Introduction to Maelo's case (Adrenal tumor, treatment with Lysodren)

[Maelo mom]

Hi,

My name is Kelly and i would like to introduce to my dog Maelo's case, as we are still trying to figure out his Lysodren maintenance dosing (i think) and i realized after the induction phase, I couldn't keep texting my vet every time i had a question all days and all hours! (Even though she ALWAYS responded and was great a help as we started our maelo Lysodren).

We are looking for any additional opinions/advice as to his treatment and responses to current treatment etc...

Maelo is a pound puppy and full fledged Mutt!
A "shepherd mix" , medium in size, 75 lbs
Born around April 1996, which makes him 13 1/2 years old!
He is the BEST most dedicated smartest dog everyone i know has ever met (of course i am his mom and so coudl be a little biased.. ;)
We have had him since he was 3 months old.

The Facts
In May 2008 he started drinking A LOT of water.
So much, so i started doing research on diabetes and first stumbled across Cushings on line.
We took him to the vet for a check up.
They did a chest x-ray and saw nothing but perhaps "lumbar arthritis" and gave us some rimadyl as i felt he was in pain.
I don't believe they tested for Cushings at that time.

May 2009, while we were on our honeymoon, my parents were taking care of him, as they do often, and notice he was drinking A LOT of water.
They took him to the vet, in our home town, and after a sonogram found "an adrenal mass with phenric vein invasion”

After we returned we took him in to our regular vet and did the ATCH stim tests and found he was "cushinoid".

We debated on how to treat, as the literature for Lysodren seems frightening
Tracked water consumption (16-18 cups in 24 hours)
After speaking with a our home town vet (who found the mass) with over 20 years experience, he said Lysodren is what he uses on all the dogs with cushings over dosing was unlikely since maelo is larger breed.

We started him on 750 mg 2/x a day on Wednesday August 12th 2009.
I started seeing improvement in water consumption, mood and energy in 12 hours!
By Sunday night, 5 days into induction, he began throwing up and not eating. (we expected induction to take 7-10 as typical)
We immediately stopped the Lysodren and took him to the vet for electrolyte check and other tests to be sure he didn't need the antidote.
All things checked ok to begin maintenance dose.
The following Sunday we began the maintenance dose of 750 mg /2x week or 1500 mg/week.
All was good for a few weeks and then water consumption began to increase again until we were back up to 16 cups a day!
He also began panting and drinking lots the day before his dose.
I personally felt the dose could be increased and he might benefit from 3 x/week dosing.

Side note-
In between, he has also had a bladder infection which i notice from urgency frequency and then blood!
He has been on antibiotics stopped and back on since it had re-occurred.
Last urinalysis was clear but i have a feeling we will be back on as it will re-occur.(just a gut feeling)

Re-check at vet showed his levels down to 11 from 18 (18 was always on low side of high i guess for Cushings?)
so the dose could be increased to get him down to the normal of 1-5.

We are now giving 625 mg lysodren/3x/week. Monday Wednesday and Friday or 1875 mg /week
Water consumption still is up. I just got him back from my parents and so will monitor consumption for a week before we return to vet to check levels again.

He is peppy still and seems happy, but anxious at times and i think STILL drinking a lot of water.
We have had no accidents in the house or “leaking” at all, just some close calls when he has a UTI.
he holds it all night but drinks water in the middle of night so we aren't doing so bad but i feel like the water consumption should come down to really help his quality of life as well as perhaps help the anxiousness he seems to feel, which i understand has to do with the Cortisol levels

i have read the adrenal cushings is different than pituitary cushings and adrenal cushings does not respond AS well??
According to standard dosing he is at the max per week for his weight of 75lbs.
Is it possible he could need more because it is an adrenal tumor?

Any other comments questions advice based on the facts above.
Additional questions that could help determine how to get him to the correct maintenance dose?
I find that Lysodren treatment and tweaks really depends on a vets experience and so am looking for any additional information we can find out there.

Looking forward to seeing your comments and responses!
Thank you!
Kelly Eugene and maelo!

[Harley PoMMom]

Hi Kelly,

Welcome to you and Maelo from me and my boy Harley. I am so sorrry for the circumstances that brought you here but I am so thankful that you found this forum with these amazing and knowledgeable people.

I want to warn you that we ask alot of questions from our new members :eek: so are you ready for some questions from me :eek::) just a few tho :p;):D Besides excessive drinking and panting, what other cushings symptoms does Maelo have? Is Maelo on any other supplements or herbs? Did Maelo have a CBC or Chemistry panel done, and if so, could you post the abnormal test results with the units and reference ranges. Was Maelo tested for diabetes? Was the sonogram/ultrasound done on a state-of-the-art machine and read by someone qualified to do that? What other things about the internal organs were found on the sonogram/ultrasound? Did your vet say anything about a referral to an IMS for maybe surgery for the adrenal mass?

I am so sorry about all the questions but the better we get to know your precious Maelo the better we can help you help him.

I know this cushings journey can be frightening but please don't worry you have found us and we are here for you always...please ask all the questions you want, refer to our resource thread and read there and then come back and ask...ask and ask, we will try to answer your questions to the best of our knowledge but we are always here for hand-holding. :)

Helpful Resources for Owners of Cushing's Dogs

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

Lysodren loading Instructions and related tips

http://www.k9cushings.com/forum/showthread.php?t=181

Links to Cushings Websites (especially helpful for new members!)

http://www.k9cushings.com/forum/showthread.php?t=180

Hugs.
Lori

[BestBuddy]

Hi Kelly,

I don't have any experience with Lysodren but Lori has given you lots of reading material. I did want to say welcome to you and Maelo and let you know that although all our stories are different and treatment varies we are all or have been in the same boat as you.

Jenny

[Maelo mom]

Hi Lori,

Questions are great. I expected them and tried to give as much information as i knew was pertinent but not being a veterinarian or have gone through this before with another dog, one doesn't always know the information that is important, so this is perfect and there can never be too many questions for maelo!

So here goes. I will answer to the best of my knowledge and get back to you on things i might not know.

Besides excessive drinking and panting, what other Cushings symptoms does Maelo have?
1-Sleeping a lot-i expect the sleeping is from just being a 13 1/2 year old and to be expected.
2-weak back legs especially getting up and down and going UP stairs-weakness is also to be expected as they get older but i read it is symptoms of Cushings too?
3-He has 2 urinary tract infections since he started Lysodren. is it Lysodren or Cushings? i don't know.
4-Distended tummy- i can't really tell...i think so.

Is Maelo on any other supplements or herbs?
1- No other supplements or herbs.
2-Just antibiotics when he has had the UTI's

Did Maelo have a CBC or Chemistry panel done, and if so, could you post the abnormal test results with the units and reference ranges.
1-Yes. I have to get this from the vet office on Monday.

Was Maelo tested for diabetes?
1-I don't know. This was the first thing i had asked the vet about in May 2008, so i assume he was. Will ask Vet and get back to you.

Was the sonogram/ultrasound done on a state-of-the-art machine and read by someone qualified to do that ?
1-I have a report from the "Sound Technologies" a company out of NJ.
www.soundvet.com
2-It does not say the machine type or name that i can see on the report.
3- I believe they are qualified to read the sonogram, as the report is extensive

What other things about the internal organs were found on the sonogram/ultrasound?
1-Yes, the report comments on all other organs as well. it is lengthy. Should i scan and post?

Did your vet say anything about a referral to an IMS for maybe surgery for the adrenal mass?
1- Yes. Because it the mass is growing into a major vein that is near the gland it is in-operable and at 13 1/2 years old, i was not really an option for us.

Ask away please. As many questions as are necessary. I certainly had and have plenty of questions as we progress but haven’t completely relieved the symptoms’ yet!

Thank you!
Kelly

[Harley PoMMom]

Hi Kelly,

First let me say YOU are doing a wonderful job taking care of Maelo, this cushings disease is a dratted one and a confusing one. :eek::) but that's where this forum and these amazing people fall into play, they really help with the confusion. Here's a post from one of members who has pup named Shiloh who just celebrated her 3 year adrenalectomy, now I realize that is not feasible operation with Maelo but Ken, Shiloh's Dad really know his stuff when it comes to adrenal tumors. This post has some interesting information in it, now the drug this member chose to use was Trilostane, and you are using Lysodren.


Hi Mary,

I'm sorry Nellie has an adrenal tumor. My dog had a very large adrenal tumor in her left gland surgically removed almost three years ago and is doing real well. I completely understand your decision not to have an adrenalectomy. Tumors in the right gland are certainly more difficult to remove.

It is very common for the unaffected adrenal gland to be of normal size and shape. Shiloh's right gland was of normal size and shape and she had her tumor for a long time. Just because Nellie's left gland is normal size, that does not point toward a diagnosis of pituitary cushing's in any way, shape or form.

The lessening in appetite is the #1 thing to look for when medically treating an adrenal tumor. You also want to watch for her drinking less water and signs of increased lethargy. These are all signs she has had too much Trilostane. Adrenal tumors often need higher doses of Trilostane or Lysodren and/or for longer periods of time than pituitary tumors. It may take a while before you see any changes in Nellie but keep your eyes on her.

Many internists prefer Trilostane over Lysodren for adrenal tumors and many prefer Lysodren over Trilostane. Many people in your position try one and if it doesn't seem to be improving the symptoms, go to the other after a wash out period.

At some point, I strongly encourage you to have the ACTH/full adrenal panel done at the U. of Tennessee. It's not that big of a deal. The only downside is that it takes 8-10 days to get the test results and it costs a little more than a straight ACTH test, maybe $50-$75 more. Not much. This is a little tricky but most adrenal tumors secrete excessive amounts of some of the intermediate (sex) hormones. These are not good and can be very bad for the dog. Long term use of Trilostane has been shown to increase some of these intermediate hormones whereas Lysodren will decrease most of them. There are 5 of these intermediate hormones. If Nellie is secreting excesses of some of them, that would be a significant factor in taking a good look at using Lysodren.

Now I'm going to take it a step further. One of the 5 hormones is called aldosterone. If the adrenal tumor is producing excessive amounts of aldosterone the dog will suffer from hypertension and electrolyte imbalances (low potassium and high sodium). Low amounts of potassium can be really bad for a dog, as is hypertension, of course. Neither Lysodren nor Trilostane will effect aldosterone. But, a drug called spironolactone will very effectively counter-act the damaging effects of the high aldosterone. I'm sure there are so many dogs out there suffering terribly from high aldosterone when all they need to do is take the above named anti-aldosterone drug. Hey, I told you it is a little tricky. But all you need to do is have the ACTH/full adrenal panel done (at some point) and then work with somebody who really knows about medically treating adrenal tumors.

You have done a great job with Nellie. You went above and beyond in your diagnostic process and you have her on Trilostane. But I hope you will consider having the adrenal panel done, then you will really know what you are dealing with. Good luck to you and Nellie.

Ken

Has Maelo blood pressure ever been checked? Do you have prednisone?


3-He has 2 urinary tract infections since he started Lysodren. is it Lysodren or Cushings? i don't know.

Excessive amounts of cortisol can suppress the immune system to the point that it can't respond properly, thus making our Cushinoid pups susceptible to infections.


Did Maelo have a CBC or Chemistry panel done, and if so, could you post the abnormal test results with the units and reference ranges.
1-Yes. I have to get this from the vet office on Monday.
I suggest then you get copies of all tests done on Maelo and keep them in a file for yourself, this is needed, just in case you would need to take him to an Emergency Hospital to give to the dr on duty, also it is handy for you to keep track of for Maelo health and for when we ask questions. :p:D


What other things about the internal organs were found on the sonogram/ultrasound? 1-Yes, the report comments on all other organs as well. it is lengthy. Should i scan and post?
You could do that and we'll see if we can read it, if not we'll ask you more questions about it. :eek::p:) For my boy Harley's U/S is says: Liver diffusely mottled & hyperechoic; enlarged; Multifocal illdefined, rounded, nodules up to at least 9mm. Then on another page it has 1. Liver: - ddx: Metabolic changes, hyperplasia/EMH, Neoplasia. There's one for his spleen, gall bladder, right and left adrenals, right and left kidney and pancreas. But it's all in what they find in the U/S as to what they write up.

Like I mentioned before, you are doing a wonderful job, I am sure others will be by soon to share their experiences and wealth of knowledge...hang in there, ok.

Hugs.
Lori

[Maelo mom]

Lori,
Thank you for the inofrmation.
i am going to get a copy of the latest blood work and scan the sonogram report with all organs noted tomorrow.
is there a way to attach pdf's to the posts?

kelly

[Harley PoMMom]

Lori,
Thank you for the inofrmation.
i am going to get a copy of the latest blood work and scan the sonogram report with all organs noted tomorrow.
is there a way to attach pdf's to the posts?
kelly

Good question about the pdf's, I will have to ask someone more knowledgeable and computer literate than me. :(:p:) I'll ask them to either PM you or they will post here, ok.

Love and hugs.
Lori

[Franklin'sMum]

Hi Kelly and Maelo,
I'm sorry Maelo has Cushing's. I'm new here myself, and only have limited experience with Trilostane.
I'll leave all things Lysodren to the very kind people here who have experience with it.
This is a wonderful group of folks.
Welcome, and good luck with your Maelo.
Jane and Franklin xx
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