sttrg03
12-29-2012, 05:03 AM
Hi all! I'm hoping you might be able to shed light on a frustrating reoccurring and mind boggling yoyo relapsing my pit bull mix, Penny has been having. I should mention that I adopted her back in September of this year knowing she had been diagnosed with Cushings. I'll list her general info here for easy viewing and what information I have with me, so far.
Breed: Pit bull mix
DOB: 8 years old
Weight:79.6 lbs
Diagnosed with Cushings: April 2012 via Dexamethasone Suppression Test (This was the only recorded record on her medical report I received from the shelter). The shelter had been treating her with:
Melatonin 6 mg 1x a day
Lignans/SDG 1 mg/lb a day
also via abdominal ultrasound the findings read: Both adrenals were symmetrically enlarged. The left was 0.87/0.786 cm and the right was 0.961 cm. The liver had rounded edges but was otherwise within normal limits in echogenicity and structure. The kidneys have small hyperechoic changes in the cortices but were normal in size; left: 4.28 x 6.28/Right: 7.31 x 3.85 cm, shape, corticomedullary region and ratios. The spleen, gall bladder, urinary bladder, stomach, small bowel, large bowel and lymph nodes were within normal limits in the planes viewed. The findings of adrenal enlargement, hepatic enlargement and inflammatory changes to kidneys may well be related to Cushing's syndrome.
Appearance: pot bellied, small tumors around legs, hair loss around neck, shoulders, tail, poor coat quality with blackheads and extremely thin skin. She has also recently developed calcium cutis on her shoulder and a bit on her back.
Symptoms: Extremely lethargic, unwilling to go for walks, not a voracious eater but more of a general grazer (she was being fed 2 cups of dry food 2x a day but would only eat about half then walk away), polydipsia (~2 gallons/day) , polyuria (no warning she would pee in her bed, on the floor, etc. multiple times a day for eg. peeing spontaneously 3 times or more within 1 hour). Hind leg weakness and stiffness.
Induction dose started 10/11: Lysodren 500 mg 2x a day once daily. No change after 10 days except for higher energy, willingness to go for walks, but still peeing just as much and still having accidents, still picky eater.
10/22: Veterinarian decided to only run a basal cortisol (??? - this was what made me start to question my vet) results >10 ug/dL. Instructed to continue with induction dosing.
11/4: Lysodren stopped (by me). No changes in polyuria/polydipsia, during this time energy level seemed to have plateaued and now decreasing to a more lethargic state not as extreme as it once was but not as energetic as she had been. No signs of Addisonian crisis during this stretch of time. Decided to seek another opinion.
11/8: Saw new vet who did general work up including blood tests, fecal flotation, urine analysis, cytology with fine needle aspiration on her little tumor by her leg, and a skin tape with a gram stain. I unfortunately don't have the written report from the general blood test but the veterinarian had told me that everything was normal except her thyroid was low, SG on her urine analysis was extremely low, no bacteria was found but as a precaution she gave me antibiotics just in case Penny had a UTI. Vet suspected possible hypothyrodism although she also suggested cutting food back to 1 cup 2x/day and more detailed thyroid panel was performed.
11/9: ACTH stem test performed *Penny was last given Lysodren on 11/4 supposedly still on induction dose*
Pre 5.4 ug/dL (HIGH) with reference range between 1.0-5.0 ug/dL. Post 7.7 (LOW) with reference range between 8-17 ug/dL
The report states pre and post cortisol levels after Lysodren loading or while on maintenance Lysodren should be between 1-5 ug/dL.
11/23: Thyroid panel performed. Unfortunately I also need to get the written report for this but the vet told me this came back normal.
12/12: My vet had put Penny back on Lysodren 500 mg 2x/day once a week. Penny still had accidents although the spontaneous accidents were less frequent. She now seemed to have more control over her bladder and could tell us she had to go potty. Still drinking the same amount. She slowly reverted back to her lethargic, sleepy state. However, on 12/12 a day after she had gotten off antibiotics (Cephalexin 500 mg 2 tabs/2x day to treat her potential UTI that the vet prescribed back on 11/8 long story short she was only on these antibiotics for her prescribed 10 days we had a delay in receiving the antibiotics) she started having spontaneously accidents and frequently! It got back to 3+ accidents/hour. She couldn't control it.
*Please note I know Penny is potty trained. When she was doing her best she would have maybe 1 accident the whole day. I am home most of the day except for running errands and I take her out frequently as soon as she wakes up from her naps. She sleeps most of the day. Since the day I got her she has had very low energy and very laid back so it is hard for me to judge what is her personality and what is the Cushings. I talked to one woman who fostered her and she seemed to have this same "yoyo" effect with Penny: for a couple months she would be energetic and want to go for walks, more alert, then she slowly wanted to not go on walks more and more until she flat out refused unless it was just to go out to pee and then come back inside. Penny was not on any Lysodren treatment when the foster parent had Penny.
12/18: Vet suspects central diabetes insipidus. SG: 1.001. Vet told me to monitor water intake and then administer desmopressin 2 drops/eye 2x day for 3-5 days.
This is the point I am at now. Penny's regular water intake was 5 quarts and with desmopressin it decreased slowly each day from 4.5 quarts to 3 quarts over a span of 3 days but since being on the eye drops she has become even more sleepy. She sleeps all day except to get up every 3-4 hours to go potty. She snores. She just seems depressed. She won't go for walks, just flat out refuses. Her hind leg weakness is back to how it was when I first adopted her. She is very stiff and has a hard time even getting up from sleeping. She has a hard time keeping her legs underneath herself. I decided to stop the drops just because I'm concerned they are making her like this. She was lethargic before but this is probably the worst I've seen her and I'm extremely concerned about her.
Has anyone else experienced this "yoyo" effect? Does anyone have any advice on the induction dose issue? It would appear that she was in some way responding to Lysodren yet at the same time, not. I just have a nagging feeling there is more to this story and it is very frustrating not knowing what or why she is having these types of ups and downs. The vet plans to do another ACTH stem test in the coming weeks to see what is going on and I still need to talk to her about the DI trial test. If anyone has any comments on what I observed for her DI trial I would be happy to hear your opinions.
Any guidance would be MUCH appreciated. I'm just in a bit of a fog right now.
Breed: Pit bull mix
DOB: 8 years old
Weight:79.6 lbs
Diagnosed with Cushings: April 2012 via Dexamethasone Suppression Test (This was the only recorded record on her medical report I received from the shelter). The shelter had been treating her with:
Melatonin 6 mg 1x a day
Lignans/SDG 1 mg/lb a day
also via abdominal ultrasound the findings read: Both adrenals were symmetrically enlarged. The left was 0.87/0.786 cm and the right was 0.961 cm. The liver had rounded edges but was otherwise within normal limits in echogenicity and structure. The kidneys have small hyperechoic changes in the cortices but were normal in size; left: 4.28 x 6.28/Right: 7.31 x 3.85 cm, shape, corticomedullary region and ratios. The spleen, gall bladder, urinary bladder, stomach, small bowel, large bowel and lymph nodes were within normal limits in the planes viewed. The findings of adrenal enlargement, hepatic enlargement and inflammatory changes to kidneys may well be related to Cushing's syndrome.
Appearance: pot bellied, small tumors around legs, hair loss around neck, shoulders, tail, poor coat quality with blackheads and extremely thin skin. She has also recently developed calcium cutis on her shoulder and a bit on her back.
Symptoms: Extremely lethargic, unwilling to go for walks, not a voracious eater but more of a general grazer (she was being fed 2 cups of dry food 2x a day but would only eat about half then walk away), polydipsia (~2 gallons/day) , polyuria (no warning she would pee in her bed, on the floor, etc. multiple times a day for eg. peeing spontaneously 3 times or more within 1 hour). Hind leg weakness and stiffness.
Induction dose started 10/11: Lysodren 500 mg 2x a day once daily. No change after 10 days except for higher energy, willingness to go for walks, but still peeing just as much and still having accidents, still picky eater.
10/22: Veterinarian decided to only run a basal cortisol (??? - this was what made me start to question my vet) results >10 ug/dL. Instructed to continue with induction dosing.
11/4: Lysodren stopped (by me). No changes in polyuria/polydipsia, during this time energy level seemed to have plateaued and now decreasing to a more lethargic state not as extreme as it once was but not as energetic as she had been. No signs of Addisonian crisis during this stretch of time. Decided to seek another opinion.
11/8: Saw new vet who did general work up including blood tests, fecal flotation, urine analysis, cytology with fine needle aspiration on her little tumor by her leg, and a skin tape with a gram stain. I unfortunately don't have the written report from the general blood test but the veterinarian had told me that everything was normal except her thyroid was low, SG on her urine analysis was extremely low, no bacteria was found but as a precaution she gave me antibiotics just in case Penny had a UTI. Vet suspected possible hypothyrodism although she also suggested cutting food back to 1 cup 2x/day and more detailed thyroid panel was performed.
11/9: ACTH stem test performed *Penny was last given Lysodren on 11/4 supposedly still on induction dose*
Pre 5.4 ug/dL (HIGH) with reference range between 1.0-5.0 ug/dL. Post 7.7 (LOW) with reference range between 8-17 ug/dL
The report states pre and post cortisol levels after Lysodren loading or while on maintenance Lysodren should be between 1-5 ug/dL.
11/23: Thyroid panel performed. Unfortunately I also need to get the written report for this but the vet told me this came back normal.
12/12: My vet had put Penny back on Lysodren 500 mg 2x/day once a week. Penny still had accidents although the spontaneous accidents were less frequent. She now seemed to have more control over her bladder and could tell us she had to go potty. Still drinking the same amount. She slowly reverted back to her lethargic, sleepy state. However, on 12/12 a day after she had gotten off antibiotics (Cephalexin 500 mg 2 tabs/2x day to treat her potential UTI that the vet prescribed back on 11/8 long story short she was only on these antibiotics for her prescribed 10 days we had a delay in receiving the antibiotics) she started having spontaneously accidents and frequently! It got back to 3+ accidents/hour. She couldn't control it.
*Please note I know Penny is potty trained. When she was doing her best she would have maybe 1 accident the whole day. I am home most of the day except for running errands and I take her out frequently as soon as she wakes up from her naps. She sleeps most of the day. Since the day I got her she has had very low energy and very laid back so it is hard for me to judge what is her personality and what is the Cushings. I talked to one woman who fostered her and she seemed to have this same "yoyo" effect with Penny: for a couple months she would be energetic and want to go for walks, more alert, then she slowly wanted to not go on walks more and more until she flat out refused unless it was just to go out to pee and then come back inside. Penny was not on any Lysodren treatment when the foster parent had Penny.
12/18: Vet suspects central diabetes insipidus. SG: 1.001. Vet told me to monitor water intake and then administer desmopressin 2 drops/eye 2x day for 3-5 days.
This is the point I am at now. Penny's regular water intake was 5 quarts and with desmopressin it decreased slowly each day from 4.5 quarts to 3 quarts over a span of 3 days but since being on the eye drops she has become even more sleepy. She sleeps all day except to get up every 3-4 hours to go potty. She snores. She just seems depressed. She won't go for walks, just flat out refuses. Her hind leg weakness is back to how it was when I first adopted her. She is very stiff and has a hard time even getting up from sleeping. She has a hard time keeping her legs underneath herself. I decided to stop the drops just because I'm concerned they are making her like this. She was lethargic before but this is probably the worst I've seen her and I'm extremely concerned about her.
Has anyone else experienced this "yoyo" effect? Does anyone have any advice on the induction dose issue? It would appear that she was in some way responding to Lysodren yet at the same time, not. I just have a nagging feeling there is more to this story and it is very frustrating not knowing what or why she is having these types of ups and downs. The vet plans to do another ACTH stem test in the coming weeks to see what is going on and I still need to talk to her about the DI trial test. If anyone has any comments on what I observed for her DI trial I would be happy to hear your opinions.
Any guidance would be MUCH appreciated. I'm just in a bit of a fog right now.