10-11 year old Ridgeback

[cmdiggs]

We have a Ridgeback named Duke who is somewhere in the 10-11 range. He was a rescue about eight to nine years ago so we don't know the exact age. He has had allergy and skin issues all of his life and was just diagnosed with Cushings a month ago. We are now on the maintenance of the lysodren. He gets 500mg on Monday and 500mg on Thursday (weighs 125 lbs.). He is also on thyroid meds and two zyrtecs a day.

Before we started the meds, he had the bloated stomach, weak hind legs and missing patches of hair.

The stomach is getting better, the hind leg weakness is gone but the hair continues to fall out. He has major patches gone. Where we used to do a quick and small dose of pred to help, we cannot use that now. He is on bison and sweet potato food just for your info.

Has anyone had issues with their dog losing hair during the meds before it turns around and clears up? Our vet is on vacation until next week so I'm not sure who to ask.

Thanks for the help.

[labblab]

Hello and welcome!!

I have only a moment to post, but wanted to direct your attention to another recent thread where this very same question was discussed:

http://www.k9cushings.com/forum/showthread.php?t=2527

As you'll see, after Cushing's treatment is begun, it is not at all uncommon for hair loss to seem worse before getting better -- but it WILL get much better once the normal hair growth cycle is restored :) :)...

I know others will also be by before long to welcome you, and also to help us learn more about your Cushpup and his treatment.

Marianne

[cmdiggs]

Thanks for the help. I was nervous when we found out Duke had Cushings. My wife was nervous about the Lysodren treatment but after seeing him get a little more active, the leg pains end and the activeness pick up a bit, we both know we made the right decision.

This site has been a huge help to ease me a bit :)

[Harley PoMMom]

Hi and welcome to you and Duke from me and my boy Harley! What a wonderful and loving thing that you both have done for Duke...Bless you both for giving Duke a forever home!

I was wondering if we could hear some more about Duke: how his cushing's was diagnosed in the first place, what tests where done? What symptoms led you or your vet to suspect cushing's in Duke? What was his loading dose? And how many days did it take Duke to load?

With regards to Duke's coat issues this might be referred to as "blowing the coat" and is one of the last symptoms to respond to treatement.

We have members here that have used or are currently using Lysodren and are very knowledgeable plus they have been treating their furbabies with Lysodren for many years. I am sure they will be along to share their advice/opinions/story. :)

If you have any questions please ask we are here to help you and Duke in any way we can.

Love and hugs,
Lori

[cmdiggs]

Let's see if I can answer everything.

Duke has always had bad skin. It never fails. We get him the expensive food and try to help out his allergies in that way. That and the cushing's has become more interesting as we have a 3 year old Great Dane and a new 4 month old baby (the real kind, not four legged.)

Duke was not responding to some of the meds he was put on for the skin issues and the vet wanted to test for cushing's. They did the 8 hour test and confirmed he had it. We were on two lysodren pills a day until his water got down to about 40-45 ounces a day. We were on the loading phase for only 3 days. Now we are on a Monday and Thursday maintenance dosage of 500mg.

The symptoms that led our vet to cushing's was hind leg weakness, the hair loss, excessive thirst and not responding to meds.

I think that is everything.

His coat is losing hair in spots he has never lost before. On top of that, he has gotten into a habit over the last year or so of licking constantly so that's a fun battle. But hopefully this will help.

Thanks for the reply and help.

[gpgscott]

Welcome from us,

I just wanted to point out that Zyrtec is also available as a generic at a greatly reduced cost, the generic is cetirizine. You are the first member I know of using this treatment and I know we all will be interested to know if Duke benefits from it.

Scott

[cmdiggs]

Thanks for the help.

We do use the off-brand zyrtec. The vet thought it would be a good idea to use it. I don't notice a big difference.

He still is scratching a lot and has the green gunk in the eyes, something we are forever dealing with. He is on an antibiotic now to clear that up.

[cmdiggs]

Has anyone dealt with constant licking as well? Sometimes I think this is a habit. Is there anything I can do to calm this?

[Harley PoMMom]

Sometimes contant licking can be a sign of pain or anxiety. With my boy when he starts to lick I know that is a sign of him being in discomfort/pain.

[labblab]

Licking of paws and/or arms and legs is also a hallmark of allergies. My non-Cushpup licks her paws endlessly when her allergies are flaring.

I will say, however, that my Cushpup with no known allergies also contantly licked his front paws basically his entire life prior to beginning trilostane treatment. Once his cortisol was maintained in proper range, the licking stopped. It seemed like a miracle to us :o.

Marianne

[apollo6]

Welcome.
I can't give any input about the medication. Apollo was always licking his front paws, with the cushings. I think it has improved since.
Sonja and Apollo
P.s. you did the right thing.
It took me almost a year before I came to the decision about medications and Apollo is doing better.

[cmdiggs]

Another question

Calling the vet tomorrow but how long after starting lysodren do you retest?

Also, how long after starting meds for the belly swelling to go down?

Thanks

[lulusmom]

You mentioned in a previous post that Duke loaded on Lysodren for only three days which is when you noticed a drop in water intake. You should have had an acth stimulation test at that point to determine if Duke's post stimulated cortisol was within the therapeutic range of 1 - 5 ug/dl. You also mentioned that Duke was on a maintenance dose now so I assume that your vet was satisfied that the cortisol levels were where they needed to be before starting the maintenance dosing. Can you please post the results of the acth stimulation test? If you don't have a copy of the test, your vet should be happy to either give you a copy of it or give you the pre and post cortisol numbers.

To answer your questions, you should have another acth stimulation test done 30 days after starting maintenance to make sure the dose is effective. While improvements in appetite and water intake can be seen fairly quickly, it does take the pot belly a bit of time to get better. The causes for the pendulous belly are normally an enlarged liver, redistribution of fat and muscle wasting caused by the catabolic effects of the cortisol. The first order of business is to get the cortisol within range and then things like the belly, skin and coat issues will slowly begin to improve.

Glynda

[cmdiggs]

Glynda

Thanks for the response. Our vet wanted to wait a few weeks before doing the ATCH test. We are calling tomorrow on when to do that.

We have noticed his hair is growing back in spots, the hind leg weakness is gone and overall he seems to be feeling better.

Will update tomorrow on what the vet says.

Chris

[lulusmom]

Chris, just so I understand, your vet did not do an acth stimulation test before putting Duke on a maintenance dose, right? If so, your vet is not following proper protocol. Acth stim tests are not cheap by any stretch of the imagination and some vets are very sensitive and will try to save money for the pet owner. Unfortunately, sometimes it costs the pet owner more in the long run when the tried and true protocol is not followed. Since you mentioned that Duke's symptoms have improved, I am keeping my fingers crossed that you lucked out and Duke's post cortisol is where it needs to be. Most of us were never that lucky. :D If it were me, I would be scheduling an acth stimulation test asap.

If you haven't had a chance to check out our Helpful Resources forum, please do. You'll find a wealth of information there that will make your head swim. :D In the meantime, I'm including a link to Lysodren Loading Instructions and Related Tips that you can find in that forum. Hopefully, this will answer any questions you may have about protocol.

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

[cmdiggs]

Took Duke to the vet today. Still concerned about his skin and some yeast infections. Switched his antibiotic and told us to give him cool baths twice a week. Was concerned about his still bloated stomach. They did xrays and saw nothing wrong with the liver but an enlarged gall bladder which he doesn't seem concerned about. Upped our maintenance dose of lysodren to 1 1/2 pills on Monday and Thursday. Is doing a ACTH in ten days after he sees how the antibiotics did with his skin.

Told us in 10 days we will either tell him he's the greatest vet ever or ask him where he earned his degree :)

Duke has always had some medical issues. I hate the anxiety I get with hi doctor visits which I am sure a lot of you have. Will update soon.

[lulusmom]

Hi Chris,

I totally understand your anxiety with vet visits. I spent two years getting my first dog diagnosed correctly so I was a basketcase. I am also having some anxiety about your vet visits too because I am having a very difficult time wrapping my head around your vet's very odd approach to treating cushing's. How Duke's skin clears up on antibiotics should have no bearing on when to do an acth stimulation test. Skin infections can increase cortisol; however so it's possible that your vet doesn't want a skewed test. That doesn't change the fact that Duke should have had an acth stimulation test done after a three day loading and another one before any adjustment to maintenance dose. Right now, neither you nor your vet have any idea whether Duke's cortisol is too high or too low. If it's too high, it's unlikely that an adjustment to maintenance dose will work and if it's too low, the increase could reduce cortisol too low and throw Chris into an Addisonian crisis. Your vet's attitude is rather cavalier considering he could very well be putting Duke at risk by blindly prescribing an increase in dosing based on nothing but a guess. In my opinion, if things go well in 10 days and it turns out that Duke's cortisol is within the desired therapuetic range, it will have nothing to do with your vet's skillful experience in treating a cushingoid dog...it will be dumb luck.

Can you please gather up copies of all of the testing your vet ran to properly diagnose Duke? Blood chemistry and urinalysis is usually done and then diagnostic tests like acth stimulation test, the low dose dexamethasone suppression test (LDDS) and an abdominal ultrasound is usually done to differentiate between pituitary and adrenal based disease. Was Duke diagnosed with pituitary cushing's or an adrenal tumor? Cushing's is a very difficult disease to diagnose which makes it the number one misdiagnosed canine condition out there. We like to have a complete medical history to refer back to as Duke's treatment progresses.