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Thread: Newbie needs help

  1. #1
    Join Date
    Sep 2019
    Posts
    6

    Unhappy Newbie needs help

    Hello everyone. I am needing some help and advice as my vet has been a nightmare and I'm in a state of despair. My 4 year old Bolognese, Teddy was diagnosed with Cushings beginning of August. He is on 30mg of vetoryl once a day and currently weighs 10.6kg. Very over weight and its just going up and up. I have cut food right down and have done nothing different for his weight to rise. He had his 30 day ACTH test yesterday (2nd attempt as my vet did it wrong last week so it had to be repeated!) but his symptons remain the same. Drinking excessively, hungry all the time, panting, won't play and sometimes won't go out for walks. My vet said yesterday that they may have to up his meds. Is that right? I think the dose is high? I can't post attachments by the looks of it so can't put his last results on here but from what I can see when he was tested first his pre ACTH was 466 nmol/L and post ACTH was 599 nmol/L. At 14 day test it came down to pre ACTH 111 and post 64. Has this come down too quick? A note from the lab recommends pre to be less than 200 and post to be greater than 50. They say his dosage is currently perfect. Be interesting to see what the 30 day test results are. If this is the case, why am I not seeing any improvements in Teddy? I am very worried about increasing the dosage on such a small dog.

  2. #2
    Join Date
    Apr 2009
    Location
    York, PA.
    Posts
    10,642

    Default Re: Newbie needs help

    Hi and welcome to you and Teddy!

    I am so sorry for the reasons that brought you to us but glad you found your way here. Was your sweet boy's Cushing's diagnosis based with that first ACTH stimulation test? Was an ultrasound or low dose dexamethasone suppression (LDDS) test performed? Also, it is vital that Vetoryl be given with a meal to be properly absorbed and those monitoring ACTH stim test have to be performed 4-6 hours after the Vetoryl is given, have these protocols been followed? Since cushdogs are prone to UTI's and this type of infection will make a dog drink/urinate more, has an urine culture been done to make sure that Teddy doesn't have an UTI? Was a CBC/chemistry blood panel done and if so, could you post any values that are marked abnormal with their reference ranges and units of measurement; as an example: ALT 150 U/L (5-50)...thanks!

    Teddy's most recent ACTH stim results (which I have converted to the units we are used to seeing) pre - 4.02 ug/dl ~ post - 2.31 ug/dl, are indeed within the therapeutic ranges, however cortisol can continue to drop for the first 30 days of treatment so please keep a watch out for symptoms of too low cortisol which are: lethargy, loss of appetite, diarrhea, vomiting, or Teddy not just acting right, if any one of these symptoms are noticed than stopping the Vetoryl is advised. When is his next ACTH test scheduled?

    I am sorry for all those questions I asked but the more we know about your precious boy the better our feedback will be, and know, we will help in any way we can.

    Lori

  3. #3
    Join Date
    Sep 2019
    Posts
    6

    Default Re: Newbie needs help

    Hi. Many thanks for your reply. His diagnosis came about with a full biochemstry when endocrinology test was pre ACTH was 466 nmol/L and post ACTH was 599. No ultrasound or LDDS (not sure what that is - is it a separate test?) in which case the answer would be no. The 14 day test yes protocol for 4-6hrs was done. The 30 day test last week wasn't - so was void. Had to be repeated 5 days later (arghhhh). I am waiting for those results. I did take a urine sample in last week and all came back clear - whatever that means. I asked to see the paperwork for it and they can't produce it (again argghhh). Needless to say I have changed my vet and see him on Monday.
    The only blood chemistry done was at 14 days. I refused to take my dog back the day after 30 day ACTH test on Monday for this. he was too stressed and to be honest would not let the vet anywhere near him again. It can be done with the new vet next week.
    Alerts as follows on 14 day test:
    Haematology:
    HCT 0.687 High (normal range 0.383-0.565) 1/L units
    MCV 84.3 High (normal range 59.0-76.0) fL units
    MCHC 27.2 Low (normal range 32.6-39.2) g/dL units
    Absolute retic count 120.6 High (normal range 32.6-39.2)
    Lymphocytes (absolujte) 0.94 Low (normal range 1.06-4.95)
    Monocytes (absolute) 0.07 Low (normal range 0.13-1.15)
    Biochemistry:
    Total protein 83.5 High
    Albumin 45.3 High
    Alk Phosphatase 1785 High (reference range less =130.0) units U/L
    Cholesterol 7.05 High (ref range 3.20-6.20)
    Clacium 2.95 High (ref range 2.36-2.84) mmol/L
    and of course his enocrinology as above
    I hope you can understand all these results.

  4. #4
    Join Date
    Apr 2009
    Location
    York, PA.
    Posts
    10,642

    Default Re: Newbie needs help

    The LDDS (low dose dexamethasone suppression) is a test that takes 8 hours to perform and is considered the "gold standard" test used to diagnose Cushing's, it also has the capability to differentiate between the adrenal or pituitary form of Cushing's.

    Some of Teddy's blood panel anomalies can be associated to Cushing's such as the elevated ALP and cholesterol but generally a dog with Cushing's syndrome have what is called a "stress leukogram," which refers to a specific white blood cell distribution in the blood. This includes a high total white blood cell count with increased numbers of neutrophils and monocytes and a decreased numbers of lymphocytes and eosinophils and Teddy's CBC shows that only the lymphocytes are low.

    Exactly what protocols weren't followed with his 30 day ACTH stim test? Glad to hear that you've changed vets and hopefully this one will work out, many of us have had to do the same thing...great job being a excellent advocate for your Teddy! Please keep us updated!

    Lori

  5. #5
    Join Date
    Sep 2019
    Posts
    6

    Default Bravecto & Milbemax

    My boy is on Vetroyl. Does anyone know if it's OK to give Bravecto and Milbemax worming and flea treatments?

  6. #6
    Join Date
    Mar 2009
    Location
    rural central ARK
    Posts
    14,082

    Default Re: Bravecto & Milbemax

    I have merged your latest post concerning parasite medication usage with Vetoryl in to Teddy's original thread. We like to keep all posts about each pup in one thread. That way it is easier for us all to keep up with the history....plus this thread will serve as a sort of diary of Teddy's cush journey for you.

    Since I am not familiar with those medications I did a bit of research and found nothing on either one that says not to use in conjunction with the treatment drugs for Cushing's. I would contact the companies that make these drugs and ask just to be sure tho....however I am a HUGE twitcher and tend to worry about every little thing. I did find some stories about Bravecto that scared me a bit concerning side effects other dogs have experienced but can be true of just about any powerful medicine like heart worm preventatives. The one I have used with all my dogs, Advantage Multi, has scary stories but I have never had any issues with any dog that used it.
    "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.

  7. #7
    Join Date
    Sep 2019
    Posts
    6

    Default Re: Bravecto & Milbemax

    Bit of a stupid question but is the 30 day ACTH test 30 days after the 14 day ACTH test or 30 days from start of medication (i.e. 16 days after the 14 day test)?

  8. #8
    Join Date
    Apr 2009
    Location
    Georgia
    Posts
    14,042

    Default Re: Bravecto & Milbemax

    Hello from me to you and Teddy! The 30 day test is generally performed one month after the start of medication. We’ve seen some vets vary the exact timing somewhat based on variables that are specific to an individual patient such as starting dose, symptom resolution, adverse effects, etc. But in general, the test is recommended 30 days after starting treatment.

    Given Teddy’s continuing problems and significant cortisol drop after the first two weeks on a somewhat high starting dose of medication, I’d definitely advocate for testing earlier rather than later in his case. How are things currently going for your little guy?

    Marianne

  9. #9
    Join Date
    Sep 2019
    Posts
    6

    Default Re: Bravecto & Milbemax

    He’s doing so much better since stopping all meds. We start again after a 10 day break next week on 20mg. He’s booked in for ACTH 14 days after starting and then I’ll book him for another one 16 days after that for the 30 day test. My new vet seems more clued up so hopefully he won’t be over dosed this time. Thanks so much for your advice.

  10. #10
    Join Date
    Sep 2019
    Posts
    6

    Default Re: Bravecto & Milbemax

    When giving Vetoryl is it ok to give directly before eating breakfast or is it best directly after?

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