Vetoryl Not Helping Excessive Urination

[StrikeJ]

Adopted Lucy the boxer three years ago. Always had family dogs growing up, but this is the first dog that's actually my dog. A couple months ago, she woke up on a Sunday, went to her water bowl, and basically hasn't stopped drinking since. And peeing. After weeks of tests and a serious hit to my credit cards, she was diagnosed with Cushings and low thyroid. Been on thyroid meds and Vetoryl 120 mg for roughly 3 weeks now (66 pounds - she always loved to eat. Didn't realize it was from a tumor). Just went back to the vet on Thursday to make sure everything is working like it's supposed to and the vet said everything was perfect. Stim test and thyroid are back to normal. Vet seemed very surprised to hear Lucy was still drinking and peeing so much and wants her back in a couple weeks. Anyone dealt with a delayed response to Vetoryl like this? Where the blood work is fine, but the dog just doesn't seem to be getting any better. Lucy had never had an accident in the house before all this happened and now she just can't help it. Sometimes it just comes out when she's sleeping and she doesnt even notice. Just too much water in her system trying to get out. Neither of us are sleeping through the night. I'm a zombie at work. Just hoping someone might have some reassuring thoughts.

[DoxieMama]

Welcome to you and Lucy! I'm sorry to hear she (and you) are still troubled with excessive urination. I've only got a moment this morning but I"m curious if she was tested for a UTI?

Also, do you have copies of the tests that were done (or can get them) to share the results? Knowing the actual numbers from the stim and thyroid tests, as well as any abnormal values from the bloodwork, will be very helpful for us to provide you with the best feedback.

[labblab]

Welcome from me, too! Shana has brought up a very good question re: the possibility of a chronic UTI. Additionally, I "second" her request for sharing relevant test results, especially this recent monitoring ACTH test. In order to achieve full control of symptoms, a Cushpup may need to have her cortisol level maintained at a level that is lower than the "normal" range for a dog who does not suffer from the disease. Also, it is possible that Lucy's thyroid supplementation is too high -- hyperthyroidism can produce excessive thirst and urination just as is the case with a cortisol level that is too high. In fact, many dogs who present with low thyroid readings prior to Cushing's treatment end up not needing thyroid supplementation at all once cortisol comes under control (the low thyroid testing is actually secondary to the uncontrolled Cushing's, as opposed to being a primary problem in its own right).

Last but not least, it may take a while for kidney function to normalize in a dog who has been suffering from untreated Cushing's. Since Lucy has only been under treatment for three weeks, it may just take a while longer for these symptoms to ease.

Once again, though, learning more about her specific test results will be a big help to us!

Marianne

[Harley PoMMom]

Hi and welcome to you and Lucy from me as well!

As Shana mentioned, getting copies of all those tests and posting the results would be helpful to us in providing you with our best possible feedback, we need to only see those values that are abnormal along with the reference ranges and reporting units. Those ACTH stimulation results are of particular interest to us because even though Lucy's numbers are perfect right now, a dog's cortisol can continue to drop during the first 30 days of treatment so we tend to get worried when the cortisol level falls within the therapeutic ranges so quickly. Regarding the ACTH stimulation test, was her Vetoryl given with a meal and the test done 4-6 hours afterwards?

Another thing that has got me worried is that Lucy's Vetoryl starting dose is well above what is recommended which is 1 mg per pound of a dog's weight, so for Lucy's 66 pounds that would of been a dose of no more than 60 mg of Vetoryl. And since a dog's cortisol can continue to drift downward during the first 30 days, I'm concerned her cortisol level might be too low which could account for the continuance of the increased drinking and urination.

An UTI, as Shana said, can cause a dog to continue to drink/urinate more, and since a cushdog's urine is so diluted an urine culture is generally performed because a regular urinalysis may not be sensitive enough to pick up any bacteria in the urine. Diabetes is another factor to rule out as this condition can arise suddenly in our cushdogs so a recheck of that blood sugar may be needed.

Dog's that have Cushing's commonly have a low thyroid level, however this is usually temporary which is known as euthyroid sick syndrome and generally goes back to normal after the dog is stabilized with treatment. Although Lucy's thyroid level tested normal the supplementation may now have caused her thyroid concentration to become elevated which increased drinking and urination are the common symptoms of hyperthyroidism. When her thyroid level was checked was the test performed 4–6-hour post-pill?

I'm sorry for the circumstances that brought you here but so glad you found us and will we help in any way we can. Please do not hesitate to ask all the questions you have and know we are here to support you and sweet Lucy.

Hugs, Lori

[Squirt's Mom]

Hi and welcome to you and Lucy!

What hit me as off was this statement -


A couple months ago, she woke up on a Sunday, went to her water bowl, and basically hasn't stopped drinking since.

Cushing's doesn't come on that fast. It is a very slowly progressing condition and signs develop over time, not overnight. There is another condition that causes excess drinking and peeing - a rare form of diabetes called Diabetes Insipidus. It has nothing to do with blood sugar but rather with how the body processes water. The test for this is risky- a water deprivation test - so most vets simply start treatment and if the treatment works, then there is the diagnosis of DI. The treatment is an eyedrop or sometimes injections. I would talk to her vet about this possibility.

I'm glad you found us and look forward to learning more in the time ahead!

Hugs,
Leslie and the gang

[StrikeJ]

Wow. Thanks to everyone for the responses. A lot of information coming at me here.

UTI and diabetes were the first tests that were done. They ruled those out right away. Her urine was very diluted, and still is, so maybe the testing could have been off. They did actually give her an antibiotic after the first appointment just in case. She was on that for 10 days, I believe.

I don't have her exact Cushings test results. The vet said after her last STIM (?) test that she went from a 20-point-something to a 5. Said that's right in the range where she should be. Pill was given at 7 a.m. Vet appt was at 11, so all testing was done in the 4-6 hour window.

The Vetoryl weight chart shows 120 mg once a day for dogs 44-88 lbs, so at 66 lbs it seems she is on the correct dosage.

The excessive drinking was the only symptom that came on so suddenly. After researching Cushings, I realized it could be something that she may have had since I got her. She always had a bit of a pot belly. She was always lethargic. Basically the laziest dog in the world, but I thought that was just because she was old. (They estimated that she was already 6-8 when I adopted her, but it was just a guess because she didn't have any teeth). She was always hungry, but that didn't see too unusual. She's had thinning hair/bald spots, but they said that could be alopecia. She panted a lot, but I shrugged that off to her being a little out of shape (She hates walks or even just being outside). Looking back now, I wish I would've known to test for Cushings on day 1 and I hope she hasn't been suffering this whole time.

[Harley PoMMom]

The Vetoryl weight chart shows 120 mg once a day for dogs 44-88 lbs, so at 66 lbs it seems she is on the correct dosage.

In 2014 Dechra, the makers of Vetoryl, revised there starting dose protocol and now recommend that treatment should be initiated at 1 mg per pound of a dog's weight, unfortunately they haven't changed their product insert to reflect that revision. :( Here's the link to where this information can be found: http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf.

[nsintx]

I totally agree with others about checking for a UTI. Antibiotics helped tremendously with our Shepherd/Husky mix, Agnes (I just posted about this today). Also, Agnes did not respond well to Vetyrol. The numbers looked great from the vet's point of view but she wasn't interested in eating and was totally listless, started losing weight. We took her off and she's doing much better. Hang in there!

[molly muffin]

Okay so a UTI was ruled out. Diabetes Insipidus doesn't show up as a diabetes test, it isn't related to glucose but water. Which is why the try the drops usually.

The drop from 20 to 5 is the post ACTH number and that test was done how long after starting vetroyl? I ask because you can expect the number to continue to drop for at least 30 days at least on the same dose. You just don't want that post number to go too low.

[StrikeJ]

First Vetoryl pill was given May 19. Her next tests were done 14 days later on June 1. She goes back in for another round of tests on Friday.

She doesn't seem to be having any negative side effects from the pills. She's just not anywhere close to back to normal. We've gone from getting up 4-5 times a night to 2-3. Still drinking way more than usual. She did, however, actually start running the other day for maybe the first time ever. Never really seen much more than a leisurely stroll from her.

I will ask about dosage and Diabetes Insipidus when I go back in this week. I would have to imagine that a dog having both diseases simultaneously would be rare, but I have no idea.

[molly muffin]

Yes it would probably be rare to have both.

You will probably know more after your next appointment.