lily

[lily]

Not sure how this forum works, new to all of it. Lily is our beloved 6 yr old chihuahua. Found out she has Cushings and began her on Vetoryl today. I am worried about side effects. She is so small (6 lbs) and is on 10 mgs, which seems high. Diagnosis was found through blood work, abdominal xrays and ultrasound, then finally a stim (?) test. So, 700 dollars later, here we are.:p

[lily]

I wanted to post Lily's ACTH test results, as it was all greek to me. Does anyone make sense of it?

Time 1: 830
Time 2: 930

Cortisol Sample 1: 2.1 1.0 - 5.0 ug/dL
Cortisol Sample 2: >50.0 8.0 - 17.0 ug/dL

Result verified


Note, they only did a 2 hr test, and i see most dogs went through a 4 hour test. Was that because her numbers were high? Plus this 10 mg dose was given because that was the lowest the pills come in.

side note, my vet seems annoyed because I am asking lots of questions and for the test results. Do other people get this, or should I look for another vet??????

[dsbailey]

Welcome Lily,

There will be lots of very helpful and much more cushings educated people than myself posting to you today asking all sorts of questions. Gather all of your test results from your vet visits (labs, ultrasound, stim test, etc...) and be ready to post them. My girl and I are still trying to find the proper dosage of Vetoryl (Trilostane), it's been a couple of months since we started. As a newbie (take this for what it's worth) I would have felt more comfortable starting out at 5 mg once a day but don't freak out you have time to figure things out so don't call the vet just yet (We all panic in the beginning). The most important thing that I can leave you with before the experts get here is watch for any of the listed side effects and re stim test somewhere in the 10 to 14 day range from now. My girl at 57 lbs started on 60 mg which dropped her levels to much, stopped for 7 days, restarted on 30 mg, and have now bumped that up to 35 mg. It sounds like you're on the correct path and have found the best place to educate yourself.

Good Luck - Darrell and Lolita

[dsbailey]

Lily,

You were posting your second post while I was replying to your first. I didn't stim test my girl before she started Vetoryl so I never got a baseline. To answer your test question (someone correct me if I'm wrong) when your vet is ACTH stim testing with compounded gel the total elapsed time is two hours and if using cortrosyn instead it's one hour. You mentioned dollars so I assume you are in the states, Vetoryl is available in 5 mg 30 count from Allivet for $32.99.

http://www.antechdiagnostics.com/Resource.ashx?sn=ANTECHAdrenalFunctionTestGuide

Darrell and Lo

[labblab]

Hello and welcome! I am battling a virus this week and am only able to post short notes, but I do want to tell you that if you live in the U.S., Vetoryl capsules are available in 5 mg. doses, and that would have been my personal preference in terms of a starting point for a dog of Lily's size. Here's a link showing the 5 mg. dose:

http://www.dechra-us.com/products/details/vetoryl%C2%AE-capsules-(trilostane)-5-mg

The combination of your vet's lack of patience with your questions and also lack of knowledge about the 5 mg. capsule is not encouraging, I must admit :o. Is this a vet with whom you have a good history?

Marianne

[DoxieMama]

Welcome to you and Lily! Darrell and Marianne have gotten you off to a good start with the information and questions they've posted. And unfortunately, I also don't have a lot of time to respond right now but I wanted to let you know we are here and "listening". :)

Do you have copies of the lab results? If so, could you post the abnormalities that lead to the diagnosis?

Another alternative for dosing is to get a compounded dose of Trilostane which would be available at other dosage amounts. I have used 11, 8 and now 6.5mg doses of Trilostane, which allows for more fine-tuning as necessary.

Hugs to you...
Shana

[Harley PoMMom]

Hi and welcome to you and Lily from me as well!

As Shana mentioned, getting copies of those tests and posting the results here would be great. Also could you tell us more about sweet Lily as this allows us to provide you with better feedback. And the way we find this additional information is through a lot of questions so here are some from me ;)

Could you tell us what symptoms Lily was displaying that led you our your vet to test for Cushing's in the first place? Does Lily have any underlying illnesses? Is she taking herbs/supplements/medications? Was Lily diagnosed with pituitary or the adrenal form of Cushing's? Were any abnormalities found on the ultrasound and were the adrenal glands visualized?

Safe and effective treatment requires an experienced vet and an educated pet owner and it is when one or both is missing that dogs get into trouble. Having a vet that is willing to work with you as a team and that takes the time to explain things to you are also very important, so the fact that Lily's vet is missing both of these critical components is quite disturbing to me.

Vetoryl/Trilostane is a strong drug, and yes, it does have some pretty scary side effects, however, adverse effects are minimized when the proper treatment protocols are followed. We have many members that are treating their cushdog with Vetoryl/Trilostane and are experiencing success.

Please know we are here to help in any way we can and do not hesitate to ask all the questions you want. I am providing a link to our Resource forum which has a wealth of information regarding Cushing's and also includes articles written by some of the most renown veterinarians that specialize in endocrinology http://www.k9cushings.com/forum/forumdisplay.php?f=10 Feel free to print anything out.

Hugs, Lori

[judymaggie]

Hi! I wanted to join everyone else in welcoming you and Lily. I, too, am concerned about your vet's attitude. Treating Cushing's can be very confusing and really requires a team effort. With regard to obtaining copies of Lily's test results, my perspective is that you are the paying client and you are owed copies. You are not asking for a copy of her whole file, just the pages that have the test results. Some vets will scan and e-mail these pages.

Hang in there!

[lily]

i posted Lily's test results, after my first post. Unfortunately, I don't know how to take picture and post on here. I gave her the first 10 mg pill today. So far so good. The vet said if she did have side effects, they probably wouldn't occur for a few days. I intially took her in because she had diarrehea. He took blood test that showed high liver enzymes. I should mention, Lily is a rescue, we have had her two years, and the vet estimates her age 6-7. About her abdominal xrays, the dr said they didn't show any masses (what he was looking for) and cost $200. So then, he did an ultrasound, looking at her adrenal glands and liver, etc. Her liver is enlarged, but again, not too concerned. Then he did the stim (ACTH)test, results in my 2nd post. I am annoyed by his attitude, like I shouldn't be questioning him. He said the initial dose is 6 to 18 mgs, so he went with 10. Also, I asked why he didn't do the 4 hr test, he said the results were such, he didn't need to.

[lily]

Part 2, Lily has never seemed "sick" but she started acting starved and begging for food about 6 month ago. Plus, she started having the pot bellied appearance. She also gained 1 pound.

[DoxieMama]

Thanks for the additional info. Do you have results of the blood test showing the high liver enzymes? It can be helpful to know exactly how high they are... then you can compare from test to test and know if they are going up or down, for example. Also if there are other values that are out of range. My vet sometimes doesn't mention everything when we discuss things over the phone, so when I get a copy of the result I can see for myself that there are other values that are a little high. He is not concerned about those, so didn't mention them. But it helps me understand better to know the actual numbers.

Also, was there anything noted about the adrenal glands on the ultrasound report?

Keep a close eye on Lily for the side effects. You never know when they might crop up.

[molly muffin]

Hello and welcome to you and Lily.

To post pictures, you go to the top of this page, user CP. open that on the left hand side you will see where it says pictures and albums, open that and it will Add Album, which is what you want to do, so click that, add a title to your album and underneath it, make it public or none of us can see your pictures.
Now you have an album, open it and it will say add pictures. You can then browse and add I think up to three pictures at a time to the album. Let us know if you have any problems.

Okay, now that ACTH test certainly is indicating high cortisol.
You want to give her the medication if doing once a day in the morning with a full meal, as vetroyl is absorbed with food.
Since you are a bit over where the 1mg/1lb watch for any adverse symptoms such as vomiting, diarrhea, won't eat, lethargy (extreme) wobbly when standing. If you see any of those you want to stop vetroyl, call the vet and have an ACTH done. You should be scheduling an ACTH approximately 14 days after starting, then another one at 30 days. You don't normally raise the dosage after 14 days as cortisol will continue to come down for 30 days on the same dose, but you do want to know how she is reacting to the medication and the ACTH will tell you that.

As for your vets attittude, he is going to have to adjust. You are the owner and have every right to question anything and everything when it comes to your furbaby. So, make him aware of that up front that there will be discussions. If you are not comfortable with the vet, find another.

Welcome to the forum.

[lily]

update on Lily...I called the vet back and told them to order the 5 mg., I wasnt comfortable with 10mg. I have them now and start tomorrow. Say a prayer. I am hoping she stops begging for food, and needing to go to potty every 2 hours. Have any of you seen increased energy, playfulness come back? That's a hope of mine, too.

[DoxieMama]

I'm happy to read that you've gone with the lower starting dose. To answer your question, I noticed a decrease in drinking/peeing within the first couple weeks of treatment. That's usually the first symptoms that resolve. The others sometimes take a little longer. He has been a lot more willing to run outside this past month... and even barked at my other dog this weekend when he had a ball. We are in our 3rd month of treatment with Trilostane.

Do keep an eye on Lily for those side effects. Even starting at the lower dose, it is something for which to be watchful.

[lily]

thank you for that info. I have 2 questions...Can I give Lily Benedryl while on Vetroyl? I have stopped since starting Vetroyl. She is so itchy though. Also, someone posted the cost of the med through a company for $32.00. My vet charged $51.00. Can I buy them direct from that company?

[DoxieMama]

I am not sure about Benedryl. I think so, but maybe someone else knows and will respond. I'd probably ask my vet about that.

If your vet will send out the prescription then yes you may be able to get the Vetoryl cheaper elsewhere. Be sure to consider the cost of shipping in comparing prices.

[molly muffin]

Hi yes you can give you Benedryl with Vetroyl.
There is also another new allergy drug out for dogs that many are having good results with. It is called Apoquel.

[lulusmom]

Hi and a belated welcome to you and Lily,

Others have already given you some excellent information but I'd like to share my own thoughts and apologize if I repeat information you've already received.

I realize that your vet doesn't appreciate being questioned, which is not acceptable by the way, he did do adequate testing before confirming the diagnosis. I give him a lot of credit for that. Did your vet instruct you to give the Vetoryl with a full morning meal. Vetoryl is fat soluble and best absorbed with food. Did your vet also schedule an acth stimulation test no later than 14 days after starting treatment? If not, you will need to take the lead and make sure that protocol is followed. I've included a link to Dechra's Continuing Education (CE) page that provided a treatment monitoring flow chart that is fairly easy to follow. I recommend that you keep copies of all testing and use the flowchart to test yourself on the test results. If you don't understand something, let us know and we'll do our best to explain it.

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

With respect to the Benadryl, it should be fine to give it concurrently with Vetoryl. What doesn't make sense is the need for it prior to starting treatment for cushing's. Cortisol is the adrenal steroid that is over produced that causes the clinical signs of cushing's. It is our body's very superior natural anti inflammatory so dogs with uncontrolled cushing's usually don't experience the effects of allergies at all because they are self medicating. It is usually when cortisol is reduced with treatment that allergies are unmasked. If Lily's allergies are so severe that she is constantly biting and itching, you may want to consider talking to your vet about Apoquel. That manufacturer of that drug has done an abysmal job for the last few years in improving processes to eliminate the constant shortages. I'm therefore not sure about the availability these days but it's definitely worth discussing with your vet as it can be a Godsend for many dogs who suffer greatly. I see that Sharlene has already mentioned Apoquel while I was trying to get this post done in between interruptions. :o

You can purchase Vetoryl for less than most vets charge and I've provided links to Valley Vet, Vet RX Direct and California Pet Pharmacy below, all of which are reputable online pharmacies. All offer 5 mg Vetoryl for significantly less than your vet. Your vet should be happy to give you a script or call it in to whichever pharmacy you choose.

https://www.valleyvet.com/ct_detail.html?pgguid=057ae20c-efea-490b-b89e-562663425dfe&sfb=1&itemguid=7706e3d4-ebb4-4cc4-8478-af8be3d49b19&utm_content=1272RX&ccd=IFP003&mr:trackingCode=87661559-BD79-E511-80FA-005056942F93&mr:referralID=NA&mr:device=c&mr:adType=plaonline&mr:ad=42125930083&mr:keyword=&mr:match=&mr:tid=pla-169289022043&mr:ploc=9013678&mr:iloc=&mr:store=&mr:filter=169289022043&gclid=Cj0KEQjwv467BRCbkMvs5O3kioUBEiQAGDZHL82rqKho FX8LD4pfDgZpGeW4V5ACYRghCXIqp7NI0G4aAktu8P8HAQ

http://www.californiapetpharmacy.com/vetoryl-5mg.html?productid=vetoryl-5mg&channelid=FROOG&gclid=Cj0KEQjwv467BRCbkMvs5O3kioUBEiQAGDZHL1BFDDaF gWbwl0ZufjC3b08ApQJ6rdXp81K4NYQm-mkaAgt48P8HAQ

http://www.vetrxdirect.com/product/view/vetoryl-trilostane/variation-12190?

[lily]

Thank you to everyone for the info....I feel so much better about the diagnosis of Cushings. Lily girl had her 3rd dose today, and I swear she is more playful and energetic!!!! Sounds like I can continue to give her Benedryl. She licks and chew her paws constantly. The vet thinks it is itchiness from the grass, and also a compulsion. She does it more often when she is nervous or excited.

[lily]

part 2, yes, the vet told me to bring her back on June 30 for another ACTH test. Also, to give her the med in the morning with food.

[lily]

Hi, I'm Lily's mom. Last time I visited was October 2016. Lily is a 6 1/2 pound chihuahua. We rescued her 3 years ago. The rescue place said she was 2 or 3, but the vet said 4 or 5 was more accurate. So that means she is now 7-8. She was diagnosed with Cushings last summer. She has had many blood tests, and her numbers are always higher than normal. The vet started her on 5 mg of Vetoryl, now we are at 20 mgs per day, (10 mgs two times a day) which is approximately 3 times her weight!!! I just rec'd the result of the latest test and it is above 10, and I know above 9.l is high. She still exhibits symptoms - ravenous, and thirsty, and pees alot. Not too energetic. The vet is going to call me back on Monday after he contacts the drug manufacturer to see if it is safe to increase the medicine. What is everyone's take on this? Has anyone ever taken their dog off the medicine? It is so extremely expensive, and if it is not going to help her, why do it? I read where some people just let the dog live out their live with Cushings. I just don't want her to suffer. She seems to tolerate the medicine well. Thanks, Lily's Mom

[labblab]

Welcome back to you and Lily! You'll see I've merged your new post into your original thread about Lily. This way, we'll have all her history and treatment info consolidated in one spot.

One quick question for you before going further. Can you confirm for us the timing of Lily's monitoring ACTH tests -- how many hours after dosing? Also, you are still giving her the Vetoryl with food, correct?

Marianne

[Carole Alexander]

Hi,
I wish I could offer you some insight as to what's going on with your Lily. Assuming the testing protocol is being followed and you are giving the Vetoryl with food, Lily's numbers seemingly are accurate and certainly the symptoms are what the symptoms are - not good. I share your concern as my dog, Skippy is not responding with a reduction to a therapeutic level with the Vetoryl yet. He's been on increasing doses since December. I know there are dogs who don't respond well to the drug but I know nothing about who, why or when. There is another drug, Mitotane, that many on this forum have used successfully. I am not giving up and while I understand the costs are staggering, your Lily is relatively young and likely can be treated successfully.

[lily]

Hi, I don't know for sure when they actually tested her...supposedly 4 hours after the medication was given...I drop her off at the vet in the morning and tell them what time she took it. Yes, with food. No problem there. The vet is supposed call me tomorrow so I can ask him more questions. He was on vacation last week, so I talked to a different one.

[molly muffin]

Did the vet call you? What did he say?

[lily]

the saga continues...I took Lily to the vet Saturday, She had been hacking and her breathing now sounds "bubbly" The vet took chest xrays and said her lungs looked cloudy and her heart was larger than the set of xrays last year. So...now we are looking at enlarged heart issues. BTW her vetoryl is $70.00 for 30 pills, 10 mgs, and she takes 2 per day. $140.00 per month. The vet said if the Cardio dr says she has an enlarged heart, he will put her on Lasix (sp). My husband thinks if she does have an enlarged heart, we should just stop the Vetoryl, give her Lasix until the end. :( She is eating and pottying normal. Decreased energy, but not by much. I asked the vet if the cushings could be causing the enlarged heart. He said "possibly." I am beyond frustrated. Does anyone know if there is drug interaction with Lasix and Vetoryl? Any advice or encouragement is so appreciated!

[lily]

contd - are we just delaying the inevitable? One more interesting note... I mentioned to the vet that she seems so young for all these issues. His response, "well, she could possibly be 10-12 years old" WHAT????? How can they get this so wrong? If that's accurate, it makes more sense, which would have made her 7 - 9 when I got her, not 4 or 5. Geez.

[molly muffin]

Oh my goodness! 10 - 12, that is quite the jump in age. She must have been a very youthful 7 - 9 years then.

I don't know about interaction between lasix and vetroyl. Some of the others might though. (always ask your vet)

Also you can get a prescription from your vet for trilostane, rather than vetroyl and get it from a reputable online pharmacy, many of our members use Diamondback and the cost is much cheaper than the brand name vetroyl.
You should also be able to order lasix from the online pharmacy too.

[lily]

Hi, it has been since March that i posted, and my goal today is to offer encouragement to those with a Cushings dog. My Lily weighed 6 lbs, 4 oz in March. Her pot belly was huge, her hair was sparse and she was drinking and peeing all the time. She was taking 20 mgs of veteroyl in the morning and 10 in the evening. $210 per month. The vet said she couldn't take a higher dosage. AND he wanted her to see a heart dr. since her heart was enlarged. At that point, I got a 2nd opinion. We see a new vet. The first thing she said is Lily is too fat. Feed her half the food. And she was put the liquid medicine, generic vetoryl. $30 DOLLARS A MONTH!!!!! Lily lost one pound, drinking water as normal and much happier and healthier. The new vet said her heart probably looked enlarged because of her massive pot belly. My final word...do not give up. Get a second opinion. Ask for the liquid veteroyl. The cost difference is enormous. BTW, Lily thinks the liquid medicine tastes wonderful, and licks it right off a paper plate!

[labblab]

Hi and welcome back to you and Lily! That's great news that she's doing so well, and that you've found an affordable alternative for her trilostane! ;) :)

By any chance, have you had a repeat monitoring ACTH performed since making this switch and subsequent to Lily's weight loss? It is wonderful that she has shown so much improvement. But it's also possible that her trilostane dose may end up needing to be altered due to her weight change. So I think it would be good to check her cortisol level again.

Please do keep us updated, OK? We love reading such happy reports!
Marianne

[molly muffin]

Hi again. Such wonderful news and so encouraging Thank you for posting an update. As Marianne said continue to monitor. Your new vet sounds much better for you and lily