Tia, 10 yr old boxer diagnosed 2 months ago with cushions

[Nlkloss]

Hello everyone and thank you for having this available for all of us. I have an 11 year old boxer that was diagnosed with cushions disease approximately two months ago. Her symptoms are pretty classic where we thought at first she may have a UTI because of her drinking and urinating. She has the potbelly appearance and unstable walking sometimes and just paces and doesn't know what to do with herself. Her veterinarian put her on trilostane. By about day eight on the medication I felt like she was dying she could barely walk without assistance and never got out of her bed pretty much all day. We decided her quality-of-life was more important so we chose to take her off of the medication. I then searched for a holistic vet and found one that was two and half hours from my home. He gave her an acupuncture treatment and switched her food and put her on three Chinese herbs. Has anyone had any luck with holistic treatments for this disease? I almost felt like the acupuncture helped but it could've been she was feeling better being off the trilostane. Any advice or direction would be most helpful as I am at my wits end on what to do
Thank you everyone
Nancy

[labblab]

Hello and welcome to you and Tia, although I am very sorry that she is feeling so poorly right now. Would you say that the lethargy has improved significantly since stopping the trilostane? How about the pacing and restlessness?

Can you tell us some more specifics about her overall health history and also the specifics testing that was done for Cushing's? Last but not least, can you tell us how much Tia weighs and also what dose of trilostane she was taking? I apologize for so many questions, but your answers will help us try to make some sense re: the best steps forward.

There are a few different possibilities that occur to me. The first is that Tia may have something else going on in addition to the Cushing's. The second is that she may have been prescribed a dose of trilostane that was too high for her body to handle comfortably. Another possibility is that if her Cushing's is caused by a pituitary tumor, that tumor may be growing large enough to place pressure on her brain, causing the pacing and confusion. These are just a few possibilities; something else may be going on as well. But your answers will help us sort things out. If her reaction is a result of a dose of trilostane that is too high, she may simply need a smaller dose in order to control her symptoms but without dropping her cortisol too low.

We do have some members who have tried to control symptoms through the use of Chinese herbs with varying success. But I am not personally knowledgeable about them and cannot make any recommendations in that regard. If you use our "Search" function and type in "Chinese herbs," you may find some threads in which they are discussed. But as I say, your answers to my questions will help a great deal in moving us forward.

Once again, welcome!
Marianne

[Nlkloss]

HuHi Marianne. Thank you for your reply.
Tia weight is 65 pounds. She was on one dose of 60 mg of trilostane a day. I would say the pacing and restlessness were better at first but now it's about the same as prior to taking the trilostane. I wouldn't say she's acting lethargic it's more like dementia.. She just seems out of sorts and when you look in her eyes it's like she's not there, if that makes any sense.

Tia's overall health history: I adopted her when she was four months old. At 18 months she had to have exploratory surgery and part of her small intestine removed. She had an allergic reaction at her first vaccine visit so always had to have Benadryl prior. She has had approximately 7 to 8 mast cell tumors removed. She is also hypo thyroid which was detected about a year ago. Also about a year ago she started knuckling her front right paw and when I took her to the vet he felt it was neurological and nothing you could do. He basically said I believe there something going on up here as he pointed to his head. At that point I thought about doing an ultrasound or MRI but there would be nothing we could have done if it were a tumor. Behavior wise she has always been a fearful and reactive dog but that has all changed in the past eight months I would say.

I too feel there may be more going on than just the cushions at this point. Her vet did say we could try the trilostane every other day but I just felt the drug was too much for her. Since it comes in capsule form there was no way I could split it into fours or even do a half. At that point I just wanted her off of the meds and back to normal. Now I'm starting to think about maybe a very low dose?
Here are the results of Tias cushions testing let me know if you need anything else

Tia had the IDEXX Dexamethasone suppression on 9/4/15
Test. Result. Reference range
Pre-Dec 5.7 ug/dl. 1.0-6.0
4 post - dex 4.3 ug/dl
8 post- dex. 4.1 ug/ dl

Low dose Dexamethasone diagnostic intervals
4 hours. 8 hours. Interpretation
<1. <1. Normal
1.0-1.5. 1.0-1.5. Inconclusive
>1.5and >50% >1.5and >50% Consistent with
Hyperadrenocorticism
of baseline of baseline Further testing required
to differentiate adrenal tumor from
pituitary-dependent
hyperadrenocorticism(PDH)
<1.5 or <50% >1.5 and>50% Consistent with
pituitary-dependent
of baseline. of baseline. hyperadrenocorticism(PDH)
<1.5 or <50% >1.5 and <50% Consistent with
pituitary-dependent
of baseline. of baseline hperadrenocorticism(PDH
>1.5 or >50% >1.5 and <50% Consistent with
Pituitary-dependent
of baseline. of baseline. Hyperadrenocorticism(PDH

High-dose Dexamethasone Diagnostic Intervals
4 hour. 8hour. Interpretation

<1.5or <50% >1.5and 50% consistent with
pituitary-dependent
of baseline of baseline hyperadrenocorticism (PDH
>1.5 and >50% <1.5 or <50% consistent with
pituitary-dependent
of baseline of baseline. Hyperadrenocorticism(PDH
<1.5 or <50% <1.5 or <50% consistent with
pituitary-dependent
of baseline. of baseline. hyperadrenocorticism(PDH
>1.5 and >50% >1.5 and >50% Further testing required
of baseline of baseline to differentiate PDH from
adrenal tumor.

[molly muffin]

There is a drug called Novofit that you can get that helps some dogs with dementia. We've had some members use it with success.

One thing that is a possibility, is a pituitary tumor that causes the cushings could be growing and have become or becoming a macro tumor. This often causes neurological symptoms, but the only way to know for sure is with an MRI and the best treatment is radiation therapy, which has come a long way in the last few years and we have had some members use it. Both the MRI and radiation can be expensive treatments, but it is something to discuss with the vet.

If it is a marco, then often the cortisol actually helps with the inflammation the tumor causes, and sometimes steroids are even given to help control the symptoms from the tumor. This is just a possibility, not a definite unless an MRI shows this is to occurring.

The Novofit though might be an option. A lower (very low dose of trilostane might help too as every dog is different and even though the 1mg/1lb is a starting dose, some dogs need less)

Welcome to the forum

[jml666]

I have an almost 8 year old boxer boy, Thor, who has hypothyroidism and also has Cushings (diagnosed April this year). We are treating him with trilostane, but he seems to be responding to it without any issues. It did take some time, however, to find the right dosage for him - Thor is 72 pounds and takes 60mg 2xday, but he never had that look in his eyes that you describe. I hope you are able to find a course of action to take with Tia.

[Nlkloss]

Thank you both for your responses. This is such a great forum I am so glad I found it. It's so frustrating not knowing what to do and who to talk to
I have decided to put Tia back on trilostane just starting her off at 10 mg once a day. I know it's probably not going to do much for her weight at 65 pounds but I just want her body to adjust to it slowly.

Sharlene- thank you for the information on the drug for dementia . Very interesting to find this out. I will be discussing this with my vet next week along with possibly doing an MRI.

Jml666- thank you for responding and sharing your information about Thor. It is amazing how they're all different. I just wish my vet would have started her off on 30 instead of 60 because it put a bad taste in my mouth for the trilostane. I am so glad to hear that is working for you.
I have also started giving Tia melatonin at night and it seems to help with her restlessness

[Nlkloss]

The past week my Tia has been going in circles almost like vestibular disease ? It has seemed to become progressively worse . Does this go hand in hand with Cushing's?
Nancy

[flynnandian]

yes, it does. most of the time it is a sign the tumor is growing and is putting pressure on the brain.
there are a lot of threads about this effect on the forum.
you can use the search button for this.

[labblab]

Wanted to let you know that I've merged your new question into your original thread about Tia. This way, all her information and treatment history will be consolidated all in one place. ;)

Marianne

[Squirt's Mom]

I would stop the Vetoryl and let the vet know asap about the circling. This could be a sign the microscopic pituitary tumor causing the Cushing's has started to grow, causing neurological signs like the circling. Unfortunately, dogs with the skull shape of the Boxer, Boston Terrier, etc. are more prone to this type tumor.

[Nlkloss]

Thanks Marianne for moving this. I am still learning! I couldn't get my search button to work yesterday so I panicked and had to post. It is finally working and I am reading up on all the posts about the cirlcling .

I also have a call in to my Vet. Unfortunaltely I had already given Tia her Trilostane this morning before reading these posts.

[Nlkloss]

So after a discussion with my veterinarianwe decided to keep her on the trilostane. The circling actually started to settle down prior to speaking to the vet and I'm not quite sure if she's doing it just when she's in close quarters because she doesn't seem to be doing it in open areas . She always circled quite a few times before lying down which a lot of dogs do I'm not quite sure if she's looking for a spot to lie down ?
However I am heartbroken again from her symptoms of being back on trilostane. Today is day six and she is only on 10 mg once a day and she is 65 pounds. She is really having a hard time walking and I try to put rugs down everywhere on my wooden floors but she always seems to find that little bit of a gap and down she goes. I have a friend that keeps telling me you have to go through this before the trilostane really starts to work. Tia is going in Wednesday to have her ACH. I just don't know if I will be able to make it until then without pulling her off again. Has anyone experienced this and how do you get through it

[Nlkloss]

So after a discussion with my veterinarian we decided to keep Tia on the trilostane . The circling actually started to settle down prior to talking to my vet . We are not convinced the circling is from the actual disease or if she's trying to find a place to lie down because she only does that when she's in close quarters not when she's in an open area. She has always done quite a few circles before lying down like a lot of dogs do
However I am heart broken to see the symptoms that are occurring again from being on the trilostane for only six days at a dose of 10 mg. Tia is 65 pounds she is really having a hard time walking and I try to put rugs down everywhere on my hardwood floor but unfortunately she finds that little bit of a gap and down she goes I have a friend that keeps telling me you have to go through this while they're getting used to the drug but it is really hard to watch as you all probably have witnessed with your own dogs . She has an appointment Wednesday at her veterinarian to test her levels but I just don't know if I'm going to be able to make it and watch her deteriorate. How do you guys go through this?

[Squirt's Mom]

If her walking has gotten worse again since starting the Trilo, I would stop it immediately and call the vet to let them know.

[Nlkloss]

So are you saying it's not normal when starting the trilostane to have a reaction where she stumbling and weaker in the back legs? I guess I thought everyone went through this with their dog when they first started trilostane 😢

[labblab]

No, that is not a typical reaction to a therapeutic dose of trilostane. Hind end weakness is a common result of chronic levels of uncontrolled high cortisol, and it can also occur in conjunction with trilostane overdosing. But at a dosing level of 10 mg. for a 65 pound dog, frank overdosing seems unlikely. Can you be more specific about this weakness -- is it completely absent when Tia is not taking the trilostane? Or is it always present to some extent but seems to worsen during the days when she is taking the trilo?

Marianne

[Nlkloss]

Marianne,
I decided to do a little test and take Tia into the area of my house that is carpeted and stay in there for awhile and watch her. So what I noticed was that she wasn't really weak in the back legs it was more her front paws. She stumbles as she walks because her front right paw knuckles. Now she's also doing it on her left front paw.
The main area of my home is wood flooring however I have 35 throw rugs down now.,lol. my precious Tia always hits that gap where there is not a rug and her front paws slide forward. Once she is on the hard wood floor she cannot get back up
So I really think this is more of her ongoing neurological issue but I'm not sure if it's getting worse from the trilostane now that both of her front paws are knuckling. She is not walking on her knuckles. She still has the ability to flip them upright but that's what trips her up.
I'm sorry I panic and get all worked up but she is my baby and I just want to do what's best for her
Nancy

[labblab]

Hi Nancy, I totally understand about your mind racing with the worry. I am the same way :o. I can also sympathize about the wood flooring. I have an older nonCushing's Lab who is very arthritic, and it's the same thing around our house. I have rugs and runners everywhere, but she still prefers to search out those few spots that are uncovered, and then she has a horrible time scrambling to try to get up again. :(

I so wish I could be more helpful about your girl's apparent neurological issues, but without actual imaging of her head, it's really hard to know whether it is a problem with a tumor there or if it is instead something else. I know that a head CT or MRI would be very expensive, though, and perhaps not worth the cost and the stress unless you felt you would choose to pursue radiation treatment even if a tumor was believed to be the problem. You really are in a tough spot right now, and for that, my heart goes out to you. If you do continue with the trilostane until Wednesday, we will be very anxious to hear about the test results.

Marianne

[molly muffin]

My dog has a hard time on anything that isn't carpet or rugged in the house too. Outside she has a hard time on the grass and ground where it is uneven.

I do sympathize with what you are going through with Tia. :( There just aren't any quick answers usually when it comes to the neurological. I had my dog into neuro when she had a back injury. It helped to just get their thoughts on what the cause would be (in our case the back) and with limited activity for 6 weeks she did get better.
Have they done an xray to see if there is anything going on with spine, etc?

[Nlkloss]

Tia had a really bad night on Sunday. She was up pacing all night. She was nauseous and just looked miserable. She was running into walls, falling , circling and acted like she didn't know where she was. Her spine was hunched down, her head was low. Not only was she knuckling her one front paw, she was doing it to both front paws and then one of her back paws. She could not squat to go to the bathroom without falling in it. Needless to say I keep did not give her trilostane yesterday and called the vet. The vet said to stop the trilostane.
I have an appointment scheduled for my other dog tomorrow and I am going to bring Tia with me so they can take a look at her.I really would like to know if there is something else going on along with the Cushing's.
I have to say, since being off the trilostane she has shown a lot of improvement in just 48 hours. Tia must have a sensitivity to this drug. I really thought trying the low dose, 10 mg for her weight of 65 lbs would have been ok.

Maybe I should go the x-Ray route first to see if there is something with her spine? Then maybe an MRI. I do have pet insurance so that should help with the cost.I think it would help me to know.

I am so glad there is this forum to be able to talk to people going through our have gone through this. Thank you everyone!

[mytil]

I surely am glad you stopped the Trilostane. I would suggest getting an ACTH test performed (and her electrolytes) while at the vets to see what the cortisol levels are. Your vet should have asked you to come in immediately with the symptoms she had, but you say now she is better right?

Keep us posted
Terry

[jml666]

Good luck with your vet appointment tomorrow and please keep us posted. I'm glad she's feeling better. I agree with mytil to get an ACTH stim test done to find out where she's at.

[Nlkloss]

I agree with you Terri I think my veterinarian should have asked for me to bring her in right away . They didn't ask me to bring her at all I am just going to bring her since my other dog has an appointment and they said I could. So the vet still didn't say she wanted to see her It's very frustrating because I have been with this animal hospital for 14 years and they have gotten so big I feel like I've kind a lost in the shuffle .
So I'm a little confused on the ACTH test Doesn't that have to be done 4 to 6 hours after a dose of Trilostane ?
Nancy

[Squirt's Mom]

Nancy, that ACTH is used in three ways - 1) to diagnose the disease; 2) to monitor the treatment and that is where that 4-6 hours after the pill WITH a meal comes in; and 3) to see where the cortisol is when there is the possibility it has gone too low, which is life-threatening. It is possible to skip an ACTH when it is being given to monitor treatment on a regular basis .....BUT it is never ok to skip an ACTH when the pup is presenting with signs of an overdose (cortisol too low, life-threatening situation). Those primary signs are - loose stools/diarrhea, loss of appetite/nausea, loss of energy/lethargy. Anytime we see any of those signs, the drug should be stopped immediately and the vet called. The vet's job then is to asses the pup via an ACTH and possibly an electrolyte check. So the ACTH continues to serve 2 purposes after diagnosis - to monitor treatment and to determine if the pup has crashed (when the cortisol has gone too low).

I'm glad your girl is better and hope you get some answers today from the vet. Let us know when you can!

[Nlkloss]

I took Tia to the vet today. Even though I thought she looked better they felt she looked pretty miserable. They decided to check her cortisol level and everything came back perfect, so the vet said she didn't think it's was necessary to do the ACTH test. They gave her something since she has been nauseous and today was the first time she has eaten a full meal in quite a few days. She has lost 5 pounds since diagnosing her a couple months ago. However I blame that on the trilostane and being nauseous . They also felt that I should see a neurologist so we set up an appointment as they think other things may going on with her. Is we are not fighting anything else and when Tia is more stable she may want took try her on Lysodren.

[Harley PoMMom]

They decided to check her cortisol level and everything came back perfect, so the vet said she didn't think it's was necessary to do the ACTH test.

I take it that they only checked her "pre" cortisol level and a full ACTH stimulation test was not performed to see where her "post" number is, right? Were her electrolytes checked?

[Nlkloss]

I'm sorry I meant her electrolytes were checked and they were in perfect range so they didn't feel there was a need to do an ACTH test.

She had diarrhea last night and today so I'm watching her closely. It may have been my fault because I was trying to get her to eat and gave her more canned food than usual. Does anyone have any suggestions for antidiarrhea meds if she is still showing signs in the morning. She was interested in eating today so that was good. paws crossed!
Nancy

[Harley PoMMom]

Even though the electrolytes were in normal ranges it does not guarantee that the cortisol is not low. Plain canned pumpkin can help loose stools, however if she is still having the diarrhea in the morning I would have an ACTH stimulation test done just to be absolutely sure her cortisol has not dropped too low.

Hugs, Lori

[Nlkloss]

Thanks Lori. No diarrhea today so far.
Any recommendations on giving heartworm prevention meds for Cushing's dogs? My vet said it was fine.

[molly muffin]

I do give my dog heartworm prevention but not when she is off in any way. I'll wait till she is back to normal.

Lori is right, while electrolytes being off can indicate that her cortisol is low, frankly, you never want them to get to that low of a point, because it can be life threatening. Cortisol can be going too low prior to that happening though and you want to actually catch it before the electrolytes become too low also, so I don't think your vets reasoning for not doing an ACTH stands the test of reliability actually.

This could be gastro and the trilostane upsetting her stomach, that is a possibility but it is taking a chance without really knowing. Grrrr

How is she today?

[Nlkloss]

This is so frustrating when you have a vet that you have gone to for years not performing the Tests that Tia needs to have . I hate having to feel like starting all over with a new one but I want to do what's best for my dog I am heading up to Ann Arbor Thursday to see a neurologist For her knuckling on her front paws and I am going to ask if they have an internist that she could see.

I have had her on a bland diet ( chicken and rice ) for the last couple of days and so far no diarrhea

Tia used to be pretty vocal, barking and whining when she wanted something. She had me trained pretty well LOL she hasn't made a sound in quite some time She used to sleep up on the bed with me and would jump on the couch and she hasn't done that in months . She also could walk about a mile and now we're lucky if we get one house away before she turns back It's so heartbreaking

[molly muffin]

I think the neuro consult will be the best option and they should have an internist too. Let us know what they say.

It is hard to see the changes that can come over them so quickly when things aren't right. :(