Toby, Parson Jack Russell Terrier (14 YO), Diagnosed with Cushing's disease)

[Philip]

Hi folks, I'm new to the forum so let me first say hi. I've been researching Cushing's disease since we got the diagnosis from the vet confirming that the family dog, our loyal Toby, has the condition.

Toby's symptoms seem to have been pretty typical - he started urinating indoors and through the course of the next few months began displaying odd behaviour usually fixating on a single toy, unwilling to go on walks, very low energy and panting. The hair on his tail is all but gone and his back legs are weak. He regularly stumbles when walking and is no longer able to jump up on to sofas (we give him a helping hand now).

I was away for a good number of months from when Toby started displaying the first signs and when I returned he was a different dog. His natural liveliness was seriously dampened and to be honest it was very distressing. Mum had been looking after him (he's her little baby) best she could but it hasn't been easy. All the carpets have been removed from the living room and his sleeping patterns have become very antisocial. His belly is very inflamed giving him the typical potbelly appearance which I imagine is straining his hind legs.

The first vet gave him a blood test which left him with ugly bruising and left my mum upset to the point that she didn't want to do any further testing to confirm if it was Cushing's.

She took her to a second vet again she was reluctant to have him have a test and asked the vet if he could do anything for Toby's weak legs and panting. He was given Previcox for his legs and Fortekor for his panting both helped especially with the panting which has now stopped.

Unfortunately mum is very distrusting of vets so I had to plead with her to have a further blood test to see if we could confirm the Cushing's. She eventually relented.

The third vet did bloods ACTH/ ultrasound/urine and confirmed it was Cushing's. Ultrasound confirmed the adrenal glands were inflamed as well as his liver.

He was put on Vetoryl for Cushing's and milk thistle for his liver. He was fine day one, day two he began panting was unable to move for most of the day and looked very confused. Mum was sufficiently worried that she phoned the emergency vet service who advised her to discontinue. She did and Toby seemed to recover. With advice from the vet they decided to put Toby on a one day on one day off regime. Again he responded badly - not to the same extent as previous but enough for my mum to decide to discontinue treatment altogether.

I encouraged her to go back to the vet to see how we could proceed. He suggested that it was because his liver was too weak to take the treatment that he was responding this way. He prescribed Denamarin to support his liver before trying the Vetoryl again and this is where we are currently at.

The way it stands we're very nervous about putting him on the Vetoryl but are also conscious that we need to treat the Cushing's. It feels like a catch 22 situation but the priority for us is to make sure we make the best decisions for Toby's well-being.

Here are the results - These are UK measurements so will differ to US readings.

Cortisol Post ACTH >1380 nmol/L
Urine Cortisol/Creat Ratio = 833.3
ALT 558 IU/L
Alkaline Phosphatase 1408 IU/L
Cholesterol 11.7 mmol/L
Amylase 324 IU/L
Chloride 98 mmol/L

Thanks for reading and apologies for the longwinded letter but hopefully with the expertise and experience apparent on this forum we might find some useful pointers!

Philip

[frijole]

Phillip, It is my guess that the dose of vetoryl that Toby was/is on is TOO high. Those are signs of overdose. Every other day dosing is not following protocol and won't work. Also all it is doing is making Toby feel badly every other day (overdosing every other day). The drug is strong and can be fatal is abused so it isn't something to be taken lightly.

Please tell us how much Toby weighs and the dosage amount you were giving him daily.

Have you done a follow up acth test since using vetoryl? Again the way it's supposed to work is you start on a dosage and go a week to two weeks and then test to see what the cortisol levels are. The goal is to reduce them.

The exception is if the dog has a reaction - you cease the dosing and depending on how serious the symptoms you either do another acth test to see if he has gone 'too low'. OR you lower the dosage and try that. Then you do the acth test after two weeks.

The panting and weak legs are simply cushings symptoms which will improve once you get the cortisol under control so I wouldn't be worried about that and would cease giving the drugs once you get the dosage of vetoryl right.

What worries me is that the vets do not seem to have any experience with this drug. Don't give up - they just need to follow the instructions. I'm providing a link so if you want you can print it out for them to read. :D

The goal is to get cortisol reduced to a level between 1 and 5. Take those numbers and multiply by 28 to convert to UK numbers. (I'm not near a calculator sorry).

Hope this is helpful.

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

Kim

[NoonelovesmelikeNorman]

Phillip and Toby...I am new as well. Sorry to hear about Toby. I don't have any advice but just want to let you know I can pray for Toby and you. Cushings is tough one to diagnose and get the medication level best for the individual dog from what I have been reading. Wishing you and Toby the best.

Sharon and Norman (12 yr old dachshound)

[Philip]

Hi Kim,

And thanks so much for the reply it's great to hear other people's experience and to know we're not alone! Toby weights around 9 kilos and was put on a dosage of 20 mg a day / 10 in morning 10 at night. Mum gave him his meds the first day and after the dose the following morning he began to exhibit symptoms of an overdose.

Philip

[Philip]

That's incredibly heartwarming Sharon and I'll pass on your kind words to Toby and my mum. It's all very confusing but we're hanging in there! We'll keep you and your pet Norman in our prayers. Philip and Toby

[frijole]

Interesting - he's around 20 lbs and 20 mgs is actually in line with the lowest recommended dose. It doesn't stay in the system long - could you notice how long after dosing it took for the reaction and how long the lethargy lasted? Was it in am or pm or both?

How long have you been off of the vetoryl and have you had any of the incidents since then? I'd stay off of it for a while just to confirm that the vetoryl was the culprit. Also you can relax for the holidays. Do keep us updated! Kim

[Philip]

Hi Kim, I'm going on what my mum tells me. He was fine the first day of treatment when he received both doses. It wasn't till after his dose the following morning did the alarm bells start ringing. Mum stop treatment and he recovered within a day. He's been off the Vetoryl for over 3 weeks I'd say and hasn't had any incidents since. Philip.

[frijole]

Sounds like the dose was too high then - could be he is very sensitive to it. I'd wait til after the holidays and talk to the vet about trying 10 mgs one time a day. Here in the US dogs just have one dose a day in the a.m. unless they need a 2nd dose. You would have been put on 20 mgs in the a.m. and none at night.

Luckily we already know that the 10 mgs twice a day was a bit much so you have 10 mg pills and can simply experiment with giving 10 mg once a day (a.m.) and see if that works better.

Kim

[goldengirl88]

Philip and Toby:
We are sending our love to you, and Toby, and hope that dear Toby can get thru this. My Tipper a Parson Jack Russell Terrier also has this horrible disease. She started on only 10 mg. Terriers can have bad reactions to things, as my Tipper has done in the past. What mg was Toby started out on? I think caution in the best way to proceed with these drugs, by using a low mg and going from there. This type of Terrier can be exceptionally sensitive to things so be careful. These dogs are so intelligent, loyal, and loving that I know how you feel, it was like the sky fell down when I got Tippers diagnosis. God Bless you both. I hope you get some good news for Toby. Feel better Toby!!!

[milosmom]

:)welcome philip and toby.milo and i am also rather new here.it is a woderful forum to be able to share our stories and get the support,love and xoxo from everyone.hang in there,hopefully they will get your pup feeling better soon.we will all be watching toby to see how he is doing.regards from patty and milo

[Philip]

Thanks everyone for the kind words, it really helps.

Mum's at the stage where she'll take some convincing to get Toby back on the Vetoryl - she's afraid she might do him some permanent damage. She tried him on 10mg which made him lethargic and disorientated.

The vet thinks it's his liver that's to blame for the adverse reaction to the drug but we're not entirely convinced. Tipper and Tipper's Mum it's interesting that Parsons seems to be extra sensitive to Vetoryl which again makes me think it's not his liver that's the problem. Out of interest what dose is Tipper on?

I wonder if you get it in lower doses and is it worth trying? Should we expect some side effects as his body adjusts and if so what is acceptable and what is not? I've read that Ketoconazole and L-Deprenyl are possible alternatives, does anyone have any experience with these?

Mum seems resigned that this is how Toby is going to be until the inevitable happens but I'm not ready to give up just yet. He still has a lot of life in him yet and if we can help have a happier retirement we have to explore all the possibilities!

Thanks everyone for taking the time to read this and offering advice, it really means a lot to me, my mum and Toby. Philip

[lulusmom]

Mum's at the stage where she'll take some convincing to get Toby back on the Vetoryl - she's afraid she might do him some permanent damage. She tried him on 10mg which made him lethargic and disorientated.

Can you tell us what you mean by disoriented? Vetoryl drops cortisol rather quickly so dogs can become lethargic. Their bodies have been swimming in a sea of a feel good steroid for a very long time and then all of sudden, it's not there so they do go through some type of withdrawal. They will feel tired and kinda crappy. It is the disoriented behavior that concerns me so if you can explain exactly what your mom saw, it would help us understand.


The vet thinks it's his liver that's to blame for the adverse reaction to the drug but we're not entirely convinced. Tipper and Tipper's Mum it's interesting that Parsons seems to be extra sensitive to Vetoryl which again makes me think it's not his liver that's the problem.

I will say that Toby's ALT, which is a liver specific enzyme, is elevated more than we usually see in cushing's so I am wondering if your vet did a bile acid test to determine if Toby may have liver disease? If he hasn't and he suspects the liver is being injured by causes other than cushing's, then he absolutely needs to rule out liver disease before putting Toby back on Vetoryl. It would really help if you could post the normal reference ranges for the test result you posted.



I wonder if you get it in lower doses and is it worth trying? Should we expect some side effects as his body adjusts and if so what is acceptable and what is not? I've read that Ketoconazole and L-Deprenyl are possible alternatives, does anyone have any experience with these?

Dechra does not make a lower dose but if it becomes necessary, you can try to find a compounding pharmacy to repackage the 10mg into 5mg capsules. As I mentioned before, when cortisol drops rapidly, a dog can feel yucky but disorientation is not normal.

Ketoconazole has fallen out of favor as a treatment for cushing's due to it's impact on the liver. it is more likely to cause liver toxicity than Vetoryl. L-Deprenyl is rarely effective, especially if the disease has progressed to a point where symptoms are overt. It is also not effective in dogs who have a pituitary tumor outside of the pars intermedia lobe of the pituitary and most dogs don't have a tumor in this area. It is unfortunate that we are limited in our choices and for those members outside of the U.S., it's even more limited as Lysodren, a very effective treatment, is not available.


Mum seems resigned that this is how Toby is going to be until the inevitable happens but I'm not ready to give up just yet. He still has a lot of life in him yet and if we can help have a happier retirement we have to explore all the possibilities!

In my opinion, if your vet thinks Toby has primary liver disease, he needs to rule that out. If he has liver disease, that takes priority and appropriate treatment be administered. If he doesn't have liver disease, then there is no reason why Toby can't benefit from the improved quality of life that Vetoryl can offer him.

I noticed that you think Toby, as a terrier, may have a sensitivity to Vetoryl. I've done a lot of research on the drug and I've never seen anything that mentions a breed specific sensitivity. All dogs are different and we've seen big dogs stabilize on doses that you wouldn't think would control a 5 pound dog much less a 70 lb one. We've also seen tiny dogs who eventually stabilize on scary huge doses. My own 4 pound dog was on 30mg for two years and did great. You just never know and I've learned over the years that it's always better to start on the lowest possible dose and work your way up.

I hope this helps.

Glynda

[milosmom]

milo is only 20 lbs and was started with 20mg,eventually up to 80mg -40mg am 40mg pm....presently he is off since friday morning.so it is a good drug to utilize as long as your vet is keeping close tabs on your pup....you wil make the right decision for you baby philip

[molly muffin]

Hello and welcome.

Glynda is right, those liver results seem to indicate that a bile acid test should be done to check the liver.
You don't want to do vetroyl until that is cleared up.

Hope you get this all figured out. We have a great support group here I am sure your mum is terrified of doing anything that is going to hurt her baby. That is a fairly normal reaction. However, we have to get this figured out, so more test it looks like. The good thing is that at least you have some good advice on what direction to look in.

Sharlene and Molly Muffin