Yorkie just diagnosed with Cushings; question about minimum dosage for Vetoryl

[Fang]

Hi everyone,

Our 9 year old Yorkie, Fang, was diagnosed with pituitary Cushing's late last week. He had all the requisite testing done that should have been done, and we don't disagree with the vet's assessment at all.
He's a pretty straightforward case with some but not all of the traditional symptoms and all of the traditional markers in blood tests and such. We actually had him tested last December because the external symptoms (hair loss, excessive thirst, ravenous hunger, and a bit of potbelly) were obvious then, but at that time his blood and thyroid tests didn't show anything significant. When we had the preliminary tests run again last week, everything was off the charts, and the follow up testing confirmed our suspicions.

Our vet prescribed a 10 mg dose of Vetoryl once a day. We picked up the pills yesterday, but we haven't started him on them yet because frankly we're terrified that he might have a very bad or even fatal reaction to it. The paperwork supplied with the box of pills was not reassuring at all. The details and results of the drug trials were particularly worrisome to us.

So, on to our questions:

Fang weighs somewhere between 6 and 7 pounds. Based on the latest research, we know that the recommended starting dose is 1mg/kg. That would put Fang's starting dose at about 3 mg per day. Is Vetoryl even available at that small of a dosage? The smallest we've found online is the 10mg capsule size. Is it extra risky to give Fang a dose that's 3 times the size of the recommended starting dose?

For those of you who have pups who have had adverse reactions to Vetoryl, how long did it take for them to get to the point where it was notable enough to be worried and get them over to the vet or emergency vet for treatment? In other words, how closely do we need to watch him for the first few days? We both work full time M-F, and Fang stays home. We're hesitant to start his treatment knowing we'll be unable to monitor him 24/7 and watch for signs of adverse reactions. We also know that the effects of Vetoryl wear off in less than 24 hours and we're worried we might miss something if we're gone and that he'll be back to normal by the time we see him again.

We have asked the vet about the necessity of having prednisone on hand at home to counter the Vetoryl in case of a bad reaction, but she did not feel it was necessary. She has several patients on Vetoryl and says it's never been a problem. We're not sure we agree with that, though we do have access to a 24 hour emergency vet if we need one. What are you thoughts on that?

Thanks in advance for any advice you can share. We'd like to make the rest of Fang's life as pleasant as possible, so we're ok with medications, but we just want to be sure that we're doing everything we can to know that we aren't going to do him more harm than good.

[Harley PoMMom]

Hi and welcome to you and Fang,

Sorry for the reasons that brought you to us but so glad you found your way here.

I was wondering if you could post the results from all tests that were done on Fang, we are interested in seeing the abnormal values and all results from any Cushing's tests...Thanks! You see the more information we know about your boy the better our feedback will be to any questions you might have.

From your post I can tell that you have definitely been educating yourself about Vetoryl. ;) UC Davis does recommend a starting dose of 1mg/kg. Dechra, the makers of Vetoryl, verbally recommends starting one's dog at the lower end of their dosage scale which would be 1mg/lb.

Since the brandname, Vetoryl, only makes certain dosages, when other doses are needed a compounding pharmacy can provide any dosages that Dechra does not manufacture. Many members successfully use Diamondback Drugs (http://www.diamondbackdrugs.com/) as their compounding pharmacy.

Trilostane, the active ingredient in Vetoryl, peak effectiveness is generally reached within the first few hours after administration, and thus, cortisol levels should be at their lowest during that time. It stands to reason that cortisol-related side effects would also be most likely then. However, every dog does metabolize the drug on an individual basis, so there can be variations.

Cushings is a slow progressing disease and also a very treatable one. Both Trilostane/Vetoryl and Lysodren/Mitotane are life-saving drugs for our cush pups, but there is a protocol to follow when giving these drugs, and one has to follow that protocol.

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

Hugs, Lori

[Fang]

Thanks for the reply, I can tell we've come to the right place for advice already! The information about compounding pharmacies and what they might be able to do for us is very helpful.

Yes, we'll post his test results here later this evening when we get home from work.

[goldengirl88]

Welcome:
Sorry Fang is having troubles. I would also recommend you go to a compounding pharmacy because 10mg is the lowest dose Dechra markets. I think you are being very wise about the dosage. A lower dose is better as it gives the dogs body time to adjust to the drug. Some vets start them too high and there are problems. You are right to be cautious. I am taken back at you vet though. To tell you it isn't necessary to have prednisone on hand is very cavalier on your vet's part. Just because they have never had a dog in an Addisons crisis doesn't mean spit. They may have not treated that many cases and are not as knowledgeable as you think about this disease. For a vet to make a remark like that I would be going somewhere else. Also you have already picked up on the fact they are recommending a dose higher than Dechra recommends. I would not trust a vet that is already crossing lines. I would call around and find a vet who has experience in treating Cushings if it were my dog. My vet wanted to start my dog off high too and I told him no way. You should start your dog off on a day you are home all day in case of any reactions. My vet told me it will be within the first few hours if you get a reaction, probably the first hour. Please get prednisone before doing this though. You need to advocate on behalf of your dog who cannot speak for himself. Don't settle for a vet who is obviously not concerned about your dogs safety. Everyone on here knows prednisone is a necessary tool you must have when administering Vetoryl. You are doing good research, so keep up the good work, and follow your gut. Don't ever solely trust your dogs safety to anyone but yourself please. Do you have the test results you could post? Please post the abnormal results so everyone can help you. Keep copies of all vet records at home. Make a daily doggie diary, you will need it to refer back to about water drinking etc. It will be ok, my dog is allergic to everything, I sat at the park across from my vets for hours after her first dose of Vetoryl to make sure she did not react. It is scary at first but it will be ok, and you will be a pro at this before you know it. You need to learn as much as possible, and come on here and ask questions for help. It will get better, and you will feel better about it. Blessings
Patti

[Fang]

Here are Fang’s results from his Complete Blood Count taken about a week and a half ago:
Test Result (Reference Range) Low/Normal/High Assessment
WBC 10.74 (6.00-17.00 10^9/l) Normal
LYM 1.21 (1.00-4.80 10^9/l) Normal
MON 0.71 (0.20-1.50 10^9/l) Normal
NEU 8.79 (3.00-12.00 10^9/l) Normal
LY% 11.2 (12.0-30.0%) LOW
MO% 6.6 (2.0-4.0%) HIGH
NE% 81.9 (62.0-87.0%) Normal
RBC 5.91 (5.50-8.50 10^12/l) Normal
HGB 16.5 (12.0-18.0 g/dl) Normal
HCT 40.59 (37.00-55.00%) Normal
MCV 69 (60-77 fl) Normal
MCH 28.0 (19.5-24.5 pg) HIGH
MCHC 40.8 (31.0-34.0 g/dl) HIGH
RDWc 15.9
PLT 653 (200-500 10^9/l) HIGH
PCT 0.64
MPV 9.8 (3.9-11.1 fl) Normal
PDWc 37.2

On the same day a week and a half ago, he had a Comprehensive Diagnostic:
Test Result (Reference Range) Low/Normal/High Assessment
ALB 3.8 (2.5-4.4 g/l) Normal
ALP 181 (20-150 U/L) HIGH
ALT 218 (10-118 U/L) HIGH
AMY 437 (200-1200 U/L) Normal
TBIL 0.4 (0.1-0.6 mg/dL) Normal
BUN 15 (7-25 mg/dL) Normal
CA 10.1 (8.6-11.8 mg/dL) Normal
PHOS 6.6 (2.9-6.6 mg/dL) Normal
CRE 0.3 (0.3-1.4 mg/dL) Normal
GLU 100 (60-110 mg/dL) Normal
NA+ 145 (138-160 mmol/L) Normal
K+ 4.2 (3.7-5.8 mmol/L) Normal
TP 6.8 (5.4-8.2 g/dL) Normal
GLOB 3.0 (2.3-5.2 g/dL) Normal
QC OK
HEM 0 LIP 3+ ICT 0

On the same day a week and a half ago, he had a Thyroxine(T4)/Cholesterol test:
Test Result (Reference Range) Low/Normal/High Assessment
T4 <0.5 (1.1-4.0 ug/dL) LOW/Didn’t Register
CHOL 330 (125-270 mg/dL) HIGH
QC OK
HEM 0 LIP 3+ ICT 0

And finally, on the same day a week and a half ago he had a Urinalysis:
Physical characteristics:
Color colorless/yellow
Appearance clear
Chemical analysis:
Urobilinogen (mg/dL) normal
Glucose (mg/dL) neg
Ketone (mg/dL) neg
Bilirubin neg
Protein (mg/dL) +/30
Nitrite neg
Leukocytes neg
Blood neg
pH 6.5
Specific gravity 1.007
Microscopic Examination:
Bacteria cccc ++
Epithelial cells OCC/HPF
All others none

After those results came back, the vet recommended follow up testing in the form of a dexamethasone suppression test and a thyroid stimulating test. So we went in for that last week. I don’t have paperwork results because she gave us those over the phone, and I don’t know if they did LDDS or HDDS. From our notes:
The thyroid is normal.
The cortisol showed no suppression, which indicated a positive test for Cushings. They weren’t able to discern if it was adrenal or pituitary, so they recommended an ultrasound be conducted.

We took him in for the ultrasound last Friday. We fasted him prior to that. They had a specialist come in to do the ultrasound, and she wasn’t able to find anything on his adrenal gland. So they think it’s most likely pituitary.

One other thing we asked about was the ACTH test that the drug manufacturer recommends after starting the Vetoryl treatment. Our vet said she didn’t think it was necessary. This was a bit of a concern to us as well, so we’re curious about what others think regarding that.

[Harley PoMMom]

Those abnormal values are what we usually see in a dog with Cushing's.

As far as having the monitoring ACTH tests done, they are absolutely necessary when a dog is on treatment, this is the only way to tell exactly how much cortisol a dog has on reserve.

Dechra's protocol does state to have an ACTH stimulation test performed within 10-14 days after starting Vetoryl plus once an optimum dose of Vetoryl has been reached, ACTH stimulation tests should be performed on a dog at 30 days, 90 days and every 3 months thereafter. My thoughts on this are: if a dog is started at a low dose of Trilostane than adverse effects are usually not seen, and the first monitoring ACTH stimulation test could be postponed until the 30 day mark because Trilostane has the ability to lower a dog's cortisol beyond the 10-14 day window.

With the monitoring ACTH stim tests one important thing is the timing. Trilostane has to be given with food to be absorbed properly and then the ACTH stimulation test has to done 4-6 hours post pill. Now, so one can compare "apples to apples" all ACTH stim monitoring test should be done at the same time frames.

Here's a link from our Resource thread with information regarding Trilostane/Vetoryl: Trilostane/Vetoryl Information and Resources (http://www.k9cushings.com/forum/showthread.php?t=185)

Hope this helps and I hope I haven't confused you. :o

Hugs, Lori

[frijole]

Whoa. Your vet wants to put you on trilostane and says doing acth testing after starting isn't necessary? Please tell me I misunderstood. That would be like giving a diabetic insulin and never ever checking blood sugars afterward. RUN don't walk to the nearest vet clinic with your records. My 2 cents. Kim

PS I really hope I misunderstood.

[Fang]

Thanks again for the responses. We're going to talk to the vet again tomorrow about our concerns with the dosage she prescribed and with the ACTH test follow up. I'm sure she will do the ACTH test for us if we ask for it. I think she's probably going on her own limited experience with Cushing's disease dogs where she's never had a problem with the treatment before when she says it's not necessary. I get the feeling that perhaps all the dogs they've treated before were much larger than ours, though that probably doesn't make it right.

We've decided that we're definitely not starting him on the 10mg a day dosage. He's not progressed in his symptoms far enough yet to make us worried that if we don't start immediately he'll suffer much. He's quite peppy and happy, and still has a full coat of hair, so we think it's still early stages for him for the disease. If our current vet won't prescribe something less for the starting dosage, we'll be going elsewhere for advice. We have a great vet school a couple of hours away with several SAIM specialists that we'll be consulting next.

Thanks again for taking the time to read through our case, for providing such great resources on the forum for us to use for research, and for your advice - we really appreciate it!

[Harley PoMMom]

Strong obvious symptoms do play a huge part of the Cushing's diagnosis, A Cushing's savvy vet will not initiate treatment in a dog without strong clinical Cushing's symptoms.

Many experts in the endocrine field, such as Dr. Edward Feldman, do not recommend treatment until symptoms are obvious. The drugs for Cushing's are used to treat/abate the symptoms and are not a cure for Cushing's.

Hugs, Lori

PS...I wanted to include a link to an article in which Dr Feldman is interviewed about how to treat dog's with Cushing's: Cushing's disease and other adrenal gland disorders (http://www.k9cushings.com/forum/showthread.php?t=2231)

[frijole]

I'm linking some info on what cushings is and about treatment so you can read up a bit and be more informed when talking with this vet. I really want to make sure you understand that you simply do not mess around with treating a dog unless you know for sure they have cushings and with the meds. They are wonderful drugs but the doses have to be right and the vet has to follow up with proper testing. If a vet is not aware of dosing protocols and testing protocols you are putting your dog's life at risk. I'm just trying to be very honest with you. Don't take this drug lightly nor this disease.

Dogs when treated properly live normal happy lives. Dogs that have inexperienced vets and uninvolved owners (you are not one of those) can get into trouble.

That is why this site exists and I came here in the same situation over 8 yrs ago. Please trust me. Wishing you the best, Kim
http://www.k9cushings.com/forum/showthread.php?t=180
http://www.k9cushings.com/forum/showthread.php?t=5428
http://www.k9cushings.com/forum/showthread.php?t=185

[molly muffin]

Hello and welcome to the forum.
Isn't Fang just the cutest little guy.

Most important in my mind is to start at a 1mg/1lb starting and monitor via ACTH as prescribed, especially until you know how is body is going to react. The likely hood of any problems when starting low dose, is lowered greatly. Their bodies I just think adjust better to the lessen cortisol levels, which can make them feel yucky.

The blood test due seem to be saying cushings, so I would just be most concerned at this point in getting the dosage right and the testing for follow up right.

Sharlene and Molly Muffin

[doxiesrock912]

Some people here use Diamondback, it's a compounding pharmacy. Giving too much is VERY dangerous and you'll notice symptoms very quickly such as a loss of appetite, weakness, maybe even vomiting, but the signs are obvious.

[Trixie]

Fang is so cute!! Sorry he has been diagnosed with Cushings but the medication can help control his cortisol and things will get better.
If you start Fang on a low dose and adjust as needed he should do just fine. You can get any dosage amount compounded. I'm now using 10mg of vetoryl along with 4mg compounded Trilostane to make up a 14mg dose. If your vet agrees you can start at half the 10mg dose if you are more comfortable with that. You may also want to ask about doing a twice a day dose, and then you would give even less at each dosing.

We started the medication back in April. My dog was approx 15lbs at the time. We started on 12mg a day...we did break up the dosing to 6mg twice a day--morning and night.
I will say that I did not see a decrease in symptoms (excessive drinking/peeing and panting were the most prevalent for us) for quite awhile...but my dog also had NO adverse reactions to the drug either. We did the acth test after 10 days and then needed to increase the dose. It's been months of tweaking the dose, little by little and testing the levels. We have increased from that 12mg a day up to the current dose of 28mg a day and now finally we seem to have control of the symptoms.
My dog has not had any side effects..I think low and slow is the way to go. The good part of the Vetoryl/Trilostane is that if you did see any side effects you just stop giving the pill. Luckily for us...no side effects. I hope the same will be for Fang!

Barbara

[Squirt's Mom]

Hi and welcome to you and Fang! :)


T4 <0.5 (1.1-4.0 ug/dL) LOW/Didn’t Register :eek:


The thyroid is normal. :confused:

I am concerned about these two points in the discussion. First, a T4 reading of <0.5 is NOT normal - that is indicative of Hypothyroidism which can present just like Cushing's. The next post says the thyroid is normal but you didn't have the actual test numbers.....so I'm wondering if Fang's thyroid was tested twice and this one was a false reading or if your vet is off the mark with understanding what "normal" is for thyroid. If there was a second test for the T4 OR if Fang had a special thyroid test that looks at values other than just the T4, please get those results and post them here, too. There is a condition called Sick Euthyroid Syndrome that happens in untreated cush pups but I want to be sure Fang's thyroid truly is functioning normally before you start treatment. ;)

Hugs,
Leslie and the gang

[goldengirl88]

My advise is if you have a veterinary school close to you please go there. I am afraid the inexperience of your vet with this disease and the drugs used to treat it may lead to trouble for your dog. First I thought it outrageous that your vet would think it not necessary to have prednisone on hand. Now I am flabbergasted at a vet that thinks an ACTH test is not necessary. My dog has had 12 ACTH tests in the last year, yes 12. I can barely afford them but,I realize the importance of the testing as these are powerful drugs you do not play around with. I never do anything concerning dosage change without one. If I see my dog looks uncontrolled I get one, if she appears to be low energy I get one. I hope you are understanding what I am trying to get across. Please go and seek the help of a qualified vet who has experience dealing with this disease and it's treatment. If you truly love your dog, and want you dog to live it's life out, please go to another vet. Blessings
Patti

[Fang]

Thanks, everyone. We've been reading all the literature in the links you provided, and we have another appointment with our vet later today to discuss with her everything we've learned and why we are concerned about her initial prescription and won't be doing it. We'll see if we can steer her in the direction we feel is best (much lower starting dose, prednisone on hand, and follow up ACTH testing as recommended by the drug manufacturer and other vets, and everyone here). If she's open to following our plan, then we'll stick with her, otherwise, we're going somewhere else. We'll also be sure to get copies of the second round of test results that showed his thyroid was functioning properly and led them to the Cushing's diagnosis. We'll let you know how it goes.

[goldengirl88]

Fang is adorable. I am glad you are going to address the situation. My vet was very inexperienced treating Cushings. He is the only decent vet out in the country where I live. He will however take direction from me very well. I tell him what needs done, how it is supposed to be done, and have him in contact with the vet at Dechra constantly. I check and recheck everything before he does anything. He is willing to listen to me and do what has to be done so that is why I am with him. He does not have a lot of experience with this drug or the disease itself. You have to be confident enough in yourself to do this though, as you are calling the shots that will affect your dogs life basically. I have learned, researched, and always get on here and check everything out with everyone else before making any decisions. The people on here have way more experience with this than the vets do. My only caution is if you continue with this vet, make sure she understands you will be making the decisions, and anything she proposes must be thoroughly investigated before she can implement anything. I would also make sure she is using the proper protocol etc. when doing the ACTH tests etc. Remember when you get your first ACTH after using the Vetoryl you DO NOT fast your dog before the test no matter what she says. After you dog is on Vetoryl you need to feed them a small meal and give the Vetoryl with it, you never fast before the ACTH tests once on Vetoryl, unless it is discontinued for some reason. If you do you run the risk of your dog overdosing on an incorrect dosage. Vetoryl is best absorbed in the system if it is given with a small amount of fat. It is fat soluble. Always come on here with anything your vet proposes and ask the forum. They will give you the straight answers on what they would do. If you are vigilant in watching your dog, Fang will do just fine. You seem like you will be so everything will work out. There is just a learning curve with this disease, and you seem to be doing great. You may want to have your vet call Dechra and establish a relationship with the vets there which will only help you and Fang. Blessings
Patti

[Fang]

Here are Fang's official results from his second round of testing:

Dexamethosone Supression - 3 Samples
Cortisol (Pre) 10.5 ug/dL HIGH
Cortisol (4HR) 9.4 ul/dL
Cortisol (8HR) 6.3 ug/dL

Thyroid Stimulating Hormone
TSH 0.24 (0.00-0.50) ng/mL Normal

[Trixie]

I'm no expert on the test numbers, but the post your dog has is the same as my dog was. What did you vet say about the Vetoryl dosing?

Barbara

[Fang]

We had a successful discussion with our vet about the treatment plan yesterday afternoon. We shared our concerns with her and showed her the research we'd come across. We asked her to consider reducing the dosage to the UC Davis recommended minimum starting dosage of 1.5 mg twice a day, and said we'd like to look into using a compounding pharmacy to get the smaller dosages. We also discussed the use of the ACTH test and how we'd like to go ahead and follow the recommended plan for regulating Fang's dosage. She was open to hearing everything, and said she'd do her own follow up research, and consult the local SAIM specialist as well.

She called us this afternoon and said she and the specialist were in agreement that our plan was good and that she'd go ahead and talk to the compounding pharmacy to get the dosages ordered for us with our permission.

So, we feel much better now about getting Fang started on his treatment. Again, thank you all for your advice and support. We're sure we'll be back for more discussion once we really get going on the treatment process. We can't tell you how much it means to us knowing that there are others out there who share the same situation and can offer support.

[Trixie]

Good for you!! Glad your vet was open minded and you can start the medication conservatively. Good Luck..I hope Fang's symptoms decrease on the lowest possible dose. Going in low may take some tweaking but the approach is much safer. Let us know how it's going. :)

Barbara

[molly muffin]

So glad to hear that you have a plan and that your vet has agreed to what you would like for Fang's treatment.

Definitely do drop in and let us know how things are going or ask any questions you might have.

Sharlene and Molly Muffin

[frijole]

That is great news. I'm glad your vet listened to you and is willing to learn. Please do keep us posted, take notes of your conversations so you can ask us questions - we will help as best we can. Kim

[goldengirl88]

Wonderful news especially about starting on the lower dose, and I am so glad the vet is willing to work with you. I hope you feel at ease now about the treatment. Please let us all know how Fang does when you get him started on the Trilostane. You should be proud of yourself as an excellent advocate for your baby. Blessings
Patti

[Fang]

Hi again everyone. I could use your thoughts on what to do next with Fang.

We started him on Trilostane just over two weeks ago. He's been taking 1.5 mg twice a day, which is the minimum recommended starting dose for a dog his size.

We started noticing an improvement in his thirst and urination habits on about day 2 of treatment, and by day 3 or 4 there was a marked improvement. I think that perhaps in the last couple of days it's started to diminish a little - he's drinking slightly more again and perhaps peeing a little more as well, but nothing near what he was doing before we started the Trilostane.

We noticed this morning that his hair seems to be growing in a bit thicker as well. He used to have black hair with silver/white tips. When he started showing his Cushings symptoms, all the black roots went away and he went all white and the hair thinned. He had a haircut a couple of weeks ago, and we noticed today that his black roots are coming in again and his hair seems to be getting thicker.

We took him in for an ACTH test yesterday (two weeks after start of treatment) and got the results today. They were:

Cortisol (Pre) 10.9 ug/dL (HIGH) (1.0 - 6.5 Range)
Cortisol (Post) 18.2 ug/dL (HIGH) (6.5-18.0 Range)

She says we have two options to choose from now:

1. Increase his dose now because post cortisol level was high. She recommends a 25% dose increase at this time if we do this.

2. Because symptoms are improving (the doctor also noticed that his hair was getting blacker yesterday), wait another couple of weeks to see if his body adjusts further to the current dose, then decide to make a change.

She's recommending option 2, but is open for discussion. What do you guys think?

[Squirt's Mom]

I agree with your vet. The cortisol in Trilo pups can continue to drop for the first 30 days so unless you are seeing a steady increase in signs, I would hold off for the next test in 2 weeks. I'm sure some of our Trilo parents will be along with their thoughts as well.

Hugs,
Leslie and the gang

[Trixie]

I agree too...I would also hold off and see how the next 2 weeks go. If you notice and increase in symptoms over the next weeks you can talk about an increase, but if you continue to see improvement then it's great to remain on a low dose.
You may want to write things down...how much water, how many times Fang needed to urinate, episodes of panting (if that happens)...then you will really be able to compare day to day how it's going.
My dog back tracked a few times...she would be controlled for 5 days then she would start up drinking/peeing again so we increased very gradually over 6 months. Hope your Fang keeps improving!! Sounds like you're doing great so far!

Barbara

[molly muffin]

Hi, I'll just agree with everything Barbara and Leslie just said. Barbara has gone through this exact scenerio with her little dog Trixie just recently and Trixie is doing very well on this management plan.

You're doing great job and sounds like things are going very well. Great to see the fur coming in like that too.

hugs,
Sharlene and Molly Muffin

[doxiesrock912]

I agree to wait. Daisy's IMS likes to retest at 6 weeks. Daisy's dose hasn't changed in weeks, but I'm still seeing improvements too. You can always increase at a later date if necessary.

[Squirt's Mom]

The protocol for testing is 2 weeks after starting (and after EACH dose adjustment), then at the 30 day mark, then the 3 month mark, then every 3 months as long as things are going well. Not all vets follow this protocol but this is how the drug is meant to be handled. Following this protocol allows for the least risk to the pup. ;)

From the Dechra brochure -


Re-examine and conduct an ACTH
stimulation test 10-14 days after every
dose alteration.

Once an optimum dose of VETORYL
Capsules has been reached, re-examine the dog at 30 days, 90 days
and every 3 months thereafter.

[Fang]

Ok, thanks for the advice, everyone! We're going to stick with his current dosage for now and retest in two weeks. We have noticed a slight increase in his drinking and urination this week, so we suspect we might be increasing the dosage after the next round of ACTH testing, but we'll see. He's definitely happier than he was a month ago, and that makes us happy, too.

[SoggyDoggy]

Hi, I haven't posted to you before but am glad everything seems to be on the right track. I've just read through your entire thread and want to bump a post from Leslie for a short time back. I know you later posted the TSH result, and I'm no expert here by any means, but I understand TSH and T4 to be different things? Is there still potentially a question regarding Fang's T4 levels?

Apologies if I have missed the answer to this somewhere (or just got my facts wrong), but it flagged my attention on page one and as someone who had to treat a dog with another underlying condition, I would caution you to keep a really good watch on Fang if there is still a question looming. I don't mean to be an alarmist, but better safe than sorry right?



Hi and welcome to you and Fang! :)

:eek:

:confused:

I am concerned about these two points in the discussion. First, a T4 reading of <0.5 is NOT normal - that is indicative of Hypothyroidism which can present just like Cushing's. The next post says the thyroid is normal but you didn't have the actual test numbers.....so I'm wondering if Fang's thyroid was tested twice and this one was a false reading or if your vet is off the mark with understanding what "normal" is for thyroid. If there was a second test for the T4 OR if Fang had a special thyroid test that looks at values other than just the T4, please get those results and post them here, too. There is a condition called Sick Euthyroid Syndrome that happens in untreated cush pups but I want to be sure Fang's thyroid truly is functioning normally before you start treatment. ;)

Hugs,
Leslie and the gang

[molly muffin]

Hi, checking in to see how you and Fang are doing. Don't we have a test coming up real soon or have you already done it?

sharlene and molly muffin

[Fang]

Hi everyone,

Just wanted to let you know that Fang's doing well. He has had notable improvements in his energy level, his hair has thickened up, his potbelly going away, and he's not peeing nearly so often since we started his trilostane treatments.

We've been really happy with the vet through the whole process. We use a local compounding pharmacy to get his medicine, and they've been great as well. Fang loves visiting the vet, even though they poke holes in him when he's there!

It took us until the middle of December to go through the process of slowly stepping up Fang's trilostane doses and repeating ACTH tests until we got him stabilized. He ended up needed 3 mg doses twice a day, which is much less than the 10 mg dose once a day that the vet originally prescribed. His external symptoms started improving at about 2 mg doses twice a day, but getting the post ACTH cortisol levels down to where they should be took a little more work. Now we are to the point where we will watch for changes in his symptoms, and if we see anything notable, we'll retest and adjust dosage as needed.

We know this is something we and he will have to deal with for the rest of his life. It's definitely been expensive, but having him here and happy is worth it to us.

[molly muffin]

Oh that is wonderful news about Fang!! Couldn't be happier for you and the little guy. :)