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

[Harley PoMMom]

One needs to be cautious when using Trilostane/Vetoryl or Lysodren/Mitotane in a dog that has renal insufficiency. I would ask your vet/IMS about this.

Love and hugs,
Lori

[lulusmom]

Hi Mary Beth and a belated welcome to you and Alivia.

I have looked at the abnormal blood values you posted and I'm going to ask Debbie, our resident expert, to take a look at everything. Debbie has 30+ years experience as a lab technician so I'd like her to comment on a lot of the abnormalities that we don't normally see with cushing's.

You mention that Alivia had IMHA when she was 7 years old. Most dogs with this condition don't recover and are on life long medications, usually prednisone. Did your vet determine what underlying condition triggered the IMHA six years ago? Was Alivia on long term prednisone? Is she currently receiving any medications to suppress the immune system? Can you also post the values for creatinine and BUN. If the IMHA caused kidney damage, I would think there would be some abnormal kidney values in addition to protein in the urine.

The ultrasound findings indicate an adrenal mass on one of the adrenal glands. Before I go into my very layman's opinion, can you please confirm that the other adrenal gland was shrunken or atrophied? Sorry to answer your questions with more questions but the waters get murky for me when a dog has an underlying condition like IMHA.

Glynda

[MBK]

Hi, Glynda and thank you,

You are correct that most dogs don't recover from IMHA. There is an 80% mortality rate. I had no clue Ali was even sick until she had a siezure. Fortunately, I was at home and rushed her to her regular vet's. Her PCV was 12 (normal is around 50) and he immediately made the diagnosis. At the time, the best place to go was OSU, so we made the 4 hour trip - many times. Alivia was in intensive care there several times. She received a couple of blood transfusions, was treated with Prednisone, Imuran and Heparin injections for awhile. High doses of Prednisone are the first line of treatment for IMHA, but Ali did not do well with that. As soon as she was stable and her PCV was higher, the prednisone was stopped. It was ironic that the Prednisone saved her life, but also seemed to be killing her with side effects from the drug! While she was critical, she also developed Protein Losing Nephropathy. She defied the odds, surprised her doctors (they said she did things they could not medically explain) and recovered for the most part. Her regular vet here is wonderful and would draw blood (sometimes twice a week!) and ship it to OSU so that the results were always run by OSU and would be more consistent. Then OSU would call me with any medication adjustments or changes. I think she survived because her regular vet worked with OSU, allowing them to direct her care, and we all worked as a team. Plus, Alivia had to have a strong will to live and I wasn't about to let her die!

Alivia has residuals of high blood pressure, treated with Amlodopine and usually has some protein in her urine (although this recent result was higher than her usual) and her "normal" PCV is now a bit lower than most dogs. She is not on any immune suppressants and is never prescribed Prednisone because of not handling it well. What caused the IMHA? They could never say for certain but she had routine immunizations about one month prior and that may have triggered it. To this day, she is not permitted to have any immunizations, boosters, etc. Not even for rabies.

She has been monitored pretty closely since the IMHA. If I even think she is a little pale or lethargic, I take her for blood testing. She's remained pretty consistant.

The additional results you requested on 3/19:
BUN 24.4 (9.0-29.0)
Creatinine 1.0 (0.4-1.4)
On 3/24 (different vet):
Creatinine 1.0 (0.5-1.6)
BUN/Creatinine Ratio 21 (4-27)

Her regular vet who has monitored Alivia since prior to the IMHA said today in an e-mail "Alivia doesn't seem to have kidney or liver problems". Which confuses me based on things her IMS (who is difficult to talk to) has said in the past. Since her IMHA days I have always requested copies of all of Ali's test results and I did request everything from the last bunch but they did not include an ultrasound report. Unfortunately, all I know is what the IMS told me on the phone, that the one adrenal gland was about 4x the size of the other. I will call them again tomorrow and ask for the report.

Ali's regular vet conferred with an internist friend of his and has recommended Trilostane as he believes that would have the least chance of negative effects. I e-mailed Dr. Oliver last night and his repsonse today seemed to favor surgery but he admitted that would be risky (I will NOT take that chance) and his other suggestion was Melatonin, Lignans and a maintenance only dosage of Lysodren WITHOUT the loading dosage. So, of course I am even more confused!

Thank you again for your time. I really appreciate any insight you can give me.

Mary Beth and Alivia

[MBK]

Glynda -

The first blood testing results I posted were from 3/19 and were drawn by Alivia's dentist (a whole different story!) because I said she was not acting like herself. Since there were so many things out of the normal range, I took her to her IMS as soon as I could get her in, 3/24.

Looking at the 3/24 results, the reference ranges are different and these don't seem nearly as bad! The only abnormal ones are:

Alk Phosphatase 205 (5-131)
Amylase 1393 (290-1125)
Hematocrit 34.4 (36-60) This is normal for Ali.
WBC 17.4 (4.0-15.5) She was getting over an abcessed tooth with severe infection.
Platelet Count 563 (170-400)
Neutrophils 80 (60-77)
Lymphocytes 11 (12-30)
Absolute Neutrophils 13920 (2060-10600)
Absolute Monocytes 870 (0-840)

Actually nothing is unusual for Alivia except the ALP and Amylase and these are higher than blood testing she had on 2/9 (pre-surgical for the abcess). Now I see why OSU wanted all the blood testing done at the same place!!

You are probably ready to kick me off of here because of these long posts! I'm so sorry. I just want to be sure you have as much detail as possible.

Thanks so much,
Mary Beth and Alivia

[addy]

Melatonin, Lignans and a maintenance only dosage of Lysodren WITHOUT the loading dosage. So, of course I am even more confused!

I don't want to confuse you any more than you feel you are. I have this treatment choice as an option for my Zoe. She has colitis and takes metronidazole to control it. I have searched everywhere to find another doctor who might think this was truly an option for us, eveyone tells me, including my internist, it doesn't work, yet Dr. Oliver does believe it is an option. It is confusing, I totally agree.

Hugs,
Addy

[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

[apollo6]

Dear Mary Beth and Alivia
Welcome from Sonja and Apollo.
Apollo is 12.5 years has the pituitary cushing and is on Trilostane, and does have the elevated hormone readings but I am still trying to figure it out. He has done well on the Trilostane.
We are hear for you and will support and guide you along.
Hugs Sonja and Apollo

[addy]

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.

Zoe 's cortisol was 40 last UTK panel. I have not tried this option so I am not stating it did not work for me. I said it was an option for me but I keep being told by others that it does not work including my IMS. I just posted on my thread what Dr. Mark Peterson told me about. He is a highly respected published specialist. I have been trying to research this option for 3 months.

My only point was, I too have been told it is an option for my dog but noone seems to think it works for a dog with increased cortisol except for Dr. Oliver. I would love to believe it could work.

Hugs,
Addy

[Rene]

Thanks Addy,

I misread...I thought u tried skipping the loading phase and it failed. I would love to believe it works, also. But, I am like Mary Beth...I want to hear from the group on real life experiences!

Mary Beth, what I do know that works if you decide on the Lyso, break down your maintenance dose in three or four doses a week and give with food. Its easier on them and does not give the adrenals a chance to regenerate in between a single weekly dose. The food helps more of the drug to be absorbed properly by the adrenals. I learned this because Snoop was having a hard time rebounding on her cortisol and these little things had helped her to hold.

Rene & Snoop

[StarDeb55]

Mary Beth, I believe that Leslie's Squirt has been on maintenance lysodren dosing for a couple of months. I don't know if she has had any repeat testing done, but Leslie has been reporting that Squirt's symptoms have show great improvement. Squirt had been on only melatonin + lignans the past couple of years.

The thing about this disease is that the great majority of dogs who demonstrate elevated cortisol will also have one or more intermediates elevated. Once you bring the cortisol within range, this will also resolve the intermediates in a large majority of cases. There is a lot of debate among the professional community as to the significance of elevated intermediates & using trilostane, so it's kind of hard for us to weigh in on it when even the experts don't have a consensus opinion. I can tell you this that with the number of dogs in this group on trilostane, keeping in mind that not all of them have had a UTK panel done, we see very few that have problems with intermediates causing increased symptoms with trilo.

Personally, when my Harley was diagnosed my GP vet used a UTK panel to make the diagnosis. I took him to my former IMS for confirmation. All she did was an ultrasound, & the US along with the UTK panel made the diagnosis. Harley had some pretty spectacular elevations clear across the board on the UTK panel, & at that point in time, the IMS would not even consider putting him on trilostane. This was 3 years ago, so her opinion may have changed. I had a serious disagreement with her over how she was handling Harley's care, & basically fired her, so I can't say what she's doing, now. My GP managed Harley's care, & we used lysodren. I had successfully treated one boy with lyso for nearly 8 years, so it was the drug I was familiar with. My GP kind of suggested trilostane, but I think Harley would have been his "guinea pig" first trilo pup. I was not in favor of that. Interesting point, I asked my GP about a month ago, if he was using trilo with any of his Cushing's patients, his response was not a single one. My GP vet has tons of experience with Cushing's so that tells me something.

Debbie