My big boy Gable - sweet Gabe is now at peace

[Harley PoMMom]

Hi Joan,

Glad that you've finally got a diagnosis for Gable and sorry it's Cushing's, but you are definitely armed with much more knowledge and experience now and I know you'll do well in treating your precious boy.

I'm just a bit hesitant with the 60 mg starting dose, even though that's a reasonable dose for Gable's weight of 76.4 lbs the study regarding that larger dogs may require smaller amounts of Trilostane per day keeps resonating in my mind, we've also seen that here on the forum. If this were me, I would start out at 40 mg instead...this is just my opinion. Either way I know you will do great!

Hugs, Lori

[Joan2517]

Thanks, Lori. I'd be happy to start at 40mg if that sounds okay to everyone. I just didn't want to go up to 90, which is what the vet probably would have wanted, unless they are still behind on the updated dosing of 1mg per lb. I wish I had waited to see what they would have suggested, just to see if they have learned anything in the last two years. I don't think they come in 40mg, though, do they? I'm sure my vet will be very happy to charge me for two different dosage packages.

I was going to stop and pick the pills up tonight on my way home. I would like to begin on Friday since I'll be home until the 4th and want to keep an eye on him. Do you think I should have prednisone on hand? If so, how much? This time around I want to be ready for anything and everything.

[Harley PoMMom]

Vetoryl doesn't come in 40 mg capsules, but what I was thinking was getting either 20 mg capsules or purchasing some 30 mg and 10 mg capsules, because unfortunately there is usually some tweaking involved.

For dogs suffering from Addison's disease, according to Dr. Peterson's blog, he recommends a prednisone dose no larger than .2 mg/kg which for Gable that would be 6.9 mg. https://endocrinevet.blogspot.com/20...-for-dogs.html

[Joan2517]

Thanks, Lori,

I'll see what my vet has. I looked up on Dr. Forster and Smith today, but I didn't see any 20mg, just 60, 30 and 10. I'd have to pay extra to get them here by Friday, and it looks like just a $5 difference in prices, so I might as well just start with my vet. I want to be home when he starts on the meds.

[labblab]

Hi again, Joan. If it were me, prior to this discussion, I too would have started at 60 mg. as I said earlier. However, one drawback to the 60 mg. capsules is that they can’t be split if that does turn out to be a dose that’s too aggressive for Gable. So making an initial purchase of 30 mg. capsules, to be used in some combination, is probably wise. If you do that, you could indeed start out at the even lower dose that Lori is suggesting by adding in a 10 mg. capsule. And if that turns out to be too low, you can keep adding additional capsules to get to the total you want. This will create added expense for the first month or so, but it does give you much greater flexibility in dosing, and your costs should stabilize along with a consistent dose by the second or third month.

If you do start out at a dose of 40 mg., I am going to break with standard protocol and say that I think it would be OK to go ahead and increase the dose as soon as the 10-14 day mark in the event that you don’t see observable symptom relief or significant downward movenent in his cortisol. Given that you’d be starting at quite a relatively low dose, I don’t think you’d have to wait a full month before tweaking upward if you’re not seeing results. But on the flip side, starting at this lower dose will also allow Gable’s system to adjust more gradually to a decrease in cortisol. And that can certainly be a good thing. So I think the combo of capsule sizes and starting out even lower can make good sense.

Marianne

[Joan2517]

Okay. I will pick them up tonight on my way home and begin with the 40 mg dose tomorrow morning.

I am so anxious about this. I'm even second guessing that he does have Cushings'...can you believe that! Then I start to think maybe I shouldn't treat him...that is until I hear him drinking, drinking, drinking, peeing, peeing, peeing, panting, panting, panting. I'm obsessing again.

Poor Gabe, he's going to have to put up with me following him around and watching him like a hawk.

[Harley PoMMom]

Thanks, Lori,

I'll see what my vet has. I looked up on Dr. Forster and Smith today, but I didn't see any 20mg, just 60, 30 and 10. I'd have to pay extra to get them here by Friday, and it looks like just a $5 difference in prices, so I might as well just start with my vet. I want to be home when he starts on the meds.

You're right, Vetoryl doesn't come in 20 mg capsules I don't know what I was thinking, sorry about that! Marianne's suggestion of purchasing a combination of 30 mg and 10 mg capsules is definitely something I would do.

It so hard not to obsess with our furbabies especially when treatment is involved but I know you'll do great and we are here for you both!

Hugs, Lori

[Joan2517]

Well, gave him his first dose this morning, one 30 and one 10. Dr. Plunkett went along with what I wanted to do even though he doubted 40mg would do anything. I said that was okay, we'd up it in two weeks if that was the case. He didn't give me any pred, though. Said with 40, I wouldn't need it. I'm fine with that for now.

Gable had his usual bowl of kibble, maybe two if the others didn't finish, a forkful of the soft food I give to the little girls with his soloxine. Then I wrapped both capsules in a piece of cheese and he didn't even know there was anything in there.

And so it begins!

[Joan2517]

One more thing, and this really bothers me. When I picked up his meds yesterday, the receptionist just handed them over. No instructions, nothing. She had no way of knowing whether the vet had given me instructions or not. I was going to say something to her, but she's new and doesn't know that I've been through this before. I know the same thing happened with Lena. No one told me how to administer. I'm not even sure anymore if she was getting them with a full meal until I joined this forum and that was a month or more after diagnosis. For all I know her first 2 tests might have been wrong.

I'm going to say something to them about it. I'm sure it happens in a lot of vet offices. That could be why a lot of our members wind up giving without the full meal...not everyone reads the inserts in the boxes. I know I don't. I'm going to read it today and see if those instructions are on it.

[labblab]

Just checking in to make sure all is well this morning! And yup, it’s so frustrating when vets (and human doctors!) don’t properly explain medication protocols. That can make all the difference between success and failure, and it ought to be the first thing they think about when they hand out Rx’s!