worried about ailing 15 yr old dog

[pcsfinta]

My dog Sampson, a lab mix, was diagnosed wtih Cushings back in 2009. His last ACTH Stim Test in December 2011 was still not where vet wanted him to be at so his 1 1/4 tabs of Lysodren 500 mg every 3rd day had to be increased to 1 1/2 tabs every 3rd day. In the last month Sampson has started vomiting. Not every day, rather once or twice a week. I started noting if it happened on Lysodren days. About 3 out of 4 times, it happened on a Lysodren day. I called the vet and he prescribed anti-nausea pill, Metoclopramide 10 mg , one tab, one hour prior to Lysodren dose. Didn't help. Since Sam doesn't always want to eat well in the AM, we were giving him the Lysodren at his 4pm feed. In middle of night, Sam would wake up, start LICKING every thing in site and pants and drinks tons of water. Wants outside two or three times ( I know he is eating grass, weeds, anything he can find). comes back inside and coughs, gags, until he finally vomits. He does a lot of pacing. Kept us up for about 3 hrs. Tried to go back to AM dosing. Vet suggested trying Sampson on just 1/2 tab of Lysodren for a few weeks to see how he does. Last two doses has been ok. Asked the vet if it is worth putting dog through this anymore. He said that Sam would probably only live about 6 months. He would stop eating and get weak. If I continue to treat him, he would have probably a year. He did suggest another more expensive medicine to try but don't think we can afford this. Sam has lost a lot of weight. He held weight last couple vet visits. He is at 57 lbs. Does anyone else have this experience with their dog with the panting, pacing, licking and vomiting while being treated? Don't even know if Lysodren is the main culprit. So worried about Sam. Along with the cushings, his back legs are getting weaker, lost a lot of muscle mass. He has a lot of life in him yet. Not sure where to go from here. Would appreciate any comments. Thanks

[Harley PoMMom]

Hi and welcome to you and Sampson!

So sorry for the circumstances that brought you here but happy you found us as we will help in anyway we can.

Could you tell us how much Sampson weighs? Is he taking any other herbs/supplements/medicines? Does he have any other health issues?

Did Sampson go through a loading or induction phase? If so, could you tell us the dosage he loaded on? Also could you post the results of all tests that were done on Sampson, we only need the levels that were marked abnormal. We are especially interested in his Cushing tests, so could you get copies of all these results and post those results here too.

Regarding his ACTH stimulation tests, were they performed 36-48 hours after his dose of Lysodren? Is his Lysodren being given with some kind of fatty food?

If a dog is acting ill in any way or just not acting like him/herself, the protocol is to not give the Lysodren. Because Lysodren has an cumulative effect it can lower cortisol 36-48 hours after the dosage.

Here is a link from our Resource Thread regarding Lysodren: Lysodren loading Instructions and related tips. (http://www.k9cushings.com/forum/showthread.php?t=181)

Sorry for all the questions but the more information we know about Sampson the better our feedback will be.

Please know you are not alone on this journey as we are here to help you and your sweet boy.

Love and hugs,
Lori

[KarenJ]

I'm so sorry you're going through this with Sampson. What you describe is exactly what we go through with Maggie from time to time. She has done the frantic licking, panting, pacing until she vomits for years, long before her Cushing's diagnosis. We finally figured out it was being caused by acid reflux. We started giving her Pepcid at night and it helped immensely. Ask your vet if he thinks that is ok to try. I'm not sure how that might interact with Lysodren. Maggie is on trilostane. I hope you find relief for Sampson soon. Take care.

Karen

[pcsfinta]

thanks for that suggestion because before he started the vomiting he was frequently coughing which sounds like it could be related to reflux. will check with the vet!

[pcsfinta]

I will go through my book (yes I have an organized book for the vet visits for my two dogs!) and see how much info is available to report to you. He is getting glucosomine and fish oil in his food. Because he doesn't always feel like eating in the AM, I do mix in a little canned dog food (same brand as his dry food) which is Purina One. On Lysodren day, I mix the med in a ball of the canned food so he will take it. Over the years I have had to disguise his meds in anything I can as he is very clever and once he suspects there is something different about it, he refuses to take. He is not on any other supplements or herbal products. His weight is 57 pounds. He just had his senior wellness exam and heart sounds good, he had labs (wish I had the result) that had testing for diabetes included. vet called and said bloodwork was good and no diabetes. He did have a loading dose at start of Lysodren. His last ACTH test was done on Friday 12/9/11 so his last dose of Lysodren would have been on the previous Tuesday. He gets his dose on Tues and Friday. I don't think I gave him any meds day of test. April 21, 2011, the highlighted blood test results were ALKP of 768, ALT of 88, BUN of 29. On 4/21/11 his baseline CORT was 2.6 and ACTH stim was 7.6. On 12/28/10 results are showing baseline cortisol was 6.2 and therapeutic monitoring cort was 8.3. On 9/7/10 a baseline corisol was 4.7 and the therapeutic monitoring cort was 7.2. I believe that is all I have record of. He will be due for another ACTH in March but I am guessing this will be pushed off a little because we have lowered his dose temporarily and I have to call vet in another week to let him know how he is doing. Since he has been on just 1/2 tab (down from 1 1/2 tab) he has not vomited and not gotten into his frenzy. I know this dose is not really doing anything, but it was just a test that he wanted to do to see if the vomiting stopped. He is on Purina One dry food (wish I could afford to buy specialty food). I just changed to the sensitive stomach salmon kind to see if helps him too. My sister suggested I may have to start cooking him chicken and rice. Will see.

[addy]

Hi,

The number one side effect of lysodren is gastric upset. Perhaps pepcid or an equivalent may help Sampson. Have you ever tried feeding him smaller amounts more frequently?

I am sure others will be along soon with comments. Hang in there.

hugs,'
addy

[pcsfinta]

Thanks for suggestion. I have a call out to the vet to see if can start the pepcid. It is certainly worth a try.

[pcsfinta]

I forgot to mention in earlier threads that I have also started giving Sam Syn-flex for pets for his glucosamine med. Has anyone else used this? Also is anyone giving the anti nausea med, metoclopramide 10 mg, prior to lysodren dose?

[jrepac]

A vomiting dog and your vet is ok w/increasing the lysodren dosage? I would be very concerned about that, in all honesty.

When you say his numbers were "no where where they needed to be", where were they exactly?

Now, it could be gastric upset as others suggest, but a sure sign of too much lyso is vomiting---cortisol levels have gone too low.

Although your baby is older, you may want to think about a switch to trilostane...it works much differently. Or, if merely comfort from symptoms is your priority, Anipryl is an option (just get the generic version).

I wish you the best of luck.

Jeff & the Girls

[pcsfinta]

I think the vomiting started on the increase to 1 1/2 tabs from 1 1/4 tabs. I think when I check in with him next week that I will try to just get him to 1 tab and leave it at that. any treatment is better than nothing. I am told that the trilotane is quite expensive. don't know if I can afford that. but may try a few weeks worth. I will have to ask for the last values done 12/9/11. that is when he increased to the 1 1/2 tab.

[frijole]

Hi and welcome from me as well. I used lysodren for almost 5 yrs successfully so I am very familiar with it. I also had to fire a vet because they didn't know how it worked and their recommendation could have killed my dog.

If a vet knows ANYTHING at all about lysodren - rule number one is never EVER give a sick dog lysodren. If they are vomiting or have diarrhea it is a blatant warning that the dose is too high. I am attaching a link that shows the protocol on how lysodren is supposed to be prescribed during the loading phase.

Please review it and compare it to your own experience and let us know if you did anything like this. To really help we need to know the tests that were done, the dates done and the results as well as the dosage amounts at the time... this way we can see if the problem was with the dose or perhaps something else.

It may seem like overkill but tell us the whole story about Sampson from when this started to now. It really helps us help you... Don't leave anything out - we can take it. :D;)



Hang in there - my girl lived to be 16 1/2 and did not die from cushings. Glad you found us... you aren't alone on the journey. Kim

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

[jmac]

Hi-

I just wanted to say hello and give you a belated welcome! Now that you have found this site we are here to help you along the way.

I am not currently treating my dog's Cushing's because she has very mild symptoms, but I do know that you need to be very careful giving meds to a dog who is not acting okay.

As Kim asked, telling us the whole story about your dog will really help. The knowledge, dedication, and support people can offer on this site is amazing. The more we know, the more we can help you help your dog.

Julie & Hannah

[pcsfinta]

I obtained the last ACTH testing done 12/9/11. Baseline cortisol was 3.5 and the 2 hr cortisol level was 8.0. this is when he was increased to 1 1/2 tabs.

[lulusmom]

Hi and a belated welcome to you and Sampson

I am sorry you are both going through such a difficult time and we'll try to help you through this rough patch. I have a few questions and comments in blue below which will help us understand a bit more about Sampson's history. Before that though, I'd like to know if your vet diagnosed pituitary or adrenal cushing's. Was an acth stimulation test done before starting treatment? If so, can you get your hands on that test and post the results here? Was an LDDS test done and an abdominal ultrasound and if so, can you post those results as well?


My dog Sampson, a lab mix, was diagnosed wtih Cushings back in 2009. His last ACTH Stim Test in December 2011 was still not where vet wanted him to be at so his 1 1/4 tabs of Lysodren 500 mg every 3rd day had to be increased to 1 1/2 tabs every 3rd day.

Whenever an adjustment is made to dosing, it is a good idea to do an acth stimulation test within 30 days of the adjustment. However, I do know that acth stim tests are not cheap so a lot of vets will try to work with us pet owners to limit costs. Unfortunately, sometimes that works against us and it may end up costing us more in the long run, especially if you have a vet with limited experience with cushing's. Unless there are other underlying conditions that you haven't told us about, there are red flags for me that perhaps your vet doesn't have a lot of experience with or knowledge of the disease.

In the last month Sampson has started vomiting. Not every day, rather once or twice a week. I started noting if it happened on Lysodren days. About 3 out of 4 times, it happened on a Lysodren day. I called the vet and he prescribed anti-nausea pill, Metoclopramide 10 mg , one tab, one hour prior to Lysodren dose. Didn't help.

The number one side effect of Lysodren is GI upset and one way to mitigate this side effect is splitting the weekly maintenance dose over as many days as possible. Sampson was getting a huge dose of Lysodren twice a week so I would be surprised if he didn't have an upset tummy. Do you remember what dose you gave him during the loading phase? For his weight of 57 pounds, max loading dose would be 1 1/2 pills or 1250mg. His maintenance dose is double that so am wondering if you could please tell us how your vet arrived at the maintenance dose. How many days did it take Sampson to load? How long after the last loading dose was maintenance started? Was 4/21 the first acth stim test done after loading? If so, Sampson's cortisol levels were not within the therapeutic range of 1 - 5 ug/dl and loading should have been continued. Did you continue loading or did your vet put Sampson on a maintenance dose and was the maintenance dose at that time 1 1/2 pills twice a week?

Since Sam doesn't always want to eat well in the AM, we were giving him the Lysodren at his 4pm feed.

Was Sam's not eating well in the AM before or after starting treatment. Curious because cushdogs before treatment are hungry all the time.

In middle of night, Sam would wake up, start LICKING every thing in site and pants and drinks tons of water. Wants outside two or three times ( I know he is eating grass, weeds, anything he can find). comes back inside and coughs, gags, until he finally vomits. He does a lot of pacing. Kept us up for about 3 hrs. Tried to go back to AM dosing.

What you describe sounds like a combination of a dog with unacceptably high cortisol, who is experiencing gastric upset, most probably from the high doses of Lysodren.

Vet suggested trying Sampson on just 1/2 tab of Lysodren for a few weeks to see how he does. Last two doses has been ok.

If the last two doses have been tolerated well, then one would have to assume that the problem was the large doses of Lysodren being administered at one time. The bigger problem is that your vet doesn't seem to understand that if Sampson's cortisol is already high or even in the therapeutic range, cutting the dose to 1/2 pill is going to allow Sampson's adrenal tissue to regenerate even more and then you will be facing another loading phase. It's basically a waste of medicine and your money.

Asked the vet if it is worth putting dog through this anymore. He said that Sam would probably only live about 6 months. He would stop eating and get weak. If I continue to treat him, he would have probably a year.

15 years old is pretty senior for any breed and with Sam being a larger mixed breed, he's up there and you have done an amazing job of taking good care of him. Unless your vet has a crystal ball or Sam has another illness we aren't aware of, I'd like to know why he thinks Sam only has 6 months to live? I rescued a 19 year old lab last year who lived another 6 months with a wonderful family. Unless there is something else going on and Sam is otherwise healthy, I don't see why he could live a lot longer with effective treatment. Key here is effective treatment and the jury is still out on whether your vet understands what that is.

He did suggest another more expensive medicine to try but don't think we can afford this. Sam has lost a lot of weight. He held weight last couple vet visits. He is at 57 lbs. Does anyone else have this experience with their dog with the panting, pacing, licking and vomiting while being treated? Don't even know if Lysodren is the main culprit. So worried about Sam. Along with the cushings, his back legs are getting weaker, lost a lot of muscle mass. He has a lot of life in him yet. Not sure where to go from here. Would appreciate any comments. Thanks

The licking, panting, pacing and muscle mass are all symptoms of uncontrolled cushing's. If the vomiting you mentioned occurred after eating grass, then it is less likely that Sam is getting sick from low cortisol and more likely that it is the gastric side effects of lysodren that is the culprit. I noted that you changed food. Was this before or after Sampson started eating grass and vomiting? Lysodren is best absorbed with fat so if the food you changed too has a higher fat content, it can increase absorption and lower cortisol. I'm not sure that is an issue considering you have reduced Sam's maintenance dose to a probably ineffective amount.

The other medication your vet is suggesting is probably Vetoryl. That medication is not without it's own possible side effects but it's an option. Just remember that any time you switch from Lysodren to Vetoryl, Sam will have to go through a washout period of no less than 30 days.

If Sam were my dog, I'd try to get him regulated on an effective lysodren dosing before throwing in the towel. I would also consider asking the vet for referral to an internal medicine specialist (IMS). These specialists deal with cushing's day in and day out, understand the modes of actions for both medications and follow proper protocol so as to insure safe and effective results. If this is something you would consider, you can use the link below to try to find a specialist in your area and/or you can let us know which city you are near and perhaps a member can provide you with a name.

http://acvim.org/websites/acvim/index.php?p=3

[pcsfinta]

thanks for all suggestions. can you comment on the 12/2011 acth results I posted? I will be calling vet tomorrow to see if we can split his dosage into smaller doses throughout the week as he has done well on the 1/2 tab twice a week. I know this is not enough. He was due for another ACTH test this month but I know this will need rescheduled because of the recent dosage altering. Started him on omeprazole, generic Prilosec, last pm. did ok. Anxious to see if it stops the coughing. Gave to him at bedtime. since once a day dosage, is that best time or should it be given different time? thanks

[lulusmom]

The post stimulated cortisol of 8 on the last acth stimulation test done in December, 2011 is too high. The goal is to reduce pre and post cortisol to within a range of 1 - 5 ug/dl. Any time a you adjust the dose, an acth stimulation test should be done within 30 days to determine if dosing is appropriate. A stim test should be done sooner than 30 days if the dog is showing symptoms of low cortisol, such as not eating, vomiting, weak, lethargic.

With respect to the Prilosec, you should call your vet and ask how he wants your dog dosed. I know that in humans you take before a meal. I must have missed your mention of Sam's coughing. Did your vet rule out heart problems? How often does he cough?

[pcsfinta]

no set time that he coughs. I'm not at home during the day with him but on weekends, I will notice it once in awhile during day. He has done it a couple times in evening. Just seems like it is a quick gag and then a cough and not repeatedly. then he will be fine. Vet said last visit that his heart sounded great.