new member- looking for advice

[jbwestie]

I am new here and looking for information. My 12 year old male westie was diagnosed with cushings this past September and started on vetoryl 30mg. Denali is 20 lbs and symptoms leading up to his diagnosis were excessive drinking/urination, incontinent of urine, hunger, and brown spots on his belly. Symptoms were gone pretty quickly after starting vetoryl. He just had follow up acth testing last week, his symptoms of excessive drinking/urination seem to be slowly coming back (not nearly to the level they were pre diagnosis though) and he has been incontinent of small amounts of urine the past week, Ive also noticed 2 new brown spots on his belly. In November is pre and post acth cortisol levels were 0.7 and 8.8. His symptoms were well controlled and his dose remained at 30mg. His levels from last week were pre 0.9 and post 5.3. My vet wanted to leave the dose the same, she was actually concerned about the pre being only 0.9 (though she never voiced concern over the 0.7 back in November). She is going to speak with an internal medicine specialist this week to review the results, but I am curious what people here think. I've been trying to read as much as I can about canine cushings. My vet is wonderful and takes a lot of time with me and Denali, but I am starting to get the impression she is not super experienced in treating this complex disease. I can't find much information about the pre acth cortisol level in regards to managing vetoryl dosing. I will add the testing was done both times 3 hours after his vetoryl dose (which he always take with a meal). Thank you all in advance, so glad I found this site and all the information here.

[labblab]

Hello, and welcome to you and Denali! I’ll be interested to hear the feedback from the specialist this coming week, too. You are correct that Vetoryl monitoring testing largely focuses on the post-ACTH result alone. Having said that, though, it does seem odd that Denali would exhibit such a big discrepancy between his quite low pre, and then subsequent post readings. I honestly don’t know what to make of that, myself.

It’s also a bit odd that his symptoms were resolved more completely when his post-ACTH cortisol level was running higher. Theoretically, his post-ACTH could still be lowered a bit more. But you certainly don’t want the pre-ACTH to dip any further, so that presents a dosing quandary. Was a blood chemistry panel performed alongside the ACTH? If so, were his potassium and sodium levels (“electrolytes”) within normal range? Glucose level? How about any other abnormal readings?

I do have to wonder whether there might be some other issue that is causing the rebound in thirst and urination — perhaps a urinary tract infection, for instance. That wouldn’t account for new skin spots, of course, but it would affect thirst/urination.

I wish I could be more helpful, but as you can see, I’m just throwing some ideas out there. Hopefully some other folks may have additional thoughts and suggestions. And as I say, I’ll be really interested to hear what the specialist has to say. So please do keep us updated. And once again, welcome!

Marianne

[molly muffin]

Hello and welcome from me too. I have several friends who have westies and one thing that really gets them is teeth. We've seen my friends westies, 2 different ones now, both have high cortisol and the cushing symptoms but it was both times due to teeth needing to be cleaned. Once cleaned, cortisol went back to normal. There was one (a different one) who was on thyroid medication for a bit, but again, dental was done and 3 months later all was normal. It's very strange. But worth checking out.

I wouldn't raise the dosage personally, because even on the same dose of 30mg the post number has decreased.

Marianne has thrown in some good questions, so we'll wait for your answers.

Denali, Alaska by any chance?