Roper - 8 y/o mini dachshund just diagnosed with Cushing's

[smijette]

Hi everyone! I'm so glad I found this forum!! :) My mini dachshund, Roper is 8 years old and was just diagnosed with Cushing's Disease (had CBC, ACTH & HDDS tests ran - I have the results). We saw the IMS last week to get the ultrasound & it came back as PDH. I was researching which the various drugs & came across this forum. I have learned more (& understood what was being said) from this site than any other site. My GP gave me the choice as to which drug (Lysodren or Trilostane) to start Roper on. My GP has had success with both drugs & seems to be educated in Cushing's as well. Of course, I think he's shocked that I have been reading up on Cushing's. After reading the posts here I decided to go with Lysodren. The GP is going to start Roper on 300 mg/day of Lysodren (Roper weighs 13.8 lbs or 6.2 kg). The GP says that he thinks Roper will be on the loaded phase for about 7 days & maybe even up to 10 days since Roper's case is very severe (GP's words). Roper's visible Cushing's symptoms developed pretty quickly over a 3 month span. He said then the maintenance dose would then be 50-70 mg per week. He wants to start on Wednesday or Thursday. I know I have to monitor Roper's water & food intake to look for any changes. My questions is for those of you who have more than 1 dog, how do you monitor food & water intake when I have a water bowl & a food bowl for all three of my dogs? They all share the 2 bowls. Also, I'm worried that I won't be able to keep a close eye on him since I'll be at work during the day. Thanks for the info & all of the help. You guys are great!!

[frijole]

Hi! Seems like you are doing all the right things by reading and getting up to speed prior to starting lysodren. Here is alink that I used and found helpful because you do want to understand how it works and what to look for.

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

I had 2 dogs when I went thru this and I measured the total water PRIOR to starting for a few days so I had a general idea of total water intake. I poured a certain amount of water each morning (more than enough to last) and measured it 24 hrs later. So when I started the loading phase of lysodren I knew what 'normal' was. If your dog's primary issue is water drinking you will notice a difference. If not then you won't... instead you'll keep an eye out for a change in the way Roper eats (I assume he/she doesn't stop to breath when eating like most cush dog?! ha ha) This is way easier to monitor... any change at all could be a sign of loading.

I worked too far away to come home for lunch and my mom went over mid day to check on her for me. There was never a need but it gave me peace of mind.

Make sure you have prednisone on hand - emergency use and that the vet has told you the amt to give.

That dosage seems about right for your dog's size for loading. Caution that vets usually say 7 to 10 days but they really have no idea. That would be a general norm but we have seen dogs load in 2 days and my poor girl holds the record for taking the longest ... over 2 1/2 months! :o It just depends on how their bodies deal with the drug. So it is real important that you and evveryone in the house keep an eye out for changes. When in doubt, just ask us and we'll help.

Look for vomit, diarrhea - signs of too much drug and STOP if that happens. If poop starts to get soft that is a sign (sometimes) of getting close. So watch the poops too. FUN huh?

The only thing I saw that you wrote that I question is the weekly dosing amount after loading. Once you load you use the same dosage only on a weekly vs daily basis. (example you give 300 mgs a week - perhaps in 2 or 3 doses) If you were to reduce it you would lose the load... meaning the cortisol will increase and you'll have to start over again.

If you can post test results it would be helpful. You will use the acth test numbers as your benchmark. So if you start out at a post reading of 32 - your goal is to get between a 1 and a 5 during loading. This means the cortisol is reduced from a 32 to between a 1 and a 5.

Hope this helps! Kim

[apollo6]

welcome
Jenny and Stewie, Roper, & Dexter
could you post the lab /cbc results. Also what was notated on the ultrasound. If it is PHD which my Apollo, age 12, has then it would show both adrenal glands to be similarity large. If only one is larger then the other then it would be the adrenal type. My Apollo has the phd and is on Trilostane since June 2010.
Hugs Sonja and Apollo

[smijette]

Kim - Thanks so much for the info about the water intake & loading dose. I thought the amount for the loading dose seemed off too but wasn't sure. I will definitely read the link you put in your post. Roper does actually inhale his food so much so that my other 2 dogs have learned to eat right away since Roper can finish off the bowl (I do have to take it away from him every now & then). I know I'll notice the water intake more so than the food just because he's very loud when he drinks (very similar to a large dog coming in from running & getting a drink...lol).

Here are the test results (numbers in () is the Reference Range):
ACTH results -
pre - 13.2 ug/dL (2-6 ug/dL)
post - >50.0 ug/dL (>22 consistent with hyperadrenocorticism)
HDDS results -
Pre dexamethasone - 6.2 (1.0-6.0 ug/dL)
Post 4 hr dex - 9.8 (less than 1.5 ug/dL)
Post 8 hr dex - 10.9 (less than 1.5 ug/dL)
CBC results - these are only those that were either high or low...I can post all of the results if need be:
ALK. PHOSPHATE - 4665 (10-150 U/L)
ALT (SGPT) - 343 (5-107 U/L)
GGT - 102 (0-14 U/L)
LIPASE - 1233 (100-750 U/L)
CHOLESTEROL - 339 (112-328 mg/dL)
GLUCOSE - 136 (60-125 mg/dL)
TCO2 (BICARBONATE) - 14 (17-24 mEq/L)
B/C RATIO - 38.0 (no range)
TRIGLYCERIDE - 327 (20-150 mg/dL)
ANION GAP - 25 (12-24 mEq/L)
MAGNESIUM - 2.7 (1.8-2.4 mg/dL)
T4 - <0.4 (1.0 - 4.0 ug/dL)
NEUTROPHIL SEG - 80 (60-70%)
EOSINOPHIL - 0 (2-10%)
AUTO PLATELET - 725 (164-510 THOUS./uL)
ABSOLUTE EOSINOPHIL - 0 (100-1250 /uL)
BLOOD - 2+ (NEGATIVE)
RBC - 20-30 (0-5 HPF)
Blood pressure - 194 mmHg
Ultrasound results:
Adrenal glands enlarged bilaterally
Liver enlarged & hyperechoic
Urinary bladder wall - mildly thickened & irregular

I've got the Lysodren & will start it tonight. BTW my checking account says ouch but it's worth it for him to be healthier & happier. I'll keep everyone posted & if I have questions I wil ask. Thanks for all the help & support you all provide.

[frijole]

Jenny - I noticed the glucose was high... did they rule out diabetes? Kim

[smijette]

No they haven't ruled it out yet. The GP thought it might be a fluke with his Cushing's. He said that once we have finished the loading phase & have been on the maintenance phase for a couple of weeks, he'll run another CBC panel to check all of the numbers. The GP was really concerned about the Cholesterol, Glucose, Triglyceride & T4 numbers as am I now that I have the lab results. The IMS also thought the numbers could be skewed because of the Cushing's & said he would tell the GP to do another CBC panel after the loading phase.

[apollo6]

Dear Jennie
Just a quick check in how you and Roper are doing. Apollo has always wolfed down his food. He does the same as Roper. To slow him down you can either put a small ball in the middle of his bowl. I bought a bowel that is divided into four triangles that slows him down. I think it is a dachshund thing. Ask us questions and know we are hear to support and help you.
Hugs Sonja and Apollo.

[smijette]

I thought I'd update everyone on Roper. He's been on Lysodren for a week now. He's eating the same amount of food & he's actually drinking more water. He doesn't have any other problems nor is he showing any of the signs of overdosing. I have noticed an improvement in his behaviour at times. Sometimes he'll run (as fast as a pot-bellied dog can...;)) to greet me when I come home just like he used to before Cushing's. Could drinking more water be a sign of him being loaded?

[frijole]

I thought I'd update everyone on Roper. He's been on Lysodren for a week now. He's eating the same amount of food & he's actually drinking more water. He doesn't have any other problems nor is he showing any of the signs of overdosing. I have noticed an improvement in his behaviour at times. Sometimes he'll run (as fast as a pot-bellied dog can...;)) to greet me when I come home just like he used to before Cushing's. Could drinking more water be a sign of him being loaded?

Sorry but no. It makes me wonder if the dose is high enough.. but for now just keep an eye out. Not sure if we share our helpful loading hints with you so just in case... for your reading pleasure. ;):D

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

Kim

[smijette]

Thanks Kim! I figured he still wasn't loaded yet. I actually have the info from the link you posted printed out. It's tacked up on a wall in our kitchen so that everyone in my family knows what to look for. Thanks for all the help & support!! :)

[frijole]

No problem. You are doing just fine. And continue to ask questions. No reason to not pick our brains. Best of luck and hugs to Roper. Kim

[Squirt's Mom]

Hi ya'll,

If Roper has been on the Lyso for 7 days now, he is approaching the time where I would want him tested regardless of his signs. If you don't see any signs of Roper being loaded by day 10, call your vet to have him stimmed anyway. While it is not normal for a pups thirst or appetite to increase as the cortisol is lowered, we DO have pups who just do not follow the rules and do just the opposite of what is expected. One of our members had a baby whose appetite would drop as her cortisol raised - bass-ackwards! But her mom knew this little quirk so she knew what she was seeing even tho her baby did not follow the norms. SO just to be on the safe side, I would have him stimmed no later than the 10 mark. Just MHO. ;)

Hugs,
Leslie and the girls - always

[apollo6]

Just checking in to see you are doing alright.
Hugs Sonja and Apollo

[Squirt's Mom]

Joining Sonya in asking after Roper...hope all is going good for you all!

Hugs,
Leslie and the girls - always

[smijette]

HI everybody! Thanks for the info! Here's an update. We are still on the loading phase. I did take him to the vet to be tested after 10 days & waited 48 hours before he was tested). His results dropped a good bit but not where they needed to be. Here are his 12-21-10 results:
Pre-ACTH 11.2 (was 13.2)
Post-ACTH 24.2 (was >50.0)
We went back to the loading dosage. I questioned the vet if he was getting enough on the dosage. Since Roper had gained weight (went from 13.7 lbs to 14.34 lbs) the vet did agree that the dosage should be increased. He's now on 375 mg lysodren. The vet wanted me to bring him back in a week thinking (& hoping) that Roper's ACTH levels would be spot on. I took him back in on 12-30-10 for another ACTH test. Here are the 12-30-10 test results:
Pre-ACTH 8.0
Post-ACTH 8.2
I started Roper back on the loading & am now waiting until he strats showing any symptoms or hits the 10th day (whichever comes first). I have noticed an improvement in Roper's personality. More and more I'm seeing the "old" Roper. He's strating to eat like normal. He has dropped in the number of times he goes tothe water bowl but when he's at the water bowl he still drinks a lot. Hopefully by the first of next week I'll see some signs & we'll be done with the loading phase. Hope everyone has a great weekend!!

[lulusmom]

Wow, Roper has been loading for a really long time and I'm glad to see that you are almost there. I've been around for a few years and I don't think I've ever seen a dog with pituitary based cushing's with cortisol as high as Roper's. If his adrenal glands were not bilaterally enlarged on the ab ultrasound, based on the LDDS, the hugely high post cortisol on ACTH stim test and the really long loading, I would swear Roper has an adrenal tumor. These cushdogs always keep you guessing. :D

I'm curious to see what kind of maintenance dose your vet will be prescribing. Given the protracted loading at a fairly healthy dose, I would think the maintenance dose will have to be pretty darn high. You've done a great job! Please keep us posted.

Glynda

[addy]

I think you have done a wonderful job loading Roper!!!!!

Keep up the good work.:D

Hugs,Addy

[frijole]

Hi! Just offering encouragement. Looks like you have been loading for a month? My gal Haley holds the record for longest load. It took her 45+ days of loading (not including time out for testing and waiting for results). We kept increasing the dose and in the end she did stay on a very high dosage for maintenance. (She was like 2 x the recommended highest dosage per kg) She stayed on it for over 4 years and passed away last year at 16 1/2. So hang in there... it is well worth it. Kim

[Franklin'sMum]

Hi Jenny,

So good to hear that you're seeing some signs of the old Roper coming back :D, and hope that everything continues to go smoothly for you :).

Jane, Franklin and Angel Bailey xxx

[smijette]

Thanks all for the support! He's still on the loading phase & I haven't seen any more signs. So I'll be taking him in Thursday morning for another ACTH test. I'm not sure what the GP is going to prescribe as the maintenance dose but I get the feeling I'm going to have to re-educate him. :) He's talking about having Roper take his maintenance dose once a week. After reading through here and the reference material, I know it needs to be more often than once a week. My "old" Roper is definitely coming back. He's started messing with my oldest doxie, Stewie (who just wants to be be left alone & play when he wants to play). There's been some growling going on between the two of them. I've noticed Roper's also not as "bloated" (pot bellied) as he used to be. He still has his belly but that'll improve over time. I'll post the test results when I get them on Friday. Maybe by next week I'll be starting the maintenance phase. Keeping my fingers crossed!! :D

[frijole]

In case you need to educate your vet on maintenance dosing... assuming Roper's numbers come in between a 1 and a 5 (2nd no on the acth) you give Roper the same dosage you have been giving daily but only on a weekly basis. Most will split the dose into 2 or 3 days.

If he isn't loaded you keep going and might have to increase the dosage. You are doing great! Kim

[smijette]

Woohoo!! Got Roper's test results from Thursday's test & here are the results:
Pre - 2.1
Post - 2.3
Doing the happy dance!!! I didn't get to actually talk to the GP, but he did leave a message on my voice mail. The GP said he would have liked to have the post numbers be closer to zero but wasn't going to complain. Now onto the maintenance dose....375 mg 3 times a week (basically, 125 mg every Monday, Wednesday & Friday). He said he'll re-test him in 3 months. I know that's not right since I've read that he's to be tested after a month on the maintenance dose & then if everything looks good, then he gets tested in 3 months. I do have to take Roper back in for a thyroid & blood pressure tests. Those numbers were very high when we first started but couldn't tell if it was because of the Cushings or not. He'll go back in the next week or two to be tested for those. That's a worry for another day. I'm just so happy & want to thank everyone for the advice & support. My little doxie is much thinner (could still lose some weight but that will come later on as he gets more like himself) & acting more & more like himself. Thanks everyone & I'll keep y'all posted!!

[addy]

Doing the happy dance with you:D

Hugs,
Addy

[frijole]

Hurray!

I just want to confirm a couple things..

1. You said 375 mgs 3 times a week and then said 125 mgs... I think its a typo and you meant 375 mgs TOTAL a week, given On 3 different days - at 125 mgs.

2. Did you load at 375 mgs a day? Just wanted to make sure...

Again, great job and great news. Kim

PS yep... schedule an acth test in 30 days... trust me... they don't turn down business. ;):D

[smijette]

@ Kim...It was a typo. I'm giving him 375 mgs total for the entire week with 125 mgs on 3 different days. 375 mgs was the amount he was given daily during the loading phase. Lol...they most definitely don't turn down business! :)

[frijole]

Woohoo!! Got Roper's test results from Thursday's test & here are the results:
Pre - 2.1
Post - 2.3
Doing the happy dance!!! I didn't get to actually talk to the GP, but he did leave a message on my voice mail. The GP said he would have liked to have the post numbers be closer to zero but wasn't going to complain.

I just re-read this and wanted to point something out. Congrats on that 2.3 number because trust me that is where you want to be. I hope your vet didn't really want you to be at a zero or under a one because that would mean your dog had gone too low and would be Addisonian.

The ideal number is between a 1 and a 5 so you are right below the half way mark and that is ideal. Feel good about that.

I'm counting on you to go in for that check up in 30 days and verify that it is holding. Then you can sit back and relax because the hard part is over with. Great job! Kim

[smijette]

Hi all! I'm still giving Roper his lysodren on Monday, Wednesday & Friday. I'll be taking him back in for his monthly check up next week. However I have started noticing something strange. His skin is extremely dry & is peeling on his belly & sides. Another thing is he has started losing hair on his paws, arms, legs & chest. The only place he was losing hair before was on the back of his ears & that was just before he started getting tested for Cushing's. Any thoughts would be appreciated. I don't think it's him shedding his winter coat or growing his winter coat. When I comb him, it comes out in very small clumps but not enough to expose his skin except on his chest. Thanks in advance for all the help!

[labblab]

Hi!

I have only a moment to post, but do want to direct you to this thread in which post-treatment fur loss is discussed with another member:

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

I don't know whether this sounds similar to Roper's situation, but as you'll see, sudden fur loss is not uncommon when the normal growth cycle begins anew once a dog's Cushing's is brought under better control.

Marianne

[lulusmom]

Marianne has already given you some good information but I wanted to comment that hair loss on the paws and legs is not the norm in cushing's. Be sure to talk to your vet about this as it could be mites or something totally unrelated to cushing's.

[smijette]

That's for the link Marianne...very good info. Roper's ears are practically bald as is his chest & abdomen. Of course, his abdomen was shaved to do the ultrasound way back in November. I have noticed & feel the stubble coming in there. He's going in on Tuesday to get his 1 month ACTH test Tuesday. I'll be sure to mention it to the vet (@lulusmom about the hair loss on his paws & legs) when I speak with him. I'll post the results when I get them. Thanks for the help!!

[Wally P's Mom]

Hello:

Every once in a while, I come back to a place that gave me a great education and helped me tremendously with my Doxie, Wally.

Wally was a Atypical/Typical Cushings dog and he is just not your average dog. All doxies have that wonderful trait.

I speak of Wally as having had Cushings as he is now Addisons and doing quite *****. I can't use positive terms the vet is leaving town next week and I don't want trouble.

Anyway, when Wally was crashing, it was not dramatic with all the typically signs. He was just lethargic and once a day vomit. The signs were hard to tell, but during that period, his coat was nasty. Lots of dander and hair loss. he hardly had hair back then, but he was loosing whatever he had.

I personally do not know Roper, but for a piece of mind, besides the ACTH on Tuesday, I would recommend that his electrolytes be also checked. It is not much more out of pocket and would provide alittle more information.

By the way, Wally today is the fluffiest little Doxie you would ever want to meet. More hair now than ever before in his life. And he has changed the color of his coat from a red brown to more of a brindle dark brown/black. I am waiting to see what color he changes to for the Spring.

I can only tell you of my experiences and hope that it helps yours. Good Luck.

Marge and Wally