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[racerx179]

Hi, my name is Charlie and I hAve a 9you old cocker spaniel mix named Tabby. This was my mom's dog.My mom passed away,So I kept the dog because mom loved the dog so much.Tabby was diagnosed with cushings probably 2 or 3 yes ago . The first vet kept wanting to do blood work all the time and mom could not afford that. She took tabby to another vet and they did blood work and put her on vetoryl 30 mg twice a day. She hasn't had any blood work for cushings done in awhile. The second vet had said if she was doing fine and not showing any unusual symptoms the would keep her at that. Tabby seems to be doing fine. She doesn't pat a lot or seems to have a ravenous appetite or drink an abundance of water. Tabby weighs about 21 lbs. She did weigh around 30 lbs when my mom had her. Also mom would give tabby bendedryl morning and nite because tabby just likes to follow you around all the time. I plan on getting blood work done at some point so my question is what blood work needs to done for her and my second question is with giving her the vetoryl it's costing me 105.00 a month and that's hard to afford so I saw on here people talking about diamondback drugs. I checked with them and they will do 28mg trisolane, they can't do 30mg. Will the 2 mg difference cause any problems? Tabby vet wasn't in Friday but another vet was and she thought it wasn't a good idea, that the medicine is dangerous and not good to change dosage that it might kill her Her regular vet is supposed to call me tomorrow to discuss this. Any ideas about what I can do? Thanks

[labblab]

Hello and welcome to you and Charlie! I apologize that I can't write more right now, but I am rushing out the door this morning for an appointment. But I wanted to at least welcome you and "bump" your question up to the top of the list this morning so that others will be sure to see you and welcome you, too. :)

Marianne

[molly muffin]

Hello and welcome to the forum. Before you change dosage what you want to have done is an ACTH test to see where her cortisol levels are at. You will have a pre and a post value. The first number should be above 1.5 ug and the second should be between 1 - 9 ug. On e you have those numbers you will know if she is controlled on 30mg twice a day and can adjust to 28mg twice a day or 31 or 32 mg twice a day.

The Benadryl is to keep her calm or does she have allergies which is usually what Benadryl is given for.

Does she have any Cushing's symptoms now? She has been on this dose for 2 or 3 years?

A CBC for health also would be a good idea. This wil tell you how she is doing overall.

[racerx179]

The bendedryl was just to keep her calm We haven't given her any since February and she's fine. She just likes to follow us around alot. The last time she had the act test was January 2014. I thought it had been longer. So I guess she has been on 30 mg veteroyl twice a day since then. As far as symptoms I guess she's a little potbellied but that's it. She doesn't seem to drink a lot of water all the time and sleeps thru the night. She had a senior blood work done in march and everything was fine. She did have a pancreatic problem in December but she's been fine. I'm getting the acth test results from Jan 2014 tomorrow. I ll to post what they say.. Anything else I need to look for? I really need to able to get the trisolane from diamondback drugs to save on the cost. Thanks

[molly muffin]

yes having a compounded pharmacy do the dose for you is helpful with the expenses. Did you get the test results? Yay, glad to hear the cbc showed she is doing fine.

[racerx179]

My dog taddy had a acth stimulation test. She now weighs15 lbs compared to 28 before. She takes two veteroyl,30 mg each,one in themorning and one at night. The only number i see is pre acth cortisol which was 5.2. Her post acth cortisol is 4.8. i was told that is just right.She seems to act fine, running around and carrying on.Anybody have any ideas how the test results look. Thanks

[Squirt's Mom]

MODERATOR NOTE: I have merged your post about reading the ACTH test into Tabby’s original thread. We like to keep all posts about each pup in a single thread as it makes it easier for members, and parents, to refer back to the pup's history when needed. Thanks!

[labblab]

Was that last ACTH test really done clear back in January of 2014, or did you mean to write 2015? Either way, you really do need to repeat the test again now. And if it was back in 2014 you really, really, REALLY need to repeat it now! Especially since Taddy has lost nearly 50% of her original weight, that same dose of trilostane is becoming increasingly more concentrated for her.

It is certainly good that outwardly, she still looks well. But she may be on the verge of being overdosed, especially given the significant weight loss. By continuing on the same trilostane dose, she is currently taking a very high dose of the medication for her current weight.

Over what period of time has the weight loss occurred? Did you consciously try to limit her food or change to a lower calorie formula?

Bottom line: we generally like to see a "post" ACTH value that is higher than the "pre," but since both of Taddy's values were up around 5, she was probably fine at that time. But you really need to have her ACTH rechecked, especially before getting a new prescription filled. She may very well benefit from a dosage adjustment downward which would both benefit her and also ease your cost.

Marianne

[racerx179]

The test results I gave were just from last week before that her last test was January 2014. The weight loss has been from January till now. Tabby is way more active now than when my mo had her and she only gets her recommend amount of food. Period nothing extra. So does the pre amount level seem low?

[labblab]

Oh good, I'm so relieved to hear that these are current results! :)

No, I don't think they are too low. As I said above, it is more typical to see the "post" result turn out to be higher than the "pre" result since the second blood sample is taken after injection of a stimulating agent. If both of the numbers were a lot lower (like below around 2.0 or so) then there might be some cause for concern because it might indicate that adrenal hormone production is consistently oversuppressed. But I think Tabby's numbers are both high enough to be fine. There can be a lot of different factors that can cause a "pre" value to be caught at a higher or lower level at any given moment in time.

It also sounds as though her current weight is actually a healthier weight for her (after cutting out snacks and overfeeding)?

For your reference, here's a link to the official Product Insert for Vetoryl. It includes a table that shows you what the desired results are for monitoring ACTH results. Tabby's "post" ACTH is right there within the desired therapeutic range. So even though she is taking a dose of medication that is comparatively quite high, it seems to be working well for her. This is further proof to us all that every dog metabolizes the drug in her/his own individual fashion, and that the "right" dose for one dog might be the "wrong" dose for another dog of exactly the same weight.

http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf

Marianne

[racerx179]

I don't think she got an injection for the second test. They had me bring in her 30mg veteroyl which I assume they gave after the first draw then waited awhile for the second draw to see what that dosage amount did for her levels. Does that sound right?

[racerx179]

Her dosage now is 30mg twice a day. We are going to try her on 28mg twice a day do I can get it compounded from diamondback drugs to help with cost. Any experience with diamondback drugs?

[labblab]

I don't think she got an injection for the second test. They had me bring in her 30mg veteroyl which I assume they gave after the first draw then waited awhile for the second draw to see what that dosage amount did for her levels. Does that sound right?
No, that definitely does not sound right at all...! :( :(

The proper protocol for a monitoring ACTH test is to give the normal dose of Vetoryl in the morning along with breakfast (it must be given along with a meal in order to be metabolized properly). Then the dog must have the testing completed within a window of time 4-6 hours after the medication has been given.

Blood is first drawn for the "pre" or baseline cortisol level. Then an injection of a stimulating agent is given. Then a second blood draw is performed one hour later to see what the "post" cortisol level is after the stimulating agent has had the opportunity to work.

If this protocol was not followed, then the testing has no value and the "post" ACTH result does not reflect a number that can be used in making decisions regarding dosing changes. You absolutely need to confirm with the vet's office exactly how the test was run. If Tabby was left with the vet all day, then perhaps they did perform both parts of the test 4-6 hours after giving her the Vetoryl. But you need to find that out for certain.

If the test was not done properly, you deserve to have your money refunded. And more importantly, you need to find a vet who is more familiar with Cushing's treatment and will provide proper care for Tabby. Many of our members use and are very satisfied with Diamondback Drugs, but you need to hold up on ordering any more medication until you find out whether the ACTH test was conducted properly and whether the results have any validity.

Marianne

[racerx179]

I did call and check about the test. They do it like you describe. So everything seems to be good then.Thanks for the info.

[labblab]

Whew! That's a relief!

The only thing I am still wondering about is whether they gave the trilostane along with food before conducting the test. A lot of vets have the mistaken idea that a dog should be fasted for a monitoring ACTH test, and this is not true. The drug must be given along with food containing some fat in order to be metabolized properly. So if Tabby was given the medication on an empty stomach, the test result may have resulted in a higher cortisol level than is normally the case for her (assuming that you give her the med along with food yourself).

So this is something to keep in mind for the next testing -- to ask the vets if they are giving the trilostane along with some food.

Marianne