New member with lots of questions-Can you help Heidi? (mini schnauzer)

[DanandJose]

Greetings all, I just stumbled across this site and am impressed with the knowledge of the subscribers. Hopefully some good people can help us out. Our mini schnauzer, Heidi (stats:female, 15 people yrs, 19 lbs, generally good health, neutered, former mother, loving) was diagnosed with cushings last summer. Our vet immediately advised Vetoryl which she has been on since. When she is up she is active and playful. When she doesn't eat for a day she is lethargic and indifferent. Thus the problem. Her loss of appetite. We switch wet foods and even make our own. We feed her whatever she will eat. She loves KFC, roast pork occassionally. She recently was spotted eating dry cat food occassionally. All of her life up to last year she ate solely dry dog food with her former mates. We resort to a small amount of Prednesone every 3 to 4 days to jump start her appetite, but don't like having to give it to her. She gets a dose of liquid generic baby vitamins every morning. She drinks well and urinates normally. The vetoryl dosage is 1 30 mg every other day and 15 mg every other day. (As the dosage comes in 30 we have to split our own into gel caps. She had a negative reaction to 30 mg every day so we experimented and cut back as stated.)
Questions -
Any suggestions on the loss of appetite? She isn't losing weight but getting her to eat even once a day can be a challenge. We sometimes have to force soft food down her. She still loves us afterward.
Should we try to increase the Vetoryl dosage to the recommended 30mg a day; now that she has been on it for over 6 months?
Is the Vetoryl affecting her appetite? (I've written to the mfg and am awaiting a reply.)
Thanks for listening and sharing!
Dan
Miami

[Harley PoMMom]

Hi Dan,

Welcome to you and Heidi, so sorry for the reasons that brought you to us but glad you found your way here.

If you could get copies of all tests that were done on Heidi and post any abnormalities that are listed that would be a great help to us in providing you with more meaningful feedback. We are especially interested in any test that was done to diagnose her Cushing's and any ACTH stim test results.

Vetoryl has a short half-life and is usually out of the system within 8-12 hours so dosing every other day is not recommended. Heidi's inappetence could be the cortisol going too low or due to cortisol withdrawal.

The 30mg of Vetoryl could be too much for her system at one time but maybe adjusting her dose to 10mg BID would agree with Heidi's system better. Dechra, the manufacturer of Vetoryl, advises against opening the capsules and dividing them.

Has Heidi's electrolytes be checked recently? Is she experiencing any diarrhea or vomiting? Has the vet been following the proper monitoring protocols, such as performing the ACTH stim test 4-6 hours after the dose of Vetoryl and did the vet tell you that Vetoryl has to be given with food to be properly absorbed?

Please know we will help in any way we can so do not hesitate to ask any and all questions.

Here is a link from our Helpful Resource Thread that has information about Vetoryl/Trilostane: Trilostane/Vetoryl Information and Resources (http://www.k9cushings.com/forum/showthread.php?t=185)

Love and hugs,
Lori

[molly muffin]

Hello and welcome from me too. :) Glad you found us, although so sorry that this is the reason.

Lori has made some excellent points. Dechra warns against opening the capsules are dividing capsules as it is a very strong medicine. I think if you could get tablets, those could be cut, but even then be careful.

With cortisol levels you are looking for an even level to maintained throughout the day and this one day this and one day another dosage is going to cause some spikes. Any of these can affect her eating. This not eating is rather worrying and it sounds like she could have some days she is going too low. I'd get an ACTH test done as soon as possible and see where she is at now and I'd get her on a steady dosage based upon the results of that ACTH.
You don't want to mess around with the cortisol levels as it is something they need to live. The fact that you have to give her prednisone at all, means that she could be in a crisis that could go Addisons which is when the cortisol is too low. She might not even need to be on vetroyl at this point if she has gone Addisons. Also her electroyles need to be checked at the same time they do the ACTH test.
Please do this as soon as possible and let us know how she is doing.

Sharlene and Molly Muffin

[Mrsbiggsy]

Hi to another Newbie. I have only been on for a few days. I noticed you said you give Prednisone to jump start appetite. I thought steroids were sometimes responsible for Cushing's. Maybe I am mistaken. Does Heidi like boiled rice and meat? I can usually get Carly to eat that. We will be keeping good thoughts for you and your precious one.

[Simba's Mom]

Welcome to the family of Cush parents and their precious fur babies. This site will teach you so much and the more you know the better you can help your baby. We all have different experiences, and can help in some way or just be beside you on this journey!

[DanandJose]

We want to thank all of you for replying to Heidi's dilema. Some very good points to consider. It may take a while to get everything you've asked for but will get back to the forum as soon as possible and after we've checked with the Vet. Does anyone know where to get the Vetoryl tablets as we've not found them offered anywhere?
Thanks much.
Dan and Jose

[DanandJose]

Hi all, Sorry I forgot to answer those questions of yours that I can.
Heidi has no pattern of diarrhea or vomitting. Occassional yes but not often. I know splitting the capsules is not ideal but it has worked for almost six months now. I am aware that the Prednesone can counter the Vetoryl that's why we use it sparingly. We are very careful with the med and try very hard to split it exactly. I am suprised Dechra doesn't make a 20mg dosage. Am I correct in understanding that Cushings increases cortisol production and that the Vetoryl counters it? If Addisons (?) is in play, what can be done for that? For her age, Heidi is fairly active and the only challenge is her inconsistent appetite. Perhaps you are correct that a consistent dosage of Vetoryl would improve that. This will be addressed with the Vet as soon as possible. Thanks again for your support
Dan and Jose

[goldengirl88]

Dan:
Welcome, and sorry for the circumstances that brought you here. I don't have a lot of time right now, but felt compelled to see if my cents can help you. Firstly as was already said by someone. Dechra advises not opening the capsules. It can be hazardous to you and your dog. They are not supposed to even be punctured by the dogs teeth. Secondly I must tell you the prednisone you are using, and the way you are using it must stop. My precious Tipper got Cushings from the Vets using prednisone on her for allergies. You cannot give prednisone and Vetoryl . Prednisone will also skew any testing.Has you dog been tested as others will want the numbers off of the tests? It would not be good to put a dog on Vetoryl without all the testing to make sure of the diagnosis. These are powerful drugs. Thirdly I must address the diet. Pork etc should never be fed to a dog normally, but especially a Cushings dog. You need to immediately put your dog on a healthy diet low in fat with no grains whether it has Cushings or not. I do know that it is sometimes easier to give them what they want, but it is very bad for them. The people on here are wonderful and will gladly help you along. I truly hope everything goes well for your dog, and I will say a prayer for you both. I am not trying to scare you, but just trying to help you not make serious mistakes.
Patti

[addy]

Hi and Welcome,

Im reading about your splitting the Vetoryl capsuls and wondered why you can't use compounded Trilostane instead? Im also wondering how much experience your vet has with Cushings. Your dosing schedule seems a bit strange. Sorry to be blunt.:(

It would be great if you get post the last ACTH test results or give us more feedback on your sweet pup.

[Harley PoMMom]

I am suprised Dechra doesn't make a 20mg dosage. Am I correct in understanding that Cushings increases cortisol production and that the Vetoryl counters it? If Addisons (?) is in play, what can be done for that? For her age, Heidi is fairly active and the only challenge is her inconsistent appetite. Perhaps you are correct that a consistent dosage of Vetoryl would improve that. This will be addressed with the Vet as soon as possible. Thanks again for your support
Dan and Jose

Dechra does manufacture Vetoryl in 10mg capsules and if one wants to try 20mg then one can give two 10mg capsules. If this is not convenient than a person can use a compounding pharmacy. A compounding pharmacy can either use the Vetoryl capsules that the customer brings in or the pharmacist will use bulk Trilostane. When bulk Trilostane is used the pharmacies just can't sell anything in the exact dosage that the brand name vertroyl comes in.

Cushing's is indeed the overproduction of cortisol. Vetoryl/Trilostane inhibits the production of cortisol. The goal of treatment is to reduce both pre and post stimulated cortisol levels to within a therapeutic range of between 1.5 ug/dl - 5.4 ug/dl and a post can be as high as 9.1 ug/dl if clinical symptoms are controlled.

An "Addisonian crisis" is caused by severe adrenal insufficiency. There are sort of two levels of Addison's: the more severe form where the adrenals cannot produce cortisol or aldosterone (the hormone that balances the electrolytes) When this happens a med like Florinef or Percorten needs to be given to replace aldosterone and to help balance the electrolytes. When Percorten is given the dog will almost always need some pred to replace cortisol too. The other type of Addison's is what is called Atypical Addison's, in this type of Addison's the adrenals are still producing aldosterone, and so the electrolytes are ok, but is unable to produce sufficient cortisol for the body's needs. This is treated with prednisone (or sometimes some other cortisol-replacing artificial steroid) and meds like Percorten or Florinef aren't needed.

Hope this helps.

Love and hugs,
Lori