Boxer with Cushing's

[dsingley]

My sweet girl, Jessie Jane, has been diagnosed and treated for Cushing's for the past 2 years. We have experimented and adjusted her trilostane dosage a couple of times and thought everything was under control.

I haven't really been happy with her breathing, she sounds congested, but the vet checks her lungs regularly, and they are clear (also has had xrays and no growths)

Well, as of a week ago, she has had 2 seizures, not lasting long, but this is something new. Prior to that she had an episode of vertigo for about a week. We treated her for possible inner ear infection, they antivert (meclizine), and she seemed to bounce back.

Is this a side effect of trilostane, or part of Cushing's disease? Just
looking for some guidance. I'm a people nurse, and right now, am fearing the worst for my baby and thinking brain tumor or other neurologic disfunction...

Thanks!

[molly muffin]

Hello and welcome to the forum. Does she have pituitary Cushing's? There are some dogs in which the pituitary tumor can grow and put pressure on other areas of the brain. The only way to know for sure is with an MRI and if it has grown the recommended treatment is usually radiation therapy to shrink the tumor. This can be expensive and may not be feasible but that is my first thought to check out. We have a dog in the forum that just completed a series of 16 radiation treatments with good results. I know unicpversity of Davis California has a radiation therapy that is only 2 treatments.
This is just conjecture until you know for sure.
How are her thyroid levels? As thyroid can also cause seizures.
When you say controlled do you have the ACTH results from her monitoring? Are any other levels high low? Kidney disease can also lead to seizures so some things have to be ruled out.

[Harley PoMMom]

Hi and welcome to you and Jessie Jane!

I have manually approved your membership so now all your posts will be seen right away. Also, please just disregard the validation email that was sent to you from k9cushings. ;)

I am sorry that Jessie Jane has experienced 2 seizures and I know that can be pretty scary situation for you both to go through. Seizures are not a typical side effect of Trilostane, meaning the medication itself.

Was Jessie Jane diagnosed with the pituitary type of Cushing's? Pituitary tumors usually do not grow much in size, but sometimes they can enlarge which can put increased pressure elsewhere in the brain. It appears that treatment for Cushing's can sometimes cause the tumors to enlarge more quickly. Seizures are actually not the most common symptom of enlarging pituitary tumors, but they can happen.

Regarding the congestion sound in her breathing, we have seen members reporting this symptom in their own cushdog. Respiratory signs (coughing, congestion) is listed as an adverse reaction in the product insert from Dechra (Dechra is the manufacturer of Vetoryl). Here's a link to that insert: Dechra's U.S. Product Insert (http://www.dechra-us.com/Admin/Public/Download.aspx?file=Files%2fFiles%2fProductDownload s%2fus%2fvetoryl-5mg-pack-insert.pdf)

Hugs, Lori

P.S. I see that Sharlene (molly muffin) and I were typing at the same time so please excuse any duplication from me :o

[dsingley]

Hey Guys!

Thanks for the quick replies. We did initial testing for cortisol levels, and started the trilostane to see if she responded. I'm not sure if we followed through with the STIM testing because she seemed to respond to the trilostane. Was told that if she responded, it was more than likely pituitary

We've started her on .35 BID, but she was so lethargic with erratic breathing that we stopped, and the doc prescribed prednisone for 2 days. We then started her back on .175 BID EVERY OTHER DAY. She is usually sensitive to any medication, and she was doing well for a while. The frequency of urinary accidents and excessive drinking came back so we increased her doing to .35 BID, but still every other day.

Again, her symptoms started to come back, along with the panting, so we then went to .30 BID Daily

Memorial Day weekend, she was having trouble walking and keeping her balance, so doctor tried her on clavamox, thinking it could possibly by an inner ear infection, and she seemed to improve. She then followed up with meclizine and my girl bounced back after about 2 weeks. SA120 showed bloodwork was fine (liver enzymes, everything). Abdominal/Chest xray showed no masses...


She was good until July 4th weekend when I got a call that she had a small seizure while sleeping. (Little sidenote: she is deaf, so fireworks didn't spook her) Lost control of bladder and was foaming at the mouth, lasting about 3 mins. She was slow to bounce back, took about an hour, but was fine, just very sleepy. Yesterday she had another one while sleeping, and had same symptoms. By the time I got home about 2 hours later, she was her happy self!

Sorry about the long history, but my girl has a lot going on. Next step, I guess, is getting levels tested again, it's just that everything is so expensive!

[lulusmom]

Hi and welcome to you and Jessie Jane.

I have some concerns and comments which I've typed below in blue text within the body of your last post. Doing it this way keeps me on track as I have a tendency to ramble on. :o


Hey Guys!

Thanks for the quick replies. We did initial testing for cortisol levels, and started the trilostane to see if she responded. I'm not sure if we followed through with the STIM testing because she seemed to respond to the trilostane. Was told that if she responded, it was more than likely pituitary

Both Vetoryl (trilostane) and Lysodren (mitotane) are effective in treating both pituitary or adrenal dependent disease so it is not possible to determine which form of the disease a dog has based on response. This statement as well as the possibility that appropriate acth stimulations tests may not have been done makes me question your vet's depth of experience with cushing's. It would be very helpful if you could ask your vet for copies of all acth stimulation tests and share the results with us.

We've started her on .35 BID, but she was so lethargic with erratic breathing that we stopped, and the doc prescribed prednisone for 2 days. We then started her back on .175 BID EVERY OTHER DAY. She is usually sensitive to any medication, and she was doing well for a while. The frequency of urinary accidents and excessive drinking came back so we increased her doing to .35 BID, but still every other day.

Are you giving Jessie Jane liquid compounded trilostane? I ask because if the total dose compounded was 100 mg, you would draw up liquid to the .35 mark on the syringe, which would be equal to 35 mg. If you are using liquid, the bottle should indicate what the total compounded dose is. Can you please check and let us know? Recommended dosing is 1 mg per lb so 35 mg BID sounds like an appropriate dose for a Boxer. How much does Jessie Jane weigh?

Your vet should have done at least a few acth stimulation tests to determine where cortisol levels were before assuming that Jessie Jane's problems were being caused by low cortisol. Trilostane has a very short half life which is why some dogs must have twice daily dosing to effectively control cortisol throughout the day. I had one cushdog whose symptoms were controlled quite well with once daily dosing and my second cushdog was well controlled with (BID) twice daily dosing. If you are treating with trilostane, I am afraid that every other day dosing is not an effective treatment protocol which again raises my concern with your vet's level of knowledge.

Memorial Day weekend, she was having trouble walking and keeping her balance, so doctor tried her on clavamox, thinking it could possibly by an inner ear infection, and she seemed to improve. She then followed up with meclizine and my girl bounced back after about 2 weeks. SA120 showed bloodwork was fine (liver enzymes, everything). Abdominal/Chest xray showed no masses...

She was good until July 4th weekend when I got a call that she had a small seizure while sleeping. (Little sidenote: she is deaf, so fireworks didn't spook her) Lost control of bladder and was foaming at the mouth, lasting about 3 mins. She was slow to bounce back, took about an hour, but was fine, just very sleepy. Yesterday she had another one while sleeping, and had same symptoms. By the time I got home about 2 hours later, she was her happy self!

As Sharlene and Lori have already mentioned, seizures can be caused by growth of a pituitary macrotumor and so are extreme lethargy and loss of balance. Has Jessie Jane experienced noticeable weight loss? If so, this is also a symptom.

Sorry about the long history, but my girl has a lot going on. Next step, I guess, is getting levels tested again, it's just that everything is so expensive!

Please don't apologize for sharing too much information. You can never give us too much information. The more you share, the more we understand your girl's history which helps us provide you with helpful feedback that makes sense. I had two cushdogs with concurrent diseases who treated with a specialist. They were on the same testing schedule so the bill for their acth stim tests was close to $600. I was paying for vet bills for at least a year after they passed away so boy do I understand the expense factor. I would do it all over again in a heartbeat. I think your decision to have an acth stimulation test done as your next step is an excellent one and I will be looking forward to seeing the results.

If you live in the states, you may want to talk to your vet and suggest that s/he contact Dechra, the manufacturer of Vetoryl (trilostane) to discuss your girl's case and get their opinion. Given the seizures, other neuro-like symptoms and the odd dosing regimen, I think your vet and Jessie Jane may greatly benefit from some guidance from the horse's mouth. I've provided a link to their contact information below.

http://www.dechra-us.com/contact/technical-support

[judymaggie]

Hi and welcome to you and Jessie Jane! All the Cushing's issues have been covered by Glynda and others. I did want to focus on the seizures as my first beagle had several which were different types. You mentioned Jessie Jane's first seizure was small but then you said it lasted three minutes. I am wondering if the three minutes covered the after effects as well as the seizure -- I am hoping so as a three minute seizure is very, very serious. I relied heavily on the Epi Guardian Angels group for guidance and wanted to give you their website:

http://www.canine-epilepsy-guardian-angels.com/site_map.htm

The most valuable things that I learned were what to do during and after a seizure as well as starting a journal, listing what occurred before the seizure, what happened during (including how long the seizure lasted) and then what happened afterwards. The journal is critical when giving details to the vet and will help you and the vet decide on whether any meds are needed.

Hopefully, Jessie Jane's seizures will be short and infrequent!

[dsingley]

Yes, they were the first to admit that they did not have a lot of experience with Cushdogs, but have always been willing to try and get second opinions and feedback from other docs. They've been her doctor since she was a pup, so I trust their concerns for her.

She has had some weight loss, she now weighs in around 56 lbs (she's a short, stocky girl!) which is about a 8 lb weight loss from when she was in her prime.

The decision to treat without further testing was initially our decision due to expenses, but at this point, I'm hoping that we did the right thing by her. For the most part, she has been healthy and happy, just has had urinary and drinking issues which cleared with the trilostane.

As far as the seizures, unfortunately, I have not witnessed either one, so not exactly sure of the timespan. I know that in an emergency, one minute can seem like a half hour! Noone was with her on the second one, my son came home right after the episode. But the recovery was the same that was explained to me from the first one...

And, yes, Jessie is on liquid trilostane.

I'll definitely get her blood work numbers and post them. Thanks again. You guys are great!:)