Newly Diagnosed Cushing's Disease

[Guest Frannie]

I've just gotten the news that Mable has Cushing's. she's 10 years old, and her last senior blood panel showed a liver enzyme that was much too high. An ultrasound, they saw on nodule on her liver that they believe is benign. They also said that her adrenals are enlarged. One a little bit more than the other. On further testing, they had reason to suspect Cushing's and that has now been confirmed with a Dexamethasone test. I didn't know much about Cushing's, but I've been reading up. I also have great that two comes to the house, and though he's expensive, he's very generous in giving free second opinions.

 

My understanding about the drug treatment (she's about to start on trilostane) is that it's tricky. The dog can go into crisis and be very very sick. as in life-threatening sick. I've been given a small supply of prednisone to keep around as an antidote in case this happens (the drug she's going to be taking suppresses the body's natural production of cortisol). I've also been given a large dose of fear.

 

I imagine there are plenty of people here who have experience with Cushing's. the veteran gave me the second opinion is wondering why she has lost weight when most dogs with Cushing's tend to gain it. He has raised a concern about possible cancer. If Mable has cancer, I'm going to keep her comfortable. I'm not going to subject her, or me, to heroic measures. she's a very timid dog and petrified of the vet.

 

So my worst fear is this: that the trilostane will prove to be a very bad drug for her, and I will be faced with the decision to either continue it and be ready for a crisis at any time, discontinue it and begin to say goodbye. I'm so not ready for this.

 

So more than anything, right now I'm just scared. I've been adopting greyhounds for 17 years, and you would think I'd be used to awful things happening. What I've learned is you never get used to them, and you just have to accept that.

[NevadasMom]

Hi Frannie....My bridge baby Nevada had Cushings disease & did well for several years. Do a search on here & you will see lots of good info from our previous posts. I'd post more, but I'm at work right now.

[TheFullHouse]

My Emmy had cushings, she also unfortunately had cancer. The tumor she had made her blind and it went down hill from there. She also was on Trilostane, which is supposed to have few side effects. Unfortunately we lost our girl but there are several people on GT who have treated their pups successfully for cushings. Hopefully some of them will chime in.

[DaisyDoodle]

My mix, Lucky (shephard/rottie/lab looking mix), was finally diagnosed with Cushings after months of a young vet screwing up blood work. We had to have BOTH stress tests done, since the first gave a weird result (equivocal, somehow).

 

She was on Trilostane. After a month?/couple of months, Lucky had another shorter stress test done to determine if she was getting enough Trilostane. The results indicated that we had to up her from the dose she was getting once a day, to that same dose, twice a day.

 

I quizzed the vet (still younger than the owner of the practice, but older than the original young one), about increasing the dose slowly, but she insisted that that was what the drug company said to do given Lucky's test results. Apparently, it was supposed to be the correct dose, but wasn't lasting long enough, so she needed a second dose at that same level later in the day.

 

After just a few days on the second dose, she looked awful. She ended up at the eVet's and the regular vet. We quickly figured out that the Trilostane had killed her adrenal gland and she was now Addisonian.

 

So, then she was treated with prednisone for a month, then she began Percorten shots once a month for the Addison's, with prednisone every other day, in decreasing doses, 'til now she only gets 1.25mg every three days.

 

 

She'll be 15 next week, she can still climb stairs, and she's at her ideal weight even though she's free fed.

 

All this scary stuff is to say that this isn't an easy journey, but it can be managed. You HAVE to keep on top of things, keep an eagle eye on your dog, and push back with the vets. I know there is an alternate treatment for Addison's. I think there is an alternative to the Trilostane also, but I don't recall what it is.

 

There is a Cushing's Yahoo group. They will probably be a good source of support, but management of greyhound Cushing's is unique from what I've heard, so info from GT and the Circle of Grey may be more on target.

[NevadasMom]

Many Vets will intentionally make a dog Addisonian. It's easier to treat/manage. If I had to do it over again, that is what I would do.

[CaliforniaGreys]

Misty was dx with Cushings just before her 10th birthday. We chose to use Lysodren vs the Trilostane which is really tricky.

 

From my understanding, with Trilostane it's easier to stabilize them but then I've been told by an Internist that the success rate is greater with Lysodren.

Obviously you can't prove that by us.

 

You've had Greys, so assuming you have a Grey savy vet because that is extremely important.

Yes, they can go into an Addisonian crisis, and it is scary to see, but, your vet will prepare you on the signs to look for, you'll have Pred on board for when it happens and you just need to be able to get them to the vet right away.

 

Misty went into a crisis 3 times and the first time scared the daylights out of me, but I knew what to look for and how to react and that's the key.

 

You can handle this, and you will! Try not to be afraid of it and if you need help, if you need to vent, you have questions, we're here.

Edited August 7, 2010 by cbudshome

[NevadasMom]

Yes...Cushings can get scary, but it's a treatable disease. Just gets a little tricky sometimes. Nevada was happy & healthy for several years. Remember that this is a disease of older dogs, so other health issues will play a role in picture. Nevada was 15.5 when she passed.

[CaliforniaGreys]

Checking in to see how things are going

[AliWest]

My westie has cushing's and was on trilostane. He did very well on it. His dose was split in half, half in the am half in the pm. I read an article in a vet journal, can't remember which one, that had done research on trilostane. It was thought, in that article, that trilostane breaks down in the body in 8-12 hours so a dog that seemed to do well at first needed to up the dose later because symptoms were coming back. I was able to reduce my westie's dose by splitting it in half and he did better than when he was on the higher dose once a day. My vet said that I could even split it in thirds but my schedule didn't allow me to do that reliably.

 

Good luck. My westie live for years on trilostane. He died last year of an unrelated accident to the cushing's

[Blaidd49]

Cushings can present in different ways initially which is why diagnosis is often delayed.

I have had first, second and third hand experience with cushings and can assure you that if cancer is NOT a complicating factor it can be managed nicely - you know your dog best and as such will be the best person to make some of the decisions.

In the vast majority of cases the initial dosing of trilostane is way too high even if it is in line with what the manufacturer or vet recommends.

I would ask what your vet feels the dosage should be and then start at 1/4 of that amount or even lower.

Watch for any adverse effects (your vet can explain) if there are adverse affects stop the trilostane and when you restart - do so at a much lower dose.

In my experience the initial month should be spent testing the dogs sensitivity to the drug not trying to reveres the disease.

If there are no adverse effects but no improvement in the test results (we normally use the ACTH suppression test) - then increase the dose somewhat.

One of the biggest mistakes I have seen is that the dog's show improved results in a month so everyone thinks great we have the dosage right then a month or so later the dog has a crisis.

Again, as a general rule, once the blood values are in the normal range it is time to reduce the dosage. Another test a month or so later should tell you if you have it right, need to come down some more or increase slightly.

A dog that is well managed on trilostane usually does not have any side effects.

The goal is to have the results in the low normal range.

Wishing you all the very best and praying that there is no malignant tumor to complicate the situation

Pam

Canada