Hi, I'm new and have a chi chi diagnosed with cushings

[pippadad]

Hi,
I have a 13 year old chihuahua recently diagnosed with Cushing's and was given an initial treatment with Lysodren, after dexomethosone suppression test...which seemed to help , but he still has lots of thirst and pees a lot....must keep putting him out and keep him in crate to avoid accidents.
I asked the vet about possibly using trilostane, as I read it blocks cortisol production without damaging adrenal gland tissue, and is less toxic. The vet wanted me to bring him back for another day long stay, another dexo test ...more expense, etc, with no clear indication on success ratio, relative to the thirst/peeing symptoms...and she claimed that the trilostane is expensive...
I paid $60 for initial dose of lysodren, after $120 initial visit, plus $300 for the next stay with blood and dexo test.

So, can my regular vet just order some trilostane like 5-10 mg...and start him on that...just to see? .....he weighs 12 lbs., and because of his age, I am reticent to keep spending money on tests, diagnosis...would rather just try some other drugs....

Does a vet have to order the trilostane, or can I buy it?
thanks all,
any input appreciated,
Terry

[Harley PoMMom]

Hi Terry,

Welcome to you and your boy! Sorry for the reasons that brought you here but glad you found us.

I was wondering if you could get copies of all tests that were done on your boy and post any abnormalities that are listed. Could you tell us what the loading dose of Lysodren that was given to your boy and the maintenance dosage too. Was the Lysodren given with a meal that contained some fat? Was your boy diagnosed with pituitary or adrenal dependent Cushing's?

A low-dose dexamethasone suppression (LDDS) test is only used for diagnosing Cushing's and should never be used to monitor a dog on treatment. Only the ACTH stimulation test is used to monitor a dog on treatment with Trilostane/Vetoryl or Lysodren/Mitotane. Could you check with the vet and ask if the ACTH stimulation test was being performed? With Lysodren the ACTH stimulation test should be done 48 hours after the dose of Lysodren was given, was this protocol followed?

When switching from one drug to another a 30 day wash-out period is recommended. Trilostane/Vetoryl is no safer than Lysodren/Mitotane. Dechra, the makers of Vetoryl, do state in their product insert that Vetoryl has caused adrenal necrosis in some dogs. Here's a excerpt from Dechra's product insert:


In a US field study with 107 dogs, adrenal necrosis/rupture (two dogs) and hypoadrenocorticism (two dogs) were the most severe adverse reactions in the study. One dog died suddenly of adrenal necrosis, approximately one week after starting trilostane therapy. One dog developed an adrenal rupture, believed to be secondary to adrenal necrosis, approximately six weeks after starting trilostane therapy. This dog responded to trilostane discontinuation and supportive care.

Dechra's U.S. Product Insert (http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf)

Vetoryl/Trilosatne can only be attained through a Veterinary prescription. There are several on-line pharmacies that can compound Trilostane which is cheaper.

I'm providing a link to our Resource Thread where you will find a wealth of information regarding Cushing's and the treatmenr protocols.

Helpful Resources for Owners of Cushing's Dogs (http://www.k9cushings.com/forum/forumdisplay.php?f=10)

Please feel free to print anything out and do ask all the questions you want.

Hugs, Lori

[labblab]

Welcome from me, too! Lori has already given you a great introduction, so I just have a couple of clarifying thoughtss to add. It sounds as though you started off with some initial Lysodren dosing, but it is not clear whether or not your boy is still receiving any Lysodren at all. When treating using Lysodren, a dog is given daily doses of the drug for several days -- until an ACTH stimulation blood test confirms that enough of the adrenal cortex has been eroded so as to drop the cortisol level into a therapeutic range. The number of days that it takes to "load" a dog is very individual, so owners have to watch dogs very carefully for signs that the daily dosing needs to stop. At that point, the dosing shifts to a "maintenance" phase which continues from then onward. During the maintenance phase, one daily dose is itself broken down into 2-3 doses that are spread over an entire week. This lower dose of the drug keeps the adrenals from regenerating to the point that they are again over-producing cortisol.

From your description thus far, I am wondering whether your dog went through the initial loading phase but did not continue on with maintenance dosing after that. If so, that would definitely explain why Cushing's symptoms would rebound. And if so, there is no reason to think that Lysodren will not remain a good choice for him, but just so long as he is dosed properly on an ongoing basis.

Marianne

[Spencersmom]

Hi Terry! I too have a chi recently diagnosed with cushings. He is taking 10 mg vetoryl once daily. He has other issues that presented about the same time as his diagnosis which have impacted his treatment as well as prognosis. He'll be 12 yrs old july 20th.

If your boy is healthy in other respects, he could have a lifespan of several more years, so your investment in him now could provide him much more comfort during this time!

I've seen comments that vetoryl is expensive! I pay $50 for a month's supply. I also pay $60 for his seizure meds and that lasts about 3 weeks. Care can be costly, but he's worth it to me and my hubs!

I hope you are able to find a happy balance for your baby!