New to a Cushing's Diagnosis

[LittleArfinAnnie]

Hello everyone . . .

My name is Catherine. I am the very proud human of a 9 1/2 year old miniature Dachshund named Annie. ( ! ! ! )

Annie and I are in the midst of a very long and expensive journey toward a definitive Cushing's diagnosis - a disease which I understand can be common to the Dachshund breed.

She currently displays "some" Cushingoid symptoms ( a bit of a pot-bellied appearance, elevated liver enzymes, low specific gravity to her urine, a positive result on the Low Dose Dexamethasone Suppression test and enlarged adrenal glands as revealed during an abdominal ultrasound ) but does NOT drink or urinate excessively. Her blood pressure is normal and her coat remains highly glossy and unaffected by alopecia.

Her energy levels are significantly reduced from what I've been used to, though, and she is not as eager to walk the distances that we did in the past. I believe that is referred to as exercise intolerance ?

We are poised at the threshold of starting her on Trilostane. ( my vet's recommendation ) But because she has also displayed symptoms of Inflammatory Bowel Disease in the past ( now completely controlled by diet ) I am VERY concerned that the Trilostane will set off a s**tstorm of side effects. ( pun intended ! )

In other words, if her own little body is producing the excess cortisol as an anti-inflammatory response to her GI "issues", will Trilostane cause her IBD to flare uncontrollably again ?

Seems to me like we're going to try to put out one "fire" only to possibly ignite another . . . !

Would it be better to engage in a period of more watchful waiting before addressing her possible Cushing's Disease ?

I'm both confused and frightened, truth be told.

Annie weighs about 13-14 pounds. The vet has suggested that we treat the Cushing's Disease very conservatively with a 10 mg dose.

Obviously, I am completely committed to the scheduled ACTH follow-up testing that goes hand-in-hand with this course of treatment.

I may have to eat Kraft Dinner for the next few months but I'll make this work !

Any thoughts and / or opinions you may have on my current dilemma would be much appreciated.

Many thanks ! :)

Catherine and Little Arfin' Annie

[labblab]

Hello Catherine, and welcome to you and Annie! I do believe I understand your dilemma and your uncertainty about moving forward with treatment at this time. I am not exactly sure what I would choose to do if Annie were my own. If she was a senior dog at the upper range of her natural lifespan, I would probably hold off on treating since she does not appear to suffer any actual discomfort from the disease right now other than a decrease in energy. If she was a younger dog, I'd probably choose to press onward with treatment now so as to minimize her risk of developing systemic damage from chronic levels of excessive cortisol. But she is at an age where I think it becomes a bit tougher to balance quality of life vs. treatment demands, especially given her history of GI distress.

I do understand why you are worried that the reduction in cortisol may cause the GI issues to flare. However, I'm going to throw out another thought for your consideration, which is that excessive steroid exposure can actually cause irritation to the stomach and intestinal tract. So there is a possibility that successful control of Annie's cortisol may improve her GI problems rather than worsen them. There really is no way of knowing without giving treatment a try. If you do opt to start treatment now, you can always discontinue the trilostane if Annie's overall condition does worsen.

I am guessing you are hoping for several more good quality years for your girl. So even if you don't opt to start treating immediately, I would definitely keep an especially watchful eye on her blood pressure and also checking her urine for significant protein loss. If either of those issues present themselves, I believe I'd start treatment immediately, even in the absence of additional outward observable symptoms.

Marianne

[LittleArfinAnnie]

Hello, Marianne . . .

Many thanks for taking the time to send me such a thoughtful reply. You really understand the "pickle" I'm in with respect to initiating treatment !

However, ( and I could almost swear that my little Annie was able to read my initial post ) in the course of the past few days, Annie has begun to display more unmistakeable signs of Cushing's.

Most notably, the polydipsia and polyuria that most Cushing's "parents" are familiar with.

It is almost as if a switch has been thrown somewhere. From one day to the NEXT I'm dealing with repeated piddle accidents in the house and I seem to be refilling her water bowl at least three times a day.

Her appetite has become RAVENOUS and her energy levels are markedly diminished.

Naturally, these sorts of things always seem to happen when veterinary offices are closed . . . but I had already managed to make an appointment for next Tuesday, December 29.

As soon as I began to witness those not-so-subtle changes, I called the vet immediately.

I have read many conflicting reports of possible side effects of Trilostane on the Web . . . the severity of which seem to be linked to dosage levels.

From what I've been able to research, it would appear that the prevailing sentiment is to administer 1mg / lb of body weight. Do you folks agree with this ?

Annie weighs just under 15 pounds. I have already advised my vet that I would prefer to start treatment CONSERVATIVELY.

That being said, if she is given a 10mg capsule with food, ( at the low end of the dosing spectrum ) will that have any benefit ?

To my mind, ( and I'm no expert - just an inveterate researcher ) any reduction in her cortisol levels would be better than no reduction at all. ( ? )

I am most uneasy about the possibility of throwing her into an Addisonian crisis should the prescribed dose be higher . . .

In the meantime, until we can get to the vet next week, I've stocked up on paper towels and puppy training pads . . . We're also walking every two hours or so . . . and I'm most grateful that Toronto's weather has been unseasonably mild so far !

Thank you again and warmest wishes to you and yours for a very Merry Christmas !

I'm so glad to have found this little "oasis" on the Web . . .

You're doing noble work here . . .

Catherine and Little Arfin' Annie

[molly muffin]

Hello and welcome from me too.

Yes 1mg/1lb is the current recommended starting dosage, but some vets do start at a conservative lower dosage to make sure of how it is tolerated. Especially with the IBD issue, I would probably start, but go conservative at the 10mg dosage and let the follow up tests and Annie show where the best level will be for her.

[LittleArfinAnnie]

Hello, Sharlene . . .

Thank you for both your kind welcome and for taking the time to clarify those dosage numbers for me.

Unfortunately, I'm in a bit of a scary emotional "place" this evening.

I took Annie to the vet this afternoon for what I thought was just going to be a routine visit to get a prescription for Trilostane.

When I told the vet that she had begun to drink a bit more than what I had been used to . . . and was having the occasional accident in the house, for some reason, everything changed.

My vet proceeded to strongly recommend some additional blood work to now rule out DIABETES.

I was more than a bit confused because excessive drinking and urinating are a very common symptom of Cushing's, aren't they ?

This diabetes possibility came right at me out of left field. Annie's Cushing's diagnosis has been pretty much definitive. I have spent no small amount on ultrasound testing, copious amounts of blood work, and a Low Dose Dexamethasone Suppression test.

As a matter of fact, Annie's last blood panel, assessed in September, showed that she did NOT have diabetes.

I asked the vet what the HELL we would have to do to address both diabetes and Cushing's Disease if today's blood work came back with a positive diagnosis.

She pretty much just shook her head and said that it would be very challenging to try to manage.

Whereupon, my eyes already filling up with very hot tears, I said, "You mean ?"

In other words, it would be time to put her down . . . ! ! ! ( ? ? ? )

I have no idea how I managed to drive home, to tell you the truth.

But, having the Science background that I do, I came home and pretty much set the Internet on FIRE.

I read that diabetes ( secondary to Cushing's Disease ) has been known to resolve once cortisol blood levels have been stabilized.

Do any of you have any experience with the dual diagnosis of canine Cushing's Disease and Diabetes ?

By the way, Annie still manages to sleep quite soundly through the night without needing to be taken outside. Nor does she wake up for any water through the night. She is also not losing any weight. As a matter of fact, she's even put ON a few ounces since our last weigh-in.

The cynic in me can't help but wonder if the vet was just looking to "up sell" yet ANOTHER expensive blood test. ( I was charged three hundred dollars for today's blood chemistry panel. )

In the event that the blood work results come back positive for diabetes tomorrow ( how I'm going to sleep tonight remains a huge mystery ), what if I were to elect to treat ONLY the Cushing's Disease at this point - to see if Annie's diabetes begins to abate ?

I am just SO not ready to say good-bye to this little sentient being yet. Yes, her energy levels are down but she's still a little trooper, stubborn as all hell and full of piss and vinegar, too !

Yes, her muscles have become weak such that she occasionally stumbles . . . but all of this is consistent with Cushing's Disease, is it not ?

I have been looking forward to getting her on some Cushing's meds ! I was hoping that my beloved little Annie would start to get her "mojo" back !

In the meantime, I'm still without any Trilostane, too . . . !

Just as an aside, this particular veterinary clinic has a bit of a reputation in my community for price gouging its clients. I didn't know that at the time when I started bringing Annie there. ( she was all of eight weeks old at the time . . . ) And since they've known her for so long, I just decided to stay with that practice. The devil you know . . . and all that happy stuff . . .

What do you think ? Is it time for me to investigate the possibility of getting another veterinarian and having all of Annie's records transferred ?

Tonight I am confused, frightened but mostly just very sad.

I look forward to hearing back from you when you're able.

Thanks so much !

[labblab]

Hello again, and I'm sorry for this additional worry. Yes, you are certainly correct that excessive thirst and urination are characteristic of Cushing's as well as diabetes. However, given the very sudden onset of these symptoms, in honesty, I do not fault your vet for wanting to recheck Annie's blood glucose level again. That does seem like a very steep price for the blood testing, though, since even a very basic chemistry panel ought to have glucose on it.

Over time, we have had a number of members whose dogs have suffered from, and been treated for, both Cushing's and diabetes. For some, the Cushing's diagnosis has preceded the diabetes; for others, it is the reverse. If Annie's glucose level is indeed elevated, whether or not you need to initiate treatment will depend on the degree of the elevation. If it is high enough to require insulin, you'll need to start that treatment regardless of whether or not Cushing's is the precipitating factor and regardless of whether the insulin can be reduced or discontinued down the road once the cortisol comes under better control.

As I say, however, both conditions can be managed successfully. We have a sister site that is devoted to the care of diabetic dogs, and we do have other members who are jointly members of both forums. So if it turns out that Annie is indeed diabetic, this does not need to be a death sentence and if your vet is suggesting that this is the case, then I do think you'd best look for a specialist who is equipped to handle the dual diagnosis.

Right now, we are really putting the cart ahead of the horse, though. Let's see how those test results turn out. Like you, at this stage, I anticipate that Cushing's will turn out to be the culprit and you will be able to proceed with the trilostane treatment as you had planned.

Marianne

[LittleArfinAnnie]

Marianne, thank you so much for your quick reply . . . !

Most surprisingly, Annie and I had a very peaceful night. I actually slept and, once again, Annie was able to get through the night without needing to either drink or urinate.

"Something" in my gut continues to echo your perception of this current development . . . in other words, this is not diabetes.

I never thought that I would be elated with it "just" being Cushing's Disease !

You're right, too . . . At this point, everything is pure speculation until I receive the definitive results of her blood work. Apparently, those results will come in some time later this afternoon.

And as soon as I receive the "news", I'll let you know.

Once again, thank you !

[LittleArfinAnnie]

Marianne, you hit the nail on the head . . .

I just heard back from the vet and Annie does NOT have diabetes.
As we both suspected, her increased water intake and urination is the result of Cushing's Disease.

I'm doing cartwheels here !

She currently weighs 18.2 pounds and she will be starting on 10 mg of Trilostane to be administered TWICE a day.

This dosage amount seems "slightly" high to me, though.

I do understand the rationale behind twice-daily dosing, however.

When I pick up the Trilostane, I will also be given Prednisone to have on hand in the event of an Addisonian crisis.

The vet wasn't comfortable with the notion of just giving her 10 mg once a day as diabetes apparently still remains a very real risk until we get her cortisol levels stabilized. Obviously, her follow up ACTH tests will let us know how the Trilostane is working.

Are you all in agreement with this upcoming dosing regimen ?

[judymaggie]

Hi, Catherine and Annie! I haven't had a chance to chime in yet but have been following your thread. So glad that the diabetes diagnosis was eliminated. Marianne and Sharlene are much more knowledgeable than I but I did have a thought re dosing. Dechra does now manufacture 5 mg. Vetoryl tablets so another option for Annie might be 15 mg. given every morning. This would be slightly under the 1 mg/lb dosing recommendation but, as most advise here, it is better to start out conservatively and increase later if necessary. Getting fives and tens also provides more flexibility if, after the 30 day ACTH testing, Annie's dose needs to be increased.

Once daily dosing is recommended by experts unless there is specific reason to have twice daily dosing. Diabetes is often one of the reasons cited but, again, this has been ruled out for Annie. My Abbie is on twice-daily dosing primarily because she has high blood pressure and proteinuria so it is important to keep her cortisol on an even keel throughout the day/night. Twice daily dosing does require more management on my part.

[labblab]

YAY! No diabetes to contend with! :)

I would be fine with starting Annie on the 10 mg. twice daily since it just exceeds the 1 mg./lb. formula by a tiny bit. But Judy does make a couple of very worthwhile points (and don't let her tell you she is not highly knowledgeable because she is! ;)). Specialists seem to remain torn re: their preference for starting out with once vs. twice-daily dosing. As Judy says, twice-daily dosing does require extra commitment on the part of the owner, however, especially since all doses should be given with a meal in order for the drug to be metabolized properly. I have a non-Cushpup Lab who has a seizure disorder and has to be dosed with phenobarb at strict 12-hour intervals, and that schedule really can be burdonsome at times. I don't think you need to dose trilostane as precisely, but giving two doses a day can be a pain.

However, if your vet really prefers you start out with the double-dosing, there is indeed research to back up his/her preference. Do bear in mind, though, that Dechra does now make a 5 mg. capsule, just as Judy says. This is a recent development, so your vet may not be aware of its availability. But however you start out, it's good to know that the 5 mg. capsule exists if you end up needing to tweak Annie's dose either upward or downward by a small amount.

Marianne

[LittleArfinAnnie]

Hello, Judy . . .

Many thanks for taking the time to reply !

You mentioned a term called "proteinuria". If that's what I think that it is - protein in the urine - then Annie has that right now, too. This was discovered just yesterday when they did a urinalysis on some freely collected urine.

The vet has asked me to bring her in tomorrow morning for withdrawal of a sterile urine sample. ( That procedure always makes me cringe. ) She wants to rule out a UTI before we start on the Trilostane regimen next week.

If Annie tests positive for a UTI then I'll have to put her on some antibiotics to clear that up ASAP.

A UTI could also go a long way toward explaining the sudden onset of drinking and urinating that I recently observed.

That being said though, doesn't Cushing's Disease also cause protein to be excreted in the urine ?

My poor little sausage . . . It seems like I get one fire put out only to have another one start up . . .

Either that or my vet is continuing to try to "jack" me for unnecessary diagnostic testing . . . ( ? )

We have definitively diagnosed Cushing's Disease. How many additional "markers" does the vet need ?

I have fairly comprehensive pet health insurance that has been in effect since Annie was eight weeks old. I have heard rumblings among many of my neighbours and friends that, occasionally, vets seem to view insurance-holders as potential cash cows . . .

My apologies if I sound cynical but I tend to be one of those critical thinkers who question everything.

Once again, warmest thanks for your reply . . .

Catherine

[molly muffin]

Considering the kind of vet bills that cushings brings on, I think we are all a bit cynical when it comes to how much we are charged and for what. :)

I do think a lot of dogs with cushings have protein in their urine, but to have it actually be confirmed as a problem in and of itself, they want 3 UPC's done, weeks apart for each. If there is any kind of stomach upset, don't bother to do the UPC test, as it seems to go up with gastro upset and take awhile to calm down.

I speak as someone who has a dog with protein in the urine, high blood pressure, retinal bleeds and cushings and it is all tied together so it's a balancing act to get everything sorted. One thing goes kapooey and they all seem to.

Diabetes is a risk, just as pancreatis is a risk with cushing dogs and it can come on suddenly, seemingly over night sometimes, but it is not a given that it will.

If there is a UTI, then yes, you want to get that cleared up and either a clean draw or a free catch with a culture done will tell the tale.

I think you are doing fine, and even if diabetes did come into the picture and there is nothing to say it will, that is certainly not time to throw in the towel. It just makes things more complicated but not impossible. So, don't worry about that, one thing at a time.

[judymaggie]

Catherine -- just to reassure you a bit, my Abbie's urine samples are almost always obtained via a syringe ("cystocentesis"). When my first beagle, Maggie (also a Cushing's pup), had her first cysto, my vet said she just laid there quietly and Abbie now does the same. I think our pups do much better than we do with all the probing -- maybe it's because they can't anticipate it. One of the national veterinary experts on Cushing's, Dr. Mark Peterson, has written about the high incidence of high blood pressure and proteinuria in Cushing's dogs and recommends testing for both as part of an initial work-up with re-testing down the road.

Anyhoo, it sounds like your vet is very thorough which is a good thing when working up a Cushing's pup. That said, I highly recommend asking lots of questions in order to know exactly why each test is being done and don't forget to get copies of each test result. You are paying for the services and are entitled to them. Hang in there -- you are being a great Mom!

[LittleArfinAnnie]

Thank you, Judy and Sharlene . . .

WOW . . . Annie and I are in for one hell of a journey together, I suspect. ( I wouldn't have it any other way. )

And here I thought that I would just have to give her the Trilostane, follow up judiciously with the scheduled ACTH testing, and life would more or less return to normal . . .

I'll give the final comment to my vet this evening . . . She said this when she called to tell me that Annie did NOT have diabetes.

"Catherine, Annie will slowly start to feel better. A Cushing's diagnosis is nothing as far as she is concerned. It is, however, a pain in the ARSE for you and me."

Rather well put, wouldn't you agree ? ( lol )

One step at a time is going to be the name of the game from here on in . . . what a nasty, intricate disease. I wish that I could go through it instead of my dearest little companion . . .

Thank you both again !

I'm hoping to sleep a bit more soundly tonight !

[LittleArfinAnnie]

Good Morning, Marianne . . .

Sorry for taking so long to get back to you but, for some reason, I only discovered your post about five minutes ago . . . ( ! )

To say that I'm preoccupied with worry about my little Annie would be a masterpiece of understatement. But it definitely eases my anguish to know that I'm just one of thousands of pet-parents who are as distressed as I am about this nasty endocrine disease.

Thanks so much for the update with respect to Vetoryl dosage strengths, too. I'm not so sure that our vet is aware that 5 mg is available. Then again, I live in Toronto so perhaps it's not possible to get that low dose in Canada yet ? I have no idea but I'll most certainly ask.

For the moment, Annie and I are just sitting tight waiting for the Vetoryl to arrive at the vet's office. They don't keep it stocked and it had to be ordered.

Marianne, I don't anticipate that I'll have any difficulty with the twice-daily dosing. I'm retired now and incredibly content to be a homebody so I expect that I'll have all the time in the world to stay on top of Annie's dosing regimen.

But here's a question that I would welcome some feedback for.

Like all of us here, I am highly devoted to my precious little girl. I have been ( and continue to be ) worried about her almost to the point of distraction.

I'm not so sure that I could characterize it as "depression" per se, because I've been depressed before and know the difference.

However, I seem to have plunged headlong into a state of "inertia". My days are consumed with research, vet appointments, many walks ( to mitigate against accidents ) and very close monitoring of Annie's energy levels and behaviour.

In other words, I seem to have lost interest in pretty much everything else !

Oh sure, grocery shopping gets done, laundry is tackled, folded and put away and bills are getting paid on time but that's about it.

Annie is the only dog I've ever had. She got me through the death of my husband seven years ago and I've never felt this depth of unconditional love from another living being in my life.

I have happily chosen to make whatever sacrifices are necessary so that, when the time comes, I'll be able to look back knowing that I provided her with nothing but the deepest nurturing and love.

But in the meantime, it feels like there's a ticking time bomb hanging over my head . . . counting down the days and hours until the pitter-patter of her stumpy little feet no longer graces my home.

I'm sure that I'm not the only one who has experienced this all-consuming worry.

My appetite has flown out the window, my sleep is fragmented and I seem to have difficulty concentrating on anything other than Annie !

How have other pet-parents managed to find that ever-elusive balance between the needs of their beloved companions and their own lives ?

An unorthodox question for this forum, to be sure . . . but it all seems to be part and parcel of being a Cushing's "parent", doesn't it ?

[molly muffin]

I really don't think you are any different than most of us here. Cushings at first is all consuming. It often remains that way but for your sake and Annie's I do hope that once you have been on this journey for a bit, you see her doing okay on treatment, then your worries and fears will lessen enough that you can go on with your normal daily life of which Annie is a big part of anyway.

I no longer am a basket case as I was when I first showed up here. The more I learned, the better I felt about being able to handle what may come up, and with a good vet team in place, the confidence does a lot better to. Plus, you always have us!

We are here any time you want to throw out a worry or thought and get some feed back or just vent or whatever. We are that, I'd like to use a lifeline or call a friend place for you to come to.

It will get better as you see Annie doing well and symptoms subsiding. :) really. :)

[LittleArfinAnnie]

Ah, Sharlene . . . Thank you so much for taking the time to ease my fears . . .
After I hit "Submit Reply" this morning, I was kind of kicking my a** for having sounded so very "low".
I can't begin to tell you how validating your post has been.
I am, INDEED, a certifiable basket case right now. Those two words summed it up perfectly !
I've got dust balls accumulating ( and apparently colonizing! ) throughout my home and I could care LESS about scrubbing bathtubs or floors.
That's what I meant by the feeling of inertia.
Memo to self, too . . . I have to stop reading all of the horror stories about Trilostane side effects on the Web. (not necessarily here, either)
I've already learned far too much about spontaneous adrenal necropsy ( I hope I got that right ) and unexpected kidney failure. All I'm doing now is freaking myself out !
We pick up Annie's Trilostane tomorrow . . . and I will likely start her first dose of 10 mg on Wednesday morning with her breakfast.
I look forward to seeing her energy start to return !
I don't look forward to the possibility of seeing her in minor steroid withdrawal, though.
Perhaps with such conservative dosing that won't be as dramatic as I fear.
And you can rest assured that I'll keep all of you closely updated, too.
Thank you again !

[molly muffin]

I started Molly on a low dose and felt better for it.

Inertia is a good description. LOL Like I said, knowledge is half the battle though.

I looked all over the internet at first too. If there are any studies out there, we usually know about them and have a link to them posted, so I no longer worry about searching all over the place. Someone will know something on here usually, or know where to find it.

If you are searching sites, stick to the tried and true of the experts, like Dr. Peterson. http://www.endocrinevet.info/

When it comes to cushings or any of the other issues with my dog, I've found myself less willing to take the flip and have become a no BS kind of gal. Just the facts ma'am and I'm fine. I can freak myself out plenty without any help. LOL

You're doing fine!!

[LittleArfinAnnie]

Good Evening, Everyone !

Just looking for a bit of clarification here before Annie starts on her Vitoryl regimen tomorrow morning.

I have been given 10 mg capsules and Annie is to receive them twice a day - with food. ( Annie weighs 18.2 pounds at the moment. )

I feed Annie twice a day. Her first meal is usually around 9:00 or so in the morning and she eats again between 5:00 and 5:30 in the afternoon.

The vet has asked me to try to adhere to 12-hour dosing as much as possible - which I understand.

Now obviously, I can't delay her evening meal until 9:00 or she'll be more than a bit agitated. ( lol ) This little Doxie can pretty much tell time to the minute and if she's not fed by 5:30 in the afternoon, I end up on the receiving end of the world-famous Doxie "stare-down".

The vet has suggested that I give her a smaller third meal around 9:00 in the evening so that the second daily dose of Vetoryl will be administered with food.

What do you all suggest I offer her ? Being a Dachshund, she is VERY prone to putting on weight and I've been highly vigilant about that throughout her life so far.

What do you think about splitting that 5:00 meal in half ? I could give the first half of it to her at 5:00 - 5:30 as per usual ( she'll definitely feel ripped off, though . . I know my girl ! ) and then the remaining half at 9:00 with Vetoryl. This way I can stay on top of her caloric intake . . .

As always, any advice you may have will be greatly appreciated !

Many thanks !

[labblab]

I think the half-and-half idea sounds great. If Annie is feeling cheated during her 5:30 feeding, maybe you can supplement it with some vegetables like carrot pieces, canned salt-free green beans, etc. I've always had Labs and they consider anything that I offer them to be a treat. So maybe Annie will be pickier. But I'll bet you can find some low-cal food that she'll eat if you need to supplement.

Marianne

[molly muffin]

I think the splitting the 5pm meal would be fine. Alternatively, you could divide both meal amounts up to 3 meal amounts that equal the same.

I do think you are going to get the stare down, as dogs just know these things. The hope is that she will adjust eventually to the new regime of meals, with the plus that she is getting an extra meal (in her mind)

[judymaggie]

Hi -- just to chime in about the meal splitting. Before Vetoryl, I was feeding Abbie breakfast at 7:30-7:45 and then her main meal at 3:30-4. Abbie gets Vetoryl twice a day so she now gets a small meal in the morning with Vetoryl after (she has been finicky about eating in the a.m. even after getting Pepcid), a slightly larger meal at 3:30 and then a very small meal at 7:30 p.m. with Vetoryl after. I basically took the day's worth of food and split it up into three. Abbie does not like her routines changed but certainly doesn't mind getting a third meal! Be sure to give Annie her Vetoryl with something fatty (wrapped in cheese, cream cheese, etc.).

[LittleArfinAnnie]

Many thanks to all of you who took the time to reply !

I think I'm going to move forward with splitting her late afternoon meal . . . not necessarily in half, either.

I may try to reserve a couple of tablespoons or so - tuck them away in a Tupperware container - and warm everything up with a bit of hot water before I offer it to her.

Knowing my little Annie, first of all she'll be a wee bit hungry since her 5:00 meal will be smaller than usual. But the best part for her will be the perception that she's getting a third meal at the end of the day ! ( lol )

It was suggested that I wrap the Vetoryl in something fatty ? I'm fully prepared to follow your lead on this, folks, but could you please help me to understand why ?

I was planning to use the product that I've always gotten from the vet. Something called "Pill Pockets" or "Tablet Tuckers". Basically a chewy, low-cal highly malleable treat that the capsule can easily be inserted into. ( and hidden )

How about peanut butter ? I've used that before with Annie and it's probably her FAVOURITE ! ( lol ) It's also kind of hilarious to watch her try to get that stuff off the roof of her mouth.

One more question for today . . .

My vet charged me $ 80.27 ( CAD ) for a box of 30 capsules of Vetoryl. ( 10 mg ) This will only be a two-week supply due to the twice-daily dosing. So, about $ 160.00 ( CAD ) give or take for a month's supply.

Is this the going rate ? Or, as I strongly suspect, is my vet expensive?

Just as an aside, I was charged over two hundred dollars for a urinalysis test on Saturday. ( I just about swallowed my teeth ! )

Your thoughts ?

Thank you again for all your help and support !

Catherine

[judymaggie]

Catherine--Vetoryl is fat-soluble so will be absorbed much better if wrapped in something fatty. Peanut butter is perfect! (I think my Abbie is the rare dog who doesn't like peanut butter!). Pill pockets could work, too, but could get pricey using two a day.

I buy Vetoryl from California Pet Pharmacy and pay $41.95 for 30 10 mg. capsules. They do ship internationally--even with hefty shipping charges, they would be less expensive than your vet. They do require a vet's prescription. My vet is very willing to help me save money on meds since I've already probably paid for his kids' college! :eek: All that said, since Sharleen iis also in Canada, she may have other suggestions for Vetoryl sources.

[LittleArfinAnnie]

Hi, Judy . . .

Thanks for explaining that fat-soluble issue ! Peanut butter will be WAY more cost-effective than those pill pocket things. They currently run at $ 10.00 ( CAD ) for just a two-week supply.

Ten dollars worth of peanut butter will last me two MONTHS easily.

Since I wrote my last post, I did a bit of sleuthing around on the Web to compare Canadian pricing for Vetoryl.

I didn't find anything to write home about, actually, so hopefully Marianne might be able to steer me in a better direction.

I had to smile, too, when I read your comment about putting your vet's kids through college ! No kidding !

I'm just very grateful that I invested in pet insurance when I first brought Annie home nine and a half years ago. They're not terrific because they seem to randomly increase my co-pay amounts depending on how many claims I make. But the highest that they'll ever go is 50 % and, at this point, anything is better than nothing.
As a retired teacher on a fixed income - in an expensive city - were it not for Annie's coverage, I shudder to think that I may have had to let her go !

Upcoming ACTH stimulation tests ( heavily front-end loaded, as you know ) will run just over $ 350.00 a pop !

Mama will be quite happy to eat Kraft Dinner . . . as long as my wee Annie gets her groove back ! ( lol )

Warmest wishes to you all and thank you again !

Tomorrow morning our Vetoryl journey begins. May it be a long one and may Annie prosper ! ( with apologies to Mr. Spock )

[LittleArfinAnnie]

Talk about ridiculous timing . . .

This morning, just prior to our first walk of the day, Annie appeared to injure her left front leg as she was turning around to sit down.

I can only assume that she hurt herself because her movement stopped immediately and she kept that little leg up in the air for about thirty seconds or so before she tried to move again. The leg didn't buckle under her as I've seen it do in the past, but "something" definitely happened.

Stoic little Dachshund didn't utter a sound, either.

This damned Cushing's Disease has definitely weakened her tiny muscles . . . I just couldn't believe that this happened right before her very FIRST dose of Vetoryl !

I've spent the day pretty much watching her like a hawk. And, sure enough, now she's limping a little bit. ( DAMN )

Now that she's started on the Vetoryl, would it be safe for me to try to get her some Tramadol for her obvious pain ?

[molly muffin]

Yes you can give tramadol for the pain. Keep her off it as much as possible so it can have time to heal on it's own.

Drat, poor little girl.

Let us know how she is doing.

[LittleArfinAnnie]

Hi, Sharlene . . .

Thanks so much for getting back to me . . . !

Annie and I have had a very quiet day . . . because I was, in fact, trying to keep her as still as possible.

I spent the day noodling and reading on my iPad and she was very content to snooze beside me . . .

I'm going to give her little leg an extra day of TLC with Mama and see if that speeds things along . . . Ideally, I'd like to avoid adding another "chemical" to the mix while she adjusts to the Vetoryl.

Thanks again !

[molly muffin]

thepetpharmacy.ca this is where I get molly's trilostane from (compounded) I use the IMS vets in Mississauga and they call it in for me.
It's located in Toronto, so you could also pick up if it's close to you. Theresa the pharmacist is very helpful and you can email them to ask for a quote and they will get back to you. :)

I might have told you this already (the mind is a bit burnt out at the end of a 10 hour work day but if you have any quetions let me know)

[LittleArfinAnnie]

Many thanks for the information, Sharlene !

The only Website I could find was "thepetpharmacist.ca", though.

They DO, in fact, carry Trilostane at 10 mg ( which is Annie's dose ) however it's not manufactured by "Dechra". The company's name is "Vetoquinol" and it's also based in Quebec. ( as is Dechra )

The price difference works out to about $ 40.00 for a 30-day supply which is very much worth looking into !

Is this a generic brand of Trilostane, Sharlene ? Much like our human pharmaceuticals also have generic alternatives ?

And if so, have you been satisfied with the performance of this product ?

We just finished Day 3 of Vetoryl with Annie and ALREADY I have begun to see a "slight" reduction in the amount of water that she drinks.

Other than that, no adverse side effects that I've been able to discern.

I was nervous that she might come down with diarrhea but everything is just fine in that department so far.

No problems with the twice-daily dosing, either. She's delighted with her third little "meal" at the end of the day !

So far so good and I'm MORE than thrilled. I'm especially delighted that our vet opted to treat her with such a conservative dose. She weighs 18.2 pounds so a dose of 10 mg ( twice a day ) seems to be WELL within the margins of safety.

Thanks again for the information, Sharlene !

Have a terrific weekend ! ( even though we're in for nothing but rain and gloomy skies . . . UGH )

Catherine

[labblab]

Hi Catherine,

The trilostane that you've found on that website is indeed Dechra's Vetoryl -- Vetoquinol has been granted the marketing/distribution rights for the drug in Canada.


[Dechra] has signed a marketing agreement with Vétoquinol, Canada. The partnership, which will run for an initial period of 5 years, allows Vétoquinol, Canada the marketing and distribution rights to Dechra’s own developed products Felimazole® and Vetoryl®. Dechra will retain all intellectual property rights to both products which will be manufactured for the Canadian market at Dales Pharmaceuticals, Dechra’s manufacturing division.

When I first read your post, I got really excited because we have been hoping that a generic version would someday hit the market. But for the time being, the only alternative to Vetoryl is custom-made versions of trilostane prepared by individual compounding pharmacies in doses other than Dechra's.

Marianne

[LittleArfinAnnie]

Good Morning, Marianne . . .

I can't begin to tell you how THRILLED I am to have found this forum, you know . . .

You folks really seem to be on top of the latest information !

Thanks so much for taking the time to clarify that issue for me.

I never would have been able to discover that on my own.

Warmest wishes for a terrific weekend !

Catherine

[molly muffin]

Looks like thepetpharmacy now is thepetpharmacist. It's the same place.

I checked out the same thing Marianne did. Lol.

I use the compounded trilostane but even the brand name vetroyl should be cheaper than a vet.

[LittleArfinAnnie]

Good Morning, everyone . . .

Today is Day 5 of Annie's Vetoryl treatment. She has just had her first 10 mg dose of the day with her breakfast.

So far, all seems to be going smoothly with one exception.

Her appetite is now somewhat reduced.

Prior to Vetoryl, she would practically INHALE both meals of the day and she had been putting on a bit of weight, too.

Now she doesn't finish her bowl of food. Rather than panic and turn this into a power struggle ( which Doxies seem to be known for ! ), I am just leaving the food right where it is. I've noticed that she tends to "graze" at it over the course of the day. A little bit here, a little bit there - until eventually it's gone.

Everything else seems to be okay, though. She's quite content to trot along happily with me on our walks and there has been no vomiting whatsoever. ( I have Prednisone on hand and know what to be watching for in the event of an Addisonian crisis. )

Do you have any advice as to how I should handle her reduced appetite ? ( if at all ? )

In your experience, will this issue eventually resolve itself once we have determined the correct Vetoryl dosage for her ?

Alternatively, should I skip this evening's 10 mg dose so that Annie wakes up tomorrow morning with more of an appetite ?

Just a friendly reminder that she weighed 18.2 pounds the last time we were at the vet. I would imagine that she's lost a little bit of weight since then but certainly not much.

As always, I look forward to hearing back from you !

Many thanks !

Catherine

[labblab]

Vetoryl is intended to reduce the ravenous appetite associated with Cushing's, so this is a predictable result and most folks are hoping that a reduction in appetite will actually be a permanent change. If Annie is indeed overweight, then I wouldn't be worrying right now and I wouldn't be changing anything. It seems as though it will be healthy for her if some pounds do come off.

Having said that, poor appetite combined with other unwelcome symptoms can signal the need for a dose reduction. But from what you are describing right now, it doesn't sound as though anything else is amiss, especially if she does finish her food by the end of the day. So I would stay the course for now unless you see other problems emerging.

Marianne

[Harley PoMMom]

An ACTH stim test is recommended within 10-14 days after treatment of Vetoryl is started, has this been scheduled for Annie?

Hugs, Lori

[LittleArfinAnnie]

Hi, Lori . . .

Yes, I'm aware that Annie will need an ACTH stimulation test in about a week or so.

I'm planning to call the vet's office tomorrow morning to schedule it for her.

I've already discussed drop-off times with our vet. ( with respect to Annie's first dose of Vetoryl the morning of the test )

And once I get those results, I'll post the details here.

Even though our vet seems to be somewhat more expensive than most, she and I are working very closely as a team through this.

Annie had a bit more of an appetite this evening, too. I very finely cut up ( literally ) one square inch of a flat cheese slice into her meal and she ate it all with no hesitation. The amount of cheese that was mixed into her food was less than if I had used cheese to "hide" her Vetoryl capsule.

Obviously, I don't plan to make that a habit ( ! ) but I wanted to see if I could stimulate her appetite a bit this evening.

Mission accomplished . . . and everything else continues to be okay.
No other apparent side effects or symptoms at this point.

Her water consumption is slowly decreasing, too, by the way.

[Harley PoMMom]

That's great to hear that Annie's appetite has picked up!

I am so glad that Annie's vet and you are working as a team that is so very important, some vets do not appreciate a pet owner being so involved in their dog's medical treatment.

Hugs, Lori

[LittleArfinAnnie]

Hello again, Lori . . .

Fortunately, Annie's vet is secure enough in her professional skills and expertise to collaboratively field all of my questions and concerns.

She already knows that I'm an intrepid researcher with a ( probably obsolete ) Science degree !

And she's always just an e-mail away, too, which is most appreciated.

Lori, would you consider my addition of that TINY amount of cheese to Annie's meals to be something that I should avoid ?

I'm doing quite the sales job when it comes to enticing Annie to eat. And even though there is a barely noticeable amount of cheese in her meal ( by the time I've finished cutting it up ), I'm thinking that her powerful little nose takes care of the rest of the illusion !

She continues to seem okay on Day 6 of Vetoryl. No vomiting, no diarrhea and her water intake is beginning to approach normal again.

Fingers crossed that this trend continues !

[molly muffin]

I don't think a tiny bit of cheese to entice her to be interested is that big of a deal. Many use cream cheese or peanut butter to hide pills so I doubt that the cheese is any more than one of those as far as fat content.

[LittleArfinAnnie]

Thanks, Sharlene . . . !

The amount of cheese that I mix into her food is probably even LESS than that which I would use to hide her meds.

Thanks for the reassurances !

I'd hate to be putting out one fire only to start up another one !

Catherine

[Harley PoMMom]

I'm glad Sharlene answered your question about the cheese and I agree with her. As Sharlene mentioned many of us have hid pills in different foods so our furbaby will take the medication willingly.

Hugs, Lori

[molly muffin]

Hi Catherine, yooo hoooo, How are things going with you and Annie?
Are you frozen yet? :) So glad we are missing that huge nor'easter. Brrr