My boxer has Cushings and I'm having problems

[Spdjbly]

Hello everyone. Any advice would be appreciated.
My 10.5 year old boxer, who is otherwise in good condition has Cushings. His treatment started with 30mg of Trilostane. After two weeks he made some improvement but numbers were not where they needed to be. Then he went on alternating daily dosage of 30mg day one and 60mgday 2, continuing to alternate. Things seemed good but after two weeks he developed severe diarrhea. Dosage was changed to 40mg a day - still having problems controlling urine.
I am beginning to lose hope. Any suggestions are welcome.
Steve

[labblab]

Hello Steve, and welcome to you and your boy! I’m surely sorry, though, for the problems you’re having. I know how much you want him to be feeling better. We’ll do our best to offer suggestions. But first, I have a few questions for you that’ll help guide us in our thoughts going forward.

First, can you tell us a bit more about your boy’s overall health history, his weight, and also the symptoms that led to the Cushing’s diagnosis? You’ve already mentioned the excessive urination — any other issues? Also, can you tell us about the testing that was done related to the diagnosis, including specific blood tests for Cushing’s as well as any other lab abnormalities? Any additional info you can share will be a help to us.

Unfortunately, even when Cushing’s is definitely the culprit, it can sometimes take time to arrive at the optimal dose of trilostane. Thus far, has your boy been getting his trilostane once a day? Some dogs end up responding better to a split dose given twice daily. For dogs who metabolize the drug quite quickly, the divided dose may extend the therapeutic effect more consistently throughout an entire 24-hour period. Also, every dose needs to be given along with a meal, regardless of whether it’s once or twice daily.

Anyway, I’ll go ahead and pause for now. Once again, we’re very glad you’ve found us and we look forward to learning more about your sweet boy.

Marianne

[Spdjbly]

Thank you Marianne.
Guido is a 10.5 year old boxer. He weighs 83lbs. He is in very good shape, still jogs when going out to bathroom and coming back. No signs of hip or leg problems. He had his annual physical in March and all was great. I did report that I noticed him drinking more water than usual, but at that point there were not urinary control problems. I requested because of his age to have senior dog blood work done. It was all great and his kidney function was fine.

About two months later we noted he was having trouble controlling his urine - peeing on floor. This was never an issue with him. I brought him to his vet who confirmed Cushing's.

I don't recall the cortisol levels, but we started him on 30mg, once a day in am with food. There was a little improvement, but it was short lived. He was retested and they determined that although his cortisol levels had improved - they still where not where the doc wanted them. He was switched to an alternating dose of 30 mg day one, 60mg day two, then 30mg....and so on. Always in the morning, with food, and once a day. Over the July 4 weekend he developed severe diarrhea and I had to take him to Tufts. They wanted to confirm that he had not switched to Addison's. They concluded that his cortisol levels were lower than they would like, prescribed one does of steroids and probiotics along with holding back the Trilostane for a couple days until his stools firm up. After regrouping with our vet, we changed his dosage to 40mg a day, in the morning. The doctors seems to like the once a day, at least for now, but did say that Cushing's is challenging to find what works best for each afflicted dog.

He's doing better, but still urinates frequently...mostly outdoors. He will be rechecked on July 23 for cortisol levels. We had a bad morning yesterday with urine several times - but as day went on he improved, was fine overnight, and is good this morning.

One question I have is should he be given access to water in the middle of the night? In general, we make sure he has as much water as he wants - seems like that is necessary with this condition.

I really appreciate any suggestions you can offer. I love my boy, he's such a good dog, and I know this is not how he wants to live. His attitude is still good - not lethargic, great appetite, so everything else seems to be good.

All the best,

Steve

[labblab]

Hi again, Steve, and thanks so much for this additional info about Guido. I’m glad he seems a little better again, but I know you’ll be hoping for consistently good results. In answer to your question, yes, my understanding is that Guido should always have access to water 24/7. Hopefully once his cortisol levels are stabilized, he’ll be sleeping peacefully throughout the night and drinking water won’t be an issue. But in the meantime it should be available to him.

And as for his cortisol, I think we’re kinda on hold until you get the new results on 7-23. When you take him in then, it would be great if you can request copies of his past lab results, including the diagnostic testing and cortisol levels. I’m puzzling a bit over the fact that aside from the cortisol and rather sudden excessive urination, apparently Guido doesn’t exhibit any other outward symptoms or lab abnormalities that are consistent with Cushing’s. It typically is a slowly developing disease, marked by certain lab abnormalities such as elevated liver enzymes and a combination of issues such as excessive hunger, hair loss, hind leg weakness, pot belly, etc. I don’t mean to cast doubt on your vet’s diagnostic process, especially since Guido has also been seen at Tufts and it sounds as though they think it’s Cushing’s, as well.

However, if none of these other typical abnormalities remain absent and Guido’s urination doesn’t improve, perhaps your vet may end up exploring some other diagnostic avenues. Cortisol can be elevated due to other bodily stressors, as well as Cushing’s. That’s one of the things that can make Cushing’s a challenge to accurately diagnose. I’ll mention one other ailment that we’ve seen in a few dogs here over the years who have struggled with excessive thirst/elevation and that is “Diabetes Insipidus.” This is entirely different from the much more common “Diabetes Mellitus,” and has nothing to do with elevated glucose levels.

But for now, I’m putting the cart way in front of the horse. Let’s see how Guido does during this next week, and also how is cortisol level turns out on the next recheck.

Marianne