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Thread: Breathing difficulties

  1. #21
    Join Date
    Apr 2009
    Location
    Georgia
    Posts
    15,292

    Default Re: Maximum dose of Vetoryl

    Monitoring cortisol production and basic blood chemistries (most notably potassium and sodium levels) are the most important tools. Historically, ACTH stimulation testing has been the preferred method for monitoring cortisol and it is still the most common method in the U.S. However, an alternative method has recently been introduced and is growing in favor, especially in the U.K. and Europe. It involves testing the baseline cortisol alone, right before a dose of trilostane is scheduled to be given. I think either monitoring method is fine — it’s just important to do one or the other in order to check adrenal function. Here’s a post that describes the newer “pre-pill” method in greater detail:

    https://www.k9cushings.com/forum/sho...=1252#post1252

    The importance of also monitoring potassium and sodium is because trilostane has the potential to lower the production of another adrenal hormone, aldosterone, as well as cortisol. Aldosterone controls the proper balance of potassium and sodium in the body, and it’s the other “half” of concern over an Addisonian condition. If either cortisol or aldosterone — or both — drop too low, an Addison’s crisis can be induced. But any basic blood chemistry panel ought to include potassium and sodium levels.

    I truly believe that you are seeking only the best for your boy, especially after the rough life he led before you rescued him. You saved his life then, and you are trying your hardest to give him the best quality of life now. We are all grateful to you for what you are doing for him. In that vein, if the trilostane is not really helping him, even if his cortisol level is OK, you might want to give him a trial period to see whether he’s better or worse without it at all. I agree with you that at his age, comfort is the most important thing. So if the trilostane isn’t making him feel any better, you might want to just forget about it. That way, you wouldn’t have to worry about any negative side effects or the need for the monitoring blood draws. Just a thought. But who knows, maybe the cortisol testing will show that his cortisol is actually remaining too high to expect good symptom control. As you say, it’s possible that he may have an aggressive adrenal tumor that is really ramping up the cortisol production. When used diagnostically, the ACTH stimulation test frequently doesn’t return a “positive” result in the face of adrenal (vs. pituitary) tumors. So that might explain his original equivocal test result. All in all, we’ll surely be anxious to hear what the current testing shows!

    Marianne
    Last edited by labblab; 12-14-2018 at 09:13 AM. Reason: To add.

  2. #22
    Join Date
    Jan 2016
    Location
    Glen Cove, NY
    Posts
    1,941

    Default Re: Maximum dose of Vetoryl

    I have used the new resting cortisol testing and it is much less stressful on my boy (and me). Simple blood draw and home we go.
    Joan, mom to my Angel Lena, Angel Gable, Angel Phoenix, Angel Doree, Cooper, Sibble, and now Raina.

  3. #23
    Join Date
    Sep 2018
    Posts
    13

    Default Re: Maximum dose of Vetoryl

    My vet has been using the pre-pill blood test. Following two ACTH tests at the end of last year, my boy has had three of these tests. Just before the dose was raised from 180mg to 240mg, the vet was going to do another blood test but decided just to go ahead with the increase based on his symptoms.

    Reading the post on the blood test, I was interested to read the following:
    Very importantly, the resting cortisol level is evaluated in conjunction with the dog’s appearance and symptoms.
    My vet has been very diligent in checking my boy and taking note of his symptoms and general behaviour as recorded by me. We see the vet every month, sometimes twice a month.

    As I mentioned, I was anxious about giving him such a high dose of vetoryl and after careful thought, and receiving your posts, I decided to lower the dose over the weekend. I called my vet on Friday to check on this but he had already left the surgery.

    Result, my boy has been absolutely fine. If anything, he is slightly perkier although it is sometimes hard to tell as he is such a quiet, gentle dog. He is still drinking more than normal and still hungrier than normal but not excessively.

    Incidentally, he was only on 240mg for two weeks, then 300mg for two weeks (dose prior to that was 180mg). Granted that is four weeks too long and I am giving myself a hard time over this but we all do what we think is best at any given moment. I did keep a close eye out for any Addison’s symptoms but I take the point that this can happen with minimal outward warning signs. I am anxious about possible necrosis but, hopefully, that has not happened (would welcome your thoughts on this).

    My plan now is to have another blood test done immediately and I have already asked for a referral for the endocrine clinic.

    Thank you so much for the information and support, it’s good to know you are all out there.

  4. #24
    Join Date
    Apr 2009
    Location
    Georgia
    Posts
    15,292

    Default Re: Maximum dose of Vetoryl

    That’s very reassuring that your vet was performing the pre-pill cortisol tests, so that’s a protocol we know that he’s familiar with and can be resumed once again. From what you’ve described, I doubt that any actual or lasting damage has been caused by the period of time that your boy was taking the higher dose. And who knows, it may turn out that the higher doses are appropriate for him. But we’ll all be relieved to know that further increases will also be monitored by actual testing.

    Do let us know how things progress, especially if you do proceed with the specialty consultation.

    Continued best wishes to you and your boy!
    Marianne

  5. #25
    Join Date
    Sep 2018
    Posts
    13

    Default Re: Maximum dose of Vetoryl

    The blood test results were, in the main, good. ALP and ALT were both high, ALP in particular (1800). It was just under 1000 when he was given the Cushing's diagnosis just over a year ago and I am concerned about the increase. However, everything else is within the normal range including sodium and potassium.

    Unfortunately, his cortisol level came back at 156 pre-vetoryl (normal range 40 - 138) so obviously the Cushing's is not being controlled. I'd reduced the dose from 300mg and he did really well for about 4 days but he's back on 240mg per day at the moment.

    Some days are fine and others, like today, are not so good (agitated, ravenous and a lot of panting). I don't want to give him more vetoryl but I do want him to be comfortable. I have booked an appointment with the endocrine clinic so, hopefully, they'll be able to point me in the right direction.

    Trying to stay calm!

  6. #26
    Join Date
    Apr 2009
    Location
    York, PA.
    Posts
    11,036

    Default Re: Maximum dose of Vetoryl

    Quote Originally Posted by 77sammy View Post
    T I have booked an appointment with the endocrine clinic so, hopefully, they'll be able to point me in the right direction.

    Trying to stay calm!
    Has he had his visit at the endocrine clinic? And how are you both doing?

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