17 yr old with bad reaction to Vetoryl

[Darryl]

My 17 yr old female jack russell...Bailey- was diagnosed a couple of weeks ago with Cushings... she was started on 30mg of Vetoryl and after her 10 day re test - an additional 10 mg was added in... she had started becoming very quiet for her at about day 6 of the start of treatment... once the additional 10 mg was started she vomited on occasion - became very weak - wobbly - and dull.... I talked with the vet today about splitting the dose - and giving half in am and half at night...there is such a huge difference between Bailey before Vetoryl in the morning and Bailey after Vetroryl I think I should wean her off the Vetoryl - try some other means to support her and let her really enjoy her last bit of time with us.... Has anyone weaned off or stopped Vetroyl and gone a different route? I have been doing some reading re herbs and other natural supplements....

[lulusmom]

Hi and welcome to the forum.

I'm traveling thru the desert with spotty service so only have time to tell you that you don't have to wean off of vetoryl. You simply discontinue dosing.

[molly muffin]

Welcome to the forum Darryl and Bailey.

Darryl, vomiting, weakness, lethargy, is all a sign of vetroyl over dosing. Please do not give any further vetroyl and have an ACTH test done immediately.

Do you have a copy of your last ACTH test, where they raise the dosage? If so can you please post the results here? Cortisol can continue to decrease on the same dose for 30 days or more even. The increase might have been too much for her. It certainly sounds like it. You never want to go to low with as you can end up in an Addisons crisis, where you actually need to give a rescue dose of prednisone and electroyltes can also end up being off and a trip to the ER and IV fluids could be needed.

If you also have any tests results from a CBC (abnormal high/low with range is all that is needed), initial diagnostic testing for cushings, like an ACTH or LDDS could you also print that out.
That information will help us to help you determine what is going on.

For now the important thing though is to immediately stop the vetoryl and have an ACTH done to determine if and how low she sent.
Optimally Dechra recommends that the post number be between 1.45 - 5.0 and up to 9.0 if symptoms are controlled.
Every dog is different though and you are looking for what keeps her feeling good and her symptoms controlled.
yes dosage can be split to a am and pm dose, but right now, you need to make sure that Bailey is okay, that is most important.

Sharlene and Molly Muffin

[Darryl]

Are these the results that you need ...
(Pre-ACTH Cortisol - 3.9; Post - 14.4)


Thank you for your replies...especially that I don't need to wean...just stop

[LtlBtyRam]

Welcome. I'm fairly new around here too. These folks are PAWSOME!
Angela

[Squirt's Mom]

Hi Darryl and welcome to you and your baby! :)

Please, do stop the Vetoryl. If she is not much better today with none of the drug on board, get her into the vet asap (TODAY) and demand another ACTH plus electrolyte check.

How much does she weigh?

Sweetheart, if the normal ranges for that ACTH are what we are used to seeing, your baby tested NEGATIVE for Cushing's and should never have been put on Vetoryl. For our own peace of mind, would you mind editing those numbers to include the normal range given by the lab?

Was this the only test given to diagnose Cushing's?

What prompted the vet to test for it in the first place?

Did she have any blood work done, a CBC or wellness panel? If so, would you post the values that were too high or too low along with the little numbers and normal ranges for each?

The more you can tell us about your baby the better. I'm glad you found us and look forward to learning more soon.
Hugs,
Leslie and the gang

[goldengirl88]

Darryl:
Welcome to the forum. I pray you stopped the Vetoryl. Your dog is probably going into or in Addisons. Please go to another vet. This vet should never have done that. I have a Jack Russell too. She was started out on 10mg of Vetoryl a day. I even sat at the park by my vets office for hours the first day she had so I could quickly go back if she had a reaction to it. That is way too much Vetoryl to start off with. You need to start low, let the dogs body adjust to the drug and tweak the dosage from there. You can't blast these dogs with a high dose right off the bat. I feel terrible this vet told you to do this. Don't go to him anymore please find someone who is familiar with treating Cushings. The dosage recommended by Dechra is 1mg per pound. So your dog was on twice the amount to start. You can call Dechra as they have vets there to help you and answer questions 866-933-2472 and get a file started on your dog. I am so sorry this happened to you. Jack Russells are very resilient dogs so when you get the right dosage I am sure things will be fine. Blessings
Patti

[addy]

Hi,

Are those ACTH test results from her latest test when her dose was changed?


Are these the results that you need ...
(Pre-ACTH Cortisol - 3.9; Post - 14.4)

[labblab]

Yes, please, do confirm whether these were the test results at the 10-day mark when Bailey's dose was increased by that extra 10 mg. From what you have written, it sounds as though the increase occurred around 4 days ago? If so, it is very unlikely that her cortisol has plummeted so quickly to a point that would actually be Addisonian. But it is possible that she is feeling really yucky from the lowering of her cortisol. It is also possible that she is reacting excessively to a lowering of her aldosterone -- another adrenal hormone that controls the balance between sodium and potassium in the body.

As the others have asked, I am wondering whether her basic blood chemistries were checked at that 10-day mark along with the ACTH. If not, I would probably be more concerned about them right now than I would be about her cortisol (if I am correct in my guess about the timeframe and the ACTH testing).

Dechra (manufacturer of Vetoryl) generally recommends that the initial dose not be increased during the first thirty days of treatment. This is because the cortisol level can continue dropping while being maintained on the same dose. If those ACTH results were indeed at the 10-day mark, then the initial 30 mg. dose does not seem excessive regardless of her weight, but it probably would have been wiser to hold off on the increase, especially since Bailey was acting subdued.

So what you do moving forward really will depend on the timing and nature of the previous monitoring test/s. Given her vomiting, I cannot disagree at all with stopping the Vetoryl until you get things sorted out. But as to what additional testing you need right now, it will help us a great deal if you will elaborate more on her complete testing history.

Thanks so much,
Marianne

[Darryl]

Thank you all so much for you knowledge and information…..
I hope the following helps......

In August of 2012 Bailey had pancreatitis so we routinely monitor her blood work -
Blood work early August 2013 revealed things that were elevated and we were concerned about diabetes:
liver values (ALT - 462, ALKP - 2321, ), hyperglycemia (285), hyperkalemia (6.4), and elevated BUN (33)

Our family vet set up an appointment and we went to internal medicine specialists for an exam and found:
A glucometer measurement was normal at 154 mm Hg. A urinalysis demonstrated a specific gravity of 1.020, pH -
5.5, 1+ protein, and trace glucosuria. A urine culture is pending.
A fructosamine assay was within reference range (324). A Chem 11 demonstrated elevated liver values (ALKP -
2686, ALT - 389, BUN - 38, Creat - 1.5, and mild hyperglycemia (160). A spec cPL was within the upper limits of
the reference range at 197

A few days later we went back for more tests to determine if she had cushings and found:
A glucometer measurement was normal at 104 mm Hg. An ACTH stimulation test was performed and demonstrated
changes consistent with hyperadrenocorticism (Pre-ACTH Cortisol - 5.1; Post - 26.6). An endogenous ACTH level
was elevated at 15.1, consistent with pituitary-dependent hyperadrenocorticism (PDH).

She was put on 30mg of Vetoryl and after 10 days was rechecked and found:
A glucometer measurement was normal at 110 mg/dL. An iStat Chem8 demonstrated normal sodium and potassium
values and a mild elevation of BUN (28) with normal creatinine. An ACTH stimulation test was performed ~ 4.5
hours after trilostane administration. The test results were improved but demonstrated sub-optimal control of
hyperadrenocorticism (Pre-ACTH Cortisol - 3.9; Post - 14.4).

Following the above results was when it was suggested to add in 10 additional mg of Vetoryl in am….she has not tolerated this well and had five days at 40 mg a day - When I say not tolerating it well she seems to become very foggy, dull, disinterested and has vomited twice over the five days. - By the afternoon of each day she seems to come out of the fog.
Yesterday i only gave her 20mg in AM and she did not seem as foggy - I gave her a 10 mg at night before reading that I should stop the meds….
Last night with only the 10mg she was her bright self and enjoyed her evening….
This morning she is bright and involved in the day…...

[Squirt's Mom]

~~whew~~ I'll stop chewing my nails now. :o I thought the ACTH posted first was the one for diagnosis and just panicked! One of my many talents, btw. ;):D

This is great info and I know our Vetoryl parents will be along soon to chat with you. I'm off to get bandages for my fingers. :p

[goldengirl88]

Darryl:
Please do not give her the Vetoryl until you get this all sorted out. There is nothing wrong with starting her on 10mg. As I said I have a Jack Russell and she started on 10mg. I would not let the vet start her higher, I told him absolutely not. I thank God every day that I did what I knew was right. Please leave her on the 10 mg. Until you get this all straightened out. I am surprised and shocked that she would be on 40mg at 17 years old you are very lucky she is still here. Please I urge you to listen to the people on here they know more than the vets. Keeping her on the 10mg until the next ACTH is what I would do. Please , please use caution these are powerful drugs. Please call Dechra please, please, please 1-866-933-2472 they have vets there to help you. Blessings
Patti

[Darryl]

Thank you for the input...

Today with the 10mg Bailey had a delightful day and I did too...She was back to being alert, cheerful and involved with the office staff...
I am optimistic....Thank you

[molly muffin]

So very glad to hear this!!! :)

Yep, sometimes an increase really isn't needed. Glad to hear that Bailey is doing so well on the 10mg.

Sharlene and Molly Muffin

[labblab]

I'm so glad to hear that Bailey is doing better, too. It seems likely to me that she will ultimately need a higher dose in order to control her cortisol level adequately. But there is nothing wrong with starting off at a lower dose and increasing more gradually. Dogs can suffer from "cortisol withdrawal" when the level is lowered too quickly. This is not a true Addisonian condition, but the dogs can still feel quite poorly from the side effects of the rapid endocrinological change. It sounds as though this may have happened to Bailey, and that she'll feel better if her dose is increased more slowly.

Marianne

[goldengirl88]

Darryl:
I was relieved to get on here this morning and see that Bailey is doing well on the 10mg. She may need her dosage tweaked later on but I would go with the 10mg for the first 30 days and get her tested to see where her numbers are. I think Marianne is right it probably does shock the endo. system in dogs. So glad to hear things are going well. Blessings
Patti

[Darryl]

I just want to update all you wonderful folks who gave me guidelines to follow with Bailey.... she is doing wonderfully on the 10mg Vetoryl... Happy and bright and enjoying her day..

Will the symptoms like water intake and appetite dictate when we need to introduce a stronger dosage or is this something that is a MUST to have fine tuned by testing at the Vet?

With her being 17 - I want to have quality of life and enjoyment of her days, the priority as we move forward.

Thank you all again.....:)

[Trixie]

So glad Bailey is doing so well! You must feel great about that. Certainly an increase in symptoms would be something to check. At some point you should have a follow up acth just as a safeguard.
I don't know when your last acth was...so if all stays good with Bailey you can probably give it a few months from the last one.
Hope she continues feel so good! :) At 17 she deserves to have the best quality of life!

Barbara

[molly muffin]

Yay Bailey. :) So glad that she is doing good. Now you know, you don't want to increase by that much again, because it isn't going to be good for her. Perhaps smaller one in the future if needed.

Is she still exhibiting the excessive drinking and peeing symptoms?

So glad you came in to let us know how things are going. :)

hugs,
Sharlene and Molly Muffin

[goldengirl88]

Yahoo!! I am so pleased that Bailey is doing well. I think what will be next is the ACTH test after this dosage has been used for 1 month you get them tested. Then any tweaking of the drug will be done if necessary after getting the results. You are doing a great job so keep it up. Blessings
Patti

[spdd]

Great news.. glad to hear this.

[Squirt's Mom]

So glad to see this great report, Darryl! I know your Heart is Singing today.

[Darryl]

Bailey continues to have good days ..... And I keep reading about options... What about using an adrenal support, melatonin and flax lignans, in order to keep her on the lower dose of Vetoryl.....
Does anyone have any experience with blending treatments- thank you all for your guidance -

[molly muffin]

Hi Darryl, do you think that the cortisol is creeping back up?
I'm not sure about blended treatments. I know that some use the melatonin for calming (like during storms, etc) but don't think it works more than just a little bit on cortisol levels.

I'm glad that Bailey continues to have good days. That is excellent. Remember, what is right for Bailey is what matters. As long as she is good at this dose, that is what is important.

hugs,
Sharlene and Molly Muffin

[jrepac]

Wow.
I'm no expert on Vetoryl, but seeing that ACTH test come back after Vetoryl treatment at 14.4 post reading, I'd really question that increase in dosage. Sounds like your vet is trying to manage the levels down more precisely/perfectly, but this is NOT helpful if the extra Vetoryl is making her ill. It's kind of like people w/blood sugar; some doctors want it to be at a very exact, low level. But when the patient gets there he/she may not feel well....and actually feels better when the levels are a bit higher (not excessively mind you, but a bit higher than normal).

Every dog responds differently to treatment and a big part of this is controlling symptoms and making your baby feel better. It's not a science challenge for your vet to conquer, so sometimes you have to use your best judgment and ask your vet to be less aggressive.

many of us have used melatonin and flax/lignans as a supplemental treatment; I believe you can use them in conjunction w/Vetoryl...I'm sure someone will weigh in on that for you. Every little bit helps sometimes. But be careful of the various drops and naturall remedies; many/most don't do anything unfortunately. May not harm, but may cost a lot of money and do nothing. Melatonin and flax/lignans have at least been found to have some marginal impact on the disease in scientific studies.

One other possible supplemental remedy that I've not yet seen tested is rhodiola rosea. From what I've read about it, it should have a beneficial impact on cortisol levels, but unfortunately no one has tested it on canines with cushings. I had added it to my daily cushings treatment mix, but as I say, it was largely unproven. I take it myself too since it's supposed to help regulate stress levels in the human body.

But, glad to hear Bailey is a happy camper now at the lower dose!

Best of luck to you.

Jeff & the Girls