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Thread: newly diagnosed and Vetoryl side effects

  1. #1
    Join Date
    Sep 2018
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    Default newly diagnosed and Vetoryl side effects

    Hi everyone,
    As most, I’m here to make sense of what is happing to a beloved family member.
    After finding this site I’ve been reading for the last couple days and already learned so much, thank you for sharing all the knowledge!
    Sharma is a 12yo kelpie/Labrador (19kg), my husband got her as a pup and I met her 2 years ago when she was a beautiful, happy, little bit overweight dog. As long as he can remember she’s had the so called “rat’s tail” and drank a lot. Within our first year she lost some weight (but she didn't become unhealthy skinny) and her coat got very dry and a lot lighter/thinner, I started giving her fish oil to see if it would help. When she went in for her yearly C5 vaccination the vet spotted the tail and wanted to do some tests.
    ALT 153 U/L 10-125
    ALKP 238 U/L 23-212
    CHOL 9.92 mmol/L 2.84-8.26
    AMYL 489 U/L 500-1500
    LYM 0.81 x10^9/L 1.05-5.10
    EOS 0.01 x10^9L 0.06-1.23
    MPV 8.4 fL 8.7-13.2
    TT4 15nmol/L 13-51
    The vet put her on Thyroxine. We move around a lot and these are the only results I can find. I can remember that she did another after some time to see what her levels were, and that they were okay, but I don’t have these.
    After she got on the thyroxine Sharma became less energetic. She always ran and chased the ball and was far ahead during a walk but the pills seem to make her old. I told the vet this and she thought is was strange because usually dogs become more active. She said to continue and give it 9 months for her coat to become normal again.

    After a month on the pills I gave her a spot on flea treatment and within a week she had a big bald spot on her neck . The next couple months she lost more and more hair, a couple big bold spots on her body, bald legs, feet and nose and she had gone from a thick, soft, dark red to a prickly, thin blond. Basically she looked like a neglected dog.

    One morning we woke up to her having a very swollen face, it looked like an allergic reaction to a bee sting, except it was winter and she sleeps inside. So off to a new vet we went (we just moved again). The vet discovered two puncture wounds inside her mouth and said she might have fractured her cheek eating a bone. That sounded like Sharma seeing she always wants to eat (fast) and doesn’t chew her food or bones properly. He was a bit concerned that she was still bleeding and wanted to do a blood test and while doing that we might as well retest the thyroid as he suspected Cushings and thought the hypothyroid could be a side effect of the Cushings. I mentioned what the other vet said, 9 months, but so far I hadn’t seen any improvements so test away.
    MCH 26.1 pg 19.5 – 24.5
    MCHC 38 g/dl 31-34
    LYM 0.40 10^9l 1.00-4.80
    LY% 3.7% 12-30
    NE% 92.2% 62-87

    They couldn’t do the ACTH test because of her cheek. So 3 weeks later we went back for the test and because although the swelling was gone she had developed a bump, she also developed (what I know to be) calcinosis cutis. Turned out she needed a tooth extracted but they still did the ACTH.
    Resting serum cortisol 162 nmol/L 20-165
    Post-ACTH serum cortisol 408 nmol/L 150-470.
    They also tested her skin for mange or mites which came back negative
    Because of these results the vet decided to do the LDDS while she was in for the tooth extraction the next week.
    Resting 147 nmol/L 20 – 165
    post 3-4h 157 nmol/L >40
    post 8h 136 nmol/L >40

    As of last week she is on 60gr Vetoryl and still on the Thyroxine. During the weekend her left back paw was a little swollen and yesterday her right front “wrist” was swollen. We went back to the vet and he said it’s not a known side effect and has put her on anti-inflammatory meds again, we need to go back if it hasn’t gotten better next week.
    So after this long story I’m hoping to see if anyone has any opinions and maybe dealt with swollen paws as a side effect too? I would love to hear anyone’s thoughts.
    Thanks so much!

    Trish

  2. #2
    Join Date
    Apr 2009
    Location
    York, PA.
    Posts
    11,037

    Default Re: newly diagnosed and Vetoryl side effects

    Hi Trish,

    Welcome to you and Sharma! I am so sorry for the reasons that brought you here but glad you found us and we will help in any way we can.

    I'm quite concerned with the validity of the Cushing's diagnosis because Sharma was tested when she had a tooth that was in need of extraction. Unfortunately all tests for Cushing's can yield false positive results while a non-adrenal issue is present, such as in Sharma's case. Another thing that troubles me is that there aren't any obvious clinical Cushing's noted such as excessive drinking/urinating, ravenous appetite, intolerance to exercise, seeking cool places, reluctance to jump up on furniture or go up steps, panting, and pot-bellied appearance. I see that calcinosis cutis was suspected, was a biopsy performed to confirm this?

    The Vetoryl dose of 60 mg that is prescribed for Sharma is more than what is recommended for a 38 pound dog. What is being advocated now is a starting dose of 1 mg per pound of the dog's weight so for Sharma that would mean a dose of no higher than 40 mg. When did the vet say to bring her back to see where her cortisol is at to make sure that her levels haven't dropped too low, this would be with an ACTH stimulation test?

    Lori

  3. #3
    Join Date
    Sep 2018
    Posts
    2

    Default Re: newly diagnosed and Vetoryl side effects

    Hi Lori, thank you so much!

    After reading here for a couple days I was starting to get a little worried about it myself, the diagnoses and Vetoryl dose. She’s has the ravenous appetite but she has always had that and same with the drinking, although in the last two weeks her drinking seems to have gotten less. But other than her skin/coat and general decline (getting slower and her front legs have lost some strength) she doesn’t seem to have the symptoms.

    The vet didn’t recognise what was wrong with her skin and at first I was told (by a different vet in the same clinic) that they couldn’t do the mite test because they use the pus and she didn’t have any. During the tooth extraction (turned out they had to pull 4) and the LDDS, they tested for mites somehow and it came back negative.
    I shouldn’t have said that it was calcinosis cutis, as I just googled it after I read it somewhere on the forum and it looks like that, but it’s not bleeding or anything. Sorry!
    Her skin has improved a little in the 2 weeks she has been on Vetoryl and she is also starting to grow a little bit of hair on her paws again and she wants to chase the ball more than before. Could this happen even if she doesn’t have Cushing’s?

    The vet said to bring her in before the pills run out, 30 capsules, but he had to make some calls to see how to test her as the first ACTH wasn’t conclusive for Cushing’s. Could they do another LDDS?
    What would be the best way to go forward? Biopsy the skin for calcinosis cutis, is that just a Cushing’s effect? Take her of the pills and wait for awhile then do the LDDS/ACTH again or are there more tests that can be done?

    Sorry for all the questions..

  4. #4
    Join Date
    Apr 2009
    Location
    Georgia
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    15,292

    Default Re: newly diagnosed and Vetoryl side effects

    Hi Trish, and welcome from me, too! Thanks so much for this additional info. I must say that I had/have all the same concerns as does Lori, so I appreciate your answers to the questions she has asked. As far as the diagnostics, I’d hope to learn still more about the way in which the LDDS was conducted. Was Sharma hospitalized for more than one day, with the LDDS preceding the day of the extraction? If not, I cannot see how the LDDS could possibly have been accurate. Since it involves blood draws spaced over 8-hours, it would have been interspersed around the stress of the surgery, and also skewed by the medication associated with the surgery. So I’m totally puzzled about that. I will note, however, that if the LDDS results were truly valid, they could be associated with either the adrenal form of Cushing’s or the pituitary form. And since the ACTH fairly frequently gives a “false negative” for dogs with adrenal tumors, an adrenal tumor might explain her conflicting test results.

    As far as other diagnostic blood work, there are several consistencies with Cushing’s: elevated liver enzymes and cholesterol, and low levels of certain white blood cells as well as the low thyroid. Some observable symptoms such as the skin and coat issues are consistent; others not so much. For instance, the swollen face and paws are not common symptoms at all. So this still leaves us with a lot of question marks, including the trilostane dosage that’s higher than we would have recommended as a starting dose for a dog of Sharma’s weight.

    Given all these questions, normally I’d say I’d be stopping the trilostane for the time being if Sharma was my own dog. But then I come to a screeching halt when I read that she’s outwardly doing better since starting the medication. So perhaps the diagnosis is actually accurate after all, even with all the questions...

    As far as repeat or additional testing, neither the ACTH nor the LDDS has initial diagnostic validity for a dog who is actively taking trilostane. And unlike the ACTH, the LDDS is never used as a monitoring test after treatment has begun. If you want to rerun the LDDS diagnostically, Sharma would need to be taken off the medication for a while beforehand. If you decide to continue on the trilostane as long as she is showing improvement, then for monitoring purposes you would use either the ACTH, or as an alternative, we have recently learned that many vets in the U.K. and Europe have now adopted a revised trilostane monitoring protocol that involves pre-pill testing of a resting cortisol level alone, as opposed to a full ACTH stimulation test. This protocol is endorsed by Dechra U.K., the maker of brandname Vetoryl. It is hoped/believed that this new protocol may aid in even better management of Cushing’s symptoms.

    http://www.k9cushings.com/forum/show...=1252#post1252

    So these are my initial thoughts about Sharma’s rather complicated situation. Please do keep us updated as to how she’s doing!

    Marianne

  5. #5
    Join Date
    Apr 2009
    Location
    Georgia
    Posts
    15,292

    Default Re: newly diagnosed and Vetoryl side effects

    Just wanted to add two more things. First, if you are suspecting calcinosis cutis, you could indeed have the bump biopsied. An actual tissue sample has to be taken in order to diagnose CC — a simple scraping of the skin is not sufficient. However, if the bump is truly CC, you’d have advanced a long way towards confirming that the Cushing’s diagnosis is accurate.

    Secondly, you might want to consider an abdominal ultrasound to see whether an adrenal tumor is present and also to assess the condition of all of Sharma’s internal organs. If an adrenal tumor exists, surgery can offer a complete cure for the Cushing’s. However, it is a very expensive and risky surgery so not all dogs are candidates. If both adrenal glands are enlarged and no tumor is seen, it is assumed that a pituitary tumor in the head is causing the Cushing’s. One note, however, is that trilostane treatment itself can cause enlargement of both adrenal glands, so it is harder to make a diagnostic call in that event if trilostane treatment is underway.

    Marianne

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