Zoe By My Side- Our Journey with Cushings

[lulusmom]

The standard rescue dose of pred is 0.25mg/kg. To convert Zoe's weight from lbs to kg, divide lbs by 2.2. then you multiply that times .25. So if Zoe she weighs 20 lbs, the formula would be (20/2.2 = 9.09) * .25 = 2.27. That's a rather odd mg so you could round it to 3; however, even if you gave her 5mg, she wouldn't overdose.

The mechanisms of actions for Lysodren and Trilostane are extremely different. Lysodren selectively erodes (kills) the cells of the adrenal cortex and when the erosion is sufficient, cortisol is normalized. For a cushdog, normal would be a post stimulated result of 1 - 5 ug/dl. Lysodren's effect is cumulative and it continues to do its thing for up to 48 hours or longer. That means if you give a pill today, you probably won't see the peak cumulative effect of that dose for 48 hours. This is why during the loading phase, you must watch the dog like a hawk for signs of loading because once you give that pill, you can't take it back. This is also why the optimum timing of stim tests for dogs on lysodren is 48 hours after the last dose.

Trilostane (Vetoryl) is an enzyme blocker that, in the nutshell, blocks the synthesis of cortisol. It's peak effectiveness is anywhere from 2 to 4 hours after dosing and then it's effect starts to noticably wane any time after 8 or 9 hours. It is because of Trilsotane's short half life that most vets don't feel it necessary to prescribe prednisone as most dogs will bounce back rather quickly simply by withholding the Trilostane.

I hope this helps.

G.

[addy]

Thank you Glynda, it helps very much.


One last question: when I read you can go on and off Trilostane please explain how that relates to Lysodren. If I start Lysodren, I cannot stop it? I am confused. Could someone give me more details? If I load Zoe and she has side effects or I make her colitis worse, I cannot stop Lysodren?


She is outside trying to eat litlle balls of dirt, tree blossoms; she has NEVER done that. Her taste went more for bunny poop and crab apples That's my girl.

We should be good to go

Thanks again!!!!!

Love,
Addy

[lulusmom]

To answer your question, the adrenal cortex cells are tough little suckers and if you stop loading before you get cortisol levels down or if you achieve loading but don't maintain the erosion you achieved during thaat loading with an adequate maintenance dose of Lysodren, those cells will start to regenerate and then you will be back to square one and have to reload. As far as interrupting maintenance dosing, as long as you get the entire maintenance dose into the dog during the week, you should be okay. For instance, Jojo and Lulu both get 60mg of Mitotane (compounded lysodren) on Mon, Wed and Fridays. I've withheld one of those doses before because they seemed off on the day of dosing and I just gave that dose to them on a Saturday or Sunday....no harm, no foul.

In my opinion, with Zoe's cortisol being higher than most dogs we see here, I personally don't believe a maintenance dose of Lysodren is going to have any impact at all.

[marie adams]

Hi Addy,

I think with Lyso you would have to wait for a wash out period of at least a month to start Trilo. That is if that is what I remember everyone saying. Lyso just stays in the system or works longer than the Trilo does in a time period.

I hope the IMS can fit you in...

Happy end of Monday--only four more days to go for this week!!!

[addy]

I don't think that is what I mean. People make the statement they use Triolstane because "you can go on and off of it". What does that exactly mean?

If we go this route, I won't do maintenance dose of Lysodren with Zoe without some type of load. I don't think it will work either. I just wanted to clarify that any time during loading or after loading and she is on maintenance dose, I can stop the Lysodren if I need to make that decision and all that will happen is her adrenals will regenerate. It is not that I could never stop the drug.
If her colitis would get so bad (IMS said she could need to use prednisone,)I could stop the drug.

Confusing statements to me are " once you start Lysodren the dog needs it for life" and as I already mentioned the "on again off again: statements of Trilostane

Me

[littleone1]

Hi Addy,

I'm not exactly sure what people mean by that either. It is my understanding that whether we use Lysodren or Trilostane, that our fur babies will be on it for the rest of their lives. There are sometimes remissions that occur in cushings, as was the case with Corky. Neither Lyso or Trilo are a cure for the disease. These meds help control the cortisol level and the clinical signs.

[labblab]

I just wanted to clarify that any time during loading or after loading and she is on maintenance dose, I can stop the Lysodren if I need to make that decision and all that will happen is her adrenals will regenerate. It is not that I could never stop the drug.
If her colitis would get so bad (IMS said she could need to use prednisone,)I could stop the drug.

Hi Addy,

Yes, you can stop giving Lysodren at any time if Zoe were to react negatively. It's just that if Zoe were to have a negative response to having her cortisol lowered, under typical circumstances it takes a longer time for her body to rebound after having been treated with Lysodren than with trilostane (days rather than hours). During the time period that you would be waiting for her adrenal glands to regenerate from the Lysodren, you would need to give her prednisone to compensate for the lowered cortisol.

Marianne

[apollo6]

Dear Addy
I can only give you Apollo's experience with Trilostane. Apollo went on a very low dosage(10mg.). We tried to up a little(12.5mg) he throw up a little, I stopped it right away(Nov 2010. He had no side effects of any kind. I restarted again after March 2011. So I guess it is easier to stop and restart Trilostane. But if Zoe is on Lysodren and you need to stop there is a certain time period before you could switch over to TRilostane( think they call it a wash out period)
The most important factor is , if Zoe's cortisone is high than maybe the Trilostane will work with the lignan and what ever else you are using. But if Zoe's cortisone is normal than no, Trilostane would lower it more which is not good. Also Apollo's intermediate hormones are elevated. But they may have been right from the beginning(don't know if the Trilostane caused it).
I will continue the Trilostane and start the HMR lignan and Melatonin in hopes it lowers the intermediate hormones. Hope this help and does not confuse you more.
Hugs Sonja and Apollo

I don't think that is what I mean. People make the statement they use Triolstane because "you can go on and off of it". What does that exactly mean?

[lulusmom]

Hi Addy,

The goal of treatment is to maintain cortisol at a therapeutic level in order to maintain resolution symptoms so going off and on treatment, whether Lysodren or Trilostane, for any reason other than adverse reactions or a dog who is not feeling well on a particular day makes no sense. Do you remember where you read that information?

[addy]

Thank you all, I was ripping apart the house last night trying to find the copies of Zoe's ultra sound and the phone kept ringing and I could not think clearly. Dang, I need a vacation even a staycation

The light bulb went on after I finally found the ultra sound copies and had quiet time to reread your posts. Glynda, I go it about not wanting to lose the load and Marianne I got it about taking longer to rebound and possible need for prednisone. That was exactly what I needed to know. That must be what they meant. So I feel much better that is all clarified for me. I feel like such a daaaaaa

THANK YOU!!!!!

Love,
Addy