Mr. Ping Dog

[Lois]

Hi everyone!

I am a doggie mom to Mr. Ping, a 120-lb newfie-like doggie with black hair and warm brown eyes. He was diagnosed with Cushings 4 years ago and has been on Lysodren since that time. About a month ago, the Lysodren stopped working and the symptoms of polydypsia and polyuria returned. My husband or I have been getting up at night to let him outside to urinate. We love him dearly and want to prolong his life for as long as we can. He had an ultrasound and no liver tumor was found and he had urine tests for infection, which were also negative. He has been on the induction phase of Lysodren for the second time per his vet for 3 days and we still haven't seen any reduction in the symptoms. I came here to find out what other people are doing and to give and receive support. This is a scary time in our family and we are hoping the Lysodren will keep working. Thanks for any input you can give.

[lulusmom]

Hi and welcome to you and Mr. Ping.

First let me say congratulations for being yet another member who disproved the theory that dogs with cushing's only live two years with or without treatment. I solute you for being a great advocate for Mr. Ping.

If the Lysodren worked the first time, it will work this time. I've there, done that with two dogs. It is not uncommon for dogs on Lysodren to relapse and if this the first time in four years it has happened, you've been very lucky. Without knowing how high Mr. Ping's cortisol levels were before you started loading, it's difficult to predict how long it will take. Your vet should have done an acth stimulation test before he started loading. I would help us greatly if you could post the results of here?

The cells in the adrenal glands are tough as nails and sometimes they simply overcome the ability of the maintenance dose to maintain the erosion achieved during loading. In other words, the cells regenerate and unless you are having acth stim tests done every quarter to make sure you catch the rising cortisol early, you will be confronted with reloading. Just relax and know that we're here with you and will get you through this. What instructions did your vet give you and what is the daily loading dose of Lysodren prescribed for Mr. Ping?

Glynda

[Lois]

Thank you for the support. Mr. Ping had an ACTH test a month ago that was normal. Then he started having the symptoms again and the vet put him on 1000 mg twice a day in 1/2 can of dog food (Costco brand) for 5 days and then is going to take another ACTH test. So far we have seen no change in his appetite or other symptoms. Our vet told us that Lysodren can stop working in some dogs. We're hoping that Ping isn't one of them.

[frijole]

Hi and welcome from me as well.

You said the test was 'normal'. There is 'normal' for noncush dogs and 'normal' for cush dogs so we really need to know the numbers on all acth tests. Do you happen to know or could you please get the last test results?

That would tell us how high the cortisol got prior to restarting these miniloads.

I just did the math and a 120 lb dog would typically load at 2727 mgs a day which is almost 3 pills so most vets would round down and go with 2 1/2 pills a day. That is the standard STARTING point for dogs just diagnosed. So that leads me to ask - what dose were you on for the last 4 years that worked?

I think you can totally get it under control - seems like the dose is too low... but I really want to work with previous test results and dosing levels before I say much more. Thanks! Kim

[Lois]

Ping actually weighs 113 lbs now. I wrote down the results of the ACTH test but have recycled the paper already. I will find out tomorrow. Ping is on 2000 mg a day total. I think the vet is being careful not to cause Addisons. We have been on 500 mg 4 times a week for 4 years and that has worked beautifully until now.

[lulusmom]

Hi Lois,

The suggested loading dose is 50mg per kg of body weight. Kim did the math based on 120 lbs which you originally posted which equates to over 2700mg per day. That is a bit over 5 1/2 pills a day but your vet has prescribed a loading dose of 2000mg (4 pills) which equates to 36mg per kg. You will note that my estimated pill count is different than Kim's. My dogs were on compounded drugs so I never purchased Lysodren pills but as I recall the pills were not 1000mg but rather 500mg. Regardless, the low dose your vet has prescribed may prolong the loading period. My cushdogs were overweight at five and 6 1/2 pounds respectively and both loaded beautifully at the full 50mg/kg dose. I believe the difference is a vet's depth of experience with the drug. A survey was done several years ago, the results of which revealed that more than 80% of internal medicine specialists routinely prescribe the full 50mg/kg loading dose while the majority of general practitioners prescribed much lower doses because they didn't want to make the dogs sick. Is your vet a general practitioner and is s/he the same vet who diagnosed and loaded Mr. Ping the first time?

Glynda

[frijole]

I would be interested in seeing the previous acth numbers if you can get them as well. I'm asking because I am concerned that your vet is too conservative. The mini load you are doing will bring the cortisol down however what is the plan after that? Normally you load at the intended maintenance dose for example

You have been 4 x 500 = 2000 mgs a week so you originally loaded at 2000 a day

since 2000 a week wasn't working you increase to 2500 a day for the 5 day load and then 500 x 750 x 500 x 750 future maintenance.

As Glynda said it happens frequently that the cortisol slowly creeps up and if you don't do regular acth tests you wouldn't know until the symptoms showed up again. That's why they recommend at least yearly testing after they are maintained.

Anyway - keep us posted. I am confident that lysodren will work because the dose you are on is well under the recommended starting dose which is 50 mgs per kg of weight. Increase the dose and you will have success.

Congrats on 4 years of success though! My girl Haley took over FOUR months to load - constantly had to slowly increase the dosage until she loaded. It was nerve wracking. She held it though until she passed 4 1/2 yrs later at the ripe age of 16 1/2 :)

Don't worry - Ping will be just fine. You've obviously done a great job already. Keep us posted and get those numbers if you can. Take care, Kim

[frijole]

OOPS Yes Glynda - my first post I calculated the number of pills wrong for some reason. My bad. My last post I got it right though. ;):D;)

[lulusmom]

Hey Kim, you can avoid making those kind of math mistakes if you take your shoes off and use your toes too. :p

[Lois]

Date Pre-ACTH Post-ACTH
11/30/10 0.5 0.5
01/28/11 1.7 2.2
04/07/11 4.2 6.4
09/13/11 3.2 9.8
02/02/12 1.9 4.8
04/17/13. 1.8 2.4
10/09/13 1.8 4.8

[Lois]

It took a few days to get these numbers which are not complete. Ping had another ACTH test on Friday and we got the results this morning. All we were told by the vet was to stop giving him the Lysodren and he would call us tomorrow and tell us what dosage to give him from now on. I plan to get the numbers to add to this chart when I speak to the vet and I'll post them as soon as I do. Thank you for all your help.

[molly muffin]

Looks like he had a real low episode back in 2010 (0.5 and 0.5), then it went up to just out of the range where you want him if symptoms are controlled in 2011 (3.2 and 9.8), otherwise the numbers all look pretty good. I assume the vet is ready to go with a maintenance dose adjustment? although it will depend on what the latest numbers look like.
Will be interested to see those.

Hugs,
Sharlene and Molly Muffin

[frijole]

Thanks for getting all of those test results!

I was working under the assumption that the dosage you have been on has been the same since loading. Looking at the results they go up and down which is a bit peculiar. Did you do anything differently or have miniloads in between in order to get the cortisol lower?

It looks like it went up beyond desired range in April of 2011 and then down then up and then down. This doesn't make sense unless the dosage was changed or miniloads were done.

If you did miniloads like you are currently doing it confirms to me that the dose is too low and the best solution is to increase it slightly.

Appreciate the updates! Kim