Otis has Cushing's - Started Vetoryl today

[TTA89]

Short Version -

Otis is a 9 year old 18lb Boston Terrier with what I now read are classic Cushing's symptoms.

Excessive Water Drinking - So much water :(
Excessive Appetite - He never used to really care about food and now is eating everything he can find, including anything in the yard.
Excessive Peeing - He can only hold it a couple hours now due to all the water drinking.
Hind Leg fatigue - He is really slow on the stairs and started "bunny hopping" the past few weeks and doesn't want to go for walks more than a few houses down. His balance is off as well and it's like he miscalculates his jumps onto the couch.
Hair Loss - His ears, head and hind legs have been losing hair.
Bloated Stomach - It's like a little pot belly pig belly.
Diarrhea - Maybe not directly related but we have been chasing this for awhile. He has always had soft stools.

We did the ACTH test on Wednesday and got results yesterday:

Cortisol 1 - 8.7 ug/dL (Reference Range 1.0 - 5.0)
Cortisol 2 - 34.0 ug/dL (Reference Range 8.0 - 17.0)

The vet also did an Ultrasound and verified that his adrenal glands looked bigger than the last ultrasound about a year ago (chasing other symptoms) but they didn't see any tumors so are going with pituitary Cushing's.

We started with 10mg of Veteroyl this morning and will bring him back for another test in 2 weeks.

Long Version -

Seizures - He had a couple of seizures in the span of a few weeks and was started on Zonisamide 50mg 2x a day. This was about 3 years ago seems to be working, he's only had 1 seizure since we started the drug and I think it was my fault as we ran out on a 3 day weekend and couldn't get a refill.

Aspiration Pneumonia - This started about 18 months ago. This usually happened in the middle of the night, he would get up and do this throat clearing thing where he would breathe in and out real quick and eventually throw up. We noticed one morning he was breathing funny and lethargic and I took him to the vet right away. He was put into an oxygen chamber for a day, IV fluids, etc, etc with a collapsed lung. He was much better at the end of the day and was back to himself in a few days. Then he did it again a few months later....And again.... each time to the tune of about $1500 bucks. We switched his food to vet prescribed bland wet food and introduced 5mg of Famotidine in the morning to act as an ant-acid and kept him strictly on his food with no treats or table scraps. This seemed to work and he hasn't had an episode in probably 8 months.

Diarrhea/Cushing's - We have been chasing this one for awhile, he has always seemed to have loose stools no matter what food we try. We had him back to the vet about a month ago for another food change and started telling them that we noticed his appetite has increased and he started drinking a lot more water. They seemed to think it could be the diarrhea and to get that under control first and then see what happens. Metronidazaole 125mg twice daily was prescribed at least 5 or 6 times over the past 2 years. He does well on it and then goes right back to loose stools about a week after the drugs are gone. We also have been giving him the powdered probiotic from the vet (I forget the name).

Fast forward to May 2018 and my wife and I leave for a 2 week vacation. We leave Otis with my sister who have other dogs, explain his water drinking and special food and that he can't make it 8 hours . About 4 days into our trip my sister calls me and says she came home and there is puke and diarrhea with blood in it everywhere. She asks if she can take him to the emergency vet hospital. He spent 2 nights there (another $1700) with IV and more anti-diarrhea stuff for colitis probably cause by stress of us leaving him. We had a friend who picked him up and stayed at our house for the remainder of our vacation and he was ok. We got back last week and I noticed his symptoms were worse and he didn't look that great. We took him back to the Vet for the Cushing's test and that is where we are now.

I also asked the Vet if I could go back to non-prescription food since it doesn't seem to really make a difference and it's expensive. She recommended Hills Science Diet Sensitive Stomach & Skin Grain-Free Salmon & Vegetable Entree Canned Dog Food and another round of Metronidazaole for the diarrhea that redeveloped once the other round wore off. This seems to be working, it's at least "soft serve" consistency instead of water.

A few questions if anyone is still reading. :) I will consult with the Vet tomorrow but I'm reading a ton about supplements for Cushing's and I'm curious if you have tried any of these in conjunction with Vetoryl?

1. I want to introduce Milk Thistle for his liver, his test results show his levels are elevated - https://www.amazon.com/gp/product/B00BCQQNR0/ref=oh_aui_detailpage_o01_s00?ie=UTF8&psc=1

2. I want to add some Omega supplements to help his coat and skin - https://www.amazon.com/gp/product/B0002XAIAM/ref=oh_aui_detailpage_o00_s00?ie=UTF8&psc=1

3. This one gets a lot of good reviews but I'm not sure if anything would interact with his current drugs - https://www.amazon.com/gp/product/B00BCQQPDC/ref=oh_aui_detailpage_o01_s00?ie=UTF8&psc=1


We feel so bad for him, I wish we could tell him that we are trying to help him feel better. :(

https://farm2.staticflickr.com/1732/41915770255_307598d68c_b.jpg

https://farm2.staticflickr.com/1739/41915768685_f29c27b449_b.jpg

https://farm2.staticflickr.com/1743/42767745492_a89554522d_b.jpg


Thanks!
-Mike

[Squirt's Mom]

Hi Mike,

Welcome to you and Otis! :)

Based on the signs, the ACTH results, and the appearance of the adrenals on the ultrasound, it does sound reasonable that Cushing's is the culprit here. YAY, huh? :D Not to worry - you are in the very best place to get reliable information based on science and personal experience, support you only dreamed of before, and the opportunity to learn more than you thought possible about canine Cushing's and it's treatments. We are very glad you found us and I look forward to hearing more as time passes.

The new starting dose for Vetoryl is 1mg per pound so at 18 lbs, 10mg is a tad low but better to start too low than too high every time! But don't be surprised if you don't see a lot of changes right away. Otis may require a dose increase in a month but we will see how things go. He should have an ACTH 2 weeks after starting the Vetoryl and that will tell us a great deal, as will any changes in his signs over the next few weeks. One thing to learn right now - it is not acceptable to raise the dose in the first 30 days because of the way this drug works. It can and usually does continue to lower the cortisol for those first 30 days on the initial starting dose. So no dose changes are recommended for that first month.

Even tho the dose is low there is always the possibility for problems so keep an eye out for the following signs. If you see ANY of these stop the Vetoryl and call the vet. Otis may need an ACTH and to have his electrolytes checked. These signs indicate the cortisol has dropped too low, which is a life threatening situation. So watch for:

nausea/vomiting
loss of appetite
lethargy

And typically loose stools/diarrhea - but since this is an ongoing issue for your sweet boy this sign will not be reliable for you. If it gets worse, tho, I would stop the Vetoryl then talk to the vet.

About that diarrhea. My little Trinket had colitis and it is SCARY when it comes on bad. All that blood! :eek::( But we started using herbs called Slippery Elm Bark and Marshmallow. SEB is the one most well known and the one most here have used but Marshmallow has the same properties and has worked just about as well as SEB when I have used it. I will say for the really stubborn cases the SEB is what I use. These herbs work as a sort of bandaid throughout the digestive system, seeking out, finding, and healing that whole track from mouth to rectum. Here are some links about SEB and one where you can purchase safe herbs of any kind (Mountain Rose Herbs).

https://www.whole-dog-journal.com/issues/5_5/features/5455-1.html

https://vcahospitals.com/know-your-pet/slippery-elm

https://healthypets.mercola.com/sites/healthypets/archive/2012/03/26/dealing-with-dog-diarrhea.aspx

https://www.thepossiblecanine.com/slippery-elm-marshmallow-little-differential

https://www.mountainroseherbs.com/products/slippery-elm-bark-powder/profile

I always use the powder from with my animals because you can so easily make anything from a thin soup to a thick gruel - what the case calls for. ;) You MUST give the SEB/Marshmallow 2 hours before or 2 hours after all other meds, supplement, herbs, etc because these herbs will prevent the absorption of other meds. Just in case you weren't aware - diarrhea is one of the side effect of the Zonisamide so that may be having a bearing on this issue too. I think the SEB/Marshmallow is worth a shot for your precious baby boy. Be patient and give the herb time to work in his body.

I would not attempt the Milk Thistle right now. It can cause digestive upset and will the diarrhea Otis is experiencing now I don't think MT would be a good thing to add right now. There are some other liver protective herbs that may be easier on the digestive system. I can look into that for you if you like. As for the Adrenal Harmony - it is not going to do anything for the Cushing's or the cortisol but for most dogs it wouldn't hurt to try because of the herbs in their current formula (PetWellBeing is notorious for changing formulas!). However, Otis isn't most dogs. His diarrhea/Colitis would also cause me to forego trying this just now. I would not start any omegas now either for the same reason (but the Grizzly is a good product for omegas!). My focus would be on the diarrhea first and foremost. When that is under control then we can look at adding some supporting herbs and supplements if you like.

If the Hill's doesn't seem to help his diarrhea, you can look into home cooking if you are so inclined. I can recommend an excellent canine nutritional consultant to work with you and Otis. It looks like I am going to be once again cooking for my old gal, an 18 yr old Chihuahua who's tummy is getting very sensitive. :)

I think I've rattled on enough for now. I am sure others will be along soon to chat with you as well. Prowl around the forum, get to know your new home - because you, Otis, and his mom are now part of our little family here at K9C. Check out our Helpful Resource section to get your education started. Reading the threads is another great way to start learning. If you have any questions never hesitate to ask and we will do our best to help you understand.

http://www.k9cushings.com/forum/forumdisplay.php?10-Helpful-Resources-for-Owners-of-Cushing-s-Dogs

Hugs,
Leslie

[Squirt's Mom]

Oh! I forgot to tell you about another new change concerning Vetoryl. There is a new monitoring protocol being used in EU that is slowly making its way to the US. This method will be MUST less stressful on everyone and should cost less to boot! Here is the link about it. Be sure to share with Otis' vet too!

http://www.k9cushings.com/forum/showthread.php?8925-GENERAL-GUIDELINES-for-Dosing-and-Monitoring-Treatment-with-Vetoryl-(trilostane)&p=206165#post206165

[Harley PoMMom]

Hi Mike!

Welcome to you and Otis from me as well! Otis sure is a handsome boy and is so very lucky to have such wonderful pet parents.

Thank you so much for giving us such a thorough history on your sweet boy, we just love details and the more we know the easier it is for us to help you help your precious boy, so thanks again!

Leslie has gotten you off to a great start and I do agree with everything she has said. The only other thing I want to mention is that the Vetoryl has to be given with a meal to be properly absorbed and those monitoring ACTH stimulation tests have to be performed 4-6 hours post pill. Did the vet tell you about those two important protocols?

If you have any questions do not hesitate to ask them, and please know we will help in any way we can.

Hugs, Lori

[TTA89]

Thanks for the links I will check them out and talk to the vet about it tomorrow. I am aware of giving the Vetoryl with food, I added it to his breakfast and will continue doing that going forward. We are scheduled for the 1st test in 2 weeks, 14 days from 1st dose and I will stick to the same feeding schedule. I'll drop him in the morning but they will wait and test him in the afternoon as the protocol requires. Thanks!

P.S. I did not know one of the side effects of Zonisamide is diarrhea. Figures.....

[TTA89]

We gave Otis his 8th dose of Vetoryl today and we already see a huge improvement in him. His water drinking has gone down dramatically and he seems like his old self again. We haven't had to get up and let him out in the middle of the night in the last 4 nights. His coat looks better but that might be the food change. So far we don't notice any side effects... I'd say at this point it's just his strength and balance that I notice is still off. He will get the first test next Friday to see where his levels are.

I haven't introduced any supplements yet, I want to make sure the Vetoryl works without adding too many variables.

[Harley PoMMom]

That's wonderful that his symptoms have improved!! Please let us know the results of that ACTH stimulation test when he gets it done.

Lori