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Thread: 15 yr old Maltese just diagnosed. So overwhelmed! Vetoryl questions

  1. #81

    Default Re: 15 yr old Maltese just diagnosed. So overwhelmed! Vetoryl questions

    Hi everyone

    I have a question. Maggie is on 5 mg twice a day. In the evening her panting drinking doesn’t seem well controlled as it does with the first dose. Her numbers at her last stim were also still above the ideal range but the vet wanted to keep her on the same dose for a few months.

    I suspect we will need an increase but I hate to go up a full 5 for a total of 15. Does anyone use vetoryl and compounded trilostane for doses that are not available (eg 2.5)

    Thanks!

  2. #82
    Join Date
    Mar 2009
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    rural central ARK
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    14,093

    Default Re: 15 yr old Maltese just diagnosed. So overwhelmed! Vetoryl questions

    Would you mind sharing those ACTH results that were "above the ideal range but the vet wanted to keep her on the same dose" with us? Proper protocol says that if signs are not controlled then an increase should be considered. What were the vet's reasons for wanting to keep her on this dose? If my math is right, Maggie weighs about 9lbs (4kg x 2.2 = 8.8lbs). Recent studies are showing that smaller dogs often need higher doses than one would think. Here is a link to that info:

    The recent report on effectiveness of lower dose trilostane treatment, given 2 or 3 times daily, for NOH prompted questions regarding dose relative to body weight.Specifically, it was suggested that smaller dogs (<15 kg)might require larger doses of trilostane/kg of body weight and are relatively resistant to trilostane as com-pared with larger dogs (>15 kg), who might require smaller doses/kg and are relatively sensitive to the drug.
    https://onlinelibrary.wiley.com/doi/...6.2012.00956.x

    You can share this info with your vet if you wish. Hopefully they will be open to you letting them in on some more up to date info about Vetoryl (Trilostane).

    As for a 2.5mg dose - you would have to get the drug compounded as Trilostane to get that dose. Dechra, the manufacturer of Vetoryl only makes certain doses and the capsules should not be opened and divided. So compounding is the only way to get doses other than what Dechra makes. 15mg is not a high dose for a dog Maggie's size especially if the signs are not controlled. Are the panting and drinking the only signs you are still seeing? Is it possible there is another reason for those such as warm temperatures in the house or outside, pain, an unrelated illness, etc.?
    "May you know that absence is full of tender presence and that nothing is ever lost or forgotten." John O'Donahue, "Eternal Echoes"

    Death is not a changing of worlds as most imagine, as much as the walls of this world infinitely expanding.

  3. #83
    Join Date
    Apr 2009
    Location
    Georgia
    Posts
    14,066

    Default Re: 15 yr old Maltese just diagnosed. So overwhelmed! Vetoryl questions

    Hello again from me. Leslie has given you some excellent info, and I just have a couple of thoughts to add. First, in looking back, here are the results of Maggie’s recent ACTH that you posted on 10-6:

    We had our second stim. Pre was 5.4 post was 9.
    That was her second monitoring ACTH, and was performed about one week after increasing her dose from 5 mg. once daily to 5 mg. twice daily. Prior to that, her first monitoring ACTH was performed about 2-3 weeks after starting treatment, and these were the results:

    Pre 2.4 ug dL
    Post 15 ug dl
    So if I’m remembering things correctly, Maggie has now been taking Vetoryl for about two months. She started out on 10 mg. total, but experienced diarrhea. Cut back to 5 mg., and performed the first test which was higher than desired. Increased her dose and performed the second test around one week later (which was around three weeks ago). Does that all sound about right?

    If so, and given the continuation of her symptoms, I’m guessing you’re right that a dosing increase will be appropriate. However, one more ACTH may be warranted at this point in order to best judge the size of the increase. As Leslie says, adding another 5 mg. may actually be the better route to go, both in terms of cortisol control and also consistency of the product she’s receiving. You can certainly obtain a compounded form of trilostane, if necessary. But Maggie may actually benefit from another full 5 mg. in order to achieve better symptom control.

    If she were mine, I believe I’d wait another week or so, and then schedule one more ACTH. That would give her a full month since her last test, and around five weeks on the 10 mg. dose. That should allow you to accurately judge the full effect of the current dose, and the size and appropriateness of an increase.

    Are you still in touch with Dr. Bruyette, or another internist? If so, you can always ask their opinion about all this. But if Maggie were mine, that’s probably the route I would go.

    Marianne

  4. #84

    Default Re: 15 yr old Maltese just diagnosed. So overwhelmed! Vetoryl questions

    thanks for the replies!

    We are rechecking STIM first week in December. The internist wanted her on the 10 mg dose for longer before rechecking and Dr B agreed.

    She’s now having kidney issues. Protein in urine. Was put on semintra and rechecked this week because she was drinking uncontrollably. The semintra worked too well. Protein in urine improved to normal range but bun creat went up. Internist took her off semintra for a week to see if excessive drinking resolves. One day off and it has! She will restart semintra in one week at half the dose. He believes we just need to find the right balance.

    On a positive side, Her bloodwork is looking better already (except the kidney issue). Liver enzymes down, cholesterol down. We just need to figure out the kidneys which is obviously a HUGE item. she’s still on blood pressure meds but her BP is down from a whopping 210 to about 140. How this little trooper keeps going is just a miracle. She’s my little fighter! Keep fighting Maggie!!!

  5. #85
    Join Date
    Apr 2009
    Location
    Georgia
    Posts
    14,066

    Default Re: 15 yr old Maltese just diagnosed. So overwhelmed! Vetoryl questions

    Thanks so much for your update! I surely understand why the kidney issues are worrisome, but overall, I agree with you that Maggie is a super-brave little miracle girl. Semintra is not a drug test I have experience with, but I’ll be hoping that things will improve once you establish the optimal dose. In the meantime, please give Maggie a big pat from her family here! And please continue to let us know how things proceed.

    Best wishes to you both,
    Marianne

  6. #86

    Default Re: 15 yr old Maltese just diagnosed. So overwhelmed! Vetoryl questions

    I have to say you're so lucky that your maltese was only diagnosed at 15 years of age! That's a long life! My maltese is 8 and she was diagnosed this summer with diabetes and cushings. She won't have as long of a life unfortunately with all of these issues ( My vet started her on only 5mg Vetoryl once a day, and she's 12lb. The first lab draw a couple weeks after starting was within normal limits, we will be redrawing acth this week to see where she's at.

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