8 yr old Terrier Mix Diagnosed w/Cushings (treating with Lysodren)

[Linus'sGuardian]

Hi - Wow, was I glad to find this forum. Linus is a rescue from Jan 2004. I got him on a Saturday and took him to my vet on Monday when it was discovered that he had mange, the first thing Linus ever gave to me. Linus did fine on the medicine, but I was not so lucky and had a reaction that meant I had to go for 3 mangy weeks with nothing more than itch cream. Since nobody else was interested in contact with me, Linus and I bonded and he is now my heart and soul.

Anyway, I took Linus to the vet in June with worries about his weight, which kept increasing despite my vigilant efforts to keep him out of Pumpkin's (other dog) and Laptop's (cat) food. Also his fur was not growing as fast as it had been and his tummy was dark brown in color. The tests for diabetes came back as non-diabetic but something in there prompted the vet to ask me to get a urine sample. Hilarious failures in meeting that request ended with the vet getting the urine sample.

I don't have that result on me, but believe it was the Urine Cortsol/Creatinine Ratio(?) and his score was 91. So we then did the ACTH stimulation. His Pre-ACTH Cortisol was 12.6 and the Post-ACTH Cortisol was 28.2.

So today we start Lysodren. I have 500 mg tablets that directs 1 in the morning and then 1/2 in the evening to be given by mouth. Linus now weighs 40 lbs, and when I calculated the dose per the instructions in the Information section, it seemed about right.

Even just giving Linus something that the pharmacy termed as "chemo" is breaking my heart. I'm not sure I would be as calm as I am without having read through this forum and seen the before and after pictures of dogs that have successfully been treated.

So thank you all very much. You are in the right place at the right time, and I am so grateful. I have printed out the information from the other section, which is essentially the same as my vet's instructions, so that I don't have to look for them in case of emergency.

Carole

[Roxee's Dad]

Hi Carole,

A big welcome to you and Linus and Laptop and Pumpkin :)

I am glad you found us and found the information to be helpful. The others as I affectionately call them will be along with a big welcome and the traditional 20 or so questions. :p

If you have any questions or concerns about anything, we are here to help you all through this. Questions, hand holding or just need a friend to talk to, we are here for you.

Finally, just wanted to thank you for rescuing Linus, he is just adorable.;)

[lulusmom]

Hi Carole and welcome to you and your gang.

It looks like you've done your homework and are off to a good start. Now for some of those questions that John promised we'd be asking. :D You're ahead of the game so it won't be so bad.

1. Did your vet suggest an abdominal ultrasound to determine whether your baby has pituitary or adrenal cushing's. I ask because surgery is a total cure for an adrenal tumor, if the dog is a good candidate. An ab ultrasound also gives the vet a good look at the surrounding internal organs.

2. Did your vet give you prednisone to use in case Linus' cortisol should drop too low? Signs of this are inappetance, vomiting, diarrhea, extreme lethagy.

3. Did you vet explain that it is very important that you pay attention to Linus while he eats. Most dogs with cushing's have a voracious appetite and it is this symptom that you use to gauge when your dog is loaded. Not sure about Linus buy my dogs before treatment never took their heads out of the bowl until it was spit polished. :D Signs of loading can be as subtle as Linus looking up at you for a second and then resuming or he takes a few more seconds to eat than the usual 10 seconds flat.

4. Most cushdogs also have increased drinking and peeing. Urine is dilute as the kidneys lose their ability to concentrate. Is this one of Linus' symptoms?

5. Did your vet do a full blood chemistry and if so, can you post the highs and lows, including the normal reference ranges and reporting units?

6. Did your vet give you instructions to dose for a max of 8 to 10 days and take Linus in for an acth stim test at that point? Of course, if you notice anything in Linus' behavior that could be a sign that he's loaded earlier than 8 to 10 days, you need to stop dosing and contact your vet.

I did the math, which can be very taxing for somebody like me that is mathmatically challenged, and your vet has prescribed a Lysodren dose of approximately 41mg/kg which is at the upper end of the recommended loading range. This is very good because you are less likely to experience a protracted loading phase. At lower dosing, a dog can take a long time to load and a pet owner usually ends up paying for more acth stim tests.

I have two cushdogs and both are much smaller than Linus and both are being treated with Lysodren. I'm sure others will be dropping in later to welcome you and ask any questions I may have forgotten. Sorry about the need for you to find us but I'm sure glad you did. Hang in there, kiddo, and know that we're all here to hold your hand, answer any questions and help you understand anything that may be fuzzy for you. We all know fuzzy.

Glynda

[sunimist]

Hi Carole, and welcome from me too. :)

I can't offer any additional information at this time. Glynda has done a great job with the questions. We welcome all the background and test results you have to offer so we can better know you and Linus. :)
Sounds like you are off to a good start.

Shelba and Suni~~

[Linus'sGuardian]

Hi Carole,

Finally, just wanted to thank you for rescuing Linus, he is just adorable.;)

He wasn't adorable in Jan of 2004. Friends and neighbors questioned my sanity (probably not for the 1st time). :rolleyes: Linus today is proof of the power of love and care. And since he gives back all that he gets + more, so am I.

[Linus'sGuardian]

Hi Carole and welcome to you and your gang.Glynda


1. Did your vet suggest an abdominal ultrasound to determine whether your baby has pituitary or adrenal cushing's. I ask because surgery is a total cure for an adrenal tumor, if the dog is a good candidate. An ab ultrasound also give the vet a good look at the surrounding internal organs.

Yes. After we decided to do the Lysodren, though. He said 85% are PDH, but we could do a high dose (xyz?) suppression test and/or an ultrasound. Do you think I should ask for it now that we've started the Lysodren, or wait for the 7-10 days to end?


2. Did your vet give you prednisone to use in case Linus' cortisol should drop too low? Signs of this are inappetance, vomiting, diarrhea, extreme lethagy.

No. However, I'm supposed to call him every day starting tomorrow, so will ask about the prednisone then.


3. Did you vet explain that it is very important that you pay attention to Linus while he eats. Most dogs with cushing's have a voracious appetite and it is this symptom that you use to guage when your dog is loaded. Not sure about Linus buy my dogs before treatment never took their heads out of the bowl until it was spit polished. :D Signs of loading can be as subtle as Linus looking up at you for a second and then resuming or he takes a few more seconds to eat than the usual 10 seconds flat.

Yes. I'm also keeping a journal as was suggested here. But Linus has sometimes been a picky eater. I finally learned that he likes change when it comes to food, and he especially likes food that belongs to others. However, he does not like anything else about his lifestyle to change.



4. Most cushdogs also have increased drinking and peeing. Urine is dilute as the kidneys loose their ability to concentrate. Is this one of Linus' symptoms?

Well, that's hard to know. When I really started observing the symptoms, it was full bore hot here in Atlanta. So, yes, much water drinking, but is it the heat?


5. Did your vet do a full blood chemistry and if so, can you post the highs and lows, including the normal reference ranges and reporting units?

I'm not sure. On the list to ask tomorrow. Is this important?


6. Did your vet give you instructions to dose for a max of 8 to 10 days and take Linus in for an acth stim test at that point? Of course, if you notice anything in Linus' behavior that could be a sign that he's loaded earlier than 8 to 10 days, you need to stop dosing and contact your vet.

Yes, although his time frame is 7-10 days.


I did the math, which can be very taxing for somebody like me that is mathmatically challenged, and your vet has prescribed a Lysodren dose of approximately 41mg/kg which is at the upper end of the recommended loading range. This is very good because you are less likely to experience a protracted loading phase. At lower dosing, a dog can take a long time to load and a pet owner usually ends up paying for more acth stim tests.

I join you in the math challenged department. I must have checked my answer 90 times. Now I am much more reassured about the dosage correctness. Thanks!


I have two cushdogs and both are much smaller than Linus and both are being treated with Lysodren. I'm sure others will be dropping in later to welcome you and ask any questions I may have forgotten. Sorry about the need for you to find us but I'm sure glad you did. Hang in there, kiddo, and know that we're all here to hold your hand, answer any questions and help you understand anything that may be fuzzy for you. We all know fuzzy.

I live fuzzy. But now I'll admit that I cried upon reading through the forum the first day that I found it. Thanks again so much.

[Linus'sGuardian]

Hi Carole, and welcome from me too. :)

Sounds like you are off to a good start.

Shelba and Suni~~

I hope so! Ask away. My mind is wide open and my heart is full.

[lulusmom]

Hi again.

If surgery would not be an option for you in the event Linus did have an adrenal tumor, then Lysodren is the most effective treatment. I am happy that your vet has asked you to contact him/her everyday but you absolutely should not start loading Linus without Prednisone. This is not an option, it is an absolute necessity! This is an indication that perhaps your vet's experience with cushing's is limited. :( If surgery would be an option for you, then I personally would want to know if an adrenal tumor is involved. The law of averages says that Linus probably has PDH but you never know. I definitely would prefer the abdominal ultrasound over the high dose dexamethasone suppression test (HDDS).

Most dogs with cushing's are not picky eaters unless there is something else going on. Most dogs also have dilute urine (low specific gravity) and your vet could have determined this with a urinalysis. So as it stands, the only symptoms Linus has is weight gain and slow hair growth? If so, I am a bit concerned that your vet has chosen to start treatment when there are none of the overt symptoms that are commonly associated with cushing's. Those missing symptoms are also going to be your guide in determining when Linus may be loaded. This is not good.

Weight gain is a more common symptom of hypothyroidism than cushing's. As a matter of fact, I seem to recall that there was a study done to determine if cushing's is a likely cause of obesity in dogs. The answer was no. Slow to no hair growth, as well as skin problems are also symptoms of hypothyroidism. Did your vet rule this out?

There are any number of underlying conditions that can elevate cortisol and yield an abnormal (high) UC:CR. An experienced vet will start with bloodwork to start ruling out other causes and ruling in cushing's. The most common abnormalities in dogs with cushing's are elevated liver enzymes (ALT & ALKP), elevated Cholesterol and Triglycerides. Other abnormalities are common but the aforementioned ones are the norm. Low T4 can be transiently effected by cushing's; however, 20% to 25% of dogs with cushing's can also have primary hypothyroidism.

Cushing's is the most difficult canine disease to diagnose which makes it one of the most misdiagnosed diseases. With so few symptoms and two test results which can be skewed by non adrenal illnesses, I am concerned. Based on the information you have provided so far, if I were in your shoes, I would not start treatment until Linus becomes a lot more symptomatic. Without an increase in appetite and excessive drinking, there is absolutely no way for you to tell if and when Linus is loaded.

I'm at work and trying to get this typed in between interruption so I hope I am somewhat coherent.

[Squirt's Mom]

Hi Carole and welcome to you and Linus! :)

As Glynda has said, the signs are critical in diagnosing and treating Cushing's. The signs for Cushing's are shared with other conditions such as diabetes, thyroid problems, liver problems to name a few...therefore, one of the most difficult conditions to pin down. The good thing is that Cushing's is a slowly progressing condition, taking years to really do irreparable damage. So you have time to make absolutely sure you are dealing Cushing's, what type and the best treatment for Linus. Tho I do understand the desire to get things underway, this is one of those times when haste can cause more harm than good. So take a deep breath, ask as many questions as you can think of, and remember, you and Linus have time to be thorough.

It sounds as if you already have a good start on educating yourself on Cushing's and that is wonderful! :cool: You are Linus' first and last defense, his only voice, his advocate and the more you know the stronger you will be in these roles on his behalf. Be sure to check out our Resource section and continue reading the threads posted here. Never hesitate to ask us anything...if we don't know, we will help you research. The collective experience and knowledge found here is amazing and we are more than happy to share. You will also learn that good old-fashioned hand-holding is available to you at any time. You and Linus are family now, and will never have to take another step on this journey alone; we will be here to help you any way we can.

Keep your chin up!
Hugs,
Leslie and the girls - always

[littleone1]

Hi Carole,

Corky and I also want to say hi and welcome you and Linus to a very special group of people.

You have gotten some very good information. Corky was diagnosed with adrenal Cushings with an ultrasound and the LDDS test.

You are doing a great job of getting all of the information that you can get about Cushings. As others mentioned, there are also other medical issues that can have similar symptoms.

Sending positive thoughts that everything will go well.

Terri

[Casey's Mom]

Hi Carole and welcome from me and my dog Casey. She too is on Lysodren, same weight as your dog and is now still enjoying life at over 14 years. We are here for you and glad that you found us!! Your Linus is absolutely adorable.

Love and many hugs,