Hair loss AFTER Lysodren treatment (Jayne) 9 y/o Husky/Beagle mix

[Skladoo]

Hi Everyone,
My 9-year-old Husky/Beagle mix -- Jayne - was recently diagnosed with Cushing's disease. She had extreme hunger, thirst, excessive urination, looting through garbage cans, dry, brittle coat, etc. She has not shed for the past 2 years. I didn't think much of it at the time, but in retrospect, I realize that the hair follicles were dormant.

Now, she is on Lysodren treatment - one pill every 5 days. She was on weekly treatment, but her extreme hunger returned, so now she's on every 5 days & doing ok. The strange thing, though, is that her hair is falling out in gobs. She has no undercoat left whatsoever, and very little outercoat. I saw one post on this website where somebody's dog lost it's "sick" coat, but it grew back in nice and fluffy.

Just wondering if anybody else has experienced extreme hair loss after treatment of this disease. :eek:

[labblab]

Yup, my Labrador retriever shed his coat in massive chunks after beginning trilostane treatment. He was already suffering from bald patches on his haunches and abdomen prior to diagnosis, so I FREAKED when handfuls of fur starting coming out elsewhere after we started the medication. But lo and behold, when I looked closely, I could soon see new little hair "stubble" appearing underneath. And he ended up regrowing a nice full coat again. I can't explain the specifics, but I was told it had to do with the fact that his normal hair-growing cycle was finally resuming again after his cortisol was lowered into therapeutic range. So massive amounts of his old hair were lost "en masse" all at one time.

By the way, WELCOME!!! :) :)

And we would love to hear more details about your dog's diagnosis and treatment history. Any info that you care to share will be really appreciated.

Marianne

[Skladoo]

Thanks for your warm welcome and encouraging response, Marianne!:D My poor baby, her fur is all white, but now she looks like a little pink pig. I don't see any stubble coming in yet, but I'll be on the lookout.

I am a groomer & I work at a vet hospital, so thankfully, I get a discount on her treatment. Also, her hair came out suddenly, in one day, because I bathed her and force-dried her, which really loosens the dead hair. I'm thinking I should see some regrowth in a few days or so.

Did your dog stop shedding prior to being diagnosed with Cushing's?

[labblab]

I don't think there was ever a time when he didn't shed somewhat pretreatment, but I honestly don't specifically remember because I was so focused on his other classic Cushing's problems -- the panting, excessive thirst/urination, hind-end weakness, actual bald spots, etc. But the hair loss after starting trilostane was really dramatic because the hair came out in big chunks rather than individual hairs, if you know what I mean...

Marianne

[Franklin'sMum]

Hi and welcome :)
A few other members have had this happen to their babies, and if memory serves it's called "blowing the coat". Jeanette's Princess is one who blew her coat, hope that helps,
Jane, Franklin and Bailey xxx

[Skladoo]

Hi, thanks for your response, Jane.

My dog USED to blow her coat twice a year up until she was about 7 years old, but then she stopped. Her fur became dry and brittle. I realize now that was because of the Cushing's disease.

What has happened now is that she is losing her entire coat. It's so sparse all over that you can see her skin. Like I said, she looks like a pink pig.

I'll keep you all posted on whether or not her beautiful coat comes back. I hope it's soon!

[acushdogsmom]

Hi and welcome from me, too. :)

It's actually pretty common for the hair loss to get worse after starting treatment, but it does grow back in. It's almost like they need to shed their old "sick" Cushing's-affected coat so that they can grow in a new healthy coat.

Sometimes the new haircoat is a bit of a different texture or a different color than it was. For example, we've had some here whose dogs' fur grew back in wavy when it had always been straight or with some other color like red in there somewhere, when there had never been any red in the haircoat before. But it does grow back. My Bichon Frise's coat came back in the same color (white) but it was even thicker and more beautiful than it had ever been before. :)

[Skladoo]

Thank you, all, for your speedy replies. I feel so much better now. It's still coming out - even on her ears and head. There's hardly any fur left. On her torso, there's just maybe 20 hairs per square inch. I sure hope it grows back before it gets really cold. We're in the Cleveland, Ohio area - these winters can be harsh!:eek:

[apollo6]

welcome,
My little guy Apollo was losing hair before, and now is getting back some of his beautiful coat. It takes time.
On the lighter side I'll email you some warm San Diego weather to keep you warm.:D
Hugs from Sonja and Apollo

[AlisonandMia]

Hi and welcome from me too.

My dog had all sorts of haircoat weirdness go on due to Cushing's and its subsequent treatment. Like Jayne she had ceased shedding while her cortisol was high - it was as if the whole hair-growth cycle just stopped. Once her cortisol was back to a more healthy level she blew her coat (something that had never happened before) and regrew a weird, strange colored fluffy thing that actually needed clipping. Her original, natural coat was smooth and sparse and I would never have guessed that she would ever need to attend a groomer for clipping!

One thing that does concern me with Jayne is where you say she was on maintenance Lysodren of a dose every 7 days but that the big Cushing's appetite returned so now she is on maintenance every 5 days. If this is the case then it is possible that her cortisol is once again too high and this may indeed be inhibiting her hair from regrowing at this stage. I am wondering if it is possible that she shed it in response to loading but maybe it isn't regrowing so well now because her cortisol has risen in the meantime. Have you had any ACTH stim tests done since loading and what were the results (the actual numbers)?

Usually when a dog becomes symptomatic on Lysodren maintenance you need to reload and then start again on a higher maintenance dose after that. (That happened with my dog and it is very, very common in the early stages of treatment.) Increasing the maintenance dose seldom, if ever, works - especially if the cortisol has risen to the point where symptoms such as increased appetite are happening again.

Alison

[acushdogsmom]

One thing that does concern me with Jayne is where you say she was on maintenance Lysodren of a dose every 7 days but that the big Cushing's appetite returned so now she is on maintenance every 5 days. If this is the case then it is possible that her cortisol is once again too high and this may indeed be inhibiting her hair from regrowing at this stage. I am wondering if it is possible that she shed it in response to loading but maybe it isn't regrowing so well now because her cortisol has risen in the meantime. Have you had any ACTH stim tests done since loading and what were the results (the actual numbers)?

Usually when a dog becomes symptomatic on Lysodren maintenance you need to reload and then start again on a higher maintenance dose after that. (That happened with my dog and it is very, very common in the early stages of treatment.) Increasing the maintenance dose seldom, if ever, works - especially if the cortisol has risen to the point where symptoms such as increased appetite are happening again.

AlisonGood catch Alison. I missed the part about the hunger returning and the maintenance dose being changed from every 7 days to every 5 days. I read the post very quickly and only saw the question about the coat regrowth/hair loss.

Like Alison, I'd like to know when Jayne's most recent ACTH stimulation test was done and what the results of that test were exactly that made the Vet adjust the dose to every 5 days? I'm assuming of course that the Vet did do an ACTH stim test and that the Vet adjusted the dose based on those test results and not just on the symptom of the hunger returning.

If the ACTH stim test numbers were too high, just an increase in the frequency of the maintenance dose (from every 7 days to every 5 days) is often not be enough to get the cortisol production back into a well-controlled range.

I'm also curious how much Jayne weighs.

[Rebelsmom]

Wow this makes me feel a lot better. Rebel has been shedding like crazy when he never really did before. I was starting to get concerned. Thanks for sharing.

Melissa

[Skladoo]

I will talk to the vet at work tomorrow (I work for a vet).

I don't know what her levels were, I could check tomorrow. I do know that after 7 days of the initial Lysodren treatment (2 x a day, 500 mg), her symptoms totally went away. She then was retested & the vet said her numbers were perfect. She said they were exactly where they needed to be. We then put her on weekly Lysodren, so her 1st maintenance pill was due on Saturday the 18th of September. By Thursday of that week, before her pill was given, she started having increased appetite, but no other symptoms. The doc said to give her the pill on Friday morning, instead of Saturday. She started having a couple more symptoms (had one accident in the house) so the vet said to administer every 5 days. The next pill is due Wednesday this week. She's actually doing very well now, just a little bit of an excessive appetite, but not too bad.

The hair loss came suddenly last week - I think on Friday. In one day, she lost the majority of her undercoat. So there really hasn't been enough time for the fur to grow back yet, since it just happened.

Also, her seasonal skin allergies have returned with a vengeance, which is actually good, because the elevated cortisol levels were keeping it under control the past 2 years.

I will get her test results & let you all know what they were. If I need to re-test her & start from scratch, then that's what I'll do.

Ugh! I'm on an emotional roller coaster! Thanks, everyone for your help. This site is fantastic. :D

[acushdogsmom]

Looking forward to seeing the test results.

How much does Jayne weigh? :)

[Skladoo]

Hi everyone,

Ok, I have some numbers.

Jayne's initial diagnostic test, done on 8/13/10, showed a baseline cortisol level of 5.0 ug/dL. The 4-hour cortisol level was 1.1 ug/dL, and the 8-hour cortisol level was 2.5 ug/dL. She was started on Lysodren the next day - 500 mg 2x a day until symptoms diminished.

On 8/20/10, she was retested, as her symptoms did diminish completely. The results of this test was <1.0 ug d/L baseline, and <1.0 ug/dL after one hour. The vet then said to administer Lysodren weekly, first maintenance pill beginning on August 28th, and every Friday after that.

So, she had a pill on the 28th, then again on 9/3, then again on 9/10. On 9/15, I noticed that her appetite had increased, so the vet said to give her the pill a day early, then again 5 days later instead of 7. So I gave her the next pill on 9/16, and she is due for her next one tomorrow. She is doing fine, except for the hair loss, which occurred suddenly on 9/17.

Her appetite is somewhat increased now, but she does not have increased water consumption, or any other symptoms of the disease. It's hot here today, and she is not panting, or laying on the cool floor of the basement. Of course, she hardly has any fur left :o
She is not voraciously attacking the other dog's food bowls, or looting through the trash. Her appetite may be completely normal for all I know, but I get nervous when she comes running for a cookie. If I think back, she always came running for a cookie - you know what I mean?:confused:

Sorry this is so lengthy. Any thoughts/concerns?

[acushdogsmom]

Ok, I have some numbers.

Jayne's initial diagnostic test, done on 8/13/10, showed a baseline cortisol level of 5.0 ug/dL. The 4-hour cortisol level was 1.1 ug/dL, and the 8-hour cortisol level was 2.5 ug/dL.So that sounds to me like it was a Low Dose dexamethasone suppression test, which takes 8 hours to complete.

There is good suppression at the 4-hour mark and then an escape from suppression at the 8-hour mark, which is a pattern that is consistent with Pituitary Cushing's.

If you put that result together with the pre-treatment symptoms you have described - extreme hunger, thirst, excessive urination, looting through garbage cans, dry, brittle coat, etc. - it is all consistent with a diagnosis of Cushing's.

I personally would have preferred to also get a pre-treatment ACTH stimulation test done (to further confirm the diagnosis, since there can be false positives on the LDDS test and to tell me how high the cortisol is) before starting treatment and to get an ultrasound done,which can further confirm the diagnosis and also check on the health of major internal organs (liver, kidneys and the adrenal glands, for example), but I guess that it's reasonable to start treatment based on the positive LDDS test results and taking into account all of the very common Cushing's symptoms you describe.


She was started on Lysodren the next day - 500 mg 2x a day until symptoms diminished. Unless I missed it, you haven't told us how much Jayne weighs (the Lysodren loading and maintenance doses are calculated based on the weight of the dog).

According to the Textbook of Veterinary Internal Medicine, the loading dose is usually 50 mg/kg/day. So 1000 mg per day (500 mg given twice a day) would usually be the dose prescribed for a dog who weighs approximately 20 kg. (44 lbs)

Here's a link to where you can see the loading instructions (plus a few additional tips gleaned from our members and their Vets over the years):

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


On 8/20/10, she was retested, as her symptoms did diminish completely. The results of this test was <1.0 ug d/L baseline, and <1.0 ug/dL after one hour.So that's a post-loading ACTH stimulation test result. And honestly, those numbers are actually very low and it's not really where I'd want my dog's numbers to be.

The goal of treatment (again, from The Textbook of Veterinary Internal Medicine) is to have both the pre and post-ACTH stim test numbers (and especially the post-ACTH stim number) between 1 and 5 ug/dL. So <1.0 (less than 1.0) - and you don't really know how much less than 1.0 because the Lab only measures to a lowest value of 1.0 - is actually bit too low.

That said, the adrenal glands of many Cushing's dogs do tend to regenerate fairly quickly. So the numbers may be higher now, especially if the maintenance dose is low. (we need to know Jayne's weight to know if the maintenance dose of 500 mg/week is low or not)

Also, in a way, it's sort of a good sign that your Vet didn't panic when the ACTH stim test numbers came back so low. Vets who don't have alot of experience in treating Cushing's would usually panic if they saw post-loading numbers that low. Yours told you to wait 8 days and then start maintenance at half the loading dose, which is something a Vet might tend to do if they've treated lots of cases successfully and have seen that adrenal glands of many Cushing's dogs do tend to regenerate fairly quickly , although I still think it would have been safer, to get anoother stim done before giving any more Lysodren. Just sayin' ...


The vet then said to administer Lysodren weekly, first maintenance pill beginning on August 28th, and every Friday after that.

It's good that Jayne was not acting ill with her numbers that low, and if you waited a week or more between the ACTH stim that was done and starting the maintenance dosing, those numbers may have come up a bit, and may have even come up into the 1-5 range before you started maintenance, but I think it may have been a better idea to wait and re-stim before starting any maintenance dose, just to be sure that the adrenals had started to regenerate a bit before giving any more Lysodren.

I wondered at first why your Vet would choose to maintain at a dose that is half the amount of the loading dose (ie if the loading dose was 1000 mg per day, the maintenance dose is usually 1000 mg per week). But I suppose it's possible that maybe the 500 mg/week dose was chosen because the numbers were so low after you stopped the loading.

Once the adrenals of a Cushing's dog start to regenerate, however, a low maintenance dose would likely not be enough to keep the cortisol in the desired 1-5 ug/dL range.


So, she had a pill on the 28th, then again on 9/3, then again on 9/10. On 9/15, I noticed that her appetite had increased, so the vet said to give her the pill a day early, then again 5 days later instead of 7. So I gave her the next pill on 9/16, and she is due for her next one tomorrow. She is doing fine, except for the hair loss, which occurred suddenly on 9/17. I'm not really a fan of adjusting dosages of Lysodren based on symptoms alone. We've seen dogs here with way too low numbers who acted totally normal, and others who showed signs of too low numbers but whose ACTH stim results proved otherwise. So it's really always much safer (and more precise) to base dose adjustments on ACTH stim test results.


Her appetite is somewhat increased now, but she does not have increased water consumption, or any other symptoms of the disease. It's hot here today, and she is not panting, or laying on the cool floor of the basement. Of course, she hardly has any fur left :o

She is not voraciously attacking the other dog's food bowls, or looting through the trash. Her appetite may be completely normal for all I know, but I get nervous when she comes running for a cookie. If I think back, she always came running for a cookie - you know what I mean?:confused:

Sorry this is so lengthy. Any thoughts/concerns?Well it's hard to say what's really going on with her cortisol production or to know if the dose is correct unless you get an ACTH stim done to see where exactly the cortisol production is right now. If the post-ACTH stim number is higher than 5, you might need an increase in the dosage. If it's right in the range (i.e. between 1 and 5 ug/dL) then the dose is fine and it's maybe just her normal appetite that you're seeing. :)

When is your Vet planning to do another ACTH stim test?

(and how much does Jayne weigh?:))

[Skladoo]

Thank you for your detailed explanation. I'm going to take my time & read this through very carefully so I understand it all better. :)

In the meantime, Jayne is 51 lbs, which is an ideal weight for her. She used to weigh 66 lbs.

[AlisonandMia]

So is Jayne now on 500mg (1 tablet) every 5 days now?

And she loaded on 1000mg (2 tablets) per day?

Is that right?

Just wanted to make sure I have it straight.:p:)

Alison

[acushdogsmom]

Thank you for your detailed explanation. I'm going to take my time & read this through very carefully so I understand it all better. :)You're welcome and take your time. :)


In the meantime, Jayne is 51 lbs, which is an ideal weight for her. She used to weigh 66 lbs.

Okay. A loading dose (if she weighs 51 lbs/ 23.18 kg) of 1000 mg per day works out to about 43 mg/kg/day , which is a good loading dose - as close to 50 mg/kg/day as you can get with 500 mg pills. :)

A weekly maintenace dose of 500 mg/week (for a dog who weighs 51 lbs/ 23.18 kg) works out to about 22 mg/kg/week, which is quite low for a weekly maintenance dose. And I can understand how your Vet may have chosen to start with a low weekly dose of 22 mg/kg/week to start with, seeing as those ACTH stim test results were so low. Giving 500 mg every 5 days instead of every 7 days doesn't really bump up the maintenance dosage by much (at least I don't think that it would make very much of a difference).

The 500 mg per week (or every 5 days) dose may have been too low to keep the numbers where you got them down to with the loading, since the weekly dose that most dogs seem to need to keep the cortisol production within that 1-5 ug/dL target range is usually the same as the daily loading dose was. For a dog weighing 51 lbs/ 23.18 kg who loaded on 1000 mg/day in about a week and whose numbers on the stim were within the 1-5 ug/dL target range, the usual weekly dose would be 1000 mg per week (so about 43 mg/kg/week) and that would usually keep the numbers down to where they were after loading.

With the low maintenance dose you've been giving, it's possible that the numbers are a bit higher now than they were right after the loading, which wouldn't be a bad thing if the cortisol is now be within that desired 1-5 ug/dL range. Even with the low maintenance dose being given, the adrenals may not quite yet have regenerated as much as they are going to after those very low post-loading ACTH stim test scores. You need to track the changes in cortisol production capacity with periodic ACTH stim tests, to know for sure what's happening, and adjust the maintenance dose accordingly.

I don't think you need to "start from scratch", but I do think you might be wise to do another ACTH stim test as soon as possible. That will tell you where the cortisol production is now, and it can also tell you if a maintenance dose adjustment may be in order at this point. Dogs usually "tell" us via certain clinical symptoms if and when the dose needs adjusting, but you can't rely only on symptoms. You need to do ACTH stim testing to be sure that the symptoms aren't misleading and to know exactly where the cortisol production is, so that your Vet can make the right decisions when deciding on dose adjustments.

[Skladoo]

I just sent my vet an email asking her about the 500 mg maintenance dose, rather than 1000 mg. I also asked if we could have Jayne re-tested on Thursday. I'll also see her tomorrow - I have to go in for a staff meeting. I'll be able to talk to her then.

In the meantime, I'm going to keep studying this information that you all have been so kind to provide :) You folks have no idea how much you have helped me understand this frustrating disease.

[acushdogsmom]

Glad to help whenever we can. That's what we're all here for! :D

I just edited my previous post to clarify a couple of points and to add something, so you might want to re-read what I wrote in my post just before this one. :)

I'm curious to know what your Vet will say tomorrow. I hope that there's no resistance to doing another stim test soon, because you need to confirm where the cortisol levels actually are now. After that bit of an overloading and then the Rx of a pretty low maintenance dose it's important to know whether Jayne is well controlled (within the 1-5 target range) at this point, or if the dose needs some adjustment up or down.

[Skladoo]

BTW - my name is Lori. "Skladoo" is a nickname I have for Jayne. I know it's weird.:o

My situation is a tad strange, since Jayne's vet is also my boss :eek: But, I must say that she is a wonderful boss and vet. I do know from working there the past 3.5 years that she is not one to overcharge, gouge, or run unnecessary tests. I think maybe she is taking into consideration my diligent monitoring (she knows I am on my dogs like white on rice);). She has said that she wishes all her clients were as diligent as me.

That said, her response to my email is to increase Jayne's dosage to 2 500mg tablets weekly instead of every 5 days. So I gave Jayne one tablet this morning & I'll give her another one this afternoon, then continue to watch her symptoms like a hawk.

Oh, BTW - I forgot to mention that Jayne does not like needles! She's just like her mother ;). So maybe that's another factor involved with holding off on the testing unless absolutely necessary:confused:?

I will see my vet this afternoon at a staff meeting. I can talk to her a little more about retesting/treatment & see what she says. I'll keep you posted (if you don't mind);)

Thanks again from the bottom of my ♥

I think I had mentioned before, that Jayne's seasonal allergies had come back with a vengeance, which is a good sign, since untreated Cushing's suppresses allergy symptoms. So now she is on Cephalexin to control the staph lesions all over her body. That actually cleared up immediately.

[acushdogsmom]

Just me maybe, but I would not increase Jayne's dosage without doing another ACTH stim test, especially since the numbers were so low on the last (only?) ACTH stim test that she had done.

Jayne's adrenals were overdosed somewhat with the loading (returning ACTH stim values of less than 1.0 pre and post stim). The adrenals do usually regenerate, but every dog is different, and the adrenal glands regenerate at different rates in different dogs. Sometimes they regenerate faster than most and sometimes they don't regenerate at all.

After such low stim test numbers (less than 1.0 pre and post ACTH stim) I personally just wouldn't consider it to be safe to increase the Lysodren dose, even by a very small amount, without knowing for sure what the cortisol making capacity of the adrenal glands is right now. And to know that you need to do an ACTH stim test.

Here's a little anecdote from my own personal experience which illustrates my point. My Cushing's dog was in the care of a fantastic Internal Med Specialist. After a few months on the Lysodren (and doing really well) I felt that maybe his cortisol might be a bit low - just paying attention to very minor clinical changes that I'd noted and maybe there was some instinct on my part, because he wasn't really showing any major symptoms of too-low cortisol, but I thought we should test and find out for sure. Better safe than sorry, as they say.

The Specialist Vet (whom I love to this day, because she kept my boy doing wonderfully well for more than 6 years on Lysodren) said that we could just check his electrolytes, because if he had indeed become "Addisonian" (i.e. if the cortisol was too low) the electrolytes would usually be "off".

I asked for an ACTH stim and she said again that there was really no need - his behaviour was not consistent with that of a dog whose cortisol was really low and that since it was so much more expensive than just checking the electrolytes, why do a stim? I said, "Humour me and let's do both. If the stim shows that his cortisol is okay, well then, I will have just paid for one extra stim." She agreed that if I didn't mind spending the money we could do both.

The electrolytes were fine, but guess what - his cortisol had gone way too low. We had to stop the Lysodren for a couple of months I think it was, and give his adrenals a chance to recover and regenerate a bit before re-starting maintenance. We did not re-start the Lysodren until we had checked again with another few ACTH stims and until the post-stim number was up to about 2.0. And then she Rxed a dose of the Lysodren (in my dog's case we lowered the dose) that would keep the cortisol right around that level, around 2.0 - where he seemed to feel very well and where we still had a bit of wiggle room for the cortisol to go up or down a bit and still be within the 1-5 ug/dL target range.

My Vet was really glad she had listened to me, and so was I! If we had only checked the electrolytes and if we had assumed that all was well with the cortisol production because of the normal electrolytes and pretty much normal behaviour, well, I don't even want to think about what might have happened if we'd continued to give Lysodren to a dog with very low cortisol production. And from that time forward my Vet has always done ACTH stims to periodically check and always before any dosage adjustment - even if the dog's behaviour does not necessarily indicate too high or too low cortisol and even if electrolytes are normal.

I'm not saying that I think your dog's numbers are too low. I'm saying that we have no idea where the cortisol production is unless you do a stim. And increasing the dosage without knowing for sure where the cortisol levels are is just really not the safest approach.

Two 500 mg tabs per week might be the right dose. But you can't know for sure that it's safe to give that dose unless you know where the cortisol levels are now.

Just my two cents, but I really think it's important to do another stim (even if you weren't planning on raising the dose) just to be sure that the cortisol production has come up somewhat since that recent <1.0 pre and post stim test result.