Junior - 6 year old lab mix - Vetoryl twice daily

[Harley PoMMom]

That bloodwork looks pretty good to me. In Dechra's product insert it states that if symptoms are controlled than a dog's post number can be as high as 9.1 ug/dl. Seeing that you are happy with the improvements to Junior's symptoms, if this were me, I would not increase his dose of Trilostane.

Link to Dechra's U.S. Product Insert

Hugs, Lori

[Junior's Mom]

I went back to older blood work…
Gamma GT 9 (0-6) July 2013 For some reason this hasn't been tested again. I will have to ask for it specifically I guess.
Diamondback has decided that 58mg is too close to the available vetoryl of 60mg, so Junior's latest order came in at 57mg instead. I'm hoping that 1mg won't make a difference.

[molly muffin]

You can always get your vet to write a prescription for 1mg or 2mg trilostane if you need to make up a difference. Strange that Diamondback wouldn't give the amount ordered by the vet. I wonder if they wrote down the wrong amount or something.

Sharlene and molly muffin

[Junior's Mom]

Hi everyone. Junior has become a bit perplexing, or should I say the results of his acth's has. Junior himself is doing well I think.
58mg twice daily Pre 127 (4.5) Post 207 (7.5) left meds the same
Diamondback would now only sell 57mg instead
57mg twice daily Pre 147 (5.33) Post 342 (12.4) Huh!!!-upped dose
67mg twice daily Pre 156 (5.66) Post 420 (15.22) WTH!

So, is it lab error-these tests are run in house by my vet, or is the problem with Diamondback, or is Junior just a dog that likes to confuse things?

I don't believe I've read any post where a dog's numbers kept climbing when dosage was increased.
I am going to have the stim run again in a week or so, and have it sent out for testing. This will hopefully narrow down where the trouble lies.

In the meantime, I will keep his meds at 67mg twice daily, from Diamondback.

Anyone have any other ideas?
Tracey

[Harley PoMMom]

Is Junior getting his Trilostane with food? And are his ACTH stimulation tests being done 4-6 hours after Trilostane is given?

[Junior's Mom]

Yep, he always gets it right after his meal, and the timing of the tests is always the same.

[molly muffin]

That is rather bizarre. Diamondback has a good reputation, but maybe try some sort of combo with name brand vetroyl and trilostane to make the dosage? I know some others do that and see if there is any difference? That is the only thing off the top of my head I can think of.

Sharlene and molly muffin

[Junior's Mom]

I just had another acth done, this time sending it out to a lab, instead of doing it in house. Drum roll please….
Pre 54 (1.96) Post 57 (2.07)
It costs me $30 more, but I will be having his test sent out from now on.
I'm sure glad I double checked this, before messing with his meds. It's also good to know that Diamond Back is on the ball after all.
Junior has been on this dose for 40 days now, so I'm not too worried about it going low, but will be keeping a close eye just in case. I will test him again in a month to be sure.
Tracey

[molly muffin]

I am so glad you had this one sent out. Good call!

Hugs
Sharlene and Molly muffin

[Junior's Mom]

I thought I'd do a summary of Junior's journey for those who are newer to the forum, as he is a success story.
Junior was diagnosed at the age of 5. Symptoms were excessive drinking, peeing, and bald patches.
After blood work to rule out anything else, a low dose suppression test, and an ultrasound, cushings was confirmed.
I decided to try the "natural" route first. I had attitude about it too, when I first joined the forum. I didn't realize how very knowledgeable and caring the people here are.
He started on vetoryl about 9 months after being diagnosed. He weighed about 50 lbs, and I started him on 20mg twice daily. The twice daily dosing made sense to me, apart from the expense. I already fed him twice a day, so I just had to adjust the times a bit. And resign myself to no life, which was pretty much the norm anyways.
My vets are great, not experienced in cushings, but willing to listen and discuss things with me. With the knowledge I gained from this forum, I made the decisions about his dosages, not the vets.
Apart from his elbows swelling a couple of times, and some lab errors, Junior's path has been smooth, and trouble free. His drinking and peeing subsided the first week he was on medication. I don't know that it will ever be like it was before, or like my other dogs, but it is fine to deal with.
I never did an increase that was more than about 25% of the dose he was on, and have had numerous acth's done to know where he is at. His dose is now (after a year) at 67mg twice a day. He has been on vetoryl/trilostane for a year now.
We tested his liver values every 2nd acth for a while, and now will do full blood work twice a year.
His diet is a good quality kibble, with only 10% fat. He gets a cranberry supplement regularly. I alternate between omega 3 wild fish oil (human grade) and coconut oil a few times a week. I also smear him with coconut oil every week or 2. It has made a huge difference in his dry, flaking, peeling skin. He gets milk thistle 5 days a week. All these supplements, I just put in his food. His trilostane, which I have been getting from Diamond Back for a number of months, is in a blob of cream cheese, after he finishes his meals.
The things I have learned to watch out for-incorrect lab work, and higher anxiety. My vet can run the acth samples in house, but either the machine, or the tech has problems, and the numbers are not always correct. It's a good idea to have them sent out periodically to be sure. Junior is also more nervous than he used to be, easily frightened by noise.
As he gets older, I may switch to once a day dosing if he starts to be affected by arthritis. For now, twice a day is what works best for him.
I think that is about all the info I have right now. I will say to everyone just starting this journey, read the forum, take the knowledge to your vet, and never let them talk you into something you don't agree with.
Tracey