Suggestions for newly diagnosed Toby

[Fran]

Hello. My 12 yo Toby has recently been diagnosed with Cushing's Disease. He is a 50 lb Wheaton Terrier mix who we rescued at 8 years old.

He had a low dose Dex Suppression test. He has all the classic symptoms and our vet started him on Mitotane/Lysodren 3 days ago. (Liquid) I am also giving him Sam-E for slightly elevated liver enzymes. The only change I see so far is he has slept through the night. Will I see any physical changes before his blood test in 10 days? Should I have him on any other supplements that might help? Any suggestions or thoughts would be appreciated. I forgot to mention that he is the best dog ever!
Thanks to all for suggestions and ideas.
Fran

[Harley PoMMom]

Hi Fran,

Welcome to you and Toby! It would help us a lot if you could round up copies of all tests that were done on Toby and post those results that are abnormal with the reference ranges and units of measurement...e.g..ALT 150 U/L (5-50)...thanks! We are especially interested in the results of any tests that were done to diagnose Toby's Cushing's, such as that low dose dexamethasone suppression (LDDS) test. Was an ultrasound done? An urinalysis? Since there isn't one test that is 100% accurate at diagnosing Cushing's I do hope that the vet has done other testing to validate Toby's diagnosis of Cushing's.

Could you tell us what Toby's dose of Mitotane/Lysodren is, in the liquid form the bottle should state how many mg are in 1 ml. Is Toby getting his Mitotane/Lysodren twice a day with some fat? With Mitotane/Lysodren it is important to give the dose after the dog has eaten because a dog that is showing any hesitation to eat might well be loaded. There really is no set timeframe for the Mitotane/Lysodren loading phase, it could take a day, a week, or longer. When a dog shows signs of being loaded, you are looking for changes in appetite or water consumption, an ACTH stimulation test needs to be done 48 hours after the Mitotane/Lysodren was given. If a dog vomits, or has diarrhea, or is listless, any one of these could be a sign that the dog is over loaded and the Mitotane/Lysodren is stopped and an ACTH stimulation test should be done. Has the vet written a prescription for Toby for prednisone to keep on hand?

I am very glad you found us because you should have very specific instructions regarding using Mitotane/Lysodren. I am attaching a link that I want you to read and print if you can: Lysodren loading Instructions and related tips (http://www.k9cushings.com/forum/showthread.php?t=181)

If you have any questions please do ask them. ;)

Hugs, Lori

[Fran]

Thank you Lori for your response and great suggestions. :) I have printed the loading instructions. Toby's LDDS test showed:

Baseline of 4.1 Reference range is 2.0-6.0
4 hours post <1 Range 0.00-1.5
8 hours post 1.9 Range 0.0-1.5
ALT 140 Range 5-110
Eosinophils 11 Range 0-10
EOS# 1452 Range 0-1250

He has not had a ultrasound or a urine analysis. My vet said this shows pituitary Cushing's Disease.

Toby started his Lysodren on Saturday and now has 5 dose's on board. He is due for his next one tonight. I was given a small bottle of liquid Mitotane/Lysodren 300mg/ml. I have given him 1.1ml every 12 hours. I noticed today that he seems a little funky. He only had a few bites of food, but he did drink water and has had normal stools. He is panting less and has slept through the night the last few nights. Not sure if this is time to stop or not. He does have problems with weakness in his legs, but he had this before he started the Lysodren. If I do end up giving him a Prednisone, will this mess up the test and we will have to start over?
My vet said to call her after about 5 days to see if we are going to continue treating Toby since she has to order the test to be delivered. She told me it was about $400.

I am also giving him SAM-E for his slightly elevated liver enzymes. Should I add anything else?

Well, thanks for listening and any comments and suggestions are appreciated. Glad I found you!

Fran

[Harley PoMMom]

When it comes to dosing our motto is "when in doubt don't give the drug" it is better to underdose than to risk overdose.

With the LDDS test you first look at the 8 hour number and if this is over the lab's cut off reference ranges than the dog is likely to have Cushing's. I am a bit worried, even though those LDDS test results do indicate Cushing's that 8 hour number is just a hair above the cut off value.

Could you tell us exactly all the symptoms Toby is displaying?

If I have done my calculations right, Toby's dose is 330mg given twice a day. The loading dose is usually 50mg per kg of a dog's weight, so for Toby's weight of 50lb you need to find his weight in kg, which is dividing the 50lbs by 2.2 and that would be 22.72 kg. Then take that weight in kg and times it by 50 mg, which is 1136 mg, which is then divided by 2 ( because the drug is given twice a day) = 568 mg. So it looks like Toby's dose is 29 mg, when the usual dose is 50 mg...which would take a dog with Cushing's a while to load.

If Toby is acting off, than I do recommend in stopping the Lysodren/Mitotane and if he continues to act like that than I would suggest that an ACTH be done. Prednisone will have an effect on the ACTH stimulation test, however if Toby doesn't perk up than I would give him some prednisone. Is his appetite good? Any diarrhea?

[Fran]

We initially noticed Toby's legs getting weaker and had a spinal x-ray. This showed some arthritis and disc disease. We went through a comprehensive course of rehab with swimming, treadmill, massage, and laser therapy. He seemed to love it. After a few weeks his symptoms were getting worse and his legs were collapsing. He started knuckling on his rear legs and now has started that with his front legs. He is constantly panting, and is restless. He doesn't seem to know what to do with himself. He is usually very happy and a constantly wagging tail. When I started the Lysodren, he has now slept through the night.
Normal stool today. He finally ate an hour ago.:-).

I can't tell you how much I appreciate your help and guidance. Many thanks!

[Fran]

I forgot to mention that he has the pot belly and the thinning hair.

[Harley PoMMom]

Knuckling is generally a neurological or spinal problem and usually not caused by Cushing's disease.

I'm glad to read that Toby has slept through the night and his appetite has perked up, normal poops!! YAAA!! I hope you don't find it strange that we celebrate normal poops, oh and, yellow pees!!!! ;):D:o

Hugs, Lori

[molly muffin]

It's true, many of us around here have been on poop patrol at one time or another. :)

Welcome to the forum.
Sharlene and molly muffin

[Fran]

Thank you all for the guidance. Regular poops are a big deal at our house!
Toby is so restless, especially at night and his legs are getting weaker. As of today he has had five days of treatment. No difference. I am going to try the Melatonin at night to see if this helps him. Can you advise what dose of Melatonin to give him? He is 50 lbs.
Thanks,
Fran

[molly muffin]

I'd start with just 3mg to see if that settles him. It should.

Sharlene and molly muffin

[Squirt's Mom]

Hi and welcome to you and Toby! :)

I am a tad bit concerned about the veracity of the diagnosis - if it is in fact correct. Some of the signs you listed are not typical of Cushing's, like has been said, and the LDDS is borderline. Also if there is another illness or problem present, the LDDS is more likely to be skewed. I would feel MUCH better about the diagnosis if other tests had been done, especially the ACTH and ultrasound. The following list are common signs seen in cush pups. Would you mind telling us which of these you saw or are seeing in Toby?

The most common symptoms include:
• increased/excessive water consumption (polydipsia)
• increased/excessive urination (polyuria)
• urinary accidents in previously housetrained dogs
• increased/excessive appetite (polyphagia)
• appearance of food stealing/guarding, begging, trash dumping, etc.
• sagging, bloated, pot-bellied appearance
• weight gain or its appearance, due to fat redistribution
• loss of muscle mass, giving the appearance of weight loss
• bony, skull-like appearance of head
• exercise intolerance, lethargy, general or hind-leg weakness
• new reluctance to jump on furniture or people
• excess panting, seeking cool surfaces to rest on
• symmetrically thinning hair or baldness (alopecia) on torso
• other coat changes like dullness, dryness
• slow regrowth of hair after clipping
• thin, wrinkled, fragile, and/or darkly pigmented skin
• easily damaged/bruised skin that heals slowly
• hard, calcified lumps in the skin (calcinosis cutis)
• susceptibility to infections (especially skin and urinary)
• diabetes, pancreatitis, seizures

Has the vet done any testing or even examined his spine to see if that is the cause for the knuckling? Unless the tumor on the pituitary is quite large, that is not normal for a cush pup and indicates to me there is another problem somewhere that is being ignored and blamed on Cushing's. ;)

Based on the info in your post on the 15th, the Lyso should have been stopped that day and the ACTH performed to check his cortisol levels. Did the vet tell you what to look for that would indicate he is loaded and, even more important, what to look for that would indicate his cortisol has gone TOO low and he needs immediate medical attention? Did the vet give you any prednisone and instruct you on when and how to use it?

What improvements or changes have you seen since starting the Lysodren? Is he still "funky", not eating or drinking as much?