New to site--Lysodren (Calcinosis cutis)-sweet AnnaBelle has passed away

[BostonLover]

Hi,

I'm so glad I found this place. My baby Annabelle(9-10 yrs old) was an Amish puppy mill rescue and we've had her about 5 years. A year and a half ago we noticed a HUGE increase in water consumption and urinating. We took her in and she was diagnosed with Cushing's (small tumor on pituitary gland). She's been on Trilostane this whole time, while progressively getting worse. For every check up, and God knows there were A LOT of those, we expressed to the vet that she didn't seem to be doing better, but in fact worse (seizures, hair loss, same water consumption and urinating every 15 minutes). The vet assured us her cushing's was under control because the tests showed that. Within the last 2 weeks we started noticing scabs along her dorsal spine.

Well we took her in on Saturday and when the vet walked in with the most somber face, we knew something wasn't right. She said she has calcinosis cutis, and must have misdiagnosed her from the get go, and thinks it may be A-Typical Cushings. She also did a short ultrasound that showed both adrenal glads abnormaly enlarged. She first suggested Lysodren, then went into how dangerous it was and it could kill her etc etc, so we said no to that, then she said to just bump up her trilostane to 30 and 30 a day. Currently she is on 30 in the am, 10 in the pm. We don't think by pushing her to 30/30 is going to do anything, since clearly the drug hasn't worked at all. After doing some research, we now think the Lysodren may be our best option.

Any advice would be greatly appreciated...Pros and Cons.

Thanks,
Crystal

[Squirt's Mom]

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[BostonLover]

Hi,

I never received an email.

[Roxee's Dad]

Hi Crystal,
Welcome to you and Annabelle :)

The message fro K9cushings may be in your spam folder.

[Roxee's Dad]

Just me again...:o

Do you have copies of the test that were performed to diagnose the cushings ? If not, your vet's office should be more than happy to provide them. Just post the cushings test results and any abnormal blood work results including the normal ranges.

We have quite a few Atypical cush mom's here that I am sure will come by to welcome you and share their experiences. How much does Annabelle weigh?

[BostonLover]

I will request copies of the tests and post results.

Well, 3 weeks ago she weight 16.8 pounds, Saturday she weighed 14.9. :(

[Roxee's Dad]

Here are a few good articles and papers on Atypical cushings. They are in our Information and Resources section...

http://www.k9cushings.com/forum/showthread.php?t=198

[BostonLover]

Thanks SO much!

[lulusmom]

Hi and welcome to the forum.

I am so sorry about the circumstances that brought you here but I'm glad you found us. I am more than a bit perplexed with your vet. There is a huge difference between atypical and typical cushing's and the treatment is most certainly different. Vetoryl (trilsotane) is anything but benign and it is not prescribed for atypical cushings so for your vet to now come forward and admit to misdiagnosing your dog makes me very suspicious of her experience with any type of cushing's. It also makes me suspect that your vet may be like my dogs' old gp vet, who didn't know how to assess an acth stimulation for purposes of determining whether cortisol is controlled or not. If I had listened to him, neither one of my dogs would have been controlled and could have quite possibly ended up with calcinosis cutis.

It would really helpful if you could please round up copies of all tests that were done to diagnose Annabelle, as well as all acth stimulation tests that were done after treatment started, and post the results here. If it is easier, you can send the results to k9cushings@gmail.com and one of us staff members can post the abnormalities for you.

It could be that Lysodren may be a better treatment of choice, especially with the calcinosis cutis, but let's make sure you Annabelle's cortisol levels are within the desired therapeutic range before jumping into a switch. There is a washout period when you switch from Lysodren to Trilsotane and vice versa so with the calcinosis cutis, I'd do that as a last resort. I will tell you that a renown expert, Dr. David Bruyette, admits that his practice hasn't had good luck with Trilostane in dogs with calcinosis cutis but we have had dogs here with good results on Trilostane. Every dog is different but the one common thread with all of them is that calcinosis cutis is not something that is going to resolve quickly. It is a long term battle so patience and lots of loving care is called for.

Looking forward to hearing more about your girl's diagnosis and most definitely anxious to see test results.

Glynda

[Squirt's Mom]

Hi Crystal and welcome to you and Annabelle! :)

Ok, to start with, if Annabelle's cortisol is elevated she does NOT have Atypical. Atypical does not involve cortisol but involves elevations in one or more of five intermediate, sometimes called sex, hormones which are Estradiol, Androstenedione, 17-Hydroxyprogesterone, Progesterone and Aldosterone. The only place I know of that tests for Atypical Cushing's is the University of Tennessee in Knoxville.

BUT since she was put on Trilostane, I am assuming Annabelle's cortisol was elevated which rules out Atypical. ;)

Calcinosis cutis does occur with conventional Cushing's (elevated cortisol) so the appearance of CC does not mean she was misdiagnosed. I am having some concerns about her vet's experience with Cushing's but we will know more once we see the test results - both those that were done to diagnose the Cushing's and all monitoring ACTHs since she started the Trilo.

In order to switch from Trilo to Lyso, you will need a washout period of 30 days with neither med in her system. BUT before we talk about switching treatments, let's look at the test results and see where we are today and how we go here, 'k?

Has Annabelle been checked for diabetes recently? The weight loss is a bit concerning and diabetes can come on suddenly. If she hasn't been checked lately, I think I would have that done asap.

For today, try to relax and breath. You have found the very best place to be for experience, knowledge, and good old fashioned support. The more you can tell us about Annabelle's medical history the better. We LOVE details so don't worry about long posts. ;)

Hugs,
Leslie and the gang

[BostonLover]

WOW! You guys are great! I'm calling the vet to have her chart faxed to me. I will email to the email address provided and let you guys take a look.

[Budsters Mom]

Hello and welcome from me too. :)
You have come to the right place! There are many K9Cushing's angels standing by to help and stay with you every step of the way. They love details, test results, any information you can get your hands on. The more the better. We will do all we can to help, but be ready for lots of questions! So again, welcome Crystal and Annabelle.

Hugs,
Kathy

[molly muffin]

Hi and welcome from me too. :) Glad that you and Annabelle found your way to us.

I want to throw in that the normal range for a dogs cortisol is different when they are being treated with trilostane (vetoryl) than if they are not. (it is also a different range if treated with lysodren). I cannot tell you the number of times that we have had vets say the cortisol is too low, too high, etc, when they were in fact Not looking at the correct range for a dog on treatment.

Looking forward to seeing those numbers.

Again and hello and welcome. Glynda and Leslie have gotten you off to a good start, and they are very well versed in both typical and a-typical cushings.

Sharlene and Molly Muffin

[BostonLover]

STILL waiting on her paperwork to get faxed to me. Also still waiting on a return phone call from the Internal Med Vet (who diagnosed her and has been treating her).

But yesterday when I got home I noticed that some of the calcinosis cutis "scabs" were about to come off.:( Is there anything I need to treat these with once they fall off, or anything to do before they fall off. Is she in any pain? She wouldn't express pain if you held fire to her feet. She's a strong girl who put up with a lot in the Amish puppy mill. my heart breaks for her.:(

[Trixie]

Hi Crystal,
I'm of little help with the tests/numbers..still new at sorting out all this stuff myself. Just wanted to say welcome and that Annabelle is so cute. The people on this board are great and know a lot...I know you will get help here.
Hope little Annabelle is doing okay and not in pain with her skin.
Once you get your test results on the board you will get plenty of good advice and answers to your questions.

Barbara

[BostonLover]

I'm becoming quite impatient waiting on AnnaBelle's chart to be sent to me.

In the meantime, I should mention she is also on 5mg of Enalapril twice daily because her protein in her urine has continued to go up since she was diagnosed and put on Trilostane.

Also a couple of the scabs from her calcinosis cutis came off last night, and I don't know what to treat them with, if anything.

[labblab]

Hello from me! Just wanted to pop in for a moment to tell you that I've edited your thread title to include "Calcinosis cutis." I am hoping this will catch the eyes of others who are also battling CC, making it more likely that they will stop by with their thoughts and suggestions.

Marianne

[BostonLover]

Thanks Marianne!:-)

[addy]

In the meantime, I should mention she is also on 5mg of Enalapril twice daily because her protein in her urine has continued to go up since she was diagnosed and put on Trilostane.


Please note: Enalapril should be used with caution when using Vetoryl/Trilostane. Enalapril is an ace inhibitor. Make sure your vet monitors the elctrolytes not just the cortsiol. I would discus it with her/him to make sure the proper monitoring happens.:)


The risk of hyperkalemia developing should be considered if trilostane is used in conjunction with potassium-sparing diuretics or ACE inhibitors (i.e., drugs that interfere with aldosterone production

[khockman]

I am so sorry to hear about Annabelle and her struggle with Cushings and Calcinosis Cutis (CC). Our English Bulldog Millie was just recently diagnosed with Cushings and she has a horrific case of CC…to the point where her dermatologist awarded her “Worst Case she has ever seen Award”…woo-hoo go Millie! I can certainly sympathize with you as the CC can be very aggressive and extremely difficult to manage. It starts as open, oozing sores, then scabs over a blackish color and then when scab falls off, there seems to be hardened pink skin below (her trunk kind of looks as if she is a soft shelled turtle). My little girl started with two spots that kind of opened and seeped, and within two weeks it was on her face, neck and down her trunk (8-12 inches wide). IT WAS AWFUL and I know you probably feel helpless as it spreads, but I continue to get feedback that sometimes it just gets worse until it gets better…patience is not one of my strong suits! We started her on Trilostane on 6/29, and I swear I stare at her skin hourly to see if any improvement…but if there is, it is SLOW! Seems like it is not progressing as fast, but then again this skin disease has taken over 1/3 of her body already.

When contacting my Dermatologist I asked her about the possibility of using Sudocrem or Manuka honey (as recommended by others). She asked me to stay the course and said no to the Sudocrem (I think her sores were more open than the cushpups mom that used this with success) and said honey did cross her mind, but given the extent of the problem, thought it would be an unbelievable mess – which I probably can concur with – although it would smell a heck of a lot better than the rotten garlic smell of DMSO…I will never get garlic on pizza again! When I say stay the course, she is a little too difficult to bathe right now and makes her so uncomfortable, so we are using an antibacterial mousse (once a day on all lesions: face, neck, trunk) – It is DUOXA Chlorhexidine + Climbazole Mousse with phytoshingosine. She is not thrilled when this goes on her face cheeks and I feel it may be hurting her. She also gave us Comfort Spray by Animal Pharmaceuticals which she recommended spraying on face 2-3 per day. Millie will have nothing to do with a spray bottle coming at her face, so she recommended soaking a paper towel and dabbing. Millie seems to be okay with this…

If you ever have any questions, or want a friend who is having the same problem, feel free to reach out to me via PM if you want and I will be happy to share anything that I can. Millie’s thread can be seen :

http://www.k9cushings.com/forum/showthread.php?t=5449

Xoxox,
Kerry (Millie’s Mama)
Hang in there!

[Boriss McCall]

HI Crystal..

welcome to you an Annabelle. I also am a BT mom who has Cushings. I have not experience the CC with my dog. But, I know there are several on her who have. So sorry you are having to experience that.
I hope you get some good advice from the others on here. I know some have used different herbal type stuff along with the meds to sooth the skin.
We are all here for you.

hugs..
Amy

[Sabre's Mum]

Hi Crystal,

Welcome to you and Annabelle.

Our Hungarian Vizsla, Sabre, had calcinosis cutis and was treated with Lysodren. The scabs will unfortunately come off if they are knocked or the dog scratches them. We put a T-shirt on Sabre ... we also allowed time without it to let the air at any scabs. Will Annabelle tolerate a t-shirt or a jacket on her?

Angela and Flynn

[BostonLover]

I'm so annoyed. I STILL have not got AnnaBelle's records faxed to me...I've been asking everyday since Monday.

And, I spoke to the vet this morning, and they want to do a one week wash from Trio to Lysodren. Isn't it supposed to be 30 days?? Not only that, since increasing her Enalapril to 10mg/day her protein is STILL going up. One month ago it was 6.1 and now it's 7.7. What could be causing her protein to continue to rise? She also lost 2 full pounds in less than a month.

I just don't know what to do....I'm scared of the one week washout, but what if don't comply and do a 30 day wash out.Will this mess up her intial induction dose of 1/4 Lysodrene every 12 hours??

I'm on the phone with the Internal Med Vet's office begging for her test results to be emailed or faxed. :mad:

[addy]

Most of the endocrinologists will tell you it is a 30 day wash out when changing from Trilostane to Lysodren or vice versa. However, Dechra (manufacturers of Vetroyl-name brand Trilostane-tells the vets that it is only a 30 day wash our when switching from Lysodren to Trilostane, not from Trilostane to Lysodren. My speciaist called them to clarify about a month or two a go because she was proposing no wash out and a switch - I had a fit so she called.

I reviewed Dechra's instructions and they do not say a wash out when switching from Trilostane to Lysodren. So it is a quandry as the specialist do recommend it.

At this point, could you travel to the clinic and ask in person for your tests? Would that be an option?

[Squirt's Mom]

There is no way under the sun that I would allow a switch EITHER way without a 30 day washout - either from Trilo to Lyso, or Lyso to Trilo. And I wouldn't give a flying flip what Dechra had to say about it - it's my baby, not theirs, who would suffer if they are wrong. PLUS each of these babies is unique and just because 50 other dogs didn't have a problem that does not mean mine wouldn't. It just wouldn't be worth the risk to me. ;)

[BostonLover]

They said they are faxing right now. Hope to post soon.

[BostonLover]

Ok, I just emailed her entire chart to K9Cushings. Hopefully it will give you all a little more insight.

[addy]

Just to clarify- I am not suggesting you do not do a wash out period, I am only explaining why your vet said none was needed.

Having said that we did have a member switch without a washout period and that dog did not have a problem.

Just providing information.;);)

[BostonLover]

I run out of Trilostane on tomorrow, and they want me to start the Lysodren 7/21, so I'm not listening to my vet, and that will give her a 2 week wash out, which makes me feel better than just a one week.

[frijole]

I checked the dosage on the lysodren so please confirm I got the facts right. She weighs approx 15 lbs so the max per day she should get (to start) is 340 mgs. You are to give 1/4 a pill twice a day or 1/2 a pill daily. 500 x 1/2 = 250 mgs so you are below the high end of dosing. I think that is a good place to start. You may end up having to increase the dose but it's a good recommendation imo.

Kim

Here is a link to loading with lysodren that is very important.

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

[BostonLover]

Thanks Lori! :)

[BostonLover]

I checked the dosage on the lysodren so please confirm I got the facts right. She weighs approx 15 lbs so the max per day she should get (to start) is 340 mgs. You are to give 1/4 a pill twice a day or 1/2 a pill daily. 500 x 1/2 = 250 mgs so you are below the high end of dosing. I think that is a good place to start. You may end up having to increase the dose but it's a good recommendation imo.

Kim

Here is a link to loading with lysodren that is very important.

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

Thanks Kim!!

[labblab]

Hello again, and I wish you very good luck in getting Annabelle's calcinosis cutis under control with the switch to Lysodren. However, I am trying to get as clear a picture as possible of Annabelle's adrenal status prior to making the change. In particular, I am wondering what the results were for her most recent ACTH monitoring test.

I have not had the time to look through her entire chart in detail, but the most recent monitoring ACTH test that I've found so far is dated 4-28-13. Has a test been done more recently? The reason why I ask is because these were the April results:

Pre-ACTH: 7.6 ug/dl
Post-ACTH: 8.0 ug/dl

These are not horrible results by any means, and per the printed Antech laboratory interpretation for the test, they fall within their "optimal" trilostane treatment range of 1.5 - 9.1 ug/dl. However, per Dechra (manufacturer of brandname Vetoryl), a post-ACTH result up to 9.1 is considered acceptable ONLY in the event that all symptoms are satisfactorily resolved. If not, the target post-ACTH goal is no higher than 5.4 ug.dl. So even though 8.0 is not highly elevated, it still would have warranted a trilostane increase according to Dechra since Annabelle's symptoms remained inadequately controlled. Was Annabelle's dose increased at that time?

I have not had the time to go back to track all of her preceding ACTH results. And I am not trying to talk you out of the medication switch now. But I do want to point out that if Annabelle has not had another monitoring ACTH subsequent to April, her cortisol may be even higher now and, if so, her current dose of trilostane inadequate to control her cortisol level. Either way, I would have thought that your IMS would have wanted to know Annabelle's current ACTH results before deciding to make the medication switch.

As I say, I may be missing the boat entirely and there may be a more recent ACTH that I am overlooking. So it will help us a lot if you can summarize Annabelle's total trilostane dosing history and also all her ACTH testing results so that they are all in one place within a reply here. That will make it easier for us to judge her progress both in the past and also from this point onward.

Thanks so much in advance!
Marianne

[BostonLover]

Hello again, and I wish you very good luck in getting Annabelle's calcinosis cutis under control with the switch to Lysodren. However, I am trying to get as clear a picture as possible of Annabelle's adrenal status prior to making the change. In particular, I am wondering what the results were for her most recent ACTH monitoring test.

I have not had the time to look through her entire chart in detail, but the most recent monitoring ACTH test that I've found so far is dated 4-28-13. Has a test been done more recently? The reason why I ask is because these were the April results:

Pre-ACTH: 7.6 ug/dl
Post-ACTH: 8.0 ug/dl

These are not horrible results by any means, and per the printed Antech laboratory interpretation for the test, they fall within their "optimal" trilostane treatment range of 1.5 - 9.1 ug/dl. However, per Dechra (manufacturer of brandname Vetoryl), a post-ACTH result up to 9.1 is considered acceptable ONLY in the event that all symptoms are satisfactorily resolved. If not, the target post-ACTH goal is no higher than 5.4 ug.dl. So even though 8.0 is not highly elevated, it still would have warranted a trilostane increase according to Dechra since Annabelle's symptoms remained inadequately controlled. Was Annabelle's dose increased at that time?

I have not had the time to go back to track all of her preceding ACTH results. And I am not trying to talk you out of the medication switch now. But I do want to point out that if Annabelle has not had another monitoring ACTH subsequent to April, her cortisol may be even higher now and, if so, her current dose of trilostane inadequate to control her cortisol level. Either way, I would have thought that your IMS would have wanted to know Annabelle's current ACTH results before deciding to make the medication switch.

As I say, I may be missing the boat entirely and there may be a more recent ACTH that I am overlooking. So it will help us a lot if you can summarize Annabelle's total trilostane dosing history and also all her ACTH testing results so that they are all in one place within a reply here. That will make it easier for us to judge her progress both in the past and also from this point onward.

Thanks so much in advance!
Marianne

Hi Marianne,

Well, on paper her Cushing's appeared to be under control, however, it never did help any of her symptoms. She still will drink 8 cups of water a day if allowed, she pees every 15 minutes, gobbles food in 25 seconds. She started losing her hair and having seizures once on the trilo for about 7 months. She's been on trilo for about a year and 3 months. which no change in any symptoms. This is the reason we are switching, and now that she has the calcinosis cutis, the vet recommended switching to the Lysodren.

We are currently washing her out right now. Her last 10mg of Trilo was given Satruday am. She starts the Lysodren on 7/21 with an ACTH test scheduled for 7/27

[BostonLover]

Well almost a week into the wash out of Trilo and I can definitely say it was never doing anything for her. Her thirst/urination/hunger hasn't changed a bit. She's still the same as when she was on 30/10

Looking forward to trying the Lysodren and HOPING this works.

[Boriss McCall]

Good luck! I hope the Lyso is the magic drug that works for her.

[molly muffin]

I don't think she was ever really controlled on the trilostane. I do hope the lyso makes a difference.

Hang in there. None of this is easy until you reach a controlled level of cortisol production.

Sharlene and Molly Muffin

[Budsters Mom]

Fingers, toes, and paws crossed that this helps Annabelle.:) XXXXX

[BostonLover]

Thanks everyone!!! We told the doc over and over and over again that her symptons were never improving, but on paper she looked good, so I guess the doc thought we were exaggerating until I did the free choice water----she drank 8 cups of water in a 24 hour period!!! That's when we came back in and she said maybe we need to switch to Lysodren. Also that is when the Calcinosis cutis started to set in, which really worried her. :( I have her on an antibiotic for that now, and she's still taking 10mg of Enalapril daily since her last Urine test showed her protein at 7.1---it has continuously gone up since diagnosis and treatment. Really anxious to get her on the new drug and crossing all paws that it works. :)

[BostonLover]

I just can't say enough about how helpful and friendly everyone is here. God bless you all! Have a wonderful Friday:D

[Tina]

Hi Crystal,
I just have a second to post before work, but wanted to say that my Jasper has had protein in his urine also and is on Enalapril to treat it. My vet also put him on fish oil twice a day mixed in with his food. The brand we use is Welactin, but there are many brands available. Fish oil also helps to decrease protein loss from the kidneys and it is beneficial for many other things also. You might want to ask your vet about it. The combination of the Welactin and Enalapril has decreased Jasper's UPC significantly. It is still not in normal range, but it made a big improvement on our last check.

Hugs,
Tina and Jasper

[labblab]

Hi again, Crystal. I'm so glad Tina has seen your reply and will be checking up on you, because she really knows her stuff re: proteinuria. One thing I am wondering is whether you've made any dietary changes for Annabelle? With a UPC that high, I'm thinking that many specialists would be recommending a moderate reduction in protein. Even if the other renal lab values are normal, I'm thinking that dietary changes would be considered in hopes of lessening the amount of protein that is being spilled into the urine. Even though recommendations have been shifting re: the advisability of protein reduction for certain other types of kidney abnormalities, I think significant protein loss is a problem for which dietary adjustment is desirable. Tina is well-versed in this because her Jasper has been shifted to a special food that is moderately reduced in protein. So I hope she'll be back to add her thoughts and experiences about this part of things, too.

Marianne

[BostonLover]

Hi Crystal,
I just have a second to post before work, but wanted to say that my Jasper has had protein in his urine also and is on Enalapril to treat it. My vet also put him on fish oil twice a day mixed in with his food. The brand we use is Welactin, but there are many brands available. Fish oil also helps to decrease protein loss from the kidneys and it is beneficial for many other things also. You might want to ask your vet about it. The combination of the Welactin and Enalapril has decreased Jasper's UPC significantly. It is still not in normal range, but it made a big improvement on our last check.

Hugs,
Tina and Jasper

WOW! I will definitely give that a try. Thanks Tina!

[BostonLover]

Hi again, Crystal. I'm so glad Tina has seen your reply and will be checking up on you, because she really knows her stuff re: proteinuria. One thing I am wondering is whether you've made any dietary changes for Annabelle? With a UPC that high, I'm thinking that many specialists would be recommending a moderate reduction in protein. Even if the other renal lab values are normal, I'm thinking that dietary changes would be considered in hopes of lessening the amount of protein that is being spilled into the urine. Even though recommendations have been shifting re: the advisability of protein reduction for certain other types of kidney abnormalities, I think significant protein loss is a problem for which dietary adjustment is desirable. Tina is well-versed in this because her Jasper has been shifted to a special food that is moderately reduced in protein. So I hope she'll be back to add her thoughts and experiences about this part of things, too.

Marianne

The vet has never said anything about her diet. We used to have her on wet Science Diet, but her stomach would protrude so bad after eating that we switched to a raw food diet (Raw Naturals chicken and salmon). This has SIGNIFICANTLY decreased the size of her belly after eating, but it's a lot of protein.

Nutritional Information
Ingredients: Chicken, Ground Chicken Bone, Chicken Liver, Salmon, Broccoli, Carrots, Cantaloupe, Egg, Ground Flaxseed, Salmon Oil, Apple Cider Vinegar, Blueberry, Cranberry, Inulin, Dried Kelp, Potassium Chloride, Sodium Chloride, Ginger, Parsley, Garlic, Zinc Proteinate, Iron Proteinate, Vitamin E Supplement, Copper Proteinate, Manganese Proteinate, Mixed Topocherols (as preservative), Vitamin D Supplement

Guaranteed Analysis
Minimum Protein 12%
Minimum Fat 9%
Maximum Fiber 2%
Maximum Moisture 72%
Minimum Calcium 0.7%
Minimum Phosphorous 0.4%


Any suggestions on another diet? I'll do anything for my sweet pea.:o

[labblab]

Was the Science Diet one of their specialty prescription foods (they're usually marked with letters like I/D or K/D)?

Marianne

[BostonLover]

Yes, she was on that in the very beginning because our first vet diagnosed her with Kidney Disease, and actually said her kidneys were failing, so we had her on that. Once we went to Internal Med Vet, it was diagnosed Cushing's and her kidneys were completely fine, so the Dr. told us to take her off that food. I know she was VERY glad to be off that food!!!

[labblab]

Hmmmm...yes, I think the Hills K/D is pretty severely restricted in terms of protein, so that is probably a lower level of protein than would be recommended for Annabelle right now. And I do understand why the IMS expects/hopes that Annabelle's proteinuria will ultimately improve if it is secondary to Cushing's. However, if her monitoring ACTH tests have indicated that her cortisol has been relatively well controlled during this past year, it seems worrisome to me if her UPC keeps increasing instead of holding steady or showing some improvement. A UPC of 7.1 is really high. I wonder if there is something else going on with her kidneys after all, and that may be contributing to the uncontrolled thirst/urination.

Regardless of cause, right now while the proteinuria is high, I admit to feeling surprised that the IMS would be comfortable with your switch to an especially high protein diet. I am anxious to get the thoughts of some of our other members who are also dealing with issues of protein loss right now. I'll also rustle up some links that you might want to look at and then discuss further with your IMS.

Marianne

[labblab]

OK, here some excerpts from a reply that I actually posted a while ago in Tina's thread when she was making some dietary decisions for her Jasper. But I think they may also be relevent to Annabelle, too.


...Boy, the topic of canine renal management is definitely a contradictory one. And one of the chief difficulties is the lack of controlled experimentation. There have been lots of studies on humans and rats, but not so many on dogs and cats. So it is difficult to find substantiated evidence. However, here are some links that I had found a couple of years ago and kept bookmarked. I do think the sources are quite credible. And if I'm understanding the discussion correctly, the opinion among many specialists is that from a physiological standpoint, treatment (dietary and/or drug) really does seem warranted for dogs exhibiting persistent levels of high proteinuria on the basis of UPC results, regardless of whether or not they show other symptoms of renal disease. The first link is to a "2004 Concensus Statement of the American College of Veterinary Internal Medicine: Assessment and Management of Proteinuria in Dogs and Cats." Even though this statement is now almost a decade old, I still see reference made to the recommendations:

http://cms.evsrl.it/SocSpec/SiteTailorCommon/ShowBinary.aspx?id=2200

The second is a round-table discussion among veterinary renal experts ("Proteinura and Renal Disease") sponsored and published in 2005 by IDEXX Laboratories. This is a most informative "read," and further endorses the basic recommendations of the ACVIM Concensus Statement. It has an especially interesting section re: the advisability and degree of dietary changes depending upon patient symptomology.

http://www.idexx.com/pubwebresources/pdf/en_us/smallanimal/education/proteinuria-round-table.pdf

Lastly, here's a 2009 article from the "DVM360" magazine that discusses diagnostic and treatment issues associated with hypertension and proteinuria in dogs with renal disease:

http://veterinarynews.dvm360.com/dvm/Medicine/Diagnosis-management-of-hypertension-proteinuria-i/ArticleStandard/Article/detail/591639

Here's a quote from this last article that is a pretty good summary of the train of thought represented in all of these links, and I will look for even more recent articles when I get the chance. But for what it's worth, I think your IMS has a significant amount of professional support regarding the advisability of dietary and/or drug intervention in the face of persistent proteinuria to the extent that Jasper has exhibited. However, I don't know the specific profile of the food you're giving Jasper. As Glynda says, it may be that it is more severely protein-restricted than these panels would recommend in his situation. I especially encourage you to read the IDEXX round-table discussion in that regard, because I believe they suggest only mild/moderate protein restriction early on for a dog without other symptoms of renal disease. It's a fine line because you want to keep up with the protein that is being lost, but you don't want to cause additional renal damage from excessive protein leakage into the kidneys.



In addition to being a diagnostic marker of the severity of renal disease, renal proteinuria may be a mediator of glomerular and tubular injury. Recent findings have demonstrated that proteinuria is associated with increased risk of developing progressive CKD in dogs.

In addition, studies have shown that therapies that reduce the magnitude of proteinuria often are renoprotective. Proteinuric renal disease is often associated with systemic hypertension, which can conversely exacerbate renal proteinuria and therefore, it is difficult at times to separate the effects of high systemic and intraglomerular pressures and proteinuria.

Marianne

[Harley PoMMom]

My non-cush boy, Bear, has proteinuria and is being treated with enalapril. He also gets wild salmon oil, which I purchase from Monica Segal's website.

Proteinuria has been classified into 3 categories: pre-renal, renal, and post-renal. Based on these categories, some recommendations can be made about the type of treatment that is needed.

One important thing I wanted to mention is that when an UPC is going to be performed an urinalysis needs to be done first. Any type of sediment can falsely elevate the UPC results. When I have Bear's UPC scheduled the lab always looks at the urine first for any sediment, if none is found than the UPC is done. If any type of sediment is found than the UPC is NOT done and action is taken for whatever sediment is found.

Hope this helps.

Love and hugs, Lori

[Trish]

Hi
I am just wondering what the protein of 7.1 signifies, is it the UPC test or just a straight protein count? If you could type out exactly what it says on the results it might help. Sorry if I have not read this correctly.

My dog also has proteinuria, he is on Benzapril. We did find the cause was his elevated BP and now we have that under control with the Benzapril + Amlodipine his UPC has improved by over 50%. As Lori says if they can pinpoint what is causing the proteinuria and get that treated it can improve. I limit his salt, but he still has raw diet of venison and also grain free kibble. Hope that helps :)

[labblab]

Per the lab results that Crystal sent to our gmailbox, the UPC result on 7-1-13 was actually 7.7 and not 7.1. And that is a genuine UPC, not a straight protein count. So I believe that is really high, guys, is it not?

From what the IMS has said, I am assuming they believe that uncontrolled Cushing's is the basis for the proteinuria. But I believe that Annabelle's monitoring ACTH results have indicated reasonable cortisol control for the most part during the past year.

Marianne

[Trish]

Yes that is very high, I think general recommendations is they should be on medication if it is >2 and she is in Enalopril

[labblab]

OK, from a quick scan of Annabelle's lab results, these are the numbers I am seeing. I hope I am getting them right. Crystal, can you look at your records and double-check these for me?

ACTH history:

5/15/12 (presumably the diagnostic ACTH?):

Pre: 1.6 ug.dl
Post: 22.3 ug/dl

6/6/12:
Pre: 2.8
Post: 2.7

12/23/12:
Pre: 6.8
Post: 11.3

1/27/13:
Pre: 2.5
Post: 5.2

4/28/13:
Pre: 7.6
Post: 8.0

History of UPCs:
5/12: 5.6 (active sediment); 1.7 (quiet sediment)

7/8/12: 1.7

12/23/12: 4.6

4/28/13: 6.9

5/28/13: 6.1

7/1/13: 7.7 (Had changed to raw high-protein diet mid-June?)

[Harley PoMMom]

Yes, those are some high numbers but many things can cause protein loss.

What I haven't seen are urinalysis done prior to the UPC, any kind of sediment will cause false elvations from an UPC, even stress can make an UPC elevated and I bet with the CC Annabelle is very stressed.

[addy]

Those are high numbers for a UPC but dont they have to also be taken in context with the BUN and creatinine, etc so dont we need to look at the blood work? Skin disease can also throw protein in the urine as well as the change to a raw diet. I would not think high levels of protein in food would make the UPC that high, though.


An elevated Urine P:C Ratio indicates that there is a clinically significant amount of protein in the urine. To determine if renal disease is responsible for this urinary protein loss, you must first localize the protein loss to the kidneys by ruling out prerenal and postrenal causes (via a history, PE, CBC, biochemical profile and a complete urinalysis). And because the test is so sensitive, you must rule out transient proteinuria (which can be caused by fever, exercise and changes in temperature) to determine that the proteinuria is persistent.


http://veterinarynews.dvm360.com/dvm/article/articleDetail.jsp?id=591639&sk=&date=&pageID=2

[labblab]

Proteinuria can exist both in the presence and absence of "azotemia" (abnormally elevated blood markers such as BUN and creatinine). From what I have read, I believe proteinuria can be an issue in-and-of itself even in the absence of other elevations. Since every UPC taken during this past year has been elevated for Annabelle, I think her proteinuria qualifies as being "persistent." But I can't speak to the confounding issue of sediment since I don't know the status of her urine samples that were analyzed. And I think her blood creatinine levels have all actually been a tad lower than normal.

If Annabelle were my dog, I don't believe I'd feel comfortable feeding her a high-protein diet under these circumstances. If I am calculating correctly, on a "Dry Matter Basis," this new food is 43% protein and 32% fat (which is also very high). But if the IMS does not have any problem with it, then maybe I'm totally missing the boat.

Marianne

[goldengirl88]

Hello:
Welcome to the group. I happened to read where you said that your baby was having vestibular problems like my Tipper gets. Have you discussed this with the vet? I know my Tipper had 2 episodes of this after 2 separate ACTH tests. It really scared me. Look on YouTube there is a dog on there having an episode of this. See if this looks like what your dog is doing. That's how I figured out what was wrong with Tipper. Hope all goes well with your baby. Blessings
Patti

[Tina]

Hi Crystal,
Just checking back in on you and Annabelle. How is she doing? I am happy to see that both Lori and Marianne posted, they both helped me so much when we discovered that Jasper had proteinuria at a level that needed to be treated. Marianne, thanks for posting those excerpts and links from our thread, I was going to go track down that information. I didn't have time to mention the diet aspect of treatment in my last post.

Are Annabelle's BUN and Creatinine levels elevated? These values indicate kidney function and are also important when there is proteinuria, and need to be considered when determining what treatment is recommended.


Proteinuria can exist both in the presence and absence of "azotemia" (abnormally elevated blood markers such as BUN and creatinine). From what I have read, I believe proteinuria can be an issue in-and-of itself even in the absence of other elevations. Since every UPC taken during this past year has been elevated for Annabelle, I think her proteinuria qualifies as being "persistent." But I can't speak to the confounding issue of sediment since I don't know the status of her urine samples that were analyzed. And I think her blood creatinine levels have all actually been a tad lower than normal.

If Annabelle were my dog, I don't believe I'd feel comfortable feeding her a high-protein diet under these circumstances. If I am calculating correctly, on a "Dry Matter Basis," this new food is 43% protein and 32% fat (which is also very high). But if the IMS does not have any problem with it, then maybe I'm totally missing the boat.

Marianne

As Marianne said, proteinuria can be present even when the BUN and Creatinine are within normal limits. This is the case for Jasper, at least so far. In addition to Enalapril and Welactin, he was switched to a moderate protein restricted prescription diet. The combination of all three have significantly lowered his UPC, and hopefully it will be even lower on the next check.

Annabelle has had several consecutive elevated UPC's. I can't really say if a moderate protein restricted diet would be recommended for her, but with the levels she is showing, I definitely would not feel comfortable feeding a high protein diet. I would encourage you to ask your vet about this since it looks like she hasn't addressed it.

I did a lot of research on the prescription renal diets when Jasper was diagnosed. Most are considered to be severely protein restricted. The only food I found that was actually considered to have a moderate protein restriction was Royal Canin Renal MP.

Has Annabelle's blood pressure been checked? High BP can cause proteinuria also.

Hugs,
Tina and Jasper

[labblab]

Tina, I'm so glad you had the chance to come back again to add your thoughts. Once again, Crystal, I hope you will go back through Annabelle's lab results yourself to reconfirm the numbers I'm citing here. I get nervous when I'm the only one who is looking at the numbers! But from what I can tell, Annabelle's creatinine has always actually been a bit on the low side. There are no breakouts for BUN alone, but the BUN/creatinine ratio has been "high" (but perhaps this is due to the low creatinine as opposed to an abnormality in the BUN). But one other lab result of concern to me is a consistently high level of phosphorous in the blood, because I believe this is also associated with kidney dysfunction and may be a reason, in its own right, to avoid high-protein feeding.

Bottom line, if Annabelle were mine, I'd want to ask the IMS these questions:

1. Is there any reason to doubt the validity of these UPC's (like high sediment in the urine samples, for instance)? Since Annabelle's blood creatinine has been low, would there be reason to think that the UPCs may be skewed due to low creatinine in the urine as well (I am not seeing separate urinalysis "break-outs" for protein and creatinine alone. I think the UPC analysis is supposed to self-correct in that regard, but it would still be worth asking the IMS this question).

2. Do you have any concerns about Annabelle's high phosphorous levels?

3. In view of the UPCs (if they are accurate) and phorphorous readings, should I be lowering at all the amount of protein that I am feeding her (especially in view of the fact that her UPC has elevated significantly since shifting her to this new, especially high-protein food)?

4. Since her cortisol has been relatively well controlled during this past year but her UPCs have been increasing, do you have any thoughts as to whether it may be something other than Cushing's that is causing the protein loss?

Re: Annabelle's food, one complicating factor with making a change right now is the fact that you are planning to begin her Lysodren load. You really do not want to make dietary changes at the same time you are starting Lysodren because monitoring appetite and GI issues are key to determining the correct dosing of the drug. But since you will be talking with the vet in conjunction with the Lysodren, I would definitely also ask these questions about Annabelle's kidney status so that, if advisable, you'd be prepared to make a shift in food as soon as it seems safe to do so. And even if the vet ends up thinking that lowering the protein somewhat is advisable, that doesn't mean you have to go to a prescription diet. As Tina says, they are usually very highly restricted. But you could still select a regular food that just isn't as high in protein as what you are currently feeding Annabelle.

Marianne

[BostonLover]

OK, from a quick scan of Annabelle's lab results, these are the numbers I am seeing. I hope I am getting them right. Crystal, can you look at your records and double-check these for me?

ACTH history:

5/15/12 (presumably the diagnostic ACTH?):

Pre: 1.6 ug.dl
Post: 22.3 ug/dl

6/6/12:
Pre: 2.8
Post: 2.7

12/23/12:
Pre: 6.8
Post: 11.3

1/27/13:
Pre: 2.5
Post: 5.2

4/28/13:
Pre: 7.6
Post: 8.0

History of UPCs:
5/12: 5.6 (active sediment); 1.7 (quiet sediment)

7/8/12: 1.7

12/23/12: 4.6

4/28/13: 6.9

5/28/13: 6.1

7/1/13: 7.7 (Had changed to raw high-protein diet mid-June?)

Yes, these are correct.

[BostonLover]

Proteinuria can exist both in the presence and absence of "azotemia" (abnormally elevated blood markers such as BUN and creatinine). From what I have read, I believe proteinuria can be an issue in-and-of itself even in the absence of other elevations. Since every UPC taken during this past year has been elevated for Annabelle, I think her proteinuria qualifies as being "persistent." But I can't speak to the confounding issue of sediment since I don't know the status of her urine samples that were analyzed. And I think her blood creatinine levels have all actually been a tad lower than normal.

If Annabelle were my dog, I don't believe I'd feel comfortable feeding her a high-protein diet under these circumstances. If I am calculating correctly, on a "Dry Matter Basis," this new food is 43% protein and 32% fat (which is also very high). But if the IMS does not have any problem with it, then maybe I'm totally missing the boat.

Marianne

To be honest, and now I'm even more concerned, the IMS has never mentioned ANYTHING regarding her diet. Nothing....:mad:

[BostonLover]

Tina, I'm so glad you had the chance to come back again to add your thoughts. Once again, Crystal, I hope you will go back through Annabelle's lab results yourself to reconfirm the numbers I'm citing here. I get nervous when I'm the only one who is looking at the numbers! But from what I can tell, Annabelle's creatinine has always actually been a bit on the low side. There are no breakouts for BUN alone, but the BUN/creatinine ratio has been "high" (but perhaps this is due to the low creatinine as opposed to an abnormality in the BUN). But one other lab result of concern to me is a consistently high level of phosphorous in the blood, because I believe this is also associated with kidney dysfunction and may be a reason, in its own right, to avoid high-protein feeding.

Bottom line, if Annabelle were mine, I'd want to ask the IMS these questions:

1. Is there any reason to doubt the validity of these UPC's (like high sediment in the urine samples, for instance)? Since Annabelle's blood creatinine has been low, would there be reason to think that the UPCs may be skewed due to low creatinine in the urine as well (I am not seeing separate urinalysis "break-outs" for protein and creatinine alone. I think the UPC analysis is supposed to self-correct in that regard, but it would still be worth asking the IMS this question).

2. Do you have any concerns about Annabelle's high phosphorous levels?

3. In view of the UPCs (if they are accurate) and phorphorous readings, should I be lowering at all the amount of protein that I am feeding her (especially in view of the fact that her UPC has elevated significantly since shifting her to this new, especially high-protein food)?

4. Since her cortisol has been relatively well controlled during this past year but her UPCs have been increasing, do you have any thoughts as to whether it may be something other than Cushing's that is causing the protein loss?

Re: Annabelle's food, one complicating factor with making a change right now is the fact that you are planning to begin her Lysodren load. You really do not want to make dietary changes at the same time you are starting Lysodren because monitoring appetite and GI issues are key to determining the correct dosing of the drug. But since you will be talking with the vet in conjunction with the Lysodren, I would definitely also ask these questions about Annabelle's kidney status so that, if advisable, you'd be prepared to make a shift in food as soon as it seems safe to do so. And even if the vet ends up thinking that lowering the protein somewhat is advisable, that doesn't mean you have to go to a prescription diet. As Tina says, they are usually very highly restricted. But you could still select a regular food that just isn't as high in protein as what you are currently feeding Annabelle.

Marianne

Thanks everyone for your input. Marianne I'm calling the IMS to ask her these questions right now. I start her on the Lysodren this Sunday, so I'm a little worried about changing her diet, but I don't want to be slowly killing her with this high protein diet.

[labblab]

Crystal, I'm really glad you're going to touch base with the IMS since there may be a whole piece to this puzzle of which I am unaware or that I am misinterpreting. And as for changing Annabelle's food, I would not try to change it this week, either, if you plan to start the Lysodren on Sunday. I would wait until after she has completed the "loading" phase, for sure.

Marianne

[BostonLover]

Crystal, I'm really glad you're going to touch base with the IMS since there may be a whole piece to this puzzle of which I am unaware or that I am misinterpreting. And as for changing Annabelle's food, I would not try to change it this week, either, if you plan to start the Lysodren on Sunday. I would wait until after she has completed the "loading" phase, for sure.

Marianne

Thanks so much Marianne. I'm overwhelmed with all the knowledge I'm gaining from this site. I only wish I would have found it last year when she was first diagnosed, but my other Boston was suffering from a brain tumor, and I feel maybe AnnaBelle's issues got pushed to the side. I feel awful. :(

[addy]

Hi,

I just wanted to add that my Zoe's last UPC was 1.5. She has been on a raw diet and I have steadily been trying to decrease the amount of raw (long story as she as inflammatory bowel disease). Our IMS told me that even a 10% decrease may be enough to bring down her UPC under 1.5. So the raw food could contribute to the spike you are seeing but as Marianne already said, now would not be a good time to change food.

[BostonLover]

Once I get my Bells on a maintenance dose of Lysodren, what food(s) do you guys recommend?

Also, since her Coritsol levels have been under control with the Trilostane, is there an increased chance she will go into Addisonian Crisis once I begin the Lysodren? I'm so worried about this drug, as the IMS keeps using words like "dangerous".:confused:

[goldengirl88]

Crystal:
Just about everyone has their dog on a different diet. You can opt for a nutritionist. I know form speaking to one that these dogs need a low density diet, without grain. My vet said you have to be careful of the protein because of the kidneys. I hope all goes well for you with the Lysodren. Just keep a close watch and you will do well. What part of Pgh. do you live in? Who is your babies Dr. I may know them. Blessings
Patti

[Squirt's Mom]

Cush pups need a diet that is low in fats and moderate in proteins. Grains are just fine unless there is some reason AnnaBelle can't have them, like allergies, etc. The "no grain" trend is just that - a trend. Some pups don't handle rice well but can handle oats just fine. ;) Diet is highly individual so stick with what works for AnnaBelle as long as it is low fat, moderate protein.

[BostonLover]

Tina, I'm so glad you had the chance to come back again to add your thoughts. Once again, Crystal, I hope you will go back through Annabelle's lab results yourself to reconfirm the numbers I'm citing here. I get nervous when I'm the only one who is looking at the numbers! But from what I can tell, Annabelle's creatinine has always actually been a bit on the low side. There are no breakouts for BUN alone, but the BUN/creatinine ratio has been "high" (but perhaps this is due to the low creatinine as opposed to an abnormality in the BUN). But one other lab result of concern to me is a consistently high level of phosphorous in the blood, because I believe this is also associated with kidney dysfunction and may be a reason, in its own right, to avoid high-protein feeding.

Bottom line, if Annabelle were mine, I'd want to ask the IMS these questions:

1. Is there any reason to doubt the validity of these UPC's (like high sediment in the urine samples, for instance)? Since Annabelle's blood creatinine has been low, would there be reason to think that the UPCs may be skewed due to low creatinine in the urine as well (I am not seeing separate urinalysis "break-outs" for protein and creatinine alone. I think the UPC analysis is supposed to self-correct in that regard, but it would still be worth asking the IMS this question).

2. Do you have any concerns about Annabelle's high phosphorous levels?

3. In view of the UPCs (if they are accurate) and phorphorous readings, should I be lowering at all the amount of protein that I am feeding her (especially in view of the fact that her UPC has elevated significantly since shifting her to this new, especially high-protein food)?

4. Since her cortisol has been relatively well controlled during this past year but her UPCs have been increasing, do you have any thoughts as to whether it may be something other than Cushing's that is causing the protein loss?

Re: Annabelle's food, one complicating factor with making a change right now is the fact that you are planning to begin her Lysodren load. You really do not want to make dietary changes at the same time you are starting Lysodren because monitoring appetite and GI issues are key to determining the correct dosing of the drug. But since you will be talking with the vet in conjunction with the Lysodren, I would definitely also ask these questions about Annabelle's kidney status so that, if advisable, you'd be prepared to make a shift in food as soon as it seems safe to do so. And even if the vet ends up thinking that lowering the protein somewhat is advisable, that doesn't mean you have to go to a prescription diet. As Tina says, they are usually very highly restricted. But you could still select a regular food that just isn't as high in protein as what you are currently feeding Annabelle.

Marianne

Hi Marianne,

Dr. Peterson answered the questions above. Here are her answers. Please let me know what you think.

Mrs. Franke,



In response to your questions listed below

1. Although the creatinine is mildly decreased and in theory, it may effect the ratio, it certainly should not cause the elevation we are seeing with AnnaBelle. Labratories do not provide a break down of creatinine vs. protein.



2. The mild elevation in phosphorous has been attributed to the 3+ hemolysis which has consistently been present on the serum chemistries. This is not supportive of an underlying disease process.



3. The protein in the diet does not effect the protein loss through the kidneys. The only thing that effects this is underlying dysfunction of the glomerular component of the kidney. The high protein diet does indeed increase the work load of the kidneys which can result in progression of true kidney failure. This can be a consequence of progressive protein loss through the kidneys. In general, a high quality, restricted protein diet is recommended in patients with protein losing nephropathy to help protect the kidneys.



4. Since AnnaBelle has additional clinical signs supportive of poor clinical control of her Cushing's disease (excessive drinking/ urination and calcinosis cutis), it has to be assumed the protein losing nephropathy is also associated with her Cushing's disease as well. Certainly, we can screen her for additional disease processes such as immune mediated disease, heartworm disease, various tick borne disease, etc. Other diseases that can cause this have already been tested/ screened for- blood pressure, urinary tract infection, occult cancerous process. Other diseases such as renal amyloidosis would require a kidney biopsy to diagnosis. If you are interested in testing AnnaBelle for any of these diseases, these can performed at her next appointment. The kidney biopsy would require surgery and would not be recommended until it is confirmed her Cushing's disease is clinically well controlled and all other test results are normal/negative and she is still proteinuric.



I hope this helps

Best regards,

Dr. Tracey Peterson

[BostonLover]

Crystal:
Just about everyone has their dog on a different diet. You can opt for a nutritionist. I know form speaking to one that these dogs need a low density diet, without grain. My vet said you have to be careful of the protein because of the kidneys. I hope all goes well for you with the Lysodren. Just keep a close watch and you will do well. What part of Pgh. do you live in? Who is your babies Dr. I may know them. Blessings
Patti

Hi Patti,

We live in Moon. Currently our vet is in Sewickley, Dr. Dismukes, and we take Bells to PVSEC to see Dr. Peterson in Internal Med. We have not been happy with Dr. Dismukes, and are in the process of looking for another vet. Any suggestions? What part of PGH are you in?:)

[goldengirl88]

Hi Crystal:
I lived in the South Hills do no I did not go to any vets over in that area. It is so hard to find a good vet that truly cares about your dog, so keep asking around and maybe someone in that area can help. Blessings
Patti

[labblab]

Crystal, that's great that the IMS has responded to your questions so quickly and thoroughly! I only have a moment to post right now so I will try to add more later, but Dr. Peterson's response does leave me with the continuing question as to why she has not spoken with you about desirable protein parameters in Annabelle's food.


The high protein diet does indeed increase the work load of the kidneys which can result in progression of true kidney failure. This can be a consequence of progressive protein loss through the kidneys. In general, a high quality, restricted protein diet is recommended in patients with protein losing nephropathy to help protect the kidneys.

It sounds to me as though she is endorsing the idea of some degree of protein limitation, but yet she is still not giving you any specific instructions about this or questioning you about the protein profile of Annabelle's current food. So when you return for your next appointment, I'd definitely pin her down about this. What percentage of protein (on a "dry matter basis") would she recommend?

Marianne

[BostonLover]

Crystal, that's great that the IMS has responded to your questions so quickly and thoroughly! I only have a moment to post right now so I will try to add more later, but Dr. Peterson's response does leave me with the continuing question as to why she has not spoken with you about desirable protein parameters in Annabelle's food.



It sounds to me as though she is endorsing the idea of some degree of protein limitation, but yet she is still not giving you any specific instructions about this or questioning you about the protein profile of Annabelle's current food. So when you return for your next appointment, I'd definitely pin her down about this. What percentage of protein (on a "dry matter basis") would she recommend?

Marianne

I agree. I don't understand why dietary restricitions were never discussed.

[BostonLover]

Hi Crystal:
I lived in the South Hills do no I did not go to any vets over in that area. It is so hard to find a good vet that truly cares about your dog, so keep asking around and maybe someone in that area can help. Blessings
Patti

My husband is from the South Hills. Attended Upper St. Clair highschool. :)

[goldengirl88]

I had moved from Scott Township to Upper St. Clair and lived there the last 30 years. Small world- Blessings
Patti

[BostonLover]

I had moved from Scott Township to Upper St. Clair and lived there the last 30 years. Small world- Blessings
Patti

Very small world! :D

[BostonLover]

Well almost 2 weeks with no Trilostane and I've seen no changes in my Bells. We start the Lysodren Sunday. I'm worried sick about it because the IMS seemed worried when she mentioned swtiching. Said it could cure her, or kill her :confused: I'm just real worried about the loading phase, as both my husband and I work FT and are gone for 8 hours/day. I don't want to come home to find her dead or sick. :(

[labblab]

Well, that is a frightful comment by the IMS for sure, and does very little to inspire confidence that your IMS is experienced in the use of Lysodren! :(

I must say that I am concerned that no ACTH testing has been performed since April when I believe Annabelle's post-ACTH result was around 8 or so? I would think that your IMS would want to know the exact status of Annabelle's current cortisol level in order to reconfirm that it is high enough to safely make the drug switch, and also to have a baseline against which to judge the progress of the Lysodren loading going forward.

It seems I have been encouraging a lot of folks to contact Dechra directly this week, and I'm going to make the same recommendation to you. They are the company who manufactures brandname trilostane ("Vetory"), and they maintain technical representatives on staff who are available to directly field questions from owners and vets. I encourage you to call them at their Kansas office (link to contact info is below), explain the exact situation and time frame for making this switch, and also tell them that she has not had an ACTH performed since April at whch time her post-ACTH was approx. 8 ug/dl. I think their feedback can either help ease our minds (and if so, great!) or instead prompt a request to your IMS that Annabelle's ACTH results be checked prior to proceeding with the switch.

http://www.dechra-us.com/Default.aspx?ID=365

Marianne

[Squirt's Mom]

If I were you, I would want an ACTH before starting the Lsyodren. Is Belle showing any increase in signs? If not and there is no ACTH to see where the cortisol is now, your vet is taking unnecessary risks by telling you to start the Lysodren now. Do as Marianne suggested and call Dechra. ;)

Hugs,
Leslie and the gang

[lulusmom]

I agree with Marianne and am aghast that an IMS would make such a dreadful statement. The fact of the matter is that unless a vet is totally clueless and doesn't do their job in counseling their client about the importance of being vigilant in monitoring their dog, death is extremely remote. I'm very experienced with Lysodren and have loaded my two cushdogs (now passed) more than a few times without adverse effects. My gp vet and internal medicine specialist(s) are very experienced with the drug and they wouldn't have done their job if they didn't put the fear of God into me to make me snap and do my part. Telling you that it will either cure or kill a dog is beyond ignorant. Shame, shame, shame on her. :mad::mad::mad: I also think it is beyond ignorant to switch a dog from Trilostane to Lysodren without knowing where cortisol levels are. I switched my dogs from Trilostane to Lysodren and I didn't do it until both were completely symptomatic again and my littlest one didn't start showing symptoms until her post cortisol was well over 20 ug/dl. I do know that some specialists think it's okay if post cortisol levels are greater than 9 ug/dl and symptomatic but a great many of them want to wait at least 30 days. Dr. Jack Oliver at the University of Tennessee Knoxville was considered an authority on adrenal steroids and even he recommends that you wait 30 days.

Here is a direct Jack Oliver quote from his paper, entitled "STEROID PROFILES IN THE DIAGNOSIS OF CANINE ADRENAL DISORDERS" by Dr. Oliver. The entire version can be found on the UTK website.


Trilostane. Enzyme inhibition by trilostane occurs for 3-beta hydroxysteroid dehydrogenase, but also for 11-beta hydroxylase.30 Thus, 11-deoxycortisol levels build-up in dogs treated with trilostane. It is also apparent that other intermediate steroid levels increase (androstenedione, 17-hydroxyprogesterone, estradiol and progesterone) in dogs treated with trilostane,29 which could be due to the 11-beta hydroxylase inhibition, and possibly 21-hydroxylase enzyme inhibition.29 The reason why only 11-deoxycortisol levels were increased in the above study30 may be due to the length of trilostane exposure (3-7 weeks), compared to dogs that are exposed to trilostane for extended periods. Trilostane reportedly offers effective control of Cushing’s syndrome,30 but the long-term effects of the elevated intermediate steroids remain ill-defined. Some dogs do have return of clinical signs of Cushing’s syndrome while on trilostane.29 Because trilostane seems to pre-dispose dogs to increased adrenal toxicity with mitotane, an acute switch from trilostane to mitotane treatment should not be done.29

While Dr. Oliver didn't define what an acute switch is in this paper, I sent him an email before switching my dogs to Lysodren and he recommended that I wait at least 30 days or until my dogs were symptomatic again.

[Arizona Boston]

Hello Crystal and AnnaBelle,

I have a 10 1/2 year old 18 lb Boston girl named Lucy who also has worsening C Cutis. She has been on 30 mg Vetoryl (Trilostane) for 8 months and we just recently increased it to 30mg AM and 10 mg PM so it sound like our journeys are similar.

Next week we have her ACTH redrawn and I'll post those new numbers.

I understand from many people on the board that the C Cutis is very hard to control, but I have to say that over all I could be giving a placebo for all the good the Vetoryl has done. Lucy is still pot bellied, weak legs, starving hungry, panting....well, you get the point. But her kisses are still sweet.

I have used some over- the- counter human products that may or may not have helped, including antibiotic ointment, tinactin (anti-fungal) Salicylic 3% (anti-psoriasis) and I bathe her with a dandruff shampoo. It got the crusties off and now she just has what looks like smooth moles.

I also bought some T shirts for her to wear when we are out in public because it looks like she has been shot up with buck shot.

I'll be following your story closely.

Good Luck,
Shelly and Lucy

[Budsters Mom]

Hi,
I'm just dropping in to send you and Annabel hugs and healing energy. We count on the vets to know the right course of treatment. Unfortunately they don't know everything and can really mess things up! Sorry I can't help you with the technical stuff.:o

[addy]

I am so sorry you are getting hit over the head from your vet. I do believe having an ACTH test done prior to loading is good advice. From a technical stand point, because of the Calcinosis Cutis, by waiting for overt symptoms to reappear or waiting another 2 weeks, you also could run the risk of the Calcinosis Cutis getting a stronger foothold. So it is a hard place to find yourself in, I'm sure.

I think Marianne has a very good idea for you to call Dechra. I think I already mentioned -perhaps every dog is different -but they told my IMS in May she could load my Zoe who has been on Vetoryl for two years and had a post of 4ug/dl without any waiting period though they would not recommend tweaking her dose of Vetoryl up by 25%.:confused::confused: Maybe you will get another Dechra vet with a different opinion or perhaps they factor in other things, or perhaps my IMS is full of it and just telling me that.;)

You probably feel like you are getting hit over the head from every angle, huh?

Have you asked you vet how many dogs she has switched from Vetoryl to Lysodren? You have to feel comfortable with the treatment and with your vet.

As a side note to Shelly and Lucy- if your pup is still showing symptoms, you may need a dose change.:)

[lulusmom]

I will be posting this on four members' threads, all of whom are dealing with calcinosis cutis. Kerry, Millie's Mama; Crystal, Annabelle's Mama; Shelly, Lucy's Mama and Pat, Peety's Mama.

I've seen too many dogs on Trilostane who have either developed calcinosis cutis while on the drug or had worsening effect while on the drug. Based on the frequency with which we've seen calcinosis cutis on this forum, there seems to be a correlation with the increased popularity of Trilostane for treatment of cushing's. I've had a gut feeling for a very long time that Trilostane is responsible for worsening calcinosis cutis due to it's effects on the sex hormones. Dr. Oliver, was the leading expert on adrenal steroids and he firmly believed that 11-deoxycortisol levels build-up in dogs being treated with Trilostane as did other intermediate steroid such as androstenedione, 17-hydroxyprogesterone, estradiol and progesterone. I've never been able to find anything in layman's terms that explains the affect, if any, these steroids have on calcium metabolism. While searching for that connection, I stumbled upon something even better. It was an abstract of a study entitled, "Canine hyperadrenocorticism: effects of trilostane on parathyroid hormone, calcium and phosphate concentrations". The last sentence of that abstract was eye opening.


[B]Despite no significant difference between calcium concentrations in the pretreatment HAC and control groups, calcium concentrations increased significantly with treatment....and....These results show that adrenal secondary hyperparathyroidism resolves with treatment and suggest that increased calcium and phosphate levels have a role in its pathogenesis./B]

It looks to me that cortisol isn't the only adrenal steroid that can cause elevations in blood calcium levels. Dr. David Bruyette, a renown endocrine expert, readily admits that he has had bad luck in resolving cc with trilostane. That's pretty telling coming from a high profile specialist who is a contributor to Dechra's continuing education program for veterinarians. This is not a new study. As a matter of fact, I believe it may have been published before Vetoryl was approved by the FDA.

You can find the complete abstract here: http://onlinelibrary.wiley.com/doi/10.1111/j.1748-5827.2005.tb00283.x/abstract

I'm just sharing my thoughts with those of you who may want to start asking more questions of your vets....or you may even consider calling Dechra, the manufacture of Vetoryl (Trilostane). I'd be very interested to hear what they have to say about this study.

Glynda

[labblab]

For folks who want to share general thoughts and comments about this study that Glynda has found, I've created a new thread in which our comments can be consolidated all in one place:

http://www.k9cushings.com/forum/showthread.php?t=5509

Marianne

[goldengirl88]

Crystal:
I have no experience with Lysodren, but I can tell you I do absolutely NOTHING with my Tipper before getting an ACTH test. I am surprised an IMS would not insist on this. I am even more surprised at the statement it will either cure or kill the dog. None of this cures the dog, and as far as the killing part, wow how off base is this Dr.? I would definitely seek out another IMS. Has she treated Cushing very long?? I am worried for you, and want you to please consider what the other members are advising, and would call Dechra immediately. I hope and pray all goes well for you and your baby. Blessings
Patti

[BostonLover]

Well, that is a frightful comment by the IMS for sure, and does very little to inspire confidence that your IMS is experienced in the use of Lysodren! :(

I must say that I am concerned that no ACTH testing has been performed since April when I believe Annabelle's post-ACTH result was around 8 or so? I would think that your IMS would want to know the exact status of Annabelle's current cortisol level in order to reconfirm that it is high enough to safely make the drug switch, and also to have a baseline against which to judge the progress of the Lysodren loading going forward.

It seems I have been encouraging a lot of folks to contact Dechra directly this week, and I'm going to make the same recommendation to you. They are the company who manufactures brandname trilostane ("Vetory"), and they maintain technical representatives on staff who are available to directly field questions from owners and vets. I encourage you to call them at their Kansas office (link to contact info is below), explain the exact situation and time frame for making this switch, and also tell them that she has not had an ACTH performed since April at whch time her post-ACTH was approx. 8 ug/dl. I think their feedback can either help ease our minds (and if so, great!) or instead prompt a request to your IMS that Annabelle's ACTH results be checked prior to proceeding with the switch.

http://www.dechra-us.com/Default.aspx?ID=365

Marianne

Thank you Marianne, I will give them a call today.

[BostonLover]

If I were you, I would want an ACTH before starting the Lsyodren. Is Belle showing any increase in signs? If not and there is no ACTH to see where the cortisol is now, your vet is taking unnecessary risks by telling you to start the Lysodren now. Do as Marianne suggested and call Dechra. ;)

Hugs,
Leslie and the gang

Well last night I noticed she is even MORE thirsty than ever. So much that I had to put a water bowl in the bedroom (helps her not have to climb up and down the stairs, as she is so weak). So her water intake has increased, and I did notice she eats her food in 15 seconds, versus the usual 20 seconds. LOL, I'm not joking, she INHALES it. It's raw and I put it in a muffin tin to try and make her not inhale it, but she figured out the pan pretty quick. So I am noticing some signs that her cortisol is increasing.

[BostonLover]

I agree with Marianne and am aghast that an IMS would make such a dreadful statement. The fact of the matter is that unless a vet is totally clueless and doesn't do their job in counseling their client about the importance of being vigilant in monitoring their dog, death is extremely remote. I'm very experienced with Lysodren and have loaded my two cushdogs (now passed) more than a few times without adverse effects. My gp vet and internal medicine specialist(s) are very experienced with the drug and they wouldn't have done their job if they didn't put the fear of God into me to make me snap and do my part. Telling you that it will either cure or kill a dog is beyond ignorant. Shame, shame, shame on her. :mad::mad::mad: I also think it is beyond ignorant to switch a dog from Trilostane to Lysodren without knowing where cortisol levels are. I switched my dogs from Trilostane to Lysodren and I didn't do it until both were completely symptomatic again and my littlest one didn't start showing symptoms until her post cortisol was well over 20 ug/dl. I do know that some specialists think it's okay if post cortisol levels are greater than 9 ug/dl and symptomatic but a great many of them want to wait at least 30 days. Dr. Jack Oliver at the University of Tennessee Knoxville was considered an authority on adrenal steroids and even he recommends that you wait 30 days.

Here is a direct Jack Oliver quote from his paper, entitled "STEROID PROFILES IN THE DIAGNOSIS OF CANINE ADRENAL DISORDERS" by Dr. Oliver. The entire version can be found on the UTK website.



While Dr. Oliver didn't define what an acute switch is in this paper, I sent him an email before switching my dogs to Lysodren and he recommended that I wait at least 30 days or until my dogs were symptomatic again.

I just made an appt to take her in tomorrow for an ACTH so we know if we can start the Lysodren Sunday. THANK YOU ALL SOOOOO MUCH for all the information and guidance!!!!!

[BostonLover]

Hello Crystal and AnnaBelle,

I have a 10 1/2 year old 18 lb Boston girl named Lucy who also has worsening C Cutis. She has been on 30 mg Vetoryl (Trilostane) for 8 months and we just recently increased it to 30mg AM and 10 mg PM so it sound like our journeys are similar.

Next week we have her ACTH redrawn and I'll post those new numbers.

I understand from many people on the board that the C Cutis is very hard to control, but I have to say that over all I could be giving a placebo for all the good the Vetoryl has done. Lucy is still pot bellied, weak legs, starving hungry, panting....well, you get the point. But her kisses are still sweet.

I have used some over- the- counter human products that may or may not have helped, including antibiotic ointment, tinactin (anti-fungal) Salicylic 3% (anti-psoriasis) and I bathe her with a dandruff shampoo. It got the crusties off and now she just has what looks like smooth moles.

I also bought some T shirts for her to wear when we are out in public because it looks like she has been shot up with buck shot.

I'll be following your story closely.

Good Luck,
Shelly and Lucy

Oh Lucy!!! She is DARLING!!!!

Our stories are VERY similar. Bells was on 30 in the am and 10 in the pm, but was on Trilostane for well over a year, and we never really saw any improvement worth mentioning. Instead, it seemed like she got worse on it. She got weaker, lost her hair, still has huge pot bellly, would drink 8 cups water a day on free choice, super ravenous and then developed the C Cutis. Right now it's a huge "stripe" down her spine, and I see new ones on her ribs and on her right forearm. It's like she doesn't even know they are there. No itching at all. But now parts of the stripe are coming off with the pink skin underneath.

[molly muffin]

Yay for getting into get an ACTH test! Always Know what the cortisol is doing.
Seriously Shame on your vet for saying that. I bet all our admins/mods/members who have used lysodren successfully and with great knowledge for many years are having a "what the.." moment reading That!

This is a vet that isn't very knowledgeable about lysodren, which isn't surprising perhaps, now that most vets seem to be on the all trilostane all the time bandwagon.

What one must remember though is that lysodren was used for years and years before Trilostane. Used successfully I should say. It still takes a vet that knows what they are doing though.

Hang in there!
Sharlene and Molly Muffin

[lulusmom]

Hi Crystal.

Good for you for scheduling an acth stimulation test. In preparation for loading with Lysodren, please make sure you read the Lysodren Loading Instructions and related tips, which can be found in our Helpful Resources subforum. I've included a link below for your handy reference. Please make sure you print out these instructions and keep them handy. Both of my cushpups have passed but I've kept my dog eared copy for sentimental reasons. Once you've had a chance to read and absorb these instructions, let us know if you have any questions. We will expect regular updates from you and you can count on us to be here with you and Annabelle every step of the way.

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

Glynda

[Squirt's Mom]

Way to go, Mom!

[BostonLover]

Good Morning,

Just wanted to let everyone know we started AnnaBelle on the Lysodren yesterday. 1/4 pill every 12 hours. So far, so good.

We had another ACTH done Friday, and the results of that were
Pre: 8.6
Post: 19.3
so she said we could go ahead and load the Lysodren. I'm really hoping this medicine helps her. She's so weak now, and lost 2 pounds over the last month and a half, and that worries me.

[Squirt's Mom]

Did you get the ACTH results first? Please don't start the Lyso without knowing those results are elevated again. If you do have them, would you mind sharing them with us?

Is Annabelle showing an increase in signs? If not, please don't start the Lyso.

What do you mean by "weak"? Is she eating? Walking ok? It's a pretty hard fast rule that we don't give these meds, either Lyso or Vetoryl (Trilostane), if the pup is not well.

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

[BostonLover]

Did you get the ACTH results first? Please don't start the Lyso without knowing those results are elevated again. If you do have them, would you mind sharing them with us?

Is Annabelle showing an increase in signs? If not, please don't start the Lyso.

What do you mean by "weak"? Is she eating? Walking ok? It's a pretty hard fast rule that we don't give these meds, either Lyso or Vetoryl (Trilostane), if the pup is not well.

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

Hi Leslie,

Yes, we got the results. They were: Pre: 6.8
Post: 11.3

She did show an increase in signs---drinking and peeing more (which I didn't think could be possible), and she ate even faster (10 seconds versus the usual 25).

She is eating and going to the bathroom just fine. She just has NO muscle anymore. It's very hard for her to get up and down stairs...she can do it, but struggles, so I've been carrying her when I can. On Saturday we took the box spring and frame off our bed so now it's just a mattress on the floor, because the bed was so high off the ground, and she would jump off the bed 6-7 times durning the night, we thought this would be easier on her joints and legs...I don't want her to break anything.

[Squirt's Mom]

Ok, I feel a little bit better with the increase in signs but the ACTH is a tad bit worrisome. That is high for a treated pup however it is NOT high for an untreated pup. Annabelle hasn't had any meds for what, 2 weeks, 2 1/2 weeks now? So I'm not sure if that should be interpreted from a treated or non-treated perspective. To quote Glynda's post -


I switched my dogs from Trilostane to Lysodren and I didn't do it until both were completely symptomatic again and my littlest one didn't start showing symptoms until her post cortisol was well over 20 ug/dl. I do know that some specialists think it's okay if post cortisol levels are greater than 9 ug/dl and symptomatic...

Her signs have increased and the post is over 9 ug/dl so I'll try to stop worrying. Don't hold your breath, tho. ;):p It's one of the things I do best! :D

Keep your hawk eye on her and keep in touch with us. We are here to help, to listen, to share. Are you comfortable with the signs that could mean she is loaded, the med needs to stop, and the ACTH scheduled? Are you versed in the signs that could mean the cortisol has gone too low? Do you have any prednisone on hand? If not, ask the vet for some. You won't need many, just a couple of pills. But you need to have either the pred on hand or a guarantee from the vet that they will be available 24/7 during the load just in case. We don't anticipate problems but we like to be prepared - like the Scouts, ya know! ;)

YEEHAW! We're off! :D It'll be over before you know it and on to calmer sailing on maintenance. ;)

Hugs,
Leslie and the gang

[Squirt's Mom]

Oh! the bed thing....I have developed a fear of dying in my sleep with Squirt and Trinket on the bed, unable to get down. Just one more reason not to sleep well. :rolleyes::D I'm not sure I could physically handle getting up off the floor so I've been trying to design some steps that fit either the foot or the side of the bed that they could learn to use. Trink being blind and Squirt with her legs make this interesting to say the least! I'm thinking Better Homes and Gardens is gonna pass on this decorating scheme, too. :p

[BostonLover]

Ok, I feel a little bit better with the increase in signs but the ACTH is a tad bit worrisome. That is high for a treated pup however it is NOT high for an untreated pup. Annabelle hasn't had any meds for what, 2 weeks, 2 1/2 weeks now? So I'm not sure if that should be interpreted from a treated or non-treated perspective. To quote Glynda's post -



Her signs have increased and the post is over 9 ug/dl so I'll try to stop worrying. Don't hold your breath, tho. ;):p It's one of the things I do best! :D

Keep your hawk eye on her and keep in touch with us. We are here to help, to listen, to share. Are you comfortable with the signs that could mean she is loaded, the med needs to stop, and the ACTH scheduled? Are you versed in the signs that could mean the cortisol has gone too low? Do you have any prednisone on hand? If not, ask the vet for some. You won't need many, just a couple of pills. But you need to have either the pred on hand or a guarantee from the vet that they will be available 24/7 during the load just in case. We don't anticipate problems but we like to be prepared - like the Scouts, ya know! ;)

YEEHAW! We're off! :D It'll be over before you know it and on to calmer sailing on maintenance. ;)

Hugs,
Leslie and the gang

HA HA! Well, I take much comfort in your worrying, as my husband and I didn't sleep a wink last night---every move she made we were up and snuggling on her and making sure she was ok.

I'm watching her like a hawk, and if I see ANY pausing or slowing down on eating, I'm taking her right to the vet for another ACTH. Right now, we already have her scheduled for one this Saturday...I have a feeling we'll be getting one sooner than that, but I may be wrong.

Prednisone....I asked the IMS for some, and she wouldn't give it to me. Her reasoning is she doesn't want me to give it to her when it's not needed, so if I see ANYTHING, I need to bring her in. The good news is her IMS is at PVSEC (an 24/7 specialty and emergency clinic). It takes me 12 minutes to get there.

I just really hope this helps my sweet girl.

[BostonLover]

Oh! the bed thing....I have developed a fear of dying in my sleep with Squirt and Trinket on the bed, unable to get down. Just one more reason not to sleep well. :rolleyes::D I'm not sure I could physically handle getting up off the floor so I've been trying to design some steps that fit either the foot or the side of the bed that they could learn to use. Trink being blind and Squirt with her legs make this interesting to say the least! I'm thinking Better Homes and Gardens is gonna pass on this decorating scheme, too. :p

LMBO!!!! You worry like I worry!!! :D And getting off the floor is NOT easy!! I feel like I'm in college again with the old mattress on the floor, but now she can "jump" on the bed:)

[BostonLover]

I do have a quick question about the Calcinosis Cutis. It's finally starting to get to the point where I can pull plugs of hair off (comes off very easy, and with no pain from Bells). Should I not mess with it and just leave the hair alone, or should I give her a bath and try and get the hair that hanging on off to keep it cleaner?

Also, this is day 3 on the Lyso, and we seem to be doing good. :)

[Budsters Mom]

I can't help out with the skin issues, but the meds report sounds encouraging.:) you are doing a great job! :D. I got a kick out of the mattress report. I slept on the floor many nights too! We are all worriers. It comes with the territory.:) Big hugs,

[lulusmom]

Hi Crystal.

Can you tell me what dose of Lysodren you are giving and how much does Annabelle weigh? You may have given us that info already but I'm a bit too busy at the moment to go back through your thread.

Glynda

[BostonLover]

I can't help out with the skin issues, but the meds report sounds encouraging.:) you are doing a great job! :D. I got a kick out of the mattress report. I slept on the floor many nights too! We are all worriers. It comes with the territory.:) Big hugs,

:oThanks, we are trying to do whatever we can to make things easier on her.

[BostonLover]

Hi Crystal.

Can you tell me what dose of Lysodren you are giving and how much does Annabelle weigh? You may have given us that info already but I'm a bit too busy at the moment to go back through your thread.

Glynda

Hi Glynda-she is on 1/4 pill every 12 hours. She started Sunday and has an ACTH scheduled for Saturday, unless she shows signs and needs to go earlier. Right now she is about 14.9 pounds. That's 2 pounds down from 2 months ago. :confused:

[lulusmom]

Hi Crystal,

Thanks for the info. Experienced vets usually prescribe a daily loading dose of 50mg per kg of weight, split in half and given every 12 hours. Your vet has prescribed approximately 37mg per kg, which sounds reasonable, given Annabelle's weight and her last post stim test. Most dogs are starting with a much higher level of cortisol so I can see why your vet would scale it back a bit. Just keep an eagle eye on your girl for signs of loading. Lysodren has a cumulative effect for at least 48 hours so if there is any question in your mind about a change in Annabelle, quit dosing.....you can't take it back.

We're here with you and Annabelle every step of the way. You're doing fine.

Glynda

P.S. I've had many rescue dogs with mange and they have lots of hair that's hanging on by scabs. I always bathe them to remove the dead tissue and hair. That's what I'd do but not before I checked with the vet to see if I should be using a prescription or an over the counter shampoo that is appropriate for Annabelle's condition. Others who have dealt with CC might be able to suggest a brand for you.

[molly muffin]

I'll just throw in that if you haven't had a scraping done to find out exactly what is going on with the skin, it might be worth it talk to your vet about doing that. The reason would be to verify that it is calcium issues, and to make sure that no infection has gotten into the sore areas. This happens sometimes and if so, then usually there are prescription shampoo's etc, that can help to clear that up, tailored to her specific issue.

Sharlene and Molly Muffin

[BostonLover]

I'll just throw in that if you haven't had a scraping done to find out exactly what is going on with the skin, it might be worth it talk to your vet about doing that. The reason would be to verify that it is calcium issues, and to make sure that no infection has gotten into the sore areas. This happens sometimes and if so, then usually there are prescription shampoo's etc, that can help to clear that up, tailored to her specific issue.

Sharlene and Molly Muffin

Hi Sharlene,

We did get a scraping done 3 weeks ago when we went in for a check up with the IMS. It was identified as CC, but at that point all her hair was still there, it was just standing up on end from the deposits under it. Now she's lost a lot of the hair and you can see the pink skin underneath. On Saturday I'll ask about bathing her and what to use. :)

[BostonLover]

Hi Crystal,

Thanks for the info. Experienced vets usually prescribe a daily loading dose of 50mg per kg of weight, split in half and given every 12 hours. Your vet has prescribed approximately 37mg per kg, which sounds reasonable, given Annabelle's weight and her last post stim test. Most dogs are starting with a much higher level of cortisol so I can see why your vet would scale it back a bit. Just keep an eagle eye on your girl for signs of loading. Lysodren has a cumulative effect for at least 48 hours so if there is any question in your mind about a change in Annabelle, quit dosing.....you can't take it back.

We're here with you and Annabelle every step of the way. You're doing fine.

Glynda

P.S. I've had many rescue dogs with mange and they have lots of hair that's hanging on by scabs. I always bathe them to remove the dead tissue and hair. That's what I'd do but not before I checked with the vet to see if I should be using a prescription or an over the counter shampoo that is appropriate for Annabelle's condition. Others who have dealt with CC might be able to suggest a brand for you.

Thanks!! Today will be day 4 on the Lyso. She still wolfs down her food and drinks water like crazy, so we are good. Anxious to see what her ACTH will say on Saturday.

[Arizona Boston]

Just stopping in to say Hi....I'm thinking about changing Lucy over to Lysodren and am watching your journey with double fingers crossed!
Shelly and Lucy

[BostonLover]

Just stopping in to say Hi....I'm thinking about changing Lucy over to Lysodren and am watching your journey with double fingers crossed!
Shelly and Lucy

Hi Shelly--so far, so good. No changes in drinking and eating, but I have high hopes that this drug will work, and I wish we wouldn't have wasted a year and half on Trilostane, which made her worse.

Give Lucy some sugars from me:D

[doxiesrock912]

Every dog responds differently. You never know what will work. Trilo is working for Daisy so far. You just never know.

[molly muffin]

Okay, so no infection at the time the scraping. It does make a difference I think in what the vet would like you to use usually.
They say it gets worse before better and I think that any place there are the sores the hair comes off usually before the skin gets better and before any new hair regrows. Which can take time, so don't worry about it it doesn't regrow immediately. It's all a cycle with those follicles.

You're doing excellent!
hugs,
Sharlene and Molly Muffin

[BostonLover]

Well day 8 on the Lysodren load, and still no changes. We had an ACTH Stim done Saturday, and I'm anxiously awaiting the results of that. I figured by day 8 I'd see some changes, but nothing yet. :confused:

[frijole]

All dogs are different. The average dog doesn't load until 7 to 10 days so you are still within the normal range. It is probable that the dose is too low. My Haley owns the record here for the longest load of all time. We started in September and I think we loaded in the spring. She had 2 1/2 months of loading doses (the breaks were for all of the acth tests we did) She loaded at over two times the max recommended dose.

The good news is that once she was loaded my little bug kept that load until she died 4 1/2 years later at the age of 16 1/2. So don't lose hope. Kim

[BostonLover]

All dogs are different. The average dog doesn't load until 7 to 10 days so you are still within the normal range. It is probable that the dose is too low. My Haley owns the record here for the longest load of all time. We started in September and I think we loaded in the spring. She had 2 1/2 months of loading doses (the breaks were for all of the acth tests we did) She loaded at over two times the max recommended dose.

The good news is that once she was loaded my little bug kept that load until she died 4 1/2 years later at the age of 16 1/2. So don't lose hope. Kim

Thanks Kim!!! That gives me comfort!!! She is loading at a low dose, but she was on Trilostane for a year and a half and only did a 2 week wash out.

[BostonLover]

Got the ATCH results from Saturday:

Pre: 7.6
Post: 18.3

They didn't change much.....She's going back Satuday for another one, unless I notice changes, then I'll bring her in sooner. Really hoping this drug works..

[frijole]

Do you mean she's going back this Saturday for another acth test? If so I am concerned because I can't imagine there would be much change and that test is so expensive. I think that given the high cortisol reading (18) that the dose should be increased to 3/4 of a tab once a day which would be 375 mgs. You could give 1/2 and 1/4. Perhaps others will chime in with their thoughts. Sorry I have to go to work (dang work gets in the way LOL). Hang in there. Kim

[BostonLover]

Do you mean she's going back this Saturday for another acth test? If so I am concerned because I can't imagine there would be much change and that test is so expensive. I think that given the high cortisol reading (18) that the dose should be increased to 3/4 of a tab once a day which would be 375 mgs. You could give 1/2 and 1/4. Perhaps others will chime in with their thoughts. Sorry I have to go to work (dang work gets in the way LOL). Hang in there. Kim

Yes, this Saturday! I know, I was kind of hoping she would increase the dose if we have to go back, but she didn't. If other's chime in and say I should increase it, I will because I don't want another high post saturday and have to turn around and get another ACTH next Saturday...that would be 3 in three weeks, and yes, they are very expensive. $200+ if the IMS sees her (or talks to us) $175 if just a vet tech...

[labblab]

Good Morning,
We had another ACTH done Friday, and the results of that were
Pre: 8.6
Post: 19.3
so she said we could go ahead and load the Lysodren. I'm really hoping this medicine helps her. She's so weak now, and lost 2 pounds over the last month and a half, and that worries me.
Crystal, I've got to agree with Kim. I think it's crazy to continue at this same dose and repeat an ACTH on Saturday. There has been virtually no downward movement at all over eight days at this dose. I can't imagine that three more days is going to change the results significantly.

If it were me, I'd definitely talk to the vet and request a dosing increase. This is not something you should do on your own, but I would want to speak to the vet about these results and revising the gameplan.

Marianne

[BostonLover]

Crystal, I've got to agree with Kim. I think it's crazy to continue at this same dose and repeat an ACTH on Saturday. There has been virtually no downward movement at all over eight days at this dose. I can't imagine that three more days is going to change the results significantly.

If it were me, I'd definitely talk to the vet and request a dosing increase. This is not something you should do on your own, but I would want to speak to the vet about these results and revising the gameplan.

Marianne

Thanks Marianne,

I'm going to call the IMS now and request a dosing increase. You guys are GREAT!!!!!!!!

[frijole]

Whew thanks Marianne. Kim

Good girl - call the vet - these tests are too expensive and the stress too great not to just increase with such high cortisol.

[BostonLover]

Whew thanks Marianne. Kim

Good girl - call the vet - these tests are too expensive and the stress too great not to just increase with such high cortisol.

I agree!!! I'm waiting to hear back from her....hopefully she agrees.:rolleyes:

[lulusmom]

Hi Crystal,

There are four reasons why a dog experiences a protracted loading:

1) The dog doesn't have cushing's. Excessive production of cortisol over time causes the adrenal glands to become really fatty and big. This is referred to as adrenal mass and the bigger and fattier the adrenal gland, the more senstive they are to the effects of Lysodren that is dosed properly.

2) The dose is just too low. Your vet has prescribed approximately 37mg/kg which isn't a wimpy dose for a dog with pituitary dependent disease but it's not the max either so one could expect a longer loading period. However, one would also expect to see a bigger drop in the stimulated cortisol on the last acth stim test so if it were me, I'd be looking at other reasons.

3) The dog has an adrenal tumor. Adrenal tumors are extremely resistant to Lysodren and if Annabelle did a have tumor, the loading dose your vet prescribed would be way too low to do much of anything. Adrenal tumor dogs usually require much higher doses, like 75mg/kg to 100mg/kg and at these whopping doses, Pepcid AC and even prednisone is often prescribed concurrently to mitigate adverse effects. I didn't have time to refresh my memory and I can't recall if your vet absolutely ruled out an adrenal tumor by way of on abdominal ultrasound or low dose dexamethesone suppression test. Can you confirm please?

4) Lysodren is not being absorbed into the blood stream. Lysodren is extremely fat soluble so it has to be given with a meal. If the meal is too low in fat, it's highly possible that absorption will be affected. If Annabelle's diet is fat restricted, the pill should be wrapped in cream cheese or other fatty treat to insure absorption into the GI tract. How are you giving Annabelle her doses? If you think this could be the problem, I wouldn't ask for a dosing increase because it won't be readily absorbed either.

Glynda

[BostonLover]

Hi Crystal,

There are four reasons why a dog experiences a protracted loading:

1) The dog doesn't have cushing's. Excessive production of cortisol over time causes the adrenal glands to become really fatty and big. This is referred to as adrenal mass and the bigger and fattier the adrenal gland, the more senstive they are to the effects of Lysodren that is dosed properly. --She does have "huge" adrenal glands--IMS direct quote.

2) The dose is just too low. Your vet has prescribed approximately 37mg/kg which isn't a wimpy dose for a dog with pituitary dependent disease but it's not the max either so one could expect a longer loading period. However, one would also expect to see a bigger drop in the stimulated cortisol on the last acth stim test so if it were me, I'd be looking at other reasons.

3) The dog has an adrenal tumor. Adrenal tumors are extremely resistant to Lysodren and if Annabelle did a have tumor, the loading dose your vet prescribed would be way too low to do much of anything. Adrenal tumor dogs usually require much higher doses, like 75mg/kg to 100mg/kg and at these whopping doses, Pepcid AC and even prednisone is often prescribed concurrently to mitigate adverse effects. I didn't have time to refresh my memory and I can't recall if your vet absolutely ruled out an adrenal tumor by way of on abdominal ultrasound or low dose dexamethesone suppression test. Can you confirm please? In June she did a "brief ultrasound" that we were not charged for and made no mention of a tumor, just said her glands were huge.

4) Lysodren is not being absorbed into the blood stream. Lysodren is extremely fat soluble so it has to be given with a meal. If the meal is too low in fat, it's highly possible that absorption will be affected. If Annabelle's diet is fat restricted, the pill should be wrapped in cream cheese or other fatty treat to insure absorption into the GI tract. How are you giving Annabelle her doses? If you think this could be the problem, I wouldn't ask for a dosing increase because it won't be readily absorbed either. I give her the Lydoren in a pill pocket with her food in the am, and with a pill pocket and a couple of treats at night.

Glynda

Thanks Glynda! I answered you in BLUE

[BostonLover]

Spoke to IMS and we agreed to increase her dose to 1/2 pill in am and 1/4 to pm. We will schedule ACTH next Saturday, that will make 21 days. Unless I see ANY changes, then ill bring her in immediately. Thank you all so much for the information!!! I only wish I would have found this site a year ago.

Xoxoxo

[BostonLover]

Here is the response that I received from the IMS when I asked if we should increase her dosage.

Unfortunately, Annabelle's exact dose does work well with the 500 mg tablets. Ideally she should get 1/3 tablet twice daily. So...We have 2 options:

1. keep Annabelle at the lower dose and don't recheck another ACTH stimulation test until you notice a change in her appetite/ water consumption or at 21 days, which ever comes first

OR

2. Increase her dose to 1/2 tablet in the am and 1/4 tablet in the pm.

I think it would even be safe to increase her dose and not schedule a recheck ACTH stimulation test until you notice a change in her appetite/ water consumption. This will save you some money. It is imperative not to overlook the most subtle changes in appetite and water consumption as one or two additional loading doses can make the difference between controlling her disease and causing a hypoadrenal crisis which can be life threatening.



Take care and hang in there. We will get your beautiful girl fixed



Regards,

Tracey Peterson, DVM, DACVIM

[lulusmom]

Hi Crystal.

Just wanted to let you know that pill pockets are not that high in fat. I use all flavors of pill pockets and just checked the fat content on all. Chicken and peanut butter flavor are 14% fat and beef is a little bit higher. Cream cheese has twice the amount of fat at 29% fat and peanut butter is about 24%. I have no idea how much fat is in Annabelle's food but if it's not that much, she could be a dog that is having trouble with absorption. I believe my own dog had the same problem when I loaded her at the max dose. We had to load for three more days after the seven day stim showed cortisol still high. Her adrenals were huge too and I understand why. She went undiagnosed for well over a year after becoming symptomatic because our gp vet couldn't spell cushing's nor recognize the signs, even when the dog in front of him is screaming cushing's. That was many years ago but I seem to remember that we lost the load early on in maintenance and it wasn't until I started giving her the increased maintenance dose in peanut butter that she seemed to stabilize. She had become so fat prior to diagnosis, I had already switched her to a low fat kibble and I wrapped her pill in a little piece of lunch meat so I believe it was an absorption issue with her.

[BostonLover]

Hi Crystal.

Just wanted to let you know that pill pockets are not that high in fat. I use all flavors of pill pockets and just checked the fat content on all. Chicken and peanut butter flavor are 14% fat and beef is a little bit higher. Cream cheese has twice the amount of fat at 29% fat and peanut butter is about 24%. I have no idea how much fat is in Annabelle's food but if it's not that much, she could be a dog that is having trouble with absorption. I believe my own dog had the same problem when I loaded her at the max dose. We had to load for three more days after the seven day stim showed cortisol still high. Her adrenals were huge too and I understand why. She went undiagnosed for well over a year after becoming symptomatic because our gp vet couldn't spell cushing's nor recognize the signs, even when the dog in front of him is screaming cushing's. That was many years ago but I seem to remember that we lost the load early on in maintenance and it wasn't until I started giving her the increased maintenance dose in peanut butter that she seemed to stabilize. She had become so fat prior to diagnosis, I had already switched her to a low fat kibble and I wrapped her pill in a little piece of lunch meat so I believe it was an absorption issue with her.

Thanks! I actually looked at the fat content this am, and thought it was low, so I gave her the first 1/2 dose with cream cheese. :)

[frijole]

Hi from me again. It is no big deal at all to give doses of 1/2 and 1/4 a pill... I was doing that (only larger doses) for 4 1/2 yrs... don't let her persuade you it isn't possible.. so after all that did she decide to up the dose? Kim

[BostonLover]

Hi from me again. It is no big deal at all to give doses of 1/2 and 1/4 a pill... I was doing that (only larger doses) for 4 1/2 yrs... don't let her persuade you it isn't possible.. so after all that did she decide to up the dose? Kim

Hi Kim,

Yes she increased the dose to 1/2 in the am and 1/4 pm. I started this morning and she has an ACTH scheduled for 8/10, which would mark 20 days of the Lysodren.

I thought the other day she didn't drink as much water, but then last night she got out of the bed every hour and drank a FULL bowl (large bowl) of water:eek:

I'm hoping that by upping the dose, I'll see some results.

[frijole]

Just keep track and if there are any changes at all in the way she eats and drinks before the 10 days (read the loading sheet again if you haven't recently) you stop and schedule the next test. You stop and the ideal time to test is 2 days after the last dose as it keeps working for 2 days. That is why you never give it if you have any doubts about being loaded. YOu can't take it back. So don't feel like you have to go 10 more days... the load could come before that. You're starting at 18 so I wouldn't count on anything happening for a few days. Kim

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

[BostonLover]

Just keep track and if there are any changes at all in the way she eats and drinks before the 10 days (read the loading sheet again if you haven't recently) you stop and schedule the next test. You stop and the ideal time to test is 2 days after the last dose as it keeps working for 2 days. That is why you never give it if you have any doubts about being loaded. YOu can't take it back. So don't feel like you have to go 10 more days... the load could come before that. You're starting at 18 so I wouldn't count on anything happening for a few days. Kim

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

Thank Kim,
She is still RAVENOUS and will eat anything, anytime, anywhere. All she wants is food constantly. And she will still drink buckets of water. I worry that she's so used to eating and drinking she won't show me a change, but I'm watching like a hawk.

Thanks for the test info...I didn't know I should wait 2 days after her last dose if I notice a change to get the ACTH. I would have brought her in that day!

Thanks again Kim! Have a great day!!:)

[goldengirl88]

Hello:
My Tipper uses Vetoryl so I have no experience with Lysodren, but wanted to tell you you are doing a good job watching everything. Everything will turn out ok so don't worry, just keep watching as that is paramount in keeping your dog on track. Blessings
Patti

[BostonLover]

Hello:
My Tipper uses Vetoryl so I have no experience with Lysodren, but wanted to tell you you are doing a good job watching everything. Everything will turn out ok so don't worry, just keep watching as that is paramount in keeping your dog on track. Blessings
Patti

:D thanks Patti!!!! This is a horrible disease(syndrome) and when first diagnosed I didn't realize just how hard it was going to be to control and what it would do to by poor baby's health.

Last night I noticed a fairly large white plate coming out of her skin on her belly.:(:( I'm assuming this is the Calcinosis Cutis, but on her belly it just looks so weird with no hair. This worries me, as this is brand new (within 3 days). Will she continue to get these "sores" even while on Lysodren? Do they only go away if controlled?:confused:

[BostonLover]

Well, day 15 and still no changes. :confused::( I'm so worried about her now. She is ravenous and still drinking buckets of water....I'm worried she will never show me any signs that the drug is working, and I'll keep giving it to her and kill her. :(:(:(:(:(

Last night her breathing was so labored and congestive. Sounds like she's drowning. I didn't want to leave her to go to work today, but I have to pay for her treatment somehow.

I just hope and wish she shows me a sign this week. She's scheduled for an ACTH Saturday, and if it's still not working at 21 days, I'll be devastated. :(:(:(:(:( I feel like I'm losing her. She looks awful. Now the CC is on her belly, which looks awful. She's falling down a lot, and I have to carry her outside to go potty because she can't even make up and down the low steps in front of our house. :(:(

[Squirt's Mom]

Hi Crystal,

If she has weakened to the point you are having to carry her, please stop the Lyso, call the vet ASAP and find out what is going on with your sweet girl. The length of time it is taking for the load is not normal but not unheard of either so that isn't really concerning me. HOWEVER, her continued decline and her apparent failure to respond to either drug is concerning and I am leaning more and more toward something other than, or in addition to, Cushing's. Others here may have a different take on this, but in your shoes this is what I would do.

Please let us know how our sweet Belles is doing...and know we are all right by your side.
Hugs,
Leslie and the gang

[BostonLover]

Hi Crystal,

If she has weakened to the point you are having to carry her, please stop the Lyso, call the vet ASAP and find out what is going on with your sweet girl. The length of time it is taking for the load is not normal but not unheard of either so that isn't really concerning me. HOWEVER, her continued decline and her apparent failure to respond to either drug is concerning and I am leaning more and more toward something other than, or in addition to, Cushing's. Others here may have a different take on this, but in your shoes this is what I would do.

Please let us know how our sweet Belles is doing...and know we are all right by your side.
Hugs,
Leslie and the gang

Thanks Leslie!!! I went back and forth with myself over giving her the am dose this morning, and I did it....now I'm scared I shouldn't have. As soon as I get home if she's still breathing bad, I'm going to take her in. Should I request an ultrasound to look for a tumor? She had an US 1 week prior to starting the Lysodren, but all that was stated was her adrenal glands were huge. We didn't get charged for the ultrasound, so I'm not sure if they gave a good look, or just a quick look around.

[spdd]

Just reading your update. I have no advice, I'm not knowledgeable enough, but wanted you to know I'm thinking and praying for you.

[BostonLover]

Just reading your update. I have no advice, I'm not knowledgeable enough, but wanted you to know I'm thinking and praying for you.

:)Thanks so much.

[Squirt's Mom]

If all they looked at with the US was her adrenal glands, I would want to know about her other organs if it were me. But an ultrasound saved Squirt's life so I am very partial to this test. ;)

Belle's CC has been diagnosed by the vet, right? CC pretty much ensures Cushing's is in play but like I said, it concerns me that she hasn't responded to either med and is continuing to decline with new issues cropping up like the breathing and inability to walk well. It is certainly feasible that there are pups out there who are simply resistant to both Vetoryl and Lysodren but I think Belles would be the first here if this is what is going on.

It's a good idea in my mind to at least let the vet know about her changes over the last couple of days and that she is showing no signs of being loaded. If you do take her in, let us know what you learn.

Hugs,
Leslie and the gang

[BostonLover]

If all they looked at with the US was her adrenal glands, I would want to know about her other organs if it were me. But an ultrasound saved Squirt's life so I am very partial to this test. ;)

Belle's CC has been diagnosed by the vet, right? CC pretty much ensures Cushing's is in play but like I said, it concerns me that she hasn't responded to either med and is continuing to decline with new issues cropping up like the breathing and inability to walk well. It is certainly feasible that there are pups out there who are simply resistant to both Vetoryl and Lysodren but I think Belles would be the first here if this is what is going on.

It's a good idea in my mind to at least let the vet know about her changes over the last couple of days and that she is showing no signs of being loaded. If you do take her in, let us know what you learn.

Hugs,
Leslie and the gang

Yes, the CC has been diagnosed. I'm going to email the vet and pick her brain as far as what she looked at with the US and see if we can get another one done Saturday, or before. I don't mind paying for the US, because, I agree, they can be life saving.

Thanks again for the WEALTH of love and information given on this site. <3 <3 <3

[frijole]

Leslie, This dog has an adrenal tumor so I'm not at all surprised that this dose hasn't worked in 20 days. She started out at just under 50 mgs/kg and it was just increased 5 days ago. So it really hasn't been that long. You'd have to read back to get my calculations as to what the current dosing amount is.

I doubt it is the lysodren causing the leg issues as the thirst is still so strong as is the CC. That said - whenever anything like this happens you need to report it to the vet asap. If I recall you are using an IMS right?

Was surgical removal an option for her? It may be that the tumor is growing and therefore the lysodren cannot keep up. I'm at work but will check back in later. Hugs, Kim

[BostonLover]

Leslie, This dog has an adrenal tumor so I'm not at all surprised that this dose hasn't worked in 20 days. She started out at just under 50 mgs/kg and it was just increased 5 days ago. So it really hasn't been that long. You'd have to read back to get my calculations as to what the current dosing amount is.

I doubt it is the lysodren causing the leg issues as the thirst is still so strong as is the CC. That said - whenever anything like this happens you need to report it to the vet asap. If I recall you are using an IMS right?

Was surgical removal an option for her? It may be that the tumor is growing and therefore the lysodren cannot keep up. I'm at work but will check back in later. Hugs, Kim

Hi Kim,

Haven't been diagnosed with an adrenal tumor yet. I'm beginning to wonder if that is what it is. I'm requesting an ultrasound for this Sat, in addition to the ACTH (unless I see signs and need to take her sooner). All the IMS said with the last US was that her adrenal glands were "huge".

I emailed the IMS (she is great with responding) and let her know my fears and gave her a weekend report. I'm anxious to see what she says.

I'm SOOOO ready for this day to be over so I can go home and snuggle on my girl! I'm haven't accomplished much at work today because I'm so worried. :confused:

[frijole]

My bad. I think I got dogs confused. Forgive me. I should never check in at work... again, sorry. Kim

[Squirt's Mom]

Let us know how Belle is when you can. I hope you find her more at ease than she was last night.

[molly muffin]

Oh dear, that doesn't sound good about Belle continuing to deteriorate as she is. On one hand the still drinking and eating sounds like she isn't loaded but the not being able to walk sounds like there is a definite problem. I can see why you are so very worried. CC can take what seems like forever to clear up too. :(

Thinking of you and Belle
Sharlene and Molly Muffin

[BostonLover]

My bad. I think I got dogs confused. Forgive me. I should never check in at work... again, sorry. Kim

No worries Kim!!!:D

[BostonLover]

Let us know how Belle is when you can. I hope you find her more at ease than she was last night.

She had a better night last night. Her breathing wasn't near as conjested.

I spoke with the IMS and she does not think it'a an adrenal tumor. She said since both glands were very enlarged, that point to the pituitary dependent cushings (original diagnosis).

I'm just aggravated that I've spent so much time and money over the last year and half, and she's only getting worse.:(

Praying this Lysodren works, and soon.

[BostonLover]

Well there is still no decrease in her appetite, however, I did notice a decrease in her drinking and urination!! I didn't give her the morning dose and scheduled an ACTH for Friday. Hoping for good news. :)

[Boriss McCall]

Good luck! I hope you get a good answer on Friday. You & Belle are probably both exhausted. :(
Glad you saw a little improvement today.

[frijole]

Toes, fingers and eyes crossed.!! :D Kim

[Budsters Mom]

Toes, fingers, arms,legs, eyes and paws crossed!:D xxxx

[addy]

we are all hoping for good news

[BostonLover]

Thanks everyone!!!!!!!:D:D

[molly muffin]

We'll be hoping for good news right along with you!

hugs,
Sharlene and Molly Muffin

[BostonLover]

Even more changes as of last night! WOO HOO! Her water intake has decreased by almost HALF!!!! And her urine is now yellow and small!!!!!!:D:D I haven't seen yellow urine in over a year!! So silly to be excited about pee huh??!!! HA HA

Ready to get that ACTH done and see the numbers.

[addy]

No, not silly, we actually live for good pee and poo, always a hot topic around here.:D:D

Hoping this means loaded!!!

[BostonLover]

no, not silly, we actually live for good pee and poo, always a hot topic around here.:d:d

hoping this means loaded!!!

me too!!!!:d

[Boriss McCall]

Golden Pee!! I remember being excited to see that as well. I still find myself going out with him sometimes in the morning to make sure it is still yellow. ;)

[BostonLover]

Golden Pee!! I remember being excited to see that as well. I still find myself going out with him sometimes in the morning to make sure it is still yellow. ;)

I was SOO excited when I saw that on the pee pad! We did a little dance, and she even got a special treat!:D I'm so proud of my strong little girl. :o

[spdd]

I check the pee and poo everyday. Funny how our priorities change at times eh?
Glad to hear the good news.

[BostonLover]

I check the pee and poo everyday. Funny how our priorities change at times eh?
Glad to hear the good news.

I know, right???!!! :D

[frijole]

I was out of town for a day and you know I get confused easily....:D... You did stop the lysodren already right? And you are just waiting for the acth test (48 hrs)? Just checking to be triply safe because that is a really really good sign that loading has occurred. Way to go. Kim

[Squirt's Mom]

Anxiously waiting with you for these results! I soooo hope she is in range for the load.

[BostonLover]

I was out of town for a day and you know I get confused easily....:D... You did stop the lysodren already right? And you are just waiting for the acth test (48 hrs)? Just checking to be triply safe because that is a really really good sign that loading has occurred. Way to go. Kim

:D Yep, stopped the Lysodren (last dose was Wed. am) and ACTH scheduled for today (Friday). :D:D

[BostonLover]

Even better news....last night, she actually paused, like really paused while eating and looked around, then ate some more (at a much slower pace), then stopped eating before her bowl was empty, looked at my other dog eating, then came back and finished her food!!! To me, that is a MIRACLE! I have not seen her eat so slow in years!!! She still has a great appetite, just slower, and last night she never got out of the bed to drink or pee!!!!!!!! Can't wait to get the results of the ACTH test that she is taking today. I'm so proud of my sweet baby girl!!!:D

[addy]

You go girl:D:D:D:D:D:D:D:D:D:D

Cant wait for the test results

[Squirt's Mom]

Oh, that sounds like the load is here! :cool::):cool: I so hope the ACTH supports the signs! How exciting and such a relief!

[BostonLover]

We are so excited and proud of our girl. She's a trooper!!!

[spdd]

I'd be proud too. I saw a puppy almost identical to yours at the vet on Tuesday. She was the cutest thing I've seen in ages. Definitely in the win category if I ever consider another pup. She was about 12 weeks old and friendly. Fell in love instantly.

[BostonLover]

:) They are the sweetest dogs....little lovers.

[BostonLover]

AnnaBelle is officially loaded!!!!!!! WOO HOO!!!!!:D:D:D

Pre sample 2.5 (normal 1.0-5.0); Post 2.7 (target 1-5).
Starting maintenance therapy: 1/4 tablet on Monday and 1/2 tablet on Thursday for a total dose of 375 mg weekly.

I cannot believe how once this drug kicked in, how fast it eliminated her symptoms. Trilostane NEVER eliminated any symptoms for her. Now she eats and drinks like a normal dog. I'm amazed. :D

[addy]

Great news to start the week :D:D:D

I'll join in WOOOHOOOOO:D:D:D:D:D:D:D:D:D:D:D:D

[Squirt's Mom]

Me, three! WOOHOO!!! :cool::cool::cool::cool:

Now where is that dancing happy mama icon! :D

[Woodydog]

Me four woooooooooohoooooo👍💃💃💃

[BostonLover]

Thanks everyone!!!!!! :D:D:D We are so thrilled. What a change in just 7 days!!!!!!!

[Roxee's Dad]

Me five !!!! :D Woooooooo Hooooooooo !!!!

[molly muffin]

Yay! So happy to read this!!! Congratulations!
hugs,
Sharlene and Molly Muffin

[Budsters Mom]

YAAAAAAAAAAAAAY! Thrilled with your news! Love to hear good news!:D:)

[BostonLover]

She has now been on the maintenace dose (375mg/week) and I'm thinking it's going to need to be increased. She is back to drinking more water, and lately she's been panting A LOT. And it hasn't been hot here.

Also, I've noticed that her stools are getting really loose. Is this something I need to be concerned with? I give her pumpkin with her food everyday, but it doesn't seem to be helping with that now.

[Harley PoMMom]

Also, I've noticed that her stools are getting really loose. Is this something I need to be concerned with? I give her pumpkin with her food everyday, but it doesn't seem to be helping with that now.

I am a huge worrywart, so loose stools would concern me. ;) When is AnnaBelle's next ACTH stim test scheduled? Increased drinking/urination plus with the diarrhea can be a sign of Addison's. If this were me, I would call the vet and ask if an ACTH stim test should be done. Please keep us posted.

[BostonLover]

I am a huge worrywart, so loose stools would concern me. ;) When is AnnaBelle's next ACTH stim test scheduled? Increased drinking/urination plus with the diarrhea can be a sign of Addison's. If this were me, I would call the vet and ask if an ACTH stim test should be done. Please keep us posted.

She just has one 8/9 and her results were Pre sample 2.5 Post 2.7
She's been on maintenance since the 12th (so she's had 1/4 two times, and 1/2 only once). I thougth addison's signs were not eating or drinking.

I will contact the vet about the loose stools. Her next ACTH is 3 weeks from now.

[Harley PoMMom]

Increased drinking/urination, loss of appetite, lethargy, among other symptoms can be a sign of Addison's. Dogs that have kidney issues have very similar symptoms as a dog with Addison's. I'm not insinuating that AnnaBelle has a kidney problem, I just was comparing the two illnesses.

It would seem that since she just had an ACTH stim on 8/9, which were good numbers, that low cortisol wouldn't be the culprit but you just never know. How is her appetite? Any vomiting?

[BostonLover]

Increased drinking/urination, loss of appetite, lethargy, among other symptoms can be a sign of Addison's. Dogs that have kidney issues have very similar symptoms as a dog with Addison's. I'm not insinuating that AnnaBelle has a kidney problem, I just was comparing the two illnesses.

It would seem that since she just had an ACTH stim on 8/9, which were good numbers, that low cortisol wouldn't be the culprit but you just never know. How is her appetite? Any vomiting?

Appetite is GREAT. No vomitting whatsoever, just the loose stools occassionally. I emailed her IMS so I'm anxious to see what she says. I hate this disease. One day you're up, the next you're down. It's so hard to get under control. :mad:

[labblab]

Pumpkin can work both ways -- it can firm up stools but also loosen them for some dogs depending upon how the dog is reacting to the added fiber. So you may actually try eliminating the pumpkin to see if that helps. One of my two girls has never responded well to pumpkin and it has actually seemed to worsen diarrhea for her.

Marianne

[Harley PoMMom]

Great appetite and no vomiting are very good signs. It could just be that something she ate didn't agree with her.

[Trixie]

Sticky white rice (extra water when cooking with gum it up) along side her regular food is great for binding things up. We have very good results with that when things get a little loose.

Barbara

[addy]

Gastro upset is the number one side effect of Lysodren. One would think we would see it early on but perhaps that is not the case here. My Zoe has inflammatory bowel disease and she tends to drink more water when her gastro system is bothering her.
Just a thought, best to check in with your vet.

[BostonLover]

Pumpkin can work both ways -- it can firm up stools but also loosen them for some dogs depending upon how the dog is reacting to the added fiber. So you may actually try eliminating the pumpkin to see if that helps. One of my two girls has never responded well to pumpkin and it has actually seemed to worsen diarrhea for her.

Marianne

Thanks!!! I will stop giving it to her and see if that helps.:)

[frijole]

Re the pumpkin - only give it in small doses. Not sure how much you were giving but between a tsp and a TBSP max with a meal. Otherwise... my dog got the runs worse. If a small amount it clogged her diarrhea right up. Bizarre I know. Kim

[Arizona Boston]

I agree! I hate this disease!

I've added Slippery Elm to my arsenal. Bought it at the human health food store. Haven't had to use it yet, but we are taking a road trip and have it in her travel bag.


It is a "Soothing Emollient" (says so right on the bottle). I read about it here on the forum. It shouldn't be given at the same time as medications or it can block absorption.

Last time Lucy was doing the 'back door two step', she had bacteria in her stool and needed a dose of antibiotics. Her constant hunger makes her eat all kings of things.

Hope things clear up soon....
Shelly and Lucy

[BostonLover]

I agree! I hate this disease!

I've added Slippery Elm to my arsenal. Bought it at the human health food store. Haven't had to use it yet, but we are taking a road trip and have it in her travel bag.


It is a "Soothing Emollient" (says so right on the bottle). I read about it here on the forum. It shouldn't be given at the same time as medications or it can block absorption.

Last time Lucy was doing the 'back door two step', she had bacteria in her stool and needed a dose of antibiotics. Her constant hunger makes her eat all kings of things.

Hope things clear up soon....
Shelly and Lucy

Thanks Shelly! I might give that a try. Dr. Peterson, our IMS has called in metronidazole, which is supposed to help gastric upset from Lysodren. She seems fine, drinking more water again, so I suspect her maintenance dose will need to be increased after her next ACTH on 9/14. Hope Lucy is doing well. Give her a big hug and kiss from us!

[frijole]

Slippery Elm can be great but please note you cannot give it at the same time as meds. Kim

[addy]

and make sure it is not the capsuls that contain magnisum stearate:)

[BostonLover]

Thanks everyone!:D

[BostonLover]

Just wanted to check in and let you all know the Lysodren has been a miracle for my girl!!! She is already growing hair back that she lost from the CC! She drinks and eats like a normal dog now! I only wish we didn't waste over a year on Trilostane, but glad to finally have some improvement. Even her hind legs have gained strength, and she has definitely gained the 2 pounds she lost back. :D

[Boriss McCall]

That IS GREAT news. So, glad you finally found something that works for your girl.

[BostonLover]

That IS GREAT news. So, glad you finally found something that works for your girl.

I know!:) It's so nice to see her slowly becoming her old self again. She even picked up a toy and played with it for while the other night. We are heading to the beach for a week on Saturday, and 2 months ago, I honestly didn't think she'd make it.

[Boriss McCall]

The beach sounds awesome. It feels so good to see them get better & pick up a toy. BT's were made to play & be silly to see a sad one is hard to handle.
Have a great time!

[Squirt's Mom]

WOOHOO!! I am so happy to hear that she is feeling better! I hope things continue to improve for Belle and she is soon running you ragged wanting to play. :)

[BostonLover]

Just got back from vacation to the beach, which was MUCH needed. We did have to go to the vet while there because Bells got a corneal ulcer on her left eye.:mad: Doc thought it was from trauma, but I believe I read that Cushing's can cause these, and she does NOT rough house or anything like that. Regardless, we got her eye drops and pain meds, and it looks MUCH better now. We have a followup ACTH and Protein check for her urine this Saturday. Looking forward to seeing if she is under control. She definitely eats and drinks less, but she still drinks more than a normal dog I believe.

Hope everyone had a safe holiday last week. :D

[Trixie]

My dogs last acth was a good number...showed that she was controlled, the drinking is way down but still more than she ever drank prior to Cushings. When she gets up in the morning she always goes in the kitchen for a drink now...she doesn't take much but she never drank prior to going out before now. Her drinking, though greatly improved, is also not exactly the old normal. Maybe it's our new normal though? At least she's not emptying the water bowl 4 times a day anymore!!
Glad your girl is doing so much better..hope the eye heals quickly!!

Barbara

[Harley PoMMom]

We did have to go to the vet while there because Bells got a corneal ulcer on her left eye.:mad: We have a followup ACTH and Protein check for her urine this Saturday. Looking forward to seeing if she is under control.


If this were me, I would hold off having an UPC done right now because Bell's eye issue may cause the UPC to be falsely elevated.

Sending huge and healing hugs, Lori

[BostonLover]

If this were me, I would hold off having an UPC done right now because Bell's eye issue may cause the UPC to be falsely elevated.

Sending huge and healing hugs, Lori

I didn't even think of that!! UGH. I'll let the IMS know. :(

[BostonLover]

My dogs last acth was a good number...showed that she was controlled, the drinking is way down but still more than she ever drank prior to Cushings. When she gets up in the morning she always goes in the kitchen for a drink now...she doesn't take much but she never drank prior to going out before now. Her drinking, though greatly improved, is also not exactly the old normal. Maybe it's our new normal though? At least she's not emptying the water bowl 4 times a day anymore!!
Glad your girl is doing so much better..hope the eye heals quickly!!

Barbara

HA! Yeah, I guess you're right...it's the new normal! She went from 8 cups of water a day, to about 2-3 now, so that is a HUGE improvment for her and my floors (HA).

[molly muffin]

LOL, that Is a big difference and in a good way. :)
So sorry about the eye ulcer though. Yes cushings dogs do seem to be prone to getting some eye problems, so it could have been that ranger than any damage from outside. You never know with these little ones though, they go sticking their heads in places to see whats going on and she could have scratched it.

So glad she is doing well though and recovering from the eye issue. Poor baby.

hugs,
Sharlene and molly muffin

[frijole]

Sorry to hear about the ulcer... my Annie developed one and my vet gave her some drops and no real change and I waited to go back and I really had no idea how serious these things can be. Do not hesitate to switch drops or go to a specialist if you have to... I ended up going that route as my vet had given me the wrong type drops and they were making it worse because they misdiagnosed it.

Also follow their instructions giving drops and don't miss a session. If on more than one type of drop wait 5-10 mins between. Time consuming but worth the effort.

Hang in there. Great improvement on the water intake! Keep up the good work. Kim

[BostonLover]

Well, we went in for ACTH and urine protein check on Saturday, and they just called me with the results.

Cushing's appears to be under control, as the dosage is not changing (1/4 on Monday and 1/2 on Thursday)
Pre: 4.1
Post: 4.8

Protein in urine is still high at 4.1, but MUCH lower than the last time we checked, so she will stay on the 10mg of Enalapril a day.

Still treating her corneal ulcer with ointment and tramadol for pain.

[molly muffin]

Yay! Like those numbers. :)
Maybe the next test the protein will be down too. :)
How is that eye looking?

hugs,
Sharlene and Molly Muffin

[BostonLover]

Yay! Like those numbers. :)
Maybe the next test the protein will be down too. :)
How is that eye looking?

hugs,
Sharlene and Molly Muffin

I know, I'm very happy with the numbers. Hoping in 3 months (next ACTH and protein check) that protein will have gone down.

The eye....ugh, well, sometimes it looks good, then last night in the bed I woke up twice to her rubbing it, so I gave her a tramadol and more drops, but this morning it was red again. :( I'm real worried because I know how serious these things are, and it's now been 2 weeks to the day that she's been being treated for it. I don't want her to lose her eye, and I put her cone of shame on everyday when I leave the house, but I let her sleep in the bed without it because I can wake up and stop herfrom rubbing. I'm hoping this new ointment they gave her will clear it up.:(

[goldengirl88]

Crystal:
Did you take her to Dr. Bagley?? If not have you been to an eye Dr.? I hope everything turns out ok. Blessings
Patti

[BostonLover]

Crystal:
Did you take her to Dr. Bagley?? If not have you been to an eye Dr.? I hope everything turns out ok. Blessings
Patti

Patti,
Her IMS, Dr. Peterson at PVSEC looked at it on Saturday and gave us ointment(can't remember the name). She was using drops that the vet in North Carolina (while we were on vacation) gave us. She said if it doesn't get better in a week to go see the eye doc at PVSEC or our vet. Is Dr. Bagley the eye doc at PVSEC? If it's not better, that's the route we will take next.

[goldengirl88]

Crystal:
Dr. Bagley is the eye Dr. at PVSEC, and I have know him for thirty years. I would definitely want him to see it as there are things not visible to the vet or IMS that he would only be able to view. It is 110.00 for a visit which is not bad for a specialist these days, and considering all I have spent so far it is not a lot. I had a cat with a corneal lesion about 15 years ago and he almost lost his eye, but Dr. Bagley saved it when no one else could. He is a good eye Dr. Hope all goes well. I don't even want to bring up the subject of the Steelers!!! Blessings
Patti

[BostonLover]

Crystal:
Dr. Bagley is the eye Dr. at PVSEC, and I have know him for thirty years. I would definitely want him to see it as there are things not visible to the vet or IMS that he would only be able to view. It is 110.00 for a visit which is not bad for a specialist these days, and considering all I have spent so far it is not a lot. I had a cat with a corneal lesion about 15 years ago and he almost lost his eye, but Dr. Bagley saved it when no one else could. He is a good eye Dr. Hope all goes well. I don't even want to bring up the subject of the Steelers!!! Blessings
Patti

Thanks Patti!!! I will call and make an appt just in case it doesn't get better! Thanks for the info!!!

Yes, I couldn't even watch last night!!! HA HA!

[goldengirl88]

Crystal:
No you got it wrong, not ha, ha, ha- more like cry, cry , cry!! Hope the eye is better today, but if it is not take your baby to see Dr. Bagley. I never realized how bad things can get until the situation with my cat. It cost nearly $9,000.00 to save his eye as it got so bad. That was from all the trips to the eye Dr. before I got Dr. Bagley who finally got it straightened out thank God. Hope the next week of football does not make me want to throw up!! Blessings
Patti

[Boriss McCall]

How is the eye looking tonight? HOpe you are seeing improvement. I know it does take cush dogs longer to heal.

[BostonLover]

Last night and this morning, it looks good. No discharge, no redness, so I'm hoping it's healing up. We go in Saturday for another stain to see if it's healed. *crossing fingers*

[spdd]

Fingers crossed for you !!

[molly muffin]

Oh I Do hope it is getting better! :)
How is her skin looking? Any changes?

hugs,
Sharlene and Molly Muffin

[goldengirl88]

Crystal:
Just checking in to see how things are going today? Hope the eyes is better. That is so troubling especially with a Boston as they have they bulging eyes. Hopefully you never have this problem again. After my cat having that I never want to deal with it again. Blessings
Patti

[BostonLover]

Oh I Do hope it is getting better! :)
How is her skin looking? Any changes?

hugs,
Sharlene and Molly Muffin

It's a miracle. Her skin looks GREAT!!! All the hair has now grown back. Her paws are white again (they were red). Her nose isn't falling off in pieces anymore, her eyes are no longer stained red. She looks great! She gained her 2 pounds back that she lost. I just can't believe how good she looks. Proud mama here....my baby is such a strong, little trooper.:D

[BostonLover]

Crystal:
Just checking in to see how things are going today? Hope the eyes is better. That is so troubling especially with a Boston as they have they bulging eyes. Hopefully you never have this problem again. After my cat having that I never want to deal with it again. Blessings
Patti

It looked real good this morning, and she didn't rub it at all in the bed last night. Going to get it stained again tomorrow to see if it's healed completely. I know it takes longer for cush dogs to heal.

I hope you and Tipper are doing well today! <3

[Harley PoMMom]

It's a miracle. Her skin looks GREAT!!! All the hair has now grown back. Her paws are white again (they were red). Her nose isn't falling off in pieces anymore, her eyes are no longer stained red. She looks great! She gained her 2 pounds back that she lost. I just can't believe how good she looks. Proud mama here....my baby is such a strong, little trooper.:D

What wonderful news about AnnaBelle!!!! And you should be so proud of yourself! Great job, mom!!!

[molly muffin]

What totally fabulous news! Good coat, good paws, eyes look good. Whoo hooooo!!!
Sounds like things are going really, really well. Keep up the good work!
hugs,
Sharlene and Molly Muffin

[BostonLover]

Well, just when I think she's doing great, I've started to notices some things.

Every night from 6-8 she pants and paces and has trouble breathing. Eventually I think she just wears herself out and falls asleep, but it's very hard to watch. She sounds like a little monster with her breathing. Also, now the fur on her ears is just falling off. We are not due for another ACTH until December, but I'm thinking of getting one early to see if she is still controlled. Otherwise, her drinking and ravenous appetite is under control. Sometimes she actually leaves food in her bowl!!

[goldengirl88]

My Tipper has had breathing issues all along. Does your baby have any tracheal problems? Maybe you can see something to help you on my many posts about Tipper's breathing problems. Blessings
Patti

[BostonLover]

My Tipper has had breathing issues all along. Does your baby have any tracheal problems? Maybe you can see something to help you on my many posts about Tipper's breathing problems. Blessings
Patti

I sent a video to the IMS, and she said she had no idea what was going on (comforting). She said we could bring her in overnight and they would run a bunch of tests, but $$$ is so tight that I would need to do test by test, not all in one day. I'll bring her in to see if it's something with the trachea. :(

[Boriss McCall]

My guy has been panting more in the evening as well & his numbers are great. So, I am not sure what is going on.
We are going for a senior physical in Nov to make sure nothing else is happening. It does get expensive. :(
I hope you can figure things out. I really hate the panting.. It makes me a nervous nelly.

[Arizona Boston]

Thinking about you today. Hope all goes as well as can be expected.

Lucy has started on Enalapril 2.5mg. She has some heart failure and they did a chest Xray. Her enlarged heart has displaced her trachea and that seems to account some for her more noisy breathing. I had to pass on a cardiac echo...just too expensive and I need to save my treatment dollars for most bang for the buck.

I wish we could make them young again and hold them in our arms forever ...

Shelly and Lucy

[BostonLover]

Thinking about you today. Hope all goes as well as can be expected.

Lucy has started on Enalapril 2.5mg. She has some heart failure and they did a chest Xray. Her enlarged heart has displaced her trachea and that seems to account some for her more noisy breathing. I had to pass on a cardiac echo...just too expensive and I need to save my treatment dollars for most bang for the buck.

I wish we could make them young again and hold them in our arms forever ...

Shelly and Lucy

AnnaBelle is also on Enalapril 10mg/day!!! They said it was for her protein in the urine, which was sky high. We go for another ACTH and protein check the 2nd weekend in Dec and if numbers look good, then we can take her off it. I hate this disease. I'm anxious to see her ACTH numbers, as now she is losing all the hair on her ears. :( Her panting has got better, so maybe it was weather related....

I hate to hear Lucy has some heart failure. :( They are the sweetest dogs ever, and I hate there are so many with Cushings! Sending hugs and positive vibes to you and Lucy <3

[goldengirl88]

Crystal:
The last time I was at PVSEC both people beside me had dogs with Cushings. Can you believe that? It is so prevalent it is making me sick knowing all these dogs have to go thru all this crap. I go to see the Cardiologist and Eye Dr. on the 25th. Too bad our appointments were not on the same day! Hope all goes ell with your baby and that you can soon stop the medicine for the protein. Do you give your dog a supplement for the kidneys? Might be something worth looking into in for the future. Blessings
Patti

[BostonLover]

Patti-
WOW! That makes me sick as well! I had never even heard of this disease until I started researching why my dog was drinking and peeing all the time.

Yeah, too bad they aren't on the same day, it would be nice to put a real face to your name.:D I'd love to meet Tipper as well!

What type of supplement would you recommend?

[goldengirl88]

Crystal:
Knowing how Cushings can adversely affect the kidneys I have had Tipper on Renal Essentials by Vetri Science since the start of this horrible journey. You can get them form Amazon, I use the ones for her heart also. Take a look and read about the reviews on Amazon. Blessings
Patti

[BostonLover]

Crystal:
Knowing how Cushings can adversely affect the kidneys I have had Tipper on Renal Essentials by Vetri Science since the start of this horrible journey. You can get them form Amazon, I use the ones for her heart also. Take a look and read about the reviews on Amazon. Blessings
Patti

THANKS!!! I'm ordering now!:)

[molly muffin]

Happy Thanksgiving Crystal and Annabelle!

Hope all is going well.

hugs,
Sharlene and Molly Muffin

[BostonLover]

My sweet baby girl passed away last Saturday. She played in the snow, then laid down and died. I'm a wreck.

[goldengirl88]

Crystal:
Oh my God I am so sorry. I never expected to hear this from you. I thought she had been doing so well? When you can please tell us what you think happened. God Bless you all and you baby in heaven. Have you called Dr. Peterson?
Patti

[addy]

I am so sorry to read this about Annabelle. Please know we are here for you. I am just shocked and find words not forthcoming.

[Junior's Mom]

I am so very sorry to hear this. What a shock for you, so quick and unexpected. I know it's not much consolation at this time, but she was having fun till the last minute, and was very lucky to have you.

[molly muffin]

OMG Crystal! I'm shocked. Sending you tons of hugs and love. So, unexpected, that it seems unimaginable. I know you are devastated. Sweet Annabelle. :(
My sincerest condolences.
Sharlene and Molly Muffin

[spdd]

Oh Crystal, I'm so sorry to read this.

My sincerest sympathy and condolences to you.

[grapey]

I'm so, so sorry. That is terrible, terrible. Praying for you.

[Roxee's Dad]

Oh no Crystal, I am so very sorry to read this. My heart hurts for you.... Rest in peace sweet Annabelle, You are our newest and brightest star in the sky tonight...

[doxiesrock912]

Crystal,
What a shock! I am so sorry!

I am thankful that Annabelle was happy and playing before she passed.

[Squirt's Mom]

Dear Crystal,

I am so sorry for your loss. I am sure that was quite a shock for you, as it has been for all of us. It is my deepest hope for AnnaBelle that her heart was full of joy playing in the snow and that was all she knew, other than her love for you, as she flew from this life; no pain, no fear, no discomfort, only simply joy and love. As much as Squirt loves the snow, I think this is the way she would choose to leave and knowing she was so happy at that moment would be a balm to my Soul, tho the pain would be no less.

We are here anytime you wish to talk, sweetie. You are still not alone; your K9C family is by your side now as always.
Hugs,
Leslie and the gang


A Simple Message From Your Pet
by Ken D. Conover

To have loved and then said farewell is better than to have never loved at all.
For all of the times that you stooped and touched my head, fed me my favorite treat and
returned the love that I so unconditionally gave to you. For the care that you gave to me
so unselfishly. For all of these things I am grateful and thankful. I ask that you grieve
not for the loss but rejoice in the fact that we lived, loved and touched each other's lives.
My life was fuller because you were there, not as owner, but as my friend. Today, I am
as I was in my youth. The grass is always green, butterflies flit among the flowers and
the sun shines gently down upon all of God's creatures. I can run, jump and play
and do all of the things that I did in my youth. There is no sickness, no aching joints
and no regrets and no aging. We await the arrival of our lifelong companions and know
that togetherness is forever. You live in our hearts as we do in yours. Companions such
as you are very rare and unique. Don't hold the love that you have within yourself.
Give it to another like me and then I will live forever. For love never really dies,
and you are loved and missed as surely as we are.
Your baby in heaven.

[BostonLover]

Thanks everyone. We think she may have had a heart attack, but not sure. She went and played in the snow, pooped, then came back in, started walking real slow, then laid down on her side (very rare), so we asked her if she was ok, then she just spaced out, started breathing different, then took her last breath...it was literally about 3 minutes from start to finish. :(:(:(:(

[grapey]

Wow. I don't know what to say. It sounds like she went very quickly.

I think one of my cats died of a heart attack. I found him under the couch, looking like he was sleeping, but he'd passed. He wasn't even sick. I don't know what happened exactly.

How are you doing today? I'm thinking of you.

[BostonLover]

I'm a wreck today.....sitting here at work.....TRYING to work, but just weeping. I had to move her picture out of my site today because it's too hard to look at right now. My other baby Kaya hasn't really eaten since Saturday...I even tried boiling rice and chicken for her, but she's so sad without her sister.:( I'm hoping I'll feel better once her remains are delivered to me. At least she'll be back home.

[goldengirl88]

Crystal:
I am so sorry you have to work during this time. Did Annabelle have heart problems? Do you know what the temperature was when she was out playing? Like Leslie said at least she crossed over being happy and playing outdoors. Have you called Dr. Peterson? I hope the work day goes quickly so you can get home. God Bless you and your sweet Annabelle in heaven.
Patti