My dog has had Cushings for over a year...high dosage...would love information!

[jenner1026]

Hello!
First of all, I am so grateful that I found this group. I don't know why it took me so long to find!! I read through a lot of the posts last night to try to get as much information as I could but still have questions about my case

My dog Jet is going to be 10 next month and was (unfortunately) diagnosed with Cushings in 2019 after eating things around the house and had to have stomach surgery! He is a 75-80 pound silver lab.

It's been a long road of testing (as you all know) and I am struggling with if I am making the right decisions for my dog.

The shorter version is, I see my regular vet and also a specialist at the emergency vet when I can. His next ACTH is November 25th.
My dog is on a VERY high dose of Vetoryl...in fact...it's the highest dose the emergency vet has ever seen and she has treated so many dogs with this disease. He takes 120 mg with breakfast and 60mg with dinner. We both can't believe it, but it took this many times of trying dosing to get his numbers ok. This is why I am afraid something else is going on with him.

I just told them to send me his last test results again and this is what they said:
Cortisol Serial 2 ACTH
Sample 1 - 4.1 (Range - 1-5 so ok)
Sample 2 - 6.7 (LOW) (Range - 8-17)

Not sure if that helps at all.

I also get nervous about results because he gets SO stressed out at the vet.

Anyway...I guess I just have so many questions and came here for advice. Here's a first few:
- I feed Jet dry kibble (Nature's Balance) and 1/2 can of Science Diet W/D wet food (pate) twice a day. I normally put the pill tablet right in the wet food because he just gobbles it right up. I don't open the pills just stick it right in the food so he eats it all together. No chewing. Is this ok to do? I don't like using the pill pockets because I am trying to keep his weight down!

- He has started to show some signs of possible arthritis. First, he was limping on his front right leg and I thought it was from jumping off the bed but over time I realize, it's actually happening when he first gets up or if he lays on his side for a few hours napping. It seems he gets lame and the leg isn't as strong. He is now on Galliprant for this because Xrays didnt show anything and we thought the Galliprant was ok for his liver. They seem to help.

- That takes me to CBD. I restarted him on CBD - I am giving him NuLEaf Naturals which is highly rated, however both vets cannot give any advice on this CBD. I give him 4-5 drops in the AM and 4-5 in the PM under his gums with my finger. Just started this so not sure of the affect yet. Does anyone else have advice on CBD?

- Along with the front leg, his back legs sometimes tremble/shake. It happens very randomly, usually when he is standing or sometimes pooping. I hope it's also just arthritis forming.

Phew....what a long post. But I figured good to post everything now at once.
Any help is greatly appreciated - it seems like all of the posts I read have dogs on such low doses!!! I am so fortunate to have insurance to help cover the ridiculous cost of this medication and the tests. I am just so afraid that one day it's all going to catch up with him and the meds are going to really make him even worse.

Best,
Jennifer

[jenner1026]

I wanted to reply because I forgot to mention why he was diagnosed in the first place (other than a suggestion when I took him to the emergency vet when he ate a shoe - ugh!)
Jet has always had skin problems in which I was treating with Apoquel which worked well for the itching, but he always still had patches of hair falling out and almost the entire top of his tail is now bald. This was before the Cushings. Now that he's on this crazy dose for Vetoryl, I decided to stop the Apoquel because I just don't like giving him that much medication!

So on top of the skin issues, he also had the pot belly, and was excessively drinking and eating....even eats sticks on the ground when we are on walks like they are treats. It's so frustrating. Also urinating more, but thankfully he does sleep the night and never has accidents.

So since the medicine, his symptoms have gotten a little better but not to a "normal" dog but as you can see at least his cortisol levels are in the range now.
So this is all just so hard to manage for me. Thanks again everyone

[labblab]

Hello Jennifer, and welcome to you and Jet! We’re so glad you’ve found us, too . You’ve done a great job of introducing Jet’s health situation to us — thank you so much for all this info. I want to be able to take the time to read through everything carefully before posting a more involved reply. So unfortunately, that will likely have to wait until tomorrow. But I didn’t want to wait until then to at least greet you! So once again, welcome, and I look forward to writing a more comprehensive reply a bit later on.

Marianne

[LauraA]

Hi Jennifer, I just want to make sure the ACTH Stim tests have been done correctly On the day of the test you are giving the meds with food as usual? And the test is scheduled for approx 4 hours later? Also with the skin issues, are the lesions/sores along the neck and back area as well?

[jenner1026]

Thank you both!! I am so grateful for the replies. I am trying to find/figure out how to get replies to the thread emailed to me so I will keep looking that up in the FAQ.

Yes the Stim tests were taken approx. or exactly 4 hours later and I give him the pill the 4 hours before. Most of the time I try to schedule the test mid day so that he can have the pill as normal with breakfast. If it's not exactly with breakfast it might be around an hour before or after, with a pill pocket. I hope that makes sense.

And he has had probably 5-6 ACTH tests already because we started him on 30mg, then 60, then 90, then I think maybe we jumped to the current dose which is the 120 and then the 60 with dinner. So I really hope by now we're doing them successfully. The specialist vet we are seeing next week (who's been treating him throughout this and coordinating with my regular vet) told me it's ok to feed him at 7:30 am, then give him the pill at 8:30, and then his test is at 12:30.

The skin issues vary - always the tail, but the back comes and goes. Right now for instance he is looking great! And I have been trying to bathe him every other week with the medicated shampoo from the vet. But on his belly he gets flaky skin. Nothing on the neck. The top of the head has a weird patch he's had for about a year but I never really tried to "fix" it since it's on his head and not bothering him.

[labblab]

Hi again, Jennifer. Thanks again for this additional info. And once again, we’re so glad to have you here with us. As you can see from my username, I’m also a Lab mom. My avatar is of my Cushpup, Barkis. He passed away over 15 years ago now, but he’s the reason I first joined this wonderful family, myself. Since Barkis, I’ve had two non-Cushing’s Lab girls. The only one still with me now is my 12 year-old Luna. But a Lab-lover I am, and will always be!

Turning to Jet, yes, he is indeed taking a big dose of trilostane. I would be very worried if he was starting off with such a high dose. But since your vet has arrived at this dose on the basis of ongoing monitoring tests — and Jet’s most recent ACTH was well within a safe range — a relatively high dose does seem to be what he’s needing. Given his weight, his current total daily dose is a bit more than 2 mg. per pound, and the research literature states that most dogs end up being stabilized within a range of 1-3 mg. per pound. So as high as Jet’s dose may seem to us, he *is* a big boy, and the dose remains within the overall expected research results.

I’m also glad to read that he’s being tested within that four-hour time frame after dosing. One suggestion I would make, however, is to make sure he’s being dosed along with a meal or within that hour afterward. I would not dose him one hour before eating, because in that situation the trilostane is really being processed on an empty stomach and that can alter the overall effectiveness, and also skew the test results upwards on a testing day. Dechra, the makers of Vetoryl, recommend always dosing along with the meal in order for the drug to be metabolized properly. If your internist is OK with dosing an hour afterward, then I’m assuming it’s because he thinks there’s still enough food left in the stomach to allow the trilostane to be digested alongside. But as a rule, we’ve been told that dosing right alongside a meal is best.

Back when I was treating my Barkis, trilostane had just been newly introduced and he was actually the first trilostane patient for my specialist. Dosage recommendations were quite a bit higher back then, and we started off my 65-pound boy with 120 mg. twice daily for a total of 240 mg. I shudder now to think we started him out that high, but amazingly, his post-ACTH cortisol level never dropped below around 6.0, either. So even though I would never, ever initially start a dog on such a high dose, he’s proof that some dogs do need higher doses to lower their cortisol into optimal range.

As far as Jet’s emerging mobility issues, it’s really hard to know whether muscle-wasting from Cushing’s is contributing, or whether it’s age-related arthritis, or maybe a combination. Both of my non-Cushing’s girls started exhibiting arthritic mobility issues around the age of 10 or 11. My current girl, Luna, just celebrated her twelfth birthday, and has really degenerated quite a bit during this past year. She’s been taking a daily NSAID for quite a while, and we added in CBD oil about six months ago. At first, I thought I saw improvement with the addition of the CBD. But now, she’s backsliding again so I’m fearful that the continued aging is just taking a greater toll. I apologize that I’m not offering any helpful hints about this. But I want you to know that I understand your worry since I share it!

All in all, it sounds as though you’re doing all the right things with Jet. For now, it may be kind of a waiting game to see how the next ACTH monitoring turns out, and to hope to see increasing symptom resolution as more time passes with his cortisol now lowered into a therapeutic range. I’ll go ahead and close for now, but do feel free to add any more thoughts or questions. And I’ll be watching for more updates, as well.

Marianne

[MacMajor01]

Hi Jennifer,

I just wanted to quickly note that there are no side effects or prolonged use issues with Apoquel at all. I understand not wanting to drown your pet w/a ton of pills though. My dog is on Vetoryl and the only reason I don't have him on his Apoquel is because I can't afford it! Otherwise, that is one miracle drug I whole-heartedly believe in!

[jenner1026]

Thank you!

[Squirt's Mom]

Talk to the vet about an allergy drug called CytoPoint. It is an injection and is not a steroid so it won't cause cush signs nor interfere with cush treatment. This drug was given to 2 of my babies and it was truly miraculous! Both needed less than 4 injections and their allergies never returned. Not all dogs have had this same reaction but it is not uncommon. So it would be worth having a conversation about it at least to see if it is affordable and if the vet recommends it for your sweet baby.

Hugs,
Leslie

[jenner1026]

Hello everyone! I hope everyone is enjoying the beginning of spring!

Jet had his 4 month check up today with an ACTH Stim Test. Will report results as soon as I know them.

He also is having a Urine Test done again since the last one was inconclusive. Let's see how that comes back as well!

Best,
Jennifer and Jet