14 y/o chihuahua - Vetoryl

[hoover_nyc_chihuahua]

Mitchell,

I just posted a similar question and I feel like you and I think alike. Why not try to cure this rather than just control symptoms? I do agree in your case that 8.5 years is too young to have to settle for symptom management without asking about what else is out there. My Chihuahua is 14 and I am out there looking for a cure anyway. If he were 8-9 I might consider the mris, the radiation therapy etc.

Hoover, 6.5-7 lbs is currently on 5mg of Vetroyl 2x a day. I started him on 5mg 1x a day even though the vet suggested 10mg 1x a day because aside from the peeing and thirst he seemed to be healthy and I was feeling conservative. After reading the recent studies that twice a day was more effective, that the drug has a short half life, and that my dose is a little under the 1mg per pound standard anyway, I decided to listen to the internist I consulted who reitterated the studies of the effectiveness of twice a day dosing.

That's where I'm at right now. Thanks for sharing your correspondences with the specialists.

[labblab]

Hello, and welcome to you and your boy! I noticed you had posted this reply to another member, and have taken the liberty of placing a copy here so as to begin a thread that is your very own. This way, it will be easier for our members to talk with you directly about questions that are not necessarily related to retinoic acid.

Specifically, I am feeling a bit concerned about your statement that you have doubled your dog's daily total of Vetoryl. I am hoping to obtain some additional background re: your dog's diagnosis and treatment. I am especially wondering how long he had been taking the 5 mg. once daily, and whether you've had monitoring ACTH testing performed prior to the dosing increase.

The thing is, that formula of 1 mg. per pound is simply a "stab" at picking a reasonable starting place. Every dog metabolizes the drug a bit differently, and the need for subsequent dosing changes both upwards and downwards are typical. So if your dog has been taking the 5 mg. for a period of time now, a monitoring ACTH would have been very useful in terms of determining whether an increase in the daily total was needed at all. For instance, if you wanted to shift to twice daily dosing, perhaps going to 2.5 mg. twice daily might have been the better move depending on the manner in which his cortisol level has been affected thus far.

You may already have covered all these bases with your internist, but worry-wart that I am, I'm just wanting to make sure. So as I say, I'm hoping you'll be willing to share more info about your boy's Cushing's journey.

And once again, welcome!
Marianne

[hoover_nyc_chihuahua]

Hi Marianne,

Actually the regular vet wanted to start him on 10mg once a day. He was 7 pounds. I started with half of that 5mg once a day just for the first 2 weeks to see if he had any reaction to the drug. Then I consulted with an internist I liked, Dr. Nicole Shaw at VERG in Brooklyn who sees a lot of Cushings dogs and she moved him up to 5mg twice a day. Yes, he had the acht test I don't have results in front of me. He had it 2 times so far, first after ten weeks on 5mg 1x a day then after a month on 5mg twice a day. It was 26 the second time. I'm supposed to go back in 3 months which would be Feb, but I'm going to go in Jan.

In order to confirm he had Cushings, I did the LDDS and the ultrasound as well. His symptoms are pretty classic by the book pituitary old dog.

His symptoms of constant peeing seem to be improving. We have been exercising more frequently, no panting. He is in a better mood, he had gotten so grumpy. He still is a huge eater and hungry all the time but that's a hard one because he has always been that way. He has been on a raw food diet his whole life but we always gave him table treats, that had to be curbed.

Also he turned 14 in October. No one can believe he is that old, he looks and acts that good. I did not have him the last 6 years, I just got him back when my ex husband remarried and he bit his toddler. Fortunately we are all friends and I was thrilled to him back. His elevated liver enzyme had showed up first in Jan of this year but with a new baby they didn't give it notice and assumed his behavior and peeing was normal aging. I knew something was off by spring and kept nagging them to take him back to the vet. Finally I just took Hoover in to a vet by myself for more extensive testing when they went on summer vacation. I went through 2 vets but got the diagnosis.

I am thankful for this forum and all the advice. One vet wanted to test the Vetroyl level-on an empty stomach-totally wrong, I insisted he eat get dosed and test 4 hours later. I was shocked that so much bad advice was circulating in NYC. I feel I am on the right track a lot sooner because of all the help that is here.

Thank you so much.

[hoover_nyc_chihuahua]

Marianne,

One more thing, the vets and the internist I've worked with are reluctant to divide doses, they are concerned with the inaccuracy of "compounding" drugs like Vetoryl. Granted, if I were going to split capsules, I wouldn't be winging it and doing it in my kitchen, I'd go to a reputable pharmacy that does this professionally.

That is another reason why I'm at the 5mg twice a day and not 2.5 at this point. They don't recommend splitting doses.

Yvonne

[hoover_nyc_chihuahua]

Hello everyone,

For those with a dog on Vetoryl, I just read this about the acth stim test- https://www.dechra.co.uk/therapy-areas/companion-animal/endocrinology/canine-hyperadrenocorticism/vetoryl-monitoring-1?utm_source=directmailing&utm_medium=link&utm_campaign=PreVetorylCortisolSuperPage

To update, Hoover is 7.5 lbs, almost 15 and his Vetoryl dose is 5 mg 3x a day for the past year. This is very inconvenient for me but what can I do?

I'm concerned that in the last few months my vet has added Enacard an ACE inhibitor and that is supposed to not be a good mix with Vetoryl. She is concerned with the protein level in his urine, so it is for his kidneys not necessarily his heart which its normally used for.

Anyone in the NYC area happy with their Specialist? I can't seem to find anyone who really focuses on Cushings that sees patients on a regular basis.

Thanks for any input on any of these subjects.

[Squirt's Mom]

Good to hear from you again!

How is Hoover doing?

Thanks for the link! The new pre-Vetoryl testing is something we have been following closely, hoping vets in the US will soon pick this up! Here is the info we have put together for members - http://www.k9cushings.com/forum/showthread.php?8925-GENERAL-GUIDELINES-for-Dosing-and-Monitoring-Treatment-with-Vetoryl-(trilostane)

The ACE would bother me as well. I would be asking they try to find something from another class of drugs to try. Keep a close eye on him for any slight sign something is off. This is what the literature from Dechra says:


Angiotensin converting enzyme (ACE) inhibitors should be used with caution with Vetoryl Capsules, as both drugs have aldosterone-lowering effects which may be additive, impairing the patient's ability to maintain normal electrolytes, blood volume and renal perfusion.

I'm sure others will be along soon to chat with you as well!
Hugs,
Leslie

[molly muffin]

Hello and welcome back. You could do 10mg and 5 mg perhaps to get back to a twice a day dosing. It is more optimally of course to get the same dose twice a day though.

It's tough when kidney problems enter the mix with cushings. My dog was on benazepril (an ACE Inhibitor) for her protein in urine and kidney issues also. She eventually did get worse kidney issues. It would be worth it to see if there Is anything in a different class of drug to try for the protein. New options come up so maybe there is something else since the days when we were using it.