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Thread: Daisy: 10-year-old Pit Bull/Boxer Mix with Cushing's; questions about Vetoryl dosage

  1. #11
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    May 2018
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    Default Re: Daisy: 10-year-old Pit Bull/Boxer Mix with Cushing's; questions about Vetoryl dos

    Thanks for the wonderful information, Marianne. I'm definitely going to follow up with my vet about new NSAIDs on the market and go from there.

    Yes, she has remained stable, for the most part. She did have a scary episode in December, and I'm still unsure whether it's related to Cushing's. All of a sudden, she was exhibiting trouble eating and drinking--like she couldn't manipulate her tongue normally or open her mouth as wide. She wound up spending the weekend at the vet on IV fluids/Benedryl and she improved greatly, but they recommended following up with a neurologist. I made that appt., and my options were 1) Pop her on 2 antibiotics to see if they would knock out a possible infection; 2) Put her under for an MRI and muscle biopsy; or 3) Put her on Pred. I chose the 1st option--didn't seem to make a difference after 2 weeks--and I was unwilling to put her under anesthesia, and Pred didn't seem like an option because of the Cushing's. As of now, she's much better but does still have some restricted mouth opening. Perhaps any inflammation in that area could be mitigated by one of the NSAIDs you mentioned as an added benefit?

  2. #12
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    Default Re: Daisy: 10-year-old Pit Bull/Boxer Mix with Cushing's; questions about Vetoryl dos

    Has Daisy seemed to have a problem with a lack of appetite, or has the issue solely seemed to be mechanical?

    Marianne

  3. #13
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    Default Re: Daisy: 10-year-old Pit Bull/Boxer Mix with Cushing's; questions about Vetoryl dos

    Her appetite is GREAT. I've actually never seen more of a chow hound--from the moment I adopted her (at about 1-2 years of age) until now (she's about 11, could be older). It seems she has some inflammation in the jaw/upper neck area that maybe makes it difficult or painful for her to open her mouth very wide. She's seemed to adapt to it and eats and drinks without issue, but I wonder how bothersome it is to her otherwise.

  4. #14
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    Default Re: Daisy: 10-year-old Pit Bull/Boxer Mix with Cushing's; questions about Vetoryl dos

    Hi Daisy. Galliprant is one of the newer NSAID meds and there have been many Cush pups using it with success, and it is kinder to the liver and kidney than the older types. Well worth discussing with your vet.

  5. #15
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    Default Re: Daisy: 10-year-old Pit Bull/Boxer Mix with Cushing's; questions about Vetoryl dos

    Thanks for your thoughts, Laura. I DID ask my vet about Galliprant, and she said in her experience, it's not been as effective as Rimadyl...but it might be worth a try. I gave Daisy her first dose this morning. Starting very low at 20 mg/day (Daisy weighs about 43lbs) to hopefully avoid upsetting her stomach. We'll see how it goes!

  6. #16
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    Default Re: Daisy: 10-year-old Pit Bull/Boxer Mix with Cushing's; questions about Vetoryl dos

    Hi everyone! First, I just want to express how much this forum has helped me over the last couple of years. I was lurking a while on the site before posting...and whether I'm reading other threads or seeking answers to my own questions, I'm always learning SO MUCH. You are all truly incredible, compassionate people.

    Secondly, I wanted to provide an update after trying Daisy on Galliprant for over a month. Daisy weighs about 43 pounds. Initially, I started her at 20 mg/day, increased to 30 mg in a few days, then increased to 40 mg and kept her on that for about a month. Unfortunately, I didn't notice much improvement, so I stopped and will investigate something else. But I won't try Rimadyl--and my third reason for writing today is why!

    I took Daisy for her latest ACTH test six days ago, and here are the results: pre was 1.3, post was 4.3. Great, right? My vet said let's keep her on the dose (20 mg/day, which she's been on for about 6 months after we had to take a break last year when cortisol was progressively dipping), but as of this morning, I stopped. When I took her in for the test, I reported that Daisy's been having some loose stools. It's not terribly uncommon for her, but they've definitely been looser recently, and I haven't altered her diet. She's also had terrible gas recently. I've read so many times on here that you shouldn't continue dosing Vetoryl if something seems off, so I'm thinking she might need another break.

    ALSO, the vet ran a urinalysis and checked SDMA, and here are the results:
    *Urine Creatinine: 32.3 mg/dl (no range provided)
    *Urine Protein: 62.3 (no range provided)
    *Urine Protein: Creatinine Ratio: 1.9
    *Specific Gravity: 1.010 (no range provided)
    *Urine Protein: 2+ (no range provided)
    *IDEXX SDMA Result: 15 (range: 0-14 ug/dl); in May 2018, the result was 4
    *Creatinine: 1.0 (range: 0.5-1.5 mg/dl)
    *BUN: 28 (9-31 mg/dl)
    *Phosphorus, Calcium, Sodium, Potassium, all squarely in range

    As for other chemistry, ALP remains pretty high, and other values are out of range (not new):
    *ALT: 134 (range: 18-121 u/l)
    *ALP: 1649 (range: 5-160 u/l)
    *GGT: 16 (range: 0-13 u/l)
    *Lipase: 947 (range: 138-755 u/l)
    *Creatine Kinase: 489 (range: 10-200 u/l)
    *Lymphocytes: 0.683 (range: 1.06-4.95 k/ul)
    *Eosinophils: 0.068 (range: 0.07-1.49 k/ul)
    *Platelets: 489 (range: 143-448 k/ul)

    My vet said I should bring in another urine sample in two weeks and we'll reassess the situation at that time. Could it be that Vetoryl is also causing these funky kidney values and damaging her overall organ function? What are your thoughts on my deciding to discontinue Vetoryl for now until I figure out her loose stool and now these kidney values (which seem like the priorities over Cushing's at this time)?

  7. #17
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    Default Re: Daisy: 10-year-old Pit Bull/Boxer Mix with Cushing's; questions about Vetoryl dos

    Hello, and welcome back! Iím sorry, though, about these new worries about Daisyís kidneys. However, as far as your question re: the Vetoryl, if it was me, Iíd probably not be stopping her Vetoryl right now. Those ACTH results were indeed great, and although there is an explicit warning against using Vetoryl in dogs who have compromised kidney function, I donít think this is because the kidneys themselves are at great risk of being directly damaged. Rather, if the kidneys are not functioning properly, the drug will not be excreted properly and can build up to dangerous levels in the body in terms of general overdose. Since Daisyís Creatinine and BUN are still within normal limits, it would seem as though her kidneys are still providing a proper job of excreting fluids and toxins, as well as the medication. However, Iím far from an expert about this, and you can certainly discuss it further with your vet who, in turn, can contact Dechra to see what theyíd recommend in this situation.

    I do think your vet is doing the right thing by retesting Daisyís urine. It is not uncommon for Cushingís itself to cause a particular type of kidney damage that results in protein being released from the kidneys into the urine. This is called ďproteinuriaĒ and thatís what that 2+ protein reading means. Before getting too excited about it, you want to see whether it was an isolated reading or whether it is a persistent issue. If so, then your vet may well add some additional medications for Daisy to take in order to better protect the kidneys from further damage as the result of that protein leakage. Vetoryl alone does not necessarily halt that progression in all Cushpups. I do see that her SDMA has leapt a lot higher in a yearís time, so I think itís good that your vet is continuing to monitor her urine in order to see whether additional treatment decisions are in order.

    As far as the GI issues, did your vet take a stool sample to check for parasites or infection? Also, I notice that her lipase is elevated. Has it consistently been this high? Lipase is a pancreatic marker, and we do see a fair number of Cushpups who are afflicted with pancreatitis. This can take the form of an acute episode or instead a chronic, ďsmolderingĒ type of issue. Given her new GI complaints in conjunction with the elevated lipase, one thing you might discuss with your vet is running a specialized blood test, the cPLI, that checks for pancreatitis.

    OK, thatís all I can think of for now. But itís good to have you back, even though Iím sorry about your new worries.

    Marianne

  8. #18
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    May 2018
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    Default Re: Daisy: 10-year-old Pit Bull/Boxer Mix with Cushing's; questions about Vetoryl dos

    Hi Marianne,

    Thanks for the thoughtful response. You made some good points about the Vetoryl and my continuing it for now. I’ll definitely follow up with my vet, as you suggested.

    Yes! I neglected to mention that I did bring a stool sample to last week’s testing, and it was negative for hookworm, whipworm, and roundworm. The report also states: No ova or parasites seen. Cyniclomyces guttulatus, also known as Saccharomycopsis guttulatus (non-pathogenic yeast), present. I researched that a bit and what I’ve found on it seems fairly benign, but I wonder if it could explain her loose stool (which is even looser this a.m.). Also, I’ve had her on a bland diet of boiled chicken/white rice, supported by my vet, since Friday and her stool quality hasn’t improved. She’s already a very skinny little girl, since weight has redistributed to her belly, so I don’t want to continue that for long. Maybe it’s not even necessary?

    As for lipase: It was 659 (138-755 u/l) in May 2018, but a whopping 2,983 on 1/12/19!!! Daisy was at the vet’s 1/12-14, as on 1/11, she had an episode where she wasn’t able to open her mouth wide enough or manipulate her tongue in the right way to eat/drink. She spent the weekend at the vet’s on fluids and I had followed up with a neurologist who put her on 2 antibiotics to wipe out a possible infection…but I still don’t know what caused that. Even now, she can’t open her mouth very wide but can eat/drink without issue. Perhaps her muscles have atrophied? I think your suggestion to have her tested for pancreatitis is warranted. I’ll talk to my vet.

    My follow-up questions for you all right now are: Do you think I should also talk to my vet about adding Tylan powder (which I’ve read pretty good things about on this forum) or Flagyl to try to firm up her stool? Also, when I collect the urine sample for the next urinalysis with UPC/pancreatitis blood test, should I fast her that morning? I hate to fast her, since I always give Vetoryl in the a.m. with a good meal.

  9. #19
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    Default Re: Daisy: 10-year-old Pit Bull/Boxer Mix with Cushing's; questions about Vetoryl dos

    Oh, Iíd forgotten about that scary episode over the winter! That was weird, for sure :-(.

    I definitely think itís worth asking your vet about the Tylan and/or Flagyl. I donít have any personal experience with Tylan, but as youíve probably already seen, weíve had some folks here who have reported good results. As for the Flagyl, Iíve used it a bunch over the years with my dogs. Iíve always had Labs, and theyíve periodically had loose stools for reasons unknown to me (probably often related to eating something nasty in the yard, but not always). Flagyl has often been helpful for us in those situations.

    Lots of people swear by giving a spoonful or so of canned pure pumpkin to help firm up stools. That has never seemed to help around my house, but it might be worth a try? If you do try that, make sure itís the pure pumpkin and not pumpkin pie filling, and you can check the internet for specific amounts to give depending on the size of the dog.

    As for the blood test, youíll want to get specific instructions from your vet as to whether fasting is necessary. I donít know what the requirements are for that test, but heíll have the labís instructions. It might require fasting since the pancreas is involved in the digestive process. If so, though, maybe you could give her early breakfast and then wait 6-8 hours or so before having the blood drawn. That might satisfy the fasting requirement, but your vet should know for sure.

    Good luck with everything!

  10. #20
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    May 2018
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    Default Re: Daisy: 10-year-old Pit Bull/Boxer Mix with Cushing's; questions about Vetoryl dos

    Great, I'll ask my vet about Tylan and Flagyl. I've also had luck with Flagyl over the years but have never tried the Tylan powder. And, canned pure pumpkin is actually a part of her normal diet, and I just now mixed it in with her bland diet lunch. I'm not sure it really helps her, though (and I see you can relate). Anyway... I'll keep you posted on what happens in the next few days! Thanks so much for the advice.

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