Shadow my 10 year old husky has Cushings (treatment with Lysodren)

[muskyhusky]

Shadow was diagnosed with Cushings last May & I have just started treating her, I delayed the treatment because of that nasty drug Lysodren, she is now on the meds and seems to be doing pretty good. Today is her 6'th day on them.

Does anyone know where a person can get help paying for this drug, a 30 day supply cost me $187.50.

[acushdogsmom]

Hi and welcome! :)

It's not clear from your post if you have started treatment with Lysodren or another drug ... trilostane (Vetoryl) maybe?

We have many here who are successfully treating their Cushing's dogs, some with Lysodren and others with trilostane (Vetoryl).

Others here can tell you about their experiences with trilostane, but my own dog did wonderfully well on Lysodren for more than 6 years.

He was a very sad looking and sick little dog before we got the diagnosis and started the treatment, but within just a few weeks after we started the Lysodren, all of his symptoms disappeared and he seemed to get young again right before our very eyes. His hair grew back in full and thick and soft and he became happy and playful again, too. His appetite and water consumption returned to normal and you couldn't even tell there was anything wrong with him at all anymore.

Lysodren literally saved my dog's life. Of course we did also have a wonderful Internal Medicine Specialist Vet managing his case, and she had alot of experience treating dogs successfully with Lysodren, so that had alot to do with our success too, I suppose. (She was the one deciding on dose adjustments etc.)

Can you tell us a bit more about your Shadow? What tests were done that were positive for Cushing's?

And which "meds" are you treating with?

P.S. My vet says that trilostane (Vetoryl) is usually more expensive to treat with than Lysodren.

[muskyhusky]

Hi and welcome! :)

It's not clear from your post if you have started treatment with Lysodren or another drug ... trilostane (Vetoryl) maybe?

We have many here who are successfully treating their Cushing's dogs, some with Lysodren and others with trilostane (Vetoryl).

Others here can tell you about their experiences with trilostane, but my own dog did wonderfully well on Lysodren for more than 6 years.

He was a very sad looking and sick little dog before we got the diagnosis and started the treatment, but within just a few weeks after we started the Lysodren, all of his symptoms disappeared and he seemed to get young again right before our very eyes. His hair grew back in full and thick and soft and he became happy and playful again, too. His appetite and water consumption returned to normal and you couldn't even tell there was anything wrong with him at all anymore.

Lysodren literally saved my dog's life. Of course we did also have a wonderful Internal Medicine Specialist Vet managing his case, and she had alot of experience treating dogs successfully with Lysodren, so that had alot to do with our success too, I suppose. (She was the one deciding on dose adjustments etc.)

Can you tell us a bit more about your Shadow? What tests were done that were positive for Cushing's?

And which "meds" are you treating with?

P.S. My vet says that trilostane (Vetoryl) is usually more expensive to treat with than Lysodren.

Sorry I wasn't more specific. Shadow had The Low-Dose dexamethasone suppression test, she is on her 6'th day of the 10 days of lysodren and seems to be doing fine.

She was diagnosed last May [2008, urine tests caught it] but I didn't put her on the lysodren because she really wasn't showing any symptoms, until now that is, she started getting bladder infections that won't go away, she is on her 3'rd week of treatment with antibiotics for that.

The vet says that once the lysodren starts working the bladder infections should go away, one can only hope.

She is not very tolerant of our shih tzu, Cooper, he's almost 4 months old and I swear he is a demon dog....:eek:

[Harley PoMMom]

Hi and welcome from me too,

Does Shadow have any other symptoms besides the UTI's? And was Shadow tested for Atypical cushings? Many of the nordic breeds, like huskies, have elevated "sex" hormones, known as Atypical cushings.

Hugs.
Lori

[AlisonandMia]

Hi and welcome,


Sorry I wasn't more specific. Shadow had The Low-Dose dexamethasone suppression test, she is on her 6'th day of the 10 days of lysodren and seems to be doing fine.



So she has been prescribed a 10 day loading of Lysodren? This, unfortunately, not correct protocol and could very well make Shadow very sick. When loading with Lysodren there is no set number of days for loading - the idea is to give daily doses until the dog shows signs of being loaded - that is that the cortisol level has been reduced to the point where the big Cushing's appetite (is Shadow's appetite increased?) returns to normal. This may take as little as 1.5 days (rare but it happens) or up to a month depending on the dose and the dog. Most dogs load in around 5 - 7 days so you can see that a set period of 10 days will be a problem as if you keep dosing after the cortisol is at the correct level then the cortisol will go too low which is what causes the "side effects" so commonly associated with Lysodren. It is also possible that she may need more than 10 days too, of course.

Here's a link to some info on Lysodren use, particularly the loading phase:

http://www.k9cushings.com/forum/showthread.php?t=181

You may want to print that info out to refer to while you are in the loading phase.

How much does Shadow weigh and what daily dose of Lysodren is she on? What are her Cushing's symptoms?

Alison

[muskyhusky]

Hi and welcome from me too,

Does Shadow have any other symptoms besides the UTI's? And was Shadow tested for Atypical cushings? Many of the nordic breeds, like huskies, have elevated "sex" hormones, known as Atypical cushings.

Hugs.
Lori

Oh great, how do they test for that? She has the bulging bellyhttp://i50.photobucket.com/albums/f332/muskyhusky/1Shadow%202009/014-1.jpg. Low specific gravity in her urine sample.

[acushdogsmom]

Sorry I wasn't more specific. Shadow had The Low-Dose dexamethasone suppression test, she is on her 6'th day of the 10 days of lysodren and seems to be doing fine.

Okay then, more questions for you and a link. :)

How much does Shadow weigh and how much Lysodren is she getting per day?

I ask, because Lysodren is dosed by weight of the dog, and the "loading" dose (when you are giving it daily) can be anywhere from 25 to 50 mg/kg/day. The more the dog is getting (mg per kg per day), the faster the loading may go. Also some dogs are just more or less sensitive to the effects of the drug than others, so some load faster than others (or slower).

My dog was fully loaded in only three days! Which is pretty fast, as loading goes. But you need to know that Shadow may become fully loaded (ie doesn't need that daily dose anymore) in less than 10 days.

The first signs we need to watch for, that tell us that loading may be complete, are lessening in appetite and/or water consumption.

More info about loading (and maintenance, which is when you are giving a weekly dose instead of a daily dose) here:

http://www.k9cushings.com/forum/showthread.php?t=181

edited to add:

P.S. Looks like I was typing while Alison replied ... sorry for any duplications between what she said and what I just said.

(also edited to delete something I wrote in reply to something that I misunderstood when first reading your reply)

[muskyhusky]

Okay then, more questions for you and a link. :)

How much does Shadow weigh and how much Lysodren is she getting per day?

I ask, because Lysodren is dosed by weight of the dog, and the "loading" dose (when you are giving it daily) can be anywhere from 25 to 50 mg/kg/day. The more the dog is getting per kg per day, the faster the loading may go. Also some dogs are just more or less sensitive to the effects of the drug than others, so some load faster than others (or slower).

My dog was fully loaded in only three days! Which is pretty fast, as loading goes. But you need to know that Shadow may become fully loaded (ie doesn't need that daily dose anymore) in less than 10 days.

The first signs we need to watch for, that tell us that loading may be complete, are lessening in appetite and/or water consumption.

More info about loading (and maintenance, which is when you are giving a weekly dose instead of a daily dose) here:

http://www.k9cushings.com/forum/showthread.php?t=181

She weighs 65 lbs.
She gets 1 and 1/2 tabs twice a day for 10 days
500 MG lysodren

I just took in a urine sample on the 7'th and the lysodren hadn't started working yet.
NOTE: I have been watching her today and she doesn't seem to be panting as much as she was, but I do have the AC on.

[frijole]

Welcome from me also! Lysodren mom for 3 yrs and my 15 1/2 yr old schnauzer would not be here if not for it! It isn't the lysodren that kills, it is when it is not given according to very strict instructions. Alison gave you the link that we have all used to help us thru this. Please read it. It is important.

Alison also asked about the dosage amount you are on each day. We want to double check to make sure it is within recommended range. Again, important.

I have been buying lysodren from drugstore.com and it was 1/2 the price my vet could sell it for (less than his cost!). The price is similar at Cosco.

VERY IMPORTANT: Did your vet give you prednisone pills to give in the event of emergency? If not you need to call and get them immediately. It isn't an option. ;)

As Alison said, you don't give lysodren for 10 days. You give it until you see signs of change in appetite or water intake (see the link she posted as it is all in there). If you continue to give lysodren to a dog and vomiting or diarrhea occurs you have given too much. This is when you give prednisone.

Sorry to hit you with all of this but it is important. Like I said, it isn't the drug that is nasty, it is what happens when a drug is not properly administered. We just want to make sure Shadow is safe and you are thoroughly aware of how the drug works.

Don't worry, we were all new once and it gets wayyyyyyy easier! Hang in there and let us know the dosage amount and whether or not you have prednisone on hand. Thanks! Kim

[frijole]

She weighs 65 lbs.
She gets 1 and 1/2 tabs twice a day for 10 days
500 MG lysodren

I just took in a urine sample on the 7'th and the lysodren hadn't started working yet.

The dosage is just a tiny bit over the recommended amount. You should be ok but you could load very very quickly.

Are you saying your vet is testing the urine to determine if the lysodren is working?

Have you done an ACTH test? (2 hr test)

[gpgscott]

Welcome,

If I am understanding your posts correctly you are administering approx 25mg/kg/day. This is the lowest recommended loading dose.

Other than this, you have been given good information and I encourage you to continue to learn about the treatment and post here. There are lots of folks to help you get a handle on the treatment.

Best to you and Shadow. Scott

[acushdogsmom]

She weighs 65 lbs.
She gets 1 and 1/2 tabs twice a day for 10 days
500 MG lysodren

65 lbs = 29.5 kg

1 and 1/2 tabs twice a day = 750 mg x 2 = 1500 mg per day

1500 mg divided by 29.5 kg = 50.8 mg per kg per day

Which is just a tiny bit over the usual maximum dose of 50 mg/kg/day ... and probably just fine as a loading dose ...

BUT


I just took in a urine sample on the 7'th and the lysodren hadn't started working yet.I have never ever ever heard of checking the effectiveness of Lysodren with a urine test. Ever!

The only way to know if the Lysodren has eroded away enough of the adrenal cortex to stop the loading is with an ACTH stimulation test ... which is a 1-hour (or two-hour) blood test.

And the ACTH stim test needs to be done on a continuing basis for the rest of the dog's life (while on Lysodren, anyway).

You can get to the point where you only need to do an ACTH stim every 6 months or so, but you can't rely on symptoms or how the dog is acting or any other test except the ACTH stim test to tell you how much cortisol the adrenal glands are still capable of producing.

See link on Lysodren loading that Alison and I both gave you, for details about when ACTH stims should be done

Are you sure that your Vet only checked the urine after 7 days of loading at almost 51 mg/kg/day of Lysodren???

[muskyhusky]

The dosage is just a tiny bit over the recommended amount. You should be ok but you could load very very quickly.

Are you saying your vet is testing the urine to determine if the lysodren is working?
Have you done an ACTH test? (2 hr test)


Are you saying your vet is testing the urine to determine if the lysodren is working? [No, I took the urine in for her bladder infection and he made the comment that the low specific gravity hadn't changed]

Have you done an ACTH test? (2 hr test) [The 2 hour test is scheduled for Monday the 17'th @ 8 AM]

[StarDeb55]

I would like to welcome you & Shadow also! I don't have much to add to what the others have already told you except to emphasize that most dogs usually load in 5-8 days, some can load as quickly as a couple of days, some can take a month or more.

Regarding Shadow's loading, I just calculated your loading dose, & you are right at the maximum daily dose of 50 mg/kg. 50mg/kg for Shadow is 1477 mg daily, you are giving 1500, so you are actually just a tick over maximum. You really need to watch very closely for signs of loading on such a high dose. As Kim has already mentioned, it's imperative that your vet give you prednisone to keep available. This is not optional for a dog during lysodren loading. An overload can make a dog very ill quite quickly, & this is why the pred needs to be immediately available.

We would really like to see all of the "numbers" from Shadow's diagnostic tests. We aren't trying to be nosy or second guess your vet, it's just that it helps us to give you the best advice we can. We, also, have seen too many cases of vets who aren't "Cush savy" getting in a rush to make a diagnosis without proper testing being done.

Debbie

PS- I see Cushy was posting at the same time, so sorry for any duplication.

[gpgscott]

Cushy is correct, I missed the twice daily note which would put you just over 50mg/kg/day which is considered the upper limit for loading.

Scott

[acushdogsmom]

Are you saying your vet is testing the urine to determine if the lysodren is working? [No, I took the urine in for her bladder infection and he made the comment that the low specific gravity hadn't changed]

Have you done an ACTH test? (2 hr test) [The 2 hour test is scheduled for Monday the 17'th @ 8 AM]The low specific gravity may not normalise for some time after your dog is fully loaded (ie has had enough of the daily doses). Your Vet should know that you can't judge the effectiveness of the Lysodren loading that way ...

And you may neeed to do an ACTH stim long before the appt you have booked for it already. See my previous post for the reasons why ...

[forscooter]

Hi and welcome,

Just wanted to chime in here and let you know that what the others have told you is so very important. Please make sure you understand then loading instructions and not just follow a time table. Scooter loaded on Lysodren in 2.5 days, he was about the same weight at 68 pounds, and came back a little too low when tested. The vet thought I was calling it too early but I was right. And all he showed was a very slight hesitation in eating. Bailey, my other Cushpup, loaded in much less time and bc I insisted this time, we got him in the perfect range at 2.5.

I am also a little confused about the urine test? Are you checking on the UTI or the loading with that? You should be running the ACTH to check on loading....and one should have been done prior to starting the Lysodren or at least to aid in diagnosis.

Lastly, I think you are fine without going through the Atypical Cushing's test. I asked Dr. Oliver about it once and as he said, Lysodren will work on most of these hormones anyway so it was not necessary. More important if you are using Vetoryl (or trilostane which you aren't). The only hormone Lysodren will not lower is estriadol and that can be helped with melatonin IF you are seeing some symptoms and only under the advice and guidance of a vet experienced in the Cushing's treatment area. But I don't think you need to be concerned about that just yet.

Please let us know the protocol and instructions your vet gave you for the loading....we all get a bit worried bc we have seen some vets give it for a set number of days and we want to help you have a smooth as possible loading!!!

Beth, Bailey and always Scooter

[frijole]

Are you saying your vet is testing the urine to determine if the lysodren is working? [No, I took the urine in for her bladder infection and he made the comment that the low specific gravity hadn't changed]

Have you done an ACTH test? (2 hr test) [The 2 hour test is scheduled for Monday the 17'th @ 8 AM]

Forgot about the bladder infection! :rolleyes: This test can tell if your dog does NOT have cushings but really cannot tell anything about lysodren.

The ACTH is the test you have done to see if you have "loaded". You give daily lysodren to erode the adrenals that are overproducing cortisol. Your goal is to have the 2nd number on this test be between a 1 and a 5.

Understand that you could have to cease giving the lysodren earlier than your appointment. Did your vet explain any of this to you? Sorry to repeat if he/she did. It is just very important. You started out talking about "nasty lysodren" and we see lots of people in trouble because they give too much lysodren following the vet's instructions.

Just want to make sure you have prednisone on hand and know never to give a sick dog (vomit/diarrhea) lysodren.

Kim

[muskyhusky]

I would like to welcome you & Shadow also! I don't have much to add to what the others have already told you except to emphasize that most dogs usually load in 5-8 days, some can load as quickly as a couple of days, some can take a month or more.

Regarding Shadow's loading, I just calculated your loading dose, & you are right at the maximum daily dose of 50 mg/kg. 50mg/kg for Shadow is 1477 mg daily, you are giving 1500, so you are actually just a tick over maximum. You really need to watch very closely for signs of loading on such a high dose. As Kim has already mentioned, it's imperative that your vet give you prednisone to keep available. This is not optional for a dog during lysodren loading. An overload can make a dog very ill quite quickly, & this is why the pred needs to be immediately available.

We would really like to see all of the "numbers" from Shadow's diagnostic tests. We aren't trying to be nosy or second guess your vet, it's just that it helps us to give you the best advice we can. We, also, have seen too many cases of vets who aren't "Cush savy" getting in a rush to make a diagnosis without proper testing being done.

Debbie

PS- I see Cushy was posting at the same time, so sorry for any duplication.

Here is the link to Shadows medical records, I labeled a couple of them but not all.

http://s50.photobucket.com/albums/f332/muskyhusky/1%20Shadows%20Medical%20Reports/

[acushdogsmom]

Here is the link to Shadows medical records, I labeled a couple of them but not all.

http://s50.photobucket.com/albums/f332/muskyhusky/1%20Shadows%20Medical%20Reports/

Okay, I just had a look at the LDDS and it does seem to be consistent with a Cushing's diagnosis, and it also seems to be consistent with Pituitary Cushing's, since there is suppression at the 4-hour mark and a marked escape from suppression at the 8-hour mark.

Baseline: 2.3 ug/dl
4-hour cortisol: 1.2 ug/dl
8-hour cortisol: 8.0 ug/dl

Will try to look at the rest of the results later if I can, but hopefully others here who know more than I do about interpreting lab tests will also be able to have a look at your Shadow's results. :)

[frijole]

I am impressed with the record keeping! Slick! Keeping a journal of the tests and results and what is going on with Shadow will be a great help up the road.

Please confirm that you have prednisone on hand so I can sleep better tonight. ;):p It really is important. I am hoping you do since you didn't answer.

[acushdogsmom]

Gotta run ... but just want to ask you to go read and print out the Lysodren Loading Instructions thread. Some of it is taken straight from the Textbook of Veterinary Internal Medicine and the rest is from our collective experience.

Here's that link again:

http://www.k9cushings.com/forum/showthread.php?t=181

The main things to note are the signs you need to know that can be indicators that the loading phase is complete. Loading time is different for every dog, and at 50 mg/kg/day, most dogs (not all, but most) are fully loaded in less than 10 days.

And you should also have been given some prednisone to keep at home, just in case you ever need to use it as a rescue dose/antidote if ever the cortisol goes too low.

I always had pred here at home, but very rarely needed to use it in the more than 6 years that my boy was on Lysodren

[muskyhusky]

I haven't gotten the one from August yet, I have to get the copy from the vet then I'll post it with the rest.

[acushdogsmom]

Forgot to tell you that I think Shadow is really pretty!

You can post some photos in albums too, if you like. Just look in your usercp, click on pictures and albums (on the left hand side) and then follow the prompts. :)

[muskyhusky]

Forgot about the bladder infection! :rolleyes: This test can tell if your dog does NOT have cushings but really cannot tell anything about lysodren.

The ACTH is the test you have done to see if you have "loaded". You give daily lysodren to erode the adrenals that are overproducing cortisol. Your goal is to have the 2nd number on this test be between a 1 and a 5.

Understand that you could have to cease giving the lysodren earlier than your appointment. Did your vet explain any of this to you? Sorry to repeat if he/she did. It is just very important. You started out talking about "nasty lysodren" and we see lots of people in trouble because they give too much lysodren following the vet's instructions.

Just want to make sure you have prednisone on hand and know never to give a sick dog (vomit/diarrhea) lysodren.

Kim

No he didn't give me any prednisone - but he did tell me that if she started vomiting to stop the lysodren right away and call them, I should call about the prednisone tomorrow though, maybe he'll give me some.

[acushdogsmom]

Vomiting is usually a sign that the dog may have had too much Lysodren (cortisol production too low) and if/when the cortisol does go too low, the pred acts as a substitute for the missing cortisol.

You really should always have some at home.

Hopefully, though, you can catch the signs that loading is complete before you get to where the cortisol production is too low.

You should also always have a plan for what to do (where to call and where to go) if your dog is ever needing vet care when your Vet's Clinic is closed. Is there a veterinary ER near where you live?

You may never need the pred or the emergency plan, but as they say ... "better safe than sorry". :)

[Harley PoMMom]

Please confirm that you have prednisone on hand so I can sleep better tonight. ;):p It really is important. I am hoping you do since you didn't answer.


.

And you should also have been given some prednisone to keep at home, just in case you ever need to use it as a rescue dose/antidote if ever the cortisol goes too low.


Please, I think they need these questions answered, they are very important.

Also, if you don't mind...what is your name, we are so friendly here..."hey you." is so impersonal. :(

Hugs.
Lori

[frijole]

No he didn't give me any prednisone - but he did tell me that if she started vomiting to stop the lysodren right away and call them, I should call about the prednisone tomorrow though, maybe he'll give me some.

I know we are new to you and have to earn your trust. Please understand that it is against protocol to not give you prednisone to have on hand. Very serious mistake. We have seen dogs come here in serious distress because of this.

You have a large dog. We have seen them load in 2 days many many times. The chances are good that your dog will load in less than 10 days. You must have this drug on hand just to be safe. The drug continues to work for up to 48 hrs after you give the last pill.

If you see any changes in water consumption or if Shadow pauses at all when eating (any change in eating) do NOT give the next lysodren. Give lysodren AFTER the meal to be safe. That way you can elect NOT to give it.

Kim


From the Lysodren loading Instructions from the chapter on Hyperadrenocorticism in the Textbook of Veterinary Internal Medicine, S. J. Ettinger and E. C. Feldman, editors. 1995


INITIATING THERAPY - THE LOADING DOSE PHASE:

Therapy is begun at home with the owner administering Lysodren at a dosage of 50 mg/kg/day, divided and given BID (twice a day).

Glucocorticoids (prednisone) given together with the Lysodren is not advised during loading, but the owner should have a small supply of prednisolone or prednisone tablets for an emergency.

The owner should receive thorough instructions on the actions of Lysodren and should also have specific instructions on when the drug should be discontinued.

Lysodren administration should be stopped when:

1. the dog demonstrates any reduction in appetite; this might mean just pausing slightly during meal consumption, stopping to drink some water, or stopping in response to the owner's voice.

2. the polydipsic dog consumes less than 60 ml/kg/ day of water.

3. the dog vomits.

4. the dog has diarrhea

5. the dog is unusually listless.

The first two indications for stopping the medication are strongly emphasized because they are common and they precede worrisome overdosages. The occurrence of any of these signs strongly indicates that the end point in induction (loading) therapy has been achieved.

Because of the potency of Lysodren, the veterinarian is encouraged not to rely on the instructions given to an owner. Never provide the owner with more than 8 days of Lysodren, initially. This drug is highly successful in eliminating the signs of hyperadrenocorticism because of its potency coupled with close communication between owner and veterinarian. Either the veterinarian or a technician should contact the owner for a verbal report regarding the dog every day beginning with the second day of therapy. In this way, the owner is impressed with the veterinarian's concern and the need to observe the animal closely.

It is wise for the owner to feed the dog two small meals each day, as previously described. The dog's appetite should be observed prior to each administration of Lysodren. If food is rapidly consumed (with or without polydipsia), medication is warranted.

If food is consumed either slowly or not at all, medication should be discontinued until consultation with the veterinarian.

Usually the initial loading dose phase is complete when a reduction of appetite is noted or after water intake approaches or falls below 60 ml/kg/day.

The water intake in polydipsic dogs may decrease to the normal range in as few as 2 days or take as long as 35 days (average is 5 to 9 days) Owners must continue to monitor the water intake daily until it falls to or below 60 ml/kg/day. Usually the water intake diminishes within days of beginning treatment, but it does not usually become normal until after some reduction in appetite is observed.

A small percentage of dogs demonstrate mild gastric irritation or systemic signs of illness from the Lysodren 1 to 3 days after medication has been started. These signs include anorexia, vomiting, diarrhea, weakness and lethargy.

If any of these signs are observed, the medication should be discontinued until the veterinarian can evaluate the dog. If the signs are the result of drug sensitivity and not because the treatment is complete, dividing the dose further may be helpful; discontinuing the medication for a few days may be necessary.

It is recommended that treatment be initiated on a Sunday, so that if illness develops after a few days, the veterinarian should be available during the regular work week rather than on a weekend.

[muskyhusky]

Please, I think they need these questions answered, they are very important.

Also, if you don't mind...what is your name, we are so friendly here..."hey you." is so impersonal. :(

Hugs.
Lori

No predisone, gonna call tomorrow for sure though. My name is Lynne, sorry about that,the response here has been overwhelming, I wasn't prepared for it...:o

[Harley PoMMom]

Sorry, I see you answered their questions about the pred.

I also think Shadow's a beautiful girl.

My Harley's almost 13 y/o, and he has that pot-belly too, our poor pups. :(

Hugs.
Lori

[AlisonandMia]

Although you most certainly would want to stop the Lysodren if she vomits, ideally you should stop the Lysodren before the dog vomits or develops diarrhea. Vomiting (if it is caused by low cortisol) is a sign that you've almost certainly given too much Lysodren. The signs that you are looking for that tell you it is time to stop the Lysodren are a decrease in appetite - this can be very subtle - just taking a little longer to eat a meal, not racing to the bowl or looking up at you while eating when previously the dog would have eaten like a frantic vacuum cleaner. Another sign (but not as reliable a one) that you need to stop dosing and do an ACTH stim test is a noticeable decrease in water consumption/urination. The decrease in water consumption need not be back to normal levels - any noticeable decrease is significant though.

If you are on the lookout for these more subtle signs then the risk of overloading is much reduced - and if it does happen it is very, very mild and transient. It is not a necessary part of Lysodren treatment for the dog to actually get sick and vomit or have diarrhea or any other distressing symptoms.

Alison

[acushdogsmom]

No predisone, gonna call tomorrow for sure though. My name is Lynne, sorry about that,the response here has been overwhelming, I wasn't prepared for it...:oHang in there, Lynne. We'll do our best to help you. We try to educate people so that they can be strong advocates for their dogs. We try to be good at hand holding, too. :)

[StarDeb55]

I'm a firm believer in keeping pred on hand. I kept it available with Barkley for 8 years, only had to use it once after he was loaded. On his very first loading, he had actually overloaded with no symptoms or change in appetite or drinking when he went in for his ACTH on day 8. Vet called me immediately when she got the results, & gave me instructions on how much pred to give that I already had available. This is just to show you how important it is to have the pred. You do not want to let Shadow to get to the point of vomiting, diarrhea, &/or lethargy. Signs of loading may be something as subtle as Shadow pause, looks up at you while eating, & instead of cleaning the dish, & all the crumbs around the dish, may leave a few pieces of kibble in the dish.

Debbie

[frijole]

Hi Lynne! My name is Kim! My dog is Haley - treated for 3 yrs with lysodren. She is 15 1/2 now. My young dog is Annie - she is only 13. :D

We did not mean to inundate you. It can sometimes be like an emergency room here and we see alot of cases where vets aren't following recommended protocol. First concern is always the dog! We need to make sure the owners have been given proper instructions because alot of times dogs get in trouble simply because of lack of information.

You will grow to love us, I promise!!!

The main thing is that when you have the right dosage, this drug saves lives. Shadow can lead a very normal and happy life. It gets alot easier. We just want to make sure you don't overload.

I know you will call them tomorrow and pick up the prednisone. I would mention to the vet that you know protocol requires it. Sometimes when vets know their clients are researching they put a little bit more thought into things. ;)

You are your dog's voice here and you will be fine. Any questions, just ask away!

[muskyhusky]

I want to thank you all for all the help you are giving me, I originally called lysodren a nasty drug because it scares the h-e double L out of me to give it to her. I will definately be calling my vet tomorrow for prednisone. Thank you guys so much

[acushdogsmom]

I want to thank you all for all the help you are giving me, I originally called lysodren a nasty drug because it scares the h-e double L out of me to give it to her. I will definately be calling my vet tomorrow for prednisone. Thank you guys so muchYou're welcome and it's okay, Lynne. I think we all did a bit of a double take when we first realised our dogs really did have Cushing's and the ones of us using Lysodren did another double take when we were told we'd be treating them with Lysodren. It does have a bit of a bad reputation, but I firmly believe that in the hands of a vet who knows how to dose and monitor properly and with an informed and dedicated owner, it is a life-saving and quality of life restoring drug.

Honestly, it gave me my dog back. He was so sickly looking before starting treatment -- people used to look at him and say "Aw, poor little dog, what's wrong with him?" ... and then after being on Lysodren for a few months I was getting "Aw, he's sooo cute! How old is he? Five or six, maybe?" (he was actually 10 and a half by then!)

:D :D :D

[ventilate]

Hi Lynne and welcome frome me and mine;
I have a giant schanuzer who had been diag with cushings for 3 and half years and been treated for the same with lysodren and have been on the cushings site for the same time. We were all frightened by the so called side effects of lysodren, you will learn that the so called side effects are actually signs of overdosing and are not side effects of the drug.
As others have said the signs of loading may be subtle, Nike just left some kibble in her dish and let my other GS eat it, she also didnt wake me up the night before to go outside. What I tell people is it is something that makes you go hummm somthing a bit different.
I also am a firm believer on having the pred on hand, I keep it all the time and use it occasionally still. When Nike loaded to 0.3 which is to low but she only had those vague signs, no vomiting nor diah, no lethargy, no leg weakness. So If I had of missed the signs she would have been in big trouble and I could not have helped her fast. I also want to be sure you are feeding the entire meal then giving the meds. I was told to give 1/2 the food if she eats it all give her the pills with the other half. well she wolfed down the first half, I gave her the meds then she left some kibble, to late. Remember once you give it you cant take it back, so be sure you want to give it. I think that is why her levels were to low. If you are not doing so, feed your dog the entire meal and watch carefully, if there is no change nothing different, give the meds and a treat or small bit of food to be sure the meds get into the stomach. You dont want to give the meds on an empty stomach it can cause upset.
Hope this helps, we are all here for the same reason, we love your dogs and want what is best for them and we all happen to have dogs that have cushings. We have some pits that we fell into and hope by being here we can prevent others from falling into the same.
good luck and please do get the pred, if the vet refuses please ask what the issues would be tell him that you would not give it until you speak to him/her or would only give it in an emergency, in the middle of the night until you can get your dog to the vets or emergency clinic
PS
Nike loaded in 3 days, she weighed 90 lbs at the time. larger dogs tend to load faster, So as others have said the 10 day thing is not the correct instructions, I would be cautious with your vet sometimes our vets are excellent and have treated our dogs for years but unfortunatly they have no or little experience with Cushings. The secret to successful treatment for cushings is #1 a knowledgable vet one who is willing to work with you, my vet doubted me a couple time and when it proved to be correct he now phrases me for my attention I give to her. #2 is a knowledgable and observent owner, you know your dog the best use this to your dogs advantage. If something does not seem right it probably is not, guts are always right
Sharon

[frijole]

I want to thank you all for all the help you are giving me, I originally called lysodren a nasty drug because it scares the h-e double L out of me to give it to her. I will definately be calling my vet tomorrow for prednisone. Thank you guys so much

My first thread when I found out Haley had cushings was "New, Overwhelmed and Frightened". Does that tell you that you aren't alone? :D

I had a clueless vet. She told me over the phone that Haley had cushings so I googled it. I was clueless. She had lysodren sitting at the counter waiting for me. I had read about it and it scared me too. I found these people and figured out she wasn't even CLOSE to following protocol - wrong dose, no loading, ridiculous. I picked up my dog, left the pills at the front counter and went out and found a vet that would care for my dog.

And the rest as they say... is history! :p

Welcome to the k9 cushings club!

[muskyhusky]

Hi Lynne and welcome frome me and mine;
I have a giant schanuzer who had been diag with cushings for 3 and half years and been treated for the same with lysodren and have been on the cushings site for the same time. We were all frightened by the so called side effects of lysodren, you will learn that the so called side effects are actually signs of overdosing and are not side effects of the drug.
As others have said the signs of loading may be subtle, Nike just left some kibble in her dish and let my other GS eat it, she also didnt wake me up the night before to go outside. What I tell people is it is something that makes you go hummm somthing a bit different.
I also am a firm believer on having the pred on hand, I keep it all the time and use it occasionally still. When Nike loaded to 0.3 which is to low but she only had those vague signs, no vomiting nor diah, no lethargy, no leg weakness. So If I had of missed the signs she would have been in big trouble and I could not have helped her fast. I also want to be sure you are feeding the entire meal then giving the meds. I was told to give 1/2 the food if she eats it all give her the pills with the other half. well she wolfed down the first half, I gave her the meds then she left some kibble, to late. Remember once you give it you cant take it back, so be sure you want to give it. I think that is why her levels were to low. If you are not doing so, feed your dog the entire meal and watch carefully, if there is no change nothing different, give the meds and a treat or small bit of food to be sure the meds get into the stomach. You dont want to give the meds on an empty stomach it can cause upset.
Hope this helps, we are all here for the same reason, we love your dogs and want what is best for them and we all happen to have dogs that have cushings. We have some pits that we fell into and hope by being here we can prevent others from falling into the same.
good luck and please do get the pred, if the vet refuses please ask what the issues would be tell him that you would not give it until you speak to him/her or would only give it in an emergency, in the middle of the night until you can get your dog to the vets or emergency clinic
PS
Nike loaded in 3 days, she weighed 90 lbs at the time. larger dogs tend to load faster, So as others have said the 10 day thing is not the correct instructions, I would be cautious with your vet sometimes our vets are excellent and have treated our dogs for years but unfortunately they have no or little experience with Cushings. The secret to successful treatment for cushings is #1 a knowledgeable vet one who is willing to work with you, my vet doubted me a couple time and when it proved to be correct he now phrases me for my attention I give to her. #2 is a knowledgeable and observant owner, you know your dog the best use this to your dogs advantage. If something does not seem right it probably is not, guts are always right
Sharon

The thing is she doing everything she always does, she's eating good, but she always eats good [she loves those carrots], no diarrhea, no vomiting, she is still panting alot, I had thought she had cut down on it but she hasn't. She never did eat or drink or urinate anymore then she usually does, we never would have discovered the Cushings except through the reg. urine tests I took in to make sure she didn't have a bladder infection. The only 2 signs she has is the panting and the belly.

The one thing I have noticed is that she isn't leaking like she was, man she would leave lakes of urine where ever she'd lay, now I don't notice any.

I will be on the phone tomorrow with my vet asking for prednisone for her, but what if he says she doesn't need it????

[Harley PoMMom]

Hi Lynne,

I had to search for this:

Instructions from the chapter on
Hyperadrenocorticism in the Textbook of Veterinary Internal Medicine,
S. J. Ettinger and E. C. Feldman, editors. 1995 page 1566.


"the owner should have a small supply of prednisone tablets if an emergency should arise"

http://www.io.com/~lolawson/cushings/articles/feldman5.pdf

Tell him this is coming from experts like Feldman.

Hugs.
Lori

[frijole]

Lynne,

If she is no longer peeing in the house she probably has reduced water intake which is a sign of change. Remember you do NOT want to see vomit or diarrhea. One way to monitor is to watch the poop. :p

This is what I had to do. You watch everytime she goes outside and you take a stick. (I know disgusting) and you check the texture. When my dog loaded it was certainly not diarrhea but it was getting softer. I took her in for the acth test and she was at 1.8. (goal is 1 to 5) I wouldn't have wanted to wait any longer.

Re your ? about what if the vet says it isn't needed: I cannot stress enough to you how absolutely irresponsible it is that the vet did not give you prednisone. It is REQUIRED. Most dogs won't need it but it is for emergencies. If you notice we are quoting from the Vet's Guide on Instructions. This is not something we are making up. It is what the VETS are told to do by the EXPERTS in the field. Feldman is world known as an expert in lysodren. He speaks at conferences that vets go to on cushings.

If your vet refuses to give it then I would demand it. And I would cite the Instructions from the chapter on
Hyperadrenocorticism in the Textbook of Veterinary Internal Medicine,
S. J. Ettinger and E. C. Feldman, editors. 1995 page 1566.

I am frankly concerned that your vet is not experienced with cushings. The reasons: no prednisone, no instructions to you on how to give it, instructing you to give it for 10 days (read my earlier post where it is clearly stated that vets should not give more than 7 days worth at a time), no followup calls. This is not a baby aspirin.

Again, maybe you won't need the prednisone but you are on a high dose and large dogs load fast. You do not want to be without it. Hang in there. Kim

[muskyhusky]

Lynne,

If she is no longer peeing in the house she probably has reduced water intake which is a sign of change. Remember you do NOT want to see vomit or diarrhea. One way to monitor is to watch the poop. :p

This is what I had to do. You watch everytime she goes outside and you take a stick. (I know disgusting) and you check the texture. When my dog loaded it was certainly not diarrhea but it was getting softer. I took her in for the acth test and she was at 1.8. (goal is 1 to 5) I wouldn't have wanted to wait any longer.

Re your ? about what if the vet says it isn't needed: I cannot stress enough to you how absolutely irresponsible it is that the vet did not give you prednisone. It is REQUIRED. Most dogs won't need it but it is for emergencies. If you notice we are quoting from the Vet's Guide on Instructions. This is not something we are making up. It is what the VETS are told to do by the EXPERTS in the field. Feldman is world known as an expert in lysodren. He speaks at conferences that vets go to on cushings.

If your vet refuses to give it then I would demand it. And I would cite the Instructions from the chapter on
Hyperadrenocorticism in the Textbook of Veterinary Internal Medicine,
S. J. Ettinger and E. C. Feldman, editors. 1995 page 1566.

I am frankly concerned that your vet is not experienced with cushings. The reasons: no prednisone, no instructions to you on how to give it, instructing you to give it for 10 days (read my earlier post where it is clearly stated that vets should not give more than 7 days worth at a time), no followup calls. This is not a baby aspirin.

Again, maybe you won't need the prednisone but you are on a high dose and large dogs load fast. You do not want to be without it. Hang in there. Kim

I'm waiting for the Vet to call me back, today is her 7'th day on the lysodren...she's eating good, she's drinking good, her poop is good...the only difference I am seeing in her is she's not leaking like she was...so my guess is that my vet will tell me I don't need the prednisone and there aren't alot of vets here in town, it is a rather small town.

[muskyhusky]

I am on my way to pick up the prednisone now....that makes me feel better, although my husband isn't happy.

[haf549]

Hi Lynne:

I just wanted to say hello to you. I just noticed your post today. I too have a siberian husky - Kira, who is 12 years old. She was diagnosed last fall and after a rocky start, she is doing terrific. She is on trilostane.

In one of your posts I noticed that you said most of the symptoms have gone away, except for the panting. Kira has been on her meds now for 8 months and she still pants a lot. Her numbers are always good when she has her ACTH test and she is otherwise her normal self. At first I was concerned about the panting, but am not quite as concerned any longer. I suspect some of it may be a bit of pain, due to arthritis and nerves. I can't believe how nervous this girl is. Everything makes her uneasy. This summer has seen some pretty wild weather and even the hint of rain makes her nervous. Thunderstorms literally scare the s.... out of her. I think that as huskies age, they become more sensitive to the heat too. Sometimes I think she's having hot flashes.

Anyway, welcome and hang in there. You've found a great source of information and support.

Heidi

[acushdogsmom]

I am on my way to pick up the prednisone now....that makes me feel better, although my husband isn't happy.Not sure why your husband isn't happy? But I'm glad to hear that your Vet will give you some pred today, to keep at home just in case you need it. It's just to have on hand in case of emergency and I don't see how any Vet could think that's a bad idea. Pred isn't even expensive ... but if it's needed it can be lifesaving.

Did you get a chance to talk to the vet about stopping the Lysodren and getting a stim test done sooner if you see any of the signs that are noted in the Lysodren loading Instructions in the Textbook of Veterinary Internal Medicine (reduction in appetite or water consumption etc.)

Has the Vet told you what to do, where to call or go if you happen to need Vet help when your vet's office is closed? My "Cushing's vet" is an Internal Med Specialist and her clinic is open 24/7 and there are always vets there (who would call her if she was needed). When there is no 24/7 service available, some vets will even give clients their cellphone number (for emergency use only) when they are loading a dog with Lysodren.

I don't mean to scare you ... and it's not likely that you will get into any trouble or that if you did need vet help that it would be late at night or on a w/end. I just really believe in "better safe than sorry" and being prepared. :)

[muskyhusky]

Hi Lynne:

I just wanted to say hello to you. I just noticed your post today. I too have a siberian husky - Kira, who is 12 years old. She was diagnosed last fall and after a rocky start, she is doing terrific. She is on trilostane.

In one of your posts I noticed that you said most of the symptoms have gone away, except for the panting. Kira has been on her meds now for 8 months and she still pants a lot. Her numbers are always good when she has her ACTH test and she is otherwise her normal self. At first I was concerned about the panting, but am not quite as concerned any longer. I suspect some of it may be a bit of pain, due to arthritis and nerves. I can't believe how nervous this girl is. Everything makes her uneasy. This summer has seen some pretty wild weather and even the hint of rain makes her nervous. Thunderstorms literally scare the s.... out of her. I think that as huskies age, they become more sensitive to the heat too. Sometimes I think she's having hot flashes.

Anyway, welcome and hang in there. You've found a great source of information and support.

Heidi

I read that most dog have had Cushings for about 6 years before it is diagnosed. Is she become more nervous as she's gotten older, or was she always afraid of things like that? Shadow is not afraid of loud noises, but she is skittish around people she doesn't know, she's gotten a little better as she's gotten older but boy when she was younger if any stranger reached out to touch her, man, she gone in a shot. I didn't get her until she was already 4 months old and she came with one heck of a bladder infection and they've been a problem for her from day 1. I even bought a PUR filter for the faucet so she get good water to drink.

I love huskies, their personalities are nothing like any other dog I've ever run across. Each one is so unique, I love Shadow to death, I'm gonna be so heartbroken when she isn't here anymore, and I can't even get another husky because of where I live they put them on the dangerous dogs list, I live in a mobile home court..:(

She isn't that good with kids and other animals, she's tolerating Cooper, but I think that's because he was so small when I got him. I hate this Cushings Disease, just hate it, it's so unfair for these animals to get this disease...they never done anything to deserve this.

[muskyhusky]

Not sure why your husband isn't happy? But I'm glad to hear that your Vet will give you some pred today, to keep at home just in case you need it. It's just to have on hand in case of emergency and I don't see how any Vet could think that's a bad idea. Pred isn't even expensive ... but if it's needed it can be lifesaving.

Did you get a chance to talk to the vet about stopping the Lysodren and getting a stim test done sooner if you see any of the signs that are noted in the Lysodren loading Instructions in the Textbook of Veterinary Internal Medicine (reduction in appetite or water consumption etc.)

Has the Vet told you what to do, where to call or go if you happen to need Vet help when your vet's office is closed? My "Cushing's vet" is an Internal Med Specialist and her clinic is open 24/7 and there are always vets there (who would call her if she was needed). When there is no 24/7 service available, some vets will even give clients their cellphone number (for emergency use only) when they are loading a dog with Lysodren.

I don't mean to scare you ... and it's not likely that you will get into any trouble or that if you did need vet help that it would be late at night or on a w/end. I just really believe in "better safe than sorry" and being prepared. :)

He's not happy because of the cost of all this, the prednisone was only $11.00, but this next test coming up for 2 hours is gonna cost almost $200.00, which doesn't make any sense cause the full day test was $142.00. The cost is a big thing to him, he's not like me as far as animals are concerned...

The vets here have no emergency hours, no phone numbers or anything, if something happens we have to drive to Appleton about 30 miles from here, the last person that did that, well, his dog never made it there alive...I can't believe none of the vets in this town have emergency hours, even in the bigger city of Oshkosh people have to take their dogs Appleton to the Animal Referral Clinic, last time I had Shadow there it cost us over $300.00, daughter paid almost $1200.00 for her cat to spend the night...it's ridiculous and stupid.

At least I have the prednisone if something happens, by the way the vet was gone when I got there so I couldn't ask anymore questions. I think that he only does these tests on Mondays, remember this is a small town....:rolleyes:

[Squirt's Mom]

Hi Lynne and welcome to you and Shadow! :)

Cushing's is a terrible thing for our babies to have to deal with, but I do believe it is harder on us parents than it is on them at times. :p They only know that they feel bad while we, on the other hand, worry about all the possibilities. The good thing about Cushing's is, it can be treated and the pup can live out it's normal life span, even plus! Many here can attest to that fact! ;):)

There's a lot to absorb at first, but you will get the hang of it, I have no doubt. If I can, anyone can! :p You wouldn't believe the state I was in when I got here! A friend has describe me as a woman who stuck her finger in a light socket with her hair standing on end...she kindly left out the bulging eyes and flying slobber! :eek::p But as I have learned more about the condition, I have become a bit calmer...a BIT! :p It still doesn't take much for me to start twitching like mad with worry. But I know I can come here and receive good, sound advise and loving support...and you will, too.

I am so glad you are here and hope to learn more about you and Shadow as time passes. Keep your chin up!

Hugs,
Leslie and the girls

[Wylie's Mom]

Hi Lynne & belated Welcome from me,

I don’t have much to add to the great information you have already gotten here. I have an Alaskan Malamute, 75-80 lbs, that loaded on Lysodren in 3 days… his water consumption had decreased to a normal level (8 cups), but the outside temperature had also dropped quickly that day and so I wasn’t sure if the lowered water consumption was really due to being loaded. The people here say, “If in doubt, stop the Lysodren”, so that’s what I did and it turned out that he was loaded.

I agree with Lori (early in your thread) about the UTK test for Atypical Cushing’s… especially for our breeds. Wylie has regular Cushing’s & Atypical. But since you have already started the lysodren, you can wait to do the other test – it’s good that you are using Lysodren… if Shadow happens to also be Atypical, Trilostane would probably have made it worse. I didn’t do the UTK test until after Wylie had started Lysodren – because I didn’t know about it. What Beth said is also correct, about if Shadow were Atypical, Lysodren would also reduce those hormone levels except for possibly – estradiol. Because of this, you can do what I did at first… elect to only have that one hormone tested (cheaper). But we can discuss this later.

And about getting Lysodren cheaper – I get mine from diamondbackdrugs.com. You can ask them for a quote for both Lysodren and Mitotane for comparison (Mitotane will be significantly cheaper), but I would then compare these to where Kim had suggested, drugstore.com – she’s had more experience and might have the better deal;).

-Susy

[acushdogsmom]

He's not happy because of the cost of all this, the prednisone was only $11.00, but this next test coming up for 2 hours is gonna cost almost $200.00, which doesn't make any sense cause the full day test was $142.00. The cost is a big thing to him, he's not like me as far as animals are concerned...The cost of the test doesn't really have to do with how long it takes to do the test. It's more related to the cost of the supplies (suppression agent or stimulating agent) that they need to do the testing.

The cost of treatment does get better though .... because once you get the dog stabilized, you only need to run an ACTH stim test about every 6 to 8 months, unless the dog shows signs of too-low cortisol or too-high cortisol, which would necessitate an extra test ASAP to see where the cortisol levels are and whether the dose might need to be adjusted accordingly.

And once you get the dog loaded and start weekly maintenance dosing, you'll only need to use about as many pills per week as you were using per day during the loading, so the cost of the meds goes down considerably after the dog is loaded. In Shadow's case, you'll probably be giving 1500 mg per week instead of the 1500 mg per day that you are now giving.


The vets here have no emergency hours, no phone numbers or anything, if something happens we have to drive to Appleton about 30 miles from here, the last person that did that, well, his dog never made it there alive...I can't believe none of the vets in this town have emergency hours, even in the bigger city of Oshkosh people have to take their dogs Appleton to the Animal Referral Clinic, last time I had Shadow there it cost us over $300.00, daughter paid almost $1200.00 for her cat to spend the night...it's ridiculous and stupid.

At least I have the prednisone if something happens, by the way the vet was gone when I got there so I couldn't ask anymore questions. I think that he only does these tests on Mondays, remember this is a small town....:rolleyes:There's no reason at all that I can think of that he should be doing ACTH stim testing only on one day of the week. He can store the stimulating agent that he uses to do the ACTH stimulation test (either "Cortrosyn" or "Synacthen" or "ACTHAR gel") and just use the amount of the stim agent that he needs to use to do an ACTH stim whenever a dog needs a stim test done.

Doing the stim test involves taking a blood sample before starting the test (to see what amount of cortisol is circulating in the dog's bloodstream "at rest"), then injecting a stimulating agent to make the adrenal glands dump their stored up cortisol reserves into the bloodstream.

They wait an hour or two (depending which stim agent they use) and then take a second blood sample, which will tell them how much cortisol the adrenals had stored up in reserve ... in other words, how much cortisol the adrenals are capable of producing.

The goal of treatment is to get the adrenal cortex eroded away enough so that only 1-5 ug/dl of cortisol is being stored up in the adrenal glands. Some dogs do fine with their cortisol at the lower end of the 1-5 ug/dl range and others do seem to do better with the cortisol levels up near the higher end of the 1-5 ug/dl range.

Too bad you don't have a closer 24/7 ER facility, but that's all the more reason to have some pred on hand at home at all times. And at least there is a place 30 miles away to go if you do have a real emergency though. We've had some folks here who live an hour or several hours drive away from a 24/7 ER.

When you speak to your Vet next time, you can maybe also ask him to give you some guidelines as to when you should use the pred and how much to use, if he hasn't already done that. :)

Meanwhile, keep watching Shadow for any changes that may indicate the loading is complete.

[gpgscott]

Hi Lynne,

Yes the pattern of Vet's no longer offering emergency services is alarming. The same has happened to my folks who live in Muskegon, MI. None of the Drs. in Muskegon offer emergency services and the closest 24 hour clinic is Grand Rapids 40-60 miles drive.

Hoping Shadow is nearing the end of his load.

Scott

[MiniSchnauzerMom]

Hi Lynne,

Just dropping by to offer my belated welcome to you and Shadow! You've already been given lots of important information from other members. Just wanted to wish you and Shadow well during her loading phase and say "hi".

I took a look at Shadow's pictures in the gallery. She certainly is a pretty girl and obviously one who enjoys her carrots! :D

Take care and I'll be watching for your updates.

Louise

[haf549]

Kira has been skitish about weather since she was about 6. She knows it's going to rain even before the weather forcaster does. She paces and pants and sticks to me like glue. The only place she seems to feel calm in, is in the basement. Only the weather makes her nervous. She loves people and specially kids. She's OK with other animals, but I wouldn't trust her to far. She's friendly for a while and they do the doggie dance and then all of a sudden she snarls and snaps. She's never bitten anyone/thing, but she has killed a bird to two and just a couple of months ago, she brought me a bunny she caught. At the time I didn't know whether to be angry at her or proud. It had been months since she had shown any real interest in anything but sleeping.

I know Cushings is terrifying, but it does get better after a time. You learn to deal with it. In the beginning, any heavy breathing and twitching were nerve wracking for me, but I have calmed down a lot. I'm just so happy for the extra time that I have been given with her.

I'm sorry to hear that you won't be able to get another husky because of where you live. I know when Kira passes, I'm definitely getting another, from a rescue; may-be even 2, to keep each other company. It's unfair these bans on certain breeds. Here in Ontario, there is a ban on Pit Bulls. I really think that the owners are more dangerous than the animals. If the dog has an owner that treats them well and trains them properly, they are wonderful pets.

I saw you were asking about the cost of treatment. YES... it is very expensive. Lysodren I don't think is quite as an expensive treatment as trilostane. I am currently paying out just under $300 a month for Kira's pills. Luckily, I have pet insurance and than is covering 50% of the cost. The testing gets really expensive too. In the first 3 months, I spent close to $3000 dollars on medication and testing. But, she's worth every penny!!

Thanks for all the lovely comments on Kira's pictures.

Heidi

[muskyhusky]

This morning I noticed that her front legs are bothering her, every time she jumped up to get the raw hamb I was throwing her, this involuntary yip would come out of her mouth, is it arthritis, I don't know, I didn't think she really had it and if she did, I though it would be in her back legs, is it her reacting to the lysodren, I guess we will find out as the morning progresses, of course she's already had her first dose of the day, right now she is in her crate. I will be watching her very closely throughout the day.

[muskyhusky]

http://www.youtube.com/watch?v=pfrnHskVuUE

I didn't realize how dark the video was I'll get another one later...

[haf549]

It could quite possible be arthritis. Her cortisol level is going down and it is the cortisol which might have been masking arthritis symptoms. Watch her carefully. As the others have said, you don't necessarily have to load her for the full 10 days that the vet prescribed. I don't know anything about loading with lysodren (Kira is on trilostane), but from what I have read in other posts, any changes could be an indicator that she is loaded. I know you said that she was scheduled for an ACTH on the the 17th, but may-be you should consider pushing it up.

If she does have arthritis, consider giving her glucosomine with chondroiten. You should be able to get that at any pharmacy. This herbal supplement won't do any harm anyway. Kira has been on the pill since she was 6. Try and get the capsules, as you can open those up and spread the contents over her food. Kira and I share a bottle, since it's great for my arthritis too.

Heidi

[haf549]

I just watched the video you posted and from watching Shadow walk, I suspect it may be arthritis rearing it's ugly head. Kira walks like that most of the time.

Heidi

[Harley PoMMom]

Hi Lynne,

First let me say I have NO medical background...so...what I am about to tell you is just my opinion.

Since Shadow has been living with high cortisol for a while...well it's could be masking some ailments she might be having, like arthritis.

Now that you are treating her cushings...getting that cortisol down...the arthritis is flaring up. Since you are in the loading phase, I'd really watch her now, bc this is a sign that her cortisol has come down. How is she otherwise? anything else change?

You'll have to find out if this is the problem with Shadow and if it is, we have members here that have cush-pups with arthritis that are doing well and I am sure they will be along to help you.

Hugs.
Lori

[bkdice]

My boy showed no signs of arthritis until his cortisol came down (he was 15 at the time). Acupuncture did WONDERS for him. We had been doing it as preventative for a year + before the cushings was under control. I had to increase the frequency some after the cortisol was lowered. I also had him on joint support meds. He never needed any pain management until the last 2 months of his life - we had him on 1-2 tramadol a day.

[muskyhusky]

Hi Lynne,
Since you are in the loading phase, I'd really watch her now, bc this is a sign that her cortisol has come down. How is she otherwise? anything else change?

Hugs.
Lori

She's good, eats good, drinks good, she's chewing on a rawhide bone right now, Cooper of course is trying to take it away...even though he has one the same size..:rolleyes: So no changes other then the limping and stiffness..she has also stopped chewing on the pads of feet, I didn't know that was also associated with cushings..http://i50.photobucket.com/albums/f332/muskyhusky/ACushings%20Group/015-1.jpg

[Harley PoMMom]

Hi Lynne,

Now I have never had to deal with Lysodren...yet. But from reading others' threads that have been using it the one "saying" that sticks out to me is: "Whatever makes you go hmmm," bc once you give Shadow that Lysodren pill you can't take it back. I know you are watching her like a hawk...good job :), I just wish I had better advice for you.

Hugs.
Lori

[Barney's Mom]

The chewing of the feet could be allergies. My dog has allergies, and when his cortisol is low he gets itchy. Just watch her very carefully, my instructions were to give one 500mg pill daily for 7 days and if no signs that loading was complete, then bring him in to have stimmed in 48hours. No signs of being loaded at all. I measured his water and food, timed him when he ate, and watched him like a hawk. On the 8th day he had a reduction in appetite. When we stimmed him, his post ACTH was 1.8. Although that was a good number, it scares me that he went so low and I didn't see any symptoms.
Are you measuring the water she drinks? That could be helpful too.
Also, you had posted about arthritis and lameness. There are so many ailments a dog can have that can make them lame. My dog had a bad back and he was in pain and limping. That was his only sign, lameness. If it wasn't for the vet we would have never known he had a back injury, we initially thought arthritis because of his age. Also, Lyme disease can mimic the same symptoms as you are describing.

Keep on watching close as I know you will be, and loading has to be completed soon.
We are watching too :)

Cheryl

[frijole]

Hi Lynne,

How is poop patrol going? :p Is today the day you have the acth test? (10 days of loading) Some dogs don't show obvious signs and I would have the test done regardless just to be doubly sure... my dog also ended up at 1.8 with the only sign being softer poop. (not runny) Better safe than sorry! Let us know your plan please. Love the photos you posted. Kim

[Wylie's Mom]

Hi Lynne,

About Shadows front legs… I agree, it very well could be arthritis. I saw your photos and read that she may need to lose about 15 lbs – her losing weight would surely be better for her joints – Wylie probably needs to lose 5+ lbs;). You would probably want to keep her from jumping too – for treats or other things. Wylie used to jump out of the back of my Jeep Cherokee all the time – about 2 years ago (when he was 10 yrs old), he started to hesitate to jump out and so I bought him a car ramp. I then also got a couple ottomans – one for a daybed and one for a regular bed, so he wouldn’t need to jump off of them anymore. He wouldn’t use the one I got for the regular bed at first – then one day he started to have a little limp after jumping off the bed. The limp only lasted for a day or two, but after that, he started to use the ottoman:p.

Here's a site for ideas to help with arthritis/joint issues:
http://www.dogaware.com/arthritis.html

Kim is right about the "poop patrol" - if Wylie's poop starts to look non-normal, I watch him more closely.

-Susy

[Barney's Mom]

Any updates?

[muskyhusky]

This morning I noticed that her poop is a little softer then usual, but then I did get her a peanut butter rawhide to chew on so that could be a reason. Tomorrow is her 10'th day, she isn't scheduled for the ACTH test until Monday morning. I only gave her 1 tablet this morning, I'm watching her and haven't decided if I'll give her another tonight, or maybe just a half of one. I'll be glad when that test is done.

She hasn't eaten this morning yet, except of course for a carrot, but neither has Cooper, it's warm this morning, gonna get hot, so I guess I'll turn on the AC, gonna be in the upper 80's all weekend and muggy.

I did a little video of her eating her carrots yesterday, if you listen really close you can hear the little yip when she jumps up to catch the carrots, but she stopped jumping up, I guess she decided that it was not as painful if sat there and caught them.

http://www.youtube.com/watch?v=x1RYv9zcWyE

[Squirt's Mom]

This morning I noticed that her poop is a little softer then usual


She hasn't eaten this morning yet

Lynne, these could both be signs of being loaded. Is today the 10th day of the load for her? Please be extra vigilant today...any sign of weakness, diarrhea, vomiting, or lethargy please give the pred asap.

And, if it were me, I wouldn't give any more.

Keep in close touch and let us know how she is progressing today.
Hugs,
Leslie and the girls

[muskyhusky]

Lynne, these could both be signs of being loaded. Is today the 10th day of the load for her?
And, if it were me, I wouldn't give any more.


Today is her 9'th day, tomorrow would be the tenth day, I was thinking that too, not to give her anymore...so I'll just continue to watch her and just stop the medication completely.
Lynne

[ventilate]

If possible I would call your vet and try to get the stim tomorrow. When you call your vet be sure to tell him of the signs you have seen. If it were me I would hold on any more lysodren as well, giving more to a dog that is already loaded could push Shadow over the edge into an overload crisis. For the stim Your dog has to fast. most of the time 12 hrs prior to testing water is OK. I always get Nikes done first thing in the AM so she does no have to fast longer then 12 hrs. I would not give pred without talking to your vet, I f you see signs of overloading, I am sure what Leslie ment was to call your vet first then give pred if advised.
If you give pred you will have to hold on the stim for 24-48 hrs to be sure it has cleared as it will be seen as cortisol and will skew the results.
Sharon

[frijole]

I agree that it might be time to test. I'm sorry but I couldn't remember if you have an appt set for next week or something? My point is simply you do NOT want to chance waiting the weekend = in my opinion... the soft poop, not eating the food...I think you are there.

When a dog has too much lysodren it is not pretty and it is scary. One has to respect it. If your vet is not available 24 hrs/day then you need to get the test done tomorrow, Friday so you know you are safe for the weekend.

Keep us posted!!! Kim

[muskyhusky]

Well, Shadow has the diarrhea, I just put in a call to the vet....:( Thank God it isn't the weekend.

[Squirt's Mom]

Hi Lynne,

Good for you! :cool::cool: Let us know what you learn...

Hugs,
Leslie and the girls

[Wylie's Mom]

Hi Lynne,

Lysodren works for up to 48 hours after the last pill. If you do a stim tomorrow, you need to keep in mind that Shadow's levels might have gone lower than what the test results show. If Shadow does need the prednisone, as Sharon said, this could skew the stim test results higher as pred works for 24 hours. This is a tricky time to pick a good stim day. If it seems she needs the pred, that takes precedent over the perfect day to stim. Keep watching Shadow (I know you are;)) - and keep updating us!

-Susy

[muskyhusky]

The Vet. said to give her one of the predisone a day for 3 days & 2mg of Imodium AD 3 x's a day for 3 days. So hopefully that will help. I'll let you know how it goes through out today.

[Wylie's Mom]

Does this mean you will do the stim as scheduled on Monday?

[acushdogsmom]

When is he going to do the stim test? Monday would actually be a pretty good day to do it, because the Lysodren will have pretty much had its full effect by then, so the stim test results will reflect the full effect that the Lysodren loading doses have had...

BUT ... you should really stop the pred at least 24 to 48 hours before doing the stim test. Just to be sure there's no pred in the bloodstream when they do the test. Because, as others have mentioned, if they go to measure the cortisol in the blood sample and if the sample also contains some pred, the test reading will actually be cortisol+pred, not just the cortisol alone.

(pred and cortisol are indistinguishable to the lab equipment that is supposed to be measuring just the cortisol)

So if you give pred today, tomorrow and Saturday and none on Sunday and then do the test on Monday, that should work out fine.

[Wylie's Mom]

So if you give pred today, tomorrow and Saturday and none on Sunday and then do the test on Monday, that should work out fine.

I agree;).

[muskyhusky]

When is he going to do the stim test? Monday would actually be a pretty good day to do it, because the Lysodren will have pretty much had its full effect by then, so the stim test results will reflect the full effect that the Lysodren loading doses have had...

BUT ... you should really stop the pred at least 24 to 48 hours before doing the stim test. Just to be sure there's no pred in the bloodstream when they do the test. Because, as others have mentioned, if they go to measure the cortisol in the blood sample and if the sample also contains some pred, the test reading will actually be cortisol+pred, not just the cortisol alone.

(pred and cortisol are indistinguishable to the lab equipment that is supposed to be measuring just the cortisol)

So if you give pred today, tomorrow and Saturday and none on Sunday and then do the test on Monday, that should work out fine.

Yes her test is on Monday, so I'll do what you suggest and give the prednisone today, Fri, and Sat, that would be the 3 days anyways, and none on Sunday, I hope her diarreah goes away, I wonder if I should feed her the brown rice, chicken broth, and boiled chicken instead of reg. food.

[Wylie's Mom]

If it would make her feel better, I don't see an issue with that... but I've read that overcooked white rice is easy on a pup's stomach:

http://www.dogaware.com/specific.html#diarrhea

Rice congee is made by boiling one cup of white rice (not minute rice) in four cups of water for 20 to 30 minutes. The liquid is soothing and can help stop both vomiting and diarrhea. Mix in a little chicken baby food or honey for flavor, if needed. Start by feeding the liquid alone, then try mixing the rice as well with cooked chicken breast or boiled ground beef.

-Susy

[Squirt's Mom]

Hi Lynne,

Any time you feed rice, white or brown, to pups over-cook it to the point of goo. It will be gummy and sticky, and the individual grains will have swelled up and broken down making the rice easier to digest and the nutrients more easily absorbed. The congee is a good start, but be sure the rice part is still over-cooked.

Hugs,
Leslie and the girls

[acushdogsmom]

Just wanted to mention that pred can be a teeny bit hard on the stomach if it is not given with some food. So my Vet always told me to give pred with some food, with a full meal if possible, and if not a full meal, then at least with some food.

[Wylie's Mom]

BTW - about the link I posted... I think the information regarding fasting (and gradual steps of feeding liquid alone, then later adding the chicken), would not apply in your case... since we have an idea of what may be causing the diarrhea. I've never really made the the "congee" for Wylie, I do a compromise and just double the amount of water that I would use to make rice for me.

-Susy

[muskyhusky]

Wow, that rice congee is really what I need, those of us with huskies know how sensitive their tummies can be and Shadow has had lots of problems with the diarrhea, I will get some regular rice [I have been using the min. rice, thanks so much for the tip and the link...

[frijole]

Time for the infamous "Cure for the Runs" which I learned here! :D If you have canned pumpkin (like for pies but the plain kind, not the kind that has cinnamon etc in it). Add a spoonful (not much) to the food. Stir in. My dogs both love it and it stops the runs and fast.

Glad you watched the poop. Bet you thought I was nuts telling ya to check the thickness of it. :eek: Sorry, warped humor.

Congrats on the load. Get the test and it's Easy STreet from here!

Kim

[muskyhusky]

Time for the infamous "Cure for the Runs" which I learned here! :D If you have canned pumpkin (like for pies but the plain kind, not the kind that has cinnamon etc in it). Add a spoonful (not much) to the food. Stir in. My dogs both love it and it stops the runs and fast.

Glad you watched the poop. Bet you thought I was nuts telling ya to check the thickness of it. :eek: Sorry, warped humor.

Congrats on the load. Get the test and it's Easy STreet from here!

Kim

Oh no, I didn't think you were nuts, I do it anyways, you never know with a husky, I watch her poop and when she pees for any signs of anything unusual. Lord she wants some carrots, this ought to be a riot, she can't have any...I am definitely gonna pick up some pumpkin, some chicken baby food too...thanks for these tips..

[ventilate]

Well Poop doesnt lie, that pretty much cements the idea that Shadow is loaded/overloaded. I have to say I am glad your vet didnt doubt you, sometimes that happens. This is why having pred on hand is important, it was lucky that it was noticed during the day, as you can see having this issue at night without having pred on hand could have been major badness. I am hoping that you stopped early enough and that a few doses of pred will be all you need. What doseage is the pred? Most of the time the adrenals can regenerate pretty quickly so a few days you should notice a difference.
The runs are from the low cortisol so giving the pred will help as well. I do the rice, didnt know to over cook it, thanks. I gave plain groundbeef and used the pumpkin, that works wonderful.
What is the dosage on the pred?
Good luck with the poop stuff
Sharon

[muskyhusky]

Well Poop doesnt lie, that pretty much cements the idea that Shadow is loaded/overloaded. I have to say I am glad your vet didnt doubt you, sometimes that happens. This is why having pred on hand is important, it was lucky that it was noticed during the day, as you can see having this issue at night without having pred on hand could have been major badness. I am hoping that you stopped early enough and that a few doses of pred will be all you need. What doseage is the pred? Most of the time the adrenals can regenerate pretty quickly so a few days you should notice a difference.
The runs are from the low cortisol so giving the pred will help as well. I do the rice, didnt know to over cook it, thanks. I gave plain groundbeef and used the pumpkin, that works wonderful.
What is the dosage on the pred?
Good luck with the poop stuff
Sharon

The dosage on the pred. is 5 mg. once a day for 3 days, and the Imodium is one three X's a day for 3 days.

It has to be from the lysodren, because if it were something she ate and her tummy were really upset, she wouldn't be taking pills with the raw hamburger or chewing on a rawhide bone she would be in her crate, that's her comfort and her retreat. I know how she acts when she's eaten something that doesn't agree with her.

[StarDeb55]

That dose of pred is a little low for Shadow's weight. A rescue dose of pred usually is calculated at .25 mg/kg which works out to be 7.4 mg for Shadow. It would not hurt to give her another 1/2 tablet, but you need to run that by your vet.

Debbie

[haf549]

Another sure-fire cure for the runs is yogurt (natural or flavoured). You could even give her a treat by giving her frozen yogurt. Kira had a bit of the runs when she started on the trilostane and I mixed rice in with her food and gave her frozen yogurt for dessert.

Heidi

[muskyhusky]

Another sure-fire cure for the runs is yogurt (natural or flavoured). You could even give her a treat by giving her frozen yogurt. Kira had a bit of the runs when she started on the trilostane and I mixed rice in with her food and gave her frozen yogurt for dessert.

Heidi

Sounds good, I will try that too, I have to go to the store when hubby gets home, it's been crazy here today, Shadow is just going nuts because she can't have her carrots.:rolleyes:

[Harley PoMMom]

Hi Lynne,

Are you already giving Shadow the Imodium?

[Barney's Mom]

I had a feeling today would be the day :)
I would be careful about trying all these different diarrhea cures at once though.
Your next post could be "I think Shadow's constipated ;)"
Kidding! But too many food changes at once along with the pred may upset her tummy. Does she act like all is well other than the diarrhea?
I am breathing a sigh of relief that you are done giving the Lysodren and she is going to be stimmed on Monday.
Here watching with you

Cheryl

[Harley PoMMom]

Cheryl that's my concern too, if Shadow's on the Imodium already and she given the pumpkin, yogurt etc...holy rock hard poops. :eek:

[muskyhusky]

Hi Lynne,

Are you already giving Shadow the Imodium?

Yes, she's had some, I've given it to her before for diarrhea. I usually just give her rice, chicken broth, and boiled chicken, for a few days, last time I had to take her to the animal ER, she had an IV..that was scary.

[muskyhusky]

Cheryl that's my concern too, if Shadow's on the Imodium already and she given the pumpkin, yogurt etc...holy rock hard poops. :eek:

I wouldn't give her all that at the same time...:rolleyes:

[Harley PoMMom]

The pumpkin, at least for me, was a trial and error method, a little more and Harley got constipated, alittle less, runs...I had to find a happy medium with the pumpkin.

[ventilate]

Glad you have the imodium in Shadow. I agree it is the low cortisol, to much lysodren causing the poops, the pred will help as well. it would be to much of a coinsidence that anything else would cause the poops.
Is Shadow feeling Ok? is it just the poops? I dont mean to make it sound like the poops are nothing but is there any other symptoms of overloading?
Sharon

[muskyhusky]

Glad you have the Imodium in Shadow. I agree it is the low cortisol, to much lysodren causing the poops, the pred will help as well. it would be to much of a coincidence that anything else would cause the poops.
Is Shadow feeling Ok? is it just the poops? I dont mean to make it sound like the poops are nothing but is there any other symptoms of overloading?
Sharon

Well I don't know, she has stopped leaking, which is a miracle, wow...I mean we're talking rivers where she was laying, she is begging for her carrots, I am boiling the rice right now, she'll be happy to eat it, can I mix the chicken baby food meat in with it? I don't feel like boiling chicken tonight.

[Harley PoMMom]

can I mix the chicken baby food meat in with it?I wouldn't see why not.

[ventilate]

I am sure you can. the idea is to keep it bland to help rest the tummy for the poops with the imodium and pred that should help the poops and any upset tummy. I am sure the babyfood is bland so would be fine. Glad to see Shadow is hungry, that is a good thing.
I give Nike 5 mg of pred daily as her levels were very low, I had been giving her 2.5 mg but the vet told me to give her more. She wts 93 lbs, sounds like the 5 is working OK. Any weakness?

[muskyhusky]

Well it seems I have to eat my words, she leaked on the porch,:(, but, on the bright side it was the first time in a few days that she has, usually I have to follow her around with a wet rag to wipe her off:eek: so the urine doesn't burn her skin. Now when she see's me with a rag in my hand she runs the other way.:rolleyes:

[AlisonandMia]

Has Shadow been tested for diabetes recently? Cushing's can trigger diabetes and it can come on just about overnight. There is a big overlap between Cushing's symptoms and diabetes symptoms. This leaking of urine makes me wonder - most Cushing's dogs don't leak like this (although some certainly do) but copious leaking is very, very common in diabetes.

Alison

[muskyhusky]

Has Shadow been tested for diabetes recently? Cushing's can trigger diabetes and it can come on just about overnight. There is a big overlap between Cushing's symptoms and diabetes symptoms. This leaking of urine makes me wonder - most Cushing's dogs don't leak like this (although some certainly do) but copious leaking is very, very common in diabetes.

Alison

I know they did a work up on her last year, she's always leaked like that, it's gotten worse as she gets older, if she gets really stressed then it gets worse...I will ask tomorrow I have to get a jar for a urine sample again.

[muskyhusky]

Ok, I went out and got 4 pkgs of rice, 6 jars of chicken baby food, 6 cans of chicken broth, and one can of pumpkin, forgot the yogurt, I'll get it tomorrow. She just went nuts over that rice & chicken broth mixed with baby food, she was so content she let Cooper clean her ears..:D

[acushdogsmom]

Good to hear that she ate and seems to be feeling okay. :)

About the pumpkin ... it has to be plain canned pumpkin, not the pie filling kind of canned pumpkin that has spices and seasonings in it.

[muskyhusky]

Good to hear that she ate and seems to be feeling okay. :)

About the pumpkin ... it has to be plain canned pumpkin, not the pie filling kind of canned pumpkin that has spices and seasonings in it.

Yes, ma'am that is what I bought her, plain canned pumpkin.:D

[MiniSchnauzerMom]

Hi Lynne,

Have been following your thread about Shadow and glad to read the rice, broth and baby food meal went over well and hope the runny-poo's will be resolved.

Hope she continues to feel better and will be looking for your update on her test results next week.

Louise

[haf549]

Morning Lynne:

I've been following yesterday's running commentary with great interest. I'm glad to hear that things are evening out for Shadow. Once you get the runs under control (what with all the home-made receipts, that shouldn't take too long) it should be smooth sailing. I'm anxious to hear the results of her test on Monday.

Have an uneventful week-end.

Heidi & Kira

[muskyhusky]

I am sure you can. the idea is to keep it bland to help rest the tummy for the poops with the imodium and pred that should help the poops and any upset tummy. I am sure the babyfood is bland so would be fine. Glad to see Shadow is hungry, that is a good thing.
I give Nike 5 mg of pred daily as her levels were very low, I had been giving her 2.5 mg but the vet told me to give her more. She wts 93 lbs, sounds like the 5 is working OK. Any weakness?

No there's no weakness, she's acting normal, it has been 24 hours since she last pooped, not sure if that is good or bad.

[Wylie's Mom]

No there's no weakness, she's acting normal, it has been 24 hours since she last pooped, not sure if that is good or bad.

Hi Lynne,

I'm thinking that might be a good sign... if she's like Wylie - I've noticed the last couple times that Wylie had diarrhea, when nothing came out that end for 24 hours, a solid poop was on its way:p;).

-Susy

[Harley PoMMom]

Here's hoping for solid poops. :D

[frijole]

Great news that all is back to normal. Have you continued to give the prednisone? I am asking because you might consider cutting back/stopping if it isn't needed. It is a nice pick me up but if you don't need it.. perhaps you slowly wean and aim to be at ZERO on Sunday.

[Wylie's Mom]

I am asking because you might consider cutting back/stopping if it isn't needed. It is a nice pick me up but if you don't need it.. perhaps you slowly wean and aim to be at ZERO on Sunday.

Kim makes a good point!

-Susy

[muskyhusky]

Great news that all is back to normal. Have you continued to give the prednisone? I am asking because you might consider cutting back/stopping if it isn't needed. It is a nice pick me up but if you don't need it.. perhaps you slowly wean and aim to be at ZERO on Sunday.

I could do that, should I wait and see what her poop looks like, she still hasn't gone outside to poop.

[muskyhusky]

She still hasn't pooped....I don't know if I should be concerned or not.:confused:

[acushdogsmom]

I'm not sure if there's reason for concern, but it hasn't been more than a day or two since she was having very loose stools, and she hasn't been eating as much as usual over the past day or two (right?)

Since she doesn't have diarrhea anymore, I wonder if maybe you should be stopping the Immodium, rather than giving it for a full three days.

Is there anyone at your Vet's office today? Can you call there and ask if there's any reason for concern and if you should at least stop giving the Immodium?

[gpgscott]

Hi Lynne,

The poops are an interesting issue.

If it is going in, it has to go out. But I have seen that in our case Moria's gastro tract sometimes seems to shut down for a day or two and then go back into action.

Like Cushy, I would be cautious about administering an anti-diarrheal after relief of the symptoms.

Scott

[muskyhusky]

I'm not sure if there's reason for concern, but it hasn't been more than a day or two since she was having very loose stools, and she hasn't been eating as much as usual over the past day or two (right?)

Since she doesn't have diarrhea anymore, I wonder if maybe you should be stopping the Immodium, rather than giving it for a full three days.

Is there anyone at your Vet's office today? Can you call there and ask if there's any reason for concern and if you should at least stop giving the Immodium?

No everyone's gone, I gave her 2 today, I won't give her the third one tonight. She's been eating, she been getting the rice and chicken and broth...I don't think I can remember a time when she's gone all day without pooping, she had the loose stools yesterday, I guess I'll wait and see what happens tomorrow.

[ventilate]

Wow; that is excellent Scott;
If it is going in, it has to go out
We need a place to post all these brilliant quotes
Poop doesnt lie
things that make you go ummmm
Once you give it you cant take it back
I remember who she was and I treasure who she is:):)
Sharon

[Barney's Mom]

Hi Lynne,

I'm thinking that might be a good sign... if she's like Wylie - I've noticed the last couple times that Wylie had diarrhea, when nothing came out that end for 24 hours, a solid poop was on its way:p;).

-Susy

I think so too. Hoping for firm poops!
Barney and Cheryl

[muskyhusky]

Shadow pooped this morning and it looked pretty good, I think what I am gonna do is mix the rice and the baby food in with her regular food, gave a 1/2 prednisone early this morning, no Imodium, no lysodren. The only thing I'm bummed out about is, she started leaking again...:(

[frijole]

I would STOP the prednisone. Prednisone was given because of the diarrhea and fear that cortisol was too low. Prednisone acts like cortisol and makes the dog perky... and it also can bring back the symptoms. (leaks) So cease that drug. Besides you want it out of your dog's system when you do the test on Monday.

Congrats on the poop! Shadow has to feel better. Hang in there. Kim

[haf549]

Glad to hear that everything is almost normal again. Definitely stop the pred, specially since she's going for her test tomorrow.

I'm looking forward to hearing the results.

Heidi

[gpgscott]

If the leaking you are referring to is age related loss of muscle tone (which is common) there are good medical treatments.

Proin is one med and DES the other. I prefer the DES as it is a synthetic form of the natural hormone which is lacking in those dogs for which the treatment is indicated.

Best wishes. Scott

[muskyhusky]

She has leaked all her life, it sure would be nice if that would slow down, I've asked him to put her on hormones, but he thinks she's leaking because of the cushings, where it's probably 5% cushings and 95% her, so she's on PPA, 1 and a half twice a day and it still doesn't work, so now maybe he'll listen to me and put her on hormones. Vets are like human Drs. only I have a good Dr. that's actually listens to me when I suggest something. Anyways we won't get the results of the ACTH test until Tuesday.

[ventilate]

Nike was fixed at 6 months and began leaking at 9. she has been on DES all her life. IMHO it has nothing to do with the cushings and everything to do with the lack of hormones. I agree that with all the water uptake she would leak more, so it would make it worse but thats it.
When I started Nike on the DES i had to kind of load her I cant remember exactly but had to give her a dose every day or every other day for a week then once a week every once in a while throughout her 13 years she would leak and I would give her an extra dose and she would be great again. She has been on 1 DES for the past 4 years or so and has not leaked at all.
Good luck, I have not used the other med so cant comment on how it works but Scott used both.
Sharon

[muskyhusky]

Ok here are the results of her LDD test:

5.15.2008:
4 HR. 1.2 ug/dL
8 HR .8.0 ug/dL
Cortisol Baseline 2.3 ug/dL [1.0-5.0]

8.3.2009
4 HR. 1.2 ug/dL
8 HR. 8.2 ug/dL
Cortisol Baseline 12.2 ug/dL [1.0-5.0]

Why is the cortisol baseline so much higher this time.

Her bladder inf. is gone, she still has a low specific gravity of 1.010, on 8/7/09 it was 1.014...

Her results will be back tomorrow for ACTH -

[muskyhusky]

Shadow's results from the ACTH test is she's at 5.2 and he's putting her on a dose of 1 and 1/2 tables twice a day one day a week and then retest in 6 weeks. So...that's good news.

[Squirt's Mom]

Hi Lynne,

That post # is pretty close to perfect! Are Shadow's signs controlled? Does she seem to be back to a closer version of her old self? Getting the post # within range (1-5 ug/dl) is the goal but treating the dog is more important and if Shadow is doing good at this level, then so be it! However, the maintenance schedule you have been given is a bit unusual. Dr. Feldman, a canine Cushing's guru, says that a dog can get one maintenance dose per week but most often that is not the case and maintenance is given 2-4 times a week. Here is the link to our Resource section that talks about Lyso loading and maintenance:

http://www.k9cushings.com/forum/showthread.php?t=181

Dr. Feldman's explanation of the maintenance phase is in the second post on the thread.

The goal of maintenance is to keep the level of erosion of the adrenals at the same place the loading phase took them. If the maintenance dose isn't enough, the adrenals will regenerate faster than the dose can keep them eroded, and the signs reappear - resulting in a mini-load or a full reload.

I'm not saying this dose and schedule won't work for Shadow; it may very well be just what she needs. But I did want you to be aware of the maintenance protocols so you can keep an eye on her for signs just in case.

You are doing a great job so keep up the good work!
Hugs,
Leslie and the girls

[gpgscott]

Hi Lynne,

It is easy to fixate on a number. I think the main thing for you to be concerned with right now is symptoms and if you see heightening of Cushing's symptoms before the 6 week mark is met you might want to do the stim earlier. No need to let Shadow's cortisol get completely out of control.

Scott

[Squirt's Mom]

:D I ramble on and on, and Scott puts things so succinctly! :D

[muskyhusky]

I think I'll keep her at the dose he said, it's gonna be $116.00 for the pills alone, plus he's putting her on the DES to stop her leaking [one can only hope], I don't know how much that's gonna cost. Then in 6 weeks I gotta come up with another $173.00, they cut my husbands hours so we're getting kinda short on money here. Anyways, I will keep a close eye on her at all times.

[acushdogsmom]

Shadow's results from the ACTH test is she's at 5.2 and he's putting her on a dose of 1 and 1/2 tables twice a day one day a week and then retest in 6 weeks. So...that's good news.If that number is the Post ACTH result, then that's pretty close to being within the target range of 1-5 ug/dl so congratulations on a successful loading (and you did it without overloading) :)

In my opinion, the weekly dose sounds fine ... it's the same amount weekly that you were giving daily during the loading as a loading dose and while most vets do seem to prefer that we spread out the weekly dose over a few days per week, giving the entire weekly dose all in one day is also within the known protocols. I have a friend who did it that way very successfully (weekly dose given once a week) for more than 8 years.

My vet usually does another stim 4 weeks after starting the weekly maintenance dosing, but 6 weeks isn't that much longer than 4 weeks and should be fine, unless of course, you notice symptoms that may be indicative of the cortisol getting too high again or falling too low, before the six-week mark. If you do see any of those types of signs, the next stim should be done sooner than 6 weeks from now.

Here's hoping that all you see from now on are improvements!

P.S. Regarding the price of the pills, are you buying them directly from your Vet? Because that's usually more expensive than if he gives you a prescription and lets you buy it at a regular Pharmacy. It's a people drug, and pharmacies do sell it and will sell it to you if you get a prescription from your vet.

My pharmacy charged depending on how many pills I bought each time -- the more I bought, the less it cost per pill. I saved the most money per pill (so it cost the least amount of money per pill) if I bought a whole bottle of 100 pills.

[Wylie's Mom]

Hi Lynne,

The post number is very good:D!!!

What Leslie said it true... the weekly maintenance dose is usually split up more evenly throughout the week - like 1-1/2 (750mg) on Sunday and 1-1/2 on Wednesday, or 1 (500mg) Sun, 1 Tue & 1 Thurs. If you go ahead with both doses in one day (and even if you split them further apart), as with the loading phase, keep a watch for any signs that she's not tolerating the dose well... (like the softer stools;)) and if that happens, you can try giving the doses further apart. (I hope that makes sense:rolleyes:.)

And at the same time, as Scott was saying, look for increased Cushing's symptoms that may indicate that the maintenance dose is not enough.

-Susy

[acushdogsmom]

If you go ahead with both doses in one day (and even if you split them further apart), as with the loading phase, keep a watch for any signs that she's not tolerating the dose well... (like the softer stools;)) and if that happens, you can try giving the doses further apart. (I hope that makes sense:rolleyes:.)That makes a lot of sense and I should have mentioned that in my reply. Dividing up the weekly dose into smaller doses given over a few days a week is the first thing that is recommended if the dog seems to have any trouble tolerating the drug when it's being given all in one dose per week. :)

[Wylie's Mom]

I think I'll keep her at the dose he said, it's gonna be $116.00 for the pills alone, plus he's putting her on the DES to stop her leaking [one can only hope], I don't know how much that's gonna cost. Then in 6 weeks I gotta come up with another $173.00, they cut my husbands hours so we're getting kinda short on money here. Anyways, I will keep a close eye on her at all times.

I missed your post & Cushy's while I was replying... I just want to make sure you understand that spreading the dose more evenly does not mean more Lysodren;). And as Cushy said, the weekly dose all in one day may work fine. As for the cost of the Lysodren, how much are you paying per pill? $116 is for how many (500mg)pills?

-Susy

[gpgscott]

plus he's putting her on the DES to stop her leaking [one can only hope], I don't know how much that's gonna cost.

I don't remember exactly, but it was cheap, nothing at all like Lysodren. You have to give it for several days in succession and then once or twice a week, varies by pup.

Betting it does the trick.

Best wishes. Scott

[muskyhusky]

I missed your post & Cushy's while I was replying... I just want to make sure you understand that spreading the dose more evenly does not mean more Lysodren;). And as Cushy said, the weekly dose all in one day may work fine. As for the cost of the Lysodren, how much are you paying per pill? $116 is for how many (500mg)pills?

-Susy

It's $6.25 a pill, and there's probably 6 weeks worth of them, ok, I guess I did misunderstand that, so I could give her a pill on Mon., Wed and Fri. and that would be better then the 1 and a half twice a day, that sounds good...

[muskyhusky]

I don't remember exactly, but it was cheap, nothing at all like Lysodren. You have to give it for several days in succession and then once or twice a week, varies by pup.

Betting it does the trick.

Best wishes. Scott

I hope so, she leaked a big one on my love seat, she got up on it while I was gone, I thought I had enough on it so she wouldn't jump up on it, guess not, it's a good thing I have that "Urine Gone" it works good.

[acushdogsmom]

It's $6.25 a pill, and there's probably 6 weeks worth of them, ok, I guess I did misunderstand that, so I could give her a pill on Mon., Wed and Fri. and that would be better then the 1 and a half twice a day, that sounds good...Yes, exactly. Many of us have found that it's easier on the dog when we do it that way (spread the dose out over two or three days a week) than when you give the whole weekly dose all in one day. You should probably tell your vet if you do want to spread it out over two or three dosing days instead of giving it all in one day. He shouldn't mind if you do it that way, but you should tell him.

If he wants a reference, tell him Dr. Edward Feldman at UC Davis has it written in his protocols in the Textbook of Veterinary Internal Medicine, that dividing the total weekly dose over a few days is perfectly acceptable, and sometimes actually the preferred way to do it. :)

[Wylie's Mom]

You can probably get the Lysodren cheaper at:
http://www.diamondbackdrugs.com/

You fill out the online quote form... the first time I did it, they emailed me a quote for 500mg Lysodren tablets (like I asked) and in addition, they gave me a quote for 500mg Mitotane capsules - both are going to be cheaper than what you can get at the vet, but the Mitotane will be significantly cheaper. I had my vet call in the prescription to their 800 number and then Diamondback called me for my cc number and I got the meds in the mail in a couple days. Wylie is currently on 2 prescription meds - Lysodren/Mitotane and Ursodiol, they are both cheaper at Diamondback drugs than at my vet or Walmart.

-Susy

[muskyhusky]

You can probably get the Lysodren cheaper at:
http://www.diamondbackdrugs.com/

You fill out the online quote form... the first time I did it, they emailed me a quote for 500mg Lysodren tablets (like I asked) and in addition, they gave me a quote for 500mg Mitotane capsules - both are going to be cheaper than what you can get at the vet, but the Mitotane will be significantly cheaper. I had my vet call in the prescription to their 800 number and then Diamondback called me for my cc number and I got the meds in the mail in a couple days. Wylie is currently on 2 prescription meds - Lysodren/Mitotane and Ursodiol, they are both cheaper at Diamondback drugs than at my vet or Walmart.

-Susy

I'll have to give it a try, thanks...

[Wylie's Mom]

There are other ideas on this site:
http://www.dolittler.com/2008/11/21/Pet-pharmacy-smarts-Ten-ways-to-save-BIG-on-your-pet%E2%80%99s-Rx-bill.html

[haf549]

Lynne:

Congratulations on a successful and relatively uneventful load. I'm glad that everything appears to be positive for Shadow. Hope the DES works as well.

Best wishes to you and Shadow.

Heidi & Kira

[Nathalie]

Congratulation on a succesfull load! You must be relieved. :)

Regarding the cost for Lyso - you may also want to call local pharmacies for a quote. I live in Canada and found the least expensive - 4.30 Cdn - was a local compounding pharmacy.
Nathalie

[ventilate]

I ordered Nikes Lysodren from pharms in Canada for a greatly reduced rate. Sams and walmart were a lot more expensive for me. I am glad that Shadows numbers are good. After not giving her lysodren for a few days I am thinking about 5 days, you can imagine what the level was when you first saw the signs of overloading.
You are doing a great job with Shadow. I hope the DES works, I remember once she had that loading dose it didnt take long for the leaking to stop. every once in a while I would have to give an extra pill or 2 if she had breakthrough leaking. I used to get nikes DES from the vet it was a lot cheaper. I now have to go to a compounding pharm. It isnt horrible as she only takes one pill per week now.
I am sure, along with Scott, that this will do the trick.
Sharon

[muskyhusky]

Shadow started both her lsodren and DES yesterday, the DES she takes one a day for 7 days then she takes one a week. I hope this works because yesterday it was just unreal how she was leaking, it'll probably take the 7 days before I notice the difference.?

[ventilate]

It was a long time ago for Nike, but i am pretty sure it took a while for the level to get high enough to notice a difference. The loading to a theraputic level sounds like what I did. I know I loaded her but cant remember how long, and the once a week is what she is on now.
good luck and hope it works
sharon

[muskyhusky]

Shadow has started her maintenance dose of lysodren, I gave it to her over 2 days instead of 3, the DES is finally working, yesterday and today no puddles, rivers or lakes:D Shadow is laying outside again under the porch something she hasn't done in a long time, so everything seems to be going smoothly, her next test is scheduled for Oct. 2'nd.

[haf549]

Great news!!!:) I hope everything will continue to go well for her.

Heidi & Kira

[MiniSchnauzerMom]

Hi Lynne,

Was just wondering how Shadow is doing with her Lysodren maintenance dosing this week and if she's still void of the puddles?? Hope all is going well and that she continues to improve.

Louise

[muskyhusky]

Hi Lynne,

Was just wondering how Shadow is doing with her Lysodren maintenance dosing this week and if she's still void of the puddles?? Hope all is going well and that she continues to improve.

Louise

Hi, I just got my laptop back from the repair shop. She is still leaking, I gave her 2 caps this week, if she continues to leak I don't know if I can give her anymore, I mean DES is a powerful drug too, I may have to supplement with the PPA.... it can be very discouraging this leaking of urine for her and for me.:(

[Barney's Mom]

Hi, I just got my laptop back from the repair shop. She is still leaking, I gave her 2 caps this week, if she continues to leak I don't know if I can give her anymore, I mean DES is a powerful drug too, I may have to supplement with the PPA.... it can be very discouraging this leaking of urine for her and for me.:(

:( Sorry to hear that the musky husky is still leaking. No advice for ya, but hopefully someone will chime in soon with some good advice. Hope you guys see relief soon.
Cheryl

[muskyhusky]

Shadow is going in for her test on Friday morning...I'm keeping my fingers crossed that things are well. I have some questions for him that are unrelated [maybe] to all this, she bites her front foot, she has a lump under leg, hard to describe where, she acts like she is gonna bite me when I touch her in places she doesn't like me touching her..:confused: I just have to remember to tell him these things when I drop her off.

[Harley PoMMom]

Hi Lynne,


I just have to remember to tell him these things when I drop her off. I have a notebook dedicated to Harley's vets visits, when I make an appt. for Harley I write it down it that notebook with the date and any questions that I may have.

Best of luck with Shadow's test on Friday, will be looking for your updates for the results.

Love and hugs.
Lori

[ventilate]

I would talk to your vet. Did you do like a loading of the DES? I think I gave Nike a pill a day for a few days then 1 or 2 per week. When she began leaking i would give her DES for 2 or 3 days in a week then back to 1 per week. I wonder if Shadow just does not have enough in her system yet.
Sharon

[MiniSchnauzerMom]

Hi Lynne,

Well, I'm sorry to hear that Shadow is leaking again and that the current treatment doesn't seem to be working. That's got to be frustrating for both you and Shadow!

I carry my little notebook and pen in my purse. That way I'm able to jot down my questions as they come to me and I can also jot down the answers while at the vet's office. Sometimes I go on information overload during a visit to the vet (info goes in one ear and out the other) so being able to jot everything down really helps. Carrying the notebook has really come in handy when I'm out shopping and the vet calls with some answers or results too.

Good luck with Shadow's test on Friday and will be interested in seeing the answers to your questions as well as Shadow's test results.

Louise

[muskyhusky]

Thanks, a notebook is a good idea....As for her leaking she was loaded one a day for 7 days. I gave her 2 last week and I gave her another on Sunday, today is Tuesday so we'll see how long she goes before she leaks again...

[muskyhusky]

As I read some of these threads, I really have to say how lucky I am, Shadow is basically healthy except for the Cushings Disease..she could have whole load of other problems along with the Cushings and she doesn't..She does have a benign skin tumor, I just have to keep an eye on it in case it gets bigger.

Hang in there, from someone who went being terrified of Cushings and the treatment to being extremely happy that I am treating her. And I am very grateful to people on this forum for all the help and encouragement that they give to us newbies who are facing this for the first time. A big thank you from Shadow and myself.

[gpgscott]

Hi Lynne,

It sounds like you are following the standard dosing with the DES and not seeing postive results.

I cannot see that you have tested for thyroid. If you have not I think it would be a good thing to do.

Scott

[muskyhusky]

So my Vet is off hunting for the week after telling me that he would call with the results on Sat. this really ticks me off to point where I may find a new vet...they charge these outrageous amounts for their services and then they really don't care...all they really care about is money.:mad:

[Roxee's Dad]

Hi Lynne,

I would just ask the vet's office for a copy of the results and post them here. I had my vet's office trained :p to fax me copies of any test before the vet would even call me to discuss.

[Harley PoMMom]

Hi Lynne,

I agree with John, Harley's vet has it written in Harley's chart, and she has made it perfectly clear to the staff veberally as well, that I get copies of all tests done on Harley.

Love and hugs.
Lori

[muskyhusky]

I'll stop tomorrow and pick up a copy...if he was going hunting he should have told me, not tell me he'd call on sat.

[Wylie's Mom]

There is one employee at my vet's office who refused to even check to see if results came in, let alone, fax them to me. I finally asked my vet to put a note in Wylie's file that said it was okay to fax results without a vet's direction... they do have a general policy of having a vet discuss the results to the clients first. It (was) annoying... timing can be very important in the middle of treatment.

If you have any trouble, ask to speak to another vet in the office to get them.

-Susy

[muskyhusky]

There is one employee at my vet's office who refused to even check to see if results came in, let alone, fax them to me. I finally asked my vet to put a note in Wylie's file that said it was okay to fax results without a vet's direction... they do have a general policy of having a vet discuss the results to the clients first. It (was) annoying... timing can be very important in the middle of treatment.

If you have any trouble, ask to speak to another vet in the office to get them.

-Susy

I did, she won't give me the results, she wants to wait for a week when he gets back, so they can't be all that bad...

[Wylie's Mom]

ARRRRGH!:mad:

Which tests did you have done?
-Susy

[muskyhusky]

ARRRRGH!:mad:

Which tests did you have done?
-Susy

The 2 hour low dose..
Here are the results - I talked to my husband and he was giving her 2 one day a week instead of 3 - long enough for her results to change, I told him I'll take over giving her the meds.:)

2Hr. Cort - 13.3 ug/dL

Cortisol Baseline - 6.1 [1.0 - 5.0]

Test Results from 6 weeks ago:

2Hr. Cort. - 5.2 ug/dL

Cortisol, Baseline - 2.5 [1.0 -5.0]

[gpgscott]

Hi Lynne,

So are these the numbers from the most recent test which you were unable to get yesterday?



2Hr. Cort - 13.3 ug/dL

Cortisol Baseline - 6.1 [1.0 - 5.0]


If so it appears Shadow has escaped control and will likely require another loading. These numbers from six weeks ago are perfect. Are you seeing resumption of symptoms?



Test Results from 6 weeks ago:

2Hr. Cort. - 5.2 ug/dL

Cortisol, Baseline - 2.5 [1.0 -5.0]


Have I got this right?

Scott

[Squirt's Mom]

Hi Lynne,

I'm seeing the same thing as Scott...Shadow has escaped control since her last ACTH. Has your vet mentioned re-loading or a mini-load? or an increase in the dose (not the best approach)? Is Shadow showing any signs again recently or are they about the same?

Hugs,
Leslie and the girls

[muskyhusky]

Hi Lynne,

I'm seeing the same thing as Scott...Shadow has escaped control since her last ACTH. Has your vet mentioned re-loading or a mini-load? or an increase in the dose (not the best approach)? Is Shadow showing any signs again recently or are they about the same?

Hugs,
Leslie and the girls

No signs, she's about the same, I thought she was acting a little more like herself..:o She's gonna have to wait for another dosing, I can't afford it right now, we need over $1000.00 in work done on our car, just what we needed...:(

[muskyhusky]

Hi Lynne,

So are these the numbers from the most recent test which you were unable to get yesterday?



If so it appears Shadow has escaped control and will likely require another loading. These numbers from six weeks ago are perfect. Are you seeing resumption of symptoms?



Have I got this right?

Scott

Yes, that is right...:(

[muskyhusky]

I can get 12 caps of mitotane [750 mgs] for $46.00 and that includes shipping.

The Lysodren would be 18 500 mg. tabs for $115.00 including shipping.

Now if I can just get my Vet to fax them a script for mitotane that would be just wonderful....:)

[gpgscott]

Lynne,

Mitotane is Lysodren.

My opinion is buy the least expensive.

I do not think there is a difference.

Scott

[muskyhusky]

Ok, here's what my vet said, he is keeping her on her regular dose 1500 mg. one day a week, he thinks the results were because she didn't get her dose that week, I give it to her on either Friday or Sat. so he wants another test in March 2010...I can live with that.:D

[jrepac]

mitotaine = lysodren

[muskyhusky]

mitotaine = lysodren

Yes I do know that, thank you.

[Squirt's Mom]

Hi Lynne,

We often say to treat the dog, not the numbers and it certainly seems apply in Shadow's case. Altho her numbers are a bit high, she is acting better according to you and that is the ultimate goal - for them to feel better. So as long as she continues to exhibit improved behaviors as related to Cushing's, then the plan sounds good to me! :D A break from vet visits is always a nice thing to contemplate! ;)

Keep up the good work!
Hugs,
Leslie and the girls