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Vicki, I'm afraid I don't know what's "up" with Scoop, either. I will be really anxious to find out how his ACTH testing turns out. It is true that his diabetic issues can affect the test results, but you have no other means to monitor the cortisol levels. So this is the best information that you can gather. Once we have those test results, we will put our heads together and do some more brain-storming, OK?
Hang in there!
Marianne
I took him out last night after that and then he went to sleep. I didn't see it happen again. If I see the vet today I will mention it to her(not that it will help). I get so frustrated. I wish things would go a little smoother for my "baby doll". Then I remember the vet said last summer it won't be easy with the 2 diseases.
OK Marianne.
I hope the vet realizes his BG's will affect cortisol levels. Well got to get ready to go for the ACTH. I guess I'll hear the results tomorrow. Then I'll post them.
Thanks everyone.
How important is it for cush dogs to have their blood pressure checked?
I asked the vet months ago if it was checked and at the time she said theirs was broken. That's something I just don't think about.
I think it is a good idea to get it done. I forgot to mention it to my vet but I want Molly's checked to.
The thing I read recently said that a dog with diabetes and cushings, is optimal to be on twice a day dosing, so as to limit the potential for insulin spikes that can happen on one a day dosing. I think that was Dr. Peterson's blog, the most recent cushings article, from Dec 2012.
Good luck today!
Sharlene and Molly Muffin
Does anyone get their Vetoryl from Drs. Foster and Smith? Are places like that trustworthy that you get the real thing? I still get Scoop's from the vet. The prices are outragous.
Is there a thread that talks about where is a good place to buy Vetoryl?
What kind of problems can there be if the blood pressure isn't normal?
Scoop is currently taking 40mg of Vetoryl. He weighs 17lbs. If the vet would want to up it after his ACTH results, is that starting to get to the high end for Scoop's weight?
Scoop sleeps alot. Does the Vetoryl make them sleepy or do you think it's probably something else? It's been awhile but if I remember correctly Scoop slept more after his dose went from 30mg to 40mg.
Jenny sleeps a lot when her blood sugar is higher
Zoe is 17 pounds and is on 50mgs of Vetoryl but she takes it twice a day 30 in the am and 20 in the pm. There is no maximum dose of Vetoryl. Most dogs are controlled on 1-3 mgs per pound but some dogs may need a higher dose than that. Zoe has IBD so her gastro track would not be able to handle the higher doses once a day.
I would think if the Vetoryl is packaged from the manufacturer, the only thing you would have to worry about is possible expiration dates. To tell you the truth, I never even checked that to see if our boxes have one. If it is getting pricey for you perhaps you could consider compounding. We have not yet gone that route but may end up there.
If you dont mind me asking what are you paying?
If high blood pressure is left untreated, it can lead to blindness, heart disease, and kidney disease.Quote:
Originally Posted by scoora
Harley PoMMom-Thank you
Addy-On 1/8 I got 30mg(30 count) for $93.75, 10mg(30 count) for $75.00 that was from the vet.
Where do you get your Vetoryl from? How much?
Is compounded Trilo the same strength mg as Vetoryl? Would he be able to just get the same dose on Trilo as on Vetoryl? There is a compounding pharmacy not far from us. The antibiotic Scoop was on for the infection in his calcinosis cutis was compounded there. They told me they compound Trilo for customers. Drs. Foster and Smith have a price per capsule. $1.55-10mg, $1.85-30mg. That's a savings of $28.50-10mg, $38.25-30mg and free shipping on orders over $49. That's quite a difference.
Just wondering what everyone else does.
I heard from the vet today with Scoop's ACTH results.
Pre was 2.0 Post was 5.2
Where can I find what normal is for being on Vetoryl? The vet said 6 up to something? was normal. So that would make Scoop a little low.
What bothers me is on 12/5(his last ACTH) his numbers were Pre 9.3, Post 10.1
His dose was not changed from Dec. till now but his numbers dropped drastically. Will they keep dropping? I remember in Dec Scoop's opthamologist suggested the vet wait to do the ACTH but the vet didn't want to wait. That was only a couple of weeks after Scoop started with his corneal ulcer. I guess those numbers could have been high because of that, right? Thank goodness she didn't up his dose at that time. The vet said today it might have dropped because of something with his BGs.
Scoop also had a JR wellness blood work done yesterday. The vet wanted to check his calcium because of his calcinosis cutis and putting DMSO on it. I will have to get those results in writing. She said everything looked OK. The one liver value stayed about the same as last time and the other one went down about 200 points.
Scoop's results are actually fine as long as the symptoms are controlled. Anything below < 9 on POST is okay if symptoms are good. If not then up the dose, but with the results still possibly dropping I wouldn't up the dosage right now. They say under 5 POST is good for hair regrowth, but its not necessary to be there. Many aren't. The symptoms and how he is doing is the main thing. When the vet said 6 up to something that is for a dog Not on Trilostane.
Dechra recommends a post of 1.5 and 5.5 mcg/dl, according to their website.
Numbers can continue to drop, so that is not abnormal. Yes if his last ACTH was during the cornea episode then that could have contributed to the numbers being higher I would think.
I'll let others talk about where they buy their vetroyl, but I know quite a few use compounding pharmacies to keep the cost down. Just make sure you have good, reputable one. Trilostane is the ingredient within in vetroyl. What you want is a good compounding pharmacy that is careful with the dosage so that they have the same amount in each pill/capsule.
Have you compared the price to the one you found on line, that is per pill? I didn't even know that you could buy vetroyl online.
Hugs,
Sharlene and Molly Muffin
Sharlene-Thanks. So even if you don't change the dose, the cortisol level can continue to drop?
I haven't asked the compounding pharmacy how much they get. I do know Drs. Foster and Smith are a lot cheaper than the vet. You do need your vet to send a prescription in to them to be able to get the Vetoryl.
Sometimes I wonder.The vet thought the 6 was the low. She also said if anything we would drop the 10mg in the evening but to wait till she consults with an IMS. I told her Scoop doesn't take 10mg in the evening. He takes all 40mg in the morning. That surprised me when she said that. I wonder if I missed something along the way. Something was said about maybe doing a split dose but she never told me to do it. Besides, the IMS splits the dose but she makes it higher not split what he is on. The vet and I talked about that.
Scoop was just restless. He circled around a couple of times then snuggled against my leg. He hasn't done that in a long time. I could feel him trembling. Until recently I would not notice any trembling at night. Just wonder why. He seems extra sleepy the last couple of days. Yesterday I thought maybe because of going for the ACTH but today he was the same way. All I do is worry about everything.
Pharmacies do not sell compounded trilostane in dosage strengths in which brand-name Vetoryl is sold. So, if one is giving their dog 30mg of the brand-name Vetoryl, and then would want it compounded, the pharmacy could compound either 29mg or 31mg strengths.
We have seen many dogs here have their cortisol drop lower on a dose that was being given over a period of time.
Love and hugs,
Lori
Lori-Thanks. So there is a slight difference between compounded Trilo and Vetoryl. Do the pharmacies have to do it that way because they can't be the same as Vetoryl?
No there isn't any difference, between trilostane and vetroyl. Pharmacies just can't sell anything in the exact dosage that the brand name vertroyl comes in. I saw someone say they ordered theirs from 1-900-Pets-Med online. Diamondback in Arizona is another compounding pharmacy that many have used.
hugs,
Sharlene and Molly Muffin
Vicki, my heart sank when I read that your vet is concerned that Scoop's ACTH result is too low. After his having been on trilostane treatment for these months, I would have hoped that she would know what the desired testing range is for a dog taking the drug. Per the manufacturer of brandname Vetoryl, the post-ACTH result should be between 1.45 ug/dl and 5.4 ug/dl, with it going as high as 9.1 ug/dl as long as a dog's symptoms are well-controlled. Scoop's test result was good, and no decrease is warranted. Since Scoop is diabetic, I've also been bothered that she hasn't pursued the twice daily dosing since it is recommended by so many experts. All in all, it seems as though she is kind of stumbling through the process. It would really be nice if you could get some direct input from a vet who has more experience with all of this, especially since Scoop still sounds unwell. Have you ever spoken directly with the IMS yourself? Would you want to try to arrange a consultation now? I am worried for Scoop and sure wish an expert could take a look at him.
As far as compounded trilostane vs. brandname Vetoryl, Sharlene is right that the effective ingredient should be the same chemical in both. But just so you'll know, compounded trilostane is not the same thing as a generic version of a brandname drug. Both brandname drugs and their generic counterparts are manufactured by pharmaceutical companies under FDA oversight of testing and inspection. However, there are currently no generic versions of Vetoryl for sale anywhere in the world, so brandname Vetoryl is the only version of the drug that is FDA-approved. Compounded drugs are instead prepared onsite by individual pharmacies and fall outside of FDA approval. Some recent studies have shown that there may be less consistency or effectiveness from batch to batch of drugs compounded by some pharmacies. And any inconsistency in the product could lead to less consistent dosing control. It is for this reason that some vets prefer that their patients use brandname Vetoryl and not a compounded substitute. Compounded trilostane is usually much less expensive, however, and we do have many members who have been very satisfied with their compounded product.
You are right in assuming that compounded products legally cannot be sold in the exact same dose as brandname Vetoryl. But you can buy either one online as long as you have a valid prescription from your vet. I'll try to come back later today and give you a link to a thread that lists sources with the best pricing for both types of the drug.
Marianne
http://www.petapothecary.com/
This pet pharmacy is right near my house and was suggested by our IMS. They sell both compounded and name brand. I use the name brand Vetoryl from them as their compounded Trilostane is not much cheaper. I think you can do much better then the prices your vet is charging, they seem high. I cant find my last bill but we don't pay that. Alot of our members purchase from Diamondback Drugs in AZ when the use compounded. Not all compounding pharmacies are created equal so you need to purchase from a reputable pharmacy.
I do know that we all have read that it is easier to control blood sugars when the cortsiol is more evenly controlled throughout the day, which means twice day dosing.
I am not sure why your vet thinks a post of 6ug/dl is low unless it has something to do with controlling Scoop's diabetes. It is not low.
Yes, a dog's cortisol can continue to drop on the same dose but it also can go higher. Keep in mind hormones fluctuate so that is why we have a range of numbers to begin with. My Zoe was appx 6.2 in September, 10.2 post in October and dropped to 7.1 in January all on the same dose. ( I may be off a bit on those numbers, but you understand my point) She has bounced around when she first started on the same dose going lower, then gowing higher.
There can be a difference in Trilostane and Vetoryl as far as how much of the acting ingredient is in a capsule. With the name brand, it does not vary, so we know for sure that 10mg is exactly 10mgs. There was a study done where I think it was 5 different compounding pharmacies Trilostane capsules were tested. Not all of the pharmacies passed the test and the amount of Trilostane in a 10mg capsule varied. This is why we say only use a reputable compounding pharmacy.
Hope this helps a little. Oh- I see Marianne and I were typing at the same time.
Thanks Sharlene, Marianne, Addy
That all helps to understand better.
Marianne-a while back twice daily dosing was mentioned. I don't remember the reason we didn't pursue it at that time. I do know the IMS that the vet has been in contact with said she ups the dose and then splits it for twice daily dosing. Scoop did see that IMS back in Nov. We had a long visit. The IMS said she feels Scoop's vet is doing the right things. This was when we were trying to find out a reason for Scoop's weight loss. At that same time he also had a visit with the neurologist trying to see what his head tilt is all about. Then the following week he had the ultrasound and MRI done and then his ear surgery. That facility is over an hour away from where we live. We do have IMS closer to home. I wish we would have gone there originally but wth the neurologist thing we just did it at the same time. A while back I said something to my husband about talking to someone else and he didn't think it would make a difference. I'll see if I can print out that article from Dr. Peterson and talk to the vet again. I don't think she'll be against it but it seems to me she should be the one to suggest it. If the dose gets split, does another ACTH have to be done 10-14 days? Since he's on 40mg would the best be 20-20 or could it be 30-10? Sure wish Dechra made 20mg. It would be expensive to use 4-10mg. I guess that's when you check into compounding.
I just don't know what to think. I feel so bad for Scoop. All Scoop does is sleep or wait to eat. He has no interest in anything. It seems like ever since he totally lost his eye sight. I wish I could give his sight back and see if it makes a difference.
Be back later.
Thanks everyone.
I know this all sucks for you and for Scoop. If you do decide to go double dosage, then I'd try to keep it even to start with, just because of the diabetes.
Others here probably have more knowledge though on that. I know quite a few don't do the same, they might do more in the mornings and less in the evenings.
hugs,
Sharlene and Molly Muffin
http://www.k9cushings.com/forum/showthread.php?t=4592
link to discussions about purchasing Vetoryl at a good price;)
Addy, Do you think I should ask my Vet for a prescript for Vetroyl instead of Trilostane so that Norman gets a true and accurrate amount? and maybe get it more reasonably and in a speedier fashion?Quote:
Originally Posted by addy
Sharon
Thanks everyone.
The vet called again today. She said she talked to the IMS and that nothing will change for now. She wants me to measure his water for a few days and she said her and the IMS talked about doing a fructosamine(sp?) test. That tells the BG levels for the past couple of weeks. I didn't know there was such a thing. She said it will be less stressful. I said what about splitting the Vetoryl dose. I mentioned the article from Dr. Peterson. She said she didn't think it was necessary at this time. Maybe she wants to wait till after that test and see how it goes. That's not for a couple of weeks. Then she said something about Vetoryl doesn't come in 20mg. Geez, I know that. That's where compounding would come into the picture, right? Using all 10mg would be so expensive. Even if would do 30mg morning, 10mg evening you would still think it would be better than once a day. I get so frustrated sometimes after I talk to her. I always feel rushed. I know she's busy and I can't get my thoughts straight. I'll be emailing the water measurements so I guess I can ask questions then. Nothing is easy.
Hate that when you feel like you cannot get your point across because you feel rushed, I have taken to having a list handy so I don't forget anything, even typed it into my phone. But hard to read if I am actually speaking to them on that phone :D:D Sending big hugs to Scoop and you.. what a great Mom you are!
Trish xxxxxxx
Seems like you learn something new on here all the time Vicki. I didn't know about that test either.
Hang in there! You're doing good.
hugs,
Sharlene and Molly Muffin
Thank you Trish and Sharlene
Vicki: from everything I've read the curves you've had done give you a lot more accurate information than the fructosamine test would. What good would an average of Scoop's blood sugar over the last several weeks do?
From everything I've seen people suggest saving your money on that test.
I think you are smart to push the twice a day dosing of the trilo. hang in there! Judi
Judi-I was wondering how much a test like that costs. I will see if I can question the vet as to what she thinks will be gained from the test. She said the IMS agrees with her.
12 years ago my husband told our daughter she could pick what kind of dog she'd like to have. She decided on a Pug. The last Saturday in Jan. 2001 my daughter and I went to a pet shop. I had been told they had a Pug there. As soon as we walked in the door there was Scoop. In the first pen as you walked in. He was 3.5 months old. We took that little guy home with us that day and we have been blessed for the past 12 years with so, so much love and happiness. Hopefully there is a lot more to come. It is so hard now with all his problems to see such a difference in him but he is loved more than words can say.
To my Scoop-Thank you Scoop for giving us such joy, happiness and love the past 12 years and for being "the best dog ever". We LOVE you so very much.
Mom, Dad and Molly
Hoping you got some good cuddle time in with Scoop!!!!!
((((((((((((((((((hugs)))))))))))))), sweetie.
Thanks Addy-Always lots of cuddles and smooches with my Scoop.
Scoop trembles so much more lately than he used to. Last night he shook harder than I saw before. It lasted about 10 minutes or so. When he fell asleep it stopped.
Right now he seems to be sleeping but he is shaking a little especially around the shoulder area. Scoop has been doing something for month or two. I caught it on video on my camera and showed the vet. She has no idea why he does this. He'll lick his upper lip, nose a few times then he opens his mouth almost like he is going to yawn but he's not. It seems like he has phlegm in his throat or something is caught in there. He'll do this several times in a row. Anyone ever see anything like that? Also Scoop's ears and paws get cold so easily. The vet said her feet get cold easily, too. Scoop's never used to be like that. I don't like what I see happening to my "baby doll" lately. I get so scared.
Hi Vickie
Squirt does something similar and I have asked her vets about it over and over - no one seems to have an answer nor seem very concerned about it. I decided it might be digestive, like indigestion that us old folk get at night ;). Maybe a little nausea as air licking is a sign of nausea and these meds can make their tummies feel a bit yucky even tho there isn't a negative reaction. Plus Squirt is an old lady - around 90 in human years - and I know her absorption isn't what it used to be nor is her digestion as smooth a process as it once was. She will sometimes make sounds and have movements that almost look like she is going to throw up, but doesn't and instead has this kinda "ACHK" hacking sound, then lays back down. She doesn't do the trembling, tho. However, she is on Lyso and Trilo is known to cause trembling so Scoop's trembling could be due to the Trilo.Quote:
He'll lick his upper lip, nose a few times then he opens his mouth almost like he is going to yawn but he's not. It seems like he has phlegm in his throat or something is caught in there. He'll do this several times in a row.
I can't tell you the number of times I have taken Squirt's face in my hands, looked into her eyes, and told her this sort of stuff just can't keep happening as it worries her old mom to pieces. She just blinks, kisses my nose, and takes off for fear I am going to wash her face or something equally horrid. :D
Sometimes, I am taken completely by surprise at the depth of love we have for these little ones, the lengths we are willing to go to for them, and the unbelievable joy we find in our babies.
Hugs,
Leslie and the gang
Sometimes a pup will lip lick and yawn as a calming signal for themselves so I wonder if there is some sick tummy feeling or a bit of pain somewhere. Zoe does something similar when she has been sleeping awhile. The shivering could be from the Trilo.
I know it is so hard to see our babies change with illness. You have had to deal with a lot. I know how hard all of this is for you. I have had similar emotions over Zoe.
(((((((((((((((BIGGEST HUGS ))))))))))))))))))))))))))))))))))
Hi Vicki,
Just wanted to tell you that my own Cushpup had weird tremoring episodes, too. He had a few before he was disagnosed, but they became a whole lot worse when we first started him on the trilostane. For him, it looked as though he was shivering and it was mainly across his shoulders and back (it was definitely different from the shaky back legs he had from muscle weakness). Weirdly, it happened most often when he was resting or asleep. It never actually seemed to bother him, but it definitely freaked me out. It finally stopped after a couple of months, and we never did get any explanation. I've always wondered whether it was just related to the big changes in his cortisol level -- first when it was skyrocketing before treatment, and then when it was coming down so fast after we started the trilo.
Marianne
Thanks Leslie, Addy, Marianne. It's good to hear what others think because all I do is think the worst.
Leslie-That ACHK hacking sound describes it. Like he's clearing phlegm. It made me smile what you said about Squirt kissing your nose and taking off.
I didn't know the air licking can be a sign of nausea.
Addy-It very well could be he doesn't feel well or is in pain. I just keep wondering about the tumor because I've read that the large tumors can give them headaches. He also has a lot of gas at times from that horrible food he eats. The vet has him eating a can of Hills W/D food plus a cup of dry Hills W/D. Plus he gets some chicken and carrots during the day.
Marianne-That's how Scoop started. He had a few tremors in his back end before he was on Vetoryl and after he started on it they just keep getting worse and worse. He has them all over his body now. I've seen them once or twice while he was standing still but they are usually while he is laying still. He USUALLY doesn't do it while asleep. Hope it doesn't start. He's been on Vetoryl over 4 months.
I'm so glad to have such wonderful, caring friends on here that take time and listen to what I am worried about. Sometimes I think I am just going crazy. I'm having a really hard time dealing with the worry and what's going to happen. Sometimes I wonder what will happen to me after Scoop's not here. I just don't know why I can't deal with it better. All I can think about is I have to be able to help him and I can't.
HUGS to all.
when Jenny had back leg tremors I thought it was the cushings and it turns out her blood sugar was in the 40's scary low.
we have too many things to worry about! hugs, Judi
Vicki:
Tipper also does this. Especially when she first gets up. She will even wake up and do it, during her sleep. I am convinced it has something to do with the throat, as I have talked about Tipper's trachea problems, which I am not sure this disease has not caused. When there are so many doing the same thing it makes you wonder. Since not a lot is known about this disease it could very well cause this. It seems Tipper has mucus or something also. I really wish more was known about all this disease causes.
Vicki if it is any way consoling for you, when Zoe had secondary glaucoma, the ophthalmologist said it is very painful for dogs and that Zoe had a horrible headache. She would kind of hold her head up, while laying down, and slowly blink her eyes and then shut them for a few seconds, you could just see the headache on her face and then finally she would put her head down and just go to sleep. So maybe Scoop doesn't have a headache as you fear:):):)
Hi Vicki! I know everything seems to be scary with our babies. I know it is because we love them so much that it makes it all so much worse. Plus what we can build up in our minds, probably is much worse than the reality. At least I hope that is the case.
How is Scoops blood sugar? Have you tried testing it during one of these episodes? If nothing else you could maybe rule it out as a cause.
Hang in there! You are a good mommy and that is what Scoop knows. :)
hugs,
Sharlene and Molly Muffin