Hi, New here

[Max grey]

I'm Lynne, and have an 8 yr old greyhound with Cushings. I'm really hoping you can give me some advice as we seem to be struggling. I'm wondering whether we will ever get him stabilised.

He was diagnosed last September, and has had ACTH tests every month while we try and get him stable. Around December we had just started him on 130 mg of Vetoryl when he became really lethargic and disinterested in everything, the vet advised we stop the vetoryl temporarily. He then got a urinary infection so went onto anitbiotics. Three weeks later after the UTI cleared the cushings symptoms returned, the ACTH test showed raised cortisol so we restarted the veteroly but at 90mg dose.

1 week later thy UTI was back. More anitbiotics but for a month this time. Witihin two weeks of stopping the antibiotics the UTI returned yet again. His is now on yet another lot of antibiotics. His last ACTH test showed that his cortisol levels are on the upper end of acceptable on a dose of 110mg vetoryl so we are keeping him on that for the moment.

In addition to the repeated UTI his skin is peeling really badly. It does not appear to be itchy or bothering him. The vet thinks that he has a bacterial infection so we are also having to bathe him with medicated shampoo as the antibiotics he previously had and the one he is taking should address it, although so far there is no improvement.

Finally. this week he has now developed some problem with his back/hip so is on pain killers as well.

I'm really starting to struggle, my previously happy greyhound is a lethargic, unhappy dog. His weight seems to be out of control too, he has gone from 32kg - 53 kg in 6 months, until now his weight has always been stable.

I'm sorry this is such a long post, but will I get my Max back, or this what it's going to be like with a cushings dog?

[jmac]

Hi Lynne and welcome to you and Max-

I am so sorry Max is having a hard time, and I can imagine how frustrated you must be feeling. The good news is you have found a wonderful site with many caring, helpful, knowledgeable people, who will be here to help you and Max.

Others will be coming along shortly to give you advice, but we always ask for you to provide us for as much information as possible so we can do our best to help. Please tell us a little more about Max. What were his symptoms that made you or your vet suspect Cushing's? Also, can you tell us the tests your vet has done, and post the abnormal results, along with the reference ranges?

Again, I am sorry you have found yourself here, but I think you will find that this is an amazing place filled with amazing people. We are here to support you both in any way we can!

Julie & Hannah

[Max grey]

Thank you, it's reassuring to know that there are others who understand what it's like and are able to offer advice and support. I feel so helpless and he seems so miserable.

We initially went to the vets with Max because he was having accidents in the house which had never happened before and because he was drinking a lot. He also needed to go out during the night. The vet had ruled out any infection and wondered about cushings. He's had several ACTH tests and an abdominal ultrasound to check for adrenal tumours, I'll need to see if I can find the previous results, but I do now that they were all consistent with cushings and since being in vetoryl the levels have been coming down, on the last test the post stimulation level was 182, but not sure what the first level was.

THe abdominal ultrasound showed no adrenal tumours, although the glands were puffy which they said was consistent with cushings so they are assuming it's pituitary. The UTI's have been identified as having EColi bacteria, but we have not had any tests on the skin issues.

[frijole]

Hi! Can you tell us how much Max weighs? That will help us with the dosage information you shared. Thanks. Kim

[lauraperla]

Hi Lynne, and welcome to you and Max. I am so sorry that your boy is suffering right now but glad you have found this site; I am new myself but the knowledge I have gained here has helped me enormously in doing everything I possibly can for our pointer Saoirse.

There are many here who have a much stronger technical grasp so I will respectfully leave detailed analysis of your information to them; one piece of information that I will pass on straight away, which Lori kindly provided to me, is that to interpret your ACTH results in the ug/dl format used most commonly on the site and in the supporting information, you divide the nmol/l figure you have by 27.59.
You 'll also find that you'll be asked for the detailed results for any blood work that's been done so worth digging those out if you have them, or asking your vet for copies if not (and they must give it to you, as the person who paid for the test you own the data so they cannot withhold it).

Quite often with Cushings once treatment has commenced the cortisol levels lowering allows problems that have been masked by the cortisol higher level to manifest themselves. As Max is a typically long backed large breed he will be predisposed to arthritis by that alone. We are in the same situation here with Saoirse. I had a referral to the IMS specialist at our vet hospital and he has put us on a medication regime of a low dose of metacam and tramadol. I am also supplementing her with glucosamine and chrondroitin and fish oil. 4 weeks into that she is a much brighter dog, prior to this treatment she was pretty wretched. Having said that today she is sore as she spent yesterday outside and was playing with the kids (she's not done that for a long time and tbh today she looks more achy, a bit like I do after one of my infrequent gym visits).
The weight gain will be adding an extra burden to the arthritis issue, I'm guessing if he has that gain he will have a cushings belly? Saoirse was usually 27kg and she is now 34kg despite a very strict food regime. The drag of that belly will also put a strain on the arthritic joints, and he will also have a degree of muscle wasting. If you can manage to get control of the Cushings, both of these issues should resolve in time.

As you'll see from my thread we treated with Vetoryl for 2 years and for whatever reason it has not managed the disease for us; we are due to start Lysodren this week and the IMS is hopeful that it will provide a better outcome for us.

Saoirse has many patches of sore / thin skin. I use hypoallergenic baby wipes to keep her clean, and only bath very infrequently. I think we've reduced any flare ups that way.

Saoirse's sister who passed away last year had bladder cancer and suffered frequent uti's. I found that adding cranberry extract to her meals cut the uti incidence considerably. I bought the health store capsules and squeezed the gel out.

Having been at the despondent stage with Saoirse I understand very well how you must feel. I do think there is more for you to explore in helping Max, and spending time here will help so much in gaining as much information as you can.

Love to you both,

Laura and Saoirse xx

[Max grey]

Thank you Laura and Frijole
Max is currently 35kg, previously he was 32kg.

I have an appointment with the vet tomorrow so I'll get copies of as many results as I can.

We currently have him on tramadol for the pain, poor boy rattles with all the medication at the moment. I really hope that he does start to improve, I hate to see him so depressed. When I will certainly update more info when I have the full results tomorrow.

How long does it generally take to get cushings under control? Is it usual to have so many other things happening at the same time? I just feel as we start to get one thing sorted when something else starts to go wrong for him.

[marie adams]

Hi Lynne and welcome to you and Saoirse,

There are so many ups and downs with this disease. I know when my Maddie had the skin problems--her elbows on her front legs were just red and cracking/bleeding some. Once her numbers were really undercontrol did I see improvement. I used bag balm on them and covered them up with baby socks cut open at the toes--I put panty liners (thick ones) attached to the socks to cushion the elbow areas--she didn't mess with them so she knew it was helping. Her skin was dry and she had lost a lot of fur, but I gave her yogurt, flax seed oil, and fish oil--I think it helped, but it all got better once she was on a maintenance program with the Lysodren.

The hind leg muscle atrophy never really improved for her, but I think the arthritis came into play also since the cortisol levels came down. I just made sure she had the fish oil and the joint tablets- c & c to help some.

You have definitely come to the right place to get answers and all the experts will be along to help. You are family now so just ask as many questions as you need to.

Take care!!

[lauraperla]

Did the depression precede the tramadol? Wondering as while Saoirse tolerates tramadol well it was a nightmare drug for her big sister and lots of people seem to have dogs with difficulty with it. I'd also discuss with your vet if a limited use of metacam may help ( you have to be careful because metacam can cause gi issues).
I believe that if you are successful in getting Cushings under control you would expect some issues such as hunger and pu/pd to resolve pretty quickly, and skin issues, the pot belly, muscle wasting, hair regrowth usually takes 4-6 months.
Best of luck with your vet tomorrow!
L&S!

[Max grey]

Well l I'm back from the vet armed with loads of ACTH results and blood work. I should also add that the vet is now also querying whether we have a thyroid problem as well as the cushings due to the weight gain and the excessive dry skin. When he has next ACTH test they will also test for the TSH levels.

The latest ACTH test cortisol levels were
in nmol
67.3, Post sample 186.0 divided by 27.59 = 2.4 post sample 6.7

Previous results were
in nmol / 27.59
60.1 post 301 2.1 post 10.9
139.0 post 676.0 5.0 post 24.5
110.0 post 444.0 4.0 post 16.0
136.0 post 303.0 4.9 post 11.0

his last blood work was as follows, normal ranges in brackets. (I've just copied it as it is)

Biochemistry
Protein 60g/l (54-75)
Albumin 26 g/l (25 - 37)
Globulin 34 g/l (25-52)
Albumin/Globulin ratio 0.8
Urea 4.3 mmol/l (3.3-8.3)
Creatinine 65 umol/l (35-140)
Sodium 145 mmol (140-155)
potassium 4.5 mmol/l (3.5-5.5)
Na/K ratio 32.2 (25-35)
Calcium 2.47 mmol/l(2.30-3.00)
Phosphorus 1.69 mmol/l (0.7-1.8)
ALP * 275 iu/l High (<108)
ALT * 299 iu/l High (<55)
GGT *29 iu/l High (<10)
Bile Acids *19.2 umol/l High (<10)
Cholesterol 9.2 mmol/l (3.1-10.1)
Triglycerides 1.83 mmol/l (0.29-3.88)
Total Bilirubin 3 umol/l (<3.4)
Amylase 810iu/l (<1650)
Lipase 126 iu/l (<180)
Creatinine Kinase * 191 iu/l High (<90)
Glucose * 6.3 mmol/l High (3.056.1)

Haematology
Haemoglobin * 20.7g/l High (12.0-18.0)
Red blood cells 7.30X10^12/l(5.5-8.5)
PCV 0.505 ratio (0.37-0.55)
MCHC * 41.0 g/dl High (32.0-39.0)
MCH *28.4 pg High (19.0-26.0)
Platelets 223x10^9/l (150-500)
White blood cells 6.8x10^9/l(6.0-15.0)
Neutrophils 89%6.05 x 10^/l (3.00-11.5)
Lymphocytes * 6% 0.41 x 10^9/. Low (1.00-5.00)
M0nocytes 3% 0.20X10^9/l (0.00-0.35)
Eosinophils 2% 0.14x10^9/l (0.00-1.25)

Hope that helps.

[lauraperla]

Hi Lynne,
We had a thyroid check with our ACTH in February due to the same reasons but it came back as insignificant.
A couple of thoughts, are you dosing once or twice daily? There is some thought that for dogs whose symptoms do not resolve readily on Vetoryl on a daily dose, a twice daily regime will benefit. I'm sorry I can't post a link as I'm typing on my phone but if you look in my thread in the early posts you'll see Lori posted me that link (4th post down on page 1). Also a quick check, is Max getting his Vetoryl with food / at mealtimes? That helps it absorb readily.
Regarding the uti's, has your vet had a look at his bladder on ultrasound to make sure there is nothing else going on? E coli sounds scary but it is found pretty commonly in uti's, the problem is it can be a tricky one to shift as its often antibiotic resistant. Adjusting the pH of the urine with diet is supposed to help, we've had some success as mentioned previously using cranberry extract, and a now retired vet who has probably forgotten more than my present vet will ever know told me that a good dollop of tomato ketchup with food did the job as effectively as anything else (and yes it did work, was just a bit concerned about all that sugar!)
It does seem that the Vetoryl is having some effect on cortisol levels, I guess the question will be whether it can also manage the clinical signs. Moving to twice daily may help but it may also be that Max is similar to Saoirse and for whatever reason ( I read in some vast clinical paper that the exact location of the pituitary tumour has some bearing on whether the Vetoryl is effective but I've never managed to find it again so can't quote it verbatim) Vetoryl is not fully effective. If that proves to be the case then you would have the option to move to Lysodren treatment.
Hope Max is feeling a little better today,
Laura and Saoirse xx

[labblab]

Hello, and welcome from me, too! I am so sorry that you and Max have been having such a difficult time of it. I very much hope that we can help with sorting things out. Thanks so much for posting all the lab results. I'm hoping other folks will also have comments to make, but here's a few from me.


Glucose * 6.3 mmol/l High (3.056.1)

First, I was/am worried to see the notation that Max's glucose is elevated because that would be an indicator of diabetes. However, when I converted the units from mmol/l to mg/dl (the reporting unit commonly used in the U.S.), I ended up with 113 mg/dl. And that would usually not be considered elevated (for example, the normal reference range included with my dog's recent bloodwork was 96 - 125 mg/dl). So I am confused, and perhaps I am messing up the conversion. Was Max fasted before this labwork? Did your vet make any comment about the notation that Max's glucose was "high?"


ALP * 275 iu/l High (<108)
ALT * 299 iu/l High (<55)
GGT *29 iu/l High (<10)
Bile Acids *19.2 umol/l High (<10)

Secondly, I am wondering whether Max's liver results may indicate liver dysfunction above and beyond that which is typically associated with Cushing's. I am definitely not an expert on liver disease, but I do know that some degree of elevation in the liver enzymes is common with Cushing's. However, I believe it is usually the ALP which is more highly elevated. The fact that the ALT shows a five-fold elevation alongside an increase in the Bile Acids test as well may perhaps signal greater liver involvement. But since I'm not well-versed in this, I don't want to worry you unduly until some of our members who are more knowledgeable about liver issues can take a look at this. And once again, did your vet make any comment about the liver values?


The latest ACTH test cortisol levels were
in nmol
67.3, Post sample 186.0 divided by 27.59 = 2.4 post sample 6.7

Previous results were
in nmol / 27.59
60.1 post 301 2.1 post 10.9
139.0 post 676.0 5.0 post 24.5
110.0 post 444.0 4.0 post 16.0
136.0 post 303.0 4.9 post 11.0

Last but not least, could you possibly come back and give us the dates and dosing changes that were associated with each one of these ACTH tests? The pattern of the results seems confusing, in terms of being up-and-down. It'll help a lot to know the actual testing/dosing dates. However, one thing is certain -- unfortunately, Max's ACTH results have never been within the target therapeutic range for a dog who has still been exhibiting symptoms (1.45-5.4 ug/dl; 40-150 nmol/l). So at this point, we cannot yet judge whether once-daily trilostane can be successful in managing his treatment (without unwanted side effects).

Thanks in advance for the additional information!
Marianne

[Harley PoMMom]

Hi Lynne,

I, too, am concerned with Max's liver function and was wondering if you could clarify how the bile acid test was performed.

With a bile acid test the dog is fasted, blood is drawn, then the dog is fed a fatty meal. Two hours later, the blood is drawn again. The blood tests measure pre- and post- meal levels of bile acids then the two blood levels (pre and post meal) are compared which allows the veterinarian to see how well the liver, bile ducts, and blood flow to the liver are functioning. Usually bile acid concentrations >25-30 umol/L in dogs are suggestive of a liver issue so I am curious of the reference ranges that the lab used.



Bile Acids *19.2 umol/l High (<10)


Was an urinalysis done? If so could you post those results too...Thanks!

Love and hugs,
Lori

[Max grey]

Hi Lynne,
We had a thyroid check with our ACTH in February due to the same reasons but it came back as insignificant.
A couple of thoughts, are you dosing once or twice daily? There is some thought that for dogs whose symptoms do not resolve readily on Vetoryl on a daily dose, a twice daily regime will benefit. I'm sorry I can't post a link as I'm typing on my phone but if you look in my thread in the early posts you'll see Lori posted me that link (4th post down on page 1). Also a quick check, is Max getting his Vetoryl with food / at mealtimes?

Thanks Laura, I'll take a look. Max is only dosed once a day at the moment, and he has at with his breakfast in the morning.


Regarding the uti's, has your vet had a look at his bladder on ultrasound to make sure there is nothing else going on? E coli sounds scary but it is found pretty commonly in uti's, the problem is it can be a tricky one to shift as its often antibiotic resistant. Adjusting the pH of the urine with diet is supposed to help, we've had some success as mentioned previously using cranberry extract, and a now retired vet who has probably forgotten more than my present vet will ever know told me that a good dollop of tomato ketchup with food did the job as effectively as anything else (and yes it did work, was just a bit concerned about all that sugar!)
It does seem that the Vetoryl is having some effect on cortisol levels, I guess the question will be whether it can also manage the clinical signs. Moving to twice daily may help but it may also be that Max is similar to Saoirse and for whatever reason ( I read in some vast clinical paper that the exact location of the pituitary tumour has some bearing on whether the Vetoryl is effective but I've never managed to find it again so can't quote it verbatim) Vetoryl is not fully effective. If that proves to be the case then you would have the option to move to Lysodren treatment.


Max seems a little happier today, he actually came and wanted some fuss, rather than lying on his bed looking thoroughly miserable.

Max has had an ultrasound and all the organs looked fine, the only slight anomaly was the adrenals looking at little "puffy" which they said was in line with cushings.

I'll certainly look at tomato ketchup, having three boys in the house we always have some, Cranberry I'd heard of and we are starting to use it, but not Ketchup!

I've not heard of lysodren, is it similar to Vetoryl?

[Max grey]

Hello, and welcome from me, too! I am so sorry that you and Max have been having such a difficult time of it. I very much hope that we can help with sorting things out. Thanks so much for posting all the lab results. I'm hoping other folks will also have comments to make, but here's a few from me.



First, I was/am worried to see the notation that Max's glucose is elevated because that would be an indicator of diabetes. However, when I converted the units from mmol/l to mg/dl (the reporting unit commonly used in the U.S.), I ended up with 113 mg/dl. And that would usually not be considered elevated (for example, the normal reference range included with my dog's recent bloodwork was 96 - 125 mg/dl). So I am confused, and perhaps I am messing up the conversion. Was Max fasted before this labwork? Did your vet make any comment about the notation that Max's glucose was "high?"



Secondly, I am wondering whether Max's liver results may indicate liver dysfunction above and beyond that which is typically associated with Cushing's. I am definitely not an expert on liver disease, but I do know that some degree of elevation in the liver enzymes is common with Cushing's. However, I believe it is usually the ALP which is more highly elevated. The fact that the ALT shows a five-fold elevation alongside an increase in the Bile Acids test as well may perhaps signal greater liver involvement. But since I'm not well-versed in this, I don't want to worry you unduly until some of our members who are more knowledgeable about liver issues can take a look at this. And once again, did your vet make any comment about the liver values?



Last but not least, could you possibly come back and give us the dates and dosing changes that were associated with each one of these ACTH tests? The pattern of the results seems confusing, in terms of being up-and-down. It'll help a lot to know the actual testing/dosing dates. However, one thing is certain -- unfortunately, Max's ACTH results have never been within the target therapeutic range for a dog who has still been exhibiting symptoms (1.45-5.4 ug/dl; 40-150 nmol/l). So at this point, we cannot yet judge whether once-daily trilostane can be successful in managing his treatment (without unwanted side effects).

Thanks in advance for the additional information!
Marianne

Hi Marianne,

Max wasn't fasted as such before any of these blood tests as they were done at the same time as the ACTH test. However, they could, in theory it could have been 6 hours after his breakfast. Glucose levels have not been mentioned as an issue at all.

I wondered about the liver results too. Max used to be a pet blood donor, but they refused him a couple of years ago because of the liver results. We had him checked out at the time and no problem was found, and there was a suggestion that greyhounds can sometimes have higher blood results than other breeds, but no-one has been able to give me any clarification on that one. From the very limited research I'd done, I had not realised that cushings affected the liver. I am wondering whether he may have had cushings longer than we realised. The vet did mention the levels, but ruled them out because we had previous high levels before we knew about the cushings.

Sorry I should have put the details of the ACTH tests when I posted, The Dates of the ACTH tests are as follows
67.3, Post 186.0 nmol converted 2.4 post sample 6.7 feb 24 2012 - vetoryl 110mg

60.1 post 301 converted 2.1 post 10.9 - 6 Feb 2012 Vetoryl 110mg
139.0 post 676.0 converted 5.0 post 24.5 - 6 Jan 2012 No vetoryl
110.0 post 444.0 converted 4.0 post 16.0 - 19 Dec 2011 Vetoryl 100 mg
136.0 post 303.0 converted 4.9 post 11.0 - 14 Dec 2011 Vetoryl 90mg

On the 14th December, the vetoryl was put up to 130mg. 2 Days later Max was very lethargic, wouldn't get up, and we thought he was having a reaction to the higher dose. The vet agreed and took him off vetoryl altogether. However, a couple of days later he had a UTI, so looking back we are not sure if it was the vetoryl or the UTI that affected him so badly. By the 6th of Jan we had the UTI cleared, but the cortisol levels had increased so he went back onto the vetoryl .

Hope that helps

Lynne & Max

[Max grey]

Hi Lynne,

I, too, am concerned with Max's liver function and was wondering if you could clarify how the bile acid test was performed.

With a bile acid test the dog is fasted, blood is drawn, then the dog is fed a fatty meal. Two hours later, the blood is drawn again. The blood tests measure pre- and post- meal levels of bile acids then the two blood levels (pre and post meal) are compared which allows the veterinarian to see how well the liver, bile ducts, and blood flow to the liver are functioning. Usually bile acid concentrations >25-30 umol/L in dogs are suggestive of a liver issue so I am curious of the reference ranges that the lab used.



Was an urinalysis done? If so could you post those results too...Thanks!

Love and hugs,
Lori


Hi Lori
I don't know about the bile acid test, as far as I know it was just measured with the bloods they took when he had the ACTH. I'll see is I can find out.

There have been a couple of urine tests, so I'll see if I can get them and post them up whan I have them!

Lynne

[lauraperla]

Thanks Laura, I'll take a look. Max is only dosed once a day at the moment, and he has at with his breakfast in the morning.



Max seems a little happier today, he actually came and wanted some fuss, rather than lying on his bed looking thoroughly miserable.

Max has had an ultrasound and all the organs looked fine, the only slight anomaly was the adrenals looking at little "puffy" which they said was in line with cushings.

I'll certainly look at tomato ketchup, having three boys in the house we always have some, Cranberry I'd heard of and we are starting to use it, but not Ketchup!

I've not heard of lysodren, is it similar to Vetoryl?

I'm glad he seems happier, a good sign for you! Saoirse has puffy adrenals too, as well as 'a large and bright' liver. That description always makes me smile.
Am I guessing correctly that you might be in the uk? Vetoryl is the only drug licensed for canine Cushings in the uk. Lysodren was the drug previously used in the uk but it was withdrawn apparently due to the higher risks its use supposedly poses. In the US both are still used. You can however get a specific licence to use Lysodren in the uk where there is sufficient reason. That's where we are at just now.
Will be interested to see others views on the forum, I would think you still have some further work to do with Vetoryl but keep the Lysodren card up your sleeve and do not allow anyone to fob you off with 'it's too dangerous'.
Have you got a specialist vet hospital you could get a referral to? I go to Edinburgh which is 150 miles away but worth it for the expertise and facilities.

[labblab]

Lynne, I'm still really confused about that elevated Glucose reading...


Glucose * 6.3 mmol/l High (3.056.1)

Can you double-check the reference range that is given on your test result sheet? "3.056.1" doesn't seem as though it can be right, and I'm wondering if it is instead something like 3.05 - 6.1? But even if so, the numbers just do not convert into the same normal reference range that we are used to seeing here in the U.S...

The reason why this seems so important is because if Max truly has elevated glucose suggestive of diabetes, then that could be the cause of the majority of his symptoms -- and not Cushing's, at all. So I guess the first step is to recheck the numbers that constitute that reference range. And then, maybe we can figure out why the conversion doesn't seem to be making sense.

Marianne

[Max grey]

Lynne, I'm still really confused about that elevated Glucose reading...



Can you double-check the reference range that is given on your test result sheet? "3.056.1" doesn't seem as though it can be right, and I'm wondering if it is instead something like 3.05 - 6.1? But even if so, the numbers just do not convert into the same normal reference range that we are used to seeing here in the U.S...

The reason why this seems so important is because if Max truly has elevated glucose suggestive of diabetes, then that could be the cause of the majority of his symptoms -- and not Cushing's, at all. So I guess the first step is to recheck the numbers that constitute that reference range. And then, maybe we can figure out why the conversion doesn't seem to be making sense.

Marianne

Hi Marianne,

I'm looking at the results here, sorry for the slight typo but from what you say it may not help.

Glucose * 6.3 mmol/l High (3.05 - 6.1)

The vets have definitely not mentioned diabetes and have not been concerned with the glucose level at all. I have a previous blood result for him dated 3 weeks earlier which has a glucose reading of No 0xF mmol/l (3.05-6.1). Not sure what that means

Would they not pick up Diabetes with the urine analysis?

Lynne

[Max grey]

I'm glad he seems happier, a good sign for you! Saoirse has puffy adrenals too, as well as 'a large and bright' liver. That description always makes me smile.
Am I guessing correctly that you might be in the uk? Vetoryl is the only drug licensed for canine Cushings in the uk. Lysodren was the drug previously used in the uk but it was withdrawn apparently due to the higher risks its use supposedly poses. In the US both are still used. You can however get a specific licence to use Lysodren in the uk where there is sufficient reason. That's where we are at just now.
Will be interested to see others views on the forum, I would think you still have some further work to do with Vetoryl but keep the Lysodren card up your sleeve and do not allow anyone to fob you off with 'it's too dangerous'.
Have you got a specialist vet hospital you could get a referral to? I go to Edinburgh which is 150 miles away but worth it for the expertise and facilities.

Yes I'm in the UK, Birmingham to be exact. Not sure where a specialist vet would be found, I think Edinburgh would be too far for him! ;) AT the moment we are with our own vet practice, but I know he has been talking to someone for advice. but not sure who.
Have you got a licence for Lysodren then?

Lynne

[lauraperla]

Saoirse's Lysodren was prescribed through the veterinary hospital in Edinburgh; my own vet had supplier problems but I spoke to two online pharmacist companies who said they could supply it to me provided I got a vet's prescription.
There's generally a referral hospital attached to a university vet school; not a cheap route though I am very glad for pet plan! They usually take cases referred by a vet as needing specialist assessment.
We are way up at the top of the country in Aberdeenshire.

[lauraperla]

One other thought I had to come back and tell you was to consider giving Max a milk thistle supplement. You'll see as you look round here that quite a few folk use it. I buy mine from holland and Barrett and give S a half human dose (weight wise she is a half human size!)