Advice for a newly diagnosed pooch in the UK

[clairebear]

Hi all, hope everyone’s well? Thanks for letting me join 😊.
My boy Louis was diagnosed just over four weeks ago. He’s a Staffy Collie X, aged 10 and has been prescribed 30mg Vetoryl as a starter dose, probably to be increased to 50mg following a repeat blood test which I’m taking him for tomorrow. His main symptom is fatigue although I’ve noticed he’s drinking and weeing less too. He’s eating less but I’m not sure if he’s not eating enough now.
My main question at the moment is how to best give him his pill in a morning. He’s a grazer so he has dry food down all day and just picks at it but this means he doesn’t have a proper breakfast as such. What can I give him with his tablet that counts as breakfast and how much food should I give? I’m thinking maybe chicken or fish and rice then reduce the amount of dry food for the rest of the day. I’m getting the feeling he’s feeling a bit of colour in a morning and I’m wondering if this is because he’s not having the correct type or enough food with his Vetoryl and it’s making him a bit queasy. Any general advice would be great too! 😊 x

[labblab]

Hello and welcome to you and Louis — we’re so glad you’ve joined us! You are correct that Vetoryl needs to be given along with food in order to be metabolized most efficiently. In conversations that I’ve had with Dechra, the maker of Vetoryl, I’ve been told that a full meal is best. However, if Louis simply won’t eat that much in the morning, you can only do your best to get as much inside him as you can. Vetoryl is a fat-soluble medication, meaning that it especially needs to be given along with some fat to aid its absorption. So first off, if Louis will accept the pill wrapped in some cheese or a small amount of other fatty material, that will be a good start. Here in the U.S., peanut butter or cream cheese can be a good coating for the pill, although I don’t think peanut butter is as common a favorite there in the U.K. Anyway, wrapping the pill in something fatty is a good start, followed with at least a bit more healthy food that Louis will eat.

Having said all that, I do need to backtrack, though, to find out more about Louis’ picky appetite. Has he only become picky since starting the Vetoryl, or has he always been picky? The reason why I ask is because most untreated Cushpups have ravenous appetites. Along with excessive thirst and urination, it is one of the “hallmark” symptoms of the disease. There are always exceptions, but I’m anxious to find out more about the symptoms that originally led to his Cushing’s diagnosis. You mention that his main symptom is fatigue, and that he’s drinking and weeing less. By this, do you mean these are changes you’ve seen since Louis started the Vetoryl, or was he like this beforehand? Telling us more about his overall health history will help us a lot.

For instance, if the reduction in appetite, thirst, and urination have all resulted from the Vetoryl, then I’m wondering why you’re necessarily expecting his dose to be increased even more right now, as it would sound as though the medication is doing its job to curb those excesses. And if he’s appearing to be especially fatigued, you may well not want to be upping the dose at all at this time.

So once again, we’ll really appreciate learning more about Louis and any abnormalities in labwork, appearance or behavior that led to his diagnosis. And also once again, welcome!

Marianne

[clairebear]

Hi Marianne.
Thanks for the lovely welcome and the reply.
I’ll start from the beginning then ��. Hope you don’t mind a good read!
Early December last year I took him to the vet as his breathing had gotten a bit noisy, seemed to me like it was in his airway rather than lower down in his chest. As he’s now 10 the vet wanted to do a routine basic blood test checking his kidneys and liver before prescribing anything. His kidneys were fine but one of the two liver enzymes that were tested was raised a little but not enough to warrant action at the time. I may get a little vague with specifics as I don’t usually get any hard copies of results from my vet so I couldn’t tell you off the top of my head which enzyme was raised.
We agreed to re-do the blood test after a few months. I took him back in April this year where the test showed that the raised enzyme had gone up even more. He had a liver function test done, which was fine, and a scan which showed an area brighter than the surrounding tissue. The vet managed to get a needle sample from this area (all while he was awake, he’s such a good boy!) and this showed an increase in vacuolar hepatopathy. The vet said early on these could all point to early signs of Cushings but he wanted to be cautious and try a more conservative approach so he was put on Denamarin for two weeks and the bloods re-tested. The levels came back higher still so we went over all of his symptoms over the previous few months. I’d monitored his water intake and it wasn’t sky high, we both agreed on that. He’d put weight on, starting to show a bit of a pot belly, he was going out for a wee every 90 minutes - 2 hours in the early part of the night. Once we got to about 2am he’d settle until morning. The area that the vet had shaved for his scan wasn’t growing back, and still hasn’t (the scan was done in early May I think). The main thing for me was that he’s been extremely quiet and not himself from around March/April I would say. A friend summed it up quite nicely when she said he looked shattered.
After we had a chat the vet decided to do a ACTH stimulation test for Cushings. I’m not sure if you guys have the same units of measurement over there but I remember the vet said if a result came back at over 600 (again, I’m not sure 600 of what, sorry!) then they could be quite confident it was Cushings. Louis’s result was in the low 800’s.
So we get to where we are now. He’s due to go back for his first monthly blood test tomorrow and that will be dead on 28 days that he’s been on 30mg of Vetoryl. I should mention he weighs 26kg now but is usually stable at 22-23kg. He is drinking and weeing less, but he’s also eating less. I am mindful that if it is indeed Cushings he would have been over eating and I admit I was probably over feeding him and not noticing. Now I think about it he was eating anything and everything when we went for a walk over out local fields, including fox poo (eew! ��) and I’m wondering if that could have been because of his appetite.
He’s never been a fussy eater but he will only touch his regular dry food when he’s ready, that’s how he’s always been and still is. He will still eat in a morning if I offer him a treat or a left over bit of my breakfast. This is still broadly the same but he seems a bit more reluctant this last two weeks or so. His appetite gets a bit more back to “normal” later in the day which is what’s making me wonder if he’s not having enough food in a morning with his tablet. I think this spell in a morning is meaning that his overall amount for the day is maybe not as high as it should be. I’ve been measuring out his food (around 300g) for the day and he’s probably eating between 200-250g this last two weeks. I’ve been cooking him a small potato and a bit of carrot and peas to have his tablet with but if he needs some fat in there, as you said, then that’s not going to be doing the job. He does love cheese however, and can hear me open the fridge and the cheese wrapper across the other side of the house!
I’ll mention all this to the vet tomorrow but as you guys have so much experience do you think I’m on the right track with the feeding in a morning? It’s such a rollercoaster isn’t it? This morning I was firmly convinced the vet had it wrong and the Vetoryl was causing his loss of appetite then I sort of calm down and get back to trying to think rationally, I’m up and down and all over the place! Thanks goodness I’ve got you guys to bounce things off �� x

[labblab]

Thanks so much for all this additional info, and I hope that all went well at your vet appointment. We’ll surely be anxious for an update! It sounds to me as though you’re doing a great job with things, and your suspicion may be correct that the Vetoryl may be upsetting his tummy a bit. I know your vet visit is now behind you, but you could always call back and ask if you might give him a stomach soother of some sort in the mornings, as that might make him feel more comfortable. Anyway, we’ll be waiting to hear any additional news.

Marianne

[clairebear]

Thanks Marianne!
Vet visit this morning was very quick. Louis’s not had the full ACTH test but a pre pill cortisol test and they’ve sent a sample off for an enzyme check as well to see if those numbers have changed from his previous tests. I think before I go down the route of more meds to settle his stomach I’ll try feeding him something different with his tablet. What would you guys recommend and roughly how much so it constitutes a proper meal rather than a snack? I’m thinking chicken or fish and rice maybe? x

[labblab]

Yes, our understanding is that the pre pill cortisol check has become a much more common general monitoring approach over there in the U.K. Some vets are also using that approach now in the U.S., others are still sticking with the full ACTH. Either way, we’ll be anxious to see how things turn out.

As far as the food, I think either the chicken or fish with rice in the morning sounds great. As long as he gets at least a small bowl full of it, I’d think that would be good as well as a wee bit of cheese or something similar along with the pill ;-).

[clairebear]

Evening all. Just had a phone call from the vet with Louis’s results and it’s good news! His cortisol levels have come down to 154 nmol/L, the acceptable range is 50-138 nmol/L so he’s only slightly above the higher level. The vet has suggested a small increase in dosage to 40mg per day and repeat the pre pill test in a month unless Lou shows any ill effects. His liver enzymes had also decreased. I’m not sure of the figures for these but the vet seemed pretty happy with where they were compared to the increasing figures we were getting prior to treatment.
I made up a batch of veggies, salmon and a small amount of pasta last night for use over the next few mornings to give him his tablet with. I gave him his pill this morning with some cheese and a bowl of the salmon mixture and he seems to have been a bit brighter today. Probably the best day he’s had in a while, still tired but a bit more active at times. And instead of sleeping on the floor of the living room he’s been making the effort to go and sleep in his usual places which I’m seeing as an improvement.
I’m a bit apprehensive about a new dose but I think that’s just the unknown and worrying about how he’ll react to it but I’m feeling cautiously positive today.
Much love and thanks for all your ongoing support :-) ❤️ X

[labblab]

Oh, this is great news :-)))). The one cautionary note that I’d add is that, if Louis is now getting his pill along with food whereas previously he was not, his cortisol level might well come down even on an unchanged dose. This is because the medication will likely be metabolized more efficiently when given along with food. I know you’ll be watching Louis closely for any adverse effects from the higher dose, and hopefully he’ll keep doing better instead of having any problems. But I just wanted to explain why you do want to keep a close eye on things.

Marianne

[clairebear]

Morning. Yeah, I get what you’re saying and I’ll be watching him like a hawk!
He’s had his first 40mg dose this morning, again with the salmon mixture and a bit of cheese. I wasn’t best pleased when we went for a walk earlier and he ate something he’d found so I’m hoping that doesn’t cause a tummy upset and put my nerves on edge even more! I’ll keep you all updated over the next few days :-) xx

[Squirt's Mom]

How is Louie handling the increase?

[clairebear]

Hi all, sorry I’ve not been on lately.
Louis had a good couple of days on his new dose but has been a bit more subdued over the weekend. He had a good day yesterday, now a bit quiet today. I think it’s safe to say he’s a bit up and down! He’s eating and drinking ok, weeing and pooping ok too. I’m a little worried that he may not be eating quite enough but he was over eating before and now I’m giving him a breakfast I’ve made I’m not used to gauging how much dry food he would usually have for the rest of the day. I’m putting around 250g out for him to graze on, and he’s probably eating between 150 and 200g.
Does anyone have any experience of how long it might take for me to see an improvement in his energy levels. As that was his main symptom all along I understand it will probably be the last thing to resolve itself. We’ve just been for a quick 10 minute walk across the fields in the rain (I love walking in the rain!) and he seems very tired again �� x

[clairebear]

Quick Louis update! :-) We’ve been back to the vets this morning, a little earlier than planned because I’m not happy with him on the higher dose. The first couple of days he seemed to be doing ok, and he’s had a couple of odd days since where he’s seemed a bit brighter but on the whole I’d say he’s stepped backwards. The last week he’s been very tired and quiet and I think I’ve seen him stumble a couple of times but I’ve never been completely sure. It’s been a bit difficult to judge this last week as we’ve had a couple of very hot days here and he’s always struggled with the heat. It’s cooled down quite a lot over the weekend and still no improvement so off we went to see the vet this morning. They’ve taken some bloods to check his electrolytes and dropped him back down to 30mg from today. He’s already got an appointment for his pre pill cortisol test next Monday so the vet said if his electrolytes are ok stay on 30mg until his check up next week. I’ll hear from the vet later with his results from today :-) x

[Squirt's Mom]

I'm glad you got him in and hope it turns out he's just not coping with the heat very well. Maybe he will perk up on the lower dose - some pups just don't do well with the lower cortisol and like to be kept a bit higher than the optimal range. Let us know what his numbers are when you get them!

Hugs,
Leslie

[clairebear]

Hi all. The vet got back to me very quickly, Lou’s potassium sodium levels were fine so we’re sticking with the lower dose for a week. I think you’re right Leslie, that he’s a bit happier with the slightly raised level. His numbers weren’t doing too bad on 30mg to begin with so maybe upping it to 40mg is just a bit too much for him. I think he’s seemed a teensy bit brighter today but we’ll see how he goes over the next few days.

[clairebear]

Hi everyone. Long time no see! Hope everyone and their cushings babies are doing ok?
I’ve been back to the vets with Lou this morning. He’s become very lethargic and disinterested over the last couple of weeks, even to the point of not coming to greet me when I get home. He’s still eating and drinking ok, a bit reluctant at times with food and he’s become picky - he used to love cheese but now he doesn’t seem overly bothered about it.
The vet has taken general blood and has sent off a pre pill cortisol test which I should hear back about sometime tomorrow.
He’s lost weight since being on Vetoryl which I suppose is a good thing. At his heaviest he was around 27kg, today he weighed 23.85kg which is roughly what was normal for him before he started to put weight on. I’m wondering if this weight loss is now meaning a 30mg dose is a little too high for him. I understand this is a very low dose anyway and 20mg for a dog of his size doesn’t seem like it would do a lot but I’m quite keen to try him on 20mg. The vet seemed a little reluctant to change his dose until the results are back. What do you guys think? I know you’re all very knowledgable about this, is it worth me pushing the vet to try a lower dose if they don’t recommend it first? x

[Joan2517]

Since the results will be ready soon, why don't you just wait to see what they are, then you can lower it if you want to.

[Squirt's Mom]

History has proven that larger dogs often need smaller doses than smaller dogs. It seems backwards but we (and Dechra) see that many larger dogs need only a very small dose while the smaller dogs often need higher and higher doses. It is possible that even tho his dose is small now he might do better on an even smaller dose. The signs and ACTH results will tell the tale tho.

It is a "rule" around here that dogs who are not well should not be given Vetoryl (Trilsotane) or Lysodren (Mitotane). Rather we should wait until the problem causing the dog to be ill has been defined and eliminated, if possible, then restart treatment. So that is something I would certainly keep in mind especially since Louie seems to have had problems off and on for the past couple of months at least. It is also possible that Lou is simply one of the dogs that cannot handle Veotryl. In the US we are lucky in that we have the option for these dogs to switch to Lyso - in the UK that is sadly not an option unless things have changed.

Just some points that offer food for thought. ;)

Hugs,
Leslie

[clairebear]

Thanks for the replies everyone. The base blood test came back fine, the liver enzymes that were raised are still coming down and no problems with his kidneys. The cortisol test hasn’t come back yet, we’ll hopefully have those on Monday. I spoke to the vet yesterday though and they’ve advised me to stop the Vetoryl altogether until those results are in.
Today has been the first day without medication and he was very quiet until teatime then he brightened up a bit. I’m guessing tomorrow will give me a better idea if he’s improving. I remember you saying bigger dogs tend to do better on a smaller dose than you’d imagine so it wouldn’t surprise me if the vet doesn’t suggest a small dose to try.
A friend came to visit earlier who is a massive dog lover and used to have a Cushings pooch and she has said that although he was quiet before treatment started he was better then than he is now so either the dose or the drug itself aren’t suiting him. Sometimes you need another pair of eyes to see the things that you’re missing!
I’ll keep you all posted and, once again, thank you so much for your support ❤️ x

[clairebear]

Hi everyone, hope everyone’s doing ok?
Quick update. I spoke to the vet on Monday and he aired concerns that pain from the beginnings of arthritis was playing a part in Louis’s lethargy. I’d previously dismissed this thinking that he didn’t seem to be in pain. Having thought about it though he has struggled to get into the car the last few times we’ve been out.
So....we’ve decided to hold off the Vetoryl for a couple of weeks and try some Gabapentin for pain relief. Trying one drug at a time will give us a better idea of which ones are working or causing side effects. The good news is he started the Gabapentin yesterday and he had the best day he’s had in a long time. Not up to the standard of his usual bouncy, boisterous self but a definite improvement. He is noticeably eating and drinking more now he’s off the Vetoryl. I’m a bit happier that his appetite has increased a bit as I think it had been suppressed a bit too much.
I feel a bit guilty that pain could’ve played a part in this and I didn’t notice but he’s always been a bit of a tough nut! I asked a friend months ago if she thought he was in pain and she agreed with me that he didn’t seem to be, so I suppose I shouldn’t beat myself up too much.
I think then the plan will be to re-introduce Vetoryl at a fairly small dose given that he seems fairly sensitive to it. I think I can finally see a small light at the end of the tunnel. Keep everything crossed! x

[Harley PoMMom]

So glad that the Gabapentin is helping! Please do keep us updated!

[clairebear]

Hi all.
Sorry I’ve not been on for a while, hope you and your fur babies are all doing ok?
Louis’s arthritis has been taking centre stage so I’ve neglected to post on here for a bit. The response to the Gabapentin seemed to have been a bit of a fluke. After that really good spell he slowly went back to being very disinterested and lethargic. So the vet tried a different drug called Galliprant. No instant improvement like before but he is only on a half dose to begin with. Although he wasn’t playing with his ball he certainly seemed interested if reluctant and just brighter in himself.
However last Friday he seemed to go extremely quiet. When he’s tired he’s VERY tired, I had visitors around on Sunday (no one we knew, I sold my car!) and he didn’t get up from the sofa to come and say hi. There have been a few times over the weekend when I’ve had to really coax him to get up and about. Still seems interested in his ball when I throw it up and catch it but as soon as I offer it to him he refuses. So, we went back to the vets today for a check up and a pre pill cortisol check. The vet has rang since with the blood work results and everything seems ok apart from his liver enzymes are raised which we expected as he’s only on a 10mg dose of Vetoryl at the moment. We’re still waiting for the cortisol results. When chatting to the vet he aired concerns that Louis is losing a bit too much weight for his liking (he’s down to around 22.5kg, his normal weight for years was around 24/25) and the lack of any real effect on his lethargy from either the Vetoryl or the painkillers. He’s now beginning to suspect an adrenal tumour rather than pituitary, and possibly malignant too. I feel a bit like the rug’s been pulled from under me! The vet has suggested a chest X-ray which I think is to check for any spreading and therefore malignancy and a specialist scan to locate the adrenal glands to confirm a tumour there. Statistically it’s 50/50 that it could be benign/malignant.
While I’m trying to get my head around this and the possibility of putting my boy through yet more tests what experience do you guys have of adrenal Cushings, and possible tumour problems? Any experiences, info or just plain words of comfort and encouragement would be greatly appreciated at the moment x

[labblab]

Hello and welcome back, although I surely wish that Louis was feeling better. Assuming that his cortisol level doesn’t come back too low, I understand why your vet is wondering about other possibilities for Louis’ weight loss and lethargy. Although overall they are in the minority, over the years we have indeed had many members with adrenal tumors. Unfortunately, there is no standard prognosis. As you already know, there can be a number of variables that affect the disease and tumor progression. Most importantly, is the adrenal tumor cancerous, has it spread, and is it threatening invasion into nearby important blood vessels? Your vet is correct that obtaining an actual image via abdominal ultrasound provides the best information about the status of the adrenal glands and any associated growths. Additionally, an ultrasound can reveal helpful info about the status of other internal organs such as liver, kidneys, and spleen. So I cannot argue with that recommendation, given the diagnostic information it may reveal.

Depending upon size and location, adrenal tumors have the possibility of total surgical removal. However, the surgery is risky and it is quite expensive here in the U.S. Depending upon a dog’s age and other health issues, surgery may not even be a viable option, regardless of cost. If not, then Vetoryl remains the medical treatment of choice for adrenal tumors among the majority of specialists here. If the tumor is not malignant nor growing rapidly, then an extended period of relative stability may be expected. However, if it’s cancerous and rapidly expanding, the outlook is much more sinister.

I surely sympathize with the spot you’re in. Clearly, Louis is not flourishing and the question is, “Why?” For your own peace of mind and some guidance in terms of charting the path forward, as I say, I can’t argue with the benefit of an ultrasound. You might discover that Louis is suffering from some other internal condition that can be treated more easily. But if you feel as though aggressive intervention of any type is more than you’d want to ask of him, then that might also limit the extent of the diagnostics that you want to involve yourself in.

I’m guessing that my reply will not really help to settle things in your own mind. There are just too many uncertainties. But these are some of the considerations that I’d be mulling over myself, if I was in your shoes. Please feel free to continue to talk things over with us, OK? And please give Louis a big pat from his family here.

Marianne

[clairebear]

Louis has had a mega big pat and squeeze from you!
I’m starting to get a bit of a theory and please point out any flaws in it as I’m thinking in very simple “I have no expertise” terms. When we stopped the Vetoryl a few weeks back he had his last dose of 30mg on the Friday. He then went until the following Wednesday with no medication at all, then started the Gabapentin on that Wednesday. Could it be that we hit a sweet spot as his cortisol started to rise a bit and the pain relief also started to help? I have no idea how long after stopping Vetoryl cortisol levels start to rise so that could blow my theory straight out of the water!
He’s never been on a dose higher than 10mg Vetoryl and pain relief at the same time. I’m thinking of suggesting to the vet that could we try increasing the Vetoryl up to 20mg for a week or two before we go ahead with any more tests. Is that long enough to see an improvement, even if very small, or will the delay in not doing the tests be detrimental? I’m wondering if I’m clutching at straws but it seems to be the one thing we’ve not tried yet x

[labblab]

I’m so glad Louis got his hug!!

As for the Vetoryl increase, can you tell us what his cortisol level was on the blood that was tested this week? That would really be a prime determining factor in my mind because it will help us judge the effectiveness of his current dose, and whether an increase would be safe to consider.

Marianne

[clairebear]

Hi Marianne.
I’m just waiting for the vet to ring with Lou’s latest cortisol result, it could be any time up until around 7 pm UK time before I hear from him. I’m expecting it to have gone up, I suppose the question is how much. His liver enzymes had increased from where they were last time, heading back up to the levels seen before the Cushings diagnosis. I’m not sure of the exact numbers or units the vets uses but I’ll ask. He just said they were going back up. I’m using this as my basis for assuming his cortisol levels will be raised too x

[clairebear]

I’ve just had a chat with the vet, Louis’s cortisol levels have come back at just over 190 nmol/L. We’re going to increase the Vetoryl to 20mg to see if that has any effect. His weight loss is most noticeable around his back and back legs so I’m hoping that this is muscle loss associated with the Cushings rather than something else, possible sinister. For the last week or so he’s had quite bad flaky skin too which I think could be Cushings related? We’ll try this for a couple of weeks, if it doesn’t seem to be helping then I think we’ll have to look at having a good look at the adrenal glands or even another condition altogether x

[labblab]

Thanks so much for this update. And yes, with a pre-pill cortisol level of 190 nmol/L (that translates into close to 7 ug/dL for our U.S. readers), a dosage increase indeed seems safe and even advisable. We surely hope you’ll soon see improvements, if even just subtle ones! Please do let us know.

Marianne

[clairebear]

Hi all, hope everyone’s well? I’ve got a bit of a Louis update and I want to ask for some opinions if that’s ok?
First off Lou’s had a water infection. It started around 3 or 4 weeks ago when he wee’d in the house, that’s when I knew something wasn’t right. It was just a hunch but I took a water sample in to a routine check up and it came back with white blood cells in. He was given a week’s worth of amoxicillin and seemed to be doing ok until around a week later when he had about a half an hour of wanting to go out a lot. This set my alarm bells ringing again so I gave his gentleman’s bits a wipe and there was blood on the tissue. So back to the vets, a dip test came back negative but we decided to send the sample off to see if the lab could grow and bugs from it. This came back positive to a bug that is slightly resistant to penicillin so we’re now on another antibiotic. He’s only had his second dose today so we’ll see how that goes.
So, on to the Cushings. We’re trying him back on a 30mg dose, the idea being that he might do better on them now that he’s also on painkillers for his arthritis. The problem is it still doesn’t seem to be suiting him. The first two days he carried on eating as he was, then his appetite has started to drop again, just like it did the first time we tried 30mg. I think even on 20mg his appetite was suppressed a little too much for my liking.
It feels like no matter what dose we try him on it just doesn’t do anything. If anything I think he’s better either on a very low dose or none at all. I’m getting to the stage where I’m thinking of asking the vet if we can stop the Cushings treatment altogether, maybe for a month or two to see how he is just on painkillers. I know there can be some complications from not treating Cushings, water infections being one! But as this is the only infection he’s had we can’t draw a conclusion that it’s related to the Cushings.
When he was first diagnosed the vet gave me the choice of wether or not to treat it. At the time it was a no brainier as I thought it would help him but it’s doing nothing. The vet has spoken about more tests, like the adrenal tumour one I’ve mentioned before but I’m so tired of going to the vets with him and I think Lou is too. I just want a bit of a break from it all, it feels like we’re tying ourselves in knots with all the what ifs and tests.
What are everyone’s thoughts on not treating Cushings? The vet had told me of dogs that he didn’t treat for various reasons so it can be done. I’m very mindful of the complications from not treating it, like infections and liver problems but if I decide to go ahead and stop treatment what can I give to maybe lessen the chances of complications? I’ve been told about milk thistle for the liver and cranberry tablets for the urinary tract.
I’d really appreciate your honest opinion in all this, am I doing the right thing in asking the vet to stop, even for a short while?

[labblab]

Welcome back to you and Louis! To cut to the chase, I don’t think there’d be anything wrong with discontinuing the Cushing’s treatment for a month or so, or at least lowering the dose significantly, in order to see what happens. Yes, you’re right that elevated cortisol can leave dogs more vulnerable to urinary tract infections and other types of internal damage. But usually the systemic damage progresses slowly over time, and I shouldn’t think that experimentally taking him off the Vetoryl for a while should really be a big issue. At his age, his comfort and overall quality of life is paramount. So if he seems to feel better off the Vetoryl, then that’s the direction I would go, too.

As for helpful supplements, I’ve heard that both milk thistle and cranberry can be recommended, but I don’t have any direct knowledge or experience with them myself. Hopefully one of our members with more knowledge about them will also stop by. In the meantime, no matter what you decide, we greatly appreciate this update and will be anxious to hear more about things are going.

Marianne

[clairebear]

Thanks for that Marianne! I think we may be going to the vets a bit sooner rather than later as his appetites dropped off quite a bit today. He’s having treats and bits of my food that I’m offering but he’s not touched his normal food as yet (it’s nearly 7pm here). He’s usually quite a late eater though so I need to just try and be patient. The vet said that the antibiotic he’s on could cause an allergic reaction which means he’ll stop eating. It’s quite rare for this to happen and he ate pretty ok yesterday (by his current standards) after he’d had his first dose. I’m guessing if he was going to have a reaction it would have been yesterday? He’s on co-trimoxazole which is a human antibiotic that can be used in dogs. It’s bad timing that he’s on these antibiotics and I’m questioning the higher Vetoryl dose at the same time, now I don’t know which one to blame, although I’m convinced his appetite was starting to drop a couple of days before he started the antibiotics.
I think part of the problem is I’m watching him like a hawk, every little thing he does or doesn’t do I’m over analysing! It’s sooo draining! xx

[labblab]

I surely understand how worrisome this is for you — I’d be watching Louis like a hawk, too! That’s just what we moms do...

I know that antibiotics can cause upset stomachs, but since the Vetoryl has oversuppressed his appetite in the past, I’d also be worried that it’s the culprit once again. I do think it’s reasonable to put a hold on the Vetoryl for the time being, and I hope your vet will agree. Please let us know how sweet Louis continues to do.

Marianne

[Squirt's Mom]

I agree...especially since you think the appetite was falling off before the antibiotic was started. If it were me I would leave the Vetoryl off completely until the AB course is finished and he's had time to recover from any ill effects it may have presented.

How is Louie now?

[clairebear]

Thanks for the replies everyone!
We’ve been back to the vets this afternoon but the vet we’ve been seeing from the beginning was off today. The vet I saw was lovely but she was understandably reluctant to make a big decision like stopping the Vetoryl altogether when she’s not seen Louis before and isn’t as familiar with him as our usual vet. So she’s suggested dropping back down to 20mg over the weekend but splitting the dose into 10mg morning and evening. My usual vet is back in on Monday and I’m down for a quick telephone consultation with him so we can chat a bit more about this. I’m very keen to go down even further to 10mg or even none at all for a while as we’ve talked about on here.
Another interesting thought occurred to me last night. In fact it stopped me sleeping properly as I kept waking thinking about it! Louis is fed on dry food and since he was a puppy I’ve just filled the bowl and let him graze. This wasn’t a problem until he started overeating (probably the Cushings). Since he’s been diagnosed I’ve been weighing his food out, except last night I realised I’ve been under weighing it for months! The feeding guide says around 330g for a 25kg dog, Lou weighs around 22 so it should be high 200’s, maybe 300g. For some reason I had 220g in my head so that’s what I’ve been measuring out for him. Even on the 20mg Vetoryl dose he was leaving a small amount of this, so he was probably eating around 180g per day. I’d been telling the vet that he was eating ok, leaving a little bit, when actually he’s been under eating by quite a bit. I think that this shows that even the 20mg dose wasn’t suiting him either. On 10mg he was emptying his bowl, and sometimes I’d put another handful in. That seems to be the only dose he’ll tolerate reasonably well.
I mentioned on here a little while ago that the vet was concerned about weight loss, no wonder he’s been losing weight! I don’t think we can look too closely at the weight loss until I’ve got him eating a proper amount, or close to it. I can’t believe I’ve been doing that all this time, talk about tying myself up in knots!
Once again thanks for all your help! :-) xx

[clairebear]

Hi everyone! I spoke to our usual vet on Monday and he’s agreed to drop Lou down to 10mg a day, he was reluctant to stop treatment altogether. I would have possibly preferred a complete stop but I guess that’s a good compromise but his appetite and water intake hasn’t increased as quickly as I thought it would. He’s been back on 10mg since Monday morning, it’s now Wednesday afternoon here, am I just being impatient? When we stopped meds altogether a while ago the change was almost instant. He’s possibly eating slightly more but still leaving quite a sizeable amount.
If I should have seen a change sooner does that point to the antibiotics affecting his appetite as well? I really don’t want to stop them, though, as that will mean starting a whole new course from scratch and he’s nearly halfway through them. My idea, after talking to a few people, is to make him some home made food to try and encourage him to eat a bit more, just until the antibiotics are finished.

[labblab]

Under these circumstances, I believe I’d report back to your vet that Lou’s appetite has not returned to normal. As a result, I’d once again request permission to stop the Vetoryl altogether, even if only just for the remainder of time that he’s taking the antibiotic. Of the two medications, I agree with you that I think it’s more important to continue with the antibiotic until it’s course is finished. Right now, it’s impossible to know whether either of the meds are affecting his appetite. But Lou needs to eat, and by stopping one of the meds, you’ll have a better idea as to whether or not that particular medication is the source of the problem. Once again, I hope your vet will agree with stopping the Vetoryl, even if only for a short time.

Marianne

[Squirt's Mom]

Marianne is nicer than I am. :D I would remind the vet that Louis is MY dog and that the vet works for me, not the other way around. As such I would tell him I was stopping the Vetoryl, not lowering the dose, while Lou was on the antibiotics....and perhaps for a while after to see if he improved off the drug again. The vet is not the one who will have to deal with any adverse effects of his advice nor is he the one that will have to pay any extra vet bills that may occur as a result of his advice. But again, I'm not as nice as Marianne. LOL In reality I do understand that it generally seems in the UK vets seem to have much more control over pets that don't belong to them than vets in the US do and therefore are less willing to work with their clients. ;)

Do let us know how your sweet boy is doing!
Hugs,
Leslie

[Joan2517]

I'm so glad that Leslie said that because that is exactly what I was thinking. Lou is your dog, you are in charge of his healthcare, and you pay the vet, who should know that stopping the medication won't hurt him, but continuing it might. I have stopped Gable's meds a few times during the past almost two years when he was not feeling well, and he is still with us. I would rather let his cortisol run high than deal with it being too low, which it has done.

The vets don't always know as much as we think they do. I found that out my first time around with my sweet Lena.

[clairebear]

I hope everyone has had a lovely Christmas and thank you for the replies once again everyone!
I know you’re all right about my relationship with the vet. I think there is a culture here of putting complete trust in the vet to make all decisions. We generally don’t get the detailed lab reports and test results that it seems you guys do so all of our faith is in the vet. I think I’ve learnt more about cushings from you guys than the vet himself!
Louis is still on 10mg dose but the antibiotics have now stopped. His appetite is about the same, some days he empties his bowl, others there’s still a bit left so I don’t think he’s quite where he should be. I’m bulking it up with homemade food, especially for breakfast with his Vetoryl. I don’t think that this is affecting how much of his regular dry food he is eating, it’s just that the homemade is a bit more tempting for him. I’m going to make him another appointment for in a week or so and maybe I’ll really push to stop the Vetoryl altogether. I’ve been tempted to stop it anyway but have been unsure of wether I’d be doing the right thing - this all stems from the afore mentioned relationship we have with vets here! I am sorely tempted to just stop it.
On that subject I’ve also been giving some thought to taking him to another surgery for a second opinion, or at least another set of eyes to look at the problem. I understand that the Cushings tests are not definitive and given his lack of positive reaction to the Vetoryl I’m beginning to wonder if it is Cushings at all, or even if it is if it’s not a major problem for him x