Golden newly diagnosed

[kwhit]

Hi. My name is Karen and my 13.5 year old Golden, Chance, was just diagnosed this past week. I'm so glad to have found this board.

He started trilostane on Friday, (30 mg/a day), and since then he has had really bad diarrhea. Is this just his body getting used to the drug? I'll be calling his vet tomorrow, but thought I would ask here, too. I have noticed that his panting has lessened, but the amount he's drinking hasn't changed nor has his appetite, (still huge). Should I see changes in those areas soon?

His vet also said he needs a dental with some extractions, (one being his upper canine), which she said was a difficult one to take out. He shows absolutely no signs of discomfort from his teeth at all, but I know they can be quite stoic where pain is concerned. He still asks for treats all the time and chews his dental treats with no issues. I'm very leery about the procedure because of his age, but is there any added risk with the surgery because of him having Cushing's?

Sorry for all the questions right off the bat, but I'm new to this and wanted to find out from those that have a lot more knowledge about this disease. TIA.

[labblab]

Hello Karen, and welcome to you and Chance. He looks like such a sweet boy!!

Yes, it is indeed possible that the trilostane may be causing his diarrhea, so it’s very good and very important that you discuss this with the vet today. I am assuming that Chance weighs more than 30 pounds, so a starting dose of 30 mg. is technically within the current dosing recommendations (starting dose not to exceed 1 mg. per pound). But having said that, our experience here is that larger dogs often end up needing relatively small doses of the drug to keep their cortisol levels under proper control. So it may turn out that even the 30 mg. is more than Chance requires. Or it just may be the case that it will take his body some time to adjust to what may be a rapid lowering of his cortisol level, and you may want to first start out with a lower dose before gradually working up higher. Either way, it’s important to report this side effect to your vet.

Until Chance’s cortisol does indeed drop within the desired therapeutic range, though, you will likely not see a noticeable improvement in observable symptoms. Right now, the best way of monitoring cortisol levels is via a blood test called an ACTH stimulation test. Has your vet spoken with you about this? If a dog is generally doing well, the first monitoring test is usually performed after the first 10-14 days of treatment, or at least no later than the first month. However, if dogs appear unwell, the test should be done sooner. Since Chance has had only a couple of doses of trilostane, I don’t know that I’d rush to perform an ACTH immediately. But if the diarrhea continues, I’m assuming your vet will advise you to halt the trilostane until the diarrhea ends, and then resume the trilostane at a lower dose.

You’ve mentioned excessive panting, thirst and hunger. Does Chance have any other Cushing’s symptoms, either in terms of observable issues or abnormal laboratory results? Can you tell us what tests were done to diagnose his condition? As far as surgical risks, you’ll need to talk with your vet more about that. I believe that elevated cortisol levels can delay healing. Also, if Chance suffers from kidney or liver dysfunction, there can be added risk to undergoing anesthesia. Lastly, there seems to be an increased risk for blood clots associated with uncontrolled Cushing’s. So everything being equal, it might be wise to hold off on the dental work until Chance’s cortisol level indeed comes down. But again, your vet should be in the best position to discuss the specific risks and benefits that apply to Chance.

So we’ll be anxious to get some additional info about your boy. And once again, we’re really glad you’ve found us!
Marianne

[Squirt's Mom]

Hi Karen, welcome to you and your sweet boy, Chance!

Marianne has gotten you off to a great start so I'm just popping in to welcome the both of you and tell you we are so glad you found us!

Hugs,
Leslie

[kwhit]

Thanks so much for your responses.

Chance has had elevated ALP for about a year, but no other symptoms at that time. It’s just been during the past 4-5 months I had been noticing the increase in his drinking and his appetite. Then in the past month he’s had accidents in the house which was totally unlike him. He has also had increasing muscle weakness, especially in his back legs. He couldn’t hold his stool until he got outside.

What really Got me worried, though, was his Precision PSL blood work levels in November, (he gets blood work every 3 to 6 months because he’s on Rimadyl. He has severe elbow dysplasia), extremely high. Top normal level was 140. Chance’s level was 1200. His ALP was at 900. Retested two weeks later and his ALP was the same and his PSL was 1100. Showed no signs at all of pancreatitis. Retested again in February and his ALP was at 600 and his PSL was over 2000. Decided to see a different vet that is on staff as an internist at UC Davis. She ordered an ultrasound, chest X-ray and the one hour Cushing’s test. Everything looked good except for some nodules on his liver and pancreas, but his doctor said that they didn’t look like anything suspicious and were pretty common in older dogs.

His Cushing’s test came back at 18 which his vet described as a grey zone. So he then had the 8 hour test which confirmed he had Pituitary Dependent Cushing’s. Oh, and his stool has firmed up as of this morning.

[molly muffin]

I just want to say hi and welcome to you and Chance.

It could be that just introducing a new medication into his body caused him to have some diarrhea. I'm basing that guess on it getting better.

When are you scheduled to have the first ACTH follow up test? At 18, I would expect that his cortisol should come down fairly easily but you don't know for sure until you see how his body is reacting. Staring low though is a good plan since as was mentioned earlier, some larger dogs end up needing smaller dose.

Welcome again

[kwhit]

Thanks so much for the warm welcome.

Chance’s doctor told me to discontinue his med for now and put him on a bland diet for a few days. After a few days we’ll see how he is and go from there.

I was also wondering if these symptoms could be a reaction to his new med or if it’s just a coincidence and it’s his natural age progression, (kind of hoping it could be the medication and not him getting worse from age��):

1. Increasing loss of muscle control, (I had a ramp built for him so he could go up and down the steps to the backyard on his own. More independence for him), and just in the past few days he has had a difficult time going down the ramp. His back legs give out.
2. Increasing anxiety. I think he has a touch of dementia. He would bark and whine at nothing. He would pace and get very agitated/couldn’t settle down at night. I started giving him CBD oil about 5 months ago and it worked perfectly...until he started the trilostane.

Could these two issues be due to a reaction to his new med?

[molly muffin]

Muscle loss and especially hind leg weakness is often a symptom with cushing. I used a ramp for my girl too, but I think with a larger dog that it is harder all around for them with the rear leg weakness. So that could be due to cushings.

So the CBD oil stopped working when given with the trilostane on the anxiety, dementia? Now that the trilostane has been stopped it will be interesting I think to see if the CBD oil start to work on those two issues once again.

Dementia, macro pituitary tumors, can cause some neuro symptoms, but it isn't known that he has a macro, so could also be age related. As could the back leg weakness.

This is one of the things that makes cushings so hard to diagnose because often age releated and cushings symptoms can mimic each other. The excess drinking, urination, hunger, accidents in house that didn't use to happen, those are most often associated with cushings rather than age.

I would personally see if the CBD works on the anxiety, nero symptoms again, and perhaps going forward try a smaller dose of the trilostane to see if he has the same reaction.

[kwhit]

Well, it looks like the CBD oil is working on his anxiety again. He fell asleep at his normal time, no barking, pacing or whining. Looks like it didn’t work because of the trilostane since this is the first day he didn’t get his dose of the med. I’ll let his vet know tomorrow and see what she says.

I’ll see if his mobility is better tomorrow, too.

[molly muffin]

hmmm, interesting that it is working on the restlessness without the trilostane. Yes, definitely let us know about the mobility too.

[kwhit]

Chance’s mobility is definitely better. It’s amazing that a medication can have such a drastically negative effect in such a short period of time. I’m very nervous about using it again, even at a lesser dose. Are there some cases where treatment is not given? What about a holistic approach? His urination amount is not that bad and I can deal with it. Would not treating be extremely detrimental to his health? I’m so torn as to how to approach this. I’ll be waiting one more day to email his doctor to give it more thought.