Tess, radiation therapy (Tessie has passed)

Good morning. Tessie slept really good. Know heavy breathing. Her body was not to hot or cold. She still did not want any dog food, but she did like the little peace of cheese i gave her. All my dogs are on WD can and dry. She did sneeze about 5 or 6 times in row last night and that was it. When I took the other dogs for a walk she heard the leashes and wanted to go, but then laid her head back down. Took her back to My Vet today. He said he did not think he was going to do labs to day. I said do a complete panel to be safe. I asked if her kidneys were bad. He said no. He said when I brought her in from the E-Vet, Yes they were high but now the BUN was back to normal. I said I wanted a copied of any blood work for my file. Know problem there. Some times he does some blood work in house and sometimes he sends it out. He is going do a xray of her lungs, stomach, kidneys today.
Yes I have been feeling guilty, so I will leave that Leslie. I am completive, but I let this one go to you LOL hugs. So more info tonight ty all again dottie

Dottie, of the 2 values, creatinine & BUN, creatinine is actually the most important because a lot of different things can affect the BUN including dehydration, before the creatinine is affected. Since Tess was so very dehydrated, it's not unexpected that her BUN was elevated. I would suggest you specifically ask about the creatinine. I'm not to sure how much an x-ray is going to show about any possible kidney issues, that may require an abdominal ultrasound.

Has your vet said anything about doing an ACTH? You really do need to know where Tess' cortisol level is pretty soon, in order to determine whether or not she needs to be supplemented with oral steroids such as prednisone. If her adrenal glands have totally shut down & are making little or no cortisol. I'm very concerned that she could relapse very quickly. The eating right now is not as important as the drinking. Dogs can go several days without eating. It's very important that she is drinking, even with the IV fluids. How is she doing with her drinking?

Debbie

Dottie,

I have been thinking of you and Tess and appreciate all of your updates. I have a concern and I hope it doesn't upset you. You mentioned you went back to your regular vet today for more testing. Given what happened with the trilostane I think it is very clear that he did not follow protocol and clearly is responsible for Tess' current situation. I would be very hesitant to trust future testing for cushings or addisons in his care. This is not unusual. We see it here alot sadly.

Vets have alot going on and it is difficult to know everything about every disease. This is why there are specialists. Glynda lives in LA and gave a couple names that she would recommend. If you don't want to do that I would at least find a regular vet that has an understanding and experience with cushings.

Again I do not mean to upset you because you have so much going on. Tess can lead a normal happy life but she now has special needs. Big hugs to you and yours,
Kim

Ok back home with Tessie. She is doing great. She is running, she ate some dog food at My Vets.

Now I got it wrong about the 95% adrenal. It is Pituitary like you all of said and My Vet had said. When you are up set you just don't hear thing right.

My Vet spoke with a specialist today. With giving Tessie 60mg of Vetoryl. I pulled the instructions out of the box. It says for a dog 22 to 44 pounds starting does once a daily is 60mg. My Vet did nothing wrong. I went to Vetoryl web site and it said the same thing. I thought it had said 30mg, but again being up set, I was wrong. The specialist said the only time she had seen something like what happen to Tess happen is when the dog was given to much Vetoryl. Which we now know that is what happen, but my vet was going by the instructions of Vetoryl. The FDA approved this drug May 16th 2009. This is really new. The specialist said that the dog would bounce back in a few days.
Now My Vet said on Saturday that if I had any problems with Tessie to give him a call at home. I was the one that did not won't to bother him on his day off and it being a holiday weekend. He again told me today, call him if I see anything that freaks me out, know matter what hour it is. So I couldn't ask for a better Vet. He did do a ACTH test before we gave Tes Vetoryl. The x-rays today showed know cancer, her kidneys are fine.
Now Tessie will not be given any drug until she is 100% back to her old normal, before she ever took this drug. When she start's a drug it will be on a low dose and blood test to see were we are. I bought pet insurance for her today. She is back at being a cushing dog.

I think my vet did a great job based on the information that he has on this drug. He said for 20 years he has been giving dogs Lysodren and only had one problem with a dog. Now I was the one that asked for Vetoryl. This is a new drug to every one, maybe not some, but out here in S. Cal. like I said FDA just put it out on 5/16/09 so I am standing by my vet. I can not see that he did any thing wrong.
Labs for today:
ALB 1.7
ALP 0
ALT 330
AMY 334
TBIL 0.5
BUN 25
CA++ 9.6
PHOS 6.3
CRE 0.9
GLU 87
NA+ 138
K+ 4.7
TP 6.3
GLOB 4.6

HEMATOLOGY RESULTS
HCT 34.7
HGB 12.0
MCHC 34.6
WBC 12.7
GRANS 10.7
% GRANS 84
L/M 2.0
%L/M 16
PLT 334
All of these except the first one in the HEMATOLOGY RESULTS all says Tes is normal. The HTC is low and the HGB is right on the boarder of low/normal in accordance to this chart.

So I really do appreciate everyones input. You have all given me great questions to ask my Vet that I would of never know to ask. I really do appreciate your help and when Tes does start treatment again I will be asking more questions. I am hoping it will go a lot smoother the next time around. In fact I know it will because of my crash course on cushing from all of you.

I hope my case will help someone else. There is nothing out there on this happing to a dog in just two days of treatment. Now there are two case's of this happing with Vetoryl. With this being a new drug there will be more, but now someone will know what to do because of all of you helping me. I can not thank you enough. You were all apart of saving Tessie life. Thank You thank you thank you. It feels so good to see her running again, or want to run. Ok going to go a spend time with her. My Vet deserves a big hug too. I think he did a good job based on the information he was given. No fault to him. I read some were in the last days of all of this that Vetoryl came out with 10mg dose. Maybe two many dogs at 25 pounds were ODing on this stuff. Ok bye for now Dottie

P.S. going back on Monday to do blood work to find out were she is at, how she is doing. I want to wait at lest a week before we try any more medication for cushings. Dottie

Dottie,

I'm so glad Tess is doing better. My Munchie was in a similar situation with Trilostane (Vetoryl) but not as severe as Tess. His specialist performed a new ACTH stim test, not for the purpose of diagnosing but as a follow-up and the drug had to be immediately stopped plus he was put on emergency prednisone. A new ACTH stim needs to be done to see where Tess is now and how much damage has been done to the adrenals.

Prior to restarting any drug (either Lysodren or Trilostane) she needs to become symptomatic again (the Cushings symptoms need to return) plus an ACTH stim test is absolutely necessary to make sure she has returned to normal. Tess could end up having to return to the ER with another emergency if she is given a cushings drug again and she has not returned to normal. The only way to determine this is through an ACTH stim test. This information is in the Vetoryl Treatment and Monitoring Flowchart and I hope I have helped you by passing it along.


Also, my Munchie was given Trilostane (Vetoryl) back in 2007. It's been around for awhile but has finally just been approved by the FDA here. Previously you were able to get it here (I live in CA too.) either by ordering through Masters Marketing or the veterinarians could write a prescription and a compounding pharmacy would fill it.

Hope Tess continues to improve.

Louise

Hi Dottie,

I am glad that Tessie is feeling better. Vetoryl has been approved for use for many years in the UK and many of us ordered from the UK or had it compounded by a pharmacy before it was approved in the USA. It has been available and used for many years and all of the documents I have seen have stated to start the dog with less than 5mg per kg and many say only 1 - 2mg per kg. Tessie at 22lbs is only 9.9kg so 60mg Vetoryl would be too high a dose to start, maybe she would have to end up by taking that but certainly not to start.

Any adverse reactions means a 7-10 day stop of medication and an ACTH stim test must be performed to get the current cortisol number, then continue with a lower dose and another ACTH in 10 days to see how it is going.

After the way Tess reacted to the original dose of Vetoryl I would definitley not restart her before having an ACTH and then maybe try the 10mg. This is only my opinion but if you read up in the Important Info section on Vetoryl and dosing this is what I am basing my thought on.

Please keep us in the loop because Tessie is now one of "the family"

Jenny

Dottie,

I know it is a little early as Tessie is not completely out of the woods, but I am doing the happy dance for little Tessie. It sounds like she is on the mend. And I will continue to send the healing thoughts and prayers her way. As Jenny said, Tessie is part of our family now.

I am glad that your vet has consulted with a specialist. We all realize how upset one can get with the initial diagnose and not understand or relay all the information that the vet says. I did not realize that the vet had been using lysodren for years and this was the first time that he used trilostane. I would think that he would have researched the drug before prescribing it, even at an owners request. I used trilostane with Sachi in 2005 (and I am in Southern California also). It was not FDA approved at that time, but available as an off-label from Masters Marketing in the UK. I, along with my vet, had to do alot of research on it because it was very new in the US. We had a rocky road, but paved the way for a smoother path for the others that followed in his practice. Thankfully Tessie will be okay and he will learn from her experience which will benefit all those that follow her. Always start at a low dose.

Lots of hugs to go around.
~Mary Ann

Quote:

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Originally Posted by BestBuddy

Hi Dottie,

I am glad that Tessie is feeling better. Vetoryl has been approved for use for many years in the UK and many of us ordered from the UK or had it compounded by a pharmacy before it was approved in the USA. It has been available and used for many years and all of the documents I have seen have stated to start the dog with less than 5mg per kg and many say only 1 - 2mg per kg. Tessie at 22lbs is only 9.9kg so 60mg Vetoryl would be too high a dose to start, maybe she would have to end up by taking that but certainly not to start.

Any adverse reactions means a 7-10 day stop of medication and an ACTH stim test must be performed to get the current cortisol number, then continue with a lower dose and another ACTH in 10 days to see how it is going.

After the way Tess reacted to the original dose of Vetoryl I would definitley not restart her before having an ACTH and then maybe try the 10mg. This is only my opinion but if you read up in the Important Info section on Vetoryl and dosing this is what I am basing my thought on.

Please keep us in the loop because Tessie is now one of "the family"

Jenny

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Hi Jenny, I agree 100%. I already told my vet today that we would be starting with 5mg dose after he takes ACTH test again. My Vet and my self are on the same page. He is going to do a panel on Tes Monday just to see were she is at, but I am going to wait those 10 days before we start up again.

He said ACHT test would be run before I ever had a chance to say anything. He called the specialist, because he had never had this happen to him with Vetoryl in two days. He was going by what the manufacturer of Vetoryl has said what the does is supposed to be for a dog 25 pounds. Vetoryl website chart under Vet also give same dosage, 25 pounds 60mg. Now we all know this soooo wrong. What I have read yes its been around in the UK for along time, but I am in Southern California and in my area it has not legal been around at my Vet"s office. So my Vet would know about it, which he did, but not a lot of dogs on it around here. I can bet you are going to start to get a lot more USA dog owners coming to this great site for help. I was at my wits in when I e-mail the adminastrighter of this website. Thank you for the Information section. I will go read it right now Bye for now Dottie

Hi Dottie,

I am so glad you are looking into this disease so that you can learn how to be the best advocate for Tessie. Any good vet will listen and discuss treatment options when they know you have an understanding about cushings.

I am also glad to hear that Tessie will be having an ACTH test before any more treatment because it may be that Tessie doesn't need any more medication, stranger things have happened. Please get the results so we can all see.

While we are all waiting for the next step tell us a bit more about Tess. Have you had her since she was a pup and when did the cushings symptoms appear. Which ones does she have.

Jenny

Hi Dottie,

First, I want to repeat what Jenny said - you and Tess are family now so please stick around. :) I, for one, would be worried to death if we didn't hear from you and Tess again. :(

As others have already said, Trilo (Vetoryl) has been in use in the US for a long time, it just hadn't been approved by the FDA yet. So there have been many folks using Trilo for quite some time here, getting it by either ordering from the Uk (where it's use started, I believe) or by having it made up (compounded) by a pharmacy set up to do that. It's use wasn't illegal in the US, it just hadn't been approved so wasn't being manufactured here yet.

When Squirt was first diagnosed and had done a little reading, Trilo was the way I wanted to go. But one of the reasons I decided against it was because my vet had never used it tho she had heard of it. I wasn't willing for Squirt to be the Guinea pig...I was too scared for that. :eek: So to me, you are very brave to let Tess be his first Trilo patient!

You have already learned so much, Dottie! :) And you did it standing in the midst of the roaring fire of an Addisionian crisis! :cool::cool: You should be very proud of yourself, honey. I am!

Now that Tess is doing better and seems to be on the way to recovering from this crisis, you have a bit of time to learn a little more. And we will help you.

Telling your vet that you want to start with a lower dose and having him agree with your desires, is a great start! This tells me he will work with you as a team for Tess and that is admirable. You done good, girl! :cool:

You are absolutely correct in wanting to have her tested with the ACTH. This test will let you and your vet know where her cortisol is after some time off the Trilo - which is critical before any cush meds are resumed. The ACTH is vital in monitoring the adrenals for a pup on treatment. Again, kudos to you! :cool:

One thing I'm not clear on is the 10 days you spoke of. It may be many months before Tess is ready to resume treatment, if ever. It is possible that her adrenals have been eroded to the point she won't need meds again. This is what happened to Jenny's Buddy.

Also, you don't want to have her tested if she is ill from some other source or really stressed for some reason as this could easily give higher readings than are true for the cortisol. So if that 10 day mark rolls around and there is any reason for holding off on the ACTH for a few more days, that is fine and actually preferred.

I do have one suggestion, a recommendation actually. Before you restart the Trilo, have the UTK panel run on Tess. It could be that she is Atypical. Since we don't know for sure what her cortisol levels were to start with, it is hard for us to know for sure what form of Cushing's she has. So it would be in her best interest and best for your pocketbook to rule out Atypical before starting the Trilo again. Trilo has been shown to cause certain other hormones to elevate resulting in the same signs and damage as elevated cortisol.

Now, you can help me. :) On the insert you have on the Trilo, could you look on it and see if there is a date given for when the protocols given in the insert were established? Also, what is the Vetoryl site you are looking at?

Keep reading and ask lots of questions while we wait for Tess to recover and you will be much more prepared for the next step. I am so glad you contacted Terry!

Keep up the good work!
Hugs,
Leslie and the girls

Hi again,

Something I forgot to mention about the Trilo. When it was first being used, the belief was that if a pup had a problem then all that needed to be done was to give the pup time and let the drug get out of their system. It was thought that once the Trilo was out of the body, the pup would be just fine. After it had been in use for awhile and there were quite a few cases like Tess', it became clear this original line of thinking was wrong.

Now it is known that even after the Trilo is out of the body, damage can continue to occur because the adrenals are not producing or releasing enough of the hormones that are necessary to maintain proper balance and health in the dogs system. Researchers have learned over the years, that once a pup has gone into an Addisonian crisis like Tess has, it is VERY important to supply these hormones externally - as in a pill or shot. This is why we have been so concerned that Tess was not in the hospital on IV's supplying electrolytes along with extra fluids. Having pred at home for her is also critical so you can give her a boost or steroids if needed, which is what cortisol is.

Since your vet is not familiar with Trilo it is good he consulted with a specialist. But based on what the specialist said about just giving her time, it sounds as if even the specialist isn't up on the studies done on Trilo, either. Which isn't surprising since many vets in the US have limited experience with this drug, even specialists.

One thing you can do at home to help keep her electrolytes up is to give her Pedialyte (sp?). The stuff kids use when they are sick. :o:rolleyes: I have used it on my pups often when they have diarrhea or vomiting over a period of time. It comes in unflavored as well as flavored. Mine refused flavored forms but will take the unflavored. You can add it to the water or put it in the food.

Since your vet isn't able to keep her over-nite then having pred and Pedialyte on hand will give you some tools to help her if she starts to go back toward Addison's.

I wanted you to be aware of this development in Trilo overdoses so you know it takes more than just time off the drug for Tess to recover. They say knowledge is power and that certainly is true when dealing with Cushing's!

Hugs,
Leslie and the girls

Dottie, I am delighted to hear that Tess is feeling so much better. We were all pretty worried about her.

Since you mentioned that Tess is your vet's first Trilo patient, both of you may be interested in the information on Trilo from the following link in the important information section of the forum. The second half of the link give information on the UC-Davis vet school's protocols for using Trilo. Davis has pretty extensive clinical experience in using trilo with our pups, & probably has seen most any reaction that may occur using Trilo. Your vet may be especially interested in this section as the information is coming from other vets who are using Trilo on a daily basis.

Debbie

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

Quote:

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Originally Posted by Squirt's Mom

Something I forgot to mention about the Trilo. When it was first being used, the belief was that if a pup had a problem then all that needed to be done was to give the pup time and let the drug get out of their system. It was thought that once the Trilo was out of the body, the pup would be just fine. After it had been in use for awhile and there were quite a few cases like Tess', it became clear this original line of thinking was wrong.

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Hi I spoke with the Doctor that wrote the article you wanted me to read (Dr. Hoskins is owner of DocuTech Services. He is a diplomate of the American College of Veterinary Internal Medicine with specialities in small-animal pediatrics. He can be reached at (225) 955-3252) I told him what had Happened to Tess. I was amazed he answered his phone. Any way He feels what my vet is doing right now for Tes is correct. As long as she is eating and drinking water and we are monitoring her blood. He said keep her in a stress free environment and wait at lest 2 weeks before starting any thing on Tes. Once she is back to her old normal, repeat the ACTH.

Quote:

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Originally Posted by Squirt's Mom

Now it is known that even after the Trilo is out of the body, damage can continue to occur because the adrenals are not producing or releasing enough of the hormones that are necessary to maintain proper balance and health in the dogs system. Researchers have learned over the years, that once a pup has gone into an Addisonian crisis like Tess has, it is VERY important to supply these hormones externally - as in a pill or shot. This is why we have been so concerned that Tess was not in the hospital on IV's supplying electrolytes along with extra fluids.

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Tess was in hospital getting a IV and a Sterol shot, I took her home at night because there was know one there to watch her. She has had a IV for four days. My Vet and Dr. Hoskins both agree if she is not show any signs of vomiting then to let her alone. Not to give her any Pedialyte or a Sterol shot, just let her alone.

Quote:

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Originally Posted by Squirt's Mom

Having pred at home for her is also critical so you can give her a boost or steroids if needed, which is what cortisol is.

Since your vet is not familiar with Trilo it is good he consulted with a specialist. But based on what the specialist said about just giving her time, it sounds as if even the specialist isn't up on the studies done on Trilo, either. Which isn't surprising since many vets in the US have limited experience with this drug, even specialists.

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My Vet went to UC Davis and he spoke to the specialist at UC Davis. He is very familiar with Trilo which I am calling Vetoryl, But here in the USA it just got approved on May 16 2009 that was seven weeks ago. He read all the information on Vetoryl. Vetoryl website say's to give 60mg to a dog 25 pounds. My Vet did nothing wrong.

Quote:

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Originally Posted by Squirt's Mom

One thing you can do at home to help keep her electrolytes up is to give her Pedialyte (sp?). The stuff kids use when they are sick. :o:rolleyes:

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I don't have any children so I don't know what this is. SIDE NOTE Tessie is sitting on the couch barking at the neighbors. A very good sign.

Quote:

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Originally Posted by Squirt's Mom

I have used it on my pups often when they have diarrhea or vomiting over a period of time. It comes in unflavored as well as flavored. Mine refused flavored forms but will take the unflavored. You can add it to the water or put it in the food.

Since your vet isn't able to keep her over-nite then having pred and Pedialyte on hand will give you some tools to help her if she starts to go back toward Addison's.

I wanted you to be aware of this development in Trilo overdoses so you know it takes more than just time off the drug for Tess to recover.

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I agree 100% that is why I took her up to have her blood drawn after I read your note here and I called that Doctor (Dr. Hoskins) he lives in Kansas Missouri. He was very nice and said that every thing my vet is doing is correct, except for the 60mg of Vetoryl, but again that was know vault of my vet. Vetoryl website said the same thing for dosage.

Quote:

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Originally Posted by Squirt's Mom

They say knowledge is power and that certainly is true when dealing with Cushing's!

Hugs,
Leslie and the girls

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Forgot to post Tessie Lab results for today

ALB 2.1
ALT 253
AMY 433
TBIL 0.5
BUN 32
CA++ 10.9
PHOS 6.8
CRE 1.2
GLU 115
NA+ 143
K+ 5.9
TP 7.0
GLOB 4.9
HEM 0
LIP 3
ICT 0
QC OK
Tessie goes back on Saturday 8:00 am for another blood test. Dottie

Dottie, could I ask one favor, please? When posting any lab results, please include the normal ranges & reporting units, such as ug/dl, ng/ml. etc. Normal range & reporting units can vary from lab to lab. In order to give you any meaningful feedback, I would like to see these 2 things, also.

Thanks,
Debbie

Quote:

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Originally Posted by StarDeb55

Dottie, I am delighted to hear that Tess is feeling so much better. We were all pretty worried about her.

Since you mentioned that Tess is your vet's first Trilo patient, both of you may be interested in the information on Trilo from the following link in the important information section of the forum. The second half of the link give information on the UC-Davis vet school's protocols for using Trilo. Davis has pretty extensive clinical experience in using trilo with our pups, & probably has seen most any reaction that may occur using Trilo. Your vet may be especially interested in this section as the information is coming from other vets who are using Trilo on a daily basis.

Debbie

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

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Thank You Debbie Yes I read the info and I called the doctor who wrote the paper Dr. Hoskins I could not believe he picked up the phone. Told him all about Tessie and what happen. He agreed that every thing my vet is doing is correct, except for the 60mg of Vetoryl. But I have said. The package that Vetoryl comes in and the website both say 25 pound dog 60 mg. We know the hard way this is to much. Dr. Hoskins says Tessie should be on 10 mg twice and day. He said wait about two weeks before starting any of this. He said don't give Tessie any thing if she is drinking and eating. Just let her be. She will come out of it. If she stops eating then get her to the Vet. That is exactly what my Vet told me. Just let her be.

I took my lab top to the vet and showed him the article. He had already read it. My Vet is a graduate from UC Davis. Now we could all argue the fact, then why did he give UK does of Vetoryl instead of the UC David dose, Because that is what was on the manufacture box. By law, to keep his vet license he would have to go by what the manufacture but on the box. Dr. Hoskins is right now fight this with the manufacture and maybe that is why Vetoryl came out with a 10mg on June 11 2009. I am just guess with vet license, but Dr. Hoskins did say the other thing. Dottie

Ok Lab results with range

ALB 2.1 2.5-4.4 G/DL
ALT 253 10-118 U/L
AMY 433 200-1200 U/L
TBIL 0.5 0.1-0.6 MG/DL
BUN 32 7-25 MG/DL
CA++ 10.9 8.6-11.8 MG/DL
PHOS 6.8 2.9-6.6 MG/DL
CRE 1.2 0.3-1.4 MG/DL
GLU 115 60-110 MG/DL
NA+ 143 138-160 MMOI/L
K+ 5.9 3.7-5.8 MMOI/L
TP 7.0 5.4-8.2 G/DL
GLOB 4.9 2.3-5.2 G/DL
MY VET went over this in detail, but would still like your opinion. Tessie does go back on Saturday morning.
Dottie

Quote:

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Originally Posted by Sammie

The package that Vetoryl comes in and the website both say 25 pound dog 60 mg. We know the hard way this is to much.

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On the package insert, they do say the starting dose is 1-3 mg/lb and it also shows a dosing chart that says if a dog weighs between 10-22 lb that the starting dose is 30 mg per day and that for a dog who weighs 22 to 44 lbs that the starting dose would be 60 mg per day.

http://www.dechra-us.com/File/prod_vetyrol.pdf

But I did find something on the Dechra US website that does also say to start with a lower dose ... I had to really root around for a while on the Dechra US site to also find it though. And I think they should really add the recommendation that is on their website (to start with a lower dose) to the package insert.

http://www.dechra-us.com/page/veterinarians#Prescribing

Quote:

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Ideally, the starting dose to aim for is 1.0 to 3.0 mg/lb (2.2 to 6.7 mg/kg) once a day based on body weight and capsule size. When calculating dosage, it is suggested to round down. Start at the low end of this range. If you have any questions on dosing, contact Dechra Technical Support at 866-933-2472 or support@dechra.com.

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Hey Dottie,

Thanks for the reply! You got it going on, girl...calling docs and asking questions then coming here and sharing with us what you have learned! I hope you understand that is what we are doing when we give you the information we have gleaned from living with Cushing's on a daily basis. :)

I am very glad to hear that someone is working on getting the UC Davis protocols included in the Trilo information. It certainly should be! That would help prevent some other pups from suffering what Tessie just went through!

Debbie will be along soon to give you her take on the labs, I'm sure. Thanks for posting them and the extra info she asked for. That really helps!

Hugs,
Leslie and the girls

HI Acushdogmom this is what I copied from there web sit and this is what in the vetoryl box say's
Starting dose

VETORYL Capsules should be administered orally once daily in the morning with food. Administration with food will significantly increase the rate and extent of absorption of VETORYL.

Ideally, the starting dose to aim for is 1.0 to 3.0 mg/lb (2.2 to 6.7 mg/kg) once a day based on body weight and capsule size. When calculating dosage, it is suggested to round down. Start at the low end of this range. If you have any questions on dosing, contact Dechra Technical Support at 866-933-2472 or support@dechra.com

Tessie is 25 pounds, with this chart it say's 60mg or am I looking at this wrong?
Dottie
PS can some one tell me how to calculate a MG by pounds. TY again

*Dogs over 132 pounds (60 kg) should be administered the appropriate combination of capsules.

Dottie, in general, these labs are much improved compared to the weekend. Unfortunately, I still have a concern. The Na:K ratio (sodium/potassium) is not listed, so I calculated it myself. Right now, Tess' ratio is 24.2, definitely improved over the 20. something it was when she was at the ER clinic. This value still indicates a moderately severe electrolyte imbalance as normal range is 27.1-40.1. This may be an indication that the adrenal glands are still not producing enough cortisol or more importantly aldosterone to adequately control Tess' electrolyte balance. Please bring this to your vet's attention as I believe this still indicates that Tess has a certain degree of Addison's in play, not as much as over the weekend, but I feel there definitely could be a problem. At the first sign of any issue with Tess, even something as mild as slightly increased lethargy compared to the past couple of days, I would strongly encourage you to contact your vet.

Debbie

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Originally Posted by Squirt's Mom

Hey Dottie,

Thanks for the reply! You got it going on, girl...calling docs and asking questions then coming here and sharing with us what you have learned! I hope you understand that is what we are doing when we give you the information we have gleaned from living with Cushing's on a daily basis. :)

I am very glad to hear that someone is working on getting the UC Davis protocols included in the Trilo information. It certainly should be! That would help prevent some other pups from suffering what Tessie just went through!

Debbie will be along soon to give you her take on the labs, I'm sure. Thanks for posting them and the extra info she asked for. That really helps!
Hugs,
Leslie and the girls

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Hugs right back at you Leslie. I am thinking you guys think I am mad at you and I am not. I think all of you are so cool to take the time to help me out. I would of never know about the information part of this website, because I am so worried about Tes. By all of you helping me to get the info I need NOW is so helpful then me surfing around for it. You have all helped me, and saver her life. If I could hug you all it still would not be a big enough THANK YOU to all of you. Please keep throwing it out there to me. I take it right back to my Vet. When he gives me the same answer as you or from Dr. Hoskins who is the top expert in this field. Still can't believe he picked up his phone LOL He was so cool and I went on and on for 20 min before he could say any thing LOL very nice man. He does know about your web site. I asked him LOL. Any way please don't take me mad at any one. Just worried and very direct. I am giving you all a big group hug I hope you can feel it. I do feel it from all of you Dottie:):o:rolleyes:;):D:p

Dottie you made my day sharing that story of calling up Dr. Hoskins. That rocks!

We don't mean to hound you with questions and it is particularly hard with new members whose dogs are in distress. We get hundreds each year and it is like being a 911 operator sometimes. :p Typically a dog is in trouble the owner is following what they are told to do by someone (vet) who has never done it before. Owners know nothing about the disease and we brought in on the case when dogs are very sick and need immediate help. We have to be bold sometimes to make sure new members understand their dog's life is at stake. It can be scary and we do worry... alot.

You came on here not that long ago a "cushings virgin" but you are getting it! I will sleep better knowing that Tess' mom is on the case full time and asking questions and even calling a renowned specialist in the field to get the answers. Go girl go.

Quote:

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Originally Posted by StarDeb55

Dottie, in general, these labs are much improved compared to the weekend. Unfortunately, I still have a concern. The Na:K ratio (sodium:potassium) is not listed, so I calculated it myself. Right now, Tess' ration is 24.2, definitely improved over the 20. something it was when she was at the ER clinic. This value still indicates a moderately severe electrolyte imbalance as normal range is 27.1-40.1. This may be an indication that the adrenal glands are still not producing enough cortisol or more importantly aldosterone to adequately control Tess' electrolyte balance. Please bring this to your vet's attention as I believe this still indicates that Tess has a certain degree of Addison's in play, not as much as over the weekend, but I feel there definitely could be a problem. At the first sign of any issue with Tess, even something as mild as slightly increased lethargy compared to the past couple of days, I would strongly encourage you to contact your vet.

Debbie

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Debbie TY so much. The blood work he is running takes ten min. it is called a VETSCAN. It is not a full blood panel. I am running both panels on Monday. Yes later on today around 1:30 she looked lethargy, so I took her up and he ran this blood panel. At first he did not want to, because he did not want me spending the money. I joke around with him thats its toward his next VC. So because of this blood test she has to go back on Saturday. I was working Friday to Saturday, but now I have decided not to. My husband would be here while I would be gone, but I know Tes, she sleeps with me. I can see it on her face when something is up. So I was on the fence about it, but Debbie you have convince me. LOL Had I gone on my trip the night Tes really got sick, well she would of not been here. Not taking the chance now. My vet again said call him day or night at home if any thing looks weird. Told him I will never not call again. TY again Debbie for know how to translate the LAB work. Dr. Hoskins calculated Tessie 23 pounds to 10 mg of Vetoryl. Now how its done know clue. LOL I am a flight attendant. I can get you out of the aircraft in 90 sec or less LOL think the Hudson LOL that is what I say to PAX when they are talking during the safety video LOL I get a kick out of it LOL Dottie:o:)

To convert lbs to kg divide by 2.2

23 lbs divided by 2.2 = 10.45 kgs

Hi frijole. I am trying to explain to my husband what I did today when i called Dr. Hoskins and how you think I rock LOL ty for that. OK here is one for you. I am a flight attendant who is on the know fly list. Now I have a ten year back ground check done on me every year, so ask how could I be on the know fly list. I don't have a strange last name. I got pist-off at BUSH and called the White House. Now I got the White House and spoke to one of Bush's internees that take complaints. I was a adult about it. Know cruising, Just the Facts mama Just the Facts. Well that got me on the list for the last 8 years to now. LOL I found this out a few months later, because my husband and I flew together some where, they stopped me, I had to go see a agent to have it fix and nothing to my husband, just me. LOL I think its kinda funny Dottie:)

The electrolyte imbalance is actually the most dangerous aspect of a Cushing's medication overdose (whether it be Trilostane (Vetoryl) or Lysodren). The reason it is so dangerous and potentially deadly is that for the nerves and muscles to work properly the electrolyte balance has to be correct. This means that the function of the heart can be affected and that is when it can get deadly.

As Debbie says it looks like Tess's adrenals are not at the moment producing enough aldosterone (which is the hormone that regulates the electrolytes). This means that she really needs to have the aldosterone production supplemented with a special medication called Florinef. (There is another medication that is used sometimes when the aldosterone production is known to be permanently reduced but is a long acting injection and when it isn't known whether the low level of aldosterone is permanent or not then Florinef (which is a daily pill) is often used at first.)

Maybe you can encourage your vet to talk to Dr. Hoskins (is he the specialist?) about Tess's electrolyte ratio and the possibility of supplementing her with Florinef. It should make her feel an awful lot better and will mean that she isn't at risk of a dangerous heart arrhythmia.

Your vet should be able to just check the electrolytes without necessarily running any other tests which should keep the costs down.

Alison

Quote:

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Originally Posted by frijole

To convert lbs to kg divide by 2.2

23 lbs divided by 2.2 = 10.45 kgs

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Oh this is so cool I did it, it works. But is 10.45kgs also mgs?
Dottie

Quote:

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Originally Posted by AlisonandMia

The electrolyte imbalance is actually the most dangerous aspect of a Cushing's medication overdose (whether it be Trilostane (Vetoryl) or Lysodren). The reason it is so dangerous and potentially deadly is that for the nerves and muscles to work properly the electrolyte balance has to be correct. This means that the function of the heart can be affected and that is when it can get deadly.

As Debbie says it looks like Tess's adrenals are not at the moment producing enough aldosterone (which is the hormone that regulates the electrolytes). This means that she really needs to have the aldosterone production supplemented with a special medication called Florinef. (There is another medication that is used sometimes when the aldosterone production is known to be permanently reduced but is a long acting injection and when it isn't known whether the low level of aldosterone is permanent or not then Florinef (which is a daily pill) is often used at first.)

Maybe you can encourage your vet to talk to Dr. Hoskins (is he the specialist?) about Tess's electrolyte ratio and the possibility of supplementing her with Florinef. It should make her feel an awful lot better and will mean that she isn't at risk of a dangerous heart arrhythmia.

Your vet should be able to just check the electrolytes without necessarily running any other tests which should keep the costs down.

Alison

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Hi Alison Dr Hoskins is the person who wrote the article posted on this website under resources:
Comparing therapies for canine hyperadrenocorticism
Oct 1, 2007
By: Johnny D. Hoskins, DVM, PhD, Dipl. ACVIM
DVM NEWSMAGAZINE

When I see my vet on Saturday I will talk to him about Florinef, but Dr Hoskins who I called today and my vet along with the UC Davis specialist are all saying just leave her alone. Give her nothing unless she stop's eating, gets really lethargic, ( which she is barking up a storm when the other dogs are barking) or she doesn't want water, but not wanting food is main one. I will ask him. I GOT INSURANCE ON TES. LOL very proud of my self. Saved money today. Dottie:)

Quote:

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Originally Posted by Sammie

Oh this is so cool I did it, it works. But is 10.45kgs also mgs?
Dottie

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10.45 killograms equals 10,450,000 milligrams

http://www.ilpi.com/MSDS/ref/massunits.html

Usually the dogs weight is converted to kgs and the medicine dosage is in mgs. Is that where you were headed with this?? ;)

Regarding the no fly list... perhaps they overheard someone calling you a "terror" and thought they heard terrorist? :D:eek:;)

OK.. so according to our experts here the main thing we want to focus on for our Tess is the electrolytes. I had never heard of the Pedialyte stuff that Leslie mentioned either. But we have seen dogs' electrolytes improve simply by using it. Its cheaper than an IV! Just throwing it out as an idea should you need it. Kim

Is Dr. Hoskins aware of the results of the electrolyte test?

One thing that can help when there is a moderate electrolyte imbalance caused by low aldosterone is adding some salt (normal table salt not lite salt) to the dog's food. Before aldosterone was discovered and synthesized, supplementation with salt was the only treatment for this problem (caused by naturally occurring Addison's disease) in humans and dogs. A dog with this sort of electrolyte imbalance will often actually crave salt and will lick it off your hand if you offer it whereas a dog with normal electrolytes will look at you like you are crazy suggesting that they might find salt even remotely interesting! You could try offering her some salt on your hand - she will probably go for it if she needs it and turn her nose up at it if she doesn't.

Alison

PS: With this sort of electrolyte imbalance plain ol' salt is preferable to Pedialyte because Pedialyte contains potassium and her potassium is already too high. Pedialyte is great for general electrolyte depletion but an imbalance where the sodium is too low and the potassium too high you want to add salt (sodium) to help correct the balance. Often the dog's own body knows what it needs and the dog's appetite for salt guides it to take in as much as it needs. In the past (pre Florinef and Percorten) Addison's dogs were treated with cortisone and given free access to a bowl of salt that was kept beside their water and food bowls and the dog would eat salt as it needed it!

Hi Dottie,

You are doing a good job and Tessie is the one who will benefit. Reading and learning about this disease will help Tess and even your vet so keep it up.

Don't talk to me about US flight security....us Australians have great trouble over there in my experience. Several months after 911 hubby and I took a holiday in the US and we were targeted/profiled for extra security every flight we took. Even after the usual security checks we were nearly always pulled off at boarding to be searched again. Our bags were hand searched most times and I started thinking how funny it was for them to be going through dirty undies and socks as the trip progressed.

I know it is necessary but it gives you a bit of a complex after a while!

Jenny

I'm in Australia too and I've never traveled overseas but traveling domestically I get pulled over for special attention every time. Must be my dark hair and brown eyes - or maybe I just look too innocent....:p

Alison

To take the weight conversion, & trilo dosing one step further, based on the 1-3 mg/kg suggested dose, Tess' max dose of trilo would be 30 mg.

Debbie

Quote:

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Originally Posted by Sammie

Ideally, the starting dose to aim for is 1.0 to 3.0 mg/lb (2.2 to 6.7 mg/kg) once a day based on body weight and capsule size. When calculating dosage, it is suggested to round down. Start at the low end of this range.

PS can some one tell me how to calculate a MG by pounds. TY again

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I was a washout in math but since my dogs were diagnosed, I am a whiz at deciphering dosing. You don't have to convert the mg to lbs, you simply multiply the 1.0 to 3.0 mg by the pounds. So if Tess weighs 23 lbs, to find the range of dosing, you multiply 23 times 1 and 23 times 3. So the range would be 23mg to 66mg. You would round those down to 20mg - 60mg. Dr. Hoskins has correctly recommended going with the 20mg and splitting into twice daily dosing.

Dechra does recommend that you start with once daily dose but there have been studies that have shown twice daily dosing to be more effective. This is because Vetoryl/Trilostane has a short half life and it's enzyme blocking abilities start to diminish any time after 8 hours. We have had many members whose dogs did well throughout the day but symptoms never totally resolved and actually worsened in late evening. Things got better after switching them to twice daily dosing. I have two cushdogs and one did beautifully on once daily but my other one was on twice daily dosing. All dogs are different so you never know until you go through the motions and figure out the right dose. Just so you know, the majority of dogs do require at least one adjustment so gear yourself up to be very patient.

We're all very proud of you for taking the bull by the horns. You go girl!!! I'm blown away that you actually called Dr. Hoskins and was floored that he took your call. What a guy!!! I'm a total geek and bought his book, Geriatrics & Gerontology of the Dog and Cat. I've read it front to back at least four times and learn something new every time I crack it open.

You've come a long way in the last few days and it sounds like you are doing double time in trying to understand exactly what happened to Tess. This is all good and is exactly what Tess needs you to do. Like our mission statement says, we're all here to Support, educate and encourage so lean on us whenever you need to; immerse yourself in our Resources Forum...read, read, read; and ask as many questions as you like. There is almost always somebody here to respond.

Keep up the good work, Dottie, and we'll all be looking forward to your updates.

Glynda

Quote:

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Originally Posted by frijole

10.45 killograms equals 10,450,000 milligrams

http://www.ilpi.com/MSDS/ref/massunits.html

Usually the dogs weight is converted to kgs and the medicine dosage is in mgs. Is that where you were headed with this?? ;)

Regarding the no fly list... perhaps they overheard someone calling you a "terror" and thought they heard terrorist? :D:eek:;)

OK.. so according to our experts here the main thing we want to focus on for our Tess is the electrolytes. I had never heard of the Pedialyte stuff that Leslie mentioned either. But we have seen dogs' electrolytes improve simply by using it. Its cheaper than an IV! Just throwing it out as an idea should you need it. Kim

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KIM I really like that site you post. TY Yes been in my terrible two's of being a terror all my life LOL

Quote:

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Originally Posted by AlisonandMia

Is Dr. Hoskins aware of the results of the electrolyte test?

One thing that can help when there is a moderate electrolyte imbalance caused by low aldosterone is adding some salt (normal table salt not lite salt) to the dog's food. Before aldosterone was discovered and synthesized, supplementation with salt was the only treatment for this problem (caused by naturally occurring Addison's disease) in humans and dogs. A dog with this sort of electrolyte imbalance will often actually crave salt and will lick it off your hand if you offer it whereas a dog with normal electrolytes will look at you like you are crazy suggesting that they might find salt even remotely interesting! You could try offering her some salt on your hand - she will probably go for it if she needs it and turn her nose up at it if she doesn't.

Alison

PS: With this sort of electrolyte imbalance plain ol' salt is preferable to Pedialyte because Pedialyte contains potassium and her potassium is already too high. Pedialyte is great for general electrolyte depletion but an imbalance where the sodium is too low and the potassium too high you want to add salt (sodium) to help correct the balance. Often the dog's own body knows what it needs and the dog's appetite for salt guides it to take in as much as it needs. In the past (pre Florinef and Percorten) Addison's dogs were treated with cortisone and given free access to a bowl of salt that was kept beside their water and food bowls and the dog would eat salt as it needed it!

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Alison is sea salt ok. That is what we have in the house. I will try this. Tes is sleeping right now. snoring away. She walked around the block for the first time. Slow but that was ok. She did poop today LOL amazing how happing that made me. Dottie

Yep, sea salt is fine.

Alison

Quote:

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Originally Posted by BestBuddy

Hi Dottie,

You are doing a good job and Tessie is the one who will benefit. Reading and learning about this disease will help Tess and even your vet so keep it up.

Don't talk to me about US flight security....us Australians have great trouble over there in my experience. Several months after 911 hubby and I took a holiday in the US and we were targeted/profiled for extra security every flight we took. Even after the usual security checks we were nearly always pulled off at boarding to be searched again. Our bags were hand searched most times and I started thinking how funny it was for them to be going through dirty undies and socks as the trip progressed.

I know it is necessary but it gives you a bit of a complex after a while!

Jenny

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OK this is off subject, but after 911 I am in my Uniform, clearly you can see I am a F/A. Name tag, wings and my bra set's off the alarm. Wire bra. I get almost strip searched in front off all the pax going thru O'Hare ORD that day. If I new that they would of not locked me up, I would of said out loud what I was thinking. Security has lightened up a lot sense 911. Good for PAX, but not so good for me. :o

Put salt on my hand Tes just turned her head away, but got out some torte chips that were salt and she ate about three of those. Normaly Tes goes wild for her small little milk-bones, but she has been turn noise up at them. This is one of her favorite treats. Some said tonight about being Patent, did I mention I am a LEO we were not born with that DNA. Going to be working on this one Dottie:rolleyes: