Help! Newly diagnosed 15 yr old on Vetoryl and doing poorly

[Jdemichele1964]

My sweet little mixed terrier Ellie who is 15 years old and weighs 16.5 lbs was diagnosed with cushings last week after displaying all the typical symptoms and having the ACH test. She also had a full blood panel and everything looked good except for slightly elevated liver enzymes. She was put on vetoryl 2xs a day 10mg morning and night which seemed high for her weight. After the first day she was fine but the second day after the night dose she could barely stand, was breathing heavy, was disoriented, and shaking. We held her thinking she was dying in our arms but after about an hour she has greatly improved. This was Friday night. The next morning she was much better and we decided not to give her the morning dose. We gave her the evening dose of 10mg. During the night she vomited in the middle of the night and in the morning she was extremely lethargic. This was now Sunday morning and we decided to skip the morning dose of 10mg again because she was barely eating. Sunday during the day she improved significantly and in the evening we gave her the evening dose of 10 mg. Monday morning was very lethargic again with no appetite so decided to hold off on the morning dose again. Monday night she was still was barely eating and had diarrhea so we gave her no meds except some antibiotics she has been on for a skin issue. This morning Tuesday she is still barely eating seems disoriented and still very lethargic. She has an appointment with the vet today and I pray we will get some answers. Ellie has been a very healthy dog her entire life up to a year ago when she had a soft cell malignant stage 2 tumor removed which has not returned and has not shown any indications that it has spread so I don’t think this related. We suspected Cushings because of the constant drinking, peeing, wandering around the house, incredible appetite, weakness in hind legs, etc. She was on proin for incognizance but that didn’t help much with the cushings peeing. My question is could she have gotten so sick so quickly from just a few of days of Vetoryl even after we lowered it?

[Joan2517]

Hi and welcome to you and Ellie. I would definitely not give her any more Vetoryl until you check with the vet and maybe do another ACTH test to see if her cortisol dropped too low. I also think that starting dose was too high for her.

If you could post those results from the test that confirmed Cushing's and also the blood work with just the HIGHS and LOWS along with the reference ranges that would be helpful.

[labblab]

Hello and welcome to you and little Ellie from me, too. I agree with everything that Joan has said above, and I’m surely hoping that you were indeed able to take Ellie in to the vet yesterday. Although it is rare, dogs can experience bad reactions to even a few doses of Vetoryl. From what you’re describing, that does sound like a possibility. So I would definitely hold off on giving any more, at least for now. Please let us know how things went at the vet, OK? We’ll be very anxious to hear.

Marianne

[Jdemichele1964]

We took Ellie to the vet yesterday and she was given an IV for dehydration, a vitamin B shot, and 2 other shots for nausea, and to increase her appetite. She perked right up after the IV and shots and was almost back to normal. Today she is better and has a good appetite and is alert. The vet wants to make sure Ellie continues to do well for for a few days and then she wants to restart the vetoryl on Friday again but this time only 10 mg in the morning. If she handles that OK we will continue that for 10 days and then do the blood test again. I’m nervous about even starting her on the 10 mg but we’ll see how she is doing on Friday. I was so relieved at how quickly she perked up after the IVs because we really felt like we were losing her. I will keep you posted. I have a feeling this is going to be a long road for us.

[Squirt's Mom]

Hi and welcome to the two of you!

I am glad Ellie is feeling better but REALLY wish her vet had done an ACTH as is directed by the drug manufacturer. That is the only way to know if the drug was indeed to blame. Protocol in this situation is to stop the drug, run the ACTH and check electrolytes immediately and if the cortisol is too low, then stop the med for a while until signs are strong again indicating the cortisol is once again elevate....and then to do another ACTH to make sure it is elevated before restarting at a lower dose. Since that was not done, at least he did direct you to wait and restart at a lower dose. I would NOT restart at any dose until I started seeing those signs that the cortisol is once again high - increased appetite, increased peeing, increased drinking, panting for no reason.

Would you mind telling us how the diagnosis of Cushing's came about? What signs/changes in behavior were you seeing that were concerning you? Did the vet suggest testing and if so, why? What tests were done to diagnose the disease? Would you mind getting copies of those tests done to diagnose and post them here? That would help us a great deal. Cushing's is one of, if not THE, most difficult canine diseases to diagnose because it shares signs with so many other conditions and lab results can be attributed to many other things as well. If the dog has any other illness or health issue going on when the diagnostic tests are done then false positives can and do happen....I know - that happened with both of my dogs who were diagnosed with Cushing's. :( I am asking about diagnostics because based on Ellie's weight of 16.5 lbs, 20mg a day wasn't really high enough that I would have expected such a reaction so a misdiagnosis came to mind immediately. The recommended starting dose is 1mg/lb for dogs of her weight. Some dogs are very sensitive to Vetoryl so it is possible that was too much for her but to be on the safe side I would like to explore the diagnostic testing a bit.

Does Ellie have any other health issues? Is she on any other medications?

How is she feeling today? Please keep in touch and let us know how she is progressing. I am looking forward to seeing those test results and learning more about your sweet girl soon.

Hugs,
Leslie

[labblab]

I, too, am very worried about your vet’s recommendation to start back up with the Vetoryl. When you say you’d be giving *only* 10 mg., that’s actually all that you gave her on each of two days when she became so ill. So this really isn’t a decrease at all. If she was ill enough to require IV fluids and medication for nausea and vomiting, something about the Vetoryl is making her very ill. Under no circumstances would I restart it without a much better understanding as to what went wrong, if I ever restarted it at all.

What is your vet’s explanation for what happened? A Vetoryl reaction that severe would either result from a cortisol level that dropped way too low, or an imbalance in the critical blood chemistry balance of potassium and sodium. A dog that is sick enough to need IV support should have had blood testing done to evaluate both of those potential issues at the time of the crisis, and certainly *before* you considered restarting Vetoryl at any dose.

And just as a practical matter, unless your vet is on emergency call all weekend, why on earth would she tell you to restart a medication on a Friday when it has the potential to make Ellie so sick once again?

Since you’ve come to us asking our opinions, I honestly have to tell you that I’m very worried about your vet’s knowledge or experience with using Vetoryl. If Ellie were mine, I would not restart the Vetoryl tomorrow, and I wouldn’t restart it at all unless your vet can give you a better explanation as to what she thinks went wrong before, and why it’s safe to risk it happening again. It’s rare for dogs to have life-threatening reactions to Vetoryl, but it’s possible, and if Ellie was this sick after only three days of dosing, I’d definitely want more information before giving her any more of the medication. Ever.

Marianne

[Jdemichele1964]

For the past year Ellie has been drinking excessively and peeing constantly. In addition, she has weakness in her hind legs and pants for no reason. She also has an incredible appetite and is constantly begging for food even though she gets plenty of food. In the evening is a bundle of nervous energy. She wanders around the house panting. At first the vet thought she had incontinence so she was put on proin because she was tested for UTI and that came back negative. When the proin didn’t help we had bloodwork and her kidneys checked and that came back normal except for slightly elevated liver enzymes. She was also tested for diabetes and that was normal. We chalked it up to old age and just kept her on the proin even though it wasn’t helping all that much. Ellie also has been experiencing bouts of colitis so she is on antibiotics on and off for intestinal issues. In addition Ellie is completely deaf and partially blind due to cateracts so the vet was thinking that she stress of losing her senses was causing the colitis so recommended we give Ellie a very low dose sedative in the evening when she is the most stressed. About 2 weeks ago during Ellie’s yearly exam we talked to the vet about her anxiety getting worse as well as the drinking and peeing. At that point the vet decided to do another full blood test which came back with indications that she might have Cushings. At that point we scheduled the ACTH test which came back with results indicative of Cushings. Ellie was also diagnosed last year with a soft cell carcinoma mass at stage 2. She had surgery a year ago and it was successfully excised with clear margins so we don’t think that is related. The vet said that Ellie has some of the highest cortisol levels she has ever seen so she thinks that even though 20 mg may be a therapeutic dose that lowered her levels too much too soon which caused her to crash. Also I the same day she had the 20 mg we gave her the sedative thinking the doctor wanted her to stay on it, which we misunderstood. We feel so bad because we had no idea to discontinue the sedative. The next 2 days she was on 10 mgs of vetoryl we did not give her the sedative only the antibiotics for the colitis. Anyway, today she is doing really well. Actually better than we’ve seen her in months. She has a normal appetite and she is also drinking and peeing normally. She hasn’t even messed in the house once so far today. She is bright and alert and even went outside for a bit. However most of her issues with panting, drinking too much, peeing a lot and anxiety usually happen in the evening so we will see what the evening brings. Yes, I’m very hesitant about giving her any vetoryl tomorrow. I will post her blood test results as I’m anxious to know what you think. Thank you so much!

[Jdemichele1964]

ACTH Results (done while fasting)

cortisol sample 1 - 3.3

Cortisol sample 2 - 70.4

Ellie had complete blood work done and below are the areas that were abnormal.

Platelet count 698 (high)
Eosinophils 1 (low)
ALT (SGPT) 357 (high)
Alk Phosphatase 1188 (high)
GGTP 18 (high)
BUN/Creatinine Ratio 29 (high)
Triglycerides 558 (high)
PrecisionPSL 280 (high)

Heart normal
Lungs clear
Respiration normal

[labblab]

Thanks so much for all this additional information! From these lab results and the description of her behavior, I really have no doubt that Ellie indeed suffers from Cushing’s — everything you’ve reported supports the diagnosis. My worry remains, though, about her reaction to the Vetoryl. Some Cushpups do experience ill effects from it, and simply cannot tolerate it. That would be my worry with Ellie.

Especially with the weekend coming up, I definitely would not restart it today. I find it interesting that you reported that she was surprisingly symptom-free yesterday, and I’m wondering if that has continued. If so, that’s another reason why I would not rock the boat and restart the Vetoryl now. Once again, although very rare, there have been reported cases where dogs have experienced longterm changes to their adrenal function even after only a very few doses. The adrenal function remains suppressed even though the medication is halted. If Ellie continues to look so well while *off* the Vetoryl, I would think this would be added reason to postpone resumption.

Either way, please do let us know how you all are doing today.
Marianne