Kwiggles' Joe has passed

[Kwiggles]

Thank you, thank you Natalie for making room for us on this site!

I just started my dog Joe on Lysodren loading yesterday and came online looking for a little moral support and eeek! - no caninecushings.com:eek:.

So far Joe is doing fine, no adverse reactions to the drug, still eating, drinking & peeing & me looking on nervously, waiting for 'the sign' of when to stop.

Such a relief to know I have a place to come where people understand...

Thanks again & fingers crossed that the website is soon up & running again.

Karen & Joe

[ventilate]

Karen;
glad you'er here. Good luck with the loading, just be sure you watch closely. you want to watch for anything that makes you go "hummm" makes you think thats odd or Humm I wonder if that means anything. It usually does. you know your dog best and if you notice anything out of the ordinary ( whatever that means for a cush dog) stop the lysodren and get a stim. it may be just not snapping for a cookie but taking it gently, or stopping while eating and looking around instead of being head down butt up till its gone.
How much does your dog weigh and how much lysodren are you giving? what tests were done to confirm Cushings?
Sharon

[gpgscott]

Hi Karen, and welcome to you and Joe.

Please let us comment on the dosing, would you post Joe's wt. the dose, and would you tell us what symptoms and tests led to the diagnosis.

Best to you both. Scott

[Squirt's Mom]

Hi Karen,

So good to see that you and Joe found us here! Since we don't have all our info from cc.net, could you fill us in on the pariculars again....weight, dose, schedule, etc?

Hang in there and you will do just fine. Just remember if you see anything that makes you go "hummmmm", he may be loaded. Something as simple as looking up from his bowl for a second where before he would gulp it all down.

We are here so don't hesitate to ask any questions, especially if you have doubts.

Hugs,
Leslie and the girls

[MiniSchnauzerMom]

Hi Karen,

Haven't got anything to add but I do have a question.....is this Joe Cocker????

If it is, glad you found us and good luck with the Lysodren loading. If not, the same applies!

Louise

[mytil]

Hi Karen,

Sure am glad you found us here - as Scott mentioned, please give the amount of Lysodren you are giving and the weight of your pup?

Were you able to download from the other site Lysodren loading instructions?

The signs can be subtle, such a slight pause when eating, like taking a second to look up at you. Anything that may make you go hhmmmm.

Also, watch out for diarrhea, vomiting and lethargy. Did your vet give you any prednisone just in case the cortisol levels fall too low.

Please keep us posted as you go through this and if you have any questions, please ask.
Terry

[lulusmom]

In case you haven't noticed yet, acushdogsmom has posted a sticky entitled "Lysodren Loading Instructions and related tips". I highly recommend that you print a copy and keep it handy while loading Joe. I've loaded about, now let me see, I think five times and you should see my copy of that handy reference material. You wouldn't want to touch it without gloves. :D

Glynda

[mytil]

Yes, as Glynda mentioned, we now have this attachment available so print it out.

Continue to keep us posted
Terry

[Kwiggles]

Hello again all!

Yes, this is Joe Cocker I'm talking about- I had a very lengthy (only slightly shorter than War & Peace):o post on the Cushings website with all the details of his diagnosis and treatment plan. Let's see if I can summarize it:

Joe has been showing Cushings symptoms for several months, starting with frequent urination (large volumes), excessive water drinking & hair thinning/loss.

On 12/30/08 he had ACTH stimulation test, results were:
pre 8.4 ug/dL
post 34.9 ug/dL

To diifferentiate PDH from adrenal, on 1/06/09 he had high dose Dexamethasone test, results were:

pre 8.7 ug/dL
4 hr post 4.4 ug/dL
8 hr post 6.8 ug/dL

This was a bit borderline so my vet suspected possible adrenal tumor. He did chest & abdominal x-ray and saw no neoplasia so we proceeded to endogenous ACTH test on 2/16/09. Results were: 48.5 pg/mL

I took Joe to Cornell Animal Hospital on 3/27/09 for abdominal ultrasound with hopes to get a good look at his adrenals. The ultrasonographer was able to visualize clearly the left adrenal and said it was 'slightly enlarged' but no tumor present. The right adrenal was obscured by a loop of bowel so could not be measured or fully visualized but the portion she could see 'appeared to be mineralized', suggesting a tumor.

My vet and I decided to proceed with Lysodren therapy to give Joe some relief from his symptoms with plans to continue in future to attempt to visualize the adrenals, by re-check ultrasound or maybe CAT scan or MRI.

For the Lysodren loading: Joe is 30 lbs and my vet had me give him 500 mg per day (divided into 2 doses per day: 250 AM and 250 PM), starting on Sunday 4/12. I think this dose is slightly on the low side of the range. (?)

For the 2 days prior to starting loading, I measured his water intake and it was 3000 mL on Friday and 2900 mL Saturday. Since starting loading, he drank 3200 mL on Sunday and 2600 yesterday (Monday).

His appetite has remained voracious, he just Hoovers up his meal without hesitation.

So far, so good- he seems to be feeling okay and tolerating the treatment well and I am keeping an eagle eye on him so I won't miss 'the sign'.

If I've left out anything, just ask and I'll see if I can find it (My 'Joe' folder is bulging with paperwork...).

Thanks again everybody for your good wishes and support.

Karen & Joe

[Wylie's Mom]

Hi Karen,

You are doing a great job! It looks like the dose is 36.67 mg/kg/day. If there are no other signs beforehand and if my calculations are correct, according to the Lysodren instructions, you should stop the Lysodren if Joe's water consumption gets to 818mL per day (60 ml/kg/day). You might want to stop before it gets that low because Lysodren continues to work for about 48 hours after dosing and I don't know if they took that into consideration. Others may have a different opinion on this. You may get some other sign before this happens anyway.

Since it is a low dose, did you & your vet have a preset time to stop and test if no signs are seen?

Also, did your vet give you some prednisone (for the dog, not you:)) in case of overloading? Might not have to use it, but it's better to be prepared just in case.

Best of luck to you!

-Susy

[Kwiggles]

Hi Susy,

My vet and I arranged that he will call me on Friday (day 6 of loading) if I don't call him before that to tell him Joe has shown signs of loading being complete. We'll talk then about how to proceed. He's been great about making himself available to talk to during this process.

Forgot to say last time- thanks to whomever (Scott, maybe?) moved my post and started a new thread for me- much easier this way.

And thanks, yes, i do have a printed copy of the loading instructions (by some miracle I was inspired to print it out last Friday right before the Cushings site went away- phew;)) Also have some very thorough guidelines from my vet and have the Pred standing by in case Joe needs it, so I guess we are good to go.
I'll be sure to relate to Joe all the good vibes coming his way- thanks folks, I'll keep you posted.

Karen & Joe

[MiniSchnauzerMom]

Hi Karen,

Just thought I'd drop in and see how Joe (and you) are doing. Sounds like you've got everything well covered with the Lysodren loading info, the pred on hand and a communication line open with your vet.

Glad Joe is feeling well and look forward to your updates on his progress.

Louise

P.S. Is Joe still going to do his rendition of the other Cocker's "Feeling Alright" when loading is completed???

Louise

[Kwiggles]

Hello again all, just checking in:

We are now on Day 4 of loading and everything seems to be proceeding well. No change in Joe's appetite or eating habits so far (still voracious) but looks like he is just starting to back off on the water consumption a little- down from 3000 ml to around 2400 per day. Is it supposed to gradually taper off like this or is the decrease generally more dramatic?

Last night, I was going through some notes I had written down from my online research and came across the following quote (regarding Lysodren treatment):

"90% of dogs with pituitary Cushings load on days 5,6,7 or 8."

Don't know where I got that from, but can anyone comment on that? When I asked my vet when can I expect to see that Joe is loaded, he talked about how every dog is unique, etc, but that he has never had a dog load by day 3 and rarely before day 5. And with Joe there's the complicating factor that we're still not sure whether his problem is pituitary or adrenal.

Tomorrow is day 5 so I will plan to be especially attentive. (*sigh*, I will be so glad when this is done and we can relax a little....)

And yes Louise, Joe and I will be doing the happy doggie dance to the tune of 'Feelin Alright' (and breathing a big sigh of relief) when loading is complete :)

[ventilate]

My dog loaded in 4 days and I know of many that have loaded that fast or even faster. It seems that large dogs load faster, Nike was about 90 lbs when we started. Your vet is correct all dogs are different and there is no way to know how long it will take, some take a very long time. I think Kim did a reload that took close to a month or it seems like it did, I know it was very long and she holds the reloading record:p.
It seems that most dogs do load around 5 days, my vet had me start on thurs as he did not work mondays and said that Nike should load when he was working, well it didnt quite work that way. So I would really start to watch close, It is probably close. Nike left a few kibble for her boyfriend and did not wake me up the night before to go out to pee, she had not done either in a very long time, so I knew that was the sign I as waiting for. I was told to give 1/2 the food and if they ate it all as they had before, give the meds, so i gave her the meds then she left the few kibble and she should not have had that dose and had I of waited till she was done her meal I would not have given the meds to her so be sure you are giving the meds AFTER you watch Kwiggle eat the entire meal then give the meds followed by a bit more food or treat to be sure the med moves down into the stomach. If in doubt dont give the meds remember once it is given you cant take it back, and your gut is usually right.
Good luck and keep watching and you will see:D
Sharon, Nike and Kenai

[Squirt's Mom]

Hi Karen,

You are doing a great job watching Joe and I'm sure you will notice that "hmmmm" moment.

Hugs,
Leslie and the girls

[Wylie's Mom]

Hi Karen,
Not to worry you, but my dog loaded in 3 days and I now think he didn't show any signs. His water consumption went down to the targeted number, but his water consumption varies alot and he had hit that number on occasion before he ever started lysodren. The temperature outside had dropped significantly that day and I wasn't sure at the time if the decrease in water consumption was due to the weather or due to the Lysodren load. Since I wasn't sure, as they say here..."if in doubt, stop loading" and that's what I did. He stimmed nicely afterwards and I think it was just dumb luck - because I now believe the drop in water consumption had to do with the weather, meaning there was no sign. Since then, his water consumption has varied by as much as 6 cups!

Also, my dog has always had a good appetite (I got him when he was 2-1/2y.o.). From what I know of my dog, he has to been incredibly ill for his appetite to slow down or stop. If you believe Joe's appetite has increased with the onset of Cushing's, great; but if Joe is like Wylie, had the appetite well before Cushing's, I wouldn't be too suprised if you don't see early signs of being loaded. This is why I asked if you had plans of stopping at a pre-determined point. I don't think your situation would be similar to mine on two points: 1) Wylie was 76 lbs when we loaded and as Sharon had said, bigger dogs generally load quicker and 2) Wylie's loading dose was about 43mg/kg. So for these two reasons, Joe would probably take longer to load.

Is Joe's cushing's pituitary or adreanal?

-Susy

[Kwiggles]

Hello everybody, I'm feeling in need of a bit of hand-holding here ::(

Joe is now on Day 6 of loading and I am getting a bit anxious. My instructions from the vet are: if he shows signs of loading being complete, I am to stop Lysodren immediately and call the vet. If no signs, I am to continue with the Lysodren through day 8 (Sunday), then stop and bring him in for testing.

I spoke to the vet today and questioned him closely about the water consumption (Joe has dropped only very slightly from around 3000 ml/day to around 2400 ml/day). He said that is not a reliable indicator as many dogs' drinking stays high and continues to drop slowly even after loading is complete. He said appetite is the more reliable indicator.

As Susy said with her dog, Joe has always (even way before Cushings) had a big appetite, always been a fast eater and always cleaned his plate completely. This morning he paused mid-meal to swallow and lick his lips- he does that sometimes anyway, then he dove back in , finished the food, licked the bowl and looked around for more. Might 'the sign' be something as subtle as that? Right now I am starting to feel a bit wobbly in my confidence that I will know when is the right time.

Everyone says 'you will know' and I was sure I would, but now I'm questioning myself:confused:

(Susy, you asked if Joe's diagnosis is pituitary or adrenal- despite extensive testing, the answer to that is still ambiguous. Even an ultrasound was unable to clearly visualize both adrenals and the blood tests were borderline, but there is no question he has Cushings- The test results are detailed in my long post near the beginning of this thread.)

Another frustration for me is that my only computer access is here at work and I will be leaving in a few minutes. I will try to pop in over the weekend and see if anybody has any ideas or comments.

Thanks everybody for being there (& wish us luck)
Karen & Joe

[Kwiggles]

Hi again- Susy, I meant to ask: Since it sounds like Wylie loaded in 3 days and showed no signs, did you have it pre-arranged with your vet to stop Lysodren after 3 days?

[Squirt's Mom]

Hi Karen,

A golden rule around here when loading is, when it doubt, stop the Lyso and have the pup tested. As Sharon (I think) said, you can't take the pill back once it is given but skipping a dose or two won't cause a problem if Joe's test says he isn't quite loaded. So if you are concerned that the "look up and lip lick" mean something, stop and call for an ACTH.

Hugs,
Leslie and the girls

[Wylie's Mom]

Hi Karen,

Since his water consumption had decreased - I wasn't sure at the time if it was due to the weather or due to the Lysodren load. Since I wasn't sure..."if in doubt, stop loading", so I stopped. Only afterwards, seeing more of his varied drinking levels, did I conclude that the lowered consumption for that particular day was probably not due to the Lyso.

Anyway, you have a doubt, so I would stop the dosing and get a stim, maybe on Monday. Lyso will keep working about 48 hours after the last dose - So I think it would be better to get a stim on Monday, not tomorrow, to get a true read.

-Susy

[forscooter]

Hi Karen,

My Scooter loaded in 3 days but really I should have stopped in 2 days...or maybe it was sooner than that..my memory is fading! But all he did was hesitate the tiniest little bit. And he was on the very low end when I did take him in. The vet thought I called it too early but agreed it was better to check.

With Bailey, he loaded in 2 days, and was a perfect 2.5 on his stim. Again, a tiny tiny hesitation. But learning my lesson from Scooter, I stopped.

So, what I tell people is there is no "rule". Go with your gut! You know your pup best and when something says, this may be it, listen to it! Worst case, you continue to load. You won't lose any ground.

If I hadn't listened to my gut, I would have overloaded both my pups.

Keep us posted!
Beth, Bailey and always Scoobie

[Barney's Mom]

Hi, I've been following Kwiggles progress, and I was wondering how the loading process was going?

[Kwiggles]

Hello all,

Checking in on Saturday afternoon, day 7 of loading.

Having a crisis of confidence, I went home last night and dragged out all the information I had collected on Lysodren loading and read over the whole stack, giving most weight to my vet's detailed instructions.

Then with all that info spinning around in my head, I went with my gut and decided that Joe was not yet showing signs of loading so have continued with the Lysodren.

The clincher was when I asked myself, if I was just watching Joe eat and didn't know he was on Lysodren, would I think his appetite was same as usual (i.e., usual for the past few months)? And I had to say, yes- same as usual. So I decided to go with that.

I think I made the right decision; he is still eating enthusiastically, seems to be feeling fine and water consumption still stuck at around 2.5 liters. No diarrhea or vomiting, still happy to go for a 2 mile walk every day, no weakness or lethargy.

I'm finding there is maybe more art than science to this. But I feel good with my decision, so will stick with it through tomorrow (unless of course he shows signs otherwise).

'Go with your gut' is good advice- thank you. (And thanks to everyone else who has offered advice and support- it has been invaluable to me).

Oh, can't wait for this to be over :(

[Barney's Mom]

Hi Karen,
I feel your pain. Loading my dog with Lysodren was one of the most unpleasant anxiety laden activities I have ever experienced. But the good news is that this is day 7 and if things continue with no signs of loading you only have one more pill to give before a stim test. At least you will know what progress you have made.
My dog loaded in 7 days. My instructions were to give the meds for 7 days and then stop and bring him in for a stim. After 7 days there were no signs of being loaded and then on day 8 his drinking lessened and his appetite dropped. His numbers were perfect.
As long as you know the signs and symptoms to look for, and you are in tune with your pet and paying attention, you will be just fine :)
That said, I pray I never have to go through it again!

[Squirt's Mom]

Hi Karen,

Since Joe has shown no signs of being loaded, or overloaded thank goodness!, I would say you are on the right track. You're doing a really good job of listening to your gut and you are to be commended for backing that up with the documentation you have on what to look for as he loads. Keep up the good work! Joe is lucky to have such a diligent mom! :)

Hugs,
Leslie and the girls

[Kwiggles]

Hi again all,

Well, we made it through the weekend without incident and are through with Lysodren (for now...). As of Saturday PM, Joe was still not showing any signs of loading being complete so I gave him his evening dose with his dinner, which he gobbled up as usual. But Saturday night he was very restless, couldn't get comfortable, and kept us both awake most of the night.

Sunday morning he seemed fine and I gave him the first half of his breakfast, which he gobbled down. So then I agonized over what to do- continue Lysodren or not? I decided to split the difference and give him just the morning dose (don't ask me why- not logical maybe but that's what I did).

I called the vet this morning and we discussed whether to continue him another 2 days, and finally decided no more Lysodren and I will bring him in tomorrow (Tuesday) for a stim test. So that's the plan.

And I think maybe just by dumb luck we might have hit it right because this morning, he seemed just a little less eager for his breakfast and eating just a tad slower.

Oh boy, I sure hope this is it :o (tentative sigh of relief...)

Thanks again everybody for your support- you are the best! (and keep fingers crossed for good numbers on tomorrow's stim test!)

Karen & Joe

[frijole]

Hi there! I'm a lysodren mom too so I understand how scary loading can be but I think you did the right thing and will keep my fingers crossed for your test. Also I just wanted to let you know that the restlessness is very common with cush dogs. Cortisol makes you a little hyper. Many of us have given our dogs melatonin to help them sleep. I get them at GNC and they are tiny little pills (3 mg I believe) and I cut mine in half for my 16 lb schnauzer. People that I know that have taken them say it isn't not at all like a sleeping pill/drug thing but rather a chill pill.. just relaxes them. I give them to my other dog on 4th of July and during lightening storms. She sleeps. Let us know how the test goes. Kim

[MiniSchnauzerMom]

Hi Karen,


I called the vet this morning and we discussed whether to continue him another 2 days, and finally decided no more Lysodren and I will bring him in tomorrow (Tuesday) for a stim test. So that's the plan.

Glad the weekend went well. Sounds like a good plan to me!!! Most definitely keeping my fingers crossed for good numbers on Joe's stim test tomorrow.

Louise & Munchie

[Wylie's Mom]

Hi Karen,

I have my fingers crossed, too!!

-Susy

[lulusmom]

Hi Karen,

Mom's always know best and sounds like you know your Joe....I think you called it right. Fingers and paws are crossed here hoping that Joe's stim test results are music to your ears.

Glynda

[Roxee's Dad]

Hi Karen,
Finger and paws crossed here too. Hope all goes well for Joe tomorrow.
John (Roxee's Dad)

[Rusty's Mom]

I'll join in with the crossed fingers!!

MJ

[Kwiggles]

Thanks everybody for your good wishes & crossed fingers (& paws) for Joe- He is at the vet's right now for his stim test.

There's been something else going on which I hope is just something minor-I mentioned in a previous post that he was very restless on Saturday night- same behavior continued Sunday night and last night it got much worse.

He was up and down all night, couldn't seem to get comfortable, not resting for more than a minute or two before getting up again, digging at the blankets and the mattress and all the while whimpering, moaning, sighing and even growling a little at one point.

Now, Joe has always been a rather vocal guy (he hardly ever barks but does make every other sound under the sun) but this was totally out of the ordinary. He often snuffles, grunts and sighs while he's getting settled in and while he's sleeping but nothing like this.

Needless to say, neither one of us got any sleep. I finally got up around 3 AM and took him out and walked around a little. He didn't seem to actually be in pain, wasn't limping or anything, just extremely restless and agitated. I even gave him a little canned food and he ate it right up. I finally just made a pot of coffee and stayed up with him the rest of the night. (the coffee was for me, by the way :o ).

I told all this to the vet this morning and he thought it might be a sign that Joe is slightly overloaded. He reminded me (as many here have also said) that the Lysodren continues to act in the body for 48 hours after the last dose is given, so he might still be on the downward curve of loading. (the 48 hour mark was this morning, so hopefully it is clearing out of his system now).

The vet is going to do a complete blood chemistry in addition to the stim test to make sure its not some new problem. He also said maybe he will try giving Joe a very small amount of prednisone and see if he improves. And we'll know the results tomorrow of the stim test and can take it from there.

Well, Joe is in good hands and I'm hoping this is just a bump in the road. Hoping the pred (or something) will make him more comfortable and we can both get a good night's sleep tonight.

Time to go make some more coffee.....

[Rusty's Mom]

What's the news on Joe???? We are hoping for the best!

MJ

[MiniSchnauzerMom]

Hi Karen,

Just checking in on Joe. Hope all went well with Joe's vet visit and tests today and that both of you can get a good night's sleep tonight.

Awaiting your update.

Louise

[Kwiggles]

Hello All, Just checking in for Wednesday- When I went to pick Joe up at the vet's yesterday after his stim test, he looked much happier and perkier than he had when I dropped him off. The vet had given him 5 mg Pred and suggested i give him a half pill (2.5 mg) last night and same again this morning.

I think it did the trick as he slept much more soundly last night (a little restless but not too bad) and we both got caught up on our sleep :)

I asked the vet if this means that Joe was on the Lysodren too long and he said not necessarily but it does seem to indicate the Lysodren did its job. And that if he were to have had a really bad (life-threatening) response to being overloaded, we would have seen it by now. The residual Lysodren should be pretty much cleared out of his system by now and if his Cortisol does come back too low it can be managed by Pred until it comes back up. Whew.

Just waiting now for test results- some time this afternoon I think.

Thanks again everybody for your concern & support- I'll let you know when I get the numbers. Hope my boy aced his tests :D

[Squirt's Mom]

Hi Karen,

Good to hear that Joe is feeling much better today and that ya'll got a better nite's rest! :D:D Pred can be such a wonder drug!

Hoping for great numbers today!
Hugs,
Leslie and the girls

[Rusty's Mom]

Are you getting butt wiggles???? I surely hope so. Glad to hear the good news so far!!!

MJ

[Roxee's Dad]

Hi Karen,
Very happy that Joe is feeling better. Looks like you are doing a really good job. Looking forward to some good grades on his test.:D

John (Roxee's Dad)

[MiniSchnauzerMom]

Hi Karen,

I, too, hope Joe aced his test! Looking forward to your post with his results.

Louise

P.S. Hope you and Joe are getting some serious zzzzzzzzz's right now (which I need to do myself!!) :D

[Kwiggles]

Hello All,
Checking in with a quick update on Joe- Just talked to the vet on the phone and he said Joe's response to the ACTH stimulation test was 6... That's pretty good, right? (Somebody remind me please- I think I remember hearing that 1-5 is considered ideal?) Before Lysodren treatment, it was in the 30's, so big improvement.

He wants me to wait one more day of observing Joe and making sure he's doing okay before starting Lysodren maintenance- I had not expected he would be starting Lysodren again so soon after the end of the loading- does this sound like the typical schedule? I'm wondering if maybe since Joe was on the high side of normal (at 6), the vet wants to make sure not to let the adrenal start regenerating again right away. (Does that make sense?)

Sorry to sound so clueless :o but this maintenance phase stuff is all new to me!

Anyway, feeling very happy & relieved for my boy :D And yes, MJ, Joe and I will now do the happy doggy dance, complete with wiggling butts (both of us :p )

[frijole]

Hi Karen,

Since you never reached 5 or below I agree with the vet that starting soon on maintenance is a good idea. What were the instructions from the vet? Are you giving the dosage all in one day or splitting it in half and giving it 2 x a week?

The purpose of "maintenance" is to keep the cortisol levels where they are so they don't creep back up to 30 again. Keep a vigilent eye out in the event that you didn't get low enough to maintain your level of 6. If you creep up you will probably have to do another small load referred to as a miniload. You basically do the same daily thing (perhaps at a higher dosage) for a few days and retest.

My dog didn't make it below 5 and I had to do a miniload. I waited 2 mos to retest. You might do a test after 30 days (acth) just to be sure you are maintaining.

Congrats because the very hardest part is over! Pat on the back. Treats for the dog. Good luck! Kim

[ventilate]

actually 6 is high, the normal range we want to see is between 1ug/dl and 5 ug.dl so you are correct 6 is high. What is the maintaince dose and sched he wants you do to? my concern is when dogs cortisol levels are higher then the theraputic range it crawls up higher on the maintaince then you have to reload. When did he want you do a stim again? Be sure not to go more than a month that is per protocol and time will tell if it will hold. Good job
Sharon
Now your vet seems like he knows what is going on,( not quite sure about the starting maintance when the level above the range) but I am sure the pred would have been given after the stim test was done, right? there is not way it was given before? what was the baseline stim there should be 2 numbers a pre blood draw or resting then the ACTH is administered and a hour or so later the second draw is done.
Sharon

[lulusmom]

Hi Karen,

I know that loading and maintenance is confusing so I'll try to explain it so that it makes more sense.

The little lesion on Joe's pituitary gland really messes with the communication signal between the pituitary and adrenal glands. The demon little lesion is kinda like the devil that sits on my shoulder sometimes that makes my mouth go into overdrive...so like me, the pituitary gland cannot shut up and keeps signaling the adrenals to keep pumping out them steroids. Oy vey.

The part of the adrenal glands that produces steroids and hormones is called the adrenal cortex which is the outer layer of the adrenals. Now this is perfect because the beauty of Lysodren is that it specifically targets the adrenal cortex without effecting the other parts of the adrenal glands. During the loading phase, you give heavy and frequent doses of lysodren that basically pound the adrenal cortex until it has eroded or shrunk it to a point where the excess flow of steroids is stimmed at which point you can say, tada cuz the dog is loaded.

In order for a dog with cushing's to be normal, meaning to see a resolution of all symptoms, you want the flow of post acth circulating cortisol to be no greater than 5 and optimally no less than 1.5. So any where between 1.5 and 5 is perfect. Unfortunately, the adrenal glands will regenerate so you need to maintain them in the same state they are in after loading. This is where the "maintenance" dose comes in. It doesn't take massive doses to maintain the adrenals in their current state and as a matter of fact if you give too much, the dog will get really sick from not enough cortisol being secreted. Soooo, usually a dose equal to the daily loading dose is split, preferrably into two or three doses and given on like Mon, Wed & Fri. For instance, if a dog loaded on 375mg a day, the maintenance dose would be 125mg given three times a week.

Your vet determines an appropriate maintenance dose and when to start maintenance based on the loading dose, how long it took to load and the post acth stim number. Sometimes its a crapshoot as to whether or not the maintenance dose will maintain the erosion which is why, as Sharon has stated, it is important to have another stim done no longer than 30 days into maintenance. It's alot better to know where you stand early so as to avoid having to reload.

I hope this helps.

Glynda

[Rusty's Mom]

Hi Karen,

Love that you get to do the happy dance - wiggle away!!

MJ

[Harley PoMMom]

Hi Karen,
Glad to hear that the hard part is over for you and Joe, 6 is a WHOLE bunch better than 30. Harley is smiling ear to ear for you and Joe and Joe will have to teach us how to do that wiggle dance! :)

Take care and good for you both!! Harley and Lori

[Kwiggles]

Okay, I just talked to the vet again and we decided to go ahead and start Joe on the maintenance dose of Lysodren today. It will be 500 mg per week, divided into either 2 doses or 4 doses (he gave me the option, I think I will do 125 mg X4). He suggested Joe come back for an ACTH stim test in 3 weeks. (want to keep a close eye on it as Joe's response was a little higher than we would have liked).

I have a question regarding giving the meds- I thought I read somewhere that giving the pills together with a high-fat food can inhibit absorption of the drug- anybody know if that is true? (does that mean no peanut butter? Oh dear, I don't want to be the one to have to tell Joe that...)

Sharon- I asked if the Pred was given to Joe after his stim test was complete- and yes, it was given after both time points were finished. Thanks for picking up on that- (good catch!)

Glynda & Kim thanks for the very complete explanation of the maintenance process- I think I got it now!

I forgot to ask for the specific before-and-after numbers from the stim test, I will find out next time I call.

Thanks again everybody for supporting me & Joe through this process- its good to have somebody to hold your hand when you're freaking out!

Wishing a wonderful weekend to everybody & their cushpups! (& Joe sends an extra-special butt wiggle to MJ!)

Karen & Joe

[MiniSchnauzerMom]

I have a question regarding giving the meds- I thought I read somewhere that giving the pills together with a high-fat food can inhibit absorption of the drug- anybody know if that is true? (does that mean no peanut butter? Oh dear, I don't want to be the one to have to tell Joe that...)

Joe can remain happy and have his peanut butter. The fat does not inhibit absorption of Lysodren...it helps.

Wishing you and Joe a very nice weekend too!!!

Louise

[ventilate]

Now dont tell Joe this but dont go overboard with the fat as cush pups are more prone to pancreatitis and that can be causes by to much fat so everything in moderation, Isnt that the way all things go, if it tastes good it has to be bad for you:D:D:D
will look back and see what dosage you loaded with and may edit my note
Sharon

[MiniSchnauzerMom]

Hi Karen,

It's Sunday and I'm posting this today so that you'll have it first thing tomorrow! :D

So.....how's Joe doing on his maintenance???

Louise

[Kwiggles]

Hello Louise & everybody,

Today is one week since Joe's loading was completed and he has been on maintenance dose of Lysodren (500 mg in 4 equal doses per week) since Friday.

So far, his progress has been generally good with a few not-so-good days (or rather I should say, nights). Most aspects (appetite, water consumption, energy levels) are steadily improving and I would say that in the daytime hours, he is generally a comfortable and happy guy.

Late at night, however, he often gets into this restless mode where he just can't get comfortable, can't lay still, and spends several hours (about midnight to 4 AM) laying down, getting up, pawing, fidgeting, sighing, moaning and grunting. Not every night and not always excessively but sometimes it's quite bad (like last night) and neither one of us gets much sleep. Around 4 he usually falls asleep and sleeps soundly til around 7. I don't know if he finally gets comfortable or just gives up from exhaustion.

Yesterday it was especially puzzling as, on our afternoon walk, he was perkier than I have seen him in months. Then, a very fitful night.

Someone had mentioned to me when Joe was in the midst of loading that high cortisol can cause this kind of restlessness, but Joe's cortisol levels are now (or supposed to be) lower than they've been in months. And even before treatment, when his Cushings symptoms were worst, I never saw anything like this.

I should say that, in general, I think he's doing really well and this sleeplessness doesn't seem to be symptomatic of a dire problem but it sure is impacting my quality of life. (Joe has the whole day at home to catch up on his sleep but I have to get through the work day without nodding off :o )

Anybody got any ideas?

[Kwiggles]

Oh, just wanted to add one more thing- Joe's restlessness at night kind of looks like the way a dog (or person) might behave if they had an upset tummy or really bad gas. Now, he normally has a cast-iron stomach, but I'm wondering if the Lysodren may have upset his digestive system (maybe killed off the beneficial flora in the gut?) Do you think a little yogurt might help?

And he has been having some gas lately (my nose tells me so, if ya know what I mean :eek:)

Thanks for any help, folks :)

[Roxee's Dad]

Hi Karen,
Don't know if I can help, but Roxee slept much better when we kept the temp lower at night an put the ceiling fan on. Even when it was freezing outside, we, my wife and I would be wearing 2 and 3 layers of clothes to keep warm, Rozee would be under the covers, but Roxee would then sleep much better directly under the fan and on top of the covers.

This may or may not be the case in your home.

All the Best.
John (Roxee's Dad)

[Kwiggles]

Thanks John- Yes, Joe is definitely more comfortable in a cool spot. Since we live in Maine and it's still just barely spring here :o I don't know if he's overheating yet, but something to consider. And we live in a drafty old house where the indoor and outdoor temps are usually about the same :rolleyes:

I'll open the windows a little wider tonight and see if that helps (oh, the things we go thru for our pups ).

[Roxee's Dad]

Hi Karen,
It's been a while, how is Joe doing? Hope all is well with you and Joe.
John (Roxee's Dad)

[Kwiggles]

Hi John,

Hello to you and thanks for asking about Joe- he is doing great! I will be taking him back to the vets soon (probably early next week) for another ACTH stim test, but to my eyes, he is much improved (hope the numbers say the same).

His water consumption is about half what it was before treatment and still gradually on the decrease. And he is much perkier on our walks but more relaxed when he's resting. We haven't had one of those awful agitated nights in a couple of weeks :)

When he started to lose his hair, it made the strangest pattern- like a reverse Mohawk with a bare patch down his spine but still lots of hair on his legs & head and a bizarre little ruff of fur like a necklace. His hair has not started to grow back yet but I wanted to 'tidy up' his head and neck a bit yesterday so started snipping away with some scissors and before I knew it, I had a kinda big pile of fur and a kinda funky looking Joe :o Right now he looks a little less like Joe Cocker and a little more like Rod Stewart :D (Its okay- he likes having his hair cut, I think it feels cooler and anyway he doesn't have enough sense to be embarrassed)

Now I know why you groomers go thru professional training ! :rolleyes:

Hope you and your furries are all well,
Karen

[Squirt's Mom]

Hey Karen,

I am LMAO at your story of the hair cut! :D:D You and Cheryl's (Barney's mom) hubby need to get together. You bring your scissors and John will bring his clippers. Oh my goodness! How funny!! Poor Joe, but I bet he is just a pleased as punch!

Good to hear that Joe is doing well otherwise and I can't wait to see the test results when it's time. Thanks for letting us know how things are with you and Joe "Stewart". :p

Hugs,
Leslie and the girls

[Roxee's Dad]

Hi Karen,
Oh No another furr mom with a pair of scissors:eek::eek::eek: Usually a groomers worst nightmare;););) One thing to remember....... it usually grows back:)

So glad to hear that "Joe Stewart" is doing better. Joe Stewart, hmmm and interesting combination or....maybe not;)

Sounds like Joe is a happy boy:D Good to hear good news:D

John (Roxee's Dad)

[maggiebeagle]

Maggie's post trilolstane fur grew in very fluffy and puppy-ish. We took her to Petsmart for a trim and came back to a shaved beagle. She looked strange but seemed to be more comfortable in the heat. I guess she was trying for the GI Jane look.
Virginia and Maggie

[MiniSchnauzerMom]

Hi Karen,

Just dropped by to read Joe's update. It's good to hear he's doing great and that you're seeing positive results. Let us know the results of his stim test next week. We're interested in "Joe Stewart" and want to keep up on the latest! :D :D

Louise

[Rusty's Mom]

Great to read Joe is doing so well!! Glad to hear you are seeing the benefits of treatment - know is he glad too!!

Keep up the good work!!

MJ

[Kwiggles]

Hi Karen,
Oh No another furr mom with a pair of scissors:eek::eek::eek: Usually a groomers worst nightmare;););) One thing to remember....... it usually grows back:)

So glad to hear that "Joe Stewart" is doing better. Joe Stewart, hmmm and interesting combination or....maybe not;)

Sounds like Joe is a happy boy:D Good to hear good news:D

John (Roxee's Dad)


Joe Stewart- he he! Next thing he will be dancing around singing "Do Ya Think I'm Sexy?" :p (Oh well, as long as he doesn't want me to go out and get him a pair of spandex pants...:eek::D

[Rusty's Mom]

Karen,

Ah geez, get the boy whatever he wants!! You know, living so far north probably necessitates some sleek trousers!

MJ

[Kwiggles]

Dear friends,

I am writing this through my tears. Joe is gone, he passed away this afternoon. I always thought Cushings would be the last foe he would have to face at the end of his life, I never could have predicted this.

We were walking on our favorite road on Saturday afternoon as we had a thousand times before when 2 big dogs came running out of their yard and slammed into him. They knocked him down on the pavement and just started biting him. The owner eventually saw what was happening and called them back but by then the damage was done.

I rushed Joe to the emergency vet clinic where they stabilized him and early this morning they performed 2 hours of surgery on him. He had massive internal injuries. He came through the surgery but about 6 hours later, his heart just stopped, the surgeon said it was probably a blood clot.

I am devastated. Already I miss him like crazy, he was my little buddy, always by my side, so loyal and loving. I see him everywhere I look and I know I will for a long time to come.

My only comfort is that he had the best of care in his last hours, the emergency vet and technicians were so kind and gentle and skilled. I know they gave him the best chance of pulling through, it just wasn't meant to be. And now he is out of pain and suffering and fear.

I will write again when I can. Please give your babies an extra hug and kiss for me in memory of Joe.

Karen

[MiniSchnauzerMom]

Oh, Karen,

I am absolutely stunned and so very, very sorry for your loss. What a horrid experience for Joe and you to have to go through. OMG, I just want to give you a big hug and cry with you right now.

Please, when you are ready, do come back and write. Sharing can be healing. I will be giving my Munchie a big hug and kiss in memory of your Joe.

Peace, sweet Joe.

Love & Hugs,
Louise

[forscooter]

Karen,

I haven't had a chance to post to you before, and I came to peek in and read through some threads. I came to your post almost right away. Something just made me check here...

I'm heartsick for you! What a horrible, tragic experience for you all. My eyes welled up and I just feel so sad for you.

I lost my Scoobie right after Christmas and I am still missing him like crazy...I know what an impact our little pups can have on our lives and it is HUGE.

I understand about thinking it would be the Cushing's...how we worry and fret over the disease and treatment and all that comes with it. And then to have something so completely out of the blue change all of that in a single sweep of a second....it's just beyond putting into words.

I am so so sorry...I wish there was something I could do or say to make you feel better right now. Please know that there are a million hearts going out to you as people see your news. And know too, that your Joe will always be remembered by the Cushing's family you have come to know.

Please take good care of yourself right now, Karen. Do what you need to do for yourself and give yourself this time. Again, I am so very very sorry!!

Lots of hugs being sent! Beth, Bailey and always Scoobie

[frijole]

Karen,

Well we are all just stunned by this sad turn of events... so hard to understand. I hope that you too are OK as this had to have been traumatic for you to witness... oh I feel just sick. I'm glad Joe was in such great hands and you handled it so well. Take care of yourself and when you feel like coming back to talk...please do. Big hugs and prayers from my house to yours.

Kim

[Harley PoMMom]

Dearest Karen,

I am so, so sorry for the loss of your beloved Joe.

I know words can not do much for the pain you are feeling, but know we are all here and are grieving with you in this time of saddness.

Oh Karen, I wish there was more I could say or do for you right now to help.

Come back and post when you can...please.

[ChristyA]

Karen,
I am so stunned, I just want to reach out and hug you. I just can't imagine how I would react in the same situation. I'm just relieved Joe was in good hands with his care after the attack.

I am so, so sorry. Please know we are all here if you would like to talk.

Christy

[Barney's Mom]

Oh Karen, I am just heartsick to hear of the loss of kwiggles Joe. What an absolutely horrible tragedy. You are in my heart and prayers,

Cheryl

[lulusmom]

This thread will be closed. Please go to sweet Joe's thread in the In Loving Memory Forum.

http://www.k9cushings.com/forum/showthread.php?t=480