Sausage Dog with ? Cushings

[labblab]

Hmmm…if Daisy’s lethargy persists, my worry would be that the 5 mg. increase is too much for her to handle, regardless of whether she gets it in the morning alongside the other capsule or later on in the evening on its own. The 5 mg. represents a full 50% increase, and that may be more than she can comfortably handle. It’s too bad the 5mg. is the smallest capsule that Vetoryl comes in, because for smaller dogs, you don’t have a lot of incremental dosing options unless you shift to a compounded product (and I don’t know whether that’s even available in the U.K.).

I’m very glad you’ve contacted the vet to let them know how she’s doing, though. They may suggest just cutting back to the 10 mg. again for the time being. Let’s see what they say.

Marianne

[LauraA]

Being in the UK it can be difficult to get lower doses. However if your Vet contacts either BOVA UK or Summit Veterinary Pharmaceuticals UK, then he/she can order liquid trilostane (which is the active ingredient in Vetoryl) for you. Just in case you do need to consider a lower dose It is always nice to have options.

[labblab]

Laura, thanks so much for that info! I’ll definitely make a note of that to pass on to other U.K. members.

And Pinkcat, in terms of the capsules you already have on hand, one other option occurs to me that you might discuss with the vet. And that would be to try giving one 5 mg. capsule both morning and evening. In that way, her daily total wouldn’t exceed the 10 mg. total, but she may benefit from better cortisol control by receiving a fresh dose every 12 hours without getting the bigger whammy all at once…


Marianne

[Pinkcat]

Hi all - hope everyone is well
Just thought I would check in as it’s been a few months now. Daisy has settled on 15 mg per day separate as u suggested thank u and all of her fur has grown back and she looks good. She is however seeming to be at the vets every other week has had kennel cough, anal gland blockage, now this week off her food for three days and ended up admitted on fluids and now we have found a crusty sore in the fur on her tail which we now think was the pain she was yelping when touched about and not anal glands. We are back at the vets tonight to have it checked but just wondering if this is common with cushings ? She’s becoming more and more chilled but I’m not convinced it’s chilled wondering if she can’t be bothered being her usual barky self �� how do we stop thinking everytime she is Ill she’s deteriorating �� thank u

[labblab]

Welcome back! I’m so sorry, though, that Daisy is continuing to have so many problems. Can you tell us more about her hospitalization and what the vet thinks caused it? For dogs taking Vetoryl, the first thing we worry about when we hear of inappetance, lethargy, or need for hydration is low cortisol. Has that been ruled out, and was there something else amiss that resulted in her need for fluids?

In terms of her sore, Cushpups do seem to be more vulnerable to skin infections, especially if the cortisol levels are running higher. Have you seen any other sores, or just that one place on her tail?

Marianne

[Pinkcat]

Welcome back! I’m so sorry, though, that Daisy is continuing to have so many problems. Can you tell us more about her hospitalization and what the vet thinks caused it? For dogs taking Vetoryl, the first thing we worry about when we hear of inappetance, lethargy, or need for hydration is low cortisol. Has that been ruled out, and was there something else amiss that resulted in her need for fluids?

In terms of her sore, Cushpups do seem to be more vulnerable to skin infections, especially if the cortisol levels are running higher. Have you seen any other sores, or just that one place on her tail?

Marianne

Hi marianne, when I went back to the vets for check up after fluids Friday they were a little bit puzzled because the obvious thing would be vetoryl levels but there was a couple of things thrown in to complicate it ie a temperature of nearly 41 and slow filling on gums when pressed, we had also just taken her away in the campervan for a quiet weekend to practise before we take her on holiday in a few weeks, she was stressed on the way there only just over an hour drive but better on way home, the lethargy lost appetite etc did seem to start from the Sunday evening. The vets thought that maybe the stress of the weekend has affected things so prescribed some steroid to try and level things out - since I don’t know if it’s a coincidence but her nose is back at the treat door again but she isn’t realy playing just laying around but is managing a walk if taken and it has been hot in the U.K. this weekend - at a loss but I guess that testing bloods needs doing in case - the vet also suggested maybe prescribing us some steroid to take away in case she is realy stressed - we were debating taking her but she ll be as stressed left with dog nanny for two weeks 🤷*♀️ Thanks for coming back to me

[labblab]

Yes, given your description of her behavior, I do suspect that her cortisol level had dropped too low. And especially if she was stressed and her body was not able to produce an adequate amount of cortisol in response, that could make her ill. The fact that she’s doing better on the supplemental steroid really does point in that direction.

I assume she’s off the Vetoryl right now? It would not make sense to be giving her both the Vetoryl and the steroid at the same time since they directly conflict with each other (lowering the steroid level and raising the steroid level simultaneously). I do think a check of her bloodwork before your trip, ideally including cortisol level, is in order. However, you need to be aware that if she’s taking supplemental steroid at the time of the test, it will skew the cortisol level upwards, just like natural cortisol. So she would need to be off the steroid for a few days in order to measure her genuine natural cortisol production. I realize the timing of all this may be difficult with your trip coming up, and the most important thing is keeping her as comfortable as possible. I agree that it most likely will be best to take her with you so that you can see exactly how she’s doing. For right now, let’s see whether she continues to normalize while taking the steroid, since that is a an important indicator as to whether low cortisol was the original problem. And I do think that checking her bloodwork at some point before your trip will be important.

Marianne

[Pinkcat]

Yes, given your description of her behavior, I do suspect that her cortisol level had dropped too low. And especially if she was stressed and her body was not able to produce an adequate amount of cortisol in response, that could make her ill. The fact that she’s doing better on the supplemental steroid really does point in that direction.

I assume she’s off the Vetoryl right now? It would not make sense to be giving her both the Vetoryl and the steroid at the same time since they directly conflict with each other (lowering the steroid level and raising the steroid level simultaneously). I do think a check of her bloodwork before your trip, ideally including cortisol level, is in order. However, you need to be aware that if she’s taking supplemental steroid at the time of the test, it will skew the cortisol level upwards, just like natural cortisol. So she would need to be off the steroid for a few days in order to measure her genuine natural cortisol production. I realize the timing of all this may be difficult with your trip coming up, and the most important thing is keeping her as comfortable as possible. I agree that it most likely will be best to take her with you so that you can see exactly how she’s doing. For right now, let’s see whether she continues to normalize while taking the steroid, since that is a an important indicator as to whether low cortisol was the original problem. And I do think that checking her bloodwork at some point before your trip will be important.

Marianne

Hi

Yes on steroid her appetite and drinking has increased although she still seems lethargic but could be the heat. We aren’t used to it ha ha ! But unfortunately she has been on vetoryl and steroid over the weekend but I haven’t given steroid today just vetoryl thinking that it would skew the bloods. All other bloods have been done and show ok apart from
White cell count which they prescribed antibiotics for. I’m going to ask for cortisol levels to be checked but could it be that the weekend away just skewed them because she was happy as Larry before that ? Also vets have suggested us taking some steroid tablets away with us so that when she gets stressed we can have it to hand to help her out but I’m
Not sure I fully understand how this would work given what you have just said thank you xx

[labblab]

I don’t understand why the vet would tell you to give Daisy *both* Vetoryl and a supplemental steroid. If she is suffering from low cortisol requiring steroid supplementation, this would mean that her Vetoryl dose is now too high. If so, the Vetoryl needs to be discontinued altogether for a time, and then restarted at a lower dose once her natural cortisol production has rebounded. In other words, the supplemental steroid is usually meant to be a bridge during the time period when she is off the Vetoryl and her natural cortisol production needs to rebuild. Once that has happened, the steroid can be stopped and the Vetoryl restarted at a lower dose. The time it takes for a dog to rebound from Vetoryl overdosing can vary greatly, though, from a few days to weeks.

But this all depends upon whether her Vetoryl dose is truly too high and low cortisol is really the culprit. This can only be known for sure by testing. However, for safety’s sake, whenever low cortisol is suspected, the Vetoryl should be halted until the testing can be performed. The temporary reemergence of Cushing’s symptoms in the absence of Vetoryl can be frustrating. But the dangers of low cortisol caused by Vetoryl overdosing can be life threatening. So of the two choices, temporarily halting the Vetoryl is far safer. Again, I am not a vet myself. But I am puzzled by your vet’s recommendation here.

Marianne

[Pinkcat]

I don’t understand why the vet would tell you to give Daisy *both* Vetoryl and a supplemental steroid. If she is suffering from low cortisol requiring steroid supplementation, this would mean that her Vetoryl dose is now too high. If so, the Vetoryl needs to be discontinued altogether for a time, and then restarted at a lower dose once her natural cortisol production has rebounded. In other words, the supplemental steroid is usually meant to be a bridge during the time period when she is off the Vetoryl and her natural cortisol production needs to rebuild. Once that has happened, the steroid can be stopped and the Vetoryl restarted at a lower dose. The time it takes for a dog to rebound from Vetoryl overdosing can vary greatly, though, from a few days to weeks.

But this all depends upon whether her Vetoryl dose is truly too high and low cortisol is really the culprit. This can only be known for sure by testing. However, for safety’s sake, whenever low cortisol is suspected, the Vetoryl should be halted until the testing can be performed. The temporary reemergence of Cushing’s symptoms in the absence of Vetoryl can be frustrating. But the dangers of low cortisol caused by Vetoryl overdosing can be life threatening. So of the two choices, temporarily halting the Vetoryl is far safer. Again, I am not a vet myself. But I am puzzled by your vet’s recommendation here.

Marianne

Hi
I ve just got back from checkup, they have agreed that I stop steroid (I did this morning anyway and seen an improvement in daisy already picking up toys again etc until we had to go back to vets) she’s finishing antibiotics and they are going to discuss her and see when she’s good to get tested again. I ve taken on board what you have said and will watch closely for signs of low cortisol but I’m starting to think that the stress of going away has just increased her cortisol too much and made her have all of these symptoms rather than dosage being wrong as she was fine before we went - is that possible ? And if so the key is how do we keep her cortisol levels down on our travelling days during holiday is it feasible to just give 10 or 5 mg those days ? I have to ring them back to get instructions what to do while we are away on Thursday