Bertie has cushins

[Bertie's dad]

Hi,
Feeling very sad but found this site know I'm not alone.
After weeks and weeks of antibiotics our vet finally gave Bertie a cushins test. So annoyed.the vet initially implied cushins but prescribed a 6 week course of antibiotics then steroids. My poor boy had skin so bad it was thickening and black &crusty, he had an enormous pot belly,ravenous,drinking gallons of water, panting really bad,lethargic .....all the common signs of Cushings having now read up on the subject. Why would this vet not test for Cushings if her initial thoughts were this?
Well first ACTH test read250.0pre and 684.0post
Second test 281.0 pre 441.0 post
He was on 60mg of Vetroyl for 10 days after this test they have upped this to 80mg per day
Bertie has now developed severe bouts of head shakes, very distressing to see, I told the vet but no response ???? Very worrying
She advises us to give this treatment a couple of months at least but the poor boy looks so bad now. What do we do?

[Squirt's Mom]

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[Joan2517]

How long was he off the steroids before testing for Cushing's?

[judymaggie]

Hi! First things first, you are no longer alone! You now have our entire forum along side you to help guide you and offer support. Your post raised several red flags for me -- Joan has addressed one of them, i.e., how long was your pup off of steroids before the ACTH test was done? The steroids could definitely skew the results if there was not enough time without them.

The other huge red flag for me is that your vet opted to make a very large increase in Vetoryl after only 10 days. The Vetoryl manufacturer, Dechra, as well as the endocrinology experts in the field all recommend that, under most circumstances, no change be done until at least a month on Vetoryl and, even at that point, small incremental increases are best.

With your pup's current worrisome symptoms, if I were in your shoes, I would stop the Vetoryl immediately and find a vet who is knowledgeable about Cushing's. If you could tell us what part of the world you are, we can offer some suggestions.

I am assuming that the ACTH test results are in "nmol/l" units. Many of us are more familiar with "ug/dL". I have converted the results as follows:

First ACTH test results:
250 nmol/l = 9.06 ug/dL "pre"; 684 nmol/l = 24.79 "post"

Second ACTH test results:
281 nmol/l = 10.18 ug/dL "pre"; 441 nmol/l = 15.98 ug/dL "post"

What were the dates of the tests? I am curious why two tests were done and at what point the increase from 60-80 mg. was made. Please tell us how much your pup weighs.

Did your vet do any bloodwork on your pup? If "yes", please get copies of those tests and post any highs or lows along with the "range". There are certain lab results that are typically seen with Cushing's dogs. Was a urinalysis done? If "yes", please let us know what the specific gravity was and if there was any protein in the urine.

I apologize for all the questions and request for info but this will help us help you. It is also a good idea for you to have a file for yourself of test results. Others will be along with their thoughts and suggestions.

We do have an excellent resource forum. Here is a link:

http://www.k9cushings.com/forum/forumdisplay.php?f=10

[Bertie's dad]

Hi guys,
thank you so much for rapid responses. This is all so baffling for me but trying to educate myself. I am in the UK and realise this forum looks mainly stateside? You obviously have better vetinery practices over there. Anyway after a lot of raised concerns to our vet I acquired the readings I published yesterday. The first reading was 1/10/16 the second 13/10/16 Bertie was only on steroids a couple of days then the vet rang to say stop has she wanted to do the ACTH asap. She planned this for earliest date some 4/5 days later. So this was his first test for cushins. The vet having got the results prescribed 60mg of Vetoryl I assume on Bertie's weight (33kg) and said he must have another test in 10 days to see if dosage is correct. That was yesterday, his symptoms have not altered at all plus he has developed this distressing head tremor. I was told the increase in medication is minor as to raise the dosage gradually.

[labblab]

Thanks so much for this additional info because it does help us to better understand the chain of events. It now seems to me that your vet is acting reasonably under the circumstances. Bertie was on the steroid for only a very short time, and several days elapsed before the first, diagnostic ACTH testing. Therefore, we now have no reason to think the results were skewed by the steroid.

Secondly, your vet correctly retested Bertie's cortisol level within two weeks of treatment and plans another test in ten days following this dosage increase. Typically, Dechra now recommends that no dosing increase be made at all until 30 days have passed. But there are sometimes exceptions made when the cortisol is still hanging quite high at the time of the first monitoring test, plus the owner is seeing virtually no symptom improvement at all. Both of those issues seem to be true for Bertie. Additionally, since Bertie's weight translates into 73 pounds, the dosage increase to 80 mg. only places it a tiny bit over the recommended starting formula of 2.2 mg. per kg. (or 1 mg. per pound), anyway. So this would still be considered a relatively low dose and with this added info, I'm no longer critical of your vet's actions to increase his dose in this way.

The tremoring may be a side effect of the Vetoryl, which will hopefully lessen over time. In the alternative, it may just be another symptom of the disease. Over time, several members here have noted unexplained tremoring or shivering episodes in their Cushpups that have come and gone, mine included. I have thought that perhaps they are just related to big changes in cortisol levels. Either way, I hope they will ease over time.

Anyway, I know how hard it is to be patient when your dog is looking and feeling so miserable :o. But try to hang in there and wait to see how that next monitoring ACTH turns out. Until the cortisol gets lowered into a therapeutic range, it's not surprising that you're not yet seeing symptom relief. But hopefully when Bertie's cortisol does come down properly, you'll start seeing improvement.

In the meantime, we'd love to learn more about Bertie and your lives together.

Marianne

[Bertie's dad]

Marianne,
thank you so much,your reply made me feel so much happier and given us hope❤️

[SasAndYunah]

I just wanted to offer a thought :) In the Cushing's area, the others are much more experienced then I am...so I will leave that alone :) But I noticed that at first you wrote about head shakes and then later talked about tremors? And since Bertie had such very bad skin and most likely a skininfection (vet prescribed anti biotics) if Bertie is shaking his head a lot, he could have an earinfection. But since in your second post you mention head tremor instead of headshakes, I'm not sure. Anyway, if he keeps shaking his head, ask the vet to check his ears for mites, yeast or other stuff... :)

Saskia and Quincy,
The Netherlands :)

[Bertie's dad]

Thanks Saskia,
Bertie was checked for ear conditions but negative, anyway was told today that this condition may be the caused by the introduction of medication ? Been advised to see how he goes for the next few weeks on the boosted Vetroyl.

[molly muffin]

Just checking in to see how Bertie is doing? Is his skin getting any better? How about the shakes?

My molly had periodic tremors, they seem to come and go. I never knew exactly what was the cause and it too could have been the medication as there wasn't anything that they could find to cause it.