Buddy, The Mighty Lizard Hunter - Suspected Pituitary Macro Tumor

An enormous THANK YOU and puppy love from Buddy to all of you. If I hadn't found your forum Buddy would still be taking Trilostane on an empty stomach and would had his ACTH Test yesterday fasted. I would have been throwing $$$$ that I can't afford down a black hole and Buddy would have had to go through the stress of an invalid test. Even worse than that, his dosage may have been changed based on the findings of the corrupted test. It could have been DISASTEROUS!
Instead I found support in an unlikely group of angels known as K9Cushings. I don't know how to begin to
thank you for being here when no one else was. A group full of love and hope. A group who believe that Buddy can have a better quality of life and are willing to guide me in my quest. Yes, the situation with my vet is unfortunate and it's tough dealing with someone who is willing to do what I want, but doesn't think I'm doing the right thing. There s so much I don't know and so much to learn. This is just the beginning for us and it's scary. It is comforting to know that you are just a click away. :)

Kathy and Buddy :D

Kathy,
the information and support that I've gotten here has been invaluable!
Had I not found this forum, Daisy's treatment would be heading down the wrong road really quickly!

The most important thing is to do your research and not assume that the vet knows it all! We're on our third vet since I joined this forum and luckily, we've found a great one.

You and Buddy have to keep them on their toes!

I sent the email below to my to my vet's office a few minutes ago. I am determined to get the word out even if they are not happy about it. I can always find another vet if it comes down to that, but I need to protect other Cushings puppies and families. That is the most important thing! ;)

FORWARDED MESSAGE

Please circulate this information to all of your doctors who work with dogs....
I called Dechra (the manufacturer of Vetoryl/Trilostane) yesterday to clear up my misconceptions regarding Trilostane's protocol.

Here's contact information for their U.S. office in Kansas:

http://www.dechra-us.com/Default.aspx?ID=365
919-327-0015

Please call or visit their website to verify the information that I'm about to relate to you.

Dechra - Vetoryl Called 4-4-13

1. Trilostane must be administered with food for proper absorption.

2. ATCH testing - No fast- Meal with medication - a smaller meal is warranted if the animal tends to get carsick. Test must be done 4-6 hours after taking meds with Breakfast. The same protocol needs to followed for future tests, so that comparisons can be made.

Vets often want to do several tests at once therefore requiring a fast. In that case, it is advisable to do the ACTH test at a different time.

Dechra was very helpful. They will be happy to talk with you about the Science behind this protocol.

I realize that you have been following a different protocol concerning ACTH testing and administration of Trilostane since it was approved in the US in 2008. Please be open to learning more so that you can help all of your Cushings dogs and families. Please don't hesitate to call me with any questions or for clarification.
Thank you,
END OF FORWARDED MESSAGE

We'll see what happens!:eek:

Kathy and Buddy

Hi Kathy,

I think your email to your vet is perfect and I commend you for your tenacity in trying to educate her. I sincerely hope that your efforts will help her safely and effectively treat her current and new patients that may cross her threshold. I honestly think she was probably embarrassed that you know more than her about the serious drug she prescribed for Buddy; hence, she fabricated a story to mitigate that embarrassement and she probably never thought you would continue to challenge her. I, for one, don't mind saying that she should be ashamed of herself.

If your vet attended class the day they covered the endocrine system in school, she would have read a chapter or two authored by Dr. Edward Feldman, a Professor at UC Davis and world renown veterinary endocrine expert. I don't think I would be wrong in saying that he has probably set the protocol for the diagnosis and treatment of many endocrine disorders treated and studied at UC Davis. I also believe that UC Davis is second only to Dechra, the manufacturer, in conducting clinical trials on Trilostane. I know for a fact that Dr. Feldman lectures to his students and worldwide audience during his conferences that Trilostane must be given with food. There is no way that UC Davis' databases reflect otherwise. The only notable difference between Dechra and UC Davis protocol is that UC Davis calls for doing the acth stim test as early as 3 hours after dosing. This is because Trilostane's effectiveness peaks at about 1 1/2 hours after dosing.

I've also listened to a lecture given by Dr. David Bruyette who contributes to Dechra's continuing education for veterinarians. If yur vet chooses to treat cushing's patients, she would do well to avail herself of that resource. Vetoryl (trilostane) is Dr. Bruyette's first choice of treatment, despite the fact that he is one of the developers of Anipryl, the first drug to be FDA approved for treatment of cushing's. Unfortunately, it is rarely effective for cushing's so it is primarily prescribed today for canine cognitive dysfunction. Dr. Bruyette also lectures that the drug must be given with a meal. We've already cited Dr. Peterson and I could continue to give you names of other renown endocrine specialists, including a few who did their own peer reviewed clinical trials that should be easily accessed on VIN by your vet.

I'll be on pins and needles waiting for your vet's response. In my opinion, she's dug herself into a hole that's not going to be easy to get out of without conceding to your knowledge. A good number of us members have discovered that some vets have a very hard time humbling themselves. We shall see, huh?

Good job, Kathy!

Glynda

Kathy,

it's sad that you had to go to these lengths, but you have it right from the manufacturer and your vet can't argue with that.

You go girl!

:)Hi,
I don't want any of you to get the wrong idea. I am not trying to be "right". I could care less about that. Up until a month ago, I never even heard of Cushings. If I was still blissfully in the dark, that would mean that Buddy was okay. I would rather not have been put in a position where I needed to know. I do not want to be seen as a some kind of renegade, doing this for the thrill of it, or for attention. I am an average pet parent. I am learning as much as I can about Cushings so that I can better care of my little Cushing's Budster. Now that I have absorbed so much from this site, I can't sit idly knowing that other Cush parents are being given the same instructions I was given without trying to remedy that. Cush pups are stressed enough. We don't need to add to it! So please, I'm not doing anything particularly noble or special. I'm just doing what I think is right.:)

Kathy and Buddy:)

Kathy,
many of us have had unpleasant experiences with not so knowledgeable vets and even those who think that they know everything.

We're simply happy that you're taking the initiative to educate yours.
Others may just go to a different vet which does nothing to help future Cushpups.

Thanks for understanding!!:)
Kathy

It is so common to have a vet that doesn't know all the protocols around the medicine for cushings, the necessary tests for cushings specifically and the importance of not going right to a cushings diagnosis and ruling out other possibilities. It's way to frequent on this forum.

My own vet is the same and went directly to 30mg of vetoryl based. I had to insist on a consult to an IMS and and Ultrasound and then pay to get that referral. At that point, I got the IMS to write on the report to my vet that 30mg is too high to start a dog under 20lbs on. (she did actual agree it was too high based on the 1mg/1lb recommendation now)

If you get a vet who doesn't know all this stuff, that can be okay, the main point thoughh as got to be that they are willing to adjust and learn with you. If they do that, then you Can have a perfectly fine relationship going forward. They just have to be willing to go that extra mile and find out.

Hopfully the more they learn, the better they will be with all their cushings pups.

hugs,
Sharlene and Molly Muffin

:) Hello to all!

Update :
Buddy is doing very well today! His allergies are under control for this moment! No wheezing, runny nose, or sneezing so far today! He is still on Benadryl three times daily. That pretty much drugs him for the majority of the day. I am going to look into another non-drowsy antihistamine as soon as Buddy stabilizes on his Trilo. I don't want to make any changes at this moment. I will be taking him for his first ACTH test one day this week. I'm not sure which day yet. I go back to work on Monday after a two-week break. It looks really bad taking off right away and it's hard for a sub to run my groups. My kids don't take changes well. Buddy's Cushing's symptoms have subsided. He is drinking much less water and hasn't been peeing as if the dam had burst. He is walking better, even running for short bursts to the cookie jar. His cookies are his regular dry kibble, but he doesn't seem to care. If it's hand fed, IT'S COOKIES!!!!!! I have to be very careful what I feed him due to so many allergies. He is still very stiff and wobbly when he first stands up after being down a while. Within a few minutes, he is allover the place!

I am sitting out in the backyard watching Buddy. He caught a lizard, then it got away. He is currently frantically zapping and pawing at the hole under the fence where the lizard disappeared. Seeing him play is a wonderful treat for me. It has been too long!!!:o