Second, third, and fourth what has been said. Your vet is dangerously ill-informed and not equipped to handle such a complex disease.
Second, third, and fourth what has been said. Your vet is dangerously ill-informed and not equipped to handle such a complex disease.
Reneé
Mom to Tobey, Ichiro & Skeeter. Foster mom for Polar Pug Rescue
“Animals have done us no harm and they have no power of resistance…there is something so very dreadful…in tormenting those who have never harmed us, who cannot defend themselves, who are utterly in our power.”—Cardinal John Henry Newman
Honey, we are not ganging up on you either and I hope we haven't made you feel that way. But we are here for one reason - to do the best we can for the dogs that come here by guiding their parents. We don't really care if the vets like us, tho that would be nice, nor are we here to make friends, tho that does certainly happen and we are very happy when it does - our number one priority is the dog. And Riley is simply not safe under this vet's "care". Please, please find another one. We have Canadian members here who can help you I'm sure.
"May you know that absence is full of tender presence and that nothing is ever lost or forgotten." John O'Donahue, "Eternal Echoes"
Death is not a changing of worlds as most imagine, as much as the walls of this world infinitely expanding.
I am in canada. Mississauga Ontario. If you are in my area let me know.
Sharlene and the late great diva - Molly muffin (always missed and never forgotten)
OK so I hear you all and I am now extremely reluctant to even give Riley a second pill. But to change vets - where do I find a qualified one that is knowledgeable in treatment of Cushings? We live in the Federal Way, Washington area so thanks Canadians, but it's a bit too much of a commute. I am talking to relatives and friends and will then call their recommendations but what questions do I ask? And will changing now put us back to ground zero and force us to have to pay another $280 for a complete exam? And of course this happens on a holiday weekend so another delay in getting the proper treatment for my pup. And oh yeah, I now own a useless 29 pills of 60 mg vetoryl that cost me $93.00!
Last edited by barbaraabaker; 04-03-2015 at 08:29 PM.
I have been reading Riley's story, but have not posted to you before. I can't offer a whole lot of help with the vetoryl as I have never used it. The one thing I can suggest is that your 60 mg. capsules may not be a waste. If you can find a pharmacy that would be willing to repackage the 60 mgs. into a smaller dose that Riley can use, such as 30 mgs., it would save you some money. There is usually a small charge to do this, but nothing compared to buying a brand order of vetoryl.
Debbie
Mom to 2 Cushing's angels
Debbie has made a good point about getting them compounded to smaller dosage. Just google compounding pharmacy for your area.
The closest specialist I found was at the critical care in Renton.
http://www.criticalcarevets.com/serv...ernal-medicine
They have an internal med group. You could get copies of all test from your vet. For your own files. The. Take those with you to whomever you see. So you don't repeat.
Option 2 is to start calling vets in your area. Asking what experience they have with Cushing. How many patients. Success rate. Drug they use. Etc.
It isn't always easy. Even if they don't know Cushing's well they need to be a team with you. Did you print out the instructions from dechra to give your vet? Maybe that would help him to learn. He can also call the drug manufacturer directly for input. They have an 800 number in the US.
Hang in there.
Sharlene and the late great diva - Molly muffin (always missed and never forgotten)
Yes, I agree with Sharlene. If you don't have good alternative options, you may still be able to work with your current vet if he is open to additional education about appropriate treatment. Have you been happy with him in the past? Is he a good team player?It isn't always easy. Even if they don't know Cushing's well they need to be a team with you. Did you print out the instructions from dechra to give your vet? Maybe that would help him to learn. He can also call the drug manufacturer directly for input. They have an 800 number in the US.
If so, hopefully he can learn more from this experience. In his defense, the 1-3 mg. per pound dosing range does still appear in Dechra's published info. So he may have felt as though he was doing the right thing by picking a dose in the middle of the range. The lack of testing is an entirely different issue, though, because nobody advises dispensing with testing. So the question is, why does he think this is acceptable in Riley's case? Was he just trying to save you guys money, or is the ACTH testing something he is not equipped or willing to perform? If it is the latter, then you really have no choice but to look elsewhere. If it is the former, then you can tell him that you know the testing is essential for Riley's safety, and you will pay for what needs to be done.
Sticking with this vet does place much greater responsibility on your own shoulders to ensure that things are being done correctly, though. So I guess that's what your decision will come down to as far as weighing your alternatives. If you do decide to switch, you don't necessarily need a specialist, though. A GP vet with Cushing's experience should also be fine, asking them the questions that Sharlene mentioned above.
Marianne
OK so I found another vet - Animal Critical Care and Emergency Services - and I am fairly confident that the new vet actually knows something about Cushings. After initial exam he recommended that we do an Endrogenous ACTH test and a pre post stim test. The results:
PRE POST ACTH Stim test
Pre-ACTH cortisol 5.8 ug/dL
Post-ACTH cortisol 37.6 ug/dL
reference range
2 - 6 pre-acth resting
6 - 18 post acth cortisol
18 - 22 equivocal post acth cortisol
>22 consistent with hyperadrenocoricism
Endrogenous ACTH test
<5 pg/mL
< 10 result consistent with Adrenal dependent disease
10 - 15 equivocal result
> 15 consistent with Pituitary dependent disease
So now he is recommending an ultrasound to confirm the adrenal tumor and to see if there is any invasion into adjacent structures especially vascular invasion. This to be followed by surgery. To get to here was almost a $600 trip bringing investment so far to about $1600.
In a perfect world where Riley was young and I had tons and tons of money I could see continuing this course of action. But am I a terrible owner by saying that enough is enough? I don't want to put Riley through a surgery and the cost of the ultrasound alone is $400 and I hate to think about the charge for surgery.
The vet says that he "could" consider treatment with Vetoryl but "some patients with adrenal tumors are resistant to the standard dose of Lysodren but do seem to respond to higher dosages".
Is it unfair of me to ask you folks - What do I do??????
It does sound like this vet is pretty knowledgeable, and yes, that endogenous ACTH result does point to the adrenal type of Cushing's.
You are not a terrible owner at all, and just get that thought out of your head. An adrenalectomy is a very serious surgery, and in your shoes, I probably wouldn't consider it either.
One advantage with an ultrasound is that it may show abnormalities with other organs, however, ultrasounds are expensive, and I too wish we lived in an ideal world where money doesn't need to be a factor.
The vet is correct in regarding adrenal tumors needing higher than normal loading doses with Lysodren. Trilostane treatment is a option that can be used when a dog has an adrenal tumor, and this would be the course of action I would take if Riley were my dog. These decisions are never easy or cut and dried, I think you need to listen to your gut when making decisions for Riley because nobody knows him better than you.
Hugs, Lori
I just want to say that I "second" everything that Lori has written above. I know this brings us back full circle again, as far as resuming trilostane treatment once again. But hopefully, this time, the treatment will be monitored and dosed daily at a lower level. As we had discussed back when Riley first took the med, at his weight, he should start on a dose no larger than 30 mg.
http://www.k9cushings.com/forum/show...=1251#post1251
Out of curiosity, I looked back at his original LDDS and his result on that test could have been consistent with adrenal Cushing's, too. So it may well be the case that he has an adrenal tumor. But Vetoryl is FDA approved for treatment of adrenal Cushing's, so it should be an option the specialist will consider.
Do let us know, OK?
Marianne