Cushing then Addison then ill. Please help

[Jasper - RaggyRoo]

My Tibetan Terrier Jazz has been taking Vetoryl 60mg 3 months for Cushings(ACTH reading 1,400 then down to 380) but all of a sudden went into Addison crisis (ACTH reading below 40 and electrolytes test confirmed). He is now in a norm range but is still very lethargic and unwell my vet wants to do further blood tests - biochem and hematology. Any ideas of what is going on? or any tips or advice? or have any of you even heard of this happening?

Really love my Jazz and I am worried something else is causing this and not simply a dog with Cushings. I know you are great on here and this is my first time doing anything like this but I am so desperate.

[labblab]

Sorry I have only a moment to post, but can you tell us the exact numbers for Jazz's most recent ACTH test indicating his cortisol is back in the normal range? Was Jazz given any supplemental medications (prednisone or florinef, for instance) to help with his low cortisol and low aldosterone levels during the Addisonian crash? How long ago was the crash? And I'm assuming he is not yet back taking Vetoryl?

Sorry for these quick questions, but your answers will help guide us re: further suggestions.

Marianne

[Jasper - RaggyRoo]

Jaspers last ACTH done yesterday was reading 180 his Addison crash was exactly 2 weeks ago that read below 40, he was given no medication just told to stop Vetoryl. He started again at 30mg on Monday for 3 days but ill again on third day vet said stop meds and re-do ACTH.
But he is still poorly therefore they want to do the other blood tests mentioned before.

Thanks for your help

[Budsters Mom]

Hello and welcome from me too,:)

I am so sorry to hear that Jazz has been unwell. You mentioned that you were feel desperate. That is how I was feeling when I stumbled across this forum. It gets so much better! :)

You have come to the right place! There are many K9Cushing's angels to help and stay with you every step of the way. They love details, test results, any information you can get your hands on. The more the better. The more they know, the more they will be able help you and Penny. Please keep talking to us!:)

So again welcome to you and Jazz,

Kathy and Buddy:cool:

[Squirt's Mom]

Just to be real clear - he has had no prednisone or other meds to replace the cortisol since he crashed?

[Jasper - RaggyRoo]

Yes I can confirm that Jazz had no medication when he was in Addison crisis. He is not taking Vetoryl at the moment. His symptoms now are bad hair loss worse than before, vomitting and the runs (on and off), lethargy and very shallow breathing so shallow that I think he is dead and scared to look!!!!

[labblab]

Given what you've described, I do think it is important that your vet is proceeding with more labwork. Even though, on the face of it, Jazz's cortisol level has rebounded to some extent, it may be the case that his electrolytes remain unbalanced and he needs medication to restabilize him. While off the Vetoryl, did he ever start to act normal again or has he remained unwell since the time of the crisis? At this point, I should think he needs to stay off the Vetoryl entirely until you can get to the source of his problems.

Mariane

[Budsters Mom]

That is scary!!! :eek: If it it were me, I would take him to the vet ASAP!

Sending hugs and wellness thoughts your way'
Kathy and Buddy:cool:

[Jasper - RaggyRoo]

Yeah Jasper was well for a couple of days then they put him on 30mg of Vetoryl - then poorly again.I think that either something else is going on or the vets have gave him to high a dose (60mg) at the start.

[Squirt's Mom]

How much does Jasper weigh?

[Jasper - RaggyRoo]

He is 12kg

[labblab]

Yes, it does sound as though the initial dosing was too high for him to handle. Unfortunately, your vet was probably relying on the dosing chart included in Dechra's published drug insert because it does list 60 mg. for a dog of his weight. However, more recent revised recommendations are to start dosing at a lower level -- around 2.2 mg. per kg. We really wish that Dechra would revise that chart, too! Since Jazz has gone downhill again since restarting the Vetoryl at even a lower dose, it seems as though he may remain overly sensitive to the drug. And as noted earlier, even though technically his cortisol does not seem overly low, his electrolytes may still be out of whack (Vetoryl lowers aldosterone as well as cortisol, and aldosterone helps regulate the electrolytes). I'd get him in for that repeat bloodwork as soon as possible.

Marianne

[Jasper - RaggyRoo]

Thanks for all your help. I've Requested my vet to do further blood tests.

Do you think that there is any lasting damage caused by this intense amount of Vetoryl that Jasper has been given.

[Squirt's Mom]

The most common permanent damage we see that can be directly linked to the meds is necrosis of the adrenal glands, which means they are basically killed and no longer function; they become permanently Addison's. This is not a death sentence tho and can be managed with medication.

If Jasper can eat and drink on his own alright and regain control of his bowels while off the Vetoryl, the odds are he will bounce back from this crisis just fine. But this is why it is so important that the hormones that cannot be produced and released during a crash are substituted if needed.

[molly muffin]

Hello and welcome from me too.
I know this is absolutely terrifying.
First thing I would say as the others have is no more vetoryl for now! Not at the very least until symptoms come back and then at a much lower dose, more suited to his weight. Keeping in mind that every dog is different and some require lower or higher doses, but always start low and go up.
If his cortisol remains low then he needs a supplement to restore those and perhaps even IV if his electroyltes are off. These are just basic things that go along with these medications. You always hope that there will never be a crisis, but it is so important that vets are very familiar with both the drug and the disease, or bad things can happen.
With the cortisol test, do you have a copy of the results, that show a Pre draw and a Post draw and what the numbers are with the lab range? That can be very helpful in determining exactly how bad it is overall and what needs to be done.
Again, welcome to the forum. There is a wealth of experience here and people who have been living cushings for many years. With proper treatment, a long normal lifespan can be had. We just have to get him to that perfect dosage without any crisis and hopefully with nothing else going on. (I assume that diabetes, thyroid and kidney issues have already been ruled out?)

hugs,
Sharlene and Molly Muffin

[labblab]

Since Jazz's ACTH yesterday (after having been back on the lower dose of Vetoryl for three days) was 180 nmol/l (or 6.5 ug/dl for those of who are more familiar with those units), it really does not seem as though low cortisol, per se, is his current problem. And since his cortisol had rebounded to that level even after three days of Vetoryl, I really doubt that you need to worry about the type of permanent damage that Leslie was writing about. His adrenal glands are indeed producing cortisol. But I do still wonder whether his electrolytes are still "off." And so that's why I endorse the blood testing that your vet is recommending.

Marianne

[Jasper - RaggyRoo]

My vet has just got back to me with the results of the further blood tests - Fat enzymes Normal, Liver values slightly increased but unlikely to be significant?, Electrolytes showing Addison. His Cortisol levels were at 180 from the ACTH last Thursday probably creeping up. She is unsure what to do and is going to get back in touch with the lab for advice. Do you have any ideas what should be the next steps to take as Jasper is quite up and down with symptoms as discussed before.

[labblab]

I would definitely ask your vet to contact Dechra (manufacturer of Vetoryl) as soon as possible. Dechra has veterinarians on staff who serve as consultants when questions or problems arise during use of the drug. I am not a vet, but it does sound to me as though Jazz's aldosterone level is the problem at the moment since the cortisol was OK at the last testing. As a result, he may need drugs to supplement the aldosterone level and stabilize his electrolytes, at least for the time being.

Since you are reporting Jazz's labwork in units of nmol/l, I am guessing you are in the U.K. or Europe, so here is the contact info for Dechra's UK office:

http://www.dechra.eu/contact-us.aspx

Please do keep us updated, OK?

Marianne

[Jasper - RaggyRoo]

Thanks very much. I will speak to Jaspers vet tomorrow and follow up your recommendations, hopefully this will help put Jasper back on the road to recovery. Yes we are in England by the way. Thanks again and I will update you further when I know more.

[doxiesrock912]

They may advise you to give Jasper Pedialyte. That can help with electrolytes.

[Jasper - RaggyRoo]

Jasper still not well. Vet gave him a check up yesterday, said he had an enlarged liver and his lungs did not sound clear.

They want to do a scan of liver and lungs. Has anyone got any ideas of what could be going on?

Thanks:confused:

[lulusmom]

Electrolytes showing Addison. His Cortisol levels were at 180 from the ACTH last Thursday probably creeping up. She is unsure what to do and is going to get back in touch with the lab for advice. Do you have any ideas what should be the next steps to take as Jasper is quite up and down with symptoms as discussed before.

Both of my dogs had post stimulated cortisol of a bit over 220 nmol ( 8 ug/dl) for at least a year after discontinuing treatment. It never moved and they weren't symptomatic. Given that Jasper's electrolytes were indicative of addison's I wouldn't automatically assume that his cortisol is on a steady rise. What did your vet do to correct the electrolyte imbalance? You mentioned at this point that your vet did not know what to do. That is very concerning as addison's is a life threatening condition. Marianne recommended that your vet contact Dechra for guidance. Did she do that? You also mentioned that she was going to contact the lab for guidance. Most labs do have internal medicine specialists on staff and if the lab she is dealing with does not, my level of concern goes up. Did she contact the lab and if so, what did they tell her? Can you tell us exactly what symptoms Jasper has right now and the list of medications he is currently taking?

As for Jasper's lungs, I think an ultrasound would be a really good idea. That would tell your vet if there is fluid in the lungs and/or if the heart is enlarged. Did your vet mention a heart murmur? The most common cause of lung congestion is congestive heart failure. If you walk Jasper every day, you may want go easy on that until you figure out what is going on with his lungs and heart. Hopefully you have booked the appointment for the ultrasound, yes?

Sorry for answering your question with a lot of other questions but it's difficult to provide guidance or feedback without additional information.

Glynda

[Simba's Mom]

Sending hugs and prayers to you and Jasper!

[Jasper - RaggyRoo]

Jasper is taking 30mg of Vetoryl per dayhe has been back on it for 7days now. The Lab were not very helpful with the vet and said to put him back on vetoryl Dechra said to as well even though his electrolytes are out:confused: He is booked in for a scan of his liver and lungs next week. He is very quite and breathes very shallow and really like an old man - although he is eating fine?

[Harley PoMMom]

Advising you to continue the Vetoryl while the electrolytes are unbalanced, I believe, is wrong. Vetoryl has the potential to lower aldosterone thus increasing the risk of making the electrolytes even more unbalanced.

The attention should be on the electrolytes and getting them to more normal levels.

I am really concerned about Jasper so please do keep us updated.

Love and hugs, Lori

[lulusmom]

I don't believe Dechra would recommend resuming treatment for a dog whose electrolytes are out of wack so perhaps there may be some miscommunication between you and your vet? Sodium, potassium, chloride, and bicarbonate are electrolytes and if the balance between them is thrown off, it can be life threatening if not addressed rather quickly. Since Jasper is eating, it doesn't appear he's in a critical state so again, maybe we don't have all the information. :confused: Do you have a copy of the bloodwork that was done to check the electrolytes?

[Jasper - RaggyRoo]

I have told you all I know and I am merely repeating what my vet has told me. As to the electrolytes imbalance I have told my vet all the info and advice given by this forum and both her and the lab said we must continue with vetoryl despite my concerns. The main thing I want to know is why an enlarged liver? and why problems with his lungs? and also his eyes are getting cloudier is this relevant? My vet said she thinks there is an underlying issue?