Is this the end?

[ellie and angie]

Hi, my name is Angie and my english springer spaniel is called Ellie.

Last June Ellie was confirmed to have Cushings. She weighed 26.6kgs & was started on Vetoryl at 90mgs per day.
She also suffers with Arthritis.

She had all of her initial ACTH tests, and her levels were slowly dropping. I'm sorry I don't have the numbers.

Her last test the monthly one still showed levels were to high, so she continued on the 90mgs Vetoryl.

After this test Ellie showed signs of improvement. She lost her pot belly & her coat improved.

Ellie was due her quarterly ACTH around the middle of November, but because over the last 2 weeks or so she began to get a little picky over her food. the ACTH was done last week, and the results back last Friday showed a to low a level. (below the 1.45 & 40)
The vet I saw advised dropping the Vetoryl to 60mgs.
Her weight had dropped to 24kgs.

Her appetite has continued to drop, and her last day of eating a normal amount of food was last Thursday.
I took her back to the vet last Saturday as her appetite had dropped of so much, and she had become very weak on her legs.

The vet I saw this time was more concerned about her arthritis, and prescribed Metacam with Tramadol & half a paracetamol twice daily. Also to keep the Vetoryl at 60mgs.

I'm afraid I wasn't convinced 60mgs was correct and I have therefore rightly or wrongly, withdrawn it, her last dose was last Friday.

Her appetite is virtually none existent Sunday & Monday she had about half a sausage and a couple of cubes of gammon.
She has now been eating grass and then bringing the grass
up.
Yesterday (Tuesday) she did eat a whole sausage and a few cubes of roast beef.

I'm on the verge of requesting that dreaded home visit from the vet.

How long can I let her go on like this??? I don't want to lose her, but I don't want to see her suffer.

I'm feeling pretty desperate. Your help good people, would be gratefully appreciated.

Thank You all in advance

Angie

[doxiesrock912]

Angie,
It is possible that because she isn't eating much that the metacam and /or tramadol are upsetting her stomach. Honestly, why they would want you to give both of those I would question for sure.

From personal experience, our Daisy did not tolerate metacam well at all but was fine with tramadol.

Please ask them if you can use the latter and you might want to entice her by adding a teaspoon of all natural canned pumkin from the baking aisle. That was like candy to Daisy and it coated her stomach too.

[ellie and angie]

Thanks Valerie,

I would agree the Metacam is not a good idea.
The failing appetite started some weeks ago, but no doubt Metacam is not helping Ellies condition. I will stop giving it to her.

I forgot to mention that Ellie is drinking normally.
She also seems alert to what is going on around her, and does clean her paws, without excessive licking.
Also when I administer her Tramadol orally with a syringe, I do get the dirty look treatment.

Because she is still reasonably bright, it's just making any final decision so difficult.

I know the sausage etc are not the best, but it's a case of what ever Ellie may fancy.

Angie x

[Trish]

Hi Angie

This is such a worrying time for you and Ellie. I agree with you in stopping the vetoryl. They should have done blood tests to check her electrolytes as if her cortisol has dropped to low it can be really dangerous and they can often need support with IV fluids until everything normalises and definitely no more vetoryl until her cortisol comes back up. They often need to be supported with Prednisone too, I think in this situation you need to take her back to the vet and insist those tests are done. I really am a bit concerned right now that Ellie needs this support. If your vets are not doing the testing properly I would be off to another to get this checked properly.

If her cortisol has dropped to much it definitely makes them wobbly, poor appetite so she has a lot of the symptoms and I think she needs prednisone asap as it can turn very bad very quickly. I don't want to scare you but really recommend you get her seen to. Do you have a 24/7 vet service available or have any prednisone on hand?

A dropping cortisol can also unmask arthritis problems so that could also be increasing her discomfort. My dog was taking Tramadol for a while, he had drops and absolutely hated it as it tastes quite bitter. But I do think the tramadol is preferable than Metacam.

But in the first instance her cortisol level needs to be addressed asap.

Trish

[ellie and angie]

Thanks Trish

I did forget to mention in my 1st post that Ellie is drinking normally.

Would it be safe to give her the prednisone (I don't have any) without taking her to vets for further blood tests?????
I just dont want to put any more stress on her right now.

Angie

[Trish]

They can go Addisonian if their cortisol goes too low and it can turn into an emergency and I am worried that is what is going on with Ellie, if her cortisol was less than 1.4??

You would need to take her to the vet to get tested cortisol and electrolytes to see where she is and they would have to prescribe the prednisone for her. If she is not feeling up to it, that would want me to take her there faster before she gets any worse. I hope you can do this.

[Woodydog]

I agree with Trish this possibly could be an addisonian crisis, I would contact your vet soon as and get your pup seen. I understand that the vets stress her out but better being safe :)

[ellie and angie]

Thanks
Have asked vet to call ASAP
My laptop keeps freezing to add to our problems so may not be able to reply.
Could you let me know all the clinical symptoms of Addison's Crisis please?

Thanks

Angie x

[Trish]

Sooo pleased you have been in touch with your vet, if they do not take this seriously I would be taking Ellie somewhere else.

Addisonian crisis can appear with symptoms you are describing in Ellie such as poor appetite, weakness, vomiting, diarrhea, generally feeling stink. So you are doing right insisting she gets tested properly.

When you take her in, make sure you get a copy of her results from the diagnosis to now and post them here. Soon there will be some very smart members of this forum logging on and they can advise you much better than I can. She may have been trending down for a while as she has been on a fairly hefty dose of Vetoryl and is now just starting to get really sick from it. We have had a lot of dogs arrive here like Ellie with low cortisol and with quick action they can really bounce back, but I do believe she needs some expert attention and care right now.

[labblab]

Welcome from me, too! You have already been given excellent advice, which I will "second." When it was first determined that Ellie's cortisol had dropped too low, the Vetoryl should have been immediately stopped for at least several days in order to allow the cortisol production to rebound prior to considering whether/when to begin again at a lowered dose. The symptoms you are describing can all be consistent with an Addisonian condition, and I'm afraid both vets dropped the ball badly -- including adding metacam into the mix for a dog who is suffering from reduced appetite and stomach upset.

Vetoryl should not now be resumed again at any dose until you see overt symptoms of Cushing's re-emerging and the cortisol has risen back to the level of that for a dog without Cushing's. Some dogs who have had cortisol levels drop in this way need never return to taking Vetoryl again.

Sadly, it sounds as though you will need to be very forceful in directing the testing and treatment from this point forward since your vets do not seem to be well-versed in the care of Cushing's dogs. But if this is indeed the issue -- that Ellie's cortisol just needs a chance to rebound, or her electrolytes need to be rebalanced -- there is every reason to think she will recover and do fine.

Marianne

[labblab]

Just wanted to add that if the decision is made to give Ellie some supplemental prednisone, for certain you will want to discontinue the metacam. Combining a NSAID such as metacam with a steroid can heighten the risk of very serious GI issues.

[ellie and angie]

thanks Marianne

Do agree with all you said.
Yes I am going to be forceful. Unfortunately I live in the United Kingdom on the Isle of Wight. We have only 3 veterinary practice's, one of which I would certainly not use. so I'm pretty stuck.

Ellie has not passed a motion, last one was Monday it was normal with no signs of blood. She remains alert, the only good thing. Incidentally Ellie is nearly 14 years old, and I some how get the impression the vets are wary of increasing the costs I've already incurred??

Many thanks

Angie

[labblab]

Me again, with one more comment. I do agree that, ideally, you definitely would want to have had her basic blood chemistries tested in addition to the cortisol right now. But if for any reason you can't get her in to be seen promptly, the rescue dose for prednisone in this situation is calculated to be .25 mg. per kg. daily and you will at least want to get that on hand to give her as quickly as possible. If that perks her up, well and good. If not, I agree that you must feel very worried about the possibility that the balance of potassium and sodium is out if whack, which can cause issues as serious as heart arrhythmias.

[molly muffin]

I just want to welcome you to the forum and check in and see how Ellie is doing today.

hope things are better

[jas77450]

Another welcome here, hope Ellie is doing better.