Casey - cushings dog - border collie sheltie/ sweet Casey has passed

[Casey's Mom]

Hello my name is Ellen and my dog Casey is a 13 1/2 year old border collie sheltie. She was diagnosed with Cushings in March. My vet did not do a test to see if it was Adrenal or Pituitary but relied on the ACTH stim test. I live in a small town in Canada and most large vet clinics and specialists are very far away. After 2 years of UTI's and elevated liver enzymes the diagnosis made sense after I researched Cushings.

She has been on Lysodren since that time although I don't think her levels have ever been totally right. She has had two ACTH tests and both times her cortisol was higher than what the vet would like to see. She weights 18 kg and is on 375 mg 2x a week but for example today when I gave it to her 8 hours later she did not want to eat (very unusual) so I gave her 2.5 mg pred. I am thinking that I should split her Lysodren up to 250 mg 3x a week so that she doesn't get such a large dose at once. She has some great days and more bad days. As soon as she came off the loading dose of Lysodren she had a limp in her left hind leg. The vet Xrayed and said it was arthritis but some days Casey has trouble getting up. I just read pip's story about the freeze spray - does anyone know the name of it?

All of you seem to have a lot of knowlege and insight - I am glad I found this site!

[SaxLady]

Hello Ellen,
Welcome to this wonderful and informative website. Others with a wealth of knowledge will be along to help you soon. I just wanted to welcome you and Casey.
Hugs,
Candy

[Harley PoMMom]

Hi Ellen,

Here is a quote from Julie's thread about the freeze spray and a link to it.
Here a link to the freeze spray i use on pip

www.deepfreeze.co.uk THIS IS THE ONE I USE AS ITS DOESNT HAVE ANY ANTI INFLAMMTORYS IN MY VET HAS ALREADY SHECK THE INGREDIENTS AND DOES NOT HAVE A PROBLEM USING ON PIP THERE ARE SOME FREEZE SPRAY OUT THERE THAT DO CONTAIN ANTI INFLAMMTORY'S
bUT PIP CAN STAY ON HIS PAIN RELIEF MEDICATIION WITH THE ONE I USE
TWICE ADAY MORNING AND EVENING I SPRAY ON ALL HIS JOINTS STAND NEAR HIS FACE SO THE MIST FROM THE SPRAY DOESN'T GET IN HIS FACE. JUST SPRAY AND MASSAGE .HE PLAYING AND RUNNING.
AS I'VE SAO=ID IT WORKS FOR HIM.
jULIE pIP

I'm very surprised your vet dx'd cushings with just a ACTH test, usually there are several test used to dx cushing.

As far as the limping goes, altho I am no vet or have no medical background, I believe Casey is suffering from arthritis like your vet has said. I also believe splitting her Lysodren up to 250 mg 3x a week would help too, and you may want to ask your vet about giving her Pepcid AC about 15 minutes to half an hour before the meal with which the Lysodren is given.

Can you tell us more about Casey, what were her symptoms that lead you and her vet to believe she had cushings. Casey's ACTH test results, what were her numbers, could you post them, if you wouldn't mind. Has Casey had any other tests done, chemistry, CBC, could you post any numbers that are marked "high" with their units (ug/dl, ng/ml, etc...) and reference ranges. Is Casey on any other supplements or herbs? I am sorry for all the questions, but the more we know about your beautiful girl the more we can help you, ok. :eek::D

I'm sure the "others" more knowledgeable will be along soon to ask more questions, so hang in there, Ellen, we're here for you.

Hugs.
Lori

[Tamarah]

Ellen -

I wanted to send a welcome to you and Casey. My schnauzer/beagle Crash was diagnosed in March as well. He's atypical. This is a wonderful forum - lots of knowledgeable people and a great support system. I have learned so much. I still ask more questions for Crash and myself than I can answer for others, but I know you can never ask too many questions around here. There will always be someone here that can help you. So an answer regarding the freeze spray that you had asked about. I'm aware of a product called biofeeze. I use it on my shoulder and get mine from my chiropractor. I'm not sure if it's canine compatible, but with a product name you can ask your vet.
Again, welcome! Cushings is quite a journey, but know that you are definitely among friends and family. :)

Tammy, Crash, and Darby

[frijole]

Hello my name is Ellen and my dog Casey is a 13 1/2 year old border collie sheltie. She was diagnosed with Cushings in March. My vet did not do a test to see if it was Adrenal or Pituitary but relied on the ACTH stim test. I live in a small town in Canada and most large vet clinics and specialists are very far away. After 2 years of UTI's and elevated liver enzymes the diagnosis made sense after I researched Cushings.

She has been on Lysodren since that time although I don't think her levels have ever been totally right. She has had two ACTH tests and both times her cortisol was higher than what the vet would like to see. She weights 18 kg and is on 375 mg 2x a week but for example today when I gave it to her 8 hours later she did not want to eat (very unusual) so I gave her 2.5 mg pred. I am thinking that I should split her Lysodren up to 250 mg 3x a week so that she doesn't get such a large dose at once. She has some great days and more bad days. As soon as she came off the loading dose of Lysodren she had a limp in her left hind leg. The vet Xrayed and said it was arthritis but some days Casey has trouble getting up. I just read pip's story about the freeze spray - does anyone know the name of it?

All of you seem to have a lot of knowlege and insight - I am glad I found this site!

Ellen, Welcome! My dog has used lysodren for 3 yrs now and is 15 1/2. I think your idea to split it up over 3 doses vs 2 is a good one. You mentioned that the vet says the acth results were high... could you please tell us what they were? A cush dog should be between 1 and 5. There are cases however where dogs are slightly over that and do well... so long as the symptoms are under control and you maintain the cortisol level that is fine.

If you don't know the numbers from the test, please get copies or call and let us know. It would help alot.

You mentioned Casey not wanting to eat. Keep an eye out and if it happens again it might be because the levels are too low. At that point you would withold lysodren and get levels checked to be sure. In the meantime, perhaps it was just a bad day? Let us know.

Re the back leg...agree it could be from cortisol changes... Do you give fish oil, glucosamine or any other form of arthritis relief? It has helped my girl a great deal. I recently started adequan shots and it has really helped her.

Again welcome! Kim

[Casey's Mom]

Thank you everyone for your kindness, it brought tears to my eyes and as well gave me a huge sense of relief to find others going through the same things and willing to help!

When I took her to the vet in March all her bloodwork and urine culture was normal except her urine was very watery (I can't remember the word the vet used) and liver enzymes were high and have been for a few years. My vet did a snap cortisol test which showed high levels of cortisol then did an ACTH test and said she was a cushings dog. (I don't have the results of that test but I will request and post. She started on the loading dose of Lysodren March 14th then the vet did a snap cortisol test 2 weeks later and said she was at the low end of normal and we began Lysodren 2x weekly on April 19th.

May 1st she had an ACTH test and her results were 76 pre cortisol and 183 post ACTH. I don't know if you will understand those numbers but that is what she gave me. Then July 15th she had another ACTH and her numbers were 203 pre cortisol and 317 post ACTH. The vet said those numbers were too high and did another loading dose of Lysodren but after two days Casey stopped eating and became extremely quiet. I called the vet on call and he said she was having a reaction to the Lysodren and to give her pred. Now every time I give her Lysodren she seems to have a reaction, sometimes too quiet and does not want to eat which is very ususual for her she is a little piggy (although not overweight I watch her food intake and we go for daily walks.) Sometimes too she needs to eat grass which means her stomach is upset.

Last night when I gave her pred it perked her up but then she is back to being anxious and drinking a lot. When I give her the Lysodren dose next -which will be a lower amount- I hope not to give her the pred because I feel that then I am doing nothing to help her cushings because I am just putting the steroids back in her body - what do you think? I am also thinking of trying trilostane if this doesn't work.

Her symptoms when I first took her to the vet were: drinking a lot, excessive urination - in fact she was on proin since her recurring bladder infections from a few years ago. She has been off proin for a few months now. Also anxious and panting. No hair loss or pot belly.
She just had another urine culture and everything was fine.

I have her on holistic chicken and rice dry food mixed with a homemade blend I make of chicken, brown rice, yams carrots and peas. I also give her 3 capsules of glucosamine chondroitin (900 mg each) 4500 mg of milk thistle, Missing Link supplement and some Seagreens powder which is seaweed, flax, vitamin B, digestive enzymes and probiotics.

Today was a pretty good day, she slept in the backyard for most of the day but we went for our daily walk in the park with my other dog Desi the Havanese for about 30 minutes. All I hope for is more good days than bad!

Thank you everyone for your knowledge and support and hugs!

[Harley PoMMom]

Hi Ellen,

I have a couple more questions :eek: when you give Casey her pred. how long after that dose does she get her ACTH test done? And when you give her the pred. how long do you wait to give her the Lysodren again?

If your thinking about switching to Trilostane, there is a 30 day wash-out period that Casey MUST go thru, the Lysodren has to be out of her system before starting the Trilostane. And if you are thinking about using Trilostane, then I urge you to have a full adrenal panel run on Casey before starting the Trilostane. Trilostane usually elevates one or more of the intermediate/sex hormones and will cause the same symptoms/damage as cushings.

If you want more information on the full adrenal panel let us know.

I just wanted to add that drinking alot of water and frequent urinating is not always positive signs of cushings, these symptoms could be diabetes, thyroid..were any of these ruled out? For ALL her bloodwork to be normal is really odd to me, usually a cushingnoid dog ALP, and cholesterol are high among other things and with the visual symptoms this is what leads the vet to test for cushings.

Hugs.
Lori

[Buffaloe]

Hi Ellen,

We're glad you found us, as well. Boy, a small town in Canada sounds pretty good to both Shiloh and me right now...we're in big ole Phoenix and it's 110+.

I think it's a real good idea to split the Lysodren into three weekly doses of 250 mg. Casey's diet looks good to me. You might think about adding some fish oil to his food. I give Shi a pretty good amount of it every day and I always take it myself. As far as the limping, Shiloh has limped once in a while for the past seven years but not at all the past two or three, go figure. That is awesome that Casey still enjoys his walks. That says alot.

Ellen, you'll get lots of good information and support here.

Ken

[Casey's Mom]

Casey was tested for diabetes and thyroid back in her initial visit to the vet. I am going to try to get those test results from my vet and post. How did her ACTH test results look to you? Thank you for the info on Trilostane.
I have only given her the pred the last few times I gave her Lysodren and she hasn't had any testing done in that time. I last gave her Lysodren and pred Saturday and she is due for another dose on Tuesday but I am only going to give her 250 mg instead of 375 and then give her another dose in two days because I am splitting her dose into three times a week instead of two. Hopefully the lesser amount of Lysodren will not affect her as much but control her cushings.

I will try the fish oil again, I did have her on it for a few months and then found that it was already in the Missing Link supplement that I give her.

I have been to Phoenix - great city! We have had a very cool summer so 110 sounds good to me .. .

[Harley PoMMom]

So, let's see if I am getting this right...you are giving pred. and lysodren at the same time? If not, could you post the times you gave the lysodren, then the pred. etc..

I'm not sure how to read your ACTH results since there are no units, I'm thinking they are nmol/L? IF they are (I'm used to seeing in μg/dl), 76 pre cortisol and 183 post ACTH, which converts out to pre 2.71 ug/dl and post 6.54 ug/dl are pretty good numbers, 203 pre cortisol and 317 post ACTH, converts out to be pre 7.26 ug/dl and post 11.34 ug/dl, which is high.

I really think you need the advice of the "others" who are much more knowledgeable about this cushings and Lysodren dosage, especially since the pred. is involved, I'm relatively new here myself and I don't have any experience, yet, with the Lysodren. Please hang in there, Ellen, we are here for you, others will be along to share their vast wisdom and experience, and others, like me are here to lend you moral support and to hold your hand. :)

Hugs.
Lori

[Squirt's Mom]

Hi Ellen,

A belated welcome from us! I am glad you are here! :)

In reading your posts, I am a bit concerned about several things - like Lori said, giving pred and Lyso together is not protocol, and you are absolutely correct in thinking that by giving the pred you are just putting steroids back in her system, which is kinda defeating the purpose of the Lyso. So I question this.

Also, Casey's reactions to the Lyso are worrisome. Once we can see the actual results of the Cushing's specific tests, we can tell much more about what may be going on with her. Dividing the dose into more days may do her wonders, tho. The level of the dose looks to be about right. She seems to reacting as if this is too much for her, OR that perhaps the diagnosis is incorrect...not at all uncommon when dealing with Cushing's. Her tests results will help us get a better idea there.

I don't know what a "snap cortisol" test is. Could you explain that to me? I do know that starting treatment with either of the cush drugs based on one proven Cushing's specific test, the ACTH, is dangerous. Cushing's is a complex condition that is often very difficult to confirm, even with several tests. The ACTH can show high cortisol levels that have nothing to do with an adrenal illness, which Cushing's is. In fact, all those tests can come back positive for PDH or ADH when something else altogether is at work. My Squirt is proof of that.

All her tests - LDDS, HDDS, ultrasound, and ACTH - confirmed she had PDH, pituitary Cushing's. However, a splenic tumor and part of her spleen had to be removed and since then (9/08) her cortisol level has returned to normal. Her docs now say the stress from the tumor could easily have been the cause of the results that determined PDH, when in fact she may not be. She is being treated for her Atypical Cushing's only today and has been since 8/08.

So I urge you to be absolutely positive that Casey actually does have Cushing's - and which form, pituitary or adrenal as the treatment approach may differ. An ACTH alone cannot do this for her. If a snap cortisol test is simply an in-house blood test that shows the amount of cortisol in the blood, that is most certainly not reason enough to start treatment, even with an ACTH supporting it. Very scary to me! :eek:

You are doing an excellent job, Ellen, so keep up the good work! I think you understand more about this condition than you know. ;)
Hugs,
Leslie and the girls

[Casey's Mom]

When I give Casey Lysodren if she has a bad reaction and won't eat later on I will give her 2.5 mg of pred. The last time I gave her 2.5 mg of pred about 8 hours after Lysodren when she would not eat dinner. Her last dose was Saturday and I am going to give her Lysodren tomorrow but a smaller dose 250 mg instead of 375 and hopefully that will do the trick and she won't need the pred

Today was a great day, running (although a bit stiffly) at the doggy park and then trotting and then a slow walk home - about 40 minutes. She wanted to go farther than normal so it was a good day. I always let her condition judge the distance of our walk and Desi being a smaller dog is always happy to go with whatever Casey decides.

The numbers that I gave from the ACTH test were what my vet gave me - thank you for figuring it out and I really need to get copies of those tests! I just talked to them and there is a charge for getting test results so I am going to figure out if that is a charge for each test or one charge for all of her test results and then I will post once I get them.

Thank you all again, wonderful group and I am learning a lot by reading other posts.

[Casey's Mom]

Yes a snap cortisol test just shows cortisol levels in the blood. I am not sure where to get another more comprehensive test however I do live on the border with Michigan and I have a U.S. vet there who I have been talking to about Casey - perhaps he could do a more extensive test to see what she has ? What should I be asking for?

[Harley PoMMom]

Hi Ellen,

Awww...when did you put the avatar up? and what beautiful pups they are!

I can't believe your vet will charge you for copies of Casey's tests. :mad: Harley's vet & IMS are willing to give me copies of all Harley's test at no charge. Of course here they are bound by the AVMA policy to do so. Maybe you have that there? I'll place a link to ours and maybe you can see if you can find one.

The tests that you will want to ask your vet about is the Low-dose Dexamethasone Suppression Test (LDDS), I'll paste a link for that too. And an ACTH, not a snap ACTH, this ACTH is for monitoring cortisol after your pup is on Lysodren, there will be a link for that too.

LDDS and ACTH tests

http://www.vin.com/proceedings/Proceedings.plx?CID=WSAVA2007&Category=&PID=18195&O=Generic

AVMA policy (American Veterinary Medical Association)

VIII MEDICAL RECORDS

D Veterinarians are obligated to provide copies or summaries of medical records when requested by the client. Veterinarians should secure a written release to document that request.


http://www.avma.org/issues/policy/ethics.asp

Hope this helps.

Hugs.
Lori

[Casey's Mom]

Thanks Lori for all of the great info . . . I had done a bit of research on the net when she was first diagnosed and asked my vet about the LDDS test and she said it wasn't necessary. I emailed my U.S. vet (I have one on each side of the border) last night to see if there are any further tests he would recommend so I am awaiting his response but I will now ask for this test and see which vet will do it!

She is due for Lysodren today - seems happy and normal - should I give it?

I wish I had found you guys 6 months ago but you are lifesavers to me now!

Ellen

[Squirt's Mom]

Hi Ellen,

I cannot believe your vet will charge you for copies!!! :mad::mad: You have paid for them, and any labor it may take to get them together, ten times over in the your vetting of your babies. This is just not right! Do check the link Lori gave you and see if your vets are bound by the same policy. If not, I think I would have the records sent to the US vet and they WILL give you copies...free.

One other test I highly recommend is an abdominal ultrasound done on a high resolution machine. This is a great test for many reasons...they will be able to see most of the organs like the liver, kidneys, intestines, gall bladder, stomach to name a few in addition to the adrenals. An ultrasound is what saved my Squirt's life, so I cannot emphasize its importance in a Cushing's diagnosis.

I hate to say this, but IMO your vet is wrong about the LDDS. After the UC:CR to screen for Cushing's, this is the most common test to follow with. The LDDS is a suppression test to see how the adrenals will react...it sees if the suppression holds or escapes. Some vets use the ACTH to get a baseline on the cortisol, but IMHO the LDDS will tell you more in the beginning of the testing phase. The ACTH is typically used to monitor once treatment has begun.

Hang in there...you're doing a great job for Casey!
Hugs,
Leslie and the girls

PS. LOVE the pic! What beautiful babies you have!

[Harley PoMMom]

Hi Ellen,


She is due for Lysodren today - seems happy and normal - should I give it?Honey, I can not answer that question, I'm not her vet, I'm not even a vet, I don't have any medical background knowledge except what I've been reading/learning here since. You, my dear, must trust your instincts on this one, you know Casey best and now you have some Cushings knowledge under your belt, use our Resource section if you are still unsure. I'm sure you will do what is best for Casey.

Here is a link to the Resource Thread.

http://www.k9cushings.com/forum/forumdisplay.php?s=&daysprune=&f=10

Hugs.
Lori

[Squirt's Mom]

Hi Ellen,

In order for Casey to be tested for Cushing's, she will have to be off the Lyso for 3-4 weeks, one month is what is usually recommended. So if you are wanting to make sure this is Cushing's you are dealing with, then you will want to stop the Lyso asap.

Her signs may come back in full force, but that is ok. You want her in as natural a state as she can be for the tests to be beneficial.

Hugs,
Leslie and the girls

[Roxee's Dad]

Hi Ellen,

I had to go back and read thru your thread. I am not a vet nor an expert in any of this. What I see is Casey bouncing up and down like a yo-yo. Something just doesn't seem right. This worries me.

Both Leslie and Lori have given you some really good advice. If it were me, I would stop the meds and start with a new diagnosis. I think this would be in both your best interest.

Doesn't sound like your vet has much experience in this, though I could be wrong. Doesn't look like any of the protocols for treatment and monitoring have been followed. You may have to work with your vet as his research assistant if he or she is willing. Many are:), some are not:(. I met a vet a few weeks ago and we discussed a few canine subjects, he is good and does alot of work for a canine rescue group. He even transplanted a saliva gland to replace a tear duct in one of the dogs with dry eye. When we discussed cushings, he told me his dog had cushings and he started treatment and the dog died. His response was that he should have studied it more before he started treatment as he would have monitored more seriously.

Give Casey some belly rubs from us.

[Harley PoMMom]

Hi Ellen,

I'm so thankful and glad that John and Leslie were able to answer your question about stopping the Lyso. They are very wise when it comes to this cushing and they both have more experience with it than I do.

The one thing I would like to mention is alittle about my Harley...he was first dx'd by a LDDS test, former vet didn't know if he had ADH or PDH but wanted to put him on Trilostane. :eek: On the urging of these amazing and knowledgeable people here on this forum I got a full adrenal panel test done on Harley.

The full adreanal panel test showed Harley to have "Atypical Cushings." Atypical Cushings is when one or more of your pups intermediate/sex hormones is elevated, but their cortisol is not.
The one hormone that is really elevated in Harley is his sex hormone, and it's called estradiol. Because of Harley's hormones being elevated, Trilostane is NOT an option for treatment for him because Trilostane elevates one or more of these intermediate hormones even further. On the other hand, Lysodren, lowers them, and that is where I am at now with Harley. In a couple weeks Harley will start JUST a MAINTENANCE dose of Lysodren, no loading. Maybe this is all Casey needs....but you have to be sure that she has cushings in the first place. Harley's had a LDDS test, 2 endogenous tests, 2 ultrasounds, full adrenal panel + all his CBC's, chemistry's, urine cultures, etc....just within the last 5 months. :eek::(:) My poor Harley. :(:) Harley is now considered PDH from his endogenous test.

If there is anything you don't understand or want more info about...please ask, ok.

Hugs.
Lori

[Casey's Mom]

Thank you for all of your knowledge and insight. Casey seems normal today except for drinking a little more than what I consider normal for her.

So if I understand correctly I should stop Lysodren for a month, then have the adrenal panel, ultrasound and LDDS done after the month is up to confirm a diagnoses? If she does have Cushings will it harm her to be off meds during this time - or will it just be a case of a return of her drinking, peeing and being on proin during that time to deal with the symptoms?

[Squirt's Mom]

Hi Ellen,

The time off the meds should have no effect other than allowing her signs to return. It usually takes years of untreated cortisol to cause damage. So, don't worry about Casey going 30 days with no treatment.

I know it will be hard to watch, especially now that you understand so much more about what is going on with her, but just remember this is in her best interest in the long run. The risk of giving cush meds without a definitive diagnosis or of giving Trilo without the UTK panel, is much, much greater.

And, we will be here anytime you need to vent, cry, scream or have your mind otherwise occupied. Trust me, I have done more than my share of all of these! :p But I'm a twitcher, and twitchers freak over every little thing! :eek::D

Hugs,
Leslie and the girls

[Roxee's Dad]

Hi Ellen,

If Casey does have cushings and I don't doubt that she does, just want to be sure and that it is treated and monitored according to protocol. Stopping the Lyso for a short time should be okay as Cushings is a slow progressing disease or syndrome.

I am a little concerned about the use of Proin. Some members do use it but it does come with warnings that I have quoted below.


Side Effects Associated with Proin
Side effects associated with Proin can include a rapid heart rate, elevation in blood pressure and restlessness. You may also notice a change in your dog's appetite.

Proin should not be given concurrently with L-Deprenyl (Anipryl). Proin should be used with caution in conjunction with tricyclic antidepressants, non-steroidal anti-inflammatory medications (NSAIDs) and amitraz.

Proin should also not be used in patients with heart disease, elevated blood pressure, glaucoma, hyperthyroidism or diabetes mellitus.
http://dog-care.suite101.com/article.cfm/proin_for_dogs

Not sure if any of this applies to Casey, but thought you should be aware.

[Casey's Mom]

Thanks everyone for helping me - I feel like I have a huge support group out there and it does put my mind at ease.

- I will only use Proin if her urine leakage occurs again and I know about the side effects - she was on it for quite a while before her diagnosis and subsequent Lysodren but it was better for me and for her if she wasn't leaking all over the house because she would try and lick it up.

By the way does anyone have any thoughts as to why there is such an incidence of Cushings or is it only because I am now aware. I have a theory that it is all the vaccinations we give and spot flea control (I used Advantage) but that is just an idea. My vet said they are seeing it more and more. I think before people just thought these symptoms were just their dog getting older and to be honest I took Casey to the vet was because I thought she might be diabetic.

[Harley PoMMom]

Hi Ellen,

Here are posts about DES. If you would want more info. from these very kind and knowledgeable individuals, you could PM them about the DES and ask or if you want I can.


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


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

Hugs.
Lori

[Roxee's Dad]

Hi Ellen,


By the way does anyone have any thoughts as to why there is such an incidence of Cushings or is it only because I am now aware. I have a theory that it is all the vaccinations we give and spot flea control (I used Advantage) but that is just an idea.

The million dollar question. I can say this, Roxee has never been treated with anything other than a natural ingredients flea shampoo. No flea collars or spot control of any brand.


My vet said they are seeing it more and more. I think before people just thought these symptoms were just their dog getting older

I think this is exactly the case. Now with the information highway, we are much more aware of almost everything. When Roxee started having a ravenous appetite, we thought is was a learned behavior from our foster / adopted, rescue Bailee. He ate everything in site and anything left over in Roxee and Rozee's bowls. If Rox and Roze didn't leave anything, he would pee on their bowl:):p:D. So Rozee learned to leave him a little something:) Even the vet agreed it was probably a learned behavior. I persisted that their was something wrong with Roxee and she was finally dx'd with cushings.:(

[gpgscott]

Hi Ellen and a belated welcome from me.

I am not familiar with the 'snap' for cortisol, but I am familiar with the 'snap'. It is a means for a Dr. to give the patient an immediate answer, but in the area of Cushing's I think it has no merit. It is a litmus type test.

With a 'snap' you are dealing with resting cortisol, which by anyone's assesment is of little importance.

You really need a stimed test and I think the UTK full adrenal panel is the best.

But first there are many questions, as there are many medical issue's particularly with elder's that are more common than Cushing's.

Please let us know the entire history, please excuse me if I am repeating as I have not digested your entire thread, but I will.

Best wishes. Scott

[Casey's Mom]

Casey's first stim test after her initial loading dose of Lysodren was in the perfect therapeutic range according to my vet. If she did not have Adrenal Cushings would the Lysodren have had the same effect in lowering her cortisol during for the stim test?

I am paying my vet for my records so I will post as soon as I get her initial blood work results back and all of her stim test results. Their charge is for photocopying and faxing - $15. My U.S. vet sent my Canadian vet all of Casey's previous records at no charge - maybe in Canada they just charge the patient!

[labblab]

Hi Ellen,

I apologize for being so "late" in welcoming you, but I am just now having the chance to catch up on reading your thread. I am sorry that you and Casey are having a tough time right now! And I do think that you are doing the right thing in pressing further to sort out her diagnostics. It will be interesting to see what suggestions your U.S. vet makes in that regard. And it will also be really interesting to see what her initial blood work and ACTH stim results were. The ACTH stim test is definitely the "correct" test for monitoring Lysodren treatment. But it is also still widely used as a diagnostic test for Cushing's, as well. It is actually a more "specific" test for Cushing's than is the LDDS. What this means is that it is less likely than the LDDS to falsely diagnose Cushing's in a dog who does not have the disease.

So along with her symptom profile and her elevated liver enzymes, if it turns out that Casey's initial diagnostic ACTH stim test was indeed consistent with Cushing's, then if it were me -- the first thing that I would press for right now would be an abdominal ultrasound performed by a specialized professional using a high resolution machine. The ultrasound could be performed now, without any waiting or "wash-out" period. Depending upon the results, you may receive the additional info you need to feel comfortable about the accuracy of the Cushing's diagnosis, and you may also be able to determine which form she has. If Casey's adrenal glands are both enlarged, that finding would support the diagnosis of pituitary Cushing's. If a mass or growth is seen on only one adrenal gland, that finding would support the diagnosis of adrenal Cushing's. This information can be very valuable in establishing the best treatment plan for Casey, and in making better sense of her current reactions to the Lysodren. The ultrasound can also provide the opportunity for visualizing Casey's other internal organs, in order to see whether there may be some other obvious problem that is complicating her treatment.

It also looks to me as though she has not had an ACTH stim test subsequent to her last loading period, so I would think that would be a top priority -- to find out where her cortisol level is right now, along with a simple blood test of her electrolytes. There is always a chance that her last loading may have left her cortisol level too low, since it sounds as if she is pretty lethargic except when you are giving her the prednisone? I do agree with the others that the full adrenal panel performed by the University of Tennesse/Knoxville lab is a very useful diagnostic test. But the only downside is that it will take a longer time to get the results back, and you may want to know where Casey's cortisol level is right now. If she were being treated with trilostane, the lab at Knoxville would definitely want her to be off her medication for at least 2-3 weeks before performing diagnostic testing. With her Lysodren treatment, I am not sure what their recommended time frame would be. And if the results of the ultrasound were to be consistent with Cushings and the gameplan remains to fully load Casey with Lysodren, then the Knoxville testing may become a bit of a moot point from an initial diagnostic standpoint since the full Lyosdren loading would tend to reduce most of the troublesome elevated intermediate hormones that the test might identify. But your vet can easily consult with them regarding both the advisability of the test and also the most useful timing.

Once again, please do let us know those initial test results as soon as you receive them. And I'll be keeping my fingers crossed that your U.S. vet has some additional feedback that will help you sort out the best road to travel with Casey.

Marianne

[labblab]

It's me, again! :o

I've just re-read Casey's thread yet one more time, and it is registering with me that she has been taking the Lysodren since March. Since that is the case, I'm not certain that what I said earlier is actually true -- that there would be no need to wait to schedule an abdominal ultrasound. An adrenal mass would undoubtedly remain visible, regardless. But if Casey suffers from pituitary Cushing's, I do not know how quickly or how significantly the sonographic images of the adrenal glands would show alteration after having been treated with Lysodren (and therefore not be particularly helpful from a diagnostic standpoint). So now I am even more interested to hear what your vet ends up recommending, and in what time frame...

Marianne

[lulusmom]

Hi Ellen,

I would like to extend a belated welcome to you and Casey. I have been following your thread and have just now finally gotten a chance to digest everything.

If Casey were mine, I would definitely go with Marianne's opinion and request that an abdominal ultrasound be done to take a look at the adrenals. As Marianne mentioned, Lysodren's shrinking effect on the adrenals could make it difficult to utilize the ultrasound for the purposes of a definitive Adrenal vs Pituitary diagnosis; however, the liver would probably still reveal changes that are consistent with Cushing's. The ab ultrasound also gives the vet a good look at the other surrounding organs to make sure nothing else is going on. Any number of underlying conditions can be a contributing factor in transiently elevating cortisol levels and you would be surprised by some of the findings we've seen.

I also tend to agree with John that Casey probably does have Cushing's but I personally would want to find out whether it is adrenal or pituitary. If either of my dogs had an adrenal tumor, were good candidates for surgery and I had the money, I'd go for it. Even if I didn't opt for surgery, I would want to know for any number of reasons, not the least of which is understanding how either form of tumor can progress.

I have questions as to your vet's experience with Cushing's. Therefore, seeing the results of the original acth stimulation test that showed Casey's post cortisol was greater than 22 ug/dl (607 nmol) will make everyone a lot more comfortable with your vet's decision to treat with Lysodren.

You mentioned the last time Casey's cortisol was checked, your vet did a snap cortisol test. I am not that familiar with this test and unless it can be used to provide an accurate reading of post stimulated cortisol, it would not be considered a reliable test for monitoring treatment. If you could post the results from the snap tests, we can probably figure out if, as Scott mentioned, it is only measuring the basal/resting blood cortisol level. If this is the case, then I would suggest that before discontinuing treatment and starting from scratch, you request a new acth stim test to see where things stand and make adjustments to dosing accordingly. Lysodren is extremely effective in controlling cortisol and in doing so, it is also extremely effective in controlling the intermediate hormones. The one exception would be estradiol as Lysodren targets only the adrenal glands and unfortunately, estradiol can be found in tissues outside of the adrenal glands. So for me, it makes sense to get the cortisol within the desired range of 1 - 5 ug/dl (27.6 - 137 nmol) and if symptoms are not resolved by the time you get Casey there, then I would request that the University of Tenn test the estradiol only. It's a whole lot cheaper and if Casey does have elevated cortisol, as well as one or more of the other intermediates, Lysodren would be the treatment of choice anyway so I would hate to see you lose ground and have to start over. I am looking at having just the estradiol tested for my little Pom that has pituitary dependent cushing's with elevation of all adrenal hormones. She's on Lysodren as well as melatonin and flaxhulls but I think the estradiol is still high as some of her symptoms have never resolved.

I just realized that I've written a novel and have jumped around like an ant in hot ashes. I've probably got your head spinning like Linda Blair in the Exorcist. :D Just remember that we all have our own opinions based on our own personal experience with this very convoluted disease so even though my feedback may not coincide with others, that doesn't mean I'm right and they are wrong. As a matter of fact, you have gotten excellent feedback from everybody and it all comes from the heart and always in the best interest of our sweet cushpups.

Glynda

[AlisonandMia]

I remember in the past we had a dog here that had the pituitary-v-adrenal ultrasound during treatment with Lysodren and his adrenal glands both appeared small normal which is what you would expect with pituitary Cushing's with Lysodren treatment.

Considering that almost all adrenal tumors are not completely destroyed by Lysodren but are more just inhibited, I would think that with an adrenal tumor that it would still show up on ultrasound despite Lysodren treatment, so having the ultrasound should be able to indicate whether the Cushing's is adrenal or pituitary.

I should add that even when done before treatment is started, there is a very small percentage of dogs where the ultrasound doesn't give you a conclusive diagnosis of pit-v-adrenal because of something like a nodule on an adrenal gland that may or may not be significant.

Alison

[labblab]

I remember in the past we had a dog here that had the pituitary-v-adrenal ultrasound during treatment with Lysodren and his adrenal glands both appeared small normal which is what you would expect with pituitary Cushing's with Lysodren treatment.

Alison
Upon reflection, this is what I feared would probably be the case. So in this situation, where Ellen is trying to confirm a general diagnosis of Cushing's in the first place (rather than solely differentiating the type), I'm thinking that an ultrasound at this time may be of more limited value than is generally the case. Because if the adrenals appear small normal (and without any growths), you wouldn't know whether that means that Casey has pituitary Cushing's, or whether she doesn't have Cushing's at all...?

Not every PDH dog will exhibit enlarged adrenals on a diagnostic ultrasound, but I'm thinking that for the time being, Casey's Lysodren treatment may have eliminated that as a possible diagnostic indicator of PDH. So that takes me back to considering Leslie's original suggestion that Lysodren be discontinued for a period of time prior to ANY diagnostic testing. However, there may still be enough advantages in favor of an ultrasound to go ahead with it now rather than waiting. And as Glynda says, you'd hate to lose ground with the Lysodren if that ends up remaining the recommended treatment. I know I'm repeating myself, but I'll sure be interested to see the results of that first ACTH stim test and to find out what the vet recommends!

Marianne

[Casey's Mom]

Thank you to everyone for their input - as my veterinarians are both hard to get in touch with this is a life saver for me and Casey.

I have her initial blood work test results from February - pre diagnosis and treatment:

UREA - Normal
CREA - Norml
PHOS - Normal
CA - Normal
TP - Normal
ALB - High
GLOB - Normal
ALT - High
ALKP - High
TBIL - Normal
CHOL - High
AMYL - Normal
CLU - Normal
NA - Normal
K - Normal
CL - Normal

These results led my vet to test her cortisol/creatine ratio which was high 81.7 whereas on the lab test results it states that a ratio of over 60 is supportive of a diagnosis of Cushings and suggest a LDDS test is warranted (not done but perhaps necessary?) my vet said it was better to do the ACTH test:

Initial ACTH results on March 4 : Pre treatment

Cortisol 0 hour - 98 (15 - 120 nmol/L)
Cortisol 2 hour post ACTH - 933 ( 220 - 550 nmol/L)

2nd ACTH results - after beginning treatment April 30

Cortisol 0 hour - 78 (15-120 nmol/L)
Cortisol 2 hour post ACTH- 183 (220-550 nmol)

Third ACTH results - July 24

Cortisol 0 hour - 203
Cortisol 2 hour post ACTH - 317

I know this is a different way than what you have in the US for test results but someone here figured it out - I would have to think back to who but thank you!

Since then we have reloaded and now that I have begun splitting her dosage into 3 times per week 250 mg every 3 days she is doing very well. I have an appointment for another ACTH test on September 15th and if the results are not good I have asked for an LDDS test, ultrasound and adrenal panel to be done - and I am definitely going to ask for advice here first before I do any more testing.

I think I have found my new best friends. It is very comforting to have other dog owners going through the same things to give advice. You are all great research assistants!! Your kindness is very much appreciated . . . . . .

[Casey's Mom]

Additional test results:

Urinalysis from Feb 24:
pH 6.0
LEU neg
PRO 0.3 g/L
GLU neg
KET neg
UGB normail
BIL neg
BLD 10 ery/gL
S.G. 1.011

Bloodwork results from March 25th - after 6 days of loading dose of Lysodren:

Cortisol - 14 nmol/L

pH - High
HCO3 - Normal
PCO2 - Low
AnGap - Normal
tCO2 - Normal
Na - Normal
K - Normal
Cl - Normal

When Casey became sore on her hind end after initial dose of Lysodren I was reluctant to give it to her - subsequently in June she was xrayed after falling down some stairs and it turns out she does have arthritis in one of her hips. I have to admit that I was not giving her the proper dosage at the time because I wasn't sure which was better - seeing her in pain or panting/anxious/drinking. After our second loading dose she seems much better and we are dealing with the pain. When the vet xrayed her she did some bloodwork to see if she could take NSAID's for the pain: Her ALT was 189 U/L and her ALKP was 229 U/L - down from her initial results in February but my vet was still reluctant to prescribe her NSAIS's so gave me a prescription for Tramadol. It doesn't seem to work that well but the vet said its effects were cumulative and if I give it over time it will help. Not sure about that . . . I like the idea of the freeze spray and will spend the weekend looking for something similar or see if I can get it here.

[Harley PoMMom]

Hi Ellen,


I know this is a different way than what you have in the US for test results but someone here figured it out - I would have to think back to who but thank you!Oh, Honey, it's not that it's a "different way" per se, we are just used to seeing them numbers IN a "different way" :), what we have to do is convert nmol/L into ug/dl and the way we do that is divide the nmol/L values by 27.59, ok, no big deal here, just our feeble brains and eyes like to see things the same. :D

You are doing a great job, Ellen, you are also getting very good advice from some of our "experts," these people have helped my Harley and me tremendously, take their advice to heart, Ellen, they will not steer you wrong, they know what they are talking about when it comes to this cushings disease and anything related to it.

Hang in there, Ellen, anything you don't understand, ask about, ok.

Love and hugs.
Lori

[Casey's Mom]

Thanks Lori!

[labblab]

Ellen, thanks so much for posting all of Casey's testing/lab results! I have only a short time to reply right now, so I will just comment on the initial diagnositic ACTH stim results. When the units are converted to the units commonly used in the U.S., Casey's "post" result was 33.8. And that is definitely an elevated result that is consistent with a diagnosis of Cushing's. So all the pieces taken together: her symptoms, her elevated liver enzymes, the "positive" UC:CR which led to a "positive" result on the ACTH -- these all support the accuracy of the diagnosis.

Just to elaborate for a moment on the ACTH stim vs. the LDDS...both of these are blood tests that are used to establish an initial Cushing's diagnosis. Different vets have different preferences as far as which test they use most frequently. And sometimes, the decision will depend upon each dog's particular circumstances.

The ACTH is a more "specific" test for Cushing's. This means that it is less likely than the LDDS to give a positive result when a dog does not actually have Cushing's. On the other hand, the LDDS is a more "sensitive" test for Cushing's. This means that it is less likely to MISS diagnosing Cushing's in a dog that actually DOES have the disease. Both tests can give false positives when other, nonadrenal illnesses are present. But the ACTH is less likely to do so. So in a sense, the ACTH is the more conservative test. It will miss diagnosing Cushing's in a larger percentage of dogs (and it does a particularly poorer job of diagnosing adrenal Cushing's than does the LDDS). But a "positive" on the ACTH is actually more trust-worthy than a positive on the LDDS (while a "negative" on the LDDS is more trustworthy than a negative on the ACTH).

This is a long-winded way of saying that I don't think your vet made a mistake by performing the ACTH instead of the LDDS. Ideally, it would be great to have both tests performed for every dog. But many vets will select one vs. the other for various reasons, including the type and severity of the presenting symptoms, and whether or not there are other illnesses (like diabetes) present at the time of testing.

I am really glad to hear that Casey is doing better with her new dosing pattern! And if her next ACTH stim results are in the proper therapeutic range -- you may have things well under control! If not, it'll be back to deciding on the next step. And as we've said, that may include an ultrasound that could help to identifiy whether or not Casey has an adrenal tumor or any problems with her other organs, and some selected testing through Univ. of Tennessee. But just to repeat what Leslie has already advised, there would be no benefit to performing an LDDS while Casey is being actively treated with Lysodren.

Thanks again for all these results. And I'll sure be anxious to see how the next ACTH stim test turns out.

Marianne

[Casey's Mom]

Thanks Marianne!

[Casey's Mom]

I have a general question for all of my expert friends out there - I decided to try Casey on a Yucca supplement beginning last week and then on the weekend I read on the bottle that Yucca helps with arthritis in dogs by bringing out the natural steriods in the body.

Will this harm a cushings dog?

Hope everyone had a beautiful weekend - we finally had a summer long weekend!

[gpgscott]

Hi Ellen,

I can't think of this question coming up in the past.

I don't know, I did look for the supplement and it makes claims of desireable effects and the explanation is plausible. Cortisol which is the steriod overproduced in a case of classical Cushing's is a glucocorticosteroid. The component in Yucca is saponin which is a glycoside and I gotta say that the words are similar enough that I would be concerned, just because a supplement does not require a script or claims to be natural does not mean it is safe for all.

I would not administer this to mine without approval of the treating Dr.

Scott

[acushdogsmom]

Some say that yucca helps to increase the body's own natural production of cortisol by the adrenal glands, although I'm not sure of the exact mechanism by which yucca would cause that effect. I've also heard that yucca contains saponins, which are a precursor to cortisol.

I may have been over-cautious but I always made sure to steer clear of anything containing yucca for my Cushing's dog because I didn't want to give him anything that might interfere with or compromise our efforts to keep a tight control on his cortisol production.

[Casey's Mom]

Just wondering - my vet in Canada prescribed Tramadol for Casey's arthritis and the cost is $75 for 60 pills. The Medicine Shoppe made it up for me but that's a big cost. It also doesn't seem to work very well, any advice out there?

[gpgscott]

Ellen,

this is a hijack, but I know Sharon will be OK it it.

Let me get on my soapbox.

Tram for arthritis is a give up.

Tram is a pain med it is a synthetic morphine.

There are many meds and supplements which will help arthriticic issuse that are not pain killers.

Scott :)

[labblab]

Hi Ellen,

I took the bull by the horns (:p) and acted on Scott's suggestion by going ahead and relocating both of your replies to your own thread about Casey. This way, folks will be able to respond to you directly with their suggestions and thoughts regarding both the costs and also the advisability of long-term treatment with tramadol.

I hope this will make it easier for you to get some direct feedback about your questions. :)

Marianne

[Casey's Mom]

Scott I have tried glucosamine, deep freeze spray and am now trying Mangostene juice for Casey - is there anything else I should try - supplement or meds?. She is lame and does not want to put weight on her right hind - however she can still run at the park somewhat three legged!. The vet x rayed and said she had arthritis in that hip joint. I did read somewhere on someone else's post that they can have hind end weakness due to elevated hormones as a result of cushings - could this be it?

Casey goes in for her stim test tomorrow so I will post results when I get them.

[Roxee's Dad]

Hi Ellen,
You may want to ask your vet about Adequan. It's a shot (injection) that Casey would get once or twice a week for the first month, then once a month thereafter. Seems it has helped alot of pups with arthritis. If your willing, you can get the adequan from the vet and give the shot/s yourself.

Glucosamine is good but it doesn't work overnight. as with most supplements, it takes time for it to help with the arthritis.

Looking forward to some good stim results.:)

[Casey's Mom]

I have a question for all of you cush parents out there - Casey seems to want to sleep in the dirt under the tree in our backyard all of the time now - she would stay out all night if I let her!. This is new behaviour since our summer finally kicked in these last few weeks. Usually she wants to be wherever I am - is she trying to get cool?

[Harley PoMMom]

Hi Ellen,


Usually she wants to be wherever I am - is she trying to get cool? I would have to say yes, before I knew what was wrong with my boy, Harley, he would always seek out the coolest spot...at night he usually slept on top of the bed with me, then he started getting down and going in my "mud room" and laying on the linoleum floor, my bedroom floor is carpetted, the linoleum floor is hard but cool. Now that I know he has cushings and is sensitive to the heat, I keep my house a cool 69 degrees.


I did read somewhere on someone else's post that they can have hind end weakness due to elevated hormones as a result of cushings - could this be it?Don't know if this is the issue with Casey, but elevated intermediate/sex hormones in pups can cause harm/symptoms just like cushings.


Casey goes in for her stim test tomorrow so I will post results when I get them. Good luck with the stim and will be here with the rest anxiously awaiting the results! :)

Love and hugs.
Lori

[gpgscott]

Ellen,

Sorry for the short response of yesterday.

Of course you give whatever is necessary, and I also keep Tramadol around but use it only when absolutely necessary.

I am an advocate of Adaquan, have used it in the past before it was labled for canine and Moria gets an injection monthly.

Concerning glucosomine, there are many permutations and it is my understanding the only reseach done has been done with glucosomine sulfate, which is also the least costly of the various offerings. I used to purchase the glucosomine sulfate at Sam's Club, but all they have these days is glucosomine HCI. From my understanding it is similar but requires the body break it down a time or two until it is available to the joints.

Scott

[Casey's Mom]

Thanks for the reply Scott - I ordered Casey Adequan today when I was there to get the stim test. When I rode horses it was well known in the horse world and had good results. My vet has to give the shots though they won't sell a bottle. I also give glucosamine chondroitin and have been for about a month. Tramadol really does nothing for her and it seemed like a waste of money to me but I guess if I needed to I could give her more if she showed a lot of pain.

Is she has elevated hormones what is the testing? Hopefully I should have my test results by Thursday. I will be in Toronto but the vet's office said they would email the results. Hopefully they will be good!

[gpgscott]

I think the Adaquan was approved for equine use prior to canine use here in the states and it seems to be well accepted in the equine community. I get mine at 800petmeds.com. The Dr. charges twice as much for the same amount.

In Moria's case her hip issues are extreme but she still requires some pain relief at times and in our case the Tram does provide pain relief, but it does make her a bit stupid.

Scott

[Harley PoMMom]

Hi Ellen,

The UTK full adrenal panel measures the level of the five intermediate/sex hormones which are: androstenedione, estradiol, progesterone, 17 OH Progresterone, and aldosterone, it also includes a ACTH stim. Since you are using the Lysodren treatment on Casey, Lysodren lowers progesterone, androstenedione and 17 OH Progresterone. IMO you can do a couple things here; 1) since Lysodren does not lower estradiol, just have her estradiol level checked or 2) run the full adrenal panel.

The aldosterone is what balances electrolytes in Casey's body which can be done on her Chemistry blood panel or her blood panel might be called something else, when they are looking for the electrolytes, at least on Harley's Chemistry blood panel, they call these Na (Sodium) K (Potassium), then they usually give a ratio too, Na/K.

Here is some info for the UTK panel:

SHIPPING INFORMATION
http://www.vet.utk.edu/diagnostic/endocrinology/shipping.php

GENERAL INFORMATION
http://www.vet.utk.edu/diagnostic/endocrinology/pdf/endo_tests_info.pdf?r2
The General Information is where you'll find the full adrenal panel, scroll down to #3 Adrenal Function, letter g.

Submission Form
http://www.vet.utk.edu/diagnostic/endocrinology/pdf/endosubform06.pdf?r2

Hope this helps.

Love and hugs.
Lori

[Casey's Mom]

Good news - Casey's results were pre 110 which I believe thanks to Lori's help translates to 4 and post 114 - 5.21. I know the post results were a little high but we are getting there and this is helping me to get her dosage right. I knew she was due for Lysodren the night before but I waited until the next day after her test just to see how she was doing. She weights 40 lb and I give her 250 mg 3 x a week. She is doing very well other than her arthritis but I have ordered Adequan for her and hopefully that will help.

Thank you to all of you for giving your help - the knowledge on this site is amazing and I read it every day. Will be in touch soon and let you know how the Adequan works.

Love and hugs everyone . . . .

[Harley PoMMom]

Hi Ellen,


Good news - Casey's results were pre 110 which I believe thanks to Lori's help translates to 4 and post 114 - 5.21. I think we need to recheck here... ;) 114 - 4.13, the 5.21 = 143??


I knew she was due for Lysodren the night before but I waited until the next day after her test just to see how she was doing. I am no expert at using Lysodren, but I do believe when you want to stim your dog you must stim on the dogs day off of Lysodren. I am hoping those who are more experienced at this will give their opinion.

I am so happy that you have ordered the Adequan for her and I am hoping it will work for her also, those memebers here that have tried it have had success with it on their pups, so best of luck to you and Casey.

You're doing a wonderful job with Casey, please keep us posted.

Love and hugs.
Lori

[Casey's Mom]

Lori yes that's right for the test results. The vet did not tell me not to give her the Lysodren on the day of her test - I kind of figured that so that's why I didn't give it to her that day and waited another day. Am I right in thinking her results were good?

[Harley PoMMom]

Lori yes that's right for the test results. The vet did not tell me not to give her the Lysodren on the day of her test - I kind of figured that so that's why I didn't give it to her that day and waited another day. Am I right in thinking her results were good?Yes, as long as Casey didn't have Lysodren the day before, I believe your results are good.

I can't believe your vet didn't mention that important detail...Ellen, you are doing an amazing job. :D

Love and hugs.
Lori

[sunimist]

Hi Ellen,

Yea for Casey!

I knew she was due for Lysodren the night before but I waited until the next day after her test just to see how she was doing. I also always waited until after testing if a dose was due that day, but the vet always wanted to know when the last dose was. She preferred not to give any meds until after testing in case we needed to do other blood work (which we almost always did)!
This is just my experience and should in no way be considered standard unless specified by your vet. Others may have different views and different experiences.

I am thrilled that Casey is responding and doing well! :D

((Hugs))

Shelba and Suni

[lulusmom]

Hi Ellen,

Great results on Casey's stim!!!! For future reference, it is optimum to have the stim test done 48 hours after the last dose. If you had it done less than 48 hours or longer than 48 hours, it is possible that Casey is right where she needs to be. Keep up the good work, mom!!

Glynda

[Casey's Mom]

My vet is not very communicative I seem to talk to the technicians more and they don't want to give any advice without talking to the vet. Casey didn't have Lyso for 48 hours before the test so I guess I guessed right! Thanks guys - I have learned so much on this site thanks to all of you!

Good night and sweet dreams to you and all the pups

[Casey's Mom]

Just in case anyone out there is still awake . . . Casey is very anxious tonight and does not want to go to sleep - she wants to sleep outside under her tree in the backyard but I think it will be too cold (9 celcius) for her arthritis. Can I give her melatonin to help her sleep and what is the dose? She weighs 40 lbs.

[AlisonandMia]

It should be ok to give her some melatonin. Someone else here who uses it to help her dog sleep and settle when he is restless gives 1mg when necessary. The dog is a basset so he's a medium to large dog. The dose to control hormones is higher than that so 1mg should be ok.

Here's a link to her thread: http://www.k9cushings.com/forum/showthread.php?p=13214&highlight=melatonin# (scroll about 1/3 to 1/2 the way down that page)

Alison

[ventilate]

Hi;
I havent posted to you before. Congrats on your stim results that is perfect. I agree with Selba, I do not give lysodren on the day Nike was being tested but I did the day before. Waiting 48hs was not important to my vet nor my IMS. I would always try to have her tested on the same amount of hrs after her lysodren. Like if she had lysodren on Monday AM and was tested Tues AM I always try to have her tested 24 hrs post treatment so that was consistant. For me the consistancy is the important thing so I was comparing apples to apples. having her tested 12 hrs post lysodren one time then 48 hrs post treatment the next may make her results a bit different. So even if you gave lysodren the day before the numbers are still great.. Although 48 hrs is optimal it is not life or death. I think for Nike she peaked at 24hrs, I sometimes had to give pred 24 hrs post but she was ok at 48. IMO it is more important to be consistant with the testing days and lysodren days.
Be sure to check with your vet about giving the malatonin. Even thought it is not a perscribed medication your vet needs to be aware you are giving it.
I am so glad that Casey is doing well, Keep up the good work.
Sharon

[Casey's Mom]

After I reread my posts I realize that I posted her after results incorrectly - it should have read post 144 = 5.21 on her stim. I believe that is still good. My problem now is that she is so hot all the time and doesn't want to come in to sleep and it is not that warm outside - 10 degrees celcius at night. I had her shaved at the beginning of the summer - even though winter is coming I think I may give her another shave to cool her off and then use a coat when I take her out for a walk - what do you think? Should I let her sleep outside while I am waiting to have her shaved? I have a fenced yard - right now she only comes in when I bribe her with food! This has been going on for the last week or so.

[AlisonandMia]

A compromise on the winter shave could be to get her tummy only shaved - if you can handle the "look". They seem to lose a lot of heat through their bellies and groin area but keeping the hair on over her back would keep her spine, hips and kidney area warmer. They do this sort of clip with horses that are worked hard (and will therefore sweat) during winter.

At one point I got the vet to shave Mia's belly (as they would for an ultrasound) and it really helped her keep cool even though the rest of her was fairly woolly.

I'd let her sleep outside providing there are no dangers out there.

Alison

[Casey's Mom]

Thanks Alison, I am a horse person myself so I know all about the clip you describe. Good idea! I will feel better with her sleeping outside. She is my backyard under her favourite tree and she has made herself quite a good bed under there from all of her digging this summer. It is a 6 foot high privacy fence all around the yard so she should be safe unless something jumps in - but other than the neighbourhood cats she should be okay - off to bed for me, thanks again.

[Harley PoMMom]

Hi Ellen,

I totally agree with Alison about the belly-shaving, it has helped Harley a great deal to keep cool, I also do that for my other Pom. I keep my house pretty cool...69 degrees...but if I find that my boys are panting at night I just spray alittle water on their shaved bellies and it seems to help more.

Love and hugs.
Lori

[Casey's Mom]

I keep my house pretty cool as well - 67 or 68. Right now I am beginning to think it is a behaviour issue because she won't relax at all in the house. Weird that it started all of a sudden . . . . I will get my sister to help me shave her belly today. She can't stay outside tonight or tomorrow because it is going to rain and thunderstorm.

[Roxee's Dad]

Hi Ellen,
Just a quick input from a groomer. :p Don't shave it to close as to razor burn the tender skin. I'm not sure what you have to use to shave Casey but I would'nt use anything shorter than a number 10 clipper blade. Also check the temp of the blade as you are shaving. The cheaper clippers tend to get hot very quick and can burn the skin immitatiing razor burn. Just touch your wrist with it every few minutes.:)

[Casey's Mom]

Thanks John - I ended up taking her to my groomer she did a quick job on her belly - she is now in my bedroom with me and not outside as it is supposed to rain tonight. Hopefully soon she will go to sleep . . .I gave her some melatonin to help her relax.

[Harley PoMMom]

Hi Ellen,

How is Casey, is she still so anxious?

[Casey's Mom]

Thanks for asking Lori - she is up again and I gave her a bit more melatonin hopefully she will go to sleep soon and I can get back to sleep.

[Dollydog]

Hi Ellen,
Hope you both were able to sleep last night...
Jo-Ann

[Casey's Mom]

Thanks guys, all of us slept until 9:00 - the melatonin is great for relaxing her and hopefully in a week or so she will be used to sleeping outside again. You guys are great support in the wee hours!

[Harley PoMMom]

Hi Ellen,

Just a thought here about Casey's anxious behavior, I wonder if the Lysodren is upsetting her tummy, here is a link to our Resource thread about giving Pepcid AC to your dog to help combat the gastric upset from the medication. I don't know if you ever checked out the "Collection of "tips" from our members and their Vets," but it has very valuable information.

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

"A collection of "tips" from our members and their Vets:"

For dogs who may experience some gastric upset from the medication, a Vet may prescribe a weight-appropriate dose of Pepcid AC to be given to the dog about 15 minutes to half an hour before the meal with which the Lysodren is given.

Love and hugs.
Lori

[Casey's Mom]

Thanks I wil try Pepcid AC - and of course I am tired when I reread my last post I said trying to get her used to sleeping outside when of course I meant inside. I think I need that bottle and blender!

[Barney's Mom]

Thanks I wil try Pepcid AC - and of course I am tired when I reread my last post I said trying to get her used to sleeping outside when of course I meant inside. I think I need that bottle and blender!

ROFL! We are more than happy to share! Glad to hear the melatonin seems to be working for Casey.

Cheryl

[Casey's Mom]

Hello to all of my friends, I have a question and wondered what advice you have for me. Casey was in to the vet today for her Adequan shot and I had a few minutes to ask some questions. She says Casey looks great and then I remembered to ask her about her Parvo vaccine. Originally back in March we talked about it because there is a high outbreak here and we go to the doggy park every day. My vet said to wait until we got everything under control and now that we do she gave Casey the vaccine - it was a combo with Distemper etc. I remember two years ago when she got her vaccine she was very tired for about a day following the shot. Tonight again she is very sleepy and has been since we came back from the vet. She is due for her small dose of Lysodren ( I give 250 mg 3 x a week along with some pepcid AC thanks to you for telling me about that!) tonight but I am holding off because she seems so tired. I have to go on a business trip tomorrow and will be back on Thursday my girls go to the pet sitters. Should I give her the Lysodren in the morning or wait until I come back Thursday night? I have a call into the vet but she may not get back to me before I leave. Any thoughts?

[BestBuddy]

The parvo and distemper is a must have yearly vaccination here(lucky we don't have to do the rabies one as well) and even my healthy ones seem a little lethargic for 24 hours or so after the injection. I never used Lysodren but I would not give Casey the usual dose. Hopefully the Lyso mums will chime in and advise you because I am only guessing.:o

Jenny

[AlisonandMia]

Mmmm, what you really need is a crystal ball.:p

My instinct is to skip the dose, but to incorporate the missed dose into the next two doses (provided she seems back to normal after you return on Thursday, of course). You could do it some other way, especially if you are concerned the larger dose could upset her tummy, but the aim is get the same dose into her for the week that you normally would one way or the other. Some dogs' adrenals regenerate very, very fast - if my Mia had missed a dose (she had her weekly dose split into two doses per week) her numbers would have risen as a result.

Good luck and let us know how it goes.

Alison

[Harley PoMMom]

Hi Ellen,

Just wondering how you and Casey are doing?

Love and hugs.
Lori

[Casey's Mom]

Thanks for asking Lori - we have been doing quite well, no anxiousness, no cushings symptoms and the Adequan is really helping with her arthritis. Until tonight - she just started to drink a lot today and is anxious again. Hopefully it will only be for tonight and we will get back on course tomorrow after her Lysodren dose.

Thanks for checking,

[gpgscott]

Hi Ellen,

Very glad the Adaquan is helping, it does for us.

Hugs to you and Casy.

Scott

[Casey's Mom]

Yes Scott - thank you so much for suggesting Adequan. It is helping a lot!

[Casey's Mom]

Hello everyone, we have been doing just fine- Casey is due for her next ACTH next Wednesday. Out of the blue today I gave her her Lysodren dose this morning and tonight she started acting strange, staring into space and not wanting her evening meal or a drink. I gave her 2.5 grams of pred about an hour ago to no effect. Should I give her another 2.5 grams or wait? She weighs 40 lbs and her dose on the bottle is 5 grams.

We went back to 375mg 2x a week for the last month as the 250mg 3x a week was not effective - cushing symptoms came back.

Just reaching out . . .

Winter storm coming from the states tonight. Not looking forward to shovelling!

[AlisonandMia]

You could (and probably should) give the other 2.5mg. The "rescue dose" of pred for a dog with low cortisol is around 0.25mg per kg so at 18kgs that would mean 5mgs. Usually they bounce back within the hour of getting pred when they haven't been low for long. Does she seem weaker than usual?

Alison

PS - the larger maintenance dose she's been on for the last month may have actually eroded her adrenals (especially if clinical symptoms disappeared on that dose) and she may, in fact, have overloaded slightly now. Oops, Just realized that wasn't an increase - it was the same weekly dose given in two doses rather than three. How have the Cushing's symptoms been over the last week or two?

Happy shoveling - we are having a minor heat wave here!

[Casey's Mom]

Other side of the world too strange!

She has been just fine on the 350 mg 2x a week for about 6 weeks now. Now she is whining and wants to be outside in the snow. She did have a drink but maybe I should give her the other 1/2 of her dose.

I will let you know in an hour how we are doing, thanks for being there Alison, I can always count on you in the middle of the night even though its 10 pm here. Are you at work?

[Casey's Mom]

Yes Alison, she does seem a little weaker on her back legs, and was reluctant on our daily walk at 4 p.m., walking rather than trotting.

[Harley PoMMom]

Hi Ellen,

Just to let you know even tho I haven't started Harley on his Lysodren as of yet (I do have it) and I do have his pred. too. His pred. is 5mg to be given to him if he would need it. He weighs all but 24lbs.

Love and hugs,
Lori

[AlisonandMia]

I would give her the other 1/2 of the dose especially as you won't be able to watch her over night as you would during the day. Because Lysodren is long acting her cortisol will likely continue to decrease somewhat for the next 36 hours or so, so keep and eye on her.

Alison

[Casey's Mom]

Thanks Alison, I will give her the other half. I will post in the morning to let you know how she is. She doesn't seem at all tired. Just laying down and staring at me and then off into the distance as if listening and watching for something although her ears are half back instead of forward. She did drink some more water and had some cookies but she definitely isn't her normal self. It is amazing how in tune we become with our pups.

I also plan to check on her throughout the day tomorrow. I can stop in frequently.

I am confused as to why this would happen all of a sudden? She was weighed at the vet's office on Monday when she had her Adequan shot and she was 18 kg instead of her usual 18.3 but I wouldn't think her dose of Lysodren would need to change for that?

Thanks Lori for being there and good luck with your Harley. Casey was prescribed 5 mg for 18k or 40 lbs so to be Harley's dose seems high but I could be wrong.

I may be up for a while, just lying in bed catching up on others posts as I wait for my girl to fall asleep,

[Buffaloe]

Hi Ellen,

If it were me, I would not hesitate at all in giving Casey a little extra prednisone. I hope she perks up soon.

Ken

[Casey's Mom]

Thanks Ken I did give her the other half about half an hour age. She is still staring off so I got down on the floor to try and relax her and pet her but she is still listening for something and kind of tries to talk to me. Don't we all wish they could, it would make things easier :confused:

[Casey's Mom]

Lori I was just reading about L-Glutmine on another post This sounds good for Casey's muscle wasting which is getting quite pronounced,

Any thoughts on this and where I can get it?

[Casey's Mom]

She's asleep which means I will be too - thanks everyone as always you are the best . . . .

Sweet dreams to you and you pups . .. .:)

[littleone1]

Hi Ellen,

How is Casey doing this morning? I hope she is doing better. I also hope that you were able to get some sleep.

Terri

[Harley PoMMom]

Hi Ellen,


Lori I was just reading about L-Glutmine on another post This sounds good for Casey's muscle wasting which is getting quite pronounced,

Any thoughts on this and where I can get it?

I use L-Glutamine for Harley, I purchased mine from Monica Segal's website. This is from her website:


L-Glutamine 500 mg

Description:
L-Glutamine is a component of cells that are plentiful in the epithelial lining of the gastrointestinal tract. L-Glutamine can help conserve muscle glycogen stores, support the health of nerve cells, and cross the blood-brain barrier where the brain uses it for fuel.

Recommendations:
Give one capsule per 30 pounds of bodyweight, or as directed by your veterinarian.

Each capsule contains 500 mg L-Glutamine. Does not contain preservatives, dilutents, or artificial additives and is not derived from animal sources.

http://www.monicasegal.com/catalog/product.php?products_id=338

Here is a little bit about Monica, now she is not, as far as I know, a board certified Veterinary Nutritionist, but I believe she is very good at what she does. She has formulated a diet for Harley and so far he is doing wonderful on it.


Monica Segal is certified in Animal Health Care through the University of Guelph with studies in animal nutrition,physiology, diseases and parasites, as well as pet care.

http://www.monicasegal.com/aboutus/aboutus.php

I hope Casey is feeling alot better today...please let us know as soon as you can.

Love and hugs,
Lori

[Casey's Mom]

Thanks for checking in, we had a very long night Casey started having to go out to pee at 3 then again at 4:30 and then 6:am. I think the prednisone does too good of a job on her! When we first did her loading dose back in March she went a little too far and when I gave her 5 mg of prednisone she was a fanatic, drank about 6 bowls of water and peed non stop for about 12 hours. I have always been a little anxious of her reaction ever since.

Now she is back to normal thank goodness. She is due for her next dose of 375 mg Friday evening, then again on Tuesday morning. She is then booked for a stim test Wednesday morning. The vet said no Lysodren for 24 hours but I have read 48 hours on this site. I can change the date of my stim to either Monday or Tuesday - any thoughts? Also should I give the Lysodren Friday night and Tuesday morning?

I'm thinking she needs a change in dose but I also want to get a true reading on the stim test and not hold off until then and have her cortisol levels too high and the vet will want to increase her dose, what to do is a dilema.

Nasty winter storm out there so I will work from home most of the day . . . .

Take care everyone,

[Squirt's Mom]

Hi Ellen,

So glad to read this morning that Casey is back to normal even tho the pred made for a long nite for both of you!

If it were me, I would watch how she does after the Fri. dose and if she starts to act the same way after that dose, I think I would get the ACTH Mon, or maybe even Sat, just to be sure her levels aren't too low and that the electrolytes are alright. If she needs the pred again, you will want to wait 24 hrs for it to leave the system before the ACTH.

If believe the optimal timing after a Lyso dose is 36-48 hours for the ACTH. (Someone correct me, please, if that is not right!) But if Casey has these same behaviors Fri., I would get one done asap.

Please keep in touch and let us know how she is doing if you can. We are all a bunch of worry warts, ya know! :p

Hugs,
Leslie and the girls

[Casey's Mom]

I will give her Friday nights dose and then let you know how she does with that -

I have changed her ACTH test to Monday morning.

Thanks everyone,

[Casey's Mom]

On our walk tonight Casey was running through about 6 inches of snow way in front of me at the park. I had to run after her (not easy in all that snow and carrying Desi who's feet were too cold) and put her on her leash. She had felt boots on which worked well because her feet didn't freeze up but regardless, I have not seen her do that in a long time.

Was it the pred from last night - because if it is man she feels good!!

[Harley PoMMom]

Hi Ellen,

I'm thinking the pred. is what's making her feeling so frisky! It should be out of her system in 24 hours tho.

I know when I had to be on pred. for a time period it really made me feel wonderful...as long as I took it with food, my tummy is so sensitive to everything. :eek::(:)

Love and hugs,
Lori

[Casey's Mom]

Thanks Lori and also I wanted to thank you for the link to L-Glutamine, looks interesting and I will check it out.

Have a great day,

[AlisonandMia]

Thanks for checking in, we had a very long night Casey started having to go out to pee at 3 then again at 4:30 and then 6:am. I think the prednisone does too good of a job on her! When we first did her loading dose back in March she went a little too far and when I gave her 5 mg of prednisone she was a fanatic, drank about 6 bowls of water and peed non stop for about 12 hours. I have always been a little anxious of her reaction ever since.

Now she is back to normal thank goodness. She is due for her next dose of 375 mg Friday evening, then again on Tuesday morning. She is then booked for a stim test Wednesday morning. The vet said no Lysodren for 24 hours but I have read 48 hours on this site. I can change the date of my stim to either Monday or Tuesday - any thoughts? Also should I give the Lysodren Friday night and Tuesday morning?

I'm thinking she needs a change in dose but I also want to get a true reading on the stim test and not hold off until then and have her cortisol levels too high and the vet will want to increase her dose, what to do is a dilema.

Nasty winter storm out there so I will work from home most of the day . . . .

Take care everyone,

I really wouldn't give any more Lysodren until you can get a stim done. It sounds like she is unable to produce quite enough cortisol at the moment - ie that a little too much of the adrenal cortex has been eroded - so giving more now could well be dangerous.

The way she is feeling so well on the pred makes me wonder if she hasn't been a shade low for a while, not enough to actually make her unwell, but just low enough to take her spark away. Cold weather can mean that they need a little more cortisol too, to support the increase in metabolic activity that is necessary to keep warm, so very cold conditions could (like any stressor) either make slightly-too-low cortisol more obvious or mean that a little bit of pred is necessary during a cold snap if the cortisol levels are within range.

Good luck and keep us posted.

Alison

[Casey's Mom]

Great advice Alison,

Her stim test is Monday so if I hold off on her next dose which is Friday night and she tests high on the cortisol what then? I am worried that the vet will want to increase her dose.

I am going to hold off on the Lysodren and will keep you posted if her cushings symptoms come back over the weekend. Right now she seems normal, it is a bone chilling -13 celcius with a wind chill of -21 so we haven't walked today. I put boots and a coat on Casey but she didn't want to go far unlike yesterday so that could be a sign her levels are too low.

Thanks and I will keep you posted:)

[Squirt's Mom]

Hi Ellen,

Glad to hear that you will be holding the Lyso for a few more days at least. Don't hesitate to use the pred again if you think Casey is getting too low again. It can sometimes take a little bit for the adrenal to regenerate enough to start producing cortisol on their own. But don't get discouraged...you are doing an excellent job!

Hang in there!
Hugs,
Leslie and the girls

[Casey's Mom]

Leslie you read my mind! She seems tired and didn't want to walk again although it could be this mind numbing wind chill cold:(I am going to a staff party tonight and have my good friends of the Havanese I babysit coming to my house to watch my dogs - great friends. I will give her 1/2 pred at dinner if she doesn't seem right.

[John II]

Hi Ellen

Hope Casey is back to her old self soon (and the stim test goes well - and the Lysodren dose doesn't get increased).

[Casey's Mom]

Casey was still a little tired again yesterday so gave her 1/2 pred. Today she is starting to show cushings symptoms. Panting and hungrier than normal. She has her stim tomorrow am and has been off Lyso since last Tuesday (didn't give Friday's dose). It will take until Thursday to get results so how soon after her stim test can I give her Lyso again? I may not get to talk to the vet tomorrow (pretty sure of that) so wondered what kind of opinion you guys have.

[Squirt's Mom]

Hi Ellen,

You will let the ACTH results and her signs guide you as to when the Lyso needs to be restarted. Looking forward to seeing the results!

Hugs,
Leslie and the girls

[Harley PoMMom]

Hi Ellen,

How is Casey today?

[Casey's Mom]

Casey spent the morning at the vet's. I also had them do a geriactric blood profile as well as the stim test. We also paid for another bottle of Adequan so it was lots of $$$! Oh well they are worth every penny.

Vet's think I may have results faxed to me tomorrow but we are in the middle of another snow storm so I won't be surprised if it is Wednesday. The vet said to keep her on the same Lysodren schedule and to give her meds with food and Pepcid AC (which I have told them I already do). They think her stomach is upset and that is her reaction from the Lysodren when in fact this is not what I told them, I said she had no interest in eating or drinking even though she would go to the bowls she would put her head down and then walk away, she also had this vacant stare. Somehow that message is not going from me to the person on the phone to the vet.

Casey seems quite fine today - normal in fact. Even though they told me to continue her Lysodren dosing I am going to hold off until I see the results from her ACTH. Yesterday I thought I saw cushings symptoms but it was also a hectic day for her with lots of visitors and we then we went visiting so by the time I sat down last night she slept like a log and seemed fine. I will post all of her results here when they come through.

You are so sweet to check in with me Lori, with all that is going on with Zoe and Ruby I feel guilty posting my concerns with Casey. I am grateful not to have something so major going on with my girl and my heart goes out to everyone that is going through hard times with their pups. Just so you all know I am thinking of you,

Hugs,

[Harley PoMMom]

.
You are so sweet to check in with me Lori, with all that is going on with Zoe and Ruby I feel guilty posting my concerns with Casey. I am grateful not to have something so major going on with my girl and my heart goes out to everyone that is going through hard times with their pups. Just so you all know I am thinking of you,

Hugs,

Hi Ellen,

Please, please always post your concerns about beautiful Casey here, you and Casey are family...You both are part of the k9cushings family, we love both of you and worry about both of you...no matter what's going on, always, always post about your pup, and Sweet Ellen, don't you ever feel guilty about doing that, ok.

Love and hugs,
Lori

[Squirt's Mom]

Hi Ellen,

I so appreciate the sentiment concerning Ruby, but you cannot feel guilty about posting on Casey when others aren't doing so well. Casey is family, as Lori said, and I always want to know how our babies are faring - good or bad. Sue feels the same way, I am sure. Your story and others help me keep my mind off what is happening at home and when it's good news, that just makes my day! :) So hearing that Casey is acting "normal" is a double blessing and I thank you for sharing.

Hugs,
Leslie and the girls

[Casey's Mom]

I am also worried about John and Angelina - hope she feels better today.

Thank you for your good wishes and all of your help - I wouldn't be able to do this without you guys and that is the honest truth!!

Sleep well everyone and give your pups some love from me,

[Casey's Mom]

I just took some pictures and posted them on my album - I had to get a picture of Desi doing an imitation of Squirt!

http://www.k9cushings.com/forum/album.php?albumid=146

[Franklin'sMum]

Hi Ellen,

:D squeal! Absolutely gorgeous! Isn't it amazing that they can scrunch themselves up in such a way, and still be comfortable enough to fall asleep?

Hope Casey perks up, and hugs to all,

Jane and Franklin xx
________
Vapir Air One 5.0 (http://www.vaporshop.com)

[Harley PoMMom]

Great pictures Ellen!! Just love the one of Desi imitating Squirts sleeping position, and Casey is such a beautiful girl...oh, they all are so precious.

Thanks so much for sharing the pics.

Love and hugs,
Lori

[Squirt's Mom]

Thanks for sharing the pics, Ellen! They are all so precious...but of course I am just a bit inclined to see the one like Squirt's in a special way. ;) Casey is really a beautiful girl, that face is adorable!

Hugs,
Leslie and the girls

[Casey's Mom]

Casey's results were faxed to me today from her test yesterday - I requested a geriatric blood profile and she had a complete biochemistry profile, hematology as well as ACTH. There are a lot more results on this profile than she has ever had before and everything is normal except:

ALP - 309 - last tested for this in June she was 229 and in Feb before treatment she was 370.

ALT - 291, June 189 and Feb before treatment was 275.

Not sure why these numbers are up and its a bit of a concern - she is on the Milk Thistle but maybe its the Lyso putting a strain on her system?

Her ACTH results (even though I hadn't given her Lyso in 6 days because she seemed low):

Pre 58 nmol/L which I believe is 2.10- her lowest pre before was 83 for her first test pre diagnosis.

Post 163 nmol/L which is 5.9.

I also see Free T4 results were 24.1 in normal range. She has not had this test result on her reports before.

She still seems a little tired but otherwise normal - we can't walk today because of snow and she isn't missing it - she may also be reacting to the weather (snow instead of rain!)

When I was in Monday the vet said to keep her on the same Lyso schedule but to me it seems that maybe I should hold off until some symptoms return - and maybe put her on a slightly lower dose. It is hard not to have a specialist available so I rely on you guys and my gut - I know my girl and we get so in tune to their behaviour on this cushings journey. Right now eating, drinking, peeing normal and no anxious behaviour if anything that is the opposite but if I go in the kitchen she is right there as usual!

Some imput would be helpful and I can scan all of her results and post if you want.

Lots and Lots of snow today and lots of shovelling . . . .

[Harley PoMMom]

Hi Ellen,

I am sure one of the experts will be along to give you their opinion/s bc as you know Harley and I will just be beginning our Lysodren journey.

So I am just going to give them a summary of her previous dosages from your earlier post.


Hello everyone, we have been doing just fine- Casey is due for her next ACTH next Wednesday. Out of the blue today I gave her her Lysodren dose this morning and tonight she started acting strange, staring into space and not wanting her evening meal or a drink. I gave her 2.5 grams of pred about an hour ago to no effect. Should I give her another 2.5 grams or wait? She weighs 40 lbs and her dose on the bottle is 5 grams.

We went back to 375mg 2x a week for the last month as the 250mg 3x a week was not effective - cushing symptoms came back.

Just reaching out . . .

Winter storm coming from the states tonight. Not looking forward to shovelling!

IMO, Ellen I do think you are right, the 375mg 2x a week is too much for her and I believe you need to find a dosage between the 250mg and the 375mg for her that she can tolerate and that controls her cushings.

The post of 5.9 ug/dl, again IMO, for a pup that has not been on Lysodren for 6 days is pretty darn good. And I also believe one needs to treat the pup not only by the numbers but how the pup feels and by symptoms.

Like I said, I am sure the others will be along to help you figure this all out, sorry I was no help. :o

Give Casey some belly rubs from Harley and me.

Love and hugs,
Lori

[Casey's Mom]

Yes treating by how she feels and the symptoms feels right to me too -thanks Lori,

Hugs from me and a big smile from Casey,

[AlisonandMia]

The trouble with waiting until she shows symptoms is that that will almost certainly mean a reload. I tend to agree with your vet at this point. If you put her back on the same dose and retest in a month or even a couple of weeks if you are worried (I'd worry) and the numbers have come down from where they are now then you could reduce the maintenance dose.

The other thing I'm wondering is if her cortisol was not actually absolutely too low the other day but whether she was ill in some way and the stress of this meant that she needed pred to feel ok. That stim was 5 days after the last dose?

With the rising ALT (and the possibility that she was ill lately) I wonder if she couldn't have a gall-bladder issue. The reason I mention this is the rise in the ALT (which seems to occur often with gall-bladder issues) and the fact that she is half Sheltie. Shelties are really prone to developing globs of sludge in their gall-bladder which acts a bit like gall-stones in humans. An ultrasound (if you can get one - you've had problems with this in the past if I'm remembering rightly?) is usually how this sort of gall-bladder problem is diagnosed and there is a medication that often works well to dissolve the sludge.

Good luck and keep us posted.

Alison

[Sabre's Mum]

Hi Ellen

I have done a quick review of your thread and without knowing all the dosages along they way I tend to agree with Alison. Casey may not have had "low" cortisol the other day and there may be another reason for the way she was.

Some pups can take a long time to recover from low cortisol and others quite quickly. There is not real way of knowing where Casey's levels were when she was unwell unless she was tested. With my Vizsla (who is 25kg) it took him four and a half months off Lysodren to come from a post of <1 (27.59) up to 3.73 (103).


Without knowing all the dosage changes you have made along they way I would go along with Alison and keep Casey on the same dose and then retest in a month ... or as Alison said ... sooner if you are worried; then you have a comparison and can tell whether she is on the right dose.


All the best
Angela, Sabre and Flynn

[Casey's Mom]

Thank you Alison and Angela, the problem would be getting an ultrasound but I will ask the vet if they have one. Her symptoms when I thought she was low was no interest in food or water and staring blankly into space. Usually if she has some type of upset stomach she is a maniac for eating grass and believe me she will dig under the snow until she can find something in the yard to chew on which she did not do during this episode.

Are there any other symptoms of gall bladder problems that could help in a diagnosis? Or cause the rise in ALT?

[Casey's Mom]

Thank you for the good advice Alison and Angela, I gave Casey her Lysodren last night 300 mg and will give her another dose in a couple of days. She seems great today so thank you,

I called my vet about the rise in liver enzymes yesterday and she has not called back yet and I have emailed my previous vet in the States with her lab results and to see if he can ultrasound her. I have not heard from him either . . . . hopefully I will hear something soon. What would I do without this forum, honestly!

[Harley PoMMom]

Hi Ellen,

I thought I would pass this bit of info along to you, it might be helpful if Casey would vomit.

I am hoping Casey is doing well on her Lysodren dose and continues to do so, will be keeping you both in my thoughts and prayers.


Are there any other symptoms of gall bladder problems that could help in a diagnosis? Or cause the rise in ALT?


Lori, it's very possible that it's a GB issue. If I would be able to see what's coming up when he vomits, I would know for sure, but I'm not going outside with a flashlight at 2AM to check.:rolleyes:;) Just so you know, if it looks this nice pumpkin orange color, that's bile, & that means it's gallbladder. It's just puzzling as it's been a good 2 weeks at least since the last tummy upset. I hate to give him the Pepcid all the time, if he doesn't need it, but I may have to strongly consider it.

Debbie

Love and hugs,
Lori

[littleone1]

Hi Ellen,

How is Casey doing today. I hope she is doing better.

[Casey's Mom]

Casey is just great thanks for asking Terri and many thanks to Lori about the orange bile - I will definitely remember that and see if that happens.

She just finished her breakfast and is now wanting affection - she likes to put her head between my knees and presses her face and body into me for a head scratch and hopefully bum scratch - I call it the Casey hug and tell people when she does that to them that she is giving them a hug. She loves everyone - even the mailman - if we are outside when he comes he gives her cookies as do a lot of the other doggie owners at the park so she has come to think that everyone (except the vet's office) is a friend. My other dog Desi is a Certified Therapy Dog and she loves everyone at the nursing homes too but in a different way. She wants everyone to look her in the eyes and tell her beautiful she is and could care less about food.

Give all your pups a hug,

[Casey's Mom]

Just for your info I heard back from my vet via the tech - she is not concerned about the elevated liver enzymes at all as it is a minor increase and she is fine with her cortisol levels. So we are smilin:)

[Franklin'sMum]

Hi Ellen,

Smilin' alongside you! :D Great news about Casey's liver enzymes! Cuddles to Desi and Casey,

Jane and Franklin xx
________
Body Science (http://bodyscience.ws/)

[littleone1]

That's good news, Ellen.

I know that when Corkys' liver function was elevated, his IMS was also not concerned about it. On his last blood test, his levels were in the normal range.

I hope Casey continues do do well.

[Harley PoMMom]

Just for your info I heard back from my vet via the tech - she is not concerned about the elevated liver enzymes at all as it is a minor increase and she is fine with her cortisol levels. So we are smilin:)

Hi Ellen,

:):D:):D Smilin with ya too! :):D:):D

Love and hugs,
Lori

[Harley PoMMom]

OMGosh Ellen, your pics of Casey, I almost didn't recognize her...she looks so different...so regal and beautiful.

Hey everybody, you should check Casey's new pics out...she's sporting her new "do"!! :D

http://www.k9cushings.com/forum/album.php?albumid=145&pictureid=1214

http://www.k9cushings.com/forum/album.php?albumid=145&pictureid=1215

Love and hugs,
Lori

[Franklin'sMum]

Ellen,

Casey looks beautiful! :):) Did Desi bark at her when she walked in? Plus love the first photo with Desi peeking around :D So cute!!

Jane, Franklin and Bailey xxx
________
Business Overhead Expense Disability Insurance Advice (http://www.insurance-forums.org/business-overhead-expense-disability-insurance/)

[Roxee's Dad]

Very sporty looking :D:);)

[Casey's Mom]

Thanks guys! Those photos were taken last June and her coat has grown back but I thought it would be fun to show what she looked like without hair.

We live in a winter wonderland and today when she was doing burnouts in the snow I thought I have to take some pictures of this cause all you guys see is her lying down. So I will take some pictures of her at the park to post when she is having the most fun (other than eating of course!.

Love and hugs,

[Casey's Mom]

Hello to all of my friends here at the site and to the new folks starting out on their cushings journey:

[IMG]http://www.k9cushings.com/forum/picture.php

I just posted photos I took of Casey at the park last night -you can see my new album but the above photo shows her running at the park. She will be 14 in March but except for some stiffness when she gets up and the fact that she would rather lay down than sit due to arthritis she is amazing! Thank you so much Scott for the Adequan advice - Lori for the L-Glutamine and Glucosamine Chondroitin. Alison for being there in the middle of the night and always with the right advice - Leslie for always being there and full of support. I could go on and on - you have all helped me.

Many thanks to Lysodren and my vet.

Thanks to all of the help, knowledge and hand holding on this site my girl is doing just fine. Last February when she was diagnosed and at the beginning of treatment I never thought this would be my dog almost a year later. Thank you from the bottom of my heart :):):):)

Love and many hugs,

[Casey's Mom]

I may not have posted the link correctly for the photo but its under community in new albums.:o

[littleone1]

The pictures are great, Ellen. Casey looked like she was having fun in the snow.

[Harley PoMMom]

Now, who would believe after looking at them pics that Casey would soon be 14 years old...not me. You my dear, by being such the extraordinary advocate for her and by taking such excellent care of her is why she is doing so well today. You are wonderful mom, Ellen, always remember that.

Love all your pictures!

Love and hugs,
Lori

[Dollydog]

Those pictures are great Ellen, hard to believe that Casey is almost 14 years old. She looks awesome! Congratulations to you both! Enjoy the snow....we have the cold here in Florida but not the snow or ice!
Jo-Ann & my Dollydog angel :)

[Casey's Mom]

Thank you Lori, your words mean a lot to me. Thanks Joanne, Florida even though cold today is a lot warmer than Marathon! 6 more weeks for us and we will be warm in Cuba.

Love and many hugs,

[Franklin'sMum]

Hi Ellen,

Great pics! :):D Squeal!!:) The kids look like they're having a ball! Casey sure looks like she's enjoying play time in the snow with Desi in her little pink top :) too cute!! Great photos, thank you for posting them :)

Jane and the gang xxx
________
New Jersey Medical Marijuana Dispensaries (http://newjersey.dispensaries.org/)

[bkdice]

Thanks to all of the help, knowledge and hand holding on this site my girl is doing just fine. Last February when she was diagnosed and at the beginning of treatment I never thought this would be my dog almost a year later.

Reading this reminded me of how I felt when I got my senior boy back to having a great life once the cushings was controlled. It is a great feeling, isn't it?! :D Casey is adorable, btw, and it's obvious she is very well loved. May you have several more happy years ahead.

Bettina & Angel Niko

[Casey's Mom]

Thank you Bettina - yeah she's a pretty special dog. She loves everyone at the park -she goes to everyone for a pat thinking that they are all going to be her friend and maybe a cookie source - and everyone that meets her thinks she is pretty special too!

[Casey's Mom]

Hello everyone, Casey has been doing just fine on our usual dose of Lysodren and we are scheduled for another ACTH in June.

For the past little while she will kind of cough when she eats cookies - and sometimes "reverse sneezing" as I call it - its like a cough that comes from her stomach and goes out her nose. Weird.

I was reading to give them their Lysodren dose wrapped in food which have done always. I sometimes give it to her after her meal - could it be bothering her throat? Maybe some of you have had some experience with this strange behaviour. It only lasts for a little while and its not every day, just more common lately.

Love and hugs,

[littleone1]

Hi Ellen,

I'm glad Casey is doing well on the Lyso. I can't offer any advise as to any reactions she might have when she is eating her cookies. I hope it is a very minor issue.

[AlisonandMia]

It's possible that the Lysodren could be irritating her throat if it isn't going down quite properly.

Something some people do is to wait until the dog has nearly finished the meal and then give them the pill (wrapped in food) and then let them finish the meal so that the last couple of mouthfuls ensure that pill gets pushed down into the stomach.

Do you notice any pattern that suggests that it could have something to do with the Lysodren dose?

Alison

[Casey's Mom]

I give her the next dose on Friday Alison so I will see if it is indeed a pattern. I will also give it to her during her meal from now on although she will hate to stop mid stream during dinner!

I can't think of any other reason. I am going to try and get her teeth done next month - our groomer does it - we are going to try anyway but not if it stresses her too much. She had them done at the vets when she was nine and is way overdue. I don't want to put her under any type of anesthetic at her age.

Love and hugs,

[Harley PoMMom]

With Harley's Lysodren, I give it to him during his meal...like mid-way. It's wrapped in cream cheese, he just swallows it...whole. Before when I was compounding his Lysodren I had to wrap the capsule in cream cheese and potato bread :p but since we're using 125mg (I just cut a 500mg pill in quarters) I can get away with just using cream cheese for now...shhh...don't tell Harley, he LOVES potato bread! ;):D

Been wondering how you and Casey were doing, so glad she's doing well on her Lysodren.

Love and hugs,
Lori

[AlisonandMia]

Actually I believe that sneezing can be caused by dental problems in some cases - think I read something about that recently. I believe that dentals that are done without anesthetic don't really do very much as they are unable to clean below the gumline (which is pretty uncomfortable going on painful!) and unless you do that the only improvements will be cosmetic rather than giving any health benefits.

Here's some info: http://www.petmd.com/blogs/fullyvetted/2008/october/anesthesia-free%C2%9D-dentistry-your-pet

I used to do that (dosing towards the end of the meal) with Mia and she didn't mind being "interrupted" with a what she saw as a yummy treat while she was eating. She'd gulp down the cream cheese, which was what I used, and then get on with her more ordinary food. It is best to do it as close as possible to the end of the meal (a couple of mouthfuls to go) so you can be sure the appetite is good.

Alison

[lulusmom]

Alison is correct. Dogs with dental issues will sneeze a lot. My little one, Lulu, was sneezing a lot for a few weeks and when she started sneezing blood, I took her in to get her checked out. She is very sensitive to certain cleaning products and I attributed the sneezing to a new floor cleaner I tried. Unfortunately, it wasn't that simple. She had at least two teeth that had abcessed and needed emergency dental surgery. She quit sneezing immediately.

Alison is also correct about the non anaestestic teeth cleaning. I was concerned about Lulu being put under for cleanings so I tried the cleaning with no anaestesia. It turned out to be a freaking nightmare. They did not secure her well enough and with all the squirming, she dislocated a hip. The vet had to put her out to reset the hip and put it in a sling. Seven or eight days later the tape on her leg adhered to her bald skin so hard that they were pulling several layers of skin off with the tape so they had to put her under again to remove the tape. Because the sling didn't work and the hip dislocated almost immediately, she was put under a third time for hip (FHO) surgery. Here I was trying to avoid anaestesia and she had to be anaestetized three times in less than two weeks. I'd never do that again!

Glynda

[Nathalie]

Just wanted to add my thoughts on dentals …

I agree if there is extensive dental decease with a lot of inflammation and lot of recession of the gums dentals are best done under general anesthetic for adequate pain control.
However, if there is only mild to moderate build up or extraction of already loose teeth due to boneless or a simple anterior extraction I personally would opt for sedation which has a mild anesthetic affect.

My little Sophie with a phobia of having anything done to her body and a non existing pain tolerance just had her dental done a little while ago.
She had mild to moderate tarter build up and an extraction of an already very loose tooth under sedation.
Also well sedated she would not tolerate the sound of the ultrasonic scalar but did not move during hand scaling below and above gum line and I was right there stabilizing her head and dabbing blood away throughout.
Having worked in the dental field for 12 years at one point I personally prefer a skilled hand scaling. It does take longer compared to a quick job with the ultrasonic scalar. Ultrasonic scalars produce heat and if used without caution can actually fry the pulp… a pup under general would not feel this but a dog under sedation would react to the pain. Ok, I admit it – I have trust issues – wonder why..:o:D

I do scale my boys teeth at home and do go under the gum line. Had to do this maybe once per year with the Phillip but since cushings it seems his ph level changed and he also can’t have bones anymore so he is packing on the tarter like there is no tomorrow.

Cheers,
Nathalie

[Casey's Mom]

Thanks everyone, so sedation is what I should ask for instead of anesthesia - hopefully the vet will agree. I will try and get her in soon.
Thank you all again for the great advice!

Love and hugs,

[Nathalie]

Ellen, it depends on the type/extend of the dental work needing to be done.
Some vets won't do a dental under sedation, period.
In my opinion that is more often done out of convenience/efficiency then necessity. ... It takes up to 15 min for the sedation to fully take affect and then they can't just go in whip out the ultrasonic scalar to get the bulk off - so overall it might take longer to finish one dog where under general they could do 2 or 3 in the same time and generate more money.

Just to give you an idea, I paid about $160 for a light scaling, 1 extraction and sedation – the total time spend on Sophie from beginning to end was about 45 min. If we would have done this under general, there would have been another $200 for the general itself incl. fluids. (these are approximate numbers - can't find the bill right now)
Again, this is just my personal opinion.

Nathalie

[littleone1]

Hi Ellen,

I know I was really concerned about putting Corky under when he had all of his dental work done in January. It had to be done, as he had the three teeth extracted and the two masses removed in his mouth. His vet assured me that the anesthesia he uses has been safely used on cush dogs.

I hope everything goes well.

[Harley PoMMom]

Harley had to have 3 teeth extracted also when his teeth were cleaned, he was also put under a general that his vet assured me that he would do fine with, and he did. She also assured me that he would be monitored very, very closely.

If you are considering a general and if you think some of Casey's teeth are in need of extraction...Here's a quote from Dr Feldman about giving pred. to pups undergoing stress:


Page 1570 Stress or Illness.

Dogs receiving o.p'-DDD and undergoing stress (illness, trauma, elective surgery) should be treated with glucocorticoids. The adequately treated dog with PDH has sufficient adrenal reserve for day-to-day living but not enough to handle major stress.

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

So you may want to think about giving Casey some pred. if you think this will stress her out or if she will have to have any teeth extracted.

Love and hugs,
Lori

[Casey's Mom]

Marianne had recently stated having the cortisol run a little high to help them with their arthritic issues on another thread. Casey has her next ACTH June 24th (6 months from the last one) and I am curious to see the results - she is doing wonderfully - no cushings symptoms at all but I am thinking her results will come in a little high and that is okay with me if it keeps her as she is running up and down stairs! and at the park.

She is scheduled to have anesthesia next Wednesday to have her teeth done by the vet. They won't do it any other way so I am a little nervous. This is her US vet who will do another bloodwork profile on her before they put her out to make sure she is okay for the surgery - she is 14 and its funny to think the last time he did her teeth she had the bloodwork done because she was considered a senior at 9! He knows she has cushings so I am sure he will take that into account as well.

I have been seeing my Canadian vet for all of her testing and meds but this vet has also seen her for years and truth be told he is less expensive for this procedure.

I have the surgery sheduled for 72 hours after her last dose of Lysodren - she would be due that night but I am thinking I will wait another 24 hours. Lori had suggested giving pred before hand - but maybe her cortisol will be high enough - what do you think?

I then have two weeks before her ACTH to get her back under control.

Interested to hear any thoughts or suggestions . . .

Hugs to all,

[Rebelsmom]

Wow, I don't really have any suggestions since I have not been in your place. I wish you both the best of luck.

Melissa, Rebel & Sadie

[Harley PoMMom]

Bumping this up! :)


Marianne had recently stated having the cortisol run a little high to help them with their arthritic issues on another thread. Casey has her next ACTH June 24th (6 months from the last one) and I am curious to see the results - she is doing wonderfully - no cushings symptoms at all but I am thinking her results will come in a little high and that is okay with me if it keeps her as she is running up and down stairs! and at the park.

She is scheduled to have anesthesia next Wednesday to have her teeth done by the vet. They won't do it any other way so I am a little nervous. This is her US vet who will do another bloodwork profile on her before they put her out to make sure she is okay for the surgery - she is 14 and its funny to think the last time he did her teeth she had the bloodwork done because she was considered a senior at 9! He knows she has cushings so I am sure he will take that into account as well.

I have been seeing my Canadian vet for all of her testing and meds but this vet has also seen her for years and truth be told he is less expensive for this procedure.

I have the surgery sheduled for 72 hours after her last dose of Lysodren - she would be due that night but I am thinking I will wait another 24 hours. Lori had suggested giving pred before hand - but maybe her cortisol will be high enough - what do you think?

I then have two weeks before her ACTH to get her back under control.

Interested to hear any thoughts or suggestions . . .

Hugs to all,

[frijole]

I can help! :D

Both my girls have/had awful teeth so I have taken them in every 6 mos for cleaning. At first I was very concerned about the anethesia but the vet explained to me that they use a gas that allows them to quickly take them out of sedation if the dog is in distress.

Haley was 16 and Annie 14 at their last cleaning and they came out happy and unscathed every single time. I never adjusted lysodren nor did I give prednisone as I never felt it necessary.

I don't know what kind your vet uses but I would bet it is the same. I hope that this helps a bit. Big hugs and we'll be thinking of you. Kim

[Casey's Mom]

Thanks so much Kim - you put my mind at ease!

[Casey's Mom]

Hello gang. Hopefully I can get some feedback from our lab experts regarding Casey's recent bloodwork. I had taken her into our US vet to have her teeth done but first he required bloodwork and an EKG because she is 14. After reviewing the EKG the vet recommended Xrays to further evaluate heart size and lung fields before anesthesia. I asked him how bad her teeth were and he said there was some plaque and gingivitis but no loose teeth or inflammation so we decided against doing the work - not worth the risk.

He recommended Hills TD for her teeth as well as Aquadent as a water additive to help with the plaque. I am not going to change her diet to the Hills but I will give her more crunchy treats.

I am going to post the abnormal bloodwork results and their normal ranges if someone can please help interpret. Some of the results have not been on her previous blood work with our Canadian vet so please let me know if you have any advice. Also I am familiar with the liver enzymes and the cholesterol but I am not sure what any of the others are.

ALT - 180 U/L - normal 10 -100
ALKP - 308 U/L - normal 23 - 212
GGT - 11 U/L - normal 0 - 7
TBIL - 1.1 mg/dL - normal 0.0 -0.9
CHOL - 520 mg/dL - normal 110 - 320
AMYL - 1855 U/L - normal 500 - 1500
LIPA - 3783 U/L - normal 200 - 1800 - this one is really high :eek:

Love and hugs,

[Harley PoMMom]

Hi Ellen,

I am no lab expert but I can offer you my opinion. The AMYL = amylase and the LIPA = Lipase. Both of these, when elevated, can be indicators of pancreatitis. But other things can make these values be high, especially the lipase, lipase is non-specific because there are digestive lipases, intestinal lipases, lipoprotein lipase and hepatic lipase, hormone-sensitive lipase, and lysosomal acidic lipase.

To really confirm if Casey has pancreatitis then I would ask your vet about having a spec PL test done on her. The spec PL tests for the pancreas lipase enzyme only.

Link about spec PL test: http://www.idexx.co.uk/animalhealth/laboratory/speccpl/

Link about pancreatitis: http://www.cvm.tamu.edu/gilab/research/Pancreatitis.shtml

Keeping you both in my thoughts and prayers.

Love and hugs,
Lori

[Casey's Mom]

Hi Lori, thanks for the links. Casey shows no signs of any symptoms mentioned in the links but I think I read on someone's posts here that their dog didn't show any symptoms of pancreatitis either - was that you?

Casey goes in for her ACTH on Wednesday morning. I will talk to both vets and get some opinions.

Love and hugs,

[frijole]

Ellen, I read in depth about it this weekend and it is often not diagnosed and often there are few outward signs. I am going to test Annie due to her anorexia/stomach issues. I always thought vomit was the sign but... not always. Better safe than sorry right? Hugs, Kim

[Franklin'sMum]

Hi Ellen,

Has Casey had a urinalysis done lately? If so, what was the UP:C? The reason I ask, if it's not pancreatitis currently, then the risk is still high for a Cushpup. Also, I came across something yesterday (I'll post the link when I get home in the morning) that elevated amylase and lipase can be a sign of kidney problems.
Regular kidney values (BUN, creatinine, brain fade) can remain normal right up to when the kidney function is severely impaired, like 70-75% impaired.
Don't mean to add more stress to you, just thought I'd pass that on FWIW.

Hugs to you and the kids,
Jane, Franklin and Bailey xxx

[zoesmom]

Ellen -

Did a quick search since all my bloodwork interpretation links are on my other computer. Found this one which is interesting and does talk about some of the other causes for elev. lipase/amylase - especially based on how elev. they are.

http://www.vetinfo.com/dbloodwork.html


"Lipase becomes elevated most commonly due to pancreatitis or a decrease in kidney function. The decreases in kidney function can occur due to causes other than the kidney itself. The kidney is dependent on adequate blood flow and blood pressure to work, so dehydration and low blood pressure can cause a decrease in kidney function. Kidney diseases or obstructions to urine outflow from the kidney are the other conditions that can lead to increases in lipase or amylase levels due to kidney disease. It is also possible for intestinal conditions such as inflammatory bowel disease (IBD) to cause rises in lipase or amylase levels sometimes. Pancreatitis can cause rises in lipase and amylase to three or more times the normal level, with increases as much as ten to fifteen times normal occurring in some cases. Kidney disease usually causes rises to about fifty percent of normal and smaller rises tend to occur with IBD."


Based on those last sentences, Casey's amylase/lipase isn't really off the charts, compared to how high they could go. On this link, scroll down to the Q & A for Robyn and her German Shepherd - and the one immediately after that, about a shipperke, and you can read more.

There's also some info there on elev. cholesterol - the chol on lab test. TBIL is total bilirubin and I don't have any idea about what that elevation would indicate. GGT - not even sure what that is. Debbie can tell you more, I'm sure. Also, if you read thru that page, he talks about the tendency to jump to to conclusions in the absence of clinical symptoms. Sue

PS - Oh, and Kim. Saw something on the same page about a dog vomiting bile, about six hours after eating. Sounds like what happened with Annie?? and I think it had to do with pancreatitis. Gotta run and don't have time to go back and check right now.

[Harley PoMMom]

Hi Ellen,

Although it is the norm for the lipase and the amylase to rise significantly when a pup does have pancreatitis this does not always happen and my Harley is living proof. When his spec PL results were 464 (0-200) his amylase and lipase were both in the normal ranges. Harley shows no symptoms of pancreatitis and if the ultrasound wouldn't of showed his prior bouts of it I would of never known he has it.

Love and hugs,
Lori

[zoesmom]

Lori's absolutely right. Zoe's ultrasounds also showed that she'd had previous bouts of pancreatitis and yet her amylase/lipase were never really elevated (I think her amylase was slightly up once or twice . . . . and while her lipase did become elev. and stayed elevated once she started on bromide for seizures, that one was most likely a side effect of that drug.)

I think the vet who I quoted did go on to say that pancreatitis was still something that should be looked at. It CAN (operative word) cause those extremely high elevations, but doesn't always. Plus, he points out some of the other possible causes. Sue

[Franklin'sMum]

Hi Ellen,

I'm back again with that snippet

The most common causes of rises in both amylase and lipase levels are pancreatitis and chronic kidney failure. It is a good idea to check the lab work carefully for signs of either of these conditions and to look for clinical signs such as vomiting, diarrhea, lack of appetite or increases in drinking and urinating.
It's from http://www.vetinfo.com/dogdiet.html

It's the only thing I have read so far linking amylase/lipase to kidney issues. With thanks to Sue for expanding and clarifying :).

Hi Kim, - vomiting bile- was she vomiting bile first thing in the morning? Because stomach acid can build up, and it's recommended to give a late night snack

Gastroduodenal reflux or bilious vomiting syndrome has a typical history, with otherwise
healthy dogs vomiting bile only in the mornings. The condition is quite common,
particularly in nervous dogs. It is normal for some bile to reflux back in to the stomach,
but it should be rapidly cleared. It has been suggested that a motility disorder in these
patients results in prolonged contact between bile and gastric mucosa. As bile is a
detergent, this can further result in mucosal damage and focal antral gastritis.
The vomiting of bile occurs in the early morning because the stomach is empty and the
bile is not diluted by food.
A definitive diagnosis is reached by ruling out other causes and demonstrating a response
to treatment. Endoscopic examination may reveal antral gastritis with or without
excessive bile retention. but I didn't take note of where that was from.
Sorry bout the hi-jack Ellen :o

Jane, Franklin and Bailey xxx

[Casey's Mom]

Thank you for the links - I have read all of them. If she does have Pancreatitis is there a treatment to prevent an attack? Or low fat - high protein diet? Also I will ask for a urine test for her kidneys.

She seems quite fine to me - I did read that Sue about the German Shepherd - thanks for that link.

Thank you all, love and hugs,

[labblab]

Hi Ellen,

I'm afraid that I don't have much to add at the moment other than moral support -- but you've got TONS of that coming from me!!

When it comes to pancreatitis, I definitely defer to the others here. Fortunately, that's not an issue that I had to address with my Cushpup. So aside from knowing that Cushing's does predispose a dog to pancreatic issues, I'm afraid my knowledge is pretty limited. :o

I see you've already gotten a lot of useful info, though. And I'm hoping that Debbie will also be by before long to help with those lab values. In the meantime, good luck tomorrow with the ACTH testing and I'm so glad that Casey is outwardly doing well.

Marianne

[Harley PoMMom]

If Casey would have pancreatitis there are ways of reducing the risk of her having a pancreatitis attack.

Maintaining her ideal weight is important which I believe you are doing, because obesity is considered a risk factor.

Feed several small meals throughout the day.

Since the pancreas is most stimulated to produce enzymes by foods that are high in protein and fat, a diet for pancreatitis needs to be lower in protein and very low in fat. If you home-cook her meals than a diet lower in protein and very low in fat would have additional carbohydrates added for calories. If feeding kibble than I would look for a very low fat and moderate protein kibble.

Hope this helps.

Love and hugs,
Lori

[Casey's Mom]

Thank you Lori - great advice. I already feed her a mixture of homemade and Fromms duck and sweet pototo kibble. I may end up changing her kibble back to what I used to feed her - the Holistic Brand chicken and rice - less protein.

I will ask the vets advice re testing tomorrow.

You guys are great as always!

Love and many hugs,

[Casey's Mom]

I received Casey's results from ACTH - too high in my opinion. Pre was 6 and post was 10. The vet wrote on the fax that she thought the pre was high but was happy with the post so continue on. I know Casey gets very stressed out now when she goes there so could that be the cause of the high pre numbers or do you think her cortisol levels are uncontrolled and we need to do a mini load? I waited 48 hours since her last dose of Lysodren to have the test done.

My vet said to carry on as is but my gut tells me I need to lower her cortisol levels. She seems fine - however yesterday I noticed for the first time since beginning treatment some trembling in her hind legs and she was more tired on our walk.

Advice?

Also I have her booked for a C PL test next Friday for possible pancreatis. The vet didn't seem concerned about her Lipase and Amalyse levels but I am so he agreed to do the test. He said it couldn't hurt but is not worried because she has no symptoms. I sometimes feel like they think I am neurotic about my dog considering she is 14 and getting near the end of her normal lifespan but I just want her as happy and comfortable as she can be.

[apollo6]

You are just a loving parent. My little guy is 11.5years old and I am just as worried. New to all this. It is scarey. But the people here are a great support.
Sonja and Apollo

[zoesmom]

I received Casey's results from ACTH - too high in my opinion. Pre was 6 and post was 10. The vet wrote on the fax that she thought the pre was high but was happy with the post so continue on. I know Casey gets very stressed out now when she goes there so could that be the cause of the high pre numbers or do you think her cortisol levels are uncontrolled and we need to do a mini load? I waited 48 hours since her last dose of Lysodren to have the test done.

My vet said to carry on as is but my gut tells me I need to lower her cortisol levels.

Hi Ellen -

I'm guessing the lysodren users are going to say . . . too high. When the numbers start rising like that on lysodren, it's easy to loose control and then before you know it, she'll end up way out of range, with full return of symptoms, and then you might need to go thru a re-load - as opposed to a mini-load.

As a trilo dog, Zoe did have numbers like Casey's, more than once, but in our case, we just raised her dose to get things back under control. It's a little different for lysodren pups because of the different way the two drugs work.. Sue

[frijole]

Hi Ellen! Thanks for the update. Sue was right... too high. I stopped with Haley at 5.8 or 6.8 and within a month she was way high. Trust me it is easier to do a miniload than start from scratch. Regarding the first number - my Annie's first one was 17.2! Don't worry about that number - just the last one.

Just know that you are close to loading and you can get there. The hind leg trembling is a sign of cushings. So is having difficulty walking. My Haley never liked walking on gravel after the diagnosis... don't know what that was about but expect some permanent changes yet some improvement - you can certainly get rid of the trembling once Casey is loaded and maintained. I think it was a month or two after loading that the trembling went away. Never came back either.

Hang in there - you are real close so it isn't a loss, its a win! Hugs, Kim

[StarDeb55]

Ellen, Marianne had alerted me that you wanted my input on Casey's lab values. Sorry it took me so long to get here. I have reviewed all of the great information that everyone has given you, & really don't have anything to add. I do agree with Lori that it might be worthwhile investigating those elevated amylase & lipase results further.

Debbie

[Casey's Mom]

Thanks everyone, am doing what I have done in the past when her numbers were too high which is giving her the same dose of Lysodren just every 3 days instead of 3.5 days and in a couple of weeks she should be back to normal.

Will keep you posted,

Love to all,

[Casey's Mom]

Hi guys - Casey goes for her Cpl test tomorrow for pancreatitis - I forgot to ask my vet - does she need to fast for this test?

[frijole]

Yes she does!!! Just did it. Good luck!

[Harley PoMMom]

Casey needs a 12 hour fast. Best of luck to you and Casey.

Love and hugs,
Lori

[Casey's Mom]

Thanks guys - I figured as much. I will let you know her results tomorrow and you can help me decipher!

Love and hugs to all,

[frijole]

We're cheering you on.

[littleone1]

Hi Ellen.

I hope everything goes well tomorrow. Corky and I will be thinking about both of you.

[Casey's Mom]

Hello everyone - back from my vet. The test confirmed pancreatitis and because she has no symptoms the vet thinks it chronic and could be caused by lumps (can't remember his term) on the pancreas. To confirm we would need a high density ultrasound and I would have to go to Michigan State which is about 6 hours away. He advised against this because we would not operate regardless. He advised me against putting her through anesthesia two weeks ago to have her teeth cleaned because she has some issues with her heart that showed up on the EKG and its not worth the risk.

So - he advised a fat free diet - one week of brown rice and veggies and then just strictly homemade from now on - which I did anyways I will just have to make more and feed her just that instead of homemade and kibble.

I was hesitating taking her for the blood draw this morning - she gets so stressed at the vets and she has no signs of being sick - but I am so glad that I did!!!

Now what do I put her Lysodren in that is fat free so she will eat it? I always wrapped it in sliced roast beef or turkey.

Love and hugs to all,

[Casey's Mom]

P.S. I tried to take Casey's age off of her title as she is now 14 1/2 but could not seem to manage - can someone help?

[Harley PoMMom]

I don't think you want to go totally fat-free...dogs do need some fat in their diet just like us humans do...you want to go low-fat. What was Casey's spec PL number?

PS...I changed your Thread title. :)

Love and hugs,
Lori

[sunimist]

Hi Ellen,

I know what a hassle it is to feed a low-fat diet. Misty had chronic pancreatitis too and I fed her boiled boneless chicken breast (no seasoning), rice, browned ground round (at least 80/20 cooked in a skillet in just a little water to keep from burning (pat out any excess fat with a paper towel), occasional low-fat cottage cheese and unseasoned green beans. I would think roast turkey breast would be fine if it's not the processed kind. It is low in fat. I would buy a turkey breast, bake or boil it, cut it in appropriate sizes to last a couple days, put each piece in a plastic baggie and freeze what I would not be using immediately. That way you can just pop out a bag and microwave when you need it.

Might ask your vet if this would be ok for Casey.

Hope this helps, and ((hugs)) to Casey.

Shelba and Suni

[Harley PoMMom]

For her Lysodren, which is what I use for Harley, cream cheese and this does come in a low-fat version.

[Casey's Mom]

The vet did a snap CPL test. How he explained it was to do 72 hours to one week fat free then just very low fat which will be my homemade. Thanks Sunimist for the advice. The one week fat free I am just feeding her brown rice with sweet potato and some green beans I think - I am cooking for her as we speak :)

Today is Lysodren day but she will not eat cream cheese - tried that already. Any other suggestions?

[frijole]

You'll have to check the ingredients to make sure they are ok but this is what I have been using. Very easy to use. I actually bought the cat sized (smaller pills - ingredients same) for small lysodren doses.

http://www.1800petmeds.com/Pill+Pockets-prod11029.html

[littleone1]

Hi Ellen,

Corky is on a low fat diet. I give him boiled, 93% fat free boneless-skinless chicken breasts, 93% fat free ground beef and ground turkey, which I fry with a little water and then rinse it off, rice, unsalted cut green beans, and sweet potatoes. When I give him his Trilo in the evening, I wrap it in a piece of 97% fat free ham. I hope this helps.

[AlisonandMia]

I don't want to stress you out any more than you are - but Lysodren does need some fat to be absorbed. A very low fat diet can mean you need to give more Lysodren (more mg/kg) to get the same effect.

She is only going to be on the essentially fat-free diet for a week? After that you may want to consider (ask the vet about it though) saving up a bit of her "fat allowance" for Lysodren meals to make sure the drug is being absorbed. I used to give Mia a special little "Lysodren meal" which contained a little more fat than her normal ration. Mia didn't have any particular dietary needs though - I just wouldn't have wanted her to have quite as much fat/oil in her general diet as I gave her when she took her dose of Lysodren.

Alison

[Casey's Mom]

Thank you Alison for the reminder about the fat being needed to absorb the Lysodren.
The reason he wants her on fat free for a week is to flush out her pancreas - after that we are hoping to be okay on low fat which is my homemade. I will continue to give her Lysodren wrapped in sliced roast beef - do you think that will be enough fat to help absorb the Lysodren?

[frijole]

Ellen, Last I recall the acth came in at post 10, still elevated and you were going to continue loading. I assume you stopped at some point due to the stomach issues. Are you planning on giving lysodren while the stomach is still upset? I'm just confused because my vet (though he has made tons of mistakes) has ceased all lysodren for now, partly because of the stomach issues. I think Harley stopped as well.

Is your vet saying the stomach is OK to load and yet go fat free? I'm just a little concerned although all this stomach stuff is new to me. I just know lysodren is not to be used if a dog is sick.

At this point I think getting the pancreatitus under control is the top priority and guess I just want you to know that if she gets sick from the lysodren... cease it and heck, load in a few weeks once things calm down.

Just felt the need to ask for clarification. Sending best wishes and hugs, Kim

[Casey's Mom]

Hi Kim, she has no stomach issues - we found the increased Amalyse and Lipase on a blood screening prior to anesthesia for teeth cleaning. The vet also saw issues with her heart on the EKG that needed further xrays before he felt comfortable proceeding and after discussing it with me he advised against anesthesia because her teeth were not that bad. Only needed some tartar removed.

That is why we did the CPL test and found pancreatitis. She has no symptoms whatsoever and that is why I am continuing with the Lysodren while trying to clear her pancreatic system by diet before there is a problem.

Love and hugs,

[frijole]

Thanks Ellen. Pancreatitus is new to me (obviously)... just hard to wrap my head around it - especially that you could have it without symptoms? Lord - how would you ever know you had it until things were bad? Glad you caught it. Sorry if I worried you - I just wanted to make sure.

So where are you with the loading? Did you start dosing again yet? Keep us posted so we can check in and root you on. Hugs, Kim

[Casey's Mom]

I am loading by doing her dose every 2 days instead of 3.5 days. This usually takes a week or two and she is very easy to tell when she is loaded so I am pretty confident that she will be okay by the end of this week. I am going out of town Thursday to Sunday so I hope to be done by then.

She is doing great - thank you and yes I am so glad she had that bloodwork and we were able to find this before it became a big issue.

Love and hugs,

[Casey's Mom]

Lori maybe you can advise me - Casey gets 500 mg of Salmon Oil daily which I have discontinued for now. Do you know if she should get that in the future or should I stop.

Love and hugs,

[Harley PoMMom]

I think the salmon oil will be fine especially since Casey's cholesterol is elevated.


Fish body oil, such as salmon oil or EPA oil (not cod liver oil), can help to lower blood lipid levels (both triglycerides and cholesterol) in dogs with hyperlipidemia. Studies have also found it to be beneficial in treating acute pancreatitis, while its effects on chronic pancreatitis are unknown. Dosage needed to treat hyperlipidemia may be as high as 1,000 mg of fish oil (supplying 300 mg combined EPA and DHA) per 10 lbs of body weight. Dogs with normal lipid levels should do fine on that amount per 20 to 30 lbs of body weight daily, preferably split into two doses. If you use a supplement with more or less EPA and DHA, adjust the dosage accordingly. Vitamin E should always be given whenever you supplement with oils – give around 5 to 10 IUs per pound of body weight daily (it’s OK to give higher amounts every second or third day, if that is easier).

http://www.dogaware.com/articles/wdjpancreatitis.html

Hope this helps.

Love and hugs,
Lori

[Casey's Mom]

Lori thanks for that link. Very informative. I have some virgin coconut oil - and I will add the salmon oil back tomorrow.

She is doing fine and thanks again!!

Love and many hugs,

[Franklin'sMum]

Hi Ellen,

So glad you caught the pancreas issue early :). If you're going to be homecooking, and nothing but homecooking, this is an analysis site
http://http://www.nutritiondata.com/ Input the foods you plan on using, in the amounts you're wanting to use, click analyse, and it will give you the breakdown of calories/carbs/protein/fat and such. Also the vitamin/mineral content.

You can also create recipes, analyse, and it does the same thing.
Hope that helps,
Jane, Franklin and Bailey xxx

[Casey's Mom]

Casey is doing very well on her new diet of my homemade and Wellness Core reduced fat. Thank you to all of you for your recipes and advice - you guys are the best.

I just have on quick question - I had Casey in to the vets today for her monthly Adequan injection and I mentioned to the tech that for her next ACTH I would like to bring her home and then back in an hour for the next blood draw. The tech said she would ask my vet but didn't think it would be a problem. She did mention that it is a two hour wait not one hour. Does this sound odd? I thought most of you waited an hour between blood draws?

Love to all,

[Franklin'sMum]

Hi Ellen,

Maybe they're using something different. Franklin's doc uses synacthen and they wait 1 hour after the injection to take the post sample. Maybe cortrosyn (?) the gel needs a longer timeframe. I don't remember which one Casey gets.

Hugs to you, Casey and Desi,
Jane, Franklin and Bailey xxx

[marie adams]

Hi Ellen,

I just had a 2 hours test last Friday. The first time I got the 2 hour test I didn't know it was one because I had to leave Maddie longer at the vet because of work. The next time I took her for the test it was later on a Monday and then they told me they needed 2 hours and there wasn't time, but then they came back out from talking to the vet and she said there is a one hour test--this is when I was told there is a different test. The weird thing is the 2 hour test is a little cheaper than the 2 hour. I was really shocked because at the previous vet they always had done the one hour test---so confusing...:confused:

I know the next time I am taking her home with me then bringing her back---it was a nightmare because they didn't tell me they didn't have any of the injection stuff and they didn't call me to let me know not to pick her up until later---it was a totally wasted day and she had to stay there from 8:30-3:30--not a good thing when she isn't use to staying anywhere for that long. I learned so many lessons from that day---one don't try to kill the people behind the desk because they have no clue what time is worth!!!!:D:D:D

[Casey's Mom]

Hi everyone, something scary weird going on with my girl tonight. Last night she was running and trying to play at the park with my sisters dog. At 14 1/2 she should know better and today she woke up a little sore. Came down the steps fine and I gave her her usual Lysodren dose this morning. At noon I saw she was sore so I gave her Tramadol at the same time I gave her her daily dose of Milk Thistle. Now I am home from work and she is semi drooling, staring into space and acting kind of loopy. Also doesn't want to eat. Other than that she looks okay just kind of weird. Do you think its the Tramadol? I haven't given her that in months and months because she hasn't needed it - or could it be low cortisol?

I don't think that is it either because last time she tested in June she was high. I have been giving her the Lysodren a little closer together since then - every 3 days instead of 3.5 until a few weeks ago and was going to retest in September. I still thought she was a little high, no peeing or drinking just a little anxious at night and feeling no pain so that I can live with.

Any ideas would be appreciated.

[Harley PoMMom]

How has Casey been eating? Any noises coming from her tummy?

It might be low cortisol...with our elders it is hard to judge, sometimes we can't go by stim numbers alone and we need to take in account of how the dog is feeling and responding to treatment. Maybe Casey needs her numbers on the higher side now...If it were me I think I would give her some prednisone and see if she feels better.

Hope Casey is feeling better soon.

Love and hugs,
Lori

[Casey's Mom]

Thanks Lori - do you think it might be the Tramadol? The drooling is what is scaring me now but she is spacey like she might be too low as well. I am really scared because I am going away this weekend. She is due for her next dose Sunday night when I am away but now I think I will wait an extra day until I get home.

If I give her pred will that react with the Tramadol already in her system?

[Harley PoMMom]

Drooling can be a sign of pain but it can mean nausea also. Altho all dogs are different, I have given Harley prednisone and tramadol within a hour or so of each other and he never had any ill effects.

[Casey's Mom]

Thanks Lori - I just have to get the pred in her. She has drooled so much her front paw is wet!! But again her spacey look makes me think she is too low - that and the fact that she won't even take chicken. Do we treat the symptoms and not the test results? I am going to schedule another ACTH next week. I will keep you updated.

[Harley PoMMom]

This is JMO, If Casey's clinical symptoms are controlled/manageable but her test results are on the higher side...since she is an elder than I would just treat the pup and not chase numbers...does this make any sense?

Sorry I can't remember, when her ACTH post was 10ug/dl, were her symptoms controlled? If so, then maybe trying to keep them at 10ug/dl instead of trying to get them to 5ug/dl is what makes Casey feel better since she is an elder.

[Casey's Mom]

Should I give her some Pepcid for her tummy or is that too many meds?

[Casey's Mom]

P.S. Lori I agree on letting her cortisol be a little on the high side because she didn't have any symptoms and was happy. Even last night she was great and running around. So . . . .lesson learned. I just want her to eat then I will know she is okay. Will keep you posted.

[Harley PoMMom]

I think I would wait to give her the Pepcid. See how she does with the prednisone, if she does better with that then I probably would give her the Pepcid.

[Casey's Mom]

Thanks Lori.

Waiting to see what happens . . ..

[Harley PoMMom]

When Harley was having his fits with not wanting to eat, the only way I could get him to eat was out of my hand, literally piece by piece with my fingers and he would eat it.

Please keep us posted and keeping you and Casey in my thoughts and prayers.

Love and hugs,
Lori

[Casey's Mom]

Just went out to check her again - she wanted to stay in the backyard - and she wasn't drooling and she followed me in and ate some homemade food. (chicken, rice, sweet potatoes and beans)

Yeah!!!! It is so horrible when they don't eat and I feel for everyone out there that has had to deal with this issue. She refused out of my hand, I just had to wait for the pred to kick in - 2 1/2 hours later. She didn't eat much but she ate.

Thanks so much,

[frijole]

Great news! Give Casey a treat for me! My heart goes out to you. I soooo know the frustration and pain. Hoping for continued success. Hugs, Kim

[littleone1]

I'm so glad that Casey is eating, Ellen, even if it's not as much as she normally eats. The main thing is that she is eating. Sending positive thoughts and prayers that everything is back to normal.

[zoesmom]

Ellen - now that you've got the pred in her and she's eating, here I am (a little late) to say I'm betting it's the tramadol. In fact, I think I might have used the word 'loopy' myself to describe Zoe's reaction to it. Staring, blankly, too. However, the drooling, not so sure about.

But Zoe did have an episode one night of horrible drooling. Started out of the blue, or so it seemed. And then she had a few more lesser bouts of it in the coming days and weeks. But the first night, she completely soaked her entire chest, paws, and all the towels I'd spread underneath her face. It got so bad I took her to the emergency clinic at 11 pm or so. They didn't find anything significant, but in hindsight, I began to have a sneakin' suspicion that she might have cracked a tooth that night, because a few months later a tooth became abscessed and had to come out. It was cracked apparently. That might explain the not-wanting-to-eat, too. Has Casey been chewing any bones/rawhides/or other hard things???? Alternate explanation - some kind of severe pain.

The tramadol may have curbed some of the pain but not all of it if it was bad. The loopy part tho - I'm bettin' that's the tramadol. I quickly learned that Zoe couldn't tolerate anywhere close to what the vet prescribed for a dog her size. And ever after, I only gave her like a half a dose. Sue

[Casey's Mom]

Thanks Sue, the thing is the other times that I gave it to her barely reacted at all - in fact I didn't think it worked for her. However that was months ago.

[frijole]

I missed the tramadol discussion also... search in Haley's thread and you'll find one of the scariest nights of my life. I gave her the recommended dosage and she was literally walking into walls. Then she just stood there and stared at the wall... totally high. Then... Vomited. Then got AWFUL diarrhea. Throughout the night while I slept. :eek: It was totally like a doggy on major drugs.

I learned from everyone that shared their experience here that every single one of us had to go with 1/2 of the recommended dosage. Don't know if its age related or what but we all had similar experiences.

[Casey's Mom]

Okay now she is back to normal - 14 hours after Lysodren dose, 9 hours after tramadol and 3 1/2 hours after pred. :D:D. Maybe because she is now a year older than the last time we used the tramadol she needs a lower dose. Her prescription says 40 mg and she is 40 lbs. Any thoughts?

[frijole]

Okay now she is back to normal - 14 hours after Lysodren dose, 9 hours after tramadol and 3 1/2 hours after pred. :D:D. Maybe because she is now a year older than the last time we used the tramadol she needs a lower dose. Her prescription says 40 mg and she is 40 lbs. Any thoughts?

Haley was prescribed 25 mgs (2 x a day) when she weighed 15 lbs. That was too much. I cut that in half. Your dose doesn't sound very high. My pills were 50 mg pills - how do you give 40 mgs? :D You must have different size of pill?

[Squirt's Mom]

Hey Ellen,

Glad to hear that Casey is feeling more like her old self tonite. What a scary time this must have been for you! I hope there is no repetition in the future.

You done good...I would have been running around, flapping my arms like Chicken Little crying, "My dog is drooling! My dog is drooling!" :eek::rolleyes::o

Hope you both have a good nites rest tonite!
Hugs,
Leslie and the girls - always

[Casey's Mom]

Kim her pills were compounded by a pharmacist in a capsule. My vet prescribed them back when we first began treatment and her arthritis became evident. I guess that's how we got the 40 mg. She gave me 10 repeats! I wanted to give her baby aspirin instead but am afraid because of her liver values. They aren't off the charts but they are slightly higher than normal range.

Leslie you made me laugh out loud with your post!! The thing is I knew she wasn't in any pain or discomfort just loopy :) however the not eating thing is so not Casey. I did pick up the phone at one point to call my vet - was put through to emergency on call vet and changed my mind. I would have had to explain it all in great detail and I was hoping you guys could give me some good advice and there Lori was and then all of you.

I thank all of you with great big hugs!!:):):)

[Bailey's Mom]

Hi, Ellen-
I'm glad Casey is eating once again. It IS very scary. If only our doggies could talk to us!

-Susan

[marie adams]

Hi Ellen,
Wow, I am sure you are feeling soooo much better now that Casey is back to normal or close to it. It seems like it is always something we are trying to figure out with them---are we going to be this much work when we reach their age:eek:??? I sure hope not.

I really am glad things are better!!:)

[Harley PoMMom]

Hi Ellen,

So glad to hear that Casey is eating and I am hoping that I find your next post saying she is feeling like her normal self. Give sweet Casey some gentle hugs from Harley and me...give yourself some too!

Harley's never had any adverse effects from tramadol. When the growth was discovered on his front paw, which was painful to him, I was giving him 25mg of tramadol 2x a day with no adverse effects...like we say...all pups are different!

Love and hugs,
Lori

[Casey's Mom]

Who knows what that episode was - it was just weird and scary when she wouldn't eat. She is fine now - she was drinking just a touch more than normal last night but this morning is fine - up early ate all her breakfast drank a little water and is now outside sleeping in the yard.

My dilemma is I am going away from Saturday morning to Monday night and she will be at the dog sitters. She is scheduled for Lysodren Sunday night - should I hold off until Monday night when I get home? My gut is telling me yes. Will the prednisone I gave her last night affect her cortisol levels long term or is it out of her system now?

Thanks guys for all of your collective brains and warm wishes!

[Harley PoMMom]

Who knows what that episode was - it was just weird and scary when she wouldn't eat. She is fine now - she was drinking just a touch more than normal last night but this morning is fine - up early ate all her breakfast drank a little water and is now outside sleeping in the yard.You are right...who knows what exactly caused that episode...just very happy and relieved, as you are, that Casey is acting her normal self.


My dilemma is I am going away from Saturday morning to Monday night and she will be at the dog sitters. She is scheduled for Lysodren Sunday night - should I hold off until Monday night when I get home? My gut is telling me yes. Will the prednisone I gave her last night affect her cortisol levels long term or is it out of her system now?

Thanks guys for all of your collective brains and warm wishes!

If it were me, I would wait to give her the Lysodren until Monday night. You know Casey best tho, remember that...if your gut is telling you to hold off then I would listen to your gut! Her one dose of Prednisone can remain in her system for approx. 24 hours.

Love and hugs,
Lori

[Franklin'sMum]

Hi Ellen,

I'm so glad Casey is eating again, and is back to her normal Casey self. I really hope she continues to eat well. Hugs to you,
Jane, Franklin and Bailey xxx

[littleone1]

Hi Ellen,

I'm so glad that Casey is doing better.

[frijole]

:pMy vote would be to hold off ... its only a day. Go have some fun!

[Casey's Mom]

I'm back and she is fine although tired and panting with this heat and humidity. I am sure that she is wishing for snow again - not me!!

Thanks everyone for your kind wishes.

[Casey's Mom]

Hi everyone, just wanted to give an update from my latest ACTH last week. Casey's pre Cortisol 57 nmol/L and her post Cortisol was 169 nmol/L which I converted for my American friends to pre 2 and post 6. (hopefully I did this right). I also had the lab check pancreatic profile as she was diagnosed with subclinical pancreatitis in June according to blood work but not symptomatically.

Her results are as follows:
Amylase 1461 (150 - 1350 normal range)
Lipase 1091 (0 - 900 normal range)
Triglycerides 3.73 (0.12 - 1.60 normal range)
Glucose - normal
Hemolysis - Normal
Lipemia -1+ (normal)

The vets notes say inflamed pancreas to be expected due to cushings and medical treatment for her disease. Says we can treat symptoms if necessary - however Casey is fine and has never shown any symptoms of pancreatitis.

The Anylase and Lipase are down significantly since last test in June - I believe through diet. (Thanks Lori for your help on that!) I now feed my homemade rice, ground turkey, sweet potatoes and green beans mixed with Wellness Core reduced fat kibble.

She also takes Adequan injections, glucosamine and L-glutamine as well as salmon oil for her arthritis and is doing so well - runs and trots at the park every day and is doing very well for a young lady of 14.5.

I am happy and my dog is doing well - just wanted to give everyone a happy update:):):)

[Franklin'sMum]

Hi Ellen,

YAAAYYYY!!!!! :) Love the good news :)
Bigs hugs
Jane, Franklin and Bailey xxx

[Bailey's Mom]

Hi Ellen-
Sounds like a great report, plus 14.5 is a great age to get to.
It's a lot of work, but worth every minute.
Hugs-
Susan

[labblab]

Ellen, what a super report!!!! Thanks so much for updating us. It is wonderful to be able to share in good news. ;) :) :D

Marianne

[Dollydog]

What a great update Ellen....have been wondering how Casey is doing!! 14.5 years is a wonderful accomplishment....Congratulations!
Jo-Ann

[Harley PoMMom]

What a great update!! YOU are doing a wonderful job. Keeping that pancreas happy is no easy task especially when cushing's is involved.

Congrats!! and give sweet Casey some hugs from Harley and me.

Love and more hugs,
Lori

[zoesmom]

:):):):):):):):):):):)

Luv it! So happy to hear such great news - for Casey and for you! Keep on truckin', Casey. Sue

[gpgscott]

Thanks for the update Ellen. Hoping the pancreas issue remains under control.

Scott

[Casey's Mom]

Thank you everyone for your kind wishes. :):)

We had a great hike today on our old trail in the woods across from the farm where we used to live - she is slower than her younger days but at least I don't have to worry about loosing her in the woods - she used to run off chasing a rabbit or a squirrel and I would be calling and calling . . .. .

[littleone1]

Hi Ellen,

I'm glad to hear that Casey is doing so well. It's always good to hear such positive updates.

[Squirt's Mom]

Hi Ellen,

What a great report! :) I am so happy to hear how well Casey is doing. It makes everything so worth it when they are happy and able to more fully enjoy life again.

Keep up the good work, Mom!
Hugs,
Leslie and the girls :D - always