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Dr. Stacy
Dr. Stacy, Veterinarian
Category: Dog
Satisfied Customers: 1583
Experience:  10 years of experience in general practice.
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My Westie has been diagnosed with CUSHINGS disease and has

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My Westie has been diagnosed with CUSHING'S disease and has been taking 30mg of Vetoryl per day for the past 2.5 weeks. My vet has been unable to perform the follow up ACTH test because she is unable to get the cortisone stimulating drug but has performed a blood biochemistry test and a urine test. She has told me today that he still has high levels of cortisol in his urine; also traces of blood and protein in his urine. She is also concerned about his blood potassium levels. She now proposes to increase his dose to 50mg (30mg in the morning followed by 20mg in the evening with food).
I am concerned because I have read in the medication notes that Vetoryl can increase potassium in the blood. The vet has told me that high potassium can be cardio toxic; I am worried that an increased dose will just make this worse. Can you advise me, please?
I have some concerns too. First, it is going to be really difficult to make the best decisions without being able to do the ACTH stim test. I know that the Cortrosyn gel has become harder to get an more expensive, but we have been able to get it at our clinic. We are just paying triple what we used to pay. I might call around and find out if there is a clinic in driving distance that has it. You could probably arrange to go to that clinic for the test and have them send the results to your vet.

If you are not able to get the ACTH stim test done, I would want to err on the side of under dosing because the consequences of overdosing are more severe. I would also use clinical signs as an important guide to my treatment. Has his excess drinking an urination improved?

While I agree that high cortisol levels in the urine do suggest that he is still cushingoid, it is hard to gage without that ACTH stim test. The high potassium could also suggest that he is not handling the medication well. Do you happen to know how high the potassium is or what the sodium was?

If this were my dog I would be trying to find some place to do the ACTH stim and if I couldn't do that, I would be very conservative in increasing the dose. I might go from 30 to 40 (20mg twice a day) and then recheck before going to 50.

I hope that helps, but if you have more questions or need clarification please let me know.

Dr. Stacy
Customer: replied 4 years ago.
His symptoms were only mild but I haven't seen much change - maybe he has been drinking slightly less over the past day or two. He didn't have any of the other common symptoms.
I don't know his potassium or sodium blood test results but might be able to find out.
The ACTH test was done when the condition was originally diagnosed but she has no further supplies of the stimulating drug and says it may be months before she can get any. The vet was originally considering Addison's as he didn't present as a typical CUSHING'S dog but when she got the results of the ACTH test back she said it was the strongest result for CUSHING'S she had ever seen. She told me at the time that he had a heart arrhythmia and she was very concerned about his K levels - so he already had high K before he started taking Vetoryl. I'm not sure I should increase his medication at all given the potassium problem. She seems to be expecting that Vetoryl will bring levels of potassium down but the medication notes seems to imply the opposite.
You are correct, generally vetoryl will not make potassium go down, in fact it can make it increase. I even pulled out my endocrinology books to make sure I'm not missing something. I can't see any way that the vetoryl will decrease the potassium.

The main causes of high potassium are Addisons and kidney disease. The other cause is some medications (he's not on anything else right?) There are a few other, but these are the main ones. Protein in the urine and dilute urine are also signs of kidney disease as well as cushings. If the ACTH stims showed cushings then I believe he has cushings, but maybe he has some underlying kidney disease also?

Honestly, I wouldn't increase the dose. I understand why your vet thinks you should, but I wouldn't do it. Do you have access to an internal medicine veterinarian? I might ask for a referral for a consult and they can do an abdominal ultrasound that may be able to tell you more about the kidneys and the adrenal glands.

Dr. Stacy
Customer: replied 4 years ago.
I think I will talk to my vet about her advice and also get a second opinion - maybe, as you suggest try to get some sort of scan. He has had a blood test which indicates that his kidney function is normal - I think she has already considered that.
Do you think I should stop the Vetoryl altogether until we have got to the bottom of this potassium problem? Or stick with the current dose?
I'm sure she has. It sounds like she is doing a good job, but something is not adding up. You can have kidney disease that does not result in changes in the blood work initially.

The only reason I could see giving up the vetoryl is if the potassium level is higher on it than it was before you started it. If it is the same I would stick with it at the current dose.

Dr. Stacy
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Customer: replied 4 years ago.
Thanks so much for your help. I will ask the vet for more details about the potassium result but I'm not going to increase Vetoryl dose until I've found out exactly what is going on with him. The potassium seems to be her priority concern so it makes no sense to increase Vetoryl dose if that might make it worse. Can I come back to you if I gave more questions?
Absolutely. Good luck to you.

Dr. Stacy
Customer: replied 4 years ago.
I forgot to mention, vet has also told me that she has found a UTI in his last urine test. Could that be causing the drinking/urination/potassium problems? She has prescribed antibiotics for that; I am collecting them tomorrow.
It could cause the protein in the urine and the drinking/urination problem. If the infection moved from the bladder to the kidneys it could potentially cause the increased potassium.

Dr. Stacy