Moogle - recently diagnosed with Cushings (hypothyroid) Vetoryl

[Moogle]

Hello Everyone

Has anyone else experienced their dog not eating or drinking voluntarily after taking Vetoryl?

Our dog seems to have forgotten how to eat and drink and we are having to hand feed him both. He is a 14 and half y/o Parsons Jack Russel who has recently been diagnosed with Cushings. He has been prescribed 30mg of Vetoryl once daily which he has been taking for 20 days. He also takes 250mg of Fothyron per day for his hypothyroidism which was diagnosed about a year ago.

Any advise or experiences will be gratefully received
Thank you :0)
Graham & Zoe

[gpgscott]

Welcome,

Sorry you are having to treat but very glad you have found our site.

I have no personal experience with Trilo but I do have several questions and a comment or two. There will be many others currently treating with their experiences to please check back frequently.

Is the refusal to eat and drink sudden? It is well accepted that refusal to either eat or drink is reason to suspect an overdose and cease treatment. Also, what about his activity level and energy, does he act fatigued.

What Cushing's specfic testing was done and do you have results. These tests would include, ACTH; LDDS, abdominal ultrasound, and also full blood panels with particular focus on liver enzymes.

Would you please describe the symptoms which led your Dr. to suspect Cushing's.

I would follow the advice of the suppliers of Trilo and cease treatment until the reason for refusal to eat and or drink is determined.

Best wishes. Scott

[labblab]

Loss of thirst and appetite should be interpreted as warning signals that Moogle's cortisol may have dropped way too low on this dose of Vetoryl. How long has he been acting this way? Also, has your vet performed an ACTH monitoring test since beginning treatment? Standard protocol recommends performing this testing approx. 10-14 days after starting Vetoryl in order to insure that the dosage is not too high.

I am not a vet, but I strongly recommend that you stop giving Moogle any more Vetoryl until you have had the opportunity to talk to your vet and describe Moogle's problems. Did your vet supply you with any prednisone in the event that his cortisol might drop too low during treatment? If not, and if Moogle worsens -- becomes lethargic, starts vomiting or has diarrhea -- I believe you need to take him to an emergency vet in the event that you are unable to contact your own vet over the weekend. If Moogle's Vetoryl dose is indeed too high for him, this may have caused a chemical imbalance that can be very, very serious.

Please keep updating us as to how Moogle is doing.
Marianne

[labblab]

P.S. Here is a link to the U.S. Product Insert for Vetoryl that is published by the manufacturer, Dechra. This will supply you with a lot more important information about Vetoryl treatment and monitoring:

http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf

Included in the Insert is this warning:


INFORMATION FOR DOG OWNERS:
Owners should be aware that the most common adverse reactions may include: an unexpected
decrease in appetite, vomiting, diarrhea, or lethargy and should receive the Client Information
Sheet with the prescription. Owners should be informed that control of hyperadrenocorticism
should result in resolution of polyphagia, polyuria and polydipsia. Serious adverse
reactions associated with this drug can occur without warning and in rare
situations result in death (see ADVERSE REACTIONS). Owners should be
advised to discontinue VETORYL Capsules and contact their veterinarian
immediately if signs of intolerance are observed. Owners should be advised of the
importance of periodic follow-up for all dogs during administration of VETORYL Capsules.
Marianne

[Moogle]

Thank you for quick replies - it is not something that happened rapidly - he had high liver enzymes on his thyroid test from a secondary condition which was subsequently diagnosed as Cushing's after a borderline urine test and a positive stim test. He was going down hill as a result probably of the liver (lots of head pressing, pacing, fatigue and refusal to eat food from his bowl and disinterest in food but he was drinking lots). He had his 10 day test and his level was within normal parameters but we are taking him back to the vets for a test to check his levels 23 hours after his Vetoryl and get him checked over - we will get his blood panels and results from them to post. He seems really dry mouthed and as he didn't have an appetite before I wondered if the Vetoryl suppresses appetite.

Will keep you posted!

[labblab]

He was going down hill as a result probably of the liver (lots of head pressing, pacing, fatigue and refusal to eat food from his bowl and disinterest in food but he was drinking lots).
Thanks very much for the additional information. Vetoryl does indeed have the capacity to suppress appetite, but normally that's a welcome effect since many Cushpups suffer from ravenous appeptites prior to treatment. Can you tell us a bit more about the "head pressing" and pacing? I don't want to alarm you, but Cushing's dogs with expanding pituitary tumors can exhibit neurological abnormalities once the tumors reach a size that encroach upon other areas of the brain. Most pituitary tumors remain very small, but sometimes they do expand and are termed "macroadenomas." Loss of appetite, head pressing, circling, and aimless pacing can all be symptoms of this condition. Here's a link to a thread on our Resource forum that can tell you more:

http://www.k9cushings.com/forum/showthread.php?t=229

Marianne

[lulusmom]

Hi and welcome to the forum.

I agree with the others to stop dosing. Marianne has already mentioned that the head pressing, circling, pacing and inappetance are all symptoms of an enlarging macrotumor but they are also symptoms of serious liver disease. I would think the latter would be apparent on the blood chemistry and your vet would have already done a liver biopsy and diagnosed liver failure. Another tip off that it may be liver issues is that the head pressing and other symptoms worsen or only occur directly after a meal.

If Moogle were to have a macroadenoma, you may see a worsening of these symptoms with treatment. Cortisol is the bodies natural anti-inflammatory and once treatment reduces the cortisol, the inflammation and swelling is allowed to progress unabated. Have you noticed that Moogle's symptoms have worsened since starting treatment?

Was the first acth stim test, after 10 days of treatment, done within 4 to 6 hours of dosing? As others have already requested, please post the results here. Is your vet doing the next test 23 hours after dosing to determine if Moogle may need to be on twice daily dosing? If Moogle were my dog, I'm not sure I would be keeping that appointment as I would not be giving my dog Vetoryl until his appetite was completely normal again and I knew why he was displaying neurological signs. It's an expensive proposition but an MRI or cat scan is the only way to diagnose a macroadenoma.

Glynda

[Moogle]

Hello Everyone sorry for the delay in getting back to you all with the data you asked for. Also, very quickly; Moogle has improved but I will make a post straight after this one explaining our 'guess' at whats going on with him.

Urine Test: 20/01/2011 (Pre-Treatment with vetoryl)

Albumin 39 (23-35) H
Alkaline Phosphatase 1100 (0-160) *
ALT 139 (0-10) H
Amylase 410 (500-1500)
Calcium 1.89 (2.10-3.00) H
Cholesterol 6.9 (2.9-8.2)
Creatinine 52 (0-150)
Glucose 7.3 (3.0-7.0) H
Phosphate 1.69 (0.70-210)
S-T4 11 (10-56)
Total Bilirubin 7 (0-15)
Total Protein 65 (53-78)
Urea 4.5 (1.7-9.8)

Hematology: 21/01/2011 (Pre-Treatment with vetoryl)

WBC 6.19 xlO^9lL ( 5.50 - 16.90 )
LYM 1.30 xl0^9/L (0.50 - 4.90 )
MONO 0.69 x10^9/L (0.30 - 2.00 )
NEU 4.05 x10^9/L (2.00 - 12.00 )
EOS 0.13 x10^9/L (0.10 - 1.49 )
BASO 0.03 x10^9/L (0.00 - 0.10 )
%LYM 21.0%
%MONO 11.1%
%NEU 65.3%
%EOS 2.1%
%BASO 0.5%
HCT 47.5% (37.0 - 55.0 )
RBC 7.1 x10^12/L (5.5 - 8.5 )
HGB 16.0 g/dl ( 12.0 - 18.0 )
RETIC 19.7 K/uL
%RETIC 0.3%
MCV 66.7 fL (60.0 - 77.0 )
RDW 14.8% (14.7 - 17.9 )
MCHC 33.7 g/dl (30.0 - 37.5 )
MCH 22.45 pg (18.50- 30.00)
PLT 405. K/uL (175. - 500. )
MPV 8.21 FL
PCT 0.3%
PDW 16.2%

Bile Acid Stimulation Test: 21/01/2011 (Pre-Treatment with vetoryl)
Total Bilirubin 2.1
Bile Acids (fasting) 20.2
Bile Acids (post fasting) 23.7

ACTH stimulation Test: 28/01/2011 (Pre-Treatment with vetoryl)

Cortisol pre ACTH 133.0
Cortisol post ACTH 886.0

ACTH stimulation Test: 09/02/2011 (10 day test)

Cortisol pre ACTH 59.6
Cortisol post ACTH 175.0 (Slight lipaemia in both of these samples)

I hope I've put all the data in correctly. I wasn't sure what you needed so I put it all in. If anything looks way out it might be my typing so let me know and I'll check it again.

I will be picking up copies of the most recent test today and will post them later on.

Thank you all again
Graham :0)

[Moogle]

Hello everyone.

This is a rundown of what we think is happening to Moogle. After reading about macroadenomas (Thank you labblab!) Things seem to be starting to make sense. We feel this is what is happening with moo.

Everything he is doing seems to be exactly the same as he's always done except his behavior is dis-coordinated and fractured. If he gets what he want's i.e. go for a walk, have some food or drink, have a wee he'll will wander around with his tail up or settle down in his bed or even ask for a fuss.

His loss of appetite doesn't seem to actually be a loss of appetite, again oddly it seems like he's dis-coordinated. When he is hungry (or thirsty) he will stare at someone and lick his lips. If that doesn't work he'll get up and wander around in a certain root until we work what he wants. After he gets what he needs he will settle down.

Wet Dog food: He will appear to try and take it from his bowl or your hand but although his lip lifts slightly and he may press against it the food just doesn't go in. Sometimes his grab for food turns into a yawn? He will also occasionally try and snatch at food if you start to remove the food slowly, but again it won't go in and his attempted grab just fades. When we hand feed him we just post cubes in the side of his mouth which he seems to eat normally until he doesn't want anymore.(Spits them out or turns his head away.)

Freshly cooked meat: He will eat this from his bowl or from the hand. But again he won't just eat it. If it's in his bowl he will press his mouth against it for a few seconds then snatch it up. This cycle repeats until he's finished. From the hand he will wait a second then snatch at it, once it's in his mouth he will eat it normally. Once he overcomes this first grab he will then start taking it normally from your hand until he's feeling full then the process slows down again and becomes increasingly more fractured dis-coordinated again.

When he's thirsty we lift his side lip and pop a sports bottle in his mouth and he drinks that quite happily. But he's given up drinking from bowls as he has the same dis-coordination problem.

I could go on with a detailed observation of how he's living his life but won't unless some asks. So it's safe to say he's quit happy and relaxed nearly all the time at the moment. We're stressed and exhausted wondering whether we're doing the right thing, but doing our best :0)

We are gradually putting the pieces together and as we're remembering past events it does seem that many of the symptoms have been happening gradually over the last couple of years. We thought he was just getting old!

With regards to his occasional head pressing he does do this after he has eaten and he is doing it less, but it has been confirmed that his liver problems are secondary so we are feeding him smaller amounts more regularly. I'm hoping this might give his liver a chance to recover?

As you can see he has very complicated health issues and that's without his epilepsy so we have prepared ourselves for all eventualities. Again we are very grateful for all the info given so far and for any time people have spent for Moo :0)