Java Bean

[kelly143]

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. (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

[mytil]

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

[labblab]

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

[molly muffin]

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

[goldengirl88]

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.

[SoggyDoggy]

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 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

[kelly143]

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.............

By Beanielover Kelly143 catchy pen name, huh??

[mytil]

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

[labblab]

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.

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

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

[labblab]

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?