Snoopie, a Baby Girl Beagle with PDH, (update: Snoopie has passed)

[Rene]

Can anyone refer me to a cushings specilist that works routienly with the UT lab and follows Dr. Oliver's recommendations that they have had good experiences with in San Diego?

[gpgscott]

I cannot, but perhaps another member can. You might also consider emailing Dr. Oliver, joliver@utk.edu and asking for names of practices in your general area who are submitters previously.

You could also consult our important resources area for an IMS and then individually call those in your area. Here is a link http://www.k9cushings.com/forum/showthread.php?t=182

Welcome to you and your pup, while you are searching for a Dr. we would all like to know more about your situation, you may also find some very useful adivse right here.

Scott

[apollo6]

Dear Rene
I am from San Diego and this is who I am using. I live off i-5, Nobel dr.


http://www.vshsd.com/Specialties-Internal_Medicine/
John Hart, DVM, DACVIM


carol G is also using the same vet.

[Carol G]

Hi,

As Sonya mentioned, Dr. Hart is the specialist at VSH I used for Winnie (pituitary dependent) and McGill (Atypical) and now for my cat Atty who has small cell lymphoma.

VSH sends their UTK panels to UTK via a lab so I don't know how to answer your question about "works routinely with the UTK lab" -- they certainly utilize the UTK lab but there is a middle man. I doubt that prevents any of the IM specialists at VSH from communicating with Dr. Oliver or the lab if they have questions. Dr. Hart followed the treatment guidelines from UTK for McGill (a UTK panel was not deemed necessary and was never done for Winnie).

I feel that Dr. Hart did an excellent job treating Winnie and McGill and was able to get their Cushings under control. My Atty Cat is doing absolutely great under his care.

I believe that others on this forum have used and been happy with other IM specialists at VSH too.

Best,

Carol

[Rene]

Thank you for your reply’s for my post for Endocrinologists Cushing's Vet's) in San Diego.

As requested, here is our history:

Snoopie is a 12 year young, spayed, 25 pound, beagle. She is a very active girl and has had a lifetime on the trail with her horses....trail blazing and chasing rabbits.

Several years ago she spent two weeks at the vet hospital for a pancreatic attack. Since we thought she suffered only from chronic pancreatitis we fed her grain free, low fat, highly digestible kibble for years. She suffered only a few minor episodes. We blamed it on her sneaking people food, horse poop or rotten stuff on the trail.

In July 2010 Snoop was taken to the vet for an apparent severe pancreatic attack. Her MCV, EOS, and Cl were low. Her RBC, WBC, NEU, GLOB, TBIL, CHOL were all high. Her ALKP was off the charts over 2000 U/L.

An ultrasound revealed an enlarged liver, adrenal glands and gall bladder. There were spots on her liver and a mass in her spleen.

As a result, Snoopy’s gall bladder and spleen were removed. Her gall bladder was reported as "mush". The mass in her spleen and spots on her liver were, thankfully, non-cancerous. Two non-cancerous growths were removed from her back and eye lid.

Within the week she was acting like her old self and recovered from her surgery.

What I learned:
Don't despair...if possible do a little further investigation, in this case the ultrasound…it saved my little girl’s life!

But, there is more drama. In August 2010, during her follow-up and suture removal it was discovered Snoop suffered a hernia. Her incision site was slow to heal, I assumed due to the Cushing’s. Because of this only some of her stitches were removed and surgery was being discussed to repair the hernia. During the examination, she open herniated her abdominal contents from the incision site.

This little trooper just stood there wondering what all the fuss was while I "held her in" and the vet wrapped her up for emergency surgery. These little miracles truly have no concept of death!
She recovered again without a hic-up….amazing!

Her post surgeries re-check labs in August 2010 were normal except:
Lym 0.48 K/ul EOS 0.08 K/ul CHOL 435 Mg/dL ALT 962 U/L (rising was 694 before the first surgery)
ALKP over 2000 U/L

After she was finished with her post surgery medications, suspecting Cushing's, I placed her on the following:

Melatonin 1mg three times a day

NuLignan 25mg (Health Concerns) once daily (with one tablespoon of fat free/organic/low salt cottage cheese to aid assimilation).

Soy Isoflavones 10 mg

Snoopie's supplements for her Liver and General Health include:

Denamarin (Chewable Sam-e with Silybin [refined Milk Thistle], Vitamin A & B) http://www.nutramaxlabs.com/vet/products/Denamarin.aspx

Gluta-DMG (Vetri-Science)
http://www.vetriscience.com/sellsheets/Gluta%20DMG.pdf

Canine Plus Senior (Vetri-Science)
http://www.vetriscience.com/sellsheets/Canine%20Plus%20Senior.pdf

Liver Support Factors (Biochem)
http://www.iherb.com/Country-Life-BioChem-Liver-Support-Factors-100-Tablets/1670?at=1

Vitamin E 200 IU

Alpha Lipoic Acid 50 MG

Snoop had an ACTH Stimulation Test for Cushing’s on August 20th, 2010:

Cortisol Sample 1= 10.6 Cortisol Sample 2= 20.3 Interpretation: Hyperadrenocorticism

The recommendation was to put her on Trilostane.

This brings us to the reason for the post. I am aware that the University of Tennessee (UT) Endocrinology Service may have the most complete adrenal function test available in one place. I did not want to put Snoop on any medication without the supervision of an Endocrinologist here in San Diego and without further testing from UT.

Dr. Jack Oliver at UT seems have up to date research in canine Cushing's disease. UT via your vet offers complete adrenal tests which can also test for sex hormones as well as cortisol. Depending on the results, there are treatment options considerations that can be accessed online or via recommendations per Dr. Oliver’s articles.
I was seeking a veterinarian Endocrinologist in San Diego that is on the "same page" as Dr. Oliver at UT to evaluate and test Snoopie before putting her on any prescribed medication.

I was reaching out to this group to see if anyone had a good recommendation with favorable experiences. Dr. Oliver suggested I contact Dr. Peter Slusser. Hopefully, when I decide on an Endocrinologist here in San Diego, we can repeat her tests and the canine adrenal panel (w/pre and post ACTH Stimulation test, but with sex hormones and aldosterone this time). I feel it may be important to know the bigger picture and obtain a baseline of the sex hormones for diagnosis as well for prescribing any medication.

In retrospect, Snoopie had the typical Cushing's symptoms that are mistaken for old age. She had gradual poor hair coat quality, loss of muscle tissue (especially around the face and rear end) and a barrel chest with a drop in the abdominal area. Additionally, she had the typical increased thirst and hunger. She seemed to be preoccupied with food and was eating odd things to satisfy her hunger. We suspect now that Snoopie's pancreatitis had been a symptom of her Cushing's all along. Because she was apparently healthy otherwise, blood work was not completed at vaccination time. Had this been done the labs may have indicated her liver issues and pointed us to the Cushing’s earlier.

In this case, the only tip off was....ONLY HER APPEARANCE CHANGED. She appeared to be getting old but was not slowing down accordingly. Snoopie's drive and zest for life remained the same over the years as the Cushing's took its toll on her organs, unchecked.

I hope this helps someone else.
Rene and Snoopie

[apollo6]

Dear Rene
Looked up Dr. Slusser, good reviews, on Kearney Mesa Blvd off 52.
Just depends who and which is closer.
I had the same thing with Apollo, butts of pancreatitis through the years never associated it with cushings. Symptoms, hair loss both sides of body, tail, ears, dark skin, skin liaisons, pot belly, weakness in hind legs. Did the same tests, ultrasound, full blood panel, urine cortisol, ACHT STIm. took me a long time before decided on treatment. Apollo has the pituitary cushing. He started on Trilostane in June, started at 10mg. is now on 12.5mg. He weighs between 9 and 10.5 lbs. I was very cautious when I started. He has done well on this low dosage so far. I sent you a private message with my phone number if you would like to talk. Apollo will be 12 in October.
Hugs Sonja and Apollo.

[gpgscott]

Hi Rene,

Thanks for the background information, you have been busy:D

I really don't think it is imperitive that Snoopie be treated by an endocrinologist. As long as you have good labs taking into account all of the adrenal hormones an appropriate treatment should be possible under the direction of any Dr. We did see a specialist but mainly for the U/S we carried out treatment with the adivce of Dr. O under the direction of our GP vet.

Scott

[Rene]

Hello Everyone,

Snoop and I are back with an update!

I was reluctant to put Snoopie on any of the Cushings mediations without giving the "holistic period” a shot. It’s been several months now, I believe since August of 2010. As mentioned in my last post, I placed her on her on several supplements including the Melatonin 1mg at three times a day and NuLignan at 25mg, that Dr. Oliver recommended in his article posted at the University of Tennessee website.

She had several improvements in her overall health, attitude, sleep and personality return. However, she is still is thirsty, preoccupied with food, hair coat quality very poor and pot belly worsening. Her muscle weakening and back end control is rapidly declining. We have been doing stairs and coordination exercises and have had some improvement.

Interestingly, even though the Cushing’s is making her “dump” her nutrients, food and make her think she is starving she is being picky and refusing the food that is good for her… low fat, normal protein, grain free, organic, low sodium, dry kibble food.
She wants people food…processed high fat, fillers, and grain, anything that will provoke a pancreatic attack or aggravate the fact that she does not have a gall bladder or spleen! Of course she is not indulged. She eventually gets hungry enough and gives in.

Breaks my heart. She has maintained her weight, even put on a few pounds, with my prodding, but does not look good.

In the end of December 2010 all of the sudden Snoop could not close her left eye, they turned beat red, tearing, the left side of her face drooped, she could not eat hard kibble and her back end was veering to the left. It seemed she suffered a stroke. Even her left eye veered off, but she was a bit walled eyed from the start! Considered Macroadenoma.

The vet said it was it most likely the Cushing’s. When she had a MRI in July 2010 they did mention that there was a clot somewhere and that if it broke loose it could cause a stroke but that was the least of her problems, so it went on the back burner.

I am leaning toward the stroke. It came on quick and has gotten better every day.

Snoops labs were repeated in Jan 2011.

Dr. Slusser here in San Diego sent her blood for testing to Dr. Oliver at the University of Tennessee. Full blood tests, the full University of Tennessee adrenal panel with sex hormones and pre and post ACTH were conducted analysis and interpretation.
The cortosol and sex hormone levels were all high again. Definitely, Snoopie has Cushing's disease (high cortisol) and Atypical Cushing's syndrome (sex hormones are increased). Pituitary tumor biased.

The recommendation from Dr. Slusser was to start her on lysodren. We have an appointment on Friday, January 21, 2011.

Once again, I am reaching out to this group with personal experiences with similar experiences that may give me guidance, insight and hope.

Thank You,
Rene

[StarDeb55]

Rene, I have treated 2 pups with lysodren. My first boy, Barkley, was successfully treated for nearly 8 years, crossing the bridge at 15, due to medical causes unrelated to his Cushing's. Barkley was diagnosed long before anyone knew anything about intermediate hormone elevations, or the UTK panel being available.

My 2nd pup, Harley, who I lost in early October due to a fast growing oral cancer, was diagnosed 2 1/2 years ago, & successfully treated with lysodren. I was fortunate that my GP vet had started using the UTK panel to diagnose his Cushing's patients. Harley came back with across the board elevations in cortisol & all 5 intermediates. Initially, I did have Harley on the melatonin + lignans, along with the lysodren, but after doing research, including what I learned from this group, along with what my vet learned, I did stop the melatonin +lignans. I did this because lyso will control all the production of hormones, including intermediates, coming from the adrenal glands. The one catch to this is estradiol as their are non-adrenal sources of estradiol production such as fatty tissue, gonadal tissue, & a couple of other areas. When I had Harley's diagnosis confirmed by an IMS, her comment concerning trying to control the non-adrenal production of estradiol with the melatonin + lignans was, "It's a crap shoot, sometimes it will work, sometimes it won't." Harley did fine on the lysodren alone.

Let us know how your IMS appointment goes.

Debbie

[frijole]

Another success story.. my gal Haley went on lysodren at the age of 12 and was on it for 4 1/2 yrs. She passed away in May from other causes and I have no doubt whatsoever that lysodren and the people on this forum are what gave me those 4+ years. You will do fine. Kim

[Rene]

Thanks Debbie and Kim!

Sounds like Lysodren is going to be the way to go. If it is going to be a long term solution what is the most economical source that you have found in your experiences?

Rene and Snoop

[StarDeb55]

Rene, Harley was a little guy averaging about 12 lbs. on his good days. Commercially available lysodren come in 500 mg. tablets only. Loading dosage is calculated on the following formula, 25-50 mg/kg. You can see that even cutting this big tabs in 1/4 would be too much for a little guy. I had Harley's lyso compounded at Diamondback Pharmacy in Scottsdale. They can make any dosage you need, & I'm pretty sure they will ship anywhere in the country for a standard shipping fee. There are a lot of members who have used Diamondback, & I still use them for medication for my Lhasa. With Barkley, I simply cut the 500 mg. tabs.

After all of the above, a max loading dose for Snoop of 50 mg/kg would be 568 mg. daily, so the 500 mg. tab would work. You would still have to cut the tab as the loading dose is give twice a day, so you would be giving 1/2 tab twice per day. If you want to opt for cutting pills, you want to make sure you have a dedicated pill cutter used for only the lysodren, & make sure you thoroughly wash everything that touches the lysodren, including your hands. I don't want to scare you but the lyso is considered to be a chemo drug.

Debbie

[frijole]

Haley weighed 17 lbs and so we could use regular lysodren and I cut with pill cutter. I bought mine from drugstore.com. Much cheaper than the vet. They called the vet for an updated rx when necessary and it was so simple for me.. within days I had my refill. Highly recommend them. Some also use Costco. Prices are similar - or they were last I checked. Kim

[Rene]

Debbie,

I just found the thread about the AAA discount on the lysodren and other drugs not covered by insurance. I downloaded the discount card. What a helpful thread.

AAA offers 15% off on Brand and 20% on generic drugs at CVS, Wallmart, Cosco and other pharmacys if you are a automobile club member and present your card with the prescription savings discount card. Here is the link for the discount card.

http://www2.caremark.com/aaa/rxdirect_aaa.pdf

http://www2.caremark.com/aaa/

Thanks for the info about the lysodren.

Rene & Snoopie

[Squirt's Mom]

Hi Rene and welcome to you and Snoopy! :)

Girl, you sound a bit like me when my Squirt was first diagnosed except you really have it all together! I was determined not to start her on any of the traditional meds until I had covered every base and knew all I could about what was going on with my Sweet Bebe. She was originally diagnosed with PDH. She was on Anipryl (Selegiline) for about 9 mos. and did really well on it but then after a second U/S a splenic tumor was found. Once that and part of her spleen were removed, her cortisol returned to normal and remained that way. So, I whole-heartedly agree with you that an ultrasound saved my baby girl's life! :D

Squirt's cortisol has been creeping up over the last 2 yrs. and on her last UTK panel the cortisol as well as the andro had gotten higher than I was comfortable with so she is now on a maintenance dose of Lyso. This is her 3rd week and she is doing quite well. The first two weeks, she would have an off day on her med days but that has improved this week.

I wanted to make sure you know that the recommended dose of melatonin for a pup Snoop's size is 3mg BID - am and pm. Squirt weighs 14 lbs and continues with her melatonin (3mg BID) and her lignans (120mg SID) along with the Lyso (125mg 2x/week).

From the May, '10 UTK treatment sheet:

Typically, a dose of 3 mg is given q12hrs (BID) for dogs <30 lbs; a dose of 6 mg is given q12hrs (BID) for dogs > 30 lbs.

This can be found in our Helpful Resource Section:
http://www.vet.utk.edu/diagnostic/endocrinology/pdf/TreatmentInfoAtypicalCushings201005.pdf

Hope? Oh, honey, there is so much hope to be found here! So many success stories with both Lyso and Trilo among our little family! There is also, of course, heart-break but seldom as a result of Cushing's. We have babies here who have overcome so much and continue to live happy, enjoyable lives in spite of it all!

You and Snoop do not have to take this journey alone. We will walk every step of this path with you. We are here to help in any way we can. You have found the best bunch of folks around! The collective knowledge and first-hand experience is astounding and the good old-fashioned hand-holding just can't be beat! I really don't know what Squirt and I would do without our family here and I believe you will find the same to be true for you and Snoopy.

Keep up the good work! Snoopy is one lucky fellow to have such a devoted and involved mom by his side!

Hugs,
Leslie and the girls - always

[Rene]

Thank you everyone for your helpful advise and very kind words.

Snoop and I will see the Dr. tomorrow and I assume start the lyso. What should we expect? Will she be very sick? She is a fussy eater as it is. She picks at about cup and three quarters of dry grain free kibble a day. But she would woof down a peice of bacon if given the chance! I have been told that because of her lack of spleen and gall bladder and now the cushings it may be better to switch her to the canned wet version. I am reluctant to change anything right now before starting the medication.

Another factor may be the probable stroke she may have suffered around Christmas. She still has left sided facial lax, food gets pocketed on that side, trouble blinking that eye, muscles week along her left rear end, and most troubling her eyes are really discharging and she is having trouble catching a treat and hearing is going.

She sounds like a wreck...but she is a active happy little thing who is having a great dream right now. She must be chasing rabbits because she is muffled barking and her little legs are going a mile a minute!

Too cute.
Rene

[Rene]

Here are Snoops labs from January 2011.

Cortisol ng/ml 104.8 baseline (2.1-58.8 normal) 426.4 post ACTH (65.-174.6 normal)
Androstenedione ng/ml 2.44 baseline (0.05-0.57 normal) >10.0 post ACTH (0.27-3.97 normal)
Estradiol pg/ml 125.1 baseline (30.8-69.9 normal) 125.7 post ACTH (27.9-69.2 normal)
Progesterone ng/ml 0.97 baseline 0.03-0.49 normal) 20.8 post ACTH (0.10-1.50 normal)
17 OH Progesterone ng/ml 0.99 baseline (0.08-0.77 normal) 26.8 post ACTH 0.40-1.62 normal)
Aldosterrone pg/ml 30.5 baseline (11-139.9 normal) 152.9 post ACTH (72.9-398.5 normal)

Her urine was clear and her blood was in the normal ranges except:

ALT 375 IU/L (12-118 normal)
Alkaline Phosphatase 1692 IU/L was 2000+ (5-131 normal)
GGT 90 IU/L (1-12 normal)
BUN 32 mg/dL (6-31 normal)
Phosphorus 6.2 mg/dL (2.5-6.0 normal)
Cholesterol 646 mg/dL (92-324 normal)
Lipase 907 IU/L (77-695 normal)
Neutrophils 11868 /uL (2060-10600 normal)
Monocytes 966 /uL (0-840 normal)
Platelet Estimate Increased
Platelet Count 880 /uL (170-400 normal)
T4 .6 /rg/dL (1.0-4.0 normal)

Her WBC was 13.8 /uL (4.0-15.5 normal)
Creatinine 1.5 (0.5-1.6 mg/dL normal)
BUN Creatinine Ratio 21 (4-27 normal)


Can anyone interpret or give insight as to what is going on or may be comming?

[frijole]

Rene can you post the normal ranges next to anything that was high or low? That way we know how to read it. Thank you! Kim

[Rene]

I edited the post Kim.

Thanks for looking!

[StarDeb55]

Rene, just to let you know, I'm a lab tech with 30+ years experience. On the general labwork, I'm going to need a wee bit more information to give you meaningful input. With the elevated BUN, I need to know what the creatinine is, even if it came back normal. Both of these tests are to check kidney function, but the creatinine is the most important of the 2. With the elevated BUN, was Snoop fasting for this bloodwork? The neutrophils are a specific type of WBC that help the body fight bacterial infections. What was the total WBC count?

The elevated liver function studies are pretty typical for a cushpup. In light of Snoop's history of serious gallbladder trouble even with it's removal, these elevations don't really surprise me.

Hope this helps.

Debbie

[Rene]

I thought I remembered one of you were a lab tech...Im glad I posted those results. Thank You!

Snoop picks at her dry food until about 6pm then she starts eating. Her blood was taken in the late morining and she had had very little kibble if any so I guess you may call that fasting?

Her WBC was 13.8 /uL (4.0-15.5 normal)
Creatinine 1.5 (0.5-1.6 mg/dL normal)
BUN Creatinine Ratio 21 (4-27 normal)

Thanks Debbie

[frijole]

:) Deb rocks. I just knew she'd need the ranges. She does the magic with it.

[Rene]

We went to the Dr. yesterday. Snoopie weighed in at a little over 27 pounds. She was prescribed 3/4 of a 500mg tablet of Lysodren once every 24 hours for five to ten days. We were also given the predisone in case of an emergency.

I used the AAA Prescription discount card mention earlier and my Automobile Club Card and received the discount at Cosco. For ten Lysodren the cost was $59.20 with the discount it brought it down to $50.38.

We started the Lyso late afternoon yesterday and so far so good!

Rene and Snoopie

[StarDeb55]

Sorry, I didn't get back to you the other night, Rene. With a nice, normal creatinine, & BUN/creat ratio, kidney function is not an issue. BUN can be affected by a lot of things including simple things such as dehydration, & a high protein diet, this is why I wanted to see the other values. Even though the WBC were normal, I do have a mild concern about the elevated neutrophil count. Has Snoop has any signs of any type of infection including a UTI lately? I know that this kind of elevation can also be associated with Cushing's, so if there is not an obvious infection, I wouldn't be overly concerned.

Debbie

[Rene]

Thanks Debbie,

Snoopie has not been prone to accidents in her 12 years, she is very well behaived. However, only when it has been raining she has urinated on the floor just inside her doggie door about six times in the last year and a half. We make excuses for her because of the rain, cold, lack of gall bladder, spleen, rear end weekness, age and trying to get out the dog door when all this is occuring.

She could be spoiled ;}

Just in case, knowing that infections can occur, I have been giving her a Spring Valley Cranberry Fruit plus Vitamin C Supplement, which is equivilant 40 mg cranberry concentrate powder, 3 IU of Viamin E and 100 mg of Vitamin C. I don't know if this will skew urine results but, I believed it would not. Her urine results were negative while taking the supplement and having an accident on the floor. Please correct me if I am wrong.

On a different and positive note, Snoop has received her third dose of the Lysoderm tonite.

So far she is her old self, even improved!

She is a really pickey eater. She traditionaly refuses the food that is good for her begs for people food, non stop. Since starting the Lyso she has eaten her good food ahead of schedule and wants more! She seems more engaged, social and less food orienated.

Thank you again for all of the support, to all of you!

Rene and Snoop

[Rene]

Hello Everyone,

Just checking in with an update with Snoopie and her loading dose of Lysodren.

She been loading for seven days now and tonite will be the eight day of three quarters of a 500 mg tablet of Lysodren. She has shown no signs of a problem. The Dr. wants her to go to the tenth day then an ATCH test on the eleventh.

I guess after that he will decide on a maintance dose.

Rene and Snoopie

[frijole]

Thanks for the update. Keep the eyes open for any changes - regardless of how small such as simply pausing before eating. Also check the stools to make sure they are firm. If they are getting soft it might be a sign you are close. Best, Kim

[Rene]

Thanks Kim,

It is hard to tell with her because she does not bolt her food and picks at it all day when my husband is home with her. After I get home in the evening she starts crunching about five and picks until it is gone around ten pm. I have been off the last two days and cooking in the kitchen because we have house guests. She has been distracted by the cooking and guests and has been behind her slow eating schedule but catches up by bedtime. I have only noticed a slight drop off in her water intake during the day. But, when she finally catches up and eats the dry kibble she drinks the water with it then. It all seems at the end of the day the food and water intake is the same.

Is she just distracted or are these the signs we were told to look for that she is loaded and we need to get her in for a ATCH test tomorrow?

Anybody?

Rene and Snoopie

[frijole]

My dog Haley was like that and that is why I mentioned checking out the poop. Kind of gross but since you want to avoid diarrhea (sign of too much lysodren) I started poking it with a stick right after she did her duty to check consistency. It was gradually getting 'thinner'. It never got runny but it had changed. I opted to have the acth and she was at 1.8 so I am glad I did. (1.0 or lower too low) So you might check it out just to see how it looks.

It is a tough call because each dog is different. You know your dog better than anyone so when in doubt you make the call. Vets give you a date for the test because they need a no longer than date but if you think it might be time simply call them to arrange an earlier test.

Kim

[Rene]

Thanks Kim,

Her stools are the same as usual.

She has had eight loading doses of lysodren now. The only changes I have seen was when we first started the lysodren she seemed "peppy", more engaged and less food oriented for the first few doses and was ahead of her eating and drinking ritual.

That went away after a few doses then was normal for a few doses as it was before we started the lysodren.

Now, we have had house guests the last few days and I think that has distracted her and put her behind her eating and drinking ritual. But, she catches up because by the end of the day her food and water consumption has remained the same.

This is for Debbie, if she is still reading. You asked about a possible infection. I was focused on urinary. She has not had any urinary troubles that I know of. Did you have a comment on the cranberry supplement?

However, we did take her to the tooth doctor in December when she temporally went off her food. Turned out it was the left side facial nerve/stroke problem that was giving her trouble eating as it has gotten much better since. But, she still cannot blink her left eye. But, the vet he did say snoop could use a good cleaning. He said she may have a bad tooth on that side but would not know for sure until he put her under sedatation for a good cleaning and then possibly extract it.

We did not have that addressed obviously until her cushings issues are stabilized.

Also, Debbie I have been told by the vet that Snoops ATCH and hormones were very, very high. The vet said he only sees a few dogs a year that present that high. Are they high for what you see this group posting at and if they are is it typical to see a longer loading period for the higher levels?

Thanks Again,

Rene & Snoopie

[apollo6]

Just checking in. To say hi. Will try and read your thread.
Sonja and Apollo

[Rene]

Hello,

Snoopie loaded for the full ten days with no changes in her routine. In Snoops case she did fine for the ten days. Then after the maximum loading period of ten days and off the lysodren, on the twelth day she went off her food by about one third.

She was tested on the eleventh day and her ATCH came back pre 6.0 and post 10.9. Still not where we want it to be but will start the maintenance dose of 500 mg once a week and recheck in month.

I am still curious if anyone knows if pups with very high cortisol levels to start with take longer to load and are more difficult to get down to the desired ranges?

Sonja...thank you for checking in. Some of us are readers and get a great amount of comfort from the posts of the group knowing we are not going through this alone. The last week Snoopie has received a lot of hugs and kisses with you and Apollo in mind. I know today has not been the best of days.

Hugs,
Rene & Snoopie

[frijole]

Rene, I'm glad you did the acth test because you just never know and better safe than sorry. I don't understand why your vet is putting you on maintenance. Here is how it works - giving lysodren daily reduces cortisol and you do it til you are somewhere between a 1 and 5. Then you give that amount weekly and that amount will maintain that level. (that is the goal anyway)

When you stop at 10.9 the cortisol is not within the desired range - or close and what normally happens is the maintenance dose is NOT sufficient to maintain and so you will go slowly back to where you were and you will see a return of the cushing's symptoms.

There is no magical amount of time or formula for how long it takes... I wish! My dog Haley took daily doses of lysodren for 2 1/2 months - a record here. Thank GOD after we finally got there I never had to do the daily dosing again.

If you continue to see symptoms for cushing's I would not wait 30 days - I would tell the vet that the cortisol is going back up and discuss increasing the dosage a bit. This would shorten the load time.

Good luck! Kim

[Rene]

Thanks Kim,

I was under the impression that there was a max of a certian number of days for loading lysodren that was why I was so anxious. So many people posted that they loaded in only a few days. I had no idea.

My vet did tell me he is very cautious with his treatments.

Snoop did go off her food two nights after stopping the lysodren. She still has not gotten quite back to normal with her food intake. Water is a little less. I saw that someone posted that the lyso may stay in their system up to 48 hours after the last dose. If this is the case and she is showing signs of after the fact of being loaded maybe, it was a good thing we stopped. She was tested before the 48 hours so only time will tell.

As far as "showing signs of cushing" before the 30 days what should I look for. All of her symptoms are the ones aquired over time. Hair loss, pot belly, muscle weekness, ect. and will take time to resolve.

Thank You...I have been feeling a bit lost.

Rene & Snoop

[Rene]

Also, how long should you start up the maintenance dose after the last loading dose?

[StarDeb55]

I'm just catching up on things, Rene. I hate to be a "killjoy", but I have grave concerns with taking Snoop to maintenance with a post of 10.9 after loading. As Kim has already said, this is nowhere close to where you need to be. If you were close, say 6, it would be worth trying to just up the maintenance dose. My concern is based on personal experience.

When Harley was first diagnosed & his first load, I found something like a 20% drop in water intake on about day 5, if memory serves. I had to rely on water as Harley was an extremely picky eater. His post on his stim was a little over 12 which the IMS was willing to go with since his symptoms had cleared up. The kind folks in this group tried to warn me that this wasn't going to work, that 12 was too high, & I was probably going to see a return of symptoms in short order. Sure enough within 2 weeks, Harley was drinking buckets, & peeing gallons. I, literally, had to blow up with the IMS office to get him back in for a stim. It took almost another week & by that time his post had climbed to >20. I had to do a re-load & start from scratch. I'm just concerned that this is not going to work for Snoop.

Debbie

[Rene]

Thank you Debbie,

I appriciate your honesty. Im glad you are back. Snoops results from 02/01/2011 were:

Cortisol Sample 1 6.0 reference range 1.0-5.0
Cortisol Sample 2 10.9 reference range 8.0-17.0

She received her last Lysodren about 12 hours before the test. She went off her food by one third about two evenings later. She is still not back to her full ration. Unfortunately, her test was before she went off food and before the Lysodren was out of her system. Could it have dropped since and she be in the reference range?

I guess what I am saying is we would have stopped loading her because she did alter her food intake.

Confused.

Rene & Snoopie

[AlisonandMia]

Also, how long should you start up the maintance dose after the last loading dose?

I'd start ASAP - because you haven't actually loaded as such (not down between 1 & 5 on the post reading) there is no risk that you will go too low because of dosing too soon which can be an issue with a truly loaded pup.

I am hoping that this maintenance dose will be enough to at least hold the progress you have made so you don't have to start all over again. I think at some point you are going to have to resume the load to get down within the 1 - 5 range and thus resolve the symptoms. If the adrenals can produce more cortisol than that then the daily dose of cortisol in the dog's body will be high enough to cause Cushing's symptoms although they may not be quite as severe as they were when the levels were really, really high.

My dog was also one who took ages to load - 30 days. At the 10 day test she was pretty much where Snoopy is now (around 10) and was definitely looking better (brighter eyed) but was far from there (still had many clinical symptoms). We kept on loading and eventually we got there. I think one of the reasons that Mia took so long to load was the the vet was being very careful and conservative in his dosing and the loading dose was actually a bit too low. She would likely have loaded in half the time (still a long load) on a higher dose.

Strange as it may seem, the initial level of cortisol before loading doesn't seem to have much if any effect on how long it takes to load. Things that seem to affect the length of load are:

1. The daily dose given (mg/kg).
2. Size of dog (large dogs seem to need a smaller mg/kg dose than do small dogs and so will load quicker on a given mg/kg dose - although there are plenty of exceptions to this rule.)
3. The amount of fat in the diet - the higher the fat content the more Lysodren is absorbed so the larger the dose the dog's adrenals actually receive.
4. Individual sensitivity to the drug. Some dogs are just not that sensitive to the drug. We have noticed that a lot of beagles tend to be less sensitive than average and many have longish loads. Again that is a generalization and there would be exceptions.

I'm sure you've already told us, but how much does Snoopy weigh and what was her daily dose of Lysodren?

Alison

[Rene]

Welcome Alison!

You bring up some very good points. Snoopie is on a very restricted diet. She has suffered a few bouts of pancreatitis and has had her gall bladder and spleen removed. Snoop needs a little extra help processing her food so all she receives is a grain free, low fat (11%) and sensible protien (21%) kibble. I give her an excellent digestive enzyme with pro-biotics.

http://www.total-zymes.com/pdf/TotalZymesPlus.pdf

Snoopie weighed in at a little over 27 pounds. She was prescribed 3/4 of a 500mg tablet of Lysodren once every 24 hours for five to ten days then a maintenance dose of 500 mg once a week.

Thanks,

Rene & Snoopie

[Rene]

Can anyone convert the values of the University of Tennessee Cortisol tests for me from ng/ml to ug/dl so I can compare them with after her starting the lysodren?

Snoops test on 01/31/2011 from UT was:

Cortisol ng/ml 104.8 baseline 2.1-58.8 normal range
426.4 post ACTH 65.-174.6 normal range

[StarDeb55]

I am almost positive you simply move the decimal 1 place to the left. For example: 104.8 on the baseline, is 10.48 ug/dl.

Debbie

Rene, I just your response to Alison about the maintenance dosing schedule. Once a week dosing is not the ideal schedule. Dr. Edward Feldman at UC Davis, one of the world's foremost experts on canine cushing's, recommends that maintenance dosing be split over several doses during the week. For instance, you could split the 500 mg. tablet into quarters, & give 1/4 M, T, Th, F. The problem with once a week dosing is that you are giving the adrenals a 6 day rest with no medication. In dogs who regenerate their adrenal cortex very quickly, 6 days off would be more than enough to send their cortisol very high.

[Rene]

It does make sense to give the maintenance over the course of the week. Thank you Debbie.

I moved the decimal over and here are Snoops Cortisol numbers:

08-20-2010 pre 10.6 post 20.3
01-13-2011 pre 10.5 post 42.7

After loading Lysodren ten days:
02-01-2011 pre 6.0 post 10.9

Rene & Snoopie

[StarDeb55]

It's obvious that the loading has brought Snoop's cortisol way down. If you are seeing diminished symptoms, this is probably why. Unfortunately, I will still have to stick with what I told you earlier. 10 is not within the desired range on the post, & I'm concerned that going to maintenance at this time will not work. You really need to continue loading for a few more days.

Debbie

[lulusmom]

Hi Rene,

I'm not sure Debbie saw one of your earlier posts where you mentioned that the stim test was done only 12 hours after the last dose of lysodren and that you noticed 48 hours later that Snoop went off her food by one third. Lysodren has a cumulative effect so it is possible that cortisol continued to drop for a few days after the stim. For this reason, it is always optimum to do the stim test 48 hours after the last dose. How low cortisol dropped in those two days is anybody's guess and we can only hope that the drop in water intake and appetite are good indications that post cortisol would be a lot closer to 5 than it is to 10. I have the same concern Debbie has and feel it's a crap shoot as to whether or not the maintenance dose is going to be enough the sustain the erosion achieved by loading. What did your vet have to say about all of this?

[StarDeb55]

Oh, I saw it alright, but I'm still have serious doubts, with factoring the cumulative effects of lysodren in to the picture, that Snoop is low enough to go to maintenance. I agree that there were signs of loading, but, IMO, the post might have been 7-8 at that point, but to drop from 10->5, mmmmmm????

Debbie

[Rene]

Welcome Glynda,

The Dr. is very conservative. He also thought that because she slowed down on her food intake two days after we stopped loading, it may have been a good time to stop.

However, I agree with Debbie that im not sure she could have dropped that much cortisol in the meantime.

The other part of the rub is, I misunderstood on when to start the maintenance dose of 500mg once a week. When I realized I was suppose to start it right away I confirmed this with my vet and gave it to her on day fourteen. She was back on her normal food and water routine. She ate all of her dinner late last night before dosing her.

After sound advise from Debbie, I called the vet back and he confirmed that the maintenance dose could be given in a single dose or several doses throughout the week. We will be breaking down the maintenance dose in the future. Thank you, Debbie!

This would put Snoop at:

Ten days of 3/4 of a tab of 500mg lysodren
Day eleven, twelve and thirteen no lysodren.
Day fourteen 500mg lysodren.

The only thing that has me saying maybe she did load is this very unprofessional way of looking at things.

She did drop from a post 42.7 to a post 10.9 in the ten days. That was a mean drop of 3.18 a day. If she was tested less than 12 hours after her last dose, that day would count as one 3.18 drop period. Then if the Lysodren remained in her system for two more days of blocking cortisol, that would be two more 3.18 drop periods bringing her cortisol level down to 1.36.

Then, if I maintenanced dosed her a full 500mg on day fourteen (yesterday) this could have served as another loading dose.

Now, I guess I need to decide when I should start her quarter tablet (125mg x 4 weekly) for her maintenance dose?

Way over analyzing!

Rene & Snoop

[frijole]

Rene, You are doing a great job! As you know from my original post, I agree with the others that you should have loaded a bit longer but... for now, since you waited 2 days to begin maintenance and gave the full 500, I'd start the smaller doses right away... because in my mind it gives you a better chance of maintaining your 10.

Kim

[Rene]

Thank you Kim, nice for you to say!

I was upset with myself because I messed up her dosing. But, after the kind words of the group, I am feeling a bit like it may have been for the better.

I have a new question for the group.

Snoops Estradiol was 125.1 and post 125.7 pg/ml (reference 30.8-69.9 normal/27.9-69.2 post). Her other hormones, except aldosterone, were also elevated. I had her on HMR Lignans and melatonin but the melatonin was too low. I was going to start again, after she is tested in a month, if the Estradiol does not come down (doubtful).

Where can I get HMR Lignan in the correct dosage for Snoop (27 lbs) at a good price? The brand I was getting is no longer avaiable.

Thanks again,

Rene & Snoopie

[marie adams]

Hi Rene,

Welcome!!:) In the beginning with my dog Maddie, I had a very conservative vet who ended up messing up Maddie's original load--I was nervous about the Lyso so I was okay with being conservative, but even gave her a higher dose than what he wanted, but not the correct dose--which meant we had to load again. Of course this vet thought he knew it all--haha!! Everyone here knows their stuff so much better; they helped me educate myself and know what was the right dose. I got to the point I knew more than the 2nd vet we went to. It can be very confusing and frustrating so hang in there.

Do not beat yourself up for not knowing because we have all been there. Keep doing the great job your are and keep asking questions here, then question the vet.

[Harley PoMMom]

Where can I get HMR Lignan in the correct dosage for Snoop (27 lbs) at a good price? The brand I was getting is no longer avaiable.

Thanks again,

Rene & Snoopie

I don't know about the pricing for the HMR lignans but you may be able to find a suitable product from this link: http://www.vet.utk.edu/diagnostic/endocrinology/pdf/20100810-LIGNAN

Love and hugs,
Lori

[lulusmom]

Hi Rene,

I wanted to mention that Lysodren usually addresses the intermediate hormones as well as the cortisol so chances are, once you get the cortisol within the therapeutic range of 1 - 5 u/dl, Snoop won't need the lignans or melatonin. Estradiol is the only intermediate that can be found in tissues outside the adrenals and Lysodren would not be effective in these cases; however, I wouldn't worry about that scenario because I doubt that will be an issue. I personally don't remember any dog being effectively controlled with lysodren who has had a return of symptoms due to elevated estradiol. If I were you, I'd focus on getting the cortisol where it needs to be and I think everything else will fall into place....symptoms will resolve and no further UTK adrenal panels should be necessary.

Glynda

[Rene]

Thank you Marie, Lori and Glynda!

I have seen the literature you referred to but I am still curious what the dosage for HMR Lignan for a 27 lb pup might be and what other sources may have been found in that dosage from the group.

Even Dr. Oliver was not specific on the dosage for a 27 lb pup, "10-40 mg for a small to large dog" seemed vague.

However, he did say that he felt Snoop had a good response to the loading of her lysodern and "was where she needed to be" to start the maintenance dose. He felt her adrenals were producing the Estradiol and not the other tissues. He agreed with my vets recommendation to recheck the Cortisol in 30 days. He said we could also recheck the baseline Estradiol if I was concerned about it. He was confident all the other elevated hormones including the Estradiol would resolve with just the lysodren.

We will just have to watch and be patient.

Rene & Snoopie

[Squirt's Mom]

Hi Rene,

If I am understanding you, there was a UTK panel done after the load? Would you mind posting those results?

Thanks! We do love details and when info seems to be missing that is being referenced, it helps us to see that info.

Hugs,
Leslie and the girls - always

[Rene]

Hi Leslie,

No...Her UTK Panel was done before in January 2011 here they are:

Cortisol ng/ml 104.8 baseline (2.1-58.8 normal) 426.4 post ACTH (65.-174.6 normal)
Androstenedione ng/ml 2.44 baseline (0.05-0.57 normal) >10.0 post ACTH (0.27-3.97 normal)
Estradiol pg/ml 125.1 baseline (30.8-69.9 normal) 125.7 post ACTH (27.9-69.2 normal)
Progesterone ng/ml 0.97 baseline 0.03-0.49 normal) 20.8 post ACTH (0.10-1.50 normal)
17 OH Progesterone ng/ml 0.99 baseline (0.08-0.77 normal) 26.8 post ACTH 0.40-1.62 normal)
Aldosterrone pg/ml 30.5 baseline (11-139.9 normal) 152.9 post ACTH (72.9-398.5 normal)

Her urine was clear and her blood was in the normal ranges except:

ALT 375 IU/L (12-118 normal)
Alkaline Phosphatase 1692 IU/L was 2000+ (5-131 normal)
GGT 90 IU/L (1-12 normal)
BUN 32 mg/dL (6-31 normal)
Phosphorus 6.2 mg/dL (2.5-6.0 normal)
Cholesterol 646 mg/dL (92-324 normal)
Lipase 907 IU/L (77-695 normal)
Neutrophils 11868 /uL (2060-10600 normal)
Monocytes 966 /uL (0-840 normal)
Platelet Estimate Increased
Platelet Count 880 /uL (170-400 normal)
T4 .6 /rg/dL (1.0-4.0 normal)



Only her Cortisol was tested after the 10 day loading on February 02, 2011 they were:

Cortisol ug/dl 6.0 pre (1.0-5.0 reference) 10.9 post ACTH (8.0-17.0 reference)

Snoop is still eating and drinking as usual. I sure hope she got loaded properly...but...this sure will be a long wait! She sure makes a lot of noise when she sleeps and her breathing seems labored.

Thanks to all,
Rene & Snoop

[apollo6]

Dear Rene
I have the same with Apollo the labored breathing and noise. Think this is a Cushing issue. Not sure.
Will be praying for you and Snoopy.
HUgs Sonja and Apollo

[StarDeb55]

10.9 post ACTH (8.0-17.0 reference)

Rene, this normal range on this post is not correct. This range is for normal, healthy dogs. The desired range for our pups is 1-5. With your vet willing to accept Snoop's post cortisol of 10, is there any possibility that they have confused the range for a normal, healthy pup with the desired cortisol range for a pup undergoing treatment for Cushing's?

Debbie

[frijole]

Aha... this would make sense.... Rene, I think Deb makes a valid point. A normal reading for a cush dog on lysodren is between a 1 and a 5 which is why we are saying your dog isn't loaded yet. I bet the lab reported it and the vet didn't catch it. I would certainly bring it up. We have seen this happen many times and I can't remember a single time when the dog didn't need to do a reload. You are so close I'd hate to see you wait and go thru the whole thing again. Probably a couple days loading would do the trick. My two cents. Kim

[Squirt's Mom]

Even Dr. Oliver was not specific on the dosage for a 27 lb pup, "10-40 mg for a small to large dog" seemed vague.

However, he did say that he felt Snoop had a good response to the loading of her lysodern and "was where she needed to be" to start the maintenance dose. He felt her adrenals were producing the Estradiol and not the other tissues. He agreed with my vets recommendation to recheck the Cortisol in 30 days. He said we could also recheck the baseline Estradiol if I was concerned about it. He was confident all the other elevated hormones including the Estradiol would resolve with just the lysodren.

Hi Rene,

The above statement has sparked an interest in me as my Squirt is Atypical. How did Dr O determine that the estradiol was not being produced outside the adrenals? I wasn't aware this determination was possible other than trying the lignans and melatonin then waiting to see if the estradiol came back to normal - as it did in Squirt's case. Her estradiol returned to normal prior to us starting a maintenance dose of Lyso. That told me that her estradiol was being produced in areas other than the adrenals. So I am very curious if UTK has come up with some way to determine where estradiol is being produced.

Thanks!
Hugs,
Leslie and the girls - always

[Rene]

Debbie I will recheck the lab report and make sure I reported the values correctly.

Leslie...Dr. Oliver said, because all of the other hormones were elevated he thought the adrenals were producing the estradiol and not the tissues. Im sorry I dont have any other details as I dont quite understand all of this.

Rene and Snoop

[Rene]

Ok Debbie...I finally get it!

I read the lab report. In the notations down below it states,

"POST-LYSODREN: Pre & Post Cortisol levers after Lysodren loading or while on maintenance Lysodren should be between 1-5 ug/dl."

You gals are such sharp cookies!

It just disturbes me that even Dr. O is concurring with the vet about her, "being where she needed to be".

Thanks,
Rene & Snoop

[Rene]

Leslie,

Here is the e-mail conversation between Dr. O and I re: the Estradiol.

"I am concerned about her Estradiol. Your literature indicated that Lysodren will most likely take care of the other elevated hormones but not necessarily the Estradiol. Did I read this correctly? "

>>>"You did, but often when all the hormones are increased, it means the estradiol is probably coming from the adrenal gland. If so, the estradiol will likely come down too. Dr. Slusser could do a base line estradiol level in a month or so, to see if the estradiol value is being lowered. You don't need to do an ACTH stim for this."

Hope this helps,
Rene & Snoopie

[StarDeb55]

I assume you will be talking to your vet, then, Rene?

Debbie

[Rene]

Yeppers,

Also, shot Dr. O an e-mail.

Keep you all posted!

[lulusmom]

It just disturbes me that even Dr. O is concurring with the vet about her, "being where she needed to be".


Dr. Oliver is an amazing man and the world's expert in atypical cushing's; however, I don't believe he should be relied on to be directing treatment for a dog with typical cushing's. Snoop most definitely has typical cushing's. Rene, if I were in your shoes, I would be providing Dr. Slusser with reference material reflecting the targeted therapeutic range for a dog on Lysodren. I don't have time at the moment to provide you with any but hopefully somebody else can. Don't be afraid to tell him that you are confused as to why he thinks a post stim number of 10+ is acceptable and ask him to explain it to you. If he doesn't have the answer, he should be contacting a board certified internal medicine specialist for guidance.

Glynda

[Squirt's Mom]

Hi Rene,

Thank you for sharing the email about the estradiol - that is interesting. Not all of Squirt's intermediates were elevated on every UTK panel, they varied. But her estradiol was always elevated until the last panel. It will be interesting to see her next panel after she has been on a Lyso maintenance for a bit.

Since Snoop does have true, or conventional, Cushing's (elevated cortisol with or without elevations in the intermediates) you may well see all her levels come down with the Lyso, tho I would still be curious about the estradiol simply from a learning perspective. I don't recall hearing that if all the intermediates are elevated that is an indication of estradiol being produced in the adrenals along with the others. Thank you for sharing this with us.

For an Atypical pup, Dr O is the one to rely on IMHO; for a true cush pup like Snoop, your GP/IMS would be the prime source of info and treatment. Unless you see at some point that Snoop is losing hair and having skin issues even tho the cortisol is within range (1-5ug/dl), then I would forget about the intermediates. ;)

Good luck with your vet! Our new vet knows next to nothing about Cushing's and had never heard of Atypical Cushing's, so we are on a learning curve, too. ;):D Dr B has been a champ about it, too!

Hugs,
Leslie and the girls - always

[Rene]

Hello, I hope everyone is well and those who are struggling are finding something to brighten their day!

I need the experience of the group. Now that Snoops water and food intake is less, I would like to switch her from kibble to a canned food.

She was doing fine with dry, slowing her down, picking at it all day when she was "starving".

She was on an organic, grain free, low fat and fiber, with a sensible protein, kibble. She needs help with a highly digestable source of meat, that does not produce gas, as she lacks a gall bladdler, spleen and has had bouts of pancreatitis.

What can you suggest that is good for this little cush pup?

Rene & Snoopie

[frijole]

You might go to http://www.dogfoodanalysis.com/

You have specialized needs and I would hate to make a recommendation. I used Solid Gold for years - all natural and I know it has helped my dogs live long lives. Now my girl is so fussy I have to mix it up and go with whatever she will eat on a given day.

Hope the site helps you.
Kim

[Squirt's Mom]

Hi Rene,

If you are going to change to a canned feed and what she is eating now works for her, try to match the ME, kcal, nutrient percentages and ingredients as closely as possible. You can cut the info from a bag of the kibble and take it with you to compare to the canned feeds available. Take the time to transition from kibble to canned to make digestive upsets less likely.

A pup eating kibble will drink quite a bit more than dogs on other forms of feed so don't panic if her drinking slows with the change in feed. ;)

Hugs,
Leslie and the girls - always

[apollo6]

Dear Rene
I use Solid Gold made out of Escondido, Ca, also I have used Halo also a good product. But with all the issues Snoope has I would suggest you check with the Vet. I go to a holistic vet-Animal Healing Center, San Deigo, Dr. Weingardt for years and diet is a very important issue with the health of our dogs. Also book Dr. Pitcairn's Complete Guide to Natural Health for Dogs & Cats is a good resource.
I would not recommend anything with the issues Snoope has.
Apollo has always had a sensitive stomach, pancretatis and intestional issues , so he is on a low fat bland diet with the input from my vet. I am dealing with Apollo having a lot of gas now also.
Hope this helps.
Hugs Sonja and Apollo.

[Rene]

Thanks Kim, Leslie and Sonya,

Like Sonya's, my computer crashed and I just got it back right now. I saw that Sonya is trying Honest Kitchen Embark. I will check that out, if it helps Apollo's gas, is grainfree and doesn't upset his pancreatitis it may be the ticket.

I have been having trouble comparing "Apple to Oranges" when shopping to change from dry to a canned food. Leslie mentioned;

"try to match the ME, kcal, nutrient percentages and ingredients as closely as possible."

Some of the canned foods do not have that information and the only compairson that can be made are the Protien, Fat and Fiber. Because of the Mositure content these numbers are ascew. I was told to make the comparison easier, to the dry food, times the Protien, Fat and Fiber on the canned food by four. The people at the food stores say this is not an exact but at least it you can get an idea if you are trying to match ratios of what you were feeding before.

So far this is the closest to Snoop's dry ratios that I have found using this theory;

Dry:
California Natural; Grain Free Lamb
Protien 21%
Fat 11%
Fiber 4%
Moisture 10%

Canned:
Natural Balance Grain Free Chicken & Sweet Potato
Protien 5.5% x4= 22%
Fat 3.5% x4 = 14%
Fiber 1.5% x4 = 6%
Moisture 78% = 312%

Has anyone hear of this theory and is this sound advice?

Hugs,
Rene & Snoopie

[BestBuddy]

I can't find the link I used but this might be worth a look.

http://www.dogfoodscoop.com/dogfoodlabels-partII.html#dryvcanned

Jenny

[Rene]

Thanks Jenny,

I cut and pasted a portion of that link;

"Assuming a can of dog food contains:

• 9% protein
• 4% fat
• 1% fiber
• 81% moisture

At first glance, 9% protein looks on the very low side compared to dry dog food. Now watch this number after we convert it.

1. Calculate the dry matter of the canned food by deducting the moisture
percentage (81%) from 100. i.e. 100 - 81 = 19%.

2. Now, using this dry matter figure of 19%, apply the formula to each of
the components, as follows:

Protein: 9 divided by 19 x 100 = 47.4%
Fat: 4 divided by 19 x 100 = 21%
Fiber: 1 divided by 19 x 100 = 5.3%


Notice the protein percentage now. You will find in many cases, canned dog food values tend to exceed that of dry dog food."

Applying that formula to the Natural Balance example in my last post it changed it:

From Protein 22% to 25%
Fat 14% to 15.91%
Fiber 6% to 6.82%

This is extremely helpful!

All of you have been wonderful.

Rene & Snoop

[Rene]

Hello,

Just got back from being out of town.

I looked at the input on the foods and it looked like the best option for Snoop was the grain free, gluten-free, dehydrated Honest Kitchen Embark.

Snoop has excessive tearing, a little red crust in her ears and black spots on her body. I'm hoping the food change will also help with her gas problems. We started changing her over today and she really gobbled it up.

Snoopie also gets her 30 day ACTH tomorrow (a little over due because of the vacation).

Wish us luck.

Rene & Snoopie

[apollo6]

Dear Rene
I started Apollo on the Embark. Still gas but a little less. The skin problems take a while to resolve themselves due to the weaken immune system.
Sonja and Apollo
p.s. you can call me.

[Bichonluver3]

All 3 of my dogs are on Embark. However, I may have to switch Sparky (diabetic) according to vet as Embark has too much fat for him.
Carrol

[Rene]

Hello All,

Snoops doing very well on the Embark. The gas problems are much better. She is much more active and alert, so maybe she is more comfortable.

I have been dabbing 50/50 water and white distilled vinegar on the black spots (red yeast infection) and they have been flaking off. Some have recommended to add organic cyder vinegar to her drinking water to alter her ph. But, I am hoping that just by changing to the better quality food, that will do the trick. The excessive tearing and stains are already a little less.

Snoops 30 day stim test came back. As suspected, she was not properly loaded. We are re-loading 500mg lysodren till loaded or 7 days then will retest.

03/14/2011 pre stim 6.9 post 24.3

Rene & Snoopie

[lulusmom]

Hi Rene.

I'm sorry to see that Snoopie's cortisol is way up there again. What is Dr. Slusser recommending that you do?

Glynda

[Rene]

Thank You Glynda,

At least we were expecting it.

As you may recall in February Snoop was loaded at 3/4 of a 500 mg tablet of Lysodren for 10 days and STIM tested out at pre 6.0 and post 10.9. She was then put on 500mg once a week for a month.

She has now STIM retested at pre 6.9 and post 24.3.

The plan is to put her back on 500 mg of Lysodren daily until signs of loaded or 7 days and repeat STIM.

Time to go out and chase those rabbits!

Rene & Snoopie

[apollo6]

just checking on you and Snoppie.
Hugs Sonja and Apollo

[Rene]

Thanks for checking in Sonja! Glad to hear Apollo's Stim test was still close to the target range!

Does anyone know if:

B.N.P Triple Antibiotic Opthamologist Ointment (Neomycin Sulfate 3.5mg/Polymyxin B Sulfate 10,000 units/Bacitracin Zinc 400 units)

or

C-Bright Lubricating Ophthalmic Drops (Sterile water, ascorbic acid, glycerin, benzethonium chloride, zince sulfate, boric acid, camphor)

CAN DRIVE UP CORTISOL OR EFFECT AN ACTH Stim test.

Snoop has been on these drops for her excessive tearing.

Rene & Snoop

[lulusmom]

Hi Rene,

The BNP ointment you mention does not have steroids in it so it should not affect the cortisol or the stim test. I have a little foster chihuahua who is on the BNP with Dexamethesone twice a day. My Jojo has also had eye issues over the years, as have a number of fosters to come through here, so I have tubes of all kinds here, including the BNP with Hydrocortisone. The C-Bright Lubricating Ointment does not appear to have any steroids in it either.

[Rene]

Thanks Glynda!

[Rene]

Hi,

It seems the question's never end.

I found, what appears to be, a live tapeworm segment on the floor where Snoop and my husband's cat, Arnie, greeted me when I came home from work today...good grief! No one has even had fleas that I have seen! I checked the bedding and poo's for both. No signs of infestation there...just a lone solider I guess!

I'm assuming, after the vet confirms one or both has worms, they will get meds or a shot.

The question is with the Lysodren, liver issues and other Cushing's issues is this safest way to worm Cushing's pups or are there alternatives?

Rene & Snoopie

[lulusmom]

Okay, Rene, you've finally stumped me. I have no idea which wormer you should use. :confused: I'm happy to say that worms are one problem I haven't had to deal with. Give your vet a call and let them know about the worm. Who knows, they may be able to give you a name of an over the counter dewormer and save you a trip to their office.

[Rene]

Hi Glenda,

She is going to be wormed, she is due. I was concerned about the method with these cush pups. I am wondering if there are bad experiences out there with the meds or if someone knew of a hollistic method that may be gentler but still effective.

I just found something again on the organic apple cider vinegar. I was reluctant to give it to her internally for her red yeast infection. Its working great externally. But now it seems worth a try if a teaspoon in her food or water will take care of both the tape worms and the yeast.

Will wait for the results from the vet but any input on the subject from the group would be appriciated.

Rene & Snoop

[apollo6]

Dear Rene
Sorry what you are going through with Snoppie. Don't have an answer for you. The vet would probably know what is best. There are natural products out there. But no way of knowing if they are legitimate.
With an already weak immune system it is harder for our furballs to fight things.
Hugs Sonja and Apollo

[Rene]

Thanks Sweetie!

They are just bumps in the road. We were very lucky to have are angles with us to hold and keep us grounded at the end of the day. Every day is a blessing. My heart goes out to those who can no longer can cudle theirs.

Im am just frightened that a mistake might be made that could cause a liver, kidney or other crash. As educated as vets are sometimes the experience and wisdom of this group has proven to be lifesaving.

Rene & Snoopie

[Rene]

Good Morining.

Last night was the seventh day of re-loading the 500mg of Lyso. The vet wanted me to call after the seventh day of loading to revaluate.

Her water intake is the same. Yesterday, she ate her late afternoon food no problem and was dosed. She only ate one third of her evening food and I had to put it in the refrigerator. However, she ate a bowl of dry food I leave out (that she really never touches) in the meantime! Maybe the worms are making her unusually hungry and throwing off the loading signals or the Lyso is making her feel better and stimulating her appetite? She then woke me up at 2am and wanted the rest of her food and gobbled it up.

This morining she ate her breakfast no problem. Too many mixed signals. Im getting the feeling she is not loaded yet.

To make matters worse the vet has been the "only one in the office all week" and has not called back re: the worm issue so i'm still in the dark there.

Rene & Snoopie

[lulusmom]

Hi Rene,

The squeaky wheel gets the grease so keep calling your vet until you get through. Tell him you saw a tapeworm and if he doesn't have meds in the office, ask if you can pick up a prescription for Droncit. This is what the rescue uses for tapeworms and we see worms a lot in shelter dogs and puppies. Good luck.

Glynda

[Rene]

Hi Glynda,

I got to speak with the vet. We don't believe she is quite loaded yet so we are going to keep loading her probably till monday then retest. As far as the worms he said worming her won't be a problem even while loading her. I asked him for the Drontal Plus, which I believe is a broad spectrium version of what you suggested, but he did'nt carry it so I will have to find it on line and call in the RX.

Rene & Snoop

[lulusmom]

Hi Rene,

I'm glad you finally got through to your vet. I didn't think the deworming would be a problem but you just never know and better safe than sorry. Please keep us posted on Snoops progress. I know your plan is to keep loading until Monday but please check in daily and let us know how it's going.

Glynda

[labblab]

Hi Rene,

Just one thought before you go forward with the deworming -- might you want to take in a fecal sample for your vet to analyze? It sounds as though you're not sure whether Snoop or the cat is the host, and it also seems a bit odd that you would have discovered only one single segment and absolutely no other evidence. Are you positive that what you saw was actually a tapeworm segment?

As I say, it's just a thought, but maybe a consideration before dosing Snoopie with the tapeworm product.

Marianne

[Rene]

Hi Marianne,

I did find another little bugger giving me the raspberry during poop patrol. I will post an album for those who are interested. Snoops regular vet wants to give her an injectable for the tapeworm.

But, it will all have to wait because Snoopie went off her food this morining and will be getting her STIM today.

Wish us luck,

Rene & Snoopie

[Rene]

Glynda,

I know you mentioned before that it is best to get a STIM 48 hours after the last dose but my IM wanted her in today. What is your take on that?

I am nervous because as you, Kim and Debbie all pointed out she was not properly loaded last time and did not hold on her maintenance dose.

Snoopie weighs 27.5 pounds. Exactly how much maintenance Lysodren should she be getting. Last time she was receiving 500mg. I found this foumula:

Weight % 2.2 lbs x 50mg = maintenance dose

27.5%2.2x50= 625mg Lysodren

Would this be correct? If so, no wonder she did'nt hold.

Rene & Snoop

[Squirt's Mom]

Hi Rene,

Lysodren doesn't reach it's peak for about 48 hours after the last dose is given so if she is tested today, less than 24 hours after an indication that she is finally loaded, the results will more than likely not be accurate. Her cortisol will continue to fall for at least another day. It is for this reason that it is recommended to do the ACTH 36-48 hrs after the last dose.

Hugs,
Leslie and the gang

[lulusmom]

Yes, 48 hours after the last dose is optimum; however, I'm sure your IMS knows what s/he is doing. If you were talking about a gp vet, I'd be a bit more concerned; however, an IMS is trained and experienced in assessing acth stimulation tests, taking all things into consideration, including timing. I would think that with your IMS knowing that cortisol will continue to drop for a day or two, he'll probably stop the loading if Snoopie is anywhere close to the therapeutic range of 1 - 5 ug/dl. If that happens, you'll be discussing when to start maintenance dosing and how much and how often.

Fingers and paws are crossed hoping that you have arrived. :D:D

P.S. Another very important thing to remember is that two days from now is Sunday and your IMS may not be open. If your IMS is open tomorrow, have the test done then. In the meantime, watch Snoop for signs of cortisol going too low.

[Rene]

Hi there Leslie, Congratulations on Brick!

Im getting frustrated again because this is our second time loading. Would you kind folks keep an eye on us. I will post what the is vet recommending and see what you all have to say.

Something told me I just should have stopped the Lysodren and waited till monday for the STIM. The office is closed Sat and Sun. Snoop is at the IM vet now and will pick her up later this evening.

I suppose I won't get the results for a few days and then he will recommend a maintenance dose.

Was the formula correct should she have been on 625mg the first go around?


Rene & Snoop

[StarDeb55]

Rene, your maintenance dose is the same that you have been giving daily except it's now split up into 3-4 doses over a week. If you have been loading at 500 mg. daily, I assume you have been using the 500 mg. tablets, & cutting them in 1/2. You could go to half a tab twice a week, or 1/2 tab once a week, & 1/4 tab twice per week. This is going to be up to your IMS. The problem with only dosing twice a week is that some pups have adrenals that regenerate in the blink of an eye, so the 3-4 days between doses would be plenty of time to lose control. To give you an example, my Harley's last load a couple of years ago was 250 mg. daily. He got a 125 mg. capsule twice per day. We went to 3x weekly maintenance dosing of 75 mg, 100 mg, 75 mg. on M, W, F. I had to have his lyso compounded since he was one of these little guys, so I had several size capsules available to make these kinds of dosages. My GP vet who took care of Harley preferred 3x per week dosing as he had seen, & had too many problems with pups on a maintenance schedule of twice a week.

Hope this helps.

Debbie

[Rene]

OMG...I called the vet. Snoop now weighs 25.7 pounds. Darn that tapeworm!!!

So I guess if I recaculate that formula she should be on 585mg of maintenance Lysodren?

[Rene]

Hi Debbie,

I guess we were typing at the same time. You told me about Dr. Feldman and breaking down the dose awhile back (Thanks sooo much). Snoop was on 500mg of maintenance when she did'nt hold. That is why I am concerned about the dosage this time. I just want to be armed with information this time when I talk to the vet when her STIM comes back and he tells me what he wants her maintenance dose to be.

[StarDeb55]

Actually, the formula for dosage is 25-50 mg/kg, to get to kg, you divide lbs. by 2.2, so for Snoop that is 11.7 kg. I just rechecked your math & you are correct, the 585 is 50 mg/kg. 500 mg. weekly would be 42.7 mg/kg which I would think should be ok, too.

Debbie

[Rene]

By the way you and Obi are a crack up...Im not sure who is funnier!

[StarDeb55]

Thank you so much, not many folks describe me as funny! I appreciate the compliment.

Debbie

[lulusmom]

Hi Rene,

The 500mg maintenance may not have held last time because Snoop was not loaded. As I recall, his post stim was 10+. If Snoop is loaded this time, the maintenance dose may hold but there are no guarantees. A lot of dogs have to have their maintenance dose tweeked a bit before finding the right dose that will maintain the erosion achieved through loading. If only it were easy. :D

[Rene]

Another thing,

Anybody know the the formula for how much water she should be drinking daily for her weight (25.7lbs)? I think Glynda had one.

This time I am going to put her distilled water in a container with a line on it watch it like a hawk.

[Rene]

Ah...there u are...again typing at the same time.

Thanks Glynda...was it you that had the water formula?

[lulusmom]

No, it wasn't me with the water formula but I just did a quick google and according to Dogster, a dog should drink 1/2 to 1 ounce per pound of body weight per day. If that one doesn't work for you, here is an excerpt on the subject from Drs. Fosters and Smith:


A general rule of thumb is that an animal needs to consume 2.5 times the amount of water, as its daily intake of food. If an animal eats 2 lbs. of dry food, he should consume 5 lbs. of water. (There are 8 lbs. in a gallon.) If he eats 4 oz. of dry food, he should drink 10 ounces of water (1¼ cup). If your pet seems to be drinking more than usual for no apparent reason, have your pet checked by your veterinarian. Increased water consumption is a major symptom of several severe diseases. Factors such as high heat and exercise or lactation can increase the needed amount two or three times above normal. Most animals consume more than their daily requirement. A little extra water consumption never hurts, but too little can be catastrophic. Animals that eat canned foods get most of their moisture from the food and may drink much less than an animal on dry food.

I hope this helps.

[frijole]

:D Looks like the gals answered all your ?s already so I'll just say great job!! We will all keep an eye out for you this weekend. You are doing just fine. Hugs to your baby. Kim

[Rene]

Thanks for all your help ladies!

I hope you both get to the root of Annie's and Jojo's pain.

Hugs to you & your babes.

Rene & Snoopie

[apollo6]

Dear Rene
Just checking in on you and Snoppie.
Hugs Sonja and Apollo

[Rene]

Thanks Sweetie,

Snoop is not really interested in eating or drinking much it looks like we may have gotten her loaded. We will see.

I hope you can get some water in your little Apollo. Give him a little smooch for us.

Rene & Snoopie

[frijole]

Wonderful news Rene! OK... no lysodren until after the test no matter what right? :D Keep us posted on the results. Meanwhile, enjoy the weekend! Kim

[Rene]

Gosh no...Lyso is not her friend right now. It was the last part of the week though. She was down right a different dog. I was so happy for her.

As far as my weekend, I have my semi-annual asthma/bronchitis and am off to urgent care for meds. My husband got sick when we got back from vacation and gave it to me then, as usual, it turned into the crud. Oh well...Snoop is taking good care of me.

How is Annie?

Rene & Snoopie,

[frijole]

Rene - Your comment about lysodren not being her friend has me concerned. It sounds like her cortisol might be low but I could be wrong. Refusing to eat and drink are signs of loading. But she should eat and drink some! Keep an eye out for vomit or diarrhea. If it happens - that is what the prednisone is for. Call the vet but if unavailable due to the weekend, give the amount on the bottle. To be safe you can post here and tell us what is going on but the prenisone won't hurt her - it will give her a 'cortisol rush' that her body is missing and within hours she will feel much better.

So meanwhile you go take care of yourself. So much for a fun weekend huh?

We'll keep an eye out for your updates. Hang in there, Kim

[apollo6]

Hope you get well soon.
Hugs Sonja and Apollo
will post some new pictures.

[Rene]

Hi Sonja and Kim,

Im worried now. Snoop and I have both been in bed all day. Snoop does eat but only if I hand feed her. Offered her water and she does drink.

I just went outside and looked at the poo in the run on the other side of the dog door and it was a little soft. Saw her walk away from urinating and there was a white-ish colored string hanging down after she urinated.

She follows me around and wags her tail when I talk to her. Seems a little off and licks her gums a bit when trying to sleep.

Just voice mail at vet.

Rene & Snoopie

[Rene]

Ok...my husband is pulling me down out of the trees.

He is a retired 30 year K-9 handler. He says he has seen those mucus strings in the urine of dogs that have tape worms before and we have yet to address Snoops worm because of loading the lyso. He just worked with her a bit and she perked up for treats and he said she looked "pretty good" to him.

It has been a little over 48 hours since her last dose of lysodren. I know she is a little off because she is not eating normally only hand feeding. She has taken to the bed probably because mom is sick and she is off to. Snoop and my husband are playing in the next room.

I worry too much.

Rene & Snoopie

[frijole]

Rene have you scheduled the acth test yet? If it is tomorrow and she seems ok then leave the prednisone alone. So long as she is walking ok and eating, drinking that is fine. Remember lysodren continues to work for 24 hrs from the time of the last pill. When was that? Fri or Sat?

Keep us posted... we'll watch out for you. Kim

[Rene]

Hi Kim...to the rescue...thanks.

Going back and looking actually her last pill was Thursday the 24th about five-ish. She was semi-off her Friday morining feeding and the vet wanted her that day for her acth. Thats when I started feeling poorly so my husband took her in. I questioned it with you folks but it was too late.

We have not got the results yet. Probably tomorrow.

Thank You,
Rene & Snoopie

[lulusmom]

Hi Rene,

If Snoop is still feeling poorly, you may want to give her a dose of prednisone. If low cortisol is her problem, you should see her start to feel better rather quickly. Your vet did give you prednisone right?

[frijole]

OK... so since the vet didn't wait 2 days then the test results you get tomorrow will be HIGHER than she is today. (since the drug keeps working)

So if she is 3.0 post on the test (2nd number) she could be at 2.something now. If she is close to a 1.0 post on the second number then you might have her checked out OR talk to the vet about giving her prednisone.

Since the test is already done you are safe to give the prednisone if you think it will perk her up. That is what it is for. When cortisol levels go low dogs feel yucky. When they are TOO low (below 1.0) they are ill and need immediate attention. That is why I mentioned that the test results taken last week will be higher than where she is today.

Assuming she is loaded the vet will tell you to start weekly maintenance. Normally you wait one week from the last pill to start doing that. If a dog is kind of low you wait longer to allow the cortisol to rebound a bit.

Just let us know what they tell you and we'll help you thru it. You will be fine. Hope you guys are all feeling better!!! Kim

[Rene]

Glynda and Kim...welcome to the roller coaster.

Snoop is laying at my feet on the bed. In the last fifteen minutes she has gotten up three times to find another spot. Usually she is a dead dog in the bed because it is such a treat. When she gets up and lays back down, before she drifts off, she quivers just a tiny bit.

As my husband did, if you engage her she responds, wags her tail, takes treats, plays, ect. but then after she just wants to lay in the bed with her sick mom.

I did not want to make my husband sick so Snoop and I have been sleeping in the guest bedroom since wednesday night. Its a treat for Snoop and Arnie because my husband does not allow them our bed. The timing of all of this is rather poor. I am not sure if Snoop is sick from the lyso or if im causing this.

What do you make of the urine string. Is that a Lyso symptom?

Rene & Snoop

[frijole]

Rene, I can't say I've ever heard anyone mention a urine string like you described. When a dog is really low and distressed you KNOW it because you really are worried they are dying (and they can). It sounds to me like Snoop is just a tad low and/or reacting to everyone else being ill. So I wouldn't worry about it. I'd think you'd have the results tomorrow. Give the Snoop a hug for me and I'm glad she gets to snuggle in bed tonight. I am sure that will help her tremendously. :) Kim

[Rene]

Thanks Kim,

My husband said he has seen the strings with tape worm dogs and he should know. I just did'nt know if it was also a lyso thing. He also says im a "worry wart". I was just very concerned because of the hand feeding thing and the quivering.

I would just never forgive myself if I did not do anything if she was crashing.

Rene & Snoop

[Rene]

I took Snoop out to pee and catch her urine to get a look at it earlier tonite.

She had a little white-ish slimy discharge hanging from her vulva before she went. After she urinated, the long white string reappeared. Thick and mucus-ee I had to pull it off. About six inches long.

She did not strain, pee'd a little less than normal (I would too if someone was chasing me around with disposable tupperware) and it was a normal color.

My husband said he misunderstood that the string was coming from her vulva after she urinated. He said he has seen the mucus strings from the rectum of wormey K9's. Anyways, the string and the urine had no offensive odor.

I got through to Snoop's regular vet, who is also an ER vet. I reported to her. Because the urine appeared normal and Snoop is not urinating frequently or straining she did not feel it was a emergency. Besides an infection one of the other things she mentioned that can cause the discharge was hormone changes. She said to give her a baby asprin and let her know how she is doing in the morinig. Snoop has been snooring away quite comfortably. I just can't sleep.

The hormone thing is quite interesting. All of Snoops were really high when we ran the UT panel before starting the lysodren. I wonder if just getting her loaded caused a drop and that had anything to do with it?

Rene & Snoopie

[Squirt's Mom]

Hi Rene,

How is Snoopie this morning? Any diarrhea or vomiting? Any lethargy? How's her appetite? If she is still off this morning, I would give her a dose of pred just to be on the safe side as that would indicate to me that her cortisol has fallen too low.

How are you feeling? Hope you are getting better, too!

The white string from the vulva isn't anything I can help with. My first thought was some sort of infection....

Let us know how you gals are doing, ok?

Hugs,
Leslie and the gang

[Rene]

Hello,

Snoops Cortisol came back pre 3.2 and post 4.9. What a relief! As Kim pointed, out since we did not wait two days for the test, she is probably a tad bit lower, but still where she should be.

As far as her being off...no diarrhea or vomiting, she is laying around with me and she does not like her food. I had to change it up. When I put it down she actually runs away! Possibly, she associated it with not feeling well because she was getting her loading dose. She is a very smart cookie...she has done some amazing things. I know when my husband was sick receiving chemo certian foods he ate then, now have a negative association. I tried the food that I was feeding before and she eats that. Go figure. She still is not eating as much as she should, but she is eating.

I have not seen the mucus string after urinations since yesterday. I felt better today and got her out to chase her rabbits. When she saw her bells and bonnet she perked right up. She was on the scent of one and against my wishes she ran right into the creek and lost it. Normally, she does not disregard my call.

I took a picture and posted it. You can see the guilt on her face through the bonnet for being in the creek!

I know she does not feel quite right but she still wants to go and do her thing. She seems a bit uncomfortable and restless now. Probably over did things a bit.

Im thankful for days like today.
Rene & Snoopie

[apollo6]

Dear Rene
What you are going through with Snoop is normal. Once they have cushing we seem to watch for the abnormalities more often. They do pick up on our worrying.
Hope you and Snoop are better.
P.s. my hubby says I am just looking for things with Apollo
Hugs Sonja and Apollo

[Rene]

Thanks Sonja,

I know you are having a tough go with our little Apollo too. Snug to him too.

Snoop had another one of those mucus strings in her urine last night. They seem to be intermittent. We got the results of her urinalysis and blood today.

URINE

LEU +
NIT neg
URO 200
PRO +
ph 5.0
BLO neg
SG 1.010
KET neg
BIL neg
GLU neg
Urine Sediment
WBC none
RBC occasional
Bacteria none
Crystals none
Casta none

BLOOD (most values were in the normal ranges except)

NEU 12.47 2-12
LYM .50 .50-4.90
EOS .08 .10-1.49
PLT 810 175-500
BUN 32 7-27
CA 11.9 7.9-12.0
ALT 157 10-100
ALKP 1814 23-212
CHOL 357 110-320
WBC 14.32 5.50-16.90
CREA 1.5 .5-1.8

Snoops bladder or a spleen was removed last July so it might elevate some values. She ate very little in the hours before the blood and urine tests.

She received fluids while there and a RX for 250mg Clavamox one tab every 12 hours for a week.

I don't know if the loading was just too much for organs or she is experiencing a random infection? Because of all this we did not address the tapeworm yet. Could this have some impact. Hopefully after this all settles down after the antibiotics are done we will give her a tape worm injection.

We would sure appreciate input from the experienced and educated folks out there as to what may be happening.

The positive side of all of this is she is loaded and we are due to start maintaince tomorrow. I will be breaking down the 500mg of lyso into quarters.

Rene & Snoopie

[StarDeb55]

Rene, from what you posted it sounds like you collected a urine at home & brought it in for the UA? If that's the case, I'm mildly concerned that Snoop was put on an antibiotic without the presence of WBC or bacteria. I can explain why that was done & it's the positive esterase result. Esterase is an enzyme that is released from WBC when they lyse (die), & it's one of the tests on a urine dipstick. I'm concerned because usually what happens is you will see intact WBC, & a neg Esterase because the WBCs have not had time to lyse & release that enzyme. These results, therefore, kind of don't make sense to me, & my worry is the positive esterase result may be a "false positive". The presence of all of that mucus in the urine probably does indicate that Snoop's bladder is irritated for some reason, but it's hard to say why. Of course, you have got to finish the full round of Clavamox, now that it's been started. IMO, if you don't see any improvement after the Clavamox is finished, you will probably need to talk to the vet about a repeat UA by cystocentesis, where a needle is stuck directly into the bladder, & a sterile sample can be collected. This procedure does not hurt our pups. If you have to do this, I would request that a UA, culture, & sensitivity be done. That way, if there is an infection present, the bacteria can be identified, & the most effective antibiotic can be given. I've been to the point for a couple of years that any time any of my boys need a UA done, I take them in for a cysto collection because I want to make absolutely sure it's a good result.

Regarding the blood results, Snoop has the quite typical elevations in her liver function tests that the great majority of our babies have. She does have a pretty high alk phos, but we have seen pups with alk phos numbers in the several thousands. With treatment, including liver support supplements, these numbers should improve.

Regarding your question about Obi, he is definitely part Shi Tzu. You can tell that by looking at his face, head, & general body shape. The question is where did his incredibly long legs come from.

Debbie

[Rene]

Thanks Debbie,

I only "caught" her urine so I could get a look at it. She was taken for a proper collection and test by the vet prior to any antibiotics being given. Since being given the fluids by the vet and starting the clavamox she is feelng much better!

She has been on liver support supplements, prozyme plus and other supplements. Some of her values have actually gotten better, some worse, but i'm not sure what it all means.

Here are Snoops labs from the time before in January 2011. We have not repeated any of the hormone tests as of yet.

Cortisol ng/ml 104.8 baseline (2.1-58.8 normal) 426.4 post ACTH (65.-174.6 normal)
Androstenedione ng/ml 2.44 baseline (0.05-0.57 normal) >10.0 post ACTH (0.27-3.97 normal)
Estradiol pg/ml 125.1 baseline (30.8-69.9 normal) 125.7 post ACTH (27.9-69.2 normal)
Progesterone ng/ml 0.97 baseline 0.03-0.49 normal) 20.8 post ACTH (0.10-1.50 normal)
17 OH Progesterone ng/ml 0.99 baseline (0.08-0.77 normal) 26.8 post ACTH 0.40-1.62 normal)
Aldosterrone pg/ml 30.5 baseline (11-139.9 normal) 152.9 post ACTH (72.9-398.5 normal)

Her urine was clear and her blood was in the normal ranges except:

ALT 375 IU/L (12-118 normal)
Alkaline Phosphatase 1692 IU/L (was 2000+ Aug 2010) (5-131 normal)
GGT 90 IU/L (1-12 normal)
BUN 32 mg/dL (6-31 normal)
Phosphorus 6.2 mg/dL (2.5-6.0 normal)
Cholesterol 646 mg/dL (92-324 normal)
Lipase 907 IU/L (77-695 normal)
Neutrophils 11868 /uL (2060-10600 normal)
Monocytes 966 /uL (0-840 normal)
Platelet Estimate Increased
Platelet Count 880 /uL (170-400 normal)
T4 .6 /rg/dL (1.0-4.0 normal)

Her WBC was 13.8 /uL (4.0-15.5 normal)
Creatinine 1.5 (0.5-1.6 mg/dL normal)
BUN Creatinine Ratio 21 (4-27 normal)

These are the Labs from last week:

URINE

LEU +
NIT neg
URO 200
PRO +
ph 5.0
BLO neg
SG 1.010
KET neg
BIL neg
GLU neg
Urine Sediment
WBC none
RBC occasional
Bacteria none
Crystals none
Casta none

BLOOD (most values were in the normal ranges except)

NEU 12.47 2-12
LYM .50 .50-4.90
EOS .08 .10-1.49
PLT 810 175-500
BUN 32 7-27
CA 11.9 7.9-12.0
ALT 157 10-100
ALKP 1814 23-212
CHOL 357 110-320
WBC 14.32 5.50-16.90
CREA 1.5 .5-1.8

Shi-Tzu w/Dane Legs...ha!

Thanks Again...
Rene & Snoopie

[apollo6]

Dear Rene
At least you got some good news. Let us know about Snoop's other issues. Never ends does it. Will post on my thread about Apollo.
Hugs Sonja and Apollo

[apollo6]

Dear Rene
Just checking in on you and Snoopy.
Hugs Sonja and Apollo

[Rene]

Hello Sonja,

Thanks for checking in!

Hello Group,

Snoop was properly loaded this time on her Lysodren 03/26/2011. Her ACTH was:

Cortisol Pre 3.2 Reference 1.0-5.0
Cortisol Post 4.9 Reference 8.0-17.0

She is now on a maintenance dose of 500mg weekly, broken down into quarters given four times a week.

She is due for a full work up around July 1st.

Whatever was causing the bladder issues and the "strings" in her urine, thankfullly, resolved with the clavamox.

After she recovered from that debacle we addressed the tapework issue and she received an injection. The injection itself causes intense itching for about fifteen minutes which you massage for them. But, other than that it did not have any ill effects at all!

She had been refusing her food, was wasting away and occasionally, falling over. Her eyes always had profuse tearing and were beat red. So with reluctance, because I have tried everything else, we switched to raw. We found StevesRealFood in beef flavor. It is a small 1/4 frozen cube in 10 pound bags for about thirty dollars. I found it locally. Immediately, her eyes stopped tearing and the redness went away. The hair under her eyes had fallen out from the constant tearing. Within three weeks it had grown back in white! I posted pictures of Snoop in her Bonnet just before the food change so you can see the difference. I am posting pictures of the food change progress as we go along.

Snoop has done very well in the last month or so. I believe it is a combination of a lot of factors...the lysodren, de-worming and better protien food with red meat. Mostly the lysodren getting her hormones back incheck. They are not robbing her blood, muscles, and electrolytes. The rear end weakness is almost a non-issue now...she is gaining weight and muscle. The hair from a surgery, that she had almost a year ago that never grew back in, suddenly is growing back in! Even her pot belly is sucking up.

Because she lost her gall bladder, spleen and had cronic pancreatitus, gas, allergy and renal issues I think I was restricting her diet too much and depriving her of essential nutrients. I was afraid to give her too much protien and overload her kidneys.

Old school says lower protien no red meat with renal issues (use cottage cheese or egg as protien source with renal issues...graduate to chicken, turkey, ect.). New school says good quality moderate protien red sources (including muscle meat...that was a hard one to swallow) to keep the kidneys healthy and functioning. Of course the exception to this is renal failure...then the rules go back to old school.

I have always fed Snoopie chicken, turkey, ect. Im not sure if its the Lysodren, the elimaination of the tapeworm or the addition of the red meat or all the above. Snoop also gets L-Glutamine for her muscle weakness and pancreatitus, Oli-Vet 250 for immune support and gum/bladder infections, Total-Zymes Plus Pro-Biotics, Liver Support Factors, and Canine Plus Senior supplements.

This is just what has worked for Snoop....But it has been dramatic and i'm thankful,

Rene & Snoopie

[Rene]

Hello All,

Snoop still has been doing very well and improving daily.

I discovered a product called Juven for cancer and Aids patents. It contains many of the same supplements that Snoop has been doing well on. There has been a dramatic improvement in her cachexia (muscle wasting), rear end weakness and strength. I though I would give it a try as it would be nice to be able to give one supplement, instead of several. I did the math on it and it looks like it breaks down to 14 servings per pouch or 1/2 tespoon daily. That would be equal the maximum daily dosage of 500mg L-Glutamine & 500mg L-Arginne recommended. Its the HMB that is key in helping the muscle wasting. The other ingrediants seem to be at a lower daily allowance levels. But, i'll be checking with the Dr. tomorrow to be on the safe side.

Juven
(Powdered Nutrition Drink) Buy Unflavored If Possible As My Dog Does Not Like The Orange

One 24g packets can be divided into fourteen daily servings which is 1/2 teaspoon each or 1/4 teaspoon twice a day.

1/2 Teaspoon equals:

500mg L-Glutamine
500mg L-Arginne
86mg HMB
564mg Carbohydrate
71mg Sugars
14mg Calcium

Has anyone else tried this or know of a reason why we would not want to give this to our cush pups?

Rene & Snoopie

[Squirt's Mom]

Hi Rene',

Having never heard of Juven, I started researching a little bit and don't find much other than site selling it. I did find the following link that pertains to human usage of Juven, tho.

http://www.webmd.com/drugs/drug-16948-Juven+Oral.aspx?drugid=16948&drugname=Juven+Oral

In the following link at the same site you will find a list of side effects:

http://www.webmd.com/drugs/drug-16948-Juven+Oral.aspx?drugid=16948&drugname=Juven+Oral&source=0&pagenumber=6

One thing jumped out at me -


Infrequent side effects of Juven Oral:

Acute Inflammation of the Pancreas - Severe

Hugs,
Leslie and the gang

[Rene]

Hi Leslie,

I saw the MD sheet as well. My husband was taking a similar RX product when he was being treated for his cancer. There was several of these "infrequent side effects" and others that scared me that the manufactures had to list after their trials. As the patients in the trials are Aids and cancer or just very sick is unknown. But the illnesses reported during the trial must be listed.

At least that was how it was explained to me when I read the scary side effects when they put my husband on the similar product. Thankfully, he gained back bunches of weight and had none of the problems listed.

By the way the song you posted is beautiful...I posted the lyrics in my poem thread!

Thanks,

Rene & Snoopie

[Rene]

Well, I gave Snoopie a 1/4 teaspoon with her dinner mixed in with a little water, instead of her regular supplements with the similar ingredients. She ate it just fine. However, she turned her nose up at her breakfast.

I didn't even put anything in it...she looked at me like I did!

I guess she did not like the after taste. It was orange flavor. I took a fresh batch of breakfast out off the fridge, in front of her, and offered her that and she gobbled it right up. She is such a little smartee!

They do have an unflavored version but I guess I would have to get it online. So, for now we will just stick with what has been working so well.

ON ANOTHER SUBJECT:

Snoop is not due for a full work up until July. However I have noticed a few hormone changes and was cosidering just getting a baseline Estradiol to be on the safe side in the meantime. I have read the literature about the possible usefulness of periodioc baseline cortisol checks for pups on trilo but does anyone have any information about this tool being used on pups on Lysodren?

Rene & Snoopie

[StarDeb55]

Rene, if I recall, the use of baseline values from an ACTH is mostly to determine whether or not a pup may be in need of twice daily dosing, when an owner is seeing "bounce back" symptoms in the evening. This is practical since trilo clears the system in about 10-12 hours. Looking at a baseline value in this situation, you would be looking for a elevation above acceptable ranges. It would not be useful monitoring, as far as I know, for lysodren since the 2 meds have totally different modes of action. With lysodren selectively eroding adrenal cortex tissue, once the lysodren has done its job, it doesn't exactly go away since the tissue is already gone. The other aspect is that lysodren is a long acting drug not reaching peak effectiveness until about 48 hours after a dose is given. I hope this helps.

Debbie

[labblab]

I have read the literature about the possible usefulness of periodioc baseline cortisol checks for pups on trilo but does anyone have any information about this tool being used on pups on Lysodren?

Hi Rene,

I am guessing that you are referring to this new study published by Dr. Audrey Cook and Karen Bond: "Evaluation of the use of baseline cortisol concentration as a monitoring tool for dogs receiving trilostane as a treatment for hyperadrenocorticism."

http://avmajournals.avma.org/doi/abs/10.2460/javma.237.7.801

This approach is indeed a departure from the more traditional standard trilostane monitoring protocol whereby ACTH stim tests are performed at each of the recommended testing "windows" along the treatment path (e.g., after 10-14 days at a given dose, after 30 days, then every 3 months, etc.). As the authors state, this approach would only be safe and reasonable under certain conditions, and I do not believe it is yet being commonly utilized. However, per this recent reply posted elsewhere by Glynda, it sounds as though Dr. Mark Peterson may be adopting this approach for some of his monitoring testing:

http://www.k9cushings.com/forum/showthread.php?p=55379#post55379

Although I've seen nothing written about using baseline cortisol as a monitoring approach with Lysodren, I agree with Debbie that I think it would be more problematic due to the different mechanisms by which trilostane and Lysodren work. Since effective Lysodren control depends upon selective erosion of the adrenal cortex (which requires time to both achieve or reverse), I would think that you'd be more anxious to have an accurate reading of the dog's post-ACTH "status" with every monitoring test. You don't want to have to keep repeating Lysodren loads over time. And therefore, you'd want to be as precise as possible as to the effects of any given loading or maintenance dose. But this is just my own speculation.

Marianne

[Rene]

Thanks Marianne and Debbie,

Here is what Im thinking. Snoops not due for her full work up until July. We suspect she is one of those dogs that can regenerate their adrenal cortex rapidly therefore we went to breaking down the maintainence dose into 4 doses during the week. If she is that responsive/reactive to the the drug I believe I am seeing swings in her similar to what the trilo dogs experience on a daily baisis. In other words the lyso has the same type rebounding cycle that needs "tweeking" but slower. I have seen these swings every week two two weeks and have corrected them with a little less or a little more on that dose. The symptom then usually resolves within a day or two and she is back to her normal behavior similar to when she tested in the proper loading range.

Instead of guessing that this is occuring and "tweeking" the dose I was just wondering if I could take her in for just a baseline cortisol just to check if my suspicitions were correct if she was a little low or high that week.

So far what we have been doing is working well...but it would be very nice to have proof with out having to run the full stim every time I suspected something was up with her cortisol or hormones.

Thoughts?

Rene & Snoop

[StarDeb55]

Please remind me what is Snoop's current dose, the dose she loaded with, & her current weight. Even though you describe a cyclic nature of her symptoms, it sounds like Snoop, in general, is symptomatic. What symptoms are you seeing? If Snoop is gradually becoming more symptomatic, my concern would be that her cortisol is climbing. With lyso usage, I'm afraid you really need to see both numbers. There is an issue called a non-stimulatory result that can indicate a developing Addison's problem, so this is one of the reasons why getting a full stim is important. If Snoop's next stim is not due soon, I would think moving that up may be a good idea.

Debbie

[MBK]

Hi, Rene -

Just checking in to see how you and Snoop are doing? I hope your weekend is going well and has been uneventful. I find more and more I really appreciate uneventful! ;)

With the raw diet you are giving Snoop, what else does it include other than the red meat? Sounds like she has really done well on it.

Alivia is doing well (fingers crossed!). Our next step is to follow through with the consultation with Dr. Peterson. There are conflicting test results which is always the way with Alivia. She is one of a kind! :D I am hoping he can make sense of it all.

[Rene]

Thanks Debbie,

She is about 29lbs now! Her loading and current dose is 500mg of Lysodren.

She has symptoms only perceivable probably to me, such as euphoric days followed by bouts of disintrest in what peaked her interest before. Almost similar to mild depression in humans. But, she is still a very happy little camper!

She is very connected to me and I work long hours some days and she has been known to pout and hold a grudge some times. I can break the mood by simply taking her out to chase her rabbits. But, she will pout again if I don't let her tag along with me the rest of the day or evening....I don't mind of course! She is not left home alone for long periods of time. My husband is retired and she hangs out with him in the day. He tells me when I am expected home she waits for me and when I am on overtime she keeps checking around for me and runs to the door everytime a car drives by. So some of what I notice may be psychological. The only outward symptoms I actually see is sporadic swollen vulva which resolves with a little extra lyso that week. Her vet told me said she believes this is a hormonal reaction. She also sometimes seemes hungrier some days. Otherwise she is gaining muscel, weight, hair growing back, pot belly sucking back up, eyes, sleep, heart rate, and breathing improving. The only thing we haven't gotten back and probably won't is she is almost deaf.

I was going to get the baseline Estradiol for sure but just didn't know if I could get away with a baseline cortisol to see if she is still within the target range. If not, I am leaning toward shelling out for another stim prior to July to be on the safe side. Its hard to describe everything I see and feel but it puts me on the fence as to if she is symptomatic, Addy, in flux or mom is just a big fat worry wart!

Mary Beth,

She is doing great...here is the link you asked about. Also, follow the tab on the link for the nutrition analysis. I am soooo glad Ali is doing so well!

I have been very surprised that Snoop has done so well on Raw and on some of the supplements we have her on with her problems...it really went against my grain...but we tried everything else and it just wasn't working. I felt if it made things worst we could just stop but so far so good. Don't let the brocolli scare you. I guess they use the nutrient portion of it without the gas producing problems (ha..if such a thing exists). Snoop has/had gurgling stomach, cronic pancreatitus and could clear a room in a second. These issues have resovled for whatever reason, for now.

http://stevesrealfood.com/rawmeat-products/raw-meet-dog-food/beef-diet/

Love to all,
Rene & Snoopie

[Rene]

Hello All...our Turn on the ROLLER COASTER today!!!

Aganst my wishes my husband continues to put out bait stations with ground squirrel bait (diphacone) in them because the squirrels eat the electrical wires of our motorhome and also make tunnels under our house causing water issues when it rains. This is an ongoing source of tension especially when I find dead rodents in the yard or our horse barn.

Well, today as Snoop an I are walking to the barn I turn my back on her for a second...a second...and what does my little angel do? Finds a fresh dead squirrel on the bank between the house and the barn.

I can actually see blue dye from the posion around the mouth and chin of the squirrel so I know it is one that has been poisioned. So, im in a full blown panic :eek: I tell her to "drop it" but she just ignores me :mad: I can't get to her because she is up on the bank :( Now, i'm shouting at the top of my lungs...waving my arms all over the place, like im trying to take off or something! Why is she still ignoring me :confused: But wait....oh yeah...the little dear is... deaf :D silly me! So, now im running for the water hose...where is a video camera when ya need one. This must have been a sight! Ok, I have the hose now but she is pulling the intestines out like spaghetti...I hit her with the hose and she gulps down the intestines and runs :eek:

We go running up to the house shouting at my husband to get the #^%! box of posion because he just killed my dog and I have to call the posion control center! Not my best moment :rolleyes: The posion control center said that they did not think there would be enough of the posion left in the tissues to cause concern if a dog injested a rodent killed by diphacone :cool:

Now, I explained that Snoop tore the stomach and intestines out and injested only them, and that my husband...when sent to retrieve it...could see blue dye in what was left of the entrails. He then said to follow the protocol as if she actually injested the posion herself.

3% hydrodgen peroxide/one ml per pound of weight/to induce vomiting/can be repeated every ten minutes for a maximum of three doses. If vomiting does not occur, ususual bleeding or other signs of illness take to vet for vitamin K regimen.

So, out came the 30ml syringe from the barn and in the front yard we are. Down the hatch!!! Mission accomplished!!! About four minutes later...bombs away!!! Of course...im right there to comfort my little angel! Mistake...big mistake...hugh!!! I saw those entrails and caught one wiff of them and bombs away for me too :D Now, my husband is just cracking up...Snoopies barfing...im barfing...the more she barfed the more I barfed and so on! Have you ever laughed so hard you were crying? Well, add barfing at the same time and you have a picture of me :p We could have been the hundred thousand dollar winner on that show...where's that camera!!!

You just can't make this stuff up!

Mother and daughter resting comfortably.

[StarDeb55]

OMG, Rene!! I couldn't help but laugh, even if it truly is not funny. I'm glad to hear that both of you seem to be ok. Now on to the serious stuff, most rodent type poisons contain warfarin which is a blood thinner or anticoagulant. Even though you did get Snoop to give it back, "in a manner of speaking", please watch her for any signs of bleeding. Things like black, tarry stools or stools that have a coffee ground appearance, it doesn't necessarily need to be obvious bright red blood. Also, keep an eye out for any bleeding from the gums or her nose. Vitamin K is a big cofactor in the blood clotting system, & warfarin counteracts vitamin K to prevent clots. Warfarin & coumadin are basically the same thing. I certainly hope that your significant other has gotten the message that he needs to give up the blasted poison.

Debbie

PS- I just found this link doing a "google" for diphacone. Some of it is pretty technical, but I think it will emphasize what I said above.

http://www.vet.uga.edu/VPP/clerk/Harrell/index.php

[Rene]

Gosh I hope so!!!!! I have been harping on him for years about this happening!!!!

Thanks Debbie I am not letting her out of my sight and will watch for all the above! So, far she is snooring away and her little feet are kicking...must be chasing wabbits!

As for me...can someone bring me a bottle of that Chocovine you guys talk about???

[apollo6]

What a video that would have made. Thank God you got her in time. They can be so fast with putting things in their mouth.
Rest mother and daughter. You must be exhausted. I get rats in my backyard, but because of Apollo I don't have poison.
What a day you have had.
Sonja and Apollo

[Rene]

Thanks my friend,

Pink Floyd...Hey You...on the i-pod now.
Snoop still snooring away...all is well...so far!

[lulusmom]

It was a miserable day until I read your post. I hadn't found one thing to smile about all day long but you had me in hysterics with that story. I'll be giggling until I fall asleep.

[Rene]

Your very welcome Glynda!

See what great lengths Snoop & I will go to, to "pay it back foward" to you kind folks that have helped us so much!

[Harley PoMMom]

OMGosh, Rene!!!

I too, was laughing out loud while reading your story and I am so happy that Snoopy is acting normal with what you both went through.

Our furbabies!! Yep, I know exactly what you mean, they are fast!!!! :eek::D

Sending huge loving hugs to you both, Lori

[Rene]

Thanks Lori...hugs back!

I am so glad we are making folks laugh tonite. We all need it so much! The nature of this site itself and our struggles with our fur babies is often heavy. Sometimes I feel guilty for posting about how well Snoopie has been doing, when so many are not. But, I feel we all need some positive energy and in todays case just a good ol' fashioned belly laugh! You gotta laugh at yourself.

Love to all.

[Harley PoMMom]

Please do not ever feel guilty about posting how well sweet Snoopy is doing. We all love to read good news!!! ;):)

[addy]

I can't even believe that, I had mental images reading though it. If that would have been me, YIKES!!!!!;) I would have been a babbling idiot afterward.:rolleyes::rolleyes:

Never feel bad about posting good news. We live for good news and celebrate with you. In fact, we DEMAND good news. It is the law.
:D:D:D:D:D:D:D

Hope today is uneventful and restful.

Hugs to Snoopy,
Addy

[Squirt's Mom]

Hi Rene',

What a great story and told so well! Well, it was quite scary, but the imagery was hilarious! :p I have a clear image of arms and legs flailing as you charge after the hose while dear Snoop goes on about her business happy as a lark! :p:p We had a sad night and I was dreading this morning but you started it off with a laugh. Thanks for that!

Never, ever, hold back on good news or funny stories. Sharing hope and laughter is the perfect "medicine" for us humans. ;)

While waiting for Squirt's spleen surgery, the surgeon told me some things to look for that would indicate internal bleeding should the organ rupture while we waited. The key one to check her gums to see if they were losing their "pink" and for the refill rate. You press your finger on the gums and release it. The spot where you were pressing will be much paler, almost white, at first but will refill with blood quickly if there is no internal bleeding. The capillary refill rate should be about 2 seconds. Less than 1 and more than 3 mean she needs to see the vet asap. This crude little test along with Debbie's suggestions will let you have a fair idea if the poison did get into her system to any real degree.

Your hubby and my brother are cut from the same cloth. :rolleyes: Mark and I go 'round and 'round over poisons used around here. He has killed nearly every flower bed I have planted by spraying the grass in the beds with RoundUp. He used it in the garden last year on the food I was growing for Squirt's menu. :mad: This year he bought Malathion for the bugs in the garden. :eek: He knows everything about everything and these chemical companies are just after our money - scaring us into using the more expensive products they make. :rolleyes: Carolyn and I have both threatened bodily harm this year if he drags those bottles and his sprayer out. I lost all of Squirt's food but beans last year. :mad: The only reason they survived is because his sprayer somehow got a hole in it over nite and he's too cheap to buy two in one year. ;):D The Malathion has disappeared from the barn only to reappear in Carolyn's mom's house 2 hours away. Magic! :p I hope your hubby has finally gotten your message and will find another way to combat the mice.

Hugs,
Leslie and the gang

[MBK]

Oh, Rene!

What a funny story - AFTER THE FACT! :D The things they do to us! I can picture you running around like a lunatic, imagining the worst. Exactly what I would have been doing! We pamper these little fur babies with the best of everything and then what do they do? Turn around and act just like a dog! ;) Can you imagine what was going through Snoop's little head through all of this?!

[apollo6]

Dear Rene
We love to hear the stories even if it is exhausting going through it. Also good news is always welcome especially if it can help our cushing babies.
Hugs Sonja and Apollo

[marie adams]

Rene,

I read on I think Addy's thread about a story you told and boy was it a story. Visualizing the whole story--well told. LOL :D:D

Keep the stories coming because we all love them.

Right now I am upstairs letting my new little one cry in her Condo/Kennel--she is downstairs. She loves the kong with peanut butter, but as soon as it is gone--whine, whine, whine--it is so sad. :(

Enjoy your day with Snoopy!!!

[Rene]

Addy,
I was a "babbling idiot afterward" it was that post! So far it has been an uneventfull day...too uneventfull...she has not given me a poo! Maybe I missed it. She had her bonnet on when we went to the barn this AM so she couldn't sneek anyting else...she could have taken a quickie when I was busy and I didn't see her.

Leslie,
You mentioned you had a sad night and surgery for Squirt. I hope everything is ok. Im pretty sure I took this out of context there is nothing new going on for Squirt? Snoop's capillary refill is aye ok and so far so good. I just wish I could get a look at a poo!

Mary Beth,
I know exactly what was going through Snoops head! ABSOLUTELY NOTHING! I swear...I think there is a direct corrleation to the amount of money we have spent on these creatures to their risk taking behaviors!!!

Sonja & Marie,
Hopefully Snoopie will not give any more of these stories to post. I am about a year away from being old enough to retire from my job. After yesterday I feel like going in tomorrow morining and telling them I am officially old enough!!!

Love,
Rene & Whats her Name!

[Squirt's Mom]

Sorry for the confusion! Squirt had part of her spleen and a tumor removed in '08 - that was the surgery I was talking about. She has done beautifully ever since!

Our sad nite was because one of my sister-in-laws dogs was killed - hit by a car. :( Sammy was Trinket's buddy. :(

Another point in my brother's "flawed" thinking - no fences. Things like hair appts, nail appts, spas, boats, pools, lake house, guns, etc are SOOOOOO much more important that protecting their animals from the deadly road. :( And heaven forbid they miss a phone call or ball game because someone stayed out with the dogs when they let them go outside. :rolleyes: We just don't think alike at all in so many ways. But I love 'em anyway!

[Rene]

Im so sorry Leslie. I was pretty sure the two were not connected as Snoopie had her spleen removed and that is why I remembered Squirt's surgery. They seem to do just fine with a few adjusments. I just wanted to make sure nothing new was going on that I may have missed!

Yes, our men....I am very lucky. Mine only has a few bugs. This one is about vermin and the posion boxes. I think yesterday scared him too. One down...just maybe one or two to go and he will be PERFECT!

Rene & Snoopie

[MBK]

Rene,

How long did it take for you to get him to almost "perfect"? :D:D:D

Leslie,

So sad about Sammy! I don't understand the logic (or lack of logic) of people who let their dogs outside unfenced and unattended.

[Rene]

Mary Beth,

I got real lucky. He was pretty much perfect in when I met him in 1988 and has stayed that way!

[Rene]

Hi guys,

It has been a sad day. Snoopie's kitty Arnie was killed last night. She loved him so much. My deaf little princess is such a hero. She tried to save him. We love her so much.

Snoopie never uses her voice but since going deaf she has been startling easy and ruffing for no reason off and on. My husband says, "she sees ghosts." To calm her, we go with her to investigate and she settles back in easly.

We have a dog door that goes into a small fenced in dog run on the side of the house. Late last night she full blown alarm barks and comes running in from the run and gets me. She takes me to the dog door and goes half in and half out and alarm barks again. She never alarm barks. We didn't take her seriously and tried to quiet her down. She persisted so I let her out into the front yard to investigate. She took me to the side yard where the run is. She barked at the run door but I didn't see anything because it was dark. I didn't open the door and just told her to quite down and go back inside. Very reluctantly she did. We went to bed.

Arnie usually sits on the toliet in the AM and unrolls the toliet paper while we are in the shower. When he wasn't there for the morining toliet paper ritual my husband found him in the dog run. He said it looked like his neck or back had been broken, but no blood or trauma. We have owls and coyotes around our home. Arnie must have been the little yard mousing and was attacked. Snoop probably scared whatever it was away or it would have been worse. Snoop snoors very loudly and sleeps in her bed on the floor on my side of the bed. But last night it was quiet. Something tells me the little dear spent the night watching over her kitty because whatever it was didn't come back and get him.

How horrible that must have been for her. Us scolding her for barking, not trusting her, and leaving her to mourn alone in the cold. I feel terrible!!! Snoopie seems depressed tonite and has been sleeping in Arnies bed and chair.

On top of it loosing Arnie is a real blow to both of us. Arnie was my husbands cat. He feels about Arnie the way I feel about Snoop.

I know it was probably already over with by the time she came and got me...but...I wish I would have listened to her.

Just because they are sick, old and maybe deaf...there is nothing wrong with their brains...they are still very present. I forgot that. I will never under estimate my little beloved angel again.

God Speed Arn Ball

[rbeasl]

Rene,

I am so very sorry to hear this very sad news about Arnie. I wish I could say or do something that would make you, your husband and Snoopy feel better.. Arnie was family and this will be hard.. I just pray that God will bring you through this very difficult time. Please realize that there was no way for you to know what was going on. Please do not beat yourself up and just think about the happy times with Arnie... Snoop is very smart and she is watching everything... Just try to be strong for her and give her hugs and kisses from me.

God Bless
Rhondalyn and Honey

[labblab]

Oh Rene,

I, too, am so sorry to read your sad news. What a good girl sweet Snoopy is, doing her best to try to protect her family. But I agree with Rhondalyn -- please do not be hard on yourself for not understanding what had happened. You did not know, and it is not your fault.

But today, you all three are left to grieve your kitty. That is so hard. Please extend our sympathies to your husband. And if you should wish to post a thread for Arnie on our special memorial forum, we would very much welcome having the chance to read about his life with you and Snoop:

http://www.k9cushings.com/forum/forumdisplay.php?f=8

Your family is also our family. So we join you in mourning Arnie, today and everyday. Once again, I am so very sorry.

Sending many hugs,
Marianne

[addy]

Renee, I am so sorry to hear about your kitten. It is a terrible tragedy for your family.


My thoughts and prayers are with you and your family.

Love,
Addy

[Harley PoMMom]

Oh Rene,

I am so sorry for the loss of your beloved Arnie. Keeping you and your family in my thoughts and prayers.

With Heartfelt Sympathy,
Lori

[lulusmom]

Renee, I am so very sorry for your loss and my thoughts are with you, your husband and brave little Snoopy.

Godspeed Arnie.

[Squirt's Mom]

Dear Rene and hubby,

I am so sorry to hear about Arnie. :( What a sad morning for you all.

As others have said, please don't blame yourselves. I have no doubt that he was much loved and attended to every day. We have to let them be who and what they are, and a cat loves the night. I am sure that Arnie was as happy as he could be that night and that was thanks to you and your hubby.

Arnie will be there to greet ya'll when it's your time to cross The Bridge and he will thank you himself on that day.

Our sympathies,
Leslie, Squirt, Trinket, Brick and our Angels, Ruby and Crystal....and our many kitty Angels who were there to greet Arnie, too

[apollo6]

Dear Rene and hubby
I am so sorry to hear about the loss of your beloved Arnie.
Cat Poem
They will not go quietly,
the cats who've shared our lives.
In suptle ways they let us know
their spirit still survives.
Old habits still make us think
we hear a meow at the door.
Or step back when we drop
a tasty morsel on the floor.
Our feet still go around the place
the food dish used to be,
And, sometimes, coming home at night,
we miss them terribly.
And although time may bring new friends
and a new food dish to fill,
That one place in our hearts
belongs to them. . . and always will.


by Linda Barnes

Sending you both and Snoopy healing prayers.
Hugs Sonja and Apollo

[Cindy Thoman]

Dear Rene and family, I am so sorry to hear about the loss of your Arnie. My thoughts and prayers are with you.

xoxo,
Cindy, Alex, Bear and our kitty angels Mieko, Pedro, and Poncho

[apollo6]

To all of you.
I did talk to Rene today. They have all had a hard time with the loose, Rene, husband and Snoopy. When she reads all the lovely posts she cries and can not post. She will be back after taking time to grieve.
Hugs Sonja and Apollo

[Squirt's Mom]

Thanks, Sonja. That was kind of you to let us know...

Rene - take all the time you need, just know your family here is beside you all during these difficult days. If you need us, simply reach out.

Hugs,
Leslie and the gang

[Rene]

Dearest Rhondalyn, Marianne, Addy, Lori, Glynda, Leslie, Sonja & Cindy,

Thank you for all your kind words and support. I have really appreciated you all in the past couple days. I have been working very long hours since this happened and now have a few days off. I would come home read your lovely thoughts and choke up. Just couldn't post. Thank you, again.

Snoop is a bit out of sorts. She is fearful to go into the dog run at night to pee. She pees once in the house, on the floor, during the night. I take her out before bed. I have not made a big deal of the area where the event occured. She still goes out during the day and does her business...no problem. I go about my business in the morining picking up. She follows me out but her whole body language changes when she looks at that end of the run. If I ask her over to the "spot" she will come but then can't get away fast enough. I have just left it alone for her to work out.

She has had some scary things happen in her life but it has never thrown her nor has she been afraid of anything before. She is a tough little cookie.

This has her shook. I know whatever she witnessed that night was tramatic for her and it will take time.

Love,
Rene & Snoop

[Rene]

SHARING THE “ARN BALL” EXPERIENCE

Arnie’s red heart shaped tag read, “Escaped House Cat…Please Return”. But he wasn’t very feline at all….more STUFFED TOY. He should have chosen a little girl to own him. One who would have carried him around for hours, all day long…then dressed him up in silly clothes. He would have loved that!

Instead Arnie was born in the map box of a boat with several of his siblings departed. We took them in. My husband took a shine to one special one. Arnie, was the kindest and biggest one of in the litter. Just like my husband! When it was time, we found them good homes. But, my husband couldn’t part with Arnie. Neither could I. There was just something special.

Snoopie and Arnie became inseparable. Snoop is a horse dog and spent time out on the trail. Arn Ball was a pampered house cat and a little jealous of Snoop’s adventures. So, when Snoop returned home they would spend time in all their favorite spots. By the patio door in the “sunbeams”, by the air conditioner to cool off or in front of the fireplace when cold. Arnie would spend hours “reading the newspaper” all over Snoopie from the day! That was their evening ritual.

Arnie's day ritual was usually on my husband’s lap “helping” him on his computer. If the computer was getting more attention than him he would he would sneek up on you from behind. Gently put his paws up on the back of the chair, stretch out and reach up to tap your shoulder with his paw. The first time he did this to me, I was home alone, and almost had a heart attack. After awhile, Arn Ball figured he would get a bigger reaction out of me, than my husband, and always seemed to “target” me for this cat prank!

Sometimes, Arnie would be left to do his important cat business. If we went away for a few days, Snoopie either went with us or to her second home, at our dear friend’s house. Usually when we returned there would be a departed lizard, mouse or bunny next to my husband’s chair. Always, in the same spot. As if he were giving a gift to his god, my husband, and willing his safe & speedy return. When we did return Arnie would “talk” about it for hours!

Arn Ball had many rituals. One could not enter the bathroom without company. If you seated yourself on the "throne", you had “company “in your lap. There was never a need for a magazine! He would plop himself down and throw his arms over your knees, dangling. He would look back at you with the most yellow eyes and demand a shoulder rub. You were only finished with your business, when he got a sufficient shoulder rub!

Then, once the lid closed, that became his perch. Now it’s shower time for us and sauna time for Arnie. While we were in the shower, he worked on the toilet paper roll. One could always gage his mood by the amount of toilet paper on the floor! Afterwards, he would sit on the throne, alone, in the dark, until all the steam was gone!

Another Arn Ball game. How many times could he sneak up me, while I was trying to get ready for work, and smack me in the back of the feet? It was his way of letting me know he didn’t want me to go. He never did that on my days off.

On the days when I did go, they knew the sound of my car as it came down the drive. There they would be...Snoop and Arn Ball…just waiting….inside the door…on the mat…next to each other…right where I left them!

Snoop still sits off to one side of the mat like Arnie is still there. I hope she continues.

Kiss all those little furry faces while you can!

Rene & Snoopie

[MBK]

Dear Rene -

I just now read about the loss of your beloved Arnie! I am so sorry for your family's loss! Poor Snoop must be devastated to lose her friend in such a tragic way. I'm sure seeing Snoop mourn so deeply is very difficult for you, as well. Arnie sounds like he was quite a character and he was obviously very loved by his humans and by his dog!

You, your husband and Snoop are in my thoughts.

R.I.P. sweet Arnie.

[Rene]

Thank You Mary Beth,

I understand you have had a tough time of your own with the loss of Ali's sister, Patches. Be sure to tell you sister that there are many thoughts of empathy coming her way from our little cush family.

Love,
Rene & Snoopie

[littleone1]

I'm sorry for your loss, Rene. My thoughts and prayers are with you and your family, which definitely includes Snoopy.

Terri

[apollo6]

dear Rene
It was so nice to read about your Arnie in your life. Take care my friend and an extra hug for Snoopy and your husband.
Hugs Sonja and Apollo

[addy]

Renee what a wonderful tribute to Arnie. I feel as though I knew him.

I have been privileged to share my life with 3 very special kittens. I loved them all and miss them to this day.

Sharing memories with others helped me. I hope it helps you and your family as well. Keep sharing the memories, we love to read them.

Love and hugs,
Addy, Zoe and Koko

[Squirt's Mom]

Hi Rene,

What wonderful memories you have to hold onto! It is those memories that will help you and your hubby start to heal in the days and weeks to come. One day, you will laugh out loud at a particular memory and the pain will retreat another step.

Hugs,
Leslie and the gang

[Rene]

Terri, Sonja, Addy & Leslie,

Thank you for your continued thoughts and prayers.

When I first started here I was more of "peeping tom" and considered myslef a "reader". But, the group has been so kind and open with theirselves...sharing trials, tribulations and the "little wins" as I call them in this horrible disease. One cannot feel anything but part of this family.

The groups kind and gentle "pearls of wisdom" and hand holding are the most appreciated. You all have made it easy to share experiences, good or bad.

Leslie & Addy...i'll try to keep the stories comming. But, lately I have felt that when you choose to read this thread...its kind of "like a box of chocolates, you never know what your gonna get!"

Thanks for everyones support.
Rene & Snoopie

[rbeasl]

Rene,

Thank you for sharing your very precious memories of Arnie. Arnie was a very special cat. I just never knew cats had so much personality. I've always been scared of cats, but after reading about Arnie, I want a kitten. Arnie was one lucky cat with a great family. My thoughts and prayers will continue to be with you and your family.

God Bless
Rhondalyn and Honey

[Rene]

Thank you Rhondalyn,

He was very dog-like. He wasn't allowed outside unless in the little dog-poop run or with me in the yard gardening. He would just take his sun/dirt baths and never try to run off. The neighbors always got a kick out of him when he would trot along after me down the road to the mail box to get the mail and back again, just like a dog.

Rene & Snoop

[apollo6]

Dear Rene
What a special little guy Arnie was.
Hugs Sonja and Apollo

[Rene]

Hello,

We pushed our Stim up and had it today because Snoop seems just a bit off. Had a little surprise.

Usually we pay $37.00 for .25mg of Cortrosyn. Today we paid $84.28 for .25mg of Cortrosyn! This is just the price of the Cortrosyn we still pay the price of the ACTH stim test and the Technician Services on top of that.

When I questioned it they claimed the manufactured had raised their prices. They said they are still splitting the ampules and nothing had changed at their end. I told them that seemed a bit unreasonable with no notice and we settled on $50.00. Has anybody else experienced this and is this true?

Also, Snoop is acting differently after this Stim. She is restless, lip smacking and breathing rapidly.

Rene & Snoopie

[rbeasl]

Rene,

So Sorry Snoop is not feeling well. Maybe it is the stress from being at the vets. I hope someone can tell you what is going on.

WOW !!! That is really a big increase in the cortrosyn. Just when I thought I could get a break. You are one tough cookie... GOOD for you for getting them to reduce the price.:)

Take Care
Rhondalyn and Honey

[Harley PoMMom]

It sounds, by her symptoms, that she have been experiencing nausea. Hoping today finds sweet Snoopy feeling more like herself.

Love and hugs,
Lori

[MBK]

Hi, Rene -

Wow that was quite an increse!

How is Snoop today? I hope she is feeling much better. Maybe she is still out of sorts from the loss of her pal.

Keeping you in my thoughts!

[Rene]

Hi,

I gave her melatonin when she started with the uncomfortablness to help her settle. When she started the lip smacking I gave her a tums. She has taken both of these before so I hoped it wouldn't hurt. She seemed to quiet down sometime after midnight. I hope the fact that she reacted to the stim doesn't mean that her cortisol is back up?

I was not told about the pepid by my vet before giving the Lysodren and want to start. Is it the AC and how much and how much in advance of the dose? Also, should it be given before a stim in light of this incident? Snoopie was fasting for this stim.

Snoopie is doing much better with the loss of Arnie. I went into the dog run and moved things around. Gardening table, chair, potting soil, ect. to make it look different. That seemed to have made things a little better for her, or maybe it was just time. She has stopped peeing in the house at night and has been going into the run at night to do her business, but comes back in quickly. That is a good thing in case it was a coyotee. But we are quite certain it was a large barn owl as we have several.

Rene & Snoop

[Harley PoMMom]

According to this website: http://www.walkervalleyvet.com/otc-meds.htm the dosage of Pepcid AC (10mg) for dogs: less than 20 lbs = ¼ tablet ;20-60 lbs = ½ tablet ; over 60 lbs = 1 whole tablet.

When I was treating Harley for Cushing's I would give the pepcid ac 20-30 minutes before the Cush meds.

I would definitely talk to your vet about Snoopy's recent issues with the stim test and ask if the pepcid ac can/should be given before the ACTH stim test.

FWIW, I never fasted Harley for his stim tests.

Love and hugs,
Lori

[Rene]

Thank you Lori!

[littleone1]

Hi Rene,

I also give Corky Pepcid AC for a few days whenever his Trilo dosage is increased, and when he starts taking new meds. Corky's IMS has him taking 5mg once a day. He weighs 18.1 pounds now. I also never fasted Corky before his stim tests, as he has to have his Trilo 4-6 hours before his stim, and it has to be taken with food.

Corky's last stim was also much more expensive. His IMS told me that the cost of the Cortrosyn did go up, and so did the lab fees.

I hope snoopy feels better soon.

[Rene]

Thanks Terri,

They did increase the cost of the test also from $178.50 to 189.25. I happen to know that the lab they are using charges $56.00 for a two sample ACTH Response test. This is how they recover their overhead. They also charge for the Technician Sevices for the draw itself. We settled on a total price this time of $264.85.

I spoke with the vets office and got clarification. They did want Snoop fasting for 8 hours before her stim test. I explained about the restlessness, rapid breathing and lip smacking she had last night. They are having someone call back.

Rene & Snoop

[apollo6]

Dear Rene
Hope things have settled a little for your family. The grief will be there for a long time. Sorry to hear about Snoopy. I have always given Apollo children's pepcid when he had an upset stomach.
I have also had to fight for increases in pricing on stims. Like in one month a $50.00 increase. I even asked for a little of a break considering spent over $6,000.00 with IMS. If you look at the University of Tennessee and see what they charge for a lot of these tests. You 'd be surprised on the mark up vets make and the pharmaceutical copies on the meds for our babies. I am lucky to even break even in our business.
Hugs Sonja and Apollo

[Rene]

Hi Sonja!

Yep...I understand the overhead and that everybody is struggling. But, I thought that the explanation of the markup from $37.00 to $84.28 that was solely coming from the manufacturer was not so honest. That is why I wanted to know what kind of increase others were paying.

I just got a call back from the vet. They just though Snoop may have been stressed. She does not stress easly, actually enjoys the attention at the vet and has not reacted to a stim this way before. I am almost afraid that because of the incident with Arnie and then the trip to the vet she is not handling stress well now. This could indicate Addy! On the other hand she has been drinking more and seems hungrier, which could indicate a rise in her cortisol. I will just have to be patient. Her pre-stim was not even back yet to give us a hint!

Another thing I have been noticing is Snoop has a rapid twitching at the front of the apex of her left ear. She suffered sudden facial nerve paresis last December on the left side. She suddenly could not close her left eye and could not chew on the left side. She also went deaf then. It has gotten a little better but she still can not blink. We try to keep her eye lubricated with Optixcare or sterile eye lubricant but she now is getting a corneal ulcer which I give her BNP or Terramycin for.

Unfortunately, when Snoop gets her stims it is just a lab call and she does not see the vet. The plan is to see what the comes back on the stim. If things are not good then get blood panel and when that comes in get a sit down with the IMS.

Good thing I am off today.

Rene & Snoop

[apollo6]

Dear Rene
A lot of what Snoopy may be feeling is the loose of her best friend Arnie. She is probably not understanding that he is not here anymore and maybe is more stressed out then normal. Are cushing babies have enough to deal with and any extra stress just elevates their issues more. You have to watch what they charge. I went through the same.
Hugs Sonja and Apollo

[MBK]

Hi Rene -

I hope Snoop is feeling better since her stim testing. I think that was really smart of you for rearranging the dog run area a bit! Hopefully you'll get the chance to relax a little and enjoy the weekend.

[Rene]

Snoops Stim came back....

pre 3.7 post 18.0!

:(

[addy]

Hi Renee,

Zoe had a similar experience in January after her UTK adrenal panel and blood work. She had to fast for her blood work and gastro panel and threw up in the car on the drive to the IMS (she never throws up)

She was sick to her tummy on the ride home after her test. I fed her a small amount of food but she had the rapid breathing and not acting right. It was a bit scary, but I do believe it was as Lori said, being sick to her tummy and the test put her over the edge. I did not like the rapid breathing as I had never experienced that with her.

I plan to discuss a head of time Monday with the IMS so I know what to do if she has the same side effect Monday.

Hugs,
Addy

[Rene]

Good Morining Addy,

I hope you and Zoe are doing better this morining!

Snoop has never been so low then so high on a stim test before. I don't know what to make of it?

Snoopie is a very confident tough cookie and does not shake easly. But she is also a very sweet and sensitive girl. She did not do well witnessing the loss of her kitty and was out of sorts for days. She was pretty much back settled in by the time we took her for the test....but I can't help think the strees took it toll.

Also, I may have been confused before and did not fast her on the other tests. I did confirm that the vet did want her fasting for 8 hours before the test. Maybe all of these things contributed to her reaction to the test and the strange results.

I don't know about these things...maybe nothing has anything to do with the other....anybody have any explainations?

Unfortunately, I have to go to work.

HAPPY SATURDAY TO EVERYBODY!
Rene & Snoopie

[Harley PoMMom]

Snoops Stim came back....

pre 3.7 post 18.0!

:(

Oh Rene I am so sorry to see that Snoopy's cortisol has risen. My thinking is with a dog being treated with Lysodren is that the only way the cortisol will rise is if the adrenals are regenerating. According to Dr Feldman:
Dogs receiving o.p'-DDD and undergoing stress (illness, trauma, elective surgery) should be treated with glucocorticoids. The adequately treated dog with PDH has sufficient adrenal reserve for day-to-day living but not enough to handle major stress. http://www.io.com/~lolawson/cushings/articles/feldman5.pdf So, in my mind, the stress could not of raised her cortisol but if the Lysodren dosage is not sufficient to control the cortisol than a elevated post stim is likely.

Has Snoppy's IMS said anything about reloading her?

Keeping you and Snoopy in my thoughts and prayers.

Love and hugs,
Lori

[apollo6]

Dear Rene
Wish I could give you input on the reading will check back on Apollo's to see if his was similar at any time.
Sonja and Apollo

[Rene]

Hi Lori,

Thanks...that was sort of what I was thinking...but I don't know enough about it. What I do know is that apparently Snoop has super adrenals that have been re-generating, despite the Lysodren! At first the vet told me to put her on 500mg maintanence dose after she was loaded the first time. He did not say to spread it out. She did not hold. The second time we loaded and went to maintanence, after the kind folks here pointed out the need to spread out the dose, he did not disagree. We tried bi-weekly, which did not work, then went to 4 times a week...as splitting a Lysodren tablet into 3 is impossible.

My method is...split it into 4 on Sunday, put it into a separate bottle, if the bottle is empty on Saturday we did well! What I was afraid of all along was we never adjusted her maintanence up. She had always had a dose of 500mg weekly. I was afraid even though we got her down to 3.2/4.9 she would not hold unless we adjusted her weelky dose up.

She has not held. Possibly, due to the combination of improper maintanence dosage and super adrenals. Can someone give insight?

Here is where we are now.

Snoops stim came back 3.7/18.0. I got this news on a voice mail, as I was working. The IMS said "I understand Snoop is having anxitey issues (witnessing the loss of her kitty) so we should sit down and talk". Hopefully, he is on top of what is gong on and I am the only one in the dark about the big range in resting cortisol 3.7 and stimulated 18.0. We will see what he has to say on Monday.

Snoopie weights 28.1 pounds now. I am going to assume we have to reload now. If so what should her maintanence dose be to hold this time?

I have a concern. I am not afraid of loading as Snoop obviously has had no problem with Lyso.

But, I am concerned with loading so many times...can this cause a crash...does this happen?

Especially with her issues...no gall bladder, spleen, renal dysfunction, cronic pancreatitus...all of which have seemed to relsolve, for the moment, thanks to the lysodren....what a double edged sword!

She has been doing so well and I just feel like we are really pushing the envelope with all this loading!

Happy Sunday!

Rene & Snoopie

[frijole]

Rene, Refresh my memory... how long did Snoopy maintain at the current level? (when loaded and when did levels start going up) We need to figure out if it is the dosage that is too low or if something else has caused the cortisol levels to rise. I learned from my Annie's misdiagnosis that there are lots of other things that can cause the acth test to be high. Stress and other illnesses. I think that is why the IMS mentioned the death of Snoopy's companion.

More important - have you noticed the symptoms returning? Sometimes we get so focused on the numbers being right that we forget that what is most important is how the dog is acting. Sorry if you have already discussed this.. I have been away and don't have time right now to go back and read.

Big hugs, Kim

[lulusmom]

Hi Rene,

I had to go back and refresh my memory on Snoop's loading history so can now make comments that make sense...to me anyway. :D See below in blue.


Hi Lori,

Thanks...that was sort of what I was thinking...but I don't know enough about it. What I do know is that apparently Snoop has super adrenals that have been re-generating, despite the Lysodren! At first the vet told me to put her on 500mg maintanence dose after she was loaded the first time. He did not say to spread it out. She did not hold.

I don't believe Snoop's adrenals regenerated so much from a maintenance dose being given once a week as it was the fact that Snoop was never loaded to begin with. Snoops first stim was not done at optimum times and her post was 10.9 after ten days of loading. That's a long time but then again your vet took a very conservative approach of 30mg/kg loading dose. A 10.9 post stim after 10 days of loading most definitely would call for a larger maintenance dose, so the IMS prescribed 500mg which is 41mg/kg. Even if Snoop's post stim had been 4 or 5 ug/dl, a higher maintenance dose should have been prescribed simply because it took 10 days to get there so it was a big crap shoot as to whether even an increased maintenance dose was going to hold. I think Debbie pointed this out and she was right.

The second time we loaded and went to maintanence, after the kind folks here pointed out the need to spread out the dose, he did not disagree. We tried bi-weekly, which did not work, then went to 4 times a week...as splitting a Lysodren tablet into 3 is impossible.

My method is...split it into 4 on Sunday, put it into a separate bottle, if the bottle is empty on Saturday we did well! What I was afraid of all along was we never adjusted her maintanence up. She had always had a dose of 500mg weekly. I was afraid even though we got her down to 3.2/4.9 she would not hold unless we adjusted her weelky dose up.

She has not held. Possibly, due to the combination of improper maintanence dosage and super adrenals. Can someone give insight?

Unfortunately, there is no magic formula for calculating the correct maintenance dose and in Snoops case there were a lot of things to consider when attempting to arrive at an appropriate maintenance dose. I agree that the problem is a combination of things. Snoop's post cortisol on the UTK adrenal panel was 42 ug/dl which is a severe elevation. As a rule, adrenals that are pumping out this much cortisol are working overtime because the feedback with the pituitary gland has been lost. The more they secrete, the bigger and fattier they become and at that point I think they are as you called them "super adrenals". Super adrenals will have to take a bigger Lysodren beating to shrink them down to size. In my opinion, your IMS has never prescribed a loading dose that is high enough for super adrenals nor were the last two stims done at the optimum times which makes the already difficult task of trying to determine an appropriate maintenance more difficult.

Here is where we are now.

Snoops stim came back 3.7/18.0. I got this news on a voice mail, as I was working. The IMS said "I understand Snoop is having anxitey issues (witnessing the loss of her kitty) so we should sit down and talk". Hopefully, he is on top of what is gong on and I am the only one in the dark about the big range in resting cortisol 3.7 and stimulated 18.0. We will see what he has to say on Monday.

Snoopy's pre stim number is well within the normal basal range so if Snoop were stressed or experiencing anxiety, I would think that number would be higher. In my opinion, it isn't anxiety that caused the high post stim number. Raising the maintenance dose is not an option and you are looking at having to reload.


Snoopie weights 28.1 pounds now. I am going to assume we have to reload now. If so what should her maintanence dose be to hold this time?

I would recommend that when you reload, you discuss using the maximum dosing with your vet and start reloading on a day that would insure that the IMS' office is open to do the stim.


I have a concern. I am not afraid of loading as Snoop obviously has had no problem with Lyso.But, I am concerned with loading so many times...can this cause a crash...does this happen?

We've seen dogs here that have had to go through multiple reloads. As long as cortisol doesn't drop too low, the number of loadings doesn't usually have an adverse impact on the dog. However, there comes a point where enough is enough and you need to rethink whether Lysodren is going to work. I can't remember but is there a reason why Trilostane was not an option for Snoop?

Especially with her issues...no gall bladder, spleen, renal dysfunction, cronic pancreatitus...all of which have seemed to relsolve, for the moment, thanks to the lysodren....what a double edged sword!

Was Snoop formally diagnosed with renal failure or was the presumed dysfunction secondary to cushing's?

She has been doing so well and I just feel like we are really pushing the envelope with all this loading!

Happy Sunday!

Rene & Snoopie

[Rene]

Thanks Kim & Glynda!

I hope I get the questions answered...here it goes. Glynda did an excellent job of explaining most of the scenero.

On 3/28/11 she stimed at 3.2/4.9.

I started noticing in just the last month an increase feening for food and thirst. She also has off and on swollen vulva which resolves the next day if given her maintanence dose. Her regular vet said she though this may be hormonal.

Which brings us to the lyso/trilo question. We did a UTK panel 1/13/11:

Cortisol 104.8/426.4
Androstenedione 2.44/10.0
Estradiol 125.1/125.7
Progesterone .97/20.8
17 OH Progesterone .99/26.8
Aldosterone 30.5/152.9

So trilo was not the recommended treatment because of some of the severly elevated hormones.

The renal issues were discussed with her regular vet because of elevations on her CBC tests. Im not sure is that means it is a presumed dysfunction secondary to cushing's or an actual diagnosis.

I agree with Glynda in that I don't feel she was ever loaded properly except for the last time.

Overall she is doing sooo well. Gaining weight and muscle. The only red flags are the hunger, water issues and now the stim results. She seems restless too. When I get home she just wants to be with me but can't find a comfortable spot. I think she keeps moving away because she is hot. Then she comes back for awhile...but has to leave. She keeps going back and forth from one side of the couch to being next to me. Im hoping that is the elevated cortisol and not that she is sick from something else and uncomfortable.

The other red flag she is showing is this situation with her facial nerve paresis as her eyes look terrible again...red, lifeless, and the third eye lid is raised at times about half mast up toward the paralized left eyelid. She also has exposure keratitis because she cannot blink that left eye. We do keep it moist with drops and/or terramycin. It has developed a corneal ulcer probably because she was out in the wind and sun too much a few weeks ago while we went camping a the beach for a week. It is getting better with BNP...but very red and weepie.

It is confusing because I don't know if these are indicators of a bigger crisis or a by product of the parensis. The 3rd eyelid could be compensating for lack of tear production because she cannot blink and that is why it is raised at times. It is not swollen like you see in "cherry eye" but her whole eye is very red. Both look lifeless at times. She just seems "off" when you look at her expressions. Like she does not feel well. She acts ok...wants to go "wabbit hunting", happy to see me, talks to me if im not paying attention, ect.

I am aware of the issues that can occur with a growing pitituary tumor, which could be one of the explaination for the paresis and sudden deafness. I am fearing what I am seeing are growing neuro issues.

So I dont know if we have two problems or one. Elevated cortisol again and/or something synister behind the paresis or renal issues...she sure drinks a lot.

I will call the IMS tomorrow and see what he has to say.

Hope this helps...you guys are great!

[lulusmom]

Hi Rene,

I only have a minute but wanted to tell you that if Snoopy had an enlarging tumor, high cortisol would actually be helping instead of the other way around. I don't know anything about paresis but I'll do a little reading on my lunch hour.

[Squirt's Mom]

Something I learned with Trink - all meds of the "mycin" family have the potential to cause deafness. It doesn't matter if it is given orally or topically, ear or eye drops or pills or cream - if it is "mycin" it can cause deafness. :( Trink was on gentimycin eye drops and antibiotics for the colitis until I learned that and with her being blind, she won't get any more of that family of drugs - or Brick either. It rarely happens, but with my luck it would happen with my babies! :rolleyes:

[SasAndYunah]

Hi Rene :)

I noticed you talking about facial nerve paresis and went all the way back on your thread to get more info but I cannot seem to find it. Since you also said that the deafness occurred at the same time, I am wondering if she was ever checked for an inner and/or middle ear infection? Since this is the most common cause for facial nerve paresis/paralysis. There are, of course, other more rare causes too that could be checked.

Did Snoopy see an eye doctor to get a good treatment plan for her eye(s)? I ask because my Yunah had very persistant (dry) eyeproblems and recurring eye infections due to it and I went to see a specialised eye doctor who was able to perform a whole lot of tests and to tell me exactly how I had to treat Yunah’s eyes. The artificial tears she was prescribed earlier, didn’t seem to work and after our visit to the eye doctor it became clear why. Yunah now wears glasses when it’s windy, when there’s a lot of sun and when she is in a sandy surrounding like a beach. Apart from the glasses I clean her eyes with (home made) saline and use an ointment that makes her eyes more “greasy” so the artificial tears stick better to her eyeballs. If not treated properly, dogs can go blind from this and that would be a shame since it is preventable...

Anyway, just wanted to let you know that there is a lot one can do to prevent possible blindness due to eye/tear problems.

Saskia and Yunah :)

[apollo6]

Just checking on on you.
Always something.
sonja and Apollo

[Rene]

Hi guys!

Glynda,
Snoop had the sudden facial nerve problem and the sudden deafness last december. Her cortisol has probably only risen in the last month because I have noticed the increased thrist and hunger since then. So the only saving grace with the enlarged pit tumor, if that is what is going on would, be within the last month :(

Leslie,
Does the deafness reverse when stopping the mycin? She had a sudden onset when I was not using it so I don't think it was mycin...but just curious.

Sas,
Yes, she had ear examinations and there was no infections...only a foxtail once. Her eye problems are secondary to the facial nerve parensis. She had a sudden onset around Christmas we talked about. She could not blink her left eye and the left side of her face drooped. Food just fell from that side of her mouth. I thought she had a stroke because her ultra sound revealed a clot somewhere and I feared it brook loose...her IMS said it was parensis. Because she cannot blink the left eye we keep it moistened with a long lasting gel surgical lubricant several times a day and a lubricating drop. She has a bonnet made from screen door material that serves as eye protection that she wears when she goes outside. She now also has "doggles" for certian exposures. When she gets a flare of Exposure Keratitis we treat it with terramycin...but after what Glynda said about deafness maybe not anymore...we had a overexposure a few weeks ago and got a little Corneal Ulcer and it is resolving with BNP.

It is just that her eyes are awful red now. I think I read on someones thread that when the cortisol is elevated that it can cause red irritated eyes. Does anyone know about that?

Thanks for everyones input...Hi Sonja!

Rene & Snoop

[apollo6]

Hang in there.
Sonja and Apollo

[rbeasl]

Hi Rene,

Just wanted you to know I think of you and Snoop often and send out many prayers for Snoopy to get better.

Stay Strong
Rhondalyn and Honey

[Squirt's Mom]

Hi Rene,

Slow to respond here....my understanding was the deafness could be reversed but rarely is.

Hugs,
Leslie and the gang

[Rene]

Sonja, Rhondalyn and Leslie,

Thank you for your response and lovely thoughts!

I just returned from TN from a visit with family. Orginally, we had planned on stopping by Dr. Oliver's office and thanking him personally for saving our little angle telling him how much we appreciate his time and responses to our questions. But, we just dropped by and left a note and picture instead. Godspeed.

Snoopie went to her home away from home at our dear friends house and now we will address her ATCH test.

On 06/08/11 she stimed at 3.7/18.0 while on 500mg weekly maintenance dose of Lysodren. She last loaded on 03/25/11. She gained weight, muscle, hair regrowth and intrest in life. About a a month and a half ago there was a return of hunger & thirst. She weighs 28.1 lbs now.

Her IMS will be calling back Saturday as he was out of the office today.

Another issue came up while we were gone. Snoops Corneal Ulcer tore or the center shed while we were gone. She has never had one before so we do not know what to expect. She has Exposure Keratitis due to Facial Nerve Parensis (sudden deafness and onset in December 2010) and can not blink her left eye. Her third eye lid (or lower eye lid) has compensated by rising almost half way sometimes and she rolls her eye backwards to blink.

It is kept moist with syrgical gel and drops. She had a Corneal Ulcer from a over exposure last month from a week at the beach.

We picked her up last night. She used to have a small white star in the center. Now it looks like it has shed or torn off in the center. Her eye is red and weepy but not as "angry" as it was before. It was explained to me that it was very red before because the blood vessels were engorged, speed healing the ulcer. She is not rubbing it or clamping it closed but it is sun sensivive, as she always is. We are putting BNP ointment on it several times a day.

Waiting to hear from the IM tomorrow. Any thought on her stim?
Do Corneal Ulcers shed? I posted a picture on my albums.

Rene & Snoop

[Rene]

if something else has caused the cortisol levels to rise. I learned from my Annie's misdiagnosis that there are lots of other things that can cause the acth test to be high. Stress and other illnesses. I think that is why the IMS mentioned the death of Snoopy's companion.



Kim...you mentioned Annie's misdiagnosis and other things causing test to be high. Snoop's test was within range then when stimed high...any thoughts?

[frijole]

Kim...you mentioned Annie's misdiagnosis and other things causing test to be high. Snoop's test was within range then when stimed high...any thoughts?

Just wanted to clarify you are asking me what else might have caused the numbers to be high (if not cushings). Assuming this is the question - stress over the loss of a companion, other illnesses the body is fighting (in my case an adrenal tumor/pheochromocytoma but certainly other diseases would cause it)

I remember reading Glynda's post (right after mine) and she took the time to go back and read the entire history and I have to say she makes some valid points as to whether you ever achieved a true load and for reloading. You could do it for just a few days to see if it makes a difference.

I'm sorry I can't answer your question about the cornea. Annie just had an ulcerated cornea and we went to a bd certified specialist in Omaha. (my vet misdiagnosed it as an infection/allergies) The eye went from having a slight 'marking' to being sunken.

What she said was that alot of dogs injure their eyes and they are able to heal without meds. But a dog whose immune system is weakened or that is older needs help (antibiotics). Wow... poor Snoop has had a tough year. :(

Sending love and positive vibes your way. That was really nice of you to stop by Dr Oliver's office with a note. xoxo Kim

[Rene]

Thanks Kim!

She has been mostly just great! Just these bumps. I feel so bad for her because she is a 10 then all of the sudden a 2. Tonite not so good. Sleeping off discomfort of some type. I gave her her Lyso this morining and she did not want her dinner tonite. I think she is afraid I will put another pill in her dinner because she will eat other food. Don't know if it is the Lyso or the eye.

Did you see the picture of her ulcerated eye on my album? Did it look like Annie's?

Which brings me to my question for you. If she stimed out at pre 3.7 (within range) then post 18.0 that does mean she has to be reloaded right? Even though her pre is where it should be? Will that mean the load will be short?

It is so hard to come home from a trip to this and then to work tomorrow....thank you for your help.
Rene

[Rene]

Sending love and positive vibes your way. That was really nice of you to stop by Dr Oliver's office with a note. xoxo Kim

Thank you Kim...very sweet for you to say.

I just wanted to share this with you all.

Many of us were blessed with sharing correspondence of some type with Dr. Oliver. I experenced his patience, gentle way and grace first hand. While visiting family in TN last week, I went to his office drop off a note and photo. It was not surprising to find that his surroundings reflected his good nature.

Dr. Oliver's office is located in a building on the Tennessee riverfront boardwalk. It has a view across the river of the UT Medical Center, which is a beautiful facility. Adjacent to his building there is a gorgeous large garden.

When I saw that garden, I pictured Dr. Oliver strolling about taking in the riverfront, thinking of ways to save our cush pups...

[addy]

Sorry to hear about Snoops, Renee. I hope her eye gets better soon.
She's been through so much but she has been a trooper through it all.

It was nice to hear about your description of the Knoxville campus and Dr. Oliver's office setting. We will all miss him.

Let us know what your vet thinks about reloading Snoopy. Maybe a mini load is all you need.

Love ya,
Addy

[frijole]

Thanks Kim!

She has been mostly just great! Just these bumps. I feel so bad for her because she is a 10 then all of the sudden a 2. Tonite not so good. Sleeping off discomfort of some type. I gave her her Lyso this morining and she did not want her dinner tonite. I think she is afraid I will put another pill in her dinner because she will eat other food. Don't know if it is the Lyso or the eye.

Did you see the picture of her ulcerated eye on my album? Did it look like Annie's?

Which brings me to my question for you. If she stimed out at pre 3.7 (within range) then post 18.0 that does mean she has to be reloaded right? Even though her pre is where it should be? Will that mean the load will be short?

It is so hard to come home from a trip to this and then to work tomorrow....thank you for your help.
Rene

Annie's eye was not swollen - just very very very red and there was pus coming out. Hard for me to tell from that photo on this pc.

When looking at the acth results we really only are concerned about the 2nd number being within range. That is the number that measures cortisol. 18 is much higher than the DESIRED number for a dog that has been treated for cushings. You wish this number to be between a 1 and a 5. The first number is usually meaningless... if it is above range it often means the dog was stressed out... or in my dog's case... she had high cortisol already in her body because her tumor is emitting adrenaline!

[Bagel's Mom]

Just glancing at the ADORABLE picture and catching the tale end of your post...

Find and read Dr Feldman's study of canine Cushings for 35 years- He is very specific about Lysodren dosing...and the loading phase. It use to be on here somewhere...

Bagel is 2.3 yrs on Lysodren- and I spread her 1500 mgs per WEEK out to three days, a half pill AM and PM on those days.It's rough stuff.. DDT !

But my vet checked with an internist who told me to give it with a fatty snack like cream cheese b/c the Lyso processes better in her system.
Also, ( they told me ) I give her a 10 mg (generic) pepsid on the days she gets the Lyso too. Only 10 mg...She weighs 30 lbs...
THAT made all the difference!
Sometimes I give the Lyso in peanut butter blob too..SHE LOVES THAT

running here....Sande and Bagel

[apollo6]

Dear Rene
Sounds like your trip was bitter sweet in regards to Dr. Oliver. I hope you were able to have some quality time with your parents.
I am so sorry to hear about Snoopy's eye. I will be praying for you an will look at picture.
Call me if you have time.
Hugs Sonja and Apollo

[Rene]

Hi Addy, Kim, Sande & Sonja,

Snoop gets 10mg of Pepsid AC about 30 minutes before her Lysodren and gets it in a fatty cheese or peanut butter ball. We had not been doing this until recently because we did not know about it. Fortunately, the lyso has never really bothered her. Only recently has she been bothered by something. We are trying to pin it down. It just may be she caught me putting supplements in her food and just wanted something else. She is very smart that way.

Sande...I was curious...what was Bagel's pre and post cortisols that prompted the heafty dose of Lysodren. I know he has others issues, as Snoopie does...and you have had success for over two years....have you always been at that dose?

Snoopie currently gets 500mg of Lysodren weekly. We cut it into quarters with a pill cutter and put it into a separtate bottle. We start on Sunday and try to give a quarter every other day. If the bottle is empty by Saturday we did well.

I spoke with her IMS today. He said if her eye does not appear to be doing better each day then take her to the eye specialist. Her eye is not swollen and there is no pus like Kim's Annie. It is just red and weepie. She does not rub it. We keep putting the triple antibiotic ointment in it several times a day. There is a white haze around where the center came off, about 2mm. But, where the center shed off it looks healthy underneath. I am wondering if the white haze part will shed off also? The IMS did not know.

Snoopie's stim on 06/08/11 was 3.7 & 18.0. She weighs 28.1 lbs. She has been on 500mg lysodren broken down 4 times a week.

Her IMS wants to change her maintenance dose to 625mg weekly, without a load.

He said to give her five 125mg doses a week. Give her the new dose for 30 days and call him. She had a return of thirst and hunger this time so he wanted a call in 30 days to see if these symptoms resolved.

I completely agree her maintenance dose should be raised to 625mg.

I know he is being conserative because of her issues...lack of spleen, gall baldder, ect.... However, are there any thoughts about to load or not to load? Will this work with a stim of 3.7 & 18.0?

Rene & Snoop

[frijole]

Rene, I can honestly tell you that I cannot recall an increase working to bring down numbers (vs a miniload) - particularly when you are so high to begin with. While I understand being conservative, on the flip side - I find this approach more stressful because it typically does not work AND it means more time, more testing, more money, and mostly a whole lot more stressing out.

About the eye - my eye specialist did say that you want to see the blood vessels/pinkish colors around the injury because it means the blood is flowing to the area and it is healing. Any doubts I'd go to the specialist. Continued hugs and well wishes. Kim

[Rene]

Thanks Kim,

Just a quick note before work. Snoops eye looks about the same. There is red blood vessels giving it a blood shot appearance but it is not the angry red it was a few weeks ago before the center shed off. A trick I learned at bedtime and for long exposures from before was to open a capsule of cod liver oil and put a couple drops into her eye. It is suppost to a natural antibiotic and really put a good coating on the eye to keep it moist. It also was a good base for her other drops making them last longer in her eye. Well, about a half hour after the BNP and just before bed I put some into her eye to help keep it moist for her while she slept.

This morining the eye looked the same but she is all "bright eyed and bushey tailed" rolling her treat ball all over, wagging her tail and just having a great time! I think the coating is giving her some relief.

"Just One Good Thing Today!"

On another note I think the IMS is being consertative by skipping the mini load. Glynda predicted this and already suggested a mini load of 625mg. 3/4 pill in AM and 1/2 in PM thought would load in 3-5 days. Then weekely dose of 625mg 1/4 parts M-F. At least that was her experience.

Sounds like the IMS wants to try just raising the dose to 625mg and seeing if her hunger and thirst resolves in 30 days. If not he will probably suggest the mini load without a test. So, it sounds like we are just prolonging her controlled cortisol for another 30 days.

Does that sound about right?

Got to run.

Rene & Snoop

[Harley PoMMom]

I agree with Kim, increasing maintenance doses rarely does the job at lowering the cortisol. With a dog being treated with Lysodren the therapeutic ranges are between 1-5 ug/dl.

With Snoopy's post stim of 18 ug/dl it seems that her adrenals are regenerating and I believe that a mini-load will be the only way to erode enough of the adrenals to get her post stim within the therapeutic ranges.

Sending healing energy your way for Snoopy's eye.

Love and hugs,
Lori

[apollo6]

Dear Rene
You are always on top of it. Snoopy is a lucky little girl to have you.
Hugs Sonja and Apollo

[Squirt's Mom]

Hi Rene,

I agree with Lori and Kim - increasing the maintenance dose will likely do little other than cost you more money and Snoop more time before her cortisol is under control. :( Being conservative has it's merits for sure but there comes a time when we have to look at the lesser of two evils, so to say. The sooner her cortisol is under control, the sooner her body is going to start recouping from it's effects. You and your vet will have to discuss and decide which course to take, but my vote would be to do a mini-load. :)

I would have never thought of putting cod liver oil in the eye! But, I'm glad it seems to be helping her. It sounds as if she is feeling better and wanting to play again is always a good sign, not to mention great for mom's hearts. :D I hope she continues to improve day by day!

Hugs,
Leslie and the gang

[Rene]

Hi Kim, Lori, Sonja & Leslie,

Thanks again for your posts! I agree with you all and Glynda that Snoop needs a mini load.

I am on the fence about her eye, now. When I got home from work tonite she is still happy and playing! Her eye looks like do do...but, it is not worse. I think we all know our guys are slow to heal with their compromised immune system.

I am leaning toward giving her eye time to heal and not rocking the boat with a load. I am a firm believer in priorities and in addressing one issue at a time. By the time her eye heals it will probably be closer to the 30 days the IMS wanted to wait and we can mini-load then when I report to him that her thrist and hunger have not curtailed. Does that sound like a sensible plan?

One Good Thing Today..."she is still happy and playing!".
Rene & Snoopie

[Harley PoMMom]

I am leaning toward giving her eye time to heal and not rocking the boat with a load. I am a firm believer in priorities and in addressing one issue at a time. By the time her eye heals it will probably be closer to the 30 days the IMS wanted to wait and we can mini-load then when I report to him that her thrist and hunger have not curtailed. Does that sound like a sensible plan?

One Good Thing Today..."she is still happy and playing!".
Rene & Snoopie

This sounds like a good plan to me. Dr. Feldman writes that:
Dogs receiving o.p'-DDD and undergoing stress (illness, trauma, elective surgery) should be treated with glucocorticoids. The adequately treated dog with PDH has sufficient adrenal reserve for day-to-day living but not enough to handle major stress. So even though Snoopy's not displaying any outward signs of stress because of the eye issue, I believe, letting the cortisol run a bit high might be a good idea at this time.

Love and hugs,
Lori

[addy]

Hi Renee,

Glad to hear Snoopy is feeling playful.:) I remember Marie posting about Maddie, her cortisol had gone higher and she thought she would have to do a mini load but IMS increased Maddie's maintenance dose and it did bring her cortisol down without doing the mini loading. I remember Marie being surprised by that. Ask her about it.;) Each dog is so different, you never know:rolleyes:

Hugs,
Addy

Hugs,
Addy

[frijole]

Rene, I wanted to let you know that once I started antibiotics the green pus went away so she only had that for a couple days. Scary though. I know it is hard to know what to focus on. :confused::) I say carry forward with your plan... but if something comes up between now and then.. you can always change your mind. :D Kim

[Rene]

Thanks Lori, Addy & Kim!

I have gone ahead with raising Snoopies maintanence dose from 500mg to 625mg weekly. I am giving it in quarters five times a week. Does it matter if I give it M-F and rest the weekend or should it be more spread out like Su Tu Th F Sa?

Boy, it sure would be nice if just the higher dose did the trick like it did for Marie's Maddie! I wonder what it was before she started and what it brought it down to? I will have to ask her.

I was also wondering about if the cortisol being elevated while her eye was healing was a good thing. That was one of the reasons why I was on the fence to wait until her eye healed for the mini-load. I was aware of the masking issues and problems that surface when cortisol is controlled. But, I didn't really know if high cortisol naturally occuring in their system had the same affect as when you administer hydrocortisone for medical reasons. Good to know...thanks Lori!

Boy if it isn't one thing...its another. But it is all falling into place and we will have to be patient.

One Good Thing Today...Snoops eye is not worse!
Rene & Snoopie

[MBK]

Hi, Rene -

Glad things are going pretty well for Snoop right now. So happy to hear she is feeling a bit playful. That is always GREAT to see! It is so nice when they get to be a regular happy go lucky DOG, isn't it? I took your suggestion and put Alivia on L-Glutamine daily. Probably too soon to tell if that is making a difference, but she is doing well!

[Harley PoMMom]

Hi Rene,

I think that dividing the maintenance dose in too many smaller doses can actually decrease the eroding effect so if it were me, I would try to divide the maintenance dose into 3 doses. Here is an excerpt from Glynda mentioning this dosage protocol as well. Hopefully the others will share their opinions on this also.




Dr. Edward Feldman has changed his protocol for maintenance dosing. He now lectures his students to never give a once weekly maintenance dose but rather to spread it out over the week, preferrably in three doses. This allows for more consistent maintenance of the erosion achieved with loading as well as allows for easier adjustments in dosing. For instance, if the first post maintenance acth stim shows that cortisol has increased after giving a maintenance dose of 250mg on M, W & F, Dr. Feldman would have the pet owner add an additional 250mg on Thursday. Both of my dogs have been on 3 x weekly maintenance for quite some time now.

Glynda

[lulusmom]

I have gone ahead with raising Snoopies maintanence dose from 500mg to 625mg weekly. I am giving it in quarters five times a week. Does it matter if I give it M-F and rest the weekend or should it be more spread out like Su Tu Th F Sa?

Lori has already given you some information on how Dr. Feldman prefers to split the weekly maintenance dose but I'd just like to add that I think it would be fine to split Snoopy's maintenance either way you have mentioned. Lysodren's effect is cumulative so as long as she gets the full weekly maintenance within the week, I think it will be fine. I think I already mentioned that with a post stim as high as Snoopy's, I doubt that increasing the maintenance dose will effectively reduce the cortisol. Snoopy's adrenal glands seem to regenerate quickly so it's possible that the increase in maintenance will have no effect whatsoever and cortisol will continue to climb.


I was also wondering about if the cortisol being elevated while her eye was healing was a good thing. That was one of the reasons why I was on the fence to wait until her eye healed for the mini-load. I was aware of the masking issues and problems that surface when cortisol is controlled. But, I didn't really know if high cortisol naturally occuring in their system had the same affect as when you administer hydrocortisone for medical reasons.


I can tell you that dogs with uncontrolled cortisol are self medicating themselves for conditions like arthritis and allergies and even brain tumors. Dogs with these conditions are often prescribed Prednisone or Prednisolone, which is a synthetic form of cortisol. These conditions are unmasked when treatment reduces cortisol to acceptable levels.

[Rene]

Hi Guys,

So if her IMS wanted her on 625mg weekly, what I am getting is a Monday 250mg/Wednesday 125mg/Friday 250mg dosage may be best for her right now?

As far as her eye is concerned it is coming along slowly. Looks like an indolent ulcer but it is not worse.

Rene & Snoop

[lulusmom]

Hi Rene,

I think that will work.

[Rene]

Thanks Again Glynda!

[apollo6]

Dear Rene
Just checking how you and Snoopy are doing. Hope her eye improves. With cushing's their immune system is pretty well shot. Will post about Apollo.
Hugs Sonja and Apollo.

[rbeasl]

Hey Rene,

Hope all is well with you, Snoopy and the hubby. I like that COWGIRL UP. I'm from Texas, so you know I have the hat and the boots. The COWGIRL IS COMING OUT:)

I found a store by my house that has the Liver Support your were telling me about. Honey and Snoop are the same weight. Do you give Snoop one whole pill? I know that an untreated cush pup will have high liver enzymes, but Honey has been on Denamarin for 5 months now and you would think paying all that money every month I would see some type of drop with the liver enzymes. I just really want to see better numbers with the liver count next time. The Denamarin is not working.

Thanks for the Advise
Rhondalyn and Honey

[Rene]

Hi Rhondalyn,

I did not like the Denamarin either. The Liver Support Factors was the only thing that really helped. You are suppose to dose Sam-e at 10mg per pound of body weigh. When Snoops ALTP's and others were off the charts I was giving her two AM & PM. Now I just break one in half and give it to her AM & PM.

Your very welcome...I hope it helps.
Rene & Snoopie

[Rene]

Ok...Hi guys...I guess sometimes when I "go dark" Im just waiting for news.

Sorry.

Snoops eye ulcer was not getting better as fast as we would have liked on the antibiotics. Snoop was depressing and showing signs of cortisol increase from stress. The eye specialists thought that she would not heal on her own.

Sooo....they did a "Graft Surgery" over the hole. Essentally, it is a flap of the healthy corneal tissue "flapped over" over three sides on the hole that would not heal of the corneal tear. It took about 45 minutes. She came throught with flying colors!!! But, with her history we have a home IV bag of Lactated Ringers we that can push a couple times a day and oral Clavamox along with her other topical eye & pain meds, but she will do just fine!

I will post pictures....she is already working the...CONE OF SHAME!

[Squirt's Mom]

Hi Rene,

Sorry to hear the eye wasn't healing but very glad to know the operation went well and hope it does the trick for Snoop. :) Seems there is always something, huh? :p

I hope Snoop's depression improves with the surgery, too. It has to be hard on her to feel bad on top of missing her buddy. :(

Hugs,
Leslie and the gang

[addy]

Hi Renee,

Sorry to hear about Snoopy. Hope everything calms down soon for the wee girl. You have had so much on your plate lately. It might be time to Chocovine again:D:D:D;)

Love,
Addy

[Rene]

OH LoL...U 2 FUNNY...I don't do well on caffeine or sugery sweets. So when they are offered I usualy tell people , "No Thank You...I may go on a Shooting Spree!" Trying to Post the pictures of the Princess now!

Got em...posted...And Addy...not so wee...the little porker is almost 30lbs now...the raw agrees with her!!!!

A little win in this terrible disease!

Rene & Sleeping Beauty!