Molly 13 Sheltie (35-40 pounds) cushings and hypothyroidism

[ziglori]

To begin I thank god and all of you for this forum. I was able to find an internal medicine specialist and for the first time I feel as if I'm getting answers about my Molly.

Molly has been formally diagnosed with Cushings twice now (reg. vet and specialist).Low dose suppression test: pre:6.4 and post:28.5. She was also diagnosed with hypothyroidism. There are so many numbers on this test that I'm not sure what to include. At the internal medicine specialist she was also diagnosed with protein spillage into her kidneys. Molly also has deep skin infections as well.

Thursday she started this round of medications:
Vetoryl- 60 mg one every day
Enalapril- 5mg every 12 hours
Cephalexin- 250 mg every 12 hours
Soloxine- .3 mg 1/2 tab every 12 hours.

By Monday she had lost all appetite for food(what little food we did mange to get her two eat was being thrown up in the evening when we gave her the Vetoryl). I called the specialist Monday afternoon who said to take her off the Vetoryl for two days to see if her appetite returned. Today, Molly threw up her morning food and has refused to eat at all since then.

I am worried sick about her and am wondering if I am being selfish by prolonging her life when she seems so miserable. She has zero energy, has trouble navigating the stairs and has many scabs on her body in addition to the scaly skin.

Can any of you help me with tips to get dogs to eat who are on Vetoryl? All she will eat now is sliced turkey and chewy dog treats.

Thanks in advance for any help,
Lori Z.

[Roxee's Dad]

Hi Lori,
Did vet give you pred, If yes, I would call the vet and discuss giving Molly some Pred, If not ..call the vet and get some pred. Sounds as if her cortisol has gone too low (overdose of trilo)

Pred should make her feel better.

ETA Pred = Predisone

[Harley PoMMom]

I'm thinking that this is the Cephalexin that is making her feel sick. When my boy Harley had to take this he could not tolerate the Cephalexin, made him feel so nauseated and he would not eat.

Maybe ask your IMS about changing the Cephalexin?

Love and hugs,
Lori

[ziglori]

Thanks John and Lori!

I've put in a call to the IMS to ask about both your thoughts.

Lori Z.

[Harley PoMMom]

Tips to get her to eat: Try to hand-feed her; try Baby food but make sure it does not have any onions or onion powder listed in the ingredients, tripe, Grated parmesan cheese as a topper on the regular food, tuna water on top of her food...usually the nose leads the way so if one can get the "nose" interested the pup will eat.

Hope this helps.

Love and hugs,
Lori

[zoesmom]

Hi and welcome to you both -

I would be most concerned that the vetoryl is causing the vomiting and that her cortisol may have gone low. A good rule of thumb that we've all learned to practice around here is to only start one new medicine at a time. That way, if there are any adverse reactions, you'll know what is the likely cause.

A couple of points. I think I'd stop them all and give it a couple days and start over, introducing just one thing at a time. If it is the antibiotic, it's hard to determine right now. Some dogs are sensitive to certain a/b's.

If we assume it is the trilo (vetoryl) causing the vomiting, then, two days may not be enough of a break. Definitely, prednisone (to counteract too much trilo) might be in order, IMO, just to be safe. OR running an acth test which would tell you for sure if it's the trilo or not. If you go ahead with the pred instead and it perks her back up, then I'd be extra suspicious of low cortisol. If pred doesn't stop the vomiting, and perk her back up within a day, then she may need to get to the vet for an electrolyte check and possible IV.

The enapril is a heart medicine, right? Did you start that at the same time - and the thyroxine as well? Maybe you can't hold off on the enapril but certainly it's safe to hold off on the thyroxine and the trilo for the short term. Then you could reintroduce the ceph for what, a week or two worth? If it doesn't cause any problems, then when that's done, maybe the thyroxine next, and a couple weeks later, the trilo. However, I'd suggest a lower dose of the trilo when you get to that point (unless you go ahead and do an acth now. Only thing is, if you go ahead and give her a pred right now, that can screw up the results of the acth.)

So really, you need to figure out what's causing the vomiting first, IMO. It might very well be the a/b, but I wouldn't want to take that chance with the vetoryl in the mix. Another thing is in dogs with compromised kidney function, vetoryl is NOT recommended. I don't know if spilling protein into the urine is a sign of that, but I'd sure ask about that. There's always lysodren for those dogs with kidney problems. It's a lot to sort out and really, you have several ways to approach it. But I'd want to get it figured out before proceeding any further with any of the drugs.

Can you tell us what symptoms Molly was having that led to the cushings diagnosis. And as we always ask, could you maybe post the results of all the tests and labwork that were done in making the diagnosis. The one you posted looks like an ACTH test, but you mentioned LDDS (low dose dex suppression) so maybe she had both done during diagnostics. Also, they generally first pick up on cushings from certain values in the general labwork (blood/urine). Those would be helpful to know too. Anything that was above or below the normal range is adequate. But first things first. You need to get Molly to feeling better and then you can take things one step at a time. Sue

PS the timing also makes me more suspicious of the vetoryl as you said she started it on Thursday and the vomiting began on the following Monday. I would think if it was the ceph. that she would have vomited sooner. When my cush girl Zoe started on trilo, she got sick on day 3. Then after stopping for just two days and restarting her on a lower dose, she had more diarrhea and vomiting, only that time, it was on day two of the lower dose. Molly's dose is within the recommended range for her size, but many dogs do better if started at the very lowest end of the range. For Molly that would be 20 to30 or 40 mg/day (depending on what formula is used.) Even at that, some dogs need far less than the norm, and some end up taking far more than the standard dose. But definitely, starting them off slowly and working the dose up if need be seems to be the best approach with trilo - and we've seen that proven here many many times.

[zoesmom]

Just rethinking what you wrote. Molly vomited last night and this morning and then she hasn't eaten at all today,right? And her last dose of trilo was yesterday? If she hasn't had any trilostane today and yet she's still not eating, I think if it were my dog, I'd take her in asap and get that acth test. They could then check her electrolytes and give her some prednisone after the test, just in case it is the trilo. Not to scare you, but if it is addison's (too low cortisol from too much trilo), you need to act on that asap. And if it's after-hours already where you live, I'd look for an emergency clinic. Has she had any other symptoms - like weakness, lethargy, diarrhea? Sue

[ziglori]

Happy evening! When my husband and I sat down to eat our supper, Molly seemed interested in eating. We gave her a bit of bread and she ate that so I put out some dog food and she ate it up as well! I'm so relieved to see her eat. It was upsetting to try to get her to eat several times during the day with no interest whatsoever. After she ate, she seemed a bit more energetic. She stayed up and moving for over an hour which I hadn't seen in many days. She jumped up onto the couch by herself and is napping at the moment. Molly had her last dose of Vetoryl at 6 am yesterday so it had been 36 hours since her last dose. I don't know if that means anything. She has not had any other negative symptoms other than not eating and lethargy. No diarrhea or new weakness.

I called the IMS and she said to bring Molly in for an acth if we thought she was doing that poorly. Her IMS practice is at an emergency care facility. Neither vet gave us pred. nor told us about it. We just spent over 900 dollars last Thursday ( $450 at the reg. vet less than a month before that). Finances are getting to be an issue.

zoesmom-The Enalapril is for the protein spillage into the kidneys and a high blood pressure medication. Molly has a slightly elevated blood pressure. It was an acth test and not a low dose suppression. The only other test results I have in my possession are for the hypothyroid diagnosis (Thyroglobulin Autoanti body:8 for example) and a UPC test of 1.1 . The IMS said her electrolytes were good. An ultrasound of the adrenal glands showed no tumors present.
Her symptoms were hair loss, back leg weakness, intense hunger, increased water consumption and scaly skin.

Lori- Thanks for the tips on getting Molly to eat.

It is a comfort to have a support system and such giving people to talk to.

Thanks for all you do!
Lori Z.

ps It has been an hour and a half since she had the cephalexin and she has not vomitted :) I had already given her the meds, except for the vetoryl, by the time I saw your replies. The IMS wants to put her on a once daily dose of 30 mg of vetoryl after the two day wait.

[Harley PoMMom]

So happy to hear that Molly is eating!! My boy Harley has high BP and is losing protein in his urine as well. His last UPC results were 5.0 (</=0.5) :eek::(

Vetoryl has a short half life and its enzyme blocking abilities start to diminish after 8 to 12 hours.

One thing you might ask your IMS about is giving her pepcid ac 20-30 minutes before her dose of Vetoryl.

Love and hugs,
Lori

[zoesmom]

Yippppeeee! That's great news. Based on the latest, it still sounds to me like her cortisol was running low - but probably not TOO, too low, since she seems to be bouncing back after the 36 hours off of the trilo and without any pred. I'd still suggest waiting longer than two days, though, before starting the lower dose. Maybe more like 4 or 5 days, minimum. Or . . . until the cephalexin is done, if you - and she - can stand to wait that long. Of course, her cush symptoms would probably return during that wait. But I think it will be much easier to figure things out if she's not beginning so many new meds all at once.

In any case, having some prednisone on hand would still be a good idea and would give you peace of mind, if there are any more signs of low cortisol. Keep us updated! Sue

[sunimist]

Hi and welcome from us too! I would be interested in seeing results from her chemistry profile if you have those handy. My girl was hypothyroid along with everything else and she also had proteinuria with a gosh-awful UP/C ratio at times. Here is a good link explaning loss of protein in the urine. http://www.petplace.com/dogs/proteinuria-in-dogs/page1.aspx

And about symptoms...


Her symptoms were hair loss, back leg weakness, intense hunger, increased water consumption and scaly skin. FWIW, these symptoms, with the exception of hind leg weakness (not sure about that) are also symptoms of hypothyroidism so that's why we say don't rely on just one test to determine cushings disease.

I am so glad Molly is feeling better and hope this was just a little bump in the road. We are all too familiar with all those little bumps. :D

Hope you and Molly have a restful and peaceful night! :)

Shelba and Suni

[ziglori]

Molly's appetite improved again today. No vomiting at all :D She will be on the antibiotic for 6 weeks so I don't think I can hold off on the vetoryl for that long. I do think I'll take your advice and wait longer than two days to put her back on the 30 mg once daily dose of vetoryl.

Lori Z.

[ziglori]

The past two days Molly's only eaten at 4:00 and 6:00. She seems to have lost her appetite in the day. She's sleeping a lot but she is 13;) Her skin issues seem to be clearing up a bit from the antibiotic.

We're just worried if she is getting enough food since she refuses dog food. We're feeding her a combo of rice, meat and veg.She eats over a cup between the 4:00 and 6:00 feedings. I have some dog vitamins (21st Century Healthy Skin and Coat Supplement) but was wondering if any of you might have some general vitamin recommendations?

Thanks in advance, Lori Z.

[zoesmom]

Is she back on the vetoryl yet????? Sue