Trudy, newly diagnosed - Trudy has passed

[Trudymom]

Hi there...So Trudy had her first ACTH results (day 14). She's on 10 mg, twice a day.

Her results:

Lab Result Evaluation Range

08/01/18 Cortisol Sample 1 4.3 ug/dL - 1.000 - 5.000 ug/dL
08/01/18 Cortisol Sample 2 6.5 ug/dL Below Normal 8.000 - 17.000 ug/dL


I heard it was a good spot. She will continue and be retested on day 30.

Question for you. I am in a facebook cushings group. I am learning a lot there too! I'm curious if you guys compound your Trilostane? I was told it was a lot cheaper to do it, but in order for it to be compounded it, it cannot be a dose that is already made. (Vetroyl has 5, 10, 30, 60 mg). So what some members do is take a 10 mg dose and instead compound it to 11 mg and it ends up being much cheaper for tablets...a lot cheaper!

I'm curious if folks here in this group do that.

[LauraA]

Hi Trudy. Yes Trilostane is so much cheaper than the named brand Vetoryl. I am not sure where you are from but in the US you do have to get a dose that Dechra does not make. However I am in Australia and we can get any dose we want in the compounded trilostane. If you are in the US then Diamondback drugs is the most trust worth and cheapest place to get it. I would wait till your 30 day test and then you can see what combination of dose will be most effective as the cortisol will continue to come down a bit more at this stage. The 6.5 is a good place to be at this stage but if you notice any signs of cortisol going too low then you can do the stim test a bit earlier

[Trudymom]

Cool! Thanks Laura! I think I hesitated just a bit because my vet consulted with our internist who did not recommend compounding the trilostane. I was surprised. As for waiting 30 days, yes, we are doing that. Since we are testing on day 30 and her vetoryl runs out on that day, we are getting another box. Here in the US you can't compound any dose that is already available so it would have to be 11mg instead of 10 mg. It's more than twice as cheap. I'm glad my regular vet is willing to do it as she knows we are juggling other diagnosis' as well. Thanks again Laura!

[labblab]

I’m very glad that Laura was able to give you the info about compounded trilostane availability here in the U.S. She’s exactly right in what she’s written. One note that I’ll add is that the reason why some vets are cautious about recommending compounded trilostane, however, is because a research study has shown that some versions are more variable than is brandname Vetoryl in terms of dosing accuracy and drug effectiveness. The study did not name the pharmacies that made the versions they tested, so it’s impossible to know from the research which pharmacies are ones to use and which are to be avoided. As a result, we must rely on our trust in using pharmacies that have established a good reputation among our members. As Laura has written, Diamondback is one that is at the forefront.

Given these general concerns about compounding, however, I also strongly agree with Laura that I would wait until my dog was stabilized on a given Vetoryl dose to make a change to a compounded product. Once you’ve established where the cortisol level is holding on Vetoryl, you’ll have a better idea as to whether or not the compounded version is maintaining the same level of control and consistency. I do agree that your first ACTH result for Trudy is in a good area, and hope you guys will see continued improvement!

Marianne

[Trudymom]

That is our plan to have her stabilized first.

Trudy seems to be struggling. She is more lethargic. Doesn’t want to do anything. We are still struggling with appetite. She eats but I have to add beef, chicken, broth, stew. The dr suggested maybe trying once a day to see if it helps.

I’m not sure what to do. Someon suggested we stop the meds for now. This would mean symptoms return too ��. What would our options be if she can’t hsve this med?

[Squirt's Mom]

Lack of appetite is a sign the cortisol has gone too low which can be life threatening. Personally I would stop the med and have an ACTH done to see where the cortisol is today. That's me tho. Others will probably disagree. LOL

[Harley PoMMom]

The inappetence could be due to the antibiotic she is on for the UTI.

Another thought is that her electrolytes may be unbalanced and/or since she has kidney issues the phosphorus may be elevated which can cause a dog to lose it's appetite.

[Trudymom]

she began the inappetence very soon after starting the vetoryl. Her kidney disease is in early stages. Her creatinine and phosphorus were all normal two days before she began taking the vetoryl. She started taking the antibiotic on day 14 when her ACTH was done and was in the good range and she was already have appetite issues.

I feel like it's the vetoryl unless it's something else we don't see. I have a consult with her doctor today and I'll have the urine culture results today. Her last antibiotic was last night too. I believe we will stop the meds, at least for a few days to see if that's the definite cause.

[Harley PoMMom]

Has her urination/drinking normalized since being on the antibiotic? And are they going to do a repeat urine culture to make sure that the UTI is completely gone?

I think discontinuing the Vetoryl to see if her appetite picks up is a great idea.

[Trudymom]

After I posted I heard from the doctor. Her UTI seems to be resolved but they will redo a urine culture in one week to be sure. Not sure if I said this or not but she started the antibiotics two weeks after starting vetoryl. Her panting improves quite a bit and her drinking was getting better. As for urinTiin, not quite on par so I asked for a urine culture. It was positive. I have seen improvement on the antibiotics.

I would say the drinking is more than 75% improved and panting 100%. BUT now she’s lethargic and appetite is worse. Sometimes she begs for something human though so go figure.