New user - 11yr old (F) Malamute on Vetoryl (60mg 2x day) - still losing weight

[cushingsmally]

Hello all,

My Malamute was diagnosed (first via abdominal ultrasound and then confirmed via a ACTH test) with Cushings a few months ago. The vet has been dialing in her numbers, starting with 10mg / 20mg / 40mg and finally up to 60mg (all twice daily). After this latest dosage increase, instead of doing blood tests every week, we waited two weeks on the 60mg x 2. After that two week period, my malamute seemed to be doing a little better. She seemed just a little fuzzier and just a little heavier (she had gained 2lbs - which could have been water weight). This time, we're waiting a month between testings.

She's scheduled to go back to the vet next Friday, but it's that time of year again, and she decided to start blowing her coat. After removing half a dog worth of fur, I noticed that she was still really skinny and after her undercoat was removed, I can see a lot of skin - which I've rarely - if ever - seen on her before. Also after the undercoat was gone, it was very easy to feel the bones of her spine. Her ribs are really bare as well - she sort of looks like she has the mange (not quite that bad, but you get the idea). Her ultrasound was on June 9th of this year, and her belly has yet to regrow anything other than peach fuzz in the shaved area.

She eats and drinks well, has as much energy as a normal 11yr old Malamute would have (which is to say she's a lazy slob unless there's treats on the line). She'll chase her squeaky toy and argue with my Shiba. In other words, she doesn't seem any worse for where in any other way. Having said that, I'm pretty sure she's lost any weight gain, and she's definitely not getting any thicker. Both the dogs are on Solid Gold: Barking at the Moon with supplements of some Wellness wet food now and then (once or twice a week). I've gotten to the point where I'll leave food in their bowls and it's hardly ever bare - so they're both eating their fill.

It feels like she's eating as much as before, she's just still losing weight. When the vet did her ATCH tests, they were never perfect - even on the 60x2 dosage, but she didn't want to go any higher until we let some time pass. I don't recall the exact numbers, but what I do remember is that "normal" was 1-4, and my dog was an 8 (highest of 12).

tl;dr: My female mally's currently around 52lbs, down from a high of 77lbs. She's taking 60mgs of Vetoryl twice daily and still losing weight, possibly still losing fur or just not growing it back at all. Next ACTH test is in approximately 2 weeks. Dosage too low? Takes time? Opinions? Thanks in advance!

[Squirt's Mom]

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[Harley PoMMom]

Hi and welcome to you and Mally!

If you could get copies of all the tests that were done on Mally and post those results here that would help us a lot. We need only to see those values that are abnormal along with the reference ranges and reporting units. For those monitoring ACTH tests please include the timelines along with the dosage strengths. The timing of those ACTH stim tests are critical, the post draw should be performed 4-6 hours after the Vetoryl/Trilostane is given. Is Mally getting her Vetoryl with food?

For a dog being treated with Trilostane/Vetoryl the therapeutic ranges are 1.5 ug/dl - 5.5 ug/dl, and that post number can go as high as 9.1 ug/dl if all clinical symptoms are controlled, so that 8 ug/dl (I'm assuming the reporting units are ug/dl) is satisfactory if the Cushing's signs were controlled, and it does sound like they are, right?

Improvements in the skin/hair do take a while to show, and sometimes they may not improve all that much. The loss of weight is not a common symptom for a cushdog, however, on the forum we have seen that happen. Did Mally have a ravenous appetite before her treatment began? Carbs can help a dog gain weight such as pasta, potatoes, etc.

What symptoms was Mally displaying that led you or your vet to test for Cushing's in the first place? Does she have any underlying illness, and if so, what is it and what medication is she taking for it? Is her urine diluted? Were her adrenal glands visualized on the ultrasound? Any anomalies found with the internal organs?

I'm sure glad you found us, if you have questions please do not hesitate to ask them, and know we are here to help in any way we can.

Hugs, Lori

[cushingsmally]

Hey there Harley, thanks for the reply. I'll try and get the test results from the vet this next week (closed on Sundays).

My Mally's weight loss was very slow at first, starting as early as last November - she dropped a few pounds here and there, going from her (very) high of 86lbs (she was overweight), down to a much better 78lbs - and she maintained that weight +/- 4lbs for a couple of years. Starting around last Thanksgiving, she started losing weight, dropping to 72lbs, to 67lbs and I believe she was 64lbs when she first saw the vet. The initial symptoms were treated around April or May, I believe. She started drinking like a camel and then having "accidents" afterwards. She'd have to pee constantly, but she was also drinking what seemed like gallons at a time. She was ravenous at the time, usually dancing around her food bowl whenever she knew it was feeding time (usually did 1x a day feedings with a secondary smaller snack/dry food combo at night). She'd clean the bowl out every time, and sneak some of my Shiba's food as well. However, she kept losing weight. Prior to Cushing's, she was pretty big pig (said with a smile), but not quite ravenous like she was then.

The urinary accidents were really what brought me to the vet, she was having them multiple times a week, and she'd ask to be let out into the yard what seemed like every hour. She gets crated at night and if she was in there for longer than six hours, chances were high she'd pee in her crate overnight (which she had never done). At first she was treated for a UTI, which seemed to help a little, but she kept having accidents. The vet also noticed the major weight drop. After the accidents kept happening after the urine tested clean, that's when the ultrasound was suggested.

The ultrasound found enlarged glands (sorry, I can't recall exactly which ones, I'm assuming adrenal since you can't really see the pituitary from an abdominal - but the xray tech did say that they were consistent with Cushing's from her experience) as well as an enlarged urethra (which might have also led to the "accidents"). No other major issues were seen internally. At this point, I believe my vet did the low-dose Dexamethasone test to verify Cushing's.

She's currently taking only the 60mg x 2 Vetoryl (both times with food), she has no other illnesses. She's still symptomatic with low/no(?) fur regrowth, possible weight loss, and still has pretty thin/wrinkly skin. She does eat and drink well - neither seems excessive in nature. When she gets treats, she does seem to have an appetite.

Sorry for some of the more nebulous answers for the test specifics, I'll get them when I speak to the vet!

[Harley PoMMom]

The ultrasound found enlarged glands (sorry, I can't recall exactly which ones, I'm assuming adrenal since you can't really see the pituitary from an abdominal - but the xray tech did say that they were consistent with Cushing's from her experience) as well as an enlarged urethra (which might have also led to the "accidents"). No other major issues were seen internally. At this point, I believe my vet did the low-dose Dexamethasone test to verify Cushing's.

When bilaterally enlarged adrenal glands are seen this is indicative to the pituitary type of Cushing's. The LDDS test also has the possibility to differentiate between the adrenal or the pituitary form of Cushing's.


She's still symptomatic with low/no(?) fur regrowth, possible weight loss, and still has pretty thin/wrinkly skin. She does eat and drink well - neither seems excessive in nature. When she gets treats, she does seem to have an appetite.



Just to make sure I'm getting this right, :eek:;) when you say symptomatic, is this referring to her skin/hair issues but all the other Cushing's signs she was displaying (those increases in her appetite, urinating/drinking) are controlled?

Hugs, Lori

[cushingsmally]

Just to make sure I'm getting this right, :eek:;) when you say symptomatic, is this referring to her skin/hair issues but all the other Cushing's signs she was displaying (those increases in her appetite, urinating/drinking) are controlled?


That's correct!

She no longer has accidents in the house, and I'd say her appetite is currently "peckish," but healthy. I never really measure my dogs' food when I feed them, but I'd guesstimate that she gets around 1 to 1.5 cups of food at her main feeding, then another 0.5 cups via treats (their "treats" is just a chopped up strip of jerky dropped into a treatball with additional normal dry food mixed in). There's usually food leftover in both her dish and the treatball (after she's satisfied that all the jerky is gone, of course).

It's been about three months and change now and I'd say that her potbelly has gone away as well as her urinary issues, but the underbelly is still pretty hairless (more like peach fuzz) and the skin you can see there is very thin looking. Her spine and ribs are very palpable.

[Harley PoMMom]

The hair/skin issues will take a long time to improve. When dogs have elevated cortisol over a period of time it can do damage to the hair follicles. Hair follicles have to go through a cycle so they die off and then regrow and that can take a long while to see any regrowth. We have had some dogs on the forum that when their new hair grew in it was a totally different texture/color.

You're having an ACTH stimulation test done in a month, right?

Hugs, Lori

[molly muffin]

Did your vet also rule out things like diabetes?