Yohnny 11 year old Shih-tzu with Cushing-like problems

Just keeping you in the loop with Yohnny.
Good news :)
He did his second Pre Cortisol Vetoryl Pill Tes today after 2 month on Vetoryl and this is his result:

Cortisol-Vetoryl 76,1 nmol/l 30 - 200 emås

Also his U-Protein/Crea quote is now 0,5 (Earlier it was up at 1.7 and then 0.9 after a moth of Vetoryl)

I am happy. They did find a small heart murmer (Level 1 of 6) so wanted to ask if it is ok to give supplements for this? Just to help his heart a a little. My understanding is to stay away from fats, but would it be ok to give CoQ10 oil?

Thanks in advance. /Amanda

Hi Amanda, and thanks for this excellent report! I’m so happy for you two! ;)

As far as the CoQ10 oil, I’m afraid I don’t know anything about it so I can’t make a recommendation one way or the other. I doubt that the fat from the oil would present any problem, but I just don‘t know whether the supplement itself would be a help in this situation. If the vet recommended it, though, I’d think it would be fine.

Continued best wishes to you both!
Marianne

Great update on Yhonny! Always nice to hear good news! The CoQ10 should be fine to use and can help with any heart issues, along with other conditions. Here is a link to an article written by Drs. Steve Marsden, Shawn Messonnier, and Cheryl Yuill.

https://vcahospitals.com/know-your-pet/coenzyme-q-10

My boy Yohnny is on Vetoryl 10 mg per day taken in the morning. He ways 7kg/15 lbs. He is 13 years old. He started Vetoryl April 29, 2020 and has improved and been doing good.

His most recent Pre Vetoryl Tests have been 148/138/149 (30-200) but this latest one was different: 51 (Sep 14, 2021)

U-Proteine/krea was high before Vetoryl (1,4 to 1,7) and then since Vetoryl between 0,5 and 0,9. But agian, the latest one was 1,2 (Sep 14, 2021) Should be < 0,5

Also from Sep 14 blood test:
ALAT-BM 1,7 ukat/l < 1,2
ALP -BM 12,8 ukat/l < 1,4
Kreatinin -BM 52 umol/l < 135

He has been doing great until Sunday when he seemed to have less energy than usual, also yesterday walking very slowly. And today he threw up his lunch. Poop is good.

He ate a small dinner at 4 pm and this has stayed in his stomach. But now when I was going to offer him a little more food (He eats small portions 4 times a day) he just tasted it and left the plate. This has NEVER happened. He usually has a ravenous appetite and finishes food in seconds. But he did want banana.

I called vet (animal hospital internal medicine) and her opinion was to see if it might be something temporary. If not I should wait and skip one dose of Vetoryl tomorrow morning. Of course if he gets worse I should go to the hospital.

His tummy seems a little swollen and more sensitive to touch than usual He did have the typical potbelly but this has got better - but now seems to be back a little.

I am of course worrying and would love some thoughts/comfort/advice from this group. I think my vet is competent but I also read about all the mistakes vets have made. He has some symptoms mentioned for low cortisol: vomiting (once), lethargy, reduced appetite, But not diarrhea, weakness, collapse.

Input welcome so I can either calm my nerves a little - or get ready to go to hospital.
Thanks ❤, Amanda

Lack of appetite, vomiting, lethargy... all pretty clear signs to stop Vetoryl until you can figure out whats going on. Pretty sure Vetoryl says to stop w/ these symptoms. Much better to deal with higher cortisol for a few days than an Addisons crisis. Might just be getting too high a dose. As time goes by, it seems we find that smaller doses of Vetoryl do the job. Others on the forum will be more equipped to dive into those numbers.

Good luck Amanda. Hope you get it figured out. You came to a good place.

Thanks Kevin.

Welcome back, Amanda. As you’ll see, I’ve merged your new question into your original thread so we can have Yohnny’s whole history here for us to refer to.

Many thanks to Kevin for his prompt reply to you, and I agree with him 100%. From the sound of things, I would guess that Yohnny’s cortisol is now dropping too low for his comfort. Even though he’d been doing quite well earlier and his Vetoryl dose had stayed the same, he may be responding differently now to that same dose. It is not unusual for doses to have to be changed over time, and this most recent monitoring test shows a significant drop in his cortisol level (down to about 1.8 ug/dL for our U.S. readers).

So I totally agree with Kevin, and I would not want to restart his Vetoryl again until he is once again eating and behaving normally. Even at that point, reducing his dose, at least temporarily, would likely be the safest thing to do. It’s possible that something else may be going on, but I do think that low cortisol is the most likely culprit until proven otherwise. Hopefully giving him a break from the Vetoryl will allow him to normalize quickly. But if not, as your vet suggests, a trip in to be examined will be important.

Please keep us updated as to how he’s doing tomorrow, OK?
Marianne

Hi Marianne! So nice to be greeted by you!

Thanks for confirming this. I have read about Addison crisis and got scared he was/is having one. But I guess that is not the case here?

He has slept pretty well, he ate some banana around 5:30 - when I got hungry ;) - but at 9 am breakfast he did not want his regular breakfast or banana (which he usually loves) instead he opted for a few treats.

We then took a short walk, he peed and pooped (normal) and now he is resting again. He did try and throw but not much in his stomach. He is very tired.

He did not get his Vetroryl this morning. What should I expect/look for today and tomorrow? Obviously if he gets worse - more lethargic, vomiting, shaking etc - I will go to ER. But anything else? How long does it take to normalize?

One more thing, looks like his potbelly is back slightly. Can this be the case when this happens?

Thank you, Amanda

Update 8 pm local time. Yohnny has been sleeping all day except for when I have fed him. He ate a little cooked white fish this afternoon and about half an hour ago he actually seemed a little more hungry and ate a slightly bigger portion fish and drank some broth. But he still seems very tired and weak. He barely wants/is able to walk. But he did wag his tail a little for the first time since he got sick. Carried him out for a pee. Is this still what to expect? He has now been 36 hours without Vetoryl. What if he is the same tomorrow? Feeling anxious.....

After this much time, I would let your vet know that Yohnny is still doing poorly. If his adrenal function has been oversuppressed by the Vetoryl, simply stopping the Vetoryl may not be enough help for him right now. He may need some supplemental prednisone pills, at least temporarily, to make up for the lack of cortisol coming from his own adrenal glands. He may also be suffering from a lack of aldosterone, which is another adrenal hormone. If his aldosterone level is too low, that can throw off his blood chemistries, most especially potassium and sodium. Again, sometimes a supplemental replacement is needed until the adrenal glands rebound to normal production.

So I would definitely contact your vet and let her know that he’s not doing well. She may want to see him personally, or she may prescribe a steroidal supplement that you can get for him yourself. Either way, I think she needs to know he is not doing well. I’m so sorry!

Marianne