Need some info about Vetoryl (9 y/o dachshund)

[ljcornell]

My 9 year old dachshund, Harley, was just diagnosed with cushing's disease. He has a pot-belly, loss of fur on his back, drinks a lot of water, is hungry all the time, and has urinary incontinence. The doc wants to start him on 30 mg of Vetoryl and I am so afraid to give it to him. The side effects sound awful and some dogs have died from this stuff. I can't risk losing my dog to a bad side effect from a drug. Please let me know if anyone has tried this stuff and the problems they have encountered.

Thanks.
Lisa

[mytil]

Hi and welcome to our site. I am sorry you and your pup are having to deal with this. Here are some additional links to help you in understanding Cushing's, the available treatments and monitoring. http://www.k9cushings.com/forum/showthread.php?t=180

Firstly, when you get the chance post the results of the tests performed to come to the diagnosis of Cushing's. You can post the actual numbers. (usually there are several tests performed - LDDS, ACTH, elevated numbers associated with liver functions etc from a blood panel, and a high resolution ultrasound)

Here is a link to understanding more about Vetoryl/Trilostane - http://www.k9cushings.com/forum/showthread.php?t=185

Yes, these are strong medicines and if administered and monitored correctly, they are effective in controlling Cushing's and having your dog live out his normal life span.

Keep us posted
Terry

[addy]

Hi and Welcome,

In addition to Teriry's comments and links and making sure you have a correct diagnosis, I just want to add that you should be starting Vetoryl at no more than 1mg per pound to minimize side effects. Please let us know how much your pup weighs.

My pup was on Vetoryl just a few months shy of 3 years. Make sure your vet is up to speed as things have changed with Vetoryl the longer it is used here in the states. Double check how many dogs your vet has successfully treated with the drug and make sure you have good access to your vet - not a tech- direct communication is key.

Please read all you can about the drug and be a strong voice for your pup. All these things will result in lessening potential problems or dealing with them correctly if something arises.

Welcome again, glad you found us.

[goldengirl88]

Hi and welcome to the forum. I just want to add one thing. We need to know how much your dog weighs? It is very important that you start off on a low dose if yyou want the least chance of problems. 30 mgs sounds high to me for a dog that size. If it is Kore than 1 mg per pound, don't do it. Tell the vet you need a lower dose if it is too high. No matter what they say do not go higher, it causes problems. If you start low and watch your dog chances are it will be ok. When you give too high a dose it makes problems. Blessings
Patti

[Trixie]

My dog has been on Vetoryl for almost one year. She never had any side effects and her Cushings symptoms are now controlled and she's doing well. The important thing is to not give too much. How much does your dog weigh? The current recommended starting dose would be 1mg per pound of your dogs weight, and then after 10-14 days on that dose and acth test to see how the dogs level is and if the dose is correct or needs adjusting.
My dog weighed about 15 pounds when we started and we went in low with a dose of 6mg twice a day. After testing to check cortisol levels we slowly and steadily built up the dose to a higher amount until it controlled the disease. It takes time but if the dose is too high at the start you can run into trouble.

Unless your dog is about 30 pounds then that dose of 30mg could be too high and subject your dog to adverse reactions.
Yes, the medication has risks...but just so you see it from both sides-Cushings has risks too. The symptoms you see...drinking, eating, panting etc are all signs of bad things happening internally. So be cautious with the medication but don't think using it is any worse than not treating the disease. Of course that is a judgement made depending on the dogs overall health, age and severity of symptoms. For most dogs the medications are life savers and they can get back to normal, or close to normal with treatment. The owner needs to be vigilant when using the medication and work with a vet who has experience treating this disease.
I would definitely discuss the dosage with your vet though...the starting dose of 30mg is old protocol. You can check with Dechra the company that manufactures the drug to go over your dogs treatment plan.
If you post your test results here...blood work and tests for Cushings there are many experienced people on this forum who can help you.

Barbara

[molly muffin]

I'll send a big welcome your way too and reiterate what the others have said.

Starting at a lower dosage, diminishes the chances of having problems. It's a good idea to stick to the 1mg to 1lb to start out and see how she handles the medication and reacts to it.

Welcome
Sharlene and molly muffin

[KatyGirl]

Our Vet started Katy Girl a 26 pound Jack Russell on 30 mg of Vitoryl today. If you read the paper work that the company puts out they recommend 30 mg once a day for 10 to 22 pound dogs for initial treatment doseage. He also gave Prednisone to take if there is a reaction to the Vitoryl. Katy is 10 1/2 years old. We were trying to decide whether to treat or not and the Vet said that if we waited to treat Katy would die.

[molly muffin]

That is true what the insert says, Dechra hasn't changed their inserts to reflect what they are actually telling people and their own current study recommendations, which is the 1mg/1lb ratio. I wish they Would update their insert, as many people and vets go off that paper. grrrrrr

Sharlene and molly muffin

[KatyGirl]

Molly, you are probably right but I am stuck between a rock (the Vet) and a hard place (the husband) so I have no room to move. Doing the treatment with close watch for direaha, vomiting, or loss of appetite. I think Katy will be fine. Oh, Katy weighs 27 1/2 pounds on any given day, almost 30, right. lOL

[molly muffin]

I know you are in a hard place. I feel better knowing that you have pred on hand and a plan in place.
Check with us if you have any question or worries. You know that we'll be around to answer. :)

hugs
Sharlene and molly muffin

[ljcornell]

Thank you all for the information and guidance. Harley weighs 34 lbs. I know his AST was elevated, but I don't know the result. I also don't have the results of his Low Dose Dexamethasone Suppression Test. The vet gave the results of the test to me over the phone.

Regarding the Vetoryl, are the side effects lessened if you give the medication at night right before bed. I know it needs to be given on a full stomach. We feed our dogs after we get home from work around 11 pm. They are also fed first thing in the morning when we get up.

Also, has anyone tried using the natural supplements like Cushex or any of the others. I've read really good things about Cushex and I actually ordered some, but haven't received them in the mail yet.

Thanks for all your help. After talking to the vet today and you all tonight, I will start giving Harley the Vetoryl . I'm off work tomorrow and can monitor him all day. I think the dose is low enough for him and I also have prednisone on hand if there are problems. I'm praying all will be well with my sweet boy.

[Renee]

You'll want to give the dose in the morning, following the morning meal.

There really is nothing you can do to reduce side effects... except of course, follow protocols and be conservative. This will not reduce side effects per se, but it will greatly reduce the chance of negative side effects occurring in the first place. Low and slow is the safest way to go.

And, as soon as you receive the cushex, package it right back up and send it back for a refund. It's a waste of your money, frankly.

[goldengirl88]

Welcome to the forum. If this were my dog I would not be treating until I got copies of all testing and posted the abnormals so the forum can see them. The reason I say that is Cushing's is probably the hardest disease to diagnose. Other illnesses can have similar symptoms. You want to know for sure your dog has Cushing's before using these powerful drugs. Many vets are not familiar with or have experience treating Cushing's, and that can mean trouble. Never put blind faith in anyone including your vet. Please put your test results on here, and we will help you. This panel has many years of experience with this disease, which is what you need. You will also be the only advocate for your dog so please read and get up to speed on all things Cushing's. You are not alone, we are here to help and support you. Blessings
Patti

[Elsie's Mom]

Hi Lisa, I too have a dachshund, but she is a 12 lb mini. Like you, I was scared to death to start Elsie on Vetoryl/Trilostane, and I held off for quite a while after she was diagnosed, until I couldn't take the drinking and peeing any more! She was drinking about 30 oz of water a day, and couldn't make it more than two hours without peeing!

Elsie has been on Trilostane for just about 6 months now, and is doing really well! We have had absolutely no bad side effects, and she is happy and healthy! Her water consumption is still a bit high, and she'll never turn down food, but she has more energy, seems happier, and her fur is finally growing back from when it was shaved for surgery 3 years ago!

Elsie did start on 10 mg/day, but after the first ACTH stim test the vet wanted her to go to 10 2x/day, and I was not comfortable at all with that, so she went to 7 mg 2x/day, had a couple adjustments and for now is on 8 mg 2x/day, and doing well!

Good luck to you! Start low and go slow! It's not as scary as it seems!
--Torie

[ljcornell]

Thank you, Torie for your advice. I started Harley on his first Vetoryl this morning and I've been watching him like a hawk all day. He seems to be doing fine. I'm not seeing any changes in his behavior. He's not had any side effects at all.

The thing I have the most problem with is being sure that he really does have cushing's and not treating him unnecessarily. He is thirsty, but I'm not sure he's overly so. He would eat anytime you give him food, but what dog wouldn't? He drips pee all the time, but is it from Cushing's? Couldn't he just be incontinent from his age? He doesn't normally pee in his sleep. I'm not convinced yet that I'm doing the right thing. I guess time will tell and if things don't improve, I'll stop giving him the medicine. I felt good about it after I talked to the vet yesterday and then today I've been reading more and I'm not so sure again. It says that Cushing's left untreated is not a death sentence, but others say it will cause other problems if left untreated. What and who should I believe. I trust my vet. I know that she has Harley's best interest at heart. I will play this out and keep a very very watchful eye on my dog.

Thanks again, Torie!
Lisa

[goldengirl88]

If you are not convinced that your dog has Cushing's then why would you give Vetoryl? Did you get copies of the testing as you did not post the numbers. We can't help you unless you post the numbers so we can a see what is going on. If you are solely and blindly trusting a vet you are making a mistake. Many vets no very little about Cushing's, or how to treat it. Please if you value your dog get us the numbers and do not start the Vetoryl until we can see what is happening. Blessings,
Patti

[Squirt's Mom]

Two things -

1) when that Cushex comes in, send it right back and get your money back from those predators that sell it. It may help some pups with their signs but it can also cause more problems as there are ingredients in it that a cush pup does not need. This product has one purpose and one purpose only - to make the ones who make and sell it rich off of the fears of new cush parents. Send it back to them. ;)

2) in your shoes, if I had the LEAST doubt, I would not be giving such a powerful drug to my baby. These are not drugs to be played around with - they can and do cause irreparable damage, even death when misused. I would like you to do us a big favor. PLEASE get copies of all the testing done to arrive at the Cushing's diagnosis and post those results here. If you choose to continue giving Trilo in spite of your doubts, you must keep an extra close eye on him for any signs he is in crisis. Did your vet tell you what to look for that would indicate he is in trouble?

Many of us felt complete trust in our long time vets when our babies were diagnosed with Cushing's....only to learn the hard way they were not equipped to deal with this condition. Please do not place blind faith in your vet or any vet. Learn all you can so you can be an advocate for your boy. You are his only voice.

Hugs,
Leslie and the gang

[Renee]

I am going to second Patti and Leslie.

Vetoryl is a powerful drug, and should never, ever be used on a dog that may not have cushings. It is not the type of drug where you can 'try it out' to see if it has an effect or not.

Please stop the medication immediately until you are 100% sure about the diagnosis and have had a chance to educate yourself.

[ljcornell]

Thanks everyone. I won't give Harley the Vetoryl any more until I get the results and post them on this site. I've asked the vet to mail them to me so I should be getting them soon.

[Renee]

Thanks everyone. I won't give Harley the Vetoryl any more until I get the results and post them on this site. I've asked the vet to mail them to me so I should be getting them soon.

Excellent!

[ljcornell]

If you are not convinced that your dog has Cushing's then why would you give Vetoryl?
Did you get copies of the testing as you did not post the numbers. We can't help you unless you post the numbers so we can a see what is going on. If you are solely and blindly trusting a vet you are making a mistake.

First, I'm giving Harley Vetoryl because his veterinarian recommended it. If I can't trust my vet, then who can I trust? She's been taking care of Harley since he was born and I know she would never do anything to hurt him. We live in a pretty small town so I'm sure she doesn't have tons of experience treating Cushing's, but she does have some. She has another Dachshund with Cushing's that they are treating with Vetoryl that is doing very well. I'm not blindly doing anything. I have read and read and read everything I can get my hands on regarding this disease. I work as a lab tech and understand the difference between sensitivity and specificity of tests and it scares the crap out of me that the specificity of the LDDST that was used to diagnose Cushing's Disease is very poor.

Many vets no very little about Cushing's, or how to treat it. Please if you value your dog get us the numbers and do not start the Vetoryl until we can see what is happening.

I love my dog dearly and would never do anything to harm him. I will share the lab results as soon as I receive them in the mail.

Blessings,
Patti

Thanks for your concern, Patti.
Lisa

[doxiesrock912]

Lisa, welcome to the forum :)

Too many of us have experience with great vets who don't know enough about Cushings. Every dog's situation is truly unique when it comes to Cushings which makes determining the proper treatment for each one difficult. Dechra, the manufacturer of Vetoryl has outdated information of the insert of the box and many vets still follow those instructions which is dangerous.

We took Daisy to three vets before finally seeking the help of an IMS vet where she is finally being treated properly. If I hadn't learned what I did from the people here, I wouldn't have recognized their mistakes and Daisy wouldn't be here now.

People here aren't vets but many of them have more experience with Cushings than many vets do and they can interpret the test results and let you know if Harley is being treated the right way. Wrong treatment of Cushings can be life threatening.

Lastly, if there are any other medical conditions present the tests results might not be accurate so those need to be addressed first.

[Renee]

Lisa,

I just want to jump in here and say that no one is trying to make you feel defensive or like we are attacking you.

I think that many people on here have been through the ringer with bad vets, bad advice, etc, etc... and, so when someone comes here looking for help, and we see dangerous decisions being made, we generally just jump right in!

In some respects you are correct - if you can't trust your vet, who can you trust? But, when it comes to taking medications that could potentially cause irreparable injury (including death), it's just not enough to say that if you can't trust your vet, than who can you trust. That is not a safe mentality to have when we are talking about drugs like vetoryl or lysodren.

This is generally why everyone on this forum will request you to post all your lab results. This way, when we offer advice, it is with those concrete figures in front of us.

Vetoryl is fairly new and the product insert from Dechra has become outdated, even in that short time. Many vets are woefully uneducated about it, due to lack of experience, and on top of that, a good number of vets have pride that does not allow them to admit they may be wrong, not know something, or they are not willing to take/share advice with the dogs owner. Just read through even a few of the threads on this forum and you will see this played out over and over again. Inexperienced vets, with owners that don't know any better (not their fault), and bad things happen for the dog.

Anyways, sorry that got so long. The point was to try and help you see that we are on your side, on your dogs side.... we can just be a little blunt sometimes!

[goldengirl88]

Lisa:
These are not personal attacks on you. I am sorry if you feel that way, but it was not meant in that manner. As far as your vet goes, we are not attacking your vet. You must understand however that few vets have experience with this disease as you too admitted your vet did not. Your vet may not intentionally hurt your dog, but her lack of experience and understanding of how to treat your dog could, that is all I am trying to say. So as far as trusting your vet, the harsh reality is you can't take anything for granted as it can come back to bite you. We have seen time and time again vets making crucial mistakes with this disease that can cost the dog its life. My biggest interest is to get the owner to understand I am only concerned about the dogs welfare and safety, not attacking anyone. We see so many dogs on here being misdiagnosed and not being properly managed. I know you would never hurt your dog. Your education into Cushings sis crucial to the correct management of this disease, and will only help your dog. We are just trying to let you know that there are many other diseases that have symptoms similar to Cushing's and there for you need a diagnosis using the correct
testing protocol, which all vets do not do. We are here to support you, help you on this journey, and educate you so your dog can live out its natural life. We cannot guide you with no test results, as that is flying blind. These are powerful drugs, not to be taken lightly. We want to make sure your dog has Cushing's so there are no mistakes. Blessings
Patti

[molly muffin]

Hi Lisa,

A vet with not a lot of experience need not be a bad thing, If they are willing to do plenty of research and work with you as a team for what is best for Harley then that can be very beneficial. There should be an IMS that they can call upon if they have any questions about anything. So don't get discouraged.

I know one thing, no one shows up on this forum, who does not love their dog and want to find out everything they can to help them. Kudos to you.

I think what worried many, was when you said you didn't feel convinced that Harley had cushings. That scares people and we have had seen some vets who aren't necessary as devoted as we would hope for to the dogs care. I know that is very sad, but it happens.

So, what makes you question whether Harley has cushings or not? What questions do you have that we can help you with?

One thing is that you can start and stop vetroyl with no problems. So, it won't hurt to make sure before you start back on meds, or discover if there is another reason.

It's a journey, that's for sure. :)

Sharlene and molly muffin

[Squirt's Mom]

Another factor for my concern based on your doubt is this - when Vetoryl (Trilostane) was first released it came with the hype that it was "safe", that it would not cause adrenal necrosis resulting in a permanent Addison's state or worse, death, like Lysodren. In the time it has been in use, we now know differently. It is no safer than Lysodren - it simply works differently and has a shorter life in the body. WE see this clearly because we see this happen in our membership over and over HOWEVER most vets do not see the sheer number of cases that we do - nor do they keep up with the changes in the cush world like we do. ;) They rely on the information in the product insert - which is no longer correct yet has not been updated and is not apt to be any time soon.

So we see vets who throw this drug at dogs because they still believe it is "safe" based on outdated info. If the diagnosis is wrong, no big deal with a "safe" drug, right? Wrong...so terribly wrong. So we speak up ANY time we see something that causes us concern - and your own doubts are reason enough for us. See...we believe that no one knows our babies better than we do; no vet, no test, no one. We know our own babies inside and out and as such we trust our guts first and foremost, not the vets. We are listening to YOUR gut, too. ;)

[ljcornell]

Good news! I have the results from the vet. Here they are:

CBC - normal except:
RDWR 18.4% H 12.0 - 17.5
HGB 19.3 g/dL H 12.0 - 18.0

Chemistries - normal except:
ALP 295 U/L H 0 - 140

Dexamethasone Suppression - 3 Samples:

Cortisol (PRE) 4.7 ug/dL 1.0 - 6.5
Cortisol (4HR) 8.5 ug/dL
Cortisol (8HR) 6.7 ug/dL

I'm not sure by these results how the vet diagnosed Harley with PDH, because the report says:
"PDH or Functional adrenal gland tumor: Cortisol concentrations greater than 1.4 ug/dL at both 4 and 8 hour post-dexamethasone." So that sounds like they can't tell with these results which type it is: pituitary or adrenal. "PDH only: Cortisol concentration less than 1.4 ug/dL at 4hr but greater than 1.4 ug/dL at 8 hr is highly indicative of PDH. Cortisol levels less than 50% of the baseline value at 4 or 8 hours is more consistent with PDH." I don't really understand the bold statement.

I really appreciate any and all help with these results. Harley seems to be urinating alot more the last two days. Not sure if having him on Vetoryl for one day made things worse.

Thanks for helping me out and I'm sorry if I'm overly sensitive, but he is my baby and I love him dearly.
Lisa

[Renee]

Well, the LDDS is definitely consistent with cushings, but I do not believe it points to PDH or ADH. My pug had an LDDS which was inconclusive for pituitary vs adrenal (just like yours), but through CT scan, we did determine it was pituitary.

Have you thought about doing any imaging?

[Squirt's Mom]

An abdominal ultrasound will help a great deal to determine which form. In PDH both adrenal glands are typically enlarged. In ADH we typically see one gland very large while the other is much smaller, even atrophied. The ultrasound will also give them a good look at other organs to make sure there aren't any issues with them that could result in elevated cortisol that has nothing to do with Cushing's. An elevation in cortisol is NORMAL anytime there is stress of any kind - internal or external - so diagnosing Cushing's is a process of ruling out other things as much as anything else.

The ALP is higher than normal but we see that value in the 1000's many many times so Harley's elevation isn't anything shocking in the least. ;)

[ljcornell]

Well, the LDDS is definitely consistent with cushings, but I do not believe it points to PDH or ADH. My pug had an LDDS which was inconclusive for pituitary vs adrenal (just like yours), but through CT scan, we did determine it was pituitary.

Have you thought about doing any imaging?

I haven't, Renee. I think it would be pretty cost prohibitive for us. Is treatment different for PDH vs. ADH?

[ljcornell]

An abdominal ultrasound will help a great deal to determine which form. In PDH both adrenal glands are typically enlarged. In ADH we typically see one gland very large while the other is much smaller, even atrophied. The ultrasound will also give them a good look at other organs to make sure there aren't any issues with them that could result in elevated cortisol that has nothing to do with Cushing's. An elevation in cortisol is NORMAL anytime there is stress of any kind - internal or external - so diagnosing Cushing's is a process of ruling out other things as much as anything else.

The ALP is higher than normal but we see that value in the 1000's many many times so Harley's elevation isn't anything shocking in the least. ;)

"Alkaline phosphatase is a non-specific metalloenzyme which hydrolyzes many types of phosphate esters at an alkaline pH in the presence of zinc and magnesium ions. There are different isoenzymes (gene products) and isoforms (posttranslationally modified gene products). The main use of ALP is as a sensitive indicator of cholestasis in the dog (it will increase before bilirubin), however it is non-specific because corticosteroids (exogenous or endogenous "stress") induce increases in this enzyme. In the cat, ALP is a very specific indicator of liver disease, whereas in large animals, the enzyme is not very useful as it is insensitive, cholestatic disorders are infrequent, and reference intervals are quite broad."(1)

Reference: (1)https://ahdc.vet.cornell.edu/sects/ClinPath/modules/chem/alkphos.htm

Harley gets VERY stressed at the vet. His fur starts dropping as soon as we hit the door. Could that cause his ALP to be so high?

[Renee]

Yes, cost is absolutely a factor when considering imaging. I completely understand that. We spent about $1,300 for the CT for Tobey.

The treatment can be different, because when an adrenal tumor is present, then surgically removing the tumor *may* be an option. There are a few threads on here from people that have had success with removing adrenal tumors. With PDH, there is no removing the tumor (although some have done radiation!).

For people that cannot remove an adrenal tumor, then the treatment is much the same as it would be for PDH, using either lysodren or vetoryl.

[Squirt's Mom]

Chemistries - normal except:
ALP 295 U/L H 0 - 140

Again, this is not very elevated at all - we see this value MUCH MUCH higher every day here so don't let this very slight elevation concern you. ;)

And you are right - many things can cause the ALP to increase but it will also go back to normal all on its own. It would not be out of the question for the stress of the vet visit to cause the hair to start falling immediately - my own have done this. And stress from the visit can have an effect on lab work but again not to the levels that would indicate a real problem.

Our IMS told me a couple of years ago when I was fretting about my babys' APL values (too high to be recorded in fact!) that he was not in the least concerned about it. He said the ALP indicates LIVING liver cells and elevations mean the liver is working extra hard for some reason. As long as it is just the ALP, he doesn't worry especially in a cush pup as that is part of the deal. Now if the ALT, AST and / or GGT also have elevations, and higher elevations that remain over several tests, then there could be a problem with the organ. The ALT, AST, and GGT represent dying liver cells according to him. So as long as those values remain normal or return to normal, he doesn't worry.

[ljcornell]

Hi all!

I'm waiting for someone to give me some guidance as the whether they believe I should start treating Harley for Cushing's from the results that I posted.

Thanks for any and all help!
Lisa:D

[Harley PoMMom]

Hi Lisa,

A belated welcome from me to you and Harley! Cushing's is one of the most difficult diseases to diagnose and unfortunately, it is also one of the most misdiagnosed. There isn't just one test that is conclusive, so a vet has to rely on more than one diagnostic and validation test. Harley's LDDS test is indicative for Cushing's but does not differentiate between the adrenal or pituitary type of Cushing's. If this were me, I would have an ultrasound done. An ultrasound can be a very useful diagnostic tool as it can show irregularities in the internal organs. An ultrasound may also be able to distinguish between PDH and ADH if both of the adrenal glands are visualized.

Does Harley have diluted urine? Is he taking any other herbs/supplements/medications?

We are here to help in any way we can so do not hesitate to ask all the questions you want. ;)

Hugs, Lori

[ljcornell]

Ok, here's my dilemma in treating Harley for Cushing's. I don't feel he has enough symptoms to be treated medically. I don't feel he has a "pot belly". His belly is almost the same level as his chest, but it's not a pot shape. He doesn't drink excessively. He doesn't eat constantly. Sure he would eat all the time, but what dog wouldn't? The vet didn't even check his urine, but when he drips in the house, it's yellow, not colorless. He's doesn't urinate constantly, he drips when he walks and sometimes when he wakes up or barks.

So, what kind of problems am I facing if I don't treat him now.

[doxiesrock912]

All of the symptoms that you have described are present with Cushings. Often the pot belly is one of the last symptoms to show up. At least it was with Daisy.

As Cushings progresses, they become prone to skin infections, UTIs, muscle wasting, loss of fur, and organ damage from prolonged exposure to the cortisol being too high.

Have they ruled out other possible causes for the incontinence (dripping urine)?
Ruling out other problems is important because they can also affect test results which need to be accurate in order to treat Cushings properly.

Cushings progresses slowly so I would rule out other possibilities and then retest before starting treatment if you're still unsure.

As others have said, a good dose to start at is 1mg per 1 lb. Many dogs do better with taking half the dose in the morning with a meal and the other half 12 hours later with a meal.

[Squirt's Mom]

A cushing's dog's appetite is something to behold and once seen, you will never again be able to say "what dog wouldn't want to eat all the time?" When the cortisol is elevated to the levels seen with Cushing's, the dog literally feels as if they are starving 24/7. They will wolf down a bowl of food then look at you as you never feed them and start hunting for more to eat immediately. They beg, they eat trash and other unsavory things just trying to stop the feeling of starving.

One of Squirt's nicknames is Miss Piggy and when we started this journey I told everyone that appetite would not be a reliable sign for her. BOY was I wrong! Once that appetite kicked in, there was no doubt it was vastly different from her usual Miss Piggy ways. ;)

If I were you, I would not treat for Cushing's but would do further testing to see why he is have some continence issues. It could be simple aging and he will need a diaper. But I would not start any treatment in your shoes right now.

[Renee]

I agree with Leslie. The appetite associated with cushings is quite different from the average dog. My girl will literally wake me up multiple times a night to eat. She eats kleenex, any trash, basically anything. And is always hungry. She used to take treats so nicely, but now she wants the food so bad that she will bite my fingers to get to it quicker. She even started choking on her food, she was trying to eat it so fast!

For the incontinence, have you tried anything like proin to help with that?

[goldengirl88]

I agree with Leslie and Renee and the reason why is my little Tipper goes along the baseboards in the house and looks for fuzz to eat!! These dogs will eat anything. Tipper tries to get worms when it rains!! Blessings
Patti

[Renee]

I agree with Leslie and Renee and the reason why is my little Tipper goes along the baseboards in the house and looks for fuzz to eat!! These dogs will eat anything. Tipper tries to get worms when it rains!! Blessings
Patti

Oh, I forgot about the worms! Yes, Tobey started eating worms last summer, before we got the diagnosis. Ughhhh YUCK!

[ljcornell]

As Cushings progresses, they become prone to skin infections, UTIs, muscle wasting, loss of fur, and organ damage from prolonged exposure to the cortisol being too high.

Harley has had skin infections his whole life. He has been treated many, many times with antibiotics and steroids. The vet said he has a weak immune system because he is a purebred dog. That's why I'm not sure his loss of fur on his back, which isn't a complete loss, is from Cushing's. He rolls on his back and rubs several times a day. I just think it feels good to him and I know it itches.


Have they ruled out other possible causes for the incontinence (dripping urine)?

He's had several UTI's, but I could always tell when he got them because he would also drip blood. He wasn't neutered at the time and the vet told us that he needed to be neutered or he would continue to have UTI's due to a prostate issue. She said she talked to a vet at U of I in Champaign, IL that made that recommendation. So we got him fixed and that when he started putting on weight. He also has an inguinal hernia on his right side which has previously been repaired twice and is back again. That was the original reason I took him to the vet, when a new vet looked at him and immediately thought he had Cushing's. Not sure she even reviewed his history before coming in the room and looking at him. I've told them multiple times about his incontinence. I took him to another vet for a look at his hernia because this one can't seem to fix it and told him about the incontinence too and he said it could be from the hernia. Right now they won't even address his hernia until his Cushing's is under control. Well, I'm not so sure he has Cushing's!


Ruling out other problems is important because they can also affect test results which need to be accurate in order to treat Cushings properly.

Agree. If they would only listen to me.


Cushings progresses slowly so I would rule out other possibilities and then retest before starting treatment if you're still unsure.

As others have said, a good dose to start at is 1mg per 1 lb. Many dogs do better with taking half the dose in the morning with a meal and the other half 12 hours later with a meal.

They prescribed 30 mg and he weighs 32 lbs so I guess they are doing something right!

[ljcornell]

A cushing's dog's appetite is something to behold and once seen, you will never again be able to say "what dog wouldn't want to eat all the time?" When the cortisol is elevated to the levels seen with Cushing's, the dog literally feels as if they are starving 24/7. They will wolf down a bowl of food then look at you as you never feed them and start hunting for more to eat immediately. They beg, they eat trash and other unsavory things just trying to stop the feeling of starving.

I have seen Harley eat toilet paper rolls before and he will eat dirt when he's outside. So maybe I'm not catching him eating all the crap or like you said his levels haven't reached peak yet.

One of Squirt's nicknames is Miss Piggy and when we started this journey I told everyone that appetite would not be a reliable sign for her. BOY was I wrong! Once that appetite kicked in, there was no doubt it was vastly different from her usual Miss Piggy ways. ;)

If I were you, I would not treat for Cushing's but would do further testing to see why he is have some continence issues. It could be simple aging and he will need a diaper. But I would not start any treatment in your shoes right now.

Now how do I get the doctor to look into the incontinence issues? We do put a diaper on his, but he manages to slip out of it.

Thanks for all the info. I appreciate it. Hopefully we'll get this figured out.
Lisa

[ljcornell]

Oh, I forgot about the worms! Yes, Tobey started eating worms last summer, before we got the diagnosis. Ughhhh YUCK!


Yuk!!! Worms??? LOL! Haven't seen Harley do that yet!

[ljcornell]

Hi Lisa,

A belated welcome from me to you and Harley! Cushing's is one of the most difficult diseases to diagnose and unfortunately, it is also one of the most misdiagnosed. There isn't just one test that is conclusive, so a vet has to rely on more than one diagnostic and validation test. Harley's LDDS test is indicative for Cushing's but does not differentiate between the adrenal or pituitary type of Cushing's. If this were me, I would have an ultrasound done. An ultrasound can be a very useful diagnostic tool as it can show irregularities in the internal organs. An ultrasound may also be able to distinguish between PDH and ADH if both of the adrenal glands are visualized.

Does Harley have diluted urine? Is he taking any other herbs/supplements/medications?



We are here to help in any way we can so do not hesitate to ask all the questions you want. ;)

Hugs, Lori

Lori, thanks for your reply and welcome. I don't notice that Harley has dilute urine. When he drips on the floor it's yellow. He's not taking any other meds. Sometimes I give him bladder support vitamins, but I'm not very consistent with it. They don't help anyway. I think they make things worse, actually. I give him blueberry, cranberry treats and they help him quite a bit.

[ljcornell]

I agree with Leslie. The appetite associated with cushings is quite different from the average dog. My girl will literally wake me up multiple times a night to eat. She eats kleenex, any trash, basically anything. And is always hungry. She used to take treats so nicely, but now she wants the food so bad that she will bite my fingers to get to it quicker. She even started choking on her food, she was trying to eat it so fast!

For the incontinence, have you tried anything like proin to help with that?

Hi, Renee!

No, I haven't given Harley proin for incontinence. The only thing I've tried is Bladder Support vitamins and blueberry/cranberry treats. I'm not very consistent giving him the vitamins mainly because they seem to make it worse rather than better. I am interested in proin? Is it prescription or over the counter. I've looked for over the counter stuff, but haven't had any luck finding anything.

Thanks for your help, Renee!

[ljcornell]

One more quick thing that I forgot to mention...Harley was born with a heart murmur too. So, it worries me anytime I try something new with him.

Lisa

[goldengirl88]

Lisa:
Please do not give Proin, it is really bad stuff. Asked Leslie on here and she can tell you. This product has caused a lot of deaths. Blessings
Patti

[Renee]

Lisa:
Please do not give Proin, it is really bad stuff. Asked Leslie on here and she can tell you. This product has caused a lot of deaths. Blessings
Patti

I guess I will have to disagree, and say that each person must decide for themselves. I have known several rescue dogs that successfully used proin, and it improved their quality of life. And they are still alive.

[goldengirl88]

Proin used to be used in women, until it was killing them off from strokes and heart attacks. It does the same thing to dogs and give them high blood pressure too. I would never ever even think of using this crap. I would rather have a dog with a wet doggy diaper, than a dead dog. Bad stuff but I respect your opinion on it. Blessings
Patti

[Squirt's Mom]

Proin nearly killed Squirt.

http://www.fda.gov/downloads/AnimalV.../UCM296349.pdf


Table 6: Adverse reactions in the 28-day placebo-controlled clinical study
Adverse Reactions
PROIN
-
treated (N=123) (first number)
Placebo (N=61) (second number)

Emesis 20.3% 8.2%
Hypertension (≥ 160 mm Hg) 19.5% 14.7%
Anorexia 16.3% 3.3%
Body weight loss (≥5%) 16.1% 6.8%
Proteinuria 13.0% 8.2%
Anxiety/aggression/behavior change 9.7% 3.2%
Diarrhea 7.3% 9.8%
Polydipsia 6.5% 9.8%
Lethargy 5.7% 1.6%
Musculoskeletal disorder .2% 1.6%
Insomnia/sleep disorder 2.5% 0.0%

She experienced all of these but I put them off to other things for nine months. The drug caused a seizure then that she nearly didn't survive. It was 2-3 months before she was past the crisis and has lasting effects still today.

http://www.livestrong.com/article/25...ects-of-proin/


Allergic Reaction

Dogs that are allergic to phenylpropanolamine or any of the components of Prion should not be treated with this medication. Improper use of Proin by hypersensitive dogs may induce a severe and potentially life-threatening allergic reaction. Symptoms of a hypersensitive reaction in dogs include weakness, seizures, pale gums, facial swelling and difficulty breathing. Dogs who exhibit any of these side effects after taking a dose of Prion should be transported to an emergency veterinarian clinic immediately.

Not all dogs react like Squirt did but enough have around the world that this drug has been banned in some countries for both humans and animals. If you wish to use Proin, that is of course your choice but I will never allow another dog in my care take one single dose. ;)

[labblab]

I'm gonna be a bit of a devil's advocate here regarding the use of Proin, because I also know a couple of folks who have given it to their dogs and have been pleased with the results. Out of curiosity, I followed the FDA link to the drug's product application and admittedly only skimmed the contents, but the report's conclusion is that the drug is generally safe and effective when used as recommended. In looking at this listed table of side effects, three of the listed effects were actually more common in the placebo group than in the treatment group.

Emesis 20.3% 8.2%
Hypertension (≥ 160 mm Hg) 19.5% 14.7%
Anorexia 16.3% 3.3%
Body weight loss (≥5%) 16.1% 6.8%
Proteinuria 13.0% 8.2%
Anxiety/aggression/behavior change 9.7% 3.2%
Diarrhea 7.3% 9.8%
Polydipsia 6.5% 9.8%
Lethargy 5.7% 1.6%
Musculoskeletal disorder .2% 1.6%
Insomnia/sleep disorder 2.5% 0.0%

Interestingly, neither stroke nor seizure (except as an acute allergic reaction) are listed as adverse effects that were associated with this drug when used in dogs, even though increased risk of stroke was the reason the drug has been prohibited for human use.


Phenylpropanolamine was once available in numerous forms on the shelves of every drug store but two problems have changed that. The first problem is that this drug was found to cause an increase in the incidence of strokes and cerebral hemorrhage in people age 18 to 49. The second problem is that phenylpropanolamine can be used in the illegal production of methamphetamine. The drug was withdrawn from the human market and restrictions have been placed on quantities of the veterinary product that can be ordered at one time. Fortunately for dogs, phenylpropanolamine is a generally safe drug for dogs and has been a great boon in the treatment of urinary incontinence.

http://www.veterinarypartner.com/Content.plx?P=A&A=614&S=0&EVetID=3004065

Most current veterinary drug sites that I have visited do express cautions re: using Proin in dogs with known cardiac/renal issues or pre-existing elevated blood pressure. So it might be a very good idea to first check the blood pressure in any dog for whom the drug is being considered. And certainly, the drug should be discontinued for any dog who does experience ill effects as Squirt did. But overall, it does not seem to me to be considered a drug that is generally unsafe for veterinary use.

FWIW, here's a link to a fairly detailed article by Mary Strauss on Dogaware.com that discusses a number of features/remedies (including Proin) that may be helpful in addressing canine incontinence:

http://dogaware.com/articles/wdjincontinence.html

Marianne

[Renee]

Well, I would certainly never recommend something known to kill dogs / women, but as Marianne pointed out, there are some for whom this drug has worked well. I can name off at least three dogs I know in the rescue community that used this drug and has success.

I guess the point would be that each person must decide for themselves, based on their own research. I only brought up the proin as a possibility or something to consider when dealing with incontinence, if that is a big issue.

[labblab]

P.S. question to Leslie: I see that there is a specific contraindication to giving Anipryl and Proin at the same time (can result in excessive fluctuations in blood pressure). NSAIDS and Amitraz (in some tick control products) also carry this risk. Was Squirty on Anipryl at the same time as the Proin? If so, perhaps that could account for some of her discomfort...

(And Lisa, thank you for allowing us to momentarily "hijack" your thread for this discussion!)

Marianne

[goldengirl88]

I respectfully disagree. If someone came to me and said they had a drug that would help Tipper's incontinence, but it could cause high blood pressure, stroke or heart attack, I am sorry but that is a deal breaker for me. It is everywhere that this drug is dangerous, but I have never seen anything saying it is safe, so that is indisputable to me.

[ljcornell]

FWIW, here's a link to a fairly detailed article by Mary Strauss on Dogaware.com that discusses a number of features/remedies (including Proin) that may be helpful in addressing canine incontinence:

http://dogaware.com/articles/wdjincontinence.html

Marianne

Thanks, Marianne. I will check this website out and try to determine if there are other options. There is a natural product for urinary incontinence on petmeds.com that I thought about trying first.

[Squirt's Mom]

No Squirt hadn't started the Selegiline when she was on Proin.

[labblab]

I think this is a topic that merits more discussion, but not at the expense of us taking over Lisa's thread. ;)

So I am going to create a new thread about Proin on our "Everything Else" forum and shift copies of our replies so that any additional conversation can continue there. Here is the link to the new thread where we can proceed with any further discussion.

http://www.k9cushings.com/forum/showthread.php?p=146165#post146165

Marianne

[ljcornell]

Good discussion everyone! You've given me lots of stuff to think about. I will do lots of research before I decide to treat Harley's incontinence issue with a prescription any prescription med as I have with his Cushing's disease and Trilosane. I believe I've made the right choice in not treating him right now for Cushing's. He doesn't the the starving symptoms that you all describe. Today I tried to give him a worm and he wouldn't touch it :) I also tried a strawberry and he wouldn't have anything to do with that either. However, if I offered him meat or cheese he would gobble that right up as any normal dog would. :D Right now I'm going to focus on researching this incontinence thing. Petmeds.com has a natural product that I may try. I also have a doggy diaper, but he wiggles his way out of it all the time. His chest is so big it just pushes it right off lol! He's a big wiener dog! And he's strong! He loves digging and playing with rocks!

Thanks again everyone and feel free to steal my thread anytime you wish lol!
Lisa

[goldengirl88]

You probably think we are all nuts right about now!!! I just wanted to say maybe the belly bands are a better option, the ones you can put the sanitary pads inside them. I used them to potty train my Yorkie so he did not have any accidents on my rugs and they worked out well. Blessings
Patti

[Squirt's Mom]

I finally got Squirt's measurements and am going to order one of these -

http://peekeeper.com/

[ljcornell]

I finally got Squirt's measurements and am going to order one of these -

http://peekeeper.com/

That's so funny, Squirt's Mom, cause I just ordered one for Harley today :)

[ljcornell]

You probably think we are all nuts right about now!!! I just wanted to say maybe the belly bands are a better option, the ones you can put the sanitary pads inside them. I used them to potty train my Yorkie so he did not have any accidents on my rugs and they worked out well. Blessings
Patti

The belly band is what we have, Patti and he wiggles right out of that too. Doesn't matter how tight we put in on. So I ordered another type today that was suggested on a website -- no escape kind. That's what I need because Harley is an escape artist!!!;)

[molly muffin]

Oh that is funny. You and Leslie will be able to compare experiences. :) We'll all be waiting to hear about This adventure. :)

Sharlene and molly muffin

[Budsters Mom]

Don't laugh Sharlene, We may need "Pee Keepers" before long! That little red number is quite attractive! Lol :D:D:D

[My sweet Ginger]

Then you will all be thanking me.:rolleyes::o

Just a few reminders for new PeeKeepers users from a long time user;

1) The colors bleed like crazy (for a long time) so DO NOT mix with other light colored when washing.
2) Do your own experiment before settling on human diaper pads. The ones recommended totally didn't work for us : too thin and too long so the diaper harness got wet each time Ginger went pee.:eek:
I had to get very creative to get them work perfect for us.
3) Don't get frustrated so soon, you will become a pro after a few practices to put them on and off.;)
4) Get a spare if you like this and it will come in handy after sometime #2 accidents as this only takes care of #1 or for washing purpose.

After these are taken care of, they work fantastic and she even looks like a fashion savvy.:cool:

[goldengirl88]

Song:
Great tips for using this. I am glad there is something like this as so many on here can use this. I would go for a spare too good idea. Blessings
Patti

[My sweet Ginger]

I don't know where I'd be today without these diapers because she was going so many times, so randomly through out the day.:)

A few more to add, I must say I wouldn't know how differently boy's works but thinking and hoping as good as girl's.
I've found it easy going head first then a front leg then a rear leg then the tail to put it on and the exact opposite way taking it off. It's not as easy as you might think at first:rolleyes: especially when the Velcros get in the way relentlessly.:eek: I'm the only one who can handle these in my house or maybe the others are just being smart about it as usual.:(
You have to stay on it otherwise your pup will get diaper rashes just like babies.:o Try to keep it as dry as possible.
I hope this will be helpful.

[ljcornell]

Quick update on Harley..after talking with his vet, I decided to start him on Vetoryl. He's been doing really well and has had no side effects. His fur is starting to come back, but I haven't noticed a drop in his weight at all. He does have more energy that's for sure. He still drips urine, though :) He takes 30 mg a day. The 2 week check showed that his cortisol had dropped but not as much as the vet would have liked, so they told me to increase his dose to 1 and 1/2 pills a day and bring him back in 2 weeks for another check. I haven't started doing that yet because it's impossible to split the capsule in 1/2. Any ideas? This medicine is so expensive, I don't really want to buy a 30 mg and 10 mg dose. :confused:

[goldengirl88]

Welcome. Sorry but Dechra specifically states do not open capsules. You can get many different mgs at Diamondback or California pet pharmacy. It is compounded trilostane, it will save you money. Please think twice about using a vet that tells you to split capsules, as that is very scary to me. Blessings
Patti

[labblab]

In addition to the danger of splitting the capsules, Dechra also generally recommends waiting until after 30 days before increasing a dose. This is because cortisol levels can continue to drop during these first few weeks, even when the dose has not been changed. For both those reasons, increasing the dose this early in treatment may not be a good idea. Here is a link to Dechra's Treatment and Monitoring Flowchart which confirms this information.

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

Marianne

[My sweet Ginger]

I'm not a trilo mom and I'm sure our dedicated angels will come on soon but I think I've read enough to know that you do not increase dosage after 2 weeks because the drug continues to work for 30 days. If you post the latest pre & post numbers they will give us a better picture but I think as long as those two numbers are going down maybe after another two weeks his numbers will be within the therapeutic ranges. If not a dosage increase then.
Can you get the numbers and post them if you don't have them on hand? Too many times we see our precious pups get overdosed because vets are not following proper protocol and then put in dangerous, sometimes life threatening situation. Thanks.

[molly muffin]

I agree with Marianne, I would keep him on the 30mg until at least 30 days have past as his number might continue to go lower and no change would be needed.

It doesn't hurt to wait and see what those levels do and that is what I'd tell the vet. Under no circumstances should a capsule be split, shame on the vet if they recommended such a thing!

Sharlene and molly muffin

[goldengirl88]

I agree to I would never even think of switching the dose now. You could cause the cortisol to really drop and you dog would be in trouble. Blessings
Patti

[ljcornell]

Well it sounds like I'm doing the right thing by holding off on increasing his dose of Vetoryl. Will plan on taking him back to the vet in a couple weeks to be retested. I asked for copies of his results, so I will post them as soon as I get them. Thank you all for the good information and insight.

:) Lisa

[My sweet Ginger]

:):):) How is he doing?

[goldengirl88]

Just checking in to see how things are going? Blessings
Patti

[ljcornell]

Harley is now on 60 mg Vetoryl. He's doing well with that. I just had his levels tested on Friday, so I don't have the results yet. We did have to take him to the vet today because last night he was coughing and breathing very heavily. I just started him on PPA for his incontinence and after the 1st dose I noticed that he was breathing heavy and panting. I thought he was just hot. I gave him another dose last night before he went to bed thinking that the side effects wouldn't be so bad, if they were side effects. But it was worse. I'm not sure if the PPA is causing that or if something else is going on, but he's at the vet right now. They are doing a chest xray and will call me later to pick him up. I'll let you all know what's going on as soon as I find out. Please pray that he is ok.

Thanks.
Lisa

[ljcornell]

I swear I'm tempted to take him off of all the meds he's on and just let him live life out naturally.

[Squirt's Mom]

If PPA is the same as Proin, and I think it is, I want to give you some info. I gave my Squirt Proin without researching the drug and she had every side effect listed just about up to and including a seizure that she never fully recovered from.

Proin info -
http://www.fda.gov/downloads/AnimalV.../UCM296349.pdf



Table 6: Adverse reactions in the 28-day placebo-controlled clinical study

Adverse Reactions
PROIN
-
treated (N=123) (first number)
Placebo (N=61) (second number)

Emesis 20.3% 8.2%
Hypertension (≥ 160 mm Hg) 19.5% 14.7%
Anorexia 16.3% 3.3%
Body weight loss (≥5%) 16.1% 6.8%
Proteinuria 13.0% 8.2%
Anxiety/aggression/behavior change 9.7% 3.2%
Diarrhea 7.3% 9.8%
Polydipsia 6.5% 9.8%
Lethargy 5.7% 1.6%
Musculoskeletal disorder .2% 1.6%
Insomnia/sleep disorder 2.5% 0.0%

My Squirt displayed just about all of these but I didn't connect the signs to the drug.

http://www.livestrong.com/article/25...ects-of-proin/



Allergic Reaction

Dogs that are allergic to phenylpropanolamine or any of the components of Prion should not be treated with this medication. Improper use of Proin by hypersensitive dogs may induce a severe and potentially life-threatening allergic reaction. Symptoms of a hypersensitive reaction in dogs include weakness, seizures, pale gums, facial swelling and difficulty breathing. Dogs who exhibit any of these side effects after taking a dose of Prion should be transported to an emergency veterinarian clinic immediately.

[Harley PoMMom]

You and Harley are in my thoughts and prayers, waiting anxiously with the others with news about sweet Harley.

Hugs, Lori