the pituary area and ultrasound doesnt
keep pushing forward, lots of experience here in this forum, sometimes general vets get an idea formed in their mind that their searching for and forget to listen to you and to what your baby is showing
you know her pet child best, you see them day in day out, and in their home, not a stress environment
you have every right to receive every copy of lab that is performed, to know what ranges are normal, and what is being ruled out
when my situation started back in september i was told her lab was ok some slight elevations, i pushed onward, wanted details, pushed more, and then the answer, adrenal turmor
glad i didnt stop in September and let things go at that
stressful as this all is, conquering what is wrong, not knowing and letting it continue to progress would have not been good
take notes on what you see in daily behavior, what was done prior to them responding the way they did, like, fed at 12, did this or that at 1, last poohed at 3 and was it normal or straining etc
details help with clinical to know what labs to do
hang in there, and your doing a great job and doing all you can