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-   -   Barney - 8yo Jack Russell Terrier (http://k9diabetes.com/forum/showthread.php?t=900)

Kelley 05-12-2009 06:57 PM

Re: Barney - 8yo Jack Russell Terrier
Thanks so much for the reply Alison!

Barney had an ultrasound in March of this year when they were looking for kidney problems. Here's the results:
Ultrasound of the abdomen revealed that both kidneys appear normal. A single nodule was found in the spleen and determined to be reactive lymphoid hyperplasia.

The UTK report has 12 treatment options listed. I wonder why my vet said she would recommend Trilostane? It says on the list "Lysodren may be preferred for atypical Cushings". Maybe I got them mixed up??

stardeb55 05-12-2009 07:03 PM

Re: Barney - 8yo Jack Russell Terrier
Kelley, I'm the Debbie that Allison mentioned. Barney is, indeed, Pit Cushing's + Atypical which is what my Harley is. Some of Barney's values are higher than Harley's were, while Harley was higher on others. Harley is being treated with Lysodren + melatonin +purified lignans. Lysodren is used to control the cortisol but it will also control most all of the other associated hormones because of the common biochemical pathways that these hormones share. The problem is estradiol. Estradiol has non-adrenal sources of production such as fat cells besides other tissue. Lyso will control the adrenal production of estradiol, but does not affect the non-adrenal sources of estradiol. This is where the use of melatonin + lignans comes into play, so that the non-adrenal production is controlled. I totally agree with Allison that Trilostane usually isn't an appropriate choice of treatment for a pup with these kind of values on a full adrenal panel. It would be very helpful to get a copy of the treatment recommendations.

Has Barney had an abdominal ultrasound? If not, I would strongly recommend that as your next step. Not only will you be able to get a look at the adrenal glands, but also all of Barney's internal organs, so you can get a better idea of his overall health. Based on my experience during the diagnostic phase for Harley, I disagree with the need for an LDDS at this point for Barney. All Harley had done to diagnose was the full panel & an abdominal US. In fact, I even asked the IMS that I was using at that point if she needed to do the LDDS, she said nope, all she needed was the US & the full adrenal panel results.

Hope this helps.

frijole 05-12-2009 07:45 PM

Re: Barney - 8yo Jack Russell Terrier

I don't have much to add but want to reinforce what Alison and Debbie just said. If you had the UTK panel done there should be treatment recommendations from Dr Oliver who is THE guy in treating atypical cushings. I agree that it doesn't seem like doing the LDDS test has any value - am curious why they are recommending it. Again, get the treatment recommendations from that lab report and maybe it'll be explained. I also agree that the preferred treatment for atypical cushings is not trilostane. It is easy to get all of these drugs confused so don't worry if you did. We all make mistakes. :p

I'm just glad you found us!


gpgscott 05-12-2009 07:57 PM

Re: Barney - 8yo Jack Russell Terrier
Hi Kelley,

Sorry your Barney is having issues.

You need the treatment recommendation from UTK.

Better to wait until you have a good diagnosis than to commence a treatment too early.

It appears to me that Trilo is not indicated as you have elevations of intermediate hormones.


SasAndYunah 05-12-2009 11:36 PM

Re: Barney - 8yo Jack Russell Terrier
Hi Kelley,

Sorry about the problems Barney's having. I understand that at this time it's not exactly clear with wich medication Barney will be treated. But I wanted to let you know that if the treatment will be with either Trilostane or Lysodren, that neither of these meds should be given/handled by pregnant women. (or women planning to become pregnant sometime in the future for that matter) I'm pretty sure your vet will also tell you this when the time comes to start treatment but wanted to let you know anyway. Congrats on the pregnancy :) And the best of luck with barney...

Saskia and Yunah,
The Netherlands.

Kelley 05-13-2009 08:03 AM

Re: Barney - 8yo Jack Russell Terrier
Thanks for the info everyone. I hadn't heard about not handling the meds while pregnant, thanks so much for that. The treatment options on the report from Dr. Oliver are as follows (I wonder if these are in order of preference? anyone know?)
1. Ultrasound (we had one done in March)
2. Melatonin
3. Melatonin Implants
4. Flaxseed oil with lignans
5. Maintenance dose of Lysodren
6. Lysodren traditional treatment
7. Trilostane (it says in the notes that Lysodren may be preferred for Atypical Cushings)
8. Ketaconazole
9. Selegiline
10. Specific hypertrinism treatment
11. Ovarian remnant detection (he's a boy...)
12. Retained testicle detection

stardeb55 05-13-2009 08:17 AM

Re: Barney - 8yo Jack Russell Terrier
The recommendation sheet isn't in any specific order. There should have been a comment that was something to the effect that say treatments #2, 3, 4 are recommended.l


Kelley 05-13-2009 09:49 AM

Re: Barney - 8yo Jack Russell Terrier
Unfortunately, there aren't any solid recommendations from Dr. Oliver. The comments say: Various treatment option considerations are attached. Some veterinarians consider items 2-6.

Squirt's Mom 05-13-2009 10:10 AM

Re: Barney - 8yo Jack Russell Terrier
Hi Kelley,

Did the ultrasound say anything about his adrenal glands? These are the glands looked for in an U/S on a cush pup so I am curious as to what they had to say about them.

As for the treatment options, it sounds as if Dr O would use either melatonin and lignans, or those plus the Lysodren as maintenance or with the usual loading approach. On Squirt's results, it states which numbers are "recommended" but I have noticed some of the latter results say "some veterinarians consider items..." like yours does. Still, whether recommended by Dr O directly or whether stated as it is on your sheet, I would stick with his ideas, which doesn't include Trilo. As high has some of her hormone levels are already, that would be playing with fire, IMHO. So I hope you simply got confused with what your vet said. Very easy to do with all these new terms, meds, etc! ;)

You're doing a great job, so keep it up!
Leslie and the girls

PS. Since you are pregnant, please use gloves if you use the Lyso and wash your hands and arms off good after dosing, ok? We want all in your house to be well! :)

Kelley 05-13-2009 10:21 AM

Re: Barney - 8yo Jack Russell Terrier
The ultrasound just said that his kidneys are normal and a nodule was found in the spleen. I wonder if another ultrasound should be done to focus on the adrenal glands?

For the meds, she said she didn't want to use the one that destroyed the adrenal cells, just the one that inhibits them...does that help clear it up? I'm thinking if she suggests the Trilo, I'll have to disagree. Barney is also on an ACE inhibitor for his blood pressure and I read that Trilo is contraindicated with that as well.

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