Tucker 12 y/o -Llasa-Vetory

[DoreneT]

Hi there,
We just found out on Thurs. that our Llasa has Cushing's also. After several discussions with our vet about excessive drinking and frequent accidents in the house, he tested for Cushing's, which turned up positive for "pituitary" type. We started the Vetoryl, 30mg, 2x daily yesterday evening. We are concerned about the side effects also, but don't know of proven alternatives. We're watching our 12 year old "puppy" carefully, hoping that the meds work, but don't have a negative impact.
It seemed like the dosage our vet chose, was a bit of a guess, because our dog, Tucker, is a medium size.
We would really appreciate any knowledge and suggestions.
Thank you,
Dorene

[gunthersmom]

Loooooooove retail therapy lol. Even tho I bought more stuff for Gunther and my nephew than I did for myself.

Dorene I would start another thread so that everyone can see your post, the people here are very knowledgeable and they have all helped me immensely, I'm treating Gunther with lysodren, but am sure the moms who are using the vetoryl will jump in and help you, be prepared for lots of questions, the more info you can give the more everyone can help you. Just breathe and take in the knowledge from the awesome folks on here!!!!

Angela

[doxiesrock912]

Doreen,
how much does Tucker weigh?
Daisy is 11lbs and takes 5mg twice a day which seems to work for her.

Every dog is different, but it's best to start on the low side and work up from there if necessary.

At first, Daisy started showing improvement within 3 days but by the end of the week, she was always sleeping and refused to eat. These are signs to look for that indicate that the dose is too high. She was on 10mg twice a day which was too high.

[molly muffin]

Hello and welcome Doreen and furbaby.

I am a bit concerned about the 30mg twice a day. Normal starting vetorly level recommendations now are 1mg/1lb. If you do twice a day dosing then that dose is split. So, say that your dog weigh 30lbs, for twice a day you would give 15mg in the morning and 15 mg in the evening. Unless your dog weight 60lbs, the dose you are starting at is on the very high side.
Unfortunately we have found over the years an even very recently, that not all vets are as well versed in giving the medicines for cushings as they need to be. This tends to worry us because it is easy to see how too high of a dose can send a dog the wrong way into Addison's which is when they do not have enough cortisol in their bodies. The ONLY way to know if this has happened is via an ACTH test. Which needs to be done as soon as possible if you see any of the following symptoms, vomiting, diarrhea, refusal to eat, lethargic (which can get to the point where they can't even stand if it goes way way low and is at that point life threatening). So not to scare you, but to make you aware of the dynamics of the drug and what you need to watch for. I know I would question that dose with my vet, because I did question it when they wanted to start my dog at 19lbs on 30mg and an IMS that we went to see said no, not that high to start.

Can you tell us what tests where done to diagnose cushing and what the results were? Also any abnormal high/low blood or urine testing. So many things can mimic cushings disease and it is a very hard one to get an accurate diganosis of. Diabetes (glucose test), thyroid (T4 test), kidney issues or any other problem all need to be ruled out first. (to include UTI that needs to be diagnosed in a dog with dilute urine by culture).

Hope to hear back from you soon and I'm sure that many more will be by to welcome you too.

Sharlene and Molly Muffin

[Simba's Mom]

Hello and welcome, so glad to have you here with the rest of us cush moms and dads....you will get lots of questions answered and lots of encouragement too...settle in, we are here for you and your furbaby!

[Budsters Mom]

Hello and welcome from me too!:)

You have come to the right place! There is a huge arsenal of K9Cushing's angels standing by to help and stay with you every step of the way. They love details, test results, any information you can get your hands on. The more the better.

So again welcome to you and Tucker,

Kathy and Buddy:)

[goldengirl88]

Doreen:
I wanted to say hello and welcome you to the forum, where you will gain knowledge and get much support for Cushings problems. I am a bit concerned about a Lasha Apso being on 30 mg of Vetoryl twice daily. In my opinion with their size, unless your dog is extremely large I would not even start them on 30 mg once a day. Is your Vet experienced with Cushings? Most aren't you know.These are powerful drugs, and should be started on the lower end of the scale to minimize side effects. My dog is a little under 18 lbs. and she started on 10mg. I am convinced that is why she did so well. Her body had a chance to adapt to the drug. She is now on 30, had I started her there I feel would have been asking for trouble. Please check this out. Do you have prednisone in case she has too much Vetoryl, and do you know the signs? Lethargy, diarrehea, vomiting, not eating. I hope you have good luck with your baby. Blessings
Patti

[Boriss McCall]

Hi Welcome to the group.

[SoggyDoggy]

Hi Dorene and welcome to the group (though the reason for being here sucks :o)

If you feel like your vet "guessed" the dose, then the biggest advice I have for you now, is to ask for a referral to an Internal Medicine Specialist (IMS) and seek the expert advice right from the beginning! Trust me, the level of confidence you will feel in the treatment is so vastly superior it's just amazing.

Anyway, as Sharlene said earlier, please be very careful watching Tucker as the dose does seem particularly high. Lhasa's aren't typically big animals, so I would be concerned that the starting dose of 30mg 2x a day is going to be too much. My boy Fraser is a 20lb Maltese x Scottish terrier and was started on 60mg once a day. His cortisol dropped too low (picked up by a blood test before the signs got too bad) and was dropped to a dose of 10mg 2x daily by a specialist. His dose has just today now been dropped to 5mg 2x daily. Now remember, all dogs do react differently (Fraser is particularly sensitive to trilostane/vetoryl), but I would still be very concerned about that dose!

The best way folks here can help you out is if you are able to provide us with a bit of extra information. Could you get copies of the blood tests that your vet performed for the diagnosis of cushing's? If you are uncomfortable asking for them, I told my vet it was so I could keep all of Fraser's records together in case he had an after hours emergency and I had to seek help elsewhere. While this is all true, it is also a great idea for you to watch over your vet's shoulder. They are human and like the rest of us, prone to mistakes; particularly if they do not have a huge amount of experience with cushing's and the associated drugs.

Anyway, once you have the blood results, if you can post the results here (usually just the results that were flagged as unusual) with the reference ranges listed (as pathology labs differ in testing protocols and reference ranges) it will give everyone a better idea of how to help you out with any specific questions you may have. In addition, and very importantly, how much does Tucker weigh?

Anyway, this is just the beginning of the questions that will follow so bear with us, but again, the more information you can provide, the better the advice you could get.

In the meantime, I hope Tucker is going well, just please watch him closely.

[DoreneT]

Hi everyone,
Thank you so much for jumping in. Tucker weights a little over 30 lbs. so by what you are saying, 30 mg. 2 a day is too high. It's Sat. afternoon and he's had 4 doses so far. His stool is starting to become, (sorry) soft and more liquify, (if that's a word?). Being that it's Sat. I'm not sure what to do. Can you tell me about the "Internal Medicine Specialist" mentioned in one of the posts??? I am aware of the side effects to look for, but not sure if they occur within the first few days or as the dog is on the medication for a longer period of time. Do you think I should call the vet's answering service and question the seemingly double dose prescribed?
OMG

[DoreneT]

The diagnosis was made based on An ACHT test and then confirmed with a sonogram. I will ask for blood test results on Monday. Based on everyone's responses, I feel like dropping the dose to 1x per day until I speak with a specialist. Does that make sense?
xo

[Squirt's Mom]

Hi Dorene and welcome to you and Tucker! :)

Loose stool and diarrhea are one of the signs of an overdose - so if it were me, I would simply stop the Trilo until I could talk to the vet. It would be much easier on Tucker and you for him to be without it for a few days than to go into an Addison crisis because his cortisol is too low. We are a Lysodren house so I will let the Trilostane (Vetoryl) parents take it from here but I wanted to welcome you and let you know what you are seeing could mean he is in trouble and the med needs to be stopped for a bit. Did they give you any prednisone by any chance?

Hugs,
Leslie and the gang

[molly muffin]

If you have any concerns at all, then you can stop it completely. Talk to the vet on Monday and take it from there. If you feel that he is acting normal, other than some softness that is abnormal, you could do only the 30mg in the mornings only. It doesn't hurt anything to stop and then start at a lower dose once you know there is no crisis.

Also, I'd just keep the number to a 24 hour emergency vet hospital on hand, in case for any reason you need to take him in. (this is actually a good thing for all pet owners to have readily available) You could and I probably Would give the ER vet a call and see what they think too. (Do you have emergency dosage of prednison on hand? some vets give it and they should, but not all do)

An IMS, is an Internal Medicine Specialist, and you can usually find them at for instance, Emergency VET Hospitals, or Vet Clinics sometimes.

I don't know if your vet is unfamiliar with the Dechra protocols for this medicine or what. They did at one time suggest starting higher, this has been more than a few years ago though and as further studies have been conducted since it has been allowed in the U.S., those protocols have changed to the lower dose recommendations. Your vet or even you can call Dechra if needed even. They have an office in Kansas that I believe will respond usually to inquiries from owners who have started on vetoryl.

Now don't panic but do be aware.
Hang in there! Let us know how things are proceeding.

hugs,
Sharlene and Molly Muffin

[Harley PoMMom]

Hi Dorene and welcome to you and Tucker!

I agree with Leslie that since Tucker is displaying signs of being over dosed (diarrhea) the Vetoryl should be stopped. If this were me, I would have a talk with your vet and ask that Tucker's dosage be lowered to 30 mg. We do see less adverse side effects in dogs that start at the lower end of the dosage scale of 1mg per lb.

Here is an excerpt from an article about IMS':
A board certified veterinary internal medicine specialist is a licensed veterinarian who has obtained intensive, additional training in understanding how your pet's internal body systems function and in diagnosing and treating the many serious diseases that can affect the health of those systems. An internal medicine specialist has advanced training in the following disciplines:
•Endocrinology
•Cardiology
•Gastroenterology
•Hematology (study of the blood)
•Immunology
•Infectious Diseases
•Nephrology/Urology
•Neurology
•Respiratory Diseases
•Oncology
This article can be found here: http://www.vcaspecialtyvets.com/animal-specialty-group/departments-doctors/departments/internal-medicine

Please know we will help in any way we can so donot hesitate to ask any and all questions.

Love and hugs,
Lori

[SoggyDoggy]

Hi Dorene,

Just to add to Lori's post above, in case you aren't sure, Cushing's is an Endocrine disease, so an IMS has specialist training in this field and will know considerably more than the average local vet. It just means you get to deal with an expert who understands the big picture that is cushing's, and they will also have a thorough knowledge of the drugs that are used to treat it.

Now, one other thing that I haven't seen mentioned yet is the half life of Trilostane (vetoryl). The really good bit about this drug is that it is out of the dog's system in 8-12 hours. So if at any point you are worried about Tucker, you can stop the drug immediately and know that within 12 hours he should be fairly safe. (mind you, if he demonstrates signs of lethargy, vomiting etc, then seek help immediately, don't wait 12 hours). If I were you, I would either stop his dose for a couple of days until you get to speak to your vet, or at least drop his dose to just the morning 30mg only, again until you speak to your vet. Honestly, it is better to be safe than sorry, and as someone who has dealt with starting at the wrong end of the scale, it's a lot less stressful going slowly! Also, make sure you have some prednisone on hand, just in case. Again, not to panic you, but better to be safe than sorry. I guess because of what I went through starting so high with Fraser, and a vet that insisted it was right (despite repeated questioning by me that is - she screwed up big time!), I am just a bit paranoid myself now. He's my baby, and the thought of anything happening is just too devastating for words. So don't ever be afraid to speak up!

On that note, how well do you know your vet? Do you have a good relationship with them? I am asking as I am wondering how comfortable you would be asking them to be completely honest about how much they actually know about cushings and how many cases they have dealt with before? If you are at all worried that they don't know their way around the disease back to front, then I would probably just ask for that IMS referral and see the experts. Again, that is my experience and situation talking, but it was/is so much more reassuring to deal with someone who really does know what they are doing. It's much less scary and stressful on you too.

Anyway, I do hope we haven't managed to freak you out, that is not our intention at all. Just a heads up to be vigilant and please don't be afraid to ask questions when you have them. The good news is that you will become more comfortable dealing with this all as time goes on, but there is a pretty steep learning curve when you first start. If only our babies could talk hey? :o

[DoreneT]

Thank you, thank you, and thank you. I did call the vet last night and he felt strongly that it was too early for "toxicity" to occur and told us to keep Tucker on the 30 mg 2x as prescribed. We know this vet for a long time and he's a very nice man. Having said that, recently some friends have relayed some sad stories involved this vet. In any case, when we went to take Tucker out last night, he seemed a bit unsteady on his legs and John carried him down and then up our flight of steps. Uneventful night and then this morning, John took Tucker out, (yes, I'm a bit spoiled:)) and then fed him. UNCHARACTERISTICALLY, especially over the last few months, Tucker sniffed his food and walked away. He went back and ate a little and the rest is still there. By this time, we called the vet again and he agreed that Tucker should come off the vetoryl until at least Tues. and then we will re-evaluate. Now, the vet is saying that if Tucker doesn't return to his recent "normal," there is something else going on. Aghhh! We think that the vetoryl did what it's supposed to, just too much too fast. I've sent an email out seeking help from the "medical specialist" website.
If it wasn't for this forum and all of you, we may not have been as strong and persistent with the vet. My poor baby doesn't want to move today, and still hasn't eaten and has some diarrhea. Hopefully, this will improve as the day goes on.
xoxoxoxo

[frijole]

Hi from me too! I just read your last post and everything you posted is without a doubt a sign of low cortisol so stopping the drug is very important. Because your dog is having trouble walking and has diarrhea that is a sign of real real low cortisol. Do you have prednisone on hand? If so I would give Tucker a dose - it mimics cortisol and he'd have relief in a couple of hours.

If this keeps up you aren't waiting a few days you will take him to that vet or another vet (:D) and have an acth test done immediately to see how low the cortisol has gone. You will get a supply of prednisone to have on hand and start him on that. You also should have his electrolytes checked out. This is serious stuff and it is obvious the vet doesn't have experience or he'd know that these are all clear signs of drug overdose/too much trilo which has resulted in low cortisol.

The good news is this drug goes out of the system relatively quickly. It is still very serious though and if your dog continues to be lethargic to the point of not being able to walk or stand up you need to get him to a hospital asap for treatment and the acth test. If your vet won't do it find one that will because it can be life threatening.

Not trying to scare you but want you to know this is serious and knowing what to look out for is very important. If there is a specialist in your area fine but if not then just fine a vet that knows how to treat cushings.

Give Tucker a hug and keep the eyes on him. You are doing great. I know it's hard to fire a vet that you like. I had to do that. Kim

[Harley PoMMom]

Hypoadrenocorticism can develop at any dose of Vetoryl capsules and at any time.

Here's a handy link that has a ton of information about Trilostane/Vetoryl:Trilostane/Vetoryl Information and Resources (http://www.kcushings.com/forum/showthread.php?t=185)

I am so relieved to hear that you have stopped giving Tucker the Vetoryl and would not restart the Vetoryl until strong symptoms return and an ACTH stim test shows that his cortisol is at least above 9.1 ug/dl.

Love and hugs,
Lori

[Trixie]

Hi Dorene,
I am very new to all of this too so I am not a huge help with info but there is a great wealth of information here and many who can help you with their knowledge and advice.
My dog is on day 9 of Vetoryl/Trilostane. We started very low and very slow to avoid any nasty side effects. All dogs are different of course. My dogs weighs about 14 pounds and is on 6mg 2x a day. We have noticed no changes in the excessive drinking and eating so maybe after testing she will need an increase to control these symptoms.
I hope Tucker is feeling better...you can take your cues from him and if worried you can always withhold a dosage.
Barbara

[molly muffin]

Hello. I'm absolutely thrilled that you did not give any more vetoryl. The thing is that an over dose can cause Addison's as the others have mentioned, so one has to be very careful. It isn't that something else is going on it is that there was an overdose, which caused the cortisol to go the opposite direction and of course the symptoms will come back eventually usually and at that point, a much lower dose, appropriate to the dogs weight and sensitivity to the medicine would be started. That might not happen for a while though.
As the others mentioned, if it your baby continues to be lethargic, diarrhea, not eating, just go to the IMS immediately. Don't wait and maybe you would want to see an IMS anyway, as I'm not certain that your vet is overly familiar with either cushings or the medications used, which is really not a good thing. You want experience and knowledge.
Hang in there. You did great!!!
hugs,
Sharlene and Molly Muffin

[DoreneT]

Tucker ate his dinner last night, still a bit lethargic. Looking forward to contacting an IMS today-maybe that's optimistic? We're also going to try to get copies of his blood work today. Do we need blood work prior to the ACTH test?
Thank you:)
Dorene

[molly muffin]

Hi Dorene,
The reason you want to get copies of his previous blood work is so the IMS knows what was used to diagnois Tucker and can have a clear big picture. Plus you don't want to pay to have tests redone that were Just done. I keep a file of all of Molly's tests now, it just seems easier to have said to my regular vet that I want a copy for my own file and now they just give me one.
Good luck today. We'll be thinking of you!
hugs,
Sharlene and Molly Muffin

[SoggyDoggy]

Hey Doreen

Not at all optimistic to contact an IMS! Making contact is easy, you may just have to wait a little for an appointment is all :o

Anyway, glad to hear that Tucker ate his dinner last night and that your vet sounds like he may be willing to concede a point. Will be great if you get an IMS on board to work with you too though. It really is a whole other experience!

Good luck and keep us posted.

[Simba's Mom]

Sending hugs to you and Tucker!!

[molly muffin]

Good evening, checking in on you and Tucker. How is he doing today? Did you get to speak with an IMS?
What about copies of the test results?
I know, tons of questions. :) Worry warts here.

hugs,
Sharlene and Molly Muffin

[DoreneT]

Good Morning,
We're meeting with an IMS today at 4:30. Poor Tucker can't eat all day!
We asked his vet for copies of the blood work and tests yesterday, but didn't receive them. This IMS knows the vet and has requested copies of lab work, radiology report and sonogram results. I think it's a good idea to get copies on a regular basis in any case, thank you.
Tucker is so much better. HOWEVER, the vet had his office call yesterday to tell us to restart the vectoryl at the same dosage????
My husband, John, told them that we weren't comfortable with that. No other communication with the vet either way yesterday. Oh boy!!

[molly muffin]

Hi Dorene,

I don't like the sound of Tucker not eating. That too is a sign of too low of cortisol. Oh good gosh what on earth is your vet thinking. *sigh* Unfortunately we see this all too often, that vets, no matter how great they might be in other areas are just out of their depth when it comes to cushings and the medications. Unfortunately that isn't acceptable when the medicine is so strong and they need to know exactly what they are doing with it. When vetoryl first came out here in the US, vets seem to have all been told that it was safe and wouldn't harm pets because it leaves the system quicker than the other medications. Unfortunately that is not true and even Dechra (the maker) acknowledges that too much can cause an Addisons crisis (when the cortisol goes too low) and that can be deadly for pets. I don't know why vets don't keep up with the latest studies and protocols. Even Dechra has now changed the starting dosage in acknowledgement of the more recent studies. Luckily, here we have those who make it a point to read ever study that comes out and are up to date on what those studies show. Even all IMS are not created equal. When you are very lucky the vets are willing to work with you for the best outcome for your pets.
If the cortisol is too low, then rescue doses of prednisone are given to replace the cortisol Medication is never restarted until symptoms of cushings reappears and then you Never start at the same dose that caused problems but at a lower dose.
Tsk tsk. I'm not happy with your vet this morning. grrrrr
Hoping for a good appointment with the IMS.

Hang in there.
Hugs,
Sharlene and Molly Muffin

[SoggyDoggy]

Hey Dorene

Sharlene, I don't think it is so much that Tucker is not eating, rather that he is not allowed to eat. The IMS probably wants to see him after fasting in case they need to perform various tests.

Dorene, if the IMS has requested copies of the tests too, it is more than likely that your vet sent them straight to the IMS rather than you. I highly doubt the IMS will see you without having chased up test results if they haven't come through. Their time is valuable and they want a full picture. I am however very concerned that your vet said to resume the vetoryl on the same dose :eek::eek: WTH??? I'm glad your hubby said no to that! Good man! :p

See how your appointment with the IMS goes and if you get a great feeling from them, you may be able to transfer all cushings treatments direct to them without having to go back to your obviously clueless vet about it. That's what I've done. If it's vaccinations, toenails etc, then the regular vet can see him (though I still won't see the one who screwed up Fraser in the first place), otherwise the IMS is his only care provider for anything medical related now. Then again, I'm not sure how your med systems work over there and if you can do that. But it's worth the try if you like them. :D Be sure to go in with questions written down, most people have a full head of questions and then forget them in the stress of the visit. (Myself included).

But at this point, I want to wish you luck with the appointment, I hope it answers the questions you need addressed and that you get poor Tucker sorted out.

[Squirt's Mom]

WOOHOO! Way to go, Hubby! :cool::cool::cool:

[molly muffin]

Oh I see Naomi. I read that wrong. Tucker is fasting. :). Dish on my part :).

Hugs
Sharlene

[DoreneT]

OK, met with the IMS yesterday evening. He did receive the blood work from Tucker's regular vet, and had a phone conversation with him as well. I relayed Tucker's history before diagnosis, and what had occurred over the last week. He did agree that starting at a lower dose was the more recent trend, but feels that the higher dose was not totally out of line, based on the literature, etc. His thoughts are that it's possible Tucker may not tolerate Vetoryl. In which case, we would have to try lesodryl,(sure I have this misspelled:)) which is an even scarier proposition. He weighed T again and determined that 10mg 2x per day would not in any way cause toxicity, but would help us determine if T can tolerate this medication. The IMS does not feel this lower dosage will help Tucker's Cushing's Disease, but will help determine if he will tolerate vetoryl. If Tucker manages this low dose, he'll increase, but it sounded like maybe to 20 mg/ 2 x daily.
I now have a copy of Tucker's blood work also and can post that info in a later post. Do you want to see the numbers in "red?"
I so hope Tucker can pull through this, his stool started getting soft again this afternoon, but no other symptoms at this time.
Thank you for checking in.
xo

[Harley PoMMom]

I believe that the dose of 10 mg BID sound reasonable and I do hope that Tucker does well with the Vetoryl.

Did the IMS state when he wants Tucker to come back for a follow up ACTH stim test?

Regarding his blood work results; you need only post the values that are abnormal and they are usually marked high (H) or low (L).

Love and hugs,
Lori

[addy]

Hi, I have not yet had a chance to welcome you. I have a Lhasa too, we are not sure how old she is, she came from animal control but she could be 12-14 years old.


Does Tucker have any history of colitis? Doe he ever have a problem with loose stools prior to starting Trilostane? I ask because when I started Zoe, we had loose stools for almost a month and it was because she had a history of colitis, also eating things outside, she should not, like bunny poo, rotten crab apples,:rolleyes:

Zoe weighed about 18 pounds when we started. She started very low at 10 mgs and her cortisol dropped like a ton of bricks those first 10 days and I had my hands full.

Twice day dosing with Vetoryl can sometimes minimize side effects of the drug so I think 10 mgs twice a day, given Tucker is 30 pounds is a resonable restart. Soft stools can be a side effect of the drug.

Did the specialist perform any tests to measure Tucker's current cortisol levels? If not when will Tucker go back for the ACTH test?
Could you please remind us how long he was on the higher dose and how long he will be off the drug before restarting the new dose?

We want to see any abnormal numbers along with the normal reference range given for the tests.

Hang in there

[frijole]

Maybe I'm confused but I thought that Tucker was due for an acth test to make sure he didn't go too low so I'm surprised the IMS is starting him back on meds without doing an acth test. Can you confirm this is true? Anyone reading along go back and read the history. Thanks.

[Harley PoMMom]

Maybe I'm confused but I thought that Tucker was due for an acth test to make sure he didn't go too low so I'm surprised the IMS is starting him back on meds without doing an acth test. Can you confirm this is true? Anyone reading along go back and read the history. Thanks.

Kim, You are absolutely correct, Tucker should have an ACTH stim test done before any dose of Vetoryl is started. Great catch, Kim, as I didn't go back to the beginning of Tucker's Thread. :(

[addy]

Did the specialist perform any tests to measure Tucker's current cortisol levels? If not when will Tucker go back for the ACTH test?

It sounds like no ACTH test was done because the IMS did not believe he dropped too low but that is why I asked to confirm.
My error on the new dose though- I'll go back to fix it.

[DoreneT]

IMS did not do any additional testing, felt he had what he needed. Tucker was off vetoryl Sunday & Monday all day and took first 10 mg dose last night, (Tuesday). He said to call him in a week if all seemed to being going well. If we have concerns, we should call him sooner.
Tucker does have loose stool after taking Vectra and other unidentifiable times. We have transitioned carefully if and when we've changed his dog food. It doesn't last long.
Soo, is it possible that he'll have some stool issues, that will diminish over time if we stick with the vetoryl?
Kind of weird...but even though Tucker was off meds for 2 1/2 days, the Cushing's symptoms of over drinking and eating haven't returned and no accidents in the house??? Does that mean vetoryl stays in the system at some level for longer than 8-12 hours?

[Harley PoMMom]

Kind of weird...but even though Tucker was off meds for 2 1/2 days, the Cushing's symptoms of over drinking and eating haven't returned and no accidents in the house??? Does that mean vetoryl stays in the system at some level for longer than 8-12 hours?

Vetoryl actually has a short half-life with it's effects waning any time after 8 or so hours.

If Tucker's symptoms have normalized this could me that the Vetoryl has caused some necrosis of his adrenal gland/s and he should not be taking any Vetoryl, only an ACTH stim test can tell for sure.

[SoggyDoggy]

Hi Doreen,

It wouldn't mean that the Vetoryl is still in his system, rather that his cortisol level dropped low enough that the symptoms disappeared. It takes time for that cortisol level to rise again (providing no necrosis has occurred as Lori mentioned) in order to have the symptoms resume. That was the biggest concern, that they dropped that low so fast! To me, it seems strange that the IMS restarted Tucker without either the ACTH or at least waiting a little while longer to at least see the symptoms reappear. Be sure to watch him very carefully over the next few days at least (though I'm sure you will anyway) and make sure that he is eating and drinking ok at the very least. If he has a history of loose stools at times (my boy certainly does), it can be his system readjusting itself so the stools alone are not always a true indicator, but they are a good place to start.

Also, has your vet or IMS given you any prednisone to have on hand as an emergency? You have seen Tucker when he got lethargic and wouldn't eat. If it were me and I saw him get to the lethargic bit again, I would give the pred then contact the IMS immediately. Better to be safe than sorry is all. I do know when Fraser's levels dropped with the 60mg dose he was on, I waited 10 days before resuming treatment. He didn't show strong signs of the crash though (I think that was purely luck, another couple of days and he would have), his was instead caught with a routine ACTH test. During those 10 days I waited, it was long enough that his appetite and thirst increased again, so I felt fairly safe resuming at a much lower dose. The 10 days was no predetermined amount of time either. The directions was "when you see the signs". As Tucker's symptoms haven't returned, it means you are basically starting to suppress from a lower starting point, so you will need to be very vigilant. Alternatively, you could notify your IMS that you are withholding a little while longer, just to be safe?

Hope this helps you somewhat.....

[DoreneT]

Hi there,
I think the theory that cortisol levels dropped too fast too soon is what we thought might have happened. Tucker seems to be doing OK today, eating and drinking normally, stool back to normal. (I'm keeping my fingers crossed...) John spoke to IMS and he will test Acth when 1 week has passed, next Tues.
I haven't been able to decode the blood work????
The best I can make out is the day is Cort01 on 4/13 10ug/dL and then Cort06 on 4/13 24.1 ug/dL (1 hour later)
There are results in "red", which appear to the far right or left of a line graph.
Feeling encouraged today:)
xo

[molly muffin]

This was the results prior to starting Tucker on vetoryl correct?
If so that is your ACTH test and is in line with cushings. (always a chance of a false positive of course)
Anything that is abnormal you can post.
Just keep an eye on him and hopefully there was no damage to the adrenal gland.
Love the avatar of Tucker. How very handsome and inquisitive looking.

hugs,
Sharlene and Molly Muffin

[DoreneT]

Yes, the blood tests were b4 vetoryl. He's laying next to his water bowl again this morning:( That's what he did when we were metering out water to him. Now he has a full bowl. I'm looking forward to the weekend, so that I can keep my eye on him, 24/7. So far, he seems to be tolerating the low dose. We're about 1/2 week away from the next Acth test.
Enjoy your day! We think Tucker is rather handsome, too:)
xox

[addy]

Side effects generally involve an over suppression of the adrenal glands (hypoadrenocorticism, also known as Addison's Disease). Look for the following side effects that may indicate your dog is having a problem with Vetoryl Capsules or may have another medical problem:

Depression, lethargy or decrease in activity.
Change in bowel movements (such as diarrhea or loose stools).
Vomiting.
Stops eating or loses all interest in food.
As Vetoryl Capsules control the hyperadrenocorticism, there should be a decrease in food and water consumption to normal levels. There should also be resolution of excess urination. If, however, there is a dramatic decrease in appetite or the dog stops drinking water, it could be an indication of a side effect requiring treatment.

It is important to stop therapy and contact your veterinarian immediately if you think your dog has a medical problem or side effect from Vetoryl Capsule therapy. If you have additional questions about possible side effects, talk to your veterinarian.


IF Tucker stops drinking water this could be a side effect requiring treatment. See quote above from the Dechra insert.

((((((hugs))))))))))

[DoreneT]

So funny, Molly looks like Tucker a bit. We had a shih tzu, that more or less found us. Named him Hudson after the community we live in near the Hudson River. We lost him a few years ago.
xo
Tucker seems to be tolerating this dosage:)
xoxo

[molly muffin]

I was thinking the same thing, they do look similiar in some ways. Molly is shih tzu/llhaso, so she looks a bit like both but has the llhaso nose, that I think is so cute.
I'm glad Tucker is doing okay.

hugs,
Sharlene and Molly Muffin

[SoggyDoggy]

Hey Dorene,

Just checking in to see how Tucker is doing? Still ok on the dose? You must be about due for that ACTH now wouldn't you?

Let us know how it is all going.

[DoreneT]

Hi everyone,
I didn't drop off the face of the earth, but a lot going on right now. Here's the update:
On Sat. am, Tucker ate 1/2 his breakfast, we gave him his dose anyway I went to a "Pilates" class, (yes, omg) and when I returned he was at the top of the stairs, didn't get up, but had his head up. I noticed his head slightly shaking and thought he was "experiencing "a tremor. I enticed him to eat a cookie, petted him and didn't see anymore tremors. John hand fed him his food later in the afternoon and he ate his dinner completely. We gave him his evening dosage.
I called the IMS, and being Sat., no-one was around, left all the info and hoped the "on-call" IMS would call us. Someone called us around 8:30 and advised us to skip the morning dose and wait for the Sunday, Dr. to call us with possibly a change in dosage. (Turns out the Dr. who called us on Sun., I had met last Tues. when I brought Tucker to the IMS first time. It seemed she might be an intern or??? When she called on Sun. she repeated the mantra from my first visit, saying we had to find out if Tucker could tolerate the vetoryl or not, and that we should continue the current dosage. By the way, I asked both of these on-call Dr.s if we should have prednisone on hand. The Sat. person said, if need be, we should bring Tucker in and they would give him an injection. OK, that makes sense, but this facility is 30 min. away. Anyway, I got a little annoyed with the Sun. Dr. because she didn't even mention ACTH as a follow-up or doing it sooner than later. I said something about we won't know if this dosage is effective or not until we do another ACTH, and she then agreed we should come in Wed. or Thurs. I felt compelled to tell her that my good friend's beagle weighs 50 lbs. and has been successfully taking 30 mg of vetoryl/day for the last 4 months!!! I am a bit frustrated and suspicious that our original vet clouded the picture with these folks, possibly suggesting that we don't understand that the dosage he originally prescribed shouldn't have any adverse effects.
The good news....Tucker has been doing fine since, eating all his food am and pm since Sun. evening. He's not had any accidents in the house and his energy level has increased to the point where we are seeing our lively, happy pet back again. (I feel so bad that we didn't push the issue with our vet sooner, as we started noticing the symptoms at the end of the summer. MY poor Tucker:(!!) Our appointment for the ACTH stim is Thursday at 1:00. I have the chart from Dechra, with "post-ACTH" serum suggested actions. I am confused about how the cortisol level was reported at first, 10 ug/dL, then 1 hour later, 24.1ug/dL and the way the levels are listed on Dechra's chart with < and > signs and numbers below 10???????????
I am so sorry this is sooo long.
xoxoxo

[Harley PoMMom]

A complete ACTH stimulation test requires two blood draws; a pre and a post.

The pre number reflects the cortisol at "resting." The post number is after the (synthetic) ACTH is put into the dog's blood stream with the aim of getting the adrenal cortex to make and dump into the bloodstream as much cortisol as possible - this allows us to see what the maximum cortisol-producing capacity of the adrenals is.

If the vet uses Cortrosyn or Synacthen as the stimulating agent the post draw is done 1 hour after the stimulating agent was injected. If the vet used ACTHAR gel then the post draw is 2 hours after the ACTHAR was injected.

When a dog is being treated with Vetoryl/Trilostane the therapeutic ranges are between 1.5 ug/dl - 5.4 ug/dl, and as long as the clinical signs are controlled the post can be as high as 9.1 ug/dl.

Hope this helps. If you have any questions please ask.

Love and hugs, Lori

[DoreneT]

Thank you, will let you know his levels and change of dosage or not tomorrow! I've got my fingers crossed:)
xo

[molly muffin]

We'll be thinking of you and Tucker tomorrow! I'm sure the appointment will go fine, sometimes we just have to educate our babies doctors :) (I am positive they do Not look at it that way, but I rather like that analogy) hahahaha
Glad Tucker is okay and maybe it was just that one episode, have you seen him doing it before?

hugs,
Sharlene and Molly Muffin

[Fellasmom]

Hi
Fairly new to this site as well but wanted to welcome you and Tucker.Our fingers are crossed and our babies paws are crossed that Tucker gets good news!:)
Love and hugs to Tucker
Patty

[DoreneT]

I agree with the education process:) We know our "children!" No, I never noticed tremors before. My thoughts...he needs to eat enough food to balance the meds.
More later.
xo

[DoreneT]

Thank you Patty! Stay tuned:)
xo

[DoreneT]

No news today, they'll let us know the results of the blood tests tomorrow.

[molly muffin]

Arrggghhh waiting is not my strong suit. :) Hope you hear something soon. I'm waiting on a UTI result and will call tomorrow if I don't hear anything from them. Guess we can hang out together. :)
hugs,
Sharlene and Molly Muffin

[DoreneT]

Ok, so here it is.....
Cortisol sample 1 - 2.9 -
Cortisol sample 2 - 6.5 "low"

We're going to stay on the current dose of vetoryl 10mg, 2x daily
YAY!!!
According to the IMS's report "Post-trilostane Pre & Post cortisol levels between 1.5-9.1 ug/dl indicate optimal control" AND that coincides with the information you have provided
Thank you again and again!
Hope you get favorable results on the UTI, Sharlene! Let me know:)

[SoggyDoggy]

WOOT! I's coming down! Now the big question, have the symptoms resolved as well?

Good choice to stay on that dose, the cortisol can continue to drop as time goes on anyway so better safe than sorry. :D:D

[molly muffin]

That is wonderful Dorene! So glad to hear this.

I haven't heard anything from the vet, but I'm guess the way Molly was running around the house and being the little minx tonight that the answer is no. I don't think any dog that felt bad and had an infection could have pulled some of those maneuvers.
So, it's a happy Friday. :)

The dose sounds like it is working and he isn't too low, so that is good. How Are those symptoms doing?

hugs,
Sharlene and Molly Muffin

[DoreneT]

My latest dilemma...Tucker stills seems a bit lethargic at times, needs some persuading to get up if he's been laying down. However, John has been able to get him to go on much lengthier walks than a month ago.
Also, occassionally, he walks away from his food bowl, leaving some behind. Yesterday morning, I put the food left in his bowl in front of him and he ate it right up?? Those symptoms of eating and drinking as if he's been deprived have disappeared as well. Since the first dose of vetoryl, he has NOT had 1 accident in the house:)
SOO..now is the remaining lethargy a result of the Cushing's or the vetoryl. Does that mean we should consider increasing the dosage?
I'm feel like I should encourage Tucker to eat all his food, because I'm afraid he'll get shaky due to the meds.
What do you think?????
We can wait to see how his levels are after 30 days too???
Glad to hear Molly's running around!!!

[Harley PoMMom]

The lethargy could be due to "cortisol withdrawal" so if this were me, I would not increase his dose. Even though his most recent ACTH stim results were great ( pre = 2.9ug/dl - post = 6.5ug/dl) his cortisol could of dropped further. You could skip a dose and see if he perks up, if he does, then maybe a decrease of his current dose of Vetoryl is needed.

[frijole]

I agree with Lori - most likely cortisol has dropped and making Tucker lethargic. She's right - skip a dose and see if it goes away. Most likely it will and the hunger will return. Kim

[Squirt's Mom]

Cortisol sample 2 - 6.5 "low"

I'm not sure what this means. Do you have the reference range and little letters that followed those numbers? Would you mind editing the results to include the range and little letters?

If this is in ug/dl with the usual ranges we see, this is not low. A pup on Vetoryl CAN go as high as 9.1ug/dl if and ONLY if all signs are controlled. Optimal post results are between 1.45 and 5.1 ug/dl. ;) UNLESS they have changed things again.

[DoreneT]

Yes, the letters ug/dl follow the numbers...
Recent ACTH results: Time 1 2.9 (Range 1.0-5.0 ug/dl)
Time 2 6.5 (Range 8-17 ug/dl) The word "LOW" is listed after the 6.5.
Their note: "Post-Trilostane-Pre & post cortisol levels between 1.5-9.1 ug/dL indicate optimal control." (This is listed with other definitions such as "Post-Lysondren...)
I hope this is clearer. Thank you.

[molly muffin]

In this case, they should not have written LOW because Tucker is being treated with vetoryl, so for him. 6.5 is fine as it should be between 1.55 - 9.1 POST, if symptoms are controlled. If not controlled then you would want to be around 5. Post. I don't think I'd look to up the dose, as walking away from food and not eating, lethargy can be signs of cortisol continuing to drop. At this point, you are going to want to maintain the same dose unless you see signs like diarrhea, vomiting, etc, that would suggest he has gone too low.

Hope that is helps.
hugs,
Sharlene and Molly Muffin

[Squirt's Mom]

Thanks for the rest of the info on the ACTH! :)

I realize this is confusing but there are three normal ranges used with the ACTH. The one listed on the results, 8-17 ug/dl, are only for non-cush pups or cush pups that are not on any treatment yet. Once treatment has begun, this range no longer applies.

For a pup on Vetoryl (Trilostane) the normal range is 1.45 - 5.1ug/dl but can go as high as 9.1ug/dl only IF ALL SIGNS ARE CONTROLLED.

For a pup on Lysodren the normal range is 1-5 ug/dl.

Since labs don't keep up with which drug each pup is using nor do they even know treatment has begun, they use the standard normal range for a non-cush / untreated pup of 8-17ug/dl and expect the vets to know what the correct range to use is based on which drug the pup is on. Yet one more reason for us parents to educate ourselves because not all vets know there are differing ranges. ;)

[DoreneT]

You are the best, quizzed the IMS some more, "poor guy," and he then explained those ranges for "non Cush" pups. They probably should find a way to remove them from their results form as it's quite misleading. Anyway, the IMS believes that Tucker's difficulties getting up have to do with arthritic or joint pain that was masked by his higher cortisol production pre-vetoryl. (Plausible, as once T gets up, hard to watch right now, he seems to 'warm-up" and move with some ease.) For this, he's going to order an anti-inflammatory. The decrease in appetite is a hard call and we have agreed to keep T on the 10mg 2x daily dose. So far, we have skipped a dose when we see his disinterest in eating a good part of his food. IMS wants us to leave the dosages in place and allow Tucker to eat less if that's what he does. It may lead to our original concern that he can't tolerate vetoryl, but he wants to find out. I guess I've been intercepting to try to save my baby from discomfort. This will be tough to watch for sure! But, if Tucker starts to have diarrhea or vomiting, we'll raise the red flag. I hope it doesn't go there...
Hope all is well with all of you and thank you. xoxoxoxo

[molly muffin]

We see this a lot when the cortisol comes down that problems like arthritis rear their ugly head. Cortisol is self medicating when it comes to joint problems and often we don't realize they have it till the cortisol levels drop.
I know that Molly has issues with at least one leg and always has as the joint grove is not well defined in her, but we do what we can to help them. Just keep an eye out. Hopefully he'll tolerate vetoryl fine.

hugs,
Sharlene and Molly Muffin

[DoreneT]

Hi everyone,
We've visited a new vet, who comes highly recommended by a dear friend. This Dr.'s office practices holistic treatment as well as traditional medicine. We've kept the dosage of Vetoryl the same, added an herb, Rehmannia, to his food and now added Metacam once a day for back and joint issues. As of last night, we added 2 tsps. of pumpkin pie filling to aid in a bit of constipation. This is the 4th straight day of vetoryl, without missing a dose and Tucker seems to be OK. Hopefully, he'll continue on this path:) We have to give him his Heart Worm meds and Interceptor tomorrow. Seems like a lot of medication!!

[Harley PoMMom]

Just a word of caution regarding the pumpkin; it should be the plain pumpkin, not the filling with spices in it.

Sending loving hugs to you and Tucker, Lori

[doxiesrock912]

Look in the baking aisle. That's where I find the all natural, plain pumpkin when we need it.

[DoreneT]

oops, not being much of a pie baker, I did't even think of checking the ingredients. Thank you:)
:o

[Squirt's Mom]

Another word of caution - Metacam is a NSAID which are very hard on livers. A cush pup's liver is already under stress so NSAIDs are generally not good for them. I used Metacam with Squirt recently for her arthritis and it helped her pain level a great deal - but it also made her liver enzymes shoot WAY up. Our vet has said no more for her period - but she does have other issues and is older than Tucker (15 this Feb).

[DoreneT]

Thanks for the heads up. I'll definitely mention that concern to them. Poor Squirt...I know there are also "joint bones" or chews available. The vet offered them to us, but I wanted to wait until we tried the Metacam and Rehmannia herb, before introducing anything else. Tucker's loving the pumpkin pie filling:)
xo

[Squirt's Mom]

Nutmeg - Nutmeg is an aromatic spice that’s used a lot around the holidays. Nutmeg can be found in sweet potato and yam recipes and, of course, in pumpkin pie! It has mild hallucinogenic properties that when ingested by your dog can cause seizures, tremors and central nervous system problems. In severe cases, shock and death have been reported.

Please do not feed any more of the pie filling! PLAIN pumpkin only for our babies. ;)

[molly muffin]

Hi Dorene, checking in to see how you and Tucker are doing! Hope all is going well. Did the pumpkin help? Is everything calmed down now?

hugs,
Sharlene and Molly Muffin

[DoreneT]

Things have calmed down. Tucker has more energy and has been more playful over the last week or so. His next ACTH test is on Wed. We're hoping for good results! I will be surprised if they suggest raising the vetoryl dose as the symptoms seem to have disappeared. No accidents since the first dose of vetoryl, eating and drinking reasonably. If anything, we wish he would drink more water as sometimes he's panting, but doesn't go for water. We'll ask the vet on Wed. Also, stool seems a bit hard first time of the day.
Maybe, there's another high fiber, all natural solution other than pumpkin??? He does love the pumpkin and he takes all the meds in his food because the pumpkin is mixed in.
He still doesn't often want to go for a long walk, so for now we follow his lead.
I hope all is well with all of you
xoxo

[molly muffin]

oh good to hear that Tucker is doing well. Pumpkin can work both ways, maybe try cutting it back a bit from the amount that you give him.
Having controlled symptoms is the most important part. As long as that is good, the numbers will probably be fine. Plus they can continue to fall so as long as he is good at this dose, I'd probably stay there.
I have issues with Molly drinking enough water too. She has never been an over drinker, and sometimes doesn't drink enough. *sigh* I don't want the cushings water drinking, but I want her to drink enough to keep the crystals under control.

hugs,
Sharlene and Molly Muffin

[doxiesrock912]

Dorene,

I use no more than a teaspoon of pumpkin with each meal when Daisy needs it, and I discontinue once there has been a day or two of normal stools because it can also cause constipation.

[DoreneT]

soo, we dropped the pumpkin to 1st per meal (2x/daily) and added 1tbsp of water!
Latest ACTH results: Cortisol Sample 1 1.4 ug/dL
Cortisol Sample 2 5.0 ug/dL

The vet reduced the dosage to 20 mg one day (10mg am and 10 mg pm) and 10 mg the next day. He felt his levels were a bit low. We'll retest in 3-4 weeks. Of course, we'll watch for Cushing's symptoms - I so hope he'll be symptom free on the lower dosage.

Other results: Alk Phoshatase 140 U/L (Ref. Range 5-131)
Calcium 11.5 mg/dL Ref. Range 8.9-11.4)

(noted as "high")
xo
Dorene and Tucker:p

[molly muffin]

Tucker's post number is 5.0 which is right where you'd like him to be and to stay. :) In cushings the most important number is the post number. You don't want him to go up, symptoms could return.

so, are the poops all good now with that pumpkin dosage.

I everything is going well with you and the family and Tucker.

hugs,
Sharlene and Molly Muffin

[DoreneT]

Hi everyone,
I'm back with a few questions…
Tucker's cushiness disease seems to be under control taking 10mg of Vetoryl 1x/one day and 2x/the next day. He's taking Metacam 30ml in the morning and Tramadol-50mg 1tablet at night. We added milk thistle to support his liver as there was concern. (I remember mention on some of our discussions that the metacam may affect his liver function.) Recently we've had to add Thyro-tabs, .4mg.
Tucker just had his ACTH test and his cortisol sample 2 level was 4.0.
His T4, post level was .6 (noted as low.) The vet wants to increase his Thryro-tabs to 12mg/daily and then to 24 mg/daily over a short time??? (After 2-3 weeks on the initial dose, he lost 5 lbs-GOOD NEWS!
I'm not sure which levels indicate liver function…
His hemoglobin was 10.7 (noted as low) and hematocrit - 33 (noted as low)
Additionally, ALT (SCPT) 139 (noted as high)
and Alk phosphatase - 452 (noted as high)
Any insights, as we are nervous about giving him all this medication!
Thank you,
Dorene
PS I hope all is well with you and your pets

[addy]

Hi,

I'm just curious was the acth test given after a previous day of 1x Vetoryl or 2x Vetoryl?


My Lhasa weighed about 17 pounds. I could only giver her 1/4 to 1/2 of a 50 mg tablet at a time, or it totally knocked her out. They would usually prescribe 1/4 to 1/2 table every 8 to 12 hours for her and tell me to watch for sedation.

The metacam as you know, is hard on their liver. I never used it.

I am sure others will be along to chime in.

[lulusmom]

Can you please post the normal reference ranges for the values you posted? Low hemoglobin and hematocrit are indicative of anemia. Did your vet discuss this with you?

[DoreneT]

Hi addy,
The ACTH was administered after a 1x vetoryl day. Are you talking about the partial Thyro-tabs?? Did you use something other than Metacam? I'm concerned that between he vetoryl and metacam, Tucker will suffer other organ damage-not sure how to avoid, except to give him supplements to support his liver and iron now for his anemia.
Hi lulusmom:
the normal ranges:
ALT 12-118 Tucker's recent 139
Alk Phosphatase 5-131, Tucker's recent 452
Hemoglobin 12.1-20.3, Tucker's recent 10.7
Hematocrit 36-60, Tucker's recent 33
T4 0.8-3.5, Tucker's recent <0.5
Thank you!

[molly muffin]

The ALT and the ALKP are both liver enzymes, and really Tuckers doesn't look that bad. Sure they are high but we quite often see much higher. The ALKP in general the vets don't worry so much about as it isn't indicative of liver damage if I understand it correctly and his ALT isn't that much out of range.

I'll let someone else who has used pain medication answer about the Metacam. I've always read that it's hard on the liver and if the cortisol is high you don't want to use it (uncontrolled cushings), but Tucker does seem to be controlled.

Good to see you again and great to hear that Tucker seems to be doing pretty well.

hugs
Sharlene and molly muffin

[addy]

Hi,

Thank you for responding to my question. I guess my concern would be if he is post 4ug/dl after a once day dosing, where is Tucker's cortisol after a twice day dosing? But I nitpick so perhaps it is not an issue unless that post goes lower or you seem behavior indicative of cortisol going too low, which does not seem the case now.

Regarding metacam- our vets told us if my pup's cortisol was not controlled not to use it because if they start having problems with the drug it is hard to tell is it their cortisol or the metacam. That was their opinion.

[DoreneT]

Thanks everyone, nice to chat with you again:) Glad to hear your opinions' are that he's really doing better than we thought.
Hope all your pets are well!
xo