Katie - 12 yo mini wire dachshund - Katie has crossed the rainbow bridge

[Wendy Tillotson]

Katie was just diagnosed with Cushings. I knew there was something wrong when she blew her coat - but her thyroid came up low, so we treated that. The coat did not come in and when her partner literally licked a hole in her side, we tested her for Cushings.

She finished day two of the loading. She is 11.6 lbs and is getting 250 mg of Lysodren per day - in two doses.

Unfortunately, other than the coat and seeming like she is starving to death (which is pretty normal for a doxie), she shows no other signs of an issue. So unsure of how to gauge when it is loaded. Really scares me.

The vet said typically takes 7 to 10 days to load. I've heard it can take as little as 3 to 5. So HOW do I know. I am worried that we can ruin her adrenals. Do smaller dogs load faster? Or is that not a factor at all?

I have prednisone as well as azium (injectable) if I start to see a problem. I also have a number where I can reach someone at the vet 24 hours a day. Sure hope I never need that number.

[frijole]

Welcome! I'm linking you to an info sheet on loading... I used it and it helped a great deal.

Good news is your dog eats like a little piggie.. and THAT is how you will know when she is loaded. Your dog's appetite is caused by cushing's. (excess cortisol production) Lysodren will reduce the cortisol levels and you will see a change in appetite. When you do, you stop the lysodren and you have another acth test to measure cortisol.
If the reading on that test is between a 1 and a 5 you are loaded.

So watch her like a hawk for ANY sign of change in appetite. Even eating slower. If you see it, don't risk it, get the test. Cease lysodren. Any questions, you ask us and we will chime in!

Signs of too much lysodren include vomiting or diarrhea. If this happens CEASE giving the drug, call your vet and get the testing done. You have the prednisone to give in case of emergency.

I checked and your dosage is spot on for your dog's weight so that is a good thing. Do you know what tests were done to diagnose and what the results were? If not, get copies and post them. Also always get copies and file them away for future reference. It will come in handy.

OK... here's the link. Any questions, ask! Kim

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

[frijole]

I should have added.. my dog Haley was on lysodren for 4 1/2 yrs! It saved her life and she led a very normal, happy life. She passed at 16 1/2 of old age. So please know you are doing the right thing and while the drug might scare you at first it does work. Kim

[Skye]

checking in to see how you and your pup are doing.........did you start the med? everything go okay?

[Squirt's Mom]

Mornin' Wendy,

Welcome to you and Katie! :) Glad you made it over. ;)

This is day 3, right? Have you seen any changes in her behavior relating to eating or drinking? If you see anything that you question, just holler...someone is on just about 24/7 to help.

The link Kim gave you is very handy to keep close. It has some really good tips as well as info from experts on treating with Lyso. Several folk have stuck it up where they, and their families, can easily see it to refer to when needed.

I know this is scary but you will do just fine. Lysodren is no more risky than any aspirin when used correctly - and it sounds as if your vet is on the right path. And you now have a whole bunch of folks right beside you. The load is the worst part - once that is over, you will feel like you can tackle anything! ;) And all you have to do right now is watch her closely, follow the docs orders for medicating her, and stay close to us. Talk often - there are no dumb questions...trust me, if that were an issue, I would be LONG gone! :p

You and Katie are not alone; we will walk with you every step of the way. The knowledge and first-hand experience found here is astounding, and it's yours for the asking. You couldn't find a better bunch of folks for support. We have been known to hold hands until they ache and run with sweat. ;) Everyone is here to help and support each other...and I am glad you and Katie have joined our little family.

Hang in there! You're doing fine, Mom!
Hugs,
Leslie and the gang

[Wendy Tillotson]

Thank you all so much. I really am feeling stressed out about this. Hearing from all of you just brought tears to my eyes.

My vet chose the Lysodren because she felt it was the safest of all the drugs and if there was a problem, would not hit so fast that we couldnt deal with it. I have both prednisone pills and an azium shot to use, if needed. I also have a number through which she can be reached 24 hours a day.

Based on her hair not growing in even on thyroid medication and then the other dog licking a hole in her side, the vet just did one test - the ASTM. After reading some of this stuff, that is making me a bit nervous, but she has always been a very astute vet. Katie also eats like she is starving which is pretty typical doxie - but this is rather extreme. She is not drinking an excess amount of water.

Anyway, the results were as follows:

Cortisol Serial 2 (ACTH)

Time 1 Pre
Time 2 Post
Cortisol Sample 1 3.7
Cortisol Sample 2 28.6

This is the start of day three. Usually my husband feeds her - but I am going to keep track as well. One thing that I saw on here was to see if she will easily pick up her head if you call her when she is eating. That was a good tip. I did get her to pick it up after I yelled at her. LOL. I have a feeling she is going to load quickly.

If I see even the slightest sign that she is loaded, I am going to stop the medication and have her tested. I don't want to take any chances.

I saw something that said you should put them on maintenance for a month and then test.

Anyway, she is her usual perky self right now. Maybe if she takes a dog biscuit without trying to rip my fingers off that would be a good test. LOL.

Thanks again for all your support. :o

[Wendy Tillotson]

Oh - is there any precedence for how long it takes to load one type of dog - breed/size - versus another?

[frijole]

Oh - is there any precedence for how long it takes to load one type of dog - breed/size - versus another?

I forgot to answer that question sorry! NO... wish there was but we've seen dogs load in a day and my gal took 2 1/2 months. (she is a RARE exception so don't even worry about that)... anyway ironically it seems small dogs take LONGER than large dogs.

Couple other tips - always give the drug AFTER the meal. That way if the dog hesitates while eating you can NOT give the drug. You can't take it back and it continues to work for 48 hrs so if you have any doubts just don't give the pill. It won't hurt anything.

Most of us wrapped the pill in cheese or peanutbutter because it coats the tummy making it easier on the system. I ended up using cream cheese as it is so easy to form and you don't need a lot.

Since diarrhea is a sign of loading you'll need to watch the poops and if they start to be less formed (not funny but less formed) that is a sign you are getting there. It isn't fun but POOP PATROL is just a way of making sure all is well. It is especially fun at night during the winter... did that myself. :)

Kim

[Wendy Tillotson]

What's interesting is that I am noticing that she is chewing her dog biscuits instead of swallowing them whole. She also didnt practically bite my fingers off to get it. Very subtle, but not sure I am going to see much else.

We will check the poop. LOL.

[Wendy Tillotson]

What do you think of the test results and the clinical signs?

I used to breed and show mini wires a bit - and ran into one of the breeders that I know. She had a dog with Cushings with her and when I saw her, gave me a strange feeling about Katie. My gut said that's what I was seeing in her, not just a low thyroid. Not sure if they come from the same line. I would have to find out - but is it genetic at all?

[frijole]

What's interesting is that I am noticing that she is chewing her dog biscuits instead of swallowing them whole. She also didnt practically bite my fingers off to get it. Very subtle, but not sure I am going to see much else.

We will check the poop. LOL.

Your description of the dog biscuits would be enough for me to think your dog might be loaded. Does she eat her dog without breathing/chewing? :D My dog went from that to eating normally. Anyway... always better safe than sorry. You do NOT want to give the drug if you think there has been change. Better to be safe and risk paying for an acth test and having to restart than to have the cortisol go too low. If that happens dogs can be very sick and put on IVs and hospital stays... so please don't risk it. Moms know best is our slogan.

Kim

PS We do see that some breeds have a higher propensity to have cushing's.

[Wendy Tillotson]

I did not give her the pill with tonight's meal. She ate pretty quickly, but seemed a drop more patient. I gave her a dog biscuit and she waited a tiny drop before grabbing. A couple of days ago, she almost bit me trying to get it.

I figured I would talk to the vet and see what she says.

After reading some of the material here, that seemed like the smart thing to do. We can always give her the medication - but can't take it away.

[lulusmom]

Hi Wendy,

Kim has done a great job of providing information but I wanted to share a cost savings tip with you in the hopes that you can save some money on the acth stimulation tests.

The most accurate and widely used stimulating agent is cortrosyn. We call it liquid gold around here because it is so dang expensive. Cortrosyn comes in a .25 mg vial and the instruction on the label says to inject the dog with the entire vial. What most gp vets don't know is that only a fraction of that is needed for smaller dogs. Any remaining cortrosyn can be stored in the freezer for up to six months and I believe in the refrigerator for a month. If Katie weighs 20 pounds, your vet should be able to get five acth stimulation tests out of one vial. That is a huge savings to you so it is well worth dicussing this with your vet. Here is a comment from another member who let us know how much she saved with this bit of information.


That is definitely a money saving tip on diluting/freezing cortrosyn. I will be paying $152.00 (one-time fee) for the bottle of cortrosyn and will be getting five stims from it. So, I will only be paying the cost of lab work which is $142.00 each time Logan gets stimmed = Big Savings. Thank you for that good information

This member went from paying a max of $1,470 for five stim tests to $862. That's quite a savings. I have included a link below to Dr. Mark Peterson's veterinary blog where he provides information on the amount to use as well as how to reconstitute and store the remaining cortrosyn. You can either provide the link to your vet or print the blog. Dr. Peterson is a reknown endocrine specialist and I suspect s/he knows who he is.

http://endocrinevet.blogspot.com/2011/03/how-to-extend-your-supply-of-cortrosyn.html

Glynda

[Wendy Tillotson]

I did not give her the pill this evening. I noticed that when I gave her a dog biscuit - she chewed it instead of inhaling Plus she didnt practically rip my fingers off to get it.

Not sure I did the right thing - but wanted to err on the side of caution. Will talk to the vet later.

[frijole]

Wendy, I think you did the right thing. Like I said better safe than sorry... none of us want to pay for multiple acth tests but if you read ANY of the information on lysodren you will see it written that ANY change in appetite you should cease giving the drug. We have had members whose dogs paused while eating and that was there sign.

I will caution you that sometimes vets will get hung up on going a certain number of days - these vets are usually less experienced in dealing with cushing's. It really is YOUR call if you feel you should do the acth test you have the right to insist on it to be cautious.

I think every vet should have a dog with cushing's prior to being allowed to treat it. IT sure would change the way alot of them administer the drug. :D;) Not poking fun at your vet - this is based on the stories I've read here over the last 6 yrs.

Do keep us posted and we will keep an eye out for updates. Kim

[Wendy Tillotson]

Posted a few things and they never seemed to post. I wonder what happened.

Anyway, I did NOT give her the pill tonight and the vet never called me to discuss. Really upsetting.

Katie seemed more relaxed and not so desperate for food.

[Wendy Tillotson]

Instead of jumping off the couch to follow me into the kitchen, she just lay there. She chewed the small dog biscuit instead of swallowing it whole. Also, instead of grabbing the dog biscuit and practically biting our fingers off - she took it much more gently.

She seems a lot less desperate.

[Wendy Tillotson]

I wanted to err on the side of caution. Am I off base here? Only had pills for 2.5 days.

[lulusmom]

A conscientious vet should always make themselves available to a pet owner who is loading their dog, so I'm disappointed in your vet too. :(

Just remember that Lysodren has a cumulative effect and will keep doing it's thing for up to 48 hours. You are not seeing the full impact of the last dose or two so keep a close eye on Katie for signs of low cortisol. Hopefully you can get her into the vet on Monday for an acth stim test.

[frijole]

I wanted to err on the side of caution. Am I off base here? Only had pills for 2.5 days.

Wendy we are getting your posts. Scroll up to read our previous answers. :D

Lysodren can make a dog tired as they become accustomed to it. Keep in mind that cushings is caused by too much cortisol. High cortisol makes a dog restless and hyper. So when you reduce the cortisol they will be less active. I remember Haley sleeping all the time during loading and I'd just stare at her. Trust me - she'll get used to it and be normal again.

If Katie were to get lethargic to the point where she couldn't stand up or lift up her head - then that would be a sign of too much lysodren but what you described is normal.

Again, please scroll up and go to the previous page (1) to read all of our responses. Kim

PS I just want to echo what Glynda just said - the drug continues to work for 2 days after the last dose so I wouldn't give any more of it. And I wouldn't call the vet to ask for a test I would call the vet to TELL them you want the test on Monday. You can't be too cautious. And your vet not returning your call during loading is NOT good. You should be upset.

[Wendy Tillotson]

Good advice on the stim tests. I will print that out and bring it to her. Katie is under 12 lbs so that should last quite a bit.

I am a little confused on the testing. How long after the dose do you normally test? And if the test comes back good - do you just start the maintenance dose right away? And how soon after the loading dose would you start the maintenance one?

I read somewhere on your site that if a dog loads really fast that you may use as little as 25mg/kg to maintain.

Good thing I had you guys to help - because I stopped as soon as I saw the subtle change. On my own, and not knowing better, I might have given her the dose tonight. THANK YOU!

[frijole]

You are asking great questions!

It is ideal to test 2 days after the dose because the drug keeps on working that long so the results are most accurate at that point. Sometimes timing with vets and weekends make this impossible so you test as soon as you can.

The ACTH test will have 2 numbers on it - a pre and a post. You are looking for the post number to be between a 1 and a 5. (this is the reading of the cortisol) If you are between those numbers you are loaded. Below those numbers the cortisol is too low. Above them you are not loaded.

If you are loaded typically you wait and give the next dose ONE WEEK from the last time you gave the drug. (there are exceptions but let's keep it simple) At that point you give the same amount weekly that you gave daily during loading. This is to keep the cortisol at the current level. (maintain) You would probably give it in 2 doses a week since you are only giving 1/2 of a pill. (250 mg right?) That would mean giving 1/4 pill twice a week.

If you are not quite there yet ... well you know where you are (progress) and you resume the loading, look for changes and you test again.

I hope this helps. Kim

[Wendy Tillotson]

Well the last dose was Saturday morning so I would hope that testing on Monday would be okay.

So let's say she is loaded, then the next dose would be the following Saturday morning and the rest on Tuesday. Does that sound right?

Hopefully can get the vet tomorrow so can do the test on Monday. I guess going back and forth until you get it right is normal. Keeping my fingers crossed that it's loaded.

Meanwhile, will keep watching Katie to make sure everything is ok. She is such a cute little dog. Very perky and bouncy - even at 12.

(Not sure how I missed that the replies were posting - probably the same way I couldnt figure out how to register. DUH. LOL)

Thanks again! Really appreciate the quick responses - you are all amazing!

[frijole]

Yes you are right. And Monday is fine for testing but you don't want it to go too far out (ie WED) or the results will be skewed. Don't take NO from a gal at the front desk who doesn't know what you are talking about. :D

[Wendy Tillotson]

I'm going over to track down the vet today. They are closed, but someone is always there. I printed out the info on how to make the test less expensive and will bring that along too.

Good to know that can go out a few days tho - was wondering if Monday was too late (even tho you said 2 days later was worrying lol).

[Squirt's Mom]

Hi Wendy,

Mon. will be perfect...but as Kim said, don't let them put you off another day. The earlier Mon the better. If your vet gave you a cell# or other # to reach her clinic, then do make that call now. Let them know she needs the ACTH Mon morn.

The last dose of Lyso you gave her Sat will continue to work for about 48 hours so continue to watch her just as you have been. You are doing a great job...that little Katie is lucky to have you as her mom!

Hugs,
Leslie and the gang

[Wendy Tillotson]

I have been trying to get the vet all day. I stopped by her office and left a message around noon my time - about 4 hours ago.

In all fairness, she may have worked overnight, but that is even more upsetting because she had plenty of time to call me.

At this point, not sure WHAT to do. I hate to have to call and badger them. But, I sure don't want to wait to 10 at night to see if she is going to call me.

[frijole]

Didn't your vet give you the cell number? If so call it. (sorry if you already did and I misunderstood) Your vet needs to understand that lysodren and loading is not like just any other drug they hand out. Things can happen and they need to be available. If they aren't then they aren't the vet for you in the future. (I had to fire my vet fwiw)

Like I said earlier, don't ASK for an appt to have the acth test done tomorrow - tell them it has to be done. Let them know you are not in the dark about these things (like alot of people are) - you are spending aLOT of money with them and it is only fair that you have testing done when you need it done. Do NOT feel at all bad for being pushy on this. It is the right thing. Trust me on this. Kim

[Wendy Tillotson]

Thanks Kim.

I called the vet's office again and they said she knows I was by and is going to call me.

She didnt give me her cell - she gave me the number for the back office which is manned 24x7.

I may just drive over there again. They expected her in.

[frijole]

No problem. It took my dog being sick for me to realize how awful health care can be and we just can't sit back and wait or ASSume anything. We pay good money and we deserve good health care and service. Go get 'em Wendy. ;):D Kim

[Wendy Tillotson]

Well, got vet. At first she said she wanted me to go to 1/4 pill per day for a few days as she has never seen a dog load this fast.

When I said I wanted to test her, she said to bring her in tomorrow. She was a little unhappy that the last dose was yesterday and at first wanted me to give her a small dose tonight. But decided that I shouldn't when I said I saw a dramatic change in her behavior. I sure hope it doesnt effect the test.

One thing she said about the pills that bothered me is that they are not homogenous - and that if you use 1/4, you could get more or less of the dose.

She was thrilled to get the information about the cortrosyn as she says this stuff is so outrageously expensive. She basically uses it at cost and doesn't put any overhead on it.

Well, will let you all know how the test goes.

Thanks for all the support - good thing I have you!

[Wendy Tillotson]

Another thing that just hit me - is the first time we did the test, she might have eaten something within 12 hours and definitely had a dog biscuit at night around 11 pm and then no food after that. She was tested around 9 am.

This time, the vet said not to give her anything after 8pm.

[frijole]

:D Good girl. Already teaching the vet some new stuff and that is a good thing.

FYI you don't have to fast your dog for this test. We've had discussions on this before because for years I did... poor Haley was starving too. ;) So don't worry about that.

I'd stick with pills - you'd have the same issue with liquid - still room for error with such small quantities and I bet it is more expensive. Also you don't have to buy lysodren from your vet. I'd use up the first batch and get her loaded but when it's close to time to refill I would order online or from Costco. I ordered from drugstore.com for years without a single hitch. They had to call my vet and get the rx but once they did it they always renewed it without even bothering me. Painless and it was like 1/4 of the price.

Best of luck with the testing. Keep us updated. Kim

[Wendy Tillotson]

I love all of you - you are so amazing.

I printed out the loading instructions from the site - the one that has the info about the Milk Thistle. I wanted to ask the vet about that.

Do you think that having the last dose on Saturday morning is going to be an issue? I sure hope not. I was very reluctant to give her anymore as I saw a dramatic change. I think it will be a close call since you said it continues working for about 48 hours.

Pills are infinitely easier. Not sure what Costco charges - but the vet basically dispensed them at $8 a pill which appears to be fairly reasonable - this is brand, not generic. Do you use the generic version? Katie is not great with liquids anyway. It would be a battle to get it in her.

Will keep you posted. :)

[Wendy Tillotson]

Well, here is another stupid question.....if the medication works for basically 48 hours, how do you maintain the dog on pills twice weekly - or even once a week? Something doesnt compute in my brain. LOL

[frijole]

Well, here is another stupid question.....if the medication works for basically 48 hours, how do you maintain the dog on pills twice weekly - or even once a week? Something doesnt compute in my brain. LOL

It is absolutely NOT an issue that the last dose was given on Sat a.m. You are having a stim (acth) done on Monday a.m. which is 48 hrs so it is an IDEAL time to test because for the last two days the drug has continued to lower the cortisol. Your vet might not know this by the way if she hasn't worked with the drug a whole lot... we just know it because we are users of it :)

When you load you reduce cortisol in a short amount of time and your goal after you load is to keep the cortisol at that desired range (between a one and a five on the acth test) forever. In order to do that you give the same amount but over the course of a week vs daily. If you continue daily dosing the cortisol will go too low, your dog will over dose and go Addisonian. If you give the weekly dose you maintain the same level. That said... you have to check on it.

30 days after your dog is loaded you need to go back in for another test JUST to make sure that the dosage is maintaining.... trust me its' an expense and a pain but it is an insurance policy because you don't want to load again right?!

You give the same amount (250 mgs i believe you said) during the week. Since it is 1/2 of a pill it is probably easiest to cut that 1/2 of a pill in two and therefore you'd give 1/4 of a pill on Sunday and 1/4 of a pill on Wednesday for example. The drug is therefore constantly reducing cortisol and maintaining your load. Not sure if this helped but trust me - this is how it works. :p Kim

[Wendy Tillotson]

Are you kidding? EVERYTHING you tell me has helped! You have all brought a tremendous amount of peace and relief in this very stressful situation. I feel like we may actually get through this.

Thank you thank you thank you!:)

[frijole]

About the milk thistle...there isn't any scientific research that I know of that can prove it works.... but my dog had liver enzymes (alk phos) that were around 2000 (normal is like 200) and I started pouring 1/2 a capsule over her food in the am and 1/2 at night and next test she was down to 700 so I was impressed :)

I would wait to start any new treatments, foods, treats, etc. until after you are loaded just to be safe... I was loading and tried something new and my dog vomited... I didn't know if it was the food or the lysodren so I went in for an acth... it was the food. :( So learn from my mistake! ha Kim

[Wendy Tillotson]

Funny that you should say that. I was thinking of changing Katie's food. She and Zachary - her half brother - were both on Wellness Senior and he decided he didnt want to eat it. He kept stealing the greyhounds food - Annie so switched him to that - Natural Balance. It would be much easier if they were all on the same food.

Did you ever try Denosyl? Its a nutraceutical that is made for the liver. But I bet milk thistle is a heck of a lot cheaper. :p

[StarDeb55]

Wendy, I would like to give you & Katie a late welcome! Kim has given you some excellent advice about the proper protocols for using lysodren. I would like to add one thing. A lot of vets have their own preference as to how frequently maintenance dosing is done. This is because some pups will have adrenal glands that will start to regenerate the adrenal cortex in almost the blink of an eye, some other pups not so much. For instance, my GP vet who has treated both of my cushpups with lysodren, told me that in his experience twice a week maintenance dosing never seems to work for his pups. This is why my Harley got his maintenance dosing 3x per week. If you are fortunate to be able to dose twice a week, that's great, but I just want to make you aware of it. I, also, think that Dr. Edward Feldman at the UC Davis vet school who is one of the foremost experts on Cushing's in the world seems to prefer that maintenance dosing be broken down into 3-4 times per week.


Maintenance therapy involves choosing an o,p'-DDD protocol and altering that regimen as required clinically for each dog. Whenever possible, the weekly dose of medication should be divided into as many doses as possible. For example, if a 10-kg dog is to receive 50 mg/kg per week, rather than give that dog one 500-mg tablet once weekly, we give one-fourth tablet four times weekly.

The above quote is from one of our links in the important information section, & is from Dr. Feldman.

One other suggestion is to consider compounding Katie's lysodren dosage. Since you are having to cut those whopping big 500 mg tablets into 1/4s right now, that's not so bad. If you need to maintenance dosing more than twice per week, cutting that pill is going to be a major aggravation. My Harley only weighed about 13 lbs. I got his lyso compounded into 3 sizes, 50, 75, & 100 mg capsules which allowed me to make small changes in his dose as needed. With the compounded doses, I was assured that he was getting an accurate amount of medication, rather than me trying to guess as to how to cut that pill. If your interested in compounding, I can highly recommend Diamondback Pharmacy. I have used them, along with a number of other members. They have great customer service, & I believe they ship anywhere in the country for a flat rate.

Debbie

Debbie

[frijole]

Debbie - great advice. I never used them because I never needed compounding. Aren't their prices less than vet's also?

And Wendy - Debbie is right - splitting it into 3 or 4 x a week is more effective... I just couldn't figure out how you'd cut that 1/4 of a pill into 2 pcs :) Too small. So compounding would be easier. Again - use the pills you have up first because you paid for them and you don't want to compound until you know that this dosage is where you need to be. Sometimes tweeking is needed.

Wendy - just a word of caution that lysodren should not be handled by anyone that is pregnant. Also if you have a cut on your hand you might want to wear gloves when handling it. You don't want to start loading yourself :D Kim

[Wendy Tillotson]

Well with 20 pills - that could take a long time to use at 1/2 pill a week. UGH. I would rather have it compounded down, that's for sure. And it sounds like if you do that, you have a greater chance of getting a uniform dose in a pill

I do wear gloves when cutting the pills and handling them. And I also wash my hands, just in case. I will mention to my husband about the cuts on the hands because he often gives medication and in the winter, he can have cuts/cracks on his fingers.

[Wendy Tillotson]

Well, the test is done. Keep your fingers crossed. :)

I cannot believe how stressful this situation is.

[Jenny & Judi in MN]

Good luck on the results! My Jenny loaded quickly and uses 1/4 of a pill at a time also. She has an adrenal tumor and even attempting 2 times a week didn't cut it for her.

we are currently doing 2 days on, 1 day off and she is due for an ACTH soon.

hang in there. I have a separate pill cutter just for the Lysodren. Even with washing it out I'd hate for my other dog to get half a benadryl and wind up with some Lysodren dust.

Judi

[StarDeb55]

I would rather have it compounded down,

Wendy, I didn't think about it when I saw this last night, but I do know that some compounding pharmacies may be willing to take those 500 mg. tablets, use them to compound the smaller doses you might need.

Debbie

[Wendy Tillotson]

Sorry to be dense - but what do you mean by 2 days on and 1 day off?

I did get a separate pill cutter for the lysodren.

It would be super if a pharmacy could use the pills to make the dose I need.

Just REALLY hoping that the test shows she loaded. If it doesnt , I wouldnt know WHAT signs to look for.

Hugs to all!

[lulusmom]

Hi Wendy,

Please see my remarks in blue below:


Well, got vet. At first she said she wanted me to go to 1/4 pill per day for a few days as she has never seen a dog load this fast.

Unless your vet has treated a whole lot of cushdogs, which I suspect is not true, then she probably hasn't seen any dogs load in 2 to 3 days because the average loading time at max loading dose is anywhere from 5 to 8 days. However, on rare occassions, it happens. Regardless, the number of days is not a factor in assessing a dog for the possibility of loading and the need for an acth stimulation test.

When I said I wanted to test her, she said to bring her in tomorrow. She was a little unhappy that the last dose was yesterday and at first wanted me to give her a small dose tonight. But decided that I shouldn't when I said I saw a dramatic change in her behavior. I sure hope it doesnt effect the test.

I'm sorry that your vet was unhappy with your educated and intuitive call to quit dosing. A cushing's savvy vet would have given you a pat on the back and told you what a great job you've done in monitoring Katie for signs of loading. Had you noticed the definite change in Katie's behavior and continued to dose, you would have greatly increased her risk of an adverse reaction.

Had you given Katie 1/4 pill last night, 1) it would have put her at undue risk and 2) it is highly unlikely that your vet would have seen the effects of a dose given less than 24 hours before a stimulation test. I think I, and others, have mentioned previously that you don't see the maximum cumulative effect of the drug for about 48 hours.

One thing she said about the pills that bothered me is that they are not homogenous - and that if you use 1/4, you could get more or less of the dose. Meanwhile she dispensed 20 pills - which is a HUGE amount and now if I wanted to go to liquid, I would basically be out $160. I was upset when I first realized, but unfortunately was already at home. I doubt they will take them back. Nothing ever seems to come easy.

It is pretty much standard protocol to dispense any more than 8 to 10 days worth of pills when initiating the loading phase of treatment. If you are ultimately unable to use the pills you have, you should ask your vet to take back and credit your account for any pills exceeding 10 days worth of loading. An acth stimulation test should be done no later than 10 days after starting treatment, unless signs of loading were noticed before then. I'm not sure what your vet meant when she said you can get more or less out of 1/4 pill. If she means you should be able to cut a pill into 1/8ths, that's a real stretch, and if she means that it's safe to give Katie 1/4 of a pill when she should be on 1/8th, that's dangerous.

FYI, if Katie loaded on a maximum dose of 50mg/kg in less than 3 days, her weekly maintenance dose should probably be cut in half, being 25mg/kg.

She was thrilled to get the information about the medication as she says this stuff is so outrageously expensive. She basically uses it at cost and doesn't put any overhead on it.

Awesome! I hope more members with smaller dogs will think about talking to their vets about saving them money. There is no reason why a vet should not be willing to do this.


Another thing that just hit me - is the first time we did the test, she might have eaten something within 12 hours and definitely had a dog biscuit at night around 11 pm and then no food after that. She was tested around 9 am.

This time, the vet said not to give her anything after 8pm.

As Kim already mentioned, it is not necessary to fast a dog for an acth stimulation test, unless the vet is planning on doing additional bloodwork (chemistry/cbc). Dr. Mark Peterson also touches on this subject in his blog so you may want to share the link below with her or print it out for her.

http://endocrinevet.blogspot.com/2011/03/whats-best-protocol-for-acth.html

The problem here is that you get incomplete instructions because most of the time you speak with the office staff instead of the vet.

I have so had it with this situation.

We've all been there and the only thing you can do is insist on speaking to the vet. My dogs treat with a specialist and they know that unless my question is very general, I expect them to return my calls.

I think I may try bringing in the pills tomorrow, saying I haven't even touched them and if the vet thinks I am better with liquid, I would rather use that. Any thoughts? Do you think it is ok just to stick with the pills? They are easier because the dog will eat anything that is put in cream cheese.

I definitely would stick with the pills. I tried the liquid and it is fine for loading but because you use a lot less for maintenance, it gets real gunky about half way through the bottle. Also, because Lysodren is best absorbed with a little fat, giving it with a little cream cheese is a good thing.

[Jenny & Judi in MN]

Sorry to be dense - but what do you mean by 2 days on and 1 day off?



first we tried 1/4 of a pill once a week. the folks here warned me it wouldn't be enough and it wasn't. had to reload. ugh

Then we tried 1/4 of a pill every 4 days. wasn't enough.

Now I give her 1/4 of a pill 2 days in a row then no pill for 1 night. Then 2 days in a row. Then nothing. Since I haven't made up a calendar yet the pill cutter is helping me. I know by how many quarters are left where we are at.

Jenny loaded in 2 days, she is 8 pounds and was taking half a pill once a day.

Like I said though she has the adrenal tumor so I'm not sure if that has any bearing on how much Lysodren she needs. She has been on this regimen for 2 1/2 months now and she is eating slower, her bloated belly is down, and she wants to play every night when I get home from work.

hugs to you and Katie, Judi

[Wendy Tillotson]

So much great info. I am just keeping my fingers crossed that the loading is complete. I was so scared and if the signs I saw weren't enough - WHAT would I look for. I don't want anything to happen to Katie.

I lost

So this makes me doubly worried. I don't want to do anything to hurt Katie. She is such a cutie.

[Wendy Tillotson]

What she meant by saying the pills are not homogenous is that the medicine is not evenly distributed throughout the pill. For example, if you have an aspirin and cut it in 1/4s each part would have the exact same amount of aspirin. With the Lysodren, she said if you cut the pill in 1/4s - each 1/4 can potentially have a different amount of Lysodren.

[Wendy Tillotson]

Interesting to hear Judi. I can't imagine how we are going to maintain her.

If she is loaded now, then its going to be a bit difficult to figure out the dose. So sounds like since your dog loaded quickly, you went with the 25 mg/kg and then had to adjust.

And if I understand correctly, you seem to be giving her a lot more per week than the original daily loading dose.

I also found it interesting that you gave the dose once a day. My vet originally said that - but I told her I wanted to do it twice a day. I always like to divide medicine up, if I can.

I'm so confused.

[Wendy Tillotson]

So vet called to check to see how she was doing.

I like the idea of the compounding into capsules. That would make it so much easier.

[lulusmom]

What she meant by saying the pills are not homogenous is that the medicine is not evenly distributed throughout the pill. For example, if you have an aspirin and cut it in 1/4s each part would have the exact same amount of aspirin. With the Lysodren, she said if you cut the pill in 1/4s - each 1/4 can potentially have a different amount of Lysodren.

I have read everything I could get my hands on about Lysodren and have never heard this before. Granted, not all quarters are absolutely identical but if done carefully with a pill cutter or knife, any variation would be negligible. I will call my friendly pharmacist tomorrow to confirm. Regardless of being homogenous or not, giving another quarter pill to a dog who appears to be loaded is not a good idea.

It is possible that Katie is not loaded yet but you always err on the side of caution. If she isn't loaded, you bite the bullet for the acth stimulation test and continue loading her. Are her symptoms identical to those when you first started loading her or has her eating habits remained static since you stopped dosing?

[frijole]

I didn't take the pills in - I am going to talk to the vet about it first. I dont know WHAT she was thinking to give me so many pills. Its crazy.

What she meant by saying the pills are not homogenous is that the medicine is not evenly distributed throughout the pill. For example, if you have an aspirin and cut it in 1/4s each part would have the exact same amount of aspirin. With the Lysodren, she said if you cut the pill in 1/4s - each 1/4 can potentially have a different amount of Lysodren.

:D Yeah, just like every time you use the liquid lysodren and it isn't exactly the same amt because of the way it is dispensed. Sorry but your vet sounds like a rookie with this drug. Yes you want it to be as equal as possible but trust me, once the load is done.. it doesn't really matter so long as during the week the dog gets the total amount. They don't have to be perfect.

Praying for good test results but just know that even if she isn't loaded all is not lost - better safe than sorry. The last thing you want is to not test and have a very sick dog. Trust me, we've seen it and the dogs are very sick and they are hospitalized and it costs thousands so don't sweat it ok? !!! You did the right thing without one doubt. Kim

[Wendy Tillotson]

Prayers are good - we can use all the help we can get!

Not that I'm made of money, but I would rather pay for the test than risk having a problem. I hope to have Katie for many more years. Her mom died at 15, so I am hoping she will at least make that. I have her half brother as well. Zachary is two years younger (10) and is beyond attached to her. He will be heartbroken if something happens to her. (He's the culprit that licked the hole in her side, kissing her.) Zachary had crystals in his urine, which seems to have been resolved by giving him cranberry pills.

Besides the two mini wires, I have a rescued greyhound, Annie, that has IBD, urinary tract issues, and a thyroid problem. We have trouble getting her to eat. She is 9.

It all gets to be overwhelming at times.

[Wendy Tillotson]

Before I started loading her - she was starving and looked desperate for food.

Now she seems like her usual doxie self - starving, but not desperate. She has been that way since Saturday. I don't see where anything has changed since them. She is chewing her dog biscuits instead of inhaling them. And she hesitates before taking them whereas before she was grabbing them so fast, we were getting bitten.

I kept retesting it to see if it were my imagination. I swear she has gained weight with all the treats I gave her. Fortunately she eats carrots just as happily.

[Wendy Tillotson]

Katie is still looking good. I am going to be shocked if it shows she isn't loaded. Zachary left some food in his dish and she went over to check it out. When I said something, she backed right away. A few days ago, she would have ignored me and devoured it.

So now I'm wondering are we going to be able to maintain her on only 1/4 pill a week? That is going to be very difficult to split into two pieces. Yikes!

[Squirt's Mom]

Hi Wendy,

I use 1/4 pill twice a week on Squirt and it isn't difficult at all. My pill cutter has a tear-drop shaped pocket the pill goes into to be cut. So I half the pill first then set one of the 1/2 pills down at the small end of the tear-drop so that it sits evenly across the pocket (it's not perfect but as close as possible), then cut that into half again. That leaves me with 2 quarter pills and one half pill.

Squirt eats home cooked feed so it is easy for me to further cut that quarter into little bits and mix in her food. For those on kibble (dry feed) cream cheese, American cheese, peanut butter, plain butter - something with a bit of fat in it, wrapped around the pill usually works.

Can't wait to see the results!
Hugs,
Leslie and the gang

[Wendy Tillotson]

Have been watching her today - and if she isnt loaded, I will eat my hat. I was really surprised when she stopped in her tracks when I told her not to eat Zachary's food. That is DEFINITELY a good sign! My husband also said that when he called her name when he fed her, she looked up.

If I understand correctly, I may need to give her 1/4 pill for the week - and would need to divide THAT in half. Ugh.

I am going to definitely talk to the vet about getting the pills compounded. It would be so much easier.

Katie is great about taking pills if you put them in anything. We generally use neufchatel cheese as its a little softer, but could use full fat cream cheese if that is better.

[lulusmom]

Hi Wendy,

I'm rather late in asking questions I should have included in my first post so would like to do that now. It appears that your vet diagnosed Katie based solely on one acth stimulation test. Is that correct? If the answer is yes, I think that was inadequate amount of testing to diagnose Katie, plus there is no way for you to know which form of cushing's you are dealing with, pituitary or adrenal. Did your vet discuss the forms of cushing's and did she mention to you that if Katie has an adrenal tumor, surgery could be a permanent cure?

Can you obtain copies of any blood chemistry or cbc tests that were done and post the abnormal values, along with normal reference ranges? Also, get copies of any urinalysis that was done and post the results here. All of these are standard tests that are done when a dog is suspected of having cushing's.

[Wendy Tillotson]

I don't remember what other testing was done. I know that we tested the thyroid in the spring and it was very low. The year before we did a complete blood chem and everything was normal.

We put her on thyroid medication and while the thyroid is now normal, her coat never came back in. Then about a month ago, her roomie, licked a hole in her skin.

She had a voracious appetite where she looked totally desperate for food.

Based on the clinical signs and the ACTH test, the vet decided it was Cushings. My vet tends to be very conservative and to avoid unnecessary testing. I have to say when I have pushed for other tests in the past on another dog and took her to other vets for consultations, my vet was always right and I just spent a lot of extra money checking things out.

But, I have to admit after reading the postings here, I am a bit worried that we didnt do our homework. BUT, she did respond quickly to the medication and seems pretty normal - no more panting and no more dying for food (beyond the usual doxie routine). She does have a little bit of a pot belly - but not that much. And whether that goes away and her beautiful mahogany coat grows back in remains to be seen.

She was up to almost 13 lbs before the thyroid medication - but she lost about 1.5 lbs after being on it for a short time.

Would other testing be valid now that we have her on the medication? What would you suggest?

And at 12 years old, is surgery safe if it was an adrenal tumor? Can the tumor come back?

[Wendy Tillotson]

Still haven't heard the results of the test. Was hoping would hear today.

[frijole]

I'm surprised you didn't get results today also. Two days is usually the max for most labs. Maybe due to the holidays they were crunched? I would be phoning the front desk non-stop because they simply have to follow up... don't wait for them to call you.. could be they got them in and forgot to call or were too busy... sad but it happens.

Also - I would go get copies of all tests done to diagnose. In addition to the acth test (the first one) they probably did a full blood panel. Usually they start with that and if liver enzymes are elevated they will do cushings tests. If they didn't do a blood panel I would DEMAND one. It would not be affected by the drug.

Also I would consider having an ultrasound done. The reason is that it can tell you what is going on internally with the organs including the heart, liver, adrenal glands. You could rule out an adrenal tumor if none are found. I would not have this done unless I knew the ultrasound was a high resolution machine - most vets don't have these so you'd have to get a referral. A fresh set of eyes could be helpful.

So Friday start calling them Friday or drive over and pick up the results and copies of previous tests. We are here!! Kim

[Wendy Tillotson]

The vet just called with the results. She tends to call late at night because she is so busy.

Anyway, the original pre and post were 3.7 and 28.6. The new readings are 3.8 and 13.8.

So the readings came down quite a bit - but still not perfect.

The plan now is to give her 1/4 of a pill every other day for 10 to 14 days and then retest. Of course, I now need to watch her carefully to make sure she doesnt get sick as she is acting totally normal.

Needless to say, I am upset. I was so hoping she was totally loaded. This is so nerve wracking.

I did ask the vet about doing other Cushings testing and she said it was good academically, but no real point as either version would be treated exactly the same. She has sent other dogs to AMC when owners opted for surgery, but doesnt feel it would be appropriate for Katie - and neither do I. I HATE AMC. I lost a dog there after surgery. Long story and won't go into it, but I would NEVER use them. Katie is 12 years old.

I will talk to her about the blood panel. Not sure what was done most recently. Are you saying if the liver enzymes aren't elevated, it is NOT Cushings?

We did do a full urine panel not that long ago because she was peeing in the house so much. She had crystals in her urine - but so did her brother and their urine was alkaline. This has been corrected in both dogs.

We did have the thyroid testing and the thyroid was low. It is now normal as well.

At this point, I think we need to concentrate on getting the Lysodren loaded to the point that the levels are within 1 to 5 after testing.

[Wendy Tillotson]

I will talk to the vet about doing a full blood panel again, if one wasn't done in the last six months.

[StarDeb55]

Wendy, I hate to burst your vet's bubble but this plan, IMO, will not work. You need to continue loading exactly the same way you've been doing, because any delay in the lysodren, even 48 hours will give Katie's adrenals a big chance to regenerate, & you will lose the ground you have gained.

I have double checked the loading dose calculation as I don't remember seeing if any of us have done that for you, or explained how to calculate it. If someone has, pardon the duplication. Normal loading dose is 25-50 mg/kg, preferable as close to 50 as possible. To get weight to kg, divide by 2.2. Katie's dose at 50 mg/kg would be 263 mg. daily, so the 1/2 pill you are giving is absolutely appropriate.

Let me tell you why it's important to simply continue loading the way you have been by relating my experience with my Harley. I believe Harley's diagnostic ACTH was even a little higher than Katie's, in the low 30s. He never was a very good eater, so I had to rely on other signs such as a drop in water consumption. When I saw the water drop, I would swear on a stack of Bibles he was loaded. My IMS agreed to test him, result came back with a post of 11 something. Since Harley symptoms had eased up, she was agreeable to let him go at 11, with a retest in one month. I had joined this group,& these folks tried to warn me that a post of 11 was not going to hold up with maintenance dosing of twice per week. Sure enough, in 2 weeks time, Harley was drinking gallons, & nearly flooding me out of the house. I had to argue with the IMS that he needed another ACTH, so by the time I got him back in, his post was now over 20, & I had to do a full blow reload.

I know this is very nerve wracking, but no deviation from protocol, at this point is what's going to pay off in the long run. During the first six months after Harley was diagnosed, I had to do 2 reloads, so I don't want to see you go thru the same aggravation. Believe me, I was aggravated since I had already been thru this once, and thought I had a handle on how to manage lysodren and run a load on a pup.

Debbie

[Wendy Tillotson]

Hi Deb

Im sure you are right, but this whole thing just scares me to death.

The problem I see is that she is acting totally normal right now. So HOW do I know she is loaded?

How many days did it take to load Harley? Katie appeared to be loaded in 2.5 days.

1/4 pill every other day will be almost double the maintenance dose.

In the middle of all this, I have a cousin across the country that had a stroke. I am his emergency contact and he has nobody else in the area. So, I am going to need to go there to see what I can do. I have been in constant contact with the doctors, nurses, and social workers.

I am very afraid to leave the dog with my husband until I know she is stable. I'm afraid he wouldn't recognize that there is a problem - or wouldn't respond to it quickly enough. If something happened to her, we would both be devastated.

Talk about stress. At this point, I don't know which end is up.

[frijole]

Glad the vet phoned you. Deb is right in that if your dog has cushing's what your vet is proposing will not work. How do we know this? Because we've seen this and other variations for years and it always ends up just wasting time and money because you are paying for wasted drugs and wasted acth tests... not to mention the stress...

What concerns me is the lack of symptoms other than appetite. Trust me you can have false positives on the acth tests - my dog Annie had 5 or 6 of them - yes all false and we tried loading her... oh what a waste... but anyway... please please please go to the vets and get a copy of all tests that were done to diagnose. This would include blood tests, the urine tests etc. GEt copies of them and post them here and it will better help us.

With what you have going on I would do it asap because you might have to leave town it sounds like? If need be, give your hubby your password and we will talk him thru this every day :)

Does Katie have a roundish belly? Skin issues? Any problems jumping onto furniture? Excess water intake? Peeing in the house?

Hang in there - we will help you. Kim

[Wendy Tillotson]

Hi Kim -

Katie does have a roundish belly. She is peeing in the house - AND pooping in her crate at night. Her skin is so thin that Zachary licked a hole in it. That was what caused me to do the ACTH test.

She was never one to jump on the furniture - but she has been having trouble with steps, which we attributed to her age.

I will talk to the vet, hopefully later tonight.

[Wendy Tillotson]

I will go Friday and get all the latest tests.

Do you think it is possible that 1/4 pill a day would finish loading her? Or do we really need to use 1/2?

Personally, I would feel more comfy at 1/4 since she looks so normal right now. She is still peeing and pooping in her crate tho. Why she is peeing is beyond me because she doesnt drink much water.

Will have to mention that to the vet. She did not have any type of an infection when we tested her about two months ago.

[StarDeb55]

Harley loaded in about 5-6 days on both loads, if my memory serves.

Yes, Katie does have other symptoms consistent with Cushing's, but they are also consistent with several other problems. Was thyroid & diabetes ruled out? If, indeed, this is Cushing's, Katie is having accidents because the excess cortisol in her system puts the kidneys on overdrive. The problem here is that a normal Cushpup will drink gallons to makeup for the kidneys having to work so hard. Even though you are still in the middle of a load, I would suggest you start measuring water intake. I know you have 2 pups, but it can be done. I had 2 when I my first boy was diagnosed a number of years ago. You simply have to assume that any change in water is due to the Cushing's baby & not your other one. Even though my first boy had the voracious appetite, I learned quite quickly that his appetite was not a reliable indicator. He was treated with lyso for nearly 8 years & never lost the appetite. He would have eaten until he popped, if I had let him.

Debbie

[lulusmom]

Hi Wendy,

It's difficult to answer your questions without the benefit of seeing all of the test results. Dogs with cushing's lose their ability to concentrate their urine and it becomes dilute...clear like water and usually odorless. If a cushdog is peeing too much, they most certainly are drinking too much too. Is Katie's pee yellow? Does it have the usual urine smell? Part of diagnosing cushing's is a urinalysis to check for a number of things; urine specific gravity, which is low in cushdogs; protein in urine, which is common in cushdogs; and high white cells present with infection. The extent of white cells present in the urine cannot be detected in a cushdog because the urine is diluted out so a urine culture must be done. We'll be able to figure out what your vet did when you post the results of all testing.

FYI, peeing in a crate doesn't always equate to loss of concentration and pooping too much is not a symptom of cushing's; however, it can be a byproduct of eating too much food. My first cushdog, Lulu, pooped more before being diagnosed because I was responding to her constant begging for food. I think that may be why she looked like a whiskey barrel on toothpicks. :D

Glynda

P.S. I have provided a link below to information in our Helpful Resources for members who are new to the disease. I recommend that you take a look at the various sites as they will give you a good idea as to the sequence of testing that is done to properly diagnose a dog.

http://www.k9cushings.com/forum/showthread.php?t=180

[Jenny & Judi in MN]

I'll chime in and say my vet tried exactly the same way. Jenny's maintenance dose hadn't been working so instead of reloading he had me increase her 1/4 pill doses for a couple of weeks to see if that would do it.

He was concerned because the Lysodren seemed to upset her tummy. It didn't really work. We had to reload.

I know this is stressful and I'm so sorry about your cousin.

Judi

[frijole]

Wendy - As you can tell from our postings, no two cases are exactly the same and there is no set rule for how long it takes to load or what symptoms occur - different dogs have different symptoms and loading experiences. So we only can speak from 'trends' from what we have seen. I've been here over 6 yrs and when a vet tries to do what yours is suggesting I've never seen it work that I can remember. It also is a sign that the vet does not understand how the drug works and isn't very experienced with cushings. She is not following well established protocol and that is what bothers me... you didn't confirm the dx with multiple tests and now the lysodren dosing situation.

I would say it is probable given the multiple symptoms you just described that Katie has cushing's but we can't be sure. As Deb said it could be something else.

My Haley had cushings and she had an appetite, huge tummy,hind leg weakness/shaking, and peeing in the house but she never drank gallons of water. She drank a bit more than normal but probably only 1/2 cup a day more. I did measure the water (had 2 dogs also) just as Deb suggested.. but it was the change in eating that told me she was loaded. She literally inhaled her food - didn't chew the kibble at all. After loading she maintained her voracious appetite for life but she at least chewed it!

So as you can see - we all have different experiences. As I said earlier, I would absolutely get my hands on the tests because yes, if the liver enzymes weren't very elevated I would suspect the dx is off. I also want to see the glucose readings to rule out diabetes... and a thyroid test wouldn't hurt because the symptoms are similar to cushings.

So we throw all of this as you might have to head out of town.... question - do you know how long you'll be gone?

[Wendy Tillotson]

Hi. She DID have a thyroid issue.

Her coat gets long over the winter because I generally don't trim it. I trim her in the spring. The previous year when I did that, it was very thin, but it grew in beautifully.

THIS year when I trimmed it, it was even thinner and never grew back in.

So the first thing we did was test her thyroid. It took us awhile to get it properly regulated - but now it seems fine.

However, her coat is thinner than ever. And, like I said, Zachary actually licked a hole in her side.

I had a major peeing issue with both of my dogs so we tested them both. What came back was that there were crystals in the urine - and both had alkaline urine. Both had been on pepcid - the only thing they had in common. The vet wanted to medicate both right away (cranberry pills) as she was very concerned, but I wanted to try taking away the pepcid.

In two weeks, Katie was normal, but Zachary was not. He is now on cranberry pills. I have had them both retested and they are both still fine - but Z is still taking the pills.

What could possibly cause Cushing's like symptoms and high cortisol without being Cushings if we have already ruled out the thyroid?

I would think if she were diabetic, she would be drinking like crazy - and that is not one of her symptoms.

I think the vet put her on the low dose in response to my being so scared. I will talk it over with her - but do you think that 1/4 pill once a day can load her or does it have to be 1/2 pill a day?

She is acting so normal that the only way I could tell she is loaded is if she starts acting sick. I really hate to do that. Seems rather dangerous to me.

[Wendy Tillotson]

And Zachary seems to be drinking much more than Katie - we see him all the time. Go figure.

[Wendy Tillotson]

I did mention this before but its quite a ways back. Once Katie was on thyroid medication, she dropped weight. She went from 12.9 lbs to 11.6 in a couple of months - which is a large loss for such a little dog.

If we could get rid of the pot belly and have her coat grow back in, she would look really good. If she lost a little more, that would be good - but not that important. She does love her treats.

[frijole]

I have to leave to meet my family but wanted to answer a few questions... will return later.

Good point on the diabetes and water intake.. not my specialty though so perhaps others will have thoughts...

Thanks for reminding us on the thyroid.. do you know which thyroid test your vet has done? I ask because I remember members specifying that there is one test that is a must and mine did it wrong... sorry can't remember.

Non adrenal illnesses can result in FALSE positive readings on the acth and it happens a great deal. So if something else is going on you can get a false reading - meaning the cortisol might not even be elevated... happened to me. Also the body could be fighting an illness which elevates cortisol and therefore it is high but not as a result of a pituitary or adrenal tumor (cushings).

This is why additional tests are done. Can you tell us about the urine? If it is yellow I would definitely get more testing done. If it is clear (as described perfectly by Glynda) I would be inclined to say you are probably dealing with cushings.

Sorry to have to run. Try to have a good day despite... this disease progresses very slowly so if she doesn't load overnight it is OK... just more stressful on you. Hugs, Kim

[Wendy Tillotson]

Hmmm, not sure on the color of the urine for sure - but do think it is not particularly yellow. Will have to check.

Also not sure which thyroid test she did. I can find out. It cost about $65 if that helps at all. We repeated it several times while we were trying to get the dose right.

I've been with this vet for 20 years. And I have to say that she has always had really good instincts. She is also an amazing surgeon. She got my one doxie through cancer. If I had to use someone else in her practice, I would have left.

I do think we should repeat all the blood work tho - just to see how her liver is doing with all of this.

And still trying to figure out if 1/4 pill per day would finish the loading as this symptom disappeared so quickly.

[lulusmom]

Hi Wendy,

I agree with the others. It is highly unlikely that 1/4 pill every other day is going to be effective in bringing cortisol down to the therapeutic range of 1 - 5 ug/dl. You need to resume loading at the same dose you were giving before the acth stim test. I realize you are very confident in your vet and trust her ability to treat Katie and I understand that because I felt the same way about my gp vet.

As with all members, we point out issues of concern based on our own experiences, the experiences of our many members and reference material published by endocrine and pharmacological experts. Just as nobody dealing with canine cushing's should place blind faith in their vet, nobody should place blind faith in members of this forum to know what is best for their dog. We all need to make educated decisions for our dogs. Unfortunately, it's a really difficult disease to wrap your head around and even if it were easy to understand, our fears tend to cloud our brain's ability to absorb all of the information.

The best advice I can give to anybody new to the disease is first, grab a paper bag and stick it over your mouth until the hyperventilation stops. Then sit down with a cup of coffee, tea or non alcoholic drink of choice and go back through your thread so you can really absorb the feedback you've gotten. It's all Greek in the beginning so the light bulb is not going to come on overnight. Most importantly, be sure to take a look at any reference material that has been provided because that is where the answers lie for you and Katie. I promise that at some point down the road, you are going to look back at this and think "wow, I've come a long way and what the heck was I so afraid of?"

[Wendy Tillotson]

Right now, I just wish the whole thing would go away....

So if I go back to 1/2 pill per day and if I already see signs that she looks fine - how do I know when to stop before she gets sick?

THATS what I am worried about.

[frijole]

Wendy, I'll share more of my loading experience because it might help. My dog Haley took forever to load - there were multiple times when I noticed changes in her eating habits and so I stopped and did the test. It took us over 4 months - a record on this board. It was a total of 45 days loading with breaks in between for testing and waiting for results. Very stressful.

Haley didn't have large amounts of water intake either. So I monitored her poop. I figured if diarrhea meant overloaded then perhaps softer poo meant loaded. :D It was winter too but every time she went out - day or night I had a stick (and flashlight). We call it Poop Patrol. You poke it for consistency. When Haley's got softish (not at all runny) I stopped and she was loaded.

So it could be that she'll refuse food, eat a partial meal leaving some in the dish or you discover it by using a stick.

The good news is that in your case I think it will be rather quickly. You think you were stressed? Try doing it over a four month period. People here ran out of advice to give me. :D I kid you not.

Glynda's advice about the paper bag is good... deep breaths and don't over complicate this. We are here to help and answer questions. The reason this board exists is because there is a need... we were all there too. The best thing you can do is to read all you can so that you understand what this disease is, how the drug works, etc. so that you can act as Katie's mouthpiece.

Re-read the loading instructions - it's all there. Just remember every dog is different and so there is no clear cut path. If you go to the info section you will see presentations done by the world's experts on treating cushings. The protocol is 25 to 50 mgs of lysodren per kg of weight... we checked and your vet is spot on at 50 mgs. You could cut it down to 25 but most of have been thru this (me included) and 25 mgs usually is not enough and it drags on forever and you end up having to increase to 50 mgs anyway.

Kim

[StarDeb55]

Wendy, even though I mentioned earlier that Harley was a very picky eater, & his appetite was never a good gauge for me to use. I will tell you what happened the second time I had to load. We had been loading for about 5 days. That evening, he absolutely refused to eat. Normally, he would eat a little bit, & if I'd wait an hour or so, offer his dish again, he would finish eating. Not this night, he refused, again. I opened a different flavor of canned food. Nope, he doesn't want any part of it. I, then, resorted to the Nutrical which is a supplement for dogs with poor appetites or sick dogs as I didn't want him to go totally without eating. Nope, he refused the Nutrical which he would normally eat without a struggle.

I got into a fight with my IMS about this as she wanted me to try to load him one more day. I refused, took him to my GP vet for the ACTH, & sure enough he was loaded. If I had followed the IMS instructions, Harley & I would probably have been facing an overload. I fired the IMS because of this. This is just to illustrate that even with a poor appetite, Harley had a change in behavior, that really clued me in that he was probably loaded.

Debbie

[Wendy Tillotson]

Thanks Debbie. All of this has been really helpful. You sound like you were like me when this all started.

I want to talk to the vet. I doubt she will call tonight, but you never know. If not I will get to her tomorrow and even if I dont dose her in the morning, sounds like it wont make that much difference once we start up again. The only thing to lose is time and a few dollars on pills.

I will have to start watching her poop. She goes out in the yard, so this ought to be interesting.

I guess what has me worried is that she might get overloaded. The vet has said that Lysodren is not as difficult as Trilosane - and less likely for the dog to go down quickly, which is why she prefers it.

Very nerve wracking.

[Wendy Tillotson]

What does IMS stand for?

[frijole]

What does IMS stand for?

Internal Med Specialist - Just like in human health care there are vets that specialize in treating more difficult cases. I live in Nebraska and when my Haley was diagnosed with cushings there were ZERO specialists in our entire state so I went thru several vets before I found someone that knew what the heck they were doing. Very scary because i was using lysodren also. If I'd have listened to them she'd have either never loaded and died from the disease as a result or she'd have overdosed. This board saved my dog's life and my sanity.

My other dog Annie was MISdiagnosed with Cushings 4 yrs later and we actually started loading her with lysodren. She had those false readings on the acth that I told you about. We increased the dose but her cortisol went UP..... well she didn't have cushings. After about a million tests - several new vets - and enough money to buy a car I finally drove FIVE hours each way to the closest IMS which is the Kansas State University Vet Hospital. She has a very rare condition (tumor) and it caused all of those false readings for cushings.

I didn't want to have to end the vet relationship that I had but that vet was over their head and didn't admit it. All he had to do was refer me to the specialist and he could have still remained involved with my dogs care locally. Its a long story but going to an IMS was the best thing I ever did. Annie would be long dead had I not. She is still very ill but she is a fighter surrounded with love coming from me and her new vets.

Its tough... I know you want to just run from it, wake up and have the nightmare be over etc but trust me - cushings is a walk in the park compared to other illnesses. Annie taught me that. Lysodren is a wonderful drug when used properly but can get dogs in trouble when vets are over their heads or owners aren't involved and don't pay attention ... that is why we are so persistent in our questioning etc. It's just because we care and want to make sure that the dog has cushings and that the vet is communicating the proper way to give the drug.

Hang in there. Kim

[Wendy Tillotson]

Hi Kim

I appreciate all the help - that's for sure.

I do think I can work this through with my vet. I have gone through a lot with her - and she has always been right on - and if she didnt know, she was quick to say so. She is not one to tackle something she doesnt feel comfortable with.

Oh well.

[StarDeb55]

Actually, Harley, was the 2nd time around for me, so I wasn't a total newbie. I had used this IMS previously with my other boy, & really liked her, so that's why I took Harley back to her to get the diagnosis confirmed after my GP vet did the initial round of testing. It's just a case of I knew enough about the disease, the drug, & my dog to know that continuing to load him another day was going to be an extremely risky proposition.

Even though I had a bad experience with an IMS, it just goes to show that all vets whether they are a specialist or general practice vet are not created equal. I have a terrific general practice vet who has worlds of experience with cushing's, so, GOD FORBID, if I have to do this a 3rd time, I'll just stick with my general practice vet.

Deb

PS- This is an important PS. I dont' recall any of us asking you or you telling us, did your vet give you any prednisone? Pred is an absolutely necessity when doing a load, & treating a dog with lysodren. If you think your pup is getting in trouble, you can administer pred, & if the cortisol has dropped too low, pred will act like cortisol, & your pup should start feeling better in about an hour. If your vet did not give you pred, please demand it the next time you talk to her. I really don't want to bash your vet, but if she didn't give you pred, this raises another red flag about her experience with lysodren & Cushing's. After treating 2 dogs for Cushing's, I absolutely would not be without pred in my "doggie pharmacy". You may not ever need it, but if you do, you need it right now, not a couple of hours from now, or the next day.

[Wendy Tillotson]

Hi Deb -

The vet did give me pred - she even gave me some syringes with azium, just in case. We had a talk about when to give each one. Fortunately, I can do subcutaneous shots.

I did not hear from her tonight - and really didnt expect to. I will track her down tomorrow.

Katie was doing a lot of panting tonight.

I guess it gets easier when you've done it already - but I sure hope I never have to do this again. My heart feels for you. I've had dogs for many years and I have to say that after this, I'm not sure I ever want another. I had five dogs at one time and am now down to three. With all the medication and supplements they are on, I feel like I am running an animal hospital. I have dealt with a lot - but this is just putting me over the edge.

Anyway, enough of my falling apart.

How did your dogs do once they were diagnosed and treated and fully loaded?

Thanks for the help.

[StarDeb55]

The good news is that Barkley, my first boy, was successfully treated with lyso for nearly 8 years, crossing the bridge at 15. Harley was 13 1/2 when he was diagnosed, so being a realist, I figured that if I was able to keep him with me for about 3 years that would be great. He was simply a little, old man when all of this started. Harley did pretty well for 2 years. Unfortunately, we found what was probably a fast growing bone tumor in his jaw that had already spread to his lungs when we found it. He crossed the bridge at 15.

I commiserate about running an animal hospital. I've never had more than 2, but here's the litany I've dealt with over the past 12 years or so. Cushing's x2, Barkley developed lymphoma at 13, went through chemo, & survived for 20 months with a good quality of life. Barkley also had very severe allergies with chronic ear infections that he was on a bucket load of meds to try to control those. Presently, Chewy my 11 yr. old Lhasa is another severely allergic pup who is on allergy shots, & is hypothyroid. He was on the ear infection roller coaster when my derm vet did his skin testing, put him on the shots, & he might get an ear infection every year or so. I adopted Obi at the end of this past January. He is about 2-3, & appears to be healthy. I had to call my vet about another pup I was considering because of a possible health issue. To quote him, "I think it's a really bad idea for you to take her. You need to at least try to start out with a healthy one." I started laughing & said that I was trying. He said this because my nickname at his clinic is "medically needy dog magnet".

Debbie

[Wendy Tillotson]

That is too funny Debbie. :)

Annie, my greyhound, has IBD, a thyroid issue and a urinary tract issue. She is on 6 pills in the morning 7 at night.

Katie you know about. In addition to the Lysodren, she gets thyroid, K9 conquer, pet tabs plus, cosequin and occuvite.

Zachary has major back surgery and we are super careful with him. He also has that urinary issue. He gets cranberry pills, K9 conquer, pet tabs plus, cosequin and occuvite.

We need a score card just to keep track of all the medication and supplements.

[Wendy Tillotson]

Let me bring you all up to date since the last time I posted. I went to California to help my cousin and while I was there, I broke my arm - so was unable to really type much.

I've been really disheartened about poor Katie. She seems happy as a lark and carefree like not a thing is wrong. She will be 13 tomorrow.

The 1/4 pill every other day has not worked.

My vet said to do 1/4 pill daily and test after a month - that is where we are now.

[Wendy Tillotson]

I do have a rather strange question that I hope someone can answer. I have two doxies - Katie and Zachary. Lately Zachary has been not eating very well.

He does tend to lick Katie - is it possible he is picking up some of the medication this way?

[Squirt's Mom]

Hi Wendy,

Sorry you broke your arm! :eek: Hope it is healing well.

Don't be disheartened if Katie is doing as well as you say. The numbers on the tests are important but the signs being controlled and the pup being happy is just as important! ;)

Do you have the test results from the ACTHs she has had done? What were her results after the load when the vet started the maintenance dosing? Did the cortisol go back up after starting the maintenance?

I'm not sure that switching to Trilo right now is the best idea. First, let's see if the Lyso is being used according to protocol. If not, then a change in vets might be more appropriate. ;) Switching from Lyso to Trilo requires at least a 30 washout period between drugs.

So, if you don't mind, fill us in again on the details - weight, dose for loading, loading results, dose for maintenance, and the results since being on maintenance. In other words, bring us up to date on all her testing and treatment.

Good to hear from you again and glad you can type again. I go bonkers when I can't get online. Sad, huh? :p

Hugs,
Leslie and the gang

PS. And, as I said elsewhere, I really doubt there is any concern about Zack licking Katie.

[Wendy Tillotson]

Hi Leslie

We are doing another ACTH test tomorrow. Katie seems perfectly happy - trucking around, wagging her tail and just normally doxie hungry. She is 13 today!!! Happy Birthday to my cutie!

I have to get all the results to post them accurately.

She had full blood work last June - only the thyroid was off. We got that under control but she continued to be super hungry and her coat is beyond atrocious. She is totally bald in spots.

The vet did an ACTH test - that was it and decided with the clinical signs that she had Cushings. The prevalue was in the 2 range and the post was in the 28 range.

We started her on the Lysodren - 1/4 pill 2x a day (Katie weighed 11.6 lbs). There was a pretty dramatic change in her eating in only 2.5 days of dosing so I stopped the Lysodren and asked the vet to retest her. (The vet said it was too soon.) The test now showed in the 2 range before and in the 13 after.

My vet told me to give her 1/4 pill every other day as she appeared to be super sensitive to the drug. This did not work so my vet told me to do 1/4 pill EVERY day for a month. She told me that the doses are cumulative and this should work. So testing her tomorrow and keeping my fingers crossed.

If her coat looked normal, you would never know there was a single thing wrong with Katie. She is perky and happy - acts more like a young dog than one that is 13.

Oh - one strange thing - she has had a "growth" on her stomach for years. A few days ago, it swelled up the size of golf ball cut in half. Then by the next day, it was almost gone.

[Wendy Tillotson]

Really beginning to wonder about all of this.

[Squirt's Mom]

Hi Wendy,

Ok, at 11.6 lbs, Katie weighs 5.27 kg (11.6 / 2.2 = 5.27272...). The loading dose is 50 mg per kg a day. So 5.27 x 50 = 263.5 which would be rounded down to 250 mg a day divided into two doses of 125 mg twice a day. So your vets initial loading dose of 1/4 tablet two times a day was right. And, you were right to stop the Lyso and request an ACTH when you saw a change in her eating. Where things seem to have gotten off track was that rather than continue loading at this point, she was started on a maintenance dose even tho the numbers were still out of range with a post of 13. The second ACTH with the post of somewhere around 16 shows the load has been lost and she needs to be reloaded. Increasing the maintenance dose at this point is not going to help her and is going to cost you more money. ;)

If it were me, I would request another load phase at 1/4 tablet twice a day, keeping a very close eye on her for indications she is loaded. When you see that, ask for another ACTH; if the post number is above 5.1ug/dl, you will continue the load. If the post is within range, then you start the maintenance. The maintenance dose has nothing to maintain until the loading has done it's job. ;)

As for the possibility that something else could be going on - that is always a possibility with our cush babies. The signs of Cushing's are shared with many other conditions and other conditions can cause false positives on the Cushing's test. This is why it is best to do thorough testing before starting treatment - to rule out all other possibilities. How long has it been since Katie had a CBC? It might be worth checking for diabetes, as it can come on very rapidly, and checking the thyroid - both of which can be done via the CBC. Has Katie had an ultrasound? If there was a problem with other organs, this test might catch it like it did for my Squirt who had a tumor on her spleen causing elevated cortisol.

Hope the knot on her belly is nothing. Ain't it great to have a vet you can rely on? :rolleyes: Is there another doc in the office who might could look at the knot for you?

Hang in there!
Hugs,
Leslie and the gang

[Wendy Tillotson]

There is nobody else in the office that I trust. I will ask them to look at it when I bring her in for the ACTH tomorrow tho. Hopefully my regular vet will call me on Friday.

Should be interesting to see the results.

You are right - this is all very expensive.

Are there any tests they can do given that she has been on this medication for awhile?

I am hoping that even tho she is not loaded that the medication has controlled it a tiny bit.

Very frustrating.

[Squirt's Mom]

There is nobody else in the office that I trust. I will ask them to look at it when I bring her in for the ACTH tomorrow tho. Hopefully my regular vet will call me on Friday.
It is
Should be interesting to see the results.

If my vet is not willing to reload at 1/4 2x a day - will have to look for someone else to work with. She is very stubborn about this and feels she is right. She doesnt like when someone questions what she is doing.

It is very frustrating to have a vet who won't listen or gets upset with us when we are trying to do the right things for our babies. Our vet admitted he knew nothing about Cushing's - but he was willing to learn. I chose him over others who claimed to have experience but who either made it plain they were the boss or the things they were saying I knew were wrong for Squirt. I had rather have someone who is ignorant, knows they are and is willing to try than someone who is too arrogant to listen to me.

You might consider printing out the link on Lysodren Loading and Tips in the Helpful Resource section and share it with your vet. It has info from world renown endocrinologists she might be willing to listen to.

And you are right - this is all very expensive.

Are there any tests they can do given that she has been on this medication for awhile?

If you are asking about testing to determine if she does have Cushing's (ie LDDS, HDDS or UTK panel), she would need to be off all meds for 30 days. I don't know that I would go through all that expense nor put Katie through them again either. But, if she hasn't had an abdominal ultrasound, I would look into that if you really think there could be something else going on. The treatment won't affect an ultrasound, I don't think.

Treatment shouldn't affect a CBC for looking at the possibility of diabetes or thyroid issues.

I am hoping that even tho she is not loaded that the medication has controlled it a tiny bit.

I hope you aren't holding you breath on this one. Floors can be very hard when they fly toward your face. :p

Very frustrating.

Keep your chin up....we'll get there!
Hugs,
Leslie and the gang

[Wendy Tillotson]

Great. Well hope the delay hasnt hurt her.

I will see what my vet says when we get the results.

I think what worries her is that Katie presents atypically - she does not drink a lot of water. The only sign we really had was the poor coat and the voracious hunger.

[lulusmom]

She once made a comment to the effect that people that don't listen she could do without.

I don't think I would be the only one to tell you that the same could be said for a good many vets too. When the ego becomes so huge so as to cloud a vet's ability to recognize and appreciate a pet owner who takes the initiative to learn about cushing's so as to be a proactive participant in their treatment, then it's time to find another vet who doesn't place their status above a pet and/or petowner's welfare.


I think what worries her is that Katie presents atypically - she does not drink a lot of water. The only sign we really had was the poor coat and the voracious hunger.

Do you think lack of symptoms is concerning to your vet because of possible misdiagnosis or is her concern that your ability to determine when Katie is loaded may not be easy? Since Katie has a voracious appetite and coat issues, I wouldn't think she presents as atypical. If she truly presented as atypical, your vet should not have confirmed a diagnosis nor prescribed treatment. As far as a petowners ability to properly monitor their dog during loading, if your vet is experienced with cushing's, she probably knows that the hunger is a much better gauge to use in determining if a dog is loaded. I would be more worried if a dog didn't have a huge appetite because some dogs who are drinking and peeing buckets don't always show improvement in this area until well after loading.

With respect to a possible misdiagnosis, if your vet understand cushing's and Lysodren's mode of action, she probably knows that a cushdog is much more likely to suffer adverse reactions to lysodren than a dog with normal adrenal glands. Normal dogs usually do not respond to the drug, even at very large doses.

[StarDeb55]

Wendy, I agree with everything Glynda has told you. The first time I loaded Harley, with his poor appetite, I was dependent on water consumption. I don't remember the timeframe, now, but I'm thinking about 3- 4 days or so, & I saw about a 40% drop in water. I called the IMS, insisted that I wanted an ACTH, the office was kind of doubtful, but did the test. He had dropped from something in the low 30's on his post down to 11 something. All of his symptoms had resolved, so the IMS was willing to go with that high of a post. At about this time, I had joined this group, & all of these wonderful folks tried to warn me that a post of 11 was not going to work. They were right, within about 2 weeks, Harley was drinking buckets & peeing gallons. I called the IMS, told them what was going on, demanded another ACTH. By the time, I got him back in for a stim, Harley's post was now around 20!!:eek::mad: This caused the reload where I got mad at the IMS & fired her. Usually, when you are loaded, you have to go back in 30 days for another stim to confirm maintenance dosing is correct. If it is, then you can go possibly as long as 6 months between tests.

I do want to give you one suggestion that I don't think any of us has mentioned. Lysodren is better absorbed by the body with a certain amount of fat. I was, initially, mixing a 1/4 tsp of sunflower oil with Harley's evening meal to try on pill days to try to make sure of the fat content. I, then, pulled what I term, a "stupid pet parent trick". When Harley had his ultrasound, they found that he had a pre-existing gallbladder problem. I, now, over thought all of this, decided to stop the sunflower oil because of the gallbladder. On the 2nd reload, Harley's numbers had come back great. In the one month before the confirmatory stim was done, was when I stopped the sunflower oil. Yes, you guessed it, he had unloaded when we stimmed at 30 days. Now, I'm doing another reload, & about to pull my hair out at the roots. From that day on, Harley go his lysodren in a dollop of peanut butter to make sure he had enough fat. Worked like a charm.

Debbie

[Wendy Tillotson]

I knew from what all of you had said this was going to be a bust - but my vet was so insistent....

Well this time if the results are not good, will push the issue and if she doesnt cooperate will get someone else.

Just found out something very interesting. How is the ACTH test usually done? Is the cortrosyn done intravenously or IM? My vet has been using a larger amount IM. She is going to switch to IV based on the article you gave me so that she can save $ and pass it onto the customers.

Oh - we generally give her the pill in cream cheese. Its the 1/3 less fat - but hopefully still ok.

[Harley PoMMom]

All the ACTH stim tests done on my boy, Harley, were intravenously.

One really does need a vet that is willing to be a team-player. A vet that will listen to one's fears and questions, and then explain things in a way that a layperson can understand.

Wishing you both the best of luck. ;):)

Love and hugs,
Lori

[Wendy Tillotson]

She was happy to adapt the cortrosyn and was thankful for the article the site provided.

We did somewhat agree if this test is not good that we would go back to loading correctly.

I just feel so bad for this poor little dog. She has no clue that anything is wrong. And fortunately, she doesnt act sick.

Going to have to monitor her very carefully when we reload as her appetite is not that crazed anymore - closer to normal doxie vacuum cleaner.

And now to find out what is going on with poor Zachary. Oh well. I feel like I am running an animal hospital here.

Thanks for all the support.

[Wendy Tillotson]

Well, just got the results of the ACTH Stim test. I honestly did NOT think there would be an improvement - but the before was 2.3 and the after was 7.6 - so heading in the right direction.

The vet wants to keep her on 1/4 pill once a day for now until she is fully loaded and then feels we will have to fiddle around with the maintenance dose. The last test was 2 something before and 16 something after.

I really wasnt buying the 1/4 pill rather than the 1/2 pill per day but does seem to working. I even told the vet I was very surprised.

The bad news is that she has an abscessed tooth and it needs to come out. Amazing that she was still eating. She is at the vets now and they are going to take it out right away. Her face was all swollen and her eye was teary and half the size.

Also got the blood work from my other doxie -and something is going on with him - we are testing his stool for parasites. He isnt eating very well. The vet said he clearly isnt getting enough protein. Ugh.

Never a dull moment.

[Squirt's Mom]

Hi Wendy,

Yes, that is progress, slow but sure. :) How are her signs? Any changes in appetite, drinking or peeing? Is she sleeping better? Sounds like she has good energy.

I hope her tooth comes out with no problems and that she is feeling much better soon.

Also hope the problem with Zachary is no big deal and a change in diet will help.

Hugs,
Leslie and the gang

[Wendy Tillotson]

I really did NOT think this was going to work after what Ive read here - but it has, so that is a good thing.

She never drank a lot of water, but did seem to pee a lot - she wet her crate at night - although it has been getting better.

Her appetite seems about the same - but not as voraciously hungry.

Going to be hard to tell when she is loaded. We are giving her the medication after she eats - so if she shows any different signs like eating slower, we will not give it. She was eating with the bad tooth even....

She sleeps well and seems to be quite perky and happy.

Hopefully Zachary will be ok - hard to get him to eat all. I keep wondering if he is picking up some of the medication from her somehow - altho how, I dont know. He is barely eating food so don't think he is eating anything he shouldnt. Frustrating.

[Wendy Tillotson]

Just picked Katie up from the vet - she had TWO abscessed teeth - poor girl. She is on antibiotics and pain pills. Zachary is very happy to see her home. He whined all night.

[Wendy Tillotson]

Kind of surprised nobody commented.

Well - hopefully someone will comment on this.

Katie is eating normally but all of a sudden wont eat things she normally would. Gave her a blueberry - wouldnt touch it. Gave her some yogurt, but she wouldnt eat it from the container (and usually licks it clean) so I put some in a bowl and she ate it but didnt try to get every drop.

She was tested last week and the after was 7.6

She has only had 3 extra days - so not sure if this is a sign or not. She also had dental surgery, so hard to know if that is effecting it.

Didnt give her the pill today and have a call into the vet.

Any thoughts? Really at a loss here.

[labblab]

I, too, am surprised that your previous reply slipped past us without anybody commenting!! Poor baby, having those teeth pulled!!

But in answer to today's question, I absolutely agree with your decision not to give any more Lyosdren. Yes, three more days of loading could indeed be all that Katie needed. The mouth surgery does complicate the monitoring, but I don't think you can risk overlooking this change in her appetite. In terms of loading, it is always much better to be safe than sorry. And this sounds like a significant change in her eating pattern. I would definitely have her tested before giving any more Lysodren.

Marianne

[Squirt's Mom]

Hi Wendy,

It is possible that the dental cleaning has affected her taste. Prior to the cleaning, her mouth probably had a pretty nasty taste to it that mingled with the food she was eating. So now that the infection is cleared and her mouth is not tasting quite so bad, her food may taste different.

Also, antibiotics can affect the appetite. Is she still on them? If not, how long has she been off?

I hope now that those bad teeth are out you will start to see more of her signs clearing up and you will have a better idea of where she really is with the Cushing's. The stress of the bad teeth and the dental procedure could affect the cortisol levels so giving her a bit of time to get over all this would be wise IMHO.

We may not always have an answer or comment to offer that has any bearing - we are simply listening and watching in case we can be of some help to you and Katie. BUT, we are always here. :)

Hugs,
Leslie and the gang

[Wendy Tillotson]

I spoke to a different vet in the practice and was told to do another ACTH test rather than risk anything. Even my husband noticed a change in her - and he is generally not very observant.

So hard to tell and Im sure the surgery could be coloring things. I really dont want to have anything happen to Katie which Im sure you all more than understand.

Looked like she had diarrhea as well - but again could be the antibiotic and/or the change in food as we have to give her all wet food because of the surgery.

Gee - what a few more hundred. UGH. Just got a $900 bill for the surgery. Pathetic.

[Wendy Tillotson]

She is still on the antibiotics, forgot to mention that.

[Cyn719]

Wendy

So sorry I never saw your post - How is Katie now? Penny had 4 teeth pulled one being her K-9:eek: but she did well -- I agree to hold off on the meds for now till she is tested - better to be safe

Hugss xo

[Sabre's Mum]

Wendy ... I have been following as welll but missed the tooth post ... school holidays here in NZ so it is a little busy! Ouch to the surgery bill!!!!

I tend to agree with Marianne and the vet ... but your bank account probably doesn't! The only way to know where the cortisol levels are to get an ACTH stim done. The test may be skewed with the antibiotic treatment and surgery but it is better to be safe!

[labblab]

Wendy, if the ACTH does not indicate that Katie is loaded, in all honesty -- I would wait to resume the loading process until she has totally rebounded from the surgery. You have so many variables going on right now that it will remain really hard to separate the signs of loading from these other issues. I know you don't want to lose ground, and the need for the dental work right now was really unfortunate. But "it is what it is :o," and my personal opinion is that, if Katie isn't already loaded, it will be best to hold off on any further Lysodren for the time being and just start fresh when she's fully recovered from the surgery, off the antibiotics, and back on her normal food.

Marianne

[addy]

Oh Wendy,

I thought I did reply because I indeed read your post. It must have been one of those days when I hit preview and forgot to hit the other button:rolleyes::o

I remember when Zoe had dental work and teeth pulled. She cried cried and ran around the house even with pain meds. I think it is a good idea to wait too. I think Leslie and Marianne have good repsonses to you.

Antibiotics can cause loose stools. Some say it does not help to give probiotics while taking them but I always give probiotics. I just make sure they are about 4 hours or more (if possible) apart.

Hang in there. I hope Katie feels better soon.

hugs,
addy

[Wendy Tillotson]

Okay - but if I wait, do I keep giving her the lysodren? Or should I stop it?

[Wendy Tillotson]

I am afraid to keep giving it to her if there is a change - as can't be sure what its from.

She had the surgery last Saturday - and is getting only a very small amount of pain killer.

[Wendy Tillotson]

I am SOOOO confused.

So some say to do the test, others say not.

Sounds like if I DONT do the test that I should stop the Lysodren until she is better.

[labblab]

Wendy, others can leap in here and correct me, but I don't think anybody is telling you not to do the ACTH test now. Based on her behavior and previous ACTH result, Katie may very well be loaded, and you'd want to find that out. You also want to make sure that her cortisol level hasn't actually dropped too low.

I think the "waiting" question is: what do you do about more Lysodren if this ACTH test is still too high? Should you wait until she's recovered from the surgery to give any more?

But first things first. And just as the vet has recommended, I think that people here are also encouraging you to have the ACTH test done now, before you give any more Lysodren. Once you have the test results back, you can decide whether to wait to give any more.

Marianne

[Squirt's Mom]

If I were in your shoes, here is what I would do -

1) Stop the Lysodren.

2) When she has had time to recover from the surgery, and she is either eating her normal food or had time to adjust to her new food so there is no more loose stools/diarrhea, have an ACTH done.

3) Based on the results of that test, either start the loading phase over or go to the maintenance phase.

Just my 2 cents worth - others may differ. ;)

Hugs,
Leslie and the gang

[labblab]

OOOPS!! I guess I was wrong, and Leslie is advising you to wait with the test. So you were right about the differing opinions...

Just as an additional thought -- I'm actually kinda surprised that your vet opted to continue the loading immediately after Katie's surgery, due to all these issues that are involved (including the fact that the ACTH results can be skewed by the stress that has been placed on Katie's body by the surgery). But since she did tell you to continue, I'm feeling as though you now need to check Katie's cortisol due to safety issues. If she is not eating and has diarrhea, her cortisol may have dropped too low. And the only way to know for sure is by testing her. But if you don't want to proceed with an ACTH right now, I'd at least ask that Katie's basic blood chemistries be checked (her "electrolytes"), just to make sure that they are not seriously out of whack. That just involves a single blood draw and is much less expensive than an ACTH.

Marianne

[Wendy Tillotson]

One thing I am sure of is that I will NOT give her anymore lysodren for now.

I called the vets office again to ask if it might not make sense to just leave her off for now until she is 100%, then restart it ( I would think a week in between) and see how she does.

It does make sense that the test could be impacted by any stress she is feeling - and that the cortisol may be low because of that - which may be effecting her right now.

I do know that in people, cortisol is low due to stress - so makes sense it would work the same for her.

[labblab]

Wendy, I think you'll find that it's the opposite effect -- stress (or certain illnesses) tends to elevate cortisol rather than lower it. So an ACTH performed at this time might actually be abnormally inflated, assuming that Katie's adrenal cortex has not been eroded by the Lysodren to an extent that makes it difficult for sufficient reserves of cortisol to be produced.

I just saw a reply that you had posted elsewhere, and am now reminded that you have been loading Katie for a month now? So maybe it's true that only three more doses of Lyosdren are unlikely to have produced a significant additional effect. But it's really hard to know. I surely hate to think of you losing a whole month's worth of effort. I know it's been a really long haul for you girls. :( :(

[Sabre's Mum]

Wendy ... whenever Sabre had surgery or was unwell, we always with-held the Lysodren.

Your stress level and nerves must be frayed with such a drawn out loading phase.

I have just reread your posts just to try and get my head around the dosages and stim test results. Just a summary:
1. You loaded for 2 1/2 days at 250mg per day (equivalent to 47 mg/kg) ... ACTH post was 13.8
2. Vet changed dosage to 1/4 pill every other day ... 20 days later. ACTH post result 16
3. Vet changed dosage to 1/4 pill every day (22mg/kg) [ I am lost on the timeline here but at a guess this was about a month?] latest test was a post result of 7.6
4. Katie had three more days of 1/4 pill daily and you noticed changes

At a guess she has now been on about four days of antibiotics.

Given the above there is a possibility she finally made it ... there is no right or wrong answer as to whether to test her now or later IMO, given that you are with-holding her Lysodren at the moment, as we are just offering our opinions. If you think that the surgery has knocked her around, then it may be better to hold off on the ACTH stim test until you think she is OK to start on the Lysodren again and that test will indicate which way you go.

On the other side of the coin ... there is no harm in doing an ACTH stim now if you do believe she is loaded. It just may not be wise to continue loading Katie until she has fully recovered from surgery.

Angela

[Wendy Tillotson]

Well, just got off the phone with the vet.

Katie has major diarrhea - which the vet obviously doesnt like - most likely from the antibiotics. Switching her to a different food may be part of it as well - needed to put her on soft food - used the same brand, but still could be problematic.

The game plan is to stop the antibiotics until we can get the diarrhea under control. I have to pick up medication tomorrow morning. She will need to go back on it though because she had a major infection.

We will keep her OFF the lysodren until she is better - probably at least another week, possibly longer.

The problem with testing now is that we may get a false positive as stress lowers the cortisol levels.

Other than the diarrhea - Katie seems her normal perky self. She isnt eating certain things, but she is eating her regular food normally. Im not so worried about that.

Once she seems better, we will put her back on the lysodren and go from there.

Ugh.....a set back but better safe than sorry.

[Sabre's Mum]

Wendy .. sounds like a good plan. Just a comment on the cortisol levels with stress - as Marianne said - stress is likely to increase cortisol levels.

All the best and take care ....

Angela

[Cyn719]

Wendy

Hoping Katie feels better soon. Hugssssss to both of you. Xo

[addy]

Hi Wendy,

Poor Katie, poor you, so much all at once. I hope the meds stop her diahreea.

Hang in there, I know it is hard to have so much thrown at you all at once.

Hugs,
addy

[Wendy Tillotson]

Well she got up this morning and the diarrhea is gone.....

NOW Im really upset altogether. Maybe we SHOULD have tested her.

This is such a nightmare.

[Wendy Tillotson]

I feel like I am having a nervous breakdown.

So could it be she is loaded and if we put her back on the loading dose we will have a problem?

I am totally sick to my stomach.

[labblab]

Wendy, you can still perform the monitoring ACTH test if you so choose. Lysodren remains active in the system for approx. 48 hours after the last dose, plus even after that time, it takes a while for the adrenal cortex to begin to rejuvenate. So you can go still go ahead and test Katie if you would feel more comfortable knowing what the results are now. If she is indeed loaded, yes, it would be harmful if you continue giving her more Lysodren at the same dosage/timing.

But at this point, I really encourage you to call the vet and jointly decide on a gameplan that feels safest to you. As you can see, we all are offering a variety of thoughts and opinions. But none of us are professionals, and I'm afraid we may be upsetting you even more with our range of suggestions. :o

I'm truly sorry for this bump in the road!!!! You girls really deserve a break...

Marianne

[Wendy Tillotson]

I have an appointment with her tonight so will figure out what to do then.

[labblab]

That sounds good!! Now I hope Katie will continue to improve today, and you can have a little bit of a break from your worry! You still have time to test or not, depending upon your conversation with your vet.

Marianne

[Wendy Tillotson]

The last dose was Wednesday.....

[addy]

Sweetie you are not having a nervous breakdown and believe me when I say I know exactly what you mean about being sick to your stomach.

Sometimes we get such a roller coaster of a ride with our pups and there are always so many variables and "what ifs".

You are doing a wonderful job and we are all here to send you a tidal wave of hugs and if you need us to have a "breathing moment" with you, we can do that too :) That's when we all come on line and breathe in and breathe out at the same time. It's awesome:);)

sending love and hugs
addy

[Wendy Tillotson]

LOL

Well as much as I was upset with my vet at times - turned out in the end that she was right with a little trial and error on how to get her there.

I will let her figure this out. Im thinking that since we didnt do the ACTH test and she is showing all signs of being loaded that we should maybe act like she is for a week or two and try her on a maintenance dose and then retest. If she is NOT loaded, we can go back to that. I will see what she says tonight. Just too many variables.

The good thing is that Katie doesnt act sick and Zachary - the dog that wasnt eating, IS. I changed the food AGAIN and he seems to like this one - even the dry, which is very important. Dry food is much more nutrient dense, especially in protein - which he is sorely lacking. I also started him on Periactin which stimulates appetite - and that may be part of it, BUT he still wouldnt eat his original food and he gobbled down the new stuff. He wouldnt eat Blue either - which is beyond bizarre. He likes the Nutro Ultra. Keeping my fingers crossed that it stays that way. Having three dogs with issues is a bit too much.

[Cyn719]

Good luck at the appointment:) Will check back to see what was decided. Hang in there you are doing a good job Mom!:)

hugs xo

[Wendy Tillotson]

Thanks. Very strange situation.

Well, like I said - I do have faith in my vet, so I am sure we will figure this out together.

[Wendy Tillotson]

Just got back from the vet.

Katie's mouth is healing nicely.

We really lost the window to do the ACTH accurately and with all the stress in her life with the surgery and the pain, the results would probably have been skewed.

I feel rather strongly that she is loaded - she has stopped peeing in her crate at night and is eating normally. The diarrhea did resolve so not sure if it was from the anesthesia in the surgery, the lysodren, the change in food or the antibiotics. We stopped the lysodren on Wednesday.

So here is the game plan - we are going to put her on maintenance of 1/4 pill 2x a week. We will do this for two or three weeks UNLESS we see a change and more peeing and hunger. Then we will test her.

Is it best to test her a day or two after the last dose? Or does it really matter at all?

I feel comfortable with this approach as I am very worried about hurting Katie. Right now she seems perky and happy - and want to keep it that way.

Keep your fingers crossed that she is loaded and maintenance works. I would rather lose a few weeks than hurt her.

[StarDeb55]

Is it best to test her a day or two after the last dose? Or does it really matter at all?

Wendy, lysodren reaches it peak effect about 48 hours after a dose is given. If you end up testing prior to 48 hours, you & your vet just need to keep in mind that the results would probably somewhat lower, if the test had been done at 48 hours.

Debbie

[Wendy Tillotson]

So if she gets a maintenance dose on Sunday, then testing on Tuesday would be best?

[Wendy Tillotson]

Well one of the good things is that she was able to continue on the antibiotics. She had a massive infection from the teeth - up into her sinuses.

She is doing well, but I think we need to beat this before going crazy on anything else.

We start the maintenance dose on Sunday and then Wednesday. I will do that for a couple of weeks and then test her on a Tuesday.

Keep your fingers crossed, please. :)

[Squirt's Mom]

Hi Wendy,

Your testing schedule is very important. If she has her last dose at 8am Sun morning, then she needs to be having the ACTH as close to 8am Tues morning as possible. That would be the peak time for the Lyso levels in her body. The test needs to be done as close to that 48 hour mark as possible for the most accurate results. It isn't always possible to do it right at the perfect time, but we do try to get the timing as close as possible. ;)

I agree with your vet about testing her right now - the results could easily be skewed because of all the stress she is under right now. I hope starting the maintenance dosing now works; based on your descriptions of her behavior, she could be loaded and starting the maintenance now shouldn't hurt her. BUT continue to keep a close eye on her for signs of an overdose just in case. The Sun/Wed schedule is the one I used for Squirt for quite some time. The days my family went to church were my reminder to dose! :D I like reminders - feeble brain an all, ya know. :p

Hang in there, Mom!
Hugs,
Leslie and the gang

[Sabre's Mum]

Wendy

Given the last day of Lysodren, the surgery and everything going on it sounds a good plan. Kepp up the good work!

Angela

[Cyn719]

Wendy

Fingers and paws are crossed!!!! :)

love and prayers to you and Katie xoxo

[Wendy Tillotson]

Thanks everyone - does seem like the best course at this time.

The interesting part is that neither my husband or I EVER see this dog drinking. And yet, she has been peeing in her crate at night for quite some time. At first, we thought it was from the alkaline urine, but that resolved. So THEN I just thought she got in the habit. But in the last week or so, its been less and less - so guess she is drinking somehow. LOL.

Her brother Zachary has been on periactin for a couple of days and he is now EATING quite happily. Hope this solves the issue with losing protein - if not will have to explore whats going on further. Its been months since he started this no eating nonsense, so its nice to see him hungry.

Would be so wonderful to have Katie in maintenance and Zachary feeling better. Its been a very trying time. They are the last of my wire doxies - and I bred both of them - so extra special to me. I lost their mother a couple of years ago this month - she was 15 and a Champion - and the kindest, sweetest dog you could ever know. All the showing and taking her everywhere made her very well-adjusted. I even took her to the nursing home when my mom was there and she was great with everyone petting her. Her nickname was "Smoochie Pooch" for a good reason. LOL.

[Wendy Tillotson]

Zachary got very sick - totally stopped eating and then started throwing up. He ended up in the hospital for two days. We did an ultrasound of his stomach and there was a thickening of the intestines. He is now on prednisolone and a special diet. Fortunately, he seems somewhat better and is eating. He actually likes that crummy Z-D food altho I hope to find some other food that he will like as I think Z-D is horrible with little nutritional value.

Katie went in for her ACTH test on Tuesday, so waiting to hear the results. Sure hope its good because NO clue how we would figure out if she is loaded otherwise. She has stopped peeing at night and is acting pretty normal. I even see some red coming back into her coat altho I dont see the bald spots filling in as of yet. She has quite a pot belly - but not sure she will ever lose that.

[Sabre's Mum]

Sorry to hear about Zachary .... keep us informed on Katie's results .... fingers crossed that she is loaded.

Angela and Flynn

[Squirt's Mom]

Hi Wendy,

Sorry to hear about Zachary but hope he is feeling better today. Can't imagine he actually likes that ZD food! Maybe he's a junk food doggie at heart! :D Did they give you diagnosis for Zach?

That pot belly? Once the cortisol is under better control, the body can start processing fats in a more normal fashion and that belly usually disappears. So tease Katie about being fat while you can! :p

Let us know what the test says and hang in there!
Hugs,
Leslie and the gang

[Wendy Tillotson]

They think Zachary has Crohn's disease - something more than just IBD. He is seeming a lot better, so will see how he does. The vet cut the prednisolone in half as he is eating and looking pretty normal. We did a blood test and will see how his protein is doing. Seems very bizarre to me that he would suddenly develop this at almost 11 years old.

As far as Katie - WELLLLL - her levels are 10. something again - up from 7.6. UGH. So did not get into maintenance. We will go back to the loading dose of 1/4 pill per day and watch her closely. Meanwhile, she exhibits all the signs of being loaded - not frantically hungry and no longer peeing in her crate at night. We have NEVER seen this dog drinking which is very bizarre - just the night issue. The vet said to look for her getting wobbly or not eating or diarrhea. If we dont see any signs of this, will just test her in 2 or 3 weeks and see where she is. This is beyond nerve wracking. I have prednisone and I also have some injectable stuff to give her if I need it. I just hope this doesnt prove fatal. Not sure what else to do.

The vet seems to think that Lysodren is a safer choice than Vetoryl and that if the dog has a problem, its more likely to be fixable.

[Wendy Tillotson]

Has anyone used Marin on their dogs? Its a new supplement by Nutramax that has silybin (milk thistle), Vitamin E and Zinc for liver support.

They also have Denosyl - which is Sam-e and a new one Denamarin which combines both.

Any thoughts?

[Harley PoMMom]

With my boy, Harley, I was using marin in the morning and denamarin in the evening, making sure they were given 12 hours apart. I did this for a long while and then switched to milk thistle.

[Wendy Tillotson]

I would use plain milk thistle if I could figure out how much to give to a 12 lb dog.

I want to give it to Katie for the Cushings and to Zachary because he is on steroids right now and his liver enzymes are elevated as a result.

[Harley PoMMom]

Hopefully this link will be helpful to you: Milk Thistle/Sam-e and more (for liver "support") (http://www.k9cushings.com/forum/showthread.php?t=192)

If this does not answer you question please feel free to ask. ;):)

[Wendy Tillotson]

I think I will just stick with the marin - its made for animals so hopefully will absorb better. And it takes the guesswork out of things.

[Harley PoMMom]

Here is a post from me to another member concerning milk thistle:
Milk thistle's side effects may involve stomach upset and diarrhea. With Harley I started him on one drop once a day for one week then increased this to one drop twice a day for another week. By the fourth week he was getting the two drops twice a day. When possible, I always tried to start any new medication on him very gradually. Harley weighed about 23lbs so with Lucy weighing 15.5lbs I believe gradually getting her to two drops twice a day would be adequate.

Here's a link to an informative article about Milk Thistle: http://wendyblount.com/etvma2/milk-thistle.pdf An excerpt from this article about dosage: Although I don't recommend the alcohol extract.


Dosage: Milk thistle is usually supplied as a solid extract, standardized to 70-80% silymarin. Milk thistle should be used for at least 8 weeks before expecting results such as improvement in biochemistries.
· Dried herb: 15-20mg/lb SID
· Concentrated extract: 2-5 mg/lb BID-TID
· Alcohol extract: 2 -5 mg/lb BID-TID

Love and hugs,
Lori

Hope this helps.

Love and hugs,
Lori

[Wendy Tillotson]

Thanks for the information :)

[Wendy Tillotson]

Has anyone heard that Cushing's predisposes a dog to infection?

Katie had a cyst on her neck that broke open so took her to the vet right away as I thought she would need an antibiotic.

She is on Clavimox 2x a day and have to clean it and put medication on 2x a day.

The vet that took care of her told me that.

[Harley PoMMom]

Dog's with Cushing's disease are prone to infections due to the elevated cortisol making the immune system weaker.

[Wendy Tillotson]

If the Cushing's is under control and the cortisol is "normal" should this still be true?

As soon as I saw this, my inclination was to take her to the vet rather than treating myself - good thing.

[Harley PoMMom]

When the elevated cortisol is under continuous control, the weaken immune system should strengthen.

[Wendy Tillotson]

Keeping my fingers crossed. Still trying to finish the loading.

Very tempted to take her to Dr. Peterson in NYC.

[Harley PoMMom]

Dr Mark Peterson is an expert in Cushing's. If taking Katie to see Dr Peterson is feasible, I would highly recommend this.

[Wendy Tillotson]

Well waiting to see how the next ACTH test turns out and if she is not loaded, will do that.

The vet that saw her on Monday was really surprised that after so many months, she wasnt loaded.

[Wendy Tillotson]

Had to take Katie to vet today - and was able to get my regular vet. She said that was not a cyst, but a tumor - and removed it using a local.

We talked about retesting and will do it next week, unless she shows any signs of changes or having an issue.

[Sabre's Mum]

Thanks for the update. Sorry have only skim read but when was Katie's last ACTH test and what were the results?

Angela and Flynn

[Wendy Tillotson]

Her last test was on 2/17 - and she was at 10 something.

She is happy as a clam - other than the crummy coat, you would never think there was anything wrong.

Can't wait to see the next test results.

[Wendy Tillotson]

Still not loaded but she is down to 7.4

[Sabre's Mum]

Wendy,

Thanks for the update. On the good side .... it's going down!

All the best
Angela

[Harley PoMMom]

Still not loaded but she is down to 7.4

Glad to see her cortisol is coming down. Could you remind us of her Lysodren dose and the time schedule she is being given it...Thanks!

Love and hugs,
Lori

[Wendy Tillotson]

Katie is on 1/4 Lysodren daily. The numbers are definitely coming down. If she hadnt had the surgery on her teeth, would probably be there. Her numbers were in the 7s - but I wanted to put her on maintenance until she felt better and jumped back up to 10.6 in the 2.5 weeks.

She also had a tumor removed, but kept her on the medication as that was done under a local.

My vet wanted to use a lower dose rather than make her sick - even if it took longer. It is working, but taking a LONG time to get her there.

I see her coat coming back in and turning dark red which is great as its been a flyaway beige instead of the her normal rich mahogany.

The scary part is that she is looking totally normal - not drinking a lot, eating normal for a doxie, not panting, etc. So hard to know how much longer this will take.

[Wendy Tillotson]

Spoke to the vet and she is scheduled for another test next Monday.

This is getting scarier and scarier. On the last test, she had been on medication for 18 days and she came down about 3 points to 7.6

This time she will have been on for 17 days. If things were linear - this would be okay - but ....oh boy.

She is acting totally normal so really hard to tell what is happening. We just keep watching her to see if any drastic changes - like refusing to eat at all. Right now, eating pretty normally and her coat is coming in. She is acting fine.

I am a nervous wreck.

[Harley PoMMom]

Katie is on 1/4 Lysodren daily.

Hi Wendy,

The protocol for loading a dog on Lysodren is giving a dosage of 50 mg per kg of a dog's weight being split and given twice a day. With Katie weighing 11.6 pounds her dose should be around 250 mg and divided into two doses of 125 mg given twice a day.

I really don't know if you will see her cortisol getting down to the therapeutic ranges of 1-5 ug/dl on the dosage that Katie is being given.

Will be waiting anxiously with you for the next ACTH stim results and keeping all fingers and toes crossed for good test results.

Sending huge, loving, and soothing hugs,
Lori

[Wendy Tillotson]

Lori -

She has been going down consistently on 1/4 pill per day. Its been very slow - but its been going down.

It jumped up when we went to maintenance for 2.5 weeks - but we did that because she had surgery.

I have no doubt in my mind that this will get her loaded. My worry here is that we should test a few days sooner.

Wendy

[Harley PoMMom]

Although I know you are already watching her like a hawk :) just be observant of her cortisol getting too low, which I don't expect to happen BUT if she would show any symptoms such as diarrhea, vomiting, lethargy, and or just not acting herself, stop the Lysodren and make an appointment for an ACTH stim test. And remember we are here to help. ;):)

[Wendy Tillotson]

If I dont have a nervous breakdown, it will be a miracle.

We have been watching her very closely. Seemed like she had soft stool one day - but then it disappeared. UGH.

Took her for a walk today - .8 mile and she kept up the way she usually does.

Sometimes I think she is staying in her crate a little too much and then next thing you know, she is bouncing around and barking for treats.

At this point, I just dont know WHAT I am seeing. She is 13 yo and acts like 6.

Her coat is growing in so have to take that as a good sign - but does that mean the cortisol is where it needs to be - or just getting there. I just don't know.

This has been the never ending, nerve wracking saga. Just want Katie to be ok and have this under control.

[Wendy Tillotson]

We are going to test her instead of waiting until Monday.....so on for tomorrow.

Keep your fingers crossed.

[Harley PoMMom]

Just a reminder that the ACTH stim test should be performed 36-48 hours after the dose of Lysodren has been given.

[lulusmom]

Sometimes I think she is staying in her crate a little too much and then next thing you know, she is bouncing around and barking for treats.

At this point, I just dont know WHAT I am seeing. She is 13 yo and acts like 6.

Her coat is growing in so have to take that as a good sign - but does that mean the cortisol is where it needs to be - or just getting there. I just don't know.

I think what you are seeing is a cushdog whose cortisol has been brought down a therapeutic level or close anyway. The results of tomorrow's acth stim test will tell you. Remember that cushing's is a very graded disease and the symptoms come on gradually so it's possible that you haven't seen the real Katie for a few years. Isn't it wonderful to see them with a spring in their step again?

Fingers and paws are crossed that the acth stim test results are good.

Glynda

[Wendy Tillotson]

Funny - my husband and I were just having a discussion as to when the test should be done.

She got a dose this morning and is scheduled for testing tomorrow morning - so it will be about 24 hours. However, she has been getting daily doses.

My vet always does it on an empty stomach - so doing it later in the day is not the easiest.

Ive done testing two days after the last dose too.

Starting to believe it just doesnt matter..... either she will be loaded or she wont. On March 8th, after 18 days she was at 7.4 (down from 10.6) - so this is 13 days later.

At this point, I am so down about all of this - not expecting it to be in range. But, for safety's sake, am doing it sooner than later.

[Wendy Tillotson]

Finally loaded! Her post was 3.6 :D:):D:D:):D

[frijole]

Wonderful news! I know it is a huge relief. Assume your vet told you to go back in in 30 days to check and make sure the load is sticking .,.. a pain i know but it prevents having to reload. Give her a big hug and you can have a great weekend now! Kim

[Wendy Tillotson]

I'm a little worried about the maintenance dose.

She loaded on 1/4 pill per day.

At first vet said to go to 1/4 pill every other day - and then decided to do 1/4 pill twice a week. She wants to retest in 2 to 3 weeks to make sure it is holding.

[frijole]

You should be worried about that dose because it doesn't follow protocol. Protocol is to wait a week (approx) from the last dose (before you did the acth test assuming you stopped for the test).

Weekly dosage is whatever the daily dosage was for loading. Your challenge is that 1/4 pill is so small it is hard to cut into smaller pieces but with a good pill cutter you could cut it into halves. You need to give it at least twice a week, preferably more to keep the load going.

The concern is that if you increase the dosage you might lower cortisol more so I'm confused as to why she wants to test in only 2 to 3 weeks.... perhaps she wants to test her theory of increasing the dose?

If you go with the dosage she recommended I'd be inclined to keep a vigilant eye out to make sure she doesn't go too low and wouldn't worry a bit about maintaining the load.

[lulusmom]

Congratulations....way to go! That's a beautiful way to start your weekend. I hope you are going to go out and celebrate.

Glynda

[Wendy Tillotson]

Spoke to a friend who went to Dr. Peterson. Her loading dose was 250 a day and her maintenance dose is 500 a week. So sounds similar......

She also didnt wait a week in between to start maintenance.

My concern is that its really difficult to break those pills further as I would prefer to give the dose more than twice a week.

Im okay testing in 3 weeks. This way if the maintenance dose isnt holding, we can catch it faster.

[StarDeb55]

Wendy, I haven't posted to you in a bit, but have been keeping track. Congratulations, I guess slow & steady wins the raise. To back up what Kim has said about maintenance dosing, Dr. Edward Feldman at the UC Davis vet school, one of foremost vet endocrine experts in the world has stated many times that maintenance dosing should be broken up in multiple dose over the week. After I moved Harley's cushing's care back to his GP from an IMS, the GP said that he never had any luck with maintenance only being done twice a week, he want three time a week. You may be ok with twice a week as long as Katie doesn't have adrenals that regenerate in the blink of an eye.

I know you have been cutting those huge big pills, but now that you will have to cut a 1/4 of a pill down even further, you might want to consider getting the maintenance dosage compounded. Harley was only 14 lbs, so was on a very small dose. I used Diamondback Drugs, & actually kept two capsule sizes available, 50 &75 mgs, in case there had to be any tweaking done to the his dose.

Debbie

[Sabre's Mum]

Yeaaaahhhh!

Fantastic news that Katie had finally loaded.

I tend to agree with the twice weekly 1/4 of a pill. You have been loading Katie recently on 1/4 pill per day, and generally the loading dose is what is used as the maintenance dose BUT you also need to take into account the length of time that it is taking to load. With Katie's weight (in Nov was 11.6lbs - converting to 5.27kg) the total weekly maintenance dose is still within the recommended dosing range.

I know you will ... but just keep an eye on her for signs of overloading.

I think for piece of mind, perhaps not financially, 2-3 weeks testing sounds a good idea with the dosage increase.

All the best
Angela and Flynn

[Wendy Tillotson]

That's what I was thinking too - that the 1/4 pill twice a week was ok based on that corresponding to the original 1/4 twice a day. Just hope its going to hold.

I also think that if I could divide the dose into smaller amounts, would be better so may end up getting it compounded also.

Will see what the test shows in a few weeks.

My husband has said she is eating so much slower - so very glad we stopped and tested when we did.

[Wendy Tillotson]

Well she was tested last week and got the results. Her pre was 4.9 and her post was 6.0 so the 1/4 twice a week is not maintaining her. :confused::confused:

I am really upset. The vet wants to put her on 1/4 pill 3x a week and retest in another 3 to 4 weeks.

When does this ever end?

[Sabre's Mum]

Sorry to hear about Katie's latest ACTH stim results. Just watch Katie ... as this dose now brings it up to a maintenance dose of about 71mg/kg ... we all know you will without my comment anyway! Just out of interest ... did your diagnostics determine whether Katie has pitutary or adrenal cushings.

Take care
Angela

[Wendy Tillotson]

Yes, I am very upset about all of this.

She doesnt even look like a Cushings dog any longer - her coat has come back in and she has lost the pot belly.

I am beside myself - I cant even sleep I am so upset. I was really hoping she would still be in range. In fact, I thought she might even be lower as she has been eating less and less. When I tried to give her some food tonight she actually walked away from it.

I dont know how anybody gets through this. I am sick of the whole situation and just want my dog to be ok.

[StarDeb55]

I haven't posted to you in a bit but have been following. I do have a couple of thoughts. Lysodren is better absorbed with fat. You might try giving Katie her pill in bit of peanut butter or full fat cream cheese. I learned the deal about fat the hard way. My Harley had been getting 1/4 tsp of sunflower oil over his food at night for quite awhile, don't remember why I was giving it to him. Anyway, I decided to stop the sunflower oil since our babies are prone to pancreatitis. Well, because of the no oil, Harley proceeded to unload. His ACTH at the end of the first month after he loaded had jumped to 9 something. After that, he always got his lysodren in a small bit of peanut butter.

I'm not overlooking your fears concerning this increase in maintenance, but this should get her back within range. The other thing is most of the experts agree that maintenance needs to be broken down into multiple doses over the week, especially if the pup has adrenal that regenerate quickly, which is what might be the issue with Katie. My vet preferred that maintenance be given at least 3x a week as he felt that twice a week simply did not work, as there would always be a 3 day vacation between doses during each week.

I will also say that compounding may be the way to go since Katie is one of our little ones. My Harley was 14 lbs. when he was diagnosed, & got down as low as about 12 lbs. All of his lyso was compounded as his vets felt that cutting those big 500 mg. tablets wasn't a good option for him. They wanted him on a uniform dose. I always kept 50 & 75 mg capsules available, so if I needed to make small adjustments in his dosage I could. To give you an example of the maintenance dosing that I used with Harley, he was getting 200 mgs. weekly. That dose was broken down into 75 twice per week, & 50 once per week.

Debbie

[Wendy Tillotson]

Katie gets her medication in cream cheese - not the full fat one tho. I could switch it. She also gets her thyroid pill in cream cheese.

Where do you get the compounded medication from? I was thinking that might work better.

I am very worried about giving her such a high dose on a regular basis as she is under 12 lbs.

I will talk to my vet about all of this. Giving her 3x the amount per week that we used to load her scares me to death.

If we compounded it, I wouldnt mind giving her 50 mg 4 or 5 x a week.

How often do you test your dog? This is all so nerve wracking.

[Wendy Tillotson]

It worries me that she is eating less and less. I couldnt believe it when she walked away from food. She did take a dog biscuit tho.

[Sabre's Mum]

Wendy .. the first thing that is needed is to get Katie back in the range so I think that as the post result was 6 then upping her dose to 3 x 125mg is a good option. What I am also saying is that in the long term this may not be the ideal maintenance dose but firstly you need to get Katie back in range.

Debbie's suggestion re the fat content with her tablet is a great suggestion.


How often do you test your dog?

Well you are probably not asking the right person as our dear Sabre (who is no longer with us) did not read the book!!!! Generally .... you would do a test when you believe your dog is loaded, another a month after maintenance dosing, then test every three months. After any dosage change an ACTH stim should be undertaken after a month (or sooner is symptoms indicated otherwise) ... then back to three monthly testing if the maintenance dose is acceptable.

It can be nerve racking .... I hear you loud and clearly on that one! But we are here to help and hopefully calm those nerves.

Relax and take care
Angela and Flynn

[Wendy Tillotson]

We are not giving her 1/2 pill three times a week. Its 1/4 pill three times a week.

She loaded slowly over a long time at 1/4 pill per day.

Maintenance was going to be 1/4 pill twice a week.

[Squirt's Mom]

Hi Wendy,

What signs are you still seeing? Have you seen a reduction in them while on maintenance or are they becoming stronger?

Treatment is two-fold - the numbers and the signs. Some pups do better with their numbers a little higher than the norm; some do better with numbers a bit lower. The signs tell us as much about how our babies are doing as the numbers do. ;)

Hugs,
Leslie and the gang

[Sabre's Mum]

Whoops sorry Wendy .. slipt up on the last post ... had many things going on around me I was thinking quarter of a tablet ie 125mg but typed 250mg. I will go back and amend the post.

I agree with Leslie to a point ie treat the patient not the numbers but the thing is that Katie is not "holding" her maintenance dose ... her numbers increased from 3.8 to 6.

Angela and Flynn

[Wendy Tillotson]

Katie is perfectly normal - if anything her appetite is below where I would like to see it. She scared me a bit the other day because she walked away from food - but she took a dog biscuit and the next morning was eating fine.

Her coat came in - a nice beautiful mahogany. Still a little thin, but getting better everyday.

Her pot belly is pretty much gone.

She is not super peppy, but still thrilled to go for a walk - and she is 13 years old, so can't leave that out. Barks for her dog biscuits as per usual. LOL.

She is getting hit by seasonal allergies - scratching and watery eyes - but not related at all. (Started her on eye drops.)

All in all if I saw her the way she is right now, I would never know anything was wrong with her. She's a happy girl.

[Wendy Tillotson]

Well retested again and her pre is 4.2 and her post is 6.6 - so she is going up.

We are going to put her back on 1/4 pill a day to reload.

Not sure HOW we are going to maintain her tho. This is getting really frustrating.

What was the name of the pharmacy that compounds? The local vets use Wedgewood - but they are very expensive.

[Wendy Tillotson]

One of the things I discussed with the vet was how Katie acted when she was around 3.9 She was VERY sluggish and didnt seem to want to move at all.

So she was saying that some dogs do better if they are slightly above the desired range. She does seem happier in the 6's

Any thoughts?

[frijole]

One of the things I discussed with the vet was how Katie acted when she was around 3.9 She was VERY sluggish and didnt seem to want to move at all.

So she was saying that some dogs do better if they are slightly above the desired range. She does seem happier in the 6's

Any thoughts?

Your vet is right - not all dogs can handle cortisol in the ''desired range'' and we have a tendency to get hung up the numbers because we fight so hard to get there... if Katie is comfy at a 6 and you don't have peeing and excess water intake there is nothing wrong with keeping her there.

[Wendy Tillotson]

That's good to know....

Well for right now as she is getting higher, we are going to reload her on 1/4 pill a day - which is what we used originally.

1/4 pill twice a week did not maintain her so the vet increased it to 1/4 pill 3x a week - and she continued to go up - so thats not working too well either.

Beginning to wonder if we will ever get out of this and get her stabilized.

[Harley PoMMom]

I totally agree with Kim, one can not go by the "numbers" alone. How the dog is feeling and control of the symptoms are very important, also, in gauging whether to increase or not. Since Katie seems to feel better when her cortisol is around 6ish than I would keep her there.

Love and hugs,
Lori

[Wendy Tillotson]

She seems fine - but I noticed that her coat is losing color again and getting a bit wispy - it stopped growing in - so not sure what to make of it. I did mention it to the vet.

I am going to call Dr Petersen and make an appointment. Will get all the test results so he can review them. This way we (my vet and I) have him as an additional resource.

[labblab]

Diamondback Drugs in Arizona is a compounding pharmacy that many of our members use with satisfaction.

Marianne

[Wendy Tillotson]

We have an appointment with Dr Peterson on Sunday.

Katie had a growth on her stomach that suddenly bloomed to the size of a golf ball and the vet felt it needed to come off as it looked like it was going to burst. $1000 bill....the vet did a lot of blood work before she did the surgery.

A number of weeks ago, she had a little cyst on her neck that broke open - didnt even know she had it. She had it removed with a local.

Beginning to wonder if this is related to Cushings.

We have been reloading her - and think she was close to needing another test - so have to talk to the vet. Right now Katie is feeling the effects of the surgery and is very droopy from the anaesthesia. she had the lysodren this morning - but think I will hold off tomorrow morning and see how she is during the day before giving it to her again.

I almost feel like she needs another test - but with the surgery, might be better to wait and keep her off the medication for a few days.

What a mess - never seem to get ahead. Its one step forward and two steps back.

[Sabre's Mum]

Wendy,

Sorry to hear the latest news on Katie. You have been having a rough ride lately.

When Sabre had surgery we withheld Lysodren (I can't remember the duration .. it may have only been just before then maybe his next maintenance dose ... he was dosed three times a week) and this may be advisable. Consult with your vet or Dr Peterson about this.

Hope things turn for the better.

Hugs
Angela and Flynn

[Wendy Tillotson]

Will have to see

[frijole]

Wow, I can understand your disappointment - it's not like you aren't dealing with enough stress... Please try calling again tomorrow and if you have to leave a message just be honest that you are disappointed that she hasn't returned your call given that everything you are dealing with. Sending positive vibes. Kim

[Wendy Tillotson]

One of the problems is that the vet doesnt officially work on Thursdays - so may have to wait.

Katie's stool is loose and cant tell if its from the antibiotic or from the lysodren. She is acting perfectly normal.

I dont know if its a good idea to test her when her body is possibly feeling stressed. Seems like poor timing for that.

[Wendy Tillotson]

My vet had left a message on my cell - but never spoke to her.

Left a message that I stopped the lysodren because of severe diarrhea. I was able to control it by giving her rice - so she is ok.

I think she could very well be fully loaded again - but since I stopped and did not test (think the test could be stressful since she isnt feeling well), will have to figure out what to do.

Seeing Dr. Peterson tomorrow - so looking forward to his advice.

[Wendy Tillotson]

Well just got back from Dr. Peterson and have to say I am VERY disappointed.

I found him very vague and unfocused. My vet had sent him a lot of paperwork and I dont think he even read it.

He kept changing what he said based on how I asked a question.

The first thing out of his mouth was that we should change the medication - but when I said she was doing well on the Lysodren, he agreed and said we should stay on it then.

He talked about putting her on low dose prednisone for the rest of her life - so that we didnt have to worry about the medication - which I thought was very bizarre.

He said he likes dogs to be below 4 but if she does better on a higher number, that was fine too - but that to maintain them it was better to have a lower number so that the tumor doesnt grow back. And that you need to get the number within range before you can maintain them. Makes sense - but then what about the 6? Another contradiction. (He did say having her on the pred would allow her to stay lower.)

He did say that around surgery, she should not be on the medication. He did NOT understand when I told him she had 10 days of reloading before I stopped it - had to tell him that several times.

I gave him a sheet of questions and rather than going thru them methodically, he bounced around. Very confusing.

In general, he didnt quite know why I came to him as Katie is doing well. Basically said maintenance is trial and error - which I knew - and that he would talk to my vet about some alternatives. I asked him about the maintenance dose and he said you just have to play it by ear. He thought 1/4 pill 3x a week should work if we got her in range first - but of course, what that range SHOULD be was vague.

He was more concerned about her surgery and what the biopsy showed than he was about the Cushings.

He wanted to sell me the low dose pred, which I did not take as wanted him to talk to my vet first. He also wanted to do a blood test to see what was causing the Cushings as my vet had not, but will talk to her about that as well.

When I made the appointment 10 days ago, I was told the cost was $300 - and they charged me $350. When I asked about it and said Carol had told me $300, he just said, its $350 and wouldnt even discuss.

Overall, a very disappointing visit - expensive and a total waste of time and money for the most part. I felt like we never really connected and there was no real communication.

Maybe if you have a dog that is having major issues, it would be worthwhile.

Was so looking forward to this as have been feeling so lost - and this was a GIANT disappointment.

[Wendy Tillotson]

Any thoughts anyone?

[lulusmom]

Hi Wendy,

I'm sorry that nobody has responded. Let me just say that i am thoroughly disappointed that your appointment with Dr. Peterson went so badly. I was so hoping you would feel better after talking to him. :( The rest of my comments are in blue within the body of your post below:


Well just got back from Dr. Peterson and have to say I am VERY disappointed.

I found him very vague and unfocused. My vet had sent him a lot of paperwork and I dont think he even read it.

He kept changing what he said based on how I asked a question.

The first thing out of his mouth was that we should change the medication - but when I said she was doing well on the Lysodren, he agreed and said we should stay on it then.

Could Dr. Peterson's comment about changing treatment be because the reason you stated in making the appointment was that you've never been able to stabilize Katie on Lysodren for the last six months? I was starting to think the same thing actually. Both of my dogs were stabilized within the first 45 to 60 days but they never had a long drawn out loading like Katie, which makes it very difficult to determine an effective maintenance dose. One advantage of treating with Lysodren over Vetoryl is the convenience of not having to give the meds daily; however, for the most part, you haven't had much success in enjoying that benefit since Katie started treatment.

He talked about putting her on low dose prednisone for the rest of her life - so that we didnt have to worry about the medication - which I thought was very bizarre.

He said he likes dogs to be below 4 but if she does better on a higher number, that was fine too - but that to maintain them it was better to have a lower number so that the tumor doesnt grow back. And that you need to get the number within range before you can maintain them. Makes sense - but then what about the 6? Another contradiction. (He did say having her on the pred would allow her to stay lower.)

You may be able to treat the dog and not the numbers with Vetoryl but it doesn't work so well with Lysodren. I think what Dr. Peterson was saying is that he understands that Katie feels better at a higher number and that's fine but you have to expect that the adrenals (not a tumor) will regenerate if you do not maintain cortisol levels within the therapeutic range of 1 - 5. If Katie feels badly with a post stimulated cortisol of less than 5 then the prednisone would make her feel better while maintaining effective control.

He did say that around surgery, she should not be on the medication. He did NOT understand when I told him she had 10 days of reloading before I stopped it - had to tell him that several times.

I gave him a sheet of questions and rather than going thru them methodically, he bounced around. Very confusing.

In general, he didnt quite know why I came to him as Katie is doing well. Basically said maintenance is trial and error - which I knew - and that he would talk to my vet about some alternatives. I asked him about the maintenance dose and he said you just have to play it by ear. He thought 1/4 pill 3x a week should work if we got her in range first - but of course, what that range SHOULD be was vague.

What reasons did you give him for making the appointment? That you have continually had to reload and Katie has never stabilized on maintenance dosing? We all know that maintenance dosing is a crap shoot so he's right. Did you ask him what range he was talking about? If not, I can tell you that he was referring to the therapeutic range I mentioned before being 1-5 ug/dl.

He was more concerned about her surgery and what the biopsy showed than he was about the Cushings.

And I would have expected nothing less from Dr. P. Cushing's is not fatal whereas cancer is.

He wanted to sell me the low dose pred, which I did not take as wanted him to talk to my vet first. He also wanted to do a blood test to see what was causing the Cushings as my vet had not, but will talk to her about that as well.

I think it's good that he's going to discuss Katie's case with your vet and I'll be interested to hear what she has to say after that conversation. I believe your vet did a inadequate amount of testing to diagnose Katie and I personally would have wanted to know if I was dealing with pituitary or adrenal dependent cushing's. Adrenal tumors are highly resistent to Lysodren and it can be a real chore to get a dog with an adrenal tumor stabilized. If Katie has an adrenal tumor, and I'm sure Dr. Peterson would like to know, I believe Vetoryl might be a better choice of treatment for her.

When I made the appointment 10 days ago, I was told the cost was $300 - and they charged me $350. When I asked about it and said Carol had told me $300, he just said, its $350 and wouldnt even discuss.

I would spitting nails if this happened to me. If you didn't talk to Carol, I would suggest you call her and remind her of your conversation and ask for a $50 refund.

Overall, a very disappointing visit - expensive and a total waste of time and money for the most part. I felt like we never really connected and there was no real communication.

I'm really sorry that things went so badly and yes, it doesn't sound like you two communicated well at all. However, I'm hopeful that his conversation with your vet will be a lot more meaningful. After all, they both should speak the same language, a language us laypeople find too technical and don't seem to understand.

Maybe if you have a dog that is having major issues, it would be worthwhile.

Was so looking forward to this as have been feeling so lost - and this was a GIANT disappointment.

Oh Wendy, I know you are very disappointed but for what it's worth, I'm not convinced your appointment was a total bust just yet. Let's see what your vet has to say about moving forward with treatment. Things might just go better for Katie.

[Wendy Tillotson]

You have some very good points.

I have gone over the conversation in my head over and over and have to really wonder.

I dont want to put Katie on pred for the rest of her life - which he was suggesting. I think its a horrible idea. AND its contra-indicated based on everything else Ive read.

When he suggested changing her medication and I said she was doing ok on the Lysodren, he kind of backed off. He didnt like that it took a month to load her, which I can understand. I wasnt so thrilled either.

I am curious to hear what he will tell my vet, but have to say I am sorry I ever went. It just confused me even more.

As far as the cost - I told him Carol said it was $300 and he just ignored that and said its $350 so not sure what calling her will do for me.

[lulusmom]

Hi again,

From the sound of it, I doubt Dr. Peterson mentioned the prednisone dose that would be recommended for Katie. I think it would probably be considered a physiological dose, meaning it's much, much lower than the therapeutic doses administered to supplement a dog who is in Addison's crisis or to treat allergies. I don't believe that long term treatment at such low doses would cause clinical problems for a dog but it would supplement the cortisol just enough to make him feel better.

[Wendy Tillotson]

Not so sure about that. He did mention the dose - 1/2 to 1 mg per day - which is very low. But he also said that if we gave it to her that we wouldnt have to worry about the medication because we would be replacing with this drug so even if it got very low, she wouldnt crash.

I think the best thing to do is to let my vet speak to him and go from there. They can talk the same language and my vet can have an educated opinion.

I was trying to understand what he was saying and we just talked at cross purposes. For example, when the first thing he said was to switch and I said why would you switch if she is doing well on the lysodren - he didnt stop and say because xyz. Instead he backed off and said I should stay with the lysodren. I just wanted to understand, not to negate what he was saying.

He obviously is an expert in the field so hopefully when he speaks to my vet, she can make sense out of what he is saying.

He did say he sees mainly cats - he works on thyroid issues with them, I believe.

Just sorry that I feel more confused than before.

[Wendy Tillotson]

Well I was hoping to get some level of comfort and assurance and unfortunately, didnt get that at all.

[Sabre's Mum]

Wendy

I am sorry you did not get what you wanted from Dr Peterson.

With regards to the pred ... my vet suggested using pred with Sabre when he had a "down day" ie not low but looked as tho he needed a pep up. But the dose was to more of a rescue dose ie .25mg/kg so for Sabre more like 5mg. I never used it as to me it seemed to defeat the purpose of treating with Lysodren.

I would take the visit in your stride, put it behind you, see what Dr Peterson discusses with your vet and move forward.

Take care
Angela and Flynn

[Wendy Tillotson]

Dr Peterson sent a report to my vet and it pretty much agreed with what she was doing - including the loading mechanism.

She thought we should go with his recommendation of low dose pred while we are loading. She said he is the expert and I paid for the advice so we should go with it.

But things just went from bad to worse - the tumor that was removed last week was a Mast Cell tumor - and the margins were not totally clean.

The vet is going to look at the incision to see if its possible to take out more - but she took very wide margins. She is a great surgeon.

The options are to cut away more, chemo or just watch it. We both agreed chemo is not an option - and she is going to see if she can enlarge the margins.

All the blood work that was done on Katie was 100% normal and she did fine under anesthesia so that is a good thing.

Feel like this is all a losing battle. Poor little Katie.

[Squirt's Mom]

Oh, Wendy,

This was not what any of us wanted to hear. :( I so hope there is something more your vet can do to help Katie but I am with you, chemo would be out.

If I were you, I would forget about the Cushing's and concentrate on finding out how to best address the Mast Cells for now.

Hugs,
Leslie and the gang

[lulusmom]

Hi Wendy,

For what it's worth, I agree with Leslie. If I were you, I would put cushing's on the back burner and focus on whatever surgery your vet needs to do.

[addy]

Oh Wendy, I am so sorry to hear this. But it may not be a losing battle, lets not go there yet.

You know, I had a weird visit with a "really good" derm vet and we were just not able to communicate well either. Funny thing, he said he was "old" and used lysodren but he told my IMS to put Zoe on 40mgs Trilostane. I refused as it was a 100% increase but we ended up there after increasing to 30, then 40 and that was the dose that controlled her cortisol.;);)

love,
addy

[Sabre's Mum]

Wendy, sorry to hear the news on the tumour. As the others said ... put cushings to the side and deal with the mast cells.

Angela and Flynn

[Wendy Tillotson]

My vet wanted to go back to loading her - and we will deal with the Mast Cell tumor. Really the only way to address it is to try to resect it - but she doesnt think there is enough skin. I have to take her in on Wednesday for a bandage change and she will look at it. She said we may need to just wait for the skin to stretch and then try again.

I was doing some research online and one of the ways they deal with this is prednisone.....which obviously is not an option with the Cushings.

Like I said, all of her blood work was normal which is a good thing - but have to talk about how we know if it has spread anywhere. I did see something about using radiation - but have to ask myself how much we should put this poor dog through.

I am beyond sad.

[addy]

Wendy, I think I remember another member using prednisone and eithe lysodren or Trilostane. I know it seems conterintuitive but I think they were dealing with a tumor as well.

Help me out guys, was it my fellow Wisconsinite? I'll try to look for the thread.

love,
addy

[labblab]

Addy, you're remembering correctly. There have been a couple of instances in the past when we've heard of a trilo/prednisone combo for treatment of a tumor or cancer. I think we've seen the combination used for treatment of lymphoma, and also for treatment of an enlarging pituitary tumor. Here's a quote from something that I wrote on Kathy's thread about macroadenomas:


Kathy, I am sorry that I am so late in responding to your question about the combination of Vetoryl and prednisone. I am not sure that I fully understand the ins and outs of macaro treatment myself (or I guess I should say that I am sure that I DON'T fully understand it ). But even though it may seem counter-intuitive to give a dog both trilostane and prednisone, we've learned from our experience here that it is sometimes recommended. To the best of my understanding, it is for this reason. In situations where a steroid is thought to be helpful, you want it to be dosed in a very consistent and predictable way. That means that for a dog with Cushing's, you need to make sure that the dog's own cortisol level remains under reasonable control as well. Otherwise, the natural cortisol can elevate by leaps and bounds, and you have no idea whether or how much supplemental prednisone to be adding into the mix.

When a macro is involved, I believe that prednisone can be recommended in order to try to control and limit the swelling and inflammation caused by the expanding tumor. But this is why the vets may want to leave the dog on trilostane, as well -- in order to keep the natural cortisol level in check and at a predictable level so that the supplemental prednisone can be dosed appropriately.

Please keep in mind that this is just my speculation. I haven't had a vet tell me this directly. But he bottom line is, yes, if prednisone is the recommended treatment for tumors/cancer, I think it is sometimes paired with the Cushing's treatment.

Marianne

[Wendy Tillotson]

Katie is going to the vet tomorrow for her to look at the incision.

I think the first thing to do is to check if this has already spread. Mast cell tumors can cause itching - which Katie had in spades. At first I thought it was environmental because she has had this before - but nothing seemed to work on it.

THEN I noticed as did my husband, that her itching has stopped since the surgery. So wondering if this is related. Another question for the vet.

We had already decided to put her on low dose pred as per Dr. Peterson - so need to discuss this further. I dont think the amount he was suggesting is therapeutic for cancer.

Anyway, more to come.

There is also a very good homeopathic vet nearby that has had a lto of luck treating cancer - just not so sure about the combination of Cushings and cancer.

Thanks for all the support. Greatly appreciated.

[Wendy Tillotson]

The vet said there was not enough skin to resect right now - so will wait a few weeks.

She gets her stitches out tomorrow.

[Wendy Tillotson]

Retested Katie on Wednesday and her results were 1.1 pre and 2.1 post. Good thing I decided to test her when I did. Since she is on 1/2 mg of pred a day, she is acting totally normal. If I had waited longer, could have thrown her into Addisons disease.

My vet spoke with Dr. Peterson and he said to put her on 1/4 pill 3x a week and to keep her on 1/2 mg of pred a day. In his written report - he said we might need to go as high as 1/4 pill 4x a week to maintain her - which would be double the normal loading dose. Hard to believe.

Anyway he said to retest in 6 to 8 weeks.

[Wendy Tillotson]

Katie had her resection. She is now cancer free!

She did not develop diarrhea this time and we are keeping her on the maintenance dose and the pred.

My vet was great. She kept her two nights - which was perfect. She was able to give her extra pain med and keep her comfy. Right now she is sleeping on the couch. :)

[Sabre's Mum]

Hi Wendy

Great to hear to news on the resection. Sometimes dogs do need a higher dose of Lysodren ... mostly in the cases of adrenal tumors.

Take care
Angela and Flynn

[Squirt's Mom]

Hi Wendy,

I am soooo glad to read this update this morning! :):cool::):cool: And ever so glad they think they got all the cancer - I can only imagine how relieved you are.

Hugs,
Leslie and the gang

[Wendy Tillotson]

Super relieved.

Since cancer is such an unpredictable disease - glad its gone.

I felt like I was waiting for her to die with nothing to do to stop it.

She is doing well - altho she keeps trying to scratch the area. She pulled out one stitch already. Since its a week after the surgery, not that critical - but sure dont want her to pull out a bunch.

[Squirt's Mom]

Hi Wendy,

So glad they got all the cancer this time and that Katie is recovering well! :) Keep in touch and let us know how she is doing.

Hugs,
Leslie and the gang

[Wendy Tillotson]

Hard to believe that Katie will be 14 in January.

She has been doing okay. Loading the Lysodren was a lot of trial and error.

Dr. Peterson said to put her on 1/2 mg of pred as she seemed quite ill when the levels got within range.

Just did an ACTH and her post was 7.1 - so she is out of range. She is a small dog and has been on 1/4 pill 3x a week - which should have maintained her.

So the question I have - does the 1/2 mg of pred impact the Lysodren and make it necessary to use higher doses of the Lysodren for maintenance?

Her specifc gravity was just below normal at 1.014.

Will talk to the vet later in more detail on how to proceed.