rocksmom
05-02-2018, 04:14 AM
My 10 year old Boston terrier, Rocky, was diagnosed on 4/10. He had been showing signs for quite some time, and was tested about 10 months ago which unfortunately resulted in a false negative. Since the reason for the initial test was elevated liver enzyme levels we spent the intervening months doing various treatments and re-tests for that including Denamarin, antibiotics, ultrasound, x-rays, etc.
During that time we switched vets due to location. Our original vet was about an hour away. The new vet as well as the one at the veterinary hospital that performed the ultrasound both suggested retesting for cushings, which we agreed with due to his clinical signs. The ultrasound had shown intestinal inflammation (he’d been having gi issues which are currently better but not 100%), enlarged adrenals, and an enlarged liver. The results of his acth test on 4/10 were:
Pre-acth: 3.4
Post-acth: 33.9
The vet asked if we wanted to start trilostane or try lignan therapy but from already having done some research and seeing how quickly his health was declining I knew I wanted to start with trilostane. His initial dosage was 10 mg twice daily. He weighs just under 21 pounds currently. I was very happy to hear her treatment plan as I know dogs are often dosed too high initially.
He seems to have responded positively. His hunger and thirst are still elevated but I know that is to be expected, especially the hunger. He has always been very food motivated anyway. He is sleeping better and has more energy. The biggest difference though has been with his emotional state. He had become very depressed and withdrawn. Refusing to play, not wanting to snuggle or really touched at all. The only time he would show excitement was for food or when I would first come home, he’d greet me but then return to his new normal. Since starting treatment he has been much more his old self. Chasing and sucking on his stuffed animals. Tugging. A little bit of playing with our other Boston, but she’s always been a bit much for him, especially the last couple years. Less anxious behaviors like carpet licking. One major symptom that seems to already be improving and I hope will continue to improve is muscle weakness. His hind legs shake and seem very weak, even hesitating before stepping over the threshold which is only 3-4 inches high.
On Friday, 4/28, he had his first follow-up acth test. The results were:
Pre-1.7
Post-10.1
Despite his cortisol not being in the ideal range yet, the doctor is decreasing his dose from 10 twice daily to 10mg in the morning and 5mg at night. She’s doing this because his potassium increased from 4 to 5.4 putting his Na/K ratio low at 27. How concerned should I be about this? Especially since his post acth cortisol level is still high? I know I read on here in one of the references that cortisol levels can continue to decline early on in treatment. Should I not start worrying until we see the results of his next test? I guess I was just expecting everything to be perfect because of the improvement in his clinical signs and lack of any negative visible effects. Wishful thinking :rolleyes:
This ended up being way longer than I expected without even going into everything! I didn’t delve into his gi issues much or his health history or how squishy his perfect little cheeks are ;-) I guess I will quickly mention that a low fat diet has definitely helped which I’ve read on here is common. He’s currently eating raw rabbit from small batch pets which is the lowest fat protein as well as one he isn’t allergic to ( which is just about everything you can think of).
Anyway, just wanted to introduce my little man and his cushing’s story so far. I went from wondering if he’d make it to Christmas or at least knowing that he would be in a wheelchair sooner rather than later to being cautiously optimistic. I really hope things continue to improve for him. He’s my little momma’s boy and watching his quality of life decline was breaking my heart. It really frustrates me knowing that he could have started treatment nearly a year ago!
Any insight into the potassium and dosing would be fantastic. Thanks everyone!
During that time we switched vets due to location. Our original vet was about an hour away. The new vet as well as the one at the veterinary hospital that performed the ultrasound both suggested retesting for cushings, which we agreed with due to his clinical signs. The ultrasound had shown intestinal inflammation (he’d been having gi issues which are currently better but not 100%), enlarged adrenals, and an enlarged liver. The results of his acth test on 4/10 were:
Pre-acth: 3.4
Post-acth: 33.9
The vet asked if we wanted to start trilostane or try lignan therapy but from already having done some research and seeing how quickly his health was declining I knew I wanted to start with trilostane. His initial dosage was 10 mg twice daily. He weighs just under 21 pounds currently. I was very happy to hear her treatment plan as I know dogs are often dosed too high initially.
He seems to have responded positively. His hunger and thirst are still elevated but I know that is to be expected, especially the hunger. He has always been very food motivated anyway. He is sleeping better and has more energy. The biggest difference though has been with his emotional state. He had become very depressed and withdrawn. Refusing to play, not wanting to snuggle or really touched at all. The only time he would show excitement was for food or when I would first come home, he’d greet me but then return to his new normal. Since starting treatment he has been much more his old self. Chasing and sucking on his stuffed animals. Tugging. A little bit of playing with our other Boston, but she’s always been a bit much for him, especially the last couple years. Less anxious behaviors like carpet licking. One major symptom that seems to already be improving and I hope will continue to improve is muscle weakness. His hind legs shake and seem very weak, even hesitating before stepping over the threshold which is only 3-4 inches high.
On Friday, 4/28, he had his first follow-up acth test. The results were:
Pre-1.7
Post-10.1
Despite his cortisol not being in the ideal range yet, the doctor is decreasing his dose from 10 twice daily to 10mg in the morning and 5mg at night. She’s doing this because his potassium increased from 4 to 5.4 putting his Na/K ratio low at 27. How concerned should I be about this? Especially since his post acth cortisol level is still high? I know I read on here in one of the references that cortisol levels can continue to decline early on in treatment. Should I not start worrying until we see the results of his next test? I guess I was just expecting everything to be perfect because of the improvement in his clinical signs and lack of any negative visible effects. Wishful thinking :rolleyes:
This ended up being way longer than I expected without even going into everything! I didn’t delve into his gi issues much or his health history or how squishy his perfect little cheeks are ;-) I guess I will quickly mention that a low fat diet has definitely helped which I’ve read on here is common. He’s currently eating raw rabbit from small batch pets which is the lowest fat protein as well as one he isn’t allergic to ( which is just about everything you can think of).
Anyway, just wanted to introduce my little man and his cushing’s story so far. I went from wondering if he’d make it to Christmas or at least knowing that he would be in a wheelchair sooner rather than later to being cautiously optimistic. I really hope things continue to improve for him. He’s my little momma’s boy and watching his quality of life decline was breaking my heart. It really frustrates me knowing that he could have started treatment nearly a year ago!
Any insight into the potassium and dosing would be fantastic. Thanks everyone!