Cushings doggy, pancreatitis & sudden renal failure

[K123]

Hi,
I came across this site searching for Vetoryl prices. My dog Star, an 8 year old blind Bichon Frise was recently diagnosed and finally stabilized at 60mg twice/day. I was wondering if anyone else has found a good online pharmacy with discount prices? I found a few that look like they will save me about $40/month from the vets prices but I was hoping to hear from any of you.
Also, has anyone had to reduce the dose at some point (perhaps due to weight loss)? Star has developed quite a pot belly and voracious appetite but since starting her on the twice daily dose she seems to be eating less and has already lost a few pounds. She is at the upper end of the dosage guidelines for her weight.

[marie adams]

Hi and welcome to you and Star,

I wish I could help you with info on where to purchase Vetoryl. I treated my Maddie with Lysodren.

The experts will be along to help you where you can find better pricing. I know they will ask for a little more info about Star.

You are in good hands here!:)

[StarDeb55]

Welcome to you & Star! It's always great to hear that a pup is doing well in the initial stages of treatment

When it comes to pharmacies, a lot of members, including myself, use Diamondback Drugs in Scottsdale, AZ. You can have them compound any dose of trilo you need, except for the dosages that are available from the manufacturer. At 60 mgs., you could have them make 59 or 61 mg. capsules. It's possible that your vet may not like the idea of compounded trilo, but of the members I can recall who have used Diamondback's compounded trilo, there hasn't been a problem. You can order from their website, & they ship anywhere in the US for a standard fee, if I recall.

If you want to share Star's history, including symptoms & the tests she had done, we all like to hear how you got to your diagnosis. Every pup may be a little different, so we always have something to learn. I'm sorry that I can't offer much help with your questions about trilo. I've never used it as I treated both of my Cushpups with lysodren. A large number of our members are Trilo parents, & I'm sure they will be stopping in to give you some input.

Again, welcome! We are to help in any way we can.

Debbie

[labblab]

Hello and welcome!

Can you please tell us how much Star weighs and also the results of any monitoring ACTH tests that have been performed since starting on the Vetoryl? How long has she been taking the medication? And am I correct that she is receiving a total daily dose of 120 mg. (60 mg. twice daily)?

If Star weighs 20 pounds or less, that is a REALLY big dose and actually far exceeds the initial dosing recommendations of the manufacturer. If that's the case, yes, I would be very concerned that she may soon need a dosing decrease. Especially because we have been told that dogs who are dosed twice daily may run an increased risk of having their adrenal function oversuppressed over time.

Does Star seem to be feeling OK aside from the weight loss? Please do let us know more about her diagnostic and treatment history. The effectiveness and potential safety of any given dose of Vetoryl cannot be judged by outward appearance alone -- that's why the periodic monitoring ACTH tests are also so important. I've just seen your new reply on our "Polls" thread whereby you are paying just under $100 for your ACTH testing. That is incredibly inexpensive, and makes me wonder whether Star is actually receiving a true ACTH stim test. For her testing, is she having two blood samples drawn 1-2 hours apart from one another?

I apologize for all the questions, but as you can see, I am feeling very concerned about the size of Star's Vetoryl dose. :o

Marianne

[addy]

Hi and Welcome from me and my Zoe,

I am a bit concerned too about the dose of Trilostane. I just finished reading a study by Dr. Edward Feldman, from UC Davis. The conclusion was twice day dosing allowed for lower doses of the drug to be administered while retaining control of the cortisol and symptoms. Much lower doses than the manufacturer of the drug recommended were used. This also allowed for less side effects.
Admittedly, some dogs may be resistant to the drug but, wow, that seems a lot for a bichon.

Dont mean to scare you.

hugs,
addy

[Squirt's Mom]

Hi and welcome to you and Star! :)

We are a Lysodren house but the others have given you good direction on finding prices for Trilostane (Vetoryl).

I saw that Star is blind. I am the proud mom to two blind babies, Trinket and Brick. Trink lost her sight and eyeballs to glaucoma, Brick is blind from Hydrocehpalus but still has his eyeballs, unfortunately. My two constantly amaze me and fill my soul with wonder. Brick, in particular, is just the happiest little thing ever and Trink is simply amazing - she has sonar like a bat! They both teach me daily how to be a better person regardless of what life may throw at me. I am ever so blessed to share my life with them. How did Star lose her sight? Has she adjusted well?

I'm glad you found us and hope to learn more about you both as time passes.
Hugs,
Leslie and the gang

[K123]

Wow! Thank you for all the quick replies.

My vet first suspected Cushing's at the end of last year. She had a Dexamethasone (sp?) Suppression test that indicated possible Cushings, and an ACTH test, then was put on 60mg once daily, and had another ACTH test. I will have to get the results to post, but the Vetoryl 60mg had not brought her Cortisol down enough, so we retested again in 2 weeks at the same dose, and it was still high. The vet raised it to 90mg (a 60mg and 30mg) in the morning, and the ACTH test showed her Cortisol was in an ok range for a Cushings dog. However, I brought up possible twice/day dosing with my vet, to better control her syptoms overnight. Star seemed to be fine during the day at 90mg, but became restless during the night, having to wake up frequently to drink water with fits of heavy panting and urinating overnight. The vet said that for twice/day dosing the dose would be upped by 1/3rd and split into two doses. I had another ACTH test done last week after having her on 2 weeks of twice per day 60mg dosing (total of 120mg per day), and am expecting the results any day now.

Star seems to be doing well at this twice/day dose. She weighs about 25lbs now, down from just over 28lbs. I know this is big for a Bichon...prior to her current condition she weighed in at about 18lbs, and probably over the past year she started putting on half a pound-a pound per month and became less active.

Prior to being on the Vetoryl she would eat anything you put in front of her, gobbling up her kibbles so fast she would go into reverse-sneezing fits (making this horrible snorting noise). This is the first time in a long time she will walk away from her food bowl with food still in it.

As for her blindness, I do not know how she lost her sight. She always seemed to have limited sight, bad vision, and in the past she was given steroidal eye drops thinking it was allergies. I think she may have been blind in one eye for some time...she always had kind of a "googly eyed" look, like one eye was off in another direction. I got the diagnosis of blindness in conjunction with her being treated for Cushings. You wouldn't know she's blind unless you put a treat in front of her face and see that she can't track it left or right. However, she navigates just fine most of the time. My vet suggested SARDS...but I checked into that and found that dogs with SARDS have pupils that are unreactive to light, and Stars pupils still contract with light shined in them...I mentioned this to the vet and she said it's not always the case. I'm skeptical that it is SARDS because I think she would not be getting around so well if the blindness was a sudden onset.

The ACTH test is $98.50...broken down it is $54.50 for the ACTH Response test, $20 for the acth injection for a 0-40lb dog), $5 for first lab sample collection $5 for second lab sample collection, and $15 postage to the lab. They use michigan state university for the lab, which i told was cheaper than another lab i could've chosen. When I take her in for the ACTH test, it takes a little over an hour, they draw blood 1 hour apart.

I have one other dog, a very active 6yr old Bichon/Shih-Tzu mix who's only 14lbs, and he seems to keep Star active and I think following the pitter-patter of his little paws makes it easier for Star to get around.

Thank you for all the info, I will look into the pharmacy that was mentioned...my vet and I discussed compounding and she is ok with it.

[K123]

Hello,
My baby Star has was diagnosed a year ago with Cushings. She is a bichon frise, was close to 30lbs at diagnosis, now a year later she has dropped to 22 lbs. She's been on 60mg twice daily since around the time of her diagnosis. Her most recent ACTH a little over a month ago was normal. Over the past few weeks she had tummy upset, vomiting and diarrhea. I took her in and the vet suspected bacterial infection and prescribed metronodazole. After a few days she showed no improvement and looked worse. No eating and was giving her pedialyte by dropper to keep her hydrated. I went back in for an emergency visit. I told the vet I suspected pancreatitis based on symptoms including abdominal pain. Test was positive but also the vet said kid eh failure. She never had kidney trouble before. She was admitted to the hospital and is showing improvement. Kidney values have come down some with iv fluids. Also pancreas levels are coming down. Any input would be appreciated. I know treatment for pancreatitis is to rest the gland and nothing by mouth, but she hasn't eaten since Monday and today is Friday.

[labblab]

I'm so sorry your baby has had such a serious setback. I do want to make sure, though, that your vet has ruled out an Addisonian episode as the cause of Star's problem. By any chance, do you have the actual numerical results for her most recent ACTH monitoring test? Even if her cortisol level was OK a month ago, it still could have subsequently dropped, leading to an Addisonian crash. The reason why I ask is because so many of the symptoms you are describing could be consistent with Addison's -- even the kidney dysfunction:


On examination of dogs with Addison’s disease one may see depression, weakness, dehydration, weak pulses and sometimes a slow, irregular heart rate.* Routine laboratory tests often show a low blood sodium and high blood potassium. Loss of water, in vomit and diarrhea, can lead to dehydration. Severe dehydration increases waste products in the blood (creatinine and blood urea nitrogen = BUN) that are normally eliminated by the kidneys. Addison’s disease can be confused with primary kidney disease...

Regardless of the cause of the problems, the supportive care would probably be very similar (appropriate hydration, making sure electrolytes are in balance, etc.). But in terms of longterm management, it will make a difference whether the current renal/pancreatic crisis is only temporary as a result of an Addisonian crash as opposed to a longer term, chronic condition. And it will certainly make a difference in terms of reinstituting trilostane treatment once again vs. her perhaps needing the opposite -- supplemental steroids to treat adrenal function that has been oversuppressed by the medication.

As far as pancreatitis and eating, I think current recommendations are shifting away from limiting any food by mouth. My own dog suffered from acute pancreatitis last year, and I've read some articles that have promoted resumption of feeding sooner rather than later in an effort to normalize GI function. The meals, however, should be small, frequent, lowfat, and very bland (like boiled chicken breast and mushy white rice). Of course, this is assuming that the dog has been released to homecare. If Star is still ill enough to require hospitalization, then there may be other factors that are figuring into your vets' decisions regarding nutritional support.

I hope Star will soon be perking back up! But in the meantime, as I say, I am curious to know whether or not her cortisol level has been checked in conjunction with this illness.

Marianne