First 4 weeks of treatment with vetoryl - Addison's episode

[Dax]

Dax, my 10 year old boxer, started treatment a month ago for cushings and is doing great! After only one week we saw improvements in all of his symptoms and he gets better every day! Much fewer accidents, almost no panting and has more energy. He went for his check up today and levels are getting back to normal. I just wanted to share, as I haven't posted before but I've read many threads on the forum and this group helped me feel more comfortable with my decision and feel prepared for what may come with the treatment choice. Thank you for all your participation and best of luck to all the babies struggling with the same problem. If positive results continue this medicine could prove to be a true lifesaver. God bless.

[Trixie]

Congratulations on successful treatment! Sounds like things are going great for Dax. We are starting to finally see some real improvement too with Vetoryl but it's taken about 4 months to get to the right dosage.
Hope Dax continues to do so well!

Barbara

[Roxee's Dad]

Welcome to you and Dax,

Glad Dax is doing so well :) Please feel free to share Dax's story with us if your up to it :)

[goldengirl88]

Welcome to you and Dax. Great news that he is responding well to treatment. Just be diligent in watching him. Do you have prednisone if you need it? If you keep a daily doggie diary it will help you, as you will refer to it over and over. Are you using Vetoryl? If so call Dechra the manufacturer and get a file established with your dog. They have vets on staff there to help you and your vet. The number is 866-933-2472. Watching your dogs for any signs is the most important thing. If you watch carefully your dog should do fine. Blessings
Patti

[Dax]

Thanks y'all, I didn't see any replies. I will need to check my settings. Sorry for the delayed response and thanks so much for the support.

I'm extremely worried right now. I had to bring Dax to the vet today. He was doing so well until Saturday. He became very lethargic, loss of appetite and weak. His back legs actually gave out while we we walking and he fell. I stopped the med and brought him this morning. Forgive me I don't have my doctors notes written down so I will sound non specific at this time. But long story short they are keeping him, he's dehydrated, his levels are to low. It seems the dose has now gotten him to where he doesn't have enough of the steroids he needs. The are giving him fluids, he's off med for now for cushings. They are giving him some steroid shots. We have to get his strength back to then determine next steps. I can't remember the exact word the doctor used, Adonic maybe? When I have more information tomorrow I will update with specifics so maybe you can offer some feedback if you've heard of this.

I'm so grateful that I've been paying close attention, in all honesty all though his recent symptoms may sound dramatic they really were so subtle, I have been doing what is recommended which is keeping a very close eye. They did a full scan on him today, not just the stem test and many levels were off. The vet said with most lab work like his dogs are in kidney failure. Thank God he was not and we got there in time.

Sorry to be so long winded, I'm a little overwhelmed because he was doing so great I didn't expect this.

I will keep y'all posted, thanks for listening. Bless your babies and say Lil prayer for Dax, he's my best friend :)

[Harley PoMMom]

I am so sorry that Dax is not feeling well, it seems that he has had an Addison's crisis, this is when cortisol goes too low and/or the electrolytes become unbalanced. With this condition Dax is exactly where he needs to be and it sounds like he is getting the help that is required, do keep us updated, ok?

Could you get copies of his recent ACTH stim results and post them for us? Thanks!

Hoping Dax is feeling much better soon, sending you both hugs, Lori

[Dax]

Thank you Lori, I think you are right. I will post his test results tomorrow.

I'm going to go read about Addison's now, I couldn't remember for the life of me what the vet said it was, I was writing it down and left that paperwork at the office. She said so many things and all I could do was worry, I was fearful I wouldn't recall it all. (And I was right unfortunately), I knew this forum could help! It was Addison's, are you familiar with this?

thanks again, Tara

[Harley PoMMom]

I have no personal experience with Addison's but have seen cases on the forum.

An Addison's crisis can be life threatening if left untreated but it seems that you have caught Dax's crisis early and I really believe that Dax will have a full recovery. Now, he might need the medications for Addison's for his entire life, one just never knows, only an ACTH stim test will be able to tell us.

Sending love and hugs, Lori

[Dax]

Thank you :) I hope so, I'm grateful he's in good hands.

Ill send an update tomorrow.
Tara

[Harley PoMMom]

Will be looking for your update tomorrow ;) Keeping you both in my thoughts and prayers too, hugs, Lori

[Trixie]

Hi Tara,
So sorry to hear what happened with Dax. Glad he is at the vet recovering. Good thing you were attuned to the change in him and the symptoms of dropping too low. I'm curious as to what the strength of his Vetoryl dose was, and how much he weighs if you wouldn't mind posting it?
Will be watching for your update and hoping Dax makes a full recovery.

Barbara

[Simba's Mom]

Welcome Tara and Dax, cool name...this cushings is so up and down, your happy one minute and sad the next, its quite overwhelming, so glad you found us...be careful if the put Dax on predisone, it can really make them bloat, my Sim had too much I think, hang in there....

[doxiesrock912]

Tara,
awwww...Dax was doing so well. Getting the dosage right is tricky even though the tests indicate one dosage; sometimes it's too high for the dog to tolerate. We went through this with Daisy and I'm glad that you know what to watch for.

Dax is in good hands. Crossing my fingers!

[spdd]

Hi & welcome to the forum. I know what it's like to be up and down with a dog on Vetoryl. My dog too was doing well after tweaking the dose for a couple of weeks then in my case the symptoms returned. He also (crashed) as they call it like your dog. At this point I have taken him off all meds for now, and persuing other possibilities that have caused cushings symptoms.
Glad you got him into the vet, and looked after.
Good luck and let us know how Dax makes out.

[labblab]

I hope it's OK, but I've edited your thread title to include this info about Dax's Addisonian episode. We do have some other members who are also treating Addison's in their dogs, and I hope this will make it easier for them to "spot" you guys so as to offer their support and suggestions.

Marianne

[goldengirl88]

I am so glad you posted what happened with Dax. It will truly be helpful to the rest of us, should our baby get in that situation. I hope Dax is doing better and improving every day. Blessings
Patti

[Squirt's Mom]

Let us know how sweet Dax is doing when you can!
Hugs,
Leslie and the gang

[molly muffin]

oh my gosh, I don't know how I missed your thread. Welcome to the forum.

I'm so glad that you were aware of the what the possibilities were when Dax crashed and got him to the vet. The thing to remember is that cortisol can continue to drop, even being on vetroyl for 30 days or so. Then it can level out and perhaps a year or 3 years down the road, it can require a dosage adjustment again.

Every dog reacts differently so it's just something to keep in mind. Most likely they will stabalize his electrolytes and then send him home. You won't want to restart any cushings meds until symptoms come back and then you'd start at a lower dosage than what you were on before, as obviously this was too much.

I just know that Dax is going to be A-okay because you are on top of this and knowledge is always your greatest asset when dealing with any illness.

So, great big deep breaths and I hope the next thing we see is a wonderful update from you on how well Dax is recovering. :)

Hang in there,
Sharlene and Molly Muffin

[Dax]

Hello, I apologize for the delay. I haven't been able to post all week. I picked up Dax yesterday. He was on fluids til Thursday.

Here's his test results from Monday. USG:1.040. ACTH stimulation test (IDEXX) reveled a per ACTH .o7ug/dL and post ACTH 0.7 ug/dL. Chemistry revealed a BUN 37 mg/dL, creatinine 2.1mg/dL, potassium 6.0 mEq/L, Sodium 139 mEq/L, CBC revealed HCT 57.6%. On 8/20 BUN 24mg/dL, creating 1.0 mg/dL.

While in hospital he was on Iv fluids- Normosol r180 Mls/hr and received 1 mg dexamethasone 12 hours apart twice.

Oral meds prednisolone 20mg day, omeprazole 20mg day. dOCP 4mls (100 mg) IM.

His diagnosis Iatrongenic Addison's disease.

I am to keep a close eye on him and call if signs of Cushing's comes back otherwise bring him back sept 10.

Since he's been home he seems better, but not himself. He seems very unsettled, woke up panting this morning and is starving. He's eaten 3 times and acts as if he could eat more. His eyes even seem different. I left a message for the vet to call me. Maybe it's all the steroids?

Thanks again for your caring and feedback.

Dax's mom. Tara

[Dax]

Trixie, Thank you he was on 90miligrams and just changed to 85 the day he had negative side effects. He weighs 103.5

[Squirt's Mom]

Hi Tara,

I'm glad Dax is back home! And I'm sure he is as well. The signs you are seeing could well be from the steroids he is getting but I'm glad you have a call into the vet just the same. They did send you home with pred?

Let us know what the vet says and hang in there! You're doing a good job, Mom!
Hugs,
Leslie and the gang

[Dax]

Thank you :) yes, he's on 20 mg of prednisone 1/2 tablet twice a day. I'm just so worried about my little buddy I appreciate everyone's support very much.

[Dax]

Doc said its probably the prednisone, if persists to reduce his dose tomorrow. He's been a little better today, thanks!

[Squirt's Mom]

Glad it's nothing more major to worry about than meds. I hope he continues to improve as each hour passes and is soon off the pred altogether!

[Simba's Mom]

Sending hugs and prayers for you and Dax!!

[Junior's Mom]

I am glad Dax is better now. What dose did you start with? Did it ever change? What were the results of his acth tests after you started dosing? I'm curious as I recently started my dog, and he has been doing great as well, but I am about to up the dose because his numbers aren't low enough yet. Info from you would be greatly appreciated. Thanks.
Tracey

[Dax]

Hi Tracey,
These were his results just a week before he had the Addison episode and she reduced him to 85 mg from 90mg because he wasn't as low as she'd like ( the vet) ACTH STIM results Pre ACTH 0.7ug/dL , Post ACTH 2.0 ug/dL.

That was on the 13th and he started having the symptoms I previously posted on the 18th. It was subtle but fast. The vet said it was a good thing I brought him when I did. I didn't realize how quickly and dramatically he could drop.

Just keep a close eye, what made me notice was he slept very hard, was weak, and wasn't eating, not even treats. And wasn't really drinking water. He's pretty lazy anyway but something made me notice he was just sleeping harder. My recommendation is if anything is off in your baby's behavior call the vet. Dax was doing so good I thought I was just being paranoid but I called anyway, thank God.

I am sure your baby is going to do well, it's true that its a roller coaster but can be controlled, we just have to pay close attention.

[Dax]

Thanks Lettie and Squirt's mom! :D

[Junior's Mom]

If I saw results like that, I would be stopping the meds immediately. What did your vet think would be accomplished by dropping such a small amount. I know others will chime in here, but I have to ask if your vet knows what they are doing? I'm sorry if this sounds harsh. I know the post number falls within Dechra's recommendations but that pre number is really low.

Sorry, I meant to say thank you for sharing with me as well.

[Dax]

I appreciate you candor. I am not familiar with what the results should be so I am not sure. Sounds like I should've known based on the results from the 13th? What are ideal levels?

I've been pleased with his care, You post does cause concern. But they seem like they know. This isn't the first time I've gone to them. I haven't blamed the vet, i am not well versed in this condition. He's going to a specialist not a regular general practice vet. I am depending on the fact that they know what they are doing but trying to educate myself along the way.

I am taking all advice :) and am keeping an open mind. And staying in prayer of course.

[Junior's Mom]

Dechra-the manufacturer of vetoryl says " A positive response to therapy is regarded as an improvement in clinical signs and a post-ACTH serum cortisol concentration of between 1.45 u/dL and 9.1 u/dL (40-250 nmol/L).
They also say that it is important that there be some stimulation from the pre to the post sample. Cortisol levels of <20 (pre) and <20 (post) are not acceptable. I don't know how to change these numbers to nmol/L.
Stim tests should be done at 10 days, 4 weeks, 12 weeks and then every 3 months post treatment. This pattern is repeated every time there is a dosage change.
The stim test is done 4-6 hours after the dog has been dosed and the dose must be given with food.

Was Dax's first acth after a month on Vetoryl?

[Junior's Mom]

I know there is a spot on this forum that explains medicating with vetoryl in great detail. I believe you can find it on the main page of the forum.
You are doing great staying on top of things and watching so closely.

[Squirt's Mom]

Some links from the Helpful Resource section on Vetoryl (Trilostane) -

http://www.dechra-us.com/files//dechraUSA/downloads/Client%20Literature/47902_VETORYL_10mg_Treatment_and_Monitoring_Brochu re_Update_3_2_ps.pdf

http://www.dechra-us.com/files//dechraUSA/downloads/Client%20Literature/48685_VETORYL_10mg_PatientBro_COVER_FLDOUT_2_0_dis .pdf

http://www.dechra-us.com/files//dechraUSA/downloads/Client%20Literature/38965_Technical_Brochure.pdf

These and more can be found at -

http://www.k9cushings.com/forum/showthread.php?t=185

The pre number for Trilo (Vetoryl) pups does matter but I will let those who understand Trilo better explain it to you. I know if the pre is less than 1.45ug/dl, that is cause for concern. I know the post of 9.1ug/dl is acceptable ONLY if all signs are controlled. IF all signs are not controlled, they want that post number closer to 5.1ug/dl.

How is Dax this morning? You did a great job of watching him and recognizing when something was off then took the appropriate action. You done GOOD, Mom!
Hugs,
Leslie and the gang

[Dax]

Good morning, thanks so much for the information. Dax had a rough night. He woke up again panting and is having accidents inside (several) of both kinds. Inspite of going outside. The vet told me to take down his prednisone dose to 5 mg and see how he does if he needs the second nightly dose. Does this sound right to you? These symptoms seem very much like cushings.

I am going to read all the info you provided. Thanks again. :confused:

[Dax]

Dax had very bad diarrhea all day today, panying heavily and urine was also clear and was pping constantly. He's back at the vet :( more to come.

[molly muffin]

Oh poor Dax. Poor you! Hope all is going to be well. I wonder if the electrolytes are not adjusted yet.
We'll be on pins and needles waiting to hear from you.

Sharlene and Molly Muffin

[frijole]

20 mgs of prednisone is a hefty dose... how much does your dog weigh? so you took it down to 15? just so you know you can't go down too fast as it'll whack out the metabolism

Yes it is cushings like symptoms you are seeing because that is what prednisone is designed to do. When a dog's cortisol goes too low on the drugs you have to supplement it because they DIE without enough cortisol. It's a balancing act. You don't want too much or too much prednisone because you end up with sick dog either way.

Please answer question re weight. Thanks

Kim

[frijole]

Here's the math done for a 56 lb dog ... only 6 mgs of prednisone. Please confirm weight and dose. I am very worried. Kim


For future reference the standard rescue dose of pred is 0.25mg/kg. For this dog, you would divide 56 lbs by 2.2 = 25.45 kg.

25.45 * .25 = 6.36 mg of pred.

[frijole]

I read your entire thread and see your dog weighs 103.5 lbs. Using the standard rescue dose (emergencies like yours) the dose should be 11.8 or nearly 1/2 of where you started. No doubt in my mind that is why your dog is panting, peeing, and sick.

I read you are seeing a specialist. Have you gone to them a long time? Are they the ones that did the dosing on the vetoryl as well? Gotta say I am a bit concerned about them from what I've read.

I know this is new to you but frankly that is the only reason this site exists - we've been here for decades helping people get up to speed when either they don't listen to the instructions or their vets are not up to speed.

There are all sorts of links provided with info on the drug and how it works as well as Addisons. Perhaps you've read them but please take the time - you are your dog's voice and we'll help you speak so long as you give us all the info you can.

I hope that the reduction has helped a bit. I wouldn't want to stay on 15 mgs very long to be honest. It is a steroid and addictive so the longer you are on it without decreasing the longer it will take to get off of it. That said - I'm not sure how low your dog went. Several days in ER sounds like it was pretty serious. It may end up that your dog is permanently Addisonian and will require prednisone forever. Time will tell - and more acth tests.

Hang in there, Kim

[Squirt's Mom]

Please let us know how Dax is doing. Be sure they check his cortisol level and especially the electrolytes. I hope he is much better soon and back home where he belongs.

Hugs,
Leslie and the gang

[Dax]

Thanks y'all so much. He's still at the Vet. I called this am. They were waiting on blood test results and Coristol test. He is still drinking a tremendous amount of water and there's blood in his stool now. They were also going to do an ultrasound to make sure it's nothing new. I have read the information everyone has posted, thanks so much. I am also going to put a call in to the manf. and get a patient id as well. Great advice.

On the persidone, he came home on Friday and wasn't due another dose until Saturday. At that time he had 10mg in the morning and 10mg at night. He hadn't had any on Sunday at all. The vet suggested if he improved Saturday night to reduce him to 5 in the am and if did well don't give him any more. He did't do well so I didn't give him any and that's when I brought him Sunday.

Today- they did say that his electrolytes were normal, phophates normal but Sodium high.

After I call the vet I will post another update. Thanks again, I can't say that enough. I have been reading all of the suggestions and information and do feel much more confident when speaking to the vet.

In response to the question if I have been there before and how many cushings babies have they helped. Many, on both. I have had several dogs treated there as well as many friends (not for cushings). They have a great reputation. I don't even know of a better place in LA to bring him, they are the best of the best where everyone gets referred to.

I had another boxer that had cushings in 2003 at that time lisdrone was the only treatment and he went on it, had a 7 day treatment and lived 2 years longer happy life with no additional treatment required. He was ten at the time and I don't recall it at all being like this at all.

More to come....

[frijole]

I can't believe the vet would have you give 20 mgs of prednisone one day and tell you it is ok to not give it the next. That would be like telling a diabetic to skip insulin. Right now your dog needs the prednisone to live. You have to slowly wean off of it. He started you on such a huge dose I have no doubt that is why you have all of the issues. Please read up on this stuff so you can quiz the vet on this.. it just isn't ringing true with me.

I am linking you to one of the world's most experienced cushing's vets and as you will see he says he rarely gives any dog of any size more than 5 mgs of prednisone because that is the dosage for a HUMAN being. Why would your vet have you give 20 mgs? Sorry to be a pest but I am upset FOR you not AT you. Kim

http://endocrinevet.blogspot.com/2011/02/q-whats-ideal-prednisone-dose-for-dogs.html

[goldengirl88]

Having Lupus I know all about prednisone. This is a terrible idea to have you stop all of a sudden with a 20mg dose. You need to slowly step it down with the dosage. This drug can do harm to internal organs when used improperly. Please call your vet and tell him what you know about this, and ask what he is thinking?? I am so sorry you are going thru all this. Blessings
Patti

[knitbunnie]

I hope Dax is doing better, and that he's able to come home today. He has such a sweet face :). I can't add anything to the knowledge of others who have written regarding Dax's dosing and prednisone. All I can add is positive thoughts and virtual hugs to both you and Dax.

[Junior's Mom]

How is Dax doing? I sure hope he's all better now. If you have a chance please give us an update. Everyone here worries when there has been no word for a while.

[molly muffin]

Hope Dax got to come home and is doing better.
Thinking of you,
Sharlene and Molly Muffin

[spdd]

Dropping by to see how Dax is doing. Sure hope he is feeling better and home.

[goldengirl88]

Hope your baby Dax is feeling much better. Is he home now? Hope he continues to improve. Blessings
Patti

[Junior's Mom]

Hi again. It's been a while since we have heard from you. I sure hope Dax is better.

[goldengirl88]

Just checking in on Dax. He is home right? Hope he is doing well. Blessings
Patti