8 yr old jack russel diagnosed w cushings

[mvalerio2018]

my dog bella, underwent several exams at vet and she was diagnosed w determined that cushings decease in june. Now she's gotta be on vetoryl for her entire life. Ever since the diagnosis, i have been getting myself educated w this diagnosis.

I really was not aware of it's severity. I hear there's some holistic s treatment available to. She taking good so far to vetoryl 60 mg. No side affects. Does anyone out-here have any advise ?

[labblab]

Hello and welcome to you and Bella! You’ll see that I’ve moved your thread to our main discussion forum — this way our members will be more likely to see it and respond to it.

To help get us started, can you tell us a bit more about Bella’s overall health history, including the symptoms and testing that led to the Cushing’s diagnosis? Also, can you tell us how much she weighs and also whether she has had any monitoring blood testing since starting the Vetoryl?

I apologize for asking questions instead of giving answers, but your own answers will help guide our thoughts and suggestions. Unfortunately, I’m not aware of any naturopathic treatment that has a proven ability to lower the elevated cortisol levels associated with Cushing’s. However, once we learn more about Bella’s situation, perhaps there may be some supplemental options that we can suggest. So do tell us more, and we’ll go from there.

Once again, welcome!
Marianne

[mvalerio2018]

Hi marianne
thanks for the push. I'm new to this forum so i'm kinda lost. I copied the dr's notes. We did eveything she suggested and that's we came up w bella's dianosis. Please read.

Dr. Stated that , she conserned with some the results from diagnostics. Her (albumin) was high that can be (inflamation and liver values. Her (cholesterol & tryglyceride) high -(kidney values)
her( platelet count ) high could be (inflammation somewhere)
dr. Stated that she suspects ( kidney dicease 66% nonfuctional 10.40
( might need to be on meds. Her entire life )
take sample of urine to (rule out cushings decease )
also possible urine bladder infection ?

In her profesional opinion these test below are needed:
Routine blood work & results:
Per blood results dr. Stated possible inflamation and future liver problems
cholesterol & tryglyceride high. Afect kidneys
platelet count high could be inflammation somewhere. Also suspects kidney dicease 66% nonfuctional 10.40
needs urine test to rule out cushings decease/possible urine bladder infection
extractions, canine dental, blood collection,pressure check,lddt,47071 rc low fat dog ,thyroid ft4
camicrolab urine,pharmacy estimate, radiolraphh consult, xray

[mvalerio2018]

HI,
AFTER DIANOSIS WE BROUGH BELLA BACK AND THEY CONCLUDED W THESE TEST.
Vetoryl 60mg Box Hazard Waste Fee* 1.00 Blood Collection Fee Examination Courtesy First Pet Cortisol Resting Level

[labblab]

Thanks so much for this information! After looking it over, I do have a few additional thoughts and questions. It’s true that Bella exhibits several lab abnormalities that are common in Cushing’s dogs. I’m also wondering about any outward symptoms such as excessive hunger/thirst/urination, pot belly, hair loss, muscle wasting, panting, heat intolerance. Does Bella “look” like a Cushing’s dog on the outside as well as the inside? External symptoms can be a very important important part of the diagnosis, as well as an important way to judge treatment progress. So it’ll help us to know what symptoms you are actually seeing.

It looks as though Bella had a LDDS blood test to confirm the Cushing’s, and has since had a test of her resting cortisol after beginning the Vetoryl. Can you tell us what time of day, generally, that the resting cortisol was taken? Was it during the day after she’d taken the Vetoryl, or was it early in the morning right before she had taken the Vetoryl? It always helps us to see the actual numbers for any abnormal lab values, but we’d especially like to see the numbers for the LDDS test and the resting cortisol. The LDDS will be in the form of three cortisol levels — the second two will be listed as 4 and then 8 hours after the first. The resting cortisol will just be a single number.

One thing that does concern me is the size of Bella’s Vetoryl dose. Can you tell us how much she weighs? Current initial dosing recommendations are not to exceed 1 mg. per pound. So I am guessing that 60 mg. is quite a large dose for a dog of her size. It’s good that you are not seeing any ill effects from the medication at this point, but the size of the dose does concern me.

OK, thanks again for this info, and I’ll be watching again for your next reply.

Marianne

[mvalerio2018]

Hi there.
Bellas's towards the end of 2017 statrted drinking water in excess. Also satrted to notice her peeing habits.
She began to beg to food. From then on i had a feeling something was off. We take ever yr blood work . Shewent this year abd her vet doctor statrted to notice something different. We took her to a different doctor for a second opinion and thats's when we found out what the out come was. We left bella w the vet since 9 am and picked up @ 7pm the same day. So she was there almost 12 hrs. The vet needed to rule out everything. Originally the vet had stated that subspected thyroid desease and bladder infection. Bellas test was in the morning around 9am then picked up @ 4pm. After taking vetoryl for 2 weeks.
As ar as bella looking on the outside as a cushings dog. Ever since she was puppy she had unsual hair loss in her tail . Like i said ever since she was a baby of 4 months, she's being taking yearly blood exams and the doctors would ask about the loss of hair in her tail. The would give us a topical spray and her haid in tail would grow a bit . I did start to notice her excessice water consumption late last year. As was her painting that olso. And little tolerance for heat. We usally have the portable ac, but when it gets in the 90's it takes a while to cool the room. But we have fans. And spray freshen her up w pouring a bit of water on her. As far as the ldds the section got cut off for some reason, but i due remember the doctor stating that she was tolerating her 60 mg well. Next exam is on in nov. To determine if maybe bellas is tololerating her meds and to check for any other activity. They stated that if everything was fine. The doctor may lower the dosage of med to 30 mg. As ypu may know the meds through the vet are spensive. $130 per box. I was fortumate to obtain some grants for several foundations to coveral her exams and 4 boxex of her meds. I found the for a good price w allivet.com. Like $60 per box of 60 mg w prescription. I have not had to purchase because she still has her meds until sep. But i registererd undr site. So like 2 boxes of 30 each if a totla of $125. Better than 1 box for $130.
Next step is care credit. I was lucky this year w grants, but its a lot work. We changed her diet and theirs been a significan change in her water consumption amd urination. She has only threw up just once but after a month of taking meds. Just a day then next day was fine. She's done that before her dianosis. Been looking into hollistics therapy and i'm gonna maybe suggest this vest that makes there anxiety and depression from taking meds better to vet. Along with drops.
I wish i would be able to upload bella's zipper folder w all info and dr's notes to uplaoded, but i don't think this forum has that obtion.
Thanks for you feedback

[mvalerio2018]

Hi there!
Bella does have excessive from time to time. As soon she started her med. She began to stop drinking less water. Her urine has improved. But last night on the 4th due to all the fireworks. She was throwing up a bit. Also today after she ate she vomited. She;s still playful and will play. When she get's this , i don't give her the vetoryl. I just think i might make it worse.

I asked the doctor the same thing as far as the dosage, she stated that the reason she prescribed her 60mg was due to test results.
I see this monday to pick up more meds. I'll ask her again. Bellas weighs 25 pounds. She's on diet food now. I only give her 3 treats.
Chicken jerky( made in america only ) her favs. Bacon and dentistix. She does not like hard food, since she was puppy she's being frigidity w her food. My other dog i had i would feed her only blue products, but bella does not like the wet food from blue either.
It's a struggle. So i tried natures best and she loves them. Before it beneful . I tried the most expensive brands but she would not eat them. The doctor did state that her upcoming exam in nov. Would determine if she will lower the dosage.

It's tough. I don't know what to think because the first month of taking meds she did not vomit at all. I guess she has her moments.

[Squirt's Mom]

I asked the doctor the same thing as far as the dosage, she stated that the reason she prescribed her 60mg was due to test results.

I am going to speak bluntly - her vet is absolutely wrong if they are basing starting dosage on test results. The starting dose is based ONLY on weight. Nothing else. This type thinking, which has NO scientific support, is what kills our cush babies - vets who think they know but in truth have no idea what they are doing. Vetoryl/Trilostane is a powerful drug that has a very, very specific protocol to follow. To vary from that protocol is to put the life of the dog at risk. So I am very concerned that Bella is vomiting with a dose that is twice what it should be and concerned about a vet who is NOT concerned and justifies the dose based on invalid data.

How many ACTHs has she had since starting the Vetory? What were the results of each of those tests (not the invoice telling what test was done and the cost but the actual numbers from the test itself)? If you don't have those results ask her vet for them. In the US they have to give them to you - you paid for them after all. ;) And now is the perfect time to start a habit of getting all test results to keep at home in a file for her. Again, not the invoices with pricing but the actual test results. That way you have everything in hand in case Bella ever has to see a new doc like on vacation or something. Plus that will help you answer all our questions! :D

I'm glad you found us and look forward to learning more about your precious baby girl as time passes.
Hugs,
Leslie

[mvalerio2018]

Hi there.
I really appreciate your input. I thought the same thing as far as the dosage of 60 mg at first, but she stated that test that bella underwent determined that she would be able to take that dosage. I having second thoughts. It was all good for the first month but afterwards, i started noticing changes in her. Including vomiting more often. And no appetite. I'm picking up her med on monday, so i
will ask the vet for the results you suggested. I gave her med yesterday and today, bella is eating at a slow pace. Something is off.

I appreciate your advice.

[labblab]

Hello again. I’m so sorry I only have a moment to post right now, but given what you’ve just written, I absolutely would not buy more 60 mg. capsules on Monday. I am really worried that is too high a dose for her, and before spending your precious money on a dose you cannot safely use, there are several questions to be answered. I’ll come back tomorrow and write more. But right now I am worried about Bella, and I think you should stop the medication altogether if she worsens more. It is safer for her to temporarily take no drug at all rather than to be overdosed.

I’ll write more tomorrow, OK?
Marianne

[mvalerio2018]

Hi marianne,
i agree w you 100% and thanks for looking out for bella. I should have gone w my gut feeling from the start, because i was also concerned w the high dosage. But the doctor stated that due to result from her 12 hr exam day, bella would be able to handle the dosage. She did the first month w no problem but now she's up and down and today she hardly ate anything. But she's still playful & will bark at dogs on tv. Like always!
I look to your reply tomorrow. Have a goodnight

[Squirt's Mom]

Again....I am going to be blunt...for the sake of Bella's life.

I am BEGGING you....PLEASE do not give Bella any more Vetoryl! Please please please please!!! I am very concerned her life is at risk as I am writing this. Please no more Vetoryl. In fact, if I were you, I would be getting her to an ER asap to have an ACTH run immediately and to have her electrolytes checked. The most you can do to help her is to stop the Vetoryl. BUT understand - she has been on a dose that is too high for her and just stopping now may not be enough to save her adrenal glands. She may need steroid replacement and medication to help re-balance her electrolytes. If she continues to get this dose it may well kill her.

I want to repeat - HER VET IS WRONG ABOUT HOW TO ARRIVE AT THE STARTING DOSE. IT HAS ABSOLUTELY NOTHING TO DO WITH TEST RESULTS. DOSE IS BASED **ONLY** ON WEIGHT. To start treating dogs using this very powerful drug based on anything other than weight makes this vet dangerous for our cush babies.

By telling you to continue giving this drug at this dose to an obviously sick dog is another reason this vet is very dangerous and I would be running out the door as fast as my feet could carry me before they killed my dog.

Please. I know you love Bella with all your heart. I know what she means to you and your hubby. Trust me on this - it is better to let a dog with Cushing's go completely untreated than to misuse the drugs used to treat the disease. And her vet IS misusing Vetoryl and by doing so is putting your precious angel at risk. Please stop giving this drug and if she continues to be sick get her to an ER asap. It is because I also care about Bella that I tell you these things. Please let us help you and Bella.

Hugs,
Leslie

[labblab]

Hi again, and I’m afraid I still have only a moment to write but I will return later today. If the only adverse effect that you’re seeing today is a lack of appetite, then I’m not as worried as Leslie that there is an urgent crisis that requires emergency attention today. However, if Bella starts acting lethargic, vomits, has diarrhea or any other more serious symptoms, then it’s a different story.

I absolutely would not give her any more Vetoryl, though, until you’ve been to the vet tomorrow and any necessary monitoring testing has been completed. Again, I’ll write more later on.

Marianne

[labblab]

OK, I’m finally back again! In advance of your appointment tomorrow, I urge you to read through this post on our Resources forum. It will explain the initial dosing protocol that is now recommended by the majority of clinicians worldwide, as well as the makers of Vetoryl. As you will see, initial doses are based solely on weight, and not on cortisol level. Subsequent dosing changes are indeed based on monitoring cortisol results, as well as observable symptom resolution. However, it’s not yet clear to me that Bella has had any specific monitoring blood testing since beginning the Vetoryl. This testing would involve one of two tests: either an ACTH stimulation test, which involves two cortisol blood samples drawn one-hour apart, 4-6 hours after a dog has taken her Vetoryl dose with breakfast. The other option is a single resting cortisol blood test drawn one hour before being dosed with Vetoryl at breakfast. The all-day LDDS that is referenced on your paperwork is solely a diagnostic test for Cushing’s. It cannot be used for monitoring purposes after treatment has begun.

Additionally, you want to monitor a dog’s basic blood chemistries after beginning Vetoryl. Potassium and sodium levels are especially important in this regard, because dogs can become very ill if the levels of these blood chemistries become unbalanced due to an overdose of the medication.

Given Bella’s loss of appetite and even only occasional nausea, it is doubly important to make sure that her current dose of Vetoryl is not oversuppressing her adrenal function. So before resuming treatment, I’d insist that the appropriate monitoring tests first be performed. In closing, here’s a link to that post about initial dosing guidelines. You may even want to print it out and take it to discuss with your vet tomorrow.

http://www.k9cushings.com/forum/showthread.php?185-Trilostane-Vetoryl-Information-and-Resources&p=1251#post1251

Also, here’s another important resource thread that explains the necessary monitoring testing in greater detail:

http://www.k9cushings.com/forum/showthread.php?8925-GENERAL-GUIDELINES-for-Dosing-and-Monitoring-Treatment-with-Vetoryl-(trilostane)

Marianne