Harley 12 yr Lab recently diagnosed

[nordlexx]

Hi all,
Glad to find this forum, I've learned so much already. About 2 weeks ago during a vet appt, Harley had her bloodwork done. Here are the high/low results:

ALP 724 0 - 140 U/I high (very)
GGT 16 0 - 14 U/I high
Triglycerides 299 30 - 130 mg/dl high
RDW % 19.3000 12.0 - 17.5% high

Basically, other results were normal. She had lung x-rays done too, all normal.
Harley has always, since a little puppy, loved food- and water too.
She is almost 13 yrs, does have the potbelly and pants a lot.
Her coat is shiny black -no problems there. She weighs 80 lbs.

On 4/20/12 she had the low dose dex test:

Time 1 7:25 a.m.
Time 2 11:25 a.m.
Time 3 3:25 p.m.
Cortisol sample 1 2.4 1.0 - 5.0 ug/dL
Cortisol sample 2 (Dex) 2.9 0.0. - 1.4 ug/dL (High)
Cortisol sample 3 (Dex) 3.4 0.0 - 1.4 ug/dL (High)

Vet said she has Cushings, but can not tell which type.

This is day 6 with 750 mgs in a.m. and 750 mgs in p.m. Lysodren. Total 1500 mgs per day.

It is hard to tell if there is a change yet....

Any info will be appreciated.

Thank you, Linda.

[Sage]

To go from an appointment 2 weeks ago to already being on day 6 of Lysodren (a very powerful chemotherapy drug) only based on the 2 tests you have posted seems premature.
I would think an ultrasound, an ACTH, and urine test would have been done prior to a diagnosis. Cushing's symptoms are shared by many other health issues and the last thing you would want to do is give a dog Lysodren without more testing, in my opinion.

[frijole]

Linda,

Welcome and glad you found us!!! You didn't really mention whether or not Harley has a HUGE appetite or RAVENOUS intake of water. That is what you measure. If your dog doesn't have either then I would be concerned the diagnosis is not correct (it happens alot).

Please tell us more about Harley, the symptoms etc.

The liver enzymes are elevated at 724 but they really aren't that high - many cush dogs are over 1000 or even 2000. Sage is right, normally more than one test is done to diagnose cushings because other illnesses can cause false positives. (I had a dog that had 7 false positives for cushings - she started on the drugs but she never had cushings!)

I hope your vet explained the whole 'loading' process with you and what to look for. I am providing a link that helps describe it and I used it when loading.

Do you have prednisone on hand in case of emergency? YOu really want to make sure you stop giving the drug if you see any change in appetite or thirst. Any change regardless how small. Large dogs tend to load more quickly so keep an eye out.

If your dog vomits or has diarrhea it is a sign that she has had too much lysodren. Stop and schedule an acth test.

Ask questions, we are here to help! Kim

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

PS I want someone to look at the LDDS test and give me their opinion as to the dx

[nordlexx]

Harley never stopped thinking about food. Always looked at me like she was starving no matter how much food we gave her. We couldn't keep the water dish full, she would always empty it before the other dog could get any. She peed walking around the house several times- then we finally got a dog door. And panting a lot. She eats twice a day. Weighs 80 lbs.

I actually took her to 3 vets- didn't like one, one internist for a consult, and the one we are keeping. They all said she could have an ultrasound- mainly to tell which type. But due to her age, I felt surgery is not an option and both types are treated with Lysodrin anyway. As soon as her appetite decreases the vet will get her in for the ACTH test.

Thanks for the info. Linda and Harley.

[frijole]

Linda,

OK - couple more questions and I'm asking because I want to make sure you are 'prepped' ;) and fully aware of how serious loading is. Sounds like you will be looking for changes in water consumpton or food intake.

Since you have multiple animals measure daily intake of all of them (how much is there in the a.m. vs how much is left end of day) and look for a decrease. (I marked my water dishes so I put the same amount in them each morning and could just measure what was left and record it then refill)

Food is trickier. Cush dogs typically do not even chew their food - they literally inhale it. So a change could be simply chewing food, or pausing while eating. It is enough of a signal to warrant WITHHOLDING the lysodren and scheduling the acth test.

If you have any doubts - do NOT give the lysodren. Its easiest to give AFTER the meal so you can wait and see if there are any changes and elect to not give it. You can never take it back. And IMPORTANT - it keeps on working (eating away adrenal cortex) for TWO days after the last dose. So it is easy to give too much and dogs can get very sick.

This s why I asked about prednisone and if you have it on hand. It is mandatory that you have it.

I'm being very cautious because we have had like 4 people this week with dogs that had this problem (some with lysodren some were using trilostane)....

Oh and I would monitor Harley's stools to make sure they aren't getting soft. THat is a sign of loading also.

Whew... but once you get thru this it is a true breeze! :D Seriously, this is the hardest part of treating cushings. Kim

[nordlexx]

Also, I do have Prednisone 40 pills - if needed.

Linda

[mytil]

Hi and welcome from me too.

I see Kim has asked a lot of usual questions so I will forgo those :).

As Kim also mentioned, the very slightest changes can occur. For example, while eating a little pause or she looks up at you when you say her name means she is loaded. I will say that adrenal based Cushing's can at times take a bit longer to load though.

The Lysodren you are giving is on the low side according to the recommended range. Harley weighs 80 pounds so 36.4 (rounded off) kilos and giving 50 mg per kilos = 1818 mgs (round off to 1800). But starting a bit lower side can be just fine.

Keep us posted
Terry

[nordlexx]

Hi and welcome from me too.

I see Kim has asked a lot of usual questions so I will forgo those :).

As Kim also mentioned, the very slightest changes can occur. For example, while eating a little pause or she looks up at you when you say her name means she is loaded. I will say that adrenal based Cushing's can at times take a bit longer to load though.

The Lysodren you are giving is on the low side according to the recommended range. Harley weighs 80 pounds so 36.4 (rounded off) kilos and giving 50 mg per kilos = 1818 mgs (round off to 1800). But starting a bit lower side can be just fine.

Keep us posted
Terry
Yes, when I did the math I thought she should take another 1/2 pill per day.

I getting scared now- I know it's a potent drug, and I am watching for subtle changes. There is a little difference in her water consumption but when I start thinking - then she does something like last night- staring at me while I was eating, looking starved. Yet, this morning she didn't ask for breakfast. Usually as soon as she wakes up she wants to eat. This is nerve racking!
Linda

[frijole]

Linda I would cease lysodren and phone to get an acth test done 48 hr (or as close as possible) from the last dose. The fact that Harley didn't ask for breakfast and you've been loading for one week is enough. You should have it done to be safe and know where you are. Better safe than sorry.

I checked the dosage and it is under 50 mgs/kg (the high end of recommended dosage) but closer to 50 than 25 so it is a reasonable place to start. Vets usually round down to the nearest number that is easy to administer - in your case 1500 mgs is 3 pills. Going higher makes it harder to cut pills and remember when you gave what so I think the starting dose is fine.

Remember the drug keeps working for 2 days - that's why setting up a test for Tuesday am or Monday pm is best. Keep us posted!! Kim

[mytil]

Hey again Linda,

If she did not seem interested in breakfast I, too, would stop the Lysodren and call my vet to schedule an ACTH test to see where you are.

Terry

[nordlexx]

I took your advice- Sunday a.m. was the last time I gave Harley Lysodren. She is having her ACTH test now.

I'll let you know what happens.
Thank you, Linda.

[frijole]

Fingers and toes crossed. Keep us posted! Kim

[lulusmom]

Linda, fingers and paws crossed for you and Harley. I'll be anxiously awaiting the results with you.

Glynda

[nordlexx]

The Vet called with the results of the ACTH test last night. Bottom line Harley is not loaded yet. So she is back on 750 mgs Lysodren a.m and p.m. The numbers were 2.7 and 14.9 I have no idea if that is good or bad. They also found she has a urinary tract infection and that is sent to a lab.

Is there there a post about interepting ACTH results.
Thank you, Linda.

[Nikki]

Hi! I'm newer to Cushing's disease so I probably won't be too much help. But I just wanted to pop in and let you know my dogs post ACTH number was 14.1 and the very informative people on here let me know that is too high(and my vet had told me he was "right on track") I believe its supposed to be between 1.5-5.5
My dog is on Vetoryl though, so I'm not sure if the numbers are supposed to be different depending on the treatment. Sorry if that's not much help!!

Nikki

[lulusmom]

Hi Linda,

The goal of loading is to kill off enough of the adrenal tissue in adrenal cortex so as to reduce circulating cortisol to within a therapeutic range of 1 - 5 ug/dl. 14.1 ug/dl is still too high, which is why your vet has instructed you to continue to load Harley. Whatever you do, you should not be kicking yourself for stopping the loading. You did exactly what you should have done based on Harley's change in drinking and eating habits. I've been through loading a few times with my dogs and I wouldn't have handled it any differently. Just pick yourself up, forget about the "woulda, coulda, shouldas and resume position. Ready, aim, start loading! :D We're right here with you.

Glynda

[Sage]

Hi Linda,

Just pick yourself up, forget about the "woulda, coulda, shouldas and resume position. Ready, aim, start loading! :D We're right here with you.

Glynda

Glynda,
I am interested in your opinion about the strength of this Cushing's dx based on the information provided. It was my opinion earlier, and continues to be my opinion that Harley "coulda and shoulda" had more testing prior to the Cushing's dx.
"Ready, aim, start loading!" based on a L-Dex, a blood test, and a pot-belly seems a bit against the grain from what I have been reading here about the importance of thorough testing in light of the toxicity of this particular medication.

[lulusmom]

Hi Sage,

To be perfectly honest, I came to the party after Linda stopped dosing Harley so I didn't really go back and read her earlier post. Now that I have, I will tell you that I personally would not feel comfortable with the lack of testing done to reach a confirmed diagnosis. The abdominal ultrasound that was declined would have been my next test of choice to not only validate the borderline LDDS but to differentiate between adrenal and pituitary cushing's. Yes, Lysodren treats both but adrenal tumors are very resistant to Lysodren so usually much larger doses of Lysodren are necessary. We are talking large doses like 75mg/kg to 100mg/kg and at these doses, some vets will actually prescribe concurrent prednisone to mitigate the adverse reactions.

Vetoryl has become the treatment of choice for adrenal tumors due to much lower risk of adverse reactions. Knowing which form of the disease a dog has makes it easier to determine which drug would be best.

There are three reasons why dogs don't respond to Lysodren. 1) The dose is too low; 2) the dog has an adrenal tumor or 3) the dog does not have cushing's. Believe it or not, dogs with normal adrenal glands don't really respond to Lysodren so in my opinion, the chances of adverse reactions are much lower for a healthy dog. I don't have much time to go into detail as to why that is but just know that scientists in initial studies way back in the 40's figured it out. Healthy dogs received daily loading doses of 50mg/kg and were still alive a year later.

The goal of treatment is to resolve problematic symptoms, symptoms which are usually a bigger problem for the pet owner than the dog. If Harley doesn't really have any symptoms or if Linda were to be concerned that Harley may not have cushing's, then she wouldn't have to start reloading and simply take a wait and see approach. Wait for three or four months and do another chemistry panel to see how things look. Cushing's is a very graded disease, progressing at a snail's pace, so there is plenty of time to observe and make sure you are absolutely comfortable with the diagnosis and any treatment you may choose for your dog in the future.

I hope this helps.

Glynda

[Sage]

Thank you Glynda.

[nordlexx]

Harley will have an ultrasound next Friday. Since she had no real results with 2 weeks of Lysodren......

Will post results then, thank you, Linda.