Running out of ideas

[Moorsey]

Hi

I have a 10 year old boxer 'Mutley' who was diagnosed with cushins 12 months ago. He had the cortisol test after displaying pretty much all the symptoms, he then had a scan at the animal hospital which showed both adrenal glands to be enlarged, it has been assumed it is the purtuity variant of the disease. He was started on Vetoryl at 120mg once a day and the symptoms subsided but he was getting sores so after more tests he went down to 90mg. The symptoms gradually worsened and after various ACTH tests, urine tests, blood tests and varied doseage change he is now on 120mg in the morning and 90mg in the evening, he is a large boxer weighing in at 37kg.

His symptoms are worsening, he is constantly peeing, drinking (and also deficating in the house when left alone). His back legs are week, hair loss worsening, he is lethargic and not himself (dosent seem to respond to me as usual and eyes are not all there).

His ACTH tests keep coming back normal, as does his urine and bloods. The Vet has spoken with the animal hospital and Vetroyl themselves, they just suggest gradual dosage increase and more ACTH tests. It has cost me a fortune over the past 12 months and the constant care combined with seeing my boy in this state is killing me. However i am determined to sort it out and would be most grateful if anyone could lend their thoughts on the situation as im a bit lost as to what to do for the best.

Thanks in advance

[labblab]

Welcome to you and Mutley, although I am surely sorry that he is doing so poorly right now. From what you have written, I am guessing you are in the U.K., and if that is the case, I know that vets there do not regularly release all the numerical results for lab tests. But at a minimum, if you could perhaps get us the results of Mutley's monitoring ACTH tests, it would be very helpful in giving us a picture as to his response to the varying Vetoryl doses.

The dose he is taking now is pretty hefty, so that is why I am especially interested in the test results. Since your vet has been consulting with the hospital and also with Dechra, I am assuming that the test results support the increase. And yet, we are a curious group here, and like to see the numbers for ourselves.

Assuming that the testing is indeed all on target, then Mutley's lack of response is indeed puzzling. However, it may just be the case that Vetoryl is not having the desired effect on his endocrinological system. Here in the U.S., we are lucky in that we have an alternative drug, Lysodren, that can be used as an alternative to Vetoryl. Some dogs respond much better to one drug over the other. However, Lysodren is not readily available in the U.K., although I don't think it is impossible to obtain when dogs are unresponsive to Vetoryl.

Another variable that could account for some of Mutley's issues is the possibility that his pituitary tumor is enlarging and placing pressure on other areas of his brain. If so, this could be causing issues such as weakness, lethargy, lack of coordination, loss of toileting control, and mental dullness. The only way to know for certain if this is a problem, however, is to perform relatively expensive imaging of the head (MRI or CT scan).

But before going further, though, let's see if you can obtain those ACTH results. And also any other current lab values that are outside normal range. I am hoping Mutley has been having blood chemistries performed during his Vetoryl treatment? Because sometimes the Vetoryl can affect other levels besides just the cortisol (such as the balance between the sodium and potassium in the body).

Thanks in advance for any additional info you can supply!
Marianne