My boy is struggling with Vetoryl

[siansetter]

Hello everyone, and thank you so much to the administrators for getting me on to the site. Bob was diagnosed with Cushings 18 months ago, he initially responded well to vetoryl but after a month he started to struggle. The vet (in France at the time) gave him another sedative type drug to help him but it just turned him into a Zombie. Back in the UK and the vet put him on 60mg of vetoryl, again OK initially but I cut him down to one every other day when he started to vomit. He has now had another episode of vomiting and showing other addison symptoms, drinking and peeing but off his food and that is rare! He has had no vetoryl since Thursday and is much happier but I don't know how long to keep him off and whether I should let him go back on. The vet still wants to keep him on 60mg a day and didn't agree with one every other day. What do you think?:confused::confused:

[k9diabetes]

How bad were his symptoms prior to treatment?

Any question about whether the Cushing's diagnosis is solid?

I ask because we have seen a lot of dogs improperly diagnosed, especially by general practice vets with little experience with it. There are a lot of other health conditions that can skew the Cushing's test results.

If you have results of Bob's Cushing's testing, it is good to post it here so those with long-time experience can take a look at it.

Natalie

[frijole]

Hello! The dosage is usually daily and it is dependent upon your dog's weight so if you could tell us how much he weighs we can quickly see if the dose is too high. It sure sounds like it from what you described.

Is he now eating normally and no longer vomiting? Never give cushings drugs to a dog that is sick fyi.

Kim

[mytil]

Hi,

I sure am glad you and Bob made it here. :)

I agree with Kim and IMO, I would stop the Vetoryl until his vomiting and other addison symptoms have completely stopped. I would not even do every other day, I would stop. Cushing's is a slow progression disease.

I am not a vet, but with these symptoms going on it would be unwise to continue to give such a strong medicine until he is feeling much better. You do not want to mess with lowering the cortisol levels just now when he is ill.

It could be that his electrolytes are off which causes the symptoms you mentioned. If you are able have another ACTH test and have his electrolytes check, you should.

I am also wondering if Bob was correctly diagnosed - post those diagnostic results as soon as you can.

If your vet is giving 60 mgs daily then your Bob weighs between 10 and 20 kilos - is this right?

Has Bob been checked for diabetes?

Keep us posted
Terry

[molly muffin]

Hello and welcome. We are very glad that you found this site too. No more vetoryl until bob's cortisol levels are checked. You don't want to run the risk of him going too low. If you don't have any prednisone on hand, you should get some from the vet. This you give if he looks like he is going into crisis. So, a must to have on hand. Next, giving every other day isn't a good option with Vetoryl. What you will want to do probably going forward is a lower dose daily, but not until he is back to himself and not showing any symptoms like vomiting, lethargy, diarrhea, etc. Anything off and you want to hold off on the vetoryl.
He's been on vetoryl for 18 months, diagnosed in France, medicated and now you are in England the dosage was upped once you got back to England?
When first starting vetoryl, there is usually an adjustment period with there cortisol will continue to decrease throughout the first 30 days. Optimally, after any dose beginning or change, you want another ACTH within 12 - 14 days, and then again a couple weeks later to monitor the cortisol. If there is any sign of an adverse response, you want an ACTH right away to make sure that you aren't entering an Addison crisis.
Did you get a copy of the test results from France and now the ones there in England? If you didn't I don't know, maybe you can contact the vet in France and have them email the results to you. You're going to want to keep copies in your own file, so that any change of vet, any crisis that you have to go to an ER, you have all that information with you. Also you'll probably want to just review them occasionally yourself.

I'm really glad you found us. Now that we are past all of that I have to say that Bob is a very handsome boy. You have two Irishsetters? Bob and Bert. They are just so very handsome in the picture you posted.
My groomer has an Irish Setter, tons of allergy problems, but a very good looking happy dog.

Welcome,
Sharlene and Molly Muffin

[labblab]

I just wanted to stop by and welcome you and Bob, too!

The others have already done a really good job of asking helpful questions. So I mainly just want to welcome you. As they've said, dosing every other day is generally not a recommended dosing protocol because trilostane only remains active in the body for approx. 12-18 hours. If a dose is too high, it's better to just decrease the daily dose rather than increasing the interval between dosing. Dechra is now advising folks to begin initial dosing using a formula of 1 mg. per pound, or 2.2 mg. per kg. But that is just a starting point. Every dog metabolizes the drug individually, so even a small dog may end up needing more while a big dog may end up needing less. The decision all depends upon the ACTH testing and the way in which the dog is clinically responding.

So yes, indeed, it will be a big help for us when we can actually see Bob's test results -- both related to the original diagnosis and also the ACTH monitoring. And also if we can learn more about his health history and symptoms that led to the diagnosis in the first place.

Marianne

[siansetter]

Thank you all, am just off to work, will post results when I get back this evening - no vetoryl and will stop the every other day protocol. Bob weighs 42Kgs so the 60mg should not be an issue but he just can't cope with that. Speak to you all later:)

[siansetter]

Here are Bob's test results from initial diagnosis:
21/07/11 Base level 270nmol/l after Acth 521nmol/l Technique EIA 14nmol/l Technique Elisa TSH 0.520ng/ml
27/07/11 Technique EIA base 392 nmol/l +4hrs 45nmol/l +8hrs 141nmol/l
10/08/2011 Cortisone base 381nmol acth +1hr 356nmol/l
urea 30.6 mg/dl Glu 136mg/dl GPT 91.6U/l
15/12/2011 base 88.3nmol/l post acth 205nmol/l
He has had one more assessment but I don't have those results as they are with my new vet, but we are off for another visit tomorrow so I will be able to get those and see how he is doing now as they will run some more bloods then.
Any thoughts?

[k9diabetes]

Did Bob have numerous classic physical symptoms of Cushing's disease?

- skin problems
- bony hips and head but saggy belly from fat redistribution
- panting, seeking cool places
- hair loss
- increase drinking and urination?

http://www.kateconnick.com/library/cushingsdisease.html

Natalie

[siansetter]

Hi Nathalie
It was the excessive panting, drinking, peeing and ravenous appetite that first took us to the vet. However for at least 6 months before hand we had had various bouts of vomiting for no particular reason, we had tried various things to address this from drugs to raising his food bowl etc. I forgot to add that the drug he was put on alongside the Vetoryl was Selgian - UK vets notes say " tx of canine cognitive dysfunction/anxiety. But in US licensed fo tx of PDH where mitotane not tolerated. The other big symptom with Bob was his nervousness and stress levels, he lost his confidence and wouldn't go out of the garden for walks etc.
Sian

[lulusmom]

Welcome to you and Bob.

I have taken the liberty of converting some of Bob's test results to reporting units that we here in the states are used to seeing. I have also included comments and questions below each one.

Diagnostic Tests
ACTH Stimulation Test - July 21, 2011
Pre injection Resting Cortisol 9.78ug/dl
Post stimulated cortisol 18.88 ug/dl
This post number is barely above high normal so if this is a diagnostic test, post cortisol is not high enough to confirm a diagnosis. I assume that is why your vet did a low dose dexamethasone test a week later.

Low Dose Dexamethasone Suppression Test
July 27, 2011
Pre injection resting cortisol 14.20 ug/dl
4 hour draw 1.36 ug/dl
8 hour draw 5.11 ug/dl
These results would be consistent with pituitary dependent cushing's; however, any stress or nonadrenal illness can yield a false positive LDDS result. I'm hoping that Bob was very symptomatic when your vet diagnosed him; otherwise, I would be suspicious of a misdiagnosis. Because all these these tests are less than optimal, with false positive and false negatives, misdiagnoses is not uncommon. I would like to echo Natalie (k9diabetes) and ask what symptoms Bob had at the time of diagnosis.

Thyroid values
July 21, 2011
T4 - .5 ug/dl (low) (reference range, 1.0-4.0 μg/dl)
TSH .520 ng/ml (reference range, 0.01-0.6 ng/mll)
Low T=4 is commonly seen in cushingoid dogs. This usually normalizes once a dog has been stabilized on treatment.

ACTH Stimulations Tests post treatment
August 10, 2011
Pre resting cortisol 13.8 ug/dl
Post stimulated cortisol 12.9 ug/dl
I am assuming this was the first test after starting treatment, right?

December 15, 2011
Pre resting cortisol 3.2 ug/dl
Post stimulated cortisol 7.43 ug/dl
Can you remember if Bob's symptoms had improved at this point? At what point did you switch to every other day dosing and did an acth stimulation test at that time show that cortisol was too low? Were the acth stimulation tests done within 4 to 6 hours after dosing?

I would like to echo Marianne and tell you that every other day dosing is highly unorthodox, given Vetoryl's short half life.

I'll be very interested in seeing the most recent acth stimulation test as well as your answers to the various questions we've asked. I'm sorry if our questions are overwhelming but the more information you can provide, the better able we will be to provide you with meaningful feedback.

Glynda

[k9diabetes]

Just had a peek at Bob and Bert in your album... so handsome...

Natalie

[siansetter]

Haven't been back on line for a while as a result of your help I have had Bob go through all of his tests again, guess what he is not Cushings! I don't expect that is a great surprise to many of you. We are having some further tests done as he is obviously not right, Thyroid levels are low and they are investigating Euthyroid, liver enyme test is too high and they are looking at scanning him to look at his liver. Although he is bright and has better energy levels, actually playing with Bert, he has vomited a couple of times over the last day or so, not bringing up all of his food just a little and excessive licking of his front paws and legs. Will keep you posted on developments. Thanks everyone for pushing me to look at what I was having suspicions of.:)

[molly muffin]

I am glad that you are looking into what might be going on with Bob beyond Cushings. That disease is just so darn heard to get a good diagnosis on. gggggggggrrrrr

There is nothing wrong is being certain and doing whatever tests are necessary and possible to confirm any given diagnosis. Do, let us know what you discover and what sort of treatment is recommended. You never know when your experience might help someone else with the same thing going forward.

Sharlene and Molly Muffin