Taz's Tale

[jennskin]

Hi fellow cushing dog owners! It's so great to have this resource of others going through similar sagas. Taz, my sensitive 8 yr old male yellow lab first started showing signs of Cushing back in July. (his rough, dry coat started a month before that) But it coincided with a move from room to roam in the country to a fenced suburban yard. Big changes meant a lot of stress for our sensitive guy. So, i thought it was just the move at first and him getting older. But, his sister was still energetic and happy in her new surrounding. Taz started slowing down more and more, drinking lots, and panting. I took him to the vet who ran blood work/ and wanted to do an ultrasound but when I asked him about cushings (since taz showed most of the symptoms) he blew me off. I didn't like his bedside manner at all. So I tried another vet who treated taz's symptoms but also wasn't convinced Taz had cushings after looking at his blood test results (mainly because he was thin not overweight) eventually i asked to do the test for cushings ( after trying some alternative treatments for it that didn't help) and sure enough he was a full blown case by then- on the high range - In 4 months he developed pretty much every symptom of cushings except for the weight gain. He had the pot belly look but if anything he was losing weight. He started on the trilostane 120mg./day and after a month his thirst and peeing decreased, his energy increased a little, his blood pressure was back to normal but he had a lot of hair loss (clumps with skin dropping off his back) and his weight was continuing to decline despite me cooking chicken /rice/sweet potato and greens for him- he would only eat 3-4 cups /day. Appetite loss is a side effect of the medicine but usually dogs need their appetites tapered and taz definitely didn't. After the 1 month ACTH test, he was on the high side of the good range and things were looking up. My vet decided to up the dosage alternate between 120 mg one day and 240 mg the next. But after a few more weeks he was getting so thin and as my vet was closed over the holidays and I hadn't remembered to renew the trilostane, he ran out. After a week of being off the medication, his appetite came back drastically. He would eat dried food (canidae) with broth on it now. I also mix cottage cheese in to help build muscles back. He's been off of it 3 weeks now, and is getting back to a healthier weight. His hair seems healthier, he's panting sometimes and drinking a little more but so far I'd say his energy levels and happiness are as high or better than on the medicine. I am giving him cushex drops from pet alive and just started him on melatonin which I've read may help regrow hair in cushing dogs/ help them deal with stress better. So, I'm tempted to leave him off of it and see if he can keep the cushings at bay. Financially, not continuing the tests/ medicine would help our family's tight budget to - it's been tough. I think the stress of a big move exasperated cushings in our sensitive guy, but I'm hoping the brief use of trilostane helped get the cortisol back to better levels and now we can maintain it with the cushex. I can't see medicating him to help the cushings only to have him waste away to skin and bones. Has anyone else experience the weight loss issue in treating for Cushings?

[Harley PoMMom]

Hi and welcome to you and Taz!

There is a small percentage of dogs with Cushing's that do lose weight but most times that extra cortisol makes their appetite ravenous.

Could you tell us what Taz's weight is? Also Vetroyl/Trilostane is recommended to be started at 1mg per kg of a dog's weight, so unless Taz weighs 120 lbs I believe he was started out at a too high of a dose.

Could you get copies of the tests that were done on Taz and post any abnormalities that are listed, we are especially interested in the results of any diagnostic and monitoring tests that were done.

Cushing's is when a dog's body is producing too much cortisol and unfortunately that cushex will do nothing to help reduce that excess amount of cortisol.

Other non-adrenal illnesses do share some of the same symptoms as Cushing's, such as diabetes and any thyroid issue, and need to be ruled out, have these been ruled out?

We will help in any way we can so do not hesitiate to ask all the questions you want. ;)

Hugs, Lori

[LauraA]

120mg one day and 240mg to me sounds like a very high dose. Every second day his cortisol will come crashing down on 240mg - no wonder he is feeling better now that he is off the meds. Do you have the results from his stim test, how much does he weigh? He should not have been started on more than 1mg per 1 pound of body weight. The Cushex drops will not help at all with reducing all that extra cortisol in his body unfortunately. How long as he been on the Vetoryl? I am not sure it this was his first Stim test but his cortisol would continue to decrease if it was. My girl took 3 months to get her cortisol controlled. Low and slow is the best way.

Also once you get the dose sorted you can order the compounded form of Vetoryl an it is much cheaper. You are in the right place here and I am sure the Guru's will be along soon to advise you the best course of action to take. You did the right thing in stopping the meds :) Hope your boy continues to improve, such a scary time first starting out on the Cushings journey. I was more of a nervous wreck than my dog hehe. Hubby thought there was no hope for her but luckily she responded well and is still going strong, annoying me whenever she likes and growling at the hubby when he tries to move her off his pillow so he can go to bed lol.

[labblab]

Welcome from me, too. First of all, if your boy is basically behaving normally right now, I would hold off on restarting the trilostane, too. However, if he truly has Cushing's and the related symptoms start rebounding, he will need more than the Cushex to control them. And actually, there is every reason to believe that he may respond well to the trilostane if he is dosed appropriately. I can think of no other words to describe your vet's decision to add the alternating 240 mg. dose than "absolutely crazy!" I don't understand why he increased the dose at all at the one-month mark if Taz was showing significant improvement and his ACTH was within therapeutic range. Regardless, the recommendations related to a dosing increase in that situation would be to modestly increase the daily dose (which is easily possible since even brandname Vetoryl also comes in 10 mg., 30 mg., and 60 mg. capsules). To double such a high dose every other day truly is crazy! :eek:

In addition, I want you to know that my Cushpup was also a Lab diagnosed at age 8, and he too was one of the rare ones who was losing weight at the time of diagnosis. He had every other classic symptom, including ravenous appetite, but between his weight loss and fur loss, he looked downright scrawny. His weight actually normalized once his cortisol level was brought down. So there can always be exceptions to every rule.

If you could get us the actual results for any of Taz's Cushing's tests, that would be great. I am especially interested, though, in that monitoring ACTH test that prompted your vet to increase the dose so oddly and dramatically. Truly, don't lose heart. If it turns out that Taz's symptoms rebound in such a way that treatment is warranted, there is every chance that he will do well on trilostane, just so long as he is prescribed an appropriate dose!

Marianne

[jennskin]

THanks for everybody's quick inputs. Taz was 70 lbs in optimum health (pre-cushings) and dropped to 65 (muscle loss with onset of cushings) then after taking trilostane was down to I believe 58# at the last visit when dosage was doubled - he continued to drop pounds after that for 2 weeks before going off of medicine. I don't think my vet (who runs her own sm. practice) has had much experience with cushings but in her defense reading the dosage on the Vetoryl box it does recommend 120 mg 1/day for a 44-88# dog which is what she started him at but doubling it every other day does seem a little drastic.... I'll probably start looking for Vet #3! Haven't heard of a great option in the SB area though. I will call their office today and ask to get copies of his blood test and ACTH tests - he's just had 1 prior to meds and 1 at the 1 month mark. He definitely has a clear case of cushings - no doubts about it and diabetes was ruled out - not sure about thyroid. I will try to gather more info. today and post it. Thanks ALL!

[Harley PoMMom]

Dechra, the makers of Vetoryl, have since changed their dosing protocol, they now do recommend 2 mg/kg once daily, which is 1mg per lb of a dogs weight.

Here's a link to that information: http://www.vetsonline.com/news/product-news/140722-new-lower-starting-dose-for-vetoryl.html