Pyr Sonoma Pit Cushings/Diabetes/Radiation?

[BeachgirlK]

Wow, I sure wish I had found this forum months ago. I have been trying to find out what has been happening to my sweet Great Pyrenees Sonoma for nearly 3 years. (She will be 12 in late August.) Test after test, and the vets kept saying she didn't have Cushings. Her hair falling out, kidney problems (special diet for that), blood pressure elevated, extreme thirst, skin infections, arthritis disappeared, excessive urination, finally diabetes, urinating in the house. Finally after inconclusice LDDS, ultrasound, skin scrapings, etc., we sent blood to U-TN and it came back elevated on 5 of the 6. Then my vet said to get the diabetes under control before starting Cushings -- and her diabetes is getting worse and worse. So I insisted on seeing a specialist, and this morning we went. My poor sweet girl looks like a severly neglected dog and we have spent thousands on her this year! The specialist said her pituitary Cushings could either be macro (which responds well to radiation) or micro, which responds to medication. He knew of a Great Pyr that was 13 and had a macro and responded really well to the radiation, lived another 2 years to age 15. So tomorrow we are having a at scan to see if it's macro or micro.

Does anyone have any experience with radiation treatment, especially with a dog that has Diabetes? The vet said her kidney function might probably return to normal after her Cushings in under control. Her diabetes is recent. Her urine was normal on her April 6th test, by May 18th, her urine glucose level was high.

My mother is very sick and weak in California, and I have been putting off visiting while waiting to see if I can get SOnoma stabilized before I travel. But I have to go visit my mom next week, leaving my dog in either petsitter (a good one -- really good) or vet boarding, or maybe in radiation treatment, if that is recommended. After a solid year of investigation, it is finally coming down to this crunch.
Any advice or experience is appreciated!

Karin

[Franklin'sMum]

Hi Karin and welcome to you and Sonoma :)

I'm really sorry that it's been such a rough diagnostic phase for you both, and for your Mum's illness.

One of our members, January has a beautiful Havanese, Serena, who underwent radiation treatment for her pit. tumor. I'm pretty sure their thread is (at the moment) on the first page of Questions and Discussions. Serena is doing very well, I think she finished her radiation more than a year ago.

We have some wonderful folks here with firsthand experience of Diabetes, so I'll leave it up to them to chime in on this. I will say though, I believe that getting Sonoma's diabetes under control currently takes priority over Cushings.

Was Sonoma's cortisol elevated, or only the intermediate/ steroid sex hormones? And would you mind posting the results, please? That will help our more experienced members give you more meaningful feedback about your girl.

Again, welcome Karin. These wonderful people saved my little boys life. You won't find a more loving, caring, helpful and knowledgeable bunch of folk anywhere.

Love,
Jane, Franklin and Bailey xxx

[zoesmom]

Hi Karin -

I'm really sorry about your mother and your dog - so much all at once for you.

We like to play 20 questions around here, but will start off with just a few. Do you have the results from UTK and can you please post them. And any previous testing that was done by your vet - reg. labwork and the LDDS you mentioned. Was an abdominal ultrasound done at any point? Macros are extremely rare and I'd hate to see you spend the big bucks on a ct or mri if not necessary. Has your Sonoma shown any neuro symptoms rof late? Just trying to figure out why your vet(s) think this may be a macrotumor.

As to the diabetes, it sometimes does appear, around the same time as the cushings diagnosis. What exactly was the timing on the two diagnoses. How long ago were both dx'd. Don't have any personal experience with DM but I know that our members who've dealt with both diseases usually say that it is important to get the DM under control first, if at all possible. Then again, sometimes that's hard to do, without also treating the cushings. But will let those who know best comment on that. We have a member here who started the k9diabetes forum - her name is Natalie. Have you checked out her diabetes website.?

k9diabetes website:
http://www.k9diabetes.com/

k9diabetes forum:
http://www.k9diabetes.com/forum/

She is on this forum too, alot. But we also have several members who are dealing (or have dealt) with the double whammy of DM and cushings.

If it were a macroadenoma, do you live close to a vet school or some other big metro area where radiation is available? I'd suggest checking out our RESOURCE section as there'll be more good info there on macros and radiation tx. The radiation tx process takes several weeks, of repeated tx's, but in dogs, doesn't seem to make them as sick as humans. The one case I remember best among our members was Brandi's beagle Molly. I think she spent 4 or 5 weeks at Texas A & M for radiation - and received like 3 tx/week. Her humans would visit her on weekends. Could be wrong about that time frame tho. But I'm hoping maybe Sonoma does NOT have a macro.

So anyway, if you can start with the above questions - that will help us get a better idea of the situation. Sue

Here's a link on macros from our Resource section:

http://www.k9cushings.com/forum/showthread.php?t=229

And here's the one to Serena's story:

http://www.k9cushings.com/forum/showthread.php?t=959

Will see if I can find anything about Molly - not sure we have her thread on this newer website, tho.

As I thought - Molly's story was on our previous, now defunct forum. Here's a link to an update we got from Brandi tho' (sadly, Molly passed away shortly after that.) But she lived another good four years after having the tx for the macrotumor. She was dx'd quite young. And I think Brandi did say the radiation may have affected Molly's hearing.
http://www.k9cushings.com/forum/showthread.php?t=1599

[BeachgirlK]

Thank you, Jane and Zoe's Mom! I do have copies of Sonoma's file which is extensive! The U of TN results (on May 28) for my spayed female (spayed at 1 year): Baseline Result
Cortisol ng/ml: 44.4 229.3*
Androstenedione 0.61* 8.80*
Estradiol pg/ml 107.5* 102.7*
Progesterone 0.25 3.0*
17 OH Progesterone 0.14 2.96*
Aldosterone 71.3 217.5

LDDS on April 21 2010:
Pre Dex 4.6
Post 4 hr 1.7
Post 8 hr 1.4

Two abdominal Ultrasounds
1. Oct 16, 09
Relevant history: Proteinuria, hypoalbuminemia, elevated ALP 518, ALT 158, Albumen 2.3, Cholestrol 420
Spleen - abnormal others - normal
Comments: There is no evident peritoneal effusion.
There is a solitary hyperechogenic nodule of undetermined nature in the spleen which measures approximately 1 cm. It appears located in the dorsal 1/3 of the organ along the cranial visceral margin. The appearance is of an older benign lesion but a biopsy or cytological evaluation would be needed for a definitive diagnosis. Both kidneys appear generally unremarkable. There is a slightly reduced contrast between the coritcal and medullary layers which may be related to mild inflammation or a variant of normal. No focal lesions nor uroliths are apparent in the kidneys and there is no visible dilation of the renal pelvis. A renal mass or other specific renal pathology is not identified as a cause for the proteinuria.
The liver, billary tract, adrenal glands and other viscera appear unremarkable. The lymph nodes do not appear enlarged.
Differential Diagnosis: Protein Losing Nephropathy -- Glomeruloneephritus or Amyloidosis
Solitary Nodular Splenopathy of Undetermined Nature.

2. May 18, 2010
Relevant History: Proteinuria; polyuris; currently on enalapril and meltonin; results of recent LDSST equivocal (4.6, 1.7, 1.4)
Spleen - Abnormal
L. Adrenal - Enlarged
R. Adrenal - Enlarged
Comments: There is no evident peritoneal effusion. There appears to be a well-delineated, discrete hyperechogenic nodule in the peritoneal space which meaures approximately 1 cm x 1 cm x1.5 cm. It appears proximal to the spleen and has a benign appearance although its nature is undetermined.
There is a solitary mixed to hyperechogenic nodule of undetermined nature in the spleen which measures approximately 2 cm. This nodule is located between the head and central body of the spleen nearest the visceral surface. The remainder of the parenchyma appears unremarkable. This appears to be the same nodule imaged on the last study without a significant change in appearance.
The liver appears mildly swollen witha diffusely coarse echotexture. There are no visible focal lesions. There is no evident intrahepatic bile canallcular dilation. The gall bladder and bilary tract appear unremarkable. Both kidneys appear unremarkable with no visible focal lesions. no significant mineralization, nor loss of corticomedullary contrast. There is no visible pelvic dilation. The parenchymal echogenicity appears appropriate as well. The overall size of the kidneys are within normal limits. Neither ureter appears dilated.
There is no visible sediment, mass, or polyp within the urinary bladder. There is no visible focal wall thickening.

Both adrenal glands are thicker than normal but otherwise of normal shape. This finding of bilateral adrenal enlargement is consistent with increased pituitary stimulation (eg PDH).
The stomach wall thickness appears uniform and lacks any visible focal lesions or masses. There is luminal gas in the stomach and no foreing bodies are apparent. The pancreas, small inestine, and other viscera appear unremarkable as well. The lilac, medenteric and other abdominal lymph nodes are not visibly enarged.
Differential Diagnosis:
Bilaterally Symmetrical Adrenal Enlargement -- suggesting pituitary stimulation.
Diffuse Hepatopathy -- consistent with a metabolic or hormone Imbalance.
Solitary Nodular Splenopathy of Undetermined Nature
Protein Losing Nephropathy - Glomerulonephritis or Amyloidosis

This is a start -- I have to pull out her other test results!
Thank you for all your good wishes. My family thinks I am insame to do this much for an old dog, but thankfully, my husband agrees that money comes and goes, but there is only one Sonoma! (Plus one other Great Pyreness "Cambria", plus our 5 cats!)
Karin

[lulusmom]

Hi Karin and welcome from me too.

Sue has already touched all the bases but I want to make sure that you saw her question about whether Sonoma has displayed any neurological signs. As Sue already mentioned, macro tumors are not that common and unless a dog has overt neurological signs, most vets don't suspect a macroadenoma and will not recommend a ct or mri. Can you fill us in as to why your vet suspects a macroadenoma?

Glynda

[BeachgirlK]

Also, have been suspecting Cushings since her hair stopped growing back in August 2007! Active testing for Cushings started last summer 2009 when she had more hair problems, urine problems, lethargy, thyroid problems, then skin infections over the winter. Urine tests showed no diabetes from June 2009 through April 6th 2010. Urine test on May 18 2010 showed diabetic, and blood glucose follow-up confirmed diabetes. We have been treating with insulin since May 24, but BG readings keep going UP even as insulin is increased! They think the Cushings caused the diabetes. She was on a low-protein, high carb diet for her kidney problems, which may have helped start diabetes -- not sure.

Neurological symptoms -- not sure what they are yet, but she has lethargy, eating problems, shaking sometimes - like tremors in her legs, some swaying from side-to-side as she walks. No walking into walls, no seizures. The Internist said that we could try the medicine and wait and see if the tumor grows (which we can see when she starts walking into walls) or we could do the CAT scan to be sure. I wanted to be sure b/c I'm tired of putting my poor dog through so much and not getting answers. I feel like she is close to death already. She sometimes looks at me as if she wishes she were dead! I know the medicine is tough on them and I just want to be sure, I guess.

I will look up the neurological symptoms somewhere so I can determine if Sonoma has many... I think he suggests this because it is better to get the tumor under control before the neuro symtoms become overwhelming.

[lulusmom]

Here's a link to information on macroadenomas we have in our Helpful Resources section:

http://k9cushings.com/forum/showthread.php?t=229&highlight=macroadenoma

[BestBuddy]

Hi and welcome.

One of the main reasons to try to get the diabetes under control before treating cushings is that you can get some false positive results for cushings with unregulated diabetes and getting the BG under control is important to do quickly to stop other issues such as eyesight problems. Cushings disease is usually a slow moving disease. But sometimes unless you start getting the cushings sorted out then it will be impossible to get the diabetes under control.

What insulin are you using and how much, is it twice a day with meals. What are you feeding? I am sorry to ask more questions but it will give a bit more to go on.

Jenny

[BeachgirlK]

Hi,

She was taking antibiotics for her skin infection and started balking at eating. Her weight last October was 123 and it came down to 96 in May.

Initial B.G. was approx 450 on May 24. ( These numbers are from memory), and he prescribed 16 units twice daily. Food is a mix of chicken with j/d kibble (along with a small amount of k.d kibble) and pretty much anything I can get her to eat. I read that Paul Newman chicken treats are good, so I started giving her those treats as well. Now, I am phasing out the k/d, as it is high carb/low protein which is not good for diabetes.

Her first BG reading after a week of 16 units was lowered to 340. Her insulin was raised to 20 units twice a week. Her weight was raised to 98 from 96, after the first week and eating all the chicken.
She had been craving protein (knocking down barricades to get to the cat food) and I was so glad to get her feed her the chicken with her food, she had previously been on k/d kibble and canned for kidney disease (form of nephritis).

After a week of 20 units twice daily, her BG went UP again to 450 (approx), and that is when I insisted on seeing a specialist.It was nice to meet with someone who had experience with these diseases, as I got the impression that my local vets were not too experienced with what Sonoma is going through. Not knowing what is causing all this stuff is extremely frustrating! Especially for me, as I have a degree in Chemical Engineering (even though I no longer practice it) -- as a problem solver, it is important to know what is causing all the havoc!

She is still on 20 units twice a day until we decide what to do -- she is not feeling well, but eating well.

We are getting the ultrasound this a.m., here in Connectiut.

I really appreciate all the help. I have read (finally!) through the threads you helpful angels have recomended -- it's not easy to find the the time. My other Pyr has arthritis and needs a massage nightly, and the cats crawl into my lap whenever I sit down at the computer! Reading through Serena's story, I am nervous about treating this disease at all. My poor sweet thing has been through so much already. And it's very tough when you have a giant breed, because you can't "hold" them too well when they are feeling down.

Well, we are off to the VREC for tests. Ca-ching! Oh well, I need answers, even if it does turn out to be a waste of money...

Thank you again for your replies!
Karin

[BeachgirlK]

Sorry, insulin is downstairs, but it is something like "Humalin" -- human insulin...

[January]

Hi Karin,
I was so sorry to read about Sonoma and your mother. I don't visit here as much as I used to, but today I saw your posts and wanted to write to you. As far as the neurological symptoms went with Serena, she really didn't have any of the classical ones of head rubbing, circling, etc. BUT she was lethargic, had no appetite and had shaking/tremors -- especially in her lower body. The vet was suspicious of a macrotumor because she also had diabetes insipidus. I am sorry that you read Serena's story and it made you apprehensive. It really wasn't hard on Serena and it bought her some good quality time. Feel free to write to me privately any time you want to. I will be thinking of you.
January and Serena

[zoesmom]

Sounds like you and Sonoma went in for the ct or mri today. Hopefully, you'll have a concrete diagnosis and it will not involve a macro. True, the LDDS was borderline - not conclusive. But Sonoma does have two enlarged adrenals, the clinical signs, elevated liver enzymes, etc., Plus the results of the UTK panel. Don't know the normal ranges of the UTK panel, off hand, but if you say 5 of 6 were elevated, that's pretty strong evidence. Did Dr. Oliver of UTK include his recommendations for tx? Lysodren is usually his choice when both cortisol and intermediate hormones are involved. My only concern would be if her BG was so out of control when that UTK panel was done, that that could affect the UTK results to the point of them being wrong. Anybody know? I know it can affect the more standard cush tests.

Many of her symptoms can be attributed to both cushings and DM - as some tend to overlap. I do think that if you can get a handle on the BG #'s first, alot of those debilitating signs that you are seeing will improve. Ideally, as Jenny said, getting those #'s under control should take priority and then worry about the cushings. But that can take some time and patience, especially if there is uncontrolled cushings too. Don't quote me on this, but seems like some vets do try to address both the cortisol and the BG issues simulataneously. Probably much harder that way and I have no idea if that's a good or bad idea. Just wonder if it is a necessity in some cases, when the DM is being so stubborn, as Sonoma's seems to be. Did the specialist have any thoughts on that?

I know how hard it is to see our pups so down and out. And on top of that, you've got your mom to worry about too. Just try to hang in there and do let us know what you learned today. Sue

[k9diabetes]

Hi Karin,

I'm Natalie from the diabetes forum. Wanted to welcome you here and at www.k9diabetes.com/forum (http://www.k9diabetes.com/forum) as well.

Sonoma currently is on a pretty small dose of insulin for her size - she could easily need twice as much as she's getting.

At the same time, though, I'm a little concerned with a 4-unit increase in her insulin dose when 16 units brought her blood sugar down into the 300s. Please correct me if I have misunderstood that.

It is possible when too much insulin is given to induce a "rebound." When the blood sugar goes too low, the body's defense mechanisms kick in and the liver releases stored glucose to bring it back up. Works great in a normal body but in a diabetic relying on injected insulin, that sugar dump overwhelms the insulin supply and sends the blood sugar high. And the after effects of that rebound event can linger for several days.

So when blood sugar rises in response to more insulin, it's always good to consider whether rebound might be occurring.

Add in the very large increase in her dose and I especially worry that a rebound might have occurred. I personally would not have voted for such a large increase given that her blood sugar was already down into the 300s.

Regulating takes a month or so unless you happen on the right dose right away. It is usually best to work up to the right dose slowly over a few weeks.

Sounds like the vet is testing her blood sugar. Did they do curves or spot checks?

Are you monitoring her at home with some like urine tests?

Would you be up for learning to test her blood sugar at home?

Natalie

[BeachgirlK]

Hi all,

Thank you Natalie, for your analysis! I will look into the rebounding. I too thought the increase from 16 to 20 was too fast. I will ask the vet about it today.

The CAT scan showed no macro tumor, so no radiation. I am still glad I did it though, because at least I know. With a sick mother on the other side of the country and a sick dog (or two) at home, I need some definite answers, because it is too time-consuming always having this wait and see attitude.

Some have mentioned that diabetes symptoms can been the same as the Cushings, but she has had Cushing syptoms for well over a year, but her blood and urine tests have not indicated diabetes until the May 2010 test. Her urine test on April 6 2010 did not show diabetes.

I will be speaking with the Internist/Endocrine Guy tomorrw and will speak to my regular vet today (hopefully) about the rebounding possibility.

Most of the vets have been saying to deal with the diabetes and Cushings together in this instance... The problem is that I HAVE to leave town to visit my parents on Tuesday through Saturday. (They're not too pleased that I have been not visiting in order to get my dog stabilized -- it has taken months and months! -- they are the type to put the dog to sleep once anything goes wrong... As a kid, I was the one who took care of all the pets in my family of 5 kids!)


I will go through the diabetes forum today -- thank you VERY much! Everyone here is so smart -- such a nice change from many websites!

Karin

[BeachgirlK]

Natalie, I did buy an BG monitoring system at CVS, but I have to get the lancets, which I will do today. I am going to do a curve on her if I can. I am interested in finding a good diet that will best manage her diabetes. I am sure I can find many helpful hints at the diabetes forum and will go through that later today!

The vet only did spot checks. At $60 a pop, I would rather do my own more often if I can.

Thank you!
Karin

[zoesmom]

Karin -

If you're leaving next week, I think the best course of action is to hold off on any cushings treatment until you get back. Trying to get her more stabilized on the insulin is enough of a task without throwing trilo or lysodren into the mix too. You really want someone to be around to watch her closely during the beginning of cushings tx (S'pose that's true with the diabetes, too). Who will be in charge of her while you're gone? There are just so many things to watch for - in the early stages of treating both diseases - that it's best if somebody her knows her like the back of their hand is present. I know you are anxious to get her problems under control, but as has been mentioned - on the short term, diabetes is a much greater concern than the cushings. My opinion, FWIW. Let us know what the IMS has to say. You're doing a great job!!! Believe me, we've all had close encounters with those who feel that it's easier just to put them down when the going gets tough. We ignore them!!!! Sue

[zoesmom]

I assume the ct scan did show a pituitary tumor - just not a macro? If so, you will no doubt be using either lysodren or trilostane. But with so many of her secondary hormones also out of whack, then lysodren will probably be the drug of choice. Trilostane, itself, can screw up some of those other hormones, whereas on lysodren, they will automatically return to the normal range (with the infrequent, possible exception of estradiol, I believe.) And during the loading phase with lysodren, you will be watching for what can sometimes be very subtle changes - which only you may notice.

[BeachgirlK]

Hi Zoesmom,

Thank you for your valuable advice. I know the Cushings treatment is tough and my presence is crucial. I normally have a wonderful petsitter who comes 3 times per day (and he is amazing, practically better than I am with my dogs!), but there is a vet tech who now takes pets into her home as her job while she raises her kids. She would be my sitter of choice, but even with her, I am reticent to start the Cushing treatment. So I may start after I arrive home on Saturday June 26..

I am talking to the specialist doctor today and need to go through more threads on everyone's Cushing stories. It all sounds so varied -- does ANYONE have a drama-free experience? I feel better knowing that the BG increase after the insulin increase could be "rebounding" and not Sonoma's body just shutting down. I was paniced that she was dying! She actually seems a little better since the CAT scan, although the first night she was dopey. She hasn't urinated in the house since then, and seems okay, not too uncomfortable. I do want to get the insulin in the right range. When she first was getting insulin and her range was lowered from 450 to 350, she seemed much better -- she even ran away into the woods! Once they raised the insulin, she got worse, which made me think it was Cushings rearing its head.

Zoes mom, I saw your beautiful Zoe in your photo album, and I saw that you recently lost her. She looks wonderful. I had my yellow lab Honey West as my first puppy and we were together until June 2006 when we had to let her go, after many health issues, when she was 15 and 1/2. The last year of her life was very intense, both emotionally and labor-wise. I wouldn't have done anything different, although many people thought it was a waste of my time. Bless you for being such a good mom and thank you for all your help here.

[BeachgirlK]

The specialist told me yesterday that she definitely needed to start lysodrene NOW because she is such a sick dog. He feels that the insulin needs will drop with Cushings coming under control, because the Cushings has been here for so long and the diabetes is so new.

I had a vet tech lined up to pet-sit in her home for both my dogs, and she could certainly handle the insulin requirement and testing as well, but I don't think that finishing up the lysodrene is a good idea, so I will have to postpone my trip to California to see my sick mom. I feel terrible about that, as I know that it will hurt her feelings and the feelings of my dad, too, as he needs a break from caring for her... UGH! I KNEW as soon as I bought the plane tickets that all heck would break loose, and it sure did. At least they finally finished my car today (needed new transmission-- two weeks in shop).

Sonoma is 97 pounds and will be getting 3 - 500 mg pills a day. My regular vet prescribed it as 2 pills in the am and 1 pill in the pm. They want me to get her BG checked twice daily but didn't say when. They also say that when she stops eating ravenously, that is when I stop giving the pills... but she doesn't eat ravenously at all now, hasn't for a month or more. (In April she was busting down barriers to get to the cats' food.)...

If it wasn't for this forum, I would be totally lost! The (regular) vet gave me a poorly-written handout that didn't even make sense of define any of the terms. What a mess. The specialist was in a hurry when he called, but he did impress me that Sonoma is REALLY sick, so I'm glad I jumped up and down and shouted at my regular vets.

I still can't get blood for testing from Sonoma! I have, however, tested my blood several times! Yesterday, I took her in and her BG was 408 2 hours after her shot, down from 458 last week at the same insulin level...

Sonoma's 3rd day on the meds (when things may start getting dicey, it seems), is Father's Day, and, of course, my stepkids are THINKING about coming to visit my hubby... which means that I have to clean the house! They better come if I spend the time to clean the house and cook while Sonoma is undergoing this treatment!! ha-ha.

Thank you for all your help.
Karin

[zoesmom]

Karin - Gosh, so sorry you are having to postpone your trip. Maybe Sonoma will load quickly (and uneventfully!!!!) You are not necessarily looking for her to stop eating completely. And as long as she's eating (even if not ravenously), you want to watch for any hesitations. The signs can be very subtle. Like not jumping at her favorite treat. Or eating slowly and leaving a little more in her bowl than she usually does. I didn't use lysodren, but did find that Zo's water consumption was a good way to read her. For I don't know how long, I measured and recorded her daily water intake. Would start each day by filling one of those gigantic 12 c. measuring cups and then fill her bowls as needed from that. (Actually, she drank like a fish, so we often had to fill it a second time and continue.) Next morning, I measured what was left and subtracted that from the total. I know that can be trickier with more than one dog in the house, especially if you can't separate them and their water supplies. But some who've tried it say that the other dog(s)' water consumption probably is pretty consistent from day to day so any variation in the total is most likely coming from the one you are monitoring.

The challenge is to catch them BEFORE they stop eating or have diarrhea or vomiting. We've all done 'poop patrol' . . . as we like to call it here. Watch for soft stools, if they are normally firm. If you see any deviations from her norm, then don't give the next dose and call your vet to get an acth. I forget - did they give you prednisone to have on hand. If not, good idea to ask for some. We've had dogs who've slipped low over weekends and holidays, when it's hard to reach a vet. Pred can make a difference in those situations. I think you and Sonoma will do fine. You're so in tune with her and have taken the time to learn about all of this. Any concerns or questions in the next few days, just pop in here and ask. Almost always somebody around. Hugs to Sonoma and good luck. Hopefully, somebody who has done a lysodren loading on a diabetic dog will be along soon to offer more advice on the BG's and what to expect with that during loading. Sue

[AlisonandMia]

I see you are starting to work out the testing of BG thing.:) From what I've seen at the K9Diabetes forum is that just about everyone has problems at first (most usually with getting enough blood) but that just about everyone manages it eventually and it becomes routine for them and their dog. The fact that you've already managed to test yourself is great! (That's what I think I'd start with if I had to learn to test my dog.)

The information (videos) here might help: http://www.k9diabetes.com/bgtestvideos.html

Alison

[Harley PoMMom]

Hi Karin,

Don't know if you had time to go through our Resource Thread so I am going to paste this link on Lysodren loading/tips.

Best of luck to you and Sonoma.

Love and hugs,
Lori

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

Helpful Resources for Owners of Cushing's Dogs
http://www.k9cushings.com/forum/forumdisplay.php?f=10

[BeachgirlK]

Thank you, Lori, I have read those threads... and I need to re-read them, about 3 times a day! I am so nervous about this! All this info is so helpful. I would be lost without it.

Karin

[SachiMom]

Hi Karin,

I saw on your post to Addy that Sonoma started loading with Lysodren yesterday. So today, Father's Day is day two. How is she doing?
If you have any worries, be sure to post and someone will be about to help. Even if it is only hand holding - which we excel at!!!!:D:D:D
I also want to mention, as I'm sure others have, that there has been a tendency for the larger dogs to load quickly. So just watch her closely tonight and at breakfast tomorrow. I know that some have given the breakfast first, to see if she slows down or hesitates eating, then give the Lysodren. If anything seems unusual. Don't give it.

So now you have a clean house and on a clear path to getting Sonoma better. I hope your mom does understand and will soon be doing better.

Take care ~ Mary Ann

[BeachgirlK]

Hi Mary Ann, thank you! Actually, I started Sonoma on Friday, so as of this evening, she is finished with 3 days (Fri, Sat, Sun) -- I spent most of the day with my husband im the E/R , where he was diagnosed with shingles on his forehead! It could spread to his eye and has potential to cause blindness in that eye... boy, when it rains, it pours. So I missed most of the day with Sonoma. She was inside with her "sister" Cambria in the air conditioning. She seems okay though, and ate all her food quickly, so she did get her dose tonight. I will watch her tomorrow morning carefully. Unfortunately, she stopped wolfing down her food last April, when she got sick from her antibiotics, and starting hesitating, sometimes not eating, back then. So a hesitation when eating is more than normal for her. The vet says to cut back on her food so she stays hungry, i.e., give her 3/4 of her regular amount of food, so she starts wolfing it down. This evening, she really was hungry though, and ate it all up pretty fast, so I think she was still loading. I didn't know that large dogs loaded faster, so thank you for telling me that. I figured the first 3 days would go fairly smoothly, and I know tomorrow (Monday) I will need to start REALLY really making sure she doesn't over-load. Thanks again for your good wishes. I'm glad we made it through the weekend. I was nervous about lack of vets. Hopefully she will be loaded by Friday night, and things may calm down for her.

Karin

[BeachgirlK]

Sue, Allison, & Lori, thanks for your posts. You guys are amazing. I almost laughed -- my regular vet called me on Friday (after his day off on Thursday) to go over what I already had started -- the lysodrene loading. He asked if I had any questions, and, thanks to all of you, I asked if I was supposed to have some prednisone on hand, particularly over the weekend. He was embarrassed that he forgot to tell me about it (at all!) and told me he would write the prescription for me. If it wasn't for you all, I wouldn't know ANYTHING about that!

Thank you again!
Karin

[BeachgirlK]

Sonoma has completed 4 days of lysodrene treatment. Fri, Sat, Sun, and Monday.

What happens if I think she has loaded and I stop giving her the pills and when she takes the test she is NOT loaded after all? Do you have to start from the beginning again?

Sonoma has always been the drama queen (or, as my hubby says, "she thinks she's a supermodel!") -- so her relationship to food and everything else is subject to her moods. So far, though, I think she's doing okay.

Karin

[SachiMom]

Karin,
Good to hear that all is well. I was just getting ready to request an update!

What happens if I think she has loaded and I stop giving her the pills and when she takes the test she is NOT loaded after all? Do you have to start from the beginning again?
The short answer is no. You would have a reading, giving you an idea of where she is at. Then you would just continue with the loading dose. If the numbers are really close to the 1-5 range, maybe a day of loading dose and then on to maintenance. It maybe some extra $ for the testing, but it will also buy you peace of mind.

I mentioned the other large dogs loading fairly quickly to give you a heads up. It doesn't mean that Sonoma read the "Large Dog Loading" book! :D;):D

You're doing a great job.
Take care ~ Mary Ann

[BeachgirlK]

I started Sonoma on her lysodrene treatment on Friday. 1500 mg per day. On Wednesday, after she had 5 full days of mediation, she didn't seem like she wanted to eat and was acting all mopey, so I didn't give her the medication and called my vet and the specialist. The specialist wasn't there, but another vet from that office called me back and told me that I should get my vet to do a ACTH stimulus test and a Blood Glucose test and wait until the next day to see the results before we give any more lysodrene. My vet's office called back and said it was too early to stop the medication because it "must be given for at least 7 to 10 days"! I insisted on stopping and getting the ACTH test and they agreed to fit me in.

Later, of course, Sonoma was barking and acting okay, so I figured she was not overdosed!

This morning I called and, after insisting that I needed the test result numbers right away (they tend to return calls after the office closes), they told me that Sonoma's ACTH results were
pre-- 2.9 and post--5.6

So I gave her the medication again today.

The specialist doctor called later and said that we are very close and to give Sonoma her loading dose for 2 more days (today (Thursday) and tomorrow (Friday)) and then she can start on her maintenance level (750 mg twice a week) on Mondays and Thursdays.

Does this sound right to anyone here? I know that the post-stim is supposed to be 1 - 5, but I don't have any levels on Sonoma BEFORE the lysodrene was started. I don't know what the typical levels are before loading...

Lastly, Sonoma had high levels on estradiol also, and the UT panel treatment options states that lysodrene treatment is not effective at supressing estradiol -- any experience at reducing estradiol here?

Thank you for all of your help!

[AlisonandMia]

Yes, she is very, very close to where you want her. Just my opinion, but I would doubt that she's going to need a full two days of dosing to get there - maybe only a couple more doses. How long after the last dose of Lysodren was the ACTH stim test run? The optimum time is 48 hours after the last dose because Lysodren goes working to low the cortisol for about that period of time. If the dog appears unwell then it needs to be done earlier - but the reading may come back a little higher than it would if you had waited the 48 hours or so.

I am so glad you didn't listen to your vet on the 7 - 10 days thing - that is an average (it appears in some textbooks) but it is only ever stated as being an average. Some load faster and some take much, much longer. It is an individual thing and considering her behavior you did the right thing. Sometime rapid lowering or cortisol can make them feel a bit rough even though the cortisol isn't necessarily too low - that is possibly what you saw.

Regarding the estradiol - Lysodren sometimes helps with estradiol and sometimes doesn't. Unlike the other hormones, which are being produced by the adrenal cortex, estradiol may be being produced by the adrenal cortex (in which case Lysodren will help) but it can also be produced elsewhere in the body - even fat can produce estradiol. Lysodren cannot have any impact on estradiol produced anywhere than the adrenals. I have heard of an IMS vet saying that when the estradiol is elevated along with all or most of the adrenal hormones then the chance that Lysodren will help is greater - because the estradiol is more likely to be a result of adrenal activity in that situation. So fingers crossed that the Lysodren addresses Sonoma's estradiol.

Some people give melatonin and lignans along with Lysodren to deal with estradiol. The only med that is currently used on dogs that will definitely lower estradiol is ketoconozole - it lowers the other hormones (including cortisol) as well but it isn't favored because it is not always that effective and also carries a risk of liver toxicity.

How have you gone with the home BG testing? And what was her BG on the recent test at the vet's?

Alison

PS: I see her cortisol level on the UTK panel was around 22. So she has gone from 22 to 5.6 in 10 doses (is that right?).

[SachiMom]

Karin,
It seems that Sonoma at least skimmed through the "Large Dog Loading Book"!!!:D:D:D
I would say that 5.6 is a very respectable number. :D:):D Very, very close to the goal.

I know that they told you to load for two days - today and Friday - BUT watch her real close before giving her the dose on Friday. Don't want to have a problem when the vet office is closed!!! Because that is when they love to give us heart attacks - weekends and holidays.

Also, please double check the maintenance dose. I do not have personal experince using Lysodren, but I thought that the "daily" loading dose in this case 1500 mg would then be the "weekly" maintenance dose.
Maybe it was 750 mg twice a week? I will try to have someone check that is a lot smarter than me.

It is always interesting to know the ACTH numbers before starting any of the medications, but not necessary. It give you a gauge of how quickly the numbers came down, or how much further you have to go. However, most important is that you have DONE IT!!!! She is just a whisper away!!!

I can't really comment on the estradiol. Perhaps it will come down once the cortisol is under control? There are several here that have had the UT test done, so perhaps they will have ideas.

Again, great job!
Take care ~ Mary Ann

Note: I see that Alison has answered some of the questions.

[BeachgirlK]

Thanks for the replies, Allison and Mary Ann!

And yes, I am the knucklehead -- the maintenance is 750 mg per week (I just edited my previous post to correct it.)

Sonoma's BG level on Wednesday was 406, which is similar to her past BG readings. The super vet says we should get a BG curve done once we have her on maintenance -- he thinks her insulin requirements will drop.

That info on the estradiol is very interesting. I wondered where it was coming from!

Sonoma's post cortisol reading on the UTK test was 229 (base/pre injection was 44) -- perhaps they're using a different measuring system. If the test measurement was the same, and I went from 229 to 5.6 in 5 days, I don't think I need 2 more days!

The ACTH test was run a little over 12 hours after Sonoma's previous dose. She has had a full dose today (Thursday), so I will watch her carefully tomorrow. She was most definitely hungry tonight, so I think I can rest easily (finally) tonight.

I was reading somewhere that the post-level should be 1-5 but that a level of 3 is better than a level of 5, so maybe that is what the vet is shooting for.

So far, I am very excited (and exhausted) that I have avoided catastrophe. I feel like changing vets (for my normal vet) because they have been very vague and confusing. They have not called me ONCE since I started giving Sonoma the lysodrene. I thought for sure they would have called on Monday to see how she was over the weekend...

I also want to get my pooches on a home-made or semi-homemade diet. I have to look into that!

Thanks again, Karin

[BeachgirlK]

Anyone know how long after loading that dogs perk up more and act more like their former selves? Sonoma is still acting tired for the most part, although she has started barking at nothing again, occasionally. (The neighbors won't be happy at that, but I am!:D )

[AlisonandMia]

The units of measurement are not the same - but they are similar in that all you have to do with the UTK numbers is divide by 10 - so 229 on UTK = 22.9 (actually probably round it to 23).

How many mg of Lysdoren was Somona getting per day during loading? The usual maintenance dose whatever the daily loading dose for the week - so if a dog loads on 1000mg per day then the maintenance dose would be 1000mg per week. This applies for dogs that load in an average type of time frame (which it looks like Somona is set to do). If they load very quickly (2 or 3 days or take ages then the maintenance dose may be lower or higher.)

It is possible that the estradiol is adrenal - fingers crossed that it is as then the Lysodren should fix it. I think it will be a matter of waiting and seeing. The good news is that the test for estradiol is a non-stim test and only costs about $50.00 from UTK.

Alison

[SachiMom]

Sonoma's post cortisol reading on the UTK test was 229 (base/pre injection was 44) -- perhaps they're using a different measuring system. If the test measurement was the same, and I went from 229 to 5.6 in 5 days, I don't think I need 2 more days!
I see Alsion explained the UTK numbers. I didn't have a clue. So to go from 23 to 5.6 isn't quite as dramatic, but still is amazing. The cortisol was lowered quickly, which will also make her feel yucky for a bit. I have heard cortisol described as a feel good steroid, so think of it as her coming down from a high.:rolleyes:


I was reading somewhere that the post-level should be 1-5 but that a level of 3 is better than a level of 5, so maybe that is what the vet is shooting for.
The desired level is 1-5. Perhaps a 3 is better than a 5, but not necessarily. It depends on the pup. Sharon's Nike (a giant schnauzer) did extremely well at numbers close to 1.5, and others needed to be above 5. You don't want the numbers too far out of range, but you don't want to chase numbers for the sake of numbers. Sonoma will end up letting you know where she wants to be.

I just had one additional thought. I am always looking for convenience wherever possible, :D since Sonoma's weekly maintenance dose will be 1500 mg, you could ask about giving 500 mg three times a week. Say Sunday, Tuesday and Thursday. Or Mon, Wed, Fri. Beats splitting pills!!!

Again, good job.
~Mary Ann

[zoesmom]

Aha - Like Mary Ann said, apparently Sonoma DID skim the book on lysodren loading!!!! Many of our dogs - on trilo or lysodren - don't follow the rules. I know my Zoe never read ANY book. In fact, I think she wrote several of them herself. :rolleyes::p:eek:

Sonoma's so close, that one extra dose could tip her over the low edge. Just one, rather than two, might be adequate. (Or maybe you've already reached the point of stopping and waiting to start maintenance?) In any case, you did a great job of watching her and, hopefully, smooth sailing from here on out. Will be anxious to see how her BG responds now, too. Sue

[BeachgirlK]

Yikes, she took her medication this morning and seems okay, so she has one more dose tonight (750 not 7500 mg!) -- maybe I'll just skip tonight's dose... we'll see. I know the special doc was worried about her eyesight becoming affected... How many days do most people go between stopping the loading and starting the weekly maintenance?

Everyone's dog is so cute in the photos. Those eyes kill me...

Karin

[frijole]

Karin, Most suggest waiting a week before starting the maintenance dose but it depends on what the acth results are.. if they are way low you need to wait longer. If they are borderline some start earlier..

I would think within a few weeks you'll start to see a dog that is much closer to normal. Of course each is different. :rolleyes: My dog not only did not read the book but she ate it. :p

[SachiMom]

Karin,

How's the girl doing today?

~Mary Ann

[BeachgirlK]

I decided to skip Sonoma's dose tonight, she seems fine, gobbled up her food like a puppy, but I worried about overdoing it on the weekend. I'd rather pay for another acth stim test than overdose her. (I am so broke over all this already, I am behaving like a mad hatter...) Today I had to take my OTHER dog, also a Pyrenees, in to start getting adaquan injections for her arthritis. Sonoma was worked up over another dog getting to go in the car, it seems, so now Sonoma is crashed on the floor along with her "sister" Cambria.

I'll talk to her special vet on Monday about when to start the maintenance dosing. I probably will have to get Sonoma on arthritis med soon, her arthritis magically disappeared with the arrival of Cushings 3 years ago, so I will try adaquan with her if the vets think that is okay, Hopefully, her kidney/blood pressue problems will dissipate now that the Cushings is being treated.

I'm actually amazed that this went so well. Generally, if there is any chance of a difficulty, than it will happen with Miss Sonoma!

Thank you again, and again, and again!
Karin