Using Vetoryl on 6 year old Sheltie

[shelties4ever]

My 6 year old sheltie has been diagnosed with cushings. Blood work and low and high dex test done, but neither have confirmed if adrenal or pituitary based. Having an ultrasound this week and with 85% chance of it being pituitary, wanted to get some feedback on how shelties have responded to vetoryl and suggested beginning dose for 34 pound dog. Her main symptoms are excessive drinking and urination (can only last 3 hours max before needing to go out - i have had some long nights these past few weeks!) Her coat is looking dull and has thinned out on the flanks and tip of tail. Some times of the day her breathing gets noisy. No skin problems at present and still loves her walks on the beach every day, though not as lively. Have noticed slight weakness in hind legs. Still seems very happy and alert so need to help extend her life, or at least make it comfortable. She has helped me through the death of one of my children, and I owe her a good life. Thanks for any imput you wonderful people can give me!

[Squirt's Mom]

Hi and welcome to you and your baby! :)

First, I am VERY concerned that you have used an email as your user name. This forum is visible to everyone who wants to look, not just members here. So you have put this email address out for the WORLD to see. If I were you, I would contact the Admins and have my user name changed asap. ;)

Second, I understand all too well the connection you have to your baby. My Squirt was my only comfort and constant support when my own 29 yr old daughter passed away suddenly in 2006. She saved my life and I do everything in my power to make each of her days as perfect as I can make them. The gods willing, she will be 16 in Feb. so I know our time is limited and the very thought of facing one day without her is unbearable. We will do all we can to help you and your baby have many, many more years together.

We are a Lysodren house so I will let the Vetoryl (Trilostane) parents talk with you about the use of this drug. It will help a great deal if you can get copies of all the testing done and post the actual results here.

I want you to know that you are not alone on this journey. These pups can and do live out their full life span, and beyond because of the excellent care and attention they get from parents like you. We will be by your side every step of the way. Never hesitate to ask questions and we will do our best to help. We are here anytime you wish to talk, to cry, to scream, to laugh, whatever - we will be here for you. I am so glad you found us and look forward to learning more about the both of you as time passes.

Hugs,
Leslie and the gang

[labblab]

Hello and welcome from me, too! If you do decide to change your username, you can let us know right here on your thread, or you can send me a Private Message (PM) in order to tell me what username you'd like to switch to.

Secondly, yes, we have had dogs of every breed who have been treated successfully with Vetoryl. As far as a starting dose, many specialists now recommend beginning at a dose no higher than a formula of 1 mg. per pound (this represents the lower end of Dechra's published starting range (Dechra manufactures brandname Vetoryl). So for your girl, this would translate into appox. 30 mg. You can always increase the dose over time if the monitoring testing indicates that is optimal. But starting lower can offset some of the side effects associated with rapidly lowering high cortisol levels.

We are really glad you've found us, and we will be anxious to learn more about your girl!

Marianne

[goldengirl88]

Hello:
I also wanted to welcome you. When you get time would you post the abnormal readings of the tests you had done and the scale the lab uses to compare them to as they are all different. I do use Vetoryl and have had my dog on it for the last 13 months. She too has breathing noises, and had muscle loss in the hind legs. The best way to keep your dog safe, and problem free is to start on a low dose no matter what the vet says. This way the dogs body has time to adjust to the drug. These are powerful drugs that a lot of vets do not understand and give to high of a dose. Starting low will help you eliminate problems from your dogs cortisol dropping to fast and too low. Please get prednisone from your vet. You will need it if you see vomiting, diarrhea, lethargy, or your dog cannot get up or eat you would give prednisone and go to the vets asap. When you monitor your dog carefully you will get thru this easier as there are less problems with a watchful owner. It is when people do not pay attention that things go down hill. It is scary at first, but you will get used to it. We are all here to help you so don't feel alone, we all walk this road together. The best thing to do is educate yourself on this disease. You are the only advocate for your dog. Never put blind faith in anyone even your vet. We can answer all your questions so feel free to come on anytime for help. It will all be ok, just know we are here for you. Blessings
Patti

[shelties4ever]

I will post Bonnie's test results shortly.

[shelties4ever]

Bonnie's blood work showed the following red flags:
Neutrophil 13.875
Lymphocyte 0.801
Eosinophil 0.015
TCO2 16
ALT 508
ALP 3339
GGT 152
Cholesterol 699
Total T4 0.8
Free T4 (ng/dl) <0.3
Free T4 (pmol/L) <3.9

Low dex test
Pre: 8.00
Post 4 hr: 5.7
Post 8 hr: 9.2

High dex test
Pre: 7.8
Post 4 hr: 3.8
Post 8 hr: 6.9

Hope this makes sense.

[goldengirl88]

Have you had an ACTH test, urine, and an ultra sound?

[Squirt's Mom]

Would you mind editing those lab results to include the little letters that come after the numbers and the normal ranges for each value listed? Different labs use different units of measurement (the little letters like ug/dl, nmol/L, etc) and normal ranges so it helps us to see what that lab is using. ;)

[shelties4ever]

As requested, here are Bonnie's red flags with
'normal' ranges shown:

Bonnie's blood work showed the following red flags:
Neutrophil 13.875. normal range 3-11.5k/uL
Lymphocyte 0.801 normal range 1-4.8k/uL
Eosinophil 0.015 normal range 0.1-1.25k/uL
TCO2 16 normal range 17-24mmol/L
ALT 508 normal range 5-107u/L
ALP 3339. Normal range 10-15/uL
GGT 152. Normal range 0-14uL
Cholesterol 699 normal range 1[/B]12-328mg/
Total T4 0.8. Normal range 1-4 ug/dl
Free T4 (ng/dl) <0.3 normal range 0.6 - 37ug/dL
Free T4 (pmol/L) <3.9 normal range 7.7-47.6 pmol/L

Low dex test
Pre: 8.00
Post 4 hr: 5.7
Post 8 hr: 9.2

High dex test
Pre: 7.8
Post 4 hr: 3.8
Post 8 hr: 6.9

She has had frequent small sometimes bloody diarrhea for the past week, and an examination shows bacterial infection. Now taking metronidazole and fortiflora, and she is already feeling better after one day.
Her ultrasound is scheduled for Thursday. Will report findings.
Thank you for your concern

[Squirt's Mom]

Did the vet say anything about the thyroid results?


Total T4 0.8. Normal range 1-4 ug/dl
Free T4 (ng/dl) <0.3 normal range 0.6 - 37ug/dL
Free T4 (pmol/L) <3.9 normal range 7.7-47.6 pmol/L

Based on the above, hypothyroidism is a possibility.

[shelties4ever]

You know, the vet never talked about Bonnie's thyroid levels. I have sent her an email, to ask her to explain those results to me.
Thanks for the heads up.

[labblab]

I'm glad you'll be asking about that. Your vet may decide it is worthwhile to pursue another round of more extensive blood testing that may give you an indication as to whether the low thyroid response is a primary problem in its own right, or whether it is secondary to another endocrinological problem such as Cushing's. If it is the former, you'll probably want to go ahead and treat. If it's the latter, successful control of the Cushing's may normalize the low thyroid function as well. That may be what your vet is assuming right now, and may be the reason why she hasn't discussed it with you. But it will be good to know for certain as to what your vet is thinking.

Marianne

[shelties4ever]

Bonnie has had her ultrasound and both adrenal glands were slightly enlarged, so looks like pituitary cushings. The scan also showed an enlarged gallbladder with possible immature mucocele. Vet prescribed 425 mg denamarin 1x per day, 0.3 mg thyrozine 2x per day, 30mg vetoryl 1x per day, (vet wanted to start at 40mg, but he listened to my concerns and the fact that Bonnie has no appetite and has been losing weight, now 32 pounds (lost 5 pounds in 2 months ). She has been on medications for past two days and seems fine. Enjoys her walks, but still no appetite. Only enjoys chicken jerky (made in the U S) and my dry corn cereal. Tried poached chicken,eggs, pumpkin, steak.....any suggestions would be appreciated!

[molly muffin]

The gall bladder could be affecting her appetite and if it is even a small mucocele, then perhaps she should be on medication to get that cleared up. It can also affect the ALKP numbers, making them soar.
Just a thought you might want to talk over with your vet.

hugs,
Sharlene and Molly muffin

[shelties4ever]

The Denamarin has been prescribed to help break down the mucocele. Are there other supplements that would be helpful to the health of the gallbladder?
Thanks for your imput.

[goldengirl88]

My Tipper and my cat both have gallbladder sludge which can form stones. They are both on Ursodiol, it is expensive, but it works. Blessings
Patti

[molly muffin]

We have another dog on the forum with the same issue and she is on Ursodiol too.

Sharlene and Molly muffin

[lulusmom]

Hi and a belated welcome to you and Bonnie.

Canine Canine cushing's is difficult to diagnose and it is one of the most misdiagnosed. Based on Bonnie's breeding and the information you have provided, my very non-veterinary professional gut tells me that her cushing's diagnosis should be questioned.

Shelties are the number one breed mentioned as being predisposed in everything I've ever read about mucoceles. They are also at the top of the list of breeds predisposed to hypothyroidism. Conversely, they are not a breed we usually see here or read about as being predisposed to cushing's. Mucoceles are linked to cushing's but they are also linked to hypothyroidsm and inflammatory bowel disease.

In my layperson's opinion, Bonnie's symptoms, as well as the lab abnormalities point more to the profile of a dog with low thyroid and mucoceles than a dog with cushing's. As for the adrenal enlargement on the ultrasound, not all dogs with enlarged adrenal glands have cushing's. Any chronic disease can put great stress on the body and the adrenal glands respond to that stress by dumping cortisol and other adrenal hormones. Constant stress creates hyperadrenal activity, which enlarges the adrenal glands.

If Bonnie were my dog, I would absolutely not feel comfortable with starting treatment for Cushing's but would want to get Bonnie on Ursodiol and possible thyroid supplementation. If you can afford it, I would highly recommend that you have Bonnie seen by an internal medicine specialist and let him/her reconfirm the cushing's diagnosis before starting treatment with Vetoryl (Trilostane).

Glynda

[shelties4ever]

Thanks for your feedback. I will be putting Bonnie on ursodiol next week. I have a talked to two other vets (none of them internal specialists) and they all think bonnie has cushings. I will see what happens with the 14 day blood work check on Dec. 5th, and mention your post to them.

[shelties4ever]

The web site Dr. Foster and Smith sell ursodiol in 300mg formulation. Has anyone bought this product from them and any advise for the dosage of a 32 pound dog?

[lulusmom]

Was the LDDS test done after the bacterial infection was resolved or was it done while there was an active infection?

[doxiesrock912]

Urisidol is prescribed by the vet. I would get the other issues under control and then retest for Cushings because other issues will skew the results which could lead to overmedicating.

Our Daisy Mae is also on Urisidol. If in doubt, I urge you to visit an IMS specialist since the vets do not seem to agree on treatment.

[labblab]

I see there seems to be some questions raised re: Bonnie's diagnosis, but I am wondering how she is doing on the trilostane. If I'm calculating correctly, she has been taking it for about ten days now. Are you seeing improvement in her, or does she instead seem any worse? How about her appetite? I believe she will have her first ACTH test this week. Since many aspects of her symptom/lab profile are indeed consistent with Cushing's, in my own mind, I would use her behavior and those test results as an indicator as to the appropriateness of the diagnosis and treatment now that it has already begun. We'll be anxious to hear about her progress.

Marianne

[shelties4ever]

Bonnie has been taking 30mg of trilostane for 10 days. Have not seen any side effects except having a very picky appetite, but she was having that before starting the medication. She seems hungry now, but i can't find anything she wants to eat except chicken jerky, lean pupparoni sticks, and a little turkey and some mornings, unfrosted mini wheats.
She has been on purina fortiflora since her intestinal infection and i think that has helped her stools normalize, so i will continue to Give her that daily.
I have also been giving her the 2x daily thyrozine for the past 10 days.
She will have her blood test at 2 weeks, on Thursday, Dec 7th.
Panting has stopped, but it has also cooled down....!
She still drinks alot of water but mainly at 10pm and 2.30am (she is drinking less during the day now) she still asks to go out at 2.30am and then 6am (but wonder if this is becoming more of a habit) She loves her beach walks and goes for 40 minute walks twice per day. To look at Bonnie, she looks beautiful and happy (gets complimented every time she out walking) Just had three little boys playing with her for a week over Thanksgiving and she loved it.

[shelties4ever]

LDDS test was done one week after infection resolved.

[Squirt's Mom]

I would stop the Pupperoni ASAP!

http://www.democraticunderground.com/10022145850

[shelties4ever]

Thanks, have thrown away chinese made treats.

[shelties4ever]

Bonnie has been on 30mg trilostane for 14 days, so had blood test check. Cortisol levels still high : pre:9 and post:13.9
Vet wanted to increase dosage to 40mg, but I am keeping her at 30mg for another couple of weeks and get rechecked. Her electrolytes were also checked and they are fine.

[molly muffin]

I think staying is a good call, to see if the cortisol will continue to drop.
How are the symptoms? Any improvement there?

Sharlene and Molly Muffin

[shelties4ever]

Bonnie's symptoms have abated a little. Panting has decreased a lot, but it has gotten cooler.....! Still drinking a lot and peeing a lot, but had decreased to just drinking about 2 cups each time at 5am, 10am, 3pm, 8pm, 10pm, 2pm. She can now go Six hours at night before barking to go out. No accidents. Hind leg weakness shows itself occasionally when running around corners on stone floor. No skin issues as of now. Appetite finally returning, will eat her dog food when mixed with warm chicken broth.....

[molly muffin]

Sounds like you are on the right track!

hugs,
Sharlene and Molly Muffin

[shelties4ever]

Have ordered trilastane from diamondback drugs as i need 35 mg tablet For bonnie (30mg is not making an impact on drinking and urination, every 3 to 4 hours) they are making the product for $28 plus $8 shipping. My vet has only heard good things about them so am prepared to try for one month and see if i can save money going forward. Will do a blood retest in a couple of weeks.

[molly muffin]

Several of our members have used Diamondback and been pleased with their service and product. Hopefully it will work out for you. :)
hugs
Sharlene and Molly Muffin

[doxiesrock912]

We'be had no issues with Diamondback. In fact, our IMS used them when she lived in California.

[flynnandian]

i contacted them too, and they are indeed very cheap, but they charge 60 dollars to ship it to europe. so, it does not work for me........

[shelties4ever]

Oh my, international postage is so expensive. Have you checked for a similar drug compounding company based in Europe? Perhaps DiamondBack Drugs knows of a european company they would recommend.

[flynnandian]

thanks for the tip. i will ask them. but vetoryl [dechra] bought the right to sell trilostane in europe and no other company is allowed to. that is why it is so expensive...no competition is what they told me.

and my ian has a pedigree shetland sheepdog as a father. he is a blue merle [bi-blue] what colour has your sheltie?