Tucker, 10 1/2 year-old mini dachshund (Lysodren)

[tuckersmom]

[Administrator's Note: This message was initially posted specifically addressed to "apollo6." However, I know that other members will want to offer their welcome and feedback to Traci as well.]

I have been pouring over this board and from what I've read your furbaby and mine are very similar.

My Tucker is 10 1/2
Weighs 10 pounds

Has been through the mill. Four years ago had a slipped disc in his neck...(not back) survived the surgery. Only then to be diagnosed with PRA (eye disease) about 2 years ago and is now almost completely blind. In addition to also going deaf over the past year. The last five years have not been kind to my poor baby.

The latest is a month ago I noticed all the classic symptoms of Cushing's, increased water intake, urinating, accidents, eating behavior change. At first we thought it was a kidney or bladder infection or perhaps diabetes. None of his initial blood work suggested Cushing's however, after many many tests and an ultrasound, and finally the ACTH lab test we got confirmation that it was Cushing's. No diabetes, no tumors.

We began with the Lysodren (don't have the bottle of meds in front of me at the moment but the dosage rx'd was 1/4 tablet 2x a day), until we saw him change his aggressive eating behavior. That took about 5 days. We then went in for the repeat blood ACTH test and his levels were very very close to normal range, so the vet had us start giving him a quarter tablet once a week. That was 2 weeks ago, we are still dealing with a huge water intake, more accidents in the house, and just overall not himself. The vet has now said lets try giving him a quarter pill every 3 days and see if things improve. Because as you know too much Lysodren can cause an entire host of other medical problems my vet is very cautious about giving him too much.

I was hoping you could give me some feedback on how long does it take to get the dosage correct? What is the normal dosage for our little dachshunds?

Thanks in advance for any info you can provide.

Tuckers Mom Traci

[labblab]

Hi Traci,

Welcome to you and Tucker! I have taken the liberty of making a couple of changes to your thread-starter. The first is to change the title of your thread just a bit. I know you are especially hoping to get some feedback from Sonja, Apollo's mom ("apollo6"). So I am going to send a private message to Sonja to alert her to be sure and take a look at your post the next time she visits the forum. But in order to also give everybody else a little more information about Tucker, I'm adding a few more specifics about Tucker to your title.

Secondly, I'm editing out your email address from this publicly-posted reply. You are free to give your email address to anyone whom you choose, but for the purposes of maintaining your own privacy, you'll probably prefer to do that via our private messaging system. That way, your email address is not being "broadcast" throughout the entire public internet but instead is only being shared with the specific people who you wish to have it. Since you especially want Sonja to get your address, you can also send her a private message yourself. Just click on the word "Community" from the menu bar at the top of any page. Then click on "Members List" and you'll be able to find "apollo6" under the "A's." Finally, click on "apollo6" which will take you to Sonja's personal profile page, and then you can select "Send a private message" as one of the available options.

Once again, I'm so glad you have found us. And I'm certain that before long, many other members will soon be welcoming you right alongside Sonja. :)

Marianne

[StarDeb55]

Traci, welcome to you & Tucker! I'm not sure Apollo & Sonja can help you a lot as Apollo is on trilostane. I have used lysodren with 2 pups so I will give it my best. I warn you that we tend to play 20 questions with new members. You have given us a good start by telling us about Tucker's symptoms, & an overview of the testing that has been done. I need to ask you some very specific information about the testing. If Tucker had some screening labwork done such as a super chemistry panel or senior wellness panel. we would like to see only the abnormal results, along with reporting units, & normal ranges. We are asking about routine labs, specifically liver function tests, as there are common abnormalities on liver function tests that are almost universally found among our babies.

When it comes to Cushing's specific diagnostic testing, were the ACTH & abdominal ultrasound the only 2 tests done to make the Cushing's diagnosis? Can you post the actual numbers from the ACTH? What did the ultrasound say about the adrenal glands? For example, were both glands normal, were both enlarged, or was one enlarged, & the other one normal or perhaps even shrunken?

Now, when it comes to lysodren dosage, the loading/induction dose is 25-50 mg/kg. Take Tucker's weight & divide by 2.2, which gives 4.5 kg, so his loading dose needs to be between 114-228 mg, daily. During loading the dose is split in two, given twice per day. A loading dose of 200 mg. would be given as 100 mg morning & night. If you were giving 1/4 tablet twice per day, & you were cutting some rather large white tabs in fourths, those tabs are usually 500 mg. Based on that Tucker was loading at 250 mg. daily which is a bit over the max dose. Tucker's voracious appetite slowing down, is a clear sign that he was was probably loaded, but did your vet do an ACTH to confirm that? Without an ACTH being done at that point, there is no way to confirm that Tucker is loaded. Since you say his other symptom have really not improved, I have a very strong suspicion that you have one of two problems, either Tucker was not loaded, or his maintenance dose is too low to maintain the cortisol at a healthy level.

A maintenance dose is the same dose as what you used during loading, but it is split into several doses over the week, usually a minimum of two doses. It seems that a great majority of vets prefer maintenance dosing to be given 3x per week. With Tucker only getting 125 mg. (1/4 tab) per week his maintenance dose is very low, 27.8 mg/kg. This is why I suspect that Tucker may have unloaded at this low a dose. Standard protocol states that once you have confirmed loading by an ACTH, (results should be 1-5 mg/dl), you then go to maintenance dosing. You have another ACTH done at the end of one month on maintenance to confirm that the maintenance dose is correct. After that, ACTH's really only need to be done every 4-6 months, as long as the pup is clinically well. Once a week maintenance dosing in the great majority of cases will not keep the cortisol level where it needs to be as the adrenal glands can regenerate very quickly in some pups. Lysodren acts by eroding some of the adrenal cortex tissue where cortisol is produced to bring the levels down. With dosing only being done weekly, the adrenal glands have 6 days to regenerate.

Looking forward to hearing more. Hope all of the above helps.

Debbie

[tuckersmom]

Debbie.....

Wow! Thank you so much!!! I will do my best to answer your questions.


Yes, he had a lot of lab work....including senior panel and chemistry tests. The only abnormality that came back was the liver enzymes...they were sky high (sorry I do not have actual numbers) But they were so high that the vet at one point was thinking possible liver caner. From there they put him on 3 meds thinking he may have gotten into something (not possible...he is a house dog) but worth a try. I do not remember what those meds were...one was a liquid. Because it was just the liver enzymes that were so bad the vet did not suspect Cushings....10 days of those rx's and then another liver test showed his liver enzymes were even worse than before the meds.

That is when they did the ultrasound.....everything looked good...no tumors on the liver and the adrenal glands wer both good, gall bladder looked great too.

It was the aggressive eating that prompted the vet to do the ACTH test, because again, no other labs pointed to Cushings.

Yes, your description of the loading phase sounds like exactly what we did after the ACTH test confirmed it was Cushings. I cut a big pill into 4 little pills. The vet was very cautious and said as soon as we saw the eating change to call and get him back in for the ACTH test again to see where his levels were. After 5 or 6 days of taking the pill twice a day, we saw a slight change. While his eating did change a bit, it was still not back to normal for him which was eating kibble one by one. However, ACTH test confirmed his levels were very very close to normal. Again, sorry I do not have the numbers......but it was something like 6.2 is normal and Tuckers was 6.5....very close.

I think what you are saying is dead on....and my Mommy instinct even told me so when the vet said lets now do just a 1/4 tablet once a week. His water intake was still not normal, still having a few accidents..etc etc I thought to myself...ummmm....ok.....so we are going to go from a pill 2x a day down to giving a 1/4 tablet once a week? But I thought possibly this was a medication that needed to build up in your system. And as these two weeks have gone I think it has proven the maintanance dose of 1x a week is not enough.

We have another ACTH scheduled for 11/1. I gave him a 1/4 tablet today and I am going to give him a 1/4 tablet every three days, while watching him very carefully.

Thank you again Debbie, your information confirmed what my gut has been telling me.

Traci
TuckersMom

[StarDeb55]

Traci, I know we have all been through the stress, trauma, worry, & last but not least, the financial strain of getting a newly diagnosed pup stabilized on their medication. My Harley who is a 12 lb, 15 yr. old Shih Tzu, unloaded twice in the first 6 months after diagnosis. I guess what I'm trying to say is that I don't think you can wait another month for an ACTH. I think you need one ASAP to see exactly where Tucker is, because I strongly suspect you will have to reload him, as I think his cortisol has probably gone pretty high. I will tell you from my experience with Harley, when I thought he was initially loaded that ACTH came back at around 11-12 which is way to high. Harley's symptoms had improved, so my internal medicine specialist was willing to go with that result, but the folks in this group kept telling me this was not going to work. Within 2 weeks, Harley was peeing buckets, again, I had to demand that my internal medicine specialist see him, & by the time I took him in, his cortisol had skyrocketed to over 20. I had to do a full reload on him. It seems that these little guys seem to have adrenals that regenerate fairly quickly, & that the little ones seem to do better on a higher maintenance dose. For instance, Harley's maintenance is 300 mg. weekly, broken up into 3 doses, that works out to 54.5 mg/kg.

He's not due for a stim until the end of next month, but it may have to be earlier because he is starting to drink like a fish, again, & I absolutely do not want to have to reload him.

Debbie

[tuckersmom]

oh oh oh....I am slow....but I am getting it now. The 1/4 tabs twice day for 5 or 6 days was the initial load.......which got his levels real close to normal.....got it! And now that it has been 2 weeks his level may be way up there again and even giving him the tabs 3x a week is not going to load him properly, or get his levels back to where they should be. The load is achieved by giving him the pills 2x a day...I think I get it now!! Thank you.

I think I will call my vet and discuss another ACTH test.

Thank you again so much.

[StarDeb55]

Yes, I am sorry that I apparently didn't explain loading vs. maintenance very well. Here is a link from the important information section of the forum on lysodren loading which should help fill in some of the information gaps.

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

Debbie

[apollo6]

Hi Tucker's Mom
What a cutie. My Apollo will be 12 in October. He is on Trilostane so I can't give you input as to dosage. It has to do with how much he weighs.
I sent you a private message, asking you about what the ultrasound showed and what was notated. In Apollo's case both adrenal glands were equally enlarged, enlarged liver, kidney, scarring on pancreas from reoccurring pancreatitis. A full blood panel showed extreme elevated readings, ACHT STIM test showed high cortisone.
For Apollo the symptoms were, increased thirst, loss of hair on both sides of body, loss of hair on tail, loss of hair on ears, skin liaisons, ingrown hair , dark skin on belly, weakness in hind legs due to muscle wasting. It was hard to determine if his appetite increased, because he always wants to eat- a dachshund thing.
Please let me know how I can help you.
Hugs from Sonja and Apollo