8 year old dog losing appetite

[urick6]

My 8 year old Chorkie kilo has recently been diagnosed with cushing and has been on vetoryl 10 mg and weighs around 5.5 pounds and after about a month ive noticed hes been somewhat reluctant to eat and usually would love to beg but hasnt been doing that recently which has scared me as we've had to hand feed.It also quite puzzling cause hes still active and after long walks still wont eat.should i be worried or is that him adjusting to the dosage and him being a smaller dog?
Dex supression test
pre 8.4 ug/dl
4hr:1.1 ug/dl
8hr:2.3 ug/dl
1 month later Snapshot Dx
5.9 ug/dl 10:04am
3.6 ug/dl 2:23 pm

[labblab]

Hello and welcome to you and Kilo! The goal of Vetoryl treatment is to curb symptoms such as excessive thirst, urination, and hunger. So after a month of treatment, we’d hope that a dog would no longer be ravenously hungry. However, we do worry if the balance tips too far in the other direction and appetite drops to being less than normal. It is indeed possible that it’s just a matter of a dog’s system adjusting to a sudden drop in cortisol. However, it can also be a sign that cortisol is dropping too much, or that other chemical imbalances can be resulting from the treatment.

I see you’ve posted a LDDS result that is consistent with the pituitary form of Cushing’s. I also see what looks to be a monitoring ACTH stimulation test performed just now at the one month mark. One concern that I would have had initially is starting a 5.5 pound dog with a 10 mg. dose of Vetoryl. Initial dosing recommendations used to be higher, but the most widely accepted protocol now is not to exceed 1 mg. per pound when first starting off. However, that is now water under the bridge for Kilo, and technically his 30-day cortisol level has not fallen too low, even on that higher dose. One big oddity, though, is that his cortisol level prior to the injection of the stimulation agent is double the level afterwards. That is the opposite of what you’d expect, and I’m not sure what to make of that. We have seen that on occasion with other dogs, but remains somewhat puzzling.

Was any other bloodwork done at the same time as the ACTH monitoring test? As mentioned above, Vetoryl can sometimes throw off blood chemistry balances even when the cortisol level remains within a safe range. So if a dog is acting unwell, checking basic blood chemistries can be important.

Can you tell us a bit more about Kilo’s overall health history, as well as the symptoms and testing that originally led to the Cushing’s diagnosis? That’ll give us a better idea of his overall situation. Also, aside from the loss of appetite, does he otherwise seem to feel well? Any diarrhea or GI upset?

Thanks in advance for any additional info. And once again, welcome to you both!
Marianne

[urick6]

we first thought it was stress as that was when we got our second dog who kilo just doesn't tolerate so we tried medication but the hair loss got gradually worse and cyst were beginning to develop and several months later we went to vet who diagnosed him with cushing. Hes otherwise an active dog and makes me take him at least several kilometers a day when the weather allows it as it can get quite hot in Orlando.I also saw his hair looks alot worse but ive been told that normal and can take a few months to regrow.He hasn't been constipated yet and seems quite normal otherwise just an loss of interest in food as he would usually gp crazy over some leftover turkey but now they can remain virtually untouched if hes not prompted to eat.

[Harley PoMMom]

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

If this were me, I'd skip a dose or two of the Vetoryl and see if his appetite picks up (skipping a couple of doses won't hurt him). If his appetite perks up than more than likely his cortisol has dropped lower than what his system needs to make him feel more like himself, some dogs do better when their cortisol is allowed to run a bit higher.

Lori

[urick6]

Surprisingly his appetite seemed to have picked up last night when we offered him some deli from publix and the next day was back to begging for some fish which he gobbled up but ill most likely watch him closely tomorrow and see if he just being a picky eater and if it doesn't pick up like it did today well skip his next dosage and see how he responds to that.

[Squirt's Mom]

Welcome to you and Kilo!

How is he doing today? Did he get the Vetoryl?

[urick6]

We did end up giving him vetroyl today just to see as his appetite looking was quite good but im thinking we might skip it tomorrow as he appears to be constipated now and so far hasn't defecated today regardless the length of his walk and now isn't interested in chicken so ill keep watch and see if his appetite picks up at night because thats the time he seems to be craving food.Hes surprisingly not weak or fatigued during our walks but refuses to eat even a little after a lengthy duration.

[labblab]

If you do decide to hold the Vetoryl, it’ll be interesting to see if that perks up his appetite.

Just so you’ll know, though, it’s not constipation that’s the particular worry with Vetoryl. It’s the opposite — diarrhea. Diarrhea and/or vomiting can be signs that cortisol levels have dropped too low. I’m not aware of any similar issue with constipation. If Kilo hasn’t been eating as much, he may just not be producing as much stool right now.

Marianne

[urick6]

he didnt eat yesterday and after his walk look extreemly fatigued and it hard to tell if he peed or throwed up a puddle of liquid whith white foam and still refuses to eat im so confused

[urick6]

Im scared that this could indicate kidney failure and has only been recently diagnosed with cushing so its really stressing me out and im pretty sure his water intake is still good despite the no hunger is this something that is out of the norm as so far hes only had that problem once or should i be scheduling a vet

[labblab]

At this point I would not give any more Vetoryl and yes, I would take him in to the vet tomorrow. If he were to worsen even more today — acting really ill — than I’d take him to an ER vet if you can’t contact your regular vet.

As I wrote earlier, Vetoryl can cause irregularities in certain blood chemistries as well as cortisol. So basic blood chemistries need to be rechecked alongside cortisol, especially if a dog is acting unwell. If the blood chemistries are unbalanced or if the cortisol has fallen too low, different types of fluids and/or supplements need to be given. The vet can also check his urine to see whether anything is amiss there.

Foamy urine can be an indication that protein is being leaked into the urine from the kidneys. This condition, “proteinuria,” can be a consequence of Cushing’s. However, you’re right that Kilo may just have vomited up some foamy bile, especially if his stomach is empty and upset. It sounds as though you may have given him some unusual (for him) foods in the effort to get him to eat, and those may have ended up giving him some GI issues.

All in all, I think there’s enough going on that you do need to consult with your vet. It may turn out to be nothing serious, but you don’t want to risk letting things worsen.

Marianne

[urick6]

We did Take him off of it for several days and has started his usual begging my parents want to try to put him back on vetroyl and or thinking about every other day or giving it later in the day as the vets bill have been high and have been trying not to go back to square one and end up redoing the testing again which would be so expensive as we’ve already payed 600$ for one dog with ear infection and kilo testing.If it gets any worse they say we’ll take him to the vet if that’s the case should they try 5 m/g instead as honestly the vet hasn’t met with us directly yet since diagnosis which scares me and makes it seem he doesn’t care for my poor friend and has given us minimum info and Vetoryl seems to have lead him to have a mowhak on his back anything supplementary for hair loss?

[urick6]

I sent my dad a picture of the mystery liquid and he said it looked like bile and not pee I would post a photo but I have no idea how to use this site and my dad is pretty competent with dogs as he used to breed

[Harley PoMMom]

If his appetite has returned than I believe the 10 mg dose of Vetoryl may have been too high even though the ACTH stimulation results were within the therapeutic ranges, some dogs just need their cortisol to run a bit higher to feel their best. Another thing you may want to talk to the vet about is adding pepcid ac as Vetoryl is known to cause gastric upset, the pepcid ac is given 20-30 minuted before the Vetoryl dose is administered.

Was Kilo getting the Vetoryl with a meal? And are those monitoring ACTH stim test being performed 4-6 hours post pill?

If you do decide to restart the Vetoryl I would recommend going with 5 mg once a day, every other day dosing isn't advised as it allows the cortisol to fluctuate too much and it would be difficult to get a true gauge of his cortisol with the ACTH stim test because on the day the Vetoryl is taken the cortisol would be lower than the day it was not.

Lori

[urick6]

Yeah we did our best to get him to eat in the morning along with the vetoryl try to give him it with his favorite snack eggs but then his appetite gradually waned until he wouldn't eat anything but yesterday he was up and begging for the steak we were eating so it was most likely to high as you said

[urick6]

got home from the movies today to a crazy load of diarrhea and pee puddles and it doesn't look like he lifting his leg to do it because it away from furniture and the diarrhea was almost in every room hes been off his pill for a couple days and was wondering if it's just we weren't home to walk him on schedule or could it be something else but right now im scared and stressed as right now we don't have money to be taking him to the vet for testing.

[labblab]

I’m so doubly sorry about both the health worries and also the financial burden. Kilo sounds sick enough to me, though, that I don’t know of any safe option other then letting a vet examine him. To be honest, I’m wondering whether the Cushing’s diagnosis was even accurate since the only symptoms you’ve described are the hair loss and skin cysts. The initial LDDS test can give a “false positive” for Cushing’s when the body is stressed by some other unrelated condition. In the absence of many observable symptoms or other consistent lab irregularities, a Cushing’s diagnosis can be questionable. Kilo may have had some of these other irregularities on his general blood and urine panels, but at this point, we don’t know about them. There may be something else, totally different, that’s going on with him right now.

I definitely would not give him any more Vetoryl, at all. I’m very disappointed that your vet has not personally followed up with you at all since starting treatment. That is not right at all, when such a powerful medication is being given. Do your parents have a trusted vet who you could see? Either way, I’m afraid we’re beyond the point where we can try to guess what’s wrong, and a vet needs to be consulted. In lieu of the more expensive ACTH test, just a resting cortisol along with a basic test of blood chemistries would give you some important information.

There’s a program called “Care Credit” for which you might apply for help with medical and veterinary bills. A number of our members have used it, and it can be a big help in spacing out your payments with reduced or even no interest. Here’s a link:

https://www.carecredit.com/

I’m feeling very worried about Kilo, too! Please do keep updating us, but as I say, I really think he needs to be seen at this point.

Marianne

[Joan2517]

Care Credit was a Godsend for me when my Lena was in the ER a few days before she died. The bills were so high at that point. I still have it for my Gable who is also being treated for Cushings. Without me even asking they raised my limit...just in time for one of my other dogs who had an an abscess on her anal gland. They are very good and depending on the vet or ER, the charge can go six months to eighteen months with no interest charged as long as you pay it off in that amount of time.

If Kilo was my dog, I would not give any more Vetoryl.