Black Labrador Tara cushings and other issues

[thewickedpickett]

5 days on vetoryl now and very little to report. She has all the same symptoms as before. If this dose (60mg) was going to work would I know by now?

[molly muffin]

You won't really know how the vetoryl is working until it's time for the ACTH test, which is about another 6 days. Then you'll see how those numbers are pre and post (the post is the one that you are going to really be looking at) and that will tell you if the cortisol is coming down or not. As the cortisol Does come down, then you should see some let up on the symptoms. Pay attention especially around day 10 for any reduction in symptoms. I don't know why I always think of day 10, just that seems to be a day that we often see some signs if the vetroyl is kicking in.
Often you won't actually look for a dosage change within the first 30 days unless there is really no drop at all, or even just very minimal. Some vets say that the cortisol won't continue to drop for 30 days, but based upon the results that we see on this board, where we are all cushings all the time, it can continue to drop and often does.
So, hang in there. You're doing A-okay.

Sharlene and Molly Muffin

[thewickedpickett]

Thanks I guess I can be heartened that she has tolerated this dose at least. She goes in on 3rd jan for the ACTH test again.

[thewickedpickett]

Day 14 of 60mg vetoryl. Tara has had her follow up ACTH test at day 10 and I'm waiting on the results.

No real positive change so far. Still drinking more and having accidents. Noticed she's not just as mobile as she was and is licking herself some more. Both signs that cortisol is lower I suppose.

[molly muffin]

When do you expect to get the results?
Could be that the cortisol has come down, but not enough yet. Will be interesting to see what the ACTH is.

Sharlene and Molly Muffin

[thewickedpickett]

Next few days. I forgot to ask the vet to send it next day delivery.

I'm worried bringing cortisol down more will further expose arthritis and skin issues. Guess we will see.

[thewickedpickett]

Tara's ACTH test came back at 217 nmol/L and the vet is pleased with that. That is down from 742 nmol/L. Vet wants to leave her on this dose and do the test again in 4 weeks.

[addy]

Hi,

I am not certain about converting nmol to ug/dl. I thought it was divide by 27.59. Hopefully someone will come around and confirm how to change the units. I think Tara is under 9ug/dl and so waiting another 4 weeks would make sense as the cortisol can still drop.

Lets see what our math experts say

[labblab]

Addy, you are exactly right about the conversion, and so I think Tara's actual post-ACTH result is approx. 7.8. And since the ACTH was performed at the 10-day mark, I totally agree as to leaving the dosage unchanged for the time being. However, if you don't begin to see any improvement whatsoever in the thirst and urination and those symptoms are bothersome to you and Tara, I don't know that I'd wait for another whole month from today to retest. That would put her six weeks out from the start of treatment. And per Dechra, you can start to think about dosage changes after the first 30 days.

However, I realize that you are walking a fine line as far as not wanting to lower her cortisol too far. So I guess my point is just that, if you're not seeing any improvement at all in her Cushing's symptoms, I don't think you'd be amiss if you move up the recheck a bit earlier than a whole month from now. For instance, depending upon where her cortisol level and symptoms are at that point, you might want to consider trying a shift to twice-daily dosing in order to see whether that helps with things.

Marianne

[thewickedpickett]

Thanks guys. Perhaps it is misplaced but it seems that she's drinking a little less and isn't doing big floods of urine any more. I'll maybe give it another week and if there really hasn't been any improvement I will opt for an earlier test. The other signs (stiffer, itchier) would indicate cortisol is lower but as you say it really is a tightrope hoping it does not have to go any lower. The vet suggests the urinary/drinking problems can take a little longer to settle?

Off to the acupuncture vet today. This will be the first session of it with cortisol tested lower. It'll be interesting to see how it helps her joints now.