Introduction and question (6.5 y/o beagle)

[maggiesmom]

Hi! My name is Connie. My 6.5 year old beagle has just been diagnosed with Cushings. She went in last month for a routine dental and had a plugged gland on her eyelid removed. The pre-surgery bloodwork showed elevated liver enzymes. My vet had us wait a few weeks to let her heal from the surgery and then did a LDDS test. She was at 7.2 after 8 hours. Normal is 0 to 1.4.
Other numbers that are out of range are ALP 715, normal is 20 to 150, glucose 125 normal is 60 to 110. TP 8.4 normal is 54. to 8.2. Bun and Creatine are normal. Last year she had a bout of pancreatitis with struvite bladder stones. Enzymes were elevated then but my vet did not retest after the pancreatitis and stones were resolved.
Maggie does have some symptoms also but they didn't come together in my mind until the vet said Cushings. She is drinking more water than usual, ravenously hungry (excessively even for a beagle), and I have noticed her coat is drier and not as glossy...no hair loss though. She has been itchy and has had two ear infections in 9 months (never had one before this)
I would love to hear your thinking about medication. My vet gave me the choice and told me to do some research and let him know what we want to try. He is suggesting Lysodren or Vetoryl. He said he will not prescribe Ketocaonazole because in his experience the results are not as good. I can see there are pros and cons to each medication so I would be interested in your experiences or recommendations. Maggie is so young. I want to give her good quality of life and of course keep her with us as long as we can.
Thank you so much.

[Harley PoMMom]

Hi Connie,

Welcome to you and Maggie, so sorry for the circumstances that brought you here but glad you found us.

Cushing's is one of the most difficult diseases to get a confirmed diagnosis for because not one test is 100% accurate at diagnosing Cushing's and other non-adrenal illnesses, like pancreatitis, uncontrolled diabetes, and bladder stones can create false positive results.

It is very important to rule out other health issues before any tests for Cushing's are done. Pancreatitis can be present without the dog showing any symptoms so I would suggest having a spec cPL test done to rule this out.

Reoccurring ear infections and hair coat problems can be attributed to hypothyroidism and usually a Free T4 by equilibrium dialysis is done to rule this out.

If you could get a copy of the LDDS test and post the results here, which are 3 numbers; the resting or baseline draw number, the 4 hour and the 8 hour draw, we would really appreciate it.

Please know we will help in any way we can so do not hesitate to ask any and all questions.

Love and hugs,
Lori

[maggiesmom]

Her 0 hour is 6.4., 4 hour is 12.9. Normal range is 0 to 10, 8 hour is 7.2 with normal range 0 to 1.4.

[Squirt's Mom]

Hi Connie and welcome!

The LDDS should have 3 numbers - a pre, a 4 hour, and an 8 hour number. Are you sure this isn't an ACTH? The ACTH test has only two numbers. The LDDS is an all day test, the ACTH is typically 4 hours. Could you verify which test this was? Thanks!

Hugs,
Leslie and the gang

[lulusmom]

Les, the 8 hour is in Connie's first post. I was just about to ask her the same thing but remembered she already posted it. To make it easier for everyone I've reposted the LDDS results below:

Pre 6.4
4 hour 12.9
8 hour 7.2

[Squirt's Mom]

:D:o Thanks! That makes more sense to this addled ole brain! :o:D

[molly muffin]

Lori, what do you think about the glucose reading?

Connie, did your vet say anything about the high glucose? Are they going to rule out diabetes before starting the cushings meds?
We've had members here who have been successful on both types of medicine. So, I'll let those who are using, have been using to give their take on each one. (I should add that both have had successful results) Is your vet more comfortable with one form of med over another?

Can you add anything about the vet ruling out other problems? Like the diabetes, Thyroid, etc?

Sharlene

[lulusmom]

Sharlene, the blood glucose of 125 is a very mild elevation. I believe anything up to 180 would be considered mild. This can easily be caused by stress during a blood draw. A recent meal, cushing's or pancreatitis can also elevate glucose.

[molly muffin]

Oh good, thanks Lori. I don't know the glucose numbers that well yet and what they may or may not mean.
So Connie that is good to know.

Sharlene

[maggiesmom]

I am hoping my vet will be in on Monday so I can ask him about the test for pancreatitis and the T4.

[Squirt's Mom]

Hi,

When Squirt was first diagnosed and I was looking into treatment options, I decided early on that Vetoryl (Trilostane) was the one I wanted to use because everything I read said it was safe. As time went on and I learned more and "observed" more on this site, I realized that simply wasn't true. Vetoryl has the exact same risk factors as Lysodren. The literature from the manufacturer, Dechra, supports this fact as well. In fact, the more I "watched" and read, the less comfortable I became with Vetoryl until it was no longer the "better" choice in my mind.

I was able to take the time and see how the two drugs affected the dogs here. What I saw was that Trilo pups seem to require more dose adjustment which means more testing (each dose change means the testing schedule starts all over). I saw pups having the same adverse reactions as those on Lyso as well as having some that didn't seem to be present with Lyso, like trembling. I saw vets who believed the hype that Trilo was "safe" be less than cautious with a powerful drug putting pups in danger, who told the parents it was "safe", giving them a false sense of security. What makes it seem safer is the short life in the body - Vetoryl is leaving the system in 2-12 hours while Lysodren is just reaching it's peak at 48 hours. So if there is a crisis, the Vetoryl will leave the system more quickly than Lysodren. Trilo was, and still is in my mind, the "new kid on the block" and I don't trust "new and improved" anything for the most part. We were, and still are, learning more and more about how Trilo works and the effects it can have. Lysodren has been around for a long time and it seems more is understood about it to my mind. So I chose Lysodren for Squirt.

This was a time before Vetoryl could be bought in the USA and when Lysodren was the drug typically chosen. That trend has changed since the FDA approved Vetoryl here, and more and more vets are using it instead of Lysodren. That means we have seen more and more Trilo babies here as time has passed, and fewer and fewer Lyso babies. I'm the oddball in the family on this question, tho; most seem to prefer Vetoryl. Over the last few years however, I have seen nothing that changes my mind - Lysodren will be my first choice if I ever have another cush pup. ;)

Your vet is right on the mark with the Keto. It is very hard on the liver and has little effect on cortisol typically.

So, there's my 2 cents worth! :D
Hugs,
Leslie and the gang

[maggiesmom]

Thank you. I am hoping that my vet will be the one working tomorrow so I can talk with him. I am leaning toward the Lysodren for Maggie but want to discuss a few other things that were mentioned here before we make the decision to start the meds.

[molly muffin]

So what did the vet have to say today?

Sharlene (always curious)

[maggiesmom]

He is fairly sure based on her test and symptoms that she has Cushings but is willing to do what we want as far as further testing
(pancreas and T4).
He is going to be out of town for about 10 days and would not want to start meds until he is back anyway. There is another vet available in the clinic but he wants to be available during the initial phases of medication.

[molly muffin]

I think that makes sense and it's good that he wants to be around when starting the meds.

The thing is with this disease is that you want all the information possible prior to starting the meds. I'm not saying that just so that you are sure that it is cushings, of course that is a factor, but okay, so it's cushings. You want as absolutely many baselines of "before" meds as you can have. There is no being able to go back and find out what results might have been before if you haven't done it.

So, okay, everyone has their "thing" with this disease. Mine is to have as much information possible before.
Then if something comes up, and you have to test after meds for say, pancreatic issues or thyroid. You have something to compare it to.

I am really glad that you have a vet who wants to be on site and who is willing to do whatever it takes to make you feel comfortable with the decisions that have to be made. That is very reassuring.

So what do you think you want to do at this point? The good thing is that you have time to think and decide since the vet is away.

Sharlene and Molly Muffin

[maggiesmom]

I think that what you are saying makes sense. We will get baselines on as much as we can now. I am lucky in that we have pet insurance that will cover quite a bit of the cost of the testing and some of the medication. I have been with this vet for over 20 years. He was just starting out when I first went to the clinic. Now he owns the clinic. Maggie is my first dog but this vet has helped me have many kitties with good quality of life for a lot of years. (21 and 19.) He is willing to talk about options and encouraged me to research but not get too scared by what I read on the internet. The nice thing is that most of the time the clinic has a vet on call even at night. I can phone the answering service and he will call back within minutes. Only rarely are they both gone and the service says to call the emergency clinic.

[maggiesmom]

Also, I should have added that I told the vet we would go with the lysodren.
Thank you so much for your concern and advice.

[molly muffin]

Hi Nikki, I just wanted to stop in and see how you are doing and wish you a safe thanksgiving and know that you are thought of.

hugs,
Sharlene

[maggiesmom]

Thank you so much for the Thanksgiving wishes and for thinking of us. We will be starting medication next week, Tuesday or Wednesday. My vet returns tomorrow. I had a couple more questions for him and left a message asking him to call me on Monday.
In the meantime, I am reading posts here almost daily and learning from all of your comments and experiences.
Connie

[maggiesmom]

We started Maggie's Lysodren this morning. I am glad I work and my husband is retired because I think I would sit around all day and watch her for problems!

Do those of you who use the Lysodren take precautions when handling the medication as suggested...wearing gloves etc. ?

[frijole]

I used gloves at first but after a while I quit using them. They key is if you have any cuts on your hands not to expose them to the drug. Or if you are pregnant! :D I used a pill cutter to cut the pills and that helps handling also.

I assume you got the lecture on always giving the pill AFTER the meal, wrapping it in cream cheese (or the like) and to NEVER give to a sick dog. Also if you see any change in water intake or the way she eats (even minor) cease giving lysodren. IT continues to work for 2 days after the last dose so you can't take it back and cortisol will continue to drop for 2 more days. Ideally schedule the acth test for 2 days from the last dose.

Any questions - just shout. We're here. Kim!!!

[maggiesmom]

Thank you Kim! Hopefully things will go smoothly for Maggie but if questions come up I will ask.

[frijole]

I see we haven't posted this link which is very helpful... I used it myself 8 yrs ago! I think I memorized it. Also, I assume you have prednisone on hand to give in case of emergency. If you don't, it's a must. You probably won't need it but you need to have it just in case. Kim

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

[maggiesmom]

Thank you for the link. I have read this several times and am printing it for my husband who is the one home during the day. We measured Maggie's water for several days and are measuring it daily now so we know for sure if water intake has decreased instead of just guessing. There is definitely no decrease in appetite, as she just tried to crawl in the refrigerator when I was cooking dinner.
Connie

[frijole]

:D:D:D:D:D What a visual... love it.

No two dogs are identical but I remember at first I noticed my Haley slept more during loading, then I noticed her tummy growling (thus the need to coat lysodren with cream cheese) then the farts.. oh my.. but their bodies get used to it and all we be well.

Normal time frame is 7 to 10 days.

I can't remember if I asked the dosage?!:eek: I always do this! How much does your baby weigh and how much lysodren are you giving? Also please tell me you have prednisone on hand.

Thanks! Kim

[maggiesmom]

The dosage is 500 milligrams. She is getting one and one half tablets a day. Maggie weighs 36 pounds. My husband talked to our vet about prednisone but he really didn't want to prescribe it. My vet said that he has had too many people get in trouble by getting scared and using prednisone when it wasn't really needed. He is available by phone 24 hours and he is about 7 minutes from the clinic and I am about 5 minutes from the clinic. He wants us to call him if we have questions/concerns any time during the process. I can have my husband call and talk with him again tomorrow if you think we should.
Connie

[maggiesmom]

Actually, when I think about it, I do have prednisone that we were giving a kitty a few months ago. Just out of curiousity...what would be the dose for a dog Maggie's size.

Also she is scheduled to go in for testing the morning of the 7th day, (he wants to see her before of course if we see any of the signs mentioned) He didn't want her to go more than seven days without seeing her.

[frijole]

One and one half pills a day is equal to 750 mgs not 500 mgs. (the pills are each 500 mgs). So I assume you meant to say the daily dose is 750 mgs.

That dosage is spot on for a dog at 36 lbs. Re the prednisone - we've seen vets with that opinion before but I disagree with it because we are the ones that get the distressed messages in the middle of the night and on weekends when vets are unavailable and dogs are in distress. Not a good thing. Obviously you don't give it unless the dog is in trouble but it saves lives.

The standard rescue dose of pred is 0.25mg/kg. To find her wieght in kg, divide the lbs by 2.2...then multiply that result (her weight in kg) by 0.25 and you will have the amount for her weight.

So she weighs 36llbs...36/2.2 = 16.4 kg * .25 = 4.09mg of pred.

You can certainly use the prednisone given to your kitty.

Kim

[maggiesmom]

Yes, thank you the dosage is 750 mgs daily. I got the prednisone out last night. I had a kitty that had lung abcesses for the last 5 years of his life, so we had to use all kinds of meds to keep him happy and comfortable. Several times we needed prednisone. I have a bottle of 5mg tabs that are still current (well within the expiration date). I will discuss the reasons for not wanting to prescribe with my vet when I see him in person. I suspect a part of his reluctance is that I am gone all day, my husband is home. My husband tends to panic easily..(.like taking a 4 year old to the ER for an ear infection when my daughter was young)I can't ask him that on the phone while my husband is standing here but as long as I have the prednisone for now, I feel ok. We have worked with this vet for many years and he knows us well. He is really very good and generally very open to suggestions and questions from us.
Does the testing at day 7 seem right to you?

[frijole]

The normal range is 7 to 10 days UNLESS you see signs of loading before then so don't wait - if you see any signs whatsoever before then you cease giving lysodren and schedule the acth for 48 hrs from the last dose. If not then yes go in at day 7 and see where you are. Kim

[molly muffin]

Sorry I can't help it but I am having a giggle about Maggie trying to crawl into the fridge. :)

Like Kim says just watch her and if anything is off, then stop and schedule the test.

Sharlene and Molly Muffin

[maggiesmom]

Yes, fridge, dishwasher...anywhere with food. Not uncommon for a beagle but since all this started she is so intense and totally focused on food. Maggie does make me laugh though. When we got her as a pup, people asked me why I would even want a beagle...my answer was always that she makes me laugh every day. She still makes me laugh every day!

[frijole]

since you are dealing with a beagle... remember any change in appetite so in your case it could be just eating more slowly. seriously! kim

[molly muffin]

Beagles really are adorable. I had one when I was a kid, it was my first real "my" dog and he went everywhere with us, loved to travel, head sticking out the window, ears flapping in the wind. I have to agree, they are Very funny creatures. Mine was also the picture of loyalty and smart as a whip.

My Molly has to be told to get her nose out of the dishwasher sometimes when it's down and I'm loading it up. The smells must be awesome to her. She could care less once they are clean and I'm unloading though.

Sharlene and Molly Muffin

[maggiesmom]

I do think when I see a change it will be in her eating. I have been monitoring very closely...making sure her meals are given before I leave for work and when I come home so I can keep on eye on it myself. This morning she was still eating as though ravenous. Maggie has always been a good eater and never left a crumb in her bowl, but now she is devouring her food in glups. After she ate, she checked the kitchen floor and area around the food container for crumbs and checked the chair where my husband was sitting last night for crumbs.
I don't know if it is coincidence or medication but I am seeing some of my "Maggie personality" again. She was just out rummaging through the toy box and dragged in a toy she hasn't had out for months. She only played for a minute before she got up on the couch to nap with me but it is nice to see that spark in her, even if only for a minute.
I am going to call the vet when the clinic opens this morning, reconfirm our Tuesday morning appointment and let them know if anything changes this weekend we will be in Monday morning. Also want to confirm with my vet that he is my on call person for the weekend if I have questions, concerns, or emergency issues. Thank you so much for all the help and advice.
Connie