Cairo, 8 year old staffordshire bull terrier just diagnosed

Well there you have it, now you know why he couldn't handle the stress of noise or being outside away from you, his cortisol went low again.
That dose he takes now is lower than the before when he went low correct? He can't go back on vetroyl/trilostane unless his symptoms come back, he might need steroid for awhile even. If he ever does have to go back on vetroyl, then he goes at a lower dosage, but for now don't worry about that.

Ask them to check his electrolytes and make sure that they are okay.

Let us know, we'll be worrying about you both

hugs
Sharlene and molly muffin

That's us back. It was the night vet we saw and she wasn't quite as forthcoming as our own vet. I asked how low his cortisol was and she just said "low". From past conversations with our own vet, if his cortisol was below 5, then they start worrying (and I need to go back and look at the conversions) so it was obviously below 5.

He got a steroid injection and he's on 5mg prednisolone for a week and go back next Friday for a baseline cortisol. Of course we stop the vetoryl as well.

I asked the vet if his electrolytes had been checked and she said no, it wasn't necessary :confused: We'll need to wait till Monday to speak to our own vet.

He actually seemed to be a bit better by the time we got home, so I'm assuming the injection had started to have some effect - he looked happier that's for sure. Poor boy. :(

Oh that poor baby, that is why he was so afraid, he had no cortisol in the fight or flight mode. I do not agree with the electrolytes not being checked as that can cause real problems. I just don't understand some if these vets attitudes with things that can be fatal, it just amazes me. I am glad to hear he is feeling better already. Blessings
Patti

I feel just so bad that I thought I was being kind, taking him different places for different walks and the poor baby was terrified.

I'm a bit fed up that his electrolytes weren't checked and I'll now need to wait till Monday to speak to his regular vet. I know that if my Addison's plays me up, I'll drink water with some salt and sugar in just to give myself a bit of a boost and I'm wondering if I should do something like that - or even give him rehydration drinks? Just in case?

Without knowing for sure if any or what electrolytes are unbalanced I would not try any liquid supplementation, such as pedialyte, right now because these types of solutions may have high levels of potassium and some dogs with unbalanced electrolyte may already have elevated potassium levels, just my opinion.

Hugs, Lori

Thanks for that. I'll keep an eye on him, and hang off till I speak to his regular vet. He ate all his dinner tonight and is now lying, quite content, snoring his head off. He seems quite calm and relaxed now.

I swear we could see him brightening up considerably on the journey home - it was like his lights got switched back on.

That is probably a very good way to describe it. Before he would have been a constant state of anxiety and with a bit of help, he could just relax and enjoy himself again. A good snooze is always enjoyment to a dog. (you can tell by the way they end up on their back belly to the world half the time! :) )

hugs
Sharlene and molly muffin

You mean like this? lol

https://www.flickr.com/photos/140327...n/photostream/

I agree with what Lori said, and just wanted to add that if you did give him like Pedialyte it would then skew any electrolyte test you vet does and you would not have a true reading, so as you said I would hang on for your regular vet. Blessings
Patti

I mean Exactly like that!
haha
sharlene and molly muffin

Alison. that picture is hysterical!

He decided at 11pm last night that he wanted to play!!

He seemed to have a good night and this morning he wasn't bad. He went on his walk and it was left to him for how far he wanted to go. He was fine on the outward journey but he started struggling and fast panting on the way home so he's not 100% yet.

We'll just have to take it easy with him and see how he goes.

I am so glad he was not afraid on his walk. I was worried about him when he went low. So glad you got him to a vet. I hope he continues to improve. Blessings
Patti

He wanted to go a little further on his evening walk but the further he went, the further he'd have to go home so we had to tell him it was home time. He's still not himself - normally we have a little chase and run but he didn't want to.

I know from personal experience when cortisol goes low it can take a few days to get over it so we'll just take it easy with him and let him dictate how he wants to play it.

He didn't eat much of his dinner tonight and he's still awful clingy. He just can't get close enough :(

My Tipper is real clingy when she does not feel well. These dogs are smart and they stick close to the person who cares for them in case they need help. I am hoping you get you vet and fond out about the electrolytes as that could be playing a a role in this. Just keep him close and watch for any signs of distress. I truly hope he is just taking a while to spring back to his normal self. Blessings
Patti

He's still not right. Still very clingy and didn't want to go far this morning - just far enough to go to the toilet and he's still stressing when he's out :(

We'll need to speak to the vet tomorrow - but is it normal for them to take a while to get back to normal after their cortisol has dropped so low?

It can take awhile yes. Speak with the vet on monday about having the electrolytes checked. Also, it might not be bringing the cortisol up enough, although 5mg should. Rescue is very small dosage but he has been down this road before of his cortisol going to low. Even 60mg vetroyl is too much for him.

I wouldn't take him on very long walks. He might think he can go, but his energy level is going to be very low and not sustainable. For now, I'd let him out to do his business, then back into where he feels most comfortable.

He probably feels safe with you, as we now know this is an indicator of still low cortisol levels for him.

Sharlene and molly muffin

Thank you. I always think that prednisolone doesn't act quick enough - I have Addison's and take hydrocortisone as it's in your system quickly but I guess it's different for dogs - I wouldn't use dex as an emergency injection as again it takes too long to get active - but that's from a human perspective.

Just away to take him out for his afternoon stroll. I'll do what I did yesterday and not let him continue even if he wants to.

I feel quite neurotic - though I did say to the vet I felt I was being a neurotic mum - but I wasn't cos he was ill.

You are not being neurotic, it takes a watchful eye to manage these Cush pups well and you are doing a great job. Blessings
Patti

Just spoken to the vet. We've to take him back in to get his electrolytes checked and I'll ask her to recheck his cortisol levels.

He's just not picking up at all.

My mum asked what his cortisol levels were on Friday and she said they weren't even registering.

I could cry.

Omg. That is danger low. He might need some iv fluids and larger shot of pred or dex.
Since this is is second crisis, please do not restart vetroyl unless 1) symptoms come fully back. 2) a test shows that his adrena l glands are now functioning.

Hugs
Sharlene and Molly muffin

We're back. They took more blood to check his electrolytes - the vet will phone later today with his results. He got another steroid injection and we've to increase his prednisolone from 5mg a day to 10mg twice a day and he goes back on Friday.

The vet said that it wasn't worth checking his cortisol today as they normally leave it a week before checking. He said the 5mg was quite low for a dog of his size hence the increase.

The vet's just phoned. His electrolytes are fine which is a relief.

She's not sure what's going on but she says it's like he's storing the vetoryl and will tick along OK but it's like it's building up in his system and then he's crashing which she says is not good.

He's to take it easy this week - no heavy exercise, no long walks and he goes back on Friday to get his cortisol checked again.

Glad to hear the electrolytes are ok. The thing that concerns me is that the vet states he is storing up the Vetoryl, which it leaves the system within 12 hours. I am wondering how she then thinks this is possible?? That is the reason many use it, as it goes out of the dogs system. I am wondering bout the dosing you were doing. How many mgs and how many times a day? The dose may be too high, needs split up, or reduced all together. I definitely would give no more Vetoryl until he is well, and until this is figured out. He is lucky to get thru that Addison's crisis as well as he has. Hope he continues to improve. Just know you will want to ask what his numbers are any time this would happen, instead of the vet just saying he is low. Blessings
Patti

He was on 60mg once a day but if and when he's to go back on it, I'll see about twice daily dosing. It might be more stable doing that?

She couldn't give us numbers as his cortisol levels weren't registering :(

The vet just said it was as if he was storing it as he ticked along for quite a few weeks fine, then he suddenly plummetted.

I am not thinking this vet is understanding how trilostane works, or he would not say the dog is storing it. How much does Cairo weigh? He should have started out on this at 1 mg per pound. If it is over that then that is the problem that his dosage is too high, and he is OK for a while until it takes the cortisol down too low into Addison's. If he is on the correct dosage then there is something wrong. How experienced is this vet at treating Cushing's? Blessings
Patti

He's lost a wee bit of weight and is now 27kg (about 60lbs)and was on 60mg.

Could it be that he's just needing a lower dose? We can only get Vetoryl in 10mg, 30mg, 60mg or 120mg doses here. Obviously we can mix and match to get the right dose if it's in between available strengths.

Yes just a recap for those who don't know. Cairo was on 120mg and crashed. Vetroyl was lowered to 60mg and once again, a crash.
In England they cannot currently have a full ACTH done, so base cortisol and electrolyte monitoring is all that is available.

Cairo, should not if and when symtoms come back, go onto 60mgs of vetroyl again. The dosage should be lower and perhaps even a spit. At 60lbs the 60mg was a decent dosage to be at, but he'd already crashed once on 120mg. I'm thinking now, a lower dose split of like 20/20, (you can get compounded trilostane). You could also try a 30mg AM and a 10mg PM. But not a 60mg of any combination since he crashed on that. That is IF symptoms come back completely.

Patti is correct. Vetroyl does not store in the body, in 12 hours it leaves the body. That doesn't mean that too large of a drug wouldn't send him into a crash, which we have seen. Every dog reacts differently and some are more sensitive, and it appears that Cairo is one of the more sensitive.

Hope that helps to clarify.
:)
hugs
Sharlene and molly muffin

Thank you. Yes that helps. He goes back on Friday to have his cortisol checked so we'll see what that says but I'll make sure he doesn't go back on that dose again and I'll ask about twice daily dosing as well.

When he was on the 120mg, his cortisol dropped to 17 and was caught on his routine stim test - he wasn't showing any symptoms of low cortisol at that point which scared me cos I didn't know if I'd recognise if he was too low - though I really didn't want to have to put it to the test.

We did get the stim test done on Friday - so I'm assuming we're back up and running with the synacthen now thankfully. I wonder if this would have been caught earlier had he been getting the stim tests.

I assume his cortisol will be quite high on Friday since he's going to have been getting 10mg pred twice a day? It was increased today because he wasn't picking up as well as hoped.

Oh, and I'm not sure if we can get compound trilostane over here - I've never heard of compound medications for dogs - but I could be wrong. I'll ask.

Please post the results of the testing you had done so we can see if we can make anything out from it. Sharlene is right her needs a much lower dose and I would go with the 20mg morning and 20mg evening also. You so not want him to crash again. Blessings
Patti

I don't have his results in any paper form so I've went hunting for what I had.

His first stim test after diagnosis and being on 120mg was 88

He was left on 120mg but our vet was on holiday and it was a different vet that did his next stim test.

Cortisol was 133 on that stim test and that vet said to leave him on the 120mg.

His next stim test was done by our normal vet and she phoned urgently to say that his cortisol levels were only 17 and we were to stop his vetoryl for 10 days and repeat the stim test.

Next stim test was over 700 (can't remember the exact number) so she started him on 60mg this time and repeat stim test was to be done after 3 weeks.

Results after that were 60 (November 2013 and this was fasted)

January 2014 - 55 (baseline only and he'd been fasted)

February - 67 (this was baseline cortisol only and he'd had his breakfast with his pill - prior to this, we'd been told to fast him but then I found out that he should have been getting food)

These values are all nmol correct? I think that is the unit used in the UK.

Sharlene and molly muffin

Yeah, they are. Just trying to remember the conversion - it is posted somewhere - divide by 27.49?? Is that right?

you divide by 27.59

is first stim test after diagnosis and being on 120mg was 88 (3.18 ug)

He was left on 120mg but our vet was on holiday and it was a different vet that did his next stim test.

Cortisol was 133 (4.82ug) on that stim test and that vet said to leave him on the 120mg.

His next stim test was done by our normal vet and she phoned urgently to say that his cortisol levels were only 17 (0.61ug) and we were to stop his vetoryl for 10 days and repeat the stim test.

Next stim test was over 700 (25.37ug) (can't remember the exact number) so she started him on 60mg this time and repeat stim test was to be done after 3 weeks.

Results after that were 60 (2.17ug)(November 2013 and this was fasted)

January 2014 - 55 (1.99ug) (baseline only and he'd been fasted)

February - 67 (2.42ug) (this was baseline cortisol only and he'd had his breakfast with his pill - prior to this, we'd been told to fast him but then I found out that he should have been getting food)

Was he on pred after that first crash? That could have made his next stim (700nmol) go up a lot, because it is actually the abnormal of all of these.

No, he didn't get put on pred - just told to stop the vetoryl for 10 then repeat test and that's when it went up to over 700.

Having said that - all the previous tests were done fasted as we'd been told he wasn't to get anything to eat - then I discovered on here that he should have been getting his vetoryl with food so prior to the February test, he'd been fasted.

BTW - the vet we saw today (wasn't our usual vet) put his pred up to 10mg twice a day to try and get some improvement in him - is that OK for a 60lb dog?

In my opinion the whole thing started off wrong. This dog should never have been started on 120 mg. This has all been mismanaged by these vets and I thank God your dog is still alive after all this.please make sure you feed him and give his Vetoryl and have the testing completed within 4-6 hours after taking the Vetoryl. Every time you take him for a test take him at the same time of day. Let us know his stim numbers , before doing anything with the dosage no matter what this vet says. Please let him fully recover, then go low and slow with any changes. The 20 mg in the morning and 20 at nite will be a lot safer for him to start back on. Same dogs can have real sensitivities to this drug, so low and slow is your best bet. I feel so bad for this dog. He must feel rotten after all this. There is a lot of experience on this forum, and you can trust what they tell you, we only want to keep your dog safe which is paramount after all this mess. We will all be here to help you every step of the way. Give Cairo a hug for me he sure deserves it! Blessings
Patti

I do appreciate all your advice and every time I went to the vet, I expressed concerns and told her what I'd been told but she was convinced she was doing the right thing going by Dechra's recommendations. When she put him on the 120mg, that was right in the middle of the dosage guidelines and even now, she says that 60mg is the bottom end of the recommended dose for his weight.

It's become obvious that Dechra need to sort out their literature that goes out to vets - they maybe need to instruct vets to start low and slow instead of having them hammering drugs into the dogs.

Nobody feels worse than I do. I can't forgive myself for what's happening to him.

OMG, of course no one feels worse than you do about what Cairo is going through and it's really only because you got him in and demanded that they do the tests that he has made it through this.

I blame Dechra completely for the mess, along with vets, but I can tell you that here in Canada and in the UK it is not like in the states,where you can pick up a phone and talk to Dechra personally about what to do. We can't and are told that they will only talk to the vets themselves and the vets are told they need to speak with the manufacture reps who sell/provide the the medication. They haven't updated their literature and they won't from what I understand. The reps read the same literature by the way that is included in the medication inserts, so we are rather royally screwed on this and have to fight for every little step.

On the forum here, luckily, we keep up with the latest studies and what the universities and professional IMS's are doing with cushings. That is really the only edge that us who are not in the states have, is a forum like this.

In the UK it is even harder to get compounded trilostane. It can be done, but it's not easy and most vets haven't a clue they can or how to go about it. My vet here in Canada didn't have any knowledge about it either, and only when my IMS mentioned it and thank goodness I have that in writing, was trilostane considered an option.

It's darn hard and you have and will continue to be Cairo's champion, I know that.

I'd have to go back through our thread, but was an ultrasound ever done? or is that even an option? It might be worth it to see if it is possible, just to see what is going on inside of Cairo. Something to think about and maybe talk to your vet about.

Even though 60mg is on the low side of the recommendation, what works is unique to any dog, and those are only guidelines. We know that Dechra in the states is no longer starting dogs out at the high end of the range, but at the low. I wish the rest of the Dechra world would get on board and put that info out to every vet. *sigh*

Okay, I'm ranting at this point. I just want you to know that we DO know that you care and are doing your very best for Cairo and we understand that it is sometimes an uphill battle with the vets.

hugs
Sharlene and molly muffin

Thanks Sharlene:) I tried getting in touch with Dechra, and as you said, they won't have anything to do with me.

I think an ultrasound was mentioned at the beginning but if my memory serves me well (which most of the time it doesn't) the vet said that the LDDST indicated pituitary based so it wasn't worth putting him through the ultrasound. I was just saying to my mum tonight though that I wonder if it's worth getting it done. Only problem is that Cairo doesn't sedate well - and I'm convinced that's down to the Cushings - I don't know if I'm right or wrong - but many years ago, I had to get a gastroscopy and I was sedated and don't remember a thing about it - but most recently, since my Addison's diagnosis, I had to get one and they gave me extra steroid before it, sedation and I fought like a mad woman and I reckon it was down to the extra steroid. Anyway, I digress. I think if I can ask her to sedate him and let me be there for the ultrasound so I can keep him calm, that could be an option - but I don't know if they would let me do that. Vets here seem to be a bit funny about you being around when things are getting done - like the vet the other day (not our normal vet) asked if we wanted her to take him away to get his injection - err, no, he stays with us.

I really did try though to get the vet on side about the initial starting dose but because of the Dechra literature, she wouldn't be swayed. I suppose I can see where she was coming from - the manufacturers literature said one thing and the neurotic owner was saying something different. I've no idea how UK vets can be informed about new research in the US if Dechra aren't going to sort out their literature.

Has Dechra US actually stated about the lower starting dose? If they have, I have the urge to write to Dechra UK and rant at them. I did have a look on both sites and the literature seems to be the same.