bella

[barbara1]

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my dog and friend, Bella has cushings. We had gone through the process of diagnosis and there were too many false negatives and so we took her to an internal medicine vet who did an ultra sound and confirmed her diagnosis as cushings. Her physical symptoms are not too bad but her blood work, alkaline phostate (3,000) was the clincher. She was started on 10mg of benazepril as her BP was
over 200 and now is good at 140. Today, she starts on trilostane and we are very nervous. The mg given are 25mg but our vet has asked us to give her 1/2 tab at dinner for 4 days to start as she has a very sensitive stomach. I have been reading your forums and you are all very caring people. I have never participated in something like this and hope I can do the website correctly as I am very elderly and not very computer savvy. I hope and pray that Bella tolerates this medicine and that her system will improve. How long does it take for the medicine to work? We have an apt with our vet two weeks from today for the post testing on this particular dosage.
If Bella get sick with the side effects, how long does this last and if they aren't too bad do you continue with the meds. Today I am feeding her boiled chicken and brown rice so that she does not have a hard time digesting her food which is usually acana dog food and boiled chicken breast. I know you have been through all this but I think my husband and I need a hug today to start this off as we are very nervous

[Joan2517]

Hi and welcome to you and Bella. I am not as knowledgeable as some of the others, but I do know that you are not supposed to break the tablet in half. Others will be along shortly to explain it all to you.

[judymaggie]

Hello again! Let me be the first to send hugs your way. For not being familiar with forums, you did a great job with your first post.

I do have a couple of questions to get you started on -- others will be along soon.

Would you tell us how much your Bella weighs? The current dosing recommendations from Dechra, the manufacturer of Vetoryl (which is the brand name for trilostane), are to give a pup 1 mg. per pound. Since your vet has prescribed 25 mg. a day for Bella, hopefully she weighs about 25 lbs.

How was the 25 mg. given to you? In one capsule? You do mention a "tab" when talking about giving Bella "1/2 tab" for four days. If a capsule, I am a bit concerned that you may be opening up the capsule and splitting the contents. I don't see a problem with starting off slowly but you will definitely want to dose Bella in the morning very soon as the post test (the ACTH) needs to be done 4-6 hours after a full meal and a dose has been given. In order to avoid any stomach issues with my pup, I give her Pepcid original before each meal that is followed by a trilostane dose. It is also recommended that the trilostane be given with a bit of fatty food; for example, wrapped up in a piece of cheese. This helps with absorption and also helps with getting it down the dog's throat.

To answer your question about whether you continue to give trilostane if the dog shows negative side effects (diarrhea, vomiting, lethargy), the answer is "no". Typically, these side effects show up if a dog is being overdosed. That is why it is important for us to know how much Bella weighs.

More hugs -- you and you husband will do great!

[labblab]

Oh welcome to you and your husband and Bella, all three!! And plenty of hugs are being sent your way. ;)

You have done everything just right in terms of registering and posting, and now your registration has been formally approved so that all your replies will be immediately visible as soon as you write them.

I only have a moment to post, myself, right now. But I have every confidence that Bella will do fine. It will help us a great deal if you will give us more specifics about the symptoms that led to Bella's testing, as well as any other significant features about her overall health history. Also, how much does Bella weigh? Current recommendations are to begin trilostane dosing that does not exceed 1 mg. per pound.

Also, brandname Vetoryl capsules should not be opened and the powder split, but it sounds as though you are working instead with solid compounded tablets. If they are indeed solid and scored, it should be OK to split them.

Your vet is following recommended procedure by planning to test after two weeks of trilostane dosing, so that is good. In terms of side effects, etc., I'm going to give you a link to a Dechra publication that does a great job of explaining all about monitoring and side effects. How quickly you will see results will depend upon how quickly the trilostane reaches therapeutic level in her bloodstream. So take a look at this brochure, and then you can let us know about your additional questions.

http://www.dechrace.com/pdfs/vetoryl/VETORYLTechnicalBrochure.pdf

Marianne

[labblab]

Hi again, Barbara. :)

I just now retrieved your visitor's message to me in which you mention you will be giving Bella her trilostane after dinner. Actually, it is recommended that for dogs who are dosed once daily, the trilostane is given in the morning along with breakfast. This is because the monitoring ACTH blood testing should be performed 4-6 hours after dosing. This is for safety's sake -- to find out what the cortisol level is during the time when the drug is maximally effective in the body. Few folks/vets are equipped to perform this blood test in the evening, so morning dosing is generally preferred.

Marianne

[barbara1]

Thank you so much for your speedy replies. Bella is taking a capsule and it does have a scour line on it. Her vet is concerned as she has a super sensitive stomach and it took her awhile to adjust on the benazepril. She weight 55lbs and I know you will all say she is not on the correct dosage (25MG) 1/2 to start for 4 days, but I would rather start very low with her and go up gradually. I am a little confused about your comment on the testing as her vet said she should not take her dose before the testing which is why Bella taking her meds at dinnertime.
Bella's medical history started with freguent urination and we did the urine test but it came out negative. Then blood work was done and the alkaline phosphate was off the chart (3000) I refused to commit my dog without definite proof of this disease and therefore we went the route of the ultrasound which confirmed it along with the high BP and elevated liver enzymes. I usually give Pepcid when she eats grass outside and I am glad you mentioned it. Her vet asked me to call her daily to give an update as to how Bella is doing. We are very elderly and she know how much this baby means to us. We even get a dog sitter if we go out to dinner so that Bella is not alone. Sometimes when you are an empty nester and get an animal, it becomes like your own child and you pay more attention to them as your children are gone and you have more time to spend taking care of and enjoying them. Thank you for you concerns and replies.

[DoxieMama]

Hello and welcome to Bella, you and your husband.

Marianne and Judy have already covered the questions and suggestions, so I'll just be content to send lots of hugs for each of you! :)

Shana

[barbara1]

I just called Bella's vet as per the dosage in the evening as you all have said it should be in am and she was in surgery and will call me. The assistant said the reasoning for this is so that Bella would not have to wait for the testing in the am after dosing in the morning. The vet will get back to me. The internal medicine vet that we took Bella to for the ultra sound has made the recommendation that Bella NOT be left at the clinic for the testing. She feels that she is way too high strung and that we should remain with her during this time. (outside, in the car, walking, etc) And so, of course, we shall do this. This is why perhaps the dosage is going to be given in the pm rather than in the am so the testing can be started asap

[labblab]

The recommendation that Bella not be stressed by waiting is a very good one. However, I'm not understanding how that would have any impact on the timing of the test. If you are living in the U.S., an ACTH stimulation test should take only one hour to perform. A baseline blood sample is first taken, then a stimulating agent is injected, and then a second blood sample is taken one hour later. So no matter what time of day the test is performed, you ought to be free to take Bella with you to relax during that intervening hour.

The reason why the blood testing should be performed 4-6 hours after dosing (and not the next morning after 12+ intervening hours) is because trilostane only has a short active life in the body. The time frame of 4-6 hours after dosing captures the effect of the medication when it is maximally effective. For safety reasons, this is very important because you need to know the status of the dog's cortisol at its lowest point during the day. By 12 hours later, the drug is already exiting the body and the cortisol may already be rebounding upwards again. Test results in that situation may lead a vet to mistakenly think a higher dose is needed to control the cortisol when that is not the case and overdosing may result.

I will try to come back and arm you with some more specific information in this regard to help you discuss this further with your vet. Try not to stress too much about this on your first day, though! The testing won't occur for a couple of weeks so we have time to sort it out. The more important thing right now is to make sure that whatever time you give Bella her trilostane, you give it alongside a meal so that it is metabolized properly.

And I totally understand how important she is to you! My hubby and I have no human children at all, so our furkids really are our only little ones. :o

Marianne

[Joan2517]

I always waited with my Lena. She was less stressed and so was I. It made it much easier on all of us. She would nap while I read or made friends in the waiting room.

When she was a baby we took her everywhere and never left her alone, so I totally get the babysitting when you go out to dinner.

When we took a trip to Colonial Williamsburg, VA, I wouldn't go without her, so Williamsburg arranged a babysitter for us. Lee had her own badge and was allowed in all of the buildings. Her babysitter was just so we could go out to dinner.

Bella is lucky to have such a loving mom and dad.

[barbara1]

thank you Marianne! I rewrote your message to me and will speak to dr moberg when she calls. I fully understand what you are saying and once more, am glad for this forum. I have my answers to this but I will discuss them w/dr moberg and get back to you on her answer.

[labblab]

OK, I'm back again with a direct quote from the Dechra technical brochure link that I provided to you earlier. Once again, Dechra is the manufacturer of the brandname veterinary form of trilostane.


Once treatment with VETORYL Capsules has been initiated, samples should be taken for biochemistry (including electrolytes) and an ACTH stimulation test 10-14 days later, 30 days later, 90 days later and every 3 months thereafter.

After the administration of VETORYL Capsules with food, cortisol levels are most significantly suppressed for 3 to 8 hours. Therefore, in order to obtain results at the peak time of effect, the ACTH stimulation test should be performed at 4-6 hours post-dosing. This will ensure you are assessing the dog’s cortisol levels when they will be at their lowest, thus uncovering any unintended oversuppression of the adrenal glands that would indicate the need to decrease the dose.

[Sadielove]

Welcome and lots of love to Bella. We all love and worry over our Cush babies.

[barbara1]

Marianne and all the people in the forum: I want to thank you so much for all your information. Bella's vet called me back and there was a misunderstanding. She thought that we had to come in her office early in the morning for other reasons and therefore had to come up with some plan with her medication. I told her we are retired and that Bella is our main concern. SOOOOO, Bella will take 1/2 tab of 25mg for 4 days, then 1/2 in am and 1/2 in pm for 2 days and by the 30th 1 whole pill in the am! On the 7th of June, her appointment is for 12 noon. If it weren't for you, this would not have gone over correctly.
Bella took her 1st pill tonight. I gave it to her with a piece of cheese as suggested in this forum.
Today is the 1st day to getting her to feel better! Thank you all again!!!!

[Whiskey's Mom]

Hugs to Bella from Whiskey!:p

[barbara1]

thanks Whiskey!

[DoxieMama]

Hi Barbara,

Is the June 7 appointment for an ACTH test? If so, be sure to give Bella her Trilostane around between 6am and 8am, 4-6 hours before the appointment... with food (as should always be the case). :)

[barbara1]

Hi Barbara,

Is the June 7 appointment for an ACTH test? If so, be sure to give Bella her Trilostane around between 6am and 8am, 4-6 hours before the appointment... with food (as should always be the case). :)

thank you for telling me this. I shall mark it on the calendar!

[barbara1]

I posted a need help message but do not see it on the main page. I think it went to a visitor post.

[DoxieMama]

I don't see any other messages from you today. Can you repost your question here?

[barbara1]

Bella weighs 55lbs. She started on trilostane on Tuesday, 12 1/2mg at dinnertime. she continued on this dosage until yesterday, Saturday where I gave her 1/2tab in am and pm. This morning she had bad diarrhea. I have been feeding her boiled chicken and brown rice throughout this transition as she has a very sensitive stomach. After she made I gave her a small portion of rice and chicken and her 10mg of benazepril and the 12 1/2mg of trilostane with a piece of American cheese. She took everything. I am just wondering, do I report this to my vet or do I disregard it at this time or do I call the
emergency internal medicine vet who has 24/7 replies? I don't want to do the wrong thing. thank you.

[DoxieMama]

How is Bella other than the diarrhea? Did she eat readily or did you have to coax her? Is she lethargic?

[barbara1]

she is fine otherwise. she ate her breakfast and is now sleeping

[DoxieMama]

I would just keep an eye on her, though I would definitely mention it when you speak with the vet next. You can always withhold the Trilostane tonight if you are concerned. Maybe once a day is enough for Bella, for now, even though it is such a small dose.

Hopefully someone with more experience will be by later today to give their thoughts.

[barbara1]

thank you for your insight. I tend to agree about not giving her more tilostane this pm and so I have a call in to a vet at the specialist office. they have 24/7 people there. thank you for answering me. it always seems that there are other opinions that you don't think about when it is your pet.

[Harley PoMMom]

I agree with Shana, and even though Bella is on a dose that is reasonable for her weight of 55 lbs, diarrhea is a concern and can be a sign of low cortisol. When a dog exhibits symptoms of not feeling well withholding the Vetoryl is the best thing to do.

Keep us updated.

Hugs, Lori

[molly muffin]

How is Bella doing today? Does she still exhibit diarrhea?
Did you give your vet a call?

[DoxieMama]

Hi Barbara,
I hope Bella is feeling better today. Please let us know!
Shana

[barbara1]

I have been treating Bella like a baby. Last week she wasn't doing very well. Very tired and not responding well. Almost to the point of taking her to the emergency vet in the area. Then, the next morning, she turned the corner! New Dog! Perky and full of energy. We were able to take a mile walk, she wasn't jumping into her bowl of food, but she did finish and less water consumption. Also, she
started sleeping through the night and not getting up to go outside.
Today, we went for her 14 day tests. She is on 12 1/2 mg of trilostane and she is 55lbs. Also she takes 10mg of benazepril for her B/p which is 144. We will see what the results will be.
I told her vet that I would like baby steps if any of her meds have to
be raised as even with these low doses, I had stomach problems with her and with all your guidance, was able to get through it. I still give her cheese with her meds in the AM as per your forum.
I will keep in touch.
I am optimistic, but do these dogs have relapses? Do I have too much hope?

[Harley PoMMom]

Unfortunately there is some tweaking involved in finding the right dose for dogs with Cushing's. And there is every reason to believe that with treatment a cushdog can enjoy a good quality of life and live out their expected life span.

When her stim results come in could you post them?

Hugs, Lori

[DoxieMama]

I am happy that she turned the corner after that episode last week. It sounds like she is getting some relief and feeling better. Your approach sounds sensible to me.

Please do keep in touch! As Lori said, please let us know the numbers from the ACTH test when you get those.

Shana

[barbara1]

I have such good news! Bella's ACTH test results are wonderful!

pre test 3.1 post test 5.5

She can stay on the 12 1/2 mg and retesting will be in 2 weeks at the 30 day mark. Bella is a very lucky doggie and we, as parents, are overjoyed!
I will keep in touch.

[judymaggie]

Woo-hoo!! Good work, Mom! :D

[molly muffin]

This is awesome news!!! Good results. :)

[Harley PoMMom]

Those are great stim numbers!!!! You're doing an awesome job!!!

[My sweet Ginger]

Hi Barbara,

I feel like a buzz killer here and I apologize for that but Bella's (love her name) pre:3.1 and post:5.5 make me very concerned if she's to continue on her current dose. Barbara, is it 12.5mg or 25mg a day? I couldn't figure that out because you mentioned 25mg somewhere too.

Of course, I'd be very happy with those results if those were the results from 30 day mark. In 14 days, until her next ACTH test on her current dose I fear her cortisol will trend downward much lower than her current ideal results even though Bella's on a very low dosage (either 12.5 or 25mg) for her weight of 55lbs. I'd bring this up to your vet's attention as I wouldn't feel comfortable at all with these numbers at 14 day mark. Hugs, Song.

[barbara1]

I don't understand your reasoning. She is on 12 1/2 mg. of trilostane. Dr Moberg said that the normal range is 1.5--9.1 Even
if Bella comes down some from pre 3.1 post 5.5,after testing, she still would be ok. If you could explain it to me and I will get in touch with the vet.
This is after 14 days.

[DoxieMama]

Those are very good numbers. As Song said, cortisol can continue to go down in the first 30 days of treatment at a particular dosage level, which is why you have another ACTH test at that time. At this point, I'd continue to keep an eye on Bella for signs that her cortisol is going too low (lethargy, diarrhea, not wanting to eat). When you have the next ACTH test, it's possible the results will be lower... and could be too low, requiring an even smaller dose of Trilostane. But we're not there yet. For now, she - and you - are doing great. :)

Shana

[My sweet Ginger]

I'm sorry that I got you upset. My worry comes from the fact that trilostane continually works for 30 days so next 14 days there's a chance Bella's cortisol will still go much lower than her results from yesterday although there still is room with her numbers.
It just seems to me that Bella is very susceptible to trilostane going by her ACTH test results on her very low dosage. I guess I saw too many pups going into Addison's crisis literally overnight when thought to be doing so well. Please disregard my post if your vet already thoroughly explained it to you. Can't help being a worrywart. :o
Still I'd monitor her very closely.

[barbara1]

Yes I was upset and spoke with Bella's vet. She said you are absolutely correct and that Bella has to be watched carefully until her next test and perhaps will have to go on a lower dose. This disease is getting to be more confusing for us and we worry all the time. My indication of her condition is in the morning when I take her to a baseball field where she does her business, I walk her a mile and then let her run unleashed in the field. Dr Moberg said if she is not doing well, she won't want to walk. Then we come home for breakfast and her medications. I have a severely handicapped and sick husband and so I can only hope to do the very best I can
for the both of them.

[DoxieMama]

It sounds like you have a wonderful vet, Barbara. :)