How effective is Lysodren in helping dogs with Cushings Disease?

Question

My dog Cookie was recently diagnosed with Cushings and she also has a heart murmur. I first noticed she was ill when she had a seizure/episode. After being hospitalized, getting treatment and now on Lysodren and Enalapril she seemed to be her old self (she's 11 yrs). A week after starting the Lysodren she had another episode (she collapses backward, her legs go straight, and she howls in pain), they usually last less than a minute and she seems to recover quickly, however after her last one she wont eat, drink just sleeps, seems very weak. I've noticed that the last 2 episodes which came almost 24 hrs apart, came almost 2 hrs after I gave her the Lysodren. After almost 3 wks, and $3,000 later, I still dont know what's causing these episodes and I'm very concerned. Could the Lysodren be making her worse instead of better? Any help would be appreciated. Thanks.

Answer 1

Believe it or ont, there isn't much evidence that treatment prolongs the life span of patients with Cushing's disease, if you
don't count euthanasia due to problems like increased urination. So the major benefit of treatment is not prolonged life but comfort of your pup in the remaining life span. With this in mind, if there were no symptoms beforehand, there seems to be no strong reason to treat the disorder at all. On the other hand, since you did notice symptoms, there is good evidence that it makes patients with clinical signs feel better and some evidence that starting treatment early helps to control symptoms long-term. So perhaps treatment IS a good option in your case.
There is an alternative approved treatment for Cushing's disease, which is the use of selegiline (Anipryl Rx), a medication that works well in about 40% of Cushing's disease cases and has less potential for harmful side effects and for causing hypoadrenocorticism (Addison's disease). It may be worth considering the use of this medication, but you'll have to consult with your vet first, of course.

At the present time, most vets still favor the use of mitotane (Lysodren Rx) for the treatment of Cushing's disease, primarily because it is effective more often than selegiline but also because some veterinary endocrinologists question whether selegiline works at all, because it doesn't improve the results of standard tests used to assess the treatment of Cushing's, even though it DOES appear to alleviate symptoms in many patients. So your vet's choice of this medication is not really unusual. It is important to monitor for signs of hypoadrenocorticism and to know that it may occur when using Lysodren!

It should not bother your vet much if you opted to discontinue treatment for this condition and see what happens. However, you must realize that you would have to repeat the initial stages of medicating (in which regular lab work (ACTH response tests) would have to be done to ensure that we have the correct dosages) when/if you decided to start the medication again due to the occurrence of clinical signs. I know of no evidence that suggests that stopping treatment and then restarting it
is any more likely to cause problems. It would be best if you can schedule some time to discuss all this with your vet.

I'm sure the choice to use Lydodren was made in good faith based on your vet's experiences with Cushing's, and this
medication. However, it's not always right for every case ... talk to your vet about different options because, like I said, the medication is meant to help with your dog's comfort. If she's not any more comfortable ON the medication, you may want to consider switching it, or taking her off it completely.
Good luck!

Answer 2

You are not bound to one vet. If you have concerns about your pet and your vet is not addressing them, seek a second opinion. If you want the test done, tell the vet you would rather be safe than sorry and have the test done. And if the test comes back positive, ask for a referral to a vet who deals with diseases such as this on a regular basis. There are veterinary specialists. Make sure that your dog is getting enough nutrients on the reduced calorie diet too. Ask your vet about a multivitamin. My vet believes that all dogs should be on one because the AFCO standard feeding guidelines are not always good for every pet and some may gain weight on the amount of food needed to get all their nutrients. If your dog's behavior changes, especially painful yelping, see a vet immediately!

Answer 3

pets.groups.yahoo.com/group/CanineCushings-AutoimmuneCare

This is the yahoo support group for owners of Cushings dogs.
Treating cushings is ticklish - its caused by excess cortisol. The lysoderm tries to suppress the amount of cortisol produced - unfortunately if it overachieves you can cause the opposite problem - too little cortisol which is Addisons disease. A addisons episode can be fatal but is easily treated with predisone so if she stays not eating & drinking get her to the vet quickly.