Scottieboo - Scottie is now at rest

[ScottieBoo]

My Dog Scottie has recently been diagnosed with Cushing. After all the x-rays , ECG, EKG, Blood work, ACTH test etc.
you can imagine the financial hit it has caused. Now we are having to face how to proceed with medications etc.. My Vet wants to place him on Trilostane 30 mg. $90 a bottle. and blood work every two weeks.
I also have three other pets and a family I care for. Does anyone have any other recommendations? I worry that maybe I will put all this money forward and still loose him in a short period of time. Yet my heart breaks if I do nothing.

Please give advise.!

Thanks:

[samba7282]

Hello and welcome ScottieBoo! I understand what you are going through, our Daisy was diagnosed with pituitary dependent Cushings on 12/5. My advice is trilostane (vetoryl). We have Daisy on it and she is doing really well. Our vet rechecked her ACTH two weeks after treatment started, and she is responding very well to it. I do have a question though, about your vet saying they would need to recheck bloodwork every couple of weeks? That seems like a lot to me. Ours said after the initial ACTH recheck, only every 3 months, unless we feel or see symptoms that her levels are getting too low. Also, how much does your baby weigh? Our vet based Daisy's dose at 1mg per pound(of her normal weight which was 10.5) I hope this helps, I know how hard this is for you;)
~Sarah 'n' Daisy

[Shelby01]

I understand the financial concern. When my boy got sick in November we were at the vet multiple times in just two weeks doing all sorts of blood work and meds. It started with hemorrhage in the eyes and he lost his sight. Then we couldn't get it to drain properly and pressure was building. We also discovered a lump and inflamed lymph nodes. Turns out he had cancer of the lymph nodes which is extremely fast acting. In two weeks time we had to say goodbye. When your baby is sick, the price tag made no difference. Although it was all quite spendy. Now my girl Shelby has cushings, I haven't even begun to heal after loosing my boy, and now this. I know it will impact my wallet as well, and so I will do the best I can to budget. I know there is no curing this disease, only a hope to manage symptoms. Every day with her is precious and I am thankful for it.
Definitely look into all the options... I am still weighing mine, as you know from my post! It is becoming more clear to me that nobody can make the right decision for my Shelby, except me. And so I will do my best to be as informed as possible. This site is already helping. I hope you can find the right decision for your Scottie :)
Hillary - Shelby's mom

[LauraA]

You shouldn't need blood work every 2 weeks. Initially you generally have a test at the two week mark, then a month then depending on your vet anywhere btw 3-6 monthly tests. If you tweak the dose then they also recommend testing again in two weeks. Initially it is very expensive but once you get the dose worked out it becomes less expensive as you don't test the tests as regularly.

I am in Australia so don't know if this is the same for where you are - but once we got the dose sorted we were able to order 100 tablets at a time which was a lot cheaper than getting a 30 day supply. The meds have made a huge difference for my girl and I have no doubt she would not be with us if it wasn't for the drugs. I hope that Scottie is just as successful.

[ScottieBoo]

Hello and welcome ScottieBoo! I understand what you are going through, our Daisy was diagnosed with pituitary dependent Cushings on 12/5. My advice is trilostane (vetoryl). We have Daisy on it and she is doing really well. Our vet rechecked her ACTH two weeks after treatment started, and she is responding very well to it. I do have a question though, about your vet saying they would need to recheck bloodwork every couple of weeks? That seems like a lot to me. Ours said after the initial ACTH recheck, only every 3 months, unless we feel or see symptoms that her levels are getting too low. Also, how much does your baby weigh? Our vet based Daisy's dose at 1mg per pound(of her normal weight which was 10.5) I hope this helps, I know how hard this is for you;)
~Sarah 'n' Daisy

Thank you so much for taking the time to reply to me. My Scottie weighed in at 14 lbs on the day we took him in. of course much of this weight is due to his condition of retaining water and potbelly. He is always hungry and thirsty (but we do control the eating). Very hard to see him liking empty water bowl. so we do keep the water for him always. So will definitely ask the vet as to why 30 mg. I will keep you posted.

[ScottieBoo]

I understand the financial concern. When my boy got sick in November we were at the vet multiple times in just two weeks doing all sorts of blood work and meds. It started with hemorrhage in the eyes and he lost his sight. Then we couldn't get it to drain properly and pressure was building. We also discovered a lump and inflamed lymph nodes. Turns out he had cancer of the lymph nodes which is extremely fast acting. In two weeks time we had to say goodbye. When your baby is sick, the price tag made no difference. Although it was all quite spendy. Now my girl Shelby has cushings, I haven't even begun to heal after loosing my boy, and now this. I know it will impact my wallet as well, and so I will do the best I can to budget. I know there is no curing this disease, only a hope to manage symptoms. Every day with her is precious and I am thankful for it.
Definitely look into all the options... I am still weighing mine, as you know from my post! It is becoming more clear to me that nobody can make the right decision for my Shelby, except me. And so I will do my best to be as informed as possible. This site is already helping. I hope you can find the right decision for your Scottie :)
Hillary - Shelby's mom

Shelby

Thank you also for sharing your thoughts. I know I have to make a decision and soon. Its just that I would also hate to see him on such harsh chemical drugs. Considering part of what accelerated his condition was having taken prednisone for what they thought was a back injury. It was after the prednisone drug that he Bloated up Potbelly and got system worse.

[ScottieBoo]

You shouldn't need blood work every 2 weeks. Initially you generally have a test at the two week mark, then a month then depending on your vet anywhere btw 3-6 monthly tests. If you tweak the dose then they also recommend testing again in two weeks. Initially it is very expensive but once you get the dose worked out it becomes less expensive as you don't test the tests as regularly.

I am in Australia so don't know if this is the same for where you are - but once we got the dose sorted we were able to order 100 tablets at a time which was a lot cheaper than getting a 30 day supply. The meds have made a huge difference for my girl and I have no doubt she would not be with us if it wasn't for the drugs. I hope that Scottie is just as successful.

Laura
Thanks for letting me know about your story as well. I would love to know that once I get the dose he needs (if it does work). That I can find a bottle that contains 100 pills at a time. Actually if anyone knows if I can get the meds at Costco or Sam's Club please let me know.

Gino- Scottie dad

[Renee]

Hi there,

I just wanted to give you a timeline of how the expenses worked for me with using vetoryl.

First, I want to tell you that vetoryl can be found much, much cheaper online (I pay $48 per box of 30 count 10mg), or you can get it compounded into generic trilostane. I don't do that, but I know it can cut the cost quite a bit. Just be careful about the compounding pharmacy you choose. A lot of people here use Diamondback Drugs or Wedgewood.

Now, the blood work is done at the 2 week mark and the 30 day mark each time you make a dosage adjustment, then every 3- 6 months depending on your vet. What this means is that if your first dose is 10mg per day, you'll test at 2 weeks, then again at 30 days. If the results of the testing and the symptom control are in good range, then you don't test again for 3 months. If your dosage is not correct and you need to move the dose up or down, then you start the 2 week / 30 day schedule over again.

My pug's dosage went from 20mg up to 40mg per day, in 10mg increments, so we ran 6 or 7 stim tests over a perios of 3-4 months before we got into the perfect range, and then I went to testing every 3 months.

[Harley PoMMom]

Shelby

Thank you also for sharing your thoughts. I know I have to make a decision and soon. Its just that I would also hate to see him on such harsh chemical drugs. Considering part of what accelerated his condition was having taken prednisone for what they thought was a back injury. It was after the prednisone drug that he Bloated up Potbelly and got system worse.

Hi and a belated welcome to you and Scottie from me as well! Could you tell us how long and what dosage of prednisone Scottie was taking? I am concerned about this because dogs that are given a steroid over a period of time can get what's known as Iatrogenic Cushing's. With this type of Cushing's a dog can display the same symptoms as the naturally-occurring Cushing's while the only treatment for Iatrogenic that is needed is to slowly taper the steroid use.

Hugs, Lori

[ScottieBoo]

Hi there,

I just wanted to give you a timeline of how the expenses worked for me with using vetoryl.

First, I want to tell you that vetoryl can be found much, much cheaper online (I pay $48 per box of 30 count 10mg), or you can get it compounded into generic trilostane. I don't do that, but I know it can cut the cost quite a bit. Just be careful about the compounding pharmacy you choose. A lot of people here use Diamondback Drugs or Wedgewood.

Now, the blood work is done at the 2 week mark and the 30 day mark each time you make a dosage adjustment, then every 3- 6 months depending on your vet. What this means is that if your first dose is 10mg per day, you'll test at 2 weeks, then again at 30 days. If the results of the testing and the symptom control are in good range, then you don't test again for 3 months. If your dosage is not correct and you need to move the dose up or down, then you start the 2 week / 30 day schedule over again.

My pug's dosage went from 20mg up to 40mg per day, in 10mg increments, so we ran 6 or 7 stim tests over a perios of 3-4 months before we got into the perfect range, and then I went to testing every 3 months.

Renee

Thank you so much for sharing your experience on how testing and expense of meds have gone. Now I just need one more clarification.
So basically Trilosane is the generic brand of Vetyrol? (if that is the case then why would my Vet be charging $90 for it??
should I question her on the Vetyrol and Trilosane names and ask which is better ?

Gino

[ScottieBoo]

Hi and a belated welcome to you and Scottie from me as well! Could you tell us how long and what dosage of prednisone Scottie was taking? I am concerned about this because dogs that are given a steroid over a period of time can get what's known as Iatrogenic Cushing's. With this type of Cushing's a dog can display the same symptoms as the naturally-occurring Cushing's while the only treatment for Iatrogenic that is needed is to slowly taper the steroid use.

Hugs, Lori

Lori
Hello and thanks for joining on my issue to help me out. Scottie was given prednisone because we took him in due to what they believed to be possible Neck or back sprain. My wife rushed him to a 24 hours emergency vet hospital. Because he said se noticed as if he was in allot of pain. He was just shaking and not wanting to walk. He was on it for around a week 5mg tablets but the way we had to give it to him as in a manner in which the dosages did gradually go down. They also gave him 25 mg of Tramadole (for pain) along with 500 mg 1/4 th of Methocarbamol (muscle relaxer).

So I hope you can see why I am so afraid of giving more meds.
We did give our Vet a copy of the records containing everything the emergency hospital did.

[labblab]

To answer your earlier question, trilostane is the name of the active chemical that is contained in the brandname drug, Vetoryl. Currently, there is no generic form of Vetoryl on the market because the patent on Vetoryl has not yet expired. Generic drugs are FDA-approved, legal "copies" mass-produced by pharmaceutical companies after the original patent is no longer in place.

When our members here talk about "trilostane" as an alternative to Vetoryl, they are referring to individual pharmacists who are preparing custom-made doses of a substitute for Vetoryl that also contains the chemical, trilostane. Theoretically, these doses are supposed to be made up specially for each dog at the time a prescription is presented. But these are not generic drugs that can be bought on the open market.

It is true that compounded trilostane generally costs much less than brandname Vetoryl. Many of our members have been very satisfied using compounded products, and sometimes there is no alternative if a dog needs a custom dose that is not available in Vetoryl. However, a recent research study has determined that some compounded products are not as consistent or effective as brandname Vetoryl. For this reason, some vets prefer that their patients stick with the brand. You can certainly discuss this option with your vet, though. And either way, you may likely be able to buy the drug for a better price from an internet provider than what your vet is charging you.

Marianne

[doxiesrock912]

Many of us have used Diamondback pet pharmacy without any problems and the meds can be made into several types such as capsules or chewables.

[ScottieBoo]

To answer your earlier question, trilostane is the name of the active chemical that is contained in the brandname drug, Vetoryl. Currently, there is no generic form of Vetoryl on the market because the patent on Vetoryl has not yet expired. Generic drugs are FDA-approved, legal "copies" mass-produced by pharmaceutical companies after the original patent is no longer in place.

When our members here talk about "trilostane" as an alternative to Vetoryl, they are referring to individual pharmacists who are preparing custom-made doses of a substitute for Vetoryl that also contains the chemical, trilostane. Theoretically, these doses are supposed to be made up specially for each dog at the time a prescription is presented. But these are not generic drugs that can be bought on the open market.

It is true that compounded trilostane generally costs much less than brandname Vetoryl. Many of our members have been very satisfied using compounded products, and sometimes there is no alternative if a dog needs a custom dose that is not available in Vetoryl. However, a recent research study has determined that some compounded products are not as consistent or effective as brandname Vetoryl. For this reason, some vets prefer that their patients stick with the brand. You can certainly discuss this option with your vet, though. And either way, you may likely be able to buy the drug for a better price from an internet provider than what your vet is charging you.

Marianne

Thank you so much Marianne.

Another question, can anyone tell me if they are any statistics out there. In Regards to what is the most amount of years a diagnosed dog has lived comfortably under treatment for cushing.

Gino

[Squirt's Mom]

I don't know about statistics but a few years back someone came to the group and posted that their baby had lived 12 years after diagnosis. They didn't stick around and of course we can't verify one way or the other, but I still hold onto that. ;)

[ScottieBoo]

I don't know about statistics but a few years back someone came to the group and posted that their baby had lived 12 years after diagnosis. They didn't stick around and of course we can't verify one way or the other, but I still hold onto that. ;)

Thanks Squirt's Mom
I can honestly say that sounds very reassuring. I think I would like to hold on to that as well. Considering that Scottie is only 6 going on 7 yrs. old. I would love to get several more years with him.

Gino

[Squirt's Mom]

My Squirt was first diagnosed at the age of 10. She went thru a surgery on her legs plus having a tumor and half her spleen removed after diagnosis. She passed this past May at the age of 16 and a few months. There is always hope, honey, always. ;)

[Harley PoMMom]

I don't know of any concrete studies that can accurately say how long a dog with Cushing's will live while on treatment. However, we have many members whose dogs have lived out their normal life span with treatment.

Cushing's is a treatable disease but success in treatment does depend on a few things; keen owner observation, a pet parent willing to educate themselves about Cushing's, and a vet/IMS that has experience treating Cushing's and is knowledgeable about the protocols for Cushing's.

We sure do understand how expensive this dratted disease is to treat, those ACTH stimulation tests are expensive and your vet can save you money by using less of the stimulating agent, cortrosyn, and storing the remainder for future tests. With Scottie weighing about 14 pounds, I suspect your vet could get more than seven acth stim tests out of one vial of stimulating agent. It is well worth your while to ask your vet if she is aware that you do not need to use the entire vial of cortrosyn. If not, provide her with a copy of Dr. Mark Peterson's blog for veterinarians where he provides instructions on how to reconstitute the agent and store for future tests. The agent should last for at least six months which amounts to hundreds and hundreds of dollars saved. You can find this information at
http://endocrinevet.blogspot.com/2011/03/how-to-extend-your-supply-of-cortrosyn.html

Hugs, Lori

[ScottieBoo]

I don't know of any concrete studies that can accurately say how long a dog with Cushing's will live while on treatment. However, we have many members whose dogs have lived out their normal life span with treatment.

Cushing's is a treatable disease but success in treatment does depend on a few things; keen owner observation, a pet parent willing to educate themselves about Cushing's, and a vet/IMS that has experience treating Cushing's and is knowledgeable about the protocols for Cushing's.

We sure do understand how expensive this dratted disease is to treat, those ACTH stimulation tests are expensive and your vet can save you money by using less of the stimulating agent, cortrosyn, and storing the remainder for future tests. With Scottie weighing about 14 pounds, I suspect your vet could get more than seven acth stim tests out of one vial of stimulating agent. It is well worth your while to ask your vet if she is aware that you do not need to use the entire vial of cortrosyn. If not, provide her with a copy of Dr. Mark Peterson's blog for veterinarians where he provides instructions on how to reconstitute the agent and store for future tests. The agent should last for at least six months which amounts to hundreds and hundreds of dollars saved. You can find this information at
http://endocrinevet.blogspot.com/2011/03/how-to-extend-your-supply-of-cortrosyn.html

Hugs, Lori

Lori
Awesome information you have shared with me about the testing. Thanks so much and I will definitely look into this with my Vet. I have also kind of challenged my VET / this particular Hospital that we are using. I asked them why would they not take into consideration possibly offering the medication at a discounted price. If I can get in online saving $30.00 Why on earth would they not be willing to price match at least. ? I am being quite stern because I have dished out quite a bit of money to this place. I have four pets with them (Two dogs & Two Cats). I called and requested copies of all my pets medical records and testing.

I let them know I wanted to do more research and look into possible comparable level of service and treatment with a lower cost.
Guess What? (Amazing now the Head Vet is going to be calling me).

I am so glad I found this Website / Forum it has been a blessing to us.!

[Shelby01]

Everyone on this website who is willing to talk and share is truly what makes it amazing! I too, am so thankful :)

I am so impressed with length of life after diagnosis. 16! It truly does give hope - especially for Scottie who is still young :)

Hillary ~ Shelby & Wrangell's mom

[ScottieBoo]

Well everyone
Scottie is on his second dose of Vetoryl this morning. So far it looks like the first dose has not bothered him. Crossing fingers and praying. My Wife and I are monitoring him closely. We are even making sure we get our Kids involved with watching him. They are teenagers so wish us luck with that (LOL for those that have teenager may know what I mean). He goes for his first lab work from being on treatment on Saturday the 24th. I will keep everyone posted. A very Heartfelt Thank you ! to all those that have sent me messages and post on my thread. Even more special thanks for those helping understand how to work with this forum.

My condolence to those that have lost their pets recently.

Gino- Scottie's Dad.

[addy]

Good to hear so far so good. Make sure the ACTH test is started 4-6 hours after the morning dose with food.

Let us know the results.

[ScottieBoo]

Ok. Anyone that can help me understand this stuff. This is the first ACTH Test they ran on Scottie to confirm he had cushings.

ACTH STIMULATION
Test Result Reference Range Low Normal High
PRE-ACTH CORTISOL 14.0 ug/dL
POST ACTH
CORTISOL >50.0 1 ug/dL
Comments:
1. ACTH Reference Range:
Canine: Feline
2 - 6 0.5 - 5 Pre-ACTH (resting) cortisol
6 - 18 5 - 15 Post-ACTH cortisol
18 - 22 15 - 19 Equivocal post-ACTH cortisol
>22 >19 Post-ACTH cortisol consistent with
hyperadrenocorticism
<2 <0.5 Post-ACTH cortisol consistent with
hypoadrenocorticism
1 - 5 n/a Desired pre- and post-ACTH cortisol on
lysodren therapy

[My sweet Ginger]

Scottie not only looks like my Ginger but also has the exact same ACTH number of >50 which is through the roof. I'd have thought they are from the same litter if I didn't know his age.
If I can go back to before treatments after everything is said and done I'd def. choose Vetoryl over Lysodren not favoring former but to get the cortisol level down gradually to avoid the sudden and rapid drop in cortisol that threw Ginger onto such a long and winding road trip. You just have to be very vigilant for signs of low cortisol. I wish you and Scottie all the good luck on this journey with Vetoryl for many more happy years together. Hugs, Song.

[ScottieBoo]

Thanks for the post and letting me know that Ginger had the same reading. So far his has had two dosages and we are just monitoring. We still do not see any serious issues or strange issues. Yet the frequent drinking of water has still not changed so that does worry me. Yet again it is only going on three days of loading. So I am hoping for results.

[ScottieBoo]

Can anyone tell me what a Normal or Healthy cortisol reading level should be?

[My sweet Ginger]

Can you please tell me Scottie's weight and the dosage of Vetoryl?

[ScottieBoo]

Scottie showed to last weigh 14.5 lbs and they started him with 30 mg

[My sweet Ginger]

Hmm. Have you set up his after 10-14 day ACTH stim test with your vet?
I'm concerned about his 2mg/lb dosage. The general recommended starting dose on this board is 1mg/lb. You know the low and slow. I'm sure members with much experience with Vetoryl will chime in.

[ScottieBoo]

I have questioned that myself. Yes he is scheduled for Saturday the 24 for his nest ACTH Test.

[My sweet Ginger]

Until then I'd watch him very closely for any signs of his cortisol going too low. Lethargy, inappetence, diarrhea, vomiting, wobbliness, hind leg weakness etc,. You see any of these, you stop Vetoryl and call the vet.

[ScottieBoo]

I just noticed I was looking at Scottie's weight from his previous Vet visit. His actual weight in his Last visit Dec 30th he weighed 16.60 lbs,
The Vet new this when she decided to give him the dosage amount. I want to say I would assume she also went maybe by the results form the first ACTH test. So can anyone tell me if this dosage amount is safe for him? I do not want to overload him>

[My sweet Ginger]

I thought about that too as his post# was sky high. It's such a balancing act in that you want to bring down cortisol level but at the same time you don't want it plummeted too rapidly either which will cause him a cortisol withdrawal then. I think his next ACTH will be very indicative of how this 2mg/lb is working for him.

[Harley PoMMom]

Ok. Anyone that can help me understand this stuff. This is the first ACTH Test they ran on Scottie to confirm he had cushings.

ACTH STIMULATION
Test Result Reference Range Low Normal High
PRE-ACTH CORTISOL 14.0 ug/dL
POST ACTH
CORTISOL >50.0 1 ug/dL
Comments:
1. ACTH Reference Range:
Canine: Feline
2 - 6 0.5 - 5 Pre-ACTH (resting) cortisol
6 - 18 5 - 15 Post-ACTH cortisol



That pre ~ 2-6 ug/dl and post ~ 6-18 ug/dl, which I bolded, are reference ranges for a dog that does not have Cushing's. When treating with Trilostane/Vetoryl you want the pre/post number to be with in the therapeutic ranges of 1.5-5.4 ug/dl and if the clinical symptoms are controlled than that post number can be as high as 9.1 ug/dl.


1 - 5 n/a Desired pre- and post-ACTH cortisol on lysodren therapy

Those reference ranges are for a dog being treated with Lysodren, not Trilostane/Vetoryl.

For Scottie's weight of 14.5 lbs, the 30 mg starting dose is a tad high. I am such a worry wart, so if this were me, I would of been more comfortable starting out a 10 mg and then slowly tapering upward when needed.

Just watch Scottie very closely and if you see any signs of his cortisol going too low stop the Trilostane/Vetoryl. Trilostane/Vetoryl does have a short half-life and leaves a dog's system rather quickly.

Hugs, Lori

[ScottieBoo]

Lori
Thank you so much for this information. Again I also thought it was a bit high myself as I did all my possible research before actually starting him on it.

First let me correct myself on his weight. He did actually weigh in at 16.60 lbs in his last visit. I am also again assuming the VET is taking that weight, along with his Lab work results of the ACTH into consideration. Maybe that is why she started him with 30 mg. Gosh I really do not want to overload him!!

Again I so appreciate YOU and everyone on this site.
Gino

[Harley PoMMom]

I'm including an article with Dechra, the makers of Vetoryl, revised dosage protocol which does now recommend that a starting dose of 2mg per kg of a dog's weight, that comes out to 1 mg per lb: http://www.vetsonline.com/news/product-news/140722-new-lower-starting-dose-for-vetoryl.html

I think I would print that article out and take it to the vets than along with your concerns about his high starting dose she may want to decrease it.

[ScottieBoo]

I have just called the VET office and asked to speak with the VET that
prescribed the dosage. I was told she is currently with a patient. However, I did ask to leave her a detailed message with my concerns on Scottie's Dosage. I explained that I was concerned that we can possibly be overloading him. Considering the makers of the drugs themselves say 1 mg per pound. I also made it clear that I just wanted to make sure whether she wanted to continue this 30 mg dosage. And or considering we are just 3 days into it possibly adjusting. I will definitely follow up on this today.

Again, Thank

[ScottieBoo]

I just remembered that I did not share one other thing on Scotties diagnoses. They did some x-rays and other imagine test. The Vet showed us on how the potbelly was due to the possible retention around the organs. and how when feel against the bottom area where the Liver would be. It did feel more like Liver either being pushed down and or swollen. She gave this conclusion because it did not feel "Swooshy" yet quite firm. So my question to everyone with that is: Will this be something that hopefully in time will also get better with ongoing cushings treatment?

Please advise and share input. Thanks

[Harley PoMMom]

80% or 90% of dogs have a steroid induced isoenzyme of ALKP so if one of those dogs has cushing's, you are gonna see anywhere from a mild to severe increase in ALKP. These increases are not because the excess steroids are killing liver cells, it's because the steroids are causing an abnormal accumulation of fat in the liver and it is having to work a bit harder.

So yes, if a dog does have Cushing's treatment will help the liver get back to its "normal" self.

[ScottieBoo]

Harley PomMOm

YOU ARE THE BEST!!!

Thanks for the quick reply. To think for a long time we thought he was just a Greedy over eater! he would eat his and his sisters food really quick. Then if we did not stop him on time he would run to eat the cats food as well. All this time my baby was suffering from Cushings. I feel so bad and guilty for getting angry with him.

[ScottieBoo]

I do have a question regarding Food & Diet for Dogs with Cushings.
My Vet did say I could continue feeding Scottie the food I always do. I have kept all my pets on IAMS foods all these years. I do also know that sometimes quickly changing a food can also cause issues. So is there maybe something I should add to his food to help him with his Cushings. Or should I just leave it all alone for now.?

Thanks

[labblab]

Right at this moment when you are first launching into trilostane, I would not change anything else. If Scottie has problems, you will not know which is to blame. Since GI disturbances are a symptom of trilostane overdose, I definitely would not change anything in his diet that could also cause an upset and confuse the issue.

Marianne

[ScottieBoo]

So True I should just leave everything else alone.
No sense in shocking his poor body anymore.

Thanks

[ScottieBoo]

I'm including an article with Dechra, the makers of Vetoryl, revised dosage protocol which does now recommend that a starting dose of 2mg per kg of a dog's weight, that comes out to 1 mg per lb: http://www.vetsonline.com/news/product-news/140722-new-lower-starting-dose-for-vetoryl.html

I think I would print that article out and take it to the vets than along with your concerns about his high starting dose she may want to decrease it.

My Vet just called me back after I emailed her with my concerns and questions of Scottie's starting dosage of 30 mg. I also attached a copy of the link / article you provided for her to review. She explained to me that she could understand how I would be concerned based on this link and how she understands it is coming from the manufacture itself. She went on to share that she started Scottie on 30 mg based on the results of the test she had performed on him. She truly feels that based on his levels he will be ok with that dosage. However, that she would not mind going down to 10 mg if that is what I wanted to do. Yet she still thinks that come two weeks from now we will need to go back up to 30 mg. At this time I have agreed to just watch him for two weeks until his next testing. If there is any drastic changes of course I will stop giving Immediately. Then once we get the Second test results we can take it from there. The good thing is that as of right now Scottie is not showing any signs on any major issues. He is still eating normally and drinking (excessive drinking still).

[molly muffin]

Excellent. It take a few days for most dogs to see some results. Some of course are pretty quick but a good average is 10 days to see some changes.

[Squirt's Mom]

I'm not clear on which dose you started on - 10mg or the 30mg?

[ScottieBoo]

We started him on the 30 mg and decided to stay that way. This was based on the results the Vet saw from his lab work. On Saturday the 24th is his next ACTH test. We will then see how to procceed. So its just fingers cross and close eye on him meanwhile.

[Squirt's Mom]

For your own knowledge, these meds are dosed based on the weight of the dog, not the test results. ;)

[My sweet Ginger]

If I were you I'd move his ACTH stim test up at 10 day mark rather than 14 in this case.

[ScottieBoo]

Update
So far Scottie seems to be doing well with no major signs of side effects. We are now into day #5 of loading. We have noticed that as of yesterday there has been a decrease in drinking and peeing. Not the high frequency like before. So my first instinct would be this is a good thing? or is this something that is too soon after dosing?

[ScottieBoo]

If I were you I'd move his ACTH stim test up at 10 day mark rather than 14 in this case.

I am expecting a call from My Vets office sometime today. I will ask about possibly doing a 10 day out ACTH test vs. 14 day out.

[Harley PoMMom]

Update
So far Scottie seems to be doing well with no major signs of side effects. We are now into day #5 of loading. We have noticed that as of yesterday there has been a decrease in drinking and peeing. Not the high frequency like before. So my first instinct would be this is a good thing? or is this something that is too soon after dosing?

Dogs being treated with Vetoryl/Trilostane do not go through a "loading", only Lysodren has a loading/induction phase. Improvements in drinking/urination are usually seen within 2 weeks of treatment, so the 5 days is rather quick, just keep an eye out for signs of the cortisol going too low which could be vomiting, diarrhea, loss of appetite, or Scottie just not acting himself.

Hugs, Lori

[ScottieBoo]

Dogs being treated with Vetoryl/Trilostane do not go through a "loading", only Lysodren has a loading/induction phase. Improvements in drinking/urination are usually seen within 2 weeks of treatment, so the 5 days is rather quick, just keep an eye out for signs of the cortisol going too low which could be vomiting, diarrhea, loss of appetite, or Scottie just not acting himself.

Hugs, Lori

Thank for the clarification of what is considered "loading"
We are keeping a very close eye on him. So far we are not seeing any major issues or reason for concern. I will keep you posted, as always thanks for your help.

[ScottieBoo]

Not Sure if there is something already out there. But I was thinking of finding a way to help promote this forum (K9 Cushings.com)
Because of everthing it stands for. Of course I will be posting on my Facebook page etc.. I am also going to have a bracelette made for myself saying: "I Love my cushpup".. May sound cheesy to others but I thought I would share. :)

[Squirt's Mom]

I think the bracelet sounds wonderful, Gino!

[ScottieBoo]

[QUOTE=Squirt's Mom;169726]I think the bracelet sounds wonderful, Gino![/QUOTE

Thank You! Animals deserve Awareness Ribbons / Pins/ Bracelets etc.. as Well. They are GOD CREATURES

[molly muffin]

That is a very sweet idea about the bracelet!
Getting the word out on facebook, or other places is a great idea. It is of course, all about helping dogs and parents of dogs with cushings. So important to have the correct information when on this journey.

[Shelby01]

Gino, I love your idea :)

[ScottieBoo]

Gino, I love your idea :)

Thanks!
:)

[ScottieBoo]

Today I guess is the first time I notice possible side effect for Scottie. He kept me up all night coming to my bedside and waking me up. I would think he wants to go outside and pee (Yet he would not). I thought he was thirsty (Yet would not drink), also not hungry. He would have his tale between his legs but no shaking.

I am thinking it is more possibly Gas, or stomach discomfort.??
As if he could not seem to make himself comfortable. ??

Yesterday was his 10th day on Detoryl.

[labblab]

Today I guess is the first time I notice possible side effect for Scottie. He kept me up all night coming to my bedside and waking me up. I would think he wants to go outside and pee (Yet he would not). I thought he was thirsty (Yet would not drink), also not hungry. He would have his tale between his legs but no shaking.

I am thinking it is more possibly Gas, or stomach discomfort.??
As if he could not seem to make himself comfortable. ??

Yesterday was his 10th day on Detoryl.

Not wanting to eat or drink and general discomfort can definitely be signs that cortisol levels have truly dropped too low (Addisonian issues), or that they have dropped too low for comfort (corticosteroid withdrawal). Has Scottie already had his Vetoryl today? Is there any way you can get him in this morning for an ACTH?

You do need to notify your vet of these changes so that she is aware of what is going on and can push up the ACTH accordingly.

Marianne

[ScottieBoo]

Not wanting to eat or drink and general discomfort can definitely be signs that cortisol levels have truly dropped too low (Addisonian issues), or that they have dropped too low for comfort (corticosteroid withdrawal). Has Scottie already had his Vetoryl today? Is there any way you can get him in this morning for an ACTH?

You do need to notify your vet of these changes so that she is aware of what is going on and can push up the ACTH accordingly.

Marianne

Thanks Marianne and that is exactly what I was thinking. I have called the Vet Clinic and left a message for her to call me. I still have no given todays dose.

[ScottieBoo]

I am hoping the Vet will call me back shortly. I am going to recommend se let me take him today for testing. I will not give him today's dose if he does not eat. But I wonder if that will affect the results of the test?

Darn now I am so freaking stressed out and worried. I just called the workplace letting my Boss know I will mostly likely not be in today.

[Harley PoMMom]

Not giving the Vetoryl today and having an ACTH stimulation test performed will make the results higher than if Scottie did have the Vetoryl, so this does need to be taken in consideration when evaluating the ACTH stim results.

Our motto is that when a dog is presenting symptoms of feeling unwell or just not acting quite like them self that the Cushing's medication be withheld, stopping the Vetroyl was absolutely the right thing to do.

Keep us posted.

Hugs, Lori

[labblab]

Hey Gino, we are worried about you guys! How did things turn out yesterday? How is Scottie doing?

Marianne

[ScottieBoo]

Marianne
Thanks for your concern I am sorry I am just logging on to update.
We did take Scottie in to see the Vet. Before I took him I let her know how did not give him his Vetoryl because I was concern it may be something to do with that. She felt I should still give him the dose because based on the symptoms it does not sound like side effects of the medicine. She instructed me to still give him his daily dose then bring him in for tests. I asked if she would consider running the ACTH test at that time. Vet felt once again this was not related to meds or cortisol levels. There are some urine tests that were taken and some swabs. We are expecting the results by tomorrow (Thursday). She did agree to do the ACTH test tomorrow Thursday (by then it will be his 13th dose). Vet thinks Scottie either has a UTI or having symptoms from so many ongoing issues of constant peeing. There is also the possibility of gas or digestive discomforts. Vet did not want to quickly put on antibiotics if not necessary until concrete results. Scottie did a little better last night but I still notice him being hesitant laying down and pausing with tail between his legs. I am going to let the Vet know when we bring him in. I am right now trusting my Vet hoping it does not kick me in the behind or I end up regretting it. But I do not know what else to do.
:confused:

[Harley PoMMom]

When a dog is presenting signs of not feeling well treatment has to be stopped, I don't agree with your vet, no Vetoryl should be given while Scottie is feeling unwell.

[Shelby01]

After reading through the new posts on your thread, I was just thinking, is there only one vet at your clinic? Maybe you might think of asking what the other doctors at the clinic think?

[Budsters Mom]

I agree with Lori. Vetroyl should be witheld until Scottie is feeling better. ;)

[KristinT]

Hi Gino - I'm new to the forum but I've been following your post. My advice would be to go with your gut; if Scottie isn't showing signs of feeling better just stop the medicine for a day or so. You can always restart the medicine but giving him too much can't be reversed as easily, ya know? You have nothing to lose by getting another Vet's opinion.

I can tell you are a wonder Dad; I know you'll make the right choice. :)

Kristin
(Chloe's Mom)

[Squirt's Mom]

I pray your trust isn't misplaced as well. Let us know what the tests results show is the problem and what the ACTH shows. If you continue to see signs that indicate the cortisol is too low, for Scottie's sake and to heck with the vet, please do not keep giving him this very powerful drug. It has the potential to take his life if misused. :(

[labblab]

As long as Scottie is still doing somewhat better, I believe I would go ahead and still give this morning's dose of Vetoryl so that the ACTH is as accurate as possible in terms of reflecting this dose's effect. But beyond that, I agree with the others and I would give no more of the med, certainly at least not until the test results are back and you can be assured that his cortisol is high enough to eliminate that as a worry.

Marianne

[ScottieBoo]

Scottie has been dropped off at the Vet for his ACTH test.
I am extremely stressed out right now. I DID NOT GIVE HIM IS MED THIS MORNING. I did not feel comfortable at all doing it.
Scottie showed more signs of not being well last night and this morning. So I made the call MYSELF to not give it to him. I let he VET clinic know of this. While the VET was still not in I told them they are to give her a copy of the email I sent her detailing the issues I see with Scottie , the symptoms he is showing etc..
I also made it very clear to them and The VET in my email on how with "MY RESEARCH" on Vetoryl IT CLEARLY SAYS ON HOW WE ARE TO IMMEDIATELY STOP GIVING WITH ANY SIGNS OF LETHARGY OR ILLNESS.
We left the dose with them should she feel it is SAFE to still give to him prior to testing. Yet making it very clear how I honestly feel he should not be given the meds.

His is very lethargic, low energy, and vomited & Diahrrea this morning!!!!! I AM SO ANGRY AND WORRIED

[Harley PoMMom]

I believe you absolutely did the right thing in not giving Scottie the Vetoryl, that's exactly what I would of done, to me it is always better to be safe than sorry.

Now, not giving the Vetoryl will make his ACTH stimulation post result to be higher than it normally would if the Vetoryl was given, so this will need to be taken in consideration when evaluating the ACTH stimulation results.

You did good! Trilostane, which is the active ingredient in Vetoryl, has a short half-life so it does leave a dog's system rather quickly, I think Scottie will be fine. Please do keep us updated.

Hugs, Lori

[KristinT]

I'm glad you are going with your gut feeling for little Scottie. He's fortunate to have such a wonderful Dad. ;)

[labblab]

I heartily agree -- you did absolutely the right thing under these circumstances. I truly do not understand why your vet did not go ahead and perform the ACTH on Tuesday since Scottie was unwell at that time and everything was in place to go forward (including the fact that you were already within the initial 10-14 testing window recommended by Dechra). But that is water under the bridge, and your vet absolutely needs to perform an ACTH today, no matter what.

As Lori says, without the Vetoryl today, Scottie's cortisol level will be higher than it would be on a day he was dosed. So your vet definitely needs to take that into account when interpreting the results.

We'll be waiting anxiously to hear how things go today!

Marianne

[Squirt's Mom]

Oh you did so good! Way to be an advocate for Scottie! From now on, I hope you and your vet have a much more positive relationship, working together as a team with mutual respect. Good for you! Always trust your gut - NO ONE knows your baby better than you. ;)

Please let us know how things are as the day progresses and what the ACTH shows when you get it.

[My sweet Ginger]

Gino, no way you should've given him Vetoryl this morning when he was showing all these adverse signs of low cortisol. I'd call them back and tell them DO NOT give him any more Vetoryl until you get the results from the ACTH test. I understand the possible inaccurate results from skipping Vetoryl this morning but I'd rather have this than sending him to even more dangerous level of cortisol by giving it to him to get accurate readings. So you absolutely did the right thing. As we all say here, the parent knows the best.
He may just need a break from Vetoryl and restart on a lower dosage at an appropriate time as it should've been in the first place. Please, keep us posted. Hugs.

[Shelby01]

I agree! You did the right thing by not giving him the meds! I would have done the same thing.

Poor Scottie - you guys are in my prayers -

[ScottieBoo]

I am right now beyond Anger and disappointment with my VET and the office.

It is clear they DID NOT give her my detailed messages before her seeing Scottie. I called this morning and asked if the Doctor still decided to give Scottie his dose of Verytol and I was told Yes she gave it to him anyway! I asked if she was given a copy of my email detailing out the reasons why I was against the dose. The reply was "we did not see the email in the system"
I asked WHY IN THE WORLD DID NO ONE CALL ME BACK IMMEDIATELY TO SAY THE EMAIL STILL HAS NOT ARRIVED!
I WAS GIVEN IM SORRY WE GOT BUSY.

I asked to speak with her immediately and was told she was in currently doing an examination on another pet. They would have her call me. I then asked to speak with the Main VET (owner of the Clinic). To be told she was in a meeting at the time. I am trying very hard to control my emotions right now!!

[Renee]

You did good. Way to stand up to your vet! You know your baby better than anyone and it's your job to look out for him. The vet can go kick sand if they can't understand that! A too confident vet that does not welcome your concern and research is a dangerous vet.

[Squirt's Mom]

Oh my word, Gino. How disappointing, I know. But look at it this way - Scottie is at the vet's should he have problems. They should be close at hand and notice if there is an issue. Just to be on the safe side, I would call and tell them to have someone checking on him often for signs he is getting worse. Get the name of the person you speak with so you know who to go back to if you need.

[Renee]

Oh dear. I didn't see your reply before posting my earlier one.

I am so sorry. Frankly, this calls for a serious meeting of the minds, or a new vet.

:mad:

[My sweet Ginger]

Hi Gino,
I hope little Scottie is doing ok and will pray for his quick recovery.

I'm so sorry that you had to experience your trust in your vet being shattered this way. Granted, most GP vets are not as versed as IMSs when treating Cushings. They are mostly good in preventative care and many of us maintain excellent relationship for many years as long as our pups stay healthy so we naturally build up a blind faith in them like they must be good in everything else.

To me what draws a line between a good vet and a bad one other than their medical knowledge is in their attitude, their willingness to listen and communicate with pet parents as their patients can't talk, research extensively and learn to keep up to date to double check when dealing with potent drugs and having empathy for pet parents etc,. I haven't seen any of these in your vet yet, actually she's the opposite of all these it appears to be. I'd search for a new vet in the mean time but right now you have to get Scottie better and he needs you more than ever.

I know he's at the vet but I hope they gave him rescue dose of prednisone to see if he feels better.

[Shelby01]

Oh dear!! I would definitely keep calling until one of the Vets finally realize you are not happy and are not going away.

I would be demanding to speak to the owner as well -- very unacceptable behavior!

[ScottieBoo]

Well the Wife is on the way to pick up Scottie. I unfortunately am still stuck at work. Yet I was able to have a very lengthy chat with the Vet. Expressed my concerns and frustrations in regards to the very dismissive / lack of concerns I share with the clinic. I also expressed how extremely unacceptable it was for them not to share the detailed information I had sent prior to her treating Scottie.

How I was even more importantly upset that Vetoryl was still given to him despite how concerned I was that he may now have too low of a Cortisol level. Which of course can lead to much more serious things.
She did apologize for how things were handled and again assured me that she honestly did not think "one more dose" was going to set him over to a deep end. She says she truly feels that once she gets the results from this ACTH it will let her know how much we may need to adjust his medicine. Yet still certain it will probably just be possibly going form One 30 mg per day (10 mg twice a day).
She went on saying how she has discussed Scottie's results with other Vets and Vet Fourms. They also felt it was safe to start him at the 30mg.
How The symptoms he is now experiencing may yes be due to some side effects from the Vetoryl. Yet not affects that are because he is in a dangerous state of Addissons? or Exreme Low Cortisol.
then she said some other medical terms I of course have no clue what they are. We are stopping Vetoryl until we get the results of this recent test. She will start him back up on Vetoryl Monday (with whatever dose she feels is best).
For now he comes home with some medicine to help with any GI discomfort and help with any possible diarrhea.
We will then go back for ACTH testing two weeks from Monday.
I will keep everyone posted.

Love Yall Gino

[Shelby01]

I am relieved to hear he will definitely get a break from the meds. Should be interesting to see what the tests show.

Give him lots of TLC!

Been thinking of you guys all day!

[ScottieBoo]

I am relieved to hear he will definitely get a break from the meds. Should be interesting to see what the tests show.

Give him lots of TLC!

Been thinking of you guys all day!


Thanks Hillary
Please also keep me posted on Shelby Ok!

[labblab]

She did apologize for how things were handled and again assured me that she honestly did not think "one more dose" was going to set him over to a deep end. She says she truly feels that once she gets the results from this ACTH it will let her know how much we may need to adjust his medicine. Yet still certain it will probably just be possibly going form One 30 mg per day (10 mg twice a day).
She went on saying how she has discussed Scottie's results with other Vets and Vet Fourms. They also felt it was safe to start him at the 30mg.
How The symptoms he is now experiencing may yes be due to some side effects from the Vetoryl. Yet not affects that are because he is in a dangerous state of Addissons? or Exreme Low Cortisol.
then she said some other medical terms I of course have no clue what they are.

Hmmmm...this is what bothers me about your vet's response to your concerns. She seems extremely defensive about insisting that 30 mg. was the correct starting dose, which seems incredibly odd since she is halfway acknowledging that perhaps these side effects are the result of a dose that needs to be lowered. In the same vein, she cannot possibly yet know whether or not Scottie's cortisol is seriously low, so there is no basis for her to insist that Addisonian issues can't be the issue. :confused: :confused:

I am being a broken record here, but there really is no excuse for the ACTH not to have performed on Tuesday when you took Scottie in for evaluation at that time. I have no idea why your vet keeps insisting that these are not symptoms of a cortisol level that has dropped too low -- because they are. Yes, something else could be responsible instead. But the only way to be reassured that it is not low cortisol is to perform an ACTH. And that should have been done on Tuesday.

Perhaps it is the case (hopefully it is the case!) that they also drew a basic blood panel to check Scottie's electrolytes today, and already have inhouse results to indicate that his potassium and sodium levels are OK. Those levels are one component of Addisonian issues. So if they are OK, that's a good thing. But there is no way in which she knows yet whether or not his cortisol has dropped too low, or whether/what a reasonable dosing adjustment might be. So for her to already prep you with the notion that the only thing necessary might be to drop to 10 mg. dosed twice daily -- where is that coming from???? She can't possibly know that now. Also, as a sidebar, why is she suddenly deciding to shift to twice daily dosing? What is the basis for that decision?

So much slipped through the cracks today re: Scottie's care that it makes me very nervous on your behalf. And I am sorry to say that it seems as though your vet is more invested in defending her own decisions than she is in taking proper care of Scottie. I don't know what your previous relationship with her has been, or whether you feel as though you have other vet options available to you. But her response to all of this makes me very nervous. And I encourage you to make sure to obtain a copy of each and every test result that is performed on Scottie. This sounds like a very disorganized practice, and her response to your concerns today makes me question your vet's experience treating Cushing's patients.

Marianne

[Renee]

I was just coming to check in on Scottie! So glad you posted.

Way to go advocating for your boy. This vet... I just don't know. I appreciate and respect a confident vet..... but, this behavior of dismissing your concerns is unacceptable.

Also, I'm glad she has spoken with other vets.. but, unless she has been consulting with an IMS, I'm not inclined to give much credit to her for that. Overwhelmingly, gp vets are not familiar with treating cushings. My own vet, who is admittedly not experienced with cushings, attended a conference where a roundtable discussion was held on cushings. Most of the vets at the conference admitted that they don't have patients who choose treatment. This means when they do get a patient that will be treating cushings, they are relying on whatever they learned in vet school or possibly outdated research and protocols. It's just the way it is.

[My sweet Ginger]

You hit it on the head on every point, Marianne.
I have nothing much to add other than to say that it bothered me when she said that she didn't think one more dose was going to set him over to a deep end. I don't know that just bothers me when a vet says that when they are talking about these dangerous drugs.

[ScottieBoo]

Rene and Mariane
To you both I say I HEAR YOU LOUD AND CLEAR!
Trust me I am not as naïve as my VET thinks I am. Little is she and this Vet Clinic getting to quickly realize how I am an "IN YOUR FACE' Type of person. I do not take likely to having them Blow Smoke up my......!!! LOL
I also have started to show them they will be challenged by me if I see something does not seem right.
I too have noticed that she tends to go back and spend more time defending / justifying her actions Vs. taking the time to really understand where I am trying to come from.
I eagerly await the results of the test and see just where is ACTH levels are now. Also yes they did run some blood work internally because they can check some results right in the office. She tells me that they checked potassium. electrolytes, etc.. and he did not show any signs of anything resulting in too low of Cortisol.

I think when she realized just how stern I cam across and how I will not allow to be treated as an naïve person. She is now being very cautious on her way of updating me on Scottie.
Yet, that is not going to change the fact I will still insist on speaking with the owner of the Clinic.
I want her to personally hear me out and what I feel.
I want her to let me know just how many Cushing cases their clinic has treated.
I want her to let me know how comfortable & Confident she feels they can handle Scottie and his issue.

Thanks to all of you for all this Support and Guidance.!!!

[Harley PoMMom]

Show the vet this:
PRECAUTIONS:
Hypoadrenocorticism can develop at any dose of VETORYL Capsules. In some cases, it may take months for adrenal function to return and some dogs never regain adequate adrenal function. A small percentage of dogs may develop corticosteroid withdrawal syndrome within 10 days of starting treatment. This phenomenon results from acute withdrawal of circulating glucocorticoids; clinical signs include weakness, lethargy, anorexia,

This an excerpt from Dechra's product insert: http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf

Hugs, Lori

[ScottieBoo]

Show the vet this:

This an excerpt from Dechra's product insert: http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf

Hugs, Lori

Thanks Lori
Well Noted for my file and records. LOL

Gino
:)

[Renee]

Go, Gino, Go! You are doing good. I do hope you are able to speak with the owners and get this resolved once and for all.

I also hope that Scottie is doing better tonight and he starts to improve.

[Squirt's Mom]

then she said some other medical terms I of course have no clue what they are. We are stopping Vetoryl until we get the results of this recent test. She will start him back up on Vetoryl Monday (with whatever dose she feels is best).

uh, no. That is what got us to where we are today - her failure to study current info on this very powerful drug she is using, or listen to one who HAS that info, and continues to display a lack of understanding, willingness to learn, and professional ethics in my book. Her response yesterday would have been all I needed to hear to know that this is not the person I want caring for my baby and I would have gotten his records and walked out the door. But I'm a mean crazy old broad. ;)

[labblab]

Gino, I just want to add that even though your vet did give Scottie the trilostane capsule yesterday, it probably was not metabolized very efficiently in the absence of food in his stomach (and in the face of his vomiting and diarrhea). Assuming that to be the case, it is likely that the ACTH results would have been lower on a "normal" dosing morning for him.

I mention this because I suspect your vet will persist in trying to support her contention that Scottie needs a higher rather than lower dose of the medication. So here's another quote and link that discusses the issues involved with interpreting a monitoring ACTH if trilo has been given on an empty stomach.


When a dog ‘s food is withheld, the absorption of trilostane from the gastrointestinal tract is decreased. This leads to low circulating levels of trilostane, resulting in little to no inhibition of adrenocortical synthesis. Therefore, serum cortisol values will higher when the drug is given in a fasted state than when it is given with food.

The higher basal or ACTH-stimulated cortisol results could prompt one to unnecessarily increase the daily trilostane dose. That misjudgment may lead to drug overdosage, with the sequelae of hypoadrenocorticism and adrenal necrosis in some dogs.


http://endocrinevet.blogspot.com/2011/03/whats-best-protocol-for-acth.html

[ScottieBoo]

Good Morning Everyone
I will begin with what is most importan! Scottie did VERY WELL Last night:).
It was very clear he needed a break from the Vetoryl. His energy was up, he was eating and the Tail wagging so much I thought it would fall off. he was back to somewhat normal running to the door when he heard the bell ring etc.

While I am still waiting for the results from the ACTH. I will share with you what the VET wrote on the notes from yesterdays visit.
Notes: Discontine Vetoryl over the weekend. ACTH Stimulation test is still pending, Scottie's electrolytes were normal today. We are going to treat his symptoms which can be related to Vetoryl administration. Again, we do not feel that he has become Addisonian or developed hypoadrenalcortisicm. Some dogs develop gastrointestinal singns (ie lethargy, diarrhea, vomiting, decreased appetite) strictly from the medication without becoming Addisonian. Today we gave Scottie ant--nausea and antacid medications to help him feel better.

[labblab]

That is terrific that Scottie is feeling better! If he has perked up this much overnight, it is indeed unlikely that he is suffering from a serious crash. But yup, some dogs do develop side effects strictly from the medication, and that's exactly why the newest recommendations are to start with lower doses -- so as to minimize the likelihood of that happening! :rolleyes: :rolleyes: :rolleyes:

Hopefully this may turn out to be a positive learning experience for your vet, and she'll start abiding by the 1 mg/lb recommendation with her patients in the future.



While I am still waiting for the results from the ACTH. I will share with you what the VET wrote on the notes from yesterdays visit.
Notes: Discontine Vetoryl over the weekend. ACTH Stimulation test is still pending, Scottie's electrolytes were normal today. We are going to treat his symptoms which can be related to Vetoryl administration. Again, we do not feel that he has become Addisonian or developed hypoadrenalcortisicm. Some dogs develop gastrointestinal singns (ie lethargy, diarrhea, vomiting, decreased appetite) strictly from the medication without becoming Addisonian. Today we gave Scottie ant--nausea and antacid medications to help him feel better.

[Harley PoMMom]

So happy to read that Scottie is feeling more like his ole self again!!!

Thanks for keeping us updated, and I guess those ACTH results will tell the tale.

Hugs, Lori

[Squirt's Mom]

Such a relief to hear that Scottie is feeling better! ~~whew~~

[ScottieBoo]

Let me also add how I know my VET is coming to her "senses"
and realizing that I am doing my homework and reasearch. Her sudden deccission to possibly going to 10 mg twice a day is something I asked her about trying. She comes back to say she was now thinking of doing that becuase (maybe 30 mg at one shot is hard on his stomach). She now thinks 10 mg. twice a day may be easier for him to digest and get used to easier. Based on ACTH results if we need to go back up to 30 mg we can gradually do it. LOL.
Interstesting eh?? I hate to say this and sound like an Arrogant Jerk. But I think this is her back paddling and or "Damage Control".
Either way she and that Clinic need to understand when it comes to MY BABY Scottie!!! I will defend like my Human Kids.

[labblab]

Good for you, Gino! You are doing a great job!!!! ;) ;)

Given all the irregularities these last couple days with Scottie's digestion and the dosing, it will be interesting to see where his ACTH did end up. I am just musing out loud here, though, and unless it is really high, you may be better served knocking clear back to 10 mg. once daily and starting a complete do-over. In checking back, I see that Scottie weighs 14 pounds, so even cutting back to 10 mg. twice daily, you are still dosing him at a level higher than that 1 mg./lg. formula. If you want to stick with brandname Vetoryl, you are kinda stuck in that there is no way to give him 15 mg. But given the events of the last few days, you may want to start lower rather than higher when you start dosing again.

I am actually not sure that there is any research to establish that twice daily dosing, in and of itself, is any easier on the GI system than is once daily dosing. The real benefit of dosing twice daily is to keep cortisol consistently lowered throughout an entire 24-hour cycle. And in doing that, dogs may end up needing a smaller overall daily total which may translate into less side effects. And as you already know, for some dogs, twice daily dosing keeps their symptoms better controlled; for diabetic dogs taking insulin, twice daily dosing is absolutely recommended. But on the other side of the coin, we have been told by one endocrinologist that dogs dosed twice daily may run a greater risk of dropping their cortisols too low overall, since there is no daily rebound. In humans and animals without Cushing's, normal cortisol levels do rise and fall in cycles throughout the day and night.

So we will all be anxious to see the ACTH results. For sure, that is #Step 1. Depending on the results, there is a possibility that you may end up considering an initial dose even lower than 20 mg., even though it's hard for me to imagine your vet endorsing that concept. :o

Marianne

[ScottieBoo]

:confused:Marianne
Very interesting that you brought up the point of Compounding into the 15mg dosage. I did talk to my Vet about that.
In regards to that she did say that is an option we could take. Her only opinion on that is sometimes there have been testimonies that Compounding is not as effective as going straight from the manifactures. There are however good cases yet she thinks we should stick to what we have now. If we agree to 20mg per day do it in separate dosages. See results after 10-14 days on then tweek as needed.
Let's wait for the results and I will ask for evryones opinion.
I may just make the decision to say "NO" I want to start fresh and only 10 mg per day and gradually work my way up.
WHAT STINKS IS THE EVERY 14 DAY EXPENSIVE ACTH TEST.!!
I AM ABOUT TO START SELLING MY FURNITURE LOL.:)
:eek: :p

[Renee]

Gino, I don't think it is a negative reflection on your vet that she does not like compounding. A lot of vets are apprehensive of compounding, and there are studies that have shown compounded trilostane to not be as effective as brand name. My own vet is not supportive of compounded trilostane, and neither am I (I choose to stick with brandname even though we run through a single box of vetoryl every 7 days). But, that's not to discount the need for them at times or the success that many members on here have had using them. It's a personal choice.

[Harley PoMMom]

WHAT STINKS IS THE EVERY 14 DAY EXPENSIVE ACTH TEST.!!
I AM ABOUT TO START SELLING MY FURNITURE LOL.:)
:eek: :p

Don't forget about this money saving tip:




We sure do understand how expensive this dratted disease is to treat, those ACTH stimulation tests are expensive and your vet can save you money by using less of the stimulating agent, cortrosyn, and storing the remainder for future tests. With Scottie weighing about 14 pounds, I suspect your vet could get more than seven acth stim tests out of one vial of stimulating agent. It is well worth your while to ask your vet if she is aware that you do not need to use the entire vial of cortrosyn. If not, provide her with a copy of Dr. Mark Peterson's blog for veterinarians where he provides instructions on how to reconstitute the agent and store for future tests. The agent should last for at least six months which amounts to hundreds and hundreds of dollars saved. You can find this information at
http://endocrinevet.blogspot.com/2011/03/how-to-extend-your-supply-of-cortrosyn.html

Hugs, Lori

[ScottieBoo]

Don't forget about this money saving tip:

Thanks Lori
I have sent an email to my Vet and sent her this link. Letting her know that I would like to discuss this option for Scottie by his next ACTH Testing. Most likely his next testing will be around February 9th.
GQ

[ScottieBoo]

Marianne / Lori

I realize I NEVER gave you the results of the VERY FIRST ACTH Test for Scottie.
I have copied and attached the part I believe you need to see?
If not please let me know. So by reading the below information.
What can you beautiful Genius Women:);):D tell me about My Scottie?


ACTH STIMULATION
Test Result Reference Range Low Normal High
PRE-ACTH CORTISOL 14.0 ug/dL
POST ACTH
CORTISOL >50.0 1 ug/dL
Comments:
1. ACTH Reference Range:
Canine: Feline
2 - 6 0.5 - 5 Pre-ACTH (resting) cortisol
6 - 18 5 - 15 Post-ACTH cortisol
18 - 22 15 - 19 Equivocal post-ACTH cortisol
>22 >19 Post-ACTH cortisol consistent with
hyperadrenocorticism
<2 <0.5 Post-ACTH cortisol consistent with
hypoadrenocorticism
1 - 5 n/a Desired pre- and post-ACTH cortisol on
lysodren therapy

[labblab]

Scottie's pretreatment cortisol level was very high and definitely consistent with the Cushing's diagnosis.

I think the mistake that some inexperienced vets make, though, is equating a high pretreatment cortisol level with the need for a higher initial dose of trilostane. Our experience here is that initial dosing by weight remains the preferred course, regardless of the pretreatment cortisol level. Individual dogs metabolize the drug very differently, and there is no way to predict in advance how effective any given dose will be for any given dog. So the safer, more comfortable route for all dogs is to avoid overdosing or rapidly dropping cortisol like a brick on the front end.

[ScottieBoo]

Scottie's pretreatment cortisol level was very high and definitely consistent with the Cushing's diagnosis.

I think the mistake that some inexperienced vets make, though, is equating a high pretreatment cortisol level with the need for a higher initial dose of trilostane. Our experience here is that dosing by weight remains the preferred course, regardless of the pretreatment level. Individual dogs metabolize the drug very differently, and there is no way to predict in advance how effective any given dose will be for any given dog. So the safer, more comfortable route for all dogs is to avoid overdosing and rapidly dropping cortisol like a brick on the front end.

Thanks for sharing .
I am hoping that she will call me today with the results of his second ACTH after two weeks of 30 mg of Vetoryl.
Then I am interested to see how she will proceed Monday. As we are planning to put him back on it then.

[ScottieBoo]

Good Morning Everyone!
I was finally sent he results to Scottie's ACTH test. This is the first one after two weeks on Vetoryl.

Cortisol - Pre ACTH 7.5
Cortiol - Post ACTH 12.1

Vet is wanting to move forward with 10 mg (twice a day starting today or tomorrow). She is waiting to hear back from me. I wanted some time to get the feedback of all my K9 Cushing.com fellow members.

Regards,
Gino

[Renee]

Gino,

This is a bit of a predicament.

On the one hand, while I do believe 30mg was a bit too high to start, based on those stim results, I'm not sure I would drop back, since the cortisol will continue to drift down and could potentially come right into range on the first dose!

But, since the pre-treatment cortisol was greater than 50 and the post cortisol at 2 weeks has dropped down to 12.1, I would guess Scottie was experiencing some hefty cortisol withdrawals. That big of a drop would possibly warrant dropping back just a bit, just to avoid another huge drop within the next 2 weeks.

However, just for some perspective - my pug showed a big drop in the first 7 days, then her cortisol rebounded over the next few weeks and we ended up increasing her dose a few more times.

Hmmm... that's a tough one. Which ever dosing you decide on, you'll be retesting in 2 weeks anyway... so, I don't think that would be a factor to mess you up.

How are symptoms?

[ScottieBoo]

Gino,

This is a bit of a predicament.

On the one hand, while I do believe 30mg was a bit too high to start, based on those stim results, I'm not sure I would drop back, since the cortisol will continue to drift down and could potentially come right into range on the first dose!

But, since the pre-treatment cortisol was greater than 50 and the post cortisol at 2 weeks has dropped down to 12.1, I would guess Scottie was experiencing some hefty cortisol withdrawals. That big of a drop would possibly warrant dropping back just a bit, just to avoid another huge drop within the next 2 weeks.

However, just for some perspective - my pug showed a big drop in the first 7 days, then her cortisol rebounded over the next few weeks and we ended up increasing her dose a few more times.

Hmmm... that's a tough one. Which ever dosing you decide on, you'll be retesting in 2 weeks anyway... so, I don't think that would be a factor to mess you up.

How are symptoms?

Renee
Thanks or sharing your view.
Right now what we did was Stop his Vetoryl for the Weekend. The plan is to start him back on it Today or Tomorrow AM.
We are leaning toward 10 mg twice a day. Just because of his possible reaction of too much at one time. He was having some symptoms of withdraw. Then we will see if after two weeks on that dosage what happens. If we go back to 30mg per day the good thing is I still have some of those dosage pills left over.
Then I can always just finish using up the 10mg tablets also.
this is again of course if we go up to 30 mg. I would just need to see how to divide up the dosages of 10 mg tablets (to come up with the 30 mg per day).

[labblab]

We have to bear in mind that Scottie's cortisol level undoubtedly would have been lower had his stomach not been empty at the time he was dosed (REALLY empty since he had been previously vomiting in addition to receiving the capsule without food). So I also would be in favor of lowering the dose to the 20 mg. daily total. Based on this test result, I don't think his cortisol had truly dropped too low. But like Renee says, I think this was a rapid decline in a very short time. I think you want to apply some brakes, for the time being. ;)

Marianne

[ScottieBoo]

We have to bear in mind that Scottie's cortisol level undoubtedly would have been lower had his stomach not been empty at the time he was dosed (REALLY empty since he had been previously vomiting in addition to receiving the capsule without food). So I also would be in favor of lowering the dose to the 20 mg. daily total. Based on this test result, I don't think his cortisol had truly dropped too low. But like Renee says, I think this was a rapid decline in a very short time. I think you want to apply some brakes, for the time being. ;)

Marianne

I totally agree with putting on the breaks. I am comfortable going to 20mg daily.
:);):cool:

[Renee]

I think my biggest caution here would be switching back and forth between once daily and twice daily. If you switch to twice daily dosing, I'm not sure it would be beneficial to go back to once daily, if you end up needing 30mg rather than 20 (10 x 2 daily). I just think that adds another factor in that will affect how you can interpret symptom control and your stim testing.

I believe the official (or un-official) recommendation is to start at once daily, and once you are controlled, then split the correct dose in half to twice daily. But, that is only when you are seeing control. I cannot recall if that is Dr. Peterson that says this or Dr Edwards?

However, I started out dosing twice daily and have kept it going, even though it is more costly. We started 10mg am / pm, then went to 20mg am / 10mg pm, and finally ended at 20mg am / pm. There is no rule that says you absolutely MUST have the exact same dose am / pm, it's just more ideal.

I'd probably drop to the 20mg.

[ScottieBoo]

Just to update on Scottie.
This morning we started him on his NEW Dosage of 10mg of Vetoryl twice a day. Fingers crossed that this time around we will get better results with little to no side effects! I will keep everyone up to date.
Oh ad the VET and I had a very intense Heart to Heart conversation. She heard me out! and I heard her out!
She was hurt and concerned that I would question her capabilities.
As if she did not have Scottie's best interest at heart.

I let her know I was upset she would dismiss my questions & concerns. Treating me as if I should not question her on things when it came to Scottie. How the information I was sharing with her was strictly out of my research etc.. I can see how she can view it as me not trusting her. However, she should also view it as a Pet Parent that is concerned and being involved in the treatment process.

Therefore, at this time we both can agree to disagree on some matters. However, it does not take away that in the end Scottie comes first.

I also shared on how my dealings with the Reception desk and Staff.
Does not send a positive message to the pet parents. When they failed to communicate information to her as I instructed. How their very Arrogant dismissive attitudes even in PERSON needs improvement. This sets the tone leaving me to wonder the overall operation.

I think we ended in somewhat good terms. Time will tell I will give the respect deserved (I am a BIG Boy and can be that better / bigger person). Just as long as Scottie gets the treatment he needs.
:D:p







For no I will continue to work with her. I will see what the near future

[labblab]

Just wondering how things are going with Scottie? Hope you guys are doing well!

Marianne

[ScottieBoo]

Dear K9 Cushings Family!
Yes, it is with great pain I say we had to put Scottie to rest yesterday the 12th. We did everything we could for an entire year to get Scottie's Cushings under control Unfortunately he was not responding to the treatments as we hoped. Even up to the morning of yesterday, when the VET said she thinks its time. In our hearts we knew she was right but did not want to believe or accept. He was so full of Skin infections, Sores, and getting very thin. The entire family was there in the room with him to say goodbye. Myself, My Wife, My Daughter and Son. Even Scotties pet family. Our Dog Sophie (his sister from birth), our Cats Charlie and Katie were also there. We all touched him as he went to rest. Then we all cried our eyes out and stood in silence in the room.
We now wait for them to call us when is Ashes are ready to bring home. I want to thank everyone that took the time to talk to me on this site. I know I only posted in the very beginning of his condition then nothing throughout. The issue was I was so consumed with work, family and Scottie.

I will never forget this site and will continue to be a supporter for k9 cushings.

Regards,
Gino Quintana

[Budsters Mom]

I am so very sorry for your loss.:o

Fly free Scottie, fly free!

Hugs,
Kathy

[Joan2517]

So sorry for your loss. He was obviously beloved by you.

Joan

[WeLoveAthena]

We are so very sorry for your loss. So touching you were all together in the end. Scottieboo was and always will live in your hearts

[mytil]

I am so very sorry to read of the passing of Scottie - my heart is with you and your family! He knows you did everything you could.

Terry

[My sweet Ginger]

Gino, I'm so sorry for your loss of sweet Scottie. I hope you will be able to take some comfort in knowing that you've tried everything you could've. It's such a shame that he left us at such young age.
Fly free Scottie. xoxo Song

[Renee]

Gino, I sure remember you and Scottie. I am so sorry things never stabilized with your boy. My condolences. Rest in peace Scottie!

[molly muffin]

I am so sorry to hear that sweet Scottie has passed. :(
My sincerest condolences to you and your family

[judymaggie]

My heart goes out to you and your family on the loss of Scottie. Please know that you did everything possible for him. He is now at peace and free of pain.

[DoxieMama]

I'm sorry to hear of your loss, but what a beautiful moment for all of you to be there at the end.

RIP Scottie... run free and happy.

[budindian]

So sorry for your loss, its not easy losing a member of your family.
Be good to yourself.

[ScottieBoo]

Thank you so much

[Allison]

I am sorry for your loss of Scottie. Our senior adopted dog struggled for years with Cushings and other issues including pancreatisis. He too at the end had gotten very thin and started to have sores. It's so hard to see our companions deteriorate this way and then to say goodbye.

It is good the whole family could be there. Wow, even the other pets were there! That's not something I had ever considered, but I might now in the future. Our own clan of three cats and one dog are close.

Like you, I didn't post often. I joined when our dog started to develop multiple issues but then got preoccupied with helping him through this battle with pancreatisis. Yet as you said, everyone was always so supportive. This is a good site with caring people.

Hugs to you!


Dear K9 Cushings Family!
Yes, it is with great pain I say we had to put Scottie to rest yesterday the 12th. We did everything we could for an entire year to get Scottie's Cushings under control Unfortunately he was not responding to the treatments as we hoped. Even up to the morning of yesterday, when the VET said she thinks its time. In our hearts we knew she was right but did not want to believe or accept. He was so full of Skin infections, Sores, and getting very thin. The entire family was there in the room with him to say goodbye. Myself, My Wife, My Daughter and Son. Even Scotties pet family. Our Dog Sophie (his sister from birth), our Cats Charlie and Katie were also there. We all touched him as he went to rest. Then we all cried our eyes out and stood in silence in the room.
We now wait for them to call us when is Ashes are ready to bring home. I want to thank everyone that took the time to talk to me on this site. I know I only posted in the very beginning of his condition then nothing throughout. The issue was I was so consumed with work, family and Scottie.

Regards,
Gino Quintana

[budindian]

I am so sorry for your loss.