Nathalie's Phillip has passed...

[Roxee's Dad]

Hi Nathalie,
I am absolutely happy, happy, happy that no tumors or other nasties were found in the US. I hope the increase in lyso works well without any problems.

Good boy Phillip :D:D:D and great job Nathalie :D:D:D

[Harley PoMMom]

Hi Nathalie!

I am happy too, that no nasties were found in the u/s...YAAAA!!!! And that the ALT is looking so good...another YAAAA!!!!

Great job Nathalie! All along here with Phillip's care you have been the one taking charge instead of his vet and you have been doing a fantastic job. You should be so very proud of yourself, I know I admire you for everything you have done. You are such a wonderful mom to Phillip.

Now, please keep us updated!

Love and hugs,
Lori

[littleone1]

Hi Nathalie,

I'm glad that all of the tests were good. I'm sure that puts your mind at ease.

Terri

[Nathalie]

Thanks Guy's :o I could not have done it without you!
I am going to take him in for another stim in a month - if we are lucky he is holding and if not we just going to have to deal with it.
I will keep you guy's posted. I may not post a heck of a lot but I do read ALL the posts. :)
Thanks again,
Nathalie

[AlisonandMia]

Great to hear that Phillip's US was "boring" - love "boring" results of medical tests!:D And that his liver enzymes are heading in the right direction. He may well be one of those that eventually achieve liver enzymes in the normal range with treatment - quite a few do.

It would be so interesting to know if Phillip's adrenals are somewhat "Lysodren resistant" or if he is a poor absorber of the drug or (ha! ha!:p) both! Wish that serum levels of Lysodren could be routinely measured in dogs - I think it has been done in research but isn't offered to the general public. Probably aren't even reference ranges.

It is odd how he seems to load pretty readily but is so hard to maintain. (Mia, if anything, was the opposite.)

Here's hoping that the dosage increase does the trick!

Alison

[Nathalie]

Thanks Alison.


It would be so interesting to know if Phillip's adrenals are somewhat "Lysodren resistant" or if he is a poor absorber of the drug or (ha! ha!:p) both! Wish that serum levels of Lysodren could be routinely measured in dogs - I think it has been done in research but isn't offered to the general public. Probably aren't even reference ranges.

It is odd how he seems to load pretty readily but is so hard to maintain. (Mia, if anything, was the opposite.)


He is probably both – bugger, giving me a coronary in the process. :oBack when I first got concerned about what now seems a ‘low’ dose of Lyso we did call IDEXX inquiring about a serum levels test and was told that no they don’t have a test like this available and there is no set range as what is toxic for one dog would be adequate for another …
He is ‘slightly’ symptomatic right now, appetite and more panting, so if the 3500mg is holding him I am thinking to maybe give him 2 days of 1500 mg just to bring him down a notch and continue with the maintenance dose. His vet pretty much leaves it up to me. For now I am going to enjoy the good US results.
Nathalie

[Franklin'sMum]

Hi Nathalie,

More congratulations on Phillip's U/S results from here too :D:D. YAY!!! :):D:):D:):D:):D:)

Big ((hugs))

Jane and Franklin xx
________
Kitchen Measures (http://kitchenmeasures.com/)

[Buffaloe]

Hi Nathalie,

'Such tremendous news that Phillip doesn't have any tumors. That is so great and I am delighted for you. May you have many more happy years together.

Ken

[Squirt's Mom]

Hey Nathalie,

What great news on the ultrasound! :D So many good things were seen and so many worries removed...couldn't ask for better than that! I am really glad you decided to have it done.

So, it seems we have another pup who just won't follow the rules, huh? Sit Phillip down and have a heart to heart with him, explaining how this is supposed to work, and letting him know that he is driving you batty with worry. :p I'm just sure that will work. ;)

Hugs,
Leslie and the girls - always

[MiniSchnauzerMom]

Nathalie,

I'm enjoying Phillip's excellent U/S results right along with you!!! :D

Louise

[Harley PoMMom]

Hi Nathalie,

Just wondering how you and Phillip are doing, and I love your new avatar!! Phillip is quite the handsome boy!! ;):D

Love and hugs,
Lori

[Nathalie]

Hi Lori my friend we are doing fine – thanks for thinking of us.:D
The best thing that came out of getting the U/S done aside from there where no findings is that it has given me permission to relax and to stop obsessing that he has a tumor and is on the decline.
Sure I am still concerned about him – the inflammation on his right elbow has gone right down but the growth is still a concern – hard to tell whether or not it is growing right now and he is a bit too hungry. I would hate for him to constantly feel a sense of hunger – I love my food and it shows and I would hate for him to feel like that all day long. But overall I feel I do what is within my power and means and I have acquired enough knowledge to feel confident that I am doing the right thing.
At this point I could not even guess if his new maintenance dose is adequate or not. We have another stim test coming up next week – I was thinking of giving it full 6 weeks since the change in dosage but I am not sure if I can or even should wait this long…
I have been somewhat on a “vitamin kick” – aside from the L-Glutamine he is now taking Ester-C, E and B-Complex.
I am not sure if the L-Glutamine is helping as I am seeing a lot of hind end tremors even when he gets up in the morning – mind you the winter weather is not helping either as I am not able to walk the dogs my usual 1.5h per day as I usually do.

Thanks again for thinking of us, it does make a difference.;)
Nathalie

[Nathalie]

Yesterday was stim test day AGAIN and guess what …… what I thought would never happen finally did ……. His current dose of 3500 mg seems to be controlling the cortisol!!!!!!! :D:D:D
His last test was 5 weeks ago and his post came back at 4.93. Yesterdays post (I skipped the pre draw) came back at 5.
We started this journey on March 30 of last year and FINALLY 9 months later and 11 stim tests we are finally there. Nock on wood – unless Phillip decides to throw us another curve ball.
AND the growth on his elbow seems to have stopped growing so for now I am just keeping an eye on it. The inflammation on his right elbow is minimal – does not look ‘angry’ as it used to.

I ‘think’ it would be save to take a 3 month break from testing unless there is an indication that his cortisol is rising again. What do you think? I am so used to going in every 4 weeks and have him tested it seems ‘strange’ to not to.
I am also thinking to no longer do a pre draw – unless he shows signs of running too low I can’t see the diagnostic value in it.

It sure is nice getting the financial break not having to test all the time. My little Sophie has to go in on Monday for some dental and possible lipoma removal plus blood work which won’t come cheap either. Anyhow, its not the $ I am concerned about on Monday but rather that all goes smooth as Sophie has a sever phobia from having anything done to her body and has had fear induced seizures in the past. So we will have to give her an IM anasthetic in the parking lot so that we hopfully get the injection done and over with before she figures out what is going on :(:(

Thanks guys,
Nathalie

[Harley PoMMom]

Yesterday was stim test day AGAIN and guess what …… what I thought would never happen finally did ……. His current dose of 3500 mg seems to be controlling the cortisol!!!!!!! :D:D:D
His last test was 5 weeks ago and his post came back at 4.93. Yesterdays post (I skipped the pre draw) came back at 5.

OMGosh, This is great news!!! YAAAA!!! Excellent job Nathalie! ;):D

We started this journey on March 30 of last year and FINALLY 9 months later and 11 stim tests we are finally there. Nock on wood – unless Phillip decides to throw us another curve ball.

Nope, not even going to think about them curve balls!! :)

AND the growth on his elbow seems to have stopped growing so for now I am just keeping an eye on it. The inflammation on his right elbow is minimal – does not look ‘angry’ as it used to.

Another YAAAA!!!!

I ‘think’ it would be save to take a 3 month break from testing unless there is an indication that his cortisol is rising again. What do you think? I am so used to going in every 4 weeks and have him tested it seems ‘strange’ to not to.

I believe since you know Phillip so well and the fact that you have been taking over his care from the beginning...a 3 month break is safe.

I am also thinking to no longer do a pre draw – unless he shows signs of running too low I can’t see the diagnostic value in it.

It sure is nice getting the financial break not having to test all the time. My little Sophie has to go in on Monday for some dental and possible lipoma removal plus blood work which won’t come cheap either. Anyhow, its not the $ I am concerned about on Monday but rather that all goes smooth as Sophie has a sever phobia from having anything done to her body and has had fear induced seizures in the past. So we will have to give her an IM anasthetic in the parking lot so that we hopfully get the injection done and over with before she figures out what is going on :(:(

Oh Nathalie, my heart goes out to you, you get one of your precious pups stablized and another one has issues. :( I will be keeping you and Sophie in my thoughts and prayers and please let us know how everything goes.

Thanks guys,
Nathalie

Great Job Nathalie!! I am so happy for you and Phillip.

Love and big hugs,
Lori

[Roxee's Dad]

Hi Nathalie,

That sure is a long awaited piece of good no, great news! :D:D:D You had the patience and knowledge and Phillip is all the better for it. :D Great Job!!!!

[Nathalie]

Sophie and I are back from the vet and overall it went very well! :D

She got a good scaling and polish and one lower incisor removed – just in time as the infection started to effect the adjacent teeth who had become a bit loose but should firm up now since the culprit is gone. Nails are short, anal gland empty and a little growth removed. We decided to not touch the lipoma as it is not interfering with anything – and the removal is not worth the risk of a reaction to the sutures (which she had before) or other complications so no general anesthetic was needed. Blood sample for full panel was send to lab – results back tomorrow.
No wonder I can’t cut down on smoking with all this crap going on all the time and I am tuning all grey. :D
Thanks for the well wishes it worked.
Nathalie

[Harley PoMMom]

Hi Nathalie,

So happy that "overall" things went well with Sophie. :)

Love and hugs,
Lori

[Nathalie]

Phillip has been throwing up bile 4 times over the past 10 days, the last time this morning. 2 times he got sick at night and since there is no grass yet he ate ½ of an evergreen bush which he did throw up again.

I am thinking this can only mean increased inflammation of the pancreas. What do you think?
Now I am worried that we might be heading straight into a full blown pancreatitis attack if this cannot be stopped.:eek:

There has been no change in diet. Poop’s are ok. But he did have a pooping accident in the house the other day while I was at work and that means he ‘really’ had to go. I am never gone for more than 5.5h so he really must have been hurting.

I feel sorry for him because he already has a stomach ache 5 nights out of the week ever since we went over 2500mg of Lyso and at 3500mg it got worse, even so he gets 20mg of Pepcid.:(

I called the vet for suggestions but could not talk to her personally ... the suggestion where , run another cPLI or give 5mg of Prednisone for the next 3 days to help bring the inflammation down.

I am not seeing the point in running another cPLI just to tell us that its high or am I missing something?
Do you think 5mg of Prednisone is worth trying? Does the dose sound alright?

Any suggestions?:

Nathalie

[Harley PoMMom]

Hi Nathalie,

I know this is a gross question but...What exactly does Phillip's vomit look like?

Love and hugs,
Lori

[Nathalie]

No problem Lori ;)

It's yellow liquid. Does not contain any food but may contain anything he managed to eat just before throwing up such as the evergreen, grasses etc.
He also drinks more when he feels not quite well and especially on the days when he throws up.

It just occured to me that it only happens when he has an empty stomach or it has been at least 4h since his last meal.
Do you think this is his pancreas acting up?

I am just reading the article you send me and I am trying to find drugs that could be causing but I can't find a list it only states that ' many pharmacutical compounds can cause pancreatitis". I am wondering if the high dose of Lyso might be contributing to the problem?:confused:

Nathalie

[Harley PoMMom]

Hi Nathalie,

I think Phillip might be having a mild pancreatitis attack. Is he still vomiting? If so, there are meds your vet can give him to help stop the vomiting and she probably should see if he needs fluids. JMO.

Here are 2 more articles, they do list some meds.

http://www.dcavm.org/00oct.htm
http://dogaware.com/articles/wdjpancreatitis.html

Hope Phillip is feeling much better soon.

Love and hugs,
Lori

[Nathalie]

Thanks Lori, excellent resources!

I have to sit with this for a bit. I am not sold on giving him pred for 3 days ... it may suppress the inflammation (if that is what is going on) for a bit but then it will come right back. This is so typical conventional medicine - steroids or antibiotics ... "rolling eyeballs'
Too bad there is no icon for that:D

I would like to get a handle on this before the problem gets bigger - if possible.

He has 'only' vomited 4 times in the past 10 days and does not seem to be in any discompfort other then prior to vomiting. So I think we don't need vet intervention at this point in time.

I think Phillips raw days might be over - so for now I am going to cook his meat - that's a pain in the butt but it might be well worth it.
That's the beauty about feeding raw - No Cooking ;)

Up the L-Glutamine to 1000 mg per day. I always thought it should be given away from food but per the dogware article (http://dogaware.com/articles/wdjpancreatitis.html#causes) it can be given with food?

Now if the Lyso is the culprid then we are in BIG trouble .....

Nathalie

[frijole]

Nat, I did all kinds of research on raw diets and decided to do it right before the cushings dx. Oh my... both of my dogs got ill. Haley was real bad. (both ends) Shortly after that I got the cushings dx and so I stuck with the food that had worked during treatment. I know Haley is just real sensitive to fats now and will vomit if she has the tiniest piece of white chicken. Might try switching to see if Phillip's stomach gets back to normal. ??? Kim

[Nathalie]

Hi Kim,

I am a firm believer that a raw quality diet is the best diet one can provide for a dog to help achieve/mentain optimum health along with minimal vaccines etc. All my dogs are fed raw and so have been all my foster dogs and I can honestly say all have done great on it and the fosters that continued to be on a raw diet keep on doing wonderfully.
Phillip, has been fed raw for 7 years and has done wonderfully on it up until Cushings.

Having said this, I do realize that there are certain conditions where a raw diet might not be beneficial as the dog may not be able to digest a raw diet.

Phillip actually had his first pancreatitis attack after a short break from raw 2 years ago - after things calmed down again I switched back to raw and he was fine again.
No offense to anybody who feeds kibbles but I just can't do it - it goes against everything I believe in. I have no problem cooking but kibbles I can't do no matter how tight the money. I am going to see if it makes a difference if I cook the meat, but I am not totally convinced that the high dose of Lyso is not causing the problem.

Kim, I am sorry you had a bad experiance feeding raw. Perhaps the timing also played a big role as well as what you had been feeding before and for how long.
So what did you end up feeding?

Nathalie

[frijole]

They have been on Solid Gold foods for about 10 yrs. (Holystique and Jundenflocken) I mix their canned food with the kibble. They were on a prescription diet for years prior to that and it was awful. I noticed an immediate improvement in their energy level and hair. I now live in a small town and have to have it shipped from a distributor in Minneapolis but it is worth it.

Wish the raw had worked out. I decided to give it a try next time I have a new pup. Best of luck with Phillip.

[Franklin'sMum]

Up the L-Glutamine to 1000 mg per day. I always thought it should be given away from food but per the dogware article (http://dogaware.com/articles/wdjpancreatitis.html#causes) it can be given with food?
Nathalie

Hi Nathalie,
I'm so sorry Phillip is having tummy problems. Is there any chance he might have gotten hold of that may not be considered food?
Re: glutamine... I have "nature's own"-glutamine that says take with food, and "musashi"-l-glutamine that says take on an empty stomach 1/2 hour before food, so maybe it just depends on the manufacturer?

Hugs to you and Phillip,
Jane, Franklin and Bailey xxx
________
California Dispensary (http://california.dispensaries.org/)

[Nathalie]

Thanks Kim and Jane.

“Is there any chance he might have gotten hold of that may not be considered food?”

VERY possible,:D but I don’t think this is the culprit this time around since we had 4 separate incidences over the past ~10 days and usually if he gets sick from eating something rotten it happens fairly quickly and it just comes up. Ok – now I am getting crossed out myself.:p

Nothing is ever straight forward ... food .... no food .... duh, maybe I should just check my bottle of L-Glutamine – yikes. I need a vacation!!!:D:o:eek:;):p

Cheers,
Nathalie

[Harley PoMMom]

Since the vet and I believe that Harley's tummy is sensitive to the Lysodren, I now give Harley Pepcid AC the morning after his Lysodren day. So he gets Pepcid AC 20-30 before his Lysodren meal and the next morning too. Do you think this might help Phillip?

Love and hugs,
Lori

[littleone1]

Hi Nathalie,

Corky has never been on a raw diet, but he does take 1/2 tablet of a 30mg Pepcid AC daily, per his IMS.

Terri

[Nathalie]

Hmm, it might … it certainly something to consider if the dietary changes don’t do the trick.

All these pills! I am having a real hard time with all of this, especially with the Lyso. I HATE giving it to him. I was sort of ok with the 2500 mg but the 3500 mg …. call me crazy but it feels like slowly poisoning him. I completely realize that without it things will really go downhill quickly but it still is a crapshoot.

Ok – I am done venting.

Phillip’s Lyso is divided into 5 doses per week and on those days he gets 20 mg of Pepcid prior. Let’s say the throwing up of bile gets worse, and my gut is telling me that it’s the high dose of Lyso that is now catching up on him – he would get 40 mg of Pepcid daily…

Do you know what are the long-term affects of taking Pepcid? It does not say anything on the box and I was not able to find anything online.

Terri – what is the reason behind giving Corky the Pepcid daily and not only on the Lyso days?

Nathalie

[lulusmom]

Hi Nathalie,

When is your next stim scheduled? 3500mg per week is a pretty heavy dose at a little over 125mg per kg. That probably isn't all that uncommon for a dog with an adrenal tumor but Phillip doesn't have an adrenal tumor. :( In your shoes, I'd probably feel the same way you do and I'd let the next stim test guide me as to what to do next. Honestly, if his post stim has gone higher, you're gonna have to bite the bullet and reload or you may even want to consider going through a washout and switching to Trilostane. I normally wouldn't even suggest making a switch but Phillip seems to be one of those dogs that's either resistant to Lysodren or he's just not absorbing it well. In the long run, Lysodren is usually more cost effective than Trilostane but I don't think that holds true with Phillip. Seven pills a week is not cheap. Of course, if his post stim is where it needs to be, I wouldn't rock the boat. Just thought I'd give you some food for thought.

Glynda

[littleone1]

Hi Nathalie,

Corky is taking Trilo and not Lyso. His IMS said to give him the Pepcid AC because his kidney values had been elevated, and she felt that his stomach could have been upset because of the Trilo. Since he's been taking the Pepcid AC, Corky's kidney values have been reduced, and she wants him to keep taking it, especially if I have to give him any other meds, including baby aspirin for his arthritis.

I hope this helps.

Terri

[frijole]

Nat,

I just wanted to share that my girl was slow to load and I had to increase her dose over the course of months. She is currently on 115 mgs/kg. I raised it a wee bit when she went high after 3 yrs but she was always at twice the high end of recommended dosing. There is a quote from Feldman which I won't be able to find that confirmed that sometimes dogs need more and being an expert I found comfort.

Every now and then Haley will vomit as well. It is usually the day after her dosing. I have just learned to live with it. But she just does it once, it isn't daily. I make sure to coat the pill in something when I give it as that really does help. (peanut butter, cream cheese, cheese, pill stuffers)

I understand the frustration and it is easier to take it out on the drug but it truly has saved many dogs lives, including mine. I felt bad giving it until I finally got her maintained. Once we managed that the pill became a miracle and not a curse.

Sorry I can't be more helpful but wanted to share - you aren't alone. Kim

[Nathalie]

Thanks guy’s for your feedback and ongoing support.:)

Glynda – the plan is do another stim at the end of May, which is 3 months after the last stim test. I don’t think the cortisol is rising and he has been on 3500 mg for about 7 weeks. Unfortunatly switching to Trilo is not an option due to costs for the drug alone. I wish it where, because then at least I would have an alternative in case he no longer can tolerate the Lyso. But, I just don’t have $300 +, plus the costs for testing per month. I think all in all I am spending about $200 for the Lyso, Soloxine, Pepcid and supplements every 4 weeks plus any testing etc. that may need to be done.
Hence, we have to make the Lyso work for him.

Terri – that makes sense – sorry, I forgot you are treating with Trilo.

Kim – 115 mgs/kg is quite a large dose as well.

“There is a quote from Feldman which I won't be able to find that confirmed that sometimes dogs need more and being an expert I found comfort.”

Yes, I read this somewhere as well and it makes sense. But I also read about a study posted on PupMed that clearly showed that life expectancy and complications increased simultaneously with increased doses.

“I understand the frustration and it is easier to take it out on the drug but it truly has saved many dogs lives, including mine. I felt bad giving it until I finally got her maintained. Once we managed that the pill became a miracle and not a curse.”

My frustration is more with the limited treatment options available and finances forcing me to use something that does not sit 100% well with me and may cause Phillip damage in the process.

I am happy for you that Lyso has worked so well for your dog. In Germany you are no longer able to use Lyso, which I think is a mistake because that leaves you with nothing if you can’t afford Trilo or if the dog cannot tolerate it.
Another part is that I wanted Phillip to be one of the success story’s … getting at least a couple of carefree years – we had some great improvements after he was first loaded – months of struggling to get the maintenance dose right and now that we are finally there I feel sad that he has not been able to bounce back as much as I hoped and now new problems arise. He was eating away on the evergreens again this morning and when I came home he limped so now it is official he has arthritis in his right elbow.

Phillip is a real introvert with a very high pain threshold – there is no way for me to tell if he does not feel rotten most nights or is in pain unless it is real bad???

I know I sound like a broken record but this guy, like so many dogs, really deservers a break. He has only been with me for the past 7 years. I adopted him when he was 5.5 years old – he was not well emotionally, would not wag his tail for months or make eye contact just kind of lived in his own little bubble. He never turned into mister social but he did come out of his bubble as much as was possible for him and has been nothing but easy going, not asking for much companion to me, my 2 other dogs and the numerous foster dogs that came and went.

The vet left a message to see how he is doing which I think is nice. I am going to try and speak to the vet personally tomorrow, especially if he is still limping.

There goes another long-winded post – thanks for listening.:o
Maybe someone just needs to tell me to suck it up and shut up:D
Nathalie

[Harley PoMMom]

Oh Nathalie,

You and Phillip BOTH deserve a break!!! You both have been through so much...you are an amazing person and I deeply admire you.


Maybe someone just needs to tell me to suck it up and shut up:D
Nathalie

Nathalie, my dear friend, this forum is also for you. This is the members sounding board...we may never have all the answers but we are always here to listen, and give cyber hugs. ;):)

Love and hugs,
Lori

[frijole]

Nat, It is OK to vent - some dogs follow the text book and some don't. You and I chose the short straws I guess. You said:

Yes, I read this somewhere as well and it makes sense. But I also read about a study posted on PupMed that clearly showed that life expectancy and complications increased simultaneously with increased doses.

I offer my girl Haley as at least one example - she has been on lysodren at a very high dose for almost 4 yrs. I gave her a loading dose for over 45 days! She is 16 and 3 months old. She is frail and failing but it is from old age.

I truly believe that you can have the same results. You are obviously on top of things and Phillip is in the best hands he can possibly be in. I mean that as a compliment. So hang in there and know we are all rooting you on. You aren't alone. Keep venting. We have big shoulders. Hugs from me and my clan

[Nathalie]

Thanks Guy's! :)

I spoke to Phillip's vet -
the plan is to discontinue the Pepcid and give him Omeprazole 1ml before bed per day instead.
The side effects don't make me feel warm and fuzzy but I found this little study (http://content.karger.com/ProdukteDB/produkte.asp?Doi=201139) and the result makes me feel better.

Apparently the pill form for dogs is something like $5 per pill/day but they also make suspensions for horses which is way less expensive and it works out to about $0.60 per day.

Has anybody used this drug before?

For his elbow I am going to start him on liquid Glucosamine, Chondroitin and MSM, 500mg 2x per day for the next 6 weeks and then switch to 1x daily.

Does this sound like a good plan, especially the Omeprazole?

Nathalie

[O'Riley]

Nathalie...omeprazole is the same as Prilosec. It can be purchased everywhere in the U.S. over-the-counter (no prescription). In the dose you're looking at, it would be dirt-cheap to buy the 10mg tablets and a pill cutter. Edited to add: Ooops, sorry, just noticed that you've been prescribed a very low dose of omeprazole. I use a small marble mortar-and-pestle that I think I paid about $5 or $6 for at Bed Bath & Beyond and it works great for grinding vitamin pills into a fine powder which I then divide among my cat & dogs.

I once took a prescription to CostCo for Riley for diarrhea ($30). The pharmacist suggested I buy Immodium instead and cut the tablets into thirds since it was the same exact medicine as the prescription drug.

[Squirt's Mom]

Hi Nathalie,

From reading the study and some info on Omeprazole, I think it should be ok for Phillip. He doesn't have any liver disease, right? It is the human drug, Prilosec, which I have taken in the past. One thing I did notice was the difference in the time of dosing...your vet said at nite, the drug info says best in the morning with breakfast.

The supplements you are adding to help with the elbow are good. He is already on Omega 3's, right? A couple of other things you might look into are Arnica Montana and cetyl myristoleate, if you haven't already. Also, hyaluronic acid might help. How is the Ester-C working out?

You're doing good, Mom! Keep it up!
Hugs,
Leslie and the girls - always

[Nathalie]

Hi Rosey, I am located in Canada and over here it is only available through prescription. He is suppose to take 1 ml per day so I am not sure yet until I see the bottle how many mg this would be. The suspension is usually made for horses so 1ml could actually be quite a larger dose.
Since I want to get him started on this asap I am going with the suspension from the pet pharmacy here but will look into if it is worth of ordering from the states if Phillip does well on it. Thanks for pointing this out to me.:)

Hello Leslie :)– his ALT was nicely around 35 last time. His ALP is over 2000 but I think it is safe to say that his liver is healthy but working very hard.

“The supplements you are adding to help with the elbow are good. He is already on Omega 3's, right? A couple of other things you might look into are Arnica Montana and cetyl myristoleate, if you haven't already. Also, hyaluronic acid might help. How is the Ester-C working out?”

He is only getting a little Herring Oil and Sunflower oil because of the pancreatitis. I have a whole bottle of hyaluronic acid sitting in the fridge from Omega Alpha but after I bought it I done more research and I found next to none evidence that taken orally has any benefit. Omega Alpha also has a product called Anti-Flam and I do know people that had very good results with it. If the Glucosamine does not do the trick after 6 weeks I think I will give Anti-Flam a try.
I have used Arnica for acute things such a sprains .. I am going to look into it.

Have a great weekend Everyone.
Nathalie

Sorry forgot to answer one of your questions Leslie …

I thought the Esther-C was helping … but if it does not help with the arthritis I figure it is still good for him.
The whole elbow problem got probably aggravated because of his stomach problems 2 weeks ago. That’s when he refused to sleep in the bedroom with us where the whole floor is covered with blankets and started sleeping on the kitchen tile floor again. Whenever he has stomach issues he seeks out cool places.

[Nathalie]

Hey Guy’s,

The Omeprazole seems to working better then the Pepcid – he still wakes me up most nights to go outside but his poops are ok and no more throwing up bile. It’s not perfect but he does not show any distress of stomach pain other then having to poop at around 3 or 4am during the night.
The other night I put him outside and fell asleep for a little bit, woke up and thought crap he is still outside.:o There he was laying out on the deck enjoying the night.:)
For now I decided to keep him on is raw food, he seems to be doing well on it.

Yesterday, the growth on his elbow split open – just like an overripe plum – I can see the granular mass inside and the tissue covering the remaining growth is paper-thin and necrotized. Looks like it has to be removed now – his vet is on vacation until next weeks Thursday which sucks because now he is back in his dogleggs to keep it clean and then it will be at least another 10-14 days after the removal he has to wear them IF it heals nicely.

I really did not want to touch this lump because healing in that area could be a disaster and the plan was not to touch it as long it does not get any bigger.
On the other hand side once this ‘thing’ it might take care of the chronic inflammation on this elbow that never completely went away.

The strange thing is that the day before the area looked so nice, a little bit pink but that is it and the next day bam. Well, I guess it was only a matter of time for the tissue to rip.

Cheers,
Nathalie

[Harley PoMMom]

Hi Nathalie,

I am happy to hear that the Omeprazole is working for Phillip, it is so sad when they are feeling yucky so this is great news...and one that I will keep in my memory for Harley too...Thanks!

Oh, poor Phillip's elbow :( Please keep us updated on this. I will be keeping you and Phillip in my thoughts and prayers.

Love and hugs,
Lori

[Nathalie]

I was wondering, is it possible that an adequate maintenance dose can become to too high of a dose without any changes in fat intake?

Phillip's appetite has gone down ... stopped eating apples at night, eats his meals slower and picks around the vitamin pill in his meal.

His hind legs seem quite weak with more tremors and if I would judge by all of this I would say his cortisol has dropped to around 3.

I am just wondering if any of you have experienced this or heard about?

The elbow is not healing well as I expected - it is still not closed after 10 days.

Nathalie

[frijole]

Yes Nathalie, we have seen this happen. Dogs under control for years go low at their regular dosing. Try giving a prednisone dose to see if the issues subside. I assume Phillip hasn't lost any weight causing the dosage to be higher.

[Nathalie]

Thanks Kim.:)

Hmm, interresting - wonder why.

No weight loss, I think. I am going to pop him on the scale next week to double check so. He has gotten so furry that he looks chubbier then he is. :)
I am not really concerned yet as he is finishing his meals, just with less gusto and that is very unusuall for him and the not apple eating ..
For example this morning I put his food down and he looked up at me 3 times and then rather slowly went back to eating.

He is also getting a bit too paranoid about fly's and bees again. He hates anything that buzzes around him but he is over reacting a bit and last time that happens was when he went lower then what is compfortable for him.

There is just no way of knowing if he is really getting LOW or just a bit lower then 5 (his last post stim result).

We have another 4 weeks until his next stim test and I would really like to wait the full 3 months to see what his current maintenance dose does if we can.

Just in case, can someone please remind me what a good 'pick me upper' pred dose would be for a 64 lb dog?

I am also wondering if a lower cortisol level can cause an increase in panting?

Thanks,
Nathalie

[Harley PoMMom]

Thanks Kim.:)


Just in case, can someone please remind me what a good 'pick me upper' pred dose would be for a 64 lb dog?


Thanks,
Nathalie

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

I got 7.27 mg for his weight.

Nathalie, Just a thought here...you don't think his thyroid is acting up, do you? Maybe his thyroid meds need adjusting because his Lyso dose is controlling the cortisol now?

Wishing you and Phillip the best of luck.

With much love and hugs my friend,
Lori

[Casey's Mom]

Hi Nathalie - it sounds to me like he may be too low. He has the same symptoms as Casey does when she gets low although I am no expert by any means!

Casey is 40 lbs and when I have given her pred in the past I give her 2.5 mg then if that doesn't make her feel better I give her another 2.5 a couple of hours later. I know that her dose is 5 mg for her weight but I am very conservative in giving her this because the first time I gave it to her (during our very first load) she went a little too far the other way.

Best of luck with Philip,

Love and hugs,

[EllyAugie]

Nathalie, just wanted to say welcome. You will find some of the most caring & helpful people here.
Best wishes with Phillip.
Elly and Augie

[Nathalie]

Hey Lori, :D

Thyroid .. I had to think about this for a bit .. he went hyperthyroid once before and and his drinking increased, became restless and appetite stayed the same.
My gut tells me cortisol is the culprid unless something else is brewing.
I was thinking thyroid at first too...

I might get him tested sooner - this is bugging me know - get a stim, thyroid and maybe liver test done while we are at.

Too bad the lab does not offer a program for frequent customers eg. buy 9 get the 10th for free. Yeah - that would be the day :rolleyes:

You know, for the longest, I been meaning to get a thyroid panel done for my beagle boy Matthew once there is a month without any vet bills - looks like he has to wait a bit longer.:o


Ellen, thanks for the feedback. :)

Elly, thanks for the welcome ;)

Cheers,
Nathalie

[Harley PoMMom]

The reason I thought "thyroid" is because of Corky, Terri's pup. When they increased his thyroid meds he became overly anxious...and then you mentioned Phillip over reacting a bit/getting a bit too paranoid about the bees and flies...darn bugs! :mad::p:)

Listen to your gut, Nathalie, YOU know your boy best.

Love and hugs,
Lori

[Nathalie]

Just no way of telling for sure without blood work.
I may know my dogs very well - I think we got a pretty 'good thing' happening here but it helps tremendously to bounce things of to put in perspective, rethink, reconsider and inspire.

Cheers,
Nathalie

[littleone1]

Hi Nathalie,

I was just reading through your posts. As Lori mentioned, after Corky's vet and IMS had increased his Soloxine, he did start getting anxious and drinking more water. But unlike Philip, Corky started eating more. When I started giving him his previous dose of Soloxine, the drinking and food intake went back to his normal levels.

When his anxiety levels continued, his IMS had me bring him in for a stim test and a full adrenal panel after only 6 weeks, instead of going a full 3 months. I'm glad I had the tests done, as Corky's cortisol levels had increased, and are still increasing. When Corky's level increases, he starts showing some of the clinical signs again, especially with his eating and drinking.

Since Philip is not showing too much interest in eating, it is possible that his cortisol level might be on the low side. Another possibility might be that his stomach might be a little upset. I give Corky 1/2 tablet of Pepcid AC when he eats in the morning and takes his Trilo.

I hope you will be able to find out what is happening.

[Nathalie]

Hi Terri,:)
Phillip had the very same symptoms when he went hyperthyroid.
He is not really anxious or restles but perhaps more fearful of things such as anything buzzing around him.

Years ago, poor guy stepped in a wasp nest and those suckers were just clinging to his body - he was flipping out and so was I trying to get these things off him.
I hate these things - for some reason they have become more and more aggresive in my area. A couple of years ago I had one of my foster go limp on me at the dog park after being stung.

Stomach problem was my very first thought when this all started a week ago. With the high dose of Lyso he is on I am always worried that his stomach is hurting him.
He used to take 20 mg of Pepcid but it was not enough. He is now getting Omeprazole daily and it seems to be helping him more then the Pepcid.

Cheers,
Nathalie

[littleone1]

Hi Nathalie,

The poor little guy. I can understand why he would be afraid of them. We have Africanized bees here, and they are really aggressive. I'm just thankful that I don't have any nests near me.

Corky's been doing good with the Pepcid AC. So far, so good!

Our babies always manage to give us something to worry about!:(

I hope you will soon be able to find out what's going on.

[Nathalie]

Yesterday, I took Phillip in for a stim and a FT4 ..
The day before he almost walked away from his breakfast and yesterday, after being fasted for over 12 h he ate but with very little interest. He also appeared to see/hear ‘things’ that where not there.
He is staring into space right now so I gave him some pred.

Well, I am glad I took him in before the weekend. Usually I don’t do a pre anymore but I thought it might be good to do one just in case it comes back with a non-stimulatory response.

Pre: 0.58
Post: 1.8

His previous 2 posts came back at 4.9 and 5, while being on 3500mg of Lyso for over 3 months.
FT4 dropped just a tad from 2.8 to 2.4 (0.7 – 2 ng/dl) so FT4 is just fine where it is.

What I was thinking of is to drop the maintenance dose from 3500 mg to 3000 mg.
I need to bring up the cortisol a bit – he feels best when his post is close to 5 but at the same time don’t want to loose control. In the past his adrenals seemed to regenerate quite quickly after loading.

He had his last dose Thursday night, no Lyso yesterday (normal schedule) … I am thinking of skipping today’s and tomorrows dose (total of 1500 mg) and start fresh on the new maintenance dose of 3000 mg on Monday.

How does this sound to you guy’s so far?

Regarding his new dosing schedule I was thinking to just spread it out over 6 days.

Which brings up another question …
If I have a 3000 mg maintenance dose is this dose more effective if divided by fewer days eg. 750 mg 4x over 7 days compared to 500 mg 6x every week or is there no difference?

I am really glad that I can lower the Lyso and want to get the most effect at the lowest dose possible.

What do you guy’s think? :)

Nathalie

[frijole]

:) Just curious... did your vet have any recommendations?

Given Phillips' "unique" sensitivity to lysodren I would probably skip a dose and then lower. What is your current regime? 4 x a week?

I believe that is what Feldman recommends. I also recall reading that if you stretch it out into too many doses it loses its effectiveness at maintaining the level. But again, Phillip has been a bit special and likes to break all the rules. ;)

I'd be curious what others have to say. Glad you checked him when you did. Give him a big hug for me. Kim

[Nathalie]

":) Just curious... did your vet have any recommendations? "

Hey Kim - that's funny :p:)

She suggested to lower by 500 mg, which sits well with me because whenever we did an increase of only 250 mg it had no effect.
Other then that she leaves it up to me .. schedule and testing - which is fine too ;)

Currently I pill 5x per week to not - Phillip's stomach can't take more then 750 mg in one dose.

" I also recall reading that if you stretch it out into too many doses it loses its effectiveness"

I 'think' I read something like this too but can't remember where.
If this is the case I could give him 750 mg 4x per week.... Call me lazy, but I was looking forward not have cut pill anymore. :)

Kim, do you think that skipping only one dose of 750 mg would bring him up enough?

Nathalie

[frijole]

Kim, do you think that skipping only one dose of 750 mg would bring him up enough?

Nathalie

That is tough. Nat, we always say moms know best. You know the sensitivities each way with him. I really can't say. That was my first thought but I have to say go with your gut based on your very keen observations. :D I start loading my very unique dog Annie today so I'll be right back in the tweaking game with ya! Kim

[Nathalie]

My gut tells me to skip 2 doses and pill 4x per week at 750 mg -> re-test after 4 weeks.

Good Luck with Annie's loading - I will be looking for updates.
Nathalie

[Casey's Mom]

Hi Nathalie, I just wanted to mention the staring into space thing that Philip was doing is Casey's sign that she is too low. She also takes lysodren.

I do believe that you are the only other person I have seen post that symptom with their dog.

Good luck with your dosing.

Love and hugs,

[Nathalie]

Quick update on the Phillip ....

I could be wrong here, but I think his cortisol is dropping again on the lowered dose.
After I skipped 1500 mg and started him on 3000mg per week I thought I had made a big mistake by withholding this much - his appetite had gone up way too much. After 2 weeks on the lower dose his appetite has returned to normal and after 3 weeks his apple eating, which has always been a good gage has gone down.

It is quite hot here and the heat is really getting to him - poor guy.

For the past 2 days he has also been itchy like there is no tomorrow - knowing his legs and belly he hardly can catch a breath despite the benedryl I been giving.

His hind end tremours are terrible these days - last week he tripped going up two steps.

I am going to take him in for a stim in a couple days to see what is going on.

I am off work for the next 2 weeks so I am going to take the dogs swimming in a little while before it gets too hot.

He perks right up after he has been in the water and even does the occasional puppy run.:)

Cheers,
Nathalie

[Casey's Mom]

Hi Nathalie, just a suggestion for you and Phillip. I am not sure how thick or long his coat is but I have had my Casey shaved for the past two summers and wish I had done this every year. It really has helped during the summer months.

She is a border collie, sheltie mix so her hair is quite long and I find she has great relief from the heat.

Love and hugs,

[AlisonandMia]

The "post-Cushing's" coat that some dogs get is extra thick and hot too, even when it is not that long. Mia's was and I ended up having to get her shaved for the summer too. Made a huge difference to her ability to handle the heat, poor little thing was horribly overdressed in the thick, dense coat she grew. She was like a new dog when she was shaved.

Alison

[Harley PoMMom]

Hi Nathalie,

Our poor Phillip :( I get Bear, my black Pom, groomed and she cuts him very short plus she shaves his belly almost bare. He acts like a new boy when he comes home, especially in the summer, so I have him groomed more in the summer than the winter...no bare belly in the winter!

The signs that you are seeing with Phillip, I believe it is a good idea to get a stim done. You are such a wonderful mom, so devoted and such a loving mom to your Phillip and to all your furbabies.

I will be waiting anxiously for more updates. Give Phillip some gentle hugs from Harley and me.

Love and hugs,
Lori

[Nathalie]

Thanks for all your feedback!

I was thinking of having his belly shaved ... I don't think the rest of his coat is long enough but very fuzzy. I know next to nothing about grooming, but doesn't the top coat also act as an insulater against heat?
Maybe I should get him buzzed down all over?
What lenght are we talking about to make a differance?

He has been shedding like hell for the past 3 months - much to his dismay I brush him about 5 times per week and I still can plug him like a chicken.
By the rate he is shedding he should be naked by now.:D

Lori, we are going to have to postpone that hug until later - the bugger rolled in some coon poop and even after shampooing him he still does not smell like roses.;)
Nathalie

[Harley PoMMom]

Thanks for all your feedback!

I was thinking of having his belly shaved ... I don't think the rest of his coat is long enough but very fuzzy. I know next to nothing about grooming, but doesn't the top coat also act as an insulater against heat?
Maybe I should get him buzzed down all over?
What lenght are we talking about to make a differance?

Yes I am pretty sure you are correct that the top coat acts as an insulation against the sun's rays and their effects, so I would not go short on Phillip's coat here, on Bear's belly it is shaved almost bare but it does have some hair and he is cut short not shaved.

He has been shedding like hell for the past 3 months - much to his dismay I brush him about 5 times per week and I still can plug him like a chicken.
By the rate he is shedding he should be naked by now.:D

I really believe brushing him is the best thing for him, so you, my dear friend, are doing everything you can for Phillip.

Lori, we are going to have to postpone that hug until later - the bugger rolled in some coon poop and even after shampooing him he still does not smell like roses.;)
Nathalie

OH NO!!! COON POOP!! :eek::eek: Every now and then I'll catch Harley trying to roll in something awful...lucky for me I'll catch him before he does it!! Why do they like to do this?? Ok, hugs later :)

Love and hugs,
Lori

[littleone1]

Hi Nathalie,

I know that Corky really minds the heat here. We usually have 3+ months with temps over 100 degrees. I do a few things with Corky to cool him down. On our early morning walks, I always carry a water bottle with me. That way he has water to drink, and I squirt him down. I put him on the top step in the pool, and I also have a container of ice water. I dip a washcloth in it and wipe him done with it. These really help him.

I hope you get good results on Phillip's stim.

[katiesmom]

Hi Nathalie!

Just a quick note to see how Philip is doing. Poor thing. Are you on vacation now for 2 weeks?

Thank you for all your helpful info. Keep us posted on philip.

Cathy

[Nathalie]

Hey Cathie :D
Well, I am off this and next week. Off to the vets for another stim test in a little while.
Phillip is having a hell of a time with this bloody heat - we are at the park at 7 am to beat the heat but still .. He looked old yesterday, breaks my heart to see him like this. But then I have to remember he is turning 13 in 4 months and he is doing and looking a whole lot better then a lot of younger dogs at the park. As a matter of fact, all his buddies seem to be dying, predominantly of cancer, and he is now one of the oldest dogs in our group.

Anyhow, glad to have you back. Hope you stick around and let us help you.

Nathalie

[Casey's Mom]

Nathalie I think if you had Phillip shaved right down you would notice a big difference. Is he outside in the sun much of the time? If not I don't think he needs protection from the sun if that is what you are thinking. Casey got totally buzzed in May and she thinks this is wonderful.

It does grow back just as nice as before in time for our cooler months.

Love and hugs,

[Nathalie]

Hi Ellen,

Darn, this heat is getting to me - I totally forgot to ask them to shave his belly while I was at the vets - yikes.

He is not in the sun much but their is this long stretch at the park - about 20 min walk - that is full sun.

I have not done any research about this so perhaps this is a myth but for some reason I thought that the top coat acts as an insulation from the sun as well as the heat.

I don't care about the 'look' as long it makes him feel better. You should have seen him 1 year ago before the cortisol came down and the soloxine kicked in. Pittyfull! Sagging back, pot belly, rat tail, bare on the stomach and he had lost all feathers on his butt - yep, not too pretty. :o

He has had a bath today and I put a rinse of apple cider vinegar on him to help with the itchiness. He is still wet. I am going to have to see how much hair I can brush out once he is dry.

I was very surprised to see that he lost 3.5 lbs in the past 4 weeks. He is not too skinny - 61 lbs is a perfect weight for him - I just don't want him to loose anymore.

Nathalie

[marie adams]

Hi Natalie,
"I thought that the top coat acts as an insulation from the sun as well as the heat."

My husband has always said that Maddie's coat keeps her warm in the winter and cool in the summer. When you shave them then they lose the insulation to keep cool. Seems funny, but I guess he might be right. If I were to shave Maddie now she would look really scary without her underfur--a lot of bald spots. Poor baby when I went to the new vet they had a younger Aussie--same coloring as Maddie, a black tri--her coat was beautiful like Maddie's use to be. Maddie looks a little ragged--I think Cushings has turned her black fur a reddish coloring a little.

I am done talking--haha!!! Hope this helps!!

[Harley PoMMom]

Hi Nathalie,

To shave or not to shave...that is the question! :p:D I've been doing some googling and there are different opinions on this. :eek::confused:

Here is a good link on one, altho this is about shaving old english sheepdogs:
http://www.oes.org/page2/2554~Summer_Heat_Exposure_and_Bobtail_Coats.html

Here's another from Whole Dog Journal: Whole Dog Journal offers the best methods for keeping your dog cool this summer (and why it's a good idea).

http://www.whole-dog-journal.com/issues/10_8/features/Canine-Heat-Stroke-Prevention_15954-1.html

Phillip got a stim test done, right? Will be watching for his results! :D

Let us know the answer to the shaving question!!!

Love and hugs,
Lori

[Nathalie]

Marie, my gut tells me your husband is right:)
I saw this dog at the park today, about Phillips size, shaved down all over. Probably had a medium coat before someone went wild with the clippers. For the life of me I could not even guess the breed or mix.
He pretty much looked like a freshly shorn black sheep.:D But hey, whatever works.

"To shave or not to shave...that is the question! :p:D I've been doing some googling and there are different opinions on this. :eek::confused: "

You are too funny Lori:D The decision making just never ends:rolleyes::p
Thanks for the laugh.

Yep, we did a stim test this morning - will be posting them as soon as I get them.
I probably should not be doing this, but I think he is going to come in at around 4.

Nathalie

[Nathalie]

Well, the answer to the shaving question is ..

I have been reading the articles, loved the one about the old english sheepdog, spoke to a friend who has had Beardies for the past 30 years keeping them in show coat and only recently after much research and discussions with her groomer decided to go shorter, considered everyone’s feedback I don't think there is just a no/yes answer it all depends on circumstances, dog and life style etc.
As for my Phillip, after his bath yesterday I gave him a good brush today and I pretty much was able to get rid of all the wool so there is not that much left and it is quite smooth to the body so he is keeping what is left.:)

As for the stim test result I was wrong, came in lower then I thought at a post of 2.9 which would explain the itchiness.

His last post 4 weeks ago was 1.8. That is when I skipped 1500 mg out of of his 3500mg weekly maintenance dose and started him on 3000mg.
After that his appetite initially increased but about 2 weeks into 3000 mg his appetite started to decrease slightly and by week 4 he became quite itchy.

I did not speak to his vet but the receptionist told me the vets recommendation would be to keep him on 3000 mg.

I know that 2.9 is a good number but call me anal - I want him closer to 5 - he just feels better and does not get itchy. I have been giving him Benedryl every 12h and it does not do a thing.

Also, based on the initial appetite increase and later decrease I am thinking that if we would have done a stim just after I skipped the 1500 mg the result would have been greater then 2.9 which would mean that if I am keeping him on 3000 mg his cortisol will go down even further. If he goes down by even 1 he will start feeling really lousy again and I have to take him in for another stim right then and there.
If I further decrease the lyso, 500 mg might be a bit to much at this point but perhaps by 250 mg, I do have to do another stim in 4 weeks.:confused:


I have started the Lyso treatment 13 months ago. 12 months ago I joined this group. 8 weeks was the longest in the past 13 + months that we did not do a stim test. I am not even thinking about the numerous other test we did for liver, pancreases, thyroid etc.

Yikes, we are stuck in testing mode and no end in sight.:eek:

What do you guy’s think?
Keep him on 3000 mg, lower by 250 or 500? It seems like no matter what – there is no end to the testing. :confused:

On the bright side, the temperature dropped from 31 C to 24 C overnight and everybody had an excellent walk and swim today. :D
Nathalie

[littleone1]

Hi Nathalie,

I wish I had an answer for you about Phillipi's Lyso dosage, but since Corky is taking Trilo, I really don't know what to tell you. I'm actually very thankful that Corky is on Trilo.

I really hope that everything will be resolved soon.

Take care.

[Nathalie]

Thanks Terri, I appreciate your support! :)

Well, I called the vet – she actually answered the phone herself which was quite handy.;)

So we been tossing around some ideas on how to best to proceed going under the assumption that 3000 mg is too high of a dose …

1. We need to bring up his cortisol
2. Lower his maintenance dose

What do you guy’s think about this …

Currently I pill 750 mg of Lyso on Monday, Tuesday, Thursday and Saturday.

We where thinking of skipping the Saturday dose and start him on 2500 mg on Monday giving 625 mg on each of those days and as usual retest in 4 weeks.

It’s a bit scary to skip a dose and lower the maintenance dose by 500 mg but it would be fantastic if 2500 mg would keep him steady.

Does this sound like a sensible plan?

Thanks,
Nathalie

[Harley PoMMom]

Dr Feldman writes: "Maintenance therapy involves choosing a regimen and altering that regimen as required."

http://www.io.com/~lolawson/cushings/articles/feldman5.pdf

Oh, dear Nathalie, sweet beautiful Phillip sure does keep his mom on her toes! And you sure have been having to alter Phillip's regimen, huh?! :eek: :) I believe the only thing I would change would be to dose on Monday, Wednesday and Friday. With Phillip's adrenal's regenerating so fast I'd be concerned with the lapse of dosage from Thursday until Monday. But you are so intune with Phillip that you will know if this plan is working or not for him.

Love and hugs,
Lori

[Nathalie]

**********


Dr Feldman writes: "Maintenance therapy involves choosing a regimen and altering that regimen as required."


http://www.io.com/~lolawson/cushings/articles/feldman5.pdf (http://www.io.com/~lolawson/cushings/articles/feldman5.pdf)

I understand – I actually have a copy saved on my computer.

Oh, dear Nathalie, sweet beautiful Phillip sure does keep his mom on her toes! And you sure have been having to alter Phillip's regimen, huh?!

Good thing he is so darn cute because those toes are feeling quite sore at times.:rolleyes:;)

I believe the only thing I would change would be to dose on Monday, Wednesday and Friday. With Phillip's adrenal's regenerating so fast I'd be concerned with the lapse of dosage from Thursday until Monday.

Well, it is a long stretch from Thursday until Monday … perhaps starting him back up on Sunday might be enough to let the cortisol rise closer to 5.
I thought about pilling 3x per week, lets say Sunday, Tuesday and Thursday to not spread it out to much and get the most bang for our buck but I can’t come up with a good way of dividing 2500 by unless I give him 1000 mg on one of those days. I have to sit with this a bit.

As always – thanks for your feedback Lori.:)
Nathalie

Love and hugs,
Lori

[Harley PoMMom]

Nathalie,

I got myself confused! I was thinking you were going to pill Phillip just Monday, Tuesday and Thursday only...dumb me!!!

Could you pill him just less on Saturday, and then his maint. schedule could stay the same...Monday, Tuesday, Thursday and Saturday? Does this make sense? I'm thinking not alot mg to hit them hard, you know just alittle bit and then I believe his adrenals would regenerate but not so much...what do you think?

[Nathalie]

:D:D:D

No, Lori - its not only you, the whole thing is just bloody confusing.
You should have listened to the conversition between the vet and me ....

I had a couple of hours to think about all this, she didn't, plus she pretty much has only the numbers to go by.

First she said, 'can you run this by me again', then at one point I said ' so what are we going to do' and 'sounds good,but, mhh .. I don't think that is going to work either' ....
You probably had to be there to appreciate it but it was pretty funny. :p

Ok, now you are confusing me ... I am probably just complicating things ..
Are you getting sick of me yet?;)

I think I am going to skipp 750 mg on Saturday and instead of sticking with his old schedule we are going to switch to Sunday, Tuesday, Thursday and Saturday - 625 mg each = 2500 mg

Of course I might be whining in 4 weeks from now that now the number is too high, wishing I had listened to you .. that's when you can tell me 'I told you so'

I see how he does Saturday evening and just play it by ear for now.

[Harley PoMMom]

:D:D:D

No, Lori - its not only you, the whole thing is just bloody confusing.
You should have listened to the conversition between the vet and me ....

I had a couple of hours to think about all this, she didn't, plus she pretty much has only the numbers to go by.

First she said, 'can you run this by me again', then at one point I said ' so what are we going to do' and 'sounds good,but, mhh .. I don't think that is going to work either' ....
You probably had to be there to appreciate it but it was pretty funny. :p

Actually I can relate to this...will have to update Harley's thread as we are approaching our loading phase very soon. :eek:


Ok, now you are confusing me ... I am probably just complicating things ..
Are you getting sick of me yet?;)

You, my dear Nathalie, I never get weary from, I have learned so very much from you and I have the upmost respect for you because I realize that you have been the one taking the lead in Phillip's care.


I think I am going to skipp 750 mg on Saturday and instead of sticking with his old schedule we are going to switch to Sunday, Tuesday, Thursday and Saturday - 625 mg each = 2500 mg

Of course I might be whining in 4 weeks from now that now the number is too high, wishing I had listened to you .. that's when you can tell me 'I told you so'

I see how he does Saturday evening and just play it by ear for now.

Actually this new maint. plan sounds better and I really think this is the one that will keep Phillip steady. ;):) Wishing you and Phillip the best of luck! Keep us updated, please.

Love and hugs,
Lori

[marie adams]

Oh Natalie,

Here I thought once we figured this out, got the numbers right, it was sort of smooth sailing--I guess I know there isn't a set answer on maintenance--trial and error for a while. I guess it is only money--I thought the new vets stim test was $90 well it is $90 plus $70 for the injection; so $160 ouch!!! Good thing we love them to death....

I hope you find a comfortable schedule for maintenance.

You have been a wealth of information for me and I truly appreciate it!!!

[Nathalie]

Well don't let our journey discourage you. My guy just did not read the book and his adrenals are taking us for quite a joyride.

You might get lucky and Maddie is loaded now, you put her on her maintenance dose and in a month the stim test tells you the maintenance dose is adequate.;)

I think we talked about this before, but you could bring your cost down by only doing a post blood draw. That's all I am doing unless I suspect his cortisol has dropped way to low, in which case I do want to know his pre level to make sure that there is a good stimulatory response between the pre and post value. It could save you probably 30-40 $.

My costs for a pre and a post stim are $128 and $78 for a post only.

Thanks - I am glad you found some of the info helpful.:)

Nathalie

[AlisonandMia]

We where thinking of skipping the Saturday dose and start him on 2500 mg on Monday giving 625 mg on each of those days and as usual retest in 4 weeks.

It’s a bit scary to skip a dose and lower the maintenance dose by 500 mg but it would be fantastic if 2500 mg would keep him steady.

Does this sound like a sensible plan?Thanks,
Nathalie


Sounds like a good plan to me. I do agree it does look like 3000 was actually reducing the cortisol fractionally and so you don't want to continue with that. Just hope that 2500mg isn't too low!

At one point I decided to let Mia's cortisol rise slightly (she was completely well and her numbers were in range as per very recent testing but I thought she was lacking just a teensy tiny little bit of hind leg strength - wasn't bouncing about on her hind legs quite like she used to) so all I did was give one dose (1/2 her weekly dose) about 36 hours later than usual and then resume the schedule on different days. Because she was stable on the dose (it was holding the adrenals steady) I didn't change the dose. The result was an overall increased leg strength literally overnight. We never restimmed but I bet her number came up just fractionally - probably from 2.9 to around 3.1 or 2 if I had to guess - but it was all she needed.

Are you standardizing the fat/oil dose with the Lysodren meal? I found that to be vital to stability with Mia.

Just one other thought: If he is really, really itchy then a little (probably one off (or "two off" at the most) knowing his adrenals) dose of pred maybe wouldn't hurt. It could be good to get the inflammation under control, have the itching abate so you can use it to judge how things are going - like if it returns in a week you'll know to let his adrenals off the leash a bit more, maybe. I'm just thinking it may take a more considerable dose of cortisol/pred to damp down the inflammation now it has got going than it will take to keep it calmed down and you could end up inadvertently letting his cortisol go too high in a bid to damp things down now. Geez - I hope that wasn't too confusing....:o

Alison

[Nathalie]

“I do agree it does look like 3000 was actually reducing the cortisol fractionally and so you don't want to continue with that. Just hope that 2500mg isn't too low!”

Alison, in your experience do you think that a further decrease of 500 mg will be too much and rather just decrease by 250 mg? It would be a total decrease from his original maintenance dose 1 month ago of 1000 mg.

Now I am having doubts again …

“Are you standardizing the fat/oil dose with the Lysodren meal? I found that to be vital to stability with Mia.”

Fat and diet has been the same for 6+ months.

“Just one other thought: If he is really, really itchy then a little (probably one off (or "two off" at the most) knowing his adrenals) dose of pred maybe wouldn't hurt. It could be good to get the inflammation under control, have the itching abate so you can use it to judge how things are going - like if it returns in a week you'll know to let his adrenals off the leash a bit more, maybe. I'm just thinking it may take a more considerable dose of cortisol/pred to damp down the inflammation now it has got going than it will take to keep it calmed down and you could end up inadvertently letting his cortisol go too high in a bid to damp things down now. Geez - I hope that wasn't too confusing.... ”

Yes it is confusing BUT I think it is an excellent approach. I thought about giving him some pred, but that is where my train of thought came to a full stop. :o
I already gave him some Benadryl tonight – he is sleeping so I am not going to bug him now. But if he is still as itchy tomorrow morning I am going to give him some pred. His skin is quite agitated, when I touch his torso he starts twitching and scratching.

How much pred would you give him in this case? He weighs 61 lbs.

Nathalie

[AlisonandMia]

There is dosing info here: http://www.petplace.com/drug-library/prednisone-prednisolone/page1.aspx

It says " Anti-inflammatory doses range from 0.1 to 0.3 mg per pound (0.2 to 0.6 mg/kg) up to twice daily."

With a treated Cushing's dog within range as Phillip is, I'd think you go a bit more towards the upper end. My daughter gets quite severe asthma at times and I've become a fan of really hitting the inflammation hard for a short period rather than being more "gentle" - and ending up actually giving more pred over a period of time - so if it was me I'd go for the higher end of the dose for a day or two.

With regards to the Lysodren dose - has Phillip ever been on 2000mg per week before?

Alison

[Nathalie]

Thanks for looking the pred dosage up for me. I tell you, when it comes to my own dogs my brain goes to mush somtimes.

I am going to give him 12.5 mg which is 0.2 mg per lbs now.

Sorry I did not make that clear in my previous post. The highest MD he was on was 3500 mg, then we decreased to 3000 mg so now the new MD would be 2500 mg = total decrease of 1000 mg.

Nathalie

[Squirt's Mom]

Hey Nathalie,

I have been keeping up with you and Phillip and am so very proud of you! You have really taken the bull by the horns and are making sure he is getting everything he needs!

How is your sweet Sophie doing?

Hugs,
Leslie and the girls - always

[Nathalie]

How nice to hear from you Leslie and thanks for the vote of confidence. :D
If I may say so, I think he picked the right home after being dumped with his sister at the age of 5.5 at a pound that sells to animal research - way to go scum bags. At least he could have done way worse.;)

I am still on the fence weather or not to decrease to 2500 mg or 2750 mg … but I have until tomorrow night and I want to see what Alison has to say.
The pred kicked in – hardly any scratching and no twitching.
Thanks for asking about little Sophie – I think I am going to post an update under her thread ..

[Bichonluver3]

Natalie, just noticed you are in Hamilton. Years ago, I lived on Haddon Street and went to McMaster University. I also worked at the Medical Center in Neonatal Intensive Care.
We now live in Rancho Mirage, California, near Palm Springs.
Small world!!
Carrol

[Nathalie]

Yep, beautiful Hamilton;)
I live in the east end of Hamilton but walk my dogs up at Rock Chapel (Dundas escarpment) not much nice, open green space left to run the dogs around here.
Originally I am from Germany, but I have been living in Canada for the past 20 years.
I have been a bit busy with my guy's but I am going to head over to your thread to read about your pup.
Nathalie

[Nathalie]

It is with great sadness that I have to share with you the untimely death of my poor Phillip.

Wednesday, after walking the dogs, on our way home we got hit head-on by a drunk driver trying to do a U-turn, loosing control and smashing full force into us.
All the airbags instantly deployed and my Phillip who was laying on the bench got tossed against the front seat. Him being a senior and having lost a lot of muscle mass did not have a chance to brace himself. I have no idea how Sophie got so lucky with only hurting her leg as she got tossed into the airbag. Matthew and Sophie got both quite traumatized but appear otherwise ok.

Since the Van started to fill up with smoke I pulled out my two little guy’s and a very kind gentlemen pulled out Phillip who was in sever respiratory distress and rushed him off to the vets.
Unfortunately Phillip passed away in front of the clinic, I was told that there was no time to do anything, most likely of internal injuries/bleeding.

The other driver was so drunk, the police had to pull him out of the car and handcuffed him right there.

Unfortunately, this does not help my Phillip who did not deserve such a violent death and me not being able to be at his side. Thanks to the kind help of a stranger, at least he did not have to die at the side of the road.

Phillip will be greatly missed! He was my ‘big guy’, always going with the flow, not getting excited about too much kind of guy.
He was an excellent foster brother to the numerous foster dogs we had come and go.
He hated confrontations and even put up with the most obnoxious foster dog.
Before he become ill with Cushings he loved and lived to ‘hunt’ never quite fast enough with his shorter legs to get that squirrel but making up for it in determination.
He was a perfect canine companion to me.

So tell your dogs/cats and companion critters each day how special they are. How smart and beautiful because I wish I would have had the chance.

Nathalie

[Harley PoMMom]

Oh Nathalie,

I am so, so sorry. This is just tragic and my heart aches for you. I wish there was more I could do than just these mere words to comfort you at this time.

I am here for you, my dear friend, and am crying with you.

Godspeed sweet Phillip.

With Heartfelt Sympathy,
Lori

[k9diabetes]

Oh Nathalie... I'm just heartbroken to learn of this horrible accident and Phillip's passing. I'm so very very sorry.

Natalie

[Sabre's Mum]

Oh Nathalie .... tears are streaming down my face after reading your latest post. What a tragic end to your dear Phillip ... I am so so sorry. My thoughts are with you.

Take care
Angela

[frijole]

Ah Nat, this news is just gut wrenching. I am so so so sorry. Dear Phillip was lucky to have you as his mom. I am glad that someone was kind enough to stop and help you with him. May memories of a happy and healthy Phillip sustain you as you heal from this loss. Thanks so much for coming back to tell us. I have missed you. Please come back from time to time when you feel up to it to let us know how you are doing. Phillip is a cush angel now and I hope that my dear Haley who passed in May will greet him and show him the ropes. Big hugs, Kim

[labblab]

Dear Nathalie,

In the midst of your own grief, thank you so much for coming to tell us about Phillip. There are no words to express how cruel and unfair it is that Phillip was taken from you in this way. But we can help you to honor your sweet boy, and we can do our very best to offer you our support.

Phillip has now been added to our special memorial thread of honor, "Remembering All Who Have Left Us (http://www.k9cushings.com/forum/showthread.php?p=22309#post22309)." He will always remain a member of our family, and you will always be able to find him here alongside our other beloved companions.

Nathalie, I am so very sorry. Please remain with us yourself, and allow us to help you in any way that we can.

Sending many hugs to you, always in loving memory of your precious "big guy" ~
Marianne

[Dollydog]

Oh Natalie....life can be so cruel....I'm so sorry to hear of Phillip's passing and in this horrible way. I know that Lady was there to greet him when he crossed the Bridge....I'm sorry that you weren't with him when he left.
Please come back and let us know how you and your family are doing.
Jo-Ann & my Dollydog angel

[littleone1]

OMG Nathalie. I am so very sorry to hear that Phillip has paseed due to such a tragic accident. Rest in Peace sweet Phillip. You didn't deserve this.

I am also sitting here with tears in my eyes. My thoughts and prayers are with you Nathalie. I know how difficult this must be for you. Words can't express what I feel.

God be with you and your loved ones.

[BestBuddy]

Nathalie,

I am so very sorry. Phillip will be missed but he knew what it was like to be loved and cared for.

Jenny

[Roxee's Dad]

Dear Nathalie,

I am so sorry for your loss of Phillip. I share in your tears and heartache.

Rest in Peace Sweet Phillip, You are now our newest and brightest star in the sky.

[HarrysMom]

Nathalie,
I am so sorry - this is so tragic. I can't even imagine how you must feel. My deepest sympathies. Phillip was truly well loved, and this is the best a dog could ask for.

Yunhee

[apollo6]

I am so sorry for the loss of your beloved Phillip. May he rest in peace.
Hugs Sonja and Apollo

[Franklin'sMum]

Nathalie,

I am so very very sorry to hear Phillip has passed. My thoughts and prayers are with you.

Jane

[mytil]

Oh Dearest Nathalie,

I just cannot find the words to express how terribly sorry I am - and how heartbroken we all are to read about this horrible creep taking him from you.

Please do stay with us. My heart is with you and we will always remember your big guy, Phillip.
((((((((hugs)))))))
Terry

[John II]

Nathalie,

I am so sorry to hear of what happened to Phillip. :(
My thoughts and prayers are with you.

[lulusmom]

Nathalie,

I am so terribly sorry that Phillip was taken from you by a drunk driver. I hope he goes to prison for a very long time. My thoughts and prayers are with you.

Godspeed sweet Phillip.

Glynda

[Squirt's Mom]

Dear Nathalie,

Oh, honey, I am so, so sorry! To have Phillip taken in such a manner is just unfair. You have worked so very hard to make his life wonderful and as healthy as you could. It is hard, I know, that you weren't able to be with Phillip at the vets, but I am grateful for that stranger who took his time to care for Phillip as best he could. Honey, I believe Phillip knew you were holding him in the only way that really counts - in your heart and soul, where he will never leave.

I am also angry that drunk will never pay for taking Phillip's life, for the anguish he has caused you, for the trauma he caused Sophia and Matthew.

It is a relief to hear from you and to know that you were not seriously harmed physically in the wreck tho I know emotionally you are devastated. :(

My heart aches for you, sweetie, my tears fall with yours.

Our deepest sympathies,
Leslie, Squirt, Trinket, and our Angels, Ruby and Crystal

[marie adams]

Dear Nathalie,

I am so sorry to hear about Phillip. Of course there are no words to truly express how sorry we are. I am glad you and the rest of the brood are okay. I had missed hearing about the adventures of Phillip.

Please take care of yourself and our sincerest thoughts are with you!!!

[Casey's Mom]

Nathalie I just now have returned to Canada and read your post - this is so tragic. I am hoping he gets thrown in jail for what he has done to you and sweet Phillip.

There is a brighter star in the sky - please stay with us Nathalie.

Love and many hugs,

[Spiceysmum]

Nathalie,

I was very sorry and sad to hear about Philip. Thinking of you.

Linda

[mypuppy]

Hi Nathalie,
I don't believe I had ever posted on your thread, but the bizarre thing was that just yesterday I saw your profile picture of your precious Phillip and it took my breath away for some reason, and I just had to view your album. I did post a comment on his picture. I could not believe when I signed on today and read what happened to your sweet, precious face. How very unfair to him, you and every single person that had been touched by him. I am deeply sorry for your great pain Nathalie. We will never understand these tragic events in life and that of the senseless people behind them. God Bless you and your little angel Phillip. We love and hold you in our thoughts, hearts and prayers. Jeanette and Princess

[Nathalie]

Thanks guy's for all your kind words!

Some of you lit candles ... It made me cry but is so appreciated.

It's good to know that others care as well.
The guy who hit us is in jail but frankly, I don't care. I miss my Phillip. We just got to a point where did not have to do any stim tests every 4 weeks. I was never able to really control his cushings well but he was holding his own and was far from geriatric.
I would like to just grief for him and take care of my other 2 guy's but now I have to deal with insurance bs and buy a new car etc.

To my great surprise little Sophie is handling it better then Matthew. Today we had to go to the car lot and he was shaking and panting in the car as if he is going to have a panick attack.
I talk to them and toss treads while driving hoping this will only be temporary.

Thanks again,
Nathalie

[Chloe's Caregivers]

Nathalie,

Our deepest sympathies for your loss under such disturbing circumstances. All you did for Phillip, the care, concern and devotion you showed through your posts clearly illustrate your love and commitment to a furry friend who obviously gave those same qualities back to you day after day.

God's peace to you and to Phillip. Take comfort in the fact that you gave your all to see him have the best life possible.

Alan, Lynette and Chloe

[gpgscott]

So tell your dogs/cats and companion critters each day how special they are. How smart and beautiful because I wish I would have had the chance.

I will tell all of mine Nathalie, and tonight in rememberance of your Phillip.

Scott

[Harley PoMMom]

Thinking of you, my dear friend.

Love and (((hugs)))
Lori

[jrepac]

Nathalie,
I am terribly sorry to read this about your Phillip. That man should pay the price for what he has done.:mad: Luckily, no one else was badly injured; you are very fortunate for that. I hope Philip is up there in doggie heaven romping around with the rest of our cush babies...Mandy loved the big dogs and I hope they can play together up there! ;)

Blessedly, this awful month will soon come to an end; hopefully December will be much better for all of us.

Jeff & Angel Mandy

[Bichonluver3]

Oh, Nathalie, my heart is breaking. Our sky will be so bright with so many new shining stars this month. I am so sorry you have to go through this sad time. You have our deepest sympathy and our most fervent prayers and healing energy. And to have to "take care of business", I know, must be so draining. Please take time for yourself and your other little ones.
To Phillip, our sweet, precious prince, run free, bask in the sunshine of doggy heaven and know that you are loved by so many who did not even know you. God bless and godspeed.
Love and hugs,
Carrol & Chloe

[bgdavis]

I'm so sorry to read about Phillip's untimely death. Such a tragic way to lose a beloved dog.

Bonnie and Angel Criss Ann

[happydogs]

Terribly sorry to hear about the tragic loss of Phillip. Rest in peace.

Angela

[sunimist]

Thinking of you at this sad time with love and prayers. Spread your angel wings sweet boy.

(((HUGS)))

Shelba and Suni~~

[labblab]

Hi Nathalie,

You and Phillip and Sophie and Matthew are on my mind this morning. I've just visited your newest sweet picture of Phillip once again. It is such a lovely image of such a handsome boy.

I hope that Sophie and Matthew are continuing to adjust. I know it will take a much, much, much longer time for you.

Always in loving memory of your brave boy,
Marianne

[zoesmom]

Nathalie -

Just now seeing the sad news about Phillip. I am truly sorry. So tragic and inexcusable, I can't even find the words to say. I am glad the rest of you are ok, physically, but I know that you are in pain emotionally, regardless. Hugs. Sue

[fivebichons]

Nathalie,

I am so very sorry about your tragic loss of Phillip. How heartbreaking. My deepest sympathy to you and your family.

Blessings from another born in Hamilton, Ontario....
Heidi and the bichons

[Squirt's Mom]

Hi Nathalie,

How are you doing? I think of you often and hope you are finding some peace as the days pass.

Hugs,
Leslie and the girls - always

[Marlene]

I have been off the forum for a while. My Lacey was very sick and died December 4th. I looked back through your posts and it took my breath away. I am so, so sorry. I saw your words, "I wish I could have told him." You told him every day with your care and love. Words could not have done more. I wish I had some magic words now to make it better, but I know there are none. Just know that there are so many of us out here caring and wishing you well.

[Nathalie]

Well, it’s going …

I miss being Phillips, Sophie’s and Matthew’s mom. All of my dog’s have their quirks but together they where just perfect.
It’s been a month and Phillip’s passing is ‘old news’ – people ask if I am going to get another dog … yikes … no, even so it crossed my mind to bring in another senior pound puppy for the simple reason that I feel guilty having the space while there is a dog sleeping on concrete in some god forsaken pound, but I just can’t do it right now. I have some health issue I have been dealing with and there seems to be no end in sight right now. Sophie and the cat’s would hate having a new dog in the house. The only one that would really enjoy it would be Matthew.
Unfortunately with this cold weather Sophie can’t go walking with us so it is just Matthew and myself out there in the cold which makes things difficult too.

My sincere condolences Marlene. I am so very sorry about the recent passing of your Lacey.
Thank you very much for your kind words!

I have ordered a portrait pendent from Suzi Beber at http://www.smilingblueskies.com/jewelry/blue_skies_jewelry.html (http://www.smilingblueskies.com/jewelry/blue_skies_jewelry.html) similar to the Sheltie pendent which is number 9 in the picture gallery.
She will actually make a pen and ink study by hand from the pictures I send her of Phillip which then is made into an embossing stamp to make the pendant. I just fell in love with the idea of a handmade portrait pendant when I saw the one showing the Sheltie and being able to inscribe some meaningful words on the back of it.

For anybody considering bringing a new dog into their homes, please consider adoption – take a look at the many listings on petfinder.org (http://petfinder.org). Some of these dogs don’t stand a chance because of age or geography. Phillip was 5.5 years young when I adopted him and I would do it again in a heart beat.

Nathalie

[mytil]

Natalie,

I am so very glad you posted again. Know that our hearts are still with you. As I have told others it is hard to describe knowing when the time is right, but when it is you will just absolutely feel it without doubt.

I am sorry you are going through some health issues.

What a wonderful idea - I looked at the site!!!

Please stay in touch as you are part of our family here - as you are Marlene (please stay with us the both of you).
((((((hugs)))))
Terry

[bkdice]

Nathalie,

Sorry this is late, but I just read your story of Phillip's passing and wanted to express my sincere condolences. I cannot imagine the trauma you have suffered from such a sudden and horrible accident.

It has been a month, and only a month. You seem to be a very kind and giving person. Remember to be kind to yourself during your time of grieving.

Kind Regards,