Kayko-Boxer with Cushings

[TamsBoxer]

My name is Tammie, our boxer is Kayko, she will be 11 in November. Here is our story:
Kayko is a small boxer she only weighed 40lbs at her peak. She has always had an excessive thirst, drinking more than our other dogs. (we have 6 currently) She also has what I call a reflux. When she drinks or eats she vomits when she burps. This was just an issue we dealt with over the years. The vet always kinda put it off like it was not a big deal.
The past couple years she started drinking out of the toilet (she will open it if the lid is closed so there was no monitoring or keeping her out.) She will drink a toilet dry (bowl and tank) and still want more. I took her to the vet, they ran blood work an came back with Hypothyroidism. They put her on Levylthyroxine (Synthroid) her drinking didn't subside it got worse. She started having accidents in the house (she never did that) and it wasn't like a little trickle or puddle, it was a monsoon. So I read up and found that Synthroid causes excessive thirst, so I took her off the Synthroid. Due to it was causing more of a problem then helping the situation.
Well last June she was official diagnosed with cushings. The vet did an ultrasound, and said she does NOT have and tumors on her adrenal glands, but found her bladder was as big as the vets head. So I am assuming it is a pituitary problem. They put her on .5ml of Trilosten. This seemed to be helping initially.
After about 6 months Kayko became very lethargic, and quit eating ANYTHING. I spoke to the vet they ran more blood test, everything came back good. She had a UTI and was given an antibiotic. We were told to take her off the Trilo for a period and to give Prednisone to counter act, that she was showing symptoms of overdose.
After a couple weeks the vet recommended we put her back on the Trilo, we did, again she became lethargic and quit eating. We thought it was just time for us to put her down. So again we took her off the Trilo. She has been off all meds for about 2 months now.
She has become very weak in her hind end. She gets what I call "the shakes" when she is in a restful position, sleeping, when she inhales her upper body quivers.
She still eats ok, not great but she eats 2x a day and drinks A LOT. He stool is healthy and her urine is clear, very clear. When she had her urine tested it came back that she was not concentrated. But all the other blood work came back that there was nothing wrong with kidneys, liver, or and signs of diabetes.
My husband and I decided that since the meds made her worse that we were not going to give them to her anymore. We want her to have some quality life, not so much quantity.
Well she just seems to get worse everyday and we are now again debating on what to do with her. Her quality of life is diminishing and she is too good of a friend to suffer.
We tried the cushex drops from petalive. they didn't help her.
She is still happy to see us when we come home, but she has lost her energy.
My main question is how do I know if she is in pain? I can't let her live in pain. I feel bad enough that she is uncomfortable and don't want her to suffer in any way.
Any suggestions are welcome. Thank you
Tammie

[labblab]

Hello and welcome from me! I literally only have about five minutes to type right now, so I must make this very short. But can you please look at the trilostane bottle and tell us exactly what the dosing information is on the label? From what you have written, I am assuming you are giving Kayko a liquid form of the medication, and we need more complete info in order to know how high (or low) the actual dose is. In other words, we need to know how many mg. of active drug is suspended in that .5 ml quantity of liquid. The label on the bottle ought to tell us that.

Also, after temporarily stopping the drug and giving Kayko the prednisone, did you restart again at exactly the same dose or was the dose lowered?

Last but not least, if you could get us the actual numbers for the monitoring ACTH blood test at the time that the trilostane was stopped, that would also be a big help.

It seems possible to me that this may be more a dosing issue than anything else. Also, Kayko might do better taking the trilostane in capsule rather than liquid form. I have heard some vets question whether the drug remains as actively and consistently effective when it is made into a solution rather than given in capsule form.

Sorry for so many questions, but your answers will be really helpful.

Marianne

[goldengirl88]

Hello and welcome to the forum. Sorry your baby is having so much trouble. I am guessing to from the dosage you posted.5ml that this has to be in a liquid form? It can't be a capsule or it would be mg. If so I am in agreement with Marianne. You must be giving a dosage too high for the dog and the dog is going into Addisons. That is why you were given the prednisone to raise the cortisol level. Did you wait for a period of time before resuming the Trilostane or go right back to it after the prednisone? Because a dogs cortisol drops quickly within the first thirty days, they need to have an ACTH test done at 10 days to make sure the dog is not going to low, then at 30 days. Did you have this done? If so could you post the results? Were the dogs electrolytes checked when your vet suspected an overdose? That is something that should always be done as it can become life threatening. I think if this were me and my dog I would stop the Trilostane and give the dog a breather. Dechra the maker of Vetoryl says use a starting dose of 1 mg per pound. We need to convert the ml to mg, but the problem is ml measures volume and mg measures weight. I think you should consult with a pharmacist for what the conversion would be, unless any of the others on here know as I do not. I think it may be to your dogs benefit to use the capsule form. If you were to use the capsules I would start my dog at 30mg if it weighed 40lbs. I am very conservative with this drug. It takes time for your dog to adjust to the drop in cortisol, and to the drug itself. Starting at a lower dose minimizes your dog having problems. You can always raise the dose after the initial 30 day period as the cortisol will drop for thirty days or more. Has you dog only been on the .5ml or was the dose ever changed? Please post all your abnormal test results and the lab reference guide as they are all different. This way we can get a better picture of what is going on. Was your dog sick with any other issues when tested? That can skew the numbers if so and create a false positive. If a dog has thyroid issues it must take the proper medication to have proper body function. Your thyroid controls the hormones, it needs to be right or your dog will not feel well at all. You cannot just stop abruptly giving some medications as that can makes more problems. If I were you I would post the results, get my dogs blood checked and get him back on the thyroid meds, then after he is managed on the thyroid end, I would tackle the Cushings if you have a diagnosis of Cushings. I would proceed with a low dose capsule. I don't think I would like to dispense liquid myself as how could you tell how much they actually got? I myself would want a capsule unless there is no way you can get it into the dog. You dog does have some symptoms consistent with Cushings, but we need to see the numbers. I know this is a lot of questions and information, but we need to go over all this to help your dog. My dog was miserable with a thyroid problem. She is so much better after medication now. You may have thyroid and Cushings going on just like my dog does. That will make them drink more, but if your dog has Cushings the Trilostane dosed properly will help the symptoms. Yes dogs on thyroid meds do drink more, and combined with Cushings that is a lot of peeing and drinking. Please start with the thyroid and concentrate on one issue at a time. We will help you with this so don't worry. Oh by the way,has your dog had an infections, urinary, ear etc.? Blessings
Patti

[TamsBoxer]

OK, Thank you for the information and don't apologize for the questions :) I will get all her lab results and post them. When I get home I will check the exact dosing for the trilotane.
Then we will go from there.
After stopping the trilostane we waited about 2 weeks before restarting her, the vet did not run any test, the dose was not lowered.
Kayko has only ever been on the .5ml dose.
She was given a ACTH test after starting the meds and her levels came back good at the dose. It is a compound liquid form. It supposed to taste like chicken, she took it very well in the beginning but towards the end she didn't want it. So I am not sure if she knew it is what was making her feel bad.
I will post results as soon as I can.
Thank you again for everything.
Tammie

[labblab]

It's so good to hear back from you, and we will anxiously await the test results.

From what you've written so far, I do think we have both good news and bad news. The bad news is that it does not sound as though your vet has followed proper protocol -- at all -- in terms of dosing and monitoring Kayko's trilostane treatment thus far. If they believed she had overdosed on the drug to the extent of needing supplemental prednisone, the very last thing you would do is reinstitute treatment at the very same dose. Plus, testing of her cortisol level should have been performed in order to exactly gauge the effect that the drug was having at the time she was overdosed and again before resuming the trilostane.

So the good news is that it is very possible that Kayko will respond well to trilostane, if and when she is given a dose that is both safe and effective for her. Also, unless there is some reason that it was necessary to give in liquid form, I would dispense with the liquid dosing altogether. Even if it is effective to begin with, I have been told that the liquid suspension has a very short shelf-life. So that may have been part of what she was reacting to -- it may have just gone bad in addition to being the wrong dose altogether.

I am still just speculating, however, and will be anxious to see those actual test numbers.

Marianne

[goldengirl88]

I just did not want you to forget to read that ml dosage off to a pharmacist and ask him how many mg that would be, I would like to know how badly your dog has been over dosed, and am really worried about the electrolyte imbalance it can cause. I do not think you vet is familiar with this disease or its management. For this dog not to be tested after an over dose and given the same dose again, what does he think the end result would be????? You either need to put him in touch with Dechra and monitor everything he does from now on or seek another vet knowledgeable in this disease . You dog could have been in real trouble because you vet did not follow proper protocol at all. These drugs are very effective at managing this disease, but can be deadly when not used correctly. Also when your vet told you your dog was at a good level, I am surmising he was using the scale for dogs that do not have Cushings to judge your dogs cortisol since he is obviously unfamiliar with all this, that will not work out either. Please get us this information so we can help you help your dog safely. Blessings
Patti

[StarDeb55]

Here's a late welcome from me, too! Not to keep pounding away, but I'm also very concerned about your vet's experience in treating Cushing's. In this group, we have seen too many time to count, a pup gets in trouble when a vet is not following proper protocols, & has little knowledge about Cushing's.

I think one point you may be missing is the importance in providing us the exact dose of trilostane that Kayko has been on. Yes, your pup is getting .5ml per dose, but what we are looking for is the total number of milligrams. For example, if Kayko's trilostane was formulated to have 100 mg. per 1 ml, then the .5 ml you are giving would equal 50 mg. of trilostane.

At this point, in the light of the overdose, if I were in your shoes, I would due 2 things, insist that your vet run an ACTH on Kayko, along with checking the electrolytes. Aldosterone is one of the hormones that is also made in the adrenals which can be affected if the overdose is severe enough. Aldosterone controls the electrolyte balance in the body, meaning sodium & potassium. A severe electrolyte imbalance can be life-threatening, & is absolutely nothing to fool around with.

The second thing I would demand is a referral to an internal medicine specialist. IMS vets have very specialized training & are usually the experts in treating Cushing's.

Debbie

PS- I, also, wanted to mention that normal range for cortisol for a pup being treated is totally different than a healthy pup. Normal ranges for our pups are 1-5, & I believe Dechra states that a cortisol of up to 9 something is acceptable as long as the pup's clinical symptoms are well controlled.

[molly muffin]

Hello and welcome from me. I think I am pretty much convinced at this point that I don't care for the liquid form of medicating for cushings. Your's must be the third dog in the last couple months that I've heard of having serious problems on liquid trilostane. It is just too hard to get it exact for what they need and it seems they have all had experiences like yours.
Basically you need to dose at the 1mg/1lb as mentioned by the others. This needs to be given with food, in the am if once a day or in the am and pm if twice a day, then testing for ACTH should be 4 - 6 hours after the morning dose with food. Timing is very important to get the best reading of what is going on.

As the others said, an ACTH at the point where she appeared to be having problems along with electrolyte check is important and never start back at the point you were at when the trouble started. Always go lower, and don't start until symptoms reappear.

That is just my initial thoughts on reading your posts. The others have given you some good information and lets just see if we can't get your Kayko back to a good quality of life. :)

Sharlene and molly muffin

[jxeno13]

Hi and welcome! I'm sorry too that your baby is having problems. I did find this out..."That means that 1 ml = 100 mg"..so, your Kayko was getting somewhat equivalent to 50mg of the Trilo. She weighs only 40 lbs. So, your baby could have getting too much of the Vetoryl...since now she has been on it for awhile.....and the dosage needed to be lowered at some point. Your Vet should have been aware of that...or at least had an idea. I personally would stop the Vetoryl and get an ACTH stim as soon as possible to see just where her cortisol levels are right now. I'd also get a CBC to check her electrolytes right now. Did he say why he was giving you the liquid and not the capsules?

Edited to add......what Sharlene and Debbie said. We all must have been posting at the same time. :)

[goldengirl88]

I would be getting Kayko an ACTH test like yesterday. If these mgs and mls are correct, that is high to start your dog at. If this were my dog, I would have started a 30mg Vetoryl to minimize the risk to your dog. You can always go up if needed, but starting high is not an good way to begin this at all. Blessings
Patti

[goldengirl88]

How is Kayko doing? Did you get him an ACTH test? If so how were the numbers? Hope he is doing well. Blessings
Patti