How long until we see significant improvement?

[Ebonysmom]

Ebony, our 6 year old lab was just diagnosed this week. We started 60 mg of Vetoryl on Tuesday. I will have to get her lab numbers from the vet office. I do see a little improvement in the panting and tremors but was curious as to when or if we will see significant reduction in these symptoms. She also has major hair loss, I know that will take awhile.

She was always a great eater but since starting the medicine, I can only get her to eat a few bites of kibble mixed with chicken breast twice a day. She even turns her nose up to her favorite treats.

Any insight would be appreciated.

Thanks for having this forum...it has been helpful already in just a few visits.

[Junior's Mom]

Welcome to the forum. What symptoms prompted you to look into a cushings diagnosis? What tests were run to determine cushings? Were other things ruled out first?
How much does your dog weigh? The recommendations are to start no higher than 1mg per pound of vetoryl (trilostane). Lack of appetite can be a sign of too low of cortisol. Did your vet give you prednisone in case this happens, and tell you the signs to watch for?

[Ebonysmom]

Thanks for the quick response. We have been fighting what we thought were severe skin allergies for several years off and on. Prednisone, antibiotics worked for awhile but they came back again and again. Eventually we saw a new vet in August and he asked if she had been tested for low thyroid and I did not believe that she had been. A thyroid test found she was and we started on .6 soloxine twice a day. Her thyroid levels are now good. 2 different antibiotics, special shampoo and we were still fighting the scratching and hair loss. I did ask about Cushings given that she had started to pant and drink excessively.

An ACTH stim test was done a week ago and the levels definitely indicated Cushings.

Ebony is 62.5 pounds. She had been as high as almost 80 before regulating her thyroid. The 60mg Vetoryl seems to be the recommended starting point. How soon should I ask for a retest? The vet said 30 days. Is the retest the same test as given for the diagnosis? It was $300, I was hoping that retests might be a little less.

I will get her levels from the vet office next week. I'll need to stop in and pick them up.

Thanks.

[lulusmom]

Hi and welcome to the forum.

Please do get all of the labs that were done and post the results here. With respect to the blood chemistry and complete blood count (CBC), we need only see the highs and lows and please include the normal reference ranges. An ACTH stimulation test does not tell you which form of cushing's (pituitary or adrenal) a dog has so I'm wondering if your vet did an abdominal ultrasound or another differentiating test to make that determination? If so, please include those test results. Did your vet do a urinalysis, including a culture to rule out a urinary tract infection? I would be most interested to see the USG (urine specific gravity). Cushdogs who have true polyuria/polydipsia have low specific gravity, very dilute urine and a good number of cushdogs have a UTI at the time of diagnosis.

Are you dosing your pup once or twice a day? If you feel that Ebony is not eating normally and/or if her inappettance gets worse, you should stop dosing and contact your vet. This could be a sign that cortisol is too low and to continue dosing is very risky. The acth stimulation test is used for both diagnosing and monitoring treatment. An acth stim test should be done no longer than 14 days after the start of treatment so your vet is not following proper protocol if s/he is telling you that Ebony does not need on until 30 days. She should one at 14 and 30 days. I know they are expensive but there is a reason why the manufacturer of vetoryl established this protocol. It is for the safety and well being of the dog. We've seen members whose vets have ignored protocol and it cost the member a lot more than an acth stim test because their dog(s) ended up in the ER on fluids for a day or two. I have provided a link to a wealth of information on Vetoryl that includes monitoring protocol. Some of us learned the hard way that placing blind faith in our vets can carry a heavy price tag for our dogs and that is why we encourage all members to educate themselves. It takes an experienced vet and an educated pet owner to facilitate safe and effective treatment. It is when one or both is missing that dogs get into trouble.

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

I'm sorry for the reasons that brought you here but I'm glad you found us. We'll help you in any way we can and you can help us provide more meaningful feedback by providing as much information on Ebony as possible.

Glynda

P.S. Symptoms can resolve rather quickly with effective treatment but skin and coat issues do take longer. Panting can also take longer as it takes a while to regain muscle mass and drop some of the excess weight that some cushdogs carry around the thoracic area. These are contributing factors as to why cushdogs pant.

[Renee]

While 60mg is the correct starting point for your 60lb dog, I do believe it has been shown that larger dogs respond to lower doses. If Ebony has lost her appetite so dramatically, I would be concerned that her cortisol is too low, and you'll want to reduce the dosage. I think I would drop back to just 30mg per day and work my way up.

Unfortunately, the stim testing is expensive but necessary. There really is not much way to get around it. In order to follow the proper protocols, you will need to do many stim tests in the beginning. I have been treating my pug since December, and next week is stim #5 or 6.

Did you vet run any other diagnostic testing? A single ACTH is generally not enough to diagnose cushings, because other issues in the body can skew the results.

[Ebonysmom]

Thank you for your responses. I did not give Ebony a pill today nor will I give her one tomorrow. I will contact the vet on Monday to discuss her not eating, lethargy and diarrhea.

I will get test results at that time as well. They did full blood panel and urinalysis, as well as the ACTH stim test. I suspect that they didn't do anything else because she had been off and on prednisone for several years due to what we thought was allergies.

[addy]

I did not give Ebony a pill today nor will I give her one tomorrow. I will contact the vet on Monday to discuss her not eating, lethargy and diarrhea

You were absoultey correct to withhold the pill, please do not give an more Vetoryl . We have seen many labs sensitive to the drug. Please try to post her diagostic tests results as Gylnda mentioned, ok?

[molly muffin]

Hello and welcome from me too.

It is possible her cushing symptoms were caused by the prednisone. How long had she been off prednisone prior to the ACTH test being done. Was she tapered off the prednisone?

Steroids can cause a type of cushings and usually the cushing symptoms will resolve once the steroids are not being given. Have you looked at possible alternatives from prednisone for the allergies? I know there has been a new drug approved in May 2013 for Allergies for dogs. (Zoetis' oclacitinib tablets (Apoquel) ) I am just wondering since it is possible that the prednisone has been the culprit here and that might be why there was an immediate reaction to the vetroyl too. (I am just throwing these ideas out for you to have a discussion with your vet about)

Sharlene and molly muffin

[Ebonysmom]

Ebony has not had prednisone since the fall (Sept or October).

[goldengirl88]

I just had time to look at your thread. Even though 60 mg is the dose for a dog the size of yours, it is not always the wisest decision to start high. If your lab is sensitive to this drug I would back up and start over at a lower dose. My dog is super sensitive to everything. One vet wanted to start my 18 lb dog on 30 mg right off the bat. I said no and demanded 10 mg pills to start. She is so sensitive I even went to the park across the street and waited there with her for hours to make sure nothing happened. Your dog may end up on 60mg, but maybe that is too much for his system to handle right now. If it were my dog I would stop the vetoryl and let the dogs system get stabilized again before starting on a much lower dose like 30 mg. You can always increase the dosage, and I do my increases in tiny increments which makes it a smoother transition, and is safer than increasing in big doses. You can buy compounded trilostane in smaller mgs from Diamondback Drugs. I use a combination of Vetoryl and trilostane. I would be questioning if your vet is experienced in treating this disease as you need someone who either knows what they are doing, or willing to work with you. Before I do anything with my dog, I come on here and check with the experience on this forum. I am glad you stopped the trilostane. Whenever in doubt, just stop and be safe. You can always restart. These are powerful drugs and I do not give my dog 1 mg more than she absolutely must have. I hope you get things straightened out, so your baby does well. Blessings
Patti

[Ebonysmom]

I did get the full blood panel report today and the only thing outside the normal ranges was that her platelets were increased (hers were 422 with the normal range of 170-400).

I know they did a urine test but those results weren't on this lab sheet but I was told that that was fine. No UTI.

Here are the ACTH results:

Pre-test - 2.8 Normal 1.0 - 5.0
Post-test - 23.9 (High) Normal 8 - 17

Hyperadrencorticism (HAC) Post ACTH results greater than 20 are consistent with HAC.

I hope these are the results that you were requesting. We have a vet appointment for Saturday to discuss treatment options for Ebony. Since discontinuing the medicine on Saturday, we have seen progressive increase in appetite, although still very loose stools. She hasn't gone yet today so we are hoping it will be better.

Thank you for your assistance.
Alison

[Ebonysmom]

Please see last reply for stim test results. She is is eating pretty much back to normal and had a regular bowel movement yesterday for the 1st time since last Wednesday after getting her first Vetoryl on Tuesday evening.

My thought is to suggest that we try the 30mg Vetoryl rather than the 60 mg that Ebony didn't tolerate. If she does ok on the 30 for the 10 days - retest at that time and re-evaluate dosage based on tolerance and test results. We have a vet appointment on Saturday and would appreciate any advice.

Thanks!
Alison

[Harley PoMMom]

Hi Alison,

I see that Ebony is on thyroid medication, was her thyroid level checked recently? I ask because if her level is high, which is known as Hyperthyroidism, this can cause increased drinking/urination.

Although Ebony's ACTH stimulation results are indicative for Cushing's we are not seeing the usual abnormal levels from her chemistry blood panel such as elevations in the ALP (Alkaline phosphatase) and cholesterol. On her urinalysis, did they find any crystals, stones, blood? Also, shown on the urinalysis should be her urine specific gravity (USG). was this low?

Hugs, Lori

[Ebonysmom]

Ebony's thyroid was just checked several weeks ago as we are only into the start of the 2nd month of her meds.

I was told her urine sample was fine but I will ask about those particular components when we go in on Saturday. I will take a sample in with us as well.

Thanks,
Alison

[Ebonysmom]

Thank you all for your help....your confirmation to stop the Vetoryl probably saved Ebony's life. The vet confirmed that today.

We met with her vet today. He is not convinced that she has Cushings. He feels certain that something is wrong - hormonal, autoimmune? The other vet in the practice dosed the Vetoryl. Her regular vet said he may not have given us the Vetoryl looking at her full blood panel. Yes, the ACTH stim was in the Cushings zone but her liver test was in the normal range and all her urine levels were in the normal range. The USG was low normal, but normal.

He is sending her urine out to the lab for a full urinalysis, a fungal test on her skin and a full thyroid panel sent either to Michigan or California (not just the normal t4 test). He put her back on an antibiotic and special shampoo for her skin and we will be adding vitamin E to her food. We already add 1200 mg of fish oil.

In addition he will do a referral to a specialty vet hospital to see a dermatologist.

I'll keep you posted on her progress.

Thank you again for your help!

[Renee]

Your regular vet sounds like he's making some good suggestions. I think you are on the right path to finding out what could be going on with Ebony!

[molly muffin]

Oh I am so glad you stopped the vetroyl and that your regular vet is going to get you a referral.

Hang in there. Hopefully you're regular vet along with an IMS will get this figured out. I agree with him, could be something else going on.

Sharlene and molly muffin