To treat or not to treat?

[Harley PoMMom]

I do believe 20 mg of Vetoryl is a good starting dose, however if the vet prefers 30 mg, you can give 20 mg in the morning and 10 mg at night. Just remember these important rules: Vetoryl has to be given with a meal, and those ACTH stimulation tests have to be performed 4-6 hours after the Vetoryl is given with the meal.

Does he like hot dogs? If so, maybe try to put the Vetoryl in a piece of hot dog. I've used pill pockets before with my dogs and they ate them with no problem but my dogs always had a healthy appetite!

Hugs, Lori

[Squirt's Mom]

A couple of things that have worked for me with hard to pill babies. Tomlyn and Vetoquinol make a pill paste that is bacon flavored (DON'T get the cheddar cheese one...it's very greasy!). You can form the paste around any size or shape pill and I've only had one dog refuse it. And I've offered it to probably a 100 dogs or more over the years. Another that I just recently discovered thanks to our wonderful vet is Hill's Science Urgent Care canned food. I hate SD but this stuff is miraculous for getting pills down. You scoop a small amount onto something like a tongue depressor, spoon, etc and then push the med into it and around the pill. Then let the dog smell it and when they open their mouth scrape it off on their upper front teeth. It is VERY slippery in the mouth and just slides down the throat. I started using this when my Pug developed Addison's and wasn't eating anything....she never refused this tho. I tried it with my itty bitty girl who hates pill and it was the same...she loved it!

Now a trick...make 3 balls with the pill paste, cheese, hot dogs, etc. Put the med in one of the balls. Offer a plain ball immediately followed by the one with the med immediately followed by the second plain ball. Usually the dog is so interested in getting all the treats they miss that the second one has med in it. If you have more than one dog this works especially well. Use the same set up with 3 balls (all 3 plain except for the medicated dog's) and start with the ones who do not get medication, letting the medicated dog get the bites last. After watching others get treats they want theirs too!

[inheriteddog]

Well, the Vet called and Kobe's LDDS test confirmed Cushing's (I am awaiting the actual results from them by email). So now I'm looking at cost of Vetoryl, which seems to be higher today than the last time I looked it up online. 10mg twice a day is the staring dose. Any recommendations on pharmacies?

In any case, if the dose goes up I probably won't be able to afford it.

[inheriteddog]

Just got the results from the LDDS test for Kobe.
Baseline 8.8
4 hours 2.1
8 hours 2.5

I'm not sure how to interpret this. Please advise.

[Harley PoMMom]

It's been a while since I've interpreted a LDDS test but to me these results show that Kobe has the pituitary type of Cushing's (PDH), hopefully Marianne will be along to confirm. I also want to include a link to information regarding the pharmacies to buy Vetoryl and other cost savings: https://www.k9cushings.com/forum/sho...096#post211096

Let us know if there is anything else we can do.

Hugs, Lori

[labblab]

Hello again, and yes, Lori is correct about those LDDS results. To explain, it’s the 8-hour value that determines the overall Cushing’s diagnosis. You’ve not included the lab’s normal reference ranges for the test, but typically the “normal” 8-hour cutoff is 1.4 or 1.5 ug/dL. This means that any result higher than that is consistent with Cushing’s — which is the case for Kobe. Next, you look to see whether either the 4 or 8-hour result is less than 50% of the baseline. If so, the result is consistent with the pituitary form of the disease. In Kobe’s case, they both are, and there you have it.

I’m very glad that Lori has given you the cost-saving link. Hopefully one of the options given there will be helpful especially if Kobe’s dose increases, including the possibility of a compounded version of trilostane. In terms of brandname Vetoryl, I’ll throw out one other option to discuss with your vet if Kobe’s dose ultimately does end up being increased to 30 mg. I know your vet is recommending twice daily dosing, which is a dosing regimen now favored by many researchers and clinicians. However, the maker of Vetoryl (Dechra) has consistently stuck with recommending that dogs initially start with a once daily dose given in the morning with breakfast. If it appears as though the effects of the medication are wearing off too quickly with symptom rebound later in the day, they then recommend the twice daily shift. I mention this because your daily cost of a single 30 mg. capsule would likely be significantly cheaper than three 10 mg. capsules. So if his dose does increase and the cost becomes prohibitive, trying the single morning dose could be an option to consider with your vet.

No matter what you decide, the best of luck to you and Kobe. And please continue with your updates!

Marianne

[Squirt's Mom]

You will also find that using Trilostane VS Vetoryl is often less expensive...especially the liquid form. This is because with the liquid you may not have to have a new prescription every time the dose changes...you simply increase or decrease the ml given using the same bottle. Not all vets will allow their client to use Trilostane but many will. Trilostane is the active ingredient in Vetoryl. A compounding pharmacy will take that ingredient and formulate it into forms (chewables, liquid, etc) and doses other than what Dechra produces with Vetoryl. You want to be sure the compounding pharmacy doesn't use bulk product but rather compounds from Vetoryl.

[inheriteddog]

Hello from Kobe's grandpa. Here is update on his treatment and situation. Started Vetoryl 20mg (10mg capsule given twice a day). I was glad to see the capsules are small so there has been no problem giving it to him hidden in pizza (his favorite). Tested its effectiveness by ACHT yesterday. Vet says results are slightly higher than he'd like, but good enough to continue at this dosage and retest in one month. So far no visible sign of improvement. Kobe still has big hunger, drinks, pees, pants, and skin infections are returning. Also, he apparently put on weight since last time. Doc says may take up to a month to see changes. Although Kobe did not show signs of med causing adverse reaction (i.e., no vomiting, diarrhea, lethargy), he sometimes looked sort of sad or not well for a while shortly after a dose. This condition did not last, however, and may not be due to Vetoryl. Now it's wait and see.

Checking the price at several pharmacies, I found most were exactly the same, pretty steep. A couple were cheaper but not sure if their shipping and customer service were reliable. So I chose a pharmacy with a good reputation. It is expensive to buy 60 capsules a month. I know this is not a new story, just sorry I have no advice for anyone else looking in.

Will try to keep you updated as time goes on. Take care and good luck.

[Squirt's Mom]

Good to know there have been to adverse effects from the dosage! I hope the next test shows better results and that you soon start to see some improvements. If the post ACTH # is still a bit high and his signs aren't improved by the next test then a small, SMALL, increase is in order.

As for the cost...it is steep but once he is settled on a dose you can talk to his vet about Trilostane. This is the active ingredient in Vetoryl and it can be compounded into other doses that Vetroryl doesn't come in OR into different forms like a chewable tablet or liquid. The liquid can save you money on top of the saving using the compounded Trilostane because you can easily increase or decrease the dose without a new 'script. So something to think about and discuss with his vet for sure. Not all vets will allow their clients to use the compounded but as long as the pharmacy uses the Trilostane and not a bulk product it usually works just as well while saving you money.

Thanks for the update!

Hugs,
Leslie

[inheriteddog]

It's been a while, but here's an update on Kobe's treatment and condition. About six weeks now on Vetoryl 20mg per day divided as 10mg given twice a day. He just had his second ACTH test last Monday, but it took a few days before I could get in touch with the vet for the results. Using 6 as a desired level, his results were 7 and later 10.4, in other words the cortisol is not under control. Physical effects I observed showed small improvement, but not dramatic. The first thing I noticed was that the raw spot on his tail was starting to cover up with hair. His drinking and peeing are diminished although that is irregular. Appetite lately is reduced, but he is picky with his food. He used to scarf up his kibble along with anything else, now he lets it sit until we mix something with it. He still pants quite a bit while walking and doesn't walk far before he seems to be tired. The infections in his feet remain bad and he recently showed a couple of bare spots on his underside. When he gets excited he seems a little more aggressive than before. He tends to sleep more in corners and under chairs. Sometimes I will see him trembling for a little while. He sometimes has trouble jumping into the car, but again this is inconsistent, like so many other things about Kobe.

I did not notice any of the typical adverse effects of Vetoryl such as vomiting, diarrhea, lethargy, etc. I think he tolerated the medicine well enough.

Vet recommended increasing dose to 15mg twice a day. Since there is no 15mg capsule for Vetoryl, this would involve two capsules, 10mg and 5mg. I told him this would cost more than I could afford. He then said we could consider a compound (which surprised me since he had earlier volunteered that he did not want to use compounds). Either that or try 30mg capsule once a day, although vet prefers dividing the dose. So we are looking into these options to see what might work and what I can afford.

One of my major concerns is how Kobe will respond when the weather gets hot. Even now when the temperature is mild, he pants too much. I hope we can bring this down. Along with that are the skin infections, which need to be reduced.
That's about it for now. Take care all.