New Diagnosis 7 yr old Jenna

[J@ke]

Our 7 yr old lab/shepherd mix was just diagnosed with cushings earlier this week. We already have another dog with EPI so are quite familiar with complicated treatment that is a trial and error process to dial in.

Jenna is currently 96 lbs after being 83 lb 6 months ago. Vet initially tested for hypothyroidism which came back negative and then tested for cushings which was positive. Vet wants to start her on 60mg Vetoryl 1x per day. Some posts I've seen make it seem like that is high to start out at but it seems within the dosing range recommended. It makes sense to me to start lower and work our way up as needed but having a hard time understanding what's really recommended as a starting point. Is there somewhere I should be going to get the right information?

Jenna's test results:

Alkaline Phosphatase (ALKP)
Lab results:702.000 U/L
Lab range:23.000 - 212.000 U/L

ALT/SGPT (ALT)
Lab results:198.000 U/L
Lab range:10.000 - 125.000 U/L

Cortisol Sample 1
Lab results: 4.9 ug/dL
Lab range:1.000 - 5.000 ug/dL

Cortisol Sample 2 Dex
Lab results:0.6 ug/dL
Lab range:0.000 - 1.400 ug/dL

Cortisol Sample 3 Dex
Lab results:1.6 ug/dL
Lab range:0.000 - 1.400 ug/dL

Thanks!

[labblab]

Hello and welcome to you and Jenna! We’re so glad you’ve joined us, and thanks very much for adding her testing results. Her elevated liver numbers are indeed consistent with Cushing’s in general, and her diagnostic LDDS test points to the pituitary form of the disease. I’m assuming she also has outward observable symptoms that led to the testing in the first place? We’d welcome any additional info in that regard that you’d care to offer.

In the meantime, though, I’ll head right to your specific treatment question. Dosing recommendations for Vetoryl have been refined during the past 20 years that it has been in worldwide use. The general initial dosing recommendation has evolved into a formula not to exceed a daily total of 1 mg. per pound. However, there has been more recent recognition that larger dogs may be more susceptible to overdose at that level. Therefore, a lower initial starting dose for big dogs has been recommended by certain well-known veterinary endocrinological specialists. I’ll give you a link below to a summary of these recommendations that one of our staffers has compiled. I’m relieved to know that your vet wants to start Jenna at a dose that is lower than 1 mg. per pound. But as you’ll see from the link, this group of specialists would advocate for even a lower dose, probably not exceeding 30 mg. each day. As you read the articles, do note that “BID” refers to twice daily dosing as opposed to a once daily (“SID”) total. Also, that 1 kg. equals 2.2 pounds. So you have to make some mathematical conversions in order to plow through the articles. But if my own math is correct, a starting daily total of around 30 mg. would be the recommendation. Anyway, here’s the link:

https://drive.google.com/file/d/155a...s5kmGrNmtAjBXA

You’ll see that at least a couple of the researchers recommend twice daily dosing (splitting the daily total in half and administering 12 hours apart). However, this is an issue that we can talk about in another reply. In the real world, once daily dosing is a lot easier to handle, and the makers of Vetoryl still recommend starting out with one dose in the morning with breakfast, and only advancing to twice daily dosing if satisfactory symptom resolution has not been achieved. But the bottom line remains the daily total. As I say, I’m glad your vet is planning to start Jenna off at less than 1 mg. per pound. But if you’ve not already bought the 60 mg. capsules, I’d strongly advocate for buying 30 mg. capsules instead. If Jenna were my own dog, I’d prefer starting at the 30 mg. level with the ability to later work up to a higher dose if that’s what is needed. Either way, good luck and please keep us updated. And also, here’s another link to general info about Vetoryl treatment that may be helpful to you:

https://www.k9cushings.com/forum/sho...TH-Stimulation

Marianne

[J@ke]

Thank you for getting back to me. I've read all of the articles included within the Larger Dogs/Smaller Doses document and it all seems to make sense. I have a call tomorrow with the vet to discuss the dosage that we will be starting with. Will update with the end result. I'm intended to try to push for 30mg and am fairly optimistic that they will be receptive to adjusting the initial Vetoryl dose down to 30mg. They have been pretty open with us in adjusting and recommending changes to our other dog's treatment for EPI. We are unfortunately all too familiar with dealing with complicated conditions that vets frequently don't know the latest information about and for which treatment is a bit of a balancing act.

We took Jenna in at her regular 6 month appointment. She had gained almost 15 lb in the last 6 months. She has been ridiculously hungry the last couple of months. She has wound up with a bald spot on her belly about the size of a football. It hadn't occurred to us as a symptom until reading about cushings but she has been drinking more and has been somewhat lethargic of late. The vet had been fairly confident that the testing for hypothyroidism would come back positive.

[labblab]

Yep, this additional info about changes in her behavior and appearance do indeed correspond with Cushing’s, so I feel reassured about you launching into treatment. Thyroid questions can certainly muddy the water since the two disorders share many symptoms. My own Cushpup, a Lab, was originally diagnosed with hypothyroidism alone. But thyroid supplementation didn’t resolve his symptoms and further testing identified Cushing’s. As it turns out, his low thyroid readings may just have been secondary to the Cushing’s as opposed to being a primary issue in its own right. At any rate, if Jenna’s thyroid reading is normal, then at least that eliminates one variable that you have to deal with, which seems like a good thing :-).

And one more note about initially requesting smaller dosage capsules — I often advise folks to request smaller capsules when they’re starting off, regardless of the target total dose. You can always combine capsules, but you cannot split them. So for example, even though it is more expensive to buy two boxes of 30 mg. capsules as opposed to one box of 60 mg. capsules, you still may be better off financially during the first weeks of treatment when dosage adjustments are common. Large capsules that end up being too high a dose are wasted, whereas smaller capsules give you the flexibility of adding or subtracting. Once Jenna is stabilized on any given dose, then you’ll have greater confidence in making future purchases.

But once again, good luck, and definitely let us know how things go!

Marianne