Cushing questions my Codyboy just diagnosed

[Codyboy]

Hello to you all, Codyboy and I are new to your forum. I've never joined a forum before and I hope I am doing this right. I have a few questions on this cushing's disease that my 12yr old Shilo shepherd was diagnosed with last week. My vet wants to start him on 120 mg vetporyl 1x a day to start the 44-88 pound doasage. CODYS symptoms started with the constant panting, excessive drinking and urinating, hind weakness and wasting and now bowel control, I had him checked with the orthopedic and was told he had a lot of arthritis thruout his lumbar spine and hind knees so they ruled out degenerative myopathy , I still want to get the blood test to def rule this out. That being said with Cody's symptoms and being dionosed with cushing's , when I start him on this medication will it relieve any of these symptoms and how long does it take. I would like your advice with what your fur baby has gone thru and if things got better after medication. Thank you all .
Cortisol-pre. 4.9. Reference 1.0-6.0 ug/dl
Cortisol-4hr 4.6. Reference
Cortisol-8hr. 2.6

[labblab]

Hello and welcome to you and Cody! I have only a moment to post, so apologize that I only have time to discuss one thing right now. But I'm hoping to catch you before you buy the 120 mg. capsules. In years past, initial dosage recommendations were higher. However, the most recent recommendation made by the maker of Vetoryl (which is a revision to their dosing chart) and most specialized clinicians is not to exceed an initial formula of 1 mg. per pound. I'll come back later and give you some specific citations.

Can you tell us exactly how much Cody weighs? From the range you are giving, I'm guessing that the 60 mg. capsule may be a better fit. There are a couple of reasons for this that involve both safety and also financial considerations -- you cannot split capsules, so especially when starting out, it is better to combine smaller capsules than to start with a large capsule that can no longer be used if a decrease is warranted.

So once again, welcome, and stay tuned!
Marianne

[Codyboy]

Thank you I was thinking this was to high of a dose. Cody weighs 84lbs haven't started any medication yet it was on back order

[lulusmom]

Hello and welcome from me too.

In addition to the information Marianne has already mentioned, I would like to know if an abdominal ultrasound or other test was done to determine which form of cushing's Cody has...pituitary or adrenal? Sometimes the results of the LDDS test can tell us if a dog has pituitary dependent disease but unfortunately, Cody's does not so a differentiation test would be necessary to make that determination. The law of averages say it's most likely pituitary but you can't be sure. If my dog had an adrenal tumor, I would definitely want to know as these tumors are often malignant and survival time is greatly diminished. You cannot make that differentiation after treatment has started so if this has not been done yet and your finances allow, you may want to consider an abdominal ultrasound. I would definitely be interested in imaging given the bowel issue, which is not a symptom commonly associated with cushing's.

With the exception of the excessive drinking and peeing, all of the other symptoms you mention can be attributed to arthritis in Cody's lumbar spine and knees. Was a urinalysis, including a urine culture done to determine if the excessive drinking and peeing is due to cushing's and to rule out a urinary tract infection? Your vet should have done a full senior screening before the LDDS and it would be helpful if you could please share the results of the blood chemistry and complete blood count (CBC). You need only post the high and low values, and please include the normal reference ranges. Also can you share the results of the urinalysis? We would be most interested in seeing the urine specific gravity (USG).

With respect to your question about how quickly you can expect to see improvements, the answer is dependent upon whether the initial dose is adequate. My cushdogs responded in the first week with vast improvement in symptoms but I was fortunate that both stabilized rather quickly on the initial dose. As Marianne mentioned, the 120 mg prescribed by your vet is too high. Recommended started dose is now 1 mg per lb of body weight. This is particularly important to note for bigger dogs as a study found that:


Dogs weighing more than 66 lb (30 kg) required less trilostane to control their clinical signs. The results did not achieve statistical significance, but a trend suggested that as body weight increased, the relative amount of trilostane needed to control signs decreased. The researchers also found that only 11% of dogs required more than 3 mg/kg/dose to control their disease—the manufacturer's recommended initial dose is 3 to 6 mg/kg once daily.

For clarification, trilostane is the active ingredient in Vetoryl. You may want to share this information with your vet. The abstract can be found at https://www.ncbi.nlm.nih.gov/pubmed/22708554. You may also want to share an article from July, 2014 in Vet Times (in the UK) announcing the new lower recommended starting dose. That can be found at https://www.vettimes.co.uk/news/new-lower-starting-dose-for-vetoryl/

Before you start treatment, I highly recommend that you make sure that you and your vet follow proper treatment and treatment monitoring protocol. I've two of Dechra's brochures below, one for pet owners, which includes important Do's and Don'ts and the other includes a treatment monitoring chart which will help you understand a bit more about the acth stimulation test. Please let us know if you have any questions. I know this is overwhelming and that your head will be spinning for a while. This is completely normal and the more you learn, the more relaxed you will become.

921

922

Reading your intro brought back memories of when I showed up on our predecessor site many years ago to reach out for help with my second cushdog. Marianne was there to welcome me and was a major contributor to my continuing education. My first cushdog was diagnosed three years before that and I thought I knew what I was doing but I quickly discovered how ignorant I was. LOL I had never been part of a forum before and was never really technically savvy so it took me a while to figure things out. I promise that you'll get the hang of it. If I can do it, anybody can do it. :D

Glynda

[Codyboy]

Just a quick note Cody did have his ultrasound the same day and showed normal size Adreanals and have a full blood work up. His wbc was a bit up 16.98 ( 5.5 - 16.9) neutrophil - 14. (2-12) on ultrasound he had an enlarged spleen with nodules seen inside, biopsy reveled them to be myelolipoma tissue benign yea. Cody had surgery on 10/17/16 to remove his spleen and did recover well. now I have to work on this Cushing diagnose. My vet did give me a printout on the ACTH protocol and constant maitence while on this medication.

[labblab]

Hi, me again! I'm so glad Glynda was able to give you so much more thorough a welcome! Just a couple more quick comments from me...

First, you'll see that I've moved your thread here to our main discussion forum. This way, our members are more apt to see your thread and have the opportunity to write to you.

Secondly, here's the link that I mentioned earlier re: revised initial dosing recommendations. It may duplicate some of the references that Glynda has already provided, but I'll go ahead and give you the chance to take a look.

http://www.k9cushings.com/forum/showthread.php?p=1251#post1251

Marianne

[DoxieMama]

Welcome from me, too. I'm not an expert by any stretch, but am curious if Cody's symptoms may have been from the arthritis and spleen issues rather than Cushing's. If his spleen was only just removed on the 17th, then an ACTH test done a week later, wouldn't that have effected the results? I'd want to be sure that he is fully recovered from that surgery before testing for the next thing.

Just a thought!

Shana

[Squirt's Mom]

I'm also wondering about the normal appearance of the adrenal glands on the ultrasound. Typically we see at least one of those glands enlarged...tho with Cushing's ya just never know so I guess normal adrenals could be feasible! ;)

[lulusmom]

Thank you for your response. Normal size adrenal glands are possible with cushing's but that's not the norm. Nor are the results of the CBC. Do you have copies of the blood chemistry? I would be very interested to see results of liver enzymes ALT, ALKP and GGT as well as cholesterol and triglycerides. These are all commonly elevated in dogs with cushing's. Was a urinalysis done by your vet to make certain that Cody's drinking and peeing are clinical manifestations of cushing's? The clinical terms for this is polyuria (excessive urination) and polydipsia (excessiving drinking). As I mentioned all of the other symptoms you listed can be attributed to arthritis so in the absence of the normal organ abnormalities on imaging and no urine tests, I am concerned with the accuracy of a cushing's diagnosis. Does Cody have a voracious appetite and I mean a hunger that makes him beg constantly, finishes his food in seconds and leaves the dish looking like it's right out of the dishwasher? Does he have any loss or thinning of coat. Any problem with the skin and/or any changes in skin pigmentation?

[lulusmom]

I also forgot to mention that Leslie's beloved Squirt was misdiagnosed with cushing's. As I recall, it was her spleen which caused false positive results on the LDDS and/or ACTH stimulation test. Like Cody, she had her spleen removed. This was another red flag for me. I hope Leslie will come back and share her experience.

[Codyboy]

Shanna , my Cody went into the vet for the Cushing test , full CBC/Chem, & ultrasound, that's when they found the spleen situation. So to prevent it rupturing I had it removed. Waited for the biopsy making sure it wasn't cancer in there which luckily it wasn't . Now we can move forward with treating the cushing's

Lulusmom, the only thing about CODYS appetite he is not begging for food, he does however hunt the yard for stool to eat which he never did that before. His ultrasound report states his adrenals were high end normal size and echo texture <0.7 cm diam poles R + L ddx normal vs PDH
My vet told me that still doesn't mean there isn't a very small tumor there , the IDEXX Lab came back with the numbers on his low dose dex test leaning towards pituitary tumor vs Adreanals
Is there a way of me posting his blood work and urinalysis on here, maybe a second opinion is warranted
I do have an appointment tomorrow with the neurology to run the DM test I will ask about this cushing's

[Squirt's Mom]

Yep....Squirt had the LDDS, HDDS, ACTH, Ultrasound, and UTK panel...all came back positive for the pituitary based form, PDH. However, the US showed a tumor on her spleen and once the tumor and half her spleen were removed her cortisol returned to normal. She was tested again after she had fully recovered from the surgery and her cortisol was normal.

Cortisol is one of the body's natural responses to any stress - internal or external. A dog who is terrified of the vet can have cortisol elevations as high as a cush pup and can test positive on the cush tests but not have Cushing's....that is a normal response to the stress of being in the vet's office for that dog. ;) A tumor is a stressor and in Squirt's case caused false-positives on all her testing until it was removed.

[Codyboy]

Just had CODYS blood work repeated on 10/29 the results were as follows. ALP- 278. (5-160 U/L ) it's been going higher
GGT- 6. ( 0-13 U/L )
ALKP don't see on record, need to call vet for that
Cholesterol was on 10/17 ( 254) 10/19 ( 396 ) 10/29 (278 )
Reference is 131-335 for cholesterol.

His WBC rangeing from 16.98/ 33.15/now 22.2 Ref: 4.9 - 17.16
Neutrophil range from 14/ 29.35/ 19.003 went up now coming down but still in the high range. Ref: 2.94 - 12.67
Monocyte range norm 1.92/ high 2.84 / now 1.31 ref: 0.13-1.15
All other blood work was within normal range.

In regards to his skin he is showing balding spots around his elbows, and on his legs. His coat is looking Drabby. I hope you understand this.

[Harley PoMMom]

Just had CODYS blood work repeated on 10/29 the results were as follows. ALP- 278. (5-160 U/L ) it's been going higher
GGT- 6. ( 0-13 U/L )
ALKP don't see on record, need to call vet for that
Cholesterol was on 10/17 ( 254) 10/19 ( 396 ) 10/29 (278 )
Reference is 131-335 for cholesterol.

ALKP and ALP are the same thing just abbreviated different, ;) it stands for alkaline phosphatase and is an enzyme mostly produced by the liver but some is also made in the bones, intestines, and kidneys.

We commonly see dog's with Cushing's have their ALP in the 1000's :eek:


His WBC rangeing from 16.98/ 33.15/now 22.2 Ref: 4.9 - 17.16
Neutrophil range from 14/ 29.35/ 19.003 went up now coming down but still in the high range. Ref: 2.94 - 12.67
Monocyte range norm 1.92/ high 2.84 / now 1.31 ref: 0.13-1.15
All other blood work was within normal range.


Was an urinalysis done? An UTI will cause a dog to drink and urinate more and infections can cause elevations in the WBC (white blood count).

Hugs, Lori

[Codyboy]

Took Cody to a specialist 11/1/16 the Dr preformed a ACTH stimulation test to verify if Cody definatly has cushing's and check pituitary vs Adrenals & compare with his low dex results. His results were post 26.5 ug/dl . I still have to get him in for a urine culture & protein creatinine ratio/endogenous Cody has not started any treatment of Vetoryl as of yet. My first vet wanted to start him on a 120mg dose 1x a day, I thought this was to high. She didn't have it in stock is on order. The specialist said to start him on 40mg 2x a day total 80 mg a day. Does this formula sound better to you? I just want the lowest,safest dose to start him on. Cody also has full arthritis in his back and joints dr put him on derramax 37.5 mg 1x a day. It helps a little but I'm going to start with the adiquan. Injections I hope this will help him, he is becoming so lame. Once I get results of his urine test I will post if he has a uti or not. I just want him to feel like his old self again. Any positive news on treating a Cush pup with arthritis and disc disease ?
This all began happening in August I need to get ahead of this, so fustrating. Everybody says different things��

[Squirt's Mom]

Hi,

I'm going to be very blunt. There is no way in holy hell I would start Cody on treatment for Cushing's at this point.

He is less than ONE MONTH out of a rather serious surgery and that is not long enough to say he has fully recovered. It takes months! I would simply make sure he is truly recovering well from the spleen surgery and let him get back to his old self then think about looking at the Cushing's again if, and ONLY IF, he is still showing signs. Let him rest from the surgery, stay away from the vets to lower his stress level (and yours), eat good food, drink clean water, play as he feels like, and beg for all the lovin' you can dole out. And that is all I would do for at least the next couple of months.

However, this is your baby and you have to make the final decision. If you decide to start him on the Vetoryl, yes the 40mg 2x a day is appropriate to start for a dog weighing 84lbs. ;)

But again - no way I would start him on treatment now if he were mine.

Hugs,
Leslie and the gang

[Joan2517]

Blunt is good...Leslie is right. It is way too soon to start Cody on treatment for Cushings. Let the poor guy rest a little. There will be a lot of stress with the testing and he shouldn't be stressed out while trying to recover from major surgery.

[labblab]

Hi again from me, too! Given Cody's entire picture, I guess I'm not as skeptical of Cushing's as are some of the other folks here (excessive panting/thirst/urination, thinning coat, rising ALP, certain types of white cell elevations, adrenals on the high end of normal range on ultrasound, etc.). However, having said that, I don't disagree at all with the notion of giving Cody more time to heal from the removal of his spleen before making the decision to start treatment. It will be interesting to see whether or not his lab values normalize even more fully after a bit more healing time. However, if he were mine and his external symptoms are still present just as strongly 4-6 weeks from now, I believe I would go ahead and repeat the blood cell counts and chemistry panel in order to see whether there have been significant changes in either direction. If the abnormalities increase and the overt symptoms worsen such that they are compromising Cody's quality of life, then yes, I'd revisit the notion of starting the Vetoryl at that time (and also yes, I think the 40 mg. twice daily is a reasonable starting dose).

One comment as far as the mobility problems, though: it's certainly true that Cushing's can cause high-end muscle wasting and ligament damage. But given Cody's age and apparent skeletal issues, it's hard to know whether or not Cushing's treatment will make much difference in that regard. If Cody truly does have Cushing's and you begin treatment, you may be more likely to see improvements in the panting/thirst/urination/coat issues as opposed to vastly improved mobility.

Marianne

[Codyboy]

I just want to thank you all for your advice on my Codyboy. It has been a big help to me. It has only been 3 1/2 weeks since his surgery and I will take your advice and give him time to completely heal. I am still waiting on a few more test results to come back. His DM test which they don't think he has , his steril urine culture , and checking on the protein levels and endogenous test. I have not started him on any cushing's medication yet. I really want to get him in for therapy to regaine his hind end weakness from his athritis, disc disease . I've heard acupuncture / chiropractic has worked for some dogs, any opinions or feed back would be great. I had started him before splenectomy with only 4 doses of adiquan , 2 cold laser treatments , and was gonna start Him back on the water treadmill again. But had to stop all due to the surgery.
I do sometimes think the panting,thirst,and urinating & bowl weakness could all be coming from his back and spine issues. I am getting so confused on what to do. Right now he only gets derramax 37mg 1x a day and 1 1/2 tramadol 2 X a day. They gave me gabapentian too which I tried 1x at bed time for a week but he got so much more imbalance in his legs, And would fall too much. My vet said I needed to give it more time but I don't want my baby to fall and make his back worse. ??????? Any advice please..

[judymaggie]

Hi! I just wanted to let you know what I have tried with my beagle, Abbie, who has IVDD. This past February she had surgery for a ruptured disc in her neck. Prior to her surgery I had tried acupuncture -- Abbie barely tolerated the first two sessions. At the third session she was squirming so much she shook off any needles that the vet had been able to insert. (I will say that this is certainly not the typical reaction -- I think one issue was that the vet had Abbie up on an examining table rather than trying to make her comfortable on the floor. I had taken my last beagle to an acupunturist who spent a great deal more time comforting her and there was a different reaction.)

We both agreed that something else needed to be tried and she referred me to a chiropractic vet who came to her office to meet clients. At Abbie's first visit with the chiropractor I was amazed to see how much more comfortable she was after just 15 minutes. She visibly relaxed and had no problems with either manual or mechanical manipulations. A few months after Abbie's surgery she was in obvious pain in her back -- tramadol and Deramaxx offered some relief but she was still unwilling to go on walks. I decided to start chiropractic visits again. We went every week for a couple of months -- I would see improvement for only a few days and that is why we went so frequently. Then I saw the improvement gradually last longer and we now are going once a month. Abbie still has many days when she is obviously uncomfortable but, like you, I don't want to keep piling on the pain meds which put her into a stupor. I don't think that is a good quality of life.

[Codyboy]

Hello everyone just wanted to give you an update on my Codyboy
Cody is doing great after his splenectomy and after all testing and retesting for his cushing's it was a definite pituitary type so I started him on the tirlostaine 120mg 1x day in the morning he took it for 12 days then had him retested his post number was 3.6 which was a normal range, that made me happy. the panting went away and he is more relaxed. The only thing concerning me is he is loosing his appetite and still seems to be weak. But he does have a bum knee and athritis in his back end, I just started him on therapy to regaine his lost muscle mass in his hind end. Any pointers on how to get my baby feeling good enough to want to go for walks again. Has anyone had problems with this medication? And what should I watch out for. He hasn't had any vomiting, diarrhea , ect. Just his loss of appetite and being weak, I'm hoping this will get better. Thanks for listening
I'm so glad I found this forum.

[labblab]

Welcome back to you and Cody! Can you please tell us how long it has been now since his 12-day ACTH test? The reason why I ask is because cortisol levels can continue to drop downward for a full month or so even when the dose remains unchanged. That's why a second ACTH test is recommended at the 30-day mark after beginning treatment.

It is true that 3.6 would be within therapeutic range if that's where Cody's cortisol level had remained. But whenever I hear about Cushpups losing their appetite and growing weaker, I worry that cortisol may be dropping too low. It's good that Cody is not acutely ill, but it would be far safer to recheck his cortisol level before he might reach that point. So please do update us regarding the timetable for his treatment.

Marianne

[Codyboy]

Hello labblab Cody's test was on December 2, his next 30 day mark is scheduled for December 30th. Should I not wait 30 more days and retest in 15 more days instead? I am keeping a close watch on it, he might not be excited on eating but he does eat his meals morning and evening.. If he stops eating I will have him back to my vet sooner and I will stop the meds.. It's nice to know you all know so much about this disease and have been very helpful.

[Codyboy]

Hello Maryanne , I had a question maybe you can help. Cody's tirlostaine was reduced from 120mg 1x a day to 90 mg 1x a day he has been on this dose for 1 week now his appetite still isn't good,( he will eat but has gotten very picky looking not happy and is still weak. Should I change it to a lower dose or maybe the 40mg 2 X a day. His weight is 82 lbs. I am so full of anxiety and sadness to see him getting this way. Im so frustrated I want to just take him off this medication. I just want him to regain his strength and want to eat. Please help !!!!!

[labblab]

Please bear in mind that I am not a vet, and I recommend that folks always discuss any proposed treatment changes with their own vets before moving forward. But if Cody were mine, this is what I would do.

At his age, comfort and quality of life would be my top priorities. So if he appears to be more uncomfortable now than he was before starting the trilostane, I would stop it completely, at least temporarily. I would want to see whether he regains his appetite and energy while off the medication. Even if he truly does have Cushing's, significantly lowering his cortisol level may expose other problems that a higher level of cortisol was actually easing (like arthritic pain, for instance). For a senior dog, treatment can have trade-offs, and in Cody's case it may not be worth it. Or in the alternative, treating with a lower dose of medication may be preferable.

So I would stop the trilostane altogether for a while and see what happens. If Cody perks up again but the thirst, peeing and panting also increase again, I would revisit restarting the trilostane but this time at a dose no higher then the 80 mg. daily total that the internist originally suggested. If you are using brandname Vetoryl capsules and you have 60 mg. capsules on hand, I'd probably start as low as that. And then I would start fresh with the testing cycle and retest again after 10-14 days.

Once again, I would take no action without letting your vet know. But these are the options I'd want to discuss. I surely hope you can get Cody back to feeling better again.

Marianne

[Codyboy]

Thank you labblab this is what I have decided to do. I'm going to stop the tirlostaine this past 2 weeks have been unbearable watching his appetite dwindle to eating barley nothing and becoming so weak, I'm just so upset with my vet right now, I feel she doesn't really listen to what I have been telling her. Cody went from the 120mg 1x day then tested 3.6 then we lowered dose to 90 mg 1x then retested and his number went to 10.2 so the past 4 days switched to 50mg 2x day.
This is getting so ridiculous I feel like this medicine is killing my dog. I am going to stop it all and hope for the best. Maybe my baby will start to feel better. I have an appointment with my other vet on Tuesday. we will discuss how to just keep him comfortable hopefully regain back his appetite and his athritis problems. Thank you for starting this forum it really helps me get my frustrations out . I'll keep you updated and let you know how this all plays out for my Codyboy. Another quick question? Once I stop the tirlostaine how long does it take for his Adreanals to start working properly again ?

[labblab]

Hello again to you and Cody. I remain very sorry that he does not seem to be reacting well to the trilostane at any dose, and as I wrote earlier, I do believe I'd try stopping it altogether, too. I wish I could give you a definite answer as to how long it will take for his cortisol level to start rebounding upward again, but we have found that the time varies from dog to dog. Theoretically, it should only take a few days and for many dogs this is true. But we have seen other dogs who take longer to bounce back. You'll just have to wait and watch to see how things go. Please do keep us updated, though. We will really want to know how he does once he is given a break from the medication.

Hang in there, and please give Cody a big pat for me!
Marianne

[Codyboy]

Thank you I will

[Codyboy]

Just want to let you all know that Cody has recovered greatly after taking him off the tirlostaine , his strength and appetite game back and is feeling like himself again. He pants a little but not like before. Don't ever let your doctors give you the bigger doses. It almost did my Cody in. I'm giving him a break and will decide later to restart the meds at a lower dose only if his symptoms come back full force. I do thank god that CODYS cushing's is pituitary and was able to use tirlostaine and not lysodron so I was able to stop it without any side effects or damage of his Adreanals . Please to you all out there with cushing's babies don't take this medication lightly, start with the lowest possible dose then go from there. My vet started my 82 lb shepherd with 120mg 1x a day which made my dog feel sick and not want to eat and became so weak. Even switching to a 90mg 1 X a day dose same effect. Then switched to a 50mg 2x a day my vet up it but split the dose, still my dog was getting sicker. So this is when I said enough is enough and saw a new vet who agreed with me to stopped the meds, we ran a blood test for his resting cortisol level and it was 2.9 so I was happy that he didn't develope addisons.
He has been off the meds for a week now and we are so happy to see our baby feeling good.:):)

[Harley PoMMom]

So happy that Cody is doing much better!!! You're doing a great job, Mom!!

[molly muffin]

Yay!!! So glad Cody is doing better.
You're right. You have to take the meds seriously and low and slow is our motto for this very reason. No one can say for sure how any one dog will react to any medication.
Good job!

[Codyboy]

Good morning lulusmom , had cody off tirlostaine for 2 months now, he was ok for a while then the heavy panting came back then the excessive drinking and peeing. He started getting weaker and weaker so I just had him back into the vet , he was only taking rimadyl and tramadol for his athritis these past few months with famodine. I wanted blood work done and results were kidneys good / but liver values went way up. His ALT- 487 ALKP- 475 so the put him on
Denamarin 425 mg 1x day // metronidazole 250mg 2x a day and amoxicillin 250mg 2 tabs 3 X a day. To help out liver. But everything I'm reading cushing's untreated will effect the liver so I just started him back on the tirlostaine but a low dose of 50 mg 1 X a day. The old doses were 120 mg then 90 mg and both of those in the past made him loose his appetite and become lethargic .
AM I DOING THE RIGHT THING PUTTING HIM BACK ON THIS DOSE OF TRILOSTAINE?

[Squirt's Mom]

Welcome back...first, the Rimadyl is VERY hard on the liver so the first thing I would do is get him off of that and on another pain med if really needed. Second, he needs an ACTH **before** restarting the Vetoryl. ;)

[Codyboy]

Yes cody has been off rymidal for a week now and just on amoxicillin ,
Metronidazole , derimamin for his liver. He now is getting so weak it's so hard for him to get up and has totally lossed interest in any kind of food. Cerenea had helped a bit to make him eat a little. I think he is nearing the end, between his cushing's ,bad athritis and now because of the rimadyl his liver values went up into the 400's. It's been only 4 days on this liver medication just want to know how long it takes to make him feel better again, or is it time to make that tough decision .
I want to give him a fighting chance, but I see him so weak now that by morning I help him up and noticed that he peed under himself a little. SO LONG STORY SHORT how do you know when to give up and let go....

[Joan2517]

I'm sorry that Cody is doing poorly. It is very unfair that we try so hard, they go through so much and then we get to this point of wondering if it's time to give up and let them go. My thoughts and prayers are with you.

[Codyboy]

--------------------------------
Thank you it's such a hard decision .Just wanted to ask you if I made the right decision taking cody off the TRILOSTAINE for the past few months. Just a refresher when Cody was diagnosed they put him on a 120 mg dose 1x a day which brought his levels to normal but made him week , lethargic and loss of appetite . So we changed to 90 mg didn't change anything then switched to 50 mg only on for 4 days then decided to stop all together and give him time to reboot which he did. Appetite came back and he was feeling good. Just had bad athritis days, so my vet said put him on rimadyl 50 mg 2 X a day and tramadol for any discomfort. And I also had him in hydrotherapy 1 X a week to build up muscle and strength . With in the last 3 weeks Cody started up with the heavy panting, drinking and noticeably a big appetite. I was growing concerned and ask the vet a few time should I start him back on the 50 mg TRILOSTAINE again she kept saying not yet. I don't think she was too concerned . Now as of last week I noticed his appetite decreasing. And on Monday 4/10/17 took Cody in for blood work he wasn't looking good. His alt & altp were both in the 480
Not sure if the cushing's took a toll on him not being treated these past 2 months. He's on the liver treatment amoxicillin , metronidazole and deramin and cerena only 3 days now. He still has no appetite and is very weak, I wanted to restart the TRILOSTAINE but with no appetite I'm afraid it will make him worse. The vets never give me answers . I want to hold out and hope he feels better soon but my husband says it's time to let him go. I don't know much about how this Cushing's works and what course it takes. Am I too late to fix it.

[labblab]

I am so very sorry that you guys are having such a tough time. I'm afraid I only have a moment to post right now -- I'll try to come back later on today and write some more. But I think you did do the right thing by taking Cody off the trilostane, and under these circumstances, I wouldn't start it up again now either. I can surely understand why you're so worried and upset, though. And as I say, I'll try to check back in and write some more later on.

Marianne

[Harley PoMMom]

Since Cody is not eating regular meals the Trilostane should not be given. Getting Cody to eat is the most important thing right now and I know how frustrating and worrisome it can be when they lose their appetite.

Sometimes enticing their appetite may help and usually for a dog the stinkier the better :eek::D some that I have used are tripe, grated parmesan cheese, yogurt, warm meat broth, boiled potatoes. Also carbs are a good filler such as pasta, oatmeal, barley, and quinoa.

I searched for food toppers and found this: http://www.flavoredspray.com/about.html

Oh, forgot something, I have used baby food in the past for some of my picky eaters but make sure it doesn't contain any onion or onion powder. And one more tidbit :o Dogaware has a really informative article on their website that pertains to a dog with a loss of appetite, here is the link: http://dogaware.com/articles/wdjinappetence.html

One of the supplements they recommend is slippery elm bark (SEB) which I and others have tried with success. One caution note with SEB is that it slows down the absorption of other drugs or herbs so it is recommended that it be given 2 hours before or after other herbs or medications. I'm providing a link with information regarding SEB: http://www.littlebigcat.com/health/slippery-elm/

Keep us updated.

Hugs, Lori

[westcoastflea1]

if you do decide to put him back on vetoryl i would start with dosing twice a day they make 10 mg and 30 mg maybe start him on 10mg 2x a day see how that goes

[molly muffin]

I've always used the quality of life to try to judge what to do as I think that is the single most important thing. If you can get him eating alright, so he could have vetroyl then the smaller dose would be an option. It can be a balancing act for sure.
Right now, getting him to eat the liver values down (especially the ALT) is important, probably more than the cortisol.

[lulusmom]

I apologize for not responding sooner. Dogs with cushing's most often have moderate to severe elevations in ALKP. I've seen this liver enzyme in the 4,000's and 5,000's so Cody's elevation is mild compared to the vast majority of blood labs we’ve seen. “There are two sources of ALKP, the liver and bones. But in dogs, two isoenzymes originate from the liver: a liver-specific isoenzyme and a corticosteroid-induced isoenzyme.” Dogs are the only species on earth that have the corticosteroid-induced isoenzyme but a very, very small percentage of dogs are lacking that genetic marker so there really are dogs who have cushing’s whose ALKP is normal. Because steroid induction does not kill or damage liver cells, liver support supplement such as Denamarin may not have any effect at all in lowering this liver enzyme. That’s a long explanation for a very short answer but I wanted to clarify for members as to why Denamarin is not an effective fix for high ALKP caused by high levels of cortisol. :o ALT is usually mildly elevated or normal in cushdogs and that's not the case with Cody. His ALT is higher than the ALKP and while you didn't post the reference range, I do know that an ALT of 487 is a four-fold increase according to most lab reference ranges. This could be a sign that a non-adrenal issue is having an adverse effect on the liver in which case Denamarin would help in regenerating liver cells.

Metronidazole is not prescribed specifically for the liver. It is prescribed for irritable bowel, pancreatitis and even non specific causes of diarrhea. Is Cody vomiting or experiencing diarrhea? I am wondering if there were other abnormalities on the blood chemistry that suggested a gut problem that would warrant treatment with Metronidazole? Can you please check the test results and let us know if there were any other abnormalities besides the ALKP and ALT? To quote Dr. Edward Feldman, cushingoid dogs aren’t sick, they are polyphagic”, meaning they are extremely hungry all the time. They don’t quit eating unless there is an underlying complication. Low cortisol can cause gastrointestinal problems and inappetence so I am wondering when the last acth stimulation test was done?

In my layperson’s opinion, I don’t believe cushing’s is the culprit for Cody’s problems right now and if your vet cannot determine the underlying cause, you may want to consider consulting with an internal medicine specialist (IMS), and the sooner the better. An IMS is in an excellent position of experience and knowledge to get to the bottom of Cody’s problem and is also much more qualified to tell you if Cody’s condition is bad enough to consider euthanasia. I’ve had dogs with kidney and liver failure on IV fIuids for days and they lived to see many more years so I wouldn’t give up on Cody yet, especially since you don’t know what's causing his extreme lethargy and lack of appetite. I am familiar with quality of life decisions as my first cushdog had severe osteoporosis which destroyed her quality of life. I had to make the decision to release her from the pain. :( If you let us know what city and state you are located, members may be able to provide you with a reference to an IMS. You can also search here: http://vetspecialists.com There are drop down boxes that will require you to click on the Type of Specialist and Small or Large Animal practice. The Type of Specialist you need is Veterinary Internal Medicine in the practice is Small Animal.

I look forward to your updates on your precious Cody and will be keeping fingers and paws crossed that he turns the corner soon.

Glynda

[Codyboy]

Hello cushing's family friends, I first want to say how great you have all been with helping us with all of our supporting questions. On that note A month ago my Codyboy wasn't doing well, the rimadyl or being off the TRILOSTAINE had caused his ALT & ALKP to rise both 487/475 after 2 weeks of liver treatment the values went down to ALT-137 and ALKP - 308. Which my vet said was good vs his bad athritis and spinal disease. We started him back to the TRILOSTAINE again at a lower dose of 50 mg 1 X a day ( Cody's weight 80 lbs ) on 4/28 - 5/3 by the 9th day his started loosing all interest in any kind of food again. He now has been back off the TRILOSTAINE again 3 days now and appetite slowly coming back. If and when I try the medication again how low of a dose should I try. I want to help with the panting, constant drinking and peeing. If I decide to not put him back on the TRILOSTAINE, can I put him on proin and would this help with the frequent urinating. Cody does ok during the day it usually happens when he's lying down and mostly at night I hear home getting restless 2-3-4 am and by the time I get him up he started leaking where he sleeps. Just wondering if proin would help with that and if anyone has had good results with a Cushing dog. My lab who is the same age and weight as Codyboy has been on proin low dose 25mg 1 X a day for 10 months with no side effects. So basically I'm asking 2 questions
1- do you know if proin has helped with the bladder on a Cush dog
2- what dose of TRILOSTAINE is appropriate to help a little without causing him to loose his appetite.
So much trial and error here patience is really needed...

[Codyboy]

Hi glynda, just wanted to point out CODYS liver ranges both highs range is
ALKP- 23-212 . ALT 5-160 . I'm personally thinking Cody picked up some kind of intestinal bug causing him to feel like crap and after 2 weeks of antibiotics and derimamin his levels came down and began eating again. So who knows???
Didn't want to put him through the whole stim test again feeling the way he was so I had my vet run a resting cortisol level on April 26th along with his blood work and that level was 4.3 ref# 2.0-6.0 even though this was normal he had all the extreme cushing's symptoms back again.
So I started him back on the TRILOSTAINE at a low dose of 50mg 1x a day. Started to work but when I reached the 8/9 day dose he did not want to eat again . My vet suggested stop it again and then possibly when he's feeling good and eating again start him up at every other day . I am so darn confused. The main symptoms he get with this Cushing's is the excessive thirt , urinating, and panting. I wondering on treating the urinating symptom with Proin. My lab who is same age and weight has been on a low dose 25mg 1x a day it for 10 months now with no side effects. Wondering if this has helped with a cushing's dog situation?
Oh yes I forgot I live in woodlyn Pennsylvania in Delaware county zip code 19094.

[Harley PoMMom]

If this were me, I would probably give the Trilostane another go and restart at a very low dose and give it twice a day as this may help get better control of those symptoms. A Trilostane dose of 10 mg BID, for a daily total of 20 mg is what I would restart at. The results of one study indicated that larger dogs require smaller doses so it is entirely possible that a low dose would be adequate for Cody. And since I am such a worry wart I'd have an ACTH stimulation test performed before starting the Trilostane back up.

Proin is definitely an option, another alternative RX medication is Incurin.

Lori

[Codyboy]

Thank you Lori , it's been 3 days off the TRILOSTAINE and his appetite is slowly coming back. So I'm hoping the lower dose of 10mg 2x a day will help him better without loosing his appetite. Right now he is just so thirsty all the time I let him drink but now he has to go pee every 3/4 hrs. Even in the middle of the night. This is the major symptom that is so sad to see him go thru and me a lot of sleepless nights. I do have a few washable pads down under his sleeping areas so when he can't hold it this is a big help. Do you think these inconsistency medicine will help with the nighttime leaking?

[Harley PoMMom]

If it's a weak bladder sphincter the medications for the incontinence should work, if however this issue is not from that and from another medical problem you may not see a big improvement.

Cushing's, hypothyroidism and even an urinary tract infection can cause incontinence in dogs.