Austen 11 year old, male Colli/Shep Mix - Vetoryl

[austen]

Austen is an 11 year old, male Colli/Shep Mix(58 pounds). Needless to say he is the Love of our Family. Within the last year he developed the following symptoms:
Loss of Hair
Intermittent limping,
but of greatest concern became the fast breathing, this even if he rested and breathing was not "deep".
Started with Vetoryl, gradually ramping up, now at 100 mg/d (administered 40 mg in the morning and 60mg in the afternoon). Austen noticably recovred, except for the continuing fast breathing (even if bearily noticeable). From time to time there are still panting episodeds, but these are rather short and could often explained with physical exhaustion, like a short dart in the backyard.
Any advice woulod be greatly appreciated.

[lulusmom]

Welcome to the forum.

Loss of hair, intermittent limping and fast breathing are not symptoms that are exclusive to cushing's nor are they the most common cushing's symptoms. Have you taken Austen to the vet? If so, can you tell us what the vet had to say about these symptoms and what tests have been done so far? It would be very helpful if you could please post the results of any bloodwork and/or urinalysis? You don't have to post everything, just the abnormal values, including the normal references ranges and reporting units. i.e. ug/dl, nmol, etc.

If Austen has not yet seen a vet, I highly recommend that you get him in. Fast breathing can be a sign of pain and with the intermittent limping, it's possible that he is very uncomfortable.

I'm sorry for the reasons that brought you to us but I'm glad you found us. We'll help you and Austen in any way we can but we'll need a lot more information re Austen's medical history in order to provide you with meaningful feedback. Looking forward to hearing more.

Glynda

[austen]

Repeat from other forum where posted erroneously:Austen is an 11 year old, male Colli/Shep Mix(58 pounds). Needless to say he is the Love of our Family. Within the last year he developed the following symptoms:
Loss of Hair
Intermittent limping,
but of greatest concern became the fast breathing, this even if he rested and breathing was not "deep".
Started with Vetoryl, gradually ramping up, now at 100 mg/d (administered 40 mg in the morning and 60mg in the afternoon). Austen noticably recovred, except for the continuing fast breathing (even if bearily noticeable). From time to time there are still panting episodeds, but these are rather short and could often explained with physical exhaustion, like a short dart in the backyard.
Any advice woulod be greatly appreciated.

[lulusmom]

Okay, so now we know that Austen has been formally diagnosed with cushing's and he is currently treating with Vetoryl. How long ago was Austen diagnosed and when did you start treatment? Do you have copies of the tests that were done by your vet to make the diagnosis? If so, please post the results here. If you don't have copies, your vet should be happy to provide them for you. We always recommend that members keep an up to date folder for their cushpups. It comes in handy if you ever need to take Austen to an after hours clinic and believe me, the vets on call appreciating having the medical history at their finger tips. It also comes in handy for times likes this when we request that you post test results.

Physical symptoms are a huge part of the diagnosis and with Austen having so few symptoms that are commonly associated with cushing's, I do hope your vet was thorough in his/her diagnosis. Common diagnostic tests are the acth stimulation test, the low dose dexamethasone suppression test (LDDS) and an abdominal ultrasound. The ab ultrasound is usually done to differentiate between pituitary dependent disease and an adrenal tumor. Which form of the disease did your vet diagnose? Is Austen treating with a gp vet or a specialist?

It's always a good idea to start low with Vetoryl and make adjustments if necessary so I'm glad to hear that your vet chose this approach with Austen. You have undoubtedly had a few acth stimulation tests since starting treatment. Can you please post the results of those tests, including the dates and doses that Austen was on at the time? Sorry for all the questions and requests but it's difficult to provide you with meaningful opinions or thoughts without anything to go on.

To address your question, it is possible that Austen is panting like a lot of other cushdogs. It is one of the symptoms that does not resolve quickly. This is usually caused by an enlarged liver, redistribution of fat to the thoracic area and muscle wasting that is caused by excess cortisol, which is a catabolic steroid. The key to resolution is getting a dog stabilized on the correct dose and even then, panting and coat & skin issues are usually the last symptoms to resolve. Patience is not one of my strong suits but having two cushdogs myself, I've learned over the years that patience really is a virtue when it comes to cushing's.

Glynda

[austen]

Glynda,
Thank for the quick and extensive response. This is my second effort to get a response to you, I am still very awkward in negotiating this site.
In my first attempt, probably lost somewhere in the e world, I merely reported that I did not follow the medical terms, etc and test names used in my vet's office (gp). "Cushing's" just made me freeze up. I really do appreciate your wake up call and notch to actively participate in Austen's medical treatment and not just sit there and expect good results.
As to tests, I merely know that Austen had repeated blood tests (ACTH?). I will get the info suggested by you and submit my report. Thanks again for your attention to Austen and me.
Stephan

[frijole]

Stephan - You are wise to heed that advice. I treated one dog successfully for cushings for 4 yrs. She passed in May and she was over 16 and did not die from cushings. I have another one that was diagnosed in April and we are still trying to figure out if it is really cushings or something else... So even those of us with experience have to constantly pay attention.

You got it - you are Austen's voice and the disease can be treated with success but key is knowing enough to question the vet and having a vet that is experienced.

Trilostane is really not a new drug. Its been around the 4 yrs that I have read here. Like Glynda said - both lysodren and trilostane can be effective and they are chemo drugs so you can have issues with both if the dog is given too much. Some vets aren't that familiar with trilo yet so they think its safer.

Best drug to use depends on the type of cushing's as well as your vet's familiarity. I didn't use trilo because my vet had never used it 4 yrs ago and I didn't want to be his first. :p

So yes - please post the results and ask questions. Know that there is no rush to start treatment so better to get it together and be up to speed than to rush things because you think its a must.

I think you said you are helping out your parents. It is real important that they engage in the process as well. (you can get them up to speed) Glad you found us. Look forward to the testing info. Kim

[austen]

Still can't manage site well, too powerful. Just posted reply, should have been directed also to Kim.
Thanks.
Since can't see my reply, let me quickly repeat: wrote (initially directed to Glynda) that I will finally get around to see the vet. In the meantime continued Austen 100 mg Vetoryl. Overall his contiditon is pretty good. Hairloss stopped. But still heavy panting once ore twice a day for 10 to 15 minutes. Sometimes longer, then I give him Lorazepam.
Yours gratefully, S

[gpgscott]

Hi Stephan and welcome to you and Austen,

Not sure what your problem is in seeing your posts, you are a regular member and not in any sort of restricted status as a just registered member is (we restrict just registered members until we can be sure they are legit)

Just continue to post in this thread and the person to whom you are replying as well as the rest of the membership will see your response when they view your thread.

We use this one pup one thread format because it keeps all the information about each pup in one place. As you become more familiar with the site you will see there are other forums for topics of discussion other than your pup.

Scott

[austen]

I hope I am not repeating what I thought I just did, i.e, posting a reply.
First, thanks to everyone again for the kind words and interest.
Second, went to Vet today, ACTH readings were 4.9 and 8.8, pre and post injection respectively.
Increased Vetoryl dosis from 100 to 120 mg (60 mg 2x daily). Vet had performed last ACTH test in July, when we increased dosis from 80 to 100mg.
Austen now weighs 58 pounds.
Hair loss not that obvious, but tail is no longer as bushy as it used to be (Austen is a Sheperd/Collie mix with a silky double layer coat).
We are using Lorazepam from time to time, when A becomes very agitated (e.g., thunder). One or one half 2mg tablet. About once a week.
What do you think about taking Austen on walks: used to walk him 3 to 4 miles a day, now no more than 1 mile. Is this dangerous in his condition? He just loves it and insists on getting out. I watch him closely and try to be home before any panting.
Thanks again for your interest and help, it feels so good not to be alone with this problem of one's best friend.
S

[apollo6]

Welcome
Will try later to read your thread.
My Apollo is on Trilostane/Vetoryl and is doing well. He will be 12 this October.
Hang in there.
We are here to help.
Hugs Sonja and Apollo

[austen]

Sonja and Apollo, thanks for the note from the Coast. When you get chance, please read Austen's thread and comment.

[apollo6]

I have read your thread.
First there are three kinds of cushings.

Kind of a quick run down and symptoms.

http://www.kateconnick.com/library/cushingsdisease.html
Apollo has the pituitary kind(both adrenal glands are enlarged similarly)
Apollo had increased appetite, pot belly, skin liaisons, dark skin, loss of hair on both sides of body, loss of hair on ears, loss of hair on tail,accidents because drinking to much water, tires easily, hind leg weakness due to muscle wasting, skeleton look in face. The test I did were the full blood panel( showing very elevated readings) urine cortisol. ultrasound on abdominal(show if one or both adrenal glands enlarged, enlarged liver, kidney, scaring on pancreases from past pancreatitis) and the acht stim test.
we'd like to see the results if you haven't posted yet. if you look at the first few pages on my thread_Apollo trilostane, you will see what I mean.
Apollo started 10mg Trilostane after I was sure it was the pituitary kind. He weighs 10lbs. We started lower then what was advised based on input from the forum. Which I am glad I did. He started in June is doing well, some hair as grown back, skin liaisons have healed, pot belly is somewhat improved. But he has a harder time walking and is a lot more heat intolerant then before, and tires easily.
As far as the walking is concerned Apollo has a stiff gait in his hind legs, falls down easily and drags his hind legs somewhat. I have been told that is due to muscle wasting caused by overproduction of cortisone in the body. It can take up to a few months for improvement after starting treatment.
I have concern of the dosage breakdown.
Double dosing wound mean twice a day but this is the role of thumb

15. Individual dose adjustments and close monitoring are essential. Re-examine and conduct an ACTH stimulation test 10-14 days after every dose alteration. Care must be taken during dose increases to monitor the dog's clinical signs and serum electrolyte concentrations. Once daily administration is recommended. However, if clinical signs are not controlled for the full day, twice daily dosing may be needed. To switch from once daily to twice daily dosing, increase the total daily dose by 1/3 to 1/2 and divide the total amount into two doses given 12 hours apart.
This would mean 100 mg plus 1/3 would be 130/2 =65 in morning and 65 12 hours later. Usually start with just once daily dosage. But every case is different.
Don't understand why, but maybe your vet has a reason to do 40 then 60 mg?

But Austin sounds like he is doing better. Be patient. How long has he been on the drug.
Hope this helps
Hugs from Sonja and Apollo

[austen]

Sonja, it looks like I just lost a long message to you after I finished typing and wanted to add a picutre of Austen.
However, what it boiled down to was:
= Austen on Vetoryl since April, increasind doses from 30/30mg to now 60/60mg (i.e., from daily 60 to now 120mg); A weighs 58 pounds; pituitary infliction.
= Splitting of administration of medicine held to be safer by Vet, because supposedly assures more even absorption and in case of overdose (I think as you indicate) more easily counteracted. Moreover, even manufacturer's instruction call for splitting for doses in excess of 120mg. But please, expand on your reasoning, because this concerns me very much.
= Last ACTH test of Sep 2 indicates 4.9 and 8.8 for pre and postinjection, respectively. A had several ACTH tests in the pasts which all indicated increase of dose. Testing started out with "Low Dose Dexamethasone Suppresseion" and blood test. I am reluctant to ask for results now because I am afraid Vet (she) will feel I am second guessing her. So far (last 2 years) I have had only the best experience with her. But if you think the old data area absolutely necessary, I will ask for them.
Austen improved since he is taking greater values of Vetoryl. I am great hopes after the recent increase.
Overall, he seems to have improved, or, at least his deterioration seems to have been arrested. Here to his major problems:
Hairloss: his tail has become somewhat stringy, but see no longer any hair flying around.
Trembling in hind legs: still there from time to time.
Appetite: rather reduced.
Drinking and urinating: definitely still high level. Have to get up, about every other night, to let him out. He is very good in making his need known.
Reduced energy: In the "good old days" I used to jog or walk him every days for 2 or 3 miles. Now we are down to 1/2 to 1 mile. I am watching him closely and soon as I notice that he slows down, we turn in. Once or twice I was too slow in cutting it off and, unfortunately, he fell into panting. Please let me know what you think as to excerice/walk.
Any further thoughts you have would be greatly appreciated.
Tell Apollo "hello" from Austen and me and, when you get a chance, let us know how he is rolling into October.
Thanks again, Steve

[Harley PoMMom]

Hi Steve,

A belated welcome to you and Austen from me and my boy Harley! I hope it's alright that I have added my 2 cents worth here! :eek::)


= Splitting of administration of medicine held to be safer by Vet, because supposedly assures more even absorption and in case of overdose (I think as you indicate) more easily counteracted. Moreover, even manufacturer's instruction call for splitting for doses in excess of 120mg. But please, expand on your reasoning, because this concerns me very much.

Actually, according to the Dechra's U.S. Product Insert:
However, if clinical signs are not controlled for the full day, twice daily dosing may be needed. To switch from once daily to twice daily dosing,
increase the total daily dose by 1/3 to 1/2 and divide the total amount into two doses given 12 hours apart.

Combinations of capsule sizes should be used to slowly increase the once daily dose.

You can find this information here: http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf



Please let me know what you think as to excerice/walk.


I believe Austen will let you know what he can tolerate, nice walks, I think, are fine as long as Austen wants to participate and the weather is not too hot.

Love and hugs,
Lori

[labblab]

Hi Steve!

For my own benefit, I checked back to try to put together a summary of Austen's dosing history. Is what I've written below correct?


Diagnosed in April and started with 30/30 mg. (total daily dose: 60 mg.);

Between April and July, subsequently increased to total daily dose of 80 mg. (I'm guessing the breakdown was maybe 40/40?);

In July, increased to 40/60 mg. (total daily dose: 100 mg.);

Increased to 60/60 mg. last week (total daily dose: 120 mg.) subsequent to ACTH test results of 4.9 "pre" and 8.1 "post."
If this is correct, then your vet is definitely following a very careful and conservative path of raising Austen's dose very slowly and surely. I'm really glad to hear that, overall, Austen is doing better. And I'll surely be hoping that this most recent increase will finally prove to be "just right."

I believe that both Sonja and Lori are correct in saying that the current recommendation of Dechra (the manufacturers of brandname Vetoryl) is to start all dogs on once daily dosing, and only shifting to twice daily dosing in certain circumstances -- mainly if it appears as though the effects of the medication are wearing off too quickly during a 24-hour time period so as to allow symptoms to rebound later in the day. I just double-checked their published dosing chart, and I believe that what you are interpreting as a recommendation to split any dose equal to or larger than 120 mg. into two doses is instead just their way of saying that you will have to COMBINE two or more 60 mg. capsules in order to arrive at the correct once daily dose.

However, having said all that, we do know that some specialists prefer that dogs be dosed twice-daily from the very beginning of treatment. And it seems as though that is your vet's preference, as well. As long as Austen is doing well and showing steady improvement, then it sounds as if your vet's protocol is agreeing with him :). And I do think that as long as Austen is enjoying his walks, it is perfectly fine (and probably beneficial for his muscle tone) to continue them.

Once again, welcome to you both. And we'll be anxious to continue to read updates on how Austen is adjusting to his increased dose.

Marianne

[apollo6]

Dear Steve
will give you some input on your post:
results now because I am afraid Vet (she) will feel I am second guessing her. So far (last 2 years) I have had only the best experience with her. But if you think the old data area absolutely necessary, I will ask for them. You should always have copies of all reports to see the progress and set backs. Never be afraid to ask for copies, You are Austen's advocate, and the vet is working for you.Austen improved since he is taking greater values of Vetoryl. I am great hopes after the recent increase.
That is a good sign.
Overall, he seems to have improved, or, at least his deterioration seems to have been arrested. Here to his major problems:
Hairloss: his tail has become somewhat stringy, but see no longer any hair flying around.Apollo's tail has little or no hair at all so far.
Trembling in hind legs: still there from time to time.Unless he has arthritis or some other problem it should be less. Apollo's trembling in legs has stopped. But he does have a stiff gait and weakness in his hind legs. This can take a few months to improve due to muscle wasting from cushing.
Appetite: rather reduced.That concerns me. Austin 's appetite should not be less, if it is less then normal then the dosage needs to be corrected, contact the vet about this.
Drinking and urinating: definitely still high level. Have to get up, about every other night, to let him out. He is very good in making his need known.That is also another issue that should have improved by now. Is it less then before starting the Vetoryl? If it hasn't improved within a short time , need to ask Vet. Apollo doesn't drink as much and the urinating has come down a lot.
Reduced energy: In the "good old days" I used to jog or walk him every days for 2 or 3 miles. Now we are down to 1/2 to 1 mile. I am watching him closely and soon as I notice that he slows down, we turn in. Once or twice I was too slow in cutting it off and, unfortunately, he fell into panting. Please let me know what you think as to excerice/walk. Unfortunately , Apollo tires more also, and has a stiff gait. He is more heat intolerant now also. Austin may be experiencing the same. Just do as you are doing. A little walk each day is good. I had to stop my long walks also.

It is hard to give input on the dosage. If Austen is improving than stick to what works, if not then you need to talk to the vet.
Hope this helps.
Hang in there.
Hugs Sonja and Apollo

[austen]

Lori, thank you for your response. I particularly appreciate the reference to th Dechra site, should have thought of that myself. Also like very much the reasonable and practical advice regarding exercise. So far I only heard about regimes of complete immobilization which Austen would hate. Your advice makes much more sense and takes the Austen's nature into account. I will certainly follow. it.
There is a Pommeranian in our neighborhood who after several "meetings" finally became good friends with Austen.
Thans again for your help.
Steve and Austen

[austen]

Marianne, your exlplanation of once vs. twice daily administration of Vetoryl extremely helpful and enlightening. It's all beginning to make more sense. Will finally read manufacturer's recommendations myself (apologize for my tardiness)
Also, your support of exercising Austen very encouraging and greately appreciated (especialy by Austen).
After a week of increaed dose, noticeable change in the right direction. No more panting episodes, although still fast breathing (but "low").
Thanks again, Steve
PS: Greetings and pats to labblab.

[austen]

Sonja, just lost a message to you and Apollo in my PC somewhere. What I had written was to thank you for addressing all my questions and combining Q&A in such a helpful way.
Yes, I will be ask for the documentation of the tests, even though I am reluctant to do it, but you reminded me I am the only advocate Austen has.
Your sharing Apollo's hairloss and leg weakness gives me a better idea of what to expect with Austen. Similarly, your comment on intake and discharge (I am trying fancy word for appetite, thirst, and urination) straighten out my thinking.
On exercise, this is one area where Austen seems to being doing comparatively well, and I hope that Apollo will improve soon.
On dosage, again very practical words, for which I thank you. You know how it is, very often one needs to hear from somebody else to clear or reinforce one own'w thinking.
Thank you again, Steve and Austen (needless to say, pats and ear scratch for Apollo)

[apollo6]

Happens to me allot losing messages.
Hang in there. It does get better. Remember you and your fur ball Austen are not alone in this. We are hear to help and support you.
Likewise from Apollo and Sonja.

[Franklin'sMum]

Yes, I will be ask for the documentation of the tests, even though I am reluctant to do it, but you reminded me I am the only advocate Austen has.

Hi Steve and Austen :)

Just a few thoughts on how you could approach your vet if you feel at all uncomfortable asking for results- you could tell him/her that you're putting together all Austen's info, in case you should ever need to see an emergency vet (which is a great idea, and comes in very handy), or updating his boarding kennel record so they know what's going on if they need to take Austen to a vet.

Jane, Franklin and Bailey xxx

[littleone1]

Hi Stephan,

Belated welcome to you and Austen.

Corky is on twice a day dosing with Trilostane. He started with 20mg once a day, went to 25mg once a day, 31mg with BID - 20 in the A.M. and 11 in the P.M. He is now up to 40mg split in 20/20. He is back to going for his 2 1/2 - 3 mile walks every morning. He's been taking Trilo for a year and is doing well.

You're doing great at taking care of Austen.

Terri

[austen]

Jane, thank you for the "diplomatic" advice. Yes, I will do that. Made me think of doing that for myself too (actually, in the past it would have been a good thing to have had that info when I myself had to go to an ER).
I love Franklin's picture.
Thanks again.
Steve and Austen

[austen]

Terri, appreciate the welcome. I am very interested in two items you are mentioning: (1) Do I read it correctly that you split the Vetoryl into 25 or 5 or similar mg doses; I could not find capsules other than 10/30/60; (2) I really was encouraged by your returning Corki to long walks (if Austen reads that he will certainly be sitting by the door with his leash and requesting similar treatment).
Again, thank you for welcoming Austen and me.
Steve

[littleone1]

Hi Steve,

You are very welcome.

Corky's Trilo is compounded, as the mg capsules you mentioned are the brand name. He is now on twice a day dosing, with 20mg in the A.M., and 20mg in the P.M. If your vet or IMS recommend a different dose than the name brand, I get Corky's compounded at Diamondback Pharmacy. If you need a different dosage, please let me know, and I'll give you their toll free number. One thing that you don't want to do is to break open the capsules to split the dose.

Don't tell Austen about Corky's walks!:D It is so good to see our furbabies getting back to their normal routines.:)

[austen]

Terri, really do appreciate the pointer regarding the possibility of getting the capsules with different mg contents specially prepared by pharmacy. Right now I am going with twice a day 60mg, so no problem. But in case I should change, to dose which can't be managed with one or two capsules each, I will ask you for pharmacy reference.
Austen and I are so glad that Corky and you are enjoying great walks because we know how important walks are once you grew up with them.
Licks and greetings, Austen and Steve.

[austen]

Could need some advice on weakening hind legs.
Austen now on Vetoryl since April, by now, for 130 days we have been on 2x60 mg a day/weight 58 pounds. Everything seems to be going fine, exceptfor a progessive weaking of hind legs. Now sometimes need a push to get into car and collapses sometimes on ice (never before).
I walk him about 2 miles a day.
Coat is shiny, no hair loss.
Other major Cushings sympon is still fast breathing. Sometimes it gets heavy breathing, if lasting too lkong I give him Valium.
Any thoughts regarding weakening hind legs.
Thank you.

[frijole]

Hi from me! My girl Annie has both symptoms you just mentioned, the occasional increased breathing and hind leg weakness. She's a bit of a mystery - originally thought it was cushing's but now we believe she has an adrenal tumor that sends signals out resulting in these symptoms....

I had an EKG done and they sent the results to a heart specialist out of state and he recommended benazepril as a safe guard.

I had x rays done on the hind legs to confirm the bones were ok. They were great but there was a bone spur on her spine. It could be causing some pain. So they wanted to treat with an anti inflammatory but not with a pain med containing steroids or that could upset her stomach (another issue is her appetite is bad).

The head of the animal science department at Kansas State Univ recommended I try an all natural product called Duralactin that is used as an anti inflammatory. Alot of vets are not yet familiar with it. I have been using it for over 6 mos now and it truly has helped her. I have to use it every day or her symptoms return but it is a vanilla tasting pill that she just chews.

Here is a link to info I posted earlier which will tell you more. Kim

http://www.k9cushings.com/forum/showthread.php?t=2635

[austen]

Kim, thank you for extremely helpful info on trembling hindlegs and intermittent heavy breathing. Will pursue your suggestions.
Do I understand that you are not using Vetoryl at all?
Again, thanks for your help.
Steve and Austen.

[lulusmom]

Hi Steve,

When is the last time Austen had an ACTH stimulation test done to make sure her cortisol was being well controlled? Can you please let us know the date and post the results?

Glynda

[frijole]

Kim, thank you for extremely helpful info on trembling hindlegs and intermittent heavy breathing. Will pursue your suggestions.
Do I understand that you are not using Vetoryl at all?
Again, thanks for your help.
Steve and Austen.

That is correct. My dog had like 5 false positives for cushing's. So no we are not treating cushing's with anything. They believe the adrenal tumor is sending cushing's like signals.. very complicated.

I just shared my info in case you do not feel it is cortisol related which is why Glynda posted about the last acth test. Could be the cortisol is just too low.

Kim