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Old 08-05-2010, 07:15 PM
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MyRudy MyRudy is offline
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Default Rudy: New diagnosis, on Trilostane/Vetoryl, lethargic

Hi, I am new here, been reading all day and just wanted you to know I feel so much better after reading this. Apollo has almost identical symptoms to what my dog has.

Rudy was diagnosed with Cushings July 22 and started on Vetoryl that day. I saw vast improvement in the water drinking, panting and peeing within a few days. But about a week later, my poor puppy looked half dead. He was lethargic, not eating and his hind legs suddenly seemed to give out on him. He no longer wanted to go for walks more than a few feet.

I called my vet and he was surprised because he said Rudy's cortisol was 'super high' according to the ACTH test we had done. He gave me a script for prednisone in case Rudy got 'shocky'. Rudy weighed about 45 lbs at the time he was diagnosed, so he was prescribed the 60 mg capsules once a day.

I quit giving Vetoryl to him since Monday. He has improved every day since, finally eating a little bit and today he actually made it to the park for a shorter walk, but did not appear to have as much trouble as he had even yesterday.

My vet said to give him the Vetoryl every other day, since it is in capsule form and I can't just half the pill. He also said I could open up the capsules and sprinkle half on his food every day if I wanted to, but I have read not to do that.

My question is: since he is almost back to normal and has been off Vetoryl for 3 days now, when should I start him back on every other day? It is obvious to me that the dosage was too high even though it is correct for his size. We are supposed to have a follow-up ACTH on Aug 21st and I believe I read in here that he needs to be taking his meds for 2 weeks prior to that time in order to get an accurate reading?

I hope there is more good news on Apollo from the Vet today!

Last edited by MyRudy; 08-05-2010 at 07:16 PM.
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Old 08-05-2010, 07:31 PM
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StarDeb55 StarDeb55 is offline
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Default Re: Rudy: New diagnosis, on Trilostane/Vetoryl, lethargic

I want to welcome both you & Rudy! I must warn you that we tend to ask a lot of questions of new members, but that just helps us to give you the most appropriate feedback possible from the group's collective experience. Can you tell us a little more about Rudy's history? What symptoms led you to take Rudy to the vet? What tests were done to diagnose Cushing's? Some of these tests may include an ACTH, low dose dex test, or even an abdominal ultrasound. If you could post the actual results for us, that would be great. We are not trying to second guess your vet, but we have seen too many pups mis-diagnosed due to lack of sufficient diagnostic testing, a vet who is inexperience in treating Cushing's, or both. Did your vet rule out diabetes & thyroid problems? I ask about these 2 problems as their symptoms can overlap with Cushing's.

I'm very concerned about your vet's experience in using trilostane & treating Cushing's. Trilostane only has a half life in the body of about 12 hours, so every other day dosing is a complete waste of time. Most members who use trilo, dose once daily, some members have to dose twice daily. We do have many members using trilo, so I'm sure some of them will be along to offer their input.

Looking forward to hearing more.

Debbie
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Old 08-05-2010, 07:43 PM
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Default Re: Rudy: New diagnosis, on Trilostane/Vetoryl, lethargic

Quote:
Originally Posted by StarDeb55 View Post
I'm very concerned about your vet's experience in using trilostane & treating Cushing's. Trilostane only has a half life in the body of about 12 hours, so every other day dosing is a complete waste of time. Most members who use trilo, dose once daily, some members have to dose twice daily. We do have many members using trilo, so I'm sure some of them will be along to offer their input.

Looking forward to hearing more.

Debbie
Yes, this is exactly what I was concerned about! Thank you so much. I fear my vet is not very experienced as well.

Rudy went to the vet first in June for his 6 month check-up since he is a senior dog (12 1/2). I had recently noticed excess drinking and peeing and some coughing as well as one of his hind legs giving out at the end of our walks. I described these symptoms to the vet and he did a urine test and blood test that day, but I have no idea what kind and I never got the numbers on any of the tests I've had done on him.

He said his urine was very watery and that his blood levels were in normal ranges, he had been worried about kidney disease. So next we had a urine bile acids test as he was afraid of liver disease. That came back with numbers a little high but he said still not too far from normal.

An ultrasound was performed a few days later and it showed all organs normal except the adrenal glands were both enlarged. So then they performed the ACTH and all I was told is that the cortisol levels were super high. I will need to call the vet's office tomorrow to get the actual numbers.

Last edited by MyRudy; 08-06-2010 at 09:05 AM.
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Old 08-05-2010, 07:51 PM
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Default Re: Rudy: New diagnosis, on Trilostane/Vetoryl, lethargic

Welcome from me as well! I question the dx as well as the experience level... hard to know without those reports. If I were you and it isn't too big of a deal I would go in person and get copies of the reports.

I just went thru an ordeal with my vet and there were several times when I'd get a verbal report that didn't quite have all the info in it that was in the reports. So if you can - go get copies of all blood tests, etc that have been done. Then post the results here and it will help us understand the situation a bit better and help guide you thru the process.

Cushings is a serious disease but it isn't imperative you start treating right away so I'd cease with the trilostane until I had a greater comfort level that the dx is right. Frankly the regime you are on is a waste of time - as Deb said - the drug doesn't last long enough in the system to be effective with every other day dosing.

Hang in there and keep us posted. Glad you found us. Kim
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Old 08-05-2010, 08:19 PM
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Default Re: Rudy: New diagnosis, on Trilostane/Vetoryl, lethargic

Corky and I also want to welcome you and Rudy.

I know you have gotten some very good information, but I just want to mention that you can get Trilostane compounded in other doses than Vetoryl. Corky is taking Trilostane, and is doing very well on it. His IMS started him on the lower dose, and then increased it as it was necessary. Corky started with his dosage once a day, and is now dosing twice daily.

I hope everything goes well with Rudy's treatment.

Terri

Last edited by littleone1; 08-05-2010 at 08:22 PM.
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Old 08-05-2010, 09:30 PM
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Default Re: Rudy: New diagnosis, on Trilostane/Vetoryl, lethargic

Thanks for everyone's advice, I feel better already.

I had another vet at this same clinic for many years and then I guess he quit working on Saturdays (which is the only day I can take Rudy in since I work and am single) so I got switched over to this new vet. My other vet was much older and more experienced and he explained things much better than the new guy. I may ask for him back and just take time off work if necessary.

I am going to call them tomorrow and ask them to fax the test results, is that okay? What reason do I give for wanting them?

There were a few days this week when I thought I was going to lose Rudy. I don't understand why he is worse now than he was before I gave him any pills at all. His hind leg weakness is the most difficult to deal with - I felt just like Apollo's mom did, it was like Rudy aged 30 yrs in a matter of days!

I gave him a total of 11 pills and the last few I wish I had not given him. I have paid close to $1,000 already with all the tests and $100 for a month's supply of vetoryl which the vet told me I would have to keep Rudy on for life.
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Old 08-05-2010, 09:33 PM
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Default Re: Rudy: New diagnosis, on Trilostane/Vetoryl, lethargic

I should also mention that Rudy does not have any hair loss or skin problems that I can see, his symptoms are excess water intake and urination, including accidents in the house which he never had before, coughing and panting heavily. He is a Chow/Husky mix and I have had him since he was 8 weeks old. He is my fur-kid since I have no human kids and I would spend anything to make his quality of life better.

I assumed from the little the vet did tell me that Rudy has the pituitary cushings.

Last edited by MyRudy; 08-05-2010 at 09:35 PM.
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Old 08-05-2010, 09:59 PM
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Default Re: Rudy: New diagnosis, on Trilostane/Vetoryl, lethargic

I would just tell them that you would like to keep a file on Rudy at home, in case you might ever end up at a strange vet, especially an ER clinic. When you ask for the fax, please make sure you get not only the Cushing's testing, but any general labwork that might have been done such as a senior wellness panel or super chemistry panel. There are common elevations in liver function tests on our pups that will frequently point a vet toward Cushing's. On the general labwork, please post only the abnormals, along with normal range & reporting units. Just to let you know, I'm a medical lab tech with 30+ years experience, so I can help you sort those results out.

Debbie
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Old 08-05-2010, 10:02 PM
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Default Re: Rudy: New diagnosis, on Trilostane/Vetoryl, lethargic

My first dog was diagnosed with cushings over 4 yrs ago and I had never asked for records before unless I moved. Well... with cushings you really want to be more actively involved and frankly check everything that is done. You want to make sure you have all the facts and understand what is going on because you are Rudy's voice.

You don't have to explain why you want the copies. You paid for the tests and legally if you ask they are to give them to you. If you feel you need to offer something, just tell them you'd like to read them over. You can get a fax but they are often hard to read because the print is so fine. Perhaps they could scan them into documents and email them to you?

My last request had so many pages that when I went in on Saturday (same thing single and working) they were busy and I just said - make copies and mail them to me which they did. It just will delay things if they are mailed.

My 2nd dog was diagnosed with cushings and ended up having a nasty bacteria in her stomach that resulted in bleeding ulcers. I ended up going to 3 different vets on this one (and remember I have experience w/ cushings ) and after all this they think she was misdiagnosed and might not even have it. (She had 5 different tests indicating high cortisol/cushings)

So when we say it can be misdiagnosed it is because we've been there and seen it alot. Perhaps Rudy does have it but the reaction to the drug isn't making sense.

Hang in there - you already are doing the right thing by getting up to speed on the disease and asking questions. Rudy will be just fine. Kim
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Old 08-05-2010, 10:12 PM
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Default Re: Rudy: New diagnosis, on Trilostane/Vetoryl, lethargic

I went back & rechecked what you had posted for Rudy's weight & the daily dosage your vet initially recommended. Dechra's recommended dosage range is 1-3 mg./lb. which does work out to 60 mg. Univ. of Cal. at Davis has a little different protocol as they have found that starting at a lower dose & working up, if needed, seems to be a little safer. UC Davis starts at 1 mg/kg, which for Rudy would be a starting dose of 20 mg. daily. Rudy's problems may simply be due to the fact that his initial dosage may be a bit too high. Has he had an ACTH done since he started trilo, especially recently since he has been feeling bad? Dechra protocol states that the first ACTH needs to be done within 10-14 days after starting treatment, then, again at 1 month. We have frequently seen in this group that pup's who start vetoryl whose initial stim (ACTH), may still be mildly elevated, or even within range will continue to drop their cortisol during the first 30 days. It is very important that with each stim test, that Rudy's electrolytes be checked. Were Rudy's electrolytes check during this period where he was feeling so bad?

Here's a link from our important information section which will give you tons of information about trilostane including Dechra's & UC Davis dosing protocols.

http://www.k9cushings.com/forum/showthread.php?t=185

Debbie
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