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

[Maya]

Hi, Leah,

Sorry to hear you are also going through the same thing with Maya. What kind of dog is she? How old? Is her Cushing's pituitary or does she have an adrenal tumor, like Alivia?

We may not be able to offer any advice at this point, but since they were both diagnosed about the same time, we certainly can offer each other much need moral support!

Please keep in touch. I hope Maya's treatment goes well!

Warm thoughts,
Mary Beth and Alivia

Hi Mary Beth, Maya is a cross breed ( a mutt, I guess you could call her) She was 12 on the 1st of April. We think that she has pituitary type Cushings as no tumours were found on the ultrasound scan. Her adrenal glands were on the large side, but still within the normal range. One was slightly bigger than the other.
I'm sure you'll find all the help and support you need here, they are a great bunch!
Best wishes to you and your little babe

[Harley PoMMom]

What about Trilostane v. Lysodren for a dog with an adrenal tumor? Anyone have any opinions on this?

Grateful for advice,
Mary Beth and my sweet Alivia

I think you will find this article interesting:
Cushing's disease and other adrenal gland disorders (Q&A with Dr. E.C. Feldman).

Dr. Edward C. Feldman is a renown Cushing's expert, also this is the Editor's note:

Edward C. Feldman, DVM, Dipl. ACVIM, is the chair of the Department of Medicine and Epidemiology at the University of California-Davis School of Veterinary Medicine. He is a co-founder and former president of the Society of Comparative Endocrinology, a special interest group open to all veterinarians, and is a co-author of the Textbook of Veterinary Internal Medicine with Dr. Stephen Ettinger and Canine and Feline Endocrinology and Reproduction with Dr. Richard Nelson.

When deciding to treat with Lysodren/Mitotane or Trilostane/Vetoryl, IMO, either medication is safe when monitored appropriately and with owner observation and each med can have similar adverse effects. So "owner observation" is always a crucial component of treatment.

Each has it's pros and cons, they work differently, they are both safe when monitored appropriately, yet they both can have the same and serious risks and adverse effects.

One or the other may work better for an individual dog.

Another important consideration is the degree of experience your vet has with whatever treatment he/she chooses. Cushing's requires a good partnership with one's vet.

Love and hugs,
Lori

[Rene]

Hi Mary Beth,

This was also helpful to me when I first started out...if you haven't already seen it.

http://www.vet.utk.edu/diagnostic/en.../treatment.php

You were correct in your post that the trilo may elevate the intermediates. I have learned that the lyso will lower them. I had
e-mail conversations with Dr. O at UT re: this subject. You can e-mail him with general questions. He is very good about getting back to you.

joliver@utk.edu

Take Care,
Rene & Snoopie

[addy]

Hi Mary Beth,

Choosing treatment can be agonizing for us so don't feel you are all alone in that regard. We are the ones administering the drug to our pups so we can find it overwhelming.

Knowledge will make you feel more comfortable with your decision.
My dear friend Sonja, Apollo's mom has always given me sage advice. "Go with your gut". I pass that advice on to you

Hugs,
Addy

[MBK]

Thanks, Addy. Just when I think I am leaning towards one treatment, I change my mind.

I'll post Alivia's test results and if anyone has any opinions, I'd love to hear them. Alivia is a spayed female Jack Russell Terrier, 13 years old and 18 pounds.
LDDS Results:
Cortisol Pre - 7.1 ug/dl
Cortisol 2 - 0.9 ug/dl
Cortisol 3 - <0.7 ug/dl
I think these results were all in normal limits, but I am having a hard time reading the reference range information.
Ultrasound
I haven't received a copy of the report but was told there was a mass on one adrenal gland and that it was about 4x larger than the other side.
Adrenal Panel (U of Tenn)
Baseline / Result
Cortisol ng/ml 115.8* / 249.0*
Androstenedione ng/ml 3.90* / 7.84*
Estradiol pg/ml 68.8 / 65.4
Progesterine ng/ml 1.09* / 2.55*
17 OH Progesterine ng/ml 0.91* / 3.25*
Aldosterone pg/ml 222.1* / 414.5*
"These results indicate presence of increased adrenal activity. (severe)"
Blood tests (abnormal results only)
Result / Ref Range
Glucose 129 H / 75-125
Cholesterol 351 H / 120-310
ALP 203 H / 0-140
Amylase 2093 H / 100-1500
Lipase 436 H / 0-225
Triglycerides 238 H / 30-120
Sodium 104 L / 141-152
Potassium 2.8 L / 3.8-5.3
Chloride 74 L / 102-120
WBC 17.5 H / 6.0-17.0
GRAN 13.9 H / 3.5-12.0
HCT 35.1 L / 37.0-55.0
PLT 596 H / 200-500
Not sure if there is any significance to this, but handwritten on the blood results it says "Serum-cloudy/white"

So, how bad is all of this??

Terri, since your dog is about the same age as Ali and also has an adrenal tumor, could you tell me why you chose Trilostane over Lysodren? It sounds like you are having good results?

Sorry for such a long post, but I am at a complete loss as to what to do. It's 1:30 A.M. and I get up for work at 5:30, but I can't sleep. The only thing I have ruled out completely is surgery - that terrifies me due to her age and prior history of IMHA. The more I read, the more confused I get....wish I had a crystal ball.

Thanks all,
Mary Beth and Alivia

[MBK]

One last test result:

Urine Protein/Creatinine Ratio 4.5 / Ref Range <=0.5

Thanks again,

Mary Beth and Alivia

[littleone1]

Hi Mary Beth,

Corky has been doing good on the Trilostane. Originally, when Corky was first diagnosed with cushings over two years ago, his vet was putting him on Lysodren, which really scared me. Due to two UTIs, Corky couldn't start treatment due to the antibiotics he was taking. In the imeantime, his symptoms went into remission for seven months. When his symptoms started appearing again, his IMS is the one that recommended that we use Trilo with Corky instead of Lyso. She felt that it would be easier on Corky because of his other medical issues. He hasn't had any problems with it. His dosage has had to be adjusted, but that is to be expected. She started him at the low end with 1mg per pound.

[addy]

Hopefully Deb will come by and look at your test results for your blood work. Glynda and others can make sense of your UTK panel in the mean time.

Don't forget you can always switch between Lysodren and Trilostane as long as you do a 4-6 week wash out period if you have ruled out surgery. Boy, I know that "change your mind" every day!!!! I still do it even with food

Terri will stop by too to discuss Corky and Trilostane or you can read her thread "Little One".

You have some time to decide.

Hugs,
Addy

[Harley PoMMom]

One last test result:

Urine Protein/Creatinine Ratio 4.5 / Ref Range <=0.5

Thanks again,

Mary Beth and Alivia

Many dogs that have Cushing's do have protein-loss but also blood pressure that is elevated or not controlled properly can cause the the protein-loss to increase. Has Alivia's blood pressure been checked recently, as I seen from your prior post that she does have elevated blood pressure which amlodipine is being given to control.

My boy, Harley, was on amlodipine for a while for his elevated blood pressure but this medicine ceased to control his high blood pressure, we had to add benazepril along with the amlodipine to bring his elevated blood pressure down to the normal ranges.

Love and hugs,
Lori

[MBK]

Hi, Addy and Lori. Thanks for the replies.

Addy - So funny you should mention the changes in food!! I spend so much time in the pet stores reading labels. I won't give my dogs anything not made in the U.S. and since I have a hard time committing to any one food, I vary the (premium) brands I give them. Fortunately neither of them have sensitive stomachs and actually seem to enjoy the variety! I often bake them homemade treats because I feel better knowing exactly what they are eating.

Lori - Alivia gets her blood pressure checked every couple of months and the Amlodopine seems to be keeping it in check so far. The protein in her urine is due to glomerulonephritis, a residual from when she was 7 years old and had IMHA. So her kidney function has been a bit compromised for awhile.

Currently, I am leaning towards starting Trilostane, but still am very undecided so any opinions are welcome!

Thanks,

Mary Beth and Alivia