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Cushings And Lysodren

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I posted a few months ago asking for advice. As you might remember Wendell, who was 7 in April, was diagnosed with Cushings a few months ago. He has been taking trilostane, but unfortunately he is still drinking constantly, peeing all of the time, has insatiable hunger, has thinning/hair loss, and continues to get cuts and bruises so easily. He's been wearing a cone pretty consistently since July because he keeps getting cuts on his legs that he won't leave alone. (And, unfortunately he hates the muzzle and thrashes and knocks things over trying to get it off!)


Anyhow, initially he started out taking 30 mg of trilostane every twelve hours. For about a month he seemed under control and then the symptoms resumed. In July he was bumped up to take trilostane every 8 hours, but again for the last month his symptoms are back. The last two times his ACTH stim tests presented as though we were controlling the Cushings, but his thirst and urination are still out of whack. The internist (and his primary vet) say that his blood work looks normal and his urine isn't growing any bacteria. His urine is still pretty diluted though.


So, the internist thinks we need to switch his drug. He is recommending taking him off of the trilostane for a week, he'll retest the ACTH, and then start him on Lysodren. The internist said he has now seen a few dogs that have presented this way--that it appears as though we are controlling the Cushings, but it isn't.


Do folks have recommendations? What I read about Lysodren seems really scary. Is there something obvious that I am missing? This has been a really long and frustrating process. We've just passed the one year mark of when he first started having significant symptoms and tests--and I don't want to do the math on what I've spent so far on trying to figure this out. I need help!

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Yes, his normal vet is Point Breeze Veterinary Clinic and the Internist is at PA Veterinary Specialty and Emergency Center (PVSEC). I'm planning to follow what the internist recommends. Wendell didn't get his first dose of trilostane this morning so we'll see how this goes. It just makes me nervous given what I've read. They've done two different ultrasounds, but they haven't ever suggested an MRI.

Edited by wendell
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