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Thread: Cushing’s diagnosos 14+ yr old Vizsla - Vetoryl start dose?

  1. #11
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    Default Re: Cushing’s diagnosos 14+ yr old Vizsla - Vetoryl start dose?

    Hi. My Viszula is also 14.5 & recently diagnosed. I’m at a loss at this point. I’ll find her labs & post
    Thanks.

    __________________________________________________ ____________________________________
    Administrative Note: I’ve made a copy of this reply and started a new thread for this member so that we’ll have a specific place to discuss the lab results and any further related questions. Here’s Vavinya’s new thread:

    https://www.k9cushings.com/forum/sho...-14-y-o-Vizsla
    Last edited by labblab; 07-28-2020 at 05:24 PM. Reason: To add link to new thread.

  2. #12
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    Default Re: Cushing’s diagnosos 14+ yr old Vizsla - Vetoryl start dose?

    Our old lady Vizsla Rumor is mostly responding so far on Vetoryl 40mg with reduced symptoms and will get her first ACTH followup in a couple days. Less anxiety, not panting, not guzzling water or asking to go out as much like she was at night. She is still eating well but not as ravenous and not looking for stuff to eat in the yard. Still has the potbelly and still gets heated up sooner on the walks in this hot weather, and not running like she was 2 months ago so we go short and easy. If the vet thinks we could/should raise the dose level, I may want to do twice daily to spread out the pharmacodynamics. We have another 14 yr old Vizsla who still runs and a 3 yr old “pup”.

  3. #13
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    Default Re: Cushing’s diagnosos 14+ yr old Vizsla - Vetoryl start dose?

    Basically this sounds like an encouraging report to me :-). I hope Rumor’s monitoring testing goes very smoothly. Just another reminder: she needs to take her Vetoryl dose along with a normal breakfast on the morning of her ACTH. Also, the recommendation of Dechra (manufacturer of Vetoryl) and experienced clinicians is to hold off on dosing increases until the first month of treatment has been reached. Even if Rumor’s cortisol is still running higher than you’d like it to be at this first testing, it may continue to lower somewhat during this first month, even if her dose is unchanged. So if you can remain patient for a couple more weeks, you’ll actually have a more accurate sense as to the true effect of this initial once-daily 40 mg. dosing regimen. That will allow you to make subsequent dosing changes with greater confidence as to optimal timing and amount.

    Marianne

  4. #14
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    Default Re: Cushing’s diagnosos 14+ yr old Vizsla - Vetoryl start dose?

    Thanks Marianne, The new vet we are trying wasn't so adamant about the 10-14 day first ACTH because he thinks it is often too early to see a drop in Cortisol, as long as symptoms are improving and there no Addisonian symptoms. He thought 3-4 weeks.. But we are doing 14 days. I will talk to him about the pre-Vetoryl test as well going forward... I hope he will work with is on that.

    It does seem like Rumor starts paw licking more again in the evening, probably as the Vetoryl effects wane. But she still isn't asking to go out nearly as much and sleeps all night. Before the drug’s effects 3-4 hrs after breakfast dosing, she is a bit less settled and asking to go out more. In maintenance mode I am wondering if BID dosing would be better.

    Does the potbelly eventually go away if we watch the diet? She has always been so lean and the added weight on her belly effects her getting up and squatting (arthritis more noticeable) and breathing in the heat or laying down sometimes. She’d be more comfortable without that belly...
    Last edited by cken; 07-29-2020 at 02:42 PM.

  5. #15
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    Default Re: Cushing’s diagnosos 14+ yr old Vizsla - Vetoryl start dose?

    I’m kind of an outlier here in that I don’t really disagree with your new vet’s theory about waiting a bit longer for that first monitoring test, as long as there are no indications of overdose. There are other clinicians who follow that approach, as well. However, from a safety standpoint, you can never go wrong by testing at that 10-14 day mark. In other words, you can never have *too much* information to go by. And yes, hopefully you’ll see improvement in the pot belly over time. But it does take time for the musculature to rebound.

    Marianne

  6. #16
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    Default Re: Cushing’s diagnosos 14+ yr old Vizsla - Vetoryl start dose?

    Just got Rumor’s 14 day post Vetoryl ACTH stim results this evening. Haven’t spoken to the vet yet but based on what I’ve read, these numbers look OK so far.

    Cortisol Pre ACTH 2.8 ug/dL
    Cortisol Post ACTH 5.0 ug/dL

    Most importantly, as mentioned above, for the most part the Cush symptoms have reduced markedly. She has had a couple intermittent days of diarrhea and vomiting and lethargy. The vet is thinking more gastroenteritis than Vetoryl AE and did prescribe Cerenia and metronidazole and it seemed to work well. She had a really good day today. More active after getting going this morning with less rear foot dragging. We are encouraged so far but am wondering if a lower dose than the current 40mg (she’s 43 lbs) could be tried now (30mg) given these numbers? Also BID vs QD? I don’t have an endocrinology background but do have a research and antibiotic pharmacology background so always in pursuit of lowest effective dose and timing.

    I also found this nice summary writeup on Trilostane treatment and monitoring: Trilostane Treatment and Monitoring: Is the ACTH Stimulation Test Gone for Good? by Jon M. Fletcher, DVM, DACVIM.

    https://www.isvma.org/wp-content/upl...oneForGood.pdf

    Thanks for the help and thoughts. Ken

  7. #17
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    Default Re: Cushing’s diagnosos 14+ yr old Vizsla - Vetoryl start dose?

    Spoke to the vet today. He also was thinking we could try the lower 30 mg dose (drop the 10) given Rumor’s response so far within 14 days. He also thinks the pre Vetoryl cortisol level testing is a good way to go going forward. Another good day for Rumor.

  8. #18
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    Default Re: Cushing’s diagnosos 14+ yr old Vizsla - Vetoryl start dose?

    So glad to get this good report on Rumor! Those initial testing results are certainly excellent. If you want to try dropping the dose, you can do so in an experiment to see whether she continues to maintain adequate symptom control while taking less of the medication. But these first results are very good.

    Thanks very much for the link to the article. As the authors discuss, there are reasons why BID dosing may hold advantages. Without any doubt, a dog who exhibits symptom rebound at the tail-end of a 24-hour dosing period may do better when dosed every 12 hours instead. And BID dosing is generally always recommended for diabetic dogs in order to keep insulin and trilostane efficacy as consistent as possible over time. However, after sharing in so many treatment journeys here over the years, I’m inclined to think that if a dog is doing well on once-daily dosing, there may not be a big benefit to shifting. Since trilostane should always be given alongside a meal, timing of the evening dose may become a bit of an issue. Plus, some dogs may actually feel better if their cortisol level is allowed to increase a bit through the course of a day as opposed to remaining consistently more flattened. From a practical standpoint, it can be more expensive to dose twice daily. For instance, if you continue to give brandname Vetoryl, it will likely cost less to give one 30 mg. capsule in the morning as opposed to giving the combination of 10 mg. and 5 mg. capsules both morning and evening.

    So, yes, without a doubt there are research studies that have found certain benefits to twice-daily dosing. However, we’ve had many dogs here who’ve done fine with dosing just once in the morning. If I were to have another Cushpup, that’s probably how I’d choose to start off, myself. Whatever you decide, though, I’m so glad to hear that things are going well thus far!

    Marianne

  9. #19
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    Default Re: Cushing’s diagnosos 14+ yr old Vizsla - Vetoryl start dose?

    I and the vet agree with everything you say in the 2nd paragraph. We are trying 30mg QD now and if she’s doing OK so far with QD stick with it. Its certainly easier. She seems to be doing a little better strength wise every day and the potbelly actually seems to be just a bit less prominent.. also, less and less symptom rebounding later at the tail end of the dose. So encouraged. She’s much more herself. Who knows we may have to go down in dose later. The vet said maybe check in 30 days if symptoms are still reduced and she’s still doing well.

    Thanks, Ken
    Last edited by cken; 08-06-2020 at 10:52 PM. Reason: Thanks

  10. #20
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    Default How much food necessary for Vetoryl?

    For our 40 lb dog. How much food minimum do we have to have her injest for her once daily 30mg Vetoryl dose and does it have to have fat or protein content for proper absorption and distribution?

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