Lysodren effectiveness

[Ginny's human]

Hi all! My sweet, lab mix dog, Ginny was diagnosed with Cushings Disease recently. We just started her on her lysodren and I actually think her polyuria is getting worse. She has been urinating frequently (a common symptom) -- we have been taking her out more but now on lysodren we have had to add one more visit outside and she peed in the house twice yestrday. She is on day 3 today. She takes 1 and 1/4 pill twice a day. Has anyone else experienced an increase of urination while in the loading phase?

Also, for those in the maintenance phase, how long do the symptoms take to go away/get less? As mentioned above, Ginny has the increased urination, but she also has thinning hair, weak hind legs, panting, etc.

We live in an apartment and I feel like she is in pain whe we have to walk to take her outside (there are a few stairs she has to walk down to get outside), but she can't help it because she has to pee so bad. I would love to know when either or both of these can be alleviated.

Thanks so much!

[addy]

Hi and Welcome,

I am sorry to hear of Ginny's issues but glad you found us. I have a few questions that will help us give you meaningful feedback:

How much does Ginny weigh and what Lysodren dose are you giving?

What tests were done to confirm Cushings?

Did your vet explain what to watch for during the loading phase? Did your vet give you Prednisone to have on hand?

I have to run to work so cant give you the links but their is much information regarding Lysodren in our research section.

Others will be along soon.

Glad you found us.

[Ginny's human]

Ginny weighs just a little over 50 pounds. We are giving her 1 and 1/4 tablet twice per day -- the pils are 500mg.

The vet did a Low Does Deaxmwthasone Suppression Test over the course of the day to test for Cushings and did explain the loading process. We are waiting on her to reach the full load and then we haev to go in for a ACTH test to make sure everythign is going okay.

I just wasn't sure on how long it took lysodren to actually hekp with the symptoms and if anyone had experienced more urination with their dog while in the loading pahse.

[molly muffin]

Hello and welcome to the forum. So you are giving her about 625mg of lysodren per day. Normally the loading dose is usually 50 mg Lysodren per kg of the dog's weight (50 mg/kg/day) and is given each DAY of the loading period.

To calculate your dog's weight in kg, divide the weight in lbs by 2.2 (example: a 22 lb dog weighs 10 kg)

So, 50lbs would be 22.72kg so you'd give 1136mg of lysodren daily till loaded. Your vet has started much lower than that.

Here is a link to tips about lysodren loading and maintenance and signs to watch for. http://www.k9cushings.com/forum/showthread.php?t=181

In it, there is specific instructions about water and urination. It can take as little as 2 days or much longer, over a month to see the change in urination. I don't think normally you see an increase, but I wonder if that is because the dose is low.

Remember, if you see any change, like not inhaling their food, water consumption down, that is when the load is complete and lysodren continues to work for 48 hours after the last dose given, so you don't want to give the meds if you see that decrease. Even a lift of the head when it doesn't usually happen can single a load.

One of our other members/admins who have used lysodren successfully will be along soon I'm sure to comment and can give you more information.

Sharlene and molly muffin

[Harley PoMMom]

Ginny weighs just a little over 50 pounds. We are giving her 1 and 1/4 tablet twice per day -- the pils are 500mg.

Could you clarify Ginny's loading dose for me, is she taking 1 pill + 1/4 pill, which is 625 mg, once a day or is she getting 625 mg twice a day for a total loading dose of 1250 mg?


The vet did a Low Does Deaxmwthasone Suppression Test over the course of the day to test for Cushings and did explain the loading process. We are waiting on her to reach the full load and then we haev to go in for a ACTH test to make sure everythign is going okay.

If you could obtain copies of all tests that were done on Ginny and post any abnormal values that would be great. Was Ginny's appetite ravenous before the Lysodren was started? How is her appetite now? With Lysodren you are watching for any subtle changes, and generally dogs with Cushing's have voracious appetites, so any change in the way she eats such as pausing or not finishing her food with the same gusto or even leaving any food in the dish when before she would lick her bowl clean, is a sign of Ginny being loaded.

Did the vet prescribe any prednisone for you to keep on hand in case of an emergency?

If you have any questions at all please do ask, ok?

Hugs, Lori

[My sweet Ginger]

Sharlene, Ginny gets Lysodren twice a day so her dosage is pretty close to the recommended 50mg/kg/day. :)
I was thinking that maybe she drinks more because of hot weather so pees more. I mean has the weather where you live been hot recently? Just a thought.
As Sharlene said, stop Lysodren if you see any slight change in her and call the vet and schedule for an ACTH stimulation test 48 hrs after the last dose. Did your vet send you guys home with some prednisone to use in case of an emergency?

[Ginny's human]

Thanks everyone for your advice. I don't have the test results on me at work. We do give her 1250 mg a day (625mg twice a day). She is 55 pounds (a little over the 50 pounds I referenced before).

As far a the prednisone, we do have it and the vet told us what to look for. She had and still is scarfing down her food and drinking lots of water so we don't think she is loaded yet. We haven't seen any behavorial changes either.

It has been hot in the DC area -- around 90 everyday but we keep the AC on pretty low in the apartment so she does't get overheated. We called the vet yesterday to see if she could explain the increased urination and she wasn't worried. She said that a decrease in water consumption wouldn't happen until at least 5-7 days. Thanks for your post, Molly Muffin, that it coudl be a month before we notice anything.

[Harley PoMMom]

For Ginny's weight of 55 lbs, the 625 mg given twice a day comes out to 50 mg per kg of a dog's weight, which is good.

I'm also relieved to hear that the vet did give you a RX for prednisone and that she has explained when to use it, your vet sounds like a keeper!

Subtle changes in drinking, eating, or Ginny just not acting quite like herself, if any one of these are seen this could mean that Ginny is loaded.

Your doing a great job! And remember we are here for you both. ;)

Hugs, Lori

[jrepac]

It's been a long time since I used lysodren, but I remember it taking a good 2 weeks to see cushing symptoms resolve. But, every case is a little different. you just won't see results overnight, is my point.

Jeff and the Girls

[jrepac]

By the way, did your vet consider trilostane/vetoryl?

[StarDeb55]

Here's a late welcome to you & Ginny! I'm sorry to hear of Ginny's problems, but certainly glad that you found us.

I wanted to let you know that I have successfully treated 2 pups with lysodren over the years. My 1st boy was treated for nearly 8 years, crossing the bridge at 15 from causes unrelated to his Cushing's.

When it comes to loading as others have mentioned, any change in Ginny's behavior may be a clue that she's loaded. This could be something so simple as pausing to look up at you while she's eating, when, previously, she would inhale her bowl, & beg for more. It is possible that you may not see any change. Normal protocol for loading states that if there has been no change in the dog by day 8, you go in for an ACTH to see where you are. This happened with my first boy. Fortunately, I had been monitoring water intake, & that was the clue that he might be loaded. We had reached day 8, my boy went in for his ACTH. The vet called me the next day, asked if I had measured water yet, I said no, & she said to measure that she would wait on the phone. Well, there had been a 60% drop in water consumption. The vet tells me that the stim test indicated that, & unfortunately, my boy's cortisol was so low, the vet had me put him on prednisone immediately. If I recall, he was on pred for about 5 days, then another ACTH. His cortisol had come up enough that we could start maintenance. I don't want this to scare you because I did not miss anything. My boy still had the voracious appetite. In fact, Barkley had the voracious appetite until he passed. If you do get to day 8, & the stim shows that the cortisol is still not within acceptable range, you just continue the load. One of our administrators had a pup that took something like 45 days to load. This just shows that each pup is different.

We know how stressful loading can be. We are here to help in any way we can.

Debbie

[Ginny's human]

She didn't mention it as an option right now. She says she likes to try the lysodren first before anything else. Have you had better luck with trilostane/vetoryl?

[molly muffin]

Not necessarily better luck. If one doesn't work, then the other is always an option.

How is she doing today?

Sharlene and molly muffin

[Roberta]

Good morning!

Yes, the same thing is happening with my Italian Greyhound, Emma. I am in the process of her second load. The first time her ACTH stim test numbers were 4 and 5 and we started a maintenance dose of 125 mg twice per week. Her 30 day stim test was 11 and 12 so we started another load. This morning she only ate a bit of her breakfast so I've stopped her pills and we'll have her tested again. I don't know yet what her new maintenance dose will be.

Anyhow - days 3 and 4 were particularly rough for Emma both times. Her drinking and urinating actually increased. But, a few days later it goes down.

We initially tried Trilostane but that was only partially effective, so we made the decision to switch to Lysodren.

Good luck with Ginny!

[Ginny's human]

Thursday night we saw that Ginny was slow to eat her food so we stopped giving her the lysodren. However, on Friday she ate nothing, she wouldn't even eat one of her treats. We got worried and called the vet. The vet said to give her prednisone. She has her appointment right now for her follow-up bloodwork. I am not sure if we missed where she was loaded or what but hopefully we cought it in enough time. Last night was very rough, with Ginny on pred, she woke us up every hour or two to use the bathroom. I know this is a side effect. We liekly won't get the blood results back for a few days but will let you all know what we are advised to do, whther we have to continue the pred for a while and then go back for bloodwork or if we can start with the maintenace phase.

[molly muffin]

It can be very difficult to catch that one small thing that might indicate a load is done. It sounds like you did catch it though so that will be good.

How is she doing now?

Sharlene and molly muffin

[Ginny's human]

She is doing better now. My fiance talked to the vet and the lysodren worked -- her levels are in the right place. Howver, the vet told us to hold off on the maintenace dosage until she begins to eat normally again. She didn't take pred yesterday and her drinking and peeing were back to 4-5 times a day, not every hour and a half.

The vet says once she starts to eat like normal, we can start the maintance does of one tablet (500mg). After a month, she will go in for some more blood work. The vet also said we needed to monitor how much she is peeing. If Ginny isn't back to normal (3 times a day) in 1-2 weeks, we will need to have a urine test done to make sure there isn't an infection or something else. Hoepfully, this symptom just takes a little longer than others for Ginny.

We are hopeul that the maintenance doasge and blood work next month will be positive. We just want what is best for her and want her to feel better. It is really heartbreaking to know something is a little off with your pet and not be able to figure out what it is. We just hope that with a little maintenance and diligence, Ginny can be her normal sweet, happy self.

[Harley PoMMom]

I see that prednisone was given, could you tell us how long after the prednsione dose was the ACTH stimulation test performed?

[Roberta]

Emma was prescribed Cerenia (an anti-nausea drug) back when she did her first load, which I think helped. I had one left so I gave it to her last night and she ate a little better today. It could be a coincidence, but I think the pill may have helped with her appetite this morning. I picked up a refill today and am going to give her another one tonight. I'm also going to give her one the night before her first few maintenance doses.

Maybe that (or some other tummy drug) might help Ginny...

[Ginny's human]

We gave her some prednisone about 24 hours before her test was performed. The vet was aware of this when they did her bloodwork. She is now not on prednisone or lysodren until her appetite comes back. The vet said it could take a week or two. She is eating but not near as much as she was prior to loading.

Thanks, Roberta, for the suggestion. We do suspect that her stomach is upset and that is why she is eating slowly.

[lulusmom]

Hi Ginny. Can you get a copy of the post loading acth stimulation test and share the results with us? There are only two numbers, a pre and a post. so if you don't have a copy of the test results, your vet should be happy to give you the two numbers over the phone.

Glynda

[Ginny's human]

Ginny had a terrible weekend and is back at the vet today with my fiance. She hasn't eaten in about 4 days and hasn't been on lysodren for over a week. We were told to wait until her appetite picked up to start maintenace. On Saturday, she woke us up at 6am throwing up -- it was just water because that is all she has in her system but it has still got to be uncomfortable. And she was up every 3 hours to go to the bathroom on Sunday night. We just have no idea what is going on with her and want her to get better.

Has this happeneded to anyone else?

[lulusmom]

Did you call your vet when Ginny stopped eating four days ago? It would help us understand what is going on if you would please get a copy of the acth stimulation test that was done after loading and post the results here. When you say she woke you up to go to the bathroom, was that to pee or poop? If poop, is her stool firm? If Ginny is not producing enough cortisol, not eating and vomiting are symptoms so without seeing the results of Ginny's acth stim test, there is no way for us to know if that could be the cause of her problems. If you can't copies today, can you call the vet and get the two numbers on the results and post them here?

Glynda

[kaibosmom]

I was worried about how I would know when Kaibo was fully loaded on the lysodren too. However, when it happens you will know. I am sure that doesn't help much but that was the case for us. We had to load him a couple of times and every time we were able to tell. We noticed decreased water consumption but the main trigger for us was eating slower. Good luck.

[Ginny's human]

OK sorry about my lack of response -- we have had a hard time. First to answer your questions about numbers after loading phase -- I believe it was 8 and 12. Does that make sense? The vet said she was in a good place and had come down quite a bit from where she was.

As far as the eating, she stopped eating as quickly on Thursday morning. We stopped the lysodren then and called the vet to make an appointment and the earliest they could do was Monday so that was the days of not eating. We stopped giving it to her but she still didn't start eating like herself (she'd eat a little but about 1/4 of normal) until she stopped completely. In addition, she was actually using the bathroom more and vomiting a kind of clear liquid. We took her in again and the vet recommended soft food, which she begin eating more of and recommended if the vomiting and the frequent urinating continued we take her to a specialist. Apparently her something to do with her blood test had higher than usual level for her liver and still having protein in her urine. The vet wasn't sure if this was due to her not eating or something else.

Well after a few day, we ended up making her an appointment with the specialist (she is going today) and they are looking to see if she has liver or kidney disease or failure as she has had symptoms for this (they can be similar to cushings) and it is not uncommon for a dog to have cushings and liver or kidney disease (I also have heard a dog with diabetes and cushings is not uncommon). I will let you know what we find out. Hopefully, we don't have to wait too long for the results.

I

[molly muffin]

Do let us know what the specialist has to say.

Yes, all of those can be issues along with cushing, or rather than cushings, as some of the symptoms can be the same.

hugs
Sharlene and molly muffin

[Ginny's human]

Alright so we have an ultrasound and blood work done. We found out that Ginny has pituitary Cushing's, instead of adrenal glad Cushing's. The internist said there was liver damage (lesions). However, he said that he has seen more and bigger lesions and after the biopsy it was related to Cushing's disease. He said he thought based on teh size and number that it was Cushing's related and did not recommend a biopsy for it at this time. He said that since she had been off Lysodren for so long, that could be the issue.

As far as her not eating for days after being off the Lysodren, he could not really explain that. He did say that it could be because of her teeth hurting her (she has bad teeth -- when my fiance adopted her it looked like she had been eating rocks) and that soft food was okay to continue giving her. He actually gave us a recipe to make food for her because I think the smell of canned dog food is awful. I made the recipe yesterday and she loves it.

He recommended going back to the vet and getting another ACTH test and going from there. Hopefully, we can get her on the maintenance dosage for Lysodren, rather than loading again but we will see. Thanks!!

[molly muffin]

Oh I'm so glad that you found something that she would eat. Poor baby with the bad teeth, that must be awful for her.

Good idea on the repeat ACTH, to see where she is at.

Sharlene and molly muffin

[Ginny's human]

I just wanted to update everyone on Ginny. She is now back to hard food. After the visit with the specialist, she went back to vet to test the ACTH test. Her levels were normal and within the right range. So...the vet had no ieda what was going on. She called the specialist to see what the next steps would be for Ginny as she is still drinking water and peeing all the time and there is no health issue. What we have decided to do based on their recommendations is:

1. Start Ginny on her maintenace dose of lysodren.
2. Start her on a medicine called DDAVP that is "is a synthetic replacement for vasopressin, the hormone that reduces urine production."

They believe that this hormaone coudl have been reduced as part of the Cushing's disease.

Has anyone on this forum ever used DDAVP for their dog? What were your experiences?

Thanks!

[Squirt's Mom]

Would you mind getting the actual results of the ACTH and posting them here? Thanks! that will help us help you.

One thought on the drinking and peeing - there is a rare form of diabetes called Diabetes Insipidus, DI, that has nothing to do with blood sugar but rather with the way the body process water. The test, a water deprivation test, is risky and many vets will simply start treating. If the treatment works, there is the diagnosis. Treatment is an eye drop. ;) It would be worth mentioning to your vet just in case.

[labblab]

Looks like Leslie and your vets are on the same page, because the new med you have been given is the one that treats Diabetes Insipidus! ;)

So we will be very anxious to hear how things go.

Marianne

[Ginny's human]

My fiance talked to the vet about the ACTH, which he said the vet sad was normal. I asked him and he thinks the numbers were 1.5 and 9.3 so it seems like the Cushing's is being contained.

The new medicine which is being prescribed, DDAVP, is actually prescribed with dogs with diabetes insipidus. We are taking the prescription to be filled today and hope to have them to start by Monday or Tuesday. We hope that this helps with her drinkign and peeing.

[Squirt's Mom]

If the post number was 9.3, then that is higher than the accepted post for a Lyso pup. The max on the post for a pup on Lysodren is 5.0 ug/dl. If the post is actually 9.3, that could very easily be the reason you are still seeing increased drinking and peeing instead of something like DI - the cortisol is not under control. How are her signs other than the drinking and peeing?

[molly muffin]

Leslie is right, while with vetroyl, the number can be up to 9.ug with controlled symptoms, with lysodren, you need to be under 5. ug. So that is likely why she's still got symptoms. Pre number you wouldn't want to go down any more though. Maybe some of the ones whose used lysodren know if that would still go down or not.

I am thinking maybe it is the low pre number that made her not want to eat.

Sharlene and molly muffin

[Ginny's human]

I could have the numbers wrong because the vet said we could start the maintenance does for Ginny since her levels were under control. I can call the vet to check and sorry if I cause any confusion.

Her symptoms are simply chugging water like there is no tomorrow and peeing a lot.

We gave her the first maintenance does on Sunday and we noticed that her hair on her ear was shedding. This could have been happening before but we didn't notice until yesterday. Her ears are almost bald:( Hopefully starting her back on lysodren will help.

We also gave her the first does on DDAVP this morning. For the first seven days, we are supposed to give her 2 (or 200 mg, I can't remember the pill measurement) 3 times a day. After seven day, we go to 2 does a day. We are very hopeful and hope this works, and will let you know.

[Squirt's Mom]

It would help us a great deal if you could get the numbers of the stim (ACTH) and post them here. There should be 2 numbers, a pre and a post number. Thanks!

[Ginny's human]

I thought i had responded yesterday about the test results. I talked to the vet about that and another issue. Something must have happened when I tried to post. The results were 1.5 ug/dl and 3.8 ug/dl.

I called about her losing clumps of hair (on her legs, ears, and body) and having dry skin -- like dandruff when we pet Ginny. The vet said it must be an allergic reaction to something external. The medicine she is on should not cause any of those symptoms. Anyway, we have her own 50 mg of benedryl at night (because it can make dogs drowsy) to see if that helps.

We are on day 5 of 3 doses per day of DDAVP and I can only say how amazing it is. Ginny is back to drinking normal amounts of water and is using the bathroom a little more normal. She got used to going out so much that sometime she looks at us, and we assume she has to go and it ends up she just wanted to sniff the fresh air. We do not mind this at all, as before we were almost running down the stairs and hall (we live on the second floor of a building) just so she could barely make it out. I know it wasn't comfortable for her so we are so happy.

Her eating is normal so we think that the cushing's is under control, as well. Her one month check up where we do another ACTH test will be in a few weeks so we will see then.

[Squirt's Mom]

ah...good! That post is perfect at 3.8! Happy to know that 9.3 was not correct and happy to hear that the DDAVP is helping! Sounds like DI is in play since it is helping her signs. I applaud your vet for trying the DDAVP!

[Harley PoMMom]

I thought i had responded yesterday about the test results. I talked to the vet about that and another issue. Something must have happened when I tried to post. The results were 1.5 ug/dl and 3.8 ug/dl.

Those are really great numbers!!


I called about her losing clumps of hair (on her legs, ears, and body) and having dry skin -- like dandruff when we pet Ginny. The vet said it must be an allergic reaction to something external. The medicine she is on should not cause any of those symptoms. Anyway, we have her own 50 mg of benedryl at night (because it can make dogs drowsy) to see if that helps.

Many times we have seen that when a dog's elevated cortisol has started to be controlled with treatment that they do lose clumps of hair, we call it "blowing their coat" so this might just be what is happening to Ginny.


We are on day 5 of 3 doses per day of DDAVP and I can only say how amazing it is. Ginny is back to drinking normal amounts of water and is using the bathroom a little more normal. She got used to going out so much that sometime she looks at us, and we assume she has to go and it ends up she just wanted to sniff the fresh air. We do not mind this at all, as before we were almost running down the stairs and hall (we live on the second floor of a building) just so she could barely make it out. I know it wasn't comfortable for her so we are so happy.

Her eating is normal so we think that the cushing's is under control, as well. Her one month check up where we do another ACTH test will be in a few weeks so we will see then.

So glad to read that Ginny is doing so well on her treatment!! Good job, Mom!

Hugs, Lori

[molly muffin]

Really good numbers! So pleased to see this.

Sharlene and molly muffin

[pansywags]

I just love reading good news. I hope you both feel great!

[Ginny's human]

Thanks all for your support!

Lori -- for the hair loss (losing clumps of hair), do you know typically how long that lasts? During this time should we avoid giving her a bath or does that help?

[Harley PoMMom]

Lori -- for the hair loss (losing clumps of hair), do you know typically how long that lasts? During this time should we avoid giving her a bath or does that help?

I don't know exactly how long it will take, maybe 2 to 8 weeks. It's almost like they need to shed their old "sick" Cushing's-affected coat so that they can grow in a new healthy coat. Sometimes the new hair coat will be a bit different, the texture and/or color may change, so don't be alarmed if this should happen.

I don't believe you have to avoid giving her a bath, and it may help, brushing her coat may also aid with the shedding of her old coat.

Hugs, Lori