Toby, 9 y/o Yorkie - From Trilostane to Lysodren

[Tobias]

Hi to all my cushing's friends--long time no post!. Toby is still in the one month respite from treatment period...we would be due to start the Lyso at beginning of February. Just wanted to take advantage a little time space on the weekend to discuss my plan for comment if anyone has anything to say about it.

For water measurement: I bought a small animal automatic waterer. It turns upside down and automatically waters. Hubby measured amount to go in bottle total, amount to fill bowel and base, and marked intervals from top to bottom with total of 12 cups. I can count the lines either up or down to see. I have a notebook I have been writing it in... Toby's special notebook. I log water intake at 9 a.m. and 9 p.m....when I will be giving the lyso. Overnight 9 p.m. to 9 a.m. Toby averages anywhere from 1 to 2 cups! This concerns me. His water intake is quite variable. I plan to check water intake bf a.m. dose, and I hope I can interpret this correctly. I can see the difference on the bottle, but it varies.

For appetite monitoring: Toby is eating two cups of food per day..A.m. meal is given in two parts for bloating prevention...1/2 cup 9 a.m. and 1/2 cup between 10 and 10:30 before I go to work.

I have made a log of his appetite behaviors, pawing at me, hanging around the food preparation area, etc. There were actually about 7 behaviors. I will interpret a change in these behaviors as a clue.

I can't use the calling his name when he eats because no matter how hungry he is he always stops if I talk to him...but not for long ha ha ha...

I have decided to use reluctance to eat, etc as a parameter.

My biggest concern is over-vigilance and stopping too soon... I will be posting quite a bit, I'm sure.

One thing I am confused about...If Toby keeps eating and drinking...how will I know loading is completed? We could go straight to the diarrhea which as it says in the VIM text book sheet is a worrisome sign....maybe meaning we have gone to far.

Also...if Toby so much as throws up or acts lethargic when I initiate this, I will not have the heart to continue...I feel so bad about giving him Vetoryl that was actually making him sick, espeically for the last 3 months...I kept thinking the vomiting, loose stools etc were bc of the Cushing's progression, when in fact it was the Vetoryl. No one who saw Toby keyed in on this. Not his home vet, not the specialist, not me. Since stopping Toby has had no further vomiting, no loose stool...it looks normal pretty much all the time now. We have had no accidents in the house (poop wise) which was happening almost daily when he was on the Vetoryl. Toby had a really miserable life for 3 months because I did not recognize this. So I never want to do that do him again. This has become quite a sticky wicket for me to sort through as far as treating him with such a potent drug, where the damage could well be permanent if I screw up again.

I will give med after 1/2 cup 9.a.m. feeding in the morning. If he hesitates, I will not give the meds.

At night I will give the med after the 9. p.m. feeding when I get home. Gary will give first feeding at 6 p.m. and he will tell me when I get home how Toby's appetite was.

Toby is doing well on the milk thistle. Also I started something called Acetylator by Vetri Science for digestion...it is helping him quite a bit with the smelly farts...we only get maybe 1 a day now whereas before there were up to 5 or 6....boy that little guy can clear a room...and look so innocent the whole time!

Also I give him Plaque off for his teeth...it is seaweed only...it does a really good job of keeping the plaque off.

This is where I am right now. Toby is gaining weight off the vetoryl..another reason I feel so guilty about giving it to him for so long...the more we increased the dose, the more weight he lost.

I am very concerned about starting this when my work schedule is so heavy...I really want to be home mornings to observe him. Yet they have me on an earlier schedule to cover now...I should find out Monday how much longer I have to do this...then I will fine tune a starting date.

Blessings to all from Linda and Toby! :)

[Squirt's Mom]

Hi Linda,

Man! You have it all laid out! That is great! :D I just jump in with both feet and ride the waves but you are so organized!

The water measuring method your hubby set up is amazing but too complicated for my simple mind. :p I had a hard enough time keeping up with the amount of water I provided each day via measuring cups....the lines on the bottle would do me in, I fear. :D

With the way you and your hubby work, I think Toby will fine during the load. If, IF, he does experience an adverse reaction he won't be alone for long plus I think you will see a problem pretty quickly should it start, as closely as you both watch him. If that should happen, you will have time to give him the prednisone. If possible, you might want to start the load when one of you will be home with him for the first day or two just for your own peace of mind. ;)

Toby is a lucky guy to have such a great mom and dad on his side. Please do post often during this phase...even if all you need to do is SCREAM. :p

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

[Tobias]

Hi Leslie: Thank you for your input! I really think I could use a bit more of the "jump right in and ride the waves" personality myself, actually..( I have great admiration for this approach, actually) .but I am just not wired that way lol...anyway, last night I had a few minutes to further research lysodren and I have some major concerns and now, a couple of big questions. Could someone please review and correct my thinking where necessary.

When giving lysodren, appetite loss means the end of induction and that an addisonian reaction of some degree is likely occurring . 1/3 of patients go to low during loading and 1% have fatal complications. (Of course I have no doubt my dog will be in the 1% range)

The whole purpose of the lysodren treatment is selective destruction of the cortex. If we are selectively destroying the cortex, why doesn't it make sense to give a scaled back dose of the loading dose and gradually do stim tests until the the science tells you that the selective destruction has occurred rather than depending on the investigative skills of the owner and her non-observant spouse, who will be in charge of the patient a good part of the day. Doesn't this make more sense than intentionally giving the dog enough of a dose to bring him to this near addisonian state?

The key to bringing the dog out of the Addisonian reaction (should it happen, God forbid) is prednisone. How do I give oral prednisone at home when the dog is refusing food, lethargic, staggering around the kitchen, etc.

I am terrified of lysodren, the more I read! I know anipryl is only for tumors located in certain parts of the brain....do people ever have imaging studies done to see exactly where the tumor is and then give Anipryl?

I was hopping around to quite a few lysodren sites last night....Toby is doing so well right now. Everything balanced (except for the spiraling cortisone levels and excessive drinking and peeing of course) no gucky eye discharges, no accidents in the house, no smelly farts....still the bloating, though. I know he needs treatment but I really wish I did not have to take this step, which although possibly positive (and I do feel encouraged by the success stories i have been given by you lovely people, for sure) could take him down forever in a heartbeat. Honestly I might have to sedate myself; I do worry about having a stroke or a heart attack out of fear I am killing him. (Good Lord that sounds unbalanced).

Blessings to all from the crazy lady in New York and her tiny, zippy dog. Linda and Toby

[StarDeb55]

Linda, my replies are in blue:



The whole purpose of the lysodren treatment is selective destruction of the cortex. If we are selectively destroying the cortex, why doesn't it make sense to give a scaled back dose of the loading dose and gradually do stim tests until the the science tells you that the selective destruction has occurred rather than depending on the investigative skills of the owner and her non-observant spouse, who will be in charge of the patient a good part of the day. Doesn't this make more sense than intentionally giving the dog enough of a dose to bring him to this near addisonian state?

I would tend to agree with your thinking to a certain degree, but when standard loading protocols are closely followed the chance of an overload is pretty small. It's when the standard protocol aren't followed that we see pups get in trouble. This happens when vets aren't experienced in treating Cushings, using lysodren, or both. There is also a cost issue here, too. When we have ACTH costs running as high as $400, a large number of people probably couldn't afford the type of monitoring you are suggesting. I have been through this twice, now, & it's very nerve wracking, but you can do this.



The key to bringing the dog out of the Addisonian reaction (should it happen, God forbid) is prednisone. How do I give oral prednisone at home when the dog is refusing food, lethargic, staggering around the kitchen, etc.
I have had to do this once with Barkley. I notice one night that he was extremely quiet, did not want to get up, drink, or anything else. As much as I hated to do it, I literally had to push that pred tablet down his throat. While he was not happy with me, we both got through it. We never knew if this was a true Addisonian crisis, as he had a stim done a few days prior to this, which was fine. He had a stim done a few days after this, & that was fine. The vet really couldn't offer an explanation, but agreed that giving the pred was probably the best thing to do. I, also have to add, that you do not bring the pup to a near Addisonian state, if everything is being done "by the book". You are bringing the cortisol level down to a more healthy level which is totally different than the cortisol level for a healthy pup.


I am terrified of lysodren, the more I read! I know anipryl is only for tumors located in certain parts of the brain....do people ever have imaging studies done to see exactly where the tumor is and then give Anipryl?
These type of imaging studies can be done, either a CT scan of the head or an MRI. They are normally done when radiation therapy is being considered for a macroadenoma. Keep in mind, that these type of imaging studies must be done under full sedation, as the pup must be absolutely still. There is only a 15% chance that the microadenoma will be in the correct location where anipryl will work. IMO, those are pretty small odds, & I would rather use a drug that is known to work, no matter the location of the lesion.

To conclude, if you have noticed no change by day 8 or so, this is when you do a stim to see where you are, which will help avoid any problems. I think your nerves are stretched pretty tight over this, so you might consider bumping this stim up to about day 5 or so, if you have seen no changes. I would, also, stress to the hubby how important it is for him to help you watch Toby, as this medicine is very strong, & if Toby gets too much, he could become quite ill. As closely as you watch Toby, I know you would have him to an emergency clinic at the first sign of trouble, if you couldn't get him into see his regular vet.

Debbie

[Harley PoMMom]

When I was loading Harley, I had prednisone and dexamethasone shots on hand. Dexamethasone will not interfere with an ACTH test, I had Harley's vet give me the dexamethasone shots that were appropiate for his weight.

[addy]

Hi Linda,

I have been following along and you seem so organized it will all be fine but I understand your concern.

When I asked my IMS about maintenance dose rather than loading for my Zoe she told me it was her experience that if the dog has "high" cortisol (Zoe does) that the maintenance dose does not bring the cortisol down low enough. She did go on to say we can't just go by numbers and have to take into consideration that some dogs may feel better with a little higher cortisol levels.

I too am worried about loading Zoe because she has colitis and has been on metronidazole for 3 months. I just thought I would share how my IMS explained it to me. SHe said she has done other things when people don't want to load, pulsing back and forth between higher and lower doses. Honestly, I think that scared me more!!!!!!

Hang in there,

Hugs,
Addy

[frijole]

Linda - You have been thru a lot and so has Toby. I have been in your shoes and I know it is nerve wracking but I gotta tell you - deep breaths and quit worrying so much! You are the type that will watch Toby like a hawk and you will be just fine!!!!!! Plus we are here! :D

First off - what are Toby's primary symptoms? Eating without breathing? Drinking tons of water? My Haley didn't drink excess water so measuring intake didn't make any sense - I had to watch her eating. You monitor what needs to change.

If you are worried about missing a sign - do poop patrol - I did. You watch the poop for firmness and in my dog's case it got gradually looser/softer and that is how I knew it was time. And I was right.
I poked it with a stick. Every single poop. Day and night. Yep flashlight in the snow.

If your dog needed the prednisone you would shove it done the throat and make sure it is swallowed. Trust me you wouldn't put it in a pill pocket and say "please eat this". ;) You don't give prednisone unless your dog is seriously ill and at that point you would know and not hesitate. It is an absolute must to have on hand but probably 1% of owners have had to give it so you must not take on this as a big issue. You got it and just know how much to give should you need to.

On to the lysodren... it saved my Haley's life. It gave her 4 1/2 more years. I was scared to death of it. I came home at lunch to look at her. And she was just fine and sleeping. The only thing I noticed was at first she slept more and her tummy growled.. oh yes and the worst farts. That is it.

So long as you follow the rules and I just know you will then you will be fine. I am a believer that dogs pick up on our every signal and mood is one of them. If you act scared and nervous then it will affect dear Toby. So just change your mindset from "will this drug kill my dog" to "I am going to save your life Toby" and please know in your heart that you will.

Deb, myself and so many others are here to help and we would not steer you wrong. So please do not lose sleep. You have our words on it. Kim

[Tobias]

Hi all and my heart is full of gratitude for all of your precious words, in each precious post. I will start with Debbie: I did just have a major talk with hubby, I told him we could kill Toby if we didn't watch him closely. I think he understood...no, I'm sure he did. But he may be off on a job. I may take some days off...I gotta play it by ear at work. I do like the idea of the 5 day stim test and I'm sure the vet will agree. If he wants to do more of the maintenance than a true loading and then test, I don't know how I will deal with that . Honestly I think he is mulling it over and isn't sure yet himself what he is going to do..I do think he's thinking of my welfare as well as the dog's...Now Addy's post...the maintenance dose may not bring it down..but is there a chance that it would? Would it be worth taking that chance? Could we just increase the dose like we do with Vetoryl? I do plan to pay attn to symptom resolution, and once we have that, I don't think I am going to push for a lower number. And now dear Kim...for poop patrol I bought a really good lamp. But the problem I'm finding is that the snow covers over the poop quickly, sometimes I can't find it even if I watch from the window to see if he is pooping, and then go out. Going out every single time is really not safe, there are drifts and it is very, very cold. It is also very dark for at least the night time "event", and even with the light there is a chance I will slip in either the snow or the ice... I have to get down off the back porch, go down the steps, etc.. This is really a tough time of year to poop hunt! The other problem is that once the poops hit the snow the consistency changes. A lot of times it looks fine coming out of his butt but then when I go to pick it up it looks more smooshy and I am not really sure. Also his poops just seem to vary no matter how consistent I am with the diet...poops are going to be less reliable because of the weather conditions right now. I might try to wait another month or so...but I definitely want him loaded or at least stable by the time our tortoise comes out of hibernation (March) because Rocko is at his most vulnerable time then and requires quite a bit of monitoring, bathing etc...I may shoot for mid february and take toby up beginning of february for the appointment to discuss the emergency coverage, loading plan, bloodwork, etc...Blessings to all from Linda and toby...it's late and those bird cages gotta get cleaned! You are all such sweet people. I just can't get over it.

[frijole]

FYI my girl took a long time to load and I was out in the snow in a robe with a flashlight.. you are right - you can't wait cuz it freezes. But you do what you gotta do. :p

Thought of something I forgot to mention... once you start the load process stick to normal food and don't switch up. No new types of treats, people food etc. The reason is that you want consistent poops and to avoid upset stomachs. I gave my Haley some popcorn and she vomited it up... I didn't know if it was that she was loaded or just vomited popcorn. :rolleyes: So don't do what I did. Lesson learned.

Regarding starting with a maintenance dose... I've never seen that work. Mostly I've seen people come here because they did that and wanted advice on why lysodren didn't work. Wasn't the drug - it was the vet not following protocol. Protocols are written for a reason - they work. :)

I'm sure you will figure it all out. But like I said.. just keep a big smile on your face and don't fret too much cuz Toby will figure it out. We need him smiling too. xoxo Kim

[Tobias]

Hi to all from Linda and Toby--I hope you have enjoyed your hiatus from my pesky questions:D. This coming Friday is my vet appointment for my Toby to do pre lyso bloodwork, set up pre lyso stim test, ask vet my final questions, talk about the emergency plan, discuss the loading phase issues I have identified as being possibly problematic, give him the input collected from my brainy advisors (i.e. this irreplaceable forum), etc. I did think of one more question for clarification prior to the decision about how to load, end result (value) desired, and here it is: Toby's last stim on Vetory done only a few weeks prior to his development of watery (i.e., true diarrhea--not just loose stool) was 4.__--I can't remember exactly. But it was very low. The lower it got, the worse Toby got. The more vomiting he had. The more watery the stools got in those last few days. The lethargy and staying in his crate was quite pronounced the day I stopped it until able to talk to vet. The farts were awful. So the fine point of the loading with lyso, and my questions, is this: Does that mean getting Toby below 5 could be dangerous on the lyso, because at least with the vetoryl he was able to recover by the next morning. But if that were lyso I were giving him and he developed this awful picture I have just described, the damage could be irreversible. Actually the lower Toby's level went the sicker he got. How do I know if it was Vetoryl or actually the low cortisol that was making my boy so ill? Based on how he looked at 4.--I do not want him to go that low again. Another troubling thing I read in my studying is that sometimes as the cortisol levels fall due to the drug therapy the signs of the pituitary tumor are unmasked and the neurological symptoms of the tumor which if he were human could indeed present as the nausea and vomiting I was seeing. Another big problem... I will not be able to use stools as a cue to stop loading....they just vary no matter how consistent I am with his entire routine/feeding....believe me, I am totally consistent. Even when his level was 4.__ and he subsequently crashed he was eating and drinking as usual. So really, I don't know for sure if I can depend on the eating and drinking. That leaves me with only one option--early testing...I know someone posted I could try for 5 days...that is definitely what I will do. I was thinking of asking for 3 or 4 days (while keeping him on the lyso) just to be sure. It is critical that the stim test be interpreted and returned with great speed because I will still be giving him the med and I cannot take the last dose back, as was pointed out in a past post. So my question is--Does the fact that Toby crashed bad requiring stopping of Vetoryl just after receiving a low stim of 4.__ mean that I should not take his cortisol levels that low again... Second question is as long as there is no stopping of med, can't I just do the stim test earlier--it will only run about 70.00 for just the stim test, which I can afford....all the other bloodwork will have been done this week, prior to starting (enabling me to spread it out a bit) Honestly Toby has has such a good 5 weeks I dread starting all this again (Yet I know he requires treatment and I will proceed given that understanding) Blessings and gratitude to all. Linda and Toby

[addy]

Hi Linda,

You have a lot of good questions and they will all be along soon to help you sort it out. I only know I just discussed this with my IMS and she said if I go ahead and load Zoe she might only do a 3 or 5 day load. I don't know if that is good or bad but she is considering it if I go that route. Zoe is a bit of a mystery and her case is not clear cut. :rolleyes:

Hang in there, you have worked so hard to get your details all worked out. I can only imagine how stressed you are but you are really doing a good job.

Hugs,
Addy

[StarDeb55]

Linda, the normal ranges vary slightly between vetoryl & lysodren. Ideally, the range you are shooting for is 1-5 for both drugs, but with vetoryl, the range can be somewhat higher, if clinical symptoms have resolved. With lysodren, a post value of 4 is ideal. I would worry about a crash if the post were in the low 1's or <1. In fact, at a post of <1, this would be considered Addisonian.


It is critical that the stim test be interpreted and returned with great speed because I will still be giving him the med and I cannot take the last dose back

This is not correct. Once you go in for the initial stim during a load, you MUST stop the lysodren until the results are back. It's when lysodren is continued at this point that the risk of an overload increases. When a vet gives instructions for a lysodren loading, standard protocol dictates that the lysodren is stopped when going in for the first stim test. When you get results back, & you are not within range, you simply continue loading.

I hope this clears up some of the confusion for you.

[Squirt's Mom]

Hi Linda,

Bless your heart! Me thinks your twitcher is stuck! :p

I will answer the best I can -


Hi to all from Linda and Toby--

I hope you have enjoyed your hiatus from my pesky questions.

This coming Friday is my vet appointment for my Toby to do pre lyso bloodwork, set up pre lyso stim test, ask vet my final questions, talk about the emergency plan, discuss the loading phase issues I have identified as being possibly problematic, give him the input collected from my brainy advisors (i.e. this irreplaceable forum), etc.

I did think of one more question for clarification prior to the decision about how to load, end result (value) desired, and here it is:
Toby's last stim on Vetory done only a few weeks prior to his development of watery (i.e., true diarrhea--not just loose stool) was 4.__--I can't remember exactly. But it was very low.

4._ would be a great post stim number for a Trilo pup. In looking back over your thread, it appears that his Trilo dose was increased several times yet his food seeking and other signs did not abate.

The lower it got, the worse Toby got. The more vomiting he had. The more watery the stools got in those last few days. The lethargy and staying in his crate was quite pronounced the day I stopped it until able to talk to vet.

I am not clear whether it was the cortisol going too low or the result of him eating some strange things like bird poop? With the stim results I saw, his numbers were not too low...but I could have missed something for sure! :o

The farts were awful.

So the fine point of the loading with lyso, and my questions, is this:
Does that mean getting Toby below 5 could be dangerous on the lyso, because at least with the vetoryl he was able to recover by the next morning.

The ideal post value for Lyso is between 1-5 ug/dl. With Trilo, the post number can be as high as 9.1 ug/dl. When the post stim reaches 1.0, you are getting too low; below 1.0 ug/dl can precipitate an Addisonian event, but not necessarily a crisis on either drug. If the cortisol goes too low on either med, you will see the same signs. Trilo does have a much shorter life in the body thay Lyso - that is why pred is so important as is knowing what to look for as signs they are loaded. With pred, IF he were to go too low on the Lyso, it will perk him right back up within an hour.

But if that were lyso I were giving him and he developed this awful picture I have just described, the damage could be irreversible.

Going too low on Trilo can be permenant as well. ;)

Actually the lower Toby's level went the sicker he got. How do I know if it was Vetoryl or actually the low cortisol that was making my boy so ill?

Again, based on the post stims I found, Toby's cortisol did not get too low but rather it seems the Trilo just did not work for him as his signs continued and worsened in spite of increasing dosages.

Based on how he looked at 4.--I do not want him to go that low again.

Another troubling thing I read in my studying is that sometimes as the cortisol levels fall due to the drug therapy the signs of the pituitary tumor are unmasked and the neurological symptoms of the tumor which if he were human could indeed present as the nausea and vomiting I was seeing.

Yes, it does happen rarely that by reducing the cortisol levels the pituitary tumor starts to grow. This is because the cortisol has been "treating" the tumor and helping to keep it small. But this is RARE. The signs you would see if a macro did occur are distinctly different from cortisol being too low...even tho vomiting and nausea can be present. You would see things like incessant circling, head pressing, staring into space.

Another big problem... I will not be able to use stools as a cue to stop loading....they just vary no matter how consistent I am with his entire routine/feeding....believe me, I am totally consistent. Even when his level was 4.__ and he subsequently crashed he was eating and drinking as usual. So really, I don't know for sure if I can depend on the eating and drinking.

You have a great system set up for measuring the water. Just know ahead of starting the load what amount Toby normally drinks. Usually, you will see a marked difference in the amount drank, the number of trips to drink, and/or the length of time spent at the bowl to drink.

The signs for eating can be a subtle as looking up from the bowl, pausing for a second while eating, taking longer to eat, not beg for extra feed or treats, or try to take your food, or show any interest in the trash - any of these things that would be a change for Toby could indicate he is loaded.

That leaves me with only one option--early testing...I know someone posted I could try for 5 days...that is definitely what I will do. I was thinking of asking for 3 or 4 days (while keeping him on the lyso) just to be sure. It is critical that the stim test be interpreted and returned with great speed because I will still be giving him the med and I cannot take the last dose back, as was pointed out in a past post.

If you think there is the slightest possibility that Toby may be loaded when/if you do test early, STOP giving him the Lyso until you get the results back. If he is not loaded, you simply start where you left off and continue the load. If he IS loaded, and you continue to give the Lyso while waiting on the test to come back, he could go too low again.

So my question is--Does the fact that Toby crashed bad requiring stopping of Vetoryl just after receiving a low stim of 4.__ mean that I should not take his cortisol levels that low again...

Again, this value is not too low. But, no, you do not want to take his cortisol too low on either drug.

Second question is as long as there is no stopping of med, can't I just do the stim test earlier--it will only run about 70.00 for just the stim test, which I can afford....

Lyso should be stopped the moment you suspect Toby is loaded. He should not continue the med until the stim result is back.

Lyso should also be stopped if Toby were to become ill from any other reason and resumed once he was over it. You never give Trilo or Lyso to a sick pup.

So, "no stopping of the med" is a misunderstanding somewhere. :confused:

...all the other bloodwork will have been done this week, prior to starting (enabling me to spread it out a bit).

Honestly Toby has has such a good 5 weeks I dread starting all this again

Is Toby showing any signs now?
(Yet I know he requires treatment and I will proceed given that understanding) Blessings and gratitude to all.

Linda and Toby

Hang in there! You are doing a great job!
Hugs,
Leslie and the girls

[Tobias]

Hi and many thanks! Okay, as far as the protocol saying stop the lysodren when the stim test is done...I do remember that from before...but that was when the stim test would be done at 8 days, I thought. Honestly I can't wait 8 days...I want to do the test sooner because of the unreliability of reading toby's signs...which is exactly how the Vetoryl dose ended up making him ill...I was observing him all the time--but the signs just weren't there. That was a valuable learning experience on a "safer" drug. Now I know that Toby MAY not give me these signs. So allowing for that possibility I have to cover it by testing sooner rather than later....I really don't know what the vet will say but I'm pretty sure he will agree. I thought that with doing the test earlier I would keep giving the drug. But Okay...I get that part, and I majorly thank you for pointing it out--it is extremely important to know this--we will just resume loading if necessary. I understand that...I am comfortable with this just so I can test earlier as a security blanket. But I still don't get taking him to 4 on Lyso when taking him to 4 on Vetoryl was majorly detrimental to him and obviously undesirable. I don't want to repeat that experience!:eek: Dear helpers, Is there something I don't understand about cortisol level of 4 making him sick on the Vetoryl but the same level not resulting in illness with lyso...is there some different mechanism of action in the lyso that would make the level of 4 somehow less critical than it was with Vetoryl? In spite of my "thickness" I am so willing to learn and so thankful for the instruction... Linda and Toby

[Tobias]

Please forgive me--I missed Leslie's beautifully detailed answers to my questions. I don't know--maybe the posts somehow crossed. I need to go over that post several times--Leslie, you and the others are so smart. What collective brain power. I won't post anymore till I reread your post several times, making sure I understand it. I thank each and every beautiful soul for their hearts and minds applied to my situation. Blessings and many hugs Linda and Toby PS He seems to feel really good right now...drinking has been holding amazingly steady at 7 cups per day as a rule including other 2 dogs. No accidents in the house. No farting. Still some bloating after meals but no nausea and no vomiting. Poops range from soft to absolutely normal. He is stable, status post failed Vetoryl therapy.. are you guys okay with a 3-4 day stim test...God I hope so. Blessings Linda

[Tobias]

Hello dear friends: Just a quick update on Toby--we are really jam packed today. Toby did see the vet yesterday. We have to delay starting the lyso (I am 100% ready now, having been told by my dear vet friend that Toby has actually lost 2 ounces off Vetoryl and is "eating his own body" at this point (good Lord that freaked me out). The lyso needs to start, and it is being ordered, but Toby has pancreatitis. He is not vomiting and stools are really not bad, but lipase was elevated and a further test (lipase snap test) was done to confirm the pancreatitis is in this instance not directly caused by the cushings. He is being treated as his white counts were elevated. He has 10 days on the antibiotic (Clavamox) and then we will load according to a protocol from Cornell given to my vet by a Board Certified Diplomate at Cornell (they went to school together) My vet gave me the paper to read published by the Diplomate, and loading dose is specified to be 30-50 mg/kg...my vet is going for the low end, with which I am in total agreement as Toby really has become quite frail looking. We will test on day 4 and stop med at that point. Toby's energy remains good, appetite excellent, desire to play strong (I have to limit him as he looks so frail now and I am so worried about his legs holding up till the lyso kicks in). I really wish we could have started the lyso sooner (I have arranged for time off at work) but I of course don't want to give two new meds at the same time. He has had one dose of the Clavamox and seems to be handling it well. Toby's bloating has become quite severe...I do think it may be partially related to the pancreatitis, which is almost subclinical in presentation otherwise. This is where we are....I gotta do a bird cage! I send greetings and blessings to all. Linda and Toby

[frijole]

Linda, Absolutely this was the right decision. Never give lysodren to a dog that is sick. Even after the loading stage. Make sure he's fine before commencing. Thanks for the update. Kim

[maish costello]

Excellent tips !!!!! I am learning something new every day from you awesome people !!!!

[lulusmom]

We have to delay starting the lyso (I am 100% ready now, having been told by my dear vet friend that Toby has actually lost 2 ounces off Vetoryl and is "eating his own body" at this point (good Lord that freaked me out).

Hi Linda,

I've done a lot of research over the years and I have never heard of a dog with cushing's eating his own body. This sounds very scarey to me and I think it would be great if you could get your vet to explain in more detail exactly what he meant. For instance, was he referring the catabolic effect of cortisol on the body, which usually doesn't cause weight loss but rather loss of muscle mass or did he mean that Vetoryl had some unknown effect on Toby that caused a problem with his metabolism or absorption of food?

In any event, two ounces for a dog weighing 7.6 lbs from one office visit to the next is not unusual at all. My Lulu weighs less than 5 lbs and she's treated with both trilostane and lysodren and through both, her weight could fluctuate more than two ounces on any given visit. Her specialist never attributed that to the disease or the treatment. When I went back and recreated a schedule of dosing and stims, I was really surprised that in 10 months of treatment, your vet was unable to get Toby's cortisol within an acceptable therapeutic range. For this reason, it is quite possible that Toby may look thinner because of the continued muscle wasting due to uncontrolled progression of the disease.

I haven't posted in a while but have kept up with everything. As I mentioned, I recreated the dosing and related stim tests and I was wondering if you could fill in some blanks. You started the twice daily Vetoryl dosing sometime after 12/16 and then you mentioned a post stim of 4. Was that the last stim test that was done after Toby got sick and if so how long was it after Toby's last dose of Vetoryl? I'm asking because I can't see where your vet determined that Toby's vomiting episode was actually due to cortisol being too low or if it was something he ate out in the yard. As I recall, you mentioned that your Shih Tzu puppy was sick at the same time. Does Karl believe that it was the Vetoryl that made Toby sick and if so, do you know why?

I am very glad to hear that you will not be starting Lysodren until Toby is well. Well means no stomach issues and a strong appetite. Given that it is the symptoms that will guide you in determining if Toby is loaded, I strongly recommend that you do not start loading him until overt symptoms return.

Glynda

[Tobias]

Hi Glynda: I just somehow deleted my entire post in response to your questions and I was just about to submit it. So this post will be more brief.. ("There is a God" I hear you say). The vet just meant the muscle wasting, I think--He was using it in a poetic sense...this is how I took it. Toby got sick about 2 days after his stim of 4.___because he developed pica for a while, and/or the cortisol was too low, and/or the Vetoryl just became to much for him. I must "take credit" lol for the belief that the cortisol was too low...my vet is just going to watch with the lyso what happens as we get to the target range, or toward the target range . We are really not sure what made him ill; it is all intertwined, a sticky wicket to sort, it seems. My vet seemed to think if anything, I think, that his appetite for a while was causing him, on the Vetoryl, to eat strange items. Thankfully this is over since being off the vetoryl...we will see. Thankfully the pancreatitis has not affected Toby's appetite or drinking...so once the antibiotic is finished and the stim test is done, and the lipase has been rechecked we will start the lyso. Thank you so much for your time and concern, the time you took to trace toby's posts and formulate your thoughtful questions. Toby and I thank you for this from the bottom of my heart....We are all on such a journey..you, me, Toby, the shih tzu puppy (now a defiant, sturdy, glowing "toddler" with a huge heart. Thank you for helping to allay my concerns about the weight loss ..again, Karl did not really obsess about this--"mom" did. When you post you always remind me of my Lulu, my beloved diabetic Queen Lu, an American Cocker with a spirit so big the earth shook when she died. You come across like her--strong, determined and loving....many blessings to you from Linda and Toby

[Tobias]

Hi to all dear Cushings forum members/most excellent helpers! all...just an update on Toby. Toby was on Clavamox for pancreatitis. The plan was to start the lyso when lipase was normal. The lipase is still not normal...vet was doing what sounds like a screening test with color of blue indicating lipase elevated. So vet is sending a spun down (?) sample for an exact number. Pre lyso stim test is still scheduled for monday and medicine is in so that we can start. But I am kind of squeamish about subjecting Toby to the rigors of lysodren induction if his lipase is not resolved/understood. The vet has been online at the VET INFO site and has also consulted his "brain trust" from the University of Pennsylvania. I was wondering if anyone has ever heard of an elevated lipase with Cushings, or would this mean the pancreas is not functioning well enough to help Toby process the medication. I hope I gave you all the info you need...I am off with a MAJOR back strain (so bad I cannot lift toby) and time at the computer has been strictly limited! Boo hoo! Thanking anyone who might know anything about this as all of my local resources seem somewhat flummoxed. Blessings, light and hugs to all Linda and Toby

[Harley PoMMom]

Lipases are an enzyme that are created by the pancreas and they are also produced in other parts of the body as well. The only way to tell if the elevated lipase is coming from the pancreas is by running a spec cPL test.

If Toby's gut is giving him some discomfort then this lipase could be elevated along with pancreas lipase.

Hope this helps.

Love and hugs,
Lori

[lulusmom]

Hi Linda,

There are different forms of lipase, including one that is cleared by the kidneys. I can't remember what that particular lipase enzyme is called but that's the one that is usually involved in cushing's. How high is the lipase now? Did your vet ever do a SPEC cPL test to confirm a pancreatitis diagnosis? This is the most accurate test available and it will exclude almost all other causes and your vet would know fairly quickly if pancreatitis is causing the increased lipase. Without knowing, you could be waiting forever for lipase to normalize because if cushing's is the cause, you probably won't see any improvements without treating the disease.

Was your vet unable to answer this question? If so, I would highly recommend that you consider consulting with an internal medicine specialist. I think I may have recommended that in the past because it appeared that your vet was not well versed in cushing's and it appears that this is still the case. If your vet consulted with a specialist at the Univ of Penn and he still couldn't answer your question, I would then question whether he is consulting with an internal medicines specialist. They are the most experienced and knowledgable of endocrine disorders. How familiar is your vet with Lysodren and how many dogs has he treated?

Glynda

P.S. I see that Lori posted before I was able to finish my post so please excuse any duplication.

[Tobias]

Hi Lori and Glynda: Thank you. I feel from the description the vet gave me of the test and from the description I read when I googled, the test was in fact the in office SNAP cPL and he has sent out for the spec cpl to further specify. So am I correct that if the spec cpl shows as elevated (at that point I gather I would have a number, whereas now I have a color) that we should proceed with the treatment with lyso? Because we know if this test shows as elevated that it is the kind of pancreatitis caused by the cushings? Many thanks to all. Linda and Toby.

[Harley PoMMom]

Sometimes the exact reason for pancreatitis is unknown...a lot of times pancreatitis is associated with IBD. My Harley has Cushing's which as of right now is not being treated and this elevation of cortisol running through his body does not seem to have any ill effects on his pancreas...ie making his pancreatitis worse.

Colipase is cleared by the kidney, and can result in increased lipase concentrations when there is a decreased GFR.

[addy]

Hi Linda,

The number one side effect of Lysodren is gastric upset. Not meant to scare you, just throwing that out there in case Toby's tummy is still not quite right.

Hugsm
Addy

[Tobias]

HI again all, and many thanks. I am starting to feel as if even if the amylase is high on this more specific test, it would would be okay to start the lyso. Toby's pancreatitis seems to be subclinical, except for the off and on stool being loose. Given Toby's overall situation (i.e., really needing to be treated) am I correct that it would be okay to start the lyso anyway, if this is the only thing that would hold us back? I think because of the underlying pancreatitis it will be difficult to use the stools as a clue, (they vary so much anyway) But we are doing a very cautious loading with the first stim test on day 4....The vet seemed to be inclined to go ahead, but he is waiting for the results of the lipase spec cPL to come back.. I know there are no guarantees and no crystal balls, but does it seem reasonable to go ahead with lyso? Or should we have a specific number first? And will the number mean anything in terms of whether or not to proceed with the lyso (i.e., a higher number would mean not a good idea, a lower number might be more favorable for initiating treatment. Thank you to all! Linda and Toby

[lulusmom]

Hi Linda,

Please see my questions and comments below in blue.


HI again all, and many thanks. I am starting to feel as if even if the amylase is high on this more specific test, it would would be okay to start the lyso.

What are the circumstances that make you believe this is okay?

Toby's pancreatitis seems to be subclinical, except for the off and on stool being loose.

I'm not sure what you mean by this but I am thinking you mean that Toby may have pancreatitis but isn't really showing any symptoms at the moment??? Is that correct?

Given Toby's overall situation (i.e., really needing to be treated) am I correct that it would be okay to start the lyso anyway, if this is the only thing that would hold us back?

Can you tell us what Toby's overall situtation is at the moment and what about his situation makes you feel a sense of urgency to treat? What cushing's symptoms are you seeing? With reference to the pancreatitis, is the occasional loose stool the only symptom you are seeing?

I think because of the underlying pancreatitis it will be difficult to use the stools as a clue, (they vary so much anyway)

Most cushdogs have a voracious appetites and drink and pee to excess. For this reason, changes in these two symptoms are usually the tip off that a dog is loaded. You should keep an eye on the stool too, not for a gauge as to whether the dog is loaded, but rather as a clue that the dog may be overloaded and cortisol is too low.

But we are doing a very cautious loading with the first stim test on day 4....The vet seemed to be inclined to go ahead, but he is waiting for the results of the lipase spec cPL to come back..

Aside from the suspected pancreatitis, why does your vet want to do a cautious load? I think I mentioned this before but it's worth mentioning again that low loading doses can be very drawn out and very expensive because of the additional acth stim tests that are usually necessary. The mode of action is entirely different from Trilostane in that it has a cumulative effect. Once a pet owner sees any sign of loading, the lysodren should be discontinued and a stim test is done, preferrably 48 hours later. Of course, if the dog starts showing signs that cortisol has dropped too low during that time, the stim test should be down asap. To do a stim prior to 48 hours, depending on how early the test is done, the numbers will be understated. The average loading time is 5 to 8 days on a maximum loading dose. In my opinion, to do a stim test on day four of a low loading dose is a waste of money and an unecessary stress on the dog. Is your vet in agreement with doing a stim test on the 4th day? Is he familiar with Lysodren? How many cushdogs has he treated?

I know there are no guarantees and no crystal balls, but does it seem reasonable to go ahead with lyso? Or should we have a specific number first? And will the number mean anything in terms of whether or not to proceed with the lyso (i.e., a higher number would mean not a good idea, a lower number might be more favorable for initiating treatment.

If you are asking if you should start loading with lysodren while Toby is still having stomach issues and no real cushing's symptoms, then the answer is absolutely not. When you say higher and lower numbers, are you talking about the Spec cPL test or the acth stim test that you plan to do before starting lysodren?

Thank you to all! Linda and Toby

[Tobias]

Hi again; thank you for your response. I believe it is okay because he is showing no other symptoms of pancreatitis. The stools are mostly okay, from time to time they look soft...but yet it has been posted that cushing's dogs can have loose stools. If we never would have known he had the pancreatitis except incidentally, I wonder how much of an issue it is. So yes, you are correct. I do feel an urgency to treat because he is so wasted looking, never feels relief from incessant hunger and thirst, and has been off treatment for over a month. I know to watch for the drinking and eating to taper, but he showed no signs of tapering anything off when on the Vetoryl, even as he went to the post stim level of 4. My vet is not urging a cautious load. He suggested it based on a protocol suggested by a board certified diplomate and I am in agreement. This is how I want it done for my own peace of mind. I am not a big bold spirit like you! But I get what you are saying about not doing the stim test until 48 hours after the med is stopped, because it would be understated. This is a VERY valuable insight and I thank you! But I would be willing to go 5 days and then stop and then do the stim test...as was posted earlier, and if the post stim numbers were not low enough we would just start reloading. I do get your point about the stress to him--believe me, I thought about it, but Toby goes so often I don't think it even phases him anymore. The same vet handles him all the time, when I am present, and Toby seems happy to see him, does not pull back or resist being handed to him, etc....He handles toby with great calm and relaxation and toby is very relaxed with him. He has some experience with cushing's from the early days of his career, it seems. He is very open to learning and is doing his best for Toby. My one experience with the "specialist" was extremely dissappointing and stressful. We are not going down that road again; she was our last option for a "specialist" within driving range. Her feeling about Toby was reckless and without regard for him or dogs in general...Driving him to Addisons would not have upset her as it was "easier and cheaper to treat"...well,....what about "first, do no harm?" What about all the poor dogs who sacrificed their lives in clinical trials so my dog would not have to suffer? It just made me sick, to be honest. My vet is bright. He is unguarded, nondefensive, absolutely open to learning. He has years of experience and experience with my dogs. I feel as blessed to have him on board as I do this list of "overseers" who can help us along the way. Blessings to all from Linda and Toby

[Tobias]

Sometimes the exact reason for pancreatitis is unknown...a lot of times pancreatitis is associated with IBD. My Harley has Cushing's which as of right now is not being treated and this elevation of cortisol running through his body does not seem to have any ill effects on his pancreas...ie making his pancreatitis worse.

Colipase is cleared by the kidney, and can result in increased lipase concentrations when there is a decreased GFR.


Oh my God I think I have just had a Eureka moment! I was just re-reading all the posts to get everything through my thick skull and I think Toby might have IBD! It would account for his chronic loose stools that vary, his weight loss, and and the fact that his eosinophils were elevated. In fact the vet commented in regards to the recent blood work that the eosinophils were elevated (now, I am not sure how much) and that this would be associated with inflammation....I think I am on to something, thanks to this post. I am going to call my vet first thing thursday and talk to him about this. Also, after reading Glynda's post I really want to be more sure of his digestive issues before starting the lyso....thank you to everyone, thank you thank you. Can anyone tell me how their dogs are being treated for IBD? I really feel excited about this....Blessings and hugs to all, Linda and Toby

[addy]

Treating IBD depends on what is causing it and the symptoms. If you go to the Dogaware website there is much good information on IBD. I would start there.

Zoe has IBD/colitis but has never had a colonoscopy or endescopy. We believed for two years it was stress colitis. We treated with diet, calming herbs and metronidazole durring flare ups. She had chronic stool problems, she never threw up and did not lose weight. Her gastro panel is always normal and her stool samples were always normal. Nothing in her blood work. This past November she had a flare up where she did lose weight and I lost control of her IBD/ colitis. Her colitis is now controlled with daily doses of metronidazole. She was diagnosed with Cushings June 2010.

Hope little Toby is feeling better. He is so precious.:)

Hugs,
Addy

[Tobias]

HI Addy....thank you! I am going to the dogaware site right now. It is very helpful to know that your dog was stabilized on flagyl as this is what I was going to ask my vet about....also to know that you diagnosis did not depend on endoscopy, etc. I really do not want to put toby through that at this moment; he is very frail. It would certainly be worth a try (giving the flagyl a shot). Many thanks for the further info! Blessings and light from Linda and Toby, hugs too

[Tobias]

Hi all: This is Linda signing on about Toby. Toby is the one we are starting on lysodren shortly. Toby's amyalse was called to me today and is 598 (vet said over 400 means pancreatitis). Toby has no symptoms of pancreatitis--no vomiting, no diarrhea, no (apparent) abdominal pain. Poops are actually looking quite good lately. Appetite is excellent. Although Toby has no signs of pancreatitis (other than the bloodwork) he has many signs of cushings, as per his diagnosis. He always hungry, always thirsty, peeing frequently with muscle wasting. Should we start Toby on the lysodren in spite of the elevated amylase/pancreatitis? Could anyone give me their opinion of this. All Toby's other blood work is stable and within normal limits. Thanking anyone who has an opinion on this and with gratitude and appreciation, linda and toby

[addy]

Hi Linda,

Lori's Harley had pancreatitis and I thought without symptoms at first. I remember reading about a specific test for it, Spec Cpl, I think was the name. Also Lysodren can cause gastric upset so what does your vet think about all of this?

I guess it boils down to do you trust your vet? What does your gut tell you?

One of the reasons I am waiting a few months for Zoe's lysodren is because she was pretty sick with colitis for 2 months, lost weight, weak, etc. IMS said it is possible once I start lowering her cortisol that it will unmask problems and her colitis could get worse. She was so sick, we wanted a few months for her to get strong.

So I am wondering what has your vet told you about cortisol and pancreatitis and lysodren?

Hopefully, Glynda and/or Lori will stop by and give opinions/experience about how does lysodren affect pancreatitis?

Give little Toby hugs from me,

Addy

[Harley PoMMom]

Hi Linda,

My boy, Harley, does indeed have pancreatitis. His pancreatitis was discovered on his first ultrasound and believe me I was shocked because Harley displayed no symptoms of pancreatitis. The spec PL test has confirmed his pancreatitis even though he still displays no symptoms of this dreadful disease.

Before I tried loading Harley with Lysodren I ran a spec cPL test to see how his pancreas was doing, his results came back at 303 (0-200). His vet and I thought that these numbers were pretty darn good and since he was showing no symptoms, I preceded with the induction phase of Lysodren.

Four days into loading, Harley stopped eating which I took that he was loaded...had him stimmed, CBC/Chemistry panel done and another spec PL test done. His stim test came back at 18.3 ug/dl and his spec PL came back at 900. Harley's pancreas could not take the Lysodren.

Now, all dogs are different and may have a different reaction to the same medicine...this was Harley's journey with Lysodren but Toby's could be completely different and he may not have any problems. You have to remember, too, that Harley is a bit older than Toby and Harley probably had some kidney problems also.

I am wishing you and Toby the best of luck.

Love and hugs,
Lori

[Tobias]

Oh my gosh--I thought we would just go ahead and start--I had the final talk with the vet today and toby has been stimmed today pre induction...we are still waiting for the results Toby's value on the lipase was 598...now I do not know if I should give him the lyso or not:eek:. He seems so good other than the cushing's eating and drinking and peeing. My vet seems to be in agreement....Now I don't know. I don't know... yet I thought I read that if we don't treat the cushings the lipase may never go down...I am really confused. Should I ask for the pancreatitis to be treated..the problem is that Toby is allready on a low fat diet (Purina EN) receives fortiflora and Marin. This may be why he is asymptomatic??? I am really scared and petrified and not sure what at all to do upon reading your post...I don't want to make Toby's pancreas worse...yet the vet seemed to feel the pancreatitis was related to the cushings and that we should start treating:confused: Thanking anyone who could help me decide...I just feel so bad about Jersey dying and I feel exactly the way Destiney did about being so unsure to begin with....what to do????? Toby doesn't seem like his stomach is upset and his poops have been really good and he is not vomiting and his appetite is excellent...yet the 595 value for the lipase seems not to be a good sign somehow...Good Lord I have gone from feeling positive about starting to being scared again...should I treat the pancreatitis to make the number go down? Help! Gratitude from Linda and Toby

[lulusmom]

Hi Linda,

I just wanted to let you know that you are correct. Cushing's can cause elevated lipase values so it could very well be that it will go down once you treat the cushing's.

Glynda

[Tobias]

Wow, I thank you from the bottom of my heart for that---I so respect your phenomenal understanding of all this...if you think it's a good idea, I'm going to take the ball and run, and now I don't feel so scared. Thank you. Blessings and light and hugs from Linda and Toby

[addy]

Hi Linda,

Whatever you decide is the right thing. You know Toby the best. If you have a good relationship with your vet and trust your vet then if you gut tells you go ahead, you should. Don't look back, if you feel good about treating then go forward and treat.

Look, I could treat Zoe and perhaps her colitis will improve. I could treat Zoe and her colitis could get worse. I believe my IMS does not know which will happen. I don't fault her for that.

You have to do what you think best for Toby and don't look back.

We support whatever decision you make.

Hugs,

Addy

[Tobias]

OK thank you SO much. We are going to go ahead. We will start I believe next Monday , February 28. We plan on testing Friday at 5 days or sooner if he shows signs of loading and will stop the med as per Glynda....If I am feeling really brave and relaxed once we have started (yeah, right!!!) I may try to go the 7 days...I am praying for guidance about this because I really do understand what Glynda posted about the timing of everything...I will try as much as my heart (and nerves) will bear. I am such a timid mouse! If he gets sick from the lyso in the first day or so I will also stop till he can be seen and of course I will post!. I think I am ready. I'm sure I will have tons of questions (and prayers). I try to tell myself that I did not create Toby and I do not know when his Creator will call him home (I know He must miss Toby so much, he is so precious) yet I also feel God is trusting me with him to make the best decisions possible. Love and hugs, thank you over and over for your loving presence...you truly are God's angels. Linda and Toby

[addy]

Hi Linda,

Just want to make sure you are okay and little Toby is doing well.

I know you have a big day coming up next week. Just wanted to remind you to breathe.:);)

Hugs,
Addy

[Tobias]

Hi Addy and all--hugs to you and all the other beacons of light. Thank you for the thoughts and good wishes! We are going to start next Monday, March 7.The reason for the week delay is the on call staff--I want the best, smartest backup available at the clinic especially at the week ends. This meant finding out who is on call and adjusting plans accordingly. Toby has had a good week--a lot of energy and seems "up" for the next round. I keep telling him "Next week is our big week!" He just looks at me with the those pleading eyes so intently and I love him so much! My biggest concern for induction is the "wild card" of the elevated lipase. Lori posted that Harley's lipase elevated even further and that really has me worried about Toby's doing the same thing. Yet I see that he cannot go on without treatment. Blessings to all--March 7th it will be, then. His groomer appointment is March 8--I'm wondering if I should reschedule it or maybe start Wednesday....TC all from Linda and Toby

[lulusmom]

Hi Linda,

If you haven't read the Lysodren Loading Instructions and Related Tips, here is the link to it so you can print it out and keep it handy while you're loading. I've used mine so much, it's dogeared. :D

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

You'll note in that paper that it is recommended that you start loading on a Sunday. The reason for this is that the law of averages says that a dog is going to load in 5 to 8 days and by starting on a Sunday, you are increasing the odds that your vet will be open should Toby have an adverse reaction. I've loaded my dogs more than a few times and have started on Saturday or Sunday.

Glynda

P.S. Thank you for your lovely post on my thread. :)

[Tobias]

Hi Glynda: You are welcome! I meant from the bottom of my heart every word. Also, I have in fact studied the protocol, made a copy and just reread it. I really am debating about the starting day of the week. I did strongly consider Sunday and still may do that but my vet rotates out to another clinic Wednesday--although he would be there again thurs and fri....Wednesday is the wild card... The coverage in the clinic Wednesday afternoon is weak--a new graduate, basically. There is a more experienced vet on board all day until 4 that I am very familiar with from my early days at the clinic but he really has zilch experience with cushings and may be doing hip surgeries. The other wednesday morning vet would be okay....she will really listen and get the answers she needs. The new graduate is also taking call wednesday night... I'm really mulling this over.....Blessings and light back to you from Linda and Toby

[Tobias]

Hello to everyone! I have made my decision about Toby's starting date.. It will be this Saturday, March 5. The only difficulty with this would be the groomer appointment on Tues (as the drug is starting to build up in his system). But I will watch him and if there is any doubt I will have to reschedule...The other difficulty is the wednesday afternoon/evening coverage should anything go wrong--the new graduate. So if anything goes wrong Wednesday I will use personal time and start posting on the list like crazy! But I really feel we need to get started. My regular vet will be in the office Mon, Tues, Thurs and Friday and the coverage for the weekend of 12 th and 13th is strong. Then the regular vet will be back Monday. I am going to try REALLY HARD to go Saturday through Saturday (unless toby gets sick or seems to have loaded). I will have stim test done monday afternoon or Tuesday morning. Our tortoise comes out of hibernation Sunday the 14th and Toby will be finished at least with the initial INTENSE observation phase. This will allow more time to focus on Rocko at this time (a very vulnerable time for tortoises is the immediate post hibernation period). So this is my plan. I will post over the weekend that we have started on our journey....Blessings and light to all. PS Because we are loading toby at 30 mg/kg I feel more confident about going the full week...

[Tobias]

Hi all: I am just not sure what to do...I thought I would check in with the forum. I have the mitotane and was to start today. Because of just getting over a bug and being a little under the weather yesterday, I decided to start Toby's mitotane tomorrow. Yet today I have been home and keeping a close eye on him...I see he had two normal poops this morning but just now when he went out it was diarrhea...pure water....He also seems more lethargic today. I really hate to put off the mitotane past tomorrow, but I may have to. His appetite is still very good.....is there a chance the intermittent diarrhea could be related to the cushings and should I start anyway? I feel like if I don't start it soon Toby will suffer....he just looks really wrung out at this point. If I call the vet he will probably say just go ahead...I am not sure...I hate to start if he is not okay. He didn't seem crampy...just went outside as normal and pooped really watery stool. Thanking anyone for advice...Linda and toby

[addy]

Hi Linda,

Sorry to hear about Toby. I can only tell you when Zoe had bad poo my IMS did not want to load her until I had her poos firmed up consistently with metronidazole. She has told me it could be Zoe keeps having frequent infections from her Cushings which could be why we keep having colitis flare ups. On the other hand she has told me that treating her Cushings could unmask things and her colitis could get worse.:confused::confused:

Have you ever found out why Toby has intermittent diarrhea? You have posted before about his stools.

Hopefully someone will be along soon to give advice. I always read her do not give lysodren to a sick dog so not sure if that applies here.

Hang in there. Hopefully Glynda will be along soon.

Addy

[Tobias]

I think the vet would say it is related to the elevated lipase and that it is a manifestation of the pancreatitis that may not be showing vomiting, etc. I am going to ask him when he calls me back but the poops have always varied depending on diet, etc.....although we try to keep it all consistent. Then he developed pica for a while due to the obsessive hunger. Now we tail toby around the yard...he does not get away from us ever... I am waiting for him to call me back. I wonder if I should ask for the flagyl just to see if this straightens it out. Toby seems very tired today. He has been so bloated no matter how small meals I give him, hand feed him slowly, etc. I wish I knew what he wanted to do. Sometimes I feel he is pulling his energy back on some level...yet that may be my own attempts to try to deal with what could be coming. I just feel we are getting to the end of options. If he stopped eating right now I would probably feel he was getting ready...that is how he looks right now. Just wrung out. yet he is eating and drinking still. It's more of a spiritual/emotional wrung out on top of the physical. Maybe we will try the Flagyl....I will see what the vet thinks. Thanks again for your post. Linda and Toby

[StarDeb55]

Linda, I can't recommend that you start loading today with Toby showing even small signs of a GI problem. You do not give either drug to a dog who is not 100%. It would be very difficult to tell if Toby were loaded or getting into trouble during loading, if he already has diarrhea prior to loading.

Debbie

[Tobias]

Hi deb--Yes, I agree. I have spent a few hours thinking about it....I will not, until we have this more under control...Also I was thinking with diarrhea and with things passing through the system faster it might not even be metabolized normally. So I will talk to the vet if he calls me back but I will not start the med this weekend...I will post if vet calls me back. Toby perking up a bit and has had no more diarrhea since that one time. Blessings and light with gratitude for all my helpers from Linda and Toby

[Tobias]

HI all: Toby has perked up a bit with no further diarrhea--eating and acting as usual with his tail up again....I am not sure what that was about earlier today. The vet says we could try him on metronidazole for 5 days and then try the lyso--he does not want to start lyso until the poop issue is settled.... So as Toby is not in an urgent situation I am to pick it up Monday for monday through friday, if I understand him correctly. We continue to keep an "eagles eye" on what toby is doing at all times. Just to give this update and to thank everyone for all their help. Toby and Linda

[Harley PoMMom]

For a dog with pancreatitis, metronidazole would not be my first choice.


Many other medications have been linked to pancreatitis, though the relationship is not always clear. These include certain antibiotics (sulfa drugs, tetracycline, metronidazole, nitrofurantoin); chemotherapy agents (azathioprine, L-asparaginase, vinca alkaloids); diuretics (thiazides, furosemide); other antiepileptic drugs (valproic acid, carbamazepine); hormones (estrogen); long-acting antacids (cimetidine, ranitidine); Tylenol (acetaminophen); and aspirin (salicylates).

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

Maybe ask your vet about tylosin (tylan).

Love and hugs,
Lori

[Tobias]

Hi Lori--Love and hugs to you, too, and thank you!. I was quite mystified by this and so went to the whole dog journal and read the article...I subscribed to that for a while and found it so interesting! Anyway, several years ago Toby was hospitalized with pancreatitis and they treated him with Flagyl, first IV and then I think when he came home for a while. He was at death's door upon entering and came out as pictured in my little picture that shows it is my post (forget what it is called!). It brought him round quite nicely along with the IV hydration, etc.... I did google an on line vet through just answer who said that although she could not comment on the particular sensitivity of any dog to any drug, in general Flagyl is a treatment for pancreatitis and in her opinion does not cause it. The other thing is that Toby tried tylan in the past but he HATES the taste. Both his vet and I remember this. I could not disguise it even in hot dog (wow--I'm thinking back to the days when he could have hot dog treats...long gone...sigh). Although he is certainly eating much better these days (although not for the healthiest of reasons lol) I do not know if he would accept it or not. I am still mulling; I so appreciate and respect your contributions to Toby's welfare. Because my experience with it was so positive before and he would never accept the tylan previously I might go on with the Flagyl and just observe very carefully for symptom worsening etc, or vomiting or any adverse effect and stop if necessary. Blessings and light to you and yours from Linda and Toby

[addy]

Hi Linda,

Just checking in to see how Toby did with the flagyl and to see if you both are okay. Hope the flagyl helped.

Hugs,
Addy

[Tobias]

HI all: Just been quite a few months since posting! Toby is now officially loaded. It took quite a while, the (new) specialist vet quipped "Your dog didn't read the book"! Ha ha. Pre and post values last Friday 3.2 and 3.3. It just about broke the bank getting him there. I just want to thank everyone for their concern and love for Toby, and I want to share happiness that we are in a good spot now. Loading Toby was very scary. We had to medicate him with Tylan (obscuring the loading sign of diarrhea). We could not take him of the med while waiting for test results because everytime we did that he bounced back to the excessive eating, peeing and drinking and on retest his values just skyrocketed. At times the bloating was so bad he became ill and through up...but we were never sure if he was loaded or just nauseous from bloating. So would stop, retest, etc...it was unbelievable. Toby is back now to our regular vet and all seems well. I just wanted to let you all know! You have all been so helpful and I am very, very appreciative. I just had one of those "aha" moments and understood rather suddenly that Toby was trying to teach me faith in my own judgement, faith in my instincts, and the need for Toby and I to walk this road alone. Toby went through a lot of blood draws, car trips etc., and there was one time I thought (as I watched him in the backyard, a tiny figure pelleted about by wind and snow, vomiting and pooping at the same time) we should just put him down. I thought we would never get it figured out. But the next day he would rally, and we would go back for another test, and I would feel better about things. I know not everyone is into this stuff, so I will be brief, but I did have a reading for him by a pet psychic about what his wishes were and she said. "he wants to fight this with everything he has, he is determined to stay with you no matter what it takes. Funny thing is that the vet tech made the observation (when I asked her how toby was handling all the testing etc) "It's really different from most dogs. He just puts his tiny little paw out like he know's exactly why he's here and what its for. So I felt reassured by that. Specialist outlined the plan and the go ahead for keeping him on the med while waiting and said he could adjust dose based on that...He also did offer as an option initially putting him into Addison's intentionally (this is what they do in Europe, he said) but I told him is was not on the table for me in any way, shape or form. So it was risky, but we had no choice, so proceeded with tight monitoring for an approximately 2 week period of loading and bloodwork up the Yazoo (the lipase has really increased as we struggled to regulate him but the specialist said we don't worry about that). Toby is filling out a bit and the specialist was a bit concerned about his appearance but did a whole bunch of bloodwork and concluded there was nothing indicating anything but cushings...well, Toby says woof it's finally over for us for the time being. Blessings and light to all from Linda and Toby

[addy]

Linda, I am so glad you posted because I think of you and Toby often and kept wondering what happened to the little one.

It sounds like you had quite a journey and I fully understand your need to go it alone.

Thank you for telling us Toby's story of the last few months and I hope only good things happen to him from now on and that he is on the road to recovery at last.

Love,
Addy

[Tobias]

Thank you, Addy...you are so precious! Toby and I thank you for your light. Hugs from Linda and Toby

[Squirt's Mom]

Hi Linda,

Good to hear from you again! And especially good to know that our little Toby has fought so hard and is now so much better. :) I'm so glad he seems to be settling in on the med and turning the corner. He is a trooper, just like his mom! ;)

I have to say that I would never have been able to go through all of that alone. You are much braver than I. If one of my babies had been through that much, their thread here would be miles long! :eek::o Please know if you ever feel the need, you family here will be by your side to listen and help if we can.

Keep up the good work!

Hugs,
Leslie and the gang

[Tobias]

Hi Leslie: thank you for your comments! I am not brave. I had to tune into the inner guidance in this situation (only a dog could teach me a lession like this--I would never accept it from a human as I am flawed that way) Only the love of my dog could enable me to walk this path alone.. nothing is coincidental..this lesson was intended as part of my life's journey, not anyone elses....many of you I can see from the posts are strong and corageous people who have your own acts together to the point that you do not need the lesson of learning to trust yourself on a deeper inner level...but this truly was a reason Toby chose me to live with, to teach me this lesson and trust only him, my relationship to him, the strength of his bond with me, his abiity to rise above my fears and send his love out to me, and see me through. So that in the end, I would be less timid and afraid to trust myself. Toby has done something really great with his life...he has helped me to grow, and I appreciate his coming here to do this for me. Everyone has a history--mine has been no more traumatic than many others--but before I leave this earth I must overcome that history and move forward. I do believe my deep bond with my dogs (as all of you feel with yours--it is very clear to me!) came out of this history as they were always there as "silent witnesses" Loving and healing. I am so different now than when I started out on my "grown up" path...my dogs have loosened the knots around my heart. Toby--my tiny terrier-- came in at the 11th hour, when the lessons become increasingly difficult and hard to teach. I congratulate him, I really do and I just hope with all my heart he sticks around for a while having accomplished so much. I know his Creator is waiting with Toby's wings. All of you are part of this too, you brought Toby and I to a point of understanding that once the foundation of knowledge was laid, and the principles were understood, the spiritual journey could begin. As I am grateful to my tiny boy so I am to all of you, from the deepest levels of the heart where it meets the Source of Life. Blessings and light to all from Toby and Linda

[Squirt's Mom]

Hi Linda,

Squirt saved my life - literally - when she was diagnosed with Cushing's. My path had become so very dark and empty, filled with guilt, shame, grief, anger when I was able to feel anything at all. For the most part, I was one of the walking dead. My body continued to function but my soul had ceased. I had no purpose, no desire, the god I had been raised with long dead but I still prayed ceaselessly to be released. When Squirt was diagnosed and I believed she too was going to leave I woke up.

All at once, I had purpose again, I was needed again, and I began to live again. I could see colors and feel the warmth of the sun and soft kiss of the breeze. It has been a difficult and painful journey, and one I could not have made without Squirt. Her diagnosis brought me to my family here. Every battle we have fought has made me stronger, made me love her that much more, taught me so much about myself.

Then Crystal came along and awakened another part of me that had been long dormant. Her life was so short but she gave so much in that limited time. Because of Crys, Trinket and Brick came to me, bringing so much light and joy and love.

My babies led me out of the Valley of Shadows and Death, back into the light and continue to sustain my soul and teach me daily. So, I think I understand what you are saying and admire you that much more.

Hugs,
Leslie and the gang

[Tobias]

Hi Leslie: Your post was so moving and thank you for understanding what I am saying and for sharing with me that understanding in the way that you did. Because I do get it, I really do...all connections, as you say, especially these wonderful people, would not be a part of our lives if dogs weren't! And I do think we feel such a connection with dogs because of our individual "stories"....so no matter what the stories were they brought us to our dogs and to each other! So a BIG WOOF OF THANK YOU TO ALL OF YOU FROM TOBY AND LINDA! Hugs back to you from Linda and Toby