Pure Exhaustion

[punkieg0]

Jersey is our 13 year old Rat Terrier little cushings guy. He was diagnosed about 3 years ago now after we believe living with this for a few years without diagnosis by our vet. We now have him in the care of our University vet hospital and they are fabulous with him.

We started Trilostane 20mg twice a day and eventually went to 30mg twice a day for him which he maintained for quite a while.
This summer he was changed to 30mg in the am and 40mg in the pm because he was starting to show more cushings symptoms again.

In October Jersey just wasn't acting right, his breathing changed and we brought him in to the vet to find that he was in CHF. Poor little guy spent 4 days in the ICU in an oxygen cage but once they figured out a medication dosage for him he perked right up and was good as new with additional medications. He also had some new quirks of course, his eating has never been the same. (he will not touch kibble in any way, will not eat his normal treats. we associate this to the new meds throwing off his taste)

In November one night we noticed he was drooling and acting really different so again we brought him in to the vet- addisonian crisis.
They had us stop the Trilostane, being his pred for 5 days and then nothing for 3 more days. At the end of this period he was acting like a full blown Cushings boy again, panting, drinking, STARVING.
The vet had us put him on 10mg twice a day to start, last week we asked to increase it again because he was bad, they did 10mg in the am and 20mg in the pm. We increased his dose up to 20mg twice a day and today he is having his ACH test again. I still think he needs an increase up to 30mg twice a day because he is still showing so many symptoms.

All of our problems happened after the 40mg was added to him at night, or in my mind that is what i blame for all the problems. With all of his meds both Cushing and CHF we are exhausted. We go to bed after he gets meds at 10pm, he is usually up around midnight to 1am..then again up at 330am or 4am. With all the water he drinks for the cushings and his CHF meds that pull fluid from his body the boy can't go more than a few hours. And of course once he is up he then decides he needs food because he is starving again.

In our house we need to alternate who’s night it is to look after him so 1 person can get some sleep. I realize that he will not be with us forever and I love his smiles and tail wags so I know how happy he is..but I am beyond exhausted. Could it be that the Trilostane is just not working for him anymore? Has anyone else had a pup that has gone though these challenges? We are spending about $425 a month on his meds not including ACH and vet visits. I feel like every time he is doing good something else pops up and we have a whole new round of issues to deal with.

As I was putting up the Christmas tree this weekend I just broke down because he was watching me and I realized I don't know how many more of these precious days I will have with him. He is so content to not be a runner and be limited in movements but we have a backpack so he can hike with us and his able bodied brother but I dont' know how much more all of us can handle some days.

Sorry for the ranting but I just don't know what to do anymore. I just wish they could talk and let us know what they need or what they are feeling so we could better take care of them.

[goldengirl88]

Welcome. I feel your pain and have experienced a lot of this myself. I am wondering what chf meds he is on? Are you saying he was taking his regular Vetoryl and they added 40mg on top of that or did I get it wrong. Giving too much Vetoryl will certainly make the cortisol plunge and can bring on Addisons. I know how you are feeling and this forum is so supportive and informative on this disease. I know it seems like one thing after another as that is where I am at too. It can sometimes be overwhelming and some on here do have a hard time financially including myself. It is a struggle to afford all the testing and medications etc. I am so sorry you are going thru this . The panel will want to know what testing you had done and the abnormal results. Please also list the normal range the lab gives you as they are all different. How much your dog weighs, current dosage and times a day given. Ever have any diabetes or thyroid testing done? This is a hard disease to diagnose and other diseases have similar symptoms. When you said it wasn't working anymore I wondered if there are other issues not discovered yet. Everyone on here will help you get to the bottom of this. Just remember to keep a daily diary on your dog, and keep all test copies at home. You will get thru this like we all do, with the help of these wonderful people. Blessings
Patti

[punkieg0]

They changed his pm dose to 40mg. So 30 in the am and 40 in the pm.
When I get home I will post all of his meds- they had him on 8 different ones but it was actually dehydrating him so they took most of his meds away (yeah for us so we don't have to hide so many in his food, now if it was the more expensive ones that would have been even better :))
I will post the test results when we get them in a couple of days.

Thank you!

[Squirt's Mom]

Hi and welcome to you and Jersey! :)

A rat terrier on 70mg a day?! What does Jersey weigh? That sounds like a high dose to me but the weight will help determine that for sure.

In my simple mind there are two main possibilities here - 1) Jersey is resistant to Vetoryl (Trilostane) and needs to be switched to Lysodren or 2) something else is going on in addition to the Cushing's (or even instead of). Has she had an abdominal ultrasound on a high resolution machine? If not, I would strongly recommend that be done asap if you can swing it.

I also have some concern about the heart meds along with the Vetoryl. Some are not recommended to be used with these drugs that treat Cushing's. So would you mind telling us the names and doses of all the meds Jersey is taking? Also if you can get copies of the actual test results that were used to diagnose her Cushing's and all monitoring ACTHs done since starting treatment the posting those results here that would help us tremendously. Please include all normal ranges and any little letters that follow the numbers. Health screens that look at things like ALP, BUN, CHOL, etc. will look something like this when posted -

ALP 810 ug/dl 150-500 (EXAMPLE)

The monitoring ACTHs will have two numbers - a pre and a post.

I'm glad you found us and look forward to learning more as time passes. I want you to know that you have found the very best place to be. The collective knowledge and first-hand experience is astounding and the support found here is simply unbeatable. You and Jersey are part of our family now here at K9C and you will never be alone again. We are always just a holler away. We will walk every step of this journey with you.

Hugs,
Leslie and the gang

[addy]

If you can post the ACTH results with the Vetoryl dosages that would be so helpful.

My pup has been on Vetoryl since June 2011, on the same dose for well over a year and her numbers have been all over the place. I recently decreased her dose as I was seeing some unwanted side effects or else I uncovered something with her lower cortisol. Her cortisol dropped down to a post of 1.9 ug/dl but Zoe did not feel well with her cortisol that low. It can be a balancing act to get it so the pup is feeling good.

Try to post the test results when you can.

[molly muffin]

Hello and welcome to the forum.

Oh you poor dear. The others have gotten you off to a good start with needing the lab results for abnormal, and ACTH. The numbers can tell us a lot, but along with that, comes the question of what dosage actually works best for you and for your precious little guy. Right now, doesn't sound like it is, and the suspicion is as Leslie mentioned, something else going on, or not responding as well to the vetroyl. We'll know more by the numbers.
30/40 though sounds like a big no no, as that induced a crisis. 30/35 Might have worked, but again, back to those numbers.
It does sound horribly exhausting what you are currently going through and no one can keep that pace up forever.
We'll help you all we can to get this figured out.
Just know that you Have a place now to come to vent, to cry, to rejoice the successes, we're here for it all.

Welcome again.
Sharlene and Molly Muffin

[goldengirl88]

Keep the faith you will get thru this one day at a time like we all have. It is hard and sometimes you have two steps forward and one back so it can be frustrating. We have all been there believe me. It is a very complex disease. I think too that your baby had to large of a dosage. Once you get that corrected it will get better. Hope your baby is feeling better. Blessings
Patti

[punkieg0]

Hi everyone...
Test results FINALLY came in this morning. His levels look good, which is an improvement. I still think he is not 100% because he is still so warm - and by warm I mean we keep the house at 65 for him (it's freezing outside and he thinks its a day spa) and I keep a fan on him. But he is comfortable so for now I just bundle up.

Current meds are as follows:

Trilostane-20mg twice daily
Levothyroxine-0.3mg twice daily
Furosemide - 20 mgtwice a day (waiting on his cardiologist to see if we can bump up to 3 times)
Pimobendan-1.25mg 3 times a day

He was removed off of Enalapril 2.5mg in November when he had his addisonian crisis.

Testing came back
12/17- pre 3.5 post 5.9 which they are happy with at the moment

in Nov: Pre 2.8 post 3.2

his kidney levels were looked at as well because of all the cardiac meds and they are looking good.

Jersey currently weighs 9.4kg which is up from last month where he was 8.9kg right before he had to go off all meds with his crisis.
Thankfully he had the best 2 nights sleep he has had in a while which is wonderful. His tail still goes flying all around and there is still a smile on his face which is all I am asking for.

I just feel like every time he looks at me funny I start to panic and begin the checklist of what we might be missing or if he needs to go in again. I don't want to miss and obvious sign but I don't want to be that over paranoid momma.