Veteroyl still showing clinical symptoms

[vms1177]

Hi all, I am new here and have an issue with my Yorkie Lila.She had been diagnosed with Cushings pituitary in August.She is around 6 pounds and has been on 10mg of Veteroyl for about 4 months.She has had an ultrasound and 2 checks I am assuming they are dexamethasone testing pre and post test sent to Cornell university.Lila levels I was told after being on Veteroyl were very good post test being at a 7.Long story short.She initially had a decrease in symptoms the first month.The incontinence in the house urination is the only symptom that has not returned She has hairthinning ravenous hunger, panting has decreased but still present swollen belly.She has always been a high strung dog so I cannot say that she is restless.My concern is that the get says she has great levels on the Veteroyl and states that there should be no increase but she is still presenting will most of the symptoms that led us to the discovery of cushings .I am really struggling I just lost my other yorkie to liver shunt on Wednesday and we are devasted.please help.

[labblab]

Hello and welcome to you and little Lila, but I am so deeply sorry about the loss of your other little one. What a sad and difficult time for you, especially having to worry about Lila, as well.

One thing you can do that will help us a great deal is to get the dates and actual numbers for the monitoring tests that have been done since Lila began taking her Vetoryl. It may simply be the case that she is in need of an increase. I know you've said that the vets haven't recommended an increase, but I am wondering how recently Lila has been tested and what the numbers actually were.

The testing that is done after a dog starts treatment is an ACTH stimulation test. There are typically two numbers involved if you live in the U.S.; possibly three numbers if you live in Canada. However, a result of 7 would indeed be good -- as long as all the Cushing's symptoms were being well-controlled. If symptoms rebound or are left unresolved, then that test number should be lower. Or, another possibility is that the total daily dose may need to be shifted to two half-doses at 12-hour intervals. For some dogs, the Vetoryl leaves the body quickly enough that symptoms come back before the end of a 24-hour time period. Dosing twice a day can help keep the medication more consistent in the bloodstream throughout an entire day and night.

However, we can talk about all that a lot more. As I say, the first and most helpful thing will be to get us the results of those tests. Also, if you can give us abnormally high or low values on any of Lila's regular bloodwork, that would also be good.

Once again, I am so sorry, though, about the loss of your other sweetie.

Sending big hugs,
Marianne

[molly muffin]

It is not uncommon for a dog to need a dosage adjustment. A post of 7. up to 9. is fine, as long as symptoms are controlled. Lila's are not, so I'd think a dosage adjustment would be the next step and according to the Dechra guidelines that would be what should be done.

Here is a link that might help you with guidelines from the vetroyl manufacturer: http://www.dechra.us/Admin/Public/Download.aspx?file=Files%2FFiles%2FSupportMaterial Downloads%2Fus%2FUS-046-TEC.pdf

What I want you to look at is page 2 the flo chart. This will help to determine where you think Lila is at. It sounds like she needs to come down a bit more, maybe to 5.0 or 4.0 post even. Many dogs do and many need dosage tweaks, this is not at all unusual.

[vms1177]

Thanks so much for your fast responses and appreciate for the welcome. Lila had her last test on October 26th thelow-dose dexamethasone suppression test.I will get those test results tomorrow.I am almost positive that Lila had normal blood results. I will double check with the vet tomorrow imperious I mentioned to the Vet that I wanted to increase the dose she was hesitant to do that she also is hesitant about using a compounding pharmacy due to the fact that she's concerned about the strength of the actual better of the veteroyl when it's been compounded. She was definitely against increasing the dosage at all. Lila is 6pounds 2 ounces and she is on 10mg. I have gone to her with my concerns and She repliec that she thinks it could be some behavioral issues which I don't agree at all. If get dosage would need to be split 5.mg 2 times a day she would need to go through a compounding pharmacy as well as an increase in dosage because the next capsule is 20mg.I feel that vet has found me to be a bit confrontational and has challenged her with my sweetie Yorkie Mandy who I lost last week to liver shunt.I maintained Mandy with lactalose and a home cooked diet for 3 years after her diagnosis. The vets wanted her to go on the prescription diet which I found was to be garbage.After a few months the vet complemented me on my efforts and told me how sucessful I was with controling Mandys shunt and told me that she was doing the best out of all her dogs with shunt. I am also a social worker and advocacy and it is very important to ask questions and research everything possible.I am sorry I have started to rant.I will get those results hopefully tomorrow from her.Thanks again so much.

[judymaggie]

Welcome to you and Lila! I am so sorry about the loss of your yorkie. From what you've told us, you did a remarkable job as her caretaker. Having two dogs with special needs at the same time can be very overwhelming.

As Marianne has posted and as the flow chart that Sharlene references, follow-up testing should be done with the ACTH. If that is not the test that Lila had in October, I do think you need to ask (tell ...) your vet that you want one done. Dechra, the manufacturer of Vetoryl, now has 5 mg. capsules available so a split dose of 10 mg. is quite easy or, if an increase is indicated on the ACTH, you could go to 15 mg. The availability of 5 mg. capsules is relatively new so your vet may not be aware of this.

I am a bit concerned that your vet is so adamant about the possibility of an increase. Hopefully, if the ACTH results indicate that is what is needed, she would change her mind.

P.S. I definitely don't think you are ranting--you are obviously concerned about Lila!

[molly muffin]

As Judy just mentioned, Dechra released a 5mg in the US late last year (2015), it was available in the UK for about a year before that I think or maybe it was 6 months.

You can also combine if needed vetroyl and a small compounded amount. We have another member who does that her dog.

Also, as Judy mentioned, it is the ACTH that is used for monitoring once medication has been started. The low Dex (LDDS) is only for diagnostic purposes. With the ACTH you should have a pre and a post number. I think that is what they are doing since your vet mentioned a post result of 7.

[vms1177]

Hi thanks for the info regarding the 5mg dosage. I am waiting for the Vet to send the results to me via email she is also consulting with the specialist regarding Lila unresolved symptoms

[molly muffin]

We will be waiting to see what the specialist recommends. Crossed fingers for some answers and a plan.

A plan is important in the world of cushings. :)

[vms1177]

Good afternoon everyone I spoke with the veterinarian yesterday we have an appointment with her on Saturday I explain my concerns she spoke with the specialist and basically she wants to split dose the better all 5 milligrams twice a day. She was not aware that they had offered 5 milligrams so I'm so glad that I came here on this site. I also voice my concerns regarding the symptom management

[vms1177]

We will be waiting to see what the specialist recommends. Crossed fingers for some answers and a plan.

A plan is important in the world of cushings. :)
I also received the testing via email. she was tested on October 24th she had the ACTH test and pretest was 4.60 and post was 7.13. She had her ultrasound in July and the results from that where pancreas was normal , bladder was normal kidneys, normal adrenal glands, normal spleen normal lymph nodes normal , and liver obviously was enlarged . She also has a mucosal mass in her stomach GI tract so I'm hoping when we go on Saturday we will either go up on her medication however we are going to do a urine screen as well as a blood panel before we increase the dose to make sure that there's nothing else going on I will keep everybody posted I just want to make sure that the blood work will be appropriate screening to rule out any other issues

[Harley PoMMom]

The reporting units for that ACTH stimulation test result are in ug/dl, right? If so, although she does have some wiggle room for an increase, I want to make sure you are aware that a small number of dogs do not resolve their pu/pd which in known as as renal medullary washout. This means that all the stuff (solute) the kidneys need to concentrate their urine has been washed out for a very long time so the kidneys will take a while to recover.

Hugs, Lori

[vms1177]

Hi Lori, yes it is reported in units are the ug/dl .I am not understanding the kidney issue relation to the cushings symtoms.If you can explain it to me please. I researched medullary wash out means.Are you saying that her body is not filtering the medication or the ability to absorb it? Sorry I am just trying to relate and connect this with her condition. Thanks so much 😊

[Harley PoMMom]

Dog's with Cushing's are producing an excessive amount of cortisol. This inordinate volume of cortisol increases the blood flow (also called GFR-glomerular filtration rate) to the kidneys and the result of this is pu/pd. When a dog has pu/pd for a long period of time the kidneys lose their ability to concentrate urine which is why their urine is so diluted and they have a low specific gravity. With this continued "wash out" it takes the kidneys a while to recover and produce the solute needed for the concentration of urine. I hope this makes sense and I haven't confused you more.

Hugs, Lori

[lulusmom]

Lori, I believe PU/PD has resolved as Lila is still not having accidents in the house. It is the other symptoms that seem to have rebounded since resolution in the first month of treatment. Based on the acth stimulation test results, I agree that 5 mg twice daily would be the likely option. It wasn't that long ago that when switching to twice daily dosing, it was recommended that the daily dose be increased a bit and split in half am and pm. For instance, if the once daily dose was 10 mg, a vet would increase to 15 mg and split am and pm. This would have to be compounded into 7.5 mg capsules. Since Lili is symptomatic and her post stimulated cortisol is at the upper end of the range, it will be interesting to see if 5 mg will be enough to keep cortisol levels controlled low enough throughout the day to see resolution of all symptoms again. I'll be looking forward to updates.

Glynda

[Harley PoMMom]

HThe incontinence in the house urination is the only symptom that has not returned.

Oh crap, sorry about that for some reason I totally skimmed over the "not" returned and thought it was "returned."

Glynda, thanks so much for catching my goof, and it is so wonderful to see you here.

[vms1177]

Thanks for the clarification:) I appreciate that.Lila is no longer urinating in the house that is the one symptom that they have under control. But today is the appointment and I will let everybody know what the verdict is. I also wrote down the contact information regarding a compounding pharmacy that we have in New York State and all the 5 milligram tabs through the California pet pharmacy. So they can fax over the prescription right away so I don't have to wait. Thanks so much for everybody's help I really really appreciate it means a lot to me. I'm so glad that I joined the group . I just wish I would have done it a little sooner but at least I'm in the group now

[vms1177]

Hello everyone sorry it took me awhile to get back but I've been feeling kind of down because of my little Mandy. We went to the vet she check ed Lila's blood work everything came back normal. We went ahead and ordered the 5 milligram Veteroyl and we'll be giving her the split dose for now to see how she's doing. I asked about the split. Dose increasing it.She informed me when she consulted with the specialist that for some reason they do better with the split dosing even without the increase. So we shall see if I don't see any improvement in a few weeks I'm going to bump her up. Thank you for everyone's help and I will keep you posted on her progress

[molly muffin]

It's true that often with the split dose they don't need an increase. Give it awhile as even at 30 days the cortisol can be dropping on the same dose.

It's hard to be worried for one while still in grief for little Mandy. :(