Alivia was recently diagnosed with Cushing's - Alivia has passed

Hi Mary Beth,

Thank you for all the information you've provided on Alivia. I'd still like to know if the other adrenal gland is normal in size. Maybe you can just call the vet and ask?

Glynda

Hi, Glynda.

Your post reminded me that I needed to call them and request the ultrasound report again. Thank you! I just got off the phone with them and they are to fax it to me, so hopefully I will have it in a little while and will post the info. The receptionist wouldn't be able to tell me anything and I am still waiting for a return call from the IMS from two weeks ago, so that would have been useless! :mad:

Thanks again for your time!

Stay tuned....
Mary Beth and Alivia

Hi, Glynda.

I finally received Alivia's ultrasound report that was done by her IM. It is not really long so I will type it in its entirety. I am not at all happy that it contains things she never even mentioned! Here goes:

Ultrasound Abd - liver- course echotexture throughout with small hypoechoic lesions scattered throughout
GB - single stone noted along with other echogenic debris in lumen
spleen and kidneys unremarkable
urinary bladder WNL
left adrenal: 2.29 x 0.35 x 0.42 cm
right adrenal: 2.43 x 1.21 cm x 0.5 cm
suspect adrenal mass, right side, cranial pole

Looking forward to your thoughts and anyone else who would like to comment as well!

Thanks,

Mary Beth and Alivia

Quote:

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Originally Posted by Rene

Hi Mary Beth,

When I mentioned it earlier it, was Dr. O that told me that the Maintenance lyso could be used along with the lignans and melatonin without loading. My IMS confirmed this. However, Snoops cortisol was too high (104.8/426.4 ng/ml) and she had to be loaded. I believe Ali's is much lower and according to this theory, you could try this. I believe the course was to administer for three months and retest the cortisol and intermediates.

I was really hoping after I posted that, that someone who has actually tried this succefully would come along and post their experience. It did not work for Addy but I am curious what Zoe's Cortisol was when they started? Supposedly, it is only an option for cortisol that is not really high.

I am also skeptical and would love to know if this actually worked for anyone and what the cortisol was before and after the 3 months if it did...anyone?

Your doing a great job with your research...hang in there. Any decision is a good decision!

Rene and Snoopie

---

Hello,
I just wanted to relay my experience with Max - a maltese who was initially diagnosed with Atypical Cushings. I was resistant to doing a full loading so tried the Maintenance dose of Lysodren only route (with Melatonin and Flax hulls).

3/27/09 adrenal panel from Univ of Tenn cortisol levels:
pre 22.1 ng/ml
post 192.7 ng/ml

Max at the time I started was 11.5 lbs, and, 4/10/09 I started him at the low end of the Maintenance dose range at approx 25 mg/kg - so Max got 62.5 mg of Lysodren twice a week (mondays and thursdays)

5/16/09 ACTH stim results:
pre 4.4 ug/dl
post 21.4 ug/dl

5/20/09 - did a "mini load" of 62.5 mg per day for three days (wed, thursday and friday)

5/25/09 (monday) - changed his dose to 62.5 mg three times a week (mon, wed, friday)

8/7/09 ACTH stim results:
pre 3.2 ug/dl
post 11.9 ug/dl

Aug 2009 Max was diagnosed with a heart murmur

Sept 2009 Max tested positive for Lyme Disease (treated successfully with antibiotics)

in Feb 2010 Max had his spleen removed and biopsied and liver biopsied (both biopsy results were benign)

still maintaining Max on the 62.5 mg three times a week

6/11/10 ACTH stim results:
pre 3 ug/dl
post 16.5 ug/dl

by this time, Max had lost some weight and was down to 8 lbs, 12 oz

still maintaining Max on the 62.5 mg three times a week

3/18/11 ACTH stim results:
pre 3.8 ug/dl
post 28.1 ug/dl

You can see the Maintenance Dose only did not work for Max.

However I DO think I wasn't as focused on the Lysodren treatment as I could have been. What I mean is that after the May 09 "mini-load", Max's cortisol levels did drop somewhat. But then they went up again by the time of the next ACTH stim. In August of 2009 I should probably have done another "mini-load" and seen where that took us. But at that time Max was diagnosed with the heart murmur and that led to visits to the cardiac vet, and then he tested positive for Lyme, and then came the spleen removal - and I let all those things distract me from trying to control the Cushings.... :(

After the 3/18/11 ACTH Stim being so high, I decided to go the full loading route. This was mostly because of Max's heart murmur - the cardiac vet suggested I get the cortisol levels under control.

If you are interested, you can read the rest of Max's story under his thread - but for a quick summary: I loaded Max at the 50 mg/kg rate (he got 93.75 mg twice a day) and stopped after 4 1/2 days. The ACTH stim results were pre 0.8 and post 1.1 ug/dL. A little too low since Max was very lethargic. He was eating, but was very lethargic and not the normal Max. I gave him prednisone for 4 days. Retested with another ACTH stim this past Monday and he was pre 1.6 and post 2.4 ug/dl. Am now starting Maintenance at the low end of the range - giving him 31.25 mg three times a week. Just started the first dose today.

I hope our experience is helpful to you. I know I was/am eager to hear actual experiences of other people, and I think this site helps one do that.

Janette

Hi, Janette,

Thanks for your post, but I am really confused.

I am looking at Alivia's results from University of Tennessee and the normal cortisol baseline range is: 2.1-58.8 ng/ml and the normal range post ACTH is: 65.0-174.6 ng/ml

According to what Alivia's results say, your Max's are almost always way too low. Or, are the normals that much different for a male dog?

I will read your thread later on to see if I can figure out why your numbers are so low.

Thanks,

Mary Beth and Alivia

Mary Beth, the results that Janette posted are in ug/dl. Ali's results are in ng/ml. That's why Max's results appear low, & I think that might be what is confusing you. To convert Ali's results to ug/dl, simply move the decimal one place to the left. For example, the normal ACTH range you posted would be 6.5-17.5 ug/dl. The other thing to keep in mind that the normal range on an ACTH for a healthy pup is much, much different than a cushpup under treatment. A pup under treatment needs to have their ACTH from 1-5 ug/dl.

Hope this helps.
Debbie

Thanks, Debbie -

I see now where her first results from U of Tenn were in ng/ml and the others were in ug/ml. I guess the testing must have been done elsewhere. Can they make this any more confusing?? :confused:

Alivia's first ACTH test was $410. That was for the test only, no examination. The breakdown was actually $322 for the test and $88 for a .2 ml injection of Cortrosyn. So expensive for one test! Is that about standard? I know things vary geographically, but if she has to keep having this test done, I may have to drive her to a different location!

Thanks for all the information everyone!

Mary Beth and Alivia

$410.00 for an ACTH stim test sounds high to me. My vet was charging me $160.00 for Harley's stims.

That is outrageously high for a stim. My GP vet was charging about $250.

Wow! That is a HUGE difference. I have been suspecting that Ali's IMS is extremely expensive. It is bad enough that she charges a fortune for testing, I just found out when I requested a copy of Alivia's ultrasound report that she fails to tell me things that the tests show - she NEVER mentioned a gall stone. Not happy about that.

Hi Mary Beth,

I was paying $250.00 for Corky's stim tests, but the last two he had were higher. The cost of the Cortrosyn and lab fees went up. I am now paying $315.00

Terri

So far I am still the highest! :p But, that's definitely not a good thing!!! It might be interesting to start a thread with just what people are paying for the ACTH tests and where they are from.

Mary Beth, I'm going to give you a link to Dr. Peterson's blog. He is one of the foremost endocrine experts in the country. Your IMS may be using what they need from a whole vial of cortrosyn when doing Ali's stim, & tossing the rest. He has instructions on how to make up the whole vial then separate it into smaller doses, freezing what is not used at the time. The frozen cortrosyn can be used for up to 6 months. This can cut the cost of a stim considerably as the drug is the most expensive part of the test. When you pull up the blog, go to the links on the right side of the page, click on the one for Cushing's, go to the post for 3/22/11. If you have trouble finding it let me know. I will tell you that when my Harley was first diagnosed, & my former IMS did his stims, she was charging in the $400 range.

http://endocrinevet.blogspot.com/

Debbie

PS- We already have an on-going poll about what people are paying for various tests. If you will go to the sub-forum below the main Cushing's forum, there are a number of different polls listed pricing on various tests. They are usually listed by country.

Thanks, Debbie. I will check out the link, but according to my invoice I only paid $88 for the Cortrosyn and $322 for the test itself!

Thanks for the info on the poll threads. I voted, but it doesn't seem like a lot of people have participated in it. :( I am still definitely on the high end for all testing!

Hi,

Was that just for the stim or for the UTK panel? I don't remember exactly what I paid for Zoe's UTK panel but I think it was pretty close to the numbers you listed drug plus the test.

Hugs,
Addy

Hi, Addy -

This is all new to me so I am not quite up to speed on all the lingo. No idea what a "UTK panel" is! The invoice lists: "Adrenal Function Testing - Tennessee $322" and "Cortrosyn Inj per .2 ml. $88" for a grand total of $410. Obviously this is the test that went to Dr. Oliver and included a check on Cortisol and 5 other hormones. Is there something less that can be done in between to check on whether treatments are working?

At the moment, I am still leaning towards watching and waiting a bit before beginning any treatments (other than the natural supplements), as Alivia's symptoms do not seem nearly as severe as many I've read here. In fact, they seem to be lessening. In the past she has been totally symptom free for long periods of time, so I am hoping that occurs again.

Thanks for your concern,

Mary Beth and Alivia

Sorry, I get so used to calling it UTK :o University Tennessee Knoxville=UTK panel:D

Then that is about what I paid- I believe that full adrenal panel is more money than just an ACTH test which does not check all the other hormones, only the cortisol.

Once you start treatment- I am not sure how often they run the full adrenal panel verses just a stim to check cortisol. I am hoping that the full panel will not need to be done every test but maybe others can chime on on that.

I believe there is also a test to just do a post stim not a a pre measure of the cortisol but it would probably depend on the vet and where you are in the treatment phase.

We will all be eating popcorn for dinner soon:D:rolleyes:

Hugs,
addy

Quote:

---

Originally Posted by MBK

Hi, Addy -

This is all new to me so I am not quite up to speed on all the lingo. No idea what a "UTK panel" is! The invoice lists: "Adrenal Function Testing - Tennessee $322" and "Cortrosyn Inj per .2 ml. $88" for a grand total of $410. Obviously this is the test that went to Dr. Oliver and included a check on Cortisol and 5 other hormones. Is there something less that can be done in between to check on whether treatments are working?

Mary Beth and Alivia

---

I can now see why you paid more, the UTK (University of Tennessee) Adrenal Function test that gets sent to Dr. Oliver's lab is quite more expensive than just a regular ACTH stimulation test.

The "regular" ACTH stimulation test is used sometimes to help diagnose Cushing's and used primarily to monitor treatment with Lysodren and Trilostane.

So, Alivia has had a UTK panel! Who knew?! Glad to hear that when (if) I begin treatment there are less expensive tests available for monitoring!

Pocorn for dinner? I may have to see if I can find a generic brand of popcorn at the rate of Alivia's medical bills! :rolleyes: Oh, well. Thank goodness her vets all accept plastic!

Thanks to both of you for clearing up one thing I was confused about....now for the 3,000+ other things! :confused:

Happy remainder of the weekend!

Mary Beth and Alivia

HELP!!!!
As much as I was hoping they would, this time Alivia's symptoms are not going away. She is having rear leg weakness. I have steps for her to get on my bed and this morning she sat at the bottom of them staring up for several minutes. Eventually she made it up them, but it was like she knew she had to work up the strength. Her appetite is increased. Her water consumption seems to be a bit increased, but not as much as it has been (maybe this has something to do with the humidity being so high, as it has rained here almost every day for the past 6 weeks!). Her fur is hardly growing at all. Her leg was shaved 2 1/2 months ago for an IV and it is still bare. She has also has a pot belly, which is now also bare from having the ultrasound. She seems restless sometimes, like she can't get comfortable. I think I have to face the fact that it is time to start treatment. :confused:

Initially her regular vet thought Trilostane would be easiest on her (Alivia has an adrenal tumor but is not a good surgical candidate). I was concerned because of the potential of Trilostane elevating the other hormones and also the risk of it enlarging the adrenal glands. Dr. Oliver, via e-mail, suggested the possibility of using a maintennace dose of Lysodren, without loading, lignans and melotonin. I asked if he could direct me to any studies where this was proven to be successful. He said there have not been any, but he has seen test results improve, using this treatment. I wasn't comfortable with this.

I came across this quote from Dr. Mark E. Peterson:

“In dogs with Cushing's disease, you must use a daily loading protocol in order to adequately destroy enough of the hyperplasic adrenal cortex. It's quite unlikely that starting with a weekly maintenance dosage of mitotane would do much at all to lower the high serum cortisol concentrations in your dog.

But you don't necessarily have to use the standard loading dose for mitotane of 50 mg/kg per day. You could try a lower daily dosage of 20-25 mg/kg (with food) to evaluate the effect. “

I just got off the phone with Ali's vet. Between his research and mine, we agreed that this "Low dose mitotane loading" sounded like a reasonable treatment compromise (I REALLY hope so). Alivia weighs 18 pounds and he is going to start her on 200 mg per day. Has ANYONE had any experience with this?

I'm just plain terrified of starting ANY treatment.

Hi Mary Beth,

I know all of the treatments scare us, but cushings does need to be treated. There is nothing that says you have to stick to one of the meds. If one does not help, with a washout period, you can always switch.

Corky has only taken Trilostane with his adrenal tumor, and was started at a low dose. He's had two adrenal panels done, and his intermediate levels were elevated, but not much. They have not caused any problems for him.

Hi Mary Beth,

We are all scared in the beginning. They are serious drugs and it is no wonder we are scared out of our minds when we have to start them. :( It is a normal response from us, I think.

That was my post from Dr. Petersen. Zoe's cortisol went up on her last UTK to 40 she was at 32 last June. She has colitis and has been sick alot this year and has shown a low tolerance to some drugs in the past so that was why I was looking for options for her.

Alivia's post cortisol was no where near as high as Zoe. I think it is a reasonable option. I have heard it can mean it may take longer to load the dog. I felt better having the suggestion come from Dr. Petersen since he is so highly regarded.:D

We'll see what others come along to say. But the low dose load option is what I am looking at too for Zoe.

If I did the math right, it looks like your dose is a tad less than 25mgs per kg. I'll go recheck my math, not one of my strong subjects:rolleyes:

Hugs,
Addy

Hi, Addy -

I am reading so much stuff that I forget where some of the info comes from! Alivia has not done well with some medications when she was treated for IMHA, so I worry giving her any drugs. She had an especially hard time with Prednisone. What is Zoe on now? (I need to start a speadsheet with who's who and what treatment they are on!)

How long does the loading period usually take? Ali was 18 pounds when she was last weighed, but since she has been eating more, she is probably around 19 or so. Since her Cushing's is not pituitary, if the mitotane successfully lowers her cortisol levels, can it be stopped after awhile? I hate the idea of giving her something so strong for an extended period. Plus, I think with the tumor, her cortisol levels seem to fluctuate and are not always high because there are times when she has no symptoms.

Hi, Terri -

Alivia's baseline Aldosterone was pretty high, so that's why I was afraid of Trilostane. Her only normal level was the Estradiol. How long has Corky been on Trilostane? Did his symptoms improve significantly? I am so conflicted about which to use. Wish I had a crystal ball.

Zoe is only on melatonin and lignans. We had work to do with her colitis and because her blood work is all normal and her symptoms were mild, we postponed treatment with lysodren. My IMS does not use trilostane.

Each dog is different when it comes to loading. In my opinion, I think underlying illnesses come in to play there as well. Kim's dog took over a month to load and some others loaded in 3-4 days. Seven to nine is the average, if I remember correctly. Alivia weight is like Zoe's.

We have so many members that have loaded and will be here to guide you and support you if you go that route.

I don't want to confuse you or make you second guess yourself. If you go to Apollos's thread, our Glynda laid out a case about Trilostane and increasing intermediate hormones. It was last week.

I have to learn how to copy the threads and post numbers for people:rolleyes::rolleyes:

I know this is a hard decision but you will make it and it will all work out. You have to feel comfortable with the treatment. My IMS has stressed that to me.

Hugs and love,
Addy

Hi Mary Beth,

Corky's been taking Trilostane for 19 months. Most of his clinical signs were resolved in a short period of time. Within the 1st ten days, his cortisol level was down to 2.1. His dosage has had to be adjusted several times since he started taking the Trilo, but he has been doing very well with this treatment.

Hi Mary Beth,

I am just stopping by to say hi to you and Ali.

hugs,
Addy

Hi Addy and Terri -

Thanks for checking on me and Ali. I am still crying a little bit every day. It is just awful to realize that my precious little Alivia is getting up in years and our time together is getting shorter.

I went to a seminar the other night called "Living With Aging and Ailing Pets". The speakers were a vet, a pet loss grief counselor and a funeral director (a human one but they actually do complete pet funerals, too!) Sometimes I have some really bad ideas and this would be one of those times! HUGE MISTAKE!!! They were collecting donations on the way in for the animal shelter that sponsored the seminar. When the program started, I started crying and just could not stop. If I had been sitting in the back, I would have quietly slipped out the door. :o But, unfortunately, I was towards the front. They were filming it, so I didn't want to create a commotion by getting up and leaving. So, I sat there with tears streaming down my face for what seemed like hours, but was actually only about 45 minutes! About halfway through the presentation I realized I had written my donation check out to the WRONG animal shelter! When the program finally ended, I had to explain about the check, fish it out of the donation vase and re-write another! Then, I won the door prize - a CD called "Coping with the Loss of a Pet". I couldn't get out ther fast enough! :p

I think I told you my vet ordered a compounded 200 mg mitotane to start Ali one. It hasn't come in, yet. I think part of me is kind of relieved about that, because I am dreading starting anything!

Oh, I can totally relate to your post. When I first heard the news of Zoe, I cried for days on end. All of that anticipatory grief just wipes a person out. So then I started putting Cushings in the drawer:)

It really works!!!!! Open a drawer or your glove box in the car and say out loud, very sternly "Cushings, get in the drawer and don't come out!!!" and close the drawer and then try to step back from it and do something you would normally enjoy. Sometimes I had to do this 10 times a day:eek::eek::D:D:D

We are all here for you and Ali. The loading will be fine. Positive thoughts;);)

Love,
Addy

I don't think I can put it out of my mind right now, because there is too much of it in my face. Ali has a shaved bare belly and leg, plus she is having symptoms. So, as long as I am around her (which I want to be!), I see Cushing's and I am very much reminded of it. :(

Both of us might feel better if we could just get on with her treatment but, I am still waiting for the compounded Lysodren/mitotane...just called her vet and they are supposed to check with him and get back to me. It should have been ordered on Tuesday. Hope it didn't slip through the cracks! Anyone know about how long it usually takes to get a compounded version?

Quote:

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Originally Posted by MBK

I came across this quote from Dr. Mark E. Peterson:

“In dogs with Cushing's disease, you must use a daily loading protocol in order to adequately destroy enough of the hyperplasic adrenal cortex. It's quite unlikely that starting with a weekly maintenance dosage of mitotane would do much at all to lower the high serum cortisol concentrations in your dog.

But you don't necessarily have to use the standard loading dose for mitotane of 50 mg/kg per day. You could try a lower daily dosage of 20-25 mg/kg (with food) to evaluate the effect. “

I just got off the phone with Ali's vet. Between his research and mine, we agreed that this "Low dose mitotane loading" sounded like a reasonable treatment compromise (I REALLY hope so). Alivia weighs 18 pounds and he is going to start her on 200 mg per day. Has ANYONE had any experience with this?

I'm just plain terrified of starting ANY treatment.

---

When Dr. Peterson commented on the feasibility of a lower daily loading dose, I don’t believe he was talking about dogs with adrenal tumors. Adrenal tumors are much more difficult to treat with mitotane because they are highly resistant to the drug and usually require much higher doses. My concern is that with such a low loading dose, you are going to be in for a very, very long loading period and when you do eventually achieve loading, it is going to be very difficult to determine an accurate maintenance dose. I realize that you and your vet want to take a very conservative approach because of Alivia’s history but I thought you should know what you may be in for. Most vets start dogs with adrenal tumors on no less than 50mg/kg and it is not uncommon to have to increase the dose some times to as high as 75mg/kg to 100mg/kg to achieve loading. These are huge doses which is why Pepcid is definitely a necessity.

Quote:

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Originally Posted by MBK

Since her Cushing's is not pituitary, if the mitotane successfully lowers her cortisol levels, can it be stopped after awhile? I hate the idea of giving her something so strong for an extended period.

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Once a dog is on mitotane, it is for life. The loading dose is the roughest phase and once you get loaded, maintenance is not bad. I have two cushdogs, both are much smaller than Alivia (4.5lb and 6lb) and they loaded at the full 50mg/kg. They have been maintained for over two years on a maintenance dose of 60mg three times a week. For me, it’s part of my routine to dig the cream cheese out of the reefer and stick a capsule in it on Monday, Wednesday and Friday. I should be so good about taking my own meds. 

Quote:

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Originally Posted by MBK

Anyone know about how long it usually takes to get a compounded version?

---

If I ordered my Mitotane or any other veterinary drug on Tuesday, I have it no later than Thursday. I use Diamondback Drugs in AZ.

Glynda

There was a mix up with the mitotane order. It was actually ready in one day. I thought it was going to my vet's but he called it into a pharmacy I had never heard of - probably 15 miles away. They left a message for me to "call to schedule a delivery", but never said a name or who it was for or anything. Thinking it was a wrong number I never called them back. Anyway, they are supposed to deliver it to me in the next hour or so. But, I am right back to square one and pretty sure I am not going to use it at all. I don't think I can load a dog who has a fluctuating appetite to start with. She hasn't had anything to eat all day and just walked away after eating half her food (something I know she likes, too).

I am just as confused as I was the day she was diagnosed (19 days ago). I am now re-thinking Trilostane and a bottle of wine. The wine would be for me, of course. :rolleyes:

Glynda, refresh my memory, do your dogs have adrenal tumors?

Pour me a glass while you are at it, is there room on the couch?;)


Arrggggggg!!!!!! It is always so darn confusing. Did Dr. Oliver suggest a maintenance dose to you knowing Ali's adrenal tumor and history? Just curious. Maybe I am remembering wrong but if he did then how would that work?

Okay, maybe pour us each TWO glasses:rolleyes::rolleyes:

Love ya,
Addy

Lysodren was delivered 10 minutes ago. Alivia just finished the rest of her food, after an hour and half break. I don't think I can do it.

Addy, thanks for reminding me of what Dr. Oliver said (in red):

Attached are the results of the adrenal panel testing done at your facility. My dog, Alivia, is a 13 year old, 18 pound, female, spayed Jack Russell Terrier. She had IMHA when she was 7 years old. She has recovered from that but has some residuals and still takes Amlodipine for high blood pressure and compounded aspirin to help prevent any clotting issues. Ali has been exhibiting typical Cushing’s symptoms off and on for about 2 years (fur not growing, panting, thirst, hunger, laying in cool spaces, skin infection), I did mention these things to her internist, dermatologist and regular vet but she was not tested for Cushing until recently. I am really confused as to the best treatment option for her. I have ruled out surgery because of her age and health; I am terrified she would not survive it and I don’t want to put her through the trauma. Her regular vet has recommended Trilostane because he believes it will be easier on her, with less chance of negative side effects.>>>We usually don’t recommend trilostane where sex hormones are increased. Trilostane increases androstenedione and estradiol levels in particular, and these dogs often come back with clinical signs of Cushing’s after they have been on treatment for awhile. Then you have to switch to another drug; usually Lysodren.

I am pretty scared of Lysodren because the drug seems so harsh and because Alivia’s appetite varies - she can be ravenous, have a normal appetite and occasionally has no appetite for a day. I am not sure how I would ever get a proper loading dose and wouldn’t want to cause her more harm than good.
>>>You can use melatonin, lignan and “maintenance” Lysodren (without the loading dose). This treatment is often used for these cases with good results.

[COLOR="Navy"]Current medications and supplements: Amlodipine, compounded aspirin, The Missing Link Canine Food Supplement, Flax Hulls (SDG) Lignans, Melatonin 3 mg BID (the Flax Hulls and melatonin are recent additions as I didn’t think it could hurt, but I can stop them if you recommend that).[/COLOR]>>>They can be continued.

>>>Your choices seem to be surgery (expensive and fairly critical surgery); careful follow-up needed in the immediate post-surgery time period. Otherwise, the melatonin, lignan and maintenance Lysodren could be tried. If the tumor is a carcinoma, it can develop rapidly and cause problems for you.

I have 200 mg capsules of Lysodren, just delivered....should I or shouldn't I. :eek: I am pouring the wine now!!!! Addy, I'll pour you one, too, but if you don't show up soon I'll have to drink it for you!

Girl, I am here but I don't know what to tell you.:D

I wish I could get into my email at work but I can't. I am trying to remember if I told Dr. Peterson that Zoe had Pituitary or I just said Cushings. I am so sorry I can't get at my emails for you.:(:(

I'll go look to see if I sent a copy to my other email account.

Glynda, Marianne, Lori, Leslie, please help us out here!!!!!!

I know I have read not to give mitotane to a dog that does not have a good appetite. Not sure how far to take that comment.:confused:

I'll be back.

Found it!!!!! I did tell Dr. Peterson Zoe had Pituitary Cushings. I guess the thing that bothers me is right back at Dr. Oliver thinking a maintenance dose could work so if that could work could a low dose load work?


You don't have to give it tonight unless you need to start on a Friday for the ACTH test to come out on the right day? Is it a timing thing with your vet?

My other question would be to Glynda- did your pups have other health issues when you loaded?

Who here has loaded a dog with concurrent health issues?

Hang in there and save me some of that wine:cool:

Love ya,
Addy

I think the appetite fluctuation, and health issues, was the reason Dr. Oliver recommended a maintenance dose instead of a full loading dose. Dr. Oliver is aware Ali has an adrenal tumor. Glynda posted here earlier today and she thought the low dose loading would not help with an adrenal tumor.

A maintennance dose would be much LESS than the low dose loading of 200 mg per day, right?

I wanted to start her on a Friday, so that I could be home with her for the first three days of dosing. But, I think Ali is making the decision for me that tonight is not the night to start. She seems to be constipated - she tried to go for at least 5 minutes when I came home from work and was not successful. That's not a normal thing for her - lignans, maybe? Her appetite was off - she paused for 1 1/2 hours before finishing her dinner. She is not panting like she has been and she hasn't drank any water since I've been home (2 1/2 hours). She seems very tired. If I had been "loading" her I would probably be calling the vet for Prednisone right now. I would LOVE to think she is going into a remission phase, something she has seemed to do in the past.

Hey Mary Beth,

I don't want to leave you but I have to run out with hubby. I am hoping others will come along to comment while I am gone.

I'll check in with you later. If you are in doubt, don't give the drug. Delaying treatment for a week won't mean anything. I have read over and over that treating Cushings is not an emergency.

Love ya,
Addy

Hi Mary Beth ,

I can definitely relate to how you feel right now. When Corky was first diagnosed with cushings, he was going to be treated with Lysodren, which I actually still have. Because he was on antibiotics for two UTI's, his treatment had to be delayed. His clinical signs then went into remission for seven months. His IMS is the one that put him on Trilostane, as she felt it would be easier on Corky because of everything else he had going on. I was actually relieved.

There are successes with both Lyso and Trilo. I hope you get to a point where you are comfortable with whichever treatment you decide on.

I know we do worry and wonder if we're doing the right thing.

I'll join you and Addy for a glass of wine. :D