Java Bean

My Beanie is 11. We have done the tests and she has cushings. :(

we did blood, urine, and finally the dexamethasone suppression test. now the decision is vetoryl vs. lysodren? The info I have come across seems to favor the vetoryl. I am happy to eat kraft dinner for the next few months (or forever) if my Bean will get better again, but I must draw the line at cup of noodles. :p (ok, if I have to...of course I will eat it) Her dosage of vetoryl is 12mg 1x daily. Can I buy the 120mg and use a scale to weigh 1/10th (12mg) to also afford my mortgage? I found a 30 cap box for 109.00, which will really help until I can finally find a job. I know it won't be so bad once the regular testing phase is over. I will do what it takes to see her get better. This is so painful to see her so weak, bloated, and lethargic. She doesn't even bark at the mailman anymore:(. She is starting to fall down on her hind legs now. I took her in in Jan when she started drinking a lot of water. We did blood tests and urine that were borderline, so my vet said to come back in 1 month to check the urine again. It went down a little, so she had me come back in 2 weeks, with the numbers going back to the original numbers. We did the DST on 3/6 with the results coming back positive. I would like to start treating her ASAP.

Beanielover

Hi and welcome to our site. I am sorry your pup is having these troubles. I love her name!!!

When you get the chance, post the results of the dexa test (LDDS for short) as well as any elevations found in the blood chem panel. Now one of the most obvious symptoms of Cushing's is a ravenous appetite - you did not mention this symptom. Cushing's is a difficult disease to diagnose as there are other conditions that mimic Cushing's symptoms - thyroid problems, diabetes for example. Have these been ruled out by tests? Being lethargic is the one thing that has me pausing here - could it be arthritic pain (the excess circulating cortisol actually helps with this) or something else.

Actually Vetoryl contains Trilostane and is really is no "safer" than Lysodren (Lysodren is cheaper though). They may say it is easier to use (no loading period like Lysodren) and it works differently by controlling the adrenal gland's excess production of cortisol. Take a minute to read through the interactions with other drugs and if you are going to use it make sure you are well versed in the possible side effects - http://www.k9cushings.com/forum/showthread.php?t=185. (I am not trying to scare you, but like human medicines always read the material). :)

And no, please do not open any capsules - the powder can get absorbed into your skin.

Last thing is that Cushing's is a slow progressing condition and there is no need to rush into treatment until there is a most definite diagnosis.

Keep us posted
Terry

Hello and welcome from me, too!

As Terry has said, it will help us a great deal if can share some more specifics about Bean's symptoms and actual testing results (like the numbers on the LDDS). Also, if you can tell us about any other abnormal results on the blood and urine tests, that will also be great. Cushpups often have elevated liver and cholesterol values and very dilute urine, for instance.

Leaping ahead, though, please do not buy any medication until we've had the chance to talk things over more thoroughly. You absolutely should not be buying large capsules, opening them up, and trying to divide the contents yourself. It is not safe for you to expose yourself to the powder, it is impossible for you to divide the doses evenly enough, and the medication may not even work properly once it has been taken out of the original capsule and added to food, etc. If you do decide to treat with trilostane, there are other less expensive options such as buying a product that is prepared onsite by a compounding pharmacy in the exact dose that you are needing.

But first things first. Can you tell us your dog's breed and weight? This will help determine the initial dosing for either Lysodren or trilostane. Depending upon your dog's size, it may turn out that Lysodren might actually be less expensive for you. Does your vet have experience with either/both drugs? The worldwide trend is certainly towards treating with trilostane, but that doesn't mean that Lysodren has not been an excellent choice for many dogs here in the U.S. But if you opt for Lysodren, you will want a vet who is knowledgeable and comfortable with using it (which, of course, is the case with either of the two drugs! ;)).

So I know we are asking you a lot of questions. But your answers will help us with our feedback and further suggestions.

Marianne

Hello and welcome from me too. :) I'm glad you found us as it sure does help to go through all of this a bunch of people right beside you and a place you can come ask any questions and get some feedback.
Saving the house of course is important too and Marianne mentioned the compounding pharmacies which are quite a bit cheaper than using the brand name, vetroyl. So that could be an option once you are very sure it is cushings.
I agree that you want to be sure because the drugs are so strong that you don't want to give them if the problem is something else as mentioned by Terry.
If it is cushings, then you do have time to learn as much as you can and make an informed decision. Look at Diamondback compounding, which some of our members use, read through the resource section here so you know as much as possible about both the disease and the treatment and drugs used. Knowledge is your friend.
Again welcome and we look forward to getting to know you and Beanie.

Sharlene and Molly Muffin

Hello and welcome:
Sorry you and your baby have to experience this awful disease. It is expensive to start , but it does get cheaper. Please do not open any capsules. You will put yourself and your dog at risk by doing so. They are never under any circumstances to be opened, or punctured by your dog according to Dechra. I know what you mean about the macaroni and cheese dinners. I do whatever it takes to help my Tipper and if that means going without things, so be it. God Bless you and you baby.

Hi and a big welcome from me too!

As the girls have already said, there is no rush to start the treatment, even though you desperately want to see Java bean get better as soon as possible. Sometimes it's better to be sure and have every I dotted and t crossed before starting down the path, as if there is even a remote chance that it may be something else other than cushing's, she could end up worse for the treatment. I too am not trying to scare you, but please be aware the drugs are very specific and do have side effects if used incorrectly.

I also have to caution you against dividing the caps yourself. Trying to measure such a small dose out on scales is incredibly difficult, and you would need to have scientific microgram scales to be anywhere near accurate, then you would have to make sure that you got all of it to Java Bean and none of it on you. There are compounding pharmacies around that can do this for you and package specific doses into caps, it can be considerably cheaper than buying brand name. Perhaps if you give us an indication of your area, someone maybe able to help you out with suggestions of cheaper price? I personally buy 100 10mg caps for $99.00 - in West Australia, but that is an example of a cheaper price for compounded meds. And yes, it does get cheaper eventually - I too am a classic one for not caring what/if I eat as long as my boys are looked after first :D My friends don't understand and think I am nuts - but they're my boys.

Anyhow, before going the treatment route, are you absolutely sure of the diagnosis? As others have mentioned above, there are a lot of different issues that mimic similar symptoms. If possible, ask your vet for copies of all of the tests that have been done on Java Bean and post the results here. That way you can get some extra feedback and more supportive help. It's also a good way to keep check on your vet. We need to remember that they are human and do make mistakes on occasion, so we need to just look over their shoulder at times.

Keeping a file of all of the test results is actually a good idea though in case you have an emergency situation and need to visit an ER. Having a complete history to take with you if you have to see a foreign vet will make things easier for everyone involved.

At this point, take a deep breath and try and get hold of those test results first. And while you are waiting, tell us more about Java Bean. Such a cool name has to have a spunky pup to go with :D:D

WOW! You all are so AWESOME! Thanks!
Quick Bean Bio: We were the the Java Rush coffee shop in Lake Havasu. (desert) That's where the name Java came from. The kid behind the counter was 4 wheeling in the desert b4 work and came across a box of 5 puppies left out in the desert to die. Bean was the runt - black white brown white tipped tail with a big pink freckle on her nose. She has a flash on her bum to mark the sweet scratching spot. She is a beagle mix (maybe some pit and or lab?) What she lacks in brains, she makes up for in sweetness. Everyone loves her, because she will greet you with a kiss on your leg and a "waggalie daggalie" tail. She ended up to be 50 pounds. Her big brother, Alex, 20 pounds of blond bouncy brains with a curly tail wasn't happy in the beginning, but now he grooms her and takes good care of the Bean.

Ok, down to biz. Got copies of everything today. My vet is nice, but I do not feel she has a lot of experience with Cushings. I found a site, Marvistavet.com, which gave a lot of info and compares the different meds - worth a checkout all-. They are in LA, CA and I am in Orange County, CA - 45 to an hour depending on the time of day. I am going to call them tomorrow. The mfgr of vetoryl, Dechra, says that formulary pharms are not FDA approved in US.

Java is hungry, thirsty, weak, pot bellied (hardly fits thru doggie door). At her vet visit in July 2012, I told the vet she could no longer get up on the bed. She has extreemly deteriorating muscle mass on her hind legs, her back is dipping like a lame horse. She stopped being able to get on the couch in January, when I noticed her extreme thirst and took her to the vet for that. Note- in May 2012 I started fostering my grandpuppy Missy. She is a 4 1/2 pound teacup silky terror. (no, I mean terror!!!) Missy and Java used to play like crazy on visits, but when she moved in, I thought Java was depressed. I think this is when her symptoms really started- hindsite 20/20.

Testing and timeline:
1/5/13 -Blood- I will only list the high counts, as there are so many listed-
ALT (SGPT) 340, Alk Phosphatase 716, Phosphorus 6.4, sodium 152, potassium 5.4, differential "absolute", monocytes 1035, T4 .06,
urine - spec grav 1.006, pH 7.0, occult blood "trace".

3/6/13 - Dex sup test:
cortisol sample 1 - 9.0 9:45
cortisol sample 2 dex 10.6 1:46
cortisol sample 3 dex 9.0 5:48

Current status:
Vet gave me Ketoconazole to start today until she can get the Vetoryl, as Java is declining - she fell on the door jam going out to tinkle last night - she's so weak - it's killing me, I'm crying in my kraft dinner. Upon research of the Ketoconazole, it seems as if it has fewer side affects, and no chance of Addisons syndrome, and it is cheap, and no tests are needed after initial month check. No problem giving her pills 2xd as she always is up for a treat! I haven't seen anyone listing the Ketoconazole on your site as a treatment. Has anyone used it??? Oh, one more thing, I can get my Dr. to give me an RX for it, to "treat my excema";) (don't tell anyone I said that). I think I would like to try it first before the more dangerous drugs.

Frankly speaking:
From what I have read, I don't really see the outstanding benefit of Vetoryl vs Lysodren for the cushpup. It seems to be of more benefit to the Vet, as my vet intends to sell it to me and peform expensive tests for the the rest of the Bean's life. Ketoconazole was never even mentioned until I pleaded to start treatment today and my vet could not find any Vetoryl anywhere today. She handed me this bottle and told me to start when I get home. The Lysodren and Keto are available at any pharmacy - easily price compared on Goodrx.com.

This is the end of "The Life and Times of The Bean" a cushpup novel available at your bookstore soon.............:D

By Beanielover Kelly143 catchy pen name, huh??

Hi again,

What a wonderful story on how the boy saved these puppies and how Java came to live with you!!!

Okay the symptoms do match Cushing's as well as the LDDS test results. And Java is not on any other medications right? And thyroid problems have been ruled out?

I have never used Keto but here is some information about it. It is in the antifungal class of drugs and it interfers the synthesis of cortisone in the adrenal gland. There are drug interactions to be careful of (heartworm preventions, heart medications and antibiotics). Long term use can be hard on the liver.

Terry

I agree, what a great story about the puppies!!!!! :)

One initial thought for you -- it is true that the LDDS results are consistent with an overall diagnosis of Cushing's, but the pattern does not give us any clue as to whether Java suffers from the adrenal or the pituitary form of the disease. As you've undoubtedly already found out from your reading, adrenal Cushing's can actually be cured through surgery. But the surgery is very serious and very expensive, so it may not even be an option for Java. If it would be, however, I'd encourage you to proceed with an abdominal ultrasound in order to image her adrenal glands and other internal organs.

If surgery is not an option, then the form of Cushing's may not matter so much to you. However, be aware that some specialists now prefer trilostane over mitotane (Lysodren) for treatment of adrenal Cushing's because experience has shown that adrenal tumors often require very high doses of mitotane with an associated higher risk of unwanted side effects.

As far as ketoconazole, you can certainly give it a try. However, historically the two biggest drawbacks have been expense and the fact that it just doesn't seem to work well long-term for many dogs. That is mainly why it is not recommended as a first-line treatment compared to Lysodren and trilostane. Here's an excerpt that relates to using keto for treatment of pituitary Cushing's, and although the percentages may differ, I think the overall theme is applicable to adrenal Cushing's, too.

Quote:

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The efficacy of ketoconazole in dogs with PDH is debatable. A marked reduction in the serum cortisol concentration can occur within 30 minutes of administration and lasts from eight to 12 hours. In a single small study, 81% of dogs with PDH attained complete remission with ketoconazole.32 However, anecdotal evidence suggests the efficacy may be lower. In a survey of internists and dermatologists, most thought ketoconazole was effective in less than 25% of dogs with PDH.11 Only one of seven surveyed considered the efficacy of ketoconazole similar to that of mitotane.11 Treatment failure has been associated with poor bioavailability of orally administered ketoconazole.32 Assessing serum drug concentrations can differentiate between animals with poor intestinal absorption and those with true treatment failure.32

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http://veterinarymedicine.dvm360.com...date=&pageID=5

Historically, Keto was also REALLY expensive prior to its release as a generic. Most dosing formulas that I've seen state the majority of dogs will need a daily total of 30 mg/kg (split into twice daily doses) in order to hope for symptom resolution. For a dog of Java's weight (50 lbs or 23 kg), this translates into a daily dose of 690 mg (or approx. four 200 mg. tablets daily). So from checking online pricing, a monthly dose of generic keto from Costco would cost about $72. I don't know about Lysodren pricing, but I just checked and you can buy thirty 10 mg. brandname Vetoryl capsules for around $50, and I'm certain that compounded trilosotane would be even less. You do not have to buy any of these medications directly from your vet, and can undoubtedly the pricing will be bettter if you get it directly yourself.

So purely from the standpoint of drug pricing, I don't know that keto will save you money (except as a result of insurance coverage for keto). You are right, though, that you would save on the need for monitoring ACTH testing. You would still need to test the keto at least a couple of times to make sure the medication was actually working for Java. But since keto doesn't carry the same risk of Addisonian crisis, you don't need to keep testing for safety purposes.

Bottoom line, you can certainly start out with keto if you wish. Whether or not you'd want to stick with it would depend on how rapidly Java continues to degenerate, whether or not you see any improvement, or instead if you see any troubling side effects.

Marianne

Right after I posted my reply, I realized I was quoting Vetoryl pricing based on your initial comment that Java's initial dosing would be 12 mg. per day? That was before we knew her weight, and now that we do, that 12 mg. dose does not make sense for a dog weighing 50 pounds. That is REALLY low, since the typical starting formula is closer to 1 mg. per pound. Can you clarify the proposed 12 mg. daily dose?

Hi Kelly and welcome to you and Java.

Others have given you some good feedback and I'd like to add my own to theirs. I confuse easily so in order to keep myself from rambling and stay on track, I've typed my comments and questions in blue text within the body of your last post. Before I start, I'd like to thank you for saving Java and her siblings from a certain ugly death. I'm a rescuer so I'm acutely aware of how evil people can be. Abandoning pets at a shelter is bad enough but abandoning them in the desert to die in the hot sun or be killed by prey is beyond disgusting. You mentioned Lake Havasu and my eyes lit up. I spent every other weekend at Havasu Springs during the spring and summer months when I was a sweet young thing. I have many great memories of those times. I was a bikini clad babe (even if I do say so myself) skiing behind some really bad ass boats, baking in the sun with no sunscreen...just baby oil to make sure I was well done. :D

Quote:

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Originally Posted by kelly143

Ok, down to biz. Got copies of everything today. My vet is nice, but I do not feel she has a lot of experience with Cushings. I found a site, Marvistavet.com, which gave a lot of info and compares the different meds - worth a checkout all-. They are in LA, CA and I am in Orange County, CA - 45 to an hour depending on the time of day. I am going to call them tomorrow.

I had two cushpups, both passed who treated with a great internal medicine specialist in O.C. I live in San Bernardino County and drove to Fountain Valley because I could not find anybody in my neighborhood who was experienced enough to treat or diagnose a cushdog. Sounds like your vet is like most I've met in my area. The fact that your vet suggested ketoconozale is pretty good evidence that her experience with cushing's is very limited. A good number of dogs (1/3) don't absorb it into the GI tract and it is tough on the liver. So efficacy is iffy and it's probably tougher on the liver than Trilostane or Lysodren. If it were all that and a bag of potato chips, my dogs would have been treated with it. Out of hundreds of members, I can only recall one or two who opted for keto. I seem to recall that one of them eventually switched to Trilostane or Lysodren. Perhaps other members can recall.

VCA All Care is a specialty hospital open 24/7 so I made my appointments on Saturday or Sunday. My favorite specialist is Dr. Michael Moore, who is the Director of the Internal Medicine Department. Specialists are always more expensive and you usually get what you pay for. My first cushpup went undiagnosed for more than a year and it was an IMS at VCA All Care who finally diagnosed her and he left no stone unturned in confirming a diagnosis. After the diagnosis and starting treatment, I went to a regular gp vet to get the stim tests done as it was a lot cheaper. There is no reason why a specialist and a gp cannot work together. The one thing I think your vet should have done was order an abdominal ultrasound to validate the LDDS and check the status adrenal glands, liver and other surrounding organs. There is no doubt that Java has overt symptoms associated with cushing's and some vets may think a positive LDDS test is enough but a specialist usually doesn't as they want to know exactly what they are dealing with. I personally prefer to know that too.

The mfgr of vetoryl, Dechra, says that formulary pharms are not FDA approved in US.

Compounding pharmacies are governed by the State Boards of Pharmacy, not the FDA; however, they are subject to periodic FDA inspections. My dogs were tiny and all of their meds had to be compounded and did quite well on them. Compounded Trilostane is usually a third of the price of Vetoryl and can only be compounded for doses other than the Vetoryl doses manufactured by Dechra and approved by the FDA.

Java is hungry, thirsty, weak, pot bellied (hardly fits thru doggie door). At her vet visit in July 2012, I told the vet she could no longer get up on the bed. She has extreemly deteriorating muscle mass on her hind legs, her back is dipping like a lame horse. She stopped being able to get on the couch in January, when I noticed her extreme thirst and took her to the vet for that. Note- in May 2012 I started fostering my grandpuppy Missy. She is a 4 1/2 pound teacup silky terror. (no, I mean terror!!!) Missy and Java used to play like crazy on visits, but when she moved in, I thought Java was depressed. I think this is when her symptoms really started- hindsite 20/20.

Testing and timeline:
1/5/13 -Blood- I will only list the high counts, as there are so many listed-
ALT (SGPT) 340, Alk Phosphatase 716, Phosphorus 6.4, sodium 152, potassium 5.4, differential "absolute", monocytes 1035, T4 .06,
urine - spec grav 1.006, pH 7.0, occult blood "trace".

Can you please provide the normal reference ranges for these abnormalities

3/6/13 - Dex sup test:
cortisol sample 1 - 9.0 9:45
cortisol sample 2 dex 10.6 1:46
cortisol sample 3 dex 9.0 5:48

As Marianne has already mentioned, these results don't tell us which form of cushing's Java has. An abdominal ultrasound should be done to make that differentiation. It's not an inexpensive test but it provides so much information and even if I couldn't afford surgery if an adrenal tumor was identified, I'd want to know as adrenal tumors can metastasize and cause extremely high blood pressure.

Current status:
Vet gave me Ketoconazole to start today until she can get the Vetoryl, as Java is declining - she fell on the door jam going out to tinkle last night - she's so weak - it's killing me, I'm crying in my kraft dinner. Upon research of the Ketoconazole, it seems as if it has fewer side affects, and no chance of Addisons syndrome, and it is cheap, and no tests are needed after initial month check. No problem giving her pills 2xd as she always is up for a treat! I haven't seen anyone listing the Ketoconazole on your site as a treatment. Has anyone used it??? Oh, one more thing, I can get my Dr. to give me an RX for it, to "treat my excema";) (don't tell anyone I said that). I think I would like to try it first before the more dangerous drugs.

As I mentioned earlier, Keto is not without risks and its efficacy is questionable. It used to be used routinely by UC Davis to lower cortisol levels in preparation for adrenal surgery but they dropped it like a hot potato in favor of Trilostane.

Frankly speaking:
From what I have read, I don't really see the outstanding benefit of Vetoryl vs Lysodren for the cushpup. It seems to be of more benefit to the Vet, as my vet intends to sell it to me and peform expensive tests for the the rest of the Bean's life.

Vetoryl and Lysodren are serious drugs and their ability to improve a dog's quality of life has been proven time and time again. There is a reason why these two drugs are the treatments of choice by experienced vets. They work! I am intimately familiar with both as my dogs treated with both and did beautifully. Treatment with either can be safe and effective if prescribed by an experienced vet and an educated pet owner.

Periodic testing to monitor treatment is expensive but it's necessary to insure the safety of our dogs while trying to determine if treatment is adequate, too much or too little. Not all vets put money above their patients and many work with pet owners to contain costs. For instance, Dr. Moore and would call in my dogs' prescription to a compounding pharmacy who shipped directly to my home and charged my credit card. My current gp vet not only does that but shops the price for me so that I get the best price from trusted compounding pharmacies. They don't make one cent on my dog's medication.

My current vet also stays abreast of the latest advances and saved me money by using a fraction of the stimulating agent used to do the acth stim test. The stimulating agent is called Cortrosyn and vets have no control over the obscene cost of one single vial but they can control costs for the pet owner who have small dogs. Java is small so your vet can save you a lot of money by learning how to reconstitute and store the remaining cortrosyn for future tests. We can provide that information to you

Ketoconazole was never even mentioned until I pleaded to start treatment today and my vet could not find any Vetoryl anywhere today. She handed me this bottle and told me to start when I get home. The Lysodren and Keto are available at any pharmacy - easily price compared on Goodrx.com.

As I mentioned previously, my dogs treated with compounded Trilostane and Mitotane (Lysodren) and the annual average cost of both was about the same. My dogs weighed 4.5 lbs and 6.5 lbs. One thing I wanted to mention is that Java's ALT is a lot higher than we usually see on the many labs posted here and while it may be 100% attributed to excess cortisol, if it were my dog, I'd want to know if something else was pummeling the liver before I started treating with Keto.

This is the end of "The Life and Times of The Bean" a cushpup novel available at your bookstore soon.............:D

By Beanielover Kelly143 catchy pen name, huh??

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My vet told me that she went on facebook and had a forum with many professionals that she respected. They included internists, dermatologists, surgeons, endocrinologists and vets who had a lot of experience with cushpups. It seems that the vets have limited experience with the drug since the FDA approved it in 2009, and they are finding that the dosages listed by the MFGR are extreemly high, and that the lower dose is a better way to go. I think that the big issue here is that the dosage question is the downfall of the use of this drug, as the dosages listed in UK are different than the ones here. Since it is still pretty new here, vets are still working out the kinks with the dosage. As a result, I would like to start with the keto, if no results, I will go with the Lysodren, and keep an eye on the progression of the Vetoryl dosage situation. I have not seen any info as of yet to show that Vetoryl is greatly superior to the Lysodren, Lysodren is cheaper, more redily available, and once a week dosage is easier. I would also like to talk to the Marvista vet to get their take on Java. I really don't feel comfortable with my vet's experience with this disease or with the Vetoryl.

I must stop for now. My eyes are rolling back in my head again!!

kel

Thank you for your input! I wrote my last post before I saw it.... Thanks for the info on VCA. I was told the ultrasound was $1600.+ from my vet. I have been out of work for 3 of the last 4 years, with little hope for the near future. I just can't do it right now. My vet understands this and is trying to help us by keeping the big ones as a last resort. If (WHEN) things turn around in my employment, we will go forward with the big guns. It is understood that 80 to 85% of cushings is Pituitary based, chances are quite good that Lysodren will work well. I don't know, I guess I am still trying to digest the whole situation. It's been 3 whole days since the diagnosis and my brain is fried and I am exausted from dealing with this whole thing. I am totally confused now, I guess I will simmer a while longer in my tired brain juices and research a little more. But first....I need a nap. Think I will go cuddle a while with my sweet beanie.

I am so grateful to all of you for being there. Animal lovers are such great people. You are all so supportive and kind. It's so nice to know there a nice people left in the world.

Kel

Dear Kel,

You are absolutely right that newer research and experience is trending towards much lower doses of trilostane than were originally used when the drug was introduced for veterinary use in the U.K. a decade ago. However, even with that in mind, an initial daily dose of 12 mg. for a 50 pound dog is far lower than any current revised protocol of which I am aware. Since you are not opting to treat with trilostane, that is seemingly a moot point in your case. But I just wanted to mention that, for future reference, in case circumstances should change for you. If you're ever interested, here's a 2011 research study out of UC Davis which summarizes their current thoughts and dosing recommendations:

http://www.k9cushings.com/forum/show...0146#post80146

Since you've already started with the keto, I think your strategy to give it a try and then move on to Lysodren (if need be) sounds reasonable. If you do end up opting for Lysodren, however, be prepared to dose a bit more frequently than once a week once you reach the "maintenance" phase. Others who are more familiar with Lysodren can clarify further, but I think the recommendation is to split the weekly maintenance dose into 2-3 administrations over the course of the seven days. And as I said, the one issue that might arise with Lysodren treatment relates to whether or not Bean has an adrenal tumor -- if so, how high a dose of Lysodren might be needed for effective symptom control.

Of course, from your perspective, it sounds as though the best and easiest solution will be the keto if it proves effective. Over the years, we have had at least one other "keto dog" who did well on the medication, and we'll surely hope that will be the case for your Bean.

Do keep us updated, OK?
Marianne

Hi Kel, I think you have a plan and you can certainly see how the keto works and then plan to move on to lysodren if it isn't optimal.
You sort of have to take this learning about cushings in moderate amounts. It can be over whelming. There is just so much to learn. I think you're doing really great though.

And yes, I do think the pen name is catchy! :)

Sharlene and Molly Muffin

It does sound like you have a plan for your sweetie pie. Please do keep us posted on how things are going.

Also, this may be redundant (sorry) but with Lysodren there is a loading period where it is given every day until the cortisol levels are within accepted ranges and then you go on maintenance dose (weekly).

Terry

Hi again.

Since you have decided to move forward with Ketoconazole, I want to share some additional information that you should also share with your vet. I have cut and pasted an excerpt from a paper written by Dr. Mark Peterson, a renown endocrine specialist. Apparently my number regarding efficacy was at the low end of the range he has experienced in his practice. Since you don't know how much experience your vet has, this will help make sure dosing and monitoring is done properly.

Quote:

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Ketoconazole is an imidazole antifungal drug that also inhibits the synthesis of glucocorticoids and androgens. It effectively lowers the circulating cortisol concentration but has minimal effect on mineralocorticoid production. Ketoconazole controls hyperadrenocorticism in some dogs, but unfortunately, the drug is not efficacious in many dogs with the disease. In our experience, one- third to one-half of dogs fail to adequately respond to treatment.
Initial Dosage—Ketoconazole is started at a dosage of 5 mg/kg given twice a day for 1 week. If the drug is well tolerated (i.e., no decrease in appetite or icterus is seen), the dosage is increased to 10 mg/kg given twice a day for 2 weeks.
Monitoring Ketoconazole Dosage—The efficacy of the initial 14-day course of treatment is determined by an ACTH stimulation test. To ensure adequate control of hyperadrenocorticism, both the basal and post-ACTH serum cortisol concentrations must be lowered into the basal reference range. If the serum cortisol concentrations remain above this range, the dosage is increased to 15 mg/kg twice daily, and an ACTH response test repeated in 14 days.
Most dogs require a daily dose of 30 mg/kg for a long period for good clinical control. The disadvantages of ketoconazole are the expense, the requirement for twice daily administration for life, side effects, and the drug’s lack of efficacy in some of the cases. In one report, less than 2% of veterinary specialist (internal medicine and dermatology) use ketoconazole for treatment of canine hyperadrenocorticism.

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Please do post the normal reference ranges for the abnormal blood values. As I mentioned, most cushdogs have mild elevation in ALT and even without the benefit of seeing the normal reference ranges, Java's appears to be a lot higher than we're used to seeing here. Plus, you mentioned that her condition seems to be in deep decline recently and while all dogs are different, sudden and deep decline isn't the norm. Please ask your vet about that and if he doesn't have an appropriate answer, perhaps he can call an internal medicine specialist to see if there are any concerns. Most gp vets have an internal medicine specialist they call when they have an unusual case and cushing's is unusual for a lot of gp's. I'm a worry wart who understands the financial constraints of this horrible economy but asking questions doesn't cost anything.

There is another drug sometimes used in cush pups that doesn't have a high efficacy rate either but did help my Squirt for about 9 months. That drug is Anipryl, generic is Selegiline. It is only effective if the pup has the pituitary form, PHD, and the tumor is in the pars intermedia portion of the pituitary gland - which applies to about 25% or less of PDH pups.

I don't know that it is less harsh on the liver but your vet or a pharmacist could tell you that more than likely. It is more expensive to use than the Lysodren (Mitotane) she is now on but has many fewer possible side effects. However, the trade of is in the effectiveness of the two - Lyso far more effective than Anipryl. The same would hold true for Trilostane (Vetoryl) VS Anypril. But it is another option if the Keto doesn't work out and you aren't ready to try the Lyso or Trilo.

Hugs,
Leslie and the gang

Some links on Anipryl -

Anipryl info*

http://www.marvistavet.com/html/body_anipryl.html

http://vetmedicine.about.com/cs/dise...rylseniors.htm

http://www.lbah.com/anipryl.htm

http://www.selegiline.com/

http://www.petplace.com/drug-library...ryl/page1.aspx

http://www.drugs.com/vet/anipryl-5-mg-can.html

Hi All,

Thank you all again so much for all of your support. I have decided to go with the Lysodren. I will start her on it this afternoon.

Now the next question: Who has info on the cheapest ACTH test in the Orange County, Ca area? I came across a thread with this info, and it seems that the prices vary A LOT depending on where you go. I am looking to compare "out the door" cost. Some people list test only, some include visit cost (if any), meds, etc. I am wondering if the prices reflect the Diagnostic Lab charges to the vet. My Vet used Antech for the low dose dex test and charged $170.00 for the test and $15.00 for the dex. The total bill was $185.00, no charge for Java spending the day there. My vet said the ACTH would cost between $300. and $400. dollars. That seems VERY high in comparison to most of the posts in various areas.

We will make it thru this. I took my nap and I am strong again! :)

Kelly143

Hi Kelly

The reason why the acth stim test is so expensive is because the stimulating agent, cortrosyn, is ridiculously expensive. There is good news for those with smaller dogs because studies show that while instructions on the .25 mg (250 mcg) vial is to inject the entire vial, only 5 mcg per kg of weight is necessary for an accurate result. While Java isn't small, her weight is still low enough to get two stim tests out of one vial. If you do the math, she'd need a bit over 113 mcg so your vet could just split the vial exactly in half.

I have provided the url to instructions on how to split, reconsititute and store for future use. This info is brought to us by a highly published and well respected endocrine specialist, Dr. Mark Peterson. Either give the url to your vet or print out the article for him and ask for a revised quote.

http://endocrinevet.blogspot.com/201...cortrosyn.html

At 50 lbs, Java should be getting the recommended daily loading dose of 50 mg/kg which equates to about 1113 mg. Most vets would round down to 1000 mg which makes for easy dosing. You would give Java one 500 mg pill in the morning and one in the evening WITH FOOD. The average time to achieve loading is between 5 to 8 days but we've seen some load in two days and some taking months. Unless your vet is open 24/7, I would suggest that you wait a few more days before you start dosing. The reason for this is that because of Lysodren's cumulative effect, it's unlikely that a dog will have a crisis in the first two days of loading. If you start today, there's a much greater likelihood that you're going to need your vet when he's closed for the weekend.

If your vet has not given you prednisone to use in case emergency, do not start loading until it is in your hands. Having had two cushdogs treated with Lysodren, I'm a seasoned veteran of loading and I can tell you that if you watch Java like a hawk and look for signs of loading, like the least little change in eating behavior and/or decrease in water intake, you and Java will ace it without incident. Many of our staffers are also seasoned Lysodren vets so expect them to chime in and want to help you and Java.

If your vet were experience with cushing's, which I don't get the impression he is, he should be calling you every day to check on Java's progress. If that's not the case, we'll gladly take the case and lead you through everything. You just need to check in frequently, okay? Before you start, please, please read the Lysodren Loading Instructions and Helpful Hints. Print it out and keep it handy while loading so you don't forget anything. I've provided a link below.

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

Read through your homework and let us know if you have any questions. :D

Glynda

Thanks for all the info...............GULP. Here we go......:eek:

Kelly143

Kelly did you read Glyndas last reply? If not do so!

Sharlene and Molly Muffin

Hi Kelly,

If you haven't actually started the Lyso, could you wait just a bit until we get a chance to learn a few things?

What is the dose of Lyso you are using?

How many times a day were you told to give the Lyso?

Were you told to give it with a higher fat meal?

Were you told what to look for that will indicate the load may be achieved?

Were you told what to look for that would indicate a crisis?

And, most importantly, do you have prednisone on hand and were you told when and how much to give?

Hope to hear from you soon! And you are absolutely correct - you can and will get through this. ;)

Hugs,
Leslie and the gang

Hi all,
An update and response to your emails:
Yes, I read Glynda's wonderful email. Yes, my vet sent me home with a info sheet and prednisone for emergency (after I insisted because of you all). I did not know the food should be high fat. Thanks for the heads up.
We started the meds last night, 3/14/13, as they were not available at the first pharmacy I went to. I ended up at Costco and paid $154.51 + tax for 30 500mg tabs of Lysodren. So far, so good.
I would still like to know where to go in Orange County for the cheapest ACTH test. My vet is going to charge in the $400 range, and I have seen it cheaper on this site, but with no specifics as to where. I am giving her 500mg every 12 hours for the loading phase to start.

kelly143
Kelly143

Quote:

---

I did not know the food should be high fat.

---

Oh, me! :eek: No, that is not what I meant. The Lysodren is better absorbed and therefore works better when given with a little oil or fat. You can smear peanut butter on the pill, put it in cream cheese, or add some fish oil to that meal. But a high fat diet is NOT what a cush pup needs. Cush pups are prone to pancreatitis which can be triggered by fats so a low fat diet is what our babies need to eat as a regular food. Only with the meals when giving the Lyso do you want to add a little bit of fat or oil to assist the drug in doing its job.

Sorry to confuse you!

ok, gotcha. High fat only with the meds! ;)
Thanks for straightening that out.

k

Hi and welcome, good luck with the new meds for your pup, hope it goes smoothly...sending hugs from Sim and me.

thanks. I needed that!!!!

You all are so wonderful. Really! It really means a lot to know you are all out there. It feels like the bean and I have a great big family rooting for us, looking out for us, and loving us. I'm so glad I don't have to handle this alone anymore. There really are angels among us. :D

k

Quote:

---

Originally Posted by kelly143

I would still like to know where to go in Orange County for the cheapest ACTH test. My vet is going to charge in the $400 range, and I have seen it cheaper on this site, but with no specifics as to where. I am giving her 500mg every 12 hours for the loading phase to start.

---

Hi Kelly,

$400 is higher than most specialists charge for a stim test! Honestly, you would do well to take Java in for a consult with VCA All Care and pay the $85 consult fee and have them do the acth stim tests for $255. The cost of the consult and one stim test is less than your vet is going to charge for one stim test and Java would be under the care of a very experienced internal medicine specialist. The facility is also open 24/7 and they don't require a referral so it's a win win all around. They literally treat hundreds of cushingoid dogs and have clients all over So Cal, including a lot of us folks who drive an hour or three to get there. I called VCA and confirmed those prices for you.

If you didn't talk to your vet about splitting the vial of cortrosyn, you should do that because you may be able to get them done cheaper than $255. You can also do what I did and call vets in the area. Ask them if they treat cushingoid dogs and if so, how much do they charge to do an acth stim test on a 50lb dog.

Glynda

I printed out the info you sent about saving the meds and printed a copy for my vet.

Now, what do you or anyone know about hind leg paralysis? :confused:

I can't believe this! My other dog Alex last nite suddenly can't move his hind legs. I think he might have had a bad landing off the bed last nite or something. He is the healthy one who never has any problems. This happened to Java on one leg about 5 years ago. The vet gave me steroids and I had to put a towel under her and lift her hindy to go outside. It lasted for a little while and she got better.

I took him in today. My reg vet has Monday off. The sub vet gave Alex a shot of anti inflams and sent me home with muscle relaxers and prednisone, after checking his spine. He wanted to run all the tests and x-rays, keep him in the hospital and keep him on IV. I did that with Java last time, but I decided to just do the same home care as I did when Java had the same prob. He told me to keep him quite and resting. I have yet to create a hind leg lifter for Alex due to the plumbing difference, but I'm thinking a halter leash put on the back rather than the front may just due the trick.

Everything happens for a reason. Maybe I am meant to create my own job. A home daycare for sick pets! I am really good at it now, and I dearly love animals. I can't imagine handling this if I had to go to work everyday. What choice would I have? leaving them in some cage in cold, loud, bright, stinky hospital?

sorry for rambling......Java seems to be doing better. She seems to be a little perkier.....She is watching over Alex, so sweet......she knows something is up. She is laying right up against him. She usually lays by herself by the window. She woke me with a kiss this morning.....we are all on a mattress on the floor for now, until everyone gets better! She is wagging her tail a little more, and ran into the garage today when I took Alex to the vet.......(only now would I see that as a GOOD thing!) She is also barking and chasing cats in the back yard. She seems to be drinking a little more water. The bowl was almost empty this morning. We want to see less water drinking, but it has been warmer these past few days and she LIVES to lay outside in the sun! Will continue to keep a close eye on both now. No calls from the vet to check on her as of yet.

Kelly143

Glad to hear that Java is gaining, sorry to hear about Alex, goodness girl you need bunk beds for those two. Take care of you too!

Hi Letti and all,
thanks!
We all are settling in with the situation at hand. I have figured out that if I wrap a towel under Alex I can lift his hind legs up to take him outside to do his biz. I am proud to say that I have figured a way to direct the flow with the towel away from his feet so he doesn't get them wet! Ahh, life's little triumphs!
The Bean seems to be drinking a little less water today, so I will take that as another little triumph to celebrate.

Thanks again for being there. ;)

kelly143

Hey Kelly, how is Alex and Java doing? I do hope that Alex starts to show improvement soon. Maybe a pinched nerve?
Java is acting himself?

You're doing an amazing job!

hugs,
Sharlene and Molly Muffin

Sharlene and all,
Thanks for your support....Today, Java did not finish her breakfast for the first time in history! Soooooooooo the call was made for the ACTH test. Maybe tomorrow?? I am waiting to hear back from the vet. Java is still moving with some difficulty, but I am hoping to see her get stronger as the meds keep doing their job.

Alex is showing no improvement as of yet. He is very angry about this whole thing. I have been instructed to 1/2 his muscle relaxer, but I am going to see if we can continue his whole dose to keep him a little calmer.

kelly143

Hey Kelly,

How did Java do for the rest of the day? Any interest in food? It's been 7 days I think. Started on the 13th?
Make sure no diarrhea. If so, schedule sooner rather than later.

Darn, how long did it take Jave to show improvements when this happened to him? I do hope Alex starts to show some improvement soon.

Hope you aren't too exhausted yourself from all of this

Sharlene and Molly Muffin

Hi Sharlene,
Java was pretty slow for the entire day. She didn't finish dinner either, and water consumption is back to normal. We are going in tomorrow for the ATCH, as anticipated. Vet told me to discontinue meds until the test tomorrow. Looks like we will b moving to the next phase and just giving meds in smaller doses 1 to 2 days a week. I am looking forward to her getting stronger again.

Alex is still paralyzed, but he did wag his tail a little today, so that is good I guess. He is eating so that is good too. I hope he gets his legs back. I don't remember how long it took Java to get her leg back (she only had one bum leg)....time will tell.

BTW - tired is for whimps!!!;)

Kelly143

Kelly,

I had a friend whose dog went lame. They looped pantyhose around his midsection and took him for walks that way. It helped him recover faster. Might be worth asking the vet about:-)

Good luck sweetie.

Oops, sorry, Java is a her and I called her a him.:eek::eek: I hope she gets her strength back soon too.
Poor Alex, hope he starts to show some movement in the legs soon. Everything always seems to happen at the same time. sheezz

Sharlene and Molly Muffin

Hi Kelley,

You won't give any more Lyso until the results of the ACTH come in. It is normal to have a waiting period between the load and starting maintenance so you and Java will have a little break from the meds. ;) Then when you do start the maintenance, it will be spread out over 2-4 days a week - usually the same dose but that dose a week VS daily like in the load.

Keep an eye on Java - the Lysodren will keep on working after the last dose reaching its peak at 48 hours. Let us know how she is doing and what the ACTH shows. You're doing a great job, Mom! Keep up the good work!

Hugs,
Leslie and the gang

Hi All,
Thank you yet again for all of your helpful and loving input. Here's the latest in the "Life of Al and The Bean":

Al: Today was a turning point in my life over the past week. He hobbled outside by himself and did #1 AND #2 without rolling or falling in it and getting it all over himself. :D:D:D:D He is so stubborn and won't let me help. It is so nice not to have to wrap a towel around his head and carry him out biting and growling, then having to put him in the tub after every call of nature! He looks like a cross between an newborn fawn and a drunken sailor when he tries to walk, but he is getting around the yard a bit.

The Bean: Her test came back in the "low part of the acceptable range" whatever that means. I will get a copy when I go in next time. I started 1/4 tab 2 days on 2 days off last night. She seems ok one minute and weak the next. She is licking her paws a lot. She seems restless - she gets up and moves then lays back down frequently. Today I noticed her squatting and dribbling outside (tinkling)a lot and panting more than usual. I suspect she may have a bladder infection. :(:confused: What next.......errrrrrr. She has been much more cuddly in the past few days, which is nice but strange. She usually likes to stay at the foot of the bed rather than right up beside me with her head on me. If she keeps the squatting thing up til tomorrow, I will get some anitibiotics.

That's all folks!!:D

Kelly143