1 Vetoryl capsule, afraid to continue

[Jacie]

Beau is a 9 year old, 16 lb. Yorkie, just diagnosed with Cushing's. He had surgery for bladder stones at the end of April this year, preceded and followed by UTI's (his first ever). After the last UTI, the vet suggested Cushing's tests. Major symptoms (since very young), include constant heavy panting, extreme thirst, and excessive appetite, arthritis, and allergies/asthma, but no one ever made the connection. Vet prescribed 30 mg Vetoryl 1/day. I gave him the first capsule Friday AM (6/27/14). He did fine during the day (completely stopped panting - amazing!), but then nausea & diarrhea all night. I called the vet next morning (Sat) and was told to hold the Vetoryl till Monday (6/30) and try again. Nausea & diarrhea stopped on Sunday but he remained lethargic, no appetite. Not much improvement by Monday AM, so I delayed resumption of the Vetoryl. Long story short, I'm still waiting to resume the Vetoryl (now a week since supposed to resume ) and I am very much afraid to give it to him. I can't believe that one capsule could still be affecting him after 10 days, but he has not resumed panting, or excessive drinking/urinating. He is only eating about half his pre-Vetoryl amount. He is terribly lethargic, no interest in anything except staying close to me. Sometimes he wants to go for a walk, but other times, he hides when we get the leash. He seems to alternate between good/bad in about 4-6 hour stretches. I know I should call the vet, but I'm afraid she will say to resume the meds and I'm terrified it will kill him. I 'm posting the lab tests listed as High or Low. Advice please?
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UC/CR Ratio 41.2 (0.0 - 25.0)
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ACTH Stim Test:
Cortisol Resting 13.50 (1.00 - 5.00 ug/dl)
Cortisol Post ACTH 26.40 (8.00 - 20.00 ug/dl)
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Chem Profile & CBC:
Bilirubin, Total 4.05 (0.10 - 0.60 mg/dL)
BUN 11.2 (12.0 - 25.0 mg/dL)
Cholesterol 367.0 (125.0 - 250.0 mg/dL)
Glucose 130.0 (60.0 - 110.0 mg/dL)
Protein, Total 8.7 (5.4 - 7.7 g/dL)
LDH 313.0 (20.0 - 225.0 U/I)
Anion Gap 21.0 (-2.0 - 16.0)
RBC 8.530 (5.500 - 8.500 10^6)
HGB 20.6 (12.0 - 18.0 gm/dL)
HCT 61.7 (37.0 - 55.0 %)
EOS % 0.5 (2.0 - 10.0 %)
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[Harley PoMMom]

Hi and welcome to you and Beau,

I have manually approved your membership so there is no need to respond to the email that is automatically sent to you for validation.

30 mg of Vetoryl for Beau's weight of 16 lb is a bit high to me. If this were me, I would of felt more comfortable starting him out at around 10 mg but no more that 20 mg. He's not getting any vetoryl right now, correct?

Also, could you clarify that his Total Bilirubin level is indeed 4.05 (0.10 - 0.60 mg/dL)....Thanks!

I have only a moment to post but did want to welcome you and your boy, I am sure the others will be along to share their advice and to give their support.

Hugs, Lori

[Jacie]

No, I stopped the Vetoryl and have not resumed. He has only had the one capsule.
And Yes, the Total Bilirubin was 4.05
What does that mean? Thank you so much for your help!

[Harley PoMMom]

Elevated bilirubin can be attributed to a liver or a decreased bile flow problem, I am a bit concerned about this, has the Vet mentioned anything about the bilirubin being high? Was an urinalysis done, and if so could you look and see if any bilirubin was found?

[Jacie]

The vet has mentioned that she thinks his pot belly is due to enlarged liver. When she called with the lab results, she said it was "all normal" except for one enzyme (I think it was a liver enzyme) that was the opposite of what she would have expected. I didn't call to get copies of the tests until a few days ago. A complete urinalysis was done with the UC/CR test. It shows "UA-Bilirubin" to be "Negative".

[molly muffin]

Hello and welcome to the forum.

My concerns are a couple, in addition to the too high of a starting dose of vetroyl, which should start at about 1mg/1lb to be on the safe side.

The glucose and cholesterol are both high and I'd want to have diabetes ruled out.
The Bili could be showing a problem with gall bladder sludge, and as Lori mentioned a bile duct blockage. These all need to be ruled out before starting any sort of cushing medicine, even at the appropriate dosage.
I think I'd most likely want to go to see a specialist, IMS and if it is at all feasible have an ultrasound done.
It is a tad worrisome that your vet let these values go and went directly to cushings.
I definitely wouldn't give any more vetroyl until these questions are answered and even if cushings is later confirmed, keeping in mind that cushings tests can show false positive if any other illness is going on and it looks like there is something else going on. So, you need some answers to those questions first, in order to get your furbaby on the right track I think.

Sharlene and molly muffin

[Jacie]

My apologies to all for the delayed response. I decided to ask the vet about her statement that all blood work was normal when there were so many high readings. The answer was in the Fine Print at the end of the lab report:
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Platelet Estimate Adequate
Notes: Hemolyzed +2
All results may be compromised by specimen condition
Lipemic +2
All results may be compromised by specimen condition
Lipids removed prior to analysis
All results may be compromised by specimen condition
------
Response from the vet was that the lab they use always has extra-high Bilirubin when the sample is Hemolized and she doesn't think it is a problem. I did see that fine print, but took it to be just boiler-plate text if the vet accepted it as normal. Looking back on it, I wonder that she didn't say we need to repeat the tests. But in her defense, she knows our vet budget is maxed out ($1800 in 10 weeks). As for glucose level, on 6/4 a urine dip stick (UTI) showed sugar 140, but subsequent blood test was ok.
At any rate, Beau is back to pre-Vetoryl-dose status, except for the panting that is still greatly improved since that one dose. (???) I am really curious about what causes the panting. Is that a definite pointer to Cushing's or can it be a symptom of something else? I don't think I can put him through another Vetoryl dose, so don't really know what to do. May need to see another vet but cost has become a real factor.
Thanks so very much for all your help and guidance.

[Chloe's Mom]

I join the others in welcoming you and Beau to the forum. I'm not (yet) very experienced at evaluating all of the test results, but you're getting good information from the pros here.

The only thing that jumped out at me was the high dose of vetoryl you were given. My Chloe is a 14.5 lb. JRT and is on 5 mg of vetoryl. While we don't believe this extremely low dose will be her "forever" dose, it is better to start low. You can always go UP, but the potential for an Addison's crisis is far more concerning to me than Cushing's symptoms that may need a slightly higher dose.

My vet has several Cushing's dogs in her practice, and she is extremely cautious with the starting dose. Her dosing protocol is 1 mg/KG (2.2 lbs). IF Beau were to follow this protocol, he would be prescribed 8 mg of vetoryl. 30 mg. seems extremely high, and I'm glad that you're not giving him that dose right now.

Unfortunately, many vets prescribe according to the outdated dosing guidelines from the manufacturer. The manufacturer, from my understanding, has revised those guidelines to 1 mg/lb. My vet is even more conservative than that, and I am grateful for her caution.

I would ask the vet to lower the dosage to 10 mg. at the most right now. Good luck with your baby and keep posting here. The people here have helped sooooo many Cush pups, mine included.:)

[Harley PoMMom]

My apologies to all for the delayed response. I decided to ask the vet about her statement that all blood work was normal when there were so many high readings. The answer was in the Fine Print at the end of the lab report:
-----
Platelet Estimate Adequate
Notes: Hemolyzed +2
All results may be compromised by specimen condition
Lipemic +2
All results may be compromised by specimen condition
Lipids removed prior to analysis
All results may be compromised by specimen condition
------
Response from the vet was that the lab they use always has extra-high Bilirubin when the sample is Hemolized and she doesn't think it is a problem.

Yep, I agree that a high bilirubin level in the blood can be caused by red blood cells being destroyed (hemolyzed).



At any rate, Beau is back to pre-Vetoryl-dose status, except for the panting that is still greatly improved since that one dose. (???) I am really curious about what causes the panting. Is that a definite pointer to Cushing's or can it be a symptom of something else? I don't think I can put him through another Vetoryl dose, so don't really know what to do. May need to see another vet but cost has become a real factor.
Thanks so very much for all your help and guidance.

When dogs have Cushing's the panting can be attributed to many things; often they have an enlarged liver and this can put pressure on the diaphragm, redistribution of fat to the abdominal area and the muscle loss in the abdominal area are factors that can cause a dog with Cushing's to pant more.

Regarding Beau's reaction to the Vetoryl, it could be that he is a bit sensitive to it and dropping down to 10 mg would be better suited for him

Hugs, Lori

[Jacie]

Thank you all again. Just wondering...I have 29 30-mg Veterol. Would it be possible for me to open a capsule and divide it into 2 or 3 doses to be mixed in with food?

[Renee]

Thank you all again. Just wondering...I have 29 30-mg Veterol. Would it be possible for me to open a capsule and divide it into 2 or 3 doses to be mixed in with food?

Absolutely not! Please do not do that. These are not pills that can be split. It is very dangerous.

I have heard some pharmacies are able to take the pills and rewrap them into smaller doses, but I am not sure how that works or how expensive that is.

[Jacie]

Re dividing up the capsules myself -really just grasping at straws. Wouldn't have the nerve to do it. But checking with a pharmacy is a good idea if/when I come to the conclusion that i need to put him back on the vetoryl. Really think I need to see another vet first -preferably one who is more up to date on recommended dosages.
Thanks to all of you.

[Trixie]

That dose is too high for your dog. My dog was 16pounds and we started on 6mg twice a day...total of just 12mg. Also do not split the capsule or put it on food.
You were smart not to continue. The newest recommended dose is for 1mg per pound of the dog, but I wouldn't even give 16mg to start.
My dog has had real success on this drug but we had a low and slow approach...very low dose (and twice a day also means less at one time) and tweaking very slowly until symptoms are controlled. It can really help your dog but conservative use is best for safety and effectiveness.

Barbara

[molly muffin]

Hi Jacie, checking in on you and Beau.

How is he doing? Did you find a way to get the capsules split by a pharmacy?

Sharlene and molly muffin