Dog Diagnosed and feeling unsure about diagnosis and treatment

[Winston's Mom]

Hello and Happy New Year! Winston and I are back home in California after a trip back to our family in New York during the holidays. We got the chance to go and visit Winston's trusted vet while we were back on the east coast. During the same time as the Cushing's diagnosis, Winston was also believed to have a pneumonia due to what looks like fluid in the lung. He was put on antibiotics, and is still on them, since we did a recheck with his vet back in New York. He's due for another X-ray since he's been on antibiotics for a month now and the specialist here said that if his chest X-ray hasn't changed that we'll stop the antibiotics and it could be something else, like PTE which is common in Cushing's dogs. Is this something anyone here has experienced or heard of?

When we visited with his vet while in New York our vet agreed that 60mg per day was far too high for Winston. So he wrote us a prescription for 40mg per day. The thing I also liked is that he wrote a prescip for 10mg capsules which allows us to continue to use the capsules if we have to reduce the dosage eventually. He also mentioned that there many people who do not want to medicate their dogs put their Cushing's dogs on melatonin and lignin's which was researched by vets at the University of Tennessee. Has anyone heard of this?

The pharmacy we dropped the prescription off has to order the vetoryl so it we won't be able to start Winston on it until this Thursday. I'm more comfortable with our long time vet's dosing, but I'm still extremely nervous about the risk that my decision to medicate with Vetoryl will do Winston more harm than good...very scary at bringing levels too low. When we returned home and I emailed the specialist an update and our vet's lower does of 40mg per day, she mentioned giving him 40mg once a day and doing the ACTH stim test 2 weeks later (her original 60mg per day was broken into 2x doses of 30mg) Meanwhile, my vet in New York said to split the 40mg dose into 2x/20mg per day. Is there a reason why one vet recommends 1x a day and the other 2x a day?

[Squirt's Mom]

I am very glad this vet lowered the Vetoryl dose for Winston! The comment about melatonin and lignans however is not correct. That combination is the treatment for a form of Cushing's called Atypical in which the cortisol is NORMAL but two or more of the intermediate, or sex, hormones are elevated. The combination will do next to nothing for elevated cortisol. So I wouldn't worry about trying that with Winston. The only place that does testing for Atypical is the University of TENN in Knoxville who did the initial research on this form. However Vetoryl causes elevations in the intermediate hormones so having that test done now would not be valid nor would I waste my money since the diagnostic ACTH showed elevated cortisol. So for now, just use the lower Vetoryl and let us know how that works for him.

As for PTE, that means blood clots in the lungs which is very serious so I am surprised no further testing was recommended. Our cush pups are prone to blood clots and Cushing's is one of the causes of PTE. Here is a link about PTE in dogs for you to read - https://www.petmd.com/dog/conditions...hromboembolism

[Harley PoMMom]

Regarding the once or twice a day dosing, if a dog has diabetes it is strongly recommended that the Vetoryl be given twice a day to help keep the cortisol on a more even level which is needed to control the diabetes.

Now for dogs without diabetes, once a day dosing is generally tried first but if it seems that symptoms rebound in the evening than twice a day dosing can be done.

Lori

[Winston's Mom]

Squirt's Mom - we haven't had the 3rd chest x-ray performed yet. He's going in this Thursday for the chest X-ray and that will determine whether or not to continue the antibiotics course. The specialist had only mentioned that if they find that there are no change to the lung on Thursday when they perform a new x-ray then we will stop the antibiotics and that it *could* be something like PTE, so I'm not sure what the next steps from there would be.

[Winston's Mom]

Lori - thank you for clearing that up!

I guess we'll go with once a day to start based on the specialist recommendation. Today I read a PDF of all the fine print information (ALL OF IT) for Vetoryl describing how to dose, testing stages, etc. and adverse effects including information regarding the studies that were done on the dogs and how many died and suffered from various adverse effects. Reading that gave me anxiety and continued worry. My dog's biggest obvious symptom is a ravenous appetite and lethargy which is pretty bad right now. That being said, one of the adverse effects is decreased activity and decreased appetite and if that happens to my dog how will I know that it's not a serious side effect and I need to stop the medication or if it means it's working?

Also curious if anyone can tell me from experience when I can expect to see improvement of his current symptoms like depression, large loss of muscle mass and increased appetite?

Very nervous about how he will react to Vetoryl - Winston is my entire life, we don't have kids, so he is even more so truly my baby - the thought of him getting worse or losing him due to the medication pains me beyond belief.

[Harley PoMMom]

Kudos to you for reading up on Vetoryl! I know it's scary starting your furbaby on treatment but we are here and will help in any way we can, we are the best hand holders!

Adverse effects are usually only seen when the dog is started out at a too high a dose. Diarrhea, inappetence, lethargy are some ill side effects so if you should see any one of those symptoms the Vetoryl needs to be stopped, also, if Winston would start acting not like his "ole" self than you would need to stop the Vetoryl, remember you know Winston best so if he would act off in any way cease the Vetoryl.

Muscle mass takes a long time to improve, that ravenous appetite should calm down within 2 weeks of treatment.

Lori

[Winston's Mom]

I am so so thankful that this group exists and that there is such a vast knowledge and first hand experience of Cushing's from actual dog owners and I think that is pure gold. I am very scared for my senior puppy but feel a bit better knowing you and everyone here is able to support me through this journey!

Olivia

[Harley PoMMom]

We are definitely here for you both! And remember, if in doubt don't give the Vetoryl as missing a dose will not harm him in any way....oh another thing, remember to breathe

Hugs, Lori

[Winston's Mom]

So, I've been having increasing anxiety about medicating, even though I feel like I should give it a shot. To be honest, the dosing is what has been bothering me the most even though it was decided to start with 40mg a day. Took my boy in this morning for a recheck on his chest to see if the lung has cleared up or not. Won't have results until tonight, but while I was there I spoke with the Internist who diagnosed him and the stress that starting him on Trilostane has been consuming me.

Surprisingly, she told me she didn't want me to do anything I wasn't comfortable with and even told me that I won't hurt her feelings if I wanted to go to UC Davis for other treatment options or another Internist at the same clinic that is familiar with other ways of treating Cushing's aside from the usual meds. Well, I still felt like I should give the Trilostane a shot at least and since I already paid for and picked up the Vetoryl from Costco yesterday. Luckily, they are 10mg capsules so I suggested starting with .5mg per lb/ a day and she said that's totally fine. So I'm going to start him on 10mg 2x a day. She also scheduled me in for an ACTH stem test this Monday, just a few days after starting treatment so we can check his levels to be sure they aren't too low. Feeling a little better about this now...but I am still so afraid. The anxiety is really starting to consume me. I have this fear I'm going to make my dog so sick. Does it matter if I begin the first capsule for his dinner tonight or wait until tomorrow AM?

Thanks in advance!
A very nervous me.

[Harley PoMMom]

Since you are dosing twice a day than its fine to start this evening, just make sure that he gets it with a meal. I'm sure he'll do fine, and remember to try to stay calm as possible because our furbabies can pick up on our stress...breathe!!!

Hugs, Lori