Cushing's diagnosis - Sweet Iris has passed

[Sweet Iris]

Hi, my 11 year old dachshund Iris just got diagnosed with Cushing's today :( She just took her first dose of Vetoryl 30 mg. I am wondering what to expect if anything in the next few days. I am sad about the diagnosis but yet relieved we know what has been going on with our baby girl. She started drinking water like crazy and urinating excessively in the last year. She fit every thing on the list including the pot belly, hungry all the time, thinning and hair loss. We just took her to a new Vet last week when she wasn't feeling well and not able to use her hind legs well. We were having to carry her in and out to go potty and ect. She has a history of back problems (disk disease) and I really thought we were just going to be bringing her to get some prednisone and pray to God that would get her back to herself again. Well she was a lot sicker than we knew. She was actually dehydrated and her blood was so thick they could not run it through their machine. They gave her fluids via IV and were finally able to get a sample that day. She was to return the next day. The Vet called us about an hour later and asked us to look up Cushing's disease and that he would be running blood work to test for it in the morning. I am so thankful for him right now. Just praying this medicine will work and her quality of life improves.

[doxiesrock912]

Hello,
how much does Iris weigh and will you please post the type of test used to diagnose Cushings and the results please?

30mg sounds quite high for a small dog. The protocol is to start low 1mg - 2mg per pound and then work up from there.

Seeing the tests result will help us to help you better though.

[Sweet Iris]

Hi, she is 17 pounds and they used the low dose dexamethazone. They also did CBC chem panel and UA. I am not sure what the numbers were but they said 100% Cushing's. She goes back for blood work in 14 day's. Thanks!

[doxiesrock912]

Is she still sick or acting lethargic?
Please watch her carefully and if either of these symptoms persist, stop the Vetoryl and call the vet immediately.

[frijole]

Hi, she is 17 pounds and they used the low dose dexamethazone. They also did CBC chem panel and UA. I am not sure what the numbers were but they said 100% Cushing's. She goes back for blood work in 14 day's. Thanks!

That dose is on the high side so please read up on this drug and make sure to let us know if you see anything like lethargy, vomit, diarrhea - cease giving the trilostane and call the vet and schedule that test early. 2 weeks isn't set in stone, it is dependent upon the reaction. So if the drug works and reduces cortisol more quickly you will want to test as you might have to lower the dose. All dogs are different but normally vets start doses low and slowly raise them just to be safe.

Here's a link to how the drug works. Good luck, Kim
http://www.k9cushings.com/forum/showthread.php?t=185

[Sweet Iris]

Hi, Iris is having adverse reactions to the treatment with 30 mg Vetoryl. She started gagging constantly, not eating, not drinking much and has labored breathing. We took her to the Vet today and she is receiving IV fluids. She did not take the dose last night so I am hoping she will be getting it out of her system soon. She just started the treatment on Monday night so she had 3 doses. The vet mentioned maybe trying ketoconazole. I am just not sure if I want her to get sick again. I would rather her live happy with the Cushings than see her go through the reactions. I really don't know what to do. I am wondering if her being 11 is just too old to be putting her body through these medications. Any input and suggestions would be great, thanks!

[Junior's Mom]

Welcome to the forum. I'm sorry your dog is not doing well. It's good you brought her to the vet. Did they do an ACTH test as well. It sounds like her cortisol dropped to low, which can happen if the dose is too high. How much does Iris weigh? The recommended amount of vetoryl to start with is 1mg/pound.
The medications can work great to improve your pets quality of life, but it is very important that both owner and vet know what to watch for.
Tracey

[labblab]

It may simply be that the 30 mg. dose was too high for Iris. Can you tell us how much she weighs, and also what symptoms and diagnostic tests preceded starting her on the medication?

Thanks in advance!
Marianne

[Harley PoMMom]

I went ahead and merged your new posts into Iris' existing thread, that way we have all information about Iris in one place.

I think that maybe the 30 mg might have been too much for Iris, from your previous post I see she weighs 17 pounds. I would ask to have her cortisol checked (ACTH test) and her electrolytes too.

Hugs, Lori

[doxiesrock912]

As well as a lower dose, many dogs do best when the dose is split in half and given twice a day, 12 hours apart with food. Our Daisy was on a once a day dosage, she got super bad diarrhea. Since we lowered the dose and split it in half she's been fine. Please readthe informative link that Kim provided.

[molly muffin]

You said she didn't take the dose last night. Are you doing twice a day dosing? Or giving once a day? (if only doing once a day, then give in the morning with food. Tests need to be done 4 - 6 hours after the medication is given, and if you give once a day at night, then you don't get accurate test results the next day)

Either way. 30mg is too much to start her off at. Should have been 17mg optimally, but 20 would have been better than 30 if going with vetroyl. The symptoms are all the common symptoms of over dosing. Many dogs need to at the very least have the medication introduced into their systems gradually.

Typically after an over dose, you wait till symptoms return and then start at a lower dosage. It might be she would also need what they call resuce dose of prednisone. The IV is usually to get the potassium and sodium (electrolytes) regulated to normal, but if cortisol is too low, they might still need the prednisone) Did your vet discuss this with you?

Sharlene and Molly Muffin

[Sweet Iris]

Hi, thanks everyone for your thoughts and input. Well Iris went to the vet and received IV fluids, he also put her on Furosemide. She is still having rapid breathing, and loss of appetite. She also has been sounding congested and you can feel it when you put your hand on her. CHF? I don't know but I did get her to eat a few bites tonight. She is drinking little water and I believe it's because she starts gagging every time she drinks. Just giving her lots of love and support right now and praying she starts feeling better. If she starts doing well enough the plan would be to start at a lower dose of the Vetoryl or Ketoconazole. I am really not sure at this point. They did more blood work today to check electrolyte's and her potassium was low so he gave me a gel to give her once a day. The dose on the Furosemide is 12.5 mg once in the morning. He is hoping this will help her breathing. I did get a copy of the blood work. They did not do a ACTH test on her. Thanks everyone for your support.

[Sweet Iris]

She was on once a day Vetroyl. She was given it at night with food. The fact that she may have had a cortisol crash was never mentioned, (Molly Muffin). Will she be ok if her the levels did fall to low? How long do the side effects typically last?

[doxiesrock912]

Every dog is different. Please watch for lethargy, vomiting - if these happen call your closest emergency vet right away. Do not give her anymore Vetoryl until she is back to normal and exhibiting Cushings symptoms again. Then insist that they do an ACTH test and start on the lowest possible dose twice a day. Don't be discouraged if it takes several rounds of dosing changes and ACTH tests to find the right dose. This is not uncommon.

Please read through the links under the helpful resources section, they are invaluable and have helped many people recognize when their vets are off tract with treatment.

I have read that Ketoconazole is only affective in a small percentage of cases.

[Sweet Iris]

Thank you so much!

[doxiesrock912]

No problem,
We all started out where you are now :-)

Educating yourself is a must with this disease and the information that you'll learn here is invaluable.

[Sweet Iris]

One thing I have been forgetting to mention is that her blood has been really thick. They are having a hard time running it through their machine? Anyone know why? This scares me.

[Harley PoMMom]

Since her potassium was low her cortisol could of dropped too low also. If they are not giving her any steroid substitute, like prednisone, I would ask them to at least perform a resting/baseline test, which is the "pre" of an ACTH stimulation test. If the pre number is low than she will need some sort of steroid which could perk up her appetite.

Hugs, Lori

[Sweet Iris]

Yes, I have learned a lot about this disease in a very short time. I will continue to read. I really like this forum because you get input from other peoples experiences which is more helpful then a one size fits all information site. Thankful I found this site!

[Harley PoMMom]

One thing I have been forgetting to mention is that her blood has been really thick. They are having a hard time running it through their machine? Anyone know why? This scares me.

I would say that she is dehydrated, she needs more hydration and if she is not drinking water on her own than she needs to get fluids through an IV.

[doxiesrock912]

I believe she is on IV fluids, right?
There is no "one size fits all" with Cushings.

Once Iris is stable and all other health issues have been resolved, I would start with an ACTH test. Infections can skew the results of the test.

Please post her weight, how they conducted the test (I believe that a dog not on Cushings meds should not eat before the test).

Then share the results with us here and the vet's recommendations before filling a new prescription.

Keep us posted.

[labblab]

Since her potassium was low her cortisol could of dropped too low also. If they are not giving her any steroid substitute, like prednisone, I would ask them to at least perform a resting/baseline test, which is the "pre" of an ACTH stimulation test. If the pre number is low than she will need some sort of steroid which could perk up her appetite.

Hugs, Lori
I wanted to repeat this reply that Lori posted last night, because I think you were writing at the same time and may not have seen it. It is very, very important to know whether the cortisol level has dropped too low and whether or not it is rebounding now that the trilostane has been stopped. If not, Iris definitely needs supplemental prednisone to replace the cortisol she is lacking. Please call your vet today and confirm with them whether or not they checked her cortisol level (even just a resting cortisol) while she was with them. They may have done so and just not told you. If not, it needs to be checked ASAP if you do not see significant improvement quickly in your girl.

Marianne

[Meg_Elizabeth]

Hi, my 11 year old dachshund Iris just got diagnosed with Cushing's today :( She just took her first dose of Vetoryl 30 mg. I am wondering what to expect if anything in the next few days. I am sad about the diagnosis but yet relieved we know what has been going on with our baby girl. She started drinking water like crazy and urinating excessively in the last year. She fit every thing on the list including the pot belly, hungry all the time, thinning and hair loss. We just took her to a new Vet last week when she wasn't feeling well and not able to use her hind legs well. We were having to carry her in and out to go potty and ect. She has a history of back problems (disk disease) and I really thought we were just going to be bringing her to get some prednisone and pray to God that would get her back to herself again. Well she was a lot sicker than we knew. She was actually dehydrated and her blood was so thick they could not run it through their machine. They gave her fluids via IV and were finally able to get a sample that day. She was to return the next day. The Vet called us about an hour later and asked us to look up Cushing's disease and that he would be running blood work to test for it in the morning. I am so thankful for him right now. Just praying this medicine will work and her quality of life improves.

Wow 30mg of vetoryl is quite a high dose. My girl has been diagnosed with Cushings for 3 years now (I think). She weights about 40 lbs and is only on 10mg. Did you talk to the vet about the dosage? Is she having any noticeable side effects?

-Meg

[Sweet Iris]

Hi, thank you all. Wow I wish I had been a little more prepared at the vet yesterday. I had read about the cortisol crash prior and have been an emotional wreck when it comes to her not feeling well. I need to just stay strong and educate myself to help her. I am so thankful for all of you and your wisdom. I am feeling like myself and the Vet are new to this disease and doing a crash course with the meds ect. I think they just ran a CBC. I don't see cortisol results on it. I am half tempted to do a low dose of prednisone on her myself today and see if it gets her out of this funk.

[Sweet Iris]

The problem I am having is we started with a new Vet and it is a small clinic and a 40 min drive. They are closed on the weekends. We really like them and they are much more affordable than any of these places in town. I am going to research and find someone who is closer and have experience with Cushing's and treatment. I don't want to make them feel I didn't appreciate all the care they have given her but I just want her to get better. This is horrible. Please pray for my Iris:(

[molly muffin]

I would give the vet a call and get their take on prednisone and how much should be given as a rescue dose when the cortisol gets too low. (they can even do a baseline to get an idea of where her cortisol is at) That way you will have them on board, you can tell them you have read that this is standard for when a cortisol crash happens, etc. If they are unhelpful, start calling around to other vets and see if you can find one with experience with cushings, trilostane dosing and testing.
An immediate red flag is giving the dosage at night, when you won't be able to do the follow up testing that is needed and get an accurate result. This is pretty basic for cushings using vetroyl/trilostane. It's okay to have a vet who is willing to learn, but mistakes can't be made, as dire consequences can happen.

You'll find that Knowledge is the best weapon you'll ever have with cushings. The more you know the better and advocate you'll be for Iris and in no time at all, there won't be anything getting past you. You'll know exactly what should be done and when. :)

Sharlene and Molly Muffin

[Sweet Iris]

I agree with you 100%, great advice. Thank you!

[labblab]

Just so you'll know, the usual formula for calculating the rescue dose of prednisone is 0.25 mg. per kilogram. A kilogram equals 2.2 pounds. So if Iris weighs 17 pounds, this would equal 7.7 kilograms. If you multiply that by 0.25, you end up with approx. 2 mg. of prednisone once daily. As you can see, this is not a large amount. But it is important if Iris needs it.

Marianne

[Sweet Iris]

My baby Iris passed away late Sunday night! I am devastated and heartbroken. :( Her breathing never did get better and she died in my arms minutes after we pulled up to the emergency vet. It was the hardest, saddest thing. I can only take comfort that she died with me and not a stranger. :(

[Renee]

I am so sorry to read that your baby girl passed. What an unfair tragedy.

[molly muffin]

Oh no, no :( I am so sorry and you have my deepest condolences.
I know you are absolutely heart broken and filled with grief. At least she was in your arms and knew she was surrounded by your love.
I'm really so very sorry.

love, hugs and strength to you
Sharlene

[doxiesrock912]

Oh no!!!
I am so very sorry! I'm in shock and crying as I type this.

Iris was in the best place possible at the end and I'm sure that she was grateful to be in your arms. My sincere condolences sweetie.

[Budsters Mom]

I'm so sorry for the loss of your little Iris. She had joined our other fur angels at the rainbow bridge. Run free Iris, run free! xxxxx

[scoora]

I am so sorry to hear of the loss of your sweet girl Iris.
My thoughts and prayers are with you.
Hugs

[Spiceysmum]

So sorry to hear that Iris has passed away. My thoughts are with you at this sad time.
Linda

[goldengirl88]

I am so sorry your little Iris passed away. I have read your thread before and was shocked to read this this morning. Blessings
Patti

[BostonLover]

I'm so sorry for your loss. It's so hard to lose our babies, and this disease just makes me SICK.

[Sweet Iris]

Thank you all for the condolences, I am thankful for you all. Iris' death came so fast and I thought I would have more time with her. She died exactly one week after I got her Cushings diagnosis which is insane to me. But my baby was sicker than I knew. I do take comfort in several things like the fact that my husband and I had a very lazy weekend and enjoyed her all weekend without me going anywhere. I think deep down I must have known. I really did think she would pull out of it though.. Sunday she would not eat anything nor take but a few licks of water( which we all know is very bad for our cushings dogs) I am going through the stage now where should have, would have and why? Regardless I do believe she would of passed no matter what meds, vet she had. At this point I am back and forth. I take comfort in hugging the pillow she loved and sleeping with her toys! Thanks for the support :"(

[molly muffin]

The only thing you can do and remain sane, through the loss, is to hold onto the wonderful memories and the love you had for her and her for you. That is what is really important.
All of us do the best we can with the information we have, trying to figure out what is wrong, how to treat, and the could have, would haves, can drive you crazy and it's already an emotional roller coaster to have this kind of heart breaking thing happen.
I'm glad you had a great last weekend with her. That is most important.

hugs,
Sharlene and Molly Muffin

[Bo's Mom]

I am so sorry to read about your dear sweet Iris. I realize how hard this must be for you and your family but please know we are all here for you whenever you need a comforting ear to listen.
RIP Sweet Angel Iris....

[apollo6]

Words can not comfort you in your loss. May your sweet Iris be at peace.
Hugs Sonja and Angel Apollo


Last Night
I stood by your bed last night, I came to have a peep.
I could see that you were crying, You found it hard to sleep.
I whined to you softly as you brushed away a tear,
"It's me, I haven't left you, I'm well, I'm fine, I'm here."
I was close to you at breakfast, I watched you pour the tea,
You were thinking of the many times, your hands reached down to me.
I was with you at the shops today, Your arms were getting sore.
I longed to take your parcels, I wish I could do more.
I was with you at my grave today, You tend it with such care.
I want to re-assure you, that I'm not lying there.
I walked with you towards the house, as you fumbled for your key.
I gently put my paw on you, I smiled and said " it's me."
You looked so very tired, and sank into a chair.
I tried so hard to let you know, that I was standing there.
It's possible for me, to be so near you everyday.
To say to you with certainty, "I never went away."
You sat there very quietly, then smiled, I think you knew...
in the stillness of that evening, I was very close to you.
The day is over... I smile and watch you yawning
and say "good-night, God bless, I'll see you in the morning."
And when the time is right for you to cross the brief divide,
I'll rush across to greet you and we'll stand, side by side.
I have so many things to show you, there is so much for you to see.
Be patient, live your journey out...then come home to be with me.

- Author unknown

[Meg_Elizabeth]

I cannot imagine the pain you are going through.... Sending many hugs. May Iris truly be at peace

[gatorgirl_bama]

So sorry for the loss of your sweet Iris. I understand completely how hard it was losing her so quickly because I lost my baby 2 days after her Cushings test. Like you I got to spend the weekend with her and then lost her on Sunday, August 11, 2013.

You're in my thoughts and prayers. RIP Sweet Iris.

[grapey]

I'm so sorry for your loss. I lost my baby girl Elliott on Jan. 15. She was also on furosemide, as well as a few other heart meds. It seemed like with the cushing's it just all happened at once. Our puppies do not deserve this. I think Iris is a beautiful name. It's my favorite flower.

[Dukes Mom]

so sorry for your loss. I know the feeling of having the loss as you pull up to,the Vet. I have owned 4 dacshounds, 3 of the 4 have died in my arms. The fourth is now fighting cushings and diabetes. some tough decisions ahead,:(