Nelly 13y black lab. Recently started treatment

[Nellybell]

Nelly is a female 13y black lab mix. In July I took her in her annual check up. The vet suggested havering a complete blood work up done because Nelly is on the older side. The blood work came back a few days later. I was told that her cortisol levels were alittle abnormal and she might have a under active thyroid, but other then that she was in great shape for a dog her age. I have to admit I was happy in a way to find out she might have a thyroid issue because I have tried different weight loss formulas with no luck and had almost given up. At the time of the blood work she was 69lbs which is the heaviest yet. The vet said that he wanted to test her for Cushing since her levels were abnormal. I looked up cushings in dog to see what I might be dealing with but other than being a bit slower she didn't have any other symptoms. I had scheduled the low dex test for the next week. The vet put her on Hills diet found to help with her weight until we could address the thyroid issue. Unfortunately over the next week Nelly seemed to go down hill. She was drinking a lot, and started having accidents in the house, very sluggish. Told the vet what was going on and he said lets rule out a UTI before any more test are done. Nelly has a history of UTIs so it made sense. She was positive for a UTI they determined what kind and treated with the right antibiotics. Over the next two weeks on antibiotics Nelly did not seem to be getting better in fact she seemed worse. She started having lots of accidents in the house and I was getting up 3-4 times a night to let her out. I took her back in once the antibiotics were done they check her and the UTI was gone. At this point they sent her pee to get checked for cortisol levels. They were high. Next we did the low dex test. She started out at 3.8. They despensed the meds and checked at 4hr mark it dropped to 2.2. But then at 8hrs went up to 2.8. They started her on 60mg of Vetory(Trilostane). She seemed to perk back up alittle and less water in and out. Did a ACTH test on the 13th day and her levels were at 1.3 (8/27/15) they lowered her meds to 30mg. They told me not to give her meds for 48hours then start the 30mg. During those 48hrs she seemed more like her self. She even ran a little bit. A very slow run but more then I saw out of her in about 4months. I then started her on the 30mg and she seems to be tried and sleeping more. She isn't perky like she was the 2 days without meds. I am starting to wonder if she is being treated the best way. She is still peeing a lot in the house and water intake has dropped much. She also has muscle weakness. I know her levels have come back down but I worried that she hasn't improved more and at the same time unsure of her meds. I thought 60mg was high at the beginning and now they dropped it to 30mg. It seems like a big and sudden drop. I have tried to educate my self on cushings cause my vet is not good at communicating (looking for new vet) but I feel like I'm barely keeping my head above water. I'm 27 and I have had Nelly since she was only a few months old. I rescued her off the street and she's been my baby ever sense. I catch myself starting to cry when I think about her. I know cushings is treatable but I fear maybe it's to late and she's to old to improve. I don't want her to suffer and I don't want to put her down. I don't know if she should have gotten better by now or if it will take more time. I apologize for the length of this. If any one has advice it would be much appreciated.

[My sweet Ginger]

Hi, I'd like to welcome you and Nelly to the forum.
I know you will soon get many in depth explanations and advice from our in house experts but I'd like to comment on a couple of things.

First I'd stop the Vetoryl right now. I'm not sure if a diagnostic ACTH stim test was done or not before the start of Vetoryl but to bring it down to 1.3 on monitoring ACTH for pre and post both in 13 days means she was dangerously overdosed!!! Although her starting dose was appropriate for her weight it seems like she's very sensitive to this drug and that's the reason why that 10-14 day mark test is recommended, to see if the dosage is too high or not.
We don't want those 1.3 pre and post numbers even at 30day mark because they are not only too low but also there's no stimulation in her cortisol after one hour. Vetoryl shouldn't have started at any dose in her case until she feels better. I figure she's been on this 30mg Vetoryl for about a week or so by now and that was too early to restart after only two days of break. She needs a break from Vetoryl until her adrenal glands recover from this overdose and in her case I think she needs much longer than two days. She also needs to have her electrolytes checked to check for Addison's.

Do you have an internal medicine specialist near you as your vet doesn't seem knowledgable enough with this potent drug? Is she having any other symptoms such as vomiting or diarrhea?

[molly muffin]

Hello, did they do a culture to make sure the UTI was completely gone or did they just do a urinalysis? Some UTI's are particularly resistant and when when you think they are gone, they sometimes come back. Is her urine dilute at all? If so a culture might need to done.

Next, My Sweet Ginger is correct, you don't want a pre and post of 1.3. It makes me wonder if she really had cushings as you can get a false positive sometimes.

The key is that you do not start back on any trilostane/vetroyl, until she has been off trilostane and the symptoms come back and you retest to see if the ACTH is high enough to warrant needing medication.

This is key so that you don't get into trouble with too low of cortisol and with a pre and post of 1.3 her adrenal glands are not producing cortisol and storing it in the adrenal gland and that is BAD. Her electrolytes could be off and that is even worse than Bad, it's life threatening, so this medication, while very helpful, needs to be carefully monitored by a vet who knows what it does, how it does it, and how cushings actually work.

What trilostane does, is interrupt the communication between the pituitary gland, telling the adrenal gland to produce cortisol.

Welcome to the forum

So stop that and then wait till symptoms come back and retest.

[Nellybell]

I wanted to thank both My Sweet Ginger and Molly Muffin for your helpful advice. I have an update since earlier today. Around 5pm I noticed Nelly was swaying when she stood. She had been sleeping today a lot and seemed alittle depressed. So when I noticed the swaying movement I decided to take her to the Vet ER. I am happy I took her the vet I saw was very informative and explained things in a way that a normal person could understand. I told her about How nelly went from 3.8 to 1.3 after only 14 days. And how my vet cut her dose in half to 30mg. The ER vet was worried that Nelly was dropping to fast and to low sending her toward Addisons. The vet want to check her electrolytes. The vet told me in that if you took a line and put Cushings on one end and Addisons on the other that nelly was about to cross into the Addisons zone. She recommended taking Nelly of the Trilostane and seeing how she does. She also gave her 5mg of prednisone to be safe. We talked a long time about how to make Nelly comfortable. After a long conversation we decided to put nelly on an anti inflammatory to with her hips along with a tramadol to help with any pain she is having from arthritis and straining to get up due to muscle weakness in her hips and back legs. I also brought up the UTI and how I wasn't sure if it was gone. So she also gave us a nother 2 weeks of antibiotics. The vet also said we should start her on a thyroid med(finally). I'm hopeful if the thyroid gets under control then she will lose weight which will help her hips and overall comfort. I said in the earlier post that she was 69-70lbs but what I forgot to say is that she should weigh about 55lbs. Im so happy that someone finally decided to treat the thyroid cause a dog should not gain weight on a diet food. And I've tried many and she kept getting bigger. The ER vet also recommend a nother vet office for me to see that have more experience with this sort of thing. We will see how she does and go from there.
I wanted to touch on something Molly Muffin said about maybe not being cushings. I was actually starting to wonder that myself. She was doing great right up to when I took her for her annual exam, she was just alittle slower then normal maybe the thyroid. But other then that's fine. From what I was told a UTI as bad as the one she had could affect the cortisol levels. It wasn't untill the vet put her on the Hills diet food that they sell at the vet that she went down hill. It was during the first week and a half of the new diet food that she started to get really sick. I also noticed she didn't want to eat the food and Nelly never turns food down. My mother found a few forums on Hills Science diet food and got really scared. There were so many stories about how people's healthy dogs went on the food and with in a month or so were very sick or even dead. There was one then one that described symptoms just like Nelly and how it started after starting the food. It got so bad for nelly that she was not eating it. I took her off it last Friday once I read the forum and bought a small bag of everyday food to give her untill I could buy a higher quality food. She ate the food right up and pushed the bowl across the kitchen. So I now know there was something wrong with the Hills food and her appetite was fine. Just wondering if anyone else has had problems like this on Hills Science diet food. I'm not positive that's what made her sick but I am wondering about it.

[Squirt's Mom]

Sweetheart, I am SO glad you saw another vet and they seem to be guiding you in the right direction.

Yes, do stop the Science Diet. I haven't heard of any problems with the feed that would warrant a recall but SD is just not a good feed. It USED to be a great feed until it was sold by the vet who formulated it originally and the formula was changed to use cheap ingredients - mostly corn and sodium. Tho they have changed formulas again in the last few years to use less corn and less sodium, it's still a low quality feed sadly. I credit the old SD formula with saving one of my Dane's lives and have really hated to see how far down this feed has come from then. :( Here is a link with pretty good info on dog feed/food (feed is low quality ingredients, food is human grade ingredients) - http://www.dogfoodadvisor.com/recent-updates/

[molly muffin]

We had another dog recently and off the topmof my head I thought it was Hills food they where on but can't say positively. Anyway once they stopped that food. Had the Uti cleared up, no more Cushing symptoms and values coming back into normal. Thank god you went to the ER vet. Bravo to them for being more knowledgeable and good for you for being proactive! Kudos!