10 days on lysodren and need your guidance

[jzkeegan]

My little maltese, Cali, is 6 lbs, and 14 years old. She was diagnosed with cushings several weeks ago and we determined to treat with lysodren. I had it specially formulated because she is so small, and we started with 40mg 2x a day. We tested on day 5 and her pre-test was 6 and post was 21. So...dr advised we continue with the loading phase. It has been 10 days and the numbers are nearly identical (pre 6.6 and post 21.5).

She is still drinking a TON and peeing a ton so I knew she was not "loaded."

I am waiting for the vet to call me back with instructions. But I wanted to ask you all in your experience what you've done if the 10 day loading phase did not work. Do you raise dose immediately and if so do you go super slow? Do you start the loading phase all over again with an increased dose? Is this common for the dog not to respond after 10 days? I know my vet started on the smaller dosing, but since Cali is so small, she didn't want to risk putting her in Addisons.

Any advice would be greatly appreciated! Thank you!

[DoxieMama]

Welcome to you and Cali, though I'm sorry she's not responding to treatment yet. I do not have experience with lysodren so will not be able to answer your questions on that. I'm sure others will be by who do.

In the meantime, would you mind sharing the symptoms that led you and/or your vet to test for Cushing's in the first place, as well as the test results which resulted in her diagnosis? Not because I doubt it but we like to have the full picture so to speak.

Once again, welcome! I look forward to learning more about your precious little girl.

Shana

[molly muffin]

Hello and welcome to the forum.

I'm giving you a link to our lysodren loading instructions: http://www.k9cushings.com/forum/showthread.php?t=181

you should load at 50mg per 1kg. 6lbs is 2.72 kg so load dose should be 68mg twice per day. (138mg daily) so 80mg daily might not be enough to get a load going for her.

did they do an ultrasound or ldds test during the diagnostic phase? an ultrasound would show if there was an adrenal tumor, which can be harder to get control of. An LDDS test results might show that too though.

I'm thinking the load is probably not strong enough and that is why it is taking longer.

[Harley PoMMom]

Hi and welcome to you and Cal from me as well!

I agree with Sharlene, Cal loading dose is lower than what is recommended, and because of this it will take a lot longer to achieve a load. Also, Lysodren is a fat soluble drug and needs to be given with some fat, is this being done?

The link that Sharlene posted is full of information regarding Lysodren so I do urge you to read it and feel free to print it out so you have it as a quick reference.

Please do not hesitate to ask all the questions that you want and know we will help in any way we can.

Hugs, Lori

[Squirt's Mom]

Welcome from me as well! I am a Lyso fan personally.

Are you giving the drug with food? It must have fats to be absorbed and used by the body so Lysodren must be given with a meal. Is she on any other meds? Do you use steroid creams for any reason?

Glad to have you join us and look forward to hearing from you again soon!

Hugs,
Leslie and the gang

[labblab]

Hello and welcome from me, too. I just want to reinforce Shana's request for some background info on Cali. It will help us a lot if you'll tell us more about her overall health history, the symptoms that led your vet to suspect Cushing's, and the results of her diagnostic tests.

As the others have said, your lack of improvement on the Lysodren thus far is most likely the result of using too low a dose for the load. However, even though it doesn't make logical sense, the adrenal glands of dogs who don't have Cushing's do not seem to be as responsive to the effects of Lysodren as are the adrenals of Cushpups. So when we have members who tell us their dogs are not responding to the medication, I always like to double-check the diagnostic history, as well.

Thanks in advance for any additional info!
Marianne

[jzkeegan]

Hi and thank you to all for your replies!!

Here is calis story.

About 1 year ago she began losing some hair. I thought this was due to age and didn't think any more of it.

A few months ago she started drinking a ton of water and peeing large less concentrated volumes of urine. After three days of this I took her to the vet and they ran blood work and informed me she was in early kidney failure and to switch her diet to a kidney diet. The vet did not seem terribly concerned.

She also was developing crusty scabby sores in her skin tags (skin tags which has been there for about two years and are benign)

Then one month later I took her for her wellness exam and dental and they ran blood work and her liver values were up significantly from the last blood draw one month prior.

We ran a bile acid test and that came back at 53.

Both vets in the practice guessed that it was likely we were looking at liver cancer. We had the option to ultrasound to confirm and we chose to do such.

In the meantime it was me who read all I could about Cali and her symptoms and cushings disease kept popping up.

We had the ultrasound done and it was confirmed that she has two tumors in both adrenal glands and NO cancer. I was thrilled and chose to test right away.

We ran an acht (?) test and her pre number was 7 and post was 21.

The vet gave me an option to use lysodren or trilostate (?). She explained the latter was a bit more safe because of the mechanism of treatment, but it's significantly costlier and the blood test needs to be done way more frequently in he first year of treatment. In contrast the lysodren works on melting the adrenal glands which does run a higher risk of addisons, however it is more affordable, given 2x a week (after loading phase) and blood tests are run every 6 months.

We chose lysodren and the reason the loading dose was so low is the vet wanted to inch slowly up as to avoid putting her in addisons. We just moved from 40 mg 2 x a day to 68mg 2x a day. (Her acht test still was at 6 pre and 21 post before we upped her dose)

It has been three days of higher dose and I see no change. She is drinking and peeing more than ever.

Thanks for hearing my story and any and all input or advice is welcome and appreciated!!

[Harley PoMMom]

Adrenal gland tumors are very resistant to Lysodren and it usually takes larger than normal doses of Lysodren to achieve a load which in turn increases the chance of an Addison's crisis.

My layperson"s opinion would be to switch to Trilostane after a washout period from the Lysodren.

Lori

[labblab]

Yes, like Lori, I'm really noticing your comments about the presence of adrenal tumors. Can you tell us any more specifics? You mention two tumors -- do you mean that each adrenal gland seems to have a tumor, or are there two tumors in one gland?

I'm wondering whether the ultrasound instead just showed that both of the adrenal glands were enlarged as opposed to containing tumors. If so, that finding would instead be consistent with Cushing's caused by a pituitary tumor.

Why this is meaningful is because, as Lori notes, adrenal tumors may be more resistant to Lysodren's effects. Additionally, the presence of two adrenal tumors may be a bit more sinister in terms of long-term prognosis, since adrenal tumors may be either benign or cancerous, and they have the potential of invading important blood vessels. So the size, exact location, and growth patterns of adrenal tumors can be important factors in weighing treatment decisions.

I'll be anxious to hear more about those ultrasound results.
Marianne

[jzkeegan]

Hi! Ok...so I went to the vet and physically picked up the report from her ultrasound. Here is what it said:

Adrenal glands: Left-cranial pole 7.1mm, hyperechoic nodule, rounded margins. Right Maximum 6.6 mm in thickness normal echogenicity.

liver: mildly enlarged, diffusely hyperechoic with a single hyperechoic nodule (1.5cm) on the right. Gallbladder wasll is normal, with mild debris, some of which is adherent. no organization. Biliary tree is normal.

kidneys: left 2.6 cm, right 3 cm, decreased cmd with multiple cortical cysts (4.6mm maxiumum) pelvis is normal.

conclusions:
1. mild nodular hepatopathy.
-This may be vacuolar change or hyperplasia, but given high bile acids an inflammatory or infectious hepatopathy is also possible. Neoplasia is unlikely.
2. Bilateral chronic renal degenerative changes with cortical cysts.
3. mild adrenomcgaly. Cushing's disease is a reasonable differential diagnosis.


Thoughts?