New Member - Simon (10 y/o westie)

[simon1]

Hi we're new here. I am Lisa and my 10 year old westie Simon has Cushings and is currently undergoing treatment. Unfortunatly the loading dose of Lysodrin(sp?) caused a temporary addisons and he has to be removed and put on cortisone for a week. After a week off the cortisone he went for another ACTH test this morning. Depending on the test the vet will try the Trilostan. I have noticed he has lost 6 lbs. since november even though he is eating well. he has always been a little "over weight" and now looks like a waif. So we are trying to deal with this and get some weight back on the boy.

[addy]

Hi and Welcome Lisa,

Glad you found this forum. You will receive a ton of support and good advice. Sorry to hear about your pup. Must have been scary.

I do know normally there is a wash out period when switching from lysodren to Trilostane but the moderators will all be along to guide.

They also ask a million questions;) That is a good thing but just to get you going, they will ask for tests, dosages of lysodren, weight of pup, when did this all happen, etc.

Gave you a big project huh?

Again, glad you are here,

Addy

[frijole]

Addy is right - you can't just switch to another drug. The wash out period is a minimum of a month - might be longer going from lysodren to trilostane.

Do us a favor and tell us more about Simon. What does he weigh and what dose were you giving him daily? When you get the acth test results - get the 2 numbers from it and post it here.

How is he acting now? Is his energy level better? What dose of prednisone are you giving? Tell us as much as you can please. :D And we are glad you found us. Kim

[Squirt's Mom]

Hi Lisa and welcome to you and Simon! :)

I am sorry you have had such a rough start on this journey but hopefully we can help you get things sorted out and off on a better foot this time.

First of all, if you could post the actual test results that were used to diagnosed Simon that would really help us. Be sure to include all the letters and numbers on the tests. They help us to interpret the values that relate to Cushing's.

When was Simon diagnosed?

Can you tell us what caused the vet to suspect Cushing's in the first place? Did they do a routine lab for a dental, etc? Were you seeing signs in him that prompted a visit and if that is the case, what signs did you observe?

How much does Simon weigh?

What was the dose of Lyso that he was given during the loading phase?

What signs did you see that indicated an Addisonian episode?

Has diabetes been ruled out?

Has he had an abdominal ultrasound? If so, what were the results?

Ok...enough questions for now.

Lysodren is a much longer acting drug than Trilostane and it is recommended that a minimum of 30 be allowed to pass before switching to Trilostane AND that there is a return of signs.

You need to be aware that Trilostane can cause Addisonian episodes just as Lsyodren can and usually for the same reason(s) - 1) the dog was misdiagnosed; 2) protocol for administering and/or monitoring treatment was not followed; 3) vet failed to educate parents on what to watch for with treatment that would indicate a problem and what to do about it; 4) parents failed to be diligent (typically not a problem with folks who seek out help ;) ). So don't be lulled into thinking this cannot happen again once you switch to Trilo...it can.

It's great you knew to get Simon the help he needed when he got sick with the Lyso and that your vet seems to have him on the right treatment and testing schedule for the ACTH. You will want to be sure his electrolytes are checked then, too, just to be sure. I can just imagine how scary it was to see Simon get sick but you done good! :):cool: How is he feeling today?

Ok, if you can give us some info on Simon's cushing's journey so far, any other health issues he may have, and the test results then we can offer you some really good feedback. You will be amazed at how much these folks here know and just how wonderful they are.

I am glad you found us and look forward to learning more soon!

Hugs,
Leslie and the girls - always

From the Vetoryl (Trilostane) diagnostic brochure:

http://www.dechra-us.com/files//dechraUSA/downloads/Client%20Literature/47901_VETORYL_10mg_Diag_Testing_brochure_4pg_3_1_p s.pdf


Mitotane (o,p'-DDD) treatment will reduce adrenal function. Experience in foreign markets suggests that when
mitotane therapy is stopped, an interval of at least one month should elapse before the introduction of VETORYL Capsules. It is important to wait for both the recurrence of clinical signs consistent with hyperadrenocorticism, and a post-ACTH cortisol level of >9.1 μg/dL (>250 nmol/L) before treatment with VETORYL Capsules is initiated. Close monitoring of adrenal function is advised, as dogs previously treated with mitotane
may be more responsive to the effects of VETORYL Capsules.

[simon1]

I will try and remember what you asked, lol.......
The reason the vet tested Simon for Cushings was because i did my homework and found he had all the symptoms and asked him to. Simon has been treated for low level hypothyroidism for the past few years on and off. I found he was very sensitive to the meds (voracious appetite, hyper)so took him off for awhile. Also had him checked for diabetes, doesn't have it. His senior blood panels (electrolytes, liver etc.) were always great. (except the slightly low thyroid). So all along i thought Simon's hair loss was the thyroid. But when his thirst became unmanageable and he started having potty accidents, his hair loss worsened,and he didn't want to go for his long walks I knew something was up. So he had the 8 hour ACTH test in mid December that came back positive for Cushings. I don't have all the lab values of all his tests.

He was on the Lysidrene for about 6 days before I noticed a slight change in his thirst and appetite in the morning and then by the afternoon he completley bottomed out, he couldn't even walk. he went right in to the vet for an Emergency ACTH test. (2 hours). It showed he was almost "Addisons" so the meds stopped. (He never got to go past that 6 days of the loading dose which was 25mg. twice a day.) The vet had then put him on cortisone and tapered the dose down to nothing. After a week off the cortisone he went for another ACTH 2 hours test which showed he was still producing too much cortisone so the vet is Giving him Trilostan which he said is tolerated better by some dogs. He has been off the Lysidrine about 3 and a half weeks. He just started the Trilostan today. he is going for another ACTH test in 10 to 12 days as long as all is well.

An interesting notation is Simon has always been hyper sensitive to Cortisone so we never gave it. I bet he has had Cushings all along since a youngster.

Other than exact lab values i think i amswered the questions? I wasn't sure where to respond to them as i am trying to get used to the forum.

Thanks!
Lisa and Simon (10 year old westie)

[frijole]

Hi! Thanks for the info. The reason we ask alot of questions is that we see alot of dogs that are misdiagnosed.

How much does Simon weigh? The dose of lysodren you were on 25 mgs twice a day is WAY below the recommended amount. So if your dog weighed 15 lbs the dosage amount would be 170 to 340 mgs a day. (25 to 50 mgs/kg of weight). My point is that if your Westie was on 50 mgs and had that reaction to lysodren that quickly I am wondering about the diagnosis.

Do you have (or can you please get) the results from all testing? You mentioned an 8 hr test was done to diagnose. This would be the Low Dose Dex Suppression test. (acth tests are only 1-2 hrs) It would also be helpful to know what you mean by 'almost addisonian'... what was the number on that acth test as well as all others. (there are two numbers on these tests)

While your dog has all signs of cushings - I am concerned about the quick switch (less than the 4 weeks MINIMUM recommended by the manufacturer of Trilostane).

Please get the numbers if you can. If your dog went too low on lysodren and then was given prednisone what is normally done is that you wait until the cortisol number is within the desired range (between a 1 and a 5 on the acth test) and you maintain your cortisol level by simply giving a maintenance dose weekly.

Maybe I am missing some information but going low on such a low dose dose not make sense. Thanks!!! Kim

[simon1]

I will try and get the lab info from the vet. Simon is 21 pounds. he lost 6lbs since November. He is a tall westie and his usual weight is 25-27lbs.
The lysodrine loading dose was 500mg. 1/2 tab twice a day for 10 days. Sorry, I didn't have my reading glasses on and saw 50 when i checked the label for you. Checking my calender he made it 8 days before becoming lethargic, and he also had diarrhea and vomiting.

He never got to a maintenance dose of lysodrine and his last dose was almost 3 1/2 weeks ago. He started the new meds today.

His diagnostic cushings test was an 8 hour test All others after have been 2 hours.

Is weight loss part of this disease? he seems to be wasting away. BUT in November before we knew he had Cushings the vet switched him to a prescription kidney diet because he had spilled protein in his urine in 2 tests. So perhaps it was lower calorie than his old food. He is now weaning back on his old food with an increase in the amount. I hope he gains. His appetite is VERY good.

Oh the vet said he was thinking of an ultrasound but decided not to because his other labs are good.

Thanks