lysodren & kidney troubles (11 y/o Boston) - Eva has passed away

[littledook]

My boston, 11 yrs old, started lysodren for the first time. It took her 18 1/2 days to suppress. A few days later her eye started looking bad. She was diagnosed with glaucoma. Drops didn't work. The vet eye specialist I took her to decided her best option was a genocin shot in the eye. She was fine for a couple of days. Eye looks a lot better. But she got very ill. Her kidneys are failing with 16 phosphorus value. She has spent the last couple of days at regular vet getting fluids. She won't eat, will drink. Did the lysodren do this? Was she on it too long? Her ACTH test was 8 the day before she suppressed, then it was 2.5.

[littleone1]

Corky and I want to welcome you and your furbaby. I'm so sorry that you are experiencing these issues.

Corky has never been on Lysodren, so I don't have any advice to offer.

Others will be along that have experience in using Lysodren.

You have found a wonderful group of very caring, supportive, and knowledgeable people that have alot of experience in dealing with cushings. I'm glad you found us. I know that I would have been totally lost if it wasn't for this wonderful group of people.

Terri

[Harley PoMMom]

Hi and welcome to you and your special girl. I am so sorry for the circumstances that brought you here but glad you found us.

I was wondering if you could tell us more about your precious girl, you see, the more information we know about her the better our feedback can be, ok?

How much does your girl weigh? What was the Lysodren loading dose? What test/s were done to confirm her Cushing's diagnosis?

Both of the Cushing medicines, Lysodren/Mitotane and Trilostane/Vetoryl can unmask kidney problems in a dog. Could you post any abnormalities that were marked on her Chemistry/CBC blood panel, especially the creatinine, BUN, and her electrolytes, with the reference ranges.

With a elevated phosphorus value a dog is usually put on a phosphorus binder, has your vet said anything about this?

Please know we are here for you and your sweet girl and we will do any thing we can to help.

Love and hugs,
Lori

[mytil]

I too wanted to welcome you to our site.

When you get the chance, please provide the information Lori asked as it would let us see these chem numbers, especially the BUN and creatinine.

Are you still giving her the Lysodren?
Terry

[addy]

Welcome !!!

Sometimes when we drop their cortisol, we find problems the high cortisol was masking. Sometimes the cortisol continues to drop and goes to low which also causes problems What does your vet say about all of this?

I am so sorry you are having a hard time. Is your pup eating anything now? I think the moderators need more information as they have indicated.

Hugs,
Addy

[littledook]

Thank you for your responses.

She was 33 lbs at the time of lysodren start with 350 mg dose 2x day. She is now down to 29 lbs. She eats from time to time now. She is now eating ground beef and rice. Unfortunately she throws up about 1-2 times a day. She is taking cerenia and pepcid ac for that. But still throws up.

She is now taking aluminum hydroxide to bind phosporus. Friday's test results for phosphorus was down to 14.3, an improvement.

She is at home now for the weekend. I am giving her fluids subcutaneously. She doesn't drink much now on her own and has had tacky gums from time to time. I have been giving her water with a syringe and also the subcu fluids mentioned above.

She is now taking 10mg pred 2x day.

She is now taking amoxicillin 250mg 2x day for possible kidney infection.

The last creatinine was 2.5.

I don't remember BUN.

Tomorrow, she goes back to vet for new blood panel. Will report new results then.

Thank you for info about lysodren unmasking kidney probs. This seems to be the problem.

Thank you all for your responses and kind words.

[addy]

I am so sorry you have so much going on. I am sending hugs and prayers. Please let us know what happens tomorrow with the blood work and post results listed as abnormal.

Could you tell us a little more information? I am sure you are distraught but if you could tell us a little bit more. What tests were done to diagnose? Her symptoms. Anything else.

Hugs.
Addy

[Harley PoMMom]

Thank you for your responses.

She was 33 lbs at the time of lysodren start with 350 mg dose 2x day. She is now down to 29 lbs. She eats from time to time now. She is now eating ground beef and rice. Unfortunately she throws up about 1-2 times a day. She is taking cerenia and pepcid ac for that. But still throws up.



Was her loading dose 350mg given twice a day for a total of 700mg? And this was given for 18.5 days? If so, what your sweet girl might be experiencing is an Addison's crisis. A dog in Addisons has some of the similar symptoms as a dog with kidney problems.

Could you tell us the time-line of the ACTH test.

Please keep us posted and I hope your precious girl is feeling better soon.

Love and hugs,
Lori

[littledook]

For testing... She was diagnosed 1-2 years ago. She had high liver values on blood work. Then she had all the other tests the acth stim test, the uptake test, and ultrasound. She is the pituitary kind.

Initially I tried selegeline. Then I tried trilostane for about a year. Then vet said to try lysodren.

She was healthy until 2009 when I found a hard lump on her throat. Needle aspiration showed abnormal cells. Surgeon removed lump and lump was sent for testing. It was thyroid cancer. But the lump was well contained and all opinions are that cancer is gone.

Took her to NC State Oncology for full work up. They discovered she had an acquired liver shunt and kidney problems. I was overwhelmed at the time, but remember that her kidney numbers were considered strange because this test would say this and that would say something else.

Shortly afterwards she was diagnosed with cushing's after all the regular cushings tests. She is my 3rd cushingoid boston terrier... Do they make non-cushingoid bostons?

I tried lysodren for her with trepidation. It took 18 1/2 days to suppress according to the tests (though she started turning her nose up at food at about her 5th day but ACTH stim test was in the 20s.) Two days later she turned her nose up at treats. ACTH test was 18. It took 18 1/2 days to get to 2.5.

ACTH test on this last Friday was 10.

Between last Friday and the 2.5 test, Eva was diagnosed with glaucoma, she had lost her sight. She was put on drops. She started throwing up 2 days later. Eye pressure was 55. Thought the vomiting was because of pain. It was determined that she needed more than drops. Removal of eye was thought to be too risky given her other health concerns. Gentocin seemed to be the best bet. But 2 days after that, she started throwing up constantly. Tests showed the extreme phosphorus levels.

We've been treating her for kidney failure ever since.

[Harley PoMMom]

Could you tell us why the vet switched Eva from Trilostane to Lysodren? And did your vet advise you to do a wash-out period before starting the Lysodren?

[littledook]

The vet said she didn't think the trilostane was working because Eva had some bad liver values on her latest blood panel. Vet did not suggest wash out period, but I waited at least a month to start lysodren.

I could be very wrong, but I thought that trilostane had a very short (20 hours) period of effectiveness. That if you go from lysodren to trilostane, you must wait a month because lysodren takes a while to get out of the system, but that trilostane gets out of the system very fast.

Either way, I did wait a month before using lysodren, because I was afraid of it. In hindsight, I think I should have listened to myself.

[addy]

Hi,

The wash out period when switching is generally four to six weeks. You were absolutely correct to wait.

It is hard to know exactly why things happen. Medicine is not an exact science. There are so many variables and unknowns. You made the best decisions you could at the time you made each of them.

Perhaps some of our more knowledgeable members will have some thoughts.

I'm so sorry this happened to you and Eva. Did I miss your name? I apologize if I did.

Hugs,
Addy

[Harley PoMMom]

You were right to give Eva a wash-out period, good for you! According to Dr. Feldman, a renown Cushing's expert, one should wait at least six weeks before switching from one medicine to the other. You can read his statement here:
Cushing's disease and other adrenal gland disorders (Q&A with Dr. E.C. Feldman). (http://veterinarynews.dvm360.com/dvm/Internal+medicine/Cushings-disease-and-other-adrenal-gland-disorders/ArticleStandard/Article/detail/672663?contextCategoryId=40534)


Also many members have communicated with a vet tech, Dr. Tim Allen, from Dechra's Kansas office. Dr. Allen does suggest that before switching from Lysodren to Vetoryl/Trilostane that a dog have strong clinical symptoms and a post ACTH stim of >12 ug/dl.

I'm confused as to why your vet based switching from Trilostane to Lysodren on elevated liver values. Some dogs can take a long while before the liver values are within the normal ranges while being treated, also, some dog's liver values never do fall within the normal ranges even though their cortisol is being controlled.

Usually the reasons for switching from one medicine to another is because the dog is not tolerating the medicine or the medicine does not seem to control the cortisol and symptoms.

I was wondering about the time-line of the ACTH test while using Lysodren. To get an accurate reading of the cortisol reserve a dog's ACTH stim test should be done 36-48 hours after the last dose of Lysodren, is your vet's procedure the same?

Please know we will help you and Eva in any way we can, so please do not hesitate to ask any questions, ok?

Love and hugs,
Lori

[littledook]

Eva's blood test on Monday was awful. No need to post the numbers. But most markers were high. She wasn't going to make it.

The vet came to our home on Tues morning and she is at peace now.

Unfortunately, so many thing happened in a short amt of time for us to put our finger on what was the culprit. She had suppressed on lysodren, a few days later was diagnosed with glaucoma and had to be put on a myriad of eye drops. Drugs were administered left and right. Eye drops didn't work. Vet eye care specialist thought best option was to kill eye with gentocin shot.

Little Eva was subjected to so many different medications, and spent so much time in hospitals that it is difficult to tell what did her in. I think it was a perfect storm of everything.

I can't blame the lysodren with certainty, but I will never do it again.

Another one of my bostons has cushings. He started using accupuncture last week. At least I know that won't kill him.

[Squirt's Mom]

Hello,

I am so sorry to hear about Eva's passing yesterday. :( I know your heart is broken but please don't feel as if you did anything wrong - you didn't. You did all you could to help her overcome all she was facing. Today Eva's pain is ended and her spirit restored to its perfect form.

Her name has been added to the In Loving Memory list for 2011. She will always be remembered and honored by her family here. Please feel free to share memories when you feel up to it - it would be our pleasure to help celebrate her life with you. You can post a memorial at:

http://www.k9cushings.com/forum/forumdisplay.php?f=8

Thank you for coming back and letting us know about sweet Eva.

Our sympathies,
Leslie, Squirt, Trinket, Brick and our Angels, Ruby and Crystal

[littledook]

Lori,

You asked why vet wanted to switch from vetoryl to lysodren.

Now that my mind is clearing, she had a dog she owns have an addisonian crisis after taking vetoryl for 2 years. My other cushingoid dog, Sammy, thought to be 10yo boston (rescue - not sure of age) had taken vetoryl for 2 years and had an addisonian crisis last Dec. He is not being treated right now for cushings because of that and because he has chronic bronchitis. My vet said that treating his cushings could cause his bronchitis to get worse. (The cushings is suppressing the bronchitis.) He has had a horrible reaction to his first dose of maintenance level of albuterol and had to spend a night in ICU at emergency vet clinic. Not breathing trumps cushings.

Plus my brother, a vet who I try not to pester, told me that Sammy's addisonian crisis on Vetoryl was not a fluke. That for some unknown reason, I dog who is successfully on Veltoryl can suddenly become addisonian on it.


As I mentioned in previous post, Sammy started undergoing accupuncture from a vet certified for accupunture.

[littledook]

Thank you, Leslie, for your comforting words.

[littleone1]

I'm sorry for your loss. My thoughts and prayers are with you.

[Harley PoMMom]

I am so sorry for the loss of your beloved Eva. The pain of losing them is devastating. Please know we do understand how you are feeling and are here for you.

Godspeed sweet Eva.

With Heartfelt Sympathy,
Lori

[mytil]

I am so very sorry your Eva has passed. My thoughts and prayers are with you.

Terry

[bgdavis]

I'm very sorry for the loss of Eva. Sometimes when our beloved little ones have so many medical problems, it is just impossible to 'cure' them all. Eva is free of hospitals and medications and that awful glaucoma.

Bonnie and Angel Criss

[addy]

I am so sorry to hear of Eva passing. So many struggles you both have had. I hope you can find peace. It is so hard sometimes and we all doubt ourselves. Please take comfort in knowing you did the best you could for Eva and that you loved her just as unconditionally as she loved you.


God Speed Little Eva.

Please know you may come here anytime you need to or want to. We will always be here for you.

Love,
Addy

[k9diabetes]

My deepest sympathies to you and yours. Eva obviously was deeply loved and I know how hard it is to lose one so dear.

Natalie

[marie adams]

I want you to know how sorry I am about Eva. It is never easy to make that decision, but it is the best for them. I know to well how it feels. Take care and keep the happy thoughts of Eva...:o

[jrepac]

So sorry to read the sad news about Eva. :(

Bostons seem predisposed to Cushings; I've been there as well with 2 Aussie terriers in a row coming down w/cushings. Seems like the terrier class is plagued by this condition, from what I have read.

Don't feel that you did something wrong in switching from Trilo to Lyso...sometimes things go bad really quickly, when you least expect it. :mad: I'm not sure I agree w/the switch from trilo to lyso if there was a concern about Eva becoming Addisonian...not sure what that would accomplish. :confused: And as others have said, you can have high liver values even when cortisol is under control. BUT, it seems like other factors were at work there; this is not uncommon when Cushings is present.

Your little girl is at peace now.


Jeff & Angel Mandy