Syd

[Alipot]

Thank you for accepting me to the forum.

Syd my 11 year old border terrier was diagnosed with Cushings in June.
He had a number of symptoms including hair loss, pot belly, hunger, lethargy, drinking and peeing excessively and was put on a daily dose of 30mg vetoryl. The drinking and peeing improved almost immediately but last week we noticed it was increasing again so returned to the vet.
Based on his last acth test (07 August) she decided to increase his dose by 10mg to 40 mg daily, she explained this as being due to his cortisol levels still being slightly high (219) on his last test but the lab had recommended not to increase his dose as in their experience it would not be necessary.
He has had 4 days on the increased dosage and so far there has been little improvement, he has to have a repeat acth next week and depending on the results, if there is no improvement they will investigate further, just to add he was tested for diabetes on our initial consultation in June and this was negative.
This is all new to me and I feel a little overwhelmed and out of my depth, particularly as I have difficulty retaining information. I feel I am panicking unnecessarily but do so miss my bouncy, happy little chap.

[Squirt's Mom]

Hi and welcome to you and Syd! :)

It is not uncommon to have a period of finding that sweet spot with Vetoryl. Dogs do well on a certain dose for a while then need an increase or decrease...so this is not something to worry over. It is common. So take a deep breath and try to relax about this part. And BOY! do I know how hard it can be to relax so let's just call this a kettle talking to a pot. :D

It would help us a great deal if you could get copies of the actual test result for Syd, both those when being diagnosed (ACTH, LDDS, ultrasound, wellness check showing things like BUN, CHOL, etc) and the monitoring ACTHs since starting treatment. This info will help us provided the most meaningful feedback we can.

Can you tell us more about Syd. Does he have any other health issues? Is he on any other meds, supplements, herbs? What prompted the testing for Cushing's in the first place? Were you seeing changed in Syd? If so what were they? The more you can tell us the better. We LOVE details! :p

I'm glad you found us and know others will be along soon to chat with you.
Hugs,
Leslie

[Alipot]

Thanks for the reply. I will try and get his test results but I'm pretty sure my vet's will not print copies will ask if they will e-mail them.
Up until 2 years ago Syd was a happy, typical terrier, very healthy with no vet visits except for routine ones for several years. Then 2 years ago he was attacked by another dog, just after this he became very reluctant to go on walks, we put this down being attacked but gradually he got worse and lost his terrier enthusiasm. I kept saying to my husband that something wasn't right, I've known all my dogs and you can just tell, but couldn't put my finger on it. Vet checks revealed nothing either.

Last year he developed recurring ear problems, itchy and sore, this was put down to allergies so we changed his diet and did see improvement but I still had this niggle, people put it down to aging but I've had terriers for most of my life and this didn't ring quite true, he'd also lost some hair from his tail, his muscle tone on his back legs was disappearing but this was put down to lack of exercise. During his last treatment for his ears he was given a course of steroids when the treatment was completed I again voiced my concerns that something wasn't quite right with the vet, they did a full blood count which showed raised cortisol levels which was put down to the recent course of steroids.
He was also becoming increasingly hungry all the time, then the little accidents started at night when he'd wet himself or dribble in the morning before he was let out to toilet. I'd not monitored his water intake we'd just fill his bowl as and when needed so I began to measure his water intake before going to the vet's and was shocked to realise he was having approximately 3 pints per day.

Went to see the vet (a new one at the practice) armed with a water sample, this confirmed no diabetes but it was very diluted. A full blood panel was done and this indicated possible Cushings so the relevant tests were done the following day and he was on 30mg vetoryl 2 days later.
The improvement in his drinking was fairly rapid and he seemed a little more interested in life then we noticed the drinking increasing again.

[Harley PoMMom]

Hi and welcome to you and Syd from me as well!

Diluted urine is very common with cushdogs and they can also get UTI's frequently, which does increase water consumption along with urine output. When their urine is diluted a regular urinalysis may not pick up any bacteria so an urine culture and sensitivity test is recommended. Has Sydney had this kind of test performed?

Hugs, Lori

[DoxieMama]

Welcome to you and Syd! Leslie and Lori have covered all my questions, so I don't have anything more to add. You are doing a great job! We'll be here to help you along the way. Hang in there!

Shana

[Alipot]

Thank you for the replies, I have to say testing in the U.S. seems much more thorough than here in the U.K..

I have decided to take him back to the vet today to voice my concerns, he is due to go next week for an acth test following the vetoryl increase, I may be jumping the gun, but his wellbeing is my main priority and I'm going with my gut feeling that this increase isn't working and isn't going to. Hopefully they will bring the test forward so we can move on and try to find out what's really going on.

[Alipot]

Oh and Lori, I will be armed with a pee sample :)

[Harley PoMMom]

Oh and Lori, I will be armed with a pee sample :)

LOL! Good job, Mom!!! Keep us posted, please.

[Squirt's Mom]

Let us know what you find out! You're doing a good job, Mom!

[Alipot]

Well the pee sample may have possibly been a success, I asked outright about the possibility of it being a UTI, she said they'd need a sample which I then gave them, tested again for diabetes and was negative, no blood but there was a little protein, though she did say it was almost pure water, and he has a raised temperature.
We now have a course of antibiotics and if no improvement will have a full blood count to check liver and kidneys. Thanks once again for your support and advice.

[Harley PoMMom]

When the urine is diluted an urine culture and sensitivity test is recommended because a regular urinalysis may not pick up the bacteria in the urine.

[molly muffin]

It's very possible that there is a UTI now, which a culture would catch. At 219, he has room to come down further (219 = 7.9ug) And you can go to under 5ug if symptoms are not resolved. So it might be better to get him down to somewhere just under 5.0 mg (around 137nmol, which is what the results in UK are given in)

[Alipot]

Yesterday I had Syds latest acth results, his levels are now at 322 despite the 10mg raise in his dose, compared to 219 in August. The vet contacted Dechra and they are confused too, they said to repeat test in 2 weeks, this will be a month after dose increase. If results are not improved then further liver tests will be done as both values are raised. Dechra have registered his case and will work with the vet.

I still haven't obtained his full test results yet.

[molly muffin]

Did they check for a UTI? It is strange the levels would continue to rise with increases in cushing meds. I'm curious if something else is going on, causing the cortisol increase.

[Alipot]

That's what I think as well, to be honest I don't see the point in waiting another 2 weeks before looking into it, if his levels were raised on an increased dose then it's not working. The only reason we''re waiting is because Deuchars asked to give it more time as they say it can take longer for the increase to work.

[Carole Alexander]

Hello to you and Syd and welcome. Just read thru your thread and the moderators here are giving you great advice. While I know the 'numbers' can fall lower over a month, my experience was similar to yours, number creep and little to no improvement in symptoms over nearly four months. I regret the decision to not look deeper for the underlying cause much sooner. I agree with your thinking and wish you the best. I am uncertain as to what additional testing would be appropriate but others here and your vet will have thoughts. If nothing is found and an MRI is in the realm of affordability, I would do it knowing what I know now. It could rule out or in a growing pituitary tumor and the potential months of anguish, frustration and confusion along with the trickle of dollars wasted by the hundreds for tests and treatment.

Carole

[Alipot]

Spoke to the vet today, syd's latest result is 270, an improvement from the 324 from his previous acth. He has now been on the 40 mg of vetoryl for just over a month. They are now consulting with dechra about the possibility of another increase to his dose, he's a 12.2kg border terrier, an increase would see him on 45 or 50 mg, does this seem too high? I realise they are trying to reduce the symptoms but am a little concerned, she said ideally they would like to see him at around 150.

He is still drinking and peeing, about the same and has the hunger, apart from this he's pretty much ok.

[labblab]

Hello and welcome back! Yes indeed, it seems to be a good thing that Syd's cortisol level is lower this time around. But if he remains symptomatic, I understand why your vet is considering an increase.

I would not be concerned about a dosage of 45-50 mg. for a dog who weighs 12.2 kg. (almost 27 lbs.). It is the case that initial starting doses of Vetoryl are based on weight alone. But after that point, the combination of test results and symptom resolution determine optimal dosing, and this proposed dose does not seem to be exorbitantly high given therapeutic dosing ranges that have commonly been reported in clinical studies.

So if it were me, I'd feel OK about an increase if that's what Dechra recommends. Do let us know, OK?

Marianne

[Alipot]

Thanks, that's eased my mind, will hopefully know more on Monday.

[molly muffin]

We've seen smaller dogs on large doses and big dogs on smaller doses, so much is determined by the dog itself and how it reacts to the drug.
As Marianne said the starting recomendation is just where to start until you know how your dog will react to the medication and you go from there based on testing and symptoms. 150 would be a good place for a post result to be.

[Alipot]

Just had the latest acth result back for Syd, post result is 146, dechra happy to continue at present dose then retest later in November. Could anyone please advise what the lowest result would be before levels drop too low please.
We are seeing quite a few improvements in his symptoms, drinking/peeing reduced, much livelier, he's still a greedy little git but then he always has been.

[Harley PoMMom]

You don't want to see the post number under 2 ug/dl, which is 55.18 nmol/L.

[Alipot]

Thank you.

[Alipot]

Well the rollercoaster of Syd's Cushings continues, his latest acth result is 282, following the 146 in October after the increase to 60 mg.
My vet has once again spoken to dechra and they don't want to increase the dose as I think she said his electrolytes are lower than they would like.
We have to take a urine sample in on Friday, continue on the present dose and retest in a month when the vet will send an extra sample to another lab for more accurate testing.

[labblab]

Wow! What a rollercoaster, indeed... How is Syd doing in terms of obervable outward symptoms? Is he holding his own, or are they worsening again?

Marianne

[Alipot]

He actually seems quite happy, still hungry and drinking too much, lost more hair on his underside, he's still quite active likes his walks, doesn't play as much as he used to and is pretty alert. I'm at a total loss with it all!

[Alipot]

The vet did mention twice daily dosing yesterday but it was dismissed as his symptoms didn't get worse in the evening's, he does however drink a hell of a lot in the mornings, it has been suggested to me that twice a day and maintaining the vetoryl in his system, may be beneficial, I've just made an appointment to see the vet tomorrow as i have a few questions, does anyone have any experience or thoughts on this please.

[Harley PoMMom]

My vet has once again spoken to dechra and they don't want to increase the dose as I think she said his electrolytes are lower than they would like.


What were his electrolyte levels, mainly the potassium and sodium?

[Alipot]

Won't know until tomorrow when I see vet.

[molly muffin]

Hello, Just wanted to check in and see how Syd is doing. :)