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View Full Version : New to forum, mini Doxie with Cushings—questions about Vitoryl



erincandicez
05-14-2018, 07:19 PM
Hi everyone. Thankful to have read a blog referring this site. It’s been a long weekend for our family dog, my moms dog and companion. I’m typing this out as she naps from a rough weekend of scares. Mitzi, our estimated guess 17 year old Doxie was diagnosed with Cushings a few months ago, though we suspect from the excessive water drinking/urinating and pot belly that she’s has it a while.

My mother takes her dog to Banfield due to the “older dog” pet insurance, I personally am not a fan of anything Banfield but that’s for another post. Her vet recently after tests, started her on 30mg of Vitroyl. She recently had tests done showing cortisol levels had gone down. This weekend my mother called and woke me up panicked as Mitzi was wandering and getting stuck in corners, having accidents and not drinking water, not eating as much (still eating, but she’s normally a vacuum—so this was weird) she has stability issues, weak back legs and fell over easy/couldn’t get her balance. We took her to the emergency vet as Banfield refused her. 😡 and her liver enzymes were up but blood test wise she seemed normal. Erik meandering around and restless, we took her home as the only other option was a neurologist that wasn’t in the office until Monday. Which takes us to today, I woke up again to panicked calls from my mom and skipped work thinking today was the day Mitzi crosses the rainbow bridge. Same symptoms, back legs weak, balance issues and accidents. This time we took her to my vet and he explained dosage issues of vitroyl and that again, would be best to see a neurologist, so we went. He took her off of vitroyl and she’s taking some prednisone. She received a shot before we left and seemed to have put some pep in her step. I don’t know what I’m looking for, maybe some insight from others who have been given vitroyl and of its possible these side effects were a result of being put on it. Her vet was quite young and I don’t think she was in the right (having newly graduated) to be prescribing meds for gland issues....I’ve also read it’s best to start vitroyl 1mg for every 1lb of weight as well, and that the vet may likely not have noticed the drop in cortisol so quickly after prescribing it as a bad thing, and likely these side effects were a result of the drop as this was a very quick random decline, bc when I babysat my fur sister last week, she showed none of these signs.

Basically any insight to assist my mother and ease her mind would be helpful and much appreciated. I’ve convinced her to ditch Banfield as I get her vet did her dues in school and graduated, but I don’t think a vet with a year under their belt should be rightfully prescribing meds without more training in gland issues and that should be referred to a specialist or someone with significant experience. I’m sure she has her test results somewhere if it’ll help, but just wondering what more we can do for our old lady. I’ve read melatonin in the forum, any other suggestions while we’re away from vitroyl and on prednisone right now would be appreciated. Thank you!

molly muffin
05-14-2018, 09:12 PM
Hello and welcome to the forum.

Yes she should only have been started on 1mg/1lb. This is so that you don't get an overdose of vetroyl. No one knows how a dog will react to any drug, so better safe than sorry.

The other thing I am curious is did they do a monitoring ACTH or test her cortisol to see if it was low? No way you want to just guess.

Quality of life is always the most important aspect of any situation with our cushpups and at 17, it is possible that lower cortisol too much will also cause her some issues with pain, arthritis, etc. So you want to be careful of that and maybe keep her on a higher end anyhow, rather than a lower one.

I wouldn't restart at all until you know Exactly what the cortisol level is now. The other possibility is a tumor that is enlarged in the brain causing some neurological symptoms. Which with lowered cortisol could be worse. These are called macrotumors and there really isn't any way other than symptoms or an MRI to know for sure and at 17, I probably wouldn't put her through anything like that.

What I'd do is not start her back on vetroyl at this point. See how she does, if she recovers more pep in the step and if the neuro symptoms go away. I assume she didn't have the nero symptoms prior to these episodes on vetroyl?

If you do have the ACTH test results can you post them?

How is she today.

erincandicez
05-14-2018, 10:14 PM
Thanks for the quick response and welcome, this forum has been a great resource today. So I don’t know much about the meaning of results, so forgive me...but I did pull her records so on 3/20 I’m seeing 3 cortisol samples, taken prior to starting her on vitoryl. The samples were morning noon and evening...
Sample 1: 4.9 ug/DL
Sample 2 DEX: 0.6 ug/DL
Sample 3 DEX: 2.2 ug/DL

And then, a month on the meds on 4/20 she had tests also.
Sample 1: 3.4 ug/DL
Sample 2: 3.7 ug/DL

As far as the neuro symptoms, she’s always been kinda a wanderer but not staying still, not resting and having issues walking wasn’t a thing. I watched her just a week or so ago when my mom was or of town and she didn’t show any of these signs, they were very sudden. We aren’t going to do anymore vitoryl as the neuro suggested to stop it bc he said it’s likely dropping her levels low. But we’re wondering if she should’ve been on it in the first place, and what we can do if anything else for her, be it natural or otherwise as we want to make sure she’s comfortable and feeling better since this weekend took quite the toll on her. Appreciate your response, sorry I don’t know much about her results.

Edit: after reading some helpful links I believe (Bc it’s not noted in her online file) it seems she had the LDDS test first and the ACTH second?

She’s sleeping right now so hopefully she gets some rest tonight.


Hello and welcome to the forum.

Yes she should only have been started on 1mg/1lb. This is so that you don't get an overdose of vetroyl. No one knows how a dog will react to any drug, so better safe than sorry.

The other thing I am curious is did they do a monitoring ACTH or test her cortisol to see if it was low? No way you want to just guess.

Quality of life is always the most important aspect of any situation with our cushpups and at 17, it is possible that lower cortisol too much will also cause her some issues with pain, arthritis, etc. So you want to be careful of that and maybe keep her on a higher end anyhow, rather than a lower one.

I wouldn't restart at all until you know Exactly what the cortisol level is now. The other possibility is a tumor that is enlarged in the brain causing some neurological symptoms. Which with lowered cortisol could be worse. These are called macrotumors and there really isn't any way other than symptoms or an MRI to know for sure and at 17, I probably wouldn't put her through anything like that.

What I'd do is not start her back on vetroyl at this point. See how she does, if she recovers more pep in the step and if the neuro symptoms go away. I assume she didn't have the nero symptoms prior to these episodes on vetroyl?

If you do have the ACTH test results can you post them?

How is she today.

molly muffin
05-15-2018, 10:11 PM
The LDDS does seem to indicate pituitary cushings.


Normal: Cortisol level
<
1.4 ug/dl at 8 hours post
-
Dexamethasone.
Adrenal tumor (AT) or Pituitary
-
Dependent (PDH): Cortisol level > 1.4 ug/dl forthe 8 hour
test period.

PDH only: Cortisol levels <1.0 ug/dl at 2-6 hours post-Dex and > 1.4 ug/dl at 8 hours post-Dexamethasone.
Note:Approx.5% of dogs with PDHhave normal results. Stress ornonadrenal illness may cause false positives.

The cortisol level on the ACTH is within range, but as i mentioned, with a 17 year old dog, there is the possibility that lower the cortisol could uncover other issues. I think I would want her on a higher level than lower level.

Is she still off vetroyl? How is she doing? I think I would keep it removed until she is back to normal, retest ACTH. Then if the cortisol is coming back up.. maybe start at a lower dose. Did her symptoms get better on the vetroyl before this episode?

As I said, quality of life is what is most important, so if she is better off the vetroyl then that is something to consider.