Trixie - Cushings symptoms w/o diagnosis

[sunfirefarms]

No message.

[labblab]

Hello and welcome to you and Trixie! In your situation, there are two more tests that I would want to perform: an abdominal ultrasound and the LDDS test. It is well documented that the ACTH returns a high number of "false negatives," even when a dog truly has Cushing's. It does an especially poor job of diagnosing the disease in dogs suffering from an adrenal tumor as opposed to a pituitary tumor. If Trixie does indeed have an adrenal tumor, diagnostic information regarding the size, location, etc. may be of some importance to you in terms of prognosis and treatment path. Also, it may be the case that there is another underlying condition that is contributing to her problems even if Cushing's is indeed at play. In terms of elevations in liver enzymes, for instance, it is somewhat unusual for a Cushpup to exhibit elevated GGT in isolation as opposed to elevations in ALKP and ALT.

In puzzling back-and-forth in my own mind, I believe I might start with the ultrasound because it will give you important info re: possible abnormalities relating to other internal organs in addition to the adrenals. You really need the benefit of high-resolution ultrasound equipment for this type of diagnostic, however, which is lacking at many GP veterinary offices. So a referral to a specialty clinic may be needed for this imaging and interpretation.

Since your own vet is equipped to perform a LDDS, you can always start there instead. If positive, depending upon the numbers themselves, it is sometimes possible to conclude that it is a pituitary rather than an adrenal tumor that is the cause. But in some cases, you are still left with a question mark in that regard and still need to move on to the ultrasound. That is part of the reason why, given Trixie's age, I am thinking you might just want to start with the ultrasound in order to first get a general assessment of her overall internal organ functioning.

With those questions yet unanswered and the diagnostics available to you, I would not want to start Cushing's treatment prematurely.

Marianne

[sunfirefarms]

Hi everyone. My dog Trixie has (finally) been diagnosed with Cushings and my vet and I have agreed on a starting treatment of 30 mg daily of Vetoryl. I agreed to purchase the Vetoryl capsules from my vet because he had them in stock and I wanted to get started with the treatment right away, but I also asked him if he would give me a prescription in the future so that I could obtain them at a less expensive cost elsewhere. His response was that he would price-match, and that hardly any vets write scripts for this medication, and then he went on to say that he didn't believe that I could find them significantly cheaper--that he believed the price I was seeing online wouldn't be honored; that upon placing an order the seller would tell me it was out of stock and try to sell me something more expensive, and that this happens a lot.

The seller I intended to purchase from is a well-respected veterinary supply company (at least in the horse world) that also happens to be in my state, so they are somewhat local as well. In other words, they are not a fly-by-night online presence only, and I have never had any problems purchasing horse meds or supplies through them (my horse vet doesn't have any problems writing scripts for them). The cost difference between what they advertise online for the 30mg Vetoryl capsules and what my vet charged me is $22.

As long as my vet is willing to price match, that's fine--not as convenient as getting them delivered to my mailbox (especially since my vet is 30 minutes away), but I can deal with that. But I'm really curious to know if there are others out there who get scripts from their vets for Vetoryl, and/or if anyone has experienced an issue with a veterinary supply trying to get them to purchase something else by saying what they need is out of stock?

Thanks!

[Harley PoMMom]

Hi and welcome to you and Trixie!

Glad you found your way here and we will help in any way we can.

I have some questions :eek::D How much does Trixie weigh? Will she be getting her Vetoryl once or twice a day? Did the vet mention that the Vetoryl has to be given with food to be properly absorbed? Is her next monitoring ACTH stimulation test scheduled? Could you get copies of all tests that were done on Trixie and post any abnormalities that are listed, we only need to see the low/high values. What test/s were done to diagnose Trixie's Cushing's, and could you post those results too? Is Trixie taking any other herbs/supplements/medications? Does she have the adrenal or pituitary type of Cushing's?

Many of our members do buy their dog's Cushing's medications online, a lot of them also use a compounded form of Trilostane, which is the active ingredient in Vetoryl. Getting the medication compounded can save some $$, however, when doing it this way it can not be compounded at any of the brand-name Vetoryl dosages, so if one wants 30 mg they would have to have it compounded at either 29 mg or 31 mg.

Here are a couple links where members are discussing compounding: Where to get Vetoryl? (http://www.k9cushings.com/forum/showthread.php?t=6355[/url)
Compounding pharmacy questions (http://www.k9cushings.com/forum/showthread.php?t=385[/url)

Link from our Resource Forum with info about Trilostane/Vetoryl: Trilostane/Vetoryl Information and Resources (http://www.k9cushings.com/forum/showthread.php?t=185[/url)

If you have any questions please do ask them ;)

Hugs, Lori

[sunfirefarms]

Hi, Lori. Thanks for the links. I do not have any questions about the diagnosis or treatment protocols at this time. I am very well educated about this disease and have experience dealing with it in horses and humans...just wanted to know others' experiences with small animal vets and obtaining the medication for dogs. I am finding that dealing with small animal vets is a whole different world than dealing with my horse vets...unfortunately. Going forward, I will probably just get a script from my horse vet for my dogs pills--luckily, the 30 mg seem to be the right fit for her.

I'll be sure to check back if I have any additional questions.

Thanks!

[labblab]

Hello and welcome from me, too. Just wanted to re-emphasize that many of our members successfully order their Vetoryl online --actually, probably the majority do. We have heard of very few problems, and virtually none like those described by your vet (being told that Vetoryl was out of stock and trying to substitute a different more expensive medication?).

It is always important to be a savvy consumer, however, since there are indeed counterfeit meds being sold on the internet. Never patronize a site that does not require a valid prescription. And for an added layer of protection, you may want to select a veterinary pharmacy from this list (you can view this organization's homepage in order to better understand their credentialing process):

http://www.nabp.net/programs/accreditation/vet-vipps/find-a-vet-vipps-online-pharmacy

One other observation: the compounding pharmacies that Lori spoke about above do not necessarily also sell brandname Vetoryl. So that is why you may see members recommending names of two different subsets of internet pharmacies depending upon the type of product you are looking for.

Good luck to you, and please do return with any questions.

Marianne

[Squirt's Mom]

MODERATOR NOTE: I have merged your post about the Vetoryl prescription into Trixie’s original thread. We normally like to keep all posts about each pup in a single thread as it makes it easier for members to refer back to the pup's history when needed. Thanks!

[molly muffin]

Welcome. I encounter up herein canada that vets do not want to write prescriptions for outside pharmacies. We have had members who said their vet wouldn't right a prescription in the states too.