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Thread: New diagnosis- questions

  1. #1
    Join Date
    Sep 2021
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    Post New diagnosis- questions

    Our baby, Pearl, is a 10 year old french bulldog(maybe a little Boston terrier in her as well). She weighs 22lbs. She's never had any health issues but looking back now the Cushings symptoms have been present for the last 1.5 years, getting worse in the last 6 months. She has recently gotten a presumed diagnosis of Cushings. She had all the symptoms including the potbelly. Her bloodworm came back normal. The vet ruled out Diabetes and had her cortisol level checked in her urine which was very high. Pearl has extreme anxiety and goes into attack mode at the vet. We've had a vet tell us once she is the most dramatic dog they have ever seen. The only way they've been able to draw blood is to sedate her so they did not do the ACTH testing. The vet prescribed 30mg of Vetoryl. She's been taking the medication for 18 days as of yesterday. She responded so well at first. Less water chugging, less food crazed, less peeing, belly had started to seem less swollen, more active, more engaged with us, and overall a lot happier. We were thrilled and then yesterday afternoon after having meds and breakfast, started throwing up in the afternoon. I could tell she felt bad all day yesterday and she wasn't interested in her dinner and had some tremors through the night. Today is better but I did not give her meds this morning and called the vet. I guess I'm just wondering if its unusual for a dog to have a negative reaction after almost 3 weeks on the medication? It just seems so sudden and out of the blue. After reading the posts, I'm thinking maybe she needs to go to a lower dose. The vet said we could switch to 10mg in the morning and 10mg at night and told me to not stop the meds at all. Any advice is greatly appreciated. Thank you!

  2. #2
    Join Date
    Apr 2009
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    Georgia
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    Default Re: New diagnosis- questions

    Hello and welcome! I’m afraid I only have time for a relatively short note right now, but I’ll come back again later on to write more. Most importantly, though, if Pearl were my own dog, I would not give her any more Vetoryl at all until she is once again eating and behaving normally. I know this is advice contrary to your vet — and I’m not a vet myself. But it definitely sounds as though Pearl may have overdosed on the medication and, if so, it may take some time for her adrenal function to rebound such that it’s safe and desirable for her treatment to resume. It can be very dangerous to continue to give Vetoryl at any dose to a dog whose adrenal function is being oversuppressed. And yes, oversuppression can happen at any time, including during the first weeks of treatment.

    I’m especially concerned because your vet started Pearl off at an initial dose that it is higher than is currently recommended by either the manufacturer or clinicians who commonly treat Cushpups. The current recommended starting dose is not to exceed 1 mg. per pound. So the 20 mg. daily total would likely have been a better place to start in the first place. That may turn out to be an optimal dose, but only time will tell. Every dog metabolizes the dog differently and dosing adjustments are common. But as I say, I wouldn’t resume giving any more Vetoryl at all until she has observably rebounded.

    The lack of diagnostic or monitoring blood tests is another issue, of course, which we’ll talk about. Although I understand your problem here, the lack of testing would make me even *more* cautious about being sure to start at a very low dose as opposed to a high dose. When I come back, I’ll give you links to some helpful resource material regarding dosing and side effects. But again, I’d not give Pearl any more medication for now.

    Also, before heading off, here’s a quick question for you. When you say that Pearl’s initial blood work was normal, do you mean that all her results were within normal range? It would be very unusual for a dog with Cushing’s not to exhibit any elevation at all in her ALP (or ALKP) which is a liver enzyme that is particularly responsive to high levels of circulating cortisol in dogs. If there were any abnormalities at all in her blood work, it would help us to know about them.

    OK, gotta run for now. But in the meantime, once again welcome!
    Marianne

  3. #3
    Join Date
    Sep 2021
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    Default Re: New diagnosis- questions

    Thank you so much for the reply! I feel much better about stopping the medication until she's better.

    And I'll need to get the details on the blood work. All I was told was that it all looked normal. They did a CBC and palet count, comprehensive chem panel, thyroid screen, and then the urinalysis chemical and sediment exam.

    The only numbers I saw were for the urine:
    Cortosil 4.66
    Creatinine 4.76
    UCC ratio 305.7

    They also said the cortisol may have been so high partially due to her stress level at the time. Like I said, poor baby completely melts down at the vet.

    Thanks again. It really so helpful to have a place to post and see others experiences. I'll get the details on her blood work asap.
    Lacy & Pearl

  4. #4
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    Apr 2009
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    Georgia
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    Default Re: New diagnosis- questions

    Lacy, you’re so very welcome! And yes, it’ll be a help when you can check on those test results.

    And also, yes, the urine cortisol test is also *very* sensitive to stress. For this reason, it’s recommended that urine for the UCCR test be collected at home and not at the vet’s office. The best scenario is for a sample from the first pee of the day to be collected on three successive mornings at home and pooled (and refrigerated). Then the pooled sample is taken in to the vet for analysis. Cortisol from a single urine sample taken under stress can definitely be skewed upward, and thus result in an inaccurate test. I don’t mean to keep piling on your vet, but if that’s how Pearl’s UCCR was conducted, then I do have to question the validity of that test result :-(.

    The one thing that offsets these question marks about the adequacy/accuracy of the diagnostics is the fact that Pearl’s observable symptoms seemed to initially improve under the Vetoryl treatment. That’s kind of a back door manner to confirm the diagnosis of genuinely elevated cortisol, but it does sound as though the Vetoryl was helping her, at least at first. And hopefully she’ll soon be rebounding in terms of this new abnormal behavior which we’re assuming are medication side effects.

    In terms of initial dosing, here’s a link to a post on our Resources forum that lays out the revised recommendations for lower dosing. In Pearl’s case, this is now water under the bridge since you’ll be resuming at a lower dose, anyway, if/when you do start back with treatment. But this info may still be helpful to both you and your vet:

    https://www.k9cushings.com/forum/sho...=1251#post1251

    Most importantly, how is Pearl doing today? Hopefully she’s better! If not, and if her adrenal function was significantly oversuppressed, she may actually benefit from some temporary doses of prednisone to supplement her cortisol level if it has been driven too low. So please do let us know how things are going today, OK?

    Marianne

  5. #5
    Join Date
    Sep 2021
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    Default Re: New diagnosis- questions

    Yes, the urine test was given under extreme stress, so it sounds like her presumptive diagnosis is mainly from her symptoms. My vet is nice but yeah, I don’t think its probably the best place for expert advice. They seem to have a rotating cast of very young vets so it sounds like I need to find someone who has more specialized knowledge going forward.

    Thankfully, She is so much better! Monday morning she was extremely tired but the throwing up and tremors ended at around 6am. She was tired all day and ate/drank very little but started to pep up by the end of the day and ate dinner. Yesterday she was back to normal. We didn’t give her any medication Monday or Tuesday.

    I did pick up the lower 10mg dosage but am feeling very apprehensive about when to resume at the lower dose.

    Thanks again!

  6. #6
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    Apr 2009
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    Georgia
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    Default Re: New diagnosis- questions

    I’m so relieved to hear that Pearl is back to normal! If it were me, I might think about resuming by Friday if she’s remained normal through this week and you’re starting to see a rebound of her excessive thirst and hearty appetite. But I’d be super cautious and only start with the single 10 mg. dose in the morning. Maybe stick with that for a week or two, and if all is well, consider adding the second dose if necessary. However, if you see symptom improvement on even the lower dose, that may be all the medication you want or need to give for right now.

    Since you’re encountering difficulty in getting accurate cortisol readings, for safety’s sake, I’d really opt for starting back at a very low dose and only working upward if necessary for more complete symptom resolution — and if the apparent symptoms of overdose don’t recur. I know I keep repeating that I’m not a vet and my recommendations need to be judged on that basis. But as Pearl’s advocate, I would encourage you to discuss whatever plan you arrive at with your vet, explaining that you’d much rather be safe than sorry. The purpose of the monitoring blood tests is to catch any unsafe lowering of the cortisol *before* symptoms or damage from overdosing presents itself. Since your vet is dispensing with this recommended monitoring, then he/she ought to be respectful of your desire to lessen the risk of overdose for Pearl by lowering the dose she’s given until you all have a better idea as to how she will be tolerating the drug longterm. Cushing’s is a very slowly progressing disease, and it’s much safer to start with a low dose and gradually work upward as opposed to starting too high and risking serious side effects from the get-go.

    So those are my personal thoughts. No matter what you decide, though, I’m so glad she’s recovered so quickly.

    Marianne

  7. #7
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    Dec 2020
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    Detroit, Michigan
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    Default Re: New diagnosis- questions

    Something I found with my vet(s) was that they were pretty responsive to my "day to day" interracions, as they only see "the numbers."
    (I had basically two vets who were fluent with my girl, and I wouldnt see anyone else)

    It was almost more satisfying when we would come up with solutions together, as opposed to just a diagnosis given to me.
    - meaning, the back and forth was helpful on both ends.

    - Cushings, to me, is a 'fine tuned' issue... there is no 100% way to simple fix, it's a fluid situation.
    In Loving Memory - Gigi (2006-2018)
    - Had a great quality of life as a "Cushings Dog"
    - And passed non Cushings related...

  8. #8
    Join Date
    Dec 2020
    Location
    Detroit, Michigan
    Posts
    34

    Default Re: New diagnosis- questions

    At one point, I remember there wasnt a doseage available to equal out the number my girl needed (15 mg? maybe)
    But later became available.

    The choice was to make up the remainder every other day, and THAT didnt work. (the roller coaster needs to keep steady)
    (I know this sound kind of odd, but like I said, the odd doseage wasnt avalable then)
    In Loving Memory - Gigi (2006-2018)
    - Had a great quality of life as a "Cushings Dog"
    - And passed non Cushings related...

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