Badger, ADH, Trilostane, CCD?

[suemartin]

Hi, I have a 13 yr old welsh corgi That was diagnosed with adrenal cushings July 2013. In the past month he has started showing cognitive dysfunction that seems to be getting worse quickly. He was precribed prozac and has been on the medication for 2 weeks. I do not think it is helping and is possibly making him worse. Badger has always been a very well adjusted happy dog and is now disoriented trembling and lately shows a diminished appetite. He also is starting to move very slowly and quite stiffly. He stares into space and acts like he does not know me at times.The symptoms come and go but seem to be more constant every day. He is on trilostane for the cushings and all blood work is good. His most recent ultrasound showed an increase in the size of his liver from 4 months ago . Could the trilostane be causing the cognitive issues? How long do I keep him on the prozac before I give up on it? Is there anything else to try that may help him? I am really concerned about the quality of his life and how quickly he is deteriorating.

[Squirt's Mom]

Hi and welcome to you and Badger! :)

I've edited the title of your thread to indicate what you are dealing with so those with experience in those areas will be more apt to see and share with you.

We are a Lysodren house so I will let those who use that drug talk to you about that. And we have several adrenal based Cushing's (ADH) pups here and I'm sure their parents will be along to chat with you, too. We ask a LOT of questions at first but that is just so we can get a better idea of the big picture and offer better feedback. So be prepared to play 20 Questions! :D

I did want to address the cognitive issues. My Squirt was recently diagnosed with CCD, or CDS, - doggy Alzheimer's in short. She was showing signs, like incontinence, that I missed. Then she got bad very quickly. She would display what in humans is referred to as Sundowners - she got very restless and unsettled as night came on; on and off the bed, roaming aimlessly around, for hours on end night after night after night. Then Squirt experienced what I call terrors, usually starting late afternoons - she would become absolutely terrified and I had no idea why. A friend told me about a product called Novifit that helped her pup a great deal. I talked to our vet about it and he's never heard of it. Novifit is a stable SAMe product that helps with canine cognitive issues. Squirt started it and within days she was sooooo much better! Another friend of ours tried it with her dog but it didn't help him as much as it did Squirt and the other pup. So it's not a guarantee but it's well worth a try. Here is a link about it. I don't need a prescription for Novifit but you may - it may depend on where you live. ;) Shop around online and find the best price. I found it at Countryside Pet Supply but I don't use credit cards so that limits where I can buy things. They are very quick in shipping, I can say that for them!

http://www.virbacvet.com/products/detail/novifit-novisame-tablets/behavioral-health

http://www.countrysidepet.com/search.php?search_query=novifit&x=65&y=16

Squirt is also taking Anipryl (Selegiline) which is helping as well. Anipryl increased dopamine in the brain which is one of the chemicals that become depleted with age and is connected to Alzheimer's, if I understand correctly. It takes this drug a bit longer to show improvements. You will need a prescription for Anipryl.

In addition to these, Squirt also takes melatonin, just plain melatonin - not time released, extended release, etc. - twice a day, am and pm.

So there are three suggestions for alternative or additions to the Prozac that I would certainly talk to the vet about asap.

I do some other things to help her but these will give you a good start. I'm glad you found us and look forward to learning more about your sweet girl as well as you.

Hugs,
Leslie and the gang

[frijole]

How many tests and which ones were done to diagnose the cushings? Did you do an acth test? Does your dog have incidents where he's breathing quite rapidly? Does the stiffness and trouble walking come and go? What is there before giving the prozac? Was the trembling happening before diagnosed as well?

I ask these questions because what you described to me sounds like it might be a pheochromocytoma tumor and it is a tumor that is not cushings. I just want to make sure because my dog was misdiagnosed as having cushings.

Kim

[labblab]

At least some of the symptoms you are describing could be associated with a dose of trilostane that is too high. Can you please find out and tell us the exact numbers for all of the ACTH monitoring tests that have been done since starting the trilostane in July? If your dog is being overdosed on the trilostane, the situation needs to be remedied quickly.

Thanks,
Marianne

[addy]

I totally agree with Marianne, please post his test results. My Zoe has been on Vetoryl for 2.5 years and recently started showing new bothersome symptoms, very stiff back legs, head tremors, falling over, mental dullness, her post was 1.9 ug/dl. Perfectly acceptable by some specialists but maybe not for Zoe. I just lowered her dose of Vetoryl and she seems to have rebounded so please, please, post those test results.

[lulusmom]

Hi and welcome to you and Badger.

When you say Badger was diagnosed with adrenal cushing's, do you mean he has an adrenal tumor? Only a very small percentage of dogs with cushing's have an adrenal tumor, with the majority having pituitary dependent cushings. If he actually has pituitary cushing's, what you are seeing could be neurological signs caused by an expanding pituitary macrotumor. It is known that treatment with Vetoryl (Trilsotane) or Lysodren can facilitate growth of a macrotumor.

If Badger does in fact have an adrenal tumor, low cortisol could be the problem but you mentioned that bloodwork was okay. Because so many general practitioners don't know how to assess an acth stimulation tests for purposes of monitoring treatment, we are not that trusting and ask members to post the actual test results. That would certainly help us rule out low cortisol as a causative factor.

Glynda

[littleone1]

I also want to welcome you.

I'm not on the site very much anymore, but when I saw what you are dealing with, I wanted to let you know about Corky. Corky had a right adrenal tumor, and was treated very successfully with Trilostane for sveral years. Since he was not a good candidate for surgery, he was treated with Trilo. He was also diagnosed with CCD. His IMS put him on Novifit, which really worked well for him. He was one of the fortunate fur babies that only had to take it for 30 days. There was such a big improvement in him. He didn't have to take it any longer.

I hope Badger's issues will be resolved.

[suemartin]

Hi, thank you for all of the response! The vet that performed Badgers ultrasounds is a cushings specialist. They did an acth as well as a dex suppression test. We have been checking his cortisol levels regularly, I do not know the numbers but I will get them.Badger is on 10mg trilostane every other day. I have stopped the prozac as I believe it may have been making him worse. The vet gave some tramadol yesterday. I gave a dose of tramadol last night and it seemed to help although he still was not very interested in food. The tremors started before he was on prozac. He also started losing his hearing several months ago and that has progressed as well. I do not believe he hears much at all but is still startled by loud abrupt noise. He definitley shows the sundowner syndrome, he has some symptoms during the day but everything gets much worse in the evening. I have read about sam-e . My vet does not have experience with it . I am making an appointment with another vet that is using alternative and holistic approaches. I do not doubt that he has an adrenal tumor, and we have discussed the possibility that he has a pituitary tumor as well. My vet thinks the liver mass is pressing on his vena cava , possibly causing reduced blood flow and or pain.