bozwell (Chocolate Lab)

[bozwell]

My poor Chocolate Lab was diagnosed with cushings about 5 months ago....but not responding well to the lysodren. He became very week, walking slowly, could not go up or down stairs, and not eating or drinking. Had to drop him of at the vet today for fluids and lab work. Has anyone elses pet not responded well with the lysodren?

[bozwell]

Hi,

I am new to the site. My dog is a choc lab that was diagnosed with cushings about 4-5 months ago. We are having a really hard time getting his lysodren ajusted correctly. he is 100lbs and he is on 500mg 2 1/2 tabs 2 times per day....but his labs seem all over the place. does this seem appropriate?????

[frijole]

Note I am approving this post so I can reply quickly. I will then deal with membership approval etc. When you get an email please reply right away.

Meanwhile - Don't give any more lysodren! If your dog can't walk and is lethargic then the dose might be too high. Do you have prednisone to give in case of emergency?

You've been on the drug for 5 months. Did you do a load and then maintenance? Have you had acth testing done to know what the cortisol level is?

Normally dogs go thru a loading phase and then do tests to see where the cortisol is.

Go ahead and send a response to this giving us as much info as you can about your dog. Important - we need weight, dosage amount and any test info you might have.

Please trust me and no more lysodren for now. I used it for many years and it was great. You just have to know how it works and when to quit giving it. Hang in there. We'll help you! Kim

[bozwell]

we gave a loading dose of 500mg 2 1/2 tabs 2 times a day for about 8 days then 21/2 tabs every 3rd day.....we have to keep starting over the loading dose because as soon as we start the every 3rd day after about 2 weeks he is back to urinating and excessive drinking and abn labs....

[frijole]

Are you telling me you gave your dog FIVE pills a day for 8 days? How much does your dog weigh? Kim

[bozwell]

my dog is 100 lbs....he started of at 500 mg 2 1/2 tabs 2 times a day for 8 days then blood work...then he went to 2 1/2 tabs every 3 days after about 2 weeks he started urinating and excessive drinking and labs were dran by vet..labs were off...so start over at loading dose again for 8 days then give every 2 days. got labs drawn after 2 weeks labs off, same excessive drinking and urinating. Stared over with loading dose again and so on......

[bozwell]

100 lbs he is a choc lab.....that is what the doctor said we needed to give

[frijole]

Did you get an email from us? If so please send it back so your posts will start to show up without me approving them each time. Thanks.

Do that while I write another response to your last post please! :) Kim

[frijole]

First off the dose is just fine for a 110 lb dog. Whew.

OK... it's a bit hard to follow what happened. The way it's supposed to work with lysodren is you give it daily as you did for a week to 10 days (which you did). You do an acth test and you see what the cortisol reading is (cortisol is why your dog has cushings). There are two numbers on the test. Your goal is to get the 2nd number between a 1 and a 5. Higher than that and your dog will keep peeing (too high cortisol) Lower than that and your dog is sick (lethargic, can't walk, won't eat)

So after the first test - if the number was higher than a 5 (too high) you keep giving the drug daily as you were before. If the number is between a 1 and a 5 then you are "loaded" and you starting giving those five pills but instead of giving it once a day you split it into multiple days - but only a total of five pills a week. Is this what you have been doing?

I'll let you read and answer before writing more. :) Thanks Kim

[bozwell]

yes ..kind of...our vet never tells us what his number is, just what we need to do..this is great information. we give 2 1/2 tabs which is half his daily loading dose .. every 2 or 3 days ...so sometime she has given him more when every 3 days has not worked....He started acting funny yesterday so I did not give him his dose yesterday or today, because once again we are in a loading dose cycle again....

[frijole]

Well you were very smart to quit giving the lysodren. Know this - it works for two whole days after the last dose. Dogs can become very ill if they overdose. That is probably why your dog is at the hospital right now.

we give 2 1/2 tabs which is half his daily loading dose .. every 2 or 3 days

This is just plain wrong. Sorry but this is how dogs get into trouble. I suspect your vet has very little experience with the drug - or has just been lucky in the past.

You give the loading amount until they are loaded. If it isn't working you increase the dose. You don't mess around like you've been asked to do.

OK - here's what I'd like you to do. Know that your dog probably had a bit too much lysodren. Call the vet and make sure they are giving your dog an acth test. If they aren't demand one. This is the only way you will know what your dog's cortisol level is. Also make sure that they are checking the electrolytes. They are vital to LIVE. When dog's overdose they go low. You want to make sure your dog's electrolytes are OK. If they are not they might put your dog on an IV.

If they let your dog go home assuming the cortisol is low they should give you a prescription for prednisone. It mimics cortisol and it works very quickly. Just make sure you have it. Post and let us know how much your vet said to give. I want to make sure it's the right amount ok?

Also I want you to get copies of every single test that has been done. We're going to try to figure out what has been going on.

The most important thing is that you do NOT resume lysodren until it is safe to do so.

Here's some info on lysodren and how it works... a little late but it'll perhaps help :)

Kim

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

[mytil]

I am sorry your boy is having these troubles!

Firstly, I am glad you are not giving any more Lyso. As Kim mentioned, this drug will continue to work in his system for several days so I would not give him anymore until an ACTH stim test is performed and your vet should give you the numbers if you ask for them.

Remember you are your pup's advocate and his voice and you are doing a good job as it seems your vet is not following the recommended protocol.

Keep us posted
Terry

[bozwell]

Bozwell is getting to come home today...he is feeling much better! His acth test results are not back yet. My vet is going to call me in the morning with results and I will post. He did end up getting to much lysodren...my vet and I had a very good talk today about med management. Your have been so helpful!!! I will post labs tomorrow. Thank You.

[frijole]

So relieved that he is OK. Please get the numbers from the tests and also please confirm whether he was given prednisone to take and how much etc. We'll help with that part as well.

The numbers from that test determine the next step regarding lysodren. Please no more till you post results. I still want to understand how your dog loaded so that we can help you determine the maintenance dose. Since you were giving 5 then 2 1/2 pills off and on it kind of messes things up... but we'll figure it out.

For now the important thing is that he is able to go home and will be OK. He is a lucky dog and you were a wise owner to take him in. Seriously!

Give Boz a hug from us. Kim

[mytil]

Glad to hear he is ok.

Good thing your vet is receptive to talking about what went wrong. Keep us posted on those numbers.

Terry

[bozwell]

The vet called yesterday with his lab number: his cordisol number was .7...so she put him on 20mg of prednisone 1/2 tab 2 times a day x 7 days then 3 days and so on..to taper him off....he seems to be feeling so much better with the prednisone. does this seem like an appropriate dose?

[bozwell]

also no more lysodren till he gets more labs on the 23 rd of feb.

[Squirt's Mom]

Excellent plan! Glad to hear Bozwell is feeling better and hope the trend continues. Don't be afraid to ask for more pred if he needs it. Sometimes it takes a bit for the adrenals to start working again and they will need help until they do.

Keep in touch and let us know how things are going!
Hugs,
Leslie and the gang

[bozwell]

Thank you so much..I will keep you posted on labs next week, and on how we are starting loading dose again....(as while Im writing this I can here my dog peeing on my kitchen floor, at 100lbs, its alot of pee ...lol) . He is now back to running, jumping and playing since starting prednisone.
I want to thank you very much.

[mytil]

To me this sounds like the right dosage given he is responding so well. Am very glad to hear.

Keep us posted
Terry

[molly muffin]

I am glad that things are moving back onto the right track. Keep us posted on what is going on.

Sharlene and Molly Muffin

[bozwell]

Bozwell had his labs drawn yesterday....his results are .7 again. My vet wants to restart him on another round of prednisone with no lysodren....does this sound appropriate.
bozwell's mom

[frijole]

Yes. In case your vet didn't explain how this works:

You loaded using lysodren and as i commented earlier your vet did not follow protocol and in my opinion is what caused the overdose. OK so what that means is that you went from having a dog with cushings' disease (too high of cortisol because the adrenals are overproducing) to to a dog that is Addisonian (Addisons disease which is the opposite of cushings) as he is not producing enough cortisol. This is because lysodren is designed to intentionally erode the adrenal cortex where cortisol is produced. This is why you have to be very careful and follow protocol (its been around for over 20 yrs) because if you don't and the dog gets too much lysodren which is what happened then the TOO much of the adrenal cortex is eroded.

Now the question is whether or not Boz is permanently Addisonian or if it is temporary and his adrenals regrow and start producing cortisol again. This is CRITICAL because dogs require cortisol to LIVE. This is why he was so out of it when he went low.

So you did the acth test to measure his cortisol. He was at 0.7. Anything less than 1.0 is considered Addisonian. (meaning too low and he requires prednisone to live as it mimics cortisol that he can 't produce.

You will need to continue monitoring and one of two things will happen: either he is permanently Addisonian which means you no longer have a cush dog - you have an Addisonian dog and he'll take prednisone for life.... OR his adrenals start to produce cortisol (he goes over 1.0 on the acth test). At that point he can go off of the prednisone (you must wean slowly as you can't just stop it). If his ACTH numbers go high again then you might have to treat with lysodren again - but you are a long ways away from worrying about that. No lysodren until that number is above 4.0 would be my guess.

The other thing that needs to be monitored are his electrolytes and you should ask your vet if they are being checked each time he does the acth test.

Sorry to tell you but prednisone will cause peeing just like cushings. All you can do is hope that you can slowly wean him to a lower dose of prednisone and the peeing stops... but there is no guarantee.

I hope this helps explain what has been going on with dear Boz. Take care, Kim

[lulusmom]

Hi Bozwell's Mom and a belated welcome from me.

It would be a tremendous help in understanding why Bozwell's cortisol dropped so low while on maintenance dose. I realize your vet has not offered you copies of all of Bozwell's acth stimulation tests but please get them from your vet and post the results here.

What I would like to know is:

1. Does Bozwell have pituitary dependent cushing's or an adrenal tumor. Adrenal tumors are resistant to Lysodren so if Bozwell has an adrenal tumor, that might explain why your vet prescribed a loading dose in excess of the recommended maximum of 50mg/kg. Bozwell was getting 55mg/kg per day which is a pretty hefty dose.

2. Did your vet do an acth stimulation test before starting loading?

3. Can you look at your calendar and tell me how many days you loaded Was it 7, 8 or 9?

4. What was the results of the first acth stim test done after loading?

5. Was the first acth stimulation test after loading done one or two days after the last loading dose?

64. How long did you wait after loading to start the maintenance dosing?

I personally think 5000 mg of Lysodren every week may have been a bit much for Boz, depending on how long he loaded and what the results of the stim test was. 7500 mg of Lysodren every nine days is completely scarey and I am hoping that your responses to my questions above will help me understand your vet's rationale.

FYI, it is quite possible that Bozwell's adrenal glands have taken such a beating from the Lysodren that he may not need to restart treatment for quite some time.

Glynda

[bozwell]

well bozwell got his cortisol level drawn again yesterday. The vet called with results of less than .7 again. She has him on 20mg prednisone 1/2 tab every other day. does this sound correct ? she thinks he will probably will have addisons now instead of cushings. I am still working on getting all the info from my vet. Bozwell seems to be feeling ok, I just dont want him to start going down hill if he is not on high enough dose of prednisone.

[bozwell]

I am so frustrated with his lab results.

[lulusmom]

Can you answer any of the questions I asked in my prior post? Please do round up copies of the tests so you can post the formal results here. What about the lab reports you've seen are frustrating for you? Is it the fact that Bozwell very well could be a permenant Addison's dog?

[bozwell]

I am taking him in today to get his electrolytes drawn..so I will pick up some of the information you requested today. I am frustrated because the vet doesnt seem to know what to do with him now. I have read some info on addison disease and most of those dogs get monthly injections and are on prednisone every day. I just dont want my vet to mess around with prednisone everyother day and get him sick again.

[molly muffin]

Prednisone every day or injections are both/either used to treat Addison. I wouldn't even bother with every other day, as that isn't an accepted protocol of treatment that I know of.

Sharlene and Molly Muffin

[Squirt's Mom]

Hi,

Point blank question :D - do you have a problem sharing the lab reports? Some folks do and if that is the case, just let us know and we will stop asking you for them. However, please understand that without that info we are handicapped as to what info we can offer.

If you do not have a problem sharing those labs, would you please get copies of all that have been done and post the results here along with the normal ranges?

Hugs,
Leslie and the gang

[bozwell]

no I dont have a problem sharing them at all! I will post them later tonight. I picked them up yesterday from the vets office when I took him in for blood work. They are at home, I am at work. His electrolytes were normal...the vet wanted to make sure he is not in and addisonian crisis. He is not!

[molly muffin]

Oh so glad not addison crisis. So, now on to the next possibilities and hopefully the lab results will give some hints as to what is going on.

Sharlene and Molly Muffin