Buddy - How long should it take for the Vetroryl to reduce the symptoms?

[MichelleBuddy]

Hello and thank you for this forum.
My 77 lb 11.3 year old Lab (Buddy) was diagnosed with Cushings about 25 days ago. He had been on Vetoryl for 24ish days now. At the 2 week point we had him tested again and the vet said the meds were doing great to keep his levels in the right range. She said it would take about 4 weeks (total on the pills) for the symptoms to begin to go away.

We are only seeing a minimal change, if at all. Buddy still drinks a large amount of water and is up 2 - 3 times in the night. Also, we give the pill to him in the morning. If we gave it to him more toward evening would it help him sleep?

The only symptoms he has is the excessive drinking and urinating. He also shows signs of weakness in his back legs, but overall he is still in great spirits and healthy for an 11+ year old dog.

All his other blood test have come out normal.

Any suggestions as to how we can help with the excessive drinking and urinating? Also, does it take big dogs longer to minimize some the symptoms?

Thank you in advance for your help!

[Squirt's Mom]

Hi and welcome to you and Buddy!

First I am going to ask a few questions - what dose of Vetoryl is Buddy taking?

What were the results of that 2 week ACTH?

There were no changes in his appetite, no hair loss or failure of hair to regrow if shaved? Any panting for no reason or pot belly?

What tests were done to determine he has Cushing's? Would you please get copies of those test(s) and share the results with us? That will help us give you more meaningful feedback. Include any testing that shows things like BUN, CHOL, ALT, etc. - btw it is unusual that all the results in this test will be normal in a dog with Cushing's so your comment that all other tests were normal is bit concerning to me.

Does Buddy have any other health issues that you are aware of?

Is he taking any other medications and if so, for what?

The more you can tell us about your sweet boy the better we can help. We LOVE details so don't be shy! :D

As for when to give the med, mornings are best unless his vet can see him at night. The ACTH must be given 4-6 hours after the pill has been given. The pill MUST be given with a meal, not a snack, a meal. If your vet tells you to fast Buddy for the ACTH then that test will not be valid and can put him at risk so never ever fast him for the ACTH. If his vet questions that tell them to contact Dechra, the manufacturer.

As for how it takes to see improvements, some are almost immediate and some take time...and some never completely resolve in some dogs. The drinking and appetite are usually pretty fast in most pups while the return of muscle mass can take a long time in some dogs. Time is the best thing to see resolution of the signs...time, an accurate diagnosis, and the correct dose of medication is what is needed to see improvements. A caution - do NOT restrict his water. A cush pup doesn't pee so much because they drink a lot - it is just the opposite. They drink so much because they are going to pee a lot regardless. Restricting water will cause them to quickly dehydrate so don't withhold or restrict water. Look into a belly band if he is having accidents but make sure he always has plenty of fresh water available.

I'm glad you found us and look forward to learning more soon!
Hugs,
Leslie

[MichelleBuddy]

My 77 lb lab was diagnosed with Cushings about 25 days ago. We started him on Vetoryl (120mg) about 24 days ago and on the 14th day he was tested. It was determined that he was responding to the meds and it was the right dosage.

At the time the vet said it would take Buddy about 10 more days to respond to the meds and we would see less symptoms. At this point, we are seeing minimal improvement in his thirst and frequent trips to urinate. At night he is up about 2 – 3 times.

He is still very happy and healthy for an 11+ year old lab. At what point do you see an improvement on the Vetoryl? Is it just that he is a bigger dog that it is taking so long? Also, we give him his meds with breakfast. If we gave them to him later in the day would he have a better chance of making it through the night. He has to go out about every 2 hours during the day.

Any suggestions would be helpful so we could get some sleep. 😊

Is there more we can do to help with the frequent urination?

Thank you in advance for your help.

[Squirt's Mom]

I have merged your most recent post, almost a duplication of the first, into Buddy's original thread. We like to keep all posts about each dog in one thread. That way it is easier to look back thru the history if needed....this thread will also serve you as a sort of journal for Buddy's Cushing's journey. ;) I have also taken the liberty of including his name in the title so it will be easier for to find from now on.

[MichelleBuddy]

Thank you so much for all of the questions. I will reply, but first I want to get his medical records from the vet.

His only symptoms have been the drinking and urinating. He was great in October and this started in November. We did a total blood and urine test early on, that indicated it could be cushings then we did the test for where he stayed at the vet for the day and his levels did not drop. So the vet was sure it was cushings and they tend to see a lot of it. Oh and we also check his kidneys...Anyway, I will get all the tests emailed to me and post here.

He did not have a pot belly, and he is a lab so he never lost his appetite LOL. He has lost muscle mass, but I am not over concerned about that as he is still very active.

[Squirt's Mom]

Whenever I see that the primary signs in a dog diagnosed with Cushing's have to do with drinking and urination my mind goes to a rare form of Diabetes called Diabetes Insipidus. It has nothing to do with blood sugars or diet and doesn't require insulin, etc. Rather it has to do with how the body processes water. It can be confused with Cushing's and cause false-positives on the cush tests. Here is a link on DI for you to read and see if you see your Buddy in it -

https://vcahospitals.com/know-your-pet/diabetes-insipidus-in-dogs

[DobermanMom]

What food is your dog on? Mine was on Hill’s dry food. When I stopped the food his Calcium levels dropped and he stopped drinking and peeing so much. Still starving though.

Waiting for the vit D test bc the drinking and pering are consistent with the vitamin D toxicitu. Hill’s says dry food not affected, but I am seeing signs to the contrary.

[MichelleBuddy]

Okay,
I have Buddy's test results from his various tests.

11/2/18 They did a complete blood count, T4 and urinalysis.
The Urinalysis came out fine. We did put him on a dose of antibiotics just in case, with no results.
Also, regarding his dog food, his older sister is on the same dog food Nutro dog food. They have been on it for their whole lives.
From the CBC, I will only report out on the abnormal ranges.

AST (SGOT) 148
SLT (SGPT) 297
Cholesterol 344
Neutrophils 78

[MichelleBuddy]

1/23/19
Cortisol 3 DEX test
Pre Sample 1 6.6 (normal 1 - 5)
Cortisol Sample 2 5 (Normal 0 - 1.4)
Cortisol Sample 3 6.0

His cortisol levels never went down through the whole day.


2/8/19 Cortisol ACTH test
After being on the meds for 12 days
The next test was
2 ACTH test
Time 1 was a 7 (normal was 1 - 5)
Time 2 was a 6.7 I think the normal range is 8 - 17?

I was told after this test on 2/8 that his levels were normal and that it would take another 2 weeks for his symptoms to get better.

Curious about the diabetes suggestion someone made?

Thank you for all your suggestions. We need it.

[Harley PoMMom]

Hi and a belated welcome to you and Buddy from me as well!

I am concerned with the dose of Trilostane Buddy is taking as it is strongly recommended that the starting dose of Trilostane be no more than 1 mg per pound of the dog's weight and there is one study that suggest that larger dogs may need lower doses of Trilostane per pound than smaller dogs to control clinical symptoms, and we have witnessed this on the forum too.

Even though his ACTH stim test results were great a dog's cortisol can continue to drift downward during the first 30 days of treatment so please keep an eye out for symptoms of cortisol dropping too low which are: diarrhea, vomiting, lethargy, inappetence, or Buddy simply not acting himself, if any one of these symptoms are observed the Trilostane needs to be stopped and an ACTH stimulation test should be performed.

Cush dogs are notorious for UTI's and a regular urinalysis may not pick up any bacteria in the urine so it is recommended that an urine culture and sensitivity test be performed instead.

Lori

[MichelleBuddy]

Thank you so much for the information.
I have left a message with our vet to talk later this week. He is not finishing his breakfast in the morning, but I think he is just 'off'. He is focused on getting outside to urinate, getting water and eating all at once. :)
His stools are normal and all else is good.
It is just the need to drink so much and urinate.

[lulusmom]

Hi and a belated welcome from me too.

I went through your posts and there are some inconsistencies that I would like to clarify. You mention that Buddy's only symptom of cushing's is his excessive drinking and peeing. You then mentioned the urine test was normal. If Buddy's drinking and peeing is caused by cushing's, the urine test would not be normal. The urine specific gravity would be low in which case a culture should have been done to rule out a urinary tract infection. Actually a culture is routine for any dog suspected of cushing's as a fair amount of cushingoid dogs have a UTI at the time of diagnosis. Can you recheck the results and let us know what the USG number is and whether a culture was done? I also see that only the ALT and SAT are abnormal. These are liver specific enzymes that can be mildly elevated by liver problems. It is the ALKP that almost always is moderately to severely elevated in dogs with cushing's. Can you please look at the blood chemistry and reconfirm that the ALKP (aka ALP) is normal? Thirdly, the results of the LDDS is consistent with cushing's but unfortunately because Buddy had very little suppression at 4 and 8 hours, we can't tell if he has pituitary dependent cushing's or an adrenal tumor. With so few symptoms and lab abnormalities that don't raise a lot of red flags for cushing's, your vet should have suggested an abdominal ultrasound to make that determination as well as look for the usual liver and adrenal gland abnormalities that would validate the results of the LDDS. Validation is important as this test can yield false positive results if there is a non-adrenal illness that has not been ruled out or even extreme stress in highly anxious dogs. Did Buddy have an abdominal ultrasound done and if so, can you share the interpretation with us? I'm not saying Buddy doesn't have cushing's, I'm saying that based on the information you have shared, his case is far from textbook. I was also concerned about the large dose that was prescribed and I'm happy to see that Buddy isn't one of those large dogs that is uber sensitive to Vetoryl. However, there is always a possibility that could change so keep a close eye out for signs of low cortisol. Are you giving the Vetoryl with a meal in the morning and was his acth stimulation test done 3 to 5 hours after dosing with a meal? Sorry for asking so many questions but it's difficult to provide appropriate feedback without putting all of the pieces of the puzzle together. I look forward to your response.

Glynda

[MichelleBuddy]

Hi Glynda,
I am very happy for all of your questions and I thank you for them! ;)

So I should be clearer. He did have a very low concentration of urine. So - yes that was not normal. But as for the culture that came back normal and just in case that the low concentration of urine was hiding an infection, we did put him on antibiotic treatment. So the culture was normal but his concentration is very low.

And you caught an error in my reporting so I apologize. His ALT was 148 and his ALK was 297 - so I reported it wrong.

The vet did suggest an ultrasound, but right now I can't really afford it. I am sorry to say that. She also said we could have one done and it could come back inconclusive.

I do give him his dose first thing in the morning with his breakfast. He is very normal except for his needing to drink large amounts and go out every 2 - 3 hours.

Also the Acth test was done after a dosage and a meal.

Lately he is not thrilled with eating his whole breakfast. He eats about 5/6 of it and leaves a little behind. But within 2 hours he is ready to finish his meal. He still has a wonderful appetite and is still very active.

I appreciate all the help you are giving me. I am also keeping a very close eye on his health. We can't leave him for long because he has to go out so often.

Thank you - please keep the questions coming.
I have a call into his vet also.

[Harley PoMMom]

Could you check on his chemistry blood work panel and see if his creatinine level is normal? Also, diabetes can come on suddenly in dogs with Cushing's, which makes them drink/urinate more, so you may want to ask the vet to have his blood sugar checked.

Lori

[MichelleBuddy]

Hi Lori,
His Creatinine levels are normal - .8

His glucose is also normal 113
And not sugar was found in his urine.

Please keep the questions coming.

I just talked to the vet and asked more questions. We are hoping to see a change soon (honestly it is exhausting as many of you know.) He goes out every 2 - 3 hours. Also I am going to give him some anti anxiety meds at night to help him sleep more.

Thank you everyone for your support!

[Squirt's Mom]

In a prior post you had asked about the DI - diabetes insipidus - that someone mentioned. Here is the link I posted just to make sure you see it -

https://vcahospitals.com/know-your-pet/diabetes-insipidus-in-dogs

And a few more links -

https://www.merckvetmanual.com/endocrine-system/the-pituitary-gland/diabetes-insipidus

https://www.diamondbackdrugs.com/dealing-with-diabetes-insipidus-in-animals/

https://www.vin.com/apputil/content/defaultadv1.aspx?meta=&pId=11147&id=3846170

The test for DI is a water deprivation test and is rather risky so many vets simply start treating. If the treatment takes care of the signs and abnormal labs then there is the diagnosis. Treatment is easy - nasal drops. So check out these links and see if they could fit Buddy. His Cushing's diagnosis is questionable in my mind. ;) It's worth looking into and talking over with his vet if you think it fits his profile. Remember - DI and Cushing's share signs so it is easy to confuse the two.

[MichelleBuddy]

I specifically asked the vet this questions and she stated that he did not have DI. His glucose is normal and there are no proteins found in his urine. I do know he has a low concentration of urine given because we did run that test. I think it was somewhere like 1.008? I don't have those notes in front of me.

Should I be asking more questions along that line?

He was given the 8 hour test for Cushings where his Cortisol level never went down after the injections of the synthetic. To me that is a sure sign of Cushings and my vet said he is definitely Cushings given that test.

Could I be missing something else?

I plan on talking to her again maybe at the end of this week or next. What other questions should I be asking in terms of DI? His only sign is the drinking and excessive urine. Would something else in his CBC or urine test point to DI?

[MichelleBuddy]

Hi
I am newly concerned. Buddy's appetite has decreased.
He did eat his breakfast, but it took two tries. The initial feeding and a second feeding an hour later.
And for the first time ever he spit out part of a banana.
I was shocked.

Advice?

[labblab]

As Lori warned earlier, my worry right now would be that Buddy’s cortisol may be dropping too low for comfort on his 120 mg. dose. I know the ongoing thirst/urination remains an issue, and makes you wonder whether his Cushing’s remains somewhat out of control. But as other folks have suggested, there may be other factors that are affecting the thirst/urination. On the other hand, this worsening inappetance — which seems likely to be directly related to the trilostane — is decidedly a concern. Even if Buddy’s cortisol level is not low enough to actually be a safety issue, it may be the case that a dramatic decrease in cortisol over a short period of time may make him feel unwell. This is one reason why we encourage folks to start at a lower dosage and work upward if need be, rather than vice versa. Starting lower allows a dog to adapt to the endocrinological changes more gradually and more comfortably.

Bottom line: I would give no more trilostane until you can report the inappetance to your vet. Since this can be a symptom of a cortisol level that has dropped too low, I would not resume dosing until Buddy’s appetite normalizes. And even then, likely at a lower dose for at least the first month of treatment.

Perhaps Buddy is doing better this evening, and our worry is unfounded. But if not, I would give no more trilostane until you can get this sorted out.

Marianne

[Squirt's Mom]

I specifically asked the vet this questions and she stated that he did not have DI. His glucose is normal and there are no proteins found in his urine.

Blood glucose has nothing to do with DI...that is related to DM - diabetes mellitus. It is concerning that this vet doesn't know the difference!

[MichelleBuddy]

Taking Buddy to the vet this afternoon.
For the first time in months he has not needed to go out at night. This is rather remarkable. I noticed yesterday afternoon that he stopped drinking bowls full of water. I see him drinking normally amounts now. However, my concern now is his lack of appetite. I have read that this is can be a side effect of the meds. I am keeping a close watch on him today and seeing the vet at 5pm. I am also looking for a new vet who specializes in Cushings.

He did eat his whole dinner last night with a little bit of delicious food hidden in it. But this morning he has no interest in his food. I plan on trying again a little later when he has worked up more of an appetite.

He has not been losing weight, in fact on the meds he has begun to fill out a little. Looking forward to weighing him this afternoon at the vet to compare his weight.

I will ask about a lower does for him.

Thank you again for your help in this matter. Clearly I have a lot to learn.

[Harley PoMMom]

I'm relieved to hear that you are taking Buddy to the vet and I would tell the vet that you want Buddy on a lower dose of Trilostane, I can't emphasize enough that we have seen that large dogs need lower doses of Trilostane. I'm also reiterating what Marianne stated, no more Trilostane until Buddy's appetite has normalized.

Let us know how it goes.

Lori

[MichelleBuddy]

Has anyone had a side effect of the dog having a thickening in the throat when palpated? Or had their dog develop a cough while on the meds. Or a sore throat. I have looked at the side effects for the medication and it mentioned the coughs.
Thanks so much.

[labblab]

Hi again, Michelle. I’ve merged your newest question about Buddy into your original thread so that we can review his entire history when we think things over. Coughing is not commonly reported as a medication side effect, nor are throat issues. When you speak about a “thickening,” do you mean some sort of external lump? Otherwise, I’m not exactly sure what you mean. Maybe you can describe it in more detail. But if there is some sort of physical obstruction in Buddy’s throat, it seems entirely possible that a cough would result. That might also account for his inappetance.

Did you take him in to see the vet? What decisions did you make about the medication? Was Buddy bothered by the thickening and the cough at that time?

Sorry for all the questions, but your answers will be a help to us.
Marianne

[MichelleBuddy]

Thank you so much for your help. Not sure what I would have done without this group.

As of Friday, I have taken Buddy off of the Vetroryl. I was able to tempt him with morsels of food on Friday morning, but today he does not want to eat. He is still drinking (thank God). I took him to the vet on Thursday and his blood work was fine. Friday I talked to the vet again and feel he is having a reaction to the Vetroryl. She did not think so based on her test results, but she told me that she trusts owner's feelings. He is off all meds except for prednisone to simulate his appetite again and in case he has gone too far with the Vetroryl.

He is no longer quivering. I have not heard the cough. He is resting comfortably. What I need is for him to start eating again. I have an appetite stimulate I can give him (from the vet) but I want him on minimal meds to get him back to 'himself'. The prednisone should help him want to eat and drink more. What I wouldn't do for him to be begging me to go out 8 times a day like he was just this past Wednesday. Any recommendations would be great.

Thank you for your help.

[Squirt's Mom]

The vet did an ACTH and the results did not indicate the cortisol was too low? Do you have those results you could share with us? Too often we have seen vets that didn't' know how to interpret the results - they didn't know the ranges listed from the lab are NOT the ranges that apply to a dog on treatment so we like to verify the results if possible. If Buddy is still not eating even on the pred I would try the stimulant tomorrow. Today try giving him a soft boiled egg or one fried over easy. Or boil some chicken and give him the broth - no seasonings! If he takes the broth, add a little bit of rice or pasta to the broth later and see if he will take that. If he takes the rice then add a little bit of the chicken to the rice and broth until he is eating good again. Please try to get the ACTH result and let us know what they were. And stay in touch, ok?

Hugs,
Leslie

[MichelleBuddy]

She did not repeat the ACTH test. I forgot what she tested, but said it would be elevated if he was in Addisons.

I have tried all foods and to no success today. I have tired A/D dog food to get the high calories in him. I have tried turkey, Chicken, beef, crackers, A/D food watered down - nothing. I have even wiped some A/D food on the inside of the lips. That worked once. The second time he spit it out.

He is drinking the water. I am also give him the appetite stimulant tonight if I still am getting nothing from him. It is odd to me, but he keeps wanted to go to the water that is frozen on the top of the pool - maybe to lay on the ice? I am not sure why. This too is out of character.

[Squirt's Mom]

:eek::eek::eek: Oh dear.... if he were my dog I would be finding another vet RIGHT NOW and get the ACTH done asap. His dose was too high and now he is acting as if the cortisol is too low which is a life-threatening situation. I am appalled his vet didn't do the ACTH when you brought him in and he wasn't eating. I am very worried about your sweet boy.

[labblab]

Hi Michelle. How is Buddy doing this morning? Can you tell us what dose of prednisone you’ve been told to give Buddy? If his lack of appetite stems from low cortisol, the supplemental prednisone ought to be helping. Trilostane overdosing can also cause another adrenal hormone, aldosterone, to drop too low. Aldosterone controls the balance of potassium and sodium in the body. If those levels become unbalanced, they can cause major problems. They can measured by drawing blood for a simple chemistry panel, though, and I’m guessing that’s what your vet did. I do agree with Leslie that I would also have wanted an ACTH, but if Buddy is now taking the prednisone, you’ll need to hold off on an ACTH until he’s had no prednisone for at least 24 hours. This is because prednisone will skew the test results.

Hopefully his appetite will be improving today! If so, then I do think we have to suspect that the trilostane caused the problem — or at least, that high a dose of trilostane. If even the prednisone does not help, then I think the situation is more puzzling, and I would wonder whether the Cushing’s diagnosis is accurate, or whether perhaps there is/was something else going on with Buddy instead of Cushing’s or in addition to it.

My heart goes out to you, because I know that at his age, additional quality time that you can spend together would be such a gift. You’re wanting only the best for him, and now you’ve got these added problems to contend with. And trying to encourage a dog with no appetite to eat has got to be one of the most stressful things of all. Anyway, I surely hope that things are looking better this morning. Please do let us know.

Marianne

[MichelleBuddy]

Thank you all for your support and love.

Buddy is drinking like crazy so I know the prednisone has kicked in. (Thank God), but still not eating. We are taking him back to the vet for a more thorough evaluation today. We are talking to a different vet in the same practice. I want his throat examined which would still not explain why he won't take liquid food that we have provided.

We are at the point where we are mixing a/d dog food with water, putting it in a syringe and forcing him to take it. He is not happy, but I am not giving up without a fight to find out what is wrong. If it is truly cancer then I don't want him to suffer, but if it is something else - that can be cured then darn it we are going to do it.

He also is seeking the outdoors a lot. I think because it is cold and he gets hot on the pred. And just to note, even when he has had a stomach upset, he has NEVER refused food - ever. We even made him fresh bacon and still nothing. His gums look good and I swear he is a little stronger since being fed by the syringe, but that is such a battle and he really does not want it. I don't want him to suffer, but until I know what takes a dog from being crazy active on Wednesday to stopping eating on Friday, I still have hope.

[Squirt's Mom]

Thank you so much for the update! And please let us know what you learn from the vet. We are by yours and Buddy's sides all the way.
Hugs,
Leslie

[MichelleBuddy]

It is just so odd. He will take water, but not food.
Just now we tried raw meet. He licked it, but then spit it out. It is like he wants to eat but can't.

[Squirt's Mom]

I would want the vet to check his aldosterone level while he is there today.

[MichelleBuddy]

Can you tell me why? What would that indicate?

Thank you for the information. We are also thinking about having him sedated and checking his mouth and down his throat.

[Squirt's Mom]

The prednisone will be replacing the cortisol if it had gone too low when the vet failed to do the ACTH when called for. However it will not raise the aldosterone or other electrolytes if they have fallen too low because his Vetoryl dose was too high. Both cortisol and eletrolytes are affected when the drug dose is too high. It would take a separate drug to raise the electrolytes. So while the ACTH would be useless on the pred the test on the aldosterone should still be valid. His behavior is in keeping with both low cortisol and low aldosterone to a strong enough degree to be worrisome...along with other concerns like something with his mouth or throat, the cancer you are worried about, and other things. But I would want to make sure that the aldosterone and other electrolytes were checked since his cortisol cannot be while the vet is looking.

[MichelleBuddy]

His Sodium level was normal - 159

[Squirt's Mom]

That is good news!

[Harley PoMMom]

Did the vet check his mouth and teeth thoroughly? If there is a tooth acting up it could cause him to not want to eat...just a thought.

[MichelleBuddy]

We have been syringe feeding Buddy. He would fight it and groan. It was so painful for all of us.

Two hours before the vet appointment Buddy took in a marble size piece of raw hamburger. We were stunned. Since then, he has had bacon and some peanut butter. But took no treats at the vets.

The vet did an exam of him and he had xrays. I also had him check his teeth and throat (no issues.) There is no blockage and the xrays showed no obvious sign of a tumor. The liver had clean lines, the spleen looked good. So that was good news. Still not sure if there is other cancer, but for now nothing obvious. He did have a lot of gas in his intestines which was colic for a dog.

Came home and gave him the meds for colic to get things moving, waited 30 minutes (as was needed) and he ate chicken. CHICKEN! LOL

This morning we did not have to force meds down his throat. He took them with the peanut butter. Waited the 30 minutes and he again ate the chicken. It has been less than 24 hours of eating, but I thought we would never get here. Honestly we thought we would be putting him down this week, but wanted to give him every chance possible (hence the syringe feeding.) I honestly think that saved his life (for now) and putting him on the prednisone.

I am thinking a nice bowl of scrambled eggs and cheese for lunch! Wish me luck.

[labblab]

That’s great that he’s doing better! One quick word of warning, though. You’ll want to be careful about giving him a lot of high fat foods. There is some belief that this can trigger acute pancreatitis, and that’s the last thing you want to add into the mix. I know you’re trying hard to tempt him, but try to limit the amount of fatty foods. So mainly the eggs and maybe only a dash of Parmesan would be better than a lot of cheese.

[MichelleBuddy]

Thanks for the advice. I will skip the cheese all together. :)

[Squirt's Mom]

Did you talk to the vet about the aldosterone? Was it checked when the sodium was?

PS...yes I am a worry wart! LOL

[Harley PoMMom]

If this were me, for a few days I would give him a bland diet such as skinless boneless chicken breast with very mushy rice. This type of diet is recommended for dogs recovering from pancreatitis or tummy issues.

So glad he is eating!!

Lori

[MichelleBuddy]

Thanks for the advice.
And yes the vet looked at those numbers and felt he was okay.

He rejected the eggs.
Likes his peanut butter with bread, but not much of it. :(

[Squirt's Mom]

Cool! I will breath a bit easier now! ;)

Keep working with the foods and I am sure you will find something he will take. I am very glad he is eating a bit and pray his appetite will return very strong soon!

[MichelleBuddy]

Thank you
He ate part of a chicken breast this morning again and peanut butter on bread (so I can hide his pills). He seems a little more alert, but he is so depressed looking. Little tail wagging, no kisses.

Tired on of his favorites (banana) and he refused. I am concerned when he goes down in doses with the prednisone how he will react - and if he will stop eating again. But I guess time and prayers will tell.

[labblab]

If Buddy’s appetite worsens again once the prednisone is discontinued, it’ll be really important for the vet to run the ACTH stimulation test. There simply is no alternative to finding out whether his cortisol production remains seriously oversuppressed. It may be the case that he’ll require daily supplemental prednisone for a lengthier period of time. If that’s the case, the recommended daily dose of replacement prednisone falls within a range of 0.1-0.2 mg./kg. Given Buddy’s weight of 77 pounds or 35 kg., this would translate into something around 3-7 mg. of prednisone daily. If he needs ongoing prednisone, dosing in that relatively low amount ought to give him the steroid boost he needs but without causing a rebound of unwanted Cushing’s symptoms. Again, this would only be necessary if his own adrenal glands are not producing enough cortisol. But the only way to know this for sure is to perform an ACTH stimulation test after he’s been prednisone-free for at least 24 hours.

Marianne

[MichelleBuddy]

Just talked to the vet.
We are going down to 1 prednisone a day today.
I believe if he stops eating, the vet feels like he has some cancer versus cushings or addisons. She stated that the prednisone probably would reduce the inflammation around the cancer.

So going down to 1 pill a day. He is going out 4 - 5 at night. It will be interesting to see if tonight he is better and if he can keeps his appetite. He has been off of the vetroryl for a full week. I can't imagine that his cortisol level would be low after having it so high for 2+ months before we went on the vetroryl.

Thoughts?

[labblab]

Has Buddy been eating today? If the prednisone is normalizing his appetite, I’m really puzzled as to why your vet is not considering low cortisol as the probable cause since the inappetance began after a month of Vetoryl treatment. There really is no relationship at all between pretreatment cortisol levels and the likelihood that a dog may end up with a cortisol level that falls too low after treatment has begun. A dog may have a cortisol level that is sky high prior to beginning treatment. But if he’s overdosed on the medication, the natural functioning of the adrenal glands can be severely compromised, either temporarily or even permanently. Such overdosing can occur within just a few days if a dog is especially sensitive to the medication. Sometimes the damage that’s done is permanent and requires lifetime low-dose prednisone supplementation thereafter.

Of course, there’s always a possibility that something else is going on. I would be especially concerned about an alternative cause if the prednisone isn’t helping. Glynda mentioned earlier that Buddy’s diagnostic LDDS results could be consistent with an adrenal tumor. Adrenal tumors can be cancerous, so that possibility exists, among other things. Or a pituitary tumor could be expanding and placing pressure on the part of the brain that controls appetite. So if Buddy’s appetite is not being helped by the prednisone, I’d be less likely to susoect low cortisol and instead worry about something else. But if Buddy eats when he’s taking the prednisone and stops eating if the prednisone is stopped, low cortisol seems to be the first possibility to consider. In that event, if he were mine, I’d insist that his cortisol be tested, and I don’t understand why your vet wouldn’t make that testing a top priority.

Marianne

[MichelleBuddy]

Thank you so much for the information.

She seems convinced that it is cancer. I think it is too coincidental and tied to the medication.

And yes - he is still eating. I would never take him down a level if he was not eating. He has had 2 chicken breasts today and little hamburger. But he is still not the same. This is a dog that would steal a 10lb bag of apples off of the counter and eat it all (I miss that dog!) He is also no longer 77 pounds. His last weigh in was 69 pounds, but I would venture to guess that he has put on a few pounds now that he is eating.

He is on 20 mg twice a day of Prednisone so we are going down to 20mg once a day. I think the idea with the vet is that he is a 'Cushings Dog' given that his cortisol levels were so high.

I was unaware that that meds for Cushings could have caused permanent damaged. I was under the impression that once a cushings dog always a cushings dog.

And yes, he is still eating. We discussed taking down to once a day, but she said if his eating stopped again, to put him back up to 2x a day.

I would like to see him weaned off of the prednisone so we could do another cortisol test. But I can't risk him not eating again. That was awful. So if he stops eating he will go back on higher doses of pred.

He seems slightly more alert each day and sniffing around more often. He is watching what goes on in the kitchen. :-) Less hiding in his crate. But still not the eating machine of the past.

[labblab]

Michelle, I am really worried about your vet’s approach to this whole situation. I have no idea as to why she would consider cancer to be the most likely cause of Buddy’s inappetance. I think you need to start reading about Vetoryl treatment yourself, because it does not seem as though your vet is familiar with the potential side effects and the need for cortisol testing if a dog who’s been taking Vetoryl becomes unwell. There ought to be a printed product insert in Buddy’s box of Vetoryl, but if you no longer have that to look over, here’s a key excerpt:


WARNINGS: Hypoadrenocorticism [Addison’s] can develop at any dose of VETORYL Capsules. In some cases, it may take months for adrenal function to return and some dogs never regain adequate adrenal function...Owners should be advised to discontinue therapy immediately and contact their veterinarian if signs of potential drug toxicity are observed (see INFORMATION FOR DOG OWNERS, DOSAGE AND ADMINISTRATION, PRECAUTIONS, ADVERSE REACTIONS, ANIMAL SAFETY and POST-APPROVAL EXPERIENCE). In case of over dosage, symptomatic treatment of hypoadrenocorticism with corticosteroids [such as prednisone], mineralocorticoids and intravenous fluids may be required...

... The most common adverse reactions reported are poor/reduced appetite, vomiting, lethargy/dullness, diarrhea, and weakness...

...If the ACTH stimulation test is < 1.45 μg/dL (< 40 nmol/L) and/or if electrolyte imbalances characteristic of hypoadrenocorticism (hyperkalemia and hyponatremia) are found, VETORYL Capsules should be temporarily discontinued until recurrence of clinical signs consistent with hyperadrenocorticism and ACTH stimulation test results return to normal (1.45-9.1 μg/dL or 40-250 nmol/L). VETORYL Capsules may then be re-introduced at a lower dose...

Here’s a link that will take you to a brochure published by Dechra, the maker of Vetoryl. It contains the info I’ve given above, with a lot more in addition. Your vet has prescribed quite a high dose of prednisone for Buddy — much higher than is necessary if the cause of his inappetance is low cortisol, and can actually cause gastric upset in its own right. At that high dose, unfortunately you’re likely to see a rebound of unwanted Cushing’s symptoms such as excessive thirst and urination. If Buddy’s problem is low cortisol due to the effects of the Vetoryl, much lower doses of prednisone would be adequate to replace the cortisol that he’s lacking.

http://www.animalhealthinternational.com/animalhealthinternational.com/media/Animal-Health-International/Training/Dechra/VetorylClientBrochureSpreads4_20HighRes.pdf

Once again, it’s indeed possible that there is some other issue that’s causing Buddy’s inappetance. But as I think you’ll see from the published info above, if a dog taking Vetoryl loses its appetite, low cortisol and/or imbalances in blood chemistries due to overdosing always have to be suspected. You want to check out that possibility first. If that turns out not to be the problem, then you know to look elsewhere. But that’s really the first place to start.

Marianne

[Squirt's Mom]

I am going to go a step further and beg you to take Buddy to another vet asap to have him checked out...one who hasn't apparently already made up their mind about what is wrong with him and who has completely ignored everything related to Vetoryl. What reason for thinking this is cancer has his vet given you other than the appetite? Any labs to support this suspicion? Any ultrasound or xrays? Anything? Please get him to another vet for a second opinion, please.

[labblab]

Hey Michelle, just thinking about you and Buddy, and surely hoping that he’s doing better. We’ll love to see an update whenever you might have the time to write.

Marianne

[MichelleBuddy]

Hi all,
Sorry for the delay in responding. We thought we were going to lose Buddy again this weekend.
He vomited fluids this weekend and now I am seeing a pattern. When that happens he stops eating for a whole day. He has only vomited twice in this journey, so I am not overly concerned about it. Most of my Sunday was in tears for my poor puppy, but then he started to rebound again.

It seems like we are able to get him to eat 4 times a day - small meals only.

I am afraid to take him off of Predisone because he is eating and drinking water. Not too excessively with the water. Has to go out 2 times in the night, but when his Cushings was the worst, he was out every hour.

He will take peanut butter, chicken, rice, soup...

I will read the material above. I am thinking about going to a specialist, but the cost of one visit is $163 for just the exam. Crazy expensive. I have also been emailing a friend of mine who is a vet. She feels like if it was Addison's, on the pred he would be rebounding by now. She too suspects Cancer.

I fear if I take him off the pred, and he stops eating it will be impossible to get him back to eating given his weaken thin state.

Yesterday, my hubby took him for a walk just to give him some exercise outside our home and something new to sniff. He did okay.

But for now, he is eating small frequent meals. I have a call into my vet for the name of a specialist.

Thank you and keep the suggestions coming.

[MichelleBuddy]

Had a long talk with the vet.
We are keeping him on the pred for two weeks to see how he does. Thankfully his appetite seems to be increasing daily.

He is also more alert and looking more for food.

After two weeks we will slowly begin to wean him off of the pred to be able to to repeat the ACH test. But not at the risk of him stopping eating again. So only time will tell, but for now I am glad I have him with me and he is eating great.

He is also sleeping very comfortably and not in pain. So taking it one day at a time. I would like him to gain some weight back. He is also going for short walks which have to be good for his spirits.

Thank you to all. I would like to get to a point where he can see his pool open this summer and get to swim again.

[labblab]

Thanks so much for these updates, Michelle. I’m so glad to hear that Buddy is improving! The fact that he’s doing increasingly better while taking the prednisone does lead me to continue to suspect that low cortisol may have been playing a part in his inappetance.

Here’s one important note that you can discuss further with your vet. Dexamethasone is another corticosteroid, just like prednisone. However, it does not skew the results of an ACTH test in the same way that prednisone does. I’m guessing that Buddy could be shifted pretty easily to dexamethasone, at least for a couple of days. That way, you could proceed with the cortisol testing without having to wait on a prednisone taper, or without having to discontinue his steroid supplementation at all. So that could be another option for you to consider in your effort to figure out exactly what’s going on with him.

Either way, I surely hope you’ll see continuing improvement.
Marianne

[MichelleBuddy]

Good evening,
Still at a loss about Buddy. He takes pred 20mg in the morning and 10 mgs at night.

He is weak, but not in any pain.
We backed off some of the pred. I would like to see him off it all together, but not sure if he will stop eating.

He is not eating a lot. And when he tries to run he falls and has to do a bunny hop to get going again.

I will be calling the vet again on her day back in the office for advice. He is still going out multiple times a night. And is very picky about his food. Today he liked bagels, ham and chicken and rice.

Praying for an answer, but I think it is beyond Cushings.

[Squirt's Mom]

I wish I had an idea to offer but I just don't. The pred will cause him to drink and pee more and I am glad he is eating some at least but wish, like you, that his appetite would pick up. I offer my prayers along with yours for your sweet baby boy.
Hugs,
Leslie

[Harley PoMMom]

I think you should really give Marianne's suggestion about switching from prednisone to dexamethasone as dexamethasone doesn't interfere with cortisol assay so an ACTH stimulation test could be performed.

Lori