Spanky, 12 yr old Boston Terrier (from Lysodren to Trilostane)

[Honey]

Hello all! I'm a new member here and want to introduce myself. I live in the Richmond, Virginia area with my Boston Terrier (Spanky) who was diagnosed with Cushing's 2 years ago. My husband and I adopted Spanky from a Rescue group in 2002 so his age is an estimate of 12 years old now. He's had Lysodren off and on for about a year and a half, and with his most recent elevation in water consumption, our Vet recently switched him to Trilostane. We are using a liquid compound and Spanky receives 0.5 ml daily; he weighs 25 lbs. We're excited about the switch - from what we've read about this drug, it sounds like a better choice. Spanky lost most of his eyesight to cataracts and is almost completely deaf. It is hard to tell if he suffers from dementia as a result of his age or if the blindness and deafness cause him to seem "off" at times. Occasionally he will slowly pace around inside the house, and has decided to use our carpet for his potty sometimes. We love him like a baby and have been looking for a support group just like this one! :D

[littleone1]

Hi Honey,

Corky and I want to say hi and welcome you and Spanky to a very wonderful group of very caring, supportive, and knowledgeable people.

My Boston, Corky, as we refer to him as the Corkster, was originally diagnosed with Cushings when he was 11 1/2 years old. He was going to be treated with Lysodren, but because he had 2 UTIs, I wasn't able to start his treatment. His clinical signs actually were in remission for 7 months. When his clinical signs started to resurface after 7 months, his IMS started him on Trilostane, for which I was very greatful.

Has Spanky been tested for any urinary tract infections, as these are common with our cush pups? I know that with Corky, the accidents in the house were due to both the UTIs and the Cushings.

Corky now weighs 18.13 pounds, and is taking 31mg of Trilo daily, split into 2 dosages of 20mg in the A.M., and 11mg in the P.M.

I know how you feel about Spanky being treated like a baby, as Corky is my baby.

Would you please let us know what tests were done to determine that Spanky has Cushings, along with the test results. This will help our more experienced members to give you good advice.

Terri

[Harley PoMMom]

Hi and welcome to you and Spanky from me and my boy Harley! You are a very special and wonderful person for rescuing Spanky and giving him a forever home, Bless You for that.

How long had Spanky been off the Lysodren before switching to Trilostane? And was an ACTH stim test done before switching him over? The reason I am asking is because Dechra, manufacturer of Vetoryl/Trilostane, requires a 30 day wash-out period before switching from Lysodren to Trilostane. Thirty days is the appropriate washout period unless a dog's post acth stim number is clearly above normal and is overtly symptomatic. Do you have prednisone on hand?

Oh those pee accidents!! Yep we can relate to that! What I have done is buy those puppy training pads and put them down.
I am so very glad you found this forum and we will help you in any way we can.

Here are some links for reading in you spare time! :eek::D
Dechra's U.S. Product Insert
http://www.dechra-us.com/File/prod_vetyrol.pdf

Links to Cushings Websites (especially helpful for new members!)
http://www.k9cushings.com/forum/showthread.php?t=180

Helpful Resources for Owners of Cushing's Dogs
http://www.k9cushings.com/forum/forumdisplay.php?s=&daysprune=&f=10

Love and hugs,
Lori

[StarDeb55]

Welcome to you & Spanky! I am not a trilo parent, so I will not comment to much on the use of trilo. I must warn you that we have a tendency to ask loads of questions with new members but that just allows us to give you the best feedback from the group's collective experience. Terri has given you a good start. We always like to see what diagnostic testing was done to determine Cushing's including the actual results. We aren't trying to second guess your vet, but we have seen pups misdiagnosed, too. Could you tell us what symptoms Spanky had that led you to take him to the vet? Was any sort of general labwork done such as a senior wellness panel or super chemistry panel? If so, we would also like to see only the abnormal results from those tests, along with reporting units, & normal ranges. There are common abnormalities on general labwork especially in liver function tests that will frequently tip off a vet to suspect Cushing's. Was diabetes & low thyroid ruled out? I ask about these 2 as their symptoms will frequently overlap with Cushing's.

When it comes to the liquid trilostane, you say that Spanky is getting 0.5 ml. daily. What is the concentration of the liquid form? This would be something like 25 mg/ml, 30 mg/ml, 50 mg/ml, etc. How long has Spanky been on trilostane? How long was he on lysodren? Did your vet discuss with you the reasoning for switching to trilo? Also, was their a washout period where Spanky was taking neither drug before you switched to the trilo? Most experienced Cushing's vets, including internal medicine specialists, will want a washout period of 30 days before switching lysodren->trilostane or vice versa.

It is very hard to watch them age & suffer the disabilities associated with aging. My 15 yr. old Shih Tzu, Harley, has been treated with lysodren for a little over 2 years. He has gone blind in the past 3 months or so, & is having some difficulty adjusting to his sightless world, so I totally understand.

Again, welcome to both of you. We are here to help in any way we can.

Debbie

PS-I see Lori & I were posting at the same time, so sorry for any duplication.

[Honey]

Thanks for welcoming us into the group! I will do my best to answer the questions posed and perhaps it will give you a better understanding of Spanky and his current situation.

Spanky was checked in March ‘08 for his increase in water consumption & frequent urination. A significant amount of blood was found in the urine & he started antibiotics in case of urinary infection. Blood tests showed low thyroid & he started Soloxine to treat that. Urine was checked again 3 weeks later & urine was diluted…more blood work to check for Cushings.

An ACTH Stim test performed April 14th indicated he probably had Cushings as his enzymes were twice as high as normal. Inflammation of the liver was ruled out as his liver enzymes were not high. Tested negative for arthritis and diabetes, and thyroid tested low. (Vet said thyroid can test low but actually be normal when there are stresses from other diseases present – hence the thought of Cushings.) He was tested for Pituitary or Adrenal and it is felt that he has Pituitary Cushings.

Began Lysodren treatment in May ‘08. Cortisol was tested after initial chemo treatment and was down to .5 and .7 (normal levels are 1 – 7). Began maintenance dose of Lysodren, 1/3 of a 500 mg tablet twice a week. ACTH Stim performed again in June; electrolytes & cortisol levels were good. Began maintenance dose of Prednisone, 2.5 mg every other day. Once normal water consumption level was reached, I stopped giving Pred.

We keep a daily chart of his water consumption which has enabled us to determine when he needs to be seen by our vet for analysis. He’s been on a cycle of Lysodren (either 167, 250, or 500mg/day) & Prednisone (either 2.5 or 5mg/day).

Another ACTH Stem test in Aug. ’09 was performed; his level before the injection was 15, after the injection the level should’ve been between 6 – 18 and he was over 50. Began aggressive Lysodren treatment.

In March ‘10 a Total Health Plus-Chem test was done along with a CBC. Since Jan. he has strictly been on Pred (usually 2.5mg/day) whenever needed. He experienced 4 seizures over 3 days in March & 2 in April over a 2 day period. We feared he was on his last legs but he has rebounded with the help of Prednisone and has been seizure-free to date.

We just switched him from Lysodren to Trilostane - today is only his third day on Trilostane. When we started him on the Trilostane, he hadn’t had any Lysodren since January (with the exception of a half tablet (or 250mg) 2 weeks prior to his first day of Trilostane. The concentration of the liquid is 100mg/ml and he receives 0.5 ml once a day. Spanky always had a hard time with the Lysodren, he would get very lethargic, weak & sometimes have diarrhea. Our Vet discussed Trilostane as an “easier” less toxic way to possibly treat his Cushings and once we read about it, we were on board with that decision. Spanky is the first Cushings dog our Vet is treating with Trilostane but she confers with an Internist.

[StarDeb55]

Thanks for giving us Spanky's history! It's basically water under the bridge now, but there are several red flags with the use of lysodren that indicate why Spanky had such a tough time. My comments will be in blue.


Cortisol was tested after initial chemo treatment and was down to .5 and .7 (normal levels are 1 – 7). Began maintenance dose of Lysodren, 1/3 of a 500 mg tablet twice a week.
With an ACTH test after the loading period showing these kinds of results, this is considered to be Addisonian. Did you begin maintenance dosing immediately or did you treat with prednisone? If you began maintenance dosing immediately, it's almost certain that Spanky's cortisol levels continued dropping & this is why he beame ill.


Began maintenance dose of Prednisone, 2.5 mg every other day. Once normal water consumption level was reached, I stopped giving Pred.
Were pred & lysodren being given concurrently at this point? This is usually a red flag for us about the vet's experience with treating Cushing's. When you are giving pred concurrently, you are simply replacing the cortisol or steroid that the lysodren is trying to halt the production of by the adrenal glands. Giving these 2 meds together can easily mask the signs of a low cortisol emergency which would easily explain why Spanky became ill, too.


Another ACTH Stem test in Aug. ’09 was performed; his level before the injection was 15, after the injection the level should’ve been between 6 – 18 and he was over 50. Began aggressive Lysodren treatment.
Normal range for an ACTH for one of our pups who is actively being treated with lysodren is 1-5. The normal range you have posted is for a normal, healthy pup, not one of our cushbabies.

I'm glad to hear that your vet is consulting with a specialist on Spanky's treatment at the present time. From what I know about recommended trilo dosage, it looks like Spanky's is in the middle of Dechra's suggested range which is 1-3 mg./lb of body weight. I must tell you that Dechra is now recommending that you start at the low end of the range & work up. The other thing is that it's critical that Spanky have an ACTH done 10-14 days after beginning treatment with trilo. The test has to be done, I believe within 4-6 hours after giving the dose, but I will let some of the trilo parents confirm that.

Debbie

[littleone1]

Hi,

I just want to confirm what Debbie said about the time period for getting the stim test done. For a cushoid dog being treated with Trilo, the test has to be done within 4-6 hours after the Trilo is given. I personally usually have Corky's done between 4 1/2-5 hours after his morning dose.

Terri