Newbie - Newbie questions.

[woof]

Thank you for letting me join this great community. I’ve lurked for a while since diagnose and read a lot in the forums.

H (phonetically, just because that what we call her) is a female twelve-year-old Jack Russell and Staffordshire Bull Terrier cross who weighs 12.5 KG and we live in the UK.

Her first ACTH post stim was 737 nmol/L and BASAL normal
As a result, the vet prescribed 30mg Vetoryl

I didn’t start H on the drug but instead asked for a second ACTH test two weeks later to confirm the diagnose which was post stim 891 and BASAL 89.

At which point we began 30mg Vetoryl daily.

At the 10 day ACTH test the results were Cortisol post ACTH 76 nmol/L and Basal 36

4 weeks on the ACTH test the results were Cortisol post ACTH 204 and Basal 102.

The lab comments on the last two results reflect good control ?

Both H and I would be gratefully for any advice on these numbers.

[Harley PoMMom]

Hi and welcome to you and H!

Glad you came out from the shadows and created a thread for H! There are 2 very important rules in monitoring a dog on Vetoryl with the ACTH stimulation test: 1) the Vetoryl has to be given with a meal to be properly absorbed, even on the day of the ACTH stimulation test; 2) the ACTH stimulation test has to be done 4-6 hours post pill. If both of these protocols were followed than those monitoring ACTH stimulation results are within Dechra's guidelines as long as the clinical symptoms are controlled. Since we are used to seeing the results in ug/dl, I'm converting them :) post ACTH 76 nmol/L = 2.75 ug/dl; ACTH 204 = 7.39 ug/dl. So, my question is: are H's symptoms under control?

Now, could you share a bit more information about H? Did she have a chemistry/CBC blood panel done, and if so, could you post those values that are abnormal with the reference ranges? Is her urine dilute? What symptoms led you or the vet to test H for Cushing's in the first place? Does she have any underlying illnesses? Besides the Vetoryl, is she taking any herbs/supplements/medications? Was she diagnosed with the adrenal or pituitary form of Cushing's?

I'm sorry for all those questions but the more we know about your sweet girl the better our feedback can be, ok? Please remember we are here for you both and we will help in any way we can.

Hugs, Lori

[woof]

Thank you so much for the warm welcome and for interpreting the results!

I first took H to the vets as she was drinking more water than normal, always wanted to eat more and was lethargic. Her eyes have also started to cloud over, but previously this was put down to age.

The vet carried out bloods described as a senior dog heath check and dip tested her urine which on the day showed positive for glucose.

Based on the urine test alone the thought was that she was diabetic.

During the few days (it was a holiday weekend) I bought the same urine test strips and could not reproduce the positive glucose test at home.

When the bloods came back they showed she wasn't diabetic, her sugar levels were normal and a further vet urine test was negative but a problem with her liver was highlighted which led the diagnosis moving towards cushings.

The vet advised an ultrasound scan and ACTH test. The ultrasound scan showed nothing remarkable but the ACTH came as described in my original post.

The vet commented that I had caught the signs very early on, and that it was normal for people to put the symptoms down to ageing and usually only presented their pets when further symptoms, excess peeing and fur loss appeared.

The vet offered to carry out a high dose dex test to differentiate between adrenal and pituitary but advised the treatment would be the same so I declined for the time being though that is an option if there is a benefit in knowing?

I collected the prescription the same day but held back so that I could learn about the drug and the condition. It struck me as strange that all my fellow dog walkers had never heard of cushings so I was great-full to be able to read the stories and advice here.

I decided I would be happier for a second ACTH test before I started H on a lifetime of Vetoryl.

When that came back I started her on 30mg which is hidden in a meal given in the morning and she eats with no problem.

The excessive drinking has now gone, her appetite is good, she must have a good clock because a minute past 6pm every single day she makes it known she wants her evening meal something she has always done.

The only noticeable side effect of the drug once given is it seems to knocks her out for several hours, she curls up in her bed and has a sleep. But she is not completely out of it and happy to go for a walk or go out in the car at any time. Is this a common side effect?

In the evening, around 10 to 12 hours after the pill I believe I can see the drug has warn off somewhat, she becomes active and wanting more food. To counter this I stopped giving her Vetoryl at 7am and changed it to 10 am moving the time frame on by which time shes asleep on the bottom of the bed when it wears off.

To answer the other questions, she has been extremely healthy all her life and only went to the vet for her yearly vaccinations. She takes no other drugs and all the tests were carried out at the 4 hour post dose stage with food.

I haven't changed her diet, she has always had chopped cooked beef steak with some dry food in the morning and a foil of dog food in the evening. It may sound like an odd mix but its always worked for her.

Just for reference here in the UK at my vets the ACTH tests cost £130 each and the drug is £2 a tablet (manufactured I noticed 30 miles from home in Yorkshire). I know there are cheaper sources of the tablet online but for the time being I'm content with buying them from the vet.

Many thanks again for taking the time to read my posts, its great to talk with other people who know about this condition.

[Carole Alexander]

Hello and welcome to this forum. Glad you joined. It seems to me that you and H are doing fabulous so far. H's response to the Vetoryl is all that one might hope for. It doesn't sound as if you are seeing muscle weakness or problems with fur thinning, blackheads, etc. If H only wants a nap after breakfast, more power to him and compliments to you on your thoughtful caretaking. You could split the Vetoryl dose but that doesn't seem necessary in light of your management techniques!

[molly muffin]

The medication has the most effect immediately after taking it, within the first couple hours in that the cortisol drops the most at this point, then starts to go back up throughout the day. Some vets combat this with doing a split dose, 15mg am and 15mg pm, which keeps things more even, but unless you see symptoms rebound then that isn't necessary.

As long as they do the test after the medication is given 4 - 6 hours, giving it at 10 is okay. You'd be testing at around 2 - 4pm on the test day.

The results itself is showing good control so that is good. If you notice anything like diarrhea, refusing to eat and/or drink and wobbly can't walk, then that is a sign of too much medication and meds should be stopped and a retest done. That doesn't seem to be what you are describing so far though. Just something to keep in mind.