Another newbie with questions, please - Hannah (5 y/o schnauzer)

[Hannah's Mom]

Hi Everyone --

My five-year-old schnauzer, Hannah, was very recently diagnosed with Cushing's. The vet just gave her one test which I believe was the ACTH Stimulation Test. (I am contacting my vet to get more information.) The vet wants to put Hannah on Lysodren. Has anyone had any experience with Lysodren vs. Trilostane? And shouldn't more testing be done to find exactly where the tumor is - adrenol or pituitary?

BTW, you guys have warmed my heart. I am so worried about my chubby little girl. Thanks very much.

[StarDeb55]

Welcome to you & Hannah! I'm sure glad you found us, but awfully sorry for your reasons to be here. Could you get a copy of the ACTH result along with any general labwork that might have been done on Hannah, & post the results for us, if you don't mind. On the general labwork, which can be something like a senior wellness panel or super chemistry panel, please post only the abnormal values, along with units of measure & normal ranges.

What symptoms were you seeing with Hannah that led you to take her to your vet? Was diabetes & thyroid ruled out? I'm especially concerned about the diabetes since Schnauzers are very prone to developing it. Cushing's is one of the most frustrating diseases to get an accurate diagnosis for, so it is very important that a positive results on any single test be confirmed by another test. We frequently suggest an abdominal ultrasound to get a look at the adrenals which should determine what type of Cushing's. You will also be able to see all of Hannah's internal organs to get a better idea of her overall health. The US must be done on a high resolution machine & most general practice do not have this kind of equipment.

I am a lysodren parent, never used trilo. I have now successfully treated 2 pups with lysodren. My first cushpup, Barkley, was successfully treated with lyso for nearly 8 years crossing the bridge at 15 from cause unrelated to his Cushing's. In general, with trilo, there seems to be some dose tweeking needed to get the pup on the appropriate dose which means more ACTHs, & more $$$. Whichever drug you use to treat, the most important thing that you can do is read up on the medication, what signs to watch for if a problem might develop with your pup while under treatment, & the appropriate monitoring that needs to be done including timeframes. In general, the best thing you can do is to read up on Cushing's, in general, & become a knowledgable, educated owner as you are Hannah's only voice & advocate.

Again, welcome, we are here to help in any way we can.

Debbie

[Harley PoMMom]

Hi and welcome to you and Hannah!

Since Cushing's is one of the most difficult diseases to get a proper diagnosis usually multiple tests are done. The reason for this is because not one test is 100% accurate at diagnosing Cushing's. Strong symptoms are a huge part of the diagnosis, does Hannah display any Cushing symptoms?

We do have members that are using Lysodren and we also have many members that have used Lysodren in the past so I am sure they will be along to offer their support and knowledge.

Here is a link with information about Lysodren: Lysodren loading Instructions and related tips (http://www.k9cushings.com/forum/showthread.php?t=181)

Please know we will help you in any way we can so feel free to ask any and all questions.

Love and hugs,
Lori

[littleone1]

Corky and I also want to welcome you and Hannah.

I don't have any experience using Lysodren, as Corky has been taking Trilostane for almost 2 years.

I'm glad you found us. We have a wonderful group of very caring, supportive, and knowledgeable people that have alot of experience with cushings.

Terri

[frijole]

Hi... I love schnauzers! I treated my Haley with lysodren and it worked just great. Like the others... I'd like to know the whole story, the symptoms etc... and yes... I would do more testing because you can get false positives on the acth test... I did with my other schnauzer. So share what you know and don't be shy. Kim

[addy]

Hi and welcome from me and my Zoe.

I LOVE your avatar.:D:D:D:D

I do not have much to add since the others have covered things pretty well to get you off to a good start.

So I will just say I am glad to meet you and Hannah and hope we can help.

Hugs,
Addy

[Hannah's Mom]

You guys are fantastic! As you all know from your own experiences, I have been worried sick.

I am waiting for a reply from my vet after asking all the pertinent questions you have given me to ask. I'll be back to you as soon as I hear from her.

Thanks so very much.

[Nika'sMom]

Hello. I am new here as well so I don't have any advice to offer you, but I would like to welcome you and your Hannah to a really wonderful group of amazing people. I look forward to learning more about your you and your girl. Welcome with hugs, from Lynda and Nika

[MBK]

I am sorry for the reason that brought you here but I also wanted to welcome you and Hannah. There are many others here with much more knowledge than I when it comes to the medical aspects, but we all are here to listen and offer whatever support we can. It is so hard to not feel totally overwhelmed by all that you will be learning, but hang in there. We all understand how worried you are, so hopefully this site will help you.

[Hannah's Mom]

OK, my new friends, below are the questions I asked my vet and the answers she gave me. I believe everything she says is a very conscientious assessment of Hannah's condition and her suggestion for meds seem appropriate now.
==================
1. I am learning about this illness and I need some basic information to do my research. I believe you gave her the ACTH Stimulation Test to diagnose, correct? Could I get a listing of the abnormal values, along with units of measure and normal ranges?

Yes, we did the ACTH stimulation test. Hannah's values were 4.7 (range 2-6 ug/dl) up to 24.3 (6-18 ug/dl). This is consistent with Cushing's disease

2. Is there any other testing that might be useful – such as an imaging test to pinpoint exactly where the tumor is (adrenal or pituitary) to accommodate gauging its growth in the future?

She has already had the standard imaging, which is an abdominal ultrasound. Both adrenal glands were normal in size, which is consistent with pituitary-dependent Cushing's. We typically do not image the pituitary gland, as these tumors are most often microscopic and will not show up with standard imaging.

3. I believe you recommended Lysodren (Mitotane) as a treatment. I was wondering your thoughts about treating her with Trilostane instead since this med doesn’t damage the pituitary gland. How have dogs compared when you treated them with Lysodren vs. Trilostane?

Either drug can have side-effects, and I do not find one to be safer than the other. Lysodren does not damage the pituitary gland, it kills off the excess adrenal tissue. Trilostane decreases the hormones made by the adrenal gland. There is no difference in efficacy between trilostane or lysodren.

4. Is there a chance that Hannah has something else like diabetes or thyroid problems? Could any other illness(es) present these same symptoms?

Hannah tested negative for diabetes and hypothyroidism.

5. Is it unusual that Hannah, who just turned five, got this disease? From what I’ve read, this is a more common disease for older dogs.

That is just the average age. Dogs of any age can get this disease.

6. Is there any possibility there is a relationship between her gall bladder problem and the Cushing’s symptoms?

Yes, often dogs with gall bladder problems have concurrent Cushing's disease

7. Is surgical removal of the tumor(s) an option in this case?

Since she does not have an adrenal tumor, standard surgery is not an option for Hannah. There is a surgery to debulk the pituitary gland, but it is only performed by 1 or 2 surgeons in the country. I do not have any personal experience with it.

8. Since Hannah won’t have the extra cortisol in her system (produced by the Cushing’s) to buffer the pain from her soft tissue injury, what can I expect to happen with her already pronounced limp in her front arm?

The limp may get worse because of decreased cortisol. However, cortisol can also cause muscle and ligament weakness. So the limp could also get better! It's hard to predict.
===============

I'm sorry I've posted so much to read on this, but I wanted you guys to get a full picture. You also asked about her symptoms. They are obesity (she weighs 32 lbs. now - very big for min. schnauzer), panting, pacing (I only recently found out this could be symptom), increased water consumption, increased urination, there also seems to be some weakness in her hinds legs. About the only thing she doesn't have, as far as symptoms, is the hair loss.

Finally (and I know I've worn out anyone reading this post), here is what the vet has recommended:

First we will start off with the loading dose of lysodren. She will get 1 and 1/2 tablets (500mg size) once daily for the next week. Then I would like to see Hannah back for a re-check ACTH stimulation test once her appetite "normalizes". This is usually after one week of treatment. And if she is still ravenous after one week, we will test her numbers anyway. But if her appetite decreases to normal sooner (ie after 5 days), then she will need to come in on the following day. Does that make sense?

You will need to monitor Hannah closely for poor appetite, vomiting, diarrhea, weakness, or lethargy. If this happens, stop the drug immediately and let me know.

Once Hannah's ACTH stimulation test numbers are in the appropriate range, and her clinical signs are improved, we will switch her over to the maintenance dose of Lysodren. I am only going to dispense one week's worth of the Lysodren, with the plan that I will see Hannah next Friday (or Saturday, depending on when you start the drug) at the latest, but possibly earlier if her signs change sooner.
===================
Now I am worried sick about monitoring her for any of these things. I mean how can you tell whether her appetite has "normalized" or if she has "poor appetite."

What do you guys think? Thanks again so very much.

[Squirt's Mom]

Either drug can have side-effects, and I do not find one to be safer than the other.

I just fell in love with your vet! :D:cool: Trilostane can destroy the adrenal glands just as Lyso can. The key is a positive diagnosis, careful prescribing, and diligent monitoring for both drugs. ;)

What your vet is proposing is correct protocol for Lyso and I am so impressed. The loading dose is calculated at 50mg/kg/day. At 32 lbs, Hannah weighs 14.55kg (32 / 2.2 = 14.545454...). 14.55 x 50 = 727.5. Since Lyso can't be easily divided, the dose is figured at 750mg/day - which is what 1 1/2 tabs equals. So the dose is correct. ;) When the load is completed, Hannah will go to maintenance at 750mg/week vs per day.

What you will look for to determine if she is loaded are her appetite and drinking primarily. The sign may be very subtle, something as innocent as looking up from her bowl while eating. Take a few days before you start to really observe her eating and drinking habits - does she gulp her food? will she look at you when you say her name while she is eating? does she stay at the water bowl for a good length of time? or return to it often? Once you see a change in these behaviors while she is being loaded, there is a good possibility she is loaded and ready to be tested. We don't want Hannah to get to the stage of loose stools, vomiting, etc. and most pups will give us a sign before this happens. Here is a link from our Helpful Resource Section on Lysodren - loading and some tips from our members that are very beneficial.

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

Read it carefully before starting the loading process. Many of us have printed it off then hung it in a place we could easily see.

You are going to do just fine with the loading phase. We will be right here anytime you need us and it sure sounds like you have an experienced vet!

Hugs,
Leslie and the gang

[frijole]

I loved all of your vet's answers too. Now.. that said... I want to clarify the symptoms... because you don't treat unless there are symptoms... you mentioned water intake being more than normal. Cush dogs drink 'buckets' of water, not a bit more. Dogs drink 1 oz per lb of weight ... am curious how much your dog is drinking. If you don't know... start measuring it NOW before lysodren dosing so you can compare it (yes you'll measure it daily) during the loading phase.

Appetite change - dogs with cushings are ravenous. They inhale food without even chewing it, they knock over garbage cans to get to food. Does your dog not do this?

Kim

[Hannah's Mom]

Not sure about the water intake. I do know I have had to add a lot of water to the water dishes that I didn't have to do about 8 mos. ago. And Hannah is always hungry. Causes me some grief with my neighbors because she will bark at me to feed her or give her treats which she also started doing about 8 mos. ago. Hannah will steal food from my other dog if I turn my back. She looks for food on her walks and I have to watch her carefully. She has eaten a number of chicken bones in her day and lived to bark again. I don't know if this is actually as "ravenous" as you mean, though.

[Hannah's Mom]

Thanks very much, Leslie. I have printed this out now and will post it at home. It has helped me to breathe easier. Sorry if I've been whiny, but I'm sure you understand. I owe you guys a lot.

[Harley PoMMom]

First we will start off with the loading dose of lysodren. She will get 1 and 1/2 tablets (500mg size) once daily for the next week. Then I would like to see Hannah back for a re-check ACTH stimulation test once her appetite "normalizes". This is usually after one week of treatment. And if she is still ravenous after one week, we will test her numbers anyway. But if her appetite decreases to normal sooner (ie after 5 days), then she will need to come in on the following day. Does that make sense?

You will need to monitor Hannah closely for poor appetite, vomiting, diarrhea, weakness, or lethargy. If this happens, stop the drug immediately and let me know.

According to Dr Feldman, a renown Cushing's expert, the Lysodren loading dose should be split and given twice a day.

Also during the loading phase if Hannah should not act like herself in any way, Lysodren should be stopped and an ACTH stim test should be done within 36-48 hours. Any hesitation in eating that Hannah displays can be a sign of her being loaded.

Love and hugs,
Lori

[Hannah's Mom]

Thanks Lori. I will be on the lookout for ANY indication (including what you have listed) that Hannah is being loaded. And I'll see what the vet has said regarding dosing twice a day. I will be sure to split it in half to two dosages per day (3/4 of a tablet).

Really appreciate your help.

[Jenny & Judi in MN]

good luck. sounds like your vet is very thorough! My vet was rushed when we started loading my Jenny and I didn't realize you should give the Lysodren with food. (but you probably already know that)

Jenny, an 8 pound diabetic poodle, loaded in 3 days. We just had to increase her maintenance dose of Lysodren 2 weeks ago though and you may not think Hannah is acting ravenous but I bet you will see a change.

I could tell when Jenny's Lysodren wasn't working anymore because she is STARVING. And when I pet her while she eats she mantles like an eagle and growls (very un-Jenny like)

best of luck. The folks on this forum have been very helpful even when I don't always take their advice!

Judi

[Hannah's Mom]

Thanks Judi. I didn't know you were supposed to give with food, although that might be listed on the prescription. Really appreciate that. I'll be sure to ask questions when I pick up the prescription today.

[Jenny & Judi in MN]

let us know how it goes. Are you getting a prescription for prednisone too? In case you need to counteract the Lysodren. You should be.


I let the pharmacist cut our pills in half when he offered and now I regret it cause Jenny is taking 1/4 of a pill at a time and the pharmacist didn't use the lines on the pills making me worry about my 1/4's. I have control freak issues. :D

keep us posted on Hannah!

[Harley PoMMom]

Thanks Judi. I didn't know you were supposed to give with food, although that might be listed on the prescription. Really appreciate that. I'll be sure to ask questions when I pick up the prescription today.

For Lysodren to be properly absorbed it should be given with some adequate fat. Many members put the Lysodren in peanut butter or cream cheese. Also, giving the dose of Lysodren (in cream cheese or peanut butter) after the meal buffers the tummy from gastric upset.

Another reason to give the dose of Lysodren after the meal is if Hannah hesitates while eating this could be a sign that she is loaded and you would not want to give the Lysodren.

Love and hugs,
Lori

[frijole]

What the others have just posted is very important. Give the lysodren AFTER the meal, not during. Remember, you cannot take it back and it continues to work for 48 hrs so when in doubt do not give it. You can always post here and we will help you thru it.

I used that same reference sheet for loading years and years ago and I read it every day... it helped a lot!

Please confirm you have prednisone on hand. If not, don't start the lysodren til you do. You probably won't need it but we protect all our furry ones. ;):D Kim

[Hannah's Mom]

Ok, guys, ready to give my first dose. Hope I can hear from you guys before I do.

The vet said to give her 1 1/2 tabs.once a day with food. That's not what you guys mentioned and not what I've read. Most posts say TWICE a day. I was also shocked to find rubber gloves with my prescription. I was never told about that either. Very worried now. Advice from the experts?

[frijole]

Twice a day... and its from those of us who have all done it as well as specialists in the field. Divide it into two doses - AFTER each meal.

Gloves.. interesting the vet provided them but didn't explain. The drug is a drug and it if you had cuts in your hand it could have an effect on you. Always use them if you are pregnant. I used them in the beginning but after I got used to it I never did unless I had a cut on my hand. Don't be scared - just respect the drug and pay attention to water intake and food intake as we discussed. We will all keep an eye out for your posts.
Kim

[frijole]

PS Please confirm you have prednisone on hand. :D

[Hannah's Mom]

Please confirm you have prednisone on hand. If not, don't start the lysodren til you do. You probably won't need it but we protect all our furry ones. ;):D Kim

You know what? This can wait another week until I get the prednisone. AND I can wait for your responses on the once-a-day vs. twice-a-day dosing.

Thanks very much, everyone!

[Hannah's Mom]

Much love to you, kim!

[frijole]

You know what? This can wait another week until I get the prednisone. AND I can wait for your responses on the once-a-day vs. twice-a-day dosing.

Thanks very much, everyone!

:D We probably posted at the same time but you want to give it twice a day - this is the protocol established by the world renowned cushings experts like FELDMAN. The drug is strong and it is just better to divide it up and give it after each meal - so feed twice a day if you aren't now.

Its a weekend so I would go get the prednisone NOW so you aren't without it for potentially 3 days. Prednisone is also required to have on hand just in case of emergencies. You can read about it on that sheet/link we provided earlier. Kim

[Squirt's Mom]

WISE move, Mom, waiting on the Pred! :D:D And don't take no for an answer from your vet. Pred is not an option with these drugs, it is a necessity! ;) Most pups never need it but we should always have it on hand when treating our babies.

You can direct your vet to the chapter on Hyperadrenocorticism in the Textbook of Veterinary Internal Medicine, S. J. Ettinger and E. C. Feldman, editors. 1995, if they balk. This is the protocol that is followed still today.


INITIATING THERAPY - THE LOADING DOSE PHASE:

Therapy is begun at home with the owner administering Lysodren at a dosage of 50 mg/kg/day, divided and given BID (twice a day).

Glucocorticoids (prednisone) given together with the Lysodren is not advised during loading, but the owner should have a small supply of prednisolone or prednisone tablets for an emergency.

The owner should receive thorough instructions on the actions of Lysodren and should also have specific instructions on when the drug should be discontinued.

You are doing a great job so keep up the good work. As Kim said, we will be here any time you need us!

Hugs,
Leslie and the gang

[Hannah's Mom]

Thanks so much, Leslie! I am preparing the email to the vet and I will use the Feldman quote you listed. I kind of think there was an instruction sheet missing from the bag that contained the Rx, but still no reason for the vet to say "once a day" instead of "twice a day." AND also to overlook the prednisone.

Question on the prednisone: You give it IF there are reactions, correct?

[frijole]

Good job Leslie on providing her the text!

Regarding prednisone - like Leslie said, most never need to use it however it is necessary in the event of overdose. Lysodren reduces the amount of cortisol that your dog is producing (the cushing's culprit). You want to reduce it to a normal level but not completely. Your goal is to get it between a 1 and a 5 (the 2nd number on the acth test).

So you give lysodren daily (called loading) until you reach that point. AFter that you are 'maintenance' and you start only giving the drug a few times a week and at lower amounts (we'll save details for that for later)

Anyway, the reason you need to watch for changes in food/water intake is because if you reduce the cortisol too much (giving too much lysodren) your dog will get sick. Usually starts out with diarrhea or vomit, lethargic as in cannot get up off the floor... Scary stuff but the prednisone is there for this.

Prednisone mimics cortisol. So if your dog gets into an emergency situation you have it on hand to shove down their throat ;) and within a few hours your dog will act normally. It is very important and can save dogs lives... in the unlikely event you get to that point.

So while most of us have never had to use it... you want to have it on hand and your vet's office should not have given you lysodren without it. Does that make sense?

Kim

[Hannah's Mom]

Makes perfect sense, Kim. Soooo, where do I send my check? :) Honestly, you guys can explain things so well for laypeople. And people like me, just learning about this very, very tricky disease, need that as much as we need the meds.

[frijole]

:) Just play it forward! I found these people 6 yrs ago and they saved my dog's life and my sanity. I had a vet whose idea of treating was: give 1/2 pill for 3 days and then stop. No testing. Give 1/4 pill weekly from then on. Lord. No following of protocol. I asked how we would know if it was working if we didn't do acth testing and she said "I'll have to talk with our specialist" I said "Who is the specialist" "She said the lab where we send our tests"... I left the lysodren on the counter and told her goodbye. :D

[Hannah's Mom]

Amazing! And your pup lived with Cushing's for eight years, right? You are one smart researcher.

[frijole]

Amazing! And your pup lived with Cushing's for eight years, right? You are one smart researcher.Not smart, lucky... google landed me in the right spot. Haley is my schnauzer that had cushing's. She is the one in the front of my avatar. All heart. She was diagnosed 6 yrs ago - probably had it for 3-4 yrs before we even knew it. I treated her for 4 1/2 yrs. She passed away May 2010 at the ripe age of 16 1/2. She didn't die from cushing's. My other gal is Annie, seen at the back of the photo. She was misdiagnosed as having cushing's. She has an adrenal tumor that took us a year to figure out.

Suffice it to say that Hannah can do just fine. Key is getting up to speed on the disease, symptoms, drug, etc because you are her voice. You are already off to a great start. You also will need to either have a vet that is seasoned in treating the disease OR willing to listen to you correct him/her and learn along the way (prednisone, twice daily dosing etc.) ;):D Anyway... most of our dogs, once treated do not die from cushing's.

Kim

[Hannah's Mom]

You make me want to ask so many questions, but I'll save them because my questions aren't as urgent as so many other questions from so many other partners of ill dogs. I'll save them for later.

Thanks for these answers and for the ones I'll ask in the future.

[Harley PoMMom]

You make me want to ask so many questions, but I'll save them because my questions aren't as urgent as so many other questions from so many other partners of ill dogs. I'll save them for later.

Thanks for these answers and for the ones I'll ask in the future.

Please do not hesitate to ask us any and all questions. If there is something you want to ask, please, please ask away, we are here to help everyone. ;):)

Love and hugs,
Lori

[addy]

Hannah is in the best hands, meaning, everyone here, Kim and the other Lyso experts know what they are taking about so you are not to worry.

Signs of being loaded can be very subtle, very subtle so you just need to watch Hannah like a hawk. When I first contemplated it with Zoe's internist, she refused to give me prednisone. So just a word of warning that you may possibly run into resistance.

I will be here for moral support and hugs and love and we are all here to help anyway we can. You are not alone.

Love,
Addy

[frijole]

Hannah's mom sent me a message because today Hannah did not want to eat - she did not start lysodren but is concerned about starting it and wondering if she has cushing's.

I reread the entire thread and based on the symptoms I would guess that Hannah does have cushing's. You ruled out diabetes and hypothyroidism which would be the alternatives that I would suspect first.

The diagnosis included an acth test as well as a couple of ultrasounds. No tumors were seen which would lead one to suspect pituitary cushings.

Regarding the symptoms - you have water intake, hunger, pacing, panting and weak hind legs. Not all dogs have all symptoms. My Haley only had hunger and weak hind legs. She never drank much water and never had hair loss.

Since you are concerned about today's eating situation let's discuss in greater detail Hannah's water and food intake ok?

She weighs 32 lbs which is aLOT for a schnauzer. Does she have a round tummy? Obviously she is overweight but is she solid or roundish? :);)

Does she eat her food slowly and chew every bite or does she eat it quickly, sort of inhaling it? Does she search for food in the house? Does she eat other pet's food? Please elaborate about her eating habits including how much she is eating and how often (x per day).

Has she been peeing in the house? Even if you have other pets you should measure the water you pour each morning into each dish and how much total is drank between them. Dogs drink an oz per pound on average. Is your number above or below normal? I know you can't answer this yet. Do you have to let Hannah out to go potty more frequently? Ever have to do it at night?

YOu mentioned she isn't always hungry. What do you mean by that? HOw often does this happen? Does she eventually eat or does she skip the meal?

The more you can share the better as it helps us understand her symptoms as well as consider whether lysodren is the best drug to give.

Thanks! Kim

[Hannah's Mom]

OK, Kim, I am understanding now. Here are some answers:

Her body is rounded with a slightly pot belly.

She is definitely drinking more water in the past months - with me having to refill the water dishes several times a day. I will try to measure in the future.

She usually gulps her food and will then try to steal from the other dog. She is very obedient, though, and will stop stealing when I tell her to.

She hasn't had a accident in the apartment (she is very conscientious about that), but I have now started to take her out four times a day instead of three. She pees immediately upon getting outside.

Yep, I think you've nailed it. She has Cushing's. I feel more comfortable about that diagnosis now. As soon as I get the prednisone from the vet, I'll begin the treatment with Lysodren.

Thanks very much to all of you!

[StarDeb55]

I haven't posted to you in several days, but wanted to chime in on the water issue. When my first pup, Barkley, started his lysodren loading, I had discussed with the vet the problem of keeping track of his water drinking when I had 2 dogs in the house. She told me that we would just have to make the assumption that any changes in water will have to be attributed to Barkley. She had me hold off loading for about 4-5 days, so I could get a good average for total water consumption for both dogs. Once I had that average, I started loading. At day 8, Barkley was showing no signs of a change in appetite or anything else you look for to indicate loading, so off we go for an ACTH to check to see where we are. I get a call the next afternoon from the vet asking if I had checked water yet, I told her no. She said that she would hold, & for me to check. Much to my shock & concern, water consumption had dropped by 60%, & she said that B's ACTH reflected that. I don't remember the exact results, except to simply say that he had gone low enough that he had to be put on prednisone immediately, & for the next 5 days. He never showed any signs of an overload, so if it had not been for me knowing what to expect on the water consumption, & the stim that was done at day 8, I could have very easily had a very sick boy on my hands.

It is normal loading protocol that if there are no signs of loading after 7-8 days, depends on the vet, you stop the lyso, come in for stim to see where you are. If your pup isn't within range, yet, you just resume loading. I don't recall seeing if your vet has discussed this part of the protocol with you, it can be very important for your sanity, & your baby's safety.

Debbie

[Squirt's Mom]

Hi,

One of our members has give us her spreadsheet she used with her baby, Niko, to measure water intake. I am not able to access it via the google doc site for some reason but perhaps you can. If not, contact Bettina, Niko's Mom, and she will be glad to send it to you via email. Here is the link to the thread in Everything Else -

http://www.k9cushings.com/forum/showthread.php?p=60454#

You're doing a great job getting info so you are prepared to start the load!

Hugs,
Leslie and the gang

[Squirt's Mom]

The link to the spreadsheet is fixed. You can access it by clicking on the big, bold "HERE" in the first post of that thread - http://www.k9cushings.com/forum/showthread.php?t=3583

This will help you a great deal in keeping up with the amount of water consumed both now and as time passes. ;) Bettina has been so kind to share her sheet with us.

Hugs,
Leslie and the gang

[Hannah's Mom]

You guys bring tears to my eyes every day with your kindnesses. (I live in NYC and I'm not used to this kind of treatment! :D)

Much love to you all!

Marilyn

[Squirt's Mom]

No matter where they are found, dog folk are the best people in the world! And I happen to believe we have the best of the best right here...including you, dear Marilyn! ;)

Hugs,
Leslie and the gang

[addy]

We are all here rooting for you and Hannah. It will be fine.:D
Hey, my hubby was born and raised in NYC so we are practically relatives:p:D:)

Love, Addy

[Hannah's Mom]

HA! HA! The New Yawk part of Addy put the smiley with the tongue sticking out on her message, right? :D And I totally agree with Leslie - dog folk (and I love this term and promise to steal it) ARE the best people in the world.

Hey, another question: I am worried about Hannah getting sick during her loading. The vet would not give me prednisone. She wants to get readings without interference of the drug. Here's the deal - I am not totally convinced Hannah has Cushing's. Most days she is so energetic, chasing her ball. Maybe I'm in denial, but I also want to be prepared if she reacts badly to the Lysodren. Being that I'm in NYC, I am thinking I should reserve a dog taxi for the first few days of loading. It'll cost a fortune, but if Hannah gets sick and is vomiting and/or has diarrhea, I think it might be a good idea. I guess what I'm asking here is if someone could relate information about dealing with a sick dog during the loading.

[jmac]

Hi-

I have no experience with Lysodren, but I know from my own reading, as well as the helpful and knowledgeable people here that you NEED prednisone. To me it's sort of like carrying an EpiPen. If I eat something I am allergic to and have a reaction, the EpiPen will save me until I get to the hospital. If your dog gets too much Lysodren, the pred will save her. I don't understand why your vet would not give you any, and I would not start until I had it.

My Hannah only has mild symptoms and she is taking Anipryl (and now we just started Cosequin for joint support), but I know that if I need to move to Lyso or Trilo I will NOT give it without the pred. It seems too risky. Again, I am certainly no expert, but it seems like your vet isn't getting it. It's not like you're just going to give pred for the heck of it and mess up the tests. You want it for an emergency.

I'm sure others will chime in, but I just wanted to share my thoughts. Good luck to you and your sweet little Hannah!

Julie & Hannah

[addy]

That was exactly what I ran into with our IMS. She said the same thing. We ended up with Trilostane after all and I had some prednisone left over from one of my asthma attacks so I kept it for for Zoe just in case. Some other members were able to get a perscription from another vet they had a relationship with.

I am sure our Lysodren experts will be chiming in soon.

I use the tongue sticking out alot, usually my thinking is it depicts a joke or me being silly---maybe I should rethink that:D:D:D:D:D:D:D

Hugs,
Addy

[Jenny & Judi in MN]

I was a doorknob when I loaded Jenny. My vet was so rushed because it was 5:30 on Friday of 4th of July weekend and I was running to a pharmacy. I should've taken my time and waited a week like you are doing.

Jenny, 8 pounds, loaded in 3 days. I should have stopped her in 2. She spit up just her water so I didn't count that as puking. Then I noticed she had watery diarrhea RIGHT after I'd given her her day 3 dose. I got on here in a panic. Quit giving her the Lysodren but never had to give her the Prednisone.

Her post ACTH went from 26 to 4.9 based on her 3 days of loading. But I really screwed up and am lucky I didn't cause her any harm. That is my story.

[Squirt's Mom]

Some vets don't trust us not to panic and give the pred when it isn't needed, resulting in skewed test results. And not all vets can be assured we know the difference...or appreciate the fact we have someone else to fall back on. ;)

If your vet simply will not give you pred, then get a 100% guarantee they will be available to you 24/7. No vacations, no overnite trips, nothing that will take them away from you and Hannah while she is loading. Make sure you have a phone number or two they will answer no matter what and that they will meet you at their clinic regardless of the day or hour if needed...without charging you extra. ;) This, along with giving the parent prednisone, is recommended by Dr. Feldman, a world-renown vet in Cushing's. Surely, your vet will accept one of this experts recommendations? ;)

The odds are, you will need neither the pred nor your vets extended time. Most pups load just fine and proceed to maintenance without a hitch so don't get upset if your vet won't comply with your wishes. Someone will be here at all times so if you see something that concerns you or you don't understand, just ask. The thought of loading is 99% of the time much worse than the actual doing. ;) You are going to do just fine!

Hugs,
Leslie and the gang

[Harley PoMMom]

This is just me but I would absolutely not try loading a dog without a synthetic glucocorticoid on hand. If your vet does not want to give Prednisone ask about Dexamethasone. Dexamethasone is not supposed to interfere with cortisol assays.

[Hannah's Mom]

OK, I've asked my friends here in NYC and found that one has some Pred onhand. Now all I need is the dosage for an emergency (and I really, really hope there isn't one). Anyone know that?

Have I told you guys lately how much I appreciate you????

PS to Addy -- I was only teasing you about the smiley. I like that smiley also. :p

[StarDeb55]

Ok, prednisone rescue dose for Hannah is calculated based on .25 mg/kg. You posted a weight for Hannah of 32 lbs. at the beginning of her thread. Using that weight, a rescue dose of pred would be 3.6 mg.. The smallest tabs you can get are 5 mg., the extra will not hurt her. To reinforce what the others have already said, I would not dream of loading a pup without pred being immediately available. I would also not ever treat a pup with lysodren long term, with no pred available. The vet who is refusing to give it to you is being somewhat negligent, IMO. They should know that you can get an accurate ACTH about 36 hours after pred is administered. As Addy had also mentioned, dexmethasone can be give for steroid replacement, & dex will not interfere with an ACTH. If you & Hannah had an emergency, I don't think you will, you gave her pred, any vet with experience in treating Cushing's should know that an ACTH done within that 36 hour window will be falsely elevated & should take that into account.

With Barkley, I had to only use pred once after he had been stabilized on treatment for a number of years. He became extremely lethargic, & quiet one night, refused to drink, & I'm like, "Oh boy, what's up with this!!" I gave him the pred, called the vet the next day, & got him in for a stim. The weird thing is that he had a stim done about a week before this incident & his numbers were perfectly acceptable, not even on the low side. The stim that was done immediately after this incident showed good numbers, so the vet was at loss as to what happened. I was not chastised for giving the pred at all. In fact, I was told that I had done the right thing, the motto being, "when in doubt, give the pred".

Debbie

[Hannah's Mom]

OK, I am going to email my vet again. Obviously I am going to need Pred onhand to protect Hannah for the long term. This is really a scary disease for a novice like me to handle - and it's really worrisome if my vet isn't doing things that are essential. What's up with that???!!!

[frijole]

I chime in with the others ... its a NO NO not to give prednisone with lysodren.. now your vet said he didn't want to combine the two during loading and I agree with that... but that isn't why you want it... you only want it in an emergency... I'm wondering how experienced the vet is with lysodren and cushing's. Don't be afraid... just respect the drug and follow protocol. All will be fine. You are doing a great job. Kim

[addy]

The way our IMS explained it to me and I think what yours may also mean is that they are concerned durring loading we will decide to use the prednisone and they don't want us to do that; they want the dog brought to them so THEY can determine whether or not the dog needs it. I took it as a control thing and my IMS has treated lots of dogs and she was the exact same way.

Maybe if you have a long discussion about it with your vet, your vet will realize you will not use the prednisone indiscriminetly as that, I think, is what they are afraid of.

Hugs,
Addy

[Hannah's Mom]

OK, emailing the vet today. Thanks my buddies.

[Hannah's Mom]

Vet agreed to give me a prescription for Dex. Here's what she wrote:

"You can have some dex if you would like. The dex can still interfere with the AcTh stim test but not as great of a degree. I can script some out for you. I would still like you to contact me if you think Hannah needs the dex."

She sounds a little P.O.'d at me, but getting what's best for Hannah is my #1 concern. She'll have to deal with it.

Thanks again to everyone.

[frijole]

Vet agreed to give me a prescription for Dex. Here's what she wrote:

"You can have some dex if you would like. The dex can still interfere with the AcTh stim test but not as great of a degree. I can script some out for you. I would still like you to contact me if you think Hannah needs the dex."

She sounds a little P.O.'d at me, but getting what's best for Hannah is my #1 concern. She'll have to deal with it.

Thanks again to everyone.

She is confused. She is thinking you plan on giving the drug. You would NOT give it unless there was an emergency. So it will not interfere with the acth test results unless the dog is in distress... and at that point it would potentially save Hannah's life. I am still questioning how much experience this vet has with lysdodren and cushing's. Good for you - keep pushing and she will either get up to speed on what protocol is or you will be forced to find someone who is. Kim

[Squirt's Mom]

When you pick up the script, assure the vet you won't use it unless Hannah is in crisis - vomiting, collapsing, diarrhea - and the vet cannot get to her immediately.

You won't use it when you see signs that Hannah is loaded - you simply call the vet at that point to schedule the ACTH and don't give any more Lyso. You will have us here and your vet a phone call away so don't hesitate to reach out if ever you have a question...even if it seems silly or minor, ask! :)

The flip side of all this is, some vets prescribe pred to be given at the same time as the Lysodren during a load - something I haven't been able to wrap my head around. :confused::rolleyes:;) I understand your vet's caution more than I do that approach.

Now you are fully armed and ready to start! It will be behind you before you know it!

Hang in there and keep up the good work!

Hugs,
Leslie and the gang

[Hannah's Mom]

Honestly, guys, I am scared to death I am going to do something wrong and hurt Hannah. I really couldn't make it through this without you guys helping me.

One more time - could you tell the the signs to look for that indicate Hannah is loaded vs. the signs that Hannah is in crisis mode. Thanks for your patience with me.

[Harley PoMMom]

A dog with Cushing's will usually have a ravenous appetite, they will bury their head in the food dish and not come up for air until the last morsel of food is gone! So any hesitation that Hannah displays in eating could be a sign of her being loaded. Also their stools might become soft (with some form), not diarrhea or squirty, if the stool is still formed but soft, this too can be a sign of being loaded.

A dog overloaded on Lysodren can have any one or all of these symptoms: lethargy, vomiting, diarrhea, not wanting to eat.

You will do great and we will be here for you.

Love and hugs,
Lori

[Hannah's Mom]

So any hesitation that Hannah displays in eating could be a sign of her being loaded. Also their stools might become soft (with some form), not diarrhea or squirty, if the stool is still formed but soft, this too can be a sign of being loaded.


Should I get her to the vet once she shows any of the signs you mentioned that might show her being loaded? The vet wants me to bring her in one week after she starts the med. She did not mention loading signs as a signal to bring her in.

[Squirt's Mom]

When loaded, Hannah may look up at you while eating, pausing for just a second before going back to the bowl. She may chew VS gulping. One member timed her baby eating before starting the load There will be less or no urgency about her eating behavior. She may drink less often or stay at the water bowl for a shorter period of time. Observing her behavior now will help in monitoring her during the load.

A pup in crisis will not eat, has diarrhea (not loose stool, diarrhea), will vomit, they will be lethargic to the point of collapse, not just tired. It's obvious they are sick.

As close as you watch Hannah and as well as you know her, I have the utmost faith in your ability to notice any subtle change. Hannah is in good hands!

Hugs,
Leslie and the gang

[Squirt's Mom]

Yes, as soon as you see signs that Hannah is loaded, call your vet and schedule an ACTH to see where her cortisol level is. The test needs to be given 36-48 hours after the last dose of Lyso.

If you have not noticed any changes in Hannah within that week you vet talked of, then you will call for an ACTH at the end of that week; but if you see signs prior to that week ending, stop the Lyso and call for an ACTH.

[frijole]

Honestly, guys, I am scared to death I am going to do something wrong and hurt Hannah. I really couldn't make it through this without you guys helping me.

One more time - could you tell the the signs to look for that indicate Hannah is loaded vs. the signs that Hannah is in crisis mode. Thanks for your patience with me.

Like the others said.. signs of loading include ANY change in appetite - even if it means leaving a few bites when they normally don't, not quite eating as much, pausing between bites. Reduction in water intake (if water intake is above normal... you should measure before hand so you know what 'less' is).

Too much = diarrhea, vomit

Crisis = Trust me, you will know it. They cannot get up, lift their head. Give prednisone asap. That is why you have it.

[frijole]

Should I get her to the vet once she shows any of the signs you mentioned that might show her being loaded? The vet wants me to bring her in one week after she starts the med. She did not mention loading signs as a signal to bring her in.

Once you see signs of loading simply quit giving the lysodren. It works for another 48 hrs so ideally - call the vet and TELL THEM, don't ask, that you want to schedule an acth test 2 days from now. That way the lysodren will be at its 'peak'. If it isn't exactly 2 days it is ok.

You can bring her in after one week for a test but know that she might not be loaded. Dogs are never the same. Small breeds load slower for some reason that big dogs. That said.. we've seen it range from one day to my dog Haley who owns the record and I'm not telling you what it is cuz you'll freak. ;):D:)

Just keep an eye on her and post here with questions... we will be checking in. Kim

[StarDeb55]

Not to repeat what the others have told you, I did want to explain why the vet said 1 week for a test. Normal loading protocol states that you continue giving lysodren until signs of loading occur, or 7-8 days have elapsed with no signs of loading. Some vets use 7 days, some 8, but the point of a test at this time is to check to see where you are in the load since your pup has not demonstrated any noticeable change in symptoms. This is a safety precaution to make sure you don't overload. If you get to the 1 week timeframe with no signs of loading, have the ACTH done, & Hannah's numbers are still too high, you simply continue loading.

As I mentioned previously, this ACTH at day 8 is what totally saved Barkley from getting very ill as his numbers had totally bottomed out, but he showed absolutely no change in behavior until that drop in water consumption on day 8.

Debbie

[Hannah's Mom]

OK, I've got it now. I now know what to look for. Really appreciate it and I know Hannah appreciates it!

[addy]

I am sending hugs and moral support for you and Hannah. You will be just fine.

Love,
Addy

[Hannah's Mom]

Hey Gang --

Someone just asked me a question that I thought I'd put to you also because I really don't know the answer. How will Hannah's quality of life be on Lysodren? I was under the impression that she will be in better shape, but this question made me think I'd better ask the experts about it.

Right now Hannah is very overweight and likes to sleep. But when I take her outside, she will chase her ball and act happy, barking at other dogs. I am hoping that when she gets the med loaded properly, she will have more energy and will not be driven by an overwhelming appetitite any longer. Is my thinking right?

As you know, I am worried about this very toxic med that might, if not handle precisely, make her very sick.

Thanks very much.

Marilyn, Hannah & Cotton

[StarDeb55]

. I am hoping that when she gets the med loaded properly, she will have more energy and will not be driven by an overwhelming appetitite any longer. Is my thinking right?

Marilyn, you are spot on with the above. I don't think any of us would be happy if we felt like we were starving 24/7, & driven to constantly search for food. All I can tell you is that my first boy, Barkley, was very successfully treated with lysodren for nearly 8 years, & he had a great quality of life.

Debbie

[lulusmom]

Hi Marilyn,

I have two cushdogs, both treating with Lysodren and their quality of life, especially my Jojo's, was vastlly improved. Jojo was a shelter rescue and I can't even tell you how horrible his symptoms were. He was a physical mess and I just wanted to cry for him. His transformation was nothing short of a miracle. I will tell you that obese dogs are not healthy dogs and chances are Hannah's weight a real contributating factor to her lack of energy. I know this from experience with my Maltese, Buster. I took him to the vet for a suspected UTI but he actually had oxalate stones which had to be removed via surgery. My gp vet at that time didn't have the best bedside manners and told me that Buster was fat and that I was killing him. :eek: I was more than insulted but after all was said and done, I realized that she was right. I quit free feeding and based on rave reviews from a friend, I decided to switch from kibble to a commercially prepared raw food diet. Within three or four months, Buster was at a perfect weight and he was a different dog. He and the rest of the crew were acting like youngsters again. Hannah is still a spring chicken and I believe that once you get her stabilized on Lysodren and get the extra weight off, I think you will be amazed at the transformation. I also think I'll be here to tell you "I told you so". :D:p:D

The fact that you are concerned about Lysodren tells me that you have read up on it and have a basic understanding of how it works and what side effects are common. I am OCD when it comes to canine cushing's and have a number of audios of lectures given by reknown endocrinologists. I distinctly remember that one of those experts, Dr. Edward Feldman, said; "If a dog loading on lysodren gets sick, somebody screwed up." What he was saying is that treating a dog with Lysodren, and most certaining during the loading phase, is a team effort. It is the vet's responsibility to provide comprehensive instructions to the pet owner, including but not limited to what side effects to watch for and what to do if these are observed. The vet should also be in close daily contact with the pet owner, starting on the second or third day of loading. When I loaded Lulu, her IMS called me like clockwork after day two. My gp vet did the same when I loaded Jojo.

It is the pet owners responsibility to be vigilant in monitoring their dogs. I don't think any of us members have ever been laxidaisical about watching our dogs like a hawk but the fact that we're here makes us special. :D So let's talk about the millions of cushparents who aren't all that special. Even if a pet owner strives to understand what their vet is telling them, an experienced vet knows that cushing's is not an easy disease to comprehend nor do they trust that the pet owner will do what they are supposed to. Soooo, the phone calls are made to insure the welfare of the dog in the event the pet owner isn't holding up their end of the bargain.

I'm going to echo everybody else and tell you that you and Hannah are going to be fine. If you don't feel right about something, tell us and we'll guide you. If you keep one eye on the loading instructions and helpful hints and the other eye on Hannah, I think you'll ace it.

Glynda

[addy]

We are all here sending hugs and positive vibes.

I am hoping you see positive changes in Hannah but be patient, it may not be overnight;););)

Hugs,
Addy

[frijole]

:D Do you think we would have given it to our dogs and recommended it to you? Nah... quit worrying about that. I think you know enough to get it started. What is the plan? Hugs Kim

[addy]

Hi NYC relative:D:D:D:D:D

I hope everything is okay with you and Hannah. Sounds like you might have your hands full this weekend!!!!!!:(:(:(:(

I was not sure if you started loading Hannah or not and then the news starting telling us about the hurricane and NYC. I hope you are both okay.

Hugs,
Addy

[Hannah's Mom]

We are doing fine, my buddies. Actually took Hannah and my other puppy Cotton to a friend's house in upstate NY. Just a heavy rain on Sunday. No biggie.

Only problem we had was that Hannah aggrevated a long-time soft tissue injury on one of her front arms. She loved running up and down the stairs of my friend's 19-century house until yesterday and then she couldn't get down the steps. She stopped halfway, just giving me sad eyes. All her fun had caused her trouble with her injury. She could run UP the stairs, but couldn't run down.

I'm watching her and will start a regime of anti-inflamatory meds tonight. I am still planning to start the Lysodren this coming long weekend. More on that later. Also wondering if any of you have seen this article? (http://endocrinevet.blogspot.com/2011/02/diagnosing-canine-cushings-disease.html) Wondering what you think.

Thanks very much, guys. More later.

Marilyn, Hannah and Cotton

[Hannah's Mom]

Hi Everyone --

I am back with an update and another request for help. I joined this group in 2009 because my mini-schnauzer Hannah had been diagnosed with Cushings. My vet put Hannah on Mitotane. She said it was the lowest dosage for the drug recommended for Hannah's size. She then cut it back when Hannah started vomiting every day. Hannah just got worse. After about 3 months of her health declining, I called the vet in tears and said I wanted to take Hannah off the med and let her die in peace.

Then Hannah started improving! Within two months, she was playing with her ball and running and was happy again. I then realized it was the med that was the problem and not the Cushings. I swore I would not put her on any Cushings med again.

Now a new vet told me that she didn't understand why the other vet had put Hannah on Mitotane because she has found in her own patients that that drug has many toxic side effects. She wants to put Hannah on Trilostane because from her own experience with her patients, there are a lot less problems. The vet also said that there were some changes in Hannah's blood platelets that might lead to a blood clot. The platelet change was what has prompted her to push for Trilostane. She also says she usually does not send Prednisone home with the patient "because it it so safe compared to Mitotane."

Honestly, I was avoiding going in for the ACTH test she wanted to do because of my past experience. But then last weekend Hannah got sick again. It could have been something as simple as a bacterial infection, but I'm still not sure. I am waiting for the bloodwork results. All I know is that Hannah is hypersensitive to lots of meds from antibiotics to pain meds to Mitotane.

I know this is a tough one to consult with everyone on because every dog is different, but I'm hoping someone can give me some insight. Thanks very much.

[labblab]

Welcome back to you and Hannah, although I am sorry that your little girl is again having some issues. I apologize because I don't have enough time to write a proper reply right now. But I first want to have the chance to read back through your entire thread to refresh my memory once again.

I do want to make one comment, though. Even though trilostane is now emerging as the drug preference for many vets, we know from our experience here that it does have the potential to cause very serious side effects including Addisonian crisis from cortisol that has dropped too low. That may be the exception rather than the rule, but it doesn't mean it cannot happen. So if you do end up treating with trilostane, we will point you towards important dosing and monitoring information to share with your vet. And you will want to remain very vigilant in watching for any ill effects from the drug.

But for the moment, I am putting the cart ahead of the horse. As I say, I want to have the chance to read back through your thread. But in the meantime, we are so glad to have you back with us once again.

Marianne

[frijole]

:) You said you realized it wasn't the cushing's it was the drug and are thinking of switching to trilostane. I'll throw this one at ya. What if the reason the meds didn't work is because it isn't cushings?

You have been off of the mitotane/lysodren for how long now? Have symptoms reocurred? If so describe them.

Also note you can't just make a switch - you must be off of the mitotane for 45 days to flush the system.

Kim