Originally Posted by
labblab
Hello again from me! I’m sorry it’s been such a long time since I last wrote on your thread, but I’ve been traveling and am just now having the chance to catch up again on the forum. After reviewing your recent posts, I agree with your decision to hold off on starting the Vetoryl at this time. Truly, I think there are too many question marks as to whether or not Pookie would benefit from the medication, even assuming that she truly has Cushing’s.
A first cautionary note is that resting cortisol levels alone have no Cushing’s diagnostic value at all. They are simply too variable. For instance, stress itself can elevate a baseline cortisol level in even a healthy dog. Conversely, I would guess that a medication with sedating properties such as trazadone could artificially lower a baseline reading in a dog who otherwise might routinely run higher levels. For this reason, Cushing’s diagnostics require a more complete picture gained from either a LDDS test or an ACTH test, both of which you’ve had done in the past. Pookie did return a mildly elevated result on her LDDS, but that test is particularly vulnerable to “false positives” in the presence of other illnesses or systemic stress, of which it sounds as though Pookie has had quite a few medical issues going on. The ACTH is less vulnerable to false positives, and Pookie’s cortisol level fell within normal range on that test. If her repeat ACTH is still negative next week — coupled with the recent drop-off of the observable symptoms that prompted you to suspect Cushing’s in the first place — I would really question whether she actually suffers from the effects of elevated cortisol at all.
Even if so, I do think you need to carefully weigh the advisability of giving Vetoryl to a dog with a history of serious renal dysfunction. If the kidneys are not working properly, the danger of a trilostane overdose is increased because the body is not capable of optimally flushing the drug out of the system. This can create a very dangerous, even life-threatening, situation.
I know you are trying so hard to give Pookie the best quality of life that’s possible. I’m just fearful that given her age and medical history, the testing and risks associated with starting Vetoryl may make things harder for you both rather than easier. Her appetite may be depressed even further, she’ll require ongoing blood draws and vet visits, and her risk of overdosing may be heightened. If you do decide to proceed with treatment, we’ll do our very best to support and guide you. But in honesty, if Pookie were my own dog, I’d likely forego starting a potentially risky treatment requiring such rigorous follow up as Vetoryl, and instead try to keep her life as stressfree as possible with the foods, supplements, and homecare that brings her the greatest comfort. Either way, though, we’ll surely be anxious to know how things are going for you both.
Marianne