Thanks... and yes, we are going down from 30mg once a day to 10mg 2x a day for a total of 20mg.
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Thanks... and yes, we are going down from 30mg once a day to 10mg 2x a day for a total of 20mg.
FYI... wanted to update. Kiwi is still kicking butt. He is old, no doubt about it, he will be 13 in March, but he is still spirited and active. He has lost more weight and has some occasional issues with arthritis, but still is very eager to go for a several mile walk every day. I'll have to take him back sometime soon and get his cortisol level check I suppose. I am interested in Anipryl, not just for its Cushings effect but also for its longevity and cognitive benefits. I see some folks out there with some experience with the substance. Has anyone used it in conjunction at a low dose with Vetroyl?
Mark
My Squirt used it with Lysodren. Dr. Jack Oliver with the University of Tennessee in Knoxville told me it would be fine to use them together. HOWEVER, Lysodren and Vetoryl do not work the same way. Lyso works ONLY on the adrenal glands while Vetoryl works on the HPA (Hypothalamus, Pituitary, Adrenal) axis, or loop. Many many things are controlled along that loop so I would want to talk to Dechra about using the two of them together. You can reach Dechra here -
Telephone: (866) 933-2472
E-mail: support@dechra.com
According to Dr. Mark Peterson, who is a renown veterinarian that specializes in endocrinology and frequently contributes to Dechra's online continuing education for veterinarians, Anipryl can be used concurrently with Trilostane; here's an excerpt from Dr. Peterson's blog:https://endocrinevet.blogspot.com/20...hings-dog.htmlQuote:
If you believe that Rigby has canine cognitive dysfunction, you can certainly use the drug selegiline hydrochloride, also known as L-deprenyl (veterinary trade name, Anipryl) along with the trilostane that the dog's already getting.
So glad to hear that Kiwi is doing so well! You're doing a wonderful job!!!
Lori
I used it several years back before Vetoryl became available here in the US...it helped w/some of the more "out there" behaviors, which I assumed to be Cushings (as she was diagnosed) but are also common w/doggie dementia. Such as nighttime wandering, restlessness, barking, etc. Worked very well for us, and took the edge of the hunger and drinking urges. It's one of those hit or miss drugs...works for some, not for others, from what I have heard.
Maybe this is a dumb question, maybe it has already been asked before. If that is the case forgive me, but interesting scenario I am facing with my dog Kiwi.
1. He is pretty old... turned 14 in March
2. He is also diabetic and at times has been a bit difficult to control
I suspected Cushing's a few years ago because of this diabetic control issues as well as his thirst. When I first had ACTH stim done his baseline was 0.5 and post 25.8. We started vetoryl at 30mg once daily. I found pretty quickly he seemed to be more arthritic. I theorized that his dose was too high and without so much cortisol he was having more joint pain. Also I was concerned that he should have twice daily dosing as he is diabetic and it might make for more consistent control. We moved to 10mg 2x per day and his pre was similar but post ran 2.8-5ish. We continued with this dose for the next two years.
More recently I became aware of Selegiline and decided to try that for its general anti-aging effect. I only give him 5mg in the morning, but this detail I think is important because it can have a pituitary Cushings effect.
He was on both meds for roughly 6m and then in March had anoerxia and vomiting. I was concerned he had cancer given his age, but a whole battery of tests and nothing found. I started to suspect the vetoryl may be at issue. We did another ACTH stim test and he was 0.7 pre 1.7 post... I cut his vetoryl in half and low and he started eating again and was fine.
Come to last weekend. I had dropped him off at his dog sitter a few days earlier as I was heading to the Black Hills/Badlands for a little Memorial Day vacation. Wake up one morning with an urgent message from the dogsitter that he had a 3min siezure and they rushed him to the emergency vet clinic. His electrolytes were low, not severely, but they were low. His blood sugar was high which was odd as he apparently wasn't eating well. They provided supportive treatement, prescribed some antibiotics in case he had a subacute UTI as diabetics sometimes can, and generally got very interested in the shiny object of his blood sugar levels. I had them release him the next night and he was fine for the dog sitter and since I picked him up again Wed afternoon he has been great. I have not given him any vetoryl at all since and his blood sugar levels have actually been better than ever and he is eating robustly.
So of course I need another ACTH stim test after a time. I understand that. But I'm somewhat wondering if Cushing's ever resolves after years of vetoryl treatment? Or has it been so blunted that maybe the Selegiline alone, low dose that it might be, is sufficent?
Hi Mark, welcome back to you and Kiwi! You’ll see that I’ve gone ahead and merged your new post into your original thread. This way we’ll be able to keep Kiwi’s entire treatment history consolidated in one place ;-).
I’m sure sorry for the scare last weekend, and so relieved to hear that he’s doing much better again. Your question is not dumb, at all, but I guess that time will tell as far as an answer in Kiwi’s case. We do know that it’s possible for Vetoryl to make permanent changes in adrenal function. It happens rarely, but on occasion we’ve had members who found that continued use of Vetoryl ended up oversuppressing adrenal function such that treatment was discontinued, sometimes for good. In some cases, the dogs end up needing actual supplementation of adrenal hormones in order to make up for the oversuppression. In other cases, the dogs don’t require supplementation but also never need to resume Vetotyl. So maybe Kiwi is a lucky boy who falls in that latter category.
I don’t think the selegiline would be responsible for the lower cortisol reading, because my (feeble) understanding is that selegiline’s effect is not actually reflected in measured cortisol levels. However, my knowledge about selegiline is sadly minimal. It does seem possible to me, though, that both effects may be possible: the selegiline may be helping to make him feel more comfortable even as the Vetoryl may have produced a longterm effect on his cortisol level. Either way, I think it’s a great gift that he’s doing better. And under these circumstances, I definitely wouldn’t be rushing back to add in Vetoryl again now, if ever.
Please do keep us updated,
Marianne
Thank you... I will keep an eye on things and do another ACTH stim test in a few weeks.
Mark
Well, based on ACTH stim test I guess I'm done here:
Date Lab Test Lab Results Evaluation Lab Range Location
06/09/20 CORTISOL SAMPLE 1 2.2 ug/dL 1.000 - 5.000 ug/dL Rockwall
06/09/20 CORTISOL SAMPLE 2 8.6 ug/dL 8.000 - 17.000 ug/dL Rockwall
Hi again, Mark! Honestly, I think only time will tell as far as ever needing to resume Cushing’s treatment (and that’s not because I’m trying to hold you captive here :rolleyes:). As long as Kiwi is comfortable and essentially symptom-free, that post-ACTH reading of 8.6 is good. However, the question will be whether or not his cortisol production plateaus at that level, or whether it continues to rise over time.
The diagnostic normal range that the lab has given you is applicable when the purpose of the test is to determine whether a dog has Cushing’s. For dogs known to be suffering from Cushing’s who are under treatment, the desired range is much lower: approx. 1.5 - 9.2. So Kiwi remains within that range for now — we don’t know whether he’ll ever leave it once again. His cortisol now is higher than it was when you tested back in March, and that’s a good thing since it was too low for him at that time. We don’t yet know for certain whether or not it will ever start increasing more rapidly again. However, especially given his age, as long as he’s doing well and doesn’t start exhibiting Cushing’s symptoms once again, I think you guys are good to go. Enjoy your time together, and especially this vacation from treatment for however long it may last — hopefully forever!!
We’ll always be here should you need us again, though ;-). All best wishes to you and Kiwi, today and every day.
Marianne