5 yr old Boxer female. Being treated for Cushings with Trilostane 120MG per day. She weighs 71 pounds.

Problem is she is very tired and lethargic. Has been on drug for 3 months. ACTH indicated all chemical levels are normal.

Any idea's as to why she is lethargic and what I can do to increase energy levels?

Hi, Mike,

Lethargy is probably just part of her problem. Get her urine/blood checked for diabetes. May as well get her thyroid checked, too.

Walter

Thanks for the info. My Vet checked for Diabetes and found nothing to note. She did determine a bladder infection. {antibiotics inhand}. She also sent off a blood sample for a thyroid check.

Because my boxer has arthritis located later half of her back {just past her ribcage} {2-4 inch area} , my Vet has prescribed 20mg of prednisone. Seems to be doing better today although I have only given 2 doses. Lots of hair loss over the past 4 months.

Will keep you posted as thing's develop...if you don't mind.

Vet stated after urine test, Jewels {boxers name} had a bladder infection. {Antibiotics inhand}. No Diabetes present. Also, due to severe loss of hair and poor overall condition {loss of muscle mass} with pain in back, Vet took an xray of spine. Located authritis later part of spine just past ribcage. She has prescribed prednisone 20mg twice daily for 3 day's then one a day till all gone. She also sent blood in for complete panel workup checking thyroid condition. Suspects hypothiroidism {spelling} present.

Will keep you posted Dr. Beswick should you so decide.

R/
Mike

No Diabetes and no Thyroid condition confirmed. Current DVM referred me to and Internal DVM who confirms heart, Liver, Lungs etc are normal. He did however, recommend the ACHT test be given 4 hours post ingestion of 60mg of Trilostate. In the past the ACHT was done early am pre-ingestion. Apparently the Trilostane does not remain in the body very long. This is expected to yield a better reading and result which will "clearly dictate if enough or too much Trilostane is being administrated." Full bloodwork done to include electrolytes, sodium and potassium levels etc with results today. Internal DVM recommended Antinflamtory {Deramaxx} 100mg 1/2 each day for arthritis and was told to stop Prednisone previously prescribed by current DVM.

Bladder infection still current but she vomits after ingestion of meds. Told to lay off the antibitic until Monday.

Boxer still lethargic but expect her to perk up in the next few day's now that the drug situation has been fixed.

Guess it's a matter of time at this point having exhausted all means available to fix her.

I firmly believe that she is being administered too much Trilostane. ACHT results due today. Guess we'll see what we'll see.

Hi, Mike,

Prolonged steroid treatment for arthritis can cause various side-effects (including Cushing's disease).
It does look as tho your DVM is pulling out all the stops to help.
Be guided by him.

Walter

Fortunately the Prednisone was only given for 1 week. Arthritis was only detected in an X-ray a week ago..towards the end of the backbone...not much but still there just the same.

I will provide you the results of all the tests should you so decide. May help someone else's pooch that may come across similar circumstances while trying to deal with the Cushing's saga.

Thank you for your advice and consult.

R/

Hi, Mike,

Thanks - I hope all goes well.

Walter

Growing concern. Since being off the Trilostane {120mg per day} as of 28 Oct, Jewels did improve and started coming out of her lethargic, loopy disposition. She even started running around in the park...20 min a day. She still runs in the park but when I get her home as if yesterday, she goes back to laying down and seems drifty again. She has also stopped eating as of today. But her water consumption has gone from approx 6 cups a day to approx 9 cups a day. She did however eat some turkey cold-cuts...but only gave her 3 pieces approx size of bologna. Stools are normal, urine output increased obviously due to increased water consumption. Her last pre/post ACTH stim {28 Oct} showed normal levels but due to her dilapidated condition, it was decided to get her off so she could recover from the "crash." Well, she is not recovering too well and it's been 8 day's.

Dr. is out of tricks. Maybe it just takes longer for the trilostane to leave her body. Anyone got any ideas?? She has had all the tests from blood to urine. Healthy in all respects save the Cushing's saga which for what ever reason we cannot get under control.

Does anyone have any ideas or suggestions? We {Dr. and I} must be missing something.

Well, it appears there's simply nothing we can do here with this Boxer. We took her off the Trilostatne approx 11 day's ago. She is losing muscle mass fast. We are once again going to try Trilostatne but a much lower dose. 30mg each day. We will pre/post ACTH in 10 day's. Will raise the mg if need be. She is still very lethargic and uninterested.

Walter,
Any idea as to what we might be missing or haven't tried?

Hi, Mike,

have you discussed this with your vet? Since all her blood levels seem Ok, has he suggested gradually lowering the dose of Trilostane and saee what happens?.
Could be a good idea to get her Thyroid levels checked too.

Walter

I have discussed with the Vet lowering the Trilostane to 30mg per day for the next 10 day's....she agrees. We ran Thyroid {full blood panel} at Michican state. Her T4 was within limits {normal} as was everything else.

At the end of this 10 day period on 30mg's, I will have the blood work done again but at the local level to check for hypothyroid, sodium/potassium levels and electrolyte ratios in addition to the pre/post stim ACTH.

She is not eating as much as she used to. approx 3 cups a day vice the 4 she used to eat.

She also shivers when she is lying down {front legs then traveling up to her shoulders....like she's cold. Has a headache as well. You can tell this because when you attempt to pet her on the head she whinces. Her skin is very thin. Legs hurt due to loss of muscle mass I guess.

Hi, Mike,

Sounds like you are doing all that it is humanly possible.

Walter

Not sure if you are getting these Walter. Will send again for comment/advice.

Jewels' PDH ACHT Pre is 3.2 and Post is 6.0 @ 30mg Trilostane per day for the preceding 10 day's. However, although she's not too far out of norms, she's still extreamly lethargic and not interested, poor coat condition, poor muscle mass, loopy, water consumption is approx 1-3 cups per day and food is approx 1-2 cups per day {was 4-5}. Her weight now is approx 56lbs as of 30 Nov. All indications are we're losing her.

We will take yet another ACHT on the 2nd of Dec thinking maybe an additional 15mg per day of Trilostane might be called for or less for that matter.

Maybe we should try Lysodren and kill off the adrenal glans and treat for Addisons which from my undertsanding is much easier to control and has a better survival rate and quality of life for the dog.

I posted in the earlier forum that we had found a supplier of inexpensive Trilostane here in Spain to treat the Cushings disease in our whippet. Our vet has steadliy been increasing the dosage of Trilostane because of poor test results. Finally we have reverted back to Vetoryl and after 3 weeks our vet says the test results are much improved. I guess this means you get what you pay for.
Sorry if I raised anybody's hopes that there was a less expensive treatment available.
Regards,
Jonathan

Appears Trilostane is not getting the results we expected. Looks as though we will try Lysodren as a last ditch effort. If that does not work then it is assumed that the tumor in the pituitary glan is quite large and growing. And at that point we're out of options.

Hi, Mike,

However hard we try, we cannot save every patient!

There does come a time when we run out of options, and if our pet is in distress which we cannot relieve, our ultimate responsibilty - and privilege - is to spare it further suffering and have it put painlessly to sleep. Fortunately we are able to provide that final service for our pets.

Walter

Seems the results of the ACTH pre and post indicate cushings has been arrested although no Trilostane administered for 2.5 weeks. Jewels' bloodwork {12/11/05} indicates something is going on with the pacreas. Pancreas indicators are off the charts. Sorry, but I don't have the results here in front of me. We're however headed to the Internest to get a MRI/CT{?} of the pancreas. He will also photo the head due to a swollan tongue which appears to be quite painful at this time. She will not be given Lysodren unless ACTH levels indicate it's needed.

Only medication being administured is Thyroxin .08 twice a day for hypothyroidism.

Current physical condition of Jewels is poor.
severe loss of hair
lethargic
cries at night
very low muscle mass
thin
droopy eyelids {lower}

Diagnostic results. Figured you may want to see them and possibly shed some light on what appears to be a moving target for us.

Hopefully the Internist will get to the bottom of it. Their high/low
is all I can say. You obviously will get more out of them than I will.

Glucose 143 High mg/dl
Creatinine 0.4 Low mg/dl
Alkaline Phosphatase 3070 U/L High "VERIFIED BY REPEAT ANALYSIS."
ALT {SGPT} 419 HIGH U/L
CHOLESTEROL 358 HIGH mg/dl
LIPASE 5690 HIGH U/L "VERIFIED BY REPEAT ANALYSIS."
AMYLASE 2431 HIGH U/L
GPK 48 U/L LOW
GGTP 120 U/L HIGH
T4 0.3 LOW
ACTH RESULTS PRE 5.6 POST 12.4

Hi, Mike,

Thank you for your e-mail with the blood test results

From these results it appears that you are dealing with liver failure as well as a pancreatic problem.

I would like, sadly, to refer you to my reply dated 10 December.

Walter

Hi,

I've a new box of Vetoryl Capsules (30 x 120mg).
I have no chance to use it cos my dog was passed away last month.
Anyone who are interested in taking this box of capsule please reply to this e-mail.

Regards,
Terence

My dog has been diagnosed with Cushings disease and is being treated with Trilostane 125 mg once a day. It has made a big difference and I want to continue the medicine but it is very expensive.

I haven't been able to find any pet medicine companies that carry Trilostane so that I can send in a written prescription and get the medication at a less expensive price.

Wedgewood Pharmacy in New Jersey is where my veterinarion gets the Trilostane but they do not fill prescriptions for pet owners.

Can you help me?

Hi, Sue,
I am based in UK, so I cannot help you, but I will popst this message and ask if anyone in the US can assist.
Walter

Hi - I have just come across your messages on the internet whilst looking for a solution to my boxer bitch, Kaz's problems. They seem very similar to yours. I got her from Boxer Rescue 2 years ago aged 2 then, so 4 now approx. A few months ago she started showing signs of stiffness when getting up and symmetrical hair loss along her flanks. Following various tests at the vets, i.e. x-rays, skin scrapes, basic blood tests, blood tests for thyroid, hormone, Cushing's etc - apart from finding she has got arthritis of the spine (problem from rib cage area) they can find no reason for the hair loss. She has been put on PLT for her arthritis and I was told she won't make "old bones". First, on this treatment, she was like a scavenger and drinking excessively but her stiffness improved remarkably. However, because of the side effects (she was licking the floor when out walking etc, picking up cigarette butts etc) she is now down from 4 to 2 a day and although the stiffness is a little better (not amazing though) her hair loss is terrible - falling out by the minute. She is almost bald down both flanks. She is lethargic and doesn't much like her walks these days but not as bad as your poor girl yet, i.e. she does seem quite happy and eats without being ill etc. I am at a loss as what to do next for her as it has cost me nearly £500 already so if you do come up with anything I would be very, very interested to hear from you.
Regards
Sandra McKay

Hi, Sandra,

I found that PLT was one of the best treatments for arthritis, but do try to get to the minimum dose regime. Two per day sounds reasonable.
I suggest that you see a dermatologist, who may take a skin biopsy to try and get a definitive diagnosis, since thyroid deficiency and Cushings seem to have been ruled out.

Walter

Sandra....I would just like to say that apart from the lethargy, This is very similar to our Wolfhound and we are scratching our heads. (There is a post on this forum about hair loss in our Wolfhound and I got some great starter pointers from the vet's on this site) There is something called recurrent cyclical flank alopecia and there is a great deal of mystery surrounding it. Our Wolfhound is aged 4 and has arthritis and is on a low dose of rimadyl (literally one very 7 days or less) and acupuncture which helps enormously and has bilateral hair loss. We have seen 4 vets and a dermatologist and no conclusion has been drawn. He is in rude health and exercises at least 4 hours a day chasing anything he can find (this is why the lethargy in your dog is the only difference)He has patchy, big bald patches that have grown and he looks a mess but there is no irritation or heat etc. We have changed food to no avail so are now doing nothing as we have tried everything. If the condition hasn't altered towards winter when he should grow hair again, we shall seek further help if there is any. Like you we have had every test done and no result as to what is wrong. Hope this reassures you that you are not alone. I would get the lethargy checked out again.
Ken

hello, my 12 year old bedlington terrier has been taking vetoryl capsules for just under a week, and i have noticed he has become very unsteady on his feet, his limbs seem to shake, and he walks like he's had one to many, but it's not all the time, it seems worse in the morning. thankyou

Hi, Linda,
You must report any adverse effects of the medication to your vet, and ask his advice about changing the dose.
Walter

Hi,
My cat has been operated on recently for (cushings) tumor in the right adrenal gland. He also had one Kidney removed as it had attached itself to it.He does not have diabetes nor alot of the other symptoms associated with this disease.Blood work on the other Kidney says it is functioning well.The symptoms he did have were exsessive drinking,urinating,tired (but he does weigh 9.5 kilos)and the panting was the final straw.It took us 18 months to get him diagnosed.You know your animals and when there is something wrong with them.By luck with a different vet on the third visit we got an answer.The Biopsy has come back cancerous but so far no sign of secondary cancer in ultrasound or when they opened him up.He was in hospital for 15 days with electrolights going mad,managing to flood his lungs with too much fluid(wrong weight entered) 1 blood transfusion(they were testing it every 4 hours) he managed to survive.Home for 3 days now and doing as well as to be expected after such a major operation.I know he will have to go regulary for ultrasounds for anything that may be microscopic and hasnt shown up yet.We have been told he is about 1 in 20 cats in the world that this has happened to but all things going well,what is the life expectency of a cat with this disease??

Hi, Kelly-Anne,
After spending the vast sums which you must have spent on this treatment, I hope that for your sake there is a significant survival time.
It is almost impossible to prognostigcate a survival time for such a complicated case. but I would, sadly, put it at weeks rather than months or years. I hope that I am wrong, and my very best wishes go to you and to your pet.
Walter