Unsure about diagnosis

[spuddeebuddee]

Hi, I'm hoping I can get some advice concerning my dog's diagnosis. My pup is a 10 year old (5/10/03) welsh pembroke corgi and his name is Spud. Up until November of last year Spud was very spunky and anyone who asked his age was super surprised to find out he was a senior. Just after thanksgiving last year he started slowing down drastically. He became very lethargic, unwilling to participate in any activity, and he began drinking and peeing excessively. He started having incontinence, sometimes peeing in his crate at night. He also became very touchy...he would growl anytime anyone tried to pet or touch him around his abdomen. By February he simply looked miserable and so we took him to the vet for an evaluation. He hadn't been to the vet in over a year and his weigh in showed a 1.9lb gain, putting him at 36lbs. Upon initial assessment the vet noted that his heart rate was abnormally low, somewhere in the 50s if I remember correctly. The vet ran a blood chemistry, CBC, and urinalysis. I'll list some of the abnormal results as a reference:

Results. Normal Range

Cholesterol - 992 (H)! 112 - 328
Amylase - 1573 (H) 450 - 1240
Lipase - 2473 (H) 100 - 750
T4 - 0.8 (L) 1.0 - 4.0
Free T4(ng/dL) - 0.3 (L) 0.6 - 3.7
Free T4(pmol/L) - 3.9 (L) 7.7 - 47.6
Urinalysis was + for blood

Additionally the vet took an x-ray to determine the cause of the abdominal tenderness. The x-ray showed an enlarged liver.

All signs pointed to hypothyroidism and a possible urinary tract
infection. He was started on Soloxine 0.3mg twice daily and given 10 day course of antibiotics. We were told to return in 4 weeks for a reevaluation.

4 weeks later we returned and the vet ran the same tests. Here are some of the results:

Amylase - 376 (L) down from 1573
Lipase - 151 (WNL) down from 2473
Cholesterol - 483 (H) down from 992
T4 - 1.6 (WNL) up from 0.8
Free T4(ng/dL) - 1.4 (WNL) up from 0.3
Free T4 (pmol/L) - 18.0 (WNL) up from 3.9
Urinalysis remained + for blood

Things were looking a lot better with the bloodwork, but spud wasn't showing any improvements in terms of energy, polydypsia, polyuria, or overall demeanor. The vet put him on an extended 2 week course of a different antibiotic.

Spud continued to show very little improvement even after the antibiotic course was completed. We decided to get a second opinion and took him to another clinic. We took over copies of his lab values and the vet there said he suspected cushing's disease. He started him on Vetoryl 60mg/day but told us to continue the soloxine as well. On the vetoryl Spud started improving, especially his thirst and incontinence. He also had some more energy, although he wasn't nearly back to his old self. We chalked that up to the disease taking a toll on him. He suffered for a long time.

Now it's December of 2014...and spud has seemed to go backwards. While he is not having the issues with incontinence, he has started drinking more and he is VERY SLOW, lethargic, and overall just uninterested in life. He sleeps almost all day and doesn't get excited about anything. It's almost as if he's depressed, but it seems like it's more physical than emotional. For a long time I've been trying to convince myself it's just his old age showing, but it's just breaking my heart to see him like this. He isn't my smiley boy anymore, he just looks sad all the time. We don't have very much money at all, so continuously taking him to the vet isn't realistic...but he's my baby, he means so much to me and I just want him to feel better.

I'm hoping someone here has some advice for me. Could his medication be hurting more than it's helping? Is there a solid next step I can take? Any and all ideas and advice are appreciated. I'm really sorry this is so long. Thanks for reading.

[StarDeb55]

Welcome to you & Spud! I'm certainly sorry for all the issues that Spud has been having but very glad that you found us. I'm a lab tech with 30+ years experience, so I'm used to reading lab results. The very first thing that pops out are the elevated amylase & lipase values even though they came down on the repeat labs. These 2 enzymes are frequently associated with pancreatitis. Did your vet mention pancreatitis to you? The only test that can totally rule out pancreatitis is a cPL test. Was that done? Spud does indeed have a lot of the common lab abnormalities we see in our babies, along with his symptoms. Did the vet rule out diabetes? The other thing that concerns me is you didn't say whether or not a urine culture was done to determine whether or not Spud is being bothered by a UTI. A culture is the only way to tell exactly what kind of bacteria may be present, & what antibiotic they are sensitive to. It's very important to do a urine culture on our pups if they have signs of a UTI because their urine is normally so dilute that a routine UA may not reveal the presence of a UTI. What tests were done to diagnose Cushing's? These may include an ACTH, low dose dex test, or a high dose dex test. Was an abdominal ultrasound done? If so, could you round up that report & post any abnormalities that were seen.

Now, when it comes to trilo, I have no personal experience with it, but I can help you with the basics. 60 mg daily is a pretty high dose for a pup who weighs 39 lbs. Dechra has been verbally recommending a starting dose of 1 mg/lb for quite awhile. It's unfortunate, but Dechra has never updated their printed material which still recommends a starting dose of 1-3 mg/lb. Univ of Calif. at Davis vet school recommends an even lower starting dose of 1 mg/kg. We have seen time & again in this group that it's much better to start low with trilo & increase the dose gradually, if needed. Also, have regular monitoring ACTH tests been done to check Spud's cortisol level, & confirm that the medication dosing is correct? Could round the results up of the ACTH monitoring tests & post them, along with Spud's dose of trilo that he was on when each test was done? There is also a way to save $$ on the ACTH monitoring tests that we can provide you with to take to your vet.

I'm so sorry for all the questions, but answers to these questions will help us to give you the most appropriate feedback that we can.

We are here to help in any way we can.

Debbie

[labblab]

Hello and welcome to you and Spud! I have only a moment to post right now, but from what you have written, my biggest worry is that he may be overdosed with the Vetoryl. It sounds as though the second vet started him on the medication without the benefit of any confirmatory testing that is specific for Cushing's. That is extremely worrisome in and of itself, but I will move past that for the moment since Spud initially showed improvement while taking the medication. However, it is very important for cortisol levels and other blood chemistries to be periodically monitored because dosing adjustments are commonly necessary. If a dog's cortisol level drops too low or if certain blood chemistries become unbalanced (particularly the balance between potassium and sodium), a life-threatening condition can develop very quickly. The symptoms you are currently describing could definitely be caused by a dose of the medication that is too high.

Has any vet performed any blood testing since Spud started taking the Vetoryl? If not, that is really your first priority. I realize that repeated testing can be a financial burden, but unfortunately it is not safe to continue administering Vetoryl in the absence of any monitoring. At the very least, it would be important for him to have a basic blood chemistry profile performed in addition to a resting cortisol (although an ACTH stimulation test is the more definitive and preferred monitoring tool).

Can you please recap Spud's history on Vetoryl? How long ago did he start taking the drug, and has there been testing of any type since that time? If so, the results will be very helpful to us.

Thanks so much for this information,
Marianne

[Renee]

I just want to welcome you here too. I am new on this forum as well.

The long-timers here really know their stuff, and I hope you'll take their advice.

It worries me that it seems your boy was put on meds without confirming a proper diagnosis.

I would suggest educating yourself more and then find a new vet. Sounds like your old vet wasn't very good, and the new vet doesn't sound much better. A vet that would put a dog on a cushings med without confirming cushings is probably not a vet you would want to take your dog to.

[goldengirl88]

Welcome to the forum. It would help us know what is going on with your baby if you could post the abnormal results of all testing done to confirm Cushings and post the normal range the lab gives as they are all different. If I am reading correctly it seems your vet put your dog on Vetoryl without any testing only his opinion of what she had??? If that is true that is a scary scenario. This is a very hard disease to diagnose. Once diagnosed if you manage it well and are watchful you dog may live out it's natural life. Normally there are several tests done to confirm this such as LDDS, ACTH, Urine, Blood Panel, Ultra Sound. Has you dog had any of these? Could you also tell us the weight of your dog? Did any of the symptoms go away since starting treatment. How much Vetoryl are you giving for a dosage, and how many times per day are you giving it? Has your dog been checked for diabetes? We are here to help you thru this journey so others will be on to ask questions and let you know what they think. Feel free to ask your questions as your are the only advocate for your dog, and it is important to educate yourself as much as possible on this disease and treatment. Wishing you and your baby good luck. Blessings
Patti

[spuddeebuddee]

Thanks everyone for welcoming us and for posting so quickly! Reading your responses I feel so stupid...I honestly just took the vet at his word that he should be on Vetoryl :( I said earlier that his liver was enlarged on the x-ray but it may have been his pancreas. it was a while ago so I'm a bit fuzzy.

Let me clarify the timeline a bit. He started showing symptoms in 11/2012. Our initial vet visit to our regular vet was in 2/2013. This was when the initial bloodwork/UA/x-ray were completed and when he was started on Soloxine and antibiotics. His follow-up was in 3/2013, this was when he was given a second course of antibiotics, and when that was finished and he hadn't improved we took him to the second vet who runs a weekly clinic. That was sometime in 4/2103.


The second vet did a physical exam and asked for a copy of his labs. It was the elevated amylase and lipase that he said indicated cushing's. He said he had a lot of experience with dogs with cushing's and that spud was a typical presentation and he should be started on vetoryl. No additional labs were run. If I remember correctly we started him out with 60mg every other day for a couple weeks and then progressed to 60mg every day. He has been on this dose for 8 months now.

Like I said, initially it seemed to be working. He stopped having accidents and he perked up some. He never really had issues with his skin or coat that are typical of cushing's so there was no way to evaluate it's effect in that area.

As far as the UA, they did not do a specific culture. I was told the presence of blood was indicative of a UTI and that a culture was unnecessary. His UA was negative for glucose and his blood glucose was WNL (93) which I believe rules out diabetes?

Since April no further labs have been run. No one told us follow-up was needed. I have been anticipating that I'll need to take him in for a work up soon...but I'm concerned that the medication he is on already would throw the results off? Is that possible?

Thanks again everyone. I really appreciate your help.

Let me add that Spud is currently 36lbs and he is on a 60mg/day dose of Vetoryl.

[Renee]

Oh wow. Just wow.

I cannot believe you and your dog have been so poorly served by not one, BUT TWO vets!! Unbelievable! I am so terribly sorry for you and your pup.

I know you'll get a lot of advice here from some very knowledgeable people, so I will leave it to them... but, I urge you to immediately stop the medication, educate yourself, and find a new vet!

I have extensive experience with UTI's and bladder issues from my own girl pug. A urinalysis is darn near useless when you are dealing with an infection. In addition, a UA will often have a false negative. It's not sensitive enough to detect all infections. The only way to know what the bacteria is, and what antibiotics will kill the bug, is by doing a culture and sensitivity. When a vet does a UA only, they are just guessing as to what abx will work. If they are wrong, you are wasting time and causing unnecessary usage of a medication that is doing nothing. The infection will not go away, and could in fact get worse, stones could form, etc. At the height of my girl pugs bladder issues, we were sending out cultures every four weeks. It took months of doxycycline to finally clear her up. My vet thought I was a little overboard, but I wasn't about to waste my time on the UA's.

[goldengirl88]

I am concerned you could be overdosing your dog. I would stop all Veroryl and go to a competent vet and have all the proper testing done and start from there. The story you told is very scary and you are putting your dog at risk by blindly following these vets that have grossly failed you. Please if you want your dog to get thru this stop the Vetoryl and start over. I am telling you this out of concern for you and your baby. This diagnosis requires testing, not just an opinion from a vet.
You also have to have blood work done regularly to check cortisol levels. If your dog exhibits any if the following go to the emergency hospital: lethargy,vomiting,diarrhea,won't eat,can't get up and stand. Please let us know what is happening. We will help you, so you aren't alone in this. Blessings
Patti

[StarDeb55]

It was the elevated amylase and lipase that he said indicated cushing's.

I beg to disagree with this vet. As I said in my earlier post, the elevation in these 2 tests are most commonly associated with pancreatitis. It is possible that the elevations could be other things, but any vet who saw these two elevations should have run a cPL test to confirm pancreatitis. If, indeed, Spud has pancreatitis or chronic pancreatitis, that is just another symptom associated with Cushing's. Our pups can be very prone to pancreatitis.

The trilo parents can correct me if I'm wrong, but I'd like to give you some idea about what a normal schedule for follow-up testing when using trilo would be:

7-10 days after starting meds for the initial ACTH.
If a dose adjustment is need, another test will have to be done in about 7-10 days.
Once the pup is stabilized on a specific dose, the regular monitoring can be done every 3-6 months. A lot of vets have their own preference as to how frequently.

If your pup has not had the appropriate testing for diagnosis, I totally agree with the others, stop the trilo. I would then ask for a referral to an internal medicine specialist, & bring all of Spud's labs from the 2 other vets, if you choose to do this.

Debbie

[spuddeebuddee]

I realize I was pretty rash in putting him on the medication. I was just so desperate for something to help. I thought for sure I was going to lose him and when the vet tells you it's something treatable and easily managed with medications it's hard not to just jump on to it.

It's glad to be armed with the information you've given me when I see the vet though. I'm looking right now into the animal hospitals in my town. Unfortunately the options aren't that great. I want to get the most out of this visit, so I'm wondering if it's best to stop the vetoryl and wait a few days until it's out of his system so it won't effect the tests...or if it would be good to evaluate him while he's still on it?

For those of you who are treating with vetoryl, do your vets usually work something out financially for the follow up tests, or do you pay the full amount each time?

[Renee]

There are not a lot of options where I live either. There is one internist, and she's not even here full time (she commutes from another part of the state). I don't care for her either anyways.

I have a regular vet I trust completely, and we discussed the learning curve of cushings on her end and my end. We are basically reading a lot of the same stuff and learning together. She is not completely uneducated on cushings... I mean, she went to vet school! Haha. What has really reassured me about sticking with her though is that she is willing to admit what she does not know, and she is working closely with three specialists and spending a lot of time researching on my behalf. Every thing I have brought up has been met with respect.

If you end up meeting with an internist, ask them to recommend a regular vet that they work with. This way you have both.

As for vet fees... I have always paid my vet at the time of service. The ACTH test (I was told) would be approx $250 per test. But, vet costs in AK can be expensive.

[Dawn Anderson]

Welcome and I am so sorry that those so called Vets. Have treated you and Spud so poorly, they should be stripped of their license to.practice. I hate to hear these thing, but they do happen and its up to us as parents to educate our selves as best as possible. By finding us you will be feed so much info it will blow your mind, I know it did mine and I could not have made it this far without all of them.
Keep supplying lab results and as much info as you can. I myself am new to all of this.
All.I can say is search out a new Vet. ASAP, you and Spud deserve the very best treatment, contact your local shelters and a lot of them can help you find an ethical vet( so many volunteer their services to help the shelters) also contact your nearest Vet. medical teaching hospital , they can also help and the cost isn't as bad as a regular pet hospital. I take my girl to UC Davis, she has a regular Vet but with her condition Im sticking with Davis .

I can feel your pain regarding Spuds slow gradual decline" like a depression" my girl did the same thing and I thought the same things that you did about getting older. Do not let this get you down, you are Spuds advocate and his voice, so keep pushing for answers and never take things at face value always ask WHY, and make them give you the answer in away you can understand if you do not understand ask the ? again and again, lord knows thats what I've had to do, so many Vets can be real fast talkers, I know all about this first hand.

So hang in there

Hoping for you to get the answers you need

Dawn & Buttercup

[labblab]

Hello again from me. I am hoping you will be able to find a competent vet in your area who will accept "Care Credit." This is a credit card account for which you can apply that will allow you to defer medical/veterinary payment without accruing any interest. Here's a link to their website. You can look at the plan details as well as check to see whether specific vets and animal hospitals are participants:

http://www.carecredit.com/vetmed/

As far as the testing itself, that is a hard call. If Spud were my own dog and I could get an appointment for him to be seen quickly -- and as long as you are not seeing any acute degeneration -- I would probably leave him on the Vetoryl until you meet with the vet. That way, you will be able to clearly assess the effect of the 60 mg. dose. Even though I think the vet was irresponsible for starting him on the drug without confirmation of Cushing's, it does seem entirely possible that Spud is indeed a Cushpup based on his symptoms and initial positive response to the drug. If that's the case, he may only need to have the dosage altered, and finding out his cortisol level on the 60mg. will help determine the optimal adjustment.

This is all prefaced on him remaining stable until the vet appointment, however. If he were to become more acutely ill with vomiting, diarrhea, extreme lethargy, etc., then all bets are off and for safety's sake you would want to discontinue the Vetoryl and take him to be seen on an emergency basis. When you do take him to be seen, I believe you will want to have general blood tests of his chemistries and cell counts in addition to the testing of his cortisol reserves. In the short run, the cortisol testing will be of a monitoring rather than a diagnostic nature. This is because even if you discontinue the Vetoryl, it will take some time for his adrenal function to rebound back to a pretreatment baseline.

Now having said that, it may be the case that the new vet will indeed advise you to first stop the Vetoryl altogether to see what effect that has on Spud's behavior and lab profile. But my thinking at the moment is that if you at least temporarily leave Spud on the Vetoryl, then the vet will have the choice of testing either (or both) ways.

Also, just so you'll know, if Spud ultimately remains on the medication but at an altered dose, it is possible to purchase compounded versions of trilostane at a much cheaper price than brandname Vetoryl. Also, compounding pharmacies are able to specially prepare trilostane capsules at almost any dosage strength. There has been some recent research indicating that not all compounded versions are as consistent in dose or as effective as the brandname drug, but a number of our members have been quite satisfied with some specific internet compounders for whom we can supply you with contact info.

So do not despair, and do not beat yourself up over trusting the vets' recommendations. This is their "bad," and not yours! Starting today, we will be moving forward together!

Marianne

[goldengirl88]

Yes I was going to suggest Care Credit too. I hope everything is going alright with you and your baby. Keep us informed what is going on. Blessings
patti

[spuddeebuddee]

Hi Everyone,

It's been a long time but I finally got the results of Spud's ACTH test. I took him to a new vet clinic and of course the first thing they recommended was this test. Here are the results:

His base cortisol level was 3.3
His cortisol level increases to 12.3 following the cortisol injection

I spoke to the vet on the phone and she said that if the level increases to a level >9.0 an increase in the vetoryl dose is recommended.

She said, however, that a definitive diagnosis could not be made without a low dose dexamathasone suppression test. She said she was hesitant to prescribe an increase in the vetoryl without this test.

In order to do this test I would have to take him completely off the vetoryl for 3-4 weeks. I decided to try taking the dose down gradually and started giving it to him every other day. With the lower dose he seems to be doing a lot worse. A lot slower and more lethargic. He just wants to sleep all day.

So...at a crossroads here. I thought he was on too high a dose and turns out his dose is too low. The vet said we could run a basic chemistry and/or do an abdominal ultrasound to see if anything else is going on with him. I obviously want to get the diagnosis confirmed, but I'm really worried about how he'll do off of the vetoryl for that long. Any advice you guys have would be greatly appreciated. Thanks.

And for those of you who may be reading about spud for the first time, here's a quick background.

10 year old male pembroke welsh corgi. Started showing symptoms of polydypsia, polyuria, lethargy, and overall just not feeling well in November of 2012. In February of 2013 a blood panel was run and he was diagnosed with hypothyroidism. Started on thyroxine. T4 levels improved over the next 4 weeks but his symptoms did not. Taken for a second opinion and started on Vetoryl 60mg/day to treat cushing's disease which was never confirmed through blood test. He improved quite drastically on Vetoryl for a short while but has begun to have some symptoms resurface in the past few months. I took him to a new vet about a week ago, which I discussed above.

[goldengirl88]

Hi:
I just read your thread for the first time. Just wanted to welcome you back. I am not understanding something. Are you saying because your dog was starting to display symptoms you took him for an ACTH test? Then are you saying based on that the vet cannot recommend changing the dosage? If that is true then I am mystified as to why I have had like 13 ACTH tests for my Tipper before dosage changes?? If this were true then she would have to have an LDDS every time ?? That does not make sense to me so maybe I am confused on your scenario. Even if the dog is at 9 the recommended level and still experiencing symptoms the cortisol is not controlled, the 9 is if the dog has no clinical symptoms. So your dog went to 12 and is having symptoms right? So that would mean the dog is still not controlled, and needs the dosage adjusted. I am not understanding why your vet cannot change the dosage based on the ACTH that was 12?? As I said if you give a higher dosage of Vetoryl and I am assuming that is what you are using and the cortisol comes down to 9 and there are still clinical symptoms the dog is not controlled. What dosage are you currently using? It takes some tweaking sometimes and I have had to do a lot of that so that is why so many ACTH tests for my dog. If you just need to increase a little there is also a compounding pharmacy that can help in that case as Vetoryl only comes in certain doses, and nothing in between. Giving a dosage every other day in my mind would make the cortisol go up and down. That cannot be good. I wrestled with this when my vet wanted to do that with my dog. Most of the forum thought I was better using the Vetoryl at a different dose every day. Could you call Dechra and talk to them? They have a staff there that will start a file on your dog, and help you with this. You can even have your vet call 866-933-2472. I hope you can get this all straightened out and that your baby gets to feeling better. Blessings
Patti

[spuddeebuddee]

Hi:
I just read your thread for the first time. Just wanted to welcome you back. I am not understanding something. Are you saying because your dog was starting to display symptoms you took him for an ACTH test? Then are you saying based on that the vet cannot recommend changing the dosage? If that is true then I am mystified as to why I have had like 13 ACTH tests for my Tipper before dosage changes?? If this were true then she would have to have an LDDS every time ?? That does not make sense to me so maybe I am confused on your scenario. Even if the dog is at 9 the recommended level and still experiencing symptoms the cortisol is not controlled, the 9 is if the dog has no clinical symptoms. So your dog went to 12 and is having symptoms right? So that would mean the dog is still not controlled, and needs the dosage adjusted. I am not understanding why your vet cannot change the dosage based on the ACTH that was 12?? As I said if you give a higher dosage of Vetoryl and I am assuming that is what you are using and the cortisol comes down to 9 and there are still clinical symptoms the dog is not controlled. What dosage are you currently using? It takes some tweaking sometimes and I have had to do a lot of that so that is why so many ACTH tests for my dog. If you just need to increase a little there is also a compounding pharmacy that can help in that case as Vetoryl only comes in certain doses, and nothing in between. Giving a dosage every other day in my mind would make the cortisol go up and down. That cannot be good. I wrestled with this when my vet wanted to do that with my dog. Most of the forum thought I was better using the Vetoryl at a different dose every day. Could you call Dechra and talk to them? They have a staff there that will start a file on your dog, and help you with this. You can even have your vet call 866-933-2472. I hope you can get this all straightened out and that your baby gets to feeling better. Blessings
Patti

Hi Patti, thanks for your reply and sorry for the confusion.

To clarify, Spud never went through the specific diagnostic tests (ACTH, LLDS) before he was started on Vetoryl. I took him to two vets early last year and based on his symptoms and blood panel one of the vets diagnosed him with hypothyroidism and started on thyroxine, which fixed his T4 levels but did not improve his symptoms. So we took him and his blood test resuts for a second opinion and that vet diagnosed him with cushing's.

I had no idea at the time that specific tests were supposed to be done to confirm the diagnosis of cushing's before he was started on the medication. The vet said that because of his symptoms and his elevated ALT and AST he had cushing's and he subsequently started him on Vetoryl 60mg/day based on his weight (36lbs). His symptoms improved drastically when he was started on the Vetoryl, so we assumed the diagnosis was correct and he's been on the vetoryl ever since.

In the past few months Spud's condition has been deteriorating. He's not showing symptoms specific to cushing's necessarily, but he's very slow and lethargic and just appears to be not feeling well. I joined this forum because I was worried about him, and that is when I learned that he definitely should have undergone diagnostic tests to confirm cushing's prior to being started on the Vetoryl.

So I took him to a third and completely different veterinarian in order to have the ACTH test done to see if Spud even had cushing's. Ideally, the process would be do diagnose, initiate treatment, and them temporarily re-check levels to ensure that your dog is on the right dose and the condition is being controlled. It sounds like that's the process you went through, and that's good.

I unfortunately dealt with some incompetent vets, and so the ACTH test that was done a couple of weeks ago, was the first test spud had ever had regarding his cushing's. Like you said, looking at the results it seems very clear that he does in fact have cushing's, and that his dose should be increased. But the vet told me that she would want to absolutely confirm that he has cushing's through the LDDS before increasing his dose. I don't know this vet so I don't know if she is saying this for ethical reasons, or because she wants to run another expensive test.

Regardless of her reasons, I'm worried about taking him off the Vetoryl completely, because he seems to be struggling even more off of it. Maybe, like you said, giving it to him every other day is just causing his cortisol levels to fluctuate. I thought that maybe it would just decrease the concentration of the medication in his system, but I guess that depends on the half life of the med.

Anyway, I hope that explains everything better. I will look into those resources you mentioned. Thanks for the post. Best wishes to you and Tipper

[lulusmom]

Hi and a very belated welcome to you and Spud.

I have just read your thread and wow, how scarey that not one but two vets thought it was perfectly fine to start treatment with Vetoryl without doing any adrenal function testing at all. This also means that if Spud has cushing's, you don't know if he has pituitary dependent disease or an adrenal tumor.

I am hoping you made a mistake when you said that your vet was comfortable with a diagnosis based on elevated ALT and AST. This is not the normal pattern with cushdogs. Dogs with cushing's have elevated Alkaline Phosphatase (ALKP or Alk Phos), which is a liver enzyme that can be steroid induced. ALT and AST are liver specific, meaning when these two are elevated, there is something that is assaulting the liver and damaging or killing cells. Can you please check test results to make sure it really is ALT and AST that were elevated?

Not to beat a dead horse but an ACTH stim test and/or an LDDS test should have been done. Sometimes the LDDS test tells you if it's pituitary or adrenal dependent disease but often times it does not. An abdominal ultrasound is usually done to visualize the adrenal glands to validate and/or differentiate. It also gives a vet an opportunity to check surrounding internal organs for abnormalities associated with cushing's as well as identify possible noncushing's related problems with the other organs. It's a shame that your first two vets screwed up so badly because you almost have to start over if you want a confirmed diagnosis. I agree with your new vet and would definitely start with fresh blood chemistry and an abdominal ultrasound. While a recommend an abdominal ultrasound, I do know that chances are Vetoryl has probably already enlarged the adrenal glands, making it difficult to distinguish enlargement due to the disease or the drug.

I had two cushdogs that went through a washout period when I switched medications; one became symptomatic quite quickly and the other took over two months for symptoms to come back. Unless a dog has concurrent diabetes, a 30 days washout shouldn't be a problem. You mention that Spud's condition has been deteriorating in the last two months but what you are seeing isn't really specific to cushing's. Can you tell me what you mean by "he struggles more off of Vetoryl"? Dogs don't usually get sick when you withhold Vetoryl but rather they become symptomatic again as cortisol continues to rise. Spud's cortisol has risen since his last stim test, and correct if I'm wrong, but he isn't showing any symptoms of cushing's but is just extremely lethargic and not feeling well.

Since Spud's primary symptoms associated with cushing's was pu/pd, I would hope that your vet confirmed that Spud's was pu/pd via urinalysis. I realize a urinalysis was done but you did not post the USG (urine specific gravity). This is a very important part of the urinalysis because if the excessive drinking and peeing truly pu/pd, the USG will be very low and urine very dilute. Can you please go through your test results and post the USG for me?

Glynda

[goldengirl88]

Wow! You are very fortunate nothing has happened to your dog. You are right you must have testing done first to confirm Cushings. The Dr. Is right wanting to do the LDDS test. You must have a definite diagnosis. The other thing that scares me is this vet started your dog on twice the starting dose. Dechra recommends 1mg per lb to start. I would definitely get the LDDS test and go from there. The reason he may be slowing down could be the dosage. When cortisol is higher it masks arthritis in older dogs. The Vetoryl controls the cortisol. By doing this it starts up inflammation in their joints etc. I am also concerned about you dog being lethargic, as that can be signs of Addisons.
The numbers you gave do not bear this out though. If it were my dog, I would find a competent vet and get the appropriate testing done. You can then make a plan once you have a diagnosis. These are powerful drugs and you do not want to be giving them if your dog does not have Cushings. I would never listen to a vet that diagnosed my dog with Cushings without performing any testing. When you get the LDDS results please get copies of them and post all the abnormal results along with the scale given by the lab for normal ranges as all labs are different. Everyone here will be able to help you when they see the numbers. Please come here for help, as that is what vwe are all here for. There is a lot of experience on this forum. Blessings
Patti