Vetoryl treatment

[Gandalf's Mom]

My eight-year-old, 150-pound American Bulldog has been a very healthy, active dog until this past year. Over the past year, he all of the sudden developed a bloated belly and started panting very heavily and drinking and eating excessively. He tested positive for hypothyroid and is on .12 mg of Thyrosyn twice a day. We have also tested him for diabetes and he has tested negatively for that. The vet kept telling me he was just getting old. I was not content with that diagnosis, so I researched his symptoms myself and made the vet test him for Cushing's disease and found out I was right. By this time, he had bleeding sores, which the vet attributed to hypothyroidism skin disorders, and would just collapse if he stood up too long, creating a pressure sore on his back side. He even fell twice because his legs were so weak. Finally, he just started pacing wobbily and mainly just drinking, sleeping, and peeing buckets full. We have a doggy door, which he was very good to use, but prior to us realizing he had Cushing's he had great difficulty getting in and out of it and just started peeing in the house. We have quarantined him to the kitchen/dining room area because there is not much carpet there. Where there is carpet, I keep it covered with pee pads, blankets, and sheets. And I wash, wash, wash and wash...

I have since started taking him to a new vet that loves animals more than money and he read the test results from the Cushing's test and prescribed Vetoryl 120mg, which he has been taking since last Friday.* He slowly started improving; standing longer without collapsing, standing with a stronger posture, showing that he realized he was supposed to go out the doggy door to use the bathroom, just not able to go through it, alerting me that he needed to go to the bathroom and waiting to get outside or close to the door, anyway, to get out to use the bathroom.* Yesterday, in fact, he was doing so much better, my husband even commented on how much better he was looking.* He has lost the bloated belly and is actually skinny now. After doing so well that one day, he is acting really weak again and panting heavily.* Do dogs with this illness, taking Vetoryl, take one step forward and two steps back before completely improving?* Could he possibly have overworked himself yesterday because he stood and walked so much after hardly walking at all?* I have read so many testimonials of this drug giving you your dog back, but how long does that take?* When do you know you've done all you can?* This is breaking my heart.

[labblab]

Welcome to you and Gandalf! I'm so glad you've found us and you were able to start a thread here. It does indeed sound as though Gandalf has many classic symptoms of Cushing's. It will be a big help to us, though, if you can round up copies of his actual numerical test results, especially the numbers for the diagnostic Cushing's test. For any other recent blood or urine tests, all we need to see are any abnormal values. You've already mentioned low thyroid, which is not uncommon with Cushing's dogs. Sometimes the hypothyroidism is secondary to the Cushing's and the thyroid treatment can be discontinued once the Cushing's itself is controlled. So time will tell with that.

When you say Gandalf is taking the biggest dose of Vetoryl, I assume you mean 120 mg.? Since he is such a big boy, this was not an unreasonable place to start. But it is very possible that he will need a dosing change, either upwards or down. It is very important that dogs taking Vetoryl be followed closely with monitoring ACTH blood tests in order to judge the drug's effect on cortisol levels. It is recommended that the first test be performed 10-14 days into treatment. Especially since Gandalf seems to be backsliding again, I think it's important for this monitoring to be done. Has your vet talked with you about this test?

The most worrisome issue would be if cortisol is dropping too low. If you should see signs such as vomiting, diarrhea, or extreme lethargy, this would be cause for immediate attention. You would want to stop giving the Vetoryl entirely and take Gandalf to the vet as quickly as possible.

I am hoping that perhaps he was having a temporary setback, and is feeling better again today. Dosage changes are very common, especially at the beginning of treatment. But once a dose has been stabilized, we would be expecting to Gandalf to have consistently good days from that point onward.

Please do let us know how things are going today, OK?
Marianne

[DoxieMama]

Welcome to you both! Will you clarify exactly when Gandalf started taking the Vetoryl? Has it only been one day, or a week? From what I've seen, the excessive drinking and peeing are the first symptoms to resolve, then others follow in the weeks and months to come. Dogs do have both good and bad days, we enjoy the good as much as possible and hope the bad days are few and far between.

I look forward to seeing those test results Marianne asked for, and getting to know your boy more.

Shana

[Gandalf's Mom]

Thank you, Marianne and Shana, for the warm welcome and quick responses.

I will have to get the copy of the Cushing's report from the vet as soon as I can to give you the numbers. He has not had a urine test or an ACTH test. I simply could not afford to keep paying for more tests, as I am out of work right now.

He started the Vetoryl 120 mg Friday, March 17th. This past Thursday, March 23rd, is when he was more active than he has been and was pacing and standing for long periods of time. Then the vet called and told me to split the dose in half and give half in the morning and half in the evening, which I did Thursday and Friday. He slept most of the time Friday and yesterday and when I gave him his pill yesterday, he took it in some food lying down and it ended up dissolving in his mouth and most of the powder ended up on the floor. He got some, but not much. Today, he didn't take it until around 3:00PM. We didn't get home today until a couple of hours ago and he was walking around, walked outside as we were coming in, and he even went out his doggy door and came back in it a few minutes later. The doggy door was the most exciting thing I've seen lately.

I have noticed he doesn't appear to be peeing or drinking quite as much as he has been doing, the past couple of days.

We live in Alabama and Auburn University is an excellent vet college where this new vet graduated from and he faxed the Cushing's test results to a vet professor at Auburn and that is how he came up with the prescription. I will get the numbers to you as well, though, because I truly believe the more eyes and knowledge the better.

Thank you SO much for your wisdom and input!!!!

Lisa

[molly muffin]

Hi and welcome from me too. Y you will have a better idea of how he is doing on the medication. Adjustments might be made down but not upward in dosage at the first test as cortisol will continue to lower for 30 days on the same dose.

So one option is the next time you order medication to do a 60mg/60mg pill and give one morning and one evening.

Also I wanted to mention that you can get the compounded trilostane vs name brand vetroyl and order it from a compounding pharmacy online. They just need the vets prescription called in to the pharmacy and the price is usually much cheper than brand name (since out of work i'm sure money is tight as it is for a lof members) One online pharmacy many use is Diamondback drugs and they have a good reputation.

Welcome!

[labblab]

Thanks so much for giving us this additional info, and I'm sorry I didn't get the chance to reply to you yesterday. I do want to talk about a couple of things. First, when you say you are now splitting Gandalf's dose, how are you physically doing that? Do you now have 60 mg. capsules of Vetoryl, or are you somehow opening and repacking the contents of the 120 mg. capsules? Dechra (maker of Vetoryl) specifically warns against people opening the capsules and trying to manipulate the powder themselves. This is partly due to risks to humans to be exposing themselves to the powder, and partly due to the challenge of making sure the drug is still being delivered in a consistent and effective manner. This is especially an issue when the powder is being emptied out of the capsule and directly dosed, like added to the food bowl, for instance. So if your vet wants you to switch to twice daily dosing, it would be better to wait until you are done with the 120 mg. capsules and can reorder capsules of the proper dosage. And as Sharlene says, compounded trilostane would be much less expensive.

However, having said all that, I am struck by the fact that Gandalf seems to be perkier after having missed a couple of doses. This leads me to again wonder whether he is being overdosed when taking a daily total of 120 mg., regardless of whether medication is given once or twice a day. There is some speculation among researchers that many larger dogs may require less medication, per pound, than do many smaller dogs. I can't give you an explanation for that, but even though Gandalf is a big boy at 150 pounds, the daily total of 120 mg. may be too much for him. Without the benefit of monitoring testing, it is impossible to know for certain where his cortisol level is at. But if you can see that, behaviorally, he is faring better on less than 120 mg. daily, I would definitely stop the medication until you can get a supply of the trilostane in a lower dose. Overdosing is a serious matter, even life-threatening. So if you cannot arrange for him to be tested in the very near future, you want to minimize the possibility of overdose to the greatest extent possible.

Marianne

[Gandalf's Mom]

https://www.facebook.com/photo.php?fbid=1031163676672&set=a.1031162996655.4533.1752804077&type=3&size=453%2C604

[Gandalf's Mom]

I just sent a link to a group of pictures of Gandalf when he was younger. He has always been my gentle giant.

Gandalf seems to be going through phases of acting like he's getting better and then reverting back to just sleeping and appearing absentminded. He will walk to the end of the hall and just sit in the corner for several minutes, or he will get himself in a tight place and seem discombobulated about how to get himself out or how he ever got there in the first place. Then without any warning, he will wake up one morning and his eyes will seem very clear and he seems to be more with it and a few days later, back to discombobulation land. I would describe what he appears to be doing is backing his way out of his symptoms, if that makes any sense - going back the way came from.

He's not drinking as much, and he's actually gone in and out of the doggie door a few times. He has, for the most part, always shown that he knows he is supposed to go out the doggie door, he just can't make it work, so he uses the bathroom just in front of it. He is also still peeing a lot in the house, but if I am close to him and notice him frantically pacing, I will open the door and he will walk outside and use the bathroom, so he is doing the best he can to alert me, sometimes, that he needs to go outside. He's even gotten himself into a little routine where he will walk out the front door to use the bathroom and walk around to the side door to go into the kitchen, where he is mainly quarantined to instead of going back through the opened front door. :) Right now, he is sleeping a lot during the day and pacing a lot a night, which is another thing he did before he was diagnosed with Cushing's.

He is not ravenously hungry like he was. I read that you shouldn't feed a Cushing's dog kibble, which we do feed grain free already, so I have shopped around to find Natural Balance Wild Pursuit canned food that has 11 grams of protein and I have a freezer full of ground deer meat that I have been cooking by the pound and mixing with the canned food and making meatballs out of so I can easily hand feed him.

As far the Trilostane goes, I have been breaking the capsules apart and halving them. I hold it over the meat recipe described above so that if any spills out, it will get in his food, and I put half in one meatball and leave the other half in the capsule to put the capsule in another meatball later. The vet told me that splitting it in half would also save me money and I couldn't figure that one out since he will still be getting one pill a day, so for a couple of days, I just gave him half one day and half the next day, but he appears to have gone downhill since I did that, so I have started back to giving half in the morning and half in the evening. My thought about that is that it keeps a consistent dose in him instead of one bolus dose each morning.

He has never seemed to like being in his kennel much, but now he stays in it quite a bit. I have a dark sheet covering it, so it seems cave-like, which I guess he likes. I also have a thick baby mattress in it to give him good cushioning. He developed a pressure sore on his rear end, to the left of his tail, and the vet sewed it up last week, but it looks like blood is starting to seep out of it. I will ask about getting an ACTH when I go to have his stitches removed in two weeks.
I know you aren't supposed to get stitches wet, but I had to bathe him yesterday because he is stained yellow from laying in his pee while he sleeps - TMI, I know, but my heart is absolutely breaking seeing such a majestic animal crumble like this.

Did we wait too long in finding this out and getting him started on medication? Is he so far gone he can't come back? Is this a rollercoaster ride where they are good one day and revert for several days before he gets better?

Thank you all for all of your advice. It is good to be in a group that is going through or has been through the same thing.

[Joan2517]

Are you still splitting the capsule? Or are you splitting the dose? The capsule should not be opened and sprinkled onto the food.

[Squirt's Mom]

Joan is correct - these capsules should never be opened nor divided. For one thing, the capsule itself ensures the drug reaches the correct place in the digestive system for it to work. By removing the capsule you are causing the drug to start breaking down in the mouth and by the time it actually reaches the place it SHOULD start breaking down it is mostly used up to no avail. For another reason, the filling of the capsule is not pure active ingredient, in this case Trilostane. The powder also contains fillers so by separating the powder you cannot be sure how much Trilostane is in each part, meaning one dose may contain most of the active ingredient while the other contains very little. Then there is the comment by the manufacturer itself to NEVER open the capsule. So while you vet is right that doing so will save you money they are wrong to advise that on every other level. ;)

[Carole Alexander]

Hi Lisa and welcome from me too. Certainly others have given you excellent information about treating Cushing's. I also want to recommend that you through your vet contact Dr. Ellyn Barron (spelling?), an endocrine specialist at Auburn to explore the possibility that dear Gandalf's pituitary tumor is growing and may be pressing on other parts of his brain causing what is termed a macro tumor. The symptoms that you describe, disorientation, getting into corners and can't get out, pacing, periods of not eating, extreme lethargy, confusion, and in my dog's case add trembling, stumbling, refusing to play, unwilling to walk, no tail wagging, starring, are all highly suspicious of a macro tumor. If it were me, I would stop the Vetoryl (that can make the tumor grow) now and secure a further consultation. An MRI or CT is the only absolute means of diagnosis but it could spare you months of expensive tests, trips, treatment, torment and tears. Unfortunately, many of the Cushing's symptoms are very similar to those of a macro tumor and so nuanced and erratic that five different vets did not think that my Skippy had one. A macro can be treated with radiation and a substantial chunk of cash. I am sorry that Gandalf is struggling and I certainly understand your frustration.

[Budsters Mom]

Not only is splitting Vetoryl capsules cautioned against by the manufacturer who produces it, it is extremely dangerous to you.:eek::eek: It is advised to avoid handling the capsules with your bare hands beacuse the medication can be absorbed through the skin. Wearing gloves is advised. It is very difficult to split capsules without touching the powder. :eek:

As for Gandalf....He isn't getting his required dosage for the reasons Leslie stated below. We all realize how expensive Vetoryl is and many of us have used the compounded Trilostane instead.

Kathy