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Thread: 15 year old cocker spaniel on Vetoryl - Dagget is gone

  1. #1
    Join Date
    Jan 2010
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    Default 15 year old cocker spaniel on Vetoryl - Dagget is gone

    Hello. I was here years ago when my Newfoundland Daisy was diagnosed with Cushing's quite a few years ago. Unfortunately she passed away quickly after starting Lysodren. You all were so helpful and supportive. I was unable to come back and thank you because I was just broken for awhile. So thank you.

    Now, my 15 year old cocker spaniel, Dagget was diagnosed last spring, started 30mg of Vetoryl once a day, and did great! I mean absolutely wonderfully! In October he started breathing rapidly, fainting, etc. I took him to an ER and a cardiologist. He was hospitalized for three nights. They believe he had a blood clot in his lung, causing pulmonary hypertension. He nearly died, Viagra saved his life! He also has a heart murmur and is now on 8, yes EIGHT different meds plus Adaquin injections monthly.

    Anyway, starting in October he lost his appetite. I mean he would barely eat hamburgers and pepperoni. He had an ACTH stim test in early October that was fine. I thought this appetite issue was from all the new meds. I mentioned to my vet about the issues, and noticed he'd lost 5 pounds, from 30 to 25, 4 of those since mid-October. But no one thought this was a Vetoryl issue.

    Two weeks ago I finally insisted they do another ACTH stim test (I had been told we could go six months this time, so wasn't due for a few months). His pre level was 1.0. Post was 1.2. They did not test his electrolytes. The vet said to start him on a lower dose the next day. I called her back and made her call Dagget's internist at the specialty hospital (ya he has one of those because he had a gallbladder infection 3 years ago that nearly killed him) and i also said there's no way we will start him back on Vetoryl in any amount the next day. I had lost my border collie mix Lola to cancer that same week and wasn't about to lose Dagget.

    As soon as I discontinued the Vetoryl, his appetite started coming back! This was two weeks ago. He now eats kibble with a bit of canned mixed in, not hamburgers and scrambled eggs! He's gained back a pound. He is also walking up and down steps much steadier and seems happier.

    He had another ACTH test 2 days ago, 2 weeks after discontinuing Vetoryl. Pre 3.2 Post 9.6. Electrolytes normal. Vet is waiting to hear from the internist to see if we should get back on Vetoryl.

    Sorry this is so long. Anyway, I guess I'm wondering if it's possible since his levels are actually normal after 2 weeks, if his levels might stay normal and he won't need vetoryl anymore? I feel like 1.2 post was dangerously low, but was it? It's is such a relief to see him eating normally again, and he seems stronger and happier without Vetoryl.

    I'd love to hear any insights, ideas, experienced etc. I really love my little guy

    Thank you!
    Nancy

  2. #2
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    Jan 2010
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    Default Re: 15 year old cocker spaniel on Vetoryl...dose too high

    I forgot to mention, he was having terrible sticky diarrhea. That also has cleared up for the most part since taking him off of the Vetoryl

  3. #3
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    Default Re: 15 year old cocker spaniel on Vetoryl...dose too high

    Hello, Nancy, and welcome back! Absolutely, I remember you and sweet Daisy, and how heartbreaking her loss was to our whole family. I’m so glad you’ve found us again, and I certainly hope that we can help keep Dagget comfortable.

    From what you’ve described, it definitely appears as though the 30 mg. dose of Vetoryl was driving his cortisol lower than was safe or healthy for him. The good news is that his cortisol level has rebounded so significantly, so quickly. This implies that no lasting damage was done to his adrenal function. My best guess is that you’ll end up returning to the Vetoryl, but at a lower dose than before. Before doing so, however, I’d probably wait to see whether his cortisol keeps on increasing. If his post-ACTH never again exceeds the range of 9-10, then perhaps you’ll have somehow won the lottery and can dispense with the Vetoryl altogether. But as quickly as it has rebounded thus far, I’m guessing it will continue to elevate further in the absence of treatment.

    You don’t mention the symptoms that initially led to diagnosis and treatment. At Dagget’s age, I’d mainly be focused on his quality of life. So if his symptoms were not making him really uncomfortable, then I’d consider foregoing the Vetoryl if he seems happier not taking it. One wild card, however, is the history of the blood clot. Uncontrolled Cushing’s has been linked to even a higher risk of blood clots, so that may be an issue that might sway your decision. You can always resume treatment at a much lower dose, however, and that might offer you the best of both worlds — a degree of cortisol suppression, but not so much as to recreate the unwanted side effects associated with the higher dose. It is not at all uncommon for Vetoryl doses to require adjustment over time.

    In order to give you our best feedback, we’d love to hear more about Dagget’s overall health and treatment history, including the symptoms/testing that led to the Cushing’s diagnosis. We’d also like to know what the results of the October ACTH testing were.

    Once again, welcome back. And from those early years, we forever join you in loving memory of sweet Daisy, and Rosie, too. I’m also so very sorry about Lola. You’ve sure had a lot to deal with during these last few months...

    Marianne

  4. #4
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    Default Re: 15 year old cocker spaniel on Vetoryl...dose too high

    Hi Nancy and welcome back!

    I am so sorry to hear about your sweet girl, Daisy. I will contact you later today to talk about that with you. For now, accept my deepest condolances.

    Now for Dagget - since the vet started him on 30mg of Vetoryl that means he should have weighed 30lbs at that time. The starting dose is 1mg/lb. Can you verify that he did indeed weigh 30lbs?

    Also if you would tell us all the medications he is taking since some should not be mixed with Vetoryl, including some for heart issues.

    Here is a link about Vetoryl (Trilostane) from our Helpful Resource section. Please read up on the drug Dagget is taking so you are educated. This drug has the exact same risks as Lysodren so it is just as important that we know what to look for that indicates an over dose - loss of appetite, nausea/vomiting, loose stools/diarrhea, lethargy....AND so we know when the vet is not following protocol, which is very specific for this drug.

    https://www.k9cushings.com/forum/sho...-and-Resources

    Hugs
    Leslie
    "May you know that absence is full of tender presence and that nothing is ever lost or forgotten." John O'Donahue, "Eternal Echoes"

    Death is not a changing of worlds as most imagine, as much as the walls of this world infinitely expanding.

  5. #5
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    Default Re: 15 year old cocker spaniel on Vetoryl...dose too high

    Marianne,

    Thank you for welcoming me back. I'm glad you and this website are still here.

    Dagget's health was was very good until he was 12 years old. I noticed him straining to pee/poop but nothing would come out, he got weak, and would not eat. We discovered he had a severe gallbladder infection. The surgeon said Dag was too sick for surgery. We ended up treated him with two strong antibiotics for over a year, and also Ursodiol. After about 1 1/2 years of ultrasounds every few months, his gallbladder finally looked normal, yay!

    So time went by and his bloodwork was all good except ALP. It was still crazy high, I don't have the actual numbers, but in the many thousands. He also was very hungry, at one point we had to put all the dog food AND the trash behind closed doors or he would find a way to get into them. Before we did, one morning I found him inside the heavy metal trashcan I had in the kitchen, he'd knocked it over and opened the lid somehow.

    He didn't gain weight, I was VERY careful about feeding him and keeping him out of things. He drank a lot of water and peed in the house at that point. He did not have the large abdomen. HIs coat was more dull that he had been, but no hair loss, and I attributed that to old age. He was rather tired, but once again, old age.

    His internist wanted to test for Cushings. I still thought it was all old age combined with a hearty appetite. They did the low dose dex test and it was positive for Cushings. Adrenal ultrasound showed adrenal glands were normal, so we didn't treat. a few months later another low dose dex test, still positive.

    We decided to treat with 30 mg Vetoryl once a day. This was last spring. Within DAYS there was a positive difference. He stopped peeing in the house, appetite less ravenous, energy level increased. When my son came home from college a month later, he immediately noticed that Dag was acting like a puppy again! Very happy, rubbing against us, wagging his little nubby tail. I was SO happy.

    Oh, by the way, I forgot to mention sometime during his gallbladder treatment he became deaf.

    All of his ACTH stim tests were good. We did them regularly. Beginning of October vet said we could go 6 months until next one, woohoo! Then a few weeks later Dagget started breathing rapidly. Got very weak. Couldn't get up on couch and bed even with stairs. Appetite was nonexistent. I took him to vet, she said it was his heart murmur causing it. Blood work was great, and ALP was, for the first time in years, nearly normal! Put him on a few heart meds. But it got worse. Took him back, asked for more bloodworm, to test thyroid. I called on a Sunday to find the results. The vet was a sub who comes in for emergency hours on Sundays. I'd never met her. She said Dagget's blood work was normal but after reviewing his info said I needed to take him to the ER in Pittsburgh NOW.

    So I did. They though was his heart at first, but found severe pulmonary hypertension. From a blood clot in his lung. After 2 nights said he prob wouldn't be able to come home. Third day gave him Viagra and he went home the next day, with oxygen for a couple days. He was very happy to be home and seemed okay. But appetite was terrible. I was cooking for him, chicken and hamburger...cardiologist told me to give him whatever he'd eat! He lost weight.

    Cardiologist checkup a month later, pulmonary hypertension downgraded from severe to mild. Appetite still very very low. Weight down 5 pounds since spring. Adjusted some heart meds (ws now on 8 meds total) appetite unchanged.

    I kept asking about a new stim test but none of the vets (regular and cardiologist) thought that was necessary. I finally just scheduled one, results were as stated above, 1.0 pre, 1.2 post.

    Sorry this is so long, but idk at this point what is relevant and what isn't. I didn't write down his stim test scores from October, but I did ask before and they were right in the middle of the normal good range.

    HIs vet called me earlier today, and I will post my questions a little bit later, as she is leaving the Vetoryl and testing decisions up to me.

  6. #6
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    Default Re: 15 year old cocker spaniel on Vetoryl...dose too high

    Leslie

    Thank you for replying! Dagget weighed exactly 30 pounds when we started the Vetoryl. He wasn't overweight. He dropped to 25 pounds, mostly since October, but has gained back a pound since we discontinued Vetoryl.

    Here is a list of his meds:

    1 Vetoryl 30mg 1x/day (currently discontinued.
    2. Sildenafil(Viagra) 20mg 2x/day
    3. Enalapril 2.5mg 2x/day
    4. Pimobendan 7.5mg 1/2 pill 2x/day
    5. Furosemide (Lasix) 20mg 2x/day
    6. Clopidogrel (Plavix) 75mg 1/4 Daily
    7. Ursodiol 250mg 1/4 Daily
    8. Enoxoparin .1ml every 8 hours

    He also gets Adequan injections about once a month.

  7. #7
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    Default Re: 15 year old cocker spaniel on Vetoryl...dose too high

    Nancy, thanks so much for all this additional info. You’ve surely been taking such good care of Dagget in the midst of multiple challenges!

    It sounds as though Dagget’s Cushing’s diagnosis and initial treatment plan was reasonable given his symptoms, testing, and weight. My major concern mirrors your own — when he started doing poorly, I believe there should have been a greater sense of urgency for monitoring retesting among the vets. Necessary dosing changes over time are commonplace, both upward and downward. So even though it does appear as if Dagget’s initial 30 mg. may have been appropriate, it also seems clear that it ended up being too high as time went on.

    So what to do now? I think you’re on the right track by taking a wait-and-see approach. As time goes on, it’s entirely possible that you’ll see a rebound of Cushing’s symptoms if his cortisol continues to increase. If so, you can always resume the Vetoryl, but at a lower dose. In the U.S., Vetoryl is availble in 10 mg. and even 5 mg. capsules. So you would have a lot of flexibility in terms of dosing options.

    If you do resume, I also want to point out one other potential “issue.” I see that Dagget is also taking enalapril. Medications of that class can act alongside Vetoryl to lower another adrenal hormone, aldosterone. Aldosterone controls the balance of potassium and sodium in the body, so it’s important to carefully monitor the levels of those blood chemistries when the two medications are taken in tandem. We do have members who successfully take both meds, but the combination does add another reason why regular monitoring is important since a potassium/sodium imbalance can make dogs ill even when cortisol levels remain OK.

    Marianne

  8. #8
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    Jan 2010
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    Default Re: 15 year old cocker spaniel on Vetoryl...dose too high

    Marianne,

    I didn't realize the interaction between Vetoryl and Enalapril. Thank you for mentioning that. Most times, when we did the ACTH stim test we also checked electrolytes, and thankfully they've been normal.

    My vet heard back from the internal med vet, and the internist said we should start Dagget back on Vetoryl now, at 10mg twice a day. Remember his ACTH stim results were 3.2 pre and 9.6 post on January 25th after testing 1.0 pre and 1.2 post on January 8th. He has not been tested since 25th.

    I would like to wait a little longer and test him again before we re-start Vetoryl, and my vet agrees that is reasonable. Especially considering the following.

    We seem to have a problem now. I feed twice a day, morning and evening. Beginning yesterday, Dagget's appetite dropped. Immediately after discontinuing Vetoryl on January 9th, Dagget's appetite started coming back and was pretty normal after a day or two. Yesterday he refused breakfast. He also refused dinner. All he ate yesterday was not quite one whole scrambled egg and a couple pill pockets. It took hours to get him to finish the egg.

    This morning he refused breakfast but did eat one whole fried egg and a pill pocket (with his pills).

    I have spent so long trying to get sick dogs to eat. When Lola stopped eating in December she ended up having untreatable cancer. Diagnosed at a veterinary cancer center. They said there was nothing they could do. My vet thought it was just some arthritis pain lowering her appetite. It was a large mass in her liver that was already spreading. She had normal blood test results. Within a month she went from healthy and happy, to gone on January 7th.

    My point is, maybe something else besides Vetoryl was causing Dagget's decreased appetite. He's had so much bloodwork and ultrasounds...but there could be something else going on that we don't even know about. I wouldn't have known about Lola's cancer until we x-rayed and ultrasounded her abdomen.

    I don't understand why Dagget stopped eating yesterday. If it were Cushing's he'd definitely be eating MORE, right? Would rising cortisol levels ever cause a loss of appetite? I am so confused.

    And how long should I wait before doing another ACTH stim test?

    Thank you all for your help. Words cannot express how thankful I am for your support.

    Nancy

  9. #9
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    Default Re: 15 year old cocker spaniel on Vetoryl...dose too high

    The lack of appetite would be a concern for me, too, especially in relation to restarting the Vetoryl. Under these circumstances and given his age, regardless of ACTH level I would probably choose to await a rebound in Cushing’s symptoms and especially a return to at least a normal appetite. I do understand your worry about this, since there’s no way to ask him if he’s hurting or feeling ill. I think inappetence can be one of the most upsetting problems a pet parent can face and my heart goes out to you, especially given your recent experience with Lola. Since Dagget’s cortisol has increased to the level of the most recent ACTH, I agree with you that I wonder whether there may be something else going on with him right now. Increasing cortisol ought to make him more hungry as opposed to less.

    I wish I had some great suggestions for you. But mostly I want you to know that we’re right here alongside you and hoping that perhaps tomorrow will bring a better report.

    Marianne

  10. #10
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    Default Re: 15 year old cocker spaniel on Vetoryl...dose too high

    Dagget ate a little better yesterday evening, but not nearly a normal amount. This morning he refused breakfast again, but he will eat small pieces of dog treats (Blue Stix) and took all of his morning pills in pill pockets. I don't really know what to do if this continues...something isn't right. I'm still afraid there is something else wrong that we have been unable to find. He is still off of the Vetoryl. Should I ask for an abdominal ultrasound? Lola's cancer progressed quickly. I might be over-concerned about this. An ACTH stim test result of pre 3.2, post 9.6 after discontinuing Vetoryl, would you expect to see a normal appetite?

    I was reading a little about supplements for Cushing's dogs. I see that flaxseed lignans and melatonin are used..some say just for atypical Cushings, but I'm getting confused about that. Are there any supplements that are useful for Cushing's dogs? Has anyone been able to substitute supplements for Vetoryl/Lysodren and get good results? Is there any danger involved with supplements? I don't mean because of not giving Vetoryl, I mean can the supplements themselves cause issues? Can they lower cortisol too much or cause diarrhea or anything? Would they affect his appetite?

    If anyone has had good results, I'd love to know the exact products used.

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