Need help as soon as possible!

[BobbiA]

I have a miniature schanuzer (12.8 pounds) that just turned 5 on 8-27-10. He has had increased urination/drinking. I took him to the vet for a blood panel. Everything came back fine except that his urine was so diluted from all the water intake. The vet suggested an ultrasound. On the ultrasound everything looked fine. Liver, kidneys and adrenal glands all look normal. The vet then scheduled an ACTH stim test to confirm what he believed to be Addison's Disease. The results came back Cushing's. He prescribed Lysodren (500mg/day broken into 2 doses) which we began on this last Friday. The first day he was fine, played with the other pets. Yesterday he ate his food (hamburger and rice) and gulped it down which was abnormal for him. A couple of hours later he vomited it up but before we could get him away from it, he ate it back up and it stayed down. Same thing later that day (chicken and rice). We gave him a half tablet of prednisone and he was fine. He got up this morning and ate at 7:30 played a little and then about noon, he began to lay around, shake and his back legs seem very weak. At 1:30 he vomited the food back up. We waited a couple of hours and tried giving him more food, just less. He ate and it stayed down. This evening it seems as though he is very weak. We have had to go outside and carry him back in the house twice now. He is shaking like he is freezing, drinking excessively again and extrememly lethargic. Help? I'm terrified that he's not going to make it through the night. I just gave him a half a pill of prednisone but is this normal????

[AlisonandMia]

Hi and welcome,

Sorry about the delay in approving your first post and membership. I've just got back from shopping (I'm in Australia) and saw your post sitting there. Your membership is now approved so any subsequent posts will show up immediately.

It sounds like you have done the right thing giving him the prednisone. Has he improved since you last posted? If not it is possible he needs more than just prednisone and may need emergency care ASAP. An overdose of Lysodren can cause the electrolytes to be out of whack and prednisone doesn't do much to help that. Intravenous fluids are necessary to treat that.

How many mg are the prednisone tablets?

You say he weighs 12.8 lbs - are you sure that is lbs not kg's? (12.8lbs seems very small for a schnauzer.) If he is only 12.8lbs then the Lysodren dose he was way to high - but he is actually 12.8kg then it would be about right.

It sounds to me like the diagnosis is possibly doubtful - based on just an ACTH stim - false positives are definitely possible Cushing's tests which is why more than one test is usually needed for a safe diagnosis. Five years is also quite young for Cushing's - its not impossible for a dog to develop Cushing's at a young age but it does make the diagnosis even more doubtful, IMO. Most Cushing's dogs are well into their middle years or even elderly.

Mini Schnauzers are very prone to developing diabetes and there is a huge overlap in symptoms with Cushing's and diabetes. Has he been checked for diabetes?

I presume you have stopped giving the Lysodren - when did he have the last dose? (Please tell me how many hours/days ago as I get mixed up with the time zone differences.:p)

Alison

[BobbiA]

Thanks for approving me. He really hasn't improved much. He wanted to go outside, so I let him out but he won't come back in now. He acted hungry and I did give him some hamburger and rice and he has kept it down so far.

The prednisone tablets are 10 mg and the vet told me to give him 1/2 of one if he needed it.

He is a very small mini schnauzer and he is only 12.8 lbs. He has lost weight since this all started but he was only still under 15 lbs to begin with. I actually questioned the vet about the dosage amount because 500mg seemed like a lot of medicine to me and he sadi that it was correct.

I'm very skeptical of the diagnosis. The only Cushings symptoms he has are the excessive drinking/urination, and the rear leg weakness.
I'm not sure if he was tested for diabetes or not. I know they did a full blood panel, two different urinalysis, a urine culture, an ultrasound and the ACTH test.

His last dose of Lysodren was almost 5 hours ago now. It's 2 a.m. here now so I still have roughly 7 hours before the vet even opens here.

I'm really scared and I don't have alot of faith in this vet at this point. I feel as though they have bounced me around from vet to vet within their office and that no one truly knows what is going on.

[AlisonandMia]

I would presume that the full blood panel did include looking at blood glucose - but it would be worth asking again and even insisting that they do an in-house BG test first thing rather than sending it out to a lab.

Weight loss is not really typical of Cushing's - in fact it is more consistent with diabetes. Many dogs with Cushing's put on weight due to an increased appetite. Over how long has this weight loss occurred? Increased urination and drinking - and leg weakness too, for that matter can be a symptom of diabetes or Cushing's.

The fact that he is only 12.8lbs means that that Lysodren dose (500mg per day - that is one tablet a day) is a huge dose for him! How many doses has he had since you began dosing?

When you take him in in the morning insist on getting his electrolytes checked too. Lysodren doesn't usually affect the electrolytes but if the dog gets a large overdose then the electrolytes can be affected and this needs prompt treatment. Is there any way you can get him to emergency care tonight?

Alison

PS: You said the ACTH stim test was originally done because Addison's was suspected. Do you know why the vet was suspecting Addison's in particular?

[gpgscott]

Welcome from us as well,

Like Alison I have concerns that more testing should have been done before commencing a treatment with Lysodren. Also the dose of 500mg daily far exceeds the maxinum recommended dose of 50mg/kg/day for loading. In addition many Drs. split loading doses into two equal doses which can help with gastic upset.

Do you have copies of labwork, we have a member skilled in interpreting bloodwork and many of us are familiar with results of Cushing's specific testing.

If this was my pup I would want a better diagnosis than you have described.

Best wishes, please let us know more.

Scott

[frijole]

I agree that the dose is high and further testing should be done to make sure it is cushings. Not sure where you live but if you can, try to find a specialist in your area. Let us know how your little one is today. Kim

PS Here is a link to find specialists. Vet schools are also an option if you aren't near an IMS
http://www.k9cushings.com/forum/showthread.php?t=182

[BobbiA]

Bent made it through the night. I will post answers to your questions later today, I have to get ready for work. He is at my moms house so she can keep an eye on him today. He's not getting anymore meds until I talk to the vet and receive some answers. It may be time to change vets. He definitely seems stronger today. He's at least walking in and out of the house on his own and even jumped on the bed. Back to excessive drinking again too though. Thank you all for your help, you don't realize that you helped me make it through the night!

[zoesmom]

Hi and welcome -

If at all possible, I think Bent needs to be seen by a vet today. From your vet's seeming miscalculations, I'd think a different vet would be in order. But I would urge you to take him in for an ACTH and an electrolyte test asap. It's good that he's shown improvement on the prednisone and that you've stopped the lysodren. But based on his symptoms of yesterday, he could be dangerously low on cortisol (on the verge of an addisonian crisis) in which case he may need more than just prednisone. Only way to tell is by doing those tests. Drinking can also increase with addison's so don't let that fool you. Plus he had extreme weakness, vomiting, and shaking.

I also agree that the diagnosis is questionable. It would help to see the results of all the labwork done so far (blood, ACTH, notes from ultrasound, anything), if you could get copies and post. Cush dogs usually have an enlarged liver on u/s and often enlargement of one or both adrenals. Also, on bloodwork, there are certain things that are almost always elevated.

And as mentioned, there is overlap with diabetes symptoms. That often involves weight loss whereas cushings usually means weight gain. The LDDS (an 8 hour cushings test) is generally considered the gold standard for cushings diagnosis nowadays. The ACTH is still used, but more often when additional confirmation is needed - like if the LDDS is inconclusive. (And, of course, it's used to monitor a cush dog on tx or to diagnose addisons). So if your vet was thinking addisons, that would explain why he used it, but then if it came back high, best move would have been to do an LDDS next. Both tests can return false results, depending on various other factors - other medical problems for instance.) Please let us know how your pup is doing today, so we don't worry!:o Sue

[Squirt's Mom]

Hi and welcome to you and Bent! :)

I am very glad you found us last nite and that Alison could help you. It's good to hear that Bent was feeling better today as well! :)

With luck, your job will allow you to at least peek in and read even if you can't post, and that you will be able to call your mom to check on your baby.

All things considered, I doubt the vet explained to you what Lyso does to the adrenal glands. It's job is to erode layers of the glands until they are no longer able to continuously secret cortisol. This is done by first eroding the glands by dosing daily (loading) to that point where they still respond when needed yet not constantly, and then maintaining that erosion level with a dose spaced out over a week.

If the dose is too high, then the erosion goes too far causing the cortisol to drop too low in the body. "Too far" can mean nothing more than needing to stop the Lyso and give Pred for a day or so, all the way to total destruction of the adrenal glands, in which case the dog becomes Addisonian - the opposite of Cushing's.

Trilostane can do the same thing.

This is why it is so important that a vet see Bent asap. If the electrolytes are affected as well, then he will need more than just the Pred. There are specific drugs to help replace these essential minerals in the body while Pred only replaces the steroid. The body cannot function without electrolytes any more than it can without cortisol and an overdose of Lyso can prevent either of these from being produced.

Please let us hear from you as soon as you can. We are a bunch of worry warts around here! :)

Hugs,
Leslie and the girls :D - always

[apollo6]

Welcome to you and Bent.
Like the other members said, that is way too much for a little guy like that. :eek:And we would need more information before jumping into a diagnose. Treatment isn't started until all tests care done, and deciding which form of cushing if it is that. Your little guy has had a bad reaction to this drug.
Please read the resource information to help you first.
Would help to know were you are from to fill out on your profile, this way we can help you with resources in your area and website to get an internal medicine specialist with knowledge in cushing's.
http://www.acvim.org/websites/acvim/index.php?p=3
first get Bent stabilized. Take a deep breath.
Hugs from Sonja and Apollo

[acushdogsmom]

He prescribed Lysodren (500mg/day broken into 2 doses) which we began on this last Friday.

He is a very small mini schnauzer and he is only 12.8 lbs. He has lost weight since this all started but he was only still under 15 lbs to begin with. I actually questioned the vet about the dosage amount because 500mg seemed like a lot of medicine to me and he sadi that it was correct.I'm not sure where your Vet got the dosing protocols, but that's wayyy too much Lysodren for a dog who weighs 12.8 lbs!

Here's a link to our post in our Resources Forum called "Lysodren loading Instructions and related tips". The quote there is taken from the Textbook of Veterinary Internal Medicine.

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

You can see there, that the daily loading dose should be no more than 50 mg per kg of the dog's bodyweight per day (50 mg/kg/day).

If your dog weighs 12.8 lbs, that translates to 5.8 kg. And 50 mg/kg/day for a 5.8 kg dog would be 290 mg as a TOTAL daily dose! Since the Lysodren pills are 500 mg, the dose would likely be half a pill (250 mg) per day, divided and given as 1/4 pill (125 mg) with breakfast and the other 1/4 of a pill (125 mg) given with supper.

I'm no math whiz (someone please correct me if I'm wrong) but 500 mg a day given to a dog who weighs 12.8 lbs (5.8 kg) would work out to be 86 mg/kg/day!

It's pretty scary that you actually questioned the 500 mg per day dosage and the Vet told you that it was correct! I think the Vet may be mistakenly calculating the dose using a 50 mg/lb/day dosing guideline instead of 50 mg/kg/day. Thank goodness you had the pred on hand and could give it to Bent right away, but the Lysodren dose being so high and the Vet not even realising that it's the wrong dose (nearly twice as high as it should be) is not acceptable, in my opinion.


I'm very skeptical of the diagnosis. The only Cushings symptoms he has are the excessive drinking/urination, and the rear leg weakness.I'd be skeptical of the diagnosis too, with only those few symptoms and with the only Cushing's-specific test coming back as consistent with a Cushing's diagnosis being the ACTH stim test. Cortisol production can be high (and thus appear to be consistent with a Cushing's diagnosis) on an ACTH stim test due to other non-adrenal illness or stressors on the body, since cortisol is released in response to many different kinds of stress and/or illness.


I'm really scared and I don't have alot of faith in this vet at this point. I feel as though they have bounced me around from vet to vet within their office and that no one truly knows what is going on.I think you need to get Bent in to see another Vet asap. Preferably an Internal Medicine Specialist with a focus in Endocrinology, or at least another GP Vet with a better understanding of how to diagnose and treat Canine Cushing's correctly. If you need some help trying to find a Specialist for Bent, let us know - we may be able to help you find someone.

Shivering, lethargy, vomiting etc are some of the symptoms of Lysodren overdose/too-low cortisol and you very well may have saved Bent by giving the pred last night. Feeling better after getting some pred is also a sign that the cortisol may have fallen to too-low levels. And he may need to continue taking pred until his adrenal glands can have a chance to regenerate and start producing more cortisol again, which can take some time.

To know where the cortisol production is now, you'll need to do another ACTH stim test. With that in mind, I also wanted to mention that if the Vet does an ACTH stim today, you might get a falsely elevated result, showing that the cortisol levels are higher than they really are, because there may still be some pred in his system. When the Lab is trying to measure the cortisol in a blood sample, the pred actually measures as cortisol along with the actual cortisol in the blood sample (the Lab equipment can't tell the difference between pred and cortisol). A break from taking pred of about 24 to 48 hours would be needed so that you can get a reliable result on an ACTH stim test. If necessary, there are other cortisol "substitutes", such as dexamethasone, which can be given to the dog to temporarily supplement the too-low cortisol and which do not interfere with ACTH stim test results.

Please update us again soon.