Sasha - Shivering when awake

[sd_tom]

Hello everyone. Been checking this site on/off again for the last couple years. Our 14 year old staffy Sasha got diagnosed two years ago (pituitary based) and really poured over positings here and everywhere else at that time; luckily finding a vet that while she didn't know much about Cushings, was eager to learn.

A little bit of history; for the first 12 months, she well controlled on 0.5mg per lb trilostane twice a day (so a 0.23ml suspension for her 50lbs). Then we started noticing lethargy, wasn't eating, etc. So went back for ACTH checkup and turns out she was up in Addison's territory so we stopped trilostane for a couple weeks, then restarted and several rounds of lowering the dose / ACTH test over a few months and have ended up with 0.05ml now twice daily... so 0.1mg per lb. Pre:4 Post:6 test at that point.

It seems like somewhere during that she picked up occasional shivering. But over the last three months it's become just about constant when she is awake and sitting prone, she's shivering. Took her to Neuroligist and she had no idea, considered them seizures.. suggested doing a MRI to see if she had a brain tumor. To us that sounded traumatic (let alone $$) for a 14 year old pup. Plus, she was somewhat doubtful as she didn't think a tumor would move so slowly that we could be witnessing it for 6 months (i.e., would be dead by now). We tried an anti-seizure pill (Keppra) and it made her absolutely drunk so we took her off that after a couple days. Her and an additional Cushing's specialist didn't think it was related, so left without any answers.

We've most recently taken her to a holistic vet just for something different.. accupucture, diet change (wet food/high protein), laser therapy, a bunch of suppliments (zypan, catalyn, drenamin).. none helped. Tried Duralactin after reading here, nothing. Tried other arthritis supplements.. nothing. Also took her off trilostane for a week, zero effect other than Cushings symptoms came back w/in 48 hours.. so back on that. Thinking more of a paliative care, tried CannaCompanion for 3 weeks.. zero response there as well. We've now pulled back from most of that (just too much going on).

So exhausted with all these 'experiments' we're now sitting on a diet of her normal Kirkland Grain-Free Dry Salmon, some ground turkey with her trilostane, fish oil pill, and zypan just cause it helps with the new wet food. And just this week her back end weakness seemed to start accelerating as well to add to her problems right now.

Anyways, any ideas? Poking around here this morning again.. seeing some references to L-Glutamine to help with the back end weakness; so we may try that. But the thing we've been most worried about is this constant shivering. She doesn't seem in pain, but it has to be uncomfortable. With her age, mostly looking to make her comfortable if we can.

Videos from this morning. And no, we don't keep our house freezing (it's San Diego, was 80F yesterday)
https://youtu.be/Y-1BpteK638
https://youtu.be/B0C2PEbM97Q

[labblab]

Hello Tom, and welcome to you and Sasha. Gosh, as soon as I took a look at your videos I was transported back in time. Sasha's shivering looks SOOOO much like the tremoring episodes that my own Lab boy suffered in conjunction with his Cushing's. With my Barkis, we first noticed some slight shivering even before his diagnosis. After he started taking trilostane, it worsened significantly and continued for about 2-3 months. After that, it strangely dropped away. The tremors occurred most often when he was laying on the ground while awake or even asleep (sometimes they would jerk him awake). But just like Sasha, he would usually just stretch afterwards and never seemed to be in any particular pain or discomfort.

I don't tell you this to worry you unduly, but he did subsequently develop other neurological problems that pointed to an expansion of the pituitary tumor that was also causing his Cushing's. He became uncoordinated, started aimlessly circling, seemed "vacant," and ultimately lost the desire/ability to eat and drink. Having said all this, however, we do not know whether the tremoring was also related to his tumor. For what it's worth, tremoring is listed as a possible side effect of trilostane itself. However, throughout the years here, we have had other members who have also reported similar episodes, both before and during Cushing's treatment, both in treatment with trilostane and also Lysodren, both in conjunction with other developing neurological problems and without. So while I do believe the tremoring is somehow Cushing's-related, I do not know by what mechanism.

So I'm afraid I'm not offering out any answers to you, but perhaps it will bring some comfort just to know that you're not the only parent who has grappled with this. And for what it's worth, once again, I do think the tremoring seems to bother us humans more than it bothers our dogs :o.

[sd_tom]

thanks for the response... yes we're quite convinced it is bothering us more than her. and appreciate your stories, even if there's no silver bullet here :) We still take a mile walk each morning despite all that, which is pretty good for a 14 year old I think. It's when she turns that down that we'll start thinking about her quality of life / hard choices.

BTW my wife has a friend with a cushing's pup and was having some of these tremor like things and they put him on Zonisamide and they seemed to help. She explained it as a partner drug to anti-seizure meds; normally not given by itself but seemed to help. Anyone run across this option?

[labblab]

We have had pups here who have been put on Zonisamide for treatment of bona fide seizure disorder, I believe with good results. If you enter "Zonisamide" into our forum search function, I hope you'll come up with some posts to review. I don't know that anybody has tried the drug for tremoring, but heck it might be worth it.

I have a nonCushpup Lab who started having grand mal seizures of unknown origin about six years ago. We have been really lucky in that she has been 100% stabilized on phenobarb with a minimum of ill effects, so we have not tried shifting to any other anticonvulsants. But I have been relieved to know that there are now other options out there, such as Zonisamide, that can be used alone or in combo.

Marianne

[Joan2517]

My Lena has had this on and off since before the Vetoryl. It got a lot worse after she started, but then calmed down again. It happens when she's sleeping and when she's awake and then all of a sudden it stops.

I freak out whenever it happens, but sometimes at night when she's sleeping and it occurs, I just put my hand on her back or pet her until it stops. I don't even know if she realizes it is happening.

Cushing's sucks!

[sd_tom]

yeah i'm thankful it never does it when sleeping. Just has gotten to the point it's just about every waking moment when relaxed (when standing seems to go away or at least light enough not to get in the way of movement).

[HMystDox]

Hi there,

I am so sorry your pup is suffering the "shivers" our girl Sarah who is also 14 suffered them in the beginning also prior and post diagnosis I have seen the same sort of shivering with pain so I asked the vet to try some pain medication to see if that would help they recommended I try Metacam or Rimadyl to start and see if it helped and for Sarah it was teh answer she stopped with the tremors almost immediately since that time I have been able to take her off those drugs but for about 6mos she took NSAIDS to this day I don't know what may have caused the pain the specialist said inflammation anywhere can cause the tremors.

Have you tried an NSAID just on the off chance the shivering is due to pain ... most dogs will not shiver in their sleep as they are less aware of the discomfort. Another cause could be Addison's this causes those same tremors .... I know you've taken her off the meds to see if that helped but it might take longer than a week or it could be that for some reason your dog doesn't do as well on Vetoryl as perhaps on another drug?

Talk to your vet. I hope your baby will feel better soon!

Jen & Sarah

[molly muffin]

Hi and welcome to the forum.

Molly has tremors sometimes, since starting trilostane, but again, doesn't seem to be in any pain and doesn't do it as much as Sasha is.

I think I'd try the pain medication first, as that is usually a quick reaction of that is the cause, even if it is just aches and pains in the muscles. So, if that works you should notice within a couple days I'd think.

If not, then try the seizure med mentioned. I'm not convinced that it looks like seizures to me, but I'm certainly no expert.

I'm thinking actually more of a muscle relaxant type of pain med. See the way the tremor seems to make her draw up her legs almost? That is what is making me lean in that direction.

[HMystDox]

Robaxin is the muscle relaxer I use for Sarah it's helpful if her neck and shoulders get stuff in the damp cold weather.

I finally got the videos to load for me on Youtube. I would still try the pain medication but if that doesn't work you may want to try for a second opinion as it's more exaggerated than the tremors I've seen :/ Could indeed be neurological but doesn't look exactly like typical seizures either.

Pain is the most common reason for dogs to shake or have tremors ... many people think (wrongly) their dogs are cold but dogs don't get cold like we do except perhaps tiny toy dogs or if the cold is extreme sometimes heat seeking behavior can be a symptom of overactive thyroid but generally most dogs don't shake if it's chilly. Another cause for trembling is low blood sugar... have you checked that? Usually that is an easy fix try rubbing a bit of karo syrup on your dogs gums and giving her a small meal see if the trembling subsides if that is the case and she's shaking often have her blood sugar checked Cushings dogs are more prone to other autoimmune disorders.

Wishing you the best!
Jen

[WeLoveAthena]

Hi,
I'm new here. Our lab was diagnosed with Cushings last week. Started on Vetoryl but she also takes tramadol. We use tramadol in our 14 year old staffy as well for pain and it works great. As a Nurse I never liked it for humans, lots of reactions but it's a great vet med for dogs. Our older Staffy will get the shakes in her back legs. Soon as she is given the tramadol it stops. So we started her on a schedule of it morning afternoon and with her dinner meal as well. It really helps her.

Sorry I can't offer more help but I do hope that you can get some and try it and that it helps


I just watched your videos on you tube (Hard to watch been through it). That's what our staffy would do. She was hurting from Arthritis but it may be something else in your case best to check with vet but for us the Tramadol works like a miracle.

Your baby is sure beautiful- Looks alot like our girl but our's is brindle

Wanted to add. Our girl didn't seem to be acting like she was in pain but she was. Xrays shows arthritis in back legs. Her back legs are weak but she does get around so much better now on the Tramadol. I forgot to add ( sorry overwhelmed with our newly diagnosed Cushings Girl) she is also on Gapapenten. Together they make her feel so much better.

[My sweet Ginger]

http://youtu.be/H1ZytwhYlsM

Looking at Sasha's and my Ginger's videos, to me they are quite similar tho Sasha's seem a little more pronounced. Ginger started her tremors mostly on her legs before her Lysodren treatment but started this across the shoulder blades tremors sometime after the treatment. I mostly saw them while she was sleeping, resting and only during inhalation it seemed. Unfortunately she also developed focal seizures on her head/neck after the treatment. Not for the tremors but for her focal seizures her neurologist prescribed Keppra which she handled it ok. I think some time after Keppra was started the across the shoulder blades tremor was gone but not the focal seizures. As I thought her seizures could've been controlled better, we then added Zonisamide with Keppra. As soon as Zoni was started she developed a bad case of colitis. Despite repeating dosage decreases on Zoni her colitis persisted. So back to Keppra alone and not so much colitis after that. The only downside with Keppra for us was the 3x dosing schedule which we finally got used to. I know every dog reacts differently to different drug but I thought I will tell you what our experience was like with the two drugs. I still don't know what caused her across shoulder blades tremors and what stopped them but I have to agree they are very disturbing to watch for us parents.

[sd_tom]

ok we're taking this options and will work through them. starting with pain meds on the chance it's pain related afterall, and shouldn't take weeks to see a change. Will keep you all posted.

[sd_tom]

Ok update. Been about two weeks on Metacam.. mixed. The shivering is definitely not gone, however there are some occasional good days now. So, instead of shivering 100% of the time when awake and sitting prone or on her side; maybe it's 70%. Went back to the vet with the ideas from here, plus her rear end weakness is getting worse as well so we wanted to do a ACTH test (results: 2.8 Pre, 3.2 post).

So right now she's getting:
- Metacam - 45lb dog dose - 1x day
- L-Glutamine - 500mg - 2x day
- Standard Process Canine Musculoskeletal Support -1/4tsp - 2x day
- Trilostane - 5mg - 2x day (liquid suspension)
- Fish oil pills - 2x day

As far as next ideas. Vet had two ideas
- Gabapentin - We will start that next. Said that can take up to a month to know if it's going to help. Pain Reliever but focused on Nerve pain. Believe she said, if needed, it's compatible with Metacam. We're not so convinced the Metacam is doing a ton, but nice to know it's an option. She had it in stock so we already have that ready to go.

- Also left with an RX for Zonzamide to fill after we've tried the Gabapentin.

[Harley PoMMom]

A little bit of history; for the first 12 months, she well controlled on 0.5mg per lb trilostane twice a day (so a 0.23ml suspension for her 50lbs). Then we started noticing lethargy, wasn't eating, etc. So went back for ACTH checkup and turns out she was up in Addison's territory so we stopped trilostane for a couple weeks, then restarted and several rounds of lowering the dose / ACTH test over a few months and have ended up with 0.05ml now twice daily... so 0.1mg per lb. Pre:4 Post:6 test at that point.



Math is usually my strong point but not today:confused::o So, can you clarify for me how many mg are per 1 ml of her Trilostane liquid suspension?

And what were the results of the ACTH stimulation test that showed she was in an Addison's crisis? It has me a bit worried that her cortisol continued to drop even with the lower dosage of Trilostane...but I may be missing something.

Hugs, Lori

[sd_tom]

Math is usually my strong point but not today:confused::o So, can you clarify for me how many mg are per 1 ml of her Trilostane liquid suspension?

And what were the results of the ACTH stimulation test that showed she was in an Addison's crisis? It has me a bit worried that her cortisol continued to drop even with the lower dosage of Trilostane...but I may be missing something.

Hugs, Lori

it's 100mg/ml suspension. So we worked our way up originally to 0.23ml , so 23mg 2x day for 50lb (~23kg) dog.. so 1mg/kg.. this was 2 years ago. Then this past summer, so 9 months or so she started losing appetite etc, and when we had her tested, she was too low (I don't have numbers, will have to see if my wife still has them).. so even went on prednisone for a week / no trilostane to get her out of danger zone. We over the course of several ACTH tests across a couple months got her with basically the numbers we have now, but with just 5mg (0.05ml) 2x day.. which is a tiny dose but if we go to zero trilostane, or even just 1x a day trilostane the heavy water drinking comes back pretty quick (~48 hrs). Nobody has any ideas on why the controlling dose would drop like that, and we kind of moved on from there but if there's something telling there that would point to the shaking, all ears.