Rascal, 11yo Wheaten Terrier about to start Lysodren

[winterhorses]

I'm so glad I found this board! Honestly, I'm a bit overwhelmed right now.

About a month ago, my BIL and his wife came to visit, and they brought their young dog who they adopted from a shelter. It was so nice having a dog around, and after they left, I started browsing online shelter dogs - specifically low-shed dogs due my son's possible allergies (we're still trying to figure out what's going on with him). I wasn't actively searching for a dog - more like window shopping - but when I saw this 11yo Wheaton terrier's picture and read his blurb, I felt I had to do something for him. If anything, I could give him lots of hugs and a comfy couch on which to spend his remaining golden years.

http://photos.petfinder.com/photos/US/VA/VA331/22567879/VA331.22567879-2-x.jpg

The kids and I went to visit, and while there I learned he only had a little time left at the shelter before he would be PTS. Apparently this shelter has a high kill rate. :( After pleading with DS, Rascal came home with us the next day.

I had a full wellness exam and senior screen done at the vet. The paperwork from the shelter stated he had a mild heart murmur, and he was on doxy for a respiratory issue (poss. kennel cough). The vet said his heart murmur was more severe than reported, so I had x-rays done. He did have an enlarged heart, but no fluid.

At the exam, I mentioned to the vet that Rascal had excessive thirst, was always hungry, and tired easily. She nodded, then also pointed out his thin-skinned potbelly with a thinning coat. Cushing's was officially on the table.

The initial blood work came back. Abnormalities included:
Positive for Lyme
Alk. Phosphatase 1302 H
Alt (SGPT) 188 H
Cholesterol 331 H
T4 0.6 L
Neutrophil Seg 81 H
Lymphocytes 11 L

I had a Lyme Quant C6 done, and it came back <10, so that was a relief.

Next step was the Urine Cortisol/Creatinine ratio test.
Cortisol 24.1 ug/dL
Creatinine 103.7 mg/dL
Ratio: 73

With this result in hand, the vet wanted to do an ACTH stim test, then an ultrasound. However, almost everything I read suggested a LDDS would be the better first diagnostic choice. The vet said she had personally had better experience with the ACTH stim and that she wouldn't start treatment without the stim test unless I opted for the LDDS plus ultrasound.

The expense did give me pause. With the bills racking up, DH was giving me The Look. I already have a very expensive 4-legged creature (equine) who stretches the budget, and when making my initial case to rescue Rascal, I said if the situation went awry and I couldn't find a no-kill rescue to take him, at least he could be put down after spending time in a real home instead of a dreary shelter situation.

I had a very sleepless night trying to decide what to do, but honestly, from Day One I knew I'd go the distance for this guy. Except for his health issues, he is perfect in every other way. The kids love him, and he decided almost immediately that I was his new momma. He is so well-behaved, and I know that when he disappears to hang out with the dog pack at the barn, he'll always be waiting at Sofie's stall when I'm done riding.

So, I gave the go-ahead for the ACHT stim.
Pre-ACHT cortisol 5.8 ug/dL
Post-ACHT 39.7ug/dL

With the high number plus all his clinical symptoms, we're going to start the Lysodren on Monday. Yes, and ultrasound would be preferable, but it's just not possible right now, especially with the very near-future expense of more ACTH stim tests ($315 a pop!).

I've read through a number of the links provided here, and I'm going to read up some more tomorrow, but hopefully I'm ready to take this on. It's been a whirlwind 3 weeks of dog ownership, but our boy is very much worth it. I know there's a good chance the loading phase will be rough on him, but hopefully we'll be moving in the right direction. It just breaks my heart to see him always panting, drinking water, and begging with his eyes to have more food.

What a long post! If you'd stayed with me this far, thanks for listening. I know I'm going to need a lot of support, and I look forward to getting to know everyone.

[labblab]

Welcome to you and Rascal!

What an angel you are to have rescued this sweet boy in his hour of need. I don't know whether you know any of his history as to how he landed at the shelter. But I do believe that a number of undiagnosed Cushpups end up being "dumped" because their owners cannot deal with the excessive thirst and urination. :(

However, no matter what the reason, Rascal is such a lucky boy to have found his final home with you. He certainly exhibits classic Cushing's symptoms, both outwardly and in terms of lab abnormalities. And if it gives you any peace of mind, a positive result on the ACTH is actually more trustworthy than a positive result on the LDDS. The reason why many vets prefer the LDDS is because the ACTH is more likely to mistakenly render a negative result and thus miss diagnosing Cushing's in a dog who really does have the disease. But an ACTH result of 39.7 ug/dl definitely qualifies as a "positive!"

You may have already seen this thread on our Resources subforum, but I'll give you the link just in case. It gives you a lot of helpful information about Lysodren loading and maintenance treatment:

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

I'm certain that you'll soon be greeted by many other folks here, so I'll sign off for the moment. But once again, welcome to our family!

Marianne

[Bo's Mom]

Welcome to you and your beautiful boy Rascal. I probably won't have much to say other than from experience. But here on this group are a bunch of wonderful people who can help guide and support you through everything you will be going through with Rascal. He sure is a good-looking dog and so very lucky to have you as his family as I am sure you will also find that you too are lucky to have him in your lives.

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

[frijole]

Hi! Glad Marianne gave you the link to the lysodren loading instructions - I used them myself about 7 yrs ago and they helped alot! Some other helpful hints -

1. measure water intake so you can check daily for any decrease
2. always give the pill AFTER eating so you can withold it if the appetite has decreased, chewing is slower or if there is pausing where there hasn't been previously.
3. most give the pill in cheese or creamcheese because it helps coat the stomach and prevents upset tummies. It also helps absorb the lysodren (fat does)

Just watch Rascal carefully and ask us questions.

What is the dosage you will be giving, the frequency and what is Rascal's weight? Just checking. ;):) Thanks Kim

[jmac]

Welcome to you and Rascal! I can see why you couldn't turn away; he's a cutie! It is so wonderful you chose to give him a loving home in his senior years. My parents do that often and have four rescues who are either old, have health issues, or both, but they do whatever they can for them and the dogs are forever grateful and make up for it many times over with their love and devotion. I commend you for spending all the money to do all the testing with a new dog. Of course you'd never think you'd be spending that kind of money right after adopting!

You have found a wonderful site with knowledgeable, helpful, and supportive people. It sounds like you are already doing a wonderful job, but now we will be with you and Rascal on your Cushing's journey. Don't hesitate to ask questions, and please keep us updated on how things are going with Rascal.

Julie & Hannah

[winterhorses]

Hi! Glad Marianne gave you the link to the lysodren loading instructions - I used them myself about 7 yrs ago and they helped alot! Some other helpful hints -

1. measure water intake so you can check daily for any decrease
2. always give the pill AFTER eating so you can withold it if the appetite has decreased, chewing is slower or if there is pausing where there hasn't been previously.
3. most give the pill in cheese or creamcheese because it helps coat the stomach and prevents upset tummies. It also helps absorb the lysodren (fat does)

Just watch Rascal carefully and ask us questions.

What is the dosage you will be giving, the frequency and what is Rascal's weight? Just checking. ;):) Thanks Kim

The first thing I did when I found this site was read those great instructions and print them out. :)

Thanks for reminding me about the cheese. I forgot that I ran out yesterday and will have to get more!

Rascal is 39lbs, and he is to have one 500mg tablet 2x/day for 7 days.

It's a bit odd, but I'm actually really excited to be starting the medication. I feel like the clock is ticking, and I want him to hang around as long as possible. We're still getting to know each other, and yet I tear up every time I consider losing him. :( When I came back to the house after dropping him off for the ACTH stim, it seemed so odd that I could open the door without him being curled up there, waiting for me to return.

I don't know anything about his past history other than knowing his owner for the previous 2 years had been a man, according to his rabies vaccination paperwork. (The shelter didn't do a very good job blacking out the name.) I did call the vet listed on the paperwork, and while they couldn't give me many details due to privacy reasons, they said Rascal had only been seen there for those 2 years, and it was just to get the rabies shot and once for an ear infection.

I can tell his previous owner was a man because he responds to commands much better when I use my deepest "man-like" voice possible. I don't know if it's just his nature or if he has been trained well because he has very good doggie manners. He will give me the puppy eyes to ask if he can come on the couch, and when we're eating - even though it's obvious he ravenous - he merely lies his head on my leg and gives me those sad eyes. It's so hard to resist, but I know he needs to stick to his normal diet. He's also polite about letting me know he needs to go outside. He'll give a short, quiet bark that is different from any of his other barks. Yikes, I could go on forever and ever about this guy. :D

Thanks so much for the welcome! I'm sure I will have questions after the treatment begins, and I'll definitely keep with the updates!

[frijole]

I checked the dosage and it is at the high end of the recommended range. That is fine. I just wanted to make a comment because your vet said to take the lysodren for 7 days. I'm assuming the plan is to do an acth test at 7 days? Anyway... what is most important is watching for signs of loading - regardless of what day it is. We have seen dogs load in a day and my girl Haley I believe still holds the record for taking the longest and it was a very long time.

So if you notice any signs of loading as described in the link - cease giving lysodren and call to arrange the acth test. If you have any doubts just ask us :D

Good luck, Kim

[lulusmom]

Hi and welcome to you and Rascal.

Bless you for saving Rascal and for making a commitment to him. He looks adorable and it sounds like he has a personality to match. What lucky dude to have cross paths with you and your family. You're awesome!

I have two cushdogs, one of which was also a shelter rescue. Jojo was a stiff walking, tremoring poster pup for canine cushing's. Aside from calcinosis cutis, I think he had every symptom in the book. Already having a cushdog, I pretty much knew on day one that he was going to be an expensive venture but I couldn't turn my back on him. I'd like to say he is as sweet as Rascal but he's actually a grumpy old fart and the only one who cops a tude with the rescues I bring home.

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!!! :D 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/2012/03/how-to-dilute-and-store-cortrosyn-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.

So sorry for the reasons that brought you here but I'm really glad you found us. We'll be here every step of the way with you and Rascal.

Glynda

[marie adams]

Hi and welcome to you and Rascal! :)

I used Lysodren when I loaded my Maddie Girl. She did not have any side effects at all--she was an 11 yr. old Aussie about 70lbs. This forum helped me through the loading far better than the vet I had at the time because they were not that familiar with the disease. It was the slight decrease in eating or when she looked at me when she was eating that I knew we were loaded. She had the ravenous appetite so it was easy to see (of course I say that now, but at the time it wasn't so easy:D).

Yes, you worry and you will do a lot of researching on your own, but everyone here is so helpful and knowledgeable so ask as many questions as you can think of--there will be answers or research on their part will be done to get you those answers.

Take care--glad you found us!!!:)

[winterhorses]

Day One is pretty much in the books. Of course, I don't expect any significant changes yet, but it's hard for me to not imagine that he has a tad more energy or is slightly less ravenous. He's still scarfing his food and asking for more, but he seems just slightly less desperate - I think!

I do have a question about water intake. I never measured it before, which in hindsight I probably should have done, but today, he drank just over a liter, which is right around the "check the levels" mark (60mL/kg/day). I know that some dogs come down fairly quickly, but I'm wondering if I should take into account water in food. He does have wet food and munches on a lot of carrots, which are always on hand at the barn. Plus, it's been raining buckets here, and the grass that he likes to eat, plus (sigh) the horse poo he sneaks when I'm not looking, is very watery.

I do plan on giving him the Lysodren tomorrow if he inhales the first 2/3 of his meal, but I will certainly mention the water intake amount to the vet when she calls tomorrow. Unless those with experience think I shouldn't give it?

Thanks!

[frijole]

Just measure the liquid water and don't worry about the other. Dogs with ravenous thirst drink buckets so perhaps your dog isn't one that drinks a ton of water. In that case it is the appetite you would be monitoring for change.

It is my opinion that in case a vet has actually loaded a dog they really aren't helpful in telling you whether to stop or not... because they are not watching the dog and don't know what is normal or not... and they are relying on your words and may or may not be listening intently when you ask the question... and they have NO idea unless they've done a load how truly stressful it is. Whew... all that said.. go with your gut. Re-read the loading instructions. Remember the drug continues to work for 48 hrs after the last pill and ideally you want to test at 48 hrs AFTER the last dose. So if you think perhaps your dog is loaded you have 2 days to watch to see if you are right or wrong before doing the test... you can always postpone it and restart the load if you think you erred. Kim

[winterhorses]

Remember the drug continues to work for 48 hrs after the last pill and ideally you want to test at 48 hrs AFTER the last dose. So if you think perhaps your dog is loaded you have 2 days to watch to see if you are right or wrong before doing the test... you can always postpone it and restart the load if you think you erred. Kim

Thanks for the quick reply! I've been considering finding a new vet since we first discussed treating Rascal and she said she would have to do some research on the differences between Lysodren and Trilostane. I feel like I know as much as she does about Cushing's - maybe even more in some areas.

She wants me to schedule an ACTH stim for next Monday - the day after (about 15 hrs or so) the last scheduled loading dose. Should I wait until the next day instead?

[frijole]

She wants me to schedule an ACTH stim for next Monday - the day after (about 15 hrs or so) the last scheduled loading dose. Should I wait until the next day instead?

I would. Also keep in mind that vets are used to dosing that is "x mg's for x days and then do x" The trouble with lysodren is there is NO MAGIC formula for how long it will take to load. So she can tell you to schedule a test for Monday but you could load before then in which case you would not wait that long. It is usually smart to test after 7 to 10 days to gauge progress. That way dosage can be upped if need be. After that you really just let the dog tell you when it is time.

Trust me I understand about vets that know less than the patient about cushings - and they charge full rate while you train them. :D Thank God some are on top of their game though. I don't mind training so long as they get out the book and read along if you get my drift... it isn't a drug to practice with. They need to get up to speed and sometimes bringing in articles for them to read (from our resource section) from intl experts in the field is just what the doctor ordered. ;):)

[winterhorses]

I knew this morning was going to be different because Rascal didn't wake me up at 5am to be let outside and then beg me feed him. Around 6:30 (when my son normally wakes up), we went downstairs, and Rascal was happily following - not bounding down the stairs in front and heading straight for the food bowl. He was still happy to get breakfast and ate it all, but he actually stopped to breathe every now and again instead of inhaling his food and looking for more.

So no Lysodren today, and I moved the ACTH stim for Monday. I'm so excited that there have been no side effects so far (knock on wood). I hope we stopped just at the right time, and hopefully his numbers will be good. Will the results be skewed because it will have been over 60 hours since his last dose? Of course everything has to happen on a weekend! :rolleyes:

[frijole]

Will the results be skewed because it will have been over 60 hours since his last dose? Of course everything has to happen on a weekend! :rolleyes:

NO - it will be perfect. Lysodren keeps on working for 48 hrs after the last dose so Rascal's cortisol will continue to go lower. That is why you stop as soon as you see any little sign at all... So you did the right thing by stopping and Monday will be perfect for the test. Sounds like you are almost there. Fingers crossed. Keep us posted. Kim

[tiggylola62]

Hi my little boy Tiggy is on his 5th day of vetoril which I think is the same as Lysodren and so far so good he goes back for another acth test on thurs. I was very nervous of giving Tiggy this strong drug but no choice as I was told he would just go down hill without it.
I keep seeing people talking about loading:rolleyes::confused:I guess its how they respond to the drug:(

I can not give much advice but just to let you know I am going through the same. Love to you and Rascal Tiggy and I wish you well xx

[winterhorses]

Thanks Tiggy and Linda, and same to you two! I'm sorry you're dealing with difficulties from the Trilostane, and I hope you get some answers (wish I could give you some). :(

[winterhorses]

Rascal last had a 500mg dose of Lysodren during Friday's dinner. On Saturday, he paused during eating breakfast, so I didn't give him any more Lysodren and scheduled the ACTH stim test for Monday (this morning).

He was looking for breakfast this morning, but didn't seem too upset when I didn't give him any due to the stim test. I sent his food along with him to the vet, and they told me he had eaten when I picked him up this afternoon.

He seemed rather listless in the car, and for the first time, he didn't finish dinner - only ate about 1/2 of it. A few hours later, I noticed that it was all gone, but he still is listless and seems very tired. I took him for a short walk, and when I stopped to chat with a neighbor, he lay down on the sidewalk with his head on the concrete after only a few minutes - another first.

Granted, I've only have him about 5 weeks, so I have no idea what his "baseline" is when it comes to eating and energy levels...or really anything at all. I've only seen him with Cushings, so it's hard for me to tell what's normal for him. Still, I can't make much sense of it. Could this be a side effect of the ACTH stim test? If it were, I would think he'd be more hungry, not less. His water consumption since the test is been about the same as before the test, though less than before we started the Lysodren treatment.

I'll be keeping a hawk-eye on him tomorrow, and hopefully the ACTH stim test results will only take a day like previously. If the vet doesn't call tomorrow with results, I'll ring them myself, though I'd love any thoughts from the wonderfully knowledgeable member here!

[frijole]

Sounds to me like Rascal is loaded! Hurray. For those using trilostane - you don't do loading with trilostane so don't worry about trying to understand what it is. :D

I think that dogs need time to adjust to these drugs. They are after all chemo drugs so they are strong and wonderful when used properly. They work magic and give us our old dogs back. I remember my Haley slept more than normal when first loaded. She adapted and was herself before long so don't worry about that.

Since you don't have your results back do keep an eye on rascal just to be sure the cortisol doesn't go too low. I assume you have prednisone and instructions on what to do in case of emergency. I say this just as a precautionary thing - nothing you have said makes me worry that this is anything more than a tired puppy dog.

Keep us posted on the test results. Fingers and paws crossed. Kim

[winterhorses]

Thanks Kim! I really appreciate your response.

I do have prednisone on hand if needed. I'm starting to think I have a picky eater on my hands. Currently, I mix dry food with wet; when I first brought him home, he was not interested in dry alone. Now that he is not ravenously hungry due to Cushing's, I think he is making is preferences known. Even with food left in the bowl, he still gets excited over Pupperonis! :D

[CJandTucker]

That is exactly what I do. When I am really worried that the Lysodren has gone too far. I offer Tucker a treat. If she won't take it, I give her the prednisone. My vet told me that if I am worried, it is better to give it and be extra safe. Glad things are going well this morning.

[Jenny & Judi in MN]

this thread is very helpful to me since Jenny & I are going through the same thing. best of luck to Rascal and you too!

[winterhorses]

Well then.


Rascal's pre-ACTH cortisol was .4ug/dl and after was .8ug/dl.

That would explain the eating and listlessness alright.

So vet said she wanted to take a resting cortisol blood draw in 10-14 days and see where his numbers are before going to maintenance.


That's consistent with what I read in Small Animal Medical Therapeutics; Michael D. Lorenz, Larry M. Cornelius, Duncan C. Ferguson, 1992. ( http://books.google.com/books?id=xKFl5Yro5NUC&lpg=PA112&ots=BJx2tU6w6O&dq=lysodren%20administration%20protocol%20dogs&pg=PA108#v=onepage&q=lysodren%20administration%20protocol%20dogs&f=false. )The text also recommended supplementing with hydrocortisone during that time frame.


In the GENERAL GUILDELINES FOR ACTH RESPONSE TESTING on http://www.showdog-magazine.com/medical/cushings.htm it gives:

3. If both cortisols (pre and post ACTH) are below 30 nmol/L, stop Lysodren, wait 3 weeks, retest with ACTH stimulation and start maintenance when cortisols increase into 30-110 nmol/L range. Dog may require glucocorticoid supplementation, especially if stressed. Also, monitor Na/K to see if Addisons is present.


In terms of the waiting time frame, I prefer my vet's direction of retesting in 10 days, which coincides with the first text I listed. Three weeks seems too long, and I worry about having to load again. However, both of the above references indicate supplementing with a glucocorticoid. Should I push the vet to follow this protocol? Thanks!

[frijole]

Wow... This is like the 4th or 5th dog in the last few days that has gone low (on cortisol). Technically anything below 1.0 is considered addisonian. (too low) Do you have prednisone on hand to give in case you need it? Did the vet check the electrolytes?

Your vet is correct in telling you to hold off and to do another acth test to see where you are in 10 OR SO days. Trust me - I doubt it will rise quickly so don't worry about that at all. Biggest thing is that if it doesn't get to above 1.0 in that time frame you have to wait longer and then go have another Acth test. This is to make sure your dog can handle the lysodren. If it were me I would go more than 10 days - maybe split the difference.

Once you go on maintenance the goal is maintaining where you are so you want the level to INCREASE (you are too low now) so that your dog is comfortable before starting to maintain. So if you get to 2 or 3 - that is fantastic, then start the lysodren.

Good for you for doing the research. You are doing fantastic. Kim

[winterhorses]

Ah, my poor pup.

To recap the Cushing's treatment part:

- First ACTH stim was 5.8 ug/dl pre-cortisol, 39.7 post-cortisol. That confirmed the Cush diagnosis for us.

- Rascal started Lysodren the following week (500mg/2x day - he's 39lbs.). On the 5th day of Lysodren, his "usual" voracious eating slowed a bit, so I stopped the Lysodren and he had another ACTH stim after 2 days.

- The numbers came back low - .4 pre-cortisol, .8 post-cortisol. Obviously, no more Lysodren, and I had prednisolone on hand to give if needed. Other than a normal appetite, which was decreased from his ravenous state, he didn't show any immediate changes from being off the Lysodren. He was scheduled to test his resting cortisol level after 2 weeks to determine when to start the Lysodren maintenance treatment.

- His belly became less bloated, and his eyes cleared up from their previous green glassy state. He regained a normal appetite and water consumption level. Things were looking great, but I watched him like a hawk and thought I started to notice it was taking him just the littlest bit longer to stand up after lying for a while. Also, he began licking his paws and scratching at his ears. The day before the scheduled cortisol test (this past Thursday), I came home after a 3hr trip out, and for the first time, he actually struggled to rise. Once he finally lurched up, his hind legs trembled for a second, then he walked off normally. I changed the vet-assisted blood draw to a full dr's appointment.

- The vet flexed his hind legs and said they showed signs of some medical term that I don't remember. In layman terms, she said the joints were a little crunchy. (In a gallows-humor sort of way, I find that funny). We figured this was pre-existing arthritis that was now expressing itself. She gave me Tramadol to use as needed until we found out his cortisol level.

- I LOVE that the results usually come back the next day, so on Saturday, I had a message that his resting cortisol level was 1.8, which is below the desired 2 - 5 range. I'm surprised that after only 5 days on Lysodren and after 2 weeks of no medication that his number is still low. We'll do another resting test on Thursday and determine where to go from there.

So...now I'm off to research arthritis. I'm going to get a glucosamine/chondroitin supplement for starters, probably also some fish oil and vit E. I have to research Cushing's + arthritis, but hopefully I'll be able to add Adequan to the treatment.

Oh, and to add insult to injury - or maybe injury to injury? - DS might be allergic to him. He has been breaking out in hives all over his body and face, and his eyes, ears, and fingers are swollen. The frequency and intensity of his reaction varies, plus, we've been spending a lot of time outdoors, so I'm not able to figure this out yet. It's sort of like the movie "Hitch"; I feel like he's been drinking Benadryl out of a straw these days - except that every dose is a battle for me to get it down. I've got an immunology appointment for him next month, but I've got my fingers crossed it's "only" some other allergen causing this and not Rascal. Otherwise, well...no need to think about that yet. Especially since we all love him so much!

http://i108.photobucket.com/albums/n1/winterhorses/Dogs/2012-05-11001005.jpg

[frijole]

Glad to see the update and the adorable photo :) What a sweet family.

I'm a bit surprised you never gave any prednisone. It mimics cortisol and makes them feel perky. I would try giving one and I bet Rascal will get some relief. (just an experiment) So you know - Rascal may never get the cortisol back to normal and could be permanently addisonian which requires different meds and attention. Probably not the case but you might be one of the lucky ones who doesn't have to deal with cushings again.

Anyway.. I'd give a prednisone to give Rascal some relief for his muscles. If it makes a huge difference report back in and we'll chat more.

Kim

[winterhorses]

Glad to see the update and the adorable photo :) What a sweet family.

I'm a bit surprised you never gave any prednisone. It mimics cortisol and makes them feel perky. I would try giving one and I bet Rascal will get some relief. (just an experiment) So you know - Rascal may never get the cortisol back to normal and could be permanently addisonian which requires different meds and attention. Probably not the case but you might be one of the lucky ones who doesn't have to deal with cushings again.

Anyway.. I'd give a prednisone to give Rascal some relief for his muscles. If it makes a huge difference report back in and we'll chat more.

Kim

Honestly, he was looking great and seemed to be feeling the same except for rising from a side-lying position, and that only became truly noticeable two days before his scheduled resting cortisol test (last Friday). Even when his numbers were .4/.8 on the ACTH stim done just after I stopped on Day 5 of Lysoden, he seemed so much better than pre-Lysodren. We go to the barn every other day, and he has never stopped taking his little sniffing trips in the woods. Also, he's always eager to go on our daily walks. He manages the stairs without problems (again, except for those 2 days), but now he's on Tramadol (25mg/2x a day), and I know that's helping a lot.

I'll admit to being surprised that after only 5 days of Lysodren, his cortisol was still low 2 weeks later. I'm assuming that means he will be on the lower side when it comes to the maintenance Lysodren dose?

[frijole]

I'll admit to being surprised that after only 5 days of Lysodren, his cortisol was still low 2 weeks later. I'm assuming that means he will be on the lower side when it comes to the maintenance Lysodren dose?

Lysodren works at treating cushings because it eats away/erodes the adrenal cortex. (where the excess cortisol was being produced) Sometimes a dog gets too much lysodren and too much of the adrenal cortex is eroded. It may or may not ever grow fully back. So it may not produce enough cortisol, it may produce normal amounts OR it may grow back to the point where it overproduced cortisol again and only then would you ever give lysodren.

So at this point, we don't know if Rascal will resume lysodren treatment, let alone when. If you were to resume treatment you would need to reduce the dosage and use it with extreme caution meaning lots of acth tests just to be safe.

I can't remember whether your vet is experienced but you really want someone on top of their game managing his health because the adrenals play a very important role in his health. I'm attaching a link to an article that explains it.
http://www.whole-dog-journal.com/issues/9_7/features/Canine_Adrenal_Glands_15824-1.html

Keep us posted and don't rush to treat - let the adrenals grow and you'll know if the symptoms return. Kim