Restless 12.5 Year Old Cocker Spaniel -Vetoryl

[osupeaches]

My name is Jill and I have a 12.5 year old Cocker Spaniel named Tucker. He was diagnosed with Cushings about 8 months ago. He is about 32 pounds now and was originally doing 60 mg. of Vetoryl. Once the Cushings was controlled we started doing Vetoryl every 2 days with one day off.

In the last week or so we began to notice that he is very restless on the days that he would take the meds. He just paces around and paws at us but does not seem to want anything. We cannot seem to get him to calm down. My vet advised that we reduce is dose to 30 mg. every other day since his last test he was on the low normals side. The pacing and panting happened on the first day of the new dose but on the next dose he was fine. This evening the pacing and restlessness has returned. We cannot seem to figure out what he wants or how to make him comfortable. Is there something else we can do for him. He only seems to act this on days he takes the vetoryl.

The other change we have noticed in him since the Cushings is he has severe separation anxiety. He is a cocker and has always been a bit needy.;) He would occasionally get upset if we would leave him but now it has become a more regular thing. He even gets upset when go to work which he never did in the past. I wish there was something we can do to help with the anxiety.

Any insight on this will be very much appreciated. We just want to make him as comfortable as we can.

[labblab]

Hello Jill, and welcome to you and Tucker! I will apologize in advance for the many questions to follow, but your answers will allow us to give you our best feedback.

First, can you tell us more about the symptoms that first led you to suspect Cushing's? Also, what diagnostic testing was performed? If you don't already have them on hand, requesting copies of Tucker's actual test results -- both the initial diagnostics and also subsequent monitoring tests -- will be a huge help.

One thing that stands out to ne, however, is that your vet has departed from recommended dosing protocol from the very beginning of Tucker's treatment :o. Vetoryl (brand name trilostane), has a relatively short active life in the body. For most dogs, the chemical has exited the system within 12 hours of dosing. For this reason, it is intended to be given at least once a day in order to keep cortisol levels within reasonable control at all times.

Current initial dosing recommendations are to start a dog at a dose no larger than 1 mg. per pound. So for Tucker, that would have meant starting off at no more than 30 mg. once daily. Subsequent ACTH monitoring testing will then help you judge whether this daily dose should be raised or lowered.

There are a couple of problems with dosing on alternate days. First, the cortisol level has the potential to rollercoaster by being lowered one day, but permitted to climb too high during the next day. Also, it is hard to interpret the monitoring ACTH testing. If the test is appropriately performed 4-6 hours after taking the Vetoryl with food, you know where the cortisol level is at that time, but you have no idea how high it has rebounded during the 48 hours until Tucker is dosed again.

Finally, the goal of Vetoryl treatment is to consistently lower cortisol to a range than is actually lower than the normal range for a dog without Cushing's. So when you say that Tucker's cortisol was "low normal," it will help us to know exactly what that number was. From what you are describing, it is possible that his cortisol is never really within the desired range at all, or it could be that he is reacting poorly to the peaks and troughs produced by dosing only every 2-3 days.

Here's a link to a publication by Dechra, the maker of Vetoryl, that will give you a lot of helpful info re: recommended treatment and monitoring:

http://www.dechra-us.com/Files/dechraUSA/downloads/Client%20Literature/Treatment%20and%20Monitoring%20of%20Hyperadrenocor ticism.pdf

Once again, welcome to you both, and I look forward to reading a lot more about Tucker's Cushing's journey.

Marianne

[osupeaches]

Thank you for the fast response. I can request all of the test results from my vets office. I already have a call into them this morning since Tucker did not sleep last night.

He was originally diagnosed after he was drinking and a lot of water and peeing a lot. Often times he would not even make it outside and would have an accident right by the door. We did several rounds of blood work and the ACTH which led to the Cushings diagnoses. We started him on Vetoryl everyday and he was doing great for several months. Most of our early ACTH were done while he was on the daily dose. For the past 3-4 months we have been skipping days and then last week lowered to 30 mg. every other day because of his restlessness. Usually the restlessness happens on days where he has taken the vetoryl and normally in the evenings but not always it sometime happens during the day but usually only lasts for a few hours.

Last night it started after dinner and he has not calmed down since. He has been pacing all over the house. He spent hours last night messing up his bed with his paws. He will only lay down for a few seconds and then back up again. I am wondering if he needs an even lower daily dose but I am worried about the restlessness and him not sleeping. He did not sleep at all last night. Thanks again for your response. I will get his test results hopefully from the vet today.

[molly muffin]

Cortisol is produced by the adrenal glands with input from pituitary gland telling it to make or not make more. Trilostane interrupts the command to make more cortisol. On days he has trilostane, he is being told don't make any cortisol and on days he isn't he's being told go for it, make as much as you want. This bounce would I'd think wreck havoc on any dogs endocrine system and I can see why this alone would cause anxiety. There is a reason why the recommendation from the manufacturer is every day and that is as Marianne said, to keep a steady level in the body of what works best for any given dog. You see what I mean? Cortisol lowered, can unmask aches and pains they don't feel when it's higher and then cover them up when it jumps up. So, that is another factor.
You want a post ACTH that is between 1.5ug - 5.0ug or up to 9.0 ug if the symptoms are controlled and you want this to be maintained throughout each day. Some dogs bounce enough in the evening that the dose is split and given am and pm. Like say you are doing 30mg and that maintains a level fine for your dog but you notice an increase in symptoms only in the evening, then you'd split and give 15mg morning and 15mg evening. However, the acth is only going to give accurate results if the proper protocols are being met and you can actually find out what is happening inside his body.

That's my initial thoughts about what might be going on with your dog.