New member, 12 year old dog - Vetoryl

[Rhoobarb_whippet]

Hi everyone

just found this forum and was hoping for a bit of advice. My whippet, Rhoobarb, was diagnosed with Cushings a few months ago. He's on vetoryl and seems to be coping OK.

My question is: he's quite overweight (21kg!) and has the usual pot belly of a Cushings dog. I'm finding it incredibly hard to get his weight down, partly because he also has cauda equina and finds a lot of exercise difficult. But I've tried restricting his diet: he's on portions for a dog literally half his size, but there's been no change in his weight. Is this usual for Cushings dogs and is it just something we have to live with, or might it be symptomatic of something else?

Any ideas welcome.

Many thanks

[Rhoobarb_whippet]

By the way, Rhoobarb is male, neutered and 12 years old.

thanks

[mytil]

Hi and welcome to our site.

Sorry, but I do have a few questions.

Is your Rhoobarb taking any medication for his cauda equina? Anti-inflammatory medication containing prednisone?

Weight loss is typical symptom of Cushing's, however some dogs just do not play by the normal rules :o Water retention could be the cause for this weight problem as well - what has your vet mentioned?

How much Vetoryl are you giving?

When you get the chance post the results of the tests performed to come to this Cushing's diagnosis.

Keep us posted
Terry

[addy]

Hi and Welcome,

We usually ask tons of questions, Terri just asked a few and I will ask a few more:

what were the results of the latest ACTH test?
have you checked for hypothyrodism?

I am not clear as to how long it may take for weight to come off, but if treatment has been only a few months, it may take a bit longer as long we the cortisol is within control range.

Are any other medications being administered?

I am so glad you found us and I am sure others will be along soon to offer experience and advice so hang in there.

[Rhoobarb_whippet]

Hi

he's on 60 mg of vetoryl a day (1 capsule) and yes, he's on metacam (meloxicam: a NSAID)for his cauda equina.

I don't have the results of the last ACTH test to hand, but he has been tested for thyroid problems (a full spectrum scan) and it came back OK. I know these can be difficult to diagnose/spot but it was something we tested for before thinking it might be Cushings and testing for that.

He's had a pretty hard time of it over the past few years: he's had various joint-related problems and also had meningitis a couple of years ago (treated with steroids and seems to be nicely in remission).

[Rhoobarb_whippet]

I just checked: he was actually diagnosed at the end of Feb: so has been treated for it for 8 months now: how time flies!

[Squirt's Mom]

Hi and welcome to you and Rhoobarb! :)

Love the name! That's cute! :D

What are you feeding, including any treats he gets during the day? Sometimes it's not how much they are eating, but what they are eating that makes weight loss difficult. Don't purchase feeds that claim to be "lite" or "weight management", etc. These feeds show lower fat content but what they don't include are the carbs in the analysis and usually they really ramp up the carbs when they lower the fats - which defeats the whole "weight loss" purpose.

Most commercial treats are nothing but fats and carbs, causing massive weight gain all on their own. Giving fresh foods like green beans, carrots, apples, etc are much better all around as treats VS the commercial ones.

Are his signs all controlled now?

It would be a great help if you can get those results and post them here in Cheyenne's thread. If the cortisol isn't under control, that will make it more difficult for him to lose the extra weight...and sadly, we often see vets that don't know how to interpret those results. ;)

Hang in there!
Hugs,
Leslie and the gang

[Rhoobarb_whippet]

Hi

thanks for all the info so far, folks!

I've have tried him on a variety of foods: initially a dried food (for older dogs) as I'd heard using dried food can help with portion control etc. He got about half of the reccommended amount of that. We're now back on Nature Diet and he's getting the amount they reccommend for a 14kg dog (he should weigh around 17-18kg). The only treats he gets is a dentastick every two days and bits of raw veggies (cucumber, green beans etc): I'm quite strict about that and he doesn't get any "extras" from us.

I don't have a copy of the last ACTH test results, he is due another soon, but my understanding of the last results was that the levels were back to "normal". The vet is puzzled too: like I say, he initially thought it was hypothyrodism, but the tests all came back fine, whilst the ACTH suggested Cushings and the vetoryl does seem to be helping.

I wonder is there any contraindications with vetoryl and NSAIDs?

[Squirt's Mom]

Yes. NSAIDS are hard on the liver and it is already under stress from the Cushing's so we try to find alternatives to using NSAIDS. Others with a deeper understanding and experience will be along to share with you about this soon I'm sure.

Hugs,
Leslie and the gang

[mytil]

I have not heard of any recorded problems with the combination so I am at a loss too.

I am thinking out loud about fluid retention here causing the weight problems. Were the electrolytes checked as well on with the most recent ACTH test?

Terry

[Rhoobarb_whippet]

Hi

as far as I know electrolytes were not tested last time, or it they were, we were never told about it....

[Rhoobarb_whippet]

well, he's back in for another ACTH test. I'm getting them to check electrolytes too.

Will let you all know how he gets on....

[Squirt's Mom]

How has he been doing? Let us know what you learn from the testing!

Hugs,
Leslie and the gang

[molly muffin]

Crossing fingers for an excellent ACTH result!

Sharlene

[Rhoobarb_whippet]

Hi all

Rhoobarb is his usual self, which at the moment is fairly lethargic and sleepy. But then he's 12 and slowing down.

Anyway, I have the results for the latest ACTH. I have two numbers (pre and post stimulation): 103 (range of 25-125) and 111 (range of 125-520). The electrolyte levels are all normal.

The vet thinks that this is showing possible over supression of the cortisol and that we might need to reduce medication, but wants to do another test in a month: if the results are the same we'll start to reduce the meds.

Does this sound about right?

thanks in advance.

[Squirt's Mom]

Hi,

If it were me, I would want the dose lowered now and not wait for the next ACTH. Since he is lethargic and that is one of the signs that the cortisol is too low, and his test confirms this, I would not continue as we had been. I would withhold the Vetoryl for a few days until he perks up and then have another ACTH. Then if, and only if, his numbers are back up in range, start on a lower dose. Just my 2 cents worth. ;)

Hugs,
Leslie and the gang

[lulusmom]

Anyway, I have the results for the latest ACTH. I have two numbers (pre and post stimulation): 103 (range of 25-125) and 111 (range of 125-520). The electrolyte levels are all normal.

The vet thinks that this is showing possible over supression of the cortisol and that we might need to reduce medication, but wants to do another test in a month: if the results are the same we'll start to reduce the meds.

Does this sound about right?

No it does not sound right. The numbers you posted are exactly where you want them; however, if the acth stimulation test before this one showed much higher numbers, then I might be worried that a dog under treatment for eight months on the same dose is all of a sudden experiencing a drop in cortisol levels. If this is not the scenario, then I have to assume that your vet is using the normal reference ranges provided by the laboratory. You cannot use normal reference ranges for purposes of monitoring treatment. The goal of treatment is to reduce both pre and post stimulated cortisol levels to within a therapeutic range of between 40 to 150 nmol/L. As you can see, Rhoobarb's numbers are perfect.

For those of us in the states, who are used to seeing these numbers in ug/dl, they are pre 3.73 ug/dl and post 4.02 ug/dl.

I have gone back and read your posts and I don't see where you ever told us what symptoms Rhoobarb had that made you or vet suspicious of cushing's. Can you please list those now? Also, did your vet do more than an acth stimulation test to 1) determine which form of cushing's Rhoobarb has and 2) to validate the acth stimulation test. Cushing's is a very difficult disease to diagnose, making it one of the most misdiagnosed canine disease so I'm always concerned if I can't find the usual symptoms listed and only one diagnostic test mentioned. Another concern is that it appears Rhoobarb was on a NSAID before he was diagnosed and started cushing's treatment. Dog with uncontrolled cushing's have high levels of cortisol which is the body's natural steroidal anti-inflammatory. As such, cushdogs with arthritis, and I would think cauda equina, usually don't feel any pain from these conditions until Vetoryl treatment reduces cortisol to acceptable levels. I would appreciate it if you could fill in the blanks for us.

Glynda

[labblab]

Hello and welcome from me, too.

Actually, Rhoobarb's ACTH results are not too low for a dog being treated with trilostane. The normal ranges that you posted are the expected results for a dog who does not have Cushing's when the ACTH is being used for diagnostic purposes. For a Cushpup being treated with trilostane, the desired therapeutic range on a monitoring ACTH is much different.

For the purposes of our U.S. members, Rhoobarb's test results convert to 3.7 (pre) and 4 (post) when the units are changed from being reported in terms of nnol/L to ug/dl. The conversion formula requires dividing units of nmol/L by 27.59.

According to Dechra, the manufacturer of brandname Vetoryl, the ideal therapeutic "post" range for a dog being treated with trilostane falls between 40-150 nmol/L. So with a result of 111, Rhoobarb is well above the lower limit and actually closer to the upper limit. So his result is technically not too low, especially in view of the fact that his electrolytes are normal. However, if he is feeling unwell, that presents a separate issue.

Can you tell us a bit more about what you mean when you say he is lethargic? Is this a new pattern for him? Does he seem "off" to you in other ways?

Marianne

P.S. I see that Glynda and I were typing at the same time, so please forgive my duplication.

[Squirt's Mom]

Of course...I didn't even think about which range was being given. :o Ignore my post, Mom. :o

[Rhoobarb_whippet]

Hi all

thanks for the responses.

Initially we thought Rhoobarb might have a thyroid problem. A full specturm test came back normal. He had a thirst, was ravenously hungry and a pendulous belly. He vet said he looked typically Cushingoid (he's treating a couple of other dogs with the condition) and an ACTH confirmed this. I'm a bit hazy over the other details: I think he had an ultrasound which was inconclusive, but the vet seemed happy to diagnose Cushings from the symptoms and ACTH.

The initial test results were pre 238.0 and post 615.0 (nmol/L) with reference ranges of 25-125 and 125-520 and the conclusion was that this is consistent with hyperadrenaocorticism in the abscence of a non adreanl stressful disease.

Since he's been on treatment he doesn't drink so much, but hasn't lost weight, despite being on a strict diet (the original reason for posting here). His breathing has become more laboured (climbing the stairs makes him out of breath, whereas before it didn't), but I've been putting this down to the extra weight he's carrying. The lethargy isn't really a new thing: I've put it down to weight and age. He used to be a very active dog but has slowed down in the last couple of years to the point of not wanting to go out on daily walks, which he used to love. He still comes out about three times a week and does enjoy it, but it seems to take a lot out of him.

It's interesting about cortisol being a natural anti-inflamatory, this makes this back problem seem more odd, and I'm confused as to why the vet has kept him on the metacam. The back condition was diagnosed prior to the Cushings and caused him a lot of pain and was managable with metacam. I guess I need to talk to my vet about this....