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Cushings advice
02-04-2017, 05:32 PM,
#1
Cushings advice
I have an 8 year old Sheepadoodle who has been full of life and energy up to roughly 6 months ago.  He's always been a big dog 95-105 lbs. and a very social dog who would want to lie down next to, or on anyone who visits.  He initially started showing symptoms like panting, excessive water consumption, increased urination, an insatiable appetite, desire to lie on hard cold surfaces rather than the sofa...  After a series of tests $$$ we determined that he had Cushings disease.  We also had an abdominal ultrasound the double check his adrenal gland and help make sure the type of cushings he has.  It was determined it is Pituitary. 
We started him on Trilostane initially with a very small dose of 10mg and gradually over the course of the next 4-5 months increased his dose to 65 mg/day. (several ACTH tests were done during this phase).  During this time (and for a couple of months prior), we saw a steady decline in his energy levels.  He rarely interacts with us anymore (this was a dog who could not stand being more than 10 ft from us for any period of time).  His walks seem to be laboured and he lacks the desire to even go out for one.  He no longer runs, does not jump up on sofa at all anymore, can't jump into the back of the car without a stool and just generally lacks the zest for life he had only a short time ago.   Our vet has indicated that the reduced Costisone in his system has probably uncovered arthritis that was previously being masked by the elevated Cortisone levels.  We have been giving him Fish Oil supplements along with Glucosamine, MSM, Chondroitin for several months now.  Many of the symptoms have subsided (virtually no panting, less water consumption, decreased appetite).  Although the quality and thickness of his coat remains diminished. 
My main concern and why I'm posting this is to see if anyone has had experience with or suggestions to improve his energy levels and perhaps increase the muscle tone that he lost over the last few months.  I have seen many dogs with arthritis and they do not have the reduced energy levels that my guy has.  We are working on getting his weight down slightly to help any arthritic issues but the lack of energy poses a real issue in trying to rehabilitate his weakened leg muscles.
Suggestions are much appreciated.
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02-04-2017, 06:35 PM,
#2
RE: Cushings advice
All of the symptoms you listed are known side affects of Trilostane.

https://dailymed.nlm.nih.gov/dailymed/ar...d=11916#AR

You started with a Cushings dog, and through medication have achieved an Addison's disease dog. Have you discussed with the Vet possibly lowering or altering the Trilostane dose? See if you can find a middle ground where the quality of life is better? Sometimes a drug can overshoot in its effect. Or once under control an endocrine disease may stay under control with lower doses of a drug. Discuss with your Vet.

I'm on the other side of this with a Leukemia dog which through prolonged Prednisone has acquired Cushing like symptoms. Where we cut the Prednisone to a minimum, and changed the dosage scheduling. He still drinks water like a drunk.

Ask your Vet if a NSAID can be prescribed for the arthritis. My Nerve Sheath cancer dog is on Rimadryl, which has helped her hind leg arthritis. Requires liver monitoring every few months. She now wants to go on longer walks, which helps the muscle tone.
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02-05-2017, 01:14 AM,
#3
RE: Cushings advice
Hello there!
If your dog's muscles are wasting hydrotherapy can be a low impact option that can help a lot. Ask your vet about passive range of motion exercises and possibly using an underwater thread mill. If there is a place where they do physical therapy for dogs near you, I would inquire what options they have for you.
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02-05-2017, 12:55 PM,
#4
RE: Cushings advice
Thanks for your replies. Dragondawg, it's a tough thing because lethargy and rear leg weakness is also a symptom of Cushings itself, so determining which is the cause is challenging. He was showing signs of lethargy before we started the trilostane, it just seems worse now. So you may be right and it may be worth exploring reducing his dose (mind you he is on about 1/3 the dose the Vetoryl site suggests and it appears adequate per the acth stim test). I'm inclined to believe that the vet's suggestion that the increased cortisone levels were masking some underlying arthritic condition, but really not sure.
An underwater treadmill may be a good option, some of these types of services along with regular acth tests, drugs etc become somewhat cost prohibitive unfortunately. We are working on a number of hind leg exercises to help maintain/improve his strength.
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02-05-2017, 03:14 PM,
#5
RE: Cushings advice
(02-05-2017, 12:55 PM)DoodleDad Wrote: Thanks for your replies.  Dragondawg, it's a tough thing because lethargy and rear leg weakness is also a symptom of Cushings itself, so determining which is the cause is challenging.  He was showing signs of lethargy before we started the trilostane, it just seems worse now.  So you may be right and it may be worth exploring reducing his dose (mind you he is on about 1/3 the dose the Vetoryl site suggests and it appears adequate per the acth stim test). I'm inclined to believe that the vet's suggestion that the increased cortisone levels were masking some underlying arthritic condition, but really not sure.
An underwater treadmill may be a good option, some of these types of services along with regular acth tests, drugs etc become somewhat cost prohibitive unfortunately. We are working on a number of hind leg exercises to help maintain/improve his strength.

Indeed the Cushings leads to muscle weakness.  However Addison's disease can also cause muscle weakness, and lethargy.  So your dog is caught in the middle, where dosage, and frequency of dosage for the trilostane can have effect.  Again, discuss with the Vet, and see if s/he is willing to try a different dose/schedule, without having a flood of ACTH tests.  

My Leukemia dog is caught in a similar trap.  Instead of regulation of the ACTH in turn regulating corticosteroid production as in yours, mine is dealing with low pulse Prednisone supplying corticosteroids directly.  Lethargy has increased over time be it due to corticosteroid imbalances, and/or the cancer.  

Your Vet is correct that the increased corticosteroid levels of the Cushings could have mask the inflammation caused by arthritis on the hips.  Prednisone is sometimes prescribed for dogs with severe arthritis, to get the inflammation under control.  However, the Prednisone or increased corticosteroid levels of Cushings would not alleviate the pain from the arthritis which has already affected the bone in the joints.  

The underwater treadmill sounds like a great idea for exercise.  Or a nearby pond the dog can swim in for exercise.
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