Krockett 8 year old min pin

[Krockett]

Hi my name is Brenda and my dog Krockett has just been diagnosed with cushings. I had been taking him to the vet since December because the only symptoms I was seeing was in his hind legs. He started having trouble jumping on the couch, cannot jump in the car anymore, tripping going up the stairs so they gave me rhemocam and glucosamine. It seemed to work for a bit but I took him back a month later because he still was not better so then they did an ultrasound and then they did the 8hour blood test and told me he has cushings disease so now he is on 60mg of trilostane. He has been on it for only 4 days now but his legs are so bad he cant even get out of bed today and I have to carry him everywhere. Does anyone know if this is part of the disease or maybe some bad arthritis and if I should get an xray done on his hind legs. I have no idea what to do at this point. I said min pin but he is just under 25lbs so not that easy to carry everywhere and I don't want to hurt him. It seems he is all right during the day and then at night when he sleeps everything seizes up on him and he cant get up in the morning. Any suggestions would be great and if it is arthritis can I give him that with the trilostane.

[Harley PoMMom]

Hi Brenda,

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.

Welcome to you and Krockett! I am so sorry your boy is having a hard time right now and let's see if we can figure out what's going on.

With Krockett seemingly getting worse instead of showing improvement I would recommend that you stop giving him the Trilostane as of right now. His Trilostane dose of 60 mg is a bit high for a dog that weighs 25 lbs. Dechra, the makers of Vetoryl, have since revised their starting dosing protocol and now recommend that treatment should be initiated at 1 mg per pound of a dog's weight, so for Krockett his dose shouldn't have been higher than 25 mg (20 mg if brand-name Vetoryl is being used).

It would help us if you would get copies of the tests that were done on Krockett and post all abnormal values here along with the reference ranges and units of measurement...e.g..ALT 150 U/L (5-50)...Thanks! Also, we are especially interested in the results from tests that were used to diagnose the Cushing's. What were the findings from the ultrasound? Does Krockett have diluted urine? Dogs with Cushing's generally have a ravenous appetite, drink buckets of water and pee rivers, have skin/hair issues, and a pot-bellied appearance. Does Krockett display any of those symptom, and if not, could you tell us exactly what symptoms he is displaying?

Please know we are here to help in any way we can, and if you have any questions at all do not hesitate to ask them.

Hugs, Lori

[Krockett]

He is actually at the vet right now getting an xray done on his legs. I will get the blood test results when I pick him up. He had an ultrasound done and then the 8 hour blood test. He does show signs of drinking lots of water but its not totally excessive, he has the pot belly and the hind leg problem but I don't really see anything else.

[Krockett]

And I also just paid 168.00 for this medicine for one month. I wonder if they will take it back or if I could give him one 60mg every 2 days.

[molly muffin]

You can see if a compounding pharmacy will break it down for you into multiple pills.

First though you want to see if his cortisol has dropped too low as lethargic, wobbly, unable to walk, not wanting to eat, diarrhea or vomiting can all be signs of an overdose.
I wouldn't give him any more of the 60mg and would see how he does.
What excessive cortisol can do is weaken the tendons and ligaments, cause muscle wasting and often shows up in the back legs. Sometimes this can get better with treatment and sometimes it doesn't. Usually though ,you do see a change even if it is seems to be a small one towards the better.

The key though is knowing if his cortisol has dropped too much. Even a baseline acth should tell you if he is going into any danger zone, but most try to do a full ACTH to find out.

This is my initial thoughts. Welcome to the forum.

[Krockett]

But he has only had 4 pills and his legs have been acting up for a while now. He is still eating good, no vomiting or diarrhea, I told the vet about the dosage and she said she will research it and get back to me. Nothing showed up on his xrays for his hind legs so she said it just might be the cushings disease.

[molly muffin]

This is the revised Dechra guidelines for dosage, feel free to print it out to give to your vet or read it to her.

http://www.vetsonline.com/news/product-news/140722-new-lower-starting-dose-for-vetoryl.html

updated july 2014. It is I believe now on the inserts in the UK but not in the USA. I think that has to do with the FDA and how you get approval for drug use in the US.

I know it has only been 4 days, but yes, it could be a factor. Whether it is or not, would only be known by some sort of testing, even a baseline.

Every dog is different, and they Can react differently to any medication. Some small dogs need Huge doses, some large dogs need small doses. You don't know positively till you start and see what the next test shows. It can be frustrating but once they are on the right dose, things usually go along very smoothly and testing isn't as often.

It could also be, severe muscle deterioration of the hind legs along with weak tendons and ligaments. Arthristis perhaps. It is possible that a low dose of tramadol might help too, just in a pinch, dogs can get pretty lethargic from it.

How old is he? Sometimes you have to balance how low you want the cortisol to go vs anything like arthritis.

[Krockett]

He is 8 and we are in Canada, not too sure how to read this blood test.

[molly muffin]

I am in Canada too, are you east or west? My vet wanted to start my Molly on 30mg, I balked, asked to see a specialist and she started her at 8mg. We are currently at 11mg, Molly weighs 18.2 lbs.

Just type out anything that is high or low such as ALKP 259 nmol and the range beside it. The LDDS test will have 3 draws a pre, 4 hr, 8 hr, give the result for each and the range beside it.

Hope that helps

[Krockett]

it says 4 hours 28 nmol/L
28-41 nmol/L
41 nmol/L
It says consistent with hyperadrenocortism

[Harley PoMMom]

He had an ultrasound done and then the 8 hour blood test.


it says 4 hours 28 nmol/L
28-41 nmol/L
41 nmol/L
It says consistent with hyperadrenocortism

The 8 hour blood test used for diagnosing Cushing's is known as the Low Dose Dexamethasone Suppression (LDDS) test. This test requires 3 blood draws; first a baseline blood draw is taken, than a low dose of dexamethasone is injected, two additional blood samples are taken in four and eight hours later.

So, we need to see those additional blood draw results in order to properly interpret the test, do you see any other results, and if not could you call the vet and get those numbers for us?

[Krockett]

Cortisol 0hr 268
Cortisol 4hr dex 63
Cortisol 8hr dex 160
Is this right??

[Harley PoMMom]

Cortisol 0hr 268
Cortisol 4hr dex 63
Cortisol 8hr dex 160
Is this right??

Yes! Now, am I correct in assuming that the reporting units are in nmol/L? If so, than converted to ug/dl, which we are used to seeing :) :
0 hour = 9.71 ug/dl
4 hour = 2.28 ug/dl
8 hour = 5.8 ug/dl


These results point to the pituitary type of Cushing's. Is Krockett still receiving his Trilostane?

[Krockett]

yes he is still at 60mg, the vet said she ordered the lower dose.

[Krockett]

ok good I still didn't know how to read the blood results. And by the way I think this forum is great for people that don't know about these things.

[Harley PoMMom]

That LDDS test can be hard to figure out, one of the top canine Cushing's experts, Dr. Bruyette, does explain on how to read the results of a LDDS test, here is a link to that article: http://veterinarymedicine.dvm360.com/clinquiz-interpreting-low-dose-dexamethasone-suppression-test-results

Is he still having difficulty in walking? How is his appetite and is he drinking normally?

[Krockett]

He seems to be getting a bit better, still eating good and no diarrhea. I still take him for a walk everyday, its the mornings when he is the worst, it is kind of like everything seizes up on him when he is sleeping. Does he have the more common type of cushings?

[Harley PoMMom]

Yes he does, approximately 85% of dogs with Cushing's have the pituitary type.

I'm too lazy to look back into your thread, sorry, so could you remind me if Krockett is getting his Trilostane once or twice a day?

[Krockett]

once a day 60mg

[Harley PoMMom]

I still think that his starting dose of 60 mg, for his weight of 25 lbs, is too high. It may be dropping his cortisol too fast, or it could be that his cortisol has dropped too low.

I'm no vet, and this is just my opinion but he might just feel better if the Vetoryl was stopped for a day or two, and then depending on how he is feeling, revaluate the Vetoryl dose.

[Krockett]

Yes I am waiting for the lower dose to come in, do you think I should just give it to him every second day.

[Harley PoMMom]

Every-other-day dosing is generally not a good option, at any dose. Since the medication remains active in the body for no longer than 24 hours, skipping a day only sets up a roller-coaster of higher cortisol one day, lower cortisol the next.

This is especially troublesome in terms of trying to interpret the results of an ACTH stimulation test. If the test is performed on an "off" day, the results will be higher; if the test is done on a day with the med, the cortisol level might even be lower.

Ideally you want to keep the cortisol controlled more consistently during each day.

By the way, what dosage strength has the vet ordered for Krockett? Also, before starting his lower Vetoryl/Trilostane dose, and if it is feasible, I do recommend having an ACTH stimulation test performed just to make sure his cortisol hasn't dropped too low.

Hugs, Lori

[molly muffin]

I would do a lower dose, every day myself for the same reason. You don't want bouncing up and down, you're looking for maintaining a good steady level in the body, not excessive and not too low.

[Krockett]

Yes I get the lower dose today so hopefully this works for him.

[Harley PoMMom]

Yes I get the lower dose today so hopefully this works for him.

What strength (mgs) is the new lower dose?

[Krockett]

the new medication is 30mg

[Krockett]

Do you think he will ever be able to jump up on things ever again because that seems to be the main symptom that I see that he has. The back legs, he does drink water when he gets up in the morning sometimes doesn't stop but my main concern right now is the back legs. Will the muscle tone ever come back?

[Harley PoMMom]

Yes, but it will take some time to see improvement there. Hydrotherapy can help with the rear leg muscle wasting, and having them, as an exercise, walk backwards can help too.

[Krockett]

Yes I still take him for walks every night and then when we are just sitting around I massage his back legs, have you seen other dogs with this problem and how long does it usually take.

[pansywags]

I kept Pansy as strong as I could for several years with a strict regimen of outpatient and at-home physical therapy. This included hydrotherapy and e-stim at her clinic, and a variety of home exercises including weight shifting, cone hurdles, walking backwards and periods of walking interspersed with slow walking (so she had to bear weight on each leg and not counter-balance/compensate at regular speed). She still had some muscle wasting as her condition progressed, but it was much slower than it would have been otherwise and I think she may have failed with lameness much earlier if I hadn't done this.

You could consult with an animal rehab clinic near you to find the best course of action, including recommendations for at-home exercises. If you don't know where a rehab clinic is, you can find some guidance here http://www.caninerehabinstitute.com/

[Krockett]

So it will be 2 weeks tomorrow that he has been on vertoryl, the first 4 pills were at 60 mg and now the rest of the pills are 30mg. I don't see any improvement at all. He can barely move his body to get out of bed in the morning and then he is walking all wobbly. Once I get him up he seems not too bad but why does everything seize up during the night and day when he is laying for too long. He was kind of shaking when I got home yesterday. He is still eating good and no diarrhea. So what do you think is going on, I just cant stand this breaks, my heart that he cannot move.

[labblab]

Since he has now been taking the Vetoryl for two weeks -- and especially since he is still doing so poorly -- it is time for a monitoring ACTH stimulation test to be performed. Has your vet already spoken with you about the need for this test? Given the fact that Krockett was already weak and unwell prior to starting the Vetoryl, it is not necessarily the case that the Vetoryl is making the problem worse. But for safety's sake, you really need to know exactly what effect the Vetoryl is having on his cortisol production. The ACTH is also used as a diagnostic test for Cushing's, in addition to being the only blood test used to monitor cortisol level after treatment has begun.

Your vet opted for the LDDS test in terms of diagnostics, which is perfectly OK. But that does mean that you have no baseline stimulated measure of Krockett's cortisol prior to beginning the Vetoryl. So I do believe it makes it extra important to go ahead at this point in time -- two weeks into treatment -- in order to see what effect it is having. There is always the chance that even the 30 mg. dose is driving his cortiosol too low, and you need to find that out sooner rather than later.

It may be the case that his hind end weakness and lethargy are not even related to Cushing's or the medication, but instead to something else that is going on with him. I guess time will tell, to some extent, and may end up necessitating some additional diagnostics. But in the short-term, if he is going to continue with the Vetoryl treatment, first and foremost, you have to be assured that he is not being overdosed with the drug. Has your vet discussed this testing with you yet?

Marianne

[Krockett]

Yes I guess I will have to get his blood tested to monitor the cortisol. I am not too sure what other tests they can do to figure out what is going on with his hind legs. I already have gotten an xray and nothing showed up on it. I thought at the very least it would show arthritis but that didn't even show up. What other disease is there that would affect him like this.

[molly muffin]

Lets see what the monitoring ACTH shows his cortisol levels at and that might give you and idea. Muscle wasting is common with cushings and affects the hind legs for the most part.

If the cortisol is at a good place and not too low or high, then even you still might consider trying adequan shots (which is for arthristis but might make his joints feel better) or some gentle exercise to build the muscles..not too much.
First things first though, ACTH.