6 y/o cockapoo Bonnie recently diagnosed

[labblab]

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.

It is always OK — and important — to withhold the med for any period of time that a dog is acting unwell. Let’s see if she continues to improve. Hopefully so. But if she were mine, I wouldn’t consider restarting the medication again until/unless she’s completely back to normal. And if she remains “off” by tomorrow, I’d still encourage you to contact your vet to report what you’re seeing.

Marianne

[Squirt's Mom]

How is Bonnie doing now?

[BonnieandDre]

Hi everyone,

Bonnie's ACTH level were too low on the 30mg, so now we're moving to 10mg 2x per day and retesting in a few weeks...
As this group suggested, the levels continued to drop between her initial test and the followup. When I had brought this concern up with the vet, he said he didn't see that being a problem.
So frustrating they don't know better, so grateful to you all for knowing to keep an eye on it.

Thanks for all the help. Hopefully this dosing will be right..

[Harley PoMMom]

How is Bonnie doing? Is her appetite normal, any diarrhea? What where the results of her recent ACTH stimulation test?

[BonnieandDre]

She's doing okay now. Until I can pick up her new dose at the pharmacy next weekend, I've been doing every other day of the 30mg.

ACTH results: Pre was 0.7, post was 1.3.
(So it fell a lot since the last test at pre - 1.3, and post - 3.4)

She had also lost .6 lbs which is good.
No diarrhea. Less appetite.

[Harley PoMMom]

If this were me, I'd stop giving the 30 mg dose of Vetoryl even though it's every other day, the day she gets that 30mg her cortisol could really drop and it is recommended that when cortisol drops too low that the Vetoryl be stopped completely until symptoms return and an ACTH stimulation test shows that cortisol is high.

[BonnieandDre]

Hi everyone,

At Bonnie's May appt, she had lost ~.5 lbs and her readings were very low: Pre 0.7 -> post 1.3
The vet decreased the dose from 30mg to 20mg.

In June she still wasn't eating enough so I decreased the dose myself from 20mg to 10mg.

At her ACTH appt yesterday, she had lost more weight (1.5 lbs, she's now 14.9 lbs) and her readings were still low/flat. Pre: 1.7-> Post: 1.9.
I can tell she's not eating enough, but otherwise she is normal.

The vet said to stop the Vetoryl for now, and see if her appetite goes back to normal.

It doesn't sound like Cushings ever 'resolves' like this?
Was this a misdiagnosis?
If so, something else is causing her liver problems..

Has anybody seen this?

Thanks!

[labblab]

Hello again. We’re glad to hear back from you, although I’m very sorry to hear that Bonnie is not doing so well. I absolutely agree with stopping the Vetoryl entirely at this point. Chronic oversuppression of the adrenal glands can definitely lead to loss of appetite, and it sounds as though Bonnie’s cortisol has been running too low for a couple of months now. Even for dogs who truly suffer from Cushing’s, medication overdoses can indeed lead to symptoms of oversuppression. For most Cushpups, temporary cessation of dosing will ultimately allow the adrenal glands to rebound. Once that happens, medication may be resumed at a lower level after cortisol levels once again elevate to abnormally high levels. On rare occasions, the adrenal oversuppression for Cushpups may become permanent. If that happens, not only is the Vetoryl never restarted, but supplemental prednisone may be required in order to make up for the permanently decreased level of cortisol.

In Bonnie’s case, though, I know we’ve always wondered about her true diagnosis — whether there is something else going on with her liver, either instead of or in addition to Cushing’s. If she doesn’t truly have Cushing’s at all, then Vetoryl at any dose would never be indicated.

Going full circle, for sure I think the first step is to entirely stop the Vetoryl and see whether her cortisol rebounds, her behavior normalizes and her appetite returns. If not, then I do think additional diagnostics are once again in order. I know you’ve held off on a UC Davis consult, but if Bonnie doesn’t rebound pretty quickly, you might gain some much needed peace of mind from a second opinion at the vet school if that is possible to arrange. Either way, please keep us updated as to how she’s doing.

Marianne

[BonnieandDre]

Thanks Marianne.
Sounds like a plan. We've stopped the Vetoryl and hopefully she'll get her appetite back in a few days.
I'll follow up in a week after I reconnect w/the vet.

[labblab]

That sounds good — we’ll definitely be anxious to hear what develops. I just want to add/clarify that if Bonnie does indeed have Cushing’s, she just may need only a very small dose to keep her cortisol in proper range. That remains one of the puzzles about treatment with this medication — there is really a wide variation in how effectively any individual dog metabolizes trilostane. Some small dogs may end up needing bigger doses than large dogs — some larger dogs may require only tiny doses. That’s why the ongoing monitoring is so important for all dogs.

Also, if Bonnie’s appetite still hasn’t improved by next week, or if any other worrisome symptoms emerge, I’d encourage you to ask your vet about going ahead and at least temporarily giving her a small daily dose of prednisone in order to offset the possibility that her cortisol is remaining at too low a level. If the prednisone perks her up, you’d have added evidence that her natural adrenal function remains overly suppressed.