Recent diagnosis; lab test recheck and dosage change

[TheBean]

Hi. I am a new member and my little guy Bean was diagnosed with cushings about 2 months ago. I am thankful to have found this group as this is our first experience with this disease. I know what an excellent resource a group like this can be for those struggling with the myriad of issues that arise in connection with a complicated illness like Cushings.
We recently had our 3rd stim test (stats & results posted below) and his numbers were "high" pre cortisol test, and "low" post cortisol test. He has recently been exhibiting a bit of an increase in some of his clinical symptoms (which had previously been decreasing on vetoryl) including hunger, thirst, anxiety. He had a bout of vomiting for a few days a couple weeks ago and the vetoryl was stopped for 2 days and then resumed without further vomiting.
There was discussion of adding an additional afternoon dose of 5 mg vetoryl to his current 10 mg dose he takes in the morning. Or adding an additional 10 mg dose in the afternoon. Absent clinical signs, there was discussion there would be no change to the dosage.
Since we have been noticing clinical signs over the past couple weeks we are wondering if anyone else who has been thru this type of scenario might comment on things we should be discussing and thinking about.
Thank you for any input - really appreciate it!
Age: 8 yrs
Weight: 7 lb 5 oz (3.35 kg)


DATE: PRE CORT / 1 HR CORT

10/31/23: 8.98 ug/dL / 55.7 ug/dL
Multiple clinical symptoms
(Initial diagnosis; started on 10mg Vetoryl 1x per day)

11/17/23 : 3.91 / 11.9
Clinical symptoms improving; No change to dosage

1/4/2024 : 6.97 / 6.22
Clinical symptoms starting to return

Update on 1/9/2024: medication change: vetoryl dosage increase to 10 mg in the a.m. plus 5 mg in the p.m.

2/9/2024: ACTH stim retest after dosage adjustment last month:
"Pre Cort: 6.47 ug/dL range: 1.0-5.0
1 Hr. Cort: 7.5 ug/dL range: 7.8-19.7
Pre-trilostane Cortisol Concentration
> 5 ug/dL (> 140 nmol/L)
Post-ACTH Cortisol Concentration
1.8 – 9.1 ug/dL (50 – 250 nmol/L)

[Harley PoMMom]

Hi and welcome to you and Bean!

I have manually approved your membership so now all your posts will be seen right away. Also, please just disregard the validation email that was sent to you from k9cushings.

Unfortunately there is tweaking that needs to be done with Vetoryl, getting that dosage strength correct can be challenging but it looks like you are on the right path. The vomiting episode is concerning, it could be that the Vetoryl is upsetting Bean's stomach so I would ask the vet if Pepcid AC could be added. How is Bean eating? Is the Vetoryl being given with a meal? Any diarrhea?

The therapeutic reference ranges for a dog being treated with Vetoryl are 1.45 ug/dl - 5.4 ug/dl and as high as 9.1 ug/dl if clinical symptoms are resolved. So, with Bean's last ACTH post of 6.22 ug/dl along with symptoms rebounding, adding 5 mg of Vetoryl in the evening could be an option.

Are Bean's ACTH stimulation monitoring tests being performed 4-6 hours after the Vetoryl is given with a meal? Does Bean have any other health issues? Is Bean taking any other medications?

Sorry for all those questions but the more we know about precious Bean the better our feedback will be....thanks! Again, welcome to the forum and know we will help in any way we can.

Hugs, Lori

[TheBean]

. Thank you so much for your response. We have a call in to the vet and should hear back within a few hours. Love all the questions and I will answer below. Questions are good as they help us focus on certain things amidst the many questions swirling in our heads.

We use the pepcid (2.5 mg) PRN - when we hear his tummy gurgling we know it's a pepcid night). Vetoryl is given with meal. His appetite is good (currently too hungry but hopefully an increased vetoryl dose will help with that). Poops are perfect, no diarrhea, (although he has recently taken an unusual interest in eating them which the vet thinks may be due to a new probiotic we started which we have now stopped using). The vomiting occurred 2 days in a row about 4 hrs after breakfast/vetoryl dosage. After discontinuing for 2 days we had no further vomiting when resumed vetoryl. It was suggested we freeze his vetoryl before giving him his dose which we also did with a few doses. Now back to room temp dosing and tummy seems back to normal with just occassional grumble-tummies in the evening.

Stim tests have been done 4-6 hrs after vetoryl given with a meal. No other health issues of significance (luxating patellas, old fractures and wound scarring from injuries he had before we adopted him 7 yrs ago). Only other meds he takes are Pepcid (PRN), probiotic (currently stopped). We also are considering melatonin and fish oil but have not started either yet.

Thank you again for your input. Love to talk about the Bean - he's our little man!

[Harley PoMMom]

Is the Vetoryl a liquid suspension? And if so, could you post the dosage amount, as an example 2mg/ml? I've never heard of freezing Vetoryl, did the vet contact Dechra, the makers of Vetoryl, to make sure this could be done? If not, you can and here is their contact info: "Please contact Dechra's 24-hour Veterinary Technical Support Team at support@dechra.com or 866-933-2472. One of Dechra’s best resources is our highly trained Veterinary Technical Support Team." This info was taken directly from their website here: https://www.dechra-us.com/contact/inquiry-form

[TheBean]

Not a suspension, just a 10 mg capsule. Thank u for the dechra info. They only had us do that for a couple days a few weeks ago, after vomiting incidents, stopping for 2 days, and then resuming vetoryl. No longer an issue, but know now to double check. Thx!

[judymaggie]

Hi! I wanted to add my welcome to you and Bean. As I am sure you have realized already, the Admins have a wealth of knowledge and experience. When working with my first two Cushing's pups, I relied on them heavily. I often came here to discuss my vet's recommendations and my vet learned that he could actually have discussions with me about treatment rather than me blindly following his treatment plan. He came to respect my research. I now have my third Cushing's pup and a new vet after moving so am back here again. I am looking forward to learning more about Bean!

[TheBean]

Thank you! We are looking forward to the wealth of knowledge and experience here on this forum!

[Squirt's Mom]

Just wanted to welcome you and your sweet Bean to our little family here at K9C. Lori has done an excellent job as always so I don't have anything to add at the moment other than the welcome! Looking forward to learning more about you and your Bean as time passes.

Hugs,
Leslie

[TheBean]

Thank you. The Bean is now on 10 mg vetoryl inthe a.m. and 5 mg. in the pm. He has been on the new dosage for about 10 days now and his symptoms that had returned are starting to get better. However he does struggle with late afternoon/early evening anxiety. I am wondering about people's experience with using melatonin for their cushings dogs. And/or adaptil phermone sprays? He is doing well otherwise. He's due for another stim test in about 2 weeks.
Thank you!
Ps. I'm guessing i should start a separate thread for that question

[Squirt's Mom]

Nah, we like to keep everything in one thread.