I have one little sick doxy (sweet Copper has passed)

[jpatterson]

My sweet doxy Copper was seen today at NC State Univ. Vet School by an outrageously great neuro vet. We have been on a roller coaster for about 6 months not knowing what was wrong with my best little man. We have been to his vet multiple times, referred to an alternative vet for accupuncture and immediately sent to a surgeon for what was believed to be a herniated disc. After a myelogram which turned out to be negative and thank goodness averted surgery...we were back to square one with what is wrong with his legs. His presenting problem has been his hind legs. He has been having weakness but extreme stiffness especially in his right side. Now that I am aware of Cushing's Disease....yes he has the appetite of a Hoover vacumn cleaner and yes he drinks lots of water he has thin hair and his tail is so slick it looks like it belongs on an opossum it is starting to make sense.

I was shocked to hear the neurologist talk about Cushing's Disease as she could find nothing neurological wrong with him. His little hind legs just stretch way out stiff and he has trouble walking. Sometimes are better than other. MY BIG QUESTION IS....is the muscle problem with his hind legs permanent???? If we can get on with the diagnostic work up, treatment and I am willing to do all the physical therapy necessary...what is my hopes of getting his mobility back??? Does anyone have any experience?

I am a nurse and I understand a lot of the endocrine system and I can handle the medications. I am still scared out of my wits but I love this little fellow. He is 9 years old. I have had him since he was 4 weeks old and he is like one of my children. I hate to see him struggle so to walk.

[Nikki]

I just wanted to say Hi and Welcome!!!
I'm fairly new to Cushing's disease, so I can't offer much information. My baby (8year old boston terrier) also has bad hind leg wasting. Less than a year ago he could jump and run and walk up stairs. Now I'm lucky if he can make it up the one or two stairs to get inside the house. I believe I read somewhere that the muscle can return to somewhat normal, if the dog has exercise.

[trippyjanet]

I am relatively new to all this Cushing's myself, but I will tell you that my boy was completely unable to move his legs just a short two months ago. After two months of medicine, he is starting to use his legs much better. He can walk throughout the house and outside--albeit very slow and he has to take breaks. We keep working on strengthening his back legs and we have seen a huge improvement. I wish you luck on your journey!

Loni

[jpatterson]

God Bless Both of you!!! I have almost been without any hope of him improving. I will keep in touch. I will be off to the home vet on Monday and hope to get his treatment started. J

[Harley PoMMom]

Hi and welcome to you and Copper!

Sorry I only have a moment to post, the symptoms you are describing such as the muscle stiffness could be Pseudomyotonia. It is a condition that is rare with Cushing's disease but does happen. Here is some more info on this: Q & A: Pseudomyotonia in Dogs with Cushing's Syndrome? (http://endocrinevet.blogspot.com/2011/02/q-pseudomyotonia-in-dogs-with-cushings.html)

Love and hugs,
Lori

[LillyMae]

Hi and welcome to you and Copper!

Sorry I only have a moment to post, the symptoms you are describing such as the muscle stiffness could be Pseudomyotonia. It is a condition that is rare with Cushing's disease but does happen. Here is some more info on this: Q & A: Pseudomyotonia in Dogs with Cushing's Syndrome? (http://endocrinevet.blogspot.com/2011/02/q-pseudomyotonia-in-dogs-with-cushings.html)

Love and hugs,
Lori

I am so glad I read this thread as I am sure that my LillyMae has this.

[beachwalkerz]

I, too, am new to this Cushings forum but I will tell you that my french bulldog has already started to show improvement in her back leg mobility after just a couple weeks of being on treatement.

Hugs
jodi

[jpatterson]

Thank you for your post. My plans are to have my Copper starting his treatment by next week...if all the labwork comes back as we are expecting. I am not certain if my current vet will want to take this on or refer me to a newer vet in the area just out of vet school. From everything I read on this site...the meds, dosing and labwork results are intensive.

You give me hope that with treatment, my little fellow will be able to get around better. I am not expecting full recovery...I just want him to be able to walk 10 feet or make it to the kitchen from the den.

[Squirt's Mom]

Hi J and a belated welcome to you and Copper! :)

There is always hope to be found here. We have seen all sorts of pups through the years with myriad issues as well as Cushing's. I don't remember one pup who didn't find some hope, some path to try. We have seen pups who had to be carried outside and held up to do their business change into a pup who is once again able to take walks and play ball. We are a stubborn bunch when it comes to throwing in the towel. :D

And, even more importantly, when the day comes, as it will for most of us, that all avenues have been exhausted, no one here walks alone through those last days unless they choose to. You and Copper have a new, amazing family now who will stand by you through thick and thin. You will always find someone to talk to, to hold your hand, to laugh with you and to cry with you. So you tell Copper that he now has people all over the world, literally, who love him and are standing right beside him and his mom, rooting for him all the way, always ready to help in any we can.

I'm glad you found us and look forward to learning more as time passes.
Hugs,
Leslie and the gang

[jpatterson]

Thank you for your kind words. I truly believe I have found a wealth of information on this blog and YES friends who understand the journey of caring for much loved dogs with Cushing's Disease.

Copper spent the day at his local Vets office. According to my bill, he had a CBC Lasercyte Complete Blood Count, Catalyst Chemisty 17, Pre and Post Cortisol ACTH Stim and a urine cortisol:CRT Ratio.

I collected a urine specimen on him this morning before taking him to the vet. It was suppose to be under non-stressful circumstances. Trying to catch the specimen in my little cup without stressing him was a little stressful for me. You can only image how I disagreed with the receptionist at the vet office when she said the sample was not necessary and that they would be getting the sample after they gave him the medications. You would have thought his pee was gold to me!:D

Should know test results in a day or two. Vet will review them and let me know what he thinks. I read so much about false negatives, I am not sure how reliable the results will be even after all the work. I will keep you posted.
J

[apollo6]

Welcome
Cooper could have numerous things wrong with him. It could be back, neurological, or another issue. Hard to say. My Apollo was diagnosed 2 years ago with cushing and now has cushing myopathy( started with hind leg weakness now all 4 legs, stiff walk) i went through the same thing trying to get a diagnosis.
But before you diagnosis , let us know if Cooper was tested for Cushing's etc. I have attached a link on Cushing to help you.
This is a very complicated disease and can mimic other diseases. So take your time to be sure what it is. We are hear to help and support you.
http://www.kateconnick.com/library/cushingsdisease.html
HUgs Sonja and Apollo

[Harley PoMMom]

I collected a urine specimen on him this morning before taking him to the vet. It was suppose to be under non-stressful circumstances. Trying to catch the specimen in my little cup without stressing him was a little stressful for me. You can only image how I disagreed with the receptionist at the vet office when she said the sample was not necessary and that they would be getting the sample after they gave him the medications. You would have thought his pee was gold to me!:D

J

Good for you! You are doing a great job at being a well informed advocate for Copper. When doing the UC:CR test it should be done at home because of this being the least stressful on the dog, so GREAT JOB!!!! ;):)

Love and hugs,
Lori

[jpatterson]

Copper is doing something like sneezing frequently. I am a little concerned he may have contracted an upper respiratory infection from being boarded when we traveled to the vet school. Does anyone know anything about when this is serious and I would need to take him to the vet? I am still waiting to hear the results of his labwork done on Monday. Maybe I will hear tomorrow.

[Jenny & Judi in MN]

is it the reverse sneezing where they sound like they are going to die? Jenny has done that, scares the crap out of me. stroking her and calming her are all that help for that.

I've read that getting excited can make their little breathing passageways close up and cause this. calm, soothing voice and stroking are all that help for Jenny

She did get kennel cough from her nasal vaccine for it this fall. it was a cough though not a sneeze.

I hope it is nothing serious!

[jpatterson]

I talked with the vet about the sneezing and they think it is allergies. I have given him some benadryl and it seems to help. He has spells of the sneezing but it is not getting any worse.

[jpatterson]

Today has been a little trying. Copper has ACTH challenge and urine cortisol levels done on Monday of this week. I spoke to his vet this moring and he had received the results and consulted with the referring neurologist from NCSU Vet school. He said all of Copper's test showed elevated cortisol levels and was highly suggestive of Cushing's Disease. He said Copper had a rare type of Cushings and that we needed to get an adrenal ultrasound done on him soon. He did not have the capabilities and suggested I try back at the vet school or at the surgical hospital near Atlanta to see if they could help get an adrenal ultrasound done of Copper. Well, it was a nightmare. The first practice said I would have to be referred to an IM vet and they would evaluate him and determine if he needed the adrenal ultrasound. I called this office and they only work Monday through Thursday. I have accreditation surveyer in my office for three days next week. I can't leave my work to get my dog tested then. A great vet friend of mine suggested a practice that covers Asheville, nC and Greenville, SC. I was able to call and get Copper an appointment at 9 am on Monday morning.

PLEASE pray for copper an me that we don't find tumors and that his Cushing Diesase can be treated. I really love this little dog. I am afraid the more time we delay getting him on treatment, the harder it will be to reverse his hind leg muscle atrophy.

Any ideas on adrenal ultrasounds and reversal of hind leg rigidity after starting Cushing;s Disease meds?
J

[jpatterson]

I will be taking Copper for his adrenal ultrasound early Monday morning. I worked really hard to get his appointment as soon as possible. He is really having a terrible time with his muscle myopathy. His hind legs are so stiff and he can hardly walk at all. My vet and the neurologist both said he has a rare presentation with the severe muscle problems. I am so concerned that the longer we take to get him on medications...if indicated, the more muscle wasting and damage he will have and this will make rehab impossible. I have literally carried my little man on my hip for over 3 months. Until last week...no one knew what was wrong with him. Everyone thought he was having back problems and we failed to see all the other classic signs of Cushing's.

I am praying we find no adrenal gland tumors on Monday. I want to start him on medications as soon as possible and pray that I can help him start walking just a little again. Does anyone know if I am causing him any further harm to gently massage his legs and put them through range of motion exercises when he can relax them??

Moderator's Note: I have moved your latest post on Copper into his original thread. We, normally, like to keep all posts on a pup in a single thread as it makes it easier for other members to refer back to the pup's history, if needed.

[frijole]

Since you have ruled out spine and bone issues I would assume that you could not do harm by massaging. In fact I am sure it would help him relax and give him comfort. I had a dog with severe wasting also and I took her to acupuncture every week and it worked wonders.

Don't feel bad for not seeing the signs - so many of us discovered cushings accidentally and after lots of tests. It can be tricky to figure out.

Glad you were able to get the ultrasound done quickly. Tell them to do their very best to get film of both adrenal glands. The first one I had done they only could see one and the one they couldn't see had a tumor on it. Not to scare you - just make sure they do their best to see both of them because they need to in order for you to get your answers.

I am going to merge this thread with your other thread so that all of your info is in one spot and we can all follow Copper's story from the beginning.

You won't be alone on your journey - all of us cush angels will be hovering over you and keeping you strong through out. Do keep us posted. Good luck! Kim

[Skye]

Hello, following your thread...........couple of things for me and my girl to relate to.
If this does end up being adrenal........couple of us have seen our babies go through this.......whatever the is around the corner.....dont worry, because the angels on here will never ever stray from your or your dear ones side....you walk surrounded. So if you hear tons of fluttering, or breezes, lol thats just the angels all squeezing in to their places!!!! and trust me...lol they have carried, dragged, picked up, dodged, every thing you can think of probably from me alone. (smiling) and they have danced with us as well. :)

[jpatterson]

Copper was seen by a wonderful Internal Medicine Vet and she ordered his abdominal/adrenal ultrasound. I guess this is good news...both adrenal glands were enlarged and the test indicates he has pituitary cushing's disease. His liver is a little flared up but she said that was normal with cushing's. She took lots of pictures of him because she said it was very unusual to see a cushing's case with his myopathy/myotonia symptoms. She plans to use it the pictures in her lectures. He is really pronounced with his little legs stuck straight back. She said she might go her entire career and not see another case like Copper.

He will be starting medications this week...I hope. The IM vet is going to speak with my local vet and they are going to decide which of the two meds to start him on. I am beginning to feel a little better. I will need all my cush angels to help me along with the meds and how to watch for symptoms.

Oh yes....they said he liked the abdominal ultrasound once he figured out it didn't hurt. I told them he loved to have his Buddah Belly rubbed. :)
J

[Skye]

I am glad the answer has been found. Trust me......the angels will always be with you.........there are no words to describe how amazing they are.

[jpatterson]

My Copper has been on trilo 30 mg. for the past 13 days. When do I take him back for bloodwork...I guess ACTH?

[StarDeb55]

Dechra recommends that the first ACTH be done 10-14 days after the start of treatment. Did your vet not explain the monitoring protocols for trilostane?

Debbie

[Squirt's Mom]

Hi J,

You are right on time for the ACTH. It needs to be given 4-6 hours after Copper's Trilo (Vetoryl) is given. If he gets his med at 6am, then the test needs to be done between 10am and 12pm.

Let us know how things go!
Hugs,
Leslie and the gang

[jpatterson]

I have been giving it at night...guess I should have been giving it in the morning. Is there a danger in waiting until until day 21. I have to be out of town with the dog and I don't think I was told to get it done 10-14 days. I will get the hang of this. Do you think I am would be putting my dog in danger to waith until day 21?

[jpatterson]

I have also noticed a change in his personality. He is a spoiled little dog but he whinned a lot last night. He doesn't seem to be in pain at all...just wanting attention. He is still drinking a lot of water and his appetite is still good. I got up at least three times last night to either take him for water, food or outside. That is really tough when I have to work all day. This evening when I came in from work...he had managed to get himself across my living room, into the hallway. I have hardwood floors and he has not been walking very much at all. There was a little storm going on but it has been months since he has mobilized himself due to his hind leg muscle problems.

Any thoughts on all of this. He seems more lively...does this seem consistent with cortisol levels decreasing?

[frijole]

The drinking, going outside in the middle of the night and the restlessness are all signs of having too much cortisol n the system - which is what cushings is. So to me it is a sign that the dose you are on is too low. That is why you test after 10-14 days - to see how it is going. You don't have to wait 21 days to test.

Signs of success would be if the appetite, thirst and wrestlessness had gone away or were reduced. You shouldn't have to get up in the middle of the night.

So did you say you are still travelling and that is why you can't get the test done? Please let us know. Kim

[jpatterson]

Yes I am traveling and will not be able to get to my vet's office until May 29. By then he would have been on trilo 30 mg once a day fo 21 days. I have to be gone for my job and I take him with me and day board him in a vets office where my meetings take place. My friends think I am crazy. He just doesn't let me get much sleep at night.

[jpatterson]

I would skip these meetings but I need to work like many others. Just hope I am not putting at risk. I knew he needed ACTH test but was not told 10-14 days and I will be waiting 21.

[jpatterson]

It seems like his night restlessness and whinnying has gotten worse the past few nights rather than better.

[labblab]

I don't think it is a huge deal if you wait until 21 days to test. But it IS a huge deal that you need to switch to dosing in the morning beforehand, or else the test will have no validity. Trilostane has its greatest effect for only about the first 8 hours after a dog has taken it. After that, the levels of the drug drop back to baseline until the next dosing. For this reason, the monitoring ACTH test should be performed 4-6 hours after dosing, and also should always be given with a meal in order to ensure proper absorption. The day of the ACTH test, the morning dose should be given with at least a small meal -- not on an empty stomach.

If I were you, I would immediately hold this evening's dose and then give the trilosotane tomorrow morning with breakfast. Maintain this same pattern until the ACTH test a week from now. Otherwise, if you dose in the evening and wait until the next day to test, the results will give you no indication at all as to the maximal effect of the drug and whether or not a dosing change is in order.

It concerns me that your vet has not given you proper instructions about either the dosing or the testing. I know you've written that he/she is not very familiar with Cushing's treatment and has been consulting with a specialist. It sounds as though a bit more consultation would be in order :o. Or else, Copper's care should perhaps be turned over to the specialist entirely for the time being.

Here's a link to the U.S. Product Insert published by the manufacturer of Vetoryl (brandname trilostane). It will give you a lot of helpful info about treatment and monitoring:

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

Marianne

[jpatterson]

Thank you for the information. I live 2hours away from a specialist that could treat copper. I love his vet and hopefully with me being a little vigilant and my cushings Angels....Copper and I will make it through. Traveling a long distance to a vet would be hard financially and I would have to miss work.

I will need some advice about his ACTH levels. I hope to get him tested next tues. or wed. My vet is really easy to talk to and knows I am a nurse and full of opinions and questions. He will be open to discussing the dosage of trilo with me when we get blood work results.

[jpatterson]

I need some quick advice. I am out of town and my dog had a spell this am. He cried out like he was in pain and looked like he was trembling or fine seizure activity. He normally has trouble standing but seemed weaker. He came out of it fairly quick but seems very tired. I have not given his trilo 30 mg dose this am and plan to hold it. He has not had his first monitoring ACTH since starting trilo. We are on dose 17 and he has vet appointment in 3 more days. He weighs 16 lbs and is taking about 2 mg/lb. what I need to know is do I need to rush him to a "strange" vet er or if he has no more symptoms like tremors, etc can I with hold trilo and monitor?

[jpatterson]

Is this trembling an emergency?

[lulusmom]

What you are describing is not a common symptom of low cortisol so I think you are dealing with something else. It does sound like it could have been a small seizure. You've done the right thing by withholding the Trilostane. If he appears to be okay, I'd say keep a really close eye on him and call your vet when their office opens. If your vet is not open on Saturdays, you can call the emergency facility now, give them the details of the episode and let them guide you.

Glynda

P.S. Trembling can be a symptom of many things, including a seizure. It is also a side effect of low cortisol and pain. Unfortunately, our dogs can't tell us what's wrong so it's always better to err on the side of caution and let a vet try to figure it out.

[jpatterson]

He is eating and drinking. It is like he trembles every hour or so.

[lulusmom]

I forgot to mention that muscle tremors are listed as a side effect of Vetoryl. We've had more than few members report this. It seems to be a benign side effect with no other accompanying symptoms; however, if your little one's tremors started this morning after his episode, I would definitely discuss it with the vet.

[lulusmom]

How is Copper doing today?

[jpatterson]

I have given the trilo yesterday and today. The only dose is skipped was saturday. He seems ok now. Will be having ACTH drawn on Wednesday. I have noticed he is not drinking water as much and he seems less hungry. He seemed a little lethargic yesterday but not today. We have been traveling and he may have been tired. So far so good.

[jpatterson]

Waiting for first ACTH results after starting trilo. I have noticed his water consumption and hunger has gone down. No diarrhea or anything like that. Hope meds are helping.

[Squirt's Mom]

Oh, that's sounding good, J! :) Looking forward to those results!

Hugs,
Leslie and the gang

[jpatterson]

I am going to try and post copper's lab results....
Initial cortisol level pre injection 25
Initial post ACTH level >50

Test results this week after 20 doses of trilo 30mg.:
Cortisol level pre injection .9
Cortisol after injection 5.1
Potassium 6.2
Sodium 154
Ratio 25

Doctor decided we need to lower dosage since he dropped so much so fast. Will lower his dose to trilo 10 mg. daily and repeat bloodwork in 30 days. Does this sound ok to everyone?

[labblab]

Do you mean that your vet is planning to lower Copper's daily dose to a total of 20 mg., or clear down to only 10 mg.?

It does not sound like a good idea at all to drop Copper's trilostane dose clear down to 10 mg. from 30 mg. if that is what your vet is intending. Copper has been on the 30 mg. dose for nearly three weeks now, and his ACTH results are right at the upper level of the ideal therapeutic range according to Dechra, the manufacturers of brandname Vetoryl. So even if his cortisol were to drift downward a bit more over the coming days, he still has some lee-way to work within. As long as he is doing well and you are seeing improvement in his Cushing's symptoms, I honestly wouldn't want to lower his dose at all. But I am hoping that your vet is only intending a decrease down to 20 mg. total. I don't see how the Cushing's will be controlled at all if his dose is lowered to only one-third of what he is currently taking.

Since you are trying so hard to get Copper's cortisol lowered in an effort to help his pseudomyotonia, I worry that you'll risk losing control of his Cushing's again if his trilostane is lowered. Given Copper's special issues, I'm hoping your vet will consult with the specialists about the pros and cons of a dosing change.

For your reference, here is a link to Dechra's Treatment and Monitoring Flowchart:

http://www.dechra-us.com/files//dechraUSA/downloads/Client%20Literature/47902_VETORYL_10mg_Treatment_and_Monitoring_Brochu re_Update_3_2_ps.pdf

You'll see that their recommendation in Copper's situation would be to leave his dose unchanged at this point in time.

Marianne

[jpatterson]

How do we get the dosage to 20 mg. if the pills come in 10 mg and 30 mg.? My vet mentioned using a compounding pharmacy locally. What are my other options if I want him on 20 mg per day?

[addy]

You have to use two 10mg pills. It costs more but I did for quite some time, there is nothing wrong with giving more than one pill. Right now Zoe gets one 30mg and 1 10mg pill.

No problems with that or you could compound one 20 mg pill.

[jpatterson]

That makes sense. For some reason I thought it could be obtained in a liquid form that could be dosed specific by me. I will be getting the 10 mg pills next week. I will talk to vet and see if we can do the 20 mg daily instead of dropping to 10 mg daily. Until the 10 mg tabs arrive, my vet wanted me to give the 30 mg every other day. How does this sound? I hate to be a complicated dog Mama but I am trying hard to take care of copper. And does anyone know of a resource for the trilo that is below $100 for pack of 30?

[labblab]

You are not being a complicated Mama at all!! You are doing a wonderful job of advocating for Copper. And I'm sorry to keep pressing you, but do you know whether your vet has consulted with anybody else about this dosing change? There are several red flags that have come up along the way that worry me about your vet's experience with trilostane, including the facts that he didn't instruct you to dose Copper in the morning rather than the evening and also that you had to be the one to ask about the monitoring testing. I am now wondering whether your vet is confused as to the target treatment range for a dog on trilostane. The printed lab report will list a "normal" post-ACTH range that is much higher than the range that is desirable for a Cushpup.

It is true that Copper's cortisol has dropped a lot. But that is the whole point of the treatment. And the drop has occured over three weeks time, not just within the first 10-14 days. Again, with Copper's pseudomyotonia, gaining good control of his cortisol is really important. And that's the point you're at now -- good control. To lower his dose and then wait 30 days to see what happens means that you can risk losing an entire month of effective treatment. Right now, Copper's cortisol level is fine. But if your vet is worried that this dose may be too high, he can always perform another ACTH at any time in order to see whether it is still drifting downward. With Copper's pseudomyotonia, I'd rather go that route if it were me.

But I am definitely not a vet, and this is just my personal opinion. If your local vet consults with the specialists and they think a dosing decrease is a good idea, then I will totally shut my big mouth :o. But I do hope you'll ask whether the specialists are on board with this change at this time. Or at least, ask your vet why he wants to depart from Dechra's published monitoring/dosing guidelines (the link I gave you above). That way, you can find out if he's truly aware of the desired treatment range.

I promise I won't bug you any more about this. And other members may chime in with totally different opinions. That's the beauty of a forum like this -- that you can gather lots of different thoughts!

Marianne

[jpatterson]

I think my vet is afraid to push copper to Addison state. You are right he is not very experienced with this. He told me he has two other dogs being treated with trilo for skin conditions. He runs a VERY busy vet practice but works really well with me. He is close, convenient (I live in a very rural area) and he is a wonderful man. My plan is to request to keep copper on at least 20 mg per day and retest. I may also give the internal medicine vet a call and see what she thinks. I was worried copper was dropping too fast, too soon. He was doing the shivering thing on me last Saturday. Like the vet, trilo still scares me a little.

[jpatterson]

Please keep giving me advice and don't hold back. You are not being too forward. I love this dog and am working with all my means to help him feel better and walk again. He was my best friend during some very trying times in my life and I owe him a lot! Any help or advice is truly appreciated in making decisions about copper's care.

[labblab]

By the way, can you please give us the "normal" range for the potassium and sodium results that you posted? I was so focused on Copper's cortisol earlier that I didn't pay much attention to those electrolytes. But looking at them now, I'm wondering whether the potassium is a bit higher than normal? If so, then that might warrant a decrease in the trilostane in its own right, regardless of the cortisol. Trilostane lowers aldosterone as well as cortisol, and that can increase the potassium level in the body. So maybe that's what your vet is also taking into account. If so, I'd still really welcome the specialists' input, though, as far as how large a dosing change would be desirable.

Marianne

[lulusmom]

I only have a minute, maybe less if I lose signal, but wanted to chime in about your vet's concerns. To be perfectly honest, my first thought was wow, the vet is showing his inexperience again and is probably using the reference range for a normal dog as opposed to the therapeutic range for a cushdog. Then I went back and looked at Coppers pre treatment stim test and honestly, I don't think I've ever seen pre and post stim numbers as high as Coppers. Pre 25 and post > 50 are huge numbers. Now that I see where Copper came from and where he is now, I'm going to cut your vet some slack.

You normally disregard the resting cortisol for purposes of monitoring treatment but in this case, I was uneasy with the dramatic drop in resting cortisol from 25 to less than 1, which is below the normal reference range of 1 - 6 ug/dl. I share Marianne's concern with such a drastic drop in dosing and I also would feel a lot better if a specialist was directing treatment. However, if that's not possible, I would recommend that sit down with your vet and discuss his recommendations so that you have a good understanding of his approach to treatment. I think all you would have to do is mention to him that Dechra's treatment monitoring chart indicates that a post stim number of 5.1 is good and if you are seeing a resolution of symptoms, no change in dosing is necessary. At that point, he would have to explain why he thinks a dosing adjustment is necessary and why such a drastic decrease.

[jpatterson]

Normal values for potassium is 1.45-9.1
Sodium is 40-250.
His potassium was 6.2 and Sodium was 154. Doc thought potassium was climbing and sodium was dropping from initial test. Don't know what baseline electrolytes were. I think he does not want him to drop so fast. I am going to ask to give him 20 mg every day. That should be a little more than 1 mg/lb. he weighs 17 lbs.

Funny thing...he will try and walk about 3-5 feet for a piece of bacon. Sound like that might help me with physical therapy!

[labblab]

Thanks so much for those electrolyte norms. I've glad to see that Copper is still well within the normal ranges. I'm also glad that you are not opting to drop him clear back to 10 mg. of trilostane. And if it turns out that his Cushing's symptoms rebound again after the decrease, I would not wait a full 30 days to retest him. I would retest him sooner. I do believe that a rebound of observable symptoms will be an indication that you are losing control of the cortisol again.

You had asked earlier about Vetoryl pricing. Yes, you can definitely purchase Vetoryl online for significantly less than $100 per thirty 30 mg. (or 10 mg.) capsules. If you google "Vetoryl," a number of internet pharacy sites will come up. Do not ever purchase from a pharmacy that does not require a prescription (that's a definite red flag as to the integrity of the source). But there are several well-known suppliers of pet meds that offer Vetoryl online.

Also, yes, you can obtain compounded trilostane suspended in liquid. However, given your vet's concern about dosing issues, I would recommend against going that route during these early days when you are trying to establish an optimal dose. We've had a few folks here who have used liquid trilostane, and my own impression is that there have been more question marks about precision and consistency of dosing when the liquid has been used. I think the liquid suspensions may also have a shorter shelf-life than prepared capsules. So right now in the midst of your dosing concerns, I'd ecourage you to stick with prepared Vetoryl and wait until Copper is stabilized to shift to a less expensive compounded product, either in liquid or capsule form. Once again, just my personal opinion.

Marianne

[jpatterson]

Thank you for input. My vet mentioned his potassium was climbing faster than he liked from his initial baseline. Copper got his 30 mg today and I will only be dropping him to 20 mg per day when the new dosage come in...and be watching closely for symptoms. I will let you know how things go. I don't know what I would do without this forum. God bless you!

[jpatterson]

Copper is now taking trilostaine 10 mg. twice a day. His Pre and Post ACTH Stim levels are between 1-5. At this point we have his cortisol levels controlled. His hair growth looks great and his coat really looks healthy and shines. He is eating well and his thirst is well within normal levels. His only remaining problem is his hind legs are still stiff. I have been taking him for accupuncture and tomorrow will be his third treatment. We are doing this once a week. He has been responding well and has been trying to walk more but it is hard for him. I have been putting him in my garden tub/jacuzzi and doing a little water therapy.

I am so hoping he will walk again but know this is a long shot. I am also considering a cart for the future. There is so little research about cushpups with muscle myopathy and what if anything will work. If there are any suggestions or new research I would be interested.

Does anyone have suggestions about doggie strollers as I would like to get dog and I outside for walking? The past few months have been really hard on us and I think some strolling and exercise would help Copper's mother destress.

[Sugar]

I highly recommend you getting a stroller. I had one for my Sugar, a 14 pound white Peke who could no longer go for walks with me and my other Peke. I felt so bad leaving her at home. The stroller meant that we once again could all go together as a family. She loved being in it and I loved watching her head move around from side to side as we strolled down the street together. We went out 4 times a day, regardless of the weather, even in snowy days. It was the best purchase I ever made. Sugar has been gone now 5 months, I can't part with her stroller because of the wonderful memories we had together. If you check her blog you will see a picture of her in her stroller. The brand name of the stroller I purchased for Sugar was Petzip. You can see a picture of her in it in her album.

[jpatterson]

Copper had a spell of tremors tonight. He was weak and could not stand to drink water or take food. I held him and rocked him and after about 30-45 minutes he stopped tremors and seemed to be resting. I am giving him trilostane 10 mg twice a day. His last ACTH challenge and electrolytes were within normal range. The testing was done about 4 weeks ago. I think I may hold his dosage tomorrow and see how he does. I worry that he may be getting low. Any thoughts? He is down to 15 lbs.

[lulusmom]

The symptoms you describe sound like low cortisol so yes, do not give any more trilostane until you talk to your vet. Did your vet give you prednisone in case of emergency? If so, you should give him a dose. Not being able to stand, walk or eat is serious so if he continues like this, you should get him in right away to have his cortisol and electrolytes checked.

Glynda

[Squirt's Mom]

How is Copper this morning?

[jpatterson]

Copper and I are not doing really well. I took him off trilo due to tremors for about 5 days. He came out of his lethargy and acted like a frisky puppy. Then on the 5th night off...he woke me up from sleep three times for water and bathroom. I have to work and that will not work. I started him back on the trilo but at 10 mg. like my vet wanted to do to start with...not the 10 mg. twice a day like the IM Vet suggested. I figure I will do more harm over medicating him vs. undermedicating him. Every time I have ACTH stim levels done it is several hundred dollars. I figure I can go ahead and reduce him and then wait for 10 days and get his level checked again.

He is still having episodes of tremors and twitching about 12 hours after his dose at night. Also this evening I saw an abcess between his toes on his right front foot. It was as large as a grape or larger and it drained on its own. I read about abcesses of the paw and got the fluid mostly out and he seemed better. He had a paw upset about 2 months ago I think in exactly the same place. he was treated with clindamycin at that time.

I don't know how everyone else handles the decision of when is enough...I am so worried about my dog and his quality of life. He is sitting beside me now twitching....paw abcess and can't walk because of weakness in his hind legs. I love him so much and I know it is times like this that make me realize I will soon be facing one of the hardest decisions I have ever made in my life. I am asking for prayers from the other cush parents.

[labblab]

I am so sorry to hear that Copper is having such a difficult time. I can imagine how exhausting and upsetting it is to see these changes without knowing for certain as to the cause and whether things will improve. Oh, if only we could find that precious crystal ball!!

Just a couple of questions to throw out... Did the tremoring cease entirely during the five days that Copper went without trilostane? If so, that might suggest that it is indeed a side effect he is experiencing to the medication itself. And perhaps, over time, this might cease. I can't remember if I mentioned this earlier, but my own Cushpup exhibited odd tremoring episodes that worsened during his intial couple of months taking trilostane. Whether they were caused by the drug or whether they were some physiological response to the lowering of his cortisol, we never figured out. But they did stop after a couple of months.

I also can't remember whether or not you've considered Lysodren as an alternative treatment. Just as is the case with any drug, some dogs seem to tolerate and respond better to alternatives. If Copper truly seems to be perkier and tremor-free while off the trilostane, perhaps a medication shift might be something you could consider.

As I say, just a couple of thoughts to throw into the mix. I know you are wanting the very best for your little boy, and that you are facing difficult decisions. I am sending you hugs of strength and support, and some extra pats for little Copper, too!

Marianne

[Squirt's Mom]

Hi,

I want to second the suggestion that you consider switching him from Trilo to Lyso if the tremors don't stop and he continues to have problems. The Lysodren may not help his muscles any more than the Trilo is but it may not cause him additional problems either. Many folks are much more afraid of Lyso than they are Trilo but that is because they don't understand that one drug is just as powerful and carries just the same risks as the other. Trilo's main attribute that makes it SEEM safer is it's short life in the body. Trilo is leaving the system in 2-12 hours while Lyso reaches it peak at 48 hours. Often, simply stopping the Trilo for a bit will prevent a crisis while pred is used just about every time a crisis arises with Lyso. Trilo parents need to have pred on hand just as Lyso parents do and for the very same reasons. ;)

So don't give up on him yet. There are other things to try first. ;)

Hugs, prayers and healing white light for you both,
Leslie and the gang

[jpatterson]

I have cried for two days now since I had to reach the decision to put my Copper down this morning. Copper and I have been dealing with this disease for 9 months.

He had muscle problems so badly in his hind legs he could hardly stand to use the bathroom. I carried him everywhere he went because he could not walk at all. He would tell me when he needed water or food and go out. Often he would wake me up three times a night to drink or go outside. I am still working full time on a very stressful job. My job requires I travel out of town for several days at a time. I would take him with me and board him at vet's offices in different towns. They would not keep him in a PetSmart hotel because he could not walk. Sometimes he would tremble and look so afraid and some times he would refuse to drink water and eat. I adjusted his trilo and had lab work trying to monitor his levels. I also have meniere's disease which gets worse with stress and exhaustion.

I love that dog with all my heart. My husband left 6 years ago after 32 years of marriage. Copper has been my faithful companion and love of my life. He would have given his life for me and I know it. His mind was very good but his body was worn out. Releasing him this morning was the hardest thing I have ever done.

He loved hamburgers...I fixed him two yesterday. He loved to go through the McDonald's drive through ( I limited that to occassional) so I took him this morning through for a sausage patty. I held him so tight this morning and stayed with him until he left this world.

I have a beautiful hill side above my house that looks over the lake in front of my house. After holding him and talking to him and saying my goodbyes...I buried him where he could continue to watch me and be near me forever. I had a flowering crab apple tree I planted at his gravesite.

My arms are so empty and my heart is so broken and the pain is so terrible. I can't see how I could miss him any more than if he had been my child. I know he is better off and he runs with Angel wings but my heart is so shattered. I wanted so much to keep him with me. My vet told me he knew I had done everything possible and much more than others would have even tried. He told me I was doing this because I loved him so much. My mind understands all this but my heart still longs for my dog.

I know all of you understand what I am going through and I don't want to feel foolish for loving him so much. I had people say to me what are you doing? He is just a dog. Well he wasn't just a dog...he was my best friend and he will be missed terribly.
Janice

[Squirt's Mom]

Dear Janice,

I am so sorry to hear about Copper. It is clear he was much loved and a huge part of your life. I know he is ever so grateful to you for all you have done for him to give him the best life possible. Today, you gave him the greatest gift of all - freedom from a failing body. He is strong and whole once again, running free in the Rainbow Fields with his new friends who were there to greet him. Copper knows that one day he will be in your arms again and when that time comes, you will never be parted.

Our deepest sympathies,
Leslie, Squirt, Trinket, Brick, Tasha and our Angels, Ruby and Crystal

[jpatterson]

Thank you so much for the kind words. I am just having trouble stopping the tears. I know he is better off running and jumping in heaven....I just miss him. He slept with me every night for the past 10 years and tonight will be very lonely. He always "scruched" up against me and would bark if he heard anything at night. Because of my meniere's disease, I have lost about 50% of my hearing in my right ear. He was my protector and my ears.

I know time will lessen my pain but for right now, the pain is sharp.

[frijole]

Janice, My heart broke just reading your message... the love for dear Copper jumped off the page. Don't feel foolish for how you loved your pet. I lost the love of my life Feb. 26th. It hurts. It's quiet. Just keep the memories fresh and the love in your heart. Feel free to come back and talk to us. We truly understand. Sending you as much healing and love as I can. Copper knows he was loved. Run free of pain little guy and know you will be missed. RIP dear angel Copper RIP. Kim

[infoviewer]

I am so sorry for your loss. All of us who have lost our beloved pets understand the grief you feel. My heart aches for you. Love, JoAnne

[marie adams]

Dearest Janice,

I am so sorry for your loss of Cooper. I know how hard it is to make the decision and to have to carry it out. Yes the pain is sharp and it does take time, but do not beat yourself up over the tears. I still have them after a year and half and a new furbaby.

That is a lovely site on the hillside for Cooper and you will forever know the crab apple tree as Cooper's watching over you!! :)

[jmac]

Janice,

I am so very sorry for your loss. I hope knowing you did the right thing for him, along with your happy memories will eventually lessen your pain. He is now running around happily, waiting for the day he will see you again. You are in my thoughts...

Julie & Hannah

[Bo's Mom]

I am so sorry to hear that your sweet baby boy has passed. Sweet Angel Copper is the newest star in the sky tonight watching over you and running around making new paw prints in Heaven.

[apollo6]

Dear Janice
I am so sorry for your loss. Your feeling are justified. May sweet
Copper watch over you. I am going through the same with my little Apollo, a day or a week before I loss him. Like you I cry everyday, holding him and knowing I will not have him soon. Please know we are hear to comfort and hold you in our impress. Let it out.
Hugs Sonja and Apollo.
this poem says it all

MY FOREVER PET
There's something missing in my home,
I feel it day and night, I know it will take time and strength before things feel quite right.
But just for now, I need to mourn, My heart -- it needs to mend.
Though some may say, "It's just a pet," I know I've lost a friend.
You've brought such laughter to my home, and richness to my days.
A constant friend through joy or loss with gentle, loving ways.
Companion, friend, and confidante, A friend I won't forget.
You'll live forever in my heart, My sweet, forever pet.

[jpatterson]

Thank you all for your special thoughts and prayers. I slept last night with his puppy bed in my bed beside me. I put my hand in his bed and it felt like he was still with me. He slept with me every night and spent the day in his bed while I was at work.

I will work every day to keep his memory alive in my life and do everything in his honor. I can truly say I have been loved and loved in my life.
Janice

[Jenny & Judi in MN]

Oh Janice I'm so very very sorry. Judi

[Nika'sMom]

I am so sorry for your loss.When my wolfhound passed away (from cancer) I slept with her blanket for a while, it smelled like her and it helped me to feel her with me for a while...your story made me cry, but smile at the same time cause I know that you loved your baby as much as the rest of us here love ours :)..sending prayers that your heart heals and you will have such sweet memories always running through your mind, and in your heart..hugs Lynda

[Roxee's Dad]

Dear Janice,
I am so very sorry for your loss. Rest in peace sweet Cooper, you are our newest and brightest star in the sky.

[infoviewer]

So sorry for your loss. I have a doxy with Cushings and it is such a terrible disease. Always remember the love you had for Copper and how much he loved you. He is no longer in pain and I am hoping your pain will lessen as the days progress. Hugs, JoAnne

[Casey's Mom]

I am so sorry for your loss, I babysit a doxy and they are wonderful dogs. Your love for Cooper is so evident and you did all you could honey, that's all we can do.

Love and hugs,