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**gpgscott** · 05-07-2009, 05:08 PM

Re: What's better lysodren or trilostane

Hi Teresa and Pep.

I would not start a treatment yet with the results you have posted.

There are many conditions other than Cushing's which can cause similar symptoms.

Poodles are a breed which are prone to Atypical Cushing's, this is when hormones other than and sometimes including cortisol are out of range.

To determine this you need a full adrenal panel from UTK (university of Tennessee @ Knoxville) I will place a link.

Scott

http://www.vet.utk.edu/diagnostic/en...logy/index.php

**PepsMom** · 05-07-2009, 05:15 PM

Re: What's better lysodren or trilostane

Thank for responding Scott. Does that mean he needs to have all those tests listed? Should I be bringing the list to my vet and asking they run these and do they have to send this to U of T or can they send this to a different lab? Sorry to ask so many questions. I am feeling very stupid and confused

Teresa

**barney's mom** · 05-07-2009, 05:43 PM

Re: What's better lysodren or trilostane

Hi Teresa and Pep, Welcome! I am sure the folks much more knowledgeable regarding cushings will be along soon, but I will try to answer whatever I can. It would be helpful if you could post the results of Pep's ultrasound, and what it showed regarding his adrenal glands. Also, it is my understanding that the dog must be fasting during a LDDS. Which medication is better is a very hard question to answer here! I think there isn't a "better" drug, some dogs tolerate one drug or the other better than others. My dog was treated first with Trilostane and then with Lysodren with good results with both medications. We have so many dogs that are treated very successfully either medication. I did see where Pep is 11, does he have any other health problems? The reason I ask this is because if he has kidney disease or is taking ACE inhibitors for blood pressure, Trilostane isn't recommended. Also have they looked into the microalbuminemia? It often is related to the cushings disease, but it can be the early stages of kidney disease. Vets usually perform a urine protein an creatinine ratio to determine the loss of protein in the urine and if there is kidney damage. Another test that is very wise to perform before you start treatment for cushing's is a complete adrenal panel. This is useful in seeing if the intermediate hormones secreted by the adrenal glands are elevated. Many pups here have Atypical cushings as well as pituitary cushings. If you go with Trilostane it will almost certainly raise some of the intermediate hormones, and if Peps are already elevated this could make his symptoms worse.
There should be some folks on shortly who can help you a bit much.

Cheryl

**stardeb55** · 05-07-2009, 09:55 PM

Re: What's better lysodren or trilostane

Welcome to both you & Pep, Teresa! I would like to strongly stress the need for a UTK full adrenal panel, if you are contemplating the use of Trilostane. Atypical Cushing's occurs when one or more of the intermediate hormones secreted by the adrenal glands is elevated with or without a concurrent elevation in cortisol. For example, my Harley has both Pit Cushing's & is Atypical. When it comes to the full adrenal panel, UTK is the only lab in the US, if not the world that is doing this panel. All of the tests are part of the panel, so you would be charged for a panel, not each individual test. Let me stress that poodles, along with several other breeds seem to more prone to developing Atypical. If this would be the case with Pep, Trilo is not the drug of choice as it is known to raise the levels of some of these intermediate hormones.

When it comes to the tests that have already been done, could you post the reporting units for the LDDS? Those of us in the States are used to seeing reporting units as ug/dl, & I almost sure Pep's results have different units. Also, has your vet or vets ruled out other conditions such as diabetes or low thyroid? Both conditions have similar symptoms to Cushing's. As Cheryl has already mentioned, the abdominal US report would also help us out a great deal.

When it comes to the 2 meds, I can't really offer much input with Trilostane. What I can tell you is my 1st Cushpup, Barkley, was successfully treated with lysodren for just about 8 years, crossing the bridge at 15. Where any pup runs in to trouble with either med, is when you are dealing with a vet who IS NOT Cushing's savy, doesn't follow standard protocols for using either med, & the pup pays the price. Harley was diagnosed a year ago & is also being treated with lysodren. After a few small bumps in the road, Harley is doing well, at the ripe old age of 14.

Cushing's is a very slowly progressing disease. It is also extremely difficult to diagnose as there is no single test that is either 100% specific or sensitive. This is why it's extremely important to have a positive LDDS confirmed by a second test as the low dose can yield a false positive result in the presence of non-adrenal illness. You can take a step back, take some time learn about the disease, & make sure you have a rock solid diagnosis before initiating treatment. The delay, even if it's a month or two, will not due Pep any harm, & is probably more to his advantage to make sure of the diagnosis, & give you the time to become an educated, knowledgeable owner. Your education about the disease is the absolutely best thing you can do for Pep as you are his only voice & advocate.

Looking forward to hearing more. We are here to help in anyway we can.

Debbie

**Harley PoMMom** · 05-08-2009, 04:40 AM

Re: What's better lysodren or trilostane

Hi Teresa, Pep and Welcome,

You have definitely came to the right place for advice for your cushpup. These wonderful people have helped tremendously with my 12y/o male Pom. Harley. Harley was dx in March 2009 with cushings, I found this forum before I started treatment with trilostane(this is what Harley's old vet wanted to use), they begged me to get the full adrenal panel done on Harley(adrenal panel ACTH STIM, for dog, cat, cost $ 135.00 at the UTK web site), I got his results back and found out his one hormone is high and may well be what is causing his cushings. If I would have went ahead and let Harley's old vet use the Trilostane on him, the Trilostane would have increased this hormone even more.

I'm not saying Trilostane a bad drug to use, it's just not good to use on cushpups that have increased sex hormones. I am no expert by far,

everything I have learned about cushings I found from these wonderful people and their educational links.

So hang in there, some of the experts will be along soon.

Take care, Harley and Lori

**Squirt's Mom** · 05-08-2009, 07:54 AM

Re: What's better lysodren or trilostane

Hi Teresa and welcome to you and Pep!

I know you are scared to pieces right now but that is perfectly normal when starting down the Cushing's path, so you are right where you are supposed to be. Now, don't you feel better already?

You really are off to a great start, Teresa, so just hang with us for a bit and you will find yourself understanding more and more as time goes by. With that understanding will come confidence in dealing with Pep's diagnosis and treatment. Until then, you can lean on us as much as you need to and we will do our best to help you along.

To answer the question posed in your thread title, neither drug is better than the other. It all depends on the pup and the vets experience, as others have said. Some pups do well on Trilo, others don't and need to use Lyso. And of course the reverse can hold true as well. One major factor to consider when contemplating Trilo is the form of Cushing's called Atypical in which intermediate and/or sex hormones can elevated causing the same signs as true Cushing's. Trilo always elevates one or more of these other hormones and can cause the issue to get worse instead of better. This is why we strongly suggest the UTK panel that Scott mentioned. From the link he gave you, the test you want it this one:

Adrenal Panel (ACTH Stim) Dog, Cat Serum Adrenal Function $135.00

This will look at the cortisol level as well as the other hormones and give you a much better starting point for dealing with all possibilities. Since the signs seem to have been present even tho testing didn't support the diagnosis of Cushing's, I am inclined to think Atypical may well be the problem for Pep, or at least part of it. Treatment for Atypical is much easier and gentler that Lyso or Trilo. It is treated with melatonin and lignans.

I want to caution you about a common misconception concerning Trilo. It is NOT any less powerful or risky than Lyso. It simply works differently and stays in the body for a much shorter time. But it has the same potential for adrenal damage as Lyso. Neither drug is dangerous in the hands of a vet that follows the established protocols for diagnosis, administering and monitoring, plus educating the parent on what to watch for and how to handle any crisis that may arise. Both are life-saving drugs and should not be feared when in the hands of an experienced, caring vet. Even if your vet has little experience, if they are willing to listen, learn, and work with you as a team, then you and Pep should be just fine. Besides, ya'll now have all of us on your side!

The single most important thing you can do for Pep is to educate yourself on the condition. To help you get started, there will be a list of links following this post. Read, read, read, then read some more. Read not only the links, but the treads here so you can start to gleen some ideas from those already further down the path. Please, ask any and all questions you may have and we will try out best to help you understand. You are Pep's first and last defense, his only voice, his advocate, and the more you know the stronger you will be in these roles.

A few questions for you before I finally shut-up.

Does Pep have any other health problems? Is he on any other meds, supplements, herbs at the moment and if so what and what for? How much does Pep weigh? We just love details and numbers from tests, so don't worry about too long a post. The more info we have about Pep, the more meaningful insight and guidance we can offer.

When my Squirt was first diagnosed, folks sent me all these messages telling all this stuff in Greek and I despaired of ever understanding enough to help my Sweet Bebe. But these good folks took my hand and gently led me along until I could begin to understand. They have never failed us in the 14 mos. since. I was an absolute basket-case when we got here, I can tell you. Glynda, Lulu's mom, later told me she had the impression of a woman with her hair standing on end as if she stuck her finger in a light socket!

She kindly left out the bulging eyes and flying slobber!

So see, sweetie, if I can calm down and start to comprehend a little bit, I KNOW you can!

I am so glad you and Pep found us and hope to learn more about you both in the time to come. I also want you to know that you are not alone. We will be with you all the way. You and Pep are family now, and family sticks together no matter what.

Keep your chin up!
Hugs,
Leslie and the girls

the links

Kate Connick*
http://www.kateconnick.com/library/cushingsdisease.html

PowerPoint Presentation
http://talkoftheinternet.com/etvma1/hac-3-13-07.ppt

Long Beach Animal Hospital*
http://www.lbah.com/canine/cushings.htm

Drs. Foster and Smith*
http://www.peteducation.com/article....2+2097&aid=416

Newman Veterinary*
http://www.newmanveterinary.com/CushingDiag.html

Cushing�s signs and pics*
http://www.newmanveterinary.com/CushSignFrame.html

BMD Health Library*
http://www.bestbeau.ca/bmd_health_links_4.htm
(scroll down to see Endocrine Diseases)

Mar Vista Animal Medical Center*
http://www.marvistavet.com/html/cushing_s_disease.html

Vetstream*
http://www.vetstreamcanis.com/ACI/Fe...ctSheet052.asp

Atypical Cushing�s*
http://veterinarynews.dvm360.com/dvm...date=&pageID=1

http://www.vetcontact.com/en/art.php?a=132&t=

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

**PepsMom** · 05-08-2009, 02:37 PM

Re: What's better lysodren or trilostane

I want to thank everyone for your replies. Thanks to Leslie and the girls, Harley and Lori, Debbie, and Scott. I am filled with gratitude to have found you all. I already feel so much better. Thank you so very much for taking the time to respond and for all your wonderful advice.

I am taking your advice about the full adrenal panel. I called my vet, but she is out until Monday. I left a message that I want additional tests run. I am going to also see about a full thyroid test as well. I think it was in 2006 that Pep's T4 came back low. Then it has been in the lower range but not low again until 9-08 when it was .85 with normal at 1.0-4.0. The test on 3-9-09 the T4 was 1.4. As far as meds go, the only thing he is on is some meds for an ear infection he just got and he is taking sentinel tab once a month. In the past he has had indulent ulcers first in one eye and then the other eye. His liver is enlarged but they said a biopsy is too invasive. The first ultrasound on his liver area showed one small dark spot. This more recent one the vet said liver enlarged / rounded kidney, unk structure with shadowing in bladder spear unk and adrenals not imaged.

As far as Pep's health goes, he did have a lump removed in 10-08. The results were that it was liposarcoma. It is considered low grade and chance of metastasis may be low. It states the tumor cells are close to the deep margin (less than 0.1 cm) but appears completely excised. The lateral margins are clear at 0.3-0.6. Pep weighs about 17.8 lbs. He also has a heart murmur but nothing any vet said was something to worry about. Pep did have a urinalysis this last time and the ph was 5.5 with normal 5.5-7.0 and his protein was 2+ Negative and listed as being high. Pep also had another urine test, but I can't remember the name and the paper I received just said Source: Urine, Status: Final, Completed Culture Results: 04/02 No Growth. As far as the Microalbuminuria being high they didn't mention anything about what I should do. I may see if they can run this test again.

I am going to go through all those wonderful links Leslie posted and start to educate myself.

Thank you again to all of you. I feel better about what I have to do to make a better choice with Pep's meds. It is good to know that they both can help and it depends on other factors which I hope to find out about.

Blessings to all.
Teresa and Pep

**stardeb55** · 05-08-2009, 03:50 PM

Re: What's better lysodren or trilostane

Teresa, you absolutely do not want to do any further diagnostic testing until Pep is over his ear infection & off antibiotics for probably 7-10 days. Any active infection is likely to increase the levels of cortisol in the Pep's system which can skew the results of any Cushing's diagnostics.

Could you please post the reporting units for the LDDS test? They would be something like ng/ml, ug/dl, etc.

Debbie

**PepsMom** · 05-11-2009, 02:46 PM

Re: What's better lysodren or trilostane

Thanks Debbie for the information. I spoke to the doctor today. She said the ear drops are not an antibiotic but for a yeast infection and is called Miconosol Lotion. That's the good news. When I mentioned I wanted additional tests for Peppie, specifically the full adrenal panel. She asked lots of questions and stated that the panel is the same as the ACTH test. Then she again suggested I see a specialist as she doesn't know enough about this. I mentioned I wanted to rule out Atypical Cushings and once again she recommended I see the specialist. I will have to call them tomorrow (hopefully), as they don't have the best of office hours.

Does anyone know specifically what the full adrenal panel is called? Is it just the ACTH test, or is it more?

Also Debbie as per your question on the LDDS test, those numbers I gave you are what is on the test results. This is how it looks (hope it comes out right).

Procedure 3/30/09 Ref Range Units
Cortisol Baseline 251 H [15-110] nmol/L
Cortisol low dose dex 6h 70 H [0-30] nmol/L
Cortisol low dose dex 8h 145 H [0-30] nmol/L

Then below it states "xEndo NO Interp"

**gpgscott** · 05-11-2009, 02:58 PM

Re: What's better lysodren or trilostane

The full adrenal panel requires a stim.

This is also refered to as ACTH, or 'stim'

The reason for this is that you are testing the resting state of hormones and also how the pituitary is controlling those hormones. The stim is an injection of a synthetic hormone that the pituitary releases to control the production of hormones.

So you take a sample of blood, label it, then inject the stim agent (usually cortrosyn), wait an hour and take another draw. The results will be notated as pre, and post stim.

I thnk your Dr. is taking a measured approach by telling you she is unfamiliar with some of these tests but also urging you to see a specialist.

Hoping you find this useful.

Scott

**stardeb55** · 05-11-2009, 03:40 PM

Re: What's better lysodren or trilostane

The following link will give the information about the full adrenal panel. You want to look at the one that is $135. Your vet can ship directly to UTK which is what you want. Do not let them ship samples to the lab they use for routine testing as all that lab will do is forward them to UTK, & add on their charges for sample handling. Also, by going to the local lab, you are running a greater risk that something can happen to the samples during transport.

http://www.vet.utk.edu/diagnostic/en...logy/index.php

The drops are still an anti-fungal & the same applies as to what I said previously, you DO NOT want to do any further diagnostic testing in the presence of an active infection. It will not do Pep any harm to wait until his ear infection has cleared up.

Thanks for posting the units for the low dose. In the States,we are most familiar with seeing this report in units of ug/dl, so I have made the conversion (divide by 27.59), which gives you the following results:

Baseline: 9.1
4 hour: 2.5
8 hour: 5.3

This numbers do appear to be consistent with Cushing's, but you can't determine what type. I still believe that the full adrenal panel would be in Pep's best interest, & with your vet's admitted lack of experience, a referral to an IMS would definitely be a good thing.

Debbie

**Wylie's Mom** · 05-11-2009, 03:51 PM

Re: What's better lysodren or trilostane

Hi Teresa,

Doing the UTK panel is a great decision! I wish I had done it sooner.

In addition to what Debbie has posted, please be aware that the prices listed are only the costs that UT would charge your vet, additional charges would include your vet drawing the blood, injection, prep & shipment – for example, my vet would have charged me about $300+ total (not just $135) for the “Adrenal Panel – ACTH Stim”.

Your vet will have to follow specific instructions to collect & prepare sample. Here are the instructions for your vet (there is a phone number listed if they have questions):
http://www.vet.utk.edu/diagnostic/en...tests_info.pdf

This is the submission form (for your vet):
http://www.vet.utk.edu/diagnostic/en...osubform06.pdf

-Susy

**PepsMom** · 05-12-2009, 04:52 AM

Re: What's better lysodren or trilostane

Thank you Scott, Debbie and Susy. I will wait until Peppie's ear infection is cleared up and then contact the specialist to have the full adrenal panel run. Thank you for the clarification. My Vet made it seem like it is the same test that they do. I hope the specialist will do as I ask and send it to UTK. Debbie, I live in Michigan and those test results I listed came from Michigan State. I wonder why they are different? Also, thanks for the conversion numbers. It will help when I do more research.

Thank you all again, so very much. I never knew this would be such an up hill battle. I guess I thought I would be be given more concrete direction from the Vets. If it wasn't for your help I don't know what I would have done.

Teresa and her beloved Pep.

**Harley PoMMom** · 05-12-2009, 05:15 AM

Re: What's better lysodren or trilostane

Hi Teresa and her beloved Pep,

from Teresa: I guess I thought I would be be given more concrete direction from the Vets.

I, first, took all the paperwork into my vet and asked them point-blank if they thought they were capable of performing this test for UTK, with out any errors, and they told me yes.

When my vet. did the prep work for the full adrenal panel on Harley, it was their FIRST time to do such a test(they actually do the drawing, spinning, freezing), I copied all the info. the forum told me that I needed to have and gave it to my vet.

They (vet/forum) did a wonderful job and I got Harley's results back within 2 weeks. It usually takes 10-14 days to get your results back from the UTK.

I just wanted to share that with you, even tho my vet wasn't experienced in doing this test, she made extra sure she did this test right. Hopefull this makes you feel better, alittle?

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