Questions about treatment using Vetoryl

[Karla]

Zoie has had Cushings for probably over a year, I was treating her holistically and her only symptoms were excessive drinking and peeing. Energy levels were good as was appetite. All of a sudden she quit eating and had diarreah. Took her to the vet where an ultrasound was done, an adrenal tumor confirmed with subsequent tests confirming what I had already suspected as Cushings. She started on Vetoryl a week ago today. My questions, her appetite is still very week, I'm giving her Recovery RS several times a day for calories and energy and she will eat occasionally through the day rice and 98% lean ground beef or rice and baked chicked breast. Will her appetite return when her Cortisol levels begin to fall ? And what I'm assuming is slight nausea due to both the falling cortisol levels and the side effects of the Vetoryl. Will that nausea subside once her system has been on the Vetoryl for a period of time ? She's not throwing up and as of just today her excessive drinking is subsiding. She is 20 lbs (Dachshund) and I opted to start on the lowest dose of 20 mgs. a day. Her poop is s-l-o-w-l-y returning to a more solid state but she won't even THINK about eating dogfood and barely people food. Any insight into what I can look for or expect is GREATLY appreciated. We've had her since she was 6 weeks old and needless to say this is exacting quite a toll from us emotionally.

[Roxee's Dad]

Hi Karla and welcome to you and Zoie,

I am so glad you found us although sorry for the circumstances that brought you here. You have found a great group of people that will help you and Zoie through this.

If you have Zoie's ACTH test results, it woiuld be very helpful if you could post them. If you don't have them, please ask your vet's office for a copy as they should be very happy to provide you with them.

In the meantime, please check your e-mail for a message from K9Cushings and follow the directions to activate your account. If you don't see it, you may want to check your spam folder. Once your account is activated, your post will automatically appear and will not have to be approved by a moderator or Admin.

Thank you and look forward to learning more about Zoie.

[Roxee's Dad]

I also wanted to add that the loss of appetite is quite worrisome while on Vetoryl (Trilostane) Typically the loss of appetite comes when the cortisol gets too low. Normally a dog with high cortisol has a veracious appetite. I look forward to what the others have to say.

[Karla]

I clicked on the activation link that was sent to me via email ? Is there another step to take after that ?

Her appetite has been voracious up until a week and a half ago and out of the blue she quit eating. That's what promted taking her into the vet and the path that I am now on. I'm just wondering if there's something secondary going on I should be concerned about (like I need something more to worry about with this). I though maybe as Cushings progressed the excessive cortisol might have the opposite effect once it got to a certain level but the thing that concerns me is that it was so sudden. Now I don't know if her not eating is because of the medication, the Cushings or something secondary ? I will get the test results tomorrow as I have to go back to get more of the Recovery food.

Let me know what I need to do to straighten out the moderation to posts thing.

Thanks for everything, she's 14 and my husband and I love her unconditionally.

[Karla]

This is what is showing after activation:

Your account has been activated but you are currently in the moderation queue to be added to the forum.

[Roxee's Dad]

Thank you for activating :) sometimes it takes a little time for it to take effect. In the meantime, there will be many others more knowledgeable than I that will help you and Zoie get through this... Hang in there.

[Simba's Mom]

Welcome to the family here, you are in good hands! I also have a doxie and am quite new to all this cushings stuff too. I have my Simba on Blue turkey and potatoes dog food, it's been working great for him. I give him his trilostance 25 mg, in a piece of turkey hot dog, and he also takes a pill for his thyroid. I do have to put a little canned turkey and potatoes on his dry food to get him to eat dog food, I swear he thinks he's a human....His appetite has always been good and he has never gotten sick from the meds yet. Hope you get your pup's eating back to normal!
PS I hope Blue is good, Simba used to be on Science Diet that the vet sells, he always had loose stools then. So we traded vets and food! My old vet said Simba was just fat, my new vet said he has a pot belly and asked about other stuff hence the cushings diagnoses!

[Harley PoMMom]

Hi Karla and welcome to you and Zoie,

Dog's with Cushing's disease usually have a ravenous appetite which does not slow down until the elevated cortisol is decreased.

With Zoie having a decreased appetite before the Vetoryl was started, IMO, there is something else going on with your girl and if this were me, I would stop giving her the Vetoryl until the reason for inappetence is discovered and corrected.

Does Zoie have any other health issues? Was diabetes ruled out?

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

Love and hugs,
Lori

[labblab]

Dear Karla,

Welcome from me, too! Your membership has now been finalized, so you shouldn't have any more problems with posting. I have only a few moments to write, but I join you in my concern that something else besides Cushing's has caused the sudden appetite and GI issues. What you are describing is not typical of Cushing's. One possibility that leaps into my mind is pancreatitis, because Cushpups are vulnerable to pancreatitis and it could definitely cause the symptoms you are describing.

Does your vet know about the loss of appetite and diarrhea? In honesty, I would not want to start trilostane treatment when a dog is suffering from GI issues of unknown origin. These issues really confound your ability to monitor whether the medication is safe and effective. If it were me, I would want to proceed with additional diagnostic testing before launching into the trilostane. Has you dog had a general blood/urine panel performed since the onset of the GI issues?

Marianne

[Squirt's Mom]

Hi Karla and welcome to you and Zoie! :)

Not to scare you, but your sweet girl could be in serious trouble.

I understand you have already started the Vetoryl, right? Do NOT give any more for now, not one single dose more. If you have prednisone, give it now as directed by your vet. If you have not called your vet, do so immediately. No matter what your vet says, do NOT give any more Vetoryl until Zoie is eating well again and her stools are normal.

I have more questions for you about the holistic things you were using but right now I don't want you spending your time reading but talking to your vet and tending to Zoie. Tell the vet you want her tested for pancreatitis today.

Let us know how things are going after you have talked to and hopefully seen the vet.

Hang in there! We will be right by your side!
Hugs,
Leslie and the gang

[labblab]

Karla, I just want to clarify -- I'm thinking that the loss of appetite and diarrhea started before you began the trilostane, and the diarrhea is actually somewhat better now? If so, then it seems less likely that the trilostane caused the problems and instead more likely that there was a pre-existing complicating condition. That doesn't change the fact that I would halt the trilostane until you can figure out what is going on. But if these symptoms preceded the trilostane, I am less worried that low cortisol is the culprit.

Marianne

[lulusmom]

Hi and welcome to the forum.

I would like to echo John and ask that you round up all of the testing that was done to diagnose Zoie. I realize that an adrenal tumor was seen on imaging but not all adrenal tumors secrete excess cortisol. An acth stimulation or low dose dexamethasone test should have been done to check cortisol levels. I am assuming that your vet also ran a blood chemistry when she got sick and it would be great if you could post any abnormal values, including the normal reference ranges.

Cortisol secreting adrenal tumors don't usually make a dog quite eating, it usually does the opposite. A pheochromocytoma, a different type of adrenal tumor, however, will cause anorexia and diarrhea as well as an increase in drinking and peeing. Symptoms can also mimic cushing's. A pheochromocytoma does not secrete cortisol but rather hormones called catecholamines. Vetoryl would not be an appropriate treatment so I'm hoping you have a copy of an acth stim test or low dose dex suppression test that shows elevated cortisol levels. Pheos are usually seen in very senior dogs, average age is 11 so Zoie fits that profile.

Dogs with uncontrolled cushing's are predisposed to pancreatitis and no appetite and diarrhea are definitely symptoms of this condition. Did your vet rule this out?

I'm just throwing things out there because it is very unusual for a cushdog to get sick enough to stop eating and develop diarrhea. It is also very unusual for a vet to prescribe vetoryl to a sick dog. When my two cushdogs were on Trilostane, if they ate less than normal or looked at all ill, I discontinued dosing until they were 100%. Did your vet explain why he felt cushing's was making Zoie sick?

I'll be looking forward to seeing results of testing so we can try to understand your vet's rationale.

Glynda

[Karla]

She's eating a little bit more each day of the Rice and Chicken and the Rice and Beef. Her stools are firming up progressively and don't have the apperance of what is reflected in the case of pancreatitis (I had researched that angle previously). Like tonight for example, I made a roast and she ate 3 small bowls of roast and rice. Not all at once but total. She's just VERY particular when and what she eats rather than before when she ate EVERYTHING. I give her her medicine first thing in the morning, and it seems that her appetite increases closer to evening when I would presume would be when the medication is on the downside. She does eat some during the day, just again, particular to how much and when. Wouldn't her blood and urine tests point to something amiss with her pancreas ?

[Karla]

Glynda, yes a low dose dex test was done, I'm getting the paperwork tomorrow and will post the results of what it shows. Her morning stool is back to basically normal, if another movement is made in the day its more like pudding but at the same time I'm giving her the Recovery food blended with water so am thinking that may have something to do with possibly the consistancy of her stools ?

[Harley PoMMom]

Only a spec cPL test can confirm pancreatitis and I do recommend getting this test done.

My boy, Harley, had pancreatitis which was found on an ultrasound and later confirmed with a spec cPL test. Harley showed NO symptoms of the pancreatitis but he indeed did have it, not all dogs will display symptoms.

[Karla]

Here are Zoie's test results, I have more information in them if needed, wasn't sure how much to include:

Ultrasound:
Suspected tumor involving the left adrenal gland that measures 19x32mm
Right adrenal gland has normal width
liver is mildly enlarged and contains numerous small hypoechoic nodules.
Stomach cointains more fluid than considered normal but wall layering and thickness are normal
Both kidneys have decreased corticomedullary distinction from the reported PU/PD.
Remainder of study were unremarkable. (all other organs show normal)
Changes in liver are probably benign and associated with nodular hyperplasia. Changes in the intestine are consistant with inflammatorhy changes that could be associated with Cushings or IBD. Kidney changes probably represent age related degeneration.
Lose Dose Dex Test:
Cortisol Serial 2 (DEX)
Time 1 - 830
Time 2 - 1230
Time 3 - 430
Cortisol Sample 1 - 3.9
Cortisol Sample 2 - 4.3
Cortisol Sample 3 - 2.5

Her eating is still not 'normal' for her (still picky as to what and when) but is improving daily, as are her bowels.

[Squirt's Mom]

MODERATOR NOTE: I have merged your post about Zoie's test results into her original thread. We like to keep all posts about each pup in a single thread as it makes it easier for members to refer back to the pup's history when needed. Thanks!

The merged post was subsequently deleted because it was a duplicate of the prior post concerning test results.

[addy]

Changes in the intestine are consistant with inflammatorhy changes that could be associated with Cushings or IBD.


Hmmmmmm, my Zoe has IBD. I guess if it were me, I would want clarification from the vet on that since IBD can cause a dog to have loose stools and vomiting, not wanting to eat, etc. I had Zoe's IBD well controlled until we started Vetoryl. She ended up flaring with loose stools for a few weeks. In her case, we knew this was a distinct possibilty so we knew what we were dealing with. She takes metronidazole for her IBD.

Just wondering and throwing that out there.

[Karla]

Actually, in reading the symptoms of IBD, it sounds exactly what she may have. He gave her an anti-inflammatory shot and antibiotics and seems to be helping with all but her appetite. She's still not interested hardly in anything...I'm feeding her baked chicken and pasta right now to get her to eat...

[Karla]

She looks like she feels good, poop looks good, not much of it but firm but SHE WILL NOT EAT ! Turns her nose up at everything. Am feeding her Recovery RS blended with water through a big syringe right now. :confused: