Otto-matic Love (miniature schnauzer)

[kstomotto]

Hi....
My name is Leslie. I was with a Miniature Schnauzer Rescue for about 10 years. I served on the Board, Fostered, trained, educated etc... My prior mini schnauzer Kassie age 13 was (bridged to the other side on 2-27-09) passed from Cushings as well. She is what inspired me to do rescue. WE were an amazing team!! She evolved from a cranky snot, to a pro foster trainer. (EVERY foster we had, she would train them in the do's and don'ts!! One early Jan. morning at 4a.m. things went south very quickly. I literally cared for her 24 /7 until her quality had diminished. God bless you for your incredible 10 years!!!! I couldn't look at another dog, God forbid a mini schnauzer. One day I get a call on a dog I had placed months ago. The new owner who had this little guy had spent over $1,300. in 4 months on this little guy. Eventually I decided I best take him in and see just what was wrong with this little guy named Otto. He had a 5 hour journey to meet with me. The day we met, all 14 little pounds of Otto decided I was going to be his Mom and loved his Dad and two new human brothers. He smelled like a goat. Couldn't tell his ass from his head except his rib cage stuck out. Health issues.. Had bladder stones removed, put him on Hill's CD. They found he was highly pancreatic. I spent the next several months in a painful search of "finding a diet!!! Which we did. I was told by the prior vet he might not make it to his 10th Birthday. He will be 11 Oct 30. Because of Kassie, I have become paranoid. Blood tests consistently!!
Aug 10,2013 the day before my birthday, I had to take my husband of 17 years off life support. Otto had my hubby everyday, every night his entire life with us. He Loved Daddy!! We are still trying to establish a new "routine" as we cared for my husband the last 5 years. Otto had his blood tests last week. I knew the news would be bad when the vet said "he'd call me back!!" The news of Cushings is all to familiar to the schnauzer breed. The Dr put Otto (as with Kassie) Vetoryl 30 mg. In Kassie's situation, it was too much, too late!! I believe that in Otto's case we have caught it much earlier... :) So I came home and thought I better hop on to the internet and see what this medication really does. IF ANYONE has experience with this medication, can you please inform me on anything you may know about it?

My apologies for the long winded story. Thank you in advance for reading my story and helping me with ANY info you can provide <3

[Trish]

Hi Leslie, welcome to you and Otto!

Gosh you have had a rough few months, my condolences on the passing of your husband. It sounds like Kassie was a special little dog and maybe had a hand in steering Otto into your home :) It sounds like you have done a good job on sorting out his health issues to date and now you have another challenge on your hands, but rest assured you have come to the right place!

Unfortunately all the experts on cushings and getting dosage sorted out are asleep right now, (I am more an adrenal tumour person!) but they will be on in the morning to welcome you and share their knowledge.

There are some great resources on this forum, have you had a chance to read through the resource section here. http://www.k9cushings.com/forum/forumdisplay.php?f=10 there are threads in that section on medication used for cushings.

While I am no expert I do know that most recommend a starting dose of 1mg/kg Vetoryl. So as Otto weighs 14 pounds or 6.3kg, 30mg is quite a hefty dose and I would not start him that high or you are asking for trouble with his cortisol dropping too fast and going too low which can lead to Addisons, which is an emergency situation. The trouble appears to be that the insert in the packet recommends 1-3mg/kg hence the confusion and often too high starting doses are prescribed by vets. Have you started it yet? If not, please wait until you hear from the others here. Your vet should have also given you rescue dose of Prednisone to give him in an emergency situation if he suddenly goes off, vomiting, diarrhea, unsteady, going off food or just acting yuck!

Do you have the results of the tests that have been done to diagnose Otto, we also often see dodgy diagnosing with vets often not up to date with the intricacies of cushings. Fortunately the members here are up to date, we see a LOT of dogs passing through the forum so they have a lot of experience here. If you could list the results of the tests he has had done you will be a step ahead as they will for sure want to take them into account when giving you advice. Especially ACTH, LDDS, any other blood or urine results you have. For the blood tests, just list those that are abnormal and also include the reference range as different labs can have different ranges.

Has Otto been well lately, you have mentioned pancreatitis, that can affect testing for cushings if it was flaring. It always pays if any other diseases are playing up to get them sorted before testing for cushings and especially before starting any treatment. Is Otto on any other medications or supplements?

So my advice for tonight is to sit tight, post any test results you have and read up in the resource section and the others will be on tomorrow to help you. Please do not give any Vetoryl until you hear from them.

Best of luck in getting Otto sorted, it sounds like he is in very good hands! :)

[spdd]

Hi, and welcome to the forum. I cannot give any advice but what you will get here is the best of it.

There can be many issue with a Cushings dog, I've been through the gamut, but everything I now know all came from here and not the 5 vets that I have taken the dog to.

Someone with lots of experience will be on here to help you with any questions and issues as mentioned before.

[mytil]

Hi and welcome from me as well.

Looks like Trish started you off with our usual questions and comments about dosing and what to look for and testing.

I do agree that 30 mgs is a high dose. It is best to start low and adjust as needed.

My deepest condolences for the loss of your husband and your sweet Kassie

We are all here to help.

Keep us posted
Terry

[labblab]

Hello and welcome from me, too!

I am so sorry about your losses, and totally understand about the special healing bond that a doggie can provide. When my mom suffered a massive heart attack several years ago, it was my beloved Cushpup who never strayed from her side as she recuperated, his head in her lap and his sweet presence a constant comfort.

I "ditto" what Terry has said, in that Trish has already given you a ton of helpful information. The one clarification I will offer relates to dosing, and it has to do with kgs. vs. lbs. I, for one, kinda wish the U.S. would join the metric world and dispense with pounds as measures, but that is not going to happen anytime soon! And so, even though some specialists do advise starting doses of 1 mg. per kg. (such as those at the University of California at Davis), the U.S. offices of Dechra (manufacturer of brandname Vetoryl) are recommending a starting formula of 1 mg. per pound (with a published initial dosing range of 1-3 mg. per pound. So that would mean a starting dose a bit higher than what Trish is citing, but still lower than 30 mg.

As Trish has rightly pointed out, though, Dechra's Product Insert does contain an outdated chart that lists 30 mg. as a starting dose for a dog of Otto's size. So that is undoubtedly what your vet is going by. If you contact Dechra, they probably won't declare that starting dose "wrong," but I think they will also state that as a general rule, it is best to start at the lowest end of the dosing range so as to minimize side effects and risks of possible overdosing. And that has definitely been our experience here. So in Otto's case, that would point to a starting dose closer to 15 mg. If you are using a compounded trilostane product, you could have a dose made up in that precise amount. If you are using brandname Vetoryl, if Otto were my dog, I'd prefer to start at the lowest capsule strength which is 10 mg. (or at most, two 10 mg. capsules for a total of 20 mg.). I would not want to start as high as 30 mg.

If your vet wishes to discuss dosing further with Dechra, they maintain staff veterinarians who are happy to confer with vets (and also with owners). In the meantime, here's a link to their U.S. Product Insert that contains both that outdated dosing chart but also the written dosing range of 1-3 mg. per pound.

http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf

Marianne

[Squirt's Mom]

Hi Leslie and welcome to you and Otto! :)

We are a Lysodren house so I will let those who use the Trilostane (Vetoryl) help you with the med. I wanted to let you know how sorry I am for the loss of your Kassie and your husband. Our babies so often are the healing force for us during these times when nothing and no one else can penetrate the pain we feel. My Squirt saved my life after the worst time I have known and has always been the one to lay by me when I'm sad, kissing my tears. They just seem to understand.

I'm glad you found us and look forward to following Otto's journey, learning more about the both of you. I want you to know ya'll are not alone - we will be here any time you need to talk.

Hugs,
Leslie and the gang

[frijole]

Greetings from another schnauzer lover. Bless you for taking in another one in need. I lost both of my girls - one to cushings and another to pheochromocytoma tumor and my family members with schnauzers all 3 of them are dealing with diabetes. :( Our breed is so prone to these things.

Please do give us all the results of tests as it is frequently misdiagnosed - my Annie was. You don't want to start on the treatment until you are sure. So read the questions from others and provide answers so we can help. Glad you found us, Kim

[Trixie]

Hi Leslie, Welcome to you and Otto. So sorry to hear about the recent loss of your husband. I would recommend not starting a 14 pound dog at 30mg.

My mini schnauzer is 9 and she has been on Vetroyl/Trilostane for 6 months now. When she was diagnosed she weighed about 14-15 pounds and is now about 16-17lbs.
We started with a very low dose of 6mg 2x a day and have increased little by little to the current dose of 14mg 2x a day. It did take awhile before I saw any decrease in symptoms but I was happy to not see any side effects.

Along the way she had weeks of good control and then she would back track and begin excessive drinking/peeing/panting again. Those are the symptoms most prominent for Trixie. So in between we did the acth to check levels and increased in small increments when needed.
Lately control has been very good on 14mg twice a day, but some days she still shows symptoms. She seems to do very well when she's kept cool, the hot weather really brings out the symptoms! We'll have another acth test soon and see what her numbers look like.
For us it was caught fairly early too..she was diagnosed probably about 3 months after the onset of symptoms. She had very high liver enzymes along with high triglycerides and cholesterol but the most recent blood work showed the numbers finally coming down...slowly but at least they're headed in the right direction.

She has been fine on the medication. We are using both brand name vetoryl (10mg caps) and Trilostane (4mg caps) no adverse reactions so far.
I believe the low dose and a gradual approach to dose increase worked really well for my dog. Maybe going slow acclimates the system to the medication and keeps the side effects at bay. Just my take on it.
She's on low fat everything, being a schnauzer prone to gastro issues so food and treats are all low fat and I also give her one half tablet of Pepcid a/c every night at bedtime.
All in all she's doing pretty well.
Hope you can work with your vet and maybe try the low and slow approach for Otto.
If you can post all your test numbers the test experts here on the forum will be a huge help in advising you.

Barbara

[molly muffin]

Hi and welcome to the forum.
I'm so sorry for all the losses you have had lately in your life. I'm sure Otto is a real treasure to have with you though all of this. You were meant to be together obviously.

I would second the idea of going with a lower does to start with, using the 1mg/1lb ratio. That is what we have seen to be a good starting dosage and to have the last amount of risks. Not that there are no risks, there are always with any drug.

Welcome to the forum
Sharlene and Molly Muffin