Hannah-mini dachshund diagnosed cushings July 2011

[Seiberbb]

Hi all. I am so glad I found this site. My mini dachshund Hannah (age 10) was diagnosed with cushings back in July. I will try to explain the best I can what we have gone through thus far, but there is so much about cushings I don't understand, and I have many questions.

She is on lysodren and has had her dose adjusted 3 times now. Our vet did not do the initial loading dose. He said he is not comfortable with that, he fears throwing her into Addison's. He decided to start dosing her slowly, and then we have been going back every 6 weeks or so to get her blood rechecked and lysodren dose adjusted. It has been creeping up with each visit. This most recent visit her post stim test number came back in the mid 20's. Apparently the normal is below 5?? When she first started on lysodren her dose was 125mg on M, W, and F. When they wasn't enough he bumped it up to 250mg and I believe that was still M, W, F. When that wasn't enough he bumped it up to 250mg every other day and that is what she is on now and was on for 4 weeks prior to her most recent stim test that came back in the mid 20's. He said she isn't responding to the lysodren like he had anticipated and he suspects her cushings is being caused by an adrenal tumor and not by what we originally thought which was pituitary tumor. He now wants Hannah to have an abdominal ultrasound to look for adrenal tumors. This is where things get difficult for us. I have been looking around online trying to get an idea of what it might cost should Hannah need surgery if there is an operable adrenal tumor. The only thing I found said to expect between $3000 and $5000 for the surgery. Is this accurate? IF this is the case, sadly, we can not afford this option. We are a single income family with 2 small children as well as another dachshund that has inter-vertebral disc disease and was recently paralyzed. That was another whole expensive ordeal. So here are a few questions I have for anyone out there that has been through this that can help me...

1) what would you say is the average cost for an adrenalectomy?

2) if it turns out we can not do the surgery, what are the chances we can treat this with medications alone?

3) can Hannah be on high doses of lysodren long term? Or will this eventually cause her more harm leading to death?

4) Assuming we can't do the surgery due to cost, is there any reason we should still have the ultrasound done that he is asking us to do? Will that help us at all in her treatment even though she wont have surgery?

This is all very hard because Hannah seems perfectly fine to us. Nothing at all has changed about her throughout this whole process with one exception. She started losing some hair on the tip of her tail. She was at the vet for a well check and when he noticed the hair loss he suspected cushings and here we are. Other than the hair loss on her tail tip she looks, acts perfectly normal. She runs and plays, plays fetch, tug-of-war etc. It's hard to believe she is as sick as she is. You wouldn't know it. Is this common?

Any answers you can give me would be so much appreciated. Thanks.

[lulusmom]

Hi and welcome to the forum.

I only have a minute but wanted to ask you to please gather up copies of all testing that was done to diagnose Hannah and post the results here. The vast majority of cushdogs have pituitary dependent cushing's, so I wouldn't jump to the conclusion that Hannah has an adrenal tumor until an abdominal ultrasound or an endogenous acth test is done to determine that.

I am not surprised that Hannah's cortisol continues to climb with the unorthodox treatment protocol your vet is using. It is apparent that he/she is not familiar with Lysodren and it's mode of action. I have to assume that his experience is limited with cushing's to as the results you are seeing, or lack thereof, is typical when trying to reduce cortisol without proper loading. It isn't unusual for a gp vet to have limited exposure to the disease. My gp vet couldn't spell it much less diagnosis it and there are many others here who have discovered the same thing about their gp vets. I believe the majority of us with cushdogs (I have two) have consulted with an internal medicine specialist and either have their dogs treated solely by them or they are associated in with the gp vet. Given the information you have provided so far, this is something you may want to seriously consider.

Lysodren has a cumulative effect and it take very large doses (loading) to achieve sufficient erosion of the adrenal cortex to stim the flow of cortisol. If Hannah has typical cushing's, she needs to be loaded according to protocol.

I have to get going but I'm sure others will be by to provide you with more information, including a link to Lysodren loading so that you have a greater understanding of proper protocol.

Looking forward to hearing more about your precious Hannah.

Glynda

[frijole]

Hi and welcome! Please do get the results of all tests done to diagnose cushings. Was a blood panel done? If so please post anything that was high or low on that as well.

What is bothering me is that you said your dog seems healthy and only has hairloss. Doesn't sound like a definitive cushings diagnosis to me. It is well known in the vet world that you never treat a dog that doesn't have symptoms - even if they do have cushings. I'm not sure your dog does. Frankly I wouldn't treat based on just having hair loss.

I agree that what your vet is doing is not following the protocol for treating cushings. Do you know if there are any internal med specialists (IMS) in your area? A vet teaching school? If you don't know please post where you live and we'll look it up or perhaps we know of someone.

Hang in there and don't fret because a lot of vets are not up to speed on cushings - it can be tricky to diagnose and that is why you always do multiple tests.

I'm not sure I'd waste any money on an ultrasound and I definitely wouldn't do it with your current vet - no offense but you have to have the right equipment AND be able to read the results.

Again, please post whatever results you have (tests done) and we'll help you thru this. YOu aren't alone. Kim

[Seiberbb]

Hi. Thank you for the responses.

After our vet initially suspected cushings he did extensive blood work on her to officially confirm it. I am so unfamiliar with all of this so I don't know exactly what he ordered to be done, but I do know that it cost me well over $300 and that it had to be sent over night to a lab in Tennessee. When he went over the results with me (shame on me for not writing everything down) one of the main tests came back with a number to extremely high that the machines in the lab in TN were unable to provide an exact result because their machines don't read that high. Apparently it was pretty bad. Our vet claims to treat many dogs with cushings and has told me that he has never seen one with numbers quite this high. He also says that he doesn't typically do the loading dose on any dog. This is so confusing and frustrating. I would have asked him many more questions when he called me yesterday with her most recent results, but when he started suggesting the abdominal ultrasound and told me that could run me about $500, I just lost it on the phone and began to cry. We are just spending so much money on this and I feel like we haven't gotten anywhere. I mean, her numbers are lower than when we started, but still not within the normal range. I will call him on Monday and see if I can come and pick up copies of all of her blood work pertaining to cushings. Then I will post everything. I really do believe she has the disease based on the blood work that was sent to TN. When they sent him the results they even sent him literature to give to me on the different meds to treat her with. The one thing that just gets to me though is that she has NEVER appeared to be ill or had any behavior changes. Just that bit of hair loss on her tail. Like I said, she was in for a well check when all this started. I had no complaints. She was just due for the well check. I hope to have more info for you next week. Thanks so much for this support group. I have been lost in all this.

I forgot to add that she is also taking hmrLignans. 1/2 capsule a day sprinkled on her food, as well as melatonin 3mg twice daily.

[Squirt's Mom]

Hi and welcome to you and Hannah! :)

My Squirt is a Miss Piggy, too, and always has been! :D I was convinced when we started this Cushing's journey in '08, that I would never be able to use that as a guide with her. Man! was I wrong! When that cush appetite kicked in, there was no question this was an abnormal reaction. She acted as if she were literally starving allll the time. She wolfed her food; searched constantly for something, anything, to eat inside and out; she had a pained, haunted look in her eye begging to be fed. She was literally driven to eat. It was truly pitiful to see. :(

With proper treatment, she is back to her usual Miss Piggy! :p

Like Glynda and Kim, I am a bit concerned with your vets unorthodox approach to treating with Lysodren. This is much harder on Hannah than a load would be...and harder on you and your pocketbook. ;) I also question the diagnosis based on the info we have right now so I look forward to seeing the test results. It sounds as if Hannah may have had a full adrenal panel done via UTK (Uni of TN in Knoxville). If her intermediates are elevated but the cortisol is normal, then your vets approach may not be as off as it seems but seeing those results will let us know much more.

There are several forms of Cushing's and the adrenal based is one of the rarer forms - most pups have the pituitary form. Again, the tests may help us see which type is suspected in Hannah. For now, do not worry about whether it is adrenal or whether she may need surgery. One step at a time, 'k? And the first step is to post all the tests results you can. That will help us and keep your mind busy for a bit! :p

Take a deep breath and try to relax a little bit now. You are in good hands with us. We will help you all we can; never hesitate to ask any questions you may have. You and Hannah are no longer alone on this journey. We will walk every step of the way with you.

Keep your chin up, Mom! You are doing just fine.
Hugs,
Leslie and the gang

[lulusmom]

Hi again,

Since Hannah's bloodwork was sent to UTK, I suspect that a full adrenal panel was done. If this is the case, it is possible that Hannah's cortisol is normal but one or more of her other adrenal (sex) hormones are elevated. This would be called atypical cushing's and the first line of treatment is melatonin and usually lignans, if estradiol is elevated. If no improvements are noted in three or so months, then a maintenance dose of Lysodren is recommended. Perhaps this is why your vet is not loading Hannah. We'll be able to figure that out once you post the results of the panel. It's very possible Hannah has atypical cushing's which may be why your vet is recommending an abdominal ultrasound. Adrenal tumors are weird in that they may secrete all adrenal hormones or just sex hormones and if it is just the sex hormones, UTK recommends that an adrenal tumor be ruled via an abdominal ultrasound.

If you only paid $300 for diagnostics, I would assume that the UTK panel is the only test your vet did to confirm a diagnosis, which would normally be considered insufficient testing. However, if atypical cushing's is suspected, the treatment is much more benign so a vet may understandably try to save the petowner the expense. Cushing's is not an inexpensive disease to diagnose because no one test can be relied upon to be 100% accurate. That is why if one test is consistent with typical cushing's, additional testing needs to be done to either validate or differentiate between the two forms of cushing's.

I know this is overwhelming for you because we've all been on the same roller coaster ride and some of us more than once. I promise you that the more you learn about the disease and the drug you are putting in Hannah's mouth, the more calm you will become. At some point, you'll look back on this and will be amazed that not only did you both survive but somewhere along the way you became an incredible advocate for Hannah. Treatment is much easier facilitated safely and effectively if the vet is experienced and the pet owner is educated. It takes teamwork to do it right.

Your decision to reach out to others who have been in the trenches is one of the best things you could have done for both of you. We're here to help you learn, hold your hand and most importantly help you help Hannah.

When you ask your vet's office for copies of all of Hannah's testing, be sure they include blood chemistry, cbc or any urinalysis that may have been done. With respect to the blood chemistry and cbc, don't worry about posting every value, just the abnormal ones and please include the normal reference ranges.

Glynda

[Seiberbb]

Thanks for all the support. I hope to get Hanna's labs next week.

I do remember him doing a urine test on her back in the beginning. After that came back abnormal we moved on to all the blood work. I will ask for all the labs.

[Seiberbb]

Hi there. I took your suggestion and got all of Hannah's labs from her vet. At first suspicion of cushings he odered a urine cortisol/creatinine ratio. RESULT: 59.3. NORMAL RANGE 0.0-25.0 This was 7/17/11

On 7/27 he ordered a chemistry profile. I will just give you the

abnormals. If you need something else let me know.

ALT(SGPT) RESULT: 130.0 NORMAL RANGE: 10.0-88.0

BUN RESULT: 9.9 NORMAL RANGE: 12.0-25.0

ALK PHOS RESULT: 731.0 NORMAL RANGE: 20.0-150.0

GLUCOSE RESULT: 114.0 NORMAL RANGE: 60.0-110.0

ANION GAP RESULT 18.5 NORMAL RANGE: -2.0-16.0


Next are the results of the blood sent to Tennessee. Completed on 8/3/11

Cortisol RESULT (baseline) 37.3 Normal Range:2.1-58.8
RESULT (post ACTH) 381.9 Normal Range: 65.0-174.6

Androstenedione RESULT (baseline) 0.74 Normal Range: 0.05-0.57
RESULT (post ACTH) >10 Normal Range: 0.27-3.97

Estradiol RESULT (baseline) 61.4 Normal Range: 30.8-69.9
RESULT (post ACTH) 55.5 Normal Range: 27.9-69.2

Progesterone RESULT (baseline) 0.37 Normal Range: 0.03-0.49
RESULT (post ACTH) 4.55 Normal Range: 0.10-1.50

17OH Progesterone RESULT (baseline) 0.13 Normal Range: 0.08-0.77 RESULT (post ACTH) 4.28 Normal Range 0.40-1.62

Aldosterone RESULT (baseline)80.1 Normal Range: 11-139.9
RESULT (post ACTH) QNS (insufficient sample) Normal Range 72.9-398.5


Here is another Chemistry Profile that was done on 9/8/11 along with a cortisol stim test. Again, I'll just post the abnormals. Let me know if you need something more.

ALT (SGPT) Result: 232.0 Normal Range: 10.0-88.0

BUN Result: 11.1 Normal Range: 12.0-25.0

ALK PHOS Result:1160.0 Normal Range: 20.0-150.0
**** alert value!

Glucose Result: 119.0 Normal Range: 60.0-110.0

Cortisol (resting) 3.20 Normal Range: 1.00-5.00
Cortisol (post ACTH) 41.50 Normal Range: 8.00-20.00

This next draw was on 10/18/11

Cortisol (post ACTH) 33.80

And FINALLY the most recent draw was on 11/15/11

Cortisol Post ACTH 28.70. Normal Range: 8.00-20.00


At this point is when he suggested a abdominal ultrasound to look for possible adrenal tumors. Any feedback or advice will be appreciated more than you know. This is like me trying to translate a foreign language. Thank you sooooo much!

[Squirt's Mom]

Hi Sweetie,

Based on this info, Hannah would be considered to have conventional Cushing's with elevated intermediates. This is treated by going through a loading period on the Lysodren then on to the maintenance schedule - which is what your vet is doing now. He skipped the first, most important step - the load. Therefore, it is no wonder you are not seeing more improvement since starting "treatment".

I don't know that I disagree with the ultrasound, especially in light of the last liver values. (Tho your vet's unconventional, and probably ineffective, approach may be causing this as well since the cortisol is not well controlled.) Here's why - my Squirt was diagnosed with the pituitary form based on five tests - LDDS, HDDS, ACTH, UTK panel, and ultrasound. On the second ultrasound, I was told about a tumor on her spleen. When the tumor was removed, her cortisol returned to normal and has remained within normal range since.

Cortisol is one of the body's natural responses to stress of any kind - external or internal. That tumor was causing her cortisol to be elevated and when the cause was removed, so was the high cortisol. The U/S will allow the docs to see many of the internal organs other than the adrenals like the spleen, liver, kidney, stomach, intestines, and others. If there is a problem in some other organ, this is one of the best test to find it.

I think it's time to sit down with your vet and have a heart to heart about the correct way to treat with Lysodren - which is the preferred drug in a pup with elevated intermediates whether cortisol is elevated or not...and Hannah's certainly is. Here is a link to our Helpful Resource section that you can print out and share with him/her.

Lysodren Loading and Tips
http://www.k9cushings.com/forum/showthread.php?t=181

Hope this helps.
Hugs,
Leslie and the gang

[Seiberbb]

Hi all. I posted on this board a few months back shortly after my 10 year old dachshund was diagnosed with cushings. A lot has changed. The last time I posted we were unsure of many things. Hannah was being treated by our regular vet under the assumption that her cushings was caused by a pituitary tumor. (she was properly diagnosed by numerous blood tests including ones sent to University of Tennessee) The unfortunate thing was that our vet did not start treating her with a loading dose of Lysodren. Instead he did the opposite thing and started her off on very small amounts and kept rechecking he blood and gradually increasing the Lysodren dose each time in hopes of finding a maintenance does for her in that way. I mentioned the loading dose to him but he was not comfortable with that as he feared throwing her into Addisons. I was never quite comfortable with this, but I went with it and trusted our vet. Well here we are 6 months down the road and Hannah is up to 500mg of lysodren three times a week and her cortisol post ACTH result is still in the mid 30's. Most recently (1/5/12) it was 34.40 and the normal range is 8.00-20.00. We decided to go ahead and have an abdominal ultrasound done to rule out adrenal tumors. We had this done today and there are no adrenal tumors. YAY. We consulted with an internal medicine specialist today prior to her performing the ultrasound. Now that we know this is pituitary dependent cushings we can move forward with proper treatment. Our internal med specialist is starting her on a loading dose of Lysodren 500mg a day for 7 days and then a recheck again. I am nervous about this loading dose. I don't want her to get too much and start to develop addisons. I would love any feedback, encouragement, advice from anyone who has been through this. Do you think Hannah will be back to "normal" soon? I can't wait for this situation to finally resemble something stable. This has been a roller coaster since July of last year. Thanks for listening.

[Squirt's Mom]

Hi again,

Good to hear from you but sorry you and your baby have been put through so much for nothing. :(

Here is the link I gave you in my last post -

Lysodren Loading and Tips
http://www.k9cushings.com/forum/showthread.php?t=181

It will be very handy so you might want to print it out and hang it where you can see it easily.

The only thing I worry about is the time frame for loading. Your baby may load in as little as 2 days or as long as 4 months -tho neither are the norm. My point is this - you have to know the signs of your baby being loaded and know to stop then and schedule the ACTH. That may happen before seven days so now is the time to read that link and ask questions.

Make sure you have prednisone on hand before you start the load. This is not a suggestion, it is a requirement. Should your babies cortisol drop too low and your vet isn't immediately available, you will need the pred. It seems our babies like to wait until the weekend or on holidays or when their docs are on vacation to have a crisis. :rolleyes:;):) The pred is insurance against such times as this.

Have you seen any changes in Hannah's behavior as far as appetite, drinking or peeing?

What is Hannah's weight and I will check the dose amount for you.

Hugs,
Leslie and the gang

[Seiberbb]

Thank you. I will read the link about lysodren dosing. Hannah was weighed today and weighs 18.6 lbs. I will also talk to my vet about getting some prednisone on hand.

[lulusmom]

Hi and welcome back to the forum.

I have merged this recent post with your original thread so as to maintain all of Hannah's medical history in one place.

I am sorry to hear that you have had such a rough time with the Lysodren treatment but I can't say that I'm surprised, given your vet's unorthodox approach to treatment. I just went back through your thread to reacquaint myself and noted that your vet admitted that he never loads a dog because he was afraid that too much Lysodren would cause Addison's. This is not an uncommon fear among many general practitioners who do not understand the modes of action of the drug and therefore do not understand that you cannot achieve the objective of Lysodren treatment with low (maintenance) doses. You have to bombard the adrenal glands with heavy twice daily doses to kill off enough of the adrenal tissue to stim the flow of cortisol.

The normal lab range you posted of 8 ug/dl to 20 ug/dl for the acth stimulation is only normal in a normal dog, not a cushdog. The object of Lysodren treatment is to lower the stimulated cortisol concentration to a therapeutic range of between 1 ug/dl and 5 ug/dl so as to see a resolution of all syptoms and normalization of blood and urine abnormalities. The objective has not been reached until the post stimulated number is within that range. Having said that, I will tell you that we've had a few members who have opted to let their dogs post stim cortisol run a little high because they remained asymptomatic or their arthritis was better at a higher number. I am not one of those members. Our internal medicine specialist and I choose to maintain my two cushdogs' cortisol within the desired therapeutic range.

The last time I had stim tests done for my dogs, I decided to have a gp vet do them because it was much cheaper. The vet called me the next day and gave me the results. Their post stims were something like 8.2 and 9.2. Those are not desirable numbers as this indicates their adrenal glands are regenerating and either an increase in maintenance dose or a reload is needed. He said those results are considered low normal and was concerned about continuing treatment. :eek: I asked if he treated any other cushdogs and he said yes. My heart sank because if this guy doesn't know that you don't use normal lab reference ranges for purposes of treatment, I doubt that any dog he has ever treated has seen good results. :( So you see, your vet is not that unique.

The unfortunate thing about inexperienced vets is that they cost us more money in the long run. For instance, you probably just spent a whole lot of money for multiple stim tests that were never going to reflect acceptable results. Acth stimulation tests are expensive because the stimulating agent most vets use, Cortrosyn, is ridiculously priced. Instructions on the vial say to administer the entire vial to the dog but only 5 mcg per kg is needed. With Hannah being 18.6 lbs, your vet or specialist can get four or five acth stim tests out of one vial. That is a huge savings so make sure you ask about this. In the event your specialist is not aware of this fact, I would suggest that you use the link below and print out a copy of Dr. Mark Peterson's instructions for "How to Extend Your Supply of Cortrosyn and Lower the Cost of ACTH Stimulation Testing". Dr. Mark Peterson has contributed to most of the internal medicine textbooks used by veterinary treating hospitals and is a worldwide lecturer, so I doubt that there are few, if any, internal medicine specialists who are not familiar with him.

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

I apologize for regurgitating info I may have already posted previously but I felt it important that anybody reading your update know that the additional expense of multiple acth stimulation tests and continued lack of results are to be expected when proper "loading" protocol is not followed. The drug itself is not cheap either so having to start all over after paying for the pills you administered for the last six months is probably a, pardon the pun, big pill to swallow. :D

I've loaded my dogs more than a few times and each time I used my copy of the Lysodren loading instructions and related tips. It's pretty dog-eared...I think I need a new to print a new copy for future reference. Please do follow Leslie's advice and print out a copy for ready reference. Has the specialist counseled you on what signs to watch for should cortisol go too low? Most common are not eating, vomiting, diarrhea and inordinate weakness.

We're here to help in any way we can so be sure that once you start loading, you stay in close touch with us. We want to know how you and Hannah are doing.

Glynda

[Seiberbb]

Thanks Glynda. You are right. I have spent so much money over the last 6 months on Lysodren pills as well as trips to the vet for blood draws only to find out that her numbers are still abnormal. Ugh. Well, there is nothing I can do to change that now so I just hope to move forward and see some positive results.

I am glad to have the ultrasound behind us and know that we are not dealing with adrenal tumors. As I mentioned we were at the specialist today, but she is having me go back to our regular vet for the next draw after the load. I just talked him on the phone and he is providing me with some prednisone to have on hand per my request. What exactly will this do for Hannah and how do I know if I need it? Is this what I would give should she start showing signs of too much lysodren during the load?

The specialist told me to start the load today. 500mg a day for a week. 1/2 a pill twice a day. I did ask our regular vet if he thinks the load will really take this long and he said in most cases he would say "heck no." But in Hannah's case he said he is certain it will take a week if not longer based on the fact that she has been on such high doses and her number is still in the mid 30's. But based on what you said about how lysodren works, it is no surprise her numbers have not improved. I plan to keep a close eye on her over the next several days. She had her ultrasound today and had to be sedated, so today she is extremely lethargic due to that. I hope to see her back to her "normal" self tomorrow.

[Squirt's Mom]

Ok, at 18.6 lbs, Hannah weighs 8.45 kgs. (18.6 lbs / 2.2 - 8.454545...) The loading dose is 50mg/kg/day, given in two doses per day. So 8.45 X 50 = 422.50mg/day. Since the Lysodren comes in 500mg tablets, most vets would start at 500mg/day for a dog Hannah's size. She would take 250mg in the morning and 250mg in the evening. That equates to 1/2 tablet morning and evening.


Hang in there! You will do just fine. Stay in touch and let us know how things are going.

Hugs,
Leslie and the gang

[Seiberbb]

Thanks Leslie. That is exactly what they told me to start her on. She has officially started today. I go next Friday for a draw to check levels. Fingers crossed we finally get somewhere with this. Thanks for all the help and support.

[lulusmom]

I just talked him on the phone and he is providing me with some prednisone to have on hand per my request. What exactly will this do for Hannah and how do I know if I need it? Is this what I would give should she start showing signs of too much lysodren during the load?

That is correct. I don't believe you ever told us what symptoms Hannah has. Does she have a voracious appetite and does she drink and pee in excess? These are the two things you will need to monitor for changes. For instance, most cushdogs plow through food without taking a breath so like with my dogs, if they picked their head up before they had finished inhaling their food, I knew something was up....and if they looked around and dilly dallied half way through their food, I knew something was seriously up. Something this subtle can be a sign that loading has been achieved.

Lysodren has a cumulative effect and continues to do its thing for at least 48 hours so just remember that you can't take a pill back once you put it in their mouth. If Hannah gives you a sign, stop dosing and schedule an acth stimulation test within 48 hours after the last dose.

Glynda

[Seiberbb]

Hannah's only real symptoms of cushings are her incredible appetite (scarfs down a bowl of food in seconds flat without even chewing), her rat tail and her protruding abdomen. She does not urinate or drink in excess. So since I don't imagine I will see a quick change in her rat tail or abdomen, I assume the appetite is what I will have to monitor closely. Thanks for the advice.

[Squirt's Mom]

Yes, you will watch her eating habits closely for any change. It can be something as subtle as raising her head to look around then going back to eating that can indicate she is loaded and no more meds need to be given. She may actually take the time to chew when she hasn't been doing that. The sign can be easily missed as just "no big deal" but to a cush parent, we notice those little things. ;) Pay particular attention to her eating before you start the Lyso so you know if something tiny changes once treatment has begun.

Sounds like you are getting things on track! :)

Hugs,
Leslie and the gang

[lulusmom]

You are correct again. It is the appetite you want to monitor.

[labblab]

She had her ultrasound today and had to be sedated, so today she is extremely lethargic due to that. I hope to see her back to her "normal" self tomorrow.
Hello and good luck from me, too!

It sounds as though you have already given Hannah her first pill. However, if it were me, I would hold off on continuing further with the loading until you see for certain that she is back to her normal self (which hopefully will be by tomorrow morning!). I know your vet is expecting the loading to take some time, but we have seen dogs load within just a couple of days. And as Leslie and Glynda have just said, you really are counting on being able to catch subtle signs with her appetite. So you want Hannah to be starting out at her normal behavioral baseline as you proceed with the load.

Also, just to clarify, you would not need to be administering prednisone unless you fear that Hannah has been overloaded with the Lysodren: extremes such as lethargy, vomiting, diarrhea (that's why you want to make sure the post-ultrasound lethargy has cleared). When you instead notice a more subtle change in her behavior -- that's the time to simply discontinue the Lysodren and arrange for the monitoring ACTH test.

Marianne

[labblab]

Just checking in to see how little Hannah is doing today!

Marianne

[Seiberbb]

Hi. Hannah has now had 3 full days of the loading dose. She seems to be doing just fine so far. I worry what this week will bring.....She is supposed to be tested on Friday. I am not sure if it will take that long.

Does anyone know of a dog that took a week to load? A small dog at that.

[Seiberbb]

Hi all. Hannah has been loading since last Friday. She goes in tomorrow for testing to see if her levels are down to normal. There is no doubt in my mind that she is definitely not loaded. There has been absolutely no change in her behavior. She still eats like a maniac and barely chews her food. She hasn't had any signs to say she is loaded or over loaded. I almost don't even want to go tomorrow and wait a few more days....but doctors orders are to come in tomorrow. I hope to get good news that she is loaded but I highly doubt it....:confused:

[frijole]

Wishing you good luck - I assume it is the specialist that ordered the test done after one week of loading?

To answer your question - small dogs actually take longer (from what we have seen) than larger dogs :) That said - no two dogs are alike. My schnauzer took forever to load. But once she did she maintained it for many years.

Keep us posted on the results. Kim

[Seiberbb]

Yes, the specialist ordered this test for one week after start of load.

I have a question. She was tested today but I wont get results until Saturday or Monday. Do I stop loading her for now until I hear back? Or do I continue to give the Lysodren? I forgot to ask today and they did not say........

[Harley PoMMom]

The specialist told me to start the load today. 500mg a day for a week. 1/2 a pill twice a day.

Since you are loading Hannah at the optimal loading dose I would definitely wait until the results of the ACTH stim test are known.

[StarDeb55]

I have not posted to you before, but have been following Hannah's story. Normal procedure with lysodren is that if there are no signs of loading the dog is brought in at day 7 or 8 to see where you are. You don't want to risk an overload. I can tell you from experience that this can be just about a lifesaver. My 1st cushpup, Barkley, had gone 8 days on his load with absolutely no signs of being loaded, still a voracious appetite, drinking lots of water. I was monitoring both appetite & water. We went for an ACTH. The vet calls me the next afternoon, asks me if I have checked water, yet. She waited on the phone while I measured water. Low & behold, there was something like a 70% drop in water. She told me that his stim reflected that. His results were so low, he was placed on prednisone immediately for 1 week. I just wanted to let you know how important it is to check to see where you are at this point.

Debbie

[Squirt's Mom]

Hi,

No, do not give any more Lyso until these test results are in. When you see those numbers, you will know if it is time for the maintenance to start or not. These signs can be very subtle so it is always best to see the numbers before continuing with the load.

You haven't seen any decrease in her appetite, drinking, or frequency of urination? No changes in her behavior at all? How has her stool looked this week? Did it lose form, become soft? Does she seem to have any more energy? Is she resting better at night?

Hang in there! You're doing a good job!
Hugs,
Leslie and the gang

[Seiberbb]

Hi and thanks for all the helpful responses. Not sure what I would do without all the helpful info on this site.

I was surprised to hear back from the vet already today. Hannah was just drawn late yesterday afternoon. Hannah's last cortisol post ACTH on 1/5 was 34.40. Now that we have done 7 days of a loading dose her result from yesterday was 12.27. YAY! She is getting there. The vet specialist told our regular vet to have Hannah continue the loading dose for 5 more days and then check levels again. We go back on Wednesday. I am so happy to finally be getting somewhere in this ordeal. We have not had any good news since this started about 6-7 months ago. I really really really wish that our vet would have just began with a loading dose instead of doing what he did. What a giant waste of money. Oh well. I am just so thrilled now that Hannah is showing some signs of improvement with this recent test. No more looking back. Just looking ahead now. :) I am a little nervous about the next 5 days but I think I have a pretty good idea of what signs to watch for to indicate she is loaded. Thanks for all the advice!!

[Squirt's Mom]

Great news! And you are doing a great job, Mom! Keep that eye on her over the next few days as you have been and things will go just fine! This will be behind you in no time now.

Hugs,
Leslie and the gang

[Seiberbb]

Hi all. Update on Hannah. As you recall she was not fully loaded after her first week of lysodren. Her loading dose is 1 pill a day. The vet had me continue to load her for 5 more days. She was rechecked yesterday. I just got her results and she is at 7.2. YAY. A far cry from the mid to high 30's when this all began.

The vet specialist instructed my regular vet to have me continue to load her for 2 more days, and then begin the maintenance dose of 1/4 pill 4 days a week. Recheck in a month. Here is my dilemma and questions. Yesterday, the day she was drawn, she got 1/2 a pill. But I did not give her the other half OR any lyso today because I wanted to hear the results before continuing to load her. So....what do you think about the specialists plan? I think I want to make up for the 1/2 pill she missed yesterday and the whole pill she missed today in additional to the vets plan of loading for 2 more days. By this I mean giver her a half pill today (since it is already 4pm) Then a full pill the next 3 days instead of 2 days. Does this make sense? What do you think? Either way, we wont know for sure if she is fully loaded and below 5. I guess the specialist just assumes if she is at 7.2 that she will be at 5 or below with 2 more doses.

[Wendy Tillotson]

I find this all very interesting as I experienced some of the same things with the loading.

My mini wire is 11.6 lbs. We tried her on 1/2 pill and she seemed to load - the numbers were down - but not perfect so my vet decided to do 1/4 pill every other day as like yours, she was afraid of throwing her into Addisons. We retested after 20 days and it was up again. Since Ive been with this vet for over 20 years and she is generally right about things, I wanted to stick with her. So she started her on 1/4 pill each day and we tested her after a month - and the post test results were 7.6 - a MARKED improvement.

We are kind of at an impasses now because a few days after this last test, we found she had abscessed teeth and needed surgery - which may have effected her cortisol levels.

Its just interesting that my little dog is loading on1/4 pill a day compared to what your dog is getting. Just goes to show that all dogs are different and this is a bit of an art - not just an exact science. The maintenance dose is going to be interesting.

[Rocky&LolasMom]

I just read all the post's regarding Hannah. I have also been dealing with Pituitary dep. Cushings since July with my girl, Lola (age 8). I truly understand how unnerving this is but we are just now starting to see some positive results after all these months. Last week I was lucky enough to take her to see Dr. Mark Peterson in NY just so I know we are on the right track as Lola's post ACTH is still too high at 11.5. He said to do a reload and then test in a week. That is where we are now. Hang in there and keep reading, learning. Knowledge of the disease and all other related issues will empower you to advocate for Hannah, doing what is necessary for her to be as healthy as possible. You can never learn too much as this disease affects so many other aspects of her physiology. I am trying to focus on learning more about Canine nutrtition. The Cushings disease itself taxes their bodies, their immune systems..so I believe superior nutritive adjuncts are essential. just really do not know enough. So I'll learn and do it.
Hang in there, Hannah's Mom. I really wish you the best.
ps..I love this forum!!!

[Squirt's Mom]

Hi Rocky and Lola's Mom!

I invite you to start a thread about your Cushing's baby in this same section. This was we can chat with you an offer feedback if needed while keeping all your baby's info in one place. Plus, you will always have a place to come to if you needed to refresh your memory about things like I often do! :p

To do this, all you need to do is click on the button that says, "New Thread". Then assign a title you will recognize and start talking! :)

We would love to learn about your baby and your journey so far!

Hugs,
Leslie and the gang