Possible Cushing's in 9 yo lab/akita mix (Lysodren vs. Trilostane?)

[Labs101]

My Jade has been drinking a lot for the past two months. A month ago she started this coughing, and some hacking, but only when excited really. I'm not sure if she'd eat and eat b/c we do not leave extra food in the bowls after they eat (we have 3 lab mixes). I cannot remember, but there was only one thing elevated on her blood work results. There was nothing else out of the ordinary. She has also developed the pot bellied look. It also seems as though her breathing is labored when she's resting, not panting, it just comes a bit too quickly I think. At any rate, what is the best test to go with to find out. We cannot afford to spend tons of money on just the diagnosis alone if we hope to help her. Also, has anyone tried any dietary changes that help as well?

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[addy]

Hi and Welcome,

I am sorry to hear your pup has not been feeling well. I am glad you found us.

The fastest way to rule OUT Cushings is to do a UC:CR urine test. It is not terribly expensive. It will either tell you your pup does not have Cushings or that further testing is indicated. Always a good first step but you want to make sure it is done correctly. My first vet did not do it correctly. It needs to be the first urine catch in the morning, at home before drinking or eating. Some vets may prefer you to collect three days worth and pool the samples.

Others will be along soon to welcome you and give some feed back.
Our Resource section is a good place to start.

Again, welcome,
Addy

[frijole]

Addy has given you solid advice re the urine test to rule it out. Hopefully it is hypothyroidism which is easy and cheap to treat and has similar symptoms.

Sorry there are no easy cures or treatments with cushings'. Don't waste your money on any of the 'miracle drops' you see online as they don't work. Diet won't cure it but cush dogs cannot tolerate fat so you should be feeding a diet that is low in fat yet high in protein.

Kim

[Labs101]

Thanks so much for that info. I will ask the vet about that test. I wish they'd given me a copy of her blood work results so I knew which part was an elevated number that made him think it could be Cushing's. One thing I did read was that one of the first things looked for is an elevated wbc count, which she does not have. Also, what are some good dogfoods to try for her?

[StarDeb55]

Welcome to both of you! You have already been given some good advice which I will not repeat. The test that is elevated which will frequently cause a vet to suspect Cushing's is an alkaline phosphatase. When it come to food, you want to feed a good quality food that is high quality protein, low in fat. Fat content is very important as our babies are quite prone to developing pancreatitis. You might review this website to get ideas on food.

http://www.dogfoodanalysis.com/

Debbie

[Labs101]

How do you get Lysodren from Costco or Walmart? My vet wants to go with trilostane, but I really think I want to go with Lysodren. I also have to be careful with costs and I want to be able to afford my dog's medication and all that goes with it. I stay home so I am able to monitor my dog all day if need be. That in itself is probably the only reason we haven't had more accidents with all her water retention and constant eating and drinking.

[lulusmom]

How do you get Lysodren from Costco or Walmart? My vet wants to go with trilostane, but I really think I want to go with Lysodren. I also have to be careful with costs and I want to be able to afford my dog's medication and all that goes with it. I stay home so I am able to monitor my dog all day if need be. That in itself is probably the only reason we haven't had more accidents with all her water retention and constant eating and drinking.

All you need is a prescription from your vet.

[Labs101]

I don't think my vet would give it to me since he wants to do Trilostane and he made mention of the human drug and animals needing it differently. In other words, I feel that he kind of wants to make some more money for himself since he would be the one supplying the Trilostane through his own supply. Maybe I sound cynical, but it's just that he wanted to put her on blood pressure meds before we got the results from the suppression test back. I don't see any point in attempting to bring her pressure down when her system can't process it properly anyway. Ug, my Jade aka. Munchkin is a 9yr. old, 100lbs (now) lab/akita mix. Her belly is so bloated she really does look like a hog in dogs clothing. I'm very nervous about the meds. I am unsure about what tests are really necessary. We've spent over 400 already and I'm told it'll be another 400 during her first month of drugs b/c of finding out the proper dosage. I'm sure this is all repetition for most of you on here. Thanks for your help.

[Jenny & Judi in MN]

I refilled my Lysodren at Walmart last time. For 30 500 mg pills it was $160. My dog only takes 1/4 of a pill at a time so it will last her awhile but she is 7 pounds.

If your dog is 100 pounds I don't know if it will be much cheaper. There is a compounding company some folks have used for both drugs I think that might be cheaper.

My vet consulted with a few IM specialists at the University of Minnesota when we were struggling to get Jenny regulated. Half prefer Lysodren and half prefer Trilostane. Jenny has an adrenal tumor though so she is not the norm. Lysodren is working pretty well for her.

[Labs101]

After reading all these posts I don't know what would be best for my dog. I don't know how I'll be able to afford the Trilostane, and what if my dog has an adverse reaction to it? Is Lesodryn really dangerous to use? In the end which is more cost efficient for a 99lb lab mix? My husband is having a fit about the vet bill, so I want to be as frugal as possible w/o being careless for my Jade. At her size her dosage would be 3 pills of Trilo a day, so one bottle would barely last me two weeks. Then I'm told her dosage could increase? I don't suppose there are pet insurance plans for meds? :confused:

[labblab]

Welcome back to you and Jade! I had noticed overnight that you had posted a couple of new replies elsewhere on the forum that relate to your dilemma re: medication options for Jade. I've gone ahead and consolidated them here on Jade's own thread (If you flip back to the bottom of the first page of your thread, you'll find them there along with a couple other replies that were also posted elsewhere). That way, our members will be able to review everything that you have posted about Jade, all in one spot. I think it will be easier for them to give you thoughts and suggestions that make sense for Jade, given the facts of her own specific situation.

Marianne

[labblab]

I don't think my vet would give it to me since he wants to do Trilostane and he made mention of the human drug and animals needing it differently. In other words, I feel that he kind of wants to make some more money for himself since he would be the one supplying the Trilostane through his own supply. Maybe I sound cynical, but it's just that he wanted to put her on blood pressure meds before we got the results from the suppression test back. I don't see any point in attempting to bring her pressure down when her system can't process it properly anyway. Ug, my Jade aka. Munchkin is a 9yr. old, 100lbs (now) lab/akita mix. Her belly is so bloated she really does look like a hog in dogs clothing. I'm very nervous about the meds. I am unsure about what tests are really necessary. We've spent over 400 already and I'm told it'll be another 400 during her first month of drugs b/c of finding out the proper dosage. I'm sure this is all repetition for most of you on here. Thanks for your help...

After reading all these posts I don't know what would be best for my dog. I don't know how I'll be able to afford the Trilostane, and what if my dog has an adverse reaction to it? Is Lesodryn really dangerous to use? In the end which is more cost efficient for a 99lb lab mix? My husband is having a fit about the vet bill, so I want to be as frugal as possible w/o being careless for my Jade. At her size her dosage would be 3 pills of Trilo a day, so one bottle would barely last me two weeks. Then I'm told her dosage could increase? I don't suppose there are pet insurance plans for meds?

I am not sure which drug will end up being more expensive for a dog of Jade's size. Hopefully some folks who have given Lysodren to a dog as large as Jade will stop by to comment on their costs (and please do look back to the first page of your thread to see Judi's earlier reply to these same questions). Initial dosing of either trilostane or Lysodren is based on a dog's weight, but depending upon each individual dog's reaction, more or less of either drug can end up being needed over the long haul.

And as Judi also mentioned, buying compounded versions of either drug can be much less expensive than buying the brandname product. If you would otherwise be financially unable to treat Jade, your own vet may be willing to obtain a compounded drug on your behalf or he may write you a prescription that you can have filled by one of the internet compounding pharmacies used by several of our members here. A "compounded" version of either drug is a product that is put together by the pharmacy itself, rather than the brandname version that is manufactured on a large scale by a drug company. There are pros and cons to using compounded drugs, and some vets prefer not to prescribe them when brandname drugs are available in the dosage or form that the dog needs. But other vets are perfectly OK with them and do not have any problem at all with their use as long as they are obtained from pharmacies with good track records. You would have to ask your own vet whether or not he would prescribe a compounded product for Jade in order make it affordable for you to treat her.

Also, in his defense, high blood pressure is a condition that warrants treatment regardless of the cause. So I cannot be critical of him for wanting to start her on medication prior to knowing whether or not she has Cushing's. Blood pressure medication acts directly on the problem itself -- not the disease that causes it. And prolonged high blood pressure can be very dangerous and damaging. Is Jade's blood pressure still running high, and have you started treatment for it yet?

One last question for you -- can you find out the actual numbers for the test results that your vet has perfomed to confirm Jade's Cushing's? That info can be very helpful to us. Thanks!

Marianne

[Labs101]

Yes, I will be getting picking up her paperwork today. Also, the way my husband and mother (both in medical fields, not veterinary though) put it, was that treating the high blood pressure would be, hmm, I guess thinking about it, it would just be extra cost when we can get her on Cushing's meds and it would be regulated thereafter. I know, I wanted to get it as well, just to help. But then my mother also mentioned that due to all her fluid retention her pressure is likely high and would a diuretic be able to be prescribed to see if that would help in the meantime. Forgive any ignorance of canine biology, as neither I, nor my family is in the veterinary field. Thank you for putting my posts together, I was a bit confused at first seeing my old post, then thought, hmm, says it's new, clicked on it and there everything was.

[labblab]

That'll be great if you can get those test results. Also, here's a tip that you can pass on to your vet that might cut down on some of the cost associated with the monitoring ACTH tests after treatment is started:

How to Extend Your Supply of Cortrosyn and Lower the Cost of ACTH Stimulation Testing (http://endocrinevet.blogspot.com/2011/03/how-to-extend-your-supply-of-cortrosyn.html)

ACTH Stim tests are the "gold standard" for monitoring the effectiveness and safety of either Lysodren or trilostane. However, in addition to the tip re: lowering the cost of ACTH tests, a few specialists (including, I believe, Dr. Peterson who wrote the article above) are starting to sometimes use less expensive "resting" cortisol levels at certain points along the treatment path. If used at all, this should only be done at certain times and under certain conditions, but it might also offer savings on the testing. I'll try to come back later and add more info in that regard.

As far as pet insurance, I'm also not sure as to whether or how much coverage most policies offer for prescription drugs. However, in Jade's case, I feel certain that no insurance policy would cover her for a condition that she already has at the time the policy is purchased. So unfortunately I don't think she would likely have any coverage for charges that are Cushing's-related. :( But once again, perhaps members with more experience with insurance coverage can chime in.

Marianne

[Labs101]

Okay, so I took Jade's paperwork to another vet. She actually prefers the Lysodren since she's seen more improvement with it in the larger dogs. She's started her on one pill, twice a day. It is a supply for 7 days which says 500mg on it, so I assume it's about 30mg per pill. It cost $111 which is about what I've been seeing as an average price for the drug. The other vet said it would be about $4 a pill but he was not willing to prescribe Trilostane for her. I honestly don't understand why he would not let her have that option after describing both to me as the options he was giving me. At any rate, I'm anxious and excited to start seeing some improvement. I know I can't expect it for now, but I'm reeeeeeally hoping this will work for her.

[Cyn719]

Hi. I was just catching up on your thread. Did you get the results of the cushings test?? So you did check prices? I don't use lysodren but when I used trilo I got mine from vet depot. I understand about the money....it is a lot!! Will check back!

Hugs xoxo

[Sabre's Mum]

Hi

OK ... the tablets are 500mg each so you are loading on 1000 per day. The recommended loading dose is 25-50mg per kg. To convert lb to kg divide by 2.2 ... so Jade's weight is 40.9kg. Therefore the loading dose is 24.44mg per kg. This is on the low end but some large dogs are more sensitive to Lysodren so this may be OK ... it may take longer to load. My Sabre was 34kg at the time of loading .... we loaded on 50mg per kg and loaded in about 6 days but eventually maintained at 20mg per kg.

Please read up on this link as it gives great useful information for Lysodren loading. http://www.k9cushings.com/forum/showthread.php?t=181 Update us and we can help you on the way.

All the best
Angela and Flynn

[Squirt's Mom]

Hi,

Good to hear from you! Do get those test results and post them here, unless you are uncomfortable with that. They really will help us give you more meaningful feedback, tho. ;)

It sounds as if you are starting the loading phase with Lysodren. Don't panic. It sounds much scarier than it really is...and you have your family here to help you along anytime you need it.

The signs of being loaded can be very subtle, as slight as simply looking up from the feed bowl when they didn't yesterday. ;) A change in the rate they eat, the way they eat - gulping vs chewing, a slight decrease in the amount of water they are drinking can all indicate the load is complete. So watch your Munchkin very closely these next few days.

ANY signs of loss of appetite, diarrhea, vomiting, lethargy - STOP the Lyso immediately and call your vet immediately. Did they give you any Prednisone? If not, call right now and insist they give you some just in case. We never know how a pup will react and if a crisis were to occur while your vet was unavailable, you must have something on hand to help Jada right then - and that "something" is Prednisone. ;)

Another tip - we have noticed that often larger dogs seem to load more quickly than smaller dogs. Many vets will tell the parents to give the Lyso for X number of days then have them tested. The dog may load days earlier than the X number stated by the vet, or they may take longer than the X number of days stated. The single most important factor during the loading phase is us, the parents. It is up to us to know our babies and recognize the tiny changes, to watch them like a Hawk during this time, and to make the call when it is time to stop the load and call for the test. Please read the link Angela provided; many of us have printed a copy and hung it up where the info was readily seen so we can check where we are and what we are seeing.

Please keep in touch and know we are here anytime.
Hugs,
Leslie and the gang

[Labs101]

Here is Jade's info.

Cortisol Serial 3 (DEX)

Time 1 9:30 Sample 1 Dex 4.1ug/dL

Time 2 1:30 Sample 2 Dex 1.1 ug/dL

Time 3 4:30 Sample 3 Dex 2.3 ug/dL

Significant highs and lows in bloodwork include: ALT (SGPT) 191 U/L HIGH
Alk Phosphatase 1195 U/L HIGH
Cholesterol 366 mg/dL HIGH
Total T4 0.5 ug/dL LOW

[Labs101]

So far so good with the Lysodren for Jade. I think she is breathing a bit easier and it seems as though her belly is a little less rotund. It is nice to be able to breath a bit easier seeing that she has had no adverse symptoms. She's still crazy about her food though, so I know she has adequately loaded as of yet. I did post her bloodwork and all if that helps anyone.
As far as cost goes, it really doesn't seem like the vets will be willing to give me a prescription. I feel as though I'm going to have to play the big B in order to get a prescription to fill myself when they want to fill it themselves. That's scary simply b/c they are the ones who know how to care for my dog. Anyway, just another little stressor I suppose. But for now, I'm just happy that this seems to be okay in her system.

[Harley PoMMom]

Here is Jade's info.

Cortisol Serial 3 (DEX)

Time 1 9:30 Sample 1 Dex 4.1ug/dL

Time 2 1:30 Sample 2 Dex 1.1 ug/dL

Time 3 4:30 Sample 3 Dex 2.3 ug/dL

Significant highs and lows in bloodwork include: ALT (SGPT) 191 U/L HIGH
Alk Phosphatase 1195 U/L HIGH
Cholesterol 366 mg/dL HIGH
Total T4 0.5 ug/dL LOW

The LDDS test is consistent with Cushing's, but I think the results do not accurately diagnose whether the Cushing's is pituitary or adrenal dependent.

The elevations in the Cholesterol, ALT and ALP are what is usually seen in a dog with Cushing's and probably will decrease, in time, within the normal levels.

The low T4 is probably due to the Cushing's also, which is known as sick euthyroid syndrome and after the elevated cortisol is controlled the thyroid will be begin to function normally again.

Please keep us updated!

Love and hugs,
Lori

[lulusmom]

I'm glad to hear things are going well with the loading. The price you quoted for a 30 days supply of 500mg Lysodren is pretty good actually. The last time I checked with Costco, the price for 30 pills was definitely more than that. It was over $4 per pill so your vet is definitely not gouging you, which is what I'm used to. :D

With respect to the LDDS, I believe those results are consistent with pituitary dependent cushing's. If the 4 or 8 hour draw is 50% less than baseline (1st blood draw prior to injection), then pituitary dependent disease can be diagnosed. In Jade's case, her four hour draw of 1.1 ug/dl is definitely 50% less than 4.1 baseline.

Keep up the good work and watch Jade like a hawk for signs of loading. Good job!

Glynda

[lulusmom]

Hi again,

I went back through your thread and see than nobody has provided you with a link to our Lysodren Loading Instructions and Related Tips so am including a link below. I would recommend that you print them out and keep them handy. I have two dogs being treated with lysodren and have had to load them a few times. My print out is so dog eared and stained up, I can hardly read it. Looks like I need to print a new one before I load them again. It's a great resource for sure.

http://www.k9cushings.com/forum/showthread.php?t=181

With respect to saving money by splitting the cortrosyn vial, unfortunately with Jade weighing 100 pounds, that's not going to be possible. The vet will have to use the entire vial for every acth stimulation test. I have small dogs and can get at least five acth stimulation tests out of one vial so I guess having a little dog with cushing's has it's benefits after all. :D

http://www.k9cushings.com/forum/showthread.php?t=181

I hope this helps.

Glynda

[Harley PoMMom]

With respect to the LDDS, I believe those results are consistent with pituitary dependent cushing's. If the 4 or 8 hour draw is 50% less than baseline (1st blood draw prior to injection), then pituitary dependent disease can be diagnosed. In Jade's case, her four hour draw of 1.1 ug/dl is definitely 50% less than 4.1 baseline.


Glynda

Thank you, Glynda for catching my goof about the results of the LDDS test...sorry for the mistake on my part. :o:eek::)

[Labs101]

Hi again,

I have two dogs being treated with lysodren and have had to load them a few times. My print out is so dog eared and stained up, I can hardly read it. Looks like I need to print a new one before I load them again. It's a great resource for sure.



Why have you had to re-load your pups?
Thank you for all the information. Yes, so far so good. I have managed to get my 5yr old to understand she cannot feed Jade treats without asking me first. She likes to feed each of our dogs individually now anyway, so that helps in giving her a little job, instead of just having all three of our labs crowd around her begging for treats which she will dole out generously. She loves it that they listen to her commands when she has treats. At any rate, we have a system now. Each dog gets fed individually in the garage. At least this way I know that our boy (not really, he's old than Jade by 6 mos) gets to eat all his food. Sorry if I already posted that about how I'm feeding each. Thanks again!!

[Jenny & Judi in MN]

I'm not Glynda but I've had to reload Jenny because the first maintenance dose we attempted did not work, her levels went back up. It took a couple of tries to figure out the best maintenance routine for her.

Caution on the loading. Jenny spit up spit on her 2nd day so I didn't think that counted as puking and gave her another pill during the loading period. The next day she had scary watery diarrhea. So watch for ANY type of vomit. and keep us posted! Judi

[lulusmom]

Thank you, Glynda for catching my goof about the results of the LDDS test...sorry for the mistake on my part. :o:eek::)

Lori, don't be sorry. You got the most important part, being it's definitely consistent with cushing's. It took me quite a while to learn how to interpret the LDDS. This stuff isn't easy, plus I have a retention problem so it's possible that I knew at one time but forgot and kept having to figure it out all over again. :D It didn't stick until I listened to a Dr. Bruyette audio. He made it really simple when he told his audience that if the 4 "or" the 8 hour draw is less than 50% of the baseline draw, it's PDH. He did a pop quiz too, which reinforced things for me. Until that time, I kept forgetting if both post injection draws had to be 50% of baseline or just the 8 hour draw. Once I really, really get it, I own it so now we both know and so does everybody else. :D

Glynda

[lulusmom]

Why have you had to re-load your pups?


Judi has already mentioned one of the most common reasons for having to reload. A vet has to determine an appropriate maintenance based on a few factors and there's no guaranty that it's going to be the right dose....it's always a crap shoot. It is also not uncommon for a dog to stabilize on a maintenance for a long period of time and then have the adrenal glands regenerate too much and start pumping out too much cortisol.

I loaded my dogs a few times because I switched them from Lysodren to Trilostane and then switched them back to Lysodren. It's a long story as to why I did that and in hindsight, I probably would have kept them on Trilostane but luckily, they've done splendidly on both drugs.

Glynda

[Labs101]

I just remembered this was a question I'd thought of...What kind of food is best for our Cushing's pups? I'm just curious to see if there are any universals since I know every dog is different, but ya never know. Thanks!:)

[marie adams]

Hi There and Welcome!!! :)

Sorry for the belated welcome.... :o

I treated my Aussie with Lysodren--no side effects, but there were reloads, but I think mine were because I didn't have a vet who truly understood Cushings. Everyone here helped me so much through it all. I remember 30 pills cost me close to $170 at Costco.

As far as food for me--I took Maddie off grains and started a raw chicken diet (Northwest Naturals) and then added some dry in - Venison with no grains (California Naturals). This is what worked for me. I had read that grains and beef were not good for Cushings dogs.

My new puppy is eating the Venison diet, but she ended up being allergic to chicken and beef; so like you said every dog is different.

I am so glad you found this forum--they are caring, loving, and knowledgeable!!! A family....:)

Take care!!! :)

[Labs101]

I just know I need to do something about Jade's diet as she has awful gas all too frequently. It makes everyone bust up laughing sometimes b/c she sounds like she's making people stinkers. But, whew! She never used to have gas like this. I think being on the Lysodren actually helped a little. But then again, she has good days and bad days, and she's been on a rigid diet with the 2 small meals a day (this is what the info sheet said that I was directed to). At any rate, I know having gas like that is no fun, so it'd be nice to make her a bit more comfy. Thanks for the info, I appreciate it. OH, and Walmart can get it for $156 for 30 pills, which is roughly 3 bucks less per pill than what the vet is charging! I'm psyched and hoping her lab work comes back as saying that the Lysodren is working for her. I'll know on Monday.

[addy]

Hi,

I hope you get good news on Monday. It is probably best not to change anything or start anything new until Jade is stable on the Lysodren. Lysodren can cause gastric upset so maybe she is gassy from that. Down the road a probiotic may help with gas if it is still a problem.

My Zoe used to be so funny, she would pass gas and then get this weird look on her face and run as fast as she could with her tail tucked betwen her legs. It was always liked "what the heck was that?"

Hugs,
addy

[busyman370]

After reading all these posts I don't know what would be best for my dog. I don't know how I'll be able to afford the Trilostane, and what if my dog has an adverse reaction to it? Is Lesodryn really dangerous to use? In the end which is more cost efficient for a 99lb lab mix? My husband is having a fit about the vet bill, so I want to be as frugal as possible w/o being careless for my Jade. At her size her dosage would be 3 pills of Trilo a day, so one bottle would barely last me two weeks. Then I'm told her dosage could increase? I don't suppose there are pet insurance plans for meds? :confused:

This may help you, I hope it can. If you are buying drugs for a pet that are human drugs, being a member of the Auto Club, otherwise known as AAA, will qualify you to buy the drugs at a very reduced rate.

As unbelievable as this is, they cover prescriptions for pets as well as uninsured humans!

I know because I have been buying Desmopressin at my local pharmacy and I am almost getting it for half price when I present my Auto Club Prescription card. My membership is around $50.00 per year, and that's more than made up on the first purchase.

Get on the AAA web page and check it out for yourself.

This also covers people who do not have health insurance coverage for prescriptions.

Hope this helps you.

[Sabre's Mum]

Hi

Just checking in to see how you are going with the Lysdoren loading?

Angela and Flynn