My sweet little Ginger - Ginger has her angel wings

[My sweet Ginger]

Hi to all. My almost 14 years old 10.5 lbs chihuahua Ginger is on her 5th day of her 250 mg loading phase treatment for PDH. Her symptoms were more than usual drinking, frequent peeing, lethargy, sleeping all day & night, occasional panting and weakness on her hind legs. On her 1st day of treatment I noticed an improvement in her demeanor ; more alert, less sleep and brisk walking at times. Food and water consumption almost no change so far. My question is when would I know when she is loaded? Doesn't her improvement of demeanor count for anything or is there one thing that clearly tells me she is loaded? Is the end point her refusal to all food? I really don't want to miss her end point but I'm afraid I'm going to miss it and then we will have the opposite problem! Not to make you guys worry, she got CBT, ACHT, LDDST and abdominal ultrasound done and been diagnosed with PDH. If somebody can give me an advice on that from your own experience, it will be greatly appreciated. Thank you.

[Squirt's Mom]

Hi and welcome to you and Ginger! :)

Here is a link with some great info on Lysodren loading and maintenance. During the load, you want to watch for a reduction in water intake and / or a lessening of the appetite. These signs can be very subtle - as in looking up from her feed bowl when before she wolfed her food down, or looking up at you when her name is called when before nothing would interrupt her eating. Even eating at a slower rate can indicate the load is achieved. She may go to the water bowl less often or stay there drinking a shorter period of time than she did before starting treatment. You are absolutely correct, you do NOT want to wait until she loses her appetite - that could mean she has gone too far.

Did the vet tell you a certain length of time for the loading - before you stop and bring her in for the ACTH? If she's been on treatment for 5 days, she should be getting close to loaded so watch her carefully for the reduction in drinking and / or appetite - these are typically the signs we see first when they are loaded. BUT the fact that her demeanor has improved says she is getting close in my mind. You may see signs very soon that she is drinking less and/or eating less - then you stop giving the med, call the vet, and ask for an ACTH scheduled 48 hours after stopping the med. Lysodren keeps working for quite a while, reaching it's peak at 48 hours so you want the test around that time so the optimal control is shown on the test results. Test too early and the cortisol level can continue to drop; test too late and the cortisol could be on the rise again. By testing as close to the 48 hour mark as possible will give the most accurate information on the cortisol level achieved with the load.

I'm glad you found us and will be keeping an eye on ya'll, as will many others. You are both family now. We will be with you all the way. Never hesitate to ask question or simply talk if you need.

Hugs,
Leslie and the gang

Lysodren loading instructions and related tips -
http://www.k9cushings.com/forum/showthread.php?t=181

[My sweet Ginger]

Thank you so much Leslie for such a quick reply.
I'm sorry, my name is Song and the reason why I'm nervous is that my Ginger hardly showed such an aggression during meal time. I can't really tell the difference in her eating habits before and now. She stops and looks at me when I call her name while she is eating but that was what she was doing before the treatment, too. So it's hard for me to see the difference before and after the treatment. Also, she showed an improvements on the first day of treatment and she couldn't have been possibly getting ready to be loaded already, right?
She came home w 6days supply of Lysodren along w prednisone. When I expressed my concern for possible side effects, she said give her both during loading period but I've been tapering off on prednisone for more accurate readings for coming ACTH test and so far she is not showing any signs of side effects yet. One new info I learned from your post is that to wait 48hrs after a suspected end point. I thought I have to take her in for test right away. I really appreciate your kind and detailed explanations and that puts my mind at ease more than you know in case for my future questions. Thank you.

[Squirt's Mom]

ahhhh...giving pred along with the Lyso is not the normal process because prednisone acts just like cortisol in the body - in fact, it causes a form of Cushing's called Iatrogenic that is cured by weaning the dog off of the steroid. It may take longer to load since the vet has chosen to go against standard protocol by using the pred with the Lyso. And, yes, this will make it more difficult to know when she is loaded. :(

It sounds like she wants you to stop after 6 days and since she seems to be following an approach that is not the norm, I would have the testing when she asked. Be aware - this approach may take longer and cost you more than if it was handled in the normal way. On the flip side, it may work just fine - but do NOT continue to give the pred once the loading is achieved. ;)

[goldengirl88]

Song:
I don't have any experience with Lysodren so I will leave that up to Leslie she is the expert with this. I just wanted to welcome you, and hope that you and Ginger do well and get help on this forum. Blessings
Patti

[My sweet Ginger]

Leslie, I'm trying to keep my cool here after I read your last post.
I asked her more than once if giving her both drugs would not interfere with the accurate results and she said yes. Another reason other than my gigantic worry would've been the unusually high number on her post ACTH stim test. She suspected a dramatic drop in her cortisol level might more likely bring on certain reactions in her body. Her baseline # was over 5 and post ACTH # was over 50 which was way too high even for a dog w this disease I was told. I gave her 1st & 2nd prednisone on the mornings of the 1st & 2nd day and the 3rd & last one 36 hrs after which was Sat afternoon. She's been doing ok so far w/o the prednisone. I'm not sure if I'm doing right by Ginger by tapering off of prednisone on my own or I should keep giving it to her. I just want to do the right thing for her and help her get back to her old self as closely as possible. It's ao hard to decide what to do when you know sooo little about what you are doing. :(

[Squirt's Mom]

In my book, your gut was telling you right when it said to taper off the pred. You will be more apt to get an accurate reading and quicker load without it on board at the same time.

You DO want to have pred on hand just in case of a crisis - if the cortisol were to go too low. But I think you did right by tapering it off and giving just the Lyso. Your vet probably isn't going to agree with me and I am not a vet by any means so it is entirely possible the vet feels she is giving Ginger some added protection by using the pred along with the Lyso. ;)

[My sweet Ginger]

Hi Leslie, just spoke to our vet and I brought it up again and she said it would've been ok w the results because her dose is pretty small (a quarter tab) and agreed w me on staying off pred. Unless Ginger's loading period comes sooner, she will be off Lysodren by tomorrow afternoon the latest and then an ACTH stim test is scheduled on Thursday morning. I can't wait to go onto the maintenance phase.
Thank you Leslie & Patti for your warm welcome and encouragement.
I will keep you guys posted.

[grapey]

Hi Song,
It sounds like Ginger has a similar appetite to my Boston, Elliott. Before loading, she was never totally ravenous--she would sometimes pause, look around, then start eating again. So I wondered how I'd see a difference in her appetite to tell me she might be done loading.

I didn't see any difference at all until day 8, and that morning she didn't finish her breakfast--and that was the sign I had been looking for! Turns out she was loaded at that point. (Just wanted to note that she never completely lost her appetite--she just ate less than normal, and we couldn't coax her to eat the rest. )

Of course, this is just my experience with lysodren loading, but just wanted to share my story.

You obviously care a lot about Ginger. I know you'll do what's best for her.

[molly muffin]

Hi :) I just wanted to welcome you and Ginger to the forum.
It sounds like Leslie has got you started out and answered your questions.
Just remember that you stop the lysodren, when you notice anything like what Jen mentioned, not finishing breakfast for instance and then no more lysodren and schedule the ACTH test for 48 hours later.
You should be just fine with that.

Sharlene and Molly Muffin

[Squirt's Mom]

Mornin', just checking in to see how Ginger is doing. :)

[My sweet Ginger]

Good morning, everyone?
I appreciated all of your kind and helpful posts.
If leaving a couple of kibbles in her bowl is considered 'a loading achieved', then my Ginger's loaded. She was a little bit slower finishing her BF this morning and I saw 2-3 kibbles left, that usually not happening. Another possible sign might be that I've been noticing for last couple of days her stools seemed to be getting more solid where as they were rather mushy before (Please, forgive me and I'm really sorry to bring this up this time of the day.:o). So I was quite convinced that she was getting closer to be loaded soon and when I saw her solid jewels before BF this morning, although I don't remember reading about this subject being mentioned anywhere so far. So, do I stop right now or give her the last dose of Lysodren at dinner time? She's going in for an ACTH stim test on Thurs. morning.
Thank you everyone in advance and I wish I'd found this site sooner maybe then I could've saved some of my tears and fear, too. I still get emotional here and there but doing much better ever since the ultrasound which showed she had PDH and NOT ADH. Can't wait to see if everyone agrees w me that she's loaded. Thanks.

[Squirt's Mom]

I would say, yes - withhold the pill tonite. It does sound as if the load may be achieved and the pill she took this morning will continue to lower the cortisol for 48 hours. Keep watching her just to make sure things are going good but I think you are right - it's time to stop and have the ACTH Thurs. Way to go, Mom! You done GOOD! :cool::):cool: So you and Ginger try to enjoy the next few days with no big ole pills to take! ;)

[frijole]

Technically this morning's pill should have been skipped. Never give it once you see signs of loading as it does continue to work for 2 full days. Yes this was a sign of loading so no more lysodren. Schedule an acth test for 2 days from this morning so it'll reflect the 2 days of continued dosing she's getting from this am's pill.

Re the poop - loose stools wasn't caused by cushings - it can be caused by too much lysodren but since she got better I'd say that the two are totally unrelated.

Keep us posted! The hard part is over is she is loaded. Kim

[My sweet Ginger]

Thanks, Kim. Yes, I'm now convinced that she's loaded. She turned her head away from her treat late this morning. With that and the other previous signs from this morning, there's not much doubt. Called the vet's office and she agreed.
I was lacking in description regarding her stool. Since we switched her dry food (we get them from the vet's office now) some time ago due to high level of crystal in her urin, it's been mush to loose and then since the Lysodren, they were becoming regular although I still have to wait and see if that's the case for sure.
I'm hoping for the good numbers on Thursday. Song.

[goldengirl88]

Just watching your posts and hoping your Ginger is doing well and that you are too. Blessings
patti

[molly muffin]

Oh so glad to hear that she is probably loaded! whew, one step down, now to the test and forward Ho!
Don't worry, we talk about poops on here all the time. It is the indicator for so many things about how they are doing, reacting, that we could probably write a book on it! LOL

Sharlene and Molly Muffin

[My sweet Ginger]

So, Ginger's been off Lysodren since Tues. morning and is going in for her ACTH @ 9:30 & 10:30 this morning. Although she did her usual 'hurry up' barking (clearly less enthusiastic), she didn't finish her bf, about a quarter I'd say (they didn't tell me to fast). Her water intake seems about the same, possiblly a little less although she didn't wet her diaper yesterday when I came home from work after 5 hrs. By the way, if anyone having a problem w diapers not staying on I can suggest the one that stays so well even for overnight. I was having a Hugh problem w Ginger peeing all over the floor through out the day like every hr for a long time, all the while trying desperately to find one that works to no avail. Since these new ones, can't remember when I cleaned the Floor the last time. She wears them 24/7 and of course I still take her out as often as possible.
I'm worried that she might be over loaded. If so, is she still going to be ok? She seems a little groggy and unstable when walking but that could be because she got up not too long ago. I'd like to think so.

[frijole]

She might have gotten a bit low but if she was in danger you would typically see a dog that was so lethargic she couldn't stand up and was refusing all food.

Perfect time to be having the test done. You stay off of the lysodren for one week from the last dose before commencing the maintenance. If she is a bit lower than recommended (1.0 or lower) you can simply wait a few extra days to allow her cortisol to increase and then start your maintenance regime.

My guess is the dosage was perfect but that last pill you gave was after you noticed she had left food so it might have tipped the scales a bit. Do not feel bad - this happens - I wouldn't lower the dose based on this but rather just wait a bit longer to start maintenance - again all of this is assuming test results that we don't have yet.

After you get home from the appointment you can give her a prednisone. I bet a single pill will make her feel better.

Do keep us posted on how it goes ok? Thanks, Kim

[My sweet Ginger]

Thank you so much, Kim. That gives me a heads up for sure. I sure will post her progress on here as I'm also going to start a file on her from now on. Thankfully, so far she seems to be doing fine and I can only hope it will always be like this.
Since I'm new here I've been trying to catch up with some of your stories and oh boy! what you guys've been through is just remarkable. I've been on pins and needles many times already. I cry often reading these not only the stories are so sad because what your babies have to go through and endure to get better but also it's incrediblelly heartwarming for the depth of love all you guys have for your fur babies! Just incredible! It's so sad that all your babies have cushings but each one of them is unbelievably smart and lucky for who they picked as their parents!
I'm sooo impressed by you all.

[molly muffin]

How did it go today? How is Ginger acting now?

Checking in for all us worry warts. :)

We get through everything because we have each other for support. That makes it all so much better. Even with a supportive family, which not all have, it can be rough because they don't understand the ins and outs like on the forum, were we all live and breath, dogs, cushings, other ailments constantly.

You have that support group now too. :)

hugs,
Sharlene and molly muffin

[My sweet Ginger]

Good morning everyone?
This question is for Leslie. We were told after Ginger's US that it showed a tumor on her spleen and advised to recheck in 3-6months after get cushings under control. Our vet is convinced Ginger has cushings and that's why she put her on Lysodren. After reading your post about your baby's case on another thread, that made me pause and think about it again. What's your thought on this? I'd love to hear it. I just hope it doesn't rupture. Song.

PS: I will get the ACTH result today.

[Squirt's Mom]

Hi,

Yes, Squirt's tumor and half her spleen had to come out - we weren't given an option to wait and watch. I have been unable to find her old vet records to get the particulars about her tumor but I do know there was no option but surgery if I wanted her to have a chance. Over the couple of days we had to wait for the surgery, I was told how to pick her up to lessen the chances of causing a rupture so her's must have been obviously risky when found. She wasn't supposed to go up or down the stairs by herself, no jumping, no running - I was to keep her calm and prevent exertion.

Once the surgery and recovery were over, she was retested for Cushing's and her cortisol had returned to normal. Her IMS told me the stress from the tumor had caused the cortisol to be elevated and once the stressor was removed, the body no longer had any need for the excess cortisol and stopped over-producing it.

She did test positive for Atypical Cushing's at that time - normal cortisol, elevated intermediate hormones - and then did become true cushinoid in a few more years with elevated cortisol in addition to elevated intermediates.

If you are concerned, talk to the IMS, talk to a surgeon, and see what they think. The tumor seen in Ginger may be very small and thought to present no real problem but I would want to hear it from either the IMS or a surgeon familiar with Cushing's. And I would certainly be wanting regular ultrasounds to check on the growth, if any, of the tumor.

Hugs,
Leslie and the gang

[My sweet Ginger]

Leslie,
On the report it says 'the spleen contains a small (2cm diameter) slightly hyperechoic mass bulging the serosal margin.) and under summary it says ' small focal splenic mass'.
Thhe conclusion : the bilateral adrenomegaly is most consistent w PDH hyperadrenocorticism. The differential diagnosis for the splenic lesion includes nodular hyperplasia and neoplasia. Options to further investigate the splenic lesion include 1) recheck US in 3-6 months, 2) percutaneous ultrasound- guided FNA or 3) splenectomy.
By the way, all of her tests came back positive for cushings so I really don't doubt her diagnosis but am concerned about her spleen, tho. I will ask the vet again. Thank you.

[grapey]

Hope you get some great news today!

[My sweet Ginger]

The numbers are in and they are:
1st ACTH test, 9/24/13 2nd ACTH, 10/24/13
Pre: 5.6 Post: >50 Pre: 4.6 Post: 7
The vet was pleased w the result and may want to do a 2nd mini induction for 2 days after giving Ginger's body a little break since she seems weak and her appetite is a little off or she will just go to maintenance phase. Either way she wants to do another ACTH test in about 2 wks. She also suggested I should give her a quarter tab prednisone over the weekend and wants me to report back to her on Mon. What does everyone think about this, please let me know. I'm concerned about her weakness, tho.
She doesn't even do the brisk walking hardly anymore. She feels a little warm to the touch to me.

[frijole]

Her approach makes sense since your didn't quite get to the desired range of 1-5 on the last number. That said your girl started out with cortisol that was very high if over 50 so any time you reduce it that much and that quickly I can see why she'd feel a bit drained. I would give her the prednisone mentioned (she meant one dose one time right) just to give her some relief from the cortisol being so low. She should respond to that. (basically you are giving her more cortisol)

I agree - let her rest a bit but I wouldn't wait a real long time before doing that mini load or you'd have to start all over again. Oh and I wouldn't do another acth test until TWO days after the mini load 's last dose. That way you know how you did. There is no reason to do one before that.

Kim

[My sweet Ginger]

Thank you, Kim. I'm glad to hear that you agree. I will definitely do the mini load and the test 2 days after it's last dose. How many days after would say we should start the 2nd load, Kim? A wk or two or a few days? I just gave her pred and what the vet said was give it to her today, Sat. and Sun. and call her back on Mon.. Thank you so much. Song.

[frijole]

It's never that simple! :) I would see how she does today with the prednisone and wait to see if you really need to give any more. It is good stuff but it can raise the cortisol higher so I wouldn't give it every day unless Ginger really seems to still need a bit of a boost. She might not.

I'd do the mini load based on how it goes. I'll check in and others will too so you aren't alone. Hang in there - this is the toughest part and you are close. Kim

[Squirt's Mom]

Hi Song,

What do you mean by "she seems weak and her appetite is a little off"? Her appetite is supposed to change with the load - it is supposed to decrease so that she isn't as hungry or as interested in food as she was before the load. HOWEVER, she is not supposed to lose her appetite. ;)

She shouldn't be "weak" either. "Weak" to me means she can barely move on her own, very wobbly, trouble holding her head up, etc. This should NOT be at all. With her cortisol dropping so much she is very apt to feel kinda yucky from what is basically a withdrawal but not weak.

A post # of 7 is still higher than the recommended desired range so on the face of things, the cortisol is not too low and the normal procedure would be to simply continue the load for a day or two more. Waiting now is going to allow the cortisol to start rising again. BUT the weakness is concerning to me - based on the numbers, she should not be weak. But as Kim said, it is never easy and there are pups who simply do better with their cortisol levels a bit higher than what is recommended so Ginger may be one of those pups who's post number needs to run a bit high.

And, of course, in my mind because of Squirt's experience, I am wondering about the spleen. I can't help but wonder if, like Squirt, her body is over-producing cortisol because of the spleen and not because of Cushing's. Squirt tested positive on five different tests before the tumor was found and removed. After it was removed, her cortisol returned to normal and remained within normal range for a few more years. I would certainly discuss this possibility with the vet asap. ;)

So this brings me back to the statement that she is "weak" - can you describe what you are seeing that means "weak" to you?

And let us know how Ginger responds to the pred.
Hang in there!
Hugs,
Leslie and the gang

[My sweet Ginger]

Thank you Leslie and I will try my best. The first 2 days or so she was more awake (slept much less than pre Lyso) and had a little speed in her walks and moves. They might have been tiny changes but I couldn't miss it and I was very happy. On 3rd day w Lysodren, she didn't want to eat a piece of carrot as a treat but I didn't stop the Lysodren because the vet said in her 17 yrs of practice she never saw any dog gets loaded less than 5 days and also it was Sat. so I couldn't let the vet know of this and the next day I didn't see any more changes in her eating habits. The next few days I noticed a little less of the new changes in her demeanor and on day 6 she left a few kibbles at bf and no more Lysodren and her stim test 2days after, Thursday.
Since I didn't really see the little sparks that I saw earlier anymore I was very worried of her cortisol gone too low thinking I missed her endpoint and should've stopped over carrot incident. Although the vet was pleased I still was concernd about her 'weakness' and told the vet and that's why she said give her body a break before reloading.
I gave her a quarter tab of pred yesterday & the day before as vet said it will help her but she still sleeps like before Lysodren.
Now this is what I called 'weak' Leslie ; looking sleepy, unstable on her legs walking or getting up, sleeping a lot, slow walking and moving. W her appetite, she never showed aggressiveness w her meals and she finished last of the three and now even slower and she's been refusing certain treats but still finishes her meals. Without pred, I'm not sure. She is mostly sleeping today.
Her nose has a cracked look all over and I wonder if it hurts and I keep forgetting asking the vet about it and something must be discharging and dry out. I see her licking her nose w her tongue sometimes.
I'm really new about this disease and I know it's only a starting point for us. With what I've gathered online so far, I only know bits and pieces which amounts to nothing. As sacred as I am ( as all of you experts'd been once before when you first found out of your babies's condition), I'm trying to find some comfort that you guys will guide me through this journey that Ginger & I are about to take on together.
Leslie, we decided to wait and watch on her spleen because we didn't think Ginger was strong enough to go through a surgery. I will talk to the vet about Squirt's case. Thank you as always. Song

[My sweet Ginger]

To clarify her eating habits, although she didn't show such aggressiveness toward meals, she's never one to pass up any treats that was given to her and her speed and enthusiasm now at meal times are slower and lower than pre cushings and not just before Cushings. She doesn't look like she is enjoying eating anymore.

[Squirt's Mom]

I would keep the pred up and if she's not stronger by Monday, I would have the vet take a look at her. I don't see the cortisol being too low and affecting her appetite but something seems to be.

[My sweet Ginger]

Good morning, Leslie,

Do you remember whether Squirt's adrenal glands were enlarged and how big or small her mass was when she did the US? Both Ginger's adrenals appeared enlarged and the mass was 2cm in diameter which the US Dr. described as 'small' but on a 10 lbs. dog I wouldn't say it's small. So if you can remember the size of Squirt's mass and her weight, that will be very helpful to me when I talk to our vet tomorrow. By the way, how do you get an IMS? From yellow page?
Thank you.

[My sweet Ginger]

Morning Kim,

I skipped Ginger's pred yesterday because she was awake and more alert in the afternoon and finished her dinner. She was doing fine through out the evening and night. This morning, she didn't want to touch her bf of kibbles & scrambled eggs at all so I gave her bacon & kibbles. She ate maybe a half of it, mostly bacon. I have no clue as to what's happening with her at all except for something might be going on. I just gave her a half tab of prednisone as you suggested instead of a quarter tab and hope it will help her. Could it be from too big of a drop from her first post ACTH #of >50 or connected to the mass on her spleen? Maybe we need to do another ACTH & CBC and urin test to see where she is. What do you think?

[Squirt's Mom]

I'm sorry, I can't remember how big her tumor was. :o Her weight at the time I would guess was around 13-14lbs. I threw out more stuff yesterday and looked for her old file while I was working - still no luck. :rolleyes::( More and more I'm afraid I threw that away by accident in my tossing of stuff recently.

Here's a link from the Helpful Resource section here on finding an IMS -

http://www.k9cushings.com/forum/showthread.php?t=182

If the pred is helping her eat, I would keep it up until I could get her into the vet Mon. I would want to be sure nothing else, besides the cortisol or med, could be found to account for her lack of appetite and weakness. It is possible the cortisol fell a little bit more after stopping it for the ACTH but it would typically need to fall quite a bit to cause the things you are seeing. If you and/or your vet think there is a real possibility that her cortisol could have gone too low since stopping, then by all means do another ACTH. Unless diabetes, a UTI or other kidney issues is suspected, I don't know that a urinalysis would tell you much but that is a call for the vet. ;) A CBC could help point toward something that needs further investigation and could help show if something has changed since the last one was done.

[frijole]

Scratching my head on this because the signs you mentioned are for low cortisol but if the acth test was accurate and it was at 7.0 then the drop to below 1.0 would be a huge one especially since you haven't given any more lysodren. Please confirm I am correct on this statement (no lysodren has been given since you took her in for acth test).

I'm glad you gave her some prednisone and hope it works. I understand you give whatever you can to get them to eat but please note that cush dogs have a real intolerance to fat so the only real no-no diet wise is to avoid fats. My cush dog Haley was a little piggy and she couldn't even tolerate a small piece of white meat chicken after diagnosed - she vomited it up. My point is to try other meats than bacon if you can. ;):)

I would use the link that Leslie gave you and then google the IMS in your area to read up on their practices and education. YOu want experience in endocrinology. If there are teaching hospitals (vet schools) in your area they are often good sources for specialized treatment.

Kim

[My sweet Ginger]

Hi, Kim,
That's correct. She started her loading on Thurs. the 17th and her last Lysodren was Tues. morning, the 22nd and Stim test was on Thurs., the 24th. So no Lysdren since Tues..
I always used prednisone ( now I know that was prednisone ) for her ear infection during her early years like it was one of the first aids. The vet then never gave me a warning of overdosing that drug. The infection subsided around the time of her kibble change onto senior dog food. A few years ago she was given prednisone again for her lower back and legs a couple of times.
I remember started seeing her pee spots on the carpet in my bedroom upstairs many years ago and thought she was just being lazy. Started peeing (occasionally) downstairs last year and tests came back normal except for her heart murmur and a lot of crystals in her urine and was put on special kibbles and that was last Sept. After that, things were progressed slowly adding sleepiness, slow walking in circles, grogginess and spacing out to the list of excess drinking and peeing (only much, much more frequent now). No hair loss, no pot belly, hardly any panting, no weight gain and no noticeable muscle loss.
I'm guessing that her body's been so used to high level of cortisol for the most of her life (prednisone & cushings) the huge drop in her recent cortisol level in such a short time period maybe just too much for her body to handle. Am I even making any sense here?
The way she's been feeling, I don't think she needs her 2nd loading now. We may just go on to maintenance phase and do the ACTH in a month or so. What do you and others think? Thank you.

[Squirt's Mom]

Just me, but her picture is not the norm for a cush pup so I wouldn't even think of starting the maintenance until the vet sees her and can try to find a reason for the lack of appetite and weakness. ;)

[My sweet Ginger]

Oh, about her diet, she's always been eating the same as the others.
Kibbles and some kind of meat (about a quarter of kibbles) and her system's been pretty regular, though I will decrease fat amount even more. I hardly give them any fat thinking if fat is not good for us it must be bad for them, too. I've just begun this journey and I will have to learn so much very fast.

[labblab]

Hi! I haven't had the chance to write to you before, but I did want to mention that, just as you are suspecting, there is such a thing as "corticosteroid withdrawal" that can occur when dogs drop their cortisol level significantly and rapidly. The dogs can feel yucky even though their cortisol level is not so low as to signal a true Addisonian situation. Here's a quote from the Product Insert for Vetoryl, which is an alternative medical treatment to Lysodren. Even though the drug is different, I would expect that the withdrawal syndrome could occur just the same:


A small percentage of dogs may develop corticosteroid withdrawal syndrome within 10 days of starting treatment. This phenomenon results from acute withdrawal of circulating glucocorticoids; clinical signs include weakness, lethargy, anorexia, and weight loss1. These clinical signs should be differentiated from an early hypoadrenocortical crisis by measurement of serum electrolyte concentrations and performance of an ACTH stimulation test. Corticosteroid withdrawal syndrome should respond to cessation of VETORYL Capsules (duration of discontinuation based on the severity of the clinical signs) and restarting at a lower dose.
You'll see that the remedy in this situation for dogs taking Vetoryl is to teporarily discontinue the drug and then restart at a lower dose. However, Vetoryl works in an entirely different way than Lysodren. It is always taken on a daily basis, so you can start it and stop it at any time. With Lysodren, the remedy may be different. In order to not lose the load, the vet may want to proceed with the Lysodren dosing but continue to give some supplemental prednisone at the same time for a while (in order to offset the physical "blahs" that are resulting from the rapid decrease in cortisol). Normally you don't give Lysodren and prednisone at the same time. But maybe this would be an exception. I do not know. And the other folks here who are more experienced with Lysodren may say that's a nutty idea.

But above all, I just wanted you to know that you are right -- there is an actual syndrome that can be associated with the rapid lowering of cortisol.

Marianne

[My sweet Ginger]

Thank you so much Marianne and you are absolutely right.
Even though her latest post ACTH test number was 7, her post ACTH number before Lysdren was greater than 50! The drop had to be a significant one.
Since I gave Ginger a half tab of prednisone this morning, she is doing clearly better and she even finished her dinner faster than last few days. She is also doing her brisk walking now with her tail up. What a relief it is! I'm going to stay with 1/2 tab instead of 1/4 tab for now. I will see what the vet wants to do with this situation when I talk to her tomorrow. I will certainly let everyone know.

[frijole]

I'm glad the prednisone is giving her relief. You've given it before so you probably know this but the longer you give it she will become accustomed to that level of cortisol and you will have to wean her off of it slowly.

Marianne mentioned perhaps starting the maintenance dose of lysodren while giving the prednisone. It is a possibility but to be honest I've always hated when vets do that. The reason is simple - a dog can overdose (go too low) and you won't know it because you are giving a drug to lower the cortisol at the same time you are giving prednisone which mimics cortisol - you won't be able to tell via hunger reduction etc if she is lower.

I'd be more inclined to try to wean her off (hopefully before too long) and do another acth test to see how high she has gone. Based on the results of that test I would either start maintenance or do a mini load. But I wouldn't do a thing until you have her weaned off the prednisone.

Kim

PS A reading of 8 is not a bad or dangerously low number at all. I would think that regardless of the drop in cortisol that she would not have to be on the prednisone more than a few days.

[My sweet Ginger]

Thank you so much, Kim. You are giving me a very valuable advice.
I feel I'm well prepared to talk to her vet tomorrow and I think we will be able to come up with a solution that's best for Ginger. It's so nice to have real experienced people in the back ground and not blindly have to believe everything the vet says. I don't know how many cushy dogs she has treated. I'm going to ask her that when I see her next time.

[frijole]

No problem - we were all new to this at one point. That's how i found this place over 8 yrs ago! I know I've seen more cushings cases than my local vets because it's a small town. Not a vet but when it comes to giving these drugs - unless they have had to do it to their own dog - they can't imagine the stress. We get it.

Good luck tomorrow - hope it goes great. Kim

[goldengirl88]

Good luck at your vet visit. Hope all goes well, and that your baby is doing well also. Blessings
Patti

[My sweet Ginger]

Dear Patti,
Thank you so much for your concern for my Ginger and me.
I haven't dropped any post on your thread yet because I'm not finished reading you and Tipper's brave battle with this terrible diease. My heart aches and tears coming down whenever I think about your baby and you for what the two of you've been going through so bravely all by yourselves against all odds. I can't remember how many times I've cried reading your posts sobbing and praying and admiring your courage and the depth of love you have for your little baby. My hat is off to you and I command you for your fierce, fierce love for your Tipper. Patti, I want you to know that even if she is soooo unjustly suffering from this cruel diease, in my mind she is one of the luckiest fur babies anywhere if not the luckiest for having picked you as her mom. How smart she was and still is.
I know you won't stop at nothing to help Tipper feel better and know that I'm with you all the way. Through reading your posts I've been learning a lot about cushings so thank you for that from the bottom of my heart. I know I don't have to tell you this but keep going at it like you've been up to now. You are truly an inspiration to all of us here. Love you for having the kind of love for Tipper and being who you are. To me, this world is a better place because I've known you.
True admirer, Song.

[goldengirl88]

Song:
Thank you for the kind words, it is nice to hear something good about yourself in the midst of all the chaos. I love my Tipper more than anything on this earth, and I am so grateful to have that recognized. She is everything to me, and has been by my side though many tragic events. Every day I wake up and see her sweet face is the biggest blessing I could have. It is only right that I am here for her now. If I am able to help one person with something I am very thankful I can do that. If I take away one thing from my wonderful father, it is don't ever quit anything. He was a humble man that saw everything to the end once he started something. I learned this trait from him at an early age. When he was dying he still never gave up, and it will always be with me. It is hard sometimes and I get frustrated with these vets. They just don't hear me when I am telling them what is wrong. I went thru this with my vet when Tipper first got sick. My vet explained everything away as she is getting older and blah, blah, blah. I went in his office one day and said I had enough, my dog has Cushings and I want her tested. He did test her and I was right. If I had not stood up to his bullying me and making me look stupid where would we be??? So I ignore him when he makes light of situations I am telling him about. I have news for him, I called in the cavalry this time and I will get answers and get her the help she needs. I am counting on the wonderful kindness of Dr. Bruyette who has been a God send to me, to help me with this. I know I am right, I don't care what my vet says. I have two outsiders looking in and working on this along with myself. I may not have the where with all to perform things in a hospital, but I can get people moving to help my girl. I hope you do not have to travel the bumpy road that Tipper and I have been on, but should you find yourself on that path, remember I am always here for you, and don't ever give up. I hope some of this discoveries I have made along this bumpy ride can help someone to get the help they need for their Cush baby. Tipper is all I have and I will fight this fight every second of every day for her. God Bless you Song and your sweet Ginger.
Patti

[My sweet Ginger]

Oh Patti, don't you doubt that some of your discoveries along the way have been a big help to others and I have no doubt it will continue on. I for one already am learning a lot from your posts. Thank you for that.
I hope Tipper's having an easier day today. I will keep you and Tipper in my mind.
Luckly for me our vet is really nice, always ready to listen although not always easy to reach but she does call back at the end of her day.
Take care. Song.

[molly muffin]

I do believe I see a Ginger avatar up. Isn't she just a super cutie. How is she doing today? What has the vet said? I hope she has more strength and bounce to her step. :)

hugs,
Sharlene and molly Muffin

[My sweet Ginger]

Yes, Sharlene. That's my Ginger ans I was happy that I was able to put her photo up finallly. She is resting right next me but she is not asleep. Just resting. She's doing just about how she was yesterday. Not really active but more awake and a little faster walking and thats an improvement for her compared to before Lysodren. Although her overall drinking seems to have decreased, I still see her drink quite a bit when she does and she finishes her meals now.
Her vet agrees with me about Ginger's cortisol withrawal syndrome and said we will take time to get her where she should be and stay on prednisone (1/4tab) until the morning of the 4th and ACTH on the morning of the 5th and go from there depending on her numbers and I like her approach on this.
This roadblock has made me realize the importance of our roles as our vet's eyes and ears when our pups are not well because they can't see our babies from where there they are.

Now, I have to find out how to view everyone's babies' pictures & videos. I'm dying to watch Kathy's little Rosie's pics and videos.
I'm such a sucker for tiny puppies.

[molly muffin]

Yes we are perhaps the most important part of treatment, because we watch for changes, signs of anything, up or down and know our beloved companions better than any vet possibly could. The really good vets know this and work together as a team.

Oh yes, Rosie, Gus and Archie, Henry, so many cute little ones have come into our lives. :) Just click on the members name and you'll see some options drop down, you can click directly on "View Public Profile" or right click and open in a new tab to get a new page. On their public profile, on the far right side, scroll down if you need to, you'll see albums, which you click on and the pictures will be there. Some have one album, some have more. It's fun to go through and see all the pictures of everyone that is talking to you. :)

Let me know if you run into any problems.
Sharlene and Molly Muffin

[frijole]

I only have one problem with the vet's plan and that is if you stay on the prednisone and go directly in for an acth test be prepared for a HIGH cortisol reading. I think you should wean off of the prednisone before attempting the acth. The reason is that you won't know what Ginger's "true" cortisol reading is because it will be influenced by the prednisone.

Kim

[My sweet Ginger]

I see what you're saying, Kim. Each time I mention about prednisone interference, she keeps saying 'minor dose' won't affect the results.
Since I'm not going to have Ginger loaded until she is strong enough to go through another induction if necessary, weaning her off of prednisone first and then ACTH makes more sense to me, too. It should only take a few more days to wean her off, right? How do you do it? I can talk to her vet about this. She is a pretty good listener.

Thank you Sharlene but somehow I was able to go on the photo album and I saw Rosie's pics and she's just too cute! She reminds of my Stella when she first came to us 2 1/2 years ago from TN. She was a rescue puppy, all black and only weighed 3 lb. with fuzzy hair. She was supposed to be a mix of chihuahua & Yorkie. Well, without any exaggeration she gained 1/2 lb every 1 to 2 weeks for a few months and by 6months old, she was the largest of the three in height and weight both! She is almost 17lb. now and so strong and so fast I should enter her to some racing competitions if I knew how. No one knows what breed she is but she looks like a rat terrier we see in pictures. She certainly is not a lap dog but living with two those, she sometimes acts like one and it's so funny. At any rate, Kathy, Rosie looks like one smart girl. I'm sure she will master the house break training in no time like a pro. I know she will do her best to fill the huge hole that was left in your heart by your baby Buddy. They say time heals. Lets hope for that how long ever it takes.

[frijole]

The longer you give the prednisone the longer it takes to wean. If you only give it a few days you can cut the dose in half each day and then be done. But when you go for weeks you are making her body rely on the prednisone and therefore you have to taper it more slowly. That is why while I like the drug I'm not a fan of it. It is fantastic if you really need it. I'm not convinced Ginger needs it but I'm not there with her. That's why I mentioned testing to see if she needs it. Usually it is given as emergency when dog is so lethargic you think they are dying. I'm not sure how lethargic Ginger is as I'm not there. It has to be your call.

Every day that you do not do maintenance or the mini load your dog is producing more cortisol. Plus you are giving prednisone. Those two combined means that number 7 or 8 that you had could be up to 15 or higher in a week which means you might have to give more than 2 days load the next time.

It's a balancing act and there is no exact science. That is why I caution to use the prednisone but only if you really need it. The sooner you get her off of it the sooner you can get her loaded. That said don't rush it if she is truly sick.

Not sure I helped. :confused::) Kim

[labblab]

Gosh, I have to agree that it's hard to know what will work out best for Ginger, overall. I do understand Kim's concern about the prednisone. But in order to try to gauge how big a problem it is, let me ask you a couple of things. First, how much does Ginger weigh? Secondly, what dose of prednisone are you giving her (how much does 1/4 of a tablet actually work out to be)?

If I'm understanding correctly, your vet intends that she will have taken the pred for a week in total prior to the ACTH testing. So that is really not a super long time, and depending upon the size of the dose may not require any weaning. If you were to need to wean, you'd probably have to go to every-other-day dosing for a few days because I don't know how'd you split a quarter-tab any further. But having taken a very low dose of prednisone for only a week, I would think that any skewing effects of the drug would be out of her system, without a wean, as long as you wait 24-36 hours before giving the ACTH test.

But in order to judge all of this better, it will help to know her weight and the prednisone dosing.

Thanks!
Marianne

[labblab]

P.S. Great job with your avatar!! :) :) Ginger is such a sweetie-pie! :o

Plus, I see in looking back through your thread that Ginger weighs 10+ pounds. So now all we need is her prednisone dose to figure out how low or high it actually is.

[goldengirl88]

Song:
What a cute Avatar of Ginger, she is a sweetie, I can see why you are so worried for her. Hope it all gets sorted out. Blessings
Patti

[addy]

Hi, I just thought I would jump in here as a human who has been given prednisone for asthma numerous times over the years. As Marianne did point out, whether I was weaned off of it or not depended on the dose and how long I was on it. You may not have to wean Ginger off of it.

[My sweet Ginger]

Good morning, everyone?
Ginger weighs 10.5-6 lbs and her pred. pills come in 5mg each and she gets a quarter of it a day. I just thought all prednisone come in 5mg in size and I don't know how big or small a quarter tab is for her weight.
When I mentioned that maybe we should stop pred 2 days prior to her ACTH she said stop it from the morning of the day before and didn't say anything about tapering off. I hope this helps. Thank you everyone.
Song.

[labblab]

OK, so that means Ginger is getting around 1.25 mg. daily, which would be the appropriate "rescue" dose of prednisone for a dog of her size whose cortisol level has dropped too low (formula is 0.25 mg/kg, and a kg equals 2.2 pounds). At that level of dosing, I'd think she can stop after just a week without weaning. And the 24-hour time period before the test is probably long enough, as well. So I'm personally OK with the prednisone, as far as that goes. (And yes, prednisone comes in many dosage strengths clear up to 50 mg. tablets, so you have to be careful as to what dose you've been given).

Like Kim, though, I'm thinking that two weeks is a long time to go without any Lysodren. So there is indeed the chance that her natural cortisol will have rebounded enough to necessitate another load. That's why I was initially thinking your vet might want to go ahead with some maintenance dosing even during the week Ginger was taking prednisone (thinking the temporary pred might get her "over the hump" of cortisol withdrawal).

But now you have a plan in place, and you can always reload again if need be. Above all else, if Ginger is still acting "off" next week after the week of prednisone (and assuming her cortisol level is not too low), then you really may want to investigate if there is anything else unrelated going on before you'd start back on the Lysodren at all.

Marianne

[goldengirl88]

Checking in to see how Ginger is doing today. Hope all is well.
Blessings
Patti

[My sweet Ginger]

Hi, everyone,
I got a message from our ver's office (I left a msg with 2 questions earlier today) and her instruction was due to her minimal dose she needs no weaning and ACTH test still 24 hrs after her last dose of prednisone and it won't interfere with the test. So I feel better. She should've explained this to me already and that's what I'm missing from her from time to time. A little detailed explanation up front about her upcoming treatment or plan.
Ginger is still being selective about her meals and snacks which is a concern to me though overall she is doing better. She even joined the other two in greeting me when I came home from work today. Usually she's in her bed either sleeping or just laying in there with a blank look in her eyes. So that teared me up and it was really good to hear her barking.

[molly muffin]

I am so glad to hear that Ginger has perked back up and even got up to greet you! Yay!

hugs,
Sharlene and Molly Muffin

[goldengirl88]

I am so glad to hear sweet Ginger perked up and greeted you mom. What a nice surprise. I hope she continues to improve every day. Blessings
Patti

[My sweet Ginger]

Hi everyone,
By the time I found this wonderful forum Ginger was already on day 5 with her Lysodren loading phase so I didn't get to run her tests numbers by the expert moms here. As I read other threads, I sometimes compare her numbers to theirs but not really understanding what those numbers are for.
Like:
1) Her T4 (now I know what it is) is 0.5 (reference range is 1.0 - 4.0 ug/dl, Sept 17, 2013. Is it low enough for me to be concerned about?
2) Her ALK. PHOS. is 935, ref range is 10 - 150 U/L done on 9/17/2013. That was an increase from 175 from 9/26/2012. A big jump.
Her ALT is 121 (ref. 5-107 U/L), 67 in 2012.

Nothing else is really low except for EOSINOPHIL of 0.8 % (ref. 2-10%) and a few other highs.
In her urinalysis, negative glucose, blood 2+ (high), protein 2+ (200-300 mg/ dl), RBC 10-15 (0-5) and crystals 3+ CA OXALATE (6-10) HPF.

I'm asking this (kind of late in doubting the diagnosis now) but because neither her diagnosis process or treatment progress hasn't been as clear as what I'd like them to be and I see some numbers that are either too low or too high as I read through other threads which I have no idea what they'd mean so somewhere in the back of my mind I keep having this lingering thoughts about her diagnosis. I think the vet said Ginger doesn't have diabetes or kidney diease but we know she has a mass (2cm in diameter) on her spleen.
I worry a lot in general, maybe too much (my husband can't stand it)
and maybe that's all it is. Any thoughts? Thanks.

[goldengirl88]

I know from personal experience that these vet bills can almost bring on cardiac arrest sometimes. It is so hard to keep putting out the money, but there is nothing you can do if you love your dog. I swear we should be able to claim this on income tax, and I am very serious. Other health care is deductible so why not this, they are part of your family. I hope sweet Ginger continues to do well. Blessings
Patti

[Harley PoMMom]

1) Her T4 (now I know what it is) is 0.5 (reference range is 1.0 - 4.0 ug/dl, Sept 17, 2013. Is it low enough for me to be concerned about?
2) Her ALK. PHOS. is 935, ref range is 10 - 150 U/L done on 9/17/2013. That was an increase from 175 from 9/26/2012. A big jump.
Her ALT is 121 (ref. 5-107 U/L), 67 in 2012.

As far as the low T4, sometimes when a dog has an illness such as Cushing's their system can suppress the thyroid which is known as sick euthyroid syndrome. In this case, I believe I would have at least a Free T4 by ED (equilibrium dialysis) done.

With Cushing's a dog's ALK PHOS can become quite elevated and moderate elevations are seen in the ALT, this does not mean that the liver is damaged, it is only having to work a bit harder.



In her urinalysis, negative glucose, blood 2+ (high), protein 2+ (200-300 mg/ dl), RBC 10-15 (0-5) and crystals 3+ CA OXALATE (6-10) HPF.

Could you post Ginger's USG (urine specific gravity) for us? I am always a little worrried when crystals are found in the urine, did the vet mention anything about this?

Hugs, Lori

[My sweet Ginger]

Thank you, Lori,
What would a free T4 by ED tell us?
Her specific gravity: 1.053 in 2012 and 1.015 in 2013.
Her crystals: 4+ in 2012 and 3+ in 2013 and the vet didn't know why its so high but she put her on special diet (kibble) ever since and now it's 3+.
To my blind eyes her protein (2+) and blood (2+) look troublesome. Are they?
What concerns me is that I'm not sure if her vet ruled out all other possible diseases before Cushings. I just nodding to whatever she was saying because I knew NOT A THING about cushings like 2 -3 wks ago. I guess I will have to ask her again just to make sure but some how it makes me feel bad when I do that like I challenge her skill or knowledge or something and that's what I meant when I mentioned about her in my earlier post. She didn't lay out everything on the table for me to understand why it has to be cushings. We will see. Thank you everybody. Song.

[Harley PoMMom]

About the FreeT4:
FreeT4: Serum freeT4 represents the tiny unbound fraction (< 0.1 percent) of biologically active thyroxine. It is much less likely to be influenced by NTI or drugs, and so is a more accurate test of thyroid activity. While some prefer the equilibrium dialysis (ED) RIA method for measuring freeT4, newer technologies (improved analog RIAs and non-RIA methods) offer alternative, accurate methodology. These new assays are faster and less costly.

http://www.barfplaats.nl/forum/index.php/topic,85921.0.html

Because the diagnosis of hypothyroidism can often be complicated, a thyroid profile is usually recommended. Dr. Dodds is known as an expert in canine thyroid problems, her lab would be my first choice if I wanted a thyroid panel done, here's her link: http://www.hemopet.org/index.php?option=com_content&view=article&id=24&Itemid=39

Crystals in urine should always be looked into, especially when a dog has concentrated urine as Ginger did in 2012. Cyrstals may cause increases in a dog's drinking and urine output, and should be ruled out when a diagnosis of Cushing's is suspected.

[My sweet Ginger]

Good morning, Lori,
I'm feeling rather helpless this morning like I'm right back to square one. I still have questions for the vet at this point in the game about how she came to cushings diagnosis and that's not a good feeling. She never pin pointed the cause of Ginger's high level of crystals in her urine and still diagnosed her with cushings. That problem was not mentioned during cushings diagnosis. Through my reading of other threads and words of wisdom from well experienced moms and dads, I am now left with questions for my vet when Ginger's treatment's already well on the way.:mad: I know the vet didn't do all other tests to rule out other diseases other than CBC, ACTH, LDDST and Ultrasound. On top of this Ginger's only showing just a few classical symptoms of cushings : Excessive drinking & peeing, lethargy, leg tremor, sleepiness and almost no panting (except when she's at the vet's office) and somewhere I read that those are also the symptoms of diabetes, too. :confused:
I hope she's on the treatment for the correct disease.
PS: I left out her cholesterol previously. Cholesterol 611-2 (112-328 mg/dl) High. Pointing at anything?
Feeling lost. Song.

[labblab]

Hi Song,

I think it is perfectly reasonable to question your vet further about Ginger's urinary crystals. But for what it is worth, every other lab abnormality that you've posted (including low eosinophils and high cholesterol) can be associated with Cushing's. You can double-check her blood chemistries, but if her glucose level (often written as GLU) was within normal range, she does not have diabetes. So her overall laboratory and testing profile is consistent with Cushing's, as opposed to other illnesses that might account for individual bits and pieces.

It is true that it is often recommended not to move forward with treatment in the absence of classic overt symptoms. But there are exceptions, such as when it appears as though uncontrolled cortisol may be adversely affecting the kidneys as indicated by the presence of protein in the urine. If crystals are present, perhaps they may affect the interpretation of the urine results (hopefully Lori may know more about that than me). But for both low thyroid and certain kidney issues, the abnormalities can improve significantly with Cushing's treatment if elevated cortisol is the cause.

As far as the low thyroid, I agree with Lori that you could go ahead and request a more advanced thyroid blood panel at this time in order to see whether the results point to the low thyroid being a likely result of Cushing's or whether it is likely a primary problem in its own right (and therefore requiring ongoing supplementation). But since you are in the midst of Lyosdren loading, another option would be to wait and see whether Ginger's T4 starts to normalize again once her cortisol is under better control. If not, then you'd have added reason to suspect there is an independent thyroid issue.

Overall, Ginger's results are all consistent with Cushing's, though, and I expect that is the basis for your vet's diagnosis. Don't know if that helps ease your mind any, but I don't think you are actually back to Square One even though I know it feels that way to you right now. However, where you go from here will definitely depend upon her ACTH testing tomorrow and also how she responds behaviorally now that you're discontinuing the temporary prednisone.

Marianne

[goldengirl88]

Lori:
Was the urine sample sent out to a lab or done in house at the vets? If it was sent out and refrigerated my vet said sometimes it will form crystals from being refrigerated. When this happens to Tipper's urine, I have the vet do one in house to see if it really had them from refrigeration or what. Tipper's have bee from the refrigeration. Blessings
Patti

[My sweet Ginger]

Thank you so, so much Marianne. You helped me more than you know and most definitely your post gave me how I should go about it. I'm hoping in time though I will be able to educate myself better about this diease therefore I will be able to read the whole picture better from a wider point of view. Everything seems so scattered to me right now for me to be able to come up with an educated thoughts. For that I really appreciate everybody for their understanding and patience in explaining things in plain language.
Like you said Marianne, I now know I have to wait for her ACTH and how well she does without prednisone and go from there and after a month or so should be another ACTH & CBC to see where everything stands.
That seems like a plan I can deal with. For the moment I feel like the fogginess is gone from head. Thank you again. Song.

[molly muffin]

It is so easy to be confused when it comes to cushings and perfectly normal to wonder if you are on the right track. Having a plan is something I think we have all found, can ease some of those doubts. Just knowing what your next step will be helps so much.
Hang in there. You really are doing great.
hugs,
Sharlene and Molly Muffin

[goldengirl88]

Sharlene is right, even though sometimes I do not want to see what is coming in the horizon, it is much better to have a plan. You don't feel so scatter brained about the decisions you make if you have a plan ahead of time, and it gives you time to think things thru. Knowing is really much better for your baby, even though some of this stuff I would rather not know it is necessary. I formulate a plan of action, and I will not let go of something until I solve it, so in that respect it has helped me. It will all come together for you and Ginger. I hope she continues to improve daily. I just think she has the sweetest and most soulful look. Blessings
Patti

[My sweet Ginger]

Good morning everyone,
Here are the numbers from Ginger's latest ACTH test.
Pre 6.1 (11/5/13), 12 days after last Lysodren, up from 4.2 (10/24/13, 2days after first induction)
Post 7.9 (11/5/13), up from 7 (10/24/13)
We'll talk about her 2nd loading today. I don't think cortisol numbers went up as high as I thought they would've after 12 days of Lysodren break and if so I'm thinking that we better be careful as her body could be rather sensitive to Lysodren and still may not used to having low cortisol in her system therefore maybe she still needs prednisone during her 2nd load? Yes, she's been on prednisone (1.25 mg daily) after her initial loading except for the morning of her ACTH test and she seems to be doing ok. Any input'd be appreciated, please. Thank you. Song.

[labblab]

If it were me, prior to giving any more Lysodren at all, I'd first want to see how she behaves entirely off the prednisone for a little while. With cortisol levels at that range and almost two weeks post-loading, I don't think she should still be acting abnormally if cortisol "withdrawal" was the source of the problem. If she is still unwell, I'd be thinking there is something else going on that needs to be looked iinto.

Like you, I'm surprised that her cortisol level has not rebounded any higher during this time period, and I'd be wary about redosing her if she is still acting "off."

Marianne

[goldengirl88]

Hope you get all this figured out with Ginger. I know nothing about Lysodren so maybe when I get time I will read up on it. Blessings
Patti

[Squirt's Mom]

Since you have continued the pred all this time, except for the ACTH testing day, I am a bit concerned about starting another load right now. How long between the dose of Pred and the ACTH that you posted the results for this morning? If it was less than 24 hours, I am concerned that her cortisol was actually much lower, and the numbers show the pred, not cortisol. I would feel much better about those results if it had been a couple of days or more without pred when the ACTH was given.

So you've got a pup who's feeling pretty good but is that because of the pred in her system? :confused:

Trying to load at the same time as taking pred, in my mind, is illogical. Pred acts like cortisol and tests as cortisol. So you are trying to lower a natural hormone, Cortisol, at the same time you are giving a synthetic steroid, Prednisone, that acts like the same hormone. HOWEVER, I have seen pups loaded this way and the load did eventually take - please note the "eventually". It took a very long time and many, many ACTHs for one pup I keep up with. The pup is doing fine, tho she had several dose adjustments along the way, and continues to take pred along with her maintenance dose.

You can try to reload with a smaller dose than the 50mg/kg - something closer to the 25mg/kg may work better for Ginger tho that could make the loading process slower. Another option is to consider switching to Vetoryl (Trilostane). Some pups simply cannot handle Lyso, some cannot handle Trilo, and need to switch to the other. Ginger will need a minimum of a 30 day washout, no Lyso, before starting the Trilo and you have a fair start on that washout if you choose to try Trilo instead of Lyso.

Let us know what the vet has to say and what you plan to do. Hope you and Ginger have a great day!
Hugs,
Leslie and the gang

[My sweet Ginger]

Thank you everyone for your concern for sweet Ginger.
I just finished talking to vet. She said she talked to a friend (internist ) and they think Ginger should do a mini loading (2days), twice a day, 125 mg each along with prednisone, after 2 days (actually 1 1/2 days) one more ACTH test and go directly to maintenance phase right after. I asked her AGAIN about prednisone interference and she AGAIN said there won't be any because of her low dosage. I also asked her and she said she ruled out all other possibilities before Cushings diagnosis. About the crystals in Ginger's urine, she said they were refrigerated before shipped out to a lab so I'm thinking possibly some crystals formed during refrigeration. She asked and I told her that she's been finishing her meals so far with prednisone and doing better than before Lysodren treatment. She seemed confidant (even firm) about her plan and I said I will do it. What I will do thouggh, I'd like to cut off a tiny bit of Lysodren quarters to make them down to 235-240 mg instead of 250mg. Going by her weight, it should be 235mg instead 250 if I read it correctly. Am I splitting a hair here? Thoughts, please. Thank you. Song.

[My sweet Ginger]

By the way, she will start it from tomorrow morning and end it on Sat afternoon and ACTH test on Monday morning @ 9:30 & 10:30.

[My sweet Ginger]

Hi Leslie,
Ginger's ACTH test was taken around 26-27 hrs after her prednisone while she was on a break from Lysodren after the vet's assurance that there won't be any interference from prednisone. While Ginger was off Lysodren, when I skipped prednisone a couple of times at two different times she did not finish her meal and that's why she's been put back on prednisone and right now I don't know whether she will finish her meals without the prednisone.
She called me before I got a chance to read everyone's posts so I didn't get to ask her in a more detailed way as always and I was busy asking other written questions for her. While we were talking I got a sense that she seems to think I've been getting wrong information online. Maybe I didn't articulate my self enough. That happens a lot.
About trilostane, I don't think she uses that drug. Why? I don't know.
I will ask her next time when I get a chance. I gotta leave for work now. Talk to you guys later. Song.

[addy]

I don't know if this helps at all but it is an email Dr. P sent me a few years back before we started treating my Zoe.


In dogs with Cushing's disease, you must use a daily loading protocol in order to adequately destroy enough of the hyperplasic adrenal cortex. It's quite unlikely that starting with a weekly maintenance dosage of mitotane would do much at all to lower the high serum cortisol concentrations in your dog.

But you don't necessarily have to use the standard loading dose for mitotane of 50 mg/kg per day. You could try a lower daily dosage of 20-25 mg/kg (with food) to evaluate the effect.

Remember to do an ACTH stimulation test in a week or so and then adjust the dosage based up that result. If you are worried about side effects, you could also give a low dose of prednisone or prednisolone (0.1-0.2 mg/kg/day) during the loading period, but do not give those drugs on the morning of the ACTH stimulation test. The drugs will cross react with the measurement of cortisol and to falsely elevate the cortisol values.

[My sweet Ginger]

Addy, I think it actually helps me a good deal the way I feel about our plan. I think I feel comfortable for Ginger going on a 2 day mini loading while she is on minor dose of prednisone and Dr. p's quote puts me at more ease about the plan if I understand it correctly. The vet had me skip prednisone on the morning of ACTH test this last time and we are going to skip prednisone on next Monday morning (another ACTH that day) again. The fact that she consults with an internist makes me feel better also and I will watch Ginger very closely. I will post new numbers when we get them and I will keep my fingers crossed for good numbers. Thank you for looking that up, Leslie. Song.

[molly muffin]

Having a plan always feels better than not having one. Crossing fingers for good numbers for Ginger and that she keeps up with feeling good. You know what to watch for, so at first sign, stop and call your vet, schedule a test.

hugs,
Sharlene and Molly Muffin

[My sweet Ginger]

Will do, Sharlene. :)

[frijole]

Following along - you are only doing this for two days right? Just keep a close eye on her and any doubts you stop. Also keep an eye on the poops. Since you are giving the prednisone I doubt you'll see a change in the appetite so soft poop is one way to monitor.

I would have thought the cortisol would have gone up more as well. Hoping this does the trick. Kim

[My sweet Ginger]

Kim, could you tell me more about poop, please? Ginger's poop is already kind of soft so what should I watch out for and what would be a warning sign?
Yes, we're doing this mini loading only for 2 days, tomorrow and Saturday and then ACTH on Monday morning. Thank you. Song.

[frijole]

Signs of loading are decrease in appetite or water intake but when you give prednisone during loading you may not see any change even if cortisol goes low.

Signs of overdose are vomit and diarrhea. My dog had the longest load in the history of the board - it totaled over 4 months I believe. I watched her poop in the middle of winter because I was so afraid she'd get too much as we kept increasing the dosage.

Her poops went from firm to soft to extra soft and I elected to stop and have an acth test done. Glad I did because she was at 1.5 and finally loaded. That is my experience with watching poop. Fun huh?

Only loading 2 days it shouldn't be an issue but given how fast she dropped the last time it is the only thing I can think of to watch - obviously if she vomits you stop right away. Hope this helps. Kim

[My sweet Ginger]

Geez, Kim, 4 months of loading? I can tell you for sure that I couldn't go through it. It'd drive me insane!
As you've said drinking and eating will not really help me as a sign of loading because they've already been decreasing slowly for a while. Her poop already soft, I guess I have to look for loose one then. I'm kind of relieved it will only be 2 days although her rapid cortisol drop is still a concern of mine. I think 250 mg was a little too high for her, too. I'm definitely considering chisel away a bit of Lysodren. Will also look for signs of overloading very closely. Thanks and good night. Song.

[My sweet Ginger]

Hi.
A question for Lysodren parents. How fast reacting drug is Lysodren?
As you all know today is her first day of mini loading. I gave her Lysodren @ 5:50 this morning right after her breakfast so it's been about a little more than 2 hrs now @ 8:07 am. I just took her out and she was groggy and unstable in her steps (wobbly) and climbing up the steps wasn't as easy. I haven't seen her in this way for a while. I'm going to let the vet know when they open but wondering if we can go directly to maintenance phase and do an ACTH a month later thinking she maybe one of those dogs who is very sensitive to this drug.
Is it unreasonable to maintain her cortisol level right above (like hers at the moment) the ideal range for normal dogs? Maybe she just needs higher cortisol level than other dogs. I don't know what is going on with her but I'm getting worried for sure.
I will keep watching her and maybe I'm just over reacting. :confused:

[goldengirl88]

I think Leslie or one of the others that use Lysodren will be able to help on this. I am just checking in to give you support and hope sweet Ginger gets better. This is a hard journey on the Cush moms so I can imagine how the babies feel. Blessings
Patti

[Squirt's Mom]

I wouldn't have started the mini-load in the first place because of the reasons previously stated; I would have wanted at least a week with neither pred nor Lyso on board to see how she did and then another ACTH possibly to see where her numbers were. But since you have started and she has had this reaction already, I would stop and call the vet asap this morning. Is she still getting the Pred? I think if the vet insists on this mini-load and you are going to comply, I would seriously talk to her about a much lower loading dose or trying the maintenance with no load. ;)

You say her poop is already soft.....has she had any diarrhea this morning? How is her appetite this morning?

Hang in there! You're doing a good job of watching her and that is half the battle!
Hugs,
Leslie and the gang

[My sweet Ginger]

It's 9:40am now and we just got back from outside and she did much better this time than earlier this morning, a little spring in her walks as usual these days though still a bit slower coming up the steps to the deck. I'm scratching my head here.:eek:
I gave her the usual dose of prednisone this morning with Lysodren right AFTER her breakfast which she finished with the same speed.
She might have been still sleepy the first time she went out earlier.
I will watch her a few more hrs and decide whether I should call the vet or not. I can't wait to go to maintenance phase already.
She finished her bf before Lysodren and soon after her poop was normal for her which means it was rather soft. ;)
I guess I just have to keep on watching her very closely.
I do agree with you, Leslie about the wait without any kind of drugs in her system and assess and then start a mini load if needed but it's very hard objecting to a professional who you trust so much when you have no knowledge on your own about anything they do. I feel as though all I can do for Ginger at this point is a close monitoring of her and report it back to the vet when necessary and stop the Lysodren when I think I should. I think all of you guys've educated me enough for me to know what to look for. Thank you so much for everyone's love and care for my baby and me. :) I will post anything questionable if you don't mind. Thank you so much. Song

[Squirt's Mom]

Mind?!? We might just come hunting for you if we don't hear from you! :p You and Ginger are family and we stick by our family. ;)

I'm so glad to hear she is acting better after being up and about a bit! That is a big relief!

Keep up the good work, Mom!
Hugs,
Leslie and the gang

[My sweet Ginger]

Awww.. That is so sweet of you, Leslie. I'm relieved, too, I only hope she continues like this from now on. Our fingers and paws crossed here. ;) Song

[frijole]

I was out of town today and your first post gave me a heart attack. Glad she is better. You know the deal - when in doubt don't give it. You can't take it back. Fingers crossed. Kim

[My sweet Ginger]

I'm so sorry, Kim.
I knew as soon as I saw Ginger was doing better I have to post on that so everybody can let out a big sigh of relief and that was my second post this morning. :o :p ;) :D
Ginger finished her dinner in a normal manner and I gave her Lysodren at 5:30. 8:30 now and she is still awake and waking around the house rather aimlessly but at least she is moving around and not sleeping all the time. As long as she is awake, I consider that as an improvement these days. One more day to go now, I hope she will pull through just one more day. More posts tomorrow. :) Song.

[goldengirl88]

So glad to get up this morning and log on and see that Ginger is doing ok. I was worried yesterday. I am hoping she continues to improve for your sake and hers. Blessings
Patti

[My sweet Ginger]

Good morning everybody.
I appreciate all the concern you all have for my Ginger and me. Thank you.
She seems to be doing fine so far. After she finished her breakfast this morning I gave her Lysodren & prednisone right after and that was 6:30 AM. By 7:30 she did her normal looking you know what I mean. Yay! ;) She is taking her morning nap next to me right now (all three of them are around me. :)) and her breathing looks pretty peaceful and not rather fast. One more dose to go, girl. Song.

[goldengirl88]

Song:
That breathing scares me too. Tipper had very bad times at nite breathing and it really concerned me. We have no emergency place anywhere near me to take her too, and that is real scary. I could call my vet on his cell phone, but I know he would not answer. Don't worry about posting things on my thread I don't care who uses it, as long as they are getting help it's all good. Hope Ginger is doing well this weekend. Blessings
Patti

[My sweet Ginger]

Hi Patti,
Thank you for checking in on Ginger. She looks about the same today, maybe a tad bit slower. Finished her breakfast and has been doing her outings as usual to the front yard. That's pretty much her only exercise these days. :( She got her prednisone this morning and skipping it tomorrow morning in preparation for another ACTH test. Fingers and paws crossed. Regarding using space on your thread I just thought it was more appropriate corresponding through our own threads just in case we'd like to have an ongoing dialogue as some matters might come up. Thank you though. That's very nice of you. I hope you and Tipper have a fun day today. It's a little breezy here in CT but warm enough for me as the sun goes in and out.
BTW where are you located, Patti?

[goldengirl88]

My hometown where I lived my whole life is Pittsburgh Pa. I now live in North East Ohio, there is no comparison to where I came from. Ohio is so archaic that I swear I will see a dinosaur here some day. They have very bad laws, and programs here. Nothing seems well thought out. Oh well I have Tipper and that is all that matters to me. It is really getting cold here and the furnace keeps coming on. I'm sure it will be over to visit you soon! Glad Ginger is having a good day. Blessings
Patti

[My sweet Ginger]

Lol, I won't ask you how you ended up moving there from Pitt (my husband is from there) but it sounds like OH just might be the state my husband's been looking for. I always say that he was born into the wrong century . If OH has mountains and rivers and state parks, it will be a strong contender for his retirement place when he retires next year.
My self? If its cold, I won't be a happy camper.;)
It was nice and warm this morning, not any more. :(

[goldengirl88]

Sorry no mountains in Ohio, flat yards of clay and standing water from poor drainage. Very cold and brutal winters here. I live by a lake that is huge so that is a plus. I much prefer Pa. it is a beautiful state, with normal rules and regulations unlike this wild west atmosphere here. Blessings
Patti

[Squirt's Mom]

ARKANSAS! Three mountain ranges - the Ozark, Ouachita, and Boston. Many rivers and state parks galore! :D

[Budsters Mom]

Well Southern California is warm, but steer clear!! There are too many people here as it us! :eek::eek::eek: I have been thinking of ways to ship a few hundred thousand of them off to somewhere like Ohio or Arkansas.:D:D

[My sweet Ginger]

Well, OH's been crossed out for sure. :o
AR now a contender. How's the weather there, Leslie? ;)
Hmmm... Southern CA? I love the weather out there, been to Monterey a couple of times and my husband and I fell in love with the weather and the beautiful towns!!! Unfortunately too expensive for us to live there and I still remember those fallen bridges or highways from years back. :eek::eek::eek:

[Squirt's Mom]

Arkansas weather covers the gambit just about. We don't get blizzards and we don't have 120 degree temps...but we do have humidity during the summer.

LOL Kathy! :D

[molly muffin]

Monterey is beautiful, my old stomping grounds from my youth. Santa Cruz, Monterey is where my sister and her kids families live. Well, except for the one down in LA. I try to get there as often as possible for a visit. :)

Arkansas has the most lovely areas, just gorgeous, take a drive through it sometimes and it's hard to want to leave. Yea, had family in Little Rock to at one time too. (we seem to be all over the world, cousin in Switzerland, go figure) :)

You'll have to start taking some trips to scope out areas. Road Trip!!!

How is Ginger doing today?

hugs,
sharlene and molly muffin

[Squirt's Mom]

oooooo....I lived in Salinas, CA, in the Monterey Valley, for a while and LOVED it there! We could drive an hour and be in either mountains, desert, BIG city, beach, or forest. Temps were moderate year 'round and the ground will grow just about anything.

[goldengirl88]

Just checking in to see how Ginger is doing this morning. It is a brisk morning here, and we have already walked once. Hope you and Ginger have a good day. Blessings
Patti

[My sweet Ginger]

Good morning everyone,
It's really hard to get a feel of any place you've never lived or visited before without physically being there. My husband and I are thinking of a road trip next year to check out a few places that would still be on our list. With three dogs, it might be a daunting task to carry out but we will see.
We're about to get ready for Ginger's test this morning and she still seems to be doing ok though she finished her bf slower than usual. I'm really hoping for good results. I will post those numbers as soon as I get them tomorrow. Usually I get the results the next day. Song.

[addy]

Hoping for good test results for Ginger:):) Good luck!

[molly muffin]

I went to school in Watsonville Leslie. :) My family still all live in the area.

That will be an interesting road trip with 3 dogs, but doable. I use to travel all the time with a golden retriever and a cat. White Knight hotels allow animals, so good for traveling on a budget.
All those potty stops to do some dog walking helps you get a lay of the land. lol

Hoping everything is good today.

hugs,
Sharlene and Molly Muffin

[goldengirl88]

Song;
Hoping for some good results today for you and Ginger. I am off to the vets with Tipper for her Adequan shot and blood pressure. Blessings
Patti

[My sweet Ginger]

Hi, everyone,

:mad: :eek: Well, there it goes again. One more induction! :mad: :mad: Pre 5.6 from 6.1, post 9.8 :eek: from 7.9, starting tomorrow for 3 days this time and another ACTH on next Mon. I might have to go back to work full time if she keeps this up. :eek::eek:
The vet wanted 4 days and I talked her into 3. I'm afraid I may have to pay for it next week. No prednisone this time. I guess we will have to wait and see. :rolleyes:
Patti, I wish you and Tipper for another good day today. :) xoxo Song.

[Squirt's Mom]

This is what I was afraid of with the pred on board at the same time. And similar to what Katie went through but she did finally get controlled. I hope removing it from the picture will let the Lyso do it's job properly and Ginger is ready for maintenance soon.

I can't remember and am too lazy right now to look back :o:D - did Ginger have an ultrasound?

[Harley PoMMom]

How long was the prednisone stopped before the ACTH stimulation was done?

[Squirt's Mom]

I think she's been stopping it the morning before the tests.

[My sweet Ginger]

Yes, Lislie, first she had an ACTH, after that LDDS and then US which confirmed a PDH. She's just not being easy on me. :(
Lori, last ACTH was done about 26-7 hours after her last prednisone dose and the vet said it was long enough time to get an accurate ACTH.

[molly muffin]

Well I don't doubt that the acth was accurate, but the reason she isn't loading is because she is getting something to bring her cortisol up at the same time she is getting something to bring it down. :(

hang in there!
Sharlene and Molly Muffin

[goldengirl88]

Song:
What sort of plan has been developed from here on out? I know this has to be difficult dealing with all this. I pray you can get Ginger to turn the corner and feel better. Blessings
Patti

[My sweet Ginger]

Good morning Patti?
I hope you and Miss Tipper had a better night last night. I really hope you find your answers in a search to help your Tipper. Most of the times I don't even understand what you are talking about since you're so far advanced but I'm right with you cheering you all the way whatever that is you are doing. Go girl!
Ginger started her 2nd mini loading this morning which will last for 3 days till Saturday and an ACTH stim on Monday @ 9:30AM.
No prednisone this time. She's off of it starting this morning.
I'm still debating whether I should've listened to the vet and go for 4days instead of 3days. I'm just darn afraid she may go too low.
On the other hand, I don't want to repeat this one step forward- two steps back routine but she just looks sooo fragile I think we'd better take our time to get there. Take care. Song.

[labblab]

As long as the prednisone was discontinued for that 26-7 hours prior to ACTH testing, then I think you can rule out predisone as being the cause of the elevation in the results, because predisone neither stimulates adrenal function nor increases natural cortisol levels. In fact, it's the reverse: longterm prednisone use suppresses the adrenals' ability to produce cortisol and that's why patients must be weaned from the drug gradually in order to allow the adrenal function to normalize again.

Since predisone does not halt the adrenal erosion, the only confounding function of prednisone during loading is that it may mask the signs of overload. So I think there is some other issue at play that has been short-circuiting the load (dosage, length of load?).

Marianne

[goldengirl88]

Song:
I am so glad you have a plan put together, and I hope the discontinuing of the prednisone will make for better results. I know what you mean about 1 step forward and 2 back. I have been there many times. Keep the faith and keep on doing what you are doing. You are an excellent mom to Ginger, and I am sure this will get straightened out soon. Blessings
Patti

[frijole]

I agree with Marianne. Its either the dose or the length of the load that has kept Ginger from loading and you were close the first time. You stopped and I am sure the cortisol increased and therefore the two day load didn't stick. I would have rather you skipped the prednisone so you could monitor but.. your vet wanted the prednisone.

OK so this time around the same rules apply as the first load - you look for signs of loading and you stop if you see those signs regardless of what day it is ok? Don't try to apply logic to how loading works. Don't worry that you haven't loaded. Your first load was a week or less right? Then 2 days. Heck that is NOTHING compared to what we have seen around here. So don't think anything is wrong - you just need to get the dose and length of loading part right. Your vet is being very conservative and that is good and bad as you are learning.

Fingers crossed and promise to keep us posted ok? Don't worry about not understanding the other posters' posts... keep in mind most are not using lysodren so it is a whole different protocol and some are dealing with issues that are not cushing's.. don't expect yourself to follow it all... when I was loading I refused to read anyone's thread unless they were loading because the other stuff freaked me out. Just focus on Ginger and you will be just fine. You are doing great!!! Kim

[My sweet Ginger]

Kim, I appreciate your kind encouragement very much.
In my vet's defense, I think I'm somewhat responsible for her being very conservative as I was such a crybaby :o during the diagnosis so much so that I may have scared her a little :eek: if anything should happen to Ginger. We will get it done, I just hope it's this time. ;)
So far she is hanging in there. Thank you all. Song.

[molly muffin]

Well of course, this is Ginger we're talking about after all. How could you not be nervous about the whole process. Who wouldn't be. :)
You're doing fine. Just hang in there. You'll get it done this time, just load till you see the change, then you're done.
hugs,
sharlene and Molly muffin

[doxiesrock912]

Most of us are crybabies during the diagnosis. Trust me!
I begged my fiance to go with us because I was so scared.

[Squirt's Mom]

You're doing good, Mom! Just keep watching her like a hawk and things should be fine. Feed her before giving the med so you can judge how she is eating - ie if she is eating much slower, or looks up from time to time when before she didn't, or leaves some in the bowl, etc., then the odds are she is loaded and you will not give the med. Decrease in water intake is also a sign for many but most will tell us via their appetites that the cortisol is lowered.

And we are right here anytime you are concerned about something. You are not alone!
Hugs,
Leslie and the gang

[My sweet Ginger]

:confused: I'm sorry to sound like clueless at this point in the game but exactly what am I looking for this time around? A slight change in her appetite or vomiting, diarrhea, etc? Our plan is to give her Lysodren for 3 days without prednisone and an ACTH 2 days later unless I see a sign of overloading before the third day comes. So if I don't see either sign prior to the third day you want me to keep giving her Lysodren until I see a sign which could be possibly beyond the 3rd day or should I stop after the third day? Maybe I'm over thinking but all of a sudden this is what's on my mind and I'm :confused:.

[Squirt's Mom]

From the Lysodren link in the Helpful Resource section -


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

Quote:
INITIATING THERAPY - THE LOADING DOSE PHASE:

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

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

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

Lysodren administration should be stopped when:

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

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

3. the dog vomits.

4. the dog has diarrhea

5. the dog is unusually listless.

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

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

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

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

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

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

....
----------------------------------------------------------------

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

Lysodren is better absorbed if given with a meal. The food also acts as a buffer and can help to protect against gastric upset.

Many of our members have found it easier to administer the Lysodren by wrapping the pill in some food that the dog likes and will eat readily. Wrapping the pill in some food also helps to protect the throat and esophagus from irritation.

In order to ensure that the Lysodren goes all the way down to the tummy, it's a good idea to feed the dog 3/4 of the meal, then give the Lysodren wrapped in or hidden in some food and then feed the remainder of the meal to the dog. Also, since a poor appetite can sometimes be a sign that cortisol levels may be too low, if a dog refuses to eat the first 3/4 of the meal it could be an indication that cortisol levels should be checked (with an ACTH test) before giving any more Lysodren, so call the Vet to report any noticeable changes in your dog's appetite.

....

Many of us keep a daily journal in which we note information such as what our dogs eat, how much water they drink, what meds and/or supplements they are given and their demeanor and behaviours. Having that kind of information at our fingertips can be very helpful sometimes.

Many of us also request copies of all Lab test results to keep in a file folder at home. Having our own copies of those Lab reports has really come in handy sometimes.

....

Successful treatment of Canine Cushing's requires a good heads-up Vet and a vigilant owner who work together as a team to keep the dog well. Always report any changes or unusual behaviors to your Vet immediately. We are our Vet's "eyes and ears" at home.

We do not want to let the pup get to the point of diarrhea or vomiting - that could easily mean the cortisol is too LOW so those little subtle signs of looking up when eating, leaving some in the bowl, eating slower, etc. often mean it is time to stop and have the ACTH to see where the cortisol is.

Remember - Lysodren is going to keep working for 48 hours after the dose - each pill works for 48 hours. So whenever we are in doubt, we do not give that pill. ;)

You're gonna do find, Mom, I have faith in you!
Hugs,
Leslie and the gang

[goldengirl88]

You are doing a wonderful job, so keep it going mom. About those tights with flannel, they are sold on QVC if they have any left, and they also sell them at Harriet Carter in their catalog which is probably cheaper than anywhere else. Things will get easier so just keep watching your baby and you both will do fine. Blessings
Patti

[My sweet Ginger]

:o :o Ginger's isn't making this task easy for me at all. Since she eats slow (takes 1 1/2 to 2 min to finish her meal), pauses to drink water, looks up at me a few times for no reason and leaves a few kibble already I guess the sign would be her leaving her meal the half way or not touching it at all. I will watch her for sure. :o :o
Now Patti, I know you take Tipper out for walks each day and it is cold now I've got a recipe for you to warm you up before each walk.:)
I hope you like soup because is my all time favorite soup recipe inside or outside my house, store bought or restaurant bought. Here it is.

Portuguese Sausage - Kale Soup

6oz kielbasa, sliced (I use more)
1 large onion, chopped
1 large clove garlic, minced (I use 2-3, love garlic :p)
1 TBS olive oil (maybe 2-3tbs)
1 lb fresh kale or 1 pkg (10oz) frozen chopped kale, thawed & drained (I use 1 bunch and use them all, they cook down A LOT)
28oz reduced sodium chicken broth ( I use regular stock instead for deeper flavor and skip salt and works for me)
4 C water (more or less)
2 carrots, sliced
1 tsp dried marjoram, crumbled
1/2 tsp salt
1/2 tsp pepper
1/2 C uncooked long grain white rice (orzo works good too, maybe even tortellini, huh? Now that sounds good.)

Sauté sausage, onion and garlic in oil in a large pot over medium low heat, about 10 min.
If using fresh kale, cut off stems and slice into 1-2 inch pieces. Keep stems separate. Coarsely chop fresh leaves.
Add to the pot chicken broth, water, carrots, marjoram, salt, pepper and sliced fresh kale stems or frozen kale, if using. Bring to boil.
Lower heat, cover and cook for 15 min longer. If using fresh kale, add leaves at this point along with rice to the pot. Bring to boil. Lower the heat, cover and simmer for 15 min or until the rice is tender.

My friends, it's quite easy and so tasty that you will not be disappointed if you like soup. I'm passing this recipe down to my daughter for sure. :p The winter's here so give it a try anyways ,k?
If you do, let me know how you like it, please. ;)

[My sweet Ginger]

Correction : cut stems into 1/2 inch and not 1-2 inch. ;)

[Budsters Mom]

I want someone to make the soup for me, so it will be hot when I get home today and I wouldn't have to worry about dinner.;) I can always dream.:p

[goldengirl88]

You would never believe this but I have a bunch of kale in the crisper and keep wondering if I should make fried greens or make soup. This is a great soup so I am going to make it. I like to make soup as I can freeze some for when I am lazy and do not want to cook. The old man that is my neighbor just brought me 5lbs of potatoes and asked if I could make him mashed potatoes???? I made them and put them in containers for him to freeze. Then he takes them out when he wants them. My other neighbor's son gave her some beautiful Johnny Red apples as big a s grapefruits. Made most into applesauce and the rest into 2 pies they are cooling on the counter can you smell them??? Leslie it's a pie alert!! Tipper and Toby patiently waited for some tiny apple pieces. Tipper is eating anything she can get. I will let you know how the soup is, I think I will make it this weekend. Blessings
Patti

[My sweet Ginger]

Patti, I'm glad to hear you have kale you don't know what to do with.
Trust me, I had many friends tried this soup and all of them wanted the recipe. Just a note, I thought they were in the recipe but when I checked, not which is I also add diced potatoes and a small can (8-10 oz) of crushed tomatoes and I can clearly see the difference. I hope you like it.
Oh, man, apple pies. My hubby is a apple pie eating machine and I usually end up making good 15-20 pies every winter just for him! I can even make them with my eyes closed by now. ;). If anyone wants a fool proof pie crust, let me know 'cus I've gone one.
Good night everyone.

[grapey]

I sympathize with the eating slowly thing--my Boston usually took (and still takes) a few minutes to eat her food, even pre-loading. But the day I knew she was loaded, she didn't finish her breakfast. She refused to eat about 1/4 of it.

You are doing great!

[molly muffin]

I'm taking notes for the soup!! Never can count out a good pie recipe either *hint hint* LOL

How did Ginger do today? I think that it will be like Jen said, you'll notice a change that isn't part of her regular eating routine.

We're right here with you!
hugs,
Sharlene and Molly Muffin

[frijole]

Does Ginger drink tons of water? If so a reduction in water intake is the other thing to monitor.. and don't forget the poop watch I'm pretty sure we talked about during your first load. Go back and read the original posts - it will come back to you. :) Kim

[My sweet Ginger]

Kim, I do remember about our 'that' talk. ;) Trust me, I'm watching her really closely, I have no choice. Wherever I go, she follows. She is my shadow and she always has been. :) Sometimes if I hold her she will snap at whoever tries to even pet her my husband included. :cool: There is no change in her today so she isn't loaded yet.
Ginger's water consumption has gone down somewhat noticeably since the 1st loading so that will also be hard to say. I know I will notice the change in her appetite like the first time. Anyway I'm supposed to bring her in for an ACTH on Mon morning. She has one more day of loading left.

Sharlene, the kale soup recipe is so easy to make and taste so good, just give it a try. Now about the fool proof pie crust. I got this recipe from one of the local apple orchards here many years back and the pie king, my husband likes it and also it's been approved by my 87 yrs old mother in law. ;) Here it goes.

Fool Proof Pie Crust

4 cups all purpose flour
1 3/4 cup shorting (crisco)
1 TBS sugar
2 tsp salt
Mix these together until crumbly

1 TBS vinegar
1 egg
1/2 cup water

After mixing dry ingredients until crumbly, mix in last three wet ingredients.Form balls. Make 2 - double 9 inch crusts. Extra crust can be frozen before rolling out for future use.

It's A LOT easier if you use an electric mixer. Enjoy. ;) :)

[frijole]

This thread is cracking me up... one minute it's poop and the next it's a recipe for pie crust. :D I think it might be a first but I could be wrong. Nice to have a diversion from cushings. Kim

[My sweet Ginger]

Oh, well, what can I say? Call me crazy but my babies poops really don't gross me out that much any more. :eek: :D :eek: :D

[doxiesrock912]

You've become desensitized to them :)

[My sweet Ginger]

Good morning everyone,
I need your help. I gave Ginger Lysodren this morning @ 6 AM after she finished her breakfast in her usual way, looking up and slow...
Now & 6:25, but this morning she is not interested in her usual treat which is a piece of my toast which she's been taking consistently these days. Could Ginger still be loaded? But she just finished her bf. Is she or is she not? :confused: I'm not sure the vet's office is open today. Thanks. Song.

[My sweet Ginger]

Hi,I guess you guys'd better forget about my previous post. She's now taking my husband's treat without any hesitation. :confused: :eek: :mad: Sorry, Song.

[frijole]

Sorry just seeing this. Assume she's fine but remember - when in doubt you don't give it. Fingers crossed. Take care! Kim

[Squirt's Mom]

You're doing a great job watching, Mom! Noticing those little things is a big deal and you are doing great!

Soup, poop, and pie crusts - yep, gotta be a first! :p

[goldengirl88]

That is so funny, that is my exact pie crust recipe too, It is always good. I am gathering the ingredients for my soup to make this weekend. Yesterday my neighbor man brought me almost 20lbs of fresh beets! Hope Ginger is doing well, I see her daddy was spoiling her! Blessings
Patti

[My sweet Ginger]

Big time, Patti, a big time. We're, I mean he is (:D) sooo terrible! Now you know why Flora is over weight, right? ;);)
That is funny, Patti. I can't believe it. I wonder where they (the apple orchard) got it from. :rolleyes:
Leslie, I usual don't like to be the first in anything so I wasn't trying in this one so I don't know how I should feel about it.:eek:

Just to be sure, so I should discount the treat incident this morning, right? Because it was clearly different from previous mornings. :confused::confused:

[Squirt's Mom]

I would watch her water intake carefully through the day and if that seems to be decreased, I would stop the Lyso. If she continues to drink like she has been and shows high interest in treats and such then I would give the dose tonite. You will probably get a pretty good idea tonite at mealtime if she needs tonite's dose or not. Keep an eye on her stools; if they are loose, stop the Lyso. If she shows any signs of nausea, stop the Lyso. Signs your dog is feeling nauseous might include: drooling, air licking, dry heaves, excessive licking or chewing, and panting.

This loading will soon be over and hopefully she will come back with good numbers this time then on to maintenance, a much less stressful phase. ;)

[My sweet Ginger]

Thanks , Leslie. The maintenance phase can't come sooner.
That's what I was just thinking, too, by dinner time tonight, I will know more clearly.
Yup, I will watch her for sure. I'm really good at that.;) Just a lot of times I just don't know what it should mean tho and that's been the story of my life, folks. :)

[goldengirl88]

The soup is cooking as I am posting. Smells wonderful, the dogs have their snouts in the air smelling. Hope things continue running g smoothly for Ginger. It is beautiful out, just took the dogs for a short ride. Blessings
Patti

[My sweet Ginger]

How did the soup come out, Patti? Did you add potatoes and a can of crushed tomato, too? I tried both with and without and I prefer with those. Hope it came out good. :)

[goldengirl88]

Simply Delish. Gave some to the neighbors and froze some. I ate a big bowl tonite it was good! I used the potatoes and crushed tomato. Has a real good flavor to it. Thank you for the recipe. Blessings
Patti

[My sweet Ginger]

I'm glad to hear that you liked the soup. Lucky your neighbors, you really take care of them it sounds like. How sweet of you. We're not that chummy with neighbors on our street here. Just quick pleasantries.
I hope you and Tipper have a good night. :)

[goldengirl88]

Well most of the other neighbors get a quick heel from me and that is all. They are too nosey and want to know all your business and I do not like that. They are always trying to find out what is going on in my house. I must really interest them! They all talk about how I think Tipper is a child. They can go jump in the lake. I always try to help someone if I can. When I find out you are going all over the neighborhood talking about me and how I make my dog suffer, I cut you off. Imagine that they have no clue what is going on here, but say I am making my dog suffer. Takes a lot of nerve, and I can handle a lot, but when you start with my Tipper all bets are off. It is pouring here and Tipper is not liking it as she has to stay in. Hope Ginger is still improving and keeps it up every day. Blessings
Patti

[molly muffin]

So how is Ginger? How was she at meal time last night?

Thinking of you,
hugs,
Sharlene and Molly Muffin

[My sweet Ginger]

Good morning everyone,

Hmmmm...

Sat. the last day of Ginger's mini load she finished her dinner pretty much the same as always, maybe a bit slowly. Gave her last dose of Lysodren.

Sun morning she didn't want to touch her boiled ground chicken breast with her kibble at all.:( I made one with hamburger meat and she ate maybe about a half so I was pretty sure she was loaded. By dinner time she ate less. Her behavior remained the same from the previous few days which were awake, less sleep but looked slightly dizzy or groggy and falls down a little when she tries to stand up from sitting position or sleep and these started after the discontinuation of the prednisone and the start of the Lysodren. I had to stop myself from giving her prednisone because I thought her body was still adjusting to her lower cortisol level and also didn't think they were coming from overdose of Lysodren. Other than that she seems to be doing ok. I'd still find her in the crowd greeting me at the door when I come home or during snack times, etc..

This morning she refused her chicken/kibble bf again:mad:, made one with ground meat and she ate maybe 1/3 but took a few pieces of my toast as a treat. By going what I've learned here, I know the Lysodren is still working until this afternoon so maybe that's why she is still losing her appetite and hopefully it will come back.

She is going in this morning for her 9:30 ACTH and I will talk to her vet and see what she says about her poor appetite.
I just hope we won't repeat the same thing again this time. Remember the first time? She lost her appetite but the results weren't low enough? Fingers and paws all crossed.;)

[Squirt's Mom]

Today is too soon for the ACTH. If the last dose was last night, you want the test in 48 hours from then or on Tues afternoon/Wed morning. The cortisol is going to continue to drop for 2 days from last nite so the test today will not be accurate. I would not waste my money today UNLESS you see signs she has gone too low - diarrhea, vomiting, lethargy.

[My sweet Ginger]

Patti, thank you but relax and read my previous post. Her last dose was Sat. and not Sun. so she needs to do ACTH today. :)

[Squirt's Mom]

ahhhh....my mistake! :o I thought the last dose was last night.

[frijole]

Fingers crossed. Hopefully it is almost over with. What is most important is water - is she drinking? Kim

[My sweet Ginger]

Aha, I thought it was food. She definitely drinks less now tho I still see her drinking at length at times like good 15-20 sec. We shall see.
Her poop still looks the same.;)

[goldengirl88]

Hoping and praying this test comes out well. I know this is hard to deal with, but it will get better I promise. I will be watching to see her test results. Blessings
Patti

[molly muffin]

Checking in to see how things are going!
Hoping for good results and a firm load on the test

hugs
Sharlene and Molly Muffin

[My sweet Ginger]

Friends, what is this tremor about? Is it one of the symptoms?
Before the treatment it was her legs during her rest or sleep, quite noticeable but now it's on her head or neck too and tonight it's pretty bad on legs and all.
I gave her prednisone around noon and she almost finished her dinner at 5:30 and I was happy about it. She vomited about an hour ago all of a sudden. She was doing pretty good this evening. I don't know what to make of it.

[frijole]

How much prednisone did you give and what is her weight please? These are signs of low cortisol - especially the vomiting. Did you call your vet? Kim

[frijole]

I have to go to bed and you aren't online so I looked and Ginger weighs 10.5 lbs which is just under 5 kgs. 5 x .25 = 1.25 mgs of prednisone. I think you have been giving 1.5 mgs which is fine.

My concern is that she went too low. I am glad she ate and no doubt that is because you gave her the first prednisone dose. If the last dose was at noon I would consider giving her another dose tonight or first thing when you get up. It won't hurt her and I think she might need it.

Other signs to watch out for are extreme lethargy as in can't get up, walk, hold head up. If when you get up you see these signs please call your vet immediately and take her in. She will need her electrolytes checked. If your vet doesn't know what to do make them google it or call someone who knows.

I could be over reacting but it's late and I won't be here to post so I wanted to cover all possibilities. When in doubt get her help even if it means taking her to another vet's 24 hr ER. Just tell them you suspect low cortisol from too much cortisol and how much prednisone you gave and when.

Good luck! Kim

[My sweet Ginger]

Kim, I gave her 1.25 mg prednisone at 11:30 and what signs are you talking about? You mean the tremor too? No, I didn't call the vet, they close at 4pm. Btw Ginger is sleeping right now. Should I give her more prednisone then? Thank you.

[frijole]

Yes the head shaking is not normal. The prednisone bottle should have instructions. I don't have any here anymore so I can't check mine. If I recall the dosage is more than once a day in emergency situations. I would have given it again tonight - particularly after the vomit. Remember diarrhea and vomiting are a sign of low cortisol - seriously low cortisol. Whenever this happens you are to call your vet and I don't care if they closed up for the night they are at your beck and call when you are loading with lysodren and they should give you numbers to call.

I'm glad she's sleeping - leave her be but keep a close eye on her. I am concerned based on what you wrote. Kim

PS Sorry but I have to get up early tomorrow!! Hopefully others will pick up tonight if need be but I will check in early.

[molly muffin]

This doesn't seem right that she has had two loads (almost according to follow up test) and each time she shows loaded, she crashes. I wonder if she is very sensitive to lysodren at certain amounts. I also wonder if perhaps, her cortisol cannot go as low as some other dogs, that she has bad reaction to too low of cortisol.
I think that in light of how she is acting this evening and the head tremors that something needs to be changed, unless she bounces out of it.
Kim gave you good advice. Keep an eye on her and if she shows any further signs of overdose get her to a 24 hour vet and have her electrolytes checked out.
Hang in there.
hugs,
Sharlene and Molly Muffin

[lulusmom]

I just wanted to chime in say that I agree with Kim's assessment and her advice. If Ginger should worsen, such as start vomiting, develop diarrhea and/or have trouble walking, you need to get her to the er. Otherwise, call your vet first thing in the morning and have her checked out. Her cortisol could be too low or another possibility is that Ginger is in a very small minority of dogs who experience neurotoxicity, which is a side effect of the drug. Acting spacey, wobbly and difficulty in walking are symptom of this. The head tremors I'm not sure of. This usually resolves a few days after discontinuing the drug so if it were neurotoxicity, you would start to see improvements soon.

Glynda

[My sweet Ginger]

Thank you very much Sharlene. I've been thinking the exactly same things as you do especially her body can't handle too low cortisol anymore. I don't see the tremor right now and she is still sleeping looking peaceful to me.
I was able to talk to a Dr. from another vet and she told me to watch her closely and anything unusual happens then call her. I hope she make it through tonight all right. I will run it by whoever is still up if anything, thank goodness for that.

[molly muffin]

Glynda makes a good point, about neurotoxicity. If you have to take her to an ER doctor or when you speak with your vet in the morning, you might want to mention this as a possibility as it is a known side effect in some dogs.
Glynda knows an awful lot about these things and I would take her and Kim's advice to heart.
Okay. Now, you'll be alright and so will Ginger because you'll be watching her like a hawk. :)
So, lets get her through tonight and this episode and then look at what is going on.

hugs,
Sharlene and Molly Muffin

[molly muffin]

Checking in on Ginger this morning. How is she doing? How are you doing?

Have to leave for work, but will check in again later. We have our morning crew here if anything comes up.

hugs,
Sharlene and Molly Muffin

[Squirt's Mom]

Mornin' Song,

How is our sweet Ginger this morning? Is she alert, responsive, eating and drinking ok? How is her morning poop? Normal I hope?

I wonder if what you are seeing could be a side effect of the stim agent for the ACTH yesterday....hmmmmmm - some pups do react to the ACTHs for a period after the test but typically bounce back in a day or two. Based on her reactions to the two loads, she could be one of those sensitive pups Glynda spoke of.

Looking forward to hearing an update this morning and hoping it's a good one!
Hugs,
Leslie and the gang

[goldengirl88]

Song:
Just checking in on sweet Ginger today. You know Leslie said things may be off because some dogs have a reaction to the ACTH. Tipper did a t first it was horrible. The first time she had one, I brought her home, she went in circles in the yard and collapsed. I was near hysterical and called my vet on his cell phone. He didn't call me back for an hour and balled me out for calling him!!! I wanted to strangle him. She does not appear to have any reaction any more as she has had 13-14 of them by now. Hope Ginger is eating, and going potty normal. Blessings
Patti

[frijole]

Checking in like the others this a.m. to see how your baby is doing. Let us know when you can as we tend to worry. Hugs, Kim

[My sweet Ginger]

Good morning everyone and many thanks for caring for Ginger and myself especially during the odd hours.:) Sometime after midnight we went outside to pee for the night and her walk was the usual, came inside and I gave her prednisone as Glynda suggested which was about 12 hrs after the first one I gave her yesterday. She slept through the night and seems ok so far. I gave her smaller amount of breakfast @7:30 this morning and she left about a quarter of it but took a few pieces of my toast. I'm hoping she will keep these down. Hasn't pooped yet.
She still has mild tremors but I see this almost all the time these days.
Can someone please explain to me about the importance of electrolytes? I hear about it a lot on other threads and tried to look it up but I'm still quite vague about it.
I will call the vet this morning. Thanks for being there for us everyone when we are vulnerable.:)

[goldengirl88]

These are when the Potassium and salt go haywire and have to be regulated. The Potassium goes high and the salt goes low. These electrolytes are important as they affect the heart. When the cortisol drops and they go in to Addisons it affects the electrolyte balance and they need checked right away. Blessings
Patti

[Squirt's Mom]

A few links that explain electrolytes in dogs -

http://www.vcahospitals.com/main/pet-health-information/article/animal-health/serum-electrolytes/369

http://www.coastalanimalrescue.org/electrolytes.pdf

http://www.gopetsamerica.com/medical-terms/electrolytes.aspx

http://k9addisons.com/clinical_implications_of_sodium_potassium_ratios_i n_dogs.pdf

[My sweet Ginger]

Thanks Leslie, they were very helpful.
Now I have the results. 2.9 for both pre & post, very ideal numbers I have to say. She wants me to start the maintenance by Fri the latest. So it will be like Fri & Wed, right? I'm also to give her prednisone for now (the same dose) and an ACTH in 1-2 weeks after. Ginger's results should look perfect on paper, but..??
I mentioned about maybe Ginger might need to maintain at a higher cortisol level than other dogs and she said I'll have to see an IMS as she is not familiar with doing that.
Also she didn't think we need to check Ginger's electrolytes as they were normal a month ago or so and this test is usually for Addison's but I said I'd like to have one anyways at the same time when we do the ACTH to put my mind at ease and she agreed.

[Mel-Tia]

Hey Song

Dechra recommend that these are checked routinely in conjunction with the ACTH test. I think it may say it on the insert. I don't have any pills now to check but thought I would let you know that

Hugs
Mel
Xxxx

[Squirt's Mom]

Just FYI - Ginger is on Lysodren, not Vetoryl which is made by Dechra. ;)

[Mel-Tia]

Sorry Leslie, didn't want to cause confusion!

[Squirt's Mom]

Not a problem! Most pups here are on Vetoryl (Trilostane). ;) I did add "Lysodren" to the title so folks know.

[My sweet Ginger]

And why do you think that is, Leslie? Is trilostane simply works better than Lysodren? My vet said she doesn't do trio. Is it one or the other?
Just curious.;)

[Squirt's Mom]

Vetoryl, or Trilostane, is the "new kid on the block" in canine Cushing's treatments. It was approved for use in the US in 2009, I think..around that time anyway. Prior to that it was only available in Europe, where the testing for it was done. US citizens could get it compounded here but it was not approved by the FDA for some time. Once it was approved, it took off like wild fire. Why? In my mind it is largely due to the false idea that it is "safe" or "safer than" Lysodren. Another factor is that the misuse of Lysodren over the years caused it to get a bad reputation as a "dangerous" drug - BUT bear in mind the length of time Lysodren has been in use compared to the length of time Vetoryl (Trilostane) has been in use and it is only logical that there would be more "horror" stories about Lyso than Trilo - so far. ;) The longer a drug is in use the more we learn about it and that is where Vetoryl (Trilostane) is at the moment - we are still learning about it.

Personally, I don't care for anything that is "new and improved" - that is a sure fired way to make me stop using a product I have used for decades...print those words on the package and I'm done with it! :D I've talked with vets who feel the same way about new drugs - they do not want to use them until they have been around for some time and more is known about them. I've also talked with vets who think the newer drugs are always the best bet - if the old ones were good there would be no need for new ones. Some vets have used Lyso for years, they know it and understand it and trust it. Some vets have used Lyso without success so they leaped on the new alternative. As to why your vet prefers Lyso, I would ask!

Both drugs are life savers for our babies. Some do better on Lyso, some do better on Trilo (Vetoryl). So having viable options at last is a huge boon for cush pups and their parents. Before Trilo, if the pup didn't do well with Lyso, they were basically out of luck.

[My sweet Ginger]

Thank you Leslie, I now have a better understanding of the history of both drugs. I guess Lysodren has worked for my vet so far, I may ask her sometime. Personally tho, if Lysodren works as good as trilostane for Ginger I'd prefer Lysodren from a convenience stand point since I can't even keep up with my own vitamins regime. Twice a day, 7 days a week?:eek: I will take Lyso, please?;)
So, anyone read my post #186 yet and what did you think about Ginger's results at 2.9 for both pre & post? She did really good, huh?
If only she eats better.:(

[Squirt's Mom]

Yeah, that's a pretty good result! The post is perfect! :cool::cool::cool: You done good, Mom! :)

What is Ginger eating? Has her mouth been checked?

You might talk to the vet about giving her some Pepcid AC before the dose of Lyso. It helps some pups who have digestive upsets with the drug. If you think this is a possibility with Ginger, I'd ask the vet about the Pepcid. Make sure it's the AC form only, tho. :)

[frijole]

Those are very good numbers and I am sure you are relieved. Glad she's eating. To be honest if she seems fine I would keep prednisone to a minimum as it is addictive over time.

Your vet's comments on the electrolytes sort of scares me as if she were really familiar with treating cushings this is a no brainer and they should be checked every time an acth test is done. So they should have been checked yesterday - it is not just about addisons.

Just to be safe please tell us exactly how much lysodren you were told to give moving forward. What dose will you give on Friday and then on Tuesday?

Glad to hear she is doing ok. Kim

[molly muffin]

The numbers are great, which makes her response that much more confusing, unless for her, it is a reaction, to cortisol decreasing or to toxicity.
If this continues during maintenance, I Would consult with an IMS that has experience with lysodren.

hanging in there!
hugs,
Sharlene and Molly Muffin

[My sweet Ginger]

Thanks everyone.
I think he said 1/4 tab (125 mg) twice a week and we have to go by how she does on prednisone (1.25 mg daily) as to when to stop.
About electrolytes, I requested one done anyway at the same time when she goes in for her AcTH in a week or two.
Yes Sharlene, her results each time and her reaction to those make me scratch my head, too. She hasn't vomited again yet even though her appetite is rather poor yet. I can tell you with certain confidence that her appetite has been off without prednisone. A couple of times when she was off prednisone, she barely ate half of her meals and then she was finishing her meals once she got back on prednisone so we will see this time if that happens again.

[My sweet Ginger]

Leslie, what am I checking her mouth for?

[Squirt's Mom]

Bad teeth, sore gums, injury...something that might make it unpleasant / uncomfortable to eat.

[goldengirl88]

Song:
So sorry you and poor sweet Ginger are having such a time with this. I hope for you sake and hers it is able to get straightened out soon. I know how hard it is to put your baby thru all this, and try to deal with it. I am praying for you both to have resolution. Blessings
Patti

[My sweet Ginger]

It's kind of a weird feeling for me to go through right now and I will tell you that it's not a really happy feeling. Here we are finally got a pair of perfect looking numbers but we are scratching our heads and Ginger still has to stay on prednisone, uh? I just hope she doesn't end up going too low coming out of this whole thing in the end like some others have on here. It's such a delicate balancing act we have to walk on for our precious babies.

[molly muffin]

It is a definite balancing act, some easier than others though. If we could just figure out why these reactions are happening, then it would probably be easier to get her settled into a regime that works. I'm hoping that the maintenace will do the trick. This loading just may not be working for her.

hugs,
Sharlene and Molly Muffin

[frijole]

Thanks everyone.
I think he said 1/4 tab (125 mg) twice a week and we have to go by how she does on prednisone (1.25 mg daily) as to when to stop.
About electrolytes, I requested one done anyway at the same time when she goes in for her AcTH in a week or two.
Yes Sharlene, her results each time and her reaction to those make me scratch my head, too. She hasn't vomited again yet even though her appetite is rather poor yet. I can tell you with certain confidence that her appetite has been off without prednisone. A couple of times when she was off prednisone, she barely ate half of her meals and then she was finishing her meals once she got back on prednisone so we will see this time if that happens again.

What was the dose you were giving during the load? Was it 1/4 tab twice a day? Because maintenance dose should be the same thing in a week that you were giving in a day.

What do you mean you have to go by how she is doing on the prednisone as to when to stop? Thanks Kim

[My sweet Ginger]

Yes Kim. It was 1/4 tab, twice a day. About prednisone, she really didn't say for how long. She just said for now and I took that as Ginger will stay on it until she gets her appetite back and I really hope her appetite comes back soon. I'm finding it rather frustrating that as much as I like her I always feel like I have to ask her probing questions otherwise I'd just come home with no 'whys' and 'hows' but instructions. I hope at least she has enough experience treating cushings because she isn't getting an A from me this time with Ginger so far.

[Squirt's Mom]

With Ginger taking the pred, I don't think you have to worry very much about her cortisol going too low. And you always keep a good watch on her so you would notice if anything was off.

It's hard when they don't want to eat. Squirt worried me no end for about 3 months after her seizure when she didn't want anything. She'd eat a bite or two then walk away. I tried everything I could think of, cooked and commercial (PetCo loved me! :D) and was on the verge of trying some raw or really crappy food - I just wanted her to eat by that point. She's better now but still not like before. Sophie goes through periods of not eating and Grace doesn't have much of an appetite, which worries me no end as she's so very thin. So I can sympathize with you a bit. I hope Ginger starts eating better soon.

[frijole]

Thanks- I was thinking your vet was using prednisone as a measurement as to when to stop the lysodren so I was like WHAT??:confused::confused::) So I am relieved.

If I recall your girl was never a big eater was she? Most cush dogs inhale food and never chew - they live to eat... And your dog wasn't drinking buckets. To be honest I wondered when she didn't load at first if she even had cushings. So that's why I keep bugging you and asking you questions.

I gave lysodren to a misdiagnosed dog once - forgive me for being over protective. Hang in there and keep asking us questions. If vets were perfect this board wouldn't exist. We understand. Kim

[My sweet Ginger]

Good morning, Kim

Aww... Kim, what are you apologizing for? Do you know how much I appreciate your expertise and thoroughness in this whole thing when my vet seems to be lacking in explaining things to me in a way that I can understand? I'm wondering why you'd be saying that.:confused:
Please don't ever think like that ever. To me what you guys are telling me or asking me questions are like getting a second opinion I can't afford.:p:D Please, over protect my ginger, I'm counting on you guys now.
About the diagnosis, believe it or not in the back of my mind I still can't shake off that little question as to why she doesn't have a pot belly or hair loss or ravenous appetite or panting that we see in other cushy pups? When I asked her about that recently her answer was she ruled out other diseases and went with cushings mainly based on Ginger's increased drinking and peeing. Diabetes and thyroids came to my mind but with no knowledge on hand I couldn't go further with our conversation. Do you still have a doubt in you, too? Song.

[labblab]

Song, it is not so much that I am doubting the Cushing's diagnosis as it is that I am wondering whether there is something else also going on with Ginger that is affecting her appetite in this way. In my own mind, it makes no sense to both treat with Lysodren and also leave her on prednisone indefinitely. I honestly do not recall any other dog who has been treated in this manner in all my years on the forum. We have seen a few instances in which dogs were treated with both trilostane and prednisone simultaneously, but this was in entirely different situations when the prednisone was being given as a chemotherapy agent in conjunction with cancer treatment or pituitary tumor overgrowth.

I was initially OK with the idea of temporary prednisone to get Ginger over the hump of temporary cortisol withdrawal if that was what was causing her inappetance and feeling yucky. But that should have been a transitory issue. If your vet does not have any end-point in mind for the prednisone, I would now be doubly concerned. Ginger should not be needing to take prednisone as an appetite stimulant indefinitely. First, I would think that long-term prednisone use could result in a physiological response that would complicate her natural adrenal function. Secondly, this extreme lack of appetite is simply not typical of Cushing's. If it is so severe that prednisone is required, I would want to be searching for some more answers as to what is causing it. Just my 2 cents worth, but Ginger's reaction is really puzzling to me and if she were mine, I would want to know what the vet's overall game plan is. If the answer is just to keep her on prednisone from here on out, I would be concerned and probably wanting a second opinion as to Ginger's overall clinical picture.

Marianne

[My sweet Ginger]

Hi,
First thing first. Right before I read Marianne's post this morning I was going through Elliott's loading and was thinking about the accuracy of Ginger's latest ACTH results. Her last Lysodren was given to her @5:30-6:00 PM on 11/16 and her latest ACTH was done @9:45AM on 11/18, which makes roughly 36 hours from her last Lysodren dose and not 48 hours later as I see everywhere here.
That could mean Ginger's cortisol maybe even lower than 2.9 by 48 hr mark! What if her cortisol went too loe?
You are right Marianne, we have been using prednisone mainly as an appetite stimulant so far and what you are telling me doesn't sound good at all.
I'm thinking of getting some Pepcid and do you need a prescription for that from vet?
One more question, do you have to wait 7 days before the start of the maintenance? Wouldn't the cortisol creep up during those 7 day of waiting? I'm getting the helpless feeling all over again and just feel like crying.

[My sweet Ginger]

I even suggested that we do the ACTH in the afternoon before Ginger's 3rd ACTH since her last dose was after dinner and the vet said morning test was fine.:confused:

[labblab]

Oh Song, I'm sorry that you're feeling so upset. Let me say that I don't think Ginger is in any acute danger. Yes, her cortisol level may have dropped a bit further with the passage of another 12 hours, but her level was not so low at the 36-hour mark that I think it should be an issue.

What I am more worried about is the big picture. With the prednisone, it just seems to me as though your vet is covering a problem with a band-aid instead of really examining it. Why is Ginger not eating on her own?

I think it's OK to proceed as is for the moment. But I would want to pin your vet down re: a specific gameplan. For how many days does she want you to keep giving the prednisone? When will the prednisone stop so that you can see how Ginger is doing all on her own? If Ginger's inappetance does not resolve without being on prednisone, what is the next step?

[My sweet Ginger]

Thanks Marianne, I will place a call to her office with those questions and prescription for Pepcid AC this morning. Thanks. Song.

[goldengirl88]

Song:
I just got back from the vet's and am catching up on the posts. I am reading about the prednisone being used for Ginger's appetite. I thought it was for something else, I am sorry you have to excuse my brain cramp. I personally would never use prednisone for appetite, but that is me. After what I saw that it has done to my girl I will never use it unless she has Addisons or a life and death situation. Have you ever tried periactin? It works wonderful and not a lot of side effects. I have been using it on my cat for 2-3 years now off and on. He has eating problems off and on. Maybe you could forgo the prednisone and try this???? Hope it works and that Ginger gets feeling better. I know you have had a hard road to travel lately. Blessings
Patti

[Squirt's Mom]

If the vet's goal with the pred is to stimulate her appetite, there are other options for that besides pred and I would also question why one of those has not been offered instead. But like Marianne, I would want to know WHY her appetite has fallen off and not just throw drugs at her hoping something helped. This is why I was asking about her mouth - looking for something OUTSIDE Cushing's that could be causing her to not want to eat. Sometimes vets, and we, get tunnel vision and try to blame the Cushing's for everything when that is not always the case at all.

I haven't been comfortable with the concurrent use of the pred with the Lyso from the beginning - but I'm not a vet and don't know the full history. I can say without reserve - using pred at the same time with any treatment for Cushing's is purely illogical to my simple mind. To my mind, that's like giving cigarettes to a lung cancer patient while on chemo - kinda self-defeating. ;) But again, I'm not a vet.

Keep your chin up, sweetie.
Hugs,
Leslie and the gang

[My sweet Ginger]

When I was talking to her yesterday which seems longer than yesterday, I told her that she wasn't eating well and also looked groggy and falls down when trying to get up. So Ginger was having more than a poor appetite problem and maybe that's why she went with prednisone?
Since prednisone, she is eating a little better and seems steadier so far. I just checked her mouth and didn't see anything unusual.
I'm just wondering with almost perfect ACTH numbers why is her appetite much poorer than before? I don't remember her ever not finishing her meals going years way back. I realize she is much older but still...?
Waiting for call back from her office.

[lulusmom]

I hope your vet has contacted an internal medicine specialist to discuss Ginger's case. I agree with others here that giving prednisone concurrently with Lysodren is not a good idea; however, with her current and continued lack of appetite and inability to stay on her feet at time, it's probably a good idea. I have had a nagging concern about the acth stimulation test too. I may be totally off base on this but Ginger had no response to the stimulating agent. We see this type of blunted/non-stimulatory response in dogs being treated with (Vetoryl) Trilostane but rarely in dogs being treated with Lysodren. It makes me wonder if the prednisone has affected the results or she just may not have enough cortisol in reserve to respond to the stimulating agent. Does Ginger get really stressed out at the vet's office?

I already mentioned neurotoxicity being a rare side effect of Lysodren but if that were the case, I would think that Ginger should have started feeling better by now. There is a third possibility and that is an expanding macrotumor. A good number of dogs have a macrotumor at the time of diagnosis and it is known that treatment with both Lysodren and Trilostane can facilitate unabated enlargement of the tumor, manifesting neurologic signs. If Ginger were to have a macrotumor, the prednisone's anti-inflammatory properties would reduce swelling and alleviate some of the symptoms. The only way to determine this is to have CT or MRI done, which is very expensive.

These are all possibility that you should talk to your vet about. If she has no answers for you, then she needs to talk to a specialist who can help her sort things out. Actually, if I were you and could afford it, I would ask for a referral to an internal medicine specialist.

Glynda

[My sweet Ginger]

I will wait for her call and see what she says although I don't expect much else from her except for a short answer. I have a stinking feeling that she is already more than ready to dump me onto a specialist's lap since I get the feeling she maybe getting annoyed with my half baked questions. Just my feeling.

[My sweet Ginger]

Oh, I'm leaving for work now and will be back late afternoon. ;)

[Budsters Mom]

There are no half - baked questions. Keep asking until you understand completely. They work for you! ;) xxxxx

[My sweet Ginger]

Ok, got her msg. Ginger is going to start her maintenance this coming Friday and the other day will be Tuesdays. I'm to give her prednisone until she says stop giving it to her. If Ginger is still not doing better, then go see the specialist. Forgot to ask her when the next ACTH test will be.:(

[lulusmom]

To quote a reknown endocrine expert, Dr. Edward Feldman; "A cushingoid dog that is not eating should be considered sick and you should never give Lysodren to a sick dog". Please get a referral to an internal medicine specialist.

[My sweet Ginger]

Glynda, would consider selective eating a not eating? She didn't refuse all foods. She ate certain food tho not much when she was off prednisone.

[frijole]

Please be very specific with us. Is she eating a full meal? What do you mean by selective? It is important because we are trying to figure out if the cortisol is too low or if it's something else.

But Glynda is right - rule #1 with lysodren is you never give it to a sick dog. We are trying to figure out if your dog is sick or 'selective'. Thus we need to know what you mean by selective and how much food and what quality she is eating. Kim

[lulusmom]

As I recall, it's not just her appetite that is a problem. Didn't you mention that she was having problems walking at times? When we live with a cushdog that has been a hoover vacuum for so long, we can forget what a normal appetite looks like. Do you remember?

[frijole]

Glynda unless I have my dogs confused Ginger never really had the appetite and urination issues we usually see. Kim

[frijole]

Here's a quote from early on:

She stops and looks at me when I call her name while she is eating but that was what she was doing before the treatment, too. So it's hard for me to see the difference before and after the treatment.

[My sweet Ginger]

Ok, I will try. I just went over her journal and it looks like she was on prednisone most of the time during first loading and also first 2days mini loading right up to her second 3days mini loading which started on the 14th and ended on the 16th and then ACTH on the 18th.
No pred on 14,15 and pred on 16 because she was groggy and unstable walking and falling down getting up on that day.
On the 17th, no pred & no lyso, she left foods at bf (1/4 left) and dinner (1/3 left) on that day.
On 18th, no pred & lyso, refused bf of chicken & kibble. Ate 1/4 of ground beef & kibble and ACTH @9:45 am, pred @ 11:30 per Dr.
She almost finished dinner (ground beef & kibble)
Threw up @ 9:00PM, tremor seemed worse.
Pred @ midnight.
On 19th, ate half of bf, tremor subsided, got the results for ACTH 2.9 for both pre and post. Almost finished dinner @5.
Pred after dinner. See mild tremors.
On 20th, almost finished bf (gave her less than usual) @7am. Drank more water this morning.
Still picky at what she eats.
Finished dinner @5 (gave her less than usual).
Pred after dinner. Looks a little shakier in legs. Tremors.

I will answer question as I get them. :)

[My sweet Ginger]

Oh, I don't remember she ever left any foods in her bowl unless she was sick.

[My sweet Ginger]

Kim, although she never bugged me for foods she never refused them, always in the crowd barking at meal time and finished meals tho not the fastest.
She did have drinking and peeing problems(these were her 2 main problems and not many other problems except for tremors) and still uses diapers even though she seems to drink somewhat less.

[frijole]

Wow you really went into detail. What I want to know is - does she eat the same amount now as she did before even if it is not the same food? I recall she never had a huge appetite - but a normal one prior to starting on lysodren. I also recall she had soft stools PRIOR to starting on lysodren. and yes I went back and read and she had peeing issues and wore diapers prior to loading.

She is still wearing diapers after being loaded? Have you been measuring the water intake? Out of curiosity how many ounces does she drink a day? Does she drink 2 cups (16 oz)? I would think she would no longer need the diapers if she were loaded.

Maybe I should ask - what has changed since she has been loaded? And how much (if food or water) Like Marianne said the additional day shouldn't make her addisonian so it is strange that she was stumbing and had a hard time walking.

Next time this happens video it and share it with your vet and if you can put it on utube so we can actually see it. It will help your vet as well.

Kim

[frijole]

When was the 3rd photo taken of Ginger in your profile? Since she was diagnosed? She does not look like a cush dog to me. She looks healthy and doesn't have a rounded tummy.

[My sweet Ginger]

Kim, in those details I was hoping someone will see a pattern in her behavior with on and off of prednisone. Her appetite seems to go up and down with the presence of prednisone along with her weakness in her legs. Her poor appetite and these weaknesses already started before 36hr mark and after prednisone she's been doing a little better: eating more tho still slow, not falling down as much. Overall she still looks very fragile. She definitely eats less now than before Lysodren. I haven't been able to measure her water intake because of the other three, they all use the same water bowl. I just know she is drinking a little less going by the frequency of filling the bowl through out the day.
The differences before and after Lysodren are she seems more alert, sleeps less, eats less, more tremors it seems and a bit of decrease in drinking. Even though she may drink less(not by much) she wears diapers because she just goes in the house so I'm not sure she's forgotten about going altogether or what not.
That picture was taken from last year but I just posted three more that I took tonight so you can compare them. I don't see a pot belly that I see in other cushy dogs and she doesn't have a few other common signs either. I hope I answered what you were asking if not I will do it tomorrow. Good night. :)

[goldengirl88]

Song:
I am praying for you and Ginger that you can find out this appetite problem and what is causing it. I still have a sick cat this morning I am dealing with, but he seems improved somewhat, still won't eat. Blessings
Patti

[frijole]

Thanks for doing all of that. she does seem thicker in the waist now (kind of like me) oh and by the way I need to tell you she is a real cutie... and she's so innocent looking.

Too late now but for others lurking and reading that may be about to use lysodren - the way to measure water intake with multiple dogs is to simply measure the whole lot and assume that any variance is due to the cush dog. I had 2 dogs and I put all water in one dish and marked it with tape. Every day i put in the same amount of water and at the end of the day I measured it so I knew total consumption.

Back to Ginger - since she's had the peeing issue for a while - before loading did she constantly hang out at the water dish? Does she now? Are her diapers wet all the time? Have you considered taking them off of her to see if she can wait and go out? It could be that she is now trained to just pee whenever but her urination has decreased. YOu should be seeing some relief from that. Do you have any idea or can you tell? thanks, Kim

[My sweet Ginger]

Thank you Kim. Although the increase of her drinking started more than a year ago it was not like 5-10 times more, it always has been more like maybe 2 times at max? So no, she is not constantly around water bowl at all. But she is so tiny she still had very frequent accidents in the house. Refilling of water bowl has decreased something like 2-3 times a day now from around 3- 4 times before Lyso so I can see the change, though I see her drinking at length at times.
Now everytime she is off diaper, she goes pee on the floor and trust me I take her out as often as I can which makes me wonder about where she really is overall even without cushings diease but because of due to her age. I will use a bigger bowl and measure everyone's drinking as a total and check at the end of each night.

My uneducated guess so far would be I don't think she is in Addisonian's crisis rather her body struggling to adjust to her new low level of cortisol in such a short time. Her poops have been the same as the way they have been in months, too.

I think I will go with the vet's plan with the maintenance but maybe not the dose she wants. I'm considering at a lower dose like 25mg instead of a little over 50mg which she was taking. I have a feeling she may be more sensitive to Lysodren than average dogs.
And when this doesn't work then we will go to a specialist.
Any thoughts will be appreciated.;) Song.

[lulusmom]

Hi Song,

i think I mentioned to you that if Ginger is concentrating her urine, her drinking is probably not cushing's related. Rather than drive yourself nuts trying to figure out how much she's drinking, ask your vet to check her urine specific gravity.

Given your vets choice to follow a treatment protocol that includes concurrent use of prednisone, I would not assume that Ginger's problem is her sensitivity to Lysodren. I also am very concerned that your vet thinks it's okay to keep giving prednisone to Ginger in the hopes it will counteract the adverse effects of Lysodren and improve her appetite. As I mentioned before, it is not okay to continue to give lysodren to a dog that does not have a normal appetite.

The number one most published side effect of Lysodren is GI upset but aside from her abnormal appetite, I personally couldn't point a finger at GI upset as being Ginger's problem. GI upset does not explain Ginger's fogginess and inability to walk. I still recommend that you consult with an internal medicine specialist and let him/her sort this out.

[Squirt's Mom]

I agree with Glynda. Your baby girl needs an experienced set of fresh eyes that go with a more open mind to take a look at her. ;) Find an IMS and make an appointment for Ginger. I think the odds are MUCH greater you will find the answers you seek with them than with your GP vet. ;)

[My sweet Ginger]

I'm sorry but in order for me to understand what you are saying you need to educate me here. What is GI? Also her specific gravity that was done 2 months ago was 1.053. Is it concentrated and what does that mean in a medical sense?
The vet has a specialist who she works with in time of needs. Would you recommend to see that specialist or someone independent?

[Harley PoMMom]

GI = Gastrointestinal, which relates to the stomach and the intestines.

Dogs that drink large amounts of water will usually have urine that is diluted (watered down pee) and not concentrated.


Urine specific gravity (USG) and osmolality are measures of the solute concentration in urine and are used to assess the ability of the renal tubules to concentrate or dilute the glomerular filtrate.
The diagram and notes below detail how the kidney concentrates urine.


Specific Gravity of Urine (https://ahdc.vet.cornell.edu/clinpath/modules/ua-rout/SG.HTM)

Hope that helps. ;)

Hugs, Lori

[My sweet Ginger]

And everytime I bring up the use of prednisone, I always get the same answer from her, it is such a minor dose we don't have to worry about it. So she is not telling me the truth, then.
Ginger's been doing ok last couple days and I think I'm skipping her prednisone at dinner time today and watch how she feels and give her one tomorrow morning. Kind of trying to wean her off of it this way and see.

[molly muffin]

The thing with prednisone is that you don't just take them off of it, of the feel like they are crashing. They should be slowly removed from it under the supervision of the vet.
The urine is a bit of a mystery, because one of the classic symptoms of cushings is that the dog drinks so much water, because their body is producing so much cortisol, that the urine is almost every time, going to be dilute until the cortisol levels are lowered.
I think there is a marked difference in the pictures from the other night compared to the earlier ones. Her head is hanging lower, tail lower, doesn't look as engaged, frail as you say. Now she might be feeling yucky from her cortisol being lowered, but traditionally the predinisone would make her feel better in that case. I'm not sure how it works when giving both at the same time though.
One thing I do know is that you can't be using prednisone long term as an appetite stimulant, you really don't want her on prednisone any longer than necessary. It could be that when you remove the prednisone completely she is feeling awful. It's a steroid after all and addictive to the body.
Maybe the others have some more thoughts along these lines. Glynda and Kim and the others have experience with All of this and the different variables.
If I had to make a choice of IMS, then I would probably go completely off the range so to speak and get a new set of eyes. But that may not be what you want to do.

Hang in there.
Where through all this loading and mini loading and prior to loading, over all, has Ginger been at her best at? When has her head been up, her walk steady, her eyes shiny and her ears pointed forward? That will tell you more about when she was feeling good. I'm going to skim through the thread to see.

The last time I saw you really say that, (I went back through your thread) was on 21 Oct, before the morning pill and then the ACTH test two days later. By the 24th she was having trouble and seemed lethargic and not eating. She was doing fine it sounds like right up to that last pill on the morning of the 22nd and you also weren't giving her prednisone at that time. I know that they like to have that number down to 5 with lysodren, and on the 24th she was at post 7. Which is a big difference from the post >50. (as a recap).
Keeping in mind that she does have the tumor on her spleen which might also be causing the adrenals to work harder (and is prone to crystals). I'm just having one of those, I don't know about all this. She also had on the 24th, we noted, not had a wet diaper while you were at work for the full 5 hours.
Then because she was weak on the 24th still (keeping in mind that the lysodren continues to work from the 22nd to the 24th) she was put back on prednisone and later mini loaded again, and we start the cycle all over.

What do the rest of you think? She was best on the very first load, up to the 22nd and was off prednisone at that time. After that her appetite hasn't been good and she's been wobbling, lethargic.

I'm recapping a bunch of stuff Song, but it would be great to see the Ginger that is perky and happy again.

hugs,
Sharlene and Molly Muffin

[Wendy Tillotson]

Hi Song

I have a 14 year old Wire Doxie, Katie - she will be 15 in January. :D She was first diagnosed with Cushings about 2.5 years ago and it has been quite a journey to get her adjusted. She is about 12 lbs now - she was a little thinner when she was younger.

She is in maintenance and gets 500 mg broken into four different doses in the week; this has always seemed high to me, but seems to work well for her.

My vet used a different method for loading which had me crazy as it was counter everything I read. She had me load her over a longer period of time on 1/4 pill per day. We originally tried 1/2 pill a day, but she got sick on that. (I always had 5 mg of pred on hand in case of a crisis.)

As we got her into range, she was virtually comatose. All she wanted to do was lay on the couch or in her bed in a little ball. Doesn't sound like Ginger has that issue so shouldn't need the pred.

For peace of mind, I took her to Dr. Peterson in NYC. (Turns out he was one of my vet's professors at Penn. Have to wonder how old HE is as I know how old she is. LOL.)

He recommended that we put her on low dose prednisone during the loading and on maintenance permanently. (His reasoning was that it would keep her perky and "normal" and if her levels got too low during loading, would also keep her from having an issue.) My vet spoke with him and as a result, Katie is on 1/2 mg of pred all the time and has been for at least two years. I hated the idea but seems to be working.

Sometimes I wonder if that contributes to needing the higher dose for maintenance, but the bottom line is that she is happy and pretty healthy. Have had none of the side effects/problems that many say come with Cushings and haven't noticed any from the pred itself. (Strangely enough, when I had Katie at Dr. Peterson's, he did say she would need 3/4 to 1 pill per week for maintenance.)

At almost 15, she is slowing down, but I don't contribute that to the Cushings - I contribute it to age. She still goes for her walks (or should I say creeps), loves her treats and is quite vocal about when she feels she should have one (as is her brother). She has even trained my greyhound to beg for treats. :rolleyes:

But, it was a long journey with many stops and starts. My vet drove me nuts - but in retrospect, I think that was more my insecurity than her - and she has ultimately been my rock.

Have patience and if you are worried about your vet, possibly get a second opinion or talk to her/him. A good friend with a Cushings dog changed vets as hers was non-supportive and she has been super happy with the new one. The right vet can make all the difference and you need to have faith in your vet.

And remember that while there are general rules that apply to most, there are exceptions and what works for most, may be different for your baby.

Hang in there!

Wendy

[frijole]

:) As you can see everyone has different experiences. As soon as you posted that the urine is concentrated i just shook my head.. because cush dogs can't concentrate their urine. I keep wondering if something else is going on. And I wonder if the diagnosis was wrong.

just like Wendy shared her story - I shared mine re Annie. She was misdiagnosed. So i always keep an eye out just to make sure it doesn't happen to anyone else. Ginger's issue when you started this journey was frequent urination - not a round tummy, not panting, not an abnormal appetite, no hairloss, no hind leg weakness or shaking - just the urination.

Let me ask a real simple question - is her pee yellow as opposed to clear? Kim

[My sweet Ginger]

Hi Wendy,

First off I'm so glad you and Katie are where you are despite all the ups and downs you had to endure. I can imagine both the heartaches and excitements through out your journey that you and Katie have been on together and finally a resolve. :)
Thank you so very much for telling me your baby's story. I really appreciate you for doing that.
I'm pretty sure what I'm feeling right now was probably what you were feeling a couple of years ago. I've been doing so much reading and thinking and by now things are actually not much registering into my brain. Yesterday seems like many days ago and I don't think I'm being very productive these days being in this state for Ginger.
I will read your post again tomorrow (had to read twice) and will have more questions for you then if you don't mind but I do have a couple of questions tonight.
When Katie was comatose after being loaded, how long did it take for her to start getting better once she was in maintenance and how was her appetite during that time?
You said Katie is on 1/2mg of prednisone, do you mean 0.5 mg and if so how do you break them into such tiny pieces like that? Ginger's pills are 5mg and she gets 1/4 tab everyday for now and they are already quite tiny.

I've been thinking about my vet and an IMS but haven't come to a decision yet. Need to do more thinking and research.

You are so right when you say there are exceptions because so far Ginger's reaction to the treatment is exactly that, against everything I read or hear. Though it is exhausting we will get there with the help of all of you tireless and beautiful minded people.
Thank you so much. Song.:)

[My sweet Ginger]

Kim, I just saw your post. Ginger's USG was 1.053 before treatment started. Is her number considered concentrated? I have no idea.:o
Tomorrow I will try to collect her pee but when I check her diapers they don't appear to be yellow but rather clear. I will get back to you on that tomorrow.
Ginger had drinking and peeing problems, some weakness in her legs and leg shaking. The head tremor, I was not sure whether it was a tremor or a shiver as she always had done that but now there's no doubt in my mind. It's undeniable. Thanks Glynda. Song.

[lulusmom]

A normal hydrated dog with normal renal function should have USG of 1.030. Ginger was well above that before you started treatment so I'm wondering more and more about your vet.

[My sweet Ginger]

Sharlene, do you mean Ginger's was too concentrated? But now I don't see her urine really yellow. I guess another urine test is in order.

[molly muffin]

Actually yes, I think that is what we are all concerned about that it was over concentrated.

cushing dogs are normally very dilute. Glynda would know the numbers better than me.
she just posted, 1.030 is normal

Sharlene and molly muffin

[My sweet Ginger]

My bad, everyone !!
Not only Ginger's urine color clear (egg white color what I'd call - fresh from this morning):p but her USG was actually 1.015 as of 09/17/2013. The number I gave you last night was from 09/26/2012!! :o:o:o My big apology, everyone. Nice catch, though.:cool::D
Have a wonderful day everybody. Song.

[My sweet Ginger]

Hi, I think I'm going to consult with an IMS as a second opinion at the same time going forward with maintenance regime for the time being. In case if in fact it's Cushings then I don't want her cortisol to creep up again to the point that she has to do another mini load while deciding which way to go. This IMS is not the one she usually refers her patients to but she is closer and I liked her bio, kind of young tho. I hope this doesn't start a bad feeling between us as all my babies go to her.