Marley, 7 year old Shih Tzu, Diagnosed with Cushings Will Not Sleep at Night

[Sulreich]

Hi all,
The love of my life, Marley, our 7 year old Shih Tzu, was diagnosed with Cushings disease just this past January. Marley was a healthy, rambunctious pup until last November when he started drinking and eating excessively, urinating in the house and wanting to go out to urinate all throughout the night.
After the first ACTH test showed inconclusive and the Vet thinking it was chronic kidney disease, all Marley's symptoms lead towards Cushing's. After a 2nd test, Marley was diagnosed in January and started on 10mg of Vetoryl twice a day (20mg per day total). After only seeing the slightest improvement in Marley's symptoms, he was tested again after a few weeks and upped from 20mg a day to 30 mg a day.
It has now been 3 months on the Vetoryl; the first month we were giving him 20mg of Vetoryl each day; these last two months we have been giving him 30mg of Vetoryl each day.
We are devastated because Marley is still up almost all night long, every night. We take turns sleeping on the couch, getting only 3-4 hours of sleep each night. Marley sleeps best after he eats. This seems to be the ONLY way he will sleep - with a full belly. He wanders the house and whimpers all night long, waiting for more and more food.
We have had Marley on Prozac which just made him so groggy that he could barely walk. So in addition to all his other symptoms, he has gained so much weight that he struggles to walk at all. We took him off the Prozac in hopes of him getting more energy back and it seemed to work a little. But he is STILL not sleeping during the night. Last week we started him on tranquilizer (pills) at night which do not help either.

Has anyone else had this problem? Does anyone have any suggestions on how to get him to sleep through the night without feeding him every hour? The vet thinks that the Prozac and sleeping pills are not working because his tumor is most likely pressing on the part of his brain telling him he's hungry when he's really not.

We are at our wits end. Other than not sleeping at night, it seems that Marley could live a normal life. Oh and on top of his Cushing's disease, Marley went blind (fully blind) in February -- they believe from SARDS which is sometimes caused by the Cushing's.

Thanks in advance for any suggestions anyone might have,
Sally

[Iraklis]

Hello and welcome!

Have you performed an MRI to check for an enlarging macroadenoma?

Have you tried Melatonin (careful with dosing)?

Dosing 1 time per day?

Is he pot-bellied yet muscles seem to atrophy?

[labblab]

Has Marley had a recent ACTH to make sure the current dose of trilostane is actually optimal for him? If you could possibly post all of his ACTH results for us, that would be very helpful.

Also, is Marley still being dosed twice daily? If not, it is possible that he would still benefit from splitting his trilostane into two doses given at 12-hour intervals. The drug does not remain active in the body for a full 24 hours. For many dogs, the Cushing's symptoms remain suppressed, regardless. But for other dogs who metabolize the drug more quickly, symptoms rebound again during the evening and overnight.

If you are using brandname Vetoryl, dividing the dose may end up being more expensive and you may not be able to administer two equal doses (in other words, you might give 20 mg. in the morning and 10 mg. at night). But adjusting the dosing might be worth a trial run. Again, though, the exact dose would be dependent upon the most recent ACTH results.

Marianne

[Squirt's Mom]

Hi and welcome to you and Marley! :)

It would help us a great deal if you would get copies of all the testing done on Marley to diagnose the Cushing's and post the actual results here. We would like to see any lab work that shows things like ALP, GGT, BUN, CHOL, etc as well as all LDDS or ACTHs done.

One thing your vet has backwards - SARDS is not caused by Cushing's but rather SARDS causes Cushing's signs yet IS NOT CUSHING'S. Very often the signs will disappear after a while and no treatment is needed...in fact should not be given. So it would also help if you could tell us more about the blindness and the timing of it with the cush signs and testing. SARDS will cause false positives on the cush tests. ;) Some SARDS info for you -

http://www.k9cushings.com/forum/showthread.php?t=213

The restlessness at night could be associated with the SARDS, the resulting blindness, or any number of things. He's a bit young for cognitive issues like CCD but that constant roaming is part of CCD too.

If his cortisol is controlled, his hunger should have returned to a more normal level. Is he maybe wanting to eat out of habit or for comfort rather than real hunger? You might try giving him things like green beans, carrots, apples, bananas, etc to help him feel full without adding weight. Use fresh or frozen, not canned.

I'm sure some of our Vetoryl (Trilostane) parents will be along soon to talk to you about his treatment. I am happy you found us and want you to know you will not be alone on this journey. We will be with you all the way!
Hugs,
Leslie and the gang