Kida (10 y/o Doberman/Pointer mix) - Beginning Lysodren [Archive] - Canine Cushing's Information and Support Forums

CreepyCrawly

10-04-2010, 05:59 PM

Hi everyone! I feel very lucky and grateful to have found this forum. I have been searching for all of the information I can find, and reading everything I can get a hold of regarding this disease. I am reading up the information on this site as quickly as I can, and it has helped ease my anxiety over this diagnosis.

I wanted to introduce myself, and my sweet girl, Kida. She recently was diagnosed with having Cushings. She'll be 10 this November. We think she is a Doberman/Pointer cross, but that is a complete guess. We adopted her from the pound when she was just a few months shy of 2. She's about 45 lbs. We live in Anchorage, AK. Her symptoms were: increased drinking/urination, very dilute urine, increased hunger, appearing to have lost weight (looking boney, though not having actually lost any weight), and a little tiny bit of hair loss (maybe). She does not have the pot belly, has not been panting abnormally, does not seem to have any hind leg weakness, and she still has tons of energy.

First the vet recommended a standard blood and urine panel, as we were kind of thinking diabetes or a thyroid problem - but the results came back showing healthy thyroid function, healthy kidney function, healthy liver function, no diabetes, etc. The alk-phos was borderline high, which combined with her other symptoms, lead the vet to think Cushings. We did a low dose dex test which confirmed it.

We started her on Lysodren on Friday (the vet says that's what she's had the best luck with), and are still on the loading dose. She has diarrhea, though the vet thinks this is due to the Lysodren irritating her stomach rather than the loading being complete. She still has all of her Cushings symptoms, including the increased appetite (to the point of begging to be fed an hour before meal time, getting into the trash looking for food scraps, and stealing food from the other pets). But I'm taking her in this afternoon just to make sure she's alright. I'm planning on getting copies of the test results while I'm there since I don't have them yet.

She's always been such a good dog, even when we first got her. She needed no training whatsoever - she came to us housebroken and knowing all sorts of commands and tricks, and having pretty good manners. It makes me sad that this is happening to her, but I have hopes that we'll be able to get it under control and she'll be able to have a full and happy life.

gpgscott

10-04-2010, 06:39 PM

Welcome,

Not a Dr. here but it is very disturbing to hear the word diarreha when loading. Gastric upset is not uncommon but this would be more lack of appetiete or vomiting than diarreha. Many give pepcid or tagamet for this. (generics are famantodine and ranantidine).

Would you please post the dose and how it is being administered, (once or twice daily). Have you been given prednisone and instruction for when/if it should be administered. Have you been given instruction as to symptoms of overloading?

I am glad you are taking her in and maybe the diarreha is just the result of her scrounging something out of the trash.

Looking forward to hearing of the results of the trip to the Dr.

There is every reason to hope for a very normal life for Kida once she is settled on a stable treatment.

Got to ask you about the screen name:)

Scott

frijole

10-04-2010, 06:49 PM

Welcome from me as well. I don't mean to scare you but I am concerned that the only testing done (so far as I could tell) was a blood panel and the ldds test.

Cushings can be very hard to diagnose and if anything else is going on it can result in a misdiagnosis via the ldds. What further concerns me is the fact your dog has LOST weight and has no tummy. Cush dogs are chubby and aren't losing weight. I suspect maybe something else is going on and the reason you are experiencing diarrhea is because the dog doesn't have cushing's.

I could be totally wrong but I had this happen myself and want to be sure to caution you. I would CEASE giving the lysodren and I would have an acth test done to see if the cortisol levels are high.

If possible I would also consider having an ultrasound (high resolution machine) done to take a look at the organs. This too can help diagnose or rule out cushing's.

Again - not meaning to scare you but any dog with diarrhea - you cease giving the drug - even if you just started... for precisely this reason. Glad you found us. Ask questions. Do you have prednisone on hand? Thanks! Kim

Harley PoMMom

10-04-2010, 06:55 PM

Hi and welcome to you and Kida from me and my boy Harley! I am sorry for the circumstances that brought you here but so very glad that you found this forum.

Cushing's can be a hard disease to diagnose and not one test is 100% accurate at diagnosing this disease. Usually a LDDS test and/or ACTH stim test is done along with an ultrasound to help confirm a cushing's diagnosis. Did Kida have a ACTH stim test done before starting the Lysodren? Did your vet give you prednisone on hand for emergency purposes? What is Kida's loading dose?

I am sorry for all the questions but the more we know the better our feedback will be, ok? ;):)

Here is a link with information about Lysodren and loading:

Lysodren loading Instructions and related tips
http://www.k9cushings.com/forum/showthread.php?t=181

We are here for you and Kida and we will help you in any way we can so ask all the questions you want and we will answer them the best we can.

Love and hugs,
Lori

CreepyCrawly

10-04-2010, 07:37 PM

Thanks for all of the feedback!

You are correct - those are the only tests that were done for this diagnosis. She had an abdominal ultrasound done a month and a half ago (or so) because one day she just wasn't acting right, and seemed to have a painful abdomen. X rays didn't reveal anything unusual, and so they did an ultrasound - which too didn't show anything out of the ordinary. The next day she was acting almost herself and three or four days later she was completely herself again. The vet guessed that she may have pulled a muscle playing with one of the other dogs - but it was just a guess. Is it possible that the vet was using these ultrasound results? The vet seemed pretty positive that it is pituitary dependent cushings, and had said that we could run more tests to be sure, but that the chances of it being adrenal dependent are very slim and that she did not recommend surgery for Kida even if it were adrenal dependent. I tend to think that this is because we live in Alaska, and finding a vet who is willing and capable of doing the surgery in the state are slim. She said that in either case she would suggest treatment with Lysodren/mitotane so that's what we did.

The vet said we would do the ACTH stim test when Kida is starting to show signs of being loaded, or on the 8th day of loading - whichever comes first. Our instructions were to give (1) 500mg tablet of Lysodren twice daily, one with each of her meals (so two 500mg tablets per day). We were given prednisone as well, but told not to give any to her unless they instructed us to. They said to call with any questions, or if she does anything out of the ordinary (in particular: any slowing down of eating or pausing during eating, vomiting, diarrhea, lethargy, lack of usual energy, reduction of water intake.) They did not say anything really about overloading. Mostly they said to just watch her closely and if she does anything unusual (particularly those symptoms listed above) to call them - and so I did.

We have been pretty careful about keeping the trash up/away from her since she started getting in to it (a week or two ago) and I am pretty sure she hasn't gotten into anything since we started the treatment, so I don't think that's the cause of the diarrhea.

She hasn't technically lost any weight - she just looks like it. Her head is very boney, as is her back and hips. The vet said this is because of fat redistribution caused by the Cushings.

I was pretty worried when I came home and saw the diarrhea, as there was some blood (bright red) in the stool, but the vet clinic did not seem worried at all when I called them about it. I will ask about those medications to help soothe her stomach - if that's what it turns out is the problem. I will ask about the ACTH stim test and another ultrasound too. In any case, I'm taking her in, and she's not getting another dose of anything until we see the vet.

Thanks for all of the input.

frijole

10-04-2010, 07:49 PM

My dog's issues were a bacterial infection in her stomach (bleeding ulcers) and she showed up as positive on a bunch of tests. So it is interesting that you had something else going on worthy of doing an ultrasound only a few months ago.

Can you be more specific as to why you did the ultrasound? (what was going on with your dog) Do you have the write up from the test? You could get a copy - if neither of the adrenal glands are swollen then it is most likely not cushings.

Your vet is right - most cushings cases are pituitary. The thing is that this disease is often misdiagnosed. We see more than our share here and that's the reason for all the questions.

OK so we know your dog was taking 1000 mgs daily. You said your dog weighs around 45 lbs. That is approximately 50 mgs per kilogram which is within the recommended dosage. It is at the high end but within range.

Again, I'd review the ultrasound report and ask for an acth just to get a confirmation on the dx. Sounds like you have done a good job of reading so you will be fine. I'm glad you posted. Kim

CreepyCrawly

10-04-2010, 11:43 PM

Okay, so we went to the vet's. They're doing an ACTH stim test as we speak. We'll have the results in a couple of days, and in the meantime we're stopping they Lysodren treatment.

The reason we had the ultrasound done previously is because we were afraid she might have a blockage mostly. My husband had given the dogs rawhide bones to chew on, and a while later (while the dogs were still working on the chews) he decided to let them outside to go potty. To keep everyone's bones straight - so they didn't get mixed up - he was taking them back from the dogs. He said that when he asked Kida for hers, he thought she swallowed what was left of it. Later that evening she was kind of lethargic, she didn't want to move off of her dog bed. She was just laying there on her side, and her belly looked puffy to me. The first thing that came to my mind was "OMG! she has bloat!" and rushed her to the pet ER nearest our house. They immediately knew she didn't have bloat, and did several xrays. Those all looked normal, no twisted stomach, nothing apparent in her stomach or intestinal tract, but my husband told them about the possible rawhide gulping (which she has never done before, and hasn't done since - which is the only reason we actually give them to the dogs) and they said that something like that might not show up on the xray, but that they should be able to look at things better with an ultrasound. So we did that. They said that they didn't see anything unusual, but thinking back on it now they may have meant merely that there was no blockage. I know they did not sedate her, so I'm not sure what all they looked at with the ultrasound. I'd have thought that to really look at all of the organs they'd have to sedate her.

As it turns out, the vet did not use that ultrasound to make the diagnosis of Cushings, so the diagnosis was based on the blood panel and ldds - which it sounds like may have been a bit premature. It was a completely different vet clinic (that did the ultrasound), and while we requested that the records be sent over they didn't have the results on file when I asked for them today. I'll have to get them from the clinic that actually did the ultrasound.

I did get the rest of the test results from them though. Her LDDS was as follows: pre-dex 2.1 ug/dL, 4 hours post 2.4 ug/dL, and 8 hours post 2.4 ug/dL. I am still looking over the results of the blood panel and urinalsys and trying to make sense of all of it. The only thing that seems outside of normal levels (the normal levels listed on the sheet) are the alkp that came back at 254 iu/L when it shows normal is 5-131. The specific gravity of the urine was also low at 1.010. The sodium came back boarderline high at 155 with a normal range of 139-154.

So we'll wait and see what the ACTH stim test says. I'm not sure how accurate it will be since the Lysodren was started already, but if it comes back with high cortisol (even after being on the Lysodren for a couple of days) that would seem to indicate that it is Cushings, yes? If it doesn't come back high, I'm not exactly sure what that would mean - it could be that the Lysodren is fully loaded and that it is Cushings, or it could mean that it never was Cushings.

The vet is sending home a prescription to settle her stomach at least.

Oh, and the screen name - has to do with some of my other babies (snakes, lizards, and tarantulas).

gpgscott

10-05-2010, 05:19 AM

Me again,

Snakes, and other things:eek:

I am glad to hear that you are ceasing loading. You really only have one diagnostic the LDDS and it is known to deliver false postive results in the pressence of stressful situations.

I would want the UC:CR. It is a urine test collected at home and is a rule out for Cushing's. A result in Cushing's range means further Cushing's specific testing is needed to confirm a diagnosis but a result ruling out Cushing's means almost certainly no Cushing's so you start looking elsewhere. We are told a three day pooled collection is superior to one catch and it is also inexpensive.

Best wishes. Scott

frijole

10-05-2010, 08:23 AM

So glad you ceased the lysodren. I'm still scratching my head as to how the vet came up with cushing's... Don't have time to check those numbers but the ldds test results look NORMAL to me. And 254 is not very high at all for the alk phos reading. (same reading my dog that was dx-ed wrong has)

When you get the results from the clinic that did the ultrasound see if they will give you the actual films. Mine did. Was hoping you could at least get a read on the adrenal glands and save some money and time.

Lets talk more about the symptoms that started this... tell us about water consumption - how much a day? (if you haven't yet, start measuring it). Describe food consumption. Also detail her urination habits (frequency, changes etc)

My dog had accidents in the house but never consumer much water. The vets thought I was nuts. But... she recently was diagnosed as having bone spurs on her spine. When I read up on it, it said it can cause incontinence! So you just never know.

Kim

labblab

10-05-2010, 08:41 AM

Hello and welcome to you and Kida!

I'm afraid I'm going to throw a bit of a "monkeywrench into the machinery" as far as the value of using the ACTH as a diagnostic indicator of Cushing's in Kida's case :o. I've just taken a look at her LDDS results, and although her results are "positive" for Cushing's, the pattern of her results could be consistent with either the pituitary or adrenal form. Here's a link to an article that explains how to interpret LDDS results:

http://veterinarymedicine.dvm360.com/vetmed/Medicine/ClinQuiz-Interpreting-low-dose-dexamethasone-suppr/ArticleStandard/Article/detail/580093

Your vet is absolutely correct that on a percentage basis, far more dogs have the pituitary type. But Kida's LDDS results leave the question open. And unfortunately, the ACTH is far more likely than the LDDS to falsely return a "normal" result for a dog with the adrenal form of the disease. The ACTH is still the tool of choice for monitoring treatment results after medication is begun. But it is not a reliable diagnostic indicator of adrenal Cushing's.

Kida certainly does have some classic Cushing's symptoms. And aside from our questions about the vet's response to her diarrhea, it sounds as though all the other info that your vet is giving you is accurate and right on the money. I think this would be the stage, though, to ask about perhaps performing an ultrasound specifically designed to visualize Kida's adrenal glands. The adrenals are hard to see, so it would need to be done using high-resolution equipment and the interpretation performed by a knowledgeable professional. I'm thinking that the earlier ultrasound probably didn't fill the bill as far as anyone focusing on her adrenal glands. Ongoing Cushing's treatment does alter the state of the adrenals, however. So if you are wanting to perform an ultrasound for diagnostic purposes, probably sooner is better than later. The additional info could give you greater certainty about the diagnosis even though your treatment choice (Lysodren) may remain exactly the same, regardless of whether Kida has pituitary or adrenal Cushing's.

Marianne

P.S. I've taken the liberty of changing your thread title to add more info about Kida. Just let me or any other staff member know if you would like it changed again!

zoesmom

10-05-2010, 09:40 AM

Hi and welcome-

I agree with Marianne. The LDDS IS positive for cushings - though which kind cannot be determined from Kida's results. So to me, the next step that would make the most sense is an abdominal u/s - to look at the adrenals and liver and pancreas in particular - as those may further confirm the diagnosis. If you've been reading, you probably saw that in PDH the adrenals will be of equal size - usually enlarged. In ADH, one adrenal will be larger. Liver is also usually enlarged with cushings and pancreas could show some changes as well, as cush dogs are prone to pancreatitis. Other organs can also be looked as added bonus.

And as far as your vet, I'd agree with everything he/she said, other than the fact that the diarrhea might be from simple stomach irritation from the lysodren. That's also true, but in loading, it's not worth taking that chance as it can also be a sign that the loading is complete. Everything else you were told sounds good - dose sounds right, loading instructions are spot on. My vet also didn't suggest doing the u/s, but after reading info here, I asked to have it done. It's big bang for the buck, so definitely something to ask for before proceeding.

In any case, the ACTH really can't be avoided at this point. Like you said, if it's still high, then that would also suggest cushings. If it's not, then at least you'll know where she stands before restarting the lysodren, if the u/s proves the dx accurate.

You are on the right track. By educating yourself, you've taken the first and best step towards successfully treating Kyda. Her symptoms are tiypical and not all dogs have ALL the symptoms. But I imagine she does have cushings, based on the ones she has (she has several of the main ones, plus the labwork), but the medicines are serious and there can be misdiagnosis, so it really would be wise to get the u/s. Sounds like you're in an area of Alaska where you can gett decent vet services? Sue

CreepyCrawly

10-05-2010, 01:57 PM

Thanks for all of the help everyone - you guys are a wealth of knowledge! And thanks for fixing the thread title.

I am in Anchorage - so I have average vet access I'd guess. We're the biggest city in the state, so I have the best access here. That said, I haven't been 100% happy with any of the clinics I've tried. The one I'm using now seems to be the best, as far as being knowledgeable and responsive. I do not know what kind of diagnostic equipment they have (if they have a high res ultrasound machine). If this clinic doesn't have one, I will check with the "specialist" clinic (which tends to be outrageously expensive, and tends to have a waiting list a mile long - I know because a snake of mine had to have surgery through them) and see if they have one. If they don't have one - chances are good there's not one in the state. But I'll see.

As for the test results everything I have read indicates that the LDDS result is showing a positive for Cushings. And yes - it could be adrenal, or it could be pituitary, or it could be a false positive. The alkp isn't extremely high - and the vet admitted that, and if that was the only indicator, the vet probably would not have suggested Cushings. But that combined with her symptoms, it hinted that Cushings was a possibility. There were a few rods found in her urine (the test said < 10, whatever that means) and so the vet put her on antibiotics for 10 days, to see if she perhaps had a urinary tract infection that wasn't showing up as typical on the tests (the vet said she didn't have an elevated white count, though I'm still trying to piece that together on the results). The antibiotics didn't seem to make any difference at all, aside from making her dislike taking pills (she'd always taken pills eagerly before, and now spits them out).

I will inquire about the ultrasound, to be on the safe side. I am thinking it would be a good idea to give her a few days off of the Lysodren, and even a couple of days after she gets over the diarrhea, before we do the ultrasound. I'd rather not wonder if something appears enlarged because of inflammation from the diarrhea (or whatever is causing the diarrhea), or because of something else being wrong.

The vet didn't say for sure that the diarrhea was from stomach irritation - just that it could be. They didn't tell me to continue treating her, they told me to bring her in. That doesn't seem unreasonable to me. When we went in, they said that it could be from stomach irritation, or it could be that she has completed loading. So they did some in-house tests to make sure she wasn't in any danger (I didn't realize they were doing these) and did the ACTH which has to be sent out. I don't know exactly which tests they did in-house, but I think one was a BUN. I didn't get a copy of those results, but the doctor said they were well within normal ranges.

I don't have a good way of measuring precisely how much water intake she has herself. I suppose I could shut her in a room by herself with a water dish, but that would probably stress her out. We have 3 dogs and 3 cats - all of whom share a huge 2.5 gal stainless steel water bowl. In the past, during a typical day all six would not finish the water. When I noticed Kida peeing in the house, I also realized that I'd been having to refill the water bowl in the afternoon - that it was bone dry by the time I get home from work. So I started paying attention to it, and sure enough, she is drinking tons of water. Right now I'm having to refill the bowl twice a day (usually about 11am, and again at about 5 or 6) because it is completely empty. The sound of her drinking has actually started to irritate my husband, because she will just lap and lap and lap at the water for up to 2 minutes, only stopping for a few seconds for a breather before going back to drinking. This weekend, when I was home all day, she was asking to be let outside to pee every 2-3 hours. At night she can make it about 5 hours before she she wakes me up and asks to go out. On days I work she can make it about 4 hours between being let out - but not much longer than that. And when she pees she will pee for 20+ seconds (if it's been 4-5 hours since she was last let out). And that's just counting the time that she is peeing - not counting the few seconds it takes for her to get to her favorite part of the yard, or coming back to the house. And when she has accidents in the house they are lakes - it will take two bath towels sopping wet to soak up the urine. I am just glad that she has been going in the dining room where we're getting ready to replace the linoleum and not on any of the rugs or furniture.

As for her eating habits, she has gone from an eager eater to a ravenous eater. She (and all 3 of the dogs) are fed twice a day, measured amounts with measuring cups. They are fed in the morning before I leave for work, and again right after we eat dinner. She always has been eager to eat, finishing all of her kibble at meal time. Recently (since a little before she started drinking/urinating a lot) she has been acting like she is starving to death. She will start begging for her meals an hour or so before her actual mealtime, and doesn't behave as nicely as she used to just before feeding. She paces, drools, and whines while I am scooping out their food into their dishes. When they are released to their dishes, she will inhale her food (definitely no chewing involved) and lick it to make sure she didn't miss any microscopic bit. Then she tries snatching bites of food out of the other dogs' bowls as they eat, which I don't allow. When they are done she will lick their bowls clean as well. On top of that she has been getting into the trash looking for food scraps (which we've been pretty good about keeping away from her) and begging at us while we are eating dinner, which she didn't used to do.

After the diagnosis I started looking at her skin, and she has some areas where her hair is a little bit thinner by her armpits on both sides, and also her tail has some hair loss on the sides at the end, though this may not be due to the Cushings. She has a very short, thin coat with no undercoat, and always has. The armpit area could very well be normal for her that I never focused on much previously. And her poor tail is constantly abused. She is a happy girl, and wags her tail every waking moment - which causes her to hit it on things quite often. It's not exactly uncommon for us to find that the tip of her tail is actually bleeding from the constant pummeling against things. So the tip of her tail has a callus on it, and the little patches of hair loss are on either side of this callus, so it could just be that this is due to her continued battering of her tail. Also, from what I've read hair loss associated with Cushings is usually on the body of the dog, and not on the extremities.

Holy cow - this post has gotten pretty long. I just want to give as much information as I can, but it's kind of a book now!

frijole

10-05-2010, 02:28 PM

Thanks for all the info... you have your hands full. :D

First off, I am sorry if I confused you regarding the ldds test results.. I shouldn't read and think in the early a.m. before 2 cups of coffee. LOL

Re measuring... I had 2 dogs and I just measured the total water intake and assumed the difference was my cush dog. Not sure if you can do that or not but I throw it out...

You are doing a tremendous job of getting up to speed and I am sure you and Kida will be just fine on this journey... and we will help you along the way as best we can. Kim

labblab

10-05-2010, 02:28 PM

Thanks so much for this additional info! It does sound as if your vet is handling things very appropriately. Aside from the ACTH, the additional testing that was perfomed was probably a check of Kida's blood chemistries ("electrolytes") and kidney/liver function, just to make sure that nothing is "out of whack" in conjunction with the Lysodren loading. This is a very good thing to have done, and indicates that your vet is on top of things. I also appreciate the fact that a UTI was considered and ruled out as a possible cause of the excessive thirst and urination.

Kida's symptoms certainly are consistent with Cushing's, and at this point I hate to make you think that you have to jump over any unnecessary (and expensive) hurdles before proceeding. But depending upon the outcome of the ACTH, I'd be interested in knowing whether your vet thinks an ultrasound would be worthwhile or easily doable in Anchorage. First things first, though. Let's see how the ACTH results turn out. If they ARE abnormally elevated, then you may not feel as though you need any more confirmation of the diagnosis and you can just continue to load.

Marianne

gpgscott

10-05-2010, 05:27 PM

The more you write about the symptoms the more it supports a diagnosis of Cushing's.

The main value in the U/S for a Cushing's diagnosis is measurement and comparison of the adrenals but you also get a look at the other important internal organs.

I think Marianne is right though that with the symtoms you are describing and a positive LDDS-AND-ACTH you would have a solid diagnosis.

Scott

Buffaloe

10-05-2010, 06:35 PM

My dog had a large adrenal tumor surgically removed(adrenalectomy) and we worked with some great specialists here in Phoenix. I just wanted to mention a couple of things.

Kida didn't show suppression on the LDDS test after being injected with dexamesthasone at either the 4 or the 8 hour mark. Hence, an adrenal tumor is a possibility.

Approximately 50% of all dogs with functional adrenal tumors test within the normal range on the ACTH test. Kida had a fair amount of Lysodren which will likely affect the results.

Just in case you get a diagnosis of an adrenal tumor, please know that many Internists now favor Trilostane over Lysodren to treat a functional adrenal tumor. The best medicine choice depends on several factors.

If you decide to have an ultrasound down the road, it looks like Veterinary Specialists of Alaska might be your best bet. I believe Dr. Chang is their ultrasonographer.

I'm really glad you stopped the Lysodren. All the best to you and Kida.

Ken

Harley PoMMom

10-05-2010, 06:37 PM

So I started paying attention to it, and sure enough, she is drinking tons of water.

The excessive cortisol increases the blood flow (also called GFR-glomerular filtration rate) to the kidneys. This will result in an increase in the amount of water and waste products filtered by the kidneys. In order for our Cush pups to keep up with the increased output produced from their kidneys they have to drink excessive amounts of water.

For my boy Harley I use those puppy training pads. Although with you having 3 dogs and 3 cats I don't know if the training pads would work or not. :confused: I have a cat too...Alex the bad cat, and he sometimes likes to hide underneath the training pads (unsoiled)! :)

Love and hugs,
Lori

CreepyCrawly

10-05-2010, 07:35 PM

All of that is good information. Thank you all.

The reason the vet suggested Lysodren over the Trilostane (which she also mentioned to me) was merely that it was what she'd been using to treat Cushings in the past, and it seemed to have been working well for her patients. She said some other vets in the same clinic were starting to use Trilostane, and after speaking with them it sounded as though they were having good results too. She said half in the clinic tend to use the Lysodren, and half use the Trilostane. She just hadn't had any experience with the Trilostane or its effects personally, but knew more of what to expect out of the Lysodren - so that's what we went with.

It's good to hear that it sounds like my vet is generally giving me good information.

The Veterinary Specialists of Alaska is where I had to take my Emerald Tree Boa previously, for a recurring prolapsing bowel. I am not super fond of the clinic, but they are specialists, and if anyone has the correct technology to do the ultrasound they would be it. They were able to "fix" the snake permanently, which my regular exotics vet wasn't able to do, but they still did not leave me with a fondness for the clinic.

That said, at this point I'm not sure if I'll be having the ultrasound done or not. It largely depends on what the ACTH results come back as. If they come back high, that will probably be good enough for me, and we'll probably continue treatment, though I might try to talk to the vet about the Trilostane since it seems a little bit safer (Lysodren is scary stuff). If they come back within our targeted range or low I will probably take more steps towards the ultrasound - though we will probably have to put it all on hold until we can afford it (a couple of months probably).

I'm sure I don't need to tell you guys how quickly the expenses are piling up (so far over $1300 in less than a month in testing alone - not counting the exam fees, or medication costs - and this is at the less expensive general vet, anything done through the Specialists will easily be double if not triple). Don't get me wrong - she's totally worth it, and we'll continue to to do what's right for her no matter what - it might just take a little bit longer.

I did consider the training pads, though I don't think she would use them. Plus, I'm pretty sure that there's no way one of those pads could hold as much urine as she is producing even in just one pee. My husband leaves for work about 3 hours after I do, and I've been coming home for lunch to let her out, so between the overlap in schedules and getting let out partway through the day that's been cutting down on the accidents. We're also trying to find a really good dog door so she can go out whenever she needs to, but are being very picky (we want one that won't let the cats outside - just the dogs, and that is heavy duty enough to not make our heating bills skyrocket come winter).

AlisonandMia

10-05-2010, 07:49 PM

The reason the vet suggested Lysodren over the Trilostane (which she also mentioned to me) was merely that it was what she'd been using to treat Cushings in the past, and it seemed to have been working well for her patients. She said some other vets in the same clinic were starting to use Trilostane, and after speaking with them it sounded as though they were having good results too. She said half in the clinic tend to use the Lysodren, and half use the Trilostane. She just hadn't had any experience with the Trilostane or its effects personally, but knew more of what to expect out of the Lysodren - so that's what we went with.

Hi and a belated welcome from me too!

That is a very good reason for selecting a particular medication - that the vet has had experience (and good experiences) with that treatment.

My dog was treated very, very successfully with Lysodren and if I had to (and heaven forbid that I have another Cushing's dog) I'd use it again quite happily as I (as an owner) have experience with it. Lysodren will also very, very often work out cheaper, too.

Good luck and keep us posted.

Alison

PS: The diarrhea couldn't be a result of a Cushing's-driven dietary indiscretion could it? Many dogs (and it sounds like Kida is one of them) will eat just about anything when their cortisol is high and they can gulp something down in a flash and you never even know it happened. If the ACTH stim test doesn't show low cortisol (as an explanation for the diarrhea) is she doing to be/has she been tested for some sort of infection?

Harley PoMMom

10-05-2010, 07:51 PM

Since you are already treating with Lysodren, if it were me, I would stay with this. When switching from Lysodren to Trilostane, or vise-versa, there is a 30 day wash-out period.

Trilostane is no safer than Lysodren. Each has it's pros and cons, they work differently, they are both safe when monitored appropriately, yet they both can have the same and serious risks and adverse effects.

Another important consideration is the degree of experience your vet has with whatever treatment she chooses. Since your vet has experience with Lysodren, and it does seem she knows what she is doing, I would stay with the Lysodren.

I can tell already that you are a diligent pet mom and are going to be successful in treatment. ;):)

Love and hugs,
Lori

Buffaloe

10-05-2010, 10:28 PM

I was just pointing out some facts regarding adrenal tumors, not recommending that you treat Kida with Trilostane. But it's true that many of the top Internists (especially the younger ones) prefer Trilostane to Lysodren when treating adrenal tumors. Several years ago, Lysodren was the treatment of choice for adrenal tumors, even among the specialists but not today.

A top quality ultrasound is a bit pricy. I lost count of how many of them Shiloh's had but the average cost was about $500. As you said, you may not need one anyway. If an adrenalectomy is not an option, it's really not imperative that you find out which type she has.

In an ideal world, there is a 30 day wash out period when switching from Lysodren to Trilostane. But, in reality, many Internists treating dogs with adrenal tumors make the switch much more quickly if the situation warrants it.

I think both you and your vet are doing an excellent job with Kida. I hope she lives for a very long time with a great quality of life.

Ken

Franklin'sMum

10-06-2010, 12:20 AM

Hi and welcome to you and Kida from me, too :)

Snakes and lizards and spiders... Oh my :p:D:eek:
Hope Kida's diarrhea settles down soon, and that she and you are doing well. You've been given great advice, and I won't add anything to the medical side of things, but just wanted to give you some other thoughts regarding pee pads and doggie doors.

I did consider the training pads, though I don't think she would use them. Plus, I'm pretty sure that there's no way one of those pads could hold as much urine as she is producing even in just one pee.
I saw a TV show where the person had 4 or 6 small dogs in an apartment, and he used 4 pads side by side and up/down, making a big square of them, so that might work for the lakes :)

We're also trying to find a really good dog door so she can go out whenever she needs to, but are being very picky (we want one that won't let the cats outside - just the dogs, and that is heavy duty enough to not make our heating bills skyrocket come winter). We rarely have things in Australia that haven't been around for years in the US, and a few years ago I saw a doggie door that comes with little magnetic balls. You attach a ball to the pup's collar, and when the ball is near the door, the door will "unlock". It keeps indoor pets inside (because if they don't have a ball on their collar, the door won't let them out), and keeps neighbourhood animals out (without the ball, the door won't let them in).
The only problem (personally) was the door is metal, for the magnets to work. My little guy Franklin won't go through something that he can't see what's on the other side.

That was a few years ago, and I daresay they have come up with other similar things, that may not involve a metal door. It was at one of those huge hardware stores (in my case Bunnings), so maybe Home Depot or such will be worth a look?

Hope that helps,
Jane, Franklin and Bailey xxx

marie adams

10-06-2010, 01:25 AM

Welcome to you and Kida,

Maddie is my dog who will reach a year on Lyso in February. She came through all the loading--a few times and now on maintenance. There were no periods of diarreha so it could be something she ate. Maddie always had good manners until Cushings changed her eating habits.

The ravenous appetite--there were times I couldn't remember if I feed her because she would give me that look like feed me:D--I thought I was having senior moments forgetting if I had just feed her. She never got anything off the table after dinner before, but she started doing that. She still gets into the cat's food in my daughter's room, but it was ridiculous how many times I would catch her in there and you couldn't budge her. She would get into the trash in the bathrooms and steal things.
She would snort like a pig sniffing around in the kitchen at night. Licking the rugs and floor also.
She lost a lot of fur (all her under fur)--her belly, under her front legs-armpits, the back of her hind legs--it was sad to see her beautiful coat look so ragged. Now it is coming back and looks beautiful again - just a little different coloring , but a lot of it so I think she is a little hotter.
She had heavy panting, now I think she pants a little more because she is running hotter with the extra fur.
There is hind leg weakness and shaking. It has gotten better, but I think arthritis has shown up since her cortisol levels have come down.
She does have a pot belly and it hasn't gone away.
She is a lot slower in her movements. Still goes for walks twice a day, but not the mile and half each morning or 3-5 miles in the late afternoon with my husband on his bike.
[/LIST]
Once you have all the test results you will know better which direction to take. I was very nervous about treating with Lyso, but agreed to start because I knew she would eventually get her quality of life back as much as possible. It has been a journey, but I would do it the same again. I do not have to give her the medicine everyday so the cost is a lot less, but still expensive. :(

There is more to our story, but won't go into it--you can read our thread if you wish.

Take care; everyone here is a wealth of information and advice as you have already experienced.:)

CreepyCrawly

10-06-2010, 03:10 PM

The medication they prescribed for the diarrhea seems to have worked and she isn't having diarrhea anymore, so that's good.

In my reading I was seeing conflicting information about the Trilostane, and wasn't sure which to believe. Some stuff said that it was safer because it didn't act directly on the adrenals and that any effects were completely reversible, and other stuff said it was just as dangerous as Lysodren. One thing I read said it worked in most cases, one thing I read said it only worked in as few as 30% of cases. Pretty much everything I've read about Lysodren seems to be about the same information - which made me feel like the information about it was more reliable. I'm glad to see that Lysodren does work well for some - that makes me feel better about using this treatment.

Now that you mention it, the bathroom trash can has been spending an awful lot of time knocked over. Usually I attribute that to the cats knocking it over playing their chase games, but maybe Kida is getting into it and eating tissues, or Qtips or something. Looks like that's another trash can we're going to have to put on the counter. She licks the floors too and sniffs around the whole house a lot too. We have always had problems keeping them out of the cat's food, so we finally put up a baby gate on one of the spare bedrooms and now we feed the cats in there, and have their litter box in there too (the dogs used to LOVE eating out of the cat litter box). At least I know she's not eating the cat's food or litter for sure!

I have found a couple of dog doors that I think will work for us, using "keys" or magnets attached to the dogs' collars. One is the PetSafe SmartDoor, and another is the Solo door. I'd LOVE to get the Solo door, but it is pretty expensive. Plus we don't know if Kida's ever used a dog door before or not (we've never had one before) or if she will use one. She is kind of sensitive, and it might scare her, but she is smart and I think she'd be able to figure it out. Now I just have to convince my husband that it's a good idea. He is concerned about the dogs going outside and barking all day at everything that moves and annoying the neighbors, or digging a hole under the fence or porch and getting loose. I think that the solution is to just put the key on Kida's collar because she wouldn't do either of those things. Even when he's left the gate not-quite-latched and the dogs got out of the yard, Kida has always stayed in the yard, it's the other two who took off and we had to track down. And Kida's the only one who needs to be able to go out more frequently.

It's been good to read about other people's stories and experiences, as it helps me to know what to expect, and what is possible. I have every hope that we will be able to get her stabilized with something that will work for her, and we'll be able to enjoy her remaining years with her. I am so happy to have found this site. All of the people here have so much information - just tons of it - and its real information from vets and doctors and studies, and real experience from real people who have dogs and are actually going through this too. Everyone is so helpful - I have learned so much. It was so much more confusing and isolating before I found this site. I didn't know what information was good and correct, and what was old and outdated, or what to believe - so I was more or less just trusting my vet, hoping that she isn't some quack who was getting her information from a text book that was last current sometime in the middle ages.

frijole

10-06-2010, 04:13 PM

You just took me down memory lane... my gal Haley who passed at 16 1/2 this year used lysodren for over 4 yrs and it worked. She was the queen of knocking over trash cans. She head butted them good for years before we finally figured out she had cushing's.

When I first put in a dog door I had the same fears. My brother was on the inside and I went outside with a treat. The cush dog Haley had no problems. That treat sent her over the edge and thru the plastic. :p The squeemish one, Annie, took a bit longer but watching her sis keep going thru it finally trained her and within hours she too used the door. So I bet you will have no problems. Do it now though before it gets cold outside. It will be easier. Good luck. Kim

gpgscott

10-06-2010, 04:15 PM

I'm glad you are feeling comfortable with our site.

Our strength is as you have pointed out, we have people living with this day to day, doing their own research and also being treated by a wide range of Dr.s with varying treatment recommendations. I think more information is better than less and this is certainly the source for more information where Cushing's in dogs is concerned.

I know all of the welcoming and initial information sharing can be overwhelming for new members. I am glad you are taking the time to sort it all out so you can make the best choice for Kida.

Scott

CreepyCrawly

10-06-2010, 09:03 PM

Wow! I hope Kida does as well as Haley did. I would love to have her for another 6.5 years! That's great news. I am sorry for the loss of your girl though. That is very sad.

Well, the vet just called and left me a message. She says the ACTH stim results are back, and that they show that her adrenal function is precisely where they want it to be, and her recommendation is to wait until next week, and then start her back up on her maintenance dose of 2 tablets (500 mg ea) per week - which sounds like a typical maintenance dose, though I half expected it to be lower due to the extremely short loading time (3 days).

I'm not exactly sure what to make of this. I don't have the results themselves, I'm going to go pick those up from the vet tomorrow and see what they say. But if the levels really are "precisely where we want them" to be - in a good range for a Cushings dog, what might that mean for her? I guess I was totally expecting for the results to come back with high cortisol from her having Cushings and not being completely loaded yet and the diarrhea being from having a bad reaction to the Lysodren. If she didn't have Cushings I might have expected a low cortisol level from the 3 days of loading. But this normal result has me wondering if maybe she doesn't have Cushings? I really kind of felt like her symptoms really matched the diagnosis very well, and like this is what she has - it made sense to me. If she didn't have Cushings, would 3 days of Lysodren not knocked it below normal range?

I am confused. I suppose that me being in doubt means that I should have the ultrasound done. Would the loading phase of Lysodren have altered the size of her adrenals? Sorry if that's a stupid question. I don't know if treatment changes the size of the adrenal glands.

When the vet first suggested Cushings as a possibility and recommended we run the LDDS, she said that in dogs that have had Cushings a long time the alk phos is usually very high, and at Kida's level (barely above normal range) she may not have had it for very long. Could this have anything to do with the extremely short loading phase and the now normal ACTH?

I'm not sure... what do you guys think?

frijole

10-06-2010, 09:40 PM

OK... just to be safe.. tell us exactly when you starting the first dose of lysodren and exactly when the diarrhea hit. We've seen dogs load quickly so it has happened... but given your low alk phos numbers I'd like a little more certainty too.

And this is why it would be nice to have done an acth prior to giving lysodren... you could compare before and after numbers to see if cortisol went down. When you get the report from your vet you are interested in the 2nd number. With lysodren you want to reduce cortisol LOWER than a "normal non cushing's dog". So what is "normal" for other dogs is NOT "normal" for cush dogs. You want the 2nd no to be between a 1 and a 5.

I am still a bit concerned that Kida never had cushing's... could be totally wrong... but to be safe there are a couple of things you could do. An ultrasound would help because you could see if one, both, or none of the adrenals are enlarged. Often cush dogs have enlarged livers and/or hearts as well.

Another alternative is to do a urine test called the UC:CR. It can't diagnose cushing's but it can rule it out. Its cheap and would help you know. Did you say whether your dog's urine is diluted? (white vs yellow) Cushing's dogs almost always have a problem concentrating their urine.

I'm sure others will have ideas as well... but I wouldn't start on maintenance dosing til I had a greater comfort regarding the dx... but I am gunshy.

Kim

CreepyCrawly

10-06-2010, 11:54 PM

We gave her the first dose of Lysodren after we fed her dinner on Friday (probably around 8pm). The weekend was uneventful, and I went to work on Monday as usual. When I came home for lunch on Monday, she'd had diarrhea in the house, and urinated too. So this was following her 6th dose that morning, and probably around 10-11 in the morning. She continued to have diarrhea the rest of that day, and that evening. We started her on the medication for diarrhea that evening and by morning she was better.

Her urine is very dilute, very clear, hardly any yellow. The urine test also came back with low specific gravity.

I wish I'd known to ask for these other tests before we started treatment.

frijole

10-07-2010, 12:20 AM

You said she peed in the house along with the diarrhea. Is frequent urination a problem? If so, has it lessened? Have you seen any signs of change in her cushing's symptoms? Those back legs take a while to quit shaking - but hunger and thirst should be back to normal or reduced if cortisol is normal.

I'm asking because if she is loaded I think it is strange that she urinated in the house.

Don't beat yourself up... none of started this journey with knowledge.... You are doing a great job of getting up to speed. Am anxious to see the test results.

CreepyCrawly

10-07-2010, 01:06 AM

Yes, she has been urinating very frequently. She never had the hind end weakness. I am not real sure about her Cushings symptoms. As of Monday I would have said that I haven't noticed any change, but when I think about things more carefully I would have to say I think she might be drinking/peeing a little less. She's still been pretty ravenous, but she hasn't had any accidents in the house since Monday, and also since Monday she hasn't gotten me up in the middle of the night to go out (she was getting me up at about 4am to go out nearly every morning). Also she hasn't been asking to go out as much, and when we let her out she doesn't race to her spot and squat, she's been a little less urgent and taking her time to sniff and find a good spot before she goes.

I am curious to see what the results say too.

CreepyCrawly

10-07-2010, 02:53 AM

I did a little test on her tonight. After dinner I had some ice cream and set the bowl on the coffee table when I went to the bathroom. When I came back, it was untouched. Last week if I'd done this I would have come back to find it on the floor licked clean to a sparkle shine. This tells me that maybe her Cush symptoms are lightening up. Another thing I just thought of is how she takes her pills. She had been gulping them (her Lysodren) down like they were candy, and she's been spitting out her diarrhea meds and making me poke them down her throat. I know it could be as simple as the taste - but the way she was gulping the pills down I'm pretty sure she never got a taste of them. Now she's actually taking the time to chew them. Also, when we started with the Lysodren the vet told me to reduce her food by 1/3, so she's only been getting 2/3 of what she was. Maybe she's actually still legitimately hungry?

AlisonandMia

10-07-2010, 03:02 AM

It does sound like her voracious hunger has abated! It'll be interesting to see what those numbers are.

I was given the same instructions re reducing food and found that I actually overloaded my dog slightly because she was just very hungry because I wasn't giving her enough to eat - just as any dog would be. It was a long load with Mia and by the time she was loaded she was actually on the skinny side and I believe this kept a big appetite going past when she was loaded, resulting in a delay of the appetite sign that she was loaded.

Personally, I am actually not so sure about this reducing the food to sharpen the appetite when loading - although it is recommended in most protocols and certainly the most authoritative one - but for Mia I believe it actually caused problems. Mia's appetite didn't need any sharpening at all and it doesn't sound like Kida's did either!

Sounds like it was a good thing that she developed the diarrhea and this lead to a stim test being done.

Alison

gpgscott

10-07-2010, 04:27 AM

It will be very interesting to see the results of the stim, but it is important to note that loading varies widely from pup to pup which is why it is a bad idea to load for a set number of days before stimming. Also PU/PD is sometimes later to resolve than appetite. The fairest statement to make about Cushing's treatment is that each treatment is personalized:D

So, keep a close eye on her and post the stim numbers asap.

Hoping that it was a good loading and that you are on to an uneventful maintenence program.

Scott

labblab

10-07-2010, 07:30 AM

I, too, will be really anxious to see Kida's actual ACTH numbers! But I wanted to throw one thought out there to perhaps give you some additional peace of mind in the event that they ARE now within that desired 1-5 ug/dl therapeutic range. I cannot quote a specific resource, but I have been told in the past by some other staff members that dogs who are not suffering from Cushing's are actually more resistant to the effects of Lysodren than are dogs who DO have the disease. So if you are seeing symptom improvement and a lowered cortisol in Kida after three days of loading, I think that is actually more consistent with an accurate Cushing's diagnosis rather than the reverse. Also, due to genetic makeup, apparently a small percentage of Cushpups never do show big elevations in their alk phos reading.

As far as pursuing an ultrasound at this point, it may be of limited value to you. If Kida does have adrenal Cushing's, then any growth or mass on her adrenal gland/s should still remain evident. But if she suffers from the more common pituitary form, the Lysodren loading may have affected the appearance of the adrenal glands so as to negate the usefulness of the image for diagnosis. Enlargement of both adrenal glands is a strong indication of pituitary Cushing's. But Lysodren loading will shrink the adrenals, and thus eliminate that visual indicator.

If Kida were my dog and she continues to do well during the coming week and shows some resolution of symptoms (and assuming that the ACTH results ARE within the desired treatment range), I would move right on to the maintenance schedule so as not to lose any ground with her treatment and risk having to reload all over again. Given her symptom profile and LDDS testing, if the ACTH results are truly in that desired range, my inclination would be to think "if it walks and quacks like a duck -- I'm going to assume it IS a duck..." and just move onward with treatment unless Kida appears to be unwell. Just my couple of cents worth!

Marianne

frijole

10-07-2010, 08:09 AM

I agree with Marianne. That is why I asked about whether there were any change in symptoms. Sorry but I went to bed before you answered! :D I am delighted that you have seen a change and if the acth results are between a 1 and a 5 then I would also assume the dx is right and go to maintenance.

zoesmom

10-07-2010, 12:11 PM

Sounds right - what Marianne and Kim said. The only thing that would concern me a bit is if Kida's ACTH numbers are at the very low end of that 1 - 5 ug/dl range that is the goal with lysodren dogs (like hovering around 1.0 - plus or minus.) And I say that simply because she was only taking the loading dose for 3 days. Then again, it might only indicate that she is still in the early stages (based on her not too high ALP #). But with her strong symptoms, I think you keep going forward. You really don't need to know which kind of cushings you are treating. The u/s wouldn't have been so much to show which kind of cushings it is but rather to make doubly sure that it is cushings.

So you have prednisone on hand and you just need to watch her closely in the first few weeks of maintenance. Some lyosdren users give Pepcid before the weekly dose and that might be something to consider. Or maybe your vet gave you something when Kida had the diarrhea? That would ease any tummy upset directly due to the medicine - as opposed to the cortisol going to low. Good luck and keep us in the loop. (oh, and let us know those actual ACTH #'s) Sue

CreepyCrawly

10-07-2010, 12:25 PM

This morning I paid a little bit more attention to her behavior around feeding time, and she has regained some composure. Usually I ask all of the dogs to lie down in the living room while I scoop the food into their bowls. Kida has been unable to do this recently - she would try, and would lie down for a second, but would pop right back up and start pacing, whining, drooling, and even sometimes barking at me. This morning she managed to stay in a down-stay until I was nearly done, and even then she just came up into a sit - no pacing or other frantic behavior. She still inhaled the food like she hadn't been fed in a month, but afterwards she didn't hang around and lick the other dogs' bowls, she licked her own, and turned around for a drink of water.

And when I timed her drinking after she ate, she drank for 15 seconds - then turned around, and looked at me (which isn't unusual when she catches me watching her drink) and then turned back to the water bowl and looked at it, but instead of returning to drink, she turned back around went into the living room and found a nylabone and settled down to chew. Then out of curiousity, I timed the amount of time our other 'large' dog, Ruby, (about 60 lbs) drank water - and she too drank for 15 seconds.

So it seems like she's getting pretty close to being back to her old self! I wouldn't be surprised that if by returning her food rations to their regular amounts her appetite returned to complete normal. She wasn't presenting a lot of this improvement on Monday, but I suppose that the diarrhea might have been making her feel pretty crummy.

I'm glad to have read your responses. I appreciate this forum, and all of your support and knowlege. I was feeling very confused and conflicted last night, and had trouble sleeping. But reading all of your comments this morning makes me feel better. I was going to stop by the vet's office at lunch to pick up the results, but because I just can't wait I think I'm going to have them fax them to me while I'm here at work. I'll post the results as soon as I have them.

CreepyCrawly

10-07-2010, 12:53 PM

So you have prednisone on hand and you just need to watch her closely in the first few weeks of maintenance. Some lyosdren users give Pepcid before the weekly dose and that might be something to consider. Or maybe your vet gave you something when Kida had the diarrhea? That would ease any tummy upset directly due to the medicine - as opposed to the cortisol going to low. Good luck and keep us in the loop. (oh, and let us know those actual ACTH #'s) Sue

Would it be okay for me to split the weekly dose up into several smaller doses? The vet said to give her one tablet one day, and then a few days later give her the second, but I'm wondering if it might be a little easier on her if I were to split the pills in half, and give her half a tablet every other day, or something like that?

The vet did give me something for the diarrhea, but told me to continue to give her the medication until it was gone so I won't have any left to give her on treatment days. I would be interested in using the Pepcid on treatment days to help keep it from upsetting her stomach. I will ask about this when I call to have the results faxed over.

Squirt's Mom

10-07-2010, 01:02 PM

Hi,

We haven't "met" and I only have a few seconds before I have to leave but wanted you to know that someone will be along to answer your questions. From what I have skimmed, you seem to be in a good place right now and will be alright until then.

Today is a particularly sad day for our family as we have lost a dear baby, Harley - stardeb55's baby boy. But he didn't leave us due to Cushing's. For this reason, it may take a bit longer for a response to be posted so I ask your patience and understanding.

Hugs,
Leslie and the girls - always

frijole

10-07-2010, 01:51 PM

Would it be okay for me to split the weekly dose up into several smaller doses? The vet said to give her one tablet one day, and then a few days later give her the second, but I'm wondering if it might be a little easier on her if I were to split the pills in half, and give her half a tablet every other day, or something like that?

The vet did give me something for the diarrhea, but told me to continue to give her the medication until it was gone so I won't have any left to give her on treatment days. I would be interested in using the Pepcid on treatment days to help keep it from upsetting her stomach. I will ask about this when I call to have the results faxed over.

Re splitting doses! YES! Glad you asked. Since you are giving full pills (2 a week) you could easily split it into 4 doses of 1/2 pill.

Again - lets look at the number to make sure that that dosage isn't a wee bit high since she loaded so fast.

Make sure it is Pepcid AC.

Looking forward to the results... Kim

CreepyCrawly

10-07-2010, 02:27 PM

labblab

10-07-2010, 02:55 PM

Please don't worry -- you do not seem impatient and have no need to apologize! I'm sure Leslie was just wanting you to know why there might be more of a lagtime in responses today :o.

But you have seemed liked nothing other than a loving and devoted parent who is wanting to get the best possible care for your Kida. ;)

Marianne

CreepyCrawly

10-07-2010, 04:20 PM

Thank you for that Marianne. ;)

I finally got the ACTH stim test results. I got kind of busy at work and never made it around to calling the vet, so I just picked them up at lunch. They are as follows:
Starting - 1.6ug/dL
Post - 4.8ug/dL

So this actually is a very good test result, right? It kind of indicates that she does probably have Cushings, and that the loading worked, right?

labblab

10-07-2010, 04:28 PM

Yes, I think those are GREAT results!! So I think you're now "good to go" as far as continuing on to maintenance dosing :) :). During this next week, I'm sure you'll continue to gather some good tips in that regard.

As it has turned out, I do think your vet has been "right on" as far as her oversight of Kida's treatment. I truly hope that we haven't caused you extra worry by bringing up our questions along the way. But hopefully the "plus" is that you've also had the chance to ask some questions of your own (and also now you and Kida are part of our great big Cushfamily!). So keep us updated, and keep on asking us anything that comes to mind. But for the moment, I think you can breathe a big sigh of relief. :D

Marianne

CreepyCrawly

10-07-2010, 05:15 PM

I was a little afraid there that I'd let this all go on too fast, and that maybe she didn't have Cushings and yet we were already treating for it - but it was good for me to learn (I cannot even believe how much I have learned) and now because of it I know much more about the whole process, the treatment, signs and symptoms, etc.

I am positive I will have more questions, especially in the coming weeks establishing her on the maintenance dose, and what to expect, and if what I'm seeing out of her is normal.

I want to thank everyone so much... really, this forum is amazing - because all of you are amazing. I feel so lucky to be able to benefit from all of your experience.

Squirt's Mom

10-07-2010, 05:45 PM

I don't mean to be inpatient...

Honey,

You didn't seem impatient at all so don't worry your head about that one minute! I just wanted to make sure you didn't feel ignored if it took a bit for you to get a meaningful response.

Your patience and sympathy are appreciated by all. ;)

Hugs,
Leslie and the girls - always

frijole

10-07-2010, 06:39 PM

Those numbers are great! Whew... so glad it worked out. And being at the higher end (closer to 5 than 1) is kind of good too because if the dosage is a wee bit high then you will know it when you do your next acth test and can adjust. I assume your vet told you that you get to do this again in 30 days. :p It is to make sure the maintenance is working and not too high and not too low. The goal is to maintain a number between 1 and 5.

Great news and I am happy for you. Now you can 'coast'. Hardest part is over! Kim

CreepyCrawly

10-07-2010, 06:50 PM

I feel so lucky that this has gone how it has. It was kind of a perfect combination: the vet actually knew what she was doing, I found this community, and all of the tests and treatments have gone pretty smoothly. I probably just jinxed us saying that, but it was fairly stressful and confusing even with everything going right, I can't even imagine how tough it would have been if any of those things - or any combination of them - weren't going so perfectly.

labblab

10-07-2010, 07:41 PM

Oh, I love your avatar photo of you and Kida!!!!!!!!! :) :) :)

Marianne

acushdogsmom

10-07-2010, 07:54 PM

Just time for a very quick hello and welcome message! Wanted you to know that my Cushdog (a Bichon Frise) was treated with Lysodren and did wonderfully well on Lysodren for more than 6 years. He also loaded (at 50 mg/kg/day) in only three days. :)

His starting weekly maintenance dose was at 50 mg/kg/week (divided and given two days per week) and his cortisol production did go a tad too low after about 30 days on the weekly dose, even though he didn't really show any of the usual signs of too-low cortisol, so please do make sure to have your Vet test again (ACTH stim) in about 30 days, even if you don't see any signs of anything being amiss.

After a month or so off the Lysodren completely, his next ACTH stim showed his post ACTH stim cortisol number back up to around 2 ug/dl so we re-started the maintenance dosing at that point, at a lower than usual weekly (maintenance) dose - somewhere around 25 mg/kg/week (as opposed to the more usual 50 mg/kg/week) and that did work well for him, keeping his numbers right where we wanted them. Although there's always the possibility, just because my dog did run true to the fast loading = more sensitive to the drug idea, it doesn't mean that yours will too.

I always looked at his sensitivity to Lysodren as being a good thing because we were able to keep him really well controlled with less drug (and therefore at a lower cost, too). You'll find out what Kida's trends and patterns will be as you go along and you'll adapt accordingly. :)

All in all, after reading briefly through your thread, I'd say your Vet has a good knowledge of how to diagnose and treat with Lysodren, so that's a huge advantage for you and Kida.

CreepyCrawly

10-08-2010, 12:30 AM

That's good to hear, and I'll keep that in mind so I can monitor and hopefully we can keep her from getting too low. I have to keep in mind that symptoms can be super subtle.

And thanks re the avatar. It was part of a birthday gift from my husband last year. He paid for professional pictures for us and the dogs. It was fun and we got some really great pictures.

CreepyCrawly

10-14-2010, 12:10 PM

Just wanted to update: I spoke with the vet about the Pepcid AC, and asked about splitting the doses, and told her I was a little bit concerned about the weekly dosage since she loaded so fast.

The vet gave me the go ahead to give her one Pepcid AC per day, at least 30 minutes before her meal that she gets with the Lysodren. Also, she said that I could give her half of a tablet (250mg) every other day, so that she never has to have two consecutive days of the Lysodren. I thought this sounded like a good idea, becuase it will lower her average weekly dose from 1000mg/week to 875mg/week - and it will make the dosages more evenly spread, rather than having to have two consecutive days of dosing.

At the end of her week long break from the Lysodren she started to show more symptoms of the Cushings again - drinking more, having to pee more, stealing food (french fries, from my hand that I was trying to put into my mouth!), begging. So I was definitely ready to restart her treatment again on Monday!

And it seems like I'm going to have to start buying pill pockets in bulk! She won't take pills anymore like she used to (she used to scarf them down like they were treats), and she has stopped sitting nicely for me to poke them down her throat - I don't know why I thought that would last. She loves the pill pockets though (at least, for now) and I feel less mean about giving them to her, but at the rate I'm going through them, I'm going to have to start buying them in cases!

On that note, does anyone know if a half tablet of Lysodren will fit into a feline pill pocket? Those at least come in packages of 40 (dogs only come in packs of 25 for some reason).