Our boy has crossed The Bridge - A Question on Side Effects of New Medication

[MarieA]

Hi everyone, nice to find this message board. My 13 year old Maltese was recently diagnosed with Cushing's.

He had the blood test. I am sorry, I forget what the test is called. He was at the vet for a few hours and his levels were at 32, and the vet told me they should not be above 22... if I am remembering correctly.

She started him on Vetoryl at 10mg 2x a day. He weighs 20 pounds.

He took it for about 5 days and got very bad diarrhea. I took him off of it for 2 days. I put him back on, and he got diarrhea again almost immediately. I talked to the vet and she said to wait a few days then try again.

He does not show any other negative effects from the medication other than diarrhea. There is no blood in his stool.

Does anyone have any advice?

Thanks in advance! Marie

[Joan2517]

Hi Maria, welcome to the forum.

It sounds like the 20mgs might be too much for him. It would be helpful if you could post his blood work, highs and lows only with the reference ranges. Also the test used that led to your vet's diagnosis of Cushings. Members more knowledgeable than I am will want to see those numbers.

I would not start him back on the Vetoryl until they have had a chance to look those numbers over. You have time, Cushing's is a slow progressing disease and there is no need to rush into treatment. Take the time to become more informed on the disease and treatment.

[Squirt's Mom]

Hi Marie, welcome to you and your baby boy!

In addition to the info Joan asked for - actual test results - could you tell us what prompted the vet to test for Cushing's in the first place. What were you seeing that caused you concern or what did the vet see that caused them to start the testing. Also does he have any other health conditions that you know of? Is he on any medications and if so, what is he taking? Canine Cushing's is one of, if not THE, most difficult disease to correctly diagnose because so many other diseases share the same signs and any other condition, even something as simply as a UTI, can cause false-positives on all the cush tests. So the more you can tell us about your baby boy the more meaningful feedback we can offer.

I'm very glad you are here and look forward to learning more about the test results and his history soon!
Hugs,
Leslie

[MarieA]

I went to the vet because of his symptoms. He is panting a lot, gained a ton of weight, doesn't sleep well, urinating more, pot belly, drinks a lot. I have seen two vets. I did not like the first one, so I switched to another. The vet said that it looks like cushing's, but I decided to see a new vet and she tested him. I will ask for the test results from the new vet tomorrow.

I have known about his cushing's for a while. He was on a natural treatment that was working well for a bit, but then it stopped working. I took him off that a while before his tests, and I have not given him any of the natural treatment in a while. I am aware it is very dangerous if his levels get too low, so I make sure only to give him the pills the vet prescribed.

He is not on any other medication and has never had any health problems other than allergies.

I am not uninformed or rushing.

Thank you guys for the replies.

[Harley PoMMom]

How is your sweet boy doing? Has the diarrhea stopped?

[MarieA]

Thank you for asking. He is doing okay. His diarrhea has stopped. I know it is the pills. His cushing's symptoms are the same.

I did not call the vet yesterday because I have major health problems myself, and my fiance works hard to support us and keep everything running.

I am sorry if I sounded upset. I know you guys know how dog lovers are when your babies are hurting.

I am assuming the vet can email or fax me the results.

[MarieA]

I just called the vet and her assistant said he will email them to me.

I forgot two more symptoms. His back legs are weak and hair loss also.

Has anyone ever experienced your dog not wanting you to touch/pet them? He does not like me to pet him anymore. He always wants to be near me. It's almost like he is scared to be alone. But when we are in the bed, if I pet him, he goes to the bottom of the bed. It has been that way for a couple months now.

How do you know if/when it is time to put your dog to sleep? He was about 10 pounds and over the last year he gained another 10. He looks really miserable. He doesn't like doing anything. I just don't want him to be in pain.

[Joan2517]

My Lena was always a cuddler, in my arms at all times, under the covers with me at night. All of a sudden she stopped sleeping under the covers, then she stopped sleeping next to me, didn't want to be held anymore. She would want me to pick her up, but only stayed for a few minutes before wanting to get down. That broke my heart until the Cushing's diagnosis and I realized that she was just too hot and wasn't comfortable. She would still lay near me, even if it was on the floor where she could see me. The day before she died, she slept in my lap for hours after coming back from a night in the ER. I'll never forget how it felt to have her so close again.

Gable, my big guy who also has Cushings, stopped laying on the couch with me a few years ago. He's been on the Vetoryl since May and for the last couple of months he has started joining us back on the couch.

So, yes I think a lot of us have experienced it. They are hot almost all the time, and the extra weight makes them uncomfortable, too.

[Minnie's Mom and Dad]

Hello MarieA,

Our little Yorkie was recently diagnosed and for several months before the diagnosis she began to get very anti-social. She would typically alway be near me or on my lap if i was sitting in my recliner. At night she'd always be on or next to my legs. For a few months before he diagnosis this completely changed. She would not sleep on the bed, part of that could have been the weakness in her hind legs and being unable to get on the bed any longer. She wouldn't sit on my lap. She'd lay/sleep in the kitchen floor even at night. And prior to her diagnosis she hated the kitchen floor and avoided it whenever possible.

We began the Vetoryl treatment in September and within a month she was back to acting somewhat normal. She still doesn't have the strength to jump up on the bed but once we lift her into bed, she's content and stays. She's back to laying on my lap whenever i'm in my recliner and follows me everywhere.

Good luck with your little guy!!

The members here awesome and extremely helpful/knowledgeable.

[Harley PoMMom]

Since the diarrhea stopped after discontinuing the Vetoryl it does sound like the dose was too high for him so you could restart it at a very low dose, say 5 mg once a day. I'm also including a link with information that may be useful: Cost Savings for Owners of Cushingoid Dogs (https://www.k9cushings.com/forum/showthread.php?9066-Cost-Savings-for-Owners-of-Cushingoid-Dogs)

If you have any questions please do not hesitate to ask them. Remember we are here for you both and will help in any way we can.

Lori

[MarieA]

You guys are amazing! It is so wonderful holding them and cuddling isn't? It hurts that I can't do that anymore. I have two dogs, and one is 13 and one is 15. The 15 year old has as much energy as a puppy but she is quite senile lol. I will be devastated and in bed for months when I lose them. They have been by my side every day for over a decade.

I am happy to know your pups are doing well on Vetoryl.

Harley PoMMom, thank you for the link. We have the money to treat it, but saving money is always good. I decided to give him one (10mg) pill every other day, and he is handling that. I agree with slowly starting and the vet suggested that also.

I appreciate your help so much. I never thought there would be a forum for dogs with cushing's and such wonderful people. Thank you!

Edit- I need to call the vet again. He never emailed me the test results.

[MarieA]

Okay, he sent the results again. It looks like I didn't get them yesterday but he did email them.


Cortisol - Pre ACTH
Cortisol - Post ACTH
(Last Updated)
RESULT REFERENCE VALUE
5.6 μg/dL
33.2 μg/dL
a ACTH Reference Range:
Canine: Feline
2-6 0.5-5
6-18 5-15
18-22 15-19
>22 >19
<2 <0.5
1-5 n/a
1.5-6 1.5-6
therapy
a
Pre-ACTH (resting) cortisol
Post-ACTH cortisol
Equivocal post-ACTH cortisol
Post-ACTH cortisol consistent with
hyperadrenocorticism
Post-ACTH cortisol consistent with
hypoadrenocorticism
Desired pre- and post-ACTH cortisol on
lysodren* therapy
Desired pre-and post-ACTH cortisol on trilostane*
ACTH response test is only clearly positive (>22) in 30% of
dogs with hyperadrenocorticism (HAC); equivocally positive in
another 30% of dogs with HAC, and normal in 40 % of dogs with HAC.*
If the ACTH response test is normal and HAC is still suspected,
proceed with a low-dose dexamethasone suppression test.
Dogs with iatrogenic Cushing's disease will have flatline response
test results in the low end or below the normal reference range.
Both HAC and hypoadrenocorticism are rare diseases in cats.
*Recommendations for target cortisol levels on trilostane (Vetoryl*) therapy
vary. Per the manufacturer, pre- and post-ACTH cortisol levels of 6-9 ug/dL
(testing performed 4 hours post-trilostane) may be sufficient for some
animals if clinical signs are well controlled.

[MarieA]

This might help you see the test better. Now I know he is 12 and not 13. I forgot :)

https://imgur.com/a/GLnmB7B

[Joan2517]

I was on the couch for weeks when my Lena died. I could only get up and go to work. As soon as I got home, back on the couch with my other three. Then 10 days after Lena died my husband brought home a 2 month old toy poodle. I was furious with him. I remember lying on the couch with two of the others and we just watched her keep herself occupied. I fed her and cleaned up after her, but it took a couple of weeks before I finally started to let her into my heart.

She just turned 3 in December and I love her to pieces! She's much more independent than Lee was. I don't know if she would've been this way anyway, or if it was because I just couldn't bond with her so soon after my precious had left me. Whatever...she knows I love her and I know she loves me. I tell her every day, many, many times.

[Harley PoMMom]

I decided to give him one (10mg) pill every other day, and he is handling that. I agree with slowly starting and the vet suggested that also.


Every-other-day dosing is generally not a good option. Since the medication remains active in the body for no longer than 24 hours, skipping a day only sets up a roller-coaster of higher cortisol one day, lower cortisol the next.

This is especially troublesome in terms of trying to interpret the results of an ACTH stimulation test. If the test is performed on an "off" day, the results will be higher; if the test is done on a day with the med, the cortisol level might even be lower. If a once daily dose seems too high for your boy, usually the far better strategy is simply to lower the daily dose rather than space out the dosing over multiple days.

Keep us updated, please!

Lori

[MarieA]

I was on the couch for weeks when my Lena died. I could only get up and go to work. As soon as I got home, back on the couch with my other three. Then 10 days after Lena died my husband brought home a 2 month old toy poodle. I was furious with him. I remember lying on the couch with two of the others and we just watched her keep herself occupied. I fed her and cleaned up after her, but it took a couple of weeks before I finally started to let her into my heart.

She just turned 3 in December and I love her to pieces! She's much more independent than Lee was. I don't know if she would've been this way anyway, or if it was because I just couldn't bond with her so soon after my precious had left me. Whatever...she knows I love her and I know she loves me. I tell her every day, many, many times.

I bet that was tough at first. She is a blessing now though. She looks like my girl in the photo you have of her. She is a toy poodle also. They all have such different personalities, it is amazing!

[MarieA]

Every-other-day dosing is generally not a good option. Since the medication remains active in the body for no longer than 24 hours, skipping a day only sets up a roller-coaster of higher cortisol one day, lower cortisol the next.

This is especially troublesome in terms of trying to interpret the results of an ACTH stimulation test. If the test is performed on an "off" day, the results will be higher; if the test is done on a day with the med, the cortisol level might even be lower. If a once daily dose seems too high for your boy, usually the far better strategy is simply to lower the daily dose rather than space out the dosing over multiple days.

Keep us updated, please!

Lori

That makes sense! Thanks for telling me that. Okay one pill a day it is, and if it comes back, I will call the vet. Sigh. I was so happy to have him feeling well, but it sucks this is not working out so well.

[Harley PoMMom]

If the diarrhea comes back, Vetoryl does come in 5 mg strength dosages so that is an option, and since, unfortunately, there is usually some tweaking involved in getting the dose that works those 5 mg would be handy to have.

[MarieA]

If the diarrhea comes back, Vetoryl does come in 5 mg strength dosages so that is an option, and since, unfortunately, there is usually some tweaking involved in getting the dose that works those 5 mg would be handy to have.

Thank you :) So far so good on the 10 mg.

[Harley PoMMom]

Hi Marie,

How are you both doing?

[MarieA]

Thank you so much for asking. I am sorry it took so long to get back to you. He is doing a lot better. He is able to tolerate 20mg now. I was giving him 10mg to see if his stomach got better, and it did. His cushing's symptoms were not improving much, so I tested the 20mg (10 2x a day). That has helped him a lot. We will be getting another test from the vet soon to make sure his levels are in the right range.

We are preparing for -50 degrees windchill here near Chicago! I hope all of you stay warm because it will be getting cold in a lot of places. God bless.

[Harley PoMMom]

You really don't want to increase the Vetoryl dosage without knowing where his cortisol levels are so I'm glad to hear that he'll be getting an ACTH stimulation test done soon.

-50 degrees :eek::eek: Brrrrrrr!!!!!

[NMalfam]

Has anyone ever experienced your dog not wanting you to touch/pet them? He does not like me to pet him anymore. He always wants to be near me. It's almost like he is scared to be alone. But when we are in the bed, if I pet him, he goes to the bottom of the bed. It has been that way for a couple months now.


Yes, I have experienced that with Dagget, my Cocker Spaniel. He was always very clingy and slept close to me, for over 14 years. Then he started sleeping on the floor maybe a year or two ago. I have really nice sturdy stairs that go up to my bed that my brother-in-law built for him, and he used them for years, but stopped coming up at all. After we started Vetoryl last spring he started coming into bed again ,but he still sleeps at the bottom and not next to me. He still sleeps on the floor sometimes.

[MarieA]

Hi everyone, my girl passed away :( My boy is doing better... I suppose, but he has a lot more issues than I thought. He is acting like he feels better. I have had the test to make sure his cushing's medication are the right levels. I was wondering if you could take a look at his bloodwork. There seems to be a lot of bad stuff on here.

The vet started him on Epakitin (a phosphate binder). He is still on Vetoryl. He had a thyroid test and it was normal.

I do not know if you can upload files to this site, so I uploaded the images here:

https://imgur.com/a/Pt2aLiE

Thank you sooo much for your help and kind words!

[MarieA]

I also worry because his Na: K Ratio is low and his potassium is high which can be a sign of Addison's, I read. I can have her email me the blood work she did to test for the ACTH, but I do not have it right now.

[labblab]

Welcome back to you and your little boy, although I’m so very sorry about the loss of your girl. That must make your worries over your boy even harder to deal with — at least, that would be the case for me :-(((.

Please bear in mind that I’m not a vet, but these are my thoughts after looking at those lab results. Many of the persisting elevations are pretty commonly found with Cushing’s. But there are some values that make me worry about a couple of other things. First, the elevated anion gap is not something we typically see. I’ve just now tried to do a little reading, and I see that it can be associated with either diabetes or kidney disease. And lo and behold, your boy does have some abnormalities in both those areas. In terms of diabetes, his glucose level is a bit elevated. Was he fasted for this blood test? If not, that could explain the elevation. But if he was fasted, that’s a bit higher than normal and probably bears watching.

In terms of the kidneys, I think the elevated SDMA result may be significant, especially in conjunction with the elevated phosphorus and anion gap. These are undoubtedly the reasons why the phosphate binder has been prescribed, and it is likely a very good idea. But has your vet specifically talked with you at all about the likelihood of a chronic kidney problem being involved here? If so, there may be some other protective steps that will soon be helpful, if not right now.

As far as the potassium elevation, trilostane treatment itself can increase the potassium level. But you’re right — it also bears monitoring over time to make sure it’s not getting out of hand.

Once again, I’m not a vet, so these are just my personal thoughts about what I’m seeing here. And on the positive side, you say your boy is looking better, and that’s a very good thing in its own right! Thanks so much for coming back and updating us. And again, I’m so sorry to learn about your loss.

Marianne

[MarieA]

Thank you so much for your reply! You are completely right about how I am very worried after the loss of my girl.

I noticed the test results related to his kidneys also. The Vet is testing him again in three weeks. She said she is not worried about the kidneys yet because she thought it was related to his Cushing's. I would like to start him on some kind of natural kidney support or something after talking to my Vet again. My girl just died from kidney problems. I am thankful that he has an appointment in three weeks so this can be discussed further with the Vet.

He was not fasting for the test.

I just called the Vet about my concerns and I am waiting for her to return my call. I did not give him any Vetoryl since I posted on here, and I am going to ask for another ACTH asap. Thank you for taking the time to help all of us and our precious pets!!!

[Squirt's Mom]

I am so sorry for the loss of your precious baby boy. I hope you are healing a bit as time passes but I know it isn't easy when another of your babies is sick as well.

That SDMA result would be my MAIN focus. It is my understanding that this test is very specific for kidney function unlike BUN and/or creatinine. When it is elevated out of the normal range that does indicate a problem with kidney function and action needs to be taken. BUN and creatinine don't let us know anything is wrong until something like 75% of function is gone; the SDMA let us know MUCH earlier damage is occurring so I would want that watched very very closely.

[MarieA]

Hi everyone, my boy passed away last weekend :( He was having heart problems. I want to thank you for your help! I am heartbroken.

[Joan2517]

Awww, I'm so sorry for your loss.

[labblab]

I, too, am so very sorry! After losing your baby girl earlier this year, I can only imagine how deeply you are hurting over this double loss. Thank you so much, though, for returning and letting us know. I’ve sent you a private message about a way in which we can help honor your babies on our special memorial thread here, so please be sure to check your inbox.

In the meantime, we’re always here for you in any way that we can help. Please do return at any time that it may bring you some comfort — just to talk, or to share memories of your life together with your babies.

Always in loving memory of your two angels,
Marianne

[Squirt's Mom]

Oh Marie,

I am just so sorry to hear this! :( I am sure you are devastated not only because of his loss but over the two losses in such a short span of time. You haven't really had time to heal from the loss of his sister and now this. My Squirt was a little over 16 when she passed and had been with me since she was 5 weeks old so I understand that it feels as if a part of your own body has been severed. It is my firm belief that our babies who cross over are keeping an eye on us just as we did them for so long and that when our jobs here are done, we will be with them again, never to be parted. Both you baby boy and your baby girl are as they were when puppies again - strong, full of energy, playful, and well. And so they will remain forever and so you will find them when you rejoin them one day.

If taking to your bed for weeks is what you need to do to grieve, then take to your bed. There is only rule to grieving - do no harm. Otherwise grief has no rules. You grieve for as long as you need in any way that you need; it is solely up to you to know when you are ready to stand up and take that next step into your new world. Too often others who don't, can't, understand want to tell us how and how long to grieve our losses - that is none of their business. It isn't their loss - it is uniquely ours alone. But you don't have to be alone with you losses. We are here and we DO understand. Please know you can come talk to us anytime.

Hugs,
Leslie



The Way
Author S.Long

In the darkness I turned to go; my last day's done, I'll miss you so.
No time even to say goodbye or lick the tears spilling from your eyes.
That's when I heard you call my name; I knew then I must ease your pain.

Since I've no voice with which to speak,
It's whispers in your dreams I'll make.

Ease your heart and rest your mind, my time with you was the best of kind.
I couldn't have asked for a better friend, we've shared our journey to the very end.

There's one final thing you need to know, I'll whisper in your ear before I go...
"I'm leaving first to find the way- I'll lead you there on your last day."