Cushing’s and Food

[Freyja]

Hello!
I’m Freyja and I must confess to feeling a bit desperate. I have a 13 yr old sprocker spaniel called Mack who was diagnosed with Cushing’s in November. He was on 20mgs of Vetoryl for a month, which brought his cortisol level down from 215 to 154. We upped the dosage to 30mgs/day for another month, which only resulted in reducing his cortisol level to 153. We were on denamarin, but were told to stop and we have been advised not to up the dosage of Vetoryl. He is also on Selgian and Vivitonin for Cognitive Support, as well as just starting on Zilkene for his nighttime anxiety. We are coping as best we can with all this, but the big problem is that he will not eat anything with any consistency. He will no longer eat chicken, minced beef, sausages or cheese. Dog food went long ago. He simply will not eat any of it. We are running out of options and I am afraid that he will simply disappear before my eyes. Does anyone else have experience of a Cushing’s dog who will not eat? Can anyone help or shed any light on what we might do? Thanking you in advance...

[Squirt's Mom]

Hi Freyja,

Welcome to you and Mack!

How long ago was the test that gave the 153 result (I am asking because the cortisol can drop too low at any time on Vetoryl and loss of appetite is one of the signs for low cortisol). 153 nmol/L converts to 5.55ug/dl which is almost within range so as long as that test was recent, and it sounds as if it was, then the cortisol level should still be ok. How are his signs? Have they improved? Since he is not eating well I would not want the dose increased at all right now because this drug has to have food (fats) in order for the body to absorb and use it. So getting him to eat is the goal right now. You say he is on meds for cognitive support....has Mack developed dementia? If so, then losing the appetite can be part of that sadly. If the dog has the pituitary form of Cushing's and the tumor on that organ starts to grow (which is not common) then that can also cause loss of appetite.

Have you checked the side effects of all the meds he is taking to see if any of them list loss of appetite as a side effect? That would be my first step.

As our babies age their sense of smell starts to fade and appetite starts with smell. Have you tried stinky things like tuna water, fishes like Salmon or Cod, a little bit of Parmesan cheese, or tripe? If not I'd try mixing some of those things with the last food he would eat. I have also had luck with a brand of commercial food called FreshPet for several dogs who didn't want to eat.

I'm glad you found us and hope we can help you and Mack find a path toward eating better soon!
Hugs,
Leslie

[Freyja]

Thank you Leslie, for getting back to me. I’m glad I found you too! Mack will have another Cortisol level check on Saturday, one month after the last test which was 153. He has not had an increase in his Vetoryl dose. His sister Mabel went through nighttime panic attacks and not wanting to eat some time ago and with the help of both Selgian and Vivitonin she is back to herself, although with a slight head tilt, due to a vestibular syndrome incident 2 weeks ago! He was on metronidazole for a bit of diarrhoea recently and I know that nausea can be a side effect, but the food fussiness has been getting progressively worse for some time now. Some of his Cushing’s signs have improved. He is drinking and weeing less, but he is panting a bit more of late. He is still seemingly hungry but something stops him from eating. He likes something one day and won’t eat it the next. We have tried all the fish that you suggest and Parmesan cheese with tripe! None if it lasts. He has lost weight but has improved his muscle mass through physiotherapy exercises. He trots ahead of the pack on a walk and is up and down the stairs on his own . I’ll report back once we have another set of results and in the meantime thanks for your support. And thank God for Bonios. He still likes them...����

[labblab]

Hello Freyja, and welcome from me, too! I’m so sorry that you’re having such trouble getting Mack to eat. I know how frustrating and worrisome that can be. Do you know from your earlier testing whether it’s more likely that Mack’s Cushing’s is caused by a pituitary vs. an adrenal tumor? The reason why I ask is that since pituitary tumors are located in the brain, sometimes they can grow large enough to place pressure on the area of the brain that controls appetite. An enlarging tumor can cause other neurological problems, too, such as pacing, loss of coordination, increasing lethargy, sometimes even seizures. I don’t want to worry you unduly about this possibility, but I do feel obligated to mention it.

Imaging of the head — CT or MRI — is necessary to make the diagnosis of an enlarged pituitary tumor. Here in the U.S., both of those tests are quite expensive, so they’re not done routinely. But if you find that Mack’s cortisol level still remains within a safe range next week, then an enlarging tumor might be considered as a possible cause for his loss of appetite. If so, and given Mack’s age, you might discuss at least temporarily stopping the Vetoryl entirely with your vet in order to see whether or not that helps to restimulate his appetite. An enlarging tumor can be one situation where having higher levels of circulating cortisol can be a good thing, because it helps reduce inflammation of the tissue in the brain. Sometimes supplemental prednisone is even prescribed in such a situation.

I’m leaping ahead here to discuss a problem that may be nonexistent for Mack. But as I say, I just wanted to make you aware of the possibility in the event that Mack’s lack of appetite worsens even further, or you start seeing additional neurological problems emerge.

Definitely do let us know how his test results turn out next week.
Marianne

[Freyja]

Thanks Marianne. I’m grateful for your input. There are already some other concerning neurological signs. He is pacing and anxious and finds it hard to settle at night. We have put him on gabapentin which helps a little bit at night. His food issues seem to centre less around a loss of appetite - he comes to the kitchen and appears to want food and if it is a day when he likes minced beef he’ll wolf it down - and more around not knowing what he wants. He crunches away on cheap dog biscuits and inhales dog fish treats, but won’t have touch even the finest dog food. The tins that smell so good, I’d consider eating them. I think the increasing tumour size may well be a cause of his behaviour. While I would happily pay out for a CT scan or an MRI, (although they’re expensive here too), I wonder what would it get us in the long run. Knowledge is indeed power, but I do don’t think anything could be done about the tumour and certainly a big surgery is not something I would want for him. I’ll let you know about the test results next week and discuss with my vets the increasing tumour size idea. Again, thanks for your support. He means so very much to us and I find it so difficult not to be able to help him. Talking on this forum does help me to feel a bit more

[labblab]

My heart totally goes out to you, because my husband and I were also confronted with many symptoms that were consistent with an enlarging pituitary tumor in our own beloved Cushpup. After initially responding well to trilostane treatment, he started acting abnormally even though his monitoring cortisol levels were well within the desired therapeutic range. He became restless and confused to the point where he started pacing in circles at times. He had no exercise stamina. Most tragically for us, he ultimately stopped eating and drinking entirely. Decreased appetite occurred over a couple of months. But finally the day came when he wouldn’t eat or drink at all. It was a very weird situation, in that it almost seemed as though he’d forgotten how to make his mouth work — he’d walk up to his bowls and stand over them and look down, but didn’t bend his head over far enough to actually touch the food or water. It broke our hearts.

We ended up releasing him at that time through euthanasia. We could have opted for brain imaging, but decided against it because like you, we did not feel as though we’d want to put him through treatment even if an enlarging pituitary tumor was the cause. This was several years ago, and the only treatment available here in the U.S. was traditional radiation which involved a dozen treatments spanning a month, requiring general anesthesia each time. Since that time, “cyber-knives” and laser treatments are offered at a few veterinary centers that require only a very few treatment sessions. We might have considered that had it been available to us. But again, maybe not. It is very expensive treatment and does not offer a total cure. While it can temporarily relieve neurological symptoms, the dog may still need to continue with Cushing’s medication in order to control the conventional symptoms. And at this point in time, it’s expected that the tumor will ultimately regrow since the interventions only reduce tumor size — they don’t remove it entirely.

I don’t mean to paint a horribly depressing picture, because we’ve had members here who have obtained this type of treatment for their dogs and then been rewarded with additional months of quality time together. In our own case, though, we felt the cons of the procedure outweighed the pluses. And after having lived through our experience, I’m especially sensitive to concerns about appetite loss in Cushpups with known pituitary tumors. To this day, I can’t walk down the baby food aisle in the grocery store without flashing back to those days when we were struggling, so hard, to find any soft tempting food that our boy might lick up. Lack of appetite, regardless of cause, can be such a painful problem to struggle with.

Anyway, that’s my own saga! I truly hope that there’s something else going on with Mack that’s far less serious and more easily reversible. And of course, simply testing his cortisol level will be an important place to start.

Marianne