New to site - 9 year old Boston Terrier

[Astro's Dad]

Hello everyone,

I want to begin by saying how helpful it's been to read through the threads on this forum over the last month. I have learned so much. I wish I had found this site earlier.

I live in Los Angeles and I remember reading a posting on this site where one of the more active members mentioned a vet in the SoCal area that is a Lysodren specialist. I have searched and searched and I cannot find that thread. If anyone can point me in the direction of that vet or a vet anywhere in Southern California that truly knows how to treat Cushing's with Lysodren I would be very grateful.

My 9 year old Boston Terrier, Astro, was diagnosed with Cushing's the last week of December (2014). I foolishly trusted my old vet (I will never go back to her again) when she put him on 30mg of Trilostane 1x per day. She said 30mg was the lowest dose possible. Can you believe it?? I asked her if I should have any prednisone on hand and she said no that wasn't necessary and dogs rarely have bad reactions to Trilostane. She added that if he did have a reaction to Trilostane to take him to the emergency clinic because prednisone could only be administered by a vet. He weighs 23 pounds. Long story short he did have a bad reaction to Trilostane after only 2 doses. He looked like death warmed over. He was alive but HE was gone. He wouldn't drink and would only eat from my hand. I had no prednisone on hand thanks to my former vet. I took Astro to the emergency and they checked his levels and electrolytes and said his levels were fine and he didn't have Addison's. Ok so maybe on a lab report he didn't have Addison's but he could barely hold his head up. IMO the emergency vets still should have given me a lose dose of prednisone to give him. It took ten days before Astro was back to normal. So as you can see, this is why I need a vet that specializes in Lysodren and will be okay with a very vigilant pet owner - now that I'm more informed about Cushing's thanks to this site!

Here are his labs:

12/14/2014
ALT 166 range 12-118 IU/L
Alk Phosphatase 554 range 5-131 IU/L
GGT 39 range 1-12 IU/L
Chloride 101 range 102-120 mEq/L
Cholesterol 459 range 92-324 mg/dL

12/24/2014
Low Dose Dex Test
Cortisol Sample 1 - 2.7
Cortisol Sample 2 (4hr) - 1.6 range 0.0-1.4
Cortisol Sample 3 (8hr) - 1.9 range 0.0-1.4

12/23/2014 First ultrasound
Liver - one hyperechoic nodule 1-2 cm. Liver normal size.
Gallbladder - distended
Adrenal Glands - both have dark cortexes. Size and shape within normal limits. Everything else checked out good on this ultrasound.

12/28/2014 Labs at emergency clinic after taking Trilostane
Blood pressure: 136/137/136 mmHg
Baseline Cortisol: 9.7 ug/dL (normal range per report - no range listed)
Electrolytes : All normal per report
ALT: 161 range 12-118
Alk Phosphatase: 489 range 5-131
GGT: 40 range 1-12

1/4/2015 Second Ultrasound with Internist at emergency clinic
Findings: Highly suggestive of pituitary dependent Cushings. Both adrenal glands were clearly enlarged and the liver was mottled with hyperechoic patches. No adrenal tumors found.
1/4/2015 Needle biopsy of liver - results were negative - no cancer.
1/4/2015 Bile Acids test - results were normal
1/4/2015 Urinalysis/urine culture - results normal

Symptoms:
Astro has most of the classic Cushing's symptoms: hair loss, thin skin, hyperpigmentation, shaking (especially in his hind quarters when standing), hind leg weakness, muscle loss, pot belly, more frequent urination and lots of urine, more dilute urine.

The symptoms he does not have are a ravenous appetite and extreme thirst. He eats normally but is not pushing me out of the way to get to his food bowl. Sometimes he doesn't eat all the food at once. He may finish what's left about an hour later. About 6 weeks ago I changed his diet to a homemade diet recommended by a holistic vet I took him to. This food has more moisture in it so that may explain the fact that he drinks almost no water. Prior to this diet he was on a dry kibble and he did drink more water at that time.

I'm ready to give Lysodren a try now but only with an experienced vet. I read an interview on here that the head vet at UC Davis prefers Lysodren for pituitary dependent cushings. I'm glad many of you are having good results with Trilostane and it could very well be that my former vet should have started Astro on a much lower dose. I just don't want to take the risk again with Trilostane.

Sorry this was so long everyone. Thank you in advance for you help and guidance.

Curt

[Renee]

Hi Curt,

I don't have time for a long reply, but I wanted to welcome you and say you are in good hands now. You are absolutely right to be looking for a new vet and I commend you for not continuing to just follow you (foolish) vet.

You are not alone anymore. So, welcome to the family!

[judymaggie]

Welcome Curt and Astro! I believe the vet you are referring to is David Bruyette at VCA Hospital. Many folks here are using him for consultation and/or treatment.

I realize you are wary to try Trilostane again. However, with Astro's normal hunger and thirst levels, I am concerned that loading with Lysodren may be very difficult as subtle changes in those areas are the primary indicators of reaching a loading level.

I'm sure others will add their thoughts soon--making contact with Dr. Bruyette is a good place to start!

[labblab]

Welcome from me, too!

Dr. Bruyette is a great resource, but as a general rule, I believe he prefers using trilostane instead of Lysodren. So if you were reading about or seeking a vet who particularly favors Lysodren, I'm guessing it was someone else. Maybe someone else here will recall the specific thread or conversation to which you are referring. Dr. Edward Feldman is the UC Davis vet who favors Lysodren for treatment of PDH, but it sounds as though you are referring to a different vet located in southern California.

I apologize for having only a moment to type right now, but I did want to add this comment so that perhaps we can search further for the vet you had in mind.

I do want to quickly add that I agree with Judy's concern about trying to load a dog with Lysodren who is not exhibiting signs of excessive thirst or hunger. In terms of food, has Astro gotten pickier since starting the new homemade diet? If so, it might be worth your while to at least temporarily return him to a food that he enjoys eating during a time period that you are initiating Cushing's meds. We generally suggest that it is best to not change other aspects of a dog's routine when beginning treatment. That way, it is easier to judge whether a behavioral change is a result of the med as opposed to something else that is unrelated.

Marianne

[Astro's Dad]

Renee, Judy and Marianne thanks for your replies.

Yes, I'm aware of Dr. Bruyette, but I'm hesitant because his first choice is Trilostane. I will keep searching for the vet I read about on this site who is good with Lysodren. I do remember they were in Southern California.

I have given thought to loading with Lysodren given his lack of thirst and excessive appetite. Thank you Judy and Marianne for bringing that up. I'd like to see if his symptoms subside by beginning Lysodren on a maintenance dose much like I've read they do for atypical cush dogs. If it works and his ACTH comes back with his cortisol in check, then great. If not, then try a short loading phase. Any thoughts on this from those of you with far more experience then I? I'm just feel more comfortable starting slow and steady with these drugs based on what I've read. I hope I don't sound completely nuts, but once you go through a drug reaction to the point you think your dog could die at any moment, you just don't want to risk it again. Fool me once, shame on you, fool me twice shame on me.

About the homemade food, no I don't think Astro has gotten pickier. Maybe bored with the same meal though :). He's always very attentive when I'm preparing each meal and he likes the homemade food better than the kibble he was on for years prior. He sometimes just looks at it for 15 or 20 seconds then walks over and starts eating, but never waits to eat it longer than that. 90% of the time he finishes all of the food at each meal. I have noticed when the meat is raw he's really excited about it, but I've been preparing the meat and veggies in a crock pot on low heat for a couple hours per the holistic vet's instructions. He's been doing much better on the homemade food. His stools look perfect. He would pass blood when he was on the kibble from time to time (and it was expensive veterinarian prescription kibble too). I hear your suggestion, Marianne, and I would be willing to go back to the kibble if I thought he liked it better.

Thanks for the help!

Curt

[Harley PoMMom]

Hi and welcome from me too! I am thinking you may be talking about Glynda, she is one of our Administrators here, and she did live in SoCo for a while.




It sounds like you are in Southern California so I have no problem recommending excellent specialists in Los Angeles and Orange County. If you are in Orange County, I highly recommend that you consider VCA All Care Referral Center in Fountain Valley. I live in Rancho Cucamonga and don't mind the hour to hour and half drive there. My dogs treat with the Director of Internal Medicine, Dr. Michael Moore. If you are closer to L.A., I highly recommend Dr. David Bruyette, Medical Director at VCA West Los Angeles Animal Hospital. Both of these specialists are excellent and I don't know if you have noticed but we have a video of Dr. Bruyette discussing Trilostane in our Resources Forum.

VCA All Care Referral
http://www.acarc.com/

VCA West Los Angeles
http://www.vcawla.com/

Glynda

[Astro's Dad]

Thank you. Dr. Michael Moore in Fountain Valley is on my list of internists to research. Not sure if he's the vet I read about, but I'm definitely going to consider him. Thanks!

[molly muffin]

Have you had any luck finding an internists yet?

[Astro's Dad]

Thanks for asking. I just learned today that Dr. Michael Moore has moved to San Jose so unfortunately I'm still looking for an internist. I know I will have to just pick one soon. Just hoping to find one that will work with me in case what they recommend does not check out with the experienced members on this site.

[Squirt's Mom]

When we moved back home and started the vet search, our little country vet here was chosen for the pure fact that he told me he had never treated a cush pup, didn't want to treat a cush pup and preferred we find another vet. He was HONEST with me. Every other vet I talked with either told me how her treatment was wrong and would have to be changed (even tho all her tests showed her controlled) or told me things that I knew were flat wrong with that arrogant "I'm the vet, you're nobody" attitude. So Doc B got picked and drug kicking and screaming into the canine Cushing's world. He now has several cush pups and Addison's pups and is much more comfortable.

I tell you this story to let you know that the one single most important factor in your baby's well being on this cush journey is YOUR knowledge, not the vet's. ;) When you're not searching, research and learn all you can about the disease and the treatments available. Ask LOTS of questions of the experts here. Build your arsenal of knowledge so when you run across that vet that tell you some hogwash, you see the hogwash and can politely say, "No thanks, I know better." And guess what? You are in the perfect place to learn from the best! :)

I would say Astro has a good partner on this journey in you, too. :cool:

[Renee]

I second Leslie on this one.

An experienced vet can be invaluable - but, that does not mean there aren't other ways. My vet was much more game to treat my girl, but much like Leslie's vet, she had no experience and we learned together. It has been a wonderful experience, and (knock on wood), we have had few bumps in the road.

You can do this!

[Dixie'sMom]

I also wanted to welcome you and Astro to the family. I admire your caution and the fact that you are educating yourself and are seeking excellent care for Astro. I believe that with this attitude, you will be successful in getting the best care possible and Astro's health will benefit. I also commend you for leaving your vet and those at the Emergency Clinic far behind you.

I can't offer any recommendations or advice, but I'm here to cheer you on and encourage you! You are in great hands here and you've found the right place to get accurate information.

Carry on my friend... you're doing well!

[leahdan]

I second Leslie on this one.

An experienced vet can be invaluable - but, that does not mean there aren't other ways. My vet was much more game to treat my girl, but much like Leslie's vet, she had no experience and we learned together. It has been a wonderful experience, and (knock on wood), we have had few bumps in the road.

You can do this!

Hi - we also have a BT who's just been diagnosed with Cushings!

I will add my voice to the others who chose a vet who may not be the Cushings expert but was willing to listen, learn and work with us. There is a lot of resources out there to help vets, and this site for example for owners - having a vet that is happy and willing to use these and listen to an educated owner can make for a great partnership.

Don't get me wrong - specialists definitely have their place and were invaluable to us for a non-Cushings related problems our BT had. But just something to think about if you are having such a hard time finding an internalist.

Leah

[Astro's Dad]

Thank you to Leslie, Renee, Leah and Dixie's Mom for your responses and encouragement. I would love to find a vet with little to no experience treating cush pups AND who is willing to work with me. That would be outstanding. I've got a couple vets I'm considering. I hope to pick one this week and get treatment started. Astro is doing ok, but I'm most concerned with his muscle loss. I'm hopeful treatment will bring some or all of that back.

[molly muffin]

Good luck! It's not always easy finding just the right vet.