Hi (Bo) a toy poodle - sweet Bo has crossed The Bridge

[Bo's Mom]

I just wanted to introduce myself and our situation. First of all I am so blessed to have stumbled on this site as a source of great information.
My name is Belinda. I am the proud owner of Bo, a toy poodle, who was diagnosed with Cushings in July 2011. It has been a tough road for us so far as we are trying to tweak his meds(Mitotane) to make sure he is taking the right dosage the right amount of time. Right now, he is on a whole pill on Tuesdays and a 1/2 pill on Saturdays. I always used the symptoms on whether that dose is appropriate or not. The symptoms I have looked for are the excessive thirst and frequent urination. I am beginning to think that everytime my poor baby goes to get a drink of water, I worry. He has lost all his weight that he carried prior to diagnosis and he just seems so thin and he can no longer jump onto things as he did before. He plays and otherwise is totally normal.
I just want to thank you all for keeping this site going and I look forward to reading about all your babies.
Sincerely,
Belinda Rose

[StarDeb55]

Belinda, welcome to you & Bo! Be prepared as we will hit you with a ton of questions as this just helps us to give you the most appropriate feedback that we can. I have a couple of comments/concerns before the questions start.

Could you tell us Bo's current weight? I'm asking because a 750 mg. weekly maintenance dose of lysodren sounds like an absolutely huge dose for such a little guy. Also, weight loss is not usually associated with Cushing's. Was Bo losing weight prior to his diagnosis? When was his last ACTH, with the results, along with his lyso dose at that time?

Could you tell us a little bit of Bo's history? What symptoms was he demonstrating that led you to go to the vet? Did your vet run any type of general labwork such as a super chemistry panel or wellness panel. We would be very interested to see only the abnormal results of any general labwork, along with reporting units & normal ranges? We ask about this as our babies will demonstrate some common abnormalities on general labs, especially liver function tests, that can point a vet at Cushing's? Can you tell us what tests were done to make the Cushing's diagnosis? We would be very interested in seeing these results, also. Did your vet rule out diabetes & thyroid? If you did a loading phase with Bo, what was the daily dose you used to load, along with Bo's weight when you started loading? What were his ACTH results when he was loaded? If you don't have copies of Bo's test results, your vet should be happy to provide you copies. Most members do keep files on their babies at home as you never know when the file might come in handy, especially if you end up at a strange vet. I nearly forgot, did your vet give you an emergency supply of prednisone in case Bo gets into trouble? If he didn't, I would be demanding it, as pred can be a lifesaver when using lysodren, if your pup gets into trouble.

Now, for a brighter note. I have had 2 pups with Cushing's, both treated with lysodren. My first boy, Barkley, was successfully treated with lyso for nearly 8 years, crossing the bridge at 15. My little 13 1/2 year old Shih Tzu had been successfully treated for 2 years, crossing the bridge at 15 1/2 from causes unrelated to his Cushing's.

Sorry for all the questions, but we want to make sure that we can give you the best feedback we can. Again, welcome to both of you! We are here to help in any way we can.

Debbie

[Squirt's Mom]

Hi Belinda and welcome to you and Bo! :)

Bless your heart. Struggling with this on your own all this time. Well, that is over. We will be here for you from now on. You and Bo are no longer alone on this journey.

Debbie has done a good job of playing our usual 20 Questions so I won't repeat her requests. Those test results will help us a great deal in helping you sort out what could be going on with your baby (couldn't help adding a nudge. :o:D)

Keeping such test results in a file at home is a good idea. That way if you ever have to change vets or see a different one for any reason, say on vacation, you will have all Bo's info in hand when you walk in the door. They will also help you answer all these questions we throw at ya! ;):D

Another good tip is to keep a daily journal or diary of Bo's activities and behaviors/signs like his sleeping pattern, pee and poop history, meds (including supplements and herbs) and their schedules, diet and eating history including water intake, moods, any changes you notice in his behavior/signs. This does several things - it helps us not forget what happened last year when they got sick, it helps us start to see patterns that may exist, and it is helpful to our vets. The signs/behaviors are as important in treating Cushing's as the numbers on the monitoring tests are. ;)

Please don't hesitate to ask any questions you may have. We will do our best to help you understand or find the answer together. Just for your own education on Lysodren (Mitotane), here is a link from our Helpful Resource section that you can read to see if this protocol has been followed with Bo's treatment. If there are differences, that may be a clue.

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

I'm glad you found us and look forward to learning more as time passes.

Keep your chin up!
Hugs,
Leslie and the gang

[Jenny & Judi in MN]

welcome Belinda! My toy poodle Jenny was also diagnosed in July 2011.

We are doing Lysodren as well. Jenny is 8 pounds and currently takes 1/4 of a pill for 2 days then takes nothing on day 3, and repeats.

She is very sensitive to Lysodren though and loaded in 2 days the first time.

People are incredibly helpful around here, I hope you can get Bo figured out! Judi

[jmac]

Welcome, Belinda! Good for you for handling this all on your own for 6 months! I was immediately in a panic and searching the internet the night of Hannah's diagnosis, looking for someone to guide me. You have found a WONDERFUL, AMAZING site, with some of the most kind, compassionate, supportive, knowledgeable, and helpful people. Rest assured you will be taken care of here. As someone already asked, they will gather information from you and then help guide you along the way. There is a lot of information to read on here, and feel free to ask as many questions as you want.

Best of luck to you and Bo on your Cushing's journey!

Julie & Hannah

[addy]

A Big welcome from me too!!!!

Wow, I remember whenever my Zoe used to go to get a drink I would throw up my hands and proclaim "OH NO!!!! SHE IS DRINKING WATER":eek: Every drop of water was suspect!!!!:D

I also am impressed you have been handling this for six months. Good for you!!!

Since the others have already asked the usual questions, I wont add too many. Sometimes the muscle weakness and wasting is last to resolve. How problematic was it before you started Lysodren?

I am looking forward to learning more about Bo and it is so nice to meet you both.

I am so glad you found us.

addy

[Bo's Mom]

Hi All,
I just wanted to say how much I am learning from each of your posts. I'm still in the dealing phase with my Precious Bo. Tomorrow he has an ultrasound scheduled to see if we are currently dealing with the adrenal form of cushings. He is maxed out on the Lysodren and we are still not seeing an improvement of symptoms. We had a ACTH test run last week and it showed that the levels are too high still and so now I guess it is trying to find out if this is the right way to be treating his disease.
I was just wondering if you guys can offer any questions that I can ask my vet or the tech who is doing the exam? I am just on pins and needles with getting results as my poor little man is just trying to be comfortable with all the symptoms that he has(frequent potty/lots of water drinking/ and shaking of his back legs that he loses his balance.)
Thanks again everyone and have a peaceful night.

Moderator's Note: I have merged your update on Bo into Bo's original thread. We, normally, like to keep all posts on a pup in a single thread as it makes it easier for other members to refer back to the pup's history, when needed.

[Altira]

Welcome:
You've come to the right place. I'm sure one of our angel experts will be by soon to help...

[Harley PoMMom]

Could you get copies of the ACTH stim results and post them here, thanks.

Most times the adrenal form of Cushing's requires a much higher dose of Lysodren to maintain control. What dosage is Bo on?

Getting an ultrasound, IMO, seems like a great idea.

[Bo's Mom]

Bo is on 250/mg 2x a week and he weighs 10 lbs. He initially started (after the loading dose) at 1/2 tab (125/mg) 2x a week. That didn't work so since then we have been playing around with the dosage for about the last 7 months or so. He just had the ACTH test redone last week and I can get copies of those lab results.
Again....thank you so much for everything.

[Bo's Mom]

First, I don't know how to post to the orignal thread so that it would be easier to follow what is happening so if I am doing wrong by starting a new thread...let me apologize.
I finally got a copy of all Bo's testing that has been done so far. I want to know if any of you have any thoughts on his treatment.
Sorry for the long message.

8/20/2011: Low Dose Dexamethasone Suppression Test:

Cortisol, baseline: 6.50 ug/dl Reference range: 0.1---6
4 hours post dex. 5.22 ug/dl Reference range: < 1
Cortisol, 8 hours post dex: 5.20 ug/dl Reference range < 1

Diagnosis: Cushings (hyperadrenalicorticism)

9/6/2011
ACTH stim Cortrosyn
Cortisol, baseline: 7.07 Reference Range: 0.1---6
Cortisol, 2 hour post ACTH 12.5 Reference Range < 20

2/23/2012
Low Dose Dexamethasone Suppression Test: Done because still showing clinical symptoms that cushings is not being well controlled despite Mitotane treatment.

Cortisol, baseline: 6.51 (same reference range as test done 8/20/11)
4 hour post dex. 3.83
8 hour post dex 4.19

Blood Chemistry: I am only going to report abnormal findings and I have no idea what these things mean.
HCT: 56.5% : Ref: 37.0--55.0 (high)
MCV: 79.5: Ref: 60---77 (high)
MCHC: 28.2 g/dL Ref: 30.0--37.5 (low)
EOS: .04 K/uL Ref: 0.10--1.49 (low)
ALKP: 1615 U/L Ref: 23--212 (high)
Chol: 417 mg/dL Ref: 110-320 (high)
AMYL: 359 U/L Ref: 500---1500 (low)

Ultrasound: performed 3/21/2012: I am only posting what I think sounded abnormal

Radiographic Findings: The left adrenal gland is 0.46 cm in width. The right adrenal gland is at the upper limits of normal size parameters at 0.75 cm.

Radiographic Conclusions:
Prominent right adrenal gland consistent with hyperadrenocorticism. An endogenous ACTH test or high dose dexamethasone suppression test could be considered if further evaluation for an adrenal tumor is desired, although there is no evidence of a tumor on this examination and is thus given lesser importance at this time.

Again: Thank you to everyone for all the knowledge and kind words. Have a wonderful holiday.

[Bo's Mom]

Forgot to say:
He is currently taking 500 mg. of Mitotane a week. This is after changing doses countless times. He occasionally shows syptoms that it is not sustaining him but not as bad as it was before. Now all my little guy wants to do is sleep on the couch. He trembles quite a bit from his hind legs which is another thing that I have noticed. I am just not sure if how we are approaching this is the best for him. Any thoughts are so greatly appreciated.

[labblab]

Welcome back!

I'm so sorry that you and Bo are still having such a rough time. Have any additional ACTH monitoring tests accompanied these dosing changes? The only ACTH test result I'm seeing is the one performed back in September. And since the post-ACTH result was clear up at 12.5, it is no wonder that Bo's clinical symptoms of Cushing's were not being well-controlled :(. I'm guessing you already know this, but for the benefit of our other readers, the target post-ACTH range for a dog being treated with mitotane is 1-5 (much lower than the "normal" range of <20 for a dog without Cushing's). That being the case, I'm afraid I don't think the February LDDS test served a useful purpose, especially since the results would have been skewed since Bo was taking mitotane at the time.

When you posted in mid-March, you said that another ACTH had been performed within the preceding week. Can you look for those March ACTH results so that we can take a look at them, too? It will help to know how they correspond to the earlier test in September.

Thanks so much!
Marianne

[labblab]

It's me back again, with one more general thought. If Bo does have an adrenal tumor, it may be the case that he might get a more desirable response with trilostane as opposed to Lysodren. From what has been written (which is consistent with what you have told us), dogs with adrenal tumors may end up needing such large doses of Lysodren that they also suffer from unwanted side effects from the medication itself. A trend among specialists in recent years seems to be increasing favor for using trilostane as the treatment of choice for inoperable adrenal tumors, especially if the Cushing's symptoms are not responsive to reasonable doses of Lysodren. Just thought I'd throw that out as another thought to consider or to discuss with your vet...

Marianne

[Bo's Mom]

Hi Marianne and others,
I guess I was mistaking thinking Bo had a test done in March. I am so lost on dates and all the tests that Bo has had in the last 6 months. But my poor little guy is just not doing well.
He was taken to the vet last week because of throwing up and not eating at all. Vet ran a blood chemistry and thank goodness it wasn't pancreatitis. She gave him 2 shots (1 antibiotic and 1 anti-nausea) and this helped. He came home and is now taking a an acid controller and finally getting a little bit of his appetite back. I gave his body a rest off the mitotane and finally put him back on it 4 days after feeling better. I also am cheating him out of 1/2 a pill to see if his cushings symptoms would return that we watch for in him(peeing/water consumption). Today he really picked up his water intake so I am wondering if I am going to have to go back to the 2 pills 2 x a week (500mg/week...which is the max dose for his weight) which I really do not want to.
Also, a totally new symptom has appeared. He is falling down and just not able to steady himself real well. And he is now rubbing himself against anything he can find(grass/couch/bed/floor)
I just want to know if this is a sign that things are not going to get better with my little guy. I am just at a point where I am getting scared that I won't be able to do anything for him anymore. Any advice is so greatly appreciated.

[frijole]

Hi Marianne and others,
But my poor little guy is just not doing well.
He was taken to the vet last week because of throwing up and not eating at all.

Hi there! I just read your whole thread and I am so sorry you have been thru alot. I can relate because my Haley took a very long time to load and she ended up on a dosage that was way higher than normal also.

I clipped the quote above because throwing up and not eating is a sign of too much lysodren. I did not see where your vet did an acth test after these symptoms. (you mentioned 2 shots/antibiotics)

I know it is so confusing but if you could please go to the vet and get copies of every single test you have had done. I'd like to see the acth tests from the beginning to the most recent. Something just doesn't add up. The only way we can really offer more help is to have this information handy.

The dosage you are on is very high for an 8 lb dog and looking at the test results we could see if there has at least been some progress in reducing the cortisol levels.

I would NOT go back on lysodren until I knew for sure that the cortisol is not low. There is a rule - never give lysodren to a sick dog and your dog does not seem well right now. (vomit and appetite)

Falling down and inability to get up are also signs of too much lysodren/ too low cortisol. Please have an acth test done if you haven't already. Do you have prednisone on hand to give in case of emergency? If your dog is acting like that prednisone can save his life if the cortisol is too low and you must have it on hand.

If your dog cannot get up please take him to the vet or ER as soon as you can and tell them he's on lysodren, needs an acth test done and to have his electrolytes checked.

I don't mean to scare you but better safe than sorry. The peeing and thirst do not make sense though. Again, looking at the test results over time would be very helpful.

Hang in there and please know you are not alone. Sending love and best wishes, Kim

[Sage]

How old is Bo?

[Bo's Mom]

Bo is 9 y/o and weighs 9 lbs.

[Jenny & Judi in MN]

Bo has so much common with my Jenny. I hope taking him off of the lysodren for now helps. hugs, Judi

[Bo's Mom]

Ahhh, your little Jenny is so cute. : ) Thanks for the kind words.

[Bo's Mom]

Can you post what you feed your babies? Or is there a discussion somewhere on the forum about diet for our cushing babies?

[Squirt's Mom]

Hi Belinda,

In reading through your thread one thing jumped out at me -


Bo is on 250/mg 2x a week and he weighs 10 lbs. He initially started (after the loading dose) at 1/2 tab (125/mg) 2x a week. That didn't work so since then we have been playing around with the dosage for about the last 7 months or so.

What was the dose of Lysodren (Mitotane) Bo took during the loading phase? Based on his weight of 9lbs, it should have been 200-250 mg per day, divided into two doses - AM and PM. Is this the amount and the way he was loaded - ie twice a day?

Then the maintenance dose should be the same amount of Lyso that was given during the loading phase but spread out over a week. So Bo should be getting no more than 250mg for the whole week, given 2-4 times a week.

If the loading phase didn't follow the standard pattern of twice a day loading with the correct dose of Lyso, then it may not have worked as well as it was supposed to and the load has been lost. In which case, the maintenance dose would probably be increased over and over yet control of signs would not be good.

This is how Lyso works - during the loading phase it erodes a miniscule layer of the outer cortex of the adrenal glands. This erosion stops the adrenals from continuously releasing the cortisol. Once the desired level of erosion has been achieved with the loading phase, an ACTH is done to check the levels and if they are where they need to be then maintenance is started using the same dose as was used in the load. Maintenance does what the name implies - it maintains that level of erosion achieved during the load.

So, it the load wasn't right to start with the maintenance can be really iffy and difficult. Can you tell us about Bo's loading? How much did he take, how often and how long he was on the load? What signs did you see that led you believe he was loaded? How long after you saw these signs indicating he was loaded was the ACTH done? How long after that ACTH did the maintenance start? What dose did he initially start with on maintenance?

Bo is now taking 750mg a week, which is a huge dose for such a little guy. To my simple mind this says three things - 1) the loading wasn't done correctly in the first place causing a cascade of things that look like a loss of control when control was never achieved to start with, 2) something else is going on either along with Cushing's or instead of Cushing's, or 3) Bo is one of those pups that Lyso simply doesn't work well on and he may need to be switched to Trilostane (Vetoryl).

Now about diet - this is a tough thing to answer but I know how you feel. I became very interested in canine diet when my Squirt had an acute pancreatic attack not long after being diagnosed with Cushing's. So I started learning about feed which led me to studying canine nutrition - an ongoing passion of mine now. :) If you think Cushing's can be complicated and confusing, nutrition will make your head spin like mad! :p The short, simple, honest answer to your question about what to feed a cush pup is this - there isn't an answer. And here's why - each one of our babies is a unique biological entity, no two of them are alike, ever. So a feed that works well for my babies may not work well for any other pup here. The only way, in my humble opinion, to use a feed that is just right for Bo, or any other pup, is to consult with a canine nutritionist and have a diet designed for him that will take into consideration everything in his life. This isn't feasible for everyone, however, for any number of reasons. So that leaves us with commercial feeds - which can be mind boggling. :eek::D

There are some good commercial feeds available. But you are going to have to do a trial and error thing to see what does best for Bo. Here are some things you can look for in finding a good feed. First, high quality feeds are not sold in places like your grocery store, WalMart, Farmer's Associations and so forth. High quality feeds are not seen on TV commercials, or at least I have never seen one advertised that way. The reason for this is simple - the manufacturers of cheaper, low quality feeds don't care about anything except selling their product, even if it is total crap. So those feeds in their pretty packages get prominent exposure to prompt pet parents to buy their product. A feed found in a vet's office is not usually a high quality feed either. Here's why - vet's get very, very, very little training in nutrition so they rely on salespersons to tell them what is a good feed to sell their patients. That is typically Hill's Science Diet or Royal Canin - both crap, especially the Science Diet, any kind including the prescription ones. It is mostly corn and sodium - better for cows than dogs. ;)

When looking at feeds, you have to read the ingredient list on the package. The ingredients are listed in the order of greatest content to least content. Meaning if corn is listed at the first ingredient, that feed contains mostly corn. If the package says this is a lamb and rice feed, then in those first four ingredients listed you want to see lamb and rice listed, especially the meat. If lamb isn't listed until the 8th or 9th ingredient or lower, then lamb isn't a big part of the ingredient and the package is misleading. So study those ingredient lists and pay particular attention to the first four ingredient listed - these will tell you what makes up the majority of that feed. You want to see meat and good solid veggies listed there. If anywhere in the list of ingredients you see "by-product", put it back on the shelf and move on. By-products are things that are unfit for human consumption. Doesn't sound too bad, right? That is what the manufacturers count on us believing. In truth, by-products are things like chicken feet, beaks and feathers. So by-products are a no-no. Meat meals, like chicken meal or lamb meal, are fine; not as good as the whole meat but alright.

Another thing to look for on the package is who makes it, where is it produced? Large conglomerates like P&G, Nestles, ect. are not in the pet food business - they are in the business to make money period. These large companies have bought out some really great feeds, changed the formulas to make them cheaper to maunfacture, and ruined them. Science Diet is a prime example of this. It used to be a really great feed until Nestle's bought it out. So look for feeds that are not made large companies like P&G. Merrick's feed makes their own as do several others out there. Merrick just bought out Pollux and Castor, another good feed and I don't expect Merrick to change the P&C. If you have a PetCo or PetSmart close, they have started taking on some higher quality feeds over the last few years so that is a good place to start. If you have a pet food specialty store close, that would be even better. You will see feeds like Purina, Iams, Eukanuba, etc in PetCo and such but those are still not good feeds - they will carry cheap feeds to cater to those customer who will buy them as well as high quality feeds for discerning customers like us. ;)

Next you will want to compare the analysis listed on the packages you think you might want to try. This is where they list proteins, fats and so on. Since our cush pups are prone to pancreatitis, we want a feed that is lower in fat content. So compare that value first, looking for the lowest percentage of fat content. Next, our cush babies need good quality proteins so look at this value next, remembering what the list of ingredients says about the meats in that feed. If you find a feed that you would like to try but don't want to spend the money on something he may not eat, you can often contact the company and they are glad to send you some samples to try before purchasing.

And don't be impressed with AAFCO statements or recommendations. The AAFCO is a board set up by the pet food manufacturers, composed of people involved with those companies, and bases it's nutrient requirements on NRC (National Research Council) recommendations that are decades out of date. Why are they out of date? Because the NRC established recommendations for nutrient requirements that made it too expensive for the manufacturers to make lots of money on their feeds so they set up their own council. The AAFCO is a bit like a group of foxes set up to watch other foxes around a chicken coop. :rolleyes:

I used to be able to give you a list of high quality feeds to check out but P&G bought them all out a couple of years ago so I am no longer comfortable recommending those feeds. :( Acana and Fromm are two excellent feeds but they are expensive, very hard to find and usually have to be ordered online from the company. Solid Gold is a great feed and PetCo here has picked it up. Avoderm seems to be a pretty good feed and I really liked the Pollux and Castor feed, too. Honest Kitchen and Dick Van Patten feeds seem to be pretty good as well. There are several here who feed a commercial raw feed and I will let them share those with you - I don't do raw. ;)

What do I feed? I home cook for all three of mine tho Brick does get a little bit of the Van Patten kibble with his home cooked goodies. I was feeding Royal Canin, thinking it was ok, but both of mine that were eating it had abnormal labs in the same areas so I had to conclude it was the feed, especially since those values returned to normal once off the RC and on home cooked. ;)

So, is your head spinning like mad yet? :p I think I have rambled enough for this morning so I will shut up for now. Please keep asking questions and answering our questions and hopefully we can all help get Bo to a better place soon.

Hugs,
Leslie and the gang

[frijole]

Good catch Leslie. She is right - protocol for using lysodren is the daily dosage is between 25 to 50 mgs/kg of weight. So at 10 lbs that would have been 113-227 mgs of lysodren daily. I can see where the vet would round up to 250 mgs daily. So you'd split the pill into quarters and give 1/4 of a pill in the a.m. and the other 1/4 with evening meal.

You continue this until you see changes in water/food intake and do acth tests to determine cortisol level with the goal being a reading of between 1 and 5 on the 2nd number of the acth test. Once you have reached that level you give the SAME amount weekly that you did daily in order to maintain. So if you loaded at 250 mgs daily you would give that amount on a weekly basis (the experts recommend splitting the dosage and giving it 3 or 4 times a week)

It would be helpful if you could answer Leslie's questions regarding the load and test results. Thanks! Kim

[Bo's Mom]

When Bo was on the loading dose, we were doing 250 mg/2x a day. He did it for 6 days and then went and had the ACTH test done. Prior to having the test done and which led us to the diagnosis of cushings, Bo had the Low Dose Dex test. His levels at baseline were 6.50 normal being .1-6. At 4 hours it was 5.22 normal being < 1 and at 8 hours it was 5.20 normal being < 1. Then we went in for the ACTH 6 days on loading dose and had the test. Baseline was 7.07 normal being .1-6 and then 2 hours post level of 12.5 normal being <20. I thought we had achieved desired results with loading because his post test level was in the normal range. But ever since then we have been on this rollercoaster ride with changing his dosage up and down based primarily on his water consumption and urination frequency and not so much on testing values.
He goes for a "well" check in a couple of weeks and I think I am going to have them run another ACTH test to see if we are on the right track (which I don't think). I am opting out of giving him his vaccinations except for rabies which is required because he doesn't spend much time with other dogs except the groomers and I am starting to do that on my own now too. Poor baby looks so funny when mommy gives him a haircut. But, I am just saving him from the stress of going and being caged up with other animals. He doesn't seem to mind.:)
As far as feeding, thank you for all your information. Prior to diagnosis, he was eating Halo dry which he loved. But, I think the cushings had a lot to do with that. After diagnosis, I started making all his food which consisted of chicken, rice, and veggies mixed with a little bit of dry food. He ate well for a while and now he totally turns his head away from that. I have went back to the Halo brand and he eats it but like an 1/8 of a cup. Not nearly enough to sustain his weight. He will only eat that and a few cheerios. He doesn't even like his doggy treats. He has lost lots of weight. He started at 14 lbs prior to diagnosis and has now dropped to 9 lbs. He looks so frail. I am trying my best for my little guy but I am afraid that what I am doing is just not enough. I just wish he could tell me. That is why this group has been so invaluable to me. I really appreciate all the help and advice I get from you all. You are truly a treasure of knowledge.
To all of you who are hurting right now...we send our hugs to you. Please know that we are a keyboard away.

Belinda Rose,
Bo(cushings) and Latte's Mom

[Squirt's Mom]

Hi Belinda,

Thanks for the additional info. For now, if I were you, I would stop the Lyso and get an ACTH scheduled asap. Ask them to check his electrolytes at the same time. It may be that his cortisol is now too low based on the description of his appetite.


Baseline was 7.07 normal being .1-6 and then 2 hours post level of 12.5 normal being <20. I thought we had achieved desired results with loading because his post test level was in the normal range.

Here is a common mistake vets make reading ACTH results. The normal range for a NON-cushing's dog is <20... (labs don't distinguish between a medicated dog and an unmedicated dog - that is where we rely on our vets knowledge, or our own ;) ). For a pup on Lyso, the normal range is 1-5 ug/dl. So with a post number of 12.5, it is unlikely that Bo was loaded. To achieve a load, the post number has be less than 5 but greater than 1. This may well be the crux of the whole problem and the loading needs to be done over again from the start. The dose sounds about right, tho.

How long after the last dose of his loading was the ACTH performed? It should have been done 36-48 hours after his last dose. Any earlier or any later, and the results may be worthless.

A word of caution - these drugs are quite powerful and demand the utmost respect. Any time we see signs that might mean the cortisol is going up or going down, the next step is an ACTH as soon as possible. Adjusting the dosage without an ACTH is dangerous, in fact it can be fatal. Anytime a dose change is made, a follow-up ACTH needs to be performed in two weeks to see how the new dose is working. This is for each and every dose change. We all know how expensive this can get at the beginning but here is a tip you can share with your vet that will save you some money.

How to Extend Your Supply of Cortrosyn and Lower the Cost of ACTH Stimulation Testing
http://endocrinevet.blogspot.com/201...cortrosyn.html

So, get an ACTH and electrolyte check set up tomorrow for as soon as possible and let us know what the results are, 'k?

Hugs,
Leslie and the gang

Oh, the feed....I wouldn't worry too much about that right now. If his cortisol is too low, that will cause him to lose his appetite and he is on a really big dose so give him pretty much whatever he wants along with his Halo and that should be fine. Once you have more figured out about where he is with the Cushing's, you can look into changing the diet if needed.

[frijole]

Leslie is absolutely right and when you were at 12.5 that first test you were on your way to being loaded but not quite there. If you had just kept up the 250 mgs per week I bet money you would have been just fine within a week.

Instead you have tried all kinds of combinations - frankly none of which seem to follow the guidelines recommended for lysodren and that is why you have had the issues. And I agree with Leslie that you need to CEASE giving lysodren and take dear Bo in for an acth test. Get the electrolytes tested as well (the vet should automatically know to do this but just in case...) I too would bet money that the cortisol is too low.

Bless your heart. Hang in there and keep us posted ok? Any questions, just ask us. Kim

[lulusmom]

Hi Belinda,

Since Bo's post cortisol after loading was so high, I'm not sure you are dealing with low cortisol; however, it is possible but it's also possible that his cortisol has gone much higher and he has now developed diabetes. Excessive drinking and peeing, weight loss and loss of appetite are all symptom of diabetes so I wouldn't rule it out. Poodles are a breed that seems to be predisposed to diabetes and I would think that a Poodle with uncontrolled cushing's would be at a much greater risk. I would suggest that you get Bo in as soon as possible to check his cortisol as well as his blood glucose levels.

[Bo's Mom]

Oh my,
You are all so wonderful. I am scheduling Bo tomorrow to see when he can get in for the ACTH test. So far, his glucose has been normal. The last time it was tested was 2 weeks ago when we thought he had pancreatitis and they ran the blood chemistry. His glucose was 115 normal being 70-143. What are the electrolytes? Would they be tested with the blood chemistry? If so, what are the letters that indicate electrolytes? I love my vet but I am beginning to wonder if he has the expertise to be dealing with Bo and all his problems. Funny thing is that the same week that Bo was diagnosed, he also diagnosed a daschund with Cushings and we are his only 2 cushing patients at this time. He comes from the school of thought that symptoms are more valuable than test values and so that is why he was very comfortable adjusting Bo's medication w/o running any of the test. I guess this was all in trying to save me some money.
Sorry for all the questions and I hope that all have a wonderful evening.
Belinda Rose
Bo (cushings) and Latte's Mom

[frijole]

Glynda - this dog weighs 8 or 9 lbs and is taking 500 mg of lysodren a week. That is my concern. I could be totally wrong but either way (high or low) having the test done is important. Also, this time please get this test and post the results. Don't let the vet say its normal because we call now know that cush dog's are not normal :D;) Kim

[frijole]

Oh my,
What are the electrolytes? Would they be tested with the blood chemistry? If so, what are the letters that indicate electrolytes? I love my vet but I am beginning to wonder if he has the expertise to be dealing with Bo and all his problems. Funny thing is that the same week that Bo was diagnosed, he also diagnosed a daschund with Cushings and we are his only 2 cushing patients at this time. He comes from the school of thought that symptoms are more valuable than test values and so that is why he was very comfortable adjusting Bo's medication w/o running any of the test. I guess this was all in trying to save me some money.


It does sound like your vet isn't very experienced with cushings. I have included a link with info on electrolytes - as you will read an imbalance can occur as a result of chemotherapy drugs, which lysodren is. No offense to your vet but this isn't aspirin and while you can sometimes look at symptoms vs test values - no WAY do you do that with lysodren. It is a wonderful drug when used properly but dogs can die when it is not.

Glynda posted on someone else's thread today a detailed explanation of how to save money on the acth tests. I'm sure your vet is not aware of it - I will try to locate it so you can print it/write it out for him/her.

Kim
http://www.chemocare.com/managing/electrolyte_imbalance.asp

[frijole]

Found it! Glynda does a marvelous job of detailing how you can save money on acth tests. There is also an article from an expert in the field that you can print and bring to your vet as well in the event he/she doesn't trust info off of the internet. :D;):eek::)

Acth stimulation tests...ARGH!!! They are the bane of my existence and I was so happy to learn that there is a way to save money but only if you have a smaller dog. Rascal is small enough to save you money too. Way to go, Rascal!!! Most vets use a stimulating agent called Cortrosyn but we call it liquid gold because it's that little vial that dictates the cost. The vial is .25mg and instructions say to use entire vial but not all dogs need the entire vial. There have been studies done that show using just 5mcg per kg is all that's needed. Since there are 250mcg in one vial, your vet can get two stim tests out of one vial. This has saved members a lot of money, especially those of us with teeny dogs who can get five and six stims out of one vial. Formula for Rascal's weight in pounds converted to kg is 39 divided by 2.2 = 17.73 x 5mcg = 89mcg. Your vet can round that off to half a vial or 125 mcg.

Some vets are not aware of this so we always provide the url to Dr. Mark Peterson's blog which instructs vets on how to dilute and store cortrosyn for future use.

http://endocrinevet.blogspot.com/201...rosyn-for.html

You have nothing to lose and everything to gain by printing this out or providing the URL to your vet and asking if s/he will please split the vial.

[Bo's Mom]

The link is no longer good. This is what is posted there now: "Sorry, the page you were looking for in this blog does not exist."
Does anyone have that article that they can possibly scan and send to my email?

[frijole]

The link is no longer good. This is what is posted there now: "Sorry, the page you were looking for in this blog does not exist."
Does anyone have that article that they can possibly scan and send to my email?

Dang. Hopefully Glynda has it... I bet she does. Kim

[labblab]

I think this is the link you are looking for. :)

http://endocrinevet.blogspot.com/2012/03/how-to-dilute-and-store-cortrosyn-for.html

Marianne

[lulusmom]

Wow, I missed the maintenance dose of 500mg for a 9 pound dog. That's a lot. I'm glad to hear that Bo's glucose was within normal range.

Belinda the two electrolytes that are of primary concern are sodium and potassium. The reason folks are telling you to get the electrolytes checked is because another adrenal hormone called aldosterone regulates the amount of sodium and potassium in the blood and if Lysodren destroys too much of the adrenal tissue it can lower aldosterone as well as cortisol. Low cortisol can cause problems but if a dog is not producing enough aldosterone, it can turn into a very serious situation.

The usual abbreviation for sodium is "Na" and potassium is "K". A dog in an Addisonian crisis (very low cortisol) will typically have a low Na level, elevated K and low ratio. To determine the ratio, you divide the K by the Na.

[Bo's Mom]

Thank you so much for the link...I already printed it and am going to let the vet know. Because if I remember right, the last ACTH test done was over $250. It would be nice to save some money that is for sure.
Ok, now another question: Bo obviously is not where he needs to be as far as his cushings. Does the ACTH tell us that we need to adjust his dose again or will we need to do another loading phase and run the test after that? Or, do we do the LDD test? I want to go in with as much knowledge as I can when I get his results. I know that when they do the test, they have to send it off so it takes a few days to get it all back and squared away so I am going to be sitting on pins and needles while I wait.
Belinda Rose,
Bo(cushings) and Latte's Mom

[frijole]

When I re-read your thread I noticed your vet did the low dose (ldds) test a couple times - that is a waste of money. That test is strictly used to diagnose cushings. ONce you have done it there is no reason to do it again unless you are still trying to diagnose cushings.

So the acth test is the only thing you need to worry about right now. It is done to measure the cortisol levels. Cushings dog overproduce cortisol. Lysodren reduces cortisol by destroying adrenal tissue.

A cush dog is diagnosed with cushings if their acth test (the 2nd number) is higher than 22. You start on lysodren and your goal is to reduce the number to a range between 1 and 5 (again, the 2nd no on the test). Once you have accomplished this you are done loading and can then go on maintenance dosing. That dose is the same as the daily dose - only that amount is given WEEKLY instead of daily.

If you do the test and your dog's number is a 1 or lower that means your dog's cortisol has gone too low. Signs of this include lack of appetite, lack of thirst, lethargy, weight loss. If the dog is too low the electrolytes need to be tested. Sometimes dogs are put on IVs for a day or two to get their electrolytes in order.

What you do next depends on the results of the acth test. If your dog is real low you must wait and see if the cortisol levels come back up. (yep, another acth test to see) If they reach 3 to 5 you can safely start on a maintenance dose.

To be honest the dose you are on is very high for a bitty dog like yours and I would NOT use that as my maintenance dose. The original dosage of 250 mgs was spot on. Your vet just stopped too soon. That is why I am sure they are not experienced with cushings. (I have been there sorry to say and had to switch vets)

Sorry to write a book but trying to get you up to speed. It is real important as your dog can't talk and it sounds like your vet needs your help! Hugs, Kim

[frijole]

PS Don't feel like you have to learn everything over night... none of us did. We are here to help so just ask questions and don't be shy. :D

[Bo's Mom]

Believe me, I won't be shy asking questions to such a fantastic group of knowledgeable people. Thanks again!
Ok: since you got me asking questions again :p: How do you find a knowledgeable vet in your area to treat your babies? I have done searches to find an intermal medicine vet in my area but the closest one is 3 hours away and I would hate to drive that far or know that in a crisis it would be impossible to do. Did you just call around and ask different vets in your area?

[lulusmom]

If you let us know what city and state you are in or close to, we may have a member who can provide a name for you. Otherwise, I would call the vets in your area and ask if the vet is experienced with cushing's, how many dog are they currently treating and what kind of results they've seen. I've tried to find a good gp vet in my area and have had consults with several but have always been disappointed. We have a gp vet do the acth stim test but otherwise, we drive an hour each way to see a specialist. :(

[frijole]

Glynda has given you great advice. To add to that, should you switch vets - to save yourself time, money and reduce stress - get copies of every test done so far. Write up a diary from the beginning of symptoms, tests, drugs/dosages so that when you meet with the new vet you give them the complete picture. It also should reduce the number of repeated!

When asking about experience - if they say they are very experienced I'd be looking for one with experience with lysodren since that is what you are using. Ask them what their normal procedure is for dosing is. (if they are following protocol the answer is 25 to 50 mgs per kg) If they say anything other than this... move on. :D Kim

[Squirt's Mom]

Hi Belinda,

You are doing a bang up job, Mom! You are going to be sooo ready for your visit! :)

Sorry that link didn't work but thanks so much for letting me know. I have a long list of links and sometimes they just no longer work. I simply forgot to double check that one before I posted it. :o I have now fixed my list! :D

Let us know what the vet says!
Hugs,
Leslie and the gang

[Bo's Mom]

Well, tried to get Bo scheduled for his ACTH test and no one from the vet's called me back. I am just frustrated as I realize they are busy but I even called back to remind them to call me and still no phone call. I have to call them ahead of time so that they get the meds in for the test and then schedule him for testing. They sure didn't have a problem reminding me how much this test cost. So, after hanging up with them, I looked around our area and found a vet that has more experience treating cushings and using mitotane and comes reccommended by other patients(non-cushings) and made an appt with him but it isn't until the 1st of May. Now hopefully they will have got Bo scheduled with my other vet and I will have results to take to this new vet when we meet with him.

[frijole]

Good girl. I think you made a wise move. Now - tomorrow call them repeatedly and tell them that the drug you are giving Bo requires immediate testing and it is unacceptable not to get a return call. If you have to drive over there or have someone else do it - just get their attention. The longer you wait the less representative the test results will be. Wish I was closer... I'd do it for you! :D Glad you found a new vet and pray they are perfect! Kim

[Squirt's Mom]

Hi Belinda,

Call your vet and let them know you think Bo may be in an Addison's crisis and needs to be seen NOW. Remind them of their responsibility to make sure he is doing well. This is not a wait-and-see situation - it is a take-care-of-it now situation, and it is their job to take care of it. You pay good money to make sure of this. Demand, do not ask, do not take "no" for an answer, demand some prednisone for Bo today, this morning. You may not need it but with the apparent lack of concern by your vet's office, you need to have it on hand as it seems you can't depend on them.

How is Bo doing today? Any better off the Lyso?

Keep in touch and know we are all behind you.
Hugs,
Leslie and the gang

[Bo's Mom]

I do have Predisone for him to take but have been very weary of giving it to him. He actually is scheduled tomorrow for his ACTH test and his electrolytes will also be checked...thanks to all the wonderful advice given here. :D
I will be able to get test results hopefully by the end of the week and have it for when we see the new vet on the 1st.
Today Bo is doing okay. He isn't nearly 100% but he is moving around more and appetite is picking up a little bit each day. He now will eat his treats plus a little bit of food.
I actually feel more comfortable with the new vet's hours because it is a pet hospital where there is a staff vet on hand 24hrs/7days a week. A little more comforting knowing a vet is a phone call away where it will be answered by someone who will have his records right in front of them if ever there is a problem.
Praying for my little buddy and all our other fur babies and sending lots of Texas hugs to all tonight.

[frijole]

Only give prednisone in an emergency... you would KNOW if it was because you would think Bo was dying so you made the right decision there.

I am really concerned about the fact that you haven't had the acth test done because each and every day the cortisol levels go up and so you will have no idea whatsoever the reading was when you were giving the lysodren and therefore what dosage will work. Your vet has just not followed protocol.

When was the last dose given? (day)

I guess your new vet can make assumptions but I gotta tell you the fact you can't get into get a dang acth test tells me your current vet is clueless about how to treat this disease and how serious lysodren is. IT is a wonderful drug but you just can't give it out like candy and not monitor results. Sorry but I am mad FOR you and not AT you. :o;):D

[Bo's Mom]

I did give Bo his dose today (250 mg) and have been watching him like a hawk. He is doing better and I hope I do get some answers from the test to see if at least if the cushings is somewhat under control or if we are totally missing the mark here and maybe needing to be reloaded again according to the correct protocol or maybe it is something totally different causing all these symptoms.

Another question: Does it matter how often you give the medicine within the week? Ex: 250 mg/2x a week....or 125/4x a week? I just was wondering if loading their systems all at once is better because the half life of the medicine and how long it stays in the system or taking it in smaller doses so that it is constantly circulating in their system?

Thanks again!!

[frijole]

It absolutely DOES matter how frequently you give the dose. In your case the problem (in my opinion) is that the dose your current vet has you on of 1000 mgs a week is probably FOUR times too high for Bo. As I said before I think that the original dose of 250 mg a WEEK was the right choice.

For this reason alone I implore you not to give any more lysodren until you get the acth test done. Do you have an appt yet (sorry bad memory)?

Lets just say your vet had you at 250 a week. YOu would give that in 3 to 4 doses a week. So you'd either split that 1/2 of a pill into small pieces OR you could purchase pills specially formulated (called compounding) for your wee little one. Lots of members here have done that.

I feel really bad that you are in this situation and I truly feel it is because the vet is experimenting instead of researching and reading and following well established protocols on how to make this drug work. It is a shame. But you are going to a new vet and so hopefully those days will soon be behind you.

If your current vet does not have the decency to return a call when you are begging to do an acth test in fear that your dog has gone addisonian it makes me wonder if they are even administering the test properly.

Hang in there and I pray your new vet is a compassionate "Keeper". Hugs, Kim

[Squirt's Mom]

Hi Belinda,

I am sooooo glad you got an appointment for today! I am really anxious to see those results. ;)

We also need a "hopping mad mama" icon - I am with Kim about the vet who put Bo on such a massive dose and then ignored your pleas for help. :mad: That is incredibly irresponsible.

It was good to hear that you have the pred and that Bo seems to be feeling a bit better. The increase in appetite is especially good to hear. I feel better hearing that.

Let us know what you learn today from the new vet and I, too, hope he is a great doc and just what you and Bo need.

Hugs,
Leslie and the gang

[Bo's Mom]

:)Bo is on 500 mg/week...done 250 mg on Tuesday and 250 mg. on Saturday.
He had his Tuesday dose and went in today for a blood panel and ATCH test. Unfortunately, we won't get results until Friday. The blood panel (checking his electrolytes) will be in tomorrow morning so I will post those as soon as I pick them up. I will also post the ATCH test results as soon as they are in my hand.
Thankfully he is getting a little of the appetite back but just so slowly. So we are taking it a day at a time.
It was so cute when I picked him up today the vet tech handed him to me and he rested his head on my shoulder like an infant who misses his mom. The tech was just amazed on how he did that. :):):)
Bo won't go see the "new" vet until next Tuesday the 1st. He is the last appt so hopefully the vet won't be rushed as I want to almost interview him just to see where he stands and his experience with the treatment of cushings pups.
Crossing our fingers for some answers soon.

[addy]

We'll all keep our fingers crossed with you. wishing you success with the new vet.

They are our perpetual babies, it is part of why this is sometimes so hard.

Hang in there,
love,
addy

[Jenny & Judi in MN]

I hope you do get your results on Friday. Jenny had her ACTH today also!

Just for comparison's sake, Jenny is very sensitive to Lysodren and loaded in 2 days. Her maintenance dose has been 1/4 of a pill (125 mg) for 2 days then no pill on the 3rd day. We've been doing this since September

Might be an option for you if in fact it turns out Bo's dose is too much for his little poodle body to handle.

What a sweetie resting his head on your shoulder. give him a cuddle from me!

Judi

[Bo's Mom]

Well, we got some good news today on his electrolytes. All NORMAL!! Those are some words I haven't heard in a long time. Now just waiting for the ACTH test results which should come in tomorrow. Maybe some light will be shed on what is going on with Bo. I will post again as soon as I know. Thanks again you all.

[Squirt's Mom]

Hi Belinda,

That is a huge relief! Now to see the ACTH then we will know where we stand and can go forward. I am SO glad to hear this report this morning! :)

Hugs,
Leslie and the gang

[Bo's Mom]

Got Bo's ACTH back today. I just ran into the vet's office before they closed so I was unable to speak to the vet because he had a room full of sick animals waiting to be seen and it was already 5 mins until closing. But, I was able to get a copy of the test and here are the latest:

Cortisol, baseline: 1.54 Ref Range: .1---6
Cortisol, 2 hour 1.12 Ref Range: 14----20.

I know we wanted something below a 5 or so(I think 2nd number) but doesn't this seem awfully low? I am talking to the vet in the A.M. but just wondering anyone's thoughts on his latest. Thanks again!!

[Harley PoMMom]

The optimal time for an ACTH stim test for a dog taking Lysodren is 48 hours after the dose of Lysodren. Since Bo's ACTH stim test was performed the next day after his Lysodren dose, IMO the post of 1.12 is low because of Lysodren having a cumulative effect so I am concerned that Bo's cortisol might even be lower.

Please watch him very carefully for signs of too low cortisol which can be vomiting, lethargy, and/or diarrhea.

Love and hugs,
Lori

[jmac]

Hi there,

I just stopped by and wanted to say I hope Bo is doing okay, since Lori mentioned some concern as well. Please let us know how he's doing and what the vet says. I hope the appointment with the new vet goes well!

Julie & Hannah

[frijole]

I am with Lori on this - particularly given the strange dosing your vet had you on. Bo could go lower after that last dose so keep an eye out for diarrhea or vomiting and if it happens I would call the NEW vet and not the old because the old vet was clueless.

IMPORTANT - Please write up a diary for the new vet. List all tests, results and then the dose your old vet had you give. They will very quickly see that they need to tweek the dosage. You cannot continue to give Bo 250 mgs twice a week - it is too much based on everything I have read regarding Bo's loading and treatment.

The new vet needs to see how bizarre your journey has been and the fastest, most efficient way of doing this is to write/type it all up. This will help them and could very well save you time and money on testing.

Kim

[Squirt's Mom]

Hi Belinda,

I agree with Lori. Please don't give any more Lysodren for now and keep a close eye on him for signs the cortisol is going too low...loss of appetite, lethargy, vomiting, diarrhea.

A reminder - the normal post range for a pup on Lyso is 1 - 5 ug/dl, not 14 - 20. ;)

How is Bo today? I'm glad you have the pred just in case.

Hugs,
Leslie and the gang

[Bo's Mom]

Thanks to all for all your helpful advice and thoughtful words. Bo is doing okay today. He ate a little bit and no vomitting or loose stools. I have been watching him like a hawk these last few days looking for any signs that his cortisol is going way too low.
I guess I thought that with the last results of the ACTH test things seemed to finally start getting under control because we kept the numbers in the range of "normal" for our cush babies.
I am so sorry to keep asking these questions but I am at a point of I don't know what to do anymore.
I am not giving him any more Mitotane until we see his new vet on the 1st which will mean he would have missed 2 doses from testing until he sees the new vet on Tuesday. I guess my new "worry" now is that if he misses too many doses, will his levels start going up too much that suddenly we are having to increase his dose again and we will find ourselves back at square one with his cortisol levels. Like I said before this is what the scary thing is with my little guy is that all this back and forth with his dosage and frequency of dosage that we will be in a situation that we won't be able to turn back from(all those things that happen when we over/under dose) and then there will be system damage to his organs.
Again....thanks so much for all your helpful knowledge and kind words. I don't know what I would do without you guys.

[Squirt's Mom]

Hi Belinda,

Not giving the Lyso for several days between loading and maintenance is normal - that is the way it is supposed to be done. So don't worry about losing ground til Tues., he should be just fine.

Lysodren and Trilostane are two different drugs and work in two different ways. There is no loading phase with Trilostane and no maintenance schedule with Trilostane. The pup simply starts taking Trilo and keeps taking it every day after. With Lyso, the pup goes through a loading phase where the drug is given twice a day until signs are seen that they are loaded. Then an ACTH is done 36-48 hours after the last loading dose was given because each Lysodren dose continues to work for up to 48 hours so you want the test at the peak time - not too soon, not too late. (Trilostane on the other hand does not continue working; it has a very short life in the body, only 2-12 hours.) If the post number of the ACTH is within range, then the maintenance dose is started which is given 2-4 times a week, not daily.

I hope this helps settle some of your concerns about Bo missing a few doses - he is supposed to right now. ;)

Hugs,
Leslie and the gang

[frijole]

Leslie is right - after your dog reaches the desired range you wait at LEAST a week before giving any more lysodren. Also you normally continue on the same dosage but only give it WEEKLY and not daily. Since your load was "untraditional" your new vet is going to have to figure out what level of lysodren will work. You can't keep giving the amount you have been giving our Bo will get too much and could overdose/go Addisonian. I don't mean to scare you but I want you to understand how serious it is that the new vet know the whole story of Bo's load so he/she knows to reduce the dosing schedule. Kim

[Jenny & Judi in MN]

I hope Bo's appointment goes well today. Judi

[Bo's Mom]

On our way now to the new vet...my printer is burning rubber printing everything I need to go meet with him.

[Bo's Mom]

Well, met with the new vet today. I really liked him and he felt comfortable giving me his cell number to use if I ever needed it. He also has a few cushing dogs in his practice right now and this is a hospital which will have a vet on staff 24/7(very comforting) and all his records will be housed there. He was very thorough going through all the testing done so far. He offered a couple of suggestions on Bo's treatment...ie switching to Trilostane because he says he has better success using that medicine over the Mitotane. He did say Bo would have to be off Mitotane for a while(I wrote down the amount of time but don't remember). Also, getting a cortisol level using a resting level rather than injecting cortrsyn(sp??). He says he has been getting accurate cortisol levels doing that and saving tons of money for the patient. Which would help...but that is not what I am really looking to do.
So, I guess I have some research to do on Trilostane and this "new" way of testing ACTH....any thoughts please chime in????
Thanks to all!!!

[frijole]

So glad you liked the new vet. He sounds way more knowledgeable on cushings too.

Regarding switching from lysodren/mitotane to trilostane - I got one question and that is why? If I understand your last acth test Bo was at 1.2 which mean he is loaded. The tough part is over. YOu would wait for a week or a bit more and then start on a maintenance dose. The new vet's challenge would be to figure out what REDUCED dosage to go on. I would guess he'd try 250 mgs a WEEK split into 3 or 4 days.

If you switch you have to wait at the very least SIX weeks and during that time Bo's cortisol will increase. Symptoms will recur and you start over again. Only this time instead of lysodren you will be experimenting with a new drug to see what dosage is best.

Most people have to switch dosage amounts several times with trilo as well so it isn't a quick fix so keep all that in mind.

Is there a reason (other than his experience) that he threw that out as an option? Did he offer his thoughts on continuing with lysodren? Sorry for all the questions - I am just trying to figure out what would be EASIEST on you and Bo because you have been thru the wringer :D

You really are already where you need to be with the lysodren unless there is something I missed. Hang in there and tell us more about what he said!

I'm just glad you found a vet you can trust to care for you and Bo!! Kim

[Bo's Mom]

Kim,
Yes, he actually said we can continue the lysodren and that is what would be best for Bo with the latest results but he just offered switching because just w/his experience the trilostane has given him better results. I guess I am assuming "control" meaning dogs who aren't on this crazy rollercoaster ride and the dosage/frequency is controlling symptoms.
If we were going to switch, it is the optimal time now because I am about to be home for the summer(I am a teacher) and could keep a very close eye on him while he is off the lysodren and switching to the trilostane.
But, I told him I am going to be calling him on Friday to let him know what I decide. This was after knowing I was going to be asking you all tons of questions. :D
Currently we are going to be doing 250 mg/3 x a week and see how he does with that. Keeping everything crossed for now.

[Jenny & Judi in MN]

how are you going to split 250 into 3 doses? I got lots of slivers cutting those suckers into fourths!

does he still have Bo on prednisone? Do you need to do another ACTH before you start again?

This is so tough. hugs.

[frijole]

Kim,

But, I told him I am going to be calling him on Friday to let him know what I decide. This was after knowing I was going to be asking you all tons of questions. :D
Currently we are going to be doing 250 mg/3 x a week and see how he does with that. Keeping everything crossed for now.

You are right - summer is a perfect time for you as you can monitor and be home all the time! Bo is lucky!

I want some other members who have read your whole thread/journey to chime in regarding the dosage of 250 mgs three times a week. To me that is a loading dose and not maintenance and it's what go Bo too low. In short - it scares me.

Looking for thoughts from others experienced in lysodren loading. Please also read the whole thread because this journey/load was not normal so you have to read the whole thing to calculate what dosage Bo might be best on.

Hang in there and just remember you aren't alone and this sort of thing happens alot.

Kim

[frijole]

how are you going to split 250 into 3 doses? I got lots of slivers cutting those suckers into fourths!

does he still have Bo on prednisone? Do you need to do another ACTH before you start again?

This is so tough. hugs.

:D:D:D:D:D:D:D:D:D:D:D:D:D:D:D:D:D

LOVE IT! (splitting the pills) Wee dogs like Bo normally are on low doses and there are companies that formulate pills via compounding to their exact doses so that takes away the slicing and dicing. I have SOOOOO been there myself and it is difficult!

Note that I am the one that suggested the 250 mg WEEKLY dose split over 3 or 4 days. I suggested it because 50 mgs per kg of weight for her dog is 250 mg weekly and that is the high end of what is recommended for loading. That is where her vet started off and it appeared to be working but rather than stick it out another week and getting to the desired 1-5 he upped the dose and changed it from daily to a strange unconventional combination... which didn't work until the dosage was increased way too high which landed us where we are today.... too high of a dose.

So don't worry about having to cut the pills! There are companies that do this and you can order via internet from them - less expensive often than the vet's office, totally legal and convenient too! (Diamondback is one that I recall)

Kim

[Bo's Mom]

OMG...I totally posted that incorrectly. My apologies..
Bo will be splitting 250 mg over the 3 days. And, I am glad that this has been brought to light. I don't know if this sounds like a crazy question but Bo's medicine is compounded by a compounding pharmacy. It is 250 mg meaty looking treat things that are easily cut into 1/2's 1/4's or even 1/3rds. Now the question: When they compound the medicine, could there feasibly be more medicine in different sections of the mitotane? If that is the case, then it is feasibly possible that Bo has been doing this medicine and when I would cut his dose, I could either be giving him the side that has the medicine or the side that doesn't. Oh gosh...I sure hope not. Otherwise, I am going to spin my head crazy thinking how I have totally messed this up.
Signed,
Worried In Texas : (

[frijole]

:D Don't worry... you fit right in here... we are all a bit crazy... you have to laugh to get thru all of this trust me!!

OK - first off..... HUGE SIGH OF RELIEF from me that your vet suggested the 250 split into 3 doses because that tells me he is following protocol and knows his stuff and read your notes. WHEW

Now onto the compounded meat chewies... boy that is a great question and I would call the compounding company and ask them directly because you are right - it could cause an issue. An alternative is to have them put them into pills vs chewies. But do call them.

If it makes you feel any better my dog Haley holds the record for taking the longest to load of any dog on this forum... yep... she took like 4 1/2 months to load (with stops for about 150 acth tests ;) in there) and we kept increasing her dosage slowly. The senior members at the time were all like :eek::eek::eek::eek::eek: we have never seen anything like this... so hang in there... it will work out just fine.

Again, so glad you liked your new vet. I truly believe both drugs work equally (but very differently) but in your case you are already there with the lysodren so unless something changes I'd stick with it because you should be fine. (Fewer acth tests, fewer dosage tweaks means less stress!)

Take care, Kim

[Jenny & Judi in MN]

I always forget about the compounding because I obviously haven't done it yet. duh. let us know what you find out!

[Bo's Mom]

I spoke to the compounding pharmacy today. They ASSURED me that when Bo's medicine is made that an equal amount of the Mitotane is distributed throughout the meaty chewy thing. That was a huge sigh of relief knowing that I didn't unknowingly mess around with his medicine and how it was given.

[Jenny & Judi in MN]

good news on the compounded drugs, those sound way more appealing to a dog than a cut up pill in some cheese!

so, are you giving Bo prednisone? when do you start the Lyso again?

inquiring minds want to know! :)

[Bo's Mom]

No, thankfully we didn't have to do the predisone. We have started on the Mitotane now. We are going to be doing 250 mg/week (3 x a week...Tuesday/Thursday/Saturday).
I am hoping things start to settle down with him. He is getting his appetite back slowly but surely. Still no where what it needs to be.
I call the "new" vet tomorrow to update him and let him know how he is doing on his new dose/frequency.

[Jenny & Judi in MN]

keep us posted on Bo. I'm worried where his vet has you doing the mitotane again and Jenny's IMS said no more drugs unless her symptoms come back

every dog is different I know but I still worry. Thanks for all your support, puppy rubs to Bo!

[frijole]

:D Here you two are talking again getting me confused as to who I'm posting to :D:D:D:D

The difference in Bo's case is that Bo's last reading was 1.2 which is NOT considered too low - but it was close. So he didn't need prednisone. They waited a while to start the maintenance dose and now the key will be to see what happens at this dose.

I wish the appetite was normal as that makes it harder but if Bo quits eating - cease the lysodren and you'll have to do another acth test. Assuming all goes well and I'm thinking it will since the dosage is back to what is acceptable then you will try this dosage for FOUR WEEKS. At that time you should have another acth test... and the reason for this is to make sure you are maintaining the load (staying at the same cortisol level)... if the number is up you might have to tweak the dosage up but just by a wee bit - not like you were doing before.

Come on Bo - you can do this. :) Keep us posted! Kim

[Jenny & Judi in MN]

How is Bo doing? Is his appetite coming back? Judi

[Bo's Mom]

Judi,
Bo has been having his good days where he has the energy to go for a short walk and play and then he has his bad days where he only wants to sleep.
His appetite has improved where he will finally eat his food. It just takes him forever to do it. My other poodle eats his quickly and then begins to eye Bo's food but has never attempted to steal any. I don't know if Bo would mind if he did. Bo has started this thing that when I feed him, I don't let him leave the room but he will walk around his bowl, rub up against the cat post and rub his paws on the tile (like a bull does right before charging). Weird...but then he finally starts to eat and he will finish his food.
I am going to be making another appt with the vet to have another ACTH test done to see if his levels have finally stabled out on this new dose. I am looking to have a day off in the next couple of weeks. Anyway, sorry for the long post....how is our sweet little Jenny?
Belinda

[Jenny & Judi in MN]

Judi,
Bo has been having his good days where he has the energy to go for a short walk and play and then he has his bad days where he only wants to sleep.
His appetite has improved where he will finally eat his food. It just takes him forever to do it. My other poodle eats his quickly and then begins to eye Bo's food but has never attempted to steal any. I don't know if Bo would mind if he did. Bo has started this thing that when I feed him, I don't let him leave the room but he will walk around his bowl, rub up against the cat post and rub his paws on the tile (like a bull does right before charging). Weird...but then he finally starts to eat and he will finish his food.
I am going to be making another appt with the vet to have another ACTH test done to see if his levels have finally stabled out on this new dose. I am looking to have a day off in the next couple of weeks. Anyway, sorry for the long post....how is our sweet little Jenny?
Belinda
his new eating routine sounds pretty funny. Don't you wonder what is going through their little poodle heads?

Since Jenny is diabetic my dogs both get fed twice a day. Ranger needs to lose weight so if he doesn't eat by the time she is done, it is gone. So, he has learned to stalk her. When she wasn't interested in eating, she'd walk away and he'd pounce. argh

I hope his appetite continues to improve. And I hope his next ACTH improves. Jenny is taking a very small dose of prednisone each morning for a week to see if we can stabilize her eating so we can stabilize her blood sugar. Judi

[Bo's Mom]

Judi,
How old is Jenny? I just can't get over the similarities in each of their cases. Bo turned 9 in February and I often wondered where his "sister" went. I know it is far fetched but it is wild to see how much these two have in common.
Happy Mother's Day to you!!

Belinda

[Jenny & Judi in MN]

Judi,
How old is Jenny? I just can't get over the similarities in each of their cases. Bo turned 9 in February and I often wondered where his "sister" went. I know it is far fetched but it is wild to see how much these two have in common.
Happy Mother's Day to you!!

Belinda

Hi Belinda. Jenny is an old woman. She will be 12 in June. It is crazy how similar their stories are. Except for the diabetes. Lets just get Bo's cushings regulated and call it a day! Fingers crossed he eats all week!

Happy Mother's Day to you too! Judi

[Bo's Mom]

Hi All,
Just wanted to ask a quick question: What does a seizure look like in a dog? I have seen Bo twitch and jerk before but really just blew it off because I have seen it happen so much and it doesn't look like a "typical" seizure reaction that I have seen in humans before. When he has these twitching moments, a lot of times he is sound asleep so I thought maybe he is just dreaming.
Just wanted some other opinions....hope our babies have a wonderful day!!

Belinda

[Bo's Mom]

Can someone tell me about getting a resting cortisol level rather than they "typical" ACTH test is done? And is it as accurate? I remember the vet mentioning this at our last visit but don't remember exactly how levels are measured if you are not injecting cortrsyn(sp??).
I will be calling and getting Bo tested again real soon and was wondering if anyone has had their babies tested this way.
Update: Bo is doing better. His appetite is coming back to almost normal and seems a little bit perkier. He still has his moments of "Leave me alone Mom, I just want to sleep." But they are a little farther between. I guess I want him tested again just to make sure we have him dosed correctly.
Thanks again,
Belinda

[StarDeb55]

Belinda, I don't believe I have posted to you before, but after doing a quick scan of Bo's thread to try to jog my memory, it sounds like he has been on lysodren. If that's the case, I'm almost certain that simply a resting cortisol level is not appropriate monitoring for pups on lysodren. It's being used with trilo pups who are stable, if memory serves. If I'm wrong about using it with lysodren, I'm sure someone will correct me.

Debbie

[Jenny & Judi in MN]

Hi Belinda: Because my Jenny's cortisol went SO low, her IMS and her vet have agreed that we will be doing this test in a week or so also. It is only a blood draw and she doesn't have to stay.

The theory is that if this test is really really low like her last one was, putting her through and paying for the rest of the ACTH would be unnecessary as she is probably not producing any cortisol.

my vet was going to check on the cost because he isn't sure that it will save a lot and get back to me.

I thought Bo's levels were closer to the normal range than Jenny's (her pre test # last time was either .2 or .3) so that would be the question for me, if it is worth it for him.

let us know what you find out!

[Bo's Mom]

No, Debbie you are absolutely correct when you say that Bo is on Lysodren. And thanks for letting me know but yes also the conversation was the possibility of putting Bo on Trilostane and then do a resting cortisol. I couldn't remember what he had mentioned about doing a resting cortisol test. But, I now know it was probably doing it when(if) we switched him. Thanks again!!!

Belinda

[Squirt's Mom]

Hi Belinda,

Just a reminder that you will need a wash-out period of a minimum of 30 days if you switch him from the Lyso to the Trilo. ;)

Hugs,
Leslie and the gang

[Bo's Mom]

No, I decided to stick with the Lysodren because as mentioned before, we have done the hardest part and finally got him loaded. Now, just to make sure we keep the maintenance going.

Just to mention: You guys are awesome!!! Wanted to remind you of that just in case you forgot. :p:p:p

[Bo's Mom]

Hoping all our fur babies had a great weekend and continued good times.

Belinda Rose

[frijole]

Thanks.... assume dear Bo is doing great. Thanks for checking in!!!! Kim

[Bo's Mom]

Bo is doing as well as I can hope right now. I am about to schedule another ACTH test sometime in the next week. Crossing fingers and everything else that will cross right now.
He is not showing any signs that the dose is incorrect except all he wants to do is sleep all day. But it gives us together time to take naps. :D

[lulusmom]

Fingers and paws will be crossed here, hoping that Bo's stim test is on the money. We'll be anxiously awaiting the results so please do get a copy of the test so you can post the numbers here.

Glynda

[Bo's Mom]

I gave Bo his Lysodren this evening (125/mg) and since I have been home watching him, he seems to be drinking a lot more water again. He is scheduled for his stim test on Thursday morning to see if this is actually a dose that we will maintain on for a while. But if you were to ask me today if Bo is exhibiting symptoms that his cushings is not well controlled, I would almost have to wonder and think about it. If you were to have asked me a couple weeks ago, I would almost bet my life on it that we had him at the perfect dose. Will there always be these crazy up and down moments when symptoms abade and then come back? I know we are going for the stim test but at what point do you all decide maybe our cush baby needs another test?
Just curious...
Belinda Rose

[Bo's Mom]

Oh and the water drinking has just really started today...

[lulusmom]

Hi Belinda Rose,

My dogs got acth stim tests every three months for the first year and then we went to every six months. The first year is the worst as it's not uncommon for a dog on Lysodren to relapse in the first year. You want to have stims done no less than every 90 days during this time so you can catch things early and take corrective measures, such as increasing or decreasing the maintenance dose. I promise that there will come a time when you can enjoy life without the worrying about where Bo's cortisol levels are today and where they will be tomorrow. I remember those days only too well.

Glynda

[Bo's Mom]

Ok here are the latest ACTH on Bo:
0.8-Pre
1.0 Post
Bo is currently getting 125 mg/2x a week(Tuesday and Saturday). Now the vet is wanting to see if 125 mg. every 5 days is a little better for him since he is taking a compounded formula meaty chew and they are difficult to get an accurate dose. I don't think he was too comfortable with having numbers so close to an Addison's crisis. We will do that for a couple of weeks and he has yet another ACTH test scheduled.
Thoughts??

[frijole]

Can you refresh our memories and tell us how low Bo went the first time (during loading)? Was he Addisonian or just close to it? I think I would withold lysodren and see if the adrenal cortex grows to the point you can resume dosing... you risk going Addisonian. Thanks, Kim

[Bo's Mom]

Bo was never loaded in a traditional way. We fiddled around with the dosing with my"old" vet and that is what led me to you guys and I learned the correct way to do this. And, I have since switched vets for Bo. Needless to say, we finally achieved loading but got awfully close to having him go into Addisons with a post level ACTH of 1.12 back in May.
I had him go for another ACTH test last week and we are still kind of close with the pre and post results with him on 125 mg/2x a week(a total of 250 mg/weekly).
So the vet has decided instead of 125 mg/Tuesday and Saturday, we are going to 125 mg/every 5 days for 4 doses. The reason is because he has his medicine compounded and it is very hard to make sure you are getting the accurate dose if you have to cut it into any more than 2 pieces.

[frijole]

Interesting... I'll throw out my original thought and ask more questions .:D

Did you wait a while before resuming the dosing you have been on? If so, how long?

If you did NOT wait then the current dosage seems to be keeping the load at the exact same level. Since that level is dangerously close to addisons I would cease giving lysodren to get the cortisol level up to above a 2 and then go back on the same dosage to test to see if you can keep it at that level which is safer.

If you DID wait - depending on how much time you gave it - assuming you gave it a few weeks then to me that means that the current dose is too high.

Maybe I am worrying for naught but I would not give my dog lysodren if their cortisol was at 1.0 even if the dose was lower - too risky.

Kim

[Jenny & Judi in MN]

Jenny went a lot lower than Bo but when I took her to the IMS he said not to even consider giving her Lysodren again till she gets up to 2.0

He said he didn't want to put her through the ravenously hungry symptoms again and to just be alert.

Jenny is still taking prednisone to keep her appetite up so I think I killed her cortisol production.

sooo, I'd go with Kim's advice and tell your vet you'd like to hold off on any more Lysodren. Going from twice a week (every 4 days) to every 5 days doesn't seem like that big of a change to me

hugs, Judi

[Bo's Mom]

Thanks you guys for your replies. I spoke to the vet today and I told him I am ceasing the Lysodren for a time to see if his levels will rise some and not be so dangerously close to Addisons. I will be in close contact with him and he was perfectly fine with that. I am watching my baby boy and hugging on him as much as I can during my time off. :D:D:D

[Bo's Mom]

Quick question: Is there another test that can measure cortisol without having to do the ACTH test? Seems like I keep hearing that the post number is more important and can someone explain to me why that is in as easy to understand terms as possible? : )

[frijole]

Quick question: Is there another test that can measure cortisol without having to do the ACTH test? Seems like I keep hearing that the post number is more important and can someone explain to me why that is in as easy to understand terms as possible? : )

Nope.. acth test is what you use to measure cortisol for our cush pups. I think you'll enjoy this article. It covers cushings basics and all of the different tests. She writes in a way we can all understand.

There are two numbers on a cushings test a pre and a post (pre meaning before the stimulation and post meaning after the stimulation) The pre number is meaningless - the post number is what you use to monitor progress. It is the number you want to be between a 1 and a 5. Enjoy! Kim


http://www.kateconnick.com/library/cushingsdisease.html

[frijole]

Thanks you guys for your replies. I spoke to the vet today and I told him I am ceasing the Lysodren for a time to see if his levels will rise some and not be so dangerously close to Addisons. I will be in close contact with him and he was perfectly fine with that. I am watching my baby boy and hugging on him as much as I can during my time off. :D:D:D Good girl. I'm really glad you decided to do this. Kim

[Bo's Mom]

Hello Everyone,
Another quick question....okay really questions :p Bo has recently started this cough that keeps him up and night and it is progressively getting a little worse. At first I thought he was gagging on something but after a few nights of this, I am wondering if it is congestive heart failure or collapsed trachea. Is this cushings related?
What are the diagnostic test for these two? Is there one test that can rule out/confirm both? Otherwise he seems to be fine. We are going back probably soon to have another ACTH test done and just wondering if I wait too long to mention this that he can suffer major complications.

[lauraperla]

There's a number of things it could be. Yes to tracheal muscle weakness, possible heart issues. It could also be allergies, a lot of our cushdogs manifest stronger allergy symptoms as their cortisol drops. Could be some other form of infection too.
I'd probably phone the vet and talk if through then they can advise you whether to come in, of just watch and monitor .
Good luck, hope it resolves soon.

[Squirt's Mom]

Squirt acted similar last year and she was diagnosed with bronchitis. A round of antibiotics and cough syrup, she was fine and has not had a problem like that since. I would have the vet take a look at Bo asap.

Let us know how he is doing and what the vet determines.

Hugs,
Leslie and the gang

[Harley PoMMom]

My Bear, who does not have Cushings, has a collapsed trachea. It was confirmed with a X-Ray, also the slightest pressure on his throat will cause him to cough and gag.

I believe heart problems can be diagnosed via a X-ray.

Love and hugs,
Lori

[Bo's Mom]

Oh my: It has been so long since I posted but I have been out because I had surgery on my foot and am now not able to walk at all. I have a quick question: Bo is going in for ACTH test tomorrow and we have frozen his cortrosyn in the vials. I forgot to call the vet to ask when we should take it out to have it thawed before the visit. Can anyone tell me how long before his appt it is safe to take it out of the freezer? Should I go straight from freezer to refridgerator? Or straight to room temperature? His appt is at 9AM. Thanks for any input.
I hope all our fur babies have a safe and restful evening.

[Squirt's Mom]

Sorry - I don't know the answer to your question. Oh, that was a lot of help, huh? :p I truly would have thought your vet would keep the extra. :confused: You must be in shoes like mine and the only one at your vets to have ACTHs done. :D

I hope all goes well with Bo's test today...and that your foot heals soon. How is his coughing doing?

Hugs,
Leslie and the gang

[lulusmom]

I've never seen instructions on how to thaw but if I were you, I'd thaw it out in the refrigerator. Did your vet split the vial and store the remainder in syringes for you? If not, you should discard what you haven't used as it is not recommended to thaw and refreeze. It is also not recommended to store in a frost free refrigerator like we have at home. Dr. Mark Peterson tells vets that the best place to store the cortrosyn is in the deep freeze they use for pets who have passed as there is no defrost cycle in these units.

[Bo's Mom]

The vet stored enough in individual doses for 5 more tests(I think...I have to go count again and I am not too close to the deep freeze. I have a deep freeze at home and I used that. I did call this morning before Bo's test and he said just take it out as we head up there and it should be fine when we get there. It is about 10 miles away. It is such a small amount and it was totally defrosted when we got to the office and they began his blood draw immediately.
His coughing has improved but maybe every 4 or 5 days he will wake up and cough some. Just not like he had been. Maybe it was just a nightly tickle he was getting. I did alert the vet and he said his lungs sounded clear and we are going to play a wait and see if it starts up again. If so, then I will take him in for some xrays and blood work. Poor baby today, he bled all over the tech but he is such a good patient. We will get results tomorrow and I will post them as soon as I hear anything.
Thanks everyone....love your babies tonight.

[Bo's Mom]

And, that saved a ton of money today by taking in the medicine. Last ACTH was $402. This one was $200...big difference. I am just hoping that we don't have to use the rest of the syringes of medicine. But, it sure is nice to have them stored to save money. I owe you all that for sending me the link to that article that mentioned preserving the cortrosyn. :p

[Bo's Mom]

Bo's latest ACTH results:
Pre--1.5
Post--1.5

Yea...we are finally at a dose that he is loaded and I feel a little more comfortable keeping him at...even though I would have liked that post number at 2.
We are going to be giving him 125 mg/every 5 days. We will test again but I forgot when he said. I will call him and ask that later. Just finally feels like we have accomplished something just terrible that it took a whole year to get to this.

[Bo's Mom]

Another question:
Does anyone know if Lysodren or cushings causes twitching of legs? Bo will be either asleep or awake and he will just suddenly twitch. It happens quite a bit and it is not all in a sequence. He will do it once and then maybe two or three minutes do it again. Then he won't do it for 3 hours or so. IDK....he does have the weakness in the hind legs and that really hasn't gotten better. We aid him all we can to help him around.
Hugs sent from Texas to all the fur babies tonight.

[Bo's Mom]

Any input please:
In the last few days Bo has really started to slow down. Well, today he really was lethargic. Not wanting to get up unless I actually picked him up to go anywhere. He did eat but that is only because it was mainly cheerios with a bit of his Halo food. He doesn't want any treats and his nose is really dry even though he does drink some water. The twitching is still going on, not any better or worse. Cough maybe once this week but not since then.
The last time he got his Mitotane was 5 days ago (125 mg). I didn't give him today's dose because I didn't think it was safe. He does have an appt tomorrow AM but would you possibly start Predisone or just wait and see if this could be something else after going to the vet? I don't want to do any harm by giving him the Predisone if this is something else(not Addisons/Cushings) And, does Predisone have an expiration date? I've had it since last year and we have never had to use it.

[StarDeb55]

Most drugs are usually good for 1 year after the expiration date. If he's not scheduled for a stim tomorrow, I would give him the pred. If his cortisol has dropped, he should start feeling better in about an hour. Frankly, with Bo's numbers being so low on that last stim, you don't have a whole lot of room before he would be too low, so, IMO, I think I would give the pred regardless. If he is to be stimmed tomorrow, you may want to postpone the ACTH for 48 hrs. to give the pred time to clear his system. I just don't think it's worth the risk not to give the pred, especially if he really starts having problems.

Yes, you did absolutely the right thing by not giving the lysodren tonight. The "golden rule" around here is never, ever give either lyso or trilo to a pup who is not feeling well.

Please keep us posted.

Debbie

[jmac]

Hi there,

Unfortunately, I don't know what to tell you about the pred., but I'm thinking it was a good thing to skip the drug today. I hope others will be along soon to answer your question.

I hope Bo is okay, and that you'll figure out what's going on at tomorrow's appointment. You'll be in my thoughts...

Julie & Hannah

[Jenny & Judi in MN]

Hi Belinda: I hope you gave Bo the prednisone and I hope he is feeling better. It makes a world of difference for Jenny.

(She is still taking it, has been since April)

hugs, Judi

[frijole]

Just wanted to second what Deb told you. I was kind of surprised you started maintenance dosing at 1.5. Also I believe the dose you are using is the same one that you used when Bo went low (I think)... Anyway.. it could be that this dose is too high. You absolutely did the right thing by holding back on the drug. There is no rush to treat cushings so always remember that ok? Good job! Kim

[Bo's Mom]

I just want to say how fortunate I feel that this group is such a wonderful wealth of knowledge and I want to thank all of you.
I gave Bo the predisone (5mg). Now I guess my next question is for anyone who has had to give their dog Predisone because of a crisis... and this is totally my fault.
His predisone was in a little envelope and I accidently got it wet one day so I transfered it to another envelope and wrote what was in there with the amount but forgot to write the directions for administering it. I gave him the Predisone a bit ago and only have 4 more pills. Is it once a day dosage? Or should I give him another dose in the morning before his appt? Or only give him a dose depending on symptoms?
Again, thank you for all of your wonderful knowledge. I will post again tomorrow to update everyone.

[Jenny & Judi in MN]

Jenny was 8 pounds when we started this. She goes from 6.5 to 7 now. Her prednisone bottle was for 5 mg tablets to be given 1/2 tablet twice a day. So giving him a whole one today should be fine.

We tried once a day dosing now that we are on pred daily but it would wear out and she wouldn't be hungry for one of her meals. So we split the pred into 2 doses because she eats twice a day.

Let us know how it goes tomorrow. My IMS said he wouldn't want Jenny to consider Lysodren again until her pre and post #'s on the ACTH were both above 2. I haven't even tested her since I saw him since she is feeling good and eating good on the prednisone. but I don't think my vet will refill her prescription again until I get her in there.

Is Bo perking up? hugs, Judi

[Squirt's Mom]

Mornin' Belinda,

How is Bo this morning? Did the pred perk him up last nite? Is he interested in food and is he more responsive this morning? Let us hear from you and be sure to let us know what the vet says if you take him in this morning.

Hugs,
Leslie and the gang

[Bo's Mom]

Took Bo in after a night of me sleeping with him with the lights on so I can keep a close eye on him. The vet ran his electrolytes and all came back within normal limits although the sodium was a little low...but still okay. Vet said the results may have been different if I hadn't given him the predisone. I am to give him a 1/2 pill (2.5 mg) tonight and see if he will perk up a little more and start eating better. He is to stop Mitotane until he is checked again. I am to take him in again tomorrow if the weakness or if he doesn't start to eat or drink or if he just doesn't seem right again and they will run further tests.
Again, I can't thank you all enough for everything you have to offer.

[Bo's Mom]

What would you do?
Bo is continuing to slowly improve. His appetite is coming back a little bit. He is a little more alert. Although he is not his spunky old self but at this point I will take anything. He has been off of Lysodren for
I want to know:
1. Would you take your dog in for another ATCH test? Or rely on symptoms to decide on whether to continue the Lysodren?
2. How long would you wait?
3. What numbers would you be comfortable with in continuing the medication?
Sorry for all the questions. It is just I rely on this group's knowledge and expertise when dealing with all the issues that seem to come up with our babies. Thanks again everyone!!

[StarDeb55]

Belinda, it's going to be a combination of things. Yes, you will need to rely on the return of symptoms, but once those symptoms start returning, you absolutely do not want to restart either drug without an ACTH to know where you're at. I really can't offer an exact time frame of how long to wait. If it were me, I would be looking for symptoms beginning to return, & take it from there. This is just my opinion, but I think I would like to see post stim values between 3-4, before restarting meds, but you & your vet will have to make the final decision.

Debbie

[frijole]

I agree with Deb and I repeat - I would LOWER the maintenance dose because it was probably too much which is why he went low again after only one dose. Repeat - no need to rush. Kim

[Jenny & Judi in MN]

so, how is Bo and what did the vet say? I double checked my IMS notes and he specifically said he would not start lysodren again until Jenny was at more normal levels. hugs, Judi

[Bo's Mom]

I am going to wait to see when the symptoms return to call the vet to schedule any testing. It has been 9 days since his last dose and I still don't feel comfortable that Bo is getting anywhere near normal....if we can call anything "normal." Bo is still just moping around and wanting only to sleep but nothing like that night where he scared me to death. He is eating and going to the bathroom normally. So I am just wondering if it is going to be obvious enough to me on whether his numbers are starting to creep back up. It scares me that he may begin to climb too high and then we are back to square one. This disease is tough!!!
Trying to hang in there here in Texas.

[Jenny & Judi in MN]

are you giving him any prednisone?

My IMS said to be alert for symptoms, which Jenny has not had. But my regular vet just got back from vacation and I have to get her levels tested soon.

A little bit of prednisone could perk him up. It sure has helped Jenny

[Bo's Mom]

No, Bo is not taking any Predisone at the moment. I have not given him any medicine since that last Predisone dose (2.5/mg) on Monday. I guess I just worry about giving him anything because I always hear don't give him Predisone unless he is in a true Addison's crisis, which that evening I believe he was. He is not like that anymore except he is not as active as I would like him to be. He gets up to eat and go to the bathroom and that is pretty much it. And, his bloodwork came out normal...I am just playing the wait and see which way Bo is going to go.(Addison's or Cushings).

[Bo's Mom]

Ok, this is crazy....Target carries Lysodren for dogs?? I just ran across their PetRX site and they list all the drugs they carry for our furry friends. Lysodren is on there. I have to check that out but has anyone heard of this?
There are also other meds on their for as cheap as $4.00. I recognize the names from other members who have posted to this group. So please go check it out.

[Jenny & Judi in MN]

I got mine at Walmart so I believe it. I think Lysodren is an old human drug that isn't used much anymore. My vet has a pharmacy that keeps it in stock just for him but our Walmart had it.

Let us know if you get it for $4 that would be huge!

[frijole]

Yep. And yes it was developed for humans. It is also available at Costco. I purchased mine from drugstore.com for many years without a hitch. They dealt with the prescription renewals (calling the vet) so it was painless and I got my drugs within 3 days of ordering via regular mail. I just checked and it looks like Walgreens handles their meds now.

Kim

[lulusmom]

I just found three of the meds (Levothyroxin, Enalapril and Furosemide) for my dogs on the $4 generic list. I'm calling tomorrow to see if they carry the smaller doses. This could save me a whole lot of money. Thank you so much for posting this info.

FYI, there is no generic for Lysodren so unfortunately, you aren't going to get a 30 days supply for the price of one pill. :( I dare say that if we could a get 30 generic pills for $4, nobody would still be praying for a money tree and very few dogs would be treated with Vetoryl. For those who have very small dogs, requiring less than a 125mg dose, you have no alternative to compounded mitotane.

[Squirt's Mom]

Just contacted the local Target and, no, they don't carry it, and they won't get it in for us as it isn't on the ARK list for the 4$ program even tho their website says it is. :(

[Tina]

I have started checking around at my local pharmacies, and just Friday I priced it at Walmart. They quoted me $5.22 per pill, and that was for ordering either 4 or 8 pills at a time. I didn't inquire about larger quantities. Some other pharmacies that I checked, there was a big price difference between ordering 4 or 8, much cheaper to order the larger quantity.

So far Walmart's price has been the lowest I have found, even online. They said it would take them 2 or 3 days to get it from the time of the order.

Tina

[Jenny & Judi in MN]

Bo you are such a sweetie! Good luck with your test this week. Jenny & I hope your levels are up but not too far up!

let us know. hugs to you and your Mom, Judi & Jenny

[Bo's Mom]

I was going to take Bo today for a recheck of his levels to see where we are at with not being on the Lysodren for almost a month now. Plans are changing. I have to take him in because I think he is dehydrating. He has refused to drink at all and no coaxing has helped. I have for the whole day yesterday gave him syringes full of water every hour. Now it is just getting harder to give him that because he lets it all run out of his mouth.
It is a weird thing it is like he wants to drink but everytime he puts his head down into the water bowl, cup, floor(I've tried every container in the house for him) he gets his nose wet and then won't drink it. I've tried raising his bowl so he doesn't have to put his head down and that didn't work either. So hopefully, there is nothing wrong health wise and he will start to drink. He is even refusing ice chips.
I will see when the vet thinks we can do another test to check his cortisol production. But as we speak, I don't think his numbers are coming up at all based on his symptoms he is showing. I will let you all know. THanks again for all your support!!

[Squirt's Mom]

Bo may need back on the pred. Please let us know what the vet says. Keeping you and Bo in my thoughts and prayers.

Hugs,
Leslie and the gang

[jmac]

I hope they can figure out what's going on with Bo and that he'll be drinking and feeling better soon.

Julie & Hannah

[Jenny & Judi in MN]

Belinda: ask the vet if you can give him prednisone right away! I'm so worried about him right along with you.

Please keep us posted.

hugs, Judi

[frijole]

I agree... if I recall you took him off prednisone to check his cortisol. If he isn't drinking when off the prednisone it means his cortisol is still too low. Save the money and skip the acth test unless you had it done this a.m. The little guy needs prednisone! Keep us posted. Kim

[Bo's Mom]

Update on Bo:
Had electrolytes checked, blood chemistry, and urine gravity(??) done. Everything came out ok so far except the regular stuff that is always high because of the cushings. He was a little dehydrated but not too bad. Gave him a dose of predisone in the office and I am to call vet in the morning. I am still shooting water in his mouth every hour to make sure he doesn't dehydrate on me because he is refusing to drink out of a bowl. I don't know the vet's plans when I call in the morning and give him a report. I have rescheduled his ACTH test for Monday morning. Vet is thinking we may have an Addison's case now. He told me that there are dogs who have "normal" electrolytes but are still considered Addisons and the only way to tell would be the ACTH test. Anyone heard of that?
Hope everyone has a restful evening. Thank you all for your kind words and advice. You all are wonderful!!!

[molly muffin]

Prednisone. If his cortisol is that low then he is going to need that. I'm with everyone else on this one.
Hang in there. If it is Addison's it can be dealt with.

Hugs,
Sharlene

[frijole]

I have one question and that is why in the WORLD didn't they do the acth test today? That way Bo could go back on prednisone full time without suffering til next Monday? I wouldn't wait that long. What were the vet's instructions about prednisone dosing between now and then? It does sound like perhaps Bo is permanently addisonian and that is ok but that means prednisone. He can't live without it. Thanks for the update and give him a hug, Kim

[Jenny & Judi in MN]

that is so strange about him not wanting to drink out of a bowl. did you try changing the location of the bowl? what about ice chips? Jenny wants Bo to feel better!

My vet said he doesn't think pred messes up an ACTH but I read somewhere when googling that ti should be out of their system for 24 or 48 hours before the test. what does your vet say?

I hope your little guy is perkier this morning.

Another question I failed to ask is that if the pred is so hard on the liver should we be giving SamE or milk thistle too.

thinking of you and Bo. Judi

[labblab]

Belinda, I'm sorry Bo is having such trouble. Just wanted to tell you that, yes, it is possible for him to be "Addisonian" due to low cortisol even though his electrolytes are normal. Here's a link to an Addison's website that discusses differences among types of Addisonian conditions:

http://www.addisondogs.com/addisons/

Also, if he cannot tolerate being without steroid supplementation long enough before an ACTH test, you can ask your vet about perhaps temporarily switching him from prednisone to dexamethasone. It is another form of steroid supplementation, but apparently is not as likely to skew the ACTH results as prednisone. Just a thought.

Marianne

[Bo's Mom]

Bo is scheduled to continue the Predisone until Sunday AM. We couldn't do the test yesterday because I didn't have the Cortrysyn and it was already getting time for the office to close. He is a little more perkier today but I am still having to syringe feed him water. I have also put a lot more water in his food along with pinto bean juice(don't ask). He has just acquired a need to have the juice of pinto beans added to his food before he eats it. It used to be Cheerios and now he has wanted pinto bean juice. So every Sunday I make a pot of pinto beans with no spices or salt added and he gets a syringe full of juice added to his food. I freeze what is left over in syringes and defrost them in the fridge before he gets it added to his food. Go figure. Anything for my fur baby that gets him to eat.

[frijole]

Wow... from Cheerios to pinto bean juice... Bo has some serious cravings. You sure he isn't pregnant? :D:D:D:D Good for you to figure all that out though.

I totally forgot you are the keeper of the cortrysyn. For the record I don't ever remember a member keeping it at their home. Maybe they just never mentioned it but my vet kept it at the clinic for future use and took it out before appointments. Sorry I just forgot.

Was Bo eating normally before going off the prednisone? Or were you doing the cheerio and pinto bean thing then too? He's lucky to have a wonderful mom... I am impressed! Hugs, KIm

[Bo's Mom]

No, Bo hasn't eaten "normally" in a long time. We have had to play around with his food for close to a year now just to get him eating. He goes in cycles where he will eat a certain food for a while and then turn his nose up to it and have me switching it all around. I have always fed him Halo even when I was mixing it with home cooked feedings. The pinto bean thing was totally found by accident when a some juice fell on the floor and he was super quick to clean it up.
This has actually allowed me to really dilute his food to try to keep him hydrated. So it was kind of a blessing in disguise.
LOL at the Bo being pregnant remark. I often have asked myself the same thing.

[Bo's Mom]

Hello Everyone,
First I want to send prayers to all who are hurting right now because your fur baby has left you or is ill. We hold you all close to our hearts.
Just popped in with another question. The more I read about Addisons, the more I think that we have inadvertently caused Bo to be an Addisons dog. All the symptoms seem to point that way. I don't know which diagnosis I am more frightful of: Cushings or Addisons.
But, my question is if he has in fact become Addisons, will he possibly go into another Cushings diagnosis and we can play this see-saw with going from one extreme to another? Or, once an Addison's then always an Addisons? I think if we destroyed the adrenal gland totally and he is no longer able to produce cortisol, I wouldn't see it regenerating.
He goes in Monday AM for his ACTH test and I will have better answers by mid-week but it is so scary not knowing what is causing all his issues.

[Jenny & Judi in MN]

((Belinda)) hugs to you and Bo. I freaked out when Jenny was in this spot too, we've been on prednisone since the beginning of May and it is less stressful to me than the Lysodren was. I do like that we are doing liquid pred because the once a day dose wasn't working for her and it was easier to split it in 2 and give it to her at each meal.

The IMS told us to watch her for symptoms, not to let her be raging Cushings again if she were to start showing signs of increased cortisol.. Up until a week ago she had no symptoms but finally she has been eating a little faster so we are having an ACTH done on Wednesday. I was supposed to take her in 3 weeks after our IMS visit. But I knew she had no symptoms so we took a vet break.

The specialist told me he would not even begin to consider giving her Lysodren again until her pre and post levels were both above 2.

My regular vet said that dogs who are producing cortisol and taking prednisone usually have crappy coats, like a cushings dog. Since Jenny started on the prednisone her coat has gotten prettier and healthier. I truly don't think she is producing any cortisol anymore and it is much easier to deal with than I would have ever thought.

Here are the exact notes from my IMS if that will help you and Bo:

We discussed how best to proceed regarding treat her Cushing's disease. Because her adrenal glands are minimally stimulated based on her ACTH stimulation test, I do worry about starting medication that could further inhibit adrenal gland function, unless that was our intent (ie plan to ablate the adrenal glands and make her Addisonian). It could take Jenny's adrenal glands many weeks to start to gain normal function and ultimately become overactive. With her appetite being marginal recently, I recommend that she have a holiday from the Lysodren for at least a few weeks, with the plan to start Lysodren at 1/4 tablet twice a week (a decrease from every other day schedule that she had been receiving) once her ACTH stimulation has increased at least into the normal range. We discussed Lysodren treatment for Cushing's as well as Trilostane. I do not have a preference in one over the other. Lysodren has been effective for Jenny and this drug would be fine for her on a lower dose with monitoring. Once we start the Lysodren again, I recommend rechecking at least a resting cortisol (if not an ACTH stimulation test) every 4-6 weeks for three checks if she appears to be feeling well (an ACTH stimulation test is indicated if she is feeling poorly).

Give Bo an extra hug from me and his "sister" Jenny. And give one to yourself too. Judi

[Bo's Mom]

Thank you so much Judi. I just can't get over the fact that Jenny and Bo are so similar in their disease processes. You know what...I just found another similarity. You and Jenny start with the letter "J" and Bo and I start with the letter "B". Forgive me, I am having to get ready to go back to teaching and those things have been on my mind lately as I prepare to put up my word walls. :p :p :p
Good luck with the test next week. Hopefully, we will see some numbers that we are all comfortable with. BTW...I give Bo 2.5 mg of Predisone once a day because I can't break it up any more than that. But, I kind of like the idea of 2x a day and liquid form. I have to ask the vet about that because it might be better for us to do it that way also.
Hugs from Bo and me to you all!!! Enjoy the rest of your weekend.

[Jenny & Judi in MN]

lol at the B's and J's!

My Mom was an elementary teacher, I hope you have a great year and don't have to worry about Bo! If you look for Gabby Sue's thread, she went through the same thing with the same conclusion.

I did ask my regular vet about prednisone and the liver. He said prednisone will wash out of their system pretty quickly so if we wind up with her on nothing he is not concerned. I guess I'll talk to him more about it after we get the ACTH results.

My specialist had said if I wanted to save money I could just do the pre part of the ACTH and not the whole thing because if that first value was under 2 he would keep her on the pred. May be something to ask your vet about if Bo's values come in low again.

I hope he is eating! hugs, Judi

[molly muffin]

How is Bo doing today? Just popping in to check up on everyone!

Hugs,
Sharlene

[Bo's Mom]

Bo is doing the same as before. I am still giving him water via a syringe. Vet checked him out and said he looks "okay" not dehydrated. He is eating and going to the bathroom. We are going to wait to see what the ACTH test tells us. We will get those results tomorrow. I just have a feeling that I now have an Addisons dog and we may be dealing with that now. I will post those numbers as soon as the vet calls me. He usually calls late in the afternoon after seeing patients. So, I guess all day tomorrow I will be sitting on pins and needles.
Funny thing: Bo was among 3 patients today getting tested using the ACTH. I spoke to the other 2 families and they both are brand new to this all. Each was at a loss as to what was even going on. I told them both about this wonderful group of people that are here and they took the information. I don't know if those dogs really do have cushings but it sure is something that the vets here are really looking at.

[Bo's Mom]

I am now dealing with an Addisons dog. Bo's levels are as follows:
Pre: 1.6
Post: 1.6
So there was no response to yesterday's ACTH. Our plan is to now give him daily predisone (2.5/mg) and he is now taking Fludrocortisone which is a 0.1 mg tablet but we are starting him on 1/2 tablet daily. I am going to be calling the vet tomorrow and Thursday to give him a report and we will go from there. He mentioned an injection that he could be getting which is every 28 days but that would be after his dose is regulated and he is on a maintenance. I am trying to read all I can on Addisons and still feeling overwhelmed.
Do any of you know of an Addison's Forum that is as knowledgeable as you all here?
I just now am worried we are going to never get this straight.

[Squirt's Mom]

Addison’s*

http://canineaddisonsinfo.com/

http://k9addisons.com/faqs/

http://pet-diseases.suite101.com/article.cfm/addisons_disease_in_dog

http://www.inmetrodetroit.com/pets/dachshund/frederick/addisons.htm

http://www.vetinfo.com/dencyclopedia/deaddisons.html

http://pets.groups.yahoo.com/group/AddisonDogs_/

http://canineaddisonsinfo.com/Support.html


The last two are groups where you can chat with other Addison's parents.

Hugs,
Leslie and the gang

[Bo's Mom]

Thanks Leslie!!!
I just hope that I didn't unknowingly cause all this mess when we were going back and forth with all those dose changes. His poor little body just couldn't handle it and all the increases.

[Jenny & Judi in MN]

Belinda: I joined the yahoo addison's group but can never figure yahoo groups out so have never posted there. Hang in there. The last 2 months with Jenny have been way less stressful.

I think we'll officially be addisonian after her ACTH tomorrow.

hugs to you and Bo. Judi

[frijole]

Don't beat yourself up. Addisons was caused by too much lysodren but you were only doing what you were told to do. It can't be undone. It's a lesson to others though - because the vet wasn't following protocol and I've been here a long time and there is a reason they follow protocol.

I think you'll find treating the addisons is not that difficult and I say that based on what others have said - I have never done it. So again - water under the bridge.

You can still post here though because there are members who have dealt with this and besides - you are family now. Hugs, Kim

[lulusmom]

Was the acth stimulation test done after withholding prednisone for at least 24 hours. If not, the prednisone can cause a blunted response on the acth stim test, meaning the post stimulated number could have been higher had prednisone not been in the system. I believe Marianne suggested dexamethasone as it will not skew the results so if Bo is dependent on supplementation, he should have been switched to Dexamethasone at least 24 hours before the stim test.

My second concern is that you are the keeper of the Cortrosyn. Once opened, your vet should have split the remaining agent into individual syringes and stored the syringes in a non frost free freezer at less than -20°C (-4°F) This may sound disturbing and I apologize up front but Dr. Peterson lectures to his audience that they should store the syringes in the freezer where they keep their dead animals. Do you have individual syringes that you are storing for future use or are you thawing and refreezing the vial. If you are thawing and refreezing, you only have one use after rethawing as it cannot be refrozen.

It is common practice in Europe to overdose the dog on extremely large doses of lysosdren so as to destroy the adrenal cortex and create permanent adrenal exhaustion. Because the adrenal cells are tough little mothers, unless you kill off every cell, they will regenerate. A good number of dogs in Europe experience adrenal regeneration within a year, requiring treatment again. So to recap, I'm wondering if your vet did the acth stimulation test under optimum conditions (no prednisone in system for 24 hours) and I'm wondering if Bo is truly Addisonian. I think chances are good that his adrenal glands will regenerate over time and you'll be seeing a return of symptoms. It may take a few months or a year and even if that never happens, we'll be here for you.

Glynda

[molly muffin]

Of course we are here for you, Addisons or Cushings, it's still you and Bo!

HUGS,
Sharlene

[Bo's Mom]

Thanks to all of you for being here for Bo and me.
Yes, Glynda I am the one who keeps the cortrysyn here for future use. I keep it in my sister's deep freezer that she has. Since I have been storing it, I have asked her if she has had any power interruptions and they have not but they would let me know. But, they do have a back up generator that would kick in to power everything in the house in case of power failure. But I think for next time, I will just have the vet store it at his office after we are done with these syringes because we would have run the test when I took him for his electrolyte check. The office was getting ready to close and I would have had to go to my sisters who was not home at the time. He has 2 more left and I don't know when another test will be scheduled. I will ask tomorrow when I talk to the vet.
You guys are AWESOME!!

[Sabre's Mum]

I have been following Bo's journey ... but haven't posted but I am glad that Glynda has posted exactly what I was thinking. IMO, Bo probably is not truly addisonian. His numbers have risen from the last ACTH test which to me indicates that his adrenals are regenerating slowly.

Our Sabre went low ... and he went on a Lysodren holiday for 4 months. Each ACTH that we did after he went low slowly increased and I think we restarted when he had a post of around 3 .... and is was a "reasonable" (for want of a better word!) stimulatory response - by this I mean at least a 25% increase from pre to post. From recollection, there has been one dog in the past that took 17 months before his/her cushings symptoms returned.

Angela and Flynn

[lulusmom]

Hi again,

Thanks for the info on the cortrosyn. Glad that your vet stored the remainder in individuals syringes. :D Can you tell us if Bo was off of prednisone for at least 24 hours before the acth stim test was done?

[Bo's Mom]

Yea!!!! Bo finally drank water tonight from his doggie bowl on his own. I didn't have to give him his syringes full of water tonight. I don't know if it is the new medicine that he is on, or he finally got tired of me putting him through the routine of opening his mouth and shooting water down his throat.
I've been reading your responses and I hope that everyone is correct that he is just getting a holiday from the Lysodren.
With those who got their holiday, did you medicate your dog with the medicines used for Addisons?

[Sabre's Mum]

No we did not use any medicines used for addisons. Sabre had pred for a few days ... we didn't see much change and stopped the rescue dose of pred.

I do not recall on this board any dogs which have been given addison's medications when a dog has gone low and their electrolytes are normal. Usually, if their electrolytes are normal you gauge their behaviour as to whether they need pred, use pred if required, and retest when you believe they are back in range (of a treated cushings treated dog).

I have re-read some of your posts and I am a little perplexed as to how from an ACTH stim test, with normal electrolytes that your vet can determine permanent addisons in a dog which has been treated with Lysodren and gone to low. The results to me just indicate a dog, who has previously been treated with Lysodren and gone low, whose adrenals have regenerated somewhat but have a non-stimulatory response.

You may have missed Glynda's query in a previous post - was Bo off prednisone for 24 hours before the ACTH stim test?

Angela and Flynn

[Bo's Mom]

Angela,
I sure do hope you are correct because I have just been so scared with all that is going on with my little guy.
Bo was off the Predisone for approx. 36 hours prior to this ACTH testing. He has been showing signs that he was low and non-responsive to the ACTH for a couple of months now. We ceased the Lysodren back on 7/24 and began predisone then. I gave him a couple of doses and we watched him. He never showed signs that the Cushings was coming back and then last week he just totally stopped drinking water. He hurt when palpited, he tremored and was doing nothing but sleeping. I have read a few websites that do say that a dog can be Addisonian and have normal electrolytes. Forgive me but I don't remember if it is called something different....atypical, primary, or secondary. I have just read so much in the last few days that everything is just starting to get all confused. I am still trying to understand the cushings thing and I have been doing this for over a year now and I still have tons of questions. :confused:
We were keeping his cortrysyn here at the house in my deep freeze but with a recent storm scare, I took it to my sister's house who has a deep freeze also but has a whole house back up generator that will keep powering the freezer even though they have a power outage.
I am so appreciative to everyone on this group because you all have different experiences and I always feel that someone will always answer my questions that I have while dealing with Bo and all his issues. Thank you again. ;)

[molly muffin]

Awesome news that Bo drank on his own. I think that for now, a steady, regulated dose of the prednisone should help him to feel better. Whether or not he'll come back from the low cortisol experience and when is hard to say. I haven't had any experience with that personally, but many here have, so I would rely on them for a more knowledgeable reply.

It does sound like an up is occurring though. How did he do last night? Did he drink on his own?

Hugs,
Sharlene

[Jenny & Judi in MN]

so glad Bo drank his water on his own! Fingers crossed he continues to improve

[molly muffin]

How's Bo coming along? Hope he is continuing to drink on his own!!

hugs,
Sharlene

[Bo's Mom]

Unfortunately, Bo drank one time out of the bowl and since then has refused. We took him yesterday for a hydration check and I am keeping him hydrated with syringes full of water. He doesn't like it but that is the only way he will get any water. If he starts to dehydrate, I am going to be taking him to the emergency vet this weekend. Otherwise, we will be back at the vet's office on Monday so they can see if possibly he has something going on with his tongue and run other tests. Although, I don't think this is an issue because he has been eating okay. I just dilute the heck out of his food with pinto bean juice and lots of water.(A true South Texan poodle:p)
I did speak to the vet about his numbers coming up again and he said that it is entirely possible and likely to happen. We are just waiting for Bo to give us the sign that it is occuring. And right now he is not. We will be running another ACTH test and if his numbers do come up, we are switching to Trilostane.

[Jenny & Judi in MN]

Belinda: is there something else going on with Bo that could make him not want to drink? poor baby. I hope you don't have to go to the ER this weekend. Gag down that bean juice Bo you crazy poodle!

hugs, Judi

[molly muffin]

oh dang. I'm sorry to hear that Bo is continuing his anti-water crusade. They sure can be stubborn. I've had a few occasions when I've syringed water down molly's throat. More because I worry that she isn't getting enough water and it's important she keep her body flushed out and crystals not forming.
These guys are so frustrating and we love them so much. arggghhh
Hope the weekend goes well and he rediscovers drinking.

Hugs,
Sharlene

[Bo's Mom]

Thanks everyone!! I honestly think Bo knows that he is making mom nuts with not drinking. The vet suggested even holding back his syringe feeding and just seeing if he would drink out of his bowl. It was like playing chicken with him. We wanted to see who would cave first, me or him. Well he won. I just don't like the fact that he is not drinking and I certainly don't want him near dehydration so I gave him his syringes. He is definitly a momma's boy and I really think he knows that he is doing this. I may be pushed into buying him bottled water and see if he will take that. Ugh...any suggestions?

[Tina]

Hi Belinda,

I am so sorry to read about your difficulties getting Bo to drink, and I can certainly empathize. Just a thought, but have you tried putting a couple ice cubes in his water? I know in the past that has worked with some of my dogs when I have faced this problem. I don't know if the colder water was more appealing, or the fact that the ice cubes were in the water is what helped.

As far as bottled water, I have never had much luck with that. It seems like my pooches aren't too interested in "strange water". Even when they are feeling well, they are reluctant to drink water that isn't from home, or in their own bowl! I don't know if Bo is like that or not.

It is so frustrating when we can't get our babies to eat or drink. I hope he starts drinking for you.

Take care,

Tina

[Jenny & Judi in MN]

our well water has a lot of iron in it and I figure the water softened water has too much salt so my dogs drink bottled water. We buy the big refillable jugs.

I've noticed if I run out and have to go back to the well water they don't like it as well. So I do think animals and humans get to where they like "their" water.

could Bo have stomach acid or something? I know some dogs on the diabetes forum either take some form of pepcid or one dog was on ulcer meds for awhile.

[molly muffin]

hmm, molly use to see me drinking out of a plastic cup outside and she refused when she was out there to drink out of anything but her own plastic cup. So, I wonder if you could try that? if you drink first maybe?

hugs,
Sharlene

[Bo's Mom]

I am going to say first that I don't want anyone to think, "Boy this woman is crazy." But, I have actually tried putting my head in his water bowl to show him that his water is okay to drink. I didn't actually drink or touch anything but I was getting desparate. Ok, now I am glad to get that off my chest. To know what we do for our pups sometimes can go down as looking a little crazy. :p:p:p
I have tried the ice cubes even trying to put a treat in one and freeze it in water in hopes that he would want the treat...nope didn't work.:(
He does have his own bowl and cup that I have especially for him. It is unaccessable to the cat and my other dog hoping that he would go for that. Again...no.
He still has access to the other water bowls I have throughout the house for the other dog and cat but he won't drink out of there either. I tell you, he is a stubborn poodle. But, I am going to keep persevering to get him to drink.
I hope all are having a peaceful evening. Our prayers go out to all the pups who are not feeling well or the families who are in pain.

[Harley PoMMom]

Does Bo like chicken? If so, maybe Bo would drink chicken broth diluted with water???

[Bo's Mom]

I haven't tried the broth yet because the vet said to only use sodium free broth and I went to our grocery store today and they don't carry any broth that is sodium free. I am going to try another store this weekend. Thanks for the suggestion....I am going to keep trying. :o

[molly muffin]

We won't say a word about any bowl sharing with Bo. Pinky swear. But is there bowl etiquette involved? Like who goes first, etc? Just kidding you.

On a more serious note, I saw sodium free chicken broth today the grocery here, so it has to exist. It's in a cardboard container I believe. Rather large sized.

Hugs,
Sharlene

[Jenny & Judi in MN]

Belinda: I woke up thinking about Bo today. Have you tried cutting his prednisone in half and giving it to him twice a day? when Jenny's cortisol was really low the once a day dose did not last for her. She wouldn't eat the second meal and was more lethargic.

I'm still worried and wondering what could be causing him to not want to drink along with you.

hugs, Judi

[Squirt's Mom]

Hi Belinda,

Thank you for the morning laugh! :D I could so easily see your head in the water bowl....NOT that I have done anything similar, ever, nope, not me. Just have a really good imagination, ya know? :p

The best broth available is the one we make ourselves by simply boiling the meat and using the water. ;) That way we have more control over what is actually in the broth and a few less worries.

Does Bo eat canned feed? If so, he is getting quite a bit of moisture from the feed and may not need much more through the day. I have seen this with my own going from kibble to home cooked and back to kibble at times. On the kibble, they drink a LOT more than they do on home cooked because of the moisture in the home cooked food. Canned feeds will do the same thing.

Hugs,
Leslie and the gang

[molly muffin]

Thinking Bo today. Crossing fingers for a week where he rediscovers his water bowl. (you guys can work out any sharing issues later) :) :) :) :) :) :)

Okay, I'm going to be laughing about that one for awhile. Actually I keeping it in reserve in fact for molly who is Not a good water drinker.

Hugs,
Sharlene

[Bo's Mom]

Sharlene,
If Molly is anything like Bo, she won't fall for the, "Look Molly, mom likes the water out of your bowl trick". :)It just reminds me of those days when we tried to get our kids to "love" their baby food. We would make all kinds of sounds and faces to get them to believe that stuff actually tasted good. But, they knew what they wanted.
Bo on the other hand needs to like water. He is still refusing to drink and I guess I am going to have to keep giving it to him via syringes until we find out what is going on with him. Otherwise, for the most part things are going okay.

Judi,
I did cut his predisone to 1/4 of a tablet 2x a day(those suckers are hard to cut in 1/4's) Boy I do wish that I had it in liquid form but with Bo not drinking, I would be fearful that he would spit it all back out at me.

[molly muffin]

The thing is that we will do whatever we have to do to get them to drink or eat or whatever it is.
Molly probably wouldn't believe me either. :)

I do hope they can figure out what is causing him to not want to drink though.

Hugs, have a great day
Sharlene

[Sabre's Mum]

Hi Belinda,

What dose of pred is Bo on and how much does Bo weigh? I am just wondering whether Bo actually needs more pred to get him back drinking. How is his apetite and general well-being?

Angela and Flynn

[Bo's Mom]

Bo hovers around 9 to 10 lbs. He is taking 2.5 mg/day of Predisone and also taking the fludrocortisone. As others have advised, I am breaking the Predisone dose into 2 daily doses to see if he does better with the water drinking. So far, really no improvement. He is eating well when I make it like he wants it. Today I went and bought him some wet Halo beef flavor because he used to love that flavor and for a while they had discontinued it. I mixed it with his dry Halo and added some water. He gobbled that down...thank goodness. Maybe our days of pinto bean juice and Cheerios are of the past. Then I gave him a couple of syringes of water because he had not had too much today because I was out running errands. If you all think that dose is not correct on the Predisone, I will call my vet tomorrow morning and asking him to see if we can increase it to a whole pill.

[Sabre's Mum]

The usual "rescue dose" for a dog who has gone low is 0.25mg/kg but some dogs need double that dose which is why I asked the questions I did in the previous post. Basically Bo is currently getting double to rescue dose of pred which was the dose I was going to suggest to you. I do remember when Sabre was low he did not drink much at all .... he was eating a raw diet so there is fluid content there.

Tricking with water in the dry food as you did sounds great as well!

Angela and Flynn

[Sabre's Mum]

Just wondering how Bo is?

Angela and Flynn

[Bo's Mom]

Angela,
Thanks for asking. Unfortunately, Bo is not improving at all. His vet is getting him scheduled as we speak at an IMS in Austin. The water situation is not improving (water feeding through syringe) but he is eating (Halo dry/sweet potato and water). And today, he had a hard time getting around and was bumping into things. This was very difficult to watch. He is still on the daily Predisone and Fludrocortisone and takes that with no problem. I just hope that someone can give us answers soon because it is tearing my heart to pieces knowing he is not getting any better. I will update everyone as soon as I get some news.

[frijole]

Belinda, Sending huge hugs and strength. I think you are wise to go to a specialist. I waited so long to go to one (It's 5 hours each way) and I wish I had gone sooner. That is how we figured out what was wrong with my little Annie.

It isn't right that he isn't drinking so I think you should go asap. Also save yourself time and money on testing.... Go get copies of every single test, ultrasound etc done. Then look thru your thread and write up an executive summary from the very beginning of what happened, the dosing, the test results, the symptoms etc. It is the only way to go. It will save you from forgetting something important and really helps out the IMS.

xoxo, Kim

[Jenny & Judi in MN]

I am so sorry to see this update Belinda. I hope you can get Bo in asap and that the specialist has a plan. I bet he/she will have one. I felt a lot better after Jenny & I saw her specialist.

We are thinking every possible positive thought for our boy Bo.

hugs, Judi & Jenny

[Sabre's Mum]

Sorry to hear that Bo has not improved. The IMS appointment is a great plan and Kim's advice is spot on with compiling everything that has been done so far.

Take care
Angela and Flynn

[molly muffin]

Oh dear, still not wanting to drink. There has to be some other issue that is causing that. I think the specialist is the best thing to do and like Kim said, make copies of everything and take them with you!

I hope this can be figured out soon, I'm sure you are just broken hearted to see Bo going through this.

hugs,
Sharlene

[Squirt's Mom]

Hi Belinda,

I so hope you can get into the IMS today, no later than tomorrow, and they can find out why Bo doesn't want to drink, bringing you both some relief. It's odd that he is eating dry food and yet doesn't have a thirst for water. :confused: Please keep in touch and let us know how things are going.

Hugs,
Leslie and the gang

[Jenny & Judi in MN]

Were you able to get an appointment Belinda? Thinking of you & Bo. Judi

[Bo's Mom]

The earliest they can see her is Friday morning. That too will give me time to go to his former vet and gather all testing information that he has done. The current vet faxed over all of Bo's testing done since we switched a few months ago.
I did ask the Internal Medicine vet's office if he needs to be off his meds before going. She said no...so we will give him his dose of meds at night and if they want to run any test that will be skewed with those meds then I will have to reschedule.
Not wanting to battle Bo in the car because he tends to get ill on long rides and he is a barker who barks at everything. I will just put him in his car seat and hopefully he will sleep the whole way.
Thanks to all of you for all the kind words and worries. I don't know what I would be doing without you.

[Bo's Mom]

OMG...I just realized I referred to Bo as a "Her"....it is the vet who is a her. :D :D :D

[molly muffin]

hahahaha hmm, was Bo giving you strange looks? Like Mom! Not a her, I'm a him!

Glad you got an appointment at least. Really hoping the specialist will have some ideas of how to fix the drinking issues.

hugs,
Sharlene

[Jenny & Judi in MN]

well Friday is almost here! we won't tell Bo you called him her. He has you flustered! You have been doing the syringe water thing for a long long time. hang in there!

[Bo's Mom]

Got all Bo's testing and vet records (check)
Called and confirmed his appt for tomorrow (check)
Kept Bo hydrated (check)
Fed and gave him his meds (check)
Took care of my health issues (check)
Nap (unfortunately, no)

Going to bed early tonight because we have a good drive ahead of us tomorrow. Crossing our fingers we get something answered tomorrow.
Thanks again to all of you....here's to a restful evening.

[molly muffin]

Get some good rest and hope that tomorrow will bring news of what is going on with Bo!

hugs,
Sharlene

[frijole]

Hope you are sleeping and don't see this til tomorrow. We'll all be by your side. Fingers crossed. Hope the visit gives you answers. Hugs, Kim

[Jenny & Judi in MN]

you are ready! I hope it is very productive, update when you can!!

[Squirt's Mom]

Hi Belinda,

Make room for one more! :D You have all your ducks in a row and I hope the vet can tell you what is going on with sweet Bo and have a plan of action to get him back on his feet again. Let us know how things go!

Hugs,
Leslie and the gang

[Boriss McCall]

Good luck today!

[addy]

Thinking of you and Bo

[Jenny & Judi in MN]

I hope you are exhausted from the day and not stressed out. Thinking of you and Bo. Hugs from me & Jenny (& Ranger)

[Bo's Mom]

Just returned from the vet and the long drive home. Bo slept the entire way both ways which is very unusual for him. Sadly, we didn't get any "good" news. She reviewed all his testing done so far and told us to discontinue the Fludrocortisone. It isn't really helping since Bo's electrolytes have always tested normal. She did up the predisone dose to 1/2 tablet 2x a day. So he will be getting 5 mg a day. There will be a curve effect with him showing signs that he is getting better and then I will see him start slipping. Told me some things to look for such as him looking confused, bumping into things, and just acting strange with no apparent reason. I have seen this start to happen. Maybe the extra dose of Predisone will help. She also had a dog who had cushings that she lost a few years ago. She said her dog never refused water but food was another issue. Her dog was having her meals grilled on the pit at the very end and still no luck with getting her to eat. After consulting with the neurologist the only thing they told me that I can do is an MRI to confirm their thoughts that a pituitary tumor is growing and starting to also cause neurological issues with him. This is something that he would have to be put under and then the treatment is radiation if that indeed is the problem. I don't think Bo really can handle that looking into his eyes today. So with a heavy heart and a lump in my throat I left her office knowing I am doing all I can do to make him comfortable. They were all so very sweet and fell in love with Bo and he really enjoyed the attention. This was the first time we went to the vet where he hasn't been poked or jabbed so I am sure he was happy about that.
I am hoping we all have a great weekend.

[frijole]

Belinda, Relieved to hear from you. I know you must be exhausted so it was kind of you to check in. Did she confirm Bo is permanently addisonian? I'd have to think that the extra dose of prednisone should help. I have way more faith in vets that have experienced cushings first hand. It is hard to relate to unless you have been there and that is what makes this board so helpful.

I am stumped as to why they suspect a macro tumor (pit tumor that grows) vs straight out addisons disease. Why did they say to expect to see improvement from the prednisone and then slipping?

Don't feel like you have to answer or think any more tonight... just when you have time. Sending hugs, Kim

[Jenny & Judi in MN]

Belinda I agree with Kim. Lets just hope you see some real improvement with the prednisone. I think the right prednisone dose WILL stimulate his drinking/eating.

I'm so glad he was fussed over and not poked or prodded.

What a long day though. I've been known to get overemotional when I'm tired and then pull myself back. If Bo is happy, you are doing what you can.

Lots of cyber hugs to you and Jenny's twin. Judi

[Squirt's Mom]

Hi Belinda,

What a long day only to get such difficult news to swallow. :( I so wish things had turned out differently, turned out to be something that could be more easily treated. The pred should help him for a while but your tender loving will do more good than anything else and I know Bo will not be lacking for that.

Know we are here anytime and always praying for you both.
Hugs,
Leslie and the gang

[Bo's Mom]

I am so praying and wishing upon any star that the Predisone works for him. But, as we give him each dose I don't really see the bounce back effect that everyone keeps talking about. He still just wants to sleep and he acts like he has a headache. I don't want to say funny thing but the other day I had turned on an overhead light in our living room which is very bright and when I looked over at Bo he had his paws covering his eyes like he was shielding the light away. I took a picture because it was kind of cute but I understand stand why he was probably doing it.
The vet explained that the Predisone will only help some and only some of the symptoms if this indeed is a growing tumor. Without the MRI we don't know but she said the fact that he is refusing water is a strong indicator that is what may be going on. After maybe a short while with him feeling "better", I will start seeing a decline in his neurological status, hence the curve effect.
As far as being permanently Addison's she said that he could go back to functional adrenal glands. We would have to wait and see.
The one question I forgot to ask her and I will call on Monday was the Predisone dose. If Bo is going to be on this dose indefinetely?
Speak of my little guy, Bo just walked in and he and I are going to go try to drink some water. Everyone have a nice weekend!!

[Maya]

Dear Belinda, We seem to be in the same boat,you and I! The exact same thing has happened to Maya. Over the past few months she has been displaying neurological symptoms which kind of made me think that it was a macro tumor, but I kept coming up with other ideas of things it might be because I didn't want to believe it. For a while I was convinced that Maya had addisons, but all the tests proved me wrong. Just the NA/K ratio was borderline so the vet gave her a shot of percortyn anyway because at that point we didn't have anything to lose and she was already on massive doses of prednisone anyway! A few weeks earlier she had had a total collapse and it was the pred which brought her back.She was put on 20mgs a day until her symtoms lessened. She was taken off trilostane because she had stopped eating, drinking, she was staggering all over the place as if she were drunk, banging into things, constantly peeing everywhere and anywhere, dazed look in her eyes, dilated pupils, lethargy, falling over etc.....
She has since had blood work done and all is normal except very high ALK P which is 3600!! Her cortisol levels have gone back to that of a normal dog! We had a specialist review her case history and he is pretty sure it's a macro tumor. He suggested MRI, CT imaging etc... but we had decided not to go down that road long ago. Maya is too old for that and I could not put her through such grueling treatment. I doubt she would survive My aim is quality of life now. We are spoiling her rotten. The prednisone has helped enormously. She is now taking 5mgs a day and she is doing ok. She is still a bit wobbly on her feet and has a bit of mental dullness going on. The little stinker tried to poo on the carpet last night!!
Prednisone will help reduce the swelling of the tumor and therefore relieve the pressure which in return lessens the symptoms. Maya is now eating and drinking normally and she'll have a little play with her toys in the evening. She will never be the same as she was before, but she is still here and wagging her tail. If little Bo does have a macro tumor, the pred should make one hell of a difference. I hope he feels better soon....
Hugs from Leah and Maya

[Bo's Mom]

Thank you to all who are offering the kind words and your experiences. I think we are going to just keep chugging along doing the predisone and praying for some improvement. I spoke to my daughters about it and they agreed that Bo could not take the treatment that they have to offer. Of course we all want our babies to be back to pre-cushings state but for Bo, I think those days are over. It tears our hearts to pieces but we know that we will be here to help him through each day and love him and his fur brother and sister like there will be no tomorrow.
His local vet called me yesterday and left a message that he received the report and wants to talk to me about it. I was unavailable so I will just call him tomorrow. It is just so nice to know that there are others here to help comfort our souls when they hurt. And, again I thank you all!!

[Tina]

Hi Belinda, I have just been getting caught up on many threads today and I am so sorry about the news from your vet appt. I have to think that the increased prednisone should make a difference for Bo, and I am praying that it stimulates his drinking and helps him feel better overall.

Many hugs to you and Bo,

Tina and Jasper

[Sabre's Mum]

Hi Belinda,

I am sorry to hear the news from the IMS. On the plus his electrolytes are, and have been, normal ... so no addisonians. Hopefully the increase in dose of prednisone will give Bo some relief and get him drinking again.

Angela and Flynn

[Bo's Mom]

I don't know why I didn't think about this before but I went out and bought a water feeder(the kind for rabbits) and stuck peanut butter all over it so Bo would lick it and have to work at it. And, viola...he was drinking water. :D:D:D Granted it wasn't much but between doing this and the syringes at least I have another option because he is still refusing to drink out of his bowl. It made a big mess but nothing I couldn't just wipe up with a paper towel.
Now, I still worry because I have to go back to work tomorrow and will be gone all day. I won't be able to monitor his water consumption but do hope that he gets the idea that he has to start drinking.

[Boriss McCall]

wow.. you are one smart dog mama! I would have never thought about that. :)

[Steph n' Ella]

Awe soo cute! He does kinda look like a litte white bunny anyway!

[Boriss McCall]

I thought about you & smiled tonight. My husband is cooking beans & cornbread tonight. Boriss is a super picky eater. I don't know how he manages to be a picky eater & have cushing's. but, he will snub things even if he is hungry.

So, I thought about you when he snubbed his evening food & poured the pinto juice on his beans. :D He loved it! must be a Texas thing. ;)

[Bo's Mom]

OMG...that is too cute:D
I have to agree, it must be a Texas thing.

[frijole]

Where were you Texans with this bean juice theory when my Annie fought eating for 2 years? :p;):confused::p;):confused::p:confused:

Loved the peanutbutter trick... clever mom clever...

[Bo's Mom]

Here's another clever trick to get Bo drinking: He loves peanut butter so I also put a little bit on a spoon and put the spoon in his water bowl at the water level. He licks the spoon clean and drinks at the same time. I think all this "cleverness" is coming from desparation. :p I think we need to start a "tricks of the trade" thread.
I hope all of you are having a wonderful evening with your babies tonight.

[Steph n' Ella]

I agree with the tricks of the trade thread for eating and drinking!

[Jenny & Judi in MN]

How is Bo doing?

[Maya]

I was wondering the same thing...

[Bo's Mom]

Unfortunately, Bo is still doing the same. He is refusing to drink water but with my peanut butter trick on a spoon and rubbing it all over the water feeder, he is staying well hydrated. Possibly more than my other dog. The Predisone has helped but very little because he is bumping into things and there is still some neurological things going on with him. I am back at work so I don't get to spend all the time with them like I had before which just breaks my heart. :(:(:(
I am going to call his vet again just to reschedule another ACTH test in the next month or so. I am just curious on what his numbers are doing. But, it will have to be on one of my days off because I can't just drop him off there because he just goes nuts being crated.
I am still keeping up with everyone but this past week is been so incredibly busy with trying to start a new school year with the 2nd graders already having 4 subs in there in 2 weeks. YIKES!!

[Jenny & Judi in MN]

yikes is right. Darn it, I hope you can get some answers but at least you are keeping him healthy and probably happy with all of the peanut butter he is getting.

Hang in there Belinda. hugs, Judi

[Bo's Mom]

I received the most difficult call today from Bo's IM vet that we saw in Austin. It was just a message she left because I called and wanted to know what she thought about possibly testing again to see what Bo's levels are doing right now.
I know she was trying to break the news to me as easily as she could but basically she has pretty much given Bo 6 more months. She was telling me in her experience with treatment of dogs who have showed the same symptoms as Bo, they usually start to decline pretty quickly. And being on the Predisone hasn't really helped him at all. She knows how much he is loved and knows that I am the best Mommy for him. But, she also wants to prepare me for what I may be seeing in the months to come. I ask of you that you please keep us in thoughts and prayers. I know I am going to have to be strong for Bo and for my girls who have grown up with him. You guys havea been such a wonderful support and I am truly thankful to each and every one of you.

[Harley PoMMom]

Oh Belinda,

I am so sorry to hear this news, and will be keeping you all in my thoughts and prayers...sending huge and loving hugs, Lori

[Nikki]

I'm so sorry to hear that Bo isn't doing too well. I will keep you both in my thoughts, and just remember that there are SO many amazing people on this forum!! We are like a big happy family :).

[Steph n' Ella]

Oh poor little Bo! He is fighting so hard...keep up the good work and try to prove 'em wrong!

[Jenny & Judi in MN]

I've been dreading seeing this from you but think your vet showed real compassion giving you a heads up. I know it will be so hard for you and your girls but as loving as you are I know you will help them through it.

One of the best gifts a young person can have is loving an animal don't you think? Especially a sweetie like Bo.

Please give him an extra hug from me and his Minnesota sister.

crying a few tears with you all tonight.

I wish I could do something to help. Big hugs from me, Jenny & Ranger

Judi

[molly muffin]

I'm so sorry that this news of Bo has come your way. It's very hard to take in. However, it isn't yet, it's just coming and while it's hard to know that, just enjoy each day as you can. We'll all be joining Judi and sharing a few tears this evening. It's been a hard couple weeks it feels like. :(

hugs,
Sharlene

[frijole]

Belinda,

Sending love across the miles. Those are words we all dread. That said, none of us know how long we have left. My Annie was so dreadfully thin and my vet was amazed at how long she fought. So even experts don't know. Regardless, what I learned from the fight was to tell my girl how much I loved her every time I saw her, to hold her tight, to spoil her and to enjoy her. I cried in private.

Bo is lucky you are his mom and I am sure he feels your love. That is what truly matters. So you just keep doing what you are doing. We will never leave your side. When he's sleeping or resting you can vent here all you want.

Keep the faith my friend. Kim

[Tina]

Belinda, I am so sad to read about the call from your vet, what difficult news to receive. I will keep you and Bo in my prayers.

Many hugs and strength,

Tina

[Maya]

Oh God bless you darlin! I will definitely be keeping you in my thoughts and prayers....
Lot's of hugs from Leah and Maya

[Sabre's Mum]

Belinda, I am sorry to hear to latest news from your IMS. My thoughts are with you and Bo.

Angela and Flynn

[Squirt's Mom]

Hi Belinda,

I am so sorry the IMS didn't have better news, or at least a little hope to offer. But when we are handed news like this, we just keep on loving them and caring for them as always, cherishing each moment we have with them like Kim said.

We are here any time you need to talk, honey.

Hugs,
Leslie and the gang

[Boomers Mom]

Hi Belinda. I too am on a new and confusing journey but we have been very fortunate to find this website. I am confident we will get lots of information and support here.
Good luck to you and Bo
Linda & Boomer

[Boriss McCall]

Belinda,
I am so sorry to hear about your sweet little Bo. I hope you can have lots of good days of love & cuddling.

hugs

[Bo's Mom]

(((((HUGS)))))
I want everyone reading this post to give hugs to each of your fur babies to show our appreciation for all the kind words and prayers from Bo and me.
We are still taking it day at a time. Bo is starting to really slow down and it pains me so much that I sometimes just fear what is going to happen in the next days/months. He barely is walking and he falls down the steps that he uses to get up to the couch. I have had to move all my furniture around to prevent him from falling over and hurting himself when I am at work. I am wondering even if the cushings is coming back because he is really eating well. The only thing is the water consumption is just not there. I am still feeding him via syringes and peanut butter rubbed all over his bowl/water feeder.
I will be calling the vet to see if we can up his Predisone any to see if that will help some. Does anyone know the highest dose for a 9lb dog? I certainly don't want to do more harm that good at this point because we are walking a very fine line.