Skyler's Cushings Diagnosis

[PolishGal]

Hello everyone, One of our six Siberian Huskies has developed Cushing's about six months ago. After the ACTH stem test and abdominal ultrasound it was determined he has pituitary Cushing's. We started with Vetoryl 30mg and noticed he was having upper body tremors only when he would rest and lay on his side. So we requested a lower dosage from the Vet and resumed with 10mg for a couple months. Skyler was still showing signs of tremors. I felt so bad for him, I looked into more natural adrenal meds and came across Pet Wellbeing Adrenal Harmony Gold Bacon Flavored Liquid Supplement We tried these drops and Skyler still had the tremors, but not as bad. Interested fact, when he would rest, but but lay with his shoulders square to the ground, he would not shake. We have decided to start the Vetoryl 10mg again and see how he does. Just don't trust those drops.

[labblab]

Hello and welcome to you and Skyler! We’re surely sorry for the issues you’re dealing with right now, but hope we’ll be able to help. First of all, you’ll be helping *us* if you can give us more info about Skyler’s overall health history, the symptoms that led you to suspect Cushing’s, and also any specific abnormalities on lab tests that led to the ACTH and ultrasound. Also, I’m hoping that Skyler has had additional monitoring tests of his cortisol level since starting the Vetoryl. Tremoring could possibly be a symptom of a cortisol level that has dropped too low, so that’s why I’m especially wondering if he’s had monitoring testing and what those results have been.

While we’re awaiting this additional info from you, I’ll go ahead and repeat some comments that I’ve posted to folks in the past. As you’ll see, other members have noticed tremoring in their dogs, as well. Unfortunately, in most instances we still don’t have a clear explanation. Tremoring is listed as a possible side effect of Vetoryl. But some dogs here have exhibited tremors before they even started treatment. So questions do remain. But at any rate, here’s some thoughts to start us off.


Through the years, we have had other members who have worried over unexplained tremoring episodes. My own Cushpup, a Lab, suffered from intermittent involuntary tremoring episodes across his shoulder blades that made him look as though he was shivering. For him, the episodes happened most often when he was sitting down or at rest -- even when he was sleeping. Sometimes he would jerk himself awake, they were that severe. But just as is true for your boy, he would usually just stretch afterwards and never seemed to be in any particular pain or discomfort. The tremors began before he started trilostane treatment, worsened significantly when he first started the drug, and then ended up stopping entirely a few months down the road.

We never did figure out what caused them. Through the years, other members here have reported similar issues with their dogs under a variety of circumstances: some using trilostane, some using Lysodren (another medication), and also dogs not yet being treated at all. For this reason, it has been hard to point to a single "trigger." It is true that tremors are now listed as a possible side effect of trilostane. But I've always wondered whether such tremors more often just somehow relate to rapidly changing cortisol levels. But the good news is that they didn't really seem to bother my dog at all -- it was ME who was going crazy trying to figure them out!

So once again, welcome to you both! And we’ll be very interested to learn more about Skyler’s journey.
Marianne

[PolishGal]

Thank you for your concern. To answer some of the questions,
Skyler’s overall health history was perfect. His weight was 59 lbs. now at 56 lbs. He will turn seven this year in July. We started recognizing he was not himself, moping around. So made Vet appointment. He does have a sister who is quite overweight, but doesn't have Cushings.

Have no idea what these numbers mean, but here they are.

Aug, 2023 ACTH
ALT = 950 U/L H 10-125
ALKP = 1801 U/L H 23-212
AMYL = 316 U/L L 500-1500
RETHGB = 20.5 pg L 22.3-29.6
LYM = 0.75 K/uL L 1.05-5.10
EOS = 0.01 K/uL L 0.06-1.23
PLT = 105 K/uL L 148-484
PCT = 0.09 % L 0.14-0.46

Nov 2023 Skyler had another ACTH
NEUTROPHIL = 2563 /uL L 2940-12670
LYMPHOCYTE = 499 /uL L 1060-4950
MONOCYTE = 118 /uL L 130-1150
EOSINOPHIL= 10 /uL L 70-1490

2/19/2024 ACTH
PLATELET = 88 K/uL L 143-448
NEUTROPHIL = 2518 /uL L 2940-12670
LYMPHOCYTE = 522 /uL L 1060-4950
MONOCYTE = 141 /uL 130-1150
EOSINOPHIL = 10 /uL L 70-1490

He will be due in May, 2024 for another ACTH. We have decided to put him back on Vetoryl vs the Adrenal drops. Will monitor his activity.

Prior to being diagnosed with Cushings, Skyler was not shaking. Perhaps some nerve is pressing on the pituitary in some way to cause the tremors? Then again, I was thinking maybe taking this medication could also be causing him to be cold. So I'm putting an insulated jacket on him. Who knows. Trying everything.

Would like to add a picture of Skyler here, but you only accept URLs?

[labblab]

Thanks so much for this information! The abnormal lab results that you’ve posted contain some values that are indeed consistent with Cushing’s, such as elevated liver markers and some of Skyler’s white blood cell counts. But even though you have ACTH tests listed as having been performed, we’re not seeing the actual numerical results. An ACTH test should list two different numbers: first a “resting” or baseline cortisol measurement, and then a second cortisol measurement taken an hour later after a stimulating agent has been injected. Can you take a look back at your paperwork to see if those cortisol numbers are listed in conjunction with the other lab results?

Also, in addition to Skyler’s lethargy, have you ever seen any other outward Cushing’s symptoms such as excessive thirst/urination/hunger, hair loss, pot belly, hind leg weakness? The reason why I ask is just that Cushing’s can be a hard disease to diagnose accurately, and the presence of common observable symptoms increases our confidence that it’s truly Cushing’s that is causing the lab abnormalities as opposed to something else.

Sorry to continue to ask questions, but your answers really are a help! And in the meantime, take a look at our FAQs list to see how to upload either an avatar photo, or how to create a personal photo album. If you don’t get the help you need from the FAQs, let us know and we’ll try to give you more tips.

https://www.k9cushings.com/forum/faq.php?faq=vb3_user_profile#faq_vb3_signatures_av atars

https://www.k9cushings.com/forum/faq.php?faq=vb3_user_profile#faq_vb3_albums

Marianne

[PolishGal]

Thank you for the reply by someone with similar tremoring concerns. Skyler is eating well and drinking. No other major signs. On another note, what natural remedies would there be to maybe calm the tremors? Has anyone used anything with success?

[PolishGal]

Marianne, thank you so much for your insight on lab results. To answer your question about Cushing's symptoms observed in Skyler.....NO excessive thirst/urination, YES very hungry, NO hair loss, NO pot belly, NO hind leg weakness. And yes, I am concerned that perhaps it's not even Cushing's.

I would like to just upload the lab results or send private message.

[labblab]

Hello again, and thanks for this additional info about Skyler. I’m afraid I don’t have any recommendations re: supplements that might help with the tremors. I just don’t have much knowledge about natural supplements, in general, and especially in this situation where we’re not sure what is actually causing the tremors. I do agree that in the absence of most of the classic observable Cushing’s symptoms, the overall diagnosis feels a bit shakier.

As far as the additional test results, one option would be for you to take a photo of the lab sheet and upload it to a personal photo album that you can create for yourself here. I think the instructions for creating an album are in one of the forum FAQs links that I posted earlier. Or if you have trouble with that, you can send the photo to our forum gmailbox. We staff members can then retrieve the photo and do our best to upload it here for you. Our address is: k9cushings@gmail.com.

Continued good luck to you guys, and do let us know if you need more help with things.
Marianne

[WVEast]

Hi, my chihuahua was just diagnosed 2/22/2024. She was having tremors as well. Hers looked as though she was shivering like she was cold. We decided to only treat with natural supplements & changed her to a home cooked diet with foods recommended for dogs with Cushing's. She has been taking Prana Pets Cushing's killer combo since 2/25/24. I have noticed that she has hardly done it since starting the supplements. There is an adrenal balance, an immunity blend & CBD in this combo. I hope this helps.