Zak

[Maggie Reag]

I have a 9 yr black lab that was diagnosed with Cushing's about 3 weeks ago. His symptoms before diagnosis included hind end weakness, panting, pot belly, sunk in skull. I have only had him for 2 years and he has always been a heavy drinker and ravenous, I thought these were normal for him and labs in general. We have done several full chemistries on him in the last few months, airways pretty normal except slightly elevated liver values. We did an ultrasound which showed enlarged adrenals and we got the final diagnosis by doing a LDDST. We started him on trilostane 30mg twice daily (he was 73 pounds, down 10 pounds in 2 months) everything was going well, at the two week mark we did an ACTH stim and that came back good. Although he had lost another 6 pounds in those two weeks. His appetite has decreased, we are trying to feed him extra to keep his weight up but hard to get him to finish his breakfast or dinner, he will eat treats at any point. Now the weakness in his back end seems increased and he is trembling. Are these normal side effects or do I need to worry about Addison's? Or something else all together?

[Harley PoMMom]

Hi and welcome to you and your boy!

Could you get a copy of that LDDS test and post those results here? And we are really interested in the ACTH stimulation test results so if you would post them too that would be great....Thanks!

As for the trembling I'm including a reply from one of Administrators, Marianne, which she posted to another member whose dog was experiencing this:



One interesting side-bar comment about the trembling...over the years, we have had several members (including myself!) report that their Cushpups exhibited weird tremoring episodes that looked like shivering, but in the apparent absence of pain or cold. My own boy did that both before and for a time after Cushing's treatment was begun. Strangely, he did it most often when he was laying down or at rest -- he would have shivering episodes across his shoulderblades. I have no idea whether this is what is happening with your girl, but just thought I'd mention it as a curiosity. The episodes always bothered me more than they seemed to bother him, and they finally dropped away altogether after a few months of treatment.

Marianne

Although his Vetoryl dosage is within Dechra's guidelines it could be that it is too high for him, one study indicated that larger dogs require smaller doses so it is entirely possible that the 30mg BID may be too high for your boy, especially if his ravenous appetite, which he had before treatment, has decreased so dramatically. Does he have diarrhea? Any vomiting?

Hugs, Lori

[Maggie Reag]

Thanks for getting back to me. I will post those results when I can get them, thank you. I spoke with my vet and he was concerned the trembling might be due to pain, he seemed bothered in his left knee so we started him also on tramadol and deramaxx. Seems a little more comfortable and ate 95% of his dinner, although I had to coax about half of it.
Thanks again!

[judymaggie]

Hi! I wanted to welcome you and Zak to our family. Lori has gotten you off to a good start. My Abbie is also taking the combination of tramadol and deramaxx for pain and mobility issues due to intervertebral disk disease (IVDD). I hope Zak benefits from these meds. When Abbie is in pain, she is not interested in eating and has lost three pounds over the last few months. She is still not enthusiastic about food (atypical for a beagle ...) but will eat with coaxing. I am finding that she is more attracted to the food if I eat it up for a few seconds in the microwave -- you might try that with Zak.

[Maggie Reag]

Thanks Judy. I've been adding some warm water and canned to his normal kibble, that seems to help some. He ate pretty well this morning but not so much tonight 😞 I think his leg was really bothering him, his deramaxx would have been wearing off just about then. We are going to monitor him for a few days and maybe do his next acth a little early. Thanks again and any advice is very welcomed!!

[Maggie Reag]

Lori,
Here are Zak's results. His LDDST : pre 4.7, 4hr post 4.4, and 8hr post 3.8. His acth (13 days on trilostane) pre 3.4 post 6.6 (range 8-17). Also no vomiting and no diarrhea.
Thanks

[Whiskey's Mom]

Hi, I had trouble with getting Whiskey to eat also. What Judy said about warming it up helps. We Ended up changing to canned food from the dry kibble he ate his whole life. I still mix a bit of boiled chicken & rice in with the dog food at each meal. And he loves hard boiled or scrambled eggs also. We have managed to keep his weight pretty steady by adding these things to his diet, plus healthy treats.
His cortisol was also low for him, even on a smaller dose. Best of luck to you, hope he's feeling better. It's hard when they won't eat.

[molly muffin]

Do you see if there is a range in regards to the LDDS test and if so can you edit your post above to reflect that range?

His post level is not too low on the ACTH but the levels do tend to continue to drop for 30 days on the same dose.

Did his not wanting to eat start before that acth test (the 13 day mark) or after?

I am wondering if his cortisol continued to drop and that is affecting his appetite.

If his appetite is continuing to decrease, you could repeat the ACTH to see if he is going too low. You could also talk to your vet about only give him 30mg once a day in the morning.

When you did the ACTH test was it 4 hours after having his morning vetroyl (trilostane) with a meal?

Welcome to the forum. Sorry for all the questions.

[Maggie Reag]

There have been some updates on Zak. I brought him tonight because of his decreased appetite and limping. We think he has torn his ACL �� we are going to wait and get his Cushing's under control and then look into sedating for xrays. Keeping him on NSAIDS and rest for now. We also ran his electrolytes, although they were not in Addisonian range, his potassium was high and his sodium was low so we are cutting him back to 30mg once daily. We will monitor for a few days, see how he does, and if he responds well do another ACTH in 2 weeks.
The decreased appetite seemed to happen after the 13 day post stim and the test was done 4 hours after his morning pill given with food.
Thanks for all the help

[judymaggie]

Hi -- so sorry to read that Zak may have torn his ACL. :( That certainly would be reason for pain and resulting not eating. I sure hope that you don't have to much trouble keeping him quiet.

[Squirt's Mom]

Just an FYI toward your Cushing's education. ;)


His acth (13 days on trilostane) pre 3.4 post 6.6 (range 8-17).

The range of 8-17 shown on the lab report is NOT for a dog on treatment for Cushing's. There are two drugs used to treat this disease and two ranges depending on which drug your pup is on. For a pup on Vetoryl that optimal range is 1.45 ug/dl - 5.4 ug/dl with an acceptable post (or second number) going up to 9.1 ug/dl if, and ONLY IF, all signs are controlled.

So with a post number of 6.6 ug/dl, Zac is still not within that optimal range of 1.45-5.4 ug/dl *unless* ALL his signs are well controlled. IF that is the case, then the 6.6 is alright. Otherwise, the cortisol still needs to come down a tad bit. ;)

That 8-17 range the lab gives is for a dog who does not have Cushing's or for a cush pup who had not yet started treatment.

Hugs,
Leslie and the gang

[Maggie Reag]

Update on Zak, we decreased his trilostane to once daily 5 days ago, his appetite is greatly improved, pretty much finished his breakfast this morning which would be a first time in a long time. His pain management seems to be OK, he is still limping but that seems better too. We are going to keep in him on this protocol for 2 weeks total and then do another stim. If that comes back good we will start to tackle what to do with his ACL.
Thank you for all the support, he really is a sweet guy that we adopted as a senior and we love him very much.

[Whiskey's Mom]

He sounds like such a sweetie. My Whiskey tore his left ACL last year within weeks of his Cushings diagnosis. It's overwhelming I know. . We did laser therapy and really restricted his activity. and it worked! Best of luck to you & Zak.

[molly muffin]

So glad he is eating and feeling better. Yay! Hopefully they can help with that ACL soon.

[Maggie Reag]

Zak had another stim done yesterday. After he started showing signs of becoming Addisonian we reduced his trilostane to 30mg once daily. After 2 weeks his post came back as 6 today. He seems to be doing well, eating, active, so hopefully we have this under control. Next step ACL surgery.
Thanks for all the support!

[Joan2517]

Good news~

[molly muffin]

It is good news that he is doing better on the once daily, lower dose.
Sometimes the larger dogs end up needing a smaller dose. I don't know why that is, but studies have shown that some of the larger dogs end up needing lower doses than smaller dogs.

Glad he is limping less and hopefully the surgery will be easy on him. When is he due for it?

[Maggie Reag]

I'm hoping to have the surgery around the 22nd of December, I have the whole following week off work and figured that would be a good time especially with how much post op care is needed the first couple of weeks. My other dog had her ACL done last spring so thankfully I know what I'm getting into.