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

[littleone1]

Hi Mary Beth,

I know all of the treatments scare us, but cushings does need to be treated. There is nothing that says you have to stick to one of the meds. If one does not help, with a washout period, you can always switch.

Corky has only taken Trilostane with his adrenal tumor, and was started at a low dose. He's had two adrenal panels done, and his intermediate levels were elevated, but not much. They have not caused any problems for him.

[addy]

Hi Mary Beth,

We are all scared in the beginning. They are serious drugs and it is no wonder we are scared out of our minds when we have to start them. It is a normal response from us, I think.

That was my post from Dr. Petersen. Zoe's cortisol went up on her last UTK to 40 she was at 32 last June. She has colitis and has been sick alot this year and has shown a low tolerance to some drugs in the past so that was why I was looking for options for her.

Alivia's post cortisol was no where near as high as Zoe. I think it is a reasonable option. I have heard it can mean it may take longer to load the dog. I felt better having the suggestion come from Dr. Petersen since he is so highly regarded.

We'll see what others come along to say. But the low dose load option is what I am looking at too for Zoe.

If I did the math right, it looks like your dose is a tad less than 25mgs per kg. I'll go recheck my math, not one of my strong subjects

Hugs,
Addy

[MBK]

Hi, Addy -

I am reading so much stuff that I forget where some of the info comes from! Alivia has not done well with some medications when she was treated for IMHA, so I worry giving her any drugs. She had an especially hard time with Prednisone. What is Zoe on now? (I need to start a speadsheet with who's who and what treatment they are on!)

How long does the loading period usually take? Ali was 18 pounds when she was last weighed, but since she has been eating more, she is probably around 19 or so. Since her Cushing's is not pituitary, if the mitotane successfully lowers her cortisol levels, can it be stopped after awhile? I hate the idea of giving her something so strong for an extended period. Plus, I think with the tumor, her cortisol levels seem to fluctuate and are not always high because there are times when she has no symptoms.

Hi, Terri -

Alivia's baseline Aldosterone was pretty high, so that's why I was afraid of Trilostane. Her only normal level was the Estradiol. How long has Corky been on Trilostane? Did his symptoms improve significantly? I am so conflicted about which to use. Wish I had a crystal ball.

[addy]

Zoe is only on melatonin and lignans. We had work to do with her colitis and because her blood work is all normal and her symptoms were mild, we postponed treatment with lysodren. My IMS does not use trilostane.

Each dog is different when it comes to loading. In my opinion, I think underlying illnesses come in to play there as well. Kim's dog took over a month to load and some others loaded in 3-4 days. Seven to nine is the average, if I remember correctly. Alivia weight is like Zoe's.

We have so many members that have loaded and will be here to guide you and support you if you go that route.

I don't want to confuse you or make you second guess yourself. If you go to Apollos's thread, our Glynda laid out a case about Trilostane and increasing intermediate hormones. It was last week.

I have to learn how to copy the threads and post numbers for people

I know this is a hard decision but you will make it and it will all work out. You have to feel comfortable with the treatment. My IMS has stressed that to me.

Hugs and love,
Addy

[littleone1]

Hi Mary Beth,

Corky's been taking Trilostane for 19 months. Most of his clinical signs were resolved in a short period of time. Within the 1st ten days, his cortisol level was down to 2.1. His dosage has had to be adjusted several times since he started taking the Trilo, but he has been doing very well with this treatment.

[addy]

Hi Mary Beth,

I am just stopping by to say hi to you and Ali.

hugs,
Addy

[MBK]

Hi Addy and Terri -

Thanks for checking on me and Ali. I am still crying a little bit every day. It is just awful to realize that my precious little Alivia is getting up in years and our time together is getting shorter.

I went to a seminar the other night called "Living With Aging and Ailing Pets". The speakers were a vet, a pet loss grief counselor and a funeral director (a human one but they actually do complete pet funerals, too!) Sometimes I have some really bad ideas and this would be one of those times! HUGE MISTAKE!!! They were collecting donations on the way in for the animal shelter that sponsored the seminar. When the program started, I started crying and just could not stop. If I had been sitting in the back, I would have quietly slipped out the door. But, unfortunately, I was towards the front. They were filming it, so I didn't want to create a commotion by getting up and leaving. So, I sat there with tears streaming down my face for what seemed like hours, but was actually only about 45 minutes! About halfway through the presentation I realized I had written my donation check out to the WRONG animal shelter! When the program finally ended, I had to explain about the check, fish it out of the donation vase and re-write another! Then, I won the door prize - a CD called "Coping with the Loss of a Pet". I couldn't get out ther fast enough!

I think I told you my vet ordered a compounded 200 mg mitotane to start Ali one. It hasn't come in, yet. I think part of me is kind of relieved about that, because I am dreading starting anything!

[addy]

Oh, I can totally relate to your post. When I first heard the news of Zoe, I cried for days on end. All of that anticipatory grief just wipes a person out. So then I started putting Cushings in the drawer

It really works!!!!! Open a drawer or your glove box in the car and say out loud, very sternly "Cushings, get in the drawer and don't come out!!!" and close the drawer and then try to step back from it and do something you would normally enjoy. Sometimes I had to do this 10 times a day

We are all here for you and Ali. The loading will be fine. Positive thoughts

Love,
Addy

[MBK]

I don't think I can put it out of my mind right now, because there is too much of it in my face. Ali has a shaved bare belly and leg, plus she is having symptoms. So, as long as I am around her (which I want to be!), I see Cushing's and I am very much reminded of it.

Both of us might feel better if we could just get on with her treatment but, I am still waiting for the compounded Lysodren/mitotane...just called her vet and they are supposed to check with him and get back to me. It should have been ordered on Tuesday. Hope it didn't slip through the cracks! Anyone know about how long it usually takes to get a compounded version?

[lulusmom]

I came across this quote from Dr. Mark E. Peterson:

“In dogs with Cushing's disease, you must use a daily loading protocol in order to adequately destroy enough of the hyperplasic adrenal cortex. It's quite unlikely that starting with a weekly maintenance dosage of mitotane would do much at all to lower the high serum cortisol concentrations in your dog.

But you don't necessarily have to use the standard loading dose for mitotane of 50 mg/kg per day. You could try a lower daily dosage of 20-25 mg/kg (with food) to evaluate the effect. “

I just got off the phone with Ali's vet. Between his research and mine, we agreed that this "Low dose mitotane loading" sounded like a reasonable treatment compromise (I REALLY hope so). Alivia weighs 18 pounds and he is going to start her on 200 mg per day. Has ANYONE had any experience with this?

I'm just plain terrified of starting ANY treatment.

When Dr. Peterson commented on the feasibility of a lower daily loading dose, I don’t believe he was talking about dogs with adrenal tumors. Adrenal tumors are much more difficult to treat with mitotane because they are highly resistant to the drug and usually require much higher doses. My concern is that with such a low loading dose, you are going to be in for a very, very long loading period and when you do eventually achieve loading, it is going to be very difficult to determine an accurate maintenance dose. I realize that you and your vet want to take a very conservative approach because of Alivia’s history but I thought you should know what you may be in for. Most vets start dogs with adrenal tumors on no less than 50mg/kg and it is not uncommon to have to increase the dose some times to as high as 75mg/kg to 100mg/kg to achieve loading. These are huge doses which is why Pepcid is definitely a necessity.

Since her Cushing's is not pituitary, if the mitotane successfully lowers her cortisol levels, can it be stopped after awhile? I hate the idea of giving her something so strong for an extended period.

Once a dog is on mitotane, it is for life. The loading dose is the roughest phase and once you get loaded, maintenance is not bad. I have two cushdogs, both are much smaller than Alivia (4.5lb and 6lb) and they loaded at the full 50mg/kg. They have been maintained for over two years on a maintenance dose of 60mg three times a week. For me, it’s part of my routine to dig the cream cheese out of the reefer and stick a capsule in it on Monday, Wednesday and Friday. I should be so good about taking my own meds. 

Anyone know about how long it usually takes to get a compounded version?

If I ordered my Mitotane or any other veterinary drug on Tuesday, I have it no later than Thursday. I use Diamondback Drugs in AZ.

Glynda