Vetoryl / Cushings Disease - Dear Penny has passed

[Cyn719]

Hi my name is Cindy and my dog Penny has Cushings and was diagonsed at 8 years old - she is a shephard - akita - pit - lab and ?? she is now 11 and 85 lbs. She had all the symptoms excess very very excessing drinking thinning of fur and tail thining of her head pot belly and wanting snacks all the time - so the vet said it was time to put her on meds we waited as long as possible - her urine was totally diluted also - she has putitary tumor - ok so we did right befor Christmas - 60 mg a day - and yes the drinking stopped down to a bowl a day - not asking for snacks all the time and not asking for breakfast and dinner everyday like she use to now she just eats when I give it to her and the urinating has slowed down her coat is better she looks better BUT she just wants to lay down and sleep all the time - that spunky Penny is gone - the vet said she is not hyper cause the meds are doing what they are suppose to - but now she is having tremors I think her eyes blink her head shakes then she shakes like a mini seizure - vet said shivering is normal but I think this is more - said if tumor get big enough it will cause seizures but doesnt think this is the case - so when she had her first blood test after being on med for i think 3 weeks it was 2.4 vet said good - now yesterday 3 weeks later test again now 8.8 at 9 the push up the dose so why isnt it working at 60? I do not want to increase the dose with her sympotms and how tired she is and also she had arthritis and shes on rimadyl which was working great but now on these meds its like shes not taking rimadyl at all she can hardly stand - vet said its because when she was getting to much cortisol it was like a high and she didnt feel all the pain and now shes getting less cortisol shes feeling the pain - so now what - did I do right by putting her on meds - before I felt like I had a dog now I dont!!! What do i do now?? I would appreciate all your help Thank you so much!! Cindy and Penny

[Casey's Mom]

Good morning Penny and welcome to our forum. Glad to have you here with us but sorry that your dog has cushings. There are others on this site that will be along shortly and address the shivering issues - I know that it has been discussed here before.

My dog also had the arthritis issues show up after her cortisol was under control - what your vet told you is correct about the cortisol masking the symptoms. You should not give a cushings dog rimadyl because it affects the liver however there are lots of other things you can do to help the arthritis. My dog gets a daily dose of L-Glutamine, Glucosamine Chondroitin and Salmon Oil and monthly Adequan shots from the veterinarian. Speak to your vet about these and see if they will help your dog - my dog will be 15 in March and runs every day so there is hope. It does take a while for the strength to return to their back legs, I think with Casey it was about 4 to 6 months.

Hugs,

[frijole]

Hi! Perhaps the shivering is from pain from arthritis? There are things you can do. Many of us used Adequan which are shots for treatment of arthritis. Google it and you will see some good things. My dog Haley was 16 1/2 and she was on it for about a year prior to passing.

My other dog Annie has had shivering and back leg weakness and I have her on a homeopathic alternative to steroidal anti inflammatories. It is called Duralactin and has helped her alot. Its a chewable tablet and you can buy it online without an rx. I learned about it from the head of the small animal science department at Kansas State Univ. Here's a link with info:
http://www.k9cushings.com/forum/showthread.php?t=2635

It is not well known in the vet world fyi... google it too!

Hope this helps. Kim

[Squirt's Mom]

Hi Cindy and welcome to you and Penny!

We are going to play 20 Questions for minute, ok? This is so we can get a clearer picture of what is going on with Penny and be able to offer you the most meaningful feedback. We won't get really nosy until we get to know you a bit better!

Does Penny have any other health issues that you are aware of?

Is she on any meds other than the Trilostane (Vetoryl)? any supplements or herbs? If so, what and how much?

Is she spayed?

Has Penny had an abdominal ultrasound? If she has, would you mind posting those results?

Were diabetes and hypothyroidism ruled out when she was first being diagnosed?

Has she been tested for diabetes recently (in the last month or less)?

Do you ever notice her eyes rapidly shifting from side to side when she has the episodes you described as a possible mini seizure?

Does she circle - not circling to lay down but just going in circles for no apparent reason?

Does she press her head against things like walls, cabinets, furniture? Not pressing against you to be petted but just pressing her head against things.

How long after her last dose of Trilo was the last ACTH done in which the numbers had risen?

Have you had enough questions for a while?

Now for a bit of info - cortisol is a natural anti-inflammatory so when a cush pup has issues like arthritis or other inflammatory conditions often we see these conditions come to the surface once the cortisol is back to normal levels. Your vet was almost right...they aren't really on a high with the cortisol, but they are self-medicating in a sense.

Cortisol is the body's NORMAL response to any stress - internal or external. Anytime the body is under stress, processes happen that cause more cortisol to be released until the stress is handled and then the signal to release the extra cortisol is shut off. In a cush pup, that signal cannot be shut off so they continuously produce excess cortisol. In this was our babies are "self-medicating" because the excess cortisol their bodies are releasing mask inflammatory conditions like arthritis.

Ellen gave you some excellent suggestions for addressing the arthritis. She is right on the mark about the Rimadyl! I would add one thing to what she had to say - anytime you give oils of any kind, including fish oils, you need to add Vitamin E as well. Vit E is an anti-oxidant and will prevent oxidization of the fish oils in the body which allows the body to fully absorb and use the oils as intended without causing free radicals.

One of the unfortunate side effects of Trilo is tremors. We have seen this with other babies on Trilo but most of them adjust in time once the dose has been tweaked to the correct amount and scheduling. Some of our Trilo parents will be along to share their experiences with you I am sure. Here is a link to a file in our Helpful Resource section about Trilo:

http://www.k9cushings.com/forum/showthread.php?t=185

If you have, or will get, copies of all the testing done on Penny to diagnose her and the monitoring testing since being on Trilo, and post the actual results along with the units of measurement (ug/dl, nmol/l, ect) and the normal ranges for that lab here for us, that will help a great deal! Your vet should be glad to give you a copy of her testing results. Most of us keep a file at home of tests on our babies so if we should ever have to see a different vet, we have all their records in hand right off the bat.

Ok, I think that's enough from this old broad for now! I am sure others will be along to offer their input soon.

For now I want you to know that you and Penny are not alone any longer. You have found the very best bunch of folks to help and to support ya'll on this journey. We will walk every step with you. Don't hesitate to ask questions and we will do our best to help you understand. The collective knowledge and first-hand experience found here is astounding and you simply cannot beat the old-fashioned hand-holding should you ever need it. I don't know what Squirt and I would have done these past 3 years without these wonderful, loving folks here. I know you will find the same to be true for you and Penny.

I am glad you found us and look forward to learning more about the both of you as time passes.

Hang in there!
Hugs,
Leslie and the girls - always

[zoesmom]

Hi Cindy and welcome to you and Penny -

The early days of treating cushings can be so stresful, but you have come to the right place - for your questions and for moral support.

My girl Zoe was treated with trilostane for 4 years, but the first few months were full of ups and downs (for her) and worry (for me.) She was lab, pit, boxer mix and about the same size as your Penny. If it makes you feel better, she ended up on a much higher dose - 180 mg. of vetoryl twice a day. So for a dog Penny's size, she has a lot of upward wiggle room, if her cortisol is not being well-controlled. She also responded much like you describe for Penny in the beginning. The shivering/tremors scared me but many dogs do experieince that, when the trilostane first kicks in. It eventually went away and should for Penny, too. As for the listlessness and sleeping all the time, that also was how Zoe was. It was extreme at times, but it also improved. One time, she wouldn't even lift her head, and seemed not to care about anything I mentioned - like tr eats, bye-bye. She'd even go off in corners where she never went and just laid there. That could be from what we call cortisol withdrawal syndrome. Many dogs go thru that. They're so used to the excess cortisol and its 'feel-good' effect. It was almost like Zoe was extremely depressed. That too, passed.

That being said, it is crucial to monitor their cortisol closely in the first few months. Sounds like your vet is doing that, just as required. However, could you please get and post the ACTH test results for those first two tests you mentioned. The one with 2.4 and 8.8 numbers. There should be two numbers for each test. That will help us to understand the results better. Also, results for any of the tests done during diagnosis would also be a big help.

Your Penny started on a modest dose for her size and that IS the best approach, IMO. But since that's the case, she may need one or more dose increases in the coming weeks/months to bring her cortisol to a therapeutic level and keep it there. Some dogs will settle in quickly on the right dose. Others, like my Zoe did, require more frequent dose adjustments. I won't give you the whole history, but there were times when all of a sudden her cortisol would go up or down, after being stable for awhile, and w'd have to adjust the dose. Most dogs will need very few if any dose adjustments. Just depends on the dog. So hope that helps you feel a bit better about what's going on. Treating is the very best option, but as a cush mom, you must always be on your toes, watching for possible clues as to how she's doing. And if ever in doubt, even the slightest bit, it's good to check with your vet. I promise, you will get so that you can read Penny like a book. Sue

PS - one thing that worked well for me was keeping a record of Zoe's daily water intake. That gave me a good idea of how hercortisol numbers were doing. If the water intake went up and stayed up, then that was a pretty good indication that her cortisol was on the rise (or that she had developed a urinary infection, which she did often and, of course, that's something that would also need to be addressed quickly.)

[Cyn719]

i can really relate to zoemoms situation - sounds so much like Penny - when her ACTH was 2.4 she drank very little and now that it is 8.8 she is drinking more - where should the ACTH be?? She has more energy at 8.8 but is that to high? She was so much better today - energy - jumping aroung - like her old self - but she groans so much - dont know if its the arthritis or not?? I dont like the groaning or the tremors but we will see where that goes - The vet said not to test her again for 3 months but that seems too long - but if the drinking increases then I have to call her - I hate to increase the meds cause then she is so lifeless -- this is not an easy situation at all plus Penny broke her K9 tooth and now thats another issue - the bottom quarter broke off and shaved a piece off the side - vet said right now not in pain but its a huge surgery to remove it better with a root canal??????? so confused - this girl has been through so much - she has both kneess done over also!!!

[apollo6]

Welcome
My Apollo was on Trilostane since June, had the trembling mouth and still has weakness in legs. I stopped Trilostane/Vetroyl in December to see if that caused weakness, but he still has weakness, so I will be putting him back on the medication, because symptoms are coming back. Hang in there. It is a long tough road. But a lot of us are still here so that is a positive.
Hugs Sonja and Apollo

[Cyn719]

zoesmom

- sorry I had to get out of my post quickly before - Penny was really groaning and I had to tend to her - I just wanted to say thank you because I could relate to what you said and I feel better knowing you (and everyone else) if there for me - this is crazy - so much is going on with her at once - the broken tooth - the cushings - the arthritis - and strange but a pin hole cut above her hock on her lets say elbow that started bleeding before Christmas and still was bleeding up to two days ago! Vet gave antibiotics and wrapped and because its on her elbow nothing with stay over the cut and went exposed and she lays on run the scab opens again - I bandage her 15 times a day!! Today I am alittle nervous cause she is wanting more water and thats not good with a 8.8 ACTH - at 9 meds get increased - will get results and post - thanks for keeping in touch - Cindy

[Cyn719]

Hi everyone - Penny is laying on the couch and just had two episodes 2 mins apart. to discribe it her head started to jerk - eyes were flickering - and mouth twitching!! He body also shook alittle. Do you thing it was tremores - shivering - or mini seizures???? I never noticed this before the Cushings medicine. I could use your thoughts!! Thank you - kind of getting me nervous. Thanks Cindy

[zoesmom]

Gosh, Cindy - it's hard to know from a simple description what was going on with Penny. If you have a video cam or can video it using a cell phone, then the best thing would be to try to capture one of those episodes on video so you can s how it to your et.

My Zoe had seizures as well and those were definitely different than the tremors from the trilostane. But there are many different kinds of seizures and not all of them look like the classic version that we usually think of. The twitching eyes could also be a sign of canine vestibular syndrome (an inner ear thing).... Is she having any trouble keeping her balance? Zoe went through that too - a severe case - but it can be milder in some dogs. How did she seem afterwards. Because seizures are usually followed by a period of disorientation, where they seem generally out of it for sometimes, hours.

The ACTH goal for a dog on trilo is 2-ish to 5.5ish. But if symptoms are being controlled, they can go up to 8, or in a few cases, 9. And all dogs are different - Zoe did much better when her cortisol was running somewhere between 5 and 7-ish. Above 9, probably too high for any cush dog. But 8 might be ok, if the drinking is not bad and that would also help with the arthritis that tends to worsen, the lower the cortisol. That was another reason we let Zoe's numbers run a little higher - big dogs and arthritis, not a pretty thing to watch. As for the drinking, the norm is about 1 cup of water for every 10 lbs. of weight OR 1 oz. for every lb. of weight. I measured Zoe's water all the time, just because it's hard to estimate what they drink. So if you measured Penny's water and she's drinking less than 9 c./day, her water consumption is in a good range. That might determine whether she really needs a dose increase or not.

On the leg thing, there's some really good products for dogs' leg joints. I bought something called LEGGS for Zoe's front elbows. Not cheap but they really helped her raw and oozing, scabby mess on the front elbows. Plus that also kept her from licking at them and making matters worse. There's a picture in her album here (click on my name to go there) which shows her wearing the LEGGS. I wish I'd found them sooner. Somebody here recommended them and she wore them for her last three months. I'll see if I can find a link to their website. Like you, I was getting tired of the constant bandaging and re-bandaging. Sue