Rio - Lysodren (Is Rio loaded?)

[adukes]

Hello and thank you for any help you can offer! My fur-baby, Rio, is a 7.5- year old Australian Cattle dog who was just officially diagnosed with Cushing's today. It was a year ago that he started drinking water obessively and having urination accidents in the house. Our vet ran urinalysis and blood panel which all came back normal, so the Cushing's possibility was dismissed. Rio has shown other symptoms -- fur loss on belly, facial paralyis (which resolved after about 6 months) skin infection and a little pot belly -- making us all suspicious of Cushing's (except for our vet who stood by his decision that normal blood ALP levels could not happen in a Cushing's dog). For a 2nd opinion, we went to another vet and had an ACTH stimulation test done. Per vet, Rio unquestionably has Cushing's based on the test results. Now I have so many questions and have been driving myself crazy researching next steps. The vet offered the option of being referred to an internist for an (expensive) ultrasound to determine if Rio's Cushing's is pituitary or adrenal, OR he said we could begin treatment with Lysodren or Trilosane. I first would like to know how important it is to know which type of Cushing's it is (is it just because if it is determined to be adrenal, surgery for removal may be an option?) as it seems that most opt for treatment by lifelong medication over surgical measures anyway. I also am so concerned by what I have read about the toxic drugs and have a terrible fear of inducing Addison's disease. I would love to hear any thoughts/experiences anyone can offer. Rio is my fur-baby and I just want to make sure he is comfortable withOUT potentially causing additional issues. THANK YOU! THANK YOU!!

[doxiesrock912]

Hello and welcome.
Not only will the ultrasound help to determine which type (some meds work best on one type over the other), it is important to know how the organs have been impacted.

We went to three vets before going to a specialist who finally got the treatment plan correct. Save yourself some time and please read through the posts under the helpful resources section of this forum. Information there is invaluable.

Please post the test results when you get them along with Rio's weight and the vet's recommendations for medication ans dosage. There are many here who are great at interpreting them on here.

[Trixie]

Hi and welcome to the board. Everyone here knows exactly how you are feeling. It will all get better and you will feel much less worried in time.
My dog was diagnosed just about a year ago and on medication for about 11 months, in our case it's Vetoryl/Trilostane. It took a few months of tweaking to get her dose at an optimum level and since then she's doing great. Symptoms gone and we had no side effects from the medication. She's just like she was before she had Cushings, except she's a little older now--almost 10.
With my dog we started on a low dose of medication and after checking her levels on the acth tests we would adjust up until she was under control. If you end up choosing Trilostane a good measure is to start at 1mg per pound of dog. You can always adjust the dose if need be, but it doesn't hurt to be conservative in dosing to see how your dog tolerates the medication.
If you choose Lysodren there are many here on the board to help guide with that. The two meds work differently, I can only speak on Trilostane.
Try not to worry, if you have a good vet and you are vigilant your dog can end up doing just fine. You will learn a lot right here on this board, lots of experienced people! I wouldn't have gotten through without all the help I've gotten on this forum.
Hope all goes well with your Rio.

Barbara

[molly muffin]

Hello and welcome to the forum.

Yes one reason to know for sure is because surgery could be an option.

You can have a chat with your vet (that did the diagnosis) about what kind of experience he has with cushings and his success rates, what kind of dosage and testing protocols does he use. (for trilostane/vetroyl, its good to start at 1mg/1lb) Starting low and going up is always safer. Then have an ACTH test no 10 - 14 days to see where the cortisol is at.
If this vet seems to follow all the correct protocols then you could start medication. Thyroid and glucose all tested within normal limits? You do want to make sure nothing else is going on before moving forward with treatment for cushings.

Sharlene and Molly Muffin

[Harley PoMMom]

I first would like to know how important it is to know which type of Cushing's it is (is it just because if it is determined to be adrenal, surgery for removal may be an option?) as it seems that most opt for treatment by lifelong medication over surgical measures anyway.

Surgery can be an option if it's adrenal, another reason to differentiate between adrenal and pituitary is when Lysodren is the treatment choice than higher doses of Lysodren are usually needed for the adrenal form of Cushing's.

I am surprised that Rio's urinalysis came back normal, was his urine specific gravity (USG) measured and if so could you post that number?

When treating for Cushing's, dogs that end up with Addison's are usually a result of an inexperienced vet and uneducated owner. The key to a successful treatment plan is knowledge, and one can find a wealth of information regarding Cushing's in our Resource Thread, here's a handy link: Helpful Resources for Owners of Cushing's Dogs (http://www.k9cushings.com/forum/forumdisplay.php?f=10) Please do feel free to print any thing out and if you have any questions, please do not hesitate to ask them. And remember we are here to help you in any way we can.

Hugs, Lori

[adukes]

Hello! First I want to say how amazing this forum is and how helpful the members are!

My 7yo ACD was recently diagnosed with pituitary-depedent Cushings. An ultrasound revealed that both of his adrenal glands are very large (1.3cm) but a tumor was ruled out due to them being equally large. His symptoms: EXCESSIVE water drinking and urination, slight hind leg weakness, scabby skin infection on trunk, slight pot belly. He is in good spirits, still loves to play/exercise, and seems unaffected other than potential discomfort from being constantly thirsty and trying to hold bladder during the day.

He also was just found to have a bladder infection that we are trying to clear before beginning treatment for Cushing's -- so far 2 different antibiotics haven't been helpful.

The vet recommends Cushing's treatment with Lysodren (dosage not yet discussed). I have done a lot of reading on the drug and it sounds toxic and in some cases, terrifying. It can make a dog sick and even be fatal. It can also push a dog into Addison's disease, another chronic condition. I am SO nervous and hesitant to use this medication on a generally happy, lively dog for fear that I could cause worse results through treatment. I'd hate to see him have severe side effects or develop another disease. I have also read online about some natural homeopathic treatments and found some adrenal supplements sold online.

I would love to hear about others' experience (positive or negative) with Lysodren and am also very interested in any info anyone can lend regarding natural alternative treatments. Since treatment affects the symptoms of the disease, and not the underlying cause (pituitary tumor), I wonder if natural therapy might be worth trying first.

THANK YOU!

[Harley PoMMom]

Hi and welcome to you and your boy!

Strong symptoms do play a huge part in the diagnosis of Cushing's so I can see why you would suspect it is perhaps Cushing's.

Cushing's can be difficult to diagnose and is frequently misdiagnosed as other illnesses have the same symptoms such as diabetes or any thyroid problem. Have you ruled out diabetes and thyroid issues? I would start there as they are easy to diagnose as they are normally checked on a chemistry blood panel. Sometimes a chemistry/CBC blood panel is called a senior or geriatric wellness panel. If this was done could you post any abnormal levels (high or low), as an example: ALT 150 U/L (5-50)...Thanks!

Has an urinalysis been done, and if so could you post those results? Since he is drinking excessive amounts of water his urine could be diluted, if it is, a urine culture and sensitivity test should be done so the bacteria can be known and the correct antibiotic be prescribed that can kill it.

The two medicines generally used for Cushing's are Lysodren/Mitotane and Vetoryl/Trilostane. Both are strong drugs but are life savers for our dogs with Cushing's. Usually adverse reactions are only seen when the proper protocols are not followed. Cushing's is a treatable disease but success does depend on keen owner observation along with a vet/IMS that is knowledgeable and experienced in the treatment protocols for Cushing's.

As far as the tests for Cushing's I would not have any performed until the bladder infection has completely gone away. Stress and/or any kind of illness can cause a dog's system to produce increased amounts of cortisol which can cause false positive results on all tests for Cushing's.

Regarding the natural homeopathic treatments, they may help with the symptoms but do nothing to address the problem of Cushing's which is the excessive cortisol production.

I am sorry for the reasons that brought you here but so glad you found us. Please remember that you are not alone on this journey as we are right there with you. If you have any questions at all do not hesitate to ask them, we are here to help in any way we can.

Hugs, Lori

[Squirt's Mom]

Hi Adukes and welcome to you and your baby boy! :)

Lori has asked some pertinent questions and given some great info to get you started. I just wanted to reaffirm what she said about testing for Cushing's while your baby has an active bladder infection. That could cause false positives so it is best to wait til this is cleared up if you can.

Cushing's is a very slowly progressing condition so there is typically no need to rush into treatment. This comment is a bit concerning tho -


...scabby skin infection on trunk


There is a condition that can accompany Cushing's called Calcinosis Cutis. The presence of CC is almost always indicative of elevated cortisol - Cushing's. This condition can get very bad quickly if not addressed. If I were you the next step would be a visit with a derm vet to check out this infection and make sure it is not CC. CC CAN be caused by other things, but it is almost always associated with Cushing's. If this is CC, I would want to get treatment started asap. ;)

As for Lysodren (Mitotane, brand name), that is the drug we used and will be my first choice should I have another cush pup in my life. ;) Some things to bear in mind - Lyso has been around much longer than Vetoryl (Trilostane, the compounded form) so you are bound to read more about it, both positive and negative. Vetoryl is the "new kid on the block" in Cushing's treatments and we are still learning about it so you won't read as much on it as you will Lyso. In time, there will be a better balance out there between the two. Lysodren stays in the body longer than Vetoryl - Vetoryl is leaving the system no later than 12 hours after a dose while Lyso is just reaching its peak at 48 hours. So IF there is a crisis, the Vetoryl is leaving the system sooner than Lyso. If you read the product insert for Vetoryl, you will find the same risk factors for it as for Lyso - they simply work differently in the body. Lyso works directly and only on the adrenal glands while Vetoryl works along a pathway to the adrenals. As Lori said, both these drugs are life savers for our babies when used correctly.

As for Homeopathic treatments, I don't know of any that actually control the cortisol, the enemy in Cushing's. I'm not saying they can't but folks who take this approach don't do the testing (ACTH) to see what is going on with the cortisol and rely solely on anecdotal evidence. I can tell you not to waste your money on products like Cushex, Supraglan, and so on. The only thing those products improve is the bank balance for those folks who are preying on the fear of new cush parents. ;) Some of those things contain ingredients that are contraindicated for a cush pup. Again, those glowing testimonials you read about these products are anecdotal -at BEST....or paid testimonials at worst.

Take a deep breath and try to relax for a bit. You are in good hands here with your new family - and you are family now, both of you. You will never be alone on this journey; we will walk every step with you.

Hugs,
Leslie and the gang

[Arizona Boston]

Everything has a risk vs benefit.
The risk with the natural treatments is that they will probably not work and you will waste your time and money. But if your dog is doing pretty well at this point, you have some time to check it out. When you look at the info for natural treatments, be sure to look at the claims carefully. It's my understanding that supplements are not regulated and by law, can make any claim they want as long as they offer a money back guarantee. (think of the diet drug industry for humans….unfortunately, they just don't work….but they keep on selling them). They also are not obligated to offer any proof that the treatment works or inform you of any possible side affects.
But FDA drugs do have that burden and that is why researching them can be so daunting.
This is just my two cents worth…I am not a moderator of the board or any expert.
But in answer to your question… I have had great luck with Lysodren and did not have any side affects or trouble…that just my personal experience. But I will certainly say that I was nervous when I first started giving my girl the drug and was alert and observant for a bad reaction.
You are smart to consider all the possibilities and will make a good decision for your pup.
Shelly and Lucy

[adukes]

Hello and thank you so much for your responses!!

These are the tests we have had done to reach a diagnosis of Cushing's (I don't have many #s on the results, just what the vets described)...bloodwork showing elevated ALP level and low thyroid at .6 (vet said cushing's can cause hypothyroidism), cortisol:creatinine ratio urine test which indicated "extremely high levels" of cortisol, ATCH stim test which also indicated extremely high levels of cortisol to which the vet felt Cushing's was certain, and finally an ultrasound performed by an internist who advised that both of his adrenal glands are very large (1.3cm).

The internist was concerned also about a possible bladder infection because they gave him a "potty" break during the exam and he did not empty his bladder. Urinalysis did indicate bacteria and he was put on Amoxicillin. A check a few days later by my regular vet showed bacteria still in urine, suggesting that the amoxicillin wasn't working. They sent out a urine culture today to see what exactly the bacteria is to know how to treat. We're awaiting those results which aren't expected for 5 days. In the meantime, he is off all meds and having to deal with a painful bladder infection, poor boy :(

The plan is to treat the bladder infection, check urine again post-meds to make sure it is clear, then begin lysodren treatment. I feel a little more comfortable with the drug after reading your comments. I just want to be as certain as possible that he is Cushing's before treating. Do you think that all of the testing listed above is sufficient, or could all of those things show false positives due to a bladder infection? We have no idea how long the bladder infection has been going on so there is a good chance he had it during all tests. Could this affect his adrenal glands and make them so enlarged? In addition to the testing, he shows many of the clinical symptoms (slight pot belly, skin issues, panting, excessive water drinking/urination, slight hind leg weakness).

In regards to the skin issue, our regular vet and an internist both examined it and did not mention calcinosis cutis specifically, but called it a skin infection. The vet put Rio on Cephalexin which we gave him for about 3 weeks (which I read is also prescribed for UTIs, but Rio still has one). The vet told us to stop all antibiotics for a couple days before the urine culture so they would not affect the culture. His skin improved maybe just slightly while on the meds. I have googled CC and I'm not sure that is what it is. It appears only in small patches in front of his ears as tiny red bumps and worse around his back and sides towards the tail-end of his body as white "scabs" that can be flaked off. His skin doesn't seem to itch or affect him whatsoever. It does look like his fur is getting really thin over the affected areas.

Any other advice you can offer is much appreciated!

[adukes]

An addition to my response above...

I did find some test result values that may be helpful. I don't understand everything, but just quoting doctor's write-up... Urine cortisol:creatinine ratio was 171. ACTH stim test -> pre ACTH cortisol 113.5 ng/ml (2.0-56.5) and post ACTH cortisol >490 ng/ml (70.6-151.2). Urinalysis back in March of last year (when excesive drinking/urination 1st started) showed USG of 1.010 with 1+ protein. CBC and chemistry panel completed at the same time showed mild hypercholesterolemia (388mg/dl; 92-324) but otherwise unremarkable (normal ALP), total T4 .9 ug/dl (.8-3.5). In this past October (after more symptoms started appearing an thirst/urination continued) we went back in for another CBC and chemistry panel -- all within normal limits but total T4 .6 ug/dl (.8-3.5). Another CBC done last week, I don't have the specific values but vet said ALP is now "elevated" and T4 is still .6

[Harley PoMMom]

Posting those ACTH stim results would help us to provide better feedback. Also, does Rio have a ravenous appetite?

Any chronic illness can cause the adrenal glands to enlarge. Was Rio checked for diabetes?

Sorry my post is short and has more questions but I am at work and it is a busy night! :eek:

Hugs, Lori

[adukes]

Hello! We are starting Lysodren therapy tomorrow with my sweet fur-child, Rio, an 8yr old Australian Cattle Dog. We are SO, so nervous about this drug and want to make absolute certain that we don't push him into Addison's. A couple questions: From what I read, dosage from our vet appears correct -- 500mg pill twice a DAY for the induction period and 500mg pill twice per WEEK for the maintenance phase. Rio is about 57 pounds. Does this sound typical? Also, everything I've read indicates that an ACTH stim test be done within 48 hours of suspected loading to confirm loading, before maintenance begins. My vet doesn't want to do the test until sometime during the maintenance phase. Has anyone ever heard of this protocol? Also, in others' experience, do the symptoms (decreased appetite, water drinking, etc) drastically and very noticeably change to suggest loading is complete, or might it be very subtle? I'm so afraid to overdose when he is sufficiently loaded! And finally... he is also on Zenequin (for a 3rd and final week) for a UTI which is now clear, but vet wants to continue meds for 1 more week during Lysodren to make sure it doesn't reappear -- any issue with Lysodren in combination with this antibiotic? Thanks for any guidance/experiences you can share!!

[Junior's Mom]

Welcome to the forum. I use trilostane for my dog, so hopefully the lysodrens experts will chime in soon. I do know that while loading it is very subtle signs you watch for, such as stopping in the middle of eating, even for a second, when that has not been the norm, or less drinking. When you see signs of loading, quit giving the meds, and have the acth test done 48 hours later. Lysodren stays in their system for that long, so it is very important to pay close attention, and time the acth right. I hope that helps to others come along.
Any tests you have had done, will be helpful if you post any abnormal results, and include the reference ranges for them as well. The more we can know about your pup, the more help will be available to you.
Oh, make sure you give the meds with a meal.
Tracey

[lulusmom]

I have merged all three of your threads so that we can keep all of Rio's information in one place. If you would like, I can change your title to read something like "Rio, 8 y.o. Australian Cattle Dog Treating with Lysodren."

Having had two dogs who were treated with Lysodren, I am very familiar with the drug. The first thing you need to do is read the Lysodren Loading Instructions that is in our Helpful Resources section. I've included a handy link below. I highly recommend that you print this out and keep it handy so that you have it to refer to. Recommended loading dose is 25mg/kg to 50mg/kg. Your vet has prescribed a bit over 38mg/kg. My two cushdogs were 4.5 lbs and 6.5 lbs and both loaded on the maximum dose of 50mg/kg. Did your vet give you prednisone to use in case of an emergency?

Lysodren is a fat soluble drug so it must be given with food for proper absorption. I gave my dogs their pills in a ball of cream cheese of peanut butter. Both of these things have a good amount of fat in them so the drug will be absorbed well into the gi tract. Never give before food because you need to watch Rio eat for signs of loading. Lysodren has a cumulative effect and will continue to erode Rio's adrenal tissue for up to 48 hours. You can't take a pill back so make every effort to pick up any sign he may give you. When you get that sign, do not give him any more Lysodren and call your vet to schedule an acth stim test, preferrably 48 hours after the last dose.

You need to watch Rio like a hawk when he eats so you can't put his dish down and walk away. Signs of loading can be as subtle as lifting his head out of the bowl to look at you, just a momentary pause n eating or finishing his food in 20 seconds instead of 10 seconds with the bowl as clean as a whistle.:D Also a decrease in water intake can be a sign. You want to look for anything out of the ordinary.

A conscientious vet will start to call a pet owner on day three of loading and every day thereafter to make sure that the pet owners is doing their job. I do hope your vet is conscientious but the good news is that if he isn't, we are so we'd really like you to check in every day with an update. If you aren't sure about something, ask. A world renown endocrine expert, Dr. Edward Feldman, lectures a lot on cushing's and it's treatments. While most specialists have changed their first line of treatment to Vetoryl, he prefers Lysodren because he's been prescribing it for over 40 years. He said it takes team work to safely and effectively treat with Lysodren and if a dog gets sick, somebody really screwed up. In our experience, it's usually the vet and that's why it's so important that we do more than follow instructions. We need to learn so that we understand instructions. It's a tough row to hoe but we're here to help you help Rio.

Lysodren Loading Instructions and Helpful Tips
http://www.k9cushings.com/forum/showthread.php?t=181

Glynda

P.S. I just went back and saw that It should be fine to give the antibiotic with Lysodren and your vet needs to follow proper protocol. You have to do the acth stim test after you quit dosing to make sure he is loaded. How in the world would your vet even know when to start maintenance dosing without even knowing if Rio is loaded? Has your vet treated any cushingoid dogs or is Rio his/her first?

[Squirt's Mom]

I went ahead and added Rio's name to the title of his thread so hopefully it will be easier for you to find in the future.

[adukes]

Hello! My 8yr old, 58lb Australian cattle dog started Lysodren induction therapy on Sunday. We have not seen any changes in symptoms (drinking/urinating/eating etc) until today, day 7. While Rio never had the increased appetite, he has always had a good appetite and finished his meals. This morning I fed him breakfast (I've been feeding him a little less during induction on vet's recommendation) and he didn't finish it. He ate some, drank some water, went potty outside, came back in and nibbled a bit, but still left a bit in the bowl. It sounds to me that he may be properly loaded - or at least ready to stop the drug and have cortisol levels tested? His drinking - which is what the vet told us to use as the indication marker - is still very increased. He still drinks about 2 gallons of water a day (4.4x normal for his weight). Can a dog be loaded and still have the polydipsia? Thanks! Andrea

[labblab]

According to noted authority, Dr. Edward Feldman, reduction in appetite is sufficient change, in and of itself, to halt Lysodren loading.


Lysodren administration should be stopped when:

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

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

3. the dog vomits.

4. the dog has diarrhea

5. the dog is unusually listless.

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

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

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

I would not give any more Lysodren, and schedule an ACTH test for Monday morning. Good luck!

Marianne

[labblab]

P.S. I've merged your loading question into your original thread and edited the title. ;)

[Harley PoMMom]

I agree with Marianne 100%. No more Lysodren and since Lysodren continues to work for 48 hours after the dose was given, scheduling an ACTH stimulation test for Monday is perfect.

Keep us updated, please!

Hugs, Lori

[molly muffin]

Yep, no more Lysodren. He didn't have any this morning right? Then the ACTH will be monday. (lysodren will keep working for another 48 hours, so you'll get the most optimum results on Monday)

Sharlene and Molly muffin

[adukes]

Hello- rio went through induction on lysodren. On day 8 of taking 2 pills 2x daily, he would not eat anything, not even his favorite treats. He was extremely listless and lethargic with very wobbly legs. We were very scared and believe he may have had lysodren toxicity. We took him to vet for atch stim test to check cortisol levels. We gave him prednisone per vets orders on that day and 2 days after and have not given lysodren for 4 days now. We will not get the stim test results back until Wednesday butvet wants us to go ahead and give rio a lysodren pill to keep the adrenal gland where it currently is. I feel very uncomfortable doing this after the terrible reaction rio had. Could 1 more pill after a 4 day break period cause toxicity again? Also, is it possible we may have pushed rio into Addison's? Thank you!

[labblab]

Could 1 more pill after a 4 day break period cause toxicity again? Also, is it possible we may have pushed rio into Addison's? Thank you!
I believe the answer to both those questions is "Yes," and if Rio were my dog, I absolutely would give no more Lysodren until the results of the ACTH are known. Waiting another day should not make that much difference even if it is indeed appropriate to resume dosing. But if he has been overdosed already, giving more medication can make him even sicker and even push him into a permanently Addisonian condition. How has he been acting since stopping the prednisone?

Marianne

[adukes]

Marianne- thx for your reply! We gave him 20mg of prednisone when he appeared lysodren overdosed. It didn't take effect quickly so vet also gave a shot of cortisol. After a few hours he seemed to be himself again. We gave him 10mg of prednisone that night and 5mg the next day. He seems to be fine but maybe a slight bit lethargic.

[Squirt's Mom]

I would not give any more Lyso now like Marianne said. Also, I am so sorry your vet apparently did not tell you what to look for that indicated the load had been achieved and instead had you counting days - which is flat the wrong way to approach a load. Marianne had posted on the 15th of March pertaining to the load and when to stop it.

Please let us know what the test results are as soon as you can and do NOT give any more Lyso until then...and maybe not for a while after depending on those results and Rio's behavior. Keep a close eye on him and keep giving the pred as long as it's needed.

Hugs,
Leslie and the gang

[adukes]

Leslie, thanks so much for your reply! This was our 2nd attempt at loading. We initially started the lysodren induction at the end of march. I knew the signs to look for that would indicate loading achieved. On the 7th day rio didn't eat all of his food so I thought that was an appropriate cue to indicate loading complete. The vet agreed and didn't want to run the stim test at that time, instead beginning rio on a 2x weekly maintenance dose. We didn't see a real reduction in cushings symptoms. A couple weeks ago we had a stim test run which showed cortisol levels still very out of control so vet advised to re-load and too look for "a DRASTIC decrease in water consumption". We never saw a drastic decrease until suddenly after 8 days of doses, rio would not eat/drink/etc has described in my post. We will get the latest stim results tomorrow and hope he does not have Addison's now. I'm also wondering if a 5 day break from lysodren would cause a need to go through loading again or if enough medication is in his system to start maintenance dosage depending on what the stim test says. We are really scared of lysodren after seeing him go through the bad reaction Friday, but want to get his cushings under control. His calcinosis cutis is running rampant and back legs getting weaker. :(

[Renee]

Your vet scares me, as it sounds like he may not know the proper protocols for managing a dog on lysodren.

I am glad you came back here for advice. Please keep coming back so we can help you. I am not a lysodren mom, but there are many here that are very well versed in it. Let them help you, especially since it sounds like your vet has already made some mistakes.

[labblab]

This was our 2nd attempt at loading. We initially started the lysodren induction at the end of march. I knew the signs to look for that would indicate loading achieved. On the 7th day rio didn't eat all of his food so I thought that was an appropriate cue to indicate loading complete. The vet agreed and didn't want to run the stim test at that time, instead beginning rio on a 2x weekly maintenance dose.
I am so sorry to say that your vet's decision not to perform the original ACTH and to instead blindly advance to maintenance dosing is a total breach of protocol which launched you on this complicated and now dangerous chain of events. To add insult to injury, to resume loading with the instruction to continue until your dog REALLY looks ill is also counter to safe protocol.

I am sorry that I do not have the time right now to read back through your thread, but do you have any other veterinary options in your area? I would be very afraid to place my dog under the care of a vet who prescribes such a powerful drug without following the proper protocol for dosing and followup care. I surely understand your sense of urgency in achieving a load, but this drug can truly be life-threatening when not handled properly. As I say, under the circumstances you've described thus far, if it were me, I would wait until you have the test result tomorrow before resuming any Lysodren dosing.

Marianne

[Squirt's Mom]

Your vet is putting Rio at risk. I would find another vet today. ;)

[lulusmom]

Others have already provided their comments, all of which I agree with, but I wanted to share my own comments based on my extensive experience and knowledge of Lysodren. To keep my thoughts organized, I have typed my comments and questions in blue text within the body of your last post below.


Leslie, thanks so much for your reply! This was our 2nd attempt at loading. We initially started the lysodren induction at the end of march. I knew the signs to look for that would indicate loading achieved. On the 7th day rio didn't eat all of his food so I thought that was an appropriate cue to indicate loading complete. The vet agreed and didn't want to run the stim test at that time, instead beginning rio on a 2x weekly maintenance dose.

You were absolutely right in discontinuing dosing; however, your vet didn't follow your good work with his own. He blew it when he failed to do an acth stim test on day nine to determine if loading had been achieved. He is either inexperienced or was being cost conscious on your behalf. If the latter, I appreciate that but in the end, a dog can pay a heavy price for that bad decision and so can your wallet.

We didn't see a real reduction in cushings symptoms. A couple weeks ago we had a stim test run which showed cortisol levels still very out of control so vet advised to re-load and too look for "a DRASTIC decrease in water consumption". We never saw a drastic decrease until suddenly after 8 days of doses, rio would not eat/drink/etc has described in my post.

I suspect that Rio's appetite diminished a day or two before he completely stopped eating and drinking, which should have been a sign to you to quit dosing him. It is a well known fact that resolution of excessive drinking and peeing is not always seen when a dog is loaded. Apparently you followed your vet's instructions to the letter and had no idea that those instructions were very dangerous. Can you please post the actual results of the acth stim test?

We will get the latest stim results tomorrow and hope he does not have Addison's now.

I hope he doesn't either but if he does, the blame sits squarely on your vet's shoulders. I know that your vet is probably feeling some pressure to get Rio stabilized in the hopes to get the upper hand on the calcinosis cutis; however, this is not the way to get a dog stabilized.

I'm also wondering if a 5 day break from lysodren would cause a need to go through loading again or if enough medication is in his system to start maintenance dosage depending on what the stim test says. We are really scared of lysodren after seeing him go through the bad reaction Friday, but want to get his cushings under control. His calcinosis cutis is running rampant and back legs getting weaker. :

It is natural to be afraid of Lysodren because it is a serious drug; however, if administered by an experienced vet, who follows proper protocol, and an educated and vigilant pet owner, a dog should never get sick. Dr. Edward Feldman is probably the world's premier expert on Lysodren and he lectures on this point. He says that if a dog being loaded with Lysodren stops eating completely and falls ill, somebody screwed up. I'd say Rio is a perfect example of that. I had two cushdogs and over the course of 8 years, I loaded them multiple times with no adverse effects. Unfortunately, Lysodren is lifelong and dogs do have lapses that require a reload or increase in maintenance dose, so pet owners need to be prepared to do both with an understanding of proper protocol and an excellent understanding of the drug itself. Many members have had the same safe and excellent results with Lysodren. Experiences like yours are the reason why the internet is wallpapered with comments from pet owners who call Lysodren poison that almost killed there dogs. I would bet my next paycheck that those sick dogs got sick because their vet failed to follow protocol and failed to educate their client on the importance of their role in administering Lysodren.

In a prior post, I provided you with a link to Lysodren Loading Instructions written by Dr. Edward Feldman. We highly recommend that all members read those instructions thoroughly so they do not have to place blind faith in a vet. If you read those instructions, you will see that Dr. Feldman states that "Usually the water intake diminishes within days of beginning treatment, but it does not usually become normal until after some reduction in appetite is observed." It seems your vet told you to ignore any changes in appetite and instead only stop when you see a drastic change in water intake. Please take the time to read this thread and familiarize yourself with the drug. If you plan on continuing Rio's treatment with this vet, I highly recommend that you print out the Lysodren Loading Instructions and give them to your vet. Given Rio's calcinosis cutis and the bad experience he's had so far, I highly recommend that you consider consulting with an internal medicine specialist. If you do not know of any specialists in your area, you can do a search at www.acvim.org or if you can let us know what city and state you are in, members may be able to give you a name or two. I am again providing a link to Lysodren Loading Instruction below:

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

We are all here to help you get Rio back on the road to a much better quality of life. Yes, Lysodren is a serious drug but it is also a miracle worker. I've seen those miracles many, many times.

[adukes]

One more question... Ever since rio's bad lysodren reaction on Friday, he hasn't been back to his regular appetite. The last couple days he ate both of his meals, but bit by bit throughout the day whereas he used to inhale it all in one sitting. Today he never finished his breakfast and didn't eat dinner. Is this still lysodren toxicity? He hasn't had any for 5 days now. Should I give rio more prednisone? He last had 5mg on Sunday -- 10 mg on Saturday and 20mg on Friday. Thank you!

[My sweet Ginger]

Ignorant and inexperienced vets are much more scary than drug itself. I just can't fathom the fact that this kind of incidents keep happening to these innocent pups and their owners who put their blind faith in their vets.

Yes, my dog is one of those pups and she is still off Lysodren after almost 6months now and it has cost us way, way more than it should've been had our vet followed the Lysodren protocol correctly in the first place.
Although I understand you being worried about cortisol creeping up again but please, don't get too anxious to put Rio back on Lysodren. You really have to make sure if he can start the maintenance depending on the results of ACTH test and also there's a chance he may not going to need it right away.

Yes, I'd give him therapeutic dose prednisone everyday as long as he needs it. My baby needed it to survive for months and still on it.
I hope Rio recovers soon but I do think you need to either see an IMS or a new vet who has more experience on Cushings. It means nothing how long they've been in practice if they don't have enough experience with Cushings disease. My vet has been in practice for 17 years and look what my baby has been going through.
I will pray for you and Rio for a better outcome than ours. Take care, Song.

[Squirt's Mom]

If Rio is still not eating, I would certainly continue the pred. And I would get him in to see another vet TODAY. ;)

Would you please, please, please post the ACTH results Glynda requested in her post? Did the vet check the electrolytes? If so, please post those results as well.

Let us know how Rio is doing!
Hugs,
Leslie and the gang

[labblab]

I am thinking that you are scheduled to get the most recent ACTH result today? If so, we will be very anxious to know how it turned out because that will guide the next steps, including whether or not Rio still needs supplemental prednisone. If so, the standard formula for calculating the "rescue" dose when insufficient cortisol is being produced naturally is 0.25 mg. per kg. (1 kg. equals 2.2 pounds).

If a dog has been overdosed on Cushing's meds, however, the cortisol level is not the only adrenal hormone that can be affected. On occasion, aldosterone can also drop too low. That is the hormone that regulates the balance of sodium and potassium in the body. So as Leslie says, I hope that Rio's electrolytes were also checked (basic blood chemistries including sodium and potassium levels). If aldosterone was also lowered too much for Rio, then he may need the supplementation of another drug in addition to prednisone.

As you can see, this can all become rather complicated. I've now had the chance to glance back in your thread and see that there is a specialist with whom you may be able to consult. In the long run, this may save you money because seeing someone who is more knowledgable about proper treatment protocol can eliminate a lot of unnecessary worry, extra testing, and even possible ER visits. :o

Marianne

[adukes]

Rios acth stim test results are back: 10.73ng/ml baseline and 22 ng/ml post acth. The vet advised that this is a good result and rio
Is in non-cushingnoid levels after lysodren induction. He wants us to begin maintenance dose at 2 pills a week. We are concerned about
Giving more lysodren after his bad reaction on Friday. He still doesn't have his normal appetite back and seems very lethargic. The vet said this is just Rio adjusting to the medicine. Do you think it is safe and appropriate to start the maintenance lysodren? He hasn't had
Any in 6 days. Thank you!!

[lulusmom]

Can you tell me how long after Rio's last dose of Lysodren was the acth stimulation test done? Was the steroid injection given before or after the stim test? If before, how long before?

I'm sorry but if your vet actually told you that Rio's lack of appetite and lethargy is just him adjusting to the meds, he clearly knows absolutely nothing about how Lysodren works. These are not symptoms of adjusting to a medication, they are symptoms of a dog who has had too much of his adrenal cortex tissue killed by Lysodren and may not be producing enough cortisol as a result. Your vet needs to open a book and learn about the disease he is treating and gain a much greater understanding of how Lysodren works.

Once you respond to my questions, I'll be in a much better position to answer your questions about when maintenance dosing should be started.

Glynda

[adukes]

Thank you for your help Glynda!! The stim test was done approximately 14 hours after rio's last dose of lysodren. The steroid injection was given immediately after the test but we did give him 15mg of prednisone tablets were given 15minutes before the 2nd blood draw of the stim test because rio was in such bad shape. The vet said it wouldn't affect the results because 15minutes isn't long enough to get into the blood stream. The vet is pressuring us to give the lysodren now because the stim test shows that cortisol
Levels are right where they need to be. Thank you!!

[My sweet Ginger]

Glynda will tell you what it means and what you should be doing but I just wanted to say that you should never go back to this vet again. He seems to be doing everything wrong including waiting 48hours and not 14.

[lulusmom]

Lysodren has a cumulative effect for up to 48 hours, meaning that it's strength increases with every dose for up to 48 hours. Since Rio's stim test was done only 14 hours after his last dose, chances are the numbers on the stim test are overstated and that Rio's cortisol would have continued to drop for several hours after the stim. Do not start Rio on maintenance yet!

I have to run to an appointment so I don't have time to type anything more but in the meantime, let us know if you have any questions.

[lulusmom]

Let me preface this by saying that we don't abide by vet bashing and we do give vets the benefit of the doubt, as many members are distraught and may not understand what the vet is telling them. I don't believe that's the case here because there have been too many missteps by your vet to attribute them all to a misunderstanding. If the facts as you have stated them are correct, then it is difficult for me to be honest and not come across as vet bashing. My goal is not to malign your vet but to try to educate you so that you understand how egregious your vet has been in repeatedly breaching protocol, placing your dog at risk.


The vet is pressuring us to give the lysodren now because the stim test shows that cortisol
Levels are right where they need to be. Thank you!!

In my opinion, Rio's stim results were a bit too low for comfort, even if your vet had done everything by the book. Since your vet has done very little by the book, including understanding the cumulative effect of Lysodren, the stim results should have been concerning for him as Rio had very little wiggle room for cortisol to drop any lower. I'm sure Rio's cortisol did drop lower and that's why he has not bounced back. For your vet to pressure you into starting maintenance is outrageous and to pressure you while Rio is still sick makes me want to ring his neck.

Did your vet check Rio's electrolytes when he did the acth stim test? Marianne has already mentioned that in some cases of severe adrenal erosion, aldosterone can be affected as well as cortisol. This can be even more life threatening if not addressed with appropriate supplementation. When your vet saw that Rio was sick enough to give both oral and injectable steroid, he should have automatically checked electrolytes. Please call his office tomorrow and ask.

I personally would not start maintenance until Rio is completely well but if it were my dog, I would ask for a referral to an internal medicine specialist tomorrow and let the specialist direct me as to when to start maintenance and at what dose. Rio's adrenals could be severely necrosed and if they are, starting maintenance before giving them time to regenerate enough could kill him. That's why you need a specialist. Rio needs an experienced professional to get him safely stabilized and your gp vet is not that professional.

Glynda

[adukes]

Thank you SO very much for your help. We are feeling a bit lost here with a sick dog and a vet we can't rely on. The vet did not check electrolyte levels. I set an appt with an internal med specialist but the earliest appt available is not until Monday. I don't really feel comfortable doing nothing for Rio until then. He is drinking water like usual but seeming to eat less and less each day. He won't touch his dry food but will eat treats. Should I continue prednisone? I'm so nervous that something could be deteriorating in rio. Thank you again!!

[lulusmom]

Yay, I'm so glad you made the appointment with a specialist. Yes, give him a dose of Prednisone and see if he perks up. Do you know which steroid your vet injected?

[adukes]

The vet said the injection was cortisol. He gave it at no charge -- I think he was as nervous about rio's lysodren reaction as we were! The prednisone bottle advises to give 5mg 3x daily "as needed" for
Addisonian crisis. Is this the correct dosage I
Should be following? Should I continue prednisone until rio seems more like himself? I'm so grateful for the help I have received here!! It just may have saved my dog's life!

[lulusmom]

Here is information posted by Lori, one of our administrators, on how to determine prednisone dosing:


The standard rescue dose of pred is 0.25mg/kg. To find her wieght in kg, divide the lbs by 2.2...then multiply that result (her weight in kg) by 0.25 and you will have the amount for her weight.

If she weighs 50lbs...50/2.2 = 22.7 * .25 = 5.68mg of pred. Though since she is really feeling yucky, I would give a little more.

If you aren't sure how to do the formula above, please provide Rio's current weight and I'll do it for you.

Glynda

P.S. Since Rio still likes treats, why don't you try feeding him boiled skinless, boneless chicken breasts and rice until you can get him seen by the specialist. Make sure you cook the heck out of the rice so that it is good and mushy. It will require extra water.

[adukes]

Thanks, all! We are at the vet's office now waiting on bloodwork to check electrolytes. We have an appt mon morning with a specialist we will consult with regarding treatment at this point.

[lulusmom]

Please update us when you can.

[adukes]

Hello! Rio is currently on 2 lysodren pills a week on 2 different days. My mother is in town helping with my newborn and she mistakenly gave Rio 2 pills on the same day -- 1 this morning and 1 this evening. Should I be nervous? He already had 1 terrible reaction back when he was in the loading phase. He has been on maintenance a couple months now. Thank you!

[addy]

Please call your vet- bumping up

[mytil]

Yes I would contact my vet right away. And I would see about taking him in right away too.

[labblab]

I definitely agree with contacting your vet. My nonprofessional guess is that Rio will probably be fine, though. You will just need to wait for a full week before giving any more maintenance dosing. I think there are a few vets who don't tell owners to divide the weekly maintenance into divided doses, and only a single weekly total is given as a matter of course. As a general practice, though, I think there are reasons why the divided dosing is preferable.

Marianne

[molly muffin]

Hope to hear that everything is going well with Rio and the baby. :)

Sharlene and molly muffin

[adukes]

I need help again! Rio had to go through re-induction with Lysodren a few months ago and had a bad reaction. He had to take prednisone for a few days and we were scared to start Lysodren again after a scary experience. After 2-3 weeks off lysodren we started the recommended dose of 2x 500mg pills a week. Rio is 58 lbs. Another stim test about 2 months ago showed rio's cortisol levels increasing (don't remember the #s) so the vet suggested adding another 1/2 pill. We are currently giving 2.5 pills a week. Over the last couple weeks, cushings seems to be coming back with a vengeance. All the symptoms that had dissipated are back and getting worse than ever -- panting, drinking gallons of water a day, potbelly, back leg weakness and Calcinosis cutis. Just when we were so happy that we had our "old dog" back, he seems to be slipping away again. I haven't talked to the vet yet because he is so inexperienced and I don't trust everything he recommends. My question is -- do you think rio has to be re-inducted with the lysodren? This would be the 3rd time. Is there any harm in doing this so much? We are so nervous after the last time. Thank you!

[Squirt's Mom]

Are you doing repeated mini-loads or doing a full load again each time? Is the vet just increasing the dose without ACTHs showing increased cortisol? Would you mind posting the most recent ATCH results? Is there anything else going on with Rio that might account for the things you are seeing? Has an ultrasound been done lately? Has he had lab work to check things like liver and kidney function?

Nosy old broad, huh? :D

[lulusmom]

Welcome back and I'm sorry that things haven't been going well with Rio. It's difficult for us to provide you with any meaningful feedback without more specific details. You mentioned a while back that you made an appointment with a specialist. Did you ever follow through with that appoint and if so, can you update us on his/her opinion.

I don't have time to go back and read through your whole thread so I'm assuming that by bad reaction, you mean that Rio's cortisol dropped too low and he got sick? Was an acth stimulation test done at that time to check his cortisol levels? If so, can you please post the results? Can you give us some timelines? When did he crash, how long was he on prednisone, how long after weaning from prednisone did you start a maintenance dose. Was a stim test done before you started a maintenance dose? How long was he on a maintenance before he had another stim test? He should not have gone longer than a month, especially if no stim test was done before starting maintenance. Leslie has already requested but I will second the request for the most recent acth stim test results. I am assuming that would be the stim test that was done about two months ago.

What I can tell you for absolutely certain is that you need to get Rio scheduled asap for an acth stimulation test to see where his cortisol levels are. You need to get his cortisol under control to resolve symptoms and it becomes even more urgent when you are dealing with calcinosis cutis. I highly recommend that you continue Rio's treatment with the specialist because your vet's approach has never been according to protocol and it's not working. I would also recommend that you go back and read every post in this thread to refresh your memory, as well as take note of important information that has already been provided so that you are prepared for any future problems. I'll be looking forward to as much information as you can possibly provide.

Glynda

[adukes]

Thank you both for your responses. In answer to your questions...

We have done a full load twice -- on the 2nd one is when he had the bad reaction (signs of lysodren toxicity) and had to be given prednisone. A stim test was not done at that time. The vet has not made mention of a "mini load" so I'm very interested to hear what that is? I DREAD the loading phase, especially after the bad reaction he had last time on day 5.

The vet increased the dosage by 1/2 pill after getting the results of the last stim test (which was about a month after we re-started the maintenance dose after the "break"). I don't recall what the numbers were on that one. I remember the vet saying his cortisol was still very high,but because rio wasn't showing the clinical signs at that time and seemed to be feeling good, he didn't think a re-load was necessary but wanted to up the dose so the cortisol didn't continue to creep up.

I don't know that another issue could be causing the effects we are seeing. We haven't had an ultrasound in 6 months or so, and a blood test maybe 4 months back. Is it routine to check liver/kidney function when a dog is on lysodren? I do worry about the impact the lysodren has on his poor liver. I seem to recall at the last bloodwork that his liver values were abnormal but the vet just said that is typical for Cushing's.

Unfortunately we can't see the specialist without a general vet referral. We are working with our GP vet but I always like to check in with this AMAZING forum to see what people think since I don't always trust the vet's protocol.

Thanks again!! I appreciate your opinions and educating me so at least I know what to request from the vet.

[adukes]

I just located the results from Rio's last blood test which was done 4 mos. ago. At that time he had 4 values in "high" range. PLT = 803 K/ul. ALT = 157 U/L, ALKP = 958 U/L, GGT = 79 U/L. I understand that the last 3 are related to the liver. Should I be concerned?

[adukes]

Hello! I have another question! My dog, Rio, has just begun his 3rd round of Lysodren loading. This week we had a ATCH stim test and full blood panel. My question is... is there anything in the bloodwork of a Cushing's dog of which we should be watchful? I worry about the effects Lysodren treatment has had on Rio's organs as well as other illnesses that Cushing's dogs may be predisposed to acquiring (Pancreatitis?). The blood results show a lot of items in the high (some VERY HIGH) range -- ALT, Alk Phosphatase, GGTP, BUN/Creatinine Ratio, Phosphorus, Monocytes and Lipase (extremely high!). Does anyone have any insights on any of these values?

[Harley PoMMom]

Hi, and I am so sorry that none of us reponded to you previous post.

If you could edit your post to include the actual test results with the reference ranges along with the units of measurement that would help us a lot...i.e...ALT 150 U/L (5-50)...thanks! Also, please post Rio's most recent ACTH stim test results.

Dogs with Cushing's generally have elevations in the Alk Phosphatase, cholesterol and possibly a mild elevation in the ALT.

How is Rio feeling? What Cushing's symptoms does Rio display? What is his loading dosage? Is he getting his Lysodren with some fat after he finishes his meal?

Hugs, Lori

[molly muffin]

Lipase can be reflective of the state of the pancreas, so can you post all the abnormals with the range?

Yikes, I'm sorry that your post got missed too. :(

hugs

[Squirt's Mom]

Could you post those results along with the normal ranges? (Oh I see Sharlene already asked! :D)

So you did go ahead with the mini-load or do a full load again? Good to see you posting in Rio's thread!

Hugs,
Leslie and the gang

[adukes]

Hello and thank you for all of your responses! :) In answer to your questions: Rio seems kind of mopey overall. His symptoms -- extreme water consumption and frequency of urination, potbelly, very weak bag legs and exercise intolerance. Frisbee is his favorite activity, but due to his back legs, he cannot play at this time. Also, we have to lift him into the car or onto the couch. When we go on walks he really drags.

The loading dosage we are using is 2x500mg tablets a day. I give it to him after a meal inside bread. Is there a better recommendation for food to serve it with?

Atch stim test results: sample 1 = 7.1ug/dl (1.0-5.0) and sample 2 = 33.1ug/dl (8-17)

Blood results: T4 =.7 ug/dl (.8-3.5)
ALT (SGPT) =299 U/L (12-118)
AlkPhosphatase = 1459 U/L (5-131)
GGTP = 267 U/L (1-12)
BUN/Creatinine Ratio = 28 (4-27)
Phosphorus = 6.4 mg/dl (2.5-6.0)
Monocytes = 920 /ul (0-840)
Lipase = 1666 U/L (77-695)

Thanks for any insight! We want to make sure we covering all of our bases for our fur love!

[Harley PoMMom]

Lysodren should be given with some sort of fat, such as cream cheese or peanut butter, you can hide the pills inside the peanut butter or cream cheese, and giving the Lysodren after he finishes his meal is correct, good job!

Does Rio still weigh around 58 lbs?

[Squirt's Mom]

ALT (SGPT) =299 U/L (12-118)
AlkPhosphatase = 1459 U/L (5-131)
GGTP = 267 U/L (1-12)

I am a bit concerned about these liver values. It is common for cush pups to have elevated liver enzymes, especially the AlkPhos. But elevations in all three could indicate something other than Cushing's, like liver disease or gall bladder issues so keep an eye on them after treatment begins. If they start going down we can be pretty sure this is related to the uncontrolled cortisol. If they continue to rise, I would want some further testing. But getting that cortisol under control may well be all that is needed. ;)

You're doing good, Mom!
Hugs,
Leslie and the gang

[adukes]

Thank you! Yes, Rio is still about 58 lbs. The last time we got bloodwork an an ATCH stim test before this week was May. Those results showed cortisol levels as normal but blood still showed ALT, ALKP and GGT in high range, although not AS high as they are now. Could this suggest liver or gall bladder issues? These are the results from May vs. now:
ALT 157 U/L (10-100) currently 299
ALKP 958 U/L (23-212) currently 1459
GGT 79 U/L (0-7) currently 267

Also - does anyone know anything about elevated Lipase levels? I have read that Cush dogs can develop pancreatitis and from a little research I have done online, Lipase values can indicate pancreas issues.

Thanks again! I am so grateful for this forum!

[molly muffin]

Yes high lipase levels can indicate pancreas issues. The high GGT bothers me too.
I think I'd ask about liver bile acid test and a Spec cPL Test to rule pancreatitis in or out.

[adukes]

Rio has now received Lysodren twice a day for 5 days as we go through the loading process. The last time we inducted was in May and he had a horrible reaction (toxicity?) where he suddenly was collapsed listless on the floor. He wouldn't drink, eat, etc. I was so scared we were going to lose him that day. He had to have a shot of cortisone and prednisone tablets. We didn't see any signs that he was loaded - no decrease in water consumption or subtle signs of disinterest in food - and then suddenly he seemed "over" loaded on lysodren. I'm praying that doesn't happen again. As each day of induction passes with no signs that he is properly loaded, I get more and more nervous. I wish his Cushings wasn't overcoming him the way it is. His back leg are virtually useless and now his front legs seem to be deteriorating so quickly. Tonight he could barely make it up the stairs to go to bed -- breaks my heart. I just want our dog back :( I'm understand it varies but does anyone know how long loading typically takes -- 7-10 days? The vet said to watch for decrease in water consumption and that it will be drastic, but that didn't happen last time. I've read about all of the other signs to watch for as well and it bothers me that the vet didn't tell me about other possibilities besides just the water consumption. That's why I'm so grateful for this awesome forum. I don't know how to state it more eloquently than to say Cushings sucks.

[StarDeb55]

I haven't posted to you before but have been following Rio's story. Standard protocol for a loading normally states that if a pup shows no signs of loading by day 8, the pup should be brought in for an ACTH to see where you are, & to avoid what happened to Rio the last time. It looks like your vet didn't say anything about this. If not, I would insist your vet that you want Rio to have an ACTH done on Thursday.

Let me tell you how crucial this can be. I was loading my first boy, Barkley, measuring water daily, watching how was eating, doing everything I should be doing, absolutely nothing had changed by the eighth day. I brought him in for an ACTH. My vet called the next afternoon, asked if I had measured water yet, I told her no. She said she would wait, and to please measure the water. Much to my horror, water consumption had dropped 60%. I was back on the phone with the vet, & she was not surprised as B's stim numbers were very low. He was put on prednisone immediately, & for the next five days. Back for another stim, these number were now within the 1-5 range that you want. Appetite is usually a good indicator with the majority of pups when they're loaded, but not my Barkley. He never, ever lost what I always referred to as that "white shark" appetite, & his Cushing's was well controlled for 8 years.

Please, please talk to your vet about getting a stim done toward the end of this week.

Debbie

[judymaggie]

Hi--I totally agree with Debbie. My Abbie recently loaded after 7 full days of dosing. I kept Feldman's protocol by my side the entire time! He said that reduction in water was less than 60 ml/kg/day. For Abbie this meant less than 22 oz. I had measured the water intake a couple of times before loading so I would have some idea of what she had been doing. Her pre-loading was 28-29 oz./day. I measured water every day of loading ; she dropped to 24 oz. by the second day. I talked to my vet almost every day and he said that he really wanted to see a reduction in food before doing the ACTH. My Abbie is food obsessed--I really thought she might load without any change in eating. I told the vet that I wanted her ACTH done on the 8th day regardless of any changes. Thanks to support from the good folks here I was able to convince my vet that she didn't need to be fasted so she was a lot less stressed than she might have been otherwise. Sunday night was her last dose; test was scheduled for 10:00 the next morning. That morning I was shocked to see Abbie walk away from her breakfast after only eating half. Her eating until that morning had been competely routine. Thr ACTH pre- and post- numbers were showed some slight stimulation but were both very low. I think one more dose would have been too much. Bottom line: you really have to track the subtle changes. Our pups just don't always follow the textbooks.
If I were in your shoes, I would call the vet and tell him you want the ACTH scheduled for Thursday. No Lysodren the day of testing and you would hold off giving Rio any Lysodren until you get the results. (Mine came back in a day and a half with the vet asking for a rush.)

[Squirt's Mom]

Can you tell us how much Rio weighs now and what dose of Lyso he is taking?

Watch for the very slightest change in appetite and thirst then stop the med when you see it. Watch his stools very carefully every single time he goes out. If it is the least bit loose, stop the med. Any change you notice, come ask before giving that next dose, ok? Take it one meal at a time, feeding first THEN giving the pill so you can see if the appetite is the same BEFORE that pill is ingested.

Keep your chin up and stay in close contact while he's loading.
Hugs,
Leslie and the gang

[adukes]

Thank you for all of your support!! I really am so glad that I found this forum while Internet researching Cushings.

Rio weighs 58 lbs. He is taking 2 x 500mg Lysodren pills a day. When he had the terrible reaction last time, loading was less than a week. I don't remember how long but I'm thinking it was on day 5 or 6.

I'm refilling his water bowl from a gallon jug so I can easily see a decrease. He currently drinks the full gallon plus about an extra 32 oz. He also is CRAZY about food so if I see any disinterest, that will be a big red flag.

Based on my research I absolutely plan on scheduling a stim test Thursday if we see no signs before then.

I get more and more anxious with each lysodren pill administered.

Thanks again everybody!!

[Squirt's Mom]

Ok....based on that weight of 58 lbs, Rio weighs 26.36kg. The loading dose is 50mg/kg/day. At 26.36kg, Rio's loading dose would be 1318mg a day divided into 2 doses, am and pm. At 2 500mg tabs, Rio is getting 1000mg/day, slightly under, which makes me feel a bit better than if they had rounded up to 1500mg a day. ;)

You're doing good, Mom!

[adukes]

I just looked through rio's records and found that the bad reaction during loading back in May occurred after giving him 10 doses. As of this morning he has had 11 doses this round. I don't know if past experiences have any implications for how a dog may load. I'm guessing his adrenals could be at a different level now than they were previously. Rio still is feeling fine .. Fingers crossed!

[adukes]

Rio is trembling ever so slightly. Could this be a bad sign or a normal side effect of lysodren? Thanks!

[Squirt's Mom]

How is he otherwise? Did you notice this last time before he went too low?

[adukes]

Otherwise he seems fine. He is still drinking tons of water and begging for food handouts. When he went too low his whole body was shaking badly. Today I could just barely see a tremor in his head and ears. It made me nervous and I scheduled the stim test for tomorrow but now I'm wondering if I should wait until Thursday. I don't want to compromise the loading process but want to play it cautious too!

[judymaggie]

I am definitely not an expert on Cushing's but I don't think that having the ACTH tomorrow will compromise the loading in any way. If the results show that Rio is not yet loaded, i.e., results are greater than 5 ug/dl, you would just continue loading and continue to watch for reactions. If Rio went too low the last time and had whole body shaking, maybe the trembling you are seeing now is that fine line between being too low and being right on target with loading. Yes, the ACTH is expensive and you might find it necessary to do another in a few days but I think you ought to trust your instincts. I realize that not everyone can afford all the testing but, thankfully, I can and, for me personally, peace of mind overrides the expense.

Hang in there!

[adukes]

We were planning on getting the stim test on Thursday (day 8) if no signs were noticed by then, so I'm wondering how much of
A difference 1 day (2 pills) would make in the test results if we do it tomorrow.

[judymaggie]

I was hoping others with more expertise would chime in ... another day of pills could make a difference if Rio hasn't loaded yet but it could also mean a lower drop if he has loaded already. Obviously, that doesn't help you decide! Has the tremor continued? Have you measured his water intake to see if that has reduced at all?

[Squirt's Mom]

As Judy said, if he's not loaded you simply go back to the twice a day pilling and try again in a day or two. If his appetite and drinking have not decreased at all, I think it unlikely he is loaded...but one never really knows. Pups have certainly loaded and gone too low without showing the first sign of being loaded. So for peace of mind, in your shoes I would probably go ahead and have it done early. At worst, you will have to do another in a couple of days.

[adukes]

Thanks everyone! I called the vet last night and he convinced me to wait on the atch stim test until tomorrow. I actually think timing is perfect. Today, day 7 of loading, he finally has exhibited a sign that he has reached the endpoint. He has been drinking just a little water, not the gallon he has usually had by now. He seems to be feeling just fine with no ill effects. I'm feeling better about things!! Thanks again for all your support.

[judymaggie]

Yeah for you and Rio! Looking forward to good numbers -- you might ask your vet if he can ask for a rush on the results. My vet was able to do that and we got a response in 24 hours.

[Squirt's Mom]

YAY! Now no more meds today! Let us know what the ACTH tells and wising you the very best.

[adukes]

Rio's acth stim test results came back yesterday and he is right on target where he should be. However, since yesterday he will not eat his food and seems mopey. He will eat treats and table scraps. He is drinking water also. He hasn't had any lysodren since Wednesday morning. We are hoping to see him get a little pep back and more interest in food before starting lysodren maintentance.

[labblab]

Hi! Can you please get us the exact numbers for Rio's ACTH results?

Thanks so much!
Marianne

[adukes]

The vet only gave me the post number -- 3.3 ug/dL (I believe equivalent to 33 ng/ml or 91 nmol/L.

[adukes]

Rio still won't eat his dog food. We've tried dry food and wet food. He'll only eat treats. And he continues to lay around mopey with no energy. Our vet didnt seem concerned and kind of brushed it off as being Rio's "new normal" having Cushings controlled and wants us to start the lysodren maintenance tomorrow which I don't plan on doing. We're calling a new vet tomorrow to see if we can get rio in for an evaluation. I really want another opinion of the current situation as well as all of the abnormal values on his recent CBC. According to the stim test he is right where he should be but something is not right and we aren't sure how to correct it.

[judymaggie]

Hi -- sorry to read that Rio has not perked up yet. Have you tried giving him a prednisone tablet to see if he responds to that? If he does do better, then it might be that his cortisol has dropped too low. I definitely think a second opinion is in order. Your vet's attitude would have upset me. I read back a bit in your thread and couldn't see that you had consulted with an IMS. Is there one in your area? Typically, they have more Cushing's experience.

[My sweet Ginger]

Yea, I'd try rescue dose of prednisone and see if he perks up and won't consider Lysodren maintenance until he feels better.

[adukes]

I had considered giving him a prednisone but wasn't sure if that would be appropriate since his atch stim test #s are where they should be. Could "normal" levels of cortisol still be too low for some dogs? Could prednisone bring up his cortisol too high? I definitely don't want to ever have to go through the lysodren loading again.

[adukes]

The prednisone label says to give 3 tablets for addisonian crisis. Each tablet is 5mg. Do you recommend I try 1 tablet or 3? Thank you!!

[labblab]

I would try just a single 5 mg. tablet -- that would correspond most closely to a recommended "rescue" dosing formula of .25 mg. per kilogram. Rio doesn't appear to be acutely ill and in crisis with vomiting, diarrhea, physical collapse, etc. But it will be interesting to see whether he perks up with the 5mg. The effects should exit his system after 24 hours so it will not have a long-lasting impact.

Marianne

[StarDeb55]

The one thing to keep in mind is lysodren continues to work for 48 hours after the last dose was given, so Rio cortisol might have dropped a little lower than what the stim indicates. One prednisone will not hurt, & it will help you to determine if low cortisol is the culprit.

I don't see where anyone else has mentioned this, but pup's can go through "cortisol withdrawal" when their cortisol is brought down to a therapeutic level. This withdrawal will indeed make them feel mopey & yucky, but it's simply a case of the pup getting use to the lower levels of cortisol.

Debbie

[labblab]

Hi Debbie, thanks so much for dropping in and making that very useful point about cortisol withdrawal! ;)

Marianne

[adukes]

Any idea how long a "cortisol withdrawal" may go on? Should I continue to wait on starting lysodren maintenance until he seems himself again? We are REALLY hoping to get things under control again. His back legs have gotten so weak that he can't do the things he loves like play Frisbee and go on walks. I don't know if this is uncommon, but his front legs have suddenly started getting weak also. I'm hoping it's not arthritis that the cortisol was masking.

[adukes]

We gave rio the prednisone at 7:30 last night and didn't see any changes by 9:30 when we went to bed; however, this morning he ate a little bit of food and seems to have a little more life in him. Seems he is improving - not sure if that's because of the pred or just coming off of cortisol withdrawal. I guess we will know when the pred wears off.

[My sweet Ginger]

I think it's the pred.

[My sweet Ginger]

Can you please get the pre # from your vet also and post it for us?
Not eating can't be a new normal for any dog in my book. I'd get his inappetence taken care of before the start of maintenance.
Maybe he just needs a few days break from Lysodren before maintenance.
Please, do not be too afraid of cortisol creeping back up. Your dog's safety out weighs the potential adverse reaction that comes from Lysodren overdose. I learned it the hard way at my pup's expense.

Oh, I have to mention my pocketbook expenses, too.

[judymaggie]

Hi -- I am glad to read that Rio seems to have perked up today. I agree with others that it sounds as though the pred was responsible. Have you decided anything about locating a specialist and/or a second opinion on Rio's treatment?

[adukes]

We are picking up a copy of rio's atch stim results so we can see what the pre # was. Today he is back to mopey and not eating so that confirms that the prednisone accounted for the temporary perk and eating. I can't find a specialist who doesn't require a referral from a gp vet. We have an appt tomorrow with well-reviewed new vet so we can get another opinion on treatment and have him review Rio's latest bloodwork. Meanwhile, I'm getting some pressure from the other vet to begin lysodren maintenance despite everything I read states NEVER give lysodren to a dog who does not have an appetite.

While we wait for our appt tomorrow, I'm not sure if I should administer another prednisone or if another day's break from lysodren is sufficient. He has not had any since Wednesday morning of last week.

Thanks again to all of you! I don't know what I'd do without this forum!!

[My sweet Ginger]

Yes, I'd give him another 5mg this morning since his appt. is not until tomorrow.
Can you tell us how many hours after the latest ACTH test was performed after the last dose of Lysodren? Was it around 48hrs after?

Re an appt. with a specialist, tell them that you're trying to get a 2nd opinion and see if they will see him. That's how I saw our IMS the first time. They asked me info about our regular GP but I didn't have to get a referral which you can easily get from the vet you are going to see tomorrow anyway.

Well, I guess you don't have to worry about this vet's pressure 'cus you are probably not going back to him/her after today.

[Renee]

I am glad you are trying to get in to see another vet. It makes me so angry how many prideful vets there are that make it difficult for pet owners to see specialists or even get second opinions. :mad:

[adukes]

Ok - we got a copy of the stim test results. Sample 1 is 3.3 ug/dl and sample 2 is 4.0 ug/dl. The test was performed about 26 hours after his last dose of lysodren. The vet told us when we noticed signs of Rio reaching the endpoint to schedule the test the very next day, which is what we did.

[My sweet Ginger]

It's possible that his cortisol had dropped even lower since the latest ACTH test as Lysodren works for 48 hours. Hopefully giving him a break from Lysodren will bring his adrenal glands back to where they should be since he's not vomiting or having diarrhea. I'm glad he's seeing a vet tomorrow.