Vetoryl anyone? - Sweet Poppy has crossed The Bridge

[Poppysmum]

Hi-I'm new here and really hope someone can help me. My dog has been tested for Cushing's and though the vet isn't 100% sure she put Poppy on Vetoryl last week. She only had three tablets and had a bad reaction. She had really bad muscle tremors, stopped eating and was just generally poorly so we stopped the tablets. The vet thinks the doseage was too high, causing an Addisonian crisis.
She wants to run tests that Poppy had about 3 weeks ago, and then start her again on a lower dose.
I'm just wondering what people's thoughts are regarding Vetoryl as my gut feeling is to go for a more natural treatment, but I would never forgive myself if Poppy got Diabetes or something because I didn't want her to have these drugs. Has anyone any experience of Vetoryl? Thanks a lot.

[Harley PoMMom]

Hi and welcome to you and your girl,

First thing, please stop the Vetoryl. The fact that the vet started Poppy on Vetoryl without a confirmed diagnosis of Cushing's has me quite worried. Vetoryl is a strong medicine and a dog should not be given this medication for Cushing's unless Cushing Disease is properly diagnosed and confirmed.

Cushing's is one of the most difficult diseases to get a confirmed diagnosis for because not one test is 100% accurate at diagnosing it and other non-adrenal illnesses can create false positive results on any tests for Cushing's.

If you could round up copies of all tests that were performed on Poppy and post any abnormalities listed here, that would really help us.

How is Poppy doing now? Is she eating, drinking, and having normal bowel movements?

What were Poppy's symptoms that led you or your vet to test for Cushing's in the first place? Does Poppy have any other health issues? Is she taking any other herbs/supplements/medicines? How much does she weigh and what is the dosage of Vetoryl that is rx'd for her?

Please know we will help in any way we can so do not hesitate to ask any and all questions.

Love and hugs,
Lori

MODERATOR NOTE: Your post has been manually approved so that members can start responding to you. Please check your email for a message from k9cushings. You will need to reply to that email so that your post go directly to the board and are not delayed waiting for approval. If you have already received and responded to the confirmatory email, please be patient. Your registration will be finalized shortly. Thanks and welcome!

[lulusmom]

Hi and welcome to the forum.

Vetoryl (trilostane) is one of the only two effective treatments for cushing's and many of us have lots of experience with it. It would help us provide you with more meaningful feedback if you can provide as much information as possible about Poppy's diagnosis. Can you round up copies of all testing that was done to diagnose her and post the results here? With respect to blood chemistry and/or complete blood count, you need only post the highs and lows, with the normal reference ranges. What symptoms did Poppy have that lead your vet to believe she has cushing's? How much does she weigh and what dose of Vetoryl did your vet prescribe.

Vetoryl drops cortisol rather rapidly and some dogs will experience a form of withdrawal, making them feel crappy...or if the dose is too high, cortisol can drop too low throwing them into an addisonian crisis. Vomiting, diarrhea, extreme weakness are all signs that cortisol is too low. With respect to the trembling, it can be a sign of low cortisol but it is also listed as a side effect of the drug. Some dogs well controlled and stabilized on the drug do have muscle tremors.

Vetoryl has a short half life so dogs having adverse reactions, regardless of withdrawal or low cortisol, usually start to feel much better rather quickly simply by withholding the dosing. How is Poppy feeling today? If she is still sick, you need to get her to a vet to have her electrolytes checked asap. Vetoryl not only lowers cortisol, it can impact aldosterone levels and if too low, it can quickly become life threatening.

There is no natural treatment for cushing's and if there were, none of us would have opted to treat with Lysodren or Trilostane. There may be something out there that helps symptoms in the short term but it will not do anything to stim the excess flow of cortisol.

I'm sorry for the circumstances that brought you here but I'm glad you found us. We'll be waiting for more information about Poppy so we can help you both through this trying experience. We've all been there so we know how frustrating and scarey it is. Hang in there and we'll get it all figured out together.

Glynda

P.S. Happy Thanksgiving

[mytil]

Hi and welcome from me too. Lori and Glynda offered some good advice and I second them.

Please tell us how much Vetoryl you gave her and how much she weighs.

Without a proper and firm diagnosis no dog should be given this medication, especially when your vet said he is not 100% sure.

I also want to comment on your statement - "I would never forgive myself if Poppy got Diabetes or something because I didn't want her to have these drugs" - from my experience, stopping this medication will not allow diabetes to develop. (I surely hope your vet did not indicate this).

Keep us posted and looking forward to the test results.
Terry

[Poppysmum]

Thanks for the speedy replies everyone and though I'm in the UK I'd like to wish you Happy Thanksgiving :-)
Poppy is absolutely fine now-with the exception that she still isn't doing number 2's properly yet.
Her symptoms were mostly a little rounded tummy and skin growths. The vet suggested we had her tested but I'm beginning to wish we hadn't and just put everything down to old age. Poppy will be 12 on the 2nd December and weighs approx 10lb. I think the vet had put her on 30mg. I will ring the vet tomorrow and try and get a copy of the results of her tests and scan so I can give you more info-and thanks again for your kindness. Doggy people are always nice :)

[lulusmom]

Hi again,

If Poppy's only symptoms were a rounded belly and skin growths, I have to question the diagnosis. If I were you, I wouldn't give her any more Vetoryl. Dogs with cushing's have pot bellies but so do dogs with liver disease and hypothyrodism, both of which have overlapping blood and urine abnormalities associated with cushing's. I'm not sure what you mean by skin growths but like people, otherwise healthy dogs do get benign skin growths as they age. I have a Maltese who has a lot of wart like growths on several parts of his body but they are benign and don't cause any problem. Dogs with cushing's can have skin problems but the majority of members who come here don't have a dog with skin issues requiring vettting. They do, however, have dogs who have overt symptoms like excessive drinking and peeing, voracious appetite, panting, lethargy and inability to jump up on things the way they used to. Did your vet do a skin scraping or biopsy to determine the cause of the growths?

[molly muffin]

Hello and welcome. There is nothing safe really about any of the drugs that treat cushings. So, the main thing is to be absolutely sure that it is cushings and usually what I'd advise prior to starting any treatment is an LDDS test. That's just me though. As far as a natural treatment. I don't know of any, but keep in mind with cushings that you are treating the symptoms and that it is a very slow progressing disease, so nothing has to be rushed in treatment of it.

The next thing I'd say is that every dog reacts differently to these meds, some are VERY sensitive and go into a crisis with very little. Other dogs, need huge dosages to stabalize their cortisol. The Only way to really know what is going on with the cortisol at this point is an ACTH test. In cushings land there are many future ACTH tests, even if you don't end up treating, you will at some point, be worried and want to know what is going on. Since there Has been a mini crisis, I can see why the vet would want another one. The dosage might have been too high, it might be that your poppy is just very sensitive.

But definitely no more vetroyl until you know.

Sharlene and Molly Muffin

[Poppysmum]

Hello again! I've now got Poppy's tests and would be so grateful if you nice people could give me your opinions? (Sorry for LONG post!!)
Scan report:
"Adrenal hyperplasia is suggestive of hyperadrenocorticism...the pancreas is markedly diffusely hyperechoic and this may reflect fatty infiltration or chronic pancreatitis
Liver:abnormal moderate hepatomegaly
Left adrenal: Abnormal 8mm diameter, prominent, hypoechoic
Right adrenal: abnormal as above
Pancreas: Abnormal: marked diffuse hyperechogenicity
Everything else was normal.

The ACTH stimulation test results are a little harder to read but the cortisol range is "suspicious for HAC" and a couple of the results were high, namely ALP (?), T-BIL, CREA & WBC and the T-CHO was off scale.

Can anyone make any sense of this? Thanks so much :)

[addy]

The ACTH stim test should have a pre and post number with ug/dl after it. Should possibly say first draw and post draw.

The other info is from a blood draw most likely a full chemistry panel.

Enlarged adrenal gland may indicate Cushings but they may also be enlarged due to an illness.

On the chem panel list those marked high or low and what the reference range is.
I hope this maks sense. I am sure someone else can explain it better:)

[labblab]

Hello from me, too. The scan results you have listed are indeed consistent with Cushing's: two enlarged adrenal glands, abnormal liver, and evidence of chronic irritation of the pancreas. On the face of it, the lab results can also be associated with Cushing's: abnormal results for liver and kidney function, and high cholesterol. As Addy says, though, it would be really helpful if you could give us the actual numbers for the bloodwork, along with the normal range. That way, we can help judge how severe the kidney/liver abnormality seems to be, and the likelihood that other nonadrenal illness may be skewing the ACTH results. And since you are in the U.K., the ACTH results will probably be listed in units of nmol/l instead of ug/dl (which is the norm here in the U.S.).

However, a huge component of any Cushing's diagnosis is the symptom profile. Also as Addy says, other illnesses can result in overlapping lab abnormalities. So unless a dog exhibits some classic Cushing's symptoms, the accuracy of the diagnosis remains more suspect. Does Poppy exhibit any typical Cushing's symptoms such as excessive thirst/hunger/urination, panting, muscle-wasting in the hind legs that inhibits jumping, seeking out cool places to lie down, hair loss?

If the Cushing's diagnosis is indeed accurate, a lower starting dose of Vetoryl would be recommended by many specialists and clinicians. In Poppy's case, 10 mg. daily would likely be a wiser starting point. But before getting to that, it will be helpful if you can give us those specific lab numbers and also comment further on Poppy's symptoms.

Thanks so much!
Marianne

[Poppysmum]

Thanks a lot for your help. I didn't post everything as I was worried I would bore you all to death!
Here goes then:
Cortisol (basal) 258.0 nmol/l normal range 260.0
Cortisol (post ACTH) >1380 nmol/l

Post ACTH values .800 nmol/l - suspicious for HAC

Scan results:
ALP 182.0 (ref range 0.00 - 130
CREA 186 0.00 - 155.00
T-CHO off scale 0.00 - 2.90-7.90
WBC 6.40 7.50 - 19.00
T-BIL 40.00 0.00 - 8.00

the only low value was
CA 2.02 2.20 - 2.80

Hope this is what you need?

Poppy's symptoms have been occasional panting (but she pants like MAD when she's stressed), she does drink a fair bit but I wouldn't really call it excessive likewise with food. More telling I suppose is her back legs. They are rather weak and she can only climb about two stairs before giving up and she constantly looks for cool places. However, since the Vetoryl has got out of her system she 's been great. Her tummy has gone right down and she's generally in better spirits than she's been for a while-and I can't tell you how great this is as when she had her little "episode" I thought her days were numbered.
Thanks so much for your help-I really am so grateful x

[Harley PoMMom]

Has your vet said anything about the pancreatitis that is mentioned on the scan report? Any chronic illness can cause the adrenal glands to be enlarged and with Poppy not showing the obvious signs of Cushing's disease I am very concerned with her being treated with Vetoryl.

Since Poppy's scan did find pancreatitis, if it were me, I would have a specPL test done to confirm this finding. Also, dogs with pancreatitis should be on a low-fat diet and be fed several small meals throughout the day.

Poppy's panting could be from pain assoiciated with Pancreatitis, does Poppy's tummy seem tender to the touch?

[Poppysmum]

No to be honest she's never really mentioned it. She did mention the high cholesterol and liver values but she seems sure it's Cushing's. Her tummy isn't tender to the touch but the strange thing is that it was massive when she was having the reaction to the tablets but now it's gone right down.
I'm not sure how to tackle this without seeming like I'm telling the vet her job! Any suggestions?

[molly muffin]

Just say that the pancreatic findings on the ultrasound just worrys you to death and would it be possible to have one of those specPL tests done to put your mind at ease? You'd really appreciate it if she could do that for you. :)
Her ALP is really low for what we normally see in cushings dogs.

Having something else going on, like with her pancreas could cause her cortisol to rise too.

I'll let the lab peeps discuss the various findings on the test results, but I'm pretty good at having to convince my vet that anything other than what she herself orders needs to be done. LOL

Sharlene and Molly Muffin

[Poppysmum]

Sorry I'm not up to speed on all the medical terms-can you tell me what ALP is please?

[molly muffin]

ALP is Alkaline Phosphatase.


This enzyme is usually specific to the bile duct of the liver. It can be elevated in cases where the bile duct is blocked or congested for any reason, either external or internal to hepatic malfunctioning. This type of canine liver enzyme diffuses into serum with liver enzyme elevation noted during laboratory testing.

http://www.dog-health-handbook.com/canine-liver-enzymes.html

I didn't know much about anything either and still have a lot to learn compared to what some of the others know, so don't worry about asking the questions of anything you want to know. It's the only way to figure this stuff out.

Sharlene and Molly Muffin

[Poppysmum]

Thanks Sharlene-I'm so glad I found this forum!

[molly muffin]

I say that All the time too Poppysmum.:D

[Poppysmum]

Hi Sharlene, I have googled the symptoms of Pancreatitis and she isn't suffering from any of them so I'm even more confused now :confused: but agree it does seem strange that the vet didn't even mention it?
My post has slipped down the page so I don't know if the people who were helping me are going to see this now? Help!

[molly muffin]

You last post always shows up at the bottom of the thread. I'll recap and let me know if this is correct or not. I have given the ACTH results in ug as that is what most are use to seeing here.

Possible diagnosis of Cushings (vet unsure) Symtoms - panting, hind leg weakness,
looks for cool places to lie

12 year old - weights 10lbs - 30 mg Vetroyl

Given 3 doses of Vetroyl, bad reaction, muscle tremores,
stopped eating.

Vetroyl stopped after the 3 doses due to reaction

ACTH

Corisol base 9.35
Cortisol Post 50.01

Scan report:
"Adrenal hyperplasia is suggestive of hyperadrenocorticism...the pancreas is markedly diffusely hyperechoic and this may reflect fatty infiltration or chronic pancreatitis
Liver:abnormal moderate hepatomegaly
Left adrenal: Abnormal 8mm diameter, prominent, hypoechoic
Right adrenal: abnormal as above
Pancreas: Abnormal: marked diffuse hyperechogenicity
Everything else was normal.

ABNORMAL RESULTS

ALP 182.0 (ref range 0.00 - 130) HIGH
CREA 186 (0.00 - 155.00) HIGH
T-CHO 0.00 (2.90-7.90) off scale
T-BIL 40.00 (0.00 - 8.00) HIGH
WBC 6.40 (7.50 - 19.00) LOW
CA 2.02 (2.20 - 2.80) LOW

Vet did not mention anything about pancreatic signs from SCAN, but Poppy has none
of the symptoms.

I would have an UC:CR test done on urine. I would also have another ACTH test done After
the episode and possibly have an LDDS test done to see if Poppy is suppressing or not.

Go from there. Maybe some of the others with more knowledge can give their input based upono these
test results.

These tests are from Before the vetroyl was started and the bad reaction?

Was an ACTH test done After the reaction to see what happened?

[Poppysmum]

Hi Sharlene-what I meant was (not too hot on forum terminology!) that there have been lots of people have posted so my original post has slipped right under the radar :-(
Yes you have the details spot-on, and the tests were from before Poppy had the reaction. Can you tell me what UC:CR and LDDS tests are?

[molly muffin]

So I grabbed a copy of the explanation of UC:CR and LDDS


Urine cortisol:creatinine ratio

The urine cortisol:creatinine ratio (UC:Cr) is the simplest, least expensive test to rule out, or rule in, the possibility of Cushing’s disease in your dog. ref Dogs with normal UC:Cr values are highly unlikely to have Cushing’s disease.

However, dogs with abnormal UC:Cr values do not all have Cushing’s disease. Cortisol (cortisones) are continuously being shed in your pet’s urine. How much is present at any single time, depends on how dilute your pets urine is, as well as the level of the compounds in your pet's blood. Creatinine levels in your pet's blood remain rather constant. So by measuring how much urine cortisol is present in relation to how much creatinine is present, we get an indication as to how much cortisol was present in your pets blood when that particular urine was formed.

Urine for this test should be collected in the early morning (although a few vets still prefer a mixed, 24-hour sample). Do not bring your pet to the animal hospital – collect the urine at home. The stress of a car ride can be sufficient to alter the results in some pets. If your pet is emotional, let it calm down a few days after its last vet visit before you collect the sample. ref

Your veterinarian will send the pet’s urine sample to a national testing laboratory. If the UC:Cr value is reported back as normal, your pet probably does not have Cushing's disease. But only one dog in 4 or 5 that have an abnormally high (= positive) value actually do have Cushing's disease. This is because gastrointestinal, urinary tract, liver and heart diseases - as well as simple stress can also make your pet’s UC:Cr value go up.

Low Dose Dexamethasone Suppression Test(LDDS)

If your pet’s Urine cortisol:creatinine test was abnormal or suspicious, this second test should be run. For it, your pet will have to spend the entire day at the animal hospital.

Dexamethasone is a compound similar to your pet’s own cortisol. When it is injected, your pet’s pituitary gland should mistake it for cortisol and inform (thru ACTH release) the pet’s adrenal glands that no more cortisol needs to be produced. In normal dogs, this causes a drop in their natural blood cortisol levels. If the level of blood cortisol remains high after the dexamethasone is given, one of two things are happening: Either, your pet’s pituitary gland has a pituitary tumor that continues to produce ACTH, or your pet has an adrenal tumor that continues to produce cortisol.

The laboratory test can tell the difference between the pet’s own cortisol and the dexamethasone that was give and will report back if the natural cortisol level dropped normally after the injection, by how much and for how long.

This test will detect most of the pets that have Cushing's disease. However, certain medications (phenobarbital, phenytoin, spironolactone, tetracycline and perhaps others) can cause this test to fail. ref Also, some pituitary tumors retain some sensitivity to dexamethasone, which can also trick the test.

http://www.2ndchance.info/cushings.htm

I think it explains it better than I probably could just off the cuff.

You can always repost your original question too. That's okay. :)

Sharlene and Molly Muffin

[Harley PoMMom]

Hi Sharlene, I have googled the symptoms of Pancreatitis and she isn't suffering from any of them so I'm even more confused now :confused: but agree it does seem strange that the vet didn't even mention it?
My post has slipped down the page so I don't know if the people who were helping me are going to see this now? Help!

My angel boy, Harley, did have chronic pancreatitis which was found on his first ultrasound. Needless to say I was stunned because Harley never showed any symptoms of pancreatitis.

Harley had a specPL test to confirm the ultrasound findings and I was completely flabbergasted when the results from the specPL test came back at 528 (0-200).

Harley did have chronic pancreatitis and never showed any signs of it.

When a dog's pancreatitis is diagnosed by an ultrasound, I strongly urge any member to have this confirmed via the specPL test, especially when the dog does not display any symptoms.

[molly muffin]

Hey there! How is Poppy doing?

Sharlene and Molly Muffin

[Poppysmum]

Hi everyone. I posted a little while back about my Poppy who had a very bad reaction to Vetoryl. The vet had advised putting her back on it at a reduced dose but until now we have resisted, however I have noticed over the last couple of weeks her back legs have become very weak so much so when she shakes herself she tends to stumble. Would Vetoryl help this at all, or would anything else have a beneficial effect? I'm loath to put her back onto Vetoryl but to be honest I don't know what to do for the best. :(

Moderator's note: I have merged your post into your original Thread as to keep all information about Poppy in one place

[Harley PoMMom]

Was an ACTH test done beore Poppy went back on the Vetoryl? If, so could you post those results, please.

If Poppy is not like herself, IMO, the Vetoryl should be stopped and an ACTH test should be done.

[Poppysmum]

She's not on any medication at the moment since the original episode. It's not ideal I know but as I say I don't know what to do for the best. She's fine in herself at the moment but the leg thing is breaking my heart :(

[Harley PoMMom]

I am so sorry that I misinterpreted your post and thought that Poppy was taking Vetoryl...my feeble mind!

Regarding the rear leg weakness, it could be the result of uncontrolled cortisol.

[Poppysmum]

That's OK :-) Her legs haven't been great for a while but seem to have become weaker really quite suddenly. Would the Vetoryl help do you think? As I say I am really reluctant to put her back on it after what happened but it's hard seeing her like this.

[addy]

I think you are asking should you put Poppy back on the Vetoryl. What dose did the vet want to use? If I go back in your thread I see your vet started Poppy on 30mgs of Vetoryl. Poppy weighs 10 pounds. We usually recommend 1 mg per pound as a starting dose as per Dechra and other endocrinologists. It also states Poppy was given 3 doses and started trembling and stopped eating and you discontinued the Vetoryl but from what I am seeing the ultra sound mentioned possible pancreas issues. I know Lori mentioned to you her dog had pancreatitis with no symptoms so am a bit leery about that.

Other then the back leg weakness how is Poppy doing?

It would be reasonable to think 10 mgs would be a good starting point for Poppy and that it was possible that the starting dose was just too high but I would feel better if someone looked back at your labs.

I don't blame you for not wanting to start the Vetoryl again. I am sorry you had such a bad experience. Starting low and going slow usually works out for the better with our pups when it comes to Vetoryl.

[Poppysmum]

To be honest I'm thinking of changing my vet. She's very nice but is foreign and has quite a heavy accent and sometimes I'm not sure if she understands me 100% which is difficult when we are talking about stuff I don't fully understand myself!
Other than her legs Poppy seems OK. She is definitely drinking and weeing more but up to now it's not a massive problem. She's 12 now is an old lady and sleeps a lot but she still is interested in what's going on. It's snowing really heavily here at the moment and I had her out yesterday and she loved it, and even managed a little gentle run, which was lovely to see. As you can probably tell I just adore her and want to do the best for her and if that means the dreaded Vetoryl then I suppose we will have to give it another shot. Will it actually improve the muscle weakness?

[molly muffin]

Based upon your original report, of 30mg, for a 10lb dog, to start, is too high. Addy is right on saying 10mg would have been more likely to start with. Since you didn't have an ACTH After the episode there is no way to know positively that is what happened, just that is what all the signs point to, is an immediate drop of cortisol, which could lead to an addison's crisis.
Could vetroyl help with the rear leg weakness. It can yes, although some dogs never do recover fully to their old selves, but some do. High cortisol levels causes muscle loss especially in the rear legs. So, without treating, it is possible that the cushings has progressed. I assume that no more voimiting episodes, diarrhea, so probably not having a pancreatic episode?

Nice to see you again. :)

hugs,
Sharlene and Molly Muffin

[Poppysmum]

Hi Sharlene-nice to be back :-) I have been burying my head in the sand I suppose but her legs have made me think again. I really couldn't say about the possible Pancreatitis but she's eating normally and had no vomiting at all and only had been kind of loose a couple of times but that's not out of the ordinary.

[molly muffin]

Okay, so you'll probably need an ACTH to find out where the cortisol is at now, before starting anything back up.
Has she had any further tests since the last episode, blood work of any kind?

Sharlene

[Poppysmum]

No she's had nothing. Part of me wanted to just let her live the rest of her life without having to take drugs that would make her ill...it's a very vicious circle knowing what to do for the best I think. I guess I just want her to live forever, but sadly no drug will do that :(

[frijole]

I am 'anti drug' also but trust me... been her around 8 yrs and there is no choice but to use either vetoryl or lysodren. The excess cortisol can hurt a dog in so many ways. If a dog is old and near the end it isn't worth treating so long as you can deal with the urination.

I think in your case the problem wasn't the drug but the fact that your vet started you at 30 mgs vs 10 mgs daily. Always start low with vetoryl/trilostane and work your way up. Kim

[Poppysmum]

Hi Kim, Poppy is 12 so not ancient as far as Yorkies go so in that case would you say it's worth it? I have a friend whose dog was diagnosed quite late and shortly after Diabetes set in, he went blind and not long after died. I would never forgive myself if this happened to Poppy.

[frijole]

My dog Haley was diagnose at 12+ and I treated her with lysodren for 4 1/2 years and she passed of OLD AGE at 16 1/2 yrs. I don't regret the expense and the stress - I got another 4 years of love out of that deal. Once controlled it was a breeze.

I had to switch vets (first one was clueless) and this site held my hand thru the whole ordeal... Key is YOU have to get up to speed on what the disease is, the drugs, etc so you can be your dog's voice and make decisions and ask the vet questions to make sure all is right. We'll help there. The other piece is the vet has to be up to speed on the drug and treatment. Step 1 is to start at 10 mgs. If vetoryl/trilostane doesn't work you can always try lysodren.

Again - don't blame the drug. It isn't evil. It is a god send when given in the right dosage amount. Hang in there. Kim

Not sure if anyone gave you this link so just in case:

http://www.k9cushings.com/forum/showthread.php?t=180

http://www.k9cushings.com/forum/showthread.php?t=185

[SoggyDoggy]

Fraser had his LDDS test and was diagnosed 5 days after his 13th birthday. We had stuff ups but now he's settled and going well with the trilostane. I fully expect him to go another 2 years at least, so no, I wouldn't think 12 is ancient, and after seeing the quality of life that can be restored, I would definitely say go with it. As Kim has said though, start (well, re-start) low and take it from there. As you know, this place is full of support and everyone will hold your hand and guide you through it. There is a light at the end of the cushing's tunnel!

[addy]

We wish we could tell you, yes, the leg weakness will go away if you treat Poppy but we cant say for sure.

Sweetie it is a hard decision and everyone makes it based on their very own circumstances. It is expensive to treat, no doubt about it.
You need to follow your heart, try to read some more, gather information and then see how you feel.

We are always here for you. I will say if you have a hard time communicating with your vet maybe it would be better to find a new internal medicine specialist in your area. Maybe then you would feel more comfortable. Though that is not always a guarantee either.

((((((((((((((((((((hugs))))))))))))))))))

[Squirt's Mom]

Scan report:
"Adrenal hyperplasia is suggestive of hyperadrenocorticism...the pancreas is markedly diffusely hyperechoic and this may reflect fatty infiltration or chronic pancreatitis

Was this ever addressed? It is in your post #8 on Nov. 29th...so it seems the pancreas has been an issue since at least Nov of '12. If not, it is worth talking to your vet about.

Hugs,
Leslie and the gang

[Poppysmum]

Ok everyone-you have helped me make my decision. I am going to change vets and see what they say about starting Poppy on a very low dose of Vetoryl and see how she goes. If her legs improve that will be fantastic, and if not...well I'll carry her-much as I do now! She's not a big walker anyway and the weakness upsets me more than her-she's a very resilient girl :)
Leslie-nothing was ever mentioned about her Pancreas, which is another reason to switch vets.
Thanks for all of your help and kindness-it's much appreciated x

[addy]

but from what I am seeing the ultra sound mentioned possible pancreas issues. I know Lori mentioned to you her dog had pancreatitis with no symptoms so am a bit leery about that.

Leslie, I saw that as well and Lori commented too.

So that needs to be discussed with a new vet, I think.:);)

[Poppysmum]

I can't argue with lab results but she doesn't seem to be showing any signs of Pancreatitis, however I will get it checked out.

[molly muffin]

And ACTH. You want to know where the levels are before starting her on something to bring it down. You will want to know what the current levels are!

Sharlene and Molly Muffin

[gabelle1995]

Do you have the possibility to try acupuncture or massage for the hindquarter weakness? That seems to help Dudley a lot. He also takes Vetoryl (60mg) once a day. He weighs about 17 kilograms. The holistic vet we see for these treatments pays extra attention to Dudley's front leg joints since he uses these a lot more now with the hindquarter weakness. He has a couple of days of stiffness then he's back to himself.

It might be worth considering. :)

[Poppysmum]

I eventually relented and decided I had no option but to give my Poppy Vetoryl. She's only been on it a week and already she's stopped weeing through the night, which is great! However, she seems not to be eating much and also seems to be shivering a lot. I don't think it's muscle tremors as it stops when I wrap her in a blanket, but I'm wondering if this is a side effect or if it's just because she's getting older...and because it is really chilly here at the moment?

[molly muffin]

Hi and so glad to see you again. Okay, so catch us up on what is going on.
First did you switch vets? Did you have an ACTH done before you started the vetroly again? What does is Poppy on now? What about the pancreatis test? We know that not all dogs show signs of pancreatis even though they have a chronic case of it. (harley case in point)
Do you have another ACTH test scheduled? You need one again about 12 - 14 days after starting vetroyl.
Yes, some dogs do have tremors when they take vetroyl. If you see poppy having any voimiting or diarrhea, stop the vetroyl and immediately schedule an ACTH test.
Each dog does differently on the drug and you want to find the dosage that puts poppy right where she should be, which is around a post of just under 5. Not too low, not too high for that post number.
The leg weakness can be one of the last things that clears up if it ever does. You just won't know till she has been on it at an optimal dose for a few months. Although you would see a faster reaction in the weeing.

I'm really glad to see you back.

hugs,
Sharlene and Molly Muffin

[Poppysmum]

Hi Sharlene, we changed vets and had the ACTH test again. I mentioned the possible Pancreatitis but was told it was OK. She's started her on 10mg (I would have preferred 5 after what happened last time but 10 is the lowest dosage) and I have to go back next week for them to check her over again. She had a little bit of diarrhea yesterday but is OK now, but just seems a bit, I dunno, just not herself somehow. She seems to have got her appetite back though so that's good!

[molly muffin]

Do you have the ACTH results that you did last time and could you post them here?
This would be the one you just had done. Keep an eye on the poops. If she seems too off, then call and schedule the follow up ACTH for sooner. Right now Dechra is recommended between 10 - 14 days for the follow up ACTH.
(this is according to the newest info sent to the vets, which changed it to 10 - 14 from 12 - 14 days follow up)
if 10mg ends up being too much, then you'd need to move to 5mg compounded trilostane.

Sharlene

[molly muffin]

How is Poppy doing today? Poops still okay?

Sharlene and Molly Muffin

[molly muffin]

checking in on you and poppy

Sharlene and Molly Muffin

[molly muffin]

We have a Good News Wednesday coming up. :) Poppy is going for her follow up test tomorrow, so lets all wish Poppy and her mum the best of luck with the results.
Poor thing has had a hard time getting back on track after the first try with vetroyl, so hope this is a good result.

Remember, we're looking for the Post result to come down to below 9, if symptoms are controlled and you'll need it to go lower if they aren't. Since she's still peeing and drinking a lot I think they the post might not be where you want it to be yet.

Hang in there!! Good luck

Sharlene and Molly Muffin

[Poppysmum]

Not such a Good News Wednesday after all :-( The vet said she had to be seen about 4 hours after taking her tablet but she won't even look at her food this morning so I'll have to cancel the appointment. One step forward two steps back! She is weeing and drinking but not half as much and does shiver a lot-but this stops when she's wrapped up so makes me wonder if she's feeling the cold more?
I have brought up two really fussy girls where food is concerned-they have a diet some dogs could only dream about and still won't eat. Kids!!

[frijole]

Your vet is right in that she has to eat something 4 hrs before testing. The challenge is though that not eating and trembling can be a sign of cortisol going low. I know your dog sometimes doesn't eat but it could be due to low cortisol.

I wouldn't just cancel today's appt. I would call the vet and describe the symptoms because you really need to get her tested. Try to get her to eat something this morning and maybe take her later in the day?

Kim

[Poppysmum]

I've already cancelled but made another for the same time tomorrow so will have to make sure I make her something fabulous to eat in the morning! I thought when I made my breakfast she might perk up and want to greed off me but she didn't even look up, which isn't like her at all. Hopefully we'll find out tomorrow.

[molly muffin]

How did Poppy do today? Did she at some point eat?
Definitely get her in tomorrow, if you've missed todays dosage, it could end up screwing results too.
Did she get her dose today?

hugs,
Sharlene and Molly Muffin

[molly muffin]

Okay, here we are this morning. Did Poppy eat anything, take her meds, ready for the ACTH?

Sharlene and Molly Muffin

[Poppysmum]

Hi Sharlene, as she didn't get a tablet last night I rang the vets who've said she has to take it for another full 7 days so I can't get her in till next Thursday. It's turning into a nightmare! So by the time she eventually gets tested she'll have had almost a months worth of tablets so I sincerely hope that's OK?

[molly muffin]

Really? Another 7 days? Hopefully one of the others on her can jump in with their opinion on that, but I don't think I've heard that it had to be taken 7 days in a row before an ACTH test could be given.

Arggghh, nothing is ever easy with this cushings stuff.

Sharlene and Molly Muffin

[Harley PoMMom]

If this were me, I would not re-start the Vetoryl until an ACTH stim test is done especially since Poppy is inappetent.

[Poppysmum]

You're right there Sharlene!
HarleypoMMom- not sure what you mean about re-starting Vetoryl as she's been on it for a couple of weeks now? She's definitely not as hungry as she was put I am managing to get her to eat something so I'm not unduly worried plus after just trundling around for ages she's started on trot about, quite quickly for her, which just makes me want to kiss her little face off !

[Squirt's Mom]

What Lori means is that is a pretty hard, fast rule that you never give either Vetoryl nor Lysodren to a pup who is not well for any reason. A lack of appetite is one of the warning signs for BOTH meds that the cortisol is too low so a pup that is not eating well should not have either Vetoryl nor Lysodren.

So your vet telling you to give the Vetoryl to Poppy for another 7 days is not the best advice since she is not eating well at the moment.

[Poppysmum]

Ah I see. Her appetite has picked up a bit actually. She ate her breakfast this morning then promptly ate her sister's (who is not a morning person!) so things are looking up. She has also taken to trotting round really fast (for her anyway) which she hasn't done for absolutely ages so I think she must be OK. I go back to the vets on Thursday so I'll post after that.

Thanks everyone for your help xx

[molly muffin]

Glad to hear that Poppy is eating well again. Maybe she just had an off couple days. (Did you happen to mention going to the vets after breakfast for a test???:D:D ) They are pretty smart. She might think she's now figured out how to get out of med tests. (best not mention any thursday appointment!) :D

hehe
Sharlene and Molly Muffin

[Poppysmum]

Though her Dad and I think she's almost human and she understands everything we say even we don't think she's that clever! Then again-she could surprise us!:)

[Poppysmum]

Hi again everyone. I'm really worried about Poppy. She's hardly eating anything, is shivering almost all of the time and has had diarrhea today (that may be because of what I had to feed her this morning to get something into her but it's still worth mentioning). I rang the vet who has told me to bring her in tomorrow instead of Thursday. She's now been on Vetoryl about 3 weeks without a follow up test. The vet says because she's on such a small dose she will be OK but I really don't know what to do. My gut reaction is to take her off it but if I do she's going to be prone to all manner of infections, diabetes etc so I feel I'm stuck between a rock and a hard place. She's only on 10mg so if that's too much for her there is nothing we can do.
Sorry to be a pain but I'm at my wits end. Thanks x

[addy]

Can you tell me what you mean that she has been a Vetoryl for 3 weeks without a test? Do you mean she started on Vetoryl 3 weeks ago and was not tested at the 10-14 day mark? I just neeed to know and did not want to reread your thread.

Do you dose her once a day? Did she have her dose today? Did the vet say to bring her in tomorrow for an ACTH test and to check her elctrolytes?

[Poppysmum]

Yes-she was off her food last week and because of that missed her tablet last Wednesday. She was supposed to be getting tested last Thursday but the vet said because she'd missed one, she'd now have to take them for a full seven days before getting tested again.She takes one tablet in the morning and has had one today. The vet said to take her in tomorrow instead of Thursday so she could try and get the results back for Thurs as it's a bank holiday this weekend. She's having the ACTH test but no mention has been made re electrolytes.

[molly muffin]

Ask them to do both tomorrow and then give her the dose in the morning, since your vet won't do the ACTH if she misses it and then that is it. No more until the results come back and you see where she is at.

For everyone, Poppy is on 10mg and weighs 10lbs.

Tell them you want electrolytes tested at the same time they test the ACTH. Also, make sure the test is done 4 hours after giving her the dose.

You can go down in dosage, you can always go down, every dog is different, and you can get the dosage via compounded pharmacy. 10mg is the lowest vetroyl that Dechra makes, but you could go down to 5mg via a compounding pharmacy.

If she starts vominting get her to a vet ER.

hugs,
Sharlene and Molly Muffin

[Poppysmum]

Thanks Sharlene, that's exactly what I'm going to do. My husband is in Norway at the moment but he just rang me and said the same as you-give her one in the morning then no more till we get the results.
What exactly do you mean by a compounding pharmacy? I am new to all this!

[Poppysmum]

Just Googled it! There doesn't seem to be any as far as I can see in the UK. Do you happen to know if anyone on here from UK has found anyone who does it?

[molly muffin]

Oh gosh, why do things happen when the hubs are away. Molly had her first choking incident while my husband was away and I called him freaking and he was in help out the wife who is in panic mode while in another city and unable to do anything about it.

A compounding pharmacy will make the tablets up using Trilostane (the medical ingredient in vetroyl).
There are several you can use online, and your vet would simply need to call the prescription in or send it. I think a few members here have used one in Arizona called Diamondback. The key is to find one with a good reputation.

If your vet has one that he uses, that would be an option too, but you can price shop around also if you want.

I think we have a plan in place now, which is a good thing. :)

hugs,
Sharlene and Molly Muffin

[Poppysmum]

It is a good thing, you are so right. I am so glad I happened upon this site-I would have been lost without it. You are all so lovely and kind :)
I've just found a lab in the UK that seem to do that sort of thing so first things first, I'll get the results and take it from there but at least you've given me a possible solution now.

[molly muffin]

Oh fiddles I didn't realize you were in the UK. Okay, there has to be something. I can't remember about the UK specifically, but maybe one of the others will know.

[addy]

I'm glad Sharlene got here before I got back to you. I just want to add that for some dogs even 10 mgs can be a problem and for these subsets of dogs, there is no such thing as "too low of dose to cause a problem".

If Poppy gets worse, it is off to the ER if you have those:);)

((((((((((hugs)))))))))))))))))))

[Poppysmum]

Thanks Addy -it would seem that 10mg is definitely too much for her. To be honest I don't really want to give her another tablet tomorrow but I will have to in order to find out what's going on with her. She doesn't know what to do with herself tonight poor little thing:(

[molly muffin]

Poor thing, just try to keep her happy, with whatever she wants. It's so hard and I'm ticked at your vet for saying that she had to be on vetroyl for another 7 days before doing the ACTH test, that is just wrong. Vetroyl enters the system and is at it's most potent in 3 - 4 hours of dosage, it leaves the system in around 8 - 12 hours usually.

hugs,
Sharlene and Molly Muffin

[Poppysmum]

I can't seem to do anything for her at the moment. She won't look at food, won't stay wrapped up and is just wandering round aimlessly trying to get herself settled. She has the tablet around 9am so as it's now 00.20am it should be out of her system? It's not helping matters that she's got an upset tummy.

I think mother and baby will not be getting a lot of sleep tonight!

[molly muffin]

yes it should be, but if her cortisol levels are low, then the over all affect will be with her for awhile. I just don't want Poppy to go Addison due to too low of cortisol. Has she been vomiting? How about a walk? Is that even feasible in the middle of the night there?
Will she lay down with you?

Sharlene and Molly Muffin

[Poppysmum]

No she's had no vomiting. I've got her cuddled on my knee but she's shaking like a leaf and her tummy is making really loud noises. I wouldn't really fancy taking her for a walk at this time off night to be honest! I'm really not sure if she's poorly because of the Vetoryl or if it's due to her tummy and I'm really unsure about giving her another tablet in the morning to be honest, but if I don't we are going to be back to square one.

[molly muffin]

I know and normally I wouldn't even suggest giving her a tablet, but I feel like you are in this position because of the last time and your vet refusing to do an ACTH test.
Could/would you be able to push for a test without giving her the dose in the morning? Can you call the vet prior to trying to give her the dose and just say that you Want an ACTH to be done and you do not feel comfortable giving her the med? Can you just push to have them do it?
I'm not sure if you feel comfortable with that approach or not or how your vet would respond. I am a bit concerned about how much they know about vetroyl and it's side affects and dangers, based upon what they have done with Poppy.

hugs,
Sharlene and Molly Muffin

[Poppysmum]

I'm happy to suggest anything to them but like you say, I doubt they'll do the test without her having the tablet after what happened last week. Would the results be OK if she hadn't had it though?
My husband has suggested ringing another vet first thing to see if they are a bit more clued up. Do you think that's a good idea?
To be honest I think it's her tummy that's making her the way she is tonight but her shaking and appetite are definite alarm bells which I must get to the bottom of.

[molly muffin]

If what we are most interested in is finding out if the cortisol has go e to low then yes an ACTH test can still be done.
If your vet absolutely refuses to do a test then yes you could call someone else. I'd check with your vet first but might look into finding a different on if and I do say if, your vet is not willing to learn and work with you. One thing I thought of is what a out Pepcid to calm her tummy?

Sharlene

[Poppysmum]

OK I'll see what I can get sorted out in the morning...I will be like a zombie by the looks of things but never mind :(

I don't have anything like Pepcid so it's just going to be a waiting game, unfortunately.

I'll report back tomorrow-hopefully she'll have picked up a bit.

[addy]

Could she be having a pancreatitis attack? Is she walking with her back hunched up? Does her tummy seem tender to the touch?
Quite honestly, it will be your call whether to give her the dose in the am and it is going to have to be your gut instinct I'm afraid.
If this vet wont test her cortisol without the drug, is there an emergency clinic that you could take her to instead? Is she lip smacking, yawning, burping? When was the last time she vomited?

[Poppysmum]

No none of those things Addy. If it wasn't for the tummy noises I wouldn't think there was anything wrong with her as she looks perfectly normal and she hasn't vomited at all.

[addy]

Could she be having a pancreatitis attack? Is she walking with her back hunched up? Does her tummy seem tender to the touch?
Quite honestly, it will be your call whether to give her the dose in the am and it is going to have to be your gut instinct I'm afraid.
If this vet wont test her cortisol without the drug, is there an emergency clinic that you could take her to instead? Is she lip smacking, yawning, burping? When was the last time she vomited?

[Spiceysmum]

Hi,
I am sure by now you have decided whether or not to give Poppy todays vetoryl. In my experience vets in the UK will not see another dog without contacting the present vet first, we did that and eventually had to leave that practice as it felt uncomfortable every time we went. I did think that if she has not had todays dose because she is too ill you could always take her anyway and just not tell them but I don't know how you would feel about that. If the results were low without having had the vetoryl then you would be justified but I'm not sure how you would explain it away if they were still high. Not much help I know but it was just a thought! How is Poppy this morning?

Linda

[Poppysmum]

Hi Linda, yes you're right, I rang another vet and they said they would have to see her and have all the results of her tests etc- which I can understand.
Her tummy has settled down but she's still shaking and not 100% so I really don't know what to do for the best regarding her tablet this morning as it certainly looks like her cortisol levels have dropped too far. I'm busy trawling the net for answers but I know it's going to be my decision really and I've got to make it in about ten minutes!

[addy]

can you call your vet and ask him? Just remember the test has to be 4-6 hours after giving the pill with some food. Perhaps you could ring your vet up and then go ahead with the pill if he wont listen to you.

actually, our UC Davis says 3 hours so you could even do 3 hours after the pill, just dont do longer than six hours

[Poppysmum]

Hi Addy, I managed to get her to eat some chicken and take her tablet about an hour and a half ago and her appointment is 4 hours later so that should be OK. On the plus side she's not shivering quite so much so fingers crossed I've done the right thing.

[addy]

Ok, I'm glad she will be at the vets. It is a hard call sometimes and you are there and you know your dog. :):):)

In the States, we have emergency clinics we can take our dogs to if we cant get in to see our regular vet or if it is off hours.

Some dogs can be sensitive to Vetoryl. Jeanette's lab Princess had a hard time with 10mgs.

hoping for a good outcome.

((((((((((hugs)))))))))))))

[molly muffin]

I think Poppy is definitely sensitive to vetroyl, so we'll see what the numbers show. This is twice now though with a lower dose each time that Poppy has not done well on the med.
I'm soooo glad she is getting her ACTH test today though. I'm a worry wart, right along with most on this forum. :)
Love Poppy's avatar. She is such a little bitty doll.
You're doing good! And remember! No more vetroyl until the results are back. It doesn't hurt to stop and start them on vetroyl.

Hang in there! I'll check in again as soon as I can
hugs,
Sharlene and Molly Muffin

[Poppysmum]

Thanks so much for all your help and support :) I do feel happier now as she's still shivering but seems more herself. I have only seen the nurse today and she said to keep taking the tablets till they get the results. I suppose it's only one tablet (hopefully, if the results come back tomorrow) but do you think I'd be better off stopping it?

[Harley PoMMom]

If this was me, I would not give Poppy any more Vetoryl until the results of the ACTH stim test are known. If Poppy's post number is on the low side than additional doses of Vetoryl could throw her into an Addison's crisis.

Hoping Poppy is feeling much better soon.

[Poppysmum]

That's good enough for me then-no more till I get the results. Thanks a lot :)

[Spiceysmum]

Hi,
Glad Poppy is a bit better and you managed to get the test done. Missing one or two days of Vetoryl won't hurt until you get the results. Hopefully you will get them tomorrow before the Bank Holiday. Once you have established whether she is to stay on the Vetoryl then you could ask the vet for some prednisone in case you are ever in this situation again.
Linda

[Poppysmum]

Thanks, yes I will do. Hopefully we'll get the results tomorrow so will find out what's going on.

[molly muffin]

No don't give any more until you have the results back. Sure shivering can be a side affect we see with vetroyl, but diarrhea and shivering, I wouldn't give it. You can go back to it if the results are in a good range or still high.

Don't make me get on a plane to the UK to give them a talking to now.:D:D I fully intend to visit one day and don't want to be kicked out for taking on a vet. :D:D

:) Hugs, you can do this! You want her post number from the ACTH to be in the 1 - 5 range. It can be as high as a 9 if all symptoms are controlled according to Dechra.

Hang in there! You're doing fine. How is Poppy tonight?

hugs,
Sharlene and Molly Muffin

[Mel-Tia]

For Tia's ACTH tests in the UK the magic number was always between 50-200 not sure what the technical word is for the measurement....

Just wanted to add this in case Poppy's mum saw a result higher than 5 which it could be and panicked

Hoping that it's a good result

Mel
Xxx

[molly muffin]

Oops, right Mel! I wasn't thinking in nmol, even though that is what my results are in too. I always do the division to get the results most are use to seeing on here.
Listen to Mel. :D:D She knows the UK result ranges! :p

Hugs!
Sharlene and Molly Muffin

[Poppysmum]

Ha Sharlene-you made me laugh! You definitely need to come across and be my minder!
They haven't called yet but I'm glad I know what figure we should be looking for now. Is that all I need to know?
We haven't long been out of bed. I was shattered with being up till 3am the previous night so we had a great sleep...nine and a half hours with no getting up for wee wees! Well, I did but she didn't! Then she's not only eaten her breakfast but wolfed down her sister Lucy's too! Her little tummy has gone right down with not eating over the past few days so it will be back up again at this rate ;)

[Poppysmum]

So, the results are in some good news and some not so good. She says Poppy's levels are OK and are definitely not being controlled too much. I asked what the actual figures were and she said 148 pre and 359 post. That of course means nothing to me so I hope you good ladies will enlighten me! She wasn't thrilled that I didn't give Poppy her tablet this morning and advised me to re-start them tomorrow.
The not so good news is that her figures for her kidneys (I think she said urea & creatinine?) are a little bit of a concern so I have to take a urine sample in on Tuesday. She reckons if Poppy's kidneys aren't working too good it could cause her to be a bit off colour and off her food, and maybe the shaking is due to that too. Not sure what I make of that as she isn't shaking today?
I feel happier today (possibly a side effect of having a really good night's sleep!) as I think the vetoryl is having some positive effects.
As ever I welcome the insight of you lovely ladies! x

[Harley PoMMom]

Although her ACTH stim numbers (148 pre and 359 post), which converted are pre = 5.4 ug/dl and post = 13 ug/dl, are not within the therapeutic ranges of 1.5 ug/dl - 9 ug/dl, I was wondering how Poppy's symptoms are, have they decreased?

If you could get copies of the chemistry test and post the creatinine and BUN results that would be helpful. Also, are her phosphuros and potassium within normal limits? If Poppy's kidneys are not working properly this could be why she is sensitive to the Vetoryl; her kidneys may be having some difficulty with clearing out drugs in her system and some toxicity maybe occuring. Has your vet mentioned starting subcutaneous fluids?

Love and hugs,
Lori

[molly muffin]

Hi, okay 359 is not where we want Poppy to be (50 - 200) is best. However, Lori has made some really good points, Poppy has not ever reacted well to vetroyl even when we thought ti was because the dose was too high for her.

So, just a call to the vet and ask what those actual numbers are for BUN, creatinine, phospuros and potassium and then ask what tests they plan to do on the urine. Ask about a UPC. (this checks protein and creatinine, in the urine and is a good indicator of what is going on with the kidneys)

Lori also is spot on about why she might be having this reaction to the vetroyl I mean its all well and good to say the cortisol is high so she needs the vetroyl, but it has to be working with everything else in the body.

(Our Lori is brilliant, did I mention that, along with quite a few others on here) :D:D

This is on the official FDA site, where they approved the drug for usage in the USA.


The use of Vetoryl Capsules is contraindicated in dogs that have demonstrated hypersensitivity to trilostane.

Do not use Vetoryl Capsules in animals with primary hepatic disease or renal insufficiency.

Dechra itself has warnings about this. So that can be mentioned to the vet. That if the kidneys no workee workee, then the vetroly no workee workee either. (okay that was my humor moment of the day, not very good eh) :) Dechra doesn't really say it like that, they talk about renal insufficiency too. I like my phrase better. :)

Still, the point is the same, all things in moderation and right now, we have to figure out what is going and why showing such sensitivity to vetroyl and what is up with the kidneys.

(kidney problems can also make the cortisol levels rise)

hugs,
Sharlene and Molly Muffin

[Poppysmum]

Hmmm...things aren't as good as I thought after all then?
I feel quite bad about tackling the vet as I hate to appear to be telling her her job, but I have to. I wish I had you ladies over here with me-you are all much more clued up than my vet it seems :-(
I will try to get as much info as I can on Tuesday, but could you tell me what BUN and UPC stand for in case they are called something else over here?

Just to check although I'm sure I know the answer-I should keep Poppy off the Vetoryl for the moment?

Thank you SO much. I know I keep saying it but I am so glad I found this site-you are all marvellous! xx

[molly muffin]

Well they aren't horrible. 13 is just a bit too high still, optimally.

Okay BUN is Blood Urea Nitrogen, and it's pretty much universal, so they should know what you are talking about.
Here is the link to a site that tells you what tests mean. Do NOT go reading through and freak yourself out. There are variables in between on all tests. This is a general of what a super high or super low Might or probably means, not definitive.
http://www.acreaturecomfort.com/caninebloodwork.htm
UPC is Urine Protein/Creatinine Ratio and is helpful when looking into issues with the kidneys.

Now really you don't want to go head to head and challenge the vet right off the bat. But you can say that you simply cannot remember what every result is and it would be handy for you to have copies so you can better understand what is going on with your baby. So you and your husband can discuss treatment options with knowledge, so you can keep track of what is going up and going down without having to call her (your vet) every moment of the day. See that is how you put it nicely. :) I know, been there, done that.

Well, it is up to you what you think you want to do about starting the vetroyl. Lori is correct that it is possible her body is not processing the medicine the way it should. That is one possibility. The other she is sensitive to it. However, her cortisol isn't in any danger level, so in that regard, she isn't at Addison risk.
If you do think you want to wait, that is fine too, and if you vet doesn't like it, bring up the renal issue with vetroyl to her (you can even print out Dechras recommendations from their website) and that you were just worried until you know what is going on. I can't imagine a vet not understanding that you are a concerned mommy and this is your precious baby, Poppy.
If you do decide you want to go ahead and give it to her, then just watch for the same symptoms you always have, such as the vomiting and diarrhea.

hugs,
Sharlene and Molly Muffin

[Poppysmum]

Hi Sharlene, I have hit upon a plan. The vet said today that the surgery is open for two hours on Saturday if I could get the urine sample there and that she's on call all weekend so I think I'll write her a little note with all of the info you and Lori have given me and hand it in with the sample. OK so I'm a coward but I can shmooze better on paper than in person!
I really don't know what to do regarding giving her the Vetoryl but my gut reaction is to give it a miss, which is a shame since she'd shown such an improvement with the weeing/drinking. If it says on the Dechra site not to give it if there are kidney issues, the vet surely will understand.

Carole x

[molly muffin]

If you want to print out the dechra insert that goes along with vetoryl, on page 8, last page, it says exactly what I wrote above, about not giving to dog with renal insufficiency.

http://www.dechra-us.com/Files/dechraUSA/downloads/Client%20Literature/Vetoryl%20Technical%20Brochure.pdf

Just so you'll have it if you need it.

Writing is good, many people are better with writing than direct speaking. Some days I am too. :) :)

hugs,
Sharlene and Molly Muffin

[Poppysmum]

That's great Sharlene-the pics of that little dog are amazing! I so much want it to work for Poppy now :-(

Do you think I should suggest to the vet that we get her kidneys working properly first before we put her back on the tablets? Or is it more complex than that?

Carole x

[molly muffin]

I think that the first thing is to see what exactly is going on with the kidneys, if in fact it is something that is interacting with the vetoryl or not. At the least what you are doing though is just expressing your concern and I think that is normal and what anyone would do.
Hang in there. :) I know I say that a lot. It is however the best we can do some days.

hugs,
Sharlene and Molly Muffin

[Poppysmum]

You're right-I am going to think positive. Hopefully we'll get this thing sorted. I'll keep you posted x

[Poppysmum]

OK ladies I've got the results you wanted to see. There are absolutely loads though so shall I only post the specific ones you asked for?

Poppy is still off the Vetoryl but the vet urged me to put her back on ASAP. I said I would but thought I'd wait and see what you all thought first.

Poppy is eating OK, the diarrhea seems to have stopped but she still shivers from time to time. The vet said her urine was OK and was (can't remember the word she said?? Something like filtering or something??) but there were white cells present which could indicate an infection.

What do you think ladies?

[Harley PoMMom]

OK ladies I've got the results you wanted to see. There are absolutely loads though so shall I only post the specific ones you asked for?

We need to see the values that are abnormal with the reference ranges and units of measurement...e.g....ALT 150 U/L (5-100)


Poppy is still off the Vetoryl but the vet urged me to put her back on ASAP. I said I would but thought I'd wait and see what you all thought first.

Our motto is to never given a dog their cushing medication when they seem to be ill or just off in a some way.

Although, ultimately this decision is for you and your vet to make.


Poppy is eating OK, the diarrhea seems to have stopped but she still shivers from time to time. The vet said her urine was OK and was (can't remember the word she said?? Something like filtering or something??) but there were white cells present which could indicate an infection.

What do you think ladies?

Elevated WBC in the urine could definitely be an UTI brewing and an urine culture and sensitivity test should be performed. Is Poppy's urine concentrated or diluted (her USG)?

[Poppysmum]

OK here goes....
BLOOD COUNT
Test result alert units range
Haemoglobin 19.8 high g/dL 12.0-18.0
Hct 0.605 high 1/L 0.380 -0.570
Red cells appear normal. No abnormal white cells seen. Small platelet clumps seen
BIOCHEMISTRY
Urea 14.9 high mmo/L 2.5 - 6.7
Creatinine 235.4 high umol/L 20.0 - 150.0
ALT (SGPT) 37deg 70.8 high U/L 5.0 - 60.0
Cholesterol 7.20 high mmol/L 3.20 -6.20
ELECTROLYTES
Sodium/Potass. 28.19 low 28.80 - 40.00
Inorganic Phos. 1.92 high mmol/L 0.80 - 1.60
ACTH Stim
Cortisol pre 1.48 nmol/L
post 3.59

I hope you can make some sense of all that !

[Harley PoMMom]

Poppy's ACTH stim results look great...kudos to you!!!

When a dog has kidney issues and Cushing's disease it sure can be a catch-22 situation as to treating the Cushing's. One question I do have is; has Poppy's creatinine, BUN, and inorganic phosphorus levels been creeping upwards or is this the first time they have become elevated since starting the Vetoryl/Trilostane?

[Spiceysmum]

Hi,
In a previous post you said Poppy's ACTH results were 148 pe and 359 post but in your last post they were 1.48 nmol/L and 3.59. I assume the last one is a mis print or they would be very low for the UK range! I can't help with the other results so I will leave that to everyone else. Hope Poppy is feeling a bit better by now.

Linda

[Harley PoMMom]

Hi,
In a previous post you said Poppy's ACTH results were 148 pe and 359 post but in your last post they were 1.48 nmol/L and 3.59. I assume the last one is a mis print or they would be very low for the UK range! I can't help with the other results so I will leave that to everyone else. Hope Poppy is feeling a bit better by now.

Linda

Linda, that was a great catch on my huge mistake, Thank you! For some reason I thought those stim results were in ug/dl. :eek:

Carole could you clarify those ACTH stim numbers you just posted...Thanks!

[Poppysmum]

Oh I'm so sorry-I did make a mistake! The figures should show 148.0 and 359.0. A big difference :(

HarleyPommom-this is from her last ACTH test that I posted in November:
"The ACTH stimulation test results are a little harder to read but the cortisol range is "suspicious for HAC"
Scan results - Scan results:
ALP 182.0 (ref range 0.00 - 130
CREA 186 0.00 - 155.00
T-CHO off scale 0.00 - 2.90-7.90
WBC 6.40 7.50 - 19.00
T-BIL 40.00 0.00 - 8.00

the only low value was
CA 2.02 2.20 - 2.80

Is that any help? The creatinine seems a lot higher to my untrained eye.

[Poppysmum]

Can anyone help? I have kept Poppy off the Vetoryl contrary to the vets wishes until I get advice from you ladies!

[addy]

did they say anything about Poppy's kidneys? Current test shows:


Creatinine 235.4 high umol/L 20.0 - 150.0





Creatinine is the most specific test for kidney disease. When creatinine is elevated above the normal range (usually around 1.6 mg/dL, or 141 µmol/L), this generally means that there is a problem with the kidneys. It does not tell you whether the problem is acute or chronic, or what the cause is, or whether it can be cured, but it is a sign that your dog is having kidney problems and action needs to be taken. ◦Early Renal Insufficiency: In general, creatinine values up to around 2.0 (177 µmol/L) are indicative of mild, or early stage, kidney disease (or early renal insufficiency, as my vet terms it). In cases like these, it may still help to make dietary modifications to reduce phosphorus, but these reductions do not need to be as drastic as when the values are higher, and it is probably not necessary to do other treatments at this stage, such as sub-q fluids (unless your dog is drinking so much that she is having trouble staying hydrated, such as getting up during the night to drink). Adding calcium to each meal if you are feeding a home made diet (to act as a phosphorus binder) would be advisable, and possibly antacids, particularly if your dog is showing any signs of inappetence or gastric problems. I would also give fish oil supplements (body oil, NOT liver oil), at the rate of 1,000 mg (300 mg combined DHA and EPA) per 10 lbs of body weight, along with Vitamin E (50, 100 or 200 IU for small, medium and large dogs), and discontinue any Vitamin A and D supplements (including cod liver oil) added to commercial foods. Additional recommended supplements include a B-complex vitamin and CoQ10, which may be beneficial for dogs with kidney disease. See the Supplements section for more info.

[Poppysmum]

No nothing. She just said her urine was concentrating (I think?) well but told me to re-start the Vetoryl. I said I'd taken her off it as apart from being worried about the other symptoms, I knew it could make the kidneys worse but she was rather non-committal.
That info you've sent is great-thanks a lot. When it says to add calcium, does that mean a calcium supplement or food containing calcium?

[Harley PoMMom]

Hi Carole,

If Poppy's creatinine was elevated only on this one chemistry panel then if this were me, I would be inclined to re-start the Vetoryl but with a lower dose of 5 mg.

Many other things besides kidney disease can cause the creatinine to become elevated even an UTI can cause elevations in the creatinine levels.

Uncontrolled excess cortisol, over a period of time, is hard on the kidneys so this is the reason I would start the Vetoryl, but like I mentioned at a lower dose. I would also have her kidney values checked every 2-3 months just to be sure that they are not climbing upwards.

Love and hugs, Lori

[Poppysmum]

Hi Lori, her creatinine was high last time she was tested (186), in November. I had read that Vetoryl could exacerbate kidney disease so thought it best to keep her off it till her kidneys were sorted out but the vet just seems to be turning a blind eye to it. She already has the smallest dose you can get over here (10mg) so I'm not sure what to do?

[Harley PoMMom]

You are correct in that Vetoryl should not be used in dogs with renal insufficiency. And when a dog has both Cushing's and kidney disease it can be a very difficult decision to treat or not to treat.

Is Poppy completely over her UTI?

[Poppysmum]

I'm not sure to be honest. I had to take a sample in on Saturday and that was when the vet said her urine was concentrating (does that sound right??) well and to put her back on the tablets. I feel like I'm going round in circles!

[Harley PoMMom]

If Poppy is concentrating her urine then that is a really great sign that her kidneys are working properly.

If this were me, I would positively want to know if the UTI is completely gone, having an urine culture and sensitivity test done will give that answer.

[Poppysmum]

OK that's great Lori, I'll get onto that tomorrow. Thanks a lot xx

[molly muffin]

Oh gosh sorry I missed most of this over the weekend. Well, her post ACTH isn't within optimal range yet, so getting that in the right spot might help out. If she isn't in any kind of dire kidney situation, and she is concentrating, then I probably would restart, once I knew the UTI is gone.
It is so tricky when you have more than one thing going on. :( Just very hard to know what to do and Poppy is very sensitive to vetoryl. Did you ask your vet if she could get compounded? And maybe try 5/5 morning and night?

hugs,
Sharlene and Molly Muffin

[Poppysmum]

No I haven't done anything really...except worry! I feel like the vet has left me a bit high and dry. There's obviously something going on with Poppy's kidneys and waterworks but it seems to have been swept under the carpet. I hate to have to change vets again but I'm not getting a feeling of confidence from the one I'm with. The vets are all really young (I hate to be ageist!) and I prefer someone with a bit of experience behind them.

[molly muffin]

I know exactly how you feel, I like a bit of experience too. I admit though that my IMS is a younger girl but she is so on top of things that I feel comfortable with her.

Just make sure that you get copies of all the labs so that you don't have to repeat any if you get a different vet or specialist. The main thing is that you need a vet (we all do) that will sit down and take the time to talk and go over things with you and explain why they think what it is that they think.

You can call and ask her about the 5/5 if they do compounding there. My vet never mentioned that to me either, just sold me 30mg, but the IMS wrote it on her report. (and that I have a copy of :) )

I know, the kidney stuff is scary and not explaining it to you is very frustrating. Did she say exactly what she Does think is going on with the kidneys?
What about just starting to print out reports from Dechra and from doctors across the web and taking them in to her. :) :) :)

Or call around and start asking, have you treated a dog with kidney problems and cushings? What was the results? How many? etc. Until you find one that gives you the answers you want! :)

Hugs,
Sharlene and Molly Muffin

[Poppysmum]

The trouble is that every time I go I see a different vet so there's no continuity. The vet who rang me last week after the ACTH test was OK and seemed pretty confident but the one on Saturday hummed and hah-ed a lot when I was asking tricky questions! I think I'll ring up, ask to speak to the OK one and say I want to deal with her in future and if they can't do that I'll move on I think. I want the best for my little darling and don't feel like I'm getting it at the moment.
I shall keep you all posted and as ever I'm truly grateful for everyone's help :)

[addy]

I know how you feel. I am having vet issues too and Zoe has possible kidney issues starting as well. Our specialist was basically ignoring it all until I asserted myself. They dont like that. So it does not always work or turn out well.

Can you call the vet and tell them you are concerned Poppy has protein in her urine and that her urea and cratinine are elevated, what does that mean for Poppy? Can you explain you are very concerned about what you think are side effects from the Vetoryl and need some clairifcation on the behavior you have seen twice now on the current dose. Ask them, if her cortisiol is still too high, what are the side effects you are seeing, twice now? Just put it out there on the table in a nice way, could that help? Maybe they could confer with Dechra. I asked mine to call and she did not want to so I called them myself and told her I did. That lit a fire under her (she did not like that one bit) so then she called Dechra too.

It is hard sometimes to know how hard we can push.

[molly muffin]

That sounds like a good plan Carole. Throw in what Addy just said and I think you have a really solid plan.
Hang in there, you are strong than you know, especially when it comes to Poppy!! :) :)

hugs,
Sharlene and Molly Muffin

[molly muffin]

yooo hoooo! :) How is Poppy doing? What's been going on? Gee, you'd think it had been a week or two, but it's only been 3 days really since we heard from you. Talk about mother henning you. :) :)
Did you put poppy back on the meds? Did the vet answer any of your questions?
Let us know when you can.

hugs,
Sharlene and Molly Muffin

[Poppysmum]

Hi Sharlene-you mustn't have time to do anything for worrying about all your little patients! I was actually going to post something yesterday but I thought I'd wait a while till there was something definite to tell you as we're still between a rock and a hard place unfortunately.
I finally got to speak to someone senior from another branch who admitted it was hard to know what to do as Poppy's not a straightforward case. She suggested that we might want to see a specialist so is making enquiries as to the cost. We would spend any amount of money if it would cure Poppy but I get the feeling we might end up spending ££££££s only for her to be "comfortable". We'll see what the vet comes up with anyway.
They have found that she's got another urine infection so I have to pick up yet more antibiotics today. She'll be on them for a week then we'll see where we go from there. She's now been off the Vetoryl for a week so the weeing has started in earnest again...which is no fun!
They mentioned another kind of medication that they don't really use any more now that kills off the Adrenals...I feel like I've read about it but I don't like the sound of it. Do you have any thoughts??
I'll post again when I know any more but at the moment we feel like we're just treading water and still don't know what to do for the best. Poppy's OK at the moment, eating and drinking well but just seems a bit down in the dumps but hopefully that's down to the urine infection.
I'll post again ASAP and fingers crossed, I might have some better news.
Hope you have a great weekend xx

[molly muffin]

:) Well, you know me. :) I manage to do a few other things in between worrying. LOL

Lysodren is what the other medicine is and I think the first thing is to still figure out what is going on with the kidneys and seeing a specialist might be worthwhile. Maybe even just a consult and then follow their plan through a general vet. I do like the sound of talking to the senior vet. Sounds better informed. One reason you want copies of all your tests is because you can take this with you to your specialist consult (if your regular vet doesn't fax the results over and they should) and it saves you money on doing any tests you have already done.
Okay I'll learn some patience. :) Have a good weekend.

hugs,
Sharlene and Molly Muffin

[Poppysmum]

Hi Sharlene-I've managed to find something else for you to worry about ;) Poppy finished her anti-biotics for her urine infection today so I took a sample in straight away. They have just called to say the infection has cleared up BUT...she has very high levels of protein in her urine and they are very concerned so are getting a specialist to ring on Monday to discuss it. I think this means kidney disease so I'm assuming that will be the end of the Vetoryl? I really don't like the sound of the other medication so don't know where that leaves us :( ?

[molly muffin]

Woman! You are going to give me heart failure. :D Just kidding.

Numbers, you want numbers, this is very important.
UPC, needs to be done if they didn't do it. You need to know what the protein level is and you want to know BUN/Createnine levels. (get these and write them down so you can tell us)
Some protein can show up in urine of dogs with cushings, but if it gets too high, then you're looking at possible kidney problems and you want to know what stage that is at. You'll be looking at trying to get control of it and if possible to reverse the amount of protein. But lets see what the test results show first.
We have a couple dogs currently on the forum dealing with the same thing.
One went Addison on Lysodren and now is dealing with the kidney issue, this will be Jasper, Tina's dog. Another one Shysie is on vetoryl and I believe that is continuing while they also keep an eye on the kidney's.

Shysie's thread: http://www.k9cushings.com/forum/showpost.php?p=96284&postcount=724

Jaspers thread: http://www.k9cushings.com/forum/showthread.php?t=4372&page=31

I think I gave the page where they were both diagnosed with the kidney problem. You can do some reading through that to learn some stuff.

Let us know how Poppy is doing. Poor little thing, doesn't need any more issues.

hugs,
Sharlene and Molly Muffin

[Poppysmum]

I will give Poppy a little ticking off for worrying you (not to mention us!

Well...that's encouraging news Sharlene. I had her more or less written off earlier today but maybe there is a bit of hope? She's still not herself, but this has gone on so long I'm not sure what is herself any more :-(
I'll read up on Shysie and Jasper's threads and will ask all the pertinent questions on Monday. And if they "forget" to ring on Monday like they've forgotten to ring about the specialists fees, that will be us moving on to yet another vet!

Carole xx

[molly muffin]

Carole! We're fighters around here. :) Just as I know you and Poppy are too. We just keep on keeping on till we can't do any more.
Yep, back to school for you! Read, read, read and I am sure that you will find tons of information on those threads. Then if you have some more questions, just ask them here. :) I can always find more threads for you too. Flynn is having some high protein after surviving, liver cancer surgerys and then a pheo adrenal tumor surgery. If that boy doesn't give someone hope I don't know what would. :) :)

hugs,
Sharlene and Molly Muffin

[Poppysmum]

You're going to think I'm mad but I'm always scared to read long posts in case the poor dog dies!
OK that's my head down reading for the rest of the day :-) x

[molly muffin]

That's okay Carole, we do understand. *hugs*
The two threads I gave you are still doing fine, and they are in the same situation that you are, although they have both gone through the testing and are now in stabilizing phase.
Flynn to by the way is doing fine, just another bump on this hilly road. :)

hugs,Sharlene

[Harley PoMMom]

Elevated protein loss in the urine does not always mean kidney disease and certainly not a death sentence for a dog. Many, many other things can cause protein loss besides kidney disease. And there are many ways to treat the protein loss if it stays elevated.

A dog should have 3 high UPC's in a row before any treatment is started.

Love and hugs,
Lori

[addy]

I think this means kidney disease so I'm assuming that will be the end of the Vetoryl? I really don't like the sound of the other medication so don't know where that leaves us


Originally Posted by addy

If Zoe has kidney disease I thought I could not give Vetoryl. Am I wrong in that thinking?
When a dog has kidney issues, I believe Vetoryl needs to be used with caution...having a renal panel done regularly etc...

I dont know that you ever received an answer to your original question. I have the exact same question as it has always been my understanding that dogs with kidney disease could not be treated with Trilostane/Vetoryl.

That said, I am still in the diagnostic stage, as you are, not sure if Zoe's protein loss is coming from her kidneys or her inflammatory bowel disease or her Cushings.

So take it one step at a time with a specialist. Zoe was throwing protein in her urine but all her blood work was normal. I insisted on a retest with UPC, the retest showed she was still throwing protein and her UPC was under 2.0 so we are in the wait and retest stage. This week she will have a sterile urine draw with a repeat UA and UPC.

Here is a link

http://iris-kidney.com/

I too remain concerned as to what point will I have to discontinue the Vetoryl. Flynn and Jasper are being treated for for kidney issues, Flynn's could be coming from high blood pressure and I believe Jasper has been diagnosed (I could be wrong on that) but neither dog is currently on Trilostane/Vetoryl.

I dont mean to get you down or sound negative, just want you to have information.

[Poppysmum]

Hi everyone-the vet has just rung me with the latest. She's spoken with the drug company who have confirmed the shaking etc can happen and they've logged it as an adverse reaction. They also said they could provide a 5mg tablet, which sounded like good news to me but the vet said that the 10mg was not over-controlling the Cushing's so sadly it's not the answer.
She's spoken to a specialist in Edinburgh who is going to look at Poppy's case and give her an opinion in a couple of days so we're going to wait and review the situation then. Fingers crossed this specialist pulls something out of the bag!

Meanwhile....I've been googling Adrenal Adaptogens which are herbs that allegedly help the adrenals so I am just wondering if anyone has any thoughts or experience of them? I don't mean as an alternative to Vetoryl more just to see if it will help Poppy.

Addy, Poppy isn't on Vetoryl at the moment. I took her off it a little while ago when I first thought she might have probs with her kidneys but to be honest I don't know if I did the right thing or not! It's a hard slog trying to do the best for your darlings isn't it?

[molly muffin]

It will be interesting to see what the specialist in Edinburgh has to say. Doing the work thing here, so not a lot of time to answer, but I think this is a good thing to get a Specialist involved. I understand that isn't the easiest thing to do in the UK.

You're doing good!!! Don't try to second guess, we adapt as the situation changes. What else can we do. :)
As long as every step we take is a positive one and helps to figure out what is going on, it's good. If something changes that looks like an immediate change is needed, then you just change as needed. Nothing like feeling like you are on a shaky bike. :)

hugs,
Sharlene and Molly Muffin

[Poppysmum]

Ha! A shaky bike...love it!
Poppy just seems to be treading water at the moment, she doesn't seem any better or any worse. Getting up thru the night to go for wees is the worst bit, for us at least.
Hopefully the specialist will come up with something.

Carole x

[molly muffin]

Hi Carole,

Mel posted this on another of our UK member threads, and I thought you might want it just in case too. I know your vet is consulting with the Edinburgh specialist, but it never hurts to have a back up plan.

http://www.amcreferrals.com/0-intro.html

Looks like they are in both Manchester and Thurnscoe

hugs,
Sharlene and Molly Muffin

[Mel-Tia]

Edinburgh to Manchester is a bit of a mission

However there seems to be a great place in Edinburgh

http://www.ed.ac.uk/schools-departments/vet/services/small-animals/vets/services/internal-medicine/staff/overview

Midlothian - EH25 9RG. 0131 650 7650

Mel
Xxxx

My Nanny was from bonnie Scotland so I have a fondness for the accent and place. She was born in the isle of mull

[Poppysmum]

We live in Newcastle which is only about an hour from the Scottish borders so Edinburgh is probably closest for us but it's still good to know about the Manchester place just in case as it's not all that much further, but in the opposite direction.
It will be a bit a bit of a nightmare either way as Poppy's not keen on travelling so I think we'd have to get her sedated or something or else she'd pant herself to death by the time we got there!

[Mel-Tia]

Working now but I will see what I can find in Newcastle later. Wouldn't want your little one to be distressed unncessarily

Mel
Xxxx

[Poppysmum]

That's fantastic Mel-thanks a lot :) x

[Poppysmum]

Here I am again!
Heard from Mari the vet today. She thinks the kidney problems are "pre renal"- and that as Poppy's urine is concentrating well the problems with the urea and creatinine may just stem from her being dehydrated. She spoke to the specialists who have said that the shaking and inappetance are rare side effects. They suggested the 5mg dosage again so Mari pointed out that the 10mg wasn't overcontrolling the Cushing's, so may be pointless. They've said that perhaps with Poppy it may never be fully controlled but at least the urination/drinking problems may get sorted out at least.
It seems like it's worth a try but I told my husband I want to hear from you lovely ladies before I make any decisions!! :) x

[Mel-Tia]

http://www.croftreferrals.co.uk/locations-contacts

NE23 7RH -0191 250 3800

Have a good setup there, internal medicine specialist plus others

Mel
Xxxx

[molly muffin]

Mel you are a genius!
So I was just looking at this place you found, Croft Vets. One of their specialist interests is hyperadrenocorticism. I think it might be the first time I've read a description like this, "advice on the diagnosis and management of this fascinating condition".:D:D:D
I admit to calling it many things, but fascinating was one of them. I can see how a vet might thing that though. :p
Sounds like it might be worth looking into if your other specialist can't come up with something.

hugs,
Sharlene and Molly Muffin

[Mel-Tia]

Genius is a bit strong, good with google :D

Fascinating isn't a word I have used either. The way the endocrine system works is, but it all hurts my head after a while ;)

Someone researching in it would be an advantage in my opinion.

Mel
Xxxx

[Harley PoMMom]

Scan report:
"Adrenal hyperplasia is suggestive of hyperadrenocorticism...the pancreas is markedly diffusely hyperechoic and this may reflect fatty infiltration or chronic pancreatitis
Liver:abnormal moderate hepatomegaly
Left adrenal: Abnormal 8mm diameter, prominent, hypoechoic
Right adrenal: abnormal as above
Pancreas: Abnormal: marked diffuse hyperechogenicity
Everything else was normal.



In your post, here, the ultrasound found that the pancreas was abnormal, has the vet determined if Poppy does have pancreatitis?

Pancreatitis, if left untreated, can create a host of health issues such as kidney problems and diabetes plus it can be very painful. If this were me, I would have a spec cPL test done to confirm whether Poppy does or does not have pancreatitis.

[Poppysmum]

My head is buzzing!
I can't believe you found a specialist so near to us Mel-well done you! The only problem is we have a bit of "history" with Croft (although a different branch) so they aren't our vets of choice. That said, I would definitely consider them if they could come up with a better solution - but as the only solution seems to be Vetoryl I'm not sure what else they could do? Or am I being naive? (Or stupid?!) I really don't know what to do but I think we may as well try the 5mg as the people in Edinburgh have suggested, and see what happens then if she still can't tolerate it we'll see what the vet at Crofts can come up with. Does that sound like a good plan do you think?

Lori, when I ring today I will query the possible Pancreatitis as this seems to have been swept under the carpet-thanks for pointing it out.

Once again, many thanks to you all for your kindness and concern. You really are lovely people xx

[Squirt's Mom]

It is very important that the pancreas question be cleared up BEFORE starting the treatment. If she is having pancreas attacks, that could easily skew the Cushing's test results, causing false positives so you want to be absolutely sure the pancreas is not causing her cortisol to be elevated. The cortisol will elevate when any stress is present - including conditions like pancreatitis. ;)

[Mel-Tia]

Hey there

Glad to help

Did you speak to the vet re the pancreatitis?

Croft may consider prescribing lydrosen, my vet wouldn't entertain it but another might

I do think you might be a way from that yet, the girls are more knowledgable than me on the test side of things so I would listen to their suggestions before starting any medicine again

Mel
Xxxxxxx

[Poppysmum]

I wasn't able to ring today so will ring 1st thing in the morning. I'm a bit perturbed that they've never mentioned Poppy's Pancreas :-(

Mel, the vet mentioned the other type of medication yesterday but said they wouldn't advise it for Poppy and to be honest I really don't think I would be happy if she was on it-it seems far too harsh.

Hopefully I'll have more news tomorrow xx

[Mel-Tia]

I know, it can be very frustrating at times, most times really as your usually anxious for results or waiting on a call. You certainly learn to be persistent.

Lots of Cush parents on here use the other medicine successfully, I know it's scary sounding but it can be an option.

One step at a time

Big hug

Mel
Xxxxx

[Poppysmum]

Well! The vet admitted she'd missed the possible Pancreatitis on Poppy's notes. Not very good is it? I have to take her in next week-they are going to test her levels, feed her a fatty meal then test again. Does that sound right? They are also testing her liver at the same time xx

[Squirt's Mom]

No it does not sound right to me at all and I would be making an appointment with another vet right this minute - an IMS (Internal Medicine Specialist) if possible. Poppy has been in distress for some time, your vet ignored your reports of her behavior, missed a vital part of the testing, and is now telling you to wait a week? No. She needs to be checked out thoroughly NOW. Chronic, or ignored, pancreatitis can be very bad.

Did the vet tell you anything about feeding schedule (small, frequent meals), or what to feed (LOW fat), or tell you any warning signs (vomiting, diarrhea, walking hunched)....did they tell you anything other than wait?

Just me - but I would be doing whatever it took to get someone to look at my baby and probably not the vet I just took her to. ;) I'm sure others will have their views to add as well but this is mine.

Hugs,
Leslie and the gang

[Mel-Tia]

I am with Leslie. Fat aggravates it, I don't like the idea of them feeding her a fatty meal.

Tia had the spec test (i think thats what she is suggesting) and she just had blood drawn the next day after I thought she had an episode

Can't believe they missed it, what's wrong with these people. It's not even the money we pay them but it's the fact your little girl has been affected. I am furious for you

Big hug

Mel
Xxxx

[Spiceysmum]

Hi,
The feeding of a fatty meal sounds more like the bile acid test that Spicey had before she was diagnosed with cushings but I don't know if they do the same for the pancreatitis test too.
Linda

[Poppysmum]

To be fair, the original ACTH results that Lori posted had been taken at the original vets where she was diagnosed. Mari, the current vet, did have them but said they'd been filed away. She was very apologetic and rather than being a bit "sniffy" about me trying to tell her her job I think she was really rather grateful. I have looked at the symptoms for Pancreatitis before and Poppy doesn't really seem to be displaying very many so I've never been unduly worried but if it can skew results of the ACTH test (I think she's already had about 4!!!) I think someone really should have considered it. Apart from the fact that poor Poppy has been struggling on for months, getting no better, we may have wasted a considerable sum of money (Poppy's not insured :( ) on ACTH tests where the readings aren't true.

[Poppysmum]

Hubby and I have just been talking and have decided we are going to take her to the Croft referral place that Mel found. We owe it to our lovely girl-she's been out of sorts for ages and we are several hundreds of pounds out of pocket without being any further forward.
We are going to ring first thing in the morning and take it from there...fingers crossed that since it's the 3rd vet we've seen re the Cushings it might be 3rd time lucky :)

[Harley PoMMom]

A 12 hour fast is needed for the spec cPL test (pancreas test) to have accurate results.

My boy, Harley, had pancreatits but never showed any symptoms of it, in fact it was first diagnosed via an ultrasound and later confirmed with the spec cPL test with his results being in the 500's (reference range for the spec cPL test 0-200) :eek::eek:

I'll be anxious to hear what the Croft referral place vet has to say, please do keep us updated.

Love and hugs,
Lori

[Mel-Tia]

I am hoping they can give you some insight from the info you already have and that they won't ask your girlie to have any more tests unless they think it's necessary.

I am so disappointed in your other vets, whenever you are stuck with any issue you review your information so even common sense was lacking in this instance

One point to note, you may need to be referred there. If you explain what has happened and why you are calling they might just see you but you may need Mari to refer you, that usually is chargeable but I would say you expect that for nothing considering

Good luck, keep us posted

Mel
Xxxxx

[Poppysmum]

I will feel really guilty if she does have it as a few of you have been mentioning it throughout and I haven't really done anything about it :( ...then again I'm not a vet and am paying good money for someone to sort this out for me and up to now they are failing miserably! The only people showing any care, concern and knowledge are you fab ladies! xx

[Poppysmum]

I've checked on the website Mel and you can be referred or just go there yourself for a second opinion. I think it's going to fairly pricey anyway but at least we might get something for our money this time!:) They suggest telling your own vet that you're going to go for a 2nd opinion...so that might shake things up a bit!

[Mel-Tia]

We don't do guilt here. You said it yourself they are the professionals

That's good re the referral. Take everything you have. If you don't have it all get the rest from Mari as it could save you some money

[Poppysmum]

Cheers Mel! It's true though...you don't expect to pay money and sort out the problems yourself do you?

[Mel-Tia]

No, I got very frustrated with our vets. Drove me batty at times :D

I looked at it like this. Our vets are like gp's, general practitioner. Jack of all trades master of none...

Something like cushings needs a specialist and our vets do not seem to be very knowledgable despite the fact it would appear (at least to me) it's on the increase

Your girl may not even have it, so hopefully the IMS will rule it in or out but mostly figure out what is going on so you can take the right action for sweet Poppy. They are educated to a higher level so I hope the pieces you have already will give them the answer

Big hug

Mel
Xxxxxx

Ps our consult was about £300 initially without tests, that's why I'm saying take as much info of what you have already done as doing procedures there will probably be double what you would normally pay. Ours made you pay on the day

[Poppysmum]

You're a woman after my own heart Mel. I'm always sorting out my own health problems on the net rather than going to my GP. If it doesn't end up in them doling out drugs to you they're not interested :( I have been humming and ha-ing over going to a specialist myself for ages but keep putting off but when it's Poppy it's no expense spared!

[molly muffin]

I would tell Mari what you are planning to do and tell her why, that you heard they had a cushings specialist there and you can eve give her the website to look at. That you want to make sure that you have all the copies of any testing and see what they think.
I was a bit nervous when I had to go in and do the request for a referral to an IMS from my vet, but you know you do what you have to do. They can't do it for themselves.
Hugs,
Sharlene and Molly Muffin

[Mel-Tia]

Thinking of you all this morning

Hope that call is a successful one. Will be waiting for news

Mel
Xxxxx

[Poppysmum]

It was all quite painless! We've got an appointment for Tuesday morning. The receptionist said they'd contact my other vet to get details of tests etc so I rang them out of courtesy. Didn't get to speak to Mari just a receptionist but I feel I've done my bit. She'll know why I'm doing it after speaking to her yesterday so I don't feel guilty at all.
I'll post again on Tuesday...with good news (I'm thinking positive!) xx

[Mel-Tia]

Awesome. We could all do with good news

Fingers crossed.

Mel
Xxxxx

[molly muffin]

Thinking positive thoughts here too.

Mention to Crofts, both the pancreas and the kidney issues so as to make sure they are starting out looking at the big picture.

Have a great weekend. :)
hugs,
Sharlene and Molly Muffin

[Mel-Tia]

So it's Tuesday afternoon now, how did you get on?

Mel
Xxx

[Poppysmum]

I was really pleased we went-thanks again for finding the place for me Mel :-) I didn't ever think I'd be going back to Crofts but it was really good and in fact was cheaper than going to our normal vet who was going to run yet another test (for something that should have already been done) costing another £100.
The vet at Crofts as you know specialises in hyperadrenocorticism and said that it wasn't written in stone that you have to treat Cushing's. She said Poppy's life expectancy would be more or less the same, and that some dogs got along just as well without the Vetoryl-which was a surprise as vets normally (in my experience anyway) try to wring as much money out of you as possible!
She suggested giving the 10mg tablet on alternate days with just enough food to get it down so it's not absorbed as well, which is a pretty good idea and at least it means we can use the ones we've got rather than fork out for 5mg ones which still mightn't suit Poppy. So we'll give it a go but if it doesn't work this time we will have to call it a day. I think she'd be just as happy just toddling along as she is.
As far as the pancreas goes, she didn't think there was any cause for alarm. She said it can make Cushing's more difficult to control but also said that something like 75% of older dogs have it.
So...I'll report back in a few days and hopefully I won't have a shaking, anorexic girlie again! x

[addy]

My Zoe just had an ultra sound that the IMS said showed "evidence of past pancreatitis". I asked her what the heck that meant is it chronic and she said no:confused: they see it all the time in Cushings dogs. Yet Zoe's ultra sound report does say "changes in the region of the right upper quadrant/pancreas that would be consistent with pancreatitis". Our IMS dismissed it as something they see all the time.:confused:

I did find this in an article written by Mary Strauss for Whole Dog Journal


Chronic pancreatitis refers to a continuing, smoldering, low-grade inflammation of the pancreas. Symptoms such as vomiting and discomfort after eating may occur intermittently, sometimes accompanied by depression, loss of appetite, and weight loss. In some cases, signs may be as subtle and nonspecific as a dog not wanting to play normally, being a picky eater, or skipping a meal from time to time. Chronic pancreatitis may periodically flare up, resulting in acute pancreatitis.
Dogs with chronic pancreatitis often respond favorably to a low-fat diet. Pain medication can be helpful in relieving the symptoms of chronic pancreatitis and may speed recovery.

Chronic pancreatitis is often subclinical and may be more common than is generally realized, with symptoms blamed on other diseases. It may also occur concurrently with conditions such as IBD (inflammatory bowel disease) and diabetes mellitus.

So maybe our IMS means in Zoe's case since she is not showing any of the symptoms that hers is sub clinical but I really cant explain it.:o

We have had more than a few vets now suggest dosing with Vetoryl every other day. It peaks after just a few hours and then starts to leave the body fairly quickly. I just never understand how it can be of any benefit nor how someone would do an ACTH test either.:confused:

[Poppysmum]

Hi Addy, that's more or less the gist of what the vet said to me too. Poppy doesn't have any massive symptoms but has some of those you mention, like being a picky eater and missing meals now and again.
I'm going to give the alternate day dosage a try and see how she goes, but as I say it's a last ditch attempt and after that we'll just have to give up. I don't feel so bad about that now after speaking to the vet so we'll just continue to give her the best life possible for as long as she's got left...and pray it's a loooooong time :)

[addy]

me too, sweetie, praying for a long time for Poppy too.

[molly muffin]

Hi Carole,
Did the vet say why she thought the every other day dose would do anything? I'm just wondering if she explained her thinking. We've heard vets prescribe that before, but to me it doesn't make sense, as you are dropping their cortisol one day and letting it spike back up the next and so on and so on. Dechra the maker of the drug has never recommended very other day dosing and I haven't seen ay studies that support that, so if by any chance the IMS explained the thinking to you, we'd love to know any details.
I would have thought 5mg a day would have been more optimal to try and help out.
Did the IMS say anything about the kidney values from the test? What did she think about that too.
I know I have tons of questions. :) Every visit to an IMS or vet can be a learning experience for all of us, so we are like a sponge for information.
I hope Poppy is doing well and hope that there are some improvements seen. I know it worries you to no end.
hugs,
Sharlene and Molly Muffin

[Mel-Tia]

That's interesting and not something I have heard of before. She is training in it mind and is the specialist, I would be curious to here the justification for every other day dosing.

I am pleased it was a pleasant experience for you all and they didn't rip you off. You sound a lot happier with the proposed plan, so I say see how it goes and keep in touch with the IMS (and us!!) if you are concerned

Big hug

Mel
Xxxxx

[Poppysmum]

I'm hopeless...she did explain why but I was taking in so much info (apparently Poppy has done her cruciate ligament in as well but the excess cortisol is masking it so if she does OK with the vetoryl the pain may start up and she will have to have it operated on) that I can't remember the exact details of what she said :-( I'll ask hubby when he comes in because he's cleverer than me!

[molly muffin]

Oh no poor Poppy. Leg problems too. Maybe it helps her to have her cortisol a bit higher then. Did she talk about the kidney issue?

hugs,
Sharlene and Molly Muffin

[Poppysmum]

Yes she mentioned Poppy's kidneys in conjunction with the pancreas but didn't seem hugely bothered about either to be honest.
We still haven't given Poppy a Vetoryl yet-we keep forgetting as she's in quite a fine fettle at the moment. I was stunned about the cruciate ligament thing as last time she was hopping around on three legs! That Cortisol must be good stuff!

[Poppysmum]

Just a little update-we still haven't given Poppy any tablets. I think we have unconsciously made the decision not to medicate as she's certainly happier off the medication than on it.
Of course, this means she's more prone to a number of horrible things and I was wondering if anyone knows of any supplements that would help her? Thanks xx

[molly muffin]

Hi Carole, well, I give Molly something called hepato support which is a SamE/Milk thistle supplement for her liver, which I get from the vet. I'm sure they have something similar in the UK. I also give the glucosomine supplement for joints. That's all she is currently taking.
I'm sure some of the others will have some good idea for additional supplements.
Oh, here is a thread on one of our other members who made a list of the supplements she is trying with her baby:
http://www.k9cushings.com/forum/showthread.php?t=4509&page=23

hugs,
Sharlene and Molly Muffin

[Poppysmum]

Thanks Sharlene, that's brilliant. I've given her milk thistle before (not sure what SamE means??) so will start that again and will definitely look into the other things too. Before I found this lovely site I had found a doggie herbalist online who had a formula for Cushing's dogs. Not intended to cure but to support but someone on another site put me off, saying it wouldn't help but you nice people are more kind and positive, so I think I'll see if I can find that again too.

Carole xx

[molly muffin]

You do have to be aware of some of the online sites, that we've actually actively looked into ourselves to see if they offer any help for cushings dogs. We leave no stone unturned. Some of them actually have ingredients that are counterproductive for cushings dogs. So, let us know any that you are thinking of looking into. We know that cushex, sugarplum, I think are two that have been debunked.
Some of the others are familiar with specific ingredients and can tell you why we don't recommend them.
You can be assured though, that if EVER we find anything at all, that does help, we would be the very first to recommend it.
You can talk to a nutritionist, about specific diets that might be tailored to help Poppy. We have one member who has gone that route with success so far. That is ConcernedMom.
We have members using acupuncture for the legs to help with arthritic issues. So there are some options since you aren't going to be treating with any of the cushing meds right now.

hugs,
Sharlene and Molly Muffin

[Poppysmum]

I was directed to her site by someone on another forum and this person said the herbalist was very helpful so I've emailed her to see what the stuff contains so will report back. She does seem kosher-she's not making huge, extravagant claims like Cushex etc so I hope her potion is OK xx

[molly muffin]

That is great Carole. As I said, we always want to know anything that is being offered that might be helpful. If we find out it is truly of help, then we would not hesitate to recommend it to others too. We just are always a bit cautious.
We have had many members working with nutritionists. Some of the vet clinics have nutritionists on staff too, so that has been helpful.

hugs,
Sharlene and Molly Muffin

[Poppysmum]

I'll report back as soon as she replies, Sharlene. I know one of the main ingredients is Milk Thistle so I suppose that's a good start :-)

[Squirt's Mom]

Who is the herbalist you are talking with? What is she recommending?

[Poppysmum]

http://thedogherbalist.co.uk/shop-online.php#!/~/product/category=4322624&id=13468471

I'm still waiting for a reply-hopefully you'll all be able to give your verdict then :)

As I said earlier she's not making wild claims and is not saying it will cure Cushing's (if only!) so hopefully it will be OK.

[Mel-Tia]

Hey there

Just wondering how you both are?

Big hug

Mel
Xxxx

[Poppysmum]

Hi Mel - we are fine thanks :-) Poppy is muddling along quite well so fingers crossed we made the right decision in not giving her the Vetoryl. I have emailed the dog herbalist twice to ask what the ingredients are in the cushings formula but she hasn't replied. I don't know whether to just go ahead and buy some...it might not do any good but it can't do any harm surely? xx

[Mel-Tia]

Hmmm would make me suspicious if she didn't mail back. I would want to know exactly what was in it before giving it to her. Good to hear she is muddling along and doing ok. Hope it's the same for you :)

Keep us posted

Mel
Xxxxxx

[Poppysmum]

The funny thing is I emailed her ages ago, before I found this forum and she replied to me then with the ingredients but I've since deleted it. I'm not really suspicious as she seemed like a nice lady, just curious as to why she's not replying? Might give it another go I think. xx

[Mel-Tia]

I would, herbs can be powerful. Leslie knows quite a bit so post when you know and I am sure she will cast her eye for you

Just want to make sure it doesn't cause Poppy any issues

Big hug

Mel
Xxxxxx

[Poppysmum]

I will do Mel-thanks a lot xxx

[molly muffin]

Hi ya! So, poppy is doing alright then? That's good. Maybe just mention in next email that she Had sent you a list of the ingredients and you accidently deleted it without saving the ingredient list and you are looking to start it now. That you had to go through some testing first. See if a possible sale will encourage her to write back. :)

Hope you are having a good weekend. :)
hugs,
Sharlene and Molly Muffin

[Poppysmum]

Hi Sharlene :-) Yes Poppy is doing OK. The only problem is having to get up during the night to let her have wee wees! I'm constantly shattered, but it's a small price to pay to still have her with us. I don't know if I mentioned it but the specialist said she thought the shaking might have been the pain in her legs kicking in, whereas she doesn't seem to be in any pain at the moment and scoots around quite well. I just hope this stuff (if I ever get it!!) will do her some good. xx

[molly muffin]

Oh I hope it will help her too. That makes sense about the back leg pain, especially if you aren't seeing that now.
Hugs,
Sharlene and Molly Muffin

[Poppysmum]

Whoohoo! I have finally had a reply! The herbalist says the Cushings remedy cleanses and tonics the adrenal glands, thyroid glands and is an excellent blood cleanser, building and boosting the immune system.
Ingredients in The Dog Herbalist Herbal Formula, for Cushings Disease
Dandelion.
Burdock.
Nettle.
Echinacea.
Astragulas
Ginsing.
Rosehips.
Kelp.
Milk Thistle.
Ginger.

What do you think lovely ladies? :-) xx

[Squirt's Mom]

I wouldn't have a problem trying it other than the dandelion. Dandelion is a diuretic so it can cause them to pee more. The other ingredients are fine as far as I know. I have used Burdock, Astragalus, Ginger, Kelp, Milk Thistle and Nettle with Squirt.

[Poppysmum]

That's the LAST thing I need!! I may as well stay up all night if she's going to wee any more than she does! I'll drop her a line and see what she says...I suppose there must be a reason for the Dandelion but goodness knows what it is?

[Squirt's Mom]

I would ask if she is using the flower, leaf, root or combination. That will tell more about what to expect from Dandelion as each part of the plant has different affinities, as is common with herbs. ;) The leaf and root of Dandelion have the strongest diuretic actions.

[Squirt's Mom]

Here is a good link with info on Dandelion - http://theanimalherbalist.com/?page_id=129

[Poppysmum]

Hell again :-) She's said the dandelion has been added to detoxify and cleanse the blood and kidneys, but she's said she'll make some of the formula up without the dandelion for me. Sounds good to me...but what do you all think? xx

[Squirt's Mom]

I would try it without the Dandelion. Just be sure not to try or change more than this one product until you see how Poppy reacts. ;)

[molly muffin]

Yep, try it without and see how that works for her. Hoping for good results! Nice of her to offer to make some up without the Dandelion in it.

good luck
Sharlene and Molly Muffin

[Mel-Tia]

Hey there

Did you get your new mixture, how you both doing?

Hope your ok and little Poppy is doing good

Big hug

Mel
Xxxx

[Poppysmum]

Hi everyone! Sorry I haven't posted in a while but I wanted to give the herbal stuff a good chance to work its magic before I reported back and to be honest I'm still not sure :confused: There hasn't been a dramatic improvement but neither does she seem to have gone downhill. She's just muddling along in her own little way so that's good news I suppose. She used to hate walking but I make a point of taking her in the woods
with my other little one now and she just about jogs through the woods so all in all I have to say she seems much better being without the medication.
Hope all of your girls and boys are doing great xx

[molly muffin]

Hi. :)

I'm so glad to hear that Poppy is holding her own and at least seems to be feeling better without the medication.

Hope you are doing good too.

hugs,
Sharlene and Molly Muffin

[Poppysmum]

I don't know if I'm asking a question or just getting this off my chest but you have all been so kind and helpful in the past I thought I would let you all know what's happened.
Poppy was diagnosed approx March this year. Because she suffered horrible side effects on Vetoryl we took her to a specialist who said that we didn't have to medicate if we didn't want to-her life expectancy would be the same. So we decided to just let her live the rest of her life as comfortably as we could make it and she has been coping ok.
To cut a long story short, my husband took her to vet last Monday (18th) and she was prescribed two different tablets - one of which was prednisolone. The vet clearly had not read her notes and did not recognise the many visible symptoms Poppy has. I will torment myself for the rest of my life that I didn't ask what the tablets were and just relied on my husband to make sure she took them. I know prednisolone is a steroid so could have saved her.
I took her back on Monday and our usual vet realised the horrific mistake that had been made but also was shocked that she wasn't on Vetoryl and said if she didn't take it she would die, and suggested we put her on 10mg straight away. I already had some left from last time and said I'd split the capsule and put it into a fresh capsule case so the dose wasn't too high but the vet said we mustn't do that but can't explain why. Does anyone know? We are at our wits end as Poppy is really poorly. She won't eat and is just not relating to us at all. She seems to be in pain and we have both broken our hearts over her tonight. I guess I am just wanting a miracle for my beautiful girl, but if anyone has any suggestions please let me know xx

Please Note: I wanted to let you know that I have merged your post into Poppy's original thread.

[Harley PoMMom]

What health issues does Poppy have? What symptoms is she displaying? When you mention that you believe she is in pain, exactly where do you think the pain is located? Have a CBC and/or Chemistry panel been done recently? If so, could your post any abnormal results?

[Poppysmum]

She has a blocked salivary gland and the swelling was very sore-looking which is why we took her to the vet. Tonight, she has been whimpering a little and shivering (she often shivers anyway) and her eyes are sort of half closed and she's not really reacting to us, if you know what I mean? The vet was quite insistent on her starting the Vetoryl again and I would definitely give it another chance if it will help Poppy but I really would like to try half a 10mg tablet, but have been told we can't do that x

[Poppysmum]

She's had no further tests since going off the Vetoryl x

[Harley PoMMom]

She has a blocked salivary gland and the swelling was very sore-looking which is why we took her to the vet. Tonight, she has been whimpering a little and shivering (she often shivers anyway) and her eyes are sort of half closed and she's not really reacting to us, if you know what I mean?

What has the vet recommended to unblock the salivary gland? Is she on any pain medication? Has the swelling gone down? Is the area hot to the touch?



The vet was quite insistent on her starting the Vetoryl again and I would definitely give it another chance if it will help Poppy but I really would like to try half a 10mg tablet, but have been told we can't do that x

Putting her back on Vetoryl could be a good idea but I would not do this until she is acting more like herself.

[Poppysmum]

The vet has said from a professional point of view she'd love to operate as it would be interesting but she doesn't feel it's fair on Poppy given her age and condition. She's not on any pain meds and no, the swelling hasn't gone down and it's not hot to the touch. x

[Harley PoMMom]

Is there a way that the vet could drain it? I, also, would ask the vet about giving Poppy some pain meds.

[molly muffin]

oh my gosh!!! Poor Poppy baby. :(
Okay so it is probably the saliva gland blockage that is bothering her. It sounds like it might be infected to be causing her to act so poorly. That is just a guess. Did they do any kind of blood work on her? Do they have any other options to unblock the gland, such as Lori asked about maybe? draining.

The steroid will leave her body, you didn't give it to her for very long right?

The reason you can't open the capsule is that it is a very strong strong, that can be dangerous outside of it's containment capsule. If you want to have it split, then take them to a pharmacy that is able to do compounding and ask them to split the capsules. That is safer.
I know you are beating yourself up, but that won't do any good. Things happen and we adjust and carry on and try to fix it. I'm hoping that your vet perhaps will be able to fix this. Also, we know that Poppy doesn't react well to high doses of vetroyl if I remember right. They do have compounding pharmacies in the UK, so that is an option and your vet could send in a prescription for it if that is what you want to do. I think though that getting the gland taken care of, having a cbc and a urinalysis to see how she is doing is in order now.

Hang in there! I'm happy to hear from you again, but sure wish it was under better circumstances and that Poppy was doing better.

hugs,
Sharlene and Molly Muffin

[doxiesrock912]

Our dachshund, Daisy Mae also has a salivary mucocele which is swollen.
They can get infected and it sounds like Poppy's has. Shaking is often a sign that they're in pain.

Can you get her to an internal medicine specialist who might be more competent with Poppy's multiple health issues?

Daisy's hasn't shown signs of infection and they don't want to operate until her Cushing's is controlled because Cushing's hinders the healing process.

I would seek another opinion right away.

As far as opening the Vetoryl capsule, this is powerful stuff and they strongly advise you not to come in contact with it and to wash your hands after handling the capsules. Also, there is no way to guarantee that splitting the capsule will make the dose even. Please do not do this. Many of us use Diamondback Pharmacy for pet medication and our IMS used them when she lived in California so they're reputable and not overly expensive.

Final note, any infection can skew test results so testing for Cushing's if Poppy has an infection right now would be a waste of time. Please resolve the infection first. Sometimes they can drain the mucocele, but if the saliva is really thick they can't and it will come back regardless.

Please keep us posted, we'll be hoping that Poppy perks up soon.

[Poppysmum]

Hi Sharlene, how are things with you?

Poppy's had the blocked salivary gland for a while now so I really don't think that's what's bothering her. The skin looks sore though and she's got a bit of an infection on her lip which is the reason the half-wit vet gave her antibiotics and steroids. We really feared the worst last night but she's made it through, thank God. We have recently started using our old vet again (the one who overprescribed her originally) and she was shocked to see how much Poppy had gone downhill and when she said she must have Vetoryl or she'll die, it scared me to death.
She is going to ring the drug company re Vetoryl to see what we can do about getting her a lower dose and is supposed to be ringing me tomorrow but Poppy wouldn't eat a thing yesterday so if that continues today we will have to take her back. It's her birthday on Monday so I just pray she pulls round :-( x

[goldengirl88]

Praying for you and your dear Poppy. Blessings
Patti

[Squirt's Mom]

I am so sorry Poppy is doing poorly. :(

You keep using the term "tablet" when referring to Vetoryl....do you have tablets or capsules? If you have tablets, I see no reason whatsoever you couldn't cut them in half however, you are never supposed to open the capsules and divide. To get a smaller dose or any dose that Dechra does not make, you can have the dose compounded someplace like Diamondback Drugs out of Arizona. They are reputable and many folk here use them.

HOWEVER, I don't know that I would start treatment with anything until she was feeling more like her old self and certainly not until she was eating better. Did anyone run any labs and if so what were the abnormal results? Liver and kidneys ok?

Let us know how she's doing!
Hugs,
Leslie and the gang

[Poppysmum]

Hi everyone, we have had Poppy back to the vets as she's not had a thing to eat yesterday or today. The vet said there is something to stimulate the appetite but she didn't want to give it without knowing what was going on with her liver/kidneys etc. She has taken blood and is hoping to get the results back tomorrow so that might give us more of an idea what's going on.

I'm absolutely furious that we are now having to pay a lot of money to fix what an incompetent idiot has caused and am writing a letter of complaint. I would pay any amount of money to get Poppy well but the way things are looking we could have just paid out a large sum of money for nothing as she seems very poorly indeed.

We have been told the salivary gland cannot be drained and the vet has said that the swelling is the least of her problems at the moment. As far as having a chemist make a lower dose, we are actually in the UK so if it does come to that I will have to scout around to find one here.

Many thanks to you all for your kind words-you really are lovely people on here xx

[goldengirl88]

I think DiamondBack does ship out of the country. Did they say why they cannot drain the mucocele? I have had it with incompetent vets also. You learn a lot during the disease process, some good, some really bad. I have learned that my Tipper is a cash cow for my vet so I virtually pay not attention to things he suggests. I prefer to get my answers on here where you know the people know what they are talking about instead of wanting money. Hope all goes well and your baby gets better. Blessings
Patti

[Poppysmum]

Thanks a lot Goldengirl :-) Every time you make an appointment at the vets you know you're going to come out ££££££££s lighter!

The reckon they can't drain it because rather than it being one big thing, it's lots of little ones so they'd have to take fluid from loads of places. Does that make sense? x

[doxiesrock912]

That makes no sense to me. I've always understood a mucocele to be one large pocket of fluid. There is a risk of infection associated with draining.
Can you find a more competent vet?
Or a specialist?

[Poppysmum]

We are at the vets again at 4pm so I will ask again as the one we see now isn't the one who said it couldn't be drained. However, I don't really think this is Poppy's problem at the moment as she's had it for a while and had been managing OK. If only that stupid vet had read her notes before giving steroids to my poor girl :mad: x

[goldengirl88]

I really hope everything is turning out for you two. I am sorry you are at the vets again. Are they afraid of infection and that is why they will not drain the mucocele? I pray it all turns out well. Blessings
Patti

[Poppysmum]

To be honest I even forgot to ask about the mucocele. The blood results aren't back yet and the vet is very loath to prescribe anything without knowing exactly what's going on inside. She has been very frank with us and told us that even if Poppy gets through this, she will still have problems. She told us that she's refused to put dogs to sleep in the past if there is a chance for them but in Poppy's case she wouldn't oppose it...and that hit us very hard. I know how much you all love your dogs so you can imagine how we felt.

But, it's not over yet. I am still praying for a miracle xx

[goldengirl88]

Oh my, I am so sorry, but please don't give up hope. That is all us cush moms have is hope. I have seen some really sick dogs rally, so pray on it. I will be praying for all of you. Blessings.
Patti

[Poppysmum]

Thanks Patti. I don't know why but I don't feel like it's her time yet. I know miracles can happen and if anyone deserves one it's Poppy who is the most beautiful natured girl and is loved dearly x

[goldengirl88]

Hopefully you will get the miracle your baby deserves. Blessings
Patti

[molly muffin]

Oh :( I'm sorry the vet said that. I'm sure it hit you like a ton of bricks.
Well, when the cortisol goes too high, it can affect them, by making them wobbly and feel terrible, just like if it goes too low. A dog is best, with a happy medium I think and that medium is different for each dog.
Leslie is right, do you have tablets instead of capsules?
Is Poppy drinking? They can go without food for a bit, but they do need liquid. If she isn't, syringe some water into her. She'll need it, to keep her kidneys working etc. We don't want this to become any worse than it is already, so hit preventive mode.
Now are you trying to cook for her a bit? Does she like human food? Egg, chicken, anything? Oats, rice (my dog loves plain rice, go figure)
anything to maybe entice her.
Hang in there!
hugs to you and belly rub to Poppy
Sharlene and Molly Muffin

[Poppysmum]

Sadly there were no miracles to be had for my darling Poppy.

Thirteen years ago today she came into the world and today God took his angel back. Her dad and I have sobbed all weekend when we realised her time had come and there was no point going on.

She was the most beautiful girl with a lovely gentle nature. She was told every single day how much she was loved and had a wonderful life. We were priveleged to be the ones to share her all too brief time here. She was a true angel, the like of which I know we'll never have again.

We will bury her in a lovely spot in the garden today so she can always be with us.

I wish everyone and their boys and girls all the very best and I hope one day someone finds a cure for this horrible disease that cut my beautiful girl down into a shadow of her former self. xx

[goldengirl88]

Oh My God I am so sorry that your Poppy has passed on. This has to be incredibly painful, and I am crying for you right now. I hope you put Poppy in that special part of the garden so she will be with you always. This is the most difficult part of belonging to this forum, as everyone is family and when this happens it hits home hard. My deepest sympathy to your family on the loss of your angel. Blessings
Patti

[Squirt's Mom]

Oh, sweetheart, I am so sorry to hear this. I know you and your hubby did all in your power to give her the best possible life for as long as possible. Poppy was, is, and always will be deeply loved and she knows that well. Today her suffering is over and she is once again strong and full of energy, holding her love for you in her heart til that day she is once again in your arms.

Poppy's name has been added to the In Loving Memory thread for 2013 where she will always be remembered as a cherished member of our family here.

http://www.k9cushings.com/forum/showthread.php?t=4794

When you are ready, feel free to start a thread in the In Loving Memory section as a memorial or tribute to your sweet girl. We would be honored to help celebrate her life through your memories.

Our deepest sympathies,
Leslie, Squirt, Trinket, Brick, Sophie, Grace, and our Angels Ruby, Crys, Tasha and Josie


A Special Gift

They're a very special gift, to be cherished and loved;
You're chosen for each other by God Himself above.
It's a match made in heaven so it can't be wrong;
You're tied together by a bond that's oh so strong.

All they'll ever ask from you is to be loved and fed,
And at night make sure they have fresh water and a bed.
In return, for so little, the rewards are so great!
You'll get a companion for life with some very special traits.

When you are lost and the end seems so far away
They'll walk by your side, they'll help you find your way.
When life gets you down they can put a smile on your face
As they run you in circles with their fast pace.

You'll share the good with the bad, you'll be happy and sad;
And through it all you have a friend, the best you ever had.
You're time together will be special and unique;
It will be as priceless to you as a rare antique.

Then, before you know it, the day will arrive
When suddenly your life takes a steep dive.
The furry friend who's been with you for all of these years
Has now passed on and left you in tears.

As you sit and wonder what did I do?
Why is this all happening to you?
Into each of our lives a little rain must fall,
And you must be strong to answer the call.

Your little one's spirit has flown home on the wings of a dove,
To a special place that awaits them in heaven above.
St. Francis will meet them; when they get home
He will take them to a meadow where they're free to roam.

There in the meadows, down by the pond,
Your furry friend will remember his loving bond.
He'll look into the water, then you appear;
He can see you're frightened, he can feel your fear.

Through the bond that still ties you from heaven above
He looks down upon you, he sends you his love.
Because you loved him and because you care
Whenever you need him, he'll always be there.

There, in the meadows, they patiently wait for the day
When you will celebrate your life together, each and every day.
Waiting for that day; when you come walking back home
When together for an eternity through the meadows you'll roam.

Author Unknown

[spdd]

I am so sorry to read this. My deepest sympathy !!

[BostonLover]

I'm so sorry...I feel your pain, as I lost my girl Saturday. :( sending love and hugs.