New here - (9 y/o male dachshund) Elliot

[suezen]

My 9-year-old male dachshund, Elliot was just diagnosed with cushing's. We just did the loading dose and I stopped at 8 days even tho the vet wanted me to continue loading until we got his results (likely tomorrow--would have been day 12). Today he got listless--didn't come outside when I went and had to be coaxed to finish his breakfast. He has not taken meds since Monday (day 8). I pondered giving him prednisone but held off. My Vet is closed on Thursdays and didn't want to pay for the emergency call after two tests at $550 each... He seems fine now but am wondering if this happens tomorrow if I should dose with prednisone.

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[StarDeb55]

Welcome to your & Elliott! I want to confirm one thing since the way you have described how you've been giving the meds, Elliott is getting lysodren? If Elliott is acting the same way at any point in the next 24 hours, please DO NOT hesitate & give him the pred. All of these symptoms are pointing at a lysodren overload which is nothing to mess around with. You also need to contact your vet right away, or worst case, you will need to get your boy to an ER. I don't want to scare the devil out of you, but an overload, if bad enough can be a life threatening situation.

If you're willing to share, we would like to hear about Elliott's history. What symptoms led you to take him to the vet? What testing has been to done to make the Cushing's diagnosis, along with any general lab tests such as a chemistry panel, liver function panel, or urinalysis. What will even help us more is if you could round up copies of all the testing that has been done, & post the actual results. Were things like diabetes & hypothyroid ruled out? I ask about these 2 as their symptoms can overlap with Cushings. Is Elliott taking any other medication or an supplements?

Could you tell us what loading dose of lysodren you have been using with Elliott, along with Elliott's current weight? Sorry for all of the questions, but it helps us to give you more specific feedback. Don't worry about getting this all posted right away, let's make sure Elliott is doing ok, feeling better, & when you're ready to post, we are to help you in any way we can. We would love to hear what Elliott's ACTH results are?

Please keep us posted.

Debbie

[Squirt's Mom]

Hi Suezen and welcome to you and Elliot! :)

You did a great job deciding to stop the Lysodren - it does certainly sound as if Elliot is loaded and may be in crisis as Debbie discussed. How is he this morning?

If you need to give the pred, by all means do. You will simply need to allow 24 hours after the last dose before having the ACTH to see if he is loaded.

I won't repeat the questions already asked, but do tell us all you can about Elliot's medical history and especially the Cushing's journey so far. The more you can tell us, the more meaningful feedback we can offer. ;) And don't worry about a long post - we LOVE details! :D

You and Elliot are no longer alone. We will be here to help in any way we can. I am glad you found us and look forward to learning more as time passes.

Hugs,
Leslie and the gang

[suezen]

Thanks sooo much! My vet did the ATCH stim, resting and one other test and it was determined Elliot had Cushing's but his thyroid levels indicated hypothyroidism. My vet prescribed Solixine(sp) and then we discussed Elliot going on .25 mg Lysodrene x2 daily. I started the Soloxine for one day then backed off to do the Lysodrene--figured to put him back on the Soloxine once we go to maintenance. Will call my vet this morning to update him on things. Elliot seems great today. I had switched his food out from homemade chicken and brown rice on kibble (california gold) to Honest Kitchen's Force (wanted to avoid grain) and am thinking he is getting kind of over the Force. He gobbles up the chicken and rice.

He presented about a year ago with some nighttime incontinence so we did urine tests and his was dilute. We treated with antibiotics and it would clear for quite a while--also did xrays and blood work that indicated it might be an infection in his prostate. I kept investiagting and everything I ran into really pointed to Cushing's so we ran the tests.

I really appreciate the collective wisdom here! Thanks!

[lulusmom]

Hi Suezen and a belated welcome to you and Elliot.

It would help us a lot if you could please round up copies of all testing done by your vet to diagnose Elliot. Acth stimulations tests are used for diagnostic purposes but it is also the only test that is used to monitor treatment. What date did you start giving Elliot the Lysodren and what date did you stop? How much does Elliot weigh and can you please double check the dose? .25mg is a microscopic dose and I'm not sure you would be able to obtain that small of a dose. Could it be that Elliot's Lysodren is compounded in liquid forum or perhaps he is getting one quarter of a tablet? A quarter of a 500mg tablet would be 125 mg.

You mentioned that your vet was open on Thursdays. Did you get Elliot in for an acth stimulation test yesterday?

If Elliot truly is cushingoid, unless your vet did a full thyroid panel and determined he has primary hypothyroidism, it's very possible that his T4 thyroid hormone is low due to the effects of high cortisol. If this is the case, thyroid levels will normalize once stabilized on Lysodren and you won't need to give Soloxine any more. Once you post the test results, we'll be in a much better position to figure that out.

If you don't have copies of the test results, your vet should be happy to provide them to you. We recommend to members that they keep all of their cushdog's medical records in a folder. They help greatly if you ever have to take your dog to an ER. They also come in handy for when we hound you to post results. :D

I'm sorry for the circumstances that brought you here but I'm really glad you found us.

Glynda

[suezen]

I realized my error. The dose was 125 mg twice daily. The vet just called and said his resting ACTH was 8 and his stimulated was 9 so we are holding off on starting maintenance until next Thursday. In about a month we will retest and test his thyroid again. I asked for the results so I can post them. What I know is during his first test:

Resting was 243
Suppressed was 62
Stimulated was 883

[lulusmom]

Hi again.

With Lysodren, the goal is to get the pre and post stimulated cortisol within the therapeutic range of 1 - 5 ug/dl. Unfortunately Elliot's levels are too high and I can almost guarantee that a maintenance dose will not hold and cortisol will continue to rise. I suspect that by next Thursday, levels will be even higher. I think you really are looking at a reload or mini load to get Elliot where he needs to be.

Glynda

P.S. I now see that the acth simulated post number of 9 is in nmol which is very, very low. My comments above should be disregarded.

[StarDeb55]

Resting was 243
Suppressed was 62
Stimulated was 883

These results look like a low dose dex suppression test which is the gold standard for diagnosing Cushing's. Could you double check exactly what test this is & also what are the reporting units which would be something like ug/dl, g/L, or something like that.

Thanks,
Debbie

[suezen]

I am waiting for my vet to pass along the written test results and may have to stop by his office on Tuesday. In the meantime, Elliot seems to be doing better but curiously...he was always an itchy boy--my vet called him a "dermy dog." Those symptoms were relieved I think when he had high cortisol levels but now he is back scratching, biting and licking at himself. He gets flax oil and is not bathed too often. Could this be a reaction to the treatment and not his old state of being? Is there something he could use to make him more comfortable?

Thanks so much for doing this forum. It is s relief to have somewhere to ask these questions

[Squirt's Mom]

Hi Suezen,

Cortisol acts like an anti-inflammatory so when the levels are high allergies, arthritis and other inflammatory conditions are being "treated" by the cortisol. As the cortisol is lowered, these conditions can come to forefront.

Having a new baby in the house who has allergies, I am also working on helping her itchies. One thing that helps is a Chamomile rinse. I bath her then pour Chamomile tea (cooled to room temp or just above) over her and don't rinse it off. I am using a fairly weak concentration of 4 bags of tea to about 1/2 gal of water. She also gets Salmon and Coconut oil daily. She gets about a tablespoon of each per day on her food. Her coat is looking much better and the raw spots she had when she came here are cleared up. But she just had a pred shot for another condition so she is quite content itch-wise right now. ;)

Hugs,
Leslie and the gang

[suezen]

Elliot is losing his appetite. It has been coming on slowly for a few days. He really turns his nose up at kibble but likes his treats and chicken and rice I cook for him. Today I had to hand feed him 3/4 of his breakfast. He had his maintenance dose yesterday. Should we go with a prednisone If so, how many days do we go with this? Thanks!

[Squirt's Mom]

Hi Suezen,

I wouldn't use the pred just yet. If you see diarrhea or vomiting, then give him a dose. The inappetence could be from any number of things so I wouldn't rush the pred based on that alone. When the cortisol drops too low, we typically see more than one sign and they come on pretty much together. So watch him close for digestive upsets right now and keep in touch.

Hugs,
Leslie and the gang

[suezen]

I finally received the results from Elliot's first test that determined he has Cushings. Here are those results:

CORTISOL, BASELINE 243H [15-110]
CORTISOL HIGH DOSE DEX2 62H [0-30]
CORTISOL 1 HR PAST ACTH 883H [220-550]
TOTAL THYROXINE 5L [11-60]
TOTAL TRIIODOTHYRONINE 0.7L [0.8-2.1]
FREE THYROXINE 3L [6-23]
FREE TRIIODOTHYRONINE 0.8L [1.2-8.2]
T4 ANITBODY 13 [0-20]
T3 ANITBODY 7 [0-10]
THYROID STIMULATING HORMONE >139 H [0-30]
THYROGLOBULIN AUTOANTIBODY 7 [0-35]

Here are the results from the second test:
CORTISOL BASELINE 8 L [15-110]
CORTISOL 1 HR PAST ACTH 9L [220-550]

Elliot was tested again a week ago Monday and his thyroid levels are perfect--I barely dosed him with the Soloxine... didn't want to much stuff in the little guy at once. His Cortisol is still around 8.

Any feedback would be grand

thanks!

susan

[Squirt's Mom]

Hi Susan,

Could you edit your post to include the normal ranges for each of those results? Different labs use different norms so it helps to see what they call "normal". :)

Thanks,
Leslie and the gang

[suezen]

I edited the numbers for Elliot's results and put in the ranges. I would love some feedback. He seems more perky and back to his cuddly self. He might have had some staph which we are treating with antibiotics. His skin was peeling like he had a sunburn.

[Harley PoMMom]

Here are the results from the second test:
CORTISOL BASELINE 8 L [15-110]
CORTISOL 1 HR PAST ACTH 9L [220-550]

Any feedback would be grand

thanks!

susan

Hi Susan,

Could you please recheck those numbers, I am assuming the units of measurements are nmol/L? If that post number is 9 nmol/L, then I am quite concerned because this would indicate an Addison's crisis and Elliot would need to see a vet ASAP.

Love and hugs,
Lori

[suezen]

Yes, the numbers were nmol/L and that 9 on the stimulation was the test done on 5/14. We ran another test on 6/7 and the results were:

Cortisol baseline 38 [15-110] nmol/L
Cortisol 1hr post ACTH 63 L [220-550] nmol/L
Total Thyroxine (TT4) 31 [11-60] nmol/L
Total Thiiodothyronine (TT3) 0.9 [0.8-2.1] nmol/L
Free Thyroxine (FT4) 13 [6-23] pmol/L
Free Triiodothyronine(FT3) 2.2 [1.2-8.2] pmol/L
Thyroid Stimulating Hormone 11 [0-11] mU/L

I had stopped his Soloxine after very few doses so that his thyroid numbers were normal after loading the lysodrene makes me wonder if the adrenals were causing the low numbers on his first test. I backed off maintenance dosing with the lysodrene due to the low numbers on his post stimulation after the loading phase and am seeing him pop back to his normal self. I am planning to dose him today but would appreciate feedback on his post ACTH stimulation number. Is it safe to start him back up?

Thanks for reviewing our case!

[Harley PoMMom]

I am happy to see that Elliot's post number has come up. When a dog is being treated with Lysodren a post/pre number between 1-5 ug/dl (30-138 nmol/L) is usually what is recommended.

Were his electrolytes checked when his post was so low? How is Elliot acting right now, any diarrhea and/or vomiting, not wanting to eat or drink?

Although his post number has increased to 63 nmol/L (2.28 ug/dl), I am not sure I would start back up the Lysodren until his electrolytes have been checked. Hopefully the "others" will share their opinions on this as well.

Love and hugs,
Lori

[mytil]

I do agree with Lori, it would not hurt at all having the electrolytes checked. His numbers were very low.

How is his appetite - is he still not eating normally? How is he doing today?

Terry

[Squirt's Mom]

Hi Suezen,

If it were me, I wouldn't restart the Lyso until Elliot's signs are strong again. His cortisol got very, very low and it can take a while for the adrenals to regenerate so he needs time for this to happen - which will not happen with the Lyso in his system. ;) So I'd keep him off the Lyso until you see his hunger, thirst, urination and other signs coming back strong. Then have an ACTH done to make sure where his numbers are. If his post number is high and his signs are strong, then it is time to go back to the Lyso. Do not rush restarting the Lyso. ;)

How is he this morning? Stools solid? Appetite good? Good energy?

Hugs,
Leslie and the gang

[suezen]

Thanks for the input! I will follow advice but I did dose him a shaven 125 mg last night. He ate well this morning--I think part of it is he is over his kibble. I gave him the stuff Henrietta gets for pancreatitis. I will continue to monitor him closely and stop dosing.

thanks so much

[lulusmom]

Hi

Thank you for posting Elliot's test results. For future reference, I am posting the conversion of the acth stim tests from nmol to ug/dl. The latter is what most of us here in the states are acccustomed to. Let me just say EEK to the 5/14 results and much, much better on 6/7.

ACTH 5/14/12
Pre .29
Post .33

ACTH 6/7/12
Pre 1.4
Post 2.3

Now I'm going to be a renegade and part ways with my fellow members on the assessment of Elliot's situation. My comments that follow are based on my own understanding of the drug and it's effect on the adrenals and my personal experience with my two cushdogs, who treat with Lysodren.

It is apparent that Elliot's adrenal are regenerating and given that he is pretty much back to his normal cute self, I think his electrolytes are probably fine. What you don't want to do is wait too long before starting maintenance because you don't want to have to reload. Since it has been 12 days since the last stim and Elliot is acting himself, I think you can safely assume that those numbers are higher today and let's hope they are not too high yet. If I were you, I would get him on his maintenance dose. How much does Elliot weigh and what maintenance dose has your vet prescribed?

I have two dogs who treat with Lysodren and my Jojo's first post stim after loading was .7. We waited two weeks before starting maintenance. An acth stimulation test done 3 weeks later showed that his adrenal glands had already regenerated too much and we had to increase the maintenance dose. If only we had a crystal ball. :D


Glynda

[suezen]

Thanks for the reply. Elliot weighs 12.80 and his dose is 125 mg twice weekly but my vet is conservative and suggests I shave a bit off of the 1/4 tablet before giving it.

This Cushings is a tricky path to wander... I feel like I have been spot on with my decisions so far--especially dropping Soloxine from his regimen and stopping the loading dose before the vet told me to. My instinct, too, is to start the maintenance and watch carefully... very carefully.

Thanks again

[lulusmom]

With Elliot's post stim number being so low after 8 days of loading, I would be conservative with the maintenance dose as well. I'm not sure shaving off a bit of each dose is enough but I'm sure you will be keeping a close eye on him. Let's hope your instincts continue to serve you well.

I'll be staying tuned for your updates.