Little Girl Lily starts vetroyl tomorrow (13 y/o Beagle mix)

[leigh]

Hello,

My little dog Lily 19 pound Beagle mix 13 years old is starting Cushing's treatment.

Lily was diagnosed about 18 months ago. She really didn't have any symptoms, but in the last month she has started getting up 3 x night, eating like there is no tomorrow, and drinking peeing. Besides her issues with peeing, drinking, eating, she gets along pretty well. She recently took an agility class and loved it. Not quite as fast as some of the other dogs :) but tail wagging the entire time. She's a very happy little girl.

Initially back before I moved she had an ultrasound, some tests. With our new vet post move, she just had ACTH test done ( I think that's one ) they did one reading, injected, then another reading about an hour later. Her initial was 6.8 and later was 28.

Sorry for my vague specifics my vet called me yesterday and I didn't jot down all the specifics.

I was wondering for dogs starting meds about how long could complications arrive. I work full time and don't want to leave her alone in distress. But trying to figure out if she has a reaction to the meds could it be dire really soon? (my fear is I will be at work and she'll need help)

Thanks for this forum, very helpful.

[Todds Mom]

Hi Leigh and Lily! I am fairly new to this site also. I also have a beagle who started vetroyl on Sunday and as like you I was worried about leaving him home alone when I was at work. So far so good. Hopefully our babies will do very well on the meds. Keeping fingers, toes and paws crossed for your Lily as well as my Todd.

[Harley PoMMom]

Hi and welcome to you and Lily. So sorry for the circumstances that brought you here but very glad you found us.

Vetoryl can cause adverse reactions at any dosage but we have seen here that if a dog is started at a low dose than the adverse reactions are seldom displayed.

Dr. Tim Allen, a vet tech from Dechra's Kansas office, verbally recommends a starting dose of Vetoryl at 1mg per pound. UC Davis protocol suggest an even lower starting dose of 1mg per kg. So if you go with Dr. Tim Allen's recommendation than Lily would start at 20mg given once a day and if you start Lily with UC Davis protocol, than 10mg given once a day.

I was wondering if you could get copies of all Cushing test/s that were done on Lily and post the results here. Also, was a Chemistry/CBC blood panel done? If so, could you post any abnormalities that are marked with the reference ranges.

Please know we are here for you and Lily and we will help you in any way we can.

Here are some links that I hope will be useful: Dechra's U.S. Product Insert. (http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf), Links to Cushings Websites (especially helpful for new members!). ( http://www.k9cushings.com/forum/showthread.php?t=180) and Trilostane/Vetoryl Information and Resources. (http://www.k9cushings.com/forum/showthread.php?t=185
)

Love and hugs,
Lori

[labblab]

Leigh, welcome to you and Lily!

I am sorry for the reasons that have brought you to us, but very glad you have found us. From this point onward, you and Lily will have plenty of company on your Cushing's journey.

From what you have written so far, it sounds as though both of your vets have proceeded according to standard protocol. Even when early Cushing's is diagnosed on the basis of lab abnormalities, most vets who are familiar with the disease will refrain from treating until corroborating clinical symptoms manifest. And that sounds like exactly the case with Lily, also supported now with a diagnostic ACTH test that is consistent with a Cushing's diagnosis. Do you know whether her initial ultrasound gave an indication as to the type of Cushing's -- adrenal or pituitary? That would be a question to ask your vet, especially in the event that you might consider surgery if Lily suffers from adrenal Cushing's.

However, in the meantime, it is on to treatment. As you will see, there are many other members who are treating with Vetoryl (trilostane). Can you tell us what dose Lily will be starting off on? We have learned through personal conversations with the technical representatives at Dechra (manufacturers of Vetoryl) that they are now recommending that dogs be started at the lowest end of their published initial dosing protocol: at a formula of approx. 1 mg. per pound. So that would be around 20 mg. daily for Lily. Starting low tends to minimize the risk of unwanted side effects. Vetoryl does come in 10 mg. capsules, so that would be a dosing option that would be available to you.

Dogs can experience a variety of side effects including lethargy, diarrhea, vomiting, and lack of appetite. But once again, that is one of the benefits of starting at a lower dose: it seems as though the risk of those adverse effects is minimized. The side effects can occur at any time, but we also see many dogs who do absolutely fine when treatment begins. If you have weekends off, you might want to start dosing Lily on a Saturday so that you have two days at home to watch her as she begins her treatment, just to see how she does.

Here's a link to Dechra's U.S. Product Insert for Vetoryl. It will supply you with a lot more helpful information:

http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf

However, you will see that per their published dosing chart, the recommendation for a dog of Lily's weight would be 30 mg. daily. If you or your vet wishes to clarify their revised verbal dosing recommendations (the 1 mg. per pound formula), here's contact info for their Kansas office. Many of us have spoken directly with one of their vets, Dr. Tim Allen, and he has been extremely helpful.

http://www.dechra-us.com/Default.aspx?ID=365

Once again, welcome to you both!
Marianne

P.S. I see that Lori has beaten me to the punch as far as Dechra's dosing and contact info. So please excuse the duplication!

[littleone1]

Hi Leigh,

Corky and I also want to welcome you and Lily.

You have already received some very good information.

Corky has been taking Trilostane for 19 months, and his treatment has been going very well. He was started at 20mg once a day, which was just about 1mg/pound. His dosage has had to be adjusted, but starting at the lower dose was beneficial for Corky.

I have spoken to Dr. Allen many times. We have also been in contact through e-mails. He has been absolutely wonderful. Anytime you have questions or doubts about Lily's treatment, you can always get in touch with Dr. Allen.

Terri

[addy]

Welcome from me and my Zoe!!!!

You have already received so much really great information.:) The more info our moderators have, the better feedback they can give you, should you want or need it.

I am hoping things go well for Little Girl Lily. Please take some time to read through the links if you have not already done so.

We are here if you need us.

Hugs,
Addy

[leigh]

Thank you all so much for your replies. Her vet prescribed 30 mg, I have contacted the drug company for more information on the dosing. Such great information.

She had a blood work up not too long ago and everything came back normally.

I'll get some more info on her previous test results when I can and post back.

I hate these drugs with side affects I recently went through heartworm treatment with a dog I adopted. And it's the worry that really get's me. He is fine now and hopefully lily will be too.

Thanks for all the responses, it really is wonderful that so many people had such great information and good wishes:)

[leigh]

Lily is getting a new dosage, she never started original. She'll be taking 10mg 2x a day.

My veterinarian had recommended the 2x dosage and Dr. Allen from the drug company also got back to me. I'll pick the drugs up tomorrow.

Thanks everyone for sharing your information.

[labblab]

Leigh, super job re: contacting Dr. Allen and coordinating Lily's dosage with your vet!! Please keep us updated as to how Lily is doing. I've got all fingers crossed that she'll do well with no problems whatsoever. :)

Marianne

[littleone1]

Hi Leigh,

I'm glad that you were in contact with Dr. Allen. I hope everything goes well with Lily's treatment.

Terri

[leigh]

Yes, thanks so much to everyone. I feel much better about the lower dosage.

I really hope it's enough, she is still such a happy little camper.

here is a link to one of my favorite photos of Lily:) dogs really let you know the capability you have for love.

http://4.bp.blogspot.com/_a4W3uS78YR0/S4lZ2WuTCxI/AAAAAAAAAI8/sc8lbxLy1LE/s1600-h/lilysad.JPG

[leigh]

Lily took her first does 10 mg tonight - so far so good.

She'll take another in the morning.

Hopefully she'll be ok.

Thanks,

Leigh & Lily

[Squirt's Mom]

Hi Leigh,

Sounds like a good start! Let us know how things go, ok?

Hugs,
Leslie and the gang

[addy]

Hi,

I hope everything goes well this weekend. If you need anything, just check in ;)

Hugs,
Addy

[apollo6]

Welcome to you and your cutie Lily.
My Apollo has been on Trilostane for a while is 10lbs. and on 10mg. and has done well on it.
You have come to the right place.
Ask us questions and know we are hear to guide and support you through this journey.
Hugs Sonja and Apollo

[leigh]

Monday Morning @ 6:43 AM

Lily slept through the night! This is huge for me and hasn't happened in months.

She takes 10 mg of vetroyl 2 X a day. She hasn't had any noticeable side effects. but this was huge. Too early to say success but I am so happy.

Last night was her 4th night on Vetroyl.

Thanks for all your support.

[labblab]

YAY for Lily!!!!!!!!!!!!! Every little step is truly a milestone, Leigh :). Thanks so much for sharing your news and starting out my morning with a smile.

I'll keep watching for every update!
Marianne

[leigh]

Well she got up during the night once to potty and once to bark her way to an early breakfast and another trip outside.

But she still seems better and it's very early in her treatment. I am on day 5. She hasn't had any side effects, so that's the good news.

Yesterday when I got home from work she jumped on the top of the chair. I hadn't seen her make that jump in quite some time. Lily even with her short little legs and her full figured body used to be able to jump from a standstill from the floor to top of the couch in younger years.

So I think it's going ok, I just got so very happy about her sleeping through the night, that it was a bit of let down to not see it today.

But onward and upward, hopefully she'll feel good when I get home. She never has accidents while I am at work which always surprises me. She refuses to use the pee pads I left for her and almost always holds it. I wish she could understand going potty in the apartment if she really has to would be better than her being in pain. But she's such a good little dog. She loves to sleep with my laundry so I'll spread some out on her bed tonight.

[Squirt's Mom]

Baby steps forward are always good to have! ;) The "forward" part is the key and it sounds like that is the direction Lily is going! :)

You're doing a great job so keep up the good work! I hope you have another good nites rest tonite - getting one every other nite for a while wouldn't be too bad, huh?

Hugs,
Leslie and the gang

[MBK]

Hi, Leigh!

I just looked at your picture of Lily...she is so GORGEOUS!!! I hope she continues to do well on her vetroyl treatment and regains her strength and jumping ability (and you regain your sleep!). I will keep my fingers crossed for nothing but good reports!

[leigh]

MBK - Your little Ali is so cute. She has that expression in her eyes that my other dog Quincy (Terrier Mix) gets, you can just tell that she likes to have fun:)

[leigh]

Lily is refusing to eat this morning. Not even a treat. Does this sound like a side affect of the medicine?

[labblab]

Yes, it could be a side effect or an indication that Lily's cortisol is dropping a little too low on this dose of medication. How is she acting otherwise? Unless you have already given her the morning dose, I'd probably hold off on the trilostane until you've had a chance to check in with your vet.

I'm thinking she's been taking the trilostane for a little over a week now (?), so she's close to time for her first monitoring ACTH test. Your vet may want to proceed with that sooner rather than later. And if so, ideally you'd want to perform the test after her having been dosed with trilostane per her regular protocol. So I think you'll want to talk things over with your vet, in terms of both the testing and also whether/when to withhold Lily's trilostane.

Let us know what develops, OK?

Marianne

[leigh]

Yes, it could be a side effect or an indication that Lily's cortisol is dropping a little too low on this dose of medication. How is she acting otherwise? Unless you have already given her the morning dose, I'd probably hold off on the trilostane until you've had a chance to check in with your vet.

I'm thinking she's been taking the trilostane for a little over a week now (?), so she's close to time for her first monitoring ACTH test. Your vet may want to proceed with that sooner rather than later. And if so, ideally you'd want to perform the test after her having been dosed with trilostane per her regular protocol. So I think you'll want to talk things over with your vet, in terms of both the testing and also whether/when to withhold Lily's trilostane.

Let us know what develops, OK?

Marianne

Sure, no I haven't given her, her dose yet. Up until this morning, she'd still been drinking and peeing lots but has been in fine spirits other than the normal symptoms she'd had before meds. I'll call the vet. yep it's been exactly a week since she started her 2x a day treatment. (10 mg a dose)

[leigh]

Vet said to not give Lily any meds until she started eating and then to cut down to 1 dose (10 mg) once a day. She scheduled for ACTH next week. Since I am not giving her meds this am she couldn't get it done today anyway.

Some folks give their dogs pepcid? Does anyone know the dosage I could try with Lily (19 pounds)?

[leigh]

Lily just ate and drank an entire bowl of water. My thoughts are her tummy is upset but not that she is not getting too much meds in terms of cushings treatment, but just the side affect of an upset tummy. I gave her two empty pill pockets which she adores, then she started eating her food and drinking water (tons). I feel better now that she ate.

[Squirt's Mom]

Hi Leigh,

I'm very glad to hear that Lily has eaten this morning! :D That is a good sign!

You could be right about her tummy simply being upset due to the Trilo and that something like Pepcid AC (Famotidine) will help. But since Trilo is such a powerful drug, keep your eyes open and don't take a chance if you see this sort of thing again. Talk to your vet about trying the Pepcid - and if she oks it, make sure to get the AC, Pepcid AC. Tagamet (Cimetidine) can also be used.

I will let others more versed in Trilo dosing and testing chime in on your vets recommendations

You are doing a good job of watching her, Mom! Keep up the good work!
Hugs,
Leslie and the gang

[Harley PoMMom]

Some folks give their dogs pepcid? Does anyone know the dosage I could try with Lily (19 pounds)?

According to this website www.walkervalleyvet.com/otc-meds.htm one should give ¼ tablet of pepcid ac for a dog weighing less than 20 lbs.

Hope this helps.

Love and hugs,
Lori

[MBK]

Hi, Leigh.

I hope Lily is feeling better. My 19 pound dog, Alivia (also 13 years old), was just given Pepcid AC by her IMS and her dosage was 1/4 tablet as Lori already suggested. Alivia also adores Pill Pockets, too - they've made life a bit easier for both of us!

You are doing a wonderful job with Lily. I will keep my fingers crossed that her testing results are improved!

[MBK]

PS -

I just saw your post to me about Ali - thank you! When you get a chance, I hope you add a photo album. I'd love to see pictures of your two. Your avatar picture of Lily is too small to get a good look at her, but from what I can see - she's a beauty! :D

[addy]

Hi Leigh,

I am hoping it is just Lily's tummy bothering her. Keep in touch over the weekend.

Hugs,
Addy

[leigh]

well she just gulped down dinner like it was delicious and then started to polish off her brother's dinner as he is my skinny dog who always leaves some of his food for her:)


So I think she's ok, I'll start her on 1 10g dose in the morning and see how she does after a day off.

She was happy to see me when I came home and had drank lots of water and ate so I think she's ok.

Thanks everyone!

[leigh]

Lily went in for her test today, results come back tomorrow.

I ended up delaying the test a bit, as I put her on 1 10mg dose a day, which wasn't helping side effects. I then talked to vet and we put her on 2 a day for 4 days and ran the test today.

So tomorrow we will get results, I got another pack of 10 mg pills. I figure if I need to go up I can always combine the 10 mg pills.

Lily slept till 6 am for the last two nights:) So great, she appears to be doing well, although in the morning seems to turn her nose up at her food for a moment before eating, but once she starts eating she finishes.

She has lost almost a pound in the last few weeks though, so that has me worried, I 'll be happy to get the results in. She had been on senior dog food, but I think I'll switch her to her brother's food which he does well on. He eats Natural Balance Limited Ingredient Chicken and sweet potato. it's the only food that doesn't give him the runs, so should be easy on her stomach too I would think. Lily has never had an issue with being sensitive to dog food, so I don't think the change will be hard for her.

I'll post back her results finger's crossed. She did start running to the car today. Not sure if it's because she feels well or it's cause she doesn't like shots:)

Leigh & Lily

[leigh]

Sort of funny -

I have had a bad sinus/mouth infection of some sort for the past week- crying in pain. I went back to the doctor to tell him I needed more help than antibiotics.

He gave me prednesone - which I read has a long term side effect of cushings. Well I could only stay on it a day as it made me bonkers. (hyper, sleepless, anxious)

It's amazing what these darling dogs go through with this disease. It's not the same of course (meds vs. cushings), but these chemicals in their little bodies, I got small taste of what it may feel like.

anyway my personal experience with too much steroids in my body

[addy]

Boy, do I know what you mean;);) They had me on it once some years ago for a MONTH!!!!! Overdosed me no less. I was so out of it, I thought I was superwoman!!!:rolleyes::rolleyes:

These days, I insist on child size doses of prednisone when my asthma or sinus infections are really bad.;););)

A friend had to take it once, she stayed up all night and cleaned all her closets!!!!!

YIKES,
Addy

[leigh]

She got her ACTH test results back today

She was pre 7 post 26
and now she is 4/13

vet said normal ranges are

2-6(pre) and 6-18(post)

so that makes me happy, for now we'll keep her on her dosage and retest in a month or so.

[StarDeb55]

Leigh, I have not posted to you before, but could you double check the ranges you have posted for the ACTH. The range you have posted is for a normal, healthy dog, not a pup being treated for Cushing's. The normal range for our pups is 1-5. With vetoryl, the range can be slightly higher as long as clinical symptoms have resolved.

Debbie

[labblab]

Hi Leigh,

I'm really glad to hear that you're seeing some improvements in Lily! :)

I also do want to reconfirm what Debbie has just said -- the "normal" post-ACTH range that was listed on Lily's lab result relates to how a dog without Cushing's ought to score on the ACTH when it is used as a diagnostic test. When the ACTH is being used to monitor the effectiveness of Cushing's treatment for a dog with the disease, a different therapeutic range is desired. When trilostane is being used, the ideal post-ACTH target is between approx. 1.5 - 5.5 ug/dl. However, as long as Cushing's symptoms are well-controlled, post-ACTH results up to approx. 9 are still considered to be acceptable.

Having said that, Lily is still within her first month of trilostane treatment. And experience has shown that cortisol levels may continue to drift downward during the first month or so of treatment for dogs when they first begin the medication, even while remaining on the same dose. For that reason, Dechra usually recommends holding off on an increase until at least a month has passed in order to first judge what the maximal effectiveness turns out to be for that initial dose.

So given the fact that Lily is doing well, you are already seeing some improvement, and her post-ACTH has been cut in half -- it seems very reasonable to me that her dose will remain unchanged for a while longer. However, by the time of her next testing, I would expect that her dose would be increased if the ACTH result has not dropped down below 9 and her symptoms have not significantly resolved. Here is a link to Dechra's Treatment and Monitoring Flowchart which explains the desired testing results in more detail:

http://www.dechra-us.com/files//dechraUSA/downloads/Client%20Literature/47902_VETORYL_10mg_Treatment_and_Monitoring_Brochu re_Update_3_2_ps.pdf

Marianne

[leigh]

You know the vet did mention that under treatment the levels should be lower.

But Lily had been switched to 1 10mg dose a day for a week or more due some slight tummy upset, she'd only be on 2 10 mg dose a day for 4 days. So I think the levels still have room to go down as she hasn't been on the double dose for too long. Hopefully I'll continue to see some improvements over the next few weeks.

Thanks for information - guess i was a little to anxious to grab good news.

[labblab]

Thanks for information - guess i was a little to anxious to grab good news.
Leigh, I didn't mean to discourage you at all! I think Lily is doing well right now, and you have every reason to celebrate that. :)

Marianne

[addy]

I second that Leigh, I think you have reason to celebrate as well.:D

Hugs,
Addy

[apollo6]

Leigh
Welcome to you and Lily. You have come to the right place. You will find a lot of experience and knowledge here. My Apollo is also on Vetoryl/Trilostane and has not had any serious side effects and is doing well.
Hugs Sonja and Apollo

[leigh]

Hello,

Haven't written back in a long time.

Lily was tested a few times and now over 3 months after her first test, she is almost in the right range:)

She has remained on the 2x daily dose of 10 mg for her entire treatment.

Her levels are currently Pre 2.7 and Post 5.7

Original was

Pre 7 and Post 26

Then

Pre 4 and Post 13

Now

Pre 2.7 and Post 5.7


I feel very fortunate that her levels have continued to drop and as she remained on a 20 mg dose.


So She'll be staying her dosage and continued to be monitored and tested again in 3 months.


Thanks everyone for the great information! :)

[addy]

That is a keeper, great news for you and Little Girl Lily:D:D

Sigh of relief for you. Keep up the good work Mom!!!!

hugs,
addy