New here, Newly diagnosed. Stewie has passed

[MichelleJVM]

Thank you Marianne, it is a relief to hear from someone else that we are on the right track. I haven't been seeing much changes with stewie yet and it has been making me feel like I am taking a step backwards rather then forwards with this...

Would his next testing be 30 days from the last testing or from the start of treatment? Also my vet got anxious when I told her I fed Stewie the morning of testing (with his Vetoryl), his sample was very Lipemic, just curious if you guys feed as per usual on the day of testing?

Ps. Thanks Marianne for translating his levels into numbers others are familiar with!

[Harley PoMMom]

Would his next testing be 30 days from the last testing or from the start of treatment?

Thirty days from the start of treatment is when the next ACTH stim test should be done.

Also my vet got anxious when I told her I fed Stewie the morning of testing (with his Vetoryl), his sample was very Lipemic, just curious if you guys feed as per usual on the day of testing?

Trilostane has to be given with a meal to be properly absorbed. I am including articles that state that Vetory/Trilostane must be given with a meal, this first one is the "Vetoryl Client Brochure" which Dechra publishes, (Dechra is the maker of Vetoryl):

Vetoryl Client Brochure

On page 6 of that brochure:

How do I give VETORYL Capsules to my dog?

Give VETORYL Capsules with a meal in the morning so they can be effectively absorbed. Administration in the morning is critical so your veterinarian can perform the monitoring test at the appropriate time after dosing.

This second excerpt is from an article on Dr. Mark Peterson's blog (Dr. Peterson frequently contributes to Dechra's online continuing education for veterinarians) and is titled: What's the Best Protocol for ACTH Stimulation Testing in Dogs and Cats?

Remember that the ACTH stimulation test is the most useful test for monitoring dogs being treated with trilostane (Vetoryl) or mitotane (Lysodren) see my blog entitled, Diagnosing Cushing's disease: Should the ACTH stimulation test ever be used? Both medications are fat-soluble drugs and must be given at time of meals, or the drugs will not be well absorbed.

With trilostane, it’s extremely important to give the morning medication with food, and then start the ACTH stimulation test 3 to 4 hours later.

Fasting these dogs on the morning in which the ACTH stimulation test is scheduled should be avoided since it invalidates the test results.

http://www.endocrinevet.info/2011/03...-for-acth.html

Lori

[MichelleJVM]

Day 30 ACTH Stim Test + electrolytes

Cortisol - Baseline: 112 <28-120nmol/L>
Cortisol - Post ACTH: 210 <220 - 550nmol/L>

Calcium: 2.15 <2.20-2.80mmol/L>
Chloride: 101 <108-118mmol/L>
Hemolysis: +++
Lipemia: ++++

They say the Calcium is due to hemolysis and artifact, Chloride supports loss, Stim still supports marginal control and that the Post should be less then 100nmol/L for good control.

We have bumped up his dose to 30mg SID

And we are back to day 1 ... Woot!
_____________
Ps. Thank you Lori for the info!

[labblab]

Hey Les, I think you must have been looking at Stewie’s chloride result instead of the post-ACTH ;-). The post-ACTH was 210, which converts to about 7.6 ug/dL. So Michelle, that is indeed a bit higher than Dechra’s prime therapeutic range of 1.45 - 5.4 ug/dL (or 40 - 150 nmol/L), and therefore is apparently triggering this dosage increase. This makes sense, but Leslie’s warning about continuing to monitor Stewie carefully still holds. Any time a dose is increased, we want to be especially alert to any behavioral changes that might herald a cortisol level that is dropping too low.

In that vein — behavioral changes — are you seeing any improvements yet?

Marianne

[Squirt's Mom]

You are absolutely correct, Marianne! So I have deleted that post, Michelle....if you have already read it, please disregard.

[MichelleJVM]

Hi Les, I did see your original message, but I saw it in conjunction with Marianne's. So not to worry. I appreciate your concern, and its nice to know that if I did veer off the track that you guys would be there to back me up and get me back on the right path again. So far his transition to the new dose has gone pretty smoothly, he did have 1 bout of soft stool but it went back to normal the next day.

Still no big changes. The main change has been the lack of accidents in the house. As for eating and drinking, there is no significant noteworthy changes. His food intake is still a little wonky since prior to starting vetoryl. I think he must of bit into an ursodial capsule and doesn't trust any meds/food anymore... I'm not convinced it is strictly appetite related. As for behavioral, is there anything specific I should be looking for? I can't say he is any more playful. He definitely does not want to walk to the vet, can't say I blame him though. He was a rescue and was never friendly with other people, except maybe if it came to food. If anything maybe he's crawling into my lap a little more then usual?!

I'll keep you guys up to date as things progress.

Thanks again for the support and advice.

[MichelleJVM]

I'm curious if you guys know how soon Urine Protein Creatinine improves after starting Vetoryl. We haven't seen any Changes for the better since starting a month and a half ago. Just wondering if improvement is expected this soon in the game or if it is one of those things that takes time?! The vet seems concerned that we aren't seeing more improvements by now.

[Harley PoMMom]

With some dogs, even with treatment, their proteinuria never resolves, I know we've seen this to be true on the forum. Here's an excerpt from Dr. Peterson's blog:

About half of dogs with untreated Cushing's syndrome have proteinuria, defined as a urine protein:creatinine ratio (UPC ratio) >0.5-1.0, in the absence of UTI (1-4). Although such a protein-losing glomerulopathy is common in dogs with Cushing’s syndrome, the severity of proteinuria is generally less than that typically seen in dogs with hypoalbuminemia or hypoproteinemia. Hypertension and proteinuria are common in dogs with Cushing’s syndrome, and they may represent a “cause-and-effect” relationship.

Results of this study also confirm that proteinuria is common in canine Cushing's disease, with high pretreatment UPC ratios found in 68% of dogs of this study (9). However, as with hypertension, proteinuria sometimes fails to completely resolve despite treatment of Cushing's disease (1-4). In agreement with that, results of the present study found that the median levels of proteinuria decreased after treatment, but proteinuria persisted in 5 of 13 (38%) dogs after 12 months of treatment.

https://endocrinevet.blogspot.com/20...-frequent.html

[MichelleJVM]

Hmmm that is interesting. Thank you for sharing the article. I secretly wish some of these articles were more recent, but the studies apply all the same. I suppose it will just be something we will monitor over time. Stewie may just end up being in the percentage that does not resolve.

[molly muffin]

He might never resolve the protein loss but as long as his kidney values, BUN and creatinine stay good ranges or not too far out, then that is main thing. I'd just monitor kidneys along with everything else and stay on top of it.