Adverse reactions to vetoryl

[Daisy's carer]

My 15 year old wire dachshund has been on 30mg Vetoryl for three years. She has suddenly developed terrible joint pain which is not responding to NSAIDs or acupuncture. Vet wants to try Tramadol but she also has a heart murmur 4 and is on Cardalis.
I have a feeling the Vetoryl is causing the pain - which was very sudden in onset - almost overnight she went from walking briskly to almost unable to walk or stand. She also has constant otitis that does not improve with meds, shivering, occasional blood in stools, and back leg weakness. Her appetite is good, and she is perky when taken out in the cycle basket. At times, she is just like her old self, but the pain quickly dominates.
In view of the limited options, I have thought of taking her off Vetoryl to see if the signs improve, especially the pain which renders her immobile.

Has anyone ever needed to take their dog off Vetoryl and what were the benefits/down sides? I am aiming for quality of life here, so my priority is lessening the pain to make that responsive to acupuncture and NSAIDs. I feel sure Tramadol would compromise her heart murmur, so it feels like a choice between two evils - I'm hoping the no Vetoryl one will be better.

thanks

[labblab]

Gosh, I'm so sorry your girl is in pain! That is so hard to have to witness. Can you tell us more about her Cushing's history and her previous experience with Vetoryl? What were her original symptoms, and has the Vetoryl kept them under control? When was her cortisol tested most recently, and what were the actual test numbers?

I am not a vet, but if she has been taking the Vetoryl for three years without a problem and is now having a sudden onset of pain, it seems unlikely to me that Vetoryl is the direct cause as long as her cortisol level has not actually dropped too low for safety (that is why I am wanting to know about her most recent monitoring test results). Even if her cortisol is technically within desired range, whether she might feel better if her cortisol runs a bit higher, I do not know. However, the trade-off in stopping the Vetoryl altogether would be the likely return of whatever Cushing's symptoms were originally troubling her. Plus, uncontrolled Cushpups are more vulnerable to problems like infections and ligament injuries. And NSAIDS are even more dangerous in the presence of elevated levels of corticosteroids such as uncontrolled Cushing's or when given in combination with supplemental prednisone.

Is there a particular reason why you think the tramadol would worsen her murmur? The reason why I ask is because my elderly mom suffers from bad arthritic pain but also has a significant history of heart problems, and tramadol is the one painkiller that her cardiologist has approved her to use (she cannot have NSAiDS). The tramadol really does help control her pain. But perhaps there is something about a murmur that makes it more risky?

Any additional info you can give us will be really helpful as we try to consider your girl's best options.

Marianne

[labblab]

Hi, I'm stopping back by again in hopes you'll soon be returning to us! Also, just wanted to add one more comment in relation to your description of your dog's problems.


I have a feeling the Vetoryl is causing the pain - which was very sudden in onset - almost overnight she went from walking briskly to almost unable to walk or stand. She also has constant otitis that does not improve with meds, shivering, occasional blood in stools, and back leg weakness.

I want to double-check with you as to whether you are entirely sure that it is pain that is causing the muscle weakness and mobility problems. The reason why I ask is because aside from the otitis, the symptoms you are describing might all be the result of a cortisol level that has dropped too low ("Addisonian" condition). In that event, it is not necessarily pain that is causing the issues but instead systemic weakness/problems that are resulting from a lack of sufficient circulating cortisol. This is one of the reasons why I am especially anxious to find out the results of any recent ACTH stimulation blood tests that may have been conducted in order to monitor your dog's adrenal function and the appropriateness of her current dose of Vetoryl. ;)

Marianne

[Daisy's carer]

Hi Marianne
I did reply but I don't think I did it right!
I don't have the ACTH results but she was tested in July and was told they were OK. I expect you know we have a shortage of the usual testing stuff and are making do with some other test here in UK, but the vet says it's a good enough test.
Spoke to vet yesterday and he agreed she might do well with a short break from Vetoryl so suggested leaving it out for a week to see if her mobility has improved. He is an orthopaedic specialist and has not had (it seems!) much experience with Cushing's.
I'm very interested in what you say about Addison's and I went to wikipedia and its Addison's in Canines page describes Daisy pretty much. Vet made no mention of this and did not suggest blood tests, so I am going to contact him today and discuss with him. At least this is a positive lead because for about 3 months I have been desperate to help Daisy and she is just getting weaker.
Will let you know how things go,
Many thanks.

[Daisy's carer]

Just called the vet and he is doing blood test on Friday - allowing her a few more days to be off Vetoryl. Will keep you informed!

[Squirt's Mom]

Do you have another option for a vet that has experience, successful experience, with Cushing's and/or Addison's? If your vet is willing to listen, to research, to learn then it will probably be ok to stick with them. HOWEVER, if this vet doesn't display that willingness, find another vet asap who does have experience, successful experience, dealing with both diseases. ;) I had to educate our vet on Cushing's and now he treats several dogs with both conditions. Many others here have had to do the same.

It would be really helpful if you would get those results on the ACTH and share them here. We do know about the shortage in the UK and keep hoping the situation there will get straightened out for all our cush babies over there.

[Daisy's carer]

Hi
My home town is very short on vets and this is the third one I've tried - I mentioned the forum to him - this is a good resource:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2797351/

I suggested to him some weeks ago I was worried about her overall demeanour and queried the Vetoryl but he said as he has never had a problem with it, he doubted if her reactions were caused by that.

He did mention this which I would appreciate your thoughts on - he said the blood in her stools could be from the break up of an adrenal tumour. She has had this blood in stools intermittently all this year, bloody stools for a day or two, then a few weeks with nothing apparent. He said a tumour can fragment and get absorbed and excreted...?? This might account also for the hypoadrenocorticism she is now suffering. What do you all think??
When I take her for blood tests Thursday I will get the last ACTH figures.

[Squirt's Mom]

I would like an explanation on how the tumor pieces get from outside the digestive tract to inside it while in a closed system. ???? Not saying he's wrong but that defies logic in my book. ;) An adrenal tumor that ruptures results in death, not bloody stool.

[molly muffin]

leslie is right, a burst tumor is a bad thing indeed.

So let me see if I am right, they are only doing the baseline cortisol test because the stimulating agent is in short supply? Actually I think it has become too expensive to be used with pets after the company that makes it was sold.

In Canada we have moved to what they use in the US which is Cortrosyn I believe. Maybe your vet can get that.

However, without having the test, an option is to stop the vetroyl and see how she does without it. It could be that she is not Addison (would be good to know what that baseline number is) now arthritis is kicking in and so she doesn't feel as well.

The bloody stools is a worry. Other than saying the adrenal tumor might have burst, has your vet offered any other options for what might be causing that?
Have you had an ultrasound done to check out the digestive track?

I'd do some easy food for a bit, mushy rice and chicken sort of thing, add in a probiotic and see if that helps. Could be an antibiotic like metronidazole would help if there is a bacterial upset in the digestive track.

Welcome to the forum :)

[StarDeb55]

Here's a late welcome from me. I will not address anything about the use of vetoryl as I have no experience with it. What I do want to address is your vet's comments that the bloody stools may due to an adrenal tumor rupture. When I read it, I'm like, "HUH, does this guy know what he's talking about." I really hate to do any vet bashing, but your vet worries me greatly. Bloody stools can be indicative of a number of things, including a GI bleed, irritable bowel problems, colitis, & several other things. Leslie is absolutely right a tumor rupture outside of the GI tract is probably not going to cause GI tract bleeding. If the tumor was in the GI tract, sure there might be bloody stools. I would like to strongly suggest that you question your vet about these other possibilities for the bloody stools.

The other thing I would recommend is that your request that your vet run a CBC (complete blood count) on your baby. If the bloody stools have been occurring for awhile, there is a distinct possibility that your baby may be anemic. Just to let you know I'm a medical lab tech with 35 years of experience, so I do have a lot of experience with these kind of issues.

Please keep us posted.

Debbie

[Daisy's carer]

Daisy has had 3 bouts of pancreatitis this year - full blood panel in June confirmed vet's diagnosis. She responded to antibiotics and next bloods were clear.

She's been plagued with upset tummy problems for several years, not very serious, but usually with blood in stools for a few days.

One of the elements to her recent state of health is the random nature of the signs. She is up and down with her mood, has the odd reasonably good day, can sometimes walk a little, then is immobile, drinks a lot, then goes without water for up to twelve hours, had loose stools one day and then perfect ones the next - even over the course of a day, her health can change from good to bad, bad to worse then back to good again. Consequently, it has become quite difficult to isolate specific signs and follow their tracks but I feel the vet has tried to lump everything together and tie it to old age as much as anything else, and the Cushing's has rarely been mentioned. But, since the round of pancreatitis began, which is about March, she has not really been well. He was reassured by the ACTH results in June, but he generally gives test results by phone so you don't ever see the document itself. Again, he seems to lack experience of it - my last vet (I moved house last year and had to leave a brilliant vet) knew Daisy really well and his own mini dachshunds were Cushingoid, so he was all over it, very thorough and the surgery was a vet hospital, so they did all their own testing with the latest technology. My current home town is really bad for vets - no choice and all owned by a chain so no consistency of care.

When I go tomorrow I will ask to see the previous results and also get a full blood count with whatever test he does.

[molly muffin]

Okay, if you could post the abnormal blood results that would be helpful.

I wonder if it isn't IBD that is messing with her tummy.

It's hard when you don't have a vet that is familiar with your pet and knows them inside and out and what is off and why.