12 YO yellow Lab - Mitzi has passed

[Mitz]

My wonderful Lab, Mitzi has changed so much in the last few months. I have three other dogs, and the four have always behaved as a pack: they eat together, sleep together, go outside together, all four always at my side. In the last few monthe, Mitzi has been withdrawn, sleeping in the bathroom (cool tile floor)alone. Her appetite has no end. In the evening, she paces from the bathroom to the den. Pants a lot. Hesitates going up and down steps. No longer wags tail. A few cases of potty in the house which she hasn't done since she was a puppy. I took her to the vet who said it sounds a lot like senior senility. Her blood test crme out high (318) in Alk Phosphatase. Did the low dose dexamethasone suppression test which came out slightly high (1.6 and1.5) She is now on 120 mg Veterol once a day. So far, she has had three doses and no change in behavior.
She will be 13 in four months, and I expect some behavior changes for seniors, but she is another dog. How much of this is from Cushings and how much from age? I would do anything to get my Mitzi back and see her tail wag again.

[molly muffin]

Hello and Welcome.

I haven't started mine on the Veterol yet, but from what I understand it can take a little while to start seeing the changes. I'd give it some time and hopefully once the cortisol is back in a normal range, her behavior will adapt also.

There will be several others who have experience having already gone through this that will jump in and be able to answer your questions better.

Hopefully Mitzi will start to show signs of improvement soon and be back to enjoying her pack and home.

Hugs,
Sharlene

[Squirt's Mom]

Hi and welcome to you and Mitzi, :)

With an LDDS, the low dose dex test, there should be three numbers - a pre, one at 4 hours and one at 8 hours. Is there more info on the results you have? Is she on any other meds, supplement, or herbs? If so, what and what for? How much does she weigh?

The signs you have mentioned are certainly in keeping with Cushing's. Once treatment starts you should see an improvement in appetite fairly quickly. Water consumption can take a bit longer and coat regrowth longer still, and muscle restrengthening the longest. There is a small subset of cush pups who never regain normal drinking or peeing - but this is not the norm. Most pups will show improvement across the board but it takes some time.

Just in case your vet didn't explain - signs of nausea/vomiting, loose stools/diarrhea, loss of appetite, and lethargy are signs that the dose is too high, that the cortisol has dropped too low. If you see any of these signs, stop the Trilo and call your vet asap. Did they give you any prednisone to have on hand in case there is a crisis? If not, I would request some. With either Trilostane or Lysodren it is important that we have pred on hand just in case.

The scary part is going to be these first few days but I am sure you will do just fine and so will Mitzi. Trilostane has a very short life in the body so it is leaving the system fairly quickly. Some pups will start to show signs as the day passes into nighttime and need to take the Trilo twice a day to maintain the level but that is something to consider on down the road if once a day dosing doesn't seem to be holding. Just wanted to give you a heads up so you know what to look for.

Here is a link to our Helpful Resource Section on Trilostane -

http://www.k9cushings.com/forum/showthread.php?t=185

I'm glad you found us and look forward to learning more about the both of you as time passes. The most important thing for you to know today is that you and Mitzi are not alone. You are part of our family now and we will be here with you the whole way. Never hesitate to ask questions or to simply talk - we are here for you.

Hugs,
Leslie and the gang

[Mitz]

Thanks for the information.
In the low dose dexamethasone suppression test, blood samples were taken pre, 4 hrs and 8 hrs.
Cortisol sample 1 2.4 (1.0-5.0)
sample 2 1.6 (0-1.4)
sample 3 1.5 (0-1.4) Microg/dl
Mitzi weighs 75 pounds, a normal weight for her.
I noticed in the last year, her spine can be easily felt down her back, and her rear is reduced in size.
She seems to have lost interest in everything but eating. If I reach to pet her, she imagines I am offering her food and goes to bite my hand until she realizes there's no food in it. She has completely stopped barking and wagging tail. Her anxiety/pacing episodes are usually in the evening after dinner. She will finally lie down and sleep. Whenever she is lying on the bathroom floor or on her dog bed in the den, she seems to be "out of it", uninterested in anything going on. I usually take her for an early morning (the only time it's cool enough lately) exercise walk. She walks at a very slow pace for about 30 min.
Before Cushings was indicated, her hind weakness was thought to be arthritis and I was giving her buffered aspirin. One night she was vomiting so I stopped that and put her on Prevocox for about a week, then stopped that when the blood test indicated the possibility of Cushings. Now, the only supplement she gets is glucosamine/condrotin. She has had allergy problems for the last ten years, but it has recently been much improved. (We would much rather have the allergy than this.) Her coat and skin seem to be normal. No other health problems.
I am very grateful for your help and support.

[Squirt's Mom]

Well, there is one, ok maybe more than one, catch to Cushing's. :D Cortisol is a natural anti-inflammatory so when Cushing's arises and the cortisol goes up, the cortisol "treats" inflammatory conditions like arthritis and allergies. As the cortisol is lowered with treatment, these conditions can flare. So, more info to file away, you may see an increase in her allergy signs and more arthritis pain as the cortisol lowers. My Squirt has arthritis and she is on salmon oil, a home-cooked feed high in anti-inflammatory foods like sweet potato, and she gets GlycoFlex III - which is a great treatment. It has the glucosamine and condroitin as well as many other things that are really good for arthritis, like Green Lipped Mussels. With the GlyocFlex, I was able to stop giving her 3 separate meds for the arthritis. I love the stuff! It comes in chewable tablets or little chewy bars that she eats like a treat.

My Boston has allergies and I am in the process of learning how to deal with this. So far we have tried Benedryl, which works best but makes her a zombie. Chlortimeton worked for about a week. She was getting the long-term steroid shot but this week we started her on an oral round of pred instead as the vet wants her on a prescription for arthritis - but, with their permission, I am going to attack it via neutraceuticals first. Neutraceutical = diet, supplements and herbs. I Zyrtec next to see if it helps. We have several members dealing with allergies and I am sure they will be along to share with you, too.

Hang in there! I just bet you will start to see more and more of your girl's old personality coming out as the weeks pass.

Hugs,
Leslie and the gang

[Mitz]

After a week of Veterol, Mitzi refused to eat lunch! Is this the start of a turn-around? She was very hungry by dinnertime. (I give Veterol with her dinner meal.)

[lulusmom]

Your vet should have instructed you to bring Mitzi in for an acth stimulation tests between 10 to 14 days after starting treatment. This test must be done within 4 to 6 hours after the last dose. Therefore, unless your vet is open until midnight, you need to give Mitzi her Vetoryl with breakfast or lunch and have her to the vets office no later than 4 to 5 hours after dosing. Do not fast Mitzi and make sure she has taken the pill with food.

Some dogs are extremely sensitive to Vetoryl and as a rule, the bigger dogs seem to be more sensitive. Without knowing what Mitzi's eating habits/patterns are, it's hard to know if Vetoryl is simply normalizing her appetite or if the dose may be too much for her. I don't know about you but my cushdogs were pigs about food for so long, I forgot what their normal appetite was like. :D

I believe Leslie provided a link to Vetoryl reference material in our Helpful Resources section. I highly recommend that you use that link and familiarize yourself with as much about the drug as possible. To make the switch to am dosing, you forego the evening dose and give it in the morning.

Glynda

[Mitz]

My vet instructed to bring her back just under a month. The only instruction was to give with food.

[frijole]

Oh wow. Glad you found us! Your vet should have told you that this is a strong drug designed to reduce cortisol that is causing the hunger/thirst issues. It always requires tweeking to get the dosage right and dogs can frankly die from overdoses. When a dog quits eating like that it is a sign that the dose might be high. For this reason you call the vet as Glynda indicated and get an appt asap (don't let them blow you off) for an acth test. Kim

[Squirt's Mom]

Mornin',

How is Mitzi this morning?

Hugs,
Leslie and the gang

[labblab]

Greetings from a fellow Lab-Lover! :)

I just want to reinforce the advice you've been given re: switching Mitzi's dosing to the morning rather than the evening. In addition to conforming to the recommended testing protocol, the treatment is more effective in alleviating symptoms during the day if the drug is given in the morning. In the majority of dogs, trilostane exits the body after about 12 hours. So the cortisol is lowest and the therapeutic effect the greatest during those initial hours after dosing. It generally makes more sense to take advantage of that effect during the time that a dog is awake and active, rather than during the night when he/she is asleep.

Also, I would recommend making the dosing change several days in advance of the ACTH testing rather than just the night before. If it were me, I'd want Mitzi normalized on the new schedule prior to testing.

And one last thought to add... It may turn out that 120 mg. is a bit high for Mitzi. Even though Dechra's published dosing chart lists 120 mg. for a dog of her weight, their written text recommends an initial dosing range of 1-3 mg. per pound. In more recent continuing ed materials, they are advising vets to start at the lowest end of that range (1 mg. per pound) and work up if need be in order to minimize the incidence of side effects or overdosing. So I really would monitor Mitzi closely right now, given the fact that her initial dose falls a bit further higher in the range.

Marianne

[Mitz]

Mitzi has had problems with Veterol...diarrhea and vomiting. She became dehydrated and weak. I took her to the ER where she was treated for dehydration and x ray showed she had aspiration pneumonia. I have her home now, treating her pneumonia with antibiotics for three weeks. She is also on prednisone for a while. She looks much better now, but her Cushings won't be treated until she is better.

[Squirt's Mom]

And one last thought to add... It may turn out that 120 mg. is a bit high for Mitzi. Even though Dechra's published dosing chart lists 120 mg. for a dog of her weight, their written text recommends an initial dosing range of 1-3 mg. per pound. In more recent continuing ed materials, they are advising vets to start at the lowest end of that range (1 mg. per pound) and work up if need be in order to minimize the incidence of side effects or overdosing. So I really would monitor Mitzi closely right now, given the fact that her initial dose falls a bit further higher in the range.

As Marianne said above, her dose may well have been too high, resulting in the weakness, nausea and diarrhea you saw. Please, make sure your vet is aware that Vetoryl can and DOES cause the same reactions that Lysodren does and to take appropriate measures to make sure she doesn't go too low. Mitzi will need to have another ACTH and active signs before you restart the Vetoryl - at a much lower dose, hopefully. ;)

Please keep in touch and let us know how she is doing with the pneumonia. That has got to tough on you both. :( BTW - the pneumonia is more than likely not connected to Cushing's or the Vetoryl but a separate issue.

Hugs,
Leslie and the gang

[addy]

I hope Mitzi gets better real soon!!!!:):)

What a scare for you.

[frijole]

Just confirming that what the others have said is true. Vomiting and diarrhea are signs of 'overdose' meaning that the dosage is too high. Do you have prednisone on hand to give? I am kind of surprised the ER vet didn't pick up on this... but perhaps they weren't aware of the vetoryl or familiar with it. Regardless.... I would be inclined to hold off on the vetoryl to see if the symptoms go away. Kim

[Mitz]

BTW - the pneumonia is more than likely not connected to Cushing's or the Vetoryl but a separate issue.
It was probably from inhaling vomit.

She is on prednisone now.

[molly muffin]

Oh poor thing. I hope she gets over the pneumonia really soon. The prednisone should give her a pick up if her cortisol was dropping too low.

Hugs to both of you and best wishes for a speedy recovery,

Sharlene

[Squirt's Mom]

How is Mitzi this morning? Hope you both had a good nite and were able to get some rest!

Hugs,
Leslie and the gang

[Mitz]

Mitzi looks much better today than she has for a long time. Less than a week ago, she was not able to stand and now she is alert, walking at a faster rate, and barking! The first time I heard her bark for months. Normal BMs. She is still far from normal...crazy appetite, drinks a lot, pees a lot, but I can see signs of my old girl in her. She goes back for another thoracic radiograph in a week, two more weeks of antibiotics, and a gradual reduction of prednisone doses. After this is all over, we will evaluate and treat Cushings.
Your concern and support is much appreciated.

[molly muffin]

So glad to hear that Mitzi is better today. yay! :)

Hugs,
Sharlene

[Mitz]

Mitzi was to start on lysodren this week, but she passed away on Saturday.

[Maya]

Oh no! I'm so sorry to hear of your heartache...may God comfort you in this difficult time.....
Hugs from Leah and Maya

[Boriss McCall]

I am so sorry to hear this news. I know you loved your baby. :(

Hugs

[Steph n' Ella]

Poor Mitzi! You took wonderful care of her while she was sick and it seems like she ralleyed and enjoyed some great days with you at the end. Healing thoughts and prayers to you and all who loved Mitzi.

[molly muffin]

Oh I am so sad to hear that Mitzi has passed on. :(

hugs,
Sharlene

[jmac]

I am so sorry to hear about Mitzi. Did she ever fully recover from her last issue? Was it something new? Thinking of you and hoping your memories will bring you some peace.

Julie & Hannah

[labblab]

I, too, am so sorry for your loss. But thank you so much for telling us what has happened so that we can join you in honoring your sweet girl. Mitzi has now been added to our special memorial thread, where she will always be remembered by her family here:

http://www.k9cushings.com/forum/showthread.php?t=3918

And we will always welcome you back at any time, to talk about how you are doing or to share stories and memories of your lives together. We know how deeply the pain cuts, and how hard it can be to face a new day without your girl by your side.

Sending many hugs in loving memory of your sweet Mitzi,
Marianne

[addy]

I am so sorry to hear about Mirzi. It is hard to find the right comforting words. Please know you can always come here. We will be here for you, to lend an ear, send hugs and are thoughts and prayers are with you durring this difficult time.

[Squirt's Mom]

I am so sorry to hear about your sweet girl. Your love for Mitzi is evident and I know you did your very best for her. Please know we are here anytime you wish to talk - we do understand your pain and while we can't take it away from you, we can help carry the burden.

Today, your sweet girl is running free in the Rainbow Fields with many new friends and old ones as well. She was greeted when she crossed The Bridge by all who knew and loved her. There she will wait until that day comes when you job on this old Earth is done and she will be there to greet you as you cross. She will fly into your arms, cover your face with kisses, then dash off to show you all the wonders she has found. Until then, she will watch over you with the same love and devotion you gave her.

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

[mytil]

Big ((((hugs))))

I am so very sorry - my deepest condolences.

Terry

[Jenny & Judi in MN]

sounds like Mitzi had a good long life with you and her "pack" But I know it is never long enough. I'm sorry. Judi

[3bostons]

Im so sorry to hear of your news.

Hugs
Deb

[MBK]

I, too, am so sorry for your loss. It was evident you are a very caring pet mom and did all you could for your sweet girl. I hate that their time with us is so brief.