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Aunt Jana
05-10-2016, 06:32 PM
Hello:
I am new to this site, found it today. Thank you for this forum.
I am very confused with my special girl. She will be 8yrs in August. Up until September 2015, no problems. She was playful, very fast runner, played hide and seek, etc, ate well, good weight. 9/2015 She started out drinking water like there was no tomorrow, peeing every hour, waking up in middle of night to drink and pee. Appetite increased, hair on both flanks going bare with dark looking zits on skin, later came lage bumps too.
First vet checked for diabetes, all types. Negative. Thyroid came back positive for Hyperthyroidism. She was started on .04 one and a half twice daily. This did nothing, weeks later we tested for Cushing at my request. Numbers came back: Pre V 3.6 and Post 27.3. That was approx January 2016. She was put on 60Mg Vetoryl once daily. All the medicine really did was stop the thirst and peeing, her mood has changed to very flat. She lays around she doesn't play she looks sad, depressed it's awful. Her hind legs have become weak, her hair is growing back in spots but not normally one spot she has undercoat hair on top she also has hyperkeratosis on her nose. This month after we tested again to make sure dose was good ( Pre 0.7 and Post 4.8) we addressed the hyperthyroidism. Last week we started meds 0.6 mg Levothyroxine.

If I can add right here-- for the past month when she has been jumping up on my bed and napping I noticed that her body was shaking at times, kind of like a shiver and it wasn't all the time but it was pretty regular, almost like restless legs but it was her whole body shaking and I didn't really think it was anything. But after starting on the thyroid medicine the shaking became exaggerated, it was like her whole body was shivering when she inhaled and when she lifts her head from napping she's very out of it she looks like she understands but she can't move, sometimes her head quivers back and forth; when she's in a deep sleep it's so hard to wake her up and then she has to lay there for a while until she gets up-- very out of it. The vet said to stop the thyroid medication we did but after reading about adverse effects of Vetoryl, I think it's the Vetoryl! I stopped it today. I would appreciate any opinions I'm so confused and so worried.

FemaleK9
05-10-2016, 07:43 PM
People more knowledgable than I am will be along soon with a lot of questions for you so they can give you the best help.

In the meantime, I will just say that we see too many dogs started at too high a dose of trilostane/Vetoryl.

I think it is better to start with too low a dose than too high. The worst that can happen with too low a dose is that after allowing time for the medicine to reach its full effect (about 30 days) symptoms will not be contolled and an increase will be needed. The worst that can happen with too high a dose is literally death.

Every dog is different, but I would advise starting with no more than 10 mg twice a day. This is where my Rosie started three years ago and where she has remained to this day, and although I can't promise that your dog will be the same, it seems a good safe place to start.

Aunt Jana
05-10-2016, 08:16 PM
Thank you so much for replying. At this point I don't want to give it to her at all. I think if she recovers from these episodes that I will just go the natural route the Adrenal Harmony Gold is a good, popular product and I was going back and forth deciding which way to go and I went with the prescription.

Today after she woke up from a nap her head was bobbing up and down and she looked so confused, I'm so worried, I don't know what's going on; the vet yesterday said her heart and lungs are fine and her pupils we're good too, they did all the right things. No fever either.
So thank you again for replying, I look forward to hearing other opinions.

Joan2517
05-10-2016, 08:45 PM
I would stop the Vetoryl...I wish I had with my Lena.

Aunt Jana
05-10-2016, 10:53 PM
I did stop the Vetoryl, yesterday was last dose. I'm so very sorry for you. Was your Lena on it long?

Joan2517
05-10-2016, 11:16 PM
2 months...she started Dec.11 and I had to put her to sleep February 19. I don't know if that's what caused her death, but I think it was.

She would have been 15 on March 19. I should have just let her live out whatever time she had left without the Vetoryl. That's what I would do now if I could do it over.

She was confused on the Vetoryl and also shook a lot. She just didn't seem like herself, but I kept waiting for it to work. I regret it every day...

I hope your darling girl improves. Cushing's is a heart-breaker

Aunt Jana
05-10-2016, 11:38 PM
That's exactly what my girl started doing the other day, shaking and confused. I don't know what I'm going to do if she doesn't get better. It's been over 24 hours since he had her last dose. A lot of her shaking and shivering has subsided, it's only when she's sleeping but it's a lot better today. I'm really mad at myself because it's been going on very slightly for weeks--the shaking when she sleeps. It only became exaggerated a couple days ago and we thought it was the hypothyroid medicine that we started but last night it all came together for me--it's the Vetoryl.

I'm so sorry for you, don't blame yourself; you made a decision to help her and you didn't know she'd have a reaction. I know how you feel, however, just remember how special she was.

Joan2517
05-10-2016, 11:47 PM
The Vetoryl doesn't last long in the system, so maybe the shaking will subside as the days go by. I hope so, she sounds like a special girl.

Aunt Jana
05-10-2016, 11:49 PM
I just want to know if this can be reversed, or is there is an antidote of some kind. Will she improve and get better now that she is not taking it any longer.

Aunt Jana
05-10-2016, 11:50 PM
Thank you so much.

Joan2517
05-11-2016, 12:06 AM
There are more knowledgeable people on this forum who might be able to answer those questions. I can only speak to my feelings.

FemaleK9
05-11-2016, 02:23 AM
It isn't a side effect, it's an overdose. Vetoryl should be stopped immediately, and if the overdose is severe enough, a rescue dose of prednisone may be needed. I would say take your dog to the vet immediately.

Aunt Jana
05-11-2016, 08:02 AM
I talked to vet yesterday when it became clear to me it was the Vetoryl and I mentioned the Prednisone and what I read, he had seen her the day before. He was supposed to call me back in the evening, however, he didn't. That's what I am wondering, does she need the Prednisone.

My sweet Ginger
05-11-2016, 08:33 AM
Hi, I'm sorry you and your girl are going through this difficult and confusing time.
In order for us to give you better advice we'd like to know her weight and abnormal blood test values in exact numbers along with their reference ranges. Especially the test that determined thyroid problem for her because you mentioned both hyper and hypo in two different posts. :rolleyes:
Also the dosage of the Vetoryl and dates of the two ACTH tests (one before Vetoryl and one after a month) so we will know how long she was on this drug on what dose. That will give us a much better picture as to what is going on with your pup hopefully and what next step should be. Thank you.

labblab
05-11-2016, 09:52 AM
Hello and here's a belated welcome from me, too. I'm very sorry you and Bubs are having such a rough time right now. First off, I just want to "second" Song's request for Bubs' testing information. I know it's a pain to gather the info, but it really will help us to offer our best feedback as to what may be going on.

I'm surely glad that Bubs seems to be doing at least a bit better, regardless of the cause of the problem. I do understand why you've discontinued the Vetoryl, at least for the moment, and it is certainly possible that it is responsible for the problems. However, from reading what you've written, it also seems possible that the thyroid med was the major culprit since the condition worsened significantly when the thyroid med was increased. It sounds as though you stopped both the thyroid med and the Vetoryl at pretty much the same time, is that correct? If so, it is impossible to know right now which drug was responsible for the major worsening, if in fact it was drug related at all.

We have had numerous reports of unexplained tremoring and "shivering" episodes throughout our years on the forum. It has been hard to pinpoint causation, because they have occurred under a variety of circumstances. Some Cushpups have started tremoring even before treatment was begun, others have suffered while being treated with trilostane (Vetoryl), and others while being treated with Lysodren (an alternative Cushing's medication).

For dogs being treated with Cushing's medication, certainly the first and most important diagnostic is to make sure that the tremoring isn't due to cortisol having dropped too low, or due to imbalances in blood chemistries (specifically potassium and sodium). The Cushing's medication can be responsible for either/both of those issues, so that's why we're especially anxious to know the specific history regarding Bubs' monitoring tests.

If the lab results are all normal, then it indeed seems possible that the problems are a direct side effect of the medication. One of our staffmembers has recently been asking a noted endocrinologist about this exact situation, and that has been his response. So if Bubs does return to normal now while off her medication (and her lab results have remained OK throughout), that makes the medication seem more likely to have been the culprit. Although given the timing of discontinuing the thyroid med and the Vetoryl simultandously, we cannot be certain which of the two might be the source of the problem.

One question for you: did Bubs' diagnostic testing point to a pituitary tumor as opposed to an adrenal tumor? If a pituitary tumor is suspected and the shaking continues even if the medication is discontinued, another possibility (which I am sorry to even suggest) is that the tumor may be enlarging and placing pressure elsewhere on Bubs' brain. I believe that flat-faced dogs such as boxers seem to be at an increased risk of this type of issue due to the shape of their skulls. As I say, I hate to even mention this possibility, but I do want you to be armed with as much info as possible to discuss with your vet in the event that the shaking continues.

Just to let you know, my own Cushpup (a Lab) exhibited weird tremoring episodes, too. I first noticed it even before he was diagnosed with Cushing's -- it seemed as though he was shivering across his shoulderblades when he was breathing in, even when he was laying down and resting. The tremoring dramatically worsened for a time after we started him on trilostane, but then it just as suddenly resolved after a few months, even while remaining on the trilostane. So we never did figure out the cause. However, I will add that he subsequently developed additional neurological problems consistent with an enlarging pituitary tumor. Was the tremoring associated with that? I'm afraid we will never know.

Anyway, I see I've written a book right now. The main thing is that I don't disagree with your having stopped the Vetoryl for the time being. However, I don't think we yet know whether or not it is truly the cause of Bubs' problems. We'll be very anxious to know whether she continues to improve in the the next few days, and also what her test results have been.

Marianne

Aunt Jana
05-11-2016, 11:54 AM
Many thanks for these replies, I am so grateful. She is hypothyroid-- I made a mistake in my posting..... We discontinued the thyroid medication first on Saturday and after doing more reading, I realized it could be Vetoryl overdose so Sunday was the last day she took Vetoryl 60mg. Her weight was 60lb I say was because on Monday when we took her to the vet she was down 2 pounds and it's clear to see it's muscle loss. No one has ever indicated if it's an adrenal or pituitary related, our vet tried to keep our cost down because the testing is so expensive; that may be why we don't know which it is. I think the vet was hoping that the trilostane would work on her. I don't have many test results I'm going to have to seek them out.
The Shivering is quite decreased but her head shaking when she gets up is not, not all the time but it's pretty frequent she woke up today at 6 a.m. she had to pee she went back to bed, had breakfast around 8 then went back to bed and she's sleeping now, doesn't want to get up.

I should add that we also give her Adrenal Harmony Gold twice a day, I don't know if you're familiar with that, a lot of Cushing's dogs are on that instead of the prescription route and we were giving her that everyday twice a day. I ran out of it, had to wait for it to be delivered-- she did not have that for 3 days which happened to also be the time the drastic shaking. After I gave her the first dose (after being out of it) on Sunday night it seemed to me that the shivering lessoned. ( It makes me wonder BECAUSE she was getting this supplement in addition to the Vetoryl we may have caused the overdose ) I know there is a lot of variables here which makes it all the more confusing but as I mentioned in an earlier post she has been doing the shivering for weeks, I just did not know it was a sign because she only did it when she was sleeping and it was not severe, almost like a restless leg syndrome...there was no other signs.
Also, we always gave her her medicine in between a slice of banana so she was getting approximately 2 - 4 slices of banana as of when she was started back on the thyroid medication. After reading I suspected Maybe we messed with her potassium levels which could have did something.... I don't know.

The test results I have:
10/08/2015
T4 0.8
TSH 0.24
Her cholesterol was 350 everything else normal, HCT was elevated at 53.5%
Thyroxine 0.4 BIDx (1 1/2 tablet)

11/13/2015
T4 was 1.1
Dr. said to continue meds, on refill go to 0.6 mg BID
WE STOPPED THIS MED WHEN WE STARTED TRILOSTANE (date approx January 2016)

4/30/2016
T4 was up and TSH was down Doctor said to start back on l Thyroxine 0.6mg twice daily.
STOPPED 5/7/2016

That's all the info I have at present I have to get the rest.

Once again, thank you all for all your valuable information.

Oops, one more addition --
She eats Fromm grain-free dog food, dry we supplement with approximately 1-2 tablespoon of canned pumpkin daily, occasional eggs and occasional pumpkin grain free waffles. Grain free 10 calorie cookies (Zukes)
We switched to grain-free approximately December 2015 and settled with Fromm, I think it was in February. For 7 years we fed her Blue dog food which we thought was an excellent brand for my special love, but I've come to find out that they practice or they have been accused of practicing unsavory techniques in their dog food production, so I'm very disappointed about that.

Sorry for the lengthy post :)

labblab
05-11-2016, 12:19 PM
Thanks so much for this additional info. I have only a moment to reply right now, but I want to double-check the time frame for this week. You gave Bubs her last dose of Vetoryl this past Sunday, and then took her in to the vet the next day (Monday, two days ago) -- is that correct? Did the vet draw any blood when you took her in? If not, and if she doesn't show rapid improvement, I really think she needs to have her cortisol level checked, and also a basic test of her blood chemistries. Vetoryl overdosing is really the first thing that needs to be ruled out in this situation.

Marianne

Aunt Jana
05-11-2016, 01:18 PM
Yes, that correct.
No blood was drawn. I did talk to my vet today, he's perplexed because I'm giving her those drops too. I don't want to stop them I think it's what helped her stop all the shaking. He wants me to call him tomorrow and check in he talked about checking her cortisol levels again.
The Adrenal Harmony Gold is the only thing she is being administered.

Many thanks again.

Aunt Jana
05-11-2016, 01:24 PM
Right now as of approximately 12:22pm she's been sleeping a lot, she's not really shaking all that much anymore :) it's a very, very slight if I see it and she's not as confused but she sleeping alot, the drinking-- that seems to have lessened a bit.

My sweet Ginger
05-11-2016, 02:47 PM
Numbers came back: Pre V 3.6 and Post 27.3. That was approx January 2016. She was put on 60Mg Vetoryl once daily. All the medicine really did was stop the thirst and peeing, her mood has changed to very flat. She lays around she doesn't play she looks sad, depressed it's awful. Her hind legs have become weak, her hair is growing back in spots but not normally one spot she has undercoat hair on top she also has hyperkeratosis on her nose. This month after we tested again to make sure dose was good ( Pre 0.7 and Post 4.8)

So if I understand this correctly her latest ACTH test was done sometime in Feb. with the results of pre 0.7 and post 4.8 after a month on 60mg Vetoryl, am I getting it right?
If that was the case, as Marianne said I'd test her cortisol and electrolytes ASAP before any other test is done. Her cortisol may be going down too low. I wouldn't restart Vetoryl unless I know her cortisol level first.

Aunt Jana
05-11-2016, 03:42 PM
No, a little different ---latest test was done 4/21/2016. Yes, those are the numbers. She has been on the Vetoryl 4 months. I do not want to use the Vetoryl ever again

My sweet Ginger
05-11-2016, 04:52 PM
Thank you for correcting me.
Did your vet give you any prednisone for emergency use?
I'd try 5mg pred on her to see if she perks up and if she does that could mean that her cortisol is getting too low and she may need pred for a while but you should talk to your vet about it first.
Is your vet going to perform ACTH test very soon? If so you may want to start pred after the ACTH is done test as prednisone skews the results of ACTH so long she is doing ok but I'd bring her in if she's still doing very poorly even with a few days of break from Vetoryl.

Aunt Jana
05-11-2016, 06:18 PM
Thanks so much for your reply.

When we talked today the vet mention that he wants to do another test on her, it's very costly, I don't know if I can do it right now which is very upsetting.
How long does it take for them to come back around after you take them off the vetoryl? is the sleepiness normal?

My sweet Ginger
05-11-2016, 07:06 PM
Probably depending on how low her cortisol is and whether or not her adrenals have been damaged and that is if her adverse symptoms are related to an overdose.

I truly understand you trying to be cost effective with this disease as I went through it myself but right now if I were you I'd opt for an ACTH test and come up with a plan according to results before things get out of hand because if an overdose is not treated in time the potential damage will be truly regrettable and by then the cost will be A LOT more expensive. But it's only my opinion. Does she seem to be doing better each day since the discontinuation of Vetoryl?

Aunt Jana
05-11-2016, 08:52 PM
She does seem better, not confused looking when she awakens anymore. The shaking while at rest has improved greatly, just occasionally now but not gone. However, she is just not happy. Drinking alot, appetite as usual is voracious. Her legs seem to hurt her too.
I call my vet tomorrow, will discuss the ACTH test.
Can't thank everyone enough for all the info, its really appreciated.

Harley PoMMom
05-11-2016, 09:15 PM
We certainly understand the expense of those ACTH stimulation tests, you may be able to get away with just checking her resting cortisol and only having her electrolytes checked. For the resting cortisol, they perform a blood draw but do not inject any stimulating agent, which does save some money. If her resting cortisol result and her electrolytes come back ok than it is unlikely that she is in an Addison's crisis.

Hugs, Lori

molly muffin
05-11-2016, 10:41 PM
Oh that poor baby, it does sound like she doesn't feel good and the electrolytes are a concern, if they are out of range.
We have seen some larger dogs need very small doses of medication to keep them in control. It might be that some arthritis was uncovered making her joints hurt a bit, when the cortisol went down too.

Aunt Jana
05-12-2016, 12:34 AM
What are the symptoms she would be displaying if herr electrolytes are imbalanced?

Harley PoMMom
05-12-2016, 04:23 PM
What are the symptoms she would be displaying if herr electrolytes are imbalanced?

The symptoms of unbalanced electrolytes are similar to a dog where their cortisol has dropped too low and can be any one or all of these clinical signs: vomiting, diarrhea, increased thirst/urination, lethargy.

Aunt Jana
05-12-2016, 07:50 PM
Today, we had the electrolyte blood work-- it came out within range. Normal. Thank goodness.

Bubbles is more alert, still drinking a ton. I don't see so much confusion. She is still following me everywhere and napping alot. My vet wants to check her ACTH levels down the road from now. So, hopefully she will continue to feel better.

I'm so grateful for all the kindness from so many caring people on this forum.

Harley PoMMom
05-12-2016, 09:35 PM
That is great news that Bubbles electrolytes are within the normal limits!! And glad to hear that she is feeling better.

Hugs, Lori

Joan2517
05-12-2016, 11:37 PM
So glad she's feeling better. What a relief for you.

Aunt Jana
05-13-2016, 01:43 AM
Yes, thank you everyone for all the concern and kind words of encouragement. I love my Bubbles, wish I could figure out how to insert her pic. I'm still trying........

Hopefully the water consumption will lessen, the vet has no ideas why she is drinking so much again. I'm just happy she's feeling better.

Goodnight

Harley PoMMom
05-13-2016, 02:06 AM
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Hugs, Lori

Aunt Jana
05-13-2016, 02:22 AM
Thank you Lori!

I have been reading some other posts and I am wondering now if the little black dry zits, on Bubbles skin is something I should be concerned. They are scattered about on her skin, small zit like, dry, black. What should I do if anything?

Aunt Jana
05-13-2016, 11:27 AM
Hi again,

Bubbles is doing ok in the trembling dept--pretty much gone now, just an occasional leg movement while sleeping . She does not seem spaced out either.

The drinking and peeing have not decreased and it has me concerned. Could this of began again as a result of the overdose of trilostane? It all began when we reintroduced the thyroid meds last week?
Thank you

Aunt Jana
05-13-2016, 12:22 PM
Another inquiry --

Does anyone know of a trusted Cushing's disease specialist /Endocrine specialist in Western PA. Pittsburgh area.

Thank you

labblab
05-13-2016, 12:22 PM
I'm surely glad that Bubbles' trembling has mostly stopped. So you did start back again with the thyroid medication last week? If so, and if she is no longer trembling while taking it, then at least it seems as though we can rule it out as far as causing the problem.

As far as what to think about the Vetoryl -- it's great that her electrolytes are good. Also, since her ACTH performed on 4/21 had a post-ACTH cortisol level of 4.9 ug/dL, it seems far less likely to me that she suffered from an actual overdose of Vetoryl. Unfortunately, it may just be the case that the trembling is a side effect that she experienced from the drug itself.

If that's the case, then her increased thirst and urination is most likely a result of her cortisol level shooting upward again now that she is no longer taking the Vetoryl. I'd love to tell you that I thought the Adrenal Harmony would be able to control her Cushing's :o, but our experience here is that it really is not effective. We are very familiar with it, because many people come to us with the hope that they can bypass prescription medication by using it. For a few folks, it seems to help for a while. But I'm unaware of any of our members who have not ended up having to switch to either Vetoryl or Lysodren in order to control the Cushing's symptoms.

Of course, blood testing is the only way to know for certain what is going on with Bubbles' cortisol level. But if her cortisol level is increasing again, that would be the obvious explanation for her thirst and urination. If she truly cannot tolerate Vetoryl, you may want to discuss with your vet the option of trying the other prescription Cushing's medication, Lysodren. It works to control cortisol in a manner different from Vetoryl. But unfortunately, it requires the same careful monitoring testing. Before making a decision of that sort, however, I do agree that you'll need to get confirmation of Bubbles' cortisol level now that she's stopped taking the Vetoryl.

I know you're in a rough spot right now, and I wish I could tell you that she'll do just fine without the need for any prescription medication to control her Cushing's. But I'm truly fearful that the Adrenal Harmony will not eliminate the problems caused by the disease...

Marianne

labblab
05-13-2016, 12:25 PM
Another inquiry --

Does anyone know of a trusted Cushing's disease specialist /Endocrine specialist in Western PA. Pittsburgh area.

Thank you
I was typing at the same time as you were, so I wanted to repost your question so that it doesn't get "lost." I know we've had members in Pennsylvania, so hopefully somebody will get back to you with a suggestion.

Marianne

lulusmom
05-13-2016, 01:17 PM
Our admin, Lori (Harley PoMMom) lives in York, PA so perhaps she can share a name with you. It's always nice to get a referral from somebody who has had experience with a particular IMS. I did a quick search on the ACVIM.org and came up with several internal medicine specialists in your area. Please click on the link below:

http://find.vetspecialists.com/search_results?page=1&ttid=2&tid=9&location_value=Pittsburgh%2C+PA%2C+United+States&city=Pittsburgh&county_sn=Allegheny+County&adm_lvl_1_sn=PA&country_sn=US&location_type=locality&swlat=40.3613689&nelat=40.501368&swlng=-80.09527789999999&nelng=-79.86572309999997&lat=40.44062479999999&lng=-79.99588640000002&faddress=Pittsburgh%2C+PA%2C+USA&place_id=ChIJA4UGSG_xNIgRNBuiWqEV-Y0

Harley PoMMom
05-13-2016, 04:42 PM
Unfortunately I'm not familiar with the Pittsburgh area so I can't recommend an endocrinologist. I would definitely look at the IMS' that Glynda provided a link to.

You mentioned in your post that Bubbles' drinking/urinating increased after restarting the thyroid medication, if her thyroid levels are too high than this can cause a dog to drink/urinate a lot more, have her thyroid levels been checked since the thyroid medication has been reintroduced?

Hugs, Lori

aallegre
05-13-2016, 05:03 PM
Curious, I went and read the reviews for the holistic alternative, but they didn't seem very encouraging. I'm considering different angles, but my understanding is that the holistic medication doesn't do anything for the underlying condition, just controls the symptoms.

My 70lb dog has been on Vetoryl for almost a year now, with no ill effects--but my vet was also very cautious about the dosing and the increases. He started a 70lb dog on a 30mg dose and we've been religious about our follow-up testing.

We're running into some issues now as he's on a very high dose (150mg) because his levels were still a little high on the 120mg dosage. Starting with too much too soon can definitely cause issues--perhaps get a second opinion on what starting dose is right for your dog. I do feel that he is experiencing some mild side effects (softer stool sometimes, hind end weakness) on this higher dose, but they are things that can also be attributed to the disease itself--the hind end weakness, at least.

There are other medications out there, but vetoryl does seem to be the safest, when dosed and administered carefully--I think it also depends on whether you get it compounded or in the capsules. Hopefully you are able to sort this out to help your pup without any ill effects--we are still learning!

Aunt Jana
05-13-2016, 09:05 PM
Lori--
On Approximately 4/24 her thyroid levels were checked from 4/21 blood work and Dr said she warranted the meds. We started them 5/1 and by 5/7, her drinking was markedly increased along with all the shaking,trembling, spaced out confusion.
Her last dose was was given Sunday night.
Thanks

Aunt Jana
05-13-2016, 09:08 PM
I just posted a rather long post, approximately 7:45 pm.... I don't see it...... :(

Aunt Jana
05-13-2016, 09:23 PM
Marianne---
I just wrote a lengthy post and I don't know where it went. So I am submitting again.....

So, we did start the L Levothyroxine after 4/21 blood work warranted as per vet, we started 5/1 twice daily 0.6 mg and by 5/6 her drinking increased, peeing too and the trembling, shaking confusion peaked on Sunday 5/8. I have to add--I had run out of Adrenal Harmony Gold on Thursday 5/5. She had been getting the drops twice daily for approximately 3 months. I started them because her hair was not growing back and her mood was so flat. I know how CONVOLUTED this is! So, Sunday 5/8 was last dose of thyroid med. Monday was last dose of Vetoryl. Monday night I administered her drops (hadn't had since last Thursday) AND her trembling subsided greatly onward. Now she is ONLY on the drops-- 28 drops twice daily.

Another question--do you think the acth stim pre 0.7 played a role in all this, seems like it may have, I don't know, after reading more, I'm so confused. The post was 4.8

Thanks again

I hope this posts.......

kanga
05-13-2016, 11:55 PM
Good luck with everything and welcome to this forum. It's a great support system and we welcome you.

Aunt Jana
05-14-2016, 08:04 PM
So, today, Saturday-- the shaking while at rest is back. This is so discouraging. I don't know what to do.

Aunt Jana
05-15-2016, 03:12 PM
It's Sunday, the shaking while at rest is occasional again. The drinking and peeing is RIDICULOUS. I am so confused. It all began with the addition of the thyroid meds. Today will be a week we stopped giving it to her. I have read it can take 38 days to resolve! Has anyone had this experience?? I just want this over. :(

labblab
05-15-2016, 03:36 PM
I'm not sure why the excessive thirst and urination began again at the time you started the thyroid med, but it may be continuing because you have stopped giving the Vetoryl. Excessive thirst and urination were among the Cushing's symptoms that Bubbles' first exhibited last fall when her cortisol was uncontrolled. So it is not surprising to think that those symptoms are again rebounding since you've stopped giving the Vetoryl. If that's the case, unfortunately, only lowering her cortisol again will likely control the problem.

Marianne

Aunt Jana
05-15-2016, 03:52 PM
I just was on a thread: 're: Snickers and Jean 3 1/2 Beagle Chihuahua PHD (Update CBC/LDDS results). I tried to copy it to my thread about Bubbles, I don't think I was successful.
I am wondering if Bubs has Sick Euthyroid Syndrome???

I just can't believe how many variables to this disease there is.....awful.

If anyone is aware of this condition, please let me know. It makes the most sense because of her reaction to l recognitions.

Aunt Jana
05-15-2016, 03:55 PM
Hi Marianne: She was still on the Vetoryl when we started thyroid meds, she was exhibiting all the symptoms on Vetoryl and LLevothyroxine.

I just posted a note before this about Sick Euthyroid Syndrome

labblab
05-15-2016, 04:13 PM
I found the reply you were trying to copy, and here it is ;):


Hi Jean,

Per Dr. Jean Dodds “if you stop the thyroxine even after years of therapy, it takes 5-6 weeks for the pituitary-thyroid axis to be reactivated to its original capacity [whether low or normal] .“

So once the cushings is under control and you stopped the thyroid replacement you would need to wait 5-6 weeks until you can test thyroid function.

The below info is from Behavioral Issues with Thyroiditis: Theory and Case Review (http://www.k9cushings.com/forum/showthread.php?p=23229#post23229)Dr. Jean Dodds

“While diagnosing thyroid dysfunction in companion animals can be particularly frustrating, especially when used for wellness screening of potential breeding stock, veterinarians may fail to appreciate that a simple total T4 test is usually nondiagnostic. In fact, the in-office testing of T4 has recently been shown to produce unreliable results in 52% of dogs and 62% of cats, and therefore should not be used even as a general diagnostic screening test. Complete thyroid profiling is the most accurate and correct way to diagnose thyroid dysfunction when coupled with clinical information about the animal. “

“Monitoring of thyroid therapy should be performed at 4-6 hours post dose, and at that time the T4 and free T4 values should be in the upper third to 25% above the laboratory’s normal reference range. Rechecking thyroid profiles on animals receiving thyroid supplement is best accomplished by performing the complete profile, and is essential for those animals with autoimmune thyroiditis to determine whether the autoantibodies present are waning. If the client has financial constraints and the case is not thyroiditis, a post-pill T4 and freeT4 will usually suffice.”

My Phillip is hypothyroid as well and I always have the lab check his levels.

What are some things that can affect basal thyroid activity ?
A. Results may be affected by the following:
• Basal levels affected by certain drugs
• Basal levels lowered by estrogen; raised by progesterone
[sex hormonal cycle effects]. Test during anestrus
• Thyroid levels are suppressed slightly (up to 25%) by corticosteroids, sulfonamides, overdosing iodine (kelp), and phenobarbital
• Rabies vaccination within previous 45 days can elevate TgAA by ~ 25%

Nathalie

Yes, we see a lot of dogs here who suffer from low thyroid readings in conjunction with a Cushing's diagnosis. Sometimes it is indeed the "Sick Euthryoid" response, and sometimes the dog suffers from true hypothyroidism in addition to Cushing's. As Dr. Dodd's explains, it is helpful to perform a more complete thyroid panel, as opposed to only testing the simple T4 level, if the dog is known to have a disease like Cushing's going on. I don't know whether or not your vet had a more complete analysis done before starting Bubbles on the thyroid supplementation.

However, even if the thyroid med did cause her thirst and urination to begin with, it sounds as though she was only taking it for about a week before you discontinued it. If so, I'm doubting it would have the lasting effect that Dr. Dodds is talking about in terms of continuing to stimulate Bubbles' thirst/urination. I know I sound like a broken record here, but if Bubs' truly has Cushing's and she is now off her Cushing's meds, continuing thirst/urination is to be expected. And if the shaking is back again while she is off both the meds, then I'm again questioning whether either drug was really the cause of that part of things.

I know I'm not writing one single word that will make you feel any better :o :o. Especially because I don't have any great answers for you. But I'm mainly just trying to talk out loud, and trying to figure out what is truly responsible for these changes...

DoxieMama
05-15-2016, 04:48 PM
Hi! I may have missed it, but how much does Bubs weigh? I ask because it looks like you were giving her 0.6mg levothyroxine BID (does that mean a total of 1.2mg per day, or a total of 0.6mg per day?) Symptoms of overdose of levothyroxine are increased drinking and urination, among others. So that may have been why those symptoms started up again. And now, as Marianne said, since she isn't taking Vetoryl anymore they could be because her cortisol levels are rising.

I don't know what could be causing the shaking though. Does she appear to be in pain?

Aunt Jana
05-15-2016, 06:01 PM
Yes, it was 2 tablets, 0.6 mg . One every 12 hours. She weighs approximately 58.5 lbs, down from 60-61 lbs.

We are still administering Adrenal Harmony Gold twice daily.

I think the shivering is part of the Cushing disease. She has had it for approximately 2 months BUT became exaggerated when Thyroxine L was introduced along with confusion, excess drinking/peeing.

Thanks too Labblab.........She was on the thyroid meds about ten days.

Aunt Jana
05-17-2016, 11:07 AM
Today is Tuesday, one week off Vetoryl, 8 days no thyroid meds. Just giving Adrenal Harmony Gold 2x daily. Bubbles still is drinking constantly. I don't know what to do.

Harley PoMMom
05-17-2016, 02:42 PM
I'm not sure if this article from Dr. Peterson's blog will help or not: Diagnostic Approach to PU/PD: Urine Specific Gravity (http://www.endocrinevet.info/2011/01/diagnostic-approach-to-pupd-urine.html)

labblab
05-17-2016, 03:14 PM
Might you consider one more trial of Vetoryl, but this time at a lower dose? You've said it did control her thirst/urination prior to the introduction of the thyroid med, and I am just wondering whether there might be a lower dosage level that would help with the thirst but perhaps not trigger the lethargy again. Since the shaking has continued even though the Vetoryl had been stopped, perhaps that ill effect was unconnected all along.

Just a thought, since I'm worried that the cortisol must be brought down in order to reduce the thirst/urination, and from our experience here, the Adrenal Harmony will not accomplish that.

Marianne

Aunt Jana
05-17-2016, 11:15 PM
Hi:

Unfortunately, my vet is off until the 24th. I wanted to do precisely what you suggested. The drinking is out of control, it is so sad, my poor baby, I don't remember when she was ok. So, my husband and I decided tonight at 7pm to start her on the 60mg. No drops. Just Vetoryl. Her skin has new black zits, she is thinning in the back area, I'm so scared. I don't want to lose her, she's not even 8 yrs old.

When we gave it to her I made her an egg, and gluten free pumpkin waffle (low sugar) with pumpkin puree, every thing I read says give with food. I hope this dose is not too much, can't split a capsule.

I'm grateful for the support here, these is so much info to cover. You all are so wonderful with your advice. Thank you.

molly muffin
05-18-2016, 06:49 PM
Isn't 60mg what she was on originally and had some confusion with?

Aunt Jana
05-18-2016, 08:48 PM
Yes. That's true, however it all happened with the addition of the thryoid med too. *There was shivering (trembling) but I didn't get alarmed until it was compounded with confusion and peeing and drinking after thyroid med added*. I don't know what to do. I didn't give another dose yet, was thinking maybe wait until morning???? She is once again trembling while at rest when she inhales and all she had was one dose last night at approximately 7 p.m.
I contacted Diamondback and got a price for 25 milligrams but I wonder if she should have 20 milligrams twice daily.... could somebody please give me their insight-- she is about 58 pounds, losing muscle and had this awful reaction with the 60mg once a day. My vet is not back until the 24th. I have a paper script for 60mg.
On 4/21 her ACTH--- PRE WAS 0.7. POST 4.8
That PRE number is too low--THIS is the case -CORRECT?

Janet

Whiskey's Mom
05-18-2016, 10:34 PM
Hi, I can't give you advice, just our caring thoughts. I can sense that you're frantic and I understand. I feel for you and your poor pup. It just figures that your vet is away for so long. I'm sure someone will be on here soon to help and guide you, their knowledge amazes me. Hope you all get a good nights sleep.

Joan2517
05-19-2016, 08:23 AM
Isn't there anyone covering for your vet? Maybe you can call another vet to get a lower dose of the Vetoryl until the vet gets back?

Aunt Jana
05-19-2016, 08:29 PM
Hi all:

So I spoke today with newer vet we are possibly switching to, he phoned Diamondback and Bubbles will receive 20 mg Trilosrane twice daily. Unfortunately, it will not arrive until Tuesday if we are lucky and that's with + $20.00 shipping. I'm in PA.
My dilemma, what do we do until then, right now we are giving her the 60mg every 36 hrs(today was second dose). I don't want to make her sick. I am still aggrivated that two vets did not say : Hey! 0.7 is too low for a Pre ACTH test!

If not for this site I don't know what would be going on!

Many thanks for the valuable advice.

Joan2517
05-19-2016, 09:58 PM
Where in PA? There is a vet in Hawley who treats Cushings's....

Aunt Jana
05-19-2016, 11:49 PM
Pittsburgh area, where is Hawley?

Aunt Jana
05-19-2016, 11:54 PM
It's very far, but thank you. Never know

molly muffin
05-19-2016, 11:58 PM
Well I don't like a pre of .7, but my dogs pre has been up and down, they say even throughout the day it will fluctuate and the vets and Dechra mainly focus on the post, so I'm not surprised that your vet or any vet really doesn't pay much attention to the pre value.
The post is perfect.
Trembling can be a side effect of the medication I'm told. It could also happen if cortisol comes down too fast, it can happen if the electrolytes are off.
I too deal with trembling and shaking most of the time, but mainly in the mornings and afternoons.
You do want to make sure that you give the medication with food and it could be that there is a tummy upset too from the trilostane, so you can try giving a pepcid to her. My vet is recommending 2.5mg pepcid once a day. (this is plain pepcid, nothing else)

Aunt Jana
05-20-2016, 06:22 PM
What do I do about her skin? The black zits are now looking like pink, raw skin. I applied polysporin. I will not receive the trilostane until Tuesday! :(

Harley PoMMom
05-20-2016, 06:38 PM
Those black spots/sores may be calcinosis cutis (CC) and a biopsy would need to be done to confirm CC. Our CC resident expert, Renee, has taken pics of her Tobey during various stages of CC, I'm including a link to her album, maybe take a look and see if this is similar to Bubs' skin issue: http://www.k9cushings.com/forum/album.php?albumid=805

Aunt Jana
05-20-2016, 11:05 PM
Thank you.

How awful, that poor thing, so good to see the healing process.

I don't know, she has black crusty zits. Today, she had a bath and looks like some have fallen off, her skin is pink, raw-like. Very small lesion. I put Polysporin on all areas. I know it is CC. Don't really want to spend more $$.

I am annoyed this has gone on so long for my Bubs since November....

If not for this website, I would be still be in the dark. I have been educated here!

Aunt Jana
05-21-2016, 12:09 PM
Hi all:

I figured out how to upload pictures. I would appreciate any opinions on her most likely CC. We are still applying Polysporin. Trilostane 20 mg twice daily won't be here until Tuesday. Trying to be upbeat.


Many thanks.

Harley PoMMom
05-21-2016, 12:20 PM
To me, it looks like it could be the start of CC, but I am definitely no expert so I will PM Renee and ask if she could take a look at Bubs' pics.

Hugs, Lori

Aunt Jana
05-21-2016, 01:33 PM
Thanks Lori. :)

Aunt Jana
05-21-2016, 01:35 PM
Bubbles thanks you too. !!

Renee
05-21-2016, 04:11 PM
Hi there, I tried looking, but I don't see an album created by you? Is it set to private?

Aunt Jana
05-21-2016, 07:42 PM
No, not private, at least not intentionally. Can't you just click "Aunt Jana" then "view album" ?
It's to the right of the screen for me.......Bubbles picture and "album"

molly muffin
05-21-2016, 08:53 PM
He is just lovely. It does look like the beginning of cc that hasn't burst through yet.

Once you get him started on the 20/20 trilostane, then hopefully things will get better, but do remember. If it is cc, then any calicum deposits, have to come up and break through (which looks horrible) and then they can heal. So it does get worse before it is gets better, but the key is to keep the cortisol at the point where no new one deposits will develop. There might be some there now that you can't even see, and they will probably come up and through too, but then once they are all out and gone, no more as long as the cortisol is controlled.

Aunt Jana
05-21-2016, 11:20 PM
Well, for months she has had the hard, crusty, black zits. They never did anything. However, since beginning of May, when everything else escalated, more have developed and are changing. She had a bath yesterday and I think they were irritated and now there is raw looking sites. :(
My poor girl. We are applying Polysporin---is that good to do? I'm pretty sure I read to apply that.

Will things get worse? Or can it maintain as it has?

Thanks.

Aunt Jana
05-22-2016, 05:12 PM
Today is Sunday.
I can't take the drinking. It's all consuming. I am starting to feel like I may lose it. It's all she does. She's drinking over 16 ounces at once! She will not stop! She just continues to lap it up, I feel so bad she's going through this. At the same time I'm SO AGGRIVATED. I have to keep walking away. I know I sound like a shrill, I am so over this journey, since October, if not for this site, I would not even be where we are now. I am so drained. ..... Why does that pharmacy use FedEx, they are the worst. It was compounded early Friday morning, was not picked up until after 6 our time AND for an extra 20 dollars I paid for it to arrive TUESDAY.
I hate this disease. I want my dog back. I want my sweet, fun, loving, happy girl. :(

DoxieMama
05-22-2016, 05:49 PM
You will get through it.

Remember to breathe.

Hugs....

Harley PoMMom
05-22-2016, 06:32 PM
Oh sweetie, we sure do understand how frustrating this Cushing's can be, and as Shana said, you will get through this and yes, breathe...long deep breaths..in..out..;)

That elevated cortisol makes a dog's kidneys work more than usual (they pee a lot) and because of this the dog HAS to drink more to keep up with the urine output, for this reason a cush dog's water can not be restricted because if that would happen it can be a life threatening situation.

Once Bubs gets back on her Vetoryl the urination/drinking should subside within two weeks.

Remember we are here for you, so at any time come here and talk to us.

Hugs, Lori

Renee
05-22-2016, 06:36 PM
I still can't see your album. Even when I click your name to view your profile, it does not show up. I even clicked to view your statistics, and it did not show an album. I know other people can view it? I tried logging out and then back in and that did not work either. :(

labblab
05-22-2016, 07:33 PM
Your album setting must be inadvertently limiting viewing to staffers or specifically designated contacts. To double-check this, open your album, select the "Edit Album" option, and then make sure the permission for public viewing is checked.

Aunt Jana
05-22-2016, 10:41 PM
Ok. Thank you. I figured it out and made it open to the public.......I thought the other choice was this site and public was public (not cushings.com).....so sorry about that.

Let me know if it's viewable now.

Aunt Jana
05-22-2016, 10:50 PM
Thanks Lori for the kind words. I'm so guilty. I have no right to be annoyed, I know she can't help herself. We would never withhold the water, poor thing. I just want her to feel good again.

Also, how do we know their kidneys are not getting damaged thru all this!!?

Lastly, did all your dog's get their personalities back after medication is correctly dosed? I think that is the worst part of this.

DoxieMama
05-23-2016, 12:10 AM
I can see your album now. What a beautiful boxer!

Aunt Jana
05-23-2016, 09:39 AM
Thank you. I love her so.

molly muffin
05-23-2016, 11:02 AM
Cushings can sure give a persons patience a run for it's money. It's not easy and you've been dealing with the excessive drinking for a long time.

Hopefully your fun love Bubs will be back to her old self in no time once on meds. I never really had to deal with personality changes, but I'd think that it would have something to do with no feeling so crappy and thirsty all the time.

We monitor kidneys via blood work and urinalysis. My dog does have kidney issues, but I can't say that it was caused by the cushings or it if it was there already. This is just our specific case though. Many dogs do not have any kidney issues with cushings.

Aunt Jana
05-23-2016, 11:54 AM
Thank you Sharlene. Much appreciated.

Tracking shows her new meds only miles away.....unfortunately, won't arrive until tomorrow. :(
After seeing my girl in the picture when she was healthy is so heartbreaking. So much deterioration. I am so disappointed, I have a theory, we fed her Blue from the beginning--WANTED THE BEST--come to find out it may not be the case! No longer a customer.

We went grain free in Nov/Dec. Since Feb/March Bubbles gets Fromm dry. Seems like a great company. ( Not too sure, my judgment in the past was way off!) I'm not sure how to help her gain her lost muscle. .....any suggestions would be greatly appreciated.

Renee
05-23-2016, 02:01 PM
Well, sadly, yes, that does look like the beginning of CC. For whatever reason, is seems the brachy breeds are predisposed to cushings in the first place, and secondly, much more likely to get CC as well. I have a brachy breed myself.

The good news -- those lesions are mild and in the beginning stages. If you can get her cortisol lowered and controlled before too much longer, you may head off an outbreak like my girl went through. We did have another dog (Jed, I believe), who's mom got control of his cortisol very shortly after he developed CC, and it never got nearly as bad as my girl's CC.

I must be honest - trembling or not, once CC is part of the picture, it is vitally important to treat the cushings. You might consider switching to lysodren if you think trilostane is not for Bubs, but either way, you'll need to control her cortisol.

I know you are frustrated, discouraged, looking for any thing that may be to blame. I get it. I was there. My pug did have personality changes too. And her CC was bad. Bad. There is light on the other side. You can get through this. Take a deep breath and focus on the enemy: cushings. Don't worry about what you did or did not do in the past. Just focus on how you are going to help your girl now.

Aunt Jana
05-23-2016, 02:14 PM
Thank you very much Renee. I appreciate the advice. We are praying the 20mg twice daily Trilostane will be just right. How is your Pug now? Did things turn around after adjusting the dose? Her personality come back? I just know Bubbles is depressed.

You know, i am frustrated and know better to just forge ahead. Two vets did not suggest what I learned here unfortunately. It's too bad. Since October she has been suffering.....So I'm hopeful, my bubba needs this!

Thank you

Aunt Jana
05-25-2016, 12:34 AM
The Trilostane arrived today. I'm saying my prayers that this will be a positive experience for my girl. Her CC is looking a lot better, all I have been doing is giving her the canned pumpkin on a gluten free waffle twice a day. She loves it and I'm hoping it will help with the muscle loss too. Also we have been applying Polysporin to the CC areas. It seems to help.

labblab
05-25-2016, 08:49 AM
Whew!! So glad the trilo has finally gotten there, and surely hoping for some good results quickly. Keep us updated!

Marianne

Aunt Jana
05-25-2016, 12:16 PM
Hi all I'm not sure what's going on, I'm not sure if I'm doing something wrong but I've written 2 posts and they're not here; the first one was rather lengthy and then the second one, I made some comments about how my Bubbles is feeling today and I can't find that one either so I'm going to try again.
Bubbles has had 3 doses of the 20 milligram compounded Trilostane. I think it's too soon to tell but I have to say she's very flat she's not happy she's not sad she's just here..... she doesn't want to do anything not even intetested looking for the bunny in the yard.

Any advice or opinions will be greatly appreciated, right now I'm pretty discouraged.

Thanks,
Janet

judymaggie
05-25-2016, 02:59 PM
Janet -- losing posts can be very frustrating! Here are some tips from Leslie that might help for future posts:

http://www.k9cushings.com/forum/showthread.php?t=1329

You can also type out your post in Word and then copy and paste into your thread.

With regard to Bubbles acting kind of "blah" ... my first thought is that she might be reacting to a cortisol drop. Some dogs are quite sensitive to trilostane and, even with only three doses on board, Bubbles may fall into that group. Just let her be quiet and do what she is up to -- as long as you aren't seeing any signs of overdosing (vomiting, diarrhea), I would just see how she does in the next couple of days.

Could you clarify what you are currently feeding her? I saw in a previous post that you are feeding Fromm (which, by the way, is a very highly rated food) but then you mentioned yesterday giving her pumpkin with a waffle. If the latter is all you are feeding her right now, then it may be that she doesn't have enough food in her to adequately absorb the trilostane. In addition to needing to feed a full meal, it is best to give the trilostane wrapped in a bit of fatty food (cheese, cream cheese, etc.) to improve absorption.

Aunt Jana
05-25-2016, 03:18 PM
Judith--thank you for responding. She eats three times 8 am, 12 pm and 5pm 1 cup each meal. It's Fromm Adult Large breed Heartland Gold Grain free with red meat. The gluten free waffle spread with the pumpkin puree is a mid morning and evening snack. She has lost a lot of muscle so I am supplementing with the waffle--she loves it.

So, let her be? Ok. I am it is frustrating, seeing her be so BLAH. When will she adjust? Is this normal?

THANKS

Harley PoMMom
05-25-2016, 03:36 PM
Janet, can you clarify Bubbles' Trilostane dose for me because according to your post below Bubbles was to get 20 mg twice a day, which makes a total of 40 mg. And now in your most recent post Bubbles received 3 doses of 20 mg for a total of 60 mg?


Hi all:

So I spoke today with newer vet we are possibly switching to, he phoned Diamondback and Bubbles will receive 20 mg Trilosrane twice daily.





Bubbles has had 3 doses of the 20 milligram compounded Trilostane. I think it's too soon to tell but I have to say she's very flat she's not happy she's not sad she's just here..... she doesn't want to do anything not even intetested looking for the bunny in the yard.

Any advice or opinions will be greatly appreciated, right now I'm pretty discouraged.

Thanks,
Janet

Aunt Jana
05-25-2016, 04:03 PM
Sorry about the confusion-- I meant in total she's had 3 doses. She had the two 20 mg doses yesterday and then the one 20mg dose. this morning, which equals the three doses of Trilostane.

Thank you

DoxieMama
05-25-2016, 04:11 PM
I agree with Judy - could just be because her cortisol is lowered/lowering. Keep an eye on her for those signs of overdose, and hang in there.

Aunt Jana
05-25-2016, 04:17 PM
Should I skip the dose tonight?

Aunt Jana
05-25-2016, 04:33 PM
I don't know what to do I feel like she's just wasting away. This is such an awful disease, it's so complicated and don't understand it, I just don't know why she can't feel better. I don't know if I should give her the dose tonight!

Renee
05-25-2016, 04:44 PM
Janet, I'm not sure how much of this is your own anxiety or if Bubbles is really deteriorating to a quality of life issue.

First - calm down. You will make yourself a complete mess if you don't try and relax a little. Take a step back and try to look at the big picture.

Coming down on the cortisol can be quite an adjustment for their bodies. My own girl had some down days too when we first started. It's a bit of a withdrawal. Many dogs experience this. If you think it's truly too much for her, you could cut back to 20mg once per day and work your way up to the 40mg.

There are a lot of ups and downs in this disease and the first part of treatment can be riddled with insecurities and doubts. I had many of those times myself. When my Tobey's CC was really bad and we were only a few months into treatment, I wondered if we would ever get through it. And, she had her moments where her personality was very different. She is not the exact same as she was before, but we've found our new normal and I know my girl is still in there. I am certain the same will be true for Bubbles. Will she be different? Yes, maybe so. But, she's still your girl in there and if you can help her through this period, she may find her way back.

Aunt Jana
05-25-2016, 05:20 PM
Renee:

Thanks for your note. That is my exact fear. I don't know how dangerous it is. I just took a picture of her, it's in her album. I can only rely on my own judgment, I do keep walking away while she is resting, I don't want her to see me upset. She is not throwing up nor having diarrhea. She is still eating and drinking. Just moving very slow, not really responding either. I have a call in to vet since mid morning. I am leaning towards no evening dose of TRILOSTANE. I appreciate you and this site, so much.

Harley PoMMom
05-25-2016, 05:23 PM
Thanks Janet for clarifying Bubbles' dose for me ;) And I totally agree with Renee, this dratted disease can be so frustrating and worrisome, trust me, we completely understand, I was a mess when my boy, Harley, was diagnosed with Cushing's...so now, take some very deep breaths :)

Does Bubbles still have a good appetite? Is she experiencing any diarrhea? If there are no loose stools and her appetite is good, I believe, as the others have mentioned, that Bubbles' may be exhibiting symptoms of cortisol withdrawal syndrome and it may take a could days for her body to get used to that lower level of cortisol.

Remember we are here for you and when you need to talk, vent, or for what ever reason it may be, just come here and we will be happy to listen and support you, ok? ;)

And if you think Bubbles is acting off it is completely correct in withholding her Trilostane, only you know your girl best.

Sending lots of soothing hugs, Lori

Aunt Jana
05-25-2016, 05:48 PM
Thank you Lori--

I really appreciate the kind words. It does make a difference to hear from you and the other great people here.
It seems that I just have to give it time, withhold a dose if I see her too listless. ......

DoxieMama
05-25-2016, 05:59 PM
I think it's fair to say that most if not all of us have been where you are right now... wondering and worrying, wondering and worrying.

Remember. To. Breathe. :)

A few days after starting Trilostane, my dog looked like he was totally drugged up. He's only 11 pounds and was sleeping in my lap, so when I picked him up and his head just hung down I was so so worried. He was in such a stupor! It took some effort to wake him from that, but then he would just go right back to sleep. Unfortunately this was on a Saturday when my vet is not open. Fortunately, I knew to expect it... and even more fortunately, it did not last long. If it had, I would have stopped the meds and called the vet to bring him in for testing. Instead, I just let them know how he was doing and we just spent a little more downtime together.

Hang in there, Janet. You are doing just fine. :)

My sweet Ginger
05-25-2016, 06:24 PM
It's such a balancing act for us to oversee with our pups with this disease and I really understand your worries and anxiety that come with Cushings treatment especially in the beginning because we never want to add more harm. You can skip a dose and see if she perks up and if you are really not comfortable with 40mg, I'd try 20mg for a few days for her body to acclimate to the drug and increase if needed. Slow and low is how I'd go. Unfortunately I've learned the lesson to go by the rule 'the effects of under dosing outweighs overdosing' with this kind of potent drugs. Hugs.

labblab
05-25-2016, 06:27 PM
Hi again, Janet. Yes, by all means, if you want to withhold tonight's dose, I personally think that would be fine. You may just want to give Bubs the single 20 mg. in the morning for a few days so as to reintroduce the medication more gradually.

It may actually turn out that, overall, she will always do better being dosed only once a day rather than twice daily, no matter what the daily dosing total is. Only time will tell with that. I believe the research thus far has some contradictory results, in terms of whether once vs. twice daily carries more risks of unwanted side effects. It may depend a lot on how fast any individual dog metabolizes the drug. For dogs who metabolize it quickly, there seems to be benefit to dosing twice daily to prevent rebound. But my own speculation is that for dogs who metabolize the drug more slowly, twice daily dosing may keep their cortisol so consistently flat throughout 24 hours that they just don't feel as perky.

So that's a long, involved way of saying that if Bubs were mine and she was acting lethargic, I'd probably stick with a single morning dose for at least a couple of days in order to see whether that helps things.

Marianne

Aunt Jana
05-25-2016, 06:44 PM
Thank you ALL. I'm so grateful for these posts. Although she is down, reading all these notes makes me feel better. I am not giving the second dose, going with just one in the AM for now. I really think she is more sensitive to this medication. She just had her dinner, she's not throwing up and she has no diarrhea; therefore, I'm not going to stress because I know she's not in danger, just not feeling good--which is bad enough but not life threatening.
God Bless you all. :)

Whiskey's Mom
05-25-2016, 09:04 PM
Wondering, worrying, waiting and watching. I know it well. :( Bless you and Bubs and I hope she perks up soon! Hugs from Whiskey!

molly muffin
05-25-2016, 09:39 PM
Hopefully having just 20mg in the morning will work better for her and how she feels. Crossing my fingers. :)
I took it low and slow with my molly for a long time, adjusting with the ACTH tests based on what her cortisol was doing.

Aunt Jana
05-26-2016, 10:54 AM
Good mmorning all:

I have a question--should I give her the dose for today this morning--now or at lunch time? I'm not looking forward to her reaction, if it's anything like yesterday........

My sweet Ginger
05-26-2016, 11:24 AM
I'd give it to her in mornings after breakfast at/around the same time and monitor.
How is she doing?

Aunt Jana
05-26-2016, 01:48 PM
Hi all--
I gave Bubbles her med at 10:30
She is sleeping , lunch is usually at noon, however, the grogginess has returned. I don't want to disturb her. I'll wake her at 1 pm I guess.
Another question --how long does the grogginess last?

labblab
05-26-2016, 03:01 PM
Janet, I'm afraid there's no way to predict how long and in exactly what way the medication may affect Bubs. I think for right now, you'll just have to take things day by day. One question, though, did you give the trilostane along with breakfast? It really needs to be given at exactly the same time as a meal, and not waiting until afterwards. This serves two purposes -- it helps to soothe the stomach, and also it is essential in order for the trilostane to be metabolized properly.

Marianne

Aunt Jana
05-26-2016, 03:27 PM
Hi Marianne I gave it to her with her mid-morning waffle with pumpkin puree spread on it. She was up earlier this morning, had breakfast around 8 a.m. and wasn't 24 hours yet from yesterday dose. It usually is given with breakfast.....do you think the waffle and pumpkin were enough food with it?

labblab
05-26-2016, 03:37 PM
From what Dechra has told us, a full meal is best. However, the waffle is better than an empty stomach. For today, that is fine. But as a rule, a full meal including at least a bit of fat is the best routine (trilostane is a fat-soluble drug).

Marianne

Aunt Jana
05-26-2016, 03:54 PM
Ok, thanks.
Even though I feel so helpless for her I know I have this forum and people like you who are so caring and have so much information to share about this disease ....I'm just so grateful

Aunt Jana
05-27-2016, 02:25 AM
Hi all:

Getting ready to go to bed, wanted to ask about what I have read on this site tonight. Many times I have read that if my pet is lethargic and if there are tremors/shaking at rest that the Trilostane should be discontinued. Bubbles has and is trembling at rest. She is lethargic on this med. It was a thread from 2009 when Dr. BRUNETTE was in this site. Plus, I have read it elsewhere here too.
Help!
What should I do?

labblab
05-27-2016, 08:54 AM
Janet, I believe you've told us that Bubbles was still having tremors even during the time she wasn't taking the trilo. If so, it seems to me that it is less likely that the trilo is the cause. Also, in terms of a side effect such as lethargy, I'm afraid it really comes down to a judgement call. Is there any vomiting or diarrhea present in a dog, as well? How extreme is the lethargy? Is it present all day? Is it worsening with each passing day?

Unless Bubbles is worsening, I believe I'd continue with the single 20 mg. dose for a bit longer to see if she ends up turning the corner with the grogginess once her body adjusts to the lower cortisol. But if the grogginess worsens or additional signs of overdosing emerge like vomiting or diarrhea, I'd stop the trilo again.

Aunt Jana
05-27-2016, 09:37 AM
Thanks for responding. The tremors are from the meds. She had them slightly for 1-2 months and I didn't connect it. when thyroid meds introduced it was bad. We stopped both meds and yes, it continued then when we stopped . Until it was just slight. When we started back on trilostane--they began again. I know it's a side effect, . I just don't understand the warnings. Her
doctors don't say to stop.

labblab
05-27-2016, 09:57 AM
The biggest worry associated with tremoring is that it might be a signal that a dog is being overdosed with the trilo. Since Bubs had a desirable post-ACTH value of 4.9 while taking 60 mg., it's hard to imagine that her cortisol has actually dropped too low after only a couple of days on the 20 mg. So even if it is indeed a side effect of the medication, it may not necessarily signal anything too sinister.

Does the tremoring seem to bother Bubs anywhere near as much as it bothers you? Back when we were dealing with the unexplained tremoring in my own Cushpup, I was so upset and worried about it. But in honesty, he basically could have cared less, himself. Sometimes the shaking would actually jerk him awake when was asleep, but he'd just turn over and go back to sleep again. I know you are really worried about it, but in the absence of other negative side effects, that's why I'd say to try to relax and give the trilo a little more time. If you could talk to Bubbles and ask her to choose between the constant thirst/urination vs. the tremoring, she might say that the tremoring is no big deal. :o

Marianne

Aunt Jana
05-27-2016, 10:16 AM
Marianne--Thank you.

This is so confusing. You just put it in a good perspective, she does exactly the same thing, it wakes her up and then she goes back to sleep. You're right.

There are so many contradictions with this medicine. Not one thing is cut and clear. The lethargic, sleepiness bothers me more. I just keep telling myself her body is adjusting.

Yesterday I saw a big truck/vehicle--it was a mobile vet, I keep thinking it was a sign! Maybe they have the answers I need. I did Google them.......I wish I had the resources for more tests. I know I have to be patient, hell it's eight months already.

Aunt Jana
05-27-2016, 11:20 PM
I recently found a website where Dr.Peterson answers email inquiries about Cushings disease. He answered many questions, however, I didn't get an answer to Bubbles issues, instead he suggested I take her to a specialist to rule out a pituitary macrotumor. This was his response:
"Your dog's case is very complicated and I cannot really help by providing a sentence or two comment here. You need another opinion and workup to determine what do, but a pituitary macrotumor may need to be excluded. I'd ask your vet for a referral to an internal medicine specialist."

I am so upset. I don't know what we will do. I'm devastated. He answers so many questions and didn't even want to give any info because he knows. My poor bubba. She's not even 8 yrs old. I love her so.

labblab
05-28-2016, 08:07 AM
Janet, I'm going to requote some comments I made earlier in your thread:


One question for you: did Bubs' diagnostic testing point to a pituitary tumor as opposed to an adrenal tumor? If a pituitary tumor is suspected and the shaking continues even if the medication is discontinued, another possibility (which I am sorry to even suggest) is that the tumor may be enlarging and placing pressure elsewhere on Bubs' brain. I believe that flat-faced dogs such as boxers seem to be at an increased risk of this type of issue due to the shape of their skulls. As I say, I hate to even mention this possibility, but I do want you to be armed with as much info as possible to discuss with your vet in the event that the shaking continues.

Just to let you know, my own Cushpup (a Lab) exhibited weird tremoring episodes, too. I first noticed it even before he was diagnosed with Cushing's -- it seemed as though he was shivering across his shoulderblades when he was breathing in, even when he was laying down and resting. The tremoring dramatically worsened for a time after we started him on trilostane, but then it just as suddenly resolved after a few months, even while remaining on the trilostane. So we never did figure out the cause. However, I will add that he subsequently developed additional neurological problems consistent with an enlarging pituitary tumor. Was the tremoring associated with that? I'm afraid we will never know.
I surely understand why Dr. Peterson's comments have upset you, but at this point, he is only making a suggestion about a possibility. He does not know for certain that this is Bubs' problem. The first diagnostic question would be whether or not she even has a pituitary tumor as opposed to an adrenal tumor. When you replied to what I had written above, you told us that the location of Bubs' tumor is currently unknown. So if that is something that feels important to you to know for certain, probably the best diagnostic at this point would be an abdominal ultrasound. It is less expensive than imaging of the head, and the status of the adrenal glands as seen on ultrasound can reveal whether or not there is a tumor there. If not, we can assume the tumor is on her pituitary gland.

If that is the case, then it is true that pituitary enlargement may be causing the problems. And if so, it may not be the trilo itself that is directly causing the tremoring and grogginess, but they may instead be side effects of lowering Bubs' cortisol. Just like supplemental steroids, naturally produced cortisol can have an anti-inflammatory effect on the body. So when the cortisol goes down, irritation of the brain tissue may increase.

But this is still a big question mark. Dr. Peterson is only suggesting it as a possibility. It is true you can find out for certain by pursuing direct imaging of Bubs' head by CT scan or MRI. However, these tests are very expensive. My husband and I declined that testing for our boy, because we knew that no matter what the imaging showed, we would not pursue radiation treatment for the tumor. It was too expensive and we felt as though it would be too much strain for him to go through. So we opted to take care of him as lovingly as we possibly could for the time we were given together. He had developed other neurological problems by then: loss of coordination, loss of thirst and appetite, etc. But interestingly to me, his tremoring had stopped a couple of months earlier. So I have to repeat, to this day, I don't know whether or not it was related to his brain.

I know how hard it is to try to relax in the midst of so many question marks. It is probably impossible :o. But for right now, a pituitary macro tumor is really only that -- a question mark. It is not a certainty. So let's keep on taking things one day at a time for just a little bit longer and see whether or not Bubs might not yet still improve. If not, or if she worsens, you can then make the decision about additional diagnostics.

Marianne

Joan2517
05-28-2016, 08:49 AM
Dear Janet,

It is absolutely terrifying when we don't know what's wrong and what the right thing to do is. Marianne is right, though, you might consider getting the ultrasound done to see if there is an adrenal tumor before you drive yourself crazy about a pituitary tumor that may not even be there.

We know how frightened you are and we know how much you love Bubs. We've all been where you are right now, but you have to try to remain calm and take it step by step. You are in panic-mode and it's so hard, I know, every thing magnifies and the fear consumes you...try to stay calm for Bubs. She needs you to be strong...

Aunt Jana
05-28-2016, 09:28 AM
Marianne-
You are so knowledgeable, I am so grateful for your input. Confused, but grateful.
The part you said about the trilo lowering the cortisol which would be the result of the grogginess and shaking/tremors----I don't understand, by lowering her cortisol and if there is a pitutary macrotumor--it causes those symptoms?

So, should she still be exhibiting these effects by day 4 if there is no macrotumor? Yesterday was day 4. She becomes groggy, just sleeps, still drinking and peeling, maybe lessened by 10%. Should I give her her dose today? Do you think she should have improved any by now?

Such a complete opposite of my Bubbles, my heart breaks for her.

Aunt Jana
05-28-2016, 09:37 AM
Joan:

Thank you for your support too, I really appreciate your input, you have been through so much with Lena--I have read your posts :(

I know you're suggestions are the next step I have to take with Bubbles, I just wish she would show some positive signs where we are now.

Aunt Jana
05-28-2016, 11:25 AM
My husband thinks we should continue since its only been days, so I just gave it to her with food and within 10 minutes, she is out of it.

I HATE THIS

labblab
05-28-2016, 06:48 PM
Gosh Janet, honestly, I just don't know what is causing these problems for Bubbles. If Bubbles truly has a tumor that is expanding and putting pressure on her brain, the brain tissue may be irritated/inflamed and if so, that inflammation might be eased by a higher level of circulating cortisol. Cortisol is a steroid, and steroids can provide anti-inflammatory benefit. However, whether or not any of this is actually going on with Bubbles, I do not know. And I'm afraid I cannot offer you a timeframe, either, since I really don't know what is going on.

Dr. Peterson suggested trying to find a specialist to consult with, and I know you've been considering this on your own. I know you are feeling desperate for some answers, and that may be your best avenue for finding some. I am so terribly sorry that you guys are having such a rough time. The only saving grace to all this is that perhaps Bubs is not all that uncomfortable herself, especially if she's sleeping most of the time. But I know it breaks your heart to see these changes in her, and I hope you can find a way to get some answers.

Marianne

Aunt Jana
05-28-2016, 08:32 PM
I put a call into my vet at 9 a.m. this morning asking to speak with him to request a referral to a specialist, they had limited office hours today because it's Saturday, I called again at 12:30 and they said that he'll be calling me...... he never called. I could have called the new vet that I've been seeing but I wanted to remain loyal to my original vet plus they have all my records. So now I have to wait till Tuesday-- I wanted to discuss how lethargic she is on this trilostane too. Now I just have to wing it until Tuesday and watch her suffer. I don't know that she's uncomfortable, when she gets all loopy she just put her head down and goes to sleep, however, first she stands there like she doesn't know what to do just staring off and then she just lays down. It's horribly sad watching my sweetie like this. She used to wiggle with joy-- literally. Have not seen her wiggle for months now.
Marianne--thanks for your support

Whiskey's Mom
05-28-2016, 09:07 PM
I just caught up on your posts and I'm so sorry for all you're going through. I can tell that you're frantic and want advice to do the right thing for your sweet girl. Wish I could help. It's awful when your vet doesn't call back and worse it's over a holiday weekend. You feel so lost and afraid I'm sure. All I can say is give her tons of love and affection, which I know you already do. Tuesday will be here soon and maybe you'll get some answers. Hopefully she'll be wiggling again soon! Hugs to Bubbles from Whiskey:o

Aunt Jana
05-28-2016, 11:22 PM
Marianne--- I have a question I was reading Whiskey's thread and he had pre ACTH low numbers like Bubbles did; you mentioned that if the cortisol is suppressed permanently it needs to be supplemented with prednisone, could that be what's happening to Bubbles? I hope I worded that correctly, it's so complicated.
Thanks

Aunt Jana
05-28-2016, 11:24 PM
Thank you Whiskey's mom! This is not something I would wish anyone!

labblab
05-29-2016, 12:06 AM
Janet, it was Whiskey's low post-ACTH number that was worrisome, as well as the fact that there was so little difference between the pre and post numbers. His adrenal glands were not producing much cortisol even in response to stimulation. Whiskey's post-ACTH number was only 1.3, which is below Dechra's lowest acceptable post-ACTH number of 1.45.

However, Bubbles' most recent post-ACTH result last month while taking 60 mg. of trilostane was 4.9. That is considered to be a desirable result. It was within an ideal therapeutic range for a dog being treated with trilostane, and showed a significant increase over her pre-ACTH result. So no, in her case there should not be a need or benefit to supplemental prednisone due to oversuppression of cortisol.

Marianne

molly muffin
05-30-2016, 08:40 PM
Is Bubbles only take the morning pill now?
If so how soon does she start to act out of it and how long throughout the day does that last?

I don't know what is causing this but maybe keeping a diary of dosage and reaction, times start, times stop, etc, may help you narrow this down.

Aunt Jana
05-30-2016, 10:59 PM
Hi Sharlene:

We started with 2 and by the second day she was so out of it, it was not good. With in 15 minutes she just starts staring at nothing, standing there and then lays down. Can't keep her head up, eyes closing, very groggy and confused. So, the second day we only gave her the morning dose. By day five, Saturday, she was not any better, maybe 10% difference in water consumption. Within 15 minutes she reacts and it lasts until 9 or 10pm it seems. So, Sunday, I did not give her the meds, much more alert, not groggy but still confused, not happy at all. Today, more of the same, alert but confused. She bumps into the wall, my legs, etc --not head on, from the side of her body. I talked our newer vet on Sunday, he sent consult info to specialist, we should hear from them tomorrow to schedule an appt asap. The vet has no answers as to why she is not responding to meds.

It is very sad. I'm scared.

My sweet Ginger
05-30-2016, 11:13 PM
Do you think she has a vision problem?

Aunt Jana
05-30-2016, 11:42 PM
No. She can see. My fear is its a pituitary tumor.

Aunt Jana
06-01-2016, 11:57 PM
Hi all:

So my Bubs has not had any meds since Sunday and she is alot better cognitively. Not so confused and not so depressed, less staring into space, she seems stronger in her hind legs too; her tail wags a little sometimes, no wiggling though. Non-stop drinking and peeing.

The specialists (PVSEC) got back to me today and said the first available appointment is July 16. ABSURD. When I expressed my dismay, she stated the doctor who reviewed the referral papers and charts they were sent must not have deemed it urgent. However, for an additional amount of money I can bring her in through the ER anytime I want. So, I called the vet, told him and he said he would call them. In the meantime I called the original vet who has the entire chart and requested it be sent to the specialist, maybe seeing the entire history of these last 8 months, they may have a different opinion.
He called me back and suggested we go to another hospital nearby who he has had dealings with, said he has a particular doctor in mind for Bubbles to see. I said ok.

Pretty much disappointed in the whole process. On the other hand, maybe this is a blessing and the big fancy place doesn't have the answers I'm seeking.

DoxieMama
06-02-2016, 09:24 AM
I'm glad that she is behaving more normally, though that's a bummer about the specialist appointment issues. I hope the other one can get you in sooner, and maybe have insights into what's going on.

Let us know what you find out.

Aunt Jana
06-02-2016, 11:17 AM
Thanks for replying.

I just received a phone call from the 2nd specialist, they can't see her till June 20th-- that's their first available I'm just disgusted I can not get help for my dear pet.

Aunt Jana
06-02-2016, 11:19 AM
I can take her to the ER Department of the one Specialty Hospital, it's not a big money difference-- it's just how do I know there will be an internist on duty to see her .....you go in and she will be seen by ER doctors then what happens?

Renee
06-02-2016, 07:44 PM
Are you considering imaging of Bubble's head? Such as a CT scan? I believe this would be the only absolutely definitive way of ruling in (or out) a macro. If you are considering the CT, can you regular vet just get you referred to one and skip the specialist until after?

I had a CT done on Tobey and we skipped seeing a specialist and just got the direct referral for the imaging. It was much quicker and easier.

Just a thought.

Aunt Jana
06-03-2016, 02:37 AM
So, the first available appointment is June 20 with the second choice. Better than July I guess. This whole process is eye opening. I think the Drs look at this disease as not a critical condition. I have a different opinion, of course. The animal suffers in so many ways--who wants to lay around ALL DAY and be weak when they can be having fun with their pack leader? What animal doesn't feel those sores(CC)? What doggie doesn't want to jump up and down? My dog is suffering. Not to mention the drinking--oh Lord.

Aunt Jana
06-03-2016, 02:39 AM
Renee, hi--thanks for the note.

Was the CT very costly?

If you don't mind me asking, what we're the findings? What happened with Tobey?

Thanks,

Janet

Renee
06-03-2016, 12:30 PM
We did the CT because we wanted to rule out an adrenal tumor. If she had one (adrenal tumor), I would have done the surgery. Turns out she has PDH, so surgery was out. The CT has been useful in other regards though, imaging of her abdomen and organs. I believe I'll do another CT if she starts displaying any neurological symptoms, but she's not, so I don't have fears of a macro at this point.

It's hard to say if it was costly compared to other areas of the country. The CT was $1,300 up here in Alaska.

Aunt Jana
06-04-2016, 01:59 AM
Thank you for responding Renee,

I'm glad it all worked out for you and Tobey. That was smart to do, plus you know how her organs are, less guessing. It is alot to pay for and I'm sure I'd do the same, God willing.

At present we don't have the resources and I'm not sure of the costs ahead. I ordered some lignans, Cushex drops and coq10. Also, giving her colloiodal silver daily. So, until her appointment, we will be treating her with supplements. I have been applying Polysporin to the CC areas, they scare me.

Aunt Jana
06-05-2016, 03:04 PM
My poor Bub's, she has new sites of CC on her back near her tail area. I can tell it's tender and is hurting her when I touch the area. This is heartbreaking. What can I do? Please, any suggestions.

Harley PoMMom
06-05-2016, 04:16 PM
With cushdogs getting that elevated cortisol down to 5 ug/dl or lower seems to be crucial in controlling that CC. Did the vet prescribe any pain meds to give to her for the CC?

Aunt Jana
06-05-2016, 06:06 PM
No. Only appt is with specialist on June 20.

I feel like the vet has no options available since we discontinued the 20mg trilostane daily. Everything I learn is what I read. When I call, I feel like a nuisance. My original vet has mentioned that I am driving everyone including Bubbles and myself crazy. However, the thing is my poor pet is still suffering. I am trying not to take it personal and forge ahead with finding a solution.

The newer vet is very helpful and agrees with my ideas/requests, however, I don't know how to help my sweetie. I don't think he has had a case like Bubbles. I don't think it's right to just let her suffer until the 20th.

Today, I came across an article about Minocyline for CC and the pet responding in a very positive way and the CC healing.

Has anyone heard of this ?

Renee
06-05-2016, 07:50 PM
Yes, the minocycline is a newer treatment, still in the assessment phase. It's not widely used yet, and I haven't come across anyone on this site that has used it. I have not used it. Correct me if I am wrong, the majority of successful CC treatment using minocycline was on dogs that developed CC outside of HAC? It's been a while since I read that article, so I may be wrong.

If the CC is progressing, it most likely means her cortisol is escalating. The only way to stop the CC is to get her cortisol in check.

Since Bubbles seems to be highly reactive to trilostane, have you considered trying lysodren? It sounds scary, but it may be worth consider.

Aunt Jana
06-05-2016, 08:12 PM
The article I found was a dog with Cushing's and treated successfully with the Minocycline. I tried to paste here, however, I'm not good at all in that dept. I could probably insert a screenshot of the article in the album....I'll do that.

I have thought about the Lysodren.
Like I said, I'm at a standstill. It seems the vet is referring to specialist and that is 15 days away.

This disease is terrible. I can't believe she has been suffering since October.

Tam
06-05-2016, 09:19 PM
Hi, I am so sorry about your pup. My dog is new to this too. She is not on meds as of yet, I am worried about side effects as well. She shakes sometimes like you mentioned...a little shiver. I think it may be from the weakening legs. She has slowed down to but is still happy when we come home etc. I hope you get some answers, can you tell me if stopping the meds helps bubs? Sending you hugs and support, its a very helpless feeling. Best to you and Bubs.
Tam & Reese (my Boston)

molly muffin
06-05-2016, 09:33 PM
The only thing I ng I know that completely helps cc is bringing the cortisol down to under post 5.ug. The only way to being the cortisol down is with trilostane or lysodren.
Any calcium deposits in her skin will have to push up and put and no new ones develop for it to go away.
That is what bringing the cortisol down works on is keeping new deposits from forming.

Aunt Jana
06-05-2016, 09:39 PM
Hi Tam:

Thanks for your note. I'm sorry your pup has this awful disease as well.

We stopped the Vetoryl and Trilostane because of all the side effects. At first I did not put the shaking /trembling together, I just thought it was kinda like a restless leg thing. Then it became more pronounced. Also, Bubbles lost her personality along the way. :(
Very flat. Just layed around, no joy. She used to run about 30 miles an hour, play frisbee and hide and seek. So through the 3 months on Vetoryl 60mg once daily the drinking and peeing did stop.

It was when we introduced thyroid medicine that she became ill. Very spaced out. Head bobbing, shaking. It was terrible. She would just stand there staring into space, you could of knocked her over with a feather. So, first we stopped thyroid meds, next day the Vetoryl. After a week or so we decided to try compounding Trilostane 20 mg twice daily. She became spaced out again. So we just did once daily, still very out of it. So we stopped. Now she is cognitively better, not spaced out. She is still very blah though. My happy girl isn't there. It's so sad, I feel so sorry for her. Also, the calcinosis cutis is getting worse for her now not being on any meds.

Aunt Jana
06-05-2016, 09:44 PM
It's kind ironic, 4 years ago I was diagnosed with Psoriatic Arthritis. One the first non invasive (more safer) treatments I tried was Minocycline. It's a drug that been around forever with many good outcomes.

Aunt Jana
06-07-2016, 03:32 PM
I can use some advice.

I'm not sure if Bubbles is not doing well or just sleepy. She is very lethargic today --- in addition to drinking, eating and peeing non-stop. Right now she's sleeping on the floor, seems out of it. This is not really new, just more pronounced today. Unfortunately, it's just me here with her. She seems depressed. I'm at a loss. The specialist appt I have is either July 15 and another place has an opening June 20. Meanwhile, she is wasting away. The first place called me today and said to bring her in thru the ER if I feel she needs to be seen but I have no guarantee she will be seen by an internist. I don't know what do.

She's not on any meds, just Cushex drops we started yesterday.

It's hard not to cry

Whiskey's Mom
06-07-2016, 04:22 PM
My heart is breaking for you both. :( If it was me, I'd take her to the ER.

DoxieMama
06-07-2016, 04:38 PM
I am so sorry. I am not sure what I'd do.... if you take her in, maybe you can get some pain meds for her? If she's in pain and not feeling well, then I can understand her being depressed. :(

Harley PoMMom
06-08-2016, 05:43 AM
I am so sorry to hear that Bubs is having a hard time. I agree with Shana, if she is in pain than I believe getting pain meds could help her.

Hugs, Lori

Joan2517
06-08-2016, 07:43 AM
I wouldn't wait, I'd take her to the ER and get her whatever she needs to feel better.

Aunt Jana
06-08-2016, 10:04 AM
Thanks for the opinions. I spent the evening on this site reading some threads about the pituitary tumors. I'm very worried she has this. She keeps going in circles when she goes outside to potty. Walks beside me --very close. Is afraid of the dark. That's just some of the weird things going on in addition to everything else. It is so sad..... Not seeing her crooked bum wagging, it's heartbreaking. :(

Just talked to vet, he is going to try to get my girl in sooner with the hospital again. If he can't, I will take her thru the ER on Friday when my husband is back. Vet also said we can start Minocycline for the CC

Speciaiist can see her Monday, the 13. If she doesn't show any more tumor related effects I will wait. However, if she gets worse I will take her Friday thru ER at other hospital per vets advice--- I agree. Also, I'm alone and someone needs to sit in back seat with her.

Thank you all for the advice, I tend to go over my decisions and rethink everything. Othes who have been there, who have advice and experienced this disease is a comfort. Your kindness is a comfort too. I wish I felt better about all this, honestly, I do not. I love my sweet Bubbly so much!

Harley PoMMom
06-08-2016, 12:00 PM
Circling is also a symptom of Canine Cognitive Dysfunction and we have had several members use Novifit with some success.

Hugs, Lori

molly muffin
06-08-2016, 06:44 PM
Hopefully nothing else will happen prior to being able to see the specialist on monday. Crossing fingers.

judymaggie
06-08-2016, 06:50 PM
Hi -- just a follow-up to Lori's thought about Novifit. I have been thinking of trying the two-month trial with Abbie but, unfortunately, Virbac is not currently manufacturing Novifit and it is not available anywhere. I spoke with the Virbac folks and they advised that they are upgrading their manufacturing equipment and do not currently have any idea as to when Novifit will again be available. They told me to call them in a month to check again. Seems a bit strange to me ... I feel badly for folks who have been using this with success and now can't purchase it.

Aunt Jana
06-10-2016, 10:04 AM
Yesterday was a weird day for my girl. I had purchased some goats milk on Wednesday and she started on the Minoncycline for the CC. too, so two new things were going on within her. She was closely following me as usual. I was vacuuming, stopped to pick up a ball, she came over and started pushing it around (shocker, she hasn't played with anything for months), I was excited of course and engaged with her, she stuck her butt in the air and was in the play stance, the ball at her nose.....all of a sudden she starts trotting into livingroom and starts POOPING! I said stop! She continued, I said stop! She continued, I opened front door, said stop, go outside! I'm trying to be calm as to not upset her, she did go outside after going four times!! I was shocked. She has never, ever done this. I think she didn't know where she was. I'm so sad.

We are not waiting until Monday, we are going thru the ER today. I was secretly hopeful the Minocycline would be a turning point, maybe it was an infection causing the confusion, sometimes that's the case. I don't think we are so fortunate.

:(

Aunt Jana
06-10-2016, 03:04 PM
Well, we changed our minds again. My husband thinks she is doing better today, feels we should keep our Monday appt. I don't know what do.

DoxieMama
06-10-2016, 05:41 PM
I wish I had the answers you're seeking, but only you can make those decisions. I do understand though; my husband and I don't always agree on what to do, either. It makes it even more difficult to know the right thing.

Hugs....

Aunt Jana
06-13-2016, 11:48 PM
Well, we went to the specialist today, no good news; after she examined her she feels that it's a pituitary macro tumor and offered radiation at $9000. as the only option. She said Bubbles is very quiet which presents to her most likely a cognitive problem, very early stages. She offered thyroid meds, a different one at a lower dose. She also suggested an ultrasound but it would not make a difference, we can't afford the costs associated with an outcome of an adrenal tumor either. Bubbles was so stressed I didn't want to put her thru anything else. All three of us came home and slept. It was a four hour trip from start to finish.

molly muffin
06-14-2016, 12:34 AM
Oh I am sorry that the news wasn't better.

Did they offer any suggestions for options for Bubbles?

Aunt Jana
06-14-2016, 02:08 AM
We could have gotten an ultrasound of her belly. Ruled out an adrenal tumor, or something not related to Cushings. Only thing is it wouldn't make a difference, we cannot afford the surgery either. Stressing her out didn't seem right. She was so nervous on the drive out, she never stopped breathing heavily and shaking, so nervous. On the way home she relaxed, I guess she knew home was next!

She did mention that thyroid issues can cause so many health problems, new meds may make a difference, so we will try it. It's synthroid. Also, she did not believe in any way, what so ever that an overdose of the Veteroyl/Trilostan caused her to have side effects of cognitive issues. I disagree. It happened three times, hard to say it's a coincidence three separate times. Some dogs like people can have a reaction to meds. I kept it to myself........

After her suggestions I was upset, tried to hold back tears but when you hear what you have been dreading, it's tough. When we decided no ultrasound the Doc said she would be right back with script. Well, she sent a tech in to finish. No "thank you", "good luck", "keep in touch", "good bye"---nothing. I was disappointed.

One more thing I would like to share--the Minocycline--it appears to be working for the CC. Bub' s black zits are fading, they did not burst, thank goodness, just fading away. There are more that appeared last week that I'll be curious to see how they do. She is taking 1 capsule twice daily.

Please send good thoughts Bubbles way, I love her so. I am trying to make peace with it.

Thank you all, I appreciate this forum and all the kindness you have shared, it has been such a help for me.

Whiskey's Mom
06-14-2016, 07:12 AM
I'm so very sorry and sad for you all. :( We couldn't afford the ultrasound for Whisk either and wouldn't do surgery anyway. Costs aside, We felt the risks of surgery were too great. Hopefully the thyroid meds will help your little girl. You never know.
I hate it when a doctor/vet leaves and sends a nurse or tech back in the room. Not that you need a formal goodbye but you don't get the option to ask questions and when youre upset you just can't think quickly. I know they're busy but it lacks courtesy and compassion.
we'll keep hoping that she feels better every day. Hang in there!

DoxieMama
06-14-2016, 09:20 AM
I'm sorry that didn't go as well as we'd hoped. :( I'm glad the CC seems better. Please let us know how she does on the new meds.

Many good thoughts on their way for sure!!

Aunt Jana
06-14-2016, 09:21 AM
Thank you Whiskey' s mom, I appreciate your support. Hearing from someone who has gone down this lonely road helps , thank you.

DoxieMama, you too.....Thank you, I will.

Harley PoMMom
06-14-2016, 12:29 PM
Tons of good and healing thoughts being sent your way from my house too.

Hugs, Lori

Aunt Jana
06-14-2016, 09:11 PM
Thank you too Lori.

Got the Synthroid filled, started tonight. I pray it helps.

Aunt Jana
06-18-2016, 10:29 AM
Hi all:

Bubbles is starting to have some head tremors. I don't like it at all. I called the new vet because I want to give her prednisone. He said no. The old vet is out of office until Tuesday. :(
Why is the new vet against it? It's my dog. I have read on this site that dogs can get it with cushing's. I am so annoyed. That stinking Vetoryl caused this tumor to grow. I want to shrink it!

labblab
06-18-2016, 12:16 PM
I am so sorry the specialist is also suspecting an enlarging tumor. If that is the case, giving prednisone may be considered. But it will not shrink the tumor. The goal would be to reduce inflammation of the brain tissue that is being encroached upon by the tumor in order to try to help with some of the neurological problems. However, the trade-off is that the prednisone will likely exaggerate all the Cushing's symptoms that are already present and are troubling you so -- especially the excessive thirst and urination. So I'm not sure that is the route you want to go.

Sometimes we've seen specialists prescribe trilostane and prednisone simultaneously in this situation. The trilo keeps the natural cortisol production in check and allows the supplemental pred to be dosed in a controlled and consistent manner.

Again, I'm so sorry you are facing these issues. But I just wanted to warn you that, unfortunately, there is no way to shrink a macro tumor without direct intervention of radiation or surgery.

Marianne

Budsters Mom
06-18-2016, 12:48 PM
You might want to check out this thread. My use of the Predisone/Trilo combo is documented in detail. A SPECIALIST IS NEEDED TO CAREFULLY MONITOR AND ADJUST THE DOSAGES. Be forworned, it is a long thread.:o

http://www.k9cushings.com/forum/showthread.php?t=5121

I am so sorry that you're having to deal with these issues.:o
Kathy

Aunt Jana
06-18-2016, 05:33 PM
Thank. You both. Kathy, I have already read your thread. The difference here is Bubbles is not on a Cushing med. Too many bad reactions. I firmly believe the three, four months she was on the Vetoryl caused the tumor to grow. No doubt about it. Now, looking back the first thing was her shaking/trembling, that was the tumor first showing it's nasty self after growing on the meds. I can't go back, but God I wish I did different!

Today we went to vet, he explained fully why she can't have prednisone, we understand. We did get her Phenobarbital for the tremors, 60 mg, will start tonight, then twice daily. I asked him how long he thinks we have together, said 6-8 months. Opinions?

I appreciate all your feedback, thank you.

Janet

Budsters Mom
06-18-2016, 06:49 PM
Very tough situation. Living through it was a nightmare.:o

I only have one suggestion for you. I so wish I could do more. Make the most of whatever time you have together. Make memories. Take videos. Spend time doing what Bubs loves and just being together. I spent way too much time in miserable anger desperately trying to change the inevitable. I missed out on those precious moments
and I'll never get them back. Don't make the same mistake that I did.

Hugs,
Kathy

Aunt Jana
06-18-2016, 10:28 PM
Thank you Kathy. I am trying. Last night was a tough one. She looks at me and is not the same happy girl. I'm heartbroken. However, we are making the best of it. Goodies whenever she wants!--- They are healthy........ Her waffle with pumpkin--she is so happy when she gets it. Of course hugs galore. I don't know how I will cope. I don't think I could ever do this again. Nor love anyone one as her, she is special.

Around 6 pm she had the head tremors, it was horrible, lasted about one, two minutes; she knows something is wrong too. I gave her the dose of Phenobarbitol, I hope it works.

Aunt Jana
06-18-2016, 10:53 PM
Kathy-you and Buddy really suffered together, I'm sorry. So much support on this forum for you, God Bless you. I didn't read the entire thread, however, I went thru a lot. Did you control his tremors with meds? I didn't see any info about giving him anything. So sad, but he was loved so. :)

Budsters Mom
06-18-2016, 11:07 PM
Yes, Buddy had head tremors also. They felt like something vibrating like a cell phone. I could actually feel them when I touched his head. Oddly, through this forum we discovered that he had hypoglycemic episodes. I rubbed a small amount of Karo syrup on his gums and they stopped within a few minutes. I never had to give him meds for it because the Karo worked. He always knew and they frightened him. His othe neurological symptoms weren't as easily remedied.

There were many angels on this forum who tirelessly helped me sort this stuff out. I will be forever grateful. That is why I am still here, almost 3 years since Buddy flew.

Aunt Jana
06-21-2016, 10:09 AM
Has anyone used L Deprenyl and experienced success with the pituitary tumors?

labblab
06-21-2016, 10:23 AM
At one time, L Deprenyl (Anapryl) was hoped to be a very successful treatment. Experience has shown, though, that it seems to be helpful for only a small minority of dogs who have tumors located in a specific part of the pituitary gland. I don't know that there would be any harm in trying it, though, as long as there is no problem combining it with phenobarbital. I'm not sure whether those two can be combined without a problem.

Has the phenobarbital helped at all with the tremors yet? I know it takes a while to reach a therapeutic level in the bloodstream. I did have one reservation about starting with the phenobarbital, though. Did your vet warn you that common side effects of the drug, especially at the beginning, can be excessive thirst and urination? I just feel somewhat worried about that, since those are the Cushing's symptoms that are already so troublesome for Bubbles. I just wasn't sure whether phenobarbital was the best choice in this situation. :o

Sending big hugs to your special girl,
Marianne

Aunt Jana
06-21-2016, 11:10 AM
Marianne-hi, no. Vet told us she could get lethargic. That's all. She is wobbly, he said that's not a side effect. It seemed to help --Statted Saturday night and Sat and Sunday it did the job. However, yesterday she became very wobbly, more tremors this morning....... She rode in the car Sunday--stresses her out, thinking that's why she's so unsteady. I just don't know. :(

Aunt Jana
06-21-2016, 11:55 AM
What is another anti seizure need? Is there a better alternative. My daughter's cat is on Kepra......

Aunt Jana
06-21-2016, 01:35 PM
Talked to vet again, we are getting the Keppra tomorrow. My pharmacy quoted $113.00! He can get it for $50.

What I need is an opinion -- could the Phenobarbital be the cause of her unsteady legs? She is bumping into things, almost falling over. :(
Or is it the tumor?
:(

Budsters Mom
06-21-2016, 01:59 PM
Sorry, but I'm not sure about the phenobarbital, but the tumor could definitely be causing those symptoms.

labblab
06-21-2016, 03:24 PM
Phenobarbital could also be causing unsteadiness and loss of coordination. Those are known to be possible side effects as a dog adjusts to the drug. My nonCushpup Lab was treated successfully for epilepsy with phenobarbital for several years. However, for the first couple of weeks as she adjusted to the med, she was very unsteady on her feet and definitely drank and peed more than normal. In essence, it really made her look like a Cushpup :o. I am glad your vet is shifting to a different med since it did not seem like a great choice to me given Bubbles' existing symptom profile.


Phenobarbital inhibits seizures by decreasing the activity of neurons. Unfortunately, this effect is not specific to the neurons involved in the seizures but affects other neurons as well. Many of the potential side effects of this drug are caused by this effect on neurons. These side effects can include sedation, lethargy, excessive urination, excessive thirst and excessive hunger, hyperexcitability, ataxia (loss of coordination or hind end weakness) and restlessness. Most of these side effects diminish or disappear after the first few weeks of therapy. Excessive urination, excessive thirst and excessive hunger are the most common long-term side effects.

Marianne

Aunt Jana
06-21-2016, 08:37 PM
Thanks Marianne, I agree. She has exhibited almost all you wrote! Will it resolve? She took it for Three and a half days.

I can't stop crying today. I can't believe all she is going thru. Her CC is so bad. A big chunk of fur/skin wants to come off, I don't know what to do. My husband put Polysporin on it. This is too much to deal with. It's one thing after another.

I'm angry too because no one told me about Lysodren. We could of tried that. I know not all do respond on it, however, maybe my dog would have. I should have been given the option.

molly muffin
06-21-2016, 11:38 PM
It is very hard when and if you are dealing with a macro tumor. Almost the only thing to be done is the radiation treatments to shrink the tumor and those are expensive for most people.
The cortisol bp being high keeps the inflammation on the brain down but increase all the Cushing's symptoms. It is like a catch 22. All one can do is try to manage and keep them happy for as long as possible. It is not easy and my heart breaks for you and bubbles.
Have you tried the trichlor spray. You can get it on amazon. It might help with the cc to keep it infection free.

Aunt Jana
06-22-2016, 01:51 AM
Sharlene:

Thank you for the info, I was not aware of this product. I just ordered it from chewy.com. Thank God, I can't wait, the CC is awful and I don't know if my sweetie is in pain.

molly muffin
06-22-2016, 08:52 AM
It won't cure it or make it go away but might be helpful with keeping cleaned and bacteria free.

Aunt Jana
06-22-2016, 10:07 AM
I'm so confused and angry. I have to give this to her and it is exaggerating her thirst, etc!!!!! SHE IS SO UNSTEADY

I will get the Keppra late today.

Can someone tell me when the added on EXTRA thirst from the phenobarbital will subside?

I want to add one more thing.... after reading about the Anipryl I would really like to try it for her because the side effects are so slight (so far what i read) --she needs something to stop the CC.. I don't know how much the antibiotic is doing because she's starting to lose pieces of fur and raw skin is showing and I am sick about it and the vet yesterday -- he told me well we can't keep adding all these new medications, while I agree I feel like I have no alternative. I can't keep letting her suffer I don't want to be pushy with him but he's the one that came up with the phenobarbital --said there was no other side effects but being lethargic and now I have this extra thirst and ravenous hunger. I didn't think it could get worse but let me tell you it's really bad and she can't even keep on her feet; I'm heartbroken for her.
She currently is taking the Synthroid, the antibiotic and will be taking the Keppra, discontinue the Phenobarbital and I want to start on anipryl..... that doesn't sound unreasonable does it?

I'm adding again: the vet said yes to the Anipryl. I'm grateful. He was also told me to hold off until tomorrow to start the Keppra .

Thanks members for your advice. I know I'm obsessed but I love my girl and will try anything within my capabilities.

Aunt Jana
06-23-2016, 03:11 PM
Please, can someone tell me when the Phenobarbital thirst and hunger issue will wane??? We stopped it yesterday with her morning dose being the last.

Anyone? ??

labblab
06-23-2016, 03:33 PM
I'm sorry I missed seeing your post yesterday. I don't know exactly how long it will take for the phenobarbital related side effects to totally cease. However, I wouldn't think it should take long, especially since Bubbles' had only been taking it for 3-4 days. Unfortunately, you may just be seeing an increase in the Cushing's symptoms since Bubs' has been untreated now in terms of rising cortisol.

I really do hope that the new drug profile will be helpful for her. My heart goes out to you both!

Marianne

Aunt Jana
06-24-2016, 12:42 AM
Thanks Marianne.

Another not so great day again.

DoxieMama
06-24-2016, 08:56 AM
Janet, I am so sorry that Bubs is not feeling better. I truly understand how frustrating it is to be doing everything you can think of, and yet watching her NOT improve. My understanding is that CC gets worse before it gets better :( Have you read or been told how long it might take before you can determine if the new treatment plan is helping or not?

Hugs for you!!
Shana

Aunt Jana
06-24-2016, 07:01 PM
Shana --thank you so much, I really appreciate your support. Just got the Anipryl within the past hour. The Doc said not to get discouraged if we don't see any improvement right away, that it may take a few days. I will remain optimistic, this is our last resort. I pray something positive will happen, if only heal the CC.
So now her meds are :
Minocycline, Keppra, Synthroid and Anipryl.
She gets a few supplements as well.

molly muffin
06-24-2016, 07:21 PM
I do hope that you see some improvements

Aunt Jana
06-25-2016, 11:47 AM
It was a really bad night again, she gets up every 2 hours to pee and to drink plus the head tremors..... she had a lot of them last night and we're giving the Keppra every 8 hours. I want this new medicine to work, I pray it works but I'm losing hope. I don't know how long we have.

DoxieMama
06-25-2016, 12:13 PM
Remember, it may take a few days before you see any improvement. Crossing my fingers that you do......and soon.

molly muffin
06-25-2016, 12:44 PM
What about adding in melatonin at night. How
Much does Bubs weigh? You don't want
Time release just plain melatonin it was 3
Me for my dog who is smaller. Might be 6 mg for Bubs. i will look up

molly muffin
06-25-2016, 12:46 PM
http://www.veterinaryplace.com/dog-medicine/melatonin/

6 mg

Aunt Jana
06-25-2016, 04:23 PM
Thanks ladies, I did read about melatonin, maybe I'll get it. Thank you for looking it up too.

Aunt Jana
06-26-2016, 10:08 PM
I don't know how to deal with this CC. She is going to be all raw if all the fur/skin falls off. Tonight we put a white Tshirt of my husband's on her, she is mad. Before we put the shirt on, she was rubbing her body on the furniture, not sure if she is itchy or in pain.

I posted an album with pics i took of the CC.
I'm welcome to suggestions.

Apart from the CC the Anipryl has made a slight difference so far. She is a little more relaxed , not so restless. Thank God. She is sleeping a little better too. Also, drum roll-----she is not emptying the water bowl EVERY TIME. So happy for her :)

Whiskey's Mom
06-27-2016, 08:15 AM
Glad her drinking is slowing down- hope that continues. I know nothing about CC and I don't know what you've tried but what about aloe from an aloe plant? I could be wrong that it's safe or works but maybe someone else here does. Also the silvadene or Santyl creams used on human bedsores which are a prescription but I don't know if they would be helpful either. Feel so bad for your poor Bubs. Hope she feels better!

molly muffin
06-27-2016, 06:02 PM
CC is a build up of calicum in the body that literally calicifys and pushes up through the skin. Most often this is due to high cortisol in the body. Without lowering cortisol and that is difficult with a macro tumor (if that is in fact what Bubs has) as the high cortisol keeps down inflammation in the brain that puts pressure on the areas surrounding the tumor. The very thing that lowers the cortisol and would help the cc, would not be good for a macro tumor.

This is definitely a catch 22 situation.

Aunt Jana
06-27-2016, 08:43 PM
Sharlene:

Bubbles is on the Anipryl 30mg. Have you heard this helps stop CC? It's been 3 days and there a slight change with restlessness, sleep and drinking so far--not with the cc--it's bad. Please see the pics I posted.

I'm afraid of infections--then what happens????

Her meds:

Anipryl 30mg once daily, Minocyclin 100 mg twice daily, Synthroid 300 mcg twice daily.
Coq 10 50mg, ProCaps Liver and Brain Essentials 2 caps, ProCaps Essential Omega 3 2 softgels

molly muffin
06-28-2016, 11:16 PM
That is why you use the spray you ordered to keep it clean and lessen chance of infection. If it gets infected then they will probably give you antibiotics.

The cc spots always get worse before they get better unfortunately and the pictures definitely look like the other pics we have seen of cc. It isn't pretty by any means poor baby.

Aunt Jana
06-29-2016, 01:45 AM
Hi Sharlene:

The spray seems to hurt her and she has some awful, raw areas on her back :( The wipes work well, however. She doesn't mind when we pat her open sores with them.

I was on here last night and found a thread from a couple years ago. I can't remember the cuspup' s name, however the member said while her pup was in the hospital they applied Mupirocin ointment 2% and it cleared up the infection and CC breakout. So I called my vet today, we got it filled. The one area is very bad, I'm worried and I wanted to stay ahead of this situation.

She was very quiet today, I think more than usual. My husband didn't see it.

This is an awful journey. My poor baby, not even 8 yrs, old. I hate all of it. I have meltdowns daily.

Renee
06-29-2016, 06:36 PM
The ointment won't clear up the CC itself, it will just help with infection. These lesions are highly susceptible to secondary infection.

I've taken a look at Bubble's photo album. Is it just those two lesions she has? They are in the yucky and raw stage, which I unfortunately know very well. I would like to say this stage will clear up, and they may, but without any treatment to directly lower her cortisol, I'm just not certain what direction the lesions will take.

Does she have more of them emerging?

Aunt Jana
06-29-2016, 11:31 PM
Hi Renee:

She has the two bad lesions and a large area between her shoulder blades that have not burst through. I'm sick about it. Won't the Anipryl help with the CC? She had terrible reactions with the 60 mg Vetoryl and the 20 mg Trilostane. Not to mention the Vetoryl made the tumor grow!!!!! I thought the Anipryl may help. Is This incorrect? ? She is on Minocycline too.

I'm so over this!!!.

lulusmom
06-30-2016, 01:02 AM
As Marianne mentioned earlier, Anipryl, for the treatment of cushing's is only effective if a dog has a tumor in the pars intermedia lobe of the pituitary gland. Even if symptoms initially improve with the drug, progression of the disease most often overcomes the effect of Anipryl and symptoms will worsen. Since acth stimulation tests are not necessary for Anipryl, there is no way for you to even know if it is having any effect on cortisol levels unless you ask your vet to do the test. That might be a very good idea so that you can see for yourself whether Anipryl is doing your pup any good. To be perfectly honest, Anipryl was an exciting prospect because we have so few drugs to choose from and the monitoring testing is not easy on the dog and it's not cheap. Unfortunately Anipryl proved to be a big disappointing bust. Even the developer of the drug, Dr. David Bruyette, doesn't prescribe it unless the pet owner cannot afford the testing needed for Vetoryl or if the dog has extremely mild symptoms. Dr. Bruyette puts the efficacy of the drug at about 40% which is way generous. Other renown experts estimate efficacy at less than half that so that is not reassuring for a dog with CC. You seem to be in a double catch 22 situation. You need to get your dog's pre and post stimulated cortisol levels under 5 ug/dl and I honestly don't think that will ever happen with Anipryl. There is always Lysodren but if a macrotumor is suspected treatment with Vetoryl or Lysodren runs the risk of facilitating growth of the macrotumor. That's the second catch 22. So unless you get your pup on a treatment that will effectively reduce cortisol, you can expect the CC to worsen and continue to be difficult to manage. If you do get your pup on effective treatment, it could make the macrotumor enlarge enough to start causing neurological deficits. I don't want to bum you out more than you already are but Boxer is a breed that is definitely over represented in macrotumors. We've seen a number of them that developed large pituitary macroadenomas after starting treatment and unless you can afford the MRI to confirm the diagnosis and radiation treatment, the prognosis is usually not good.

I feel like such a downer but I think it's important that all of your questions are answered and that appropropriate feedback be provided based on your pup's case history.

Aunt Jana
06-30-2016, 01:14 AM
I appreciate your honesty.

I only wish someone told me the Vetoryl would cause this tumor to GROW in the first place!

So, what do I do? Besides cry.

Budsters Mom
06-30-2016, 01:22 AM
I know that these things are hard to hear and even harder to accept. :o I melted many times trying to process pretty much the same information provided to you here, except I wasn't dealing with CC also. As I think back, those members who were knowlegable and upfront with me from the beginning, helped guide me toward the best possible treatment for my little Buddy. They didn't sugar coat anything, or give me false hope. There helped me process his reality, so we could move forward together.

Our members are not trying to terrify you, although I know you are scared, frustated and exhausted. Yes, I was too.:o They are trying to realistically share the information they have learned over many years. Yes, they care very much. We all do and know that none of this is easy.

Hugs,
Kathy

labblab
06-30-2016, 09:09 AM
My heart goes out to you. Since I believe a macrotumor caused the loss of my own Cushpup, I can so easily imagine your fear and your pain over Bubs' situation right now. I do hope, though, that you'll be able to release some of your regret over the trilostane treatment. It was not at all unkind or a mistake to seek effective treatment for the Cushing's symptoms that have been making her so uncomfortable. Plus, just like so many things that are Cushing's related, there are still question marks as to the extent that trilostane or Lysodren treatment actually markedly hastens pituitary tumor growth in most dogs. Glynda has done a great job of laying out the theoretical framework for why this might be so, and there is at least one trilostane study that seems to bear out the notion that the tumors will grow more rapidly. But some other studies of dogs treated with Lysodren did not show that to be the case. So not all researchers/clinicians are convinced that this is true across the board. If so, given all the dogs who are successfully treated with trilostane or Lysodren, you'd expect to see a whole lot more dogs with rapidly worsening neurological issues than we do.

The fact is that all pituitary tumors will grow over time, whether or not the dogs are actively treated for Cushing's. For some dogs, their tumors may already be large enough to be deemed macrotumors even before treatment is begun. In retrospect, I'm guessing that was the case for my own dog, and it is possible that was the case for Bubbles. In that situation, you are really stuck with balancing competing issues. What is making the dog more uncomfortable: the Cushing's symptoms or any emerging neurological problems? Whether or not trilostane or Lysodren is continued or discontinued will at least partly depend on weighing/balancing those issues. Here's a quote from a noted endocrinologist, Dr. Mark Peterson, that talks about the natural progression of pituitary tumors.


More than 90% of dogs with pituitary-dependent hyperadrenocorticism (PDH) have an ACTH-secreting pituitary adenoma as the primary cause of their disease. Approximately 50-60% of these dogs with PDH have a pituitary tumor large enough to be visible on CT or MRI scans at the time of diagnosis (1). With time, these pituitary tumors will increase in size over time as they are being treated medically with mitotane or trilostane. Although these therapies are effective at relieving the clinical signs associated with the disease, neither treatment targets the pituitary tumor. Therefore, over time all dogs with PDH are at risk for continued pituitary tumor development, growth, and invasion. It has been estimated that 10% to 25% of dogs with PDH will eventually develop neurologic signs caused by expansion of their pituitary tumor (2).

My main point here is to try to relieve you of guilt over treating Bubs with trilostane. If she is suffering from a large macrotumor, the neurological issues would have been inevitable at some point in time, regardless of whether or not she was given trilostane. Is it possible that the trilo hastened the tumor growth? Perhaps yes. But without the Cushing's treatment, it sounded as though her quality of life was going to be very poor, regardless. And unfortunately, now the CC is probably one of the worst manifestations of what untreated Cushing's has to offer.

I truly hope the Anipryl helps with the CC and other Cushing's symptoms. I just don't know what to expect in that regard. I do wish I had some other great answers for you, but I'm afraid I do not. As Glynda has said, you are really in a Catch-22 situation. Having shed so many tears over my own boy, I surely do understand what a rotten place that is to be. And that's why we're here. So you can continue to scream or cry or vent over this lousy hand of cards that has been dealt to your sweet girl. Sometimes life just sucks. :( :(

Marianne

Aunt Jana
06-30-2016, 09:55 AM
Everyone--

Thank you.

Thank you all for the time you all take to share your thoughts and experiences.

Aunt Jana
07-03-2016, 12:50 AM
We are one week into the Anipryl. The CC is horrible. The Anipryl has helped cognitively. She is more relaxed.

I don't know what to do.

She had such an awful reaction to 20mg Trilostane......after 3 1/2 months on 60 mg when the tumor exhibited signs in my sweet Bubbles.

What can we do for her?

Budsters Mom
07-03-2016, 01:10 AM
It's all about making Bubbles feel as comfortable as possible. If the Anipryl is helping her to relax, then I would continue with that.

Smother her with love and attention. That's all she really wants. That's the best thing you can do for her.

Aunt Jana
07-09-2016, 12:02 AM
Hi everyone:

I've been trying not to stress over my Bubs but I need some advice. Her skin is really bothering her; between the Dechra spray, the polysporin and the ointment for the sores-- she's really uncomfortable. It seems like she's itchy and the areas of black hardness is awful-looks like it can break right off! I took some pics I'll upload. My groomer is away but there is a place in the neighborhood, it's called Pet Value store, they have an area to bathe your dog so we are going to take her tomorrow--she really needs a bath. But my fear is that she's going to have a lot of skin/ fur break off and have open sores all over! Please! !! I need some advice on how to proceed.

Thanks in advance.

DoxieMama
07-09-2016, 12:07 AM
I'm sorry, Janet, that just sounds horrible. I don't have any experience or suggestions though. :(

Aunt Jana
07-09-2016, 12:18 AM
Ah, thanks anyways.

I'm thinking Benadryl. .....how much though? One tab?

Renee
07-09-2016, 12:25 AM
Hi Jana. I'm sorry to say .... yes, it is all going to break off. Those huge plates will peal away and reveal raw skin underneath. God, I wish I could say different, but it's not likely.

My personal opinion is that once those hard plates are gone, it's actually less painful, although more susceptible to infection. Don't be afraid to help them peal away if they are ready to come off. Be prepared for bleeding though.

I never bathed Tobey during the worst of it, but by all means, feel free to do so. We waited many months before I was willing to risk getting them that wet.

Is she on any pain medication?

Aunt Jana
07-09-2016, 12:44 AM
No. No pain meds.

Maybe It's a bad idea. I don't know. .....
:(

Renee
07-09-2016, 01:04 AM
If it will help loosen up the plates so they can come off, then go through with the bath. Just be prepared. The skin will be raw and most likely bleed.

Get some pain meds and make sure she is still taking her abx.

I feel your frustration and heartache. First hand. I know how hard this is. I'm going through it for a second time after having beat this once before.

Aunt Jana
07-09-2016, 09:23 AM
What is abx?

Aunt Jana
07-09-2016, 09:30 AM
Renee--

After the plates fall off and the skin is raw---how long should we expect the raw skin? What will happen next? I'm pretty gun shy to do this, so many areas on her body. So horrible.

I'll call the vet, ask for pain meds and await your response.

Thanks

Harley PoMMom
07-09-2016, 09:31 AM
What is abx?

Antibiotic ;)

Aunt Jana
07-09-2016, 12:14 PM
Oh, yes. On Minocycline.

Renee
07-09-2016, 01:48 PM
I'm honestly not sure what will happen next, as my girl was on treatment while we went through these phases.

The raw phase may take a few weeks, but once those lesions get some air exposure, they should start drying out. The drying out phase is good. This usually signals that the lesions are now healing, because most of the calcium has worked it's way out.

Keep the skin nice and clean, and try not to let it stay moist / wet, as that will just breed bacteria.

Aunt Jana
07-09-2016, 04:41 PM
Just got her settled in. We went and bathed her. She had so much stuff on her fur......
She wasn't thrilled but I kept her face in a towel near mine, talked to her and gave her cookies the whole time. The back end section seemed to bother her, that bled a bit. Not alot of plates came off, however, her fur is so nice and clean. I dont think she is in any pain right now.
We bandaged the back end after applying the ointment. The rest--I sprayed with colloidal silver. I read it helps in healing and does not hurt/sting at all.

Hopefully, she will rest now.

Thanks all for your support, what an awful disease!

One more thing, today is two weeks on the Anipryl, my husband and I think it is working. I don't know if it is lowering the cortisol but her lesions are not getting worse either, they are horrible, yes but it is not worsening. Cognitively, I think she is doing way better. Not my old girl who was so very smart but not as confused as before---thank God.

molly muffin
07-12-2016, 11:10 PM
I'm happy to hear that she seems to be doing a bit better on the Anipryl. Hopefully the cc won't get any worse than it is now.

Aunt Jana
07-15-2016, 01:00 AM
Hi all:

Took Bubbles to the vet on Wednesday, I had sent him a pic of her large open sore on her back by her tail, didn't like the looks and had us bring her in. He put her on a stronger antibiotic, Keflex 750mg. something stronger than the Minocyclin to dry out the lesion. We talked about 5mg Vetoryl. I really don't want to do it, however, I have to see if it will help with the thirst and peeing......She is up two to three times a night. It's brutal. He agreed and said to continue the Anipryl which I plan to. I'm very scared to proceed. Also, today--she was very slow, just ate, drank, peed and slept. So sad. I cried all day. Could it be the new antibiotic? Or is she getting worse or just tired of this life!?

She's on new antibiotic- Keflex, Keppra, Anipryl, synthroid and we'll be adding 5 mg Vetoryl.

I just can't believe we're here. It's so horrible to see my little girl this way.

Harley PoMMom
07-15-2016, 01:21 AM
From googling I see that tiredness is listed as a side effect from Keflex, so this could be why she was slower today. Keeping you and Bubs in my thoughts and prayers and hoping that with this new antibiotic improvement will be seen.

Hugs, Lori

Aunt Jana
07-15-2016, 06:24 PM
Thanks Lori, I read that too.

She is the same today.

Aunt Jana
07-16-2016, 08:58 AM
Last night we gave Bubbles 2 Tramadol as per Dr. She slept great! Only up once at 3 and just this morning at 7:30, I'm relieved. We were afraid to give it to her because she is already so slow moving but last night she kept turning around and looking at the big sore above her tail area, I think that's enough to know it is hurting her. So, I decided then my husband got on board.

The Vetoryl won't be arriving until MONDAY! Very annoyed, I ordered it Wed! I wonder if it is a sign---don't do it! Don't give the Vetoryl!

Harley PoMMom
07-16-2016, 11:25 AM
I'm so glad that the tramadol was able to give Bubbles some relief from that dreaded CC. I totally understand your apprehension in treating your special girl again since she did exhibit some negative effects from the Vetoryl/Trilostane so I am hoping that this time she will respond favorably. I may have missed this but what is the dose of Vetoryl/Trilostane she will be taking?

Hugs, Lori

Aunt Jana
07-16-2016, 03:14 PM
Hi Lori:

5mg.

I don't want to give any higher because of her sensitivity. Three months on 60 mg and it must of caused that tumor to balloon. She is a scared, confused little bubba now :( HEARTBRAKING.

20 mg Trilostane was too much, she was so out of it on it. We are hoping 5mg with the Anipryl will curb the drinking and peeing and stop the CC. It's so horrible.

Thanks,

Janet

Aunt Jana
07-22-2016, 11:58 AM
Good morning everyone:

It's Friday, we started Bubbles on the 5 mg Vetoryl Monday and I started noticing last night while she was sleeping the body shivers and today taking a morning nap her whole body is shaking while she's at rest. What do I do? She really hasn't had any other side effects, the water consumption has changed very, very slightly but it has changed. I don't know what to do. Any ideas or suggestions would be appreciated.

labblab
07-22-2016, 12:15 PM
Janet, I can sympathize so much since my boy also had shivering episodes. But as I probably said before, they really didn't seem to bother him much at all -- it was only me who was freaked out. At this point, I'm guessing the CC is making Bubbles far more uncomfortable than is the shivering. So even if they are a genuine side effect of the trilostane, I think I'd try my best to ignore them and focus instead on the importance of getting that cortisol down. I know it's hard, but I think you need to pick the bigger issue to battle right now.

For what it's worth, my boy's shivering ended up stopping altogether after a couple of months, even when he was still taking his trilostane. So thankfully something ended up changing for him.

Marianne

Aunt Jana
07-22-2016, 12:22 PM
Thanks Marianne, thanks for the kind words. I'll try not to concentrate on it, she does seem more BLAH also. I didn't want to say it out loud because her little life is so limited now I'm so sad for her. She eats, she drinks, she sleeps, pees and poos. Occasionally, she wags her tail. ...no more wiggling. That's it! It's so sad and I love her so much.

labblab
07-22-2016, 12:30 PM
I don't think there's anything worse than the feeling of helplessness that comes from watching changes like this taking place in our furkids. Especially since we can't talk to them and ask them where it hurts or what they want us to be doing for them. :( :(

I'm so sorry I don't have any good answers for you, and my heart truly goes out to you. You are such a loving mom, and I know your own heart is breaking over this. I am sending both you and Bubs tons of hugs from across the miles.

Marianne

Joan2517
07-22-2016, 12:42 PM
Same from me, Janet...it really is so hard to see the changes in them, but I don't think they notice it as much as we do, they just adjust to it. Lena was so different that she seemed like a stranger to me sometimes, but then all of a sudden she would do something "normal" and my heart would sing.

Bubs knows you love her and that is what counts.

Aunt Jana
07-22-2016, 05:24 PM
Thank you, thank you both. I really appreciate your prospectives, I feel so helpless.

I do love her so.

Aunt Jana
08-02-2016, 02:26 AM
Hi all.

I don't think the 5 mg Vetoryl is doing anything to help Bubbles, probably too low a dose. Her CC is hideous, it is ALL OVER Her BACK and she is itchy--I feel so helpless for her. She had one (cc lesion) in between her toes, she must have stepped on something in the yard-it bled like crazy and her foot swelled. Dr. was pretty sure of it being the cc.

I'm at a loss. Should we bump it up to ten mg? Will it affect her negatively? Right now her breathing is very irregular at rest/sleeping but sometimes when she is awake/resting too. The thirst is still ridiculous and after she drinks her mouth is dry as cotton. I feel so BAD FOR HER!! Today, she just looked so sad, it makes me cry to see her like this.

However, yesterday my children were over and she was so happy--tail was wagging.

Please, some advice. Tell me what to do. Please.

Thanks

Budsters Mom
08-02-2016, 06:03 AM
I am so sorry that you are in such a tough place with Bubbles right now. I wasn't going to comment, but since you are pleading, I will.
With my Buddy, quality of life was always first and foremost in my mind. Could he still get up and go chase lizards? Could he still stand guard duty in the window? Was he still happy? Was he in pain? Did his eyes still sparkle. Was he holding on for me? Tough questions that I had to honestly answer.

As much as it hurts, this has to be about them. As long as you are honestly assessing Bubbles quality of life, you'll know what to do, when the time comes. In the meantime cherish every moment and make memories to last a lifetime. Spoil her, love on her and give her all the attention you can spare. That's all she really wants.

My Buddy had a probable macro-tumor. I know what you are dealing with in regard to that.

Kathy


Today, she just looked so sad