Is Vetoryl safe for dogs with kidney disease (despite the warning)?

[Alyson803]

Thank you for allowing me in the group!

QUESTION: If a dog already has kidney disease and experienced kidney failure, is it safe/should you still administer Vetoryl?
There is a warning to not give Vetoryl if a dog has kidney or liver disease, but my vet prescribed it anyway. https://www.drugs.com/pro/vetoryl.html

BACKGROUND: My 12 year old large dog likely has had Cushings for well over a year (previous vet did not diagnose). New vet detected kidney & liver problems and then diagnosed Cushing's (all via blood tests). She prescribed Denamarin (liver supplement), prescription kidney diet food*, and Vetoryl**. At that same time I discovered that my dog had adult roundworms (from eating cat/other feces when visiting my farm) despite receiving Heartgard each month. So on my dog's 3rd day of Vetoryl (did not show a side effect yet), the vet prescribed 3 days of fenbendazole dose ("Panacur"). I expressed my concern about giving him so many medications at once; the vet said it needed to be done. Yet on the last day of deworming, my dog experienced nausea (didn't want to eat) and then kidney failure (nonstop vomiting, bloody diarrhea, etc...). Rushed him back to the vet who put him on IV. Vet said that his kidneys had completely failed, did not appear to be "restarting," and then sent us home - because they were closing - with a bunch more medications (for GI upset, phosphate binder, probiotics, appetite stimulant)...yet pretty much confessed that he would just die. Well, on his own after about 10 hours, he wanted to eat & drink again! When the vet called me back a couple days later, she confessed that she was surprised he survived. She said to stop the Vetoryl and everything, at least temporarily.

CURRENT SITUATION: About 3 weeks have passed, and my dog appears to be doing much better. He is getting Denamarin, kidney special diet food, phosphate binder, and fish oil, but I did not start him back on Vetoryl (nor did I give him his monthly Heartgard - I'm looking into natural deworming methods at this juncture). I no longer trust this vet, so I have not taken him back for more tests. He has a super appetite, plenty of energy, and has gained muscle. Although his coat is still thin (from Cushings), it is shiny. I haven't detected any more worms, but he still has a pot belly (also likely from Cushings).

*Vet prescribed Royal Canin, which turns out to be mostly corn/garbage that left my dog thin. I switched to Blue Buffalo kidney diet food (also requires a prescription), and my dog started to gain back muscle and energy.

**Vet prescribed Dechra recommended dosage, even though I sent her the article found on this forum regarding lower doses for larger dogs.

[labblab]

Yay!! We’re so glad to see you here on your new thread! Thanks so much for giving us all this introductory info — it’ll be a big help to us. I want to be able to take some time to read through your thread more carefully before posting a lengthier reply of my own. But I’ll definitely be back, hopefully later on today. In the meantime, we want to welcome both you and your boy to our family!

More to come later ;-)
Marianne

[labblab]

OK, here I am back again. Thanks again for all the information you’ve already given us. I’m surely sorry to hear that you’ve had such a scare, and what a relief it is that your boy seems to be doing better now!

Before writing more, I do want to emphasize that I’m not a vet myself and I definitely agree that it will be best if you can find a vet in your area in whom you have greater confidence. For the time being, I have to agree with the discontinuation of the meds until you can get a second opinion as to what all is genuinely going on. The one exception is the heartworm protection since I know what a risk heartworm can be and I’m not at all knowledgeable about the efficacy of natural products. I’ve also had a dog who broke through with roundworms while being actively treated with a different Rx med, so I know that can happen. But fortunately I’ve never had any heartworm failures which of course would be a lot more serious.

Anyway, turning to your specific questions. My layperson’s understanding is that the cautions about Vetoryl and kidney issues arise if you have indications that the kidneys are not efficiently clearing the urine of waste products and toxins. This would be indicated by increases in creatinine and BUN values in bloodwork. If the kidneys are not functioning properly, then medications that rely on efficient kidney function to be properly metabolized (like Vetoryl), can build up in the system and cause overdosing and damage. I’m guessing that whether or not Vetoryl should be prescribed at all for any specific dog would depend upon the severity of the kidney impairment, but at a minimum, the dosing level might need to be reduced significantly even if the use is OK’d.

However, Cushing’s itself often produces a particular type of kidney issue whereby protein is allowed to leak into the urine (“proteinuria”). If kidney function otherwise appears to be normal, then Vetoryl treatment would likely be OK and even desirable in order to keep the kidney dysfunction from advancing even further. So we would want to know exactly what kind of kidney damage your vet had diagnosed prior to starting with the Vetoryl.

We’d also like to know more about the symptoms and actual test results that led to the Cushing’s diagnosis. You’ve already mentioned a thin coat and pot belly, and it sounds as though you’re pretty convinced that the diagnosis is accurate. But it’ll help us to learn more specifics, simply because some of the observable symptoms of Cushing’s can overlap with several other ailments — kidney disease being one. And if a dog is indeed suffering from a different systemic illness or stress at the time the Cushing’s testing is conducted, “false positives” can commonly occur.

Having said all this, undoubtedly your top priority is finding a vet who can accurately assess the kidney issues and who is knowledgeable about Cushing’s both in terms of diagnosis and treatment. I don’t know whether you live in an area that has any specialty veterinary practices or even a vet school. If so, we’ve come to learn that even though consultation with an internal medicine specialist may cost more upfront, you can end up saving money and anxiety in the longer run due to more accurate diagnostics and more specialized treatment recommendations. If a specialized clinician isn’t available to you, though, I’ll hope that you can find a general practice vet who seems more knowledgeable. Also, the manufacturer of Vetoryl, Dechra, is always happy to consult with vets about any of their Cushing’s patients. Dechra has technical representatives on staff who will set up case files and offer ongoing advice if vets have any questions at all about appropriate Vetoryl dosing and treatment. So as long as you can find a vet who is willing to augment any gaps in his/her own knowledge, that would be a good start.

OK, I’ll go ahead and close for now. I’m surely hoping your boy is still doing better today, and will be anxious to get further updates.

Marianne

[Alyson803]

Thank you! So far, he is doing OK. I have not started the Vetoryl again (as is indicated to not give dogs with kidney disease). I'm focused that, so I only feed him special kidney diet food (Blue Buffalo), which has allowed him to regain a healthy weight and more muscle (vice Royal Canin, which was mostly corn). I'm continuing with the phosphate binder and Denamarin. I don't think there is anything I can do about his Cushing's at this point, since I can't give him Vetoryl. I'm mostly concerned about his recently swollen lymph nodes under his chin/neck now. :-(

[labblab]

Yuck, that does sound a bit worrisome. Sometimes it just seems like it’s impossible to catch a break, doesn’t it! I’m so sorry about this new issue for you guys. But otherwise, it seems like you’re holding your own, and that’s good. Thanks so much for this update, and we’ll continue to hope for the best. As always, please do let us know.

Marianne