After the crash...(11 y/o doxie, Elliot)

[Igby]

Aloha,

My 11-year-old doxie, Elliot, has been treated for Cushings with Lysodrene for two years with great success. Lately though, he has been so listless and his appetite has wavered so while waiting for his ACTH test results I gave him a med vacation and noticed him perking up. The vet phoned with the results and had me up his dose to 5/8. I administered it on Sunday and about 40 minutes later Elliot was staggering and flopping about. I gave him a prednisone and after an initial outburst of energy he calmed and rested. I talked to the vet on Monday and he said "IF" I dose him again to start with a very small dose. Am I wrong to just wait and see how he is doing without meds? He just seems feeble and I would rather not bring him to the edge again.

[Jenny & Judi in MN]

hi: you are exactly right. Did your vet do an ACTH? I'd be curious to see the results. I overdosed my dog on lysodren and we wound up doing prednisone for about 6 months and have done nothing (no lysodren, no prednisone) for almost 2 years now.

her cortisol is slowly inching back up on it's own.

so, when we saw the specialist after her ACTH showed a pre and post op of .5!, he recommended this:

We discussed how best to proceed regarding treat her Cushing's disease. Because her adrenal glands are minimally stimulated based on her ACTH stimulation test, I do worry about starting medication that could further inhibit adrenal gland function, unless that was our intent (ie plan to ablate the adrenal glands and make her Addisonian). It could take Jenny's adrenal glands many weeks to start to gain normal function and ultimately become overactive. With her appetite being marginal recently, I recommend that she have a holiday from the Lysodren for at least a few weeks, with the plan to start Lysodren at 1/4 tablet twice a week (a decrease from every other day schedule that she had been receiving) once her ACTH stimulation has increased at least into the normal range. We discussed Lysodren treatment for Cushing's as well as Trilostane. I do not have a preference in one over the other. Lysodren has been effective for Jenny and this drug would be fine for her on a lower dose with monitoring. Once we start the Lysodren again, I recommend rechecking at least a resting cortisol (if not an ACTH stimulation test) every 4-6 weeks for three checks if she appears to be feeling well (an ACTH stimulation test is indicated if she is feeling poorly).

I periodically do the baseline part of the ACTH to see where she is at. I am in no rush to start cushings treatment again if she is not showing symptoms. Her insulin needs have gone up a little which is a sign of her cortisol going up but she does not have a ravenous appetite and she is not drinking a lot.

I hope it helps to see what my IMS said in virtually the same situation. when Jenny was at .5 she didn't want to eat and was listless

[molly muffin]

I agree with Jenny, definitely need an acth if one has not been done, to see where he is at now and he might need a break from the lysodren. I wouldn't based on what you have said, go back to giving it until the ACTH is in and you know what the cortisol is doing.

Welcome to the forum
Sharlene and molly muffin

[Igby]

That is the odd thing. We did the ACTH and the resting was in the normal range and one hour post was 208. That is why the vet said to increase him from 1/2 to 5/8. His dose was Thursday and we tried to test him Monday but the vet said he slipped up with administration so I brought him in on Tuesday. He therefore has been off meds for four days. He had a dose on 7/4 and nothing again until 7/12 when he crashed. He seems peppier today but I want to see sustained pep before I re-start his meds.

Thanks for the feedback! It helps to know there are others out there with wisdom!

[molly muffin]

I would feel the exact same way. Did they check general blood work to in case something else popped up? Just as a precaution.

Sharlene and Molly muffin

[jxeno13]

Hi and welcome to the forum! I'm sorry your Elliot is sick, and the reasons that brought you here. Judi and Sharlene are right. I have no experience with Lysodren at all. Although, my baby, Eli has crashed on Vetoryl from an overdose. He almost died that time. So, all I can tell you is ....the ACTH stim tests are the most important thing you can do before and after a crash especially. I'd hold off on dosing him with anything until you have him rechecked to see exactly where his cortisol level is. We kept Eli off any meds until after his crash until he showed the actually full signs of Cushing's again, i.e. drinking, peeing and over eating. Then retested him and started back at square one with any medication. But, again as I said Eli is on Vetoryl.

[molly muffin]

Hi, how is Elliot doing? Is he recovering from the possible crash?
Did they ever look into any further testing to see if anything else was going on?

Sharlene and molly muffin

[Igby]

Elliot's appetite is still way off--especially in the morning. His energy is low as well. What might I ask the vet to look for with him? It always seems like we turn up nothing except Cushings and Cushings-related symptoms

[Squirt's Mom]

Hi,

I have some questions.

I read the info you have posted and am not clear about the timing of the ACTH(s). In particular - was an ACTH done after the 12th when Elliot crashed? Were his electrolytes checked after the crash?

Also, in your first post you say -


The vet phoned with the results and had me up his dose to 5/8.

I don't understand the 5/8 - that is not how I am used to seeing Lysodren doses. It comes in 500mg tablets or is compounded into a liquid sometimes which would be dosed in ml. So can you tell me what the "5/8" refers to? How many mg or ml per day was Elliot taking?

How much does Elliot weigh?

Is he losing weight?

Has he been checked for diabetes since the crash?

Has he had any diarrhea / loose stools or nausea / vomiting?

Has Elliot had an abdominal ultrasound?

Has he had any blood work done lately that shows things like BUN, CHOL, etc?

Nosy old broad, huh? :D

If Elliot crashed from the cortisol going too low in mid-July and is still feeling poorly but his vet can't find the problem, I would be looking for a second opinion. Since I'm not clear on what the vet did after the crash (ACTH and electrolytes checked, pred given, ect.) I'm not sure what might need to be done today beyond a second opinion or lab work if none has been done recently.

Hugs,
Leslie and the gang

[Igby]

Thank you. I am printing up the comments and will bring them to the vet. He peps up for rides in the car and he walked strong but then sleeps...hard.