Advise please:( 12.5 yo yellow lab

[Foster's Mommy]

My sweet Foster was recently diagnosed with Adrenal Dep. Cushing's. He is 12 1/2 and other than Cushing's in great health. His weight has crept up from 86 lbs. to 94 lbs. over 4 months, despite being on Rx food for suspected allergies (cronic ear infections), no table scraps or treats:( Our vet started him on 180mg Vetoryl 1x daily. Last night was his 3 dose and I was extremely frightened! He was extremely lethargic and couldn't walk. I'm afraid he is getting too much, despite his weight. The vet office is closed for the long weekend and I want to lower his dosage. Any suggestions would be so helpful:) Thank you in advance.....I love him so much and just want him to feel better.


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[StarDeb55]

I'm so sorry that Foster is feeling so poorly at the moment. I regret the reason you found us, but very glad that you did.

Your vet is probably following the printed dosage instructions for Vetoryl which are 1-3 mg. per lb. Dechra who makes vetoryl really needs to update their printed instructions. We have had a number of members & their vets contact Dechra, & they are verbally recommending a starting dose of 1 mg/lb, & then adjust the dose upward, if needed. Univ. of Calif at Davis vet school which has done their own studies on vetoryl, now, recommends an even smaller starting dose of 1 mg. per kilogram. I'm guessing that you probably have 120 mg capsules, so you're really not going to be able to split those capsules to lower the dose as it's not recommended to open the capsule & handle the contents.

What will help us tremendously is to give us some of Foster's history? What symptoms was he suffering from that led you to take him to the vet? If you happen to have copies of all testing that was done on Foster, could you round them up, & post the results for us? If you don't have copies, please ask your vet for them. When posting those results, on general lab work, like a chemistry panel, post only the abnormals, along with reporting units, & normal ranges. We would also like to see the results of cushing's diagnostic testing. Does Foster have any other medical problems? Did your vet rule out diabetes & thyroid? The more information you are willing to share with us, the better feedback we can provide you.

Right now, you did the right thing stopping the vetoryl. Fortunately, vetoryl will clear from a pup's system in 8-12 hours, so Foster should be fine. I would give him no further vetoryl until you can contact your vet on Tues., explain what happened, & that you would like to lower the dosage.

Again, welcome! We are here to help in any way we can. I'm also going to try to locate our information on vetoryl dosing, & will post it for you when I can locate it. You may want to print it out so you can show it to your vet.

Debbie

[StarDeb55]

http://www.k9cushings.com/forum/showthread.php?t=222

Vetoryl information starts on page 3 of this link.

Debbie

[Budsters Mom]

Hello and welcom from me too:)
You have come to the right place! There are many K9Cushing's angels standing by 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. We will do all we can to help. Others will be popping in to welcome you also. So again welcome to you and Foster.

Hugs,
Kathy and Buddy:cool:

[Foster's Mommy]

Thank you so much for your response. It was a long sleepless night for us, the side effects of the Vetoryl seem to have worn off, just as you explained they would. I was given the 120 mg and the 60 mg capsules, combined to make the 180 mg dose. I don't want to stop any progress the medicine is making for his Cushing's symptoms. Do you think it would be safe to just give him the 60 mg pill 2xs daily until I can speak with his vet on Tuesday? I will give you as much info as I can regarding his symptoms and diagnosis.....
Foster began showing "symptoms" about 2 years ago. Very slight personality changes, pacing, panting and ear infections. He started distancing himself from the family, going outside to lay or to another room, or closet etc.. Then the next day would be glued to my side, I literally could not go to the bathroom or take a shower without him following me. The vet could not pin point anything from his bloodwork, nothing was out of range. His symptoms described above have gotten progressively worse. The heavy panting, crazy appetite, hind legs are weak and he stumles when he walks and general inability to get comfortable are his main symptoms. This lead ME to ask the vet about Cushing's, as I have been searching for an answer to his problems. Vet gave him the Low Dex. Test last week, after finding slightly elevated liver enzymes (I believe he said they were 186) on his senior panel. Nothing else was out of normal range. The Low Dex. came back positive. The vet did not give me a copy of the results, but I do remember a figure... "Elevated to 1.9...." Does that make any sense? I really want to do the right thing for my baby.... Any help would be great. I will ask for test results next week and post. Thank you so much! I'm thankful I found this board.

[StarDeb55]

Right now, I'm concerned that even 120 mg. may be too high. Based on the 2 dosing protocols, 1mg per lb would be 90 mg, 1 mg. per kg. would be only 45 mg. IMO, I would not give any more vetoryl until you can talk to the vet.

Debbie

[Harley PoMMom]

Hi and welcome to you and Foster,

Glad to hear that Foster is feeling better. Is Foster eating and drinking normally? Is he vomiting or does he have diarrhea? Besides the Vetoryl, is Foster on any other herbs/supplements/medicines?

Sometimes within 10 days of treatment dogs may go through what is called cortisol withdrawal syndrome, and simply withholding the Vetoryl will perk them up. But, unfortunately Hypoadrenocorticism (cortisol too low and/or electrolytes unbalanced) can develop at any dose of VETORYL, and since the symptoms can mimic cortisol withdrawal syndrome only an ACTH stim test can differentiate from the two.

Diabetes and Hyperthyroidism share many of the same symptoms as Cushing's, have they been ruled out? Getting copies of all tests that were done on Foster and posting any abnormalities that are listed would help us to provide you with more meaningful feedback, ok?

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

Love and hugs, Lori

[Foster's Mommy]

I will discontinue Vetoryl until I speak to his Vet:) He is eating and drinking normally and is on no other daily meds / herbs/ etc... I assume his vet ruled out other illness before coming to this diagnosis. He had a senior panel of blood work and nothing was out of normal range, except liver enzymes. I do not have the results in hand but will ask for a copy and post when I can. Thank you!

[Foster's Mommy]

No vomiting or diarrhea are present.... Just extreme lethargy and muscle weakness about 1 hr. after his last dose of Vetoryl last night. Those side effects are gone this morning and he is between bouts of resting comfortably and very heavy panting while pacing around the house and outside.

[labblab]

Welcome to you and Foster! I am so glad to see that you have already received excellent advice, and at this stage, I have to agree that it sounds as though this dose of Vetoryl is more than he can handle.

As Debbie says, it is very frustrating to us that Dechra has not updated their product literature to stress that in most cases, it is best to start dogs at the lower end of their initial dosing range. I am very relieved to hear that Foster is normalizing again after withholding the Vetoryl. I can certainly sympathize with how much you hate to see him panting again, but over a long holiday weekend without vet support, a rebound of Cushing's symptoms is preferable to a drug overdose. :o

If he truly seems back to "Square One" by tomorrow (meaning, back to exhibiting his pre-Vetoryl behavior with no lasting odd ill effects), if it were me, I might try giving him just the one single 60 mg. capsule -- no more. And if he remains OK, stick with that until you can consult with the vet again. But if he again has any issues at all, I would not give him any more Vetoryl whatsoever until next week.

To give you additional resource info, here's a link to Dechra's U.S. Product Insert for Vetoryl. As Debbie said above, please disregard the dosing chart and instead notice that the low end of the dosing range is a formula of 1 mg. per pound. But additionally, there is a lot of other helpful monitoring information there.

http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf

Please do keep us updated through the weekend, OK?
Marianne

[Foster's Mommy]

You all have been wonderful......Thank you so much for the support! I will keep you posted

[Foster's Mommy]

I picked up the results if Foster's LDDS Test this morning:
Pre: 3.8
4hr: 2.6
8hr: 1.9
Results of T4: 0.9
All the results from his senior panel were in the normal range, with the exception of ALT(SGPT) 148, Alk Phosphatase 185 & Amylase 1144. Urine test was fine, one level was borderline: pH 7.0.
To refresh: The vet put him on 180 mg 1xdaily and he "crashed" after his 3rd dose. Scared the death out of me. I discontinued the Vetoryl for a day. Started again on Monday, giving him 60mg. 2xdaily. Everything good. His main Cushing's symptoms are still present: Heavy Panting, Extreme Appetite, Pot Belly, Weak Hind Quarters, General Inability to get get comfortable, Lethergy / Decreased Activity.

I lowered his Vetoryl from 180mg 1xdaily to 60mg 2x's a day and he seems completely able to tolerate this dose fine. (He weights 94lbs) I am not seeing any real significant results from the medication in treating his Cushing's symptoms. I'm so worried about him..... I feel so alone in his treatment. If it were not for the support of this site, I'd be lost. Any input on his test results would be appreciated.

[Budsters Mom]

I love your avatar of Foster. He looks like one of the snuggly stuffed dogs in the toy store. I would love to sneak in for a cuddle!:D:D

Hugs,
Kathy

[Foster's Mommy]

Thank you.....he is such a sweet, loving dog. I just need to get him back to his old self and feeling better, so that he can enjoy life again.

[Trixie]

I agree with Kathy...Foster looks like a cuddly guy that's for sure. :p I don't know how long he is on the medication but for us it took over 4 weeks to notice a little decrease in the symptoms. We started on April 10 and just last week the water intake was finally down below 20oz and my dog Trixie weighs about 14 pounds, so even after all that time she is not down to normal drinking yet but it's coming gradually. Hopefully Foster will start to feel better soon. I was not very patient and expected to see a difference right away. Finally things are definitely changing for the better.. Hoping you will see good changes soon too!
Barbara

[labblab]

I am really glad that Foster seems to be tolerating the lower dose of Vetoryl without any more problems, and I, too, will be keeping my fingers crossed that you'll soon be seeing some symptom improvement.

And after looking at the LDDS results, I do want to tell you that I do not think you can know for certain that Foster has the adrenal form of Cushing's. LDDS testing can be tricky to interpret. Certain results typically signal pituitary Cushing's. But other results can be found with either form -- and I do believe that Foster's results fall in that category. You have not given us the laboratory "cut-off" for his test, but typically it is in the neighborhood of 1.5. When the 8-hour result is greater than the cut-off, the result is consistent with Cushing's. You then look further, and if either the 4-hour or 8-hour result is less than 50% of the resting cortisol level, then pituitary Cushing's is suspected. If neither of those criteria are met, the dog can have either pituitary or adrenal Cushing's, and further testing would be needed to differentiate (such as an abdominal ultrasound to actually view the adrenal glands to see if any tumors are visible).

Foster's overall result is consistent with Cushing's of one form or the other. But neither the 4-hour nor 8-hour result is less than 50% of his baseline result (although his 8-hour result is actually right at that 50% level). So I think the jury is still out as to which form of the disease he has. I don't know that this information is all that important to you, after all. But I just wanted to tell you about it. Here's a link to a professional article that explains the test interpretation even more thoroughly:

http://veterinarymedicine.dvm360.com/vetmed/Medicine/ClinQuiz-Interpreting-low-dose-dexamethasone-suppr/ArticleStandard/Article/detail/580093

Marianne

[Foster's Mommy]

Thanks for the input Marianne! I agree with you, my vet said he just " suspects" the Adrenal Dependent. I believe we would be treating the disease the same either way, so I guess that's why I decided not go any further with more testing to diferenciate. I was upfront with our vet and said if the was a large tumor, we would not want to operate given Foster's advanced age. I am very happy to hear that you agree with our vet's diagnosis and that his results reflect Cushing's. Not that I'm happy at all that he is sick, just happy to FINALLY have an answer as to what has been troubling him for so long. I've been very frustruated about his treatment for over a year. They (the vets) just kind of threw up their hands and said "Old Age.....Arthritis, etc..." I knew there was more to it.......I know my dog! Again, I'm so happy I found this sight and will continue to read the posts for encouragement, knowledge and support. I will contribute to other members as our journey into treating Foster's Cushing's continues and as he, hopefully, gets relief from his symptoms and can lead the happy quality life he so deserves.

[molly muffin]

Hi, just checking in to see you how Foster is doing. :) Hope all is well

Sharlene and Molly Muffin