We just took our first dose of lysodren and we're very nervous!

[MyLittleMan]

Hello everyone. I hope I'm starting my first post off correctly . . . I look forward to hearing your thoughts on our irregular Cushing's situation. Though, with all of your combined experience, you may have heard our story before.

My dog, Jack (a Jack Russell Terrier with a seemingly unoriginal name) is the light of my life and reason behind everything I do. He'll be 11 this May. Six years ago, Jack had a calcium oxalate stone removed and he has been on Waltham SO and eventually we added Urocit-k to control the production of crystals. About three years ago, our GP vet, Dr. Cox (I have to say he is fantastic) noticed cataracts in Jack's eyes during a routine wellness exam and referred us to a great ophthalmologist who was impressed that Dr. Cox noticed them as small as they were.

Well over a year ago, he had a little lump on the tip of his tail noticeable by the little bald patch it created. The lump was removed along with a piece of bone to allow the skin room to stitch and heal. Of course, his tail was shaved to about the half way point prior to surgery. A couple of months went by and the hair on his tail would fill in in spots and disappear in others but was only troublesome in the area that had been shaved.

Dr. Cox mentioned then that it could be Cushing's but Jack had no other symptoms, just the post-clipping alopecia. So I gave it a little more time. Next, he developed flea allergy dermatitis. We then switched from Frontline to Advantix to repell the fleas. After a visit to the emergency clinic for his little noggin swelling up from what we assume was a sting from a wasp, I went back to our GP vet and asked about this "Cushing's" thing he'd mentioned. Dr. Cox ordered the ACTH test for Jack and sent it off to the University of Tennessee. Jack's cortisol level as well as his testosterone and estrogen levels were higher than normal (Dr. Cox's office is making a copy of his file for my random vet emergency clinic visits. So I'll have test result numbers for you tomorrow) and with the advice of the U of Tenn, we started Jack on 3 mg of melatonin and flax hull lignans twice a day.

Also within this time frame, Jack had to have another surgery for bladder stones and a urethrostomy was done at the same time to give outlet to the ongoing crystal formations that we can't seem to get under control. His urine ph is always very acidic no mater how regimented we are about his diet and Urocit-K.

At a recent visit to the ophthalmologist, the Dr. noticed a pint point of a hemorrhage on Jack's retina and said that it could be caused by high blood pressure. Another trip to Dr. Cox and sure enough, BP was 210. He immediately did blood work and started Jack on Enalapril once a day and 1/2 a baby aspirin once a day. That along with Jack's now uniformly thinning coat (you can now see the black spots on his skin through his white fur but no bald patches aside from his tail), Dr. Cox ordered another ACTH test done and sent it off again to the U of Tenn. One of the other Vets on staff with Dr. Cox graduated from U of Tenn. He had dialog with the Cushing's bigwig there and they suggested that Jack be put on a low dose of Ketoconasole which we did for two weeks.

I should mention here that Jack does not have a ravenous appetite and his water consumption is normal hence the Ketoconasole with no loading. At the end of the two weeks, Dr. Cox ran another ACTH and Jack's cortisol and sex hormone levels were a little higher. So we took him off of the Ketoconasole that Wednesday (after three total weeks on it) and were told to try Lysodren 1/2 of a 500mg tablet once a week with no loading period and recheck after six weeks.

And that brings us to tonight. I could have started Jack on the Lysodren this past Tuesday but put it off until tonight so I would be with him the next three days. I put on the latex gloves. Cut the pill in half. Carefully wrapped it in a flattened out piece of a Greenies Pill Pocket. Gave it to Jack with the rest of his medications after he eventually ate his dinner when he realized I had no steak snibbles left on my plate for him . . . (He always hopes). Once done, with one eye on Jack for any sign of reaction and the terrible feeling that I had just poisoned my little man, I Googled "Lysodren reaction" and found your site.

It's now 11:40. He seems fine so far. I'm a wreck!

I know that I didn't submit any questions or test result. Just the story of Jack, my pooh bear. I have done a lot of web research about Cushing's and, this past week, Lysodren. I have a million questions yet can't think of one right now except . . . Will Jack be alright?

Kindest and best regards,
Kim

[BestBuddy]

Hi Kim and welcome to you and Jack.

We have all had the awful sinking feeling when we are first told "cushngs".

I didn't use Lysodren with my Buddy so I can't comment much other than it seems you are doing a maintenance type of treatment without the loading. It is the loading that seems to be the time to be really watchful and careful so hopefully you will not see any problems.

Looking forward to hearing some good results.

I am sure "the others" will be along soon to comment and ask questions.

Jenny

[MyLittleMan]

Thank you for the welcome. And please forgive the typos in my post. I am typing on a touch screen keyboard because Jack doesn't like me using a regular "noisy" keyboard when he's trying to sleep. Believe it or not! It's true!

It's 1:08 a.m. and he's sound asleep while I'm wide awake watching him for an allergic reaction that would probably already have happened since I gave hime the Lysodren at 8:00 p.m.

We have a 9:10 vet visit tomorrow (well I guess it's today now) for an ultrasound of Jack's bladder to see if his "pile" of individual crystals has passed or formed into a bigger stones and what to do next if they're not all gone.

If the one is related to the other, I do hope that if we get Jack's Cushing's under control his bladder stones will also stop forming. He had one stone six years ago and no other occurrences until recently. Now the crystals just keep forming despite the strict diet of Urinary SO food and the Urocit-K med twice a day.

These sweet little fur babies shouldn't have to be anything but happy and healthy!

[MyLittleMan]

I lost a lot of sleep last night but Jack is business as usual after his first dose of Lysodren. So far so good. Yeah!!! I just hope the test results from the ACTH after 5 more once a week doses show improvement.

Jack had a less than relaxed visit to see Dr. Cox today. After an x-ray, ultrasound and cyctotomy, Jack has been confirmed with another calcium oxalate stone. Dr. Cox is wary of another surgery until we get the Cushing's under control. We have another ACTH scheduled in 5 or 6 weeks to see how the Lysodren is doing for Jack. If there are no complications with the stone by then, Dr. Cox with try filling up the bladder and flushing out the stone through his urethrostomy opening like they might do for little girl dogs with stones. Between now and then, he is also looking into having the stone broken up by, I think, ultrasound to avoid having to perform surgery on Jack again. (My wallet is already starting to shrink at the thought.)

The odd part of today's exam was the urinalysis. For the second visit in as many weeks, Jack's ph was alkaline, 8.5 ph, three hours after he took his Urocit-K this morning. On 3/21/2011, his ph was 8.5 as well. Last time, they sent the urine sample off to analyze it for infection and no infection was found. They are sending another sample out today for the same reason and I'll be bringing another first morning sample in (before he takes the Urocit-K) which will most likely return with a ph between 5.0 and 6.0 as usual. I'd love to see a 7.0 just once.

This is a crazy road Jack and I are on with twists and turns but no end in sight. My little trooper puts up with a lot of poking and prodding on such a regular basis. I am so looking forward to a visit to the vet for wellness and Jack getting a good report card. Jack has been to his GP 10 times since August of 2010 and that doesn't count the random urinalysis I've dropped off first thing in the mornings and the every other month ophthalmologist visits. And did I mention Dr. Cox is around 40 miles away but well with the trip! I must pass 50+ vet offices on the way, but he is the best GP vet in the county.

I should also mention that Jack is worth every penny and every minute and mile spent! People make fun of me for all that I do for my fella but I can't understand someone doing any less. When I picked him up and brought him home as a puppy, he became my child and his welfare my responsibility. I'll hock my possessions before I short change Jack on medical care. The one thing I do regret is not signing up for a puppy health insurance plan.

That's all I have for today. If all goes as planned, which of course it never does, we'll report back in 7 weeks or so with the good word from the next ACTH.

Thank you all for just being here to read our story, commiserate and give advice as you can.


Kindest and best regards,
Kim

[hfurlotte]

Welcome Kim and believe me you are not alone. This is a wonderful site and there is always someone that can answer your questions or just chat with. I have gotten so much strength from here which has allowed me to be the best advocate for our Zoe Claire who is dealing with Atypical Cushings diagnosed in 2009 but since February she has gone down hill rather quickly so we are going to repeat her Adrenal panel through UTK as Dr. Oliver confirmed to our vet the exact thing that I felt is that the disease process with her is getting worse so we may be going from Keto onto Lysodren depending on her results this week. Please know that we are always and nothing is ever silly.

Welcome once again and many prayers and peaceful nights/day to you and your sweetie.

Heather and Zoe Claire:)

[Harley PoMMom]

Has your vet had Jack's bladder stones sent out to be analyzed?

[MyLittleMan]

Yes. They have given me copies of the lab report and pictures with scale of the stones they have removed on both occasions. They have been calcium oxalate stones removed and analyzed with both of his past surgeries and an assumption, at least on my part, that the current one he has is too.

Do you have a concern?


Kim

[MyLittleMan]

Heather and Zoe Claire,

Thank you for the welcome and best wishes for Zoe Claire! Since I am a novice compared to the rest of you, I have no sage advice to give but send our warmest and best thoughts to you both!

Kim

[Harley PoMMom]

I just wanted to make sure Jack's stones had been analyzed. My non-cush dog, Bear, has had 2 surgeries for removal of oxalate stones in the last 5 years. His vet, now, has him on Potassium Citrate plus I had a diet formulated for him. Bear's PH is usually high...7.5-8.0. It is a struggle. :(:eek:

Love and hugs,
Lori

[MyLittleMan]

His vet, now, has him on Potassium Citrate plus I had a diet formulated for him. Bear's PH is usually high...7.5-8.0. It is a struggle.

You had a diet formulated for him? May I ask how you went about that? Also, was Bear's PH high before you started the Urocit-K (potassium citrate)? Jack's is only high when they have a sample taken after his potassium citrate dose. First morning urine samples (12 hours after Jack's last dose) are always 6.0 and under.

[Harley PoMMom]

There are people known as veterinary diet nutritionist who specialize in canine nutrition. I used Monica Segal but there are others. Here is a post from one of our staff members about Dr. Rebecca Remillard.



Karen,

Just another idea I thought you might like to know about. I don't know if you'd be interested in this, but if you are looking for help with formulating a good homemade diet for Jed, maybe you and your Vet can work with Dr. Rebecca Remillard, who works at the Angell Memorial Vet Hospital in Boston.

Here's a little blurb about her on the Angell Memorial website:
http://www.mspca.org/site/PageServer?pagename=nutrition_Team (http://www.mspca.org/site/PageServer?pagename=nutrition_Team)

She is a Board Certified Veterinary Nutritionist (DVM, Diplomate ACVN) and in addition to her job at Angell Memorial, she also has a website http://www.petdiets.com (http://www.petdiets.com/) where she does offer consultations and formulation of diets for pets with medical conditions.

I've never used her service, but I did know someone (online at another e-group) who consulted with Dr. Remillard in person at Angell Memorial in Boston, and she was very happy with the homemade diet that Dr. Remillard created for her dog.

Here's some info about Dr. Remillard's services from her website:

https://www.petdiets.com/Consult/default.asp (https://www.petdiets.com/Consult/default.asp)



Note that she provides different kinds of dietary advice (commercial diets, homemade diets, or a mix of the two) depending on what you ask for:

https://www.petdiets.com/popup/popup.asp?url=body.asp&sT=Types of Nutritional Recommendations (https://www.petdiets.com/popup/popup.asp?url=body.asp&sT=Types of Nutritional Recommendations)

As you can see, Dr. Remillard's service is not exactly cheap, and the client's Vet has to also agree to work with Dr. Remillard as a consulting Specialist, but if you are interested, I don't think it matters that you are in Canada and Dr. Remillard is in the States. You and your Vet can communicate with Dr. R. via e-mail and/or fax, I'm sure, or via long distance phone calls if necessary.

Monica Segal:
Monica Segal is certified in Animal Health Care through the University of Guelph with studies in animal nutrition,physiology, diseases and parasites, as well as pet care.
She writes featured articles in many publications throughout North America. Monica conducts seminars and workshops by invitation, hosts an Internet discussion group at K9Kitchen, and authored a book called "K9 Kitchen, Your Dogs' Diet: The Truth Behind The Hype," published in June 2002. Her second book, "Optimal Nutrition" inlcudes a foreword wrtten by Ana Hill DVM, PhD and was published in 2007. Monica lives in Toronto, Canada, with her husband Morley and dogs, Cassie and Tori.

http://www.monicasegal.com/

Leslie, Squirt's Mom, has diets formulated for her furbabies as well and I'm sure she will be along to advise you too.

Love and hugs,
Lori

[Harley PoMMom]

Also, was Bear's PH high before you started the Urocit-K (potassium citrate)? Jack's is only high when they have a sample taken after his potassium citrate dose. First morning urine samples (12 hours after Jack's last dose) are always 6.0 and under.

Bear's PH has always been high, even before taking the Potassium Citrate. The one thing he does have going for him is his urine is dilute.

[Squirt's Mom]

Hi Kim,

Welcome to you and Jack! :)

My Squirt is also on maintenance Lyso along with melatonin and lignans - she is Atypical, meaning her cortisol is normal but her intermediate hormones are elevated. We started the maintenance a few months ago and I cannot fully explain the difference it has made in my Sweet Bebe! She has so much more energy and stamina, she sleeps well, she PLAYS WITH TOYS again!!!! :D:D:D

She was on the melatonin and lignans for nearly three years before we added the Lyso. Her signs started really getting strong all of a sudden - or it seemed that way to me anyway. The one that really got to me was her appetite. Squirt has always been a Miss Piggy when it comes to food so I have always said that would never be a good indicator for her. I was SO wrong! :( A cush driven pup is almost insane about food. Squirt was constantly on the hunt for something, ANYTHING, to eat. Her eyes had a haunted look in them, like she was begging me. She could not settle at all - she HAD to find something to put in her belly....her eyes told me if she didn't do this, she knew she would die. That was when I knew it was time to take further action and I started the Lyso. I don't regret it one bit! I hope you soon see the same changes in your precious Jack!

As for diet - I home cook for my babies; diets designed by a lady who is a Holistic canine nutritional consultant. I also take courses on canine nutrition. I will contact you privately about who I work with on my babies. (I also work for her on her nutrition site so I keep referrals between the two sites private.) Monical Segal is one I can comfortably, gladly recommend; personally, I do not recommend Dr. Remillard. Unless there have been recent changes, she works off of the AAFCO nutritional recommendations which are based on 1975 NRC recommendations. NRC is the National Research Council that does research on canine nutrition and formulates nutritional needs based on that research. The AAFCO does not want to comply with the NRC recommendations beyond those stated up to 1975. Also, I have talked with several of her clients - all had problems on her diets. She does have a veterinary nutrition degree and for this reason, many feel she is better equipped to design diets. From what I have seen, this is simply not true.

Please let us know how Jack is doing and keep your chin up! You are doing a great job of watching him!

Hugs,
Leslie and the gang

[MyLittleMan]

Thank you for the welcome and well wishes Leslie. I have to admit that Jack has NO ravenous appetite. This is one symptom I hope he never gets after reading your description. But, if he gets it, we'll deal and adjust accordingly.

I've thought about finding a nutritionist but have held off because none of Jack's issues have balanced/stabilized. Plus I didn't think they would be able to come up with a diet that was apt for his bladder stone issue as well as Cushing's. I guess with all of the medication juggling we've been doing, I didn't want to futz with the one constant, no harm no foul, his Urinary SO diet.

Thanks,
Kim . . . And Jack too.

[MyLittleMan]

I gave Jack his second dose of Lysodren this past Friday. Not as traumatic for me as the first dose the week before. Since he doesn't have a ravenous appetite, I am probably looking too closely for a sign that the Lyso is working. (ACTH test is 3 or 4 weeks away)

Over the past few months, Jack has been increasingly nervous/upset about my leaving him to go to work. While I am getting ready, he will tuck himself into a corner of the bathroom and watch me get ready. If I leave the room, he follows me to baby gated door and then goes right back into the bathroom corner or under the bed.

This has been very abnormal behavior for Jack but, as I said ongoing for the past few months. Yesterday, I followed our regular morning work day routine, we went out on the porch and then out into the yard. Instead of going outside, Jack went over to the cabinet where his tennis balls are stored, opened it, got one out and trotted out back to the pool like it was time for his evening biathlon of running and swimming. He seemed happy as a clam rather than that sulky/worried look I usually get in the mornings.

Also, although he is still hiding under the bed when my mom arrives to let him out at 1:00, he is coming out now without any extreme coaxing on her part.

I makes me hope that the Lysodren is helping. If cortisol and sex hormones are elevated along with high bloodpressure (which is now under control) how to they feel on the inside? Panicky? Fight or flight angst? Easily unnerved or edgy? I wish he could tell me.

Thanks again to you all for the support

[frijole]

I think you got it right - dogs with elevated cortisol have energy and can be hyperactive... my Annie is a worry wart and I'd bet that is why you saw the changes.

You mentioned not going for an acth test for 4-5 weeks and so I read back and it seems you are doing something very different (dosing wise) so could you please tell us the dog's weight, the dose you are giving and the frequency? IT will help us help you so we don't assume something that isn't right.

Thanks, Kim

[lulusmom]

Hi Kim,

It would really help if you would please post the results of the UTK adrenal panel for us.

Glynda

[MyLittleMan]

Jack is 18.5 lbs and is taking 1/2 of 500mg tablet once a week for six weeks with no loading phase because he doesn't have the ravenous appetite used to guage when the loading phase is complete.

He also still takes the Flax Hull Lignans and 3 mg Melatonin twice a day.

Before trying the Lysodren, we did a few weeks on Ketoconazole but there was no difference for the better in his cortisol and sex hormone levels. In fact they said they were a little higher than the previous ACTH test.

I just called the vets office for a faxed copy of the U of Tenn ACTH test results and will post them as soon as I can.

[MyLittleMan]

His very first ACTH
06/24/2010 Test Results from the University of Tennessee:

Test | Baseline Result | Post ACTH Result
Cortisol ng/ml | 25.4 | 215.0
Androstenedione ng/ml | 0.74 | 4.9
Estradiol pg/ml | 106.0 | 96.0
Progesterone ng/ml | 0.31 | 4.06
17 OH Progesterone | 0.12 | 3.08
Aldosterone pg/ml | 58.5 | 302.2

Most recent
02/28/11 Test Results from the University of Tennessee:

Test | Baseline Result | Post ACTH Result
Cortisol ng/ml | 59.6 | 252.6
Androstenedione ng/ml | 0.67 | 7.05
Estradiol pg/ml | 103.2 | 105.7
Progesterone ng/ml | 0.55 | 3.80
17 OH Progesterone | 0.30 | 3.98
Aldosterone pg/ml | 71.8 | 312.9

Also, there have been a few other ACTH tests done and sent to another lab. I have those results also if needed.

[apollo6]

Dear Kim
Welcome to you and your beautiful Jack. I don't have experience with Lysodren, many on the site do. We are here to help and support you.
Hugs Sonja and Apollo

[MyLittleMan]

Many thanks from both of us to both of you.

[lulusmom]

Kim, it would be great if you could post the dates and results of the other stim tests as well. After seeing the most recent UTK results, it is obvious that Jack's cortisol has continued to rise; however, apparently, the condition has not progressed enough to cause the usual voracious appetite and the excessiving drinking and peeing that are the norm with this condition. In the absence of these symptoms, the maintenance dose, rather than a loading dose, of Lysodren makes sense; however, I'm not convinced it's going to do much in the way of lowering cortisol levels. Did your vet do an abdominal ultrasound to validate the diagnose and to determine which form of cushing's Jack has, as well as check out the surrounding internal organs? If so, can you please post the findings for us.

Glynda

[MyLittleMan]

I'll get the other ACTH results posted tonight but the results have to be converted to compair them numerically to U of Tenns.

Yes. They did do an internal ultrasound specifically for the Cushing's diagnosis. I'll check my file tonight to see if I have the data from that too but I do remember the Dr. telling me the adrenal glands did not look enlarged but of normal and same size. That was June or July of 2010. He has had several ultrasounds for his bladder stone issues as well.

They also recently did a CBC as part of Jack's visit to check for high blood pressure. I don't know if that would be of any use, but I have those results as well.

Kindest and best regards,
Kim . . . and Jack too.

[lulusmom]

Hi again.

The more information you can give us, the better so yes, please post just the abnormal values on the CBC and be sure to include the normal reference ranges. As for converting the acth stim test results, we usually convert the pre and post cortisol numbers on the UTK adrenel panel from ng/ml to ug/dl because that is what we are used to seeing on the acth stims. You can usually move the decimal point one place to the left and you'll have the result in ug/dl.

Glynda

[MyLittleMan]

Here is just about everything I have to date. I do not have printed results/verbiage from the multiple ultrasounds Dr. Cox has done. Our Vet does the ultrasounds on site, the notes are added to Jack's file. They gave me copies of the images for my records. I'd have to ask them to print out the notes pre-August 2010.

I did NOT convert the University of Tennessee's test results to ug/dL because I was affraid I'd make an error!

His very first ACTH
06/24/2010 Test Results from the University of Tennessee:

Test | Baseline Result | Post ACTH Result | Normal Range |
Cortisol ng/ml | 25.4 | 215.0 | 70.6-151.2 |
Androstenedione ng/ml | 0.74 | 4.9 | 0.24-2.90
Estradiol pg/ml | 106.0 | 96.0 | 23.3-69.4
Progesterone ng/ml | 0.31 | 4.06 | 0.22-1.45
17 OH Progesterone ng/ml | 0.12 | 3.08 | 0.25-2.63
Aldosterone pg/ml | 58.5 | 302.2 | 72.9-398.6


Most recent
02/28/11 Test Results from the University of Tennessee:

Test | Baseline Result | Post ACTH Result | Normal Range |
Cortisol ng/ml | 59.6 | 252.6 | 70.6-151.2 |
Androstenedione ng/ml | 0.67 | 7.05 | 0.24-2.90
Estradiol pg/ml | 103.2 | 105.7 | 23.3-69.4
Progesterone ng/ml | 0.55 | 3.80 | 0.22-1.45
17 OH Progesterone | 0.30 | 3.98 | 0.25-2.63
Aldosterone pg/ml | 71.8 | 312.9 | 72.9-398.6


03/25/2011 Endocrinology results
Pre-ACTH 10.4 ug/dL
Post-ACTH 36.5 ug/dL
ACTH Reference Range:
2 - 6 Pre-ACTH
6 - 18 Post-ACTH
18 - 22 Equivocal Post-ACTH Cortisol
>22 with hyperadrenocorticism
<2 with hypoadrenocorticism
1 - 5 Desired pre- and post-ACTH cortisol on lysodren therapy


The 02/10/2011 Hematology results were all within normal range except:
Test | Result | Reference Range
HGB | 18.2 g/dL H | 12-18

The 02/10/2011 Chemistry results were all within normal range except:
Test | Result | Reference Range
ALKP | 265 U/L H | 10-150
GLU | 134 mg/dL H | 60-125
CHOL | 353 mg/dL H | 112-328

The 02/10/2011 Endocrinology Results:
Test | Result | Reference Range
T4 | 2.6 ug/dL | 1.0-4.0

Also Urine PH is always acidic before taking his Potassium Citrate and alkaline after.

And here is a snapshot of Jacks Current Medical standings/requirments:
Medical
Allergy: Domitor (injection)
Allergy: Flea Allergy Dermatitis

Conditions:
Cushing's Disease
High Blood Pressure
Calcium Oxalate Bladder Stones/Crystals
Glaucoma in right eye
Cataracts in both eyes
Inflammation in right eye
Dry eyes both eyes

Notes: All oral medications are taken with food except Tramadol and Enalapril

Medication:
Lysodren 500mg tablets 1/2 tablet once weekly
Potassium Citrate 540mg 1 tablet twice daily
Enalapril 2.5mg 1 tablet once daily
Tramadol 25mg (1/2 tablet) 3 times daily
Flax Hull Lignans 33mg twice daily
Melatonin 3mg twice daily
Baby aspirin half of an 81mg tablet once daily
Timolol Maleate 0.5% one drop in right eye twice daily
Dexamethasone Sodium Phosphate 0.1% one drop in right eye twice daily
Cyclosporine 2% one drop in both eyes twice daily
GenTeal lubricant eye gel one drop in right eye twice daily
Heartguard Monthly for dogs up to 20 lbs
Advantix
Dasuquin with MSM Soft chew for small to medium dogs one soft chew once daily

Food: Waltham Urinary SO 1/2 cup dry 1/4 cup wet soaked down with water twice daily
Water: bottled distilled water mixed with OxyFresh Pet Oral Hygiene dental cleanser for teeth

I'm sure I am forgetting something someone has asked for and also giving way too much info at the same time. Please let me know what you think.

Kindest and best regards,
Kim

[lulusmom]

Hi Kim,

You did a great job of posting all the test results. Thank you! Jack's cortisol increased substantially in 30 days (from Feb to March) and am wondering if you are seeing any more symptoms or more overt symptoms now??? As far as the ab ultrasound, because acth stimulation tests do not tell a vet which form of cushing's a dog has, they use the ab ultrasound to determine this. With so many ultrasound being done on Jack, your vet should know which form of the disease Jack has. Can you let us know? If your vet has not told you, you should ask him. Also ask him if the the abdominal ultrasound showed that adrenals were normal sized, both equally enlarged or was just one adrenal enlarged. If only one was enlarged, ask him if the other gland was normal or smaller.

Just a few more question and then I'll shut up. When your vet did the urinalysis, did he check the urine specific gravity (USG)? If so, can you post the results? Most dogs with cushing's have low USG. A good number of dogs with cushing's also have urinary tract infections and because a cushdog's urine is almost always dilute, a urine culture needs to be done. Was a culture done for Jack?

Glynda

[MyLittleMan]

1. I'm sorry. I should have stated from the beginning that Jack has pituitary dependant Cushing's. The ultra sound showed little to no enlargement of either/both adrenal glands.

2. I'm not seeing any more overt symptoms now although he is hiding under the bed when he feels stressed. His high blood pressure was discovered in February (BP=210). Jack was put on Enalapril and 1/2 a baby aspirin. The bladder stone that has been/still is tweeking him with pain every once in a while. He is taking Tramadol up to 3 times a day (Aside from a blockage, until the Cushing's is under control, Dr. Cox is trying to postpone/evade any surgery for Jack unless critical). With all of this other stuff going on inside, I could understand Cushing's symptoms being suppressed or overshadowed.

3. 02/09/2011 USG = 1.025 with a PH of 5.00 and 03/21/2011 USG = 1020 with PH of 8.5 (both were first AM free catch before he took potassium citrate) and this was one of only two times I’d EVER seen his PH over 7.0.

4. Dr. Cox just sent out (last week) the second culture in as many months because of the high PHs and both cultures came back negative. The main focus at the Vets office has been to check/test/maintain everything from the bladder out and do what’s best to get Jack through the 6 weeks of Lysodren doses. They want to see improvement in Jack’s ACTH stim before any thought of surgery.

[MyLittleMan]

My poor little man, Jack, had one of his four bladder stones stuck in the opening to his urethra last night and had to go for an emergency visit to the vet last night. He couldn't tinkle and there was a little blood around his urethrostomy site. A catheter, ultrasound, a shot of Valium, pain med and antibiotics, a sample of urine sent off for culture and some take home meds in a cute little bag, all this for $380 was quite a bargain.

He is doing fine now. He ate his breakfast and took his medications without a fuss this morning. He seems a bit restless/uncomfortable but better than he was last night. I took the day off to regroup and let him relax (and me too). We're waiting for a call from his regular vet to see how we will proceed. But, it looks like we won't be able to delay the bladder stone removal for the four more weeks until the next ACTH test to see if the Lysodren made an impact on his cortisol and sex hormone levels. I'm afraid that if we don't have the Cushing's under control, the bladder stones will keep developing.

I just hate that he has to go through this but no time to dwell. We are off to the pharmacy to pick up Jack's new prescription for Valium. I think I'll need a prescription for Valium for myself before this is all done and over.:eek:

[MyLittleMan]

Today, Dr. Cox is going to remove Jack's bladder stones hopefully by Urohydropropulsion. If that doesn't work, if the stones are too big to flush out, then they will do the cystotomy.

The Dr. was hoping to postpone the stone removal until Jack's Cushing's was proven to be under control but Jack won't wait. After our emergency trip the other day to clear out his urethra, Dr. Cox said Jack couldn't wait any longer. (And besides, my neighbors think I'm crazy after a few weeks of me following my dog around with a flashlight in the yard at night to watch him pee!)

I'm hoping everything goes the absolute best way for Jack and the Urohydropropulsion does the trick. I'm his mom. I worry. Paws pressed and fingers crossed!

[addy]

We are all crossing everything we can.

I'll say a few prayers as well. Let us know as soon as you can how things went.

Big Hugs,

Addy

[Harley PoMMom]

Oh poor Jack and poor you!

I understand how you feel, my non-cush dog, Bear, has had 2 surgeries for the removal of bladder stones.

All paws and other various body parts crossed! Keeping you both in my thoughts and prayers. Please keep us posted.

Love and hugs,
Lori

[littleone1]

Corky and I are keeping everything crossed that everything goes well.

Terri

[MyLittleMan]

Thank you so much for the good thoughts! We really appreciate the group hug!

I'll definitely keep you posted. I have the next six days off to help Jack (and me) recuperate.

Kind regards,
Kim

[MyLittleMan]

Jack is in recovery and doing fine. I can pick him up around 5:30 (they'll call me if he is ready sooner).

Dr. Cox just called and the urohydropropulsion was mostly successfull. He removed three stones and a lot of grit with this procedure but one stubborn stone was too big so they had to do the cystotomy as well.

Now I can look forward to two weeks of the e-collar and stitch care. Worst of all, Jack can't swim until the stitches come out. He lives to swim. He swims all year round every day from 6:00 p.m. to 7:00 p.m. Have you ever tried hold a Jack Russell Terrier back from what he really wants to do? UGH!

My biggest concern is how to be proactive with these bladder stones. Diet was working for years and now there just seems to be no stopping them. I know Cushing's can cause an increase in the calcium in their urine so I am assuming that with the addition of the lysodren, Jack's calcium production will decrease along with the cortisol and sex hormone levels. Am I mistaken? We won't know for another three weeks if Jack's current dose/frequency of Lysodren is enough or if it needs to be increased.

Also, if stones are still forming, I will probably be taking him in for more frequent ultrasounds to catch the stones before they are too big to expell with urohydropropulsion. I make it sound so simple but these past stone formations seemed to happen overnight. One month, Jack had a clear ultrasound and urinalysis and the next month, 3 stones. How do you keep proactive with that quick of a process.

Many thanks to you all for the happy, positive thoughts and prayers. I'm home for the next six days to nurse my little man, Jack.

Kindest and best regards,
Kim (and Jack too)

[lulusmom]

Hi Kim,

I'm glad to hear that Jack is doing well after his surgery. I have a Maltese who just had a urinalysis which came back with oxalate crystals. He had oxalate stone surgery about three years ago so I was concerned. His urine ph was 6.5 so we need to get it up to 7. The specialist told me to make sure he gets a lot of water. He's not a huge drinker so I make sure to put extra water in his meals. He's a healthy eater so he gobbles it up with or without water. Is Jack on kibble only? If so, you may want to start adding some canned food to his meals, plus some water. If he isn't fond of the water, you can boil some boneless, skinless chicken breasts and use the broth to add moisture.

You should also add some potassium citrate to Jack's meals. Your vet probably sells it but he's going to charge you a lot more than what you'll pay by ordering it online. If you google potassium citrate for dogs, you'll get lots of hits. I buy the granules and add it to Busters morning and evening meals. It's beef flavored so he loves the taste. If you give it once a day, make sure you give it with the evening meals because studies have shown that this supplement does increase urine ph later in the day.

Unfortunately, there's no guaranty that we are going to be able to prevent stones from forming but we have to try.

Glynda

P.S. Reducing excess cortisol will definitely help as well.

[MyLittleMan]

Jack was on only the Urinary SO kibble but I flood it with water. Like yours, he's not a big water drinker either so I dose him with water when ever I can. I have recently begun adding the Urinary SO canned food as well mostly because Jack doesn't have the Cushing's typical ravenous appetite and he is more interested in the "people" food I don't let him have than his own.

Your boiled skinless chick broth is a great idea. I will definitely try it. I have this battle of wills with Jack every evening. I can't give him his multiple medicines wrapped in pill pockets until he eats his dinner and he ignores his dinner waiting for the tasty pill pockets! Maybe the chicken broth will be an incentive to eat what's in his bowl as well as a great way to get water in his system. So, thank you for the fantastic tip!

As to the potassium citrate, he has been taking the 540 mg pill form via prescription twice a day for the past 4 years and the calcium oxalate stones have not been an issue although his PH has never been at a steady 7.0. Last August, he had a stone removed 6 years from the first occurance. And, since then we've seen crystals in his urine, high and low PHs then a clean urinalysis and ultrasound this February and, by the end of March, 4 stones. It's craziness!

All the best!
Kim

[addy]

Hi,

Stopping by to see how Jack is doing today:)

Hugs,
Addy

[littleone1]

Hi Kim,

I hope Jack is continuing to do well.

[MyLittleMan]

He's doing very well today and seems quite comfortable considering his circumstances. His appetite was back by 9:00 last night but he had diarrhea from the time I picked him up until about 3:00 a.m. this morning. Not a lot just nothing solid when he did evacuate. It started to firm back up after his breakfast at 5:30 a.m. This was his first meal since Tuesday night. He is also urinating fine.

My only difficulty for now is that he won't sleep with the e-collar on and I can't sleep if he has it off. So I lost a lot of sleep. I put the collar on him and dozed off for two hours, when I woke up, he was sitting next to me staring at me like a little dog flower in his blue and white, petal-like flexible e-collar. He looked adorable and miserable at the same time.

I have to tell you that when I picked him up from the vet, one of the vet technicians gave me a list of things he was not to do, running jumping or stair climbing for the next two weeks. When I asked the technician who gave me the list how she suggested I might keep him from jumping without continual crating, she frowned at me slightly as if i should know how to control a dog and told me I should be able to control his actions on-lead. Then she left to get my groggy little man from recovery. She walked into the room with Jack on-lead. Walked up to the bench I was sitting on. And, in one fluid motion, Jack jumped up into my lap with the tech controlling the lead. Do I know my dog or what? I gave her my subtlest "I told you so" look and we proceeded to check his stitches which were fine.

If diarrhea and medication/sedation don't stop him from jumping immediately after surgery, the next couple of weeks should be fun for me. I do everything can to prevent these activities. I even have a ramp rather than his usual stairs up to my bed. But, he invariably will jump as the tech found out sooner than even I expected.

And, Jack says hello and thank you to everyone. Or he would but he is sleeping now because I just took his e-collar off.

[jrepac]

Hi Kim,
just catching up on Jack's story here and glad to hear he is doing well. Don't know what it is about terriers and Cushings.....these little guys seem awfully prone to it! (I had 2 terriers w/the disease):confused:

The story about the e-collar is a funny one! After my 2nd terrier, I did not even bother w/it...they are GD useless and the dogs hate them. :p Whomever invented that contraption should be shot...and, on top of it all, the vets charge you for them!

I hope Jack continues to progress nicely; all the best.

Jeff & Angel Mandy

[addy]

Hope you got some sleep last night and that you and Jack have a wonderful weekend!!!!:D:D

Hugs,
Addy

[MyLittleMan]

Just a quick update . . .

Jack is fully recovered from his bladder stone surgery. The stitches are out. The e-collar is off. And, he is happily swimming, running and jumping again.

Last Friday was Jack's 6th dose of Lysodren and yesterday he had his first ACTH done since starting the Lysodren 6 weeks ago. I will post the results as soon as I get them.

During yesterday's visit, I asked them to check Jack's blood pressure. He takes Enalapril because his BP was at 210 on his first check and lowered to 160 the last two checks. This was the first BP check since starting the Lysodren therapy and . . . .

Wait for it . . . . . . . 145!!!!!! Yeah Jack!

Since yesteday's ACTH results won't be back for several days, I am hanging on to this BP of 145 as sign that the Lysodren is doing its job and that Jack's cortisol/sex hormone levels are down. I would like them to be down enough so that we won't have to increase the dose amount or frequency or both.

Fingers crossed and paws pressed!
Kim and Jack

[addy]

Yea Jack!!!!

I am crossing everything for him too!!!!!!:D:D:D


Good job Kim!!!

Hugs,
Addy

[Harley PoMMom]

Hi Kim,

It is great to hear that Jack has recovered so well from his surgery and to see his BP is 145!

If it were me and with me being such a worry-wart, I would have his BP rechecked in a week or two. You are correct that with the Lysodren lowering his cortisol that this may be what is also helping with the BP.

Looking forward to see those ACTH stim results. ;):) Great job!!

Love and hugs,
Lori

[MyLittleMan]

Thank you so much for the extra finger and toe crossings and the additional hugs!

We go back in two weeks for a bladder recheck and I will definitely get his BP checked again as well. Thanks for the excellent thought on the follow up BP check. We've been checking Jack for so many other thing's lately that I have been remiss on the BP checks.

I have to give my vet's office credit. Jack is a complete wreck when we step into the vets office and I can't blame him with everything he's been through. So, the vet techs bring the BP device outside and take the reading on the bench or in our car to try and lessen the "white coat" effect on his blood pressure.

Between my GP vet and this forum, I feel better equipped to deal with what's around the next bend in the road. You guys ROCK!

Sloppy kisses from Jack! And a huge thank you from me!

Kindest regards,
Kim

[MyLittleMan]

Dear Lori,

I just read your post regarding Harley passing. I am so terribly sorry. My heart, thoughts and sympathies go out to you. You have been a strength to me since I recently began posting here. If I can be of any support for you, please let me know.

I am so sorry for your loss.

Love and hugs to you!
Kim and Jack

[MyLittleMan]

The vet's office is e-mailing me the detailed results of the most recent ACTH test but he called to tell me that Jack's cortisol level is down from 03/25/2011 ACTH test. I didn't ask for the Pre-ACTH over the phone so I'll have to wait for the e-mail to post that number.

05/10/2011 Endocrinology results

23.3 ug/dL Post-ACTH after 6 weeks and 6 doses of the Lysodren

ACTH Reference Range:
2 - 6 Pre-ACTH
6 - 18 Post-ACTH
18 - 22 Equivocal Post-ACTH Cortisol
>22 with hyperadrenocorticism
<2 with hypoadrenocorticism
1 - 5 Desired pre- and post-ACTH cortisol on lysodren therapy

ACTH just before starting Lysodren therapy:

03/25/2011 Endocrinology results
Pre-ACTH 10.4 ug/dL
Post-ACTH 36.5 ug/dL
ACTH Reference Range:
2 - 6 Pre-ACTH
6 - 18 Post-ACTH
18 - 22 Equivocal Post-ACTH Cortisol
>22 with hyperadrenocorticism
<2 with hypoadrenocorticism
1 - 5 Desired pre- and post-ACTH cortisol on lysodren therapy

Jack's vet is on vacation and the vet I spoke to said that we wouldn't be increasing the dose because Jack doesn't have the typical Cushing's symptoms like the ravenous hunger, thirst and isn't having accidents in the house. My concern is that since the cortisol level is still high and Jack does have BP and potentially calcium oxalate crystal issues that the 23.3 is not low enough to balance out the calcium in his urine and normalize his BP.

I know when I started this thread I was worried about giving Jack the 250mg of Lysodren once a week. Now, I am wondering if it is enough.

I guess there is just no pleasing me. More to the point, I have a hard time settling for "good enough". I want as close to best as I can get for Jack. So, what to do next?

I will speak to Jack's vet on June 1, 2011 about this but am interested in what you all think. Is this a good number or just better than it was. I believe it is still higher than the original ACTH sent to U of Tenn. but the difference in ng/ml and ug/dL always puts me off a comparison.

Here is his very first ACTH
06/24/2010 Test Results from the University of Tennessee:

Test | Baseline Result | Post ACTH Result | Normal Range |
Cortisol ng/ml | 25.4 | 215.0 | 70.6-151.2 |
Androstenedione ng/ml | 0.74 | 4.9 | 0.24-2.90
Estradiol pg/ml | 106.0 | 96.0 | 23.3-69.4
Progesterone ng/ml | 0.31 | 4.06 | 0.22-1.45
17 OH Progesterone ng/ml | 0.12 | 3.08 | 0.25-2.63
Aldosterone pg/ml | 58.5 | 302.2 | 72.9-398.6

[MyLittleMan]

Also, because we didn't send the ACTH to the U of Tenn., we can only assume Jack's sex hormone levels that were up have come down.

I hate regrets and I don't like to should on myself but . . . I should have insisted that they send this last ACTH to the U of Tenn. For a more complete work up. I hate assuming as much as regrets. I'd rather know his sex hormone levels are down rather than assume they are down because the cortisol is down.

Ugh!

[Harley PoMMom]

Hi Kim,

This dratted disease, huh!! It can get so overwhelming at times and I truly do understand.

I believe since Jack has no strong clinical Cushing symptoms and his USG is within the normal ranges that I would agree with the vet that no dosage increase is needed at this time.

Now this is just my opinion and hopefully the others will comment too.

Jack's cortisol levels from the University of Tennessee converts out from 25.4ng/ml = 2.5ug/dl | 215.0ng/ml = 21.5ug/dl. What one needs to do to convert the cortisol levels from ng/ml to ug/dl from the University of Tennessee is to move the decimal point one place to the left.

Also in an e-mail from Dr. Oliver to me, he told me that one should wait at least 6 months to redo the adrenal panel.

Hope this helps!

You are doing a great job!

Love and hugs,
Lori

[MyLittleMan]

USG? Is that urine specific gravity? You'd think working in IT I'd be better at these acronyms. There are just so many new medical ones that I've been exposed to lately. It's like alphabet soup in my head! :)

I'm learning slowly but surely. Lol

[Harley PoMMom]

Yes, USG = urine specific gravity! The norm for a cushdog is having a very low USG, they can not concentrate their urine usually caused by the high cortisol stress on the kidneys.

[addy]

Hi,

Dr. Oliver told me in an email that with lysodren once you get the cortisol down to 5ug/dl the other intermediates will be controlled with the exception of estradiol.

Thought that might make you feel better.

Hugs,
Addy

[MyLittleMan]

Lori and Addy,

Thank you both for posting your thoughts.

First, Jack's urinalysis from March 2011 showed a USG of 1.020. I'm just not sure if that is low or not but I don't know what it is now after six weeks on Lysodren. I'll make sure to find out with his next bladder recheck and urinalysis on May 31. So thank you for that bit of knowledge I had not been paying attention to.

And second, Addy, you stated that Dr. Oliver said once you get the cortisol level down to 5 ug/dL that the other intermediates excluding estradoil will be controlled. But Jack's still up at 23.3 ug/dL. I am still giving Jack his 3 mg of melatonin and the flax hull lignans twice a day with his meals. But, the 23.3 is higher than when he was first diagnosed with Cushing's. After all that we have done, I just don't feel like we have not gotten ahead of this frustrating problem. His little tail is still naked (which I can live with since it doesn't cause Jack any pain). But it's like a little flag waving at me saying that there is still a problem and we don't have the Cushing's (especially the sex hormones) under control.

Thank you both again for your valuable input. This forum is a blessing to us new Cush dog mommies (and daddies too).

Kindest and best regard,
Kim and Jack

[MyLittleMan]

I just got the full results from his recent ACTH test. I was missing the PRE-ACTH number:

05/10/2011 Endocrinology results after 6 weeks and 6 doses of the Lysodren

5.0 ug/dL. PRE-ACTH
23.3 ug/dL Post-ACTH

ACTH Reference Range:
2 - 6 Pre-ACTH (resting cortisol)
6 - 18 Post-ACTH
18 - 22 Equivocal Post-ACTH Cortisol
>22 with hyperadrenocorticism
<2 with hypoadrenocorticism
1 - 5 Desired pre- and post-ACTH cortisol on lysodren therapy

[addy]

:oSorry, Kim, I did not see that Jack's cortisol is still high. My post did not make you feel better:o

Hugs,
Addy

[MyLittleMan]

Please don't apologize. Your post gave me a better understanding of what his cortisol level should be. And that does make me feel better about what questions I should bring to Jack's vet on our next visit.

Thank you so very much! Really!


Big smiles from Kim and Jack

[Harley PoMMom]

Hi Kim,

I just want to clarify to you how I came to my conclusion with agreeing with the vet about not increasing the Lysodren dosage as of yet.

When you had Jack's cortisol checked on 06/24/2010 from the University of Tennessee his post level of 21.5ug/dl was within the normal ranges.

His second ACTH stim test done on 03/25/2011 of 36.5 ug/dL did show an elevation in his cortisol but the cause of this could be from his bladder stones.

With Jack never displaying any strong Cushing symptoms and his cortisol dropping from 36.5ug/dl to 23.3 ug/dL in only 6 weeks of Lysodren treatment, IMO, I would stay with his current dosage and retest his cortisol in another 6 weeks.

If this ACTH stim test, done in another 6 weeks, shows a rise in his cortisol then I would increase his dosage of Lysodren but if this ACTH stim test still shows a decrease in his cortisol production then I would still keep him on the same dosage.

I hope this makes sense and I haven't confused you more. :eek:

Love and hugs,
Lori

[MyLittleMan]

To be honest, I never associated a rise in his cortisol levels to the 4 bladder stones and the lot of crystal grit he had removed. But, now that he is feeling better and is taking Lysodren, I suppose I was expecting a number lower than 23.3 especially since I desperately want these bladder stones to stop forming.

I must say that I am NOT wanting to increase the Lysodren unless absolutely necessary but I do find it confusing that on each test result, they enter on the reference ranges:

1 - 5 Desired pre- and post-ACTH cortisol on Lysodren therapy

Now that he is on Lysodren, I guess I've been using that range as a guideline for what Jack's levels should be. I also assumed that the 23.3 cortisol level, being just outside the normal range, was the lowest his cortisol level would be on his current dosing.

Is it possible that the current dose of Lysodren will have a better lowering effect the farther we get and the more he is recovered from his last surgery?

I agree completely with what you stated, Lori, we'll see the Dr. Cox on the 31st. I'll have my list of questions for him (he's used to this because when I get there, I forget half of my questions. So I write everything down). And we'll schedule an ACTH test for six weeks out.

Now, would it be more comparable to have the ACTH done locally again, or should I have them send it to the U of Tenn again. I'm guessing that you meant U of Tenn since the last result from them was six months ago. Also, I'd like to see the hormone results detailed for myself.

Your questions, suggestions, thoughts, etc. definitely help me zero in on what's puzzling me about this darn, rotten, dratted disease and I appreciate everything you and Addy and the others have to say even if it raises more questions for me.

Thank you thank you thank you!!!!!

Love,
Kim and some sloppy kisses from Jack too!

[Harley PoMMom]

The 1-5ug/dl range is for a dog that was diagnosed with Cushing's, meaning had some strong clinical symptoms/elevated cortisol, was loaded with Lysodren and now is being treated with the maintenance dose of Lysodren prescribed after loading.

I really do feel that if Jack's cortisol is dropping than the intermediate hormones will too. Please keep in mind that it has been shown in a study that the normal healthy dogs they tested do have elevated estradiol.

I believe if you want to have another full adrenal panel done to answer your questions about his intermediates then go ahead but I don't think a full adrenal panel is necessary, just an ACTH stim test. Remember this is JMO!

If Jack was never displaying any strong Cushing symptoms and still does not then if it were me, I would not want his cortisol to go as low as the 1-5ug/dl range. Since 18-22ug/dl is the range for a normal healthy dog (one that does not have Cushing's or any other illnesses) than I would try to keep Jack's cortisol within the range of 18-22ug/dl.

Any kind of stress, illnesses, anxiety, etc. will cause a dog's cortisol to elevate. Also, cortisol levels do fluctuate throughout the day.

Love and hugs,
Lori

[MyLittleMan]

If you could see Jack at the vet' office . . . He is so stressed and anxiety riddled that he practically vibrates he shakes is so badly. So an ACTH test taken under these circumstances could get a higher reading of the cortisol because of his nervousness? That is something to consider. I know his blood pressure reading is definitely higher if they take the reading inside the vet's office. So why not the cortisol? The "white coat" effect does a number on my little pooh bear. So I will have to keep that in mind when I'm mulling over his test results.

And, thank you for clearing up my confusion with the ranges. 23.3 doesn't sound so bad if you are shooting for 18 - 22.

All the best,
Kim

[Harley PoMMom]

So an ACTH test taken under these circumstances could get a higher reading of the cortisol because of his nervousness?

All the best,
Kim

Stress and any non-adrenal illness can create a false positive on any Cushing diagnostic test.

Here are two quotes on this subject:


Results of ACTH stimulation can be affected by prior glucocorticoid administration, stress, anticonvulsant therapy and chronic disease. As a result, final interpretation of the results must be made in the context of the history and clinical findings. ACTH stimulation tests, in common with other endocrine tests, can be associated with occasional false positive and negative results.
http://www.idexx.co.uk/animalhealth/laboratory/smallanimalprotocols/acth.jsp

This next excerpt is from an answer by Dr. Mark E. Peterson to someone that posted a question to him on his blog page. Dr. Mark E. Peterson is a renown Cushing's expert. This post and Dr. Mark E. Peterson's full response is very interesting.


You cannot base a diagnosis of Cushing's disease — typical or atypical — on the finding of large adrenal glands on an ultrasound exam. This dog was severely ill when the ultrasound and ACTH stimulation test were performed. One would expect a sick dog to have a "stress" response, which would include increased secretion of pituitary ACTH leading to increased cortisol section. With chronic illness and continued stress, bilateral adrenocortical hyperplasia would be an expected finding as cortisol hypersecretion continues. http://endocrinevet.blogspot.com/2011/05/q-atypical-cushings-disease-in-11-month.html

Love and hugs,
Lori

[MyLittleMan]

Wow!

Thank you. And, again, wow! As miserable as he was feeling before the bladder stone surgery along with the added stress of being at the vets office . . . I wonder how accurate the 3/25/2011 ACTH stim test was. Since Jack wasn't feeling normal, did we get an accurate picture of his "normal" cortisol level?

Thank you. This makes a world of difference to me! I can rest a little easier between now and the next ACTH 7 weeks away. A clean bill of health on Jack's bladder next week would be a great sign of everything balancing out internally for him.

You have eased my worry-wort of a mind. Did I thank you enough?

No. Thank you. Thank you. Thank you!

Big hugs from the both of us!
Kim and Jack