question on first testing - Vetoryl or Lysodren?

[mb935]

Hello. I'm michele

My dog has shown signs for over a year and I was told she was not at the immediate need of testing a year ago.

She now has more signs and I'm going forward w the acth test this week.
(
Because I don't put a lot of trust in the vets in my area... I like to get the opinions of those who have been through this.

Diamond had an ultrasound last year. Her new Vet wants a more evasive one. She will need to be put under.

Does his sound correct?

Thanks for any help.


I just lost my dear cat two weeks ago and I'm very stressed about all this.

[doxiesrock912]

Yes it does. Ultrasounds show much more than xrays and with Cushings, it is important to see how the other organs have been affected and can also aid in determining which type of Cushings that your dog has.

Daisy had both, the ACTH test and an ultrasound.

[molly muffin]

Hello and welcome to the forum.

You said that Diamond had an ultrasound last year, do you remember if it showed anything, like enlarged adrenal glands?
Not all dogs need to be put under for the ultrasound. If she does fine without anesthesia, then why does the new vet think she needs it? are they just looking for more thorough ultrasound?
What symptoms does Diamond have? Do you have the results from any blood work or urninalysis? Specifically if you could post the abnormal high/lows with range that could be helpful.
I'm so sorry you lost your kitty so recently. My condolences as this is already a hard and stressful time for you.

Again welcome to the forum
Sharlene and Molly Muffin

[mb935]

Thank you!

Her last ultrasound showed no issues. I did ask if that could be used.

She had bloodwork done AND a cortisol test? I assuming that needed to be added for the cushings. He did say she had very high levels of cortisol (i believe) that she is definitely hyperthyroid and probably cushings as well.

I called this morning. It is a 24 hour vet. BY the way... Do we pay more for these vets than a 40 hour a week vet? They have many obviously. I just like having them available but hope Im not paying TOO much more.

Anyway... i asked if she really needed the anesthesia and was told because she is such a nervous dog that any movement would ruin the test. I wanted to be there and hold her... but i guess its too much work with that option. I DONT want her under for something like this... although I suppose it will help her with the stress she would be under for sure.

Her symptoms have been drinking/peeing a lot, pot belly and lethargy. She had fur loss on her tail which in the last week has progressed and she is now panting (NOT due to heat). AND she will eat all day if I let her. So once these signs became more obvious I knew she had to get these tests done.

This vet said this is a very easy disease to treat (not what I read)....

Thanks again!!

[molly muffin]

Depending on what the ultrasound shows, cushings Can be easy enough to treat, with a vet that knows what they are doing and follows protocols for dosage and follow up testing.
Okay, so they want a thorough scan to see adrenals, liver, gallbladder, pancrease, etc, it sounds like and don't think they will get it if she isn't sedated somewhat. In that case if you go through with that, I would just ask that they use the minimal amount.
I'm not sure if you pay more for a 24 hour vet or not, but it sure is reassuring to have that.

Sharlene and Molly Muffin

[Squirt's Mom]

That term, invasive, doesn't really apply to an ultrasound and your vet shouldn't have used it to describe one. "Invasive" means they have to do something internally, usually meaning they have to cut the body. With an US the pup is sometimes given a mild sedative to help them lay still for the test. Their bellies are shaved as well...but that is ALL. They are not cut so an US is not invasive. geez, no wonder you are nervous about it. :rolleyes:

Diamond may be a bit groggy for a while after from the sedative and she'll look odd with her belly shaved but that should be it - nothing worse from an US. So take a deep breath and try to relax. The ultrasound is one test I cannot recommend highly enough. It saved my Squirt's life by finding a tumor on her spleen. The US gives us the biggest bang for the buck, as one of our members likes to say, because they can see so very much. It will help toward the diagnosis of Cushing's and help determine which form as well as get a look at many other organs.

Hang in there!
Hugs,
Leslie and the gang

[mb935]

So it was also correct to do cortsol resting w her bloodwork already? I thouggt that was part of the ACTH test. I was confused on that also and dont want to be charged for an unneeded test.


Thank you so very much again. This is why I use forums because I get more detailed info and support.

[Squirt's Mom]

The tests that can "see" or read cortisol are special type tests. The cortisol can't show up in regular lab work that looks at things like CHOL (cholesterol) or TRIG (triglycerides) or liver enzymes like ALP (or ALKP), AST, GGT. Those things are seen on what my vet calls a "general health screen". So other tests have to be done to see what the cortisol is doing in the body. Those tests are the LDDS, HDDS, and ACTH. Your vet may do one or two of these, usually the LDDS and ACTH. These along with the health screen and ultrasound can usually give a pretty good idea if the pup has Cushing's and which type. So your baby may have several tests but I would hope your vet wouldn't put your baby through tests that weren't needed. Anytime you have a question, tho, feel free to ask.

You and your vet are gonna get to know each other veerry well over the next few months. ;):D

[Squirt's Mom]

To further help clarify, here are what those Cushing's tests do, put very simply because that is how I understand them. ;) We have a couple of gurus here who can go into great depth on these.

The LDDS is the Low Dose Dexamethosone Suppression test, sometimes called the LDDST. The term "suppression" is the key to this test. It tries to see how well the body responds when it's exposed to excess cortisol, which is a normal response in the body to any stress. A pup with Cushing's cannot suppress the extra cortisol (found in the dexamethsone) but a normal pup can. The LDDS is typically a one time test.

The HDDS is not used very much any more. It is the High Dose Dexamethasone Suppression tests, or HDDST. It was used to help determine if the Cushing's was pituitary or adrenal based. The LDDS is now capable of helping make that determination so the HDDS is seldom used. The HDDS is typically a one time test as well.

The ACTH is a stimulation test - the opposite of the LDDS which is a suppression test. It was once described to me as imagining squeezing a wet sponge to measure how much water the sponge was holding. This test causes the adrenal glands to dump the cortisol. A cush pup will have a great deal of cortisol in the body while a normal pup will not. There is an acceptable range that is considered "normal" for cortisol levels in the body. A cush pup will have high levels on this test, sometimes very high, because the body is constantly producing and releasing the hormone, cortisol. This test is also used to monitor the cortisol levels once treatment has begun. Your baby will have this test periodically for the rest of her life IF she has Cushing's.

I hope that is as clear as mud. :p

[labblab]

So it was also correct to do cortsol resting w her bloodwork already? I thouggt that was part of the ACTH test. I was confused on that also and dont want to be charged for an unneeded test.

As Leslie says, cortisol levels generally are not part of standard blood panels (and this includes resting or baseline cortisol levels, as well as cortisols when they are part of a multi-draw test such as the ACTH or LDDS). Testing the resting cortisol would be an "add-on" test. If I am understanding you correctly, it sounds as though you are wondering why your vet already performed and charged you for a resting cortisol when you are slated for a full ACTH this week. Is this what happened?

If so, I think you are right in questioning the expense of the resting cortisol. Resting cortisols are of some value in ruling out whether a dog has gone Addisonian (cortisol level has dropped too low). But they are of little or no value when it comes to diagnosing Cushing's. For example, a dog can have a high resting cortisol just because she is stressed at the time the blood is drawn. And conversely, a dog with Cushing's may not have a resting cortisol that is elevated above the normal range. So especially if you are now going to be paying for a full ACTH (two cortisol levels drawn before and after a stim agent), I would think that the prior resting cortisol was really of no value to you.

Marianne

[mb935]

Wow... ill have to show him what you guys have to say... :) or memorize it.

And yes... he took the blood and without telling/asking me also did the cortisol level for 80 bucks.

so I was asking if that was needed.

Now I have to make a phone call.

Thanks everyone. I already know I couldn't get thru this without your input!

[mb935]

..............

[mb935]

this is what i just read

"Fasting these dogs on the morning in which the ACTH stimulation test is scheduled should be avoided since it invalidates the test results."

I was told to fast her for the ultrasound because of putting her under on the same day as this test????

NOW WHAT???

THANKS!!

[Squirt's Mom]

MODERATOR NOTE: I have merged your post about fasting for the ACTH on Vetoryl (Trilostane) into Diamond’s original thread. We normally like to keep all posts about each pup in a single thread as it makes it easier for members to refer back to the pup's history when needed. Thanks!

[mb935]

IM A TOTAL MESS today.

Just deleted the wrong message....

ANYWAY... I found the info about the fasting.

What I need to know by tomorrow is if the cortisol resting test done last week was really needed due to teh vet and i both assuming cushings.

She will have the acth test tomorrow and if that otehr test was a waste i really need to know.

THANKS

[Squirt's Mom]

The question of fasting is ONLY applicable once treatment has begun and is ONLY applicable to pups on Trilostane (Vetoryl). So for the diagnostic ACTH it isn't critical. But once treatment has started with Trilo it IS critical. ;)

As for whether the resting cortisol test was a waste or not, that is something I would take up with the vet. In my little mind, it isn't as it gave them a good idea where the cortisol was - normal, high, or low. Now, based on that resting test, the vet feels a more in depth test is needed. The resting test showed the cortisol was high and the ACTH will tell just how high. If you feel the vet took advantage, then address that with them the next time you see them and maybe they can explain the thinking. Since it is so very difficult to get a diagnosis of Cushing's, I wanted every test available for my pup when we were in the diagnostic phase so I didn't consider anything a waste. ;) There is no single test that can confirm Cushing's so the more I could learn about my baby, the better in my mind. ;)

[goldengirl88]

Are you guys saying that you are fasting the dog before ACTH testing after the dog had been on treatment??

[Squirt's Mom]

No, my understanding is that she is asking about the diagnostic ACTH and fasting. Not the monitoring ACTHs once treatment has started.

[mb935]

Correct I took the quote about a medicated dog.. not the initial test.

I had searched before posting here and couldn't find answer.... just figured it out on my own.

Sorry but still good to know.

I will ask vet tomorrow about test... I'm sure he'll have some Answer s(whether it was needed or not). Hopefully it told him something.

Thanks again

[labblab]

Per my earlier reply to you on Sunday, I *do* think the resting cortisol was a wasted expense if your vet already suspected Cushing's. This time around, I'll give you a genuine quote. ;)


Q: Where does the resting serum cortisol test fit in?

A: Resting cortisol concentrations are not useful for diagnosing Cushing’s Syndrome. In fact, resting cortisol levels in dogs with known Cushing’s Syndrome overlap 50% of the time with normal dogs. However, resting cortisol levels are very useful as a diagnostic aid in ruling in or ruling out Addison’s disease. If a resting cortisol is > 2 µg/dl (>55 nmol/L), Addison’s disease is very unlikely. Conversely, a resting cortisol < 2 µg/dl (<55 nmol/L) supports the diagnosis of Addison’s disease and an ACTH stimulation test is recommended to confirm the diagnosis.

http://www.antechdiagnostics.com/Main/ANTECHInsights/October-2012-12.aspx

I would ask the vet to apply any payment for last week's resting cortisol towards the cost of the full ACTH.

Marianne

[mb935]

I was quoated about 700. When I went to desk between 800 and 1000

Is this right?

Ultrasound. ACTH and possible sedation

I did ask abouu previous cortisol testing .. told her levels were fine (I couldn't remember). So now if ultrasound is clear they will do ACTH.

Thanks....

[labblab]

Hmmm...now I am more confused. They are planning to do the ultrasound first with possible sedation, and then, the ACTH right thereafter on the same day? Ideally, you want the dog to be under as little stress as possible when the ACTH is done, because stress itself will elevate cortisol. I wouldn't think you'd want to subject the dog to the ultrasound *before* drawing the blood for the ACTH. Plus, if the dog is sedated for the ultrasound, I would think lingering effects of the sedation could also skew the results, perhaps in the other direction.

I would double-check the order in which they plan to do the testing, or else do the two tests on separate days.

And I know I am being a broken record, but the fact that the resting cortisol was "fine" is meaningless. A dog with Cushing's can have a normal resting cortisol, and a dog without Cushing's can have an elevated resting cortisol.

Marianne

[mb935]

So she didn't need the sedation anyway... and after reading your reply I'm glad.


But yes both tests were preferred to be done the same day by two vets at this office... in that order.

Somehow after all rhqt the price came to 525...which sedation can't be that much.

Anyway... the ultrasound just showed enlarged organs so this Dr really thinks cushings is a definite.

I'm going to speak w another about homeopathic options

[mb935]

Im sure this has been discussed a million times. (sorry) I am researching the site now. But vet wants to talk to me today on what med I want to try.

He has given me the option of Vetoryl and Lysodren (which is his choice). i read on two other options as well.

From one post it seems as if Vetoryl is the drug of choice here. So Id like to choose that.

My dog is only 8 though with no other health issues or drugs. Because of this disease she is now 90 lbs (was 65 when healthy).

Since my vet doesnt seem to educated on Vetoryl ... what dosage would you recommend?

ALSO... he only recommends testing her every 6 months!!!!!

THANK YOU SO MUCH!!!!

[goldengirl88]

Welcome to the forum. I f you could tell us about your dog, what symptoms it presented with etc. that would help. Just to be sure can you post the abnormal numbers your dog had from the testing to confirm Cushings? Please post the lab normal range also as all are different. We need to make sure your dog had the proper testing as there are other diseases with similar symptoms. If you have not had the LDDS, ACTH, URINE, BLOOD PANEL, ULTRA SOUND performed please so not administer Vetoryl. These are very powerful drugs you do not want to be giving a dog unless a diagnosis has been confirmed with these tests. Vetoryl is started with 1mg per lb. The lower you start the better off your dog is as you eliminate a lot of things that could go wrong. Start low and gradually raise the dosage only after ACTH's are done when needed. The best thing you can do for your dog is read everything you can on this disease if your dog has it. You need to know the proper testing, protocols etc with theses drugs. Never put blind faith in anyone even your vet. You must get educated as you are your dogs only advocate. I caution you again about doing the proper testing protocol first. Blessings
Patti

[mb935]

Oh I see this has been moved to my old question. I think its more confusing now...hope this gets noticed...

yes sorry she had ultrasound and acth last week. I was told she would not be given meds until they were 100% sure. So the acth test determined that. She did have resting cortisol test and blood panel the week prior... and her level was normal. ???

she has pretty much every symptom but the hair loss, panting and hunger have gotten worse in the last month.... belly, thirst, urination, lethargy etc have been issues for about a year.

As far as the numbers... i dont have them and would have to call (and wait forever) to get a call back...

BUT if you would like them in order to help I will definitely do that.
THANKS!!!

[labblab]

You'll see I've merged your new thread into your original thread so that your dog's entire history will be consolidated in one place. ;)

I've also edited your thread title to let people know you are debating which drug to use. I can tell you in advance that we have members who are using both successfully, so hopefully you will get some helpful feedback to aid in your decision.

Marianne

[goldengirl88]

Sorry I did not see your old thread before Marianne merged it.

[mb935]

ok... so any ideas I have to call the vet and still dont know.

What about Ketoconazole or anipryl?

i dont mean to be snappy but she is such a young dog (8) that I dont know if that means anything since it seems most are much older.

Would she be better off with lysodren in that case.

thanks

[Renee]

I think it would be most helpful for us if you could post the actual results of all your tests. I know we've asked many times, but it is especially important, in order to get the most help here. Now is a good time to establish with your vet that you want copies of all test results, every time. My vet forwards them to my email as soon as she receives them. She knows I want them for my own records.

I personally chose vetoryl. And, my vet has never used it before. Thankfully, Dechra is very, very helpful, and we have followed their protocols closely. The key is to start very low (1mg per pound), and work up. You'll need to do monitoring ACTH's every few weeks until you get to the correct dosage.

As for cost - I believe vetoryl is more expensive.

[lulusmom]

What about Ketoconazole or anipryl?

i dont mean to be snappy but she is such a young dog (8) that I dont know if that means anything since it seems most are much older.

Would she be better off with lysodren in that case.

thanks

Ketoconazole is tough on the liver and about a third or better of dogs do not absorb it well into the GI tract so efficacy is very questionable. It's also not cheap but neither are the other treatments but if you are going to spend your hard earned money, I'd say stick with Lysodren or Vetoryl.

Anipryl is one of only two FDA approved drugs for the treatment of canine cushing's. Unfortunately Anipryl's efficacy is extremely low and not recommended by most specialists or experienced gp vets. We have had members report good initial results in dogs with mild or few symptoms but improvements were short lived. Even the developer of this drug admits that his drug of choice is Vetoryl and only prescribes Anipryl to dogs with mild symptoms and whose owners cannot afford the acth stim tests that are necessary to monitor Vetoryl and Lysodren treatment.

I am familiar with both Lysodren and Vetoryl (Trilostane) as my two cushdogs were treated with both. Both dogs did splendidly on both treatments and I would have no qualms choosing one over the other. However, I will say that my dogs cortisol levels were more consistent throughout the two year treatment on Trilostane than they were on Lysodren (Mitotane). I did have to reload them a few times while on Lysodren and that was a bummer and a bit more expensive as you end up paying for two to three more stim tests to get them stabilized again. As far as side effects, Vetoryl is considered safer as it has a short half life so if a dog starts to feel unwell, s/he will usually bounce back simply by withholding the dose. Lysodren has a cumulative effect for up to 48 hours so if a dog starts feeling unwell at 24 hours, chances are things will get worse in the next 24 hours. You can't take a dose back when you're treating with Lysodren. No matter how knowledgable of either drug, you never let your guard down.

The key to safe and effective treatment is an educated pet owner and an experienced vet. It is when one or both are missing that a dog is at great risk of overdose. We usually say that it's best to go with the drug that the vet is most comfortable with but as long as you educate yourself, I think you'll do fine with either. Looking back over the years of treating my two cushdogs, as well as a rescue cushdog, I personally would recommend Vetoryl for a few reasons. Besides remaining stable on an effective dose for longer period of time than Lysodren, pet owners here in the states have the great advantage of communicating directly with the manufacturer of Vetoryl. Many of these vets on staff for Dechra are internal medicine specialists who are willing to work with your vet to answer any questions or provide feedback based on a dog's diagnostic and treatment history. That's a huge asset to anyone who strives to be a proactive participant in their dog's care.

I hope I've helped with your information gathering so that you can make the decision you feel is right for your pup. No matter what you choose, you have a whole bunch of us here to help guide you. Please let us know what you decide so that we can provide you with links to appropriate information that will help you learn about the drug, what side effects to watch for and how to properly monitor treatment with acth stimulation tests. In the meantime, if you have any questions about any of the treatments, please let us know.

Glynda

[mb935]

ok... ill see if they will email me her info.

thanks

[molly muffin]

One thing I would point out is that testing every 6 months, won't cut it.
There are specific reasons for this, which is for the safety of the dog, you need to know where the cortisol levels are at. First test is at 10 - 14 days after you begin treatment. You are looking for them to now be with the range recommended during dosage. It is different depending on which drug you end up choosing.

Second test is at the 30 day mark and if all remains well and you haven't had any dosage tweaks, then you can go to every 3 months, and then I think you can go to every 6 months.

Glynda has already given you the run down on the various drugs, but whichever one you choose to go with, make sure you learn everything you can about it and about the testing protocols. Knowledge is key to having successful treatment.

Sharlene and Molly Muffin

[mb935]

Thanks...

I got her test results - i believe this is what you were asking for.

Cortisol Sample 1 5.1 HIGH 1.0-5.0 mg/dL

Cortisol Sample 2 26.2 HIGH 8-17 mg/dL


THANK YOU SO MUCH Glynda!!! Thats exactly the info i needed and was leaning towards Vetoryl anyway - but really wanted info on the other drugs as well. SO YES.. you helped tremendously.

Thanks also Sharlene!! Im shocked my vet wouldnt WANT me in before 6 months and Im a bit nervous now that he doesnt know better.

So these are the ACTH tests again once she starts the Vetoryl???

Seriously, you all have made a very stressful situation (which will last awhile Im sure) MUCH easier to deal with. God Bless You!!!!!

[labblab]

Just to cut your vet some slack, I think the monitoring schedule for dogs being treated with Lysodren (once they are stabilized in the "maintenance" phase) has historically been 4-6 months rather than the 90-day rechecks now recommended for dogs treated with trilostane. Since that is the drug with which your vet is familiar, that might explain his response. But Lysodren users can correct me if I'm wrong about that.

And just to further complicate your decision, I'm not sure how your relative drug costs will play out for Lysodren v. trilostane. The daily trilostane cost for a dog weighing 90 pounds may be steeper than Lysodren would cost once you reach the maintenance stage, especially if you use brandname Vetoryl rather than a compounded substitute. This may be a factor you want to explore in a little more detail before making your final decision.

Marianne

[molly muffin]

Yes, these are the ACTH that you do for follow up.

You're looking for a range with vetroyl of not over 9.0 post if symptoms are controlled, and if symptoms aren't controlled you'll be looking to bring that post (2nd draw) down to under 5.0ug.

We're always here at any time to just chat about whats going on and/or answer any questions.

Sharlene and Molly Muffin

[mb935]

that confidence didnt last long... confused again after speaking to vet and I know at this point i just have to figure it out on my own.

What is compounding? He didnt know why id want to do that. just saw it here as a cheaper option

he said I could call walmart... but I dont think they carry meds for pets.

thanks.....

[frijole]

Compounding is done for small dogs who cannot tolerate the doses pills come in (need pills compounded into smaller doses). Please find out what dose your vet is considering and post that and your dogs weight. You want to start low vs high. Kim

[mb935]

Thanks.

All I know is he wants lysodren at 10 dollar a pill which will cost 300 total for the first 10 days.

He also wants her on pred... I don't want that as I've read NOTHING about pred combined w this drug.

I'm starting to get depressed at this point. Having large dogs is really expenaive....

[Renee]

Don't get down. The beginning stages of this disease are expensive, whether you have a big or a small dog. Once you can get stabilized, that cost will go down, hopefully.

I believe the cost of the vetoryl (name brand) is more expensive than lysodren, but I don't use lysodren, so I could be wrong. I use the 10mg vetoryl, at 3 pills per day. So I use up a box every 10 days.

Thanks for posting the ACTH results!

[molly muffin]

vetdxdirect.com, has lysodren at $6.49 per 500mg pill. which would be $194.70 for the first 10 days

This is what I assume is the loading phase, after which you would give 3 pills per week instead of per day. So eventually approximately 12 pills per month at $77.88 per month (using online pricing vs vet pricing)

With vetroyl, at 90lbs you'd start with a 60mg and a 30mg pills 1mg/1lb, which Dr.s Foster and Smith has
60mg 74.70 (30 pills) and 30mg 59.70 (30 pills) $134.40 for a month. This would be the continuing price If you don't need to increase or decrease the dosage.

We have had vets do the pred and lysodren. I don't know if this is a recommended way of loading though. I think Dr. Peterson has done this method. (one of our members on facebook page did this with Dr. Peterson). If I were to go this route I'd want a doctor like Dr. Peterson to be the one in charge of the case though.

I am not the most familiar with lysodren use, but Glynda and others have used it successfully. I don't think they gave prednisone at the same time though. You do usually have prednisone on hand in case you go too low and need a rescue dose.

Not sure how much that helps you, but it does give you a look at what kind of pricing you can get using an online pharmacy, not even using compounded but the name brand. I do think Walmart might carry lysodren.

Sharlene and Molly Muffin

[Harley PoMMom]

I am always leery when a vet wants to start a dog on Lysodren with prednisone. :eek: It is too hard to tell when a dog is loaded on Lysodren because the prednisone will mask the side effects.

Lysodren can be compounded (Mitotane) which is cheaper.

Please don't give up, we are here to help and support you and your girl. ;)

Hugs, Lori

[molly muffin]

That's my thoughts too Lori. The ACTH doesn't give you the Real result of what the adrenal glands are doing, and you can actually end up in Addisons crisis while your numbers are saying you are fine.

Sharlene and Molly Muffin

[lulusmom]

Your baby girl is a big girl at 90lbs and as I recall, she should be more like 65lbs. Her weight may be more advantageous if you choose to treat with Vetoryl. Researchers did a retrospective study with 70 dogs diagnosed with cushing's and the results indicate that dogs greater that 30kg may require smaller doses to control symptoms. Your girl's weight in pounds converts to 40.9kg so she definitely falls in the heavy weight category. Most specialist I follow recommend starting dose of 2mg/kg but Dr. Edward Feldman is even more conservative and prefers twice daily dosing at .5mg/kg. Since your girl is big and research shows that bigger dogs may need smaller doses, you might want to consider Dr. Feldman's preference. If so, your girl would get 20mg or 25mg twice daily. If you go with Dr. Mark Peterson's preference, you would start her on 40mg twice daily; however, again, with your girl being so large, you could drop that a bit to 30mg or 35mg twice daily and see how she does. Both of these specialist prefer twice daily dosing to achieve better control of cortisol throughout the day but you can achieve success with once daily dosing, which is what the manufacturer recommends.

I treated two cushdogs on once daily dosing, another on twice daily dosing and all three were perfectly controlled. Oddly enough all were very small, 4.5lbs, 6.5lbs,10lbs, and all three stabilized on 30mg per day. However, hindsight is 20/20 and if I had it to do over, I would have had my tiny girl, Lulu, on twice daily dosing. She had severe osteoporosis from years of thyroid meds and cushing's. I suspect it was more the thyroid meds but I can't help but wonder if twice daily dosing to control her cortisol throughout the day would have made a difference. If I had a cushdog today, I would go with twice daily dosing. It's not as convenient but for me, it's called sleep insurance.

As far as expense, compounded Trilostane, which is the active ingredient in Vetoryl, is the least costly but you need to only purchase through a trusted compounding pharmacy. My dogs had cushing's before Vetoryl was approved and their meds had to be compounded. I used Diamondback Drugs, as do many other members, and their prices are very good. Back then I paid about $87 for a three months supply of 30mg capsules. Once you and your vet decide on a dose, give them a call and get a price. Their contact information can be found at www.diamondbackdrugs.com.

If you decide you want to use brand name Vetoryl, some of the better prices can be found at http://search.californiapetpharmacy.com/search?query=vetoryl&x=0&y=0&vwcatalog=yhst-23671804106035 and
http://www.valleyvet.com/ct_detail.html?pgguid=057ae20c-efea-490b-b89e-562663425dfe

Keep in mind that with Lysodren, the initial cost for daily loading is going to be expensive but once you achieve loading, you would go to a weekly maintenance dose, usually equal to the daily loading dose. Your expense would drop greatly once on maintenance. If loading at the recommended dose of 50mg/kg, your girl would be taking 2 pills twice daily. So it would cost a bit over $20 a day. Once on maintenance, the cost would be less than $100 a month.

If you are considering going with Lysodren, I personally would never give prednisone concurrently. While most specialists have migrated to Vetoryl, Dr. Edward Feldman still chooses Lysodren as he knows it like the back of his hand. He has been treating his patients with Lysodren for more than 40 years. I believe he is the consummate expert on Lysodren. He teaches his students at UC Davis, and his veterinary conference audiences, to never give prednisone and lysodren together. He says they are the antithesis of each other and you give one or the other but never both. Prednisone masks the signs of loading so no matter how vigilant you are about watching for signs, you may not see them because Prednisone will keep the dog hungry and drinking and peeing buckets. If you decide on Lysodren, you can get it at Costco today for $5.56 per pill. 30 count would cost $166.81. If you buy 100 pills, it $517.71 or $5.17 per pill. Walmart carries Lysodren, as does Target, so you can call these stores and ask for a price check. You can also check with Diamondback Drug on a price for compounded Mitotane, which is the active ingredient in Lysodren.

Glynda

P.S. Both of these medications are fat soluble drugs and must be given with food.

[mb935]

Wow thanks again everyone!

The amount of time given is so selfless especially since I'm sure you've written this out many times before.

OK. No prednisone. Would i just take the script and not fill it.. or he must know she's not on it...?????

A lot more work to do tomorrow. Unfortunately I don't have much tome today.

I actually am looking forward to getting diamond treated! I want her as healthy as possible and hopefully somewhat back to herself.

She will lose weight too right ... this pot belly will decrease? So her meds can be decreased then??

Have a great day everyone!!!

Michele

[labblab]

You should always be up-front with your vet re: which medications you are giving or not giving. Especially if an emergency arises, it is critical that all facts have been known by your vet. Keep in mind that we are not vets ourselves, and there may always be some reasoning behind your vet's various treatment recommendations to which we're not privy. So it is better to discuss those recommendations fully, especially if you disagree with them or have concerns such as is the case in this situation.

As far as the prednisone, you will still want to have some on hand regardless of whether you treat with Lysodren or trilostane. In our opinion, not to be giving it alongside the other medication, but instead in the event that cortisol levels drop too far and the supplemental steroid is needed to at least temporarily offset the effects of overdosing.

Marianne

[frijole]

Michele

I agree with everything posted, particularly about using prednisone and lysodren together. You would still need to get the rx filled because you MUST have it on hand to give in case of emergencies. You should also come clean with the vet and tell him/her you will NOT use them at the same time for all of the reasons we have cited. Kim

[mb935]

OK.. I guess that was stupid to even consider...

HOPEFULLY that's what he meant... not that she'd be on both but he was just prescribing to have on hand. So I WILL discuss that w him
for sure and get it..

Thankfully too this is a 24 hour office so God forbid something happen I have that option to run her over.

It sounded like he said twice he:s had 4 years experience w this - even my bf heard that on speaker phone. I'm really assuming he said 40 cause 4 is not impressive and kind of scary . I read his profile and he has been in practice since the 70s though.

Thanks

[My sweet Ginger]

Hi Michele,
If you decide to go with Lysodren, please DO NOT use prednisone concurrently no matter what your vet tells you. I was pre k9cushings forum and totally uneducated and my vet's knowledge on Cushing's disease seems very questionable at this point. I have a pup who now is being treated for Addison's and it's becoming clearer each day that the concurrent use of prednisone was the culprit in this long and foggy road. I just read your entire thread and am worried for you and your baby because to me your vet seems lacking experience in this.

[mb935]

I'm so sorry to hear that. All we want to do is help our pets and we assume these doctors "know everything" and its horrible especially when they suffer because of their mistakes

I just lost an awesome cat.. was prepared for the worst but was told by another vet he'd be fine after a blood test ... just Ibd. Was so thrilled... then I took him 30 days later since he was losing weight to this doctor and was told cancer. I lost Max 9 days later. I'm still very upset for various reasons. He was only about 6.
My neighbor and I both have been to every vet in our area... this place seems to be best.

Sorry to change subjects so abruptly. But has anyone encountered chick peas in the dogs poop.... when they've never eaten anyikng even close?

I asked several vets and no one has a clue and isn't too concerned. She can't get into anything that I wouldn't be aware of and has occurred now and then for a few months.

[mb935]

Dr does want small dose of pred w lysodern for 10 days then continuing few times a week.
he said to make sure she doesn't go in opposite direction

How do I go about telling him I'm not doing that?

[molly muffin]

Hello, most of the ones here who have personal experience with lysodren, would not give it at the same time as giving prednisone.
I guess if it were me, I would say that I am not comfortable with giving a steroid to raise cortisol at the same time as a medicine to erode the adrenal glands and prevent them from making cortisol.
That I understand the need to have a rescue dose on hand, but that the risk of a problem being covered up by the prednison is just too great to risk.
I'd say that I have been doing some reading on dosage protocols of lysodren.

http://www.petplace.com/drug-library/mitotane-lysodren-o-p-ddd/page1.aspx

http://packageinserts.bms.com/pi/pi_lysodren.pdf

There is a pdf you can download on this page:

http://www.k9cushings.com/forum/showpost.php?p=110507&postcount=6
(at the bottom)

Hope that helps.
This is just what I would do. The decision will lay finally in your hands.
You want to work with your vet and make sure that the vet is going to be available 24/7, provide you with a phone number to reach him during loading.
Some of the others who have first hand knowledge will be by to comment too I'm sure.
Sharlene and molly muffin

[molly muffin]

Maybe it would help to read through Gingers thread:

http://www.k9cushings.com/forum/showthread.php?t=5801

In the end, no matter what you decide to do, knowledge is your greatest asset.

Sharlene and Molly Muffin

[labblab]

For the reasons others have already given, yes, I still think it is a problem to give prednisone (even a small dose) alongside the Lysodren loading. And I really do not understand why you would continue to give prednisone on an ongoing basis after having shifted to the maintenance phase. That really makes no sense at all to me -- to increase the cortisol at the same time you are trying to keep it stabilized at a lower level, and to risk making your dog dependent upon the supplemental steroid. :confused:

Beyond that, I am also wondering why your vet seems to be so stuck on this 10-day number for the load. I am sincerely hoping he has explained that there is no set time period within which any individual dog will be loaded. One dog might take 10 days, but another dog might take only 3 days to load. This is why the owner has to be so vigilant as far as watching for the subtle behavioral changes that signal that no more Lysodren should be given without first performing a monitoring ACTH test (and this is also why we are worried that giving concurrent prednisone will mask those critical signs).

What instructions has your vet given you thus far about the loading period/protocol?

Marianne

[mb935]

Uh... he has given me no instructions. I didn't even know I was monitoring her for signs until the last few days of reading.

He is just calling in the script tomorrow.... so I don't think he's even has plans to contact me until the meds are finished. ( and he's the best in my area)

So I'm looking for her to stop eating and not drink as much... how soon does she need to get into he vet for the ACTH test?

Now I feel awkward at telling him I'm not using pred. I don't know when to do that even.

But I can't wait any longer either... she just stood in the living room and peer this am. (An hour after going outside) and she just looks worse...

Thanks

[molly muffin]

Wow, he is the best in your area. I really don't even know what to say to that.

Has he said how many dogs he has successfully treated in this manner? Has he had any adverse experiences with using lysodren, lost any dogs, etc. I would just be super concerned.
Yes it does sound like she needs treatment right away, but this is scary.

What dosage is he calling in? You will have to very, very vigilant. At the very first sign, even looking up for her food bowl when she wouldn't normally, or drinking a bit less water, can be a sign of loading. Stop immediately at that point, because lysodren continues to work actively for 48 hours after your last dose. Schedule the ACTH for 48 hours after the last dose.

Sharlene and molly muffin

[Harley PoMMom]

I am sure your girl's vet has heard of the renown Cushing's expert, Dr. Feldman. Dr Feldman has written many articles and Veterinary books regarding canine Cushing's, here's a quote from Dr Feldman:
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.



This excerpt can be found from the chapter on Hyperadrenocorticism in the Textbook of Veterinary Internal Medicine, S. J. Ettinger and E. C. Feldman, editors. 1995: http://web.archive.org/web/20061015185717/http://www.io.com/~lolawson/cushings/articles/feldman-all.pdf

We have many excellent articles in our Resource Thread regarding Cushing's, here's some handy links to a couple of them:
Lysodren loading Instructions and related tips (http://www.k9cushings.com/forum/showthread.php?t=181)

Links to Cushings Websites (especially helpful for new members!) (http://www.k9cushings.com/forum/showthread.php?t=180)

Hugs, Lori

[labblab]

Uh... he has given me no instructions. I didn't even know I was monitoring her for signs until the last few days of reading.

He is just calling in the script tomorrow.... so I don't think he's even has plans to contact me until the meds are finished. ( and he's the best in my area)

OK, now I am seriously frightened about your vet. I surely realize how anxious you are to start treatment, but your vet will honestly be placing your dog's life at risk if he indeed simply tells you to administer Lysodren for ten days straight without any monitoring or testing instructions. If I were you, before I picked up and paid for that Lysodren prescription, I would ask the vet what his specific treatment and ACTH testing instructions are going to be once you do start giving the drug. If he simply says, "Give the Lysodren for ten days straight and then shift to maintenance," I urge you to stop and reconsider your options because this is neither a safe nor reasonable standard of care.

Marianne

[Renee]

I just want to stop in and give you some support and encouragement.

Your vet may be 'the best' in the area -- but, clearly, he is quite lacking in some aspects. You should try and get past feeling uncomfortable in confronting him, and just tell him your concerns. If you cannot establish that now, then I fear you won't be able to, which could negatively impact the care you pup receives.

It's not always about finding the best vet based on experience or knowledge (although this is usually the best route). My own vet is admittedly not terribly experienced with cushings. But, if you read my thread, you'll see she has something your vet does not have: willingness to admit what she does not know and openness to working as a team, together.

[StarDeb55]

I have not posted to you before, but have been following along. I will repeat what the others have told you that I am seriously frightened by your vet's lack of knowledge for the proper protocol when using lysodren. You NEVER, EVER give a pup lyso for 10 days straight, then go to maintenance without any ACTH levels to monitor where the cortisol is at & is the cortisol within therapeutic range. Normal protocol is to give the lysodren twice daily, watching for signs of loading which you have already indicated that you have read about. Once you think your pup may be loaded, you want to try to schedule an ACTH for about 48 hours after the last dose. Lysodren is a long acting drug, reaching its peak at about 48 hours. If the ACTH indicates that the cortisol is within therapeutic range, 1-5 mg/dl, then you may start maintenance. If not within range, you simply continue loading. Usually protocol also states that you load for no more than 8 days. At day 8, if there are no signs of loading, you have a ACTH done to see where you are, continuing loading if not within range.


Concurrent use of prednisone may mask the signs of loading, & can put your pup at risk of going to low on the cortisol. We have seen way too many cases in this group where a vet wants to use prednisone when loading, & it's usually a clear indication of the vet's lack of experience with the drug, & Cushing's in general.

I've successfully treated 2 pups with lysodren, so I really do know how nerve wracking loading can be. I, also, know that it's very difficult to question/challenge your vet about what his instructions are, but keep in mind that you are your baby's only voice & advocate. When I was loading my 2nd boy, his care was being managed by a specialist who had taken care of my 1st boy, & I had thought the world of her. I had to reload this little guy as she thought a a cortisol level of 11 was acceptable because his symptoms had improved. This group warned me that 11 was way too high, it would not hold, & I would end up re-loading him. Sure enough within 2 weeks, his symptoms came roaring back, & I had to reload him. I was already unhappy with this specialist because of all of the above, but I got into a serious disagreement with her about when to stop the reload. I had to fire her, & move my 2nd boy's care back to my general practice vet. Confronting this specialist was not easy, but I knew I had to do it for my little one's sake, & that I had to make the best decision possible for him.

I'm really not trying to trash your vet. I'm just very concerned about the health & safety of your baby, if this vet continues to manage his Cushing's treatment.

Debbie

[doxiesrock912]

Cushings and its affects are individualized. There is no "standard" protocol that fits every dog. This is why monitoring frequently, especially when you first start treatment is imperative.

No one here is trying to scare you, but too many of us have had "the best" or among the best vets only to find that they don't know much about Cushings at all.

Because every dog's situation is unique, this makes treatment difficult because you need a vet who is experienced with treating Cushings regardless of their overall veterinary knowledge or experience.

We went through 3 vets, one whom we've used since Daisy was 6 weeks old, only to find out that none of them was experienced with Cushings treatment. The only reason that I was able to figure this out was by using the resources on this forum and studying the links in the helpful resources section and I was able to recognize that things were not being done correctly.

For the health and well being of your dog, you must education yourself and question what your vet is doing because it is clear from what you've said that he is reading a text or following instructions on a pamphlet. If your vet is offended, then you're going to the wrong one.

We don't use any of the three vets that we go to for Daisy's Cushings care. We see an small animal internal medicine specialist (IMS) and even she is wiling to listen to ideas that I have, many have come from this forum. She is not offended.

Daisy's general vet and the IMS share records so that all of Daisy's needs are met.
Proper Cushings treatment comes from knowledge and experience. You need both for it to be effective and I would honestly find a specialist in your area for this. http://www.acvim.org/PetOwners.aspx

Please don't take a chance because doing so could easily have dire consequences for your dog.

[My sweet Ginger]

Hi Michele,
My name is Song and I'm Ginger's mom. I'm not a vet and have no experience unlike a lot of other beautiful minded moms and dads on this forum. I only have one experience from what my Ginger and I have gone through since late Sept. but I have a few things to tell you regarding Lysodren loading and vets.
The very first thing I'd like to tell you is above all else it's all about Diamond and no one else from here on and frankly I'm so scared for her right now.
That's because your vet sounds so much like my vet who I considered a very nice and wonderful vet with 17 yrs of experience and have treated many cush pups. She gave me 6days supply of Lysodren and instructed me to also give Ginger prednisone concurrently when I expressed my worry about bad reactions. We came home with no written instructions and no phone # for that weekend in case and she also said no dog ever loaded sooner than 5 days when I asked what if she loads sooner. She also told many times the prednisone dosage is so minor it won't skew ACTH results. It not only skewed the results but also skewed her clinical signs, too! Long story short, Ginger went through 2 more mini loads because of prednisone and suffered so much for the next two months while trying to figure out why she was still sick with a set of perfect pre and post ACTH numbers (2.9) and she made all the experts on here scratching their heads. After two IMSs she is now being treated for Addison's disease because her adrenal glands are destroyed by Lysodren and needs prednisone everyday to survive.
Right after the 2nd loading I had to go against my vet's order and went to an IMS and I must tell you it was EXTREMELY hard because she is the professional but I couldn't put Ginger's life at risk. The risk of not following our vet's order outweighed the risk of following it and I'm so glad I didn't. I can always get a new vet but there is only one Ginger to me. Don't be afraid telling him about not giving her prednisone. Just tell him it goes against everything you've researched and from friends who've had experienced this first hand that you are following your gut and won't risk Diamond's life.

[mb935]

Thanks everyone!!

Hes had his license for 40 years. I know that means nothing. But when asked he said he's had a lot of experience with this disease and treating.

I just emailed him telling him that although I respect his views I am not using pred with the lysodren.

I also asked a few questions like what signs am I looking for during this loading phase and whether that time could vary (I KNOW from you guys- I just want his answer).

My question now is... can i just use him for the meds and the tests. I mean if i know how to go about this loading phase and what to watch for... the tests results are what they are. If i had to just come here and ask you guys. I know this may sound stupid... but if i have no better options for a vet..

SO..... yes because this is all about Diamond's health Ill see how he responds. I just have been through so much going from vet to vet that Im worn out and beyond frustrated. They couldnt handle every day issues. My dad spent 1000s for his dog who died the day after her unneeded surgery. She was 15 and he wanted to let her pass peacefully and this local vet wouldnt allow it (made my dad feel guilty) and like most people my dad trusted him and in return she died a painful death.

I just totally dislike vets!!! (sorry had to vent) THANKS!!!

And thank you Song for sharing. Im so very sorry you and Ginger had to go through that!!

[mb935]

So Dr agreed to treat diamond without pred. In fact he's going to leave some pred for me at the office instead of prescribing it. ????

My question (this time) is diamond eats out of a ball to slow her down and get her moving. Should I feed from a dish while on lysodren to monitor how she eats... usually devoring it???

Also she is pretty lazy now so when she has finished loading then she should be worse?

Thanks

[Harley PoMMom]

So relieved to hear that the prednsione will not be used with the Lysodren...whew~

If this were me, I would not change anything right now concerning her meals because you know Diamond's behavior and she may act differently eating out of a dish in which she is not accustomed to.

Hopefully her activity level will pick up after she is on a stabilized maintenace regimen, but you just never know!

Just a reminder, there are no silly questions and if there is anything on your mind, just ask us, ok? You're doing a great job!!

Hugs, Lori

[labblab]

What did he tell you about his approach to ACTH testing and the possibility that Diamond will load in less than ten days?

Marianne

[mb935]

He wants her on the med for 5.days now.. then I'm scheduling the ACTH 2 days later..

I know I'm watching for when she's ready not necessary at 5 days..

I believe he's still giving me the 30 pills. They will be ready to pick up tomorrow afternoon. He didn't call them in this am as promised. :(

Thanks

[Harley PoMMom]

Don't remember if this was posted to you or not :eek: but here is a link to info regarding Lysodren, please feel free to print anything out: Lysodren loading Instructions and related tips (http://www.k9cushings.com/forum/showthread.php?t=181)

And remember we are here too!! ;)

[labblab]

Be sure and tell us what dose you've been told to use, OK?

Marianne

[mb935]

Thanks. I had skimmed that awhile ago. But yes... extremely helpful and have that saved.

Ill let u know doseage Picking it up today

[mb935]

Gave me 500 mg 15 pills becuaee to him shell be ready in 5 days..

I.5 tablets twice a day.

Doesn't say with food

80 dollars for 15 pills at cvs

[Harley PoMMom]

Can you tell us how much Diamond weighs? The dose of Lysodren is calculated from a dog's weight.

[mb935]

I believe the exact weight is 88

Also tomorrow is a rare day when I'm gone 9 hours. OK to start her tomorrow morning or sat when I'm home all day

Thanks

[Harley PoMMom]

Lysodren is a fat-soluble drug and must be given with some fat to be absorbed properly, you can hide the pills in a blob of peanut butter or cream cheese.

You feed that dog a meal first then give the wrapped lysodren pill, you want to make sure there are no signs of her being loaded before you give her the Lysodren, any pause in feeding, even slight means no Lysodren and an ACTH stim test needs to scheduled for 2 days later.

Even though I think she would be ok, it is always a good idea if one can be home all day while the dog is being loaded.

Lysodren is usually given at 50mg/kg of a dog's weight, for Diamonds weight of 88 lbs, her dose of Lysodren equals 37.5mg...88 lbs/2.2=40 kg... I see her Lysodren pills are 500mg each, so 1.5 pills = 750mg X 2 (for twice a day)=1500mg...1500mg / 40 kg = 37.5 mg....hope I don't confuse you, I just wanted you to see how I came up with her dose, ok?

Let us know how things are going, ok? We are here for you both. ;)

[labblab]

So in other words, Diamond's dose is lower than is usually recommended, is that right, Lori? For you folks more experienced with Lysodren, what do you think this will mean in terms of the timing or success of the loading period?

Marianne

[Harley PoMMom]

Yes, Diamond's Lysodren dose is lower than what is usually given, so it may take her more than 5 days to load BUT large dogs can load faster than small ones.

[mb935]

Thanks. I'm starting tomorrow so I can be here.

The question with the next ACTH test... will she need to fast for that? Just need to know if I have to schedule really early or if its OK for later in day

Thanks

[Harley PoMMom]

Fasting is not needed for monitoring ACTH stimulation test. ;) Sometimes dogs have Hyperlipidemia, which means that there are elevated amounts of fat (lipids) in a dog's blood, when this occurs, usually a light meal would be adequate.

Hugs, Lori

[mb935]

So I got the pred... however (and God forbid she needs it). I dont know how much to give her....

again shes about 88 lbs and I was given 20 pills at 5mg.

ALSO... i know to look for her to stop eating and drinking less, being lethargic of signs to stop the lysodren. (maybe vomiting or diarrhea)

but what would be the signs of needing pred???

Im sorry.... i try looking this stuff up myself but I so dont want to mess this up. (i know you said to ask anything and i appreciate that... but i still feel bad... and lazy) :)

[goldengirl88]

What mg is the prednisone? They usually give the mg where you can give them 1 tablet, don't have mine handy to check. When youi see signs of low cortisol like lethargy, vomiting, diarrhea, weakness and can't get up, won't eat. Blessings
Patti

[labblab]

The formula for calculating a rescue dose of prednisone is 0.25 mg. per kilogram, and a kilogram equals 2.2 pounds. So 88 pounds equals 40 kilograms. Multiply that by 0.25 and you end up with 10 mg. of prednisone daily (or two of your pills).

You would not be giving the prednisone unless your dog became very ill: extreme lethargy, vomiting, and/or diarrhea. And I am guessing you'll be talking to us beforehand if things are going badly. ;)

Just remember, the point of watching for even subtle changes in appetite and thirst is so that you will stop the Lysodren before your dog becomes visibly ill. If there is any doubt, you can always temporarily halt the Lysodren and start back up again -- better to be safe than sorry. And this is also why the recommendation is to wait to give the pill until after you've seen how your dog has consumed a meal and not give it before the meal. If you've given the pill and then your dog hesitates about eating, you're already too late -- you can't take that pill back again.

Marianne

[mb935]

Thanks. I feel very well prepared - all because of you guys.

[frijole]

One more little tidbit - when in doubt don't give the lysodren because it keeps working for 48 hours. Kim

[mb935]

Thanks...
No signs at all... more hungry now

Today is third day and only have meds for five.

Guess ill get refilled tomorrow just in case...

(I replied 3 times... phone didn't send.. hope they don't end up posting)

[mb935]

Hi.

So just wondering if I should be concerned diamond is actually devouring food and drinking more now.

Tomorrow is day five.

Thanks

[mb935]

She's on day seven and not slowing down.... worse

[labblab]

I'm hoping some of our Lysodren users will soon be stopping by with their thoughts. But as we noted before you started loading, the dose your vet prescribed is lower than the normal protocol (you are dosing at 37 mg./kg. rather than at 50 mg./kg.). So our fear (which seems to be realized :() was that this would lengthen the loading period. What I don't know and what I'm hoping others can advise is whether they think you will ever achieve a full load at this lower dosing level, or instead whether you will need to talk to your vet about increasing the dose.

Marianne

[mb935]

OK.. I didn't know the lower dose meant she wouldn't load at all... just woykd take longer.

he's clueless to any of this and wanted her tested after 5 days period.

So I could have wasted $200 for nothing!!!!!!

[mb935]

Should I give her 2 pills instead of 1.5?

Thanks

[labblab]

Let's wait and get some feedback from other folks here. I know some stuff about Lysodren, but my personal experience was with trilostane. I don't know whether it would first be advisable to go ahead and perform an ACTH in order to see exactly what effect this dose is having prior to increasing (which may have been your vet's plan if I am charitable enough to think that he actually does have a plan...). I would like to hear what other experienced Lysodren users think.

Marianne

[addy]

I cant tell you what to do about lysodren but I can suggest please do not increase her loading dose without comfirming with your vet or someone who has major experience with this drug.

Are you giving the pill with some fatty food? Fatty food helps with absorbtion, maybe wrap it in a piece of cheese?

[My sweet Ginger]

Hi, I remember reading it somewhere that patients never should be sent home more than 8 days of supply with Lysodren when they first load and then perform an ACTH test and evaluate. But that's with 50mg/kg instead of 37mg. I also remember your vet first wanted to load her for 10 days initially with concurrent use of prednisone (am I correct?) and am wondering whether that is his normal cookie cutter method to treat Cushings probably with the dosage of 37mg or close to it because average loading is achieved between 5-8 days on 50mg. So if that's his usual plan with some success probably Diamond may get loaded in 10 days more or less. I do think she will achieve loading eventually tho even with lower than recommended doses for loading. In my opinion it will just take longer. What I'd like to warn you from my experience with my Ginger is that be careful with mini loadings if you come to that because that's where Ginger got overdosed and her adrenal glands are permanently destroyed it seems like.:eek: Another thing, try to do an ACTH stim test as close to 48hr mark as possible. We did ours 36hrs after her last dose and that's not what's recommended. As to when to perform her first ACTH test? I'm thinking soon but I will leave that to our experts.

[StarDeb55]

Even though your vet seems to be fairly clueless about the correct protocol for using lysodren, I absolutely would not increase the loading dose without running the increase by your vet first. Your pup should eventually load on the lower dose, but it's going to take longer, probably require more ACTH tests, so you're going to have to make a decision about talking to the vet. I will tell you that with my second cushpup, at one point I did make an adjustment in his lysodren dose on the fly without consulting my vet first. My vet had loads of experience with Cushing's, so it's not that I didn't trust him. I just felt that I had already been through this once, & knew what I was doing. My vet was not happy with me, & insisted that I talk to him first before I did this, again.

I see you mentioned this morning that an ACTH has been done? Do you have those results back yet?

Debbie

[mb935]

Thanks

The initial ACTH test was done a few weeks ago.

Cortisol Sample 1 5.1 HIGH 1.0-5.0 mg/dL

Cortisol Sample 2 26.2 HIGH 8-17 mg/dL

Wondering when to get second at this point. I certainly don't have an extra 200 or want to put diamond thru two tests (she has bad vet anxiety)

So I guess I feel better knowing she will load but u do think a test is needed if she doesnt load soon?

Being more hungry doesn't mean anything?

[lulusmom]

Based on what you have told us thus far, it does sound as though your vet is an epic failure in properly administering Lysodren and counseling you on what you need to do. It's water under the bridge at this point but your vet should have started calling you to check on your dogs progress on day two and every day thereafter until you see signs of loading or until you are out of pills. Lysodren is a very serious drug and it is a vet's responsibility to make that clear to his clients.

The average loading time administering 50mg/kg is 5 to 8 days. Clients should be given no more than an 8 day supply of pills. There are a few reasons why dogs don't have a good response to Lysodren:

1. The dog has been misdiagnosed (doesn't have cushing's)
It would have been optimum had you posted the results of all testing that was done. i.e. blood chemistry, urinalysis and the actual abdominal ultrasound interpretation; however, I feel better knowing that your dog does have textbook symptoms and an acth stim test result consistent with cushing's. I realize we are already in the loading stage but it would still be helpful if you could round up copies of all that testing and post the results for us. We need only see the highs and lows, with normal reference ranges on the blood chemistry. Your only comment on the ultrasound was that organs were enlarged. I am assuming that means both adrenal glands as well as the liver was enlarged. These organ abnormalities are common in cushing's. If the radiologists sees abnormalities consistent with cushing's, s/he will include this finding in the interpretation and tell the vet if those findings are consistent with pituitary disease or an adrenal tumor. Did your vet tell you which form of the disease your dog has?

2. The drug is not being absorbed into the GI tract
Lysodren is a fat soluble drug and must be given with food. Your pup is overweight and I suspect you have her on a low fat diet. If so, that could be a problem as well. I would wrap my pups' pill in cream cheese after they finished their meal to make sure it was properly absorbed. Can you tell me what food you are feeding and how you are administering the Lysodren?

3. The dose is too low
Every veterinary textbook or resource paper you read on loading with Lysodren shows a loading range from 25mg/kg to 50mg/kg so your vet prescribed a dose that falls within that range. Unfortunately, dogs that don't load at the maximum dose almost always experience an extending loading phase, which usually increases the cost for pet owners substantially as more pills and acth stim tests are needed.

I know you are frazzled...been there done that more than a few times so I'm going to ask that you try to calm your nerves and know that we'll get you both through this. At this point in time, I personally would not advise that you change the dose until after you have the acth stim test. One of my pups never showed signs of loading and his cortisol was less than 1 so you never know. However, we'll know a lot more if you can please answer all of my questions, which will help all of us get a much better picture of your dog's medical history. We're not vets but many k9c members understand the disease and the treatments much better than a good number of gp vets, and I think I can safely say that the good number includes your vet.

Glynda

[mb935]

Thank you glynda!

Diamond is on whole earth farms dry food senior... (Merrick) 4 cups a day.
And veggies as treats.

I give her the pill w peanut butter.

My vet has made zero attempts to contact me for which I'm pretty pissed about. I was told after the ultrasound he would not treat unless she was 100% cushing's. And yes it was her liver that is enlarged.

I actually do not know what type she has... my fault on that.

So tommorro is day 8 would u advise finishing the 2 doseages (if still no signs) and schedulong ACTH on monday?

[mb935]

Info on food if needed

Crude Protein (Not Less Than) 24.0% Crude Fat (Not Less Than) 10.0% Crude Fiber (Not More Than) 3.0% Moisture (Not More Than) 11.0%

Calorie Content: 3395 kcal/kg (calculated) – One pound provides 1541 kcal of metabolizable energy (calculated). One cup (100 grams) provides 342 calories (Caloric content calculated using Modified Atwater Method)

[lulusmom]

The fat content in the food is lower than most at a bit over 11% on a dry matter basis. Peanut butter has a lot of vegetable oil in it so that's good but make sure you give more than a scant coating on the pill. Some vets, like Dr. Edward Feldman, don't give more than 8 days worth of pills but he also prescribes the maximum dose. Other vets will give enough pills for 10 days. I normally wouldn't advise continuing loading past 8 days but since your pup is on a lower dose of Lysodren, it may be okay to give the last two pills....but only if you don't see any change at all in eating or drinking. I think others have already mentioned that a change can be as subtle as lifting their head out of the bowl before they've finished licking it clean. Lysodren has a cumulative effect for at least 48 hours and you can't take a dose back so make absolutely sure. It is also best to have a stim test done 48 hours after the last dose so schedule your stim test accordingly. Please don't forget to get copies of all the testing okay?

[mb935]

Just an added detail.. diamond is peeing less volume wise but drinking more in volume. If I wrote that correctly

I noticed this just today.. my bf said he noticed yesterday.

Thanks...

[Harley PoMMom]

Does it seem that she is straining when urinating? Also, is she trying to urinate a lot? Any odor to her urine?

[mb935]

No seems fine... not even asking to go out. She has had bladder infections in past which is where I think you're going with your questions ...

Didn't even think of that.. so focused on signs of loading

Thanks

[Harley PoMMom]

No seems fine... not even asking to go out. She has had bladder infections in past which is where I think you're going with your questions ...



Yep, unfortunately dog's with Cushing's are prone to bladder/kidney infections. :eek::(

[mb935]

Good morning...

Well she kins of paused but definitely slowed down a bit the entire feeding.

Not sure how soon I can get reaponses on whether one more pill is enough to hurt her or just assume this slowing down is enough to say she's done.

Meaning shed need her test Sunday night right. It's 24 hour hospiral so no worry there

She drank a lot but I read that may continue for awhile correct

Thanks

[labblab]

You already know I'm not an expert :o, but I've always heard people say it's better to be safe than sorry -- if in doubt withhold the pill rather than give it. You can always resume dosing if you need to after the testing, but you can't take a pill back after you've given it. Since you've seen a noticeable change in appetite, I would not give another pill this morning if it were my dog.

Marianne

[My sweet Ginger]

No more Lysodren. What you described sounds like more than ' a subtle change ' to me when it reads ' watch for any subtle change ' so I'd schedule an ACTH stim test in Sun afternoon.
I totally agree with Marianne that it's always better to be safe than sorry. You are doing an excellent job with little or no help from your own vet.:);)

[mb935]

Yeah, last night I literally prayed for THE sign soon because I was really getting worried. :) (really with my vet and lack of knowledge on all this)

I fed her again a little bit so my bf could give his opinion and he too felt she wasnt as ravenous and really was normal about it. She did want more though..

My only concern is while on meds the last week she seemed more crazy with eating and now is back to normal of just being hungry all the time - so I hope that isnt a false sign.

So sunday afternoon? I fed her 5 last night. Does the testing have to be right on the mark?

THANKS!!!

[My sweet Ginger]

That'd be perfect if you can make it right on the mark:p but I figure as close to it as you can manage it would be fine more or less but let's wait for more experienced opinions. My vet did it 36hrs after even if I wanted to bring Ginger in 48 hrs after. Go figure. :mad:

[Harley PoMMom]

Hi Michele,

I agree with Song, Lysodren has a cumulative effect for at least 48 hours so if there is any question in your mind about a change in Diamond, quit dosing.....you can't take it back. And, although it is best to have a stim test done 48 hours after the last dose of Lysodren sometimes that can't be done so try to schedule the stim test appointment as close to that 48 hour window as possible.

Keep us updated, please! ;)

Hugs, Lori

[mb935]

in the process of now arguing with a 24 hour vet that she's not waiting till monday morning for this test.

LOVE IT

Update...
im taking her in tomorrow after 2 vets said they never heard of waiting 48 hours. Of course to say I read it everywhere on the internet wasnt going to help.... I just said I would not be comfortable waiting another 16 hours getting her in.

But even if it were about waiting AT LEAST 48 hours... I work all day monday and Im not leaving her there to have horrible anxiety.

[My sweet Ginger]

I'm glad you are taking her in tomorrow afternoon especially if Monday is not a good day because of your work schedule. I figure that some of after hour ER vets are probably not very knowledgeable on Cushing's. They may charge you more tho for after hr services, you know.
Every time I brought my baby home right after the injection with our GP and bring her back after one hr to reduce her stress as much as possible since we live only 2 miles away. If that wasn't an option for us I'd have stayed with her at the vet in my car with her or walk or something and not leave her alone in one of those cages as she gets really anxious and pants like crazy the whole time.
I pray she will get good numbers so you and Diamond will have a smooth sail from here on. Good luck. Song.

[Harley PoMMom]

im taking her in tomorrow after 2 vets said they never heard of waiting 48 hours.

This statement from those vets has me worried. Lysodren and its use for treatment for canine Cushing's has been around for decades, the protocols for its use in dogs with Cushing's have not changed, as far as I know. When monitoring a dog being treated with Lysodren waiting 48 hours after the last dose is given is pretty well known.

If that 48 hour window just can not be done, than a vet/IMS, who is knowledgeable about Lysodren and experienced in the treatment protocols, will be able to make a sound judgement of the results from an ACTH stimulation test that is done sooner that 48 hours.

In other words, if the ACTH stim test is done sooner than 48 hours Diamond's cortisol will be higher at that time because Lysodren continues to work for 48 hours. Am I making any sense? Gosh I hope I'm not confusing you more. :eek:

[mb935]

I totally understand.... cant say my vet would though.

I really cant handle much more of this stress from these vets though!! That's another reason why I really need this test to have a good outcome so we can move on w/ treatment.

Im so glad i stopped the meds this am. She just took a drink of water lasting like 2 seconds. She has not done that in... forever!!!


Again thank you SO much from both of us!!!

[mb935]

Hi.

Just checking diamond is very lethargic today

She is off meds and had test yesterday (acth(

Blood was taken from both back legs and she is limping although she had trouble getting in car yesterday and even yelped.

I will call vet but want to know if any of thesr issues coyld be cushings or lysodren usage from Friday night

Thanks

[labblab]

The lethargy could be resulting from a cortisol level that continued to drop through the weekend. Is Diamond eating and drinking OK? If not, this may be the time when you need to give her some prednisone. Please update us through the evening as to how she is doing so as to help make that decision.

When did the vet say you'd have the test results back?

Marianne

[mb935]

I wondered about pred....

In fact i was responding to u when vet called and was told to give her 5 milligrams of pred.

If she hurt herself it would help with the inflammation also

She was actually reluctant to eat at first but did f.inish her food

The results will be back maybe tomorrow

Thanks

[labblab]

The formula for calculating a rescue dose of prednisone is 0.25 mg. per kilogram, and a kilogram equals 2.2 pounds. So 88 pounds equals 40 kilograms. Multiply that by 0.25 and you end up with 10 mg. of prednisone daily (or two of your pills).
I'm glad they told you to give her some prednisone, but I think they are being conservative in the dose. If she doesn't perk up with the 5 mg., I'd call the vet back and confirm if it would be OK to give her another 5 mg. tablet in addition. If not, you can even quote the formula for calculating a rescue dose, and give them the opportunity to explain why the lower dose is better. ;)

[mb935]

I was told to call in morning... unless she gets worse tonight.

So maybe ill call later w what u suggested

Is this a dangerous situation when pred is needed?

I will say not only did she wait at bowl... twice i caught her staring into space. Thought i read something about that before.....

But again... did she just hurt herself and is in pain.. i dont see anything on legs and she let me touch her w no issues.

Thanks

[labblab]

If Diamond were to need replacement prednisone on a long-term basis, probably you would not want to exceed more than 5mg. daily. But right now, we are talking about "rescuing" her from a sudden drop in cortisol that is making her feel ill. So she might feel better with a higher dose. Since the vet is a 24-hour service, though, you can give her some more time this evening and see if she perks up. If she doesn't or if she worsens, I would call them back and ask about giving a second pill.

This is most likely just a temporary issue as she adjusts to the lowering of her cortisol, and will improve as her cortisol level naturally rebounds. But we will know more when you get those test results.

[mb935]

ok... thanks

we gave her some more to eat... left for 30 minutes and she didnt touch it!!!

[lulusmom]

Please call the vet and tell them that Diamond is not eating and that you want to give another 5mg prednisone. If they give you any grief, ask them if they can guarantee you that Diamond's cortisol is not too low.

[mb935]

just got the ok for 5 more mg. THANKS

[lulusmom]

GOOD!! :D:D:D I'm so glad you took charge and called the vet. Hopefully Diamond will start to feel better. Please keep us posted.

[mb935]

Since im not sure if the vet was initially going to suggest rhe pred.... (i mentioned it first after coming here).... im going to totally credit you for helping diamond. :)

She didnt wake me up today and was difficult getting off couch BUT shes no longer limping and just ate very well. Seems much better now

But just to know in advance.... may those signs come back today or another ?

Thanks

[labblab]

Yes, depending upon her cortisol production, she may continue to need daily prednisone supplementation for a while. We will be really anxious to see the results of that ACTH test, because that will help guide the treatment moving forward.

Just to let you know, cortisol is not the only piece of the picture. If Diamond's adrenal function has been oversuppressed by the Lysodren, her aldosterone production may also be compromised. This is the adrenal hormone that controls the balance of potassium and sodium in the body ("electrolytes"). In that event, she would need a second drug in addition to the prednisone in order to compensate. If she remains "off" today even after giving more prednisone, she probably needs a test of her basic blood chemistries to check this. As always, consult you vet before giving her anything. But the effect of the prednisone wears off after 24 hours, so she may need more again today.

[mb935]

Hi...

Just wondering how long diamond can wait hefore any action is taken?

Test was sunday she seems fine. Just tired and sleeping.

I called for results this am.. not sure the desk girls are any good at getting messages out

ill wait a bit longer. Vet even said results can take longer than 2 days .m.
Thanks

[Harley PoMMom]

How is her appetite? Is she drinking normally? Any diarrhea?

[mb935]

I just fed her a little just to see. She snubbed it.. then went back when she got nothing better and finished it. But normally shed eat everything and fast

Still drinking a lot
No other issues other than maybe being sleepy

Thanks

[Harley PoMMom]

Is she still getting the prednisone? If her eating is off the prednisone will help her gain an appetite and perk her up.

Usually it takes no more than a couple of days to get ACTH stim results back, if those results aren't back by tomorrow, maybe your vet can call the lab and get the results that way.

Hugs, Lori

[mb935]

Thanks .... im sure its not shocking that im annoying wih bothering my vet. :)

Just called and the results are not in. But doc shoukd call w whether pred is needed

I didnt mention... she was 89 lbs and is now like 94 in 2 weeks!!!!

[Harley PoMMom]

I didnt mention... she was 89 lbs and is now like 94 in 2 weeks!!!!

Some of this could be "water weight." Let us know what the vet says. ;)

Hugs, Lori

[mb935]

Thanks

No response. Ive had it

NO EXCUSE for 24 hour office!!

She now isnt interested in eating and im tempted in giving 10 mg pred

Would you recommend?

Thanks

[lulusmom]

If you haven't already given her 5mg pred this evening, then give it to her now. I'd raise holy hell with that vet's office and I wouldn't settle for anything less that getting those test results tomorrow. You have a pup who is showing symptoms of low cortisol and they don't seem to think that warrants a rush on the stim test. I'd be spitting nails.

[mb935]

I did!

Thanks

I was told by the receptionist he could have results emailed over instead of faxed to their office.

Ill just have to show my frustration tomorrow morning and mention what he said.

And im already spreading the word on this practice.

So how many more days can she go before she NEEDS more lysodren??

[molly muffin]

Since the cortisol went low and you are giving prednisone I think you are okay for now. You won't give lysodren as long as you have to give prednisone.

Sharlene and Molly Muffin

[lulusmom]

The results of the stim test will tell you if loading was achieved and if so, the numbers will tell how long before you start maintenance and at what dose.

[mb935]

Thanks sorry but I have 2 more questions

She is hungry and interested in green beans and wanting to eat but she's totally turned away from her dry food and only ate a tiny bit

Is this normal? is she tired of it?

And how much pred can I give to her in 24 hours? 5mg at a time?

Thanks so much. Again I can tell she really wants to eat just not her dry food. And now she's back on the couch ready to go back to sleep for another 10 hours :(

[labblab]

Per the calculations of the rescue dose, Diamond could have a total of 10 mg. within a 24-hour time period. So if you gave her 5 mg. last night but think she could still benefit from more, I think you could give another 5 mg. this morning. But hopefully you will finally get those ACTH results today and from this point onward, make more informed decisions about the gameplan moving forward! Until you see those numbers, it's hard to know why she is suddenly so picky with her regular food.

Marianne

[My sweet Ginger]

I don't really know what it means but the same thing happened to Ginger. She wanted to eat but she couldn't. She was especially turned off by her kibble especially at breakfast while she will still eat some table foods better.:rolleyes:
During her multiple loading periods she was wobbly and often times one of her back legs would go out under her along with decreasing appetite. At one point she totally didn't want kibble anytime of the day so for a while I was only feeding her rice and either chicken or ground beef.:o Sometime after Lysodren her appetite had gotten somewhat better (mind you she never got off prednisone to this date) but she is still a very finicky eater.
I hope Diamond's case is different from Ginger's so that she will be able to go on with maintenance phase in time without any complications. Let's hope for good numbers and her ACTH stim test will show that her adrenal gland are stimulating.

[mb935]

Weird... thanks for that info about Ginger.

Diamond actually got up after my last post so I gave her more kibble and added a little parmasean cheese - she ate that. She was up for a little bit. She may be sleeping now due to boredom (horrible weather today).

Diamond's third eyelid is showing. One eye has ALWAYS been that way... but now her other one is very obvious and red.

I had notified the vet that she has tears now (never did before) and he just said to use eye drops which I have used.

Thanks for any info on this!

[mb935]

Doc called. I asked if i could have numbers emailed (ill call later for desk girl to just do it.)

Cause he himmed and hawed and said her levels were both below 7

That this is the most extreme case. ????

So i schedule another acth in 3 weeks and only give pred (20 mg twice daily) if any vomiting or diarrhea)

Sound correct?

Thanks

[labblab]

Doc called. I asked if i could have numbers emailed (ill call later for desk girl to just do it.)

Cause he himmed and hawed and said her levels were both below 7

That this is the most extreme case. ????

So i schedule another acth in 3 weeks and only give pred (20 mg twice daily) if any vomiting or diarrhea)

Sound correct?

Thanks
We desperately need to know if he meant below 7.0 or below 0.7. I am assuming it is the latter from what you have written. If so, then NO, this does not sound correct!!!! :mad: :mad:

If Diamond has dropped below .7 on both pre and post, she needs daily dosing of prednisone to compensate for the lost cortisol until her own production rebounds. She also needs to be tested ASAP to see whether her potassium and sodium levels are unbalanced due to underproduction of aldosterone, as well. If so, she needs an additional supplemental drug.

The daily replacement dose of prednisone will be far, far less than 40 mg. -- perhaps more like the 5 mg. you have already have on hand. Even Addisonian humans are typically not given a daily dose exceeding 5mg.

At this point, we have no idea whether or when Diamond's own adrenal function will ever rebound, so she may need to remain on the daily prednisone permanently. I believe you are at the stage where you absolutely have to find a competent vet to guide her care. We are far beyond the point of guesswork in the absence of a qualified vet.

Marianne

[My sweet Ginger]

He couldn't tell you what those two numbers were? We need to know the exact numbers. :(

[Renee]

He couldn't tell you what those two numbers were? We need to know the exact numbers. :(

I am just so shocked and dismayed that this vet withholds such information like this. He should be glad to give the exact numbers. I feel that a vet that withholds information is a vet that lacks competence and is too proud to admit what they don't know.

I urge you to find a new vet!

[mb935]

No he wouldnt tell me exact.
Just called to get them emailed

Receptioniat doesnt know how to do so.....so im waiting for her to ask....

Yep... this is the emergency vet in our area.

[My sweet Ginger]

I don't know where you are located but can you call him back and demand what the exact numbers are before they close for the day?

[My sweet Ginger]

Oh, I see that you have already called but why wouldn't he give them to you unless he's afraid of the low numbers in front of him maybe he needs some time to research if they are indeed 0.7 and god I hope not.

[mb935]

Still waiting.... i WILL be calling again tonight and have these numbets for you cause im now freaking out

Actually I think he said below 7.7. I even repeated that... but cant be sure. Remember i heard him say hes been doing this for FOUR years in a bragging tone. He mumbles terribly.

But even if its that number.. even i thought 40 mg was crazy. So yes most definitely i will calling a new vet tomorrow

[labblab]

I just wanted to add that sometimes supplemental pred may not be thought necessary as long as a dog is outwardly behaving quite normally even in the face of an initially lower-than-ideal ACTH test after loading. But what you've described to us is a dog who is *not* doing well, with loss of appetite and severe lethargy. Diamond gives all appearances of a dog who is suffering from the loss of cortisol, and if the results are both less than 0.7, that is confirmation as to why she is struggling.

[labblab]

Still waiting.... i WILL be calling again tonight and have these numbets for you cause im now freaking out

Actually I think he said below 7.7. I even repeated that... but cant be sure. Remember i heard him say hes been doing this for FOUR years in a bragging tone. He mumbles terribly.

But even if its that number.. even i thought 40 mg was crazy. So yes most definitely i will calling a new vet tomorrow
There is no special significance to 7.7, so if that's the number he is citing, his instructions still make no sense. If the result is close to 7.0, you've not yet quite achieved a successful load and you would not be taking three weeks off before resuming Lysodren dosing.

[mb935]

Just made appointment with another practice for monday.

I asked to see whoever has experience with cushings/lysodren

Thanks every one!

Still waiting for numbers .... calling back now

[molly muffin]

I think since he said this is a most extreme case that the numbers are going to be below .7

And now the third eyelid on both eyes are is showing with tears.

You might have to go pick up a copy of the results and in the mean time, start making some calls to other vets, any other ER's or IMS you can reach. See what the options are.

Hugs,
Sharlene and Molly Muffin

[molly muffin]

I think we were both typing at the same time. Good job on finding a different vet.

Sharlene and Molly Muffin

[mb935]

Yep... below .7 for both

They sent in pdf form so i cant copy paste

But i retyped other numbers

Cortisol sample 1 1.0 to 5.0

Cortisol sample 2 8 to 17

So should i give .5 pred daily till monday or wait?

Now did i give her the lysodren longer than needed? Did i miss a sign??

Thanks

[My sweet Ginger]

Yeah, it doesn't sound like 7.7 to me either going by his instructions.
Monday is still a few days away. What doses prednisone should Michele give to Diamond until Monday? 40mg?:eek: 10? 5? :o

[labblab]

Can you call the new practice back and tell them your dog has gone Addisonian from a Lysodren load and you need urgent guidance -- that you cannot wait until Monday? We are not vets here and we can only speculate as to what we think would be the proper prednisone dosage at this point. I don't think you should wait until Monday to get professional guidance and to get Diamond's blood chemistries checked.

[My sweet Ginger]

Do you mean <0.7 for both pre & post?

[mb935]

Yes... i couldnt find rhat sign on my phone... both pre and post

The new vet is closed. This is why i was so thrilled to have 24 hour care and they are useless.

I could call them but not sure another much younger/ newer vet would go against what i was already told.

This is awful

Im thinking i can call off work and take her in the am. If ypu think this is an emergency. She is eating.. just snubs dry food and yes is very sleepy....

[molly muffin]

This here that you typed out is the normal range for an UNTREATED Dog, not one on lysodren, or vetroyl

Yes please, call back to the clinic you want to go to Monday and tell, just what Marianne said "Addisonian from a Lysodren load and you need urgent guidance"

Does it say .7 or below .7?

This is very serious, and you need professional help now!

sharlene

[molly muffin]

what about in another town? start going through the phone book? anything to get some help for Diamond

Sharlene

[labblab]

Until you can get some help, I do believe that 5.0 mg. of prednisone daily (not 0.5) will be sufficient to replace the cortisol that Diamond currently lacks. Here's an article to that effect:

http://endocrinevet.blogspot.com/2011/02/q-whats-ideal-prednisone-dose-for-dogs.html

How is she behaving tonight? How far off from normal is she?

[mb935]

I did give her 5mg (not .5) within the half hour.

She ate and wanted to eat today. When in the kitchen she would get up to see what was happening (always her thing). I called her to me a few times and she would walk over wagging tail. But her eyes are awful. She just looks terrible. I told the vet and he said to bring her in... in a day or 2.

Right now she is snoring on couch. To get her downstairs and outside will be difficult just getting her off couch

But today she is back to walking down.... she had been hoppingdown after the test

The number by the way was less than .7 for both.

Im calling out tomorrow now and taking her at 9. They just better fax her info over asap since they cant do anyrhing right

[labblab]

Yes... i couldnt find rhat sign on my phone... both pre and post

The new vet is closed. This is why i was so thrilled to have 24 hour care and they are useless.

I could call them but not sure another much younger/ newer vet would go against what i was already told.

This is awful

Im thinking i can call off work and take her in the am. If ypu think this is an emergency. She is eating.. just snubs dry food and yes is very sleepy....
My big concern is with the possibility that her "electrolytes" (specifically potassium and sodium) may be off balance in addition to the cortisol. Since you have the prednisone on hand to counter the low cortisol, that does not concern me as much right now as the electrolytes. But an imbalance in the electrolytes can be life-threatening due to risks such as heart arrhythmias (normalizing the electrolytes is the job of the drug Percoten that is referenced in that article). Diamond would need to have blood drawn to check those levels. Even if she is OK right now, she could go into crisis over the weekend if that issue becomes a problem for her. That is why I feel really anxious about you waiting until Monday.

[labblab]

I think we were writing at the same time. I'm hugely relieved that you're taking her to be seen tomorrow!

[lulusmom]

Now did i give her the lysodren longer than needed? Did i miss a sign??

According to your post below dated 2/7, I think you and your boyfriend missed a sign a day or two before the last pill. Unfortunately I didn't see that until after you had quit dosing.


Just an added detail.. diamond is peeing less volume wise but drinking more in volume. If I wrote that correctly

I noticed this just today.. my bf said he noticed yesterday.

Thanks...

[mb935]

Im taking her now... blood can be done in house if needed.

And my terrible vet has gone

Thanks!

[My sweet Ginger]

Great! Just don't leave the hospital without checking her electrolytes tonight, k? It's not 'if needed'.

[lulusmom]

We'll be waiting to here from you. Good luck!

[molly muffin]

Waiting here too

Sharlene

[Tina]

I am not at home so posting from my phone. So glad you are taking her now, she must have her electrolytes checked immediately. This exact thing happened to my pup. As others have said, this is an emergency. I will be checking back & waiting also. Big hugs.

Tina

[mb935]

Well... crap i didnt get those responses till now. I even tried loggibg in there.This dr said he didnt think it was necessary. I know im an idiot. But diamond perked up the entire time and it was easy to assume she wasmt so bad off. My bf talked me out of getting results tonight

I was given neopolydex for her eye, he checked for ulcers AND amoxicillian for a growth i just found on her paw. He said if that doesnt go away shed need to be put undrr for removal. It looks like a large dried wart. I dont know about that.

Apparently the dr treating her actually called a specialist today to get input on what to do w her low levels. This one of course agreed on waiting 3 weeks even saying no pred.

So... yeah. Thats the update Thanks for your support and input and sorry for driving anyone crazy w my stupidity.

[My sweet Ginger]

It's hard to believe that all her Drs are so nonchalant about her incredibly low numbers and no one wants to check her electrolytes when she could have a crisis anytime. Do you still have the 9 o'clock appt. tomorrow? I'd really like to know what her electrolytes are just to be on the safe side and could it be the prednisone what made her perk up plus being at the hospital?

[mb935]

I had given her that maybe 1.5hours before so not sure.

I mean she was back to her normal self snd i felt also maybe shes just bored at home. I know she feels bad but i couldn't believe the change. But i do know this is serious and will watch her closely.

The other vets are young and i dont think they want to go against their elder.

[My sweet Ginger]

I think they do get excited being at the vet or hospital especially seeing Ginger. She gets more alert at the vet's and she honestly runs around when I put her down in our driveway:eek: after our trip to the vet or hospital and you never see her run these days, she only does slooow walk. You know what her normal is at home and I didn't think she was her normal self last few days the way you described her. There is a chance which I really hope that's the case here that she could be like Ginger and only her adrenal cortex have been damaged and her electrolytes are fine but I think you really should find out just in case. It will also give peace of mind too. I hope both of you will have an easy night tonight.

[Tina]

Hi, just checking back in and glad to see that Diamond seems to be feeling better. Interesting that she perked up at the vets. I know when my pup Jasper got over suppressed on Lysodren and his cortisol bottomed out, he absolutely did not perk up at the vets. So maybe your dog is not in an actual crisis currently, but her stim results were quite low.

What I should have said in my last post was that this could become an emergency very quickly, sorry, I was posting from my phone then. I know you are watching her closely. Please know that when the adrenals get over suppressed from Lysodren, that the electrolytes can get out of balance at any time. I too would feel better if they would have been checked at the vets, so we would have an idea of where they are at. Specifically the sodium and potassium levels. This is a standard thing to check when cortisol goes too low.

Things can go downhill very suddenly with this situation, and can become life threatening very quickly. If Diamond should start to vomit with these circumstances, it is an emergency and you would need to get her to the vet right away for IV fluids and possibly another medication to stabilize the electrolytes. Trust me, this is nothing to mess around with.

Will you still be taking her to the appt in the morning?

Tina

[mb935]

She did perk right up this morning. Was ready to go out and eat.

But i know..... in fact i gave too little notice to call out for this am.... but i will come home early tonight.

U know i did get the blood work... its just when results come back. But since theyre 24 hours even tomorrow i can still get meds if needed.

Not sure if this is true... this doc said thrse levels will fluctuate on theur own and she nay already have higher levels....

I want to know if amoxcillian is safe to give right now before i do that

Thanks!!!!

[My sweet Ginger]

I'm so glad Diamond is doing well this morning and hope she continues do well. No, I didn't know they did blood work on her last night tho I was wondering what results you were talking about. That's wonderful that they did it. We now just have to hope for the good results and this time I really hope it won't take 4 full days until you get the results. I think he's right that her adrenals may start regenerating cortisol on their own at some point and I hope that's the case but as to when? Only the time will tell. She will communicate with you through her clinical symptoms so close monitoring all the time. Do you work close enough so that you can pop in and check on her on your lunch break or something like that?

[mb935]

Ive been home for an hour and altho not willing to meet me downstairs.... she seems fine.

Shes back to hopping down stairs but she did get in the car and may have hurt herself again.

I want to use this amoxicilan. Do you think there would be any problems with the issues shes having?

Should I wait for blood test results?

Thanks
Update... she is now not only eating her kibble without any additives she's using her ball... which she hasn't had any interest in the last few days

[mb935]

Hi

Got the blood work last night... all normal levels

I toldvet she getting a bit more lazy as well as more picky. This am i had to find different options for one cup of food!

He said as long as no vomiting / diarrhea then... wait for acth test in 2 weeks.

Shes..... ok. At night she won't move off couch and growled at bf.

Thanks

[doxiesrock912]

It does sound like the jump out of the car might have hurt something. I'm glad the tests were normal :-)

[My sweet Ginger]

I'm glad too about the blood test results especially the electrolytes and hopefully her adrenals will start regenerate cortisol soon so she can go on with her maintenance.
Is she still getting prednisone daily?

[mb935]

The vet said pred wasnt needed unless emergency.

So she hasnt had it since friday. Should she now that she isnt eating as easily/ difficult to get up sometimes ?

Is daily pred necessary to keep her levels higher?

Im sorry if i ask the same questions...

[lulusmom]

Can you please call your vet and get the actual results of the stim test and post then here? It's only two number, the pre injection result and the post stimulated result. I believe Diamond was on prednisone long enough for her adrenals to quit functioning so it is imperative that you do not quit cold turkey. You must wean her off over a period of time to give the adrenals time to jump start on their own. Did your vet not tell you this or did s/he simply tell you to quit giving prednisone? Please call your vet asap and tell him/her that Diamond is not eating, is having a difficult time standing and that you think it may be because she was not weaned off of prednisone. This can be very, very serious so please put that call into your vet now.

[Harley PoMMom]

Hi

Got the blood work last night... all normal levels



Exactly what tests were done? If her cortisol is still too low than prednisone, or some kind of corticosteroid drug is needed. When a dog's cortisol has dropped too low it may a while for the adrenal glands to start producing enough cortisol on their own.

[My sweet Ginger]

That was my concern too, Lori and I wasn't sure Diamond was still getting prednisone or not because I didn't think her cortisol would shot up from negative overnight.
Michele said Diamond's ACTH pre and post numbers were both <0.7 and I think she was talking about the blood tests that were done at the ER the other night. When she said all were in normal range I took that as her electrolytes were also but I'm afraid she might still need prednisone as I just don't think her adrenals are stimulating enough cortisol just yet going by her poor appetite. Ginger's numbers were even higher than Diamond's and she is not showing any signs that they are. Ginger's getting her ACTH in a few days mainly to see whether they are stimulating or not although I doubt they are.

[mb935]

Well ita really about diamond not wanting kibble... shes spitting it out. But will eat green beans and oatmeal w ease.

I dont get that. So shes being picky. I think Saturday she ate kibble from her ball so i thought ahe was back to normal.

I just took her out and she was running.... dud that yesterday.

So... she just wants to be on couch when not eating or outside...

I did give her pred 15 minutes ago and i guess will do so daily.

Er doc just said it wasn't necessary....

[Squirt's Mom]

Exactly what tests were done? I

Could you answer this question, please? It will help us understand better.

Also wanted to make sure you saw Glynda's post -


Can you please call your vet and get the actual results of the stim test and post then here? It's only two number, the pre injection result and the post stimulated result. I believe Diamond was on prednisone long enough for her adrenals to quit functioning so it is imperative that you do not quit cold turkey. You must wean her off over a period of time to give the adrenals time to jump start on their own. Did your vet not tell you this or did s/he simply tell you to quit giving prednisone? Please call your vet asap and tell him/her that Diamond is not eating, is having a difficult time standing and that you think it may be because she was not weaned off of prednisone. This can be very, very serious so please put that call into your vet now.

[My sweet Ginger]

Yea, I know, Ginger would only eat whatever that's mixed with kibble and leave all kibble on the bottom of her bowl especially with breakfast and she was also very picky with treats as to what she'd eat, it was like a hit or miss. We didn't know what was causing it when it started but we now think it's probably coming from low cortisol in her case. So watch Diamond how she does with her breakfast tomorrow morning now prednisone in her system.
I think it's a good idea that you are doing another ACTH test soon to see exactly where her cortisol level is especially with your hunky dory doctor.

[My sweet Ginger]

Hi Michele, how are you and Diamond doing?
We all are hoping Diamond is getting better these days.

[mb935]

Good... thanks so much for asking

she got her acth test an hour ago... Ill post results.

I did want to know if blisters ... Possibly blood are results of cushongs.

On her paw.. It started as a crusty raised patch. she was given amoxicilan. I noticed last week it was flat as if drained. Today vet noticed it was raised and purple. I was given tritop.. But thought id try neosporin ( rec from vet)

Any ideas? Thanks

Other than that diamond iz drinking/peeing less. Eating normally (dry too!!!) Is willing to walk when she used to fight me every day. she even played w a toy the other day. And went from 94 to 86 pounds in the three weeks since lysodren.

[Arizona Boston]

Hi,
I'm just now reading your thread from the beginning…my heart was pounding! Hope things are better now. Here's my nickels worth of thoughts….
My dog was on Vetoryl but without good results and she is now on Lysodren.
That must be so nerve racking for you with your vet! What part of the country do you live in? Not that it matters… I live in a big city and still had to go to 3 different vets until I got the right fit.

Just a FYI … I pay $81 dollars for 15 Lysodren pills at Walgreens…so about the same as what you pay for at CVS.

Crusty lesions can certainly be part of Cushings, altho my dog had them more on her back/neck/ear.

Also, whenever your vet draws blood, it should be clear to the vet and office staff that you are paying (big money) for those results and you want the exact numbers as soon as they are available. Don't let them tell you "normal" or "good". I also tell them "I need those numbers for my records". They should be tickled pink that you are you dogs strong advocate and are educating yourself on her condition.
Good Luck for you and Diamond Girl
Shelly and Lucy

[mb935]

Thank you Arizona.

Yeah I only went back to have the test done. If any issues arise once she is on maintence im going to another. And thiz isnt even close to being the worst part... But horrible customer service. Never call to ask how diamond is and even after my cat passed... Nothing. I recieved cards when my ferret died!!!

between her, my 2 cats, the ferret, my parents 2 dogs and my neighbors 3.... I have literally been to or heard terrible reviews of every vet within an hours drive.

I live in south jersey.

Sorry if I went on a tangent again. :)

[molly muffin]

Good gads, you are surrounded by pets. I bet all that keeps you busy. :) neighbors dogs for us equals play dates, walk dates, etc. Very busy in and out.

That is very sad that they didn't even acknowledge your cat passing. :(

I do hope that things start to go better. You'll just have to tell them whats what though.

Not sure about the blisters, but scabs and skin problems yes, can be cushings related. Did they do an aspiration to see what it was?

Sharlene and molly muffin

[mb935]

Nope... Im just left to apply ointment twice daily and if it gets worse they will go further with testing.

She doesn't touch it... And it is smaller today... Not sure if the snow made it worse...

[mb935]

Hi...

So I called to get diamonds numbers for acth test.

Pre 2
Post 2.3

Im waiting for her vet to call tomorrow w instructions.

What would your take be on these numbers?

The vet I spoke to said it appears normal based on having cushings ( not for a normal pet)

Thanks again... Enjoy your weekend!

[My sweet Ginger]

Is Diamond still on prednisone daily?

[mb935]

No... I gave it just a few days after her last test.

Shes been doing fine. Even jumped on the bed last night - something shes been unable to do (weight gain) for awhile.

Did you need the numbers after the ones given??

thanks

[lulusmom]

Those numbers are perfect! Congratulations.

[mb935]

OH! ..... Great!

Im supposed to hear back today on her maintenance doseage-

Is it ok to check with you guys on whatever he recommends to see if that sounds right?

[lulusmom]

Is it ok to check with you guys on whatever he recommends to see if that sounds right?

Absolutely.

[molly muffin]

Check on anything at all.

Those are good numbers! Congratulations.

hugs,
Sharlene and molly muffin

[mb935]

Thanks

I am curious so Ill ask now.

Its been close to 4 weeks since she stopped Lysodren. So... will she start maintenance in the near future?? Or does she need another test to determine when her levels start to drop again.

[lulusmom]

Since cortisol levels have risen, chances are the adrenal tissue is regenerating and cortisol will continue to rise. When you are treating with Lysodren, you want to keep the pre and post below 5 ug/dl. Since Dr. Edward Feldman is probably the premier expert on Lysodren, I took out my veterinary endocrine textbook and did a bit of research. Dr. Feldman wrote the chapter on Lysodren (Mitotane) so I'm going to quote him.


In the more typical and mild forms of overdosage, the Lysodren treated dog becomes weak, anorectic, lethargic, ataxia, or develops vomiting and/or diarrhea. Serum chemistry profiles, CBC and urinalysis from these dogs often are unremarkable. The easiest method of confirming the diagnosis is to treat the dog with prednisone. Clinical improvement in 1 to 3 hours (sometimes 6 to 12 hours are required) confirms that an overdosage of Lysodren has occurred. Treatment with Lysodren is withheld. The prednisone is initially administered to effect (to eliminate all signs). The prednisone dose is then slowly tapered over 2 to 6 weeks. As long as the dog needs prednisone, Lysodren is is withheld. When the prednisone is discontinued and the dog is stable on no treatment for an additional 2 to 4 weeks, Lysodren should again be given but at a lower dosage.

You can print this out and discuss it with your vet.

[mb935]

Ok.... well her vet just called and agrees with everyone....

However he said to wait 2 months for anither acth test along w thyroid test

Until then he wants me watching her for any crisis when id give her pred.

He says hes never seen this... Her go so low then come up normal. Said shes not even cushings now (which I thought they are forever)

Im assuming I need her records for a second opinion now. Because if her levels have gone up... Wont that continue again in the next eight weeks?

Anyway as usual any input would be great since you've all been extremly helpful

[lulusmom]

It is highly probable that cortisol will continue to rise and if you wait two months, you'll probably be looking at reloading again. Your vets comment about Diamond no longer having cushing's is a big red flag that he isn't completely familiar with the drug he's prescribed. It's also an indication that he may not be that familiar with the disease. It's lifelong and since Diamond does not have addisons, she will always have cushing's. Before Lysodren was banned in many of the european countries, their first line of treatment was total adrenal ablation with Lysodren. The thinking was that it would be much easier to try to kill every cell in the adrenal cortex and treat a dog with addison's than cushing's. Dosing protocol calls for huge daily doses, 100mg/kg, given concurrently with prednisone for 30 days. It's a risky protocol but it works. Unfortunately because the adrenal cortex cells are tough buggers, some of those dogs had regeneration of the adrenal glands in the first year and became symptomatic again.

What your vet is seeing is a not a rare phenomenon. Lysodren didn't totally destroy Diamond's adrenal cortex and what you are seeing is some regeneration. How quickly it regenerates from this point would be a guess but it's a good possibility that you may see return of symptoms before you have the next stim test in two months. At that point, you are looking at reloading.

[mb935]

Ill get her on maintenance pills...

you know this vet diagnosed my cat w cancer when the one before him said ibd. Max died 9 days later. Here I thought I found a decent vet. I can't takethis bs and bad luck anymore.

Anyway diamond has been lounging on couch all day. Shell get up everythingelse is fine. I dont know if shes bored... But getting a tiny bit more lazy the last few days.

woukd she be in need of pred or lysodren?

Thanks

[lulusmom]

How long has it been since Diamond was weaned off of prednisone?

[mb935]

I gave it to her for like 3 days after she finished lysodren. Second vet (same practice) who saw her said she didnt need it...

So she really wasnt on it enough to be weaned.. And that was 3 weeks ago.

[My sweet Ginger]

This is for any Lysodren guru on here.;)
Diamond's latest ACTH stim was performed about 4 wks after her last Lysodren therapy and NOT 48hrs after, am I right, Michele? When you look at the results in her case, do you consider after 4 wks as a dog on Lysodren therapy or not? When we got Ginger's ACTH results, we were going by a dog who is NOT on Lysodren therapy, obviously not after 3months. I'm just wondering where Diamons's 4wks would fall.
If 4wks is considered a dog who is NOT on Lysodren therapy that might explain why she feels a little lazy these days with her pre and post numbers almost identical. Though they'd be perfect for a dog who is ON Lysodren therapy. What do you think?

[Harley PoMMom]

I'm not a guru but will try to explain!


Yep... below .7 for both



Diamond's ACTH results after loading were very low with the pre and post being .7 ug/dl which is why the prednisone was being given.





she got her acth test an hour ago... Ill post results.




Hi...

So I called to get diamonds numbers for acth test.

Pre 2
Post 2.3



Diamond's recent ACTH results done on 3/4 showed a pre of 2 ug/dl and a post of 2.3 ug/dl, meaning that the adrenals have started to regenerate and are producing cortisol. All dogs are different and how fast the adrenals regrow and produce cortisol is different for every dog BUT an ACTH stimulation test can give tell us that information.

Lysodren reduces cortisol by eroding the adrenal glands so in Diamond's case, even though her most ACTH test was done 4 weeks after her last dose of Lysodren, she is still considered a dog being treated with Lysodren.

[My sweet Ginger]

Lori, do you mean we should consider Ginger as a dog who's been ON Lysodren treatment then even after three months? If that's the case her numbers of pre 3.8 and post 18.1 is way too high and she should be exhibiting some symptoms of Cushings by now especially concurrent daily pred therapy but she isn't. As a matter of a fact she got really sluggish and weak and sleepy yesterday but perked up a few hours after a dose of prednisone and I was wondering why she still seems to need pred when her adrenals are producing their own cortisol going by her latest ACTH stim test.:confused:
Aaaaaaah, this never ends.:mad::o

I have copied this post to Song and Ginger's thread so no confusion is created

[mb935]

I just put a call in to get her on maintenance dosage.

Im leaving for 2 weeks IN 2 weeks and id rather her on lysodren than leave her on nothing. My bf will be able to give her the meds.

I will post what they suggest...

[mb935]

Dr doesn't want her on lysodren...

Wants me bring her in fir one blood test before I keave for two weeks to get her levels then

I leave the 26th of march

Do I need to get her on maintenance now w another docter

[Harley PoMMom]

I'm a control freak when it comes to my furbabies, so if this were me, I couldn't let anyone take over my dog's treatment plan UNLESS the dog was stablized on such treatment.

Since you are going away for 2 weeks, again if this were me, I would wait untill you got back to start any treatment but keep in mind that Diamond may be showing signs of elevated cortisol upon your return.

[mb935]

Really???

cause thats what im asking... should i start treatment immediately (thru another vet..)

OR wait till i return... forget the 2 month deal altogether and just get her tested again in what would be almost a month from now

THANKS!!! I was about to get info on talking to another vet.. which i would assume they wouldnt even need to see the dog... just teh test results... RIGHT???

so im not sure how they charge or deal with that...but im sure it happens.

[mb935]

If I havent come off as nuts I may now....

I know there is a calculation based how dog loaded and their weight formaintence.

Anyone willing to help me w that calculation for one dose a week

Or would one quarter a pill a week be even slightly helpful than nothing at all?

I'm asking cause this am she was already begging again for more food.. It was nice to get a break from that... But of course that's a sign too.

Thanks... Ill call another vet to see what he's willing to do w just her test results. Im justpissed I have to put more money that I never had to figure out what should be simple...

[Harley PoMMom]

No way do we think your nuts, Cushing's can be frustrating and confusing, we completely understand. ;)

In summary: Diamond's loading dose was 1500 mg being split and given twice a day, right? But she was over loaded because her ACTH stim test results showed that both the pre and post were less than .7ug/dl, correct? Diamond was given 1500 mg (split and given 2X a day) for 8 days, is this correct?

[mb935]

1.5 pills twuce daily for 7 days. I think I started saturday morning to friday night.

And yes very low at .7 now at 2 and 2.3. Its been 4 weeks since on lysodren. Only like 3 days on pred after loading

Thanks

[Harley PoMMom]

Anyone willing to help me w that calculation for one dose a week

Or would one quarter a pill a week be even slightly helpful than nothing at all?


Just wanted you to know that I have not forgot about your question, I have asked the staff for their advice in this decision, ok?

Hugs, Lori

[mb935]

Thank you for doing so and also letting me know!! Appreciate it!!

[Harley PoMMom]

Im so glad i stopped the meds this am. She just took a drink of water lasting like 2 seconds. She has not done that in... forever!!!


Can you tell us exactly when Diamond had her last dose of Lysodren, this would have been before her ACTH stim reslts that were too low (.7) I'm thinking from your post # 106 that it was Friday 2/7, is that correct?


Hi.

She is off meds and had test yesterday (acth(

Blood was taken from both back legs and she is limping although she had trouble getting in car yesterday and even yelped.

I will call vet but want to know if any of thesr issues coyld be cushings or lysodren usage from Friday night

Thanks

I gather from this post, which is #113, that her ACTH stimulation test was done on Sunday 2/9, is this right?

[mb935]

Correct ... thank you so much for your time

[Harley PoMMom]

We are still discussing but I am sure we will be able to offer our advice soon...thanks for your patience!

[Harley PoMMom]

What we are thinking is if Diamond isn't started on a maintenance dose soon that her adrenal glands will start producing too much cortisol and a reload will have to be done. According to Dr Feldman, who is a renown Cushing's expert and is very knowledgeable about Lysodren, the maintenance phase of therapy "involves choosing a regimen and altering that regimen as required".

Generally the maintenance dose is just about the same as the loading dose BUT the maintenance dose is divided up into smaller doses and given 2-3 times throughout the week. Since Diamond loaded with 1500 mg of Lysodren, being split and given twice a day, her maintenance dose would be 1500 mg too. This 1500 mg can be divided up into 3 doses pretty easily, and you could follow a schedule of: On Monday, Diamond is given 500 mg, which is one pill; on Wednesday, Diamond is given 500 mg; and then on Friday or Saturday another 500 mg is given to Diamond, which is a total of 1500 mg of Lysodren for that entire week.

What you're trying to do with the maintenance therapy is to keep the cortisol levels in that target range of 1-5 ug/dl. Dr. Feldman also suggests doing a followup ACTH stim test after one month of weekly maintenance dosing, unless Diamond is showing adverse signs than an ACTH stimulation test needs to be performed ASAP.

If I were you, I would discuss this over with Diamond's vet before starting the maintenance dosing.

If anything I have written confuses you and/or if have any questions please do ask.

Hugs, Lori

[mb935]

I totally understand... Thank you !!!!!!!

I can't remember if I asked this....

Is it correct that the acth test only take one hour? I did call this second practice since I do have to switch vets... Hes never going to treat her correctly.

This desk person thinks acth takes hours in between taking blood. I remember being told that years ago... So what is right on this???

Ahhhh!!!!

[lulusmom]

If the vet is using cortrosyn as the stimulating agent, the acth stim test takes a bit over an hour. If acth gel is being used, it could take over two hours as two post injection blood draws are done. Do not rely on people on the front desk to provide you with accurate information. We have plenty of educational information in our Helpful Resources section so please do take advantage of that information in your spare time. In the meantime, I'm providing a link to information that I think may be helpful:

http://endocrinevet.blogspot.com/2011/03/whats-best-protocol-for-acth.html

[Harley PoMMom]

The time the ACTH stimulation takes is dependent on the stimulating agent that is used.

In the U.S. Cortrosyn and ACTHAR gel are the two stimulating agents used for an ACTH test.

When a full ACTH is performed with Cortrosyn, a pre blood draw is first taken, and then the Cortrosyn is injected. After 1 hour the post blood draw is done.

With ACTHAR gel, again, a pre blood draw is performed, ACTHAR is injected and 2 hours later the post blood draw is done.

On Dr. Peterson blog he has written an article regarding the protocol for an ACTH stimulation test: What's the Best Protocol for ACTH Stimulation Testing in Dogs and Cats? (http://endocrinevet.blogspot.com/2011/03/whats-best-protocol-for-acth.html)

Hope that helps.

Hugs, Lori

[mb935]

Thanks...

Ive mentioned how diamond has been more sleepy... I do want to make it known she has been like this for a year or so. So before being diagnosed and of course medication.

So... I gave her her first maintenance dose of lysedren yesterday.. And so I cant really tell if shes worse in that sense.

as mentioned earlier she realky hasnt been on pred.

Can I give her some pred during this maintenance phase for being "lazy" or is it better she not have tgat in her system on a weekly basis since she hasnt up to this point and just let her be?

Thanks

[mb935]

I know cushings causes hair loss...

But does it do so on the nose?

Diamonds fur is growing back very fast on tail and even belly where she was shaved for ultrasound.. But I noticed recently area past "snout" is furless and I know there's other issues with this.

Thanks for any input.

[molly muffin]

I see no one answered earlier, but you don't give pred usually for lazy. You give pred only if you need in case the cortisol goes too low.

Normally we don't see hair loss on the nose due to cushings, but I suppose that anything is possible. Normally if there is hair loss somewhere I recommend a scraping to see if there is some yeast or other cause for it.

Sharlene and Molly muffin

[mb935]

Hi...

So i had been away for 2 weeks and diamond remained on her maintenance doseages.

I came home to find her full of fur!!! I read here that often happens. She had no fur when i left!

She seems to be losing that hard hanging belly.... it is now more flabby... so she doesn't look thinner. I can just feel the difference.

She is panting now... but it is much warmer. She doesn't eat all her food anymore or at least isnt begging for it

My concern is that she still has no energy. Its been a year now. Is she ever likely to be energetic again? Shes only 8.5. But acts like a much older dog.


Also wince most cushings dogs are older.... is she still likely to live as long or will she likely only have a few years now.


Thanks! I hope you all have been well.

[mb935]

Any info in helping diamond become more energetic? She eats.. but doesnt even eat it all.
thanks

[My sweet Ginger]

When and what were the results of her latest ACTH stim test and when did you start her maintenance?

[mb935]

She was last tested 3/4
Pre 2
Post 2.3

The vet wanted her on nothing for 2 months then tested again. I am giving her hte dosage recommended on the previous page started 3/17.

She practically sleeps ALL day and night. But seems back to normal in all other signs of this disease. She walks faster on walks too.

[Squirt's Mom]

What kind of dog is Diamond? I ask because 8 1/2 is nothing to a Chihuahua but is quite old for a Great Dane.


Ive mentioned how diamond has been more sleepy... I do want to make it known she has been like this for a year or so. So before being diagnosed and of course medication.

Is her sleeping and lack of energy different today than it was prior to the Cushing's diagnosis?

Was her appetite off before diagnosis as well or is that new since treatment started?

Are her stools normal?


The vet wanted her on nothing for 2 months then tested again. I am giving her hte dosage recommended on the previous page started 3/17.

So you are giving her 1500mg over a week's time, right?

Does the vet know that she is on maintenance?

Have you talked to the vet about the sleeping, lack of energy and appetite?

Sorry for the questions but the more detail you can provide the better idea we have of what may be going on. ;)

Hugs,
Leslie and the gang

[My sweet Ginger]

Going back a few months, during and after my Ginger's Lysodren treatments (an initial loading and 2 mini loads) she became lethargic, wobbly and sleeping day and night and had poor appetite. For that reason her GP vet put her on daily prednisone and if I tested her by skipping a day or two on prednisone, her symptoms got worse so we never got off prednisone to this date although it turned out that she needs prednisone for her macro now. I guess what I'm trying to say is to try a therapeutic dosage of prednisone for a while and see if it makes any difference on her after you talk to her vet that is. Ginger's lowest ACTH numbers were 2.9 and she still reacted like she was Addisonian because her body couldn't adjust fast enough to her newly plummeted level of cortisol after Lysodren loadings. Maybe she just needs a little booster from prednisone in her system for a while or for the rest of her life as that does happen sometimes. What does your vet say?

[mb935]

She is a pit mix.

It was last summer when she started sleeping all day.. no interest in play. I thought it was tge heat. Then the weight gain/ belly started then the crazy thirst. So she has been this way before. I guess i was hoping after being treated shed be over this as all othetr symptoms have improved.

She used to leave some food behind. Can't tell if its worse now than last year.

Stools are fine... she was pooping a few times a day for awhile after loading. No vomiting or diarrhea at all thru this process.

My vet knows nothing until i take her for next acth test will i tell him shes on lysodren. Nothing he has recommended has been correct. He said use pred if she vomited.

But i will ask him about pred. He wanted her on it while loading so i dont know if anything he suggests is helpful.

Thanks

[My sweet Ginger]

Are there any other vets you can take Diamond to who will look at her case with a set of fresh eyes with the reports that you will take with you? My first IMS was as lost as my GP vet but when we saw our 2nd IMS with Ginger's journal up to that point she didn't even want to do any tests because she could tell exactly what the problem was by Ginger's loading history, ups and downs with accompanying use of prednisone. The prednisone may help with her appetite too although it shouldn't be used solely for that purpose.
Ginger actually is doing pretty good at the moment tho still it's like a day to day thing with her. The other day she was strutting :eek: (only for a few yards) which I hadn't seen her do it for at least a couple of years.

[mb935]

"Strutting" : ) i know when diamond ran instead of slowly dragging to her ball what an awesome feeling it is to see them back to their old selves... you just want that to continue on going and thats what im trying to figure out.

Can she ever be herself again on a daily basis?

Im almost thinking she is the most lethargic on her lysodren days. Maybe i can give her pred also on tjose days?

I also just started joint supplements as i feel she may be in pain. She gets nupro daily but its not the joint type.

[Squirt's Mom]

No, don't give pred along with the Lyso. The pred should be used only when the cortisol has gone too low.

It may be that the maintenance dose is a tad bit too high for her but the ACTH will help shed light there. ;) I would expect you would see things other than what you are if that were the case, tho. Some pups just feel better with the cortisol a little higher than recommended - Diamond may be one of those pups. Maintenance dosing can range from 25mg/kg/week to 50/mg/kg/week. Typically maintenance is kept at the 50mg dose but it can be lowered if needed.

Do you plan to keep this same vet? I don't remember if you have any others available or not...and I'm too lazy to look back! :p

[My sweet Ginger]

What I failed to say in my previous posts was that you can try prednisone to see if it perks her up but not with the Lyso at the same time. If you notice some difference I'd take that as she doesn't need Lyso yet as my Ginger still doesn't need Lyso after 5 Lyso free months and her ACTH #s were 2.9. Sometimes it takes time for their adrenals to regenerate after a damage was done by Lyso.
I wonder where Diamond's numbers would be now after Lysodren maintenance. There's a chance her adrenals are not regenerating enough cortisol to be on maintenance just yet.

[mb935]

Im confused ... 50mg a week? Each pill is 500. Am i missing something?

I called other vets and at this point if her next test results are good and we can easily figure out what to do next then i dont see tge point in switching right now. I thpught she had to be on maintenance which is why i ignored this vets rec of keeping her off meds for two months.... so now this test will really tell me whats going on i guess.

[Harley PoMMom]

Hope this helps:


What we are thinking is if Diamond isn't started on a maintenance dose soon that her adrenal glands will start producing too much cortisol and a reload will have to be done. According to Dr Feldman, who is a renown Cushing's expert and is very knowledgeable about Lysodren, the maintenance phase of therapy "involves choosing a regimen and altering that regimen as required".

Generally the maintenance dose is just about the same as the loading dose BUT the maintenance dose is divided up into smaller doses and given 2-3 times throughout the week. Since Diamond loaded with 1500 mg of Lysodren, being split and given twice a day, her maintenance dose would be 1500 mg too. This 1500 mg can be divided up into 3 doses pretty easily, and you could follow a schedule of: On Monday, Diamond is given 500 mg, which is one pill; on Wednesday, Diamond is given 500 mg; and then on Friday or Saturday another 500 mg is given to Diamond, which is a total of 1500 mg of Lysodren for that entire week.

What you're trying to do with the maintenance therapy is to keep the cortisol levels in that target range of 1-5 ug/dl. Dr. Feldman also suggests doing a followup ACTH stim test after one month of weekly maintenance dosing, unless Diamond is showing adverse signs than an ACTH stimulation test needs to be performed ASAP.

If I were you, I would discuss this over with Diamond's vet before starting the maintenance dosing.

If anything I have written confuses you and/or if have any questions please do ask.

Hugs, Lori

[My sweet Ginger]

No. What Leslie was saying is 25-50mg/kg/week. How much does Diamond weigh? I thought you put Diamond on maintenance under the vet's instruction thinking 2 months must have passed. Yeah, I really think you need an ACTH test and that results will direct you which way you should go more clearly.

[mb935]

Well she vomited twice last night. So im getting her tested today or tomorrow for sure.

Maybe i shouldn't have put her on maintenance and waited 2 months with nothing?

Im thinking shes low again. ???

Ps... i do get the " 25-50mg/kg/week". I missed the "kg ".

Last time she was weighed she was 88.

[My sweet Ginger]

Let the vet know. I'd do an ACTH stim test and wouldn't continue with maintenance until you have the results. When did you give her Lyso last time?

[mb935]

Her last pill was Friday.

She does sleep a lot as noted... only eats when kibble is mixed w something (yogurt etc).

She is panting on couch only not so much when on floor and it has cooled downin the house.

Drinking seems ok... she will drink alot when at bowl but doesn't go to bowl thay often. Peeing is normal (and stools) but it still smells. It is yellowish now where before treatment it was a lot and always clear.

And i did mention her extreme fur growth.

Not wobbly.

Thanks

[My sweet Ginger]

Though I do think she needs prednisone now I'd feel better if you talk to your vet and do it under his instructions. It sounds a lot similar to when my Ginger's cortisol was very low except she didn't have fur and heat problems. Call the vet.

[Harley PoMMom]

Vomiting is a sign of cortisol going too low and needs to be addressed promptly because it can be life threatening. Please get Diamond to a vet ASAP and have them perform an ACTH stim test along with having her electrolytes checked. Let us know how things are going and I hope Diamond is feeling better soon.

Hugs, Lori

[mb935]

Hi.. hope u all are well.

Well diamond has a new vet.

Her last test (yesterday) was 1.7 pre 2.0 post.

She has had zero meds in over a month.

This vet wants her on 1/4 pill twice a week which i agree w wanting to try BUT ADDING pred 5 mg every other day?????

I thought this was a definite no????

Here we go again.

Im to call next week w her prognosis and get another test in s month.


Thanks!!!

[Harley PoMMom]

Her last test (yesterday) was 1.7 pre 2.0 post.

She has had zero meds in over a month.

If I am understanding you correctly Diamond has had NO medication for the treatment of Cushing's in over a month? And if this is so, then in my opinion, those ACTH stimulation results are too low and prednisone should be given.


This vet wants her on 1/4 pill twice a week which i agree w wanting to try BUT ADDING pred 5 mg every other day?????

Exactly what medication does the vet want you to start at 1/4 pill twice a week? I am hoping the vet did not want the Lysodren started again, Diamond's stim numbers are too low for any kind of Lysodren dosage, Diamond's adrenal glands need more time to recover.

I am very worried about Diamond, will be waiting anxiously for your replies.

Hugs, Lori