New to Cushings - Bloody Stools

[luvmyboo]

Thanks for the add. Out 12 year old Boston Terrier was diagnosed with Cushings in April. The vet put her on 20 mg of Vetoryl (10 in am and 10 in pm). We have not had any blood work run since diagnosis. Vet said recheck in 6 months. She was diagnosed w/the 8 hour test. It is the pituitary kind. Any way she was doing okay, but about a month ago, she had pure blood urine and bloody stools. We took her to the vet and was diagnosed w/bad UTI. Was put in antibiotics as well as Carafate. My husband and I also decided to take her off the Vetoryl and stools and urine went back to normal. We put her back on the Vetoryl 1 week ago, just morning only. By the end of the week she again is having very bloody stools, urine is fine. We will be making an appointment this week, but wanted to get advice and opinions. Also, background, Louie is hind-leg paralyzed due to back injury 2 years ago, and is blind and going deaf. TIA.

[labblab]

Welcome to you and little Louie. Gosh, I am sorry, though, for this problem! The bloody urine and stools are a major cause for concern, though, and even though the Vetoryl may not be the cause, it is enough of a coincidence for me that I would be withholding the Vetoryl, too, until you can get things sorted out.

Did your vet not run any bloodwork of any type even when you took Louie in and she was diagnosed with the UTI? As you probably now know already, interim monitoring blood testing should have been done long before this in order to check her cortisol level, basic blood chemistries, and I would think her basic cell counts, too. She may well be anemic after all this blood loss.

Before resuming the Vetoryl again, I think your vet needs to consult with a technical representative at Dechra, the company that makes Vetoryl. The bleeding is very worrisome to me, and they can help guide him re: the likelihood as to whether this is a medication effect. If you are in the U.S., you can even call them first so as to introduce Louie to them. They will get a file started on her, and then be all ready to also talk with your vet. Here's their "Contact Us" page. I believe they also have a toll-free number that I will try to hunt up and add for you.

http://www.dechra-us.com/Default.aspx?ID=365

Can you tell us how much Louie weighs, and also more specifics re: her symptoms and testing that resulted in the Cushing's diagnosis back in April?

Marianne

[Squirt's Mom]

Hi and welcome to you and your baby! :)

I am very concerned about your baby girl. Blood in the urine is not at all typical of treatment reaction but the bloody stool is and is not a good sign - you were wise to stop the Vetoryl.

It is obvious your vet has no idea how to use this very powerful drug so that makes me wonder what else he/she has goofed up on....and perhaps missed by maybe rushing into a Cushing's diagnosis and treatment before completely ruling out other possibilities. Did your baby have an abdominal ultrasound before starting treatment? Were diabetes and thyroid problems ruled out first? Was the 8 hour test the ONLY test done to diagnose the Cushing's? The more info you can share with us the better.

For now, do not restart the Vetoryl until the cause of the blood in the urine and feces has been determined. Vetoryl should not be used in dogs with renal disease so if that has not been looked into, I would make sure that happens before starting treatment back.

I hope she is feeling better today!
Hugs,
Leslie and the gang

[luvmyboo]

Thanks for the replies. We took Louie to the vet in April because she was panting a lot and drinking a lot of water. The vet recommended doing the 8 hour blood test. I picked up her test results today. The test was the AbaxisVetScanIITest. And the results are as follows:

ALB 4.5 (2.5-4.4 g/dl),
ALP 1191 (20-150 U/L),
ALT 191 (10-118 U/L),
AMY 604 (200-1200 U/L),
TBIL 0.3 (0.1-0.6 mg/dl,
BUN 23 (7-25 mg/dl),
CA 11.9 (8.6-11.8 mg/dl),
PHOS 2.9 (2.9-6.6 mg/dl),
CRE 0.8 (0.3-1.4 mg/dl),
GLU 136 (60-110 mg/dl),
NA+ 150 (138-160 mmol/L),
K+ 3.9 (3.7-5.8 mmol/L),
TP 7.7 (5.4-8.2 g/dl) and
GLOB 3.2 (2.3-5.2 g/dl).

The results of Cortisol Serial 3(DEX) are as follows:
Time 1 (10am Cortisol sample 1 15.4, range 1.0-5.0),
Time 2 (2pm Cortisol Sample 2 Dex 2.6 range 0.0-1.4),
Time 3 (6pm Cortisol Sample 3 Dex 7.1 range 0.0-1.4).

Interpretation of the Dexamethasone suppression tests: Lose dose dexamethasone suppression test: ormal cortisol level less than 1.4 ug/dl 8 hrs post dex. Hyperadrenocorticism: cortisol level greater than 1.4 ug/dl 8 hrs post dex. If the 8 hr post dex cortisol level is greater than 1.4 ug/dl, the following can be used to differentiate pituitary dependent hyperadrenocorticism (PDH) from an adrenal tumor. 1. cortisol level less than 1.4 ug/dl 4 hrs post dex is consistent with PDH. 2. cortisol level less than half the baseline level at either 4 or 8 hrs post dex is consistent with PDH. Samples taken at 2 or 6 hrs are interpreted the same way as a 4 hr sample. If neither of these criteria is met, further testing is needed to differentiate PDH from adrenal tumor Cushings.

After diagnosis, the vet put her on 20mg of Vetoryl, 10 in the morning and 10 in the evening and said to re-test her in 6 months.

Yes, from all the information I've been gathering, she should have had several tests since the first one. We do have an appointment with another vet in town tomorrow who Louie has seen regarding her paralysis. The receptionist said this vet has treated several dogs w/Cushings. I will update after that appointment. Thanks again.

[molly muffin]

Hi, I'm concerned that her glucose is high, so think that diabetes needs to be considered too.

Yes she Definitely should have been retested at 2 weeks after starting vetroyl and then at 30 day mark.

Please take the results with you to your vet appt tomorrow and ask about diabetes (the high glucose) also I would suggest an ultrasound to check liver/gall bladder/kidnesys/adrenal glands, my concern being also sludge in the gall bladder but right now, I'm concerned about that 136 Glucose. Did your vet have any concerns about that at all? As diabetes and cushings can have some of the same symptoms.

I'm glad you are seeing a different vet, as this one hasn't followed proper testing protocols as outlined by the manufacturer of vetroyl and is really needed for the safety of dosing. I'd mention that to the other vet too, that no follow up testing has been done since she started the vetroyl, what happened with the bloody stools, clearing up once off it, restarting and then the bloody stools again.

Let us know what this other vet says!