Kelso has Cushing's

[Kelsosmom]

Hello,
I'm Kelso's mom and he was just diagnosed this week with Cushing's. He is about 12(rescue from a shelter after his family decided not to pay the fee to pick him up after he'd run away for the 3rd time). I was prepared for the diagnosis because of all the googling I'd already done in response to his symptoms. He drinks and pees excessively, is lethargic and has the pot belly and pants. When they called me yesterday with the results and told me the cost of treatment, I was fine with it. They had said $75 a month for meds and roughly $200 for the testing he'd need at 2 and 4 weeks after starting treatment and then every few months to monitor. They then called back 15 minutes later and said the pricing was wrong and that it would be closer to $170 per month for the 30 mg of Trylostane, twice a day. That cost is not really in my budget but how can I not treat him? I've been researching prices online and am checking with my pharmacy to see if they will compound it and for how much. I look forward to any suggestions, tips or help I can get with this.

[labblab]

Hello and welcome! Thank you for rescuing your boy, and for your efforts in getting him the care that he needs. I have only a moment to post right now, so I have to make this short and sweet. :o

But in terms of dosing, I want to caution you that trilostane dosage recommendations have lowered over the past year or two, and not all vets are yet aware of this. When first starting out, the most widely accepted current recommendation is to start at a daily total that does not exceed 1 mg. per pound (or 2 mg. per kg.). For a dog dosed once daily, the total dose would be given in the morning. For a dog dosed twice daily, one-half of the daily total is given at 12-hour intervals. So for a dog to be given 30 mg. twice daily, we'd want to be looking at a dog that weighs around 60 pounds. How does that fit in with Kelso's weight?

Secondly, everything else being equal, there are reasons why some vets favor giving brandname Vetoryl. However, if the cost of Vetoryl is so high that it would make treatment impossible, then absolutely I would opt instead for a compounded version of trilostane. Many of our members over the years have used a veterinary compounder located in Arizona: Diamondback Drugs. They will ship anywhere in the U.S., and you can easily contact them via info on their website in order to check pricing. I am confident the cost would be much less than the cost of Vetoryl.

Last but not least, you might save money by starting out by dosing Kelso only once in the morning. In other words, for a month's worth of treatment, thirty 60 mg. capsules might cost less than sixty 30 mg. capsules. Some clinicians do prefer twice daily dosing when it is feasible, but many dogs experience good symptom relief when dosed only once daily, and the maker of Vetoryl still recommends that all dogs actually start out with once daily dosing. For them, the shift to twice daily dosing is only recommended if symptoms end up rebounding in the evening.

OK, gotta go for now. But once again, welcome!
Marianne

[Harley PoMMom]

Hi and welcome to you and Kelso!

I have manually approved your membership so now all your posts will be seen right away. Also, please just disregard the validation email that was sent to you from k9cushings.

Oh Bless you for giving Kelso a forever home!!! Now, we love details so if you would share more information about your boy that will help us in providing you meaningful feedback, and we get that info from asking a ton of questions, so here are some of mine :eek:;)

Could you get copies of all tests that were done on Kelso and post any abnormalities that are listed? With respect to the blood chemistry and complete blood count (CBC), you need only post the highs and lows and please include the normal reference ranges. Would you post the results of the diagnostic tests that were performed on Kelso that diagnosed the Cushing's? Does Kelso have any underlying illness that he is taking medication for? And if so, what is it and what is the medication? Is Kelso's urine diluted and does he have a low urine specific gravity? Is he taking any supplements or herbs? And, finally, how much does he weigh?

The test used to monitor treatment in dogs with Cushing's is the ACTH stimulation, and it's the stimulating agent that drives that cost up. Now, depending on how much Kelso weighs there is a cost savings tip for those tests. Most vets use Cortrosyn as the stimulating agent. The vial of Cortrosyn is 250 μg and instructions say to use entire vial but not all dogs need the entire vial. There have been studies done that show using just 5 μg per kg is all that's needed. As an example: if Kelso weighs 25 lbs - the lbs need to be converted to kg which is 25/2.2 = 11.36 kg. Now we take that 11.36 kg and multiply that by the 5 μg of Cortrosyn needed for each stim test = 56.8. Dividing that 250 μg (entire vial of Cortrosyn) by 56.8 = 4.4 so that means the vet could get 4 stim tests out of 1 vial which is a huge cost savings. Some vets are not aware of this so we always provide the url to Dr. Mark Peterson's blog which instructs vets on how to dilute and store Cortrosyn for future use: http://www.endocrinevet.info/2012/03/how-to-dilute-and-store-cortrosyn-for.html

You could find an online pharmacy that may be cheaper that what your vet wants for the Trilostane or you can get the dose compounded. A lot of our members use Diamondback drugs to get their dog's medication compounded : http://www.diamondbackdrugs.com/?gclid=COu81vuny8wCFYk9gQodOI8Fsg However they can not compound a dosage that Dechra (makers of Vetoryl) already manufactures so that 30 mg would have to compounded to either 29 mg or 31 mg.

You may want to look at these: to help you find the best price for prescriptions (http://www.k9cushings.com/forum/showpost.php?p=183349&postcount=1)

Vetoryl - Best Site for Purchase (http://www.k9cushings.com/forum/showthread.php?t=4592&highlight=Vetoryl)

Where to get Vetoryl? (http://www.k9cushings.com/forum/showthread.php?t=6355&highlight=compounding+pharmacies)

I am sorry for the reasons that brought you here but so glad you found us and we will help in any way we can. ;)

Hugs, Lori

[molly muffin]

I just want to say hello and welcome. Marianne and Lori have gotten you off to a good start. Much depends on Kelso's weight as they have explained and then the option is to use trilostane compounded to save money vs vetroyl the brand name. I'm one who uses a compounded trilostane and as long as you use a reputable pharmacy, it is a viable solution when cost is a factor.

[Kelsosmom]

Thank you for the welcomes. I do appreciate it especially with the emotional week I have had. I haven't yet received the specifics from the vet but I will get them. The vet dr that called me is a brand new doctor at that office and is clearly not well versed. I will be redirecting all of my questions to a different Doctor.

A bit more on Kelso, he weighs 35.9lbs. His urine is dilute but I do not know any other specifics about that. He is on no other medication or herbs of any kind. Am I to gather from the previous posts that he should be on a dosage of 36mg of Trylostane? I got a quote from Diamondback vet for 60 doses at 15mg for $38.00 which is so doable for me!

Right now while I wait for the tests, I need to get the urination under control. He can't go very long without going outside and sadly, it is ruining my floors and my husbands patience. He isn't much for crates and pee pads are literally hit and miss unless I cover the whole floor.

I look forward to this forum. I've already learned so much in the short time I've been here and Kelso and I thank you for that.

[dsbailey]

Kelsosmom,

I can understand the peeing issue. My girl isn't under control for cushings yet and has incontinence issues. Hers is a vicious cycle, she drinks too much, she leaks, then licks (both areas), gives herself an e.coli UTI which makes the leaking sooo much worse. Until I get the water intake under control then nothing is going to break this cycle. I don't know about males but maybe he has a UTI that is making things worse. Just a thought.

Please be patient, I / we all do understand.

Good Luck Lolita's Dad - Darrell

[labblab]

Hello again from me! I'm glad you had a chance to contact Diamondback Drugs, and that their trilostane pricing seems "doable" for you. And yes, you're correct, given Kelso's weight, a reasonable starting dose would be a daily total of approx. 36 mg. given all in one dose, or half the dosage given every 12 hours. If you wanted to start a little bit lower with 15 mg. twice a day, that would also be just fine.

I can surely understand how frustrating and upsetting the urination issues can be. I do want to caution you, though, that Kelso needs to have unrestricted access to water at all times. It is actually the excessive peeing that leads to the excessive thirst in Cushpups, rather than the reverse. The elevated cortisol level compromises the ability of the kidneys to concentrate urine, and therefore the poor dog has to pee frequently and voluminously. So even though it seems backwards, the dog's extreme thirst results from the need to stay properly hydrated in the face of the massive urine loss. The urination causes the thirst, rather than vice versa. However, excessive urination and thirst can be two of the earliest symptoms to improve once Cushing's treatment is begun.

In the meantime, you may want to check out these suggestions for wearable "peekeepers" that were discussed a few months ago by two of our senior members, Song and Renee. Since Kelso weighs less than 40 pounds, I think one of these devices might fit him, per the website's specs. The conversation starts with this post, and then continues off-and-on throughout the next couple of pages of the thread:

http://www.k9cushings.com/forum/showthread.php?p=183706#post183706

Hoping this may be of some help to you (and also your floors...:o).
Marianne

[FemaleK9]

I think it is better to start with too low a dose than too high. The worst that can happen with too low a dose is that after allowing time for the medicine to reach its full effect (about 30 days) symptoms will not be contolled and an increase will be needed. The worst that can happen with too high a dose is literally death.

Every dog is different, but I would advise starting with no more than 10 mg twice a day. This is where my Rosie started three years ago and where she has remained to this day, and although I can't promise that Kelso will be the same, it seems a good place to start.

I get Rosie chicken flavored Gourmed chewable tablets from Wedgewood Pharmacy online (http://www.wedgewoodpetrx.com/pet-and-horse-owners/). Two 10 mg tablets per day comes to about $1 per day when I buy two bottles of 100 each for about $100 shipped, which is a 100 day supply for us.

Also, pee pads are available on Amazon at reasonable prices. I got a large rubbermaid type of boot tray and I line it with pee pads for my Rosie to use overnight or when her weather phobias make her unwilling to go outside to do her business.

ETA I really understand your frustration with the pee everywhere. My hardwood floor and wool oriental rug are ruined. Beagles are notoriously hard to potty train, but I have finally got Rosie using the pee pads. But she kicks the snot out of them and then has nothing left to use, and it's back to the rug. It's already ruined (along with the floor under it) and I don't plan to replace it in Rosie's lifetime. I tell her frequently that she's lucky I love her!

[molly muffin]

I use a little green machine bissel to clean the rug accidents and hope she has any accidents on the tile that is easier cleaned.

Welcome to the forum