bella

[barbara1]

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my dog and friend, Bella has cushings. We had gone through the process of diagnosis and there were too many false negatives and so we took her to an internal medicine vet who did an ultra sound and confirmed her diagnosis as cushings. Her physical symptoms are not too bad but her blood work, alkaline phostate (3,000) was the clincher. She was started on 10mg of benazepril as her BP was
over 200 and now is good at 140. Today, she starts on trilostane and we are very nervous. The mg given are 25mg but our vet has asked us to give her 1/2 tab at dinner for 4 days to start as she has a very sensitive stomach. I have been reading your forums and you are all very caring people. I have never participated in something like this and hope I can do the website correctly as I am very elderly and not very computer savvy. I hope and pray that Bella tolerates this medicine and that her system will improve. How long does it take for the medicine to work? We have an apt with our vet two weeks from today for the post testing on this particular dosage.
If Bella get sick with the side effects, how long does this last and if they aren't too bad do you continue with the meds. Today I am feeding her boiled chicken and brown rice so that she does not have a hard time digesting her food which is usually acana dog food and boiled chicken breast. I know you have been through all this but I think my husband and I need a hug today to start this off as we are very nervous

[Joan2517]

Hi and welcome to you and Bella. I am not as knowledgeable as some of the others, but I do know that you are not supposed to break the tablet in half. Others will be along shortly to explain it all to you.

[judymaggie]

Hello again! Let me be the first to send hugs your way. For not being familiar with forums, you did a great job with your first post.

I do have a couple of questions to get you started on -- others will be along soon.

Would you tell us how much your Bella weighs? The current dosing recommendations from Dechra, the manufacturer of Vetoryl (which is the brand name for trilostane), are to give a pup 1 mg. per pound. Since your vet has prescribed 25 mg. a day for Bella, hopefully she weighs about 25 lbs.

How was the 25 mg. given to you? In one capsule? You do mention a "tab" when talking about giving Bella "1/2 tab" for four days. If a capsule, I am a bit concerned that you may be opening up the capsule and splitting the contents. I don't see a problem with starting off slowly but you will definitely want to dose Bella in the morning very soon as the post test (the ACTH) needs to be done 4-6 hours after a full meal and a dose has been given. In order to avoid any stomach issues with my pup, I give her Pepcid original before each meal that is followed by a trilostane dose. It is also recommended that the trilostane be given with a bit of fatty food; for example, wrapped up in a piece of cheese. This helps with absorption and also helps with getting it down the dog's throat.

To answer your question about whether you continue to give trilostane if the dog shows negative side effects (diarrhea, vomiting, lethargy), the answer is "no". Typically, these side effects show up if a dog is being overdosed. That is why it is important for us to know how much Bella weighs.

More hugs -- you and you husband will do great!

[labblab]

Oh welcome to you and your husband and Bella, all three!! And plenty of hugs are being sent your way.

You have done everything just right in terms of registering and posting, and now your registration has been formally approved so that all your replies will be immediately visible as soon as you write them.

I only have a moment to post, myself, right now. But I have every confidence that Bella will do fine. It will help us a great deal if you will give us more specifics about the symptoms that led to Bella's testing, as well as any other significant features about her overall health history. Also, how much does Bella weigh? Current recommendations are to begin trilostane dosing that does not exceed 1 mg. per pound.

Also, brandname Vetoryl capsules should not be opened and the powder split, but it sounds as though you are working instead with solid compounded tablets. If they are indeed solid and scored, it should be OK to split them.

Your vet is following recommended procedure by planning to test after two weeks of trilostane dosing, so that is good. In terms of side effects, etc., I'm going to give you a link to a Dechra publication that does a great job of explaining all about monitoring and side effects. How quickly you will see results will depend upon how quickly the trilostane reaches therapeutic level in her bloodstream. So take a look at this brochure, and then you can let us know about your additional questions.

http://www.dechrace.com/pdfs/vetoryl...alBrochure.pdf

Marianne

[labblab]

Hi again, Barbara.

I just now retrieved your visitor's message to me in which you mention you will be giving Bella her trilostane after dinner. Actually, it is recommended that for dogs who are dosed once daily, the trilostane is given in the morning along with breakfast. This is because the monitoring ACTH blood testing should be performed 4-6 hours after dosing. This is for safety's sake -- to find out what the cortisol level is during the time when the drug is maximally effective in the body. Few folks/vets are equipped to perform this blood test in the evening, so morning dosing is generally preferred.

Marianne

[barbara1]

Thank you so much for your speedy replies. Bella is taking a capsule and it does have a scour line on it. Her vet is concerned as she has a super sensitive stomach and it took her awhile to adjust on the benazepril. She weight 55lbs and I know you will all say she is not on the correct dosage (25MG) 1/2 to start for 4 days, but I would rather start very low with her and go up gradually. I am a little confused about your comment on the testing as her vet said she should not take her dose before the testing which is why Bella taking her meds at dinnertime.
Bella's medical history started with freguent urination and we did the urine test but it came out negative. Then blood work was done and the alkaline phosphate was off the chart (3000) I refused to commit my dog without definite proof of this disease and therefore we went the route of the ultrasound which confirmed it along with the high BP and elevated liver enzymes. I usually give Pepcid when she eats grass outside and I am glad you mentioned it. Her vet asked me to call her daily to give an update as to how Bella is doing. We are very elderly and she know how much this baby means to us. We even get a dog sitter if we go out to dinner so that Bella is not alone. Sometimes when you are an empty nester and get an animal, it becomes like your own child and you pay more attention to them as your children are gone and you have more time to spend taking care of and enjoying them. Thank you for you concerns and replies.

[DoxieMama]

Hello and welcome to Bella, you and your husband.

Marianne and Judy have already covered the questions and suggestions, so I'll just be content to send lots of hugs for each of you!

Shana

[barbara1]

I just called Bella's vet as per the dosage in the evening as you all have said it should be in am and she was in surgery and will call me. The assistant said the reasoning for this is so that Bella would not have to wait for the testing in the am after dosing in the morning. The vet will get back to me. The internal medicine vet that we took Bella to for the ultra sound has made the recommendation that Bella NOT be left at the clinic for the testing. She feels that she is way too high strung and that we should remain with her during this time. (outside, in the car, walking, etc) And so, of course, we shall do this. This is why perhaps the dosage is going to be given in the pm rather than in the am so the testing can be started asap

[labblab]

The recommendation that Bella not be stressed by waiting is a very good one. However, I'm not understanding how that would have any impact on the timing of the test. If you are living in the U.S., an ACTH stimulation test should take only one hour to perform. A baseline blood sample is first taken, then a stimulating agent is injected, and then a second blood sample is taken one hour later. So no matter what time of day the test is performed, you ought to be free to take Bella with you to relax during that intervening hour.

The reason why the blood testing should be performed 4-6 hours after dosing (and not the next morning after 12+ intervening hours) is because trilostane only has a short active life in the body. The time frame of 4-6 hours after dosing captures the effect of the medication when it is maximally effective. For safety reasons, this is very important because you need to know the status of the dog's cortisol at its lowest point during the day. By 12 hours later, the drug is already exiting the body and the cortisol may already be rebounding upwards again. Test results in that situation may lead a vet to mistakenly think a higher dose is needed to control the cortisol when that is not the case and overdosing may result.

I will try to come back and arm you with some more specific information in this regard to help you discuss this further with your vet. Try not to stress too much about this on your first day, though! The testing won't occur for a couple of weeks so we have time to sort it out. The more important thing right now is to make sure that whatever time you give Bella her trilostane, you give it alongside a meal so that it is metabolized properly.

And I totally understand how important she is to you! My hubby and I have no human children at all, so our furkids really are our only little ones.

Marianne

[Joan2517]

I always waited with my Lena. She was less stressed and so was I. It made it much easier on all of us. She would nap while I read or made friends in the waiting room.

When she was a baby we took her everywhere and never left her alone, so I totally get the babysitting when you go out to dinner.

When we took a trip to Colonial Williamsburg, VA, I wouldn't go without her, so Williamsburg arranged a babysitter for us. Lee had her own badge and was allowed in all of the buildings. Her babysitter was just so we could go out to dinner.

Bella is lucky to have such a loving mom and dad.