ACTH test-12 hour fast?

[scoora]

QUESTION?
My Scoop is going for his first ACTH test since starting on Vetoryl. I was told he should fast for 12 hours. Is that correct? When the vets office called to confirmed the appointment I asked, I don't need to do anything special? She checked with the vet that was in today and she said 12 hour fast is correct. Can anyone confirm that for me? I thought I read on here not to fast. I'm so afraid of doing something wrong but the vets office insists fasting is correct.
Thanks in advance for any info.
Vicki

[lulusmom]

No, that is absolutely incorrect. You need to give Vetoryl with food and have Scoop to the vet within 3 to 5 hours after dosing. If you do not follow this protocol, you might as well flush your money down the toilet. Acth stim test are expensive so your vet needs to educate him/herself so as to not put dogs through undue stress and the strain on your bank account. Hopefully you have not gone the vet's office yet but if you have and you are reading this after the test, your vet should do the right thing and refund you and schedule a new act stim test done according to protocol.

Glynda

[scoora]

Thanks Glynda. Scoop's test is Monday. I talked to the vets office a second time and they insist fasting is what I need to do. I asked to speak to the vet who is on today (not our regular one) and they said she has emergency surgeries and wouldn't be able to get back to me. Scoop needs to get this test done and his vet is going away for a few days starting on Tuesday so I can't even postpone it for a day. I know he has to take his Vetoryl with food and I told the lady that. She said just give minimum amount. I'm so scared and confussed right now. I don't know what to do! Will it hurt Scoop if he would fast? It makes sense to me that he should eat. He is also diabetic and they told me to give 1/2 of his insulin dose. His vet was also going to do a BG spot check on him and I said how could she do that with no food and 1/2 his insulin. So they cancelled the BG check. I am so horribly confussed I could scream!
Vicki

[Squirt's Mom]

Hi Vicki,

If Scoop is fasted, the test results will be inaccurate. If the vet recommends a dose changed based on inaccurate results, that could be a disaster for Scoop. Not only will fasting waste your money on a test that is no good, it will cause Scoop to have to face the stress of a worthless test which will need to be redone correctly putting him through that stress again, it will put him at risk of an unnecessary dose change, and if your vet won't admit their mistake by insisting he be fasted, they will probably charge you full price for both tests - none of which is fair or right to you or Scoop.

Dogs on Vetoryl (Trilostane) should not be fasted. Tell your vet to contact Dechra, the manufacturer, and ask for themselves. Not another vet because this is something that many get wrong - call Dechra.

[scoora]

Thank you Squirt's mom. If you were me would you just feed him and then talk to the vet when she gets in? I just couldn't get my point across when I talked to them. Does a dog have to fasted before an ACTH if they are using the test to confirm Cushing's? Maybe that is different.
Vicki

[lulusmom]

Hi again,

There is no need to be confused because we are very good at providing you with the information you need to understand things as well as your supporting documentation to provide your vet when you challenge him on anything. There is no doubt that your vet and his staff needs to educate themselves on acth stim test protocol for purposes of monitoring treatment. Yes, give Scoop his morning dose with food and take the information I am providing you below with you to give to your vet. Hopefully he and his staff will learn something and won't waste your and/or other pet owners' hard earned money.

Leslie has given you some good advice about contacting Dechra but you can also provide the url below to Dr. Mark Peterson's blog for veterinarians entitled "What's the Best Protocol for ACTH Stimulation Testing in Dogs and Cats?" Dr. Peterson is a well published, world renown endocrinology specialist who is also a consultant for Dechra. If your vet has never heard of Mark Peterson, he didn't read his veterinary textbooks in school. :D

http://endocrinevet.blogspot.com/2011/03/whats-best-protocol-for-acth.html

Here is excerpt from that blog that provides the information your vet and his staff needs to commit to memory:


Remember that the ACTH stimulation test is the most useful test for monitoring dogs being treated with trilostane (Vetoryl) or mitotane (Lysodren) see my blog entitled, Diagnosing Cushing's disease: Should the ACTH stimulation test ever be used? Both medications are fat-soluble drugs and must be given at time of meals, or the drugs will not be well absorbed.

With trilostane, it’s extremely important to give the morning medication with food, and then start the ACTH stimulation test 3 to 4 hours later.

Fasting these dogs on the morning in which the ACTH stimulation test is scheduled should be avoided since it invalidates the test results.

When a dog ‘s food is withheld, the absorption of trilostane from the gastrointestinal tract is decreased. This leads to low circulating levels of trilostane, resulting in little to no inhibition of adrenocortical synthesis. Therefore, serum cortisol values will higher when the drug is given in a fasted state than when it is given with food.

[goldengirl88]

Scoora:
My endocrine specialist Dr. Mark Peterson said if you fast a dog before the ACTH test after it has started Vetoryl that you can over dose the dog. This means like everyone was saying the test results would be no good. You could end up giving you dog too high of a dose. If you are still worried, look up Dr. Peterson- he has written some articles on this. Good luck to you, I know this is hard, but hang in there.

[JoannH]

The paper that comes in the Vetoryl box that has all the info about dose and administration and side effects clearly states "After approximately 10-14 days at this dose, re-examine the dog and conduct a 4-6 hour post-dosing ACTH stimulation test..." Have you vet look at his paperwork for confirmation.

[Steph n' Ella]

Vicki, plase look back at your original thread. Scoop is hypothyroid and any testing that you do now will be off weather you fast or not. Keep your appointment with your vet on Monday but talk about the thyroid levels (T-4). I suggest a "Free T-4" blood test be performed and that you get a perscription for synthetic replacement thyroid hormones.

I think you should scrap the whole Cushing diagnosis, stop the meds and re-do testing (LDDS) after thyroid levels are back to normal, if excessive drinking and hunger remain.

Oh and a mod should merge both these threads together.

[lulusmom]

Hi once again.

I just wanted to comment on the low t4 on Scoops bloodwork. It is most common for cushingoid dogs to have low t4 on blood chemistry and that doesn't mean the dog has primary hypothyroidism. It is much more likely that this abnormality is something called Sick Euthyroid Syndrome. This is a transient condition which corrects itself once the underlying cause has been addressed. In cushing's, it is the excess cortisol that is causing the problem and once a dog is stabilized on treatment, the T4 usually returns to normal. If t4 continues to be low after a dog is stabilized, I would then pursue a primary hypothyroidism diagnosis via a full thyroid panel.

Glynda

[scoora]

Thank you so much everyone.
The vet and I have talked about the low t4 results. She said she could do a test for it but would rather wait and do a full bloodwork after he's been on Vetoryl for a little while. She thinks the low t4 is caused by the Cushing's.
I'll be back later.
Vicki