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Thread: Not convinced my dog doesnít have Cushings! (Cesar has passed)

  1. #11
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    Default Re: Not convinced my dog doesnít have Cushings!

    I started my Gable, who weighed about 75lbs ,at 40mg at Lori's suggestion and he did well for about six months, then we had to lower it. He is on 5mg now, so I would do as Lori suggests and start at 40. You can always go up if needed. It's better than having the cortisol drop too low, which could be dangerous.
    Joan, mom to my Angel Lena, Doree, Gable, Cooper, Angel Phoenix and now Sibble.

  2. #12
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    Default Re: Not convinced my dog doesnít have Cushings!

    I agree with the advisability of starting out at a lower dose. Since you say that heís already begun 90 mg. daily, Iím assuming you have either only 30 mg. capsules on hand, or a combo of 60 mg. and 30 mg. capsules. If thatís the case, I would definitely decrease at least as far as giving only 60 mg. for the first 10-14 days, until you can monitor the effect of that dose on his cortisol level. Or you could be even more conservative and just start out with 30 mg., knowing that you can always increase the dose easily should he need a higher dose of the medication, after all. At this stage and after the six month diagnostic delay, giving him a bit more time to build up slowly from a lower dose should not be a problem and may allow his body to adjust more easily to a gradual lowering of his cortisol, regardless of whether or not the dose is increased later on.

    Also bear in mind that his low thyroid reading may have been secondary to the uncontrolled Cushingís. Once his cortisol has been effectively lowered into therapeutic range for a period of time, his thyroid level may naturally rebound, too. That being a possibility, youíll want to make sure to also monitor his thyroid level on a regular basis to make sure that he doesnít end up with too *much* thyroid supplementation.

    Marianne

  3. #13
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    Default Re: Not convinced my dog doesnít have Cushings!

    Quote Originally Posted by Harley PoMMom View Post
    Kathy is right, however, there is a published study that has found that larger dogs require less of the recommended dose of Trilostane to control cortisol, so if this were me I wouldn't start out any higher than 40 mg of Trilostane. Here's a link to that study:https://onlinelibrary.wiley.com/doi/...6.2012.00956.x

    Lori
    Thank you! Iím really not sure what to do? I only gave him 60mg this morning as I was so worried after reading this. I was also on a support group on Facebook but my god they were scary so I came off it! Pretty much told me I was killing him by giving him that dosage. Iím just so confused a vet is meant to be a professional who I pay a hell of a lot of money to and he doesnít even know what to dose him? Does it make a difference if he has had Cushings for a long time? Does that mean a bigger dose? My dog has been sick for nearly 7 months now. Thank you for any help....Iím an absolute wreck at the moment. To make it even worse he has a respiratory infection that we just canít get rid of and is in the vets every few days as he has trouble breathing. Iím so worried for my boy.

  4. #14
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    Default Re: Not convinced my dog doesnít have Cushings!

    Quote Originally Posted by labblab View Post
    I agree with the advisability of starting out at a lower dose. Since you say that heís already begun 90 mg. daily, Iím assuming you have either only 30 mg. capsules on hand, or a combo of 60 mg. and 30 mg. capsules. If thatís the case, I would definitely decrease at least as far as giving only 60 mg. for the first 10-14 days, until you can monitor the effect of that dose on his cortisol level. Or you could be even more conservative and just start out with 30 mg., knowing that you can always increase the dose easily should he need a higher dose of the medication, after all. At this stage and after the six month diagnostic delay, giving him a bit more time to build up slowly from a lower dose should not be a problem and may allow his body to adjust more easily to a gradual lowering of his cortisol, regardless of whether or not the dose is increased later on.

    Also bear in mind that his low thyroid reading may have been secondary to the uncontrolled Cushingís. Once his cortisol has been effectively lowered into therapeutic range for a period of time, his thyroid level may naturally rebound, too. That being a possibility, youíll want to make sure to also monitor his thyroid level on a regular basis to make sure that he doesnít end up with too *much* thyroid supplementation.

    Marianne
    Hi Marianne, so yes I have 60mg and 30mg. I gave him 60mg this morning and will carry on with that until he is back at the vets in 10 days. Iím so worried about him at the moment! He is so unwell. We had his thyroid levels checked on Wednesday and they look good so at least thatís one good thing. Thanks for your help x

  5. #15
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    Default Re: Not convinced my dog doesnít have Cushings!

    Welp, I actually give your vet kudos for not recommending an initial dose that exceeds 1 mg. per pound. Many vets are still prescribing doses much higher than that, even though the 1 mg./lb. recommendation has become become more widely known. One huge problem relates to the FDA-approved printed literature that accompanies boxes of Vetoryl. The language dates from the time when Vetoryl was first approved for use in the U.S. back in 2009 when dosage levels were much higher. Subsequent studies and real-life experience have led to subsequent revisions among clinicians who commonly use the medication. The first big shift was to the 1 mg./lb. recommendation, and now — as you see — even smaller initial doses are recommended by some clinicians for larger dogs. However, none of this is reflected in the formal FDA-approved labeling, which is beyond frustrating and irritating. So even though I’d like to think that every vet (and every human doctor, for that matter!) is entirely up-to-date re: all details about the meds they prescribe, I realize that’s unlikely in the real world, and I’m willing to cut some slack when the drug’s own labeling is out-of-date. But how I *do* judge a vet’s reaction is the manner in which they respond when they are informed about new, important information. So I would hope that your vet will welcome the info contained in the link that Lori provided, and integrate the new info in his approach to treatment of dogs going forward.

    And nope, the length of time or severity of the disease prior to beginning treatment does not play a role in initial dosing. The recommendations have always been, and still remain, based on weight alone. Subsequent dosing changes are then based on observable clinical response as well as monitoring blood testing. Dogs of the same weight can end up needing widely varying doses after treatment has actually been underway.

    Marianne

  6. #16
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    Default Re: Not convinced my dog doesnít have Cushings!

    Quote Originally Posted by labblab View Post
    Welp, I actually give your vet kudos for not recommending an initial dose that exceeds 1 mg. per pound. Many vets are still prescribing doses much higher than that, even though the 1 mg./lb. recommendation has become become more widely known. One huge problem relates to the FDA-approved printed literature that accompanies boxes of Vetoryl. The language dates from the time when Vetoryl was first approved for use in the U.S. back in 2009 when dosage levels were much higher. Subsequent studies and real-life experience have led to subsequent revisions among clinicians who commonly use the medication. The first big shift was to the 1 mg./lb. recommendation, and now ó as you see ó even smaller initial doses are recommended by some clinicians for larger dogs. However, none of this is reflected in the formal FDA-approved labeling, which is beyond frustrating and irritating. So even though Iíd like to think that every vet (and every human doctor, for that matter!) is entirely up-to-date re: all details about the meds they prescribe, I realize thatís unlikely in the real world, and Iím willing to cut some slack when the drugís own labeling is out-of-date. But how I *do* judge a vetís reaction is the manner in which they respond when they are informed about new, important information. So I would hope that your vet will welcome the info contained in the link that Lori provided, and integrate the new info in his approach to treatment of dogs going forward.

    And nope, the length of time or severity of the disease prior to beginning treatment does not play a role in initial dosing. The recommendations have always been, and still remain, based on weight alone. Subsequent dosing changes are then based on observable clinical response as well as monitoring blood testing. Dogs of the same weight can end up needing widely varying doses after treatment has actually been underway.

    Marianne
    Thank you Marianne, you are so knowledgable and I appreciate your advice so much x

  7. #17
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    Mar 2020
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    Default Re: Not convinced my dog doesnít have Cushings!

    So Cesar has now been taking vetoryl for nearly 7 days. I dropped his dose to 60mg and he seems to be doing fine. We have noticed a large improvement already in his excessive drinking and urinating. However there hasn’t been any improvement in his lethargy. Still just sleeping all day. How long does this usually take to improve? Thank you x

  8. #18
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    Default Re: Not convinced my dog doesnít have Cushings!

    60mg is still too high based on the latest studies which say large dogs, over 66lbs (30kg), should start at no more than 0.5mg per lb. I would have wanted a starting dose no higher than 40mg, 30mg preferably. Since you don't mention any other signs of overdose other than lethargy hopefully he is not being adversely affected by the 60mg. But do be aware that lethargy is one of the signs that the cortisol is too low so keep a close eye out for loose stools/diarrhea, nausea/vomiting, and loss of appetite.

    As for when this will go away....I can't say because of the high dose. Lethargy is not typically a sign of elevated cortisol but the opposite - cortisol that is too low. Some dogs simply feel bad when the cortisol is lowered tho. If you have ever been on prednisone then you can relate to a small degree. While on the pred you feel pretty good, no pains, more energy but when the course of pred is over all that reverses. Some pups experience a period of just being off once the cortisol starts to lower. This may be what is happening with Cesar. Just keep an eye on him as you have been and hopefully he will be feeling more like himself soon.

    Hugs,
    Leslie
    "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.

  9. #19
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    Default Re: Not convinced my dog doesnít have Cushings!

    Hi again. Leslie is definitely right that lethargy can be caused by low cortisol. However, in looking back through your thread, I see that Cesar was acting this way prior to beginning the Vetoryl. So I’m suspecting it’s not a new problem, but instead an issue that has not yet shown improvement with treatment. It may take a while, though. My own Cushpup also acted tired and lethargic prior to treating, and even though the excessive thirst and urination improved quite rapidly, it took a longer time to see improvement in his energy level and his muscle tone. He especially had grown very weak in his rear end while his cortisol was uncontrolled, and he did a lot of laying around.

    Of course, you do want to keep watch for any of the other symptoms of low cortisol that Leslie has listed. And we’ll all definitely be interested in the result of his first monitoring blood test in order to see where Cesar’s cortisol level actually is.

    Marianne

  10. #20
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    Mar 2020
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    Default Re: Not convinced my dog doesnít have Cushings!

    So we made the incredibly hard decision to get Cesar put to sleep today. I felt so relieved after finally getting his diagnosis 10 days ago but unfortunately that was very short lived. Over the past 5 days he just went downhill so quickly. Confused, crying, hasn’t eaten since Saturday, diarrhoea then constipation. The vet done and ultrasound on his liver last night and said it was very enlarged and tender to touch. He was so weak that we felt like we couldn’t put him through anything else. He was also still battling a respiratory infection that just wouldn’t go away despite 5 weeks of antibiotics. I want to thank you all for your help and advise, quite frankly your knowledge on here is superior to any vet I’ve seen. If I’d gone with my gut 8 months ago instead of listening to the vets he may still be here now. I’m beyond devastated. Good luck to everyone else and your fur babies xxx

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