Recovering from possible too high dosage of Vetoryl

[SpringerX2]

Updated on Chloe. Our vet is closed on Wednesdays which is why we scheduled her to go in on Thursday for her ACTH test. Last night she did eat some food, more of the high caloric A/D Science Diet brand mixed with about a quarter can of Blue Buffalo. By bedtime she was full of energy and even doing her happy prance around the house. However, this morning she refused food again. I didn't have any more of the A/D food but she refused everything else. So, I guess the roller coaster continues. The whole inconsistent appetite and eating thing is just throwing me. I don't understand it and she has never been one to refuse food of any kind. Her attitude indicates she is getting closer to back to her normal self. At this point it is only the eating thing that is concerning me. But at least she is eating a little bit.

A question I have from your experiences is what should I expect her ACTH test to come out like? I'm not sure what I should be expecting at this point after being off the Veroryl for over a week.

[labblab]

I’m so glad Chloe at least is showing bursts of normal behavior, and I sure do agree with you — the overall picture remains puzzling. At any rate, the ACTH tomorrow should help identify whether or not adrenal oversuppression is a part of the problem. Something altogether different may be going on, but the cortisol level and a repeat of her basic blood chemistries should be helpful.

After a full week without her trilostane, you’d normally expect her post-ACTH level to be higher than it was previously running on her earlier monitoring tests. Exactly how much higher depends on the dog, but you’d expect the lack of medication to be evident in an increase in the post-stimulated cortisol level. If, instead, her post-ACTH is low and “flat” — not much higher than the baseline reading — it would appear as though her adrenal function is impaired. Exactly how long such an impairment would last is totally a question mark, and varies from dog to dog.

Just to repeat, those potassium and sodium levels are also important. If they’re still out of whack, then the aldosterone level may be a primary issue in addition to, or instead of, the cortisol level. So I’d want those levels rechecked tomorrow, as well.

In reading back through your thread, one crazy thought did occur to me. You mention her romping around during a weekend snowfall immediately prior to her illness. Is there any chance that she got her paws contaminated with salt pellets or brine used to treat icy spots on streets and sidewalks? I believe the chemicals used can be toxic — similar to antifreeze — and if she was exposed to them via licking, etc., that might be the source of a problem. We got a couple inches of snow here in Atlanta last week, too, and I’ve been having to dodge street/sidewalk chemicals ever since. Since we don’t have many snowplows, the chemicals get dumped in BIG quantities, and it’s always an obstacle course for me and my dog afterwards. Anyway, a wild thought, but it just occurred to me in terms of the timing of her illness.

I’ll really be hoping she does better again this evening, and we’ll definitely be anxious to get the results of the testing tomorrow.

Marianne

[SpringerX2]

Well she's at the vet for the ACTH testing today and I did ask that they do a full blood analysis on her since she had so many things that were either high or low on her last draw from last week. It wasn't just the potassium and sodium levels.

We live out in the country and she was only running around in our yard not on the road with the snow, so I don't think she would have been exposed to the salt on the roadway. We did not salt our property at all. She was definitely eating the snow though. On that Sunday night we actually thought she had hypothermia. The first symptom we noticed was shaking, which I failed to mention above. She was shaking on Sunday and I was concerned I had let her outside too long playing with us. She had the shaking through Tuesday last week but that has gone away.

She still is selective with her eating. My husband keeps suggesting maybe she is just being picky. But she has never been a picky eater. She would eat pretty much anything you'd give her. She will never eat in the mornings but by evening I am sure she is starving so we can get her to eat in the evening but only select canned foods and definitely will not touch dry food even if it's mixed with wet food or broth. Very strange.

[molly muffin]

We are all I think really curious to see what the ACTH test results come back like and also her other levels. I'm glad they are looking into everything. I'm hoping that this has all leveled out in her.

I don't think she is just being picky either. It is a sign that something is going on and she doesn't feel good usually and her previous test results bore witness to that being the case, so it is important to stay on top of how those levels are changing and if they are getting into a better range.

[SpringerX2]

We won’t get the results until tomorrow on the ACTH and blood work. The vet wanted to do X-rays today since he agreed her lack of eating is peculiar. The X-rays showed nothing really other than a possible inflammation near where her pancreas is. So he sent us home with an anti-inflammatory/ pain med Tramadol. We will see what blood work looks like tomorrow but next step he said is to go to another vet that specializes in internal medicine to do an ultrasound. I’m not really sure what to do honestly. She didn’t eat breakfast again. I brought more of the high caloric a/d food from our vet and she only ate a few bites. She is definitely not acting herself. The meds he gave says they may cause drowsiness do now I won’t really know if she’s acting lethargic because of those or because she’s sick. Oh and another curve ball is that my other dog Sam threw up the same yellow bile today that Chloe did last week. He is eating fine and nothing else seems to be wrong with him. Only thing different with him is that he’s been eating all the different foods we’ve been trying to get Chloe to eat.

[molly muffin]

If there is an inflammation near her pancrease, then pancreatis is a possibility and that would cause her not to want to eat. It is also painful, so that might be what he is thinking.

If so, small meals, several times a day usually works best and very bland. Often mushy rice and chicken that is basically boiled with lots of water, is a good option.

[DoxieMama]

Just throwing this out there - but is there any chance Chloe got into something she shouldn't have? And perhaps Sam got into it as well, only more recently? I would bet that is NOT the issue but wouldn't feel right about not mentioning it.

As Sharlene said, pancreatitis is a possibility. Hopefully those test results will show something conclusive!

[SpringerX2]

Well I got her ACTH Results back, her pre level was 2.3 and her post level was 2.4

Although I asked for a full blood analysis to see how all of her other levels had adjusted over the week he didn't do it because the last one was just a week ago and he didn't think anything would change in that time. So now he has referred me to another vet specializing in internal medicine. Who will want to do an ultrasound and more blood work and who knows what else.

Meanwhile, Chloe refused food again this morning. They did call in an appetite stimulant to see if that would help. But I'm just feeling like how much more do I put my dog through? Clearly something is not right with her. Do I give her another drug to try and make her eat when something in her body is telling her not to eat? And we don't even know what it is or why this is happening.

[Squirt's Mom]

I would try a very dilute broth to start - chicken or beef as she prefers. As long as she is drinking she can go a few days with no food but after that length of time I would want to get some NutriCal into her. It is a paste that contains all the vitamins and minerals she needs....but it also has quite a bit of fat which is not good for Pancreatitis if that is what is going on with her so the broth would be best if she will take it. I would try it several days in a row before giving up on it tho. If she takes it then add a bit of rice or pasta and as she takes that add a bit of the meat til she is eating again.

[labblab]

I’m very glad you’ve been referred to a specialist, and I’d try to get Chloe in to be seen as soon as possible. Given the results of the ACTH and last week’s blood chemistry, I think we do know at least a big part of what’s going on — her adrenal function is compromised, and she may need to consistently receive two types of supplemental steroids for the time being in order to allow her to feel better. Remember that I wrote earlier that after a week without trilostane, you’d expect her post-ACTH reading to be higher than on previous monitoring tests. Instead, it is significantly lower and only barely higher than the baseline reading. This is that “flat” response that I was telling you about. That is not a typical response for a Cushpup that is not taking any medication.

Also, I’m bothered by your vet’s decision not to retest electrolytes. Good grief, they were out of whack last week, even, and nothing was done to address that. With a dog who continues to behave abnormally, I would think the vet would want to know whether the imbalance has worsened.

I totally understand your concern about the expense of starting anew with a specialist. But just remember, you don’t have to agree to any testing that you are not comfortable with. And in honesty, I suspect that along with her history, these blood tests alone will tell the specialist a lot.

Do you still have some prednisone on hand in the event that she worsens before she is seen by the specialist? I am not a vet, but I really do suspect that adrenal oversuppression is the culprit here.

Marianne