My 15.5 year old diagnosed with Cushings

[kufan0001]

So glad to have found this board as it is so helpful reading other people's experiences with Cushings. I have done a lot of research but it is still all so confusing and scaring to me. I am not sure what to believe or think.

My beloved baby, Dumbo who will be 16 in July of this year was diagnosed with Cushings last week. My vet has been mentioning this as a concern over his past couple year geriatric blood work results but neither of us were concerned since he was not showing symptoms at all. He has started showing symptons over the past some months and is now drinking in excess same with urinating and having accidents in the bed. He also has a pot belly as well as his arthritis is worsening or the diseases is ,asking his limbs very fragile. He sleeps all day which is fairly normal for him but around 8:00-11:30 each night is really bad. He sits in bed and stares and barks at us. Once he falls asleep he sleeps through the night with no problems. He truly is my baby as are all of my 4-legged children. I want to do what I can to help him.

My main concern is I know there is no cure for Cushings but it can be managed with medication. My vet has mentioned the Lysodren. I hear such conflicting information that the drugs are dangerous and will only help manage symptons. I am not sure what to do. I am deathly scared to start treatment and have a bad effect. If the medication is not prolonging his life is it worth trying? Cost is not an issue it is just about keeping my baby around with the best choice. My vet was against treating him until he had his 2 hours Cushings test and his results came back so high. This changed her mind to now treat starting with a very low dose but I am so nervous. I just need help with this struggle. I love my veterinarian very very much and trust her with my boys life but am still so nervous. He had X-rays, complete blood work and the Cushings test as of now.

Some of his test results are below. I don't have any other info at this time other than this.

ACTH pre - 1.3 post - 49.4
ALP - 1382
ALT - 194
CHOL - 645

The X-ray showed an enlarged liver which she believes is from the Cushings. Dumbo also has had a heart murmur in which he has been on Enalapril for some years. The heart murmur was also much worse during his check up.

I know he is extremely old but I do not give up on my 4 legged children. They mean more to me than most can imagine and I just need help with what road I should take in reference to treating or not treating. I also have seen some rave reviews on Cushex Drops helping with symptons but natural things scare as well since nothing is tested.

Thanks for any help or support given!

[Harley PoMMom]

Hi and welcome to you and Dumbo!!

Aww he is such a cutie pie!! Is he a Pomeranian? Wow, almost 16 years old, that's a true testament of your love and devotion.

Cushing's is one the most difficult diseases to get a confirmed diagnosis for, and unfortunately it is often misdiagnosed. Other non-adrenal illnesses, such as diabetes and thyroid problems, do share some of the same symptoms as Cushing's and should be ruled out.

Another challenging aspect of Cushing's is that there is no test that is 100% accurate in identifying the disease, and that is why symptoms are a huge part of a diagnosis for Cushing's. Cushing's is when a dog's system is producing excessive amounts of cortisol. This increased cortisol has an affect on almost every organ in a dog's body.

Dogs with Cushing's generally have these symptoms: a ravenous appetite, I mean they are like a hoover vacuum machine looking for any crumb; that extra cortisol makes their kidneys work harder so they pee a lot and to compensate for all that peeing they have to drink buckets upon buckets of water; they have skin/hair issues; a pot-bellied appearance; and they lose muscle mass. Besides the increased drinking/peeing, does Dumbo display any other of these symptoms?

The two medications generally prescribed for canine Cushing's are Lysodren/Mitotane and Vetoryl/Trilostane. They are strong drugs and one drug is no safer than the other, adverse effects are usually not seen unless the proper treatment protocols are not followed. And yes, you are correct, the goal of treatment is to help abate the symptoms from Cushing's but also to lower that elevated cortisol to within the therapeutic ranges.

I am including a post from one of our Administrators in which she replied to another members who was trying to decide to treat her elder furbaby with Cushing's:
Dear Lisa,

Welcome to you and Pepper, and WOW you've done a great job of keeping your girl healthy and happy up to age 17! First off, even though folks here do give various supplements to support healthy body functioning, there are no nonprescription drugs that will address the root cause of Cushing's and lower cortisol sufficiently to control the disease. So it really will take treatment with either trilostane (or Lysodren, the other Rx option) to control the Cushing's, assuming it truly is the cause of her symptoms. Having said that, at age 17, you may want to consider pluses-and-minuses of Cushing's treatment before rushing in to treat Pepper.

Cushing's is typically a slowly progressive disease but it does have the potential to cause systemic damage over time (from high blood pressure, vulnerability to pancreatitis and infections, high cholesterol, kidney damage, liver inflammation, etc.). So for a younger dog, I'd certainly recommend effective treatment so as to eliminate some of these risks, improve longterm quality of life, and allow the dog to live out his/her normal lifespan. However, for a dog of Pepper's age, immediate quality of life issues seem of paramount importance to me. And there are some trade-offs to treatment, especially for an arthritic dog since the arthritis may actually worsen as the cortisol level drops, necessitating the introduction of additional drugs to better manage the discomfort. Also, especially at the beginning, there can be numerous vet visits and blood draws which can be less than pleasant for a dog who's nervous at the vet (and also hard on the owner's pocketbook :o).

I don't tell you any of this to dissuade you from treating if you and your vet agree this is the best path forward for Pepper. But I do think you are the best judge as to how uncomfortable her current symptoms are to you both, and if they are not bothering Pepper all that much -- as I say, you may want to hold off on treating for the time being.

First things first, though -- as Lori says, it'll be great if we can take a look at those test results.

Marianne

We are here for you both and we will help in any way we can, do not hesitate to ask all the questions you want.

Hugs, Lori

[kufan0001]

Thanks so much for the response. That Pom is actually my 10 year old Buster who has his own trials and tribulations. He is one of my other babies. I have 4 dogs that are my life. :) Dumbo is a miniature daschund. He was my first baby and holds a very special place in my heart. I know each day is a gift with him due to his age and I have learned to accept that but I always hold out hopes he will make it in the Guinness book of world records, lol, don't we all! ;) I don't give up on my boys very easily at all.

Yes he has most of the symptons - pot belly, crazy hunger and stealing food like he hasn't in ate days, excessive thirst and urination, bad hind legs and limbs that have worsened, braking and restlessness for a few hours each night. He has always slept a lot through the day and still does with not much change to the day - he still does pretty darn good. The evenings are when he starts looking miserable. He is losing some hair on his tail as well. :(

I am just so torn. If he was of a younger age I think I would have no doubt in wanting to take the risk of treating him. Due to his age it does worry me though. I guess my main question would be like how long do high levels of cortisone take to start doing damage to vital organs and such? If going on meds and bringing those levels down is extremely important for a dog of his age then I do not want to hold back. But with how scared I get of medicine I don't want to risk it if in the end he could live just as long as planned without it. It's so hard. According to my vet his levels were high and that is what changed her mind in wanting to start treatment. I have no idea how to read any of those results. I was thinking of trying the holistic way with the Cushex drops to help him feel better (if they even work) to make his final quality of life more pleasant but if the meds are the more common sense way to go I am becoming more willing to try but deathly scared.

Thanks again! This has been such a touch and go subject for me. So glad to have found such a great forum that is extremely helpful! My baby is so old that I am just so torn.

Here are a few pictures:
http://www.keithurbanfans.com/personal/dumbo1.jpg
http://www.keithurbanfans.com/personal/dumbo2.jpg
http://www.keithurbanfans.com/personal/dumbo3.jpg

[Harley PoMMom]

AWW, Dumbo is such a handsome boy! As Marianne mentioned in that post I included, Cushing's is a very graded disease, meaning it progresses at a snail's pace and it is not uncommon for dogs to go undiagnosed for years. Most people interpret a cushdog's symptoms as simple aging and it's not until the dog usually has other stuff going on like, pancreatitis or diabetes, that the red flags start going up

I certainly understand the quandary you are in and I'm not sure what I would do if I were in your shoes. I believe that if my dog was uncomfortably symptomatic than I would consider treatment, at any age. However, I would base a treatment decision largely on quality of life. One issue in treating a geriatric dog with Cushing's is if the dog is already known to suffer from arthritic discomfort than lowering cortisol levels can actually make those arthritic issues worse.

So to answer your question as to the length of time it takes for that elevated cortisol to cause substantial systemic internal damage, there really is no set time-frame. This is because all dogs are different and they don't pass away from "Cushing's" per se, but rather from the effects of any one of a number of system or organ failures that untreated elevated cortisol can cause.

I truly wish I could of been of more help. My advice is to trust your gut because, really, the bottom line is that only you know Dumbo best.

Hugs, Lori

[mytil]

Hi and welcome from as well. Your boy is truly beautiful.

Quality of life is the most important aspect when it comes to our "kids." Should you wish not to treat at this point, has your vet mentioned anything about alternative medicines to treat the symptoms that are making him uncomfortable?

As a senior the restlessness at night could be because his sleep-wake cycle is off, (of which is common in dogs of his age) making him restless at night but sleepy during the day as well as confusion.

Keep us posted
Terry

[Squirt's Mom]

Hi and welcome to you and Dumbo! :)

As our precious babies get older they can develop cognitive issues like humans. There is a doggy form of Alzheimer's which can make them behave oddly, especially at night. My Squirt developed this but we were told about a product called Novifit and it was nothing short of a miracle for Squirt. It is an OTC product, no prescription needed. Novifit is a stable SAMe that is somehow different from the regular SAMe. Squirt was already on SAMe but the switch to Novifit was amazing. Her mind cleared. It is worth talking to the vet about with the night time behavior you describe. ;)

So many people love the puppies, and I do as well. But to me there is something special about the older babies. There is a look in the eye that captures my heart and Soul. The frosted face babies are the ones that can teach us the most about how to be a good human being.

I'm glad you found us and look forward to learning more about your sweet boy!
Hugs,
Leslie and the gang

[kufan0001]

Hi Everyone.

My vet seems to think that Dumbo 100% has Cushings. He has geriatric blood work done every year which she has been mentioning that Cushings could be coming up for him as his blood work was starting to point towards that but he was not showing symptoms at the time so she was not concerned with it. Now that he has started showing symptoms over the past 6 months or so, she wanted to test first thinking it could be his heart as he has a heart murmur that is now much worse. She did a full general health screen + T4 (GHS + T4), a heart worm test and X-rays sent to a specialist. These results came back pointing them towards Cushings. She then said she wanted to conduct a ACTH Response Test on him to be able to confirm the Cughings diagnosis test. She did so and called me back saying his levels were extremely high and she is 100% sure this is Cushings. Has Dumbo not taken all the steps to be super sure this is Cushings? Is there something more that should have been done for him to be 100% sure this is Cushings? After the ACTH test she said that confirmed so I was assured this was what was going especially since he has about every symptom of the disease.

I appreciate your input on other things that could be a cause - it is quite useful in mentioning doggie dementia/altzheimers as I do recall one time he sat in front of the wrong french door to come back inside and he is not blind at all. It was really strange. It happened not too long ago.

And during the day, he seems more sore to the body than anything. Not sure. He does not drink or pee as much during the day. The accidents are more prone to that 8-11 at night type deal. Once he falls asleep around 11:30, I do not hear a word from him. He sleeps through the night.

I do not know how to read or understand test results. Does anybody gather anything from these results? I do not have the full sheet to give ant more info so not sure if this is useful to anybody or not. According my to vet his results were extremely high and this made her change her mind in recommending treatment. At first, she said not to treat then when saw his levels, she changed her mind. So I am just so lost.

ACTH pre - 1.3 post - 49.4
ALP - 1382
ALT - 194
CHOL - 645

Xray showed an enlarged liver as well.

[judymaggie]

Welcome to you and Dumbo! You have received excellent guidance from our gurus. My almost 12 year old beagle is being treated with Lysodren. Her Cushing's symptoms are under control but the mild arthritis she had before treatment has become quite significant and is impacting her quality of life so I want to underscore Lori's caution particularly since Dumbo's arthritis is already getting worse.

Considering Dumbo's age, I wonder what others think about a low dose of daily Lysodren (with no loading) to try and alleviate some of the Cushing's symptoms. I realize that this is not a typical protocol but trying to think out-of-the-box. Maybe that plus the Novifit would be a good combo.

Dumbo is a cutie--thanks for posting his pics!

[Harley PoMMom]

If you could edit your post and add the reference ranges along with the units of measurement that would be a great help to us. The reporting units and normal ranges can be different with each individual lab that analyzes the blood panel...thanks!

[labblab]

Welcome to you and Dumbo! You have received excellent guidance from our gurus. My almost 12 year old beagle is being treated with Lysodren. Her Cushing's symptoms are under control but the mild arthritis she had before treatment has become quite significant and is impacting her quality of life so I want to underscore Lori's caution particularly since Dumbo's arthritis is already getting worse.

Considering Dumbo's age, I wonder what others think about a low dose of daily Lysodren (with no loading) to try and alleviate some of the Cushing's symptoms. I realize that this is not a typical protocol but trying to think out-of-the-box. Maybe that plus the Novifit would be a good combo.


I'm not so sure about daily Lysodren dosing, even low-dose, but perhaps lower maintenance dosing two or three times weekly might be an option. However, has your vet given any thought at all to Vetoryl (trilostane)? This is a drug that is intended to be dosed daily, and by working with a compounding pharmacy you could arrive at any size dose that you wished to try. So you could start with a very low dose and only work upward if Dumbo is tolerating it without any problem. Lysodren is a drug used here with great success, but I suspect that in this particular situation, many specialists might feel that trilostane would be the easier drug to dose and tweak.

Marianne

[judymaggie]

Marianne -- your suggestion makes perfect sense. I think I was focused on Lysodren because Dumbo's vet had mentioned it. This might be a good situation to run by Dr. Bruyette. (Dumbo's Mom -- Dr. Bruyette is a veterinarian expert on Trilostane/Cushing's and many members have consulted with him via e-mail even though he is not the treating vet.)

[kufan0001]

I don't have his test results sheets to get the other numbers needed - my vet quickly texted me those results when I asked. I am taking my other dog in on Thursday. I will get a full print off of his results while there and add them in. I would like opinions on this results as I have no idea what is good and what is bad. :)

My vet said she is against the other drugs and only prescribes the Lysodren now. She feels it is the safest and has the best track record from her cushings clients she has treated. I have complete faith in my vet but it sure does not make it easier to go forward with treatment.

And I want to make sure that Dumbo has indeed done all that is needed to diagnose this disease. It scares me when others mention it is very hard to diagnose yet my vet feels it is 100% in reference to the tests he had done that I mentioned above plus him showing all symptoms involved with the disease.

[Squirt's Mom]

I'm the oddball here at K9C and at most other cush pup gatherings and with your vet on Lyso. That will be my first choice should I ever have another cush pup. It is what we used with Squirt and I was very pleased with how it worked and how few negative reactions we saw. We did not load so I don't have that experience. ;) We went directly to a maintenance dose.

[Harley PoMMom]

ACTH pre - 1.3 post - 49.4
ALP - 1382
ALT - 194
CHOL - 645

Xray showed an enlarged liver as well.

The "ACTH" in the Dumbo's test means that an ACTH stimulation test was performed on him. Let me try to explain how an ACTH stimulation test works. But first a short lesson on canine Cushing's. :eek::D

When a dog has Cushing's their body is producing excessive amounts of cortisol. There are two forms of spontaneous Cushing’s, pituitary dependent hyperadrenocorticism (PDH) and adrenal-dependent hyperadrenocorticism (ADH).

These two types of Cushing's are caused by a tumor that is located on the pituitary or the adrenal gland. Most dogs, 85% of them, have the pituitary type (PDH) while 15% have the adrenal form (ADH), and rarely some dogs do have both.

Ok, now about the ACTH stimulation test:

The ACTH stimulation test measures how well the adrenal glands respond to adrenocorticotropic hormone (ACTH). ACTH is a hormone produced in the pituitary gland that stimulates the adrenal glands to release a hormone called cortisol. The stimulating agent generally used is Cortrosyn which is a synthetic form of ACTH.

When those adrenal glands get "stimulated" they dump that cortisol into the dog's system, the ACTH stimulation test measures how much of that cortisol was dumped, which is known as the post number.

The pre number is done before the stimulating agent is injected, and is known as the resting/baseline number.

When Cortrosyn is used as the stimulating agent, the ACTH stimulation takes one hour: first they take a base blood draw (pre); then the stimulating agent is injected and one hour later another blood sample is collected, which is the post.

If Acthar gel is used as the stimulating agent than the ACTH stim test will take 2 hours to perform.

Did Dumbo's ACTH stim test take one or two hours?

The labs in the U.S that analyze the blood draws for the ACTH stimulation test almost always use ug/dl as the units of measurement. I do believe those ACTH results are in ug/dl, so assuming I am right, Dumbo's ACTH stimulation results do show a very elevated post. Dog's with Cushing's will have a exaggerated post number, while dog's without Cushing's will have those values in the normal range.

This is one of the tricky parts with testing, when there are other illnesses present, all Cushing's tests are vulnerable in returning a "false positive" result. This is the main reason that multiple test are done to confirm a diagnosis of Cushing's.

Cushing's can be so darn hard to get one's head around, but that's what we are here for, we try to help in any way we can. If you have any questions at all please do ask them.

Hugs, Lori

[kufan0001]

Thanks so much Lori! You are all so kind.

Most of this I have known via research but you explaining how the results numbers should look and what to take from them, etc... helps immensely.

This was a 2 hour or so test. I had to drop him off and he was ready about 2 1/2 hours later. I am in the USA, so I am assuming you are correct on the measurements of the test.

Now when you say multiple tests? Are we referring to this very same test repeated or is there a test missing that my vet has not decided to give Dumbo?

I am still stuck between a rock and a hard place with to treat or not to treat. My vet was against treating him but then when she got his test results back from the ACTH test she changed her mind and said if it was her dog, she would treat due to how high his numbers were on the results. So, it really just threw me off guard on what I should or should not do.

I feel like if I don't treat, I will blame myself if something happens to him and say to myself if I would have just built the courage to take the risk and treat him he may be here now, but then if I do treat him and something bad happens then I will be telling myself opposite. I just feel like I am stuck between a rock and a hard place.

He has a very sensitive stomach as well with lots of stomach growls and gas constantly, so I am worried the medication may be very hard on his digestive tract.

I purchased the Cushex Drops as an alternative to see if maybe those would help him with the symptoms, but if turning to medication is the more common sense method - then I want to consider it. I am just torn. I have read great reviews on the Cusehex drops but am still very leary of giving my pet herbs that have not been tested for safety.

Thanks so much for all the help. Such a hard spot to be in. I just want to do right by my boy. I am afraid my selfishness and sacredness of medication is getting in the way of that. If he was a younger dog, I think it would be much easier for me to agree to treat him. My problem is his age and it leaves me torn!

[kufan0001]

Also, is this very elevated post result as bad as some of the others on this board who did treat and/or not treat??

[Harley PoMMom]

Now when you say multiple tests? Are we referring to this very same test repeated or is there a test missing that my vet has not decided to give Dumbo?


The "gold standard" test for Cushing's is the low dose dexamethasone suppression (LDDS) test. In this post I have included Marianne (labblab) explains so well the differences between the ACTH and the LDDS tests:

Turning to the diagnostic blood tests instead, both the LDDS and the ACTH have pros and cons. The LDDS has an added advantage of sometimes being able to point to the pituitary form of the disease, but it is also the test that is most likely to return a "false positive" in the face of other nonadrenal disease. A "positive" on an ACTH is more trust-worthy, but the ACTH is more likely to return a "false negative," meaning it is more likely to miss making the diagnosis even when a dog has the disease. So the decision as to which blood test to use may hinge on the overall symptom profile (in other words, how likely does it seem that Cushing's is the problem), and does the dog suffer from any other health problems that are likely to skew the test. If you have a dog with classic symptoms and no other known issues, the LDDS may be the best place to start. If you have a dog with questionable symptoms and another illness (like diabetes, for instance), then the ACTH may be the more conservative route to go out of reluctance to mistakenly diagnose and treat a dog for Cushing's when he/she doesn't really have the disease at all.
Marianne

Although his post of 49.4 ug/dl is very high, we have seen some higher than that, I believe around 30 ug/dl, give or take a few is more commonly seen.

[molly muffin]

I just want to chip in and welcome you to the forum. The girls here have given excellent over view of cushings.

I am guessing that your vet is worried that the high cortisol could end up affecting kidneys, blood pressure or other internal organs and that is why she opts for treatment. A possibility for the arthritis would be a shot, Adequan.

Welcome again.

[Harley PoMMom]

Also, I wanted to add that with Trilostane/Vetoryl you can start treatment out at a very low dose which would really decrease the chances of any adverse effects.

[mytil]

The X-ray showed an enlarged liver which she believes is from the Cushings. Dumbo also has had a heart murmur in which he has been on Enalapril for some years. The heart murmur was also much worse during his check up.

I would certainly discuss this with the vet if you are considering Trilostane/Vetoryl. Interactions may occur when given with ACE inhibitors such as Enalapril and should be used with caution!

Terry

[kufan0001]

Thanks for all the pointers! It is so much appreciated. I talked with the vet again today and I misunderstood a tiny bit. The medication she prefers to use is actually the Trilostane at a very low dose (she use to prescribe the Lysodern but no longer) and she will not be doing the part where he should be coming near ever getting to much to where it kills off the adrenal gland. Sounds like more of a maintenance type dose to me with what she has in mind for my boy. She mentioned she will compound Dumbo's medication just for him and his dose needed. Then after he has his first treatment she will do an ACTH test hours later to check. If need be - we may have to go up another small dose and try again with the tests, etc...

She has made me feel much better about it today. Special thanks to mytil for pointing out the possible interaction of Trilostane and Enalapril. She mentioned nothing to me of that today and I forgot to mention so this is on my list of final questions that need answers before starting anything.

She also gave me a phone number of another client she has and she is currently treating this clients dog who is 14 (and who is not even a candidate of anesthesia now) and he started on the Trilostane a few weeks ago on a very low dose as well and she said the lady is so happy she made the decision to do so and would be more than happy for me to call her for some more support and talking with somebody going through the experience who is local. Her dog is like a puppy again. It sure has inspired me. My vet felt if any dog would have chances of adverse effects it would be this dog and the owner was well aware before deciding to go through with medication... but the dog has responded phenomenal. I know all dogs are different but it is inspiring.

Thanks again for all your support, tips and pointers. It is beyond appreciated!

[molly muffin]

That is great to hear.

My dog is on both trilostane and benazepril (an alternative to Enalapril) (for protein loss kidneys) We monitor her kidney and liver fairly regularly but for us it isn't an option to not use something, we need both. She is also on blood pressure medication, but you do need to be aware.

Sounds like your vet is on top of the situation. Good job!

[labblab]

Hi again from me! Just wanted to stop back by to give you the reason for the specific warning about combining enalapril and trilostane:


Angiotensin converting enzyme (ACE) inhibitors should be used with caution with VETORYL Capsules, as both drugs have aldosterone-lowering effects which may be additive, impairing the patient's ability to maintain normal electrolytes, blood volume and renal perfusion.

So the combo is not ruled out entirely, but you do need to carefully monitor potassium and sodium levels, since these are the blood chemistries that are most seriously affected by low aldosterone. This monitoring is accomplished by simple blood testing, however.

This comment has me scratching my head, though:


Then after he has his first treatment she will do an ACTH test hours later to check. If need be - we may have to go up another small dose and try again with the tests, etc...

In ten years on the forum, I have never, ever heard of a dog being tested after only one single dose of trilostane, so you will want to clarify your understanding of this with your vet. The earliest recommended testing window is typically 10-14 days after beginning treatment. So you will want to double-check this. Unfortunately, this is a rather expensive test, so you will not want to be performing it any oftener than standard protocol warrants. ;)

Marianne

[molly muffin]

Exactly Marianne, you do have to be careful when using both and to monitor regularly, which is what we do. As long as your vet is aware of that issue, and sets up a monitoring schedule, you should be okay.

[kufan0001]

Hi again from me! Just wanted to stop back by to give you the reason for the specific warning about combining enalapril and trilostane:



So the combo is not ruled out entirely, but you do need to carefully monitor potassium and sodium levels, since these are the blood chemistries that are most seriously affected by low aldosterone. This monitoring is accomplished by simple blood testing, however.

This comment has me scratching my head, though:



In ten years on the forum, I have never, ever heard of a dog being tested after only one single dose of trilostane, so you will want to clarify your understanding of this with your vet. The earliest recommended testing window is typically 10-14 days after beginning treatment. So you will want to double-check this. Unfortunately, this is a rather expensive test, so you will not want to be performing it any oftener than standard protocol warrants. ;)

Marianne

Oh, I am sorry Marianne. I type from my iPhone sometimes and things don't exactly come out they should! LOL!

He gets his first ACTH test 10-14 days after taking the starting dose she puts him on - I meant to say the 4-6 hours is when she wants to test him after he takes his morning dose. But yes, 10-14 days - then maybe a couple weeks and do another test - then 3 to 6 months again if all goes as planned.

I just got off the phone with her again and she stated that is 100% safe for me to give Enalapril with Trilostane. She did say she would be reducing his Enalapril dose during the beginning of treatment. I sure hope this is ok as I did see some things about Enalapril and Trilostane online and this worries me. She says she has never had issues with this and according to her database of source the Enalapril is 100% safe. She did mention some other heart drugs that were a no no. This concerns me now as you just never know. Drug interactions scare me.

[labblab]

Well, then, this will be a great opportunity for your vet to become more familiar with the safety issue re: enalapril and trilostane. The quote I gave you earlier comes from the Product Insert that is packaged in all boxes of brandname Vetoryl sold in the U.S. Enalapril is an Ace Inhibitor, and that is the class of drugs for which the warning is issued. Here's the Product Insert:

http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf

Once again, this does not mean you will necessarily have any problem with the combo. But I do not understand why your vet's reference would not contain the same cautionary note that is documented by the manufacturer of Vetoryl.

Marianne

[kufan0001]

She did mention this when I asked her but she felt safe enough to tell me that with 100% reassurance that it is safe for his situation. She did mention another kind of medication for the heart that she felt was not worth the risk at all, can not remember the name of it. And she also did mention that she would be decreasing his Enalapril dose that he is use to taking as well.

But as I said, she feels 100% confident that this will not be an issue for Dumbo but I have done a lot of research and it does scare me. No doubt. Another concern that is now swaying me backwards again.

She did mention he will be monitored with blood work every 6 months once he is on his dose that is maintaing his cortisol level for reasons such as the Enalapril and Triolstane and other reasons for just being on the Trilostane itself - so even if he was not on the Enalapril she said she would need monitored by blood work in the same time frame as well. Sounds like he may need blood work sooner together in the very beginning of treatment.

Thanks for the link! Just another negative thing to add to my NO folder! Ugh this is so tough! Obstacle after obstacle and I do worry - some people say sometimes too much. But I don't think so!

Thanks for helping and being so cautious with me! I have had a great relationship with my vet for 15 years and love her to death. She gets me and gets that dogs are children - not pets. I have complete faith in her - but doctors - or those who work with medicine seem to always have more faith in medicine than me. I have been much of a medicine person - so all of it scares me - especially drug interactions!

[molly muffin]

Iphone and Ipad typing does in me in sometimes too. You can ask anyone here, they know when I'm sending from one of those vs the computer. :)

The testing time frame is spot on. Just so long as she knows to check those electrolytes. I have to worry constantly about potassium levels it seems when using both. My molly has gone to the high range on her potassium now so we might have to make some adjustments in the future regarding her dosing. It's always a balancing act of one thing or another it seems. :)

[kufan0001]

Iphone and Ipad typing does in me in sometimes too. You can ask anyone here, they know when I'm sending from one of those vs the computer. :)

The testing time frame is spot on. Just so long as she knows to check those electrolytes. I have to worry constantly about potassium levels it seems when using both. My molly has gone to the high range on her potassium now so we might have to make some adjustments in the future regarding her dosing. It's always a balancing act of one thing or another it seems. :)

Thanks! I am still extremely nervous. How long has your baby been on both the ACE inhibitor and the Trilostane?

[kufan0001]

I am just curious to know as to who all would treat their 16 year old dog who has a heart murmur and is on Enalapril for Cushings? I just feel this sense of comfort knowing who would and wouldn't.

Would anybody be against treating at his age and his condition with the heart murmur?

Hearing from other voices that care just as much about their 4 legged child helps!

[molly muffin]

We have been on both since last October I think it was.

Well I didn't treat for a long time but I think now I would have done so early sine high cortisol can cause its own problems. A low dose as your vet has suggested might work very well.

[labblab]

With a 16 y/o dog, to me it would be all about comfort. If overt Cushing's symptoms were making my boy uncomfortable, I would go ahead and give the treatment a try, especially since you would be starting out at a low dose and since the possible side effects from combining it with enalapril can be monitored. I would be less likely to treat if the overt symptoms were not particularly bothering my boy. At this age, I would be less concerned about halting "silent" chronic systemic changes that take time to worsen.

I would just want to keep my boy as comfortable as possible, and if I thought the trilostane could help, I would do it. In addition to Sharlene's Molly, we do have other dogs who have taken that drug combo without any problem.

Marianne

[Squirt's Mom]

With a geriatric baby, comfort is everything to me. If my pup was not bothered by the signs, I would not treat. These drugs can be quite harsh and Cushing's is a very slowly progressing disease so given her age, I would not put these chemicals in her aged system unless she were miserable.

If my baby was uncomfortable, then I would try - but not at the regular dose. I would want to start with a low maintenance dose of Lyso (my personal preference).... ;) So yes I would treat with Lyso if I thought it would make my baby feel more comfortable and bring a bit of joy to her world.

(I am not suggesting you should use Lyso over Vetoryl - you do what you feel is best. But you asked what *I* would do and Lyso is what I would try first. I do not like anything that is "new and improved" - it seldom is an actual improvement in my experience so I tend to stick with the tried and true, which Lyso is. Vetoryl is the "new kid on the block".)

[kufan0001]

It helps to hear what others would do in my situation! Thanks for helping!

My vet said she would start Dumbo on 10mg on Trilostane. Dumbo is 14.5 pounds. Is this a low dose? Any pointers on this?

[molly muffin]

yes that would be a low dose for Dumbo. I started molly who is 18lbs on 8mg and we've steadily been increasing and she has had no bad reactions, cortisol is coming down.

[kufan0001]

yes that would be a low dose for Dumbo. I started molly who is 18lbs on 8mg and we've steadily been increasing and she has had no bad reactions, cortisol is coming down.

Thanks for telling me that. I just wanted to be more sure that 10mg was a low dose for my 15lb Dumbo as I want to start very slowly.

With much stress, thought and going back and forth I have decided that I will treat Dumbo with the Vetoryl. I am going to get with my vet in the next week and start moving forward.

My vet quoted me $75.00 for a 30 day dose of 10mg pills for Dumbo. Does this seem like a reasonable price? I know some of you have mentioned ordering through other pharmacies? What are some good recommendations? Once Dumbo gets on the dose he is to remain on, if I am able to find the meds cheaper and/or if they need compounded eventually I would like to know where to turn.

Thanks for all your help and support. It has helped immensely.

[Harley PoMMom]

We have a couple threads where cost of medications and the different pharmacies are discussed, here are links to those threads: Vetoryl - Best Site for Purchase (http://www.k9cushings.com/forum/showthread.php?t=4592&highlight=Compounding+pharmacy)

Compounding pharmacy questions (http://www.k9cushings.com/forum/showthread.php?t=385&highlight=compounding+pharmacies)

I also wanted to share this cost-saving method that is on Dr, Peterson's blog: How to Extend Your Supply of Cortrosyn and Lower the Cost of ACTH Stimulation Testing (http://endocrinevet.blogspot.com/2011/03/how-to-extend-your-supply-of-cortrosyn.html)

Hugs, Lori

[kufan0001]

Just want to send another huge thanks for all your responses, support and opinions. It has helped me through this decision. So glad to have found such a forum to browse through and see other people in your shoes and their experiences. It helps more than you know.

Dumbo starts his first dose of Trilostane 10mg in the morning. I am still nervous but hopeful this is the right thing to do for him.

Thanks again for everything! Dumbo thanks you as well!

http://www.keithurbanfans.com/personal/dumboapril2015.jpg

[Harley PoMMom]

Aww!! He is such a cutie pie!!!! I am sure you and Dumbo will do fine, and know if you need us or have any questions we are here to help. ;)

Lori

[kufan0001]

Thanks Lori!

He had his first dose about 30 minutes ago and it was more stressful and scary for me than I was hoping. Not sure why anxiety is so high with giving it to him. He took it with no problem and now I hope this is a road to a positive experience.

Thanks again!

Does anybody have any recommendations on what they use to give to him? I would rather not give it to him in cheese every morning. Any other suggestions? He eats hard kibble that is a low fat diet for his sensitive stomach so putting it in his actual food is not an option for me.

[kufan0001]

Also, with this being Dumbos first dose... she started him at 10mg, he weights 15lbs at this moment. She said something about starting really low and working up and giving him the bare minimum he would need to keep his levels at a stable number. This makes me happy as I want to start low and work up IF need be.

My question is what is the most important things I should be looking for with Dumbo that the medicine is not taking to him too well? Is vomiting the main concern?

Thanks so much guys!

[Harley PoMMom]

I have used cream cheese, peanut butter, deli meat, and also those pill pockets for dogs: http://www.greenies.com/dogs/pill-pockets.aspx

The main thing you are looking for is if Dumbo just isn't acting himself. Vomiting, diarrhea, lethargy, and inappetence, now, if any one of those symptoms are displayed the Vetoryl needs to stopped and not restarted until Dumbo is acting normally.

Hugs, Lori

[kufan0001]

Thanks Lori! You are a great comfort! Your replies are so much appreciated!

So far so good with Dumbo! :)

[molly muffin]

The first day, then the first week, then the first 2 weeks, it gets better and less anxiety as you get more comfortable with Dumbo's taking it. Optimally, you won't see anything off with him and he'll feel perkier.

Hang in there. Baby steps.

I use canned food to wrap the pill in. Form a ball around it. Then give it to her with a backup ball ready to go, she swallows it quickly so she can get the next bite, then I put down her dry food as her taste buds are stimulated and she's ready to dig in.

[kufan0001]

Dumbo's treatment has been going well. We are on day 5 today. I am not sure if this medication starts to work this quickly or not, but my almost 16 year old boy was running around the house with a toy last night like he was a puppy! I have not seen Dumbo run around with a toy in a good 10 months or so! Not sure if it is a coincidence or not!

I do have a bit of a question... Dumbo's appetite is still pretty heavy but when it comes to his dog food he is being picky about eating it the last 2 mornings. Now if I pull out treats or my human food - he goes crazy like he hasn't ate in years - so that problem will hopefully get better as time goes as that was one of his main Cushings symptons.

With regards to him eating his dog food in the morning, he is acting perfectly normal but being picky about eating his food.

IS IT SAFE TO GIVE HIM HIS TRILOSTANE DOSE IF WILL NOT EAT BREAKFAST? I keep reading to give with food and wanted your opinions.

Thanks!!

[kufan0001]

Just to add to what I posted. I went ahead and fed him by hand and he ate it all up. He is silly like that sometimes - so I went ahead and gave him his dose of Trilostane. He went crazy for his morning treat and cheese of course! He just seems picky over his dog food which is quite common for him at times even before being on Trilostane.

I did just start noting that he has some shaking going on. I put in a memo to my vet to be on the safe side.

He is acting completely normal, even better than he has before treatment - but his body does have a sudden shake going on. He has his Trilostane about 25 minutes ago.

Does anybody know if this can be a common, normal symptom of Trilostane? Or does it point to something bad? He goes in Thursday for his ACTH test.

[Squirt's Mom]

Shaking is one of the possible side effects of Trilo. It doesn't usually become an issue but you did right by noting it for the vet.

I have often wondered about our pups who seem to lose the taste for their feeds once treatment starts. It seems logical to me that while the cortisol is raging in their little bodies, they really don't much care what things taste like - they just HAVE to eat. Once that cortisol is lowered to more normal levels, the taste factor becomes important to them again. They no longer feel that starving sensation and now can enjoy what they eat. So you might try a different feed with a new protein and see how that goes. ie if he has been eating chicken, try lamb or beef.

Also bear in mind that as our babies age their senses become less and less acute. That includes their sense of smell (where appetite and digestion start) and sense of taste. So think about some stinky foods to top the feed with like Parmesan cheese, tuna or sardine water, etc.

[kufan0001]

My vet has been texting me back and forth and said she sounds pretty confident it is nothing major at this moment if he is still eating and drinking as normal and no vomit or diarrhea.

The main concern for me and her was that he is on Enalapril and Trilostane so she sounded more worried about it being an electrolyte imbalance problem as that can cause shaking too. He gets a blood test Thursday also, but she is making me feel it is ok for now unless he would worsen with other symptoms. He is acting great besides the on and off shaking. It does not seem constant.

Thanks so much!

[kufan0001]

Another update. The shaking in Dumbo has stopped and was very minimal but still enough of a concern for me to want to reach out to my vet. All seemed fine.

Now about 20 minutes ago he had a bad case of diarrhea. It seems to have a lot of mucus and maybe a small amount of blood. Sadly again, diarrhea has been common for Dumbo at least 2-3x a week long before Trilostane. So I am so confused on whether to think it is the Trilostane or just normal Dumbo. This is so frustrating cause he is acting so well and I had such high hopes. My vet has treated Dumbo for his diarrhea in the past with meds and also tested for parasites and even gave him parasites medicine just in case. Nothing really ever helped him much - it just seems to be an on and off issue with him. But with being on Trilostane it is so hard because this same symptom can be a sign of something bad when on the meds. I wish he did not have this as a on and off problem before so I was able to distinguish the difference.

My vet said she thinks the diarrhea is not related to the Trilostane and wants to get him on meds for the diarrhea and she feels to be on the safe side she wants me to do his Trilostane every other day instead of every day. Thoughts??!?!???!

Thanks everybody! This is such a frustrating and scary thing for me. I keep going back on forth and seem to be worrying about every little moment Dumbo has while on these meds. Maybe I am just not comfortable enough with this med. It has been a back and forth decision for a few months and now that I finally came to terms with feeling treatment was best - I felt great - but now with seeing this - things make me think all over again. :( So frustrating.

[Harley PoMMom]

Trilostane can cause gastric upset, giving pepcid ac 20-30 minutes before his Trilostane dose may help.

Every-other-day dosing is generally not a good option. 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.

Hugs, Lori

[kufan0001]

No more Trilostane at all for Dumbo. :(

My vet wanted me to get Dumbo in today for a blood test to check his electrolytes since he is not only on the Trilostane but also the Enalapril which can interact more with the electrolytes. She recommended every other day dosing in attempt to possibly help his body adjust to the medicine since he has bad gastric tract and is more sensitive than most. So the ACTH test would have been delayed if we went through with that. But with his shaking and diarrhea she felt she could not sleep without being on the safe side and having his electrolytes tested. I brought him in tonight per her wish (thank goodness for her as he was acting completely normal besides minor shaking which I read could be normal - and with Dumbo having on and off diarrhea that was not exactly a major alert for me either)... and sadly his electrolytes were 1 away from her nervous/comfort level so she wants to stop completely. His electrolytes have dropped since his last test a couple weeks back. She felt that with this happening Dumbo should not attempt anymore Trilostane EVER and unfortunately it is just not something his body can handle. She felt if it was her dog, she would not attempt the drug again.

We may look into other options but she wants to do nothing until he is fully healthy again. We get his electrolytes re-tested tomorrow evening to make sure they have come back to his normal levels. I am praying they do and all will be fine with my baby. This was quite the scare and with as normal as Dumbo was acting it was a complete shock. I am so thankful for a vet who cares as deep as she does!

Thanks to all of you for your help and support! It has meant more than you even know!

[labblab]

I am very sorry to hear that Dumbo's electrolytes have been thrown out of whack! It's such a shame since it seems as though he was otherwise responding well to the trilostane. I do understand, though, that it means the combo of the trilostane and the enalapril are more worrisome.

I'm hoping he is feeling better today and that his bloodwork will quickly normalize. Do let us know.

Marianne

[molly muffin]

Oh no, how very scary. I hope his electrolytes come back to what they should be. Sometimes you have to pick and choose what you treat and what is best for them. He was on a low dose, so it does seem there was an interaction there that he reacted to. :(

Let us know how he is doing.

[Meg_Elizabeth]

Read a little of your thread because of the similarities in our pups. Praying everything normalizes. Loving a dog is so consuming and powerful, it hurts so bad when we can't help them. We are all here giving you strength and courage. Hoping everything gets better quick
-Meg

[kufan0001]

Dumbo went back to the vet last night to have his electrolytes checked and thankfully everything is back to normal.

Dumbo has the worst grade heart murmur so both my vet and I feel that Dumbo benefits more from his heart medicine than his Trilostane. She feels if it was her dog, she would not attempt Trilostane again even if he was off the Enalapril as some dogs are just super sensitive to this and this could be Dumbo even if he was not on Enalapril - so we do not want to take the risk of taking him off Enalapril and trying Trilostane without. We both it is best to scratch the drug off the list for Dumbo.

We are going to look into trying Melatonin and possibly Anipryl to treat Dumbos type of cushings. She is going to get in touch with a specialist that specializes with Cushings from a speciality vet and get thoughts and opinions if we should just try the safer alternative of Anipryl and if it does not help within 2 months or so, just pull him off. She said this medicine works for the certain type of cushings but it is not guaranteed and does not have a great as success rate but with it being a much more safer drug - it would not hurt to try. But before we proceed, she is going to get more opinions from the specialist and go from there. There is no rush to treat him again, so we will just look at options.

Does anybody know anything about Gabapentin? She prescribed Dumbo liquid form of Gabapentin to help with his arthritis pain. He is in bad shape when it comes to pain and I am not a huge fan of Rimadyl. So I started to try Tramadol but did not seem to notice much of a difference and she feels Tramadol is not the best option for his arthritis and I guess there are studies that may show Tramadol does not work with dogs as expected.

So does anybody have experience with Gabapentin liquid? I am so nervous about medications, always have been, but even more now. I have not even given him a dose yet out of nervousness.

Right now Dumbo is on his Enalapril 2x a day, along with Flagyl twice a day for his diarrhea - he also takes Phycox chewable at night for his joints, and he is now also getting FortiFlora sprinkled on his morning breakfast (it is a pro-biotic since he suffers from diarrhea more than the normal). I would like to start giving the Gabapentin and have been researching it and it does sound pretty safe. Just wanted to ask if any of you had experience with this drug by chance before I proceed.

Thanks so much to all of you! Dumbo thanks you also and is enjoying his late breakfast this morning!

[kufan0001]

Read a little of your thread because of the similarities in our pups. Praying everything normalizes. Loving a dog is so consuming and powerful, it hurts so bad when we can't help them. We are all here giving you strength and courage. Hoping everything gets better quick
-Meg

Thanks Meg! Sending good wishes your way as well to you and your pup! :)

Now that I can breathe a bit easier without worrying about this medicine and Dumbo, I need to take some more time to read others stories in full and send good vibes to others as well as this is a very scary thing to experience. Wishing everybody on this board great success with their Cushings journey! I have learned a lot. And I sure do feel the love and support when logging on here.

[Harley PoMMom]

I don't have personal experience with Gabapentin, from the little bit I have read about it one should monitor liver enzymes while using it.

Dr. David Bruyette, a renown endocrine specialist, is the developer of Anipryl, it's efficacy is limited to dogs with a pituitary tumors in the pars intermedia lobe of the pituitary. It may be beneficial for Dumbo's vet to confer with Dr. Bruyette regarding Anipryl, here's his email addy: David.Bruyette@VCAHospitals.com

Hugs, Lori

[kmwilliams6113]

Our Greta, a 9 year old dachshund, has been on gabapentin for the past 2 weeks for neck pain from a collapsed disk. The vet tried to fix the pain with tramadol, but that wasn't strong enough, so we went with 2 pain meds (gabapentin being one) and a muscle relaxer, and that did the trick. It worked wonders for Greta's pain, and she's almost tapered off the medicine now. The internal medicine specialist who prescribed it knew Greta has had slightly elevated liver enzymes since January and prescribed the gabapentin the same day as also diagnosing her with cushings. The liquid is what you want--much more effective.

As for liver problems, we haven't noticed any rapid decline in Greta, and her pain was debilitating before it, so we went with it. We were pretty concerned about the heavy dose of pain meds and muscle relaxer, since we haven't started cushings treatment yet, so we checked Greta into the emergency hospital for the first 24 hours she was on the medicine to be monitored. You might consider having the vet monitor your pup for a bit when first starting the medicine if you're concerned about a reaction. I am sure everyone on this board is balancing a lot of health issues with their pup, but we calculated that the neck pain was far more debilitating and urgent than the cushings, so we have been treating the neck pain pretty aggressively for two weeks and will start on the cushings after Greta has been pain free and had a month for her neck disk issue to heal, with the likely help of that extra cortisol going through her system.

Hope this helps!

[kmwilliams6113]

Also, not sure if your pup is already on it, but a proper dose of famotide (generic Pepcid) is key when the dog is on pain medicine. Greta is 16 lbs and gets 1/2 famotide twice a day.

[kmwilliams6113]

One more! Our Greta has arthritis, and she's been on a joint supplement for a little over a year, as well as a squirt of fish oil a day, and it has done wonders for her mobility. Might try those, if you haven't already. :)

[kufan0001]

Thanks for the helpful information kmwilliams6163! I went ahead and decided to give Dumbo the dose my vet sent me home with around 2 pm today and all is well. Not sure how well it has helped him but def. no bad side effects. I will give him another dose in the am since he got it later in the day today. I seem to be reading that Gaba works best with another pain reliever. Dumbo has Tramadol as well but it scares me to give him so much pain meds and my vet did not mention that.

She did tell me that antacids which is what Famatodine is I believe can interact with Gaba. Just wanted to make sure you were aware of that! Sounds like there is a 2 hour window you should wait when administering them together.

Thanks so much for all the info. I keep reading about Gaba and some seem to mention it works better as the dog has more and builds up in the system.

[LtlBtyRam]

My dog is on Gaba and has been for quite a while now. About 1/2 as long as her Trilostane. Hers isn't the liquid form. It seems to help her quite a bit. One thing to note about it is not to stop abruptly, it is one of those taper drugs if you do ever need to go off of it. She gets it twice a day as she has a lot of arthritis and doesn't like pills much so we split a capsule in half over her food. It is supposed to not have much of a taste and she doesn't seem to know it's on her food, so it works for us.

[kmwilliams6113]

So glad to hear it's working for your boy! Greta's dosage is .35-.7 every 8 hours, and we've got it tapered down to .1 every 8 hours today. At first, her pain was so bad that she had to have the medicine exactly every 8 hours, but two weeks of pen rest and medicine have done wonders. I'd like to think the benefit of helping pain was far outweighed to any extra strain on her organs.

The vet did advise that you can give up to every six, so if you need to get it on a better (i.e. not middle of the night) schedule, doing a couple doses at every 6 hours to get the timing better is okay. We didn't have any trouble the day we adjusted Greta's doses like that to fix timing.

[kufan0001]

My dog is on Gaba and has been for quite a while now. About 1/2 as long as her Trilostane. Hers isn't the liquid form. It seems to help her quite a bit. One thing to note about it is not to stop abruptly, it is one of those taper drugs if you do ever need to go off of it. She gets it twice a day as she has a lot of arthritis and doesn't like pills much so we split a capsule in half over her food. It is supposed to not have much of a taste and she doesn't seem to know it's on her food, so it works for us.

Thanks for verifying that. I was reading that. I am sure Dumbo will need to be on this for life. He will be 16 on July 1 and his poor body is dealing with arthritis pretty bad. Hoping it keeps him comfortable as I can not bare to see him uncomfortable. So far so good! :)

[kufan0001]

So glad to hear it's working for your boy! Greta's dosage is .35-.7 every 8 hours, and we've got it tapered down to .1 every 8 hours today. At first, her pain was so bad that she had to have the medicine exactly every 8 hours, but two weeks of pen rest and medicine have done wonders. I'd like to think the benefit of helping pain was far outweighed to any extra strain on her organs.

The vet did advise that you can give up to every six, so if you need to get it on a better (i.e. not middle of the night) schedule, doing a couple doses at every 6 hours to get the timing better is okay. We didn't have any trouble the day we adjusted Greta's doses like that to fix timing.

Thanks! Dumbo's dose is 0.3ml every 12 hours. Did not realize you could give it in times before then.

Dumbo is not liking the liquid form to well and is now becoming scared when he sees the syringe come out. I may have to ask for tablets as I don't think he will put up with the liquid much longer. I thought he would like it with it being flavored with chicken, but not the case!

[kmwilliams6113]

It has sedative effects, so giving it more often may result in a sleepier Dumbo, but maybe that's ok. Greta was still able to get up and do her business and be alert when she wanted to be, even on the higher dosage.

Have you tried giving it over his normal food? Greta eats canned gastro-intestinal food, and I just squirt it over her food, when I'm preparing it, out of sight. Then again, she eats just about anything!

Hope you'll be able to find some relief for Dumbo--I know a life of pain medicine isn't anyone's favorite idea. But, if that's what it takes for him to be comfortable and happy, but not basically sedated, I'd say it's okay.

[kmwilliams6113]

These are the joint supplements we use: http://www.chewy.com/dog/nutramax-dasuquin-soft-chews-joint/dp/109647

And, this is the fish oil we use: http://www.chewy.com/dog/vetoquinol-vet-solutions-allerg-3/dp/57313

Greta gets 1/2 a joint supplement with her dinner and a squirt of fish oil in her breakfast. Not sure if they would interact with any other medicines or problems, but they haven't agitated Greta's stomach, and have done wonders for her mobility, and are approved by her internal medicine specialist. She's been on both for about a year and a half.

[kufan0001]

It has sedative effects, so giving it more often may result in a sleepier Dumbo, but maybe that's ok. Greta was still able to get up and do her business and be alert when she wanted to be, even on the higher dosage.

Have you tried giving it over his normal food? Greta eats canned gastro-intestinal food, and I just squirt it over her food, when I'm preparing it, out of sight. Then again, she eats just about anything!

Hope you'll be able to find some relief for Dumbo--I know a life of pain medicine isn't anyone's favorite idea. But, if that's what it takes for him to be comfortable and happy, but not basically sedated, I'd say it's okay.

I agree! I will do what it takes to keep him comfortable! He is still a very happy dog that is for sure. He was even chasing squirrels over the weekend at the park. The pain does not keep him down constantly, thank goodness, but I want to avoid any longing pain he would ever have to endure if the medicine works and is safe. He gets a geriatric blood test every 6 months - so I am always watching his levels. I am one of those who would rather be safe than sorry. Thanks for the idea of squirting it on the food - I just worry cause I have 4 dogs and they are all trying to steal each others food even though it is the same stuff!

And to anybody else - Dumbo had another electrolyte test on Wednesday night and all results came back to normal - thank goodness! But he still has had the shivers/shakes on and off but def better than they were even since stopping Trilostane on Tuesday. He is acting fairly/closely normal so maybe it is just a side effect he is still enduring or should all side effects be gone since he has been off Trilostane since Tuesday? He ended up only getting 5 total doses of Trilostane and that was it. My vet caught the bad electrolytes on day 5 of treatment that evening. Thank goodness!

[kufan0001]

These are the joint supplements we use: http://www.chewy.com/dog/nutramax-dasuquin-soft-chews-joint/dp/109647

And, this is the fish oil we use: http://www.chewy.com/dog/vetoquinol-vet-solutions-allerg-3/dp/57313

Greta gets 1/2 a joint supplement with her dinner and a squirt of fish oil in her breakfast. Not sure if they would interact with any other medicines or problems, but they haven't agitated Greta's stomach, and have done wonders for her mobility, and are approved by her internal medicine specialist. She's been on both for about a year and a half.

Thanks for the links as I want to look into getting him on the fish oil! Thanks so much! He is currently on Phycox supplement for the joints.

[kmwilliams6113]

Does Gumbo wear clothes? Maybe he is just cold more easily these days? If he doesn't like clothes but likes blankets, we found some small cat blankets at Petsmart a while ago that Greta loves. They are small enough to stick to her so she keeps covered easier... and sometimes she walks around the house with them. :P

[kmwilliams6113]

And, so glad to hear he still enjoys squirrel hunts. That's a good dachshund boy, just a little older and wiser these days!

[kufan0001]

He does wear clothes from time to time! He def. shivers from the cold, but this trembling was different! But all seems to be looking up!!

Thanks so much and give Greta kisses from me! I love dachshunds, they are so sweet!

[molly muffin]

Hi, just checking in to see how Dumbo is doing.

[kufan0001]

Dumbo seems to have fully recovered from the Vetoryl reaction. Thank goodness.

Now I just wish I had another option of helping him feel better in related to the Cushings. My vet said with as low as a dose Dumbo got she feels Dumbo is too sensitive to Vetoryl and said if it was her dog, she would not try again but of course that is up to me. To try again at an even lower dose. But I feel the same way, I am terrified to even try again. I was terrified before finally trying the med - now more terrified, that I got over that fear - went forward and had to Dumbo get sick from it with very low electrolytes.

My vet seems to not be a fan of the other drug used to treat Cushings but of course it is all up to me. I trust my vet and her judgement so I am scared to even try that.

I just with their was an easier answer to this disease or some of kind of medication that did not have to be so risky in a sense.

Thanks for asking! :)

[molly muffin]

Without using the two main drugs I'm not sure what the options are. Lignans and melatonin will help with sex hormones other than cortisol.

If you aen't going to use trilostane or lysodren, then there is one option, that shouldn't be a worry, but is only effective in a small percentage of dogs:


Anipryl (Deprenyl, Eldepryl, Selegiline): This is the most controversial of the drugs to treat Cushing's disease. Unlike the former, Anipryl does not affect the adrenal glands directly. First marketed for dogs as a psychotropic medication to help senile dogs think more clearly, Anipryl allegedly stabilizes the balance of brain chemicals. It reduces ACTH production by functionally increasing dopamine levels. 70-80% of Cushingoid dogs responded favorably to the drug in clinical trials, yet actual practicing veterinarians are skeptical of its effectiveness. One endocrinologist claimed that it is very effective for only about 15% of dogs with pituitary-dependent Cushing's. Others report a response rate closer to 40%. The effectiveness seems to be related to the specific location of the pituitary tumor itself. Anipryl is expensive and takes 1-3 months to evidence effects. Nonetheless, Anipryl is extremely safe and cannot cause Addison's disease. It's probably a good starting point for treating Cushing's. If it works, it works. If it doesn't, one can begin lysodren therapy. Anipryl has no effectiveness at all in treating adrenal-based tumors.

It's a thought only and you can discuss with your vet.

[kufan0001]

Without using the two main drugs I'm not sure what the options are. Lignans and melatonin will help with sex hormones other than cortisol.

If you aen't going to use trilostane or lysodren, then there is one option, that shouldn't be a worry, but is only effective in a small percentage of dogs:



It's a thought only and you can discuss with your vet.

Yes, my vet did mention this drug as my last option to try and I have done research on it and it sounds fairly safe but I have read it only works in a small percentage of dogs and for a certain type of Cushings. She said she wanted to do a bit more research with a specialist that works with Cushings in regards to Dumbo's type of Cushings and see if it would be worth the shot to attempt. If we do not see improvements in a couple months, we can just go back off the drug. This option is not off the table.

My vet did also mention that the Melatonin and Lignans has been shown to not do much for the Cushings so she never seemed interested in putting Dumbo on those.

Thanks again!

[molly muffin]

You and or your vet are welcome to contact Dr. David Bruyette. He is actually a member here, although he doesn't post, he is however willing to answer any questions usually and quite quickly.

http://www.k9cushings.com/forum/showpost.php?p=4371&postcount=14


Hi,

As the developer of Anipryl (selegiline) for the treatment of Cushings disease I think we should clear up a few points. First, like trilostane it is approved by the FDA to treat Cushings in dogs. Lysodren is not. Anipryl was shown to be safe and effective and has been used in thousands of dogs. As a MAO-B inhibitor it works by raising dopamine levels which in turn can lower or modulate ACTH release. Efficacy is lower (40%) than with trilostane or op-DDD Lysodren (70-80%) but side effects are far fewer. Anipryl can be an excellent option for those pet owners unwilling or unable to perform monitoring tests such as ACTH stimulation tests and electrolyte monitoring. It only works for PDH primarily when the tumor is in the pars intermedia. It is metabolized to l-desmethylselegiline and l-amphetamine. The l-isomers have no biologic activity in dogs unlike the d-isomers and this is a common misconception.

Dave Bruyette DVM DACVIM

Hope that helps.

[kufan0001]

Hi guys!

To make a long story short, Dumbo's electrolytes dropped extremely low when trying Trilostane for his Cushings. We had to pull him off the drug of course and I have been worried to attempt to try anything else as this was a major scare and a close call.

But poor Dumbo is just getting worse and worse. His stomach is so huge I feel like it is going to explode. He had an XRAY a couple months back to verify there was no fluid or anything and all was fine. The vet feels it is all related to his Cushings diagnosis. His pee and water intake is worse but I can live with that, I am just afraid that his tummy is in pain as it is massive. Plus the pain in his back legs is so terrible. I have him on Gabapentin and it helps but not enough and I am so worried about giving him the Rimadyl or any other NSAID since has Cushings and his liver values are already affected. But I am almost thinking they would have more benefit to him that the cons at this point. Not sure?

I have him on Anipryl currently, not in hopes to help with the Cushings (if it did it would be a plus but the vet said highly unlikely), but more so to help with doggy dementia and old age problems. He turned 16 on July 1. I am not seeing much improvement with those old age problems, so we may increase his dose next month or just take him off it entirely.

Is there anything more for us that attempted therapy and failed can do to help make our 4-legged baby more comfortable? I can NOT and will NOT give up on Dumbo but you can be sure I want to do all I can possibly do to make him as comfortable as possible! He does love his new wagon he now goes for walks in - he loves sniffing the air whether walking or not!

I have never been a huge fan of drugs, for myself or my dogs, but I know sometimes they are our friends and are needed.

Dumbo is currently on Anipryl for old age problems, Enalapril for bad heart murmur, Gabapentin for pain, Phycox supplement to help with joints and once a month he takes an antibiotic to try and keep his teeth infection free as he is too fragile to put under to clean them and it scares me - so we do once a mont antibiotic use which does seem to help his mouth issues.

Thanks for listening! I just want to make sure I am doing all I can to help my baby who has all of my heart.

My original thread from awhile back is located here if you want to re-freshen your memory on my case:

http://www.k9cushings.com/forum/showthread.php?t=7078

[kufan0001]

Thought I would share a pic of Dumbo in his wagon!

http://www.keithurbanfans.com/personal/dumbowagon.jpg

[Harley PoMMom]

I've merged your new post into your original thread about Dumbo. This way, Dumbo's entire health and treatment history are all in one place.

AWWWW, he looks so cute!!!!

Have his electrolytes and cortisol been checked lately and if so could you post those values along with the references ranges?

When dogs have Cushing's that extended belly is partly due to an enlarged liver because the excess amount of cortisol is causing an abnormal accumulation of fat in the liver and it is having to work a bit harder, are Dumbo's liver enzymes elevated? These values would be included in a blood chemistry blood panel and those abbreviations are ALP, ALT, GGT.

Novifit is one that I have seen mentioned on the forum for canine cognitive dysfunction, and members have seen improvements in their dogs using this, maybe mention this to the vet and see what they have to say. NOVIFIT Tablets are an S-adenosylmethionine (SAMe) tosylate supplement.

Here's the conclusion from a study done with Novifit: Here's the conclusion from a study done with Novifit:
The current study investigated the effects of NOVIFIT tablets, a supplement containing NoviSAMe®, on laboratory measures of cognitive function in both aged dogs and cats. Overall, NOVIFIT tablets were ineffective at improving measures of short or long-term memory.

However, studies in both aged dogs and cats consistently revealed potential benefits of NOVIFIT tablets on executive function. Collectively, this supports the use of NOVIFIT tablets for cognitive health indications in aged companion animals

http://www.jarvm.com/articles/Vol10Iss1/Lobprise.pdf

Hugs, Lori

[kufan0001]

Hi Lori,

Thanks for the information! After Dumbo's bad reaction where his electrolytes got way too low, we pulled him of the Trilostane and my vet feels that with as sensitive Dumbo is, that treating him with another medication for the Cushings could have potentially bad effects on him as well, so it is really not worth the risk for me. He was on a lower dose than normal for the trilo as my vet wanted to start as slow as slow as we could to be on the safe side and that affected him badly. It now scares me. So, after that, we have not been checking his cortisol levels due to the face that she feels it is not beneficial if we are not treating him. We know the problem exists, but we aren't treating him with anything. He had his electrolytes checked a few months after the episode and they came back to normal.

He gets blood work every 6 months or so. His liver values have been high and he does show an enlarged liver on his X-ray, but she thinks that is due to the cushings as well.

And this is why it is so hard as I feel so stuck at the end of the road not feeling it is worth the risk to help him. I hate he feels terrible, but I just don't know what else to do.

Wasn't sure if there was anything I was missing that could make him more comfortable or what not? I heard something about melatonin? My vet mentioned this as well but it did not sound like it was a for sure help. Any experience with that?

Thanks!