Introduction/10 y/o Boxer bitch with Cushings

[Goldiegirl]

Good Morning All
I have a 10 y/o (May 2015) who has been recently diagnosed with Cushings. Clinically she has presented with symptoms supporting Cushings for well over a year ,but just now definitively diagnosed. She has a health (or lack thereof) history. Before 2 she was diagnosed with IBS/colitis with scoping and biopsies,although not the genetic HUC) and when hollered she was diagnosed with Boxer cardiomyopathy (an arrhythmia issue unfortunately common in Boxers but usually developed later in life). She was medicated for both and later weaned off and has been very successfully maintained with a grain free diet and nutriceuticals/supplements. She has had a few severe bouts with pancreatitis along the way and again with diet and tweaking supplements she has done very well. She's had 2 bowels surgeries,one for a large polyp and the other one for bowel interception…and I know I have that term wrong…but it is when the bowel telescopes into itself and the affected area dies from lack of proper circulation and it has to be resected. She is a dog that simply put does very well on a day to day basis until there is a crisis and then she fails and fails quickly. Her overall quality of life is excellent…until Cushings. Our vet is the same one throughout who does not hesitate to consult with other specialists and the small animal clinic at the University of FL and who overall is a simply the best. "Goldie" was started on 30 MG of Vetoryl (she weighs 52 LBS) and on the fourth day became very lethargic,had either a cardiac syncopy,a seizure (they look so similar) or was simply unable to get up because os rear weakness after related attempts…and had very runny stools. So it was advised that we stop the Vetoryl and wait 72 hours and then begin again with the 10 MG dose. Today is two weeks at that dose. The first week it was a roller coaster of symptoms…hard to define as to what was Cushings or Vetoryl side effects. But overall there has not been any improvement in her rear weakness and shaking,her exercise intolerance (I have a dog walker that has been walking my guys for 5+ years and he knows them well and he says that over 90% of the time he cannot get past the driveway with her before he has to come back),she still drinks too much and urinates all over (she had spay incontinence since she was 4….) and she pants and is either very anxious or she is sleeping very deeply because she is so worn out. I have read that it can take as long as 80 days for the cortisol levels to become stabilized but I am wondering how to determine what is best for her in the meantime…Should something else be added,is there anything any of you have found to be effective with trial and error? I want this amazing girl to have quality of life,this is what I have always strived for and to this point had success with… I am so looking forward to being mentored along this journey by those of you who have traveled this road before Goldie and I. Please feel free to share your experiences with us. Thank you for your patience and perseverance reading this post
Jane

[Harley PoMMom]

Hi Jane,

Welcome to you and Goldie! Oh my, your dear girl has been through so much, and man, that you are able to control all her health issues is amazing. It is very obvious to see your devotion and love for her, and you are a marvelous advocate for your sweet girl.

Thanks so much for your detailed post, but of course, I still have some questions. :) So here it goes: Can you get your hands on copies of all testing that was done by your vet and post the results here. With respect to the blood chemistry & complete blood count (CBC), we need only see the highs and lows, and please include the normal reference ranges. Additionally what diagnostic tests were performed and can you post those results too? Did your vet tell you which form of Cushing's Goldie has? Did your vet provide you with instructions to always give the Vetoryl with a meal? Has she had any monitoring ACTH stimulation tests, which is recommended to be done 10-14 days after initiating Vetoryl treatment, and if so, could you post those results. Has the vet told you that Goldie's ACTH stimulation tests need to be performed 4-6 hours after her Vetoryl dose?

Her starting dose is well within Dechra recently revised initial dosing recommendations, which can be found here: http://www.vetsonline.com/news/product-news/140722-new-lower-starting-dose-for-vetoryl.html However all dogs are different and it's not uncommon for dogs to do better or worse on the same dose of Vetoryl. I am glad that the Vetoryl was stopped when Goldie became very lethargic and had diarrhea. For some dogs, simply discontinuing the Vetoryl for a period of time may be sufficient. However, for reasons that are not yet clearly understood, some dogs may not ever recover normal adrenal function or it may take an extended period of time for function to rebound. In that case, a dog may need supplementation for either/both lost cortisol and lost aldosterone (the adrenal hormone that controls the balance of sodium and potassium in the body). Dechra does state in their product insert that:
Hypoadrenocorticism can develop at any dose of VETORYL Capsules. The only way to know this is to have an ACTH stimulation performed along with checking her electrolytes. Here's a link to Dechra's product insert: http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf

The muscle weakness, especially, can take time to rebound. So even when the drug is at therapeutic level, it will not bring an overnight change in that issue. I also want to add that odd tremoring episodes in Cushpups have been reported by several members through the years, both before and after treatment.

Regarding the period of time a dog becomes stabilized with treatment, again all dogs are different. Our experience here is that many dogs do take a fair amount of "tweaking" in order to arrive at their ideal Vetoryl dose. And their dosing needs can change over time.

Cushing's is a roller coaster, full of ups and downs in which we are here to help you and Goldie on that ride. ;) We have a wealth of information regarding Cushing's in our Resource thread, which does include articles written by some of the most renown veterinarians that specialize in endocrinology such as David Bruyette, Mark Peterson, and Edward Feldman. Here's a link to our Resource thread: Helpful Resources for Owners of Cushing's Dogs (http://www.k9cushings.com/forum/forumdisplay.php?f=10) If you have any questions please do not hesitate to ask them.

Hugs, Lori

[judymaggie]

Welcome, Jane & Goldie from a fellow Floridian! You and Goldie have certainly gone through a lot in her ten years but it is obvious that you have provided her with the best of care. It is so great that your vet is supportive and able to consult with the very knowledgeable folks at UF Small Animal Clinic. Many of the specialists who have treated my pups have graduated from UF and/or share their time there with their hours at Blue Pearl here in Tampa.

Hopefully, you will find this forum as helpful as I have. I now am treating my second beagle Cushing's pup and have relied on everyone here so much. Take care and know that you have landed in exactly the right spot!

[Goldiegirl]

Welcome, Jane & Goldie from a fellow Floridian! You and Goldie have certainly gone through a lot in her ten years but it is obvious that you have provided her with the best of care. It is so great that your vet is supportive and able to consult with the very knowledgeable folks at UF Small Animal Clinic. Many of the specialists who have treated my pups have graduated from UF and/or share their time there with their hours at Blue Pearl here in Tampa.

Hopefully, you will find this forum as helpful as I have. I now am treating my second beagle Cushing's pup and have relied on everyone here so much. Take care and know that you have landed in exactly the right spot!
Thank you judymaggie for the welcome. I am in Odessa

[Goldiegirl]

Thank you "Lori" for the response . I do not as yet have hard copies. Her diagnosis was made with LDDS. She will go back this Weds for a ACTH.She had several urine tests that did not support the Cushings diagnosis but she has been incontinent for so long that getting that true first morning catch is difficult because she leaks a lot through the night. She has pituitary based Cushings. Yes-Vetoryl always with a meal and in the morning and her ATCH retest will be done as a drop off so they can get the time frame needed 4-6 hours,because I work. This has always proven difficult with thyroid rechecks (she is hypothyroid and is on Soloxine twice daily 0.3). I think I may have forgotten to mention that in my earlier post.
Thank you for mentioning the tremoring that some dogs experience.
Goldie has historically not done well on several medications and they have had to be discontinued or changed before desired results have been achieved. She had a very resistant klebsiella urinary infection from Aug 2013 until March 2014 and in the latter months of the treatment lost down from 50 pounds to 41. As I look back at that now I think that is perhaps when the Cushings came rushing in.
Roller coaster rides we are used to as long as we can make progress and keep quality of life along the way I am fine. I use both a traditional vet and a homeopathic vet in Sarasota and they each have their own place in treatments and modalities. In fact yesterday I email Roger (what was Marina Zacharias's @ Natural Rearing ) to ask what she would have recommended for Cushings so I can consider other supportive measures along the way and have already received a response. Has anyone used alternatives in stabilizing with success?
My vet also told me that some dogs adapt to the increased cortisol and have trouble adjusting to it's decrease.
I see that I have a lot to digest here and you have given me some very valuable links for information that I will read and digest. As soon as I get the lab results I will post them here.
Thank you so much
Jane

[labblab]

Hello and welcome to you and Goldie from, too!

You have already gotten great introductions from Lori and Judy, so I'll just add a couple of quick thoughts this afternoon. Goldie certainly does have a complicated health history, and kudos to you for taking such good and loving care of her!! I am sorry that Cushing's has now been added into the mix, as well, because especially in her case, I think there may be some truth to your vet's words:


My vet also told me that some dogs adapt to the increased cortisol and have trouble adjusting to it's decrease.

It is true that, given Goldie's other ailments, it may be a challenging balancing act to find the cortisol level that best preserves her quality of life. This is because it sounds as though she may be suffering from certain other disorders that may actually benefit from the immunosuppressive, anti-inflammatory action of increased steroidal levels in her body. So even though the elevated cortisol of Cushing's may be causing certain unwanted symptoms, an entirely different set of symptoms may be "unmasked" if the cortisol level drops too much. I don't say this to discourage you, but instead to validate the reality that her treatment path may be more complicated than that of many other dogs.

One of the many hard parts of the dilemma is that different disorders/issues may share similar symptoms. So, for instance, is her lethargy the result of a cortisol level that has dropped too low? Or is it instead an indicator that the trilostane dose is so low that it is not having any appreciable effect on lowering her cortisol enough?

Given her constellation of issues, I do think it makes total sense to begin treatment with a very low of trilostane. After you perform the first monitoring ACTH test, you should have a much better idea as to the effect the drug is having on her adrenal function. If her cortisol level is still hanging quite high, then it is easier to assume that uncontrolled Cushing's is causing at least some of her problems. If the reverse is true, however, and her cortisol has dropped significantly, then it becomes more likely that the drop in circulating cortisol is allowing other issues to break through. So for right now, I fear that you are still in a bit of an experimental stage.

In a less complicated situation, it should not take as long as 80 days for trilostane to lower cortisol sufficiently to see positive results. ACTH testing and observed behavior should result in dosage adjustment that produces positive results much sooner than that. But I do recognize that Goldie's path forward may require smaller steps and even some back-tracking. However, we will be here to continue to support you in every way we can.

So once again, welcome to you both. I'm really glad you've found us!
Marianne

[Goldiegirl]

Thank you Marianne for the insightful response. You have given me an even clearer picture of the path Goldie is on. It will indeed be a balancing act as to treating Cushings and maintaining her overall health and making sure her other health issues don't unravel and complicate her health.
Do you have any experience of the use of alternatives in treating Cushings? Specifically this protocol:
To help with the Cushings I have had nice results when giving Herbal
Hepaclenz and Tibetan Liver Assist these are herbs to help support the liver to help compensate for the problem with the hormones. Also a glandular to help the Adrenals called Adrenal complex This will help to alleviate some symptoms and can work well with
or without medication. Lastly is a homeopathic formula called Adrenal
Liquescence that helps to further support the Adrenals. Unfortunately
there is no cure for this problem but generally can be managed quite well with the herbs.