Cushings in 12 year old boxer

[Keith W]

My 12 year old Boxer (about 70 lbs) whom I have had since he was a puppy was diagnosed with Cushings about a month ago, as he was drinking constantly and urinating like a horse every 1/2 hour or so. Up all night, pacing all day, had normal appetite.

After confirming blood tests came back, Brodie was put on 60mg capsules of Vetoryl (Trilostane), administered every morning with food. He was also put on a regimin of DES which is now 1/2 pill every 5-7 days. He was also given a form of valium to help with his sleeping.

Once he was on the Trilostane for about a week or so, another blood test was drawn and the vet said his levels were perfect for treatment. Initially, the medication helped and the urinating and drinking had subsided to some degree.

The problem developed over the next couple of weeks - Brodie stopped eating and he stopped drinking, although he slept better. He stopped urinating altogether. He was obviously becoming dehydrated and was very anxious, his ribs are sticking out, he didn't sleep, and was shaking and panting constantly. I truly think he was dying.

I advised the vet, and he had me take Brodie off of the Vetoryl for a few days to see if he improved. He did, and he bounced back very quickly. Problem is, he is still anxious, pants, paces constantly, and is up about every hour or so at night to go to the bathroom. His water intake has increased somewhat, but not nearly the levels prior to diagnosis. His appetite is fairly normal now.

Needless to say, I am worn out from lack of sleep, depressed and sad for my dog. I am petrified to put him back on the medication because it obviously did not agree with him and made him terribly ill. He has been off the Vetoryl for about 2 weeks.

Any ideas? I really don't know what to do.

[molly muffin]

Hello and welcome to the forum.

We start out with a lot of questions, so first one is how much does your boxer weigh? The starting dose should be 1mg/1lb for vetoryl (trilostane) Next is although they say perfect, we like to see numbers, like for the ACTH test.

If you don't have a copy of that, the vet should be able to provide one to you. It will have a pre number and a post number (after 1 hour)
The post number should not be lower than 1.5ug

It sounds like he went too low. You said it was about 2 weeks after the ACTH that he stopped eating and drinking? Keep in mind that cortisol will continue to decrease for around 30 days on the same dose of medication.

Was the test done 4 - 6 hours after trilostane being given with food?

This does sound like Brodie went too low. The recommendation is usually to wait till symptoms return, and start on a lower dose, retest 12 - 14 days.

[labblab]

Hello Keith, and welcome to you and Brodie! I am veery sorry he is not doing well right now, but we'll do our best to help you get to the bottom of things.

The first question about which I am very, very puzzled is why your vet would start Brodie on DES at the same time as beginning the Vetoryl treatment. Since excessive thirst and urination are hallmarks of Cushing's, one would expect those symptoms to resolve once cortisol levels are effectively lowered. On occasion, there are other conditions present, and additional medications such as DES may be considered at a later date if the excessive urination continues even when cortisol levels have dropped into a therapeutic range. But I worry that the DES may be totally confounding Brodie's overall hormonal profile, confusing the symptom presentation, and causing some of these problems. In honesty, in over ten years on the forum, I've never seen a vet start both Vetoryl and DES simultaneously. So I would be questioning your vet about stopping the DES as well as the Vetoryl, taking a bit of time, and then perhaps starting back with the Vetoryl alone (assuming the Cushing's diagnosis is accurate).

In that vein, it will help us a great deal if you can get the actual numerical results for any diagnostic tests that led to Brodie's Cushing's diagnosis. We would also like to see the number for the monitoring blood test after Brodie started on the Vetoryl. Did Brodie exhibit any Cushing's symptoms other than excessive thirst and urination? You say his appetite was normal. Any skin and coat problems, panting, hind end weakness, pot belly, lethargy, sensitivity to heat? Before being treated with the Vetoryl, of course you'd want to feel very confident that Cushing's is actually the accurate diagnosis. So finding out more about Brodie's tests and symptoms will help us very much.

I apologize for so many questions, but your answers will really help us to move forward. And once again, if Brodie is not drinking or urinating normally, I'd talk to the vet ASAP about discontinuing the DES as well, at least for now.

Marianne

[labblab]

I want to add that I am not very knowledgeable about DES, so I hope that other folks who may have more experience with it will reply with their own thoughts. But as you can see, I do feel concerned about it.

Also, I do agree with Sharlene that another big question is whether or not Brodie's cortisol dropped too low as he continued taking the Vetoryl. If so, this doesn't mean he can't handle the medication at all, but instead that he needs to be on a lower dose if it is resumed. So again, that's why the monitoring test results will be helpful.

Marianne

[DoxieMama]

Hi Keith,

Welcome to you and Brodie! Marianne and Sharlene have covered all the questions I have for now. I look forward to learning more about him, as you share the information they've requested. I certainly hope that you can figure out what's going on with him so he can start to feel better again!

Shana