Lysodren or Trilostane

[ned4spd8874]

Hi all, I'm obviously new here. My older dog Maggie (9 1/2) has a mild case of cushings. The tests show slight elevations, but nothing too drastic. However, she is showing a bunch of the signs for cushings. She has hair loss (for a couple years actually), increased appetite and food aggression towards our other dog, increased thirst/frequent urination (sometimes without her even realizing it), hesitant to go up and down stairs and a slight pot belly.

Our last vet wasn't convinced at first that she had cushings. But given the symptoms and the mild test results, he did say that she should go on medication.

The medication that the vet is recommending is Lysodren, however our previous vets recommended Trilostane if she showed positive after all the testing.

I guess I should back up for a second. We used to live in Michigan, then recently moved into the Chicago area. First North and West when we stayed with my wife's parents until we got into our permanent home, where we are now.

We started the discussion in Michigan and had a couple initial tests done. They were just the urine testing and then the urine culture test. After we moved, we had the ACTH test done at a different vet and that again showed slight elevations. Now, I just came back from a vet that had good reviews near our permanent home.

At first he wasn't convinced like I said. He was actually checking her fur for fleas thinking that might be the cause. Yeah, umm, no. After he saw she didn't have fleas and I described her symptoms, as I said before, he came to the conclusion that she does have cushings.

But he has only used Lysodren. He kept talking about some famous doctor who has lectured and written books on this stuff and said that there really isn't a difference between the two so long as it's administered and monitored correctly.

But I've looked up Lysodren and the possible side effects worry me. Especially the permanence of it and how it essentially destroys the gland. Not to mention the article I read that mentioned in the likes of chemotherapy.

Anyone out there have any thoughts or advice for me? I will appreciate any and all comments on this. Thanks in advance!

[Harley PoMMom]

Hi and 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 endocrine diseases to get a confirmed diagnosis for because not one test is 100% accurate at diagnosing Cushing's and other non-adrenal illnesses can create false positive results from all tests for Cushing's.

If you could get copies of all the tests that were done on Maggie and post any abnormalities that are listed, that would be great...e.g.ALT 150 U/L (5-50). We are especially interested in the results of any Cushing's tests. Could you also post the urinalysis results for us, please...Thanks!!

Lysodren/Mitotane and Trilostane/Vetoryl are the two most rx'd drugs for Cushing's. They are strong drugs but they are also life saving medicines for dogs with Cushing's. They are both chemotherapy drugs but they do work differently. Here are some links with information regarding these medications: Trilostane/Vetoryl Information and Resources (http://www.k9cushings.com/forum/showthread.php?t=185) and Lysodren loading Instructions and related tips (http://www.k9cushings.com/forum/showthread.php?t=181)

Other health issues, such as diabetes and thyroid problems, do share some of the same symptoms as Cushing's and should be ruled out, have they been?

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

Love and hugs, Lori

[Simba's Mom]

Welcome to you and Maggie, so glad you found us, we are one big family here and we support each other with lots of information and encouragement too, so settle in, we are here for you and Maggie too!

[ned4spd8874]

Hi and 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 endocrine diseases to get a confirmed diagnosis for because not one test is 100% accurate at diagnosing Cushing's and other non-adrenal illnesses can create false positive results from all tests for Cushing's.

If you could get copies of all the tests that were done on Maggie and post any abnormalities that are listed, that would be great...e.g.ALT 150 U/L (5-50). We are especially interested in the results of any Cushing's tests. Could you also post the urinalysis results for us, please...Thanks!!

Lysodren/Mitotane and Trilostane/Vetoryl are the two most rx'd drugs for Cushing's. They are strong drugs but they are also life saving medicines for dogs with Cushing's. They are both chemotherapy drugs but they do work differently. Here are some links with information regarding these medications: Trilostane/Vetoryl Information and Resources (http://www.k9cushings.com/forum/showthread.php?t=185) and Lysodren loading Instructions and related tips (http://www.k9cushings.com/forum/showthread.php?t=181)

Other health issues, such as diabetes and thyroid problems, do share some of the same symptoms as Cushing's and should be ruled out, have they been?

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

Love and hugs, Lori

Thanks for the reply, unfortunately I don't have the test results here anymore. I just brought them to the vet today and they kept them.

As far as ruling out other issues, I believe that has been done. Maggie has had quite a few tests already and everything points to cushings. She's had a urine test, another urine test where they kept her and took sterile samples directly from her bladder, they did a complete blood test and the ATCH test.

EDIT: Looking at those links, I see a name I recognize. Dr. Feldman, that's the guy the vet today kept talking about.

[frijole]

:) The vet is talking about Dr Feldman I bet. Good news is he reads about cushings!

We are limited in helping a whole lot until you get those tests back. Simply tell them you meant for them to copy them, not keep them and you can get them back. You paid good money for them we know.

Anyway Lori told you about the two drugs and she is correct - they work differently but both work. The thing is there is no cure for cushings so you have to treat with one of them and they are both chemo drugs. Typically you go with what the vet prefers because they are most familiar with it.

I treated my Haley a long time ago - I showed up here scared to death and clueless. Had to fire the first vet as they were more clueless than me and this group saved my dog's life and I never left. Back then trilostane wasn't even legal in the US. I used lysodren (this was 8 yrs ago) - it's been around and used for treating cushings forever. So while the way it works might scare you - I can tell you it works. My girl was on the same dose for 4 1/2 yrs. She passed away at 16 1/2 of old age not related to cushings. She had no issues at all once her cushings was controlled.

Yep the first pill scared me and loading was tough (initial phase) but we were on autopilot after that. Read the threads of others around here and you'll find trilostane is no easy drug to use either - lots of tweaking and dosing issues and some dogs do better on it than others...

Key is to have a vet that knows what they are doing and for you to pay attention and follow dosing instructions. You get both of those things down and your dog will be fine.

But first you need to confirm the diagnosis. I had another dog that was misdiagnosed - she had like 7 false positives. I can't stress enough the need to do more than one test. An ultrasound is also helpful because it gets a good look at the organs... we've had dogs with cushings like symptoms that really had tumors on the spleen etc - remove the tumors and symptoms go away...

So you see endocrine issues are complicated. So good on your vet for reading Feldman! Glad you found us. We'll help you through it. But we always will ask for test results because we've seen too many misdiagnosis in our lifetimes. :) Kim

[StarDeb55]

Welcome to you & Maggie! I wanted to let you know that I have successfully treated 2 pups with lysodren over the years. My first boy, Barkley, was successfully treated with lyso for nearly 8 years, crossing the bridge at 15 from causes unrelated to his Cushing's. My little guy, Harley, was 13 at diagnosis, so he was a senior fellow to begin with. He had been doing well on lyso for about 2 1/2 years, when he passed due to causes unrelated to his cushing's.

When it comes to using either drug, the absolute key is proper monitoring and testing of the dog. It is crucial that as a parent, you understand how the drug works, what to look for with any change in symptoms, & what to look for to determine if a possible problem is developing. Treating a Cushing's baby is a "team effort", both the pup's parent & vet have to work together.

Now, when it comes to lysodren, there is a bit of misunderstanding by a lot of pet parents new to Cushing's. The goal of lyso therapy is to erode enough of the adrenal cortex to stop the overproduction of cortisol. If the adrenal gland was totally destroyed, you would now have a pup who is just exactly the opposite of Cushing's which is Addison's. I will say that in Europe, it is quite common to use lyso to totally destroy the adrenals as the European vet community seems to feel that Addison's is easier to deal with than cushing's.

Last but not least, trilostane works in a totally different manner than lysodren. Trilo acts to block part of the enzymatic pathway that produces cortisol in the adrenal gland. It is short acting, usually clearing the pup's system in about 10-12 hours. I must strongly caution you that trilostane is ABSOLUTELY NO SAFER than lyso. A lot of vets seem to think that because trilo is short acting, it is safer. We have seen case after case in this group where pup's have had serious issues with trilostane. This usually happens when a vet isn't following dosage & monitoring protocols, or the owner is inattentive to the pup's symptoms & behaviors. I have no personal experience with trilo, so please take my comments as general in nature. For every pup we have seen that has had difficulty with trilostane, we probably have 8-10 pups who do fine on the drug. The other thing I will say about trilo is that initially, it may be somewhat more expensive to use than lyso as the trilo dose may take some "tweeking" to get right. Every time there is a trilo dosage change, you have to have an ACTH in 10-14 days.

Welcome, we are here to help in any way we can.

Debbie

[doxiesrock912]

Ned and Maggie,

we've been treating our dog Daisy Mae since May with Trilostane. A few adjustments have been made but we've had no emergencies and she's doing great :)

Each vet has a preference and their own experiences that make them choose one medication over the other.

Daisy's IMS (small animal internal medicine vet) prefers Trilostane (Vetoryl) over Lysodren because she does not believe in using a medication that kills off cells but opts for blocking the production of Cortisol production.

Both medications work well and require close monitoring.
Please visit the helpful resources section of this forum to learn more. It is important that you understand what to watch for and how each medication works so that you can make an informed decision and it may help you to create a list of questions for the vet.

Educating yourself will ensure that Maggie has proper care and monitoring.

[Squirt's Mom]

Hi Ned and welcome to you and Maggie! :)

We are a Lyso house and I wouldn't have it any other way. ;)

When Squirt was first diagnosed and I was reading all over the place I came to a similar conclusion as you - Lysodren was just too scary so I wanted to use Trilostane since it was touted as "safe". As time passed and I learned more and observed more on this board and others, I realized that Trilo is no safer than Lysodren. Both have the exact same risk factors, up to and including permanent destruction of the adrenal glands and death.

Lysodren works by eroding a miniscule layer of the outer cortex of the adrenal glands, sort of making them deaf to the signals from the pituitary to release more cortisol. This miniscule layer can and DOES regenerate when the Lyso is stopped - the glands are NOT destroyed when the drug is properly used. The same holds true for Trilo - properly used it is a life saver and when improperly used, the Trilo has the potential to also destroy the glands.

Two factors to consider when deciding which treatment to use - 1) which drug your vet is most familiar with and has had the most success with, and 2) expense. Trilo is more expensive to use - the drug cost more and the dose often has to be tweaked frequently to find the correct amount. With each dose change, the testing schedule starts all over. Another thing to keep in mind is that some pups cannot handle one drug or the other. So we have seen pups that did not do well on one, do just fine when switched to the other. The pups constitution will also play a role in which drug they use for life. So as much as we may want to use one drug over the other, there are other factors that will affect that decision.

As others have said, the test results will help us give you more meaningful feedback so we look forward to seeing those when you get copies. It is a good idea to start a file at home of all the test results from now on. This way, should you ever have to see a different vet, you can walk in the door with all her info in hand. Keeping a daily journal of eating, drinking, peeing, sleep patterns, moods, activities, any changes you notice and so on is also a good idea. This will help you see patterns and can be a huge help to our vets. You will find that treating Cushing's is very much a team effort. A cush savvy vet + an educated parent + a great support group like us gives Maggie the best outlook for a bright future with Cushing's - and yes that is entirely possible, even probable, when those 3 things are in place. ;)

My Squirt was 9 when I first heard the word Cushing's and diagnosis was confirmed when she was 10. She was 15 this Feb. I tell you this because I'm sure you have, or will, read that a cush pup has a 2-year life expectancy with or without treatment and I want you to know that is pure myth. Cushing's is NOT a death sentence. It will mean changes in your world but I have no doubt that Maggie is worth that to you.

I'm glad you found us and hope to learn more as time passes. We will be with you all the way. Never hesitate to ask questions and we will do our best to help you understand. Check out the Helpful Resource section and you will find lots of good info on numerous topics, including a thread with links that are especially beneficial to folks new to Cushing's.

Hugs,
Leslie and the gang

[goldengirl88]

I just wanted to welcome you. Everyone has pretty much gone thru everything with you so I don't want to repeat it. I will just give you some tips I go by. Keep a doggie diary daily as you will need it to refer back to. I write in mine first thing in the morning so I don't forget. make sure you have a vet who is experienced in treating Cushings, this will save you money, time and heartache. Be vigilant about watching your dog when you start drug therapy. Your dog will be fine if you closely monitor him. Last but not least if you use Vetoryl/Trilostane, start on a low dose no matter what you are told. It will let your dogs body adjust to the drug, and prevent problems form occurring when too much is given to start out with. If you use Lysodren another member will help you with that as I have never used it. Hope all goes well. Blessings
Patti

[ned4spd8874]

Thanks again for the great responses!

I did just hear back from the vet (of course he called while I was in the shower, so I didn't speak with him directly) and he said that he did some research last night and her symptoms match more closely with the kind of cushings that relate to the sexual organs and reproductive system. And the Trilostane is a better medicine for that. So he is ordering it and should have it so she can start on it on Saturday.

[Squirt's Mom]

uh...that makes no sense to me. If he is talking about Atypical Cushing's that is a form in which the cortisol is normal but there are elevations in the intermediate, or sex, hormones. He cannot know if Maggie has this form without a full adrenal panel being done by the University of TN in Knoxville - the only place in the world we know of that tests for this form. IF she does have this form, then Trilostane is NOT what is recommended because it has been proven to cause elevations in the intermediates (sex hormones). So UTK recommends Lysodren for Atypical pups. But again, without the test, there is no way to know if Maggie has this form. ;)

[Harley PoMMom]

It sounds like you vet means the Atypical type of Cushing's. Atypical involves the elevation in one or more of the sex hormones but NOT cortisol. Trilostane/Vetoryl can elevate those sex hormones but Lysodren does not. Unfortunately there haven't been enough studies done to know whether these sex hormone elevations are really harmful to a dog.

[ned4spd8874]

Aaaannnd...I'm back to being confused.

Yes, the term he used was "Atypical Cushing's".

So should I talk to another vet maybe? I don't know where to go at this point...

[Squirt's Mom]

Well, here is where you can educate your vet if needed. ;) Here are some links on Atypical that you can share with him.

http://www.k9cushings.com/forum/showthread.php?t=198

You will find the info from UTK on how to do the test, what it covers, and so forth at this link.

[ned4spd8874]

It sounds like you vet means the Atypical type of Cushing's. Atypical involves the elevation in one or more of the sex hormones but NOT cortisol. Trilostane/Vetoryl can elevate those sex hormones but Lysodren does not. Unfortunately there haven't been enough studies done to know whether these sex hormone elevations are really harmful to a dog.

I'm trying to wrap my head around this new information and just re-read your post. But Maggie did have a elevation in cortisol, albeit not much, but it did increase.

[ned4spd8874]

uh...that makes no sense to me. If he is talking about Atypical Cushing's that is a form in which the cortisol is normal but there are elevations in the intermediate, or sex, hormones. He cannot know if Maggie has this form without a full adrenal panel being done by the University of TN in Knoxville - the only place in the world we know of that tests for this form. IF she does have this form, then Trilostane is NOT what is recommended because it has been proven to cause elevations in the intermediates (sex hormones). So UTK recommends Lysodren for Atypical pups. But again, without the test, there is no way to know if Maggie has this form. ;)

I'm trying to find where it is said that Trilostane is not recommended for atypical, but can't find that anywhere. How do you know this? I'm not trying to second guess you, I'm sure you know more than I do about this. But I just can't find this information out there.

[Harley PoMMom]

I'm trying to find where it is said that Trilostane is not recommended for atypical, but can't find that anywhere. How do you know this? I'm not trying to second guess you, I'm sure you know more than I do about this. But I just can't find this information out there.

This information is found on the University of Tennessee treatment option sheet, and can be found here: http://www.vet.utk.edu/diagnostic/endocrinology/pdf/TreatmentInfoAtypicalCushings201107.pdf Scroll down to #7.

[labblab]

I am confused, too, by the message your vet left for you. But we may be creating a tempest in a teapot by worrying about possible elevations in intermediate adrenal hormones. If your dog truly tested "positive" for abnormally elevated cortisol on an ACTH test, then the correct diagnosis is conventional Cushing's, no matter what. Most all dogs with elevated cortisol also exhibit elevations in other adrenal (sex) hormones, too. So even though elevations of that sort are to be expected, both Lysodren and trilostane are recommended for treatment of dogs with elevated cortisol. "Atypical Cushing's" is a diagnosis reserved only for dogs with normal cortisol levels but some elevations in intermediate hormones. And it is in that situation that the treatment recommendations start to differ.

So if your dog has elevated cortisol, I don't know why your vet is now introducing this new variable into the mix. If you both are still uncertain as to the validity of the ACTH results (since you say the elevation was very mild), another alternative would be to perform a different diagnostic blood test prior to starting treatment. This would be the LDDS (low dex) test. If a dog truly has conventional Cushing's, this test is less likely to miss returning a sold "positive" result than is the ACTH. So if your dog's LDDS also comes back as a positive, then I'd see no reason why you couldn't proceed with either Lysodren or trilostane as was the original plan.

So I'm thinking you will want to directly talk to your vet again before starting out with treatment on Saturday. By the way, if you do decide to proceed with the trilostane, current recommendations are to begin using a daily dosing formula no greater than 1 mg. per pound. Since the drug will be new to this vet, I am worried that he may not be aware of some recent changes in dosing recommendations (lower doses than are contained in older printed materials).

Marianne

[frijole]

:D And now you know why we insist on having copies of all tests in the owners hands at all times. :D It really helps us help you. Don't worry about being overwhelmed.. we all were at first. Kim

[ned4spd8874]

Okay, just got off the phone with him again...

I pointed him to that University of Tennessee article where they suggest the Lysodren and he concluded that would be the place to start. I guess the article right above that one on their site says to use Trilostane however. But that one is from 2007 where the other one was revised in 2011.

And Maggie did have the LDDS test done. The problem is that we've been to 3 different vets with this and each one did different tests, so it's all getting jumbled up in my brain I guess.

I will go to get the medicine either tomorrow or Thursday and when I go I will make sure to get copies of the test results and I will post them here.

So far now, we are back on track to start with Lysodren on Saturday.

[Squirt's Mom]

Ok, but do me a huge favor....don't start the Lyso until we see the test results. To help you understand what we want and save you a trip possibly, it will not be the invoice that says what they did and what that cost, but a sheet, or 2+ :D, that give numbers, normal ranges, units of measurement (little letters after the numbers), comments - all the details from the tests she has had done. Including blood work that shows things like BUN, CHOL, ALP and so on. Ask if diabetes and hypothyroidism have been ruled out and if so, get those results (they may be on the same sheet with the BUN, etc.). The more you can give us, the better. Not only will that help us help you, it will be here any time you need to refer back to it. This thread can become your own little medical chart on her. ;)

Be sure and read the link Lori gave you on Lysodren. It has some good tips; some members have printed it out and put it where they, and others, could see it while their baby was loading and they were becoming accustomed to the treatment. We will be here the whole way, right by your side. Never forget that. :)

Hugs,
Leslie and the gang

[frijole]

I agree - hold off until you have all the facts/tests from all these guys in one place and we'll help. There is NO rush to treat cushings. Best to get the dx right and select the right treatment and vet. Kim

[ned4spd8874]

I will contact the vet tomorrow and see if I can't pick up the records. The medicine would probably be ready, so I would be getting both at the same time.

[molly muffin]

Hello and welcome to the forum. Wow, talk about getting a lot of information in a little time. :) I am sure that it is all very overwhelming.
Everything depends on the test numbers and what is what, as Leslie and Marianne and Kim have all gone over with you.
I won't add to the mix, because really they have gone over all the pertinent facts and pointed you to some good resource information. I'll just say that whatever you decide on treatment wise, we'll be right here with you the entire way. We have a great group of supportive people, who are all going through the same things.

Welcome again.
Sharlene and Molly Muffin

[ned4spd8874]

Okay, I finally got the papers today. Now I'm not sure if I have everything. It's been more than a struggle getting paperwork from my old vet.

So, what exactly do you guys need me to post? I got a whole bunch of greek here.

[frijole]

:D:D:D:D

Don't you worry - by the time we're thru with you you'll be a practicing vet. :)

Please put test results in chronological order from oldest to most recent so we get a progression start to finish.

type name of test (example acth, low dose dex suppression, blood panel) and then type the results. ACTH tests have 2 numbers, LDDS test has 3 number and blood panels have a whole bunch of enzymes - only need to post those that are out of normal range. Post what it is, the reading and the range for normal... for example :

alk phos 856 (50-250) note the last 2 numbers are the ranges for normal

If there are any 'conclusions' typed on the tests you can type those as well.

Thanks! Kim

[ned4spd8874]

Here's what I have. I didn't include anything prior as it was a year earlier. I do have a urinalysis test that they did first, but didn't include that. If it's helpful, I can post that too. Thanks again for the great support!

6/19:

Reticulocyte Panel

% Reticulocyte
Result: .05

Reticulocyte
Result: 32
Range: 10-100 K/uL

Total Health | Chem 27

ALK. Phosphatase
Result: 338
Range: 10-150 U/L
Flag: H

ALT (SGPT)
Result: 66
Range: 5-107 U/L

AST (SGOT)
Result: 24
Range: 5-55 U/L

CK
Result: 74
Range: 10-200 U/L

GGT
Result: 4
Range: 0-14 U/L

Amylase
Result: 262
Range: 450-1240 U/L
Flag: L

Lipase
Result: 173
Range: 100-750 U/L

Albumin
Result: 3.2
Range: 2.5-4.0 g/dL

Total Protein
Result: 6.9
Range: 5.1-7.8 g/dL

Globulin
Result: 3.7
Range: 2.1-4.5 g/dL

Total Bilirubin
Result: .01
Range: 0.0-0.4 mg/dL

Direct Bilirubin
Result: 0.1
Range: 0.0-0.2 mg/dL

Bun
Result: 5
Range: 7-27 mg/dL

Creatinine
Result: 0.6
Range: 0.4-1.8 mg/dL

Cholesterol
Result: 260
Range: 112-328 mg/dL

Glucose
Result: 91
Range: 60-125 mg/dL

Calcium
Result: 9.6
Range: 8.2-12.4 mg/dL

Phosphorus
Result: 3.3
Range: 2.1-6.3 mg/dL

TCO2 (Bicarbonate)
Result: 23
Range: 17-24 mEq/L

Chloride
Result: 112
Range: 105-115 mEq/L

Potassium
Result: 3.8
Range: 4.0-5.6 mEq/L

Sodium
Result: 152
Range: 141-156 mEq/L

A/G Ratio
Result: 0.9
Range: 0.6-1.6

B/C Ratio
Result: 8.3

Indirect Bilirubin
Result: 0.0
Range: 0-0.3 mg/dL

NA/K Ratio
Result: 40
Range: 27-40

Hemolysis Index
Result: N
Index of N,+,++ exhibits no significant effect on chemistry values.

Lipemia Index
Result: N
Index of N,+,++ exhibits no significant effect on chemistry values.

Anion Gap
Result: 21
Range: 12-24 mEq/L

Total Health | CBC Standard

WBC
Result: 13.9
Range: 5.7-16.3 K/uL

RBC
Result: 6.35
Range: 5.5-8.5 M/uL

HGB
Result: 15.5
Range: 12-18 g/dL

HCT
Result: 44.0
Range: 37-55%

MCV
Result: 69
Range: 60-77 fL

MCH
Result: 24.4
Range: 19.5-26.0 pg

MCHC
Result: 35.2
Range: 32-36 g/dL

%Reticulocyte
Result: 0.5
Range: -%

Reticulocyte
Result: 32
Range: 10-110 K/uL

Neutrophil SEG
Result: 77.6
Range: 60-77%
Flag: H

Lymphocytes
Result: 14.7
Range: 12-30%

Monocytes
Result: 7.2
Range: 3-10%

Eosinophil
Result: 0.4
Range: 2-10%
Flag: L

Basophil
Result: 0.1
Range: 0-1%

Auto Platelet
Result: 408
Range: 164-510 K/uL

Absolute Neutrophil SEG
Result: 10786
Range: 3000-11500 /uL

Absolute Lymphocyte
Result: 2043
Range: 1000-4800 /uL

Absolute Monocyte
Result: 1001
Range: 150-1350 /uL

Absolute Eosinophil
Result: 56
Range: 100-1250
Flag: L

Absolute Basophil
Result: 14
Range: 0-100 /uL

8/6:

Cortisol Serial 3 (DEX)

Time 1
Result: 827

Time 2
Result: Post

Time 3
Result: Post

Cortisol Sample 1
Result: 2.2
Range: 1.0-5.0 mg/dL

Cortisol Sample 2
Result: 0.8
Range: 0.0-1.4 mg/dL

Cortisol Sample 3
Result: 2.2
Range: 0.0-1.4 mg/dL
Flag: H

Interpretation of Dexamethasone Suppression Tests: Low-dose dexamethasone suppression test: Normal: Cortisol level less than 1.4 ug/dl 8hrs post-dex. Hyperadrenocorticism: Cortisol level greater than 1.4 ug/dl 8hrs post-dex. ... If the 8hr post dex. cortisol level is greater than 1.4 ug/dl, the following can be used to differentiate pituitary dependent hyperadrenocorticism (PDH) from an adrenal tumor: 1. Cortisol elve less than 1.4 ug/dl 4hrs post-dex is consistent with PDH. 2. Cortisol level less than half the baseline level at either 4 or 8 hours post-dex is consistent with PDH. (Samples taken at 2 or 6hrs are interpreted the same way as a 4hr sample) ... if neither of these criteria is met, further testing is needed to differentiate PDH from adrenal tumor Cushings. ... NOTE: Approx. 5% of dogs with PDH have normal results. False positives may occur with stress/nonadrenal illness. . High-dose dexamethasone suppression test: Use this test after hyperadrenocorticism has been diagnosed. PDH or AT: Cortisol level suppressed by less than 50% 8hrs post-dex. PDH ONLY: Cortisol level suppressed by > 50% 8hrs. post-dex.

8/7:

Spoke with owner regarding LDDST. 8 hour post reveals increased cortisol and 4 hour post reveals suppression. Blood work results suggestive/indicative of PDH Cushing's disease. Owner describing clinical signs of Cushings (i.e. Pu/Pd, polyphagia, alopecia). Per Dr. KB, recommend abdominal ultrasound to further assess because HAC can be difficult to diagnose and treat. If U/S not pursued, recommend start treatment with Trilostane and recheck with ACTH Stimulation test at 14 days, 30 days, 90 days, 6 months, and then yearly. Some patients can become really difficult to control with Trilostane. Owner will consult with wife and call back.

[Squirt's Mom]

ah....no testing for Atypical so your vet cannot know if this is in play or not, he cannot know her intermediate, or sex, hormones are elevated or not. So forget about Atypical. Has she had an ACTH recently?

Low potassium, low BUN, low amylase - I'm not sure what these could mean but I would want to know BEFORE putting her on either drug. ;) Potassium is part of the electrolytes and they can become lowered with treatment so that is a bit concerning in my little mind. ALK (also called ALP or ALKP) is elevated but mildly compared to some we see in the 1000's. I would also want an explanation on the Eosinophils and Neutrophil SEG before starting any treatment.

The LDDS is notorious for giving false-positive when there is another, non-adrenal, problem going on and this is why I would want these other values that are off explained first. ;)

You're doing a good job!
Hugs,
Leslie and the gang

[ned4spd8874]

Thanks for the reply. Yes, she has had the ACTH test done, I think it was back in Michigan. I'll look over what little paperwork I have to see if I can find more info for you.

Edit: Well, I thought she had it done. But I can't find any record of it. Argh, too many vets, it's hard to keep track of who did what and where and at what time.

[ned4spd8874]

Okay, so the first list of results I posted were from her complete blood work which had the ACTH. The second set of results I posted were from the LDDS test. Does that clear things up?

[Squirt's Mom]

Perhaps I'm blind. :p I looked through this thread and don't see any ACTH results but I could be missing it. By "the first list of results I posted" do you mean this? -


6/19:

Reticulocyte Panel

% Reticulocyte
Result: .05

Reticulocyte
Result: 32
Range: 10-100 K/uL

If so, that is not an ACTH. But I could be overlooking the ACTH results. Hopefully someone else will have a gander and see if they can see them! :p

[ned4spd8874]

Perhaps I'm blind. :p I looked through this thread and don't see any ACTH results but I could be missing it. By "the first list of results I posted" do you mean this? -



If so, that is not an ACTH. But I could be overlooking the ACTH results. Hopefully someone else will have a gander and see if they can see them! :p
Yeah, I thought that's what they did when they did the complete blood work. Like I said, too many vets, too much confusion. So I could be wrong.

[lulusmom]

Okay, so the first list of results I posted were from her complete blood work which had the ACTH. The second set of results I posted were from the LDDS test. Does that clear things up?

No, there are no results listed for the acth stimulation test in the first round of tests done on 6/19. The results of an acth stim test have two numbers, a pre injection blood draw number and a post injection number. Reporting units are usually in ug/dl or nmol. I will tell you that very few gp vets would do both the acth stimulation test and a low dose dexamethasone suppression test to confirm a diagnosis so it may be that your vet didn't do an acth stim test. Can you recheck your paperwork?

My cushdogs treated with both Lysodren and Trilostane and I can tell you from years of experience that both are quite effective in treating cushing's. My dogs were tiny, 4 lbs and 6.5 lbs, and they were on relatively large doses of both meds by the time they were stabilized. I monitored them closely and their vet was knowledgable of both drugs so they never had any adverse reactions. That's not to say that every dog won't, even in the perfect world, but in the vast majority of cases, if a dog gets sick, it's usually because of an inexperienced vet and/or the petowner is not educated and/or wasn't properly counseled by their vet. It's team work that will facilitate safe and effective treatment for our dogs.

You've come to an awesome place to find support and lots of first hand experience that will be readily shared. No matter which treatment you choose, we've got your and Maggie's back.

Glynda

[ned4spd8874]

I've been trying to remember and have been looking over my notes. As far as the ACTH test, I believe that we decided it wasn't necessary. I do remember talking to the second vet about it after we got the LDDS test results back and he felt that given those test results and all of her symptoms that there was no reason to run it. It was clear that she has Cushings.

[lulusmom]

I've been trying to remember and have been looking over my notes. As far as the ACTH test, I believe that we decided it wasn't necessary. I do remember talking to the second vet about it after we got the LDDS test results back and he felt that given those test results and all of her symptoms that there was no reason to run it. It was clear that she has Cushings.

That makes perfect sense.

[ned4spd8874]

Does it? Should I try and push for that test? Not that I'm all excited about spending more money, but I want to do what's right for Maggie.

[lulusmom]

Does it? Should I try and push for that test? Not that I'm all excited about spending more money, but I want to do what's right for Maggie.

Yes, your vet's rationale for not doing an acth stimulation test sounds reasonable; however, an experienced vet or internal medicine specialist may do both and they most certainly would highly recommend an abdominal ultrasound to 1) determine which form of the disease Maggie has and 2) to check out the surrounding organs for the usual abnormalities or unforeseen nonadrenal problems that may be a lot more urgent than confirming a cushing's diagnosis. With about 85% of all dogs with cushing's having a microscopic tumor on the pituitary gland, the law of averages say that Maggie has pituitary dependent disease. However, in the unlikely event that she does have an adrenal tumor, surgery could be a complete cure if 1) she's a good candidate and 2) you can afford it. In this economy it's tough to make ends meet without having to deal with vet bills so it's not always possible to finagle a way to finance our first choice but thank goodness, we have an alternative with conventional treatment. My two dogs were treated conventionally for seven and five years respectively with a very good quality of life.

Glynda

[ned4spd8874]

Yes, your vet's rationale for not doing an acth stimulation test sounds reasonable; however, an experienced vet or internal medicine specialist may do both and they most certainly would highly recommend an abdominal ultrasound to 1) determine which form of the disease Maggie has and 2) to check out the surrounding organs for the usual abnormalities or unforeseen nonadrenal problems that may be a lot more urgent than confirming a cushing's diagnosis. With about 85% of all dogs with cushing's having a microscopic tumor on the pituitary gland, the law of averages say that Maggie has pituitary dependent disease. However, in the unlikely event that she does have an adrenal tumor, surgery could be a complete cure if 1) she's a good candidate and 2) you can afford it. In this economy it's tough to make ends meet without having to deal with vet bills so it's not always possible to finagle a way to finance our first choice but thank goodness, we have an alternative with conventional treatment. My two dogs were treated conventionally for seven and five years respectively with a very good quality of life.

Glynda

Thanks Glynda. I also talked to the last vet about the ultrasound as well. But as with that other test, he felt that given her symptoms and the previous test results, that it wasn't entirely necessary and that he didn't have any concerns with the pituitary Cushings diagnosis.

[ned4spd8874]

Welp, I guess Maggie won't be starting on the medicine tomorrow. She's had vomiting problems all day today. Not sure what happened or what she got into. Just came back from the ER because she couldn't even keep water down. They gave her something to help settle her stomach and some fluids. Then on to bland food tomorrow and hopefully she'll be able to keep it down!!!

[doxiesrock912]

Poor Maggie! Hope that she feels better soon!

[frijole]

Wow - get her healed and don't even think about starting the drug til she has been well for a while. Kim

[ned4spd8874]

Thanks! For such a sweet gentle dog she has some of the worst luck! She is such a trooper, I wish we could all be like her in so many ways!

Oh, just thought I should share this. It's some pictures of our furry family that we put up on our family website. Aren't they all so adorable and awesome?!?! http://therameys.us/our-furry-family-members/

[Roxee's Dad]

Wonderful pictures :)

[ned4spd8874]

Hello again. It's been a while since I've posted. A lot has been happening. Both with Maggie and in life.

I'm hoping someone here can give me some advice. One of the things that's been going on is Maggie really hasn't started her Cushing's treatment because she is throwing up pretty regularly. At first it was just before we started the loading dose of medication. She would throw up about every other day. So we held off on the medication, gave her less treats and fed her chicken and rice.

She seemed better so we started the loading dose. About the time we stopped it, she started throwing up again.The doctor thought maybe she had some bacterial infection type thing in her stomach so he put her on some medication. We also started the chicken and rice again. She was doing fine for a few weeks, not saying that she didn't throw up at all, but it was better.

So now we started on the medication last week and now she's throwing up again. We started last Sunday and she threw up again on Friday and then again today. Today it was after a walk and she drank a lot of water. Water seems to be the common factor actually. She will drink a lot and then throw up shortly after. We did move from city to well water. But I stopped giving her water out of the tap and only the water from our house reverse osmosis system.

I'm confused and worried for her. She seems perfectly fine otherwise. Just every couple days she will throw up! Oh, and it's mostly the yellowish, foamy, slimy bile type stuff that comes up. Not much food usually.

Any advice? Should I stop giving her the medication again? Should I call the ER vet?

HHHHEEEEEEEELLLLLLLLLLLPPPPPPPPPPP!!!!!!

[molly muffin]

Never give the medicine to a dog that is throwing up. I know you have started and stopped this a couple times already. Back to chicken and rice and see if she will keep that down.

Yellow is bile, did she ever have an ultrasound done to look at her pancreas, liver, gall bladder?

You could take her to the ER if you feel that things are going downhill over night, that she is becoming lethargic and not responding well.
Sharlene and Molly Muffin

[frijole]

You need to give us more information before we can say a whole lot. First off Sharlene is right - never give cush meds to a sick dog EVER.

That said - which drug did you select? I'm thinking it might be lysodren because you mentioned loading. What is the dose and how much does your dog weigh? Tell us exactly when you started the 'load', did you do an acth test? Did your dog get loaded? What are the results of the tests?

Vomiting is a sign of overdose. Or it could be that something else altogether is wrong with your dog. Please, you haven't posted in a month and there is so much we don't know. We need to know the whole story.

But in the meantime - don't give your dog any more drugs for now. When a dog is vomiting bile it is not good - have you phoned your vet and if so what are they saying about it? Thanks, Kim

[Squirt's Mom]

I agree with Kim and Sharlene - the yellow foamy vomit indicates a problem with the digestive system...liver, gall bladder, pancreas, stomach, something needs addressing and for this to be going on at least a month is not good. And by all means, forget about trying to treat the Cushing's right now. First the doc needs to find out what is causing the vomiting.

Was she vomiting like this prior to the switch to well water? If not, I would highly suspect something in the water is upsetting her stomach. You might try getting some bottled spring water for her....and having your water tested by the health dept. I say this based on my own experiences with a well that was badly contaminated.

What med did the vet give her for this and did it work while she was on it? Has the vet given you any idea as to why this is happening? If not, I would be seeking another opinion asap.

Let us know how Maggie is doing!
Hugs,
Leslie and the gang