Molly on Vetoryl - Newly diagnosed diabetes

[SteveLA]

Hi all,
I have a pug, Molly, that was recently diagnosed and is on Vetoryl. She is on 10 mg twice a day. It seemed to really help all the typical symptoms at first, but recently she has started to decline in health. She has a weak back end, has lost weight except in belly(you can feel her spinal column and ribs), her skin is flaking and thin, has low energy, and drinks a ton. She is eating well and barks at dinner time, but something is wrong. I am scared that I am loosing her. Did another blood work up and vet said she is looking good. He did say we could increase the Vetoryl to 15( I split a pill and pour out the powder to half it).
She is so thin and fragile and I am scared this isn't working. Maybe she has had Cushings for a while and I just caught it.? I was really hoping the meds would work. Ahe has only been on them a few months. Does this sound familiar to anyone? I do not want her to suffer and am weighing options. So hard, it's killing me.
Any advice?
Thanks,
Steve and Molly

[labblab]

Hello Steve, and welcome to you and Molly -- we are so glad you've joined our family! Before I talk about anything else, one warning and one question seem most important to me. First, the warning. You should not be opening the Vetoryl capsules and trying to split the powder. First, it is not a good idea to expose yourself directly to the chemical. And secondly, there is no way in which you can be precisely dividing the active ingredient. The capsules are a combination of trilostane (the active chemical), and also "filler." They are intended to be swallowed whole, and the contents absorbed only after they've reached the dog's stomach. When you open and divide the capsules beforehand, you may be ending up with most of the active chemical in one half, and most of the filler in the other. There is simply no way to know. Plus, I assume you are then sprinkling the contents on food? If so, the active chemical may be not be absorbed properly since it is being chewed in the mouth instead of being delivered intact to the stomach. Vetoryl is supplied in 5 mg. capsules now, so if Molly's dose truly needs to be increased, that would be the safe route to go.

But backing up a step, have monitoring ACTH tests been performed since Molly started on the Vetoryl? This is critical, in order to judge whether she is taking a therapeutic dose as opposed to a dose that is either too high or too low. Initial dosing is based upon weight, but each dog metabolizes the drug differently and it is critical that monitoring testing be performed after the drug treatment has begun in order to accurately judge the drug's effect.

It will also be a huge help if you'll tell us more about Molly's overall health history, the symptoms that led you to suspect Cushing's, and also the tests that validated the diagnosis. All this information will help us provide you with our most accurate feedback and suggestions.

Once again, welcome, and I'll be looking forward to learning much more about your little girl.

Marianne

[molly muffin]

Hello and welcome to the forum.
Marianne has covered why you shouldn't be opening the capsules itself. The medication has to be absorbed in the correct manner in which to work adequately.

What is the vet basing the need to increase on? I hope no liver values as those can remain high even with adequate control of cortisol.

How is her drinking? What lab results where high or low on the last test and have you had a kidney test to see if anything is going on with them?

My dog is controlled on medicine for cushings, but her liver enzymes are still high and her kidneys are high now too. She too has the bony back (not tummy though) and is weak in the rear legs.

Anything you can tell us will help us to give you better feedback.

So glad you found us.

[SteveLA]

Thank you!!!! I so appreciate an understanding voice. I will call vet tomorrow and check on labs. After my reading here, I definitely didn't split the capsule open and have left her on the 10 mg.
I actually rescue pugs. I have 9 currently, several failed fosters. It is a crew and won't ever have this many again. I am part of a great rescue and am committed to my little crew ages 7-14. I have had Molly for about 4 years now. She is a spitfire. She can scrap and defend her toys. She doesn't share and loves to play ball. For the last couple of years she has slowed down. She would pant and stop on walks and couldn't play hard ball anymore. I chalked it up to age. More recently, within past 3-4 months, she really slowed down, had breathing issues, accidents in bed, and seemed more lathargic. I checked her for a bladder infection and did a general blood work up which showed high cortisol levels. She was perscribed the Vetoryl at 30mg which laid her out flat. I was scared I OD'ed her. We pulled her off and went to 10 mg once a day. A few weeks later I checked her values (each time with the 1 hour test...STEM?) and we increased her to 20mg 10 in am and 10 pm. She seemed to respond. She was playing again and had more energy.
Lately she has totally taken a dive. Her skin is thin and flakey, she is skin and bones( except the belly), she isn't going after the other pugs' food, she seems to just want to lay around. She does bark at dinner but then lays back down. She eats her dinner, not as fast. She drinks a ton and urinates frequently.
I am just scared we are at the end. She may have had this for years now that I look back. I just don't want her to suffer. I feel like she is on a rapid decline. I plan on talking to my vet tomorrow and will get specific numbers. Do you think we are too far gone, can a dog in her shape bounce back?
Thanks again for all the support!!
Molly and Steve

[Renee]

Hello fellow pug rescuer! Which rescue are you with? Central Coast? Pug Nation Rescue of LA? I am with Polar Pug up in AK. It's always nice to find another pug rescuer!

I think Marianne and Sharlene have started you off well with the questions. The more information you provide, the much better we can help you on this course.

It may be that her cortisol has dropped too low, and she needs to back down a bit. Like Marianne said, the 5mg capsules are now available, which can help you get the dose you need. My pug is currently on just 10mg in the morning only, but we've had plenty of ups and downs. At her highest, she was on 40mg per day.

I am so glad you joined and can't wait to learn more about Molly!

[labblab]

Hi again, Steve!

How recently has Molly had a basic blood chemistry panel performed? What you are describing now could be consistent with rapid-onset diabetes, which does sometimes occur in dogs with Cushing's. Seemingly overnight, these types of serious and even life-threatening symptoms can emerge. And it can be confusing since many of the same symptoms are shared between the two disorders. I believe I would have Molly's blood glucose level checked ASAP if it has not already been done so within the last couple of weeks.

Marianne

[SteveLA]

At vet now. Want to make sure it isn't diabetes. Nervous that I may be facing a big decision, don't want her to suffer. She didn't eat this morning and has very low energy. Thanks for all the good advice. Will keep you posted.
Molly and Steve

[SteveLA]

First, thank you for all the good advice! So Molly had Ketones in urine and was definitely heading into ketoacidosis. Her energy had dropped and appetite was declining. She barely ate this am. I have been through the diabetes part with another pug, same general symptoms.
They are trying to get her back on track and slowly rid the ketones and stabilize her. She will then start insulin. Hopefully everything goes well and then we can see how she is actually doing on the Vetoryl.
The test prior to all of this ( her first test back in Novemeber) was the ACTH had pre of 8.6 and post of 22.6, second test more recent was pre 5.4 and a post of 8.7. I believe there is even a more recent test and will inquire.
Someone inquired about my rescue, I am with Pug Nation Rescue. I am a big failed foster, lol. I am committed to my nine and then will never have more than two! I love all of mine dearly, it's worth it :-)
Thanks for all the support!! I will update soon.
Molly and Steve

[labblab]

Wow, so Molly does have diabetes! I'm sooooo glad you got her in so quickly to be tested, and I hope things will soon be sorted out and she starts to feel better.

It sounds as though you've got a handle on diabetes treatment from your previous experience, but we have a sister forum that's devoted to the care of diabetic dogs and they also provide wonderful support. You may want to join there, as well, especially because we do share several "dual diagnosis" pups.

http://www.k9diabetes.com/forum/forumdisplay.php?f=2

Please keep us updated, OK?
Marianne

P.S. I just now took the liberty of editing your thread title so people will know about the diabetes, and those with experience will be more likely to stop by. ;)

[SteveLA]

Molly is doing well. Her Ketones are gone from her urine, and she is resting at vet on fluids. I hope to take her home tomorrow, and she can start her long acting insulin. So once this is under control I can see how the Vetoryl is working.
Thanks for all this amazing information. You saved her life! I hope this post will help others :-)
I will definitely check out the other diabetes sites and keep all posted on Molly.
best,
Molly and Steve

[labblab]

Steve, what a great report -- you've started my morning out with a very big and very relieved smile! :)

One big plus for Molly is that she is already being dosed with her trilostane twice daily. Many Cushpups do seem to do fine with only once daily dosing, but it is especially recommended that diabetic dogs always be dosed twice daily so as to keep a more consistent endocrinological balance in place throughout the entire day and night. So you guys are already a step ahead of things.

Definitely keep these updates coming, OK? ;)
Marianne

[molly muffin]

This is excellent news that Molly is doing well and on the road to getting better. Yay!!