Newly Diagnosed with Cushing's

[Delianouva]

Good morning!

My ten year old mini Schnauzer was dignosed with Cushing's, he will be starting Trilostane 30mg- daily, today. He doesnt seem to be showing any symptons except hard calcified lumps on his skin. He is still very active.
My questions are, should I change his food diet? at this moment he is on senior can and dry food from Science Diet brand.
Also, should I slow down his physical activity as he loves to fetch the ball, and go for long walks.
This is all very confusing to me, as I am having a very hard time trying to understand this disease. Any answers to my questions will be greatly appreciated.
Just wanted to state that I enjoy this forum.

Thank you.

[Harley PoMMom]

Hi and welcome to you and your boy!

Sorry for the reasons you're here but glad you found us. It sounds like your boy may have Calcinosis cutis. Was a biopsy done on those hard lumps? Our resident expert on Calcinosis cutis, Renee, has pictures of her dog showing the Calcinosis cutis, here is a link to her album: http://www.k9cushings.com/forum/album.php?albumid=805 Could you take a look at those pictures and let us know if this looks like what your boy has?

To enable us to provide better feedback we need to know more about your boy. What tests were performed that diagnosed the Cushing's, and could you post those results? Was a CBC/chemistry blood panel done recently, and if so, could you post anything that is abnormal with the reference ranges and units of measurement...e.g...ALT 150U/L (5-50)...thanks. How much does he weigh?

As far as the physical activity, I believe continuing with it is ok as long you let him be the guide to how much is done.

Concerning the diet, there really isn't a "set" diet for a cushdog, it should be tailored to that individual dog's needs. However, because of the effects of excess steroid on protein and fat metabolism, a good quality, moderate to high protein, low fat diet is recommended.

Please know we will help in any way we can, and do not hesitate to ask all the questions you have.

Hugs, Lori

[Delianouva]

Thank you for your quick response. Zane had what the vet calls "senior tests" - urine, and blood work done one month ago, the vet called me and told me Zane's blood work showed signs that he could have Cushing's and suggested LDDS test. This test was performed 3 days ago, yesterday he called me and told me that indeed Zane tested positive for Cushing's, and prescribed Trilostane 30mg once a day. I have to take him to the vet's office in two weeks to qet blood work done. He has had no biopsy performed on the bumps that he has on his back. This pup weighs 19 pounds.
Since I am completely oblivious of this disease, I greatly appreciate any suggestions or questions that I need to ask the doctor. Thank you so much, this is a great forum, and I am glad that I was able to find it.

[molly muffin]

Hello and welcome.

I would say that the recommended starting dosage now for dogs is 1mg/1lb. This is a recent revision as it use to be higher, but dogs do better on a low dose to start with. 20mg might be better to start on, even if you have to go up a bit later on. And some dogs do a split and do 10mg in the morning and 10mg in the evening for example.

[Harley PoMMom]

I have just a moment to post, sorry this is so short. A starting dose of 30 mg is too high for a dog weighing 19 pounds. 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 Zane's weight of 19 lbs his dose shouldn't be higher than 20 mg . Here's a link to that info: New lower starting dose for Vetoryl (http://www.vetsonline.com/news/product-news/140722-new-lower-starting-dose-for-vetoryl.html) Zane's vet may not be aware of this so I would print out a copy and ask the vet about it.

Please do get copies of those test results and post them here, ok?

I will try to get back later...hugs, Lori

[Harley PoMMom]

Ok, I am back for a bit (I'm at work and sometimes they expect me to do something...:eek::))

We do really need to see those test results, post all levels that are marked abnormal and include the reference ranges and units of measurement.

Starting a dog on Vetoryl with out common clinical signs causes me to worry. If this were me, I would want a biopsy done on those lumps to make sure what exactly they are. Dogs with Cushing's sometimes do get a skin issue known as Calcinosis cutis, this can only be diagnosed accurately with a biopsy. If the biopsy result shows that Zane does not have Calcinosis cutis I would not start treatment for Cushing's when there are no symptoms present. In the face of a non-adrenal illness the LDDS test is more likely to yield a false positive result, his skin issue is considered a non-adrenal illness.

Please be sure to check out our Helpful Resource section. There is a ton of information there, including a great thread for folks new to the disease. Here's a handy link: Helpful Resources for Owners of Cushing's Dogs (http://www.k9cushings.com/forum/forumdisplay.php?f=10) and Trilostane/Vetoryl Information and Resources (http://www.k9cushings.com/forum/showthread.php?t=185) Feel free to print anything out and do not hesitate to ask all the questions you want.

Lori

[Delianouva]

Thank you to all for your replies, every little bit helps, as I had mentioned before Cushing's is a bit hard to understand, but thanks to this forum I am begining to understand it better.
Zane has been on Trilostane 15mg in the morning and 15mg at dinner time for 4 days, so far I have not seen symptoms in him for which I am very greatful. Regarding his skin condition he has an appointment with his vet in two weeks for bloodwork, skin issues will be address at this appointment. Again, thank you for your replies.

[molly muffin]

Let us know how he is doing. Glad to hear so far all is well.

[LtlBtyRam]

You have found a great place for help with this disease. I hope you and yours continue to do well.

[Delianouva]

Spoke too soon! On Zane's 5th day of medication, after four hours of giving him his evening dose, I notice that he looked depressed and with little coordination, I contacted the vet and he told me to stop his medication and wait one week and start it again 15mg a day instead of 30mg a day. My concern is that it has been 2 days since medication was discontinued and he still looks a little "drowsy", just not himself. I am concerned as looks "worst" since being on medication than before. I am not even certain if I want to give this med to him at all. Please any advise! Thank you!

[mytil]

Hi and a belated welcome from me. I have just a sec but did your vet order an ACTH test when he was feeling so down to check where the cortisol levels were? (and also giving such a large dose for his size).

It would be a good idea to have the electrolytes checked too.

Terry

[Delianouva]

Vet;s recommendations were to stop Trilostane for one week and re-start at a lower dose, (15mg per day) also, when he re-starts Trilostane I should administer Prednisone in case Zane has another reaction. He was supposed to have his ACTH two weeks after he had started his first trial of Trilostane. Can you advise what are the reasons for evaluating his electrolytes? Thanks to all for your help.

[labblab]

I am sorry to say that your vet's advice to give prednisone and trilostane simultaneously makes absolutely no sense. The two drugs directly compete with each other: trilostane lowers steroid levels and prednisone increases them. If your vet is concerned that Zane will have another bad reaction to trilostane at even a lowered dose, he should not be rcommending you give the drug at all! Edited to add: I just re-read your reply, and if what the vet means is that he will give you prednisone to have on hand in case Zane has another bad reaction, it is always wise to have prednisone on hand to give instead of the trilostane. And in fact, Zane may need some supplemental prednisone right now, as I explain in the next paragraphs.

The recommendation re: checking the electrolytes (blood chemistries) stems from the fact that trilostane can also lower aldosterone levels as well as cortisol levels. Aldosterone is the adrenal hormone that regulates the balance of sodium and potassium in the body. If the aldosterone level lowers too much, that chemical balance can get out of whack with resulting serious consequences.

Since a weekend is approaching, I would push your vet to evaluate Zane's cortisol level and blood chemistries ASAP if he has not significantly improved by this noon. Zane should not still be dragging two days after stopping the drug. He may need some supplemental prednisone now, without any trilostane, in order to make up for his natural cortisol production if it has dropped too low. And if his potassium/sodium level is off, there are other supplements that are needed to regain the proper balance.

Marianne

[Squirt's Mom]

I would be pushing NOW for an ACTH and his electrolytes checked. That should have been the first thing they did. ;) Do NOT restart the med until his signs are strong again AND an ACTH shows the cortisol to be elevated again. This is not a drug you can play around with willy-nilly. There are established protocols developed by both the manufacturer and endocrinologists who have been in the forefront with this treatment. If your vet can't get up to speed pretty quick, for you babys' sake find another vet.

[LtlBtyRam]

I will support what the others have said. Remember this is a journey usually an up and down one. We have all been there. We are here for support. Know you aren't alone, keep faith, and remember no vet knows your dog better than you do.

[Lifesvr7]

Is Trilostane the most common "first line" medication? This is most likely what my vet plans on starting my dog on if his test comes out positive. He's doesn't really have clinical signs of Cushings, weighs about 90-95lbs and is currently and uncontrolled diabetic.

[Delianouva]

My mini Schnauzer has been on Vetoryl 5mg for two weeks, tomorrow he will have the ACTH test done, could someone please advise what are the ranges on this test.
Thanks you.

[labblab]

Hello and welcome to you and your boy! Here's a link to a technical brochure published by Dechra (maker of Vetoryl) that will tell you just about everything you might want to know right now. Scroll down to page 11 and you will find a "Treatment and Monitoring" flowchart that details the numbers you are looking for. In general, though, unless cortisol numbers are dropping too low, the recommendation is to leave the initial dose unchanged for the first 30 days prior to increasing. This is because cortisol levels tend to continue to drift downward during the first month of treatment even when the dose is left unchanged.

http://www.dechrace.com/pdfs/vetoryl/VETORYLTechnicalBrochure.pdf

We would love to learn more about your boy's specific situation: symptoms that led you to suspect Cushing's, prior medical history, diagnostic test results, etc. All this info will help us give you our best-informed feedback.

Thanks in advance, and once again, welcome!
Marianne

[labblab]

I just now noticed that you had previously started a thread about your boy back last spring, so I have now merged our two new posts into your original thread. It looks as though he was originally started on much higher doses of trilostane. Can you fill us in re: what all has transpired since you were last with us?

In reading back through your posts from last year, it looks as though Zane was originally diagnosed with Cushing's based solely on some lab abnormalities and the presence of skin bumps. Also, he did not respond well to those higher doses of trilostane -- all of which made me feel nervous about the accuracy of the Cushing's diagnosis at that time. Were those skin bumps ever positively identified as being calcinosis cutis? How about the evolution of any other Cushing's symptoms?

Marianne

[Delianouva]

Good Day!
My guy was started on Trilostane back in Spring 2015 based on labs LDDS, (he had no Cushing's symptoms) his previous vet (since then I changed veterinary) put him on 15mg of Trilostane twice a day, to which he had an awful reaction on the 4th day of taking this med, the medication was stopped and he was diagnosed with diabetes within days of Trilostane being stopped.
I started diabetes treatment, but he has been hard to regulate, (he became completely blind last September).
I found a new internist and she recommended the ACTH test which was done yesterday (he has been on Vetoryl 5mg twice a day for 2+weeks, now his weight is 13.6lbs).
I should receive ACTH lab results today which I will post here, he also had a Cursory Ultrasound, (could anyone advise what this is for?). I apologize for this long reply but I really do not understand a lot about Cushing's and wanted to have an insight from the group for when I speak to his internist.

[molly muffin]

A cursory ultrasound means an initial ultrasound to see how things look in general. It isn't a specific type of ultrasound, it is just a lets take a look initially and see what is going on in there.

15mg twice a day for a 13lb dog is too much to start at. They like to start at 1mg/1lb in total. With diabtes it is important to give twice days, so say you are doing 10mg, which is a good starting point, then you'd give 5mg in the morning and 5mg in the evening.

What was the ACTH results and the ultrasound results?