Willow - Phenobarb; Ketoconazole - sweet Willow has crossed The Bridge

[Ginger]

Hello All!
I am new to this forum and since I am at work can only ask a quick question here. I will introduce myself and go into greater detail regarding my dog's medical issues later when I get home.
Willow is being treated for Cushing's. We believe it to be pituitary based. Willow has had the ACTH tests and an ultrasound.
She is being treated unsuccessfully with Lysodren. She also takes phenobarbital for seizures. You mentioned that you are weaning your dog off of phenobarbital. What is your dog taking in it's place?
I intend to call my vet on Monday (because I'm sure the continued use of Lysodern is a waste of time, money and effort). I have mentioned to him numerous times that I have read that Lysodren and phenobarbital do not work well together. I want to ask him on Monday if we could try a different medication. I am interested in finding out what meds you are using.
I am really going to assert myself regarding the phenobarbital issue because I'm sure this is the root of the problem of her not showing any signs of improvement.
Thanks to all for any help you can give me.

[labblab]

Welcome to you and Willow! I noticed you had added this reply to another member's thread who also has a dog suffering from both Cushing's and seizure disorder. I took the liberty of copying your reply and also posting it here so that we can start a new thread that is your very own. That way, it will be easier for others to reply to you directly.

I have only a moment to post right now, but I will come back later today. In answer to your question about alternative seizure control meds, one of the bromides (either potassium or sodium) might be a better alternative in combo with Lysodren. But a total switch from phenobarb can not be made immediately. As I say, I'll be back later to post more. And in the meantime, I'm sure other members will be by to welcome you and also to ask you more specifics about Willow's history and treatment.

Marianne

[lulusmom]

Hi and welcome to the forum.

Phenobarbital does interfere with the absorption of Lysodren so this is could be why you are not seeing improvements in the symptoms associated with cushing's. Phenobarbital can cause cushing like symptoms as well as abnormalities on bloodwork so when you post more information about Willow, can you include timelines. i.e. were symptoms apparent before starting phenobarbital or after. How long has Willow been on pheno and was she having frequent seizures?

Glynda

[Ginger]

I have included a timeline on Willow at the end of this post. Willow has never been good about letting us know when she needs to go out, so we always tried to leave her out every two hours. However, in March 2012 she began with increased thirst and large and frequent bouts of urinating...every hour some times less than an hour.

When Willow had the ultrasound I was able to watch the process. The vet took a very good look and spent a good amount of time with Willow and the ultrasound. I feel she was very thorough. She explained to me as the test went on what we were seeing during the exam. She did see one adrenal gland that was enlarged, but could not see the other one. Her thoughts were that it was Cushing's from the pituitary.

When I spoke with our regular vet on 5/1/12, he mentioned that we could try to do another ultrasound. Unfortunately, we don't have a lot of money, so I am wondering about treating Willow with medication only and no longer considering surgery if it would be adrenal based. So, that was the advice I was searching for....are there any medications that would work for either pituitary or adrenal Cushing's...and either phenobarbital or something else to for the seizures?

Thanks for all your help!

Willow's timeline:

Willow, miniature wirehaired dachshund, 9 years old, spayed female, 11.5 lbs
10-18-05 seizures/ phenobarbital ¼ gr twice a day/ave 2 seizures per year/last seizure 5-26-11
1-27-07 back surgery
1-2-10 bladder surgery/removal of stones
5-22-10 Hemorrhagic gastroenteritis
3-28-12 Increased thirst/urinating CBC/Organ Function Profile/Xray
4-2-12 Cortisol 3 Spec 221 (don’t have test result numbers available)
4-11-12 Ultrasound
4-17-12 125 mg Lysodren 2 times a day w/food
4-26-12 increased 125mg Lysodren in morning/250mg Lysodren in evening/w/ food
4-30-12 Cortrysin<50/Cortisol 2 Spec 220 (don’t have test result numbers available)
Current medications 125mg Lysodren in morning/250mg Lysodren in evening/w/ food,
Phenobarbital ¼ gr twice a day
Iams Maturity Plus 7 – 10 years

[Ginger]

Anyone out there? Please let me know which Cushing's meds you are using if your dog is also on phenobarbital, or if you have switched from phenobarbital to something else.

It is unclear at this time if Willow's Cushings is due to pituitary or adrenal.

I will be calling my vet tomorrow morning.

Thanks.

[frijole]

I have zero experience but I searched the forum and can tell you that it appears both trilo and lysodren do not mix well with phenobarbital. I found a post from Glynda:


Potassium Bromide can be an alternative anti-seizure medication if pheno can not be used.

Here is a link to an article about other anti-seizure meds: http://www.ehow.com/list_7218795_phenobarbital-alternatives-dogs.html

[Ginger]

After several weeks of being on Lysodren and determining that the Lysodren and phenobarbital were not working together, Willow's meds were changed to ketoconazole. She takes 100 mg twice a day with food. Willow weighs 11.5 pounds.

It has only been one week without any change, but I only have two questions at this point.

What is an average amount of time before we should see any change (ballpark figure)?

Does the dosage Willow is taking sound like a low (beginning) dose, as I've read on the forums, or does this sound like a maintenance dose?

I am trying to take this one step at a time, so any information I have is on my signature line. I do not have the numbers of the test results she has taken. My vet does not want to change her from phenobarbital (at least at this point) because it seems to be working so well with her seizures.

Thanks for any information you can give me on the two questions I posed.

Ginger

Willow, miniature wirehaired dachshund, 9 years old, spayed female, 11.5 lbs
10-18-05 seizures/ phenobarbital ¼ gr twice a day/ave 2 seizures per year/last seizure 5-26-11
1-27-07 back surgery
1-2-10 bladder surgery/removal of stones
5-22-10 Hemorrhagic gastroenteritis
3-28-12 Increased thirst/urinating CBC/Organ Function Profile/Xray
4-2-12 Cortisol 3 Spec 221 (don't have test result numbers available)
4-11-12 Ultrasound
4-17-12 125mg Lysodren 2 times a day w/food
4-26-12 increased 125mg Lysodren in morning/250mg Lysodren in evening/w/ food
4-30-12 Cortrysin<50/Cortisol 2 Spec 220 (don't have test result numbers available)
5-9-12 Ketoconazoyle 100 mg twice a day with food
Current medications 100 mg Ketoconazoyle twice a day with food, Phenobarbital ¼ gr twice a day
Iams Maturity Plus 7 – 10 years

[labblab]

I am sorry not to be more help to you, but ketoconazole has been used only very rarely by any of our members for long-term control of Cushing's. So off-hand, I don't know what dosing formula would be appropriate. To further complicate things, I believe that phenobarb also has the potential to reduce the effectiveness of ketoconazole just as it does with Lysodren. So that may make therapeutic dosing even more of a question mark. Actually, I'd be interested in knowing the source of the formula that your vet is using. When you have the chance, can you maybe find out for us?

Marianne

[labblab]

It's me again, and I just wanted to add one more thought. I am hoping that your vet has talked with you about close monitoring for liver problems now that Willow is taking the combination of phenobarb and ketoconazole. Both drugs, independently, can cause liver damage. And so I'm fearful that the combination of the two may increase that risk significantly.

This is on the forefront of my mind because my own dog with epilepsy (non-Cushpup) is due to have her phenobarb level and liver function tested. We do this every six months. But if we were adding ketoconazole into the mix, I'm thinking that the testing might need to be done even more frequently. This is something I'd want to talk over with my vet if Willow were my dog.

Marianne

[Ginger]

Willow's levels are checked regularly...so we're good on that front. Thanks for the followup post!

[jackiev]

Hi Ginger :). I'm sorry I didn't reply sooner, I don't visit as often as I used to. Ugga takes Potassium Bromide in addition to the Phenobarbital for his epilepsy. We weaned him to half of his original pheno dose but we're VERY hesitant to wean him off completely. His epilepsy was rather severe and it's been under control for 3 1/2 years...we just don't want to risk losing that control. We are treating his Cushings with Vetoryl and it is working amazingly well. He also takes Gabapentin but I think we'll be stopping that soon. That one was for the pain associated with the calcinosis cutis. It also has anti-seizure properties so we're not really in a hurry to stop it but his skin is almost completely cleared up now and we don't want him taking something unnecessarily. He goes back to the vet for another stim test/checkup in 2 weeks. How are you making out with Willow now?

(Administrative Note: I've made a copy of this reply which was originally posted in Ugga's own thread in order to make sure that Ginger has a chance to read it here, too.)

[Ginger]

I'd say in the last day or two, I think there is a slight improvement in Willow since we switched to Ketoconazole.

She still has bouts of drinking lots of water followed up by urinating a lot (but even that has decreased somewhat). However, hours go by when she isn't in that vicious cycle of filling up on water after huge eliminations.

She is back to her old self as far as energy level. She used to just go outside do her business and want right back in the house. The last two days I've left her out only to find her far back in the yard just nosing around in the grass. When I call for her she comes running with her little ears flapping in the breeze. I know she's feeling a lot better.

Willow's coat is looking better too.

I have also taken her off of Iams kibble and switched to Instinct Canned. She loves it, so I'm not sure if that is helping too. It's a little pricey, but well worth it. I've also bought the Instinct Raw...just haven't given her any yet.

I'm hoping the improvement continues. I'd say she's about 35% improved...not a huge improvement...but I can definitely see we're headed in the right direction. Keep your fingers crossed.

[Squirt's Mom]

Hi Ginger,

Great to hear from you again and especially great to hear that sweet Willow is improving on her new regimen! :D I hope you continue to see improvement.

Hugs,
Leslie and the gang

[labblab]

Ginger, this is terrific news! I know how much even the small improvements mean to us when we are feeling so worried about our pups! Thanks so much for this update. :)

Marianne

[Squirt's Mom]

(copied from the In Loving Memory section - )


Willow passed away peacefully this morning at home. She followed me everywhere and was my little shadow. She was my protector and my best friend. I will miss her so much.

The last few days she wasn't able to follow me anywhere, so I carried her from room to room so she could still be my darling shadow.

Over the last few weeks she had stopped eating. We tried everything: expensive food, cheap food, home cooked chicken, eggs, even cat food that she used to steal from the cats.

The last 5 days we spoon fed her baby food, which she seemed to enjoy. Yesterday evening while I was attempting to feed her I knew it was futile to continue. I held her all night. She will be cremated and will have a place of honor on our mantle.

I didn't post on the forum often because it seemed her medication requirements were quite different from everyone else on here. She took ketoconazole and it seemed to be working fairly well. She also took phenobarbital for her seizures. But, her little body was giving up and we knew there was nothing left for us to do. She celebrated her 10th birthday on October 19th.

Even though I didn't post often, I checked the forum reguarly. Thanks to everyone on this forum. Thanks for the information, the support and your kindness.

Here's a link to Willow's "In Loving Memory" thread for all who may wish to express their sympathy to Ginger: http://www.k9cushings.com/forum/showthread.php?t=4637