Hi! I am new to this- Auggie 12yo choc lab mix recently diagnosed

[Jeannine]

My name is Jeannine and live in Morgantown, WV. Auggie was recently diagnosed with Cushing's- heavy panting, drinking tons of water, uncontrollable peeing, and getting weaker in legs. He was 62 lbs and was down to 57 a week ago and getting thinner each day- he almost looks anorexic. Our Vet won't budge from 120 mg/once a day (today is one month of treatment). He is so lethargic and uninterested. This is not his personality at all! He looks like he wants to eat, but when we put it in front of him he snubs it away. So we keep trying other foods with the same results. Some days he will eat. I am desperate for him to eat and have more energy. He had his Stim test after 10 days and they were pleased with his cortisol levels. From reading on the forum and my instinct, I am wondering if 120mg is way too much for him. Any advice/insight is greatly appreciated! I am so relieved to have found this forum- thank you! Jeannine and Auggie

[labblab]

Hello Jeannine, and welcome to you and Auggie! As you can tell, I am a Lab-Lover, too!!! :)

From what you have told us, I am extremely concerned that your vet does not seem to be worried about Auggie's current symptoms. During the course of trilostane treatment, the "numbers" are only one part of the equation. Equally important is the dog's clinical response and overt health. Regardless of whether or not the 10-day stim results were OK, Auggie is clearly struggling right now and I think it is extremely dangerous to continue on the same course without knowing the cause.

Two thoughts leap into my head. The first one, which is easy to rule out, is whether Auggie may be diabetic instead of, or in addition to, being Cushinoid. Basic blood chemistry panels will have the glucose level posted, and if Auggie has had a recent blood glucose level that is normal, then we can lay that issue to rest. But weight loss is a hallmark of diabetes and relatively rare with Cushing's, so that is why I ask whether diabetes has been definitively ruled out. My own Cushdog was one of the oddballs who did lose weight prior to treatment, but as I say, that is not the norm.

Secondly, even if Auggie's cortisol level was OK at the 10-day mark, it can easily have lowered even when the trilostane dose remained unchanged. It is common for cortisol levels to continue to drift downward during the first weeks of treatment. Auggie is due for another ACTH now, at the 30-day mark. If it can be done quickly (like within the next day or two), you'll have the best idea as to what his cortisol level is now, after a month at this dosing level. But if it cannot be done quickly, I would personally want to to discontinue the trilostane for the time being, regardless. Even if Auggie is not "Addisonian" according to the numbers, he may be suffering a reaction to the rapid drop of cortisol from a much higher level ("corticosteroid withdrawal syndrome"). Lethargy and anorexia can be symptoms of either condition. And also in either case, at least a temporary break in treatment is recommended until the dog restabilizes, at which point a lower dose may be reinsituted. If Auggie is truly Addisonian, though, his blood chemistries may be out-of-whack and he may need both supplemental prednisone and also another drug in order to offset steroidal levels that have dropped too low.

Bottom line: if your vet is ignoring Auggie's worrisome behavior and appearance, I feel very concerned about his/her experience with the appropriate dosing and monitoring of the drug. Do you have any other veterinary options in terms of seeking a second opinion or additional guidance?

Marianne

[Jeannine]

Thank you so much for responding Marianne! I am checking on a couple things from my Vet- but Auggie had a senior panel 2 months ago and all was good except an elevated enzyme in urine. I am asking the vet specifically about diabetes and cortisol withdrawal.

He had two malignant tumors removed on June 6. They weren't able to get all of the cancer out (the margins were not defined). He is too weak to have more surgery. He recovered so incredibly well! We stopped the trilo for 4 days while he recovered and he seemed happier than he has been in months and was sleeping well. Within a couple days of being back on it, he started to decline, and it is so hard to know if it was because the Cushing's wasn't under control or if the trilo was causing it or now if the cancer is bothering him. That is what prompts me to think about the high trilo dose- he was doing well without it and the first 2 days back on it, then the slow decline. I am so frustrated trying to figure this out and I just want to know that he is enjoying life like he used to.
I have a call into the vet- I really appreciate your insight - more than I know how to express right now. I'll write back when I hear from the vet.
I hope you have a wonderful day!
Jeannine and Auggie :)

[labblab]

Jeannine, based on this new information, if Auggie were my dog I would absolutely ask the vet about discontinuing the trilostane for the time being. First, it sounds as though the diagnosis was made at the same time that he was suffering from active malignancies. Can you tell us the location of the tumors? Both of the diagnostic Cushing's blood tests can return "false positives" in the face of nonadrenal illness. So any Cushing's testing may have been skewed by the cancer and other associated changes in his body.

Secondly:


We stopped the trilo for 4 days while he recovered and he seemed happier than he has been in months and was sleeping well. Within a couple days of being back on it, he started to decline...
You are correct that it is impossible to know cause-and-effect right at the moment, but in the short term, it is far less dangerous to let a Cushing's dog go without trilostane for a little while than it is to overdose a dog with the drug. Even if Auggie does have Cushing's, the fact that he was doing better off the drug than on it is meaningful, and I would want to see whether he responds positively again if you stop it again. Plus, if the cancer is spreading, he may actually benefit from a higher level of cortisol in order to reduce inflammation/pain.

Again, if he were my dog, until things are better sorted out, I would talk to my vet about at least temporarily stopping the drug immediately (or right after another ACTH if it can be rapidly arranged). Given Auggie's age and cancer diagnosis, I do think his immediate comfort is more important than mitigating long-term chronic damage that can be associated with Cushing's. If he feels better off the drug rather than on it, then that's the route I would go.

Marianne

[Jeannine]

Hi Marianne! I spoke with our vet and we are temporarily stopping it and when/if we give it to him again - they cut the dose in half to 60mgs. I feel relieved already. I just can't wait to get it out of his system and perks up - I will post how he is doing, it will be interesting to see if he is better off without it. :)
Thank you so much!
Jeannine

[goldengirl88]

Jeannine:
Thank goodness you are stopping the trilostane! The dose your vet had him on is double the 1 mg starting dose recommended by Dechra. No wonder he changed so much, his cortisol probably dropped like a rock. I agree 60 mg is better, but I would try 40mg first, as Marianne suggested Auggie may need higher cortisol to help as an antiinflammatory for the tumors. Hope all goes well for you and Auggie. Blessings
Patti

[molly muffin]

Hello and welcome. I am so glad you are stopping the trilostane. I really think it's too high for Auggie. A pretty good clue is that he did so much better when it was stopped.
Marianne is quite correct in saying, you really can't test for cushings when something else is going on as the likely hood of false positives is increased.
So, yep, stop all together, see how he does . If he remains lethargic, then I'd have electrolytes checked too and anther stim. You can see cortisol levels dropping on any dose for over 30 days and a high dose, well, it can Really shoot down fast.

Do let us know how he is doing off it.

Sharlene and molly muffin

[mytil]

Hi and a belated welcome from me too.

The others have chimed in with great information. And you, great job in questioning things! We are our doggies' advocates and we know them best so when something is just not right, we see it.

Please keep us posted
Terry

[jxeno13]

Hi Jeannine and welcome from me too! I was happy to read that you are at least cutting the dosage down some. 120 mgs...is way to high for a dog of Auggie's size! I would have started back at 40 mg myself......but, I'm one of those whose dog was overdosed by taking twice the amount for his size...and my not knowing! From what I'm reading as well, your Auggie did not lose the weight until he was on the Vetoryl, right? From not eating? I would have stoped it all together though myself, until I got a CBC and another ACTH Stim test done to see just exactly where his cortisol really is. Do you have any Predisone to bring it back up if you need too?? He can go into what is known as an Addison's crisis if his cortisol level drops too low...and then it will be another ball game for you. Trust me...I've been there! Is your Vet a specialist? How many other Cushpups does he have? ....His insistence of double dosing your baby...is not a very good sign. :( .....Please post what tests you've had done. These ladies can read them as well as a Vet. :) They literally saved my baby Eli! :D After about 2 mos....Eli is now back on the Vetoryl 10mg.....for a 30lb pup......and he's doing fine. His cortisol level is going down slow maybe this time....but he's alive. :)

[goldengirl88]

Hello:
I was just wondering how Augie is doing today? Did you take him to the vets? Please let us know how you both are doing. Blessings
Patti

[Jeannine]

WOW! I am so grateful for all of your insight and genuine concern for Auggie's well-being! This forum is awesome!
Auggie hasn't had a 120 trilostane (I call it the 'V') since Tuesday; he perked up and is eating close to a full meal twice a day!!!! I feel like the weight of the world was lifted and I can smile again. He is pretty much back to the happy-go lucky Auggie! He barked at the garbage man this morning and I nearly cried with relief and joy!!
He doesn't make it through a whole night without needing to go outside (this is new within the past 1.5 weeks), but I am sure his body doesn't know how to act with all the inconsistencies.
Today our vet cut Auggie's dose in half!!!
My husband and I have such high hopes!
This evening we gave him a 60 mg and I will let you know how he does. By the way, I know most of the recommendations are to give the V to him in the morning, but it makes him a little sleepy and we are taking advantage of that in hopes of him making it through a whole night...I'll keep everyone posted on that too!
And as funny as this may sound, his sister Codi, a ~7 yo beagle mix rescue, resumed trying to bully him today- it is as if she knows he is getting better!
I hope everyone and their fur babies have a wonderful Friday!
Again- thank all of you for your support!
Take good care,
Jeannine and Auggie :)

[molly muffin]

Glad Auggie is doing so much better.

I do want to say that the reason that the dose is given in the morning is because the follow up test for ACTH has to be done within a 4 - 6 hour window of the dose being given. Most vets aren't open at midnight to do testing.
Anything outside of that window doesn't produce accurate results to let you know how he is doing.

If night time going out is a problem then often what is done is a split dose. You'd give 30mg in the morning and 30mg in the evening. That helps to keep their cortisol levels regulated throughout the entire day and allows for appropriate testing.

As you know already that Auggie doesn't do well if his cortisol goes tooo low, it is going to be very important for you to have that testing done at the right time to know what his levels really are.

Really glad he is seeming like his old self. This is how he Should seem on an appropriate dose of "V". So I hope that continues

Sharlene and molly muffin

[Jeannine]

Thank you! I wondered about splitting it to two times/day- the script we picked up today is capsules so I will order another dose if he doesn't respond well.
I also wonder if I can gradually switch to mornings prior to his next testing. If not, then I will skip a day and start him Saturday AM.
There is so much to learn with Cushing's and to think 2 months ago I never heard of it.
I cannot that everyone enough for caring!!
Warmest regards,
Jeannine

[lulusmom]

I vote for skipping Friday's dose and starting am dosing on Saturday.

[labblab]

If you feel as though you need to start back with the Vetoryl so quickly, then I agree with Glynda. But aside from the need to urinate overnight, are you seeing a return of any supposed Cushing's symptoms? Overall, it sounds as though Auggie feels much better off the Vetoryl rather than taking it and you've only given him a day-and-a-half break from the drug. Plus, it sounds as though the overnight urination began even while you were still dosing with the 120 mg. capsules, so it makes me wonder whether it is a Cushing's-induced issue at all. In honesty, if he starts backsliding again even on the 60 mg., I would leave him totally off it for at least a week and opt to retest his cortisol level before resuming again at any dose.

Marianne

[goldengirl88]

Hope Auggie is doing well. I would want him off the Vetoryl for at least a week too like Marianne said. She knows what she is talking about and has extensive knowledge of this disease. Also I just wanted to comment on a potential problem I for see when you start Auggie back on the Vetoryl ( don't know if you are continuing or quit for now) but if you are wanting to give him his dose at nite so he sleeps well that presents a testing problem. Ideally you want to take Auggie the same time of day every time he has an ACTH test. You cannot dose him at nite and take him in the morning for a test. It should be around 4 hours after he has eaten and taken his dose. So unless the vet agrees to do this testing at nite 4-6 hours afterward you have a problem. Also Vetoryl is to be taken with a meal that has a small amount of fat, as Vetoryl is fat soluble. It think you are going to be forced to either split the dose or dose in the morning. If you split the dose unevenly remember the test must be 4 -6 hours after the higher dose. Blessings
Patti

[Jeannine]

Thank you very much! That is a very good point- taking him completely off. My husband and I are weighing all options- so far after one day on the 60 mg- he is still perky and his appetite increased. We are so grateful.

[flynnandian]

great, that he is doing fine so far, just keep an eye on him and watch him carefully for any side effects of V.
hopefully the need to go outside at night will stop.
and that he will be a happy dog again of course.

[labblab]

I am really glad that the first day of the new dosing went well, and I'll keep all fingers crossed that it continues!

Marianne

[goldengirl88]

Hope all is going well with Auggie. We have our fingers and paws crossed for him. Blessings
Patti

[My sweet Ginger]

Hi from me too.
Was an ACTH stimulation test done on Auggie recently to check just how low his cortisol levels have gotten? The results of the test would give us an idea as to how soon or later Auggie should be put back on Vetoryl obviously on a much lower dosage. Can you post those numbers if you have them or is one scheduled to be done if it hasn't been done yet? I'm so glad Auggie is doing much better. Song.

[goldengirl88]

Just checking to see how Auggie is doing. Hope everything is ok. Blessings
Patti