Tess, radiation therapy (Tessie has passed)

[Squirt's Mom]

Hi again,

Something I forgot to mention about the Trilo. When it was first being used, the belief was that if a pup had a problem then all that needed to be done was to give the pup time and let the drug get out of their system. It was thought that once the Trilo was out of the body, the pup would be just fine. After it had been in use for awhile and there were quite a few cases like Tess', it became clear this original line of thinking was wrong.

Now it is known that even after the Trilo is out of the body, damage can continue to occur because the adrenals are not producing or releasing enough of the hormones that are necessary to maintain proper balance and health in the dogs system. Researchers have learned over the years, that once a pup has gone into an Addisonian crisis like Tess has, it is VERY important to supply these hormones externally - as in a pill or shot. This is why we have been so concerned that Tess was not in the hospital on IV's supplying electrolytes along with extra fluids. Having pred at home for her is also critical so you can give her a boost or steroids if needed, which is what cortisol is.

Since your vet is not familiar with Trilo it is good he consulted with a specialist. But based on what the specialist said about just giving her time, it sounds as if even the specialist isn't up on the studies done on Trilo, either. Which isn't surprising since many vets in the US have limited experience with this drug, even specialists.

One thing you can do at home to help keep her electrolytes up is to give her Pedialyte (sp?). The stuff kids use when they are sick. I have used it on my pups often when they have diarrhea or vomiting over a period of time. It comes in unflavored as well as flavored. Mine refused flavored forms but will take the unflavored. You can add it to the water or put it in the food.

Since your vet isn't able to keep her over-nite then having pred and Pedialyte on hand will give you some tools to help her if she starts to go back toward Addison's.

I wanted you to be aware of this development in Trilo overdoses so you know it takes more than just time off the drug for Tess to recover. They say knowledge is power and that certainly is true when dealing with Cushing's!

Hugs,
Leslie and the girls

[StarDeb55]

Dottie, I am delighted to hear that Tess is feeling so much better. We were all pretty worried about her.

Since you mentioned that Tess is your vet's first Trilo patient, both of you may be interested in the information on Trilo from the following link in the important information section of the forum. The second half of the link give information on the UC-Davis vet school's protocols for using Trilo. Davis has pretty extensive clinical experience in using trilo with our pups, & probably has seen most any reaction that may occur using Trilo. Your vet may be especially interested in this section as the information is coming from other vets who are using Trilo on a daily basis.

Debbie

http://www.k9cushings.com/forum/showthread.php?t=185

[Sammie]

Something I forgot to mention about the Trilo. When it was first being used, the belief was that if a pup had a problem then all that needed to be done was to give the pup time and let the drug get out of their system. It was thought that once the Trilo was out of the body, the pup would be just fine. After it had been in use for awhile and there were quite a few cases like Tess', it became clear this original line of thinking was wrong.

Hi I spoke with the Doctor that wrote the article you wanted me to read (Dr. Hoskins is owner of DocuTech Services. He is a diplomate of the American College of Veterinary Internal Medicine with specialities in small-animal pediatrics. He can be reached at (225) 955-3252) I told him what had Happened to Tess. I was amazed he answered his phone. Any way He feels what my vet is doing right now for Tes is correct. As long as she is eating and drinking water and we are monitoring her blood. He said keep her in a stress free environment and wait at lest 2 weeks before starting any thing on Tes. Once she is back to her old normal, repeat the ACTH.

Now it is known that even after the Trilo is out of the body, damage can continue to occur because the adrenals are not producing or releasing enough of the hormones that are necessary to maintain proper balance and health in the dogs system. Researchers have learned over the years, that once a pup has gone into an Addisonian crisis like Tess has, it is VERY important to supply these hormones externally - as in a pill or shot. This is why we have been so concerned that Tess was not in the hospital on IV's supplying electrolytes along with extra fluids.

Tess was in hospital getting a IV and a Sterol shot, I took her home at night because there was know one there to watch her. She has had a IV for four days. My Vet and Dr. Hoskins both agree if she is not show any signs of vomiting then to let her alone. Not to give her any Pedialyte or a Sterol shot, just let her alone.

Having pred at home for her is also critical so you can give her a boost or steroids if needed, which is what cortisol is.

Since your vet is not familiar with Trilo it is good he consulted with a specialist. But based on what the specialist said about just giving her time, it sounds as if even the specialist isn't up on the studies done on Trilo, either. Which isn't surprising since many vets in the US have limited experience with this drug, even specialists.

My Vet went to UC Davis and he spoke to the specialist at UC Davis. He is very familiar with Trilo which I am calling Vetoryl, But here in the USA it just got approved on May 16 2009 that was seven weeks ago. He read all the information on Vetoryl. Vetoryl website say's to give 60mg to a dog 25 pounds. My Vet did nothing wrong.

One thing you can do at home to help keep her electrolytes up is to give her Pedialyte (sp?). The stuff kids use when they are sick.

I don't have any children so I don't know what this is. SIDE NOTE Tessie is sitting on the couch barking at the neighbors. A very good sign.

I have used it on my pups often when they have diarrhea or vomiting over a period of time. It comes in unflavored as well as flavored. Mine refused flavored forms but will take the unflavored. You can add it to the water or put it in the food.

Since your vet isn't able to keep her over-nite then having pred and Pedialyte on hand will give you some tools to help her if she starts to go back toward Addison's.

I wanted you to be aware of this development in Trilo overdoses so you know it takes more than just time off the drug for Tess to recover.

I agree 100% that is why I took her up to have her blood drawn after I read your note here and I called that Doctor (Dr. Hoskins) he lives in Kansas Missouri. He was very nice and said that every thing my vet is doing is correct, except for the 60mg of Vetoryl, but again that was know vault of my vet. Vetoryl website said the same thing for dosage.

They say knowledge is power and that certainly is true when dealing with Cushing's!

Hugs,
Leslie and the girls

[Sammie]

Forgot to post Tessie Lab results for today

ALB 2.1
ALT 253
AMY 433
TBIL 0.5
BUN 32
CA++ 10.9
PHOS 6.8
CRE 1.2
GLU 115
NA+ 143
K+ 5.9
TP 7.0
GLOB 4.9
HEM 0
LIP 3
ICT 0
QC OK
Tessie goes back on Saturday 8:00 am for another blood test. Dottie

[StarDeb55]

Dottie, could I ask one favor, please? When posting any lab results, please include the normal ranges & reporting units, such as ug/dl, ng/ml. etc. Normal range & reporting units can vary from lab to lab. In order to give you any meaningful feedback, I would like to see these 2 things, also.

Thanks,
Debbie

[Sammie]

Dottie, I am delighted to hear that Tess is feeling so much better. We were all pretty worried about her.

Since you mentioned that Tess is your vet's first Trilo patient, both of you may be interested in the information on Trilo from the following link in the important information section of the forum. The second half of the link give information on the UC-Davis vet school's protocols for using Trilo. Davis has pretty extensive clinical experience in using trilo with our pups, & probably has seen most any reaction that may occur using Trilo. Your vet may be especially interested in this section as the information is coming from other vets who are using Trilo on a daily basis.

Debbie

http://www.k9cushings.com/forum/showthread.php?t=185

Thank You Debbie Yes I read the info and I called the doctor who wrote the paper Dr. Hoskins I could not believe he picked up the phone. Told him all about Tessie and what happen. He agreed that every thing my vet is doing is correct, except for the 60mg of Vetoryl. But I have said. The package that Vetoryl comes in and the website both say 25 pound dog 60 mg. We know the hard way this is to much. Dr. Hoskins says Tessie should be on 10 mg twice and day. He said wait about two weeks before starting any of this. He said don't give Tessie any thing if she is drinking and eating. Just let her be. She will come out of it. If she stops eating then get her to the Vet. That is exactly what my Vet told me. Just let her be.

I took my lab top to the vet and showed him the article. He had already read it. My Vet is a graduate from UC Davis. Now we could all argue the fact, then why did he give UK does of Vetoryl instead of the UC David dose, Because that is what was on the manufacture box. By law, to keep his vet license he would have to go by what the manufacture but on the box. Dr. Hoskins is right now fight this with the manufacture and maybe that is why Vetoryl came out with a 10mg on June 11 2009. I am just guess with vet license, but Dr. Hoskins did say the other thing. Dottie

[Sammie]

Ok Lab results with range

ALB 2.1 2.5-4.4 G/DL
ALT 253 10-118 U/L
AMY 433 200-1200 U/L
TBIL 0.5 0.1-0.6 MG/DL
BUN 32 7-25 MG/DL
CA++ 10.9 8.6-11.8 MG/DL
PHOS 6.8 2.9-6.6 MG/DL
CRE 1.2 0.3-1.4 MG/DL
GLU 115 60-110 MG/DL
NA+ 143 138-160 MMOI/L
K+ 5.9 3.7-5.8 MMOI/L
TP 7.0 5.4-8.2 G/DL
GLOB 4.9 2.3-5.2 G/DL
MY VET went over this in detail, but would still like your opinion. Tessie does go back on Saturday morning.
Dottie

[acushdogsmom]

The package that Vetoryl comes in and the website both say 25 pound dog 60 mg. We know the hard way this is to much.

On the package insert, they do say the starting dose is 1-3 mg/lb and it also shows a dosing chart that says if a dog weighs between 10-22 lb that the starting dose is 30 mg per day and that for a dog who weighs 22 to 44 lbs that the starting dose would be 60 mg per day.

http://www.dechra-us.com/File/prod_vetyrol.pdf

But I did find something on the Dechra US website that does also say to start with a lower dose ... I had to really root around for a while on the Dechra US site to also find it though. And I think they should really add the recommendation that is on their website (to start with a lower dose) to the package insert.

http://www.dechra-us.com/page/veterinarians#Prescribing

Ideally, the starting dose to aim for is 1.0 to 3.0 mg/lb (2.2 to 6.7 mg/kg) once a day based on body weight and capsule size. When calculating dosage, it is suggested to round down. Start at the low end of this range. If you have any questions on dosing, contact Dechra Technical Support at 866-933-2472 or support@dechra.com.

[Squirt's Mom]

Hey Dottie,

Thanks for the reply! You got it going on, girl...calling docs and asking questions then coming here and sharing with us what you have learned! I hope you understand that is what we are doing when we give you the information we have gleaned from living with Cushing's on a daily basis.

I am very glad to hear that someone is working on getting the UC Davis protocols included in the Trilo information. It certainly should be! That would help prevent some other pups from suffering what Tessie just went through!

Debbie will be along soon to give you her take on the labs, I'm sure. Thanks for posting them and the extra info she asked for. That really helps!

Hugs,
Leslie and the girls

[Sammie]

HI Acushdogmom this is what I copied from there web sit and this is what in the vetoryl box say's
Starting dose

VETORYL Capsules should be administered orally once daily in the morning with food. Administration with food will significantly increase the rate and extent of absorption of VETORYL.

Ideally, the starting dose to aim for is 1.0 to 3.0 mg/lb (2.2 to 6.7 mg/kg) once a day based on body weight and capsule size. When calculating dosage, it is suggested to round down. Start at the low end of this range. If you have any questions on dosing, contact Dechra Technical Support at 866-933-2472 or support@dechra.com

Tessie is 25 pounds, with this chart it say's 60mg or am I looking at this wrong?
Dottie
PS can some one tell me how to calculate a MG by pounds. TY again

*Dogs over 132 pounds (60 kg) should be administered the appropriate combination of capsules.