pre treatment text questions Coco

[Teri/Coco]

Hello, Thank you for allowing Coco and I to join. Coco is a 9yrs old Shih-Tzu/Cocker mix and normal weight was 23Ibs Now 26lbs gained 3lbs in last 6mos. Coco shows all signs of cushings (skin, thin hair, panting, labored breathing, weakness ,etc) and has become much worse since blood test a week ago,(drinking 3 times as much-HUGH 6 inch dark purple bruise on chest and a 3 inch dark red circle around blood draw site,,, probably due to the stress of having Bloodwork Chem screen CBC/Thyroid T3 T4. He was totally uncontrollable during exam and text-we had to use a muzzle, his eyes became blood red- just horrible on him and me. Coco over the past two years has been afraid of everything!
His ALKP was 1743 and cholesterol High (do not know number) waiting on Thyroid results.
My question / concern can my vet safely start a low dose Vetoryl without the pre- ATCH test and only do the monitoring test at 10 days? I am concerned about his liver and the Vetoryl , but with only 20% chance of Anipryl working I really don’t want to use it and wait two more months to see if it is effective. Just looking for options,, ,of course do not know if Vet will agree to forgo the pre ACTH test.
Maybe a 24hr or 3 day urine cortisol test? UCCR instead of Blooddraw just to start treatment?

[labblab]

Hello, Teri, and welcome to you and sweet Coco! I’m so sorry, though, for the rough time you’ve been having. It’s certainly true that Coco is exhibiting some of the classic symptoms of Cushing’s. However, as you already know, arriving at a definitive diagnosis may be challenging. All of the tests of excessive adrenal hormone production can be skewed by stress itself, and it sounds as though Coco is super reactive to the stress of being at the vet’s. Under these circumstances, perhaps the best, first “gateway” test would be the UCCR test. The advantage to this is that you can (should) collect the urine at home. Thus, it would be the least stressful test for Coco. It looks as though you’re already aware of the recommendation to collect samples on three successive mornings, and pooling them under refrigeration to be taken to the vet. This test can’t confirm Cushing’s, but it can let us know whether Cushing’s is indeed a possibility. If so, we can go from there.

In terms of outward symptoms, I’m curious as to whether Coco exhibits excessive thirst and urination. You’ve not mentioned them, but along with excessive hunger, those are typically the most common of the presenting Cushing’s symptoms that bring dogs to the vet.

Anyway, once again, welcome to you both! We’ll do our best to help as much as we can, and we’re surely glad you’ve found us.

Marianne

[Squirt's Mom]

Hi and welcome to you and Coco!

Anipryl can help but the dog MUST have the pituitary form of Cushing's and the tumor MUST be on the pars intermedia portion of the pituitary gland in order for Anipryl to have any benefit at all. Even then it will likely help no more than 4-6 months and then Coco would need to move to either Lysodren (Mitotane) or Vetoryl (Trilostane). My Squirt was an exception and Anipryl helped her for about 9 months...but then her case was not typical. Unfortunately, if the UC:CR comes back abnormal then the more invasive tests like the LDDS and ACTH would be needed. Another non-invasive test that can go a long way toward determining the type of CUshing's as well as ruling out other problems is an abdominal ultrasound.

I'm glad you found us and look forward to learning more as time passes!
Hugs,
Leslie

[Teri/Coco]

Trilostane also carries the possibility of an increased rate of growth in pituitary tumors.


http://cushingsindogs.com/medical-treatment-options/

There is no date on this info page.

[labblab]

Hi again, Teri. From the information that’s included in that link, I’m guessing it was written quite some time ago. Trilostane has now been used worldwide for almost fifteen years, so I would no longer describe it as being a “new” treatment, and at this point it is more widely prescribed than is Lysodren.

It’s true that at least one study has indicated that pituitary tumor growth may accelerate when trilostane is given. It has been hypothesized that the same effect may also be true with Lysodren treatment, although I don’t know of research that has actually confirmed it. So this may be a risk that’s associated with treatment, but there are also risks of chronic disease progression associated with leaving Cushing’s untreated. It will be a wonderful breakthrough if a new Cushing’s medication can be developed that is equally effective but also carries less risk of unwanted side effects. However, for the time being, trilostane and Lysodren generally offer the best opportunity for symptom control and disease management in canine Cushing’s patients.

Marianne

[Teri/Coco]

Thank you, I agree , l try not to read anything that does not have a date, and surely won't from now on. Please delete this post as l don't want to misinform or scare anyone with out dated info.

[Teri/Coco]

Anyone else still using Lysodren?
Vet has started Coco (9yr old Shih-tzu/Cocker mix) on Lysodren today, after ACTH yesterday confirming cushings. My vet has 6 other Cush dogs in his practice and has always used Lysodren. (Said he would order Trilostane if l wanted him too) Back when l was able to work and had decent income I had been to many vets thru the years because l constanly took in homeless dogs and cats, treated S/N and found homes for them. So needless to say l have ran into numerous vets that l feel should have had thier license pulled or just in it only for the $. I do trust Dr S. and have told him l only have an income of 699. SSD a month. I agreed to the Lysodren because that is what he recommends, uses, knows well and has had success with. Also Dr.S said he attended 3 seminars this year and they still agree safety is the same with Lysodren or Trilostane.
BOTH VERY TOXIC DRUGS. He said for Coco normal starting dose is 568mg Coco is 26lbs But instead of that is doing 125 (2) a day 12 hr apart 250mg total -then a ACTH in 7 days along with a urine culture to check for UTI.
Does this sound right, Coco has always been sensitive to medication can't even use topical flee. With his ALK Phos being 1743 the regular loading was really scarring me.
His ATCH numbers were pre 8.3 Post >50.0 Dr.S said highest Post he has ever seen.
I don't know if that means his tumor is very large or not.
Sorry about such long post but new to this disease. If anyone has a dog taking Lysodren with good results (long life) or any positive experience it would help me a great deal.

[Squirt's Mom]

Hi Teri,

I used Lyso with my Squirt and my Trinket...however I don't thing Trink ever actually had Cushing's. She had SO MANY other issues going on I believe they caused the cortisol to be elevated. A necropsy also indicated there was no Cushing's present. However, Lysodren will always be my first choice to treat any cush pup in my care. When Squirt started treatment, Vetoryl/Trilostane was just coming out...in fact it wasn't even available in the US yet back then so Lyso was our only choice without jumping thru hoops to get Trilo.

The vet is correct - BOTH are very powerful drugs; BOTH are life-saving drugs; BOTH can cause serious problems including death if not correctly handled. They are not used the same way nor are the protocols for the monitoring ACTHs the same. They must be given with a meal, not snack - meal. Both drugs are fat soluble so they have to have food in order to be absorbed into the body and used.

For Lysodren there are two phases -the loading, or induction, phase and the maintenance phase. In the loading phase the pup gets 2 doses a day 12 hours apart. This phase can last 3 days or 3 months depending on the dog. It is up to us to watch for the signs that the load has been achieved. Those signs can be very subtle but you need to watch for things like less water intake and a change in how they eat. We have a spreadsheet you can use to track water intake and I would strongly suggest you get an idea of how much water Coco is drinking BEFORE starting the treatment. I will post the link to the spreadsheet at the end of my post. The changes in eating can be as simply as them looking up from their bowl when called while before starting treatment they would ignore us. Or they don't wolf their food down but eat more slowly. When you see ANYTHING along these lines, stop giving the Lyso and call the vet to arrange an ACTH within the following 2 days. That will let us know if the load has been achieved or if it needs to continue for a bit. It is ALWAYS better to stop too soon than too late.

Once the load has been achieved the pup will go to maintenance phase in which the drug is given 2-4 times a week - usually the same amount as used for the load but spread out over a week. So if a pup was taking 1000mg a day to load they will take 1000mg a WEEK for maintenance.

The loading dose is determined by weight - 25-50mg per kilogram per day, typically 50mg. Since Coco weighs 26 lbs that would make her loading dose 591mg a day. Since Lyso only comes in 500mg doses that would be rounded down to 500mg day divided into 2 250mg doses given AM and PM WITH a meal. The math is as follows - (to find kg you divide lbs by 2.2) 26 / 2.2 = 11.818181...kg x 50mg = 590.909090...mg per day rounded down and divided into 2 doses. So the loading dose suggested of 125mg twice a day is based on the 25mg VS 50mg which means it could take much longer for the load to be achieved. But since she is super sensitive to medications this may be why her vet has chosen to go with the lowest possible dose for loading.

I am going to post a link to some tips for using Lyso along with the spreadsheet. NEVER hesitate to ask question. We will be here to help any way we can. And don't be scared - you GOT this! I have full faith in your ability to work with Lysodren like a pro in no time. I have worked in rescue with special needs babies for some time and based on what you have shared about your experiences I have full faith in you!

Hugs,
Leslie

The link for Lysodren loading - http://www.k9cushings.com/forum/showthread.php?181-Lysodren-loading-Instructions-and-related-tips

The link to the spreadsheet - http://www.k9cushings.com/forum/showthread.php?3583-Spreadsheet-for-Logging-Your-Dog-s-Water-Intake&highlight=spreadsheet

[Teri/Coco]

Thank you, MoM, l read, copied and saved your links.:) Your loading dose mathematics were very helpful! I am so glad my vet is being cautious, l am worried about his liver. Maybe you can help me - l read if a dogs drinks less than 60ml/kg a day to call vet. I have tried to calculate and came up with 3 cups a day. .? ... for Coco. But Will be a bit harder for me to judge because l cannot separate my cat and Pekingese from drinking from the same bowls, but will monitor the best l can, measuring the water in the morning before refilling. The suggestion of feeding in the morning before giving pill to make sure he is eating well- was invaluable info. THANK YOU

[Squirt's Mom]

With multiple pets drinking at home we simply assume any excess amounts are being used by our cush baby. The normal amount of water for dogs is 1/2 - 1 oz per lb of body weight per day day. So a 10lb dog would drink between 5-10 oz per day. For cats the normal consumption is 3.5-4.5 oz for every 5 lbs of body weight. So you can measure the total amount being consumed per day and see if the amount is excessive based on those normal intake measures.

[Teri/Coco]

Thank you that helps alot.:)