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View Full Version : 10 year old boxer - possible Addisonian Crisis?



ad8871
05-18-2015, 06:17 PM
Our 10 year old boxer boy was diagnosed Cushing's a couple months ago after going through 4 different vets who couldn't sort him out. I told the first vet it was Cushing's from the beginning but we had to get all those thousands of dollars of tests out of the way to get the official dx. The internist said his 8-hour test results came back pretty high.

Anyway, he's 65 lb. Internist started him on Vetoryl 60mg 2x daily. It seems to really help him. But I'm concerned with the last few days. His eating and drinking basically stopped, and he is laying on the couch and doesn't get up for much at all. At first he was trembling pretty bad but this seems to be easing up.

I'm sure he's reacting to his Vetoryl dose and his steroid levels are too low.

It may have been risky, but I didn't rush him to the doggy ER - just several hundred dollars more tests to figure out what I already know. I stopped Vetoryl after yesterday morning's dose and he was slightly more active this morning - but not much. Trembling seems to have subsided. I will check him again when I get home from work.

Anyway, just here to ask a couple questions:

1. Are these symptoms consistent with Addisonian crisis that you've seen in other dogs? - mainly severe lethargy, trembling, and greatly reduced eating/drinking.

2. Given that he's still alive after a day and a half with no Vetoryl, and seems to be slowly improving, can I let his natural cortisol hyperdrive machine boost his steroid levels naturally to full recovery (and get a smaller Vetoryl dose started eventually) rather than taking him in to get a steroid boost? In other words, can Addisonian crisis correct itself or does it need intervention? My understanding is Vetoryl doesn't kill off adrenal cells, so if I stop treatment, his cortisol should jump up quite a bit.

3. Anything I can do to help him balance his hydration and electrolytes at home?

Thanks in advance folks.

labblab
05-18-2015, 09:06 PM
I am really glad you've found us, and must apologize that I have only a moment to post right now. But even though I understand the financial burden of testing, I must warn you that you are playing with fire by letting your boy go unattended right now. The symptoms you describe are indeed consistent with trilostane overdose and without some basic blood testing, it is impossible to know exactly what intervention he may need right now.

For some dogs, simply discontinuing the trilostane for a period of time may be sufficient. However, for reasons that are not yet clearly understood, some dogs may not ever recover normal adrenal function or it may take an extended period of time for function to rebound. In that case, a dog may need supplementation for either/both lost cortisol and lost aldosterone (the adrenal hormone that controls the balance of sodium and potassium in the body). There is simply no way to eyeball a dog and guess whether, what type, or how much supplementation he may need. I must warn you that imbalances in these blood chemistries can remain life-threatening until they are regulated.

At a minimum, I really think you need to have at least a baseline cortisol level checked as well as a basic blood chemistry panel. Those results can help you and your vet determine what help your boy needs.

Marianne

molly muffin
05-18-2015, 09:36 PM
Hello, I just want to jump in and second what Marianne said, it is important that you get a follow up ACTH test done and no more trilostane/vetroyl.

The second thing I want to mention is that the manufactorer of vetroyl has recently lowered their starting dose recommendation. A 65lb dog would now be started at 60 mg of vetroyl DAILY, not twice a day. The reason - too many dogs having crises of overdosing.

So, even if he hasn't gone fully Addison and is having a crisis, you would need to know what the cortisol is at right now and you wouldn't restart medication until symptoms come back and then you would start at the lower dose.

I'm including a link that you can print out and give to your vet. The recommendation is to START at the lowest dose, not the middle or highest.

http://www.vetsonline.com/news/product-news/140722-new-lower-starting-dose-for-vetoryl.html

Please get him checked.

ad8871
05-20-2015, 10:20 AM
Well I'm happy to report that the boy is doing much better. He had improved Monday after work so I did not take him in although maybe it was a mistake. He's drinking a bit more water now but still not eating much. But his energy and the glow in his eyes is back.

Thanks for your support and we're staying off vetoryl a while longer until I get it sorted with the vet.

labblab
05-20-2015, 11:09 AM
I'm surely glad he's feeling better, but it sounds as though his cortisol may still be somewhat lower than normal. Do you have any oral prednisone on hand? With your vet's permission, you might try giving him a dose or two to see if that perks him up more quickly.

A typical "rescue" dose of prednisome is 0.25 mg. per kg. In your boy's case (65 lb.), that would work out to around 7 mg. daily if my math is correct. So you might want to try giving him a dose of 5-7 mg. just to see if it speeds his improvement.

Keep us updated, OK?
Marianne