Confused about subtlety of food changes with Vetoryl?

[Big Fish]

ACTH
Baseline: 2.4
Post: 25.8

1. LDDST: pre 3.1, 4hr- 1.6, 8hr 2.8

[Big Fish]

Here are results:



3/17/17
LDDST: pre 3.1, 4hr- 1.6, 8hr 2.8


4/7/2017
ACTH: Baseline: 2.4, Post: 25.8

[Big Fish]

and
4/8/ 2016
ACTH: Baseline: 2.5, Post: 22.7

[molly muffin]

He is now on the full dose of vetroyl? 30mg twice a day?

You want a post ACTH of 5.0ug at least, but can go up to 9.0ug post if symptoms are controlled, so you have a was to go. Once you are on the full dose, allow for at least 30 days before making a change, as cortisol can continue to drop for that long.

Make sure you are giving with food and enough of that topper to get him to eat all his meal. then the ACTH was done 4 - 6 hours after given the pill with meal on the morning of the test ?

[Big Fish]

We started first week on 30 mg 1x@day, for 7 days.
He's been on 30mg, 2x@day for 4 days now.
All's good so far, knock wood.
Have an appt. for ATCH recheck on 7/19 (11 days in).

Sharlene he eats ALL his food each meal, eventually...within 5 min with added toppings.
I'm feeding him 3X@day, he gets the vetoryl at 2 meals.
His meals are good sized, approx.one cup of home cooked, 2/3 cup of commercial at each meal X 3 each day.

Thank you for your input!

[Big Fish]

Hi All, So did his test results relate something different than what I wrote previously before? What are your suggestions, monitoring ttrilostane based on appetitie alone with a finicky eater? Thx!

[labblab]

Hi again, and thanks so much for posting those test results. The recent results do indeed appear to be consistent with conventional Cushing's. In terms of distinguishing between adrenal and pituitary forms of the disease, the LDDS results are borderline, in that neither the 4-hour nor 8-hour result is less than 50% of baseline (the 4-hour being just a hair above 50%). But you've told us that your boy has also had two abdominal ultrasounds performed, and an adrenal tumor should have been noted if one was present. So that would lead us to the diagnosis of pituitary Cushing's, as you described earlier.

Just to clarify, though, you've mentioned that both of the ACTH tests were part of full adrenal panels performed at Tennessee? If so, there would have been results given for multiple other hormones in addition to cortisol. When cortisol is elevated, it is not surprising to see elevations in other hormones, as well. I am wondering, though, at what time UTK gave the recommendation for the maintenance Lysodren. Perhaps it was in conjunction with last year's test, when the cortisol was a bit lower. At any rate, that is all water under the bridge now as we move forward with the Vetoryl.

I'm so glad that Sharlene is giving you helpful tips based on her experience with her Molly. I am guessing the main thing in your situation will be watching for any negative signs of overdose such as vomiting, diarrhea, or lethargy. As long as your boy is behaving in a manner that is normal for him, then we'll be assuming that he is adjusting well to the medication.

Marianne

[Big Fish]

Scheduled an ACTH Stim for 7/19. He will have been on full dose of vetoryl for 11 days then. Curious to see his numbers. He's such a stoic dog, plays his cards close to his chest. Looking for his numbers to 'be pretty' as internist said. Wishing for good results. Seems the next ACTH check is again 2 weeks after that? at a month long's time on the drug.
Thanks.

[molly muffin]

The two week test on the full dose is to see how he is tolerating it and then the 30 day test will show you where he is probably going to level at on that dosage.
You'll know if you need to increase or not at that point.

As Marianne said, with a finicky eater, even though he does eat all his meals eventually, you have to monitor more the things that would be abnormal like any vomiting, diarrhea, lethargy that is unnatureal to him specifically.

That is excellent that he is doing so well right now and we will take that as a good sign. Coming down slowly is really the best way even though it does usually involve more of the follow up testing.

[Big Fish]

I'm all about going slow. Rather be safe than sorry. If it costs a bit more here and there, it's worth it to me to have a healthier, happier dog. My dogs probably get better health care than me, LOL, sad but true. Firm believer in setting up a medical protocol that compliments your animal's best needs. I'm looking forward to knowing his test results next week. So far, so good. Thanks again.