Advice on lowering Vetoryl dose

[sheltietexmom]

I need some feedback on lowering my 8.5 yr old. Sheltie's Vetoryl dose from 40mg to 30mg. Forgive me if there's already a thread, I couldn't find it. Tex was diagnosed 2 yrs. ago with Cushings and put on Vetoryl, which was controlled at 40mg. He's been symptom-free at this dosage, but the last STIM test showed he was borderline "hypo" rather than "hyper". (they never give me the lab #s, but that's another story). He's steadily lost about 8lbs since beginning the Vetoryl 2 yrs ago so I'm wondering if that has something to do with it. Vet wanted to re-test in 30 days and possibly reduce to 30mg, but during that month the vet left the practice (unannounced) to stay home with her babies. The other vets don't specialize in seniors w/cushings. Tex has arthritis in his spine/legs, and has become really stiff lately. I've been giving him Tramadol, but it makes him a zombie and doesn't really seem to help much. I'm thinking of tapering him down to 30mg Vetoryl to see if slightly increasing his cortisol production would help with the arthritis. (He can't take NSAIDs because of liver probs unrelated to cushings). I'm searching for a new vet but in the meantime, I want to know if any of you have altered your dog's dosage on your own and how would you recommend I taper it down (or not). Thanks!

[Harley PoMMom]

Hi and welcome to you and Tex!

It would help us greatly if you could get copies of all those ACTH stimulating test results and post them here. Is Tex's appetite normal? How about his stools, any diarrhea? Is he acting lethargic or not acting his normal self?

Are you using the brand-name Vetoryl?

When the cortisol is lowered it can unmask the symptoms of arthritis and sometimes letting the cortisol run a bit higher may help. Is Tex on any supplements for the arthritis? There are many supplements that may help with the arthritis such as glucosamine/chondroitin, and fish oil. Duralactin is another supplement that can be used for arthritis, here's a link to a thread where this medication is discussed: http://www.k9cushings.com/forum/showthread.php?p=58306&highlight=duralactin#post58306 Some members have used or are using Adequan injections.

Regarding the Tramadol; I do remember some members mentioning that when they gave their dog the full dose that was prescribed that it did make their dog act different, sorta dopey, so they cut the dose in half.

Hugs, Lori

[sheltietexmom]

Thank you HarleyPoMMom,

It's like pulling teeth to get those ACTH results. I'm not sure why they won't share them with me...it's weird, it's my money and my dog! Since I'm changing vets in the next few months I'll get them when the new vet orders the records. I have him on fish oil, joint-formula multi-vitamin w/glucosamine/chondroitin/msm, and have ordered some egg membrane capsules which I've read is promising. Besides the lethargy and difficulty getting up, can't jump on furniture, limps...he's not showing any gastrointestinal symptoms or drinking lots or peeing. Appetite is always good but not insane. I'm giving him 40mg Trilostane from California Pet Pharmacy, along with the daily supplements. I was warned about the arthritis flares once his Cushings was well-controlled, that's why I'm thinking that lowering the dose so he's not full-Cushy but has a little bit of cortisol...but maybe I'll wait and give the egg membrane a chance. Wanted to do Adequain, but it's so expensive and I've maxed out my credit cards for 4x/yr Stim tests, X-rays, Trilostane, etc. Anyone tried Egg Membrane?

[Harley PoMMom]

Those ACTH stimulating tests are expensive because of the stimulating agent used, which is usually Cortrosyn. Depending on how much Tex weighs you can save money on the ACTH stimulation tests if your vet knows how to dilute and store Cortrosyn. There is no reason why s/he shouldn't so make sure you talk to him/her about splitting the vial of Cortrosyn. You and your vet can read about this on Dr. Mark Peterson's blog found here: http://www.endocrinevet.info/2011/03/how-to-extend-your-supply-of-cortrosyn.html

I've never tried the egg membrane capsules and don't recall a member using them either, so if you wouldn't mind, please let us know how they work..thanks!

Hugs, Lori

[molly muffin]

So they said at the last test that his cortisol was low and that they might lower it at the next test? But that they weren't going to lower it now?

Can you even call the vets office and have the vet just Tell you what the last ACTH result was pre and post that you are concerned about him going too low and if the dose should be lowered or not. At the very least I don't see why any vet would havve a problem giving you that information.

That would be helpful in knowing what to do next.

I would never do an increase without an ACTH number to go by, but if I was worried at all, I personally would not have a problem lowering the dosage. That is just me though, and so much depends on the ACTH results, along with how they are acting symptomatically.

Every vet should be doing the frozen method as it helps them too to provide better service at lower cost for their pet owners. IDEXX labs can also tell them how to do the freezing I think, as they put out information to vets here in Canada.