French Bulldog with Calcinosis cutis and Osteoma cutis, ?Cushings?

[beachwalkerz]

Hi
I am new to the forum, just stumbled upon it last night in my desperate search for more information about what is going on with my French bulldog. (I apologize in advance, this is a lot of background info first).
Izzy is an Oklahoma puppy mill rescue so the first 6 or 7 years of her life were spent in unimaginably horrible conditions. We have had her 4 years now and she has really come into her own and turned out to be a very sweet girl. So we are estimating her age at around 10 or 11 but there is no way to be sure since she ground off almost all her teeth trying to chew her way out of the cages at the mill...
When we first got her in Aug. 2007 she was not spayed. She also had issues with her back legs (she was very splayed and would "hunch" and sit on them rather than have her bum sit on the ground). The vet did xrays and noticed a mass on her ovary. So at the time of her spay in Oct. 2007, he removed the mass. It was sent to the lab and came back malignant. Chemo was not advised due to her health at the time.
In 2009 we noticed a bump on her shoulder. The vet looked at it and it was very deep in the muscle. It didn't change for a long time but when it started to grow, it grew more externally. It was removed in Jan. 2011 and came back from the lab as mast cancer.
Other than that, no problems with her until we moved. Six months ago we moved from the Midwest (Wisconsin) to the Oregon Coast. Shortly after that we noticed Izzy drinking more and having more "accidents". We thought move stress, environmental... etc.
Jan. 31st I took her in to the vet because I noticed she had some strange crustiness on her back. If she wasn't a white dog, I don't think I would have even noticed. The vet took a look and found flea dirt and put her on Frontline (which is what they were on in WI as well, but there you only needed it during the summer months). She also did a blood screen (NSAID) and a urinalysis and Izzy had a really bad UTI. At that time she was put on Baytril for the rods in her urine and the vet treated the crustiness like a hot spot and had us use Gentacin spray. The bloodwork came back stellar, which suprised the vet, as she said she initially suspected Cushings (I have a copy of test but dont know what values to include here). Two weeks later we went in for a follow-up urinalysis. Spots on skin were spreading and rapid hair loss had started. At this time: Woods lamp negative, Fungassay negative, skin scrape negative. Blood collected for a T4 test. At that time, Cephalexin prescribed for potential infection. T4 test came back with VERY low thyroid levels (I don't have a copy of these results but it seems to me she said her value was like 0.4 or something ridiculously low). Started her on daily Soloxine. The vet doubted the skin issues were a result of the thyroid though, based on how quickly they were spreading and the severity of the hair loss. Tried a round of prednisone thinking possibly environmental= absolutely no change. Waited a couple weeks for Pred to clear her system, then did a Skin biopsy. At this time, the vet was consulting with a dermatologist, as we figured this was going to be our next step. So skin biopsy results came back calcinosis cutis and osteoma cutis. The vet wanted to do a low dose Dex test to get a positive Cushings diagnosis. So we waited two more weeks to make sure all the Prednisone was completely out of her system. Did the test yesterday, should have results early next week. The vet has discussed drug treatment with me. Her preference is Lysodren, but she is having difficulty locating any. She seems quite noncholant about the fact that if she can't locate any, then she will just try either Trilostane or Anipryl. This led me on my quest for more info. I want the very best treatment for my dog, not just "whatever is available". If Lysodren is the best, then I will find a way to get it. I questioned my vet regarding the different drugs versus the different types of Cushings (pituitary vs adrenal) and she was very vague in her response and said she has used Lysodren in the past and liked the success she had with it.
I feel very overwhelmed at the moment and after reading other posts, see many similarities. I guess my biggest questions at the time are:
-How do I know which drug is best for treatment? The vet said the Lysodren is a once a week dosage, whereas the others are daily.
-Was this last low-dose test neccassary? I know, already said and done but I am just wondering why it was done when Izzy has a VERY severe case of calcinosis cutis and other classic Cushings symptoms.
-How is dosage determined? Izzy is 21.3 lbs. I vaguely remember the vet saying something about "...loading dosage until she stops eating, then we know we have it and we back it off a little..." Am I remembering this correctly or am I confusing things? Does this sound right?
-Also, should she continue on the Cephalexin as preventative measure against infection? What about her Soloxine?
-How often should I demand tests? thyroid? blood?
When the results of the test yesterday come in, I want to meet with the vet, armed with questions and information. I don't know what to ask but I want to be INFORMED and ACTIVE in this treatment, not just blindly agreeing to everything. I am printing out links and drug info and brewing a pot of coffee as I type....
There is no doubt in my mind Izzy has Cushings. Classic symptoms: excessive drinking/urinating, pot belly, muscle loss, skeletal head, ravenous.... The calcinosis came on so fast its frightening. In just two months, more of her body is covered in lesions/crusty/scabs/balding, than not. Through it all, she has been such a trooper and I owe it to her to educate myself and find out as much as I can.
Again, sorry for such a long post but I really wanted to provide plenty of details.
Any advice greatly appreciated!
Thanks
Jodi and Izzy

[Harley PoMMom]

Hi Jodi,

Welcome to you and Izzy! So sorry for the reasons that brought you here but glad you found us.




-How do I know which drug is best for treatment?

The treatment depends on the dog and the which drug a vet feels the most comfortable using and has the most experience using.

The vet said the Lysodren is a once a week dosage, whereas the others are daily.

Lysodren has an induction or loading phase followed by a maintenance plan. Trilostane/Vetoryl is given daily.

On the "average", the entire weekly maintenance Lysodren dose is usually just about the same dose as you used to give in just one day of the loading but spread out and divided up into smaller doses during the week


-Was this last low-dose test neccassary? I know, already said and done but I am just wondering why it was done when Izzy has a VERY severe case of calcinosis cutis and other classic Cushings symptoms.

Since Izzy does has have a confirmed diagnosis of calcinosis cutis with strong Cushing symptoms the LDDS test would not of been the test of my choice.


-How is dosage determined? Izzy is 21.3 lbs. I vaguely remember the vet saying something about "...loading dosage until she stops eating, then we know we have it and we back it off a little..." Am I remembering this correctly or am I confusing things? Does this sound right?

The usual protocol for Lysodren is administering Lysodren at a dosage of 50 mg/kg/day, divided and given BID (twice a day). Lysodren administration should be stopped when the dog demonstrates any reduction in appetite; this might mean just pausing slightly during a meal, stopping to drink some water, or stopping in response to the owner's voice.




-Also, should she continue on the Cephalexin as preventative measure against infection? What about her Soloxine?

The Soloxine supplement, in the future, could possibly be stopped because Cushing's disease can cause sick euthyroid syndrome. Sick euthyroid syndrome, refers to the condition in dogs in which concurrent nonthyroidal illness causes suppression of serum concentrations of circulating thyroid hormone and once the nonthyroidal illness is treated the thyroid performs normally.


-How often should I demand tests? thyroid? blood?

The times for the monitoring tests depend on which treatment plan, Trilostane/Vetoryl or Lysodren/Mitotane, one is using.


When the results of the test yesterday come in, I want to meet with the vet, armed with questions and information. I don't know what to ask but I want to be INFORMED and ACTIVE in this treatment, not just blindly agreeing to everything. I am printing out links and drug info and brewing a pot of coffee as I type....

Good for you!!! It's wonderful that you are being such an excellent advocate for Izzy!

Again, sorry for such a long post but I really wanted to provide plenty of details.
Any advice greatly appreciated!
Thanks
Jodi and Izzy

Thank you so much for all the details, we sure do appreciate it as it helps us to provide you with more meaningful feedback.

Please know we will help in any way we can so do not hesitate to ask any and all questions.

Love and hugs,
Lori

[addy]

Dear Jodi and Izzy,

Welcome to you!!! Lori has given you a good start. I'm here to say hi and tell you the best thing about this forum is the unbelievable support and knowledge and experience shared and given.

My Zoe is a rescue about the same age as Izzy. She was diagnosed two years ago.

The best advise I can give you is to read and learn as much as you can. Sometimes the vets, even the specialist, don't get things right.

Glad you are here.

hugs,
addy

[beachwalkerz]

Thanks so much Lori and Addy!
This group is wonderful and I am very grateful for all the experience and advice here.
Thanks for taking the time to respond and I will continue reading and post results as they come....

Jodi and Izzy

[marie adams]

Hi Jodi and Izzy--Welcome!!! :)

I can see you are off to a great start with Lori answers some of your questions. As soon as you have any test results or if you already have some, please post them.

You will have all the support you will need here with all of these wonderful, caring, and knowledgeable people. We have all been there and done it. Some of us several times--me only once. You are in good hands...:)

I treated my Maddie with Lysodren with no side effects. She did every well on the load (thanks to everyone here) and it was the slight look at me she made when she was eating. Before that she couldn't eat the food fast enough. There were times I thought I had not feed her because there she would be laying down with her paws around the bowl looking up at me.

I like when you said you were brewing a pot of coffee. Believe me you will be reading and reading, researching and researching till you just cannot anymore at night and then get up and start again. It is amazing the info you learn about dogs, their food, vaccinations, etc. that you didn't pay attention to before.:p

Take care and make sure you do get some rest--you will need it. :D

[Harley PoMMom]

Hi Jodi,

Here are some handy links from our Resource Thread, hope they are helpful. :)


Helpful Resources for Owners of Cushing's Dogs (http://www.k9cushings.com/forum/forumdisplay.php?s=&daysprune=&f=10)


Lysodren loading Instructions and related tips (http://www.k9cushings.com/forum/showthread.php?t=181)


Trilostane/Vetoryl Information and Resources (http://www.k9cushings.com/forum/showthread.php?t=185)


Links to Cushings Websites (especially helpful for new members!) (http://www.k9cushings.com/forum/showthread.php?t=180)


How to Interpret Tests for Canine Hyperadrenocorticism (Herrtage, Mooney, Bruyette) (http://www.k9cushings.com/forum/showthread.php?t=227)

We are here to help in any way we can so do not hesitate to ask any and all questions.

Love and hugs,
Lori

[beachwalkerz]

Thanks for the links Lori, and for all the words of encouragement and advice from everyone. It is so wonderful to know that I am not alone in this.

My vet really pushes glucosamine for older dogs. In some of my readings on Cushings (there's been so many, I should have noted the link), I have seen some thoughts that glucosamine should NOT be given to a Cushings dog. Does this make sense or has anyone else heard anything? I have stopped giving Izzy glucosamine (it didn't really seem to help anyways) but I don't know if I did the right thing.

Also, my vet has not once mentioned doing an ultrasound to try and determine if Izzy has adrenal or pituitary Cushings. How critical is this to a successful treatment?

Hoping to hear back the results from the low-dex test today or tomorrow. In re-reading the pathology report from her biopsy, at the very end it says: "Correlation with the patient history and other clinical findings is suggested and careful evaluation to rule out hyperadrenocorticism would be prudent. If hyperadrenocorticism is not supported in this case, other causes of calcinosis cutis will need to be ruled out."
I am thinking this is why the vet ordered a low-dex test? But from everything I have ever read, calcinosis cutis is a result of Cushings, right? What else could it be?

Izzy is very itchy today. I just keep telling her to hang on and we will get her all fixed up :)

thanks
jodi

[beachwalkerz]

I also just added an album of Izzy's progression. Hope I did it correctly.

It is frightening how fast this came on...

Got the results back today and she is positive for Cushings. Just spoke with the vet. She has located a pharmacy in town that carries Lysodren. Will start loading Izzy on Thursday so that we can (hopefully) time everything so that she has reached max early next week, then ACTH test, etc.

jodi

[addy]

I know I have read here on the forum many times that a diagnosis of Calcinosis cutis pretty much guarantees the Cushing diagnosis.

The ultra sound is not a must if funds are short. It will confirm if the Cushings is pituitary or adrenal.

We have loading instructions in our reference section. Is your vet giving you prednisone?

We have some pretty experienced lysodren users so you are in good hands. They will be with you every step of the way.

hugs,
addy

[Sabre's Mum]

Welcome Jodi and Izzy!

It seems I missed your arrival on the site ... school holidays and being the weekend.

I have just looked at your pics of Izzy in your album and this is pretty much what happened to our Sabre. He had nothing ... then in about a month he had no hair and lots of calcinosis cutis.

Calcinosis cutis is pretty much a definitive diagnosis of cushings. I have come across other cases over the last three and a bit years, I think four in total, which were not cushings related but these cases are rare.

What does Izzy weigh and what loading dose has the vet prescribed?

Following is a link to Lysodren loading instructions and tips. It is very useful to print these out and refer to them when you need to. http://www.k9cushings.com/forum/showthread.php?t=181

We are here to help you through the loading so if you have any queries just post away.

Angela

[beachwalkerz]

Picked up Izzy's Lysodren today.
Izzy was 21.3 lbs last Wednesday. Yesterday I stopped by the vet to check her weight before she wrote up script and she was down to 20.5 lbs. She has been slowly losing weight since we moved.
Her dosage on the bottle reads as follows:
"1/2 tablet by mouth twice daily after feeding..." The tablets are 500mg. So she is getting 500 mg a day during loading phase. From what I have read, this sounds about right?
Yes, I do have some prednisone on hand and the vet gave me her personal cell # in case anything comes up over the weekend.
I have read up on the Lysodren links I can get my hands on. Taking a deep breath.... hoping this goes smoothly!

A side note: for anyone who has a BiMart in their area (its a northwest chain), the Lysodren was only $5.65/per 500mg tablet, about half of what the vet expected it to be.

Will keep you posted, as we start on Thursday.

Angela: I read up on Sabre's thread. Did you ever find anything that helped with the hard plaque deposits? Given Izzy's age, I doubt surgically removing them would be a prudent option, but she does seem to roll on her back to itch them quite a bit -and subsequently gets stuck on her back, which is quite comical :) She has also developed hard deposits on either side of her "jowls" and down onto her neck. I worry about her collar irritating them.

hugs to all, you have been lifesavers!
jodi
and Izzy
and her very worried puggy brother, Confuscious :)
and doting Dad, Skott

[Sabre's Mum]

Jodi

We just "controlled" his calcinosis cutis initially then once his hair grew back it really was no longer an issue. Sometimes when he went low he would become itchy ... and thinking back sometimes he was in range and itchy so we used antihistamines. But they were "just there". Sabre also had hard plates near his ear openings (for want of a better description) which looking back I am amazed did not cause him any issues - he was a dog who always would get seasonal ear infections.

All the best with loading.

Angela and Flynn (our needy, in remission SRMA, IMHA Vizsla)

[Nikki]

I'm not sure where you live but we use DMSO on Max's calcinosis cutis and it definitely helps. I've heard that in some countries its not allowed. I don't know much about it, or how it works but I can definitely say that it has speeded up Max's recovery! It seems to make his spots not so hard.

[beachwalkerz]

Thanks Nikki. I live in Oregon. I need to read up on DMSO. Will wait and see how she responds for a few months first... hoping most of it takes care of itsself.

[beachwalkerz]

Sorry, bit of absence this last week with all that is going on in life, work, etc.
Started Izzy's loading on Lysodren last Thursday. Gave her her first dose, monitored her for a couple hours, she was sleeping so ran to the store for 1/2 hour. Came back and it looked like one of the dogs had gotten sick on the floor, then "cleaned" it up. Pretty sure it was her, as our other dog (pug) will not eat his own puke. (Sorry, maybe a bit TMI?). Anyways, rest of loading going fine. It just seems to knock her out about 1/2 hour after taking it. Saw improvement right away in her water consumption and "accidents" at night.
My biggest concern is that yesterday was Day 7 of loading. She has shown no signs of decrease in appetite. I have been keeping in touch with my vet every other day. I am concerned about overdosing her. The vet says we can go 10 days of loading and then we'll stop. I have talked with my vet that Izzy is an EATER, will eat anything and everything. I am pretty confident that not eating will never be an indicator for her being "loaded".
Izzy has to know where I am at all times, even when she eats, she pauses to look up and make sure I am near. She has always done this. Since starting her Lysodren, she seems to "look up" more often but her pace of eating is still the same. I also think that she is learning to anticipate the piece of cheese wrapped around the pill halfway through feeding :) When I take her dish away to give her her pill, she resists it being picked up. But if I call her name while she is eating, she will stop and look up at me (she did this from day one of dosing). She quickly resumes eating though.
Her water consumption has greatly decreased to about 1/2 cup a day.

Am I being paranoid? I am so worried about overdosing. Anyone familiar with this? Has anyone had their Lysodren loading take so long? Izzy is only 20 lbs.

Izzy has also been fighting a runny nose since before the treatment. I consulted the vet and she gave me the option of withholding Lysodren until a round of antibiotics was done, or proceeding with loading and keeping an eye on it. It was just clear discharge at the time, so I opted to get her going on the Lysodren. The last few nights I have seen more thickness to the runny nose, but only in the evening. I called the vet about it today. She said I could come pick up antibiotics or they could wait and look at it when they do her ACTH test on Monday. If Izzy doesn't show a decrease in appetite I will give her Lysodren until Saturday (the 10th day) and then take her in Monday morning for the test. It is ok to wait a day like that? The vet made it sound like it was something that should be done right away.

So many questions, sorry. I just don't know what to do.
thanks
jodi

[labblab]

Decrease in thirst is every bit as much an indicator that a dog is loaded as is a decrease in appetite. If Izzy is down to drinking only 1/2 cup of water daily, I am very worried that your vet is advising you to continue to give the Lysodren! Here's a quote from a set of Lysodren loading instructions (http://www.k9cushings.com/forum/showthread.php?t=181) given by renowned veterinary endocrinologist, Dr. Edward Feldman of UC Davis:


Lysodren administration should be stopped when:

1. the dog demonstrates any reduction in appetite; this might mean just pausing slightly during meal consumption, stopping to drink some water, or stopping in response to the owner's voice.

2. the polydipsic dog consumes less than 60 ml/kg/ day of water.

3. the dog vomits.

4. the dog has diarrhea

5. the dog is unusually listless.

The first two indications for stopping the medication are strongly emphasized because they are common and they precede worrisome overdosages. The occurrence of any of these signs strongly indicates that the end point in induction (loading) therapy has been achieved.

If my math and conversions are correct, 60 ml/kg/day translates into approximately 2 oz/kg/day or 1 oz/lb/day. So according to the formula above, Izzy (weighing 20 pounds) could have been loaded once her drinking fell below about 2 1/2 cups of water daily.

Is your vet aware how little water Izzy is drinking? I am very worried if you continue to administer Lysodren without performing an ACTH test in order to see whether Izzy is already loaded!

Marianne

[Squirt's Mom]

I agree, I would be calling for an ACTH now and giving no more Lyso until the results are in.

As for the timing of testing with Lyso, it needs to be done within a time frame of 36 - 48 hours after the last dose. So waiting from Sat to Mon should be just fine.

Let us know how things are going and what your vet has to say about getting the ACTH done now.

Hugs,
Leslie and the gang

[frijole]

I agree - cease with the lysodren. Some vets don't understand - not all dogs are the same :) Some load in a day and others 10 days and some in months. YOu can't just test in 10 days because your dog could overdose. YOu are doing great by monitoring but Marianne is right - its not just the food. I would cease and get an acth test scheduled for 48 hrs from now. (it works for 48 from the last dose)

Keep us posted, Kim

[beachwalkerz]

Thanks everyone! -you helped re-affirm my gut feeling. Stopped the Lyso right after reading posts yesterday. Called vet and set up ACTH for this morning. Just picked her up from the vet.

Came home with some amoxi, as she has had this runny nose for almost two weeks now.

Pred on hand and the vet's cell # in case anything happens this weekend.... Is there anything in particular I should be aware of?

Thanks again and hope everyone has a great weekend!
jodi and izzy

[Squirt's Mom]

You done good, Mom! :)

Just keep watching her as you have been for the same signs tho it is unlikely the cortisol will get too low while you wait for the results. Once they are in, you either start maintenance soon or you continue loading. But for now, you just wait and enjoy your sweet girl for a few Lyso-free days!

Hugs,
Leslie and the gang

[Jenny & Judi in MN]

I'm so glad you followed your gut. Jenny's only sign of being loaded was puking water which I didn't count as a sign so I gave her one dose too many before I got on this forum.

She never needed the prednisone, was fine after I stopped till we got the ACTH results.

I hope Izzy starts to feel more like herself this weekend.

It took a little while for me to really see a change in Jenny's appetite. She is also diabetic and had high blood sugar for awhile so that could have been a factor in her case.

Judi

[beachwalkerz]

Should I be concerned?

We stopped Izzy's Lyso after Thurs am dose.
ACTH test was Friday.
Her appetite has been steadily decreasing. She will finish her food, but it takes at least 15 minutes for her to eat. She isn't drinking much. She slept almost all day yesterday.

Did I not stop the Lyso soon enough? Should I call the vet on call? Is this normal?

She seems a little more bright-eyed this morning, but I don't know if that's just wishful thinking on my part. Her back end is very weak the last couple of days, I don't know if that's because she's fatigued or what but it is breaking my heart to see her try and drag herself around the house.

Is loading normally this "hard" on them? She was totally fine until about day 6...

thanks all
jodi and izzy

[mytil]

Hi Jodi,

Lysodren keeps working in the system for several days after the last dose was given continuing to lower the cortisol. Just to be safe, I would contact the vet and let them know the behavior and they may want you to give prednisone.

Yes, loading can be hard on some.

Terry

[Bo's Mom]

Hoping Izzy is doing okay. Keep us posted.

[labblab]

Me, too. I also agree totally with Terry. If you can call your vet, do so. But if you can't get ahold of her, this is exactly the situation for which you've been given the prednisone for Izzy. I'd give it to her now. It sounds as though Izzy's cortisol has dropped too low for comfort, and it may even be dropping too low for her safety. If she starts to vomit, or has diarrhea, or becomes even more lethargic, she may need to be seen by an ER vet. Please keep us updated, OK?

Marianne

[mytil]

Okay, worry wart here - when you get the chance, please let us know how Izzy is and if you had to give any prednisone.
Terry

[beachwalkerz]

After Izzy started shaking so bad her teeth were chattering together (well, what few she has left), I freaked and called the vet. Immediately gave her 5mg prednisone.

She is doing better, but still very weak. Sorry for not responding sooner, I have been "couch-bound" with the little sweetie snoozing in my lap.... didn't want to disturb her to get up and back on the computer.

She didn't eat much food this morning, but will still readily accept treats :) drank a little, but most of the day has been spent on the couch in a big family dog pile: izzy, me, and the senior pug.

Plan is to give more Pred tomorrow and on Monday vet should get results of ACTH test and go from there.

Has anyone had experience with this? Does this mean she "overdosed" on Lyso? Does that completely send her to the opposite side (Addison's?) or will this correct itsself once the Lyso works out of her system a little?

Thanks so much for support and concern. I would be a complete basket case without all your help!
loves to you all
jodi and izzy

[mytil]

Hi again Jodi,

I sure am glad you gave Izzy the pred. From the sound of it the cortisol level was dropping even more (especially with the severity of teeth chattering). At times this does happen and that is why being diligent during this time is critical. Poor Izzy is probably wiped out.

I am also wondering if there was an electrolyte imbalance too due to the low cortisol. I would certainly have your vet discuss this with you sooner than later.

This most likely will be temporary until the cortisol levels even out, but keep the pred handy and do not miss a dose .

I am sure right now you are keeping an eagle eye on Izzy and try to get some liquids into her. And if she is not improving, I would call the vet back or even take her in.

Terry

[Squirt's Mom]

Hi Jodi,

How is Izzy this morning?

Hugs,
Leslie and the gang

[jmac]

Hi there,

Sorry to hear there was some trouble with Izzy, but I'm sure glad you got her some pred. I'm hoping she is doing better today. Please let us know how she is.

Julie & Hannah

[beachwalkerz]

Thanks for all the concern and help.
Izzy is better this morning! Gave her the 5mg of pred Saturday am and Sunday am. She is back to her "normal" self and I even got the "dance" this morning when I woke up and went to let them out to potty (she does this cute little thing where she stiffens her front legs and kind of prances and throws them out to the sides while dancing towards me... haven't seen this for weeks).
Spoke with vet this morning. Going to stop the Pred and see if her behavior holds stable, or if its just the result of the Pred.
A bit of a bump in the road: her ACTH results came in and she is very low now. I don't have a copy yet but the vet said the first draw was 0.3 and the second 0.6 and she would like to see it at 2.0 -ish. Soooo, the vet advised that we wait 3 weeks and do another stim test. Hopefully her levels will go up. The vet said the pred can interfere with the test, which is why, if she doesn't need it, we should stop the pred.
Will be monitoring her like crazy, daily phone calls to the vet, and more watching and waiting.
I can safely say that she has made a complete turn-around compared to Saturday. Appetite is back to normal, drinking is back to normal, and she is back to following me around the house every second of the day :)

hugs
jodi

[addy]

Jodi I am so glad Izzy turned the corner.

Big sigh of relief.

hugs,
addy

[Bo's Mom]

Whew....good news about Izzy. Keep feeling better.

[labblab]

Jodi, I too am so relieved to hear that Izzy is doing better!! With a cortisol level that low, however, I don't think it would be surprising if she continues to need the supplemental prednisone for awhile.

I am hoping that some folks who are more experienced with Lysodren will weigh in re: the optimal time period to wait before retesting with another ACTH in this situation -- whether or not three weeks seems like a good timeframe. I do hate to say it, but I have concerns about your vet's experience with Lysodren. Had you continued giving the drug through Saturday as she had instructed, Izzy might now be deathly ill. So I do hope you'll continue to update us regularly as to Izzy's progress and also your treatment plan so that you can get ongoing feedback.

Marianne

[Squirt's Mom]

Hi Jodi,

SO glad that Izzy is feeling better! :)

She may need the pred for some time with levels that low. I would give it as directed for a few days then start tapering off slowly and see how she reacts. If she starts acting like she did before the pred was started, then you know she still needs the higher dose for a bit longer. The goal now is to get her off the pred without showing signs of the cortisol still being too low - lethargy, diarrhea, nausea/vomiting.

Once she can do without the pred, then have an ACTH done. The cortisol needs to be back in normal range for a Lyso pup or even a bit elevated before starting the Lyso back again. The Lyso has eroded more of the adrenal cortex than desired and the glands need time to regenerate, which they usually will do. So Izzy needs time for her adrenals to regenerate just a little bit before the Lyso is restarted. There is NO time limit for this to occur. Some pups regenerate quickly, some take a long time, some never regenerate and are then considered to be Addison's, not Cushing's pups.

So for right now you are in sort of a holding pattern waiting for the adrenals to regenerate enough she no longer needs the pred.

As Marianne said, keep watching her like a hawk and stay in close touch. You are doing a great job, Mom!

Hugs,
Leslie and the gang

[beachwalkerz]

Thanks for all the info.
I, too, am losing faith in my vet somewhat. She has been consulting with an internist and also the original dermatologist, but I am so glad I found you guys because I value your opinion more than my vets. I keep thinking maybe I should have been more insisitent with the vet when I knew Izzy had taken a turn... idk all water under the bridge and unfortunately, I live in a smaller town and when I consulted the other vet, he had little experience with Cush dogs. I originally chose the current vet I have due to her experience with the "smash-nosed" dogs haha. The nearest town is an hour away, which might become an option, we'll see how it progresses. I am not pleased, that's for sure!

Today is her second day off Pred and she seems very bright-eyed and energetic still. I will not hesitate to call the vet and put her back on a low dose if I see ANY sypmptoms return.

Thanks for the advice on the next stim test. Luckily, the test through this vet isn't too bad ($115) so I don't care how many tests we have to do, I just want to make sure we know if she is still Cush or if I now have an Addisons dog. But then again, at this stage in the game, money is irrelevant, right? :) My husband has stopped asking what the bill was and we have been blessed to be busy at work so it has been just fine. Izzy is a sweet little girl and I would do anything to make her feel better.

Hope everyone has a great day!

hugs
jodi and Izzy

[beachwalkerz]

Spoke too soon. Although her energy level is back to normal, she didn't want to finish her breakfast just now. Shes still drinking good though.
I called the vet and I am headed to pick up some 5mg Pred which we will give to her until at least Friday.

what a roller coaster ride, eh?

jodi and izzy

[frijole]

This doesn't surprise me. When a dog goes low you can't rejuvenate the production of cortisol overnight so you must continue on prednisone for a while. Also please note that once you go on prednisone you can't just cease giving it either - you need to slowly taper off of it.

Again - if a vet isn't used to treating cushings they probably aren't used to using the prednisone either. The prednisone is keeping your dog feeling good. It takes more than a couple days to repair the damage done.

I live in a small town and I understand what you are dealing with. I would take my chances and drive the extra hour to someone who knows. I actually had to drive 5 hrs each way to a specialist for one of my dogs and trust me - I took forever to make the decision but had I not she would have died.

Hang in there and keep posting. You are doing a great job of being an advocate for your dear furry friend. Hugs Kim

[beachwalkerz]

I just picked up her Prednisone. The vet prescribed 2.5mg once daily for four days. Izzy is 20.5 lbs. Does this sound right to everyone? Too little?
Excuse my ignorance, but what are the dangers of just stopping Pred? I know we had our pug on it for his back a few years ago and I do remember the "weaning" off, but I cannot recall why.

I am flying out of town for a wedding for a few days and my husband is worried sick that he will "kill my dog" while I am gone, hahaha. Poor guy.

Thanks
jodi

[Nikki]

I haven't commented much, but I've been reading everyday on your posts! I just wanted to chime in and say I also live in a pretty small town, and I don't have much faith in my vet. I am going to start looking farther for a vet that has some experience with Cushing's, because everyday it's becoming more apparent that she does not really know what she is doing! I feel like she is in over her head but does not want to admit it.
I hope Izzy continues to feel better!!!

Nikki&Max

[frijole]

Not to scare you or your husband but depending on how permanent her Addisons state is she could die if you/he forgot the prednisone. The drug is used in emergency situations where dogs cortisol has dropped below 1.0 (I think you were at 0.6). The adrenal cortex was eroded too much (due to too much lysodren) and your dog cannot naturally (at least right now) produce the cortisol is needs to LIVE and be comfortable.

Prednisone is a natural substitute and is used until you can confirm that it is no longer needed (yep more acth tests)

The standard rescue dose of pred is 0.25mg/kg. To find her wieght in kg, divide the lbs by 2.2...then multiply that result (her weight in kg) by 0.25 and you will have the amount for her weight.

If I did the math right the dose is 2.3 so you are right on the money.

In your case you will want to wean off it slowly because if the cortisol is too low still and you remove it all at once it sends the body into a sort of shock. Weaning off it also allows you to test to see if it is still needed (to see if the dog is producing cortisol yet or not)

You might want to read a bit about addisons to further understand it. This article is written for the lay-man. Note that some dogs get Addisons (which is the opposite of cushings) naturally. In your case the lysodren caused it. It may or may not be permanent - depends on whether or not your dog's adrenal cortex is permanently damaged or whether it regrows to the point where it can produce cortisol again.

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

Sorry to write a book but there are quite a few cases on the forum right now in this same boat and I wanted to document it in the event it helps a bit. Again, this isn't meant to scare you - just to make sure you (and the others reading this thread) understand how serious having low cortisol is.

Any questions - please ask. Glad you got the prednisone and I'm sure hubby will do just fine while you go party! :);) Have fun.

Kim

[labblab]

As Kim has said, the prednisone dosage sounds right. But please tell me that your vet gave you more than four tablets! Otherwise, you (or your husband) will be stuck in the middle of the weekend with no more prednisone in the event that Izzy continues to need it.

Our hope will be that Izzy's adrenal glands do indeed regenerate so that the prednisone can be discontinued sooner rather than later. But as Kim has also said, it is possible that Izzy's adrenal glands will never regenerate sufficiently to eliminate the need for the prednisone. And during however long a time it is that her natural cortisol production remains so low, she is vulnerable to life-threatening crisis without the prednisone on hand.

I have tried to hold my tongue, but Izzy need never have been placed in this situation had your vet properly instructed you regarding the signs that should have prompted a halt to the Lysodren loading. Now that Izzy's natural cortisol level is so low, I hope to heaven that your vet will properly supply you with sufficient prednisone to avoid a weekend emergency.

Also, as a side note, when your vet discovered that her cortisol level was so low, Izzy should have had a blood chemistry panel drawn in order to insure that her "electrolytes" (most importantly, levels of sodium and potassium) are not out of whack as a result of the Lysodren overload. Once again, that kind of imbalance can be life-threatening. Since she responded so favorably to the prednisone, her chemistries are probably OK and it is now a moot point. But once you get back home again, I really do think you would be well-served to explore other veterinary options for Izzy.

Marianne

[frijole]

Marianne - thank you for noticing the comment about four tablets - I missed that and it is critical. Kim

[beachwalkerz]

Sorry, she did give me a good amount of Pred. The instructions are to administer for 4 days and then check in with her. I'm at work but will type more in the morning.

[frijole]

Sorry, she did give me a good amount of Pred. The instructions are to administer for 4 days and then check in with her. I'm at work but will type more in the morning.
Great. BTW that photo of Izzy is just so cool and cute. I can tell she is alot of fun and loving. Hang in there and just know you aren't alone on the journey. Hugs, Kim

[beachwalkerz]

Thanks for your advice and support everyone!
I'm currently out of town but my husband reports all is well. Keeping her on the 2.5mg/day of Pred for awhile

Thanks
Jodi

[beachwalkerz]

Hey everyone! Just wanted to say hi and give an update now that I am back home.

Izzy is doing ok. She seems very "itchy" lately but our other dog is shedding his winter coat so it might just be that time of year. Her skin seems to be getting worse :( with the plaque deposits and such...

I have a couple questions I would appreciate some advice/insight on from those of you who have been through this:
How long should I give the 2.5mg of Pred after her overdose? First dose was two weeks ago this Saturday. I would like opinions to present to the vet when I call her and give an "update". Initially, the vet wanted to just put her on it for four days which from what you all told me (and what I believe) is NOT long enough, especially if she is possibly Addison's now. I can still see a slight difference in her when it is getting close to another dose of steroid. She is more lethargic as it is wearing down. Also, her eating is still slow. Not stopped or anything like that, but very slow. Every meal.

My second question is regarding her thyroid med (Soloxine). From what I have read, the low thyroid will often fix itsself when the Cushings is treated, yet the vet still has me giving it to her. How long does it take for the thyroid to fix itsself after starting treatment for Cushings? Also, what kind of thyroid test do I ask for? Originally, we did a T4 but from what I've read, there's something more?

I am also calling around to different vets in neighboring towns to try and find someone with experience with Cushings.

Thanks everyone!
jodi and izzy

[Sabre's Mum]

Hi Jodi

With regards to how long to give prednisone after going low ... it really depends on the dog. The one thing that I do think that you need to take into account tho is the calcinosis cutis ... which does put a spanner in the works! When Sabre went low ( I think we went as low as 0.46 ... unfortunately our computer's hard drive fried last week so I have no records now!) we actually found that his pred made very little difference so we only gave it to him for two or three days. We did find that his calcinosis cutis became more annoying to him (and this was in a healed state). We found that he always was better on Lysodren than on his "Lysodren Holiday".

However there have been dogs here in the past that have really needed the prednisone.

It is really hard to give a definitive timeline and as I said it depends on the dog. With Izzy's calcinosis cutis timing of getting back onto Lysodren (should her adrenal's recover) is more important. The removal of dosing of pred is really trial and error. If you see that she is physically needing it then ... give the dose but if you that she is getting better then see whether you can wean her off. Re the eating .... a lot of dogs once treated do eat A LOT more slowly. It is great that she is eating food though.

Just remember to have Izzy off prednisone for at least 48 hours before her next ACTH test.

I am sorry to be as "clear as mud" but hopefully may have given you some insight re the pred.

Angela and Flynn

[frijole]

I would think the vet would want you to slowly wean off the prednisone but you really need to get that from the vet... (feel free to check here first before doing anything ;)) How is it going?

If you plan on switching vets I would be aggressively figuring out who to switch over to because this is a time when you really need a ''champion'' on the case. I would be very very open with vets as you interview them and tell them point blank your dog overdosed because your current vet was inexperienced and you really need someone who is on top of the cushing's game - not just 'experienced'. Your dog requires special attention and you both deserve it!

Where do you live? Perhaps someone here knows a vet they could recommend? Sending hugs! Kim

[beachwalkerz]

Thanks!
I am in Lincoln City, Oregon which is coastal, about one hour from Salem and two hours from Portland.

Yes, her calcinosis cutis does seem to be bothering her since back on daily Pred :( Seeing her back legs deteriorate more and more, but this was something we knew could happen when the extra steroids were removed from her system and also, based on her previous issues from her neglect as a puppy mill mamma. She doesn't seem to let it slow her down much and her puggy brother stays close to her side when she is struggling. Other than that, things are as good as can be expected. Treating every day as a gift.

jodi and izzy

[frijole]

This list isn't all inclusive but here are specialists in Oregon that I found and the link :p


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

Name Univ/Hospital Specialty City State
Dr. Cassandra G. Brown Northwest Veterinary Specialists SAIM Clackamas OR
Dr. Lisa Brownlee Oregon State University SAIM Corvallis OR
Dr. Helio Autran de Morais Oregon State University SAIM Corvallis OR
Dr. Donna S. Dimski Oregon Vet. Referral Associates SAIM Springfield OR
Dr. Sue Anne Dougherty Bend Veterinary Specialists SAIM Bend OR
Dr. Karen K. Faunt Banfield, The Pet Hospital SAIM Portland OR
Dr. Robert Truman Franklin Oregon Veterinary Specialty Hospital SAIM Beaverton OR
Dr. Jana M. Gordon Oregon State University SAIM Corvallis OR
Dr. Jean A. Hall Oregon State University SAIM Corvallis OR
Dr. David L. Hammond Horizon Veterinary Services, Inc. SAIM Springfield OR
Dr. Stuart C. Helfand Oregon State University SAIM Corvallis OR
Dr. Jeffrey S. Klausner Banfield, The Pet Hospital SAIM Portland OR
Dr. Robert Edward Mack Northwest Veterinary Specialists SAIM Clackamas OR
Dr. Craig G. Ruaux Oregon State University SAIM Corvallis OR
Dr. Kimberly Barcus Winters Southern Oregon Veterinay Specialty Center SAIM Medford OR

[beachwalkerz]

Thanks so much for the links! Will be making phone calls tomorrow!

On a side note:
I have spent much of the morning in tears. Poor Izzy has had a rough few days. She hasn't wanted to eat much the last two meals and she is sleeping a lot. She is also shivering a lot -is this because she is in pain? or nervous? or what? She is still drinking fine and of course, eating treats. Her calcinosis cutis shows no sign of letting up at all. Her neck is almost completely bare now and the patches have taken over her face above her eyes. She is literally more bald than has hair now :(
I see how tired she is, how itchy she is... and it breaks my heart to see her struggling. I don't know if she is in pain? How do I tell? Her good moments are good but they are few and far inbetween now. My husband and I are struggling with the issue of her quality of life and this not eating thing has us WORRIED.
Any advice would be greatly appreciated..... sorry to put such a depressing post up on Mothers day... On a happier note: my husband and I took the dogs to the beach today. They get to ride in the bicycle stroller/carrier. Izzy just sat and took it all in. We let her "run" free on the beach for a minute or two and then she was ready to ride again. She slept while we sat and drank coffee. It was a bittersweet day.

thanks
jodi and izzy

[Jenny & Judi in MN]

poor Izzy and poor Jody. I'm glad she got to enjoy the beach today and I hope you can find an IMS to give you some suggestions tomorrow. hugs, Judi

[frijole]

Jodi - Refresh my memory and make sure I / we are up to date.... last I recall Izzy's cortisol went below accepted levels (addisonian) and you had her on prednisone. You were going to find a new vet to do another acth test.

Are you still giving the prednisone? If not I would say you could be seeing continued signs of cortisol that is too low. If she isn't eating then I'd give her prednisone (if you are not now giving it)... if you are still giving her prednisone and she isn't eating then I would get that test done asap regardless of where I went to have it done - just to make sure the cortisol levels haven't crept downwards... which would be very bad.

I can understand your concern about quality of life but trust me - dogs don't die of cushings - they tend to die from either other old age issues, overdoses when vets are clueless and owners don't get involved/up to speed.

It may not feel like it but you are just missing a good vet to set you on a course to healing up the skin issues and to check the cortisol to see what the next step is. Don't give up on her yet - I can't stress enough - all you need is a competent vet! Really.

I hope one of those vets on the list is close enough for you to get to asap. When you call make sure they know your dog went Addisonian and is in dire need of attention so you can't wait.

Hang in there... Kim

[Bo's Mom]

Feel better soon, Izzy!!

[labblab]

I just wanted to add to what Kim has already said about the possibility that Izzy's cortisol may still be too low. If it is, in addition to the need for prednisone to supplement the cortisol, Izzy may also need supplementation to offset low aldosterone, too. Aldosterone is another adrenal hormone, and when it drops too low during an Addisonian episode, a dog's "electrolyes" or basic blood chemistries can be thrown out of whack, most importantly the levels of sodium and potassium. The electrolyte levels can be checked via a simple blood draw. Since Izzy continues to do so poorly, I agree with Kim that it is time to arrange for testing to see where things stand re: the status of her adrenal rejuvenation.

Marianne

[beachwalkerz]

Thanks Kim and Marianne
and everyone else :)

To refresh, yes, I have been continuing to give 2.5mg Pred once daily since her overdose, the first dose of Pred being two weeks ago Saturday. I was afraid to stop it after three days like the vet thought we could, as you all educated me about what was most likely going on. After two weeks, I decided to skip a day of Pred to see if she was ready to be weaned off it, as she was doing so well. I think that explains her "off" behavior Saturday night and Sunday (last dose of Pred was Friday afternoon). Gave her more Pred Sunday afternoon after reading your posts. She ate good for her evening meal! She seems better today, which makes me REALLY think that she is probably Addisons now....
I am getting another stim test done in the morning and I will have electrolytes tested then as well. Thanks for all the knowledge and input. Will keep you all posted

jodi and izzy

[Jenny & Judi in MN]

jodi: before you pay for a stim will the prednisone affect the test? (I have no clue but will be having this issue myself in a few weeks)

Judi

[beachwalkerz]

Judi-
that is my concern also. They say minimum of 48 hours before the test of having no Pred, but Izzy clearly can't even go 24 hours without it....
Anyone else encountered this problem?

jodi

[frijole]

I think you need to just get the test done and to heck with not giving the prednisone because obviously your dog needs it. But I would be doing all of this at a specialist as otherwise you are wasting time and money. Your dog may need additional attention as Addisons is not something to ignore. I would get Izzy into a specialist post haste. She needs to have the electrolytes checked and may need additional drugs to supplement her.

I have no idea how this might affect the calcinosis cutis - yet another reason to see a specialist. ;):D Are you seeing a recurring subliminal message? :D:D:D Kim

[labblab]

If Izzy still needs the steroid supplement daily, then dexamethasone can be substituted for the prednisone prior to the ACTH testing. Dexamethasone does not skew the ACTH testing in the same way that prednisone does.


Prednisone, prednisolone, hydrocortisone, and cortisone
all cross-react with serum cortisol assays and should be
withheld until completion of ACTH response testing. On
the other hand, dexamethasone does not interfere with
cortisol determination and can be used in the initial
treatment of acute adrenocortical insufficiency without
interfering with ACTH response testing. In those dogs that have received prednisone, prednisolone, hydrocortisone, or cortisone treatment, glucocorticoid therapy must be switched to dexamethasone for at least 24 hours before an ACTH response test can be performed...


This quote was taken from an article by Dr. Mark Peterson:

http://canineaddisonsinfo.com/OSUproceedings093006.doc

You'll have to ask your vet for dexamethasone in lieu of the prednisone. But I would make the substitution, or else the results of the ACTH test won't be very meaningful. This is all the more reason why a referral to a specialist who is familiar with both Cushing's and Addison's would be so important for Izzy...

Marianne

[beachwalkerz]

My vet called me back right before I went to work and said exactly that Marianne :) She said she called the internist at the IDEXX lab, as well as spoke with a fellow vet school specialist, and both discouraged doing a stim test while Izzy is on Pred. I will print this and take it to her in the morning when I have izzy's electrolytes tested. Thanks!