13 yr old Yorkie w/Cushings but can't take medicine

[Jenk]

Hello everyone. I'm new here. My 13 year old Yorkie "Aria" was diagnosed with Cushings about 3 years ago and we started her out on Trilostane and increased the dosage periodically. I noticed some changes in her around March and she started to vomit/diarrhea, stay in bed and not eat or drink for days. We ended up taking her to the vet to get an IV for at least a day and later on (she's had 7 separate times this year of needing an IV) sometimes more. After the 3rd time that this happened, the vet finally got smart and realized that over the past 3 years, my almost 15 pound dog had lost nearly 5 pounds. The dosage for a dog that size was too high. We dropped from 30 mg twice a day to just 30 mg once a day. Didn't make a difference, she still got sick. She still vomited and would not eat or drink. We decided to take her off the medicine and deal with the consequences. No more vomiting but now she's showing signs of either dementia or a brain tumor but nothing is confirmed. Unfortunately for her and me, I can see her time on this earth is drawing to a close. I'm only detailing this so others might recognize similar symptoms and also realize if a dog is losing a lot of weight, the dosage needs to be lowered.

[labblab]

Hello and welcome to you and little Aria, although I am surely sorry that she is doing so poorly right now. In a situation like this, the first thing I am wondering is whether or not Aria's trilostane dosing changes have been accompanied by monitoring blood testing. I must agree that a daily total of 60 mg. (and even 30 mg.) sounds like a massively high dose for a little Yorkie. However, the only way to know for certain whether or not a dose of trilostane is appropriate for any given dog is to monitor how it is being metabolized by them. Even though initial dosing is based upon weight alone, any subsequent changes can only be made safely if they are accompanied by actual testing of blood cortisol and electrolyte levels. Through the years, we have had small dogs who end up being stabilized on higher doses than are needed by larger dogs who weigh quite a bit more. It is highly variable.

Having said that, I do think it is possible that Aria has been overdosed on the medication, even at the "lower" 30 mg. level. Overdosing can produce problems in at least two ways: cortisol levels can drop too low and/or basic blood chemistries can become unbalanced. So if you can tell us whether or not Aria has been having monitoring blood tests during these past three years, and also the specific numerical results, that will help guide us in terms of the appropriateness of her dose. It may still be the case that trilostane might be helpful for her, but just at a much lower dose than the one you have been giving her.

Thanks in advance for any additional info you can provide, and once again, we are very glad you've found us.

Marianne

[molly muffin]

Welcome to you and Aria.

It isn't uncommon for dogs on medication for a long term, to need a decrease in dosage. That is one reason why regluar testing is needed.

How are Aria's electrolytes? Sodium, potassium, etc as they can get out of wack with low cortisol. IV fluids will usually clear this up and then you don't need to do medication unless symptoms of cushings comes back.
I just wonder if electrolyte or another imbalance might be contributing to the continued decline. Also has her glucose been checked and kidneys?
Just thinks we always have to be on the look out for as our furbabies get older.

Welcome

[Jenk]

Hi Sharlene and thank you for your kind words. Aria is suffering from Kidney problems brought on by taking too high of a dosage of Trilostane. She's had about 10 blood tests in the last 6 months and the vet is monitoring her levels the best they can. I don't know what they are at the moment because they change frequently. She had two very extensive blood tests last week because of a teeth cleaning and later an ear infection which seemed to create something similar to pneumonia or bronchitis that created the need for another IV and injection to get rid of whatever they thought she might have. I do know the vet is going to put her on a drug for dementia which also helps with Cushings for two months to see if anything improves. If not, we can almost rule out dementia and my guess is it's either kidney failure or cancer. Thank you for your concern.

[molly muffin]

If it is kidney failure then the creatinine will be high along with the BUN and they can do an SDMA test that is specific for kidneys. Still if all of this is due to the high dose of cortisol, then it might be correctable. Did she go Addisons or just very low?
Cancer it just depends if it is and where it is, but it everything depends on each other.
Remember, one thing goes off it affects many other things in the body and it takes time for everything to come together in a recuperative manner. Teeth, is a huge bacterial issue and so after a cleaning, you can see liver enzymes improve and other things. So I'm holding on to hope :)

[labblab]

In the midst of all the blood testing, I'm really hoping they have been checking Aria's cortisol level? Dogs who have gone Addisonian due to loverdosing can exhibit lab abnormalities that can be mistaken for kidney failure. Once the cortisol/aldosterone levels are stabilized with supplemental steroids, most dogs who have been overdosed can be normalized once again. Can you give us the actual results for the most recent ACTH stimulation test that has been done? Has Aria ever been given any prednisone since the time of the suspected overdosing?

Marianne

[Jenk]

Hi Sharlene and Marianne. It has been awhile since we had a ACTH test because at some point, we decided taking her off Trilostane was best. She's been on Anipryl since Wednesday which should help with her dementia and Cushings but it's up and down. Yesterday she didn't sleep almost at all but walked continuously. When I noticed she was staring up at the ceiling at 3 in the morning, I picked her up and put her in bed. She finally went to sleep. This morning she didn't want to do anything but lie down. No eating or drinking. I could tell the end was near. I took her to the vet and they agreed that it might be time to put her down. I couldn't. We gave her some Subcutaneous Fluid Therapy and she's back to almost normal. I know her days are numbered but I'd rather God make that determination than me. Thank goodness I started her on a plan at Banfield Pet Hospital. We've gone through all of the tests that come with the plan but at least every office visit is free since I already paid for the plan. Yes she definitely went into Addison's thereafter but we put her on Prednisone when it looks like she's going into a stressful situation. Thanks for the concern!

[molly muffin]

It's never easy to be in that situation of having to make decisions. Many of us have been through it, some recently.

An ACTH would not be a bad idea as it can tell you how she is doing cortisol wise and there is a therapy for Addisons that they can put her on which could help.