Dr. Marie replied:

I feel for you! Cushing's is a difficult disease to treat. The good news is that once you and your vet get the dosage of Trilostane levelled out then it is usually quite simple from that point on.

I am actually quite concerned by what you have described with Buddy and I think that you will need to see your vet today rather than tomorrow. It's possible that he has become Addisonian. I'll see if I can explain:

What the Trilostane does is block adrenal hormone from being produced and used by the body. (When Buddy was first diagnosed, he had way too much adrenal hormone and this is what caused the Cushing's symptoms.) However, it's possible to block too much of this hormone.

If a dog does not get enough adrenal hormone then they can get something called Addison's disease. Addison's is very serious and life threatening.

The symptoms of shaking, reduction of appetite and thirst and lethargy can be a sign of Addison's.

Your vet will likely want to do some blood tests today. If they feel that Buddy is Addisonian then they will give him some steroids. There will be an adjustment period where they figure out when he can go back on Trilostane and what dose he should be taking for the long term.

It is of course possible that there is something else going on. But what you are describing does not sound normal and definitely sounds worthy of an immediate vet visit.

I hope he does ok!

Dr. Marie.

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