Vetoryl questions (Kira - 13 y/o) - Kira has passed

[Jlkhollins]

Hello,
I am new to cushings, as my 13 year old dog was just formally diagnosed yesterday. Her symptoms include: pot belly, muscle weakness in the hind end, sensitivity to temperature (I keep my house set at 68!), and increased thirst. I've thought she had cushings for some time and chose to treat it homeopathicaly. However, when her symptoms became uncomfortable to her I decided to have her evaluated by a vet.
The low dose dex test cam back inconclusive (because he inital pull was in the normal range). We then did the ATCH test and that came back positive. The vet felt faily confident that she has cushings because of the clinical presentation and the test results.
After doing A LOT of research I asked the vet for Vetoryl because it appeared to be the safest and most effective drug.
My vet is not too familar with Vetoryl so I am having to do a lot of my own research. The starting dose the vet recommended was 60 mg per day (Kira weighs 60 pounds). Everything I've read seems to indicate that I should be giving her 1mg/2 pounds. Does 60 mg seem high?
So far she has had two doses of the Vetoryl (60 mg spread over 18 hours) and I have noticed a lack of appetite and increased weakness. Is this a natural reaction to beginning a drug like Vetoryl that is meant to supress hormones? Or is this something that I should give her the prednisone for? I am thinking of skipping tonights dose and dropping her back to 30 mg per day.
Please help, as I truly need advice from those of you who have been working with Cushings for some time!!

Thank you,
Jennifer and Kira

[littleone1]

Hi Jennifer,

Corky and I want to welcome you and Kira.

Corky is taking Trilostane, as his dosage has to be compounded. He started at 20mg once a day, and this was just about 1mg per pound. He is currently taking 60mg TID, with 20mg 3x a day. He's been taking Trilo for almost 21 months.

Is Kira on once or twice daily dosing? When the treatment is started, you do see some differences, as the cortisol level is being lowered. After Corky had his second dose of Trilo, he seemed to be a little lethargic, but he was much better the next day. I would check with your vet first before changing the dosage.

It would be helpful to our members if you could post the test results of the tests that were used to diagnose Kira's cushings. Also, do you know if Kira has pituitary or adrenal cushings? Was an ultrasound done?

Our members have alot of knowledge and experience in dealing with cushings, and are here to help you.

Terri

[labblab]

Hello and welcome from me, too!

I'm really glad you have found us. As Terri has already said, it wil be really helpful if you can post Kira's actual diagnostic test results. But in the meantime, I will add a couple of thoughts. First, it is somewhat unusual for a dog who actually has Cushing's to test "negative" on the low dose dex test. But it is not impossible, as is noted by Dr. David Bruyette (a veterinary endocrinologist) per this following quote:


When interpreting LDDS test results, first evaluate the eight-hour postdexamethasone administration cortisol concentration. If it is above the reference range, the dog probably has hyperadrenocorticism (false positive results may occur in dogs with nonadrenal illness). If it is within the reference range, either the dog does not have hyperadrenocorticism or there is a 5% to 10% chance that the dog has PDH. (The dog may have early pituitary disease and the pituitary gland is still responding to a pharmacologic dose of dexamethasone by decreasing ACTH production, thereby reducing serum cortisol concentrations.) In those cases, an ACTH stimulation test is warranted.
Here is the article that is the source for the quote:

http://veterinarymedicine.dvm360.com/vetmed/Medicine/ClinQuiz-Interpreting-low-dose-dexamethasone-suppr/ArticleStandard/Article/detail/580093

Since Kira does have symptoms that are consistent with Cushing's and also had a "positive" ACTH, it sounds as though she may fall in the subset of dogs with pituitary Cushing's that Dr. Bruyette discusses above.

Assuming that this is the case, then 60 mg. is not an unreasonable starting dose for her. Dechra, the manufacturers of brandname Vetoryl, suggest that dogs be dosed initially according to a forumula of 1 mg. per pound. But having said that, if she does not seem to react well to that dosing level, than I would agree with your suggestion to cut her back to 30 mg. to begin with. Every dog metabolizes the drug on an individual basis, and the posted guidelines are simply that: just guidelines. So you do need to be guided by your own dog's reaction. Unless Kira worsens, I doubt that you need to administer prednisone. But she may benefit from skipping a day and starting at the lower dose as you have suggested.

However, just to clarify, I am not sure why she received her medication at an 18-hour interval. The recommended 60 mg. daily total is based on a 24-hour time period: either 60 mg. once daily or 30 mg. twice daily. If you are only dosing Kira once daily, then the preferred dosing schedule is for her to receive her trilostane in the morning, along with food. This is because all her subsequent monitoring ACTH tests should be performed 4-6 hours after receiving her daily dose. If you are only dosing her in the evening, it is impossible for the monitoring tests to be completed within the appropriate time frame unless your vet is open throughout the evening. So she may end up doing fine on the 60 mg. dose as long as she only given the medication once within a complete 24-hour time period.

Once again, I'm really glad you've found us and I look forward to learning more about your sweet girl.

Marianne

[apollo6]

Welcome to the forum

My Apollo is 12.5 years old and is on 10mg weighs 10 lbs. I started very low for my own peace of mind. He has been on and off since June 2010.
It is not normal for a dog to loss its appetite and feel weaker after taking Vetoryl/Trilostane. Please contact your vet about this.
Below is the link of the manufacture. You can also email any questions you have. It will also show you the dosage per lb.
http://www.peteducation.com/article.cfm?c=2+1597&aid=416
also a short run down on cushing and medications to start you off.
We are hear to help and support you and Kira. When you have time we'd love to have you download a picture of Kira in your profile.


http://www.peteducation.com/article.cfm?c=2+1597&aid=416

http://www.kateconnick.com/library/cushingsdisease.html

Hugs Sonja and Apollo

[Keiko's Mom]

Hi. My dog is on Vetoryl twice a day....appetite did go down and not a morning eater. I soak her dry food with water for 15 to 20 minutes, drain off and put one spoon of canned in it. She now looks forward to morning dosage and wet breakfast. You have to watch changing diet...diarrhea is one of the signs to look out for, so you don't want to cause it with diet. I take my dog for slow walk daily....she can do a mile and it doesn't over do her. Got to keep them moving and mobile.

[Jlkhollins]

Thank you for your responses.

We ended up at the emergency vet due to what I thought was a reaction to the Vetoryl. The emergency vet was incredible and did a full work up on her. Turns out we were dealing with a tumor in her abdomen, fluid/blood in her abdomen, arthritis in her spine, and Cushings to top it all off. He said the cushings was truly the least of my concerns. We tried to make Kira comfortable and prayed that she would turn the corner.

However, she did not.

She continued to get worse through the evening and the difficult choice was made on 6/29/2011 to let her pass to the Rainbow Bridge.

Please say a prayer for her, as she was my best friend and co-pilot (she loved car rides). I miss her dearly and my heart is broken.

[littleone1]

I am so sorry for your loss. My thoughts and prayers are with both of you.

[lulusmom]

Jennifer, I am so terribly sorry for your loss. My thoughts and prayers are with you and your family during this very difficult time.

Godspeed Sweet Kira.

Glynda

[Squirt's Mom]

Dear Jennifer,

I am so sorry to hear about Kira. Please know you did everything in your power to help her - what happened was out of your hands and you bear no responsibility for it. These tumors can come up suddenly and rupture suddenly in spite of all we do to keep them healthy.

Today, she is running free, whole and in no pain as she was when a puppy. One day you will hold her again. Til then, she will always be your co-pilot, ever watching over you with the same love and devotion you showed to her.

Kira's name has been added to our Remembering list for 2011 where she will always be remembered by her Cushing's family.
http://www.k9cushings.com/forum/showthread.php?t=2865

When you are ready, please feel free to post a tribute to Kira in the In Loving Memory section. We would be honored to share in celebrating her life with you.

Our deepest sympathies,
Leslie, Squirt, Trinket, Brick and our Angels, Ruby and Crystal

[addy]

Dear Jennifer,

I am so sorry to hear of the tragic turn of events. It is so hard when we lose our co pilot. Words always seem inadequate.

Godspeed Kira.

Love,
Addy

[Roxee's Dad]

Dear Jennifer,

I am so very sorry for your loss. Rest in Peace sweet girl.

[labblab]

Dear Jennifer,

I, too, am so very sorry! Please know that we will stay alongside you as you grieve the loss of your precious Kira. As Leslie has said, we will welcome anything you might care to write in honor of your girl, now or at any time in the future.

Sending you many hugs,
Marianne

[Cindy Thoman]

Dear Jennifer, I am so sorry for your loss. My thoughts and prayers are with you.

xoxo,
Cindy, Alex and Bear

[mytil]

Oh Jennifer,

I am so very sorry to read about Kira passing. I am glad you did find us as we are all here to help you.

Healing ((((hugs)))))
Terry

[EskiLvr]

I'm so sorry... you, Kira, and your family will be in our family's thoughts. My Eskie Chinook passed away due to complications of an undetected abdominal mass that went septic - and that was after he'd been heavily monitored for close to 8 months due to previously diagnosed liver disease. You did everything you could for Kira - these things are just *sneaky*.

Hugs to you,

Kris
Mom to Eskies Princess Penny (Cushings), Luke, and Holly - and Golden Retriever Murray