Breathing difficulties

[77sammy]

I have been keeping a close watch for Addison’s symptoms and I have some prednidale (steroid) tablets at home, provided by my vet, in case his cortisol is too low.

He does still have increased thirst and does need to go to the toilet more frequently, and of course has the breathing issues, but he has a voracious appetite and is not lethargic. I always keep an eye on his bowel movements, these tend to be soft as he has IBS but he hasn’t had diarrhoea.

However, I take your point about regular ACTH testing. We will be having another test in the next couple of weeks.

He has always been a quiet dog and likes to keep himself to himself – he came from Eastern Europe and was shut down when I first got him, clearly he’d had a difficult life and was very nervous of people. He’s absolutely wonderful with all other animals though – including cats. He was a street dog, likely put out on the streets when he got older and was no longer required as a ‘guard dog’.

He doesn’t covet attention, I think he has never had any love so he’s a little unsure about why I want to give him a cuddle or scratch his ear. I try not to impose but he has these beautiful, soulful eyes so it’s difficult!

Like everyone else on the forum, I want to do everything I can for my boy. It can be so difficult to know what to do when the same symptoms have different causes. I really wish I could do something to help his breathing – it’s so distressing to see. However, the next step should be another ACTH test.

Thanks for your support and please let me know if you think of anything else that might help with the breathing.

[Harley PoMMom]

Have the vet suggested to try any bronchodilators, such as Terbutaline or Albuterol, to help with the breathing?

[77sammy]

Yes, he was on theophylline for about 3/4 weeks in July 2017. It did not appear to make any difference so it was stopped.

The vet hasn't suggested any inhalers.

[77sammy]

Does anyone know if there is a recommended safe upper limit for daily dosage of Vetoryl? If so, what is it per lb (or kg)?

[labblab]

Welcome back! You’ll see that I’ve merged your new question into your original thread about your dog. This way, all the info about your boy’s treatment journey will be consolidated in one place, and that helps provide better context for any subsequent questions.

In answer to your question about dosing, specific parameters usually are given only when dogs first begin treatment. Initial daily dosing totals are commonly 1 mg. per pound, or 2.2 mg. per kg. After that, the size of the dose that’s required is based upon symptom improvement and subsequent monitoring blood tests. Dogs can metabolize the medication very differently, and thus, dogs of the very same weight may end up requiring very different doses. I’m not aware of any given upper dosing limit — it all depends on each individual dog’s physiological response to the medication.

Can you tell us what dose your boy is currently taking, and how he’s doing these days? We’d love to get an update!

Marianne

[77sammy]

Hello Marianne, thanks for moving the post.

I know that the Dechra recommended starting dose is 1-3 mg/lb (2.2-6.7 mg/kg). My boy is now on 300mg (2 x 150mg). He weighs 37kg. The dose has been increased gradually from 100mg in September. He has been on vetoryl since Oct '17 (starting dose 20mg per day).

Every time the dose is put up his symptoms improve for 3-7 days but then the hunger, thirst and panting resume. It's difficult to know what to do as, obviously, I want to keep him on the minimum possible dose but his symptoms are not being controlled by the 300mg. Also, it seems to me that a daily increase of 200mg in 3 months is a lot.
He tolerates the drug well although his stools tend to be quite loose for a day or two after the increase.

It could be that he has a fast growing tumour (I'm not sure if it is adrenal or pituitary) but this is just speculation. He is nearly 15 and I don't want to put him through a lot of tests as I think the stress would outweigh any benefits. I am thinking about contacting a veterinary endocrine specialist to have a chat. He was diagnosed in summer ’17.

Any thoughts would be welcome.

Thanks for your help.

[randomguy]

Deleted disregard

[labblab]

I am very worried if you are continuing to increase your boy’s Vetoryl dose without the benefit of testing his cortisol. Truly, this is very, very dangerous! You may not have a lot of outward warning signs prior to experiencing a life-threatening internal Addisonian crash. For this reason, it is not safe to continue giving the medication — let alone significantly increasing the dose — without checking the effect on your boy’s adrenal function and cortisol production. In honesty, I am dismayed that your vet is continuing to prescribe ever increasing doses without the benefit of the necessary monitoring testing.

300 mg. daily is a lot of Vetoryl, and works out to a bit over 3 mg. per pound for your boy. Even though published therapeutic dosing ranges fall between 1-3 mg. per pound, I don’t believe I’m aware of many dogs on this forum who have been dosed with that large an amount. My own 60-lb. Lab was initially dosed with a total of 240 mg. daily when he started treatment fifteen years ago when general dosage guidelines were much higher than they are now. His cortisol never dropped too low, but we did monitor his cortisol closely and ultimately significantly lowered his dose. Rarely since then have I seen doses that approached that level.

Once again, if I knew you were checking your boy’s cortisol after each of these increases, my anxiety would be relieved. But in the absence of testing, I’m really, really worried about the path you’re following. Given your boy’s apparent lack of response to these ever-increasing doses, it makes me wonder whether Cushing’s is even the correct diagnosis. Looking back, I’m reminded that your dog’s diagnostic ACTH results did not fall within the range that is consistent with the disease. So this makes me even more nervous.

Please, please, please make arrangements to have your dog’s monitoring cortisol testing scheduled ASAP!

Marianne

[77sammy]

Thanks Marianne. I really appreciate this. I am very worried about it as well.

Would you recommend just the ACTH and blood tests or is there something else I should be getting done?

[lulusmom]

I share Marianne's great concern that your dog has been steadily increased to such a jaw dropping high dose without the benefit of an acth stimulation test to justify those increases. I am dismayed that your vet has allowed this to go on for so long without testing and believe you are very lucky that your dog has not gone into crisis. I think your idea of getting a consult with an internal medicine specialist is an excellent one. I personally would do just that as soon as possible and would let the specialist direct treatment and any testing s/he feels is appropriate.