Recently diagnosed, looking for any insight from the community.

[LeahCC]

So today we accidentally double dosed her and this morning she had 120mg of Vetoryl. I'm waiting for the vet to call me back about it.. Has anyone experienced this? Should I go back home and watch her? The office said I could bring her in for monitoring if I wanted. I should hear from the vet in the next hour or two. The vet tech that is there now said there shouldn't be any ill effects but that they'll run it by the vet when she gets in also.

[labblab]

I’m guessing there’s no need to worry unduly about one single double dose. You may want to skip tomorrow’s dose, however, to give her system additional time to return back to baseline.

Marianne

[LeahCC]

Thanks for the quick response. I've been worried all morning thinking the worst..

So Phoebe hasn't been doing that well over the weekend. We had people over on Saturday and usually she's super happy and excited while they're there. Her energy level was clearly way lower and, other than the normal begging for food, we didn't see a lot of her. She stayed in her bed in the other room a lot, which is unusual when there are guests. That night, she seemed pretty wiped out but was shaking a bit so I gave her a small dose of xanax (.125mg) so she could relax and sleep soundly. She's been shaking a lot lately.. Sometimes she just sits and stares at me and trembles, sometimes she's laying down and shaking.. She clearly doesn't feel good and I don't know what to do to fix it. She's been panting more, and I think the thirst has ramped up a bit; not quite to pre-Vetoryl levels but noticeably more. We should hear about the UTI tomorrow, and see if we need to change or add to her current antibiotic.

It just seems like nothing that we're doing is helping, that she's not getting better, and she feels bad all the time. I know it's only been a few weeks, and for me it seems like if we just push through this rough patch and dial in her meds, that she'll be ok. But I don't want to be that person who keeps the dog too long because I can't let go. And it's heartbreaking to see her in pain. Does that make sense? I think I just needed to vent a little.

Thanks for listening,

Leah

[Squirt's Mom]

If she were mine, I'd be going home at lunch to check on her. I'm a huge worry wort and since she has not been feeling well to start with the double dose would concern me a great deal.

[LeahCC]

I went home during lunch to see how she was doing. She seemed no worse than normal, so I didn't take her to the vet. I saw no evidence of vomiting or diarrhea; just panting and trembling like a leaf. I brought her a plain hamburger and she gobbled it up as per the usual agreement.

I read here and there people using melatonin and milk thistle to help with Cushing's symptoms. Have y'all had any success with this? I have some melatonin at home that I take for sleep sometimes, and I can pick up milk thistle on my way home. I know that herbal supplements are very "your mileage may vary" but I'll try anything safe to make her feel better.

Thanks for the input,

Leah

[Squirt's Mom]

The combination of melatonin and lignans from either flax or Spruce is used to treat a form of Cushing's called Atypical in which the cortisol is normal but two or more of the intermediate, or sex, hormones are elevated. The melatonin used for this treatment is 3mg - plain, not time released, extended, etc...just plain ole melatonin. If using for calming you can start with 1mg and go up from there as needed...again plain, no additives. Milk Thistle is an herb used to support the liver. It can help in some dogs and unless they are allergic or have a sensitivity like my Squirt did it can't hurt. If the dog has seizures then melatonin is not recommended but otherwise it should be fine as well.

Tremors is one of the side effects listed for Vetoryl (Trilostane) so that may be what you are seeing. Hopefully she will adjust in time and that will settle but it doesn't in all dogs.

[LeahCC]

Oh so the tremors may just be a side effect of the Vetoryl and not necessarily indicate that she's in pain? Maybe we can look at lowering her dose if her next ACTH stem test comes back with good results. Trying to get in the Goldilocks zone with the Vetoryl.

I'm pretty sure she has the typical Cushing's so I can bypass the lignans-melatonin combo. I could use the melatonin for the calming properties and see if that gives her some relief. How did you know that Squirt had a sensitivity to milk thistle? Is there some kind of patch test maybe that I can do, or do I need to try a low dose to see if there's a reaction? What kind of reaction could I expect?

Thanks for the info

Keah

[labblab]

Tremors and "shivering" episodes are indeed complaints that we've heard before. My own Cushpup was one who suffered unexplained tremors before starting treatment, and for a period of time afterwards. There is still a lot that is unknown about Cushing's, and episodes like this seem to remain one of the mysteries. As Leslie says, tremoring has been listed as a possible side effect of trilostane, but my own dog started his tremoring before he was even placed on the medication.

Under the "Adverse Reactions" portion of Dechra's U.S. Product Insert for Vetoryl, "shaking/shivering" was reported in 10 dogs out of a total of 107 animals included in an American clinical trial. The big question, of course, is whether the shaking was truly caused by the drug or instead by something else. Since the shaking was observed in dogs during the time period they were taking the medication, it had to be listed as a possible side effect. But I don't think Dechra knows of a specific mechanism that would cause this effect.

As I say, my Cushpup definitely started tremoring prior to being treated with trilostane, so the drug couldn't have been the original cause. However, the tremoring did worsen after treatment was begun. So who knows exactly what was going on. For what it’s worth, here’s a related reply I posted to another member a while back.

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 it may be the case that Phoebe will end up improving with a dosage decrease if the ACTH results warrant it. But conversely, she may end up doing better with an increase if her cortisol doesn’t drop down a bit more.

Marianne

[Squirt's Mom]

First, I used an alcohol tincture to give her the MT and she threw up. So I got a glycerite tincture and she threw that up. So I tried using the dried herb sprinkled n her food - she threw up. Last resort I tried a capsule form and she threw up. SO I gave up on MT and switched to an herb called Schisandra that also helps the liver and she did fine with that.

[jrepac]

melatonin, lignans and milk thistle are all recommended non-Rx options. But, I have to agree w/the others, shaking/trembling is a common side effect from treatment...I think it's tied to dropping cortisol levels....but it should pass. If it does not, speak to your vet.