Meet Kaibo :) 9 y/o toy poodle - Myotonia, Diabetes, adrenalectomy; now PDH and CC

[kaibosmom]

Hi there. I think that 2 days before starting Lysodren therapy is not the best time to be reading this forum for the first time! Yikes. I'm so nervous and now I have a million questions because I haven't been good at getting his recent results from the vet. I know right off the bat you will be asking for them and I will try to supply info tomorrow when I can get them from the vet. I will start Kaibo's story...

Kaibo is a 5 year old toy poodle. He is very happy, quiet, loveable, and eager to please his mama all the time. He is a certified therapy dog (with over 400 volunteer hours) and he used to do agility and flyball. We got Kaibo in August 2007. In July 2009, Kaibo had surgery for luxating patella on his left leg. At that time, elevated liver enzymes were brought to my attention with the suggestion of repeating the blood work 6 months post op. When re-checked, the notes were that ALT showed mild improvement and GLDH had no change (ALT 81; GLDH 16u/l). It was noted he had high cholesterol at the time also (9.37mmol/l). In July 2010, Kaibo had knee surgery once again for luxating patella on his right leg. Again, elevated liver enzymes were indicated. And he was "mildly overweight".

In August 2010 we looked into the liver issues more. A note on the CBC was that he doesn't have a "decrease in lymphocytes which we would expect to occur with stress and this may indicated Addisons Disease." Liver ultrasound showed "increase echogenicity of liver, but it is still darker than the spleen. This is an interesting finding but does not necessarily indicate severe liver disease". Recommended liver function tests and resting cortisol levels. Other info from records: Chemistry Panel interpretation - relatively comparable hepatocellular leakage enzyme values compared to last chem panel. Alk phos elevation - potential bone isoform contribution on top of liver, steroid induced isoforms? Hypercholesterolemia persists. Urinalysis interpretation - positive ketone reaction suggests enhanced lypolysis for energy production. CBC - slight rubricytosis - extramedullary hematopoiesis? splenic dysfunction? Ultrasound - liver, gallbladder, spleen, stomach, kidneys, intestines and urinary bladder are within normal limits for texture, echogenicity, and appearance. Left adrenal is identified and within normal limits.

On Sept 14/10 we had the ammonia tolerance test and bile acid test for kaibo. Ammonia levels within normal range. Bile acids within normal range. No symptoms of liver disease so recommended monitoring.

From there on we just monitored liver enzymes and they continued to increase over time. This is where things get blury with regards to dates, tests, etc. We never did do the resting cortisol levels and I wish we did now! Why didn't we....??? Hmm.

In December 2011, Kaibo had a bout of what was diagnosed as pancreatitis. Prior to this the idea of Cushing's was brought up but after this pancreatitis spell and a change of food, when I took him in for the Cushing's test the vets in the office were amazed at his health, alterness, apparent weight loss, etc. so we held off on the Cushing's test. Kaibo had a couple more pancreatitis flare ups, with the most recent one October 3, where we also did a pancreatitis blood test that came back positive for pancreatitis. The Cushing's test (ACTH stimulation) was done sometime in late summer/early fall 2012 and came back positive for Cushing's. This wasn't a surprise since he has most of the Cushing's symptoms including: enlarged liver (seen on recent xrays for his knee - diagnosis torn cruciate ligament), increased liver enzymes, extreme hunger, panting, hair loss, thin, wrinkly skin, high cholesterol levels, he drinks lots of water but no accidents in the house, pancreatitis, and the cruciate ligament tear that I now know is more common in dogs with Cushing's.

So, we are just starting the induction phase of the Lysodren treatment. I am measuring his water intake for three days. We already measure his food due to the fact that he gains weight easily, and we were going to do surgery for his knee but that is now on hold. Overall, Kaibo still appears happy and healthy and he is in rehab for his cruciate tear and shows no signs of pain due to that (which is another reason we were on the fence over the surgery!). Oh, Kaibo had another abdominal ultrasound in May 2012 and during that time, liver cancer was ruled out, the only thing brought to our attention was some abnormality in the pancreas which fit with the pancreatitis flare ups.

Umm...I've kind of gotten lost over why I was posting this as I went through the records we had for him as I typed this. I also am not sure what other info to include in here. The comment over Addison's disease way back has come to mind many times but it seems unlikely given all of his symptoms and test results. I guess I am still confused and unsure we are doing the right thing with treatment. Just jitters and hoping that we are doing the right thing for him. I have questions like: will his hair grow back, will his liver enzymes return to normal, will his liver decrease in size, will he lose weight. I'm mostly hoping that the treatment will mean he will not wake up at 3:30 am begging for his food!

[frijole]

Yep you know us well. :D We will want the blood panel results (anything abnormal and the ranges for normal) as well as the acth test results.

Drat - the ultrasound only got an image of one adrenal? And it said normal. Cush dogs either have A. pituitary cushings: slightly enlarged both adrenals or B. adrenal cushings: one enlarged adrenal.

The other thing we will need to know is the dosage/frequency of lysodren your vet is prescribing as well as Kaibo's weight. That way we can check the dosage.

It's great you are measuring water intake. I'm linking you to a document that I used during the loading phase for lysodren. It is real important. Please tell me Kaibo's tummy is doing ok and the pancreatitus issues have ceased. I say that because lysodren can be tough on the tummy and you cease giving it when dogs quit eating and you might struggle if pancreatitus flares up.

Re what to expect - sorry but the tummy doesn't usually go away because it is actually an enlarged liver and/or heart from the cushings that causes that 'round' look. You get used to it though ;) The liver enzymes might go down a bit but most cush dogs continue to have higher than normal levels. The good news is that the getting up in the middle of the night goes away. Most cush dogs are getting up to pee in the middle of the night not eat. wow

There is no rush to start treatment so if you want to ask questions and feel more comfy with it you can hold off. It won't hurt Kaibo.

Glad you found us! Kim

PS I used lysodren for over 4 yrs and my girl Haley passed at 16 1/2 of old age and not cushings!

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

[kaibosmom]

He has had two ultrasounds. I'll try to get the results of his last one. As well as his most recent blood tests. I was going to start the medication Tuesday but you are right maybe I don't have to start his treatment yet. I took his sister to grandma's house while we do the induction phase but that's not a big deal. She will enjoy her vacation. He has been fine tummy wise since his flare up in October. Originally my vet directed me to this site when I questioned the treatment options. She has only experience with Lysodren (I think). I am not sure if the loading dose. I know the maintenance dose is to be 1/4 tablet twice a week. Kaibo is 5.9 kg I believe...maybe 5.6kg. So what is the conversion, about 12pounds?

[kaibosmom]

It's ok if the tummy doesn't go away...I love his little Buddha belly :). Oh one question I had was about the Lysodren. I believe it is a chemotherapy drug. One of the places he volunteers at is worried/wondering about contact precautions from saliva etc as a result of the medication.

[frijole]

Loading dosage should be between 25 to 50 mgs per kg of weight. So between 150 to 300 mgs of lysodren. I'd guess they would start out at 250 which is exactly one half a pill a day. You give 1/2 of the dose in the morning and 1/2 in evening AFTER the meal. Wrap it in cream cheese or similar to coat the tummy and aid in digestion.

Maintenance dose is based on what dosage the load occurs. Some dogs take more, some less - so you can't really know the maintenance until you go thru the load. ACTH testing is done whenever you see any change whatsoever in appetite or water intake. When in doubt do NOT give the pill. Also, never give lysodren to a sick dog (diarrhea, vomit, pancreatitus flare ups)

Lysodren should not be handled by pregnant women. Don't handle it if you have cuts on your hand. (wear gloves) I've never heard anything about dogs saliva being a problem.

[molly muffin]

Hello and welcome to the forum. Has Kaibo been on steroids? I saw this mentioned in results "steroid induced isoforms" so was curious. Also the test I'd want to determine positively for cushings is the LDDS not the ACTH. If cortisol is high for some other reason (liver, etc) you could get a false positive on that.
However, if you are feeling good about the diagnosis, then just make sure that you have prednisone on hand in case of crisis. You never know how any given dog is going to react to the drugs, some are more tolerant than others.

Kim is very knowledgeable so I'd definitely trust her take on dosage, what to expect, etc.

Others will be along to say hello and welcome soon too I'm sure. :)

Sharlene and Molly muffin

[Boriss McCall]

Welcome to you & Kaibo!

[kaibosmom]

Thank you for the warm welcome! Well, I guess there might be a blessing in disguise here....the vet didn't call the prescription in so when I went to pick it up tonight, I obviously couldn't get it and therefore can't start his treatment tomorrow as planned. We have a small window of time to start it because my husband travels a lot and we want to make sure that someone is home with him during that 8 to 10 day range when our vet says most dogs get to the threshold or well, I don't know what to call it. Ha ha. I better read more!

I was ok with the diagnosis but when I read a few posts here and there about how there were false positives I begin to wonder and doubt things. However, he really does exhibit so many of the Cushing's symptoms that it seems as if this must be the answer. That being said, I think that it wouldn't hurt to throw his data up there and see what other tests we should have done or questions we should ask, etc. I emailed the vet clinic last night requesting all of the info to be scanned and sent to me and I received nothing today :( So I don't have anything additional to share with you. My husband said, we have to treat him eventually so we should just start and I was ok with that also but now we can't so, perhaps that is a sign. I know I was asking the vet about the other medication (trilostane) but I'm not sure how I would be able to use that for him if we don't know for sure he doesn't have liver disease. Any feedback on medication choices?

And yes, he really does wake us up at 3:30am most nights for food. We do make him go out to pee but he primarily wants food. He's so hungry all the time. Poor guy. We had our last therapy dog visit with his teens tonight as I wanted to have him take time off while we get him on the meds and they made him the cutest cart. So sweet. He doesn't seem to miss his sister at this point so that's good I guess. Well, I'm just babbling now....night all....

[lulusmom]

He Kaibo's mom and a belated welcome to you and Kaibo.

Please thank your vet for referring you to our site. We're always happy to find a vet who knows how important it is for pet owners to communicate with others who have walked in their shoes and can offer their support, knowledge and experiences. The physical symptoms and lab abnormalities are textbook cushing's but we would still like to see the results of all testing done to diagnose Kaibo. If your vet has been here, s/he knows that we will be looking over his/her shoulder. :D

Most, if not all, symptoms will resolve with appropriate treatment. The improvement in coat, muscle mass and pot belly take several months to see improvements but it will come. My two cushdogs had big bellies that eventually disappeared once they were stabilized on treatment. My little Pom, however, never did regain her coat but Pomeranians are a breed that has more than a few hormonal issues that cause lifelong alopecia, so in addition to her cushing's meds, she has lots of sweaters. :D

Kim as already given you excellent information about loading with Lysodren but I'd like to add some things. Please print out a copy of the Lysodren loading instructions and keep them handy while loading. I've used mine on more than a few occasions and know exactly where it is in the event I need to use it again. I don't know if your vet counseled you at length as to what to be watching for but we need to be vigilant in monitoring our dogs. A renown expert in endocrine disorders said that while the text books mention monitoring water intake as a sign that loading may be achieved, the appetite is usually a much better gauge. This expert is Dr. Edward Feldman and he is the author of the loading instructions Kim gave you. He tells his clients to withhold 1/3 of the dog's normal food a day before starting loading and give 1/3 in the am and 1/3 in the pm. This insures that the dog is ravenous and any change in eating habits is easily seen.

My dogs never lifted their head out of their bowls before it was licked clean. You could scream their name and they'd ignore you. If Kaibo is this way, a change could be something as subtle as pausing or looking at you before he's finished his food. If he doesn't finish his food, that is a glaring indication that you need to stop dosing.

Your vet should not have given you any more than 8 to 10 days worth of Lysodren and some prednisone in the event that Kaibo's cortisol drops too low and he starts showing signs of illness. If signs of loading are not seen before you have run out of medication, Kaibo needs to have an acth stimulation test done, preferrably 48 hours after his last dose. The average loading time is 5 to 8 days so Dr. Feldman recommends that you start loading on Saturday or Sunday to insure that your vet's office is open in the event of an emergency. Our internal medicine specialist followed that protocol as well.

We'll be here with you every step of the way. I do remember how afraid I was when I loaded my first cushdog and I wish I had found this site before then. I did it solo and I was a frazzled wreck. Luckily, Lulu and I made a good team and we aced it. :D I have no doubt that you and Kaibo can too.

Glynda

[addy]

Hi and Welcome from me and my Zoe,

We use Trilostane. If blood work was done, would your vet not see an indication of possible liver problems? Zoe has IBD so we went with Trilostane so I could stop and start the medication should she flare up with her IBD. The number one side effect with Lysodren is gastro problems so I did not want to start there for my pup. Each pup is different and we have many members, especially Kim who really can hold your hand through the loading. It will be okay.

The most important thing is to have an experienced vet and be sure of the diagnosis. Cushings is seldom and emergency for starting treatment. Sometimes we second guess ourselves because we hope it is not true. Sometimes, dogs are misdiagnosed.

Follow your heart and have a good vet and read all you can to become a good advocate for your dog. You must be Kaibo's voice for he does not have one and can only speak to you through his bond.

We are here for you.

[labblab]

I want to welcome you and Kaibo, too! As you can see, you'll have plenty of folks keeping you company all along your treatment path! ;)

Just as the others have said, we always welcome seeing the actual test results. So that will be great once you have them in hand so that you can post any "abnormals." I do want to make one comment about the ACTH, test, though. As the others have said, none of the diagnostic blood tests are perfect. But the ACTH is actually less likely than the LDDS to return a "false positive" if a dog is instead suffering from an illness other than Cushing's.


It has been shown that the LDDS is more sensitive with fewer false negatives, but less specific with more false positives than the ACTH stimulation test in dogs with significant non-adrenal illness, especially liver disease.

There is a very small percentage of dogs who may test "negative" on the LDDS but "postive" on the ACTH (as did Sharlene's Molly). But according to noted endocrinologist, Dr. Mark Peterson, this result is most likely to occur when a dog is in the early stages of pituitary Cushing's:


When interpreting LDDS test results, first evaluate the eight-hour postdexamethasone administration cortisol concentration. If it is above the reference range, the dog probably has hyperadrenocorticism (false positive results may occur in dogs with nonadrenal illness). If it is within the reference range, either the dog does not have hyperadrenocorticism or there is a 5% to 10% chance that the dog has PDH. (The dog may have early pituitary disease and the pituitary gland is still responding to a pharmacologic dose of dexamethasone by decreasing ACTH production, thereby reducing serum cortisol concentrations.) In those cases, an ACTH stimulation test is warranted.

http://veterinarymedicine.dvm360.com/vetmed/Medicine/ClinQuiz-Interpreting-low-dose-dexamethasone-suppr/ArticleStandard/Article/detail/580093

So given Kaibo's classic symptom profile (and depending upon his other lab results), I would personally feel reasonably confident that the "positive" ACTH result is an accurate indicator of Cushing's in his case.

Marianne

[molly muffin]

Yes, I do want to second what Marianne said. In our case, Molly has had LDDS test 2 years ago and this year, both that she tested negative on. Since she has no cushings symptoms, other than pot belly (prob from her mildly enlarged liver), even though she tested positive on the ACTH, I'm not starting her on any treatment. She also doesn't have diluted urine. So, for us, we aren't starting treatment. I personally think that as long as she can suppress cortisol within the non range for cushings, I won't treat.
Every dog is different. Molly is either very pre cushings stage or something else is going on. We're in wait and see mode, so more tests in our future.

That is the great thing about this forum, you literally will encounter tons of different experiences and that is because while similar in some many of the areas, each best friend that ends up here is also unique.

I think that you'll be fine. :) Lets see what those test results actually show and go from there. :)

Sharlene

[kaibosmom]

Hi. I hope someone answers tonight....I did get the prescription called in and now have it in hand. The dose is 1/4 tablet twice a day of the mitotane 500mg. I had Kaibo to his rehab vet today (for his knee-cruciate tear; he was to have surgery on November 19 but that is on hold while we start Cushing's treatment). I asked her to do blood work and resting cortisol. I was unable to get info/test results from our regular vet as I mentioned yesterday. So my dilemma is should I start the meds tonight or wait to post the info on here? I'm assuming the diagnosis is correct but.....the rehab vet is very good at getting his weight and he has continued to lose down from 5.26kg to 5.18kg today. He was 5.7kg when we resumed rehab (end of August 2012)

[kaibosmom]

P.S. Kaibo is on Zentonyl for his liver. Although i admit we arent that diligent in giving it to him. Do I keep giving him this?

[frijole]

Hi. I hope someone answers tonight....I did get the prescription called in and now have it in hand. The dose is 1/4 tablet twice a day of the mitotane 500mg. I had Kaibo to his rehab vet today (for his knee-cruciate tear; he was to have surgery on November 19 but that is on hold while we start Cushing's treatment). I asked her to do blood work and resting cortisol. I was unable to get info/test results from our regular vet as I mentioned yesterday. So my dilemma is should I start the meds tonight or wait to post the info on here? I'm assuming the diagnosis is correct but.....the rehab vet is very good at getting his weight and he has continued to lose down from 5.26kg to 5.18kg today. He was 5.7kg when we resumed rehab (end of August 2012)

Did you get a prescription for prednisone? This is to be given in case of emergency and it is a must for any dog on lysodren. If you did not I would call and TELL them you need it and will pick it up tomorrow. You probably will not need it but it saves dogs lives if it is needed and normally emergencies happen in the middle of the night or weekends or holidays.

How is Kaibo eating right now? You mentioned weight loss. Is he scarfing down food? Does he drink buckets of water? Those are the two things you monitor during loading and I want to make sure you have something to measure. If he isn't eating then it'd be hard to load. If you know what he's drinking now you can measure daily and look for decrease. If not I'd wait a couple days and measure water intake and then start. (I think you said you had already done this but sometimes I confuse dogs ;) )

I also believe I linked you to a helpful document for loading. I will double check to make sure I did and add it if I did not.

Be diligent - do NOT give lysodren if he's sick. Watch for diarrhea and vomit. That means too much has been given and you need to stop. Any reduction whatsoever in water intake or the pace he eats is a sign that you need to have an acth test. Cease giving lysodren and schedule it. It works for 2 days after the last dose so do not give if you are at all concerned. Better safe than sorry.

Give lysodren AFTER the meal so you can withold if you notice a change in eating (left some food in dish, paused while eating if he doesn't now etc)

Keep us posted! Kim

PS I hope you read Glynda's post a few back - it is very helpful.

[frijole]

P.S. Kaibo is on Zentonyl for his liver. Although i admit we arent that diligent in giving it to him. Do I keep giving him this?

Yes! Cushing's takes a toll on the liver and so you need to keep supporting it. When in doubt ask the vet. :) Kim

[kaibosmom]

Hi. No tummy troubles at the moment. He is still scarfing down whatever food he can get his paws on. I do have prednisone and I measured his water for three days so I know how much he has been drinking. 1 and 3/4 cups on Saturday. 3/4 cup on Sunday. About 1 and 1/4 cup on Monday

[frijole]

Hi. No tummy troubles at the moment. He is still scarfing down whatever food he can get his paws on. I do have prednisone and I measured his water for three days so I know how much he has been drinking. 1 and 3/4 cups on Saturday. 3/4 cup on Sunday. About 1 and 1/4 cup on Monday

Awesome! My only concern regarding the water intake is that it isn't consistent so you won't know what normal is. My dog's intake was very level and dropped when on lysodren. But the difference between Sat and Sunday is huge. The good news though is that he's scarfing up food so that is easily observable.

The dose your vet gave is exactly what I had predicted and within the recommended range so that is good.

Kim

[kaibosmom]

Yes the water intake was so different. I don't know why. Saturday he was in the kennel while I drove to drop Molly off. So he was stressed about that. Monday was just a normal day. He was home alone.

[molly muffin]

I didn't want to interrupt as Kim was giving you good advice about the loading. I do love the picture of Kaibo and wanted to say so.

It'll be okay, just watch closely for any changes in behavior, eating, drinking, lethargy, etc. Keep us posted and if you have any concerns, ask away.

Sharlene

[kaibosmom]

Thanks Sharlene! That's my cute boy. So happy all the time. Looks healthy, except for the thinning hair that's started recently. It's hard to wrap my head around this disease. Well I bit the bullet and gave him his first dose of Lysodren. Here we go.....

[Trish]

Good luck!! Fingers and paws crossed it all goes well for you and your wee cutie Kaibo
Trish and Flynn xx

[Bo's Mom]

Kaibo is so cute!!!

[kaibosmom]

Ok...Kaibo chewed his food today and took a slight bit longer to eat. It hasn't even been three days. Do I need to be concerned? He's only had 4 doses of the Lysodren. Otherwise nothing remarkable. He seems happy and healthy. He might be missing his sister a bit....:rolleyes:

[kaibosmom]

Thanks Belinda :p

[Jenny & Judi in MN]

Kaibo is a doll! I would call the vet and tell them that, that could be it. My Jenny (also a poodle loaded very fast with Lysodren!)

[kaibosmom]

Jenny is so sweet!!! How is she doing? How old was she when she was diagnosed? I have a call in to the vet :confused:

[kaibosmom]

So if she loaded quickly is her maintenance dose lower? I was trying to do some reading on that but i'm confused! :confused:

[StarDeb55]

Normally, the loading time does not alter the maintenance dose. Have you got an ACTH scheduled yet? If possible, you want that test about 48 hours after the last dose of lyso. Lyso is long acting, reaching its peak at about 48 hours. The test will tell the tale.

Debbie

[kaibosmom]

I have a call in to the vet. I did give him a dose this morning after he ate because I thought maybe I was looking into things or that my mind was playing tricks on me at 4:30 in the morning!

[Jenny & Judi in MN]

Jenny spit up water. I didn't think that counted as throwing up and gave her another dose of Lysodren. She then had wicked horrible diarrhea. I didn't have to give her prednisone but knocked off the Lysodren. So she only loaded for 3 days and it should have been 2.

Jenny has diabetes and cushings and I went against everyone's advice here about a specialist since they are so far away. We did lots of ACTH tests and tweaked Jenny's dose but the Lysodren worked very well on her. We wound up with her at way too low cortisol levels. In December 2011 her ACTH was perfect, in January she showed signs of too much Lysodren and I refused to consider it as my Mom was in ICU, I was in Indiana with her, and my busy season at work was starting. So I screwed up and didn't do another ACTH till April

So, she hasn't had any cushings meds since April and her cortisol is slowly slowly slowly inching up. Frankly, it's been a relief not to be giving the lysodren. We were doing a funky dose with her of 2 days on 1 day off of 1/4 of a pill I think (going from memory here) and that was too much. She is currently 7 pounds.

Keep us posted! and don't hesitate to see a specialist. We did finally see a specialist in April and it was worth the drive

[frijole]

NO MORE lysodren! Especially since you gave it this am despite the fact that she paused. It works for 2 more days. Call and get an appt for Monday morning. The vet might not tell you to stop but I'm telling you I've been here for over 8 yrs and unless a vet has been thru this they don't understand it how subtle the signs can be. Please just schedule the acth test - better safe than sorry. My two cents !

BTW I used lysodren for 4 1/2 yrs and it worked great for my gal. Kim

[Tina]

Hi and welcome from me also. I have been following along with your thread. I am not an expert, but PLEASE do not give any more Lysodren as Kim said. My baby proved to be very sensitive to the medication and there was no way to know that going in. His cortisol bottomed out in 5 days of loading, and he did not show any warning signs that I could detect. He also became over suppressed once we tried the maintenance dose, and now he is off the Lysodren while we treat him for his cortisol being too low. I am not trying to scare you, but every dog is different, and it is possible to load in a very short time. There is no way for you to know until you have an ACTH stim test done to check.

And do you have emergency prednisone on hand in case he develops the signs of low cortisol (vomiting, diarrhea, lethargy, loss of appetite)? You should have prednisone, especially since you gave the Lysodren this morning.

Keep us posted and let us know what your vet said.

Tina and Jasper

[molly muffin]

It's such a tricky disease to load for. I know I've said that before, but you just don't know how any given dog will do on which medication. How are things going this evening. Hopefully all is well and you can get the ACTH on Monday which would be 48 hours after the last load and find out what is going on. We've had some people who have loaded, gone to low, had to wait and then reload, some can go straight to maintenance and others if it gets to low, end up having to deal with the other side of the coin, which is too low of cortisol.

We're all reading your thread and keeping up with how things are going. Hang in there! :)

Sharlene!

[kaibosmom]

OMG! I just read all of your responses. My vet said that chewing his food this morning wasn't enough of a sign and to keep giving him the medication. I monitored him when I got home from work. He seemed to be in good spirits and like my normal little boy. When I fed him tonight he ate quickly but did chew again...which isn't something he does that often. Anyway, I did give him a dose tonight as per the vet. We did talk about doing the test tomorrow if I let it needed to be done. From all of your comments and the fact it lasts 48 hours, I think I should do the ACTH stimulation test tomorrow. It is a holiday here on Monday so if I waited until Monday it would cost me big bucks (which I would pay) to get it done at the College.

As for a specialist, I'm not sure if there is one here. However, the Western College of Veterinary Medicine is here in Saskatoon so perhaps someone is. And yes, I do have prednisone on hand should I need it. He has had a bit of a rumbly tummy tonight and a bit of gas. So I'll go out in the storm with him to see what he does later.

Thanks once again for all of your support and sharing your knowledge.

Nikki and Kaibo

[kaibosmom]

Good morning! Our morning routine lasted from 3:47 to 3:55. He woke me up very persistently as usual and refused to go outside. He ate quickly again chewing his food several times and looking up at me once, inhaling it in between. I sure wish I paid better attention to the before stuff now...but I really don't remember him chewing very often. Anyway, he finished the food then wanted out to pee. I did not give him the medication after he ate this morning.

[Squirt's Mom]

Hi Nikki,

You want to wait those 48 hours to have the ACTH done. Don't do it today. You want to give that last dose of Lyso 48 hours to reach it's peak level of performance - THEN do the test. So if the last dose was last nite, then make the appt for early Mon morning...unless you can get it done Sun afternoon / evening. ;)

If you have the test too early, you won't get a true picture of what the med is doing as it will continue to work over the next two days. So the results taken today might showed a post that was still not within range and lead the vet to tell you to continue loading, while the test taken Mon., with no further drugs given, would show a lower level, the more accurate level, indicating the load is achieved. ;) So make the appt for Mon morning early.

As for the maintenance dose. How quickly the pup loads generally has no bearing on the dose used for maintenance. The same dose that was given daily during the loading phase will be given over a weeks time in maintenance. So if Kaibo is getting 250mg a day for the load, then he will get 250mg spread out over seven days given 2-4 times over those 7 days. We have seen cases in which the initial loading dose was too high causing a rapid load as well as dropping the cortisol too low and in those cases the maintenance dose is lowered from the loading dose. But is isn't the speed of the load that caused the change; it was the fact that the loading dose caused an Addisonian crisis (cortisol dropping too low). In the majority of Lyso pups, the loading and maintenance dose are the same just given on a different schedule. ;)

I'm not sure anyone has explained what the Lyso is doing so I will give you a quick "lesson". Lysodren works by eroding a miniscule layer of the outer cortex of the adrenal glands. This erosion prevents the adrenals from responding the the cues from the hypothalamus and pituitary glands to make more cortisol and release it into the body. The loading phase is what accomplishes this erosion. Those subtle signs like looking up while eating, pausing while eating, drinking less water can all indicate an optimal level of erosion has been achieved with the load - the daily Lyso dosing. At that point, we wait 48 hours and have an ACTH done to see what the cortisol level is. If the level is within range, between 1 - 5ug/dl for a Lyso pup - then we wait about a week and start maintenance dosing. What maintenance dose is just what the name implies - it maintains the level of erosion achieved during the loading phase. The job of maintenance is to prevent the adrenals from regenerating, once again starting the continual release of cortisol.

Hope this helps!
Hugs,
Leslie and the gang

[labblab]

Hi from me, too!

As Leslie has said, a 48-hour testing window is ideal. But if it will be super-expensive and inconvenient for you to test at the College on Monday, maybe waiting until Tuesday morning would be preferable to testing him today? I really don't know, and will count on others who are more experienced with Lysodren to chime in. But I'm thinking that if you are going to err in one direction or the other, it might be better to wait until after his cortisol level has dropped to the lowest point (even though it may be starting back up again) rather than testing while it's still going down.

As I say, I really don't know, and will hope that others will have some thoughts to offer.

Marianne

[frijole]

I agree - you should have it done ideally at 48 hrs after the last dose. If Monday is ridiculously expensive do it Tuesday or Sunday. Please keep us posted on how Kaibo is doing. Kim

[kaibosmom]

I just thought I'd update you all. My husband got home from a 2 week work trip and said Kaibo was eating the same as usual. So we decided to keep giving him the meds. All is well from what I can tell. Thank you for the feedback on the ACTH test though. Our impression from our vet was that he had to go in for the test as soon as possible after we notice the change. Now we know differently! I did get his medical records so I do have some lab results which I'll post later. It's report card time and I've been at the computer all day. Taking a break to get some poodle cuddles :)

[kaibosmom]

Ok. Here is one test result. ACTH Stimulation test from September 21/12.
Cortisol resting 225 nmol/l normal <20 -270
Cortisol post ACTH 1057 nmol/l normal 230-570. Flagged as high.

My vet provided the College with no history or reason for the test so this is what was written.

Results supportive of Cushing's disease provided patient has chem panel, CBC/urinalysis findings, history and physical exam findings that are already strongly supportive of Cushing's.

[kaibosmom]

I'll post the chemistry panel from that day later :)

[kaibosmom]

No chemistry panel from September. But here is one from October 21/11....oops. The records they gave me are all out of whack. Thought this was from this year. But since I've typed it out...

Results flagged as low: Urea 3.4 mmol/l (normal 3.5 to 11.4)
Creatinine 35 umol/l (normal 41-121)

Results flagged as high
Cholesterol 19.02 mmol/l (norm 2.70-5.94)
Alk phos 676 u/l (normal 9/90)
ALT 125 u/l (normal 19-59)
GGT 21 u/l(normal 0-8)
GLDH 205 u/l (normal 0-7)
Albumin 44g/l (normal 32-42)
SDH 10 u/l (normal 0.0-4.0)

Interpretation: in general, the hepatic enzymes are higher as well as cholesterol. Urea is improved from last panel.

[kaibosmom]

Pancreatic lipase 989 H range 0-200 ug/l
Interpretation: >400 ug/l serum Spec cPL concentration is consistent with pancreatitis.

[molly muffin]

I have to say I love those ears! LOL Very Action shot you got with that picture.

I'll let the others comment on the test results. It does sound like the vet is treating and has covered the bases with the test results from 2011.

I think just keep an eye on Kaibo. With these meds, any day can be a different one, reaction wise.
Just think! Now you have two there to keep an eye out. yay for hubbys coming home! :)

Sharlene and Molly Muffin

[kaibosmom]

Thanks! That shot was taken after a great walk at the off leash park. There is a pedway over the river we need to cross. It was such a warm day with a nice breeze that he just plopped himself down for a rest. I was glad I had my iPhone with me that day to capture those ears flying in the wind!

As for an update on Kaibo, he seemed to be acting strange last night so today we held off on meds. He ate his supper the slowest I've seen in ages...chewing most of it. I haven't measured his water yet but it looks as if he hasn't had that much today. We will take him for the ACTH test! His last dose was at supper on Sunday...so do we take him tomorrow or Wednesday morning? Also, if that range isn't good do we just resume treatment 2x a day or ?? We want to get our Molly girl back soon!;)

[frijole]

Glad you knew to not give any more lysodren. You can have the acth test done either Tuesday or Wednesday. Please do keep an eye out since you said he's acting strange. Specifically look for vomit or diarrhea (yep watch him poop just to be safe) and/or lethargy. Just report here any strange things and we'll chime in.

This is why you have prednisone. Most don't have to use it but it is there for a reason and you should not be afraid to use it if you have to. Just sharing to be safe so don't be concerned.

The way it works you want the 2nd number on the acth test to be between a 1 and a 5. Anything 1.0 or lower is TOO low. Above a 5 is considered too high as most dogs cortisol will continue to rise at that level. If you are between a 1 and 5 you are considered "loaded" :D no not rich but it is a good thing. You then give the same dose on a weekly basis you've been giving daily. If cortisol is still high you start over giving the daily dosing and you do it until you see signs of reloading and retest. It's a pain but worth it in the end.

Based on what you have shared I think he is loaded. Keep us posted! Kim

[kaibosmom]

Thanks! We have been watching him poop:p No changes there, no vomit, and apparently he was really playful tonight when I went to soccer. So we are just working out who can take him to the vet tomorrow for the ACTH.

I am a little confused with you saying it should be between 1 and 5. I posted first ACTH stim test results earlier. I'll post again.

resting cortisol 225 nmol/l (<20-270)
post ACTH cortisol 1057 nmol/l H (230-570)

The only thing I see with a number on it is Lipemia Pre&Post: 3+ spun to slight. Hemolysis slight. Yellow none.

I am waiting on some blood tests that were taken last week the day before we started the loading.

[kaibosmom]

One more thing. I don't have time to post other test results I got from the vet on Friday but here is the ultrasound notes. From March 15/12. We were wanting to look at the liver again and I do believe the vet was thinking cancer at the time, as a result of a Feb 17/12 visit for tummy issues/pain, etc. now known to be pancreatitis.

Notes from ultrasound were short:
R adrenal gland may be slightly enlarged but no sign of tumour. Pancreas - diffuse mottling consistent with previous pancreatic episode. Liver - no distinct mass/tumour, slightly hyperechoic (d/t fatty infiltration, steroid hepatopathy, chronic hepatitis, cirrhosis, and less commonly with lymphosarcoma). decided against liver biopsy at this time (esp since no caag (?) panel has been done). At this time, most suspicious of steroid hepatopathy and will recommend test for Cushing's.

[molly muffin]

Hi, did you do the acth test today?

Okay so when they are talking about a "5" as a result, they are talking about what the result would be if you do the conversion to the US measurement of ug/dl which is what most are familiar with here.
To get that you divide the results by 27.59. (I had to go back to my own thread to find that figure).

Resting cortisol 8.15 ug/dl
Post ACTH 38.31 ug/dl

Sharlene

[kaibosmom]

Hi! Thanks for the conversion information. Yes, we did do the test today. However, I'm extremely frustrated with the vet. The vet that usually deals with Kaibo only works at the clininc on Fridays. After a blow up just days before treatment started, I was convinced that both vets were on the same page and our care would be in good hands. Well....let's just say I know who has been researchig Cushing's disease and who hasn't been:mad: So I asked today when they blood work was taken. Apparently they took 3 samples! At 9:30, 10:30, and 11:30. So, when I went to pick him up I ask for the info on times the blood was drawn and when the results would be in. They said a week!!!!! What??? Not acceptable. So the vet overheard me saying that and paused to see what was up. I said I didn't understand how it could be a week for the results. How can we wait that long? By then won't the medication be out of his system anyway? I mean seriously. So the vet says, I'll call Dr. L, I haven't really been keeping up on this. WHAT??? OMG. I've had it. I would have switched vets last week if we weren't about to start the treatment and Molly wasn't at my mother in laws house while we do the induction! THey wouldn't give me our medical records last week so that started my rage. So, anyway....not sure when I will get results but now I can convert them ;)

[molly muffin]

Also not acceptable is refusing to give you a copy of the medical records. I don't think it's even allowed for the vet to not give you a copy if you ask for it. Check under vets ethics canada and see what you find, but I'd be willing to bet. There is also a "vet of record" and working with an IMS, getting a consult to an IMS, that sort of thing.

yes i agree a week is much too long to wait. Where are they sending the samples to do you know? what lab I mean.

Ask friends for recommendations. Ask rescue groups, ask at pet stores even. Call and find out which ones have done the most with cushings dog treatment, what they are experienced in and what sort of follow up do they do to stay on top of the latest papers on small animal medicine, that sort of thing.

I know I've had to be "firm" with my vet a couple times and I've been with her for years. Doesn't matter. You and only you and your husband are the voice for kaibo. Be nice, but be firm.

Is the vet going to call you to let you know something about the results?

hugs,
Sharlene

[kaibosmom]

Hi Sharlene,
Well, I should clarify, that after a really frustrating call to the vet clinic (after the prescription was not phoned in and therefore we couldn't start treatment on the agreed upon date), I emailed the vet that has primarily been dealing with Kaibo's liver issues and Cushing's (the one who referred me to this website). Anyway, her reply was short and she understood my desire for continuity of care but after I cooled off I realized it didn't make sense to change vets right in the middle of starting treatment. The result was a phone call on Friday with me asking some questions and we both kind of acted like nothing happened. LOL. I did get photocopies of his records on Friday and felt like they would both be up to speed and things would be fine. Not feeling that way now :(

On a different note, he just ate supper and chewed it nice and slow. Man, I haven't seen that in years!!!

[kaibosmom]

Oh and the tests are just being sent to another lab in the city (at the college I think), so it seems quite ridiculous that we'd have to wait a week. I am going to start looking for a new vet and will definitely be talking to them first hand asking about their experience with Cushing's. Part of me thinks going to the Vet College would be best but they have less than stellar customer service at the best of times, and of course, you are always dealing with the students which can be frustrating as well. Sigh.....all I want is for my little man to have the best care.......

[molly muffin]

Gee, it certainly does sound like Kaibo is in the right spot if he is eating slow.

Oh yea, I totally get wanting the continuity. Maybe you just need to make sure to see the vet that you had talked to before if the other one isn't really on board and up on cushings.

I had a disagreement with my vet, which was very distressing as she has treated molly since she was a year old (Molly will be 10 in January), so 9 years. I don't like to switch vets because it took molly almost 5 years not to try to nip at everyone in the vets office and now be comfortable there. I am good with the IMS that I ended up with at the emergency ER, so that is a plus. Now we have our regular vet and our IMS when needed.

hugs,
Sharlene

[Squirt's Mom]

Hi,

Don't worry about having to wait a week for the results. That is about how long you need to wait between the loading phase and starting maintenance anyway. So even it those results came in today, you still wouldn't start the maintenance for about a week.

What the loading phase does is basically stop all communication between the glands involved in cortisol production and release by eroding the outer cortex of the adrenal glands, a very miniscule layer. We want the body to be able to respond to the cues so we let the adrenals regenerate just a tad by waiting for a little bit before starting the maintenance phase - which will continue the rest of his life.

So, yes, the med itself may well be out of the body but the effects of the loading phase, the effects of the Lyso, will remain in place for about a week. With Trilostane (Vetoryl) this isn't true as the two drugs work differently. When you stop Trilo, the med and its effects both leave the body pretty quickly - not so with Lysodren. ;)

Hope this helps ease your mind a bit.
Hugs,
Leslie and the gang

[kaibosmom]

Oh my! It helps a lot! Now I feel like I need to apologize to the vet clinic for getting my panties in a knot! That being said, I'd still like the results sooner rather than later so we know if we have to keep loading or not. Anyway......I guess I need to be less like mama bear and ask questions here first!

[Squirt's Mom]

Mama Bears are GOOD! :D

[lulusmom]

In my opinion, you do not owe your vet an apology, he owes you one for not understanding the importance of getting quick results. It is ridiculous to have to wait a week for results of any bloodwork. If one of my dogs were sick and I had to wait a week to find out what's wrong with them, I would be pitching a fit too. That is simply unacceptable and if that is your vet's normal procedure and they think that's acceptable, I agree that you need to be looking for another vet.

[molly muffin]

I'm not good with waiting on results either. I have to say, I want to know asap any results. It wasn't such a big deal when everything always came back normal with my muffin, but once highs started showing up, my patience took a walk right out the door. :)
I don't know what is reasonable and unreasonable time frames for test results from the vet college in your area of course, but I'd probably be just like you were/are.
Hang in there! You're doing fine.
hugs,
Sharlene

[Jenny & Judi in MN]

my vet sends away for the ACTH, takes 3 days for results, not a week if that makes you feel less guilty. My vet is way up in Fargo, ND, the sticks!

looking forward to results!

[Tina]

I am not very good with the waiting either. My vet sends our ACTH stim tests out also, to the lab at Michigan State. They say it can take up to 3 days, but we usually get our results back in 2 days thankfully. With all the trouble that Jasper has had with his cortisol going way too low, that would have been really scary to have to wait a week to get it back. Keep us posted with the results!

Hugs,

Tina and Jasper

[Bo's Mom]

I hate waiting for the test results. Crossing fingers for some answers soon.

[kaibosmom]

YAY!!! The results are in! See I did get all crusty for nothing! I'm a little embarrassed but whatever. Induction is done :).
Results:
Resting 65
1hour 91
2hour post 118
Normal 27.6 to 137.5

Now what? The vet I spoke with said start maintenance dose of 1/4 tablet twice a week. But wasn't sure when exactly. thoughts? suggestions? his last dose was on Sunday night.

Recheck ACTH in 6 months. Isn't it sooner? And that's about all she said besides monitor for changes/symptoms. :cool:

[kaibosmom]

Conversion: 4.27

[frijole]

Oh boy we gotta train your vet. :D

OK... did you load giving 1/2 a pill a day? (1/4 in morning and 1/4 at night)???

If so then you will give 1/2 a pill over a course of a week. It is actually better to give it in 3 or 4 doses vs 2 but it might be hard to cut the pill that small.

Don't give the first dose until a week after your last dose - so I guess Sunday. Pick the two days of the week easiest to remember as you will always give lysodren on those days forever. :)

No way you wait 6 months. You should go in 30 days because you want to make sure the load is maintaining. (trust me you don't want to load again) You want the number to be where it is now. This way you can check it. After that you can wait 6 months.

Kim

[kaibosmom]

Thanks Kim! We were giving him a 1/2 tablet twice daily for induction.

[molly muffin]

This is fabulous news!!! Yay. I wish it would go so well for all our furbabies on here.

Hugs,
Sharlene

[kaibosmom]

Thank you so much Sharlene! I was surprised at how well he did...but very thankful:p It is so lovely to see him eat normally and not pant all the time! We were certain we'd notice the change through his sleeping patterns and getting up at 3:30 am for food. So far, that hasn't changed, but I'm hopeful :eek:

Thanks to everyone for their awesome support and information!! I've still got a lot of learning to do!

[Trish]

What a clever boy little Kaibo is!! Glad to hear it went smoothly, long may it continue!
Trish and Flynn xx

[labblab]

Thanks Kim! We were giving him a 1/2 tablet twice daily for induction.

I'm hoping others who are more experienced with Lysodren will check in, but per Kim's question to you above, I think the typical maintenance dose should be the same total amount that you were giving daily (1 tablet), spread throughout a week. So it sounds as though, for some reason, this vet is telling you to give only half your loading dose for weekly maintenance. I would worry that this is too small a dose to keep the adrenal regrowth under proper control, and I would wonder why he's recommending the decreased dose...

Marianne

[frijole]

Thanks Kim! We were giving him a 1/2 tablet twice daily for induction.

Well if you were giving him 1/2 tablet twice daily that means you were giving him a WHOLE tablet every day. If that is the case then the maintenance amount of 1/2 tablet a week is too low. The cortisol will go up and you have to reload.

Maintenance dose per week is the same as the loading dose per day. The exception is if cortisol is closer to low end of acceptable range which would be 1.0. At 4.3 you are closer to the high end which is 5.0.

If I'm understanding this right - I would have a conversation with the vet on that. Kim

[labblab]

Thanks for confirming that, Kim! :D

[frijole]

:D We were posting at the same time. No problem. Kim

[lulusmom]

I did get the prescription called in and now have it in hand. The dose is 1/4 tablet twice a day of the mitotane 500mg.

Based on the loading dose above, length of time loading and the results of the acth stimulation test, I think the maintenance dose of 1/4 tablet twice a week is right on.

[kaibosmom]

Oops....my bad....the last post was correct. It was 1/4 tablet twice daily for the induction phase. Sorry for the confusion. So the 1/4 tab twice a week is correct then? Starting this Sunday? Morning or evening? Then...?

[Squirt's Mom]

The maintenance dose is calculated at 25 - 50mg/kg/week while the loading dose is fixed at 50mg/kg/day. Meaning there is some leeway with the maintenance to run a little less than the loading dose tho it seems most vets stick with the initial loading dose for maintenance.

And, no, do not wait 6 months for the first monitoring ACTH! :eek: You will need to be back in 30 days IF his signs remain well controlled on this maintenance dose...and ONLY if. If you see the signs coming back before 30 days, schedule an ACTH asap. If the maintenance dose turns out to be too low after all, the load will be lost and you will have to start all over again. If things go well for the next 30 days, then you want an ACTH to make sure this dose is maintaining the load. Even once the maintenance dose has proven to be correct and the pup is rocking along just fine, the 6 month wait between tests is the MAX that should pass. It is risky in my mind to wait that long when first starting out for sure.

You're doing a great job, Mom! Keep it up!
Hugs,
Leslie and the gang

[Boriss McCall]

Good news.. Yay Kaibo!! sounds like you are on your way to happy times..:)

[lulusmom]

Oops....my bad....the last post was correct. It was 1/4 tablet twice daily for the induction phase. Sorry for the confusion. So the 1/4 tab twice a week is correct then? Starting this Sunday? Morning or evening? Then...?

As I mentioned earlier this morning, I think the maintenance dose is correct based on all factors. As for when to start, I wouldn't wait any longer than a week from the last loading dose. It does not make any difference what time of day you give the dose as long as you give it twice a week. For instance, you can give one dose on Sunday morning and the second dose Wednesday night or Thursday morning. It's a lot easier to keep things straight if you pick two days during the week and dose on those days every week.

Glynda

[molly muffin]

How is Kaibo doing? Isn't it going to be time soon to start the maintenance dosing?

Hope all is well,

hugs,
Sharlene and Molly Muffin

[kaibosmom]

Hi Sharlene! Thanks for checking in. Yes we did start the maintenance phase. We started last Friday. Sunday would have been a week since his last pills in the induction phase and because he was at the higher end we took a guess that Friday would be an ok day to start. Anyway, he's had three doses now on the maintenance phase. All seems well. Although I worry about every little thing. Like one day he started panting for no reason and that was something we noticed that had stopped. It didn't last long though. He spit up a small amount of water on Wednesday night and I started worrying. Lol. We have noticed he is quite a bit more playful lately. So perhaps the Cushing's was having more influence on him than we thought. He even played with another dog at grooming on Thursday. Unheard of! We are still hopeful he will stop getting up at 3:30 am for breakfast! He doesn't seem ravenous anymore (and he is still chewing his food when he eats) but he still gets up so early to eat. Maybe he's jut so used to it....?? I don't know. Anyway, there's an update for you all. Thanks for asking. Life's been so busy I haven't gotten on here at all lately! I hope you all had a great Thanksgiving. :)

[kaibosmom]

Well a great Thanksgiving to those of you in the United States :o

[kaibosmom]

Kaibo seems to be up to his old antics. He is up several times throughout the night. This had subsided but is increasing again. He is eating his food faster and seems hungrier. Does this mean we've taken a step back? If so, why? Does he need a higher maintenance dose? What do we do? Have any other dogs had these traits come back? I was reading on someone else's thread about insomnia. Our follow up ACTH stimulation test is scheduled for December 14.

On the plus side, Kaibo remains very active and playful. It seems like he has more energy.

[frijole]

It probably means the maintenance dose isn't maintaining and the cortisol is rising. The only way you can confirm is to do the acth test now. I wouldn't wait another two weeks because it will just get worse and you'll have even higher cortisol if that is the case.... so schedule an acth test. If the cortisol is high you probably will do a mini load which is just a couple days long, another acth test and then higher maintenance dose. Kim

[kaibosmom]

Ok. Thanks. I'm seriously wishing these ACTH tests weren't $175 a crack. Sigh. But we will do what is best for him. Have any others had this happen (I presume so)? Would it mean he needs three times a week 1/4 tab for maintenance or is in not as easy as that? Leave it to Kaibo to make everything seem like its going flawlessly and now this :p.

[kaibosmom]

Oh. If someone can post info on the " mini load" that would be great. Just so I'm prepared should we need it and it seems like we will.

[kaibosmom]

We are waiting for the results....:confused::confused::confused:

[lulusmom]

Oh. If someone can post info on the " mini load" that would be great. Just so I'm prepared should we need it and it seems like we will.

If Kaibo's post stim result is less than 9 or 10 ug/dl, you may be able to get the cortisol down by adding a third dose to the weekly maintenance. That's what we did for my dogs and it worked but it doesn't work for everybody. If the post stim is higher than 9 or 10 ug/dl, your vet may instruct you to restart the loading doses for a few days. That's called a mini load. I've done that with my dogs too and it worked.

Glynda

[kaibosmom]

HELP,!!! Kaibo is driving us nuts! He is getting up constantly throughout the night. Before treatment he was up often. We usually made him go out to pee but more often than not he was hungry. So we started feeding him to get some rest. Once he started the meds we hoped this would stop or decrease. It did a bit but now he's getting up even more than usual. 1:30, 2:30, 3:30, etc. I have read of other dogs taking melatonin. How do I get the dosage for this?

As for his results we are in limbo. The vet that did the ACTH test didn't send a history so it came back results normal (unless dog is being treated for adrenal disease). So our usual vet called the lab who told her that it might not be at the right levels for him. So she called an internal medicine specialist at the vet college. I have yet to hear back from her. And yes, I did request copies or for the levels to be emailed to me but that has not happened. So frustrating! :mad:

[kaibosmom]

Oh and he peed inside the house on the weekend! He's never done that before! I'm pretty in tune with him so I fear I took him for the ACTH right when it might have been hard to tell if the maintenance dose was not strong enough. I fear we are heading back to square one here.

[frijole]

HELP,!!! Kaibo is driving us nuts! He is getting up constantly throughout the night. Before treatment he was up often. We usually made him go out to pee but more often than not he was hungry. So we started feeding him to get some rest. Once he started the meds we hoped this would stop or decrease. It did a bit but now he's getting up even more than usual. 1:30, 2:30, 3:30, etc. I have read of other dogs taking melatonin. How do I get the dosage for this?

As for his results we are in limbo. The vet that did the ACTH test didn't send a history so it came back results normal (unless dog is being treated for adrenal disease). So our usual vet called the lab who told her that it might not be at the right levels for him. So she called an internal medicine specialist at the vet college. I have yet to hear back from her. And yes, I did request copies or for the levels to be emailed to me but that has not happened. So frustrating! :mad:

I may not have the whole picture here but reading this makes me wonder if your vet is clueless. I say this because when an acth test is done it can be done to test a done to see if he has cushings and later after treatment to see how low the cortisol has gone. The comment I bolded indicates that the last acth came back normal unless a dog is being treated for adrenal disease. Well your dog is being treated for adrenal disease. A normal dog's cortisol is around 20. (560 nmol) If Kaibo's cortisol is that high then that would explain why you are up all night and there is peeing going on in the house.. it means the dosage is not working and the cortisol is still way way too high.

I can't remember - are you in Canada? I know things are not the same outside the US but one thing is the same and that is this: when you are getting the run around - and in my opinion you are - you need to insist on answers. You have paid good money for all these tests and the drugs and you are getting no feedback. You shouldn't have to go to a specialist to read a dang acth test!!!

My dogs were about Kaibos size and they took 3 mgs of melatonin morning and 3 mgs night. Here's the deal though - the cushings was treated. I believe the reason Kaibo is getting you up is to pee. Melatonin isn't going to help that.

I will try to go and read back thru your whole thread later tonight if I can. I have to get dinner ready now but hope to be back after bit. I'm really sorry you are having such a hard time getting help. I feel for you and Kaibo. Hang in there and remember - you are Kaibo's voice in this. Kim

[Bo's Mom]

Hope Kaibo is feeling better soon and you get the answers that you rightfully deserve.....keep fighting.

[frijole]

I'm back..I re-read the entire thread and in short converting the tests to US the original acth that diagnosed cushings was at post 38 which is certainly high and would indicate cushings. You had a very short load and the results were 4.2 which were on the high side of the desired range of 1 to 5.

You had to wait a while for the 2nd acth test results so you withheld lysodren and didn't commence maintenance right away. Not sure how many days that was but the only thing I can think of is that it was long enough for it to rise???

If Kaibo is loaded he should not need to get up every hour to eat. Something isn't adding up. Did you actually get a copy of the acth test results or did they read the results over the phone? I'd like for you to go look to make sure they read the right numbers to you.

You could try the melatonin and it wouldn't hurt at all. I would describe it as taking the edge off. My dogs just 'chilled out' and then fell asleep while on it.

Is Kaibo still losing weight? Have you noticed any changes in the cushings symptoms at all since loading? Thanks. Kim

[kaibosmom]

Hi. I've been sick with the flu so just getting back to you now. We did not withhold any doses while waiting for his ACTh on Dec 4. In fact, we gave him his dose as usual that day. I hadn't planned on taking him in for the ACTH test that day. I am still waiting for a copy of those results. They weren't even read to me on the phone I just received an email stating the results were normal (unless dog is being treated for adrenal disease). FYI the vet who submitted the ACTH test is not the vet that's been treating Kaibo. Regardless, it took until today to hear back from our vet. She said she had contacted a specialist at the college so I was waiting to hear about that. So today I get am email and it says

The pre result was 200 and something,the post result was just over 500 with normal about 570. His initial result was well over 1000. I did speak to the specialist. She says it could be a relapse however the post result is not that bad. She mentioned checking his urine/kidey values/ and blood pressure since hypertension could be causeing the symptoms. However he may just need an additional treatment during the week. We shouldn't have to repeat the ACTH test but if you bring him by on Friday we can check the rest of the mentioned values. Once I have these reults I have the number of the specialist who will help us decide what step to take next.

So I will take him in tomorrow. I will post blood work he had done at the college just before his treatment started tomorrow (if I remember). I agree something isn't adding up. The getting up all the time at night is tiresome and we hoped it would end once treatment was in place. Things we have noticed since treatment began are increased energy, decreased panting (only now after he's been playing), and decreased water consumption. Although with the water our other poodle is home now (we sent her on vacay for the induction) and sometimes drinks from his bowl. He still chews his food but he is eating faster now, but at least he is still chewing from time to time.

[kaibosmom]

I don't think he is still losing weight. I will get him weighed tomorrow.

[kaibosmom]

And yes, I am in Canada. In Saskatoon, Saskatchewan. The Western College of Vet Medicine is here with a small animal clinic. I'm starting to wonder if I should just deal with the vet college for him....

[frijole]

So today I get am email and it says

The pre result was 200 and something,the post result was just over 500 with normal about 570. His initial result was well over 1000. I did speak to the specialist. She says it could be a relapse however the post result is not that bad.

.

I stand by my post that they don't know what they are talking about. If you take the post result (that's the one that matters) and divide it by 28 that is 17.8 which is TOO HIGH. She's referring to "normal" for non cushings dogs. Dogs being treated with cushings should be between 1 and 5 and for some reason Kaibo's cortisol has bounced back up. I disagree that its "not that bad".

I would go and insist on getting copies of the tests and I would print out the information from Dechra on how to control a cushings dog and look that vet in the face and ask how current levels are not considered too high. Either that or get the test results and switch over to the vet college.

Kim

[kaibosmom]

I'm taking him in today so ill keep you posted!

[kaibosmom]

Where do I find the Dechra info? I'd like to take it with me.

[kaibosmom]

Never mind! I found it! But it looks like its for trilostane. He is on mitotane.

[frijole]

Crap! I got your drug messed up... here is lysodren....

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

[lulusmom]

So today I get am email and it says

The pre result was 200 and something,the post result was just over 500 with normal about 570. His initial result was well over 1000. I did speak to the specialist. She says it could be a relapse however the post result is not that bad.

If the unit of measurement used by the lab is nmol, then a post stimulated number of 570 is absolutely not acceptable for a dog being treated with Lysodren. Are you sure this was an internal medicine specialist you spoke with? Kim already did the conversion to ug/dl which is 18 and honestly, at this point, you aren't going to get Kaibo's cortisol levels within the desired therapeutic range without doing another induction (reload). The maintenance doses are no longer having any effect so you may want to quit wasting any more pills until you can talk to somebody that knows how to treat cushing's and interpret an acth stimulation test for purpose of monitoring the efficacy of treatment.


She mentioned checking his urine/kidey values/ and blood pressure since hypertension could be causeing the symptoms.

I believe high cortisol is causing the symptoms and with Kaibo's post cortisol being so high, I would be surprised if you didn't see the usual blood abnormalities associated with uncontrolled cushing's. If cushing's was the cause of Kaibo's hypertension before treatment, then it's probably a good bet that if blood pressure is high again, it's because cortisol is not being controlled. Your vet apparently doesn't understand that in order to see resolution of all symptoms and blood & urine abnormalities, you have to ignore the normal laboratory ranges and strive to get the pre and post stimulated cortisol within the therapeutic range of 27.5 and 138 nmol (1 - 5 ug/dl).


However he may just need an additional treatment during the week. We shouldn't have to repeat the ACTH test but if you bring him by on Friday we can check the rest of the mentioned values. Once I have these reults I have the number of the specialist who will help us decide what step to take next.

If the specialist you call tells you to do anything but reload Kaibo, I would look for another specialist. The next acth stimulation test Kaibo has should be the one after reloading him. Doing one now would be a huge waste of money and an unnecessary stress on Kaibo.


I agree something isn't adding up. The getting up all the time at night is tiresome and we hoped it would end once treatment was in place. Things we have noticed since treatment began are increased energy, decreased panting (only now after he's been playing), and decreased water consumption. Although with the water our other poodle is home now (we sent her on vacay for the induction) and sometimes drinks from his bowl. He still chews his food but he is eating faster now, but at least he is still chewing from time to time.

Based on the latest stim test results, it all adds for me. Kaibo's cortisol is simply way too high. It will continue to get higher and you will notice more and more symptoms return as cortisol climbs.

It is really hard for me to believe that the vets and the specialist you are dealing are that ignorant of Lysodren treatment and monitoring protocol. :eek: Perhaps the unit of measurement used by the lab on the acth stim test wasn't nmol? :confused: Can you confirm this?

Glynda

[kaibosmom]

Oh I just want to cry!!! I am very in tune with my boy and that is why I took him for the ACTH test early as it seemed to me things weren't right. Having to wait 10 days to hear back from the vet saying she spoke with a specialist is unacceptable. I agree with you that his cortisol levels are not in check. I am heading to the vet in half an hour. At this point, we have not seen a specialist. The vet we have been dealing with has spoken with a specialist. So, she is going to do bloodwork and a urine sample (although the little bugger snuck out of the house and peed a few minutes ago!!). What else do I ask for at this point? I'm printing off the Lysodren stuff to take with me. What else should I have? I know that this vet has treated dogs with Cushing's before but I am not sure how many. My options at this point seem limited. I stayed with this vet since she has been the one dealing with him and I thought I would stay with her until his induction phase was over and he was stable on maintenance phase. So, now I am thinking it might be best to head back to the Vet College as there are specialists there.....however, if she has been speaking to a specialist and they think they levels of the Dec 4th ACTH are ok, then I have a problem. Ugh!!!!!!!:mad::mad:

[kaibosmom]

Ok. We are back. So, she couldn't do a urine sample because he had just peed before we went to the vet. What a stinker. Anyway, she said his blood pressure seemed normal. I am taking him back tomorrow for bloodwork and a urine sample.

Here are the ACTH stimulation test results from December 4th:

cortisol, resting 159 nmol/l (ref <20-270)
cortisol, post ACTH 375 nmol/l (ref 230-570)

Interpretation: Normal adrenal function (assuming not being treated for adrenal disease).

so with the conversion...what is it? divide by 28? I'll have to look back.

I forgot to ask the vet who the specialist she is talking to is and where they are located.

[kaibosmom]

so...divide by 27.59 then resting is:
159 nmol/l = 5.76
375 nmol/l = 13.59

:(:(:(

Now what? Mini load as mentioned previously? Restart induction? Just increase maintenance dose (as was suggested by vet at the clinic today...not the one who has been treating him but is familiar with his case). Sigh.......:confused:

according to the link on the Lysodren loading instructions he should be between 30-110 nmol/l

[lulusmom]

Your conversion is correct and still too high. Please note that the interpretation mentions that results are normal unless you are treating adrenal disease. Kaibo is being treated for adrenal disease so these references ranges do not apply. I can tell you that most members have never been successful in bringing down this high of a number by increasing the maintenance dose and reloads were ultimately necessary. One of my cushdogs had a post stim of 11 ug/dl and his specialist increased his maintenance dose and I was shocked that it actually worked. You just never know.

Can you tell me again why your vet wants you to pay for bloodwork and urinalysis? IMO, it is more important to get the cortisol down within range and then I'd worry about blood and urine tests.

[kaibosmom]

From our vet's email: I did speak to the specialist. She says it could be a relapse however the post result is not that bad. She mentioned checking his urine/kidey values/ and blood pressure since hypertension could be causeing the symptoms. However he may just need an additional treatment during the week.

So, this is why she wants blood work and urine analysis. I'm so confused right now. Right now it seems as if we need a second opinion, which will just mean all of these tests need to be done again. I am sure the Vet College won't just take copies of our records because they need to get their money. Ugh.

[kaibosmom]

I'm going to go back a bit to some blood work that was drawn just before he began treatment. I realized there was no recent complete panel on him so I requested his rehab vet (she is doing exercises with him for his cruciate tear) do blood work. These results are from November 7, 2012.
I will put normal ranges in brackets
Chem Panel
chloride 101 mmol/l low (105-120)
creatinine 25umol/l low (41-121)
anion gap 28 mmol/l high (12-26)
cholesterol 15.43 mmol/l high (2.7-5.94)
alk phos 1356 u/l high (9-90)
alt 188 u/l high (19-59)
GGT 56 u/l high (0-8)
GLDH 127u/L high (0-7)
CK 804 u/l high (51-418)
albumin 45g/l High (32-42)

Interpretation: Liver enzyme elevation persists. CHolestatic liver enzymes (ALP and GGT) have at least doubled since last submission and hepatocellular leakage enzymes (GLDH and ALT) have also increased. These changes could be consistent with steroid hepatopathy secondary to Cushing's; direct induction of ALP by endogenous glucocorticoids is also likely contributing. Although liver enzyme elevations are likely secondary to Cushing's an underlying hepatic disease can't be ruled out on the serum chemistry alone. (Has Cushing's been confirmed through endocrine testing ex. LDDST?). The moderate hypercholesterolemia is unchanged since the last submission and is likely due to a combination of elevated glucocorticoids with CUshing's and cholestasis. There is mild selective hyperchloremia; any history of vomiting with this patient? A mixed acid-base disturbance is likely occuring and is characterized by high anion gap metabolic acidosis and a hypochloremic metabolic alkalosis. Low creatinine could be consistent with muscle wasting. The urea is now within the low end of the reference interval. Mild hyperalbuminemia could be related to dehydration or due to increased production stimulated by elevated glucocorticoids.

Cortisol resting 100 nmol/l (normal <20-270)

[kaibosmom]

My husband and I have decided that before she takes blood work and a urine sample we will discuss the ACTH stimulation test results with her. We are going to lean towards starting the induction phase over again, although we will wait until we are both off for the holidays, probably starting the 26th or 27th of December. We will send Molly away to Grandma's house again :( I am off until January 2nd so we hope that induction will be speedy again. We realize we may end up having to take him to the vet college on a stat and pay huge bucks for the ACTH but c'est la vie.

The only concerns I have at this point are what do we do after induction. Do we start with a higher maintenance dose right off the bat? If so, what would that look like? How do we find that out? Who do we talk to? I really don't know where to go with this. Find a new vet? At this point, I would only go to the the college? I'm stumped.

[frijole]

Maintenance is totally dependent upon the results of the load. If a dog loads on 250 mgs a day and the result on the acth test is 2.8 (within desired range of 1 and 5) then the maintenance should be 250 mgs a WEEK split into 3 to 4 doses. If after loading the results are a bit high - say the result is 6. Then you might go with a maintenance dose of 300 a week. If it was on the low side - 1.2 then you might want to decrease the maintenance dose to 200 or less depending upon how long it took.

So you see there is no answer. And it is a total shame that the vets aren't experienced enough to know that... but that's ok.. frankly if there weren't alot of issues out there then this forum would never have been created. Truth is - we've been at this for over a decade and regardless of the drug - cushing's remains a challenge for a lot of vets. So we try our best to keep up to date with what is going on and we have the benefit of hundreds of cases a year whereas some vets may only treat a handful in a year.

The key here is you need to have a vet you can rely on to help you and if they don't understand the disease the very least they need to do is research and get up to speed before they prescribe drugs, conduct more tests and continue to bill you.

I don't know about the vet school by you but the one I went to was much less expensive than my local vet. So you never know. Sorry I couldn't be more helpful.. trying though! I send a huge hug because you are doing all the right things and are a great advocate for Kaibo. Keep up the fight and we will never leave your side. Kim

[kaibosmom]

Thank you!! And I will say for the first time in this whole process, I have tears in my eyes. I guess I am confused by what happened this time. Loading dose was two 1/4 tabs a day and if I remember correctly it was 5 days. Then, we started maintenance 5 days after the ACTH test results were in at 1/4 tab twice a week and then by December 4th we have the high ACTH results and noticeable changes at home that led me to take him in prior to the one month mark. So now I'm worried if we redo the induction, with everything the same, start maintenance at the same dose, we end up back here. I know there is no easy answer. Again, I just want to have all the knowledge I can in advance, especially this second time around.

On a side note, I have kept him from his therapy dog visits during all of this and I am no longer going to do that, especially at this Christmas season. We both need it!!! So we will do a few visits before we start induction again. :o

[kaibosmom]

Oh and the vet school here is notorious for charging more than the local vet clinics as a rule! Amazing, isn't it? Trust me, I've been there so much with Kaibo (luxating patella surgeries on both knees, chocolate toxicity, liver enzyme elevation investigation, ultrasounds, xrays, rehab) and with Molly (luxating patella surgery on the left knee)....they have a small fortune from me. Kaibo is getting close to being a $10,000 dog at this point I am sure!:eek:. But I do love the little gaffer:D

[milosmom]

what we do for our babies,and i know the medical field needs to be compensated.but even with insurance,which doesn't cover all our cushing babies have to endure,this truly is an exspensive road we are all on.watching for results on your baby kaibo.sending support,love,hugs....patty and milo

[frijole]

I remember the loading dose discussion... and the test results.. that is why I asked if you had actual copies of the reports or just them calling you because I'm not sure I believe them. ;) It just does not make sense. Kim

[kaibosmom]

Kim. I went through everything tonight. You are right I don't have the actual test results from his ACTH test after the loading. I will get them tomorrow. I am armed with my binder and more knowledge than before!

[frijole]

You go girl! Knowledge is power. I know I sound like a broken record but you are doing everything right so do not feel bad at all - you just need for your support team to actually support you! That's what you pay them for. Keep us posted and keep the faith. My dog Haley holds the record for the longest load recorded here... she required a very high dose (more than twice the highest recommended) of lysodren and it took almost 4 months to load her. I can't remember how many acth tests and broken hearts I had. My vet was clueless and that's how I found this board. So I know the pure frustration you must have. That's why I say - don't worry you aren't alone! Lots of us have been there. Looking forward to what happens at the vets. Good luck!! Kim

[molly muffin]

I know you are going in from a strong position. You now know Tons about cushings, testing and loading/maintenance. It can be a long road that's for sure but Kaibo is way ahead of the game, just as most of of our pups on here are, but having people who are there for them and give them a voice.

Hurrah!
hugs,
Sharlene and Molly Muffin

[kaibosmom]

Hi all. Not to much to report as I have not had time to pick up his most recent tests. I did talk with the vet yesterday. He has no signs of kidney disease but has ketones in his urine and acidosis. We are to monitor him in case this is pre-diabetic stat but she said it all points to uncontrolled cortisol levels. She did agree his levels are not in therapeutic range. So we are going to do another induction starting Christmas Day. We are going to do a short induction phase. 1/4 tab twice a day as before for three days. She is recommending maintenance phase be higher at 1/2 tab twice a week. How long are you supposed to wait between last dose of induction and the ACTH again?

[kaibosmom]

I forgot to add...I guess there was a low value for a kidney enzyme that is seen commonly with low muscle mass :(

[labblab]

I am "bumping up" this thread so that others with Lysodren experience will be better able to see your question about Kaibo's reloading...

Marianne

[lulusmom]

I am going to ask Natalie at k9diabetes to check in here because I am quite concerned about ketones in the urine as this is not a normal problem that occurs as a result of cushing's. I am not well versed in diabetes but thought ketoacidosis is life threatening and needs to be addressed immediately.

Will be back later to talk about reloading.

[k9diabetes]

I did talk with the vet yesterday. He has no signs of kidney disease but has ketones in his urine and acidosis. We are to monitor him in case this is pre-diabetic stat but she said it all points to uncontrolled cortisol levels. She did agree his levels are not in therapeutic range.

Hi,

I am the administrator of a "sister" forum to this one for dogs with diabetes and I am VERY WORRIED about Kaibo after reading that he has ketones in his urine and an acidosis... though I'm not sure how the acidosis was determined.

Ketones are a side effect of long-term high blood sugar from genuine diabetes and would NOT be coming from poorly controlled Cushing's disease. Ketones and Ketoacidosis have the potential to kill suddenly and quickly and they need to be addressed with insulin and IV fluids to flush out the acidosis.

Please have Kaibo seen by a more capable veterinarian immediately - today if possible.

His history of pancreatitis makes diabetes a good possibility - it is fairly common also for Cushing's and diabetes to go together. Perhaps reducing his high cortisol levels allowed inflammation in the pancreas to increase, which has impaired their functioning or he may have developed diabetes separately and is now incapable of producing enough insulin.

Although Cushing's can cause elevated blood sugar, I can't recall a dog who had that, and blood sugar high enough to produce ketones would not be likely to be caused solely by excess cortisol. The symptoms of the two diseases are very similar, including elevations in liver enzymes.

On Ketones and ketoacidosis:
http://www.caninediabetes.org/pdorg/ketoacidosis.htm
http://diabetesindogs.wikia.com/wiki/Ketones

Is It Cushing's or Diabetes or Both:
http://www.caninediabetes.org/pdorg/cushings.htm

Dr. Peterson on difficulties accurately diagnosing a diabetic dog for Cushing's disease:
http://www.k9diabetes.com/forum/showthread.php?t=3365

Management of Ketoacidosis:
http://www.k9diabetes.com/forum/showthread.php?t=4124

Things can go downhill very very quickly when ketoacidosis occurs... I hope his ketones are currently mild and he does not actually have acidosis. But regardless of what is causing it, he needs insulin to bring his blood sugar down, even if only temporarily.

K9Diabetes forum: www.k9diabetes.com/forum (http://www.k9diabetes.com/forum)

Natalie

[lulusmom]

I'm glad Natalie has posted and I urge you to please, please listen to her. She knows what she is talking about. I trust Natalie implicitly and if my dog had Kaibo's issues, she is the first person I would have sought out for advice. Based on what she has said, reloading needs to be put on hold as your first priority should be getting Kaibo's blood sugar down.

Glynda

[kaibosmom]

Hi. Well I went straight to the vet to get his test results right after work. He was at the vet college today so I knew he was in good hands if anything should happen. He was at the college for his usual rehab session for his knee. His treatment today was great. His vet said he was alert and happy and very eager to do the exercises.

I talked to one of the vets at his usual clinic and his rehab vet. Both have assured me his has no signs of diabetes and I agree from what I saw. Glucose in his urine is normal and in his blood was also normal. 4.9 mmol/l (normal 3.1-6.3).

I believe the acidosis is based on the anion gap results. I posted his last blood work recently so you can compare to that but it has increased a bit. His rehab vet always weighs him and noted he is continuing to lose weight. So it looks like maybe he is burning fat for energy production. I hope I got that right. We are starving him? He is on very low fat food (Medical low fat gastrointestinal) to keep pancreatitis under control. Not enough carbs? This could explain the weight loss. Seems logical to me but we will see what you folks say!

They didn't ask for liver values this round of blood work for some reason but here are the results that were flagged. These tests are from Dec 15/12. Normal results in brackets.

Chloride 99 mmol/l low (105-120)
Anion gap 33mmol/l high (12-26)
Creatinine 32umol/l low (41-121)
Albumin 43G/l high (32-42)

Interpretation
Continued presence of a mild selective hypochloremia - recent vomiting? Upper GI stasis? Elevated anion gap -acidosis (lactate? Exogenous acid?...hyperalbuminemia suggests dehydration and can contribute to elevated anion gap, to some degree). With low chloride value and anion gap, mixed acid base disorder is possible. Continued decreased creatinine value...lower than average body muscle mass in this patient? No liver panel ordered today.

Urinalysis. Method cystocentesis
Colour/ clarity yellow, clear
Specific gravity 1.042
Reagent strip
pH 5
Protein neg
Glucose normal
Ketones +1
Bilirubin neg
Blood 4+

Sediment WBC/hpf 0-1
RBC/hpf 5-10
Crystals scant Ca oxalate dihydrate
Fat scant

Interpretation
Well concentrated urine. 1+ ketones - due to prolonged fasting? Few erythrocytes in the urine could be related to collection artifact.

They did get a blood vessel when they took the urine. He has a huge bruise. Poor guy. The rehab vet did some laser on him today to help it heal faster. She is so amazing!

I did ask the vet at our clinic if it might be wise to see a specialist at the college at this point. I feel bad if this is to do with food. We've been told for so long he needs to lose weight and no matter what we did he couldn't drop any. We have cut his food back for a few months now as we were going to do knee surgery for his cruciate tear. We knew his exercise would be limited so wanted him to drop weight before surgery if possible. Ugh. Anyway at this point not sure what to do. Do we start induction again? Wait? Unrelated but do we switch to trilostane this time around? It seems like maybe the college prefers to treat with it now from what the rehab vet was saying. All I want is for Kaibo to get what he needs done once and for all. He's been through so much in his short 5 years.

[kaibosmom]

Oh I got his ACTH results from the end of first induction phase today also. From November 13/12.
Cortisol resting 65 nmol/l (<20-270)
Cortisol post ACTH 91 (1hr) nmol/l low (230-570)
Cortisol post ACTH 118(2hr) nmol/l (230-570)

Interpretation.
The recommended range for post ACTH cortisol maintenance therapy dog on mitotane is 27.6-137.5 you are within this range

[k9diabetes]

The ketones and acidosis just don't make sense to me... I don't know anything about other forms of acidosis, but it seems to me that you would have to be literally starving a dog to generate ketones based on diet.

Also, I would think that with any type of acidosis, IV fluids or at least subQ fluids might be warranted.

If it was my dog, I'd be "hounding" the vets for an explanation of the acidosis.

Natalie

[kaibosmom]

Thanks Natalie. I was in touch with the vet again. She still believes we should get the cortisol sorted out first and we should go ahead with the mini load for induction again. I did some research on the Internet and there were some articles that talked about nutrition and Cushing's as well as how some humans with Cushing's have acid base imbalances when being treated. It's all very confusing to me however. The blood work we had done just before he started the Lysodren already showed the high anion gap and low chloride. I wonder if we had a urinalysis done at that time if ketones would have been present then. He had already been losing weight at that point as well. He's been on the low fat gastrointestinal diet for quite some time and we were giving him a lower than recommended amount due to him being overweight and in preparation for knee surgery (which is now on hold). That has been for at least 4 months. So I don't know. Maybe he hasn't been getting proper nutrition for a long time.

[molly muffin]

Merry Christmas to you, your family and Kaibo.

Have a safe and wonderful Holiday.

hugs,
Sharlene and Molly Muffin

[kaibosmom]

Thanks Sharlene! I hope you had a great Christmas Day! We started the induction again today. Trying a mini load I guess as our instructions were three days then ACTH test. Fingers crossed.

[molly muffin]

Fingers Crossed!!! Good luck!

sharlene and molly muffin

[kaibosmom]

Since I'm a teacher and now have time off I've had time to read the last few days. I'm still trying to figure out those ketones. I haven't really gotten anywhere except that I think we will take Kaibo to the vet college for sure in the new year even if it is just to see the nutritionist. Does anyone else out there have a Cushing's dog who has pancreatitis? I'm sure there are a few! What do you feed your dog?

[labblab]

Here's an article that I found to be very helpful after my dog had a couple of acute pancreatitis attacks last year. As you'll see from the article, not every dog who has had pancreatitis needs to remain on a restricted fat diet forever. But low-fat meals are generally recommended to begin with, at least. This article will show you how to calculate the amount of fat in both commercial and home-cooked meals, and it also gives some tables listing lower fat commercial foods from which you can choose. Here's the link:

http://dogaware.com/articles/wdjlowfatdiets.html

Many of the low-fat foods are high in carbohydrates, and whether this is a good or bad thing for Kaibo, I do not know. I think it would be great for him to be seen by a specialty vet/nutritionist in order to get a handle on his dietary issues.

Marianne

[kaibosmom]

Thanks Marianne. I found a great article on that website last night too. It looks like I might have a new website to explore!

[kaibosmom]

Ok folks.....here's the latest.....

So, we started Kaibo's induction again on Christmas Day. We had checked everything out as far as lab hours and so on before we chose this day. So, started a "mini load" of 3 days of treatment. 1/4 tab twice a day for three days. We took him in for the ACTH test yesterday and NO RESULTS from the lab!!!!!!!! I called the vet this morning to ask about the test results. THey said that they had called already and were told they were just working on it. It is now well after 4 pm and my vet clinic is closed. They had tried calling the lab again but no answer later in the day. So, now what? To me, it seems like the results of the ACTH test need to come back quickly. Now, I will wait until Monday for anything. Furthermore, my vet doesn't work on Monday! How can we use results from Friday to determine treatment options days later? Do I demand a new ACTH test? Free of charge? I seriously don't know what to do. I don't know why it is so hard to get this treatment going and under control. Everything seemed so flawless the first time around induction wise. Now, nothing seems to work. We can't get it together with vet, lab, etc. Meanwhile he has these other strange test results and we are being told that we should not worry about them, just focus on getting the cortisol under control, then see if the other weird results persist and investigate those. I want to curl up into a ball and cry but I also want to punch someone in the face. LOL. I just want Kaibo to be better!!!!!!!:mad::mad::mad:

[kaibosmom]

How long can we go between the ACTH results and beginning maintenance? Reliably? And what if he wasn't in therapeutic range from the ACTH test on Friday? Do we need to do the induction/mini load again? Such a series of unfortunate events. Not fair to Kaibo or us.

[Squirt's Mom]

It is usual to wait a few days even a week between the load and starting maintenance so you should be alright there. If the mini-load didn't work you will need to either do another mini or a full load.

[kaibosmom]

Has anyone had success with any natural remedies?

[lulusmom]

If there were any effective natural remedies out there, most of us would be using them instead of the conventional medications. What I wouldn't give for somebody to find a benign treatment that lowers cortisol.

[kaibosmom]

I wish I had some good news to share. Kaibo has not yet had any ACTH test come back within the appropriate range since his first induction. I guess trying a "mini load" was the wrong choice...although it didn't help that the lab took 4 days to get the results to my vet (I finally connected with her at 10pm on New Year's Eve). His ACTH stim results from Dec 28 after a 3 day mini load of 1/4 tab twice a day (mitotane) was:
resting 111 nmol/l
post ACTH 193 nmol/l

We decided to go back to 1/4 tab twice a day for 3 more days. Again, in hindsight, we should have just done a regular induction maybe? I didn't even post on here to get some input so perhaps that might have helped. Anyway, can't change it now. ACTH restults from Jan 4/13:
resting 106 nmol/l
post ACTH 209 nmol/l

Not within therapeutic range. Our vet is not sure what to do. I have an appointment with the vet college in our city (Western College of Vet Medicine) on Tuesday. I booked that after he had the ketones in the urine and strange acid/base results (that our vet felt was simply due to the uncontrolled cortisol and the effects it is taking on his body). So anyway, she said to withhold medication until we have our appointment on Tuesday and to get a second opinion. I think she is wondering if we should switch to trilostane. It seems as if Kaibo responded to the mitotane originally and responded well but then the maintenance dose failed. So, who knows.

FYI: His initial ACTH test in September was resting 225 nmol/l and post ACTH was 1057 nmol/l.

I'm feeling really frustrated and lost. I'm hoping the visit to the college will bring some new energy and answers for us. I will be asking for the nutrition specialist to work with us as well. $$$$ but we will do what we have to! We are also thinking of taking him to Regina (a city about 3 hours away) to see a homeopathic vet that has rave reviews and has had some success with Cushing's (dogs are still treated with Lyso or Trilo) in addition to other remedies.

[frijole]

I'm not sure that the mini load didn't work - it's more like you needed a bit more time at loading. A mini load is the same thing as a load really - it just doesn't take as long because the cortisol is already lowered. Most vets in the US would try a slight increase next. Again - you've lowered the cortisol to ALMOST acceptable range so you are not that far off. I think it is too early to make a switch. I also disagree that you should hold off on giving the lysodren until you see another vet... because the cortisol is just going to go up and you are losing the progress you made already.

This is really not unusual. My dog Haley took 50 days to load. That does NOT include the time in between waiting for acth tests... It was a total of 2 1/2 months. And she required a much higher dose than most dogs. But once we got her there she was absolutely fine for 4 1/2 years.

You don't just switch to trilostane. You have to wait 45 days for all of it to get out of the system and once again the dog's cortisol continues to rise and the stress on him and YOU increases.

It appears to me that your vet isn't all that familiar with how to use lysodren - or they have been lucky in the past and never had issues. We see this all the time here so please don't feel like you are doing anything wrong or that this is unusual because it isn't.

I think seeing the specialist would be good for you. That said I would not quit giving the lysodren for reasons already stated. :) Hang in there!!! You are close. That number translates to below 7 here and that is close to 5. You are looking for that second number to be between 28 and 140. You are at 193 down from 1057! That is progress my friend!!!

Hugs, Kim

[molly muffin]

Hi. It is frustrating trying to get this disease under control, however, once under control, things do seem to go easier for awhile.

From what I've read, it seems that not all dogs take a mini load and have to do a full reload and just redo the whole thing. Some of the others that have used lysoderm can tell you better about that. But that is what my memory seems to be telling me.

What I would want to know from the college is more information about those ketons and the strange acid/base results, speak with the nutritionist and then find out if you should start over on the lyso or what. If you decide to switch to trilostane, then you need a 30 day interval of no treatment, to clear the system, a reset. This is what the specialist all seem to recommend.

I find that really interesting about the homeopathic vet who works with the treated dogs using other remedies in addition. I'd love to know what sort of treatment program the vet uses.

However, first things first. I hope that the specialist can give you some good answers for Kaibo. It does all seem so very unfair. You try to do everything the way it has been prescribed and still things don't work out as we hope them to. I still have faith that this will get sorted out. I know it feels like you are back at step one, but really you have a lot of test results behind you and that adds to your knowledge base, which is never a bad thing to have.

Sharlene and Molly Muffin

[molly muffin]

Oops, I see Kim and I were posting at the same time. :)
She has the experience behind her with the Lyso, and I'd bet she is spot on with the loading.
50 days to load!
Motto of the day is now going to be "patience grasshopper". (I think patience is grossly over rated, but in this case, it might be the best bet)

Sharlene and Molly Muffin

[kaibosmom]

Thank you :p

I will give him a dose tomorrow morning! I suspected he wasn't quite there after the last ACTH since he is still drinking a fair amount of water. We weren't measuring because it was a 3 day interval...and because Molly is here and might drink from his bowl during the day when we aren't home (highly unlikely but still). Anyway.....I'll post again after our appointment on Tuesday afternoon!

[kaibosmom]

Thanks Sharlene! I am got the name of a person whose dog is being treated by the homeopathic vet in Regina and I am going to get in touch with her directly. I was just sent a copy of info regarding her dog's situation. I guess the dog was very ill as a result of Cushing's and is doing amazing now. I'll post what was written but I haven't contacted this person directly yet. I am going to speak with the homeopathic vet this week as soon as she returns my call (she has been on holidays!). But yes, first things first!!!

[kaibosmom]

Info I received....

We treat homeopathic and traditionally she gets 30mg veteryl daily... We switched to raw food which helped enormously as with cushings they are chronically dehydrated, and kibble is so drying.. She is on a very strict no carb diet, she only eats meat bones and organs, because as you know carbs turn to sugar and sugar causes a spike in insulin and that in turn causes a spike in cortisol (that is the hormone that poisons our Cush dogs) she also takes a milk thistle to support her liver as the veteryl is hard on kidneys and liver. I keep her at a healthy weight as Cushings affects the connective tissues and muscle mass. Making Cush dogs very acceptable to acl injuries.
She is also on a homepathic remedy here and there to support her.. Don't ask me what's in it or how it works as I don't have a clue.
We did try homeopathy alone without traditional medicine but while we did see some improvement it just wasn't enough... The veteryl certainly made her more comfortable and gave me my dog back..
Your friend is certainly welcome to call me or message me if she has any questions.

Interesting.........:rolleyes:

[Squirt's Mom]

Info I received....

We treat homeopathic and traditionally she gets 30mg veteryl daily... We switched to raw food which helped enormously as with cushings they are chronically dehydrated, and kibble is so drying.. She is on a very strict no carb diet, she only eats meat bones and organs, because as you know carbs turn to sugar and sugar causes a spike in insulin and that in turn causes a spike in cortisol (that is the hormone that poisons our Cush dogs) she also takes a milk thistle to support her liver as the veteryl is hard on kidneys and liver. I keep her at a healthy weight as Cushings affects the connective tissues and muscle mass. Making Cush dogs very acceptable to acl injuries.
She is also on a homepathic remedy here and there to support her.. Don't ask me what's in it or how it works as I don't have a clue.
We did try homeopathy alone without traditional medicine but while we did see some improvement it just wasn't enough... The veteryl certainly made her more comfortable and gave me my dog back..
Your friend is certainly welcome to call me or message me if she has any questions.

Interesting.........:rolleyes:

The bolded parts of this message are just flat scary to me. First, an all protein diet is NOT good for any dog especially one who is already struggling with an illness. Her analysis of the the breakdown of carbs to cortisol is not correct - much too simplistic and carbs do not cause elevations in cortisol like are seen with Cushing's. And to give my dog something that I had no idea what it was or how it worked is nuts in my book. Homeopathic remedies work by treating like with like so an homeopathic Cushing's approach would be to give them something that causes the cortisol to rise - an illogical approach for treating Cushing's in my mind.

I want to repeat what Kim has said - Kaibo has not been given a fair chance with proper treatment with Lysodren and I wouldn't even think about switching right now.

Hugs,
Leslie and the gang

[kaibosmom]

You know what, after I posted it and re-read that...I thought the same thing as well. That's why I wrote the "interesting...." part. I'm not as experienced as you all are but it did seem a bit odd to me. Anyway, I am focusing on what can be done here and with the appointment tomorrow. After the ketones were present in his urine, we took it upon ourselves to add a bit of food with more protein and carbs....his weight has skyrocketed I am sure. He is much chunkier than before. Sigh. So we are seeking info on his nutrition as well and there is a vet that is researching nutrition so fingers crossed we can get some help there also! Thanks for the feedback and support :o

[molly muffin]

I do think, it is interesting and Good even to know what other vets, especially those who are going with a homeopathic approach are doing. We need to know what people are being told, especially in case something goes wrong. Which is certainly sounds like could happen. I think it goes to show how very difficult it is to treat cushings, when you see all the different avenues and theories put out by vets. Sometimes I think they are just all over the place from one extreme to the other. :(

LOL I caught that roll of the eyes!! hehehe I was doing it too.

I am very hopeful that the hospital has some good ideas and approaches for you and Kaibo and that nutritionist sounds like a good idea too.

I'm thinking a complete reload is going to be necessary though from what others have gone through. I wonder what the specialist will recommend.

hugs,
Sharlene and Molly Muffin

[lulusmom]

Info I received....

We treat homeopathic and traditionally she gets 30mg veteryl daily... We switched to raw food which helped enormously as with cushings they are chronically dehydrated, and kibble is so drying.. She is on a very strict no carb diet, she only eats meat bones and organs, because as you know carbs turn to sugar and sugar causes a spike in insulin and that in turn causes a spike in cortisol (that is the hormone that poisons our Cush dogs) she also takes a milk thistle to support her liver as the veteryl is hard on kidneys and liver. I keep her at a healthy weight as Cushings affects the connective tissues and muscle mass. Making Cush dogs very acceptable to acl injuries.
She is also on a homepathic remedy here and there to support her.. Don't ask me what's in it or how it works as I don't have a clue.
We did try homeopathy alone without traditional medicine but while we did see some improvement it just wasn't enough... The veteryl certainly made her more comfortable and gave me my dog back..
Your friend is certainly welcome to call me or message me if she has any questions.

The only thing scarey about these comments is that the person who made them is fairly ignorant and in the hands of an equally ignorant person, it could be scarey for a dog. The one thing I will say is that the next to the last sentence says it all. Vetoryl made it possible for her dog to feel better and she got her old dog back. So much for the homeopathic treatment this person knows absolutely nothing about yet puts it in her dog's mouth. Yeah, I want to call this person and get advice. NOT!

[kaibosmom]

Yes, I will definitely not be calling her for advice after re-reading. I think initially a person just gets excited at how something could help this disease. When I slow down and think about a lot of this stuff, I shake my head. I'm glad you are all here to confirm my suspicions. At any rate, I did hear back from the vet clinic in Regina and they just said that the vet there has helped treat dogs with Cushing's disease and it is bet to do a phone consultation (at $3/min for an estimated 30 minute call to discuss everything) if we are interested in adding some homeopathic remedies to his "traditional" treatment. Anyway, I am putting the thought of this on hold. We must focus on getting him on the meds and in therapeutic range. We have noticed in the few days without meds his panting has increased, appetite has increased, water intake increased, etc. It is amazing how fast those symptoms return. We didn't give him meds today as I had said we would. My husband is on the conservative side and said we should just wait until we see the specialist tomorrow. So, fingers crossed for us. I'll be in touch tomorrow. Thanks for the feedback on the induction and switching meds. It is good to have that knowledge behind me as I believe the University's first choice is to treat with Trilostane from what I have heard. Catch you tomorrow :)

[kaibosmom]

Hi there! Well...not much to report. The vets at the college did exactly what I expected them to do. Full blood work up, urinalysis, and an ultrasound. We did find out there are no ketones in the blood and she was very happy with that as it is more reliable than the urine test. The ultrasound showed nothing (yay!!) except what they would have expected...changes in the pancreas due to the pancreatitis and smaller adrenal glands which she said were expected as a result of the Lysodren. So....??? waiting for the blood work. She seemed surprised that the maintenance phase didn't work. She hinted that we would just redo the induction (as you all suggested) but for now we are to just give him the dose we were giving him for maintenance. I think she just said that because I said he has been without meds for 6 days or so and today was our regular day to give him a dose so I was asking what to do. Anyway...I'll be back tomorrow. Oh, they were super impressed with my binder and copies of all lab results and vet notes. You always see a student first so I hope she is learning lots from my little K-man :p

[molly muffin]

I'd be impressed too if someone walked in with a binder full of tests and notes if I were a student at a vet college. Then again, might just run for the hills as this is obviously someone that Knows a bit about what they are talking about :D

I think you did good!

Super duper happy to hear no ketones! Yay!!! That was a worry.

Well, the lysoderm is having some affect obviously, if the adrenals are smaller. So, that is a good thing. It's just a matter of getting Kaibo properly loaded, and then maintaining.

Sharlene and Molly Muffin

[kaibosmom]

Well it's hard to connect with a vet at the college apparently. We finally heard from her today. It was kind of hard to understand her but the gist is that his blood work remained similar to the last set. Anion gap is high. Creatinine is low? Liver enzymes elevated. One is at over 2000. Sorry I had no paper to write things down. She seemed really concerned about his cholesterol. She mentioned something about hypo(maybe hyper) thyroid but that it would be hard to test if his Cushing's is uncontrolled. Basically sounds like she wants to focus on the Cushing's. I asked if she thought anything else was going on but she just said we need to do induction again and get him on maintenance. She wants to discuss treatment with our other vet but will keep him on her case load until he is on maintenance. Something that concerned me was tht she wants to do this induction with a higher dose of mitotane. So feedback on that would be great. She didn't say how much. I didn't was because I think I was still stuck on her comment of ...because he is critical...freaked me out and my mind was racing!

[addy]

I dont use Lysodren but I know someone will be along to comment on the new induction dose. I do know that if we use too low of a dose for induction the load can last forever and most dogs do best when proper protocol is followed. When I considered using the drug our IMS was not going to follow protocol because of Zoe's IBD and that was a worry to me.

Do you remember what the new dose to be used for induction is?

We see high liver counts alot. Did they say anything about starting milk thistle?

It is so hard to remember when they rattle on when calling. Dont you wish we could tape record the conervsations?;) And then we freak out over a word or phrase and if you are like me, I cant concentrate after that.;):rolleyes:

From what I have read, dogs can be hypothyroid and then once their cortisol is controled sometimes they wont need their thyroid meds. The two go hand and hand. My IMS said the same thing, control the cortisol first, then the thyroid testing. Perhaps it deends on how low the thyroid readings are.


oh- found it for you


According to the protocol for Lysodren loading described above, the loading dose is usually 50 mg Lysodren per kg of the dog's weight (50 mg/kg/day) and is given each DAY of the loading period.

[kaibosmom]

Our original attempt at induction was 1/4 tablet twice a day. I forgot to ask what she is thinking for the new load. He is currently 5.4 kg. we used the same 1/4 tab twice a day for three days then ACTH test. Then the same cycle again at Christmas and New Years. Since our appointment at the vet college he has just had what we were using for maintenance as recommended by the college while we waited for blood tests results. He was so close last ACTH test (209 nmol/l). And yes, I'm the same. After I heard the word "critical" I was gone. Sigh. :eek:

[Squirt's Mom]

Has Kaibo had an ultrasound? If so, how long ago?

It would REALLY help if you could get the results along with the normal ranges and post them here for us to see. Maybe call the vet back and ask for the details with a pencil in hand? :D That's the part I always forget...the pencil!

At 5.4 kg, the loading dose would be 270 mg/day, a bit higher than the 250mg/day he is getting with the 1/4 tablet. I'm not sure those 20mg would matter much in the overall picture, tho.

It may be that Kaibo is just one of those pups who will take longer to load than usual. Did your vet set a specific time limit for the load, like 7 days for example? Or were you told what to look for that would indicate the load was achieved regardless of the length of time he was being inducted (loaded)? There is NO set time for loading, just FYI. Most pups do load in a matter of days but we have seen pups who took months to load, literally months. If the loading phase is stopped before the adrenals are sufficiently eroded, the load won't hold and maintenance won't work. So this is one thing to look into closely. Was Kaibo loaded the first time or was it stopped too soon?

Just wool gathering trying to put some things out there for consideration. But getting his test results would help a great deal. ;)

Hugs,
Leslie and the gang

[Harley PoMMom]

The 1/4 tablet twice a day sounds right to me, and Leslie is correct with her calculation of Kaibo's loading dose of 270 being split and given twice a day, so 1/4 tablet twice a day= 250, that would close enough for me.

Elevated cholesterol and high triglycerides can be attributed to hypothyroidism. Dr Jean Dodds is a renown expert in canine thyroid problems, here is her link : http://www.hemopet.org/services.html#bookmark1

Love and hugs,
Lori

[kaibosmom]

Kaibo had an ultrasound last week. I will get copies of test results this week. In November his alk phos was 1356u/l so it's increased quite a bit in a couple of months if it is over 2000 now.

Kaibo was loaded the first time but we noticed symptoms returning a few weeks into the maintenance. So we tried a three day mini load and checked ACTH even though I knew that wasn't enough. Then waited for test results, started again, and stopped again. Ugh. We shouldn't have messed around with the mini load business. But we were just following doctor's orders. Anyway, it is what it is. I guess my husband was talking to the specialist again today so I'lll get filled in soon.

[Bo's Mom]

Maybe it is a poodle thing to make things so crazy when it comes to loading. I am saying that with a grin on my face but really thinking of the seriousness of jacking around with doses and all the vet visits to get it just right.
I don't think Bo (poodle) ever loaded correctly. We fooled around with loading and I thought he was loaded but soon all his symptoms returned. We upped his dose/decreased his dose and just got on a horrific roller-coaster ride. The whole time I was just listening to what my vet was telling me to do. It was then when I found this group and ever so greatful that I did. I switched vets and we then ended up where we are now and I have completely taken him off Lysodren and all he is taking is Predisone to keep the tumor from growing and affecting him at such an alarming rate. I don't think Bo's situation would have been any different if we had started out with a different vet as far as the tumor but I probably would have saved myself tons of headaches if I would have been armed with better information.
I am not saying Bo and Kaibo's situation are the same, I am just saying I totally understand what you are going through. You know Kaibo (I love that name) best and we are all here to help and support you as you get to where you need to be and have him on the correct maintenance schedule. Keep hounding your vet for answers and hopefully they will come soon.

[molly muffin]

It is very frustrating trying to get the dosage right and get them to a controlled state. I think that too many have their own ideas of how cushings Should be treated and there doesn't seem to be one depository of information for what is working. Here we have compiled as much information as possible from literally around the world to see what is and isn't working and still there are times that are hit and miss, such as loading.

That is the most intriguing line to leave us with
I guess my husband was talking to the specialist again today so I'lll get filled in soon.
So, now I'm dying to know what did the Specialist say?
I hope that maybe they came back with a plan of action to get started on for Kaibo? (I agree by the way with Belinda, Love that name!)

hugs,
Sharlene and Molly Muffin

[kaibosmom]

Well.....I guess she didn't have much new to say. She was trying to get a hold of the vet we've been seeing to discuss treatment so "everyone is on the same page" but I guess she isn't working today:(. So, I'm hoping we don't have to wait until Wednesday (when vet 1 works again). Brett asked her about nutrition and weight gain and ketones and she chalked the ketones and everything else in the blood work to the uncontrolled Cushing's. She wants us to focus on dropping the weight (he was 5.1 kg on Dec 21 and 5.4kg on Wednesday) because of his high cholesterol. It's funny what a different vet will focus on. No one has ever seemed concerned about the cholesterol until now even though it is high (15.43 nmol/l normal is 2.70 to 5.94). So, we wait.....

[kaibosmom]

Oh and thank you...we love his name too! Although I've recently been told it means "toilet" in the Phillipines. I was having a discussion about his name today actually and the people I was talking to agreed it was a perfect name for him. We love travelling and Kaibo is the name of a place on Grand Cayman island. :o

Also, I'm going to make an appointment with the nutritionist for Kaibo on Monday.

Another question....Kaibo is a therapy dog and we've been off duty while we got him on the meds. Since this hasn't happened and he seems really happy and healthy I decided it was time to start visiting again. He was thrilled today when he realized where we were. However, I was freaking out inside because he was panting the whole time. The panting has mostly stopped at home unless he is playing. And, of course, he was obsessed with the treats. So now I'm wondering if it's too much for him. Oh wow. This disease sure isn't easy. :confused:

[addy]

I guess, just watch him to see how tired and/or stressed he may get after his therapy visits. They have a harder time dealing with stress. We have one member who's pup did agility and loved it and kept it up.

So if Kaibo (and we arent going to say anything about meaning toilet, because his name is just way too nice to mean that, is happy doing therapy visits, maybe that is okay.

[kaibosmom]

Oh agility :(. We miss it so much. Kaibo has done agility since he was 5 months old. We stopped during his recovery from his patella surgeries of course but we were back in it until we found out about his torn cruciate. He's retired now. He used to do flyball as well! Such a busy boy. Anyway, if his knee keeps getting stronger from his rehab we will not have cruciate surgery and we will just do therapy dog visits and maybe rally-o. He's happy doing anything as long as he is with me:p.

It's hard to say if he is more tired after the visit or not because we've been visiting for a long time and he's probably had Cushing's for a long time. He was tired when we were done but he always is. He's happy at the hospital and runs over to people all the time and practically jumps out of my arms to sit on their laps or on their beds :D today, the panting made me think, hey, this might not be doing him any favours. I'll take him to see the kids on Monday and reassess. He loves the kids! It makes me so sad that a dog with such a big heart and gentle spirit has had so many health issues.

[addy]

If he is panting you may possibly need to rethink it or shorten up the visits. See how it goes. I know what you mean about gentle souls and big hearts. It is hard to see them have so many issues especially when they were having such a full life and have to slow down.

[kaibosmom]

Hi. This has to be quick...on my way to soccer and hoping for feedback........

Kaibo has started induction again. We started Sunday night (long story) 1/4 tab evenings, 1/2 tab mornings of mitotane. No changes yet. The vet wants him to go in tomorrow for ACTH stim test regardless. She said we should give him his morning dose. I thought you weren't supposed to do that. So???? What do I do?? We have seen no signs of change so I'm not sure why the urgency for the ACTH test. This is from the vet/specialist at the vet college so........????:confused:

[frijole]

The drug keeps working for 2 days after the last dose. For this reason you don't give a pill. You look for signs of loading and then you schedule the appt 2 days later.

I wouldn't give the pill tomorrow because the test results won't be valid - I don't know what the rush is either. I'll check dosing amount later because I have to go now. Good luck, Kim

[Harley PoMMom]

She wants us to focus on dropping the weight (he was 5.1 kg on Dec 21 and 5.4kg on Wednesday) because of his high cholesterol...


Kaibo has started induction again. We started Sunday night (long story) 1/4 tab evenings, 1/2 tab mornings of mitotane. No changes yet. The vet wants him to go in tomorrow for ACTH stim test regardless. She said we should give him his morning dose. I thought you weren't supposed to do that. So???? What do I do?? We have seen no signs of change so I'm not sure why the urgency for the ACTH test. This is from the vet/specialist at the vet college so........????:confused:

Lysodren induction therapy is usually given at a dosage of 50 mg/kg/day, divided and given BID (twice a day).

From my calculations, with Kaibo's weight of 5.4kg, he should be getting 270mg of Lysodren split and given BID.

Kaibo's lysodren dose is now 250mg in the morning and 125mg in the evening for a total of 375mg, which is 70mg/kg/day, a bit high.

Lysodren does "work" in a dog's system for 48 hours, so the ACTH stim test should be performed between 36-48 hours after the last dose.

[frijole]

Lori she is doing a mini load I believe as she already went thru a load. I'm sorry but I am headed out of town and have to pack. If you have time to go back thru her thread you might be able to figure out what the vet is doing. I'll check in later if I can!!! Thanks Kim

[frijole]

I just re-read your entire thread from start to finish and all I can say is "insanity is doing the same thing over and over and expecting different results". You have been loading off and on now for some time and your vet has never increased the dosage. I do not understand how the first acth test came in so low to be honest with you.

You have done numerous mini loads. Each time the cortisol remains above recommended levels and poor Kaibo still has symptoms and you get billed for an acth test.

If you don't see any signs of loading I am not sure I would have the test done yet. It is insane how many times you have gone in after only a few days. I don't think they are waiting long enough - like they are afraid of the drug.

I would slightly increase the dosage. You've been giving 1/4 a pill twice a day forever. You need to increase it and if you want to try 1/4 pill in a.m. and 1/2 pill in p.m. it at least would give Kaibo a better chance of lowering cortisol.

Either that or don't stop everytime the vet tells you to because the dog isn't loaded and you have to wait a whole week for results and during that time the cortisol rises.. it is insane.

We call it a mini load but really it's the same as loading - the difference is the length of time... but in your case you give the drug a few days, do a test, you hold off for a week while you wait for results, results show still high and you then repeat the same thing.

It isn't working and I would be really upset with them if I were you. You have got to try something different. Either don't stop after 3 days and keep giving it til you see a change OR slightly increase the dose and give it til you see changes of any sort (no matter how slight) and then do another acth.

I am leaving town and won't be back on til Monday so hopefully our lysodren users can keep an eye on this thread. Sending much love to both you and Kaibo. Kim

[kaibosmom]

Thank you. It is insane. This is round four. So we did "full" induction, things were good, then maintenance failed. Then, two mini loads of three days each and you are right waiting for days between to get results. Then, we went to the vet college to get a different opinion and hoped for better results. We redid blood work, ultrasound , and urinalysis. The new vet (internal medicine resident), recommended we start over. So, we measured his water for a week. Called her to discuss. All of a sudden she's talking about trilostane and how it would be easier to dose for his size, etc. long story short, my husband and I finally decided we would stick with the Lysodren since I'm anxious to get his cortisol under control already. I didn't want to wait another two months to see results.

So, the dosage is increased by the request of the new vet. 1/2 tab in the morning and 1/4 tab in the evening. We have seen a slight decrease in the amount of time it takes him to eat. Water intake the same and panting might have decreased a bit. We started Sunday night with a 1/4 tab.

I am frustrated with the amount of money and time we have wasted to still have the same results. I think I'm going to have my husband call in the morning or not take him in as scheduled. I have been having a difficult time connecting with this new vet. She's super busy at the college and I can't take calls any old time since I'm a teacher. So my hubby talked to her last and didn't question her request to take him in on Friday. He did question giving Kaibo his morning pills several times, however. Only to be told to give him the meds and bring him in in the morning (he was trying to say he would bring him in in the afternoon).

[frijole]

So, the dosage is increased by the request of the new vet. 1/2 tab in the morning and 1/4 tab in the evening. We have seen a slight decrease in the amount of time it takes him to eat. Water intake the same and panting might have decreased a bit. We started Sunday night with a 1/4 tab.



OK this is helpful. Sorry I somehow missed your comment that you had increased it. So the dosage WAS finally increased? This is important. While it has only been 4 days since you began loading again the fact that there was a slight decrease in the time it takes to eat COULD be a sign of being loaded. Remember it is any change in eating or drinking. It really has to be your call. Is he peeing buckets still?

Since he is being dosed at a higher than normal (70 mgs per kg) dosage the vet is showing caution which I understand. REmember my Haley ended up having to go to over 110 mgs per kg. It was a very unique situation.

You have to watch like a hawk and go with your gut on this one. The increase in dosage and the slight change in eating make me waffle on my comment to cancel the visit. Sorry if I confused you - I missed that post :( Only you can know what you mean by decrease in time it takes to eat.

YOu don't want to overdose and a weekend is coming up and I assume these people are not available in emergency over the weekend?

Please keep this board updated on your decision and how Kaibo is doing this weekend ok? Thanks. Kim

[kaibosmom]

Oh dear...lol. I needed up telling my husband to give him the meds this AM and not take him to the vet! I only had him read your last post and didn't check for a new message until after my shower because it was bothering me that maybe now I made the wrong choice. They are available on the weekend since it is the vet school...we just aren't seeing the students anymore. Last night he didn't drink any water....that is something new. Ugh. I hate this guessing. Now I really do feel doubt in my choice. My husband is home this afternoon with him. We have been very cautious this week and have had someone stay with Kaibo daily. But even if we take him in this afternoon will the results be accurate? :confused::confused:

[labblab]

I am not a vet, but my opinion is that you should follow your specialist's instructions at this point and take Kaibo on in for testing, especially since he's now stopped drinking water, too. Since your specialist gave you such specific instructions in this regard, I have to assume she will factor today's dose into her assessment of the test results and whatever dosing decision she makes moving forward.

Marianne

[SoggyDoggy]

I really have no idea about lysodren, so this is just a stab in the dark, but if you have been doing these loads and then waiting the week for results and losing ground, perhaps the specialist is trying to avoid that week's wait? Could it be that she wants you to do the test, while the lyso is still active in her system then begin the maintenance as soon as the results are in and help reduce the gap of time in between?

As I said, I actually have no idea how it all works, this is just a possible question. Whatever happens, I do hope you manage to get off the loading merrygoround soon!

[labblab]

Naomi, I was thinking the same thing. ;)

(If we're right, we can claim that we are "Great Minds." :) If we're wrong...well, we can still claim we are "Great Minds," can't we? :o)

Marianne

[Trish]

I think you are both great minds whichever way you look at it :)

How frustrating for you and little Kaibo, hope today brings some answers and Kaibo is feeling better

Trish xxxxx

[labblab]

How are things going for you guys? I've been thinking about you and worrying :o, and hoping that Kaibo's testing and dosing are getting all straightened out! Please let us know when you can.

Marianne

[Bo's Mom]

Thinking about you all this morning.

[molly muffin]

Checking on you and Kaibo.

Sharlene and Molly Muffin

[kaibosmom]

Awe. Thanks everyone! Yesterday was stressful. Ask Marianne! I sent an email meant for my husband to the forum email :rolleyes: anyway, Kaibo had his morning dose (1/2 tab) and we went to work. The girl that's been staying with Kaibo this week (to watch for overdose signs...yes we are paranoid lol) stopped in to check on him and said he wasn't himself. That freaked me out but my hubby was going home at lunch so I tried not to worry! When Brett got home he texted me that Kaibo was super playful and happy. Whew! So...Brett talked to the vet and explained that we didn't take him in because this just seemed like the same old cycle - meds, ACTH, no pills for days. She said due to the increased dose she would have us stop anyway. So, we took him in for the ACTH test in the afternoon. Of course that has screwed things up as far as getting test results :mad: We might hear today but I'm not hopeful that will happen. So, once again, we wait.

Incidentally, Kaibo's water intake increased yesterday. That being said he was super playful last night and today. His overnight water has definitely decreased. So it is nice to see the activity level increase again. I'm on my way out but later I'll post the discussion I had with the specialist around his therapy dog visits! I definitely want feedback on that. :)

[Jenny & Judi in MN]

the fact that he is playful is really encouraging! I know nothing about the therapy dog visits but I do know Cush pups are more susceptible to infection. That shouldn't be a problem should it?

[kaibosmom]

Drum roll please.........Kaibo IS within therapeutic range!!! :cool: Wow. I wouldn't have guessed and I'm glad that the vet insisted he go in on Friday (even though we thought we were on the same old merry go round) and the people here said to follow the vet's advice. He had no change in water intake, no change in appetite (although he did eat slower), but was extremely playful. If we would have given one more dose, I fear we would have gone too far. He has gained quite a bit of weight in 2 weeks as well (5.7kg to 6.03!:eek:). I don't have the exact blood work results but this was in the discharge notes from the vet college.

Pre cortisol 53 nmol/L and post is 72nmol/L. Lower than the 120nmol/L they aim for but still acceptable.

Maintenance: mitotane at 312.5mg per week. Do not start Kaibo on new dose for at least one week.

It doesn't seem like she is splitting up the dose throughout the week at all. And, we are getting the medication compounded so that the dose is more accurate. Has anyone else done this? We are not sure of the increase in cost for this but I guess we will find out soon.

Now, I had said I would write back about an interesting conversation that I had with the new vet about Therapy Dog visits. I had mentioned, off handedly, that I had taken him back to visit while we waited to start the induction again. And although he really loved it and was extremely happy to be back, I was concerned due to the increase in panting. My mind had visions of cortisol raging through his little body, eating away even more at this kidneys, liver, etc. So I was kind of a mess on the inside...:p As soon as I told her this story, her tone changed. She talked again about changing to trilostane and how that might be better if we keep visiting because I can just skip a dose the day of his visits. Then she went on about how if we stay with lysodren (which we did) that on visitation days we will have to give him prednisone because he is no longer able to respond properly to stressful situations, even if they are from happy stress. So...in her discharge notes she also wrote: "Kaibo no longer has "normal" adrenal function in that he cannot respond to standard stresses in his life. This means he should receive 1.25 mg (1/4 of a 5mg tablet) of prednisone prior to any stressful event, such as grooming, going on visitation to the hospital, and any trip. Thoughts or comments on that?? :confused:

Next step for us: seeing the nutritionist at the college. She contacted me awhile back and was away for an extended time. She will be back this week and we will meet to discuss his needs. I can't believe how much weight he has gained. Before Christmas, he was down to 5.1kg...yikes! The best part about seeing the nutritionist....it's no charge since he is being treated by a doctor at the college. I certainly didn't expect that but after all of this $$$$ I am so very grateful!

[frijole]

Wow how wonderful. Now you have to tell us what 'within range' is... meaning get the numbers. Sorry but we are pests that way. :D It's because we love you.

I just got back from being out of town for 3 days and I was looking for this update! I am grateful to Marianne for chiming in - felt bad that I was leaving and unavailable!

Moral to the story for those lurkers or members who are on lysodren and following the story - like the write up says "if you see any change whatsoever in eating or drinking stop lysodren". I am so grateful I noticed the fact that you had increased the dosage before I left town so I could retract my advice! I am sorry if I caused you stress.

When you post the result know that since you did the test on a day you gave a dose the cortisol went lower by a bit - hard to say how much. So in 30 days when you retest (sorry but it's a must) to make sure you are maintaining that load you can see if it's working. (maintaining the same level)

I've never heard of a vet prescribing prednisone for every possible stressful situation. It is true that cush dogs get stressed and produce cortisol. My girl Haley who took months and months to load and was at a dose that is even higher than Kaibo's probably only had a prednisone pill twice in her 4 1/2 yrs on lysodren. I know some would give it during trips to groomers or vets - but only because their dogs stressed out as in 'freaking out'. My girl wasn't that way so it wasn't necessary.

I'm sorry she is compounding the drug and going against Feldman's protocol. Did you bring that article or mention his name to her? She certainly is dead set against it if she is having it compounded to you can't split the dose. LOL So long as Kaibo maintains the load that is fine. If the numbers creep up on you I will jump through the computer screen and talk to her directly about splitting the dose. ;)

Again wonderful news but I want to see the numbers so I can confirm they are within recommended range. Is Kaibo free of symptoms now? Tell us more about how he's doing! Kim

[Jenny & Judi in MN]

I'm really glad he is normal range, yay! keep an eye on him though. He seems to be following a similar route to my Jenny. Loaded, not loaded, mini weird load.

once a week didn't do it for her. I hope the therapy visits go well! I hate that cortisol is so expensive and stressful to test for! so used to automatic feedback with blood sugar.

keep us posted and lets hope Kaibo stays happy, fat and sassy! lol

[Harley PoMMom]

Pre cortisol 53 nmol/L and post is 72nmol/L. Lower than the 120nmol/L they aim for but still acceptable.

Maintenance: mitotane at 312.5mg per week. Do not start Kaibo on new dose for at least one week.

Converting Kaibo's stim results to ug/dl his pre = 1.92 ug/dl and his post = 2.6 ug/dl...very good numbers!!

As Kim has mentioned Kaibo's maintenance dose should be split and given throughout the week, hmmm, wonder why she isn't doing this??


Then she went on about how if we stay with lysodren (which we did) that on visitation days we will have to give him prednisone because he is no longer able to respond properly to stressful situations, even if they are from happy stress. So...in her discharge notes she also wrote: "Kaibo no longer has "normal" adrenal function in that he cannot respond to standard stresses in his life. This means he should receive 1.25 mg (1/4 of a 5mg tablet) of prednisone prior to any stressful event, such as grooming, going on visitation to the hospital, and any trip. Thoughts or comments on that?? :confused:


I have read where this should be done, in fact it was Dr Feldman who wrote about this:
Dogs receiving o.p'-DDD and undergoing stress (illness, trauma, elective surgery) should be treated with glucocorticoids. The adequately treated dog with PDH has sufficient adrenal reserve for day-to-day living but not enough to handle major stress. Unfortunately the link to this quote no longer works but I have it copied to my computer.

[frijole]

Lori, Thanks for noticing she did post the numbers... I am feeling like a fool lately. Those numbers are terrific. Perfect actually.

Re the prednisone for stress - there's a difference between surgeries, illness and going to the groomers- at least for most dogs. I guess you just play that by ear. Frankly I hate the thought of overdoing it because you fought so hard to lower the cortisol and prednisone is addictive so you don't want to overdo it. Kim

[kaibosmom]

I think I should ask about splitting the dose! It didn't occur to me until you posted. I'll have to find the article and send it with my question!

I'm grateful for the feedback on the prednisone. We visit the hospital twice a week for our therapy dog visits. So if I give him it twice a week and it's addictive (how so?) I really don't know. It's been months to get him here. I was really unsure about giving the prednisone to him when she mentioned it. still am. If I understand correctly, he can still produce cortisol. Is it just that he can't produce it quick enough to react to a stressful situation? Do I take him for a visit and see what happens? Stop visiting :eek:? He is getting groomed on Friday. Prednisone? He doesn't like going but he isn't crazy...like when I try to put him in a kennel :p.

[Bo's Mom]

So glad to hear good news about Kaibo!!!

[labblab]

Congratulations!!!!! I am glad you'll be asking the vet about the maintenance dosing because as all have said, once-weekly dosing is irregular from everything I have read and been told, too.

As far as the prednisone, the dose your vet has prescribed is really teeny (1.25 mg. at a time). So I don't think it would have any major or lasting effect if you do elect to dose Kaibo on his hospital days. It sounds as though your description of him panting while at the hospital has cued your vet into believing that the visits are over-stimulating him beyond his typical daily activities, and hence the Rx for the supplemental prednisone to add a little bit to his reserves on those days. I don't think it should be a problem to give him that amount just twice a week if it makes him more comfortable.

Good work so far!!!! And definitely update us as to the maintenance dosing. FWIW, here's one more link to Lysodren protocol that specifically describes maintenance dosing as being given in "divided" form.

http://www.idexx.com/pubwebresources/pdf/en_us/smallanimal/snap/cortisol/cortisol-mitotane-protocol.pdf

Marianne

[Squirt's Mom]

If the compounded Lyso is in tablet form, you can easily cut it and spread it out over the week like it should be done. What is important is that Kaibo get the full dose over the week, not that he get it all at once. If he is one of those pups whose adrenals regenerate quickly, waiting a week between doses could be asking for a re-load. ;) You've worked too hard to let that happen! :)

You're doing good, Mom!
Hugs,
Leslie and the gang

[molly muffin]

yay, very happy to see those numbers. It's been quite the journey to try and get to this point.

Sharlene and Molly Muffin

[kaibosmom]

Hello! I thought I would update everyone on how Kaibo is doing. He had his first maintenance dose Friday night. I guess my husband didn't mention all of his conversation he had with the specialist with me. She told him he was splitting the dose into two. So, I picked up the compounded capsules on Thursday. They are 150mg each, so he will be getting a total of 300mg/week.

Kaibo's water intake finally dropped on Tuesday of this week. He is still eating slowly and has oodles of engery. He was groomed on Friday and we had decided we would give him the prednisone before we took him in. However, my husband forgot to give it to him. I chatted with our groomer when I went to pick Kaibo and Molly up and she said he showed no signs of stress at all. He went back into the grooming area easily (my husband had told me this previously) and all he does when he is there is lay under her table before and after he is groomed. So, I'm not too worried about grooming being an issue for him at this time.

I decided to take him for a short therapy dog visit today. I didn't give him the prednisone. He was panting a bit but it wasn't excessive like it was a few weeks ago and before the first time we tried induction. The panting occurred right when we got to the hospital, in the elevator, and occasionally throughout the visits. There were times when he wasn't panting at all (more often than not). I am not sure if it could be associated with certain patients or not. Anyway......still on the fence over whether or not I should give him the prednisone on therapy dog visitation days.

I just read a bit on someone else's post about vaccinations. Is there anything I need to know about vaccines now that he has Cushing's?:confused:

[frijole]

So when you say split the dose into two do you mean you will be giving 150 mgs on let's say Tuesday and 150 mgs on Friday? That is the way it's supposed to be - not all on same day. Just wanted to clarify.

Glad to hear Kaibo is doing so well. We love to hear good news!!! Good job! Kim

PS re the vaccinations - it really depends on where you live and what the vaccination is for. Dogs with cushing's have compromised immune systems and some vets will waive immunizations as a result. Both my dogs quit getting shots once they got ill. They were indoor dogs and there were no rabies outbreaks in my area. It's something you should discuss with your vet. Hope this helps.

[Jenny & Judi in MN]

so glad the grooming didn't stress him out. I could see certain people causing more excitement!

My vet was ok with Jenny stopping her shots because she is also an indoor dog. I did get her the kennel cough vaccine because she spends 4 hours at the groomers with lots of other dogs. My vet tried the nasal spray vaccine on her for the first time and she got kennel cough! argh

I skipped it so far this year but since we took a road trip through numerous states she got her rabies and distemper vaccines in October and was just fine. She was off her cushings meds at the time though.

Apparently it is against federal law to cross state lines without a rabies vaccine. We've been driving to Fargo, ND to see a different vet since 2011. My Jenny, the lawbreaker! :)

[kaibosmom]

This is so interesting about the vaccinations! He is overdue for his kennel cough but I wasn't in a rush because I wanted to focus on the Cushing's. I would say he is less at risk for it now anyway being out of agility and flyball. We do spend time at the off leash dog park but as a rule, he sticks very close to me (people joke about his "invisible leash") and doesn't interact much with other dogs (what a mama's boy). I am interested, however, in whether or not that will change now that he is feeling better. :p I will discuss it with the vet when his rabies and distemper is due. It may prove interesting as he needs proof of vaccinations to be a therapy dog.

Anyway, to confirm his dose...it is being split into two. 150 mg capsule on Friday and another 150mg capsule on Tuesday :)

[kaibosmom]

I laughed at little Jenny being a lawbreaker! ;) One day, if I figure out how to post pictures (and if I can find it) I will post one of Kaibo sitting next to a "no dogs allowed" sign at a park in Saskatoon that we go to all the time! :cool: Who knew poodles were such lawbreakers.

[Jenny & Judi in MN]

that's funny that Kaibo is rebel too! I know some people on the diabetes forum have been able to have the dog's blood titered and if the level of rabies vaccine is still ok in their blood the vet is able to ok them. definitely worth asking about! :)

[labblab]

This is so interesting about the vaccinations! He is overdue for his kennel cough but I wasn't in a rush because I wanted to focus on the Cushing's. I would say he is less at risk for it now anyway being out of agility and flyball. We do spend time at the off leash dog park but as a rule, he sticks very close to me (people joke about his "invisible leash") and doesn't interact much with other dogs (what a mama's boy). I am interested, however, in whether or not that will change now that he is feeling better. :p I will discuss it with the vet when his rabies and distemper is due. It may prove interesting as he needs proof of vaccinations to be a therapy dog.

Depending upon Kaibo's previous vaccination history, you and your vet may very well decide that it is neither in his best interest nor necessary to continue with vaccination. I just want to mention, though, that transmission of many diseases is not limited to direct muzzle-to-muzzle contact. For instance, both parvo and distemper are also transmitted via contact with (even just sniffing) infected feces and/or urine contaminated ground. If you walk over infected areas yourself, you can even bring disease home on your shoes. It is believed that parvo virus can live in groundsoil for up to a year. Disease can also be spread by picking up a stick or ball that another dog has chewed or licked, or even licking the hand of an owner of a dog who may be the silent carrier of a disease. I always cringe at the vet when people come over and without even asking, stick out their hand for my dog to lick. And then I find out that they're there because their dog is throwing up or has diarrhea!!!

So if Kaibo doesn't particularly enjoy the dog park anyway and you are uncertain as to the status of his protection or decide to discontinue vaccination, you might want to quit taking him there. In general, it's usually not a good idea to take dogs with compromised immune systems to areas where they will be around large numbers of other dogs whose own vaccination/health history you are uncertain about.

Marianne

[kaibosmom]

Hi. Just checking in. Kaibo seems to be doing well on maintenance so far! I took him to see the kids he visits for therapy dog and he was amazing! He normally goes right past the kids and looks for food in the kitchen. But he went to the kids and let them pet him! He was a terrible therapy dog...never wanted people to pet him. :rolleyes: so this was so great. One of the girls that has known Kaibo for a long time noticed the change right away. The staff noticed too. They were amazed at how happy he looked. I think his weight is dropping again and his belly is not as pronounced. Or it could seem like that because of the grooming. He was very fluffy. Hoping to connect with the nutritionist this week. So for now, we are doing well and enjoying our little man who is filled with so much energy AND who is not getting up constantly at night to eat and drink! :cool:

[Squirt's Mom]

What a great update! So glad our little Kaibo is doing so well!

Hugs,
Leslie and the gang

[frijole]

You made my day! Give him a big hug for me. Thanks for the update. Kim

[labblab]

I agree! This is a great report!!

Marianne

[molly muffin]

Yay great news. I'm glad Kaibo is doing so well and even letting the kids pet him. That's great! Makes you wonder if he just felt off before and didn't want to be bothered.

Sharlene and Molly Muffin

[kaibosmom]

Yes, once he was diagnosed it made more sense to me. His visits changed slowly but over time you could see he was more interested in the treats! He was always still really excited to see the kids and play ball with them but he didn't much care for them holding him or petting him (without me bribing him!). I was hoping to see a change last week when I took him back. I loved how he focused on visiting first and wasn't obsessed with getting treats right away or looking for food on the floor :p He was pretty good on Saturday when we visited the adult ward he goes to. I did see more panting than with the kids but the nurses noted how good he looked and how happy he was. I've been keeping the adult visits to 75 minutes. So far I have not given the prednisone before visiting.

[kaibosmom]

Bad news friends :(. Kaibo had his one month ACTH and he is not in therapeutic range. I suspected as much. He is eating faster. Water has still been decreased and energy is still up. Here's the big news. The vet he was seeing at the college was gone this week so he saw someone new. She thinks that this is the wrong diagnosis. She referred to his 2 ultrasounds. Indicating that his adrenals were 4 mm both times. She also referred to when his liver enzymes first started increasing was when he was two. So if it was Cushing's it started then and that is way too young. Agreed and I have thought of that before but why does he respond to treatment? His cortisol was over 1000 before. Now it is at 305. I'll post the real results in a bit. She just kept saying that it was a bad diagnosis, he is too young, and that is why we cant keep him in therapeutic range. I was questioning his other blood work but i just kept getting told it is because of the Cushing's being out of control. Anyway I was at a loss for words yesterday after she went through this. Kind of numb. They requested other blood work from our other vet clinic and they will be having a Kaibo meeting on Monday. Maybe it will be like an episode of Castle where they put all the evidence on a board and solve the problem. :p.

[frijole]

I have to run out to do some errands so I don't have time to read thru all 21 pages. If possible it'd be helpful if you could post every test including bloodwork and the results that were done to diagnose cushings. Also any symptoms PRIOR to treatment.

I've been here many years and i can tell you for a fact we have seen dogs that are very young with cushings. Most dogs are old but you can't rule out cushings dx due to age. Also the fact that the adrenal glands are equal in size doesn't rule out cushings either. Dogs with cushings caught early don't always have enlarged adrenal glands.

So for this reason it would be helpful if you could post the early testing info again so we can take a look at it. Hang in there. Will the other vet be back or are they gone permanently? Would be interesting to have the 2 of them in a room at the same time. :) Kim

[kaibosmom]

They are both going to be in the room! With their supervisors. I'm not sure what that means. So many students and residents and this and that at the college! One of the problems of going to a teaching hospital/clinic I guess. I am going on a belated birthday escape with my BFFs. So I won't be able to post everything until tomorrow night at least.

[molly muffin]

I went back through Kaibo's thread and the signs where there, the tests led in the direction of cushings. There has been a bit of a problem consistently in determining when he was loaded and getting results of the ACTH test back in a timely manner. Now it is true that cushings tests can have false positives if there is another problem that is causing the cortisol to be high. It is not true that young dogs don't get cushings, it may not be as common as it is with older dogs, but it can happen as Kim mentioned.
It will be interesting to see what this group comes out of the meeting with.
Hope you are having a fun belated birthday weekend.

Sharlene and Molly Muffin

[molly muffin]

Hi, Did you hear anything back from the meeting today?

Sharlene and Molly Muffin

[kaibosmom]

No :mad: I sent over our records from the other vet around lunch. No word back. I'm calling tomorrow because I want to know...plus if it is Cushing's which I feel it probably is, his meds needs bumped up or something. I really would like to avoid a fifth induction phase if possible!:eek:

[molly muffin]

annnnnnnd? Anything today? I swear your vets are trying to give us all gray hair just wondering about Kaibo's diagnosis. We need a plan!!

Hang in there!
Sharlene and Molly Muffin

[kaibosmom]

Well...yes...I finally heard from her today. I have been crying on and off for the last hour. I am so confused and it breaks my heart so much. Here's the gist of it..and I know you still want all blood work results but I really can't do that until the weekend at least.

So the discussion went like this. She really thinks something isn't right. She (the vet we have been seeing - Dr. Parker is her name) said that on Monday she met with the dr. we saw last week and another guy. They all agree something isn't right. She finally started explaining herself...mostly leads to her thinking there is some other underlying condition. Thyroid being the major one it seems. And the ALK phos. It keeps going up and she claims it should have went down in the last 6 weeks (I was sure we didn't wait 6 weeks for the follow up ACTH but anyway....) when he was under control. She said that in Feb when he was induced again and really at the low end for the post cortisol that he shouldn't have come out again so quickly given the "huge" dose that he has been receiving. I am not denying that there may be something else going on. I am sure it is possible. But, in my gut, I have to think he has Cushing's. I asked her that. Why do we see his cortisol drop from over 1000 to 300 (where it is now)? Why do we see water intake go down? Huge increases in energy? weight dropping off? panting decreasing? eating slower and not so obsessed with food? hair starting to fill in? Why? That is the part that bothers me most. She is asking me to take him off the mitotane completely for at least a month. So I get to watch him deteriorate for a month?

After I stopped crying long enough to speak again, I asked her what the plan is. So she says in 2 weeks, we can do the thyroid test. In 4 weeks we can do an ultrasound to check the adrenals again. She seems to think that because he was on mitotane last time (January) that the results might be different when he is off meds. They will check his liver again and repeat the blood work. So, that led me to asking if they were going to do liver biopsies this time or what. I'm so tired of all of this. I think we will request that a liver function test be done, because, as I said, I'm tired of this. If the liver has been the red flag all along someone figure out what is wrong with it if it isn't Cushing's. In 2010 he had a complete liver work up - ultrasound, bile acid test, liver function test. All came back normal. Every ultrasound since then = normal. Dr. P said that this just isn't right. Not normal. atypical. something else going on. the quick recurrance of cortisol being elevated again after being under control is just not normal.

I asked her flat out if she really believes this or if she is being influenced by the vet that saw her last week. You know, now questioning her diagnosis because of this other vet. I said that we feel that he does indeed have Cushing's and that she doesn't have to feel like she did something wrong. She said that it was a good question and that no, she really does think something else is going on. So, that's that for now. I wait for your wise, kind, words to come in. Help me sort out what to do, what to think. For now, we are following her request and we will withhold his medication on Friday. I feel terrible at the thought of that. Letting all of these nasty symptoms return. I'm not looking forward to getting mad at him when he wakes up several times throughout the night again because he is hungry or needs to go outside. I know I shouldn't be mad because it is the disease but I know I will. I'm not looking forward to less cuddle time with him because he gets too hot and leaves to lay by himself panting on the floor. Sorry for being dramatic but I'm just so sad right now. :(

[kaibosmom]

You know what else I am mad about? I requested a thyroid test a long time ago. Like long time ago. Before Cushing's was ever mentioned I think. So no one did that by the sounds of it. Frustrating. :eek: We have spent $1000s of dollars on this by now. We are fortunate that we can afford it but seriously, when will it end?

[Jenny & Judi in MN]

oh I would be frustrated and crying with you. I know nothing but it sure sounds like cushings to me too. I do know, however, that thyroid is similar.

There is no rule that you have to keep him off for the entire 4 weeks. If he is miserable and his thyroid is ok, I'd load him up again and ask for better advice from the folks here about the maintenance dose.

sorry I don't know enough to offer more than total support and understanding. When we killed Jenny's cortisol production for awhile her vet wanted to keep giving her lysodren but also give her prednisone too. That is when I ran to the specialist.

hugs, Judi

[kaibosmom]

Thanks Judi! I really appreciate your kind words :o

[Trish]

Good lord, are any of those vets specialists?? If not, I would get to one pronto. I know you mentioned the college hospital but also supervisors, residents, who are these vets?... how confusing for you. I would be furious, I don't know how all of those symptoms AND improvement can be discounted? Good luck in sorting this all out and i do not envy you having to go through the next month.. poor Kaibo!

[frijole]

I overslept by 60 mins so I can't make this long. I call total BS. I'm hoping someone else will go into it... but thyroid issues are common with cush dogs and you treat both at the same time and using lysodren often resolves the thyroid issues completely and you go off of it... so the opposite.

I don't think I'd stop treatment. I think I'd find another vet. I know you don't want to hear that. Or we can arm you with data. Unless they are witholding info I just don't get their reasoning.

Kim

[kaibosmom]

I thought the person we were seeing was the specialist. I do know she is a vet not a student. At least I think she is. I guess I'll make a call today to ask these questions. If there is a specialist in my province I'm sure they would be at the WCVM. so I'm not really sure who else we could go to at this point.

[Squirt's Mom]

Mornin' sweetie,

I think the time has come for a second opinion with an IMS. If I were in your shoes, there is no way I would stop the treatment at this point. The vet gave you no concrete reason for doing so. The thyroid can be tested and treated in conjunction with the Lyso treatment so that doesn't make sense to me at all. An ultrasound could be done while on treatment as well and would still show if there is a problem that could account for the difficulty maintaining the load - like a tumor somewhere. And again, no need to stop treatment for this. The one thing that she may be thinking is that the adrenals might look different if Kaibo weren't on the Lyso, but I'm not sure what benefit that would be or not be.

There are those pups who simply do not do well with one drug or the other, and need to be switched so Kaibo may need to go to the Trilo at some point but I wouldn't do anything like this without a second opinion. Bear in mind - if Kaibo is one of these pups, you are going to just have to grit your teeth for at least 30 days for a washout between the two. You have to. No options. ;) But we are no where near that point yet.

Get on the phone right now and ask for a referral to an IMS or find one on your own to see Kaibo. That is what I would do for sure.

Hugs,
Leslie and the gang

[kaibosmom]

The ultrasound is the only reason she mentioned. She said she wants to see it without him being on Lysodren. Other than that, it was just that there may be some other underlying disease going on in conjunction or looking like Cushing's. thyroid being one of those question marks. The high cholesterol and high alk phos are the only things she kept mentioning last night.

[Mel-Tia]

How you doing? Did you get hold of anyone?

Hope you are ok and hanging in there

Mel
Xxx

[molly muffin]

What was the actual ACTH results of this last test?
You are seeing the group at the Vet university correct?

Sharlene and Molly Muffin

[kaibosmom]

Hi! I will first answer the question just asked...yes, I am seeing the vets at the Western College of Vet Medicine here in Saskatoon.

ACTH stim test Feb 1
resting cortisol 53nmol/l
post ACTH 72 nmol/l (divide by 28?? can't remember the conversion exactly = 2.57)

ACTH stim test March 8
resting cortisol 95 nmol/l (<20-270)
post ACTH 315 nmol/l (230-570 normal dog) (divide by 28 = 11.25

I got some discharge info emailed to me today. It does say that the person who saw him last week is not a student, but a DVM; resident. Dr. Parker is also a resident. I called today to ask if there were any internal medicine specialists I could see for my dog and the receptionist mentioned a few names and asked me if I wanted to make an appointment. Ha ha. :cool: I said, not at this time, just wondering who was available and how long it takes to get in to see a vet.

So, here is some info from the discharge notes. weight was 6.0kg! Highest ever I think! ACTH stim results - cortisol levels higher than what would be expected in a dog receiving the does of mitotane that he is receiving.

Diagnosis: At this time, we are unsure of the diagnosis of hyperadrenocorticism. While his clinical signs match those that are typical of Cushing's patients, the fact that he was so young when he was diagnosed with Cushing's is abnormal. As well, Kaibo persistently relapses with the mitotane treatment. The most likely reason for the lack of control is that he does not have Cushing's disease. We recommend to discontinue the mitotane treatment and to recheck his chemistry panel and ACTH stimulation in a month.

Moreover, severe hypercholesterolemia such as seen with Kaibo can be seen with liver disease or an endocrine disease called hypothyroidism. Hypothyroidism is a condition in which the thyroid gland does not make enough thyroid hormone. We recommend to test Kaibo for hypothyroidism in 2 weeks.

Kaibo's main differential is primary liver disease. Diagnosis requires liver biopsies. Because Kaibo is a small dog, the safest technique is surgical biopsies. The technique for surgical biopsies is very similar than a dog that have a spay.

Kaibo is a wonderful boy and a pleasure to treat. (well, duh).

There you have it folks. I have to get some school work done so I will try to be back and post some blood test results. I'm really exhausted and run down...trying to fight off a cold, but I don't think I'm going to win this one! Teaching grade 1 is great, but not so nice on the immune system

[Mel-Tia]

That's a lot to take in.

So the test was low on feb but higher in march, I don't know if you converted that right but am sure the girls say the magic number in the states is 5. Hope one of them will come in soon and help you figure it out. I don't have lots of medical knowledge. I have loads of questions but I figure you have enough of those yourself ;)

Hope you are feeling better, thanks for your post on our thread. I am over the place but talking to you all helps me as I spent so much time living with the condition if that makes sense

Mel
Xxxxxx

[kaibosmom]

I have been extremely busy and sick lately. I will try to get blood work info in here when I can. Too bad there isn't a scan or upload function. My last post kind of got lost in the threads. Unfortunately this forum is hopping. Poor doggies.

[kaibosmom]

He is sure inhaling his food again. I hate this. It is still bothering me that we stopped the mitotane at the request of the vet:confused:

[labblab]

If you do resume Cushing's treatment, has anybody suggested the possibility of trying trilostane? You may have discussed this at some point earlier in your thread, and if so, I apologize for forgetting. I cannot understand why Kaibo's adrenals are regenerating so quickly with the mitotane. But perhaps he's a dog who would do better with the consistent daily dosing of trilostane?

Marianne

[Squirt's Mom]

What tests have been scheduled to look at the liver? An increased appetite isn't typical with liver issues but excess drinking and urination are. Based on the US report, I would want to know what was going on with Kaibo's liver asap. Still not sure why the delay of 2 weeks to test the thyroid but that needs to be done asap as well, as signs of hypothyroidism do mimic many of the cush signs.

I know the increase in signs is going to get on your nerves and I hate that for both of you but try to be patient. Kaibo can't help his behavior as you know. ;) You might try feeding treats like carrot, apples, green beans, bananas - any high fiber fruit or veggie he can have that will help him feel full longer between meals. Then a belly band and Kotex liner may come in handy. :D If he's really restless at night keeping you awake, talk to your vet about giving him some melatonin to help him relax over the next few weeks. If Kaibo is crate trained, you may need to use it more often in order to get some rest.

I hope you are feeling better! I kept fighting cold symptoms on and off for over a month....then it got me. Most folks I know who have gotten sick this year have been ill for weeks but I was lucky and felt better in a week. Still coughing more than usual and still stopped up a bit but no fever for a few days now. I've often thought teachers must have immune systems that are massively powerful to survive year after year in contact with all those germs. :p

Hang in there! Looking forward to the rest of the info from Kaibo's vet visit the other day when you are up to.

Hugs,
Leslie and the gang

[Trish]

Hope your feeling better now and have managed to get some go forward for Kaibo, so awful when your feeling awful yourself and trying to do the best for your pup. Take Care
Trish

[kaibosmom]

Ultrasound and blood work today! I'll post results later. Panting, hair loss, crazy appetite, less energy, returned but high water consumption hasn't. Oh, his thyroid was functioning perfectly. He has gained quite a bit of weight. Anyway....more later....

[molly muffin]

We'll be watching for your update! Crazy symptoms, hope the numbers and ultrasound today are all good! :)

hugs,
Sharlene and Molly Muffin

[kaibosmom]

Still waiting for results :confused:

[molly muffin]

Geeezz, they always take a long time to get results to you. That I am sure is very frustrating.

Well, we are waiting along with you!

hugs,
Sharlene and Molly Muffin

[kaibosmom]

The blood work wasn't back (what a surprise) so she didn't want to discuss anything. Even if she saw some "interesting" things on the ultrasound. How mean is that to say then leave me hanging! :mad: I asked if there was any big changes from the ultrasound in January and I think she said not much. Waiting......

[molly muffin]

Oh that is just cruel. Now you'll be wondering and driving yourself nuts until you can get all the results. ARGGGHHHH

Deep breaths!
sharlene and molly muffin

[kaibosmom]

You know what's even more cruel? Not calling when you say you will. I shouldn't be surprised. :eek: well this vet is supposedly gone next week. I'm sure if he was dying she would call so I have to not dwell on it I guess. I guess they don't teach customer service or common sense in vet med. maybe she's scared to call because the results just show he has Cushing's disease. Lol. I still think it is and I will be surprised if it is anything else. The only thing I think it can be is liver disease. But why would he respond so well to the mitotane? Why would his cortisol be so high then come down when on the meds? Why....I could go on.....

[Budsters Mom]

I'm so sorry for you and your little one! Your vet's behavior inexcusable! :eek: I have had a few vet problems myself, and I know how bad it feels. :(Your vet's behavior amounts to cruel and unusual punishment! I hope that you get your results soon, So you'll know how to proceed. I'll be thinking of you and Kaibo.:o

Kathy and Buddy:)

[molly muffin]

Ugh, we have so many vets that will tell one of us that they'll call and then they don't. That is so frustrating when you are worried to death.
Seriously though, you're going to have to tell the vet not to tell you stuff like that and then just say nothing else. it isn't fair to you to do that.
grrrrrrrrrrrr

hugs,
Sharlene and Molly Muffin

[SoggyDoggy]

There is nothing in this world that annoys me more than someone saying something and then following it up with "I won't discuss it yet", or "I'll talk to you about it later". AAARRRRGGGHHHH! And as for vet's not calling back? I'd almost be tempted to ring and just sit on hold, or go in there and wait for a meeting to find out! I completely understand your frustration and do hope they get back to you sooner rather than later with those results. :cool:

[Squirt's Mom]

We used VetMed in TN when we lived there and for the most part were very happy with them. I had two bad experiences with them, tho - their "Holistic" vet wasn't and made Squirt sick with a dumb UC Davis diet I could have gotten off the web for free then refused a follow-up of any kind when I told her Squirt was sick. And then there was the IMS who ignored the tumor on Squirt's spleen - probably because she was leaving Memphis for another clinic. She also had the absolute worst bedside manner I have ever seen in any medical professional. She acted like every appt was an interference with something much more important she wanted to be doing and seemed to hate Squirt...and Squirt her. I've tried to find her to let her know just what I think of her but so far haven't. :mad:

I hope you hear from them Monday and that the news is good.

Hugs,
Leslie and the gang

[kaibosmom]

Oh what a terrible experience! Unfortunately I heard nothing today. So I will try tomorrow but as I said she is away this week for sure. Hopefully not longer. The last time she was away and another vet got involved they started thinking he didn't have Cushing's. now he is on no meds and in limbo.

[kaibosmom]

I did not get a phone call but did call the college today. They must have gotten to the vet as I received an email tonight. I am confused right now and just crying over the "tumor" part. I hope that this may make sense to someone here. I'm at a loss for what to think at this point. I have to take Kaibo to the vet college for a rehab session tomorrow for his knee. I will get the most recent blood work results at that time. Email is as follows:

Hello! I am sorry to be writing you but have had a very hectic schedule, in spite of not being on clinics. Essentially, Kaibo's bloodwork came back and is improved. His liver enzymes are half what they were, and I am very happy about this. On ultrasound, his liver is relatively unchanged. His left adrenal gland is of normal size and shape, but his right adrenal gland has a small mass in it. At this time, the mass is not concerning because the other adrenal gland is of normal size and shape, which means that the right adrenal gland is not producing excess steroid. Adrenal masses can include benign adenomas, tumors that secrete excess steroid, or tumors that produce catecholamines (called pheochromocytomas). When speaking with the radiologist, he did not see the mass last time. This is worth monitoring. I would like to schedule Kaibo for a repeat abdominal ultrasound, blood pressure, and chemistry profile in 1 month. It is so that we can monitor the mass, Kaibo's weight, and his liver values. If the mass is larger, Kaibo's liver enzymes increase, or he looks more Cushingoid, further testing should be pursued. This may include biopsy of the adrenal mass, which is undertaken carefully, and possibly liver biopsy. This can be determined after rechecking the values. While I want to know what is causing Kaibo's weight gain, panting, and excessive water intake, I don't want to put him at risk. Please give me a call so that we can arrange an appointment for follow-up.

[kaibosmom]

Does this mean he has cancer? Cushing's disease? What? I don't understand. Seriously........I just want some answers. Just my random thoughts as I try to wrap my head around that email. I guess at this point, I need to collect myself and figure out what I'm teaching my little grade ones tomorrow. Kaibo is at my side as usual. Comforting me and licking my tears after every new round of sobbing :p

[doxiesrock912]

With Cushings, a tumor is present on the pituitary gland or adrenal gland. These tumors cause excess cortisol to be secreted which causes one or both adrenal glands and sometimes the liver to enlarge. It does not mean that the tumor is cancerous.

Surgery is possible with adrenal tumors, but it is delicate surgery and unless the tumor causes problems that can't be treated otherwise, monitoring is the best thing to do. If Kaibo does need surgery, find someone who has done this type many, many times with great success. I would not let a general practice vet perform it.

Kaibo's bloodwork improving is great news!!!!

Right now, it sounds like good news to me :) Be patient, Cushings is a slow progressing illness and with proper monitoring and treatment, many dogs live out the rest of their natural life span and surgery is an option.

[Trish]

The good thing about an adrenal tumour causing cushings is that surgery can totally cure it and make everything go away!! Like the report said they can be benign or malignant, tricky thing is they cannot biopsy because of location of the gland to know for sure what yr dealing with. Personally I would take their advice and rescan soon and if surgery an option get the sucker out!! Kaibo is a young dog with many years ahead of him! Good luck xx

[frijole]

I feel so badly that the vet chose to communicate this by EMAIL vs by phone after you waited so long. Others are right - cushing's is either a pituitary (near brain) tumor or adrenal (abdomen) tumor. Since your dog was diagnosed a long time ago I am confused as to why this is such a surprise to your vets. By the way cushing's tumors are rarely cancerous so don't lose sleep over that ok.

It is early and I have to get ready for work but I promise to take the time later tonight to go back and read your thead from the beginning because I am stumped on your case. You already loaded on lysodren and I believe there were sensitivity issues. I'm confused as to why it's like a big surprise that there is a tumor.

So this university hospital is saying adrenal cushings but your poor dog is on NO drugs for treatment and they are saying do nothing for 30 days. My dog had the pheochromocytoma tumor which is not tumor that they refer to and I don't recall your dog having any of the symptoms that mine did.

Again I promise to come back and review the entire thread so that I can best comment. SEnding you love, Kim

[Squirt's Mom]

Wow. Just wow. After all this time they find a tumor on the adrenal. wow. This could explain why Kaibo has had such a difficult time with the Lyso, tho. I think my next step, if possible, would be to talk to a surgeon asap. I wouldn't want to wait a month so that thing could grow before having a surgeon look at his case. It could be easily removed now but become more and more complicated as time passes. Also, I think a surgeon could give you a better idea of what kind of tumor Kaibo has and what that means as far as options.

To perhaps give your mind a bit of peace - my endocrinologist informed me that doctors no longer consider something to be cancer if it isn't malignant. I have had several operations to remove what I was told were cancers but the path reports always came back "benign". My endo doc says there is no longer any such thing as a benign cancer - it either is cancer or it isn't. So the presence of a tumor does not automatically mean it is cancer. With tumors, as long as they get clean margins when removing, or the tumor is encapsulated like mine were and they get the capsule out intact, even if they are cancerous they are much less likely to spread.

So, one step at a time, 'k? Let's find out what kind of tumor this is and what your options are for addressing it. Then we can worry about cancer IF need be. ;) I say "we" because we are all in this with you and Kaibo. You are never alone.

Many hugs,
Leslie and the gang

[kaibosmom]

Thank you. I too will write more later. I kept thinking the same things last night. Why is this a surprise? But she still never said anything about Cushing's in the email so that's why I was confused. She seems so hung up on the liver. And his age. Geez. I'm running late today so must go. As I said I'll have his new blood work later today. I'll post the last few tests tonight.

[labblab]

I'm guessing that the reason why she is not focusing on Cushing's in relation to this growth is because the ultrasound is not showing the result that is typical for a dog with an adrenal tumor that is secreting excess cortisol. For dogs with Cushing's caused by adrenal tumors, you expect to see a mass in one adrenal gland but the other adrenal gland is shrunken up. Kaibo's second adrenal gland seems to be of normal size right now. So even though it looks as though he may have a growth in the other gland, it may not be the kind that causes Cushing's. Even if that's the case, the growth still needs to be monitored in order to see whether it keeps growing, etc. And as odd as it seems, if Kaibo does truly have Cushing's, it could be pituitary in nature and unrelated to this growth. So there does still seem to be a lot to sort out. :o

Marianne