Re: Suni
Most vets are using Vetoryl these days (compound name Trilostane). It has the same risk factors as Lysodren but has a much shorter life in the body than Lyso so if, IF, there is a problem with the cortisol dropping too low it is leaving the system more quickly. This means simply stopped the drug for a week or so will usually take care of the issue, rarely needing Prednisone to support the adrenal glands. The flip side is that Vetoryl is given daily (no loading phase as with Lyso), it is not as stable as Lysodren so the cortisol can suddenly drop or rise even if the dog has been on the same dose for a while, and it can take a while to get the correct dose....all of this means there is a great deal more testing with Vetoryl than with Lysodren because with every dose change the testing schedule starts all over at the 2 week mark. ACTH testing schedule for Vetoryl is 10-14 days after starting, another at 30 days after starting, then every 3 months as long as the cortisol is controlled. If the dose has to be adjusted, and most dogs have several adjustments, this schedule starts all over. So while each Vetoryl pill is less expensive than the Lsyodren pills the testing makes it more expensive to use in most cases. I am the oddball and much prefer Lysodren to Vetoryl for these reasons and others but most feel the opposite because of the short life in the body in cases of overdose. Anipryl is not in favor for most dogs because it is rarely effective and even when it is, it doesn't work very long. For Anipryl to be effective the dog must have the pituitary form and the tumor must be on the pars intermedia portion of that gland. Most pups do have PDH but only about 20% of them have the tumor on that portion of the pituitary gland.
For dogs with the adrenal based form Vetoryl is the preferred treatment because ADH requires higher and higher doses over time and Lysodren is very hard on the stomach making increasing doses tough for the pup. Vetoryl is also preferred for diabetic pups if memory serves.
If Suni does have naturally occurring Cushing's VS Iatrogenic we can help you with the starting dose for either drug so don't let the vet convince you that you have to use what they prescribe. Sadly many vets still don't understand these drugs and often overdose from the beginning, especially with Vetoryl. Also, Dechra refuses to update their literature so vets are operating on outdated info for starting and increasing Vetoryl doses. So come talk to us before accepting treatment.
As for testing, the LDDS is notorious for false positives if any other health issue is present but is still considered the gold standard for diagnosing Cushing's. The ACTH is the test that should be used in diabetic dogs for this reason. If it is feasibly possible it is always best to have both tests done along with the ultrasound. Establishing a base with the ACTH before starting allows us to see how far the cortisol has dropped at that first ACTH monitoring test.
One thing to keep in mind....for a pup who has been on long term steroid use the adrenal glands can become inactive, even atrophied, because they haven't been having to do their job...the steroid has been doing it for them. So for this reason you want to give the pup long enough off the steroids for the adrenal to fully recoup. When you are seeing strong cush signs you know they are functioning again. Some adrenals never recover if the steroid use has been high enough and used long enough, putting the pup in an Addison's state, but this is not typical. For Suni, I wouldn't rush into any testing right now but rather give her time to get all the effects of the steroids out of her system. I would wait for those cush signs to show up the test. If you don't remember those signs I can give you a list to watch for.
Remember to get copies of all the test results so you can play 20 Questions with us.
I hope she is doing well and you too....you've all been through enough for a while!
Hugs,
Leslie
"May you know that absence is full of tender presence and that nothing is ever lost or forgotten." John O'Donahue, "Eternal Echoes"
Death is not a changing of worlds as most imagine, as much as the walls of this world infinitely expanding.