Query regarding cushings

[Natt]

Firstly I'd just like to say Hya to everyone :)
I am happily surprised to find this great forum!

My 10 year old cavalier king charles, Lucy, has been diagnosed with cushings after months of tests and worry. She is taking 30mg of Betoryl a day and also Marbofloxacin 80 mg a day (for her skin infection). (this is the start of the third week of taking them)

In herself she seems to be a bit happier and her desperate water drinking seems to have settled back to a normal amount.

I have a couple of concerns though and I'm not sure if its BECAUSE of the tablets or the cushings that is giving her these symptoms. She is shaking now and again (not often) mostly when she's settled and starting to sleep. She has moments when she'll lose her balance and just kind of swoon, a bit like shes passing out. (not often, but she's never done it before) and she will lose her footing now and again and stumble and her legs will go from under her. (same again not often, but its all new for her).

This is a tough time for us but any help or advice and guidance you guys can give would be very much appreciated.

Thank you very much for any help.

[LauraA]

Hi Natt and welcome to you and Lucy :)
Do you have the results of her testing for Cushings? If so it would be great if you could post them.

How long has Lucy been on the Vetoryl and how much does she weigh? After the first 10-14 days on Vetoryl it is important to to have an ACTH Stim test done to check her cortisol levels. This lets you know if you need to tweak the dose up or down and if she may in fact be too low.

The shaking can be for several reasons.
- it may be her cortisol is too low and she needs to be on a lower dose
- it could be a side effect from the Vetoryl (shaking is listed as one)
- or it could be since her cortisol has lowered other problems as arthritis can be unmasked or made worse.

My girl has the occasional shake thing going on as well, usually when she is at rest. It doesn't seem to bother her though.

Okay just re read and saw 3 weeks she had been on the Vetoryl hehe, she should have had a ACTH stim test by now. Do you have the numbers, if not ask your vet for a copy of the results.

[Harley PoMMom]

Hi and welcome to you and Lucy!

I have manually approved your membership so now all your posts will be seen right away. Also, please just disregard the validation email that was sent to you from k9cushings.

I am sorry Lucy is having some issues, the trembling may be attributed to the Vetoryl as it is listed as a side effect in Dechra's product insert, which can be found here: http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf

It would help us to provide you with better feedback if you would tell us more about Lucy's Cushing's history, ok ;)

So here goes the questions! How much does Lucy weigh? Has she been taking the 30 mg of Vetoryl for a while now? When was her last ACTH stimulation test and would you post those results? Is Lucy getting her Vetoryl with food? And are her monitoring ACTH stimulation tests being performed 4-6 hours after her dose of Vetoryl? Could you get copies of all tests that were done on your girl and post those values that are marked abnormal with the reference ranges and units of measurement..e.g....ALT 150 U/L (5-50)...thanks! What test/s were performed that diagnosed Lucy's Cushing's and could you post those results too? Does she have any other health issues? Is she taking any herbs/supplements/medications? Is it known whether she has the pituitary or adrenal type of Cushing's? What exactly are her symptoms that led you or your vet to test for Cushing's in the first place? What is her skin infection from, and was a skin scraping or biopsy done?

Well I think I have bombarded you with enough questions and look forward to hearing more about your sweet girl.

Oh, here is a link from our Resource forum with info regarding Vetory/Trilostane: http://www.k9cushings.com/forum/showthread.php?t=185

Hugs, Lori

[Natt]

Thanks both for your promt reply :):)

I have copied and pasted the questions so here goes.

How much does Lucy weigh? Not sure tbh.but shes a normal average weight for a King charles so about 7KG.

Has she been taking the 30 mg of Vetoryl for a while now? 3 weeks

When was her last ACTH stimulation test and would you post those results?

She had her last test done about a week ago and the test was pretty good. The vet said that her results came back normal (as in they had the right dosage so far ! ) I am sorry I do not have any numbers or anything.


Is Lucy getting her Vetoryl with food? Yes .. food every morning with the tablets.

And are her monitoring ACTH stimulation tests being performed 4-6 hours after her dose of Vetoryl? yes that would be what they did.

Could you get copies of all tests that were done on your girl and post those values that are marked abnormal with the reference ranges and units of measurement..e.g....ALT 150 U/L (5-50)...thanks!

I can try .. they are a charity vet (PDSA) so I am not sure if they do that kind of thing but I can ask.

What test/s were performed that diagnosed Lucy's Cushing's and could you post those results too?

She had quite a lot of tests. She only really had a really really bad skin infection (the worst the specialist vet had seen) so cushings was the LAST thing that they tested for. In the end to determine the cushings she had a half a day test. (im sorry I cant remember what they are called) but that came back as negative for cushings. So they took her in for a whole day test and that came back as positive. So that is when we started the tablets.


Does she have any other health issues?

She has a heart murmur ( mid scale seriousness)

Is she taking any herbs/supplements/medications?

No, nothing at the moment.

Is it known whether she has the pituitary or adrenal type of Cushing's?

They do not know and we won't be findig out as The vet said that it would make no difference to the treatment that she would get.

What exactly are her symptoms that led you or your vet to test for Cushing's in the first place?

She came home one day from the groomers (that day she was not having any hair cut/shave but just anal gland and toe nail treatments) and I noticed some scabs on her head. I cleaned them and they came off in my hand with all pussy goo underneath. I was horrified and confused! After shaving the area and cleaning it we found a right mess underneath.. raw wounds that looked like she'd been mauled by a dog or something it was that bad.
We confronted the groomer about this but she denies knowing anything about it. (at the time I didnt' believe her but could prove nothing..but now I realise it was just a coincidence and glad I didnt pursue the accusation ! :o )
As time went on the infection spread and spread and spread it is still now all over her head and back (but getting better! :) ) Lucy had scrapings and xrays and she had a skin biopsy in the end too.
First few months were treatments of bathing and antibiotics.. that did not work. So after the skin biopsy they found out that it was a rare bacteria that needed the stronger antibiotics (Marbofloxacin).
They did work (thank god, she was melting away in front of my eyes) she was re tested a week or so ago and they found that she still has a bit of the infection so she is still on these antibiotics too.
The only other symptoms were excessive thirst and hair was thinning (not bald by any means)

(as a side not, she also has (as the vet discribes them) calcium deposits in her skin)

I think thats everything.. if you need any more info please ask away.

[Natt]

Id just like to add when this all started (may be pretty important)

it started about 6 months ago.

[labblab]

Welcome from me, too! Laura and Lori have already done a great job of welcoming you, and I just have one question/thought to add into the mix, and that relates to the shaking. My own Cushpup also exhibited strange "shivering" episodes, most often when he was at rest or even asleep. Laura has given three reasons that could account for shaking, but my own boy's tremoring began even before he was diagnosed. It worsened considerably right after beginning trilostane treatment, but then ended after around three months or so. We never could figure out a reason.

Through the years, we have had members report strange tremoring episodes for dogs not yet on treatment, and also for dogs being treated with Lysodren as well as trilostane. So in addition to the possible reasons listed by Laura, I have wondered whether tremoring can also just be the result of rapidly changing cortisol levels in either direction. I don't know that I will ever find an answer to that, but I did want to at least mention the fact that my dog had episodes like this, too. The good thing is that they never seemed to bother him very much -- it was me who was freaked out by them!

Marianne

[LauraA]

Poor Lucy :( Sounds like she may have calcinosis cutis? If you type it into search you will see a few people who have had to deal with it. I think they say the best thing is to get that Cortisol down and that it can take quite a while to get it under control. Usually the vets are pretty good at giving you ACTH results and it is handy to keep a record of them for yourself. Treating Cushings is very much symptom based as well, some dogs may need to keep their cortisol a bit higher than what is recommended in order to ease arthritis conditions for example. So if you could get the results it would really help in determining what may be going on.

My girl has had a heart murmur for many years, fortunately it hasn't become worse. She is 7kg as well :)

[labblab]

During the time I was typing, you added all that great information for us. Thanks so much! It very much sounds as though the calcium deposits are "Calcinosis cutis" which can indeed be caused by Cushing's and can become a major quality of life issue. So I am very, very relieved to hear that the skin issues are now improving.

Based on our experience here and the recommendations of many specialists, we are more comfortable when dogs start out taking Vetoryl in a dose that does not exceed 2 mg. per kg. So we would have suggested a lower starting dose for Lucy, but the proof of the pudding is in the monitoring ACTH tests and also symptom resolution. So if Lucy's cortisol level was good on her ACTH and her behavior/appearance are improving, those are very good signs. Vets also sometimes prefer to be more aggressive in lowering cortisol more quickly for dogs suffering from the calcium deposits so as to keep them from worsening out of control.

If you could get the actual numbers from that monitoring ACTH test, that would be great.

Marianne

[Natt]

Thanks guys. :) When I go to the vets in a weeks time I shall ask for all the details that I can get and let you all know.

[Dixie'sMom]

Welcome from me also! Poor Lucy. It sounds like she is having a heck of a time with her skin. Luckily there are folks on this forum who have experienced the same thing so they can help you a great deal with managing the CC.

The one thing I wanted to ask was if the vet had given you any Prednisone in case Lucy exhibited symptoms of her cortisol going too low? Those symptoms would include diarrhea, vomiting, lack of appetite weakness and lethargy. If you were not provided any rescue Prednisone, I would ask for this at your next vet visit to keep on hand just in case. Hopefully you will never need it. If Lucy should display any of the above symptoms of her cortisol going too low, call your vet immediately.

I look forward to getting to know you and Lucy.

[Blues people]

Hi , we also noticed Blue having head tremors a few yrs. back. They were usually during sleep, sometimes awake, and we would distract him w a treat which seems to work. He also sometimes was wobbly or seemingly disoriented. My nieces lab had these over 6 yrs ago, took him to tufts, couldn't find a thing. We read somewhere to give a calcium chewy 500 mg daily. Mysteriously to all involved- it worked. I only stopped it when I read about CC , and he is tremor ins again, but our vet doesn't think its related . Our 80 lb ABBY takes it to help w her leg ball and sockets and we have so far avoided surgery. Don't know how it works, just that it does. Her calcium levels were never low, so? All 3 vets say the tremors are harmless. I hope they are right.