Hi, new member and Toby (update: Toby is at peace now)

[Arlene and dogs]

Hi - just started the loading process for our 8-yr old Boston, Toby. He weighs 26 lbs. We adopted him on June 12, 2010 from an adoption agency who had taken him in from a family who said they had no room for him in their family as new baby coming along. The foster family said he was 'healthy', just over-weight. This boy reminded us of our Boston, Poncho, who was diabetic, but eventually died of cancer on Christmas day, 2009.

After we brought him home, we received the vet records in the mail (did they forget to bring with them on purpose???) The routine bloodwork from their vet showed ALP 798 (20-150 range), ALT 233 (10-118 range), glucose 124 (60-110 range), vet also discussed possibility of Cushings. This done April, 2010)

He has the normal Cushings signs, large pendulous abdomen, eats all the time and everything in sight, drinks constantly, thinning hair, etc. We have no history of him other then what I've written here so starting from zero. We had senior bloodwork done and here are the highs and lows:

ALT 474 U/L (high)
ALP 1323 U/L (high)
GGTP 80 U/L (high)
BUN/Creatinine Ratio 40 Ratio (high)
Amylase 275 U/L (low)
WBC 18.4 10³/ (high)
Platelet Count 629 10<sup>3</sp>/ (high)
Platelet Estimate - Increased (high)
Absolute Neutrophils 13432 (high)
Absolute Monocytes 1288 (high)
T4 0.3 <font face="sym (low)

Urinalysis
Specific Fravity 1.010 (low)

Had the dexamethasone supression test about 2 weeks ago and started the Lysodren load today. One 250 mg twice a day. So far, so good - He used to stand next and beg to anyone that was making food noises or even standing at the kitchen counter. After about 3 house after the first pill, that stopped. He still ate his dinner like he was starving, but didn't beg after that. We also think his water consumption has gone down. We figured that he drank about 2+ gal of water over a 24 hr period before - today about half that or less. Could it be working that fast?

We have a vet appointment tomorrow - just for support, I think and also to get a better understanding of what happens next. Very confused and reading EVERYTHING... this site has me seeing double!!
So much info-it's hard to take it all in.

Thanks ahead of time,

Arlene

[Spiceysmum]

Welcome to you and Toby.
Sorry, I can't help with Lysodren as we treat with Trilostane but I'm sure there will be lots of advice from others later.

I'm sure it was meant to be that you adopted Toby as I can see that he will get all of the love and treatment that he needs.

The symptoms certainly sound typical of Cushings and everyone will want to know the ACTH and LDDS test results.

Linda and Spicey

[Arlene and dogs]

I don't know what the results of the dexamethasone supression test are. I hope to understand that today. I'll try to remember to ask about ACTH. What is LDDS test? I'm not up to the lingo yet!!

[Harley PoMMom]

Welcome to you and Toby from me and my boy Harley! My boy Harley is on Lysodren. LDDS test stands for a low-dose dexamethasone suppression test. When this test is done in the dog, a plasma sample for cortisol analysis is obtained immediately prior to and 4 and 8 hours after IV administration of dexamethasone. You may read more about this test and other Cushing's tests here:http://www.k9cushings.com/forum/showthread.php?t=227

Did your vet give you prednisone on hand for an emergency situation? This is not an option but a must when using Lysodren. Here is a link from our Resource Thread about Lysodren loading tips: http://www.k9cushings.com/forum/showthread.php?t=181

We are definitely here for you and Toby so please do not hesitate to ask any questions, ok?

Love and hugs,
Lori

[Arlene and dogs]

Yes, I have prednisone. As of this morning, all is well. He's seems to be handling the Lysodren. His appetite doesn't seem to be so out of control - I can actually eat something without him almost climbing in my lap! I'm going to vet this afternoon so I'll get a copy of the LDDS so I can post here. I'll post later to let you all know what the vet says and get the results of the test. Thanks

[sunimist]

Hi, and welcome!:)

I notice that Toby's T4 is low. You didn't give the normal range, but 0.3 would be considered low. What did the doctor say about his thyroid? Did he have a complete thyroid panel run? Hypothyroidism can have many of the same symptoms as cushings disease. Also his glucose was a little high. Might be affected by stress, but was diabetes ruled out? Did his urinalysis reveal any protein or blood in his urine?
I am anxious to hear what you find out today.

Good luck

Shelba and Suni~~

[Arlene and dogs]

Hi all - missed yesterday as really busy...

Shelba - his glucose in recent blood testing was 112 -diabetes was not officially ruled out, but nothing was said about it. The first vet we saw in June, which we really like, actually put possible hypothyroidism on Toby's chart. She will be back from vacation in two weeks, so we want to see her again. Didn't feel comfortable with this guy.

We have not done a ACTH yet - plan to after the loading period. That will cost $200 -- yikes. His LDDS through Michigan State was not conclusive.

Cortisol, Baseline -- 139 H (15-110)
Cortisol low dose dex 4h -- 106 H (0-30)
Cortisol low dose dex 8h -- 108 H (0-30)

Comments were it supports a diagnosis of hyperadrenocorticism, but the lack of supression did not give insight as to whether it is pituitary dependent or adrenocortical tumor.

Vet said it was totally unhelpful - but since it did not specifically show pituitary, then it was probably adrenal. Also said the treatment would be the same, Lysodren, but maybe higher dosages -- and that with the adrenal caused Cushings, dogs usually don't last very long. NOT VERY PLEASED with this vet appointment. Is this all true....?

[apollo6]

These are the test detect Cushing
blood panel
ultrasound-adominal -can see if both adrenal glands are enlarged, if liver is enlarged.
ACTH Stim Test
Blood pressure
Urinalysis-Antech-too if any infection
Urine Culture MIC
Before you even start medication- My Apollo is 11 and I do not want to think he will not live long. I'd change vets if my vet said that.
Senior member can give you more input.

[frijole]

Arlene, Welcome and I'm glad you found us! Did you say that your vet is on vacation and someone else is filling in?

Maybe I am missing something but I am surprised they didn't test for hypothroidism and diabetes as well before starting the lysodren. All 3 of these diseases have similar symptoms. What symptoms does Toby have that led you to test? (appetite, thirst, frequent urination, hair loss, panting, weakness in legs, examples)

I am also surprised you haven't done an acth test. The reason is because the whole goal of loading is to reduce cortisol levels. Normally the acth is done prior to loading so that you know where you are starting. You also do the test to confirm that the ldds test that you already did (the one that indicated adrenal cushings) was accurate. If there is anything else going on (example - diabetes) then the ldds test could result in a false positive.

Did this vet indicate how many dogs he has treated with cushings? I know that it isn't cheap but the acth test is done to give you a baseline of where you are starting (cortisol level) and you do a 2nd one usually at 7to 10 days to see how it is working and where you are. You continue to do them until you reach the desired reading of between 1 and 5 on the test.

Don't worry if you don't understand this at first - we have all been down this path. My first vet didn't do the acth test before prescribing lysodren either - I found this group of people first though and I found a new vet prior to treating.

Also, can you tell us Toby's weight and the dosage you are giving him daily? Thanks!!! It helps us help you. Kim

PS I cannot remember how to translate your test results to confirm that the adrenal diagnosis is accurate but if it is then lysodren can be effective. Another alternative is surgery to remove the tumor but you must go to a specialist that has done many of these operations - not to a regular vet. Did you have an ultrasound done?

[Loladog]

Hi Arlene,

It's so wonderful that you adopted little Toby!:) From all that I've learned, it's most definitely NOT true that Cushing's dogs can't live a long, happy life with treatment. If your vet continues to make comments like that, I would find a new one.

We treated Lola with Lysodren so I have a couple of hints for you. The signs that they've had enough can be very subtle. The signs with Lola were so subtle that I ended up going too long with the Lysodren during loading and she ended up very ill. Fortunately, we didn't do any irreversible damage. I don't want to scare you at all but I just want to give you a heads up. If you're questioning something, go with your gut instinct. Lola had a huge appetite prior to her treatment and she could never get enough food. One sign during the loading stage was that she would stop to look at me before she'd start eating her meal. She would also stop while eating to look up at me. This was very subtle but it was different from the normal inhaling of the meal. She also became very "spacey". Make sure you watch out for lethargy, listlessness, loss of appetite and diarrhea. If any of these symptoms come up, call your vet right away and administer the Prednisone if needed.

Please keep us posted on how the loading goes with Toby.

Take care,

[Buffaloe]

Hi Arlene,

Bless you for adopting Toby. I hope you have many wonderful years together.

The LDDS test cannot diagnose the presence of an adrenal tumor. If there is not much suppression at the 4 and 8 hour marks, then an adrenal tumor is a reasonable possibility. I think it's a tricky test to interperet. Toby didn't suppress much so an adrenal tumor is possible. It's hard to say but I'm not sure I agree with your vet that Toby probably has an adrenal tumor. Clearly, the way to find out is to have a high quality abdominal ultrasound.

Both Lysodren and Trilostane are used to treat both pituitary and adrenal cushing's. They are both more effective in treating pituitary cushings than for treating an adrenal tumor.

Please be careful with the loading. The only way to know for sure if Toby is loaded is to have an ACTH test.

That is wonderful that you still have your other vet to discuss things with in a couple of weeks. Another professional opinion is always good. Hang in there and keep a close eye on Toby. Certainly, the more you educate yourself the better.

Ken

[acushdogsmom]

His LDDS through Michigan State was not conclusive.

Cortisol, Baseline -- 139 H (15-110)
Cortisol low dose dex 4h -- 106 H (0-30)
Cortisol low dose dex 8h -- 108 H (0-30)

Comments were it supports a diagnosis of hyperadrenocorticism, but the lack of supression did not give insight as to whether it is pituitary dependent or adrenocortical tumor.

Vet said it was totally unhelpful - but since it did not specifically show pituitary, then it was probably adrenal. Also said the treatment would be the same, Lysodren, but maybe higher dosages -- and that with the adrenal caused Cushings, dogs usually don't last very long. NOT VERY PLEASED with this vet appointment. Is this all true....?Actually, the comments on the Michigan State test results sheet sound right to me and I don't know why your Vet is leaning towards a dx of an adrenal tumour based on the LDDS test results, especially since it even says right there on the test result sheet that the results you have are consistent with a dx of Cushing's, but that it could be either Pituitary or adrenal Cushing's.

My dog did not suppress at all on the LDDS test, which can mean that the dog has either Pituitary or Adrenal Cushing's. There is indeed a certain pattern of suppression and then escape from suppression which is consistent with a diagnosis of Pituitary Cushing's, but just because a dog doesn't show that particular pattern of suppression on the LDDS (Low dose dexamethasone suppression) test, that doesn't necessarily mean that the dog has adrenal Cushing's.

In fact, my dog also didn't suppress on the HDDS (High dose dexamethasone suppression) test, which is a differentiating test and no supression on the HDDS test usually does mean that it is adrenal, but even then it is best to check further before assuming that it's an adrenal tumour. Ultrasound is often a good way to differentiate between Pituitary and Adrenal Cushing's.

We had an ultrasound examination done by an Internal Medicine Specialist. She could see that his adrenal glands appeared equally and only slightly enlarged and no tumours were noted and she was then able to confirm that my dog had Pituitary Cushing's. We treated my boy with Lysodren and he did wonderfully well for more than six years.

As far as I know, the best treatment for adrenal Cushing's is surgery, which can actually cure adrenal Cushing's. If adrenal surgery is done, it should really be done by a Specialist Surgeon (not a GP Vet) in a state of the art facility, where 24 post-op monitoring is available. If/when surgery is not possible for some reason, then Lysodren can be used to treat an adrenal Cushing's case. We've had a few members here who have had some good success treating adrenal tumour cases with Lysodren and I think that we also may have some here treating a confirmed adrenal Cushing's case with Trilostane.

Here is a link to where you can read about the LDDS and HDDS tests and what the test results indicate:

http://www.k9cushings.com/forum/showthread.php?t=217


Lola had a huge appetite prior to her treatment and she could never get enough food. One sign during the loading stage was that she would stop to look at me before she'd start eating her meal. She would also stop while eating to look up at me. This was very subtle but it was different from the normal inhaling of the meal.That's how I knew that my dog was fully loaded.

It was only three days into the loading when he stopped to look up at me during a meal when I said his name, when before loading started he would have never stop eating, not even for a second, until all the food was gone. We brought him in for an ACTH stim test and sure enough, his cortisol was in the target range for a successful load. ( less than 5 ug/dl, or less than about 150 nmol/L)

[Arlene and dogs]

Here we are, Tuesday, and last night, (Monday) Toby took his last Lysodren. He did what you said, Aimee, and looked at me a few times and left a few bits of kibble and a couple of green beans. Amazing! This morning, he wanted nothing to do with the green beans mixed with kibble, but he ate his kibble -not fast, just normal. So, I did not give him his pill. Called the vet to confirm what I was to do. He was pleased that it only took 7 days and said to watch to make sure he was drinking enough and not too listless. Today, he has been sleeping except to go outside. This is almost normal for him. His abdomen is so big that it makes it difficult to walk. He goes in for his ACTH on Thursday AM. At that point, I don't know what to do-have received no further instructions. We probably won't get the results of the ACTH for about a week or so, soooo, do I begin the maintenance? Will he revert back to pre-loading if I don't? So far he hasn't, but it's only been today without Lysodren. I hope we didn't adopt him too late to help him. I cry thinking about noone else or even their vets paid any attention to his symptoms. Just thinking he was fat...
Anger is not strong enough for what I am feeling... Thanks for listening!

[Casey's Mom]

Arlene sounds like you are on the right track and doing a fantastic job with Toby. Wait for the results of his ACTH before you do anything. I get my results back in a day or two and I am in a small city where the blood has to be Fed-Exed to the lab so you should be okay.

One of the more experienced members will be along to advise on waiting to begin maintenance. I too use Lysodren and don't remember how long after loading you wait to go on a maintenance dose but I am thinking it was two weeks if I remember correctly.

Love and hugs,

[frijole]

Wow - that was painless! Way to go.

You are right - you sit back and wait. Typically it takes 24-48 hrs to get test results back (unless sent over a weekend). Normally vets have you start maintenance ONE week from the last dose... but it really depends on the test results. If Toby was on the low side you might hold off longer to let cortisol rise a bit. If on the high side you might start right away. (Range I am referring to is 1 to 5)

If you aren't loaded yet you simply start giving the daily dose again until you see signs and retest.

Great job. Kim

[Arlene and dogs]

Toby's sample will also have to be fed-ex'd to Michigan State - even tho the test will be tomorrow, the sample won't go out until Monday and it takes two days. Might get results by Friday. Unless I get it overnighted-don't know what that will cost...

He didn't eat all his kibble this morning, actually left some in the bowl so I guess that is a good sign. ??? He still can't go upstairs - down is great but I have to carry him back up. My back is starting to hurt. I'm a senior also, and can't do much more of that!!!! I'll write more tomorrow after his test even tho I won't have results. It's good to get feedback (positive) from you all. Thank you, thank you, thank you!

[acushdogsmom]

Sounds to me as if he's loaded. :)

You won't lose any ground by not giving any more Lysodren until you get the test results back. When you are loading (giving the Lysodren daily) it has a cumulative effect, and can actually continue working to some extent for several days to a week or so after you stop giving it. That's one reason why it's good to wait a day or two after the last dose is given, before doing the ACTH stim test - you'll likely get a more accurate reading than if you do the test immediately after stopping the Lysodren. It's also why the Vet will usually want to wait a week or so after loading is complete to start the weekly maintenance dosing - to give the Lysodren a chance to have had its full effect before giving any more.

Now that Toby is in treatment, you should always have some prednisone on hand at home, just in case you ever need it. Ask your Vet about how much pred to give and under what circumstances you should give it. Usually you'd call the Vet and he'd tell you to give it (and how much) or he'd have you bring Toby in right away and he'd administer pred if he thought Toby needs it, but if you aren't able to reach the Vet and if you suspect that Toby might need it, you should know what he would want you to do - when and how much pred to give as a "rescue dose" if cortisol production seems to have gone too low. (signs of cortisol going too low are: no appetite, lethargy, vomiting, diarrhea etc)

Oh, and by the way, dogs with adrenal Cushing's tend to be more "resistant" to the effects of the Lysodren, so they typically take much longer (than dogs with Pituitary Cushing's) to fully load. So the fact that Toby seems to be loaded within a week gives you some evidence that it is likely Pituitary Cushing's after all.

Hoping that the numbers reflect the clinical picture and that they are just where you want them to be. Both pre and post-ACTH numbers should be less than 5 ug/dl - or if the results are in "nmol/L" you'd want both the pre and post-ACTH stim test results to be at less than about 150 nmol/L.

Most of us ask our Vets to give us a photocopy of the actual Lab Test Result paper, so that we can keep all the test results in a file at home. It comes in really handy to have all the test numbers in a folder at home if you ever need to make a visit to an Emergency Vet for any reason (even not Cushings-related), or perhaps are away from home and need to see another Vet - any other Vet that you might need to ever see will really appreciate having the relevant test results to look at.

Let us know the ACTH stim test results as soon as you know. :)

[Arlene and dogs]

I don't think Toby ever recovered from the Lysodren or maybe the disease was too far along -- or maybe there was something else going on inside of him that we were not aware of -- at any rate, he had a major stroke (we think)- couldn't walk, couldn't eat or drink, couldn't see - he lasted about 4 hours- finally we had him euthanized. We only had him a month so it was so hard to determine what without some kind of history-or maybe that wouldn't have helped. Who knows - at any rate, he's at peace now, buried out back with our 4 other dogs - Toby being out fourth Boston (aged 8 to 14), and one mixed terrier who lived a great life to the age of 17.

We still have two healthy dogs, Lefty, a mixed terrier, age 10 and Penny, a Carrin terrier, (guard dog!) Both are adopted. Got Lefty when he was three and just adopted Penny about the same time as we got Toby. She's 6. Think we're going to take a break now - I'm still angry at the people who dropped Toby to the curb without giving him a chance.
Bye

[bgdavis]

Oh, such a terrible and shocking loss! Thank you for making such an effort for Toby. He was really showered with love in his last days.

Bonnie and Angel Criss

[Squirt's Mom]

Dear Arlene,

It doesn't matter how long we have loved them, they become a part of our souls, leaving their mark with us forever and ever. I am sorry Toby's life with you was so very short but please take some comfort in knowing that you gave him the best chance he had at a loving home and quality life. Toby crossed The Bridge carrying love with him, something he may have never known without you.

Our thoughts and prayers are with you and yours.

With sympathy,
Leslie, Squirt and our angles, Ruby and Crystal

[Roxee's Dad]

Dear Arlene,
I am so very sorry for your loss. Know that you gave Toby the gift of love and happiness in the last weeks of his life. Sweet Toby will Rest in Peace knowing he was loved.

[littleone1]

I'm so sorry for your loss Arlene. At least Toby got to know what it was like to be loved and and have someone to take good care of him.

Terri

[judymaggie]

Arlene -- I can only echo what others have said ... that it is wonderful that Toby learned what love was before he left this world. Although your time with him was short, I am sure your heart is aching. Take care!

[frijole]

Arlene, I am so sorry. I agree - you gave him love and that is what counts. Now he is our newest angel. RIP dear Toby. The pain is gone now. Kim

[Casey's Mom]

Arlene, I am so very sorry to hear about Toby. I am sure that the time he did have with you though he felt loved and felt some relief. He is watching over you now . . .

Love and many hugs,

[Franklin'sMum]

Dear Arlene,

I am so very sorry that Toby has passed. I know he was only with you for a short time, but in that short time you were able to show him what love is, and he left this world knowing that he was loved. Toby is now playing happily with all of our babies who have gone before, and no doubt they're showing him the best places to sniffer
Love and hugs,
Jane, Franklin and Bailey xxx