Mikey - 9 y.o. Mini Poodle - from Trilostane to Lysodren (Mikey has passed away)

[4Mikeydog]

I am so glad I found you!! My 8 1/2 year old miniature poodle, Mikey was diagnosed with pituitary dependent cushings last March after an ACTH stim test with results:
pre 4.3 and post 39.7 and an ultrasound.
He had most of the classic symptoms; excessive thirst, excessive urinating, ravenous appetite, weak hindquarters, potbelly, and lethargy. He had a dull coat which had gone from a beautiful apricot color to a pale shade of cream, but no visible hair loss...
Mikey was put on Trilostane 30 mg 1x per day and within 2 weeks most of his symptoms started to subside.
All subsequent ACTH tests show effective management of cortisol. Mikey was his old self for quite awhile :)
However..after 5 months on Trilostane, my sweet guy began to lose hair at the tops of his ears and on his tail. This hair loss has continued.
Trilostane remained at 30mg 1x per day until some adjustments due to trembling and lethargy.
Mikey is presently on Trilostane 10mg BID. He has continued to lose hair, weight and muscle mass. He has an underlying intestinal or absorption problem which is currently being mediated.
His IM specialist ordered the UTK adrenal panel 3/30/09.
The results are as follows:

Cortisol Pre 8.3 ng/ml Post 48.1 ng/ml

Androstenedione Pre 0.90 ng/ml Post 0.70 ng/ml

Estradiol Pre 85.6 pg/ml Post 82.6 ng/ml

Progesterone Pre 1.00 ng/ml Post 1.70 ng/ml

17 OH Progesrerone Pre 4.89 ng/ml Post 6.77 ng/ml

Aldosterone Pre 21.6 pg/ml Post 37.9 pg/ml

Androstenedione, Estradiol, Progesterone, and 17 OH progesterone are all elevated.
I've read enough to know that Trilostane can do this.
Today we met with the IM specialist who is taking over for his original dr who is out on maternity leave..
I am truly confused and upset.
Clinically all signs of urinating, drinking, and appetite are mediated. However Mikey is lethargic, has lost most of his hair and is down to 12 lbs (poor guy)!
The vet initially recommended increasing the Trilostane:(
I commented that I thought melatonin,
flaxseed oil with lignans and or a maintenance dose of lysodren may be a better choice.
The specialist said we could do that and suggested 5 mg of melatonin BID first with Trilostane as is..
Then if I wanted to introduce the maintenance dose of Lysodren, I should stop Trilostane for 2 weeks and then start a maintenence dose of Lysodren. I'm very alarmed about this because I don't know if the Trilostane will really be out of his system enough to do this safely...
The IM specialist said that if we wait the 30 days without Trilostane we will have to actually load him instead. My questions are as follows:
What is your experience with this concept?
What have you experienced in switching a dog from one treatment to another?
Do you have any recommendations for how to start treatment with melatonin?
Do you think the 5mg melatonin BID is too high a dose for a 12 lb dog?
I am sorry if I am rambling..but I am truly frantic!

Thanks,
Dorothy and Mikey

[frijole]

Hi Dorothy. I'm not sure how long is best to wait before switching from trilostane to lysodren... seems like it is less than 30 days but I am bumping this up so someone will read it and get back to you.

I'm glad you found us!

Kim

[we3dogs]

Hi Dorothy - I don't have an answer for you and do not know about test results but wanted you to know that I am thinking of you and Mikey. My Angel is having issues with trilostane as well that began last fall. She's been on trilo for 2.5 years. I certainly feel your frustration! And feel free to ramble on - we've all done it and it is sometimes in those streams of thought that we discover something important! Take care - Joyce, Pebbles & Angel

[Barney's Mom]

Hi,
I had to switch my dog from Trilo to Lysodren. I want to say it is a 30 day wash out and you load on a much lower dose. It went very smoothy. I also had hair regrowth on Lysodren that I didn't have when he was on Trilo. To be fair he was only on Trilo a few months. I will see if I can't find the specifics for you.



Cheryl

[Roxee's Dad]

Hi Dorthy,
First I would like to welcome you and Mikey. You will find a lot of help here. I believe it was Glynda that seemed to have the same problem or very similiar. That is when she found out about atypical cushings. I am not sure myself about this and your UTK results but I hope she will check in soon and maybe help you sort this out.
Hope for the best for you am Mikey.
John (Roxee's Dad)

[lulusmom]

Hi Dorothy,

I switched both of my cushdogs from Trilostane to Lysodren. They are both Pomeranians (4.5 lbs and 8 lbs) and like your Mikey, they are a breed that is over represented when it comes to adrenal hormone imbalances. They should have never been placed on Trilostane without having a UTK adrenal panel done. After two years of treatment, Lulu's sex hormones had skyrocketed and I took both off of Trilostane immediately.

You are correct in that there is no way for you to tell if the elevation in the other adrenal hormones is due strictly to the Trilostane or if Mikey already had an imbalance and Trilostane has exacerbated the problem. In order for you to have correctly determined this, Mikey should have been taken off the Trilostane for at least 30 days before an adrenal panel. It is also very important that you go through a minimum 30 day washout period when transitioning to Lysodren. In our case, I waited until they were symptomatic again, plus we had acth stim tests done to make sure that cortisol levels were above 22ug/dl before loading with Lysodren.

With Mikey's very high post stim number before starting treatment, I don't believe that it is going to be possible to transition from Trilostane to Lysodren without loading. The two drugs work very, very differently...Trilostane is an enzyme blocker which over time actually enlarges the adrenal glands whereas Lysodren shrinks the adrenals as it erodes the adrenal cortex to a point where they no longer oversecrete cortisol and in most cases, the sex hormones. Maintenance doses of Lysodren given with melatonin and flaxseed can be effective in reducing cortisol in dogs with mild cortisol elevation but Mikey doesn't have mild elevations so I would be very surprised if this treatment regimen is the right one for Mikey.

My Lulu lost 3/4 lb and with a starting weight of under 5.5 lbs, that was pretty significant. I wrote to Dr. Oliver at UTK and asked him if he had experienced this phenomenon with other atypical dogs. He said yes, weight loss can be due to the excess sex hormones. I would very much like to hear how your IM was able to pinpoint the absorption problem with Mikey. Other members have also reported weight loss in their pups while having a very healthy appetite. It is very difficult to watch your dog lose weight and not know why it's happening.

According to the UTK adrenal panel, Mikey's cortisol is being controlled by the Trilostane so like you, I am very confused as to why your IM would suggest increasing the Trilostane. :eek:

My IM consulted with Dr. Oliver at UTK to discuss the best approach to Lulu's treatment. It was mutually agreed that Trilostane should be discontinued and treatment with Lysodren be started after an appropriate washout period. Perhaps you might suggest that your IM consult with Dr. Oliver too.

I hope this helps.

Glynda

[Squirt's Mom]

Hi Dorothy,

Glad you and Mickey found us here! But wish it was with better news on Mickey.

Glynda has covered the bases expertly as always. I would like to address the melatonin dose recommended, tho. Dr O has Squirt on 3mg 2x/day and she weighs about 14lbs. I think the 5mg is too much for Mickey personally. This is from the treatment sheet provided by UTK:

"2) Melatonin. Often used as a first treatment, especially if alopecia is present, since it is cheap, has few side effects and is available in health food stores or via nutrient suppliers on the Internet.
Typically, a total dose of 3 mg is given q12hrs (BID) for dogs <30 lbs; a total dose of 6 mg is given q12hrs (BID) for dogs > 30 lbs. Regular melatonin is usually used rather than rapid release or extended release products. Melatonin has anti-gonadotropic activity (effective for ferret adrenal
disease), and it inhibits aromatase enzyme (decreases androstenedione and testosterone conversion into estradiol) and 21-hydroxylase enzyme (effectively lowers cortisol level). Monitor treatment effectiveness by improvement in clinical signs, biochemistries or by repeat of steroid profile."

You can find this sheet at:

http://www.vet.utk.edu/diagnostic/endocrinology/pdf/Steroid%20Profiles%20for%20Diagnosis%20of%20Atypic al%20Cushing%27s.pdf

Hope this helps.
Hugs,
Leslie and the girls

[4Mikeydog]

Thank You so much for your kind words of support and encouragement....and especially for sharing your knowledge. Glynda, my heart breaks when I hear about your dear Lulu. I can wholeheartedly relate to your pain.
My dear sweet dogboy is fading away to nothing. He is skin and bones:(
We have tried different diets and all kinds of testing throughout the past 4 months....
Mikey presented at his initial diagnosis of cushings weighing 20 lbs!
He was quite overweight, as his usual weight was between 15 and 16 lbs.
So when he reached 16 lbs again after 5 months of Trilostane, we certainly were not alarmed. However, his weight loss has drastically continued.

Of particular interest was how an intestinal manifestation presented itself immediately after an ACTH stim test administered 11/21/08.
Up until that point, Mikey had only 1 issue with diarrhea in the past, was medicated with metronidazole and made a complete recovery. He had never had a reaction to an ACTH stim test in the past.

After this particular Acth test in Nov, within 1 hr of returning home, Mikey began to vomit recurrently. He could not hold down water and had absolutely no interest in food, as he was probably nauseus. He vomited 5 times within 2 hrs and went back to the vet's office, where he was administered subcutaneous fluids, injectable prednesone , and injectable anti-emedics.
Within 3 hrs, Mikey was back to himself...supposedly.
Two days later, continuous diarrhea began.
Mikey, ultimately, was put on a diet of boiled chicken breast and brown rice as well as metronidizole 50 mg BID.
Mikey remains on this dose of metronidizole until presently because each time the medication is stopped, the diarrhea returns within 3 days.

He has been tested for parasites twice and the results have been negative.
He has been prophylactically dewormed with Pancur.
He is only able to tolerate the boiled chicken breast, brown rice, and the switch from science diet to...Nutro dog food with chicken meal, brown rice, and oatmeal for sensitive stomachs...(uh oh, I read about the FDA investigation of this company yesterday and now will change this)
His bowel movements are fully formed but soft on this regiment.
This is much better than the yellow soup he has had in the past.

I wondered why this seemed to happen directly after this particular ACTH test. It didn't seem like a coincidence. He has had so many of these tests uneventfully in the past.

Exocrine Pancreatic Insufficency was suspected and tested for in 12/08.
A nutritional panel was run at this time as well.
B12 and Folate levels were normal and Exocrine Pancreatic Insufficiency was ruled out as well.

Mikey has had 2 additional ultrasounds as well as an x-ray of his heart since that time. All showed no changes, thankfully.
Protein Losing Enteropathy was suspected subsequently.
Blood tests showed normal levels of albumin and lymphocytes.
Endoscopic biopsies need to be done to rule out Protein Losing Enteropathy,
but Mikey is certainly not a candidate for this at this time.

Our regular vet an IM specialist both felt that, perhaps, Mikey has an inflammatory bowel condition due to a food sensitivity which he had been able to mediate in the past with his own overproduction of cortisol.
However, once the cortisol production was suppressed with the Trilostane, perhaps, the symptoms of Inflammatory Bowel Disease ran amuck and are now creating a Protein Losing Enteropathy or a nutritional absorption problem.
Tylan powder 1/16th tsp sprinkled on food 2x per day was added to his regimen.
They recommended a consultation with a veterinary nutritional specialist and, perhaps, the introduction of a novel protein (hypoallergenic) diet.
Have any of you been down this road?

We met with the nutritional specialist yesterday and she does not necessarily concur with this theory because of the fact that the gas and diarrhea return when the metronidizole is stopped.
Therefore, she believes the problem may be bacterial (such as SIBO) rather than food sensitivty.
A Pro-Biotic treatment approach was recommended and commenced today.
He absolutely hated the taste of this supplement sprinkled on his food and refused to eat his chicken for the first time ever:( Now What?

I am somewhat enlightened to hear that Dr Oliver has stated that some dogs with excess sex steroids lose weight. Every time I have ever inquired as to the possibility of this phenomenon, I am told that this cannot be!

I truly believe that the Trilostane could be behind this awful weght loss due to it's ability to increase the adrenal sex steroid levels and I cautiously think the time has absolutely come for a change!
I intend to contact Dr Oliver and get his input.
I also wonder if, somehow, the fact that Mikey's aldosterone and andostedidone levels were lowered after the stim could be responsible for the nausea and vomiting he experienced. His androstenedione level was high initially and then went below normal.
Has anyone had any experience with this?
He only vomited once after his 3/30/09 ACTH stim, but, perhaps in November his levels of those hormones went even lower....Just a thought...
I love my boy and I just want to find a way to help him....

Thank you so much for your input!

Love and best wishes..
Dorothy and Mikey

[Squirt's Mom]

Hi Dorothy,

Just checking in to see how Mickey is doing today.

Weight loss and inappetence are some of the problems I have with Trilo. I haven't really kept a log or anything, but it seems to me that quite a few Trilo pups develop these issues plus shaking in some. We don't use Trilo or Lyso yet, but when Squirt was first diagnosed and I started researching, Trilo was my first choice. But the more I read the less I like it. Since Squirt has been diagnosed as Atypical, Trilo is no longer an option for her, tho.

The flip side is, many pups have done well on Trilo and remained on it for the duration of their life with no or few complications. These pups are each individuals and as such will react like no other! It is good, observant parents like yourself who listen to what their pup is telling them by their behavior that make the difference. I have no doubt that Mickey is in excellent hands and that you will make the best decision for him possible.

I am curious to hear what Dr O has to say about the drop in his hormones. That is interesting.

Let us hear from you when you can,
Hugs,
Leslie and the girls

[4Mikeydog]

Hi Leslie,

Thanks so much for your support. Mikey has had issues with shaking as well from Trilostane in the past, but a reduction in dosage seemed to have helped.
I am eagerly awaiting a reply from Dr. Oliver, but I haven't heard from him yet. I hope he writes back.
I know a change in treatment is imminent but I really want to know how to go about making this change with the least amount of risk:eek:
I am so worried...But as you all know too well..we must be strong and educated for our babies! They need us to be educated and strong to be their advocates!
Hopefully, we will have a strategy in place soon!

with best wishes,
Dorothy and Mikey

[Wylie's Mom]

Hi Dorothy,

Someone just asked a question about IBD:
http://www.k9diabetes.com/forum/showthread.php?t=816

I don't know enough about this stuff, but this link discusses many of the issues you mentioned - hope it can help:

http://www.dogaware.com/specific.html#ibd

-Susy

[Roxee's Dad]

Hi Dorothy,
Just wanted to check on you and Mickey. Hope he is doing well and gaining some weight. Did you get any feedback from Dr. O?

John (Roxee's Dad)

[4Mikeydog]

Hi John,

Thanks for checking in. I have tried to contact Dr. O over the last 2 weeks and he has been away. I am hoping that he actually answers my email when he returns, but I'm sure he has been inundated with correspondence during his absence. Have any of you had experience in contacting him directly? What is usually his response time. I'm sure I can ask my GP vet to try on my behalf, but I know it may take him some time for him to do so. I am growing increasingly concerned.
Right now, after failing to get MIKEY (sorry..he is not a Mickey):) to eat his food with the Purina Pro-biotic, his nutritional specialist switched him to th IAMS Prosorba pro-biotic and he seems to be tolerating it well after 1 week although it has some non fat dry milk in it and Mikey has demonstrated lactose intolerance in the past:( ...Although early this morning I did hear some gurgling and there were some unkind aromas coming from his side of our bedroom :eek: I don't think he has gained any weight yet, but..he hasn't lost any either. Susy...Thanks for the IBD links. Right now Mikey is also still on Metronidizole 50mg BID and Tylosen powder 1/16 tsp BID with food as well for SIBO...:(
So....now that he is tolerating the pro-biotic, the next step would be introducing melatonin at 3mg 2x per day I asume......I sure was hoping I'd hear this straight from Dr O. however :confused:
We actually have not stopped the trilostane because I was hoping to hear if he needs the full 30 day washout vs the 2 week washout and maintanece dose only of Lysodren. I guess I need another consult if I can't get this information from Dr O. himself
I know you have all heard this before.....but I am really petrified about starting Lysodren :eek: I will follow all instructions...but my real issue is the fact that Lysodren can be so caustic to the GI tract and my poor little boy has been through so much as far as hi GI tract is concerned. I don't want to risk a downward spiral in his digestive issues..I'm so confused :confused:
I'm going to call UTK again today and see if there is another protocol to follow as far as contacting Dr. Oliver.
I'll keep you updated and I won't allow this fear to paralyze me to the point that it interferes in the course of treatment for Mikey. I just want to make the best educated decision that I possibly can. I really appreciate your input and concern!!!

Thanks and best wishes...
Dororthy and Mikey

[Squirt's Mom]

Hi Dorothy,

I am glad Mikey seems to be holding his own with the new feed and hope it does the trick for him.

As for Dr O's response time - he usually answers immediately. He has been in the hospital recently, tho, and I am sure he will get back to you as soon as he can. He really is a wonderful man, very devoted to his work and the pups who are Atypical.

If it were me, I would stop the Trilo and start the melatonin (3mg 2X/day) and the lignans now. This will give you a leg up on the wash-out period plus get Mikey off the Trilo, which is probably exacerbating the problems right now, and have a head start on the treatments for Atypical. Adding the Lyso as a maintenance or a load later on won't be a problem with the melatonin and lignans already on board. Also, without the Trilo in his system, he may recover some of his appetite.

Keep your chin up, you are doing a fine job!
Hugs,
Leslie and the girls

[lulusmom]

Hi Dorothy,

Is Mikey strictly eating chicken breast and brown rice right now? I checked out the Iams supplement that Mikey is getting and there's a lot of fat in it. :eek: The second ingredient is vegetable oil and while down on the list, coco butter is also listed. Dried skim milk is the fourth ingredient. I know that any of these would give two of my dogs gas and the runs, especially the skim milk.

My 7 y.o. Maltese, Buster, had horrible irritable bowel problems. As I recall, we never went more than 90 days without being at the vet's office with a belly so distended that I thought it was going to explode, horrible gas and chronic diarrhea. There were days when I had to wash his butt at least 20 times. I can't remember the names of meds but he was on two or three, plus a shot of Pepto Bismol.

We adopted Jojo, a rescue, after he was diagnosed with cushing's and for months, I never saw a firm poop come out of that dog. A friend of mine was visiting one day and was raving about how well her dogs were doing since she switched them to a raw diet. At this point, I was dealing with loose poop, allergies with brown faces and paws that should be white, rumbling tummies, burping, lip licking and room clearing gas. I'd tried everything else so I decided to give it a whirl. I went to an upscale pet store and bought my first bag of commercially prepared and nutritionally balanced raw food called Natures Variety. It was frozen and all I had to do is thaw out for 8 to 12 hours in the refrigerator and serve it up. Fortunately all four dogs slurped it up like it like they hadn't eaten in days. I was stunned when two days later, Jojo had firm poop for the first time ever. Buster hasn't had bowel problems since then, no gas whatsoever and we no longer have allergies and no more tear stained faces or brown paws from chewing.

I took three of dogs with me on vacation last week and unfortunately, I didn't have dry ice to keep their food frozen during a 10 hour drive and no stores were open when I got to my destination. It was late so I fed them just a little bit of kibble the first night. Oh my gosh, what a huge mistake. All three had terrible diarrhea so it was boiled chicken breast and rice for the rest of the week. They loved it but they still had runny poop all week. One day back on Primal and all were back to normal.

I'm telling you my story because if you can't get Mikey's condition under control with his current diet and supplements, you may want to try a few days of Natures Variety or Primal raw food diet and see if that helps. It's been a blessing for my dogs.

As I mentioned before, you really do need to go through a 30 day wash out from the Trilostane and have him eating like a pig again before initiating treatment with Lysodren. I personally would not consider Lysodren until Mikey's stomach problems have completely resolved. You are right, it can have huge GI effects but if given with food and a predose of Pepcid A/C, those effects can be minimized if not eliminated entirely.

Glynda

P.S. Dr. O obviously has no computer access right now because he's always responded to me within 24 hours.

[4Mikeydog]

Hi Glynda,

Thanks for the tip about the Nature's Valley Raw diet..I will look for it today on line. Mikey is eating just boiled chicken breast and brown rice right now and could use additional fiber in his diet. I also let him try beef again last week out of desperation. What a mistake!!! I'm losing my mind!!! :eek:
Thanks for the input about Dr O. I really want to hear from him!!! You've been very encouraging and knowledgeable..I feel like I'm holding my breath!

with best wishes,
Dorothy and Mikey

[lulusmom]

Hi Dorothy,

I totally understand the sheer frustration and the aching you feel for Mikey...you just want him to be better. A lot of us have been where you are and know that there is no overnight cure....it's one day at a time, just like we deal with most things in life.

My five dogs are currently on Primal, hormone and antibiotic free, 100% organic chicken. Based on everything I read, I did not bother to transition them slowly to raw. It was the first time I ever switched them cold turkey. I held my breath because I expected them to have the runnies but instead, it's just like I read and the opposite occured. Immediate firmer poop and less of it.

Here are links to store locators for both Natures Variety and Primal.

http://primalpetfoods.ziplocator.com/
http://www.naturesvariety.com/locator

We're lucky on the west coast as Whole Foods Market now carries Primal in their California, Nevada, Washington and Oregon stores.

Glynda

[Roxee's Dad]

Hi Dorothy,
Sorry for the typo. Actually I have a pup named Mickee. I hope Mikey starts to feel better soon. Ageeing with Leslie, I think I would stop the Trilo until Mikey is back up to feeling good enough to eat. The old quote around here is to not give Trilo or Lyso to a sick pup.

I stopped giving Roxee Trilo for a few days when she was not feeling well. Waited until she was eating well and re-started.

Hope and pray that Mikey starts regaining his apetite.
John (Roxee's Dad)

[Roxee's Dad]

Hi Dorothy,

Just checking to see if Mikey is doing okay. Hope all is going well for him (and you).

John (Roxee's Dad)

[4Mikeydog]

Hi John,

Thanks for checking in!! Mikey is doing a little better this weekend for some unexplained reason :) He is eating very well and seems to be more engaging.
His hair is still coming out continuously..It makes me cry to see him like this :( but I am grateful that, at least, for now he seems a little happier! I am anxiously awaiting hearing from Dr O. I hope he can answer our e-mail when he gets back. Until then, I feel as I am in a holding pattern and I will try not to make any changes other than the 3mg BID of melatonin which I have added until I can confirm the protocol with him. Our vet has mentioned the melatonin implant as a possibility. Has anyone experienced success with this?

with best wishes,
Dorothy and Mikey

[Roxee's Dad]

Hi Dorothy,

Glad to hear Mikey is feeling a bit better.:)


Scott's (gpgscott) Moria and also Steph's (corgipallie) Pallie have both had the melatonin implant.

Louise

I think Scott stopped using it because he had no way of knowing when the effectiveness was wearing off.

And I believe Glynda is also inquiring about it.

Belly rubs to Mikey:)

John (Roxee's Dad)

[Wylie's Mom]

Hi Dorothy,

I'm glad Mikey is doing better:D! Your vet should have the recommendations listed on the UTK test results. They will list treatment option numbers and those numbers correspond to this list (on their website):

http://www.vet.utk.edu/diagnostic/en...hing's.pdf

Wylie normally didn't have runny or loose stools, but I did switch to raw (Primal with some Nature's Variety). His poops in the past would be formed with medium firmness or somewhat "fluffy", but when I switched to raw... they got really firm and dense (no fluff). Just recently, I picked one of his poops up, and I thought "geez, that's hard as a rock" and then I thought, "that's odd, it's a rough shape". Then I realized...it WAS a rock:p...the poop was about a foot further than where I picked the rock up!

-Susy

[Harley PoMMom]

Hi Dorothy and Mikey,

I was also interested in the Melatonin implant for Harley, Scott posted in my thread
Concerning the melatonin implant, Stephanie (corgipalliesmom) still does it, I do not.

As has been mentioned there is no concensus concerning the effective life of the implant, and the needle is large and can cause bleeding and scabbing.


For me, the large needle was the major reason I decided not to go with the implant, Harley hates needles. I really have a time with him when he has to get his shots. :( The scabbing and bleeding :(:( I don't know, like they say, every dog is different.

Good luck Dorothy and Mikey.

[Roxee's Dad]

Hi Dorothy,
Just wanted to check in onyou and Mikey. Hope he is doing well.

John (Roxee's Dad)

[4Mikeydog]

Hi everyone,

I finally found my way over to this new and wonderful site...I hope Mikey's thread follows...as I will continue to post recent developments.
See you soon!

Dorothy and Mikey

[lulusmom]

Hi Dorothy,

Welcome and glad to see you made it to our new home. Mikey's threads have been merged.

Glynda

[Roxee's Dad]

Hi Dorothy,
Just checking in in you and Mikey. Hope all is well with you both.

[4Mikeydog]

Hi Everyone,

John, thanks for checking up on us!!!

Today is day 30 of Mikey's washout period from Trilostane and it is definitely time for an update...
Dr Oliver had replied to my email upon his return and recommended that I have Mikey discontinue his Trilostane for a few weeks and then add melatonin 3mg BID and flaxseed oil with lignans 40mg capsules daily while waiting for the completion of the 30 day washout period.
Unfortunately, Mikey had lost so much weight due to GI complications in the month leading up to this point, that he seemed to be at a critical point. His vets all were alarmed and, although I had looked into switching him to Primal or another raw diet, all 3 of my vets felt it could be harmful to him due to his compromised immune system. Finally, it was decided to put him on a novel protein diet of venison and potato for a 4 week trial period while monitoring his weight daily. If his weight loss stabilized or if he gained weight, then we would continue this protocol. If not, the IMS wanted to do an upper endoscopy :eek:

Well...the good news is that the venison seems to agree with him :) All poopies seem to be firm and the "right" color :D Mikey has gained almost 1 pound in the 30 day period. I am pleased with the intestinal "turn around" How ever, it was not without pitfalls.....
His majesty decided that canned dogfood was truly beneath him and kibble alone was not worth the effort.:( This presented quite a problem in that this ravenously cushingoid dog was now somehow being selective with his dining habits and couldn't stand to lose so much as an ounce!
So...I did what any crazed and dedicated dog-mom would do....
I frantically ran to the whole foods market to buy New Zealand imported venison loin chops to grill and mix with his venison kibble:)
Guess what? He loved it and now wants to chow down on venison loin steaks daily!!! So...I contacted my butcher and ordered 8 lbs of the stuff to be delivered and freezer wrapped!!! Now we have a barbecue every day:D I'm a lunatic...but HE'S EATING!!! Did someone mention something about getting a money tree last month? I think I need one:D

Now the bad news.....Mikey hasn't gained enough weight in the past month to be a candidate for treatment with Lysodren in the opinions of his vets...They don't want to jeopardize his intestinal situation or his appetite.
They want to try Anipryl instead and see if he has a response. I cried and cried when I heard this in that it felt like we were giving up...but I know it makes sense to try to treat him in a way in which he will continue to gain weight.
Does anyone have any advice regarding this?
Thanks for listening....Sorry this was long!

with best wishes...
Dorothy and Mikey

[StarDeb55]

Dorothy, a very limited number of dogs may respond to Anipryl, but the pituitary lesion has to be in a specific location, which escapes me at the moment. These dogs are in the minority for dogs diagnosed with PDH. Anipryl may help with some of the symptoms, & make Mikey a little more comfortable, but under most circumstances, Anipryl will not lower circulating cortisol levels. I think right now, his GI issues, & getting his weight/appetite stabilized must take the priority. I sympathize totally as my Harley is an extremely picky eater, has never had the typical voracious appetite. I have gone through several periods of anorexia/weight loss with him, where we have had to completely stop his lysodren. He also has pre-existing GI issues. Up until 10 days ago, I spent the past month in a huge struggle trying to find something he would eat with very little success. I must say I was becoming frantic as I was scared to death that he was giving up. I finally resorted to Primal, & he has been eating really well for about 10 days now. Of course, eating well for a week doesn't make up for a month plus of not eating, so his weight dropped from 13.7 lb. to 12.4 lb. He has been off Lyso for nearly 3 weeks, so he will be going in for a stim this coming Thursday to see where we are. I hope you can find an answer for Mikey's dietary/GI problems, then move on to working on his Cushing's.

Debbie

[AlisonandMia]

Anipryl can also have the effect of decreasing appetite and can even cause some mild GI symptoms in it's own right. This decrease in appetite is usually a good thing with a Cushing's dog but if you there are already appetite/weight loss issues then it could definitely be a problem for this reason.

Do you have any idea where his cortisol levels actually are at the moment?

Alison

[4Mikeydog]

Hi Alison

I do not have an exact measurement of his cortisol levels since his UTK panel which was 3/30/09.
At that time his cortisol pre was 8.3 ng/ml and his post was 48.1 ng/ml.
His cortisol was considered controlled by the Trilostane..but his other adrenal hormones were elevated.

Right now, after 30 days without Trilostane, I know his cortisol has to be elevated....as he is very symptomatic :(.
He is waking us up 2-3 times a night for water and to go out. He is peeing great amounts and it is almost clear...and worst of all for him..his hindquarters are so weak that he can no longer jump up onto the couch or onto our laps when we are watching TV. The poor guy is so bewildered by this.....He also is having difficulty walking up stairs. This is how he was prior to diagnosis.
My heart is breaking over this...I don't know what to do!
Is it selfish to want to try the more aggressive treatment? I do trust my vets and I believe if they think this isn't the time for this treatment, they have Mikey's best interest in mind ...but, my plan is to try to get him to gain more weight by feeding him on demand. I believe he would eat all day if it wasn't dog food..so I'll have to find away to give him more of what he likes within the constraints of his GI issues!
Thanks for listening.

with best wishes,
Dorothy and Mikey

[4Mikeydog]

Hi...

I have a question regarding the use of melatonin. Has anyone experienced a depressed appetite in their furbabies upon introduction of treatment with melatonin?

Thanks,
Dorothy and Mikey

[Roxee's Dad]

Hi Dorothy,
How is Mikey doing???? Is he gaining weight??

[jrepac]

I'm not aware of melatonin suppressing appetite...in the short time I have been using it, that has not occurred. Usually, it helps w/relaxation and sleep. Anipryl could help w/symptoms, but could suppress appetite, which is already a problem for you. Now, this may seem far-fetched, but, have you tried feeding Mikey wet cat food? This is an old school vet trick.....


Jeff

[Wylie's Mom]

Hi Dorothy,

I don’t know of a reduction of appetite due to melatonin… but I have heard there can be nausea & headaches with humans taking it – but that could also be a dosing issue. Are you asking about the melatonin because you’ve noticed this change since starting the melatonin or are you asking because you are afraid to start the melatonin because you wonder if this could happen?

About the cat food... I heard dogs love it too, but I think (not positive:confused:) that the fat content in cat food may be too high - but I would rather have a dog that eats something. The venison sounds good - I know the fat content, at least in Primal's venison meals, are very low... I just can't afford it:eek:.

-Susy

[Harley PoMMom]

Hi Dorothy,

I emailed Dr. Oliver about giving melatonin to their furbaby on an empty or full stomache (which one was better to do) and his reply was:

I don't think it makes any diffierence if the melatonin is taken on a full or empty stomach. No studies have been done to look at this, but many dogs are prescribed melatonin, and I've never heard of it causing an upset GI situation (i.e., no feedback of this type from owners or veterinarians). Same with the lignan.

Hope that helps. Regards, Jack Oliver.

I know Harley's appetite wasn't decreased because of it, and he has been on the melatonin & lignans for over a month now.

Best of luck to you and Mikey.
Lori

[4Mikeydog]

Hi Everyone,

Jeff, Susy, and Lori...Thanks for your information regarding melatonin and appetite suppression. I was wondering if Mikey's reluctance to eat his kibble and displeasure with his dog food was a result of the melatonin which I had introduced last month.
It seemed his appetite was great if he was offered something he really liked, but he could take or leave his kibble and canned venison with sweet potato.
So....I switched his canned food to Royal Canin prescription potato with venison, mixed some kibble...and of course, offered my little guy a venison steak grilled and cut up into his food daily. Yum..Yum..except for the kibble part:(
I also added steamed carrots as a snack..and have just introduced baked sweet potato as a snack as well.
He loves this stuff:D:D:D But still leaves the kibble in his bowl.

Mikey has always had a great appetite if he was fed his chicken in the past ( not an option now)
or if he was given pure meat..and he's always eaten a tremendous amount..he just has lost so much weight that no one wants to take a chance on a treatment which may alter his appetite.

Mikey has gained a total of 3/4 lb since switching his diet to venison. His digestion is definitely better.

His breath had become extremely foul a few days ago. When I went to clean his gums with a dental wipe, I noticed blood. So off to the vet we went.:(

Our vet didn't see anything obvious on exam, drew blood to see if any metabolic or other healthissues could be causing this and started him on an antibiotic.

We are waiting for the results of this test before we proceed with any other treatment. His breath does seem better.

This may be the reason he didn't want to eat the kibble!

He is eating very well otherwise:D:D:D

We are hoping this continues!

best wishes,
Dorothy and Mikey

[Wylie's Mom]

Hi Dorothy,

I'm not positive, but I think you might be on to something... maybe you should take Mikey to an animal dentist. The foul smell could be a bad, aching tooth (smell=bacteria, ache=pain to munch on kibble).

If you can, please join this site:
http://www.accessmylibrary.com/coms2/browse_JJ_W163

to have access to this Whole Dog Journal article:
Improve your dental acuity: what do you know about your dog's teeth?
July 01, 2008

You might want to take him to a vet that specializes in dentistry if there is one available in your area (your vet might not notice as much when it comes to teeth).

-Susy

[MiniSchnauzerMom]

Hi Dorothy,

I was reading about Mikey's foul breath and it was déjà vu! My Munchie is also on a novel protein diet (no chicken for him either) and quite honestly, I thought perhaps his bout with stinky breath was either dental or from the fish he was eating - phew! As with Mikey, the Munch has also had digestive issues in the past. He was put on Flagyl for a little tummy trouble and to my surprise the stinky breath vanished after taking 3 doses of the meds. I had no idea! A specialist dentist is still on the agenda for a check-up but no more "alligator breath".

Hope Mikey continues to improve.

Louise

[gpgscott]

Hi Dorothy

I have not posted previously but I want to agree with the others that I would first suspect a dental issue which they hide well and can cause all sorts of problems.

Scott

[4Mikeydog]

Hi,

Thanks for all of your input regarding the situation with Mikey's breath situation. As of today, he has been back on the metronidizole (Flagyl) for 3 days and his breath is better already! We are still waiting to see if the dental specialist is an option. We will keep you posted.

Dorothy and Mikey

[4Mikeydog]

Hi everyone....

I haven't posted in awhile but here's an update on Mikey...
Mikey was treated with metronidizole for potential gingavitis for the past ten days and his breath is much better!!!:) He is now devouring his food and is eating much of his kibble again :D:D:D

He had been on anipryl because his vets were initially concerned about introducing Lysodren due to his GI issues and now due to his reluctance to clean his bowl.

Within 3 days of starting the metronidizole, he was eating like a pro again.:)
All of the symptoms of elevated cortisol have returned with a vengance since Trilostane treatment ended 5/14/09.
In response to this, and because his hindquarters are growing weaker by the day :(:(:( his vet is willing to try the Lysodren...at a maintenance dose only...
There may be a possibility to lower the cortisol production slightly this way and lessen some of Mikey's symptoms without the danger of the full load.
Mikey weighs 12.12lbs now and he would be getting a dose of 125 mg Of Lysodren 2x per week.
He is currently on the melatonin 3mg BID and the Flaxseed with Lignans 40 mg capsules SID.
We would do an ACTH stim test 1 week -10 days into this maintenance treatment to see where his cortisol is and possibly continue a little longer to achieve a result.
My vet wants to try the most conservative protocol possible initially.
He has had experience doing this and feels it is a better option for Mikey.

My question is...If this doesn't improve his cortisol level, how do we go about loading him after initially being on a maintenance dose?

My heart is breaking watching my little guy trying to get up on the couche to look out the windows and being unable to. The look on his face is making me cry...

I hope this works...

Dorothy and Mikey

[Squirt's Mom]

Hi Dorothy,

Is Mikey still on the Anipryl? If so, you might want to consider stopping that as it can effect the appetite. I don't understand for sure if he is still on it or not.

Since Mikey is Atypical, the Trilo could easily have made his intermediate/sex hormones higher, causing the cush signs to become even more prevelant. My Squirt had been on the purified form of lignans until her recent UTK panel and Dr O wants her on the hulls. Glynda has done some research and found that the hulls contain a higher level of lignans than the purified form. That is something you might want to look into, too.

How long has it been since Mikey was retested for the Atypical? Since he's been off the Trilo for over 30 days, I would want the UTK panel re-run before I started the Lyso to see where he is now and to see what Dr O recommends. Buy that's just MHO. If you choose not to go that route, I do think your vet is correct in starting a low maintenance dose of Lyso and foregoing the loading phase.

I know how hard it is to see your baby feeling so badly and wanting to do something to help yet feeling helpless to do so. You're doing all you can for him and doing a good job of it, so just keep up the good work and hang in there. We are here any time you need to talk.

Hugs,
Leslie and the girls

[4Mikeydog]

Hi Leslie,

Mikey was initially tested with the UTK panel 3/30/09. This was before the Trilostane washout period.
His estradiol and 17 hydroxyprogesterone were elevated. His cush signs were mediated by the Trilostane, he just had lost so much hair and so much weight...even with a great appetite...and had severe GI upset as well.
The issue right now is that his cortisol is high..he is symptomatic as he was before Trilostane...
Mikey is no longer on Anipryl...He will start the Lysodren Monday.

I am hoping for a good outcome.

Dorothy

[Squirt's Mom]

Hi Dorothy,

Thanks for clarifying for me. This old brain don't work like it used to. ;)

I believe you will see an improvement with the Lyso added to the mix. It will help with the cortisol as well as the progesterones but may not have any effect on the estradiol. That is where the melatonin and lignans come into play. So with all three on board hopefully these signs will start to disappear and your sweet Mikey will start to come back.

Hang in there!
Hugs,
Leslie and the girls

[4Mikeydog]

Hi...

Well...Mikey started a maintenance dose of Lysodren..125mg 2x per week... on Sunday. He seemed ok with it, although a little lethargic. His appetite was still good, still drinking, and good poops:)
He slept through the night on Sunday...We were shocked..I think he was so knocked out that he just managed to stay asleep.
Yesterday, he seemed more tired than usual in the morning..but responsive and hungry!
I stayed with him until I felt he was ok, then got a friend to watch him while I went to work, and call me with updates. All was well!!!

I got home at 5:00 and he greeted me happily...
When I bent down to give him his tummy rubs, I noticed what looked like a dark brown testicle in the groin area of my neutered boy!!
It was soft but well defined. I called the vet frantically and was squeezed in at 7:45.
By the time we got there, this brown area had burst and there was a wound draining into an area of raw skin. The area was cleaned, cultured and Mikey was put on Clavamox BID while we wait for the results of this wound culture. The wound is open, draining, and does not seem to bother him. I am horrified:eek:
I know it is hard to get healing in a cushingoid dog. I also question his absorption of protein, a needed source in the promotion of healing.

He is on the Clavamox because we know he tolerates it without too much of a gastric complication and we don't want to skew the reaction to Lysodren by adding another source of stomach upset.
I am applying Hydrogen peroxide to the area as well with a sterile gauze pad.
The vet said it was important to let the wound drain until we found the source, as there could be an internal infection which chose this way out of his system.
I am heartbroken and frantic....I can't stop crying...

Dorothy

[Squirt's Mom]

Hi Dorothy,

Bless your heart! It's always something, it seems like, with these babies. I can only imagine what it must be like to see an open wound on your baby and not knowing where it came from or what it might mean. :(

To me, the fact that this lump ruptured and is draining is a good thing. Also the fact that it seems to have come up quickly is positive. I am choosing to believe it is something like a stitch that didn't dissolve, or a piece of the gonad that was missed, or a thorn that got imbedded and infected. Something minor and easily remedied! You hold on to that faith, too. If it's too hard for you to hold on to at times, just remember that I have faith and hold on to that, ok?

Cry all you need to but know we are there with you; you are not alone, Dorothy. Anytime you need to talk we are honored to listen and lend a shoulder.

Keep your chin up!
Hugs,
Leslie and the girls

[4Mikeydog]

Hi Leslie,

Thanks so much for your kind and encouraging words.
I'm doing alot of praying lately.
Right now I have Mikey at work with me:):):).
I couldn't leave him, so I worked out a way to bring him with me and do paperwork!
Hopefully we will be all right!!!

Dorothy and Mikey

[MiniSchnauzerMom]

Hi Dorothy,

I'm sorry to hear about Mikey's problem. Leslie is so right....if it's not one thing, it's another with these pups. I would have been frantic too and glad your vet squeezed him in.

Hope the culture comes back soon and a firm determination can be made as to what's causing this. Meanwhile, the antibiotic will be doing its job, the wound is draining and I know you will be an excellent nurse.

Thinking positive thoughts and saying a little prayer for both you and Mikey.

Louise

[Wylie's Mom]

Wishing you & Mikey well;).

-Susy

[Harley PoMMom]

Dorothy,

You and Mikey will be in my thoughts and prayers tonight.

Hugs to you both.
Lori

[Roxee's Dad]

Hi Dorothy,
I am keeping the faith, Good thoughts and prayers are with you and Mikey. I hope all turns out well.

[Harley PoMMom]

Hi Dorothy,

Was just checking in to see how you and Mikey were doing today.

Sending positive and healing thoughts your way.

Hugs to you and Mikey.
Lori

[Squirt's Mom]

Hi Dorothy,

How is Mikey today? How are you today?

Hugs,
Leslie and the girls

[4Mikeydog]

Hi...

Thanks for your thoughts and prayers...Mikey and I really appreciate them. Mikey is resting comfortably today. He had his second maintenance dose of Lysodren and is eating ravenously :D:D:D
His wound is till there, obviously, but seems a little less red. I am cautiously watching him and praying for a good response.
We will keep you posted!

Thanks again!!

Dorothy and Mikey

[MiniSchnauzerMom]

Dorothy,

Just checking in on you and Mikey. I am glad he is resting comfortably and that his wound is looking better. I'll be praying for a good response for Mikey right along with you.

Give that little guy some extra scritchies from me!

Take care,

Louise

[Harley PoMMom]

Hi Dorothy,

How is Mikey today?

Lori

[4Mikeydog]

Hi Lori,

Mikey is resting comfortably today. He is quite lethargic, but his appetite is great!!! :):):) He had his third maintenance dose of Lysodren today.
We are waiting for the complete results of his wound culture..These results should be in by tomorrow.
Meanwhile, I am cautiously and nervously cleaning his wound with Hydrogen Peroxide and still praying alot.
I got a copy of his recent bloodwork from 6/25/09 on Friday and I nearly had a heart attack :eek::eek::eek:

His alkaline phosphatase was elevated off the charts. It was 699.
In the past, when he was elevated the highest it ever got was 198 pre treatment and his previous test to this it was 156.

His ALT was 368. (High)
AST was 45.
His vet said the liver enzymes were elevated and it was of concern when we spoke on the phone initially. We will speak again tomorrow.
I am terrified by this latest development .

Mikey's platelet level is high at 629. It has always been high.

I know his cortisol is not controlled yet, but this Alkaline Phosphatase much higher than ever. I want him to have another ultrasound.

Thanks for your concern. We really appreciate it. We will keep you posted.

Dorothy and Mikey

[StarDeb55]

Dorothy, I wanted to put Mikey's alk phos in perspective for you. Yes, he has had a substantial elevation, but we have seen dogs in this group whose alk phos values can run in the several thousands.

Debbie

[4Mikeydog]

Debbie,

Thanks so much for your input! I am comforted to know that, although this is not routine...it is also not totally uncommon.
I just don't know how much damage is done because of this jump in values.
I guess we need to see what happens when his cortisol level is controlled.

Dorothy

[frijole]

Just to make you feel better my Haley has been on lysodren for 3 yrs now and her alkphos is usually over 1000. One time it was 800 and I was so happy. :p So hang in there and we'll all keep Mikey in our prayers. Kim

[Squirt's Mom]

Hi Dorothy,

I'm not sure that a simple jump in the values will result in any permanent damage to the liver. What those numbers are saying is that Mikey's body is under bombardment and the liver, being a purifying, filtering organ, is working overtime in response. The harder the liver works, the more enzymes it releases into the blood. And, don't forget...the liver has regenerative properties. It is an amazingly resilient organ able to take many years of abuse before irreversible damage even begins. :)

So don't worry overly much about those values right now. I'm willing to bet they are the result of his wound and whatever is causing that.

Do let us know what those results are when you get them. And, don't let yourself sit there worrying when we are right here. You don't even have to talk about Mikey if you'd rather get your mind somewhere else for a bit. Go to Everything Else and start a thread on something you enjoy - a hobby, one of your other pets, recipes (YUM!), etc. The point is, sometimes it helps just to be able to feel as if we are talking to people who understand...and we do.

Hugs,
Leslie and the girls

[AlisonandMia]

My dog's ALP and her ALT was slightly elevated like Mikey's toowas around that level at diagnosis but with treatment (Lysodren) and milk thistle her liver enzymes returned to normal.

I also wonder if the infection he's had couldn't be responsible for at least some of that elevation too. Things like infections and even injury can temporarily raise the ALP and maybe the ALT too.

As Leslie said it is very likely just a sign that the liver has been working hard - not a sign of actual liver damage. Sometimes elevations like this can be a sign of gall bladder issues - which can also cause episodes of poor appetite so that could be a possibility too.

Alison

[Harley PoMMom]

Hi Dorothy,

Can't add much to what everyone has said, it does seem, from what I've been reading that this dratted cushings disease does cause the ALT and the ALP to spike up.

Some, like me and I see Alison too, give their pups supplements for the liver, but I would check with your vet on this first.

Hugs to you and Mikey, and let us know how Mikey is doing and how you are doing too.:)
Lori

[MiniSchnauzerMom]

Hi Dorothy,

Still praying right along with you regarding the results of Mikey's wound culture. Illness, meds and anesthesia have all affected my Munch's liver enzymes. They go up then they drop back down. Just thinking out loud and I'm wondering if this could be the case with Mikey. His wound hasn't healed yet and is he still on antibiotics?

I'll be watching for your update on Mikey's wound culture.

Louise

[StarDeb55]

Just to expand on what I said about Harley's alk phos showing a substantial improvement, his AP decreased around 30% between last Sept., & the beginning of this spring. He has only been on the milk thistle for liver support. My 1st Cushpup, Barkley's, alk phos went up & down over the years he was treated from lows in the 800's to high's in the 1600-1700's.

Debbie

[Wylie's Mom]

Wylie has all your pups beat... alk phos of 7634:eek: - this was when he had his gall bladder attack - it was off the charts at the vet and they sent a sample to Antech lab and Antech's report had a note that said "verified by repeat analysis". That was one of the scariest times I've had with Wylie - and Debbie, I remember you helping me through it;)!!

As Louise said, there are several things that can cause elevated liver enzymes... Mikey's increased estradiol levels may also be one of the culprits.

-Susy

[4Mikeydog]

Hi everyone,

Just got back online and my head is reeling....

Thank you all so much for the info regarding your pups..
I was relieved to learn that this sudden rise doesn't necessarily mean irreversible critical liver damage.

Susy..7634??? :eek::eek::eek: You must have flipped! Glad that was an isolated event!!
Debbie, Leslie and Lori..i am looking into the milk thistle as we speak. I remember reading that it could cause a GI reaction. Do you have any info regarding this?

Louise and Alison..I was thinking infection could be the culprit too...

We haven't gotten the final culture results in yet, but we are continuing with the Clavamox unless we find that the bacteria is sensitive to something else.

Mikey is resting comfortably and I am happy to say, it looks like his wound is closing.:)
He is very tired lately though...but he sleeps through the night !!!:D
But....he is incontinent and urinates in his sleep sometimes:(
Poor guy!!!
We are patiently waiting and praying for things to get better!!

Thank you all!!!

Dorothy and Mikey

[Harley PoMMom]

Hi Dorothy,

I know whatcha mean about the head reeling thing.sometimes I think mine is just gonna spin off. :eek::D

I use Marin for Harley and in the insert it does say it may cause GI upset, but Marin contains Zinc, Vit B, and Silybin/Silymarin. The Zinc in the Marin might be what causes the GI upset.

In the Resourse section there is a thread on milk thistle and SAMe.

Re: Milk Thistle/Sam-e and more (for liver "support")

http://www.k9cushings.com/forum/showthread.php?t=192

Hope this helps. And I'm glad Mikey's wound is healing and he's sleeping thru the night.

Will be looking for your update regarding the results of the culture and sending prayers and healing thoughts.

Hugs from your PA. friends.
Lori

[AlisonandMia]

Mmmmm..... Really good appetite of late, but also markedly lethargic and peeing in his sleep...? Might be a good idea to get his blood glucose checked. Mini Poodles are one of the more diabetes-prone breeds and diabetes is yet another thing that can send the liver enzymes high. Cushing's of any kind also makes diabetes more likely.

Alison

[4Mikeydog]

Hi Alison,

I was thinking diabetes myself...but...Blood Glucose in the same bloodwork as the high alk phos was normal...:)
Blood glucose was 90..within normal range 70-135 mg/dl.:)
Thanks for the good tip though...Still trying to understand what is happening to my boy..
But sometimes it is impossible to understand....

Dorothy and Mikey

[AlisonandMia]

How long ago was that test done? Diabetes can come on more or less overnight if the pancreas gives out very suddenly. Also BG on blood sent to a lab can be falsely low because the living blood cells in the sample go on metabolizing the glucose in the sample while the blood sits around waiting to be tested. For a BG reading to be accurate the blood needs to be tested as soon as possible. To be meaningful BG tests really need to be done by the vet in house.

Alison

PS: ETA: I see it was 6/25/09.

[4Mikeydog]

Thanks Alison...
I need to ask my vet to do it in house then..This blood was sent out in the Vet Screen blood test.
I hope he does or else a trip to the IMS is mandated!!
I really appreciate the tip!

Dorothy

[Harley PoMMom]

Hi Dorothy,

Just checking in on you and Mikey, was wondering if the results of the culture came back.

Hugs to you and Mikey.
Lori

[MiniSchnauzerMom]

Hi Dorothy,

I'm checking in on you and Mikey too. How is he doing now?? I'm watching for your update and hope you will be posting the results of his culture soon.

Louise

[Harley PoMMom]

Hi Dorothy,

It's just me...again...but it's been over 2 weeks since you've posted...and I'm a bit of a worry-wort...hope everything is going great.

Love and hugs.
Lori

[4Mikeydog]

Hi Everyone,

I haven't posted in awhile due to some personal business..but all is status quo..
Mikey's cultures came back as staph anarchocus and staph pseduo-intermedius. The point of origin was non specific. However, both strains of staph were responsive to the clavamox and...
Thank the Lord..Mikey's wound has closed and healed!!!:D:D:D

Lori...Thanks for your concern!

Today we went for an ACTH stim test after doing a maintenance dose of 125 mg 2x per week of Lysodren for 4 weeks.
I don't expect the cortisol levels to be controlled by this protocol, although I see some improvement in the drinking and peeing!!!
We will keep you posted.

Thanks for everything!

Dorothy and Mikey

[Harley PoMMom]

Hello Dorothy!:)

So sorry that personal business has kept you away, but glad everythings okay now...we've missed you.

YAAAA!!! The clavamox got rid of the staph's, OMGosh, I can't even pronounce them, and yes, Thank the Lord that Mikey's wound is all healed up too...YAAAA!!!

Improvements in drinking and peeing, these are posts we love to see. :D

Please keep us updated. :D

Love and hugs.
Lori

[4Mikeydog]

Hi everyone,

I just got Mikey's ACTH stim results back from Monday.
They are .....Pre: 9.0 Post: 11.3 :(

Mikey has been on a maintenance dose of Lysodren of 125mg 2x per week without having been loaded because of his intestinal and appetite issues.
His vet wants to increase his maintenance dose to 125mg 3x per week as we watch him very closely.
He feels that this cautious approach is the best option, especially because
Mikey's drinking and peeing have somewhat improved and it will be even more difficult to determine if he has loaded if we, in fact, do load him at this time.
I know this is not the optimum treatment, however, it may be in the best interest of my boy.
I will be vigilant and very careful in my observation of my boy as we increase this dosage.
I suppose at some point, we may have to reduce this if it actually works and destroys some more of his adrenal cortex.:confused:

We always say..nothing is ever set it and forget it!

Thanks,
Dorothy and Mikey

[Wylie's Mom]

Hi Dorothy,

There are two things I find strange and I don't know if they mean something...

1) the pre is high for a pre, has his pre been this high before? did he seem particularly stressed that day?
2) the post is only 2.3 higher than the pre

Hopefully, someone else may know what these may mean... I'm curious.

I'm glad to his drinking & peeing has improved. I am cautiously optimistic that Mikey will do fine with the additional dose;).

BTW- I believe you know that there have been revisions to the UTK treatment sheet...
http://www.vet.utk.edu/diagnostic/endocrinology/pdf/Treatment%20Info,%20Atypical%20Cushing's,%20revise d,%20July,%202009.pdf


Lignan. Lignan has phytoestrogenic activity, and competes with estradiol for tissue estrogen receptors, with less biological effect. Lignan also inhibits aromatase enzyme (lowers estradiol) and 3-beta HSD enzyme (lowers cortisol). Use lignan from FLAX SEED HULLS (or HMR lignan). DO NOT USE flax seed oil as the lignan content is very low, and the flax oil can exacerbate pancreatitis in dogs (triglyceride levels may increase). Search for standardized products (via Google or health food stores) that allow determination of lignan content. Available products allow for flexible dosing, and the suggested approximate daily dose of lignan is one milligram (mg) per pound of body weight.

I believe you had been giving Mikey flaxseed oil (I was with Wylie)... I wonder if it may contribute to Mikey's GI issues.

-Susy

[4Mikeydog]

Thanks Susy,

I have actually been giving Mikey Flaxseed Lignans 40mg capsules from Nutraceutical Sciences Institute which I purchased from original Treatment Info sheet from UTK.
I can't give him the flax hulls that you sprinkle on the food because he doesn't always finish his bowl! I know that the lignan content is greater in that form. Oh well :(...
I appreciate the new information and I am looking it over.

I do find it interesting that Mikey only stimmed 2.3 higher on the post...He was very stressed at the vet's office. He always calms down by the time they draw the second blood.

Thanks again,
Dorothy and Mikey

[MiniSchnauzerMom]

Hi Dorothy,

Glad to hear that the antibiotic Mikey was taking was the right one for those staph bugs and that the wound is now healed.


We always say..nothing is ever set it and forget it!
You are so right about this! Wish you success with the Lysodren dosing and getting Mikey's numbers regulated.

Louise

[Harley PoMMom]

Hi Dorothy,

I'm sorry I can't give you any advice on Mikey's stim's results, the only thing I know is the post is supposed to be higher than the pre, and his is. That's basically all I know, I haven't dealt with Lysodren...yet.

With the flaxhulls, I mix Harley's in a very small bowl with some canned food & cooked rice then add his hulls in with some water until it all mixes together, I feed this to Harley first before he gets his "main" meal. That way I know he is getting all of his hulls, he licks that small bowl clean and then looks at me as if saying "ok mom where is the rest of my supper."

Best of luck to you and Mikey and I know you will be watching Mikey like a hawk bc you are such a good and loving mom.

Love and hugs.
Lori

[BestBuddy]

Buddy always had pre and post numbers pretty close and when he stopped the trilo because of other issues his pre was actually higher than his post. He was always very upset at the vet office and I was told that was the cause of the higher pre number.
Jenny

[Harley PoMMom]

Hi Dorothy,

Just checking in to see how the new increase of Mikey's maintenance dose to 125mg 3x per week was going. I know you're keeping a vigilant and careful eye on him. :) You're such a good Mom.

Love and hugs.
Lori

[MiniSchnauzerMom]

Yes, Dorothy, how is the new dosing going and how is Mikey feeling? I'd like to know too!!! :D

Louise

[4Mikeydog]

Hi,

Louise and Lori..Thanks for checking in. Mikey seems to be tolorating the increased dose of Lysodren adequately...but I don't see any improvement yet.:(
In fact, he seems more lethargic than he has in the past...but eating, drinking, and peeing are just as strong as ever..He had his first accident during waking hours this week..and the poor guy was sooo upset!:(
His appetite is stronger than ever..but I have the pred on hand just in case...I am truly worried about his lack of improvement but it seems we are doing all we can at this point..Thanks for caring!

Dorothy and Mikey

[MiniSchnauzerMom]

Dorothy,

Sorry to read about Mikey's lack of improvement on his increased maintenance dose of Lysodren. I hope things will turn around for him soon.


I am truly worried about his lack of improvement but it seems we are doing all we can at this point.

You are doing everything you humanly can for Mikey and I second what Lori said...you're a very good doggie Mom!

Louise

[Smileyspeople]

Dorothy:

Just thinking of you and Mikey...wishing you the best. To new to give you advice. We just went through our own panic with Smiley, so I am more than sympathetic to your situation. Hugs to both of you from

Another Dorothy

[Harley PoMMom]

Dorothy,

Sorry to read that the increased maintenance dose hasn't improved Mikey's symptoms. I wish I had some great advice for you...unfortunately I don't. Just know you and Mikey are in my thoughts and prayers, and I hope too that things will turn around soon.

Love and hugs.
Lori

[Harley PoMMom]

Hi Dorothy,

Just came here hoping to see a post from you with happy news about Mikey. Hope everything is well.

Love and hugs.
Lori

[MiniSchnauzerMom]

Hi Dorothy,

Just came here hoping to see a post from you with happy news about Mikey. Hope everything is well.

Love and hugs.
Lori

Me too!!!

Louise

[Squirt's Mom]

You can add me to list of inquiring minds, too, Dorothy! :)

Hugs,
Leslie and the girls

[4Mikeydog]

Hi all,

Leslie, Lori, and Louise...
Thanks so much for thinking of us. I haven't posted lately because nothing pleasant has been happening here. Mikey is hanging in there on his 3x per week Lysodren maintenance but I am sure his cortisol must be sky high by now :eek:
He has been on this protocol for over 3 weeks and is scheduled for his ACTH stim on Friday 9/4/09.
About 2 weeks ago the drinking and peeing had kicked in big time :mad:
He is lethargic and his hindquarters are weak..but his beautiful personality is still there and he enjoys socializing with people:)
He is up 2-3 times per night asking for water. I will have the vet run a full blood profile on Fri and test for blood glucose as well. I think he may be diabetic at this point if the cortisol hasn't changed...Or perhaps, he has an underlying infection which has caused his cortisol level to go higher.
I am heartbroken...Mikey has been on melatonin and Flaxhulls with Lignans for approx 4 months now and I see no change :eek:
He has been on Mainanence Lysodren for 2 months and things seem to be worse.
He has lost just about all of his beautiful hair but has maintained his weight..(at least that is good).
I am truly worried. The vet hasn't wanted to load him with Lysodren because he doesn't think Mikey will tolerate it.
I certainly want to do what is best for my dog within reason. I don't want to subject him to the risk of aggressive treatment,
but I feel we may have to take the chance now...
Please say your prayers for my boy....(there is no icon here for tears)
Thanks..

with love and prayers,
Dorothy and Mikey

[Squirt's Mom]

Hi Dorothy,

Honey, we are here for you in the good times and most certainly in the hard times. We may not have an answer right off, but we can sure listen and hold your hand. I am sorry you are so worried about your sweet Mikey. :(

I read back through your thread and didn't see where Mikey had been retested for diabetes. I haven't slept in 2 nites so my mind is rah-tha foggy, so if I missed that info, sorry :o . So now I just ask :p , has he been retested for diabetes? If so when? The weight loss, appetite issue, and lethargy would fit with diabetes, among other conditions. :rolleyes: If I were you, I would ask his vet to look into this possibility very thoroughly...and soon. It is not at all uncommon for cush pups to develop other endocrine problems, and diabetes seems to be quite common with cush pups.

I know 4 months seems like plenty long enough for the melatonin and lignans to work, but sometimes it takes much longer. Squirt was on melatonin and purified lignan capsules for a little more than 8 mos. and her estradiol and both progesterones are still high! However, she is not symptomatic. :confused: So don't lose hope with the Atypical treatments just yet.

It is puzzling that he continues manifest signs even with the Lyso. I can't help but wonder if something else isn't going on with him causing the cortisol to elevate in response. Just what you wanted to hear, I know. Has he had an ultrasound lately? That might be a good thing to do, too.

Please know we are here anytime you need an understanding shoulder. We all know just how terrifying things can be at times with our babies and have come here many times just to hear a kind, supportive word. I know I couldn't have made it many times without these wonderful, loving folks holding my hand. There are many hands ready and willing to hold yours, too. And tears to shed along with yours as well.

Keep your chin up, honey,
Hugs, prayers and healing thoughts,
Leslie and the girls

PS. Let us know how the ACTH goes! I sure hope he handles it better this time around.

[Harley PoMMom]

Hi Dorothy,

Ditto to what Leslie has said, we are always here, even if the news it's that great we want to hear from you...we worry about you and Mikey.

Re: the flax hulls and melatonin, I would email Dr. Oliver about this, these dosages are just estimates at first and can be adjusted, maybe Mikey needs more of both, I'm thinking out loud here...if he's taking his melatonin twice a day, maybe he needs to take it three times a day? I would definitely ask Dr. Oliver about it.

Wishing you luck on the ACTH on Friday and will be watching for the results.

You both are in my thoughts and prayers.

Love and many hugs.
Lori

[AlisonandMia]

If his cortisol is sky high then he probably would benefit from loading. It need not be tough on the dog (no tougher than lowering the cortisol with trilostane, anyway). A long, slow load with Lysodren using a lowish loading dose could probably be the gentlest way of treating, anyway. My dog took a month to load (this was not on purpose!) and she just looked better and better (happier and brighter in her eyes though she was still strongly symptomatic with eating and drinking and pot belly) from around the 10 day mark as her cortisol slowly came down.

A very fast load can be tough on them as the rapid change can make them feel pretty flat for a while. The only disadvantage of doing it slowly is that it will likely mean more testing, just to check how things are going - ie that the dose is actually working in the way you want it to. That and the fact that it can be pretty stressful on the owner!

High cortisol is tough on the dog too and will make them pretty frail over time - and it could well be what is making Mikey feel bad.

Alison

[MiniSchnauzerMom]

Hi Dorothy,

Well, darn.....I was hoping to read that Mikey was feeling better and the new Lysodren dosing was helping. :( I think it's a good idea to have your vet run a full blood profile to see if there's anything else going on (hopefully not!) Sending off an email to Dr. Oliver probably wouldn't hurt either. Sometimes it's just hard to know what to do - so touch all the bases. Have you thought about taking Mikey back to the IM for a consult?

You mentioned that you were wondering if Mikey had some type of an underlying infection that could be causing elevation in his cortisol and this is probably way out there in left field....but how are Mikey's teeth and gums now? The dental issue w/Munchie was a real eye opener for me. The Flagyl did help him just like it did Mikey but only after taking radiographs of Munch's teeth did the dental specialist become aware of those two dead teeth and an infection. He could not tell by just looking in Munch's mouth at his teeth and I'm pretty sure that was all your vet did was look. Anyway, this is grabbing at straws but thought I'd mention it.

Dorthy, I'm hoping and praying that Mikey's vet can get to the bottom of what's going on so little Mikey can have some relief from those symptoms and feel better. Will be thinking about you and Mikey this Friday when he goes for his ACTH.

Give that little guy a hug and kiss from me!

Here's a hug for you too....((()))

Louise

[labblab]

If his cortisol is sky high then he probably would benefit from loading. It need not be tough on the dog (no tougher than lowering the cortisol with trilostane, anyway). A long, slow load with Lysodren using a lowish loading dose could probably be the gentlest way of treating, anyway. My dog took a month to load (this was not on purpose!) and she just looked better and better (happier and brighter in her eyes though she was still strongly symptomatic with eating and drinking and pot belly) from around the 10 day mark as her cortisol slowly came down.

A very fast load can be tough on them as the rapid change can make them feel pretty flat for a while. The only disadvantage of doing it slowly is that it will likely mean more testing, just to check how things are going - ie that the dose is actually working in the way you want it to. That and the fact that it can be pretty stressful on the owner!

High cortisol is tough on the dog too and will make them pretty frail over time - and it could well be what is making Mikey feel bad.

Alison
I want to "second" what Alison has written. I am just getting caught up on reading your thread, but my thought is pretty much the same as Alison's. Until Mikey's cortisol is lowered into a therapeutic range, I'm afraid that resolution of his Cushing's symptoms is unlikely. :(

I surely do understand that his situation is both complicated and worrisome. But my hope would be that effectively lowering his cortisol in the gradual manner that Alison has suggested would lead to improvement.

Marianne

[4Mikeydog]

Hi all,

Leslie, Lori, Alison, Louise, and Marianne,

Thank You so much for your kind words of support and encouragement. You guys are the best.
Leslie, my twitcher is going overtime on this one...I don't think it's just a Lysodren issue as to why Mikey seems to be exhibiting signs ogf excess cortisol. He was retested for diabetes in early August and he was normal. I know these things can happen suddenly and out of left field, so we will surely check again. I know he needs another ultrasound. Even though the ultrasounds have been coming back completely normal and clean, we have the feeling that something is there. It's not a great feeling.
So..we will investigate further as to the possibilities.
Louise..The dental issue is still under investigation.
We will return to the IMS in the next week if we don't get answers from the testing Friday.
Thanks again.

Dorothy and Mikey

[MiniSchnauzerMom]

Dorothy,


Even though the ultrasounds have been coming back completely normal and clean, we have the feeling that something is there. It's not a great feeling.
So..we will investigate further as to the possibilities.

I feel for you and personally know how difficult it is knowing in your gut something just isn't quite right but not being able to determine what it is. :( One can end up feeling pretty helpless sometimes. Just know that you are following through on every possible angle to get to the bottom of what's going on with Mikey and that's all you, as a human being, can possibly do.

Keeping you and Mikey in my thoughts and prayers. .

More hugs for you both ((()))

Louise

[4Mikeydog]

Louise...

Thank You so much for your kind words. I am holding my breath until the process commences again tomorrow.
Mikey is not feeling well. Yesterday he seemed much weaker. We are watching him carefully. I don't know if he will be able to tolerate the ACTH stim tomorrow.
I'll talk to my vet about this. Maybe we'll start with bloodwork and see if anything has changed.
I am holding my breath.

Dorothy

[Squirt's Mom]

Hi Dorothy,

Many prayers, positive and healing thoughts for you and Mikey.

It might be worth a phone call to your vet to ask what kind of stim agent they used for the last ACTH, and see if they would try a different one this time. It may have been something in the agent itself that was so hard on him - this is just wool gathering on my part. ;)

Hugs,
Leslie and the girls

[Harley PoMMom]

Hi Dorothy,

Poor you and Mikey...so sorry Mikey is not feeling well.

I do believe a CBC and maybe a chemistry work up would be good to do.

Seeing our pups not feeling their best is heart-breaking, especially when you are trying everything under the sun to make them well and it doesn't seem to do much, it makes one feel so sad and like Louise has said so very helpless, if only our pups could talk or communicate in some way that we could understand exactly where they were hurting...ugh.

You are such a wonderful Mom, Dorothy, don't ever doubt that, you are doing everything, and I mean everything that should be done for Mikey and hopefully soon this persistence will pay off and the underlying cause of the rise of his cortisol will be known.

You both are in my thoughts and prayers.

Love and hugs.
Lori

[Roxee's Dad]

Hi Dorothy,
I've just been going back thru your thread to remind myself of all the issues poor Mikey has been thru. Wow, what a roller coaster ride.:(

I agree with your thinking, I wonder if there is still an unresolved, underlying issue that is making him feel bad. He's had a staph infection, maybe that is still lingering? Bowel problems, possible or coincidental reaction to the stim test. . . . . .Louise mentioned teeth, maybe an ear infection or UTI. All of which could be stressing Mikey.

If you do decide to go forward with the stim test. It might help to not leave him at the vet for that 2 hours. If you can, take him to the park and bring him back on time for the 2nd blood draw.

I hope his vet or IMS can help Mikey come to a resolution and make him feel better. My thoughts and prayers are with you and Mikey.

[4Mikeydog]

Hi all,

Mikey had his vet appointment today for his ACTH stim and deteriorating health issues. After the vet was fully apprised as to the developments over the last two weeks and the exam, Mikey was cleared to have the test.
He came home apprx 3 hrs ago and seems to be handling the stress of the day fairly well.
It was apparent to the vet that Mikey's cortisol was high based upon his clinical signs.
We ran a urine culture, full bloodwork-up, and a stool specimen to rule out blood.

The vet concurred with the idea that Mikey is probably responding to an additional stress factor such as a possible infection and that is what is causing the rising cortisol level.
Of course, the cortisol level will be verified by the ACTH stim test.
That being said, he looked at his gums and didn't feel that they were the source of infection and is treating Mikey for a possible UTI or underlying infection with Baytril BID.
We will know more when the lab results are in.

Unfortunately, an infection would be preferable to some of the other possibilities which would cause this.
We have suspected an underlying condition with Mikey's liver or pancreas for some time now although all his ultrasounds have been clean. Unfortunately, as Cheryl has mentioned in her thread recently, the only way to verify that there is something really there is by exploratory surgery.
That's right, not even MRI or CT scan can see some of these type of lesions. Perhaps a pet scan could...but that is not an option :(
There is no way I would allow my boy to be subjected to surgery at this point in his life. He has been to weak all along for this and the vets have agreed that his chances would not be great for recovery.
My vets have said that if, in fact, they actually could find something during this procedure, chances for resecting it were nonexisitant.

However, at this point, if Mikey's cortisol level has risen while on his maintenance dose of Lysodren, and he is still symptomatic after a couse of antibiotic,
we will actually attempt to load him to see if he responds symptomatically to this protocol.

To intensify the degree of what has been going on, Mikey lost the ability to climb up the stairs last night. He is not in pain, but his muscles in his hindquarters are just too weak. He longingly looks at me to be carried.
He looks so bewildered by this....I can't stop crying when I think of it.

So...I think my boy is suffering from some type of neuroendocrine cancer, probably pancreatic with metastises, that may have caused his cortisol levels to rise in a cushing-like manner or, in fact, have been an ectopic ACTH producing microscopic tumor. (I've been reading alot) This is very rarely documented in canines and a very obscure diagnosis to make even in humans. This could have caused absorption problems that led to the severe weight loss and muscle wasting.
The vets also agree that this is a probable scenario.

My heart is breaking and I am fighting back tears constantly. I will do whatever I need to do to make Mikey happy and comfortable. We can't give up yet but we have to be realistic in our expectations.
Thank you for listening....

Dorothy and Mikey

[Harley PoMMom]

Hi Dorothy,

My heart is breaking and the tears are flowing as I read your post...but you are right...WE will NOT give up.

If you think this is a pancreas issue, then why not run a cPLI test on Mikey, it's specific to the pancreas...just a thought.

Oh Dorothy, if there is anything I can do, please let me know...but do know that you and Mikey are in my thoughts and prayers and we are here for you always.

Love and many hugs.
Lori

[Roxee's Dad]

Hi Dorothy,

My heart is breaking for you and Mikey. It's so hard sometimes when other underlying issues may exist. I hope the test results do reveal something that is easily treatable. In the meantime just love on her as much as possible.

[MiniSchnauzerMom]

Dorothy,

I don't know what to say. I am so hoping that it is not any of those things you mentioned and is something treatable. Keeping you and Mikey in my prayers.

Louise

[MiniSchnauzerMom]

Dorothy,

How is Mikey doing and was your vet able to determine anything from the testing he did on 9/4? Looking for an update....please! :D

Louise

[Harley PoMMom]

Dorothy,

How is Mikey doing and was your vet able to determine anything from the testing he did on 9/4? Looking for an update....please! :D

LouiseI would like to know how Mikey is doing also.

Love and hugs.
Lori

[4Mikeydog]

Hi....

I am posting to update you as to the status of Mikey's condition...

Louise and Lori Thank you so much for your concern...and for getting me back here :)
Mikey is hanging in there...Sorry I haven't posted in awhile with the latest news
Mikey's stim from 9/4 came back high Pre 9.7...Post 11.9.
The urine and stool cultures came back inconclusive..so...we decided to hold our breath and load Mikey with Lysodren.
We began the load last Saturday 9/12 and I worked from home and watched him like a hawk with a printout of loading instructions in one hand and a vile of prednesone in the other :)

I saw a slight change in his water consumption by Thursday night ( I measured everyday), but no other visible changes.
As a precaution, we did a stim test this past Friday 9/18 and I continued with the load while we waited for the results because there we no significant changes... until one day later..Saturday9/19..Mikey refused his first treat!!!
I thought..hmmm.. and hand fed him some venison steak which he slowly ate :D
He did drink a little after...but I stopped the load.
Yesterday Mikey showed all the signs of being loaded...less appetite, less drinking, slept through the night, but also was trembling a little during the day.
Today we got the results from Friday's stim...
Pre: 7.7 Post 11.2...Not Loaded as of Friday :confused:
I told the vet what is going on...and we are re-stimming tomorrow.
The vet agrees Mikey sounds like he is loaded.
He said usually the cortisol comes down gradually..but as we know...Every dog is different..Maybe he is loaded as of Saturday and no more Lysodren until after the test.

I will keep you posted....
Thanks again!

Dorothy and Mikey

[Harley PoMMom]

Hi Dorothy,

I was so happy to see your post.


We began the load last Saturday 9/12 and I worked from home and watched him like a hawk with a printout of loading instructions in one hand and a vile of prednesone in the other You are such a wonderful mom. :D

I am no expert at this Lysodren, no way no how...but from what I do read, some people not only go by their dogs "numbers" but by their dogs symptoms and how their dogs are feeling. So maybe Mikey's stim numbers are alittle high but his symptoms are abated and he is feeling good.

Here's hoping his stim numbers are within normal ranges, but like I said, if not, I believe one has to look at the "whole picture"...JMO.

My thoughts and prayers are with you and Mikey always.

Love and hugs.
Lori.

[Barney's Mom]

I wonder if maybe Mikey maybe had some GI upset from the Lysodren, and maybe that was what you were seeing? No way to really know for certain though, so you were right to get him stimmed.
Hoping for good stim results!
Cheryl

[4Mikeydog]

Hi...

Mikey is LOADED :D:D:D
I just heard back from the vet regarding the ACTH stim test he had yesterday...
Pre:5.0 Post 5.5

He did not really stim.....but this is it for now!
He is drinking considerably less and eating less as well. He seems to have more pep in his step and seems more receptive to doing things.

We will keep him on a maintenence dose of 125 mg 2x per week and re-stim within 2 weeks.

Now we just have to keep his weight on!!!

Thanks,
Dorothy and Mikey

[Harley PoMMom]

Hi...

Mikey is LOADED :D:D:D
I just heard back from the vet regarding the ACTH stim test he had yesterday...
Pre:5.0 Post 5.5

He did not really stim.....but this is it for now!
He is drinking considerably less and eating less as well. He seems to have more pep in his step and seems more receptive to doing things.

We will keep him on a maintenence dose of 125 mg 2x per week and re-stim within 2 weeks.

Now we just have to keep his weight on!!!

Thanks,
Dorothy and Mikey:D:D:D YAHOOO :D:D:D Oh Dorothy, I am so happy...I am grinning ear to ear :D:D...It's about time for things to move in a positive direction for you two...so very happy for you both.

Love and hugs.
Lori

[Roxee's Dad]

Hi Dorothy,

I am so happy for you and Mikey. :D:D:D

It's been a long hard road for both of you. Finally some relief. Glad he is feeling better and hope you are too. :):):)

[gpgscott]

He did not really stim.....but this is it for now!
He is drinking considerably less and eating less as well. He seems to have more pep in his step and seems more receptive to doing things.

Thanks,
Dorothy and Mikey

Dorothy,

There is nothing wrong with this result, in fact some Dr.s think the pre draw can be skipped as it will vary with the level of anxiety of the pup.

The post number is most important and when combined with improved symptoms you are describing sounds very good in Mikey's case.

Please let us know about the follow up stim.

Scott

[MiniSchnauzerMom]

Hi Dorothy,

Running a little behind and just catching up....fantastic news that Mikey has loaded! :D Sounds like he is feeling better already. I'm absolutely thrilled for you as I know how upset you've been and how worrisome this has been for you. It was a rough road for little Mikey but looks like he's finally made it over the hump.

Just a thought...since he likes grilled venison, maybe a few extra tidbits as a treat during the day will help him maintain his weight. I don't know if Mikey is still eating Royal Canine Potato and Venison but if he likes potatoes maybe even pieces of boiled potato as a snack would do the trick....if he'll eat it (Munchie would be drooling if he could read this! :D )

Take care,

Louise

[Wylie's Mom]

Hi Dorothy,

I'm so happy for you & Mikey :D:p:D:p:D!!!

Sorry, but I do have a question on the maintenance dose... I thought the last maintenance dose was 125mg 3x/wk and Mikey's cortisol increased on this. Is this incorrect?

-Susy

[4Mikeydog]

Hi,

Thanks for all of your kind words and encouragement.
Mikey is still doing well and has had one maintenance dose of Lysodren since his ACTH stim test on Tues.
He still seems more energetic, but I have noticed that he is not drinking enough.
He is eating his venison steak like a wolverine :D:D:D and loves sweet potatoes as a snack...but really has very little interest in dog food.
Louise..I am pretty much feeding him extra steak throughout the day to keep him eating ;)
I am trying to coax him to drink...but not much interest...so..
no more maintenance until I see him drink more. I'll watch closely....

Susy..to answer your question...Mikey was on a maintenance dose of Lysodren prior to loading him to conservatively bring down his cortisol level because he was not a good candidate for loading.
At first we tried 125mg 2x per week and that didn't work so we upped it to 125 mg 3x per week to see if his levels would respond to that along with the melatonin that he was taking.
When that didn't work...we decided to bite the bullet and go for the true load and hope for the best.

I know he is more comfortable now...but I am concerned about the weight loss he has already endured and the impact of less of an appetite on this.
It's a delicate balance. Fatty foods are too hard for him to digest and he does have food sensitivities so my options are somewhat limited.
When he is stable on this protocol of maintenance, I may try to introduce so additional food choices to supplement what he is getting.

I'll keep you posted.

Thanks,
Dorothy and Mikey

[Harley PoMMom]

Hi Dorothy,


He still seems more energeticYAAA!!! You go Mikey!!!

Re; Mikey not drinking enough: This is just a thought, ok...If you put his sweet potatoes in a food processor or blender and mix them with some water...whoola...Mikey gets more water and doesn't know the difference. You can probably do this with other foods that he likes to eat.

Hope this helps.

Love and hugs.
Lori

[MiniSchnauzerMom]

Hi Dorothy,

Just have a few minutes here as I'm getting ready to leave but I was going to suggest something similar to what Lori has already posted. Since Mikey likes his venison steak, maybe some small cubed pieces with a little water over the top in a bowl? Munch is required to get a specific amount of water everyday for stone prevention and I add it to his fish & potato home cooked and previously to the Rx kibble. He drinks it right down and then chows down. Maybe Mikey would do the same? One attempt would tell all. :D

Louise

[jrepac]

Venison steak & sweet potatoes versus dog food? Hhhmmm....no contest there.....I think we all know what WE would choose!:)

but, yes, adding liquid to the potatoes and pureeing in a blender or processor is a good trick....

also, don't know if he is sensitive to milk products, but I've had good success w/feeding a few spoons of vanilla low-fat (or no fat) yogurt....water can be added to that as well.....


Jeff

[gpgscott]

but I've had good success w/feeding a few spoons of vanilla low-fat (or no fat) yogurt....water can be added to that as well.....
Jeff

I think this is a very good suggestion and with yogurt you seldom have the lactose intolerance issues. I don't give reduced/no/fat versions as they are high in sugar.

Scott

[Wylie's Mom]

Hi Dorothy,

Thanks for the clarification on the maintenance dose. I hope the 2x/week keeps him at that great level;).

Yet another idea for getting more fluids in him... I cook chicken breasts for Wylie for him to snack on. I save the broth to add to his water to entice him to drink more if his water consumption gets low. I do not use store bought broth because of the salt content and, as someone pointed out recently, the store bought broth usually contains some form of onion juice/flavoring (& dogs shouldn't have onions). How do you cook the venison? If you boil it, maybe you can save the broth for flavoring water? I boil his chicken twice and use the broth from the second boiling, so the broth is pretty dilute. When I add the broth to water, I do 1 part (dilute) broth to 3 parts water. I use a separate water bowl for this - I do not leave it out for free drinking (bacteria formation??). He laps up every last drop and always wants more... but I don't let him drink tons of the spiked water at one time - only about a cup at a time & only enough to get him to about the right amount of water intake for the day.

-Susy

[Squirt's Mom]

Hi Dorothy,

I am just tickled pink to read how good Mikey is doing on his Lyso dose! This is just great! :D I know you are so very pleased, too, and this has to be a relief to some degree in your heart. I hope he continues to improve and that very soon you will start to see your old friend coming back.

Hugs,
Leslie and the girls

PS. the suggestions on adding water to his food are on the mark! Squirt's food has quite a bit of liquid in it and she stays well hydrated just from it...to the point I had begun to worry about her not drinking until I realized just how much water was in her feed! :rolleyes: If I don't have something to worry, I worry...:rolleyes:

[Harley PoMMom]

Hi Dorothy,

How are you and Mikey doing? Have you been able to get Mikey to drink more fluids?

Love and hugs
Lori

[Harley PoMMom]

Hi Dorothy,

Just checking in...I am starting to get worried...no word from you in a while. :(:confused::) Hope everything is ok.

Love and hugs.
Lori

[Squirt's Mom]

Hi Dorothy,

We really would like to hear from you on how he is doing. If you have a minute, please drop a line and let us know.

Hugs,
Leslie and the girls - always

[4Mikeydog]

Hi everyone...

I am sorry that I haven't posted in awhile...I have been going through a very difficult time and I simply wasn't able to talk about it or post without massive amounts of tears....
I needed to focus on Mikey and give him the best positive quality of life for the duration of his days..

With deep and profound sorrow, I am writing to tell you that our dear, sweet, beloved Mikey has passed away.
Mikey died peacefully Last month on a Sunday afternoon (January 24th) wrapped in the warmth of our love.
Mikey was a wonderful dog and a very special member of our family.

Through the years we were constantly amazed by and delighted with his extreme loyalty, intelligence, and resilience.
He filled our lives with laughter, joy, and unending immeasurable love.

The bond between a dog and his or her "person" is a remarkable phenomenon that can never be truly explained by mere words alone.
The companionship, unending loyalty, and unconditional love that comes with this indescribable bond is one of life's greater gifts.

Those of us who have been lucky enough to have been touched by this relationship know the depth of feeling that accompanies it
and can understand and empathize with the scope of the void and the extreme pain of this loss.

Although our hearts are broken and we are filled with sadness,
we know we have been blessed because our lives have been touched by this remarkable dog.

Sleep peacefully sweet Mikey dog...We miss you so much...


I'd like to take this opportunity to say thank you to all of you who have been so supportive in the past. This forum serves as a wonderful source off support and information.
I couldn't have possibly made it through this experience and course of treatment with the awareness and confidence that came from what I have learned here.

Thanks again...
Dorothy

[Roxee's Dad]

Dear Dorothy,

My heart just breaks for you. I am so very sorry for your loss. Mikey was such a big part of our family here and I will miss him very much.

Rest in Peace sweet Mikey.

[BestBuddy]

Dorothy,

I am so sorry to hear about Mikey. Thank you so much for coming back to tell us, I know it wasn't easy. Many of us have been in this position at lease once (usually many times) and really do understand the bond that is formed. I hope soon that your memories of Mikey are all happy ones.

Jenny

[kaliuma]

Dear Dorothy,

I am so sorry for your loss. I lost Kiska on January 29 so can imagine how you might be feeling. Please take good care of yourself during this difficult time.

With you in spirit,

Susan

[gpgscott]

Dorothy,

I think they all love us in the same way, without condition.

I am very for your loss of Mikey.

Thanks for telling us.

Scott

[Harley PoMMom]

Dear Dorothy,

My heart is breaking for you also and I am so sorry for the loss of your beloved Mikey. He was a very special boy, who his mom loved and adored.

I wish that I had more than just words to comfort you, my dear friend. Please know that we will always be here for you when you should ever need us, maybe just to talk because we do understand the pain you're feeling. Please take care of yourself Dorothy.

Peace sweet Mikey.

With Heartfelt Sympathy,
Lori

[maggiebeagle]

I lost my Maggie December 29th so I can imagine how you are feeling. So sorry.

[MiniSchnauzerMom]

Oh, Dorothy, I am so sorry that your sweet Mikey has passed. My heart sank when I saw that your thread title had changed. I know you and your little guy had been through a lot and I thought of you both often and wondered how you were doing. Now I need to sit down and join you in some tears.

Dorothy, please take care of yourself and little Angel Mikey I'm sending up some love and a big kiss especially for you, sweet boy. Peace be with you both. I'm going to go over to the candle site now and light a candle in honor of Mikey.

With Deepest Sympathy,
Louise

[lucygoo]

Hi Dorothy..

I'm so very sorry for the loss of your sweet Mikey.

Take care,
Gina

[Coolidge]

I am so sorry for your loss of Mikey. You are in my thoughts and prayers.

[Dollydog]

Hello Dorothy, I'm so sorry to hear of the loss of Mikey and I certainly understand not being able to post while dealing with all that goes on before they leave us. I too am missing that special little being that is no longer here with me....just the memory of having that special bond with a very special dog.
Please come back to let us know how you're all making out.
Jo-Ann & my Dollydog angel

[Casey's Mom]

Hello Dorothy, I am so sorry for your loss of Mikey. Thank you for the wonderful tribute to Mikey and letting us know that he crossed peacefully and with his loved ones. I always loved his avatar.

Many hugs are sent your way,

[bgdavis]

I'm very sorry for your loss. Mikey was way too young to have left this world.

Bonnie and Angel Criss

[littleone1]

Hi Dorothy,

I'm so sorry for your loss. My thoughts and prayers are with you. Mikey is now free to be a puppy agaiin.

[EllyAugie]

Dorothy, my heart goes out to you for your loss of Mikey.
My deepest sympathy.
Elly and Augie

[Nathalie]

*hugs* So sorry for your loss.

Nathalie

[Squirt's Mom]

Dear Dorothy,

I am so sorry for your loss and understand how devastating it is to you. Mikey was such a lucky little guy to have you by his side through his life, right to the end. You fought so hard for him, worked diligently to help him feel as good as possible, and did all you could to make him comfortable and his life enjoyable...what a great mom you are.

As great as you pain has been, and still is, I hope it is some small comfort to know that Mikey's pain is over. He is whole and well once again, bouncing through the grasses with his ears flopping behind across The Bridge where he was met by many, many of our pups.

Thank you for coming back to let us know and allowing us to honor him with you. Some day, when you are ready, please feel free to come and post in the In Loving Memory section, sharing his life's story.

Our deepest sympathies,
Leslie, Squirt, Goldie, Crystal, and our angel, Ruby

[Franklin'sMum]

Dorothy,

I am so sorry for the sad loss of your sweet Mikey.
With love and deepest sympathy,

Jane and Franklin

[Carol G]

I am so sorry for your loss. My thoughts are with you.

Carol