New member - Staffie starting Vetoryl

[Sue G]

Hello everyone. Our foster boy is newly diagnosed with Cushings. He is a staffie x Was putting weight on, then began drinking and weeing a lot. His tail has always been more or less bald and he now has the typical pot belly I understand comes with Cushings we are in the UK. He is on 60mg of Vetoryl daily. Previously in the last few months he has had teeth removed as they were fractured and the vet thought they were causing a problem with swelling on his face. Now it seems he had a foreign object in there at some point and that Cushings can make healing slow. Everytime he came off antibiotics the swelling returned after a few weeks. X rays done now show no problem with teeth, bloods taken twice and urine checked before the Cushings diagnosis. Watching him carefully as he is on his second day of treatment. How soon would I see a problem if there was one, so far he is well no upset tum etc. Thanks for any help. Sue

[labblab]

Hello Sue, and welcome to you and your boy! You’ll see that I’ve moved your post so as to create a new thread that’s your very own :-). I will come back by later on today or tomorrow to address your questions, but I didn’t want to waste any time in at least greeting you both — we’re really glad you’ve found us!

So until later, welcome once again.
Marianne

[labblab]

OK, it took me a while to get back again, but finally here I am! I first want to repeat my welcome and I also want to thank you for fostering your boy, especially in the midst of these medical issues that have arisen. We’ll surely be hoping that the Vetoryl treatment will help ease his Cushing’s symptoms and improve the quality of life for you all.

From what you’re describing, he does indeed have outward symptoms that are consistent with Cushing’s. Especially when dogs are first diagnosed, we also like to see the actual numbers from the test results that point to Cushing’s. We’ve learned from other members in the U.K. that vets there often don’t routinely provide test results to owners, so you may not have them on hand. If you feel comfortable requesting them, however, it definitely helps guide us in our feedback and suggestions.

Assuming that the diagnosis is accurate, though, let me point you to a thread on our “Resources” forum that may help answer a number of your treatment and monitoring questions.

https://www.k9cushings.com/forum/showthread.php?8925-GENERAL-GUIDELINES-for-Vetoryl-(trilostane)-Dosing-amp-Monitoring-with-ACTH-Stimulation

Once you’ve had a chance to look that over, you can definitely return for further questioning or elaboration. In terms of ill effects from the Vetoryl, they can appear within the very first few days if the dose is too high and the dog’s cortisol is driven down too far too quickly. One word of caution I will offer you is that recent research has indicated that larger dogs may do better on smaller doses of Vetoryl than was previously thought. Historically, the general initial dosing formula has been 1 mg./lb. (2.2 mg./kg.). However, many experienced clinicians now recommend lowering the initial dose for larger dogs. This is discussed in greater detail in the link I gave you earlier. Depending on your boy’s weight, 60 mg. may be a larger dose for him. If so, you’ll especially want to watch him carefully for symptoms of overdose such as vomiting, diarrhea, loss of appetite, or excessive lethargy. Hopefully, though, he’ll have no problems at all.

I’ll go ahead and close for now. As I say, do look that thread over and also let us know how things are going for you.

Marianne

[Sue G]

Hi Marianne. Thank you so much for the welcome and the advice you have given me so far. I downloaded all the links last night and read through them. We will be seeing the vet next week for a general check up of the surgery they did on his face last week and I will see if they will give me the numbers for the Cushings tests and talk to them about the dose they have started him on. So far there is no sign of any problems since Hendrix started on the medication. He is already drinking less which is good, I wasnt expecting that to change so quickly but so far all is ok. I will look in every day to see what information I can gather as I learn how to look after this boy. Thanks again Sue

[Joan2517]

Hi and welcome to the forum. As Marianne mentioned, larger dogs sometimes need lower doses. My Gable was one of them. My avatar is my teacup Poodle, Lena, not Gabe (she was only 5lbs). Gable started at 40mg when he was at about 80lbs and we had to lower it a few times over the years. He ended up on 5mgs for a few years. Since Hendrix is already showing improvement, I would be on alert to any changes since the cortisol continues to drop for 30 days, which is why a cortisol check at 14 days would show if it has dropped too low. That might be the time to lower the dose, but not raise it until you see what the 30 day testing shows. Sometimes it takes some tweaking to get the right dosage and high cortisol is better than having it drop too low.

[Sue G]

Hi Joan, thanks for your advice regarding dosage. As this is my first cushings dog I am learning fast and any advice I can get from people who have been through this or are still going through it really helps. I am seeing the vet next week and will ask him about the dose he is on. For him to start on what appears to be a high dose is a bit much I think. His first review testing after 14 days will be the week after next. Hendrix weighs 31 kg at the moment and they have started him on 60mg a day. Some one else who has had a cushings dog suggested that it might be better to have started him on a smaller dose to prevent him being overdosed. She also suggested that whatever dose they finally settle him down on that it might be better for that to be split into two during the day? The dose does seem a little high to me though from all that I am reading on Cushings. Hendrix was 27 kgs when he came to us nearly 2 years ago. I believe the weight gain is down to Cushings influcence. As we go forward with the monitoring etc is he likely to lose some of the weight. The vet was also saying that his thyroid levels were indicating an underactive thyroid but that might be due in part to the influence of Cushings and that could resolve itself once his corisol levels are stable. So much to learn and quality of life is the most important thing to me and this beautiful boy. Thanks again for your help Sue

[Squirt's Mom]

Hi Sue,

How is Hendrix doing today? It's been a few days since he started that high dose and I am hoping he is doing well. Just to be sure....are you seeing any signs that the cortisol might be too low - loose stools/diarrhea, nausea/vomiting, loss of appetite, or lethargy? I hope you are seeing him start to feel better and everything is going great but I'm a worry wort so I get nosy at times. ;)

Hope to hear from you soon,
Hugs,
Leslie

[Sue G]

Hi Leslie.

Thank you for worrying about Hendrix. So far all is going well with the meds. He is definitely peeing a little less and not drinking as much. No loss of appetite in fact he is just as ravenous as he was last week. He had a surgery on his face so was a little lazy after that. However he is back to his normal self again now, albeit a bit slower than he was last year. Part due to ageing but I think also the Cushings. He has his first blood check next week to see what is happening with the Cortisol levels. Keeping a very close eye on him as he is such a gentle soul and deserves the best
Take care Hugs from me and H

[Squirt's Mom]

That sounds really good, Sue! Glad to hear you are starting to see some positive changes. These changes will occur at differing times so don't lose patience. Annnnd if you and Hendrix is anything like me and my babies....he has you well trained when it comes to food. :D Something about those begging eyes...... :o:D And cush pups seem to learn how to train us in this field exceptionally well! Time comes when we KNOW their cortisol is in good range yet they STILL beg. LOL

A word of caution....the dose should never be increased until at least 30 days have passed since starting treatment. The cortisol typically continues to fall during those first 30 days on the same dose. Sometimes when the first monitoring test, ACTH or PVC test, is run and the results aren't as low as desired the vet will want to increase at that 2 week mark....and most of the time the results are not good. So don't let them talk you into increasing the dose just yet. In another 2 weeks if the cortisol is still too high THEN a small, 25% max, increase in is order.

Give that sweet boy a belly rub from me!
Hugs,
Leslie

[Sue G]

Hi Leslie

We have the results of Hendrix's bloods from last week. They are high at 176. The vet would like them sitting nearer to 138 as a baseline. He has had no reaction to the meds so far apart from drinking a little less. I know you advised against letting them increase the dose just yet but the rescue have the call on this. The vet has today increased the dose so he is now on 70mg a day. 1 tablet of 60 and 1 of 10 given at the same time bloods will be redone 2 weeks today. The vet is concerned that they feel that Hendrix has an underactive thyroid at the same time so they are going to run tests for that probably at the appt in 2 weeks. My poor boy's fur is thinning round his neck as well as his sides and tail. He is still his same sweet self that he always is just a little quieter in the last few months. I know its going to be a long journey with him but hopefully with a lot of TLC and help we will come out the other side more lively and feeling better than he seems to feel at the moment.

Best wishes and hugs
Sue

[Squirt's Mom]

Hi Sue,

Please watch him extra close for any sign the cortisol is dropping too low. This increase is not in compliance with the very specific protocol for this drug and puts the dog at higher risk (info found in the drug insert we always hope the vets will read). If you see any of those signs listed above or any changes for the negative, please have another ACTH done asap if at all possible. I understand you don't have much, if any, say in his care but try to convince them of the seriousness of the situation should it occur. Most of the time simply stopping the drug for a few days until signs of high cortisol come back are enough but not always. IF Hendrix should respond negatively to this increase, make sure they do not put him back on the increased dose when he restarts. He needs to be on a lower, not higher, dose if he does react badly. I hope that doesn't happen and he continues to show improvements!

Hugs,
Leslie

[Joan2517]

I would be watching him very, very closely, Sue. As closely as I watched Gable, he still crashed that one time and if I had not been paying attention to any little sign, it could've been an ER crisis instead of just a run to the vet. As I said before, a high cortisol is better than an Addison crisis.

[labblab]

Hi Leslie

We have the results of Hendrix's bloods from last week. They are high at 176. The vet would like them sitting nearer to 138 as a baseline. He has had no reaction to the meds so far apart from drinking a little less. I know you advised against letting them increase the dose just yet but the rescue have the call on this. The vet has today increased the dose so he is now on 70mg a day. 1 tablet of 60 and 1 of 10 given at the same time bloods will be redone 2 weeks today. The vet is concerned that they feel that Hendrix has an underactive thyroid at the same time so they are going to run tests for that probably at the appt in 2 weeks. My poor boy's fur is thinning round his neck as well as his sides and tail. He is still his same sweet self that he always is just a little quieter in the last few months. I know its going to be a long journey with him but hopefully with a lot of TLC and help we will come out the other side more lively and feeling better than he seems to feel at the moment.

Best wishes and hugs
Sue
Hi again from me, too, Sue. Like the others, I’m wishing the vet had held off on the dosing increase, but it’s only a small increase and I’m relieved to know that Hendrix will be rechecked again in two weeks.

To give some context for our U.S. readers, I’m going to convert Hendrix’s result into the test units with which we’re most familiar here. His level of 176 nmol/l converts to approx. 6.4 ug/dL. For best therapeutic control, the preference is for a Vetoryl pre-pill cortisol level to be around 5.0 ug/dL. So that’s why the vet is slightly increasing his dose. I’ll give you a link to the recommended pre-pill monitoring protocol below. As you’ll see, it does recommend waiting until the 30-day mark to make an increase. But we’ll hope that this mild increase now will be a benefit and that his next test will show the level of improvement that’s optimal. Here’s that link:

https://drive.google.com/file/d/1gqUchP2gvFIyG8udZgNS1bWfppWW6fin/view?fbclid=IwAR2DelBbsQeFErzcG9ZODzfWJnFdlbMmZz49 p8wpQPcumL9Y6RtbrcaKAE8

As far as his thyroid function, additional testing may indeed be helpful. Cushing’s is a disease that can suppress thyroid levels as a secondary result. If Cushing’s is the primary cause, then thyroid levels may normalize on their own once the elevated cortisol comes under control. However, some dogs may suffer from hypothyroidism as a primary problem all on its own. In that case, thyroid supplementation can be called for. Simple T4 levels alone (the single reading found on most general lab panels), can’t distinguish between these two different circumstances. But more complete thyroid testing can offer better insight as to whether or not supplementation will be helpful to a Cushpup. So I’m hoping this is the kind of thyroid panel that your vet has in mind for the next visit.

No matter what, please do keep us in the loop as to how Hendrix is doing!
Marianne

[Joan2517]

As Marianne said above, some dogs have both hypothyroidism and Cushing's. Gable had both. We started with the thyroid meds to see if that was what was causing his symptoms, but they continued. When he was finally diagnosed with Cushing's and started meds for that, he was still showing low thyroid levels, so he was on Vetoryl and Soloxine for at least six years before his death this past November. That also took some tweaking to get the right level for both meds.

Lena might have had both because her symptoms never really got much better, we never checked. We were still tweaking the Vetoryl doses, so low thyroid was never brought up, but she died only a couple of months after diagnosis and treatment. Gable most probably had Cushing's then, but his blood work didn't show it until after Lena had died.

[Sue G]

Morning ladies. Firstly my apologies for not replying to your messages. I didn't realise there was a second page opened up on my thread.
I had a huge message written but then it said I wasnt logged in so I will start again and hope to send it before I time out. Hendrix is a mystery to us at the moment. Alison who is from the rescue has started a thread on here asking for advice as Hendrix's cortisol numbers are rising despite a second increase up to 80mg a day. This is fed to him in his meal at lunchtime. (I split his food into three meals a day) The vet has been in touch with the laboratory to, I think, clarify what might be going on with his results. Currently Hendrix still has all the classic signs of Cushings apart fom excess panting, he has so far never had that. He still loves to go for his walks, which includes one longer off lead walk. At the vets he is taken into a separate room for the tests to be done, which I guess adds to the stress for him.

The vet is considering changing Hendrix to half a dose twice daily which hopefully might improve his levels. Currently they are doing a cortisol monitoring test which takes place before his next dose of Vetoryl is given. If they do an ultrasound to find out if there is a tumour on his adrenal glands will that also tell them whether the tumour is benign or not? So many questions. Currently Hendrix has had 4 blood tests for Cushings since beginning of March so is well monitored in that respect. He is fed a good quality pate type food which is 85% meat protein, very few treats and no kibble.

He is certainly brighter in himself and some of his cheeky behaviour has returned, that may be in part due to the fact that he is having a free run in fields now, where in the winter it was so awfully muddy and wet that we stopped going there. He has always had 3 walks a day though and still wants to go every single time unless its raining!

The rescue myself and the vets are working together to try and find out what is happening with him. The thyroid test still isnt done as they are hoping that it might stabilise a little once the Cushings is stable. Sorry this is a bit of a ramble but trying to get as much information in as possible.

Thanks for any help you ladies can give us
Best wishes
Sue and H

[Sue G]

Morning ladies. The vet has asked to increase the dose for H to 60mg twice a day! I am not happy at all with that and am going to quickly print out all the resources I can which I can give physically or speak about on the phone when he calls later. today. For now I am not increasing the dose as I have a much brighter boy than I did at the start of his Cushings journey. I will let you know later the outcome of this. Thank you for all your help
Sue and Hendrix xx

[Squirt's Mom]

Hi Sue,

What was the result of the test that this increase is based on? Were you still seeing signs of high cortisol? When a dose is split you don't increase the dose UNLESS the testing and signs indicate that is needed. Typically you simply divide the current dose into two doses AM and PM so on 80mg a day he would take around 40mg AM and 40mg PM. Please do let us know what the vet has to say when you can.

You are doing a good job with this sweet boy!
Hugs,
Leslie

[Squirt's Mom]

Oh...about the ultrasound. Being on Vetoryl will change the appearance of the adrenal glands so unless he is looking for tumors on those glands an ultrasound at this point would be worthless. It wouldn't tell them anything about his Cushing's UNLESS again they are checking to see if he has the adrenal based form - ie a tumor on one or both adrenal glands VS the pituitary.

[Sue G]

Morning Squirts Mom.
Thank you for replying. I spoke with the vet by phone and then emailed the advice and guidance about waiting 30 days before increasing a dose, also the 'bigger dogs smaller doses' information. The Rescue and I have both spoken to him but he said he had spoken to a consultant who wanted Hendrix on 60mg twice a day. I have been giving this dose for two days now and so far no problems that I can see. He has developed awful dandruff, maybe combination of Cushings and low still undiagnosed thyroid problems. The rescue have suggested I get some coconut oil and add a small amount to his food to help with this. I realise that there are different dog foods around the world. Am I right in thinking that a high protein, low fat, low fibe diet is best for Hendrix. I am constantly looking for ways to improve the things that I can for him. He has so far shown no reaction to the medication, the vet says he is not going on bloods alone but also on clincial signs. He is very good and checks Hendrix physically, heart, temperature and gives him a good physical hands on particularly around his little pot belly. Currently his bloods were showing as high levels as when he started on the Vetoryl, retest in 3 weeks time. Thanks for all your help

[Sue G]

Just one last question please. Now we are doing two doses a day do they have to be exactly 12 hours apart. I will do my best to keep to that but will it make much difference to Hendrix if they are, for example 11 hours apart during the day. Still trying to work all this out in my head and not wanting to do anything to make him ill while he is doing well at the moment. We will be seeing the vet in 3 weeks but thought I would ask you ladies before then. Thank you Sue and Hendrix

[labblab]

Hi again, Sue. I’m not a vet, but I don’t think the two doses have to be exactly 12 hours apart. A key factor, though, is that all doses should be given along with a meal. So if his feeding schedule is such that an exact 12 hour interval isn’t possible, then I believe that being able to give the med along with food is more important.

As far as type of food is concerned, good quality protein and lower fat probably is a good choice (lower fat since Cushpups *may* be more vulnerable to pancreatitis which is possibly associated with higher fat consumption). However, I’d hold off on any major dietary changes while Hendrix is adjusting to the Vetoryl. If he ends up with any kind of GI upset right now, you won’t know whether it’s the medication or the food. Limiting the variables right now is probably the safest way to go ;-).

Marianne

[Sue G]

Hello again everyone xx

We have been having a bit of a tough time with Hendrix this past two weeks. When the vet raised the dose to 60mg twice a day all was well. Then after about 3 weeks on that dose I noticed that Hendrix was walking with a slightly stumbling gait sometimes, not putting his feet quite right, he had a paralysis on one side of his face. His ear was floppy, his eye was moving sideways now and then. His lips were drooping and he was slobbering a little, he had never done this before. This all started on my Birthday 2nd June. He was due a further Cushings blood test on 6th June and they also did a thyroid test on that date. I told the vet about the symptoms he was having. The vet felt that it was neurological possibly due to the benign Cushings tumour if its in his brain.

The thyroid results came back as normal. The Cushings numbers had dropped from a high position to 127 or 129, cant remember exactly. The results took a week to come back from the lab. On the day we got them Hendrix was beginning to show signs of reacting to the Vetoryl dose. Upset stomach, not wanting to eat so no way of getting Vetoryl into him as he was having problems both ends. He was also quite lethargic. Vet saw him straight away and checked his electrolytes, which came back as ok. The dose is now lowered to 40mg twice a day and half a paracetamol (Standard British pain killer) 3 times a day, that on our vets advice. He is now consulting with others to see if they can find out what is causing the neurological signs. The first vet said it could well be the Cushings tumour is growing and causing intercranial pressure in Hendrix's head. I know that until we get some sort of reply from the vet we are just watching for seizures, head pressing, turning circles etc. Hendrix isnt always wanting to eat first time now and I am hand feeding him at least once a day to keep his meds going in. Has anyone had experience please of a dog with Cushings having neurological problems and if so were they due to the meds or a tumour? Our poor boy is still happy just a wobbly lad at the moment. xxxx

[Sue G]

I should have added the second time we saw a vet this time round was 5 days ago. I mentioned the rapid drop in the Cortisol levels once the dose was increased, he felt that Hendrix's body may not have adjusted yet to the new levels. Hence he said that any arthritis Hendrix may have will now be revealing itself which is why he suggested the paracetamol rather than an expensive vet med. xx

[labblab]

Hi again, Sue. I’m so sorry to hear that Hendrix is having these problems — I know how worrisome this must be for you. For the benefit of our U.S. readers, his most recent cortisol level was equivalent to approx. 4.6 ug/dL. This level, in and of itself, would not be considered too low. But I think your vet is right that a cortisol level that dropped really rapidly can still cause a dog to feel unwell for a time.

Unfortunately, though, the possibility of an expanding pituitary tumor is also a genuine threat in the face of inappetance and newly emerging neurological symptoms. Some years ago, I lost my own Cushpup to what we assume were the effects of an expanding Macroadenoma. We did not perform the very expensive imaging of his head that would have confirmed that diagnosis. But like Hendrix, he started refusing food when his cortisol was well within normal range, and he developed other problems as well. I’m going to give you a link to a thread here that is devoted to discussion of Macroadenomas. I’ve posted some replies there that discuss my own experience in great detail. Other owners have also contributed a lot of helpful information.

As you’ll read on that thread, discontinuing the Vetoryl altogether may be recommended if an expanding tumor seems likely. This is because higher levels of circulating steroids can help reduce swelling and inflammation of affected brain tissue. In that situation, treatment trade-offs have to be weighed in terms of addressing the most urgent problem at the expense of leaving other issues unattended.

Anyway, here’s the link to that thread. You can look that over and see whether any of the information seems familiar or instead raises new questions. Again, I’m so sorry that Hendrix is struggling right now and I continue to send my healing wishes to your sweet boy.

https://www.k9cushings.com/forum/showthread.php?3567-Macroadenomas

Marianne

[Sue G]

Marianne. Thank you so much for your reply. I will have a good read down the thread later that you have kindly put a link to. I am going to get Hendrix out now as its getting quite warm later and I want him to have his walk first. I will reply more once I have done that. My husband also thanks you, we have both been so worried about Hendrix and he is relieved to have some answers that I can now put to the vet and the rescue. Love and licks from Hendrix too xxx

[labblab]

Sue, you are so very welcome for any help I may be able to offer. I’m afraid you’ll not find that thread to be very cheery reading :-(((. But an enlarging tumor may not be Hendrix’s problem at all. And even if so, I do believe that knowledge grants us the power to make the best decisions that are possible, even in difficult situations. So once again, take a look and think things over. And definitely do keep us updated!

Marianne