9 YO Cairn goes for LDDS test next week

[cairncrazy24]

Misty was just diagnosed with Cushings. What can I expect in the coming months.... Other than drinking alot.. and gulping food down, i havent noticed anything else. Senior bloodwork revealed possible cushings.. now a LDDS test scheduled for next Thursday.

Thanks for any information!

[apollo6]

WElcome
Below you will find two links to give you infomation first.
http://www.kateconnick.com/library/cushingsdisease.html

this one explains the three kinds of cushings
http://www.vetinfo.com/canine-cushings-disease.html
Hugs Sonja and Apollo

[cairncrazy24]

Thanks for your quick answer.. I have been lurking around the site and have read both. My vet gave me some answers..(as I am writing this.. the Misty is attacking and throwing her hedgehog toy :D)... I know I cant panic until we do the LDDS and get a definitive answer. I know after next week i will have more questions than answers... so I guess I'm curious about the drugs that they use to control this disease..

[cairncrazy24]

i do have one question.. I have read that Calcium Oxalate crystals and Cushings are sometimes related... Misty is on a special urinary diet for CO crystals. Do you know this to be the case..

[Harley PoMMom]

Hi and welcome from me as well! A dog that has Cushing's can be prone to form calcium oxalate stones.

Did Misty have a chemistry blood panel done? If so, could you please post anything that is marked abnormal with the reference ranges and the units of measurements...Thanks!

When Misty has the LDDS test please post the results here too. Has Misty has any other Cushing diagnostic tests?

Is Misty taking any herbs, supplements or medicines?

Looking forward to hearing more about your sweet girl.

Love and hugs,
Lori

[frijole]

i do have one question.. I have read that Calcium Oxalate crystals and Cushings are sometimes related... Misty is on a special urinary diet for CO crystals. Do you know this to be the case..My gal Haley had the stones surgically removed but it took us another 4 yrs before we figured out she had cushing's...but I guarantee she had it then. After about 4 yrs on the Science Diet for the stones I took her off because she wasn't getting the nutrition she needed. I gave her Solid Gold and her energy level increased and she was like a pup again. So treat the cushing's if that is the case and you can probably get off the diet which isn't cheap. Good luck with the test. Kim

[cairncrazy24]

Thanks, when i go back to the vet's office to drop my girl off for the LDDS test I will get results. This started when bloodwork was done at the emergency vets for a tick/spider (not sure which) and infection that resulted. Her belly was blood red and really hard around the bite. One of her liver panels that should have been under 200 was over 2000. When she went into my vets for a follow up, the vet stated it may have been hight due to the infection and that we would retest after the antibiotic treatment. Her vet drew blood and retested. Levels still high. She suggested a LDDS for cushings. Misty has had urinary tract infections and CO crystals about 2 years ago and was placed on Royal Canine UD for crystals. No stones. I can see if my vet will forward the blood test results, otherwise I will get a copy from them.
Thanks everyone!

[cairncrazy24]

Got her test results.

03/27/11
ALKP 2103 U/L norman 20-150
ALT 128 U/L normal 10-118


04/11/11 - Only run for these below:
ALKP 1869 U/L
ALT 123 U/L

Hope this helps. No other cushings tests done to date. She has dry eye so she gets cyclosporin in both eyes daily.. (very small amount) no other supplements besides being on UD diet from Royal Canin.

[Eskimo'sMom]

Eskimo has been diagnoised with Cushings two weeks ago and her vet and I have yet to meet to discuss treatment. Eskimo had several test: blood panal, urinalysis, ACTH stim , LDDS, the last one revealed she had Cushings. However, in this forum, I was told that to finalize that Eskimo does have Cushings, I should do an Ultrasound. So I will discuss this when I meet with the vet in a week. Just letting you know I'm about were you are right not with Cushings thing...

[cairncrazy24]

Thanks.. we can keep in touch with the updates! Both the emergency vet and her regular vet are leaning that way, but after Thursday, I guess we will have a better idea. I hope Eskimo can get back on track... ♥

[cairncrazy24]

Got her test results.

03/27/11
ALKP 2103 U/L norman 20-150
ALT 128 U/L normal 10-118


04/11/11 - Only run for these below:
ALKP 1869 U/L normal 23-212
ALT 123 U/L normal 10-100

Hope this helps. No other cushings tests done to date. She has dry eye so she gets cyclosporin in both eyes daily.. (very small amount) no other supplements besides being on UD diet from Royal Canin.

[Eskimo'sMom]

I am seeing a specialist on Monday to confirm type of cushings Eskimo has via ultrsound.

[lulusmom]

Thank you for posting the abnormal liver values and I'm so sorry that I missed them until now (thanks to Eskimo's mom). Those values, with ALKP being severely elevated and the ALT being mildly elevated is definitely the pattern we see with cushing's. We'll be staying tuned for the results of the LDDS. Is that being done this week?

Glynda

[cairncrazy24]

She is at the vets.. as we speak. Hoping for the best! Thanks to all of you, this forum has made this journey that I am ready to emark on a lot easier!

[lulusmom]

If Misty is like most of our dogs, she is going to be tuckered out from spending the day at the vet's office. :) We'll be looking forward to the results of the LDDS.

[cairncrazy24]

Well, the vet is out of town today, although the results will be in her office. She will call on Monday with the results.. so a couple of days of waiting.. Misty was starved when I got her home.. never left my side all evening.. little stinker!
:p

[cairncrazy24]

Well, the LDDS test produced a negative result for cushings.
5.9 baseline
<.07 at 4 hours
<.08 at 8 hours.
Xrays showed liver is enlarged, so now the internest for ultra sound and possibly biopsy. Money, i dont have and dont need to spend... Looks like no vacation this year.

[cairncrazy24]

Well, Misty is scheduled for an ultrasound and consultation with an internist on Tuesday. Everyone keep their fingers and paws crossed.. She may need it!:o

[MBK]

Hi, Jodi -

We will keep fingers and paws crossed that Misty's ultrasound will bring some good news. She'll have the pink shaved belly like my Alivia currently has!

I know what you mean about the costs...I sure wish I could add Ali to my health insurance! It is a shame how costly healthcare for our furry babies is.

Warm thoughts,
Mary Beth and Alivia

[cairncrazy24]

Thanks Mary Beth. I am hoping its really nothing serious and can be handled by meds and diet. I dont know much about liver diseases and my vet has sent me to a specialist who the vet techs adore.. So... keep her in your prayers!

[Harley PoMMom]

Here is a link to some really good information about canine liver disease: Liver Disease in Dogs. (http://dogaware.com/health/liver.html) The really good thing about the liver is that it is the only organ that can regenerate itself.

Keeping you both in my thoughts and prayers.

Love and hugs,
Lori

[lulusmom]

Hi Jodi,

I am happy to hear that you are going to be consulting with a specialist today and doing an abdominal ultrasound. Trying to diagnosis cushing's is like finding a needle in a haystack sometimes. If there was only one test that could be relied upon to be accurate 99.9% or even 84% of the time, we wouldn't be nagging people to post so many test results. :D A very small percentage of dogs with cushing's will test negative on the LDDS so in my opinion, the abdominal ultrasound is a logical next step. I'll be interested to hear all about your appointment.

Glynda

[cairncrazy24]

Well, she has at least 4 liver nodules. Now I have to figure out if I do the biopsy, or just try and support her liver function. A lot of soul searching.....

[lulusmom]

Hi Jodi,

Nodular hyperplasia is common in cushing's so I'm not sure that in your place, I would have a liver biopsy done at this point. I've mentioned this before but it's worth repeating that the pattern in the increased liver enzymes (high alk and pretty mild alt) is textbook cushing's. Also keep in mind that a good number of dogs with cushing's test negative on the LDDS. As I recall, Misty drinks a bit more and has a really healthy appetite but she has no other symptoms that are associated with cushing's, right? If so, in your shoes, I'd probably get Misty on liver support and redo the LDDS in three to four months.

When you said you were going to see an internist, was that visit limited to an abdominal ultrasound? Can you tell us what the ab ultrasound findings were in addition to the liver nodules? We would be particularly interested in what the adrenal glands looked like.

Glynda

[labblab]

Hi Jodi,

Has the internist spoken with you yet regarding his/her suspicions regarding the liver nodules? I don't know very much about liver disorders, but I do know that there is at least one benign condition involving nodular hyperplasia that occurs in older dogs. At age 9, I don't know whether that would be a likely or unlikely condition for Misty.

http://www.doggedhealth.com/diseases-a-symptoms/diseases-a-conditions/hepatic-nodular-hyperplasia.html

I am wondering whether the specialist may suggest performing a bile acid response test prior to proceeding with the more invasive liver biopsy. I believe this is a blood test of the actual functioning of the liver. Even when liver enzymes are elevated, liver function may still be normal. I would think that might be important information to factor into the diagnostic picture. It may be something to ask about.

Upon reviewing Misty's actual LDDS numbers (8-hour result of 0.8), I am thinking that Cushing's is pretty unlikely. While it is true that not all Cushpups test "positive" on the LDDS, according to these statistics given by Dr. Edward Feldman (http://www.k9cushings.com/forum/showthread.php?t=209), there is only a 2-4% chance that Misty has Cushing's given her LDDS result:


This test is relatively sensitive and specific, but not perfect. Approximately 90% of dogs with Cushing's syndrome have an 8 hour postdexamethasone plasma cortisol concentration >1.4 μg/dl and another 6 to 8% have values of 0.9 - 1.3 μg/dl.

Does your vet or internist draw any connection between the liver enzyme elevations and Misty's spider/tick-borne infection and antiobiotic regimen? It sounds as though that's when her liver enzymes first showed elevations.

Please keep us updated,
Marianne

[cairncrazy24]

I think that he is leaning towards hyperplasia?? benign nodules. Usually ALK is high with marginally high ALT. He did say that there are dogs who are cushings that give a negative result on LDDS. Show few of the symptoms and they are vague... He also said that the nodules may or may not be the cause of the liver enzymes. He did not remark on any other of her organs so I assume that they were ok. He only showed me the nodules on her liver.

[cairncrazy24]

We noticed her liver values high at the time of the spider/tick bite only because the emergency vet had blood tests run. They might have been high before that and there is no way to know. He didnt seem to think that was the issue.

[cairncrazy24]

Well... we had the biopsy done on Tuesday.. Nodular hyperplasia... no cancer.. so I will wait and talk to Misty's regular vet next week. I'll keep you posted.

[lulusmom]

Yay, that's good news. We'll be waiting to hear what your vet recommends next.

[cairncrazy24]

I will keep you posted! :D

[MBK]

Hi, Misty. happy to hear the results of Misty's biopsy were good! Yay for her and for you! One less thing to worry about is always a good thing! :)

You may want to ask your vet about giving Misty Milk Thistle extract. Apparently it is good for the liver and Alivia's IMS just gave us the okay to use it - the human alcohol-free extract is available at The Mecicine Shoppe's website for $9.99. If your vet's okay with it, he can calculate the dosage for you.

Have a great Memorial Day weekend!

[cairncrazy24]

Well, its been a busy two months. The internist suggested a dental be done on Misty (which she really needs) and then retest her blood values in 30 days. Dental was done on Tuesday... We are scheduled in a month for her follow up bloodwork. Not sure what we will do if the levels are still high. :D

[cairncrazy24]

Well after many tests, a dental, she had bloodwork done again and her alkp is over 2000, Vet suggests a Univ Tenn blood work be done for atypical cushings. anyone know the cost of the test? Vet started her on denamarin this week.
Thanks!

Bloodwork Results:
Protein 6.7 5.0-7.4 g/dl
Albumin 3.900 2.7-4.4 g/dl
Globulin 2.800 1.6-3.6 g/dl
Alb/Glo Ratio 1.40 0.8-3.6 g/dl
ALT 137 12-118 u/l
ALKP 2889 5-131 u/l
Urea Nitrogen 15 6-31 mg/dl
Creatinine 0.70 .5-1.6 mg/dl
Bun/Creatinine 21 4-27 ratio
Glucose 102 70-138 mg/dl

comments: Hemolysis 3+ and Lipemia 2+ No significant interference.

[Squirt's Mom]

Hi Misty,

I believe the cost from UTK is around $140.00. Then your vet will tack on their fee for the actual stim (blood draws, agent, etc) plus the cost of shipping. The information for how to do this test, how to prepare it, and how to ship it can be found here -

http://www.k9cushings.com/forum/showthread.php?t=198

Hope this helps!
Hugs,
Leslie and the gang

[lulusmom]

Hi Jodi,

Last year you mentioned that Misty's only symptoms were drinking a lot and eating alot. Are these still her only symptoms? Is her urine dilute? Your specialist mentioned dogs with few or vague symptoms so I am wondering if the elevated liver enzymes is the only reason your specialist is pursuing a cushing's diagnosis. Most cushing's savvy vets will not prescribe treatment to a dog in the absence of overt symptoms. Is Misty on liver support like milk thistle and/or SamE?

Glynda

[cairncrazy24]

She has started to show other symptoms as well... panting, laying on the tile floor. We just started her on denamarin every day, and her symptoms have eased a bit. With her ALKP levels so high, the internist suggested this test if the dental did not help.
:rolleyes:

[lulusmom]

Hi Jody,

Thanks for the reply. If Misty has typical or atypical cushing's, I'm not sure that Denmarin would make a difference in symptoms, as it does not have any effect on adrenal hormones. Makes me wonder if maybe something else is going on. Does your vet want to do a UTK panel soon or does s/he want to wait and see if the Denmarin will help?

I went back back through your thread and refreshed my memory a bit. Misty had an abdominal ultrasound and liver biopsy back in May. Do you remember if the ultrasound findings mentioned anything about normal adrenals or enlarged adrenals? Was the liver biopsy done by fine needle aspirate or did they actually do a more invasive procedure and take a piece of the liver? Were they able to determine if the increase in ALKP was steroid induced?

[cairncrazy24]

She had an ultrasound guided needle biopsy. The biopsy came back as nodular hyperplasia. The adrenals were fine. LDDS test was negative that my regular vet did. Internist suggested a dental, that was done roughly a month ago, and then recheck blood. Now ALKP is higher than ever. ALT is marginally high ... the internest did suggest possilbe UTK adrenal testing, he was not convinced that her elevated enzymes werent due to atypical cushings... so here we are....
:confused:

[cairncrazy24]

Well, after Denamarin for a year, we were finally able to get the UTK blood testing done for atypical cushings. She is now a chow hound, still drinking and it hasnt gotten too warm, so she's not panting as much. Since the Denamarin, the ALKP levels in her blood have stabilized, not getting lower, but not getting any higher. She had the tests done on Tuesday. Dr said they would be in Tenn on Wednesday. I know they only run these assays once a week, so does anyone know how long it takes to get results back?
:confused:

[StarDeb55]

If I remember & nothing has changed, I believe the UTK lab does this testing on Mondays. If your baby's samples did get to UTK yesterday, I would think they would be tested this coming Monday, & you should have the results by the end of next week.

Debbie

[cairncrazy24]

Thank you.. When Misty's vet read all of the instructions, it said they do them once a week.. but not the day the tests were done. Hoping for a resolution :o

[cairncrazy24]

:confused:

Test results from UTK on Misty's bloodwork.

Pre and post ACTH

Cortisol ng/ml 63.0* 2.1-58.8 132 65.0-174.6
Androstenedione ng/ml 1.05* 0.05-0.57 3.49 0.27-3.97
Estradiol pg/ml 87.5* 30.8-69.9 74.2* 27.9-69.2
Progesterone ng/ml 0.33 0.03-0.49 1.27 0.10-1.5
17 OH Progesterone ng/ml*0.04 0.08-0.77 0.78 0.4-1.62
Aldosterone pg/ml 62.4 11-139.9 141.0 72.9-398.5

Per the report, marginal increased adrenal activity. Some vets may consider items 2-4 on attached sheet (melatonin and lignans)......

Thoughts??

[cairncrazy24]

Just updating. Any thoughts on misty's panel results.

[labblab]

Hi Jodi,

It's so good to hear from you and Misty again! Boy, I have to say that it doesn't look to me as though her adrenal hormones are likely to be responsible for her continuing symptoms. I am not an expert at interpreting the complete UTK panel, but I do know that in the case of cortisol, a dog's "pre" ACTH number does not have significance in diagnosing Cushing's. I am assuming that is also true for the other adrenal hormones. And if so, then the only elevation that would have any significance at all for Misty would be the post-ACTH estradiol. And that is only marginal. Treatment with melatonin and lignans is essentially benign, not very expensive, and does targt estradiol levels. So I suppose you'd have nothing to lose as far as giving them a try. But I also don't know whether you could expect that her marginally elevated estradiol level is really the source of her problems. Hopefully some other folks who have dealt with elevated estradiol will chime in.

What recommendation has your vet made?

Marianne

[cairncrazy24]

The internist suggested melatonin twice a day, and we started her on that, but i havent spoken to her regular vet, and the UTK tests suggested that some vets would prescribe melatonin and lignans. I have started both. So.... now we look for any changes.. i do know one thing.. she's been sleeping better :D I know it will take about 4 months to see improvement.

[lulusmom]

Hi Jodi and welcome back.

It's been just about a year since Misty was diagnosed with nodular hyperplasia after a liver biopsy. This condition causes elevated liver enzymes and with all other bloodwork being perfectly normal (last posted in August, 2011) cushing's didn't look likely. Has more recent bloodwork been done? If Misty has cushing's, I would think there would be additional abnnormalities, such as high cholesterol and triglycerides, thinning coat, skin issues and muscle wasting. Since the ALKP elevations are probably being caused by nodular hyperplasia, what cushing's symptoms does Misty have that made your vet continue to push for a cushing's diagnosis? In going back through your thread, I noticed that I already asked that question but I'm still not clear as to whether Misty truly has overt and problematic symptoms or if the vet is trying to find an additional cause for the high Alkp.

I see that the only elevated adrenal hormone is estradiol. I read a paper a few weeks ago regarding the effects of elevated estradiol in dogs. A good number of the healthy dogs in that study had elevated estradiol which presented no problems for these dogs. Apparently elevated estradiol is not such an unusual finding in a perfectly healthy dog. The elevations Misty has are pretty negligible too which makes me wonder if it is causing any problems for Misty.

Humans take melatonin to help them sleep, so you can expect Misty to sleep better and probably more often.

[cairncrazy24]

We did another senior bloodwork in January. The ALKP had stabilized. Not getting better, not getting worse, and everything else looked ok. I dont have those results, but i should get them from the vet. she is also taking Denamarin every day.

[lulusmom]

Jodi, aside from high liver enzymes, what symptoms does Misty have that your vet thinks Melatonin and Lignans may help improve?

[cairncrazy24]

Sorry, Ive been swamped at work and at home... well, misty is drinking an excessive amount of water.. peeing as well, her appetite is like we never feed her at all. She's panting, her hair that was soft is now more like wool.. not soft and it looks a lot thinner... senior bloodwork was done about 3 months ago, liver enzymes are the same.. very high. The UT bloodwork suggested that some vets would recommend the melatonin and lignans..

[Squirt's Mom]

Hi Jodi,

Her UTK panel shows only one elevation on the post numbers and that is the estradiol. UTK recommends the use of the combination of melatonin and flax lignans to address elevated estradiol that is produced outside the adrenal glands. Estradiol is the only hormone in Atypical Cushing's that might NOT be coming from the adrenals but rather from other areas of the body like fatty tissues and hair follicles. Lysodren (not what she needs right now ;))cannot reach outside the adrenals so it cannot help elevations in estradiol if it isn't produced in those glands. The combination of melatonin/flax lignans can reach those other areas so that is why UTK makes the suggestion.

This is a fairly benign treatment so it shouldn't hurt to try. If Misty has any digestive issues, you might want to take it slow on the lignans, building up to the daily dose she needs. She may be drowsy at first on the melatonin but should adjust fairly soon. Bear in mind, it can take 3-4 months to see any improvements. This treatment may not help but don't get discouraged until she has been on it steady for at least 3 months. ;)

Hugs,
Leslie and the gang

[cairncrazy24]

I have since spoken to her regular vet. She is on the melatonin and lignans and she will call in a month to take a peek at her liver enzyme levels. She also told me that this regimen may take up to 4 months to have an effect. But on the bright side, for the first time in months.. she actually left a few kibbles in the dish when fed. I have to monitor her water, since my mom is at home, I'm not sure how much she is drinking. I know it is a lot! :-)

So in a month we take a peek at the liver enzyme values and hopefully they will start to come down.

Thank you all!:)

[cairncrazy24]

So.. Senior bloodwork was done on August 8th... liver values have risen... ALK is over 2000 and ALT is over 200,... My vet practice has a new vet which is the vet that Misty saw. New vet is consulting with the Internist to get his thoughts on the liver enzymes increase. She's not completely sure that Misty is not cushings.. here we go again. I will try and get a copy of the bloodwork results.

I know in the results
ALK and ALT both high (see above)

Thyroid was a little low

Urine sample also taken and was dilute.

[Steph n' Ella]

All aboard the cushing Dx merry-go-round! :/ If thyroid is too low you'd see a huge difference in energy level. Since starting my ella on hormone replacements, it is like she is going through a 2nd puppyhood! Good luck with little misty!

[molly muffin]

Hopefully the specialist will have some ideas on her liver values and what is causing them.
My molly too has the high ALP and ALT's. I have her on supplements and we'll be retesting in 3 months to see if there has been any good results from it. Her energy levels do seem to be better.

Are they going to do a LDDS to see if she can suppress or not?

hugs,
Sharlene and molly muffin

[Squirt's Mom]

Hi Jodi,

Good to hear from you and Misty again! :) Now, to play another game of "20 Questions". ;)

Is Misty displaying more cush signs? Is this the first time her urine has been dilute?

Was the bile acid test ever done?

Has there been another ultrasound? If so, what were the comments on the report this time?

Exactly what did the first ultrasound report say about her adrenal glands? (- they should have noted the size of the glands on the report.)

Is this the first time the thyroid levels have been low? Hypothyroidism can present with some of the same signs as Cushing's - increased appetite, increased drinking and urination, and hair loss among them.

Is she still on the melatonin and lignans? If so, at what doses? Any improvements noticed since she's been taking these?

Overall, how is Misty doing? Any new issues since we last talked?

We are looking forward to hearing the rest of the lab results to see if any other abnormal levels were reported...like cholesterol, triglycerides.

Let us hear from you when you have time! And certainly after the follow-up testing is done, like another LDDS or ultrasound. ;)

Hugs,
Leslie and the gang

[cairncrazy24]

Well here we go again... We did the LDDS test again on Tuesday.

Baseline 4.7
6 hour 1.2
8 hour 1.4

The vet wants another UTK test and ultrasound done, financially I can not afford, so what to do??? She said the 1.4 is borderline, and cannot start to prescribe any cushings drugs. Any thoughts??

[cairncrazy24]

:mad:

she is currently taking melatonin 3 mg twice a day. and lignans 1/2 capsule once a day.

[Harley PoMMom]

Is Misty displaying any clinical signs of Cushing's?

[lulusmom]

Hi Jodi,

You mentioned that Misty's T4 was low on the last blood chemistry that was done. Can you please post that value for us? Like Lori, I am also interested to hear if Misty is symptomatic.

Glynda

[cairncrazy24]

I will call and ask for the results... as far as her symptoms:
Excessive water intake... excessive peeing....
Panting .. lays on cold floor
Ravenous appetite.. she could eat all day.. I have caught her eating her poop .. ewww
Her once soft coat is now dry and matty.. no hair loss
ALT and ALKP have increased even with the melatonin and lignans

[cairncrazy24]

Senior Bloodwork Levels that are high or low... all other levels normal

ALK 2747 10-150 u/l
ALT 200 5-107 u/l
CK 290 10-200 u/l
Amylase 2124 450-1240 u/l
Potassium 5.7 4.0-5.5 mEq/l
Na/k ratio 26 27-40 (low)
T4 0.5 1-4 ug/dl (low)
Auto Platelet 662 164-510 K/ul

Urinalysis
Spec Gravity 1.015
Ph 5
WBC 5-10 0-5 HPF

LDDS Test
Baseline 4.7
6 hours 1.2
8 hours 1.4

Well.... any thoughts??

[Squirt's Mom]

Hi Jodi,

More questions....:p

Was the bile acid ever done?

Is she on treatment for hypothyroidism?

Is there a reason she isn't taking the recommended dose of lignans? The melatonin and lignans will have no effect on the liver values but can help with the intermediate hormones if taken at the recommended doses. Just guessing but I would think she should be getting something like 3 full capsules a day of the lignans.

Did the vet mention anything about her pancreas? I assume the lypase was normal but the amylase is elevated and I would want an explanation for that from the vet. Has she had any loose stools or nausea?

Personally, without further testing, especially an ultrasound, I would be very, very hesitant to start treatment with either drug right now. This position comes from my experiences with Squirt when she was first diagnosed. She would have died had I started treatment without doing the testing which found that tumor on her spleen. There are too many unknowns in Misty's case in my mind...but I am a worry wart and want to know exactly what I am dealing with if at all possible when facing the possibility of having to use drugs as powerful as Trilostane or Lysodren. ;)

Hugs,
Leslie and the gang

[cairncrazy24]

No bile acid test was done, this is the first test that the thyroid was low, which the doctor attributes to being a sick thyroid issue... the lignans are 30 mg capsules. I read that 1 mg per pound daily. She currently weights 18.5 pounds. I can give her more, but i have also read that it can cause stomach, digestion issues with stools...currently there are no runny or loose stools, no nausea.

[cairncrazy24]

The lignans are SDG. 30 mg capsules. The website says 1 mg per pound, so I have been giving her about 1/2 capsule a day... Should I give her more??

[molly muffin]

Argh, I wish I knew what to tell you on the liganans dosage. I haven't tried it though. Hopefully someone that has will stop by and give their input. I think though that you could go up some in dosage and if you do encounter any runny stools or indigestion, then cute back a bit. Since they won' t hurt over all and could help with the sex hormone levels it might be worth it to try.

I do want you to know that I'm reading though! :) You aren't forgotten at all. Things have been mildly crazy around here but seem to have settled with the passing of the storm and whew, thankfully the end of the week coming.

[Harley PoMMom]

The lignans are SDG. 30 mg capsules. The website says 1 mg per pound, so I have been giving her about 1/2 capsule a day... Should I give her more??

What is very important to know is the standardized percentage of SDG in the product you are giving. SDG is the active component of the lignan.

As an example: If one 30 mg capsule contains 20% flax lignan extract (standardized).

30 mg capsule = 20% lignans.

20% is 1/5 of 100% (or 100 divided by 20 = 5).

30 mg divided by 5 = 6 mg lignans.

Each 30 mg capsule would contain 6 mg lignans.

If Misty would weigh 20 pounds she would need around 3 (6mg) capsules.

Hope I am not confusing you, if I am please do not hesitate to ask more questions, ok?

[cairncrazy24]

I give her lignans for life... SDG Lignans for dogs.... This is what the website says...... So should I start to give her more??

Lignans For Life provides pure flaxseed hulls in capsule form containing 33 mg of SDG lignans per capsule. (ALSO available in bulk powder and money saving 2 packs. See all options at the bottom of this page.) The Hulls of the flaxseed are separated from the meat of the flaxseed providing you with the most concentrated natural form of lignans available. Our bottle of flaxseed lignans contains 90 capsules that can be separated (if desired) exposing the ground flax hulls (powder) which can be divided in half or thirds, however, vets agree that this natural grain can be given safely even up to 10x the minimum recommended amount. (Vets recommend a minimum of 1 mg of SDG lignan per 1 lb of dog weight.) E.g. a 30 lb dog would take one capsule per day.

[Harley PoMMom]

In order to know exactly how many capsules to give, you have to be told the standardized percentage of SDG that is in it.

Here is a quote and link to the supplement facts of Vitacost's flax seed Lignan Extract:
(from flax, Linum usitatissimum L.) [Standardize to 20% Lignans (as secoisolariciresinol diglucoside, SDG)(8 mg)] http://www.vitacost.com/Vitacost-Flax-Seed-Lignan-Extract

With the product you are using, Lignans For Life, I do not see the standardized % of SDG in this product. It has on the label 33 mg of SDG lignans per capsule but I don't see anything saying this is standardized, so it could be more than 33 mg or less than 33 mg.

[cairncrazy24]

Each capsule contains 630 mg of flaxseed hulls, containing 33 mg SDG lignans..... per their website.. I will also check my bottles tonight... Not chemically process so it's about 5 percent of SDG lignans per capsule per the gentleman I spoke to at the company. So.... should I give her more??


GET 2 90-COUNT BOTTLES OF CONCENTRATED FLAX SEED LIGNANS AND SAVE ON SHIPPING TOO!! SHIPPING ON THE SECOND BOTTLE IS FREE! We start with all natural chemical free flax seeds and hull them providing ground concentrated flax seed hulls (Lignans) in a vegi capsule. Each capsule contains 630 mg of ground flaxseed hulls (33 mg of SDG lignans). Flax Lignan Research has shown that people with high amounts of lignans in their bodies have notably lower cancer rates. Lignans have been linked to lower cancer levels as well as post menopausal benefits in women and better prostate health and hair health in men. Lignans provide Antioxidant protection too.*

[Squirt's Mom]

She is on the right dose if the capsules contain that many mg of SDG. The SDG is the part of the lignan that does the work. Most lignans are not that high in SDG per capsule but are standardized to something like 20% - meaning each capsule of lignans contains only 20% SDG.

[molly muffin]

Hi Jodi,
how is Misty doing?

Sharlene

[cairncrazy24]

Misty is the same... status quo here.. Thanks for asking! :)

Waiting to hear back from the internist on our next step...I'll keep you posted....

[molly muffin]

Status Quo is nothing to sneeze at. LOL Very happy to hear that!

:)

Sharlene and Molly Muffin

[cairncrazy24]

Well, the internist also wants another ultra sound. So I will make the appointment and we will go from there...

[cairncrazy24]

Well the ultrasound was done... same benign nodules on liver, adrenal glands normal and everything else was normal. So, the internist says lysodren is the med to try. With her test results borderline cushings and liver levels climbing, and all else normal, is this the right move?? Scared about the side effects. He gave a dose of 250mg twice daily for 7 days and an ACTH Stim at seven days.
:eek:

[molly muffin]

Drat. I see/saw the LDDS results, but did you also have an ACTH test done? I'd want one of those baseline before ever starting cushing medication since what you start on a treatment process the ACTH is the only monitoring test you'd have done and you want to have something to compare that to.
I'll let others pop in and give their opinion on where one needs to be prior to starting lysodern or cushings treatment at all for that matter.

Little whipper snapper looks to be doing pretty good I must say. That is such a jolly picture, I want to run too.

hugs,
Sharlene and Molly Muffin

[frijole]

I have to go back to work so don't have time to back and read your entire thread but based on your post I would not start lysodren because you don't treat dogs that are borderline or without symptoms. If the adrenal glands are normal that is a sign that it is either early cushings or NOT cushings. Perhaps someone has more time to read up or I'll review later tonight. Kim

[cairncrazy24]

She has the following symptoms:
Drinking/peeing lots!
Voracious appetite (she's been caught eating poop.. ewww)
Panting - mainly in the summertime.. not so much in the winter....
Laying on cold floors
thinning coat
high alkp and alt values
urine dilute
low thyroid - first time thyroid low... vet attributes to sick thyroid
there may be a couple more.. these have been going on since April of 2011. She has had a UTK adrenal panel done in May of 2012, results are in the post.
:(

[cairncrazy24]

Test results from UTK on Misty's bloodwork.
Done in May of 2012

Pre and post ACTH

Cortisol ng/ml 63.0* 2.1-58.8 132 65.0-174.6
Androstenedione ng/ml 1.05* 0.05-0.57 3.49 0.27-3.97
Estradiol pg/ml 87.5* 30.8-69.9 74.2* 27.9-69.2
Progesterone ng/ml 0.33 0.03-0.49 1.27 0.10-1.5
17 OH Progesterone ng/ml*0.04 0.08-0.77 0.78 0.4-1.62
Aldosterone pg/ml 62.4 11-139.9 141.0 72.9-398.5

[molly muffin]

Hmmm, this is interesting and I'm going to let the others who are quite familiar with the UT test results talk about them, but normally one is quite concerned about the Post results on the ACTH, when treating for cushings and your post results all appear to be normal, with the pre being out of range on Cortisol (not by much either), Estradiol and Progesterone.

So, I am not positive about that that means in relation to cushings treatment with lysoderm or vetroyl.
I'll be waiting for other responses about that too, as I know a few have used the UT test for information.

hugs,
Sharlene and Molly Muffin

[lulusmom]

Hi Jodi,

How much does Misty weigh?

[cairncrazy24]

Her current weight the last time I was present when they weighed her is 19 pounds... she has picked up about 1.5 pounds in the past year and a half.. she was 17.5.. Turning into a little porker! I just spoke to her regular vet ... we will start the Lysodren on Sunday...

[cairncrazy24]

Just a bump.. I dont know whether you saw my response to your question about weight.. she is around 19 pounds.. should be a bout 17.

[Squirt's Mom]

At 19 lbs, that means Misty weighs 8.6363...kgs (19 / 2.2). The dose should be 50mg/kg/day to load so her dose should be 431.8181mg/day to load her. 1/2 tablet twice a day would be 500mg/day so keep a close eye on her for signs she is loaded. It may happen quickly. ;)

Have you started the load yet? We are here if you need us!
Hugs,
Leslie and the gang

[Squirt's Mom]

Signs of loading achieved are -


Lysodren administration should be stopped when:

1. the dog demonstrates any reduction in appetite; this might mean just pausing slightly during meal consumption, stopping to drink some water, or stopping in response to the owner's voice.

2. the polydipsic dog consumes less than 60 ml/kg/ day of water.

3. the dog vomits.

4. the dog has diarrhea

5. the dog is unusually listless.

The first two indications for stopping the medication are strongly emphasized because they are common and they precede worrisome overdosages. The occurrence of any of these signs strongly indicates that the end point in induction (loading) therapy has been achieved.

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

[cairncrazy24]

Thank you! I have read, and read all of the signs.. my mother is home with her during the day, so she will keep an eye on her. I will start her on the medication on Sunday. I am away this weekend and I didn't want to start her if I wasn't available... So it begins..... :eek: I'm really scared, but after the consult with her normal vet, I am a little calmer....

[Squirt's Mom]

You are going to do just fine, Jodi. You have us all behind you, standing by should you need to talk about anything. You know your baby girl better than anyone and you will see the changes in her as the drug goes to work because you are so devoted to her. Many folks have put a copy of the Lyso tip page on the fridge or cabinet where it is easily seen by all who share the house with the pup. That way everyone knows what to look for. You can write her vet's number on it just like you would for a kid's babysitter! :D

Starting on Sunday is a good move because your vet will be available for the critical days that follow after starting the load. Smart move, Mom! And you thought it was fear making you choose Sunday! Nope, it's that great Mom instinct at work. ;)

Keep in touch and let us know how things are going.

Hugs,
Leslie and the gang

[cairncrazy24]

You guys rock! Thanks for all the support!:p

[molly muffin]

Crossing fingers for a good load!

I've been dying to respond to your thread and didn't because, well one I don't know very much about lysodren dosage and two I was worried that if I wrote something trivial but supportive, then those that Do know might have missed the question about dosage and weight.
LOL

hugs,
Sharlene and Molly Muffin

[cairncrazy24]

And the loading has begun.... Started on Sunday... hoping it is uneventful and my little girl starts her way to feeling better!

[addy]

Okay, one day under your belt. We're with you:):):):):):)

Any questions?

[Squirt's Mom]

WOOHOO! The fun begins! :D How is Misty today? How are YOU today? :p Try to keep breathing and hold the panic at functional levels...panic is part and parcel of loading so I won't ask you not to feel that! ;):) We are here anytime and right beside you all the way, hovering like annoying gnats.

Hugs,
Leslie and the gang

[cairncrazy24]

You guys are more than welcome to hover and annoy! Misty was kicking her heels up at 5AM this morning out in the yard...and barking (rolling eyes):rolleyes: So all seems well... i'm concerned not panicked...

[molly muffin]

Here I am hovering. :) How are you two doing?

Sharlene and Molly Muffin

[cairncrazy24]

So far, great! She's being a trooper... I posted yesterday... kicking her heels up at 5AM, barking at anything she hears as well (i'm sure my neighbors just love that!):rolleyes: Taking the day... one dose at a time..... LOL

[addy]

Geat news but dont let your guard down;););););)

[cairncrazy24]

I'm not letting my guard down;) I feel like a hawk, hovering all the time, but at least my mom is with her during the day and will note any changes she sees in her.

[cairncrazy24]

Just an update... Water consumption down, for the last 3 feedings she has left food in the bowl and has to be enticed to finish... spoke to the vet yesterday, was given prednisone just in case and she also told me to let her know if the food issue continued. Called and left message this morning, so I expect the vet will stop the lysodren and we are scheduled for an ACTH stim test on Friday morning...... :eek: Misty Meanor has been a trooper!

[frijole]

OK - I suspect loading was done when there was food left in the dish. You did the right thing and called the vet. It appears you gave lysodren AFTER that along with prednisone right?

I don't care what the vet says that dog has every sign of being loaded and do NOT give any more lysodren. The pill works for two more days after the last dose so you have to stop because cortisol goes lower for two more days. If you continue to give it, particularly with the prednisone you run the risk of overdose and you won't even know it because the prednisone is masking the load signs.

Also if you keep giving prednisone it will skew the test results. I believe prednisone has to be out of the system for 24 hrs but it could be 48 - hopefully someone else will see this and confirm.

Lastly waiting until Friday to do the acth test seems to far out. YOu don't mess around with lysodren. Once a dog has signs of loading you stop giving it and you set up an appointment for two days from the time of the last dose. So if you quit giving it this morning you would want to do the acth test on Thursday morning.

Regardless of whether or not you can get the date moved up please please please trust me - no more lysodren. Prednisone only needs to be given when the dog is in distress and your dog wasn't so I would cease giving that so that it is well out of the system for the acth test.

I'm guessing your vet doesn't have a great deal of experience in using this drug. Congrats on the load! Kim

[frijole]

Loading instructions just in case you need it when discussing with your vet.

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

[addy]

Kim knows her stuff so please read her posts and follow her advice.

We are here for you.

[Squirt's Mom]

Hi Jodi,

Don't wait for the vet to tell you to stop - stop now. No more Lyso and do not give the pred unless you see signs of a crisis. Leaving food in the bowl is not a crisis. ;)

If she has already had the morning dose today, watch her very carefully today and tomorrow. It is possible a dose this morning could have been too much so be that hovering Hawk! ;)

You want the ACTH to be as close to the 48 hour mark as possible after the last dose of Lyso so if she has had a dose this morning, Fri morning will be ok. If the last dose was yesterday, then Thurs would be better. Lyso peaks at 48 hours.

Let us know how things are going and know we are all right here with you!
Hugs,
Leslie and the gang

[cairncrazy24]

Spoke to the vet.. no dose tonight.. I have spoken to mom.. she has the prednisone and knows what to do... ACTH test tomorrow morning... :eek:

[cairncrazy24]

1/2 (usual )dose given this morning.. NO Prednisone was given with any doses.. I picked it up at the vets to have on hand just in case... so far today.. she seems ok...

[Squirt's Mom]

Jodi,

Tomorrow morning may be too soon. I would want to wait until at least Thurs afternoon, preferably Fri., since she had a dose this morning. The Lyso will continue building and working for 48 hours which means a reading tomorrow will not tell the true picture - it may show the cortisol higher than it actually would be given time which could lead the vet to conclude Misty isn't loaded when she really is. I may be off base here and if I am I hope someone will come along and let us know.

Hugs,
Leslie and the gang

[cairncrazy24]

Original plans was for her to take medicine up until the night before the ACTH if she hadn't shown any signs of loading... ..:confused: So, your thoughts??

[frijole]

It doesn't work like that. Your vet is scheduling your dog's load around his schedule on Friday.

Your dog loaded a day or two ago when she/he quit eating the entire bowl of food. You called the vet which was the right thing to do. Your vet told you to come in on friday for the test. Wrong. Your vet should have schedule the test 48 hrs from the last dose (more or less). Your vet should not have had you keep giving the drug. Thus my comment about lack of experience with it.

You can't take the pill back and since you gave one this a.m. Friday is two days out. Go to the appointment but do NOT give any more lysodren. None whatsoever no matter what the vet says. You just have to trust us. Kim

[lulusmom]

Hi Jodi,

It's been a while since I've had a chance to catch up on your thread so I started at the begining and whew, Misty has been a complex case for both your vet and the specialist. Misty doesn't have elevated cortisol based on the UTK test results and the more recent LDDS. A recent abdominal ultrasound showed exactly the same state of the organs as the original abdominal ultrasound done well over a year ago......same liver nodules and still normal adrenal glands.

Most dogs with cushing's, who have been symptomatic for as long as Misty, have enlarged adrenal glands. The glands basically become big fatty masses and it is at this point where dogs are most sensitive to lysodren. Dogs that do not have cushing's or have normal adrenal glands have a poor response to Lysodren. As a matter of fact, misdiagnosis is one of the three reasons for a dog's failure to respond. It could be that Misty is an anomaly, a dog with normal adrenal glands and normal cortisol who actually responds to Lysodren in only three days, but I'm a doubting Thomas. Do you know if your vet is shooting for the same goal as he would with a dog with elevated cortisol, being within a therapeutic range of 1 - 5 ug/dl?

Glynda

[cairncrazy24]

I believe that even after 2 LDDS stims which she was borderline at 8 hours on the most recent test, vet asked for another ultrasound. Ultrasound was basically the same as the first one. No noteable differences. Nodular hyperplasia should not make ALKP levels continue to rise as in Misty's case, Internist stated that she could live with those levels, but she is showing almost every sign except hair loss of cushings. I do believe that the vet is aiming for therapeutic range of cortisol. But i'm not the vet. No more lysodren will be given.

I really hope that I've done the right thing giving her Lysodren, but I am not giving any more doses, her ACTH test is for tomorrow AM.