i am going crazy

[zoeysma]

Greetings. My dog Zoey an almost 12yo staffie was diagnosed with Cushings as a result of prednisone for her allergies. She has been on vetoryl half dose for her weight and she went into addisonian crisis on Monday night. Longest night of my life! Will She ever get better? She is back on pred for a week until she has yet another blood test. I am worried sick. All i do is cry. Do i keep going?

[dsbailey]

Welcome to the group. I'm not the expert on this but one will be along soon I'm sure. Don't go crazy before then. Did she get IV fluids, electrolytes, etc ... My guess is that she will bounce back pretty quickly.

What dose of prednisone is she on for a week?

I'd be concerned with the amount of time until testing again and swinging her little adrenals so hard in the opposite direction with too much prednisone.

Take my advice for what it's worth as I stated someone more knowledgeable in this will be along shortly.

On another note my girl is 52 lbs and is stable on 15 mg once a day. Even though yours was taking a 1/2 dose doesn't mean it wasn't too much. I guess that's apparent.

Keep us informed and sorry your girl's not feeling good.

Darrell and Lolita

[labblab]

Hello and welcome from me, too. I'm really glad Darrell had the chance to welcome you and to start off with some questions that will be really helpful to us. I'm gonna go ahead and add a few more thoughts and questions, as well. As he says, though, it will be good if you can try to calm down -- we're here now and we'll do our very best to help you sort through things.

First off, can you tell us more about Zoey's overall health history, and especially the history with the allergies and prednisone. For how long a time was she taking the prednisone, and at what dosage? For how long had she stopped the prednisone before starting the Vetoryl? All this information is especially important, because if her Cushing's was truly caused by the administration of prednisone, she should not be treated with Vetoryl at all. When Cushing's symptoms are caused by steroids administered from outside the body, the illness is designated as "Iatrogenic Cushing's," and the remedy is simply to gradually wean the dog off of the steroid, thereby allowing the body's natural hormonal production to normalize once again.

That is not to say that she does not need supplemental prednisone again now, termporarily, to offset the effects of the Vetoryl she was taking. But in order to judge the appropriateness of her overall treatment, we need to find out a lot more details. So when you have the chance to come back and fill in some of the blanks for us, that will be great. There's every chance that this crisis will resolve, but her care going forward may need to change -- as in, no more Vetoryl ever, at all.

Marianne

[Lola]

Hello and welcome from me too.
You've come to the right place for advice. This forum has been a great resource for many of us taking the same journey with our cush pups. I have been in your shoes when my baby was first diagnosed three years ago and know exactly how you feel. So, just take a deep breath.
As Marianne said, we need more details on you cuch baby: weight, breed, how the diagnosis was made? what dose of Vetoryl was he put on? and if you have the latest blood work, just post the abnormal values. this should shed more light on the whole picture and you'll get better advice from all of us.
again, welcome to you and your baby

Nadia and sweet Lola

[zoeysma]

Zoey has been on pred for allergies since she was a pup but for the summer months only. Most likely allergies to grass or pollen. So from may to oct. For 10 years. This past summer she did not go on it because suddenly her allergies disappeared. Vet thinks that was because her cortisol levels were so high that they took care of the allergy symptoms. So she has not been on pred since oct 2015. She started this summer with excessive drinking and by fall the increased urination etc etc. I took her to the vet and she tested false negative on the definitive Cushings test. So iwent to am internist and they did an ultrasound and saw that adrenals were enlarged liver enlarged and she had ahuge bladder. They also found three small nodes on her spleen and liver less than 1 cm They started her on 30mg of vetoryl 2times a day on nov 10th aweek later her blood test showed her cortisol levels were within normal range. After 2weeks she was feeling better less peeing less drinking. More active.she continued on her vetoryl Then on Monday dec. 5 addisonian symptoms. Panting not eating Or drinking. I took her immediately to vet. Her electrolytes were normal and her acth a day later was down to 20...cortisol levels. She is currently on 2.5 mg of pred a day. She weighs 74 lb. I hope you have the info you need to help me. Thank you so much for your help and support. I appreciate it immensely! !! .

[zoeysma]

She is a staffie.

[zoeysma]

The pred she was maintained on for those years was large dose at first and then scaled back to 2.5 mg to 5 mg.every other day. I think i can't remember totally.

[labblab]

Thanks so much for this additional info! Now that we know she had been off the prednisone for so long, I'm no longer suspecting that it was the cause of Zoey's Cushing's symptoms. So we're back to considering naturally-occurring Cushing's caused by a pituitary tumor (based on ultrasound results).

It's good that she initially responded so well to the trilostane, and especially good that her electrolytes were normal. So that implies that she may simply need to be maintained on a lower dose of the trilostane after her natural cortisol production rebounds from this overdose. As Darrell explained earlier, dogs metabolize the drug differently, and a large dog can sometimes end up needing even a smaller dose than a dog who doesn't weigh as much.

Given her weight, the 2.5 mg. of prednisone she is taking this week is not a high dose at all. But it may be the case that just that little bit of supplementation will make her feel better until her own cortisol production kicks back in again. So for the time being, I think you are on the right track. Retesting her cortisol level, in conjunction with watching for a return of Cushing's symptoms, will help your vet decide when she may need to start back on the trilostane -- but next time on a lowered dose.

How is Zoey feeling right now? Does she seem to be doing better?

Marianne

[zoeysma]

Thanks Marianne... She is resting peacefully and seems to have a little more energy. She is drinking and eating normally. You make me feel so much more reassured in my vet too. I am thrilled you know so much about all this. Thank you so much. Hugs

[dsbailey]

I'm glad you're not going Crazy anymore - ;) I told you help was on the way.

[zoeysma]

Thank you for your support! !

[zoeysma]

Any idea what dose she should be out on with vetoryl once we get this addisonian mess cleared up? ?? Thanks

[labblab]

The most current dosing recommendation offered by Dechra (maker of Vetoryl) as well as many clinicians worldwide is not to exceed a formula of 1 mg. per pound when first starting out. However, as you are seeing for yourself, doses may need to be adjusted both upwards and downwards depending on the way in which it is metabolized by each individual dog.

Since Zoey weighs 74 pounds, her starting daily total of 60 mg. (30 mg. twice daily) was just a bit less than the 1 mg. per pound formula. But it still proved to be too much for her. Since you already have 30 mg. capsules on hand, if it were me, I'd probably ask to cut back to giving just one capsule each morning to begin with. If that doesn't prove to be enough to fully control her symptoms and cortisol level, you can then start adding back an evening dose, say by 10 mg. or so (Vetoryl also comes in 5 mg. capsules).

For people who dose twice daily, it's nice when the dose can be split evenly, but Dechra says that it is not necessary to do so. If the doses are not even, the larger dose should be given in the morning. Also, in our experience here, we've found that many dogs see adequate symptom resolution while permanently being dosed only once daily in the morning. For dogs who are prone to having their cortisol drop too low, that may actually be the preferred dosing pattern so that their cortisol is allowed to rebound a bit more through the course of each day.

Bear in mind that I am not a vet, though, so these are all only suggestions that I am throwing out for your consideration when you meet with your own vet next week. I'm surely glad to hear that Zoey is doing better, though.

Marianne

[zoeysma]

Thanks Marianne for the info. Better to have more advice then not enough from people like you with tons of experience! Glad to hear that asingle dose is effective. All the best.