sweet Ruby age 13

[estijersey]

Hello All,
My name is Esti and my little, perfect, 16 lb mutt (who may be part long haired Dachshund) has very recently been diagnosed with Cushings. Very glad to find your sight.

I initially brought her to the vet because I noticed she was drinking excessive amounts of water and panting heavily and often. The vet suggested Cushings off the bat and advised me to test for it. He took a blood and urine sample and said her liver enzymes were high which to him indicated Cushings. He then asked me to bring in a urine sample from home (while she was not under stress from vet's office) and then finally the ACTH test which showed 8 pre sample and 32 post sample.

So now, here I stand with the difficult (or so it seems so to me) decision of whether to begin treatment with Lysodren, wait a while, or not treat at all. Her symptoms thus far are still only the two I mentioned, and yes she has slowed down some in her golden years. Also, she tore her right hind ACL months ago, so I fear for the potential muscle weakness which I have also read about. But I can't get past the severity of this treatment. When I mentioned the risks of having the Lysodren cause Addison's he said, this was a possibility. He also said that some vets purposefully give the dog Addison's and then treat for that disease instead. That sounded #*@!&*% absurd to me.

I read in one of the articles that "there is no evidence that early treatment for Cushings prolongs life or reduces the likelihood of future clinical symptoms, so waiting on treatment is an option.''
I also wonder, how uncomfortable is she? (that's a difficult one) But my vet said, that if it were his dog he would definitely treat because he couldn't stand the drinking and peeing (she has not yet had an accident in the house- though he assures me she will...)The drinking doesn't bother me, what bothers me is knowing or not knowing if my girl is in pain or severely uncomfortable. Also, what's with the elevated liver enzymes?

So, though this question/s has/have probably been asked several times in several different ways, here's a new person asking it again. Thank you in advance for your time and I will better familiarize myself with this sight- so I don't get too redundant.

Many Thanks,
Esti and Ruby
East Bay, California

[Harley PoMMom]

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

Excessive drinking is one of the many symptoms of Cushing's but it can be attributed to diabetes, has diabetes been ruled out? Also, has any thyroid problems been ruled out?

If Ruby does have Cushing's then your vet should determine if she has PDH or ADH. If Ruby's Cushing's is ADH then surgery could be an option for her and a cure. If it is PDH, we will help you every step of the way, ok? To determine if Ruby is PDH or ADH your vet should run a LDDS test.

Sorry this is short but I have to get ready for work but I am sure the others will be along to welcome you and give you advice.

Love and hugs,
Lori

[mytil]

hi and welcome from me too.

Lori has mentioned other possible causes of excessive drinking and making sure these conditions have been ruled out.

IMO I think additional testing needs to be performed to make sure it is Cushing's. This includes a LDDS test and an abdominal ultrasound to take a look at the adrenal glands for irregularities.

Cushing's is treatable with both Lysodren and Trilostane and yes these are serious medicines. But they are very effective in reducing the amount of cortisol that is produced. It is a slow progressing condition so waiting for a firm diagnosis is a wise thing to do. Addisions happens when the dosing protocol is not followed, meaning too high of a dose is given and in some cases the dog does not tolerate the medicine. When going through the loading period with Lysodren one should have prednisone on hand in case symptoms show the cortisol levels have fallen low.

Let us know about any additional testing that is scheduled for your pup.

Take a minute to read through these links - http://www.k9cushings.com/forum/showthread.php?t=180
Terry

[lulusmom]

Hi Esti and welcome to you and Ruby.

I'm sorry that you have been dealt the heavy blow of a cushing's diagnosis. We've all had the same wind knocked out of us. :( I have two cushdogs so I had a double whammy. By the time my second one was diagnosed, the fear was not quite so bad but I was still extremely nervous. It was then that I found this forum and the experience, support and education I've received has been astounding. I believe that if I had a third diagnosis, I'd be a nervous wreck but only because I'd have to rob a bank to pay for the testing and medications. Otherwise, it would be just another day and by the way, both of my tiny dogs are being treated with Lysodren. Education is the tranquilizer pill for us cushdog owners.

Now, that I've got the rah rah stuff out of the way, I'd like to make a few comments and maybe ask a few questions. To keep myself on track and hold my post down to a novella instead of a novel, I've typed my response in blue text below:



I initially brought her to the vet because I noticed she was drinking excessive amounts of water and panting heavily and often. The vet suggested Cushings off the bat and advised me to test for it. He took a blood and urine sample and said her liver enzymes were high which to him indicated Cushings. He then asked me to bring in a urine sample from home (while she was not under stress from vet's office) and then finally the ACTH test which showed 8 pre sample and 32 post sample.

Others have asked if your vet has ruled out thyroid and diabetes as a possible cause. If you had a full blood chemistry, the T4 (thryoid) and glucose (blood sugar level) were probably included. If you don't have a copy of Ruby's test results, your vet should be happy to give you copies. Please post the highs and lows here, including the normal reference range and reporting units, i.e. ug/dl, nmol. You've already posted the acth stim test numbers so no need to duplicate.

So now, here I stand with the difficult (or so it seems so to me) decision of whether to begin treatment with Lysodren, wait a while, or not treat at all. Her symptoms thus far are still only the two I mentioned, and yes she has slowed down some in her golden years. Also, she tore her right hind ACL months ago, so I fear for the potential muscle weakness which I have also read about.

Did Ruby have surgery to repair the ACL? If not, it's pretty much a given that arthritis will eventually become evident. If this is the case with Ruby, she would be self medicating herself with the high cortisol, which is our bodies natural anti-inflammatory. A lot of pet owners don't realize there dogs have arthritis until treatment reduces the cortisol and the arthritis is unmasked. If that should happen, there are treatments to help with aches and pains.

But I can't get past the severity of this treatment. When I mentioned the risks of having the Lysodren cause Addison's he said, this was a possibility. He also said that some vets purposefully give the dog Addison's and then treat for that disease instead. That sounded #*@!&*% absurd to me.

Causing Addison's is not really an accepted protocol here in the U.S. It is, however, in other countries. Lysodren is not the only effective treatment for cushing's. There is Vetoryl (Trilostane), which also a serious drug but the mode of action and short half life is such that if a dog's cortisol drops too low, the dog will rebound rather quickly by simply withholding the dose. Lysodren, on the other hand, has a cumulative effect and continues to do its thing for 48 hours. For this reason, it is imperative that the vet prescribe prednisone. Yes, this all sounds scarey and if your vet didn't point out the seriousness of the drug(s), he isn't doing his job. Cushdog owners cannot rely solely on our vets to treat our dogs. As a matter of fact, very few gp vets have had enough experience treating cushing's and in our experience, it is these vets and/or an uneducated pet owner who are the cause of the majority of addisonian crises we've seen here. Do you know how much experience your vet has diagnosing and treating cushing's?

I live in Southern California and I have looked high and low for a local vet that knows what he/she is doing and I have come up empty. I drive my dogs 50 miles to an internal medicine specialist, who literally treats hundreds of cushdogs. It works out well for me because they are open 24/7 so I can take them in at any time on Saturdays and Sundays. They charge more than most gp vets but that's to be expected at a specialty clinic. With two cushdogs, I work to pay vet bills. :D A good number of members have opted to have their dog treat with an internal medicine specialist. If this is something you might want to consider, I see that you are in East Bay, which I assume is in Northern California. Perhaps we have some members who can provide you with a name or you can use the link below to find an IMS in your area:

http://www.acvim.org/websites/acvim/index.php?p=3

If and when you decide treat, we'll be here and can help you through it. However, you need to do your part by familiarizing yourself with whatever drug you are going to give Ruby. We have tons of information on both drugs in our Helpful Resources section of the forum. I highly recommend that you start reading in your spare time.


I read in one of the articles that "there is no evidence that early treatment for Cushings prolongs life or reduces the likelihood of future clinical symptoms, so waiting on treatment is an option.''

I'm not sure what article you read but it's bogus. Firstly, how do you define early treatment? If it means you treat in the absence of symptoms then, I'd say that article is even more bogus. Treatment does not cure the disease, it is given to control the symptoms. This is why symptoms are a huge component of a diagnosis. My first cushdog was diagnosed at 3 years old and she is now 9. I can tell you without a shadow of a doubt that had I not treated her, she would be dead by now. Who in the heck are these people that are spreading these fairy tales? If you know who they are, can you please have them call me? :p

Cushing's is a very slow progressing disease and it can take years for a dog to succomb to the long term effects of high cortisol on their internal organs and immune system. So yes, you have a lot of time to figure out which treatment you want to go with and when you want to start.


I also wonder, how uncomfortable is she? (that's a difficult one)
But my vet said, that if it were his dog he would definitely treat because he couldn't stand the drinking and peeing (she has not yet had an accident in the house- though he assures me she will...)The drinking doesn't bother me, what bothers me is knowing or not knowing if my girl is in pain or severely uncomfortable.

It's really not so difficult. Cortisol is a feel good steroid so with cushing's, the dog's system is being flooded with it. Unless the disease has progressed to the point where bacterial infections are rampant or internal organs are being grossly affected, a cushdog isn't really in any pain. It usually hurts us moms and dads a lot more than it is hurting our dogs.

Also, what's with the elevated liver enzymes?

Dogs are the only species on earth who has a liver enzyme called alkaline phosphatase (ALKP) that is triggered in the face of steroids. It is this enzyme that usually tips off a vet that cushing's may be involved. The pattern is usually moderate to high elevations in ALKP and normal or low elevations in ALT and sometimes GGT. If you look at Ruby's bloodwork, you'll probably see this.

So, though this question/s has/have probably been asked several times in several different ways, here's a new person asking it again. Thank you in advance for your time and I will better familiarize myself with this sight- so I don't get too redundant.

If I haven't indirectly answered your question already, here's a direct one. You have time to decide what to do. I believe Terry has already suggested additional testing which I agree with. Is there any reason why your vet opted to not determine which form of cushing's Ruby has? I personally would want to know for two reasons. 1) If it is adrenal based disease, surgery is an option and a permanent cure 2) if adrenal based and Lysodren is used to treat, the vet should know what he's dealing with because adrenal tumors are resistant to Lysodren. This can mean very protracted loading and the necessity of very high doses of the drug. I would personally opt to have an abdominal ultrasound done. This not only gives the vet a good look at the adrenals but also of the surrounding internal organs. As a rule, if it is adrenal based, one adrenal will be enlarged and the other will be smaller or even atrophied. If pituitary based, both addrenals can be normal or in most cases, both are enlarged. So if I were you, I would complete the diagnosis with an abdominal ultrasound. If Ruby has an adrenal tumor and I could afford surgery, I'd consult with a board certified surgeon. If you are in Northern California, I would suggest seeing Dr. Richard Nelson at UC Davis. If surgery were not an option or Ruby has pituitary cushing's and I was not put off by the constant drinking, I'd probably wait to start treatment until more overt symptoms are evident. Others may have their own ideas but that's my story and I'm sticking to it. :D

I'm glad you found us.

Glynda

P.S. Okay, so it was a novel

[estijersey]

(my reply just got erased since I wasn't logged in, I will try this again!) It definitely started like this,

Thank, Thank, Thank You for your novel Glynda!I am so grateful for this site, you all are amazing.

I called the vet's office and will swing by there soon to pick up the results of the blood work and will post them here.

I do trust this vet. He's new to us and comes highly recommended. And he said he has worked with many Cushings dogs. I initially came to him for a second opinion when Ruby tore her ACL (no surgery) my previous vet didn't want to medicate and after a month of her still limping I saw him and he put her on rimodyl for 2 weeks which really did the trick.
Anyway, he did mention doing tests to make the distinction between pituitary and adrenal Cushings but ultimately didn't push for it. I'm guessing because I didn't inquire and also, because the statistics seem to be high (90%?) for the pituitary type.

I am going to leave the vet a message to ask his thoughts (and get the price) on the abdominal ultrasound. It does seem wise. But to my understanding this was, in fact a "firm" diagnosis of Cushings.

I am in northern California, just outside of Oakland. So UC Davis is an option if need be... I'll keep you all posted. And again, thank you for this incredible resource. I so appreciate your time and willingness to share your knowledge, it's a beautiful thing that you all are doing.

Esti

[Squirt's Mom]

Hi Esti and welcome to you and Ruby! :)

My Squirt was diagnosed with PDH via 5 tests - LDDS, HDDS, ACTH, UTK panel and 2 ultrasounds. All five "confirmed" PDH. However, on her second ultrasound I was told she had a tumor on her spleen. In Sept. '08 that tumor and part of her spleen were removed and her cortisol returned to normal - all those tests came back positive because of her body's response to the internal stress of that tumor.

I cannot emphasize enough the value I personally place on ultrasounds as a diagnostic tool in Cushing's - it saved my Sweet Bebe's life. Removing that tumor also gave her an extra 2 1/2 years before we had to start treating the cortisol, which rose over the intervening years.

As one of our members says, the ultrasound gives you the biggest bang for your buck! ;)

I am glad you are here and look forward to learning more about you and your sweet Ruby as time passes.

Hugs,
Leslie and the girls - always

[estijersey]

Good evening,

I'm writing because I am concerned about Ruby. I left a message with the vet (as they do have appointments on Sundays- so we will hopefully get in there tomorrow). But Ruby has been particularly lethargic, and on 2 occasions today has begun quivering and shaking. Both times for very short amount of time. The first was followed by a nice burp and the shakes subsided. But clearly something is not right. Her breathing seems labored- but this is hard to tell as she has definitely become a deeper breather and snorer in these last couple of years. The other thing is she is not interested in her second meal which is only dry kibble- she eats her first meal (which I mix with wet) and she was begging for my dinner last night which I gave her a little of- ground turkey, so she does still have an appetite. But her excessive drinking and heavy panting seem less so, which is just strange since she received her Cushings diagnosis last week. I am intending to do the abdominal ultra sound and will treat with vets suggested Lysopren. But I'm nervous that something else is going on. I checked her temp earlier and she does not have a fever. Can dog's get asthma? My boyfriend suggested that her breathing and lethargy were reminiscent of his son's asthma...Any thoughts?

Esti

[Franklin'sMum]

Hi Esti, and welcome to you and Ruby,

I'm sorry that your head is swimming right now, but please know that education is key. I don't know about dogs, but we have a member who has an asthmatic cat.
I would suggest getting the abdominal ultrasound performed on a high resolution machine, with someone qualified to interpret the images. Our former vet told me my little boy had an adrenal mass, but it turned out he was looking at the kidney :eek:.

Also, an ACTH is not diagnostic in and of itself, as any underlying non adrenal illness can cause a false positive.

Jane, Franklin and Angel Bailey xxx

[Squirt's Mom]

Hi Esti,

Lethargy and heavy panting are just part of Cushing's and for my Squirt they were not ever present signs but came and went. The disinterest in a meal is not typical of Cushing's - a cush pup will eat just about anything anytime when their cortisol is raging. However, not all cush pups follow the "rule book"! :p

If Ruby has not been checked for diabetes, I would want to rule that out asap as loss of appetite is one sign of that condition.

Panting, especially if it comes on suddenly, can mean nausea and the fact that she burped then felt better could have been the result of some indigestion...as could her disinterest in the kibble.

Squirt's breathing became very labored a few months back and she was diagnosed with bronchitis. Her panting then was much more forceful, ragged, and wheezy that the typical panting she did with the Cushing's - there was an obvious difference, a frightening difference. She weighs 14 lbs, we sleep on a memory foam mattress but I could feel her breathing through the bed. :eek: She woke me several times with it. :( I know from this experience that, yes, dogs can have asthma because her doc considered that possibility.

I hope Ruby can get in to see the vet today and that there is nothing wrong other than the presence of cush signs becoming stronger. Please keep in touch and let us know how she is.

Hugs,
Leslie and the girls - always

[estijersey]

Thanks again for the responses. Vet office called this a.m. and the vet on call- not her vet- said to take her to the emergency clinic, as the symptoms of shaking and labored breathing is probably something other than Cushings and additional tests may need to be done.

I definitely have to double check with the vet to see if he did in fact rule out diabetes, but I feel like he did. Since she has not shivered other than those 2 times yesterday and her breathing seems ok. I'm not going to take her to the emergency, though obviously, I will keep a close eye on her. I left her doc a message and requested an appointment to do the abdominal ultrasound, as well as look at her breathing, and discuss her eating for Wednesday (my day off). So hopefully we can soon start with some treatment that I'm really hoping, gets her back some energy.

The curious thing is that the ravenous eating is not present. I made her some boiled chicken and sweet potato and she ate it last night, and then she eventually finished the wet food I had put in her bowl which she had been ignoring. But usually, wet food sitting in a bowl never sits there longer than 2 seconds...I fed her the chicken and potato again this morning and she was quick to gobble it up. But all of a sudden having no interest in her kibble- or her wet food, very odd.

I will keep you posted.

Thanks Again (and again and again...)
Esti & Ruby

[estijersey]

This is a copy of the email I sent to my family and concerned friends. The clarifications clearly don't need to be made for you all. Thanks for reading.

So here's the latest on Ruby. We did her abdominal ultrasound today, which was done primarily to distinguish which type of Cushings Disease she has. The ultrasound ruled out a tumor on the adrenal glad. This is good news. We can now assume she has the more common type of Cushings which is Pituitary dependent. With this knowledge, we can begin to treat her for the disease (eventually).

Since over the last few days she has clearly been under some GI distress and therefore lethargic, and not interested in eating, and at times shaking in pain, we must address this first. The medication for Cushings is a very strong drug and she must be monitored to notice for any changes in symptoms i.e., drinking and eating less, lethargy, etc. So if we suspect she's got something else going on we have to wait to treat.

So the vet now has her on 2 medications to treat what he suspects is a stomach ulcer or pancreatitis (the latter most likely related to the Cushings- the meds are Famotidine and Carafate). The vet who did her ultrasound also did notice a very small tumor on her spleen. He really does not think it's anything to worry about. So I won't. *and yes I saw Squirt's moms post, but for now I've got to trust the vet when he says it is very small and both he and the doctor who performed the ultrasound agreed...

He also was Not able to see her pancreas (which is good- although she may still have pancreatitis, if he were able to detect this on the ultrasound it would have been a Bad sign.) He recommended putting her on the ''bland diet'' of white rice and boiled chicken for the next few days which she gwalloped- (my new word) I gave her an extra bit of it, as she was fasted since last night and quite hungry when we got home from the vet. Also a good thing. So I suspect with the tummy meds she will continue to improve and we can then begin the treatment with the drug Lysodren for her Cushings.

Also, I got her blood work and urine info. Is there anything specific I should share and post? If you think I should post all of it I will. I remember reading on one of the other posts about "BUN" and wondering what that is, and saw it here on the print out. What is it?

Thanks everyone.
Esti

[Sabre's Mum]

Hi Esti

You could post any results which were out of range ie. low or high along with the reference values.

With regards to BUN it is an abbreviation for blood urea nitrogen. This is a definition from http://www.vetmed.wsu.edu/cliented/lab.aspx



BUN (blood urea nitrogen) is influenced by the liver, kidneys, and by dehydration. Blood urea nitrogen is a waste product produced by the liver from proteins from the diet, and is eliminated from the body by the kidneys. A low BUN can be seen with liver disease and an increased BUN is seen in pets with kidney disease. The kidneys must be damaged to the point that 75% of the kidneys are nonfunctional before BUN will increase. Pets that are severely dehydrated will have an increased BUN as the kidneys of a dehydrated patient don’t get a normal amount of blood presented to them, so the waste products do not get to the kidneys to be eliminated.

Angela

[estijersey]

ok will do, thanks.

Urinary Cortisol/Creatine Ratio- 40

ACTH Response
Cortisol Sample 1- 7.9 (high) ref range=1.0-1.5
Cortisol Sample 2- 32.3 (high) ref range=8.0-17.0


Differential Platelet Count- 529 (high) Range=170-400

Total T4- 0.7 (low)


Urinalysis
Protein- 3+ (high)
Occult Blood - Trace (high)

Superchem-
Globulin 4.0 (high) Range= 1.6-3.6
AST (SGOT)- 80 (high) Range=15-66
ALT (SGPT)- 264 (high) Range=12-118
Alkaline Phosphatase- 718 (high) Range=5-131
BUN- 34 (high) Range=6-31
Cholesterol- 431 (high) Range=92-324
Triglyceride- 303 (high) Range=29-291

[missbeagle]

Esti -

I would be looking into asking my vet about kidney problems with Ruby. Was she fasted before the bloodwork was run? Sometimes dehydration can lead to an elevated BUN number.

She also has high protein levels in her urine which is indicated by the Protein 3+ in her urine sample.

My Rusty has both kidney problems and Cushing's disease.

He is on enalypril once a day to help with the protein loss in his system. I had to recheck his BUN and creatinine levels about a week after I started it to make sure his numbers were not super elevated which can happen with the introduction of that medication.

Rusty is also taking famatodine in the 10mg form to help keep his stomach ulcers away.

Keeping youin our thoughts,

Gretchen and Rusty in NC

[estijersey]

Hi Gretchen,

Yes, she was fasted before her blood work. I will ask on her next visit about the kidneys.

Thank you for good thoughts and input.

Esti and Ruby

[lulusmom]

Hi Esti,

The results of the superchem panel, with the exception of the AST, the results are pretty much what you would see in a dog with cushing's, including a low T4. The AST usually parallels the ALT when primary liver disease is involved. These aren't big elevations but I'm wondering if your vet has any concerns that cushing's may not be the only thing impacting the liver.

As for the urinalysis, if there is blood in the urine, protein levels can be falsely elevated because there is a whole lot more protein in blood than there is in urine. In Ruby's case, there is definitely blood in the urine. Did your vet mention anything about this? A good number of dogs with cushing's will also have greater than 1+ protein but this is usually secondary to the disease and is not an indication of decreased kidney function. My own cushpup consistently has 2+ protein and her IMS is not concerned as every thing else is normal. This abnormality must be interpreted in view of other laboratory findings and urine specific gravity (USG) is one thing that should have been looked at but I don't see that posted anywhere. USG is routinely checked in dogs suspected of having cushing's as it is almost always low. Can you double check your paperwork and see if you can find this info?

Can you also look at the ultrasound findings and let us know how the adrenals and liver looked. A dog with pituitary dependent disease usually has two enlarged adrenals as well as an enlarged liver.

Glynda

[estijersey]

I only posted results which were high or low and the Specific Gravity was 1.029 which is within the range of 1.015-1.050.

As for the ultra sound, the only thing he mentioned was the small "growth" he saw on her spleen and that she didn't have a tumor on her adrenals. He didn't say anything about her liver, not since the initial test when he told me her liver enzymes were elevated. He also didn't say anything about her adrenals.

This visit seemed primarily about getting her GI distress addressed, ulcers or pancreatitis, before proceeding to treat for Cushings- which he has "absolutely no doubt that she has."

Worth noting, Ruby is back to and still chowing down on her chicken and rice, but today/night her water bowl wasn't as low as it has been prior to her new noisy stomach symptoms.

Hope everyone out there had a pleasant night.
Esti

[estijersey]

Hello Everyone,

It's been quite a while. Just wanted to let you know that I am going to begin Ruby's Cushing treatment...with Lysodren -today, I think. I do have the prednisone on hand. I've been measuring her water intake in grams the last few days, so I can really monitor. And her tummy stuff seems to be normalized, as she has been eating like a champ, albeit a Cushing's champ. Just thought it would be comforting to keep you all in the loop- tho I haven't been very present last couple of months. If anyone has any last minute advice of anything to look out for or be extra cautious about I'm listening. Otherwise, Happy Easter, Passover, and Sunday!

Best to you all,
Esti

[frijole]

Esti - thanks and I promise we will keep an eye out for your posts as you begin loading. I will give you a link that I found helpful and I read it every day as a reminder. :D

Watch for any change in water or food intake including speed of consumption. Most give the lysodren AFTER the meal wrapped in cheese, peanut butter, pill pocket. This way you can always see BEFORE giving the lysodren if there is a change in appetite. Also the wrapping helps coat the tummy and prevent upset stomachs.

The first few days Ruby might seem a bit more tired and her tummy might growl. This is normal. Although you will be nervous giving that first pill please know you are doing it to make Ruby well and you will come to love the drug.

Any questions, don't be shy - we are just here to help. Good luck! Kim

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

[Harley PoMMom]

Many members give their pups Pepcid AC or Slippery Elm 20-30 minutes before giving the Lysodren.

The best of luck to you and Ruby and keep us posted. ;):)

Love and hugs,
Lori

[estijersey]

Thanks Kim and Lori,

She's still on famatodine, so this should help with stomach discomfort. I gave her her very first dose of the Lysodren a few hours ago and went out for a short while. She was definitely sleeping hard when I got home. I only had a small panic when she didn't move when I called her. But once I came into the room she got up and is now licking my ankle as I type this. You can tell this stuff is no joke, but hopefully only good will come from it.

OY,
Esti

[addy]

Hi Etsi,

I just wanted to stop by and let you know that you are in the best of hands. The moderators and administrators know all the ins and outs of loading. If you have any questions at all at any time, come here and post away.

I think you are doing a really good job!!!:)

We do Yoga group breathing sessions if you need one!:D;)

Hugs,
Addy

[Harley PoMMom]

I was just wondering what dosage of Lysodren is Ruby being loaded on and if it is given twice a day. How much does Ruby weigh?

Love and hugs,
Lori

[MBK]

Hi, Esti -

I'm new here and was reading your string. Wondering what treatment decision you made for Ruby? My Jack Russell Terrier, Alivia, is 13 years old, also. She was recently diagnosed with an adrenol tumor, but I am terrified to put her through such a risky surgery at her age. The medication options also sound scary. I am at loss as to which would be best for Alivia, but need to make a decision very soon.

I hope Ruby and you are both doing well.

All the best,

Mary Beth and Alivia

[estijersey]

Ruby weighs 16 lbs (long haired dauchsand- mix- we think) And her dose of Lysodren was 500 mg and I am to give her 1/2 a pill in the morning and 1/4 in the evening for the loading/induction phase.

[estijersey]

Before I call the vet this am I wanted to check in first. I gave Ruby her first 2 doses of Lysodren yesterday. She definitely looked a little "high" but fine. This morning when I fed her before giving her her 3rd portion of pill she left about a tablespoon of kibble in her bowl. She usually cleans the bowl, BUT, I was cooking and making lots of food prep noises in the kitchen so she was distracted. I just checked and the kibble remains. Could one dose of Lysodren be enough for the loading? Just wondering thoughts?
Thank You!

Esti

[Harley PoMMom]

According to my calculations, Ruby is loading at 51.58 mg/kg. This is at the upper limits for loading. All dogs are different and react differently, so could Ruby be loaded?...if she has left food in her bowl when she has never done that before than my answer would be that she could be loaded...you would need to get her tested with a ACTH stim to be sure.

[estijersey]

Thanks so much,
left message with vet- waiting for his call back. Gotta leave, but boyfriend is working from home- so if vet recommends giving one more pill portion he can do that and monitor. But Wow, one day- that's some serious medication!

[Harley PoMMom]

Did your vet give you prednisone?

[estijersey]

yes he did ....

[Harley PoMMom]

I am glad to hear that your vet provided you with prednisone. A one-day load is unusual but like I said all dogs are different! Not eating all their food when they always do is a sign of being loaded and given the fact that she left food in her bowl when she doesn't, concerns me. If it were me and I am a worry wart! I would get her tested...better safe than sorry.

Hopefully the others will comment on this.

Love and hugs,
Lori

[lulusmom]

Yes, Lysdoren is a serious drug but I don't ever recall a dog loading in just one day. Two days yes but one day, no. We've learned from experience that no two dogs are alike so who the heck knows...maybe Ruby is going to set a new record for us. :D The average loading time at maximum dose of 50mg/kg is 5 to 9 days and if I were a gambling person, I'd bet that, even though Ruby left a little bit of food in her dish, she's probably not loaded. I suspect that your vet will tell you to continue dosing, in which case you need to watch Ruby like a hawk for any signs of sickness, such as vomiting, diarrhea, extreme listlessness, trembling.

We'll be here waiting for your updates.

Glynda

[addy]

Checking in and hoping everything is okay!!!

Hugs,
Addy

[Squirt's Mom]

Hi Esti,

How is our sweet Ruby this morning?

Hugs,
Leslie and the gang

[estijersey]

Hello everyone,

OK, so yesterday after speaking with the vet he said to continue with the lysodren since it had only been one day and a tablespoon of food left in the bowl was the only thing. So I gave her the 2 doses on Monday and this morning (Tuesday)she left half of her food in her bowl-ate the yummy wet stuff and left the rest. With that, he said bring her in, lucky I had time to bring her in before work. Just picked her up and we will have results tomorrow. I'll let you all know when I hear.

Meanwhile, she was very shaky in the car ride home, which is unusual. But I suspect that the overproduction of cortisol which is now ceasing is allowing her body to feel all the joint and spine issues she has. Poor, sweet, thing he said I can continue to give her Rimodyl but nothing else- meaning no more famatodine for the tummy, at least for now. The Rimodyl is only contraindicated if giving prednisone but that doesn't look like it's going to happen. I gave her a full Rimodyl pill (I had been giving her half every other day) for a torn ACL. Hopefully that will keep her more comfortable.

And just for a little amusement (or proof that she isn't fully loaded) I must have left the fridge open a crack because I heard a crash and ran into the kitchen to find the little mongrel attacking a plate of leftover omelette. Enjoy!

Oh, having trouble figuring out how to upload her picture onto my profile, is there an easy answer to that one?

Thanks for checking in.
Esti

[jrepac]

I'd be cautious with the Rimadyl. :eek: a dog with Cushings usually has a liver that is working over-time. Rimadyl can make things worse....if you happen to see your pup staggering or disoriented in any way, back off the Rimadyl and call your vet.

I hope things continue to improve!


Jeff & Angel Mandy

[Harley PoMMom]

Oh, having trouble figuring out how to upload her picture onto my profile, is there an easy answer to that one?

Thanks for checking in.
Esti

Hopefully this link Signatures, Avatars and Profile Pictures. (http://www.k9cushings.com/forum/faq.php?faq=vb3_user_profile#faq_vb3_signatures_av atars) will be helpful. If not please ask us to help. ;):)

Love and hugs,
Lori

[estijersey]

Greetings everyone,

Here's our update. 2 days seemed to be enough of a loading phase for Ruby. The numbers, tho not exact, were just close enough for the vet to feel Ruby was ready for the maintenance phase. So he said to give her 1/4 pill twice a week beginning on Friday, which I did.

But I gotta say, the girl has not been the same since I picked her up last Tuesday from the stim test. I sware she gets traumatized each time she has to go to the vet. I mentioned in an earlier post that she was shivering on the car ride home- which never is the case. And I told the vet she wasn't looking all that spunky. He told me to giver her half a prednisone and I did. He was aware that I had given her a full Rymadyl and said it would be ok. That was Wednesday. I'm guessing it's going to take a little while for her body to get used to the Lysodren. But I am not loving how lackluster she looks. Her tail is not wagging at all, it's been tucked down. The spark in her eye is not there. And she has not been eating her food. She is still drinking plenty of water and she will eat treats and food that I hand feed her. She just does not seem interested in her kibble which is weird especially when it's combined with wet food. The vet is not around over the weekend so I will check in with him on Monday, hopefully she will be looking brighter and happier by then. For now though, this is a bummer. I wish she could talk.

[Harley PoMMom]

Could you post the ACTH stim numbers for us, please.

Just wondering, are/were you giving Ruby pepcid ac before giving her the Lysodren? Lysodren is known to cause gastric upset so many members administer the pepcid ac 20-30 minutes before giving their dogs the Lysodren.

Hoping Ruby is feeling better soon.

Love and hugs,
Lori

[estijersey]

I scribbled it down while on the phone with vet, so I'm pretty sure:
her originals were pre=8 and post=32
and after her 2 day loading her Pre=4.8 and Post=6
(I believe normal being Pre= 1-5 range and Post= 8-17

And yes I've been giving her the famatodine with food at lease 20 minutes prior to her Lysodren. I just scrambled her an egg and she ate it- so it seems to be her regular food that she's not digging...

[addy]

Hi,

I am sorry to hear Ruby is feeling under the weather. Sometimes our pups get used to the "feel good" cortisol so when we lower it, they feel yucky for a while until they get used to having the lower cortisol so it may be as you thought, her body needs to adjust.

I'm sure others will be along soon to comment on her stim test. Did she perk up when you gave her the prednisone?

Hang in there, I know this is nerve wracking:(

Hugs,
Addy

[Harley PoMMom]

So I gave her the 2 doses on Monday and this morning (Tuesday)she left half of her food in her bowl-ate the yummy wet stuff and left the rest. With that, he said bring her in, lucky I had time to bring her in before work. Just picked her up and we will have results tomorrow. I'll let you all know when I hear.


Hi Esti,

I have another question :eek: When you took Ruby in for her ACTH stim test was this the same day that she was taking the Lysodren? If so, Lysodren continues to work up to 48 hours and that is the reason an ACTH stim test should be performed between 36 hours and 48 hours after taking Lysodren. My concern is that if Ruby's stim test was done the same day as she took her Lysodren then her cortisol was still being lowered and that post of 6 ug/dl could be even lower now.

The therapeutic range for a dog taking Lysodren is 1-5 ug/dl. The ranges you posted-Pre= 1-5 range and Post= 8-17 are for a normal healthy dog.

Please keep us posted.

Love and hugs,
Lori

[estijersey]

Lysodren was given Sunday and Monday, Stim test was Tuesday.

[Harley PoMMom]

Since the ACTH stim test was taken less than the 36-48 hours after the last of Lysodren it is possible that Ruby's cortisol is lower than the post of 6 ug/dl. By how much, I don't know, so I would just watch her for signs of too low cortisol which are: lethargy, vomiting, diarrhea, anorexia.

Love and hugs,
Lori

[estijersey]

Thank you. I will watch her for those signs. Lethargy yes, but not the rest. I just hand fed her- which of course is not usual, but she did eat. She was picky and only ate the kibble if it was wrapped inside the wet food, spit it out otherwise but she did eat all the wet food. Tho strange that she's not eating it from her bowl on her own.

[Harley PoMMom]

Any one of those symptoms can be a sign of cortisol being too low. And seeing that she is not eating as usual, I think if it were me I would give her some prednisone. Did your vet supply you with prednisone?

[estijersey]

Yes, he did. I'll give her a half of a pill and see...?

[estijersey]

Hi all,

It looks like the prednisone made a big difference. After a long day Ruby seems to have some life back in her. I left for a couple of hours and when I got home she wagged her tail for the first time in days. She's definitely interested in treats, still not eating her kibble. We'll see how she is tomorrow. And I will check in with her vet for the first time since before the weekend. Thanks to you all for your continued support and presence.

Esti and Ruby

[addy]

Glad the prednisone helped Ruby. Let us know what happens today and what your vet says.

Hugs,
Addy

[Squirt's Mom]

Hi Esti,

I've been out of commission for a bit but have been keeping up as I could and am so glad to read that Ruby is feeling better today. I hope the trend continues! Please let us know what you learn from the vet.

Hugs,
Leslie and the gang

[estijersey]

Hello All,

Heard from vet today. He said since Ruby sounds as though she has bounced back (mostly) to go ahead and give her her 2nd dose of Lysodren (she'll be taking 1/4 pill twice per week). He said she just may need to take it with prednisone, not sure if he means forever or just in the beginning. I'll speak to him again in the next few days- as we exchanged long voicemails today and didn't actually speak. But I'll monitor her of course.

Still perplexed about her total loss of interest in the kibble. She does wants food and will eat the wet stuff and any treats or yummy human things I give her, just not the kibble. So I don't know if it's stomach upset, or her knowing that when she doesn't feel well I give her yummy stuff? I think tomorrow I will get a bunch of samples of different brands from a great pet food shop near my work and see if she'll try those...? She is definitely under fed right now though, and I definitely want her to have food in her belly before tomorrows Lysodren.

Anyway, thanks for letting me go on with mundane details. They matter. Also, I finally refilled her glycoflex- and I sware that stuff does wonders. It will make me feel better too while I avoid Rimadyl- due to Prednisone...

Peace,
Esti

[Squirt's Mom]

Hi Esti,

I also use the Glycoflex and agree...it is wonderful! Squirt had to have one of her knees redone last summer and her surgeon put her on it. It is the best glucosamine product I have ever used! Brick gets it, too, even tho he hasn't had any surgeries that I know of....but he has hydrocephalus and his movements are very odd so I give it to him to help protect his joints as they move in ways they were never meant to.

I'm glad Ruby is feeling better today and hope the trend continues. Please keep in touch and let us know how things are going.

Hugs,
Leslie and the gang

[jrepac]

sounds like good news....I wouldn't worry too much about Ruby not wanting the kibble...as long as she is eating and seems OK...(no vomiting, lethargy, staggering, etc.). Re: Rimadyl, I hung onto mine ---just in case--but wound up going w/glucosamine supplements daily, which seemed to work fine. If the arthritis seemed to flare up, the occasional doggy aspirin was helpful, too, just not everyday.

I hope things continue to progress well for you and Ruby.

Jeff & Angel Mandy

[estijersey]

Hey All,

So far so good. She had her second maintenance dose of Lysodren on Tues morning and I had no reason to give her the prednisone. She's hanging in there. And I believe the Glycoflex is helping her joints. It just occurred to me that next month, June is her approximate birthday and she will be 14. I feel pretty lucky to to be loving this pup for so long. Fingers are crossed that all remains well, for her and for all of you.

Thanks,
Esti and Ruby

[addy]

I'm crossing everything too!!!

I am so glad to hear Sweet Ruby is feeling better.:D:D

Can't wait to sing Happy Birthday to her.

Hugs,
Addy

[addy]

Hi Esti,

How is our sweet Ruby doing? I am hoping everything is going well because someone has a birthday coming up.:D

Hugs,
Addy

[estijersey]

Hello everyone,

Hope summer is going well for you all. It's been a while. Ruby seems to be doing ok. Still lots of panting and drinking but she's mostly herself. I've got her on one half a lysodren pill on Tues and one quarter on Fri. Vet said her ideal would probably be one half twice a week, so we might bring her up to that. She hasn't been back for testing yet. And I must admit I will avoid that as long as I can, because going to the vet and especially being left there for the testing, has the most negative impact on my doctor-hating little beast. But my new vet is great and is very responsive and calls me back right away. I'm very glad I was referred to him.

On a bummer note, about 3 weeks ago our house was robbed and I believe the scumbags kicked my 15 pound dog. She had a loose tooth, which ultimately fell out which is why we suspect this. My hope is that she tried to bite them, and maybe even hurt one of them. But since her hearing loss has become so profound they probably startled her and she probably startled them...Either way, it was a crappy experience for all of us over here. She's doing fine, with the exception of extra nervous licking- me that is. Poor baby. And on a miraculous side note- we got ALL of our stuff back. Crazy!

And finally I wanted to ask if anyone has read about chasteberries-Along with a few other herbs? I was reading about horses and coincidentally stumbled on an article which I will paste that speaks about chasteberry for equine Cushings. Would love to hear feedback if anyone has experience with it or any other herbs in conjunction with the strong meds. Hope everyone is well. Thanks for reading.
Esti and Ruby
http://eyeofthestormequine.blogspot.com/2009/10/article-equine-cushings-cure.html