blue heeler cushings advise

[raven5]

My dog raven was diag with cushings about 2 weeks ago. The vet put her on trilostane 1mg per lb and denamarin.

Lately her hind legs have gotten extremely weak. She doesn't sleep well due to heavy breathing.

I broke down the 60 mg to 2 doses nite and morning.

Then broke it down to 3 doses. She seems worse as if we are not winning.

I am brokenhearted over her.

[Harley PoMMom]

Hi and welcome to you and Raven!

So sorry for the reasons that brought you here but sure glad you found us. Are you splitting the capsules open yourself? If so, I am quite concerned about that, it is strongly recommended not to do so because: 1) it should not be handled in itself; and 2) there just isn't a way to make sure Raven is getting an accurate dose.

We ask a ton of questions from our new members, in that way we can learn about your furbaby and provide meaningful feedback, so, moving on to those questions ;) How much does she weigh? What symptoms did Raven display that led you or your vet to test for Cushing's in the first place? Could you get copies of all tests that were done on Raven and post those results here? With respect to the blood chemistry and complete blood count (CBC), you need only post the highs and lows and please include the normal reference ranges. We are especially interested in the results of all tests that were performed to diagnose her Cushing's. Was Raven diagnosed with the adrenal or pituitary form of Cushing's? Does she have any underlying illness', and if so, what are they and what medications is she on? Was an ACTH stimulation test done recently to check her cortisol levels?

Ok, I believe I have bombarded you with enough questions from me, and look forward to hearing more about your dear girl.

Hugs, Lori

[raven5]

Hi and welcome to you and Raven!

So sorry for the reasons that brought you here but sure glad you found us. Are you splitting the capsules open yourself? If so, I am quite concerned about that, it is strongly recommended not to do so because: 1) it should not be handled in itself; and 2) there just isn't a way to make sure Raven is getting an accurate dose.

We ask a ton of questions from our new members, in that way we can learn about your furbaby and provide meaningful feedback, so, moving on to those questions ;) How much does she weigh? What symptoms did Raven display that led you or your vet to test for Cushing's in the first place? Could you get copies of all tests that were done on Raven and post those results here? With respect to the blood chemistry and complete blood count (CBC), you need only post the highs and lows and please include the normal reference ranges. We are especially interested in the results of all tests that were performed to diagnose her Cushing's. Was Raven diagnosed with the adrenal or pituitary form of Cushing's? Does she have any underlying illness', and if so, what are they and what medications is she on? Was an ACTH stimulation test done recently to check her cortisol levels?

Ok, I believe I have bombarded you with enough questions from me, and look forward to hearing more about your dear girl.

Hugs, Lori

Yes,opening them and making smaller doses.
She is 60 lbs.
She tested positive 2 weeks ago .
Plan on getting her tested again Monday to see if she needs a higher dose.
Maybe I compromised the medication in reloading the capsules
(60) mg.

I originally took her in a month ago for her teeth cleaning ,and they did blood work prior to aestheticizing her. That's when the liver enzymes showed up on the blood report. Way out of whack. So,they sent her home with denamarin and antibiotics.(roll eyes).
Well,when we got home she would not get up. I called them and asked if they had sedated her. They said yes, but she would be normal in 2 to 4 hours. Well,IT took a day and a half. After 2weeks I took her to a different vet. Her hit the nail on the head. So here we are,holding our own,but now she is weaker,much weaker.

[raven5]

I do not know if it is adrenal or pituitary.

[raven5]

If I started over,and went with a 1aday dose in the morning ,would I need to skip a day?

My last 1/3 dose was 2pm.

[Harley PoMMom]

How is her appetite? Is she vomiting or having diarrhea? I gather Raven is taking brand-name Vetoryl, correct? Is she acting lethargic or it just seems that her back legs are giving out?

Now, lets make sure I am getting this right; Raven weighs 60 lbs and was prescribed 60 mg of Vetoryl once a day and not 60 mg twice a day?

Dechra, the manufacturer of Vetoryl, specifically warns against opening capsules and splitting the powdered contents so I highly recommend not doing that.

This answer is really important, what test/s did the vet perform that diagnosed her Cushing's and can you post those results? I am hoping that her diagnosis was not based solely on elevated liver enzymes. If she is not acting like her self I would discontinue giving her the Vetoryl/Trilostane until contact can be made with Raven's vet to discuss her situation.

How is Raven feeling/acting right now?

[raven5]

Ferocious appetite,no vomiting,stool normal.
She pants a lot,and her back legs are weak. She seems wiling to go outside and she does go with me on short walks,but her back legs are weak.
The test was conducted by pulling blood,injecting a compound into her system ,waiting 2 or so hours,them pulling blood again. Test was positive for cushings.

Right now she is laying at my feet and looks/acts 100% normal,except the short choppy breathing. Occasionally she kinda dits up,and starts panting like she is hot.

Yes she is 60 lbs and is on 60 mg once a day.
I know the Addison danger,and to my knowledge she is not addisonian.

[raven5]

......and yes,it is brand name vetoryl

[raven5]

The reason I split the dose was it seemed as if by evening she showed elevated panting/trembling. I was also worried that she got the whole surge of 60 mg in the morning the after 8or 10 hours she had zero meds working.

I was wondering when I did the 3 equal doses 8hrs apart it maybe was weakening the whole results

[raven5]

Does normal function ever return to back legs?

[Harley PoMMom]

Did the weakening of her back legs start all of a sudden or has this been something you noticed that has gotten worse over time?

Dogs with Cushing's generally do have muscle wasting due to the continuation of their body producing excessive amounts of cortisol. Once that elevated cortisol is controlled the rear leg weakness should improve, but this can take a long while.


The reason I split the dose was it seemed as if by evening she showed elevated panting/trembling. I was also worried that she got the whole surge of 60 mg in the morning the after 8or 10 hours she had zero meds working.

I was wondering when I did the 3 equal doses 8hrs apart it maybe was weakening the whole results

The recommendation is giving the Vetoryl/Trilostane once a day in the morning, however, if symptoms do seem to rebound in the evening and the dog's cortisol is within the therapeutic ranges, twice a day dosing may be beneficial. The way this is determined is having an UC:CR test done, the urine is collected in the morning (prior to the dog receiving it's daily Vetory/Trilostane dose) in order to gauge whether the cortisol level has risen to a high level again before the end of a 24-hour time period. In that situation, a high morning UC:CR in conjunction with a therapeutic ACTH reading can point to the need to shift to twice-daily dosing.

If twice a day dosing is needed than that daily dose is split and given twice a day, so you are correct in that if Raven's ACTH stimulation test did show that her cortisol is within the therapeutic ranges than that 60 mg dose would be split and 30 mg would be given twice a day.

It is recommended that a dog's cortisol be checked 10-14 days after treatment is started, since Raven's treatment was initiated two weeks ago has an ACTH stimulation test been performed to see where her cortisol levels are? Another note; Dechra recommends waiting 30 days to make a dosing adjustment, due to the fact that cortisol levels continue to drift downward during that time period. The main reason in having an ACTH stimulation test performed 10-14 days after treatment is started is to make sure that the dog's cortisol hasn't dropped too low. With Raven's appetite being strong and no other adverse effects are noted it doesn't sound like her cortisol has gotten to low but I still think an ACTH stimulation test should be done, and even if her symptoms haven't improved I still wouldn't change or adjust her dosing regimen until she has been on the Vetoryl/Trilostane for one month unless, of-course, she would start to exhibit ill effects.

Keep us updated, ok?

Hugs, Lori

[Squirt's Mom]

Another aspect of opening capsules - most medicines contain fillers, things that are not medicinal but that make the presentation of the drug possible. So by opening the capsule and cutting what you find inside into smaller portions, you have no idea how much of the actual drug she is getting in those smaller doses. So she could get 36mg the first time, 3mg the second time, and 21 mg the 3rd time. In our mind, if we can divide that pile of powder evenly then the drug is divided evenly but not so. ;)

[raven5]

Ok,gave her a entire 60 mg pill at 5:30,3 hrs ago.seems she is better.

I also intend to start back on her multi vitamin.
B12,e,alpha lipoic acid,artichoke ,and c

[raven5]

Personal conclusion,she was under medicated.

She is 1000 times better after the 60 mg at 5:30 this morning

[Harley PoMMom]

Ok,gave her a entire 60 mg pill at 5:30,3 hrs ago.seems she is better.

I also intend to start back on her multi vitamin.
B12,e,alpha lipoic acid,artichoke ,and c

Glad she is doing better!

Those vitamins, has she been taking these for a while or are some of them new to her diet? The reason I am asking is because in case she does start acting "off" it would be hard to figure out if it is the Vetoryl or the vitamin/s that is the culprit for her not feeling well.

[molly muffin]

Welcome.

Giving the 60 mg at once is better than splitting it yourself due to the fillers Leslie mentioned.

As to whether the back legs will get better or not depends on how long she had high cortisol before it was diagnosed. High cortisol causes the tendons and ligaments to weaken. Some get better some do not.

If you notice a return of the panting etc then it would be better to get the 30 mg pills and give one in the morning and one in the evening.