Sick cushings dog

This is Archie, he is my soul dog. Diagnosed cushings around 4 months ago, he is now presenting oddly, any help would be gratefully recieved. Archie is 14 and weighs 22kg he has pituitary cushings. He was started on 40mg vetoryl once a day. Initially he did very well, drinking less, got his mojo back etc. Last few weeks he has become....lethargic? Just not his usual self. He also has quite pronounced tremor in his back legs (known arthritis in hips) he also started drinking a huge amount plus corresponding urinating. No vomiting or diarrhoea. He has lost alot of muscle also in the past few weeks. I took him to the vets on Thursday where he had bloods done. They came back with mildly raised calcium and mildly raised kidney functions. His ALP is high (but it was on his diagnosis of cushings) also mild anaemia. Potassium was slightly elevated. Apologies I don't have the actual blood values yet, no one at the vets were able to print them out for me(?!) Plan was for a pre vetoryl test on Tuesday and an ionised calcium test when vet could arrange. Yesterday he went off his food (unheard of) and when he refused breakfast this morning I took him back to the vets. I explained I was concerned about addisons. He was admitted about 1300 for fluids and further bloods. He had a litre of normal saline. Vet rang me about 8 and said he was "fine" and I could pick him up. His bloods were normal. Great I thought. However I then asked a few questions... They didn't recheck his calcium or kidney function - infact the oncall vet wasn't even aware they were raised. They didn't check his cortisol. They are treating him for pancreatitis which was never even mentioned. It's now the next day and I am sat with him watching and stressing. He remains weak, lethargic and he refused his breakfast this morning. What would you be thinking given the above information? What should I do next? He is insured so cost doesn't matter. Sorry for the length of this post!

Also he continues to drink a huge amount.

Hello!  You say that your vet was under the impression that Archie was fine and ready to go home, but that you are now observing lethargy, weakness and lack of interest in food.  This sounds like a definite change in expectations, so I would advise calling your vet, or emergency vet (I don't know where you are but it's Sunday night here) and giving them an update, just in case this information changes what they want to do in the short term. A price of information that might help your phone triage, if you can do this confidently, is to count the number of times Archie's heart beats in a minute (I'd usually count this over 15 seconds and multiply it by 4).  However if you are not sure about this, always admit it  (untrue numbers won't help). All the best and please do let me know how Archie gets on.  Addison's secondary to Cushing's treatment can be serious, and potassium levels can change quite quickly, so the emergency vet may want to rule this out.

Good morning Jo and thank you so much for your reply.  We are in the UK.  I personally don't think Archie was fine when he was discharged but we can manage him at home.  My vets are positive they have ruled out Addisons because his electrolytes were normal.  Om disappointed they didn't do a ACTH but they didn't feel the need.  I'm nervous about giving his vetoryl now but have been told to give it as normal.  I did ring the emergence vet last night and was quite rudely told it was pancreatitis causing all the symptoms and basically don't call again unless he collapses (not in so many words but I'm a very experienced nurse so I know exactly what they mean.)  This morning he is still lethargic, still drinking loads but has eaten some chicken and boiled rice.  He still has very loose stool but seems a bit brighter.  I'm expecting a call from the vets today about his raised calcium and I expect he will go and have that checked to make sure it's not a lab error.  I do have one other question if you don't mind?  The plan was to do a pre vetoryl cortisol on Tuesday morning, will his having pancreatitis make this test inaccurate/invalid?  My vets over the weekend didn't know.  I'm happier with him this morning, but like I said I can't help being slightly disappointed in my vets as they didn't do much to reassure me it wasn't Addisons/low cortisol and made me feel like a nusciance but I appreciate they were busy and probably stressed.  I can't help being so worried he means everything to me and I worship the ground he walks on!  Thank you so so much again I really appreciate it.

Hello!  I am sorry that you didn't feel sufficiently reassured very quickly but am pleased that you checked and am very happy to hear that Archie's Sodium / Potassium levels are okay.  It is important to have peace of mind.  You seem suitably aware but I have to state that I am not here to give medical advice for an animal under someone else's care, but to answer general questions   Your vet will always know more about your dogs' case than me. I am, however, sad about your assumptions about your vets' thought processes and sad that my children's nurses might think that about me.  I can only say that most vets I know don't think of their clients questions in that way, even when they have challenging ones. Do you feel that the Cortisol will make the blood test invalid, or has this idea come from your vets?  I am not sure but vets can easily check the possibility by checking with the lab if they are not sure. All the best and do please keep us informed with progress - I look forward to hearing how you get on!

A good question to ask would be what is causing the weakness and lethargy?  If it is pain, for example, is more pain relief needed?  If it is dehydration, are fluids needed?  Etc

Hi Liz!  Thanks so much for your reply!  Please don't think for a second I am disrespectful or think badly of my vets.  I'm just worried about my old man and desperate to do the right thing for him.  He is quieter today and had diarrhoea again this morning.  He is on pregabalin and tramadol but I will definitely ask the vet what you said.  The question about the cortisol came from the drug companies monitoring flowchart.  It says the pre vetoryl test is only suitable for clinically well dogs, which I suppose makes sense because an illness would result in a rise of cortisol?  Thanks again, I will update when I hear from the vet x

It's a complicated case.  I'm looking forward to hearing how you get on  

Hi Liz, I took him to my vets and he saw a vet who knows him, he is worried about the colour of his gums and his belly which has got big and feels fluidy.   He also said he would check it's not his cortisol being too low.  So whilst I am devastated and worried I do feel a bit better that he is in good hands.  I will update when the vet rings me later tonight x

So Archie continues to baffle.  His bloods are ok.  Hes on some fluids.  He had a very quick ultra sound scan and my vet said his liver was large and mottled (he had an USS about 4 months ago and it has changed) so tomorrow he is having a full USS, CT and liver biopsies.  And his cortisol results should be back tomorrow.  Will update!