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Thread: Advice for a newly diagnosed pooch in the UK

  1. #1
    Join Date
    Jul 2019
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    Stoke on Trent, England
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    Default Advice for a newly diagnosed pooch in the UK

    Hi all, hope everyoneís well? Thanks for letting me join 😊.
    My boy Louis was diagnosed just over four weeks ago. Heís a Staffy Collie X, aged 10 and has been prescribed 30mg Vetoryl as a starter dose, probably to be increased to 50mg following a repeat blood test which Iím taking him for tomorrow. His main symptom is fatigue although Iíve noticed heís drinking and weeing less too. Heís eating less but Iím not sure if heís not eating enough now.
    My main question at the moment is how to best give him his pill in a morning. Heís a grazer so he has dry food down all day and just picks at it but this means he doesnít have a proper breakfast as such. What can I give him with his tablet that counts as breakfast and how much food should I give? Iím thinking maybe chicken or fish and rice then reduce the amount of dry food for the rest of the day. Iím getting the feeling heís feeling a bit of colour in a morning and Iím wondering if this is because heís not having the correct type or enough food with his Vetoryl and itís making him a bit queasy. Any general advice would be great too! 😊 x

  2. #2
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    Default Re: Advice for a newly diagnosed pooch in the UK

    Hello and welcome to you and Louis — we’re so glad you’ve joined us! You are correct that Vetoryl needs to be given along with food in order to be metabolized most efficiently. In conversations that I’ve had with Dechra, the maker of Vetoryl, I’ve been told that a full meal is best. However, if Louis simply won’t eat that much in the morning, you can only do your best to get as much inside him as you can. Vetoryl is a fat-soluble medication, meaning that it especially needs to be given along with some fat to aid its absorption. So first off, if Louis will accept the pill wrapped in some cheese or a small amount of other fatty material, that will be a good start. Here in the U.S., peanut butter or cream cheese can be a good coating for the pill, although I don’t think peanut butter is as common a favorite there in the U.K. Anyway, wrapping the pill in something fatty is a good start, followed with at least a bit more healthy food that Louis will eat.

    Having said all that, I do need to backtrack, though, to find out more about Louis’ picky appetite. Has he only become picky since starting the Vetoryl, or has he always been picky? The reason why I ask is because most untreated Cushpups have ravenous appetites. Along with excessive thirst and urination, it is one of the “hallmark” symptoms of the disease. There are always exceptions, but I’m anxious to find out more about the symptoms that originally led to his Cushing’s diagnosis. You mention that his main symptom is fatigue, and that he’s drinking and weeing less. By this, do you mean these are changes you’ve seen since Louis started the Vetoryl, or was he like this beforehand? Telling us more about his overall health history will help us a lot.

    For instance, if the reduction in appetite, thirst, and urination have all resulted from the Vetoryl, then I’m wondering why you’re necessarily expecting his dose to be increased even more right now, as it would sound as though the medication is doing its job to curb those excesses. And if he’s appearing to be especially fatigued, you may well not want to be upping the dose at all at this time.

    So once again, we’ll really appreciate learning more about Louis and any abnormalities in labwork, appearance or behavior that led to his diagnosis. And also once again, welcome!

    Marianne

  3. #3
    Join Date
    Jul 2019
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    Stoke on Trent, England
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    Default Re: Advice for a newly diagnosed pooch in the UK

    Hi Marianne.
    Thanks for the lovely welcome and the reply.
    I’ll start from the beginning then ��. Hope you don’t mind a good read!
    Early December last year I took him to the vet as his breathing had gotten a bit noisy, seemed to me like it was in his airway rather than lower down in his chest. As he’s now 10 the vet wanted to do a routine basic blood test checking his kidneys and liver before prescribing anything. His kidneys were fine but one of the two liver enzymes that were tested was raised a little but not enough to warrant action at the time. I may get a little vague with specifics as I don’t usually get any hard copies of results from my vet so I couldn’t tell you off the top of my head which enzyme was raised.
    We agreed to re-do the blood test after a few months. I took him back in April this year where the test showed that the raised enzyme had gone up even more. He had a liver function test done, which was fine, and a scan which showed an area brighter than the surrounding tissue. The vet managed to get a needle sample from this area (all while he was awake, he’s such a good boy!) and this showed an increase in vacuolar hepatopathy. The vet said early on these could all point to early signs of Cushings but he wanted to be cautious and try a more conservative approach so he was put on Denamarin for two weeks and the bloods re-tested. The levels came back higher still so we went over all of his symptoms over the previous few months. I’d monitored his water intake and it wasn’t sky high, we both agreed on that. He’d put weight on, starting to show a bit of a pot belly, he was going out for a wee every 90 minutes - 2 hours in the early part of the night. Once we got to about 2am he’d settle until morning. The area that the vet had shaved for his scan wasn’t growing back, and still hasn’t (the scan was done in early May I think). The main thing for me was that he’s been extremely quiet and not himself from around March/April I would say. A friend summed it up quite nicely when she said he looked shattered.
    After we had a chat the vet decided to do a ACTH stimulation test for Cushings. I’m not sure if you guys have the same units of measurement over there but I remember the vet said if a result came back at over 600 (again, I’m not sure 600 of what, sorry!) then they could be quite confident it was Cushings. Louis’s result was in the low 800’s.
    So we get to where we are now. He’s due to go back for his first monthly blood test tomorrow and that will be dead on 28 days that he’s been on 30mg of Vetoryl. I should mention he weighs 26kg now but is usually stable at 22-23kg. He is drinking and weeing less, but he’s also eating less. I am mindful that if it is indeed Cushings he would have been over eating and I admit I was probably over feeding him and not noticing. Now I think about it he was eating anything and everything when we went for a walk over out local fields, including fox poo (eew! ��) and I’m wondering if that could have been because of his appetite.
    He’s never been a fussy eater but he will only touch his regular dry food when he’s ready, that’s how he’s always been and still is. He will still eat in a morning if I offer him a treat or a left over bit of my breakfast. This is still broadly the same but he seems a bit more reluctant this last two weeks or so. His appetite gets a bit more back to “normal” later in the day which is what’s making me wonder if he’s not having enough food in a morning with his tablet. I think this spell in a morning is meaning that his overall amount for the day is maybe not as high as it should be. I’ve been measuring out his food (around 300g) for the day and he’s probably eating between 200-250g this last two weeks. I’ve been cooking him a small potato and a bit of carrot and peas to have his tablet with but if he needs some fat in there, as you said, then that’s not going to be doing the job. He does love cheese however, and can hear me open the fridge and the cheese wrapper across the other side of the house!
    I’ll mention all this to the vet tomorrow but as you guys have so much experience do you think I’m on the right track with the feeding in a morning? It’s such a rollercoaster isn’t it? This morning I was firmly convinced the vet had it wrong and the Vetoryl was causing his loss of appetite then I sort of calm down and get back to trying to think rationally, I’m up and down and all over the place! Thanks goodness I’ve got you guys to bounce things off �� x
    Last edited by clairebear; 07-08-2019 at 11:52 AM.

  4. #4
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    Default Re: Advice for a newly diagnosed pooch in the UK

    Thanks so much for all this additional info, and I hope that all went well at your vet appointment. We’ll surely be anxious for an update! It sounds to me as though you’re doing a great job with things, and your suspicion may be correct that the Vetoryl may be upsetting his tummy a bit. I know your vet visit is now behind you, but you could always call back and ask if you might give him a stomach soother of some sort in the mornings, as that might make him feel more comfortable. Anyway, we’ll be waiting to hear any additional news.

    Marianne

  5. #5
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    Default Re: Advice for a newly diagnosed pooch in the UK

    Thanks Marianne!
    Vet visit this morning was very quick. Louis’s not had the full ACTH test but a pre pill cortisol test and they’ve sent a sample off for an enzyme check as well to see if those numbers have changed from his previous tests. I think before I go down the route of more meds to settle his stomach I’ll try feeding him something different with his tablet. What would you guys recommend and roughly how much so it constitutes a proper meal rather than a snack? I’m thinking chicken or fish and rice maybe? x

  6. #6
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    Default Re: Advice for a newly diagnosed pooch in the UK

    Yes, our understanding is that the pre pill cortisol check has become a much more common general monitoring approach over there in the U.K. Some vets are also using that approach now in the U.S., others are still sticking with the full ACTH. Either way, we’ll be anxious to see how things turn out.

    As far as the food, I think either the chicken or fish with rice in the morning sounds great. As long as he gets at least a small bowl full of it, I’d think that would be good as well as a wee bit of cheese or something similar along with the pill ;-).

  7. #7
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    Default Re: Advice for a newly diagnosed pooch in the UK

    Evening all. Just had a phone call from the vet with Louis’s results and it’s good news! His cortisol levels have come down to 154 nmol/L, the acceptable range is 50-138 nmol/L so he’s only slightly above the higher level. The vet has suggested a small increase in dosage to 40mg per day and repeat the pre pill test in a month unless Lou shows any ill effects. His liver enzymes had also decreased. I’m not sure of the figures for these but the vet seemed pretty happy with where they were compared to the increasing figures we were getting prior to treatment.
    I made up a batch of veggies, salmon and a small amount of pasta last night for use over the next few mornings to give him his tablet with. I gave him his pill this morning with some cheese and a bowl of the salmon mixture and he seems to have been a bit brighter today. Probably the best day he’s had in a while, still tired but a bit more active at times. And instead of sleeping on the floor of the living room he’s been making the effort to go and sleep in his usual places which I’m seeing as an improvement.
    I’m a bit apprehensive about a new dose but I think that’s just the unknown and worrying about how he’ll react to it but I’m feeling cautiously positive today.
    Much love and thanks for all your ongoing support :-) ❤️ X
    Last edited by clairebear; 07-10-2019 at 04:46 PM.

  8. #8
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    Default Re: Advice for a newly diagnosed pooch in the UK

    Oh, this is great news :-)))). The one cautionary note that Iíd add is that, if Louis is now getting his pill along with food whereas previously he was not, his cortisol level might well come down even on an unchanged dose. This is because the medication will likely be metabolized more efficiently when given along with food. I know youíll be watching Louis closely for any adverse effects from the higher dose, and hopefully heíll keep doing better instead of having any problems. But I just wanted to explain why you do want to keep a close eye on things.

    Marianne

  9. #9
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    Default Re: Advice for a newly diagnosed pooch in the UK

    Morning. Yeah, I get what you’re saying and I’ll be watching him like a hawk!
    He’s had his first 40mg dose this morning, again with the salmon mixture and a bit of cheese. I wasn’t best pleased when we went for a walk earlier and he ate something he’d found so I’m hoping that doesn’t cause a tummy upset and put my nerves on edge even more! I’ll keep you all updated over the next few days :-) xx
    Last edited by clairebear; 07-11-2019 at 11:51 AM.

  10. #10
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    Default Re: Advice for a newly diagnosed pooch in the UK

    How is Louie handling the increase?
    "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.

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