Starting treatment - Brittany has passed

[JaimeB818]

Hi I'm new here. My 12 year old lab mix,Brittany, was diagnosed with cushings about 3 weeks ago. She has a tumor on her adrenal glad that has not spread but is entangled in several major arteries so it can not be removed. Our vet started her on Vetroyl 120mg. After the second dose she immediately started vomiting and did not eat for 2 days. We went down to the 60mg dose and she has had no side effects but we are also not seeing any improvements. Does anyone know about how soon we should see improvements? She is on day 5 of the vetroyl 60mg. Thanks

[Harley PoMMom]

Hi and welcome to you and Brittany,

How much does Brittany weigh? It does sound like Brittany was started on a dose that was too high for her and lowering her Vetoryl dose was probably correct but an ACTH stimulation test should have been done prior to any dose adjustment to make sure that her cortisol isn't too low. How is Brittany acting now? Any vomiting or diarrhea?

What symptoms does Brittany display? Usually the excessive drinking/urinating abate within 2 weeks of starting treatment, any hair/skin issues take more time for improvement to be seen.

What tests were done to confirm the Cushing's diagnosis, also could you get copies of the results and post them here? Were a chemistry/CBC blood panel done, and if so, could you post any abnormal levels with the reference ranges and units of measurement? Does Brittany have any other health problems? Is she taking any other herbs/supplements/medications? Was an urinalysis done, and if so, could you post those findings too?

Sorry for all these questions but the more we know about sweet Brittany the better our feedback can be, ok?

We are here to help in any way we can so do not hesitate to ask all the questions you want. ;)

Hugs, Lori

[Trixie]

The medication does not work overnight, it takes time to see an improvement in symptoms. How long it takes varies with each dog. Some will have changes over the first week, but many will take a number of weeks before the symptoms begin to decrease.
Good thing your dogs dose was cut down...it sounds like she was getting way too much.

Barbara

[goldengirl88]

Everyone else has already asked everything. I just wanted to say it sounds like your dog was started way too high on the Vetoryl dosage, and she was suffering from Addison's. If you see any vomiting, diarrhea, lethargy, can't get up, won't eat, stop the Vetoryl. Remember it can always be restarted. Has your vet given you any prednisone in case this happens again? Were your dogs electrolytes etc. checked after this vomiting episode? Blessings
Patti

[JaimeB818]

Thank you all so much! This past summer Brittany started wanting to go out for a potty break (she actually hates being outside in the crazy Texas weather) much more frequently. I usually get up with her 2-3 times a night and I'm pretty much home with her during most of the day which she sleeps for the majority. I really thought it was just that she was getting old. Then a few weeks ago she started having accidents in the house which is very strange for her and she was having difficulty getting on my bed. We thought she had a UTI, but when we took her to the vet her bladder was empty. They still treated her for one because she seemed to have all the symptoms. After her medication was up we still saw that she was having a hard time urinating so we took her in for more test and that is when they said something is very wrong. We did an ultrasound and found the tumor, then came the blood work. I don't have the numbers but can ask when we go back in next week for her next round of blood work. She weighs about 58 pounds which is a little more than ideal for her, but much less than she did 2 years ago after she got put on a diet. She topped out at 69 pounds.

Right after starting the 120mg Vetroyl she had diarrhea and vomiting. She wouldn't eat. I stopped her meds for 4 days and then started the 60MG. Her symptoms now are still the frequent drinking, urination and seems like it surprises her, panting and she has a hard time getting up from laying or sitting, but after walking a little she seems to be ok. She constantly is scratching her neck on the carpet too.

What I was told about her levels was that the vet did not think the 60MG would help but that we could try it. If the 120MG was making her more sick then it was not worth giving to her. He even called a friend of his that is a specialist. I just want my poor Brit to be comfortable. She is still just as sweet as ever, runs my cat down and follows me all around the house, but she just seems like she feels bad. Oh she does have hypothyroidism but the vet said that could have actually been a misdiagnosis because of the cushings.

Thank you all. I'm so glad I found this forum.

[Renee]

Your vet risked your dogs life, to the point of almost killing her. :mad:

I would suggest finding a new vet. For me, such a gross error in judgement on your vet's part would be unforgivable.

The symptoms can take weeks, or months, to resolve. This does not mean the medication is not working. Think of it this way, cushings takes years to get to the point of needing treatment, so you can't resolve it overnight.

[Trixie]

what needs to happen next is an acth test to check your dogs levels..then you will know if she needs a higher dose or not. Do you know that you can get this medication dosed to different strengths other than what Vetoryl (the branded name) comes in? You can order the generic form-Trilostane- to any specified dose other than what is made by the brand. The brand Vetoryl comes in 10, 20, 30, 60 and 120mg. BUT if your dog needs somewhere in between those strengths which it sounds like yours may...you can get it! If 60mg proves to not be enough-based on the acth results you can slowly increase by trying 70mg...there is no need to increase by too much which can be dangerous. If your vet has not told you this then you may wish to tell him/her.
Increasing too quickly and by too much is not a good idea. It would be really helpful for you if you can post all your test results here..(you can get copies from your vet) and then some experienced members here will better be able to help you. No one comes here knowing everything so don't feel badly...but you can learn alot on this forum and be able to help you dog get better. Please try and post your tests...you and your pup will benefit with some extra help from everyone here. :)

Barbara

[JaimeB818]

Here are her test results:

4 post-dex. .8ug/dl
8 post-dex 1.6 ug/dL
Pre-dex 4.9 ug/dL

I have no idea what this means. I did leave a message for our original vet that I want her to see Brit next week and not the one that prescribed the 120mg. Thanks for all the information.

[Harley PoMMom]

Increased drinking/urinating can be attributed to an UTI. If Brittany's urine is diluted an urine culture and sensitivity test should be done so that the exact bacteria is known and the correct antibiotic can be given.

Although her LSSD test is indicative of PDH any nonadrenal illness, such as an UTI, can cause a false positive result.

Hugs, Lori

[labblab]

Hello and welcome from me, too!

In defense of your original vet, 120 mg. is the recommended initial dose for a dog of Brit's weight per the published dosing chart that Dechra, the manufacturer of Vetoryl, supplies with the drug. A vet ought to be able to rely on this published literature, but recent experience with the drug has led clinicians and specialists to recommend starting doses that don't exceed 1 mg. per pound. So I am willing to cut your vet a bit of slack re: the initial dose, but I am puzzled as to why he seems to think that there are no options between 60 mg. and 120 mg. Even if you stick to brandname Vetoryl, the other capsule sizes allow you to dose at many increments between 60 and 120 by simply combining capsules.

Also puzzling, though, is Brit's LDDS test results because they are consistent with pituitary Cushing's (barely, though, with an 8-hour result that is only a fraction into the "positive" range). Per the ultrasound, you already know that she has an adrenal tumor. So the question becomes, does she also have a pituitary tumor in addition? Which tumor is stimulating cortisol production; is either one actually stimulating cortisol production? It would be really helpful to know whether a diagnostic ACTH stimulation test was initially performed, and if so, what the results were. This is the same test that is also conducted in order to monitor the effectiveness of the trilostane in lowering cortisol levels after treatment has begun.

Bottom line: if trilostane is actually warranted, you can engineer doses between 60 mg. and 120 mg. So at this early stage, there is not yet reason to believe that you will not be able to manage Brit's symptoms effectively if either a pituitary or adrenal tumor is stimulating overproduction of cortisol.

Marianne

[molly muffin]

Hello and welcome. I agree with Marianne, the LDDS is puzzling since we know there is an adrenal tumor. I'd be interested to know if they checked cortisol levels too, via an ACTH. There is an adrenal tumor, called a pheo. It is not usually cortisol secreting, so cortisol remains normal. They can invade the vena cava (any adrenal tumor can secreting or nonsecreting) and that might be what the problem is why they can't do surgery.

A secreting Adrenal tumor can be a bugger to get control of and I think typically requires higher level of medication. For a long time, an adrenal tumor's choice medication would have been lysodren, to try and get control of the tumor and erode the adrenal cortex to not secrete as high of levels of cortisol.

All that being said though the LDDS doesn't really support the adrenal tumor putting out excess cortisol. hmm.. The symptoms do support it though.

When the cortisol goes down, any problems they have like arthritis shows up in abundance, so you might have to see what an optimal level for her would be.

Like Marianne said, there are in between dosages if needed, so that isn't a worry.

You are doing the ACTH next week? Can you call and ask if they did an ACTH before starting her on medication?

Sharlene and molly muffin

[JaimeB818]

Just wanted to say thank you to everyone who replied. It was all so helpful. Cushings ended up being the least of our problems if even that at all. Last Saturday We found a painful growth on Brittany and took her to the doggie ER. They scheduled her for a biopsy on Monday. She was so sick all week and passed suddenly Thursday morning, 2 hours before we got the results from the biopsy. The mass was a very agressive mammary tummor that doubled in size by Thursday. We so miss our girl. It's very hard going from having a pet for 13 years to having the quiet in the house.

[molly muffin]

Oh my gosh I am so sorry to hear that Brittany has passed. That must have been a very aggressive cancer. I know that your heart must be broken.
My sincerest condolences.

Sharlene and molly muffin

[molly muffin]

Moderator Note:

I changed the title of your thread so let others know that your sweet Brittany has passed. I know many others will want to offer their condolences too.

Sharlene

[Squirt's Mom]

Oh I am just so sorry to hear this! I understand - I had to let my little Toy Poodle, Grace, go last Monday for the very same reason. She did have the surgery and removed 8 tumors the month before that had suddenly come up, one rupturing...then they came back. :( We can't let them suffer nor ask more of them than they can give. You did the right thing tho I know your heart is oh so broken. My tears join yours today.

Brittany's name has been added to the In Loving Memory thread for 2014 where she will always be remembered as a cherished member of our family here at K9C. Please feel free, when you are ready, to start a memorial thread to her in the ILM section. We would be honored to help celebrate her life via your memories of her.

http://www.k9cushings.com/forum/showthread.php?t=5973

Our deepest sympathies,
Leslie, Squirt, Trinket, Brick, Sophie, Fox and all our Angels at The Bridge



May I Go

Do you think the time is right?
May I say goodbye to pain filled days and endless lonely nights?
I've lived my life and done my best, an example tried to be.
So can I take that step beyond, and set my spirit free?
I didn't want to go at first, I fought with all my might.
But something seems to draw me now to a warm and living light.
I want to go, I really do; it's difficult to stay.
But I will try as best I can to live just one more day.
To give you time to care for me and share your love and fears.
I know you're sad and afraid, because I see your tears.
I'll not be far, I promise that, and hope you'll always know,
That my spirit will be close to you wherever you may go.
Thank you so for loving me. You know I love you too,
And that's why it's hard to say goodbye and end this life with you.
So hold me now just one more time and let me hear you say,
Because you care so much for me, you'll let me go today.

by Susan A. Jackson

[Renee]

I am so sorry for your loss. Cancer is just the worst.

[goldengirl88]

I am so sorry you lost your baby. It is truly heartbreaking to owe your best friend.
Blessings
Patti

[Spencersmom]

My heart breaks reading of your loss! May you find comfort in the wonderful memories you have of your precious baby! Hold them close to your heart!

[Trixie]

I'm so sorry to hear you've lost your sweet Brittany. I'm sure she was a well loved family member and I can only imagine how much you'll miss her.

Barbara

[Tina]

I'm so sorry to read the sad news about Brittany. My deepest sympathy.

Tina and Jasper

[doxiesrock912]

Oh no!
i'm so sorry!
My sincere condolences to you and your family.

[apollo6]

with sympathy over the loss of your beautiful Brittany.
Hugs Sonja and Angel Apollo