Poor appetite - Toby is now at peace

[LINDAP1]

I am new to this site and hope someone has some insight to what is going on with my pal Toby. He is a 7 year old shepard/lab mix and is the best family dog we ever had. He has had good health until about 1 year ago when he developed the classic cushion's symptoms-bloated belly,insatiable appetite,weight gain,drinking constantly and urinating in the house. I have medical background and researched info and found out that I thought he might have Cushings. We immediately had the bloodwork/stim test done which was negative and didn't show Cushings but with my persistence and additional testing he finally was diagnosed. He was started on Trilostane which we get compounded from Diamondback drug. He was 120 pounds and now down to 86 pounds. He is on 90 mg once a day and has had the followup bloodwork as recommended-3-6months and it has been perfect. About 1 month ago I notice he wasn't feeling quite right. You know your pet and when they are "off" but nothing drastic, you just know. I took him for a physical and the vet felt he was ok. We did electrolyte bloodwork which was normal also. We did the stim test again and the values were perfect. We also did a complete bloodwork panel and it was weird because looked like he was an untreated Cushing's dog even though he has been treated daily. So swim results perfect but bloodworm looking like untreated Cushings dog. His only symptoms now is poor appetite-does not really care to eat and very very picky and wants to be outside constantly-very cold out. He seems to not be tolerant to the temperature in the house(68-70) yet not panting at all. Very weird and so my vet consulted with a specialist at the Lab who suggested taking him off the trilostane-which I do not feel is a good is a good idea at his point because all his other symptoms will return and/or doing an abdominal ultrasound with he is scheduled for this week. Any ideas because I am going crazy!!! I do not want to wait until he stops eating all together. I read that trilostane can cause live issues and maybe the dose should be lowered but has anyone given this med every other day? I would like to try half the dose twice a day instead but right now I just got a 2 month supply(which isn't cheap) and they are capsules so I cannot cut in half. I thought of trying the 1 caps every other day to see if he feels better. What do you think. Thank you from Toby!!!

[LINDAP1]

I am sorry but I see that the auto-correct feature has changed some words but hopefully readers can figure it out..so sorry Linda/toby

[Joan2517]

Welcome Linda and Toby...yes, auto correct can really do a number on the posts, but we're used to it. Toby sounds like a great companion!

I don't have any answers, but others who are more knowledgeable will be along shortly to try to help you with some of your concerns. They will want to see the blood work results, so if you have them, please be ready to post what they ask for. If you don't, maybe you can get them from your vet.

We look forward to learning more about Toby~

Joan

[LINDAP1]

Joan,
thank you! I hope someone can help and yes toby is a love. Thanks linda

[Squirt's Mom]

Hi Linda,

I took the liberty of adding spaces between you sentences so my old eyes could read your post.

First, I would ask that you contact your vet and get copies of alll the lab work your baby has had done. Then post all the info from the ACTHs and post just the abnormal values from the other labs that look at things like the liver - it will show things like ALP, ALT, BUN, CHOL, etc. Be sure to include all the little letters and numbers after each abnormal value you post. It will look something like this -

EXAMPLE -
ALP 1551 ug/dl 150-300

The ACTH will have 2 values - a pre and a post number. If you are in Canada it will have 3 values. We want to see all of those numbers.

When you say your baby was "off" can you explain in deeper detail what you were seeing?

Has your baby been tested for diabetes recently and by recently I mean since he started losing weight? Weight loss is a hallmark sign of diabetes, as is loss of appetite, and it is not uncommon for cush pups to become diabetic or vice versa. IF that has not been checked, have his glucose checked asap.

For a dog that is not eating well taking a break from the treatment is recommended. These drugs must have fats to be absorbed so if he is not eating well the drug is not working properly. Also, that is one of the signs the cortisol has gone too low. That can happen at any time with dogs on Vetoryl (Trilostane) even if they have been stable for a long time. So I would probably stop the Trilo for now and see if his appetite picks up. Using this drug every other day is useless because it has a very short life in the body - from 2-12 hours in most dogs. So using it every other day just puts the dog on a roller coaster of high then low then high.... NEVER ever open the caps and try to divide them to use.

I'm glad you found us and look forward to seeing those test results very soon! They will help us help you by giving more meaningful feedback.

Hugs,
Leslie and the gang

[LINDAP1]

Squirt's mom-
thank you for your response. when i say toby is a little

"off" i mean he acts like he is depressed,not lethargic but

very quiet and resting alot. although when i tell him he is

going for a ride he will jump up and follow me because

that is his favorite thing to do. the fact that he always

wants to be outside even in this cold new england

weather is new for him also. as soon i get him inside,

within a few minutes he is back at the door again. i watch

him and he just lays down on the deck. it is not because

he needs to go to the bathroom. we wanted his weight to

stay around 90 pounds but still losing due to his poor

appetite. so taking him off trilostane all together won't

harm him? I am including his labs-

electrolytes were all normal

alk phos 848 iu/l normal 5-131

cholesterol 331 mg/dl normal 92-324

urine ph 8.0 normal 5.5-7.0

protien 1+ normal negative

cortisol sample 1 2.6 <font face-"symbol" verified

cortisol sample 2 2.3 verified

i am so glad i found your website as well. i really trust my vet but worried because you can tell he doesn't feel well and there are so many complications that can occur. this is my fist experience with a cushings dog so from the bottom of my heart....thank you! Linda and toby

[molly muffin]

So glucose was normal, BUN, creatinine all normal and not a lot of protein loss in urine? Was his urine dilute? Cushings dogs normally have very dilute urine.

All blood wbc normal?

Normally the first things we look for with weight loss is kidneys and diabetes, but if the above values are all normal then it wouldn't seem to be that causing an issue.

There can be a bit of time after being on cushings meds when the cortisol comes come that they feel off, but that will normally pass and then they are back to normal.

How is his appetite?

Normally they test at 14 days and then 30 days after starting medication and then if normal range at the 30 day mark, they may wait for 3 months to test, but not usually 6 months as things can change. We expect to see cortisol continue to drop on the same dose for at least 30 days on the same dose.

How long has he been on the 90mg and when was the last test.

The ultrasound may tell you more, as it give a lot of bang for the buck.

[LINDAP1]

Sharlene,
Thank you for posting a response.Toby has been on trilostane. Toby over 1 year and the same dose 90 mg trilostane.He has been doing well on it and no issues.we have him stimulus tested every 6 months.this last test was 1 week ago.His appetite is off and still wanting to be outside in the cold.thank you...Linda and Toby

[labblab]

Hello Linda, and welcome to you and Toby from me, too. I am very sorry, though, that he is having some problems right now. You mentioned earlier that he has an ultrasound scheduled for this week? If so, I do think that's a good idea, and we'll be quite anxious to hear the results.

If the ultrasound doesn't reveal any abnormalities that would account for his lack of appetite, then I think I'd also be tempted to temporarily discontinue the trilostane altogether for a few days in order to see whether that makes a difference. Even though his ACTH result was within the desired therapeutic range, it was down towards the lower end and Toby may be a dog who just doesn't feel as well with a cortisol level that is consistently that low. If you find that his appetite and behavior improve while off the medication, then perhaps you can problem-solve with Diamondback re: a dosage decrease. Perhaps they'd allow you to return the capsules for reformulation, for instance.

But first things first -- so we'll be very anxious to hear about the ultrasound. Toby sounds like a lovely boy, and I surely hope you can get things straightened out for him quickly.

Marianne

[LINDAP1]

Thank you Marianne for responding.That was exactly my thoughts.I even called my vet to suggest taking him off trilosane all together now before the ultrasound but she suggested we wait.She said taking him off the med all together will make his liver enzymes climb higher, which I really dont understand.I think either a lower dose/a divided dose or different medication for cushings might be the answer if the ultrasound is negative.It is nice to hear other opinions so thank you!