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

Mary Beth, I can answer a couple of your questions. A maintenance dose is the same as a loading dose except the frequency you give it. 200 mg for loading would be give daily, split into an AM & PM dose. Maintenance dosing splits the 200 mg into several doses over a week's time. For instance, 100 mg twice per week, or 50, 100, 50 given 3 days per week.

Neither of Glynda's pups have adrenal tumors, they both are PDH. I have zero experience with adrenal tumors except the information I have read on the forum, along with my own personal research. Everything I've seen concurs with what Glynda posted to you earlier that adrenal tumors can be very resistant to lysodren & require a much higher loading dose. I can sympathize with the appetite issue as my Harley was an extremely picky eater, & loading him was an absolute nightmare because of it. I had to depend on both appetite & water consumption to make my best educated guess about loading. When it comes to trilo raising the associated hormones, it usually does, but even the experts are not sure how significant this is. I will tell you this that all dogs who have an elevated cortisol will most have definitely have one or more of the associated hormones elevated as cortisol is used as one of the building blocks to make these other hormones.

For what it's worth, if I were in your position, I think I would be asking the vet about adrenal tumors being resistant to lyso, requiring higher than the normal loading dose, & how much of a help would doing only maintenance dosing be.

I'm not sure if this has helped, but keep us posted.

Debbie

Addy, Terri and Debbie....I am thinking a bottle of wine is not going to be enough. :confused:

I think not. Break out the Scotch!!!!!

The problem is each dog is different and then if the dog has other health issues going on it really is a pickle.

Corky has elevated hormones and Terri is using Triolstane with no ill effects caused by higher intermediates.

I am going to take you back to the vet you so trust and love that helped Ali. His contact said use Trilostane. Then Dr. Oliver confused you with his maintenance dose. I have come to the conclusion that the University Tenn full adrenal panel should only be used when a dog has symptoms but standard tests are normal or if a dog continues to show symptoms even though cortisol is controlled.

What was your first gut reaction? You have another week. You don't have to start tonight. Go back and reread about adrenal tumors and Trilostane. Ask Terri questions. She has done alot of research.

Then decide and remember, you can always do a wash out and try the other drug.

Pour me a scotch!!!!!! no ice!!!!!

Hugs and Love,
Addy

It seems like the more I read the more I go in circles.

Addy, not sure I understand your point...Alivia did have many symptoms and her LDDS test was completely normal, but the ultrasound wasn't. That is why her IMS did the U of Tenn full panel. On that, everything is elevated, except Estradiol.

Initially, I thought I'd go with Alivia's regular vet's reccomendation of Trilostane. Which was also what his friend said. Then we both read more and learned it could elevate the other levels and there is the possiblity that those elevated levels can cause damage. I'm afraid of masking symptoms, while damage may continue. I also read that with Trilostane there is a risk of DEATH. That really scared me, since Ali tends to have unusual reactions to things.

Wish I liked scotch.....

Quote:

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Alivia did have many symptoms and her LDDS test was completely normal, but the ultrasound wasn't. That is why her IMS did the U of Tenn full panel. On that, everything is elevated, except Estradiol.

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Sorry, I forgot that part. So then it makes sense to me now. So many of the vets seem to be doing the UTK panel for different reasons, mine included:(

I know exactly what you mean about the more you read, the more worried and stressed you feel. I hope I did not confuse you more:o
All medication has risks. I look at my Advair asthma drug that I must take . It can cause asthma related death and all kinds of bad things according to the label. I take the lowest dose and only when I really need it for the shortest time possible, like when I get sick with the flu or a cold or bronchitis.

Trilostane and Lysorden are both serious drugs, we can't escape that fact. None of us have any way of knowing in advance how our dogs will react to either drug. All we can do is hedge our bets, so to speak.

When I spoke with Dr. Oliver about Zoe (who does not have an adreanl tumor) he thought a maintenance dose could be tried for 3 months and then she could try loading if the maintenance dose did not work. Her cortisol is high. Dr. Oliver is telling you a maintenance dose could be tried with Alivia. I don't know what the down side is to trying that for Zoe or Alivia. I do know that quie a few people including my internist tell me miantnenace does not work. Yet Dr. Oliver sees it work in some cases so it is like a Merry Go Round that you can't get off:eek::eek:

For my Zoe, I cannot try trilostane because my IMS does not use it.
I have no other IMS choices in this city and I need my internist for Zoe's colitis. If I had an internist for Zoe that used Trilostane, I would start Zoe on a low dose and if that did not work, I would switch to Lysodren. I am not telling you to use Trilostane, I am just telling you the conclusions I reached for my dog because I have been in the exact same boat you are.:confused::confused::confused: But Zoe has different isssues than Ali to some degree.

I am just babbling now and I hope I don't confuse you even further:eek::eek: I'm just babbling all the thoughts in my head.



I don't like scotch either:p:p

Love,
Addy

Hi Mary Beth,

I have some thoughts but can you remind me what cushing's symptoms you are seeing at the moment? I may not be able to give my thoughts until later today but I will get back here.

Glynda

Thanks, Addy. I think I am back to square one and leaning towards the Trilostane, which was Alivia's regular vet's first opinion...

Glynda,

Alivia has most of the typical cushing's symptoms. Her fur grows EXTREMELY slow - almost not at all. She has the Cushing's pot belly and redistribution of body mass. The skin on her belly seems very thin and her belly looks bloated. She sometimes pants. She seems listless and very clingy. She has always liked being near me, but it is now seems excessive - she will follow me everywhere, even from my bed to the bathroom IN my bedroom. She stopped sleeping under blankets like she always did; and now lays on the hardwood floor or in strange places. She has hind leg weakness, too, and sometimes has a hard time going up steps. She has increased thirst and appetite...usually. But, that can fluctuate a lot! Sometimes her appetite is ravenous, sometimes normal and sometimes none. That is what scares me the most about loading Lysodren. When Ali was treated with high doses of Prenisone years ago for the IMHA, she did not do well on it. So, if she were accidentally overloaded with Lysodren, I think it would be catastrophic for her.

In my lay opinion, I think Alivia's tumor causes her hormone levels to fluctuate. If she could be tested every day, my guess is they would be high sometimes, low sometimes and normal sometimes. Looking back, she has had symptoms off and on for a long time. But, she will go long periods with either very mild or no symptoms. Her dental surgery on 2/14 seemed to trigger symptoms and this time they do not seem to be subsiding.

And, as an aside. Alivia and my healthy 11 year old JRT, Maxwell, who normally get along just fine, now seem to grumble and growl at each other a lot. Like maybe Max senses her weakness and Ali is trying to assert herself more to hide it?

Enough? Thanks for your help.

Another question....any down side to starting Ali on a little Milk Thistle?

Bad news. Alivia is in the hospital. She wasn't herself all weekend and was very lethargic yesterday. During the night she was panting heavily and shaking and in obvious discomfort. I gave her some pain medication left over from her recent dental surgery and she slept for a little while. When she got up, she was having a hard time walking and you could tell she was in extreme pain. It was awful. She peed on the floor right in front of me because she knew she couldn't walk to go out. She has NEVER done that.

I picked her up to carry her to the car and she yelped in pain. The slightest touch made her yelp. Took her to the emergency hospital. Her temp was 104.2, they gave her a morphine type pain medication so that they could take x-rays of her chest and abdomen. Nothing appeared majorly abnormal in the x-rays. She has an enlarged liver and some degenerative arthritis in her spine and rear legs, but she is 13+, and she said unless there was a pinched nerve - nothing to explain the pain, which the vet characterized as "severe, at least a 7 on a 1 to 10 scale". They couldn't visualize the adrenal gland but said there was no evidence that it had spread. She saw no tumors anywhere and said everything was where it was expected to be. I asked if it could be pancreatitis and she said possibly, but that she doesn't have some of the classic symptoms (vomiting). They kept her so that they could keep the pain down and were going to do blood testing. By luck, her IMS was coming in to do an ultrasound on another dog, so they are going to have her review everything and probably do another ultrasound. Then they will call me. I am hoping that I can bring her home later today, but I am really scared. Please keep her in your thoughts.

Many prayers are being said and sent your way, I am so sorry that Aivia is having these issues.

My boy, Harley, had pancreatitis but never showed the classic symptoms. The test which is the best to diagnose pancreatitis is a Spec PL test. Here is a link to information about this test: http://www.idexx.com/view/xhtml/en_u...jsf?SSOTOKEN=0

Keeping you both in my thoughts and prayers.

Love and many hugs,
Lori