Moose's stiff gait

[Briet]

Hello, my name is Briet. I have had Moose since he was 8 weeks old.
He travels everywhere with us. His visits include Europe, Caribbean.
He loves to sail as well.

He is a 7 year old Male, short hair, shaded red, mini 14lb.
The last year and a half has been a difficult time for Moose.
Moose has had two episodes of IVDD, first one in Dec 2015 in his neck.(crate rest for 8 weeks) Second one in September 2016, in his lower back. (crate rest for 8 weeks)He was never a 100% after that.
Moose started walking with a very stiff gait in January 2017. (Crate rest 6-10 weeks) Thinking, that it was again IVDD. But this time his hind legs are very stiff and difficult to bend, getting worse by the day. He has also problems with his knees, especially his left, (luxating patellas). We are going for Hydro therapy and cold laser treatment weekly. The laser treatments since September 2016.

We visited a neurologist on April 20 and a EMG was performed on his rear and front legs, which was abnormal in his rear legs. Blood and urine test were negative for cushings. We had to wait 6 weeks for the predisone to leave his system. We did the ACTH stim test, still negative. On May 30 the low-dose dexamethasome suppression test was performed and Moose tested positive. We have done an ultrasound on June 21 and everything was normal.
Moose is diagnosed with (Cushing's Myopathy)
Medication starting on tomorrow, June 27 is:Trilostane (not sure of the dosage yet)and Procainamide dosage 12.5 mg/kg.
My question is what can I expect regarding the medication for Moose and will this improve his stiff gait/legs? Thank you

[labblab]

Hello, Briet, and welcome to you and Moose! I apologize that I have only a few minutes to post right now, but I wanted to tell you that we're very glad you've joined us. It sounds as though Moose may be suffering from a very rare condition that can be associated with a Cushing's: pseudomyotonia. Over the years, we have had a few dogs who have presented with this condition, and here is a fairly recent reply posted by one of our members that contains a couple of helpful explanatory links.


Hi Mitchell,
In my ongoing Cushing's research I stumbled on these two articles, one written by Dr. Mark Peterson, an endocrinologist.

http://www.vmsg.com/wp-content/uploads/2017/01/case-report-hyperadrenocorticism-and-psuedomyotonia.pdf

http://www.endocrinevet.info/2011/02/q-pseudomyotonia-in-dogs-with-cushings.html

Another thought is to email Dr. Bruyette in CA and ask if he could recommend anyone in your area, including your IMS, with whom he could consult to treat Datsun. I don't have his email but I am certain others here do.

Also, if you search this forum for myotonia, there are or were other folks whose pups were diagnosed. I'm really sorry as it seemed that Datsun was doing well before this condition emerged. This disease truly sucks and I'm thinking of you and Datsun.

As you will see, treatment aimed at lowering elevated cortisol is a top priority. Please do feel free to ask us any specific questions you may have about Moose's trilostane treatment. Since you say that his starting dose is undetermined right now, I will give you an important hint: current widely-accepted treatment protocol recommends a starting dose that does not exceed a formula of 1 mg. per pound.

Marianne

[Briet]

Thank you so for the information. I will let you know the dosage my vet recommends. Very good articles. A bit scary for the outcome for Moose. My vet also recommend to start with the procainamide, are you familiar with that medication? Thanks again for the support.

[Carole Alexander]

Hi and welcome,
I'm sure Moose's worsening condition is incredibly distressing to you. I had not heard of Procainamide but seemingly it is mostly used for heart rhythm issues. I dug further and found this off label use for treating myotonia:

PROCAINAMIDE HAS BEEN USED IN TREATMENT OF MYOTONIA, WHERE ITS EFFECTS RESEMBLE THOSE OF QUININE.
Goodman, L.S., and A. Gilman. (eds.) The Pharmacological Basis of Therapeutics. 5th ed. New York: Macmillan Publishing Co., Inc., 1975., p. 696
from HSDB
https://pubchem.ncbi.nlm.nih.gov/compound/procainamide#section=Therapeutic-Uses
http://toxnet.nlm.nih.gov/cgi-bin/sis/search/r?dbs+hsdb:@term+@rn+@rel+51-06-9

I would recommend that you ask your vet about the research on this drug in treating myotonia. If it is helpful it would be quite a breakthrough as a number of Cushing's dogs on this site have experienced this condition. Also, please read Mitchell's thread. While he hasn't posted recently, his dog, Datsun was being treated at U of FL for Cushing's when he developed this condition. My best to you and Moose.

[Briet]

My vet recommend a starting dosage of 30mg once a day? It that to much?

[labblab]

Can you tell us how much Moose weighs? The generally recommended starting dosage is not to exceed 1 mg. per pound (or 2.2 mg. per kilogram), and then work upward if dosing increases are needed based on symptom resolution and monitoring blood tests. I realize that Moose's case is one in which your vet may be wanting to rapidly gain control of his cortisol level, but still, I'd feel more comfortable starting at the dose that corresponds most directly with his weight.

Here's a link to a post on our "Resources" forum that explains the rationale for this dosing formula. You may even want to print out some of the references that are posted there and share them with your vet. Unfortunately, the printed brochure that is included inside boxes of Vetoryl is rather old and contains an initial dosing "range" that (understandably) leads vets to sometimes prescribe a higher dose than is currently recommended by most specialized clinicians worldwide.

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

Marianne

[Carole Alexander]

Hi Briet,
I don't have a clue about dosage. Can you discuss this with your vet? Or maybe others will know.

[DoxieMama]

Moose's weight was listed in the first post at 14 pounds. Given that, I would definitely want to talk to the vet about a much lower starting dose...if you use compounded Trilostane you could start at 14mg (my doxie was 11mg and that's what we did - started at 11mg). If you're using brand name Vetoryl then you can start at 10 or 15mg per day.

[labblab]

Thanks, Shana, I missed seeing his weight listed earlier. And I agree with your dosing recommendations! ;)

[Carole Alexander]

Are we talking about the proper dose for Procainamide or Trilostane? I thought you were asking about Procainamide. If that's accurate, I don't know about dosing with this drug. As I said it is an off label use and likely experimental. I think that you should discuss this drug and dosing in detail with your vet before starting him on it.

[Carole Alexander]

Please look at these articles Briet.

https://www.google.com/search?q=procainamide+for+canine+myatonia&oq=procainamide+for+canine+myatonia&aqs=chrome..69i57.13517j0j7&sourceid=chrome&ie=UTF-8&enablesearch=true

[Carole Alexander]

Briet, this article talks about dosing in a 12 lb. dog.
http://onlinelibrary.wiley.com/doi/10.1111/j.1939-1676.1998.tb02141.x/pdf

[Briet]

I was referring to the trilostane dosage. I have asked my Vet to order the lower dosage. Thank you for all the wonderful support.

[Briet]

My vet has agreed to start with a dosage for the trilostane 7.5mg twice a day. The meds have been ordered should be here on Friday.
Thank you

[molly muffin]

I just want to welcome you to the forum also and I think the 7.5mg twice a day is much safer and better way to start out. Glad you decided to go that route.

So today is the start day? Make sure you give with a full meal, as it needs food to be properly absorbed.

Let us know how it goes. If any adverse reactions are seen, such as vomiting, diarrhea, refusing to eat/drink, lethargic and/or wobbly (can't walk) stop medication and have follow up ACTH done. (these are just precautions to look out for in case of too much medication)

[Briet]

Update on Moose, he has been on trilostane since June 27. He has a little bit more energy. He has been on procainime since July 4 and I found that it is a little bit easier to bend his legs. No other changes as he doesn't have any other symptoms besides his stiff legs. Moose is going for a ACTH stim test on July 14.
Thank you so much for all the information.

[Briet]

Correction: Moose started on June 30 with the Trilostane.
Thank you

[Squirt's Mom]

Let us know how he is doing and what the ACTH shows! Good job, Briet!

[molly muffin]

yes good job. Even a bit of improvement on the back legs is good news. :)

[Carole Alexander]

Briet, yes very good news for even a small improvement.

[Briet]

Moose's result were too low and we were advised to stop to trilostane.
Cortisol - post ACTH 50. The test was done after 4 hours after the trilostane was given. The vet would like to test him again in 2 weeks.
Moose seems a little off, he received his last pill on friday morning.
But, we are travelling and that is a bit hard on him. I am not convinced that Moose has cushings and will go back to the neurologist to see what else we can do.

[molly muffin]

For our American members, that is a post of 1.81 and yes too low.

He started to June 30 7.5mg twice a day and weights 14lbs.

You never know how a dog will react and so the 15mg total a day is too much for him.

The recommendation is to wait for the symptoms to come back, retest, start at a lower dose if cortisol comes back elevated again. Maybe 7.5mg Once a day would work better. You just never know.

It also could be that it isn't cushings and is something else, exploring all options is always a good idea.

[Briet]

Thank you so much, Moose's only symptoms are his back legs, still very stiff and he has trouble walking, getting worse daily. His legs are a bit more relaxed, I can bend them better. He is still on procainamide twice a day. Very frustrating to see him like this. His first ACTH stim was low too without any medications on May 15. He was diagnosed with cushings after the low dose dexamethasone test, Cortisole - baseline 141, on June 1.
This all so very confusing. Thanks again.