Managing side effects, I think

[ticky]

Greetings K9 folks,
We are new to your site. Id like to share my situation as I need some advice and may be able to offer some soon.
My 10 yr 17 lb Female, spayed smooth fox terrier had all the symptoms of cushings and the test revealed so. I don't have the exact test at the moment however, I dropped her off allday on an empty tummy, then started her on 30mg of trilostate, vetoryl. 9 or so days later, another test revealed this as right where it needed to be per vet. Her symptons improved fast!! Just a day or two after starting, her panting, drinking,appetite an ect..were almost norm. Her coat stopped shedding and beautiful by the 9-10 days! She was not handling it well in other ways.(30mg)
Severe side effects; itching big time, lethargic and nausea, Claratin (not D) no help, some relief from benadryl. The vet thinks she is really sensitive to to the med. He suggested dropping to 10mg so we cut the dose to 10mg a day(for14 days), 1/2 morn then 1/2 night. Better but itching is a big problem. Symptoms were returning. I really think we need to up the dose an I am aware of "quality of life". Also Id feel better if she'd gain a little weight as her appetite is good but not ravenous although she looks sexy but should be gaining some. No pot belly now. Lots of yawning, stretching, lameness (a growing concern), oily coat with a few small cyst. Upped the dose to 15mg, same 1/2 morn then night. All of these symptoms improved fast again except the lameness an itching.
The Dr wants me to regulate the dose as I see fit for good life. I see him soon. Any thoughts, experiences, or... insight???

Animal friends, mike,chris and mutts thx

[Harley PoMMom]

Hi and Welcome! So glad you found us and we will help in any way we can. If you could get copies of the test/s that were done and post the results here this would help us to provide you with more meaningful feedback.

Cushing's is one of the most difficult diseases to get a confirmed diagnosis because not one test is 100% accurate at diagnosing Cushing's and non-adrenal illnesses can create false positive results. Other illnesses such as diabetes and thyroid problems share some of the same symptoms of Cushing's, have diabetes and any issues with the thyroid been ruled out?

Although Dechra's Product Insert recommends a starting dose of 1.0-3.0 mg/lb, a vet tech from Dechra's Kansas office, Dr. Tim Allen, verbally recommends a starting dose of Vetoryl at 1mg per pound.

Some dogs may go through corticosteroid withdrawal syndrome within 10 days of starting treatment. The clinical signs include weakness, lethargy, anorexia, and weight loss. The only way to differentiate between a hypoadrenocortical crisis and cortisol withdrawl syndrome is having an ACTH stim test and having the electrolytes checked.

A couple of important things with Trilostane/Vetory is that it has to be given with food to be properly absorbed and the ACTH stim test should be performed 4-6 hours post pill, no later that 6 hours.

Since Trilostane/Vetoryl may cause gastric upset, many members give their furbabies Pepcid AC 20-30 minutes before the dose of Trilostane/Vetoryl.

Please do not hestitate to ask us any and all questions and remember we are with you every step of the way.

Love and hugs,
Lori

[lulusmom]

Hi and welcome to the forum.

It would really help if you could please round up all of the tests that were done to diagnose your dog as well as the acth stim test that was done nine days after starting Trilostane and post the results here. Please include the normal reference ranges. I see Lori has already provided you with some really good information but as usual, I always have more to add. :D

If your dog's cortisol levels were within the desired therapeutic range of 1 - 6 ug/dl nine days after starting treatment, then it is possible that cortisol dropped too low subsequent to the acth stim test. Trilostane will continue to drop cortisol well into 30 days and sometimes longer. Any time an adjustment to dosing is made, an acth stimulation test should be done no later than 14 days after the starting the new dose.

I may have misunderstood you so can you please confirm that your vet has left treatment in your hands to regulate as you see fit? I hope not because this is not acceptable. Your vet needs to regulate the dosing based on physical symptoms, length of treatment and results of acth stimulation tests. It's not easy to come up with the proper dosage even when following protocol so guessing is a shot in the dark and a huge risk to the dog.

Cushing's is a serious disease requiring serious drugs and treatment is much easier and safely facilitated if the vet is experienced, including intimate familiarity with the drug he has prescribed, and the pet owner is educated. If either of those components is missing, the risk to the dog is increased greatly. We have a wealth of information in our Helpful Resources section, including extensive information on Trilostane. Please do read whatever you can so you can familiarize yourself with proper protocol. I may be wrong but based on the little information you've proved, it appears that your vet may not have much experience with treating a cushdog so you may want to share this information with him. Your vet can also contact Dechra, the manufacturer of Vetoryl (Trilostane) and ask for their help. They have a wonderful internal medicine specialist on staff, Dr. Tim Allen, who is always willing to discuss cases with vets and pet owners. Dechra also has continuing education for vets who need the training in order to safely and effectively treat a cushdog.

Here is a link to information on Trilostane, including contact information for Dechra.
http://www.k9cushings.com/forum/showthread.php?t=185

I'm sorry for the circumstances that brought you here but I'm glad that you found us.

[Squirt's Mom]

Hi Mike, Chris and mutts!

Welcome! :)

Another consideration is that when treatment starts controlling the cortisol we often see other issues crop up - like allergies and inflammatory pain like arthritis. The cortisol has been in a sense "treating" these sort of things and when the cortisol is lowered, they come to the forefront. So some of what you are seeing may not be a sensitivity to Trilo but rather issues that she has had but were "hidden" by the cortisol.

Hugs,
Leslie and the gang

[ticky]

thanks all, seein the vet and getting the test results. back soon!