New diagnosis of Cushings and meds are expensive (11 y/o smooth collie mix)

[Jcsnowberry]

Hi,
My dog Snickers, an 11 year old smooth collie mix, was diagnosed with cushings a couple of months ago. My long time vet retired and I have a new one. He tested Snickers and initially put him on 30 mg of vetoryl twice a day. Snickers weighs 63 pounds. He stayed on that dosing schedule for a month, and then had an ACTH test, with a value of 7. So my vet increased him to 40 mg twice a day, and retested him in a month, which resulted in a value of 5.3. He wants to keep him there and see how he does. The problem is I have to buy both the 30 mg and 10 mg capsules and he takes 4 a day. So to get through a month I need 4 boxes, which runs $250. I love Snickers very much and will do what I need to do to keep him happy and healthy, but $250 puts a major drain on my finances; I'm already working 2 jobs. Any advice? Thanks so much!

[labblab]

Hello and welcome!

We're so glad you and Snickers have joined us. It's a shame that brandname Vetoryl is so expensive, particularly when you have to use a combination of different capsules. From a practical standpoint, I can think of only two things (well, maybe three things) that could lower your costs. If your vet wants to stick with the twice daily dosing, your first option is to consider buying a compounded version of trilostane as opposed to brandname Vetoryl. Compounded trilostane is prepared by individual pharmacies in the specific dose prescribed by your vet -- in Snickers' case, you could get 40 mg. capsules/tablets. Compounded trilostane is generally much less expensive than brandname Vetoryl. The downside is that compounded products are prepared outside the scope of FDA approval, and recent studies have shown that the dosing of some compounded products are neither as consistent nor as effective as brandname counterparts. However, a number of our members do use compounded trilostane and have been happy with the results. If you and your vet wish to try a compounded product, we can make some pharmacy recommendations to you.

If you want to stick with brandname Vetoryl, the second alternative is to try once daily dosing with Snickers. It sounds as though he is doing well on the twice daily regimen, so it seems a bit of a shame to shake things up. But many dogs actually show the same symptom relief when dosed only once a day, and this could decrease your costs markedly. In fact, Dechra (manufacturer of Vetoryl) currently recommends that dogs first be started with once daily dosing, and only shifted to a twice daily regimen if their symptoms seem to be rebounding again later in the day. If you do switch to once daily dosing, you could first try a single 60 mg. capsule in the morning. As long as all symptoms are resolving to the satisfaction of the owner, Dechra is OK with a post-ACTH result as high as 9.1. Can you tell us about Snickers' symptoms prior to beginning treatment, and have they all resolved at this time?

The third possibility is a compromise that may or may not be any cheaper. It involves finding a local compounding pharmacy that would be willing to convert brandname Vetoryl from its original packaging into a different form (either capsules of a different size or a liquid suspension). For instance, one box of thirty 120 mg. Vetoryl capsules could provide enough "dosing" for over a month of 40 mg. twice daily administrations. However, the pharmacy will add a charge for the repackaging, and that extra cost may be the deal-breaker.

At this point, I would have a sincere heart-to-heart talk with your vet and tell him that you simply cannot continue to bear this monthly cost. And then I would discuss these alternatives to see which option suits you both best. Good luck!

And in the meantime, we'd love to hear more about Snickers -- his entire health history and all the steps that led you down the trail towards his Cushing's diagnosis

Marianne

[Jcsnowberry]

Thanks Marianne - you provided a lot of valuable information, and I appreciate it. Snickers has always been a very healthy dog. A couple of years ago, however, he started having really dry, itchy skin, mostly on the area of his back just before his tail, where it is hard to reach. His skin was flaky and dry, and would get worse in the winter. But he didn't have any other symptoms of anything else, and my doctor suggested fish oil capsules, which helped some. But this summer, I started noticing that he was often panting, drinking lots of water, having to pee a lot, and somewhat fidgety - he couldn't stay in one place for too long. But at the same time, he seemed fatigued and his belly got poochy. Then he started getting what I initially thought were hotspots - areas of crusty, scabby skin under his hair, that would slough off eventually to reveal very thin, shiny, dark skin underneath. My vet suspected Cushings and suggested we test him with the dexamethasone suppression test and another test that I can't remember right off hand (maybe the ACTH test?) and that is when he received the diagnosis. He also did blood work to rule out other disorders.

He's been on vetoryl for about 2 months now and his symptoms are improved. He pants less, drinks less water, is less agitated, no longer has a poochy belly, and doesn't have to pee as much. His skin has improved some but not completely. He seems happier and has more energy, although I believe he has a bit of arthritis (I've heard the excess cortisol can mask arthritis as well as allergies).

Thanks for asking and once again thanks for the information. I will talk to my vet tomorrow.

Judy

[molly muffin]

Hi Judy, I just wanted to pop in and say welcome to the forum to you and Snickers. What a cute name! I just love it!
Marianne had given you all the options that might help you and I hope that your vet will work with you to get these costs down. This really is an expensive disease to treat. :(
Yes, please do tell us more about Snickers.

Sharlene and Molly Muffin