Recovering from possible too high dosage of Vetoryl

[SpringerX2]

Hello! My dog Chloe was diagnosed last January with Cushings. She is an English Springer Spaniel, 10 years old, about 55 pounds. She was put on a dose of 60mg if Vetoryl. This worked great. Within a week her symptoms basically disappeared. I might add her only symptom was excessive thirst and excessive urination and leaking. That dose worked well for her for six months or so. If we forgot a dose she always presented symptoms within 24-48 hours. After her second follow up ACTH test our vet said her levels were borderline to increase her dosage. If she wasnÂ’t presenting symptoms we could keep it the same. At that time she wasnÂ’t so we didnÂ’t increase. But after about a month she started leaking again so we increased by 10mg. After a few months she started skipping meals. We didnÂ’t think much of it because our other dog was doing the same thing. We had recently switched foods and thought they didnÂ’t like the new food. Well just over a week ago we had a little snowfall and Chloe flipped out. She loves the snow, she whined to go out as soon as she woke up and had a blast running Around in it all weekend like a puppy. On Monday she didnÂ’t eat any of her food all day. On Tuesday she was vomiting yellow bile all day and refusing all food. This is the day we stopped giving her the Vetoryl. She has barely ate since until today but she did stop vomiting. We took her to vet and they did blood draw to check cortisol levels which were at 1.5 on Thursday, two days after stopping the Vetoryl. We are scheduled for ACTH test on Thursday. Does anyone have experience with this and recovery after too high of dose? IÂ’m just assuming that was the cause anyways. We have no other explanation.

[Harley PoMMom]

Hi and welcome to you Chloe!

I am so sorry to hear that your precious girl is not feeling well and we certainly will help in any way we can. On the forum we have observed many dogs with cortisol dropping too low when their Trilostane dosage was too high and we even have seen cortisol fall too low when no increase in dosage was made. Some of these dogs go months before those adrenal glands start producing enough cortisol for clinical signs to reappear.

That 1.5 ug/dl ACTH stimulation test result, I'm assuming, is the post blood draw? It makes me a bit uneasy when I see a dog's post cortisol level drop below 2 ug/dl and according to a renown veterinarian that specializes in endocrinology, Dr. Peterson, he feels the same way too:
Dosage adjustments — lowering the dose

In this report (13), trilostane treatment was continued in dogs with a post-ACTH cortisol concentration less than 1.5 μg/dl, as long as no adverse clinical signs were reported. I disagree with that regime.

When using trilostane, it has become increasing clear that we do not want the cortisol values to drop too low, because that may indicate early or mild adrenal necrosis (1,11,12). In contrast to the protocol used in this reported study, I recommend stopping the drug in all dogs that develop a ACTH-stimulated cortisol values less than 2.0 μg/dl, and repeating the ACTH stimulation test in 1- to 2-weeks in those dogs. Some of these dogs will require that the drug be restarted at a lower dosage, but others will maintain low to normal serum cortisol concentrations for prolonged periods of time. And a subset of these dogs, presumably because of mild adrenal necrosis, will never need any further trilostane treatment to control the signs of Cushing's syndrome. https://endocrinevet.blogspot.com/2012/12/low-dose-twice-daily-trilostane.html

When a dog's post cortisol level is < 2.0 ug/dl those adrenal glands may not be able to produce enough cortisol and/or an imbalance in the electrolytes could occur. Did the vet draw blood to verify that the electrolytes (mainly sodium and potassium) were normal? Was she started on prednisone? How is her appetite now? Any episodes of diarrhea?

Regarding Chloe's ACTH stimulation tests timeline, could you clarify for me when she had her cortisol rechecked as it looks like Chloe never had an ACTH stimulation test done 10-14 days after the Vetoryl was started, and she had no follow up cortisol rechecks until she was on the Trilostane/Vetoryl for six months, is that correct? Also could you get copies of those ACTH stim tests and post those results here? Two more questions I have; is Chloe getting her Trilostane/Vetoryl dose with a meal and are those ACTH stimulation tests being performed 4-6 hours after she has had her Trilostane/Vetoryl?

I apologize for so many questions, but your answers will help guide our additional thoughts and feedback. Once again, we're really glad you've found us.

Lori

[labblab]

Lori has started you off with some great info and questions, so right now I’ll just offer you and Chloe a big “Welcome!” I’m so glad you are able to join us here, and I’ll be watching for your next reply.

Marianne

[DoxieMama]

Welcome to you and Chloe! Lori covered all the questions so I just wanted to say hello. I look forward to hearing more about your precious girl.

Shana

[SpringerX2]

Okay let me see if I can clarify all of the questions above.

First, the 1.5 ug/dL reading was her level on Thursday last week about 10:15 AM, basically a resting blood draw not part of an ACTH stimulation. Her last dosage of trilostane was given on Monday evening at about 6:00 PM. Her Potassium was at 6.3 mmol/L and her Sodium was at 136 mmol.L on this date as well.

I've gotten her results from the last year and below are what her readings have been.
2/2/17
Cortisol Resting 11.4 ug/dl

3/7/17
Cortisol Resting 1.8
Post ACTH 7.5

6/14/17
Cortisol Resting 3.4
Post ACTH 7.4

9/14/17
Cortisol Resting 4.8
Post ACTH 5.9

We typically were giving her medication after dinner or right before bed with some bread. It was not ever given 4-6 hours before the ACTH test and was never recommended by our vet to do so. She started on 60mg in February 2017 and it was in October 2017 that we increased it to add an additional 10mg. This was due to her symptoms of excessive thirst and urination returning even when taking the 60mg daily. However, we never brought her in to have her levels retested after increasing which I believe is a miss since everything I am reading now says that you should always retest after changing doses. So here we are now in January 2018. Yesterday we bought some Science Diet AD wet food from the vet to feed her because she has been eating so little. She ate that right up and I got her to eat some other Blue Buffalo canned food. This morning she would not touch any food again and spit up clear liquid (flemmy water). Pretty much over the last week I can get her to eat minimal food, she would eat a homemade food of chicken and bone broth. Will not touch any dry dog food, and with the exception of yesterday and one day last week, would not touch any wet dog food either. Her weight is now at 48 pounds and she was at 58 this time last year.

[labblab]

Thanks so much for all this additional info. Upon reading it, though, I do feel more concerned that Chloe's cortisol level may indeed be too low. And under these circumstances, a baseline or resting cortisol level alone is insufficient -- unfortunately, a full ACTH is really necessary in order to determine whether or not her adrenal glands are truly functioning normally. For instance, if there is little or no increase in the post-ACTH level above the 1.5 baseline, then the adrenal glands are not responding properly to stimulation and Chloe may be suffering from a lack of appropriate cortisol reserves. This could definitely account for her lack of appetite and spitting up. For right now, I definitely think you need to continue to withhold her trilostane. And since her lack of appetite is continuing again today along with the vomiting, I think you need to contact the vet and, ideally, request an ACTH to be performed. If for some reason that can't be done, I would ask for a prescription of prednisone (or dexamethasone) to try giving her. If her cortisol level is indeed too low, then the supplemental steroid will act as a replacement for the cortisol she is lacking. If she starts perking up again after being dosed with the the prednisone, you have added reason to conclude that her cortisol has dropped too low. She does not need a large dose of prednisone in this situation -- just a small "rescue" dose that will replace any lost cortisol. I've forgotten the formula myself, but I'll try to come back and add it later. Ideally, however, you'll have an ACTH done before starting any prednisone. Prednisone will register in the same way as cortisol on an ACTH test, so a dog must be prednisone-free for at least 24 hours before being tested.

One question: were those sodium and potassium numbers that you gave us within normal range last week? I'm assuming (hoping) so. But even if they were normal, it can still be the case that Chloe's cortisol has dropped too low

Just so you'll know for the future, it is recommended that trilostane be given in the morning along with breakfast if it is dosed only once a day. Cortisol levels are at their lowest within the first few hours after dosing, and then typically start to rebound again within 12-18 hours. By the time 24 hours have passed, the drug has typically exited the body altogether. So if you dose only once daily in the evening, you have two problems. First, by the tie time the dog awakens in the morning, the medication effect is already starting to wear off and cortisol levels (and symptoms) can rebound during the day when the dog is most active. Secondly, by the time an ACTH test is performed the next day, again, you are catching the cortisol level at its highest rather than its lowest. For safety reasons, this is not a good thing, because you can be lulled into increasing a dose when it's not appropriate. This may be what happened with Chloe, and her adrenal glands may now be oversuppressed to the extent that they will need a total break from the medication for at least a while. And in addition, she may need the supplemental steroid to get her over the hump.

Please keep us updated as to how things go today, OK?
Marianne

Edited to add: Here's an article that gives the proper formula for steroid dosing for dogs suffering from Addison's Disease. You'll see that Dr. Peterson recommends a prednisone dose no larger than .2 mg/kg, which would translate into approx. .5 mg/lb. So in Chloe's case, she wouldn't need a dose larger than about 3.0 mg. total. So not very much prednisone at all.

https://endocrinevet.blogspot.com/2011/02/q-whats-ideal-prednisone-dose-for-dogs.html

[SpringerX2]

Thanks for all of the feedback. We did give her prednisone for three days after I brought her in last week, so she took a dose on Thursday, Friday and Saturday. It did not really seem to perk her up any though. We do have an appointment to bring her in on Thursday this week to do the ACTH stimulation test. He wanted to wait a few days of her being off the prednisone before doing the ACTH.

According to her blood test chart her Potassium was high at 6.3 when the reference range is 4-5.4 and her sodium was low at 136 when the reference range is 142-152

[SpringerX2]

Hmmm. The prescription I was given for the prednisone show it is for 5mg tablets. I gave her one a day for three days.

[labblab]

The 5 mg. should have been fine, I’d think — not that far above Dr. Peterson’s formula. When you say she wasn’t better, she did eat yesterday, though? And now that she’s been back off the prednisone since Saturday, she’s not eating again. So perhaps it was making a difference after all.

Also, that potassium/sodium imbalance is consistent with an Addisonian condition, too. I don’t know how severely out of range her results were, but dogs with electrolyte imbalances often need an additional type of supplemental steroid (different from prednisone) in order to address that issue. Aldosterone is the adrenal hormone that controls that balance, and it can also drop too low with oversuppression caused by overdosing.

Bear in mind I am not a vet, but I would not wait until Thursday to have Chloe’s labs rechecked and the ACTH done. If she’s not had any prednisone since Saturday morning, it should no longer pose a risk as far as skewing the ACTH results. Since she’s not improving at all, I would want to move forward with the testing ASAP.

Marianne

[DoxieMama]

My dog's ACTH results did not show Addisonian but his electrolytes were out of whack. I went back through his results to remind me how that was checked. My dog's levels got down to 25.7, and we stopped Trilostane (compounded version of the active ingredient in Vetoryl).

With Chloe's sodium level of 136, and potassium of 6.3, that gives me an Na/K ratio of 21.6... which is REALLY LOW (reference range is 27-40).

I would like to echo Marianne's statement



Bear in mind I am not a vet, but I would not wait until Thursday to have Chloe’s labs rechecked and the ACTH done. If she’s not had any prednisone since Saturday morning, it should no longer pose a risk as far as skewing the ACTH results. Since she’s not improving at all, I would want to move forward with the testing ASAP.

Shana

[SpringerX2]

Updated on Chloe. Our vet is closed on Wednesdays which is why we scheduled her to go in on Thursday for her ACTH test. Last night she did eat some food, more of the high caloric A/D Science Diet brand mixed with about a quarter can of Blue Buffalo. By bedtime she was full of energy and even doing her happy prance around the house. However, this morning she refused food again. I didn't have any more of the A/D food but she refused everything else. So, I guess the roller coaster continues. The whole inconsistent appetite and eating thing is just throwing me. I don't understand it and she has never been one to refuse food of any kind. Her attitude indicates she is getting closer to back to her normal self. At this point it is only the eating thing that is concerning me. But at least she is eating a little bit.

A question I have from your experiences is what should I expect her ACTH test to come out like? I'm not sure what I should be expecting at this point after being off the Veroryl for over a week.

[labblab]

I’m so glad Chloe at least is showing bursts of normal behavior, and I sure do agree with you — the overall picture remains puzzling. At any rate, the ACTH tomorrow should help identify whether or not adrenal oversuppression is a part of the problem. Something altogether different may be going on, but the cortisol level and a repeat of her basic blood chemistries should be helpful.

After a full week without her trilostane, you’d normally expect her post-ACTH level to be higher than it was previously running on her earlier monitoring tests. Exactly how much higher depends on the dog, but you’d expect the lack of medication to be evident in an increase in the post-stimulated cortisol level. If, instead, her post-ACTH is low and “flat” — not much higher than the baseline reading — it would appear as though her adrenal function is impaired. Exactly how long such an impairment would last is totally a question mark, and varies from dog to dog.

Just to repeat, those potassium and sodium levels are also important. If they’re still out of whack, then the aldosterone level may be a primary issue in addition to, or instead of, the cortisol level. So I’d want those levels rechecked tomorrow, as well.

In reading back through your thread, one crazy thought did occur to me. You mention her romping around during a weekend snowfall immediately prior to her illness. Is there any chance that she got her paws contaminated with salt pellets or brine used to treat icy spots on streets and sidewalks? I believe the chemicals used can be toxic — similar to antifreeze — and if she was exposed to them via licking, etc., that might be the source of a problem. We got a couple inches of snow here in Atlanta last week, too, and I’ve been having to dodge street/sidewalk chemicals ever since. Since we don’t have many snowplows, the chemicals get dumped in BIG quantities, and it’s always an obstacle course for me and my dog afterwards. Anyway, a wild thought, but it just occurred to me in terms of the timing of her illness.

I’ll really be hoping she does better again this evening, and we’ll definitely be anxious to get the results of the testing tomorrow.

Marianne

[SpringerX2]

Well she's at the vet for the ACTH testing today and I did ask that they do a full blood analysis on her since she had so many things that were either high or low on her last draw from last week. It wasn't just the potassium and sodium levels.

We live out in the country and she was only running around in our yard not on the road with the snow, so I don't think she would have been exposed to the salt on the roadway. We did not salt our property at all. She was definitely eating the snow though. On that Sunday night we actually thought she had hypothermia. The first symptom we noticed was shaking, which I failed to mention above. She was shaking on Sunday and I was concerned I had let her outside too long playing with us. She had the shaking through Tuesday last week but that has gone away.

She still is selective with her eating. My husband keeps suggesting maybe she is just being picky. But she has never been a picky eater. She would eat pretty much anything you'd give her. She will never eat in the mornings but by evening I am sure she is starving so we can get her to eat in the evening but only select canned foods and definitely will not touch dry food even if it's mixed with wet food or broth. Very strange.

[molly muffin]

We are all I think really curious to see what the ACTH test results come back like and also her other levels. I'm glad they are looking into everything. I'm hoping that this has all leveled out in her.

I don't think she is just being picky either. It is a sign that something is going on and she doesn't feel good usually and her previous test results bore witness to that being the case, so it is important to stay on top of how those levels are changing and if they are getting into a better range.

[SpringerX2]

We won’t get the results until tomorrow on the ACTH and blood work. The vet wanted to do X-rays today since he agreed her lack of eating is peculiar. The X-rays showed nothing really other than a possible inflammation near where her pancreas is. So he sent us home with an anti-inflammatory/ pain med Tramadol. We will see what blood work looks like tomorrow but next step he said is to go to another vet that specializes in internal medicine to do an ultrasound. I’m not really sure what to do honestly. She didn’t eat breakfast again. I brought more of the high caloric a/d food from our vet and she only ate a few bites. She is definitely not acting herself. The meds he gave says they may cause drowsiness do now I won’t really know if she’s acting lethargic because of those or because she’s sick. Oh and another curve ball is that my other dog Sam threw up the same yellow bile today that Chloe did last week. He is eating fine and nothing else seems to be wrong with him. Only thing different with him is that he’s been eating all the different foods we’ve been trying to get Chloe to eat.

[molly muffin]

If there is an inflammation near her pancrease, then pancreatis is a possibility and that would cause her not to want to eat. It is also painful, so that might be what he is thinking.

If so, small meals, several times a day usually works best and very bland. Often mushy rice and chicken that is basically boiled with lots of water, is a good option.

[DoxieMama]

Just throwing this out there - but is there any chance Chloe got into something she shouldn't have? And perhaps Sam got into it as well, only more recently? I would bet that is NOT the issue but wouldn't feel right about not mentioning it.

As Sharlene said, pancreatitis is a possibility. Hopefully those test results will show something conclusive!

[SpringerX2]

Well I got her ACTH Results back, her pre level was 2.3 and her post level was 2.4

Although I asked for a full blood analysis to see how all of her other levels had adjusted over the week he didn't do it because the last one was just a week ago and he didn't think anything would change in that time. So now he has referred me to another vet specializing in internal medicine. Who will want to do an ultrasound and more blood work and who knows what else.

Meanwhile, Chloe refused food again this morning. They did call in an appetite stimulant to see if that would help. But I'm just feeling like how much more do I put my dog through? Clearly something is not right with her. Do I give her another drug to try and make her eat when something in her body is telling her not to eat? And we don't even know what it is or why this is happening.

[Squirt's Mom]

I would try a very dilute broth to start - chicken or beef as she prefers. As long as she is drinking she can go a few days with no food but after that length of time I would want to get some NutriCal into her. It is a paste that contains all the vitamins and minerals she needs....but it also has quite a bit of fat which is not good for Pancreatitis if that is what is going on with her so the broth would be best if she will take it. I would try it several days in a row before giving up on it tho. If she takes it then add a bit of rice or pasta and as she takes that add a bit of the meat til she is eating again.

[labblab]

I’m very glad you’ve been referred to a specialist, and I’d try to get Chloe in to be seen as soon as possible. Given the results of the ACTH and last week’s blood chemistry, I think we do know at least a big part of what’s going on — her adrenal function is compromised, and she may need to consistently receive two types of supplemental steroids for the time being in order to allow her to feel better. Remember that I wrote earlier that after a week without trilostane, you’d expect her post-ACTH reading to be higher than on previous monitoring tests. Instead, it is significantly lower and only barely higher than the baseline reading. This is that “flat” response that I was telling you about. That is not a typical response for a Cushpup that is not taking any medication.

Also, I’m bothered by your vet’s decision not to retest electrolytes. Good grief, they were out of whack last week, even, and nothing was done to address that. With a dog who continues to behave abnormally, I would think the vet would want to know whether the imbalance has worsened.

I totally understand your concern about the expense of starting anew with a specialist. But just remember, you don’t have to agree to any testing that you are not comfortable with. And in honesty, I suspect that along with her history, these blood tests alone will tell the specialist a lot.

Do you still have some prednisone on hand in the event that she worsens before she is seen by the specialist? I am not a vet, but I really do suspect that adrenal oversuppression is the culprit here.

Marianne

[labblab]

I wanted to come back and explain further why I’m concerned about Chloe’s ACTH result. The ACTH is used to diagnose both Cushing’s and Addisonian conditions in dogs. It is actually the gold standard for Addison’s. For a dog for whom naturally occurring Addison’s is suspected, baseline and post-ACTH cortisol levels both <2 are usually diagnostic for the disease. In Chloe’s case, the cortisol levels are a little higher than that, but the “flat” response remains a concern. See this explanation:


What do we expect to see if the patient has Addison's disease?

Regardless of the underlying cause of Addison's disease, the results of the ACTH stimulation test are similar. This test is characterized by a low amount of cortisol in the blood sample taken prior to the administration of the synthetic ACTH, and either little or no increase in the amount of cortisol measured in the sample taken after the ACTH injection. A lack of response to synthetic ACTH administration confirms the diagnosis of Addison's disease.

How can we differentiate between the causes of Addison's disease?

A thorough review of all medications that your pet has been receiving (both oral and topical formulations) is essential. If your pet has received medications containing corticosteroids that are suddenly stopped, he may have a temporary Addisonian condition that only requires treatment for a short time.

If your pet has been treated for hyperadrenocorticism (Cushing's disease), the adrenal glands may become incapable of producing cortisol and aldosterone...

Now if this is the problem with Chloe, the good news is that it may only be a temporary condition that can be bridged with steroids. But until her natural adrenal function rebounds, she may need those supplemental steroids to feel better. So I would try to get her in to be seen ASAP since her regular vet seems to be uncertain as to the path forward.

Marianne

[molly muffin]

Have your vet send everything over to the specialist. Get copies for yourself too. Several times, I was glad I had my own copies when my vet hadn't sent something to my specialist for my dog.

Marianne is correct, the flat line between what is in her pre and post test isn't what we like to see. To explain, the pre shows what is in her body when she gets the first blood draw. The injection then causes the adrenal glands to dump what they have in them into the body and so you expect when they are working that they will dump cortisol into the body that shows up on the post test. Chole doesn't seem to have any excess in her adrenal glands and you do want some. So that is why we are concern. Not having enough cortisol, causes things like electrolytes to get out of balance and that is a serious condition, so the specialist probably Will want to check that and likely put her on some supplemental steroid like pred maybe dexx, possibly give some iv fluids to help with the electrolyte imbalance. These are all possibilities that a specialist will look at.

So, yep, sooner the better

[SpringerX2]

Sorry for my delay in getting out here to give an update. We made the decision to go through the weekend without bringing her in to the specialist to see how she would do. She refused to continue taking the medication for the pain/inflammation. And given how it made her look like she was on her death bed, I went along with her refusal and did not force her to take it any more. She ate some broth and chicken on Friday evening. We got her to take one dose of the appetite stimulant Mirtazapine on Saturday. She continued to eat broth and chicken on Saturday with an apparent increase in appetite. Although we did notice that the shaking she had two weeks prior had returned as well. By Sunday she continued to have appetite to eat homemade food, I made some beef and broth for her. Her appetite continues to increase daily and her demeanor is back to normal. I have not given her any medications since Saturday morning which was the Mirtazapine. With the exception of her increasing appetite, she has not yet reverted to any of her Cushing's symptoms with excessive thirst and urination. She has now been off of the Vetoryl for two full weeks. At this point we have opted to wait and see and let her system level out a little bit before we subject her to any more tests. She is eating fine and her demeanor indicates that she is comfortable and not in distress.

[Squirt's Mom]

I am so glad to see this report! Sounds like she is on the right track and I hope the trend continues! You are wise to hold off testing or restarting Vetoryl for now in my opinion.

[molly muffin]

Yes that is a very good report.

Since she Does appear to be improving and as long as that continues I'd be okay if it was me to hold off for a bit, but I would have a full checkup done at some point just to see how she is. If she were to slide backwards at any point, that would become more immediate to have done than when she appears to be doing well and making progress.

[SpringerX2]

Just thought I'd check in here with a quick update on Chloe. She continues to refuse to eat any packaged dog food of any sorts. I have taken to making her homemade food which she eats fine. She has never yet reverted to her Cushing's symptoms of excessive thirst and urination. She does urinate regularly but she doesn't leak like she was doing at the time of her diagnosis. While having answers about what it truly going on with her would be nice, we've decided that it's not really necessary at this point. We spent in excess of $600 within a week and had zero answers provided. Her behavior is fine, she eats, she plays, she drinks, she sleeps and she seems herself. The only thing is that she refuses dog food and she hasn't reverted to Cushing's symptoms. She is currently off of all medication. Eventually we will bring her in for another blood panel but for now, I just want to keep trying out the homemade food and continue to help her live a healthy and happy life.

[labblab]

Thanks so much for your update, and I’m so glad to hear Chloe is generally doing well. In honesty, I can’t fault you on your current approach. I’m sure you will continue to watch her closely. And who knows, perhaps you all will get to enjoy a long break from Cushing’s treatment!

Do keep letting us know, OK!
Marianne

[Squirt's Mom]

Her behavior is fine, she eats, she plays, she drinks, she sleeps and she seems herself.

This is what we all strive for with our babies so I would say things are good at your house! Thank you for letting us know how Chloe is doing and please do drop in from time to time to keep us updated.

Enjoy that baby girl!
Hugs,
Leslie

[Joan2517]

Sounds like a great plan! If that's what she wants to eat, then just let her have it...she deserves it!

[molly muffin]

I agree. It's a good plan. Having them be themselves in attitude is always so good to see and hear of.
Maybe after all the yummy cooked food, the dog food just doesn't do it for her any more.

[SpringerX2]

It's been several months since I've passed along an update on our Chloe. Since I last wrote here Chloe began to go through a series of ups and downs with her appetite. I was constantly switching her food around to keep her eating. She continued to lose weight and started to develop ear infections which we still have been unable to rid her of despite multiple different antibiotics. We had another blood panel done on her last week and scheduled an appointment with a doctor of internal medicine for an ultra sound. Her blood panel showed a cortisol level of .7, IDEXX SDMA at 18, BUN 43, Sodium 130, Potassium, 6.9, Na:K Ratio 19, Chloride 99. Upon meeting with the specialist she came in and said just by looking at her history and her current panel that my Cushings dog now has Addison's! This was something I asked my vet back if that was possible and he assured me it was not possible that she could go from Cushing's to Addison's. This specialist advised me that it is possible and can happen and used to actually happen more frequently before they developed new medications. The medication that she was on, Vetoryl, is not supposed to do this but apparently it did. I guess what happened is that it damaged the part of the adrenal gland that regulates the sodium and potassium levels as well as the part that controls the cortisol production. So, now we've started Chloe on a new medication to treat her for Addison's. After just a couple of days on the pills she is starting to get her energy back and appetite. For reference, she was 60 lbs when she got diagnosed with Cushing's in January of 2017, last week she weighed in at 33 lbs the day she was diagnosed with Addison's. What a roller coaster ride we've been on with her!

[Harley PoMMom]

Oh my, I am so sorry that you and Chloe have been going through so much and so glad that you have taken her to see an IMS. Hopefully that now she is being treated for low cortisol and unbalanced electrolytes she'll be feeling much better soon. What medication/s did the IMS put her on for the Addison's?

Lori

[SpringerX2]

Oh my, I am so sorry that you and Chloe have been going through so much and so glad that you have taken her to see an IMS. Hopefully that now she is being treated for low cortisol and unbalanced electrolytes she'll be feeling much better soon. What medication/s did the IMS put her on for the Addison's?

Lori

It's a compound medication that contains fludrocortisone. One pill a day. She is back to her "old self" with a steady appetite and energy levels now. She's actually getting into mischief some too. I gave her a bath yesterday and she was shaking afterwards which had me concerned. But she otherwise seemed fine and was okay through the night and this morning. I'll be bringing her in this week for another blood test to check all of her levels after being on the medication for a couple of weeks to make sure everything is in the appropriate ranges now.

[labblab]

That’s great that Chloe is feeling better! It’s amazing what a difference those supplements can make. Please do keep updating us as to her progress, OK?

Marianne