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Thank you - I'm not having much success in finding the S-Adenosyl though. :(
He seems to be putting on a ton of weight as well and he really isn't eating much. He used to love his food and now it's hit or miss if he eats anything. He maybe feels a bit off.
Alison check amazon. That is where I always bought it from.
https://www.amazon.co.uk/s/ref=nb_sb...+liver+support
Ahh, brilliant, thank you.
Does this look like the right stuff?
https://www.amazon.co.uk/d/Dogs/Dett...+support&psc=1
No you want to have both milk thistle (silymarin) and sam-e (S-Adenosyl) if possible.
If not, get the S-Adenosyl separate at least but I would definitely want both.
We've got Cairo on a liver support supplement now since his alk phos was so high (over 1000 - 36) but his weight has been going up and up despite him eating very little.
Got another stim test done today and his post stim results were 625 (22.7). Vet isn't keen to start him back on vetoryl after what happened before but we've to monitor his water intake over the weekend and try and get a urine sample.
At these levels, would anyone recommend a restart to vetoryl?
Hello Alison, and welcome back to you and Cairo. Everything being equal, yes, I would consider restarting the trilostane in a Cushpup with that level of rebounding cortisol if he is also exhibiting symptoms, as well. It's true that he had problems with low cortisol before during treatment, but there are plenty of options for him to be dosed with a much smaller amount of medication. As I recall, he previously weighed about 60 lbs. and was dosed no lower than 60 mg. -- and was even started clear up at 120 mg. Since Vetoryl also comes in 5, 10, and 30 mg. capsules, it would be easy to start him off gradually at a much lower dose while monitoring how he does. It is always better to start low and work upward, rather than vice versa, especially since research has shown that large dogs may require less medication, mg. to lb., than do smaller dogs.
My one reservation in all this is his picky appetite. The general rule is to withhold treatment from a dog who is not eating well. One reason is practical: trilostane needs to be taken alongside food to be absorbed properly. However, you additionally worry whether there is some other medical issue going on that needs to be attended to. As you know, most untreated Cushpups have a ravenous appetite. However, having said that, we've seen a few exceptions here over the years: dogs whose appetites have suffered when cortisol is high and that have normalized once cortisol is brought under control (for our veterans, Sue's Zoe is one example). So if it turns out that Cairo's water intake is ramping up again alongside dilute urine, I think I'd be tempted to try a small dose of Vetoryl once again -- no more than 30 mg. and maybe even only 10 mg. as a trial run.
Please do keep us updated as to how he's doing, and also what you decide.
Marianne
Thanks Marianne
The vet said that if she did start him back, it would only be 30mg but I could speak to her about a lower dose.
Can he still take his anti-inflammatories whilst on vetoryl?
He was indeed started at 120mg despite my arguing with the vet (different vet now). He's now weighing in at 34kg (74.8lb) which is far too heavy for a stafford.
The strange thing is that his harness has never been adjusted in all the years he's been wearing it - his weight is all round his belly at the back and I would guess round his neck which to me is typical cushy places.
He is back to eating well since starting on the liver support supplement. I wouldn't even say his drinking was over the top to be honest, which are the two areas that you would expect with Cushings. However, I myself have Addison's and I didn't have the typical symptoms of that before diagnosis (the inappropriate tanning for one symptom).
Thanks so much for this additional info! If you do start back up with the Vetoryl, I don't think there'd be any problem with the anti-inflammatories. In fact, if you're using NSAIDS, I think it would probably be safer for him if you start lowering his cortisol. The combo of NSAIDS and higher levels of steroids (either natural cortisol or supplemental prednisone) is not a good one from a GI standpoint -- gastric irritation, even bleeding, can result.
If he now weighs 74 pounds, starting back at 30 mg. is not at all unreasonable. However, if you wanted to be super cautious, you could try the first month at an even lower dose. Based on ACTH testing at the end of the first 30 days, you'd have a much clearer idea as to how Cairo is tolerating the medication and how large an increase might be warranted. But as I say, I cannot argue with 30 mg., either, since I know you'd be watching him carefully.
Marianne
Hi Alison.
It might not hurt to bring his cortisol down a bit with the NSAIDs. I'd do a couple weeks and test and see how he reacts to it. A lower dose like 30 should be okay technically but you could even try 20 mg if worried. Be sure and do the follow up acth to see how he is reacting though
We measured Cairo's fluid intake over the weekend - only 700mls per day. Got a urine sample as well and the vet says that it's good - not dilute. She's frightened to start him back on any treatment "after what happened the last time".
I'm having a hard job getting through to the vet and my mother that the last time, he was just put on far too high a dose, so between them, they've decided to leave him be - unless he gets any worse.
It's so frustrating for me and I just hope the poor little guy isn't feeling unwell in any way.