My dog, Bubba, a JRT, and cushings

[Karol53]

Hi to everyone. I have a 15 yr old jackrat. He is half jack Russell and half rat terrier. He had been loosing a little weight but was scrounging so I started feeding him more not realizing something was wrong. I just associated it with aging. Finally took him to vet after noticing his Belly getting huge. Labs done showing liver function test were elevated. Everything else within normal limits. I guess my main concern was the belly and muscle atrophy. He could no longer go upstairs. After my vets exam and labs she came to the conclusion of cushings disease but she does not do the testing. She sent us to LSU vet school for testing. A 4 hour test was done and after 5 days his test came back positive. They started him on vetoryl. He has been on it for 5 days now. His thirst has decreased in half. He was drinking 3 to 4 cups of water and now drinking 2 cups a day. I am hoping he will get some of his muscle back to have a little normalcy. The scrounging is better. Does anyone know about the muscle atrophy???

[LauraA]

Quite often they get the strength back in their back legs after they have been on the meds for a while. Quite a few members have their pups back running around and playing again :)

[Harley PoMMom]

Hi and welcome to you and your boy!


Does anyone know about the muscle atrophy???

Dog's with Cushing's do lose muscle mass and with treatment improvement may be seen but it does take some time.

In order for us to provide you with meaningful feedback, could you tell us more about your sweet boy? Some questions I have are :eek::) How much does your boy weigh? What is the dose of Vetoryl he is taking? Besides the Vetoryl is he on any other herbs/supplements/medications? Does he have any other health issues? Other than his belly weight gain, what symptoms does he display?

I don't know of a test for Cushing's that takes 4 hours to perform. The two tests that are most used to diagnose Cushing's are the ACTH stimulation and the LDDS (Low Dose Dexamethasone Suppression). The ACTH stimulation test is generally done in 2 hours while the LDDS test takes 8 hours to perform. Could you get copies of the tests they used to diagnose your boy's Cushing's and post those results here? Thanks!

Since Vetoryl is a fat-soluble drug, it has to be given with food to be properly absorbed, was this mentioned? Also the monitoring test, which is the ACTH stimulation test, has to be done 4-6 hours after the dose of Vetoryl is given. With Vetoryl the low and slow method is best, a 1mg per pound of a dog's weight is recommended, we see less adverse side effects when this protocol is followed.

I am providing a link from our Resource Forum which has a wealth of info regarding Vetoryl: Trilostane/Vetoryl Information and Resources (http://www.k9cushings.com/forum/showthread.php?t=185[/url)

If you have any questions at all please do not hesitate to ask them, and remember, we are here for you and we will help in any way we can.

Hugs, Lori

[Karol53]

Hi Lori. Thanks for ur response to my post. My Bubba weighs 18 1/2 pounds. I did not get a copy of the test done but got a copy of discharge summary where everything was done but test were read 5 days later and got a phone call about it. The vet at the school where he was diagnosed arranged for meds to be sent to me thru mail order. I think the name of pharmacy is diamond back from Arizona. It is a capsule and is a generic to vetoryl. They are Trilostane 7 mg. was glad to read that he may get some strength back. We will go back to the vet school on Dec 22 for labs. And again a month after that. I am a nurse but this is all new to me treating my little boy for cushings. The test they done at the school may have been a two hour test. I just don't remember the name of it. She did say it was 80 percent accurate and when she called me back with results she said there was enough evidence and with the test results it would be safe to say he has cushings. Before this bubba weighed 20 lbs. I am so glad to know others have knowledge about this and maybe I will learn more. Also did I state he takes this capsule every 12 hours. Bubba has no other medical issues. He has had seizures in the past mainly brought on by anxiety. Has had none in the past 4 years. The only other meds he takes is once a month heart worm prevention. Living in the south it is a must. Thanks for everyone's info and help.

[Karol53]

I do give med with food.

[molly muffin]

Hello and welcome, sounds like it might have been the ACTH test that as done. See if they can email you copy of the results (that is what my specialist does)

Diamondback is a good pharmacy, many of our members use it.

Welcome again

[Karol53]

Hi. I looked at his discharge summary and it did say ACTH stimulating test pending. We will be going back on dec 22 for labs. Can u tell me what lab will this be? Thanks everyone!

[molly muffin]

This will be an ACTH also. You'll be doing a lot of ACTH testing going forward. Although less once you are in a controlled range.

The ACTH gives you two numbers if you are in the US, 3 sometimes if you are in Canada, etc.
You first have a pre
number, and then an injection of a stimulate that basically causes the adrenal glands to dump their excess cortisol and a post blood draw is done an hour after the injection.

So, you now will know what the pre and post numbers are and this shows if you have control, if the cortisol is coming down and the drug working or if you need an increase in drug because too much is still being produced.

I have seen with my dog that on the same dose and no change, cortisol has continued to drop for at least 30 days, so if the cortisol is coming down at the next test, then I wouldn't increase dosage. Since you are already on 60mg, an increase would be highly unlikely.

If symptoms are controlled, your post number can be up to 9.0ug, if not, then you will want to come down to under 5.0ug for post number.

[flynnandian]

sharlene this dog is on trilostane compounded 7 mg x2 a day. not 60 mg.

[molly muffin]

Ooops, sorry about that! You're right Iris, 7mg x2 I got it mixed up with another dog on 60mg that is new.

[Karol53]

No problem. I know what he is taking. Is this dose about right for him. He is 18 1/2 lbs. also his belly is really big and vet said his liver was enlarged.

[molly muffin]

Starting dose is recommended to be 1mg/1lb so I'd think he would be just fine on 7mg twice a day. With that dosage you shouldn't see any ill effects either, which is nice. Of course, never say never, but it certainly is less likely.

I think you're at a good starting point.

[Karol53]

Bubba has been drinking 3 cups of water the last 2 days. Little sluggish with decreased appetite today.

[molly muffin]

Hope Bubba is doing okay,.


Wishing you a happy and safe holiday season.

[Karol53]

Hi Sharlene. Thanks for greetings and hope you are havering great holidays. I had to take Bubba back to the vet 3 days before he was due back for levels at his 2 weeks. with just not doing well. He was kinda lethargic. They had aspirated a skin tumor he had on his axillary area 2 weeks prior. This may have become infected but there was no drainage or redness. So they put him on antibiotics. He started picking up four days after that. I am a nurse and my theory was that all of a sudden it was a shock to his system bringing his cortisol levels down. I don't know that for sure. Anyway they drew his ACTH that day also coming back as normal 0H and 1H concentration. She said they would keep him on same dose and check again in one month and may increase then. He had become so out of it that I had to literally pick him up to get over a 1inch threshold to go outside. He did not know how to get over it. It was weird but am so thankful for my blessings that he is doing better. He still has a ways to go but for now I am counting his little progress. He doesn't like me out of his sight and has been hard around Christmas. I have 6 grand kids. I managed to have a wonderful Christmas with my family today and they were all so glad he was better. Hope alls well with u and yours

[molly muffin]

Do you know what the results where of the 0 hr and 1 hr test? He should be to be just right on the post anywhere up to 9ug with symptoms resolved, aim for under 5ug if not.
The lethargy and wobbliness often comes when they are low for their body.
It is entirely possible as you suggest that his cortisol came down too fast. Some dogs do not respond as well when that happens, until they get use to it. Also any possibility that the joints are feeling the less cortisol too? Lowering it often uncovers problems with joints that they didn't notice before. A stiffness, arthritis even.

I'm glad that you were able to have a good day with the grandkids. Also that Bubba is doing better. (adapting to less cortisol maybe?) Hopefully you will continue to see improvements and in time Bubba will be back to himself. It is what we all want for our furbabies.

We had a relaxing good day with the kids, called it pajama christmas. :)

[Karol53]

It was a 1 hour test.

[molly muffin]

Yes the draw at 0 hour (pre) and the draw at 1 hr (post) so the pre and post number of the ACTH test.
Just wondering if you have that and could share it? Curious as to what the cortisol is at, could tell you a lot about how he is feeling.

[Karol53]

She jus said normal 0hour levels and slightly increase at 1h. I'm new to this so it did take a little while to understand it. Maybe I can get the numbers from the post test next week. She does email me and ask that I keep her informed of his progress. Thanks for ur help also.

[molly muffin]

I'm glad she is staying in contact with you. The numbers are very important and as a cush parent, keeping track of the dosage and the ACTH results will give you a lot of knowledge about what is happening with Bubba and the response and how he feels at any given level. All important for you to know. It's not enough for the "vet" to know really, because you are the one there, the one who seems him every day and Knows how he is acting and when something is different than it should be.

You don't really want a "slight increase at one hour" you want the adrenal glands to be producing cortisol, but not over producing cortisol.

If you could actually get the original ACTH test results and then this follow up test results you'll be able to see how much the cortisol dropped during the initial dosage. My dogs dropped quite a bit in a month, as I am in Canada the results are in nmol rather than ug, but she dropped 600nmol in a month. Based on that, we didn't raise the dosage and will check in January to see if it has leveled off or is still dropping on the same dose. Also in that time, we'll see how she is physically acting, and then I'll make the decision to either keep the dose the same or raise it, with the specialist. This just an example of why you do want the numbers and want to track the numbers and the dosage correlation. Please let us know when you get them.

[Karol53]

Went to the vet yesterday and they drew some ACTH Stimulating test. Will not know the results until Monday I'm sure. I did get the results on the two last test. On 12/4/2014 his pre was 339 and post was 668 this was before any mess given. He started tripos tante 7 mg on 12/12/14. The next test was on 12/18 pre was 109 and post was 290. I have been thinking he has been getting a little low and held his medicine twice in the last month. Before his test yesterday I made sure he was on schedule for the last three days to get a correct reading. This morning he wll not eat and he threw up and is sleeping right now. His stools have been runny but no more than 3 a day. Not sure if this is related to his diet change. He has gotten picky so am offering different food. Got the canned sciennce diet and also made him some food using rice carrots and skinned chicken breast and boiled it. Not sure if I should contact vet.

[Karol53]

The test numbers were followed with nmol/L

[molly muffin]

Okay don't give him any meds till the results are back from the ACTH. I too am worried he might be on the low side. 250 nmol is actually what my vet is aiming for so if he has continued to drop it's entirely possible he is low.
Keep an eye on him okay. If it gets worse then he might need to have a dose of prednisone given to bring him up a bit.

[Karol53]

Thanks Molly. I will hold his med. he got up just now and did eat a milk bone. But won't eat his food so am watching him close. Thanks again.

[Squirt's Mom]

I edited the title of your thread to include Bubba's name so it will be easier for you to find. We like to keep all the history about each pup in one thread so it is easier to look back thru the history if needed. ;) If you would like a different title, please let me or any other staff member know and we can take care of that for you!

[Karol53]

Ok thanks. I'm new so really didn't know but I appreciate you all a lot.

[Harley PoMMom]

Sharlene is absolutely correct, those symptoms of diarrhea, vomiting and inappetence are signs that Bubba's cortisol may have dropped too low. If his cortisol has dropped too low than stopping the Vetoryl is needed and a decrease in dosage is warranted.

If this were me, I would definitely let his vet know that Bubba is having these ill effects.

Do post those ACTH stim results when you get them, and hoping that Bubba is feeling better soon.

Hugs, Lori

[Karol53]

Bubba has picked up this evening but will continue to hold his med. he took a few bites of food at noon but just laid around all day. Finally ate a few minutes ago. It's 630 pm here so pretty much all day he slept. I emailed the vet to let her know but haven't heard back from her so she must have agreed with me holding med or I know she would have let me know.

[Squirt's Mom]

How is he this morning? I would continue to withhold the med for today.