Newly diagnosed my dog with Cushings (Bruno has passed)

[whatuc]

Hi,
My dog Bruno [12] is a mixed breed. He is very large at 100 pounds. I took him to the vet for stiffness in hi s back legs, excessive drinking of water and urination.

Had a couple tests done and confirmed he has Cushings. They said the first test was borderline but the low dex suppression test confirmed it. I knew it already from the symptoms he was having.

I have not decided on a course of action yet. I don't have a lot of money but am willing to do what it takes. I have a couple of questions.
1. What diet should I be feeding him. My vet wanted him on Hills Science for weight loss, but he does not seem to really like dry food as he usually had mostly wet.
2. Has anybody tried homeopathic treatments and if so what success did you have.
3. What treatment if going that way would be best for cost and effectiveness for my Bruno.
4. I do not know what kind of tumor Bruno has, adrenal or pituitary, and they say he needs a high dose dex test to find out. Is this necessary or can I just treat him and save the expense of another test.

Any info would be greatly appreciated. Thanks,

[Harley PoMMom]

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Hugs, Lori

[Harley PoMMom]

Hi and welcome to you and Bruno,

Increased drinking/urination can be symptoms of other non-adrenal illnesses other than Cushing's disease, such as diabetes or an UTI, have these been ruled out?

It would help us a great deal if you could get copies of all tests that were done on Bruno and post any abnormalities that are listed along with the reference ranges and units of measurement...e.g..ALT 150U/L (5-100)....Thanks! We are especially interested in the results from any tests for Cushing's such as the LDDS, ACTH, and/or UC:CR.

There are no homeopathic treatments that will lower a dog's elevated cortisol which is the problem with dogs that have Cushing's disease. The two medicines that are normally rx'd for Cushing's are Lysodren/Mitotane and Vetoryl/Trilostane. These are strong drugs but a God send for our pups with this dratted disease. The only cure for this disease is if the dog has the adrenal type of Cushing's and the adrenal gland with the tumor is removed. So, IMHO, if surgery will not be an option then one has an choice to use either of the drugs, Lysodren/Mitotane or Trilostane/Vetoryl. Which one to use is dependent of the vets experience with either of these drugs and what the pet parent feels more comfortable using.

The initial expense is during the diagnostic phase, when a dog becomes stabilized with treatment the cost does go down, especially if one uses a compounding pharmacy for the dog's medication.

All of the health issues of the dog need to be considered when deciding what to feed. Cush dogs should have a high quality protein with moderate fiber, and since dog's with Cushing's can be prone to pancreatitis, a low-fat diet is suggested, but if a dog is doing well on what they are eating then a change is not needed.

Please know we will help in any way we can so do not hesitate to ask any and all questions.

Love and hugs,
Lori

[whatuc]

Thanks for your reply. I will try to get the tests from my vet, all he told me was that he never seen a lower specific gravity of urine. It was like he wasn't processing the water at all, hence the excessive drinking.

[molly muffin]

Hello and welcome from me too. Do you know if any kidney panels were run? That is another disease that often can mimic cushings symtoms and you would be looking for any proteins in the urine, etc. to determine this.
We'll definitely be interested in looking at the results of your lab work.
Lori has already told you about the two drugs used to treat cushings. What you are doing is basically treating the symptoms and getting those under control by lowering the cortisol levels. This also helps to prevent further damage to liver, kidneys and other organs affected by high cortisol levels.

It is an expensive disease, but once under control, the cost does become more manageable.

You don't Have to have a HDDS, that is up to you. Lets see what those tests show so far.

Let us know when you get the test results and in the mean time, you can tell us all about Bruno. :)

Sharlene and Molly Muffin

[NoonelovesmelikeNorman]

Welcome to you and Bruno...Norman, my doxie, and I are relatively new to this so I will leave the advice for those more qualified, but just wanted to say welcome! and let you know this is a great forum with very informative dog owners who have gone through this before, they so wonderrfully support us newbies. You and Bruno are in good hands.

Praying for you and Bruno and wishing you and him the very best with treatment.

Peace and love, Sharon, Norman and Millie

Sharon = )

[whatuc]

Thank you all for the nice welcome. I am very happy to have found this wonderful site with all the great people.

I have asked my vet yesterday to email the results of Bruno's test, and I haven't received anything yet. Unfortunately, the vet who actually did the tests will not call me until Monday, he's away, and the lady who gave me the news does not know much about any of the meds used for Cushings.

They did do a urinalysis and all I know is the specific gravity was very low. He seems to have a lot of signs of Cushings, but both me and the vet were surprised that he was leaving food in his bowl. They say usually Cushings dogs are raiding all the food they can find.

They did put him on a diet to lose a little weight (he doesn't like the kibble much) before the diagnosis, but I am switching him to a raw diet. I figure he may as well be happy and eat what he likes for the time he has left.

A little bit about Bruno. Well, what can I say. The picture for my avatar is Bruno hiding from the thunder. He doesn't like loud noises. My daughter thought it was cute and snapped the pic.

My husband and son brought Bruno home about 12 years ago. It was a surprise since I already had two little dogs. A couple baths later to get rid of the flea infestation and he was ready to move in. Although he was a surprise for me, he has become a big part of our family and I will do what I can to keep him with us as long as possible.

[goldengirl88]

Hello:
I just wanted to welcome you, and Bruno to the forum. You will be able to handle Bruno's problems, as best you can with the guidance of the wonderful people on here. I for one could not have done it without this forum. Bruno is a cutie, we are sending him hugs and kisses, and hoping he gets the help he needs. Good luck and God Bless you both.

[Harley PoMMom]

A little bit about Bruno. Well, what can I say. The picture for my avatar is Bruno hiding from the thunder. He doesn't like loud noises. My daughter thought it was cute and snapped the pic.



My boy, Harley, was really scared of thunderstorms until he started taking melatonin. The melatonin really did calm him down and when a thunderstorm came along, they no longer frightened him and he would actually sleep right thru them.

He weighed around 23 lbs and took 3 mg of melatonin BID.

[whatuc]

Molly Muffin
A quick note to say that the vet must have checked the Bruno's kidneys because they were good, if I remember correctly. It was a lot to take in all at once as everybody on here knows.

Harley PoMMom... I have heard of melatonin before, but I did not know it was a calming agent. I seen a holistic brew for animals that are afraid of storms.

Thanks for the welcome Goldengirl88, I take it that is Tipper as your avatar. He looks adorable.

[molly muffin]

Anything we can eliminate is a good thing. Even if they said it's good. We like to see the test results to confirm it. LOL We are very cautious and double check everything twice. :)

Yes we do know exactly how one feels during these news breaking calls and even afterwards. It takes awhile to sort of get your mind in order.
Three things. Keep a file of all test results for yourself. Do a test, get a copy. It's invaluable to be able to go back and look at a result when you want to.
Next, pad and paper. Write notes of anything you want to speak with the vet about or vice versa to ask us about. This will save your sanity.
A journal of what is going on, what you might notice with Bruno on a given date. Cushings is one of those diseases that is so symptom dependent that it is hard to remember, oh did he drink lots more on Sunday or did he start to have loose bowls on tuesday or wednesday. It's just one of those things it's good to have and again, sanity saver. :)

Awww, they brought him home and then you adopted him into your heart too. That is very sweet.

Sharlene and Molly Muffin

[whatuc]

Okay I have the lab results back. They sent them in a pdf and I can't copy anything from it. So will put up the pertinent ones.

Okay white blood count and neutrophils are low.

ALT 142 U/L Normal is 10-100
ALKP 674 U/L Normal is 23-212
GGT 11 U/L Normal is 0-7

ACTH Stim test 544 nmol/L This was inconclusive.

Low dose suppression dexamethasone test
baseline 172 nmol/L
4 hours 122 nmol/L
8 hours 124 nmol/L

I hope I read them right. I don't understand much of them.

[Simba's Mom]

Welcome to the family here, this place is full of info and lots of caring people, take care!

[frijole]

Okay I have the lab results back. They sent them in a pdf and I can't copy anything from it. So will put up the pertinent ones.

Okay white blood count and neutrophils are low.

ALT 142 U/L Normal is 10-100
ALKP 674 U/L Normal is 23-212
GGT 11 U/L Normal is 0-7

ACTH Stim test 544 nmol/L This was inconclusive.

Low dose suppression dexamethasone test
baseline 172 nmol/L
4 hours 122 nmol/L
8 hours 124 nmol/L

I hope I read them right. I don't understand much of them.

Those test results do not look like cushings to me. Here is a link that might be helpful

http://www.peteducation.com/article.cfm?c=2+2103&aid=315

Have you done an ultrasound of the abdomen? Kim

[labblab]

I'm gonna both agree and disagree with Kim. ;)

I agree with recommending an ultrasound as the next best diagnostic test to perform if you want more information about the status of Bruno's internal organs including his adrenal glands. However, aside from the ACTH, I do think that the labwork you've posted can be consistent with Cushing's. You noted in another reply that his urine is very dilute. I am not a lab expert, but I think that decreases in certain white blood cells can be consistent with immunosuppression associated with Cushing's (although I'm not certain about the significance of the low neutrophils), and this level of elevation in the liver enzymes could be caused by Cushing's, as well.

When we convert the ACTH and LDDS results to ug/dl (the unit of measurement with which we are most familiar here in the U.S.), the ACTH comes out at 19.7. So apparently that was not a definitive result per the norms for the lab that did the analysis. But the LDDS was definitely positive: baseline: 6.2 ug/dl, 4 hour: 4.4 ug/dl, 8 hour: 4.5 ug/dl. Unfortunately, the pattern of the LDDS result does not differentiate between the pituitary or adrenal form of Cushing's. However, one interesting point is that the ACTH does a relatively poor job of identifying Cushing's in patients who suffer from the adrenal form of the disease. So even with the negative ACTH, it does seem possible that Bruno may have an adrenal tumor, and I agree with Kim that I think an ultrasound would be my next test of choice if I wanted to know that information. If you would not consider surgery even if you found out Bruno has an adrenal tumor, that information may be less important. But the information might influence your decision about which medication to choose if you do decide to treat Bruno.

In addition to the ACTH, the other inconsistent piece of the puzzle is Bruno's poor appetite. As you already know, that is not typical of Cushing's. However, we have had at least a couple of dogs here who were the direct opposite of the typical pattern: their appetites were poor when their cortisol was high, and their appetites improved when their cortisol was controlled. It is unusual enough, however, that it might be another good reason for performing the ultrasound -- to make sure there isn't anything else also going on with Bruno in addition to (or instead of) Cushing's.

So that's my 2 cents worth as far as the results you've posted so far!

Marianne

[whatuc]

Thank you ladies for you input.

Is the treatment different for an adrenal tumor than it would be for a pituitary tumor?

[frijole]

Yes and No. :D

With an adrenal tumor, depending on where it is located surgery is an option. If removed then the cushing's is gone. It is a tricky surgery that has to be done by an experienced surgery - not a normal vet.

If that isn't an option or it is too costly you can treat with traditional cushings meds.

Pituitary tumors are tiny microscopic things located near the brain. They are treated with meds. Radiation therapy is sometimes used but normally when that tiny tumor starts to grow and affects the brain. These are called macros and are not common.

85% of cush dogs have pituitary cushings.

Kim

[labblab]

In addition to what Kim has said, I'll just add that while either trilostane or Lysodren can be recommended for treatment of pituitary Cushing's, many specialists now prefer trilostane for treatment of adrenal Cushing's. I believe this is because higher doses of Lysodren may be required to control symptoms associated with adrenal tumors, and the higher doses of Lysodren may produce more unwanted side effects.

I also want to add a bit more as to what I said last night about the white blood counts. I truly am not a lab expert at all, and so I've tried to do a bit more reading this morning. While I still think it's true that certain white blood cell counts will be "down" with Cushing's, it seems as though neutrophils are more likely elevated. So I really don't know the significance of those results for Bruno. Do you know how abnormally low the counts were, and what did your vet say about them? Does he suspect that Bruno has any type of active infection going on?

Marianne

[whatuc]

Thank you both for your replying.

Marianne, I have been reading about the wbc and neutrophils too, and did see that neutrophils should be elevated. I wrote the levels just as it shows them on the results.

WBC 3.8x10^9/L Normal is 5.50-16.90 Low
Neutrophils 1.94x10^9/L Normal is 2.00-12.00 Low

Actually, the vet never did say anything about them. He just told me he has never seen a lower specific gravity for his urine. I will do some more research and see if there is anything that could cause his symptoms. I looked up liver disease and it didn't seem to fit.

[whatuc]

My dog Bruno was doing fine. Last night he could not get up without help and today he was panting heavily after he had peed on the floor. He is not eating or drinking much anymore. I called the vet and they didn't know what it was as his stim test was within a good range just a few days ago.

He doesn't even want his treat to give him his medicine which is making it difficult. Has anyone else had these symptoms happen I didn't know if he needs prednisone or not.

Would a drop in his meds make him like this. I cut him down by 60 mg for two days, Firday and Saturday night, as I was running out of his meds and had to make it last until today. :(

[frijole]

It sounds like the cortisol has gone down from where it was a couple days ago because the signs you have given us are all classic signs of overdose meaning too much trilostane/vetoryl.

Don't give anything - it leaves the system quickly and it should make Bruno feel better but it could take a day.

Alot of vets that aren't real experienced don't realize that this drug is serious and if the cortisol goes too low does can get into big trouble. You might need to take him to the ER if this keeps up - trust me and if you feel he's in distress take him in. He might need electrolytes or an IV. I've seen it many times. Understand me that this can be serious and even fatal so don't mess around with indecision.

You need to call the vet and find out what the exact test results were a few days ago. Sometimes mistakes happen so get the two numbers from that test and post them here please.

Kim

PS how much does your dog weigh? oh and lowering your dose didn't hurt him it might have saved him from even greater peril. For now no more trilostane ok?

[whatuc]

Bruno weights about 100 pounds. We have him on 120 mg of Vetoryl twice a day. Its been about four days ago when he had his last test and she said his range was finally good.

This has all come on suddenly. He was fine, then he peed on the floor and when he came in from outside he was panting heavily. He wouldn't eat much of his supper and has drank very little water. He is not panting anymore though, he seems to be resting comfortably, but yes, I will watch him closely and my son will be up with him through the night.

I will try to get test results tomorrow, they are closed for the night now. He has already had his trilostane for today but I will withhold it tomorrow and see how he does.

[frijole]

How long have you been using the drug? Over the years the specialists and major universities that have done studies have actually LOWERED the starting dosage. A 100 lb dog would now start at 100 mgs a day. So clearly 240 mgs a day is a high dose. So please get the test results. Also we have noticed here that a dog might be fine on a dose for a period of time and then all of a sudden they go low and have to have a lower dose = like the drug kicks in even more and they don't need as much. That's why the acth tests are so important. Kim

[whatuc]

He has been on 120 mg twice a day for around two weeks. He was on 90 mg twice a day and when he got his test results they were still really high that's why the dose was upped.

His last stim test was good just a few days ago so was surprised when he took a turn for the worse. I have held his trilostane today. He did eat his supper sometime during the night and has been drinking a bit more.

The vet is suppose to call today and I will ask for test results. Thanks for taking the time to talk to me.

[juliwilliams]

If you haven't taken him in already, I really recommend it! My dog overdosed a few weeks ago. He had a hard time using his back legs, his teeth chattered, and his muscles twitched. The symptoms were around 5 hours after his dose of trilostane and didn't last long. But i took him in right away anyway and his electrolytes were so off that he needed 8 hours of fluids and then a course of prednisone.

[whatuc]

Hi JuliWilliams. Yes I was going to take him in, but he started to perk up and drink his water again when I brought it to him in a little dish. I stopped his trilostane and he is looking alot better today.

Frijole. I guess Bruno only had his cortisol levels done on his last two blood works. On April 11th, his baseline cortisol was 136 nmol/L. After the shot of cortisol it went up to 276 nmol/L. After this is when his dose was increased to 120 mg twice a day.

On April 30th, his baseline cortisol was 52 nmol/L and after cortisol shot it was 87 nmol/L. Now that I look at these numbers I think his dose should have been lowered since anything under 50 nmol/L would be considered low and his baseline was only 52 nmol/L.

Right now he is off trilostane and depending how he looks his dose will be only 120 mg once a day for a week starting tomorrow. If he still needs a bit more he will get another 60 mg at night, but only if I think he isn't controlled enough.

[mytil]

How is he doing today?

Just a little note - I would also keep an eye out for symptoms of pancreatitis.

Terry

[Budsters Mom]

Hello and welcome from me too! I'm sorry for not popping in to welcome you sooner.;)

You have come to the right place! There is a huge arsenal of K9Cushing's angels standing by to help and stay with you every step of the way. They love details, test results, any information you can get your hands on. The more the better.

So again welcome to you and Bruno,

Kathy and Buddy:cool:

[whatuc]

Thank you for the welcome Budster's Mom. Yes this is certainly a great place to get information about your dog, a life saver.

Hi Mytil. Bruno is doing good today. I am still holding his medication and probably will for a few more days, but he looks loads better. I am keeping in contact with my vet who calls to see how he is doing. Thanks for thinking about my buddy Bruno.

[molly muffin]

Well if withholding the vetoryl has improved him, then you know that this dose of 120mg twice a day is way over board and putting him in danger. I think it has to be seriously backed off. Sudden drops are not unexpected with cushings medication. Things happen and dosages need to be tweaked. We've seen some Very large dogs on really small doses because it comes about that they simply do not need as large of a dose. On the end of the spectrum we've seen some pretty small babies, needing some hefty doses. You start at 1mg per 1lb and go up or down from there usually.
So glad that he is doing better today.
hugs,
Sharlene and Molly Muffin

[Mel-Tia]

The ACTH results you posted from the 30th are not low on the uk scale. Controlled result here is between 50-200 nmol.

Typically an increase in medication would not be recommended with this result so you are correct to with hold his dose.

Has the vet explained why they did increase it? Hoping you are continuing to see improvements with Bruno and that you are hanging in there :)

Big hug

Mel
Xxxxx

[whatuc]

Hi Mel-Tia
The dose was raised so high because he was not under control on the lower dose.

I have started him back on 120 mg once daily. The vet wants to add 60 mg at night, making his total dose 180 mg daily. I haven't started him on it yet and am waiting until I think he is totally adjusted.

We shall play the wait and see game for awhile. The vet just doesn't want me to let him get really high levels like he was.

[Mel-Tia]

Hey there

Nice to see you back again..

Did he have another ACTH recently?

Mel
Xxxx

[Harley PoMMom]

If this were me, I would not add the 60 mg at night with out performing an ACTH stim test first.

Please do keep us updated!

Love and hugs, Lori

[whatuc]

Hi everybody
Bruno does not take another stim test for three months. He is really hard to read. Some days I think he looks low and then he seems to be high again.

I am watching him closely. He started drinking a lot of water again and wanting to eat a lot, so I added the 60 mg at night. His hind legs seem weak again also.

If he doesn't improve here shortly, I will take him in early for his stim test to get a read on where he is. Thanks for all the info I have been given.

[whatuc]

I am really confused right now. My dog Bruno is having trouble using his back legs. He is a big dog and it is hard trying to get him up and down the steps outside.

He won't eat his dog food anymore, he has to have meat and that's it.

Has anybody went from Vetoryl to Lysodren and saw improvement. The Vetoryl does not seem to be helping him. He is on a high dose, either 120 mg twice a day or 120 and then 60 at night. This all depends on his symptoms.

Also, does anybody have any recommendations for building up strength in his back legs as this is the symptom that is most worrisome to me.

[molly muffin]

If you switch from Vetoryl to Lysodren, then you have to have a wash out period, where you give nothing. This is like 30-45 days. Have you talked to your vet about any type of supplements that might help with reducing muscle wastage? Has Bruno ever had any seisures? I'm currently thinking of L - glutamine, which may takes weeks or more to see an affect with, but you could ask your vet about it and do look it up on the internet and do some research on it and see if you think it would help Bruno or not.

Sharlene and Molly Muffin

[whatuc]

Okay thanks Molly Muffin, I will look it up and talk to the vet on Monday. 30 to 45 days is a long time to go without medicine.

I think there might be more going on with him than just the Cushings, he seems quite ill right now. It might be just the heat, I will see how he does when we install the air conditioners today.

[addy]

When was the last acth test? I know you said you were waiting for 3 months for the next test and your vet wanted Bruno on 120 am and 60pm. Which dose have you been giving consistently, 120 mgs or 180mgs?

[whatuc]

Well that's just it, I have been alternating the dose depending on how bad he is panting and how he looks. The dose is 180 mg a day or 240 mg a day. Mostly I have been keeping him at 180 per day now.

He still is panting some but I don't keep him on the high dose for too long as it was too high for him taking it everyday.

His last stim test was about a month ago. His eyes look clearer today with the air conditioning being put in. I think it has helped him a lot. I am thinking about a urine test to see where his cortisol might be.

The big problem is his weakness in his back legs. It seems to be the big problem for dogs with Cushings.

[addy]

Okay, but that seems like a strange dosing schedule to me, did your vet suggest it?


have started him back on 120 mg once daily. The vet wants to add 60 mg at night, making his total dose 180 mg daily. I haven't started him on it yet and am waiting until I think he is totally adjusted.

What dose did your vet want after his ACTH test? I admit I am a bit concerned because it almost seems that your are changing his dose everyday based on the symptoms you see. Is that was is happening or am I misunderstanding?

When you say your are going to do a urine test to see where his cortisol is, you mean an ACTH test which is not a urine test right? The only urine test would be a UC:CR test and that usually is not used in mainstream testing of monitoring Vetoryl/Trilostane.

Yes, hind leg weakness seems to be a common problem with Trilostane but there could be other causes for it as well. The cortisol and intermediates hormones can fluctuate so you may see some ups and downs with symptoms.

[whatuc]

Sorry for the confusion. Bruno was on a dose of 120 mg twice a day. He went too low and started panting heavily. I called the vet and was told to take him off everything as he was probably too low.

I did this for about five days and then all his symptoms of high cortisol came back, panting, drinking excessively, and wanting to go outside. The vet said to start him back on 120 mg a day for a few days and then to add 60 mg back in at night also. We thought this would be the correct dosage as 120 mg twice a day was too high.

This is what I did, but he still persisted with symptoms of high cortisol. I decided to add the 120 mg back in instead of 60 at night for a few days until he was under control. (120 mg twice a day) He really has never seemed to gain control again. Right now he is back on 120 in the morning and 60 at night.

This morning he could not get up at all. I took his breakfast and water to him and my son helped him to get up. He got up the back stairs by himself when he went outside, but he is so weak in the back legs now.

Does anybody know if the vet can give some kind of shot for this weakness?

I know he needs another stim test, but my husband is working days this week so I can't get him in. I thought you could measure the level of cortisol in his urine, I wanted to see if it was high or low or what. I guess I was mistaken.

Anyway that is where we are now, I will give the vet a call and discuss things with her tomorrow, she is not in today.

[addy]

Is your dog having any other symptoms? I am very concerned about your pup and the erratic amounts of Vetoryl he has been given without any diagnostics tests being done to monitor his level of cortisol.


Sorry for the confusion. Bruno was on a dose of 120 mg twice a day. He went too low and started panting heavily. I called the vet and was told to take him off everything as he was probably too low.


Well that's just it, I have been alternating the dose depending on how bad he is panting and how he looks. The dose is 180 mg a day or 240 mg a day. Mostly I have been keeping him at 180 per day now.
He still is panting some but I don't keep him on the high dose for too long as it was too high for him taking it everyday.

What was he doing when you and your vet thought he went "too low"? I am urging you to see if you can get Bruno in asap for his ACTH test and his electolytes check. You said he was panting when he went too low:confused:

Is he eating and drinking? Is he alert?

[labblab]

I get very, very worried when I hear people say that a dog taking trilostane is unable to get up. It is true that orthopedic or muscular issues may be at play, but if there is any possibility at all that drug overdosing is the cause, then things can turn life-threatening very quickly.

The thing is, trilostane lowers aldosterone in addition to cortisol. Aldosterone is the adrenal hormone that controls the balance between potassium and sodium in the body. So concern over low cortisol is not the only worry when taking the drug. It is possible for aldosterone to drop too low, and if this happens, very serious Addisonian symptoms can result -- including lethargy and the inability to walk. The levels of potassium and sodium are included on basic blood chemistry profiles, and should be checked in addition to cortisol levels whenever a dog taking trilostane is acting unwell. Here is a link to a Product Insert that discusses the risks and warning signals of overdosing.

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

Like Addy, in the absence of monitoring blood tests, I am very worried about the effects of this variable trilostane dosing on your dog. If you cannot take your dog to be tested ASAP and he continues to act unwell, I do think the safest course is to stop the trilostane altogether until you can get a better handle as to what's going on. A return of Cushing's symptoms is bothersome, but not life-threatening. Overdosing on the trilostane, on the other hand, can have serious and irreversible consequences if your dog is Addisonian on the basis of either too-low cortisol or imbalances in his blood chemistries. If it were me, I would not give my dog any more trilostane at all until having had the chance to talk with my vet. And if he worsens or starts vomiting or has diarrhea, too, then he really needs to be seen on an emergency basis.

Marianne

[whatuc]

Addy and Marianne
When we thought Bruno was getting too much Vetoryl he was breathing and panting heavily, looked dazed, and just was not acting normally. He seemed to do better when we stopped the meds for a few days, but inevitably started showing signs of high cortisol again, so we started his meds again.

He seems to be lethargic, but he eats meat, he stopped eating his dog food though. He drinks plenty of water. I have not seen any vomiting or diarrhea, but he was eating grass yesterday.

He just heard another dog barking outside and he popped his head up, so it seems that the back leg weakness is the main concern here. This is very confusing.

I will talk to his vet tomorrow when she is in and discuss all this with her. I was hoping that the stim tests were not going to have to be done as much now as it has already been a couple thousand dollars for tests so far. But, if it has to be done, then we will do it.

[juliwilliams]

My dog had severe back leg weakness and muscle twitching when he overdosed on vetoryl, but now that he's on the correct dose he's doing much better. I switched vets right when he overdosed and started seeing an internal medicine specialist (best decision ever!). Her concern at Cooper's first appointment was that he had pituatary dependent cushings. She said treating that with the vetoryl could cause a pituatary tumor to grow and cause neurological problems that could explain his back leg weakness and twitching he was having. She wanted to do an ultrasound to determine what kind of cushings he had. Turns out he has adrenalin dependent and all the muscle problems were from overdosing. He still won't jump on the bed or into the car, but he can at least stand up again!

[whatuc]

My vet seemed to think that Bruno might have an adrenal tumor too, just because he wasn't responding to the Vetoryl very well at first. It took quite a few tries and a high dose to get him to respond to the medication.

Right now, I am holding his dose and he seems a little better this morning. Just maybe, he is getting an overdose. He doesn't have all the symptoms of it though, so it gets a little confusing. He is still eating well as long as he is getting meat and drinking well.

We will take it day to day I guess.

[Budsters Mom]

I am so sorry that you and Bruno have been having such a tough time regulating his trilo. :( I hope you are able to get it all sorted out soon.

Sending many hugs,
Kathy

[whatuc]

Thank you Kathy, I hope so too.

[addy]

Hi Again:):)

How do you know your dog is now on the correct dose? Were any tests done to show that? I'm really sorry if I sound like a nag and it may be that you have more information then what is written here. Bruno is your dog and you know him best but he has already shown symptoms of going to low and this whole situation is a worry to me. So, I dont mean to harp, please realize I remain very concerned about your dog. We read about vets, even specialists with wrong information when it comes to Trilostane/Vetoryl. So that is why we worry. There may be another reason for Bruno's hind leg weakness but you need to know where his cortisol is and how his electrolytes are. Maybe you already know that. If so, could you share any further tests that were done?

I am going to copy and paste part of what Marianne wrote the other day.





The thing is, trilostane lowers aldosterone in addition to cortisol. Aldosterone is the adrenal hormone that controls the balance between potassium and sodium in the body. So concern over low cortisol is not the only worry when taking the drug. It is possible for aldosterone to drop too low, and if this happens, very serious Addisonian symptoms can result -- including lethargy and the inability to walk. The levels of potassium and sodium are included on basic blood chemistry profiles, and should be checked in addition to cortisol levels whenever a dog taking trilostane is acting unwell.



I know how confusing and hard all of this is. My Zoe has been on Veotryl for 2 years now. It has not been easy.

((((((((((((hugs))))))))))))))))))

[whatuc]

Right now Bruno is off trilostane. When he takes it he seems to be worse with his weakness in his back legs.

He has not had any more tests done yet. He actually seems to be better off the medication than on it.

I was just emailing another vet, a holistic one, but she says she treats holistic and with conventional medicines. Since it seems the medication makes him worse, I don't know how that would work.

Right now, I am deciding whether to keep him off of the medication for awhile and then start him on Lysodren. These are hard decisions to make.

[Budsters Mom]

I am so sorry that Bruno is still having such a hard time getting his Trilostane dosing sorted out. :(Medication decisions are always difficult. I hope you are able to find a workable solution soon.

Hugs,
Kathy

[whatuc]

My buddy is gone. Bruno passed away suddenly last night. He just collapsed and died. I think he might have had something more than Cushings going on. In the end, he had bloody diarrhea which looked full of blood clots.

Anyway I like to think he is frolicking, running, and playing now, all things he hasn't been able to do for a long time.

Thanks to all the people who gave me advice and encouragement. This really is a great forum.

[frijole]

I am so sorry to hear the news but glad you told us. RIP Bruno. Run free of pain our newest angel. xoxo Kim

[addy]

I am so sorry to hear of Bruno. There must have been something else happening. It is so hard.

Run free Bruno, play with all our Cush Angels.

Hugs and my condolences to you and your family

[Squirt's Mom]

Oh, honey, I am so sorry to hear about Bruno. You gave him a great life and did all you could to help him when he became ill. You are a great mom and Bruno knew how lucky he was to have found you as his very own. I do believe that today your sweet boy is running and barking and playing just as he did in his youth, strong and whole once again in the Rainbow Fields. He has many new friends and has reunited with those he loves. One day, you will hold him again. Until that day, Bruno will watch over you with the same love and devotion you gave to him.

Bruno's name has been added to the In Loving Memory thread for 2013, where he will always be remembered and honored as a member of our family here.
http://www.k9cushings.com/forum/showthread.php?t=4794

Please know we are here anytime you wish to talk.

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


Time to Go

The time has come I think you know
the Lord is calling so I must go
I love you so much; I wish it wasn't so
I wish I could stay; I don't want to go
You're the best family a dog ever had
so kind and gentle, never mean or mad
I'll never forget the day that we met
I was so lucky to become your pet
You opened your door and showed me your heart
I'll never forget you; we'll never part
You loved me and cared for me over the years
you taught me everything and took away my fears
The Lord is calling now I must go
but before I go I want you to know
I know it hurts to lose a friend
but I'll always be with you even to the end.

Written by John Quealy

[Trixie]

I'm so sorry to hear the news of your sweet Bruno.
Barbara

[Simba's Mom]

So sorry to hear about your furbaby Bruno, no more pain for him and free flying with those new wings, sending hugs and prayers for peace in this hard time.....

[Budsters Mom]

Thank you for letting us know of Bruno's passing. :( He has crossed the rainbow bridge where he is running free with all of our fur babies that have passed before him. Sending you tons of hugs.
Kathy

[molly muffin]

I was so sorry to read of Buron's passing. He'll always be your buddy though in your heart.

hugs,
Sharlene and Molly Muffin

[knitbunnie]

I am so sorry to hear that Bruno has crossed the bridge.

[Roxee's Dad]

I am so very sorry for your loss. Rest in Peace Bruno, tonight you are our newest and brightest star in the sky.....

[Mel-Tia]

I was sorry to read of sweet Bruno's passing

I have light a candle for you both

Big hug

Mel and my angel Tia
Xxxxxx

[mcdavis]

So very sorry to hear of Bruno's passing. Rest in peace sweet Bruno.

[Trish]

I too am sorry to hear of Bruno passing. I hope you are doing ok and taking care of yourself. Such a hard time for you, hope you have support xx

[whatuc]

Thank you everybody for the kind words and support. I am doing okay. I still wake up each morning and think I have to get up to give Bruno his medicine, and then it sinks in.

I get something to eat and look around for him on the last bite because he always got it. I see something from the corner of my eye and think its him, because he was always where I was.

I don't know if I will ever get another dog, the loss hurts too much. I have lost five dogs in total over 26 years of marriage. Although I did look on a humane society site the other day and oohed and aahed over a bunch of dogs. I guess you never say never.

Love to you all, Bernie