Advise needed.

[Missy's mom]

Six months ago the groomer told me that Missy ( 1o year old Shih Tzu) might have Cushings because she was losing hair. Tzu. Otherwise Missy was completely normal. We took her to the vet who did blood work. Results were consistent with Cushings so she did a cushings test. The results showed that she did indeed have cushings and started her on 10mg of trilostane. They did another test after 30 days and said that her results were good.
The problem is that immediately after the first Cushings test, Missy started to go downhill. She is now hardly eating, drinks all the time and is lethargic....just acts like she doesn't feel good. Seems like the medicine that is supposed to be helping her is killing her.
Has anyone else had this experience? What should I do?

[goldengirl88]

So glad you found the forum. Welcome to you and your baby, but sorry she is having troubles. If all the symptoms your dog had was hair falling out, there is a problem here. Cushing's dogs drink buckets of water and pee constantly. They are ravenous all the time and gain weight. They are always panting and do not tolerate heat well. What I would do if it were me is first get the results from all the blood work and testing, post the abnormal numbers for us and the reference scale provided by the lab as they are all different. We need these to see what is going on. If your dog does not have Cushing's and you are giving trilostane it could have consequences. Vomiting, lethargy, diarrhea, can't stand are all symptoms of an over dose. I would hold off giving any more trilostane until you get us the numbers and we see what is happening. Cushing's is one of the hardest diseases to diagnose and many other diseases have the same symptoms. Has your dog had a thyroid panel done or tested for diabetes? If in fact your dog has Cushing's it will not hurt anything to stop this medication. Many vets Ade unfamiliar with this disease and it's treatment. Please get us the numbers so we can help you. Patti

[labblab]

Welcome to you and Missy, and I am so sorry that your little girl is doing so poorly right now. If you can possibly get ahold of the actual numbers for Missy's diagnostic and monitoring tests, it will help us a great deal.

But even without the numbers, here are a few thoughts that come to my mind. First of all, does the vet know how poorly she is doing right now? I would think (hope!) your vet would be concerned and would be reviewing the entire diagnostic process and looking for an explanation as to her behavior.

This is one thing that concerns me, however. Most clinicians who specialize in Cushing's are very reluctant to start treatment in a dog who exhibits few symptoms and only shows abnormalities "on paper" -- in other words, only on lab results. If Missy's only issue was hair loss, I do fear that the Cushing's diagnosis may have been reached too hastily. There are other problems/conditions that can account for hair loss and also lab abnormalities. For that reason, a Cushing's diagnosis usually builds upon at least a subset of symptoms that are known to be associated with the disease. It sounds as though Missy was lacking those symptoms and so I wonder whether she has Cushing's at all. If not, that could explain why she is reacting poorly to the medication.

Under these circumstances, I would hope that your vet would tell you to stop giving the trilostane until the underlying problem can be better sorted out. Even for a dog who truly has the disease, it progresses very slowly and it is much better to await a confirmed diagnosis than it is to dose/overdose a dog who doesn't have the illness at all.

So if you haven't already contacted your vet, please do so (and ask for copies of those test results). I hope you will be told to stop the medicine, at least temporarily until the cause for these problems can be better explored.

Marianne

[jxeno13]

Hi and welcome! I also agree with Patti and Marianne. An overdose of Trilostane is nothing you want to go through with your baby! I've been there, done that! If I were you, I'd stop the Vetoryl now, and contact my Vet as soon as possible if you haven't already. Cushing's is a slow progressing disease, so you won't be hurting your baby at all by stopping it. These ladies can sure help you though once the test results are posted.

Although, I realize most dogs do lose hair with Cushing's, my Eli actually stopped shedding when he got sick. And, trust me, he was at what I call "full-blown" Cushing's when he was diagnosed. But, he started with the drinking gallons of water, and peeing rivers. He'd eat your leg, if it wasn't connected.....they are like 4-legged Hoovers....and that's just to start.

But, anyway, welcome to you and your baby......please stay with us. I'm sorry your baby is having problems right now and hopefully she'll get straight real soon!

[molly muffin]

Hello and welcome to the forum.
I'm sorry that Missy is not doing well, and I too question the diagnosis at this point, as there was only a symptom of fur falling out. If anything else was causing her hair to fall out, like thyroid, diabetes, etc, then it could have caused the cushings testing to be false.
At this point, based on what you have said I would not give any further trilostane. (you don't give it to a dog that isn't doing well) Also let your vet know, pronto!
If you have the test results we would be interested in seeing any abnormalities on the blood work, urinalysis (is her urine dilute), how much does Missy weigh?
Also her cushings test to diagnose and the follow up test numbers, will all help us to help you with Missy.

Hang in there!
Sharlene and molly muffin

[Missy's mom]

Wow...it took a long time to pry the results from the vet. Here they are:
First Blood test that were abnormal:
ALT 384
ALK 5468
GGT 49
Cholesterol 386
Platelet Count 757
First ACTH (Cortisol Serial 2) results:
Cortisol >50
Second ACTH (Cortisol Serial 2) result after one month on Trilostane
Cortisol =18.7
Two months later a Cortisol Serial 3 ACTH test resulted in:
Cortisol =6.7

[molly muffin]

Hi, can you tell us when the tests was done with dates? Also can you post the range and the unit it is in next to each test result? (click edit to do this)

On the ACTH test is there only One results or two? We are looking for a base and a post, or pre and post result. The liver is definitely being affected and I'm wondering if you have ever had an ultrasound done to check her gall bladder? Sometimes with results that high in the ALKP (over 5000) a bile duct blockage caused by sludge in the gall bladder could be occurring. Can you speak with your vet about this possibility? Ask them to test for it? If it is, she could go on medication to try and dissolve it, called Ursoldiol, but I'd want to have that looked at very soon.

Sharlene and molly muffin

How is Missy doing now? Are you giving her the trilostane still? Is she still not eating and lethargic? how recent was this last ACTH done? If that is a very recent test, then it doesn't appear to be an over dose, but could be something else going on.