Treatment question: Dog not responding well to treatment

[MaggieHoll]

Hi,
I'm am new to the forum. I have a 6 year old black lab/english bulldog cross, Maggie, with Cushing's. She was diagnosed in the Spring while she was having a lot of lethargy and behavioral changes. She then saw the dermatologist for skin lesions which were actually calcinosis cutis due to Cushing's, confirmed with blood tests. After that she began treatment with our regular vet for Cushing's on trilostane, 60 mg, weight 67 lbs. Doing her blood tests to check her response to the medication, her numbers responded very well and were within target ranges (I don't know the numbers but both vets confirmed "textbook" response) though she clinically did not see much improvement, including continued hair loss, significant lethargy, significant thirst and urination at night, and additional skin infections due to her calcinosis leaving her skin raw. In August, she saw another dr., an internist, who performed an ultrasound and confirmed pituitary caused Cushing's. Given her continued calcinosis, he recommended an increase in dosage, to a second dosage at night as her thirst and urination at night was still significant. Maggie did ok and stopped having heavy thirst but her appetite has been significantly decreasing over her time on trilostane. Due to this we have taken her off the second dosage entirely (October), which did not improve her appetite much, and then dropped her morning dose in half as well to 30mg, in November. Maggie has lost a lot of weight, about 20 lbs, since her diagnosis, being previously at 67 lbs, now down in the high 40s, far too thin for a dog her size.
We are now still struggling with her lack of appetite. She will eat only small amounts and is extremely picky. I make her food with either chicken or beef and rice and veggies, whichever she will eat at the time. She normally picks through most of the rice and eats the meats but has more recently been more and more difficult to please. Today she would only eat a string cheese, which I tried because she wouldn't eat anything else. She is very lethargic, eats and drinks very little and has had no hair regrowth, she's about half bald. I'm not sure if we should continue treating her, if so with what, or are we just making her short life less enjoyable for our own sake?
Any suggestions would be very helpful.
Thanks,
Abby

[MaggieHoll]

Hi, I am new the forum and wondering if anyone, given your experience, has any thoughts for me and my dog, Maggie.

Maggie is a 6 year old black lab/english bulldog cross who was diagnosed with Cushing's in May. She was having issues with lethargy and behavioral changes in the Spring but was diagnosed through bloodtests at the dermatologist when she was seen for calcinosis cutis. She has been being treated with our regular vet since. She was initially treated with 60mg trilostane (67 lbs) once a day in the morning. She did all of her bloodtest follow-ups and by the numbers she responded very well (both our vet and the internist we saw said they were "textbook" numbers. However, she continued having symptoms with lots of shivering, thirst and urination at night.
In August, when she went in for an abdominal ultrasound confirming pituitary cause for her Cushing's, the internist recommended a second dosage at night, so she went to two 60 mg doses every 12 hours. Her night time thirst and urination subsided but her appetite further decreased and she has seen no hair regrowth.
Given her lack of appetite we backed off the second dosage, no longer giving it to her after about 6 weeks. Since, in November, her appetite was very low and difficult to get her to eat we halved her single dosage from 60 mg to only 30 mg, it helped a little bit but isn't lasting. Still only on one, 30 mg dose, she doesn't eat much and is very picky. I make her food and she tires of the base ingredients, chicken or beef, after 4 or 5 days so I have to keep changing it up. She is now down to about 45 lbs, about 20 pounds lost since her diagnosis, and I continues to lose weight because she barely eats. She is very lethargic and about half bald because none of her hair will regrow.

My question is what's the best thing to do now? Should we keep trying to adjust her dose? Take her off it entirely? Try something else, if so, what? Or are we putting her through too much for a low quality of life?

[labblab]

Hello Abby, and welcome to you and Maggie! We were a bit slow in getting your membership approved, and during the time you were waiting, I see that you tried to post two similar thread-starters. I’ve gone ahead and merged them both into one single thread. Even though there’s a lot of similarity between the two posts, each one also contains a bit of non-overlapping information. So we’ll go ahead and make them both visible now that your membership has been approved.

Unfortunately, I have only a limited time to write at the moment so I’ll need to make this introductory note brief. But I’ll come back later on to write more. In the meantime, though, one of the most important questions I must ask is whether or not Maggie has had periodic monitoring testing of her cortisol level and blood chemistries, especially subsequent to the August dosage increase and since her loss of appetite last month. The symptoms of lethargy and inappetence can be classic symptoms of drug overdose resulting in a cortisol level that has dropped too low and/or blood chemistries that are unbalanced. If this has occurred, simply lowering the trilostane dose or even stopping it completely may not be enough to offset the ill effects caused by the overdose. Maggie may need supplemental steroids to make up for any oversuppression of her adrenal glands that has been caused by the trilostane.

On the other hand, if Maggie has indeed received regular monitoring blood testing and her cortisol level is within the desired therapeutic range as are her blood chemistries, then another consideration may be the possibility that the tumor on her pituitary gland is growing and placing pressure on the part of her brain that controls appetite and activity level. In order to try to sort out possible issues, truly one of the most important puzzle pieces right now is to find out about any interim — and especially recent — monitoring blood testing. So please do let us know about that, and as I say, I’ll plan to return later on today or tomorrow to add more thoughts. I’m surely sorry that sweet Maggie is doing so poorly right now, but we’re really glad you’ve found us!

Marianne

[Maggiemoo1]

Hi, I am new the forum and wondering if anyone, given your experience, has any thoughts for me and my dog, Maggie.

Maggie is a 6 year old black lab/english bulldog cross who was diagnosed with Cushing's in May. She was having issues with lethargy and behavioral changes in the Spring but was diagnosed through bloodtests at the dermatologist when she was seen for calcinosis cutis. She has been being treated with our regular vet since. She was initially treated with 60mg trilostane (67 lbs) once a day in the morning. She did all of her bloodtest follow-ups and by the numbers she responded very well (both our vet and the internist we saw said they were "textbook" numbers. However, she continued having symptoms with lots of shivering, thirst and urination at night.
In August, when she went in for an abdominal ultrasound confirming pituitary cause for her Cushing's, the internist recommended a second dosage at night, so she went to two 60 mg doses every 12 hours. Her night time thirst and urination subsided but her appetite further decreased and she has seen no hair regrowth.
Given her lack of appetite we backed off the second dosage, no longer giving it to her after about 6 weeks. Since, in November, her appetite was very low and difficult to get her to eat we halved her single dosage from 60 mg to only 30 mg, it helped a little bit but isn't lasting. Still only on one, 30 mg dose, she doesn't eat much and is very picky. I make her food and she tires of the base ingredients, chicken or beef, after 4 or 5 days so I have to keep changing it up. She is now down to about 45 lbs, about 20 pounds lost since her diagnosis, and I continues to lose weight because she barely eats. She is very lethargic and about half bald because none of her hair will regrow.

My question is what's the best thing to do now? Should we keep trying to adjust her dose? Take her off it entirely? Try something else, if so, what? Or are we putting her through too much for a low quality of life?


Hi
I’m sorry I’m not as expert as some of the forum but we have struggled with the same issues. Our Maggie (a Maltese) stopped eating around thanksgiving. For her it was due to kidney issues caused by a medication she was on but after her kidneys recovered she had food aversion. It is terrible to watch your baby starve themself. I went to a vet nutritionist and they gave us an appetite stimulant called entice. It worked and she started eating again but only home cooked food. She will not eat any dog food.

Perhaps you can ask about a stimulant? There’s another one called mirtazapine. It’s not ideal but if it works then maybe he can get his weight up and start feeling better. We used both. When one didn’t work we used the other. One day we just didn’t need it anymore.

As far as the vetoryl, I guess it depends on how you can deal with the increased drinking and urination. We took Maggie off vetoryl when her kidneys were bad and she was peeing non stop. It was terrible. She peed in the middle of the night and didn’t care where. We decided to put her back on vetoryl because we couldn’t deal with the drinking and peeing. So far things are ok.

Do what is right for your family. Just because your baby has cushings doesn’t mean you have to treat. Our vet says it’s all about quality of life.

Best of luck to you. I hope things improve soon.

[Squirt's Mom]

Hi Abby,

STOP the Vetoryl now and get and ACTH performed plus have her electrolytes checked immediately. Recent studies have shown that larger dogs need a much smaller starting dose that Dechra recommends - 0.5 mg per pound. So Maggie's starting dose should have been around 30mg. She is on double that amount and had an increase so it is very possible her cortisol has dropped too low -which is life threatening and may require medications to get the coritsol back up. Please go to the vet now and get the ACTH and electrolytes done today. I'm stopping here because I want you to go, NOW.

Hugs,
Leslie

[MaggieHoll]

Thank you all for your input.
In terms of Maggie’s monitoring, she had at least 4/5 follow-up tests with dosage changes which were in line with expected numbers but I don’t know the actual numbers. We have slowed down on rechecking the last couple of months because the tests are very expensive and we talked to our vet about managing her to symptoms rather than to the numbers because she was still not responding well even with good numbers. So you could both be very correct that her numbers are now way off and we don’t know.
We have not tried a appetite stimulant yet. We talked to the vet about it but it was at the same time that she was on antibiotics for another skin infection and we know those mess with her appetite. We just haven’t revisited it with him, I’ve just been her short order cook, which is barely working anymore. I haven’t given her Vetoryl in the last couple of days though. I have a call into the vet. I will talk to him about her numbers and see if what our best options are. My fear is her tumor has grown and is impacting her negatively.
I will keep you posted.