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Omg. That is danger low. He might need some iv fluids and larger shot of pred or dex.
Since this is is second crisis, please do not restart vetroyl unless 1) symptoms come fully back. 2) a test shows that his adrena l glands are now functioning.
Hugs
Sharlene and Molly muffin
We're back. They took more blood to check his electrolytes - the vet will phone later today with his results. He got another steroid injection and we've to increase his prednisolone from 5mg a day to 10mg twice a day and he goes back on Friday.
The vet said that it wasn't worth checking his cortisol today as they normally leave it a week before checking. He said the 5mg was quite low for a dog of his size hence the increase.
The vet's just phoned. His electrolytes are fine which is a relief.
She's not sure what's going on but she says it's like he's storing the vetoryl and will tick along OK but it's like it's building up in his system and then he's crashing which she says is not good.
He's to take it easy this week - no heavy exercise, no long walks and he goes back on Friday to get his cortisol checked again.
Glad to hear the electrolytes are ok. The thing that concerns me is that the vet states he is storing up the Vetoryl, which it leaves the system within 12 hours. I am wondering how she then thinks this is possible?? That is the reason many use it, as it goes out of the dogs system. I am wondering bout the dosing you were doing. How many mgs and how many times a day? The dose may be too high, needs split up, or reduced all together. I definitely would give no more Vetoryl until he is well, and until this is figured out. He is lucky to get thru that Addison's crisis as well as he has. Hope he continues to improve. Just know you will want to ask what his numbers are any time this would happen, instead of the vet just saying he is low. Blessings
Patti
He was on 60mg once a day but if and when he's to go back on it, I'll see about twice daily dosing. It might be more stable doing that?
She couldn't give us numbers as his cortisol levels weren't registering :(
The vet just said it was as if he was storing it as he ticked along for quite a few weeks fine, then he suddenly plummetted.
I am not thinking this vet is understanding how trilostane works, or he would not say the dog is storing it. How much does Cairo weigh? He should have started out on this at 1 mg per pound. If it is over that then that is the problem that his dosage is too high, and he is OK for a while until it takes the cortisol down too low into Addison's. If he is on the correct dosage then there is something wrong. How experienced is this vet at treating Cushing's? Blessings
Patti
He's lost a wee bit of weight and is now 27kg (about 60lbs)and was on 60mg.
Could it be that he's just needing a lower dose? We can only get Vetoryl in 10mg, 30mg, 60mg or 120mg doses here. Obviously we can mix and match to get the right dose if it's in between available strengths.
Yes just a recap for those who don't know. Cairo was on 120mg and crashed. Vetroyl was lowered to 60mg and once again, a crash.
In England they cannot currently have a full ACTH done, so base cortisol and electrolyte monitoring is all that is available.
Cairo, should not if and when symtoms come back, go onto 60mgs of vetroyl again. The dosage should be lower and perhaps even a spit. At 60lbs the 60mg was a decent dosage to be at, but he'd already crashed once on 120mg. I'm thinking now, a lower dose split of like 20/20, (you can get compounded trilostane). You could also try a 30mg AM and a 10mg PM. But not a 60mg of any combination since he crashed on that. That is IF symptoms come back completely.
Patti is correct. Vetroyl does not store in the body, in 12 hours it leaves the body. That doesn't mean that too large of a drug wouldn't send him into a crash, which we have seen. Every dog reacts differently and some are more sensitive, and it appears that Cairo is one of the more sensitive.
Hope that helps to clarify.
:)
hugs
Sharlene and molly muffin
Thank you. Yes that helps. He goes back on Friday to have his cortisol checked so we'll see what that says but I'll make sure he doesn't go back on that dose again and I'll ask about twice daily dosing as well.
When he was on the 120mg, his cortisol dropped to 17 and was caught on his routine stim test - he wasn't showing any symptoms of low cortisol at that point which scared me cos I didn't know if I'd recognise if he was too low - though I really didn't want to have to put it to the test.
We did get the stim test done on Friday - so I'm assuming we're back up and running with the synacthen now thankfully. I wonder if this would have been caught earlier had he been getting the stim tests.
I assume his cortisol will be quite high on Friday since he's going to have been getting 10mg pred twice a day? It was increased today because he wasn't picking up as well as hoped.
Oh, and I'm not sure if we can get compound trilostane over here - I've never heard of compound medications for dogs - but I could be wrong. I'll ask.
Please post the results of the testing you had done so we can see if we can make anything out from it. Sharlene is right her needs a much lower dose and I would go with the 20mg morning and 20mg evening also. You so not want him to crash again. Blessings
Patti