Bad reaction to Vetyrol, not sure what to do next

[nsintx]

Our Agnes is a Shepherd/Husky mix, diagnosed through tests and an ultrasound with primary Cushings in January due to a tumor on her adrenal gland - it's on the side where the Vena Cava is (and the tumor pressing against that, though we don't know how much or whether it's malignant), so surgery is out of the question. Her main problem was/is peeing in the house, but other symptoms were hair loss (especially on the tail); darkened skin; weak back legs; and excessive drinking (though not as much as some dogs). We monitored symptoms without meds for a couple months, accidents got worse, vet recommended Vetyrol, which worked okay for a couple weeks (mostly accidents were less frequent) and her levels at the 10-day check were great. But then she started to get very weak (especially her back legs), lethargic, and worst of all, anorexic. It was a huge challenge to get her to eat. Vet suggested taking her off the meds to see whether she would at least start eating again. And she did! Also got some of her energy back, almost like her old self, for about a week. And her legs seem better, maybe she was just too tired to lift them?? AND, she's still having fewer accidents--actually, even less than when she was on the Vetyrol! We try to take her out about every hour during the day and a couple times at night. Sometimes she still has accidents but less frequently (and less volume...) for the past few days. Her energy level is "meh" but still more than when she was on the meds, and she is an old dog, after all :-)

I'm just wondering what our next options are. We'll meet with the vet this week but if anyone has ideas or thoughts, I'm all ears. We thought she was a goner right before we took her off the Vetyrol, and now she seems to have rallied...but for how long? I know Cushings needs to be treated and from what I've read, Vetyrol is the only option for primary Cushings with adrenal tumors.

[Harley PoMMom]

Hi and welcome to you and Agnes!

I'm just wondering if the problem of her inappetence was from the Vetoryl dose being too high. With Vetoryl the recommended starting dose is 1 mg per pound of the dog's weight so if you would post Agnes' weight and dosage strength that would be great.

On the ultrasound, besides the adrenal gland tumor, were any anomalies found with the other organs, and if so, could you post those findings too? Could you also post the results of all diagnostic tests that were done on Agnes? With respect to the CBC/chemistry blood panel you need only to post those values that are abnormal along with the reference ranges and reporting units. We would really like to see the results from her monitoring ACTH stimulation test/s, so posting them would be a great help to us. Dogs with Cushing's are prone to UTI's which will make them drink/urinate more, has an UTI been ruled out via an urine culture? Does she have any underlying health issues? Is Agnes taking any herbs/supplements/medications?

I'm sorry for all these questions but the more information we know about your sweet girl the better our feedback can be. I'm sure glad you found us and we will help in any way we can.

Hugs, Lori

[nsintx]

Thank you! I'll post more info later on today. I'm glad to have found you! :)

[nsintx]

Hi and welcome to you and Agnes!

I'm just wondering if the problem of her inappetence was from the Vetoryl dose being too high. With Vetoryl the recommended starting dose is 1 mg per pound of the dog's weight so if you would post Agnes' weight and dosage strength that would be great.
Agnes' weight at time of starting Vetyrol was about 60 lbs and she was started on 60 mg caps, which the vet said was the lowest dose.


On the ultrasound, besides the adrenal gland tumor, were any anomalies found with the other organs, and if so, could you post those findings too?
From ultrasound in mid-January: "Adrenals: The right adrenal is enlarged and has irregular margination. Measures 3.2 x 2.2 cm. The peripheral tissue is reactive which indicates that there is invations inot the area by the adrenal mass and most likely involveme of the renal and vena cava vasculature. Gall bladder: The gall bladder is moderately distended. The lumen contains anechoic bile. Conclusions: Right adrenal tumor with invasive properties. Most likely malignant. Surgery would be risky."
Could you also post the results of all diagnostic tests that were done on Agnes? With respect to the CBC/chemistry blood panel you need only to post those values that are abnormal along with the reference ranges and reporting units. We would really like to see the results from her monitoring ACTH stimulation test/s, so posting them would be a great help to us.
I'll have to get those numbers from the vet... I just remember that her numbers were in an excellent range for the ACTH and the electrolytes and the vet was very happy with them
Dogs with Cushing's are prone to UTI's which will make them drink/urinate more, has an UTI been ruled out via an urine culture?
They did do a urine culture a couple weeks back and didn't find much (but it was very dilute), but put her on antibiotics anyway in case there was a UTI. I think it helped, though we took her off the Vetyrol the same day she finished the 10-day course of antibiotics so it's hard to know what did it!
Does she have any underlying health issues? Is Agnes taking any herbs/supplements/medications?
Agnes has had hypothyroidism for a couple years and is on .6 mg Soloxine 2x/day. And she gets Trifexis once a month for heartworm/flea.

I'm sorry for all these questions but the more information we know about your sweet girl the better our feedback can be. I'm sure glad you found us and we will help in any way we can.
Thank you so much!

Hugs, Lori

One more note: Part of our quandary is that we're about to move to a different state at the end of June, 2,000 miles away. We're worried that the added stress of the move (driving for 5 days) itself and post-move settling in will add a lot of extra stress that could exacerbate things. Until really recently, we were pretty sure we would "let her go" before the move, since she was doing so poorly anyway. But now that she seems better, we're so confused! Thank you again :-)

[Harley PoMMom]

Even though her starting dose is within the recommended guidelines it still could be that the dose was too high. Vetoryl comes in 5 different dosage strengths: 5 mg, 10 mg, 30 mg, 60 mg, and 120 mg, so I'm a bit confused as to why the vet remarked that the 60mg was the lowest dose.

Also, the results of one study indicated that larger dogs require smaller doses so it is entirely possible that a lower dose, say 30mg, would have be adequate for Agnes.

If Agnes' thyroid levels are running high this can cause increased drinking/urination, have her thyroid levels been checked recently?

Hugs, Lori

[nsintx]

We met with the vet today and she's as surprised as we are at how well Agnes is doing. For now, we'll keep her off the Vetyrol and pulse her with antibiotics for 5 days once a month to keep UTIs at bay...and keep our fingers crossed! We actually had an appointment to have her euthanized on 5/22 when she was doing sooooo poorly, but then after taking off Vetyrol on 5/12 she got so much better. So, every day now is a gift and we'll enjoy each one as that. Thanks so much!

[molly muffin]

Hello and welcome. It really is a matter of one day at a time in some cases. Like Lori, it does sound like either, thyroid went to low (possible as it can change once on cushing meds) or the cortisol went to low. (probably most likely)
How long after starting vetroyl was the follow ACTH test done?
Cortisol levels can and usually will continue to go lower on the same dose of medication for around 30 days. So it might have continued to drop even after the first ACTH. That could cause the symptoms you mentioned.

An adrenal gland can be really tough to treat as it is hard to get them in range and keep them there.

[nsintx]

Hi all,

Our Agnes is 14 years old and was diagnosed last year with Primary Cushings due to a tumor on her adrenal gland. The first sign of the Cushings was her starting to have "accidents," peeing in the house, mostly while she slept. She'd wake up in a pool of her own pee and then get up and shake. Fun! It got worse and worse, we were taking her out about once an hour during the day (the joys of working at home) and she was still having accidents, and a few times at night, same thing.

We tried Vetyrol and it helped a LITTLE with the peeing but also made her anorexic and totally lethargic. We took her off and around the same time, tried her on antibiotics in case she had a urinary tract infection (UTI).

She started eating again, got her energy back, AND had far fewer accidents. Not none at all, but we don't feel like we're constantly cleaning up after her. Recently she started having more accidents again, the vet took a look (at her and a urine sample) and said it looked like another UTI. Back on antibiotics for 7 days, and again she seems much better.

The vet recommended "pulsing" her monthly with antibiotics to stave off future infections: 5 days every month. We shall see.

I've read that dogs with Cushings often get UTIs because their immune systems are compromised and their genital areas tend to be wetter because of all the peeing and licking. So, before you give up hope on your messy pup, talk to your vet about treating for a UTI!

Also, because she's older and somewhat arthritic, we've recently started giving her Tramadol for aches and pains. This, too, seems to be helping her spirits, heck maybe it's even mellowing her out a little.

Best,

Agnes' mom with her fingers crossed

[nsintx]

Sorry Sharlene, I only just saw this! Agnes was tested at the "correct" times, after 10 days and 30 days (I think - anyway, exactly when the vet told us to do it). I just posted about Agnes' UTIs, which really seem to have contributed to the peeing problem. And she's on Tramadol now, too, for aches and pains and she seems happier. So like you said, one day at a time, and fingers crossed. Thank you so much!!!

[Squirt's Mom]

I have merged your post about UTIs into Agnes' original thread. We like to keep all info about each pup in one thread. That way it is easier to look back thru the history if need be. ;) I have also edited the thread title to include Agnes' name; it may be easier to find that way. Thanks!

[molly muffin]

Oh gads, those UTI's have been buggers. We've had some dogs with persisitant UTI's that where on antibiotics for over a month before they actually got it to go away. They'd think it was gone, take them off medication, it would come back, do all over. It turned out that what was required was a long time on the antitibotic then a culture to make sure it was really gone.

Maybe something to talk to your vet about as with pulsing I'd worry about becoming resistant to the antibiotic after awhile.