Angel - Vetoryl, loss of appetite

[Sabina]

Hi everyone, my dog Angel, who will be 16 in December was diagnosed with Cushings after the vet did an ACTH test on her and started Vetoryl April of this year. Angel had been drinking a lot of water, peeing a lot, incontinent during the night and eating hungrily (which is one symptom I did not mind at all). Angel weighed about 30 kgs at the time and the vet started her on 30mg twice a day. About 3 weeks into treatment, Angel started with persistent diarhoea and we reduced the dosage of Vetoryl to 30mg once a day, adding probiotics and boiled rice. ACTH testing at the end of June showed that her cortisol levels were well controlled and we were on a good dosage of Vetoryl.

However, early July, Angel started losing appetite, her arthritis symptoms became strongly evident, she had no energy and we suspected that the Vetoryl might be taking its toll so the vet agreed we give her 30mg every alternate day. Angel felt better, she started eating again and moving around more comfortably but ACTH testing at the end of August showed the dosage of Vetoryl wasn't sufficient. Her cortisol levels had risen again and her ALT and ALKP levels were also high. Angel did not however become incontinent at this dosage.

So back we went to 30mg of Vetoryl once daily. Over the last week, Angel has been losing energy, she finds it hard to get up from a sitting position and soon after she eats, she has to sit for a while before she can actually get up to drink any water. She has difficulty going up stairs and keeps pausing after every two steps like she has no energy at all to go any further. For a few weeks now I have had to add various appetising titbits to her food to whet her appetite but over the last 3 days she has started to lose appetite completely no matter what I add to her food. Even trying new foods hasn't made any difference. I am quite at my wits end trying to figure out how to help her. She needs the present dose of Vetoryl she's on but have no clue how to manage this present crisis. Would appreciate feedback from anyone who has been through similar circumstances.

Thank you
Sabina Ricci

[frijole]

Sabina welcome and glad you found us. The original dose was too high which is why you saw the diarrhea - it is a sign of overdose.

Giving trilostane/vetoryl every other day is not an option. If the 30 mgs was too high then you should have switched to 20 mgs a day. The way that the drug works is that it only stays in the system for hours so to withhold it and give it every other day you were playing havoc with her system (cortisol high then low).

Going back to the dose of 30 mgs where you had problems with lethargy seems to me to be no surprise that you are back to having problems.

First off - we really need actual acth tests done at each of the three dosing amounts so that we can tell what the cortisol was doing. Without that info we really can't help a great deal so please get us that info.

Second - it would appear you live outside the US. Can you tell us if 20 mg pills are not available to you? Because that would appear to me to be the most logical next step.

Here is info on the drug for you to read - look for the symptoms of low cortisol and no doubt you will understand why your baby hasn't been feeling well. You might also want to treat the arthritis if you aren't already - the cortisol from cushings' naturally treats it so when you lower the cortisol with the vetoryl it is expected that the arthritis will show up.

Kim

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

[goldengirl88]

Welcome to the forum. Sorry you and your Angel are experiencing problems. Firstly could you please post all the abnormal readings on all the tests you have had done to diagnose Cushings. It would seem your vet is not familiar with treating Cushings from what you have said. The dosage was too high, and you said nothing about treating the over dose with prednisone. That leads me to believe your vet did not give you any which is totally unacceptable. What breed of dog do you have? You are starting off with too high of a dose. The dog will do a lot better if you start with a low dose. If it needs any adjustment they can be made after the ACTH test. If it were my dog to get this mess straightened out I would first get all copies of all the tests your vet did. I would want to know that they were done following the protocol for each. I would put my vet in touch with Dechra so he gets up to speed on what he is doing wrong, and what needs to be done. If in fact you do have a true diagnosis of Cushings I would want an Ultra Sound of the adrenals etc. I would start my dog on a low dose 10mg and see how the dog progresses from there after the first ACTH which would be done after starting the drug and consistently using it. I would see if adjustments are needed after the ACTH. Your vet is completely missing the boat here. This needs to be consistent, in order to control the cortisol, that means 10mg a day or 10 mg 2x a day in a split dosage. Splitting the dosage can help control the symptoms all day long if the 1st 10mg is not working. So I would do 10mg a day for a few days to see if that is enough. If the symptoms persist then you can go to 10mg twice a day, 12 hours apart. Before you do any dosing get prednisone from your vet, it is important and can save you dogs life. Be vigilant in watching for signs of trouble, lethargy, unable to get up, vomiting, diarrhea. That is when you give the tablet of prednisone and go to the vets immediately to have electrolytes etc. checked. I am just really disgusted at the vets giving this Vetoryl dose like it was candy, and not supplying any prednisone, it is totally irresponsible. If you start you dose low, the dog will have time to adjust to the drug with less of a chance of problems. Please post the results and just know the people on here will help you through all this, they are more experienced at this than vets who don't even understand how to treat the disease. It will all be fine if you follow what you should be doing. I wish you and Angel good luck. Blessings
Patti

[lulusmom]

Hi and welcome to the forum.

Excessive levels of cortisol, the hallmark of canine cushing's, acts as a very strong steroidal anti-inflammatory and once cortisol is reduced with effective treatment, the pain of arthritis is unmasked....and it can be debilitating for some dogs. If the acth stim test showed a post stimulated cortisol within an acceptable range when dosing once daily and appetite improved when switching to every other day dosing, that's pretty good evidence it may be arthritic pain that is killing Angel's appetite. Trilostane is short acting, the effects wearing off any time after nine or so hours. If dosing every other day, cortisol is allowed to climb unabated for many hours and you would definitely see an anti-inflammatory response. Is Angel on any arthritis meds and/or supplements? If not, this is something you should discuss with your vet. The goal of effective treatment is to remedy symptoms and mitigate chronic advere effect on internal organs so as Kim mentioned previously, every other day dosing is not going to be effective in reaching this goal.

Also, some dogs simply can't tolerate Trilostane but I think your vet needs to rule out other obvious causes like arthritis before prescribing an unorthodox and mostly ineffective dosing regimen. Tramadol, adaquan injections and joint supplements, such as Cosequin are definitely worth considering. At 16 years old, quality of life is definitely an issue so IMO, if Angel is suffering from severe arthritis, an NSAID such as Metacam might be considered as long as cortisol is well controlled. I have a very elderly Cockapoo rescued from a shelter with severe malnutrion, fused disk in her back and severe arthritis. It wasn't until I put her on Metacam that she became more active and wanted to eat more. NSAID's can have horrible side effects for some dogs but it can improve the quality of life immensely for the majority of dogs who require it to remain mobile.

Glynda

[molly muffin]

Hello and welcome.

It's a delicate balance when you are dealing with a 16 year old with arthritis, as Glynda has mentioned.

Kim also made a very good point, 30mg a day is too much and you see the same symptoms come back of lethargy, etc. I agree 20 is a better option. You are looking for the correct dosage to control cushings symptoms but not let the pain of arthritis take it's toll either.

Does your vet deal with a compounding pharmacy at all? They can compound trilostane into any amount that is not made by Dechra (the makers of vetroyl).

Also as the others mentioned, posting the test results will allow us to give you better feedback.

Welcome again
Sharlene and Molly Muffin

[LtlBtyRam]

I'm sorry you had to look for these forums. The folks around here are PAWSOME. I'll be watching for more updates on your Angel.
Angela

[Sabina]

Thank you for all your warm supportive responses. I am just doing up a list of all Angel's liver values and ACTH tests over the past months and will post them soon.

In the meantime, just a thought that occurred to me last night.... Angel underwent a small eye surgery on 06 September. Following that she had some anti inflammatory medication for a few days when she accidentally twisted a leg whilst coming in to the house. I then gave her more of the same Previcox just for a day last week when she seemed to have a very stiff painful back following a very very wet continuously rainy week. And over the last three weeks or more, I have been adding various "flavours" to her food as well as trying to change her over to a new food. Well, could she actually be suffering from stomach acidity and nausea after all that, which in turn was causing her lack of appetite?

So we acted on it this morning. She had some sucralfate to start with at home and then we went to the vet where she was given a shot of Ranitidine. More sucralfate this evening and more ranitidine if she's better. We wait to see how she responds in the next 24 hours, please keep fingers crossed......

Sabina

[Sabina]

Angel's History

Angel started with liver value tests in January 2013. Vet first suspected liver problems so she was put on Denosyl and monitored until March when the vet began suspecting Cushings as her ALKP readings continued to remain high.

11 March: ALKP: 356u/l , ALT: 47 u/l
20 March 2013: Basal Cortisol: 2.4 ug/dl, Post ACTH Cortisol: 33.2ug/dl

28 March 2013: Abdominal Ultrasound done which revealed enlarged left adrenal gland with tumour.

04 April 2013: Started Vetoryl at 30mg twice daily. Diarhoea 3 weeks later so switched to Vetoryl 30mg once daily.

14 May 2013: Basal Cortisol: 5.2 ug/dl, Post ACTH Cortisol: 10.3 ug/dl, ALKP: 438.6

30 May 2013
ALKP: 396 u/l, ALT 64 u/l

Continued with Vetoryl 30mg once daily.
19 June 2013: ALKP 335u/l, ALT 32 u/l
20 June 2013: Basal Cortisol 3.5 ug/dl, Post ACTH Cortisol: 8.2 ug/dl

Great results so decided to continue with 30mg Vetoryl once daily.

BUT early July Angel lost appetite, arthritis got worse, no diarhoea however, and this was when we made the mistake of switching to alternate days of 30mg Vetoryl once daily as per vet advice.

31 August 2013: Did a full geriatric blood panel and ACTH test.
Basal Cortisol: 7.5 ug/dl, Post ACTH Cortisol: 24.8 ug/dl, ALKP: 319 u/l, ALT: 95.3 u/l

We then reverted to Vetoryl 30mg once daily again. Angel then had eye surgery on 06 September followed by some days with anti inflammatory medication. Angel's appetite slowly got worse, to the point we are today where she is not wanting to eat at all.

Yesterday's Ranitidine shot helped a little, she managed to eat a tiny quantity two hours later at 1.45pm, and a nice quantity at 4pm. However, I gave her Ulcermin (Sucralfate) as the vet had asked me to at 7pm before her food and that blocked her appetite and she ate only a very small quantity.

This morning, she did not want to eat again so the vet had asked me try Ulcermin which I did but I guess Angel is not good with Ulcermin and she threw it up along with some bile. She does not have diarhoea, her arthritis is not too bad, she has been able to walk around the garden over the past days. But she lacks energy to rise up and go up stairs. This morning she was the worst ever trying to go up the staircase, we did one step at a time.

The bottom line is I am new to Cushings, I don't know what to expect, what is considered "normal" with the disease and when to raise the alarm. I do know that my little Angel is not well right now and I am not sure if its the Vetoryl or another problem that we need to investigate. We don't have any other symptoms to go by at this point.

Would appreciate your thoughts and ideas.

Thank you
Sabina

[frijole]

Sabina what is bothering me is that both times you made a switch in dosing your vet didn't do an acth test. If I follow your timeline you had issues at the 60 mgs per day and reduced it but you should have had an acth test to make sure she wasn't too low based on those symptoms. Then when it was decided to dose every other day (a big no no) there was no testing done. It appears to me that the 30 mg/day was doing the job but that perhaps something else was causing the inappetence but you were told to half the dose!

It is normal for a dog to have arthritis issues when cortisol is lowered. Have you done anything to help the arthritis? Adequan shots, tramadol?

Have you googled the drugs you are giving for the eye issue to see if they cause appetite issues? Just a few thoughts. Kim

[Sabina]

Kim, thank you for your thoughts. Every time we changed dosage, we went for a while on the new dosage like a month or so and then did an ACTH test to evaluate how Angel was doing on the new dosage. That is why since her last test at the end of August, we put her back on the 30mg once daily Vetoryl dose (as her levels had increased again).

We did more liver value tests on September 23, 2013, the results were: ALKP 422 u/l , ALT 64 u/l. Also repeated her glucose then and it was 82 mg/dl.

Regarding her arthritis, for all who asked, we have tried Cosequin, Omnicondro and a homeopathic remedy called Homeopet Joint Stress over the past years. They did not make much difference and she could not tolerate Cosequin or Omnicondro for a very long period. I have also tried Omega 3 and Fish Oil concentrate capsules but she would lose her appetite with these. I feel she is not too bad at the moment with her arthritis, she has up until two days ago been able to go for short walks with me or wander through our large garden picking up interesting tit bits such as rotting worms or bird poo or grass lumps from the lawn mower which yes, could cause a stomach upset and lack of appetite as a result. She did have a spot of diarhoea recently after eating grass lumps but that resolved in a day with a probiotic. They have never taken away her appetite though in the past and left her without energy.

We only use a lubricant gel (Liposic) for her eye now, as maintenance, a product we have used for the last couple of years, I don't think that this would now actually affect her appetite in any way.

Oh, its a hard one to figure out, but please keep the thoughts coming.

Sabina

[frijole]

Sabina, Just so you know - doing the acth test AFTER the increase is not following the protocol set for the drug. For example when you went from 60 mg to 30 mg the cortisol could have been so low that even at 30 mg Angel could have overdosed / gone Addisonian.

Dose changes should be made based upon the acth test results. Your vet is switching doses and then monitoring. This is asking for problems. Kim

[FemaleK9]

Also, has your dog been fasted before the ACTH tests? If so, this could give falsely high results, leading to unneccessary and dangerous increases in dose.

[Sabina]

Kim, thank you, I will bring that up with my vet. Angel is going more and more downhill and its obvious its not a gastric problem after all. Ranitidine did not help to improve her appetite at all and she ate less than three quarters of a can the whole day yesterday.

In fact the vet and I just discussed changing Angel's dosage to 10mg from tomorrow as the medicine will be delivered to the clinic this afternoon. Angel is very weak at the moment. As much as an ACTH test is indicated right now before changing doses, would it be okay to do it?

Also, as Karen pointed out (thank you Karen) would it give us false readings because Angel is as good as fasting (she's been eating hardly anything) right now?

Sabina

[Sabina]

Karen, up until now Angel hasn't fasted before any ACTH tests so we've been okay there in the past. Its only now, she's almost as good as fasting.

Sabina

[spdd]

Just want to let you know that I'm thinking about you and Angel.

[Squirt's Mom]

Please don't give this baby any more Vetoryl for now, please. Have the ACTH done asap to see where her levels are FIRST. I am concerned she is over-dosed and the only way to tell is with the ACTH. So don't give that new dose of Vetoryl until you know what her cortisol level is now, ok?

[Sabina]

Okay, so Vet has agreed with suspension of Angel's Vetoryl for at least a week to evaluate. She says that if Angel picks up energy and appetite we can be sure its the Vetoryl and not something else causing this crisis (due to Angel's age). Angel missed a dose of Vetoryl day before yesterday because she didn't eat so Vet thinks ACTH now would give us inaccurate results. But she agreed with checking cortisol level in her urine this afternoon.

Well, I'm happy enough stopping the Vetoryl for now, I hope Angel starts eating and regaining muscle energy. She ate only a tiny bit of chicken breast this morning and one egg. Refusing any kind of canned or dry dog food for now.

Sabina

[Squirt's Mom]

She needs an ACTH and to have her electrolytes checked asap. Your vet is off the mark by not doing one now to see if her cortisol levels are too low. That can be a life-threatening situation and the ONLY way to know is via the ACTH. If the cortisol is too low and the electrolytes out of balance, Sabina may well need medication to help her recover until the adrenals are functioning properly again. Please insist the vet do an ACTH and electrolyte check instead of the urine test.

[labblab]

I agree with Leslie that Angel needs blood testing ASAP. If not a full ACTH, at least a simple resting cortisol in addition to basic blood chemistries. As long as Angel's resting blood cortisol is higher than around 2.0 or so, the odds are that her cortisol has not dropped too low. But her potassium and sodium levels could still be out whack even if the cortisol appears to be high enough. I don't understand why your vet is fiddling around with a urine sample when the additional info that you need requires a blood draw. If you are willing to pay for the testing, why is she reluctant to perform it?

Marianne

[Sabina]

I think because of time differences I am reading posts later than I'd like to.
I took a sample of Angel's urine to the vet yesterday and asked her again about ACTH. She said she could do a simple resting cortisol test and I let it go yesterday not having read your posts until early this morning (my time). Well, we also spoke briefly about Angel's difficulty rising and doing stairs etc and the vet asked me to give her rehydration fluids. We have always routinely done electrolytes and kidney values along with liver values in the past, don't know why vet didn't mention doing that now when we most need it!

Angel was eager to eat tiny quantities of rice and chicken by yesterday evening which was good but is walking very stiffly and with great difficulty on her back legs (they were not arthritic in the past, just her front legs were and those seem to be okay). Will be doing more rehydration fluids today and hope that helps. This back weakness and unable to rise or do stairs just one at a time with such difficulty came on suddenly on 08 October. Is that typical with low cortisol and electrolyte levels? Could the gastric meds she had have made it worse in some way? She was losing appetite on Sunday but her legs were fine....

Sabina

[Sabina]

Just a little background, we are also checking Angel's urine because she has been prone to more frequent urinary infections since she developed Cushings.

[Sabina]

Have an appointment for blood tests in an hour and a half, vet has agreed to do resting cortisol, electrolytes, kidney and liver values.

Will post later.

Sabina

[Squirt's Mom]

Oh, YAY! Way to go, Mom! Our babies can't speak for themselves so we have to speak for them and you were a good advocate to get the vet to do these tests. Let us know what you learn!

Hugs,
Leslie and the gang

[spdd]

Glad to hear you got the testing.... the experts here will sure be a great help if you post the abnormal values if there is any.

[Budsters Mom]

Anxious to find out what the tests show and thrilled that you got them done.:p You did great mom! The more you learn, the more comfortable you will feel when dealing with vets. You Know Angel better than anyone, therefor you will always be her best advocate. Way to go!:D xxxx

[Sabina]

Thank you Leslie, Judi, Kathy. Yes, I feel relieved too getting more info to go by when dealing with Angel's present crisis.

The vet called me yesterday to let me know that her kidney and liver values except for ALKP were all normal. The UCCR test came back with a value in the 80's she said. We are now waiting for electrolyes, resting cortisol and thyroid.

Angel was hungry after the visit to the vet (but that seems to be the case with all my dogs and is shortlived). Not sure if the rehydration drink she had in the morning had something to do with that too. She didn't want her regular food however so ended up eating a little of two different cans but that was it. She had a tablespoon of more canned food around 5pm and then just 2 biscuits and 2 tiny Orijen treats at night. That's about all she could manage the entire day. She is sleeping a lot suddenly....

Am starting to worry there may be more going on than meets the eye with Angel but waiting on the rest of the results for now. Will post exact numbers when I get them.

Its so comforting having all your support at this time, thank you to everyone.

Sabina and Angel

[molly muffin]

Well that is good that everything other than liver was normal. Lets see what the rest shows. :) hang in there!

hugs,
Sharlene and Molly Muffin

[Sabina]

Angel's results as follows
BUN: 11
CREA: 0.9
ALT: 40
ALKP: 399
UCCR: 85.9
Resting Cortisol: 7.4
Chloride: 109.6
Potassium: 5.1
Sodium: 152.9
Thyroid readings:
T4 total: 0.80
TSH: 0.55

Angel's T4 is low but the lab missed out on the Free T4 test. We need to go back Monday to give more blood for that test. Angel does not show signs of hypothyroidism really and she is seeming brighter since yesterday afternoon, managed to eat 4 tiny Schesir cans through the day and although she is with stiff back legs, she wanted to walk a bit more and check out some interesting smells in the garden and outside as we walked around the house to take another entrance because she cannot manage steps right now.
Aren't thyroid values usually low when a dog is sick?
Is it the suspension of the Vetoryl that's helping her? We will do the Free T4 test and then evaluate thyroid. When vet examined her a few days ago prior to drawing blood, she noticed that Angel seemed to have some lower abdominal pain which we thought could be due to an urinary infection but her urine test has come back with nothing specific and no crystals either. We are awaiting results of a urine bacterial culture currently being done just to be sure.

Well, that's our news for now. Will post more as I know.

Sabina and Angel

:

[Sabina]

I was just reading information on Vetoryl (Dechra) from the link that Kim sent me. Okay tests seem to show that Angel is fine with her cortisol levels BUT listed in that article under "Adverse Reactions" are some of the symptoms that Angel's been presenting lately ie. lethargy, weakness, inappetence/anorexia, musculoskeletal signs such as lameness in her back legs. A routine ECG was performed on Angel prior to her recent eye surgery and a small mitral valve dysfunction was discovered which doesn't require medication yet, but is to be evaluated in a year's time. I don't know if this was a natural age related degeneration or brought on also by Vetoryl.

When Angel first started on Vetoryl, she was bright and happy and energetic and stayed that way for the first 3 months or so. She progressed to drinking less water and her nocturnal incontinence disappeared over time. But, some of the "not so good signs" she developed after she started Vetoryl were, a jerking of her left back hind leg during the day whilst walking etc (neurological?), a jerking of her front leg or muscle tremor whilst she is sleeping, a calcium deposit on her gums which we had removed whilst she underwent eye surgery in September.

Loss of appetite etc. presented itself at the end of 3 months into Vetoryl early July when we reached a good level of cortisol in her blood at a dosage of 30mg once daily, and now we're there once again with more pronounced side effects such as lameness/stiffness in the back, weakness, etc at the same dosage maybe because we stayed on that dosage longer before suspending.

The diarhoea she presented 3 weeks after she started Vetoryl (at 30mg twice daily) was resolved with a reduction of her dosage then.

She has only had diarhoea once last week and I put that down to her eating dry grass lumps that came off the lawn mower (although I give her a daily probiotic and am not sure if that masked any diarhoea). The only episode of vomiting that she had last week was after she had the Ulcermin so its likely due to that.

Am so uncertain where we stand.....we have a week or so of Vetoryl suspension to run tests and see if there is any other likely cause of Angel's present symptoms hoping that these symptoms resolve in this time.

Have any of your dogs presented similar or other side effects of the Vetoryl? How have they been managed? Has anyone had to suspend Vetoryl periodically for side effects to resolve? And then go back to the Vetoryl on a lower dosage?

Would appreciate feedback.

Thank you
Sabina and Angel

[Sabina]

We finally have proof of Angel's urinary infection despite a "no comment" report from the lab. Yesterday, she had loads of blood in her pee and we started antibiotics immediately. May have to give some anti inflammatory today as well if blood doesn't disappear. Still waiting on bacterial culture report.

Her appetite still continues to be very poor. She's eating just very tiny quantities and seems to enjoy any food for only a couple of days before going off it again. Its getting harder and harder trying to find something she'll eat and I think with all the changing, she's developed some colitis in the process. Still tired and weak too....

Sabina and Angel

[molly muffin]

I'm glad she is on a good antibiotic. It will take some time for that to sort out and she'll feel pretty yucky during it. (been through this with my dog too). Try just doing some cooked chicken (i use ground chicken and mushy rice) and see how she'll do on that. My dog loves that stuff and a bit or probiotic wouldn't hurt, like florafora, in case of the colitis possibility. Keep her on this for a while. I always cook the rice with more water than recommended because it's another way to get water into them and keep them dehydrated. I know there are cranberry pills that can be given to dogs too that have UTI's. So, another thing to look into. I think Rosie's mum is giving her cranberry, since she's had UTI.

Hang in there!
Sharlene and Molly Muffin

[FemaleK9]

... I think Rosie's mum is giving her cranberry, since she's had UTI. ...

I am! I'm giving Rosie Pala-Tech™ Canine/Feline Cranberry Plus Chewable Tablets (http://www.amazon.com/gp/product/B00296590Y/ref=oh_details_o00_s00_i00?ie=UTF8&psc=1) that I order through Amazon. The seller does ship to Portugal, but the shipping charges are apt to be expensive.

I would check with the vet before starting Angel on it though; my vet wanted me to wait until the antibiotic course was done, so I started it on the day after her last dose of antibiotic. I give Rosie (Beagle, 32 lbs) one tablet a day in her middle (non-Trilostane) meal. It's only been about 3 months, but there have been no further problems with UTIs in that time.

[molly muffin]

Ahh hhaaa Karen! My memory isn't completely gone yet! Thanks for seeing this and filling in the information.

hugs,
Sharlene and Molly Muffin

[Sabina]

Feeling terribly down and worried at the moment.....Sunday was a very stressful day. Angel did not want to eat anything at all.

I used to give Angel mushy rice and chicken initially and she would clean her bowl but she went off it and that's when we tried various canned foods. Well, yesterday, we tried chicken and rice again, sweet potato and chicken, different cans, cans, cans, dry food, soaked dry food and nothing appealed to her.

Finally got through the day with boiled eggs, little biscuits and Orijen Tundra treats. Squeezed in a B-Complex with C to offset the effects of the antibiotic and it seemed to give her more energy but did nothing for appetite.

To top it all after getting in her antibiotic at dinnertime with another egg and biscuit, she ate just a tiny bit of grass in the garden and threw everything up an hour later.

Will be doing antibiotics by injections at vet starting today. Angel's just not eating. Thyroid Free T4 test is on hold until she's done with antibiotics to avoid any wrong readings.

Thank you Sharlene and Karen for the cranberry info, will certainly check that out.

Re probiotics, Angel has had one almost everyday since starting Vetoryl along with plain mushy rice mixed into her dry food as she was prone to soft poo or tiny flecks of blood in her poo. Vet thought it would help her adjust to Vetoryl and it did stabilize her poo. Have just held off probiotics since starting oral antibiotics but since she's going to get antibiotic shots, have restarted the probiotics this morning.

Worried about my baby, is she going to come through this or are these signs that she is getting ready to leave? She is one of three puppies from the same litter born at home in our guest room. I lost her sister in December 2012 and then her brother in June this year. She is the last one left with me and my heart breaks at the thought of losing her....

Sabina and Angel

[spdd]

I wish I could help you, but unfortunately I have no solutions for you.

It has become the norm at my house that Keesh will eat well for a couple of days then nothing for another couple of days. I have become a gourmet cook for this dog and what he loved one day, walks away from it another. I don't know if it's part of the aging process in my dog, but I've gotten to the point that I just leave the food down and he can have it when he wants it. Yesterday he didn't eat at all and hardly drank and yet last night he figured it was time to play, came bouncing into the room waving a sock in his mouth. I thought he was having a bad day and yet by night time he was playful. All that and without food for the day.

It is frustrating, scary and worrisome to say the least, but I just take it a day at a time, hopefully you can too.

[Squirt's Mom]

Sometimes the antibiotics can make them sick at their tummy and make them lose their appetite as a result. You might ask the vet about something for nausea to see if that helps her eat better. There is a product in the US called NutriCal or NutriStat that is a vitamin and mineral supplement for pets who for whatever reason can't or won't eat. It will give them enough support to keep them going for bit til they can eat again. It doesn't require a prescription here, we can get it in stores like PetCo or PetSmart. If you don't recognize the name(s), ask the vet if there is anything like this available in Portugal.

I hope the vet has something to help her feel better and stronger soon. Let us know how things are going.
Hugs,
Leslie and the gang

[Sabina]

Thank you Judi and Leslie. I so hope it is just the antibiotics that are making her sick but am truly feeling now that its more than that with her.

Judi, a big hug to your Keesh, its lovely to hear about his playful moments, they must make you so happy and relieved amidst all the worry. My Mozart (in doggie heaven now) would grab a sock or shoe and run with it inviting us to come and play. Has Keesh been a long time on Vetoryl? Is that the reason for his poor appetite?

Angel doesn't have any playful moments now, just some occasional sniffing around for stray visitor cats that have passed through the garden or searching for interesting bits of bird poo to gobble up. Her energy is dwindling fast, she takes time to get up and sleeps a lot more since the last few days.

I spoke to the vet yesterday whilst Angel had her antibiotic shot. Feel a bit more prepared now to take it one day at a time as Judi suggested and make the most of my time with my precious Angel.

Someone posted about beef and oatmeal in their message and I tried that out on Angel yesterday. She loved it and ate some.

Am not sure it will go down today but will have to think up something else. Eggs were good for the past few days but not appetising today. Is that Nutrical thing a paste? I have used something like that way back in the past, I think its called Nutrigel or something here, but super, thank you for reminding me Leslie, will check that out again.

Right now, high calorie Orijen treats and biscuits are an emergency survival food here....

Will keep everyone posted.

Sabina and Angel

[Trish]

The last time my boy was on antibiotics he got through nearly the whole course until I think it was 2nd to last day and all of a sudden he started vomiting too. The vet said it is quite common for them to get that side effect. I was really worried when he would not eat. The vet recommended for a short term remedy to try and get something into them when they won't eat is to offer milk slightly warmed with a raw egg beaten into it. Flynn loved it and lapped it up. At least he got a bit of fluids and protein into him. It might not be appropriate for certain problems or dogs but it did the trick for him. I hope Angel has a better day and you can get something into her xo

PS As Leslie said something for nausea would be helpful, Flynn had Cerenia injections. They last 24hrs and I have found work very well. My vet let me give them to him myself which saved trips into see them when he was nauseous.

[spdd]

I'm just following up the question you asked about Keesh and Vetoryl. He isn't on anything other then Tramadol. He was on Trilostane for awhile, almost killed him and to this day after 5 vets there is no confirmed diagnosis of cushings. We just plain don't know what is wrong with him. His tests at first came back as probably Cushings... then after the scare.. most tests seemed normal. He pees like a racehorse and drinks just as much, and those are his only signs. We have eliminated an infection and just about everything else. So, I keep him happy, (we swim) he is lazy, sleeps a lot and very deeply, but his enthusiasm never wanes when you jingle the leash, walk, or take a car ride. I see his puppiness back every once in awhile. Tomorrow he will be 14. I'm thankful for every day I've had with him and again knowing there are fewer days left, that's why I just enjoy the present day I have with him.

[Sabina]

Happy Happy Birthday Keesh! Thank you Judi for the information and I wish you loads of happy times together.


Sabina and Angel

[Sabina]

Trish, thank you for your message. When Angel first suddenly lost her appetite totally, the vet did a couple of days of Ulcerblock shots (for nausea) and I gave her Ulcermin (Sucralfate). The Ulcermin made her throw up. Her appetite seemed to worsen with these medications.

In fact, Angel doesn't seem to have nausea, she just doesn't want to eat. Of course, her weight is dropping and I can bones starting to show where there were none to be seen before. She is slowly wasting away under my eyes. Her back legs are losing more strength each day.

Yesterday was a good day however, she managed 2 boiled eggs, small portion of ground beef with oatmeal, few doggy biscuits and a few Orijen treats through the day. I squeezed in a probiotic and a Vitamin B Complex with C.

Fingers crossed for today......

Sabina and Angel

[Trish]

Hi Sabina

Well a urinary tract infection plus getting over the Vetoryl plus the antibiotics would be enough to make anyone lose their appetite. Poor Angel, I hope today is another good one and she keeps on eating.

Just a word on cranberry products as I have noticed a couple of recommendations for these on the forum, I have just read a report reviewing 24 research trials in humans up to 2012 and unfortunately there are still no good trials that support its use. The active ingredient (proanthocyanidin) varies in the different preparations available on the market (juice, capsules etc) and the studies showed a high dropout rate and its use in preventing UTI could not be statistically proven. The drug is also only effective for 10-12 hrs so it would have to be taken at least twice a day indefinitely, to be effective. Few studies reported the actual quantity of the active ingredient so it was not possible to know which dose to recommend to demonstrate a benefit. There maybe some benefit in its use as a preventative (but the authors note this would be small at best) and it is certainly not going to do anything once the infection has set in. On the good side there is a low side effect profile, with no more reported when using cranberry products when compared with placebo. S Published in JAMA, Oct 2 2013, Cranberry Products and the Prevention of Urinary Tract Infection. Jepson, R et al.

So if there is this lack of evidence in its use in humans I would think there would be even less evidence for its use with our dogs. It seems to me the only ones really benefitting from these products are the companies pushing them!


Sorry that was a bit of an essay, but thought it might be of interest to some people here :)

[Squirt's Mom]

When was the last time Angel was checked for diabetes? Loss of appetite and weight loss are signs of diabetes and it is not uncommon for this condition to present like and cause false positives on the Cushing's tests. Diabetes can be checked via a blood draw and urine sample very quickly. Just so you know, diabetes can and does come on very quickly, almost overnight. If it has been a while since this was checked, it might be worth discussing with the vet asap.

I hope she has a better day today!
Hugs,
Leslie and the gang

[molly muffin]

Checking in to see how you and Angel are doing. Did she eat today? drinking?

hugs,
Sharlene and Molly Muffin

[mypuppy]

Hi Sabina,

Leslie asked "when was the last time Angel was checked for diabetes"? please have her tested ASAP if possible. As Leslie stated this can come on overnight, and it did with my girl. She developed severe ketoacidosis from extremely high sugar levels running thru her body. it was too late. I can't say for a fact that is what is going on with your Angel, but it certainly sounds like the same awful symptoms my girl was experiencing and again "all of a sudden". Please get her tested immediately and ask to check for ketones as well.

I certainly do so hope and pray its just an upset tummy and starts feeling better soon but in the meantime, do not wait.

please let us know how she is doing.

Xo Jeanette

[Sabina]

Trish, that is interesting info re cranberry, worth giving some thought, thank you.
Angel's glucose levels were checked only recently whilst checking her liver values and they came back normal.
After much thought, vet and I finally agreed on giving Angel a shot of Metacam yesterday along with her antibiotic to see if she would respond and she did! She actually ate her dinner standing up yesterday after so many days of being unable to do that. We haven't done the staircase yet but she walks better today and managed to do just 3 steps gingerly. Fell down whilst getting down from the car today though.
She ate well last night. We seem to have settled into a menu of boiled eggs and oatmeal with ground beef. She still does not want anything in the morning except a few biscuits but we have definitely made some progress, fingers crossed!
Because of the risk of anti inflammatory drugs on Cushings dogs, she did not get Metacam today, we need to give it carefully with breaks and only when really needed is what the vet informed me so maybe she gets a shot again in the next couple of days.
Well, the Metacam irritated her gastrointestinal tract slightly, she ended up making lots of poo last night and was slightly reluctant to eat by noon compared to yesterday but its going to dinner time again now and I hope she is hungry!
Thank u all for being there. Will post more as we progress.
Sabina and Angel

[molly muffin]

Yes you have to be careful with the metacam. It does help them, but if the cortisol is uncontrolled it can have bad effects on them, even dangerous ones, so be careful about that.

I'm very happy to hear though that she is at least able to stand up and have a bit more strength now. That is good.

hugs,
Sharlene and Molly Muffin

[Sabina]

Oh thank you Molly for that confirmation about Metacam. I am so tempted to let Angel have just one more shot to help her mobility a bit more but I will go slowly on this.

Angel did half a staircase this morning but had difficulty with the rest of the steps going up. She is weak though...when she goes from sitting to lying down position, she just collapses down and I can hear the loud thud of her head on the floor. During the night she also hardly turns (changes position) from one side to the other, noticed that just last night.

Well, its a day at a time and we will stay optimistic....

Sabina and Angel

[spdd]

Hi... I had my dog on Metacam, liquid form for a long time. It did upset his stomach so I decreased the dosage a lot. It really helped him out, but I have since stopped giving it to him.

He is undiagnosed so that's the reason I stopped it. If his cortisol level is high, which sometimes it is and other times it isn't it is too dangerous to give it to him. I only have him on Tramadol now.

The Metacam really stabilized his walking, but until I know what is going on, for now it's a no go. I liked the Metacam and prior to that he had Cartrophen shots, which in my opinion was a waste of money. Metacam in my case was a wonder drug.... but isn't worth the risk.

Just thought I'd throw that out there for you.

[Sabina]

Sharlene, sorry I put Molly's name instead of yours in my last message, guess I was all muddled up thinking of Angel....I apologise.

Judi, thank you too for telling me about your personal experience with Metacam. Yes, the one shot Angel has had so far has helped her a lot and we are thinking of giving her just one more maybe next week.
It did have its effect on her gastrointestinal system though, she emptied her bowels so totally (so many poos) the night she had the shot and from the next day on has been a bit more reluctant to start eating and the quantity of food she initially started eating has also reduced since the Metacam shot.

My old vet who I don't see anymore but consult sometimes on an advice needed basis told me that in the past when Vetoryl did not exist, Lysodren was used to destroy the adrenal glands of a Cushings dog totally at which point the dog became Addisonian and was maintained on treatment for Addison thereon. He said that it sounds horrible now but it was cheaper and easier to treat a dog for Addison's rather than Cushing's.

Could your Keesh's symptoms be the after effects of Lysodren therapy?

Sabina and Angel

[frijole]

My old vet who I don't see anymore but consult sometimes on an advice needed basis told me that in the past when Vetoryl did not exist, Lysodren was used to destroy the adrenal glands of a Cushings dog totally at which point the dog became Addisonian and was maintained on treatment for Addison thereon. He said that it sounds horrible now but it was cheaper and easier to treat a dog for Addison's rather than Cushing's.

Could your Keesh's symptoms be the after effects of Lysodren therapy?

Sabina and Angel

Sorry to butt into this conversation but I need to clarify something for those reading along for advice. Intentional overdosing on lysodren was once very common in Europe but not here in the US. I haven't seen this done much lately. The goal of the protocols established by specialists world wide is not to destroy the adrenal glands to the point of addisons. The doses are lower and the intent is to erode small amounts of the adrenal cortex. This allows the adrenal glands to function normally and to quit overproducing cortisol (which is what cushings is). Lysodren has been around for many decades.

Thanks - again that statement is to clarify for those reading so that anyone using lysodren isn't scared out of their minds thinking that their vet is doing something like this. Kim

[Squirt's Mom]

In addition, Keesh was on Trilostane (Vetoryl), not Lysodren. ;)

[molly muffin]

It can get so confusing sometimes, with so many people and their dogs and experiences. Judi is Keesh's mum, who had used the metacam and he was on vetroyl as Leslie mentioned. We have seen some problems with metacam and cushing dogs, but not all of them. Every dog is different.

Don't worry about it, Molly and Sharlene are interchangeable here on the forum. Okay, Molly is shorter and has more hair, that's about it though. :)

Yes, Lysodren and trilostane are both safe, when used by vets who know the drugs, understand the disease and follow protocols, respective for each for monitoring and dosing.

hugs,
Sharlene and Molly Muffin

[Trish]

HI Sabina

How is Angel doing? Have the antibiotics finished yet? I hope they have and her appetite has picked up :)

[Sabina]

I didn't realise when I posted about Lysodren that someone might misunderstand, thank you for clarifying the point Kim, guess I have been really muddled up lately.....

Angel's looks brighter but her appetite has been going downhill since the Metacam and I think its also because she has developed colitis with all the changes in food and the home cooked food, antibiotics, bits of cat poo or grass picked up in the garden, etc. Probiotics are barely keeping her straight any more and we sometimes skip one because she doesn't eat. Yesterday was the 8th day of antibiotic but because of resistent bacteria detected in Angel's urine, vet would like to continue the antibiotic for a few more days. Am holding off on the second shot of Metacam until antibiotics are done.

Sabina and Angel

[Sabina]

Well, its been a few days since my last post and Angel's appetite has worsened with each passing day.
I finally realised that whenever Angel started to eat a little and I increased the quantity whilst she was eating, she would just stop. Also one day, about 10 days ago now, she managed to eat a normal portion of food one evening but immediately after that she seemed to feel so sick and stuffed and tired that she struggled to walk and just laid down on the floor and stayed like that for hours. It appeared that she would get a feeling of fullness even after a tiny quantity of food and the normal portion she ate actually made her feel sick, almost as if there was something pressing on her stomach.

My vet and discussed it and decided to do an abdominal ultrasound to see if there were any new developments since Angel's last ultrasound in March this year.

The ultrasound was done yesterday afternoon and yes, malignant masses were seen in her liver and spleen which weren't there before. It was concluded that the original tumour detected on her left adrenal gland in March wasn't benign but malignant and had metastasized to her liver and spleen and most likely also to the bone in her hips or back legs as the lymph nodes there are enlarged.

Angel is at home with me now. The vet has asked me to bring her in for any pain injections she may need. She eats just a few biscuits and maybe a tiny cube of meat through the day now. I need to make the decision to let her go soon and am trying to decide on the right moment.

Angel's brush with Cushings was shortlived. It turns out that it wasn't the Vetoryl that had slowly eroded her appetite although with stopping the Vetoryl she doesn't have the muscle tremors and leg jerks that she had whilst sleeping.

I guess her mum and siblings are waiting for her now and it'll soon be time for her to join them and all the other little doggie angels at the Bridge.........

Sabina and Angel

[Squirt's Mom]

aw, Sabina, I am so sorry to hear this news but it does explain the things that you have seen with your sweet girl. Spoil her rotten, talk to her and tell her all the things you want her to know, listen to her and let her tell you the things she needs you to know. Tell her often how much you love her and let her see you cry, she knows already how much this news hurts you.

We are here if you need to talk. I know you will make the days ahead as pleasant as possible for Angel but there are times we just need a shoulder to lean on - we have them for you anytime.

Hugs,
Leslie and the gang

[FemaleK9]

So sorry for you and Angel, Sabina. Yes, we are here for you, you don't have to suffer alone. We understand.

[Trish]

Hi Sabina, I am so sad to read this news about Angel. Such a sad time for you but also a gift that you can treasure in the future. You will know when the time is right so just trust your instincts and in the meantime shower that little Miss with all the love she knows you have for her, treats galore as she will tolerate and hopefully some time doing her favourite things. I hope you have support to help you but just remember we are all here too and will hold your hand as you come to grips with this. Big Hugs xxxx

[doxiesrock912]

Oh Sabina,
I am so sorry for your news but glad that the vet is there helping to keep Angel as comfortable as possible.

[molly muffin]

Sabina, I'm so sorry to hear this about Angel. Like Leslie said, just spend some good quality time with her and love on her as much as she can stand. I think she will let you know when she is too tired to try and go on.

hugs,
Sharlene and Molly Muffin

[frijole]

Sabina, So sorry to hear this. You have been a terrific mom to Angel and I know these decisions are the toughest ones. We are here for you to help in any way we can. Sending you strength and love, Kim

[Sabina]

Thank you, thank you, thank you everyone for being there and for all your supportive words.

Have been so sad, confused, wondering how and when to make THE DECISION but all your words have helped and I will just trust my instincts and wait for Angel to tell me.

It has pouring heavy rain these past few days but this afternoon the sun came out for a few hours and Angel managed to go for a lovely walk all around the huge garden, sniff interesting nooks and crannies, eat a bit of grass, nibble on a few bird poos, etc. She's more tired than before of course but I am so happy she managed to walk all that distance and enjoy it. After a nice drink of water, she has now crawled into her little corner in the office for a little rest as I type this message.

Its truly making the most of each day now..........

Sabina and Angel