Riley, Vetoryl

[SandyH]

Hi everyone. I have been lurking for a few weeks knowing that a Cushings DX is probably coming. Riley is a 6 yr old cocker spaniel, symptoms have been insatiable appetite, weight gain in his belly, protein in urine, some of the bloodwork has been mildly off in the Cushings categories. However the main symptom of hair loss and skin issues is nonexistant, his coat and skin are beautiful hence vet didn't think he looked Cushioniod. His Dex test results are:

4hrs .6

8hrs 3

While I await a call back from the vet, are these numbers consistant with a Cushings DX?

My other main question-I have heard that the trilostane compound is much better than the Vetoryl caps. What is people's experience with this theory?

Thank you.

[SandyH]

Just heard back from the vet and yes he has Cushings. Will be starting on 30 mg Vetoryl daily, he is currently 33 lbs, should be 28 lbs so hopefully will lose that extra 5. Will have acht test in 10 to 14 days. He is currently eating Wellness Complete Health Healthy Weight Chicken and green beans and carrots, was on Core for years. Also am supplementing with Wellactin.

To properly introduce myself, I have 3 cockers, Callie, age 9(Riley's half sibling), Casey, age 8 and Riley, age 6.5. They are 3 BFF's, always playing, snuggling with each other. I am a fanatic about caring for my dogs, feed them the best food available, I titer them instead of vaccinating, followed Dr Dodds vaccination schedule as puppies, use Sentinal only for heartworm, treat my yard with DE for ticks instead of my dogs, etc. Not treating my dogs for anything is not an option. Luckily I got pet insurance for them in June so I have coverage after my $1000 deductable.

We found this by accident as my 3 cockers participated in an ITP research study(I lost my first cocker to IMHA so this was important to me) and the urine test showed protein which started this whole thing.

Any and all advice welcome. While I am quite knowledgable about IMHA and many other medical issues I have never dealt with Cushings before, although some people on my cocker forum have, but they are not experts which is why I am joining your forum and seeking your advice as you much more knowledgable about this issue.

Is this disease appropriate to request a rabies waiver as he will be due for rabies next year to avoid an autoimmune disease issue? The dog I lost to IMHA was his blood relative.

[Squirt's Mom]

Hi and welcome to you and Riley! :)

The LDDS usually has three numbers; the baseline seems to be missing on Riley's. Were you only given 2 numbers?

Were any other tests run to diagnose the disease? Has he had a wellness check that shows things like BUN, CHOL, ALP, etc? Would you mind posting those values that are either too high or two low on that test?

Compounding has it's use when the dog needs a dose that is not made by Dechra or needs a different method of delivery, like liquid, for some reason. Trilostane is the active ingredient in Vetoryl. Some feel the name brand, Vetoryl, works better and we have seen that in certain dogs here from time to time. Others do just fine on the compounded Trilostane. So it's not really a case of one being "better" than the other - it depends on the dog.

Does Riley have any other health issues that you know of? Is he on any other meds? herbs?

I'm glad you found us and have been reading some on the site. I look forward to learning more about Riley soon.

Hugs,
Leslie and the gang

[SandyH]

Sorry I didn't really properly introduce myself in my other thread, so I will do so now. I have 3 cockers, Callie, 9 next month(Riley's half sibling), Casey, age 8, and Riley, age 6.5. They are 3 BFF's, always playing, snuggling with each other and the sweetest little cockers you could meet. I am a fanatic about caring for my dogs, feed them the best food available, I titer them instead of vaccinating, followed Dr Dodds vaccination schedule as puppies, use Sentinal only for heartworm, treat my yard with DE for ticks instead of my dogs, etc. Not treating my dogs for anything is not an option. Luckily I got pet insurance for them in June so I have coverage after my $1000 deductible. I got it for "catastophic illness" in case IMHA or cancer hit one of my dogs, didn't think I would use it for something like this.

I switched him from Wellness Core to Wellness Complete Healthy Weight(purple bag) and supplement with Wellactin and lots of vegies and fruit, very sad at bedtime when he gets 2 carrots and the other 2 get 2 biscuits! Hoping with the meds he will lose the extra weight and can get back to a normal eating routine instead of being a foodaholic.

Any and all advice welcome. While I am quite knowledgable about IMHA and many other medical issues I have never dealt with Cushings before, although some people on my cocker forum have, but they are not experts which is why I am joining your forum and seeking your advice as you much more knowledgable about this issue.

Is this disease appropriate to request a rabies waiver as he will be due for rabies next year to avoid an autoimmune disease issue? The dog I lost to IMHA was his blood relative.

Is Cushings hereditary?

Bloodwork that indicated Cushings:
Neutrophil 14.28
Band Neutrophil 0.6644
Potassium 505
Alk Phos 168
Triglycerides 158
Protein in urine 2+
Dex test today-don't know the baseline # yet, but
4hr .6
8hr 3

Starting on 30 mg Vetoryl tomorrow, have the acth test in 13 days.

This is my baby that has had all the medical issues-2 cherry eyes, 2 luxating patella surgeries(weight gain is awful for his knees), and now this. Thank you for any and all input and assistance.

[Squirt's Mom]

MODERATOR NOTE: I have merged your post about yourself and your babies, and the test info, into Riley’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!

[molly muffin]

Hello and welcome from me also.
I hate to have to ask but can you edit your post to put the normal range next to the test value like Alk Phos 168 (range 50 - 150nmol) for example. Every lab is different and so that helps to know what exactly we are talking about as far as what should be normal and how far off they might be.

I know some vets seem to think there could be a genetic predisposition to cushings (if you do a search under cushings dog hereditary) but as far as I know there is no definitive proof of cause for cushings, other than itrogenic cushings which is caused by a dog being given steroid for a long period of time.
I do understand your concern though having a 1/2 sib to Riley.

As far as compounded vs vetroyl goes, most will go with trilostane as it is a cheaper option when money is tight and you are talking about a life long drug (in most cases). If you do go compounded, Diamondback is used by many of our members and has good reviews. Even if you go with vetroyl the name brand, you can usually find it at one of the online pharmacies cheaper than at the vet. Valley Vet, for instance is one I think some use for the name brand.

Most vets don't seem to want to give a waiver for cushings and rabies vac but some will. If yours will do so then unless there is a higher risk in the area you live in, I probably would get the waiver.

I'm sure you'll have a lot of questions as you go along, and we will be right here every step of the way.

[SandyH]

Riley had his first ACTH test yesterday, results were:

CORT Baseline 2.5 ug/dL

CORT Theraputic monitoring >10.0>

Other tests run:

Na(Sodium) 155 (normal range 144-160)

K (Potassium) 6 HIGH (normal range 3.5-5.8)

Cl (Chloride) 117 (normal range 109-122)


The Dex test used to diagnose the Cushings was

Baseline 3.8

4 hr Cort 0.6

8 hr Cort 3

He is 32 lbs and on 30 mg daily of Vetoryl. Lost 1/2 lb and doing the same, although appetite seems to have decreased just a tiny bit.

[Squirt's Mom]

I see why you said the second number was confusing! :D I take that to mean 10 is as high as that lab can read and Riley's result was greater than what their machine could put a number on...so it simply said "greater than 10". If that is the case, then his cortisol is still to high. Dechra says the post or second number can go as high as 9.1 ug/dl if and ONLY IF all signs are controlled. You say he is about the same so I would say he is not controlled and may need a dose increase. As for how much, I will let one of the members more versed in Vetoryl use talk to you about that.

[labblab]

Hello and welcome from me, too! :)

Leslie has given you a great start, and I have a couple of thoughts to add in. The first is that the results you have posted for the diagnostic LDDS test are consistent with the pituitary form of Cushing's. You may already have known that, but I just wanted to mention it anyway. ;)

Secondly, it looks as though Riley's first monitoring ACTH test was performed after about ten days on the trilostane. Testing is done at that early stage mainly to ensure that cortisol is not dropping too low. I am therefore assuming that this first ACTH may have been an inhouse "snap" test -- it does show that the cortisol is not too low, but doesn't give an exact reading as to how high the cortisol is hanging. At this stage that is probably fine, because treatment recommendations are to leave an initial dose of trilostane unchanged for the first 30 days unless cortisol has dropped too low. Increases are not recommended until after the first month of treatment has been completed. This is because cortisol levels tend to continue to drift downward during this time even when a dose is unchanged. At the time of the 30-day testing, however, you will want an "official" ACTH performed that gives the exact post-ACTH numerical result. This is because that info is essential to making an informed decision re: any dosing changes going forward.

For right now, though, it sounds as though you guys are on the right track. Here's a link to a new publication by the makers of Vetoryl that does an excellent job of explaining treatment and monitoring protocols:

http://www.dechra-us.com/Files/dechraUSA/downloads/Client%20Literature/Treatment%20and%20Monitoring%20of%20Hyperadrenocor ticism.pdf

Do keep us updated, OK?
Marianne

[SandyH]

Thank you for the replies. His first ACTH was after 12 days. His appetite I think has been decreasing-he left 5 carrots behind in his bowl, and he doesn't run to his dish, sits there and looks at me first, so that is progress. He has not exhibited any of the other classic Cushings signs, pants a bit at times but no pattern to that. What is bad timing and going to be difficult is we are finally able to snowbird in Fla and will be leaving shortly, and I do not have a vet down there yet. I have called the local vets and have all the info and am in process of making the best choice for our needs. My first choice is not taking on new patients and sounds like the second choice is 20 minutes away, fine for appts but I am concerned if I ever have a 911 emergency during the day-the Emergency Clinic that is only 2 miles from our house is only open nights and weekends-I would rather travel only 5 minutes than 20 if I ever had a 911 emergency such as a snakebite. So I am trying to decide between 3 that are in town, 2 are a single vet practice(one takes a 3 hour lunch) and the other is a multi vet practice, which I think I am leaning toward because of the 911 thing. I will also be working with my vet at home, sending him the results and getting his input on the results. I will be bringing down a 4-5 month Vetoryl supply because their price is $70 vs $85 in Fla.

If anyone has any vet recommendations around the Leesburg Fla area please let me know!

BTW, since these dogs seem to have increased risk of UTI's, its the time of year to stock up on fresh cranberries and freeze them and give to the dogs throughout the year as treats. Two of my dogs love them raw, luckily Riley and my female that has hx of UTI's which is why I have done this for years.

Please keep the info coming, I am a sponge for info and need all that you can offer. Marianne and Leslie, Thank you for your replies.

[molly muffin]

I don't know of anyone around Leesburg Florida but I do agree that having an option of more vets and 24 hour care is a good thing to have available.

You will want to get the 30 day acth test and see where he is at. You can ask them to send it to one of the IDEXX labs if you want but the price might be more. It does sound like it is coming down though by how he is acting with his food, so that is good.

I'll be jealous of all that warm weather, while we are up here freezing. :)

[labblab]

I will also be working with my vet at home, sending him the results and getting his input on the results. I will be bringing down a 4-5 month Vetoryl supply because their price is $70 vs $85 in Fla.
I just want to caution you about buying a large supply of Vetoryl capsules early on in the treatment process. Dosing changes, both upward and downward, are very common during the first few months, and unfortunately the Vetoryl capsules cannot be opened and divided. So you may not want to stock up on a dosage amount that you end up not being able to use. A lot of our members have found that they can buy Vetoryl for the best prices from reputable internet pharmacies. When purchased that way, it doesn't matter what state you are ordering from. So you may want to hold off before you purchase a lot more capsules right now.

Marianne

[SandyH]

Thank you Marianne. Riley is a cocker spaniel, currently overweight at 32 lbs, but working on getting down to his usual 28 lbs, so I figure he will be at least 30 mg for awhile, if he goes up it would probably be in 10 mg intervals so I would need to buy additional 10 mg caps. Luckily I have insurance which will pay the majority, and I don't think it will pay for internet drugs as the claim forms need to be signed and stamped by a vet. Maybe I will just get 3 additional months worth.

Best price I found online for Vetoryl was KV Vet Supply, $59.79 for the 30 mg, free shipping. They are a VIPPS pharmacy, and I highly recommend them, I have been ordering from them for years and always been happy with them.

[SandyH]

Update. Riley has been on the Vetoryl for 32 days and his only real symptom which was his increased appetite has returned to his normal appetite. However his normal appetite is being very picky in the morning with his breakfast, which is where he is at now. I no longer can supplement his food with veggies as he is not interested, back to bribery with hamburg in his food, and he doesn't eat much in the morning, never has. My question, how much food does he need in the am with the Vetoryl for it to be effective? Sometimes I have to give him biscuits to get enough in him because of the Vetoryl. He eats fine at night.

His breakfast eating has been a lifelong issue, I used to give him 2 biscuits and then let him eat it when he wanted, which was usually an hour or two later, but I cannot do that now with the Vetoryl. I know its behavorial and not a side effect because he eats the biscuits and hamburg fine, just not his kibble, and dinnertime he eats fine. Some people just are not breakfast folks and Riley is in that category.

Next ACTH test on Nov 19 with new vet in Fla. Hoping I do not have a conflict with 2 vets wanting different doses. Since his symptoms are being controlled on this dose I prefer to stay with this dose with no increase, 30 mg for his 32 lbs.

[Harley PoMMom]

The fat content is most important so that the Vetoryl is properly absorbed, do you think Riley would eat his Vetoryl in cream cheese or peanut butter?

Hugs, Lori

[judymaggie]

Hi! Just wanted to offer a suggestion re giving Riley his Vetoryl. My Abbie has become a very finicky morning eater and, like Riley, there are no issues giving her meds and other meals later in the day. Because of blood pressure and proteinuria issues, Abbie is on twice daily dosing so it is important that she get at least a small meal in the morning and, as Lori has said, the Vetoryl given with something fatty.

After running out of options, my vet's head tech/office manager said she had just the thing-- kitten liver pate. The one available at my vet is Purina Pro Plan Focus, kitten Chicken/Liver pate. I wrap Abbie's Vetoryl in a quarter of a slice of cheese. Since you are in Florida with access to Publix, I would suggest Borden's grilled cheese slices as they are much easier to mold than other cheese slices--I can put two capsules and two pills inside the quarter piece and then put a little bit of the kitten food on one side of the cheese ball and offer that side to Abbie.

I would think you could give Riley a little hamburg mixed with some biscuit for her morning meal and then try the cheese ball.

[SandyH]

Oh I don't have a problem giving him his pill-years ago I learned in obedience school how to pop the pills quickly(back in the daily heartworm pill days). Very difficult to explain the technique-put the pill in the back of the mouth then flick the pill with your finger-if the dog licks his/her nose the pill went down, quick and easy and no hassle hiding the pill in food, spitting the pill out or putting the pill in and messaging the throat(I hate when I see that)! If the tongue doesn't come out then you know instantly you failed. Probably would not work with very small mouths but worked well with my 90 lb golden/setter mix and my current cockers.

I feed lowfat food and always use lean meats to cut down on fat content to reduce risk of pancreatitus. I was looking for an amount of food that needs to be eaten with the pill. I also alternate coating the kibble with liver which has more fat than the hamburg or turkeyburger-I use 93% and drain it well and sometimes rinse it with water if it still seems to greasy. I think I will switch to liver for awhile and maybe order another bag of Petmix to mix with it. Petmix is awesome, its dehydrated vegetables and fruit(honestly looks like cardboard when you get it) and you mix your own protein source with it-kinda like Honest Kitchen but much chunkier and much more appetizing IMO.

Probably time to switch back to regular instead of lowfat kibble for increased fat content.

[Squirt's Mom]

As for the amount - Dechra says to give the med with a "meal", not snack but meal. So that tells me the pup needs to have the same amount of food with the med they would eat without the med. Have you considered backing your dosing schedule up to fit with her appetite? ie instead of giving breakfast and the pill at 8AM when she's not hungry, give it at 10AM...then back the PM dose up the same amount of time. Just a thought....may not be feasible. ;)

[SandyH]

Thank you for the info. He gets only 1 dose in the am. I have already backed up breakfast to 9-9:30ish. I give him his Wellactin at dinner so he gets it then when all 3 eat all their dinner. Did OK today, half some of his and some of Callie's.

Cockers are supposed to be foodies. I have 3 that are not-they pick at their breakfast, eat what they want til they have had enough, then go see what the others are eating(its the same thing guys!) I could put a plate of prime rib down and all 3 would share with each other with no conflict. Musical bowl mealtime is quite humorous in my house, only issue now is that Riley has to eat enough and eat his food with Wellactin in it. I do try to limit people food with them like cheese and meat-they can have all the veggies, fruit and healthy stuff they want but the good stuff is limited. I have never had a weight issue with anyone until Riley's Cushings, but he should lose it soon once it cools off here and we can resume our walking routine.

[SandyH]

Just got Riley's ACTH results, he has been on the Vetoryl for 43 days.

1st Cortisol Sample 3.3 Range 1.0-5.0

2nd Cortisol sample 8.3 Range 8-17

The electrolytes were all within range except:

Potassium 5.6 Range 3.6-5.5

Anion Gap 28 Range 8-25

Hair and skin continue to be perfect, his appetite has returned to normal. Hopefully we can keep this up. Recheck in 3 months.

[lulusmom]

Congratulations on a job well done...so far anyway. :) I say so far because you don't have much wiggle room with a post of 8.3, which is on the higher end of the therapeutic range and we've seen cortisol increase at this early stage of treatment. Therefore, enjoy your success but keep a close eye out for return of symptoms in the next 90 days. Hopefully, Riley will be in the minority of dogs who stabilize on the initial dose.

Glynda

[molly muffin]

That is good that things are looking up for Riley.

Just if you notice and increase in symptoms, you can always pop in sooner for an ACTH. Blast it if didn't happen with my dog. grrrr Hopefully it won't with Riley though. I'm always jealous of the ones who give a dose and it's perfect and holds the same dose for years. hahahaha I hope that for you!

[SandyH]

Just had a 3 month ACTH test and need advice. Results were:

Baseline 1 . Ref range 1-5.

4 hr post 3.4 . Ref range 8-17.

I am very concerned he is running too low. He weighs 32.8 lbs and is taking 30 mg Vetoryl daily, has been since day one. He continues with perfect skin and fur, normal appetite, drinking and elimination. If one would look at him you would never know he has Cushings.

We are in Florida for the winter and the vet here said to continue the 30 mg. I have a call into my vet at home with the results to ask him what to do. I have much more confidence in my vet at home than the one I saw down here-it was another vet in the practice, not the owner. I am also facing stepping on the vet's toes down here, but there are lots of vets here, I could just change if they get offended. I need advice over what to do over the weekend until I hear from my vet next Tuesday. Honestly I would feel more comfortable lowering him to 20 mg daily, and I know it only comes in 10 mg doses.

My choices are:

Continue to give 30 mg daily.

Give every other day.

Give every 36 hours-a compromise between the 2!

We will be heading home first week of April.

I did not have the electrolytes done this time, they were fine in November, but should I go back for them? They did not originally have that documented to do which is why it was not done(covering vet).

Another question-I was shocked that the price for this ACTH test jumped $100 from November, they said the drug prices went up in February. Just wondering if anyone else encountered this? It is expensive enough, luckily I have insurance but that does not cover all of it.

Thank you in advance for your input.

[My sweet Ginger]

Hi,

Looking at the ACTH numbers on Riley's path since Vetoryl, I think there's something we should pay our attention to. The common consensus on here has been since Vetoryl works for 30days an increase before 30 days are not usually recommended. Here are Riley's and his numbers are telling us even beyond that.

10/21/15, he was on 30mg Vetoryl for 12 days.
Pre 2.5, post > 10
11/23/15, after 43 days on 30 mg.
Pre 3.3, post 8.3
02/25(?)/16, after 3months on 30 mg.
Pre 1.00, post 3.4

His cortisol has been slowly coming down way past the 30day mark which it is now 90 days and I'm very concerned about his pre number of 1.00 if he stays on the same 30mg. It seems like for some pups Vetoryl will still work far past 30 days on the exact same dose therefore the importance of a periodic ACTH test.
So if it were me assuming his cortisol might still go downward on 30mg I'd talk to the vet and decrease his dose down to 20 mg and watch him closely and an ACTH after 2-4 wks.
This is my 2cents and let's hear from others.

Pas: the ref range of 8-17 is normal range for pups not on Vetoryl. For pups on Vetoryl is 1-5.

[Harley PoMMom]

Thank you Song for including those timelines! I'm in agreement with Song on this, it makes me a bit concerned that Riley's cortisol numbers have been drifting downward. In your shoes I would decrease the dose to 20 mg and would wait about a month to see if those Cushing's symptoms rebound if they don't then I would have an ACTH stim test to see what effect this dose is having on his cortisol.

Hugs, Lori

[labblab]

Count me in, too! That was super helpful of Song to notice and document the downward trend. Since Riley is doing so well, I kind of hate to rock the boat, but I believe I'd decrease to 20 mg. daily, too, and see what happens, both with symptoms and also cortisol retesting in thirty days. I would not shift to alternate day dosing with the 30 mg.

Marianne

[molly muffin]

Count me in agreement also. When Song put it together like that it a,Es sense to lower and see how he does.
In fact maybe if you take what song wrote out to your vet there in Florida he might agree too.

[SandyH]

Thank you for your responses. I am glad to have more support in my thinking to reduce to 20 mg but I am in a bind getting that. This vet in Florida does not carry Vetoryl in stock-they order it for me so it would be awhile before I could get the lower dosage. My vet at home will not be in until Tuesday for a vet confirmation for the 20 mg. I also find that vets do not take too kindly from internet advice even though I know you are right and this vet is wrong. I will push the issue with them once I have my vet's backup but what is the best option until then. I did not give it today. I know giving every other day or opening the capsules are both no no but I feel I must choose one of these bad options so which one is the best of the bad choices? I will not continue the 30 mg knowing how close he could be to an Addisonian crisis.

[labblab]

I would not think that Riley is in immediate danger of an Addisonian crisis, given a post-ACTH response of 3.4. That is actually squarely in the middle of the desired therapeutic range. My worry relates more to a continued lowering of cortisol over a more extended period of time. So if it was me, I'd continue with the 30 mg. on a daily basis until you can get the dosing change sorted out.

FYI, you can directly order Vetoryl yourself from reliable internet pharmacies, and that may save you money over what you are paying to the vet. You will need to supply a prescription from your vet, however. So this may be coordinated more easily with your "home" vet if he/she agrees to the dosing decrease.

Marianne

[Harley PoMMom]

One option could be to take those Vetoryl capsules to a compounding pharmacy and see if they could "repackage" the contents of brand name Vetoryl into smaller units.

[SandyH]

Great idea! Thank you. I just googled and found one in Leesburg, but it's not open until Monday.

[labblab]

How many 30 mg. capsules do you have left? Unless you have quite a few remaining, the expense/effort of trying to convert them may just not be worth it. I would expect that you would need a vet's Rx in hand before the pharmacy would make the change.

Unless you have a lot of 30 mg. capsules left, I'm still thinking you'd be better served by going ahead and finishing them off and then starting in with a lower dose when you can get the Rx sorted out. But if you have a lot of 30 mg. left, then repackaging may be an option, indeed.

[SandyH]

Marianne, the insurance will not pay for Internet pharmacies as they have to fill out and sign a claim form which I do not think an Internet pharmacy will do. It's cheaper for me to get it from a vet because I am reimbursed 80%. Thank you for the reassurance about going Addisonian. I really thought I would be increasing at some point, not worrying about decreasing!

[SandyH]

I have 12 capsules left

[tank&kat]

It's fine to stay at the 30, especially since you can order the 20 mg early next week. I wouldn't do every other day dosing. This only creates cortisol levels to be inconsistent and there are not enough studies on how this effects dogs. Clinically, Riley is doing great so you will notice if anything is off rather quickly.

The post ACTH of 3.4 is not terribly low. Ask the vet about splitting the dose to 15 mg BID (twice a day). Twice daily dosing is a bit safer and it keeps cortisol levels more consistent for the whole 24 hours. If you can't get the 5 mg where you are located, 20 mg once daily would be ideal or 25 mg once daily...options to discuss with the vet.

Diamondback pharmacy has great prices for vetoryl.

http://www.diamondbackdrugs.com/

~Katherine

[labblab]

I don't believe Diamondback sells brandname Vetoryl -- I think they only sell their custom-compounded doses of trilostane. But there are other non-compounding internet pharmacies that do sell Vetoryl; as to whether or not they will accept insurance reimbursement, however, I do not know.

Also, if 30 mg. once daily is too high for Riley, I would not switch to 15 mg. twice daily. You would still be giving a daily total of 30 mg., and we've been told that dogs being dosed twice daily will commonly drop their cortisol even lower on the same total daily dose if it is broken into two increments. Since Riley has done so well on the once daily dosing regimen, if it was me, I would stay on that protocol, but just a lower dose.

[SandyH]

Hi, I wanted to followup on what has been going on since my last post. I WILL be getting a new vet when we go back down next winter. I spoke with my vet at home and gave him the numbers of pre 1 and post 3.4 per what I was told on the phone, and he said stay with the 30 mg, the 3.4 post was great and don't worry so much about the pre at 1, which I do not understand at all about not worrying about the pre of 1. I asked several times for them to mail me the results along with the completed insurance form, which they did not do, so 2 weeks later my husband stopped in to pick up the Vetoryl and the paperwork, and when I saw it it read the pre was below 1, I was not happy that I was given inaccurate results over the phone. I did the 30 mg every other day until I got home and saw my vet and we lowered him to 20 mg daily. After 15 days on the 20 mg we had ACTH done last week, and he is pre 0.5 and post 3.7, electrolytes were fine. I spoke with a covering vet in the practice Friday pm and she was trying to get in touch with him about the results. He will be in today and should call me tonight but n the meantime I lowered him to 10 mg over the weekend until I hear from him, the covering vet agreed that this was fine.

The other thing about the Florida vet that really got me was all the documentation the owner vet did about discussing Addisonian crisis with me and reviewing results, etc-a nice long CYA paragraph, which never happened. I got the results from a female vet, not the owner who is male. Anyone in the medical field knows (whether people or animal) knows not to lie and document on record something that did not happen.

So I am hoping someone here can explain to me the logic about not being too concerned about the low pre number.

[molly muffin]

In general, many vets and indeed Dechra (the manufacturer) are not concerned about a lower pre, with the thinking that, As long as there is enough reserve in the adrenal gland (3.4 and 3.7) then an Addison crisis is unlikely. The pre number is known to fluctuate throughout the day, sometimes higher and sometimes lower. Where you might run into trouble is when you have too low of a reserve in the adrenal glands (a post of 1.5 or under and I prefer not to under 2.0ug on the post) My dog has been below 1, over 1, at 3, all over the place on the pre number on various ACTH tests.

You do however, want to be able to trust your vet to let you know exactly what both numbers are with no iffy. Just give you the exact number so you can make informed decisions.

[SandyH]

Sharlene, Thank you for the pre explanation. I guess I don't know how low the pre number can be. Clinically he is the same on 30, 20 and 10, no changes in appetite or water consumption.

The next hurdle for us is rabies vaccine, due at the end of the month. I was assured that it will be perfectly safe to give it to him after his dental, that they do that all the time after they wake up from the anesthesia, but rabies vaccine is the main trigger for IMHA in cockers, and with Cushings I am quite wary of this, but vet will not give me a waiver because Cushings is not a dx for a waiver, and I was assured by a very knowledgable friend on my cocker forum that it should be ok(she is a breeder, former vet tech, groomer and had 2 cush dogs).

[molly muffin]

So far I have been getting rabies vaccine for my dog. As long as they are healthy in general, (good lab work) then I don't worry about it for my dog. I wouldn't though if she was feeling bad, vomiting, diarrhea, etc.

[SandyH]

Its been quite awhile since I have posted, but have time tonite for an update. Riley is doing fantastic, he is on 10 mg Vetoryl (weight 33lbs), his last ACTH a few weeks ago was pre 1.5, post 2.5. His prior one to that was same pre, post 3.4, so 10 mg has been working well for us. Same appetite issue in the morning, I coddle him to eat his breakfast. One change is he is now on amilodipine 5 mg BID, his bp was high during his dental and we have had regular checks on that. I am lucky that one of the vet techs is the "bp expert" and is very experienced and does a great job, and they only charge me $24 for bp checks. He got his rabies and was fine with that, I was a nervous wreck. Dental also went well. Will titer him next year for parvo/distemper. We do notice that he seems stiff sometimes when he gets up-he has had both patellas done and has arthritis in both knees so I know that is the Vetoryl unmasking the arthritis, but it is not too bad, yet.

It breaks my heart to read of the furbabies that have been lost and the difficulties others are going thru. I pray for them when I see those postings, and even though I don't post often my thoughts are with everyone dealing with this illness.

We are getting ready to head back to Fla for the winter, leaving beginning of November and looking for a new vet. I will have an ACTH before we leave and if it is stable again we talked about waiting 4 months for next one. I would rather wait 5 months till we get home but that may be too long. That would be 7 months stability on 10 mg.

Good thoughts to all of you.

[Joan2517]

So glad to hear that Riley is doing fantastic...we love good news! $24 to check the BP is great! My vet charged me $55 to check Lena's. Enjoy your darling boy~

[Squirt's Mom]

It's good to hear that Riley is doing well! We always love hearing good reports. ;)

Be careful on your travels and enjoy your Floridian winter!

[judymaggie]

Great update on Riley! :D If you are going to be anywhere near the Tampa Bay area, PM me as I have an excellent vet.

[Harley PoMMom]

Its been quite awhile since I have posted, but have time tonite for an update. Riley is doing fantastic, he is on 10 mg Vetoryl (weight 33lbs), his last ACTH a few weeks ago was pre 1.5, post 2.5. His prior one to that was same pre, post 3.4, so 10 mg has been working well for us.

Glad to hear that Riley is doing so well, however, the one thing that concerns me is that his post number has dropped while being on the same dose of Vetoryl so I would watch for signs of his cortisol going too low.

Lori

[molly muffin]

It is really good to read a happy update on Riley.
Just keep an eye on how he seems to be feeling and if you see any signs of him being off, keep a follow up ACTH to make sure he hasn't dropped any further.