Levels still high, increase Lysodren to every other day? Will that work??

[CCM]

Hi, brand new to the forum. I hope to find positive encouragement and help with Cushings for me and my 7 1/2 year old Chihuahua mix that was diagnosed almost a year ago.
A little background info, we had just barely got him balanced out on Lysodren twice a day when I took a long road trip and gave my dog prednisone multiple times to keep his stress down. I think that is where I goofed. I got him started up with a new vet and his levels were back up. For several months now we have been giving him Lysodren more frequently, the water drinking and peeing still has us up many times a night. Now, my vet recommends giving Lysodren every other day. Could I get some input here? I keep wondering if I need to do a load dose week on the Lysodren instead of every other day dosage since every third day didn't work and 3/2 days haven't helped either. Also, his liver test was a little elevated. Am I using the wrong meds? I would love some experienced help keeping my beloved dog healthy and with us many years to come.

I LOVE my dog!

[frijole]

Hello. I used lysodren successfully for 4 1/2 yrs. It can be tricky to get the levels where they need to be - honestly I've been on this forum for 8 yrs and I now believe most problems are related to either an uninformed owner or their vet.

So I'm going to start out by giving you this link to read on how lysodren works just to make sure you have it. I will write up a series of questions for you next as we can't help you until we know more about your dog and the history.

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

[Squirt's Mom]

Hi CCM and welcome to you and your baby boy! :)

We will ask lots of questions in the beginning so bear with us. The more we know, the more meaningful feedback we can offer. ;)

Would you mind rounding up all the tests your baby had done to diagnose the Cushing's in the first place as well as all the ACTH monitoring tests that have been done since he started the med and posting the actual results here? Not the invoice, but the actual tests results. We only need to see the ones that were too high or too low on the usual labs that show things like ALP, CHOL, BUN, etc.. the results from any LDDS, HDDS, ACTH done prior to starting the Lyso, but need to see all comments on any ultrasounds that were done.

When you say you "barely got him balanced out" before starting on your trip, did he have an ACTH at that time right after the load that showed he was within range - the range for a Lyso pup is 1 - 5ug/dl?

WAS he loaded - loading is when the pup takes a dose twice a day until you see signs that indicate the drug has done it's job like a reduction in drinking or appetite? This typically takes between 3-7 days.

After the load and an ACTH that says the cortisol has been lowered into acceptable range, typically you wait a few days then start what is called the maintenance dose - giving the same dose that was given on a daily basis for the load but spread out over a week, usually 2-4 times a week. So if the loading dose was 500mg a day, you would give 500 mg a week in maintenance. Dose this sound like how your boy's treatment was handled?

Unless there is a very, very good reason for using pred, it just isn't given to cush pups. It is only given when they are in crisis, when the cortisol has dropped too low, as it will replace the cortisol. So if you gave pred while on the trip and he was loaded before you left, then you may be right that that undid all the work the load had done and he probably needs to be reloaded rather than increasing the dose or giving more often.

Has he been checked for a UTI?

Were diabetes and hypothryoidism ruled out? How long ago were these last checked?

How is his appetite?

Any nausea or diarrhea?

How much does he weigh?

How much Lyso is he getting and how often?

Hang in there! You have found the very best place for experience, knowledge and support! We will be with you all the way. And just to ease your mind a bit - Cushing's is not a death sentence; with proper treatment our babies can and DO live out their normal lifespan and beyond. Typically our babies pass from things unrelated to Cushing's. So you take a deep breath and settle in with your new family. We are so happy you and your sweet boy are here tho we regret that you have the need. You will no longer be alone. Talk to us anytime - someone is almost always on and available. Read, read, read then ask more questions; we will do all we can to help.

Hugs,
Leslie and the gang

[frijole]

I have no idea what your experience has been yet so I am going to assume no knowledge of using lysodren and how it works just to be safe. There is a specific protocol that is to be followed with lysodren. I hope that you have records of all tests that have been done as well as the dosing information. We will need that to have the total picture.

Cushing's is caused by tumors (either pituitary or adrenal) that send messages to your dog's adrenal glands to produce cortisol even though he doesn't need more cortisol. Dogs need cortisol to live. But there is such a thing as too much (think adrenal rush). Lysodren is designed to erode the adrenal cortex so that it quits overproducing. During the initial dosing which is called 'loading' this is what you are doing. You mentioned 7 days - that isn't the case. That is the average but dogs vary a whole lot. Some can 'load' in one day and my dog Haley holds the record at over 2 months.

So you follow the guidelines. You give lysodren twice a day for 7 days or so and you do an acth test to see where the cortisol levels are. Your goal in life is to get those levels to between a 1 and a 5 (2nd number on that test). If the test results come back high then you have to continue loading. If you are close you can stay on the same dose but if you are not then you increase the dosage amount. (the daily amount) You keep this up and testing until you reach a cortisol reading between a 1 and a 5.

After you reach that point your goal is to maintain the load. You don't want to further erode the adrenal cortex you just want it to stay the same size so it emits the same 'normal' amount of cortisol. At this point you give the same amount in a week that you were giving daily. Experts in the field say to split it up and give it 3 to 4 times a week. OK so as an example if you were giving one pill a day (500 mgs) during the load - you now will take that pill and give 1/4 a pill 4 times a week.

You must periodically do acth tests to make sure your dog is maintaining the load. Its' expensive but the only way to know where he is.

If you are up in the night your dog's cortisol is most likely high OR has additional issues like diabetes. When was the last acth test?

You said the problems started when you were on the trip and switched vets. Small amounts of prednisone wouldn't make a difference but lowering the dosage would. Did you make changes?

Recommended dosing is 50 mgs of lysodren per kg of weight. How much does your dog weigh? Take that amount and divide it by 2.2 to figure out kgs.

I'll do the math if you tell me what your dog weighs and what the current weekly dosing is.

It would be most helpful if you could tell us as much as possible about your guy including dates, test results, dosing amounts etc.

Just so you know you can't just switch from lysodren to another drug - you must have a wash out period of at least 45 days. So don't give up yet. Let's take a look at whats happened. Kim

[CCM]

Thank you for the great reading material and support!!!
I will have to get his records from my vet. I also see I need to keep a journal! I had started one but my sudden relocation kept me from getting much of my things. It has been a stressful time for us. Including an upcoming divorce. I dread being away from my little dog when I go get my things and sign papers. I want him much better before that trip comes up!
My dog had been through the induction phase that took about 10 days. Then on quartered tablets of 500 mg pills twice a week for maybe two months when we relocated. I did delay his dose by one day twice thinking his upset stomach needed a break after the trip. Another mistake. He was showing signs of colitis again in his feces. He had it before. He was stressed. We both were. And I feel like I did years ago when I was a first time mom holding my son...jumping up at every sound... I have so much to learn!

So, took him to the new vet... (who seems to be learning with me but is super gentle and good) ...when I saw his water consumption/frequent urination was back up. Last ACTH test done in December. No urinary, thyroid or sugar problems.
I am being instructed to give the quarter dose every other day to see if the water changes. We did 3 day then 2 then 3....2 and so on, before this. I just don't want his liver or any other organ damaged!
Before cushings, last year he weighed about 8 pounds. Now he weighs in just over 11 pounds. He never jumps on the sofa anymore and sometimes has trouble with steps. I'd read about that. He has started to eat slower the past week. But he still drinks over 60 ounces a day.

Also, what works for his very dry, brittle nose? I bought some snout soother salve and tried olive oil too. He keeps rubbing it off.

I will get his records and write back soon. So much to learn and so intimidated but I want the knowledge to help him and see that he gets the best care. Sleeping through the night would be a nice bonus : ) Getting up every 2 hours for him to pee is rough.

Thank you, thank you so very much for your support, knowledge, and questions for me to get answered.
Kim, Leslie and the gang :) I appreciate you!!!! And my little 'Gunner' thanks you too.
Happy Easter!
Crystal

[frijole]

Happy Easter to you too!

You said you give him 1/4 of a pill 2 times a week is that right? ( Or 1/2 of a pill.) We need to know what his weekly dosing amount is. I'm sorry but I didn't understand your comment : " We did 3 day then 2 then 3....2 and so on, before this". Please write it out because it because I'm not sure if you are talking about giving 1/4 of a tablet every 3 days, every two days, 3 pills every two days or what. :) We need to be sure we know what you mean - dosing is key with this drug.

Using the formula I gave you and 11 lbs as his weight his dose should have started out at 1/2 a pill. So during loading you'd have given him 1/4 of a pill twice a day (total 1/2 pill) for those first 10 days. I really want to know what his results were after that 10 day period. That will tell us alot. Also his last test results.

There is nothing wrong with having a vet that is new to cushings so long as they are willing to read up on it and follow instructions from those that have experience (other vets). That said you have to be very careful because vets without alot of experience sometimes don't realize that this drug can't be treated like others. You have to be very careful with it. If you do it works great. If you don't then dogs can get into trouble.

So go get those results. If he's drinking that much water his cushing's is definitely not under control.

Just so you know dogs with cushings have high liver enzymes - that is very normal and they will most likely always be high. Lysodren doesn't hurt the liver - the uncontrolled cushings does.

Glad you found us - you aren't alone any more. Kim

[molly muffin]

Hi Crystal,

I wanted to check in and see how you and your little Gunner are doing.
Hope all is well.
Let us know when you get a chance.

hugs,
Sharlene and Molly Muffin