Shiba Inu w/Cushing's advice wanted on changing treatment! [Archive] - Canine Cushing's Information and Support Forums

nobonez

08-09-2009, 10:03 PM

Hi, I am new to this list and have a 13 year old Shiba Inu named Cocoa who was diagnosed in the past 3 months with Cushing's. Her vet started her on Ketoconazole of 60 mg 2 x's a day. He doubled the dose after 2 weeks but Cocoa became latargic and did not want to eat. So he backed her down to 3 pills a day to where she still is now. We found out on a Friday that Cocoa had Cushing's and on Saturday she tore the ligaments in her right knee. In 2006 she had torn her left knee and we did the surgery back then, but will not do it this time. The leg specialist did not give Cocoa a good chance of making it through the surgery and the rehab is just too long. So we went to a Holistic vet and got Cocoa started in therapy to strenghten the muscles around that right knee and so far so good. With going to this Holistic vet I did start Cocoa out on a Chinese herb for Cushing's called Si Miao San........anyone ever try it before? Tomorrow I am to go from 1/4 tsp to a 1/2 tsp which is the reg. dose. So far no luck but I know I have to wait 3 weeks for the Si Miao San to possibly work. If it does, at that point they will take Cocoa off the traditional med. If neither work then I have to pick another traditional medicine to put Cocoa on. So far Cocoa is still drinking lots of water and peeing a lot. Also has anyone heard of elimanating carbs from their diet with Cushing's? I just switch to Nature's Variety canned. Before I started the Si Miao San, Cocoa's last blood stem was at 27 and she should be 10-12.

Harley PoMMom

08-09-2009, 11:15 PM

Hi Cocoa's mom/dad,

Welcome to our family, altho I am no medical expert, the one thing I want to caution you about is giving the Ketoconazole and Si Miao San together, don't know if that's a good idea, did you check with your vet first?

Now for the questions :eek::) what tests did your vet do to determine that Cocoa has cushings? And what kind of cushings does your vet say she have? How much does Cocoa weigh? What symptoms did Cocoa have that made you take her to the vet to be tested in the first place? Do you have copies of all the tests that the vet did on Cocoa, and if you do could you post them, especially like if he did a LDDS, ACTH. Did Cocoa's vet do a CBC or Chemistry blood test on her, could you post what is elevated on these tests. Where there any other tests done on Cocoa, for her thyroid? Anything you can think of? Ultrasound?

I know these are alot of questions to answer but it will let the more knowledgeable members help you when they come along.

Hugs.
Lori

frijole

08-10-2009, 08:06 AM

Cocoa's Mom/Dad,

While we wait for more detail on your dog's symptoms and diagnosis I have to tell you that in my 3 years here I cannot recall a single case where holistic treatment worked in treating cushings. Believe me, if it did then none of us would be using the chemo drugs that we use. My dog has used lysodren for 3 yrs now and is 15 1/2 yrs old. Without it she would surely not be alive.

Ketoconazole is not used much anymore and I am a bit surprised that your vet chose it but then I don't know the whole story yet. I am going to give you a link to our resources section that has a ton of information to read and get you up to speed on this disease.

It appears from your post that your vet did the acth test. This can be a sign of cushings but it does not tell you what KIND of cushings it is and I am hoping that the vet did additional tests before treating.
Treatments can vary depending upon which KIND of cushings the dog has.

Here is the link. I am glad you found us. There is a ton of experience here and no reason to go this alone. We are glad to help.

Kim

http://www.k9cushings.com/forum/forumdisplay.php?f=10

nobonez

08-10-2009, 08:07 AM

Hi Lori,

My oh my all the questions I need to find answers too. I will have to get a copy of the tests results from Cocoa's reg. vet as I do not know the answers other than we spent $1,500. on various testing for our Cocoa. What I do know is it's her pituatary gland over producing. I know they did a ultra-sound and she has a few nodules in her spleen. Since this is all new to us I am reaching out for info but see how much more knowledgable I have to be with Cocoa's vet. As far as the Chinese herb given along with the traditional Cushing's med I am uncomfortable with that. But the Holistic vet said it was okay. Cocoa goes today for therapy and I will be asking a lot more questions to the Holistic vet. I may just pay the office visit with Cocoa's reg. vet to go over all these questions. The Holistic vet and reg. vet do work along side each other.

Cocoa's symptoms were and still are.....being a food hound which she has never been, although she has not gained weight. Drinking gobs of water and I mean bowls full and peeing up a storm. She pants and has the pot belly.

Linda

frijole

08-10-2009, 08:12 AM

Linda,

We posted at the same time. :D Those are certainly signs of cushings. You mentioned tons of testing - that is good. Please get copies of the tests done and get back to us with the results of them.

If it is adrenal cushings sometimes surgery is an option and offers a cure. If it is atypical cushings you might be able to treat with melatonin and flaxseed. Pituitary is the most common and is successfully treated with both lysodren and trilostane.

Don't let this overwhelm you. Cushings is not a death sentence and you do not have to rush to treat it. (it is not harmful to your dog to take a few weeks to get it right - just on your carpet! :p)

Hang in there, get the records and tell us as much as you can. It helps us help you. You are right, you are your dog's voice and it is wise to learn as much as you can so that you can ask questions of the vets. Good luck!
Kim

Squirt's Mom

08-10-2009, 10:58 AM

Hi Linda and welcome to you and Cocoa! :)

According to the Manual of Natural Veterinary Medicine- Science and Tradition by Susan G. Wynne, DVM and Steve Marsden, DVM, Si Miao San is used for "any condition in which Damp Heat arises from Spleen deficiency; a stronger formula than San Ren Tang; hind limb proprioceptive disorders; recurrent cystitis or colitis". It is called Four Marvels Powder. In the index of the Manual, it is listed for use in several conditions, but nothing pertaining to Cushing's specifically. It is used for arthritis and spleen issues, tho, so that may be why the vet chose it. This is a herb combination that is used in TCM - Traditional Chinese Medicine, which is vastly different than our western approach and not well understood by many, myself included. This lack of understanding makes me a bit leery of TCM even tho it has a much longer history than our medical approach. I have a friend who is treating her pup with the TMC approach and her pup is doing well - from an anecdotal point of view; she does not do the cushing's testing but does do blood work, and those lab results have improved.

And, therein lies our major problem with "alternative" approaches - most people who use these approaches VS the traditional pharmaceutical approach don't keep up the cushing's testing to see exactly how, or if, these treatments are actually working on the hormones that cause Cushing's and the accompanying damage from them.

A problem I have with TCM herbs is the lack of regulation. I cannot be sure what is in those herbs, where they came from, how they were processed, the consistency from one batch to the next, the conditions under which the bottle was loaded (sanitary, nasty?)...just too many unknowns.

I am glad you have both vets working together and strongly encourage you to continue the Cushing's testing if you continue with the Si Miao San...well even if you don't ;) .

I, for one, would like to know there are other choices for my baby besides pharmaceuticals and am very interested in different treatment theories/practices but that doesn't mean I would choose to bypass the medicines that have been proven to work on Cushing's. So my studies and research continue in this area, learning what I can from texts and talking with those who use these approaches. I have become a firm believer in the healing properties of proper nutrition - I have seen with my own eyes the difference it has made in Squirt since Dec. '08 when I started cooking her meals based on a diet designed especially for her.

Hugs,
Leslie and the girls

nobonez

08-28-2009, 09:38 PM

muskyhusky

08-28-2009, 09:59 PM

Hi All,

I posted a few weeks back about my Shiba Inu with Cushing's, but I had some problems with my Mom at the nursing home. I am able to post again as things have settle down with my Mom. Cocoa was on Ketoconazle for about 2 months and had 2 blood stem tests and nothing.....the drug isn't working for her. She just had a stem on Wednesday so he wants to change meds because her level is still high and put her on Trilostane but I am scared to give it to her. The vet said the drug is out of Europe and he has to tell me that......some dogs die of unknown reasons on this drug. I thought the Ketoconazole was expensive, but Trilostane is even more costly. I get the impression from the vet that he doesn't want to use Lysodren because he says it's toxic....Yikes! But from what little I've read so far Lysodren seems to be the drug of choice for Cushings. But is that because it's cheaper?

I am new to this board and know nothing much about Cushing's yet, other than poor Cocoa is I'm sure tired of drinking and peeing. Cocoa is 13 years old.

Being new to this board their are so many post to read, but I will do my best to educate myself.

Linda

Hi and welcome:
I have to say something here, I to was really, really leary about lysodren, but not anymore, if you use it you have to monitor your dog close for any changes, I use it for Shadow, my 10 year old Siberian Husky, it works is all I can say and if monitored very closely during the loading phase, well we didn't have hardly any problems..I would go with the lysodren if she were my dog...once the lysodren starts working the drinking and peeing excessively will stop. But I'm pretty new here too, this is what worked for Shadow and I put off using it for a year, I really don't advise you do that.
Lynne & Shadow

nobonez

08-28-2009, 10:11 PM

Lynne,

I did ask the vet about giving Cocoa nothing, but he said her blood pressure will be high. Right now her urine is so diluted and has very little protein so that will only be worse with giving Cocoa no drug. As it is with this Cushing's it weakened the collegan in her body and blew out her knee 2 months ago. We choose not to do surgery but instead put her in therapy and she did very well. She is no longer limping as the water/treadmill helped with making those knee muscles stronger.

The vet just scared me too with Lysodren that it needs constant monitoring. But as your saying, your Shadow did well with and had little problems.

Linda

Harley PoMMom

08-28-2009, 10:16 PM

Hi Linda,

I am sorry that you had problems with your Mother and I hope everything is alright.

IMO, before starting the Trilostane I would have a full adrenal panel done on Cocoa. The blood is drawn from Cocoa at your vets office and sent to a lab that's located in Tennessee. They will see if Cocoa's 5 intermediate/sex hormones are elevated, and if they are, then Trilostane is not a good option for you to use on her. Trilostane elevates one or more of the intermediate/sex hormones and these hormones cause the same symptoms as Cushings.

Lysodren on the other hand does not elevate these hormones, in fact it can lower some of them.

This is why one needs a cushings savy GP or IMS for their furbaby. Alot of GP's do not know about the full adrenal panel and the 5 intermediate/sex hormones and how they come into play with cushings. My Harley's GP didn't, but she was willingly to learn and conferred with Dr. Oliver from the lab at the University of Tennessee. Do you think Cocoa's GP is willing to work with you as a team?

Hugs.
Lori

StarDeb55

08-28-2009, 11:30 PM

Linda, I have not posted to you before, but I want to give you a late welcome! Both drugs used to treat Cushing's are powerful drugs, lysodren & trilostane, but they are life-saving drugs for our pups. My 1st Cushpup, Barkley, was successfully treated with Lysodren for nearly 8 years before he crossed the bridge at 15 years old. As long as you are working with a Cushing's savy vet who follows standard protocols for either drug, you shouldn't have a problem. You, also, need to educate yourself about the medication, & what to look for. I'm now treating my 2nd Cushpup Harley with lysodren. He was diagnosed about 18 months ago & has been doing reasonably well.

I did want to comment on the ruptured cruciate ligaments that your pup has suffered with. Barkley blew a cruciate which is what put us on the road to a Cushing's diagnosis. John, Roxee's Dad, another moderator, has told us that Roxee also blew a cruciate ligament. I know of a number of members of this group whose pups have suffered this injury. This injury seems to occur because of the muscle wasting/weakness associated with Cushing's appears to also affect cartilage & ligaments. I know that if I ever have another pup who suffers an ACL injury, after treatment for the injury, the next thing I will insist on with a vet is that they be checked for Cushing's.

Believe me, I'm not knocking your choice to treat holistically, I certainly hope it works. The problem is that folks who seem to want to go the holistic route do not want to do the necessary testing to document that the supplements they are giving their pups are actively reducing the cortisol levels in the pup's bodies. They can tell us the pup feels better, but they have no testing to document this. This is extremely important because it is the long term overproduction of cortisol by the adrenal glands that does the damage. This overproduction can lead multiple organ failure, blood clots, serious immune system suppression causing multiple infections that can be difficult to treat.

Debbie

PS- I wanted to add that I have no experience with Trilostane, personally, I can tell you that it has been approved by the FDA for use in the USA a couple of months ago, so getting the medication should be a lot easier. I do think that the cost of using Trilo may be higher in the long run, than lysodren as trilo requires more frequent monitoring. I will let some of the trilo parents comment further. With lysodren, once you get through loading & get your pup on a stable maintenance dose follow up testing (ACTH) need only be done as little as twice per year as long as the pup is doing well. In Harley's situation, we have had a few small bumps in the road, so both his vet & I are more cautious, doing his ACTH test ( we call them stims for short), quarterly.

nobonez

08-29-2009, 07:08 AM

Lori,

I'm not crazy about Cocoa's vet as he didn't even ask me about putting her on Trilostane, he just gave it to me. This vet is from the speciality hospital I took Cocoa too, but her reg. vet did originally want to put her on Lysodren. I have to drive 40 mins to this hospital vs. 10 mins going to our reg. vet. I may just talk to my husband today about switcher her back locally if I do choose to put Cocoa on the Lysodern. I took Cocoa to the speciality hospital because I thought they were more knowledgable, but it seems to be more of a assembly line.

Linda

nobonez

08-29-2009, 07:35 AM

Debbie,

About Cocoa's knee injury she did tear the cruciate ligament in her left knee back in 06. We do have another dog (Belgian Sheepdog) and use to let both dogs out at the same time. It was usually a race to the back yard and neither would use the 3 steps off the deck as they'd fly over them. Well the one day we saw her do it and as soon as she landed she yelped as their went that knee. At that time Cocoa was younger and not ill so we choose the surgery and that vet said it would be 50/50 chance someday she'd tear the other knee because the left is so strong now. After that first episode we did stop letting both dogs out the door at the same time so no longer was their a race. This paticular day she use the steps but when I saw her walking she was limping and I knew. She could of ripped off after a squirrel that tore the right knee, but this time with her having Cushing's and being 13 years old we said no to surgery. The percentage of her surviving was not good and nor would we put her through months in a cage. The leg vet said she would benefit from therapy which is how I ended up at a therapudic Holistic vet. Cocoa is doing so well though with her knee after this therapy. I did swear though after trying Holistic medicine with my last dog for allergies that I'd never try it again on any of my animals. Josh was given a Chinese remedy for allergies and that evening his whole body was beat red!! That Holistic vet wanted me to put Josh in a tub of diluted Clorox to conteract what was going on and I just couldn't do it! Instead I ran him up to the local ER. Once the Chinese herb was out of his system he was okay, but after that is when I told myself I'd never do that again and yet here I am giving herbs to Cocoa. The Si Miao San powder was not to treat Cushing's but to help with the entrocrine(spelling) system. But last week Cocoa got wise to the herb and doesn't want to take it no more so I have since stopped.

I use to cook homemade meals for my dogs and I think they did benifit from it. But three years ago when my Mom took ill I had to quickly find a food for my girls as I no longer had the extra time to cook for them. Just recently I read about diet and Cushing's and to elimated 'grain' from their diets. I did ask the vet about this and he had no reply, but have since choose Nature's Variety canned to give the girls. I was going to go with the raw, but in the end just couldn't do it.

Linda

Harley PoMMom

08-29-2009, 09:43 AM

Linda,

Shiba Inu's, I believe, are part of the Nordic breeds, like my Harley, they are prone to elevated hormones. I really do urge you to have the full adrenal panel done on Cocoa, I had one done on my Harley and found that all his hormones were elevated at the baseline and his sex hormone was extremely elevated at the post.

My Harley's former GP wanted to start him on Trilostane also, thank God I found this forum and these amazing people who urged me to have that adrenal panel done before I started Harley on Trilostane. Like I mentioned before, since Harley's intermediate/sex hormones are elevated, Trilostane was NOT an option for him. As of right now, and for the past 4 months, his treatment consist of melatonin and flax hulls, altho in 2-3 weeks he will be starting a maintenance dose of Lysodren.

If you would like more info about the full adrenal panel, let us know, we can paste some links for you.

Hugs.
Lori

nobonez

08-29-2009, 10:00 AM

Lori

What does a adrenal panel consist of? We did spend over $1,000. having test done on her to find out she has Cushing's. Her reg. vet did a ultrasound and her adrenals are enlarged right now or where 2 months ago. She also has a few nodules in her spleen that the ultrasound showed. I'm just wondering if the vet already did this adrenal panel that's why I'm asking.

Yes I would like some links for info on the adrenal panel.

Thanks
Linda

Harley PoMMom

08-29-2009, 12:23 PM

Hi Linda,

What it consist of is your vet does the blood draws, spins, etc. and sends the samples to the lab in Tennessee. This lab is the only one in the world that we know of that does this kind of testing, Dr. Oliver is a reknown expert in this field and once you get this panel done, he has no problem conferring with your vet so your pup can get better.

Here are some links. This first one will explain to you about the intermediate/sex hormones.

Steroid Profiles in the Diagnosis of Canine Adrenal Disorders.
Jack W. Oliver, Proceedings 25th ACVIM Forum, Pp. 471-473, Seattle, WA. 2007.

http://www.vet.utk.edu/diagnostic/en...is%20of%20.doc

General Info: Scroll to # 3 Adrenal Function, letter g (Adrenal Panel for dogs and cats...) is the one you want to do.
http://www.vet.utk.edu/diagnostic/endocrinology/pdf/endo_tests_info.pdf?r2

Submission Form for your vet
http://www.vet.utk.edu/diagnostic/endocrinology/pdf/endosubform06.pdf?r2

Below is a thread that has informative info on "Atypical Cushing's," most of the links I pasted for you I got from there also.

Congenital adrenal hyperplasia-like syndrome/ Hyperestrinism/ "Atypical Cushing's"

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

If there is anything you are not understanding, please do not hesitate to ask, I am still confused at times myself. :)

Hugs.
Lori

Squirt's Mom

08-29-2009, 03:15 PM

Hi Linda,

I wholeheartedly agree with getting the UTK panel done BEFORE you give Cocoa any Trilo. We have had several members here who started Trilo only to see signs getting worse instead of better even tho the cortisol was in the desired range. There are five other hormones that can be involved in Cushing's - Estradiol, Androstenedione, 17-Hydroxyprogesterone, Progesterone and Aldosterone. These hormones can be naturally elevated and adding Trilo always makes one or more of these hormones elevate even more. These other five hormones cause the same signs AND the same damages in the body that cortisol can, so ignoring them can be harmful when contemplating Trilo as a treatment.

As for cost, at our IMS it is about $260; at our GP it is about $300. The GP is higher because they don't stock the gel used but the IMS does. Something else that can affect the cost is whether your vet sends the sample directly to UTK or whether they are under contract with the lab they use to send all samples to them first, in which case their lab will simply sent on to UTK, tacking their charge on as well. This can also delay the sample putting it at risk for viability.

Something else that struck me hard in your last post were the nodules found on her spleen. My Squirt had the UTK panel done (positive for Atypical BTW - 4 of the 5 elevated) and Dr O recommended another ultrasound, which we did. This time a splenic nodule was noted and surgery was recommended. The nodule was a tumor, and it plus part of her spleen were removed. When we first started this journey with Cushing's, Squirt had all the tests done - LDDS, HDDS, ultrasound, and ACTH, and they all confirmed PDH. However, since her surgery her cortisol has returned to normal and her docs now say the initial diagnosis of PDH is "highly questionable". Non-adrenal illnesses can cause the Cushing's testing to be skewed (give false positives) because the body will naturally produce and release higher levels of cortisol in response to the physiological stress. Do not take those finding on her spleen too lightly, please. If Squirt's had not been noted and removed, it could have ruptured and easily have cost her her life.

One other point I want to make, for everyone's benefit, is what a holistic vet is. They are not practitioners of only TCM (Traditional Chinese Medicine) tho that is usually the perception, as it was mine until recently. A holistic vet is one that take the whole picture of the dog into consideration - they look at the pups environment, lifestyle, energy levels, personality, and more instead of only lab reports and studies. They may use TCM, but they also may turn to nutrition, homeopathy, or other approaches, plus any combination of approaches, as well as traditional Western medicine employing pharmaceuticals. So it is important when looking into using a holistic vet to ask what approaches they typically use, what do they most rely on. If they tell you they use strictly TCM and you are not comfortable with that, then look to another holistic vet. Ideally, a holistic vet does not limit themselves to one approach but use all of them as needed. So, holistic is not synonymous with TCM. When one thinks of holistic, think whole dog, whole picture, whole realm of possible approaches.

Ok, I'll shut-up now. :p

Hugs,
Leslie and the girls

nobonez

08-30-2009, 08:33 AM

Hi All,

I am starting a new post because I am still searching for feedback on people who have put their furbabies on either Trilostane or Lysodren. Our Cocoa was on Ketoconazole for Cushing's but this drug did nothing for her. Now the vet wants to put Cocoa on Trilostane but he had to tell me.......some dogs die for no unknown reason on Trilostane. He said with Lysodren it is high maintance and requires constant monitoring. I was just wondering if some of you would post about how your dog is doing and is it so bad to use Lysodren. I need to make a decision by Monday to get Cocoa back on something as she needs it.

For those of you who have already written me about doing the adrenal panel I will be contacting Cocoa's reg. vet Monday about doing so.

Thanks
Linda

Harley PoMMom

08-30-2009, 10:10 AM

Hi Linda,

I realize I've already posted to you about the UTK panel, but this is so important, so here is some info about it.
Hi Dorothy,

I switched both of my cushdogs from Trilostane to Lysodren. They are both Pomeranians (4.5 lbs and 8 lbs) and like your Mikey, they are a breed that is over represented when it comes to adrenal hormone imbalances. They should have never been placed on Trilostane without having a UTK adrenal panel done. After two years of treatment, Lulu's sex hormones had skyrocketed and I took both off of Trilostane immediately.

You are correct in that there is no way for you to tell if the elevation in the other adrenal hormones is due strictly to the Trilostane or if Mikey already had an imbalance and Trilostane has exacerbated the problem. In order for you to have correctly determined this, Mikey should have been taken off the Trilostane for at least 30 days before an adrenal panel. It is also very important that you go through a minimum 30 day washout period when transitioning to Lysodren. In our case, I waited until they were symptomatic again, plus we had acth stim tests done to make sure that cortisol levels were above 22ug/dl before loading with Lysodren.

With Mikey's very high post stim number before starting treatment, I don't believe that it is going to be possible to transition from Trilostane to Lysodren without loading. The two drugs work very, very differently...Trilostane is an enzyme blocker which over time actually enlarges the adrenal glands whereas Lysodren shrinks the adrenals as it erodes the adrenal cortex to a point where they no longer oversecrete cortisol and in most cases, the sex hormones. Maintenance doses of Lysodren given with melatonin and flaxseed can be effective in reducing cortisol in dogs with mild cortisol elevation but Mikey doesn't have mild elevations so I would be very surprised if this treatment regimen is the right one for Mikey.

My Lulu lost 3/4 lb and with a starting weight of under 5.5 lbs, that was pretty significant. I wrote to Dr. Oliver at UTK and asked him if he had experienced this phenomenon with other atypical dogs. He said yes, weight loss can be due to the excess sex hormones. I would very much like to hear how your IM was able to pinpoint the absorption problem with Mikey. Other members have also reported weight loss in their pups while having a very healthy appetite. It is very difficult to watch your dog lose weight and not know why it's happening.

According to the UTK adrenal panel, Mikey's cortisol is being controlled by the Trilostane so like you, I am very confused as to why your IM would suggest increasing the Trilostane. :eek:

My IM consulted with Dr. Oliver at UTK to discuss the best approach to Lulu's treatment. It was mutually agreed that Trilostane should be discontinued and treatment with Lysodren be started after an appropriate washout period. Perhaps you might suggest that your IM consult with Dr. Oliver too.

I hope this helps.

Glynda

Also, I will be starting my Harley on Lysodren in 2 weeks, he has to start on Lysodren NOT Trilostane because of his elevated intermediate/sex hormones.

Hugs.
Lori

Squirt's Mom

08-30-2009, 11:52 AM

Hi Linda,

I just want to reinforce what Lori has said about the use of Trilo without having the UTK panel done first.

I also want to tell you this - when I first heard of Cushing's and started researching, Trilo was the way I wanted to go because of the hype of how much "safer" is was than Lysodren...Lyso scared me to pieces! :eek: However, as time went on and I learned more it became obvious to me that the "safer" business was just crap! Both drugs can cause the same adverse effects when not properly administered and monitored. So do not let that be a factor in deciding which one would be best for Cocoa.

Trilo can actually result in more monitoring and testing to get the dose tweaked just right...and some pups require frequent tweaking on Trilo. Also, Trilo is taken every day while Lyso is taken only a few times a week once the loading phase is past. So the cost factor is kinda hard to pinpoint and compare between the two as each pup is different.

My Squirt is Atypical and is being treated with melatonin and lignans only at the moment (for Atypical), tho Lyso may be in her future, too, like Harley, but only as a maintenance dose given a few times a week, not daily.

And, today I am quite comfortable with the prospect of using Lyso...no major fears like at first.

I am ever so grateful that these kind folks here taught me about Atypical and the UTK panel before I started any treatment on Squirt. If I hadn't heard about this form or hadn't listened, I sincerely doubt she would be doing as well as she is today...and much more money would have been spent trying to figure out why! :eek:

Keep asking questions of us and keep questioning your vet's recommendations... not because they are wrong, but simply because that will help you learn more and more. Knowledge truly is power when dealing with Cushing's! :)

Hugs,
Leslie and the girls

lucygoo

08-30-2009, 12:09 PM

Hi Linda..

I had Lucy on trilostane for 2 years, and she did great. There were a few side effects here and there, and we had to tweak the dosage a little bit, but it controlled her cushing's so well she was able to have life-saving surgery in May of this year.

I was advised against lysodren. Every dog and every situation is different, but I'm a fan of trilostane. And if your dog is not "atypical", there's no reason to fear it.

Good luck:)

Gina

nobonez

08-30-2009, 12:40 PM

What does 'Atypical' mean?

I need to find this out to ask Cocoa's vet.

Thanks
Linda

Roxee's Dad

08-30-2009, 12:53 PM

Hi Linda,

Trilostane or Lysodren? Hmmm that is always the big question. :)

Before choosing treatment, most members will agree on one thing. Be sure of a proper and thorough diagnosis. Work with a vet or IMS that does have experience in the treatment of cushings, and one that is willing to work with you as a team. I and quite few others have fired our vets because of lack of knowledge or they didn't like being questioned by us. We / you are the advocate for our /your pups.

There are so many success stories with both Lyso and Trilo but I think everyone will agree that a proper and thorough diagnosis is most important before choosing.

Both need monitoring via ACTH stim test. Both can have less than desirable affects if improperly administered and improperly monitored. And worse if prescribed by an unknowledgeable vet. But both can make your pup happy and healthy again.:D if properly used.

Small story: I met a vet a few weeks ago and we discussed cushings amognst other canine related topics. He told me his only experience was with his dog and the dog died.:eek: He responded that he should have investigated further before starting treatment. My first thought, Duh, yeah...I won't be bringing any cush dog to his office.:eek::eek::eek:

You have been given a lot of good advice. If I had a do over, I would without a doubt get the UTK panel before starting treatment with Trilo in fact I would do the UTK before starting any treatment. Sometimes we don't get do overs.

Roxee's Dad

08-30-2009, 01:01 PM

Oh Yeah, This reminded me of my first post in this forum. The title was "Is it too late to try trilostane"

I also thought Trilo was the newer and safer treatment. The Trilo did work but there were other problems that I kept wondering if the trilo was causing. Didn't know, vet wasn't sure. The only way to find out was a UTK panel.

Squirt's Mom

08-30-2009, 01:13 PM

What does 'Atypical' mean?

Hi Linda,

Atypical Cushing's is a form in which some or all of the other five hormones involved in Cushing's are elevated naturally, meaning the elevations are not caused by anything external - such as Trilostane.

An Atypical pup will not have elevated cortisol. If cortisol is involved as well as some or all of the other five hormones, then the pup is considered to have "true" Cushing's with concurrent elevated intermediate/sex hormones. These intermediate/sex hormones are Estradiol, Androstenedione, 17-Hydroxyprogesterone, Progesterone and Aldosterone.

All of these hormones will usually respond to treatment with Lyso, except for the estradiol. Estradiol can be produced outside the adrenal glands and since Lyso works on the adrenal cortex (outer layer of the glands) it cannot counter the estradiol if it is produced outside the glands. Estradiol can be produced in hair follicles, adipose (fat) cells, reproductive organs, and skin to name a few. Melatonin and lignans are used for Atypical pups to help get these hormones back in line, especially the estradiol. It is not uncommon for an Atypical pup to go on a Lyso maintenance dose as well, but no loading phase.

Here are some links about Atypical, the hormones involved, testing info, etc.

Atypical Cushing's:

DVM360*:
http://veterinarynews.dvm360.com/dvm/article/articleDetail.jsp?id=485128&sk=&date=&pageID=1

UT Panel
Explanation of hormones
http://www.vet.utk.edu/diagnostic/endocrinology/treatment.php

Cost sheet
http://www.vet.utk.edu/diagnostic/endocrinology/index.php

I hope this helps!
Hugs,
Leslie and the girls

Carol G

08-30-2009, 01:17 PM

My Winnie was on Lysodren and then switched to Trilostane. On both, she required some tweaking. She did not require more monitoring and testing on the Trilostane.

For either drug, I think the key is that your vet follow treatment protocol and, if not strongly experienced in the use of the drug, have someone who is to consult with.

With Lysodren or Trilostane, I feel the real problem is when vets are not following protocol and/or decide to fly by the seat of their pants.

Winnie is no longer with us but her death had absolutely nothing to do with Cushings or Trilostane.

Carol & Atty Cat and always Winnie & McGill

Harley PoMMom

08-30-2009, 01:24 PM

Linda,

My Harley is going on this "Lyso maintenance dose" that Leslie posted about, this is when your dogs cortisol levels are not that high, but some of the intermediate hormones are elevated, and you do not need to "load" you dog on the lyso, it's just a maintenance dose. The only way I found this out was thru the UTK panel, this was Dr. Oliver's suggestion of treatment for my Harley, Dr. Oliver will have suggestions for treatment along with the UTK panel. Please, please consider having this done.

Hugs.
Lori

Barney's Mom

08-30-2009, 02:24 PM

I too initially chose Trilostane because I felt it was the safer option. I was terrified of loading with Lysodren. Trilostane didn't work for my dog because he was on Benazepril to protect his kidneys and this drug and Trilostane taken together caused his potassium levels to rise to unsafe levels. Another factor to take into consideration is the size of your dog if you are to choose Trilostane. I don't remember the cost, but my dog was 52 pounds and the amount of Trilo he needed made treatment very expensive.

We ended up switching to Lysodren. Both drugs control his symptoms equally well.

Cheryl

acushdogsmom

08-30-2009, 03:37 PM

Trilostane was not yet a treatment option when my boy was diagnosed with Cushing's. He was treated with Lysodren for more than 6 years and he did wonderfully well on it. All of his Cushing's symptoms disappeared, he was well and happy and he acted years younger than his actual age once we got the Cushing's well controlled.

The key to successful treatment, in my opinion, is to have a good heads-up Vet on the case, who knows all the ins and outs of the condition and who is also very familiar and comfortable with the treatment being used ... knows how to adjust dosages and how to monitor the treatment properly etc.

My dog's Internal Med Specialist treats with both (Lysodren and trilostane) but she says she actually prefers the Lysodren because Lysodren only has to be given a few times a week as opposed to every day with the trilostane and she says that the cost (long-term) of the Lysodren is also much less than for dogs treated with Vetoryl/trilostane here in Canada. She says that there also isn't the problem of watching for the rising "intermediate adrenal hormones" with the Lysodren that she sees fairly often with the trilostane. And since she doesn't have to watch for the rising intermediate adrenal hormones with Lysodren, she can use the regular ACTH stim tests to monitor the treatment rather than having to do the more expensive UTenn "adrenal panel/ACTH stm" which she recommends doing before and during treatment when she treats with trilostane.

P.S. As far as I know, both Lysodren and trilostane require doing ACTH stimulation tests to monitor the cortisol production. If your Vet is saying that trilostane doesn't require as much monitoring as Lysodren does (i.e. doing periodic ACTH stim testing) I don't think that's right.

With both, the main thing is that you need to check the cortisol production with ACTH stim tests until you know you have the right dose, and then you need to do ACTH stim tests again, several times a year (maybe two or three times a year?) for as long as the dog is on the medication, to be sure the dose is still right and doesn't need adjusting, even if the dog seems to be feeling just fine.

With trilostane, you may need to also check the production of intermediate adrenal hormones from time to time, because trilostane tends to elevate some of those intermediates even while keeping cortisol nicely controlled. The only way to check the intermediates is to do that UTK/UTenn complete adrenal panel, which is actually a regular ACTH stim test, but the UTenn Lab can measure cortisol PLUS the other adrenal intermediate hormones instead of only cortisol, if requested to do so.

nobonez

08-30-2009, 05:12 PM

I am wondering why to myself that the specialist vet did not suggest getting the adrenal panel done on Cocoa. This Clinic I go occasionally too is only specialists in their field and the vet is a internist. Once hearing Cocoa had Cushing's I stopped taking her to her reg. vet and took the 40 min trip to the speciality Clinic because I thought they knew more their. After reading the posts coming in I do wonder just how much this vet I have their knows. I do know that come Monday morning I'm making a appointment with Cocoa's reg. vet and mentioning the adrenal panel to him and see what he has to say. I'll be praying he knows of it because I do think he's a good vet.

Can anyone tell me approximately what we'll be looking at $$ wise to have this adrenal panel out of Tenn. done and how long does it take for results to come back? When all done and overwith Cocoa will probably be our $10,000 dog!

I am suprised with the post coming in that none of were scared off the Trilostane as I was by when the vet told me......some dogs die on this drug for 'no unknown' reason. For that reason alone I still never gave Cocoa the pill and I've had them since Wednesday.

I just wanted to THANK all of you for posting to me so I can educate myself and try to know what the vets are talking about.

Linda

Roxee's Dad

08-30-2009, 05:40 PM

Hi Linda,
Glad to hear you will be discussing the UTK with your vet. Just wanted to mention that if you are going forward with the UTK, I believe you want to keep Cocoa off the meds until after the test is completed.

Cost of the test is approx 135 U.S. Dollars plus what your vet will have to charge, and shipping. I believe someone (Leslie) gave you the link to the UTK website and the price list is there.

You should print out the instructions for the UTK adrenal panel and bring it to your vet. You would be surprised how many vet's don't know about it.

Harley PoMMom

08-30-2009, 05:48 PM

Linda,

Many, many GP's are not familiar with the full adrenal panel/Dr.Oliver, why, I haven't the foggist idea. As for the price, I believe now the full adrenal panel cost $140.00, your vet can ship it right to the lab in Tennessee and just charge for the blood draws, spins...etcs. It costs me at my Harley's GP for the full adrenal panel, total cost was $230.00. The results take 10-14 days to get back, but are well worth the wait. Harley's GP did not know anything about the full adrenal panel but was willing to learn all about it, this can mean alot too. She talks with Dr. Oliver by phone and emails alot, concerning Harley's treatment.

Hugs.
Lori

Buffaloe

08-30-2009, 05:52 PM

Hi Linda,

Here is a link to Tennessee's website describing their various tests and the costs.

http://www.vet.utk.edu/diagnostic/endocrinology/index.php

The test that we all think would be so valuable for Coco is the 7th one down under adrenal panel. It is called the adrenal panel (ACTH stim). Tennessee's price is $140. Your vet or internist will charge you for the blood draws and sending it to UTK...probably another $140 or so. Total cost is somewhere around $280 depending on what your vet charges. You want your vet to send it straight to Tennessee. It usually takes 8-10 days before Tennessee faxes the results back to your professional.

The beauty of it is that you get your regular ACTH test results plus the results of his other 5 intermediate hormones. This is valuable information in your choice between Trilostane and Lysodren.

Unfortunately, it can sometimes get pretty expensive to take great care of our elderly dogs. They pretty much get the same illnesses as us...heart disease, cancers, diabetes, etc. My Shiloh has been through alot but I have never spent three seconds trying to add up all I've spent on her. She is almost 15 and she is still my happy, healthy, ridiculously faithful Partner.

Take a few minutes and click on some of the links up on the left side of the website I sent you, certainly "treatment options." It is some of the best information you will find about cushing's, diagnostics, intermediate (sex) hormones, etc. Good luck with Coco.

Ken