Sadie, my 14 year old American Eskimo

[Ali Sadie]

Hey Everyone,

My dog, Sadie, was just diagnosed with Cushings a few weeks ago and was prescribed 30 mg of Vetoryl daily. She has been peeing in the house and drinking a ton of water since New Year's which was about a week after her being put under to have a benign growth removed. After reading some of the posts on your website I had my vet switch her to 20 mg of Vetoryl. She is about 22 lbs. She has had diarrhea since she started on Vetoryl and is usually a bit sleepy/lethargic for a few hours after taking it. After her ACTH test (pre cortisol she was 1.0 and post cortisol she was 4.0) last Friday my vet said to give her 10 mg in the morning and 10 mg in the evening. Her diarrhea seems better and she she still seems sleepy about an hour after taking it but not as much as before. For a few days after the ACTH test Sadie's breathing was fast and shallow at times and a bit irregular. My vet says that that is because of the cortisol they gave her. I have many questions but my main concern is that Dechra says that lethargy and diarrhea are common side effects but to contact my vet if Sadie has diarrhea or lethargy. My vet is not concerned about Sadie's side effects. Sadie has not peed in the bed or the house since starting on Vetoryl and is drinking about 3 to four cups less of water a day so I know that the Vetoryl is helping. I want to make sure that Sadie is getting the best care that is possible as she truly is the love of my life. Any help would be greatly appreciated. I would attach Sadie's medical records for you to view but apparently I am not allowed to.

Thank you for your help! Ali

[labblab]

Hello and welcome to you and Sadie! Literally, I have only a minute to post right now, but I want you to know that I've moved your thread to our main Questions/Discussion forum so that more of our members will have a chance to read it and offer their thoughts.

I'm really glad you've joined us!
Marianne

[Ali Sadie]

Thank you Marianne! I look forward to meeting all of you!

[molly muffin]

Hello, I just have a minute too, but 4.0 is a good post. Be sure to retest and make sure she doesn't drop too much further though in a couple weeks after the last test.

How long did she take the 30mg for before going to 20mg? 10mg/10mg is a good dose for her according to weight.

However, we don't like diarrhea, so try a bit of pumpkin, like a tablespoon maybe to start and add in a probiotic. That would be pure canned pumpkin, not pie filling. It is very helpful for diarrhea.

That isn't abnormal to be a bit sleepy lethargic right after taking the meds.
But if she was wobbly, couldn't stand, wouldn't get up, stopped eating, vomiting and yes diarrhea can be signs of over dose, but with her post being 4.0, that is a good post. So no overdose at this point. The 30mg though might have played havoc on her system is my thought.

[Harley PoMMom]

Hi Ali,

Welcome to you and Sadie from me as well!

Could you get copies of all tests that were done on Sadie and post those results here? With respect to the blood chemistry and CBC, you need only post the highs and lows and please include the normal reference ranges. What diagnostic tests were performed on Sadie, and could you post those results too? Does Sadie have the pituitary or adrenal form of Cushing's? Is she taking any other herbs/supplements/medications? Does she have any other underlying illness? Did the vet tell you that Vetoryl has to be given with a meal and that the monitoring ACTH stimulation tests have to be performed 4-6 hours post pill?

Vetoryl is known to cause gastric upset and some members give their dog pepcid ac 20-30 minutes before the Vetoryl dose is administered.

And, yep, some dogs have side effects from the stimulating agent used in the ACTH stim test but this usually last only a day or two.

Sorry for the reasons that brought you here but sure glad you found us and we will help in any way we can.

Hugs, Lori

[judymaggie]

Hi and welcome to you and Sadie! You have received excellent guidance already. I give my Abbie, who weighs about the same as Sadie, pepcid original about twenty minutes before each meal after which she gets Vetoryl. Abbie is prone to diarrhea and the addition of pumpkin to her meals has helped a lot. If you have not given Sadie pumpkin before, I would suggest you start very conservatively and gradually increase. If you give too much, it can increase diarrhea. I now give Abbie about 1/2 teaspoon with each meal (she eats 3x a day). I also give her Forti-flora probiotics mixed into one meal.

Are you giving Sadie the Vetoryl 12 hours apart? I had to adjust Abbie's mealtimes in order to do that, splitting her mid-afternoon meal into two portions.

[Ali Sadie]

Thanks Sharlene and Lori!

Sharlene, Sadie only took the 30 mg for 3 or 4 days before I switched her to 20 mg thanks to you guys. I just recently bought her canned plain pumpkin so I will try to give her some tomorrow. Do you know how long canned pumpkin stays good for once it is opened?

Lori, my vet believes Sadie has adrenal cushings but is not sure and does not want to an aspirates of her liver because she said the test is always inconclusive? The only other supplements that she is taking are Marin liver supplements and Dasaquin and yes I always give Sadie her Vetoryl with about a 1/2 cup of cooked chicken or turkey with rice. Within the past 3 months she has had an ultrasound, ACTH, Dexamethasone Suppression Test, Blood Count Test, T4, 2 Urinalysis tests, Superchem and Ova & Parasites WI Test. I have 6 pages of results and have no idea how to interpret them. Is there no way that I can attach them?

The conclusions of Sadie's ultrasound on 2/20/16 prior to her testing positive for Cushings are as follows:
"Mildly enlarged, diffusely heterogeneous liver may be due to endocrine disease, drup hepatopathy, hepatitis or other infiltrative pricess. Fine needle aspirates of the liver could be performed for further evaluation.
Mild left adrenomegaly. Hyperplasia is considered most likely. Hyperadrenocorticism may be possible.
Hyperechoic, non-shadowing regions in the kidneys bilaterally is likely due to fat deposition.
Hyperechoic splenic nodule is consistent with a lipoma."

On the Blood Count Test:
High Platelet Count = 415 10^3/ul
High Neutrophlls = 80%
Low Lymphocytes = 11%

T4 Test:
Low = 0.6 ug/dl

Urinalysis:
Low Specific Gravity = 1.004
High pH = 7.5

Superchem:
High ALT (SGPT) = 121 U/L
High Alk Phosphatase = 242 U/L
High Calcium = 11.7 mg/dL
High Triglycerides = 986 mg/dL
High PrecisionPSL = 540 U/L

Thank you both so much for all your pointers and reassuring me that gastric upset is a semi normal side effect from vetoryl. I really appreciate it!

[Ali Sadie]

Hey Judy,

Thank you so much for your help! I do give Sadie the Vetoryl 12 hours apart. Thank you so much for the pointers and I will have to try the probiotics. My mom was actually just telling me a few weeks ago that I should try them as well.

How much do you feed Abbie a day? Sadie has always snacked on her dog food throughout the day and she loves people food. So basically, I am trying to get her on a regular feeding schedule for the 1st time in 14 years. Because she won't eat too much dog food at one time I have been making her ground turkey or chicken with rice so that she has food in her system when she takes her Vetoryl but I have no idea how much I should be feeding her a day. Thanks again for your help!

Ali

[judymaggie]

Ali--re your question about how long to keep pumpkin, I keep it for a week covered with a dog food can cover. I don't finish it all in the week but it starts to get watery by then.

I feed Abbie 1/4 cup of dry dog food mixed with a heaping tablespoon of canned food and a small cut-up piece of cooked chicken (plus pumpkin and omega3 oil) in the morning. She gets her Vetoryl along with other meds rolled up in a piece of cheese topped with a bit of kitten food! I give her the same meal at 3:00, minus the Vetoryl. Then at 7:30 she gets a repeat of the morning regimen. The chicken is a new addition--she is recovering from spinal surgery (herniated disc in her neck) and she wouldn't eat anything but chicken after the surgery. I gradually added back in her food but wouldn't eat if there was no chicken in it. You can see who the boss is in my house! If I am going out I give Abbie a piece of a Blue stix. Abhor lost three pounds since she hurt her neck and had surgery. Am trying to keep it off!

One other thought for you re the Vetoryl--reports are that it is absorbed better when given with something fatty. Abbie does not like peanut butter so we ended up with a small piece of American cheese. There are still days when she balks at taking her pills, even when disguised.

[Ali Sadie]

Thank you so much for all the information Judy! I am glad to hear that Abbie is recovering from her spinal surgery. That must have been scary! And I know just what you mean about being a picky eater. Sadie does not prefer peanut butter or American cheese but she loves feta cheese so maybe I can try that. My vet told me not to give her any cottage cheese but it did seem to work in the past she did say that I could give her plain yogurt or pumpkin. Sadie does like chicken so maybe I'll try to add that in to her normal meal plan. I have some cat treats that I feed the feral cats but I don't think I should give that to her. I also just discovered another growth on Sadie's front right paw. She's had about 5 removed in the past 3 years and the Vets don't want to do any more surgeries on her and I don't want them to either. She keeps licking it so she is stuck in her purple turtleneck with long sleeves until I can figure out another option. Thank you again so much for all of your help!

[judymaggie]

Ali--the kitten food on top of the cheese ball was definitely a last resort. I agree that the cat treats wouldn't be good for Sadie. Have you tried a sock on her paw? I've never done a search but I believe there are several different types. Maybe that with vet wrap around the top?

[Harley PoMMom]

High PrecisionPSL = 540 U/L


This is a test for pancreatitis and with Sadie's elevated result this points to pancreatitis. Is she on a low fat diet which is required for a dog with pancreatitis? Also, her diarrhea could be a side effect from an inflamed pancreas, did the vet mention anything regarding her high number for that PrecisionPSL test?

[Ali Sadie]

Hey Judy, I'm going to try to go out shopping for her this weekend or either shop online and see what I can find to cover her paw. She is very crafty with socks as well as clothing and vet wraps she manages to get almost anything off!

[Ali Sadie]

Hey Lori, my vet did mention pancreatitis but wanted to see how Sadie did on the vetoryl. I'm making Sadie rice with chicken, turkey or ground beef because she's never been a big fan of her dog food. I'm not sure what else I can make her that she'll eat. Any suggestions would be greatly appreciated!

[lulusmom]

Hi Ali,

I just wanted to drop in and comment on the labs you posted. The most concerning elevation I see is the triglycerides. You haven't included normal reference ranges but I can tell you that anything over 500 mg/dl is not good. Was Sadie fasted for these labs and was she showing any signs of stomach issues? I ask because PSL is almost twice the upper normal limit so that and the high triglycerides could point to a possible inflamed pancreas. Did your vet discuss the high PSL with you and did he discuss a low fat diet plan to get the triglycerides down?

Glynda

[Ali Sadie]

Hey Glynda, my vet did talk about pancreatitis and a low fat diet to me but she wanted to see how the vetoryl work for Cushing's first. Once Sadie was diagnosed with Cushing's it seems that the possibility of pancreatitis was forgotten. Sadie did not have anything to eat the morning of all her testing. For the past 3 weeks I have been feeding Sadie rice with either ground chicken or ground turkey and she's maybe had a fourth of a cup of her dog food a day. She also expect some kind of dog treat every time she goes to the bathroom which is my fault. I am preparing dinner for her right now and just realized that the chicken broth I've been cooking her rice in has onion in it. I've been researching diets for dogs that have pancreatitis and Cushing's. Sadie overall seems to be feeling fine other than having diarrhea for the past day and a half. I really appreciate your help. You guys are truly a blessing to Sadie and me!

[Harley PoMMom]

I've found some very good information about canine pancreatitis on the Dogaware site, here's a link: http://dogaware.com/articles/wdjpancreatitis.html Their diet has to be very low in fat and on this site they have diet examples plus the fat percentages in most commercial dog food.

Dogs with pancreatitis do better if they have several (3-4) small meals throughout the day.

Hugs, Lori

[Ali Sadie]

Thank you so much for the info Lori! I will check out the website right now and check with my vet ASAP regarding Sadie possibly having pancreatitis as well as Cushing's. My poor baby :(

[Harley PoMMom]

My Harley had pancreatitis and it can be a bugger to get under control. Harley had the chronic type but never showed any symptoms and I was shocked when it was seen on his first ultrasound. It was later confirmed with the spec cPL test, his result was in the 500's with 0-200 being the reference ranges :eek::eek: We monitored his pancreatitis with the spec cPL test and with a diet change and other things we could get that number down in the 300's but never in the normal ranges :(

[Ali Sadie]

Hey Lori, what did you feed Harley to get his pancreatitis down? I took Sadie to the vet yesterday because she was having rapid shallow breaths for a few hours and i was very worried. After checking her out my vet said everything looks fine and that it's probably either the pollen, Cushing's or that her body is still getting used to the vetoryl. I think the pollen may be the cause, at least lately, because Sadie has been snoring a little bit and she's been cleaning her eyes and pawing at her nose a bunch lately and the pollen count is extremely high in Georgia right now. I brought up that Sadie tested very high and the possibility of her having pancreatitis and she said Sadie showed no other signs of having pancreatitis. I do want to feed Sadie a lower fat diet just in case my vet is mistaken. As always, thank you so much for all your help!

[Harley PoMMom]

I had a diet formulated for him, he not only had Cushing's and pancreatitis but his kidneys weren't in great shape either so I paid Monica Segal to develop a diet for his special health needs. A food that is low in fat is needed, Harley's formulated diet consisted of skinless/boneless chicken breast, rice, gizzards and baby carrots along with a host of minerals/supplements/vitamins.

Harley never showed any signs of the pancreatitis either, in fact the pancreatic enzyme markers (lipase and amylase) on his chemistry blood panel were in the normal limits BUT that spec cPL test result was in the 500's.

[molly muffin]

I think with the trig's high, you want to go with a low fat, even if no pancreatis, as it could come on at any time, and you really want to see if that number can come down some.

It is a real bugger trying to get numbers under control for things that require diet changes, especially when you have a finicky eater. :(

[Ali Sadie]

Thanks ladies I appreciate your input! I'll keep Sadie on a low fat diet and hopefully I can find someone to pay around the Atlanta area to specially formulate a meal plan for her. She's very into her chicken and rice and so now she doesn't want to eat her dog food. Do you have any idea how much food I need to feed her with her 10 milligrams of vetoryl in the morning and her 10 milligrams of vetoryl at night to be sure that the vetoryl absorbs? She's 20 lbs and I'm thinking maybe I'm over feeding her the chicken and rice and that maybe that is why she will need any other dog food that she normally likes.

[labblab]

Do you have any idea how much food I need to feed her with her 10 milligrams of vetoryl in the morning and her 10 milligrams of vetoryl at night to be sure that the vetoryl absorbs?
Hello! I recently spoke with one of Dechra's technical reps re: this very question, and I was told that a full meal is really the ideal in terms of optimal absorption of Vetoryl. I realize this may not always be possible, especially for folks who dose twice daily. But it seems as though "more is better" in this situation -- a meal of some size would be preferred over just a small snack or treat.

Marianne

[Ali Sadie]

Thanks Marianne! I've been feeding her about a half a cup of food each time I give her the vetoryl so I believe that's enough for a 21 lb dog.

[molly muffin]

I would think that would be enough. It is about what I can get my dog to eat if I top it off with a canned food.