Transformation through treatment

Once diagnosed with Cushing’s, there is an opportunity to bring back health and restore life on every level.

Through effective disease management and treatment it is possible to improve a dog’s quality-of-life, and as a result their owner’s quality-of-life.

Treating Canine Cushing's Syndrome:

Improves quality-of-life (of dogs and their owners)
Reduces clinical signs
Prevents sequelae

Why use Vetoryl?

Only licensed medical treatment of Cushing’s
Treats both pituitary and adrenal-dependent Cushing’s
Reversible, so the dose can be titrated to effect

It is important to understand WHY Vetoryl monitoring is needed, and WHAT the results of monitoring can deliver

What the results of monitoring can deliver:

Ensured improved quality-of-life of dogs and, as a result, their owner's quality-of-life

Identify whether dogs are on an adequate dose of Vetoryl to control the clinical signs of Cushing's

Identify dogs that are unwell, whether the problem is due to Vetoryl or something else

What is the aim of Vetoryl monitoring?

Vetoryl is a medicine that delivers major clinical benefits to a patient. Every dog with Cushing’s is different, in their clinical presentation as well as in their response to Vetoryl.

Personalised monitoring is required to ensure the appropriate dose for that patient is obtained. After initiation of treatment, it needs to be ensured that the prescribed dose of Vetoryl is adequate to control clinical signs of Cushing’s.

Gaining the clinical picture

Attention to Clinical Signs

Assessment of serum cortisol concentrations alone is unreliable for the monitoring of Cushing’s therefore paying particular attention to the clinical signs is vital to achieving treatment success.

Owner Communication

Excellent owner communication is vital to truly understand how a dog is doing on Vetoryl.

Motivating an owner to take control of their dog’s condition right from the point of diagnosis is of benefit to everyone involved in the dog’s care. Explaining the need for good record keeping at home and providing the tools to enable consistent and effective monitoring can help get owners on board.

In this video, Professor Stijn Niessen DVM PhD DipECVIMCA MRCVS discusses the importance of good owner communication in patients receiving ongoing medication for a chronic disease.

Monitoring your patients on Vetoryl

When monitoring a patient on Vetoryl, emphasis should be placed on their clinical response. Use both the clinical picture and the cortisol assessment together to guide dose adjustments.

Cushing's Clinical Score

Physical Examination

Quality of Life Assessment

Cortisol Assessment

Cushing's Clinical Score

The Cushing’s Clinical Score (CCS) has been developed to make it easy to record and keep track of the most important clinical signs.

Is the patient well?
Do they have any signs of Cushing’s?
Have they got better or worse?

Carefully consult with the owner regarding their dog’s clinical response at home.

Record keeping at home allows an owner to detect subtle changes sooner. Owners can identify changes in adequacy of their dog’s control, prompting an appointment sooner than might otherwise be scheduled.

It helps detect signs of being unwell, meaning overt hypercortisolism is avoided.

It is important to assess and record the clinical signs in a standardised way, especially to ensure continuation of care in cases managed by multiple clinicians.

Download Cushing's Clinical Score Form

Interpreting the CCS

The score should be monitored over time rather than in isolation.
There isn’t a ‘cut off’ value, or a set score change, which indicates action is required.
Each dog will have their own baseline score, we would expect this to reduce with treatment.
Providing the score is reducing or remaining at a constant low level then the dog is doing well.
If the score slowly starts to increase over time, or there is a sudden increase during a routine check-up, this would warrant further investigation and possible dose adjustment.

Watch Professor Stijn Niessen demonstrates how to interpret the Cushing’s Clinical Score

Physical examination

Performing a routine physical examination provides an opportunity to look for signs that the dog is unwell and/or has concurrent disease. You are also able to check that your physical findings support the clinical history provided by the owner.

There are specific time points in the monitoring process that can act as reference points to ensure your patient is progressing as expected. Different clinical signs take different time periods to see a response to treatment. It is important to emphasise this to owners. If dogs are not responding as expected, consider whether a change in dose is required.

Stage 1 - After 10 days of therapy

Owners should have noticed that the dog is drinking and urinating less.
The animal should be less ravenous and excessive panting should have reduced.
Lethargy is another clinical sign of Cushing’s that rapidly responds to treatment; even at the first 10 day check many owners have noticed that their dog has more energy.

Stage 2 - After 12 weeks of therapy

Abdominal girth reducing so pot belly appearance diminishing.
Increased muscle tone and strength.
Some hair regrowth may be noticeable.

Stage 3 - After 9 months of therapy

Most clinical signs of Cushing’s disease should have improved or resolved.
At the end of Dechra’s 6 month clinical trial of 60 dogs, no more than 15% of dogs exhibited any of the clinical signs associated with Cushing's.

Survey of results

Quality-of-life assessment

The aim of treatment with Vetoryl is to optimise the dog’s quality-of-life. This will positively impact the owner’s quality-of-life too. The validated CushQoL-pet questionnaire has been developed to help assess QoL within your monitoring consultations.

Download Cushing's CushQol

It is recommended to complete the CushQoL-pet questionnaire at least every three months to facilitate communication and to work with the owner to decide the next steps of their dog’s management

Cortisol assessment

Steps 1-3 focus on the clinical picture of the patient. Even before measuring the patient’s blood cortisol level, you can build an idea of their degree of control. An objective measure is required to identify dogs with sub-clinical hypocortisolism and at risk of progressing to an overt iatrogenic hypoadrenocorticism. For dogs which are not considered clinically unwell, either the ACTH stimulation test or pre-Vetoryl cortisol (PVC) can be used to monitor cortisol.

If the dog is ‘unwell’ (vomiting/diarrhoea, abdominal pain, off their food), Vetoryl must be stopped, serum electrolytes analysed and an ACTH stimulation test performed using Cosacthen® as this is the gold standard test for iatrogenic hypoadrenocorticism.
The ACTH stimulation test can then be interpreted to help you decide if the dog is unwell due to hypocortisolism (pre- and post-ACTH cortisol <40 nmol/l) or due to another reason (post-ACTH cortisol >40 nmol/l).

Cortisol assessment using Pre-Vetoryl Cortisol

Treatment and Monitoring for Canine Cushing's Syndrome

Once a diagnosis of Cushing’s syndrome is reached, focus can be switched to transformation through treatment

Monitoring of dogs receiving Vetoryl is to ensure appropriate and adequate control of Cushing’s

Monitoring of a dog’s condition should move towards a more comprehensive approach, placing more emphasis on at-home monitoring by the owner and not relying exclusively on laboratory measurements

Whilst it could be seen as desirable to rely solely on owner observations and physical examination, an objective measure is also required to ensure that treatment remains suitable for those dogs whose owners’ observational skills are inadequate or for those dogs who are developing subclinical hypoadrenocorticism that could progress to an overt, life threatening disease

Pre-Vetoryl Cortisol can be considered as an alternative for monitoring Vetoryl treated patients as, when compared to the ACTH stimulation, it correlates better with clinical control (Ramsey et al, 2016), is more repeatable (Macfarlane et al, 2016), less expensive, and easier to perform.

Transformation through treatment

Treating Canine Cushing's Syndrome:

Why use Vetoryl?

What the results of monitoring can deliver:

Monitoring your patients on Vetoryl

Cushing's Clinical Score

Physical Examination

Quality of Life Assessment

Cortisol Assessment

Cushing's Clinical Score

Carefully consult with the owner regarding their dog’s clinical response at home.

Interpreting the CCS

Physical examination

Stage 1 - After 10 days of therapy

Stage 2 - After 12 weeks of therapy

Stage 3 - After 9 months of therapy

Survey of results

Quality-of-life assessment

Cortisol assessment

Once a diagnosis of Cushing’s syndrome is reached, focus can be switched to transformation through treatment

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Transformation through treatment

Treating Canine Cushing's Syndrome:

Why use Vetoryl?

What the results of monitoring can deliver:

Monitoring your patients on Vetoryl

Cushing's Clinical Score

Physical Examination

Quality of Life Assessment

Cortisol Assessment

Cushing's Clinical Score

Carefully consult with the owner regarding their dog’s clinical response at home.

Interpreting the CCS

Physical examination

Stage 1 - After 10 days of therapy

Stage 2 - After 12 weeks of therapy

Stage 3 - After 9 months of therapy

Survey of results

Quality-of-life assessment

Cortisol assessment

Once a diagnosis of Cushing’s syndrome is reached, focus can be switched to transformation through treatment

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