Hi from Wooly

[Karenwadey]

Hi There, Wooly started drinking excessively in may and weeing at night on the floor in the kitchen. She also became very hungry & are even non food items in the house. After a few blood tests & bile test I asked vet to do a cushings test & it was positive. I was quite relieved to know what was wrong. Initially we thought maybe cancer as she was ravenous eating double her food but loosing weight.
Anyway we started 20mg of vetoryl in august, initially all good symptoms all improved & then a week ago she was really ill refused to eat or even get out of bed & kept shaking. We thought pancreatitis but zantac & team adolescents prescribed but no improvement. On Fri I could get the vetoryl in her & she was that poorly I thought we might be loosing her. By the evening she started improving. We decided the vetoryl must be the problem it's now sun & she is fully recovered eating running about and happy. Dies anyone have any similar experience? We are planning to see whether her symptoms recurr & if so maybe try a lower dose.
Thank you
Karen

[judymaggie]

Hi and welcome to you and Wooly! I am sorry that you went through a rough patch with your pup.

I have a couple questions if you wouldn't mind sharing some information about your girl with us. Your answers will give a better picture of what may be going on so that our feedback can be relevant to Wooly's situation.

To begin with, how much does Wooly weigh? This is pertinent with regard to the dose she was taking. Current recommendations are to start at the lowest possible dose, i.e., 1 mg./lb. so a 20 mg. dose would be appropriate for a dog that weighs 20 lbs. When was Wooly's last ACTH? Did you talk with your vet when she started feeling poorly? Did he advise you to stop the Vetoryl? Whenever negative symptoms appear, it is best to not give the Vetoryl until the underlying problem is diagnosed. It very well could be that Wooly's dose was too high for her and it would have been appropriate for an ACTH test and a chem panel to include electrolytes be done at that time for two reasons -- one, to determine if her cortisol had dropped too low and to also make certain that her electrolytes were not too low. Vetoryl only stays in the dog's system for a short period of time so, if Wooly was feeling badly from too high a dose and is now feeling good after not taking the Vetoryl, this does point to a dose that might be too high for her. There is no way to tell without an ACTH test being run.

What test/s were performed that diagnosed her Cushing's? Please post all of those results (an ACTH will have two numbers, a pre and post and an LDDS will have three numbers, a baseline, 4 hr. and 8 hr. Was she diagnosed with the pituitary or adrenal form of Cushing's?

Does Wooly have other health problems, and if so, what medications is she taking for them? Has a chemistry/CBC blood panel been done recently, and if so, could you post those values that are marked abnormal and please include the normal reference ranges? Is she taking any supplements or herbs?

If you haven't started keeping a folder with all of Wooly's test results, this is a good time to start doing that. One, it will help us help you and it will also provide you with a complete picture of Wooly's health going forward.

Looking forward to learning more about Wooly!

[Karenwadey]

Hi Judy ,Thank you so much for your reply I feel glad to have a support group.

Initially Wooly had a blood panell done which showed her ALT to be raised. It was 201 and her ALP was 79. The vet then wanted to do a bile test. Results 18 starved 43 post feed. WE then put her on Denamarin to help with her liver. 6 weeks later she was still pacing the house at night drinking loads & weeing. Panting also. She was eating two tins a day as opposed to 1 & loosing weight. We went back to vets & they repeated bloods. ALT 187 ALP 197 cholestral 11. Hgb 19.8 HCT 59.2. I asked them to do the acth cushings test but I don't have the results but was told positive. They prescribed 20mg of vetoryl. Wooly weighs 8.6kg. Her last ACTH was 2wks ago and the vet was happy to continue this dosage until the next text in 12 wks. She then became poorly a week after the acth test. ( i am waiting for a copy of this test) she was seen by vet they did not repeat the ACTH as I had been unable to get the pills in her that morning. She prescribed zantac and tramaddol to see if she improved which she did not. I am due to see the vet again this week. She is otherwise completely healthy and on no other Medication or herbs.
Kind regards
Karen

[Karenwadey]

I forgot to mention we don't know what type of cushings.

[Karenwadey]

I spoke to our vet today and she wants Wooly to have a break from the Vetoryl now she has recovered and try again in a few weeks on a lower dose.

I'm feel very torn after what has happened, I'm not sure if I want to keep putting wooly through the blood tests required with the vetoryl and the drugs that made her so I'll. The Vet says untreated it will shorten her lifespan.

What are other owners thoughts...thank you Karen

[Joan2517]

How old is Wooly, Karen? I don't see her age listed anywhere...

[DoxieMama]

Hi Karen,

Were other possible issues ruled out, such as a UTI, thyroid problem or diabetes? Cushing's is a difficult disease to diagnose, as the symptoms could be caused by various illnesses. From what I understand, other illnesses can be more directly diagnosed/ruled out, and that is usually done before making the determination that Cushing's is the cause.

That's not to say that Wooly does not have Cushing's. I am just curious to know if those other possibilities were definitively ruled out, given her reaction to the meds.

In addition to the ACTH test (most recently) did they do other bloodwork, such as testing her electrolytes? Those results might help explain what's going on, too, if you can post any abnormalities of those.

Hopefully others will be by to provide their insights as well.

Shana

[Maddiesmom]

I hope you figure it out! I'm not sure if this is helpful - but my boxer was diagnosed with Cushings (pituitary gland) in April and in June had what the vet calls a vascular episode - like a mini stroke. It was determined to be unrelated to the Cushings and the cushings meds. She is 11 years old and her symptoms for the vascular event include: lethargic behavior, impaired vision, stopped eating, hearing loss. It was like she was in a trance for a day. It took a couple of days to fully come out of it and be back to her normal self. Again - this might not be helpful - but I wanted to share just in case.
Prayers for a speedy recovery for Wooly!

[Harley PoMMom]

Hi and a belated welcome to you and Wolly from me as well!



What test/s were performed that diagnosed her Cushing's? Please post all of those results (an ACTH will have two numbers, a pre and post and an LDDS will have three numbers, a baseline, 4 hr. and 8 hr. Was she diagnosed with the pituitary or adrenal form of Cushing's?


Your answers to these questions Judy asked are very important, could you please get copies of those tests and post those results for us? Thanks ;)

Hugs, Lori

[Karenwadey]

Thank you for replying everyone. Wooly is 12 and a bedlington terrier.
She had basic bloods in may showing elevated ALT after that she had an acid bile tes advanced bloods and ultrasound. I think I've posted results above.
She had the cushings test in august which came back positive. Her symptoms were very clear.. huge thirst, lots of weeing (needed to go out in night several times or weed floor which is last resort for her) then started with the appetite and eating random things. She ate a phone charger & chewed up things. Paces the house at night searching for food which we had doubled what we fed her. Finally her skin pigment on her belly is black.

She's been tested for diabetes and was clear. I believe the diagnosis is correct but the treatment appears more complex and invasive than I imagined. Now we've stopped vetoryl she's eating normally after a week of not even getting out of her bed. If that is her quality of life on vetoryl we would rather not pursue it.

I'm afraid now as the vet said it will shorten her life if untreated but I've read this isn't always the case as vetoryl only improves symptoms and doesn't cure.

[Karenwadey]

She had an ACTH test but they still haven't sent me the rests through. Her blood results are as above. Most recent bloods

ALT 161
ALP 130

HGB 19.4 g/dl HIGH 12.00 - 18.00
HCT 56.

I can't see the electrolytes.

[Karenwadey]

Finally have the acth results.

1st test done July 29th

Pre 309
Post 922

Wed test 3 weeks after starting vetoryl
Pre 94
Post 201

Can anyone help interpret these. My instinct says that's a big drop in 3 wks?

Thank you

[Squirt's Mom]

Would you mind editing these posts to add the ranges and little letters that follow those values? That will help us interpret them for you. ;) Thanks!

[Karenwadey]

Finally have the acth results.

1st test done July 29th

Pre 309 nm01/1 20 > 250 high
Post 922nm01/1

Wed test 3 weeks after starting vetoryl
Pre 94 nm01/

Post 201nm01/1

Can anyone help interpret these. My instinct says that's a big drop in 3 wks?

[Harley PoMMom]

Finally have the acth results.

1st test done July 29th

Pre 309 nm01/1 20 > 250 high
Post 922nm01/1

Wed test 3 weeks after starting vetoryl
Pre 94 nm01/

Post 201nm01/1

Can anyone help interpret these. My instinct says that's a big drop in 3 wks?

I'm converting her stim values in the units (ug/dl) that we are used to seeing ;) so, Pre 309 nmol/l = 11.2 ug/dl ~ Post 922 nmol/l = 33.4 ug/dl

3 weeks after Vetoryl:

Pre 94 nmol/l = 3.4 ug/dl

Post 201nmol/l = 7.3 ug/dl

And yes, that is significant drop in that post. How are her symptoms? If her symptoms are controlled than that post is within the therapeutic ranges that Dechra recommends.

And since it seems that she did have some ill effects from the Vetoryl I would probably lower her dose and see if the symptoms rebound.

Hugs, Lori

[dsbailey]

I'll take my first try at this: (http://www.vin.com/calculators/ChemConvCalc.htm)

Most of us in the states are used to ug/dL so I converted.

1st Test
Pre - 309 nmol/L of Cortisol converts to 11.2 ug/dL
Post - 922 nmol/L of Cortisol converts to 33.42 ug/dL

2nd Test
Pre - 94 nmol/L of Cortisol converts to 3.41 ug/dL
Post - 201 nmol/L of Cortisol converts to 7.29 ug/dL

You are correct it is a big drop. As per Dechra at these levels "EITHER: Continue on current dose if clinical signs are well Controlled OR: Increase dose if clinical signs of hyperadrenocorticism are still evident"

They don't recommend any dosage increases in the first month but with you being at the 3 week mark you're in a gray area in my opinion. What starts becoming important now are clinical signs, which I'll leave that discussion for the others that are more experienced.

The lower the cortisol levels, the better on the internal organs and for other systemic problems. Some dogs like my girl requires to be in the 5 - 7 range because of arthritic reasons. She started showing some severe arthritic problems in the 3 range and I had to lower her dosage from 35 mg to 30 mg. Hopefully this will bring her back up a bit and the additional cortisol will help with her mobility.

It's a quality of life issue. I tell my friends that I would rather have a happy mobile, a bit thirsty, a little extra peeing dog that lives another few years than a miserable, struggling, lame girl that lives another 5.

To sum it up. You will most likely need to bump up the dosage a bit after you take everything into consideration but things are moving in a very positive direction.

Darrell and Lolita

[Karenwadey]

Hi Lori Thank you for that. I think it may explain why Wooly was so poorly for a week. She's on a break now so may reintroduce at lower dose.

Totally agree with others would rather have my happy dog with good quality of life that a dog who couldn't even get out of bed to eat or drink.

I was so excited as virtually all the cushings symptoms have gone but I never saw her so.miserable and I'll.

[dsbailey]

You also have to remember that there's going to be a feeling like crap phase for her. Her bodies dependent drug of choice (Cortisol) is gone. I think it takes a few days / weeks of getting used to before some normalcy returns. Anyone???

[Karenwadey]

Yes but the feeling crap stage gas to be acceptable levels. She didn't eat for a week. Virtually stopped drinking and did not get out of bed. I honestly thought I was loosing her.

[Harley PoMMom]

She didn't eat for a week. Virtually stopped drinking and did not get out of bed. I honestly thought I was loosing her.

These are definite signs that her cortisol may have dropped too low and withholding the Vetoryl is the correct thing to do.


You also have to remember that there's going to be a feeling like crap phase for her. Her bodies dependent drug of choice (Cortisol) is gone. I think it takes a few days / weeks of getting used to before some normalcy returns. Anyone???

Some dogs during the first 10-14 days of treatment may go through cortisol withdrawal syndrome, this happens when that elevated cortisol is lowered rapidly.

Lori

[molly muffin]

I'd probably do exactly what you are doing. Stop for a bit, restart at a tad lower level of vetroyl, retest in a couple weeks. The drop happened very fast and that is a huge adjustment for the body. I prefer a gradual drop, but some dogs react more strongly to the medication than others.

[Karenwadey]

Hi is anyone using only 10mg of vetoryl on a dog weighing about 8.4kg.
Wooly had to come off completely as she became very pooly and we have just started her again on 10mg to see how she tolerates it. Does anyone else have any experience of such a low dose?
Thank you

[judymaggie]

Hi! I merged your recent post into your original thread about Wooly. This will allow members to have all of Wooly's history in one place and will make it easier for you as well.

Since Wooly had such a rough road after being on 20 mg., I think it is reasonable for your vet to restart at 10 mg. I think you will find most experts and members believe that it is better to start low and proceed slowly. I would suggest that you ask your vet to run an ACTH at the two week mark and again at the month's end to see where Wooly's cortisol levels are. It is also best to concurrently check electrolytes.

[Karenwadey]

Thank you, yes we test her costisol levels after 2 wks ans see where we are. Hopung this time for success. K

[judymaggie]

Hi! I know you have Wooly's ACTH scheduled for this week but wanted to check and see how she is doing.

[Karenwadey]

3 weeks in on 10mg of vetoryl and Wooly is refusing food again. Her cushing symptoms improved not crazy, drinking less and weeing less. Shes not eaten for 2 days and I keep throwing away tins. I regularly cook her chicken but dsy b4 yesterday she didn't want it. What now? Shes eating a maribone biscuit each morning.

[Joan2517]

Hi, if she's not eating, she shouldn't be getting the Vetoryl. It needs to be given with food.

[DoxieMama]

Have you had an ACTH test done since restarting on 10mg?

[judymaggie]

Hi! I am sorry that Wooly is not eating -- that is definitely a concerning issue. Did she get the ACTH the week of 10/24? Either way I think you should call your vet and let them know what is going on.

[Karenwadey]

She's going in next wk for Acth test. Feel so frustrated as no meds she starts acting crazy and wakes me a lot during the night. With Meds shes not eating or happy.

[molly muffin]

I think I would have the ACTH test done now instead of waiting for next week.