Our Silver Belle Labrador~Athena has crossed the Rainbow Bridge

[WeLoveAthena]

You'll see that I've gone ahead and merged your new thread into your original thread. This way, all the info about Athena will be consolidated in one place. I will try to edit your thread title in such a way that better reflects your current situation, though.

The risk of cortisol falling too low (going Addisonian) is always present when you are treating a Cushpup with either trilostane (Vetoryl) or Lysodren. So it is not an unusual situation, but it can be a very dangerous situation if the proper recovery steps are not taken. Athena's cortisol levels are quite low. In a situation such as this, there can also be life-threatening imbalances in sodium and potassium levels because the adrenal hormone that controls those balances, aldosterone, can also fall too low if a dog is overdosed on trilostane or Lysodren. Did your vet also check basic blood chemistries at the time this ACTH was performed? Were the potassium and sodium levels normal? If so, then it is really the cortisol alone that is the issue.

I am very concerned that the vet is instructing you to continue giving more trilostane, at any dose, while her cortisol level is so low. This is totally contrary to the instructions of both the maker of Vetoryl and also testing laboratories. At a minimum, no more trilostane should be given at all until cortisol levels have rebounded to a more acceptable range. And some dogs may even require supplemental prednisone as a bridge between the period of overdose and the time that the dog's natural adrenal production has rebounded. Since Athena is not suffering from symptoms such symptoms as vomiting, diarrhea, or extreme lethargy, she probably does not need the supplemental prednisone. But she should not be started back on the trilostane yet. I will try to come back later this evening and give you some related links, OK?

Marianne

Marianne. THANK YOU. Please post anything I can print and take to my vet in the morning. I plan to go and take the info right to the new Vet. Very concerned for my dog. Our vet we trusted for 6 years just betrayed us beyond comprehension with our staffy that we just had to put down so before we allowed this new Vet we interviewed her to make sure she could take care of our dogs properly. If she doesn't know that it's dangerous to have her on this then why say continue but at a lower dose. They didn't do basic blood work but they still have her vial so I will request they run it ASAP in the morning. At this point we have zero trust with Vets due to stuff with our old Vet who we thought was the best but we were sadly mistaken. Now this Vet seemed good and consults with other vets if she needs more info but I agree why put her on this med again at a lower dose if these are her results. I'm very apprehensive. I can't lose Athena...we just lost our staffy and right now I'm beside myself.
Anything you have please let me know. I'm very very worried about Athena. She's not acting sick except drinking a lot, pee'ing and her weight is back on a bit more. She's not acting like all the other symptoms listed for Addisons or Cushing's other than those two except her hind legs bother her which is why she's on tramadol.
I want to trust this new Vet badly but we are very gun shy right now....why wouldn't she know this info that you know. That must be a red flag
Thanks for anything you can give me tonight. We will go there tomorrow armed with this info.
Now can you cold turkey stop Vetroyl or do we have to ween her off it if we choose to take her off the med.
Our lab is young. Barely 5. This is very concerning to us both.
Thanks for helping us..... Thanks very very much

[labblab]

Here's the relevant warning/instruction from the insert that Dechra includes in boxes of Vetoryl :

If the ACTH stimulation test is < 1.45 μg/dL (< 40 nmol/L) and/or if electrolyte imbalances characteristic of hypoadrenocorticism (hyperkalemia and hyponatremia) are found, VETORYL Capsules should be temporarily discontinued until recurrence of clinical signs consistent with hyperadrenocorticism and ACTH stimulation test results return to normal (1.45-9.1 μg/dL or 40-250 nmol/L). VETORYL Capsules may then be re-introduced at a lower dose.

http://www.dechra-us.com/Admin/Publi...ack-insert.pdf

If your vet has questions about this, he/she can definitely call Dechra directly. They have technical reps on staff who can explain the reasoning beyond this recommendation.

Marianne

[WeLoveAthena]

Here's the relevant warning/instruction from the insert that Dechra includes in boxes of Vetoryl :



http://www.dechra-us.com/Admin/Publi...ack-insert.pdf

If your vet has questions about this, he/she can definitely call Dechra directly. They have technical reps on staff who can explain the reasoning beyond this recommendation.

Marianne

Thanks! I'm withholding her meds in the morning and taking this over to the new Vet. Is there a phone # to Dechra? That print is so small on the leaflet. Trying to locate one that I can give her so she can call directly. Thanks a bunch!!!!!! We really appreciate your help!

[labblab]

Yes, here's a link to the phone number and contact page for Dechra's U.S. Office:

http://www.dechra-us.com/contact/technical-support

Also, here's a lengthier treatment brochure that may be easier for you to read. You'll see it includes a Treatment/Monitoring Flowchart that again advises that Vetoryl be discontinued at least temporarily when low cortisol readings are obtained. If a dog otherwise seems to be clinically well, the recommendation is to stop for at least a week before restarting at a lower dose. But if a dog is not doing well, more investigation needs to be done before restarting. I am not sure what to make of Athena's increased thirst/urination in this situation. They can be symptoms of low cortisol as well as high cortisol, but there may be something else going on with her, as well. So I do think it would be helpful for your vet to discuss her case with a Dechra technical rep.

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

Marianne

[WeLoveAthena]

Yes, here's a link to the phone number and contact page for Dechra's U.S. Office:

http://www.dechra-us.com/contact/technical-support

Also, here's a lengthier treatment brochure that may be easier for you to read. You'll see it includes a Treatment/Monitoring Flowchart that again advises that Vetoryl be discontinued at least temporarily when low cortisol readings are obtained. If a dog otherwise seems to be clinically well, the recommendation is to stop for at least a week before restarting at a lower dose. But if a dog is not doing well, more investigation needs to be done before restarting. I am not sure what to make of Athena's increased thirst/urination in this situation. They can be symptoms of low cortisol as well as high cortisol, but there may be something else going on with her, as well. So I do think it would be helpful for your vet to discuss her case with a Dechra technical rep.

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

Marianne

Hi Marianne. Brought everything to our new Vet. She's a one vet practice and very good but hasn't treated a lot of dogs with this condition that being said she is still very open to research things and talk to whomever we ask her to talk too. She consults with others as well and she's just a good solid vet compared to our big vet practice we were at that really took us for a ride ( long story). So we held Athena's dose today, brought our vet all the info you sent us and she read everything and was very grateful we brought it to her attention. She called Dechra and then called us and the plan is to withhold the med for 14 days to get Athena stabilized. We are waiting on results of a potassium/sodium test ( they still had her blood from the other day and the lab said it's still good) and at the end of 14 days we will test her and start her on the lower dose of 60mgs vs 90mgs. Dechra and our Vets plan. So thanks to. YOU...we have a great plan in place and we are all thrilled that together we came to a good plan and agreement on it. Athena is doing good today. Nothing stands out except the things I mentioned before but for example today she's drinking normal amounts of water..but later she may start drinking a lot. So we are going to do some more blood work as well to check a few things but right now we are just so happy that it all came to a good plan in motion and it's thanks to YOU and this godsend of a site. We will keep you posted. We also started Athena ( started to slowly mix the new with current food)a new food that is good for metabolic issues and weight management. She likes it so we are just cutting back a bit on her normal food and adding some of this new one to see if that also helps her. Thank you with ALL our hearts!!!!! Have a great afternoon. PS: We like this vet a lot because she is open to hearing things and also working with pet parents. Our old Vet was one that "knew it all" and we had to fight them on things as well as the time they wanted to start Athena on the max dose and we said NO and only wanted to start her out small. We got our way and in the end they ended up thanking us for fighting them because the higher dose would have proven to be fatal for Athena but then a bunch of other stuff happened and we got our records and left. 6 years of loyalty to them and enough chances. Our dogs are our life and we were not going to jeapordize their care. The things we found out when we got their records..well suffice to say we are still reeling from it in the midst of grieving our oldest girl that had to go off to the Rainbow Bridge so it's been a tough month or so.

[DoxieMama]

I'm so glad that Marianne was able to provide you with the recommendations from Dechra - and even more glad that your vet is willing to be open and discuss things with you, and them! I think I would be inclined to like her, too! She sounds great.

Spyndal is an honorary k9c angel. I hope she found my baby boy Visuddha. Those two old pups have had all their ills healed and are romping in the green meadows happy and care free, until we join them.

Much love,
Shana

[labblab]

Oh I'm so glad your vet visit turned out so well! And Shana is absolutely right -- Spyndal is now an honorary member of our K9C angel family. If you will tell me the date of her passing, it will be our privilege to add her to our special memorial thread of honor. We can also talk later about adding a photo link, as well.

http://www.k9cushings.com/forum/showthread.php?t=7676

Definitely do keep us updated as to how you all are doing. After all your family has been through, I am so hopeful that things will quickly straighten out for sweet Athena!

Marianne

[WeLoveAthena]

I'm so glad that Marianne was able to provide you with the recommendations from Dechra - and even more glad that your vet is willing to be open and discuss things with you, and them! I think I would be inclined to like her, too! She sounds great.

Spyndal is an honorary k9c angel. I hope she found my baby boy Visuddha. Those two old pups have had all their ills healed and are romping in the green meadows happy and care free, until we join them.

Much love,
Shana

Hi Shana. So sorry for your loss. Today makes 3 weeks for us and we are so heartbroken but I bet you anything that Visuddha was there to greet our girl Spyndal and give her the grand tour. Together they are enjoying their brand new bodies, legs and yes, those beautiful green meadows, treat lined streets and so much more and we will see them again. You can rest asssured we will. :-). If I may ask how long as your boy been gone? We have had a very hard three weeks. We have our other babies that keep us going but she was the queen of everyone and the matriarch and it's been so hard not to see her sweet face. I have to keep telling me myself as does my husband we did the right thing letting her go. It was just so hard and we gave her our word she would never suffer when the time came that her battle was done. We kept our word but it broke our hearts. She went so peaceful and we are grateful for that and the emergency vet we had with us who is an ANGEL ( our vet of 6 years really let us down and we left their practice and have a new vet now). So in the end things happened in a way we know God planned for us and we are grateful he kept our old vet practice away from us through it all.
XOXOXOXO

[DoxieMama]

Thank you. It has been 4 weeks today since my baby boy crossed the Rainbow Bridge. He was 14 years and 4 days old. Some days are better than others.
Hugs.

[WeLoveAthena]

Thank you. It has been 4 weeks today since my baby boy crossed the Rainbow Bridge. He was 14 years and 4 days old. Some days are better than others.
Hugs.

Oh Shana. It's 3 weeks today for our girl. She passed at sunset. She was 14 too. A staffordshire terrier/pittie. For certain they are pals up there