Where To Start? Confirmed Cushings

[j]

I had Occy to the vet about 2 weeks ago. He was limping a little bit on one leg and I have noticed lately that although he hasn't put on any weight, he has developed a huge bulgy pot belly. He always seems to be ravenous and is always on the scrounge for food.

He had surgery last year to repair a luxating patella and cruciate ligament.

This time, it is the other leg.

Vet couldn't detect anything with his leg two weeks ago, couldn't make his patella pop out or anything and although she could see that he was limping, could not find any reason for it. Felt all around his belly, couldn't feel any lumps or any reason for his belly to be getting so big.

She did urine tests. No glucose, but there was blood, protein and bacteria in it. She mentioned that the belly may be indicative of cushings.

So he has been on antibiotics since then with a follow up urine test to be conducted when he finished the antibiotics. He was also given an anti inflammatory shot (which he has been having regularly since his surgery last year)

Fast forward to yesterday - came home from work, and he has his leg completely up, not bearing any weight on it at all. No idea what he did.

Off to the vets. Same practice, but saw a different vet. Repeat urine test - still a small amount of blood in his urine and the protein. No bacteria. Antibiotics to be continued.

Vet is able to manipulate his leg well enough to feel that the cruciate ligament is completely stuffed.

He also took blood, when I mentioned his belly and that the vet I saw a fortnight ago had mentioned cushings as a possible cause for that, but she was waiting for the bladder infection to clear up before following up on that.

The initial blood results indicate that he needs to undergo the full blood tests for Cushings. I don't know anything about Cushings, but he said they do a series of blood tests over at least 8 hours, so he is going in on Monday for those tests to be conducted. He will probably also do ultrasounds to see if he can detect any tumours or other "lumps" in his stomach. Vet is going to give me a heap of reading material on Cushings as well.

He has always been a very itchy, flaky skinned dog, very doggy smelly. They can also apparently be symptoms of Cushings?

He did say that it can be a long drawn out process to get a definitive answer as to whether it is Cushings or not, and that even if it is confirmed, the treatment can be very hit and miss and requires a lot of monitoring.

He also said that until the stomach symptoms are completely confirmed, that I should hold off doing any surgery on his leg. Without saying as much, he was intimating that the leg surgery might be pointless.

I don't know how old Occy is. I got him from the RSPCA 7 years ago. At that time, he was an adult dog, and they estimated his age at 3 or 4. Last year, when he was being treated, the vet commented on how good he looked for his age and said that if he didn't know how old he was, he would have put him at 4 or 5. So although I think he is about 10 or 11, he could in fact be much older.

What I'm worried about is that while we're trying to work out whether or not he has Cushings or something else, that his leg is causing him grief. And if it is confirmed as Cushings, what effect is it likely to have on his life expectancy? Should he have the surgery on his leg while they're trying to get everything else under control?

At his age, should I be starting the sort of regime the vet has briefly described to me? Will he suffer if the Cushings (if that's what it is) isn't treated? But he has the leg surgery? The vet said that quite often dogs that have been having treatment for Cushings reach a point where they can't determine that treatment is making any difference, so they stop the treatment and there is no visible increase or decrease in symptoms.

I realise I'm jumping the gun, as it hasn't been confirmed that he actually has Cushings, but I would just like to have thought about all aspects, so that when Monday comes and the vet gives me the results, I have some idea what to discuss with him.

At the moment, he is being confined, so he can't stress his leg too much and our other dog can't jump all over him.

Any other ideas what it might be?

And any suggestions about what I should be thinking about with regard to his treatment and/or leg surgery?

Edited March 10, 2010 by j

[Kirty]

Don't have any advice, just wanted to send my best wishes. Poor old man, that doesn't seem fair.

[Kelly_Louise]

Welcome to my world (NOT). My old girl Chloe (now almost 12) has had 2 cruciate ops, and almost 2 years ago was diagnosed with Cushings.

To answer the most important question first - a dog with untreated Cushings will become very uncomfortable, suffer, and eventually die (albeit rather slowly and uncomfortably). With treatment, they can live a relatively normal life. I say relatively, because they require monitoring to ensure medication levels remain suitable to treat the symptoms (it's a very unpredictable disease - the correct medication at the beginning of the year may not necessarily be the same dosage needed by the end of the year). Sometimes they go into short term remissions and come off meds altogether. No one can say for sure how a Cushinoid will react or respond, there is no easy answer.

We prepared and read up as much info as possible - and it does get easier once you know the symptoms and what you need to look out for. Similar to diabetes in a way, but different cause etc. But once controlled, there is no reason that a dog can't live to a ripe age.

This will all depend on the source of his Cushings problem. It can be either due to a tumour on the Adrenals, or a tumour on the Pituitary - and how big those tumours are. Most Pituitary tumours (the most common cause of Cushings) are small and never cause a problem (other than producing Cushings symptoms). This is what my girl has, and usually these tumours don't give any grief due to the fact that most are slow growing... so a dog can pass away from age etc before the tumour was to ever effect them neurologically. However, there was another dog on here that was sadly PTS not long ago as his tumour was much bigger and he was suffering from seizures and other neurological effects. Chloe has never shown any and her tumour is very small, not giving her any grief and unlikely to. Every experience with Cushings disease is different. I believe if it is a tumour on the Adrenals, that this can be operated on - or alternatively can also be controlled with medication.

Usually Cushings is diagnosed by a ACTH suppression test which is the one you described, along with other tests they have run to rule out any other possible disease. They should also perform an ultrasound to determine if there are any tumours on the Adrenals. If that comes up clear, it is assumed that the tumour is Pituitary. This can be confirmed but the tests are costly.

There are different kinds of medications. Some act as a type of chemo, and others just control the symptoms - making the effects of the meds reversible and also easier should the dog need surgery etc and need to come off medication. Chloe is on Trilostane which is a newer med, and just controls the symptoms and is easily reversible. We now get it in a liquid form that makes it much easier (and cheaper) for us to change dosages (rather than tablets that need to be re-made if dosage level is changed). Some dogs require meds daily, some require it twice a day. Chloe is on meds twice a day, but it doesn't really bother her at all - she is used to it all now.

Levels are monitored generally quarterly, where an ACTH stim test is performed (takes about an hour and they can go home) - unless of course it is required more frequently when changing dosages etc. My best advice to you, if your boy has Cushings and you go ahead with treatment - is to be referred to a specialist. They are MUCH better equipped to deal with this disease, and the unpredictability of it - a normal vet usually does not know as much about the disease and the different treatments available.

Cushings can be difficult and expensive to treat - however, when under control from meds a dog can live very happily and normally if the owners are prepared to put in the effort.

Chloe had many of the same symptoms... bloated belly, drinking and urinating ALOT more than normal, ravenous appetite, her coat dropped off eventually, her skin was dry and rashy, she put on weight and she was generally not just herself. Once she started meds, all the symptoms disappeared and her coat came back better than ever slowly.

As for his leg, sounds like it may be a cruciate injury - that will also need attention pretty soon. The longer it's left the more damage can be done. Not sure how the vet will handle it all - but I'm sure they will guide you should you decide to treat both. Perhaps they may even refer you to a specialist if he has Cushings. A specialist was a Godsend for us and has been along every step of our journey with us, and he knows Chloe so well that he can tell just from any symptoms that are showing what may be going wrong - and he's been pretty much spot on every step of the way, because he specialises in these diseases.

I gotta duck out, however, if you have more specific questions or concerns, please feel free to ask. Loraine, another DOLer who has been on a Cushings journey will also give you invaluable advice when she pops in, as will others who will also be able to answer questions and offer support.

Cushings is not as scary as it first sounds. Once you understand it, and know what you are dealing with - and have a vet/specialist who you trust 100%, it is manageable and when treated correctly usually there is no reason a dog can't live for many years with the disease.

In my personal opinion, if I could not afford or for some reason could not treat Chloe's Cushings - I would PTS. It is kinder, as the disease does get progressively worse and will affect the rest of the body, if left untreated.

I hope some of this helps - I've tried to paint the positives and negatives, and explain as best I know about this disease, from our own experience. And in comparison, ours hasn't been too bad at all so far. There are ups and downs, but Chloe's still with us - and still going strong. If you saw her, you'd never know there was a thing wrong.

Best of luck to you, and please don't hesitate to ask or air your worries.

[Erny]

It can all be so complicated, can't it ....... and I know how you feel with the "where to start" dilemma. I'm sorry, but I don't have a lot to help you.

One thing that springs to mind and that potentially has not been checked out though - and that is the possibility of hypothyroidism.

Hypothyroidism can be difficult to diagnose by symptom, as the symptoms can mean so many different other things, but the symptoms you have described, ie :

Swollen belly

Flaky skin

Cruciate ligament rupture

Tumours

can all be symptoms of thyroid issue.

Ask your Vet if thyroid is being investigated. But also keep in mind that unless 70% the thyroid tissue is destroyed, it is unlikely that the bloods will reveal thyroid as an issue. What I'm saying is that if the blood tests out here in Australia show thyroid as an issue, then you have your answer (and it is easily treatable). But if the blood tests our here in Australia show thyroid as NOT an issue, that doesn't mean it isn't. Our Aussie blood tests and the 'charts' which are used for analysis purposes, are not very precise which is why I wouldn't be satisfied unless the tests were done in the USA. I use Dr. Jean Dodds for this purpose.

If hypothyroidism has not been investigated, this would be the FIRST place I'd start with, at least to rule it out before I put my dog through more (ie other) tests. Mainly because it is the least invasive (ie blood test only); the treatment is easy and relatively inexpensive; and the results of treatment have a good success rate.

Of course, your dog's cruciate/s will still need treatment.

Good luck - and please let us know how you get on.

Edited December 12, 2009 by Erny

[j]

Thanks very much for your responses, all very useful info.

I will ask the vet about the Thyroid issue on Monday, see if they will also test for that. He did do blood tests yesterday, which indicated that cushings was the likely cause. I don't know if that same test would also have been checked for Thyroid issues?

Occy is a funny little dog. Absolutely no idea what he is. If I had to guess, I would say Schnauzer x Mini Dachshund. He is the same colour as a Schnauzer, floppy ears, a bit of a curl in his tail, very short legs and a longish body. RSPCA had him as a silky terrier cross but I don't think so. About the only thing the same is his size.

His front legs are very bowed, his feet point straight out to the sides when he is standing still.

He has had his share of problems. When I first got him from the RSPCA he had very long, completely matted hair. When I cut it all off, I found stitches that had never been removed and were completely grown over. They went all the way around his front left (equivalent of in a human) shoulder blade.

He had a ruptured disc in his neck last year - when he was xrayed, the vet said there was quite excessive bone growth on the surrounding vertebrae, indicating that it was a years old injury, so that was obviously something that happened to him before we got him.

I just hope we get something sorted quickly, so he doesn't have to suffer at all.

[Kelly_Louise]

Oh goodness... poor little guy. Seems he's had his fair share of battles to face... and now this.

Also seems he's in good hands thankfully. Sounds like a very brave little guy, and I'm sure he'll march his way through this as well, with the support of those who love him.

HOpefully it's not as serious as it seems, however, if it does happen to be Cushings, it's not as bad as it first appears - and certainly not as scary as some of the websites that I've read

There are quite a few Yahoo groups that have alot of information about Cushings and other thyroid related diseases. Might want to check them out too, lots of information, lots of people's journeys with their furkids with Cushings, Addisons etc.

[gillbear]

I am facing a similar issue.

To say the least it has been a shit year.

My Gillie has cushings .

Gillie is a poorly bred 8 yo Pekingese, who I adopted from the RSPCA 5 years ago. His joints were shocking to start with and adding the effect of this disease is devastating.

Due to this and other existing health issues I have decided not to treat the cushings. Gillie is being kept happy and comfortable until the time comes.

My thoughts are with you.

Edited December 13, 2009 by gillbear

[j]

Sorry to hear about your littlie Gillbear.

Occy had all his blood tests done today. They missed the blood courier this afternoon though, so they won't be sent off for testing until tomorrow morning, so it will be Wednesday at the earliest that I will get the results.

He also had ultrasounds done today. His adrenal glands are a little enlarged, but both are the same size, so vet is fairly confident that if it is Cushings it will be the pituitary (sp?) version. His liver is enlarged and there is a fair amount of "sludge" in his gall bladder.

She took additional blood which is in the freezer so that she can do further tests when the results from todays tests come back. I think she said those tests are to confirm which type of Cushings it is.

So, still on hold ;)

Poor thing looks like a patchwork quilt. His tummy and up his sides are completely shaved where they did the ultrasound, his leg where they took blood and a patch on his neck where they did it the other day.

( ;) He just disgraced himself and cocked his leg in the house!!! Rotten bugger. Hasn't done that since we very first got him)

[Kelly_Louise]

Well at least you're on your way to knowing the answers... it's the first step.

Chloe also has trouble holding her bladder when she is uncontrolled with Cushings. That is when I know her dosage isn't high enough, or when she's coming out of remission. She will wee in her bed or on the floor - something she would NEVER do and she is so awfully embarassed about it and tries to cover it up. Poor bugger, must be awful not to feel well and make a mistake and then think they will be in trouble.

They drink so much and are urinating so much with Cushings, sometimes it's hard for oldies to keep up and accidents do happen - so forgive him this time until you find out what is wrong

They look dreadful when they're all shaved, with bloated bellies... like little pigs. Bless the little guy. Hope the test results come back with news that is manageable, and nothing too serious.

[j]

The blood results for Occy are back and he definitely has Cushings, of the Pituitary kind.

He will be starting medication with the follow up testing to check that it is being managed at a safe level.

Because of the Christmas break and closure period over Christmas, we won't be going to the Vet until New Years eve for his first lot of medications. She said that they require a lot of monitoring in the initial phase of the medication, and she would hate us to start the medication and then the only available vet is the after hours emergency surgery if anything goes wrong. She doesn't feel that this will affect him too much, and it will give us an opportunity to actually record how much water he is drinking in a day before the commencement of medication. A decrease in water consumption is apparently one of the things they look for when they first commence on the medication, as an indicator that it is becoming controlled.

As he is still confined due to his cruciate ligament injury, this will be easy enough to monitor (we have another dog as well, so it is hard to know who drinks how much when they are together)

Vet doesn't want to do anything with his leg at the moment, other than confine him, as one of the other problems with Cushings dogs is apparently their increased healing time. She wants to get some semblance of control over the Cushings before attempting his leg.

Poor Occy. Such a patient little man.

Max, our other dog, is displaying quite depressed behaviour as well. He lies next to the pen all day when Occy is in it, or outside the laundry door with his nose pressed up against the screen door if Occy is in the Laundry. It's quite sweet to watch, but sad to know what he will be like when Occy is no longer around (Max is only 7. Occy is at least 11yrs, possibly older) My neighbour actually phoned me at work the day Occy was at the vets having his tests, to tell me that Max was howling, but she couldn't see anything wrong with him. Max rarely makes any sound, so she knew there must be something wrong. When I told her Occy was at the vets, she went over and played with him for a while and got him to settle down. Poor fellah.

[Loraine]

I would think your Occy is likely to be put on Trilostane. I am glad that your vet has indicated that it is very important right at the beginning to keep testing to get the levels right. I am sure that Kelly Louise will come by and tell you about how often she has had to change Chloe's dosage. I had my boy (RIP) on Lysodren first (Trilostane had not been released) and then moved him on to Trilostane once I could get it. This disease is a roller coaster, but very manageable. It is good that your vet wants to wait until after the holidays for you to start treatment. Ask your vet about you having some prednisolone to keep on hand in case of an overdose (easily happens and pres helps you).

Try and enjoy christmas before the game of Cush-watch begins.

[Kelly_Louise]

Oh no, I guess you always kind of hope that it's something fleeting - but again, a diagnosis of Cushings is not a death sentence by any means. When you look at it, Occy is getting on - so the chances of cushings complications ever causing him any problems before the end of his lifetime is pretty good. Chloe was 10 when she was diagnosed - and I figured if the medication can keep her as well as possible for 3 - 4 years (not unrealistic at all) then by that time she will be pushing her natural lifetime and if she goes through too many ups and downs with medication changes (and we went the first year with not a single problem or change - it was heaven! - but this year she has changed about 3 times) then that's when we can decide if it's too much for her in older years.

It is sometimes a really frustrating disease - be prepared for that. But it IS manageable, and with the support of a specialist - you can sometimes even forget it's there (other than giving the medication of course)! But over time you will find that you monitor them very regularly, it just becomes habit over time - and you do learn what you need to look for in case the medication is not right at any given time.

It probably seems very overwhelming at the moment - but it needn't be. Just research as much as you can - and really the best thing you can do is be guided by the specialist and report anything unusual to them. It's nice to be able to understand what's happening though, and hopefully if you have a good vet (and by the sounds of it you do) they try their best to ensure that you are not required to do testing unneccesarily - as you will find it can be quite costly if they don't get it right. Basically that's why I always recommend a specialist, as if you're dealing with someone not totally familiar with the disease then you might find yourself being drained financially in an effort for them to try and get it right. I do hope Occy likes vets - he will be a regular visitor just like my Chloe - who receives an old friends welcome when she arrives, and the receptionist knows my voice and what I'll be wanting before I've finished saying hello

Anyway, keep your chin up and i hope Occy holds up through Christmas, as does Max. It must be even more difficult having Cushings and ligament issues at the same time. Although, it's funny how we learn to cope and adapt with our pups - as do they. They never cease to amaze and Occy will deal with it all nicely I'm sure... once his medication starts I'm sure he'll feel much relief and feel himself again.

We're always here when you need, or if you should have any worries or concerns - or just want to have a vent

[j]

Thanks for the advice guys.

I'm pretty sure that the medication she mentioned on the phone yesterday was Lysodren? But that was for about 8 days and then the tests to check levels and things, so I'm not sure if that is what he would remain on.

She said that she would sit down with me when we go in for the appointment on the 31st and go through everything. It's a bit difficult over the phone when you don't really know what to be asking about.

What is the difference between the two medications?

Occy is pretty good at the vet. They always give him some dried liver, so they are his best friends. Hell, anyone who gives him food has to be a great person in his eyes. I'm the worst person in the world at the moment, because I don't just lead him to an open bag of food or a bag of bones and let him eat till he can't stand up!

[Kelly_Louise]

Once they put Occy on meds they are unlikely to change them - unless there is some kind of problem or need to change. Getting the dosage is hard enough without changing the meds too!!

Lysodren - and this is only from memory I could be REALLY wrong - is like a chemo medication. I think it was popularly used for treating those with more aggressive/dangerous tumours. The effects and any changes made to the body through this drug are irreversible though, and permanent - and if Occy was to ever need to go under for an op or dental work etc - he would have to go off his meds for some time before surgery can be done. Trilostane is a newer drug, fewer side effects (I believe) and the effects of the drug is not permanent and any effects totally reversible - it simply controls the symptoms of Cushings. If a dog was to need urgent surgery it is much easier on this med and can be performed straight away without concern. There are a few more places making it in liquid form now, which is really helpful when it comes to having to change dosage.

Personally, I would not want Chloe on Lysodren unless there was an absolute need to be and it was the only drug to help her. I much prefer Trilostane, and I like the fact that it doesn't alter her body permanently - it just makes sure her symptoms stay in check, I don't need the added hassle of what it's doing to her body that can't be reversed. But having said that, I've not used Lysodren and can only go on what I've read about it. My impression is that it is a drug that was first used before further discoveries were made in this area of medicine. Do some Google research on it and the differences (there should be plenty of info) and see what you think though, and if you have concerns then perhaps discuss it with your vet. I guess there are pros and cons, and you have to weigh it up for your circumstances and see what will work best for you, and what you feel okay with administering to your dog.

I remember when Chloe was also ravenous - she'd almost take you down if she even thought she got a whiff of some food on you... Take heart - this will disappear almost immediately when meds start (well Chloe went from manically ravenous to just permanently hungry as she's always been LOL) Any bladder accidents should stop straight away, same with drinking and if he's putting on weight and can't shift it you'll find it easier to manage when meds begin... and you'll feel you have a normal dog again... kind of

[j]

Thanks Kelly Louise.

I will call up and confirm which drug she said, then ask about the Trilostane (if that wasn't what she was going to use)

[Loraine]

J Kelly Louise is right - Lysodren is a chemotherapy drug. I actually prefer it to Trilostane as it is less likely to cause overloading. My lovely boy was 12.5 when he was diagnosed and he got to 15.5 and then his kidneys failed. There is life ahead with Cushing's and most dogs ae not diagnosed until they are in their latter years.

Given that your vet has said 8 days and then testing it does sound like Lysodren is the drug of their choice. Many vets are not yet confident using Trilostane and I would go with what you vet is most comfortble using - and you will need the prednisolone on hand. I had my boy on Lysodren for the majority of the time.

Please keep in touch through this board and I am sure that many of us can support and advise you.

[Kelly_Louise]

That's really interesting Loraine... why is Lysodren less likely to overload? I really should read more about it - it is very interesting.

I guess it also comes down to (agree) what the specialist is most confident and what they think is best, and what each person feels comfortable giving their dog. I was always hoping they would give Chloe Trilostane as after my research that was the one I (personally) felt most comfortable giving her. In saying that though, if it was thought a different drug was better I would have gone with it - however I would have enquired about Trilostane because that is what I felt was a best fit for Chloe and us.

Seeing each and every Cushings journey is different, no one can say what is best - I guess we can only be guided by our vets and what they think is best for each different patient. But J, I do encourage you to ask questions of the vet etc - it will help you gain a better understanding, and it will further the bond you have with your vet - which I feel is very important as they will become your best friend :D and you need to trust them 100% as their relationship and knowledge of your own dog will be paramount.

Loraine, how long was your lovely old guy on Trilostane for? And what was the reason for the change (I recall it was a very new drug when you started using it)? Just trying to learn more myself - I have come to know and love Trilostane, but know only the basics of Lysodren and would like to know people's experience/opinion of it.

J, just take it one step at a time - you guys will be fine, it becomes second nature after a while (although, you WILL have to explain to every person that meets Occy what Cushings is - no one ever knows!! )

[Loraine]

That's really interesting Loraine... why is Lysodren less likely to overload? I really should read more about it - it is very interesting.

It is quicker to notice an overloading and pop in a pred and you're back to normal.

Loraine, how long was your lovely old guy on Trilostane for? And what was the reason for the change (I recall it was a very new drug when you started using it)? Just trying to learn more myself - I have come to know and love Trilostane, but know only the basics of Lysodren and would like to know people's experience/opinion of it.

Back when my lovely Coco was diagnosed I did not know much (enough) about the disease so no ultra sound was done. It was assumed that he had a pituitary tumor. As he was always on a highish dose of Lysodren my vet and I began to think he had an adrenal tumour, as they apparently take more meds to control. I got quite excieted when Trilostane first was released in the UK and did a lot of reading, as did my lovely vet. We decided to change Coco over as he was also having outbreaks of pancreatitis and kidney problems. I found Trilostane harder to cope with as it constantly needed to be adjusted (and we could only get tablets at that time so they had to be made into a liquid). In following other stories on a US website I belong to, I get the feeling that it is harder to control the amount of meds, the ease of overloading with Trilostane and the dogs need more frequent testing. On Lysodren once Coco was sorted (after the loading phase) he only needed an ACTH test every 3 months, unless I noticed anything quirky

I think each case is very different, and we must have a vet or specialest we trust and who has a lot of experience with treating the disease. My family vet diagnosed it but had no idea on the treatment protocols, so I found one that had a great experience with treating the disease.

[Kelly_Louise]

Thanks for that Loraine - quite interesting actually. I might do some more research on Lysodren, just out of curiosity

I totally agree about finding a specialist or vet who knows these diseases intimately and knows medication procedures. I can't even begin to think where Chloe would be now without her specialist. I just don't trust anyone else to do the job... and I'm afraid to say she probably wouldn't be with us today, and as well as she is.

On a good note, after our little scare earlier this month with the pale gums - Chloe is going great guns. Her legs are a little less agile these days, but after her leg ops, old age, arthritis and her meds - it's nothing we are surprised at. Can't believe she will be 12 soon. Where did that time go? Love you ChloBo, my angel.

Hope the info you are gaining on here is proving a little helpful J. Don't forget the Yahoo groups as well... I always felt a little left out as I seemed to be the only Aussie on there and things are a little different overseas - but they have given some very useful information from a wide and diverse group of Cushinoids with very different experiences.

[j]

Occy started his medication today.

Vet will phone me on Monday and each day after to check how he is going. He is tentatively booked in for Saturday week for the follow up testing, if he doesn't need to go before then.

He is on Lysodren. Pretty scary sounding drug really. Lots of care needed when handling it.

Hopefully he will complete the induction phase quickly and move on to the maintenance phase with no issues.

Will keep you updated. Thanks for all your advice and support so far

ETA - we have the prednisolone on hand in the event he has an issue with the Lysodren. My vet also mentioned Trilostane, but they prefer to start off with Lysodren and generally only move to Trilostane if the dog has an issue with Lysodren. Said it is much more expensive.

My vet is currently treating about 35 dogs with Cushings! Amazing that I have never really heard anything about it.

Edited December 31, 2009 by j