AMSTAFF Diagnosed with Cushings - Lysodren Dosing?

[jaxon53]

Hello I have a 9.5year old, 65lbs. Amstaff named Jaxon. He was diagnosed with cushings at the end of September. He had displayed many of the symptoms for months but I thought a large part of it was just due to his age. He had become very gluttonous, drank a lot of water, started to get a pot belly, and was urinating for a long time. I googled the symptoms and found cushings. So I took Jaxon to the vet where we decided to start doing the tests to see what we had. First Xrays were done on his abdomen and that all came back ok no enlargements of organs. Then they they did a blood test- all levels looked great, wbc was good and rbc was good.They did what I want to call a dexamethasone suppression test. This was when he was diagnosed with pituitary dependendent hyperadrenocorticism. Pre dexamethasone=3.8 Post 4Hr 1.8 Post 8Hr 5.6. NOW here is the kicker. I read about all the dosing instructions with the Lysodren. In the beginning you load with a higher dose and then move to a maintenance mode. Our vet, however said that he does not bring on the dose like that. He did it like this- Days 1thru5- 1 pill per day(500mg a day. Then the next 5 days he would get 1/2 a tablet for 5 days(250mg a day). Then the next two weeks he would get half a tablet twice a week. Also I must add that during the first 10 days he was also taking 5mg of prednisone per day. A month after treatment began we took him for an ACTH test and his levels were coming down and was looking good. So the vet told us to give him half a pill twice a week. He seemed to be acting normal for a while then he starting getting the original symptoms all over again. So they did the test and the levels were going up again. So we increased to a pill twice a week( 1000mg a week). We ran it like this for2 weeks and were noticing that he was showing signs of what we thought was an addisons crisis. So the vet did another ACTH per our requests and his levels to be perfect. We thought this was our own paranoia so we continued the 1000mg a week dose. Now two weeks have gone by and he is starting to show serious characteristics of something wrong. He is still drinking a normal amount of water.. but has no appetite and just looks like hes in a daze. He ate this morning and then through up his food. I gave him a predisone pill this morning and called the vet. He has an appointment at 4 today. Im very unconfident in my vet after reading the information on this site. Since the beginning of the treatment Jaxon has never really changed for any better. He still has a pot belly, he always remained gluttonous with his food. His hair is falling out. Im just very displeased and worried. Can someone please help me

[doxiesrock912]

I would find an IMS vet (small animal internal medicine).
We have been through 3 vets before learning about the specialist.

[labblab]

Hello and welcome to you and Jaxon. I have only a moment to reply, but I share your worry about both Jaxon and your vet! I've taken the liberty of editing your reply to reflect that Jaxon is being treated with Lysodren. Hopefully, this will direct our Lysodren users to your thread more quickly.

I'm glad you've found us!
Marianne

[molly muffin]

Hello and welcome to the forum. I'm not a lyso mum, but we had another member just recently that did the load with prednisone and it didn't come out the way they had hoped and their vet had said it should either.

Lysodren has been around for years and year, longer than vetroyl and there is a very set protocol for how you use it. You load, usually for about 5 days approximate and since lysodren will continue to lower cortisol for 48 hours after the last pill is administered, the acth test is done on the 2nd day after the last pill during load. Then if the ACTH shows that you are loaded, you take the amount that was given daily during the load and you split it into 3 days during the week.

I'm not sure what the load dose should have been during the load week for 65lb dog, but this doesn't sound right to me.

Never give medication to a dog that is vomiting, lethargic already, wobbly, not eating meals, etc. Stop medication and get a test done.

Do you have copies of the ACTH results during and since medication was started?

Have you gone to the vet yet? I see htat it is 4:13pm eastern time.
What did the vet say? What about consulting with an IMS? Is that an option for you?

Hang in there. Some of our members who are more familiar with lysodren will be by to comment too.

Sharlene and Molly Muffin

[StarDeb55]

Welcome to you & Jaxon! First of all, if you could round up copies of all the testing that has been done on Jaxon to make the cushing's diagnosis that would be a huge help to us. We would be very interested to see only the abnormal values from anything like a senior wellness panel or a super chemistry panel. Please include the reporting units & normal ranges. Also, if a urinalysis was done we would be very interested in seeing the specific gravity. The more information you can give us the better feed back we can provide you. When you mention that his ACTH was perfect when he started showing signs of a possible crisis, could post those results? We have frequently found that vets who have minimal experience with Cushing's will use the normal cortisol range for a healthy dog not under treatment. This range is totally different than for a pup being treated for Cushing's, the range for lysodren therapy is 1-5 mg.

Now, when it comes to using lysodren, I'm sorry but your vet is not following standard protocols which raises a huge red flag for me that their experience with Cushing's may not be that good. Let me explain what proper protocol is. The loading dose is 25-50 mg /kg, preferably as close to 50 mg/kg as you can get. For Jaxon, his weight is 29.5 kg, so at 50 mg/kg, this works out to be 1477 mg. of lysodren daily. Lysodren usually comes in 500 mg. tablets, so you should have been giving 3 tabs daily, split into 2 equal doses. Once your pup shows signs of loading with an ACTH to confirm that, the 3 tablets your were giving daily should now be split out over a 1 week period, usually 1 tab, 3x per week. After 30 days on the maintenance dose, you will need another ACTH to confirm that this dose is holding the load. If the results are good to go at this point, the stim tests can be done either quarterly or twice a year depending on the vet's preference.

Using prednisone while loading is another big red flag that the vet lacks experience using lysodren. Prednisone is acting as a replacement for the cortisol that is being produced by the adrenals, so it will totally counteract the lysodren. The lysodren acts on the adrenal glands by eroding the adrenal cortex tissue where cortisol is produced. It's a fine balance as you don't want to erode to much tissue & push the dog into Addison's. The other thing is that the adrenal cortex can regenerate, some dogs may regenerate this tissue very quickly, other may take longer. This is why you want to continue to give the lysodren at a level that is strong enough to prevent this regeneration.

I have successfully treated 2 pups with lysodren, so I really do know how nerve wracking loading can be. The last pup I treated was 13 lb. Shih Tzu, that my GP vet wanted me to give prednisone concurrently. I refused, telling him that I've already done this once, so I think I know what I'm doing.

It may be useful to ask for a referral to an internal medicine specialist at this point, since Jaxon is having some problems. I will tell you that when it comes to vets, including specialist, they are not all created equal. I took my little Shih tzu to the IMS who had taken care of my first cushpup, doing a great job with him. The second time around, I can say that she so did not do a great job with my little guy, that I had to fire her, & take him back to my GP vet. If you do consider going to a new vet, I would ask how many dogs have they treated with Cushing's, which drug do they prefer to use lysodren or vetoryl, & last but not least, how do they handle communicating with owners. Good communication between vet & owner is an absolute must when managing the care of a Cushing's pup.

Sorry for all of the questions. We are here to help in any way we can.

Debbie

[Renee]

The best advice, besides what has already been posted here, is to educate yourself. You can only advocate and do the best for your dog if you make sure to educate yourself with as much (accurate) information as possible.

And DO NOT be afraid to discuss / question your vet. A vet that does not welcome fully informed discussion or is unwilling to listen, is not a vet you want treating a cushpup.

There is a lot of leeway in a lot of diseases, but unfortunately, cushings does not seem to be that disease. Following or not following protocol can make a huge difference in success or failure. When I first came here, that was one of the very first pieces of advice - follow protocol.

[frijole]

Hi - I'm a lysodren mom also. Wow your vet did some crazy dosing. Like Deb said - we need test results on the acth tests and blood tests asap so we can best help.

Most important have you ceased giving lysodren for now? What symptoms does your dog currently have? Are you still giving prednisone? Do you have some just in case? Please tell us if your dog has vomited, had diarrhea or is lethargic. Important please answer these questions!

What is interesting is that while the dosing regime he/she came up with is totally outside the realm of anything I have seen (and not following proper protocol) it actually is lower dosing that what would normally happen for a dog 65 lbs. Believe it or not a dog that size would normally start out at 3 pills a day during loading. Course it'd probably only take a day or two to load but...

Anyway - please get us up to speed and also please get copies of your entire files from your vets office. Then run like heck to another vet. Depending upon what you tell us is currently going on you may need to go to a specialist.

Hang in there! Kim

[goldengirl88]

I wanted to welcome you and Jaxon. I do not use Lysodren so I will leave that up to the experts on that. You cam to the best place for help. The people here are extremely educated on this disease so you can trust what they tell you. You will get the hang of this if you educate yourself on this disease as it will only benefit your dog. You will become the mouth piece for your baby so you need to know what you are dealing with and how to go about things. I wish you good luck. We are all here for you so you need to ask questions and get up to speed on things, as we will help and guide you. Blessings
Patti

[Dawn Anderson]

Morning and welcome, I also have a Amstaff/Boxer with PDH, she has a macro tumor at the pituitary that has caused all this. She under went 3 day radiation treatment at UC Davis on 11/25,26,27. She is not an any meds except for a pain killer to help ease the discomfort caused by the CC and head aches from the tumor. We go back to Davis on Jan. 6th to meet with the IMS to see were her levels are at. We could not start any meds right away because of the radiation treatments( which she did really well with) her body needed the cortisol to help control the inflammation in her brain while the tumor cells start to die off.
You will find a ton of information here and support. Your vet diag. Jaxon with PDH, if I were you and could afford it I would get a CS and or MRI so that you have a better idea of what is going on inside Jaxon
brain. Hopefully you can find a great IMS or even a VMTH in your area that you can turn to.
I was glad to read that Jaxon has not shown any signs of calcinosis cutis at this time, CC is a horrible side effect from Cushing's. I have read that not all dogs experience it and I pray that you Jaxon never will.
We will be right here for you should you need anything. Keep you chin up and keep pushing forward.

Please bourse through my thread it might help with understanding the effects of PDH (tumor) on brain.

Fellow Amstaff lover
Dawn & Miss Buttercup( Butters will be 8 in Jan.)

[Dawn Anderson]

However I did notice that you mention hair loss, pay very close attention to skin conditions, go over him with you hands and feel around for any hardening spots, it will feel kind of leathery, pay close attention the his hackles and back area. Hoping its just the meds that are causing the hair loss and not calcinosis cutis, what we call the dreaded CC.

Thinking of you and Jaxon
Dawn & Buttercup

[jaxon53]

I took Jaxon to the vet yesterday and told the vet of him acting in a daze, very tired, vomiting, and diarrhea. My Vet then referred me to a internal specialist by the name of Dr Assandri. The catch is the soonest they have available is the 10th. I have all the test results and Im going to type these out. Please let me know if you need more info.
9-16-13 This is when I had a hunch that Jaxon might have Cushings after reading articles and symptoms. He had pot belly, very aggressive hunger, was drinking loads of water and urinating for about a minute when he would go.
Test Results Reference
ALB=2.9g/dl 2.2-3.9
ALKP=55U/L 23-212
ALT=128U/L 10-100
AMYL=548U/L 500-1500
BUN=10mg/dL 7-27
Ca=9.6mg/dL 7.9-12
CHOL=390mg/dL 110-320
CREA=1mg/dL 0.5-1.8
GGT=4U/L 0-7
GLOB=3.2g/dL 2.5-4.5
GLU=103mg/dL 70-143
LIPA=1341U/L 200-1800
PHOS=4.7mg/dL 2.5-6.8
TBIL0.6mg/dL 0-0.9
TP=6.1g/dL 5.2-8.2
ALB/GL=0.9 00000-00000
BUN/CR=10 00000-00000
----------------------------------------------------------
WBC=6.27K/ul 5.5-16.9
LYM=0.91 K/ul 0.5-4.9
MONO=0.59 K/ul 0.3-2
NEU=4.55 K/ul 2-12
EOS=0.18 K/ul 0.1-1.49
BASO=0.04 K/ul 0-0.1
%LYM=14.5% 00000-00000
%MONO=9.4% 00000-00000
%NEU=72.5% 00000-00000
%EOS=2.9% 00000-00000
%BASO=0.7% 00000-00000
HCT=55.5% 37-55
RBC=7.26 5.5-8.5
HGB=18.1g/dL 12-18
RETIC=92.2K/uL 10-110
%RETIC=1.3% 00000-00000
MCV=76.5fL 60-77
RDW=15.6% 14.7-17.9
MCHC=32.6g/dL 30-37.5
MCH=24.9pg 18.5-30
PLT=423K/uL 175-500
MPV=9.2fL 00000-00000
PCT=0.39% 00000-00000
PDW=19.6% 00000-00000
--------------------------------------------------------------------------
9/21/13-The dexamethasone Supresion test was given.
Pre Dexamethasone 3.8ug/dL Ref range 1.0-6.-
Post 4 hour Dex: 1.8ug/dL Ref range Less than 1.5
Post 8hour Dex 5.6ug/dL Ref range Less than 1.5
-------------------------------------------------------------------------
9/24/13- Based on tests he was started on Lysodren 500mg a day for 5 days..Then 250mg a day for 5 days. Then 250mg 2 times a week for two weeks.prednisone 5mg tab for the first 4 days
----------------------------------------------------------------------------
10/22/13-ACTH test was given to see how treatment was coming
--------------------------------------------------------------------------
10/23/13- Results from ACTH test from 10/22/13
Pre ACTH CORTISOL-4.2 ug/dL
Post ACTH CORTISOL-4.4ug/dL
He felt results were good keep on lysodren 250mg Two times a week
----------------------------------------------------------------------------
11/5/13- signs of cushings coming back eating and drinking tons
Upped Lysodren 500mg 2x's a week
----------------------------------------------------------------------------
12/7/13- Another ACTH stimulation was done.
Pre-ACTH Cortisol 3.1ug/dL
Post 6.9ug/dL
Vet said to keep giving him 500mg 2xs a week.
---------------------------------------------------------------------------
12/24/13- Acting weird and currently acting weird...with signs above listed..

[jaxon53]

Also I would like to add...Jaxon is begging to eat his food again but only a little less than half of normal eating habbits. All the while though he would eat his treats like a pig :) Also last bowel movement his stool was not diarrhea. He still, however seems a little off and tired... I gave him a 5mg prednisone yesterday and one this afternoon.

[molly muffin]

I edited your post to highlight in red the values that are high/low, that is really all you need to type out on the blood work.
The LDDS (low dex) is consistent with cushings, and the last ACTH test on 12/7 would seem that he is not overly suppressed, yet all the signs of there of possible low cortisol (diarrhea, vomiting)
I think that an IMS is a very good option and if it financially an option, my next step would most likely be an ultrasound to look at the internal organs.

Sharlene and Molly Muffin

[jaxon53]

Ok so I guess the vet is right in diagnosing him with Cushings? Because when I went to the vet the other day that was when the vet even seemed to wonder if maybe he was misgdiagnosing and/or he had something paralleling the cushings (hypthyrodism). They did an xray of his internal organs at the beginning of all of this and as the vet said, all looked perfectly fine. Was there anything other than the high cholesterol that stood out to anyone when they read the above values?? He seems to be coming around a lot better today. I still would like to see his water consumption up a little bit more. I have given 5mg of predisone each day for the last two days just as a precautionary. Thank you very much for your help, although we are not out of the woods yet, I feel comfort in knowing that there is people on here who can help with their knowledge. AGAIN WE THANK YOU!!

[molly muffin]

There is a chance that the LDDS tested false positive, which it can in the face of other illnesses.
I was going to ask about whether there was a T4 test included on the blood work, to rule out thryoid issues.
Thyroid and diabetes can have the same symptoms as cushings and normally is ruled out first before moving to a cushings diagnosis.

Sharlene and Molly Muffin

[jaxon53]

I don't believe either of these tests were done directly but I do believe remember my vet pointing to a few things on the blood test that ruled out diabetes and I thought also he had mentioned that they ruled out thyroid issues. I know personally that thyroid issues are VERY hard to diagnose due to consistency. Another thing that I must add is how bad Jaxon's coat has gotten. Id say since we began treatment his hair is falling out a lot. On his sides he is down to just a thin layer of fur. There are other spots that are balding too. Again Im trying to give as much info as possible not clear what is relevant or not but whatever isn't just overlook...
Thanks In Advance

[molly muffin]

You never know what will be relevant, so it's always better to give as much info as possible. I'm use some of the lysodren people will be stopping in too.

Glucose is within normal range on the blood test, which would rule out Diabetes, not sure since I don't see a T4 what would rule out thyroid.

Sharlene and Molly Muffin

[jaxon53]

Well, Im really beginning to worry about Jaxons water consumption. I took him for a walk and came back and he is not drinking water like normal. I don't know how to force him to but Im trying to lure him into it. I do want to mention this too. Yes I know its all starting ot come to mind. A year ago Jaxon would start like shaking sorta like he is cold..We didn't think much of it because he would do it sorta on command. We'd say are you cold? and he would begin. Remember this dog is super smart, hence, why we spell things we don't want him to know haha. But ya when he sleeps now we are noticing him like kinda shiver??? I think shiver is the word like anxiety though...

[frijole]

Not drinking water is a sign the cortisol is too low. Can you call the vet? You may need prednisone. And yes you can have false positives on l d d s tests.

[jaxon53]

I do have prednisone. I have given him 5mg's a day for the last two days, however, I did not give him any today. Im debating on giving him one more today. The last day that he received Lysodren was sunday. I know it stays working for 48hrs so today I figured with the Lysodren out of his system that he would improve and all and all he has but again the water consumption seems less than where Id like to see it.

[labblab]

Lysodren can continue to actively erode the adrenals for 48 hours. But even when additional erosion halts, this does not mean the adrenal function has returned to pre-treatment levels. It can take days or weeks for tissue rejuvenation to occur. For some dogs, their adrenal function remains permanently suppressed. So Jaxon may continue to need ongoing prednisone supplementation for an indeterminate time period right now.

Marianne

[molly muffin]

Jaxson is a handsome fella. Love the avatar. I'd give him the prednisone. No telling how long he will need it as Marianne said and Kim.
Also, don't just stop the prednisone, because you'll eventually need to taper it off under the guidance of a vet, if the adrenals start to produce more cortisol.

Sharlene and Molly Muffin

[jaxon53]

Ok I did give him prednisone today. The good news Jaxon is drinking water pretty good now. I would say the only oddity that is happening is the fact that he just just don't fully seem himself. He almost looks like a little dazed but other times looks fine... he is pretty sleepy and the shaking thing that he used to do when he got excited about something has turned into something has doing while sleeping. Again I thank all four the help I'm feeling confident things are getting better

[Dawn Anderson]

Love your avatar. If you could, please take pics of his skin condition and create an album on your page so that we can see him. I'm hoping that the medication is causing the hair loss and not CC, KEEP A CLOSE EYE on his skin,I know I've mentioned it before, yet its real important that you go over his coat and skin and record any changes. once CC comes on it can spread real fast. Its caused by to much cortisol for to long a period of time.

Do you know for sure if its ABH or PDH?

Dawn and Buttercup

[jaxon53]

hahaha thank you for the compliments on my little guy, he is pretty handsome.. Dawn I see on his elbows that there is a dark brown area that is rough.. He has had that for a while I just figured that was from him getting older. I checked elsewhere and he see if he had anyomore. There is a lot of stuff that is adding up here although its good to be shedding light on this, its also a little nerve racking. I wish I knew about this site a while ago becasue he had symptoms but alot i contributed to him becoming older... I cant wait forr him to see the specialist I think I will feel a lot comfortable getting hard facts. I like my vet but there is only so much that he could do in these areas.
Thanks again

[frijole]

Just so you know not all dogs with cushings get the skin problems. Glad you are going to see a specialist. Kim

[Dawn Anderson]

Just wanted to pop in and see how you and that handsome Staff Jaxon is doing. Hoping things are stabilizing. By the way did you ever get confirmation that his Cushing's is PDH or ABH. ?

Dawn & Butters

[Dawn Anderson]

Just wanted to pop in & see how things are going for you guys.

Dawn & Buttercup