New member questions (9 y/o Chihuahua) - now Calcinosis Cutis?

[savannah]

Savannah is our 9 year old Chihuahua. She was diagnosed 1 year ago with cushings and is on Metatone .5 ml every 3rd day. She also developed a skin problem, hair loss, whiskers falling out. Mostly on her feet. The vet also put her on clavamox. The hair problem cleared up for about 6 months, now it is back. Not as bad, but her feet are hairless again. The vet put her back on clavamox, but is not working as fast as lastime. She also is starting to have more accidents 24 hours before she gets her cushing meds. We are struggling to deal with this. Any suggestions?

[Squirt's Mom]

Hi and welcome to you and Savannah! :)

We will ask a lot of questions at first so we can get a better idea of what is going on with your sweet girl. So, here we go!

How old is Savannah?

Is she spayed?

How much does she weigh?

What dose of the liquid Mitotane (Lysodren) is she getting? It will say something like 3mg Mitotane per ml as an example. If you would just type exactly what is on the bottle that will tell us what we need to know.

What dose of Mitotane (Lysodren) was used to load Savannah?

How long did it take to load her?

Would you mind posting the results of the testing done to diagnosis her as well as the monitoring ACTHs since starting the Mitotane (Lysodren)?

What prompted the cushing's testing in the first place?

What signs did you see before starting treatment? Have those signs lessened or grown stronger or stay the same since starting treatment?

I'm glad you found us and look forward to hearing back from you soon. I am sure others will be along shortly, too. Keep your chin up! You are in the very best place for knowledge and support. You and Savannah are part of our family here now and we will be with you all the way.

Hugs,
Leslie and the gang

[savannah]

[QUOTE=Squirt's Mom;98295]Hi and welcome to you and Savannah! :)

We will ask a lot of questions at first so we can get a better idea of what is going on with your sweet girl. So, here we go!

How old is Savannah?

9 Years old


Is she spayed?

No, We took her in to have her spayed and her liver counts were too high, this is eventually what lead to the cushings diagnoses. She had a swollen liver, Pot belly....

How much does she weigh?

10 Lbs

What dose of the liquid Mitotane (Lysodren) is she getting? It will say something like 3mg Mitotane per ml as an example. If you would just type exactly what is on the bottle that will tell us what we need to know.

175 mg/ml
0.5 ml every third day

What dose of Mitotane (Lysodren) was used to load Savannah?

not sure, will post vets results shortly see below

How long did it take to load her?

The test takes two hours, not sure how long it took to load her...

Would you mind posting the results of the testing done to diagnosis her as well as the monitoring ACTHs since starting the Mitotane (Lysodren)?

Last check was Nov 2012 before test level 8.0 after load 14.5
Vet is emailing me the reports so I can post them.


What prompted the cushing's testing in the first place?

Trying to figure out why she had liver swollen, and was urinating all the time,


What signs did you see before starting treatment?

She was always hungry, drank alot of water, panting alot, swollen belly, pot belly, uranating alot.


Have those signs lessened or grown stronger or stay the same since starting treatment?


She showed much improvement for the first six months. She was on the medicine 2 times a week. Then she started to regress, so our vet uped the dosage to every third day. That worked for a few months, now she takes the meds, seems much better 24 hrs after, but by the third day she is urinating alot, always hungry, drinking alot.

[savannah]

Is this what you are wanting to see? This is from the initial test.


5/7/2012 L ML Miscellaneous results from IDEXX Reference
Laboratory Requisition ID: 116778 Posted Final
Ascn: E6222392
2RS-PRE3RS-POSTCANINE
RE: 817 SECOND POST ACTH
SECOND POST ACTH
>50.0 RESULT VERIFIED BY REPEAT ANALYSIS

[savannah]

Patient History Report

Date Type Staff History
11/12/2012 L AH Endocrinology results from IDEXX Reference
Laboratory Requisition ID: 116778 Posted Final
Test Result Reference Range
PRE-ACTH 8.0 ug/dL
POST-ACTH 14.5 ug/dL
Ascn: H6072099
2RS/PRE,POST FI CANINE
ACTH Reference Range:
Canine: Feline
2 - 6 0.5 - 5 Pre-ACTH (resting) cortisol
6 - 18 5 - 15 Post-ACTH cortisol
18 - 22 15 - 19 Equivocal post-ACTH cortisol
>22 >19 Post-ACTH cortisol consistent
with
hyperadrenocorticism
<2 <0.5 Post-ACTH cortisol consistent
with
hypoadrenocorticism
1 - 5 n/a Desired pre- and post-ACTH
cortisol on
lysodren therapy
ACTH response test is only clearly positive (>22) in 30% of
dogs with hyperadrenocorticism (HAC); equivocally positive
in
another 30% of dogs with HAC, and normal in 40 % of dogs
with HAC.*
If the ACTH response test is normal and HAC is still
suspected,
proceed with a low-dose dexamethasone suppression test.
Dogs with iatrogenic Cushing's disease will have flatline
response
test results in the low end or below the normal reference
range.
Both HAC and hypoadrenocorticism are rare diseases in cats.
*Reference: Feldman and Nelson; Canine and Feline
Endocrinology and
Reproduction. 3rd ed. W.B.Saunders Co., 2004.
B:Billing, C:Med note, CB:Call back, CK:Check-in, CM:Communications, D:Diagnosis, DH:Declined to history, E:Examination, ES:Estimates,
I:Departing instr, L:Lab result, M:Image cases, P:Prescription, PA:PVL Accepted, PB:problems, PP:PVL Performed, PR:PVL Recommended,
R:Correspondence, T:Images, TC:Tentative medl note, V:Vital signs

Patient History Report

Date Type Staff History
5/7/2012 L ML CYTOLOGY results from DVS-In Clinic Laboratory Requisition
ID: 0 Posted Final
Test Result Reference Range
TYPE = Imp Smear
SOURCE = toes & belly
FINDINGS = in comments
READ BY = AB
TOLD BY = ML
ENTERED BY = MK
Manually entered.
FINDINGS: 0-2 yeast oil, small amt cocci in pairs Many WBC's
5/7/2012 L LD Intestinal Parasite results from DVS-In Clinic
Laboratory Requisition ID: 0 Posted Final
Test Result Reference Range
CONSISTENC = soft
COLOR = brown
FLOAT RESU = 1hook 6 demodex
READ BY = LD
TOLD BY = ML
ENTER BY = MK
Manually entered.
5/7/2012 L Microbiology results from IDEXX Reference
Laboratory Requisition ID: 116778 Posted Final
Test Result Reference Range
AMIKACIN S
AMOX/CLAV S
AZITHROMYC S
CEFTIOFUR S
CEPHALEXIN S
CHLORAMPHE S
CIPROFLOXA S
CLINDAMYCI S
ERYTHROMYC S
GENTAMICIN S
IMIPENEM S
MARBOFLOXA S
ENROFLOXAC S
OXACILLIN S
PENICILLIN R
B:Billing, C:Med note, CB:Call back, CK:Check-in, CM:Communications, D:Diagnosis, DH:Declined to history, E:Examination, ES:Estimates,
I:Departing instr, L:Lab result, M:Image cases, P:Prescription, PA:PVL Accepted, PB:problems, PP:PVL Performed, PR:PVL Recommended,
R:Correspondence, T:Images, TC:Tentative medl note, V:Vital signs
Dodgeville Veterinary Service, S.C. Page 2 of 7 Date: 3/27/2013 8:54 AM
Patient History Report

Date Type Staff History
RIFAMPIN S
TETRACYCLI R
TRIBRISSEN S
CEFOVECIN S
CEFPODOXIM S
Ascn: E6270907
SW/CANINE
RE: 5011 ORGANISM
ORGANISM
Staphylococcus pseudintermedius
4+
RE: 4219 AMOXICILLIN R
RE: 4216 MUPIROCIN S
5/7/2012 L ML Microbiology results from IDEXX Reference
Laboratory Requisition ID: 116778 Posted Final
Test Result Reference Range
SOURCE SKIN
STATUS FINAL
Ascn: E6270907
SW/CANINE
05/10/12
Staphylococcus pseudintermedius - additional
susceptibilities to
follow
RE: 5002 COMPLETED CULTURE RESULTS
COMPLETED CULTURE RESULTS
Beta-hemolytic Streptococcus sp. - 4+
Ampicillin/Penicillin, Cephalosporins, Erythromycin (and
Azithromyc
in), and Trimethoprim-Sulfa are recommended antibiotics.
Susceptibility testing is not indicated because of the
predictable
effectiveness of these recommended antibiotics.
-
Escherichia coli - 4+
Staphylococcus pseudintermedius 4+
This isolate is sensitive to oxacillin and therefore is
NOT methicillin resistant. (All staphylococci are
screened for methicillin resistance. Oxacillin can be used
to predict methicillin sensitivity.)
-
B:Billing, C:Med note, CB:Call back, CK:Check-in, CM:Communications, D:Diagnosis, DH:Declined to history, E:Examination, ES:Estimates,
I:Departing instr, L:Lab result, M:Image cases, P:Prescription, PA:PVL Accepted, PB:problems, PP:PVL Performed, PR:PVL Recommended,
R:Correspondence, T:Images, TC:Tentative medl note, V:Vital signs

8:54 AM
Patient History Report

Date Type Staff History
5/7/2012 L ML Chemistry results from IDEXX Reference Laboratory Requisition
ID: 116778 Posted Final
Test Result Reference Range
BILE ACIDS 4.4 umol/L 0.0 - 6.9
BILE ACPP 11.8 umol/L 0.0 - 14.9
Ascn: E6222392
2RS-PRE3RS-POSTCANINE
In both dogs and cats resting bile acids >7 umol/L or post
prandial
bile acid concentrations >15 umol/L are suggestive of liver
malfunction but does not indicate the nature of the
abnormality or
whether the problem is reversible or permanent. A liver
biopsy may be
warranted to further identify the underlying hepatopathy.
Increased
bile acids can be seen in diseases affecting hepatic
circulation (i.e.
liver shunts), cholestasis, or diseases associated with
hepatocellular
damage. Dehydration, hypovolemia, and chronic passive
congestion have
only a minor effect on bile acid levels. A normal bile acid
level does
not rule out a hepatopathy.
5/7/2012 L ML Chemistry results from IDEXX Reference Laboratory Requisition
ID: 116778 Posted Final
Test Result Reference Range
ALB 3.4 g/dL 2.5 - 4.0
ALKP 645 U/L H 10 - 150
ALT 222 U/L H 5 - 107
AST 32 U/L 5 - 55
BUN/UREA 5 mg/dL L 7 - 27
CHOL 275 mg/dL 112 - 328
GGT 204 U/L H 0 - 14
GLU 132 mg/dL H 60 - 125
TBIL 0.1 mg/dL 0.0 - 0.4
TP 6.4 g/dL 5.1 - 7.8
GLOB 3.0 g/dL 2.1 - 4.5
DBIL 0.1 mg/dL 0.0 - 0.2
B:Billing, C:Med note, CB:Call back, CK:Check-in, CM:Communications, D:Diagnosis, DH:Declined to history, E:Examination, ES:Estimates,
I:Departing instr, L:Lab result, M:Image cases, P:Prescription, PA:PVL Accepted, PB:problems, PP:PVL Performed, PR:PVL Recommended,
R:Correspondence, T:Images, TC:Tentative medl note, V:Vital signs
. Page 4 of 7 Date: 3/27/2013 8:54 AM
Patient History Report

Date Type Staff History
IBIL 0.0 mg/dL 0 - 0.3
A/G Ratio 1.1 0.6 - 1.6
Ascn: E6222392
2RS-PRE3RS-POSTCANINE
RE: 281 HEMOLYSIS INDEX N
Index of N,+,++ exhibits no significant effect on chemistry
values.
RE: 282 LIPEMIA INDEX N
Index of N,+,++ exhibits no significant effect on chemistry
values.
RESULT VERIFIED BY REPEAT ANALYSIS
RESULT VERIFIED BY REPEAT ANALYSIS
5/7/2012 L ML Endocrinology results from IDEXX Reference
Laboratory Requisition ID: 116778 Posted Final
Test Result Reference Range
PRE-ACTH 45.6 ug/dL
POST-ACTH >50.0 ug/dL
RESULT VERIFIED BY REPEAT ANALYSIS
TUBE ORDER AND LABELED DRAW TIMES RECHECKED
5/7/2012 L ML Miscellaneous results from IDEXX Reference
Laboratory Requisition ID: 116778 Posted Final
Ascn: E6222392
2RS-PRE3RS-POSTCANINE
RE: 817 SECOND POST ACTH
SECOND POST ACTH
>50.0 RESULT VERIFIED BY REPEAT ANALYSIS
ACTH Reference Range:
Canine: Feline
2 - 6 0.5 - 5 Pre-ACTH (resting) cortisol
6 - 18 5 - 15 Post-ACTH cortisol
18 - 22 15 - 19 Equivocal post-ACTH cortisol
>22 >19 Post-ACTH cortisol consistent
with
hyperadrenocorticism
<2 <0.5 Post-ACTH cortisol consistent
with
hypoadrenocorticism
B:Billing, C:Med note, CB:Call back, CK:Check-in, CM:Communications, D:Diagnosis, DH:Declined to history, E:Examination, ES:Estimates,
I:Departing instr, L:Lab result, M:Image cases, P:Prescription, PA:PVL Accepted, PB:problems, PP:PVL Performed, PR:PVL Recommended,
R:Correspondence, T:Images, TC:Tentative medl note, V:Vital signs
Page 5 of 7 Date: 3/27/2013 8:54 AM
Patient History Report

Date Type Staff History
1 - 5 n/a Desired pre- and post-ACTH
cortisol on
lysodren therapy
ACTH response test is only clearly positive (>22) in 30% of
dogs with hyperadrenocorticism (HAC); equivocally positive in
another 30% of dogs with HAC, and normal in 40 % of dogs with
HAC.*
If the ACTH response test is normal and HAC is still
suspected,
proceed with a low-dose dexamethasone suppression test.
Dogs with iatrogenic Cushing's disease will have flatline
response
test results in the low end or below the normal reference
range.
Both HAC and hypoadrenocorticism are rare diseases in cats.
*Reference: Feldman and Nelson; Canine and Feline
Endocrinology and
Reproduction. 3rd ed. W.B.Saunders Co., 2004.
5/7/2012 L ML Hematology results from IDEXX Reference
Laboratory Requisition ID: 116778 Posted Final
Test Result Reference Range
HCT 44.8 % 37 - 55
HGB 15.1 g/dL 12 - 18
MCHC 33.7 g/dL 32 - 36
WBC 37.9 K/uL H 5.7 - 16.3
LYMPHS 4 % L 12 - 30
MONOS 5 % 3 - 10
EOS 0 % L 2 - 10
BASO 0 % 0 - 1
RBC 6.29 M/uL 5.5 - 8.5
MCV 71 fL 60 - 77
MCH 24.0 pg 19.5 - 26.0
ABS BASO 0 /uL 0 - 100
ABS EOS 0 /uL L 100 - 1250
ABS LYMPHS 1516 /uL 1000 - 4800
NEUT SEG 91 % H 60 - 77
PLATELETS 711 K/uL H 164 - 510
ABS MONOS 1895 /uL H 150 - 1350
ABS NEUTS 34489 /uL H 3000 - 11500
Ascn: E6222356
3UNST,LCANINE


B:Billing, C:Med note, CB:Call back, CK:Check-in, CM:Communications, D:Diagnosis, DH:Declined to history, E:Examination, ES:Estimates,
I:Departing instr, L:Lab result, M:Image cases, P:Prescription, PA:PVL Accepted, PB:problems, PP:PVL Performed, PR:PVL Recommended,
R:Correspondence, T:Images, TC:Tentative medl note, V:Vital signs


Date Type Staff History
RE: 3034 REMARKS
REMARKS
SLIDE REVIEWED MICROSCOPICALLY.
NO PARASITES SEEN
NEUTROPHILS APPEAR SLIGHTLY TOXIC
DOHLE BODIES SEEN
PLATELETS APPEAR INCREASED.
B:Billing, C:Med note, CB:Call back, CK:Check-in, CM:Communications, D:Diagnosis, DH:Declined to history, E:Examination, ES:Estimates,
I:Departing instr, L:Lab result, M:Image cases, P:Prescription, PA:PVL Accepted, PB:problems, PP:PVL Performed, PR:PVL Recommended,
R:Correspondence, T:Images, TC:Tentative medl note, V:Vital signs

[Squirt's Mom]

Thanks for the additional info!

One thing I am still not clear on - the loading phase of Savannah's treatment. When using Lysodren (Mitotane) the pup goes through what is called a "loading phase" in which the Lyso is given twice a day until you see signs that indicate she is loaded - reduction in drinking or eating are the prime signs. After you see those signs, you stop the Lyso and have an ACTH done to see where the cortisol level is. If it is within range - 1-5ug/dl for a Lyso pup - then you wait a few days and start what is called the "maintenance phase" in which the pup gets the Lyso 2-4 times a week. The maintenance dose is typically the same as the daily loading dose but spread out over a week's time. Does this sound like what you did with Savannah...or were you simply told to give her the medicine daily?

[goldengirl88]

Hello;
Just wanted to welcome you and wish the best for you and your baby. You will get so much knowledge and support here to help you. God Bless you and your baby.
Patti

[savannah]

She was, the second one is here.....this was after fourteen days of the trial

5/24/2012 L GG Endocrinology results from IDEXX Reference
Laboratory Requisition ID: 116778 Posted Final
Test Result Reference Range
PRE-ACTH 20.6 ug/dL
POST-ACTH >50.0 ug/dL

[savannah]

Thanks Patti, I hope so....seems latley we are going backwards:(

[molly muffin]

Hello and welcome from me too. :)

It looks like this is your last ACTH test result?

11/12/2012
PRE-ACTH 8.0 ug/dL
POST-ACTH 14.5 ug/dL

5/24/2012 (14 days after starting load? or maintenance of Lysodren?)
PRE-ACTH 20.6 ug/dL
POST-ACTH >50.0 ug/dL

In a controlled cortisol situation, you are looking for that second Post number to be between 1 - 5.
It doesn't appear that Savannah is controlled at this point. It could be that a mini load is needed again. Sometimes they do slip but I don't see where here ACTH post was ever in the controlled range.

Some of the others who are most familiar with the blood results will be by I'm sure and can tell you what they think of the results.

You really only need to post anything that is abnormal High/Low listing the test, result and range/unit.

It does appear that at the time of the initial testing in May, 2012 that Savannah had a staph infection. That can skewer cushing testing results (just so you are aware). Have they retested the skin for recurring staph? I know that in humans, once you have had staph infections you are susceptible to future infections.

I'll just repost here the labs that were high or low in May, 2012.

05/07/2012

ALKP 645 U/L H 10 - 150
ALT 222 U/L H 5 - 107
GGT 204 U/L H 0 - 14
GLU 132 mg/dL H 60 - 125

5/7/2012
PRE-ACTH 45.6 ug/dL
POST-ACTH >50.0 ug/dL

5/7/2012
LYMPHS 4 % L 12 - 30
EOS 0 % L 2 - 10
ABS EOS 0 /uL L 100 - 1250
NEUT SEG 91 % H 60 - 77
PLATELETS 711 K/uL H 164 - 510
ABS MONOS 1895 /uL H 150 - 1350
ABS NEUTS 34489 /uL H 3000 - 11500

5/7/2012

BILE ACIDS 4.4 umol/L 0.0 - 6.9
BILE ACPP 11.8 umol/L 0.0 - 14.9

In both dogs and cats resting bile acids >7 umol/L or post
prandial bile acid concentrations >15 umol/L are suggestive of liver
malfunction but does not indicate the nature of the
abnormality or whether the problem is reversible or permanent.

A liver biopsy may be warranted to further identify the underlying hepatopathy.
Increased bile acids can be seen in diseases affecting hepatic
circulation (i.e.liver shunts), cholestasis, or diseases associated with
hepatocellular damage. Dehydration, hypovolemia, and chronic passive
congestion have only a minor effect on bile acid levels.

A normal bile acid level does not rule out a hepatopathy.

That way those who know more about the lab results can take a quick look and see what is off.

Sharlene and Molly Muffin

[Squirt's Mom]

Thanks, Sharlene! :) I was coming back this morning to work on that!

Ok, Savannah's mom - one thing I see that needs immediate attention are the liver values. She has elevations in three of the values that tell about liver function. The ALKP isn't bad at all but the ALT and GGT are very elevated. So I would want that checked out thoroughly if possible.

If the ACTH on 11/12/2012 was the one to check whether Savannah was loaded or not, what this tells us is that she was NOT loaded at this point and should have continued the daily dosing until she was. Or was this the initial ACTH used for diagnosing? :confused:

The ACTH in May of 2012 in not in range so the Cushing's is not being controlled on the current dose and / or schedule. I am still not clear if she was ever loaded or simply started taking the Mitotane. :confused: Of course, it could be that I am just not seeing it. :o;)

However, as Sharlene said, if Savannah was sick with another condition like the staph, the tests to diagnose Cushing's could easily have been skewed providing false positives when it's not Cushing's at all. Cortisol, the enemy in Cushing's, is a natural hormone in our babies, and us. It is one of the fight or flight hormones and will elevate in response to any stress, internal or external. So just because a test comes back showing cortisol higher than normal, that does NOT mean Cushing's in and of itself. It typically takes several tests, done when the pup is otherwise well, to diagnose Cushing's. It is one of, if not THE, most difficult canine condition to correctly diagnose because 1) many things can cause false-positives on the tests and 2) many other conditions share the same signs of excess drinking and peeing, increased appetite, pot belly, etc.

So let's take this one step at a time and see if we can get some things cleared up, trying to nail down the tests for diagnosing the Cushing's first.

You took her in to be spayed and the pre-surgery lab work showed elevated liver values. What were the first test(s) given after this?

Again, the elevated liver values, pot belly, swollen liver, are NOT diagnostic of Cushing's and treatment should NOT be started based only on these things. So there should be initial tests like the LDDS, HDDS, ultrasound, and / or ACTH that she had before starting the Mitotane (Lysodren).

You're doing a good job answering our questions. It's kinda like being back in school, huh? :D In no time you will have a handle on all of this and be talking like a pro!

How is Savannah feeling today?

Hugs,
Leslie and the gang

[molly muffin]

Leslie,

I see that they did do a bile acid testing. These are the results:

5/7/2012

BILE ACIDS 4.4 umol/L 0.0 - 6.9
BILE ACPP 11.8 umol/L 0.0 - 14.9

In both dogs and cats resting bile acids >7 umol/L or post
prandial bile acid concentrations >15 umol/L are suggestive of liver
malfunction but does not indicate the nature of the
abnormality or whether the problem is reversible or permanent.

A liver biopsy may be warranted to further identify the underlying hepatopathy.
Increased bile acids can be seen in diseases affecting hepatic
circulation (i.e.liver shunts), cholestasis, or diseases associated with
hepatocellular damage. Dehydration, hypovolemia, and chronic passive
congestion have only a minor effect on bile acid levels.

A normal bile acid level does not rule out a hepatopathy.

I have also edited my post to add the bile acid results and remarks along with the rest of the test results from the same date.

Sharlene

[savannah]

You took her in to be spayed and the pre-surgery lab work showed elevated liver values. What were the first test(s) given after this?

The first test were in May the ACTH Test

Endocrinology results from IDEXX Reference
Laboratory Requisition ID: 116778 Posted Final
Test Result Reference Range
PRE-ACTH 45.6 ug/dL
POST-ACTH >50.0 ug/dL

Also blood work and bile acid test as seen in above post.

Then she was prescribed the medicine....am I missing something?

[molly muffin]

Nope, you aren't missing a thing. That is exactly what Leslie was asking about. Some people don't realize that they should have an ACTH prior to starting treatment. I'm glad that you did so. It allows you to be able to monitor what affect the medication is having on the cortisol. What loading achieved, and at what point the vet determined if Savannah was loaded or not.

Sharlene and Molly Muffin

[savannah]

So she is really having trouble with the urination problem. It seems every hour or so she has an accident. She is in her heat cycle right now. Her appitite is good, drinks alot of water, spends about 1-2 min at the bowl.

She moves around well, but is a little overweight. She is acting normal and alert. She follows us around and begs for food.

[Squirt's Mom]

Thanks for clarifying and bearing with my feeble old mind. :o:D

[Simba's Mom]

Welcome to you and Savannah, what a cute name. Hope you get some questions answered and some encouragement along the way, settle in and know we are all here for you!!

[Squirt's Mom]

Mornin'!

It looks like this was the last time Savannah had an ACTH -


11/12/2012
L AH Endocrinology results from IDEXX Reference
Laboratory Requisition ID: 116778 Posted Final

Test Result Reference Range
PRE-ACTH 8.0 ug/dL
POST-ACTH 14.5 ug/dL

With a post of 14.5 ug/dL, the cortisol was not controlled at that point and the dose should have been either raised, or a mini-load done. Has her dose ever been changed?

Is there a reason you need to use the liquid Lyso with Savannah? I have to use liquid meds and capsules I can open and empty with Squirt often so I can put them in her feed easier since she is impossible to give pills to the usual way. She will no longer take pills hidden in anything like cheese or pill pockets....she toooo smart for that trick now! :p I home cook for her, thankfully, so the pills she does get are cut up, capsules opened, and put in the feed as well and she will eat that fine. It may be that you will get a more consistent dosing with the pill form VS the liquid form. Just a thought if the pills would work for Savannah. ;)

Either way, you need to contact the vet and let them know she is still peeing a lot and talk to them about a dose increase or reload for her asap to get the cortisol under control. Based on the test in Nov. it is not being controlled on the current dose. Do you remember how long it took her to load...how long she was taking the Lyso twice a day? If she has only had the two ACTHs - one in May of 2012 and one in Nov of 2012, your vet isn't following protocol with monitoring. She should have had an ACTH right after the load, then another one in about 2 weeks after first starting the Lyso to see if the maintenance dose was holding the load. Spacing the ATCHs out between May and Nov isn't good at the beginning of treatment nor when the signs are still present - which indicates the dose isn't right OR the load wasn't complete and maintenance started too soon. Do you know how many Cush pups your vet has treated successfully with Lysodren? If he/she isn't very experienced, something we see quite often and nothing against the vets, then you might think about either changing GP vets or asking for a referral to an IMS (Internal Medicine Specialist). A cush savvy vet is important, almost as important as your knowledge of the disease and it's treatments...something we can help you gain. ;)

Along the lines of education, here is a link about using Lysodren that will tell you how the load should have been done, how monitoring testing should be done, the correct dosing, and many other things.

Lysodren Loading and Tips -
http://www.k9cushings.com/forum/showthread.php?t=181

Please keep talking to us, reading and asking questions. We will do all we can to help you and Savannah get on the right path. Hang in there, Mom! You're doing a good job!

Hugs,
Leslie and the gang

[molly muffin]

Hi. I wanted to check in and see how things are going with Savannah.

Hope that all is well.

hugs,
Sharlene and Molly Muffin

[savannah]

What is a mini reload?

She is not doing well at all. The Skin areas of the hind leg are hairless and have a build up like calcium. All of her paws are now hairless. The pot belly is worse, the urination is 2 to 3 times during the night, water consuption is up and she has very soft stool. Lots of discharge from the eyes.

[Simba's Mom]

Sending hugs and prayers for you and Savannah!!

[frijole]

A mini reload means you continue lysodren, normally for a shorter period of time and you do another acth test to see where you are. It sure sounds like the cushing's was never under control give the last test results (as Leslie said). Please answer her questions regarding when the last acth test was done. We truly can't help you unless you share that info. if the last result was at 15+ then it's no wonder your dog is in pain - the symptoms are out of control because the lysodren dose is either too low or you didn't take long enough to load. Are you familiar with how the drug works? Thanks! Kim

[molly muffin]

Oh Poor Savannah. This doesn't sound good at all and my first suspicion is that her cortisol is not controlled. If it isn't controlled and by that I mean that the post ACTH test needs to be down under 5. It can be as high as a 9 if the symptoms are controlled. Savannah's aren't. Have you been back to the bet to have another ACTH test since the last one in November 2012?
It sounds like she needs to be reloaded and then put on a maintenance dose. I'll let those who are most familiar with Lysodren talk about how that works, but seriously something needs to be done. You must be worried sick and I'm sure little Savannah is not a happy camper right now. Poor baby.
hugs,
Sharlene and Molly Muffin

[Squirt's Mom]

(Sharlene, Savannah is on Lyso so the post needs to be no higher than 5 ug/dl to be considered within a controlled range. ;) )

Sweetie,

Can you fill us in on what has been going on, test results, are you still using the liquid form? What dose has she been taking and how often? Based on the info given of 175mg/ml and a dose of 1/2 (0.50) ml and her weight of 10 lbs - she is not getting enough of the med for the Lyso to do it's job. At 10 lbs, Savannah should be getting 250mg / week of the Lysodren. She is only getting about 87mg based on the info given - not near enough and a huge waste of money and time plus allowing the cortisol to continue to cause damage and even allowing the skin issues to arise and worsen. The skin you are describing sounds like calcinosis cutis and it will only get worse and worse with high cortisol levels. This is a condition that can get very bad very quickly so you must talk to your vet about getting her cortisol under control now.

Has she had another ACTH since you last posted? If so, what were those results?

Did you read the link I posted about Lysodren? Just in case, here it is again - http://www.k9cushings.com/forum/showthread.php?t=181. Share it with your vet so they understand the dose that is required for both loading and maintenance as well as the testing schedule that is required in order to monitor how well the med is working for Savannah.

The more info you can provide the better we can help you. With limited info, our input is limited because we can't see the bigger picture. So please help us see what is going on with your sweet girl. We want to help.

Hugs,
Leslie and the gang

[molly muffin]

Oops, sorry about that Leslie. So with Lysodren, the cushings is completely uncontrolled unless the post ACTH is under 5? No wonder Savannah is having problems at 15 Post ACTH.
Please listen to Leslie and help us to help you with Savannah.

hugs,
Sharlene and Molly Muffin

[savannah]

She is on the meds .05 ml every third day. The vet wants me to bring her in again to retest on Monday.

[savannah]

She is on the meds .05 ml every third day. The vet wants me to bring her in again to retest on Monday.

Mistyped, should have read .5 ml every third day.

[savannah]

(Sharlene, Savannah is on Lyso so the post needs to be no higher than 5 ug/dl to be considered within a controlled range. ;) )

Sweetie,

Can you fill us in on what has been going on, test results, are you still using the liquid form? What dose has she been taking and how often? Based on the info given of 175mg/ml and a dose of 1/2 (0.50) ml and her weight of 10 lbs - she is not getting enough of the med for the Lyso to do it's job. At 10 lbs, Savannah should be getting 250mg / week of the Lysodren. She is only getting about 87mg based on the info given - not near enough and a huge waste of money and time plus allowing the cortisol to continue to cause damage and even allowing the skin issues to arise and worsen. The skin you are describing sounds like calcinosis cutis and it will only get worse and worse with high cortisol levels. This is a condition that can get very bad very quickly so you must talk to your vet about getting her cortisol under control now.

Has she had another ACTH since you last posted? If so, what were those results?

Did you read the link I posted about Lysodren? Just in case, here it is again - http://www.k9cushings.com/forum/showthread.php?t=181. Share it with your vet so they understand the dose that is required for both loading and maintenance as well as the testing schedule that is required in order to monitor how well the med is working for Savannah.

The more info you can provide the better we can help you. With limited info, our input is limited because we can't see the bigger picture. So please help us see what is going on with your sweet girl. We want to help.

Hugs,
Leslie and the gang


You said she is only getting 87 mg per week, but she gets it every third day so that would be 262.50 per week roughly a little less since it is every third day, right?

[Squirt's Mom]

Yes, if she's getting that much then the dose would be in range.

[savannah]

Took my girl in this morning for a acth test. She also had blood work done. Her liver counts were 1300! The vet said maybe she has liver disease on top of the cushings, but will have to wait untill the acth test come back to see if the counts were too hig because of the cushings not under control.

She also has hair loss on all of her paws, pink skin, some hard custy like build ups on her hind quarter, and patchy hair loss. I mentioned I read on this site that CC was a sign of the cushings and it had happened before, but after starting the meds (lydicin) it grew back for a few months, now is back.

He said the hair loss doesn't appear to be CC because the skin is pink were the hair loss is, not white.....all the pictures of cc on this form the skin looks pink to me. He also said that liver disease will cause hair loss to mimic cc....any info would be appreciated.

[frijole]

1300 is not at all unusual for a cush dog. Some of us have had dogs at 1800 or 2000. 1300 does not mean liver disease. I'll let those that have dealt with CC skin issues answer your question about the pink skin.

From what you described the problems are probably just that the cushings is not 'controlled' (cortisol not yet lowered enough). Kim

[savannah]

Here are her results of the AHTC test done yesterday:

Pre 8.3 Post >50
Doctor said test will not show actual number if over 50

She is on liquid, doctor said the pills only come in 500 mg nothing smaller, is that correct?
Thanks

[Squirt's Mom]

Yes, the tablets are 500mg. At 10lbs, Savannah weighs 4.54 lbs. The loading dose of Lyso is 50mg/kg/day divided into two doses, AM and PM. So Savannah would need 227 mg (rounded up to 250mg) a day to load with the pill form, which would be 1/2 pill per day. The maintenance dose would then be 1/2 pill a week divided into at least two doses per week. So her size does not mean she has to use the liquid form. ;)

[savannah]

He said he wants her to have 50mg a day, so would have to divide pill by 1/10th and it is not fesable....Thoughts?

[Squirt's Mom]

50mg a day would be the dose for a 1kg or 2.2 lb dog, not a 10lb dog. The dose of Lysodren is 50mg per kg. Savannah weights 4 1/2 kg so she needs 4 1/2 times the dose your vet says he wants her on.

[savannah]

Do you know what that would translate into ml for the liquid?
Thanks

[Squirt's Mom]

Liquid meds are listed as so many mg per ml and that could be any proportion. The mg to ml amount is listed on the bottle, tho, and will tell you how many mg of Lysodren are in each ml. It will say something like 50mg/ml.

[savannah]

175 mg/ml
She weighed in at 7.5 lbs

[Squirt's Mom]

Ah...she's lost weight? I thought I read she weighed 10lbs. At 7.5 lbs that would be 3.41kg. Then 3.41 x 50mg = 170.5. So one ml with 175mg of Lysodren per ml would be the right dose for a 7.5lb pup. :)

[savannah]

1 ml how offen?

[Harley PoMMom]

175 mg/ml
She weighed in at 7.5 lbs


1 ml how offen?

For a loading dose her dose should be 170 mg SPLIT and given twice a day, so by my calculations, she should get 85 mg twice a day. Since the liquid form is 175 mg/ml, this needs to split into two doses, 1/2 ml 2 times a day.

Love and hugs,
Lori

[frijole]

Here are her results of the AHTC test done yesterday:

Pre 8.3 Post >50
Doctor said test will not show actual number if over 50

She is on liquid, doctor said the pills only come in 500 mg nothing smaller, is that correct?
Thanks

Can I ask if you are in the US or Canada? I'm just checking as the results would NOT be cushings if outside the US and I have never ever seen a 2nd reading over 50 (or 30 for that matter)... that seems very high. Kim

[savannah]

Can I ask if you are in the US or Canada? I'm just checking as the results would NOT be cushings if outside the US and I have never ever seen a 2nd reading over 50 (or 30 for that matter)... that seems very high. Kim

Wisconsin, and even my vet said he had only seen that result one time. We are going to give 1/2 ml twice daily for ten days on the advise of our doctor. Hope it works.....

[molly muffin]

I'd be interested to know, did your vet say anything about the other occurrence of seeing a post result like that?
One thing it Does explain is why you are seeing the skin issues still.

Do let us know how things go and of course you can always check in with our lyso group who have been there done that before. :)

hugs,
Sharlene and Molly Muffin

[Squirt's Mom]

Did the vet give you prednisone? If not, call and ask for some this morning. You need to have it on hand just in case of a crisis and you can't get Savannah to the vet quickly.

Giving the Lyso twice a day is called loading. The twice a day dosing is correct for a loading dose - however the 10 day thing may not be. It isn't how long the load lasts it's when the dog tells you they are loaded that you stop giving the Lyso. Some pups will load in 2-3 days, some take much longer. Have you read the link on Lysodren that gives tips on what to look for that tells you the load is probably achieved? Just in case here it is -

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

Read this, print it out, and put it somewhere so it is easily visible during the load.

Signs that indicate the load is achieved can be very subtle - like not gobbling food, or looking up from the feed bowl, pausing in eating for a second when they didn't before, a decrease in water intake - if you see any of these signs, stop the Lyso and call for an ACTH to see if she loaded. If she is, then you will wait a few days and start the maintenance dose which will be given 2-4 times a week, not daily. You will use the same dose you are using for the load, 175mg, but you will divide that over the week. Like 1/4 ml Mon, Wed, Fri, and Sun, or Mon, Wed, Sat, or Mon and Thurs....

Watch Savannah for loose stools / diarrhea, nausea / vomiting, lethargy, loss of appetite - these things indicate an overdose and the Lyso must be stopped immediately and an ACTH given asap.

You are doing a great job of asking and working for understanding...and it sounds like you had a talk with your vet about how this is supposed be done. ;) Good for you, Mom! We have to be our babies voice because they cannot speak for themselves. So we educate ourselves in order to be the best advocate for them we can possibly be. Keep up the good work!

We are here anytime you need to talk or ask questions.
Hugs,
Leslie and the gang

[savannah]

Is the ATCH Test done at the end of the loading process?

My doctor said after 10 days we should just switch to maintenance dose. What is the predisone for? What are the signs it is needed?

She has a very loose stool right now, she is on Science diet Light, she seems to bloat real bad on other food. I do not want to switch her food right now, think I should wait untill after the loading.

We started the load today, we are measuring her water intake closely.

[Squirt's Mom]

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


Here are the Lysodren loading Instructions from the chapter on Hyperadrenocorticism in the Textbook of Veterinary Internal Medicine, S. J. Ettinger and E. C. Feldman, editors. 1995

Quote:
INITIATING THERAPY - THE LOADING DOSE PHASE:

Therapy is begun at home with the owner administering Lysodren at a dosage of 50 mg/kg/day, divided and given BID (twice a day).

Glucocorticoids (prednisone) given together with the Lysodren is not advised during loading, but the owner should have a small supply of prednisolone or prednisone tablets for an emergency.

The owner should receive thorough instructions on the actions of Lysodren and should also have specific instructions on when the drug should be discontinued.

Lysodren administration should be stopped when:

1. the dog demonstrates any reduction in appetite; this might mean just pausing slightly during meal consumption, stopping to drink some water, or stopping in response to the owner's voice.

2. the polydipsic dog consumes less than 60 ml/kg/ day of water.

3. the dog vomits.

4. the dog has diarrhea

5. the dog is unusually listless.

The first two indications for stopping the medication are strongly emphasized because they are common and they precede worrisome overdosages. The occurrence of any of these signs strongly indicates that the end point in induction (loading) therapy has been achieved.

Because of the potency of Lysodren, the veterinarian is encouraged not to rely on the instructions given to an owner. Never provide the owner with more than 8 days of Lysodren, initially. This drug is highly successful in eliminating the signs of hyperadrenocorticism because of its potency coupled with close communication between owner and veterinarian. Either the veterinarian or a technician should contact the owner for a verbal report regarding the dog every day beginning with the second day of therapy. In this way, the owner is impressed with the veterinarian's concern and the need to observe the animal closely.

It is wise for the owner to feed the dog two small meals each day, as previously described. The dog's appetite should be observed prior to each administration of Lysodren. If food is rapidly consumed (with or without polydipsia), medication is warranted.

If food is consumed either slowly or not at all, medication should be discontinued until consultation with the veterinarian.

Usually the initial loading dose phase is complete when a reduction of appetite is noted or after water intake approaches or falls below 60 ml/kg/day.

The water intake in polydipsic dogs may decrease to the normal range in as few as 2 days or take as long as 35 days (average is 5 to 9 days) Owners must continue to monitor the water intake daily until it falls to or below 60 ml/kg/day. Usually the water intake diminishes within days of beginning treatment, but it does not usually become normal until after some reduction in appetite is observed.

A small percentage of dogs demonstrate mild gastric irritation or systemic signs of illness from the Lysodren 1 to 3 days after medication has been started. These signs include anorexia, vomiting, diarrhea, weakness and lethargy.

If any of these signs are observed, the medication should be discontinued until the veterinarian can evaluate the dog. If the signs are the result of drug sensitivity and not because the treatment is complete, dividing the dose further may be helpful; discontinuing the medication for a few days may be necessary.

It is recommended that treatment be initiated on a Sunday, so that if illness develops after a few days, the veterinarian should be available during the regular work week rather than on a weekend.
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.

To calculate your dog's weight in kg, divide the weight in lbs by 2.2 (example: a 22 lb dog weighs 10 kg)

Once the dog is successfully "loaded" (also called "induced") the maintenance phase of treatment will begin. The maintenance dose is usually 25 to 50 mg of Lysodren per kg of the dog's weight per WEEK (25-50 mg/kg/week) and can be given in divided doses. Example: 500 mg Lysodren per week can be given as 250 mg twice a week, or 375 mg per week could be given as 125 mg three times a week etc. The entire weekly dose is often the same amount as the dose per day that was given during the loading phase.

The weekly maintenance dose is usually determined by weight of the dog, but the Vet will also take into account how quickly the dog becomes successfully loaded, which may help to indicate the particular dog's sensitivity to the Lysodren. A dog that loads in 3 days might be started on a lower maintenance dose than a dog who took 10 days to load, for example.

The recommended target range for good control of the cortisol production is a result of 1-5 ug/dl for both the pre and post ACTH stimulation test numbers. An ACTH stimulation test is done as soon as it is suspected that the dog is loaded, to confirm if a successful loading has been achieved. An ACTH stim test is done again after a month of giving the weekly maintenance dose and another ACTH stim test is performed after three months of maintenance therapy, to be sure that the weekly maintenance dose of Lysodren is correct for the individual dog. An ACTH stim test should then be performed every 4 to 6 months to monitor the cortisol production and to determine if any dose changes may be needed along the way. Any changes in the dog's eating or drinking habits or behavior should be reported to the Vet immediately and an ACTH stim test will likely be needed to check the dog's cortisol levels and to see if the dose needs adjusting.

----------------------------------------------------------------

A collection of "tips" from our members and their Vets:

...



See more very important information at the above link. ;)

[savannah]

Day one of the mini load:
She recieved .5 ml morning and night.
Her stool is better

She slept through the night, only getting up at 7 am to go outside, first time in a month!

She drank 3/4 cup of water yesterday.

[Squirt's Mom]

Sounds good! You're doing a good job of watching her! Let us know how she is doing!

[savannah]

We are in day 8 of the load, things are worse. She is uranating every hour, and even on the bed which she hardly ever did. How long should the load take? Water consumption is up to 1 cup a day!

[Squirt's Mom]

This is not the direction things typically take tho we have had several pups who apparently read the rulebook then did all they could to act just the opposite. :p How is her appetite? Any change in that area? Any other changes you have noticed since starting the load? Are her stools the same?

I think if it were me, I would withhold the Lyso starting tonight then call the vet in the morning and ask for an ACTH Fri afternoon...that will allow the Lyso to be reaching it's peak performance.

[savannah]

Stools are solid now, her appetite has decreased slightly, she will eat half of her food, then pause to see what we are eating, then resume.

[frijole]

Great news. This is signed that you are loaded which means QUIT GIVING LYSODREN and call the vet to schedule an acth test. Note this drug keeps working for 2 more days so you will see more changes even though you aren't giving the drug so keep on the look out. Again - no more lysodren - go get the test done. The hard part is over. Kim

[Squirt's Mom]

Have you stopped the Lyso? It is critical that it be stopped now if you haven't. ;) Is the ACTH scheduled for tomorrow afternoon? Sat would be good, too, if your vet is open then. You don't want to wait until Mon for the ACTH because the Lyso will have started to decrease by then and the cortisol could be creeping back up past the loading point, making it look like she still isn't loaded when she may well be. So get that ACTH scheduled this morning for either Fri afternoon or Sat morning.

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

[savannah]

Called the vet, he wants me to continue with the load until the 10th, Friday night, then test her on Tuesday.....
She must have urinated 20 times yesterday. Got us up three times from midnight until 8 am to go outside.

[Simba's Mom]

Hoping Savannah feels better soon and gets on the right dose for her!

[savannah]

Also we are seeing alot of discharge from her eyes. Its like a white to cream color thick goo...is this normal in cushings dogs?
Thanks

[molly muffin]

Not that I know of it isn't normal. Have you told the vet about the discharge?

Sharlene and Molly Muffin

[Squirt's Mom]

How is Savannah acting today?

[savannah]

She is doing good, 2 times last night up for water and outside.
She didn't finish all of her food this morning, ate all but a couple of pieces. I called the vet and rescheduled the ATCH Test for Monday Morning. He told me to stop the medication twice a day, but give her .5 ml Sunday afternoon, then none Monday Morning.

He also said the discharge from the eyes could be allergy, have a wellness exam for Monday also.

[molly muffin]

Oh Savannah is a real cutiepie. So glad you added the avatar. I love that picture. The ball is almost bigger than she is. :)

hugs,
Sharlene and Molly Muffin

[Harley PoMMom]

She didn't finish all of her food this morning, ate all but a couple of pieces. I called the vet and rescheduled the ATCH Test for Monday Morning. He told me to stop the medication twice a day, but give her .5 ml Sunday afternoon, then none Monday Morning.



Lysodren will continue to work for 48 hours after the last dose was given. Since you are having an ACTH stimulation test done on Monday the Lysodren should only be given today (Friday 5/10) and not Sunday.

If the Lysodren is given on Sunday and the ACTH stim test is performed on Monday, the results will reflect a higher post and this has to be taken in consideration.

Love and hugs, Lori

[savannah]

So I do not listen to my vet and do not give her any meds on Sunday?

[Squirt's Mom]

Please. ;)

[frijole]

Chiming in to agree - no reason to give it on Sunday. If you do it skews the results. You got a little doggie and this is a wonderful dog when used properly but when protocols aren't followed (ie how the drug works and should be dosed) then problems can occur. I used it almost 5 years with my Haley. Been her 8 years now. Yep - we are right - no more lysodren.

It's purpose is to reduce the amount of cortisol your dog produces and it erodes the area that produces it. It's a delicate balance because you don't want to erode too much. So you dose daily until you see changes like you mentioned (reduction in water/pausing while eating) and you stop to have the acth test.

This test measures cortisol and you want the test result (2nd number on it) to be between a 1 and a 5. If it's too high you keep giving daily lysodren like before and if it is BETWEEN 1 and 5 you go to weekly dosing vs daily dosing. But you must wait until AFTER you get the test results back because the results tell you what the next step is.

Your vet's instructions indicate to me that he/she doesn't have a ton of experience with it. Read up on it and you will see we are right.

:)

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

[savannah]

I am really starting to second guess my vet. We have used them for years, several dogs, but it seems like they are struggling with this one. They didn't have time to look at her last visit, she has very large bumps on both sides of her neck like around the jaw. I think they are some type of noids?
Her hair is not growing back at all, the scabs are drying and bleeding all the time.

Anyone know of a good vet in the Southern Wisconsin area let me know.
Would it be ok to start another thread asking for recommendations on a vet?
Thanks everyone......

[Squirt's Mom]

Yes, we like to keep all info about each pup in one thread so you would ask any questions concerning Savannah here in this thread. Here is a link that will help you search for a vet and I'm sure if anyone here has a recommendation, they will be glad to share.

www.acvim.org

It is not uncommon for us to find that our wonderful, loving vet of many years has no clue how to diagnose and/or treat Cushing's. This is a sneaky, tricky disease and the drugs used to treat it require keeping up with recent studies. In addition, just because the last pup they treated with Cushing's did well that does not mean the next pup will do well with the exact same treatment so this is a rather frustrating disease for some vets. And then they are not used to parents like us who demand the very best, who take the time to learn about Cushing's so we know what should be done and what shouldn't, and who actually go to all the "trouble" to treat. So don't be too hard on your vet but I do think you are right - he is over his head on this one. His whole approach is questionable in my mind. Lysodren has been in use for a long time and the way it is supposed to be used has been established by endocrine experts...and their method works for most pups. ;)

If you have a good relationship with your vet, you might ask him to research Dr. Edward Feldman and what he has to say about how to use Lysodren...and tell your vet that is how you want Savannah handled. I used to be too timid to confront a vet about anything - they are the experts, right? But that doesn't mean they are infallible or that they know everything - especially about this disease. Since Squirt was diagnosed and I have seen some terrible things happen as a result of vets who refused to follow protocols I no longer hesitate to speak up. My baby cannot speak for herself so it is up to me to learn what I can on her behalf and fight for her when needed based on that knowledge. I failed to do that recently with a drug that was prescribed to her and she paid a very high price. So you keep talking to us, keep reading threads and links we provide, learn all you can so you can be the best advocate possible for Savannah.

How is she today?

[savannah]

She got her last dose last night. She was shaking or trembling last night in her sleep. She seemed very restless, would not lay down. She ate her food slowly this morning, but did finish it. She still got up twice last night to drink water, and seemed a little confused, but did go outside. This morning she seemed ok....

[Squirt's Mom]

Watch her very, very closely over the weekend. The Lyso should have been stopped the day she hesitated in eating but your vet had you continue and I am concerned that her cortisol could go too low over the next two days. Remember, Lysodren continues to build up and work in their system for two days following the last dose. ;)

If you see nausea/vomiting, loose stools/diarrhea, listlessness/lethargy, loss of appetite, get her to your vet or, preferably, to an ER clinic with an IMS on staff ASAP.

Do you have prednisone?

[savannah]

Good to know, also if this happens we give her the predisone?

[Squirt's Mom]

Prednisone is used when the cortisol goes too low. Ideally you will get her to the vet but that isn't always possible and sometimes we need to act very quickly so we give the pred. The pred will act as a replacement for the cortisol if the Lysodren has gone too far and made the adrenals stop working, hopefully a temporary condition if it does occur.

Do you have prednisone?

[savannah]

Yes we do.....so the signs are as you listed above...

[Squirt's Mom]

Yes, those would indicate her cortisol is too low. The first option is to get her to a vet asap. Second if the first is not optimal is to give the prednisone. Were you told how much to give her the pred in case of a crisis?

The rescue dose is 0.25mg/kg. To find Savannah's weight in kgs you would divide her weight in lbs by 2.2 and that will give you her weight in kg. Then you take that answer and multiply it by 0.25 to get the dose of pred she would need. For EXAMPLE - a 15 lb dog weighs 6.818181...kgs (15 / 2.2 = 6.818181...) That would be rounded to 6.82kg. Then you multiply the 6.82 x 0.25 = 1.7mg of pred for a 15 lb dog (if my math is right - NOT my strong suit! :D ).

[frijole]

Your dog is showing signs of loading which is great but no more lysodren please. I think you said last night was it. Like we've said it will keep working and eroding the area that produces cortisol.

Do not give the prednisone unless you are concerned for her - as in for her life - when cortisol goes too low they are so lethargic they can't stand or hold head up. You have it on hand in the event it happens when you can't get to a vet. But don't give it unless things get serious - as it will affect the tests you have scheduled for Monday (if i remember right). The tests would be skewed as the prednisone will raise the cortisol reading.

So just keep an eye out and report in and one of us will be here to answer questions. If it's serious don't hesitate to go to the ER. Kim

[molly muffin]

Hang in there. Luckily we have some people here who are very familiar with Lysodren and have used it for years, such as Kim and Leslie, and there others.
We'll all be hoping for a good weekend and a good ACTH test on Monday.

hugs,
Sharlene and Molly Muffin

[frijole]

I forgot to mention... she is as cute as a bug. Adorable little girl. Kim

[savannah]

Well had the test done this morning. Will have results tomorrow.
She also has dermatitis or mange. The vet put her on antibiotics and sent shampoo home.

He said if the results are still high after loading, we are out of options for treating the cushings. That seemed like a drastic statement to me!

[Squirt's Mom]

Honey, I would seriously be looking for another vet. geez...there are options left including using Lysodren correctly. My word. :rolleyes:

[Budsters Mom]

I don't know anything about Lysodren, as Buddy is on Trilostane, but your doctor's comment was uncalled for!:mad: We don't give up, he shouldn't either! There is always something to try, no matter what meds you use. That statement makes me furious!!:mad: Stick with us, we never stop trying to find solutions. :)

Hugs,
Kathy and Buddy:cool:

[savannah]

Thanks I almost lost it when I heard him say that. I wish I could find another vet in my area, but everyone I have talked to will not recommend anyone for cushings. I find it hard to believe no one in my area has any experience with this disease!

Her feet are all red and swollen, she has lots of discharge from her eyes, and the scabs are off and on bleeding....

[frijole]

Get the test results, get a copy of the test results and everything else that vet has done and walk.. NO RUN.. from there. That is ridiculous. My dog took forever to load as in 3 months and once she did she was fine for 4 1/2 yrs. That vet is full of it.

If you tell us what part of the US you are from we might be able to help. GRRRR I'm mad for you. Hang in there. Kim

[doxiesrock912]

Your vet is full of poop dear.
Not once, has any of the vets that we saw doomed Daisy :(

Please find another vet, and it's best to see an IMS specialist.


Could she possibly have allergies? With the skin issues being this bad, I would want to know for sure if something else wasn't at work here.

[savannah]

I wonder about the allergy thing to, do dogs get seasonal alergies?

I am in Southern Wisconsin, just called two more vets, they are not very experienced with cushings.

When you say it took three months, how did you do it? Did you stop the meds for 48 hours have a test then continue the load?

[Budsters Mom]

Yes! Yes! Yes!

They absolutely, positively do get seasonal allergies! Buddy is bothered by them, among many other allergies. SPRING BEING THE WORST TIME OF THE YEAR FOR HIM!!!

Hugs,
Kathy and Buddy:cool:

[Squirt's Mom]

Here is a list of specialists in WI - you will want to look at those listed as SAIM (Small Animal Internal Medicine)

http://www.acvim.org/PetOwners/FindaSpecialist.aspx

If none of these are feasible for you, they might could at least suggest a GP vet closer to you.

As for seasonal allergies, yes they are possible in dogs. If the irritation is mostly on the feet, face, legs, and/or belly then grasses/weeds are a first thought. The eye discharge could be from pollen in the air. Allergies are soooo hard to pin down in our pups so trial and error is usually the route we use, eliminating things we can one at a time, slowly, to see if anything changes, as well as things like looking at the products we use to clean and wash, keeping the windows closed during high pollen times of the year, and wiping them down when they come in from outside. Sometimes a regular dose of something like Benedryl helps. I have a list of OTC human allergy meds if you'd like to try something other than Benedryl - tho there is nothing wrong with trying that first. ;)

I'll let Kim share her experiences with you but if the numbers for Savannah come back still too high, then you simply resume loading usually at the same dose as before. I will be surprised if her numbers are still high, tho it wouldn't be the first time I've been surprised here! :D

[savannah]

I get this even if I just put in wisconsin to search.....


No Records Found

No records were found that matched your search.

[Harley PoMMom]

I got 2 pages when I searched. I found that you only have to put in the State, not the Country, only the State you want to search in.

Try again with only putting in Wisconsin, and if still shows no record found, I will type in a word doc. what I found, ok?

[Squirt's Mom]

Weird...the link I was trying to post has a two page list of specialist in Wisconsin but when I click the link, it takes me to the page where you search instead of the list. :confused:

On that search page, all I entered was the space for the state - Wisconsin - and it brought up two pages. I just tried it again and got those two pages again. Wonder if it is something with your privacy settings? I'm a techno idiot so I won't be much help if it's something to do with your computer settings. :o

[molly muffin]

Oh my goodness. What a thing to hear from your vet. If you don't get the 2 pages of results, then Lori will do the .doc. (if you don't have time Lori, let me know and I'll do it. I'm off work for the day now) One of these specialist Should be able to help you.

Have you tried Benadryl for the allergies? Also one of our members is now using booties for her dog to walk in grass, so that's another idea.

Hang in there!!!!
hugs,
Sharlene and Molly Muffin

[savannah]

Works now in IE will not work with Firefox, no one within 75 miles, but maybe will have to drive further...

[frijole]

I wonder about the allergy thing to, do dogs get seasonal alergies?

I am in Southern Wisconsin, just called two more vets, they are not very experienced with cushings.

When you say it took three months, how did you do it? Did you stop the meds for 48 hours have a test then continue the load?

We would go until I thought I had seen signs of loading or until we just got nervous and we'd do an acth test. You always stop not only for the 48 hrs but you have to wait til the results come back so you might have to wait 5 to 7 days. If they are loaded you start maintenance usually 7 days after the last loading dose. In my case when she wasn't loaded we normally increased the dosage a bit and carried on and repeated... we did this like 5 times and no one here could believe she wasn't loaded. She just took longer and her final dose was like more than twice the highest recommended amount. But she never ever went low after we got that load so it was well worth it. She passed away at 16 1/2 yrs and not from cushings... just from old age.

So hang in there. Not all dogs follow the rules. :D Kim

[molly muffin]

Works now in IE will not work with Firefox, no one within 75 miles, but maybe will have to drive further...

It could be that if you can go to see a specialist and take copies of all of your tests, (so they don't have to redo what you've already done) they can get Savannah set up and then your regular vet can actual do the tests and send the results to the IMS, and work With the specialist. You'd have to make the trip sometimes, but not all the time. We have had several members who have had to do long trips to get to a specialist, and then work with their local vet for regular stuff.

Perhaps the Specialist can even recommend someone local to work with you that they might have worked with before. That is a possibility too. All of these are options for you to consider.

First though, lets see what those test results show. If they show high, then you can always tell the vet, that this is what you want to do next, or that you would like to up the dose (a bit only) and then try reloading and that you want to do that until she Is loaded. Kim is an excellent example of how not all dogs follow the rule books or even know there Is a rule book. :)
We have another one who has had a heck of a time loading on the forum too. I just want you to know that you are not alone. :)

Hang in there! You are doing great.
hugs,
Sharlene and Molly Muffin

[doxiesrock912]

It's worth the trip. Once you find a specialist that suits your needs, most are quite willing to advise your GP vet and then they work together. It's a win - win!

[savannah]

Test results from Monday after 10 days loading with last two days no meds, then stim test:

Pre 4.8 Post 16

Previous test 2 weeks ago

Pre 8.3 Post <50

So we are getting there. Vet says to give her .5 two times a day for three days Tues, Weds, Thursday, then Fri and Sat give her 1 dose of .5, then retest on Monday.

Thoughts?

I think it should be 2 doses morning and night with last double on Sat night, no dose Sunday, test Monday.

Last time we stopped meds on Friday night, tested Monday morning.
Thanks

[frijole]

:D Its good to have a plan but always remember that dogs don't 'load by demand' meaning the vet is just guessing when it'll happen so what he's saying is give it a try for 3 more days and then come back in.

You went from <50 to 16 in 2 weeks so that is good. But you have no idea if 3 days will do it. Protocol says to give the drug and look for changes in eating and drinking and then stop giving it and schedule the test.

I would go with what he suggested BUT if you find out after 2 days that you see changes in the poop (it gets softer headed towards diarrhea as you load), the way she eats or water intake then you always stop giving lysodren and schedule a test - in other words if you see change stop giving it and schedule a test.

The opposite is true as well - if there is absolutely no change between now and Thursday I would give a full dose on Friday to see if you have any results. And if no change I'd give a full dose on Saturday. Or if you aren't defiant like me then you call the guy up and you say "I've seen no changes so I want to dose a few more days". If you keep stopping after 3 days you'll spend a fortune on testing. You just have to watch for signs of change and like I said perhaps that happens before this weekend but we have no way of predicting.

So you just worry about giving the dose tomorrow and check in. Then the same for the next day ok? We'll walk you thru it. You are doing fine. Kim

[savannah]

Thanks Kim,
She is hard to tell about the loading. She actually has been drinking less, not gorging down her food, but the test say she is not loaded.

[Squirt's Mom]

Sounds good other than the reduction in dose. The established way to do this is to give 1/2 ml twice a day then test - you don't change doses during a load. ;)

[frijole]

Sounds good other than the reduction in dose. The established way to do this is to give 1/2 ml twice a day then test - you don't change doses during a load. ;)

??? Did she say the dosage was reduced???? I went back and looked and thought it was the same. Leslie is right - you do not change the dosage! Keep on the same path you were on or you will never get loaded - trust me on this one. If he lowered the dosage when cortisol was high he is way over his head. Please trust me - Kim

[Squirt's Mom]

Vet says to give her .5 two times a day for three days Tues, Weds, Thursday, then Fri and Sat give her 1 dose of .5, then retest on Monday.

The bold part is what I was referring to. ;)

[frijole]

The bold part is what I was referring to. ;)

Whew OK... yeah he tried to get her to do that the last time too and I don't know why. I think he's afraid of the drug but it's a guess. ;0

So I stick with my recommendation in my earlier post. I was afraid he lowered the daily dosing for the first three days.

This reminds me... when Haley was first diagnosed like 9 yrs ago the vet was so clueless. She told me to give her 1/2 a pill for 3 days and then 1 a week after that or some such thing. She didn't mention acth testing at all! :eek: I had just found this board so I wasn't sure whom to trust but everyone here made it clear that the vet was lost in space and I had a list of questions... and I went back and sat down with her. Oh boy... I asked about acth testing and she didn't even know what it meant I could tell. she said she'd have to consult with her "IMS" and I said who is that? And she said "she works for the lab IDEXX" and I knew then it was a lost cause. So I moved on and never looked back.

So you aren't alone ! If we can get you loaded it's just a matter of maintaining and even clueless vets can do that. :D:D:D:D Hugs, Kim

[savannah]

Sometimes a regular dose of something like Benedryl helps. I have a list of OTC human allergy meds if you'd like to try something other than Benedryl - tho there is nothing wrong with trying that first.


What is the dosage of liquid benedryl?

[frijole]

I don't know but I googled and there were all kinds of warnings about different strengths of it and to be sure you knew which strength you had. I know there is a childrens version... anyway.. a word of caution to double check any free advice you get. You got one tiny baby so it should be a tiny dose. :) Kim

[Budsters Mom]

Benadryl children's liquid should be avoided as it has a children's flavoring in it, which is not good for dogs. I use tablets for Buddy, but he weighs 16 pounds not four. He takes one half of a tablet. It would be wise to check with a vet regarding you baby's dosage, since she is so tiny. It is normally 1 mg. per pound. Benadryl does act as a sedative, so you don't want to overmedicate her.

Hugs,
Kathy and Buddy:cool:

[Squirt's Mom]

From Veterinary Specialty Hospital -

Benedryl - 25mg capsules or scored caplets/tablets
Dose - 2.2 mg/kg every 8-12 hours

To find how much Poppy weighs in kilograms (kg) you divide her weight in pounds by 2.2.

If you want to try a liquid, be sure to contact the manufacturer and ask if their product contains Xilitol - a sweetener that is toxic to our babies and is now in many, many liquid drugs.

Do talk to your vet about starting this or any other med, herb, supplement. ;)

[savannah]

From Veterinary Specialty Hospital -

Benedryl - 25mg capsules or scored caplets/tablets
Dose - 2.2 mg/kg every 8-12 hours

To find how much Poppy weighs in kilograms (kg) you divide her weight in pounds by 2.2.

If you want to try a liquid, be sure to contact the manufacturer and ask if their product contains Xilitol - a sweetener that is toxic to our babies and is now in many, many liquid drugs.

Do talk to your vet about starting this or any other med, herb, supplement. ;)

2.2 mg per pound???

[Harley PoMMom]

It would be 1 mg per pound of a dog's weight. For Savannah's weight of 10 lbs, she would get 10 mg.

[Squirt's Mom]

2.2mg/kg is read as 2.2 milograms per kilogram. ;) Learning a whole new language, huh? :D

[savannah]

Update.
So we gave Savannah the meds .5 twice a day Monday, Tues, Weds, Thursday morning she lost interest in eating, she only got one dose Thursday morning, she did not get one at night because she would hardly eat. She is shaking a little, not drinking much and only went out once early this morning to pee.

Question should I stop with the meds, and test her Saturday if they can see her? I am scheduled for Monday morning.
Is it ok to give her some can food? She will take toast bites, and is still interested in what we eat, but not her food.

[frijole]

You did great! No more drugs for now - time for the acth test. 48 hrs from the last dose is when? If the last dose was TH morning then Saturday would be perfect. Waiting until Monday would mean the cortisol would creep up a bit so ideally Saturday. If you gave her drugs today then Monday is fine.

Regardless no more until you get the acth done.

As to eating - yes just don't give her anything that is fatty because it makes them vomit. If she vomits you won't be sure if it's from an overdose or from people food... so keep it bland like toast, white rice, white chicken in small quantity. Congrats!!!! Kim

[savannah]

Now I am confused, I gave her a little mighty dog canned, and she scarfed it down fast.

She is usually on Science Diet small bites. Tried to give her some of that after the other and she is not interested in it.

Now could she not be loaded?

[Squirt's Mom]

No....what Kim was saying was that you don't want to give her anything that might make her vomit because vomiting is a sign that her cortisol has gone TOO low. You do not want to change anything right now so there will be no confusion what so ever should you start to see signs that could mean her cortisol has dropped too low.

The only thing that could cause her to lose the load is waiting too long for the ACTH and waiting too long to start the maintenance phase. Right now the important thing is to watch her closely for any indication the cortisol is too low - loss of appetite, loose stool / diarrhea, nausea / vomiting, lethargy.

[frijole]

Leslie I think what she is saying is "dang it she didn't eat so I thought she was loaded and stopped giving lysodren and now she scarfed down a meal so is she loaded?"

That is the 50 million dollar question. What I want you to do is go out with her every time she goes out to potty and watch her poop. Be on the look out for soft poop and report back here. :) Also tomorrow morning feed her the food you fed her tonight. Only you can know if there are changes in eating habits. So if you feel she is hesitating or eating more slowly then continue to withold lysodren. If you doubt she is you have to decide if you want to give her another dose. It's totally up to you.

YOu have prednisone on hand in case of emergency I believe. You have to continue to watch every poop for changes otherwise you wouldn't know if she has diarrhea. That is a sign of overload.

Sorry i can't tell you exactly what to do. When in doubt keep asking more questions. Kim

[Squirt's Mom]

Leslie I think what she is saying is "dang it she didn't eat so I thought she was loaded and stopped giving lysodren and now she scarfed down a meal so is she loaded?"

aahhhhh....I read it as she was afraid eating something different had caused Savannah to lose the load. Communication can be tough in writing for an old broad! :D

[savannah]

She went in this morning for the test, results will not be in till Mon or Tues....do I give a maintenance dose today? She last had the dose on Thursday night. The vet did not say, I forgot to ask, now they are closed.
Thanks

[Squirt's Mom]

No, no meds until you get the test result back and see if she is actually loaded or not. Until then, ya'll get a bit of a vacation! :D

[frijole]

Leslie is right. If she's loaded you typically do not start maintenance until one week from the day of the last dosage.

If she is not loaded then you keep on doing what you've been doing and test again.

Fingers, toes, and eyeballs crossed! :D Kim

[savannah]

Another question, we are having a terrible time with the sores on her skin. They keep drying out and bleeding. We are using the prescription shampoo three times a week, but is there some type of lotion we can use on them? She has a cone on so its not her getting at them.

[doxiesrock912]

Another member is trying Manuka honey, applying it directly to the sores I believe.

[frijole]

Are the sores calcinosis cutis? It is found often in cush dogs. Here's a photo of one members doggie:

http://www.k9cushings.com/forum/album.php?albumid=662&pictureid=4952

I believe it requires special treatment. Others with more experience in this area can chime in!!

I use a product called Vetericyn VF wound and infection treatment - hydrogel spray and it is the fastest healing stuff I've ever seen. I bought it for Annie but still have the bottle. Last week I cut my hand while doing yardwork - like a slit. I sprayed a bit on the slice and within 24 hrs it was already healing. You can google to see if you think it'd help.

Kim

[savannah]

So we got the test results back
Pre 2.8 post 3.6

So she is loaded....bad news is she will not eat. We have tried several things, she will eat a little but not much. Very tired all the time, having a little vision problem.
Vet said to give her 1/2 of a predisone tonight. Do you all agree?

[frijole]

how much does she weigh and how much is 1/2 of a pill and we'll check it out. I do agree that you could give it to her. The rescue dose is 0.25mg/kg. To find Savannah's weight in kgs you would divide her weight in lbs by 2.2 and that will give you her weight in kg. Then you take that answer and multiply it by 0.25 to get the dose of pred she would need. For EXAMPLE - a 15 lb dog weighs 6.818181...kgs (15 / 2.2 = 6.818181...) That would be rounded to 6.82kg. Then you multiply the 6.82 x 0.25 = 1.7mg of pred for a 15 lb dog

It could be that her body is getting used to lower cortisol. That load is perfect though because it really isn't too low. So did you vet tell you to wait a week before resuming dosing? Did he say what the dosage should be?

Thanks! Kim

[savannah]

Yes wait untill Thursday, 7 day from her last dose last Thursday night and .5 liquid every third day.

She weighs 7.2 lbs right now so that would be .8

[frijole]

Yes wait untill Thursday, 7 day from her last dose last Thursday night and .5 liquid every third day.

She weighs 7.2 lbs right now so that would be .8

.8 is correct!

Onto the liquid lysodren. I went back and you said "Vet says to give her .5 two times a day for three days Tues, Weds, Thursday" so you loaded at .5 two times a day right? That means you should give 1.0 a week not every 6 days. Because your pup is so small I would give her .5 and then I'd wait four day for the 2nd dose then 3 days for the next then 4 days. So if your last day of loading was Friday for example you do NOTHING until this Friday. (because you get a week off from loading) Then on Friday you give .5 and then you give .5 on Tuesday you give .5 then the next Friday, the next Tuesday. That way you have specific lysodren days and can get a routine going and remember it! Does this make sense? Kim

[savannah]

Yes it makes sense, we first started at twice a week, but she became very high levels so he upped it too .5 every third day, or do you think its was because she was never loaded. It would be a lot easier to just remember Tues and Friday....

[frijole]

Your vet didn't follow the right protocol originally and that is why it was too high - you have to give it daily which you finally did at 1.0. That is what worked and that is why you have to continue at that same amount only weekly vs daily. You have successfully reduced the size of her adrenal cortex (that makes cortisol) and you want to keep it this same size by keeping the meds the same. Kim

[frijole]

Oops forgot to add so do the Friday Tuesday thing or whatever day you last took a dosage - sorry can't remember! Kim

[savannah]

Now we have a very serious problem.....the vet did a skin scrape last week and found dematex. He prescribed Ivermexin. We slowly started her on this, it called for .05 three days, .1 for three days, and then .2 for 30 days. We are 8 days in and this morning she could not see, was very disorientated, will not eat. Call the vet, he said stop the meds, he will look into interceptor as a replacemnet.... I looked this drug up online and see this is what is called Ivermexin Poising....no cure. Some dogs recover after stopping the meds, some do not. Anyone have this happen? Please help!

[Dodie]

I have no experience with what you are going through I just hope it works out well for you.

Dodie&Molly

[frijole]

I don't know anything about this but am BUMPING this up in case someone else does. OMG you poor thing. sending your baby huge hugs and love, Kim

[Harley PoMMom]

I have no experience with this either. Looked online and found this:


Diagnosis and Treatment

Unfortunately there are no specific antidotes for ivermectin poisoning, so treatment is primarily supportive in nature.

If the drug was ingested orally in the last one to four hours, your vet will attempt to induce vomiting, administer activated charcoal, and monitor your dog’s electrolyte levels. If the drug was taken within 24 to 36 hours, activated charcoal will be administered.

If the ivermectin was applied topically, your dog should be washed with mild dishwashing detergent and water before other treatments are attempted.

Regardless of how the toxicosis occurred, your dog will require IV fluid therapy. Dogs experiencing respiratory depression will be intubated to aid breathing.

IV lipids have been used with some success in treating ivermectin toxicity with relatively few adverse effects.

Supportive care may include keeping the patient’s body temperature in the normal range, preferably with circulating warm water or air blankets since many patients are not alert enough to know when to move away from a heat source. Dogs that are semi-conscious or unconscious should have their bodies rotated every four to eight hours.

There are a number of other supportive care measures that may be necessary depending on the animal’s condition, including catheterization, intubation to keep the airway clear, seizure control, eye lubrication, and delivering nutrition to a dog who can’t or won’t eat on his own.

Depending on the level of veterinary care your dog requires, treatment costs can range from around $100 to over $1,000.

The good news is most dogs respond well to treatment for ivermectin toxicosis, and the prognosis is very good if supportive care is given early and aggressively.

Depending on how much ivermectin is ingested and the sensitivity of the patient, treatment can be lengthy, and symptoms can take several weeks to disappear.


http://healthypets.mercola.com/sites/healthypets/archive/2013/03/06/ivermectin.aspx

Sending love and hugs, Lori

[molly muffin]

Oh no! I am so sorry this has happened. Did your vet mention the IV fluids needed and treatment to try and help out Savannah?
I wouldn't start anything new until you see what can be done to get this out of her system.

hugs to you and Savannah
Sharlene and Molly Muffin

[savannah]

She is a little better this afternoon, she is running a little, eye sight a little better. My vet said the IV's and such would be more for a dog that has really crashed and will hardly move at all.

He wants to try Sentinel which used to be called Interceptor to get the demetex under control. Her sores sure look like the CC I have read about on this forum, but he said they did a scraping and she has demetex....

[addy]

I have not been commenting on your thread but have just read it through. I am so sorry, I did not know you were in Wisconsin. I am in Milwaukee. Can you get to Madison? Could you get to UW- Madison vet school? Could you get to Pewaukee or Racine to Wisconsin Veterinary Referral Center? We also have Lakeshore Veterinary Specialists in Milwaukee, Port Washington and Oak Creek. The one in Racine I might not use.

You can pm me if you like and tell me where in southern Wisconsin you might be.

[frijole]

Oh Addy thanks for coming to help. She's been asking for vet advice! I so hope you can help her find a vet with more experience. Her wee little baby deserves it. She just got her loaded and now this. Bless you. Kim

[molly muffin]

How is Savannah today?

Sharlene and Molly Muffin

[molly muffin]

I realized it's been several days since we've heard how things are going? I do hope she is okay and has made a full recovery.
Let us know when you get a chance.

hugs,
Sharlene and Molly Muffin

[addy]

Ive been wondering as well, I hope I did not scare you away for some reason. :o

[savannah]

Savannah has cushings and calcinosis cutis. We have the Cushings under control, thanks to you folks, and the symptoms are gone. She started to grow her hair back then all went bad two weeks ago. She has sores all over her right side, now just above and below the eyes, her feet are swollen and sore. There are sores between her pads. She has a hard time walking, and is bleeding everywhere. Does this mean the Lydson needs to be increased? She has none of the other signs right now. She is on .5 ml twice a week, and on a daily antibiotic. We bath her every other day with Ketetone (SP?) it is an antibacterial shampoo. But I see more sores and bleeding every day. Today I noticed it even in her mouth. She bleeds while eating.
Any suggestions or help appreciated as my vet has little to no experiance with this.
Thanks

[labblab]

I'm afraid I have only a moment to post, but you'll see that I have combined your new post into your original thread about Savannah. This way, it will be easier for us to track through her entire treatment history. I haven't had a chance to review Savannah's entire thread yet, but I see that she was having skin issues when you first joined us. Is what's happening now similar, or something altogether different?

The thing is, calcinosis cutis can only be definitively diagnosed if a tissue sample is biopsied. To be honest, what you are describing does not sound like Calcinosis Cutis to me, but instead some other type of skin problem. I'll try to check back later on so we can talk about this some more. And hopefully some other folks will also stop by shortly. By any chance, is there a way you could take some photos of Savannah's sores and upload into your personal photo album? That would make it easier for us to try to judge what may be going on.

Marianne

[savannah]

It is the same but 10 times worse. Will try to get some pictures. Her hair on her feet grew back alittle about 50 percent so far, but these sores are getting worse. I read online that it may get worse before getting better. Anyone have experience with htis? The last time she had problems is was diagnosed as dematitious (sp?) She was given Ivermexon and it did clear up, but this time she had a reaction to it so we had to stop.

[Squirt's Mom]

Hi,

Good to hear from you again!

If I were you, I'd get her to a derm vet asap. If this is CC her dose may need to be higher to control it and the sooner you know for sure the sooner you can get treatment started. There are other things like DMSO that some have used but a diagnosis is the first order of business.

Would you mind posting the results of her latest ACTH? It would help if we can make sure she is within range as this could also play a role in the CC spread.

Let us know what the vet says! And don't be a stranger!
Hugs,
Leslie and the gang

[frijole]

Could be the meds didn't work with the lysodren? Please update us on your dog's cushings because the last we heard it looked like your wee one was Addisonian and we were concerned about electrolytes... it would be helpful to have an update of what has happened since you last posted. Glad you did! Kim

[savannah]

ATCH results was June
Pre 2.8 post 3.6

Just talked to the vet he is convinced by the photos is is dematertis and is going to prescribe Sentinal. He said the ones by the eyes and mouth are what tell him it is not cc but Dematertis.

I have just uploaded the pictures to a new album for you to see, how do I share them, if someone could tell me if you can see them, let me know

[Budsters Mom]

Yes, I can see them. They are in an album called, "Skin Pictures". I am so sorry that Savannah has to put up with that. It looks very uncomfortable for such a little one. Hugs,

[addy]

I am really sorry to hear what you are dealing with.

Did your vet by chance do any kind of skin scraping, to see what is going on? A skin scraping can tell us a lot, is there a bacteria infection and if so is it deep into the skin, is there yeast or mites?

My pup went through a lot she did not have to go through until I insisted on a skin scraping. It helps take a lot of guess work out of the diagnosis.