Buster - 10 y.o. Lhasa/Tibetan mix (Lysodren) - Cataract surgery?

[frizzcurl]

I'm just writing to introduce myself and my dog, Buster. He's a Lhasa Apso/Tibetan Terrier mix, ~10 y.o., 27lbs, and was dx'd with Cushings about 2 weeks ago (after the 8-hr low-dose dexamethasone suppression test, followed by abdominal ultrasound which showed normal adrenal glands)... just started Lysodren tx on Monday.

I don't have copies of all the bloodwork so I can't post #s, but as per usual (from what I've read) there has been a LOT of testing in the last year (a 4-hr low dose dexamethasone suppression test which did not clearly suggest Cushings, a punch biopsy of his skin, thyroid testing). His main sx are hair loss (lots on his back, his tail is almost bald, and he has no undercoat at all), thin skin, and ravenous appetite (he inhales all his food in under a minute... not sure he even chews). His water consumption is mostly in the normal range for a dog his size. A punch skin biopsy suggested that the hair loss was hormonally-based. He's also been a persistent paw-licker for the entire time I've had him (3.5 years) so right now he's on Atopica for the allergies.

For the moment I just have one question... I'm wondering how subtle/clear the changes were for folks in sx during the Lysodren loading phase? I'm timing his eating and measuring his water and so far there's been no change from before, but I want to be sure I'm not missing anything.

Thanks!
Jess

[frizzcurl]

Of course after I posed my last message, I realized I forgot to mention that the ultrasound also found very small bladder stones.

I also have another Lysodren-related question... Buster's rx is to take 1/2 a (500mg) pill, twice a day. For now I just bought a pill cutter and split the pills in half myself. But the warnings on the medication about not touching them or inhaling the dust made me wonder how others handle splitting them. And the pharmacist at CVS told me he can't split them and to do it myself. (My partner, who's a nurse said that it's b/c it's a chemotherapeutic agent and should technically be done under a chemo hood.) I'm not pregnant and don't intend to become so anytime in the near future, but assuming Buster is around for a while yet that will be a concern at some point.

[StarDeb55]

Welcome to you & Buster, Jess! We are very numbers oriented people, so if you want to post Buster's test results, we would be very interested to see them. It's not that we are doubting your vet, but we have seen it too many times on these boards where a vet with little experience in treating Cushing's has not done sufficient testing to confirm or diagnosis or even misinterpreted the results of the diagnostic testing.

Now, to your lysodren questions. A couple of comments, the loading dose is calculated based on 25-50 mg/kg, to get to kg, divide lbs., by 2.2. Buster's loading dose is well within the appropriate range at 40 mg/kg. Signs of loading can be very subtle. For instance, the pup who takes one minute to empty his bowl to the point of being spotlessly clean, now, stops in the middle of eating to look at you. The pup who will his his kibble down to the last crumb, now, leaves a few pieces. We like to tell folks who are loading that any change in behavior that makes you stop & think, "Hmm, that's different or that's new." This is probably the sign indicating that the pup is loaded. One caution, a decrease in water intake usually occurs a little later on, than a decrease in appetite. There have been members who have even monitored the pup's stool during loading. They have noted that what starts as a normal stool will eventually become much softer, with the BMs softening, this can be a sign of loading. Each pup is an individual, so not all pups will show all signs. My first boy, Barkley, never showed a slowdown in appetite, but on day 9, his water consumption suddenly dropped by 40%. Fortunately, we had done an ACTH the day before, since there had been no change. His numbers came back very low, & he had to be put on pred immediately. Barkley was fine, after a few days of prednisone, & went to maintenance without a problem. I don't want to use this example to scare you, but just to illustrate that if I had counted on only a change in appetite, there might have been a serious problem. The other important point is that standard loading protocol states that if no changes are noted by day 8-9, you should run an ACTH to see where you are. If the cortisol isn't within range, you just continue loading.

Now, about handling lysodren, right now, it's really not a problem. I cut Barkley's tablets for years. If you are worried, now, I would simply wear gloves, & make sure you have a dedicated pill cutter that is only used for the lysodren. Wash everything thoroughly when your done with the meds. If you should become pregnant, someone else is going to have to take over Buster's medication. Expectant Mom's absolutely should not handle lysodren, even with gloves.

Looking forward to hearing more.

Debbie

[frizzcurl]

Thanks so much for your quick reply, Debbie! I got copies of all of Buster's medical and lab test records from the vet today so here's a more comprehensive history (with #s).

I adopted Buster in August 07 and his vet records that I got from the rescue estimated his age at 6.5, so presumably he's ~10. When I adopted him, he had terrible skin infections that his foster mom said were hot spots from being out in the sprinklers with the other dogs. Now, this is a dog that hates water so much that he will walk around puddles if at all possible. So that seems unlikely. But in retrospect, maybe that fits with thin skin/slow to heal/skin infections sx of Cushings? Also, from the time I've gotten him his coat has been VERY thin. He has never had much of an undercoat. His fur is white with black spots and for as long as I've had him, the black spots on his skin (including his abdomen) have not matched up with the black fur. I'm not sure how long he's had the black spots on his abdomen but the black spots on his torso were there when I adopted him.

Also since the day I adopted him, he has had allergies. At the time I adopted him, I did a food trial with a limited ingredient diet (Natural Balance Sweet Potato & Venison) that helped some, but the paw-licking was still pretty persistent so the vet put him on Temaril-P, which worked beautifully in controlling his itching. (One of my friends calls prednisone the "miracle poison.") He was taking 1 tablet/day for about 1.5 years.

In the fall of 2009, I noticed a bald spot at to of the base of his tail (where it meets his rear end) after a grooming. At first I thought that maybe the groomer just shaved there and dismissed it (even though I thought it would be weird for the groomer to do that). Over time, though the spot grew and in Feb '10 I brought it up with the vet and, thinking the hair loss might be related to the long-term steroid use, we started tapering him off the Temaril-P. That's when he started taking the Atopica for his allergies (which, incidentally helps some with the licking--enough that I'm not going crazy from listening to it--but still isn't as good as the Temaril-P was). After we stopped the Temaril-P I also noticed that he was limping more and more, esp after laying down for a while or after walking. Not sure if his energy level changed, but he's always been a pretty low energy dog to begin with.

Over the last year, Buster's hair has continued to get thinner such that now the top of his tail is almost entirely bald. Also the fur on the rear end of his torso is extremely thin such that you can see his skin. In April, the vet and I started talking about Cushings as a possible dx since the hair thinning kept getting worse even though he'd been off the Temaril-P for a few months.

In August she did an ACTH stim test and his cortisol levels at baseline were 3.6 ug/dL; after 4 hours they were 16.7 ug/dL. At that time we talked about how this isn't a clear dx of Cushings and did a bunch of things to rule out other possible causes of the hair loss: blood sample allergy testing (nothing notable came up), a punch biopsy of an area where his hair is thinning (report says "findings suggest an endocrine/hormonal dermatosis with secondary superficial pyoderma or Malassezia dermatitis"), and a thyroid test (T4 = 1.4 ug/dL). Also tested for ova and parasite (including giardia) and all were negative.

In September 2010 he got infermectin injections in case the hair loss was related to something parasitic (no change).

Since September, the hair loss has continued to get worse. In mid-December, I tried brushing him with one of those slicker brushes with the metal bristles (usually I use one with plastic bristles) and he started bleeding in the places where the brush had scraped his skin. I did a bunch of reading about Cushings and took him into the vet to talk about the thin skin sx. We decided to do the 8-hr LDDST. This time his pre-cortisol levels were 5.4 ug/DL; after 4 hours they were 4.1 ug/dL; after 8 hours they were 4.6 ug/dL. Apparently they also tested his thyroid at that time and T4 = 16 pmol/L.

At that point the vet told me that Cushings was very likely and that we should do the abdominal ultrasound to try to determine adrenal vs. pituitary. The ultrasound was done on Xmas eve and the report says that the adrenal glands were normal size. It also said that there were many tiny 2-3 mm stones in his bladder which may be calcium oxolates.

I decided to do the Lysodren loading now since I have this week and next off from work, and can keep a close eye on him. As I said in my previous post, he took his first dose on Monday morning and so far no change in water consumption (today it actually went up, but it has always been at or below 20 oz/day... average is probably 17ish) or eating (average is probably about 50 seconds, barely pausing to chew). Behaviorally, he's seemed fine...perkier than normal actually--last night he wanted to walk extra, which he NEVER wants to do, esp. when it's cold out.

I have results of other lab tests (i.e., CBC, Chemistry Panel from 12/5, superchem panel from 7/27 & 4/11, etc) that I could share if that would be helpful.

I'd love to hear what people think with this additional info! Thanks in advance for any input you have... this forum seems like a really great place!

[frijole]

Hi and welcome! Did you do an acth test? Normally it's done in addition to the 8 hr one prior to starting lysodren. Then you do it during loading to see if you are 'loaded'. It is a measurement of cortisol. Takes a couple hrs and the results are only 2 numbers. ???

Anyway - wanted to make sure you were briefed by your vet on using lysodren. It is a wonderful drug - I used it for over 4 yrs with my girl Haley. It saved her life. It is a strong drug however and so it is important you 'play by the rules' and understand how it works.

So here's a link that I used and it helped alot.
Kim
http://www.k9cushings.com/forum/showthread.php?t=181

[StarDeb55]

Jess, prednisone is indeed a wonderful thing when used very carefully. Now, I have a big question for you was any of the Cushing's specific diagnostic tests done while Buster was on Temaril P? If so, you can throw all of those results out the window. The prednisone in the Temaril would have screwed up those tests. Long term use of steroids can induce a 3rd kind of Cushing's called iatrogenic. There is only one way to fix iatrogenic & that's to slowly wean the pup from the meds. If Buster was not on the steroids, how much time between his last dose of Temaril & any of the Cushing's diagnostic testing?

Allergies & Cushing's are a tough 2-some to deal with, I know from experience as my first boy, Barkley, had severe allergies, along with his Cushing's. Because of the Cushing's, my derm vet could not use any sort of steroid for his allergy treatment.

Debbie

Debbie

[frizzcurl]

Wow, you are all quick at replying!! It's quite helpful for a somewhat anxious doggy-mom like myself. :)

To answer Kim's question, the #s I posted are the only ones I see on the lab printout. I asked the vet if they did the ACTH test during the 8-hour test and she said yes. I assumed the #s I posted were cortisol levels? (From the 8-hour one, I interpreted the first # as baseline, the second as cortisol reading after 4 hrs, the second as cortisol reading after 8 hours... I can call the vet tomorrow to make sure.)

To answer Debbie's question, Buster stopped taking the Temaril P in February 2010 and the first LDDST was done in August 2010. The second one was done in December. So there was a 6-month gap between when he was weaned off the Temaril-P and the initial Cushing's test. And none of his Cushings-like sx stopped after being weaned off the Temaril-P.

[StarDeb55]

I'm glad to hear that steroid use is not the issue in this situation. Believe or not, in rare instances, we have see inexperienced vets try to make a cush diagnosis while the pup was on steroids, this is why I had to ask the questions.

Debbie

[addy]

Hi,

Buster's hair loss sounds exactly like my Zoe's hair loss. That was exactly how we started our journey. Zoe is a Lhasa and will be nine years old in April. Well, I think, I got her from Animal Control and a rescue group four years ago. We can only estimate her age.

We have not yet started our lysodren, chronic diahreea keeps poping up.

Hoping things go well with your load. Keep posting. The moderators can help you along. They are very smart;)

Hugs,
Addy

[frizzcurl]

Thanks, Addy! I hope things improve with Zoe soon.

So far things with Buster's load seem to be going well though it does make me nervous that we're on day 6 and so far I haven't seen a noticeable change in eating or drinking. This morning I thought that maybe he's less excited about being fed than usual (was just following me around the kitchen closely while I got things ready vs. jumping all over himself like he hasn't eaten in 10 years) but I also wonder if I'm just over-thinking things. He still inhaled his food without stopping for a breath in 49 seconds.

My vet isn't in today and the office is closed tomorrow but I scheduled him for an ACTH stim test on Monday morning anyway (since that will be day 8).

[Casey's Mom]

Just checking in on you and Buster and wondering how the loading was going :):)

[frizzcurl]

Thanks for checking in! He looked up and around while he was eating breakfast yesterday so that's when he took his last dose... he had the ACTH stim test this am. Should have the results tomorrow, so I'll keep you posted!

[Casey's Mom]

Great sounds like he is loaded - let us know when you get the results.

Love and hugs,

[frijole]

Buster is adorable! Good luck with the results! Kim

[frizzcurl]

So I just got the ACTH stim test results from the vet. Apparently his cortisol levels were below 0.7 both before and after the injection. (I asked for actual #s but apparently the report from the lab just says < 0.7 ug/dl.) Right now, she's testing his sodium/potassium levels to check for an Addisonian reaction.

His energy level, eating, drinking, peeing, etc. have all been normal so the vet said we don't need to administer prednisone, but need to just hold off on administering Lysodren for ~2 weeks and do another ACTH stim in 10-14 days (we scheduled it for 1/21). She also said that given eating/drinking/peeing, etc have been normal, an Addisonian reaction is unlikely but the checking electrolytes is just a precaution.

I can't help but feel like I screwed up the loading phase and missed some change in his eating/drinking as a sign that he was loaded that I should have caught. I know that's silly since I've been measuring his water consumption and timing his eating pretty meticulously and I did stop the lysodren when I noticed something subtly different. But I just worry about the little guy, you know?

Jess

[lulusmom]

Hi Jess,

Do not beat yourself up for missing signs of loading. Some dogs, like my Jojo and your Buster, haven't read the book and weren't aware that they were supposed to give us a sign. :D:D I have two cushdogs so I was no stranger to loading when I loaded Jojo the first time. I watched him like a hawk and he never gave me any sign that he was loaded. Had I waited for a sign instead of having a stim done on day 10, he definitely would have been thrown into an addisonian crisis. I was shocked when his post stim number came back at .7 because he was acting the same on day 10 as he was on day 1.

Glynda

[frizzcurl]

Thanks the reassurance, Glynda! :) I'm so glad I scheduled the stim test for day 8 even though I hadn't seen much of a change! I kept asking Buster if his appetite was decreasing and how his cortisol levels were doing but he just cocked his head and looked at me like "What do you want from me? I'm a dog, lady!"

[frizzcurl]

Just posting an update that Buster's electrolyte levels are all normal, according to the vet. So all is on hold until his ACTH stim next week. His eating/drinking/energy have still all been normal so hopefully we can just pick up with maintenance after that!

[Sabre's Mum]

Jess

That is fantastic news that Buster's electrolytes are within range. My advice at this stage is to make sure that you get Buster's ACTH post stim within range before you restart the maintenance dose of Lysodren ... which I see you have scheduled :). This will give you a valuable tool going forwards ... one making sure that he isn't "too low" and is in range and secondly going forwards in making sure that the maintenance dose is what he needs.

Take care
Angela and Flynn

[frizzcurl]

A good news update about Buster:

His cortisol levels were all within normal range at his ACTH stim on Friday (3.6 ug/dL pre; 3.7 ug/dL post). So, we're all set to start maintenance this week. Fingers crossed that things go well from here!

Question for others, though: For those of you whose dogs really lost a lot of fur, esp. undercoat... did that all grow back once you started tx? How long did it take? The poor little guy is VERY chilly this winter without his undercoat and I'm wondering how long it will take to come in.

[Sabre's Mum]

Jess

Great news that Buster's ACTH has come up in range. I am trying to piece together the timeframe of loading? How many days did it take Buster to load? What dose has the vet worked out for Buster's maintenance dose?

With regards to the hair loss ... Sabre was totally bald for a large portion of his back. If I recall correctly it was about 4 months before he grew his coat back .. I have tried to look through his archived thread but I have never posted a reference to when his hair did fill in! In the interim we placed t-shirts in the hotter times and a jacket in the winter to keep him warm. His coat grew back like a "labradors" coat not the smooth short haired vizsla coat.

Angela and Flynn

[frizzcurl]

Thanks for your quick reply! Buster started the loading phase on the Mon after New Years and showed the first clear sign of being loaded (looking up while he ate) on Sun am (day 7). We did a stim test the following day and his cortisol levels were too low ( < .7 pre & post) so we waited 10 days and he was re-tested on Fri. The maintenance dose is 250 mg twice a week, so 500 mg total per week. He weighs 26 lbs.

Thanks for the time frame on Sabres hair growth. Buster wears a coat outside already but sometimes he's still cold. I was optimistically hoping his hair would start to grow in enough to help him this winter but my guess is that I won't really see how this impacts his cold intolerance until next year. Alas, at least there's hope that it will get better from here!

[Sabre's Mum]

Ok ... so the vet is continuing with the same dose over to the maintenance dosing. This works out to be 42.3mg/kg at Busters current weight. I am not sure what your vet has said with regards to the next ACTH but I would advise an ACTH stim in a months time OR if you see signs that he is going "low".

All the best and keep us updated
Angela and Flynn

[frizzcurl]

The vet who called me with his test results was not his regular vet, and she said to come back for the next ACTH test in 3-6 mos. But given that he was low after loading and wasn't really showing any signs of being low, maybe I will just schedule one a month from now anyway.

Thanks for the support and advice you all provide here! It's such a great resource!

[frizzcurl]

Hi all,

I'm just writing with a little update about Buster, who just (on Thurs) had his first ACTH stim after going on maintenance with the Lysodren a little over a month ago. His cortisol levels were at 7 ug/dL pre-injection and 6.7 post. The vet said that although this is technically still within the normal range, it's high for a cushdog who is on Lysodren. So, she upped his dose a bit. He's been on 1/2 pill twice a week... she said to add 1/4 pill once a week and to spread all three doses out across the week (e.g., 1/2 pill Mon, 1/2 pill Wed, 1/4 pill Fri).

His eating and drinking have all still seemed normal to me, but then again neither of those things changed very much even after loading when his cortisol levels were too low.

We're going to test him again in a month to see if the extra 1/4 pill does the trick to keep his cortisol levels between 1 and 5. I'm curious how much of these types of little adjustments folks have had to make over time? How long did it take to find the right maintenance dose for your dog(s)?

Thanks!
Jess

[frijole]

Hi Jess. Good to get an update. I can see what your vet is trying to do but honestly I don't think it will work. Let me see if I got all the facts right:

You loaded, went too low and then waited to restart. (What was the original load dosage?)

You started maintenance toward the end of Jan at around pre and post 3.5. So you have GONE UP over the last 30 days at 500 mgs. Now you are going to add a 3rd day and an additional 125 mgs to hopefully go down? Not enough. The problem was that 500 mgs wasn't enough to maintain where you were and going up that much in 30 days .

Please let us know what the original load dosage was (where you went too low) It might be that the dosage was right but you just went too many days.

Been reading here for over 5 yrs and don't think I ever saw a dog's numbers go down with a slight increase on a maintenance (vs loading) dose.

How are Buster's symptoms? Improved or not? Thanks, Kim

[frizzcurl]

Thanks for the speedy reply, Kim!

You have the facts right... The dose during loading was 500mg/day. There is a chance that he ended up too low after loading b/c we went too many days. His signs of loading were VERY subtle (just glancing up while eating... no change in drinking) and he had glanced up while eating once during one meal about 2 days before I stopped the loading phase.

The thing that's been tricky about this with Buster is that his symptoms (other the hair loss which obviously isn't going to change quickly) have been pretty subtle. After starting the Lysodren his energy level improved and has remained improved since, though his baseline is to be pretty low key. As I said in my earlier post, I haven't really noticed changes in eating or drinking in the last 30 days (but I haven't been tracking them as carefully as I was during loading). So I guess the short answer to your question about symptoms, Kim, is that I haven't noticed a change really. Other than the slight improvement in energy at the beginning, he has seemed the same to me pretty much all along this process.

If increasing dosage by 125mg seems unusual, what changes in meds are more typical during maintenance?

[frijole]

Jess, Normally the way to reduce the cortisol is to do what is called a miniload which could be a few days of dosing at the loading rate. That is what causes the cortisol to go down. I find it very strange that you went too low at 500 mg, waited a bit then when at 3.5 you started at the same level on maintenance and you were unable to maintain.

The other thing I noticed which is strange is that your pre and post numbers on all of your tests are almost identical - .07, 3.6 and 7.0
Normally the first number is small and then after the stimulation the second number is higher. Do you have actual copies of the results or did someone read them over the phone? Kim

[frizzcurl]

Hmmm. Maybe I should call the vet on Monday to ask about the mini-loading thing?

I don't have hard copies of the results from the last two tests... the results of both were read to me over the phone. I will get copies faxed to me at work on Monday and confirm if they indeed say what I had written down.

One thing that occurs to me as I write this is that Buster REALLY hates being in a crate. He usually tries to lick or chew his way out and barks, even though he NEVER barks normally. The vet's office tries to just let him have free reign in the back room if they are not too busy since being crated upsets him so much (they were able to do this in the stim test at the end of Jan), but it was super busy when he was there on Friday and he had to be crated. They said he did fine but did mention that he'd been barking. Might the stress of being crated be playing a role here?

[frizzcurl]

So I got the results of Buster's last two ACTH stim tests faxed to me yesterday, and the results I reported earlier are in fact what the lab printouts say.

What do you all make of his pre-post cortisol levels being the same? Is there any harm in trying the higher lysodren dose for a month and then testing his cortisol levels again (vs. doing a miniload now and then increasing his maintenance dose)?

Thanks!

[frijole]

Jess, You can certainly do what your vet suggests and the only harm done would be that the numbers continue to creep up and a 2 day miniload becomes a 7 day load.

I'd like someone else to review my comments about the pre and post levels always being almost the same.

Kim

[AlisonandMia]

I was thinking that one reason for the pre and post being almost the same (despite not being very low) is stress (vet stress). Basically stress putting the body on "red alert" and causing the adrenals to dump as much cortisol as possible even before the stimulating agent was given.

I had Mia do that although her levels (both pre and post) were around 2-ish at the time. As in this case the pre was slightly higher. On the way (20 minute car trip) over she knew very well where she was going so it wasn't surprising really.

The aim of the stim test is to stimulate the adrenals to dump their full load of cortisol into the system. This is the way you measure the amount of cortisol-producing tissue still at work. Sometimes the stress of being at the vets can have pretty much the same effect (everyone's cortisol levels naturally rise temporarily with stress) and when this happens you can sometimes see the two numbers being very similar with the pre number sometime being higher. As long as neither number is too low I don't believe it is of much concern and if both numbers are over 3 or so I'd take most notice of the highest one, which ever it is, as that is the best indicator of the cortisol stores held in the adrenal glands - which is what you are trying to measure.



Alison

[frizzcurl]

So I followed my vet's suggestion that we try upping the maintenance dose for a month to see if that drops Buster's cortisol levels, and we did a repeat ACTH stim this past Thursday. This time, his pre-injection cortisol level was 4.9 ug/dL, and post it was 6.7. This is the same as his post-levels were last time.

We discussed the pros/cons of upping the maintenance dose again vs. doing a mini-load and decided that I will do the miniload the week after next (for 2 days max, 250mg 2x/day) and then bring him in for another ACTH stim on 4/7. [Ideally, of course, I'd like to do it sooner but I just can't fit another 3 hour vet visit into my schedule before then.] Then, I guess, we'd put him on a higher maintenance dose than we tried the first time. Seems like the extra 125mg/week at least kept him constant at the slightly-too-high level he was at after the first month of maintenance?

Thanks as always for your input!

[frizzcurl]

Hi everyone,

So my dog Buster was dx'd with cataracts this morning. I had guessed that he has cataracts from the cloudiness in his eyes and his difficulty on stairs in low or bright light (which has been getting progressively worse).

Anybody have experience with cataract surgery on dogs with Cushings? If so, where in the Cushings treatment were you when you did the surgery? We did the initial loading phase with Lysodren back in Jan but are still working on finding a maintenance does.

Thanks for any input!

Jess

[frizzcurl]

So another brief update about Buster... We did the 2-day mini-load at the beginning of this week, and did the ACTH stim on Thursday. His pre-injection cortisol levels were 1.4 ug/dL and post-injection were 2.3 ug/dL.

So, back to maintenance for Buster! Since the 625mg/week (250 Mon & Wed, 125 Fri) seemed to keep him stable before we're trying that for the next month. Hopefully that will be a good dose to keep him at for the long haul. This adventure of loading and finding a maintenance dose has proven to be quite expensive! (Thursday's test was the 5th since the beginning of Jan, at ~$320 apiece.)

Have others found that once you get a good maintenance dose going it tends to "stick"? How often do those of you who've been treating cushpups for years end up doing ACTH stim tests?

Also, I never got any answers to my cataract surgery question (see my last post). Anybody have experiences with it?

Thanks!

[frijole]

Hi! I can't help with the cataract question but I used lysodren for over 4 yrs with my girl. She took forever to load but once she did she held it for 4 yrs. I did a miniload and then kept on so it was sooooo much easier and cheaper. Most do yearly atch tests but since you just loaded and did some tweaking I'd do it in a few months just to guarantee it is sticking or at any sign of the symptoms coming back. Trust me, the hard part is over. Sit back and enjoy Buster now! Kim

[Squirt's Mom]

Hi Jess,

Check out The Owner's of Blind Dogs forum. I am sure they will have some info on cataract surgery.

http://pets.groups.yahoo.com/group/blinddogs/

Another one, less active, is:

http://www.blinddog.info/msgbd/

Hope this helps!
Hugs,
Leslie and the gang

[frizzcurl]

So, quick update... it looks like we've found a maintenance dose! Buster had his 1-month ACTH stim test yesterday and his pre-injection cortisol level was 2.1 ug/dL, and post-injection was 3.0 ug/dL. He's been taking 625 mg of Lysodren every week (250 on Mon, 250 on Wed, 125 on Fr).

This is *very* slightly higher than he was a month ago after we did a mini-load (1.4 pre and 2.3 post) but the vet said that since it's still within normal range we should keep the dose we're on. Have others of you seen slight increases like that and then it levels off? Or is that slight increase a sign that his cortisol levels are going to creep up by .7 ug/dL every month and he'll be out of the normal range in 3 months?

[frijole]

I think you should celebrate! The numbers are there to guide us but dogs are different so now that you have reached a number within range the key is to monitor symptoms and do testing every 6 mos or if you see the symptoms coming back. My dog took a very long time to load but once we got her there it held for most of her 4 1/2 yrs after loading. We had to one tweek and that was it. So hopefully you will have the same experience. :D

So sit back and enjoy Buster, go in for checkup acths and you are set to go for now. Kim

[lulusmom]

Those are great numbers! Congratulations.

The cortisol can slowly creep back up. The best way to make sure things don't get too far out of hand, you can have another stim done in 90 days and see where things stand. If this stim is higher than the last, then your vet will probably increase the maintenance dose a bit. Until that time, enjoy Buster and give yourself a pat on the back for a job well done.

Glynda

[frizzcurl]

Since it's been a few months, I thought I'd check in with an update about Buster.

It was a rough summer for him because at our last vet appt in May, the vet pointed out a growth in his gums that concerned her. I hadn't mentioned it b/c I thought it was just b/c he needed his teeth cleaned and didn't want to deal with it until things were more settled with the Cushings. But she thought it was more than just swollen gums and referred us to a dental specialist. Turns out it was a tumor growing out of a periodontal ligament that had already spread to the jaw bone. So, in early June Buster had the front half of his lower jaw (everything except his molars) removed. Recovery was tough for the first two weeks, but he was a trooper and has bounced back quite well. The oral surgeon is sure he got the whole tumor and said that we shouldn't get a recurrence of this type of tumor in Buster's lifetime.

I was worried that all the stress of the surgery and a week plus of not eating much (or really getting his meds down) would cause a problem with the Cushings treatment, but he had his 3-months-out ACTH appt on Monday. I just heard from the vet that his pre-injection cortisol level was 3 ug/dL and post was 3.6. So, we seem to have found ourselves a maintenance dose that sticks for 3 months INCLUDING a really stressful surgery. So, lots of relief going on over here. I guess we'll do the next ACTH in 6 months.

The one odd thing that the vet and I talked about is that his hair loss doesn't really seem to be getting any better; around his neck it actually looks a little thinner. But the hair is growing in better in the spot where he was shaved for the surgery than it has in the past. So, I'm just going to keep an eye on it and hope that it is slowly getting better but just won't be noticeable for another few months.

[addy]

I am so glad you posted about Buster. Thankfully the surgery went well and the ACTH test sounds really good.

The hair can be last to improve. The follicles also have a cycle so don't give up yet;)

A stressful time for you both but the end result is really good. Keep up the great work.

Hugs,
Addy