Is it cushings or not with our blue - Blue has passed

[Squirt's Mom]

We will be with you! Give Blue a belly rub from me and tell him things might be getting much better soon!

[Larinda]

We got the blood test results vet said it's through the roof...baseline of 3 and test results at 28 post. Is this bad? It sounds bad. She is starting him on trilostane i have to order it. I have to get the directions yet but I think she said 120mg. I'll know more later today. And antibiotic for his skin issues. I pray this will work and he will get better. I don't know what to expect or how this will go. Thanks for any insight or advice.

[labblab]

I’m so glad you went ahead with the testing. A post-ACTH of 28 is indeed consistent with Cushing’s, but it is far from the highest result we’ve seen here. I think my own boy had a post of 35 before we started treatment. So try not to worry unduly about that level, and now we’re all gonna focus on getting him better! I’m guessing and hoping that you’ll see some fairly rapid improvement in some of his symptoms.

Here’s a big tip about ordering his medication, though. I see that Blue is a big boy, weighing about 100 pounds. So a starting dose of 120 mg. is only a little bit higher than the recommended formula of 1 mg. per pound and may turn out to be fine. However, our experience on the forum is that larger dogs often end up needing only a comparatively smaller dose of trilostane compared to their weight. So if you’re going to be ordering brandname Vetoryl, I’d encourage you to ask your vet to write the prescription for 60 mg. capsules rather than 120 mg. capsules. This will be more expensive to begin with, but you may save money in the long run. You can always change the capsule size once you know for certain what dose Blue ends up stabilizing on. But while you can always give him two of the smaller capsules (or make different combinations with even smaller capsules), you cannot split the 120 mg. capsule. So if 120 mg. is too much for him, all those capsules will go to waste. You might even want to start with only 60 mg. for the first few days in order to help his body adjust to lowering his cortisol more gradually. Dogs tend to have fewer side effects from the trilostane if they start on a lower dose and work upwards, rather than vice versa.

I strongly encourage you to make this dosing suggestion to your vet. Over the years, we’ve really seen this sort of plan work out better, both clinically and financially. And definitely continue to keep us updated, OK? I’m really hoping you’ll see Blue starting to normalize again before long!

Marianne

[molly muffin]

Did you start him on medication yet? How is it going if you did?

[Larinda]

hello! We ordered the meds and it came on Saturday. so I need to be aware of that I guess when it comes time to refill...allow for shipping? We gave him his first dose, 120mg of trilostane yesterday. we are planning on giving it to him in the evening with his dinner, and watch him closely. they said once a day. they also scheduled the next blood tests for april 4th. we are scared to death, but realize he really needs this so we are hoping for the best. his skin condition is getting worse, but doesn't look infected. he is on antibiotics, but hes flaking with scaly bumps on his back, hair falling out in small clumps. i'll keep you posted on our progress. thanks so much for thinking of us.

[labblab]

When dosing once daily, the manufacturers of Vetoryl and also specialized clinicians tell you to dose in the morning with breakfast rather than in the evening. There are a couple of important reasons. First, if your vet is planning to monitor via ACTH stimulation blood testing, the blood should be drawn no later than 4-6 hours after dosing. For most folks, this rules out getting the medication only once in the evening.

Secondly, trilostane remains optimally effective in the body only for about twelve hours. So if you’re dosing once in the evening, the medication is most effective when the dog is asleep, and is already wearing off by the time the dog awakens and is active the next day. As a result, you may be disappointed by a lack of symptom improvement during the waking hours. So unless it is difficult to dose Blue along with breakfast, that’s the better way to go.

Also, I’m now able to supply you and your vet with a link to a research study that highlights the warning I wrote about earlier — that larger dogs often need/tolerate smaller doses of trilostane, per pound, than the general, 1mg. per pound formula. So I continue to caution you to watch Blue very closely for signs of overdose since he is starting out with 120 mg. We’re you able to order 60 mg. capsules, or do you only have 120 mg. capsules on hand?

Here’s the link: http://www.k9cushings.com/forum/atta...2&d=1522092380

Marianne

[Larinda]

oh good to know. you are so right! gosh I didn't think that through. how do I switch him over? skip tonight and give it in the morning? thanks so much! and also, yes they only approved the 120 mg tabs for 30 days supply. should I just order a lower dose now? I will definitely talk to the vet about my next order for sure. but for now I only have the 120mg tabs.

[labblab]

Yes, that’s what I’d do — skip tonight and start fresh tomorrow. Also, I think we were typing at the same time, so be sure and look at the info I added to my last reply about larger dogs needing smaller doses.

[labblab]

oh good to know. you are so right! gosh I didn't think that through. how do I switch him over? skip tonight and give it in the morning? thanks so much! and also, yes they only approved the 120 mg tabs for 30 days supply. should I just order a lower dose now? I will definitely talk to the vet about my next order for sure. but for now I only have the 120mg tabs.

Since you’ll be seeing the vet on April 4th for monitoring, you can probably hold off on a decision about placing a different order until then. However, this is assuming you don’t see any adverse effects before then. If so, I’d stop the medication and immediately let your vet know. If the 120 mg. turns out to be too high, you can take a break if necessary and await a lower dose to arrive. But if it were me, no matter what, I’d request that the next order be placed in smaller capsules so you’ll have more flexibility to make changes down the line.

Also, here’s one more helpful link for you. It’s an excellent sheet of trilostane dosing guidelines put together by a couple of our staffers:

http://www.k9cushings.com/forum/atta...3&d=1522092871

[Larinda]

4 days in with 120mg vetoryl in the morning with his breakfast, and so far so good. I may see slight improvement, but certainly not any worse than he was prior to the meds. No adverse reactions thus far. Here's hoping to a great weekend with positive improvement daily! His blood test is Thursday April 5th. Praying this works!