Buddy, The Mighty Lizard Hunter - Suspected Pituitary Macro Tumor

Hello and welcome from me too.

It is Very over whelming when the testing first begins that is for sure. Check out the ACTH frezing option that Lori posted above. Call the vet and ask if they will do this for you and give you a new quote. It helps. It is a doozy though to get through in the beginning. The hind leg weakness is definitely one of the possible signs of cushings, it causes muscle wastage in the hind legs usually. This sometimes will improve once treatment is under way. The pot belly also will hopefully go down some too and the drinking/peeing should get better as cortisol lowers to a better level.
Now on the other hand, allergies and arthritic sysmptoms may show up more since the cortisol is no longer covering it up. So that is something to keep in mind and be prepared for. Just see how he does. Hopefully no more vomiting episodes.
Hang in there. We know this isn't easy. Feel free to vent whenever you want. We've all done it more than once. :)

Sharlene and Molly Muffin

Buddy is scheduled to have ACTH stimulation testing on Wednesday. I have been reading lots of information from your site to learn as much as I can about Cushings. I found out a few things and am very distressed about it. Buddy was started on trilostane a week ago Tuesday. 7 to 10 days after initiation of treatment he is due for for a ACTH stimulation test. I have discovered a few real problems With Buddy's treatment. First of all As per RX ,Buddy has been taking his trilostane on an empty stomach one hour before breakfast. He has not been taking it with food as Dr. Mark E Peterson advises . That's the first problem! The second problem is, I was told that Buddy needs to be fasted before taking his AC TH stimulation test on Wednesday. I was to give him his pill and then bring him in for his testing 4-6 hours later. Dr. Peterson article says that fasting will cause The test to be invalidated and even can cause harm. What should I do now? I haven't been giving Buddy his pill with food. If I go ahead with the ACTH test on Wednesday it wouldn't be accurate Even if I gave him his pill with food before the test. Would you suggest that I wait another week before having the test done and start giving him his pill with food tomorrow? Should he be having his pill with his regular breakfast or Just be given his pill with a small amount of food, then fed breakfast later? The more Information I read, the more it conflicts with my vet's instructions. I'm confused. Please advise!

Thank you, Kathy and Buddy

I would ask to share Dr. Peterson's suggestions via email. My vet was unaware that the dosages recommended by the company were too high. Trilostane must be given with food and the ACTH tested is to be completed 4 - 6 hours after the morning dose of Trilostane.

Also ask if they partial out the Cortisyn because doing so lowers the cost of testing. If you have an IMS (small animal internal medicine) vet in the area, a visit to one is a good idea. Having an ultrasound is very helpful in determining how miuch Cushing's has been present. Our dog Daisy, has had it for at least a year prior to outward signs.

Ladies, I'm sure that you'll correct me if I've gotten any of this wrong :)

Good morning and good luck :)

You can go ahead an start giving the medicine with the food and just make sure you give it with the food 4 - 6 hours before the test. Even if you have not being do so until now, as long as you start to do it and continue the morning of the test, the result will be valid.

Print out what Dr. Peterson says about giving it with food and take that in to your vet. We have found that many vets do not actually Know the protocols for giving the medicine. That is okay as long as they are willing to learn.

The food allows the medicine to be absorbed into the body more efficiently. Without it, the medicine doesn't absorb correctly from what I understand.

How is Buddy doing?

Sharlene and Molly Muffin

Hello to you and Buddy,

I agree with Valerie -- I encourage you to talk with your vet about your concern that you've been told to give Buddy his trilostane on an empty stomach. In addition to Dr. Peterson's article, you can also cite these "Treatment Tips" published by Dechra, the manufacturer of brandname Vetoryl:

http://www.dechra-us.com/files//dech...UT_2_0_dis.pdf

When contacted directly, Dechra has told me and other members that the trilostane also needs to be given with a meal on the morning of the ACTH testing. If your vet has any questions about this, I know the technical representatives at Dechra will be happy to discuss this either by phone or by email.

I do not know why your vet is telling you to wait one hour after dosing before you feed Buddy his breakfast. Perhaps there is some reason of which we're unaware. But I would definitely want to discuss this before proceeding with an ACTH test. I agree with you, I'd want to dose Buddy properly (giving his trilostane along with his regular breakfast) for approx. a week before moving forward with the testing.

Marianne

Oops I was thinking that the test was Next Wed. I agree that you'd want Buddy to have been taking the medicine with food for a bit prior to the ACTH test.

Sharlene and Molly Muffin

Good morning,
I forwarded the information I learned on your site on to the vet last night. Below is her response. I copied and pasted it from the email I received.

Many studies have shown that there is no difference in absorption whether trilostane is given with or without food. This is even stated in the main veterinary drug resource book. However, the gastrointestinal side effects are reduced if given on an empty stomach and this has been the standard since this drug came to America about 7 years ago. You are welcome to do it however you wish.

If you want to have the test done giving it with food I am happy to do that. However, most labs recommend fasting anytime cortisol is read as the results are actually more accurate with the method they use to test. So it's basically up to the lab. But with that said, our lab doesn't care either way. :-

Thank you for your feedback so quickly! I'm going to reply and let them know that I will be bringing him in next week for his ACTH test.
I also conversed with them already about fractioning the drug used in the ACTH test. They already do it.

Hugs, Kathy and Buddy

Hi Kathy,

Since your vet seems to be aware of studies that conflict with what we have been told by the manufacturer and the studies we are aware of, would you mind asking her to supply you with supporting information for the studies she mentions? It is always possible there is info out there we are not aware of and having a full arsenal of information is always nice! ;)

Hope things are going better for you and Buddy!
Hugs,
Leslie and the gang

Kathy, I hate to "pile on" re: questioning your vet. But I am really puzzled by what she has told you. The clinical trials and studies in the custody of Dechra (the brandname drug manufacturer) are the basis for FDA approval of Vetoryl in this country, and it is the manufacturer's prescribing information that is likely to be contained in any official drug compendium. The link I gave you earlier was to a Dechra publication directed to pet owners. But here is a link to the official U.S. Product Insert for Vetoryl (this is the FDA approved prescribing information):

http://www.dechra-us.com/files/dechr...ts/Vetoryl.pdf

And here is a direct quote from the Product Insert:

Quote:

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CLINICAL PHARMACOLOGY:
Trilostane absorption is enhanced by administration with food. In healthy dogs, maximal plasma levels of trilostane occur within 1.5 hours, returning to baseline levels within twelve hours, although large inter-dog variation occurs. There is no accumulation of trilostane or its metabolites over time.

---

The recommendation to administer Vetoryl (trilostane) with food is not a new one. I started treating my dog with trilostane in 2003, and at that time the drug had to be imported from the U.K. because it had not yet received FDA approval for sale in the U.S. But even at that time, the recommendation was to give trilostane along with breakfast. At that time, "Arnolds" was the manufacturer of Vetoryl (Arnolds has since been incorporated into Dechra). Here's a link to an archived version of Arnolds' 2002 prescribing recommendations (click on "Vetoryl FAQs" on the main index page):

http://web.archive.org/web/200308012...Page/index.htm

And here's the relevant quote:

Quote:

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6. Should Vetoryl®be given with food?
Yes, Vetoryl® is best given with food.

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In the absence of supporting documentation, I do feel concerned if your vet persists in advocating for giving trilostane on an empty stomach. I realize it may feel awkward to press her to provide research citations and you may not wish to do so. Like Leslie, I would surely be interested in that info. But whether you ask her or not, I do encourage you to really read through that Product Insert carefully yourself. That way you'll be familiar with all the manufacturer's recommendations if/when you discuss other aspects of Buddy's care with your vet.

Marianne

Marianne,
I forwarded your entire message onto Buddy's vet giving her a chance to respond with documentation if she would like. I did tell her that was her choice. Having open communication with one's vet is vital to the well-being of our beloved four-legged family members. I don't want to upset that balance or close the door to communication. I'll forward on any response I get.

Kathy