Maddie/11 yr. old Aussie/Lysodren (Dear Maddie has passed)

[marie adams]

Hi,
I am Marie, my 11 yr. old Aussie, named Maddie, was just diagnosed with Cushing's. I started her on Lysodren last Wednesday evening. I am a little nervous with this medicine. The only side effect if it is has been more weakness in her hind legs--shaking and her paws seem to buckle under occasionally when she walks. She had a hard time climbing the stairs more than usual. This could be she is tired from running yesterday; so watching her today. I called the vet yesterday and spoke to an older vet who has more experience with Cushing's and he said to cut back her dose to 2 500mg from 3 a day--that made me feel a little better other than Maddie might have gotten too much already and affected her adrenal gland in a bad way. She will go in for test later this week so I can be patient and believe everything is going to get somewhat better the longer she is on meds.

I am checking into an holistic approach and have heard Trilostane is a better way also---soooooo confusing.

Thank you!!! Marie

[Squirt's Mom]

Hi Marie,

Welcome to you and Maddie! :)

Lyso is a scary drug until you get to understand it a bit better. When I first started this journey I felt the same way about it and was more comfortable with the idea of Trilo. As I have learned more, it is Trilo that scares me the most. Lyso has a long history of treating Cushing's in pups while Trilo is comparatively new. Trilo can cause more problems as it has been shown to elevate at least one, if not all, of the other five hormones that can come into play with Cushing's. They both have the possibility of causing problems when not properly administered and monitored. If you vet is more familiar with the Lyso, I would stick with it for now.

It would help us a great deal if you could get copies of the tests that have been done on Maddie to arrive at the diagnosis and the CBC (general blood work) results as well, then post them here. We can help you interpret them and maybe understand a bit more about what is happening with your baby.

I know how scary this can be but you have found the very best place for knowledge, experience and good old-fashioned hand-holding! You are not alone any longer; we will be here to help you any way we can. Please don't hesitate to ask any questions or just talk if you need to. Someone is usually here 24/7.

Hang in there!
Hugs,
Leslie and the girls - always

PS. Did you vet give you any prednisone? If not, call and get some. Pred is not an option when treating Cushing's with either Lyso or Trilo.

[Harley PoMMom]

Hi Marie,

Welcome to you and Maddie from me and my boy Harley. My boy Harley has PDH (Pituitary Dependent Hyperadrenocorticism) Cushings and is being treated with Lysodren also.

Since some other illnesses have the same symptoms as Cushings I was wondering what test/s your vet did to confirm the diagnosis of Cushings in Maddie. And if you don't mind me asking you some questions about your precious girl, and this is not to be nosy, this will help us gain information about your beautiful girl so we can give you better feedback to any questions you might have, ok?

How much does Maddie weigh? Did Maddie have an ACTH stim test and if she did, could you post the results here. Did Maddie go through a "loading phase" of the Lysodren and is she now on her "maintenance dose?" Do you have prednisone on hand? Did Maddie have a CBC and or Chemistry panel done, and if she did, could you post anything on there that is marked abnormal with the units of measurements and reference ranges. Is Maddie taking any herbs or supplements?

I realize that I have asked you alot of questions but the more we know about Maddie the better we will be able to help you help her.

Lysodren and Trilostane are lifesaving drugs, if given according to protocol, for our Cushingnoid pups, but can be dangerous to give to pups that do not have Cushings. That is why it is vital to get a proper diagnosis. Cushings is a slow progressing disease and one has to take the time, for their furbaby's sake, to get a proper diagnosis.

Marie, is Maddie eating alright? She isn't acting lethargic, is she?

Here is a link that I think you will find very interesting.

Lysodren loading Instructions and related tips
http://www.k9cushings.com/forum/showthread.php?t=181

Please know you are not alone on this journey, we are here to help you in any way we can. Ask all the questions you want and we will try to answer them the best we can.

Love and hugs,
Lori

[marie adams]

Hi Leslie,

Thank you!!! You have made me feel better about the choice I made to use Lysodren. Have you had any experience with using some of the natural remedies along with this drug?

I forgot to get copies of the test results last week. I know her liver number was 360; the vet said it was high, but someone told me not so high. The vet said to use milk thistle to help control it.

There is just sooo much info, but yours has helped a lot. I am seeing a lot more weakness in her hind legs since yesterday another support member said she saw that in her dog, but in 2-3 days I should notice a change for the better. I know every dog is different so I will keep a close watch on Maddie. I will check with the vet tomorrow about the prednisone--you are not the first to tell me about this.

Thank you thank you!!!! Marie

[labblab]

Hi Marie,

Can you tell us how much Maddie weighs? And am I understanding you correctly that from last Wednesday through yesterday, she had been receiving a total of 1500 mg. of Lysodren each day? And she is now receiving a total of 1000 mg. daily?


I am seeing a lot more weakness in her hind legs since yesterday.
Has your vet told you to STOP giving the Lysodren and take her in for testing when you see changes in Maddie's behavior? Or has a test just been scheduled for a specific day this week, regardless of how she is behaving? I am very worried that the increasing muscle weakness that you are seeing may be a signal that Maddie has had more than enough Lysodren for the time being, and that it is already time for her to be tested! If that is the case -- that she has already had enough -- and you continue to give her more Lysodren, she will become very ill. Please do let us know about her weight and her dosing just as soon as you are able.

Here is a quote from the "Lysodren Loading Instructions" link that Lori gave you earlier in her reply (http://www.k9cushings.com/forum/showthread.php?t=181):


Lysodren administration should be stopped when:

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

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

3. the dog vomits.

4. the dog has diarrhea

5. the dog is unusually listless.

Please do look over the information contained in that link carefully, to make sure it corresponds to what your vet has already told you.

Marianne

[Squirt's Mom]

Hi Marie,

Squirt has a form of Cushing's called Atypical which does not involve elevated cortisol and so far she is being controlled without using the Lyso, tho that is possibility in the future. The treatments for Atypical can be considered as "natural" or more precisely, as nutraceutical. She has had a diet designed especially for her by a canine nutrition consultant plus takes melatonin and flax lignans as the treatment for her form of Cushing's.

Her ultrasound showed some sludge in her gall bladder and some changes in her liver that are consistent with aging so she gets Burdock and milk thistle for those. The milk thistle is cycled; she gets it in the spring and fall months only. She also gets Astragalus as an immune booster. In her diet, taurine, kelp, zinc, manganese, and calcium in the form of egg shells (finely crushed) are added to meet the nutrient requirements for her on this particular diet. This will vary by dog, blood work reports, and by diet. To help with arthritis she also gets SAMe, Vit C & E, and cold pressed salmon oil. I am looking into starting her on some plant enzymes in the near future as well. These can help with many, many things especially as our babies age and for those pups under stress of any kind.

The island in my kitchen looks like a mini health food store these days! Squirt is one of three and another one of mine has some ortho issues so she has her own regime of goodies! :p iHerb, Vitacost, and Whole Foods love to see me coming! :D

Hugs,
Leslie and the girls - always

[frijole]

Hi Marie! I have a schnauzer that has been on lysodren for 3 1/2 yrs now.... she is over 16 yrs old! You will get used to it - it has saved her life.

I'm going to hold off on discussing the holistic stuff until we get thru the most pressing matter which is seeing that Maddie gets thru her "loading" ok. I wouldn't introduce anything else new - drugs, herbs or food because you want to know if she vomits that it is from lysodren and not something else.

Marianne posted some important info which I hope you either read or are already familiar with.

I too am curious as to Maddie's weight. Just checking the dosage to see how that is going. Not sure if anyone asked but do you have prednisone on hand in case of emergency? I never had to use it for emergency but it is a must to have just in case.

YOu asked about the legs... alot of cushings dogs have weakness in the hind legs and have a hard time getting into cars, going up steps etc. This clears up over time as the cortisol is reduced. I do need to let you know that when a dog gets too much lysodren they can have a hard time walking and even sometimes can't get up. If anything like this were to happen, obviously call the vet but if you can't get ahold of the vet - this is when you would give the prednisone. It mimics the cortisol that is being reduced and gives the dog relief in a few hours. This is all explained in the link that Marianne provided earlier.

Meanwhile, monitor food and water intake and if there is any change, call the vet as you should probably stop the lysodren and have another acth test to check the cortisol levels. I also watched the poop to make sure it stayed solid. Diarrhea and vomiting are signs of too much lysodren so watching it is a safety measure.

Do not worry - we have been thru this and you will be fine. Just read up and ask questions. We are here to help. You aren't alone! Glad you found us. Kim

[marie adams]

Hi,

Maddie weighs 72 lbs. Her normal weight is between 65 and 68 lbs. She is a larger Aussie in size--not over weight. She has been very active running many miles each day until the last 3 months or so. That is when more symptoms started showing up, but we had no clue--just thought as the vet kept telling us she was getting older. I kept looking online to see if I could come up with an idea and was looking for a reason her fur was getting thinner and there was no under fur any longer--there was a link to Cushing's. I checked it out and WOW she had most of the symptoms. I told the vet what I was sure it was--it is funny they seemed to want to blame it on being older and maybe arthritis.

She has not had any sign of problems except yesterday, but she did run in the morning and maybe it was a little too far. She couldn't climb the stairs last night, but managed to make it up there late this morning. She eats and wants more--haha--I wonder why....She continues to drink water--that seems like it is a little less--which could be a good sign. I am checking for signs good or bad all the time.

I will get her info tomorrow and share with all of you.

Thanks for the support!!

[labblab]

Marie, thanks so much for this additional info. But can you clarify for us the instructions that your vet has given you regarding Maddie's testing this week? Are you to stop the Lysodren and take her in for testing when you notice certain changes in her behavior? Or is there a particular day this week that has already been set up, in advance, for her to be tested?

Marianne

[frijole]

Thanks for the update!

:) And please let us know whether you have prednisone on hand. Thank you! Kim

[marie adams]

No I do not have a day for testing--I am calling tomorrow morning to schedule the day so everything is setup to have the ACHT test done--no instructions other than will have Maddie take the meds for 10 days and then test her. I would like it done Thurs or Fri even though it is not 10 days. I know I have seen where the load time could be 7-10 days.

No I do not have prednisone on hand - that is the other things I will be requesting.

Thanks!

[Harley PoMMom]

Hi Marie,

Optimal time for an ACTH test for a pup being treated with Lysodren is 48 hours after her last dose.

Love and hugs,
Lori

[frijole]

Marie, Oftentimes a vet will read the protocol and it comes off like an exact science.. my vet did the same thing. 7-10 is the norm, however... my dog took several months :D and we have seen dogs "load" in a couple days. Honestly bigger dogs seem to take less time.

So you can schedule the test but pay attention to water/food intake for irregularities. Drinking less, eating slower, pausing between bites of food if she normally inhales it.... subtle changes. If she vomits or gets diarrhea don't give any more lysodren.

Should you see changes then simply call the vet and schedule the appointment for the test. Lysodren continues to work for up to 48 hrs from the last dose so when in doubt, just don't give it. I always feed my dog first and then give the lysodren. That way I can see how she is doing prior to giving the meds.

And yes, get the prednisone tomorrow if you can. It really is required with both lysodren and trilostane. Your vet will know this when you call to ask for it. The reason you need it on hand is because emergencies are always in the middle of the night or on weekends. ;)

I know it is nerve wracking.. but once you get the cortisol to a reading between 1 and 5 you are on to maintenance and it is sooooo much easier. Believe me. Hugs to Miss Maddie. Kim

[marie adams]

So how long should I wait to have the test done--before the 10 days because that will be Friday and I will not get the results till Monday? Or should I have it done on Thursday morning so the results can be back at the latest Saturday if it really takes 2 days?

If a larger dog doesn't take as long to load, she might be there, but then other than the test are there signs she has loaded?

So many questions I feel like I am not on top of this and I know you all are helping--thank you! This is nerve racking....

[AlisonandMia]

The most reliable sign of loading, in a dog with an increased appetite, is for the appetite to reduce. Sometimes this is only a really subtle change - maybe not rushing to the food bowl quite so fast, not eating quite so fast, pausing during eating, leaving a little bit of food. It can even be something as little as being "polite" with treats when previously they'd been snatched from your hand.

The second most reliable sign is a decrease in water consumption - it may not be quite back to normal but any appreciable decrease can be a sign.

The food sign is a lot more reliable than the water sign (water consumption can take weeks to return to normal in some dogs) but which ever you see first is the one you heed.

Unfortunately a small number of dogs don't show any sign of being loaded until they have gone a little too far and then you may see signs of low cortisol like weakness, diarrhea, nausea, complete loss of appetite or vomiting.

If you have the slightest suspicion that she may be loaded you need to give no more Lysodren as giving any more will result in overloading and the cortisol going too low.

The standard protocol says to stop and test when signs of loading are seen (and as the others have said it is best to wait approximately 48 hours after the last tablet is given to get the most accurate result) or, if the dog hasn't shown signs of being loaded by 8 - 10 days (the recommendation varies) then to test anyway to see how things are going.

If in doubt don't give the dose. If it is a false alarm you can always start dosing again with out having lost any significant amount of ground. It is certainly better than overloading. A slight overload is not usually really a problem (as long as you have prednisone on hand) but a severe overload can be really dangerous. So a dog showing signs that could indicate low cortisol should certainly never be given any more Lysodren until it can be tested and you have the results.

If you do need to give prednisone at any point you will need to wait 24 hours after the last prednisone dose before doing an ACTH stim as the prednisone reads as cortisol on the assay and will therefore produce an inaccurate result.

Alison

[frijole]

So how long should I wait to have the test done--before the 10 days because that will be Friday and I will not get the results till Monday? Or should I have it done on Thursday morning so the results can be back at the latest Saturday if it really takes 2 days?

If a larger dog doesn't take as long to load, she might be there, but then other than the test are there signs she has loaded?

So many questions I feel like I am not on top of this and I know you all are helping--thank you! This is nerve racking....

Alison did a great job of explaining and I am going to repost the link that alot of have used as a reference guide for loading. http://www.k9cushings.com/forum/showthread.php?t=181

She is right that if you are 7 to 10 days into it and don't see signs it is worth having the test done just for peace of mind. My dog never really showed any signs other than her stools became softer and softer. She never got diarrhea.

So it is OK to schedule the test but do get the prednisone. Great questions. FYI, this is why this board was created.... so many of us have walked on the same path. We understand. The more you read and learn about the treatment the better advocate you can be for Maddie. You are doing great! Hang in there. We'll be checking in. Kim

[labblab]

I started her on Lysodren last Wednesday evening...The only side effect if it is has been more weakness in her hind legs--shaking and her paws seem to buckle under occasionally when she walks. She had a hard time climbing the stairs more than usual.



She couldn't climb the stairs last night, but managed to make it up there late this morning. She eats and wants more--haha--I wonder why....She continues to drink water--that seems like it is a little less


I am seeing a lot more weakness in her hind legs since yesterday.
Hi again, Marie.

I want to re-emphasize the really helpful info that you've been receiving. Sometimes the behavioral changes that indicate that a dog is "loaded" can be very subtle. And if there is any question at all, it is much safer to stop the Lysodren and have Maddie tested. You can always start the Lysodren back up again if she needs more.

But every dog is on its own timetable in terms of loading. There is no set number of days -- no specific forumula -- for knowing how long it will take. That is why it is really important for the owner to watch very carefully for any changes in behavior that can signal that loading is complete.

You have told us that the shaking, paw buckling, and weakness are NEW changes in Maddie that you have noticed developing within the last 24 hours (as well as perhaps a slight decrease in water consumption). So when you talk to your vet today, please be sure and tell him about these changes. And if her weakness worsens at all today, please hold off on giving Maddie any more Lysodren UNTIL you have had the chance to talk with your vet.

We'll be really anxious to know how things go for you today.
Marianne

[labblab]

And just so you'll have it right here for easy reference, I'm going to copy part of the "Lysodren Loading Instructions" from the link that folks have been posting for you:



INITIATING THERAPY - THE LOADING DOSE PHASE:

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

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

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

Lysodren administration should be stopped when:

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

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

3. the dog vomits.

4. the dog has diarrhea

5. the dog is unusually listless.

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

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

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

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

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

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

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

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

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

[marie adams]

WOW!!! Thank you for the instruction--they are so very helpful.

I am not seeing any true signs yet. The weakness seems to be better because she has rested from Sunday's run. It is back to what it was. Her drinking and eating still remain the same as before we started. She walked with me better this morning--keeping up and not dragging behind.

I think I will wait till Monday at this point to test her since there is the 48 hour time span, unless I see anything which tells me it is time. I will ask if the test can be administered over the weekend if the timing works out that way.

Thanks for all the helpful info--I am going to give this info to the vet also since I did not get this and I know it will be helpful for others in the future.

[frijole]

Checking in during my lunch break... Don't forget to get the prednisone! :o:D;) Kim

[marie adams]

Hi Kim,

Thanks for checking on Maddie and me. I am going to the vet at 2pm to get the prednisone or a prescription and give her a copy of the instructions and your link--she is kind of new to this and works with the vet in the hospital that has treated cases. Of course I am glad I can make sure things are going the way they should; so thanks for the help!!!! :D

[labblab]

Dear Marie,

I'm so relieved to hear that Maddie is feeling perkier again today, and also that you'll soon be heading off to pick up the prednisone :). You may never need to use it, but it'll give us all peace of mind to know that you have it, just in case Maddie's cortisol level should ever dip too low.

Thanks so much for updating us!
Marianne

[Squirt's Mom]

YEAH, mom! and YEAH! that Maddie is feeling better today!

Hugs,
Leslie and the girls - always

[frijole]

Good girl Marie! I am relieved. Sounds like you have things going in the right direction. Keep paying attention and ask questions if you need us. Kim

[marie adams]

Thanks to all of you for all your help!!! Yea, I got the prednisone and the vet didn't even charge me--haha--oh yes they did when I paid for the tests....I gave the vet your website to learn more and the instruction they should give in the future. She is checking with with the lab about the 48 hours after the last dose info. I had put in a call to UC Davis on Monday and they called me back; I reconfirmed with them so the vet knows this is the standard practice.

Thanks again!! Marie

[AlisonandMia]

Hi Marie,

Glad you've got the pred. How is Maddie going?

With regards your vet being somewhat inexperienced with Cushing's (many excellent vets haven't had experience with this disease) it might be a good idea if you could get her to talk to the people at UC Davis. We have seen several instances where an inexperienced vet has turned to the lab for advice on testing and treatment and very often the "experts" at the lab while knowing all about the numbers etc. have no (or very little) practical, clinical experience and that, possibly along with communication glitches, can result in the treatment not going as well as it should, shall we say.

My vet wasn't experienced with treating Cushing's either and, as well as reading up on the subject (and making me read up on it too!) he was actively consulting with a specialist, particularly in the early stages of Mia's treatment. We treated with Lysodren also - with very good results.

Alison

[labblab]

Marie, good job on contacting UC Davis and confirming the testing info!

And I also want to "second" what Alison has said above. Many otherwise excellent GP vets just don't have the occasion to treat that many Cushing's dogs. Because Cushing's symptoms can mimic those of other diseases and conditions, my own vet (who I love!) decided to consult with an internal medicine specialist in order to nail down my dog's diagnosis. We were all grateful for the additional information and feedback.

So we will be very pleased if your vet does decide to visit us here in order to check out our resources and the experiences of our members. And as you already know, UC Davis is one of the most prestigious vet schools in the country. So whatever guidance you and your vet can get from Davis would be a huge advantage to you all.

Marianne

[marie adams]

I live in Orange County, CA and I thought UC San Diego had a facility like Davis since they were connected, but they do not treat all conditions; so they suggested I call up there or call the Vet hospital next door to them. When I called the Vet Hosp. they couldn' give me much info because by law they are not allowed to consult when they haven't seen the dog. Of course, all I wanted to know is what signs am I really looking for if over loaded or loaded. Everything I keep reading is be very very careful and I thought what if I make a mistake it can be irreversible. I had left a message at UC Davis and a 4th year student/advisor called me back--she said we were doing all the right steps and the info you all gave me was correct.

My husband said this morning I am doing a great job watching over Maddie and I have to remember she has and had a good life so just enjoy her. This is our first dog, we always thought we were too busy in life and having a child that it would not be far to the dog. Well little did we know how you make time for the dog and it keeps you young & healthy--haha!!! And the people you meet through the dog--we know so many of the people in our neighborhood that my relatives ask how we know so many--we answer "the dog".

Thank you again for all your help!!! Marie

[lulusmom]

Hi Marie,

I haven't posted to your thread before now but have been following the discussions. I noticed that you are in Orange County. I have two cushdogs and even though I am in San Bernardino County, my dogs treat with an internal medicine specialist at VCA All Care Animal Referral Center in Fountain Valley. They treat a ton of cushdogs and know their stuff. I've chatted with other cushparents in the waiting room many times while my two were there for acth stim tests. My dogs see Dr. Michael Moore, the Director of Internal Medicine, but they've also seen Dr. Alyssa Mourning, who is also wonderful. They are also open 24/7 which gives me tremendous peace of mind.

Our old gp vet didn't know diddly about cushing's and my first one went undiagnosed for way too long. Even if he had known how to spell cushing's, there is no way he would have known how to treat her. My cushdogs have multiple issues so I feel fortunate to have found Dr. Moore. I have referred three members there, all of whom are very happy with the care their dogs have received. One dog had a macroadenoma and received radiation treatment and is doing beautifully. Another has an adrenal tumor that is being treated with Lysodren and is also doing quite well. Both of my dogs have pituitary dependent cushing's, are well controlled and thriving. Lulu has been treating there for over four years and Jojo for two years.

If you are at all interested, and I hope you are, I have included a link to VCA's website below.

http://www.vcaacarc.com

Glynda

P.S. I forgot to mention that VCA does not require a referral from your gp vet.

[marie adams]

Hi Glynda,

It is funny you mention them because I called over there and was asking questions; yes they did seem to know their stuff. I was a little hesitant to change over because it sounded like they wanted to do way too much testing when I knew in my heart I had finally found what was wrong. The reason I had called them was because it was weird my vet's office was waiting for the pharmacy to get the medicine to test Maddie with and I was very anxious to get the results back to start treatment so every hour of waiting was hard.

With all the help so far from the support groups, I am keeping on top of this, but if I feel I need to change....I will.

I have talked to them over the years about little things I needed help with--like when Maddie was a puppy and ate a sock. They suggested hydrogen peroxide to make her throw up. They are always helpful.

Thanks a bunch!!!

[marie adams]

Hi Glynda,

It is so nice to know your dogs have come through this. I was so afraid to treat with Lysodren, but thought it has been used for so long I want to get her back to her old self asap. Little did I know what great support groups were out there to help along the way and share stories of success with all the medicine out there.

I will let my vet know about Dr. Moore and Dr. Mourning.

Thanks again and I am happy your two are under control and thriving!!! This is where I want to be....:)

[lulusmom]

Marie, I just wanted to mention that if your vet did a good job of confirming the cushing's diagnosis with appropriate screening and diagnostic tests, most IM's are willing to use copies of those tests to keep the cost down.

I did notice that you have not posted the results of the tests your vet did to confirm a diagnosis. Do you remember which tests were done? We would be most interested in ACTH stimulations tests, LDDS test, HDDS test and findings of abdominal ultrasound. The latter two are called differentiating tests that will confirm which form of cushing's is involved.

As no one test can be assumed to be 100% accurate, it is important that more than one diagnostic test be done to validate and/or confirm the diagnosis. Which form of cushing's did your vet diagnose...pituitary or adrenal? Cushing's is a very difficult disease to diagnose which makes it the most misdiagnosed condition so even though we aren't vets, we find a great deal of comfort in knowing that sufficient testing was done.

Please be sure to get copies of those tests as soon as you can and post the results here.

Glynda

P.S. Both of my pups are treating with Lysodren. My Lulu is only 4.5 lbs and Jojo is almost 7 lbs.

[marie adams]

We only did the ACTH sim test because she had a major of the clinical signs and didn't want to put her through too much at this time.

Maddie weighs 72 lbs so she is a medium large dog she is a large Aussie than most, but she could weigh less in the 65-68 lb range. She looks heavier because of her potbelly--poor thing never had that problem before--kind of like when we get older it settles around the middle--haha.

Her Pre Test Result was 8.2 (HIGH)
Her Post Test was 22.1 (HIGH)

Other areas where she was HIGH were:

ALT (SGPT) 359 (12-118)
Alkaline Phosphatase 1846 (5-31)
GGT 42 (1-12)
BUN/Creatinine Ratio 36 (4-27)
Cholestrol 511 (29-324)
Neutrophils 11180 (2060-10600)
Monocytes 1040 (0-840)

Areas of LOW were:
Calcium 8.6 (8.9-11.4)
Lymphocytes 650 (690-4500)
T4 0.5 (1.0-4.0)

Everything else was in the normal range

I was told her liver count ALT 359 was high and I could control it with Milk Thistle. So far it looked like the liver is the only problem, but it could come down with the Lysodren.

Now I am feeling like I didn't do enough, but I won't put her through surgery to remove the tumor if it turns out to be adrenal; so I elected to start the Lysodren because it can treat both.

Marie

[marie adams]

sorry I type away and do not get all the letters in there to complete words--so read between the lines--haha

It is the ACTH stimulation test

8.2 (1.0-5.00
22.1 (8.0-17.0)

Do the (Reference Ranges) correspond to the dogs age, weight, type???

[Squirt's Mom]

Hi Marie,

The reference ranges are what is considered normal for that lab. Some labs use differing ranges of normal so it is always important to look and the norms as well as the units of measurement like ug/dl, mnol/L, etc. That way you are comparing apples to apples every time. ;)

You are doing a great job, Mom, and you tell your hubby that Maddie will be around for several more years to enjoy with your loving care and attention.

Hugs,
Leslie and the girls - always

[marie adams]

Thanks Leslie --they are ug/dL

[Squirt's Mom]

It looked like that was the unit. :) The high pre could well be caused by Maddie just being stressed from being at the vets and having the test. It is a normal response for dog's, and human's, cortisol to rise under stress...cortisol is one of the "fight or flight" hormones. Necessary for the proper functioning of the body.

The post is elevated and in range to make Cushing's a possibility. Squirt had levels in the 30's but hers turned out to be a tumor...in fact ALL her cush tests were positive and all but the UTK panel were false positives because of the tumor.

I'm not sure if Maddie has had an abdominal ultrasound yet but, if not, that would be a test I highly recommend. It saved Squirt's life.

I will let our resident lab expert comment on the blood work and I'm sure the pros will be along to give their input on the ACTH. :)

Keep up the good work and remember you have plenty of time to make sure Cushing's is indeed what is bothering Maddie. I know how hard it is to go slow but it is the best approach....at least IMHO...of which I have many. :o:p

Hugs,
Leslie and the girls - always

[labblab]

Hi Marie,

Thanks for posting Maddie's test results. From what I can tell, I do believe that her abnormal readings are generally consistent with a diagnosis of Cushing's. But I am not an expert, by any means.

It is true that we feel more comfortable when we see additional testing that is more Cushing's-specific (for example, as Leslie has suggested, an abdominal ultrasound which provides actual images of the adrenal glands). The ACTH (as well as the LDDS, which is the other primary diagnostic blood test) can be skewed by other, nonadrenal illnesses. However, the ACTH is less likely than the LDDS to return a "false positive" if a dog does not actually have Cushing's.

I do notice that Maddie's thyroid result ("T4") is abnormally low. More sophisticated thyroid testing can help distinguish whether or not the low T4 is related to Cushing's (and therefore expected to improve with Cushing's treatment), or whether Maddie may suffer from primary hypothyroidism. This can be a major diagnostic issue for some dogs, because symptoms of hypothyroidism and Cushing's are very similar. Hypothyroidism alone is super-easy to treat. So this is one of Maddie's lab results which might warrant additional testing.

One thing that will help us a lot is if you will tell us more specifically about Maddie's history of symptoms. You've already mentioned excessive hunger and thirst. And also the potbelly...that, to me, is a classic hallmark of Cushing's. My own Cushpup did not appear to have a potbelly. But if Maddie has developed one -- that symptom alone gives me greater confidence in the Cushing's diagnosis.

I'm hoping that others with more expertise regarding lab values will also stop by to offer their thoughts. Thanks again for posting them for us.

And how is Maddie doing today???

Marianne

[marie adams]

Hi Marianne,

Maddie's symptoms are panting, ravenous appetite, water intake, potbelly, thinning fur/balding areas, black dots on her belly-like blackheads, her head shape changed, hind leg weakness, she does urinates a lot, but has control so no accidents in the house, no energy--wants to go on runs/walks, but drags behind, I noticed her dark skin markings on her stomach area faded, she even snorts like a pig when she is sniffing around in the kitchen, whitish growths on her lower hind legs smaller looking callouses and her elbow callous got worse. Cannot think of any more at this time....

[labblab]

Maddie surely does sound like a Cushpup...:o :o :o

It is really hard to watch our pups declining in this way :(. I do understand why you are so anxious to get her some help.

Marianne

[Casey's Mom]

Just so you know my Casey girl has been on Lysodren for a year and is doing very well. The people on this site will help you. There is a ton of knowledge here - just keep asking the questions and listening to some very good advice.

Hugs to you and Maddie,

[marie adams]

Thanks Ellen, believe me I will keep asking.

Hugs to All!!! :)

[marie adams]

Maddie is doing great!!! I think her appetite might be changing I will check it out in the morning to make sure. I might be hoping too much--haha--just imagining it...

One thing I notice with her left back leg it seems weaker than the right and her paw still seems to buckle under at times. When she climbs the stairs it seems to slap down with more noise. I feel like I am critiquing her every move. Is this something that will get better in time? Or is it arthritis that is going to start showing up now that her cortisol level is coming down?

Thanks to All for your advice!!!

[frijole]

Maddie is doing great!!! I think her appetite might be changing I will check it out in the morning to make sure. I might be hoping too much--haha--just imagining it...

One thing I notice with her left back leg it seems weaker than the right and her paw still seems to buckle under at times. When she climbs the stairs it seems to slap down with more noise. I feel like I am critiquing her every move. Is this something that will get better in time? Or is it arthritis that is going to start showing up now that her cortisol level is coming down?

Thanks to All for your advice!!!

If her appetite is reduced then do NOT give any lysodren tomorrow. Remember it continues for 2 days after the last dose. Did you get the acth scheduled? Can't remember, sorry. If not it might be time. This would be great news.

The leg thing is hard to tell from the description. Arthritis definitely is helped by the excess cortisol.

OK so tomorrow morning feed her food and watch like you have been. (good girl!!!) If you feel she is eating slower or there is any tiny tiny change - don't give the lysodren. Better safe than sorry. Remember, you can't get take the pill back once it is given.

I suspect she is loaded. Time to test and see. Fingers crossed. Kim

[marie adams]

Hi Kim,

That is what I have been doing today--giving her food and watching. If she has changed in the morning--no pill. I have the test scheduled for Friday morning, but if I can rearrange my schedule I will go tomorrow.

My feeling is the sooner the better. Today is day #8.

I will let you know what 's up.

Thanks for checking on us!!! :) Marie

[frijole]

Marie, Yes now I remember. Friday! :)

Anyhow, that is actually perfect because that is 48 hr from the last dose. So really no need to move it up. Friday would be the truest reading.

No problem.... I remember being in your shoes and the folks here were there for me. Good luck. Kim

[mytil]

Hi Marie,

I am late in posting to your thread (I was tied up with business and traveling). I too am a Aussie lover. The 2 loves of my life were Aussies (Clancy and Mytilda).

It looks like you have been well advised and taken care of. Hang in there and remember to post those results when you get them. In fact, make sure the vets makes copies of all the testing so you can start a file at home for Maddie.

Terry

[StarDeb55]

Marie, I'm the lab tech that several people have mentioned already. When it comes to the general labwork that you have posted, Maddie has the classic elevations in ALT, alk phos, & cholesterol what are seen in most of our cushpups. In fact, a seriously elevated alk phos is frequently what points a vet toward Cushing's. These values should improve with treatment as the liver is very stressed from processing the excess cortisol produced by the adrenals. The elevated BUN/creatinine ratio is probably nothing to worry about, but could you post the BUN & creatinine individual values. These 3 test are kidney function tests, creatinine being the most important. lf Maddie was fasting when this bloodwork was drawn, that will explain this elevation.

Hope this helps.
Debbie

[marie adams]

Hi Debbie,

The BUN 29 (6-31
Creatinine 0.8 (0.5-1.6)
BUN/Creatinine Ratio 36 (4-27)

She was not fasting, she had eaten between 6:30 and 7 am and the the pretest was at 11:30 am and the post at 12:36 pm

I do have a question: The group has said test 48 hours after the last dose, but the vet told me yesterday (I told her about the 48 hrs) specifically not to stop the dosing; she said she had checked with 2 other doctors?????

I know Maddie hesitated with her food again this morning--she looked up several times while she inhaled her food and she has not been doing that; so I do not want to give her anything right now. I can get the test this morning or this afternoon, but I didn't sleep well last night because I thought oh no I gave a dose and maybe I shouldn't have last night.

Confusing....

Thanks All!!

[marie adams]

Hi Terry,

Looks like Mytilda was a tri and that is what Maddie is. This is our first dog (I had dogs when I was growing up) as a family. She is such a wonderful dog and too smart, but that is what we like about her--so easy to train and understands everything you tell her. It is like a child you let them think for themselves and make decisions, but you are there to make sure it is correct. People are always amazed at how we don't need to have her on a leash and the tricks she can do--knows every toy by a name and can go get it when you ask her to find that particular toy. You know exactly what I mean--too smart--haha!!!

What kind of symptoms did you notice? Was there a lot of weakness in the hind legs--losing muscle and shaking? Maddie is around 70 lbs--she is a bigger Aussie--could lose a few lbs, but...

Thanks and so sorry for your loss!

[StarDeb55]

With the hesitation, you absolutely do not want to give any more lysodren. Hesitation when eating is a key clue that the pup is loaded. It is not standard protocol to keep dosing at this point in time. You want to get the ACTH results back first. If those numbers are within the 1-5 range, you go to maintenance based on the day of your last dose. For instance, if the last dose was Weds., the vet wants you on a maintenance schedule of 3x per week, you would be a on a MWF schedule. Please do not continue to give lyso at this point as IMO, Maddie may be at increased risk of an overload.

Frankly, I would ask the vet who the heck she talked to that said to continue dosing. I have been through this with 2 dogs now, & all of my vets have told me to stop the lysodren, get the test, & give no more meds until the results are back.

Debbie

[marie adams]

I am not going to give her anything until I test, but should I wait to test tomorrow or go today--what is the waiting 48 hours mean exactly--a more true reading?

I think the vet meant if there are no signs keep giving her a dose, but that she wanted the test done no later than 10 days no matter what...

Thanks Debbie

[StarDeb55]

Tomorrow is fine. Lysodren reaches its peak at about 48 hours, so tomorrow will give you a more accurate reading of where cortisol production is in the adrenal glands. If Maddie should still be considerably >5, you just resume loading. You will not have lost much ground. Testing at or around day 8 when the dog has not shown any signs is good protocol. You want to see where you are, & avoid the risk of an overload.

Just to show you, my 1st boy, Barkley, had reached day 8 on his load with absolutely no signs that he might be loaded. The vet wanted him in for a test, anyway. She calls me the next day, asks me if I had checked water consumption yet which I hadn't. She said she would hold, I check his water, & WHAM, there was a 60% reduction in water. Get on the phone, the vet says she figured because the numbers on his stim were extremely low. (It's been a long time ago, so I don't remember the numbers.) The results were so low that B had to go on prednisone immediately for 5 days, then we retested, & started over with the lysodren as he had gone just a little to high to go straight to maintenance.

Debbie

[marie adams]

Thanks, I won't tell them I stopped--haha!!!

I was so nervous last night thinking oh I shouldn't have given her that last dose. I started to imagine she was shaking more than she normally does, but she hasn't had any signs of vomiting or diarrhea, still drinks water. I thought her panting had gotten better, but when we walked this morning it was still there. She makes me nervous going up and down the stairs, but cannot stop all activity or she relly will get old.

[Squirt's Mom]

Hi Marie,

On the panting...since the liver is stressed and working harder than usual, it often enlarges as a result...just as a muscle you use frequently will develop more than one you don't. With the liver enlarged, it presses up against the lungs and causes our babies to pant. As treatment continues, the liver isn't working as hard and will often shrink back down. If fat has accumulated in the abdomen area it ,too, will play a part in causing the panting. Treatment will help in all of this so don't worry about that sign too much right now. ;)

You did just exactly right in withholding the Lyso this morning! :cool: I have not heard of checking the cortisol with the dosing continuing. It has been "within 48 hours of the last dose" for as long as I have been involved with Cushing's. I wonder if something has changed? Maybe you could ask your vet where she and her peers got this info? Puzzling.....

Keep up the GREAT work, Mom!

Hugs,
Leslie and the girls - always

[marie adams]

Hi Leslie,

Thank you for the explanation on the panting--it really makes sense. I want to start her on Milk Thistle, but thought it best to wait till her test results come back--maybe she won't need it.

Does the snorting sounds she makes when she sniffs around fall into the same reasons-- everything on the inside is a little moved around--haha!!

I just read something else about excessive licking like a floor or rug might be a symptom--she has been doing that and I didn't realize it goes together with this disease--makes sense though...

Give Squirt a Happy Birthday Hug!!

[frijole]

Marie, Thank you so much for not giving that lysodren this morning. You did the right thing. If those vets that suggested you do so read here every day or had a dog of their own loading trust me, they would stop too. :p

So you'll have the results back early next week. Great.

Re the carpet licking...mine didn't start doing it til she took lysodren and was loading... weirdest thing I ever saw. So regardless of the cause - you aren't alone.

Great news and thanks again for holding back on the lysodren. Kim

[marie adams]

Hi Kim,

Thanks!!! I am hoping they will have them back asap--it looked like they were back in 24 hrs last time, but I was given the info for a few days later--I could have started her sooner--oh well.

What happens if I do not hear back from them till next week--how long can she be off Lysodren before it affects her? If she goes on maintenance - not a big deal because they get it once, twice or 3x a week depending on the dose????

The licking started a long time ago at least I think when the appetite got worst. It was like she was just doing things to get in trouble--trash digging in the bathroom, stealing the cat's food, etc. It all makes sense now--she does'nt like getting into trouble--hates the word and hates "bad" even worst--too sensitive of feelings/too smart a dog to understand the difference--hahaha!!!:D

Thanks again for the help and encouragement!!! I hope all is well with you and yours!!

[frijole]

If they have in house testing you can get it right away. Most send to a lab and it takes a couple days. So if you have the test done in the a.m. and the test goes out on Fri. I would guess the lab would do the test on Mon. Which means it might be Tues/Wed.

You've already proven you can speak for your dog so simply ask them about it tomorrow and make followup calls to make sure it doesn't drag on due to forgetfulness.

If she is loaded you typically wait a week before giving the weekly maintenance so it would be Wed. and you'd be fine. If she is not loaded, as soon as you get the results you start back up with daily dosing.

If the cortisol levels are still high you might consider going back up to the original dosing amount. But don't worry about that yet... let's just get thru the test. :)

Kim

[marie adams]

Thanks that is very reassuring to know Dr. Kim ;)

You are very helpful and I can sleep good tonight.

I will keep you up on what I find out--thanks again!!!

[frijole]

I feel I must type a disclaimer. :D I am not Doctor but I slept at a Holiday Inn last night!

I learned all this first hand and from the wonderful people on here. Before long you too will be a pro. It is our pleasure to help. We were there once. Sleep tight. Kim

[mytil]

Hi again Marie,

I just wanted to comment on the panting also - in general cushpups get hot. The elevation in the cortisol levels cause this. Being uncomfortable can cause this too and I would venture to guess that something is making her uncomfortable. When she is panting, does she stop and lie down?

The test will reveal where the cortisol levels are. Please keep us posted.




Looks like Mytilda was a tri and that is what Maddie is. This is our first dog (I had dogs when I was growing up) as a family. She is such a wonderful dog and too smart, but that is what we like about her--so easy to train and understands everything you tell her.

She is a red tri and her brother was a red merle. So very true about Aussies - Mine were smart and funny pranksters too - they loved a good joke - like hiding your socks and prancing around until you found them. I guess I could say "I was trained by an Aussie." :)


What kind of symptoms did you notice? Was there a lot of weakness in the hind legs--losing muscle and shaking? Maddie is around 70 lbs--she is a bigger Aussie--could lose a few lbs, but...

Thanks and so sorry for your loss!

Thanks for your kind thoughts; she was/is my soul doggie. This was back in 2004 - Mytilda was a bit of an odd case - 13.5 when diagnosed as "border line" not enough to start Lysodren, but high enough to keep an eye. Her only symptom was peeing a lot. She was 45 pounds. We checked her cortisol levels every 2 months and then she started to have some kidney problems and then we had to let her go.

Terry

[marie adams]

Hi Terry,

A lot of the time she does lay down or sit there. She pants the whole time we walk and is very slow. I hope this will clear up in time so she can be herself again. I notice she sounds like she is snoring a lot of the time when she lays on her side....

Thanks for the info I really appreciate it!!! Now off to the vet's to drop her off. :o

[marie adams]

So tonight Maddie didn't want to eat all her food for the first time in a long time...not sure if this is normal.

I didn't feed her this morning for her test just wanted to see if the Pre levels would be more true because the vet had said something about her eating--said it didn't matter though. I know her levels can go up because of the stress factor just being at the vet without us.

Well, when I came to pick her up someone at the vets feed Maddie some food. Now I do not know if it didn't agree with her or not because she didn't want to eat much when I got her home either. Maybe she is more stressed out because a little food couldn't cause this especially when they eat something out on the trail when you aren't looking. Still drinking water. No diarrhea.

She really seems to be weaker in her hind legs and just more tired.
When I asked the tech why her back paw buckles under sometimes she was a little concerned said it could be neurological--oh I didn't need to hear that....I think I am over thinking all of this, but....I am probably stressing her out because I am stressed.:(

I found out today the one vet at the hospital works part time at one of my client's pet supply stores in the meds department. He told me the Dr. is just back from a lecture on Cushing's. I am going to ask him about it tomorrow since he will be the vet in tomorrow when I call about the test results. I will let you all know if he tells me anything interesting.

Take care!!

[AlisonandMia]

The reason for fasting before the stim test is because fat from a recently eaten meal can be present in the blood and this can make it impossible for the cortisol to be measured. Diabetic dogs and dogs on Trilostane must be fed on the morning of the test and those dogs are given a low-fat meal. Most vets/labs simply ask for a fasting test to be done just to be sure that the dog doesn't consume fatty food.

The increased weakness could well be what is called "cortisol withdrawal" which can happen when a dog has got used to high cortisol levels and feels weak and a bit tired and maybe even a bit yukky because the cortisol is suddenly lower than the body is used to. It is also possible that her cortisol is actually a little too low - not enough to make her ill but enough to feel a bit flat and to be off her food a bit.

When did she have the last Lysodren tablet? (Time zone differences make it hard for me to keep track - I'm in Australia). If it was more than 48 hours she is very unlikely to go any lower.

The knuckling could be of concern - but it could also just be Cushing's-related weakness caused by muscle wasting - with a bit of low cortisol/cortisol withdrawal on top too. Once the cortisol is at a healthy level the strength and muscling returns gradually although issues like arthritis can slow the return of fitness. I have noticed that the older and larger a dog is the longer it seems to take too - although that is a generalization and doesn't necessarily apply to every dog!

Does she seem to know that her paw is knuckled under or not?

Going to the vet for several hours can really take it out of them too and a lot of dogs (even young, healthy ones) can be a bit quiet and tired that evening.

Alison

PS: The pre levels won't be affected by eating -not in any way that could be predicted anyway. The thing most likely to affect pre levels is stress. The most important number is generally the post level as this is shows the peak cortisol-producing capacity of the adrenals.

[marie adams]

Thanks Alison,
Her last pill was Wednesday night. I was told she will be fine even if we start maintenance by Wednesday or I start her back up to load. I think Kim told me that.

I am glad you said it might be the lower levels of cortisol causing the weakness. She does seems to notice the paw, but cannot do anything about it--I am the one who stresses. She weighs about 70 lbs but was very active before this all started to add up and I finally figured out what was the matter with her. One of the moments you wish you had known earlier.

I am in California so it is about 11pm now.

Thanks again!! :)

[Nathalie]

Hi Marie,
I just wanted to comment on the possible "cortisol withdrawal" as the cause of the increased hind end weakness …
My own dog Phillip who is also on Lysodren showed similar symptoms … In the beginning when his cortisol dropped close or below 5 his hind legs became more weak as well as his front legs. He would sometimes fall up the stairs or his front leg would just buckle under him when out walking especially after doing a bit of a run. These seem to resolve after his body got used to function with less cortisol. His hind legs still shake at times due to muscle loss but there is a different quality to it then when it is due to low circulating cortisol in which case the tremors are more violent.

There is a quick test you can do that can give you a pretty good idea whether or not the hind leg issue is neurological ..
Stand in front of a table and place your hand palm down flat on the table -> now bend your hand towards your body and place on table ..
Do the same thing on the floor with Maddies paw. If she can recover quickly and place her paw pats down on the floor quickly you are most likely not dealing with a neurological issue.
A dog that has a neurological problem has a hard time recovering from that position or can’t do it at all. Hope this makes sense.

Nathalie

[frijole]

Marie, You did real well by stopping the lysodren on Wed. Since she is not interested in food now it is probably due to the fact her cortisol is low. That was the objective of the loading phase. You want the results of the acth test to be between a 1 and a 5. I bet you are there.

I agree with Alison that the hind leg issues could be due to the change in cortisol. I remember my dog had some days like that early on but over time she was fine. Do keep us posted. Remember that you have prednisone on hand in the event that she needs it. But since it has been over 48 hrs since the last dose you shouldn't have to worry about the cortisol going any lower.

So now you wait for the results. As her cortisol levels rise she will get hungry again. Hang in there and keep posting. Kim

[marie adams]

Hi Kim and Natalie,

Just read about testing Maddie to know if it is low cortisol or neurological--just read this so I will check later.

I just got her test back and here it is

Pre 3.0 (1.0-5.0) I did not feed her before
Post 3.7 (8.0-17.0) LOW

The doctor said he was to continue her on 2x 500mg a day for a week or if I see anything more on the clinical signs. He said she is still drinking a lot of water and I explained her eating has slowed to very hestitant--not eating everything at once. I thought the eating might be turkey vs. chicken since she has been eating the chicken and now doesn't like turkey so I will test that theory at meal time and just give her the chicken flavor--didn't think it would make a difference.

I think it isn't a good idea to put her back on it but to go to a maintenance....soooo:confused::confused::confused: confused

[Harley PoMMom]

Hi Marie,


Pre 3.0 (1.0-5.0) I did not feed her before
Post 3.7 (8.0-17.0) LOW

The reference ranges you posted for the "post" (8.0-17.0) are for a healthy dog, not for a dog being treated and controlled with Lysodren. With Lysodren one wants the pre and post to be within 1.0-5.0 ug/dl range.

And I agree with you, maintenance dose should be started.

Love and hugs,
Lori

[marie adams]

so I am nervous about the post number of 3.7 and it stating LOW

The vet said to start her back on the Lysodren 2x a day for another week or if I see some other symptoms getting less such as water, but he indicated the food consumption is the key and I feel she is there because she now hesitates and almost has to be coaxed into eating I really don't think the turkey vs. chicken has anything to do with it, but if I mix in her old dry she will eat that....this evening it is back to chicken and I won't give a dose--wait till tomorrow just in case :confused::confused:

[frijole]

Marie, That recommendation does not follow protocol and would harm your dog. You have a WONDERFUL load. You are at 3.8 post which is where you want to be. It is not LOW as the lab report indicated because your dog has cushings. You desire 1 to 5 and you are there! Congrats.

I would wait until Wed (one week from the last dosing) and I would start on maintenance. It is also usually better to take the weekly dosing and divide it over 2 to 3 doses. So if it is 1000 mg give 500 mgs on Wed and 500 mgs on Sat/Sun. This spreads the lysodren out over the week and should help keep the cortisol at that 3.8 range.

Regarding the vet...he/she obviously didn't come here or anywhere else to read. Even the lysodren instructions would be specific enough. So I would be looking into alternatives. It just isn't fair to you and Maddie. Sorry if I am being insensitive because everyone makes mistakes... I just feel you are an experiment. You need someone with knowledge on your case. MHO.

No more lysodren for a few days!! You are there! Yeah. Glad you found us. Big hugs and congrats to our loaded Maddie!!! Kim

http://www.k9cushings.com/forum/showthread.php?t=193 This is the insert that comes with lysodren. If you want to have something to quote when talking to your vet - feel free.

[Harley PoMMom]

Hi Marie,

Kim is absolutely correct, please take her advice. Right now my boy Harley is on Lysodren and we (his VET and I) are trying to get his pre and post within the 1.0-5.0 range.

Love and hugs,
Lori

[marie adams]

He stated that because she is not spayed, if she had a cervix infection it could show symptoms such as Cushing's. Maddie was never spayed because she hardly went into heat. As the years went by and we decided not to breed her we felt she was too old and there have not been any problems--the one vet kept checking for signs there were problems and none. So have you ever heard this before..?

Why can't this be cut and dry???? haha that would mean life is too easy and we all need a challenge---taking the hard road is the best because of the knowledge we learn and take away from it to past on...

[frijole]

I haven't but perhaps someone else has. Everything I have read whether it is from the product manufacturer, on here, or from the reference presentations in our forum clearly state - when a dog has any change in eating habits or drink (it will vary from dog to dog) to CEASE giving lysodren.

With the leg issues you mentioned and her not wanting food I have no doubt she is loaded and another week would set her too low. When they go to low they can die! If you can get them to the vet's they are in the hospital for days, put on IVs to get their electrolytes back to normal. It is serious stuff.

I am sure one of our other members will chime in if I am wrong. :D;):p Kim

[mytil]

If the vet thinks her cortisol levels are low, why give more Lysodren that keeps lowering it?


He stated that because she is not spayed, if she had a cervix infection it could show symptoms such as Cushing's.

Also, I am not understanding this part. Is your vet saying that it could possibly be a cervix infection that is causing the symptoms of cushings and she may not have cushings at all? Maybe I missed it earlier (I will go back and re-read the entire thread). And was she placed on antibiotics for a possible infection? And the blood tests, did it show an elevated white cell count?

Sorry for bombarding you with all the questions here. But according to the Lysodren information being 3.7 is a pretty good post number.

Terry

[StarDeb55]

Marie, I'm in total agreement with what everyone else has told you. You have run an absolutely perfect load on Maddie with a 3.8 post. Please do not give her any more lysodren. We have seen vets who don't have adequate experience with Cushing's use the cortisol ranges for a normal, healthy pup, instead of the ranges for a cushpup under treatment. Unfortunately, this is one of the common mistakes we see inexperienced vets make. When it comes to maintenance dosing, it's kind of going to be the vet's preference. My former IMS want maintenance dosing done twice per week. My GP who manages Harley's cushing's now, wants maintenance dosing done 3 times per week.

Debbie

[frijole]

Marie, To Deb's point... didn't your vet say when you go on maintenance it'd be 1 x a week? This concerns me because you went from 1500 mgs to 1000 mgs, lowering the dosage 1/2 way thru the load. So we really don't know that 1000 mgs is enough to maintain this level. THIS is why I think going at least 2 x a week (vs 1) is better. You want to make sure you keep the cortisol down. Once a week dosing might allow levels to creep up and none of us want that. :)

[marie adams]

Hello All,

No Maddie did not show any abnormal white cell counts on her blood panel just the liver levels. I think he didn't like that I never spayed her and thought this might be a cause. She shows no signs of any problems in this area.

So your thoughts on maintenance---if she was originally on 1500 a day because of her weight; is that the dose for the week which I could give MWF 500mg each day? I just want to know what your thoughts are before I approach this as a way I will feel more comfortable. What can it hurt; if her numbers go back up then we go back to loading again--right? At least I will not be killing off her adrenal glands. I just am not sure how the maintenance dose is figured. When would I start this on Monday--her last dose was Wednesday evening.

Her water drinking today will not even be close to 1 gallon; she as only had about 1/2 right now and it is almost 5pm.

I hope everyone is enjoying their weekend!!! :):)

Thanks for all the help for each step of the way.

[frijole]

Marie, Can you tell us the total number of days for the load, how many were at 1500 mgs and how many were at the reduced 1000? That will help with the answer. Thanks, Kim

[marie adams]

1st dose of 500mg Wednesday evening then
Thursday thru Saturday 1500mg each day
Sunday - Wednesday 1000mg each day
nothing since Wednesday evening

Her eating hesitation today was she really didn't like the turkey flavor ate everything tonight which was chicken--are we talking finicky.

[StarDeb55]

Marie, to expand further on what Kim said in reference to what I had posted about maintenance dosing being 2 or 3 times per week. the whole point of maintenance is that the drug is given frequently enough that you maintain the adequate level of erosion of the adrenal cortex that was achieved during the loading phase. Some dogs can regenerate their adrenal cortex remarkably quickly, so if maintenance dosing being done only weekly, the adrenal cortex is going to have 6 whole days to work on regenerating, & it would be a huge concern for me that you will lose control rather quickly, resulting in a re-load.

You want a lysodren dosage to be between 25-50 mg/kg, (to get to kg, divide lbs. by 2.2). Using Maddie's current weight of 72 lbs., 50 mg./kg. works out to be 1636 mg. per week. Based on that calculation, IMO, your maintenance probably should be 1,500 mg weekly. Yes, 500 mg. given 3 times per week is a great schedule. Please remember I am not a vet, so you need to run all of this by your vet.

Debbie

[frijole]

Marie, Just curious... we are talking maintenance but didn't your vet recommend daily dosing to continue for another week? I am assuming you are going to call or visit to discuss all of this? It is just real important that should you elect to continue this relationship with the vet that both sides know what is going on.

So if you are disagreeing then let them know and why. Maybe there is a valid reason behind the request but I truly believe if you did what you were told you would be sending Maddie into Addisons disease. Maybe there is a miscommunication? Regardless... be sure to talk all of this over with the vet because they are the ones you go to for care. If you want to make a vet change - that is your call.

I know, I wish it were easy too. :( Thanks!!! Kim

[marie adams]

Thank you I will check with the vet and explain my opinion why I feel maintenance is the better way to go at this time and after the next test and the numbers go up then it was wrong, but safe at the same time.

I would rather be cautious than damage her permanently.

I will let you know what happens. :D

[gpgscott]

Welcome Marie and Maddie,

I see that you have been through what appears to be a very succesful loading and now should be moving on to maint.

The literature is very clear. You have both clinical signs of loading, and a stim in the recommended range.

I know it is difficult to talk to the Dr. at times, but I also think further loading is a bad direction.

Here is a link. http://www.k9cushings.com/forum/showthread.php?t=181

Please look it all over and let us know.

Me, I would not be continuing to load this pup.

Scott

[gpgscott]

The vet said to start her back on the Lysodren 2x a day for another week or if I see some other symptoms getting less such as water, but he indicated the food consumption is the key and I feel she is there because she now hesitates and almost has to be coaxed into eating I really don't think the turkey vs. chicken has anything to do with it, but if I mix in her old dry she will eat that....this evening it is back to chicken and I won't give a dose--wait till tomorrow just in case :confused::confused:

Yes this is the key in most cases.

Your Dr. is relying on a period of time. The problem with that is Lysodren builds in the system and so you have to anticipate the ultimate reaction.

And really given the observations you have posted and the recent stim results the cortisol level is not in question. It is appropriate for a Cushpup under Lysodren treatment. Continued loading will without question result in a low cortisol emergency.

If this was my pup the Dr. would have to give me a convincing argument to continue to load.

Scott

[marie adams]

Hi Scott,

I did not follow the doctor's instructions; I am bad :D

I reread the info from this site and printed it out saying since she tested in the 1-5 range then the dog should be put on once every 7 days or spread out thru the week.

I gave Maddie 1 500mg last night because it had been since Wed evening since the last dose and will give her another 500 mg on Wed and then Fri. I will go to MWF since she needs 1500 like Debbie said, but I am checking with the vet for sure.

I am talking to my other vet tomorrow when she is in and explain why I chose to do this; maybe the vet on Saturday misunderstood me, but I thought I was very clear about her eating and drinking has changed. She is back to not scarfing down her food and I have to coax her to lick it clean--haha--I have forgotten what that is like to have to MAKE HER.

Thanks!!!! I feel erroring on the side of caution is better than a permanent mistake. I can always load again if the numbers aren't where they should be, but I am pretty sure they are still good because of her eating pattern.

Take care!!! :)

[Casey's Mom]

Hi, I have just read your thread.

Casey is on Lysodren and from what I have read you are loaded and you are doing the correct thing in only giving her a maintenance dose. You could have really harmed her in giving her a daily dose, in my opinion.

Good luck and keep asking questions,

Hugs,

[marie adams]

Hi Ellen,

Thanks, I feel good about my decision, now I just have to convince my vet I did and not seem like I do not take any of their advice, but when they said we would learn together...that is what I thought. The other vet in the clinic is the one who has treated Cushings before--I think there might have been a little misunderstanding possibly.

As of this morning she is back to her old eating habits--taking her time and wanting me to stay with her while she eats--what a baby--haha!!! This really is a tough dog and I know it is hard on her not to go, go, go like she use to. :(

Any thoughts on the time it takes to get back more energy? I have heard around 30 days or so.

[Casey's Mom]

Hi Marie, as long as Maddie is eating and drinking normally you should be okay and see her energy levels improve. I know with Casey she has always had a VERY healthy appetite and as soon as she paused and looked up while eating I knew she was over loaded with Lysodren and her cortisol levels were too low.

All dogs are different however, you know Maddie best so trust your instincts. Cushings is a slow progressing disease and you can always do more harm by giving too much Lysodren than not enough - although you would have to reload :( Usually a vet will request another ACTH stim test after one month of maintenance on Lysodren to see the dog's cortisol levels.

Were you able to talk to your other vet today - the one who has had more experience with cushings?

Hugs,

[StarDeb55]

The one thing that I don't think any of us have really mentioned & emphasized is that it's very important Maddie have another ACTH done at 30 days to confirm that the maintenance dosing you are using is correct & doesn't need further adjustment.

Debbie

[marie adams]

Thanks Debbie,

I remember reading that in all the literature and then it is like every 3-4 months after that test to test again--right?. Do you think it is a good idea to have another blood panel done at the 30 days also to see how all the other counts looks since going on the Lysodren? I am just curious about the liver one to see if it came down or I should be starting her on the milk thistle now, just to be safe? I didn't want to introduce too much at one time.

She seems to be doing fine--the eating and water has really slowed down to close to regular for her--she was never a big eater--all though, say the word "cookie" and she always has room for those. :D The panting is still around and she is still slow on the walks, but everything takes time.

Thanks again!!!

[StarDeb55]

Marie, I have been at work all day, so couldn't respond to your question. Thinking positive thoughts that the 30 day ACTH will be good, usual protocol states that ACTH's then can be done twice per year. The frequency is really up to the vet. For example, my vet has never let Harley go longer than 4 months without an ACTH, but that may because he is 15 years old with a pre-existing gallbladder condition. It's something you need to discuss with your vet. When it comes to the general bloodwork to monitor liver function, etc., my vet does Harley's twice per year. In his office, this type of follow-up termed a "long term medication use" lab panel.

Debbie

[gpgscott]

Marie,

It is not exact science. It differs from pup to pup. There are norms and then you work from there.

This is why we are here. If it could be quantified from labwork that would be it.

Stick with us.

Scott

[marie adams]

Talked with the vet today and I told him I decided Maddie needed to go on maintenance because her numbers were in the 1-5 range - "3"and I was too nervous to continue her on a 1000mg a day for another week. He told me he was taking over Maddie's care and that he has a notebook full of information from lectures and seminars on Cushing's. He said there's a pamphlet in Maddie's file I should read. I told him I have received so much info from my support group and reading on the internet that I felt confident to stop the everyday dose.

He figured out what he would like her dose to be he came up with 875, but said he was comfortable with 750 (1 1/2 dose) once a week or split up during the week. Maddie is roughly 71 lbs.

I know you all said 1000 - 1500 was a good maintenance dose; so is 750 good and we wait for the 30 day test to see how this works. I know I do not mind a lower dose, but I want to make sure it keeps her numbers in the right range.

Thanks and thoughts are greatly appreciated. :confused: :confused:

[frijole]

Marie, is this a new vet or the same vet that has just attended a seminar on cushings? I am totally confused because the last recommendation from your vet was to continue at 1500 mgs for a week.

Now after you explain the need to stop (since your dog is loaded) the vet is saying REDUCE it by 50%? This makes absolutely no sense. It sounds more like a vet who is afraid that the lysodren will hurt the dog vs one that understands that in order to maintain your current level you must maintain the same dosing amount.

I would guess it would take very little time for your dog's cortisol levels to rise if you reduced the dosing by 1/2. Are you sure he didn't mean to take that amount twice a week?

Either there is miscommunication going on or there is a lack of an understanding on how to treat with lysodren. Did he say how he came up with that number?

Luckily Maddie is loaded. So you are at a good place. I would get copies of all tests and promptly find another vet who has experience. Just my opinion because you are paying for this advice and have to have a vet you can count on for many years in treating cushings. It doesn't go away and issues arise.

Like I said, maybe there is just a miscue going on but I don't have a warm and fuzzy feeling about the recommendations you have been getting. Kim

[frijole]

Marie, is this a new vet or the same vet that has just attended a seminar on cushings? I am totally confused because the last recommendation from your vet was to continue at 1500 mgs for a week.

Now after you explain the need to stop (since your dog is loaded) the vet is saying REDUCE it by 50%? This makes absolutely no sense. It sounds more like a vet who is afraid that the lysodren will hurt the dog vs one that understands that in order to maintain your current level you must maintain the same dosing amount.

I would guess it would take very little time for your dog's cortisol levels to rise if you reduced the dosing by 1/2. Are you sure he didn't mean to take that amount twice a week?

Either there is miscommunication going on or there is a lack of an understanding on how to treat with lysodren. Did he say how he came up with that number?

Luckily Maddie is loaded. So you are at a good place. I would get copies of all tests and promptly find another vet who has experience. Just my opinion because you are paying for this advice and have to have a vet you can count on for many years in treating cushings. It doesn't go away and issues arise.

Like I said, maybe there is just a miscue going on but I don't have a warm and fuzzy feeling about the recommendations you have been getting. Kim

ps The range we recommended is not because we are vets - it is because it is the recommended dosing range by the protocol established for this drug. It is what you loaded with and it worked.

[StarDeb55]

Marie, I totally agree with Kim. If you reduce a maintenance dose by half compared to the dose you used to load, I will almost bet Maddie will unload & unload fairly quickly. As Kim has stated, it is standard protocol with lysodren to use the same loading dose as a maintenance dose, but given as several doses over a week's time.

This is a quote from the Lysodren loadin tips posted in the important information section of the forum.



On the "average", the entire weekly dose is usually just about the same dose as you used to give in just one day of the loading. But it can be even less or a bit more, whatever is necessary to keep the cortisol levels in that target range of 1-5 ug/dl (USA values) or 30-110 nmol/L (values in which cortisol is measured in most of the rest of the world).

A dog who loads in only 3 days at 50 mg of Lysodren a day for each kg of the dog's body weight (50 mg/kg/day) probably needs less Lysodren to keep the cortisol levels in the target range (1-5 ug/dl) than a dog who takes 10 days or more to load with the same loading dosage.

Dr. Feldman's protocol says that the weekly maintenance dose may be anywhere from 25 to 50 mg of Lysodren per week for each kg of the dog's bodyweight. (i.e. 25-50 mg/kg/week)

The Vet has to consider the individual dog and how quickly the loading went etc and then decide what the weekly maintenance dose should be.

The entire weekly dose may be given to the dog all in one day, or can be divided up into smaller doses during the week.


Dr. Edward Feldman is one of the world's foremost experts on canine Cushing's disease. Pretty much all of the information on the link is from his lysodren protocols. I think it would be useful if you might review all of the information on this link, then perhaps print it, showing this to the vet.

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

A lot of us have learned the hard way that a general practice vet we have entrusted with the care of our pups for extended periods of time, don't know a nickel's worth about the proper treatment of Cushing's, & our pup's have suffered the consequences. It has become apparent to me that your vet may fall in that category. I agree with Kim that I think you need to consider finding a vet with experience in treating Cushing's.

Debbie

[marie adams]

I was a little concerned with the recommendation he gave. I have already given Maddie 1000 mg this week and think this is the dose I am going to stick with for the month. I know there is a vet close by that is an internal medicine vet who treats a lot of cushing's cases and one of the members goes to him. So bite the bullet and pay a little more--ouch!!

His calculation was Maddie weighs 70 lbs so 35 x25 mg = 875 mg then I said oh I can cut the pills in half and that's when he said he would be comfortable with 750 mg / weekly and he made sure I understood for the week. Fortunately I did not pay for an office visit for this advice, he was working at my clients place of business. He did indicate that her numbers came down nicely from 22 to 3.7 (it did take about 8 days and not 3 days).

If it wasn't for you guys I would be in a panic. I already felt like out of site, out of mind with the vets because I always am the one calling except last Sat. the vet did call with the test results first thing in the morning, but after that, there has never been a call each day to check on her. Like you all say - you are your dog's advocate and nurse practitioner--haha!!!

Thanks!!!! :) :)

[lulusmom]

Hi Marie,

Treating with an IMS may cost a bit more but in the long run, you may find that you will spend less by having someone direct treatment that has extensive experience with both the disease and the treatment of choice. For instance, if you follow your vet's instructions to cut the maintenance dose to 750mg, I personally believe you will be looking at reloading and a minimum of one additional acth stimulation test. By the way, I pay less for stim tests at VCA All Care than any of the gp vets we've seen. That's because Cortrosyn, the stimulating agent, is expensive and the vials are only good for 30 days unless you freeze them. If frozen, it must be used or discarded as it cannot be frozen again. If a gp vet has one or two cushings patients, the cost of the entire vial has to be passed on to somebody. VCA does a ton of stim tests so I doubt they waste or freeze any Cortrosyn.

Dr. Edward Feldman has changed his protocol for maintenance dosing. He now lectures his students to never give a once weekly maintenance dose but rather to spread it out over the week, preferrably in three doses. This allows for more consistent maintenance of the erosion achieved with loading as well as allows for easier adjustments in dosing. For instance, if the first post maintenance acth stim shows that cortisol has increased after giving a maintenance dose of 250mg on M, W & F, Dr. Feldman would have the pet owner add an additional 250mg on Thursday. Both of my dogs have been on 3 x weekly maintenance for quite some time now.

Glynda

[marie adams]

Thanks Glynda,

I have planned to do just that spread it out through the week. That does make sense on the acth test I paid $158 last week and I know Maddie is the only one taking it--they claim they got 2 doses because they knew they would be testing her again after the loading.

Where do you purchase your Lysodren? I was on a site that had different mg so that would make it easier to spread out the dose through the week and not cut up a tablet into fourths, etc. I was a little confused when they said Qty 1 and gave a price, but I couldn't figure out or see where it said how many pills.

Thanks for the info!!! :):):)

[lulusmom]

How cow, $158 is a fantastic price for a stim!!! If you go to VCA, you should have the IMS direct treatment and let your gp vet do the stims and fax the results to the IMS. If I had a gp vet locally that only charged $158, that's exactly what I'd be doing.

My two cushdogs are very little so they are on a compounded version of lysodren called mitotane. I get all their meds at Diamondback Drugs in AZ. They ship all over the U.S. Diamondback sells the 500mg tablets or they can compound to any mg you need. If I were you, I'd shop around.

www.diamondbackdrugs.com

Current price for the 500mg tablets at Costco:

30 pills = $157.22 50 pills = $254.84 100 pills = $489.85

I found two online pharmacies that were a bit cheaper than this but not sure what the shipping would be.

Glynda

[frijole]

I have been buying from drugstore.com for many years. They have consistently been amongst the cheapest. I pay a little over $5 a pill (quantity of 25 at a time). You can type quantity in their system and get rates without buying. They ship by mail so it's about $4 for shipping. They call the vet for the renewal Rx everytime so it is really easy for me.

Others use Cosco both at their stores and online.

Hope this helps. And I agree that the ACTH rate you paid is very good. I have paid $124.75 for over 3 yrs now and I think its the best I have seen. :p Don't tell my vet though.

I agree with Glynda. Treating a cushings dog is easy for someone who has experience. If they don't have experience it can cost your dog its life. We have seen it. If you had continued giving lysodren as recommended it could have been fatal OR cost you a thousands in hospitalization. So consider the switch an insurance policy. That is how I look at it. Its tough I know as I had to fire my first vet for the same reason.

Regardless, glad you found us and are paying close attention. You are Maggie's voice in this. Keep it up. Kim

[marie adams]

I have a question...since I was with Maddie one on one--we went on our annual trip to Mammoth Mountain and I stayed with Maddie in the condo. Of course there was lots of snow and usually Maddie loves this adventure, but it was a challenge with her weak hind legs. She still likes to drink a bunch of water--not gallons and gallons, but when she pees it is like gallons each time no matter how much she drank--it is like it goes right through her--clear like water most of the day except in the morning. Is this normal and will it get better the longer she is on her meds and her cortisol levels even out? :confused:

Her eating was very slow this weekend, but it was this way last year.

Thanks!! I hope all is well with everyone!! :)

[lulusmom]

Hi Marie,

A lot of cushdogs have had polyuria/polydipsia for so long that they have what is called solute medullary washout. A not so technical explanation is that the kidneys have lost their ability to concentrate because all the salt and whatever else the kidneys use to concentrate the urine have been washed away. Some dogs can start concentrating right away and some take a lot longer and then there are a small number who never see improvement. Lucky me....I have one of the ones that will drink and pee buckets for the rest of his life. :( It is still early in the game for Maddie so be patient.

Glynda

[AlisonandMia]

It can take up to three weeks (maybe even a bit longer) post loading for the peeing and therefore drinking to settle down. It has to do with kidney function taking a while to get back to normal after having all that water flushing through.

Of course there are many, many other reasons for increased urination and drinking aside from Cushing's. The most serious of these would be diabetes. Urinary tract infections (UTI) can also cause this sort of thing. So getting those two possibilities ruled out early on would be a good idea. Then you could wait and see what happens and investigate further if need be.

Is her pickiness with eating "normal" - as in pre-Cushing's normal or is it something new? I know it can be hard to remember what they were like before the Cushing's and when they return to normal it can actually be worrying until you get used to it again.

Alison

[marie adams]

Thank you Glynda and Alison for letting me know Maddie is still on the normal side. The vet said after Maddie's first blood panel that the only organ she said was a little concerned with was the liver. Nothing looked abnormal at this point except that she definitely had Cushings. I read that urinary tract infections can be a problem so I will watch for any sign. Of course each time I learn something new I think what if....

As far as her eating--she did this before she got Cushings. Sometimes I would have to sit with her so she ate. I have cut back her food a little, but mix a little of her old dry food in with her raw; just so she will eat. I am not really worried on the eating, in ways wasn't it nice when they ate fast--done over and clean up--haha!!

Thanks again!!! I know be patient and let time heal her!! ;)

[frijole]

Marie, thanks for the updates! We understand. Kim

[marie adams]

Thanks Kim

[marie adams]

Hello Everyone,

Just an update and question.

Maddie is doing very well on maintenance--we started our 3rd week and I see progress. She isn't panting as much especially during the night; so I think she is sleeping better and so am I. Eating and drinking are just fine. I am seeing she doesn't have to go outside as much and when she is out the peeing isn't buckets--haha. :D

My question is: Her hind legs still shake at times and her left paw seems to have a "slap" to it when see walks--is this just one of the things that is part of the weakness? Will this get better also? We are making her do more to strengthen and build her muscles back up--nothing too much though.

Of course right now--no shaking and we have already been on a walk--so maybe this is a good sign also. For us it was a little chilly out--haha it was maybe in the high 50's very low 60's, but still a lot of humdity so it is a different chill. When she doesn't have her fur coat on like she use to it is a little more chilly for her--haha!! Oops I spoke too soon--one of them is shaking as I type--she is laying on her side resting on the cool tile--how I wish she would lay on a rug!!

Thanks for all the help and guidance!! I hope you are all doing well also!! :)

[frijole]

Hi Marie! Great to get an update. I remember wondering the same thing and then one day I noticed my dog's legs weren't shaking any more... and I cannot remember if it was a month or two into it.. but it isn't very long. Hang in there. And you are right - don't push her too much. Give her a hug for me! Kim

[marie adams]

Thanks Kim!! Yea, there is hope she will be back. Our little bit of physical therapy is going up and down the sides of a walking burm in the wetlands by our house. We also setup a little agility jump the height of a brick stand on it's end. If there are cookies involved she will jump over, but when she starts to knock it off we know it is time to stop. She never gives up...:)

[marie adams]

Hello Everyone,

I have noticed Maddie's coat has a somewhat oily feel to it that she didn't have before. Also, it seems like she is getting little sores on the edge of her eyelids.

It is probably just me---I seem to notice everything now and associate it to "the disease"--haha. Otherwise she seems to be doing fine; some days she seems to have more get up and go on the walks, but I am waiting for that burst of energy she use to have or at least 1/2 of what she use to have.

Enjoy your weekend!! :)

[StarDeb55]

Marie, I have never experienced it with either of my cushpups, but a number of members have reported that pups after being on treatment will start "blowing their coats". If I understand the explanation, as the cortisol level drops, the old, unhealthy coat is shed, which is then replaced a more healthy coat, sometimes even more of a puppy like coat in nature.

Hopefully, Alison will see this as I know she saw this with her Mia.

Debbie

[marie adams]

Hi Debbie,

I haven't noticed her fur starting to come back yet, but I really notice the oily feel on the side of her hind legs and of course the fur is a lot thinner and shorter there than what is normal for her. She never really had a dog smell to her; if that makes sense, but now her fur/coat got dirtier sooner than in the past. She just had a bath the beginning of this month and now she could use one again.

Her fur has always had a coarse texture with a little wave to it; it will be interesting to see how it will change--maybe more of the silky texture I always tried to get with attempting to brush her out and smooth out the underfur--never happened until now. I am not a fan because I feel like she isn't as warm and when it gets hot she won't be able to keep cool since there isn't the insulation layer. Yep, it will be interesting.

I have never shaved her like some people do with Aussies. Right now she is starting to look thinner and not as stocky--partly because she has lost a little weight (a good thing) and her fur is shorter & thinner especially on the backs of her hind legs--those beautiful features look like she is a plucked chicken. :(

Thanks!!

[StarDeb55]

I know what you mean about the "tail feathers". My other boy, Chewy, no Cushing's, but on allergy shot for almost 9 months. His one main allergy symptom has been thinning hair, bald spots. He is a Lhasa, & that beautiful, long silky Lhasa tail has lost about 1/2 of the its hair. I look at it & want to cry.

Debbie

[marie adams]

Oh Debbie, your poor baby! Of course we are more embarrassed for them than they are--haha!!

[Nathalie]

Hi Marie,

My Phillip has been on Lyso for about 10 months and so far Phillip has blown his coat 2x. He is a Collie/Beagle mix and always had a fairly thick top and undercoat especially around the neck.

A few weeks after being loaded his fur started coming out like there was no tomorrow – even so I brushed him about 5x per week – the hair just kept on coming. He ended up loosing most of his top coat including the feathers on his tails and back of hind legs. His skin became quite oily with dandruffs. This lasted for quite a few weeks and he was left with a very soft puppy coat . Like your Maddie, he too had what I call a ‘sick doggy’ smell which also went away after a few months. The way I look at it - the skin is just another organ and if whatever can't come out any other way will push its way through the skin.
Some of the overcoat and feathers grew back.
He went through another major shedding period starting last November which lasted about 3 months – clogs up a regular vacuum cleaner, hence I use a shop vac – just to give you an idea how bad it was.
We are now left we an adult/puppy coat mixture that is very soft to the touch and has a bit of a curl to it in some areas. He used to be a nice tri-color but the chestnut brown is all gone and he is now predominantly black and cream/grey color.

As for regaining muscle mass – Phillip has not been able to rebuild much as far as I can tell. I try to keep him on his feed and walking as much as possible on a daily basis but discourage any jumping. Some days his hind legs shake more then others but as long as he is not worried about it and he maintains what he currently has, I am not too concerned.

Cheers,
Nathalie

[frijole]

Marie, Haley has never blown her coat, however, you will be relieved to know that her hair is more 'oily'. I don't know why it is but cush dogs tend to like lying on cold floors so I always assumed she is a tad hot. lol. Anyway- you are not alone. Kim

[Franklin'sMum]

but I really notice the oily feel on the side of her hind legs and of course the fur is a lot thinner and shorter there than what is normal for her. She never really had a dog smell to her; if that makes sense, but now her fur/coat got dirtier sooner than in the past. She just had a bath the beginning of this month and now she could use one again.

Hi Marie,
From what I have read a lot of cushpups develop greasy skin/hair and a kind of funky smell, and need bathing more often. That comes from somewhere on the internet, and a number of members here (both lyso and trilo parents) have also mentioned it.
Hope that helps,
Jane, Franklin and Bailey xxx
________
EXPERT INSURANCE (http://xpertinsurance.com/)

[marie adams]

Thank you everyone!!!! I just checked again to see if any new fur is coming in and I don't see it---darn. Maybe it is hard to tell since she already has kind of nappy/course fur. She still has a lot, but I am not seeing any more on the tile. I guess she will be one who takes longer for the fur to come back or maybe it won't -- time will tell.

On the weakness I think she deals with it and was even chasing a rat in the backyard last night-yuk. I just don't want her to hurt herself when she thinks she can still do something, but I think they are pretty smart and know what their limitations are--it is like being a parent to a child--they pretty much know their limitation and sometimes we need to do a little pushing in the right direction---hahaha!!! :D:D

I really appreciate your stories, words of advice, and hope I will be able to help others so I can pay it forward!!!

Thanks again!!! :):)

[Nathalie]

“I think they are pretty smart and know what their limitations are”

I think they are as long as one of their drives does not kick in. eg. prey drive, retrieve …
Just a word of caution – if your dog is pretty high in prey drive like Phillip – going after squirrels is the ultimate thrill – self preservation might just go straight down the toilet.
It happened to Phillip a couple of times – I let him out in the backyard … squirrel in the back end of the yard … he catapults himself of the deck which is 7 steps high, does not have enough strength and one of his front legs gives out right under him and he lands on his collarbone … ouch.

Cheers,
Nathalie

[marie adams]

Oh how I know that feeling. There are coyotes, racoons, squirrels, bunnies out in our wetlands and she has always been game for the chase. Since she was an older puppy she has had encounters with the coycotes. She even knows the difference between the kitties with the white stripe up their back--haha--cannot make a mistake with those or you will smell for a long time....

I was concerned last night when she was trying to jump up in the planter and running back and forth. I am glad I didn't see the whole chase or I would have been really nervous about her getting hurt.

[marie adams]

I am getting Maddie tested for her one month/4 weeks on maintenance. Should I have another blood panel done to check everything else to make sure it looks good? How time flies...

No issues at this point--she seems to be doing just fine--each day she seems more energetic--goes up the stairs a lot more like she use to when we were up there--of course she is a lot louder in her stepping--that left paw just wants to do a slap down--haha!! Of course I don't want to laugh at her she is trying so hard to get back what she had. :):)

Thanks!!!

[lulusmom]

Hi Marie,

I don't think it's imperative that you have another blood chemistry done unless your vet suggests it. I am hoping that the post acth stim is within range which means you've found the right maintenance dose and can reschedule another stim in 3 months.

Glynda

[marie adams]

Hi All,

I just had Maddie tested:

ACTH
Pre - 5.7
Post - 11.3

5 weeks ago after loading these were the numbers:

Pre 3.0 (1.0-5.0)
Post 3.7 (8.0-17.0) LOW

Before loading:

Pre - 8.2
Post - 22.1

She is on 1000mg a week and doctor wants to keep her there.

Does this sound right?

Thanks!!!

[lulusmom]

Marie,

No, your vet's instructions to continue with no change in dosing is not okay. I re-read your thread and you mentioned that your vet has attended continuing education seminars on cushing's so I am wondering why he is not aware that the goal of therapy with Lysodren is to get the pre and post stimulated number below 5. :confused: Maddie's stim after 8 days of loading was perfect at 3 and 3.7 ug/dl. You now have a post stim of 11.3 which indicates that the maintenance dose is insufficient. It's an iffy proposition to get the load back by increasing the maintenance dose if the post stim is 8 or higher so most end up reloading. You most certainly will be reloading at some point if your vet isn't even willing to try to gain control with an increase in maintenance dosing.

Glynda

P.S. Your vet's lack of knowledge on how to assess an acth stimulation test to determine effective dosing is apparent so you may still want to consider having an internal medicine specialist direct Maddie's treatment. It may be more cost effective in the long run.

[StarDeb55]

Marie, I'm in total agreement with Glynda, a post of 11 is not acceptable. I just did some math for you based on Maddie's weight of 72 lbs. You want a loading/maintenance dose to be between 25-50 mg/kg. Maddie's loading/maintenance dose of 1000 mg is only 32.3 mg/kg, so it's not too terribly surprising to me that she has unloaded. This dose was at the lower end of the range. The maximum dose that will give you 50 mg/kg is 1,615 mg weekly. Frankly, i would talk to the vet about 2 things:

1) Doing a mini-load of say 3-4 days at 1500 mg per day. Unfortunately, you will probably need a stim at this point.

2) If the mini-load has brought Maddie's numbers below 5, then you will need to stick with 1500 mg. weekly. For instance, 500 mg. on Mon, Weds, & Fri.

I sympathize with you as Harley unloaded at least twice in his first 6-8 months of treatment. One of the problems was I had an IMS who thought that leaving his post at >11 on his 30 day stim, after his original load, was fine since he was showing no symptoms. Glynda, & several other people tried their best to convince me that this was not going to work. I was insistent that I needed to follow the specialist's instructions. I learned the hard way. Within 2 weeks, Harley was drinking gallons, & peeing all over the house. I demanded that the IMS see him. She ran a stim at that point, & 2 weeks later, his post was >20. I ended up with a complete re-load. I just don't want to see you get into this kind of chaos with Maddie as it can become very frustrating, especially when the treating vet won't listen to you.

Debbie

PS- I'm not sure if anyone has ever posted the link from the "important information" section of the forum for you. This link will give you the lysodren loading instructions. Please notice that in the last paragraph, it does state that the goal of therapy is a cortisol level between 1-5 mg.

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

[marie adams]

Thank Glynda and Debbie,

That is what I was thinking also. When I made the comment of shouldn't her numbers be between 1-5 pre and post--he said don't always read into the numbers if her water drinking less and she is still eating. I think I am done with them especially when the vet goes it looks like no one was communicating with you durning the month of March--I said they turned it over to you--oh was is comment. I also mentioned to him that the tech that took blook yesterday shaved Maddie for the first time and nicked her a little--not happy about that since the rest of her fur hasn't started to come back. He doesn't remember talking to me at the pet supply place about her maintenance dose which was a lot lower than what I continued with. Darn I wish I had gone with the 1500mg.

So if I increase it to 1500 mg you don't think it will bring it down????? I don't want to put her through the loading again---in fact I am not sure I am ready for this again :(:( Of course I will do whatever it takes. One is get a better more involved vet.

Maddie has lost weight--she is now 68 lbs. Her drinking water might have increased a little; the eating is still about the same has hesitation still but eats fast and if I think about it she always seems hungry in ways.

I really really hate this disease!!!!! :mad::mad:

[StarDeb55]

Frankly, I would get a referral to an IMS ASAP, & get Maddie in to see the specialist. Make sure you bring copies of all her records including the Cushing's diagnostics, & the stims you have done with treatment being started. This really can't wait very long or Maddie will, in all likelihood, totally unload, then you will be reloading.

Just to let you know, with the new weight you have posted, 50 mg/kg works out to be 1545 mg/week. You can try to increase the maintenance dose, but I agree with Glynda, it's doubtful it will totally work. In all likelihood, an increase will bring Maddie's numbers down some, but may not get them within the 1-5 range. This is why input from an IMS will be invaluable as they have the training & experience with Cushing's, therefore offering you more detailed, specific guidance as the best thing to do at this point.

Debbie

[marie adams]

Thanks!!

I agree Monday I will get her a new doctor.

Everything seems to happen all at once. Worry about Maddie since they couldn't do her test last week; my mom just had part of her right leg removed a week ago, now in rehab; work is stressing me out when a potential client says I am not giving the right kind of personal attention "get off your Tush and meet in person" what they don't realize is I am just that type of rep they want, but because of time restraints of deadlines email has been the form of communication per their original request--you can never win or as my husband always says--no good deed goes unpunished--maybe I am the one who needs the right medicine. :D::confused::mad:

I do value all the advice you have all given--just thought I figured it out and was keeping costs down--what a fool--should have bitten the bullet and gone to the specialists in the first place.

I am off my soap box.....:o:o

Thanks!!!

p.s. Debbie I did try to explain to him about the 1-5 numbers and it was like he was mad I even brought it up--he was saying don't go by the numbers go by her drinking and eating---yep I didn't have a good feeling afterwards. I have read the literature and read many other things online about the numbers--even literature from the specialist vet from UC Davis. I really do not believe my vet knows that much or where he gets his info.....

[lulusmom]

Debbie I did try to explain to him about the 1-5 numbers and it was like he was mad I even brought it up--he was saying don't go by the numbers go by her drinking and eating

Marie, treating the symptoms rather than the numbers works well for dogs being treated with Vetoryl that have a post stim of 9 or less but it doesn't work that way with Lysodren. Once you've lost the load, meaning the adrenals are regenerating and starting to work overtime again, the cortisol will simply continue unabated.

Glynda

P.S. I am so sorry to hear about your mothers difficulties. What a horrible thing to have to go through. I wish her a speedy recovery. As for your issues at work, I've been there, done that and agree with your husband that when it comes to working for anyone but yourself, no good deed goes unpunished more often than not. I've been working for "the corporation" all my life and unfortunately, I'm too old and too vet poor to start my own business. I found that it is more tolerable once you get the right dose of your meds down. The worst part now is when my coffee dribbles down my chin from the hole I made in my lower lip from years of biting it.

[Nathalie]

Hi Marie,

Nothing foolish about trying to keep costs down. We went through something similar and I am not able to afford seeing a specialist.

My Phillip who weighs now 64 lbs readily loaded on 1500 mg in 9 days but ended up needing 3500 mg as a maintenance dose.

Phillip escaped control several times and I tried regaining control by increasing the maintenance dose 2x but failed each time and I ended up having to do 2-3 mini-loads.
Knowing what I know now I would not have messed around with increasing the maintenance dose but done a mini-load right away instead. It just gets messy and prolongs finding an adequate maintenance dose, adds additional costs for stim test and the dog is yo-yoing up and down.

Looking back, another mistake I made was trying to be too conservative when it came to increasing the maintenance dose after a mini-load. Instead of increasing full 500 mg I upped it only by 250mg, which again resulted in an escape of control and another mini-load.

I agree that you need to look at the whole picture taking into consideration, symptoms and how the dog feels at the certain cortisol level but first you must bring the cortisol down in the 1-5 range and the maintenance dose must not allow to further increase or decrease the cortisol in order to truly be able to evaluate how the dog does on a certain level.
Once you found that adequate maintenance dose you then can always fine-tune.

For example my Phillip does best around 4.5-5 – his last stim test cam back at 4.9 and 5. Any lower and he just does not feel quite right – at the same time we have pretty good symptom control.

Like I mentioned, we experienced something similar but unlike your vet, Phillip’s vet seemed to have no problem letting me take over his treatment protocol which I could never have done without the help of the dedicated people on this board.

Best Wishes,
Nathalie

[marie adams]

Thank you Glynda and Natalie,

I am feeling nervous about a mini load because how will I tell if it works--another ACTH test $$$$ darn it :(:( Her eating isn't too bad I have noticed a little "give me more" syndrome maybe the last couple weeks, but she still will hestitate and look at me if I ask while she is eating. Drinking I thought has calmed down. I am always looking at her when she goes--checking out how much---no privacy--no vomiting or diarrhea has occurred. She is going up and down the stairs with no hesitation--still makes me tense because she still is weak in the hind end--I have to stop it-haha!! The panting is sooo much better mostly on walks and after a run.

It is always there that feeling that you want them better and not to have to always be looking for signs--I feel like I am nervous for her all the time. My husband says to stop it and look at the bright picture--she along with us have had and are still having a great life together--be positive, easy for him to say because I am the one who gives the meds and does the research.

I think of how well she has adapted to her short comings right now and hasn't given up. I wish my mother had the same attitude to just work at getting stronger and dealing with what she needs to do to get aroung by herself and not be so depended on my dad and sister for even the little things she can still do--it is going to take some time, but work at it like the dog does--crazy how easy it is for animals. I am off my soap box....:D

Am I mad:mad: at the vet, oh yes!!! To think if I had followed his advice on the amount of lyso her numbers would have been higher. I just wish I had gone with the 1500 but hind sight is easy. Of course that dose might not have been enough since Philip had to go with 3500--boy hadn't even thought about that much for maintenance.

I will let you know what I find out--I have all my tests results, but the last one and I will get that tmo.

I agree you all have been my source of the right info and would be worse off if I had not followed it!!! I will still ask for advice to make sure the vets are right.

[Nathalie]

I did not want to worry you, just give you an example of a dog of similar size compared to your Maddie.
Don’t think that Maddie will end up on such a high dose – she might be fine on 1500 or 2000 mg. Unfortunately, Phillip is a bad absorber and/or somewhat resistant to the Lyso.

Doing the mini-loads was scary for me too – Phillip loaded each time in about 4.5 days. I found it more difficult to know when he is loaded again because the signs where less noticable. Phillip likes to eat apples at night but has never been over the top crazy about it – when he stopped eating apples at night after he just had his dinner a couple of hours ago I knew he was loaded.
Maybe Maddie has a similar type of food that you can use to gage whether or not she is loaded.
If you do a mini-load, also remember the 48h cumulative effect and if she goes a bit too low you do have pred on hand.

Best Wishes,
Nathalie

[Squirt's Mom]

Hi Marie,

I don't blame you one bit for being upset with your vet. But you might be surprised to learn just how many good vets are unfamiliar with the proper way to treat and monitor Cushing's...not to mention how to do the testing! :eek: Part of that is because of their training and part is due to their experiences with other pups and parents. Parents like us are rare; we demand the best for our babies, we are willing to go that extra mile over and over for them, and we take the time to learn about this disease in depth. So vets are often not prepared for us. :p;)

However, one who gets upset because we HAVE learned and DO question is not a vet I personally would want involved with my cush baby. Squirt's vets are partners with me and she deserves no less. ;) I hope you are able to find a vet that will work with you in that manner, too. Maddie deserves no less!

Keep up the good work! You have learned so much in such a short time and are being a good advocate for Maddie.

Hugs,
Leslie and the girls - always

[marie adams]

Thank you Natalie,

I do appreciate the comparision in size of Phillip and Maddie. It seems like more smaller dogs are affected. Phillip seems like the adventurous type like Maddie. Maddie seems to do well on the lyso. Her first load worked getting her to the 3. range in pre & post so I thought we would be good at the 1000 since the majority of the load time was at that rate only the first 3 days at 1500. I do have preds available--crazy wasn't given them when we first started; I had to ask for them. See, you all have been there for Maddie & me :D So I do not feel alone.

Thank you Leslie,

It seems so crazy that these vets do not want to learn more about this disease since it seems to happen more than they think it does and mirrors other types of diseases also.

I go over board and anyone new I met with an older dog or even younger; I tell them there is such a disease out there and what to look for or research just in case. I wish someone had done that for me. We could have caught this a little earlier.

If I could give hugs to all of you I would!!!! ;);):D

[Nathalie]

Hi Marie,

I am just wondering how you and Maddie are doing?
Did you get a new vet?

Cheers,
Nathalie

[marie adams]

Hi Natalie,

It seems like forever since I have been on, but work, my mom, just a ton of things have kept me away....shouldn't be here now--should be working, but....hahaha!! :D

I did finally go to a new vet last Friday and I just finished another load on Maddie yesterday so I will go have her tested tomorrow to see where her numbers are. It is funny how much calmer you are the 2nd go around, but still a little nervous I stopped the dosing too early---just really a little harder to tell this time, but I think she hesitated a lot this morning so no more. We loaded with 1500mg again and the vet thinks 2000mg will be a good maintenance dose weekly since her numbers went up after the last test. We didn't test before the loading, because I knew the numbers were up without testing by her water intake and the intense begging was back. Her fur still hasn't grown back. We will see this time....I still hate this disease--I want a little more quality of life back for her--she doesn't complain at all--she just keeps on going and adapts.

I hope all you and Phillips are doing well! :)

[Nathalie]

Hello Marie,

Nice to hear from you!:D

So you got yourself a new vet AND just finished a mini-load .. congratulations!:)
I had the same experience when it comes to doing mini-loads – each time it got harder and harder to tell when he was loaded.
I am keeping my fingers crossed that Maddie is loaded and tests nicely smack in the middle.

Is this a specialist you are seeing or a GP vet?

“We will see this time....I still hate this disease--I want a little more quality of life back for her--she doesn't complain at all--she just keeps on going and adapts.”

It gets better once you find an adequate maintenance dose and Maddie’s cortisol is being maintained within the 1-5 range at a level that is comfortable for her for a while.
I remember Phillip perking right up after about 2-3 months. We had our ups and downs and age is catching up on us a bit right now but without treatment not only would he not of had any quality of life, he would be dead by now. Over the past year I went from sad to hopeful to being angry – I wanted my Phillip back the way he was before cushings.
I am still not ok with it and probably never will but I am trying to not let it be this big black cloud over our heads and it works most days.

When you say you want a little more quality of life for Maddie what exactly do you mean by that? Is she in any pain?

Anyway, I am very glad to hear from you and will be waiting for your next update.

Nathalie

[marie adams]

Hi Natalie,

No, the vet is not a specialist, but she went to UC Davis so has ties and will not hesitate to confer with them and she has treated many Cush Dogs--she just isn't as familiar with Lyso, but welling to learn. She is well respected by many of my neighbors. I feel we will work together much better and....she does not charge an arm and or a leg so far.... :D!

Maddie is doing just fine--I would just like her to get her fur back, lessen the panting, and her front elbows to heal up. She continues to go on walks and mini runs, climbs the stairs, chases the kitties and bunnies--just not as quick. She spends more time downstairs at night. I guess it is me who wants a better quality of life with her--haha!!

Thanks for asking!! :)

[Nathalie]

“Maddie is doing just fine--I would just like her to get her fur back, lessen the panting, and her front elbows to heal up.”

It might take a while for the fur to grow back and for the panting to get better, but it should once the cortisol is been under control for a while.

Elbow problems, don’t I know about that too. I can’t remember if we talked about this before but how bad is it? Are you doing anything about it?


Nathalie

[marie adams]

I try to clean it with hydrogen perioxide and neosporin. My husband says it doesn't look infected. I tried to cut a sock to put over it--like that worked with her. Just the constant licking--the sound drives me nuts--haha!! The doctor was going to give me antiobotics, but that is when my husband said it's not infected.

Does Phillip's look like they keep getting bigger and puffier or should I say bumpier. It bleeds a little on occasion, but not much.

If you have any suggestions I am open to trying anything.

Thanks!!

[Nathalie]

There is a photo of Phillips elbow in my photo album before it really got bad. Take a look, it probably looks similar to Maddies.

You probably know this already, but these are pressure sores from laying down for too long on hard floors. Dogs with cushings are low energy and because they feel hot they like to sleep on cool floors which happen to be hard surfaces. Their skin can also get thin due to cushings not helping the matter either.

The below is what I posted to Sue who had the same problem with her Zoe …
Since then Phillips elbows look great. The dogleggs saved his elbows and my sanity.
I would only use hydrogen peroxide VERY sparingly. Flamazine is actually used by people that have bed sores and bad burns and helps with healing as well as with inflammation. So of you could get your hands on some Flamazine I can highly recommend it.
Unless it is badly infected don’t use antibiotics.
The key to getting a handle on this and preventing it from getting any worse is to get the pressure off before the skin starts necrotizing and ulcerating.

Let me know what you think,
Nathalie


Hi Sue,


As Lori mentioned we have been struggling with elbow problems as well. Last year the skin was paper thin and started to bleed, which caused him to constantly lick so it would not heal. For months I tried bandaging it different ways adding foam for cushioning but nothing stayed in place and one morning his paw had swollen to twice its size because I wrapped it too tight.
You may want to check into getting Zoe some dogleggs made http://dogleggs.com/files/adjustable.cfm (http://dogleggs.com/files/adjustable.cfm)
I wish I would have found these sooner as his left elbow completely healed and grew hair on it again but the right side is continuing to give us problems as at that time he already had grown a mass (in response to the trauma of laying on hard floors all day) with tissue starting to necrotize. Now Phillip’s right elbow is chronically inflamed and the mass is growing (now the size of a cherry) and has become a management problem. I use Flamazine http://urantiapharma.com/en-about-Flamazine_2759.php (http://urantiapharma.com/en-about-Flamazine_2759.php)
to help with inflammation when needed, comforters and dog blankets in the spots he likes to lay, the DogLeggs when needed and give vitamin E with fish oil every day. What I like about the Dogleggs is that they provide the cushioning but don’t fit tight as a bandage would to let air get in the area. If you need to put some ointment on the elbow you can just stick a pad on the inside so you don’t have to wrap the elbow. If Zoe’s lump is oozing it needs to be kept off the floor completely – with a donut like people with bedsores http://dogleggs.com/files/decubitalulcer.cfm (http://dogleggs.com/files/decubitalulcer.cfm)
I am so sorry you are going through this – this can be so difficult to get a handle on. Why don’t you just call the people at DogLeggs – they are very nice and knowledgeable.
Did your vet ever suggest removing the mass? I have been thinking of removing Phillip’s while it is still small enough to do it using local anesthetic but I am very apprehensive because we could end up with a situation worse then now.
Nathalie

[marie adams]

Hi Natalie,
I looked at the picture of Phillip's elbow--yep that is what Maddie's looks like but a little bigger. She has always layed down on the cement in the backyard like on the side of the house to keep out of the sun--she is really good about finding the shade as much as possible. We had a cat who got skin care of the nose--it was a pink nose. We put out rugs, I made a blanket for her to lay on--oh no why do that. I won't even purchase one of those dog cushions/bed because I know she won't really use it. I might just make some more blankets out of polar fleece and try putting them in her spots. I will look around for that medicine and check out the leggings--tried booties once that was hilarious to watch her shake them off--there was a waste of money also.

Thanks for the info!!! :)

[Nathalie]

Blankets are warm - cush dogs generally seek cool surfaces - Maddie sounds like Phillip - adding blankets will probably not help. At one point I covered my entire bedroom floor and is favorite spots with comforters. The result was that he moved out of the bedroom and lay beside all the blankets.

As I mentioned in my previous post - I think I tried everything, even had the owner of a pharmacy go into the basement to look for something that we could use to cushion the elbow. Absolutely nothing stayed in place long enough and allowed adequate air to the area to allow for healing and I spend quite a bit of $ in the process.

The point that I am trying to make is, don't make the same mistake as I did. By the time I finally ordered the dogleggs his right elbow was literally a bloody mess with a lump forming from the pressure and the skin starting to necrotize.

If you can come up with solution other then the dogleggs that provides cushioning and lets the air get to the area then please let us know. This is good information to have.

Bottom line is that you have got to break the cycle by taking the pressure off the elbows, which will bring the inflammation down, which will reduce the pain so Maddie does not feel to the need to sooth the area so healing can take place.

Will be watching for your post on Maddie’s stim test.:)

Nathalie

[marie adams]

Thanks for the info...I had to laugh about Phillip moving out of the bedroom or laying beside the blankets---That is what I meant about putting stuff where she lays--will lay next to or not at all unless you make her which is for a limited time--haha!!!

Do you need a prescription for the Flamazine? The vet says they have the same stuff they use (little different name) but theirs comes in a large jar. Is is safe if they lick it--like if you put it on the paws to heal the cracks that have formed? I checked for something at my pet supply place that has soooo much stuff; nothing like that--haven't been to the drug store or checked online in to much detail yet.

I did a quick look at the DogLeggs site--are all of them custom and how much are they? I was thinking I could make something similar, but I had not realized the airflow part. If there has to be airflow (which makes sense), how to you make it cushioned????

Did you get Phillip's results back?

[Nathalie]

Do you need a prescription for the Flamazine?

I don’t know and I also live in Canada. You can just call a local pharmacy to find out.

The vet says they have the same stuff but theirs comes in a large jar.

Yes, it comes in a larger jar. So why can’t they not simply scoop some in a pill jar and sell it to you? That’s how I got mine. Keep it in the fridge and it will thicken up a bit so you will need even less.

Is is safe if they lick it--like if you put it on the paws to heal the cracks that have formed?

No, it is not safe for the dog to ingest.
What kind of ‘cracks’ are we talking about? Are those open wounds, bleeding etc? How did Maddie get those ‘cracks’?

I did a quick look at the DogLeggs site--are all of them custom and how much are they? I was thinking I could make something similar, but I had not realized the airflow part. If there has to be airflow (which makes sense), how to you make it cushioned????

Yes, you would need to send in measurements. Costs: $107.50.
Well they are thickly padded around the elbow area. The material is 4-way stretch and antimicrobial. You can give them a call – they are very helpful. All I can say, is that IMO once in a while someone comes up with a good product and this is one of them. When I received them I was blown away by the quality and design – worth every penny in my opinion.
The dogleggs don’t wrap around the elbow but rather loosely surround the area which enables you also to apply ointments to the area without the dog being able to lick it.
Anyhow, call them, check their faq and the veterinarians feedback.:)

Nathalie

[marie adams]

Thanks for the info. I was checking online and I saw they wanted a Rx--so I will call them tmo and pick one up.

The cracks in her pads on just dry cracks, but with the weakness in her hind legs I thought if this really works to heal those up it might help with the slipping on the tile--just a thought since I read it works on these also.

I will call the doglegg people to see what they have to say.

[Nathalie]

The cracks in her pads on just dry cracks, but with the weakness in her hind legs I thought if this really works to heal those up it might help with the slipping on the tile--just a thought since I read it works on these also.


I will call the doglegg people to see what they have to say.

Without seeing the cracks in her pads it’s hard to say whether or not it would be better to just leave them alone or not. Putting ointment on it may soften the skin on the pads and could potentially make it worse. I would not use Flamazine – you absolutely don’t want her licking this.

If you feel that the cracks are of such nature that they are sore you could try Bag Balm (http://www.bagbalm.com/). I always have a jar at home. Its an antiseptic and helps with cuts, sores, chapping and inflammation and is very inexpensive. One of those jars will last you forever and it works wonders on dry human feet as well.:)

You could rub the Bag Balm into the cracks at night and cover it with a baby sock.
To give the socks some traction go to a place that sells fabric paints and get yourself a little bottle of Puff Paint. It is an acrylic paint that you can use to make swirls on the underside of the socks and it will dry to a raised/rubbery consistence. It’s like those none slip kids socks you can by but I have never found any of those to be small enough for Phillip so I made my own.
If you put the bag balm on I would double sock her so the outer sock with the non-slip surface stays free of the Bag Balm.

Putting cheap runners down might also be something additional you can do. There are also products out there that can be ‘clued’ to the bottom of the foot for traction but I am not familiar with those.
I recall some other folks talking about these products quite some time ago. Check http://www.k9cushings.com/forum/showthread.php?p=11487&highlight=pads#post11487

What I have done before calling the people at dogleggs, I send them an email first with a couple of pictures of Phillip's elbow attached so they where actually able to see what I am talking about.

Nathalie

[marie adams]

Hi Natalie,

Thanks for the info. I got the flamazine, but here it is called thermazene (generic for silver sulfadiazine); they just gave me some. They thought I was a little crazy yesterday using the flamazine name, but then they figured it out. I am using kids sock, a little mole skin, and the cream. She seems to understand I am helping her so she leaves them alone and wears them--of course I am always checking on her. The true test will be when we leave tonight to have dinner. What an education we are all getting in something we never thought existed....:D

[marie adams]

I haven't gotten Maddie' results back yet--taken Friday morning/holiday weekend. A little nervous I didn't go long enough with the mini load, but now a little nervous she has been off of the lyso since last Wednesday evening.

I know from going back reading comments, the maintenance starts in again a week from the last loading dose unless I need to continue loading, but then will this make the loading period multiple days since she has been off for so many days? :confused:

[Nathalie]

Are you getting the stim test results tomorrow?

Are you seeing an increase in appetite? Any other signs that the cortisol might be creeping back up?

If it turns out that she was not loaded then you would need to keep pilling daily until you see signs that Maddie is loaded.

Nathalie

[marie adams]

I should be getting it back tomorrow--Tuesday. At the old vet it was usually back the next day, so strange it wasn't at the new vet since I think they use the same lab.

I am not really seeing any changes since last Wednesday; just wondering if I stopped too soon--I could see slight hestitating with food, she was a little more gentle when taking cookies, she seems a little more playful than usual; so maybe I did call it in the right direction.

Will the healing on her elbows take up to 3 weeks or less time? The right is worst than the left. I think they look somewhat better since she cannot get to them to lick. It is funny I am seeing her lay more on the padded rugs and bedding of hers.

What did you decide to give Phillip for maintenance? I was thinking for the 2000mg to give 750 Monday 500mg Wed 750 Friday or give her 500 Monday am, 500 Wed am 500 Friday am and 500 Sat pm?

I can see why it is hard to figure out when it doesn't divide evenly...

[Nathalie]

I am not really seeing any changes since last Wednesday; just wondering if I stopped too soon--I could see slight hestitating with food, she was a little more gentle when taking cookies, she seems a little more playful than usual; so maybe I did call it in the right direction.

Lets hope she was loaded when you stopped. The reason I asked if you seeing any signs of increased hunger etc. is that some dogs adreanals regenerate quite quickly – Phillip is one of them.

Will the healing on her elbows take up to 3 weeks or less time? The right is worst than the left. I think they look somewhat better since she cannot get to them to lick. It is funny I am seeing her lay more on the padded rugs and bedding of hers.

Phillip’s took months to heal, no way of telling how long it takes with Maddie. The right one was that took the longest requiring a lump removal in the end to completely heal.

What did you decide to give Phillip for maintenance? 2500 mg

I was thinking for the 2000mg to give 750 Monday 500mg Wed 750 Friday or give her 500 Monday am, 500 Wed am 500 Friday am and 500 Sat pm?

Depending on the stim test result you might need to start maintenance tonight – let’s say her post stim was 4 on Friday, her adrenals had about 5 additional days to regenerate which means you can assume her cortisol has risen somewhat. But wait and see what her post is.

If your MD is 2000mg I personally would not mess around with cutting pills. Dividing the MD in too many smaller doses can actually decrease the eroding effect and does not make for a more even or better control.
My suggesting would be to pill 500 mg for example on Tuesday, Thursday, Saturday and Sunday (this was Phillip’s schedule when he was on 2000 mg)
Or
If her post was 4 or higher Tuesday, Wednesday, Friday and Sunday

Does that make sense?
How would that work for you?
...

I will be taking the puppers for their walk soon, will check as soon as I get back for Maddies stim test results.:)

Nathalie

[marie adams]

Hi There,

I got the results back yesterday late--I am not sure if the new vet is just soooo busy or what, but will give her the benefit of doubt. I know the old vet had results back the next day.

The Pre was 5.9 and Post 8.3--I stopped too soon :mad: and because I didn't get the results back until yesterday I am now loading again , but very nervous it will be very hard to tell when she is loaded. The vet said to go for another 5 - 7 days. I think I am always looking for signs she is loaded and imagine she is there; and the timing with the weekend adds to it stressing if it is time even though I know I have 48 hours to test. :(

I guess we will see how this goes do not have a choice. Should I ask to have only the post test done or will it have to be the pre and post?

I read somewhere you give Phillip L-glutine or something like that to build muscle---does it really help? Just wondering if it will help Maddie get some muscle back in her hind legs and help with the shaking.

Thanks!!

[frijole]

I know it is frustrating... I'm loading my 2nd dog right now and same thjing... always happens on a weekend so you have extra days. Hang in there. I would monitor and not necessarily wait 5-7 days. That would be the max. Being so close it might just take a couple days.

My first dog had the shaky leg thing and after about 30 days that went away. The muscles might never gain their total strength but take it slowly and she should improve. Hugs, Kim

[Casey's Mom]

I use L-glutamine for Casey and she is now able to up and down the thirteen steps up to the bedroom floor. She wasn't able to do that a year ago. I also give her glucosamine chondroitin, and monthly adequan injections for her arthritis and she gets milk thistle daily for her liver.

Hope this helps!

[marie adams]

Hi Kim and Ellen,

Thanks for the info. I have been giving Maddie the glucosamine chondroitin, fish oil, and just started the milk thistle. Pretty soon she will be taking more vitamins than the rest of us in the family--haha!!! I think it cannot hurt her to take the L-glutamine if it has a chance to help a little. She climbs the stairs to the 2nd story so I guess she is doing pretty good; if she stumbles she starts over again--what a trooper. :o

I think the vet thought I was a little crazy today when I said how will I tell this time if she is loaded since I miss judged it. I guess it could be she really slows down in the eating and of course I have to watch the water drinking. Since I will be working further from the house this go around I won't be able to check on her as much--I will deligate that to my daughter to come home at lunch to check on her--haha!! :D

It is funny only been at this since, what, March and I want instance results--haha!! I just have to get her numbers in the right place and the rest should follow--hopefully!! At least since it will be summer she will be cooler with her new fur fashion statement coat. :o)

Good luck with your loading....:)

[marie adams]

So we are on the 4th day of the 2nd reload. I was wrong just a couple of weeks ago; so want to make sure she is loaded this time, but a little hard to tell. This morning on our walk I noticed she seemed to stumble more on her front paws. I of course wonder if I am just noticing it and she has done this before, but I don't really think so.

One of her favorite foods is popcorn and when I feed her a little today she was gentle in taking it in her mouth. The other favorite is watermelon and the same thing not in a hurry to get it, but very attentive to get some--haha. I think watermelon is the favorite because the other night I was on one side of the sink with watermelon and my husband was on the other with popcorn--she wanted the watermelon more--what a silly dog.

[AlisonandMia]

It does sound like she might very well be "there" now. Wouldn't be surprised as she didn't have far to go really.

I know you don't want to "undershoot" again but overshooting is worse - so if she were my dog I think I'd stop dosing now and try to get a stim done in 48 hours' time. At least this time you'll be doing the test on a Monday or Tuesday, and should get the results back by the end of the week?

Alison

[marie adams]

Okay, I gave her the last dose earlier this evening. I will see how she eats in the morning. I am pretty sure the water intake is down--not seeing her go and get drinks or drink as much when she does.

So if you go on vacation how the heck do you leave them. I usually leave her with the neighbors, but now with being sick it will be a little scary and a lot more work with pills--I guess you get a weekly pill container--haha!! :D

So for the stim test--do I get a is full pre & post or would just the post be sufficient? I think I will have to go get another job to pay for all the tests and Lyso--good thing my daugther is finished with college no savings would be available :D.

Thanks for the help!!

[AlisonandMia]

Got a horrible feeling that getting both a pre and the post might be necessary - I say this because her pre on the last test was quite high which suggests she may have been stressing a bit. The worry is that with just getting the just the post done you may not be measuring the maximum capacity of the adrenals accurately. This can happen if the capacity isn't that high and they are stressed enough to make the adrenals dump a lot of cortisol before the stimulating agent is given. I had this happen with Mia - her pre was something like 2.5 and her post 2.3. Without knowing what the pre was we would have assumed that 2.3 was measuring the max her adrenals could do - which wasn't the case.

I don't know how important this would be necessarily but if you are going to be trying to gauge the effectiveness of a maintenance dose by retesting in a month, getting as much information as you can now could be a good investment.

Good luck - and it really sounds like she is loaded this time.

Alison

[marie adams]

Thanks Alison,

I knew in my gut I needed both tests, but just wondering...

She is has cut back on her water in take--I really noticed it this morning. Her eating seems some what slower, but just a little. I will take her on Tuesday.

I think being a new vet and I had to leave her for a longer time for the test might have been a little nerve wracking for her. When they brought her out she seemed fine not nervous. I always wonder what happens behind closed doors. Maddie is very independent and thinks for herself; so.....;)

I had feed her that morning not thinking I was taking her in for testing--kind of forgot and the habit of feeding in the morning when we get back from walking; but I am sure they didn't do the test right away so it might have been close to 5 hours since she had eaten. This could be why the pre were higher--who knows....

I will post the results when I get them and hopefully this time it comes back in the 3 range like the first time.

[AlisonandMia]

Mia used to get pretty nervous in anticipation of a vet visit. They said she was very calm and settled "behind the scenes" and even went to sleep - and I have no reason to doubt this. The always seemed very calm when I picked her up - I guess she knew the worst was over.

Her big worry I think was having her anal glands expressed and/or temperature taken - "not my bottom!" I think that once she realized that that wasn't on the agenda on a particular visit she would calm right down. Maddie might have a similar specific fear.

Alison

[marie adams]

So I just dropped off Maddie to have her ACTH test and they told me it is a 2 hour test?????:confused: I said my understanding is it is a one hour test---draw blood for pre and then give the acth then draw blood in an hour. They said something about a gel and then there is an intraveinous (spelling). I said all I know is what the past tests (from the previous vet) have been that I know about and read about.....is this why her numbers last time (at the new vets) might have been not as good as they could have been????:confused:

They wanted me to leave her over night to do the test in the morning because I have a meeting until 3pm tmo. I said no and that I didn't understand the 2 hour test, but then the vet told the front desk person there is an hour test. I have to think positively and this new vet really knows what she is doing, but the tech's aren't as knowledgeable about Cushing's.

[Harley PoMMom]

It depends on what stim agent the vet is using. If it is the acthar gel then it is 2 hours...if it is the cortrosyn then the test is 1 hour. ;):)

Love and hugs,
Lori

[frijole]

:) Probably they forgot to take the cortrysyn out of the freezer in time. Seriously. Happened to me once. It has to be thawed to use.

[marie adams]

They talked about the gel when I first dropped off and when I went to pay it was $5 more for the cortrosyn and they did some type of mini exam. So since I paid for an mini exam I had a few questions I wanted to ask. They took Maddie back and asked the vet about a little growth on her head--said it was non cancerous, but then I forgot I wanted her to look at her pressure sores to make sure they were healing (it has only been about a week or so since I started put thermazine on them. I think they seem better, but I have no clue.:confused:

I waited for the vet and thought I would talk to her, but then they decided to take Maddie in the back to show her since the vet was with another patient I think--it was like another 25 minutes and still no Maddie or vet :( At this point I was suppose to be on a virtual ad spec with a company artist about 15 minutes after I had been waiting--it probably was longer, but.... We all do not have enough time and the waiting kills me--stresses me out even more than I already am. Maddie seemed fine was laying down while we were waiting so I do not think she was stressed about anything. It was when we got home and I was trying to talk to my artist (of course I was trying to do this on the way home from the vets--on my phone and the computer in the car driving--yes I am crazy) so Maddie decided to chase the cat who is under my bed--she goes from one side of the bed to the other.

What I am getting at is when I took her down stairs to feed her she inhaled her food; so does this test make them a little anxious? The other test times it was in the morning and after I got her back home those times I left for work and it wasn't eating time.

Maddie now weighs 66.6 lbs down from when we started all this in February 72 lbs. I changed her diet to the raw chicken/vegies/fruits combo and no dry or grains--which means not a lot of fat in her diet.

Thanks for the help on this testing--didn't know about the gel vs. the other way.

[marie adams]

It is late in the evening, Maddie tried to come up the stairs and her hind legs gave out--she just moved herself away with her bottom dragging and her left leg out stretched. It broke my heart to see her this way--I lost it!!:(:( She got herself to the carpet and finally pulled her leg in, but last I looked she had moved a short distance to lay against the wall next to the stairs. I think I will sleep downstairs to see how she does....I had noticed her hind legs were a lot more shakey than usual. I guess we will see what the morning brings and if she will go for a walk.:rolleyes::rolleyes:

[AlisonandMia]

I wonder if her cortisol hasn't dipped a bit low. Maybe you could try a little pred?

Alison

[marie adams]

Thanks Alison,

I was wondering that myself, but at the same time wondering if I still missed the mark on dosing...I will see how she does through the night and in the morning.

[zoesmom]

Marie -

Know it's still early in CA but hoping for an update on Maddie this morning. Hope she's doing better. When do you expect to get the ACTH results? Just a note about testing days . . . Zoe usually would come home from the ACTH test, extra-thirsty and extra hungry, for 24 hours or so. Assumed it was from the stim drug releasing all that extra cortisol into her system.

If it turns out that Maddie is running too low (which might explain her legs giving out last night), that extra spurt of cortisol (from the stim drug) may have kept her from being even weaker. Don't know that, just speculating. But if true, she may very well need a pred, especially if she's still having the weak legs this a.m. Watching for your update. Sue

[marie adams]

Hello,

A quick note--She seems better this morning--still shaky legs, but not giving out. Maybe it scared her as much as it did me and she didn't want to move, but she did end of walking into the family room and sleeping there and changed places a few time--I slept down there with her. She went for her walk this morning so....

If I did give her a pred what would it do to her numbers since the test was yesterday and I want good numbers to start maintenance? I hope this makes sense.

I am not sure about the numbers coming back today since it was around 6pm when she was done yesterday--I would be surprised if they are back today, but should hopefully be there tmo.

Thanks for the explanation on the eating and drinking after the test.

[zoesmom]

Well, since she's doing better today - and presumably eating and drinking and not having loose stools or any other symptoms - she's probably good without a pred. Since the test is already done, one or two wouldn't be a big deal, IMO, even before going on maintenance. That's because lysodren works by eroding the adrenal cortex which wouldn't regenerate that fast. But unless you start seeing some of those other signs, I'd say just sit tight and wait on those acth numbers. If it turns out that she's running at the very low end, your vet might decide to hold off on starting the maintenance just a little longer than usual. Least I think that's what he'd do. (We used trilo, so maybe the lysodren people will have an opinion.) Glad she's perked up a bit today, though. Let us know when you get those results! Sue

[marie adams]

Yeah!!!! :):) Results are in Pre 2.5 Post 3.2

Maintenance will be 2000mg weekly. I will look back I know Natalie made a suggestion on how to dose 4 times a week. The vet said tmo would be good to start since she has been off since Saturday.

Let's hope this time we have the right dose to keep her numbers low. :D

[Harley PoMMom]

Those are GREAT stim numbers!!! Congratulations!!!! Well done!! :D The hard part is over, finally, huh? Now...on to maintenance dosing!

Love and hugs,
Lori

[marie adams]

Thanks Lori,

I know it seems like it was a long haul to get these numbers back and finally have a vet who says they are good and go with a maintenance plans that will work.

Natalie said this would be a good suggestion on how to handle the maintenance dosing:

If your MD is 2000mg I personally would not mess around with cutting pills. Dividing the MD in too many smaller doses can actually decrease the eroding effect and does not make for a more even or better control.
My suggesting would be to pill 500 mg for example on Tuesday, Thursday, Saturday and Sunday (this was Phillip’s schedule when he was on 2000 mg)
Or
If her post was 4 or higher Tuesday, Wednesday, Friday and Sunday

Any suggestions will be welcome for 2000mg weekly....

I hope your loading continues to go good and your numbers come in GREAT!!!:):)

[frijole]

A very big congrats from me!!!!! Great news. Hugs, Kim

[marie adams]

Thanks Kim! How are things going with Annie and you?

[Casey's Mom]

Great numbers with Maddie!!

Love and hugs,

[apollo6]

I am new at this also. I am located in San Diego, are you close by.
Don't know where you are at with this journey. The senior members can help. Read all you can about Cushing from the resources. I do some holistic, but it is very tricky. Because of these medications, you should not start things on your own with out the knowledge of your Vet.
In my case in Sept 2009, Apollo's blood panels were way out of whack. Loosing hair for over a year on his tail(looks like a rat tail.huh!) to put some humor into it I asked if I could put hair extensions on it. Excess drinking, looks for warm spots to lye down, has skin infections on and off, ingrown hair on his tummy, his little rump, seems to be able to hardly walk, gets more tired then before, more heat intolerant, appetite hard to say was always hunger, muscle weakness in his hind legs, falls easily. Seems not as joyful as before. These are all the tests I did. Went to specialist on May was not happy with her, decided to go to another specialist. First said Lysodern, second said Trilostane( which if I get the courage to start)
Sept 16, 2009-blood panel
January 2010-ultrasound-abdominal (disc)
May 25, 2010-blood panel
May 28, 2010- (Pet Emergency & Specialty Center-La Mesa)
ACTH Stim Test
Blood pressure
Urinalysis-Antech
Urine Culture MIC
Ultra sound, Focal Abdomen (only gall balder- sludge ) did not get any report?
Like you I want him on holistic, anything that will help. This is a difficult disease. There are three kinds to differentiate from. Need to make sure you have diagnosed the right one. Every one on this website has one form or another. A lot of good support and input. We are here to help you. Don't be afraid to ask your vet what ever, if not sure then ask.

[marie adams]

I am adding milk thistle, fish oil, l-glutamine along with the glucosamine/chondroitin. I have started to add a little almond meal to her meal to give some good fat to her diet. She eats a frozen raw chicken diet that I purchase from a local pet supply. I thought about a holistic approach, but after being on this site with all their knowledge I rethought that approach. I don't really like having to use lyso to treat, but it has results and that is what I want for Maddie. It has been used for sooo many years so I accept it. We have learned alot in the past couple of years about our own diet--we make most of our meals, watch the sugar/salt in foods. Love Trader Joe's.:):)

Maddie just got diagnosed earlier this year. I knew something wasn't right about a year ago--was told she is getting old. Other than the symptoms starting to show up Maddie has been a very healthy active dog--would run miles while my husband rode his bike. Maddie basically hardly ever went to the vet before this.

[marie adams]

Well, we are into week 3 of maintenance. No real problems. She still has the shaking, slow on the walks still, but over all doing good. I have noticed her skin is dry and flaky; along with her fur now seems more dry than it has been (was oilier after the first loading). She has the oily patches on the sides of her back legs so the fur seems dirtier. Haven't noticed any fur re-growth yet.

She still has a good normal appetite, but I think she needs some good fat in her diet--have been giving her a little almond meal with her meals--raw chicken diet/frozen. Just started the L-Glutamine powder and she has been taking fish oil, Glusomine/Condroit., milk thistle. Her belly still looks round, but can really feel her ribs--she now weighs about 66 lbs which would be a normal weigh except she doesn't have the muscle tone she use to have when she was well. Her pressure sores seem to be getting better--the bag balm works nicely and she doesn't seem to want to lick it--haha!!!

Has anyone heard if L-creatine is ok to give to dogs for energy??Thanks!!!

[marie adams]

Well, I took Maddie in this morning to have her acth test after being on maintenance for the past month. What an ordeal---I only gave her half of her morning meal at 6:30am; she was at the vets by 8:30am. I knew it would be after 9 before they would start the test and it would take a couple hours. My work schedule got changed around since a customer canceled on me so I stayed close to home. When I went to pick her up around noon they told me they had just given her the injection because they had to get it from another pharmacy. I was mad because they could have called to explain there would be a delay. Maddie didn't get back to the house until 3:30pm. You can imagine how mad I was--a whole day wasted because I couldn't go that far or get involved in an appointment. My husband said they wouldn't mistreat her so she was fine. My thinking is who wants to be stuck in a cage for the whole day when you are use to freedom and wouldn't this make her pre test off because she might have been a little nervous....does anyone think about other people's TIME--it is like common courteous--it is dying. Does it sound like I am in a bad mood. :mad: I had even called the vet's office the day before to let them know I was bringing Maddie in for the test...do you think the vet knows how the front area workers treat all the waiting people. It is crazy and now I wonder if I made a good change in vets since I have to ALWAYS WAIT.:(:(:mad:

Poor Maddie she just seems so tired. My husband said she kept falling asleep when she got home. Almost a deep sleep.

I hope her numbers are still good--I think they will be. I think I might want them to come up a little because she still seems to shake in her hind legs. She is very sensitive more so than she use to be--doesn't like raised voices and wants to hide--not like the Maddie we use to know. She is on 2000mg of lysodren for maintenance and I am thinking bringing it down to 1750mg. I will talk it over with the vet.

[Harley PoMMom]

Hopefully the vet staff gave Maddie extra loving attention while she had an extended wait there.

Concerning the pre draw...I don't have it done unless I'm thinking my pup's cortisol is dropping too low. What I do with Harley for his stim test is...make the appt. for a post draw only, then I take him at the assigned appt, they take him back, inject the stim agent in and bring him right back to me. I can either wait there, one hour, or I can go home and come back.

Will be checking for Maddie's stim test results.

Love and hugs,
Lori

[marie adams]

Thanks for the great idea Lori!!!:) I thought I posted a message, but it disappeared.

I like the idea I can take her with me to control the time. They will have to take her back when I get there because we will be on a time schedule for the draw--haha!!!:D:D This way I will not be so stressed--maybe my cortisol levels are off!!!! I sure wanted to kill someone yesterday--so much so when I got home with Maddie my husband was a afraid to let me go back out to see customers for fear of what I might do to them if it didn't go in the right direction---:eek::eek:

How is Harley doing? I have been a hit or miss lately with posting--crazy work schedule and all.

[Sabre's Mum]

I learnt the hard way with our vet clinic and the synacthen. After I learnt my lesson (ie no stim agent for 24 hours we have to wait for a courier order) I politely but firmly requested that they always had one in stock for Sabre and as an added precaution (because I know they did not always have some in stock) when I made his appointment I would double check with the vet nurse that they had some in stock for him.

Sabre was always the stress machine at vets ... you could not allow him to be locked up in cage ... not unless all staff wore ear plugs! So what I did was had the first draw, took him away from the clinic then returned an hour later.

Can't wait to hear the results from the stim.

Angela and my dear little Flynn.

[marie adams]

Hi Angela,

LOL of the ear plugs!! I do not even know what Maddie does when they cage her--I think just has a sad look on her face, but she could let out a few sad high pitch barks---I will ask next time if there is a next time to leave her. I love the idea of taking her with me. My husband -- Mr I know everything in the world---said why don't you make sure they have the stuff before you take her--duh that is exactly what I plan on from now on, but with this stupid testing we have time schedules, but I will think a few days ahead--the last few times they had the stuff so I assumed they always had it---is there an ASS-U-ME theory going on in my head here:rolleyes::rolleyes:

Thanks for the wonderful ideas!!!:):)

[apollo6]

Just a hi, to say hope your Maddie is doing well.

[Roxee's Dad]

Hi Marie


doesn't like raised voices and wants to hide

My Rozee was like that just before she lost most of her hearing. Vet couldn't find anything. It seemed she had super sensitive hearing and we had to tip toe around, just the sound of a chair moving across the wooden floor, she would run and hide for cover, then before we knew it she lost most of her hearing.

[marie adams]

Hi John,

I noticed one of her ears seems to have more stuff in it--her ears always seem clean before. I wonder if this has something to do with it, but it seems over all she is more nervous or sensitive than she has ever been. She has never liked raised voices so you could never really yell at her--I think the bred has something to do with it--she doesn't even like the word BAD because she knows what it means--what a silly girl she is.

Thanks for the heads up I will keep watch. I already have been checking how well she hears and sees because I know with the age factor it can happen now.

[marie adams]

Maddie's numbers came back at pre -3 and post - 2.7 The vet was happy with the results -- we maintained nicely.

I asked her if we could cut the Thursday dose to 250mg so she would be on 1750mg weekly from the 2000mg (dosing ThSatMonWed) to see if it would help with the hind leg shaking. She didn't have a problem since we have a little leway in the numbers. Her last post was 3.2 before maintenance started. Maddie seems a little nervous at times (wants to hide or shakes more all over when voices get a little loud) so not sure if this might be happening because of too low of numbers. :confused::confused: The hind leg shaking seems the same since starting Lysodren.

Looks like her coat is shedding more and little soft fur is starting to grow back on her belly--very slowly, but it looks like it is finally happening---Yeah!!!!:)

Any thoughts??!! Thanks!!! :D

[AlisonandMia]

I agree that dropping her dose a tad could be a good idea. It looks like the 2000mg per week has been dropping her numbers just a bit (hard to be completely sure but it does look that way). How long had she been on that dose between stims? If it is dropping the cortisol production then staying on that dose would eventually result in her dropping too low (be actively eroding the adrenal cortex) - could take six months or more but it would happen eventually.

I think that once you drop the dose you should ideally (if you can afford it etc) retest in a month or so just to make sure those numbers aren't rising too much. Could turn out that she needs something between 2000 and 1750 - who knows?

It is also possible that letter her numbers rise a bit will help the back leg strength. At one point I noticed that Mia's hind-leg strength wasn't quite what it could be (couldn't bounce vertically into the air of her hind legs as she normally could!) so I let her numbers rise a tad (delayed a single Lysodren dose by 36 hours in her case) and *bingo!* she was bouncing again. I think she probably went from being around 2.1 (which is what she'd stimmed at if my memory serves) to probably somewhere around 3 - she never had another stim as it turned out but where ever she was at it was for her the "magic number". (Mia had super-fast regenerating adrenals so it didn't take much to get her numbers up a bit.)

Of course there are other things (like arthritis) that can cause shaky legs too but too-low-for-the-dog cortisol has to be a prime suspect in a treated Cushing's dog, I think.

Alison

[marie adams]

Thanks Allison,

Maddie was has only been on the 2000mg for a month. I agree it is worth a shot to see how the dose works and you are right it could have kept lowering her numbers. The vet said let's see how it goes and test in a couple of months.

I think about the weakness being arthritis and hoping it's not, but I have read others using Ade... something that seems to help. Maddie's shaking started over a year ago so maybe her muscles are too far gone to come back to help stop the shaking. :( Time will tell....

[marie adams]

Question?? Over time can they develop allergies they didn't have before due to Cushings?

Maddie has been sneezing for the last couple of days--nose seems warm, but only clear drips from both her nostrils. She doesn't seem to have any problems with her teeth, eyes looks good, eats, drinks, and poops just fine. The sneezes do not seem like anything is caught in there....:confused:

The only new I introduced is Flax seed oil, but she was already starting to sneeze before I started it. I added this because her skin and fur is so dry - she is finally blowing her coat and getting new fine fuzz starting to grow--she looks so thin with less fur.:(:o

Thanks!!!

[lulusmom]

Allergies before being diagnosed with cushing's may not become apparent until after treatment has lowered the cortisol. Cortisol is the body's natural form of prednisone, a drug that is prescribed for dogs with severe allergies, so an uncontrolled cushdog is pumping out a lot of cortisol that is suppressing the allergies. Once unmasked, the dog will usually become itchy and start scratching. Since Maddie is just sneezing with a runny nose, I don't think it's likely that this was something she had before she was diagnosed. I know that all of my dogs are very sensitive to a change in cleaning products, like floor cleaners and even pet odor removers. Have you made any changes lately? Any new flooring? My Lulu has chronic bad teeth so if she has a bad abcess, she is sneezing like crazy. We're not always able to see the problem so it's still possible that Maddie has a bad tooth.

[marie adams]

No changes in anything household wise. If she has a bad tooth would she still want to chew on dry food, carrots, etc? There is no scratching or chewing...could be a cold also???

I may end up taking her to the vet today, but if it is something I can take care of I want to try first--it just is rotten to get old the poor thing. :( The only joy going to the vet is riding in the car.:D

[marie adams]

I called the vet's office yesterday and they said it could be allergies. Since the discharge is clear and not much of it just keep an eye on her. If her nose gets dried out and the discharge becomes colored & thick then bring her in. Also, since she is still eating, drinking, and good poop she is good to go. She is snoring right now, but she still wants to go out of do her normal routine throughout the day so I am not going to stress out about this----SURE!!!:rolleyes::rolleyes:

Maybe it is the weird weather here cold hot cold misting this morning...:confused::confused: And the fur is a little thin--cannot insulate either way....:D

[littleone1]

Hi Marie,

Corky has allergies, and the same thing happens to him. He'll have sneezing fits at different times of the year and have little drops on his nose. I do give him allergy medicine for that. He also has other allergies.

It doesn't seem like Maddie is affected by it. I'm glad that you're not going to get stressed out.:)

[marie adams]

I have been reading that it might not be a good thing to give flax seed oil--is this true? I thought it would be a good thing for her dry skin and fur, but.....:confused:

I give her fish oil also and just started giving her low fat yogurt--it is like dessert.:)

So confusing trying to make sure she gets the right stuff. :confused:

[addy]

Hi Marie,

Gee, I was also under the impression flaxseed oil helped a dog's coat, not sure why it would not be good for them except it may cause loose stools.

I bought sardines for Zoe but I am afraid to give them to her:eek: I read somewhere that just one sardine gives them alot of omega 3 or omega 6, forgot which one.

I do know that the coat and skin is one of the last things to improve on lysodren.

We are looking at loading in August and I am getting really nervous. We have a recheck 8/9 with IMS.

Hugs to you and Maddie:D

Addy

[Squirt's Mom]

Hi gals,

Flax seed oil is good for most pups. But cush pups have a tendency to develop pancreatitis so watching their fat intake is important. If you are using the flax oil, you will want to lower the other fats they intake from other sources - treats, meals, etc.

If you are using the flax seed oil as a treatment for Atypical, then the reason we don't recommend it is because of the low content of SDG - the "ingredient" that makes the lignans work on the intermediate hormones, along with the melatonin.

Hope this helps!
Hugs,
Leslie and the girls - always

[marie adams]

Hi Addy,

You will do fine with the loading! Just watch for the slightest change in Zoe's eating (this is where I knew we were loaded). The first time she paused just ever so slightly and looked at me. I didn't get it right on a 2nd reload, but the 3rd time I could tell because she was a lot more gentle taking from my hand and not taking the fingers with her--haha!!!

I had to reload the 2nd time because the old vet was too conservative in the dosage and her numbers went up--he yelled at me that the numbers don't mean a lot just the symptoms--decided to change vets after that, but took some time and I could tell her numbers went up so I made the appt for the new vet. It is only money:rolleyes::rolleyes:!!

Just remember everyone is here to help you through the load--they helped me each time--we have all been here....:)

[marie adams]

Hi Leslie,

Thanks for the info......Maddie doesn't have ATypical so I am safe there. She is on a pretty low fat type diet--frozen raw chicken diet(Northwest Naturals) and dry venison flavor (California Naturals), no grains. I have been giving the FS Oil a tablespoon for the am and pm meals, plus a 1200mg fish oil capsule with each meal and for dessert about a qtr cup to half of low fat yogurt.

So, I can do a little more research to see how it all fits together--:D:D

[addy]

Zoe is on raw turkey diet but it has 30% organ meat. I should recheck that fat content again. SHe also gets a tablespoon of Embark Honest Kitchen at each meal. That has 10% flax in it.

Marie- how much fat in in your raw chicken? Do you know how much organ meat? I thought Zoe's food had 30% organ meat because the turkey is so low fat. Maybe that is wrong.

Marie or Leslie- do you know how much fat is in the lignans? I am waiting to get my shipment, not here yet. Will I have to worry about that fat? How much fat is in the flax hulls?

Great, now I will be obsessed with FAT:D:D:D

Addy fatty

[marie adams]

Hi Addy,

I will check to see how much fat is in the raw and dry--I do not feed Maddie lignans so I do not have a clue.

I love the "FAT" comment---we so obsess about things now. :D:D

[addy]

Well, Zoe does things in a BIG way, she has both, typical and atypical.

I have to reread your thread, I have not been retaining things as well as I should. System is on Cushings overload. So many it seems are going the trilostane route.

I read through your thread and now need to reread it:o

Thanks Marie!!!!!!

Addy

P.S. Have you ever dealt with constipation? Zoe has a bad case now, never worried about it, she has chronic diahrrea. Well that changed now.:eek:

[lulusmom]

Addy, how long have you had Maddie on a raw food diet? One of my Maltese boys had chronic colitis before putting him on raw food. It was amazing how his stool immediately firmed up...to the point of being like little rocks. Dogs on grainless diets utilize everything they eat so they poop a lot less. This may be gross but I also noticed a huge difference in the smell. When my furkids were on kibble their poop could knock a buzzard off a poop wagon. With raw diet, there's hardly any smell at all. Lastly, because the poop is firmer, it's not quite as easy for a dog to pass so it also helps keep the anal glands flowing.

Canned pumpkin is hard to find right now but if you can get your hands on a can of plain, no sugar added pumpkin, give Maddie some and that should help with her constipation problem.

[addy]

Oh Marie, I feel like I highjacked your thread :( I am so sorry, I was just wanting to"gab" with you since we have some like things with Maddie and Zoe.

Lulu's Mom- Thanks for the tip. Zoe is Addy's dog, Maddie is Marie's dog. I guess I stole her thread. :o

Please see Addy's post about the constipation. Thanks for responding

Thanks,
Addy

[lulusmom]

Good grief, I not only hijacked a thread, I probably confused no less than 10 people. :o:o:o

[marie adams]

Hi you guys,

I don't mind the hijack at all.

Yes Maddie's stools are very firm, sometimes there is a little bit of the smell, but like you said not the knock a buzzard off the poop wagon---hilarious:D:D

I was told the raw would be good for the anal glands. Today when Maddie was doing her business in the front yard my daughter asked if she was okay because it looked like it was difficult for her; I just said no it is the food she is eating now. Sometimes it does look like the stools are a little dry so that was another reason I started the flax seed oil and yogurt--not sure if it is a good idea, but I didn't see that it could hurt her. As far as the pooping less--it seems like more....she use to poop in the am and the evening--now it kinda is whenever.

[Franklin'sMum]

Hi Marie,

Refresh my memory, please, how have Maddie's triglycerides been? Franklin's went sky-high on flax seed oil. Omega 3 by itself is also recommended for coat/skin issues, and don't seem to increase trigs.

Jane, Franklin and Bailey xxx

[marie adams]

Hi Jane,
I haven't had any blood work done since I started with the new vet a few months back and I wasn't giving her any flax seed oil until just recently. I cut back and only give it to her when I give the lyso which is Thursday, Sat, Mon, Wed evenings. She still gets 2 1200mg fish oil pills a day--does that do the same as the flax seed?

This is so crazy trying to figure out what you think is good can cause something else to go bad.:confused::confused:

It is so funny all the stuff that goes into her food each time--she now has her own basket of vitamins and pills....:D

Thanks for the advice I truly appreciate it.

[addy]

Hi Marie and Maddie Girl,

I don't have any new info on flax oil for you. Hope you have better research luck than I did. Everything I saw said how wonderful it is for their coat and did not talk about FAT.:eek:

And I just wanted to say hi, how are you, as well!!!!:D

I hope you and Maddie are having a great week.

Addy and Zoe

[marie adams]

Hi Addy,

Thanks!! We are having a wonderful week so far. The weather is pretty good--it is suppose to get over cast again on Thursday so not looking forward to that. It makes the walks in the morning a little less excitng, but it is still beautiful to hear the crash of the waves, seals barking, birds gathering in the wetlands...freedom for Maddie to roam.:)

I hope you and Zoe are having a great week so far also.:)

[addy]

Hi Marie,

Just wanted to see how things are going with you and Maddie. Did you ever get the fax oil figured out? Hopefully the fish oil and lysodren are stimulating those new hair folicles and she is getting nice and fuzzy. Zoe's IMS says takes a good three months for lysodren to "clean out" those folicles (i think I spelled that wrong) and the new hair cycle to start.

Did the smell of her hair change? I love the smell of Zoe and I hope her smell does not change. of course, i am goofy that way. I used to ride horses every week and I loved to smell my hands when I would get home. I thought the smell of hay and horses and leather would make the best perfume. Of course everyone else thought I was CRAZY!:eek::D

Now I love the smell of my pups!!!!!!

Hope you have a wonderful weekend!

Addy and Zoe

[marie adams]

Hi Addy,

You always make me laugh!!!:D:D I know the smell of horses and my husband loves that smell since he is the one who rides the most--I just liked the brushing of the fur.

Maddie seems to have more of a dog smell now. Her new fur is really different and she looks so scruffy--the old long fur (not much left) mixed with the new fur. The belly fur looks like the old, but it is soooo cute because the way she rolls over on her back and plays the cute card.:D I have always used conditioner on her after bathing her--I like the coconut flavor of Sauve.

The fur looks so dried out so that is why I thought the flax seed oil would help along with the dry skin flakes. It seems like it has a kind of oily feel also---weird. I haven't had a chance to do anymore research, but plan on it.

I hope you and Zoe are having a great weekend also!!!:)

[Sabre's Mum]

Hi Marie

Dry flakey skin ... this is what seems to happen once on treatment for cushings ... definitely from experience this is what is what happens with Lysodren. After a few months it just seems to correct itself and your pup doesn't seem to have it so bad. We used flax seed oil along with evening primrose oil. Sorry for the quick reply ... cooking dinner here down under!!!

Angela and Flynn

[marie adams]

Hi Angela and Flynn,
Thanks for checking in with us. I am a little nervous about the flax seed oil because Jane wrote:

Hi Marie,

Refresh my memory, please, how have Maddie's triglycerides been? Franklin's went sky-high on flax seed oil. Omega 3 by itself is also recommended for coat/skin issues, and don't seem to increase trigs.

Jane, Franklin and Bailey xxx

Do you think any of the oils can cause problems with the triglycerides? I have only been giving oil (flax or olive) when I give lysodren until I figure this out. I need to do more research, but just haven't had time.

Thanks again!!

[Sabre's Mum]

Hi Marie

I have just done a QUICK search with regards to triglycerides and flax seed oil. Technically it should reduce triglycerides (lots of websites indicating this), however I found some sites which said there were differing results ...some increasing and some decreasing triglycerides. Maybe others have more info or a good website which has been based on good research.

Angela and Flynn

[marie adams]

Angela,

I guess it is a guessing game which way to go. Without testing again, is there any indications if the triglycerides go up? What should I look for?:confused:

It seems it is always something new to watch out for, but the good thing is we all know so much more about the littlest details in our little ones health--maybe a little too much--haha!!! :D

Thank you again!!! How is the weather in New Zealand right now? We are having such a mild summer here in So. California--really crazy!! Take care!!

[Sabre's Mum]

Hi Marie

Yes ... my quick search did indicate that it all depended on the person/pup! Triglycerides is not something we ever worried with Sabre so maybe others may want to comment. The weather has been warming here in NZ ... still have the fire going at night ... technically it is spring here in a couple of weeks!

Take care
Angela and Flynn

[addy]

Hi Marie,

How are you and Maddie? Hard to believe it is the end of August!!!

Hope things are going well!!!!

Hugs,
Addy

[marie adams]

Hi Addy,

I can't believe it is already the end of September and it has been a month since you wrote.

I have been busy with work, working on the house, and just things going on.

We are both good. Maddie's fur is soooo thick now--it came back like everyone said it would--a little different in the coloring, she looks like a puppy--wish she got around like one:). Starting to get long in the right places, but now it is hot---crazy summer here:p---and I think she might be getting a little warm. It seems her panting is a little more heavy right now---I need to go have her tested it has been almost 4 months on maintenance, but have been wanting to give her a bath--which isn't as easy as it use to be.

How are you and Zoe doing? I hope you had a wonderful summer!!!

Take care!!

[addy]

Hi Marie!!!!

I am sooo glad you checked in and that Maddie girl is doing well. She's a fuzzy wuzzy baby now:D What great news!

You sound really good and I am happy about that as well.

We are fine, need to get Zoe in for a urine culture. Something starting to go on there, maybe our reprieve is over:eek: If it is I can handle it and I have you for a roll model, you have done so well with the lysodren, I am really proud of you.

Keep up the good work and give Maddie a big belly rub for me.

Hugs and BIG smiles,

Addy and Zoe

[apollo6]

Glad to hear about Maddie
In southern cal. we've have a heat wave going over 90 + degrees.
Apollo is having a harder time with the heat, and still the hind leg weakness.
Hugs Sonja and Apollo

[littleone1]

Hi Marie,

I'm glad that Maddie is doing good. I hope she continues to do well.

Terri

[Franklin'sMum]

Hi Marie,

I'm so sorry that my previous post about triglycerides made you feel nervous :( it was not my intention at all. Much like Angela, I've come across sites that say it's 50/50. However, it seems that in the US, you can get flaxseed oil that is just omega 3, and this might be the difference. The brand I was buying contained omega 3, 6 & 9. And like a doof, I thought 'these are good fats'. Franklin's IMS was the person who recommended that I stop supplementing with that, but said I could supp with omega 3 by itself.
So maybe what I had been using was just too fatty, but trigs have come down since only using omega 3. And quite likely it may just depend on the individual, too.
Hope that helps,

Jane, Franklin and Bailey xxx

[marie adams]

Thank you all!! It has been hot here and humid. I think this has been a little hard on the Maddie Girl. The panting seems more annoying right now, but...I really need to get in for a test just seems like no time, but should be able to sneak her in and not cause too much time away from work haha:D.

I will check the flax seed oil to make sure it is only omega 3. The fish oil and the flax seed might be too much, but I will check with the vet when we go in. She loves the yogurt bugs me every night until I give her some. Do you think this might cause her to gain a little weight--I total thinks so haha!!:D She sooooo enjoys it...

Jane you can always voice concerns. I have learned soo much from everyone and I can pass this on myself.

Anyone use Metacam to help with arthritis? A neighbor suggested it for inflammation (spelling).

Take Care All!!!:)

[littleone1]

Hi Marie,

I use to use Metacam for Corky's arthritis, but it was strongly recommended that I don't use it now because of Corky's Cushings. There are certain types of medicines that shouldn't be given to them. I give Corky baby aspirin if he needs it, but I make sure he has his Pepcid AC so it won't bother his stomach.

[marie adams]

Hi Terri,

Thanks for letting me know about the Metacam and the cushings. Glad I didn't buy it, but was going to talk to the vet first and haven't had a chance to get there to have Maddie tested. Hopefully this week if work permits.;)

Did you get any of our thunder storms? The weather is so weird here, but then it hasn't been normal for a long time--haha!!:D

Thanks again!! How are you and the Corkster doing??

[littleone1]

Hi Marie,

You're welcome.

We did get the thunderstorms. It was nasty for awhile. Hopefully we don't get anymore. I would like to see a nice slow steady rain. The weather has been strange.:(

Corkster and I are doing good. I hope all is well with you and Maddie.

[addy]

Hi Marie,

I just wanted to tell you about a food my niece and Zoe's holistic vet told me about. Zoe's vet has me adding 1 tablespoon per meal to her raw. It is The Honest Kitchen and I use their Embark. It is dehydrated food you mix with warm water. If you talk to the company and read about them you feel pretty good. They will even send you free samples. Some of it is pricey but if you use it to supplement the raw, it lasts along time. One pound makes 1 cup of food. You could probably add 2-3 tablespoons to Maddies food and it would last awhile. They have a website.

I like it too because you mix warm food with their raw. I woory about the raw too but can't change now. Sometimes I wonder if that is why her hair is bad and then sometimes I think maybe because of the raw, her symptoms and blood work are not so bad.

Who knows, Don't you wish they could talk:eek::eek:

Have a wonderful day and I hope Maddie continues to do well!!!!

Hugs,
Addy

[marie adams]

Thanks for the info on the food. Maddie has not had any problems with her skin since being on the raw. In fact, she doesn't have the flaking like she did and with her fur coming back so thick I think the combo of flax seed oil and yogurt have been a good positive. You should see her when she wants the yogurt--she has to have her fix:D:D--barks and is annoying until she gets it--then she is ready to relax for the evening.

I will check out the site when I have a little more down time which should be in about 2 weeks--maybe:eek::eek:!!! Sure!!!!

Have a Great Day!!!!

[addy]

Yup, I know that dancing, barking for raw food act, Zoe does it all the time. She never did that until we switched to raw:D

About the Armor, I was rushed this am, it is a natural product but your vet has to prescribe it and tell you the dose. It never changed Zoe's T4 or T3 numbers but she sure did perk up. You have to do thyroid test just like with the synthetic thyroid medicine after you are on it for awhile. A lot of the holistic vets use it but I did read it was reformulated in Spring of 2008 and humans were reporting hair loss as a side effect which they did not have with the product before. So, you can't just go get it, is my point and I wanted to clear that up and not give you the wrong impression.:)

Look at the Honest Kitchen when you have a chance, I think you will like the food for a supplement to Maddie's raw. I like the fact you can serve it warm and it warms up the raw. I put my Koko on it 100%. I am forever trying to clear up his eye buggers and staining. It did not do that, well at least the Embark did not. But he sure looks good physically, though his poops are big again, when he was on Stella and Chewy, they were small. My niece uses the Thrive.

Wishing you luck if you get to have Maddie stimmed. Let me know how Maddie Girl is doing. Funny thing about the panting with Zoe, we were getting worried she seemed to be panting in the evening. Then it dawned on us she likes to sleep underneath our glass table in the den in the corner. Well, it has a lamp on it. We switched the lamp to another spot and she stopped panting!!! Man oh man, I was twitching big time that it was her Cushings and it was the heat from the lamp shining through the glass table:eek:

A girl never knows:rolleyes:

Hugs,
Addy

[marie adams]

After a very frustrating time with the vet's office I got Maddie's results from a week ago Monday--that's right a week and a half:eek::eek::eek:!!!!!!

Last night one of the front office people said the vet said her number's were normal---let's see if Pre: 5.5 & Post: 8.4 are normal just shot me!!!! Wanted to talk to the vet, but of course she was busy and would call me back after 6pm---they promised---you guessed it again after leaving messages the last 3 days she didn't call me again---time for a new vet you think:mad::mad::mad:!!!!! Her previous test in July were Pre: 3.0 Post: 2.7 so I think reload at 2000 for a couple of days and maybe stay on the 2000 and not the 1750. Previously loaded on 2000mg Lysodren. She weighs around 69 lbs right now.

I just talked to the vet after attacking the person on the phone asking why why why - of course her response was the vet is very busy--of course I can sit around waiting on pins and needle for the phone call that doesn't come because my time doesn't mean anything:mad::mad::mad:!!! I responded with I work also and my time is just as important. I asked the vet if she got any of my messages--she said only the one from last night before 6, but then did I get a phone call this morning --- NO!! I had to do the calling again. She apologized and said she needed to go over how to leave messages with her staff:rolleyes::rolleyes:--do you think this might be an important part of running a business???

I had asked her on our appt over a week ago about Maddie's hind leg where she has a large bump (right lower leg), they were to take an x-ray--when I picked her up it was 3 x-rays for a skinny part of her leg:confused::confused:--of course the vet wasn't there to ask why it took 3. Well, I asked her today why and she said there were only 2 taken so I get a credit--how stupid--how many others has this happened too. I had to explain to her about Maddie's numbers and where they should be and that it should be a load not upping her dose--should I charge her for the consult???? Oh, the bump is a built up of calcium on her bone--the vet was a little confused why this would happen, but when I said do you think the cushings might have caused this she quickly agreed--I should be a vet for cushings disease....

Oh, I asked the front desk for a copy of the x-rays and was told it would be $10 for a CD of them---hello---I paid almost $200 for the things.

I guess it is going to be a new search for a more qualified vet who really knows what they are doing. Bite the bullet and pay a little more, but I spend more on her than I do for doctor's visits--let's see I don't really go so that isn't hard to do.

I am sooooooo frustrated and told the vet that--do not like waiting when I have an appointment because I work also and do not have all day to spend on this---crazy world we live in---too much of a ME world and no one else matters.:(:(

If I could do the test I would, but darn can't. Not sure how I will know this time she is loaded since eating is great, but it is the panting that has gotten heavy and maybe a little more of drinking the water. It is hot here right now and with all her fur that could be some of it; so confused again on this stupid disease.

So, what do you guys think about load 2 or 3 days and then go on maintenance or do I have to subject myself to being frustrated with the vet's office again or move on to a new one vet for another ACTH test????

Thanks!!!

[lulusmom]

Hi Marie,

Thank goodness you know your stuff; otherwise, you would have accepted that a post stim of 8.4 is normal. :eek: I would agree that it's time to find another vet. As I recall, you are in Orange County, right? If so, I can recommend my two cushdog's IMS, Dr. Michael Moore, at VCA All Care Referral Hospital in Fountain Valley. If you can't get in to see him, Dr. Alyssa Mourning is wonderful too. You don't need a referral, they are open 24/7 and they take Saturday and Sunday appointments. I rather look forward to Saturday or Sunday morning stim tests. I leave my cushbabies in good hands to be spoiled rotten by the staff and then I go have a nice leisurely breakfast with a newspaper. If you do make an appointment there or anywhere else, I'd take all of Maddie's records and most importantly, the last stim test and tell them that you don't want to do another stim test but rather receive instructions on how to get the cortisol down, whether it be a mini load or increased maintenance.

Glynda

[marie adams]

Hi Glynda,

Thanks, it looks like that is what I am going to have to do. I do appreciate you getting back to me.

[littleone1]

Hi Maddie,

I can't help with the Lysodren loading, but I really do believe that you need to find a vet or IMS that knows Cushings. I hope you'll be able to find a good one, that not only knows what he or she is doing, but also has open lines of communication and responds quickly.

[addy]

Hi Marie,

Sorry to hear about your bad experience with the vet. As Glynda said, thank goodness you know Cushings:D

Scary isn't it how screwed up the vets can be? Just proves even more why we have to be advocates for our pups.

Can't help you with the load but I hope your plan works for our Maddie girl. The higher stim helps explain why you though she was panting more and off a while ago.

Crossing my fingers all goes well but I am sure you will be just fine.:)

Hugs,
Addy

[marie adams]

Thank you Terri and Addy,

So sad we have to go thru this. Why isn't there an easy solution to this silly disease and keep it under control without the up and down numbers!!!:(

Thanks for the encouragment!!! At least it is not life or death at this point.

I had to hose down her paws and belly to help her cool off this evening. Well we know where summer went--it arrived in November--haha!!!:)

[addy]

Hi Marie,

I wanted to stop by to see if you loaded Maddie again and how that was going. I wasn't sure if you were going to find a new vet first.

Hope everything is okay and our fuzzy wuzzy girl is hanging in there.

Zoe is still having her colitis flare. I had to stop the lignans for now. Freaks me out because if she can't tolerate ligans, how are we doing lysodren:eek:

Hope things have cooled off in your neck of the woods. We might see snow in a few days:mad:

Hugs,
Addy

[marie adams]

Hi Addy,

It has cooled off--it was a beautiful Sunday though. I love it when you can see Catalina Island and the Mountains when we are out for our walks in the morning. It is a little toooo bright in the morning at 6am, but oh darn I will just have to deal with it!!!:D:D

I just made an appt with the vets Glynda goes to for this coming Saturday. I will probably have to do a regular load so good thing I am use to it, but still scary when it is as obvious if they are loaded and costly with the testing. :( We will see.

I know it will be beautiful when the snow comes, but a lot of work to get around--haha!!!

Take care of Zoe and yourself!!!:):)

[addy]

Hi Marie,

Taking a break for abit. I just wanted to say Happy Holidays and hope our Maddie girl does well on her new dose.

Talk to you soon.

Love,
Addy

[marie adams]

Thanks Addy, Happy Holidays to you Also. It looks like you are back--I read your thread....

Maddie is at the vet's getting a stem test to see where her numbers are, I don't think upping the dose worked--I had a feeling it wouldn't. So I will be loading again.

The sadder part of the visit is Maddie's left hind leg seems like it grew a massive amount of muscle in a week's time--the vet says it is possible it isn't muscle, but a tumor because she remembers not much being there because of the muscle wasting from the cushings. She is going to have her surgeons take a look at it after Maddie's stem test is done. Maddie has been having a lot of problems the last few days trying to get up---sooooo sad----what a way to spend your birthday--her 12th--on Tuesday having your bottom skooting (sp.) around on the tile while you are trying to stand up :(:( It could be it has nothing to do with cushing's--so now what will our decisions be when we find out what is going on--she is sooo tough doesn't seem in pain, but I know she is humiliated by this limitation, but still makes attempts at going upstairs---so scary for us because it is a straight shot up no landing.

I kind of lost it when I got back in my car and have been the last few days.:(


I do want to wish you all a very Merry Christmas/ Holidays & a Happy New Year!!! :):)

[Squirt's Mom]

Hi Marie,

I am so sorry you and Maddie have been having a tough time lately. :( It is heart-breaking to see our babies struggling with anything. I hope the leg turns out to be no big deal and Maddie is feeling much stronger soon. Let us know what you learn today from the vet.

Hugs,
Leslie and the girls - always

[marie adams]

Thanks Leslie,

I hope all is well with Squirt and yourself.

I am still waiting for the vet to call me to say Maddie is ready to be picked up and to learn what they think is the matter with her leg--I am hoping it isn't anything too serious. My mind is going all over the place and do not want to put her through a whole lot.

Happy Holidays to you and yours!!!

[Squirt's Mom]

I know the feeling, sweetie. Waiting with you, hoping for the best of news!

[marie adams]

Well, I finally got Maddie home after 4 hours when it should have been 2 at the most (didn't wait at the office, but still I waited for the phone call to come pick her up--I ended up calling after 3 hours to be told there was a miscommunication with the surgeons to look at her leg)--what an experience trying to get her out of the car when she won't stand up--lifting 69 lbs is a lot especially when it wiggles--haha!

Whoa did this stem test cost an arm and leg--quite a bit more than the last vet....then they did a draw to see what might be the wrong with her leg. Of course, I asked what they thought and was told we will know more when we get the test back tmo for both tests. I sure hope they call me like they said tmo. I stress out too much with going and expect my time should be respected, but oh well....think positive, think positive....too much stress all around and it is hard...