new to cushings (Brittany's problem)

[otiswoman]

hi,

My 10 year old mixed breed dog (brittany spaniel/aussie) was recently diagnosed with cushings. She finished 2 weeks of lysodren along with melatonin abd lignan. Now she is on a 3day on/4 days off lysodren along with melatonin & lignan every day. Any hints? Her energey level is good but she has to relieve herself about every 2 hours through the night. She lets me know and we go out together.

UI appreciate any and all suggestions.

[lulusmom]

Hi and welcome to the forum.

Can you tell us which form of cushing's your dog has? It would help us greatly if you would please round up copies of all of the testing that was done to diagnosis your dog and post the results here. You only need to post the abnormal (highs and lows) for the blood chemistry and please include the normal reference ranges.

What symptoms did your dog have that lead your vet to suspect cushing's? Excessive peeing and drinking, voracious appetite, hair and skin issues, panting, pot belly? Did you do a loading phase with the Lysodren. How much does your dog weigh and what dose of Lysodren are you giving? Sorry for all of the questions and requests but the more information you can give us, the more meaningful the feedback we can provide.

I'm sure sorry for the circumstances that brought you here but I'm glad you found us. We're here to help in any way we can. Ask questions, read threads and be sure to check out our Helpful Resources section and read up on whatever form of cushing's your dog has.

Looking forward to hearing more about your precious pup.

Glynda

[otiswoman]

Hi,
Thanks for responding. My dog Brittany has the adrenal Cushings as confirmed by an internest. Her symptoms were excessive drinking ansd urination. All her lab tests came back negative. We went to an internest in Albany (it was as though I was talking to a robot) but my vet said he knew his business. He took an ultra sound and said her left adrenal was enlarged. He prescibed the dose and follow-up doeses.

[otiswoman]

For everyone's info. This months Whole Dog Journal has a 9 page indepth study of Cushings. It included Medications and holistic approaches, It also gave me your website.

[frijole]

I'm heading out but wanted to post a link to info that really helped me with using lysodren and knowing when to stop. Read it and print it out for quick reference. Good luck!! Kim

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

[StarDeb55]

We would be very interested to see the results of the diagnostic testing done for Cushing's. These tests might be a low dose dex test, ACTH, full adrenal panel, & a high dose dex test. As Glynda asked, we would be very interested to know what dosages of lyso your pup has used to load, what is her current maintenance dose, & the most recent ACTH result. What is her current weight? What did the ultrasound report say about the other adrenal gland? We are not trying to second guess your vet team, but we have seen it time & again on these boards where an inexperienced vet has done inadequate testing to confirm a Cushing's diagnosis, starts medication, & the pup pays the price.

Welcome to both of you! We are here to help in any way we can.

Debbie

[otiswoman]

Brittany's initial dose was 125 of lysodren M-F for 2 weeks. Then she jhad the stimulating test(I don't have those results but I will get them from my vet). The results went to the internest and he then put her on 250 M,T,W for 2 weeks , we have finished the first week and then have to go for another test after the second week.

She will stay on the melatonin & lygnan every day. This is supposed to protect her from developing Addisons.

Thanks to all who have responded. I will do whatever I have to do to make Brittany as comfortable as I can. Her intake of water went from 21/2 gallons to 1/1/2 . I do have another dog so the amount of water is really for the 2 of them. I suspect that the other dog may only drink 1/2 of the total.

[StarDeb55]

I have never heard of melatonin + lignans being used to prevent Addison's. Normally, these 2 are given to a pup who has Atypical Cushing's, specifically to control non-adrenal produced estradiol. With an adrenal tumor, there is a distinct possibility that other adrenal produced hormones are being secreted at elevated levels. Lysodren will control all adrenal based hormones. Estradiol is the exception as it can be produced in non-adrenal tissue, such as fatty tissue, & reproductive tissue. Normally, prednisone or another corticosteroid is used to treat a possible Addisonian crisis. It sure sounds to me like your pup may have had a full adrenal panel done by the Univ. of Tenn. at Knoxville to help make the diagnosis. My Harley had pit cushing's with elevation in all adrenal based hormones. He was on melatonin + lignans to control the non-adrenal estradiol, but these 2 were never used to prevent an Addisonian crisis. Do you recall if any of the blood samples were sent out, possibly to UTK?

Debbie

[otiswoman]

I'll try to find out. PS Brittany's weight is 36lbs.As far as I was told none3 of her urine tests or blood tests were abnormal. It was at that time we were sent to the internest . Her utrasound showed enlargement of the left adrenal but he could not see the right adrenal.
Her major symptoms are still the excessive drinking and urination. I take her for walks and we do minimal agility because I read that their could be muscle weakness.

[otiswoman]

I know the blood work was sent out and took over a week to get the results. I will try to get a copy of those stats,

[StarDeb55]

Yes, that does, indeed, sound like a full adrenal panel from UTK. They will also provide a suggested treatment options sheet, along with the actual results. We would love to see what UTK recommended for treatment.

Debbie

[otiswoman]

I'll try to get those results tomorrow.

I think this site is awesome and it's good to know I'm not alone.

Otiswoman

[StarDeb55]

This is a copy/paste of the UTK results for Brittany that were posted on my visitor's messages:


10/14/11 11/15/11
Cortisol 139.3 Cortisol 41.3
Androstee 6.49 0. 88
Estradiol 65.4 80.5
progesterone 0.74 0.22
17OH progest. 1.19 0.20
Aldosterone 199.4 75.4

I hate to ask this of you, but we need the normal ranges & reporting units, along with which value is the pre, which is the post. Could you modify your post to look something like this?

Cortisol:
Pre: 139.3 (reporting units such as ug/dl)
Normal range: 100-200 ug/dl

Until we see the normal ranges it's hard to tell exactly what is going on. Right now, I'm making a guess that cortisol of 41.3 is the post value, & when you convert it to ug/dl, the value is 4.1 which is normal. UTK does report their results in different units then what we are used to seeing, so that's why we need those. Without the normal ranges, it looks like the estrogen may be elevated, but I'm guessing. I can offer more meaningful feedback when you post the rest of the results. There should also be a treatment consideration sheet from UTK, & we would like to see what they have to say about treatment.

Thanks,
Debbie

[otiswoman]

Hi Debbie,

I hope I get this right
Pre: Cortisol ng/mi 139.3
normal: 2.1-58.8
Post: 41.3
normal: 2.1-58.8

Pre:Androstenedione ng/mi 6.49
normal 0.05-0.57
post: 0.88
normal 0.05-0.57

Pre: Estradiol pg/ml 65.4
normal 30.8-69.9
Post 80.5
Normal Range: 30.8-69.9

Pre: Progesterone ng/ml 0.74
normal range 0.03-0.49
post 0.22
normal range 0.30-0.49

17OH Progesterone ng/ml 1.19
normal range 0.08-0.77
Post 0.20
normal range 0.08-0.77

Aldosterrone pg/ml 199.4
normal range 11-139.9
Post 75.4
normal range 11-139.9

Myrna

[StarDeb55]

Almost, the second readings are the post values & they are actually more important the pre. You still need to add the normals for the post as they are different than the normals for the "pre" values.

Debbie

[StarDeb55]

Myrna PM'd me the treatment considerations from UTK which are the following:

1.Ultrasound or Endogenous /acth we did that before we sent them lab tests.
2.Melatonin, dog has been on this since ultrasound.
3. Lignan, dog had been on this since ultra sound.
4. Lysodren: dog has been on this since we received the first lab results.
5. Trilostane' they say that Lysodren is better for Atypical Cushings.

Debbie

[otiswoman]

There are 2 classifications after the normal range;

1. RESULT
(post ACTH) 2. Normal Range
different than the fiest Normal range

Not sure how to place them on a new page.

Myrna

[StarDeb55]

Just edit them into your initial post, so it will look something like this:

Cortisol:
Pre: 120 ng/ul
Normal: 100-200 ng/ul
Post: 165 ng/ul
Normal: 15-300 ng/ul

It's much better if the pre & post values are all there together. I appreciate your efforts to get everything posted for us. I know getting these lab values posted can be a tremendous pain in the backside, but you're doing great.

Debbie

[StarDeb55]

I've copied your latest PM:


(post ACTH) Range
Cortisolng/ml 41.3 2.1-58.8 207.1 65.0-174.6

Androstenedione ng/ml 0.88 0.05-0.57 5.78 0.27-3.97

Estradiol pg/ml 80.5 30.8-69.9 62.4 27.9-69.2

Progesterone ng/ml 0.22 0.03-0.49 2.14 0.10-1.50

17OH Progesterone ng/ml 0.20 0.08-0.77 4.31 0.40-1.62

I'm confused as to which is the pre vs. the post because none of these values match up against your post from 420 except for the 41.3 on the cortisol. For instance, in your post you have shown estradiol values of 65.4 for the pre & "next reading" which I assume is the post result, of 80.5. Now, the PM shows values of 80.5 & 62.4. If 80.5 is really the pre result, & the 60+ result is the post result, the estradiol would be read as normal. If it's the other way around, with the 60+ result being the pre, & the 80 is the post, then the estradiol is elevated.

Debbie

[otiswoman]

I re-edited the numbers as you suggested. I placed them under each other as you suggested, did you kook at the new edited version?

The Estradiol was the o0nly one that increased:
pre== 65.4and post wass80.4

[otiswoman]

Hi,

I signed in a month ago as Otiswoman and I think some of my emails got deleted when your site had a failure. My dog is te4n years of age, diagones with Cushings and Atypical Cushings. She is on 1.2 of lysodren daily,1 melatonin daily and a lignan capsuile daily. The main problem she is having is some stomach upset. Occasionally at night she moans and i day she had the runs, I noticed on your site a reference to pepcid acid, I checked with my vet and she said that would be okay. She was diagnosed by an internist after 2 separate tests to Tenessee. I would appreciate any help with the stomach distress.

Thanks for being there.

Otiswoman

[Cyn719]

Hi and welcomw back to the forum - so sorry your posts were gone. Sorry Brittany is have stomach issues but this forum will help you - thats for sure:) Can you tell us alittle more about Brittany - what kind of dog is she and her weight - do you have any lab work that you can post or any other info to add so when to other come along that will really help them and then they will beable to give you their advice. My Penny is 75 lbs and she takes one to two pepcids a day which works for her and I have also used a tablespoon a pumpkin in her food when she has bowel issues - but like I said the others who gave me this info will be able to give you more information on this. Hang in there:)

hugs xo

[Harley PoMMom]

Could you post the exact dose amount of Lysodren Brittany is getting, also if any ACTH tests have been done could you post those results too.

Lysodren comes in 500mg tablets. When a dog is through the induction phase a maintenance dose is given and spread out, usually, 2 or 3 times a week.

If Brittany is experiencing an upset tummy with diarrhea, I am hoping that her cortisol hasn't gone too low but the only way to know this is with an ACTH stim test. Is she vomiting?

Many members do give their furbabies pepcid ac 20-30 minutes before their Cushing meds. With my boy, Harley, I preferred using slippery elm.

Sending healing thoughts your way.

Love and hugs,
Lori

[Squirt's Mom]

Hi Myrna,

I'm a bit concerned about the daily dosing of the Lysodren. This is not done on a daily basis once the loading phase is over. You would give Brittany a dose only 2-3 times a week after the load is accomplished. This could easily be the cause of what you are now seeing. If you could answer Lori's questions about the dose and her weight, that would really help.

When was her last ACTH? Have her electrolytes been checked?

Also, if she is being treated for Atypical, the usual dose of melatonin is twice a day - morning and evening. The lignan dose depends on what kind you are using. If you are using the SDG form, one capsule a day is likely not enough. If you are using the HMR form, then one may be enough. So if you could fill us in on a bit of these details as well, that would be great.

For today, I would stop the Lyso. It is a "rule" that we never give either Lyso or Trilo to a sick pup. If her cortisol is too low now, she may need some pred, but the only way to know is by having an ACTH - which I recommend you have done asap. ;)

On the Pepcid - make sure it is the Pepcid AC - just the plain AC. Not time released, fast acting, or any of that - just plain Pepcid AC. The generic is called Famotidine. If this doesn't seem to help, you can also try Tagamet (generic Cimetidine). BUT, before I started giving her any of these, I would get the cortisol checked out. ;)

I would also want my vet to explain in a way that I could understand why Brittany is still taking Lysodren on a daily basis when that is not how it is usually used. She may, could possibly, might have a reason for this that we can't see from here...but I would want to know why it was being done this way as opposed to the typical protocol.

Let us hear from you!
Hugs,
Leslie and the gang

[otiswoman]

Just a quick question. Brittany has been on Lysodren for 12 months. Her only symptom is drinking excessively and urinating excessively. The Internist has stopped corresponding with my vet. I thought that perhaps the Lysodren was damaging her body so we stopped about a month ago. My question is how long can a dog survive on Lysodren? My dog trainer says she meets people at meets whose dogs have stopped drinking excessively when placed on Trillostane.

Appreciate your imput.

[Squirt's Mom]

MODERATOR NOTE: I have merged your post about Lyso into Brittany’s original thread. We normally like to keep all posts about each pup in a single thread as it makes it easier for members to refer back to the pup's history when needed. Thanks!

[Squirt's Mom]

Hi Myrna,

Good to hear from you again! :)

Since it has been such a looong time, could you please fill in the last year of Brittany's history with her treatment? Did you continue the daily dosing of Lyso and never go to maintenance dosing? It will be very difficult to help you without more info on what you have been doing for Brittany in the last year. So give us some details! :D

How are her signs? Has she had any other illnesses in the last year? Any new meds, herbs, supplements, diet, etc in the last year? What made you stop the Lyso - what did you see? These answers and any more you can provide will be a great benefit.

Hugs,
Leslie and the gang

[StarDeb55]

It's nice to hear from you, again, Myrna. As Leslie has already mentioned, it would be very helpful if you would fill in what has been going on with Brittany's treatment this past year.

I wanted to let you know that I successfully treated 2 pups with lysodren over the years. My first boy, Barkley, was on lysodren for nearly 8 years, crossing the bridge at 15 from causes unrelated to his Cushing's. Leslie is absolutely correct that lysodren is only given daily during the loading or induction phase. Once the pup is loaded then maintenance dosing is started. Maintenance dosing is the same total dose give during loading, but it's split into several doses over the week. For example, if the loading dose was 600 mg. daily, the maintenance dose would be the same 600 but possibly split into 200 mg doses given three times over the week. Barkley was never given daily doses all the years he was on lysodren. His dose would have to be adjusted based on ACTH testing results, but even with that change he was never reloaded.

Now, our pups do not read the book on how either medication affects them, so it's possible the Brittany PU/PD didn't resolve very well. Barkley never lost that voracious Cushing's appetite, so I know it can happen. The other thing is has your vet considered other possibilities for the continued PU/PD? For instance, diabetes insipidus is the first thing that comes to mind. DI is not the same as regular diabetes & is treated differently.

The other thing that would help us to help you try to get this sorted out is Brittany's ACTH testing history with results. If you could round up copies of those tests & post the numbers, along with the lysodren dose that Brittany was on at the time of the test, that would be great.

Looking forward to hearing from you.

Debbie

[otiswoman]

My 11 yr old dog "Brittany" was on Lysodren for 15 months. Her only symptom was excessive thirst and urinating. She was diagnosed as having cushings and atypical cushings. We stopped the lysodren a month ago and just got the results of an ACTH test which showed she had normal cortisol levels. the vet has recommended we keep her off drugs and re-test in 3 months.

[Squirt's Mom]

If you stop the Lysodren, you will lose all the ground you have gained and have to start all over again. Why is your vet telling you to stop? Reaching normal levels is what the drug is supposed to do but if you stop, those levels will start to rise again. These are LIFE TIME drugs, not temporary.

[Squirt's Mom]

Copied from the "Checking in for June 2013 thread -

I don't know how to enter my own checking in but want to share my situation. My dog was diagnosed with Cushings and Atypical
Cushings in Sept. 2011. she was on Lysodren for 1 year then the internest stopped replying to my vet. I decided to switch Trillostan but my vet said we had to wait 2 months. When we check her blood levels they continue to be normal so we never put her on any other drug. Her only symptom now is the excessive drinking. She can sleep now 5-6 hours ,no accidents. I give her 3milligrams of meletonin at bedtime. She participates in agility activities as well.

[Harley PoMMom]

Excessive drinking could be attributed to an UTI, has Brittany had an urinalysis done lately?