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Thread: 13 year old Chihuahua Intro! 3 months post diagnosis

  1. #1
    Join Date
    Oct 2022
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    Default 13 year old Chihuahua Intro! 3 months post diagnosis

    Hello, happy to have found this forum!

    Our 13 year old Chihuahua Brady was diagnosed with pituitary Cushing's 3 months ago and it's been a rough experience. He was diagnosed because his cortisol levels were very high in some routine blood work (something like 1900 in whatever the measurement is when apparently it's supposed to be like 300). He never really had the Hallmark symptoms of increased thirst, peeing, thin skin, panting, ect. He did/does have the pot belly, elevated liver enzymes, and anxiety.

    He underwent a low dex test that diagnosed pituitary as the cause

    He was given a daily 15mg daily dose of vetoryl, which is close to the 1mg per lb (he was 14.5 lbs at the time).

    After 3 weeks we did a ACTH and levels came back good. At that time we chose to go compounded from chewy so we could get 1 15mg capsule instead of a 5 and 10. His would start after we ran out of the vetoryl.

    About a month after starting treatment he collapsed in his rear legs while doing his outdoor business one day. We took him to a emergency vet, to get examined. We were given some galiprant as he has luxating patella (for years) in both rear legs, but worse in his right. He recovered in a few days of rest and meds.

    We then received the compounded a week or so later, and began treatment via that. 3 weeks later, started to see some anxiety again. Figured it was time to do a checkup. Doctor did blood work and indeed cortisol levels were very high again, about 2000. So we immediately switched back to vetoryl. Now 3 weeks later (6 weeks post leg collapse) he cannot walk on his rear left leg. We brought him in for another acth, and a x-ray. Acth results were "perfect" according to the lab, and the x-ray did not show any real issues. We had an additional radiologist consult on those x rays, for a disease that is caused by lack of blood flow.

    We've scheduled a Ortho consult to get a better look at a small discoloration on the x-ray that could be anything from a cyst or cancer.

    Something doesn't feel right though, both times he's been on vetoryl, 3-4 weeks later he can't walk. Am I being crazy? The coumpounded trilostane didn't seem to work at all so crazy gut feeling is that when we switched to the compounded a couple days after the fall, he regained mobility, and now again 3 weeks after switching back, we have to carry him every where.

    Thanks for creating this website and compiling all the resources!

  2. #2
    Join Date
    Apr 2009
    Location
    Georgia
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    15,056

    Default Re: 13 year old Chihuahua Intro! 3 months post diagnosis

    Hello and welcome to you and Brady! I’ve just now officially approved your membership, so if you receive an “automatic” email asking you to confirm your membership request, you can just ignore it now. Everything’s been taken care of.

    I’ll plan to return again later today to add a more thorough reply, but I didn’t want to wait any longer to welcome you :-). We’re very glad you’re joined us, and I will be adding more later.

    Marianne

  3. #3
    Join Date
    Oct 2022
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    Default Re: 13 year old Chihuahua Intro! 3 months post diagnosis

    Thank you for the approval. While I wait I wanted to include his test results

    June 2022
    Blood cortisol levels 1900 (not sure the unit of measure, this is what was told to me by vet)

    Low dex test done 6/5
    Sample 1 - 6.6 ug/dl
    Sample 2 - 0.7 ug/dl
    Sample 3 - 3.6 ug/dl

    Got put on 15mg of vetoryl

    July 3 - ACTH results (with morning dosage)
    Sample 1 - 0.7 ug/dl
    Sample 2 - 8.1 ug/dl

    Switched to compounded after that test

    1 month later could see symptoms of anxiety again (panting, whining, ect) so vet said to go back to vetoryl and we would do a ACTH after a month of that around beginning of September. Also his blood cortisol level was now 2000 (again dont know the unit). So we know the compounded was not working.

    Oct 4 (latest) ACTH
    Sample 1 - 0.5 ug/dl
    Sample 2 - 6.5 ug/dl

    These are the results claimed as "perfect" by vet but the report says "below normal" for both samples.
    Last edited by Dus1988; 10-14-2022 at 04:44 PM.

  4. #4
    Join Date
    Apr 2009
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    York, PA.
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    10,877

    Default Re: 13 year old Chihuahua Intro! 3 months post diagnosis

    Hi and welcome to you and Brady!

    So sorry that Brady is having trouble with his rear legs, I know this is quite concerning to you and him. One question I have is: are you giving his Vetoryl with food, even on the day of his cortisol test? Another thing I'd like to mention is that Brady may need to have his cortisol to run a bit higher than the therapeutic ranges listed. Dechra, the makers of Vetroyl, do state that a post cortisol can go up to 9.1 ug/dl if symptoms are controlled.

    Lori

  5. #5
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    Georgia
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    Default Re: 13 year old Chihuahua Intro! 3 months post diagnosis

    So sorry for the delay, but here I am back again. Something wonky was going on with our website this morning and I couldn’t get online. But fortunately we’re back in action once again, so I’ll try to get this reply finally posted.

    As far as what’s going on with Brady and his mobility issues, my best guess is that highly elevated cortisol has perhaps been a double-edged sword for him. Prior to Vetoryl treatment, his high cortisol level was apparently causing some symptoms consistent with Cushing’s. However, it may have also been *easing* an inflammatory or arthritic condition in his hind legs. In the same way that dogs or humans are often given supplemental prednisone or other steroids to treat inflammatory conditions, high levels of circulating cortisol may also be naturally serving that same purpose. So even though his Cushing’s symptoms are hopefully helped by lowering the cortisol with the Vetoryl, certain inflammatory conditions may actually worsen. We’ve seen this before, especially with arthritic older dogs. Overall, the Cushing’s treatment can be a benefit. However, new or worsened mobility issues may emerge, along with the need to give ongoing pain meds — such as the Galliprant — as a result.

    In looking at his test results, it’s true that his LDDS results are consistent with the pituitary form of Cushing’s. Also, for the most part, his monitoring ACTH results would be considered to be good, as your vet has said. I say “for the most part,” because I do have a question about his “Sample 1” (baseline cortisol) readings. When dogs are being treated with Vetoryl, we expect that their cortisol readings will indeed be below the “normal” lab range for dogs who don’t have Cushing’s. Also, for treatment monitoring purposes, we’re usually largely focused on the “Sample 2” readings and don’t care so much about the baseline cortisol levels. With Brady, his post-ACTH results are where we like to see them, assuming his Cushing’s symptoms have resolved. However, his baseline readings (0.7 and 0.5 ug/dL) are truly quite low. If he’s spending a large part of each day with a cortisol level that low, it’s no wonder that he’s not very energetic! The big difference between his pre-ACTH and post-ACTH samples is honestly rather puzzling to me, and if he were my own dog, I’d welcome some feedback about that.

    Dechra, the maker of Vetoryl, has technical representatives available who welcome inquiries from vets when oddities like this arise. Your own vet may not think this discrepancy seems strange, but I’ve seen lots of monitoring ACTH results reported here on the forum, and results like this with such very low baseline readings are uncommon. Taken in conjunction with Brady’s weakness, I do wonder whether those low baseline readings may be an issue and, like Lori, I also wonder whether his cortisol levels generally should be allowed to run somewhat higher. At least, those are my initial thoughts/concerns about Brady’s situation.

    Marianne

  6. #6
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    Oct 2022
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    Default Re: 13 year old Chihuahua Intro! 3 months post diagnosis

    Thank you Lori and Marianne for your feedback

    To answer the question of his dosing, yes he gets dose first thing in the morning with food, even on acth test days

    The idea that high cortisol could mask other arthritic issues seems logical. We've got a orthoconsult in 1 week so hopefully that can shed some light on his condition.

    We will definitely reach out to his vet about his low sample 1 levels. I'm kinda wondering if we should stop dosing for a few days to get those levels up, and then do a lesser dose.

    Thanks again for your insight.

  7. #7
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    Oct 2022
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    Default Re: 13 year old Chihuahua Intro! 3 months post diagnosis

    Update on Brady,

    going to the ortho consult has all but confirmed the presence of an osteosarcoma in the lame leg. Waiting on a cytology report to confirm but it looks pretty clear it is cancer.

    the whole question of is it addisons or cushings is now moot, as he has mostly refused to eat enough to take the vetoryl.

    I do feel like he is more aware of his surrondings after 5 days without meds, but it could also be the gabapentin they gave us to give him for the pain.

    At any rate, we are devastated as his advanced age and the cummulative condition of his health seems like we may be needing to consider euthanization.

  8. #8
    Join Date
    Apr 2009
    Location
    Georgia
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    Default Re: 13 year old Chihuahua Intro! 3 months post diagnosis

    Oh my, this is definitely not the news I was hoping to read about Brady. I totally understand what a sad shock this diagnosis must be for you, and what a difficult decision you may be facing. My heart goes out to you, and I really appreciate your taking the time to update us in the midst of your own uncertainty. Please continue to let us know what you find out regarding the cytology. We’ll remain here by your side, no matter what.

    Please give Brady a big hug from his K9C family here, and we’re sending hugs to your whole family, as well.
    Marianne

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