help/tifffany

[map5499]

Hi my name is melly. I have a 12 year old Maltese, named tiffany who was diagnosed with cushings years ago and doing fine. Just recently her disease is out of control and the vet has almost doubled her meds..vetoryl 30mg an the am and 20 at pm, plus melatonin 2mg am and pm and 1/2 tsp of flax seed.
I cannot afford this much vetoryl for her.. Is there any help out there?

[labblab]

Hello Melly! Welcome to you and little Tiffany. I apologize for starting off with questions instead of answers, but it will help us a lot if you can tell us more about Tiffany's health and treatment history. This is information that will benefit us as we try to help you sort things out.

When was Tiffany diagnosed with Cushing's?
What were her symptoms?
What tests were performed to diagnose Cushing's (and any actual test results would be great)?
Any other health problems?
What has been her Vetoryl dosing history?
Has she had monitoring ACTH tests while taking the Vetoryl? Results?
What has led to the big dosing increase? Tests and/or symptoms?

Now for a couple quick comments even before getting those answers. If you are in the U.S. or Canada, a much less expensive alternative to brandname Vetoryl is trilostane (the active ingredient) that is prepared by individual compounding pharmacies. Compounded trilostane is made in custom doses based on the prescription presented for each individual dog. So that is another advantage to compounded trilostane: you are not limited to the four capsule sizes in which Vetory is sold. A possible disadvantage to compounded trilostane is that a couple of studies have indicated that some compounded products do not deliver as consistent or effective a dose as Vetoryl. For that reason, some vets have reservations about prescribing the compounded drug. However, for some dogs it is a necessity because Vetoryl does not come in the dose that is needed. And for other folks, the cost of Vetoryl simply would make treatment unaffordable. There are several compounding pharmacies that members here have used to their satisfaction. One in particular, Diamondback Drugs in Arizona, has many satisfied customers here.

One other thought or question...I am wondering about the melatonin and the flax. Usually that treatment is recommended for dogs who suffer from elevated adrenal hormones other than cortisol. So I am wondering a bit as to why your vet is adding that into the mix. Additionally, it is the lignans from the flaxseed hulls that is recommended as part of that treatment -- not the flaxseed itself. So if you are giving your dog melatonin and flaxseed, that is not the combo that is hoped to lower adrenal hormones.

OK, I hope I haven't come up with so many questions that you'll not want to return and answer them!! But truly, any additional info you can give us will be helpful.

Best wishes,
Marianne

[map5499]

tiffany was diagnosed 3 years ago due to pot belly, thirst and peeing in the house via an all day blood test. she was put on 30 mg of vetoryl and doing fine. recently she has gotten much worse, maybe due to the stress of us moving? so 1 vet told me to add 10 mg vetoryl at nite and that worked for 1 week or 2. than back to panting and peeing, no UTI. Another vet told me tp give her mealatonin 2x/dy and flaxseed like I take, she was getting really bad, panting and drinking, etc. another vet at the clinic told me today to up the pm dose to 2 10mg tabs...

[labblab]

Melly, unless Tiffany has had a monitoring ACTH blood test showing that her cortisol level has increased to a point that is too high, it is very, very dangerous to increase her Vetoryl. There can be other explanations for her symptoms such as kidney or liver problems, or even diabetes. Has she had a basic blood test recently to check her blood sugar level and organ function? Along with an ACTH, that really needs to be done before increasing her medicine since the problem may be something entirely different than Cushing's.

Has she ever had a monitoring ACTH to check her cortisol level since starting on the Vetoryl?

Marianne

[jas77450]

Welcome Melly and Tiffany, you have come to the right place, lots of caring and knowledgable folks here. Have nothing to add except Marianne is right, testing is the first place to start. We are here for you both.

[map5499]

yes she recently had a 1 hour blood test that concurred it was her cushings out of control. I am frightened for her at this point. I know it's not diabetees, because I have another dog that is diabetic ( on inulin shots2x/day...So the vet had me leave her and did the 1 hour blood test.

[map5499]

I am confused by the different approaches from the vets at my clinic. Hate to say it, but I am broke, and moving in with a friend ( who loves dogs) and all this meds and tests cost a fortune.. At least my vet put me on a payment plan, but all the meds..insulin, needles, vetoryl are killing me

[map5499]

is anyone out there to help me

[labblab]

Hi again, Melly! This morning I saw the message you sent me, and I'm so sorry you were worrying about things overnight. You are posting absolutely correctly :). The problem is that the majority of our members are in the U.S. and Canada, and so readership (and posting) really drops off during the evening and overnight hours here. But a new day is starting, and I'm hopeful you'll be getting some more feedback once again...starting with me. ;)

Wow, I can't believe your other dog has diabetes! Talk about a double whammy, and I'm sure the expense really does get to be overwhelming. In your situation, I would definitely talk to your vet about possibly switching to a compounding pharmacy for Tiffany's trilostane. That could save you a great deal of money in drug cost. For instance, right now it sounds as though you are having to buy Vetoryl in capsule strengths of 30 mg. and 10 mg., and using two of the 10 mg. capsules each day. If you switch to compounded trilostane, there are a couple of ways you could save money: you could get 20 mg. in one single capsule if this turns out to be the right dose for Tiffany and your vet wants you to stick with twice daily dosing. Or you could switch to one single 50 mg. capsule in the morning. Plus, overall, the cost of the drug will be less at any dose.

But I am getting ahead of my self by talking the specifics of the dosing. Can you please get the actual numbers for Tiffany's recent ACTH test? Also, for any other abnormal blood or urine test results? Also, how much does Tiffany weigh?

You mention that you are certain she does not have diabetes, but has it definitely been ruled out with blood testing? Cushing's and diabetes can both end up being diagnosed in the same dog. We have several members here who have dogs with both illnesses. Sometimes the Cushing's is identified first, sometimes it is the diabetes. But we know the diseases can be linked, so that is why I am asking so specifically about this.

So if you can find out any of those test results today and post them for us, that will be really helpful.

Thanks!
Marianne

[mytil]

I am sorry you are having these troubles. We all know the expense associated with this as well as diabetes.

Here is a link that may help with finances - http://www.k9cushings.com/forum/showthread.php?t=212.

Also we have a sister forum site for diabetes and you will certainly find some help there too - http://www.k9diabetes.com/forum/

Hang in there
Terry

[map5499]

thanks
I will call the vet and get that info for you. And thanks for the diabetes links I will check out both!

[map5499]

waiting for the vet to call me back

[Spencersmom]

You are not alone! Other members will be chiming in to offer suggestions, posing questions to better help.....but mainly to let you know that you are part of a big family who are dealing with cushpups and all that is involved!

[molly muffin]

Another thing to consider is whether the thyroid is off? and what the kidney values are now too.

So, my thought is to have them email the results to you, so you can share the abnormal values and we can put our heads together.

Trilostane is much more reasonably priced than vetroyl I think. My ER clinic, said to me last week that they don't even stock vetroyl, as it is just cost prohibitive and instead use trilostane from a compounding pharmacy at our vet university. So that is definitely a better option for you I think. We can give you some online pharmacies that you can price the medications at.

Definitely register and check in with the diabetes group. Awesome and knowledgeable people over there.

Oh and welcome to the forum. :)

[Dixie'sMom]

I'm sorry I did not see your post last nite. At least we could have chatted for a little while and maybe I could have bored you until you were sleepy. :) These pups of ours can sure worry us, can't they? I'm fairly new to all of this myself so I still have many moments of anxiety but the forum members here are great at easing my fears and keeping me from going off of the deep end.

As far as the cost of the Cushing's meds, the Vetoryl would have been about $120 /month if I bought it from the vets office. The compounding pharmacy is under $55 for a 100 day supply including shipping. It will of course, depend on the dosage, but you really can get that cost down once you know the correct dosage. Hang in there honey! You are in good hands here!

[map5499]

tifffany, my 11 year old maltese mix developed cushings years ago and was under control untill we recently moved. She weighs 12 lbs. was panting and drinking water like she was going to die..vet put her on trilostine compound 50 mg per day, she recently developed an uppe3r respitory infection, was put on antibiotics, taken off trilostine, and was doing great. 2 1/2 weeks later symptoms are back. vet said he3r dosage would kill her. she is just starting to pant, and is on 12.5 mg trilostine and 3mg melatonin 2x day..Needed to find out if all natural supplements like cushex or adrenal gold work???????

Please help us

[labblab]

Welcome back, Melly, but I am sorry to hear that Tiffany is not doing so well right now. I am sorry to say that we have no solid research evidence showing that either Cushex or Adrenal Gold will effectively lower cortisol in Cushpups. But since the trilostane worked for Tiffany before, I would see no reason why it won't help again once she is taking the right dose. It's true that 50 mg. was really high for her weight, but 12.5 mg. may not be high enough to control her symptoms. There is a lot of room in between those two doses. Plus, I am wondering how your vet decided the 50 mg. was now way too high after her previous monitoring ACTH showed it was OK. Is this a different vet, and/or did you have a more recent ACTH that showed her cortisol dropping too low on that dose? It will help us a lot if we can find out more about any monitoring testing that may have been done since you were last with us.

Marianne

[map5499]

Hi and thank you for all your help. I will try to get answers from our vet. Meanwhile Tiffany developed an upper respitory infection, they thought it was whopping cough and put on antibiotics. While on antibiotics trilostine was stopped, and it seems that she was doing great after 1 week on antibiotics! that was about three weeks ago. Now the panting and thirst, etc. came back about 4 or 5 days ago, She is now on 12.5 mg trilostine 2/x per day plus melatonin. All the symptoms are coming back. I wanted to know if anyone out there has trierd cushex or adrenal gold all natural drops for cushings? I am very hesitant about the trilostine, as it almost killed her.
Please help us....

[labblab]

Can you tell us what you mean by the trilostane almost killing her?

Marianne

[map5499]

The vet is the same. although there are many in the practice. The senior vet/owner said the previous dosage was way too high for her weight, and eventually would kill her.

confused. I am also trying to navigate this forum and am having great troubles!..i.e. how do I post a quick reply?

[labblab]

Melly, I don't know what you mean by a "quick reply." You are doing fine by posting replies as you are doing today.

As for the 50 mg. being too high -- yes, it would have been far too high a dose to start her on at the beginning, because starting doses are based on weight alone. But once treatment begins, increases or decreases in dosage no longer are based on weight, but are instead based on monitoring ACTH blood tests and symptom resolution. So if Tiffany was doing well on the 50 mg. dose -- symptoms improved and her cortisol level was OK on the monitoring ACTH test -- then there is no reason why that dose would kill her.

This is the part that is really important, though. When was the last monitoring test performed, what was the result, and what dose was she taking when the test was done? When you were here before, you said a test was done in November. What were the numbers then, and what dose was she taking?

Even if the 50 mg. was too high, there is no reason to think she would not do well on a lower dose. I see you are giving her 12.5 mg. twice a day right now, is that right? Has your vet told you when he plans to test her cortisol level on that dose? That is the only way to know for certain whether or not the dose is safe for her, or whether it needs to be raised or lowered.

Marianne

[Blues people]

Hi Melly, I ordered cushex drops but decided not to use as yet, esp. Since so many here aren't using. I did stumble on a site that wasn't product connected and several people noted having good results w/out rx drugs . Most were big dogs and owners were financially challenged. But long term results weren't yet available re: those dogs. Now I would probably only try if we don't see results w what we are using. I strongly recommend nuvet plus - although my vet didn't suggest them- she has patients on them that are doing great. My 3 love them, and It's what I started Blue on before anything else- saw a huge positive change.he was lethargic, diarrhea ,and quick to tire. All improved in a week. Hope some of this is helpful. Joan

[map5499]

Thank you all for your help. There is nothing worse than loving your dogs, and being bankrupt. I would do anything for them.. As far as test results Tiff has not been tested for several weeks, due to my financial situation. ( I have tifany's son, Cooper who is a blind diabetic, as well as an airedale with severe ear infections..I am always looking for alternative resources to save them. However it's time to refill her trilostine, so I feel I need to get her tested..At least I won't be guessing and have some definitive #'s to report back....I do not why the vet said that the previous dose of trilostine, was up to 100mg per day.. would kill her, tooo much for her weight.My poor baby is truly having a hard time..I am sure that my stress re having my house foreclosed and having to move in with a "friend", has all rubbed off on her. now the 12.5, 2/day plus 3 doses of melatonin are no longer working.. I shall call the vet to get her tested...... Bless all of you, at least I can vent to other dog owners and don't think I am crazy....
By the way what is nuvet?

[labblab]

Melly, I am confused. I thought you meant Tiffany was being given 50 mg. as a daily total? Do you mean you were giving her 50 mg. twice each day? This vet is right -- 100 mg. would be an incredibly high dose for a dog her size. If that was the case, I do understand why he was very worried for her and told you to decrease the dose dramatically.

Marianne

[map5499]

you are nright, during and after we moved, Tiffany got much worse, due to stress I hope. The vet told me to give her 50mg 2/x per day and try to wean her down to 25 am and 25 pm..but also said dose was too high for her. He did do an ultrasound as a "favor" and said her left adrenal gland was HUGE. When she got ill and was on the antibiotics i stopped the trilostine and started feeling better and no signs of cushngs, then of course the panting, etc started again.....

[Harley PoMMom]

Panting can be from other things other than Cushing's such as pain. What symptoms did Tiffany display before she the Trilostane was started? And besides the panting, how are those symptoms now?

[map5499]

Tiffany's panting is definetly from cushings. When she was on antibiotics no panting. Her signs are, excessive panting, extreme water drinking, pacing, pot bellied and gets skin sores and some hair loss. She was doing so good on the antibiotics, had o signs and wasw actually looking like my good tiffany....I thought it was rather strange that when she was on antibhiotics all signs of cushings were gone even though she was taken off medes, just antibiotics.