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Note that phrase - studies done after the datasheet was published supports starting at a lower dose than originally recommended. Your vet may not be familiar with these studies (posted on the first page of your thread) and may well appreciate being brought up to speed. ;)Quote:
...is consistent with the recommended dose range on the Vetoryl datasheet.
Our vet is in tomorrow so I'll go and see her and take that with me.
He seems to be OK - no diarrhoea or any other side effects.
Nice to see you again Alison. So you have started administrating the 120mg then? How many days has it been so far? Have you noticed anything different at all?
Because she's in the UK.. the FDA rules are applying to her, that's why Dechra won't start a file with her.
Don't feel bad, for us in Canada they won't either.
He's had three days of the 120mg - I'll speak to his vet tomorrow though - she's part time since she had her baby and I'd much rather keep consistency and speak with her. He seems to be fine - haven't really noticed any changes for better or worse.
Hi Alison,
I am so sorry that Dechra was of no help to you and even sorrier that they have given you a false sense of security. I am so angry at them right now for their cavalier attitude, I could spit nails. We in the U.S. are lucky to have a Dechra division fully staffed with vets who will speak to us owners directly; however, I believe we have had a few members here in the states who got a response like yours. The fact of the matter is that Dechra has been negligent in safeguarding our dogs against overdosing based on their current recommendations. One of our admins, Marianne, has been in touch with Dechra here in the U.S. more than a few times and they told her that they hadn't updated their package inserts due to cost constraints but they are verbally recommending that treatment be started at the lowest recommended dose. Once this drug was approved in the U.S., the sale of Vetoryl skyrocketed and so did the documented experience. It has been used to treat dogs here for over seven years and clinical trials by UC Davis and others indicate that Dechra's dosing recommendations are quite risky.
If you want proof for your vet, please print out a paper entitled "Update on the Use of Trilostane" authored by Dr. Ellen Behrend, a board certified internal medicine specialist, and contributor to Dechra's continuing education program. This paper comes directly from Dechra's website and I highly recommend that your vet follow Dr. Behrand's dosing and monitoring protocol included in this paper. I have included the url below. You will find a relevant quote from Dr. Dr. Behrend which reads,
Dr. Behrend suggests that this amount is still too high by stating that,Quote:
Originally, the recommended starting dose for
trilostane in Europe was 2 to 10 mg/kg Q 24 H.
However, as experience with the drug grew, it
became apparent that lower doses were needed.
Accordingly, the dosing recommendation on the
U.S. package insert is 2.2 to 6.7 mg/kg Q 24 H.
http://www.dechra-us.com/.../Case%20...trilostane.pdfQuote:
My recommended starting dose is either 2 mg/kg
Q 24 H or 1 mg/kg Q 12 H, with adjustments
made as needed based on adrenocorticotropic
hormone (ACTH) stimulation testing.
So Dechra's own paid expert veterinary specialist ignores the low end of the range (2.2mg/kg) and would start Cairo on 2mg per kg which equates to 56mg once daily. This would most likely be bumped up to 60mg which is an available dose from Dechra. UC Davis would probably start Cairo on an even lower dose based on their own extensive experience with the drug....so shame on the rep at Dechra who supported your vet's decision because it's in accordance with the packaging insert.
I know from experience that questioning your vet is uncomfortable, even when you know what you are talking about but when you are new to the canine cushing's world, it's even harder. How can you possibly argue a point unless you understand it. It's my hope that the credible reference material we are giving you will 1) help you understand things better and 2) give you a lot more self assurance when asking questions of your vet. If your vet dismisses you and assures you that he knows what he's doing, don't believe him because we've given you the proof that he doesn't.
Now having said all that, it could very well be that Cairo will tolerate a 120mg dose but it could very well be that he doesn't and he ends up in an emergency clinic on iv fluids and steroid supplementation and costing you a lot more in hospital bills and more than the usual number of acth stim tests. I personally wouldn't take that chance, especially when world reknown experts like Drs. Ellen Behrend and Edward C Feldman have my back.
Glynda
P.S. I started this post this morning and just now finished and see that in the last several hours, you posted that Cairo has been on 120mg for three days and tolerating it. I'm glad but that doesn't mean he's out of the woods so please keep a very close eye on him. I could delete my post but decided to keep it here because I think it is important information for anybody who may read your thread.
Hi Alison,
Checking in to see how Cairo and you are doing.
Hope everything is going well.
Sharlene and Molly Muffin
Hi Sharlene,
He's doing fantastic. He's had his first ACTH Stim Test and the vet was really pleased. His cortisol levels were 88 and the range was 50 - 150.
When she saw him she couldn't believe how well he was looking - the shine's coming back on his coat, he had his twinkle in his eye and looked so much more happier. She says he's got his mojo back.
He's also lost about 2kg in weight and looks less bloated than he did. He's still not able to go for huge long walks - we let him dictate the distance he goes and he's probably only managing about quarter of a mile but he's showing interest on his walks and sniffing and snuffling about the place.
He goes back on Monday for his second Stim Test (that's the four week mark from starting on the Vetoryl).
He's still got his little bald patches but I'm not expecting them to get better for a while yet, but as I said, he's less bloated looking, isn't drinking and peeing the way he was and isn't scrounging food all the time either. He looks a much happier boy.
I probably shouldn't have started another thread about the Synacthen shortage here in the UK but I've come back to this thread to try and keep things together.
Cairo seems to be still doing OK - since we can't get the stim test done, he's been getting baseline cortisol and electrolytes done.
We've noticed a tiny little bald patch though - his skin looks fine - it's just a little round bald bit. He seems fine in himself - but I worry because he doesn't always show illness - when his cortisol levels dropped too low, he was running about like a mad thing while we took the call from the vet - no sign that his cortisol was too low.
Is a new bald patch something to worry about?
You can always get a skin scrapping and have it checked to see what it is. That is probably what I would do. It could be anything and you really don't know if you need a special shampoo, or antibiotics or something until you know what it is.
Glad to hear that he is doing okay other than the skin patch.
The baselines have been good?
Sharlene and molly muffin
Yeah, his baseline for last test was 67 (2.4)
That is a good baseline
Sharlene and molly muffin
Great number for your baby!!
Cairo wasn't himself so off to the vet we went. Poor soul has an awful sore ear and we never noticed :( His ear wasn't red or anything - the infection was deep down it.
He's feeling a bit better I think but he seems to be really anxious out on walks - he's panting something terrible and is really clingy - he's very clingy in the house as well.
He's not due for a blood test till the end of May but I'm wondering if we should get it done sooner just to check?
Is he on an antibiotic for the ear infection? If so, could you tell us what it is?
He's got Aurizon drops for his ear infection - he got his first dose Tuesday last week.
Just so you know - the Aurizon contains Dexamethasone, a glucocorticoid, similar to Prednisone which can cause Cushing's signs to become stronger. Here is a link about the ear drops -
http://www.drugs.com/vet/aurizon-can.html
Ahh, could that explain why he seems a bit off this week? It's awful not knowing if he's feeling poorly or not - wish I spoke dog! :(
If it were me I would not be using this because it will make him have more Cushing's symptoms like Leslie said. I have read many time that oxygenated olive oil is good for fungus, ear aches etc. You can get it online. You must be sure the eardrum in fully intact before medicating with anything, just so you know in case this happens again. Blessings
Patti
He was meant to have them for a week so tonight would be his last application. It never dawned on me about the steroids in the drops - I guess I never thought that drops in the ear could affect his Cushings.
Poor lad - if it's not one thing, it's another.
He hasn't been eating much but we assumed it was because he was feeling icky with the sore ear.
I'm thinking we should maybe get his bloods checked? Can it be done even though he's been on the Aurizon?
If it were me I would wait a week or so. How is he doing after the drops? Do the ears seek to be better? Blessings
Patti
I ended up not giving him the drops on Monday or today - the vet said that as long as we got them over the weekend, it should be fine. He was getting really stressed out getting them. I can do anything to him - apart from ear drops - he just HATES getting them.
Today, he seemed to have a definite spring in his paw - he seemed a lot happier. His ear seems to be fine - I didn't try too hard to have a look though as he's still in alert mode to the drops so I'll give him a day or two to get over it.
Now I'm wondering if the steroid in the drops did affect his Cushings and now that the drops have been stopped, he's going back to normal.
You just never know about these pups! You can usually smell if they have something going on in there, but I would still have the vet look in next time to make sure it is gone. That drives them crazy anything with the ears. Blessings
Patti
Mine has ear issues too, and she runs if she sees me shake a bottle, thinking it's the ear drops or she is getting her ears cleaned. She still gets it done, but it's a bit of an ordeal. Keep an eye out for him to start shaking his head. Sometimes they look clear on the outside area, but deep inside there is still some bacteria.
Hope you don't ever have to go through the ear thing again! :)
Sharlene and molly muffin
Just checking in to see how Cairo is doing?? Hope you both have a good day. Blessings
Patti
We've had to go through ear trauma with horrifying regularity recently. Our old lad (no longer with us) had terrible bother with his ears and when it first started, it was a nightmare doing it but he soon learned that the ear drop bottle meant a tasty treat and he'd run into the bathroom and assume the position when he saw me with the bottle. Sadly, the same is NOT happening with Cairo - he just runs and hides when he sees the bottle and when I get a hold of him, he's giving me the eye and does the clacking of teeth to tell me that he's not happy. Ten drops the vet said - yeah, right, we have to assume the "squirt and run" technique. There is no time to be counting drops.
His ear seems to be OK but I'll definitely keep an eye on it.
I don't know if he's lazy or not feeling well or just suddenly enjoying car rides but he's obsessed. We live on quite a steep hill and I've not been feeling great, my mum has a chest infection just now, so I've been putting him in the car, driving up the hill and then going for our walk on the flat - now he doesn't seem to be wanting to walk - he wants back to the car!!
He's also fast panting a lot on walks - like he's stressed and he's constantly looking for his tugger toy to carry - he likes carrying things - it's like a comforter for him the way you give a baby a soother. He's panting and darting back and forth and sitting in front of you till he gets his toy, then he seems to be happier once he's carrying it. Not sure what's going on there.
My Tipper is like that in the car. She used to love the car and sit in her car seat. Now she is uncomfortable in her doggy car seat, so I removed it and pit a pillow on the car seat so she has some padding. The redistribution of fat is bothering Tipper I think, it makes their skin thin, and crowds their organs if they lay a certain way I guess. Just watch the heat, as Cush dogs cannot tolerate the heat. Blessings
Patti
Normally my mum comes out with us but tonight she was waiting on my brother calling round so I just went to take Cairo out myself - we got 10 yards from the gate and he sat down and he was trembling like a leaf and just wouldn't budge - that is not like him.
Eventually my mum had to come out just to get us started and she went back home and he did carry on walking but he wasn't his usual self. He seems really stressed on a walk. I gave him his toy to carry to try and soothe him a bit but when I asked him if he wanted to go home, he turned round and all but ran down the road.
We've noticed that the edges of his ears have lost their fur as well so he's going to the vet tomorrow afternoon.
He's not eating much and his drinking is normal and his peeing is normal as well but he just doesn't seem right. It's such a worry.
Just thought I'd share a couple of pics of him
http://i41.photobucket.com/albums/e2.../Photo0195.jpg
https://farm8.staticflickr.com/7071/...7118d384_b.jpg
https://farm8.staticflickr.com/7321/...376e2bbb_b.jpg
He is a beautiful dog. I see what you mean about the toy. I mentioned that Tipper acts really strange at times too, like she is afraid of something. I know this Vetoryl can change their personality, and Tipper is afraid of every noise. When her cortisol is at a lower range I can tell by her reaction to things, she is more afraid of noises etc. Hope you get things worked out. Blessings
Patti
Yeah, he seems to be scared of something. Shaking and trembling. A lorry hissed it's air brakes and he hit the ground.
I took him somewhere different last week for a walk and he was really scared as well - like he couldn't handle unfamiliar territory.
I know what you are saying that is exactly what Tipper does. She almost pulled out of her harness one time trying to get in the house when the wind blew and it scared her.
I wonder if his cortisol is low. When it gets low, they can't always handle stress situations or anything they perceive as stressful as good as they use to. I'd ask them to do at minimum a baseline and electrolyte to check.
He is absolutely lovely. The pictures are wonderful, thanks for sharing.
Sharlene and molly muffin
I'm hoping the vet will check his bloods tomorrow - though the appointment isn't a great time - it's at 5.10pm and he gets his meds at 10am - so that'll be 7 hours after his vetoryl.
Something just isn't right and I guess I'm more worried because he's not been getting the stim tests - just baseline cortisol - due to the synacthen shortage here.
And thank you - I'm a bit biased but I think he's a gorgeous boy.
I hope the vet is able to help you. It is a shame about the shortage, is there nothing that can be done to get some?? I hope all goes well. Blessings
Patti
What if you give it at 11 or 12 tomorrow? That would put you at least in the 6 hour window when the vet seems him at 5.
Yes I agree, it seems off doesn't it.
Crud about the shortage still. I thought they were going to be getting some in?
Sharlene and molly muffin
The vet said that stock was coming back in but we've not been told we can get the stim test done yet.
Good thinking about the timing of his meds. Never thought of that. Will it be OK to give him his meds 2 hours late for one day then go back to normal times?
I would probably give it an hour early the next day, same the following to get him back on his regular time.
Sharlene and molly muffin
The vet phoned and changed his appointment earlier so that he was within the 6 hour window for a stim test.
Just had a phone call from her to take him back - he's to get an emergency steroid injection - his levels are way too low.
I don't know the numbers yet - I just feel sick.
Will report back later.
Hi Alison,
I just checked in real quick from work and saw what is going on with Cairo. Please ask the vet to check his electrolytes also, as they can get out of whack when the cortisol gets low. If they are abnormal, he may need some additional medication to stabilize them. He may need IV fluids also.
This happened to my pup also. Try not to worry, you are taking him right back and the steroid injection will get him on the right track.
I will check back in later.
Hugs,
Tina and Jasper