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Thread: Buddy, The Mighty Lizard Hunter - Suspected Pituitary Macro Tumor

  1. #21
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    Default Re: It's 3:55 AM and haven't slept. Need your help!

    Kathy,

    you are correct. I voiced my opinion of mutual cooperation with Dr. Morgan at Cornell and she was in full agreement.
    I won't even take that crap from my own doctors regardless of how "good" they are.

    She's an internal small animal specialist and her recommendations were to give Trilostane with food for proper absorption and to be sure that Daisy has it 4 - 6 hours before her ACTH testing.

    It is possible that your vets information is out of date.
    Dr. Peterson is well known for his research of endocrun disorders.
    Last edited by doxiesrock912; 04-02-2013 at 02:23 PM.
    Valerie

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    Daisy Bella

    "My sunshine doesn't come from the skies, it comes from the love in my dog's eyes." - Author Unknown

  2. #22
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    Dec 2012
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    Sheboygan, WI
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    Default Re: It's 3:55 AM and haven't slept. Need your help!

    Hello Kathy and welcome to you and the Budster! I saw your heading and it brought back such memories...this is a great site, keep on your Vet or try to find a new one, I did and am very happy with him and his humbleness in taking advice - he even wanted me to thank the group after a bit of letting go of some ego....

    I am no expert, there are many on here who are way more knowledgable and experienced so I will leave the advice giving for them. Please know that I will be praying for you and Budster (Buddy).
    I was an EA as well years ago...now disabled, I will also pray you will have the funds to help buddy's quality of life.

    Peace and Blessings Abound,

    Sharon, Norman (cushings Doxie) and Millie (yorkie-pooh)

  3. #23
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    Default Re: It's 3:55 AM and haven't slept. Need your help!

    Hi Kathy, I too would be very interested in any documentation or studies that your vet could supply us with that suggests that it is better to give food later than earlier, especially for gastrointestinal upset.

    My main reason and you are welcome to supply this to your vet is that we are a forum, almost solely devoted to cushings (of course that goes along with so many other things it seems kidneys, diabetes, pancreatis, etc) and we have members from all over the world that come here looking for help, advice, etc. What we tell members is based upon, our own experiences, and also based upon documented studies, papers. So if there is something out there, that we are unaware of (and we do have administrators who read every published paper they can get their hands on for the sole purpose of staying up to date on new studies), then anything she could provide us with would of benefit to people and their cushings dogs all over the world. We never turn down or turn our noses up at new information, but we do need it to be up to date info and we welcome input from veterinarians for the purpose of helping our members.

    Sharlene and Molly Muffin
    Sharlene and the late great diva - Molly muffin (always missed and never forgotten)

  4. #24
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    Default Re: It's 3:55 AM and haven't slept. Need your help!

    Hi Kathy,

    Many of us are voracious researchers and I for one would be very interested in more information from your vet on the many studies she's seen that show there is no difference in absorption whether trilostane is given with or without food. Everything I've read and based on my own experience with two cushdogs, says differently.
    Information submitted to the FDA by Dechra, the manufacturer of Vetoryl (trilostane) for approval of the drug very specifically says that VETORYL Capsules should be administered with food. Route of administration repeatedly says; "Oral, given with food".

    http://www.fda.gov/AnimalVeterinary/.../ucm049823.htm

    I do understand that some labs specifically ask that a dog be fasted for an acth stim test; however, I believe that only applies if the test is being done for purposes of diagnosing addison's or cushing's. Protocol is completely different for purposes of monitoring treatment with Vetoryl or Lysodren. Dr. Mark Peterson, a world renown endocrine expert, mentions this in his March 16, 2011 blog entitled "What's the Best protocol for ACTH Stimulation Testing in Dogs and Cats".

    http://endocrinevet.blogspot.com/201...-for-acth.html

    Remember that the ACTH stimulation test is the most useful test for monitoring dogs being treated with trilostane (Vetoryl) or mitotane (Lysodren) see my blog entitled, Diagnosing Cushing's disease: Should the ACTH stimulation test ever be used? Both medications are fat-soluble drugs and must be given at time of meals, or the drugs will not be well absorbed.

    With trilostane, it’s extremely important to give the morning medication with food, and then start the ACTH stimulation test 3 to 4 hours later.

    Fasting these dogs on the morning in which the ACTH stimulation test is scheduled should be avoided since it invalidates the test results.

    When a dog ‘s food is withheld, the absorption of trilostane from the gastrointestinal tract is decreased. This leads to low circulating levels of trilostane, resulting in little to no inhibition of adrenocortical synthesis. Therefore, serum cortisol values will higher when the drug is given in a fasted state than when it is given with food
    .
    Like Marianne, I was treating my dogs with Trilostane before Vetoryl was approved by the FDA in 2008 and the route of administration has never changed in the last seven years. To be quite honest, I hope your vet will consider calling Dechra to confirm what we've told you. We're just laypeople so I don't expect her to take our word for it which is why we've provided citations for her. Getting it from the horse's mouth is much perferred to telling pet owners to do what they want. Vetoryl (trilostane) is a serious drug and she needs to direct treatment according to proper protocol. I will also say that if the lab involved knows that the test is being used to monitor Trilostane treatment, they need to educate themselves too and understand that a dog must receive their dose WITH FOOD no more than 4 to 6 hours before the acth stimulation test; otherwise, you might as well flush your hard earned money down the toilet.

    Glynda

  5. #25
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    Default Re: It's 3:55 AM and haven't slept. Need your help!

    Oh gosh, I just realize a bunch of us posted on the same thing. I hope we haven't totally overwhelmed you!!
    We are the forum of worry warts you know. It's like having a dozen mother hens running around after you.

    Sharlene and Molly Muffin
    Sharlene and the late great diva - Molly muffin (always missed and never forgotten)

  6. #26
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    Mar 2013
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    California
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    Default Re: It's 3:55 AM and haven't slept. Need your help!

    It's fine. I am a big girl. I can handle it. It all is a little overwhelming. Particularly since I hadn't even heard of Cushings until Buddy became ill and it was discovered.

    My biggest stress is finances right now. How I'm going to be able to afford to pay for Buddy's needs. I know in my heart that it will all work out, but in the meantime it's stressful. Thank you for all of your help. I found your forum out of desperation. I was looking for someone to explain some of it (any of it) to me. I kept hearing the words Cushings and seeing $$$$. Tests, tests, and more tests! Buddy's regular Vet, Emergency hospital for an ultrasound and A neuro exam and consultation, at yet a third hospital. It was a hole that I kept falling into deeper and deeper without a clue as to what was happening. Vets kept telling me that they need to do this and that. I didn't know what any of it meant or what they were searching for. All the while the $$$$ became bigger and brighter with no end in sight. These professionals spit out fees as if they were gum balls in an endless sea of pennies. They don't see them as thousands of dollars.

    Update: I gave Buddy his Trilo dose with Breakfast for the first time this morning. Up until then, hes been getting it one hour before breakfast. His stomach has been fine all day. The resurfacing of his allergies continues to be a challenge for Buddy, but Benadryl is helping somewhat. Sometimes Buddy will sneeze 20 times in a row, while his nose runs continuously. Now with the Benadryl, he's a least able to breathe easier and sleep most of the night. It is a blessing that I am on Spring Break right now. It gives me the opportunity to monitor him more closely as he adjusts to his meds.

    I haven't heard back from the vet since this morning. I forwarded her your questions. It is up to her whether she chooses to respond. If she does, I'll forward that on.

    Kathy and the Budster

  7. #27
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    Mar 2013
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    Default Re: It's 3:55 AM and haven't slept. Need your help!

    Kathy,
    that's great news! Benadryl can make Buddy sleepy so it's good that he takes it at night. Sleep is so important in the healing process for humans and furbabies.

    If your vet doesn't respond or makes your comments sound unfounded, honestly I would find another vet.

    Cushing's is difficult to treat and so many other issues can go right along with the disease. Properly treated and our guys can live out their full life span or close to it comfortably and happy.
    Valerie

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    ❤ ♥
    Daisy Bella

    "My sunshine doesn't come from the skies, it comes from the love in my dog's eyes." - Author Unknown

  8. #28
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    Default Re: It's 3:55 AM and haven't slept. Need your help!

    Well, here goes....I received a response from Buddy's vet this morning. It is cut and pasted below.

    Kathy, I don't know what to tell you on this. The forums on VIN, the database for UC Davis, cannot be cut/pasted and accessed without a passoword. All of the doctors here have been asked and we all agree is doesn't matter. This drug was given fasted for many many years with excellent treatment successs.

    So that it!
    Kathy and Buddy

  9. #29
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    Apr 2010
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    Default Re: It's 3:55 AM and haven't slept. Need your help!

    WOW,

    I have resisted chiming in. Me thinks she has a resentment building because she was sure not paying attention to the links.

    Solution: Why dont you call Dechra directly and simply ask them. They will give you a case number and she can then access Dechra through your case number.

    I did that and it really ticked off my IMS and embarrrassed her
    But, a girl has to do what a girl has to do to protect her pup.

    ((((((((hugs)))))))))))))
    love,
    addy, zoe and koko


    My little dog - a heartbeat at my feet. ~Edith Wharton

    Memory is the power to gather roses in the winter

  10. #30
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    Mar 2013
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    Default Re: It's 3:55 AM and haven't slept. Need your help!

    Great idea Addy, especially since my IMS at Cornell suggests twice a day! Cornell is a well known teaching vet hospital so I expect their knowledge to be current.

    Good luck!
    Valerie

    //^ ^\\ //^^\\
    (/(_•_)\) (/(_ "_)\)
    /''*''\ / "*"\
    (,,,)^(,,,)​ (,,,,)^(,,,,)
    ❤ ♥
    Daisy Bella

    "My sunshine doesn't come from the skies, it comes from the love in my dog's eyes." - Author Unknown

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