Ellie diagnosed 10 days ago (13 y/o Springer / Lab)

[angie and ellie]

Hi Everyone

My dog Ellie is a 13 year old Springer / Lab. 10 days ago she was confirmed to have Cushings. Her cortisol level from her first ACTH and the 2nd blood test, was 990. Apparently normal should be about 260.
She weighs approx 55 lbs and has started Vetoryl at 90 mgs per day. Fortunately she has had no side effects, other than her mobility.
It is her difficulty in walking, which has deteriorated in the 9 days she's been on Vetoryl.
It was her mobility that made me take her to the vet in the first place, together with her thinning coat. Her mobility now is so poor she can only manage a maximum of a 5 minute walk. Her legs become very wobbly, particularly her hind legs. and at times I have to help her to get up.
I did call my vet a couple of days ago with my concern, and he thinks it might not necessarily be connected to the cushings. She is booked in tomorrow for her 2nd blood tests. I am wondering what the way forward is with her walking??
I have almost resigned myself to the fact I may have to let Ellie go, it's so heart breaking to see a once so highly active dog reduced to being barely able to walk.
Your suggestions and advice would be most welcome. Thank you.

Angie

[doxiesrock912]

90mg for a 55lb dog is within acceptable limits, but the recommendation is to start lower and work up. Generally, 1mg for each pound. Many dogs are very sensitive and need to work up to the ideal dose and others require that the recommended dose be split in half and given twice a day 12 hours apart.

It is possible that Ellie could be sensitive and this dosage is also too high.
Cushings is a slow progressing disease so there is no reason to rush things and it is very acceptable to start with a lower dose regardless of what the ACTH test shows.

Also, once medication is started, the ACTH tests must be performed within 4 - 6 hours after the dog has eaten and had their morning meds. Each subsequent test must also be in the same time frame, so if the first ACTH was done 5 hours after breakfast and morning meds, all other ACTH tests should be done 5 hours after as well.

If you are in doubt, please stop the Vetoryl until she is seen by the vet. If Ellie becomes lethargic or vomits stop immiately and call your vet or go to the nearest 24 hour animal hospital.

Many of us have found that general vets do not have enough experience with Cushings and opt to use a (IMS) small animal specialist. It is a bit more expensive, but proper treatment is key with Cushings.

[angie and ellie]

Thank you Valerie for your reply.
Having read through some of the forums, I do take on board that a lower dose of Vetoryl could be given.
Ellie is due for her 2nd blood tests tomorrow, and my vet has advised to fast her. I've been directed by this site to Dr Mark Peterson's articles on ACTH protocol, saying quite the opposite. I have printed off his articles and will take into the vets tomorrow. I will also phone the vets 1st thing in the morning re my concerns about fasting. I must admit I'm not to keen on telling a professional his business.
I live on the Isle of Wight, a small Island in the United Kingdom, so veterinary specialist resources are very limited.

Angie

[Tina]

Hi Angie,
Welcome to the forum. Sorry to read that Ellie is having so much trouble. Does she have a history of arthritis at all? When cortisol is high in their body, it can mask a lot of other things, especially the symptoms of arthritis. Once they are on medication to lower the cortisol, the arthritis can flare up.

The cortisol level that you posted, is that the post number? For an ACTH test, there should be two numbers, a pre and post. Could you please post those, as well as the units of measurement and the reference range? Was this the test that was done to diagnose Cushing's? If you could also post any other abnormal lab results along with the reference ranges, that would be helpful. What symptoms besides the mobility problems was Ellie having that led you to have her tested? Sorry for all the questions, but the more information we have, the better feedback we can provide.

Welcome again,
Tina and Jasper

[Budsters Mom]

Hello and welcome from me too.:)

It is quite possible that your vet wants you to fast Ellie for her blood work. That is reasonable. However, that would mean that the ACTH needs to be done at another time. For the ACTH, Vetoryl needs to be given with food (usually breakfast). The ACTH test must be started 3 or 4 hours later. If you fast for the ACTH, you are throwing your money down the drain because the test will not be accurate.

I am also concerned that 90mg. Vetoryl may be too high a starting point for Ellie. It is safer to start on the low side, then increase as needed. It is generally recommended to start at approx. 1 mg. per pound.

Please check with your vet before you proceed any further. You are Ellie's best advocate. We question everything we don't understand. That is how we learn. A good vet shouldn't mind questions. Sometimes we need to educate them a little (or a lot!) I certainly had to do that with one of mine. Do not be afraid to speak up. ;)

We will help you in every way we can.
Kathy

[angie and ellie]

Thanks Kathy, Tina and Jasper

I'm not sure if the cortisol level was pre or post, but I will ask the vet for copies of the blood tests. The 1st ACTH test was for confirmation of Cushings.

I think now in hind sight the symptoms started about a year ago, and as seems so common I mistook her symptoms down to her age.
I normally around the beginning of summer have her lightly clipped, but since her clip of 2013 her hair hasn't grown back. I also noticed last year her skin started to become flaky, and this year Ellies hair started to thin on her back.
Also around March / April this year she started to slow down and started to tire after her normal length walk.
In April /May I took her to the vets, for her mobility and flaky skin. She was treated for Arthritis, and put on Metacam, which didn't seem to improve the problem. The vet also prescribed some skin conditioning spray, which also was ineffective. I now massage in some coconut oil which has improved the flaky skin.
Ellie did also at this visit have the pot belly, which the vet did pick up on, but didn't seem to concerned................... ???:o
Her other symptoms are: panting, excessive hunger, but her fliud intake has not been noticeably higher than normal.
I can't remember Tina what else you asked, but hope this may be of help.
Thank you all for your concern.

Angie

[doxiesrock912]

Angie,
The pot belly is due to organ enlargement and fat redistribution which is common with Cushings.

The original test for Cushings is done when fasting the dog. Once medication is begun, you do not fast the dog.

Errors in treatment are serious. Absolutely question your vet as Crushing is a learning process for owner and vets together. If your vet doesn't like to be questioned, do find another. I can't stress the importance of this.