6 y/o cockapoo Bonnie recently diagnosed

[Squirt's Mom]

Glad to hear the update and pray all continues to go well. Tho I am like Lori and still question the diagnosis and dose. But you're doing a great job, Mom, so I'm sure you will catch any sign if things start to turn the other way. Never hesitate to stop treatment if in doubt. That is the one thing I like about Vetoryl...it is very easy to stop and restart without losing ground. Good luck with the US!

Hugs,
Leslie

[BonnieandDre]

Hi Everyone,

We did the ultrasound yesterday and are happy to report no adrenal tumors.

1) Bilaterally symmetric upper-normal to mildly enlarged adrenal glands are
likely secondary to pituitary dependent Cushing’s disease. No adrenal gland mass
lesions are seen. 2) Steroid or other vacuolar hepatopathy. 3) Colitis.

She's going to do more treatment for giardia, since that's likely still causing the colitis. Liver should improve with continued treatment.

Next steps:
Cushings - continuing 30mg Vetoryl, followup ACTH at 3 months.
Giardia - 3 weeks of antibiotics + finishing probiotics, followup stool test

I'm thinking I'll cancel the UC Davis appointment at this point. Both vets are in alignment this is no doubt Cushings. (Also have already spent ~$2k in the last 6 weeks.)

Thanks,
Andrea

[labblab]

Hi again, Andrea, and thanks so much for this update. I’m very glad you did have the ultrasound done, and yes, the results do sound consistent with Cushing’s. FWIW, I’d probably still hold on to the UC Davis appointment for the moment, though, mainly because it was so hard for you to get it in the first place. You can always still cancel later on if everything stays stable through March. But it seems as though it’s kind of nice to have that “ace-in-the-hole” should any further worries arise. In the meantime, we’ll be hoping that Bonnie can get rid of that darn giardia and otherwise remain stable and happy!

Marianne

[Squirt's Mom]

Hey Andrea,

Word of caution....you stated:
"continuing 30mg Vetoryl, followup ACTH at 3 months."

This is not protocol for Vetoryl/Trilostane. Because it is such an unstable drug the testing schedule set up by the manufacturer is as follows -
1st monitoring ACTH at 2 weeks after starting
2nd at 30 days after starting
3rd IF ALL IS WELL at 3 months
Then every 3 months

UNLESS there is a dose change up or down then the testing schedule starts all over at the two week mark. So waiting 3 months at this point can be very risky...especially with the high starting dose. Since treatment started in early Feb, the next monitoring test needs to be in early March. So unless you insist the vet follow the protocol, be extra vigilant in watching for any of the signs that the cortisol is dropping too low. I do understand the strain of expense but in the beginning it is very important to keep to the testing schedule. As time passes and she settles into a good dose you can take a bit more time between monitoring tests.

I agree with keeping the UC Davis appointment for a variety of reasons... not the least the length of time it can take to get one later if needed.

Keep in touch and let us know how things are going!
Hugs,
Leslie

[BonnieandDre]

Hi Leslie,

Hmm, maybe I have that wrong and need to do a 1 month checkup. I can ask the vet.
Bonnie had her 14 day initial check up after starting the 30mg Vetoryl and her levels were good. I asked about the concern of levels continuing to fall, and the vet wasn't concerned (maybe because even if they did fall a bit more it would be fine?).

The other vet I talked to (where we did the ultrasound), also thought the dose was normal.

Good point about the Davis appt - I'll keep and decide closer to the date.

Thanks!

[Harley PoMMom]

The Vetoryl ACTH testing protocol that Leslie posted is correct; here's an excerpt from their pamphlet: "4. Long term monitoring. Once an optimum dose of VETORYL Capsules has been reached, re-examine the dog at 30 days, 90 days
and every 3 months thereafter. At a minimum, this monitoring should include: • A thorough history and physical examination.
• An ACTH stimulation test (conducted 4-6 hours after VETORYL Capsule administration) - a post-ACTH stimulation test resulting in
a cortisol of < 1.45 μg/dL (< 40 nmol/L), with or without electrolyte abnormalities, may precede the development of clinical signs of
hypoadrenocorticism.
• Serum biochemical tests (with particular attention to electrolytes, and renal and hepatic function).
Good control is indicated by favorable clinical signs as well as post-ACTH serum cortisol of 1.45-9.1 μg/dL (40-250 nmol/L)"

The link to where this information is found: Vetoryl Monitoring Form https://www.k9cushings.com/forum/sho...=1250#post1250

Looking forward to hearing more updates about sweet Bonnie!

[BonnieandDre]

Bonnie has been acting very funny the last several hours - she woke up in the middle of the night and won't stay still. She wont eat anything, doesn't need to go to the bathroom, breathing funny (choppy), pacing.

Any ideas? Should I bring her to the vet?

She's been on Vetoryl about 3 months now - will be bringing her in for a check up soon.

[Joan2517]

I would get her to the vet and get a Cortisol reading ASAP. Her Cortisol could have dropped too low. Don't give her anymore until it's checked.

[labblab]

I totally agree with Joan — I think Bonnie needs to be seen immediately. The breathing problem is especially worrying. We’ve just had another member whose dog developed a pulmonary embolism (Cushpups can be more vulnerable to these) and this is a life-threatening issue. Or as Joan says, Bonnie’s adrenal hormones (cortisol and/or aldosterone) may have dropped too low and may require emergency intervention. I really wouldn’t wait to contact your vet to get their guidance. Please do let us know what develops.

Marianne

[BonnieandDre]

She's acting more normal now. Didn't give her the dose today.
Is it okay to skip a few days and restart? I'd like to have her on the drug so we can do a real ACTH test and get an accurate reading.