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

  1. #1
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    Default Daisy: 10-year-old Pit Bull/Boxer Mix with Cushing's; questions about Vetoryl dosage

    Hi everyone,

    I'm newly registered to this site, but I've been following it for a few months now, as all of you dispense such wonderful, helpful advice!

    I have a 10-year-old, 45-lb petite pit bull/Boxer mix named Daisy (aka, best friend ever--haha). I have two vets for her: a holistic practitioner and a "conventional" vet, where I take her for all of her testing. My conventional vet suspected Cushing's in late 2015, after a pre-dental blood test revealed a high ALP (500). Daisy was also showing increased thirst and fur loss. They later ran an ACTH stim test (her reading was 35), and I started her on flax lignans and melatonin. After months on that natural protocol, Daisy was only losing more fur, drinking more water, and even presenting with flaky, bumpy skin problems--so I took her to a specialist for further testing, including an ultrasound. Their recommendation was: "treat with next level of medication for pituitary dependent hyperadrenocorticism." At that point, even my holistic vet suggested I put her on Vetoryl, and so our journey with Cushing's meds began....

    I think I've done a pretty good job of following the testing recommendations, and I've kept a running diary of Daisy's ACTH stim test results. Here are the latest:

    *7/11/17: Pre: 1.5; post: 6
    *10/10/17: Pre: 1.6; post: 4.5
    *1/31/18: Pre: 1.4; post: 3.7
    *5/16/18: Pre: .8; post: 2.7

    So her post numbers have been steadily declining...and after researching various threads on this site, I found others expressing concern that these numbers might keep dropping into unsafe levels. After this last testing, my vet and I decided to temporarily discontinue the 30mg once-daily Vetoryl that Daisy's been on for a year now, wait about a week, and restart her on a lower dose. My question is: Would the seasoned members on this site suggest I restart her at 20 mg, then wait 10-14 and retest her?

    I tend to panic...but I am trying to keep my head about me, as Daisy is seemingly OK, for the most part. Since starting Vetoryl, her fur and skin have completely rebounded, and she's drinking a bit less water. Just recently, though, this generally VERY ACTIVE, BOISTEROUS girl had a couple funny moments. She usually bounces up from a seated/down position, but she seemed to have a little trouble getting up recently, and even seemed to have a little back leg weakness walking up the stairs. Looking back at past threads, I've taken notice of others posting similar episodes and wondering if cortisol dropping too low has something to do with it.... Thoughts?

    One more question, for now: Even though her cortisol levels are now on the low side, her ALP level has stayed high. On this latest testing, all readings came back good except for two: CK, which has trended very high for a while now (436) and ALP (1200). Why would ALP not be coming down?

    I'd greatly appreciate any insights, and thanks in advance!

    Daisy's Mom

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

    Hi and welcome to you and Daisy!

    Even though her ACTH numbers are great I think it was definitely a good idea to stop the Vetoryl because of the cortisol continuing to drop. If this were me, I would restart the Vetoryl at 10 mg once a day instead of 20 mg with a retest in 2 weeks and see how it goes. You say that her drinking is a bit less, so I'm assuming this never returned to normal so my next recommendation would be if symptoms seem to rebound than I would give the 10 mg twice a day so that the cortisol can be controlled on a more even keel.

    Is Daisy getting her Vetoryl with a meal and are those ACTH stimulation tests being performed 4-6 hours post pill?

    Regarding the ALP, sometimes that level never returns to a normal range and if the other liver enzymes (ALT, GGT, AST) are within normal limits I wouldn't worry too much about that ALP.

    Rear leg weakness may be a symptom of too low cortisol especially if the onset is suddenly, however the other more common signs of Hypocorticism that are seen are: vomiting, inappetence, diarrhea, increased drinking/urinating. Is Daisy showing any of those symptoms?

    One quick question, what did the ultrasound show?

    Lori

    PS...Great job in keeping a diary of her ACTH test results!!!

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

    Hi Lori,

    Thanks for the quick and thorough response.

    Oh good, I'm glad to hear that I'm likely on the right track, and I appreciate your suggestions. Suddenly stopping the Vetoryl felt kind of funny...but I now know from other posts that you can stop and start again fairly easily with this med. You're right: Her drinking probably hasn't returned to normal, but it's hard to tell. I take her on long walks (you should see how nicely she jogs along, even uphill), and she comes back wanting water but isn't out of breath. She does drink a fair amount during the day, too, but it doesn't seem crazy excessive like before. I wish I could remember how much she used to drink before Cushing's started... Another thing I have noticed recently (besides her sudden trouble getting up sometimes) is her panting. She's definitely doing that more frequently.

    Yes, Daisy gets her med every morning around 7am, right after a meal. I also feed her on testing days and won't even walk her into the vet's waiting room until 11am, just to be sure they don't test her early! As for symptoms of hypocorticism: She has occasional soft stool and has had bouts of diarrhea before (mostly when I was attempting to transition her to a raw diet, which the vet eventually said might just be too "rich" for her system). We're back to high-quality dry food and canned food, a bit of canned pumpkin, and ground turkey--that's a typical meal for her.

    The ultrasound showed:
    Liver: Mild diffuse, hyperechoic hepatomegaly
    Gallbladder: Normal
    Spleen: Normal size and echostructure
    Adrenals: Bilateral enlargement, no masses
    Pancreas: Normal
    Peritoneal cavity: Normal omentum. No effusion, no lymphadenopathy
    GI tract: Stomach filled with food material
    Urinary Bladder: Normal wall and luminal echostructure
    Retroperitoneal cavity: Normal
    Kidneys: Mild, hyperechoic renomegaly with mild increased cortical echogenicity and increased corticomedullary ratio.

    Differential diagnosis: Mild steroid hepatopathy, bilateral adrenal hypertrophy with no masses, supportive of pituitary dependent hyperadrenocorticism

    That's a mouthful, huh?

    Anyway, thanks for the advice so far!
    Heather

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

    One more thing for now: I'm curious as to what other members' experiences are like with once-daily Vetoryl dosing vs. twice-daily dosing...

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

    The normal amount of water for a dog with out Cushing's drinks is approximately 1 ounce per pound of the dog's weight. Is she drinking a lot more than that?

    Panting is a common symptom with Cushing's. In cushdogs, it is believed to be caused by a combination of muscle wasting, redistribution of fat to the thoracic area and a general sensitivity to heat.

    Glad to see that the adrenal glands were visualized on the ultrasound, and yep, both of them being enlarged is indicative to PDH. The mild steroid hepatopathy is something else that is generally found with cushdogs, it means that they have a fatty liver due to Cushing's. Is she taking any kind of liver supplementation? If not, you may want to ask your vets about giving her milk thistle.

    Quote Originally Posted by Daisybaby View Post
    Yes, Daisy gets her med every morning around 7am, right after a meal. I also feed her on testing days and won't even walk her into the vet's waiting room until 11am, just to be sure they don't test her early!
    WOW, you are on top of things! GREAT job!!!!!!

    Lori

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

    I don't believe she is currently drinking more than that--but I will measure it out for a couple days.

    Wow, you are very good at interpreting those ultrasound results. Funny you mention milk thistle: I actually asked my holistic vet about that, but he didn't think it was necessary. I'll have to ask him again WHY because I also thought that would be a good supp for her. As for other supplements she's on: Crananidin cranberry tabs (she had a UTI last year), Dr. Mercola Complete Probiotics for Pets, and Dr. Mercola Digestive Enzymes. The vet also has her on a couple Chinese herbs, as he's experienced in that realm. I'm not sure if they truly help her, but they don't appear to harm her in any way.

    Also, thank you--I'm definitely trying to stay on top of things because, as others have said, we're their only voice! While I don't always do a very good job of standing up for myself, I try my hardest when it comes to Daisy. This website has certainly helped me learn so much about Cushing's, too.

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

    I just want to say hello and welcome. You are doing an awesome job and I wouldn't do anything different. I would add in a liver support supplement too, just because cushings is always hard on the liver. Another one to think about going forward might be a joint support supplement. You can get these in dog treat format, so that's a possibility.

    You're dong such a great job with the cushings medicating. That can be a tough one, but you are very on top of it.
    Sharlene and the late great diva - Molly muffin (always missed and never forgotten)

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

    Thanks so much, Sharlene! I appreciate your comments. It's very comforting to know I'm on the right track, and I'll definitely check into liver support and even joint support. You're right; navigating the meds is a toughie for sure. And although putting Daisy through so much testing is THE WORST, I know close monitoring is very important.

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

    Hi everyone,

    I haven't posted in nearly a year, as Daisy has been doing pretty well. She's currently on 20 mg Vetoryl daily, and her latest ACTH came back with a post of 8.4. I'm hoping she'll test out a bit lower on the next one, but I am hesitant to go toward a higher mg (as you can see from previous messages in this thread) if she doesn't. Anyhow...Daisy still has rear leg weakness and appears very stiff at times. She jogs along very nicely on a walk, but is stiff before and after. Per some of your suggestions, she's been on a supp for joints (Cosequin DS plus MSM) and a liver support supp (Dr. Mercola Liver and Kidney support, containing milk thistle) for months now. My vet recently recommended I also try her on Rimadyl, but I'm very concerned about doing that, as I know Cushing's is so hard on the liver. At the same time, the Cosequin--even at a higher dose than suggested for her weight--doesn't seem to be making much of a difference.

    I'd love to hear your thoughts on this!
    Daisy's Mom

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

    Welcome back to you and Daisy! I'm so glad to hear that, for the most part, she's remained stable. Given her age, I do believe that daily quality of life really takes a front seat, so if she were mine, I wouldn't be averse to being more aggressive with pain relief measures at this time. The risks associated with NSAIDS are especially heightened when cortisol levels are high and uncontrolled. Since Daisy has been managed well for this length of time on the Vetoryl, I'd probably be willing to try adding in an NSAID. However, I believe there are newer NSAID options that are generally considered to be somewhat safer than Rimadyl. For instance, my epileptic nonCushpup suffered from worsening orthopedic pain but was also at higher risk for liver damage to her phenobarb. We opted to treat her with Previcox which is a newer NSAID, and I believe there are additional, even newer, possibilities on the veterinary market now. So if you want to move forward, I'd ask your vet whether or not there might be a better option for chronic pain than Rimadyl.

    Another pain relief option is Tramadol. It is not an NSAID, so it doesn't offer anti-inflammatory benefit. But it is a straight pain-killer with perhaps a "safer" profile in certain ways. So that might be an option to discuss further with your vet, as well, to see if there are advantages or disadvantages that might be in play for Daisy. As I understand it, Tramadol and an NSAID can even be given at the same time since they represent two different classes of medication.

    Good luck to you both, and please do keep us updated, OK?
    Marianne

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