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Thread: Bad effects from Vetoryl

  1. #11
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    Jul 2018
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    Default Re: Bad effects from Vetoryl

    It is getting terribly complicated! Surgeons who perform the required hyperparathyroid surgery are scarce. And then, several have told me that I need a consult from an internal medicine specialist about the Cushing's before I get the surgical consult. Seems excessive to me. And worse, one internal med specialist followed up with me on the phone and said I needed an endocrinologist -- that determining whether Zimmy has Cushing's would be beyond her expertise. But I'm thinking as you suggested. Maybe test for Cushing's again *after* the parathyroidism gets resolved. That said, I'm not totally sure yet that I will get the surgery -- estimates from $3000-$6000 so far. It has a high rate of success but I need to hear all the "what ifs" before I decide whether it is worth it. And if Zimmy has a dual diagnosis, I may be less inclined to treat both conditions at his age.

    I will probably go to one of the two surgeons who aren't requiring an internal med consult first. Seems to me that a good surgeon will have plenty of contacts and should do that second consult on his/her own. I also found the contact of a leading canine endocrinologist in NY if the surgeon needs an extra consult. All his ACTH tests seemed to demonstrate Cushing's as did his response to the Vetoryl so it is admittedly tricky.

  2. #12
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    Jul 2018
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    Default Canine endocrinologist?

    Has anyone gone to a canine endocrinologist? I was told by an internal medicine specialist today on the phone that evaluating whether my dog's Cushing's diagnosis is a false positive and is related to his recently diagnosed hyperparathyroidism was beyond her expertise. (My current vet hospital does not treat hyperparathyroidism so sent me elsewhere, saying they weren't sure about the Cushing's now either).

    The puzzle is whether he has both Hyperparathyroidism and Cushing's, or just the former. My dog is off the Vetoryl while all this is being sorted out. I'd like to get a surgical consult about the hyperparathyroidism since that seems certain and like a bigger problem than Cushing's.

    But some clinics are saying the possible Cushing's diagnosis has to be cleared up first. Do I need to find an endocrinologist to figure this out? If so, does anyone know of such a specialist in the Washington DC or Baltimore MD areas?

    My gut feeling is that I should be able to consult with a surgeon -- forwarding the records of the ACTH tests, etc. -- and the surgeon should discuss the Cushing particulars with internal med colleagues on the staff as needed.

    For the record, Zimmy, age 11, was being treated with Vetoryl for the past few months. ACTH tests showed him responding favorably to the med and his water-gulping and increased urination ceased as well. But then he lost his appetite and vomiting, diarrhea, weakness ensued. I'm now wondering if that could have been Addison's, the possible result of a false positive treatment for Cushing's?

    In any case, a slew of scans and tests were ordered, including-- bingo -- the one for hyperparathyroidism, based on his elevated calcium level. And whaddyaknow, symptoms of hyperparathyroidism can include excessive thirst and urination, muscle weakness -- just like Cushing's.

  3. #13
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    Apr 2009
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    Georgia
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    Default Re: Canine endocrinologist?

    Hi Eve,

    Normally, we try to keep all posts related to a dog consolidated within one single thread. With that in mind, in a few days we’ll probably merge this thread into your original thread about Zimmy. However, I’m temporarily leaving it “be” in order to see whether it garners you help in finding an endocrinology referral.

    In that vein, here’s one suggestion for you that may or may not prove to be helpful. But I’m going to direct you to the website of a veterinary consultation service headed by Dr. David Bruyette. Dr. Bruyette is a noted internist/endocrinologist who formerly directed services at the VCA hospital in West Los Angeles, is an expert on canine Cushing’s, has been a consultant with Dechra re: clinical use of Vetoryl, and helped pioneer surgical intervention on enlarging pituitary tumors here in the U.S. Last but not least, at one time he was a contributor to this forum. While serving as medical director at VCA, he was surprisingly receptive to directly fielding email questions from our members. Now that he is immersed in developing his new service, I don’t know whether he has as much time available. But you’d have nothing to lose by contacting him in order to see whether or not he could help guide you in terms of Zimmy’s care.

    His new service is designed to be utilized by vets. But in a situation like this, he might allow you to personally contract for some assistance. Or at the very least, I feel certain that he could recommend an endocrinologist in your area. So take a look at the website, and see what you think. If you do decide to contact him, be sure to tell him you’re a member of our forum. Here’s the homepage for his service:

    https://www.veterinarydiagnosticinvestigation.com/

    And here’s Dr. Bruyette’s email address: DaveBruyette@veterinarydiagnosticinvestigation.com

    Good luck!
    Marianne

  4. #14
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    Jul 2018
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    Default Re: Canine endocrinologist?

    Marianne,
    This is excellent. I would be happy to pay a one-time consult fee if needed and if he can do it without a physical exam. I will contact him and see if he wants to work with me directly or whether he wants to work with the yet-to-be chosen vet I'll consult with about hyperparathyroid surgery. I will email him before I even make that decision to see if he has a local recommendation or knows anything about the surgeons I'm considering so far.

    This is a good start. Meanwhile I'm wondering if Zimmy's recent crash could have been Addison's or that his last ACTH test was done incorrectly. The consult should answer some of these questions. This is all water under the dam since he is gradually eating more and getting back to himself since stopping the trilostane. And I'd already decided not to go back to this vet for a variety of reasons. I think it's curious that the vet he was seeing didn't refer me to an internal medicine specialist at the large hospital practice... and wondering if she is covering up a mistake either about the Cushing's diagnosis or that Addison's was the cause of his recent decline or just poor judgment about starting him on trilostane again so soon after his crisis. I imagine the independent consult will help answer these questions. I was debating whether he needed such a specialist but I'm starting to be convinced it is necessary. From reading messages in this forum, it's evident that a lot of vets do not understand Cushing's.
    Last edited by Eve; 08-02-2018 at 10:33 PM. Reason: typo

  5. #15
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    Apr 2009
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    York, PA.
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    Default Re: Canine endocrinologist?

    Ryan Veterinary Hospital in Philadelphia PA is definitely my 1st pick but I realize that's a huge distance from you. My GP referred me to Dr. Dan Petrus from the Atlantic Veterinary Internal Medicine & Oncology in Towson MD, phone# (410) 828-0911, their website: https://avim.us/meet-our-specialists/

  6. #16
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    Jul 2018
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    Default Re: Canine endocrinologist?

    Thank you! I lived in Philly for 30 years and still visit often so that is not out of the question.

    I came across Dan Petrus in my research as well and called that clinic. While they could give me an Internal Med consult, no one there performs the hyperparathyroid surgery. In fact, I am finding it's so specialized that most vet surgeons do not do it.

    I have found a few options, though, that I am considering. I might go for the consult with the doctor that Marianne suggested first and then follow up with one of those surgeons or someone he recommends. But I was impressed with Dr. Petrus' credentials and reviews so could also see him for the IM consult if it's important that Zimmy be examined.

    It seems crazy to get two consults but I can see how a surgeon isn't the best professional to sort through the endocrine issues since this is not just about surgery.

  7. #17
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    Default Re: Canine endocrinologist?

    Marianne, I contacted Dr. Bruyette today and mentioned you referred me from the forum.

    In a few hours, he replied and agreed to review Zimmy's tests. I feel relieved already that an expert will weigh in. It's easy to get names/numbers of area vets who have been reviewed well online, but it's so much better to get a personal recommendation from a knowledgeable source. So, thanks again.

  8. #18
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    Default Re: Canine endocrinologist?

    Marianne, can't thank you enough for recommending Dr. Bruyette for a consult. He was prompt, knowledgeable, to-the-point, and his assessment sounds exactly right. For those who were following the saga, you can read Dr. Bruyette's thoughts here:

    1) Zimmy has primary hyperparathyroidism.
    2) I am not sure about Cushing’s. Its hard because many of the symptoms may be due to the high Ca rather than the high cortisol. The ACTH stim test and LDDS can give false positives in the face of non-adrenal illness. The abdominal US shows plump adrenals and that is consistent with Cushing’s. However the alkaline phosphatase is normal which is very odd for Cushing’s.
    3) He does appear to have an adverse reaction to trilostane but I think its a GI problem rather than due to low cortisol.
    4) I would hold off on any additional treatment and diagnostics for Cushing’s and treat the parathyroid problem.
    5) A month or so after the surgery and the Ca is has been normalized I would do a LDDS if clinical signs of Cushing’s are still present.
    ______
    I guess this confirms that Zimmy's vet is not an idiot for not knowing whether he has Cushing's or not. It will be easier to make a decision about surgery, too, knowing that Zimmy may not have a dual-diagnosis. Estimates I've been getting for surgery are $3,000-$6,000, however, so I have a lot to think about.

  9. #19
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    Default Re: Canine endocrinologist?

    Eve, I’m so glad that Dr. Bruyette worked out for you! He has been so incredibly prompt and generous in sharing his thoughts with our members through the years. I’m very pleased and relieved to know this is still the case. And now, at this point, I’m gonna go ahead and merge this thread into Zimmy’s original thread so that we can keep on following your journey. Please keep us updated, Cushing’s or not!! I surely understand why the surgery may be a very hard decision to make due to both expense and risk. Just because a medical procedure is available does not necessarily mean it’s the best choice for any given dog (or person). There can be a lot of variables to consider and weigh. So if we can help you by bring a sounding board, we will be right here by your side.

    Marianne

  10. #20
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    Apr 2009
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    Default Re: Bad effects from Vetoryl

    So happy that Dr. Bruyette replied back to you and thank you so much for sharing his response with us!

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