New and need help please (6.10 y/o female yellow lab)

[SusanB]

Hi My name is Susan my baby is Molly. Molly is a 6 yr 10 month old neutered female yellow lab. Her weight is 45kg or 99 lbs. Her ideal weight should be 75lbs. Molly was diagnosed with cushings disease May 2013 at 5 yrs old. Her regular vet tested for diabetes, thyroid both were negative. He did the low dose dexamethasone suppression test and the ACTH stim test both were inconclusive. He believed she was cushionoid because of all the symptoms. Excessive panting, excessive thirst, belly enlarged, excessive hunger and having seizures once in awhile that I thought were allergy based. I don't have those lab reports. So off to the specialist internal medicine Dr.

She examined Molly, and did an ultrasound
Liver appears very slightly hyperechoic
Spleen normal echogenecity no masses or nodules visualized
Kidneys left measured 7.37cm could get a picture of right but no adrenal mass seen
Pancreas not visualized as abnormal
GI overall appears normal no lymphadenopathy
Impressions overall unremarkable
Ec8+
Na145
K 4.3
Hct 58
Hb 19.7
Cl 119
Glu 100
Bun/Urea 18
Ph 7.444
Pco2 28.5
Hco3 19.5
Tco2 20
Be -5
AnGap 11
ACTH Stim
Cortisol sample 1 4.1 Reference range 1.0-5.0. Units ug/dl
Cortisol sample 2. 7.1 (low) Reference range 8-17 units ug/dl

She went on 60mg twice a day of Vetoryl
The testing was sent to the University of Tennessee positive for cushings the pituitary

ACTH Stim
Cortisol sample 1 3.5 reference range 1.0-5.0 units ug/dl
Cortisol sample 2. 5.6 (low) reference range 8-17 unitsug/dl

This dosage wasn't working so she decided to try a holistic approach she went on lignans and melatonin. She was doing ok until her symptoms seemed to get bad again

3/25/14
General senior profile
These did not fall in the range
Alk phosphatase 728 (high). Reference range 5-131. Units U/L
Bun/Creatine Ratio 29 (high) reference range 4-27. Units Ratio
MCV 80 (high). Reference range 58-79 units fL
Platelet Count 442 (high) reference range 170-400 units 10 (with a little 3)/uL
Differential Absolute %
Total T4 <0.5 (low) reference range 0.8-3.5 units ug/dl
Urinalysis
Color dark yellow
Appearance cloudy reference range *Clear
Specific gravity 1.054 (high) reference range 1.015-1.050
pH 8.5 (high) reference range 5.5-7.0
Protein 3+ (high) reference range Neg
Glucose ketone bilirubin blood all negative
WBC 4-10 (high) reference range 0-3 units Hpf
Rbc none reference range 0-3 units Hpf
Casts none seen Units LPF
, Struvite (mgNH4P04) Crystals 21-50 units HPF
Bacteria none seen reference range none units HPF
Squamous Epithelia 2-3 reference range 0-3 inits Hpf
Urine Microalbuminuria >30 (high) reference range <2.5 units mg/dL

We went on 70mg Vetoryl twice a day starting 3/28/14
2weeks on 70mg twice a day came for test on
4/11/14
ACTH Stim
Cortisol sample 1. 5.2 (high) reference range 1.0-5.0 units ug/dl
Cortisol sample 2. 8.5 reference range 8-17 units Ug/dl
5/27/14 increased Vetoryl to 120 mg twice a day (symptoms not improving)
2weeks later we came for more testing
Ok so on 6/10/14 we had another Cg8+ I-Stat
Na 148
K 4.5
Hct 50
Glu 115
iCa 1.43
pH 7.459
PCO2 30.2
PO2 34
HCO3 21.4
TCO2 22
s02 70
ACTH Stim
Cortisol sample 1 3.8 reference range 1.0-5.0 units ug/dL
Cortisol sample 2. 5.6 (low) reference range 8-17 units ug/dL

On 6/26/14 increased to 150mg Vetoryl twice a day
On 7/11/14 Antech liver chem
Alk Phosphatase 892 (high) reference range 5-131 units U/L
7/11/14 ACTH Stim
Cortisol sample 1. 4.2 reference range 1.0-5.0 units ug/dL
Cortisol sample 2. 5.8 (low) reference range 8-17 units ug/dL

9/8/14 increased dosage to 180mg of Vetoryl twice a day
We have an appointment for another ACTH Stim test on Monday 9/22/14

Molly's symptoms are the same still starving still panting excessive drinking,bloated belly (I call her my little Buddha baby). Sleeps on the kitchen tiled floor.

I will talk to the Dr Monday to find out what test were from the University of Tennessee and will call our regular vet for the initial tests.

I was not aware that there was a problem with Molly's Struvite Chystals nor the Urine Specific Gravity (USG) nothing was said or done. I'll talk to the doctor about it at her appointment.

I am averaging $844 a month since March I don't see the Vetoryl working and need help. I'll have to wait again for the results but I am ready to stop the Vetoryl. The specialist has never worked with Lysodren so not sure what my next move will be. Even though the Lysodren scares the heck out of me I need my baby to feel better.

Sorry this is so long I live outside of Springfield Massachusetts

Thank you for your input she is my baby heck I even bought my new car for her downgraded to an Xle vs limited because of the bench seat and of course she has the foam blocks to protect her so no falling off the seat.

[Harley PoMMom]

Hi Susan,

Welcome to you and Molly! Thanks so much for all the information you provided for us, it does help us. I just need clarification on a few things so I can help you with Molly to the best of my ability, ok?

One thing I am asking you for is to edit your post and add the reference ranges and units of measurement to those values you listed....e.g...ALT 150 U/L (5-50). Also we would really like to see those results from LDDS (low dose dexamethasone suppression test) and that ACTH stimulation test that was performed to diagnose Molly for Cushing's.

Now, another thing I need is to confirm the timelines for all of Molly's ACTH stimulation tests along with the dosage increases.


ACTH Stim
Cortisol sample 1 4.1 ug/do
Cortisol sample 2. 7.1 (low) ug/do

She went on 60mg twice a day of Vectoryl
The testing was sent to University of Tennessee positive for cushings the pituitary

When was this ACTH stimulation test done (date), was it before starting Vetroyl or after, if it was after starting the Vetoryl, how long after? How were her symptoms at that time?

Could you post the results from University of Tennessee?




ACTH Stim
Cortisol sample 1 3.5 ug/dl
Cortisol sample 2. 5.6 (low) ug/dl

This dosage wasn't working so she decided to try a holistic approach she went on lignans and melatonin. She was doing ok until her symptoms seemed to get bad again


When was this ACTH stim test done and what dosage was she on?




Specific gravity 1.054 (high)
pH 8.5 (high)
Protein 3+ (high)
Glucose ketone bilirubin blood all negative
WBC 4-10 (high)
Rbc none, Casts none seen, Struvite (mgNH4P04) Crystals 21-50

Has the vet addressed Molly's Struvite crystals? If not, I am quite concerned. The crystals could be why Molly's drinking/urinating has increased. But what I am most concerned with is Molly's Urine Specfic Gravity (USG), a dog with Cushing's would never have a USG that high. I do really question Molly's diagnosis of Cushing's, however until further information is known I can not say for certain.


We went on 70mg Veteroyl twice a day
4/11/14
ACTH Stim
Cortisol sample 1. 5.2 (high) ug/dl
Cortisol sample 2. 8.5. Ug/dl

Ok so on 6/10/14 we had another Cg8+ and
ACTH Stim
Cortisol sample 1 3.8
Cortisol sample 2. 5.6 (low)
On 7/11/14 Antech liver chem her Alk Phosphatase 892 (high)
7/11/14 ACTH Stim
Cortisol sample 1. 4.2
Cortisol sample 2. 5.8 (low)

We went 70 mg to 120 mg to 150 mg to now 180 mg twice a day of Veteroyl
We have an appointment for another ACTH Stim test on Monday
Molly's symptoms are the same still starving still panting excessive drinking etc

What were the reasons for uppong the doses ~ 70 mg to 120 mg to 150 mg to now 180 mg twice a day ~ was this because Molly was still displaying symptoms?

180 mg twice a day is high, does Molly still weigh 99lbs? It could very well be that Vetoryl is not working for Molly and maybe a switch to Lysodren could be beneficial, a wash out period has to be done for 30days before swirching to Lysodren.

We will help in any way we can and hopefully we all can put our heads together and help you help Molly. Hang in there, ok? ;)

Hugs, Lori

[molly muffin]

Hello and welcome to the forum.

Can you edit your test results to put in the normal range?

My first thought in looking at the last ACTH

7/11/14 ACTH Stim
Cortisol sample 1. 4.2
Cortisol sample 2. 5.8 (low)

is that this is not a bad result, in that the post is 5.8. You'd still want to get the 4.2 down a bit but if symptoms are controlled, then on vetroyl (trilostane) the post can be up to 9.0ug, if not controlled, then you want to bring the post down to below 5.ug.

Was her urine as concentrated prior to starting vetroyl as it is now? 1.054 is very concentrated. Also seeing the PH is off and the protein is up, have you had a UPC done to check kidneys?

Once you edit the results for ranges, we can maybe see a bit more of what is going on.
Have they checked out the thyroid? Maybe it wasn't just low due to the cushings?

If you do want to switch to lysodren, I would see about finding a specialist with experience with it.
Some of our member who have used lysodren will pop in soon I'm sure.

You'll want a 30 day wash out period between switching from vetroyl to lysodren.

Both can be very effective medications and both have to be vigilantly monitored according to protocol by owners and vets.

Sharlene and molly muffin

[Spencersmom]

Hi Susan! Welcome to the best forum for cushings support! I'm too new to this to really feel comfortable offering advice, but want to encourage you to work with our experienced members!!!

You are part of a very special family, bound together by a common disease of which we all strive to better understand, so we can provide the best care for our furbabies!

I hope you are able to obtain the level of control you need for your pup! Hugs from me and Spencer!

[SusanB]

Hi I edited my original post (not use to posting yet) Molly is currently at 99 lbs.
I will try to get my regular vets reports and will post once I have them he also ran the urinalysis before she started on the Vetoryl . The Specialist has increased the dosing because her symptoms haven't improved. I absolutely hate hearing her stomach growling all the time and her looking for food licking the floors, begging etc. How do I find a Specialist who deals with Lysodren I followed a link on this site and couldn't find anyone in my area.

Thanks again for helping us.

[molly muffin]

Do you have a vet hospital anywhere near you? I'm not sure where you are located, but often the vet hospitals, teaching hospitals will have staff that can work with you. The crystals do need to be addressed, as does the very high urine specific gravity. One of the main symptoms of cushings is a very dilute urine, due to drinking so much water, because the kidneys are working over time. The PH needs to be addressed to help with the crystal formation.

Check online for a teaching hospital, often at a university for example, or a ER vet hosptial often has specialists you can see.

Sharlene and molly muffin

[SusanB]

Hi again,
My specialist is at an ER Vet hospital. I am from Hampden Massachusetts right outside of Springfield, Ma. Molly's specialist is from the VCA Boston Road Animal Hospital in Springfield, Ma.

It looks like they have Tuffs University Cummings Veterinary Medicine about an hour from me.

[molly muffin]

Yes we know of Tuffs. One of our members dogs is getting ready to have surgery there soon I believe.

You could also ask your specialist if they can recommend someone who has experience with lysodren if the vetroyl doesn't work.

How long has she been on the latest increased dosage? 10 days? Any change in symptoms?

Sharlene and molly muffin

[SusanB]

It will be 14 days on Monday when she has her next test. The symptoms have not improved which is so frustrating. Now that the weather is cooler we shut the sliding glass door vs screen door with a doggie door. So I am up at least three times a night letting her outside she hasn't had accidents in the house yet we trained her to ring the bells on the door when she has to go out from when she was a pup.

[Rosie's_Dad]

Susan today is my first day on this forum and I want to let you know that tonight Molly and you are in my thoughts and prayers. I cant give you advice or medical help, but I do know your hurt and I have it too in my heart and I will be sending prayers for you two when I lay my head to sleep with Rosie. God Bless you and Molly

Earnie and Rosie

[SusanB]

Molly's appointment today. Her specialist did not repeat the ACTH test as Molly's symptoms have not changed in the 14 days she has been on the 180mg twice a day Vetoryl.

Molly will now go 30 days without any medication and be re-tested for a base reading before she is started on Lysodren.

I of course will be reading everything I can on this drug.
She has worked with Lysodren but not initial dosing but the other doctors have so I am feeling more confident. I have also included the lab results from the University of Tennessee. I don't have initial labs from last year at her regular vet yet.

Testing 4/29/13
Cortisol ng/ml
baseline 100.9 normal range 2.1-58.8
Post ACTH 210.7 normal range 65.0-174.6

Androstenedione ng/ml
Baseline 0.47 normal range 0.05-0.57
Post ACTH 0.94 normal range 0.27-3.97

Estradiol pg/ml
Baseline 119.6 normal range 30.8-69.9
Post ACTH 95.5 normal range 27.9-69.2

Progesterone ng/ml
Baseline 0.98 normal range 0.03-0.49
Post ACTH 2.86 normal range 0.10-1.50

17 OH Progesterone ng/ml
Baseline 0.96 normal range 0.08-0.77
Post ACTH 2.72 normal range 0.40-1.62

Aldosterone pg/ml
Baseline 54.2 normal range 11-139.9
Post ACTH 183.6 normal range 72.9-398.5

Results indicate presence of increased adrenal activity (moderate)

Comments Cortisol, estradiol and progestin concentrations are elevated. Estradiol is not a specific indicator of adrenal activity since it may also be synthesized by peripheral tissues such as adipose tissue or skin however it may still contribute to clinical signs.

[molly muffin]

This is a link that we give to anyone that is going to be starting lysodren. It tells you how much should be given, and what to watch for during loading. I remember one of our Admins saying she printed it out and put it on her refrigerator and checked it all day long.

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

Any questions about lysodren, just ask, we've a few people who have used it.

Sharlene and molly muffin

[SusanB]

Thank you for the link Sharlene I will take your advice and print it as well.

[SusanB]

Hi,
Molly has been off vetoryl for 30 days now. We are starting Lysodren on Saturday. This dosage seems very high to me. Molly weighs 102lbs.

Diagnostics
Physical exam: Wt-46.8kg
Molly was bright and alert and nervous. Her heart and lungs ausculted normally. Her liver felt enlarged on abdominal palpation. Her abdomen is slightly pendulous.

ACTH stimulation: Pre: 10.4 Post: 14.9

CBC: Within normal limits

Chemistry: ALP-1542, otherwise unremarkable

Lysodren (mitotane) 500mg tablets: Please give 2 tablets by mouth every 12 hours. (We will confer on the best day to start the medications once you get the medication. Appointment 8 days from start.
If needed Prednisone 20mg tablets: Please give 1 and ½ tablet by mouth if needed and seek veterinary care

ACTH

Alk Phosphatase results 1,542 Range 5-131 High
Bun/Creatinine results 29 ratio Range 4-27 High
Calcium results 11.5 mg/dL Range 8.9-11.4 High

Cortisol Sample 1 10.4 ug/dL Range 1.0-5.0 High
Cortisol Sample 2 14.9 ug/dL Range 8-17

If anyone can tell me what they think I would appreciate it.

[labblab]

Hi Susan, according to the loading instructions of Dr. Feldman provided in that link above, since you will be giving 2000 mg daily, the dose your vet has prescribed is within the range of what is recommended per the formula of 50 mg/kg/day (50 mg x 47 kg = 2350 mg).

I so hope all will go well for you two!! Even though your vet has officially scheduled a check-up after eight days, I know you will stop the Lysodren and report back to him sooner if you notice even those subtle changes in appetite and/or thirst that are discussed in the link, OK? For that reason, it is best to first offer a meal before dosing so that you can evaluate any change in appetite before giving the next tablet. Always remember, whenever in doubt, it is much safer to temporarily withhold a dose and consult with your vet. You can easily resume at any time, but once a dose has been given, you cannot take it back.

Marianne

[Squirt's Mom]

Hi Susan,

The dose seems right, tho compared to Vetoryl it really does seem high, huh? ;)

Read this info carefully. Some of us have printed this out and kept it handy.
http://www.k9cushings.com/forum/showthread.php?t=181

We will be here to help any way we can. Keep your chin up and never hesitate to ask questions. I am sure you are nervous about the Lyso but if it helps, this is and will be my drug of choice should I ever have another cush pup. ;)

[SusanB]

Thanks for your responses. I did read all of the information on the site and actually printed it out. After I posted I took out the calculator and was figuring out the dosing. I guess I was a little nervous reading other posts when all of their dosing was much lower but again little pups vs my big one. Hopefully this drug will help my baby. The upside is that my doctor doesn't stock the drug so Costco and savings here I come.

[molly muffin]

Savings are always good. Good luck with your load starting Saturday.

Sharlene and molly muffin

[SusanB]

Hi,
I had gone away for a week so we delayed Molly's start of Lysodren. We are on day 5 of the induction and I was feeling pretty good about how it's going. Molly had a doctors appointment on Sunday until I received a phone call today saying her specialist is no longer at the VCA hospital we go to. I called and they have another Vet taking her clients but she is not an internist or specialist. I looked her up online and could find very little about her. She is starting on Monday. I called them up to voice my concern and they said they have another oncologist coming to work with her for a few weeks a few days a week. I called my regular vet and he told me to meet with them and see how it goes. I am panicking for when Molly loads and the testing involved. They made my appointment for Monday but I read once Molly is loaded she needs to be tested 48 hrs after her last dosage.

I just needed to vent.

[Renee]

Oh dear. Nothing worse than losing the vet you've built up trust with. I would just be lost without my vet.

Take a deep breath though -- you can take charge of your vet appointments, regardless of whichever vet you get, as long as you are armed and ready with the knowledge you need to direct the vet. Come prepared and make sure this new vet knows without a doubt that you are an active and informed pet owner. You can do it!

[labblab]

Wow, this is really worrisome (and IMO totally irresponsible of the IMS who abandoned you not to first call to personally discuss your options!!! :mad:) so I understand why you are venting!!!

It's not clear to me whether anybody with specific knowledge is capable of performing an ACTH test right now. Can your regular vet perform the test? What has VCA told you will happen if you need to test before Monday??

Have you noticed any changes at all with Molly?

Marianne

[SusanB]

Molly is still eating her food like she's starving. Her panting today seems better, she made it through the night from 1-8 without having to go out, and although she is still drinking more than normal it has decreased slightly. My regular vet gave me the Vet in charge of the VCA hospital to speak with about who to have contact with concerning Molly and testing if needed before Monday.

They are also an emergency hospital and said the vets on duty would be able to do the ACTH test. I am still a nervous Mom.

[SusanB]

I forgot to mention I emailed her specialist vet that will no longer be her doctor and haven't heard back from her yet.

[molly muffin]

Oh my gosh! What a worry to have happen in the middle of a load. Does this vet have any experience with cushings? Is there another specialist in the area? Is there a 24 hour emergency vet ER? Often those have specialists.

I'm so sorry as this is just another worry that you don't need when trying to get things sorted out for Molly.

Hang in there!!
hugs

[Squirt's Mom]

I am with Marianne...this is irresponsible to not let you know she wouldn't be around to continue caring for him through the load. :eek::mad::mad: I hope you end up with a vet you can trust and work with...one that won't abandon the two of you!

[Squirt's Mom]

Keep a very close eye for any further changes in signs and STOP the Lyso when you see them. Don't wait for day #X or for the vet to tell you to stop - watch those signs. You should be seeing some major changes very soon. ;)

[SusanB]

Good morning,

Molly is loaded she had her last pill this morning at 8:45 day 7. She ate 1/2 of her food and has been taking small (or normal) drinks of water. I am watching her like a hawk right now to make sure she is ok. I measure her water at night, yesterday she drank 64 oz of water. I do have prednisone on hand if needed but so far so good.

Hopefully we will be heading in the right direction with the Lysodren for some reason she didn't respond to Vetoryl that took 7 months of dosage increases before we decided to try Lysodren. I wish I hadn't been so scared of this drug my baby could have been doing better sooner.

We have our appointment set for Monday at 10:00 am that will be 49 hours do you think that will be ok or should I call for an earlier appointment?

[Squirt's Mom]

Oh, you did so good, Mom! Way to watch your baby! WOOHOO! Now to check the levels and settle back with a maintenance dose. Good job you two! :cool::cool::cool:

[Squirt's Mom]

I think your schedule will be fine. ;)

[labblab]

I think your Monday ACTH sounds fine, too. The only thing that worries me a little bit is that it sounds as though Molly got an additional dose this morning, after she already was showing signs of being loaded (eating only half her breakfast and drinking less water)? If so, that final dose has the potential to drop her cortisol even lower. So it is good that you have the potential to test sooner (and the prednisone on hand), just in the event that you see any worrisome changes in her. Overall, though, I think you've done great!

Marianne

[Dixie'sMom]

Go Molly! It sounds like she is finally there. I can't wait to see what her tests show Monday.

I do have one question for you. On her senior profile on 3/25 she had a low T4. Was this ever mentioned by your vet or has it been rechecked? I know its thyroid related, but I'm not sure if her values were low enough to do further thyroid testing or if it was overlooked due to the cortisol issue. It may be worth a mention.

I hope the new vet will be all that you want and need and willing to work with you to get Molly happy and healthy. She's beautiful. :)

[SusanB]

Great news Molly is going on maintenance. She had her ACTH test yesterday morning with her new veterinarian. The vet called tonight with the good news. She will email the lab report tomorrow but Molly fell in the range for both pre and post. She was on the lower levels so we are starting meds on Wed. She is starting with 1 1/2 tabs on Mon. Wed. and Fri. The new vet gave me her personal cell phone number and email address. We will retest in a month unless I notice any changes. I want to thank everyone for their support I was better prepared and less scared of the Lysodren because of you.

[judymaggie]

Way to go! Your Molly and my Abbie are on the same track with both loading and starting maintenance this week. It is a good feeling to get past the loading, isn't it? :D

[SusanB]

Hi Judy,

I am happy Abbie is on the same track. Loading was stressful I didn't let Molly out of my sight because of horror stories I read about. This actually was so easy. I wish I had switched to this drug a long time ago. I am going to be saving $400 a month if she stays on the maintenance dosage my Vetoryl was up to $500 a month and was doing nothing for her.

[molly muffin]

Susan did they give you the pre and post number?

It is less stressful if you can get through and easy load and keep them stable.
Since you said Molly was on the low side of her numbers keep an eye on her for any signs if her going low. She shouldn't if course but you want to stay vigilant with her.

Good job and congrats on a successful load

Hugs

[Squirt's Mom]

OH ya'll done so good! Nice to have that load behind you and ready to settle into the maintenance phase, huh? Let us know when you get the results!

WOOHOO! Way to go Abbie and Mom!

[SusanB]

Molly's ACTH
Cortisol sample 1 1.1 Normal range 1.0-5.0 ug/DL
Cortisol sample 2 1.1 Normal range 8.0-17.0 ug/DL. Low

Post Lysodren: Pre and post cortisol levels after Lysodren loading or while on maintenance Lysodren should be between 1.0-5.0 ug/DL

We started our maintenance tonight. She is eating and drinking water. I am still measuring to make sure she is getting enough. She seems to be a little more playful and she is back to her gentile self when taking food from my hand.

If anything seems off to anyone please let me know.
We are doing 1 1/2 pills Mon Wed and Fri

[labblab]

Hmmm....now that we have the actual ACTH results, I do have a bit of concern about the size and timing of the maintenance dose given how low her cortisol still was on Monday, 48 hours after her last dose. It is not just that her numbers were right there at the "basement" of the desired range, but that they were totally flat -- there was no stimulated increase whatsoever. If I am calculating correctly, your weekly maintenance dose is even a tad higher than your daily loading dose (4.5 tablets vs. 4 tablets). So if my math is correct (and Molly weighs approx. 100 pounds or 50 mg.), your maintenance dose is approaching the top of the dosing range of 25-50 mg. per kg. From Dr. Feldman's Lysodren instructions that we are so fond of quoting:


Once the dog is successfully "loaded" (also called "induced") the maintenance phase of treatment will begin. The maintenance dose is usually 25 to 50 mg of Lysodren per kg of the dog's weight per WEEK (25-50 mg/kg/week) and can be given in divided doses. Example: 500 mg Lysodren per week can be given as 250 mg twice a week, or 375 mg per week could be given as 125 mg three times a week etc. The entire weekly dose is often the same amount as the dose per day that was given during the loading phase.

The weekly maintenance dose is usually determined by weight of the dog, but the Vet will also take into account how quickly the dog becomes successfully loaded, which may help to indicate the particular dog's sensitivity to the Lysodren. A dog that loads in 3 days might be started on a lower maintenance dose than a dog who took 10 days to load, for example.

Since Molly took 7 days to load, she definitely didn't load overnight. Also, after the failure of the trilostane, I know the last thing you want is to allow her cortisol to rebound to a level that is too high again. But the fact that both her "pre" and "post" ACTH results are so low leaves me feeling somewhat concerned about such an aggressive maintenance dose. But (and this is a huge BUT), I am not personally experienced with Lysodren since I used trilostane with my dog. So I may be worrying about nothing. I do hope that others with more experience with Lysodren will also be stopping by. And most of all, even though I know you are already watching Molly like a hawk, I would be very, very careful if you start to see any indications that her cortisol production is remaining too low or dropping even lower.

Marianne

[My sweet Ginger]

I had experience with Lysodren and flat (blunted) pre & post ACTH numbers so I'm very concerned about Molly's pre & post numbers of 1.1 and higher end of maintenance at this point.
My Ginger's numbers were 2.9 pre & post at the end of last year and she still doesn't need maintenance Lysodren.

[SusanB]

Ok I am worrying again. Molly had her 1st dosage tonight with dinner.
Wow Ginger still hasn't started maintenance I didn't realize that was something that could happen.

I'll have to talk to her doctor. I did question the fact that her maintenance is more dosage than her daily pills but the doctors wasn't concerned. She did give me her cell number in case something goes wrong.

I still have my prednisone still in case.

[jas77450]

Suzie and Susan, yeah for both of you!!!

[My sweet Ginger]

The one clear difference between Molly and Ginger is how they felt/feel during and after their loadings. Unlike Molly, my Ginger was lethargic, falling over, slept a lot and most of all wouldn't eat so she was started on prednisone even during her loading which she still is on to this date. So, to me it's such a relief that Molly is acting her normal self so far tho those blunted pre and post numbers still concern me as that means Molly's adrenal glands are not stimulating at all going by her ACTH numbers. It also concerns me that your vet seems to think nothing of this fact. I'd at least wait until her adrenals start stimulating to start the maintenance. I was anxious too to start maintenance on Ginger myself worrying that her cortisol might get out of control again but waiting and making things sure is the right way to go when everything was said and done with this potent drug.

[SusanB]

How would I know when she starts stimulating? I am going to email her Vet tonight and see what she says and most likely hold off on any more maintenance for now. I just hope tonight's dosage doesn't do any harm.

[labblab]

It would take another ACTH to know exactly what's going on. But there are two very good things to keep in mind. First, as Song says, that Molly is behaviorally doing well. As long as that doesn't change tomorrow or Friday, that is important info to factor in. Secondly, you don't have to decide about the next maintenance dose until Friday evening. So you have two days to gather more recommendations.

I may have started you down a path of worry unnecessarily. So please take pleasure tonight in seeing these improvements in Molly, and we will get the rest sorted out over the next couple of days. It may involve something as simple as just reducing the maintenance dose a tad. Or maybe it won't even involve any changes at all.

Marianne

[judymaggie]

Susan--I would be curious to know the vet's rationale behind the raise in the maintenance dosage. Abbie's loading dose was 500 mg -- she weighed 25 lbs. when that dose was decided on so it was actually a bit lower than the high end based on Feldman's recommendation (568 mg.). Abbie now weighs 26.4 lbs. so 650 mg. would be the high end of the maintenance dosing range. Because Abbie's ACTH numbers were at the low end (although they did show slight stimulation), we decided to leave her maintenance dosage at 500 mg. One other difference from Molly's path is that Abbie's ACTH was done 24 hrs. after her last dose.
I am glad that Molly is feeling good -- you are very aware of what would be a change in behavior and I have confidence that you will do just fine!

[My sweet Ginger]

I'd watch out for symptoms of low cortisol ; lethargy, vomiting, diarrhea, hind leg weakness (falling over), wobbliness, sleepiness and inappetitance. As long as Molly feels good and doesn't have any of these symptoms she may just need a few days break from Lysodren before maintenance.
I'm just concerned that Molly doesn't have any room to go any lower which will probably take her to the other side, Addison's if her post number of 1.1 goes any lower.

[SusanB]

Hi,

Thanks for all of your suggestions and comments. I emailed the Vet based on all of the concerns so I'll see what she says. I don't want to push Molly to Addison's and I also questioned her dosage amounts. Even if it takes awhile to get the maintenance dosage right I am willing to go slow, we've been working on this since March 2013. Diagnosed when she was just 5 years old.

[Squirt's Mom]

Maintenance is typically the same dose that was used for the load just spread out over a weeks' time. ie, if they loaded on 500 a day then the maintenance dose would be 500mg a week. It can go lower but I wouldn't want it to be higher than the load dose. ;)

[SusanB]

Good morning,

Molly's Dr. Called because of my concerns. She feels that the dosage is still within the range but said we will go with just 1 pill vs the 11/2. We are not giving her another dosage until nex Wed so it will be a week without meds.

Thank you all for your help I am feeling better with this new dosing and giving her a week off.

[My sweet Ginger]

I'm so glad with the new plan. It is awfully hard to question your vet's instructions or voice your opinion when they are the professionals but when it comes to Cushings, it's so surprising to see how often we come to read about very clueless vets on this forum. We read too many scary stories that pups have to suffer due to their incompetent vets and their lack of knowledge on this very complicated Cushings disease here. It's mind boggling to me. I now have a different approach as far as where my pups's care is concerned with their vets.
Good job, mom. It's better safe than sorry when we are dealing with our precious babies. :)

BTW, my negative comments about vets weren't specifically aimed at you new vet but was made in general sense after one year on the forum. In fact, I like your new vet's timely reply and accommodating attitude in dealing with your concerns. We need a vet who is willing to work with us.

[labblab]

Hey Susan, just wanted to check in and see how Molly is doing. I'm really glad your vet has agreed to back off on the maintenance dosing.

When is she wanting to schedule the next monitoring ACTH? I don't think you will want to go any longer than a month even if Molly outwardly continues to do fine. After the cautionary lowering of her dose, of course there is always the possibility that her cortisol will start elevating too much once again. As long as that is caught early, hopefully it will be possible to correct simply by increasing the maintenance dose. But if it goes on for too long, you face having to reload again. Of course, if Molly seems unwell in any way, you will want to recheck the ACTH even sooner.

Marianne

[SusanB]

Good morning,

Molly is doing great. I had a scare Thursday morning Molly slept in and when she got up she wouldn't touch her morning chicken breast treats and wasn't drinking. She just went outside and laid down again. I took her in the car for a local errand and she just laid in the car. When we go home I called the vets office (phone was busy when I tried). So I scrambled a few eggs, she ate those, she then ate her chicken and then started drinking her water. I was so relieved. We are up in Maine for the weekend and she is her old normal self averaging 5-6 miles of walking a day (not all at once). She is back to being her old finicky self with treats, eating her meals and drinking. She is scheduled for her month ACTH visit already from our last appointment. She won't get her next maintenance pill until Wed. dinner time it will be a week from her last pill.

Thanks for checking in on us.

[SusanB]

Hi,
Well it seems my maintenance dosage is too low. Molly's symptoms have returned, panting, excessive thirst and hunger, and having to go out during the nights again (she goes out a lot during the day as well). I am contacting the vet tomorrow but wanted to ask if her cortisol is too high again do we go through the reloading again?

[Squirt's Mom]

It depends on how high the cortisol is and how strong her signs are. If she is only getting one pill a week for maintenance, that could well be the problem. Maintenance should be given 2-4 times per week, per 7 day span. Giving it once a week may be letting the adrenals regenerate too much over the days her body is completely without medication on board. The goal of this phase is to keep the same level of erosion achieved with the load. The adrenals can and do regenerate if the dose isn't managed correctly or if it is too low.

Let us know what you and the vet decide about the load.
Hugs,
Leslie and the gang

[SusanB]

Molly is on 3 Lysodren pills a week Mon, Wed., Fri. She loaded on 4 pills daily but when it came time for maintenance she was going to be on 4 1/2 pills a week but her numbers were so low from the ACTH test there were concerns she could go the other way ( from myself and others here) so I talked to her vet and she lowered the dose and we held off all pills for a week.

I'll see if her vet wants to do another ACTH test earlier than our scheduled appointment on the 9th. I just wanted to be prepared in case we need to reload, preparing myself.

[molly muffin]

Hopefully there will be no need to reload but the only way to know for sure is with an ACTH test.

:(

hugs

[SusanB]

Hi,

Molly started having symptoms Monday shaking, not moving around too much, just laying outside in the snow. I called the Vet and rushed her in. I specifically asked about Addison's and was told no. She was due to have her ACTH on Tuesday. They examined her, said she was in some sort of pain. They did the ACTH test and I went home with pain pills. Threw up in the car on the way home. Not eating

Vet called Tuesday with the results and said they were within limits and we can start her Lysodren again on Wed.

Pre cortisol sample 1 1.0 range 1.0-5.0 ug/dl
Post Cortisol sample 2 1.0 8-17 ug/dl low

again I mentioned this number seemed too low to me but she assured me it was within normal range.

Wednesday, called Vets first told to give Molly a prednisone pill, went to the Vets again, they did blood work twice, not Addison's, was assured, took a urine sample, she was dehydrated so they gave her a bag of iv fluids, a cortizone shot (double what the vet told them to do), and a shot for nausea. Told not to give her the Lysodren just the pain pills. Still not eating.

Thursday she did eat some dinner and she seemed a little better.

Saturday (today) went to the emergency room. Molly is definately in Addison's Crisis. She is in the hospital now at least over night.

I just want to scream because I questioned it both on Monday and Wednesday.

The emergency vet is going to call me before she heads home to give me an update.

[Harley PoMMom]

Oh my goodness, I am so sorry to hear that Molly has had an addison's crisis :( Sometimes we have to get forceful with these vets because only a pet parent knows their furbaby best.

You were absolutely correct in questioning those ACTH stim results, they show a non-stimulating result and a corticosteroid drug was needed. Has her electrolyte levels become normal again?

Please do let us know how she is doing and I will be keeping you both in my thoughts and prayers.

Hugs, Lori

[Squirt's Mom]

While 1.0 isn't below the normal range it is the lowest it can get and not be....PLUS both the pre and the post are the same. The fact that you were not told to stop the Lyso the first time probably did send her crashing too low. Please let us know how she is doing.

Do NOT beat yourself up! You did right and if this happens again, you will be even stronger and more apt to listen to your gut. ;) That was one of the hardest things to grasp - that my gut often knew something was up very very quickly and was seldom off the mark.

[My sweet Ginger]

Susan, I'm so sorry that Molly is in a crisis and hope they treat her correctly this time.
I'm very worried for Molly regarding your vet's knowledge on Cushing so far and I totally lost confidence in her and am very scared for Molly when I saw this in your post today. -

- Vet called Tuesday with the results and said they were within limits and we can start her Lysodren again on Wed.

Pre cortisol sample 1 1.0 range 1.0-5.0 ug/dl
Post Cortisol sample 2 1.0 8-17 ug/dl low -

There's no stimulation what so ever! Molly should've been treated for Addison's crisis for her symptoms. Normal ranges of electrolytes (assuming the vet was referring to the normal ranges of these after blood test when she said Molly is not in Addison's crisis) do not always mean a dog is out of danger. You still have to go by the symptoms and the results of ACTH test.
My Ginger's electrolytes have never been out of wack but her body still requires steroid.

I'm relieved she is at the hospital at the moment and hope they will make things right for her.
I want you to know that you did your best expressing your concerns with the vet. I wish she'd been more thorough and cautious when dealing with very potent drugs.

I will pray for you and Molly. Hugs.

[molly muffin]

Oh no. Do sorry to read Molly is in an Addison's crisis.
I'll be watching for an update. I am thoroughly disgusted with your vet. Always error on the side of caution is my motto and it should be every vets motto too.

Hopeing for a good next update

Hugs

[SusanB]

I called the hospital around 8 and Molly was responding to treatment. I am going to call back at 11:00 again to check.

When a dog goes into Addison's Crisis does this mean she is now going to be an Addison's dog vs Cushings dog?

My Vet Specialist called and said that all medication would be stopped for awhile when Molly comes home. She suggested that Molly's cushings could come back. I need to be prepared for discussions. Because if she is going to need medications for addisons she is going to be getting them.

The ER doctor also said I will need to find an Internal Medicine Doctor........ ok that is what they told me my Specialist was. I was too emotional in the ER to get into that and just asked the ER doctor if they could recommend a doctor.

I will call my regular vet on Monday and get a referral as well.

I have been reading about Addison's but the forum that I found isn't as active as this one.

Thanks for everyone that has responded. I am going crazy here without my baby the only time she has been away from home was when she was 6 months and was getting spayed.

[molly muffin]

It is possible that Molly will be Addison's instead of Cushing's as what lysodren does is to erode the outer cortex of the adrenal gland. Whether that will be able to slowly come back in time depends on how far it was eroded. If it is too much then yes she will be permanently Addison's. If not some day Cushing's Might come back. You will not be giving her any more lysodren for a long time though is my guess. They say that Addison's is easier to treat though. We have one dog on the forum now that went Addison's from lysodren I'll post a link to Tina and Jasper's thread. There has been a few bumps in their road but jasper is still okay. He has a few other issues but the Addison's is okay and controlled.

http://www.k9cushings.com/forum/showthread.php?t=4372&highlight=Jasper&page=7

You definitely need a specialist who knows what they are doing. Not sure what knd of specialist you are currently seeing and that needs to be clarified but they shouldn't be treating dogs with Cushing's using g lysodren if this is how they go about it. Any time a dog is acting like Molly was and on medication for Cushing's the first thing you do is stop all Cushing meds and immediately check cortisol levels. Full ACTH and electrolytes. It's textbook and I don't think they read the text book. So get a new IMS. Please.

You can also write to Tina and I am sure she will give you some pointers. She isn't on all the time but when she sees it I know she will respond.

Hang in there. You are doing good and asking all the write questions. Some of the others will be by with their thoughts too

Hugs

[Squirt's Mom]

The adrenals can and do regenerate after a crisis with Lyso so don't lose hope. Some folk feel Addison's is easier to treat and in some other countries, intentionally causing Addison's is how they treat Cushing's for that reason. But it is too soon to tell right now....however you responded quickly and got her the help she needed so I anticipate you will be dealing with Cushing's signs again pretty soon. ;) Meantime, you will have a bit of a reprieve.

Stay in touch and let us know how she is. And remember - it's not the drug nor you that caused the problem but your vet who didn't listen and apparently doesn't know how to use Lyso nor read test results. ;)

Hugs,
Leslie and the gang

[SusanB]

Hi,

Thanks for all of your replies and help. I just brought Molly home from the hospital. They wanted to keep her overnight again but I said no ( this was after they told me her abdomen seemed tender and that she isn't urinating for them. When they took her outside she peed for them. I had told them she wouldn't pee in the pen she was in.

Molly is getting 10mg of prednisone every 12 hours, Celenia every 24 hours for 3 more days, and 1 1/2 tablets of Pepcid every 24 hours for 5 days.

I am going to contact them tomorrow to get every test result they did this past week. I told them straight out this should have been caught on Wednesday but the ER doctor said her blood work was within the specified counts.

They now want the critical care doctor to take care of Molly's future visits. My problem with this is that the critical care doctor looked at her both Monday and Wednesday as a second opinion and yet we ended up Addison's crisis, not very reassuring.

I'll call my regular vet tomorrow for recommendations.

Thanks again for the support I cherish all of your kind words and helpful suggestions. At this point in time I don't know if we are still a cushings pup or an Addison's pup.

Molly is sleeping next to me on the couch a happy baby.

[molly muffin]

So glad to hear that moly is home with you. I do think they do better in their home environment.

Yes I see what you mean about the critical care doctor not being reassuring. It sure is harder than it should be to find the right vet for each situation. I wish that wasn't the case.

You're doing good though.
Hugs

[My sweet Ginger]

I'm so glad Molly is doing better and home with you. I think her adrenals will start regenerating cortisol on their own with this break from Lysodren in the future. When will that be? Molly will tell you with her clinical signs. Please, don't be anxious to restart her maintenance. Trust me, she will tell you. I go by the rule of not administering Lysodren outweighs overdosing it when in doubt.
Susan, I keep reading the vets mentioning this 'her blood was within specific counts' so they didn't treat Molly for Addison's crisis but I'd would like to know exactly which blood test they were referring to when they say it.
Was it normal blood work or an ACTH stimulation test because only an ACTH stim test can show cortisol level and if they were referring to the ACTH pre and post of 1.0, are you kidding me?
I really hope Molly's adrenals will start regenerate cortisol again on their own soon and I see in many cases they do after a crisis.
I hope you will find a Cushings experienced vet soon. Hugs, Song.

[Squirt's Mom]

I am so glad she came home and hope this morning she is doing better. Yes, that post was within range...just barely. BUT there was no stimulation between the pre and the post, which should have told one of those professionals to keep a close eye. Thankfully she has a great mom who knew something was wrong even tho the experts kept saying there wasn't. ;) Don't hesitate to let them know YOUR baby isn't between the pages of a text book or in the lines of a study but right in front of them, living and breathing and unique....and they better pay attention to the one person who knows that dog best - her mom. ;)

[molly muffin]

checking in to see how molly is doing.

hugs

[SusanB]

Hi,

Molly seems to be doing good but still sad looking. She has been eating but very selective. Being on prednisone I figured she would be hungry she walked away from her homemade food (chicken thighs, livers, carrots, broccoli, and white rice, l put down some of her dry dog food nothing, cooked some ground beef and she ate that.

I didn't leave her at all today, watching her and still worrying if she is on the road to at least feeling better.

I called our regular vet with some referrals one internal Dr he mentioned I probably wouldn't get in to see her she is so busy. I am calling tomorrow. She is about an hour from me. The other person he recommended is not board certified which makes me nervous. He said he would trust his dogs to her care so she might be my second call she is about 45 min from me.

Molly is on 10mg prednisone every 12 hours. Hopefully this will help, she is on this for 14 days.

[Harley PoMMom]

One thing I want you to be aware of, a dog's system responds to prednisone just like it would with cortisol, so you may see increases in thirst and urination.

When she was in the hospital did they check her electrolytes too? Sometimes when a dog's cortisol drops too low with treatment it can affect their electrolytes as well. All that is needed is a blood draw to see if her electrolytes are normal, mainly looking at the potassium, which is listed as K on the blood panel, and the sodium, abbreviated with Na. If this would happen, replacement therapy of these mineralocortioids is required.

This involves more than just the prednisone. There are several drugs available to help replace the missing hormones from a dog's body. The two most used are Percorten V and Florinef. If Molly's electrolytes are unbalanced this would have a negative effect with her appetite. So in case her appetite doesn't pick up by tomorrow, I would recommend having her electrolytes checked.

Glad she is home, and hoping her appetite perks up.

Hugs, Lori

[SusanB]

Molly update,
We ended up at the VCA hospital the critical care doctor examined Molly. Her breathing last night sounded horrible at 4:00 am I turned on the bedroom light and kept saying her name, her eyes were open but she didn't respond. She finally got up and I gave her a Benadryl to calm her a little. Today she had an ultrasound everything on the report was normal, couldn't see the right adrenal again and the doctor said the left adrenal was larger than her ultrasound from 3/2013. I mentioned could be from Addison and she is going to consult another internal medicine doctor. They also did chest X-rays results tomorrow. I questioned initially today if she was getting enough prednisone. They increased her to 15mg twice a day.

These were the blood test from the emergency room Sat. I haven't received Mon and Wed. yet even though I have asked 3 times. They know they messed up because they offered to pay for an exam at another Internal Medicine Dr but we couldn't get an appointment, it's why I ended up back at the VCA. They are back pedaling saying the specialist never said it wasn't Addison's. I set them straight about that.

Diagnostic Tests:
Istat EC8 on presentation:
Na 130
K 7.2
HCT 62%
CL 114
Glucose 186
BUN 74
pH 7.176
TC02 16
BE -14
Na:K ratio 18

Istat two hours post dex sp injection and 800 ml Plyte bolus:
Na135
K 6.4
HCT 56
Glucose 154
icalcium 1.49
pH 7.237
PC02 29.5
BE -15
Na K ratio 21

Blood pressure:
172/109 (144)
178/119 (135)
155/112 ( 123)

She had at least 4 bags of fluid, DexamthSP 4 mg/ml/ml quantity 10.10 on Saturday
On Sunday another DexamthSP 4 mg/ml/ml quantity 5.0 and 10 mg of prednisone.

I am trying to find a new doctor in the mean time.

[My sweet Ginger]

Did they check her electrolytes on Sat? Were they in wnr?

[SusanB]

They did they discussed her sodium and potassium and the need for all of the fluids. They wisked her away and started them right away. This was in the report after being overnight in the hospital

Progress of patient in the last 12-24 hours: Molly did ok overnight, she was painful throughout the night and Methadone was added initially which was then switched to hydromorphone this morning. Her blood pressures have been high, however, these were taken when it was noted she needed to urinate (as she was taken outside after each blood pressure reading and released a large volume or urine). Molly is also very nervous is the hospital and this is a potential contributing factor for her increased blood pressure. She is stable and bright and alert this morning, her electrolyte abnormalities have resolved. She is still 5% dehydrated so she was given a bolus of fluids and her rate was increased from 150 ml/hr to 200 ml/hr. She appears more comfortable on abdominal palpation.

[SusanB]

Trying to make sense out of this information:
RESULTS Time 14:36
STARTUP PASSED

WBC: 6.1 6.0-17.0
RBC: 8.23 5.50-8.50
HGB 20.8 H G/DL 12.0-18.0
HCT: 61.8 H % 37.0-55.0
PLT: 382 200-500
MCV: 75 H 60-72
MCH: 25.3H PG 19.5-24.5
MCHC: 33.7 L G/DL 34.0-38.0
RDW 13.9 % 12.0-16.0
MPV: 8.0 6.1-10.1

DIFF:
%LYM: 19.0% 0.0-100.0 #LYM: 1.1L 1.2-4.5
%MON: 4.4% 0.0-100.0 #MON: 0.2L 0.3-1.0
%GRA: 76.6% 0.0-100.0 #GRA: 4.8 3.5-12.0

VETSCAN VS2 1:56PM

ALB 4.8 * 2.5-4.4 G/DL
ALP 2285 * 20-150 U/L
ALT 136 * 10-118 U/L
AMY 1011 200-1200 U/L
TBIL 0.3 0.1-0.6 MG/DL
BUN 42 * 7-25 MG/DL
CA 12.4 * 8.6-11.8 MG/DL
PHOS 7.9 * 2.9-6.6 MG/DL
CRE 1.4 * 0.3-1.4 MG/DL
GLU 148 * 60-110 MG/DL
NA+ 137 * 138-160 MMOL/L
K+ 5.5 3.7-5.8 MMOL/L
TP 7.7 5.4-8.2 G/DL
GLOB 3.0 2.3-5.2 G/DL

QC OK
HEM 1+ LIP 1+ ICT 0

[SusanB]

Molly's in the hospital again. She is now at Tufts. After getting Molly's X-ray results back nothing on it,the Dr said the next course of action was to schedule someone to take her blood pressure at home. I wanted to scream through the phone about how incompetent they were. The Tufts people were so nice they took their time with us discussed options and made me feel good. It's funny when we were in the waiting room I was chatting with a guy who lives 1 town over from me he too had the same experiences with the VCA hospital in Springfield that I did. He said the hour and fifteen min drive is worth it. Hopefully they can get her back to her old self for Christmas.

[molly muffin]

Good to hear you are at Tufts. Hopefully they can get Molly back on track.

hugs

[molly muffin]

Merry Christmas to you and Molly.

I hope Molly is doing okay and making a good recovery.

hugs,

[SusanB]

Hi Sharlene,

Thanks for checking on us. I have been busy ready about Ginger on here. I am up to page 42 of 70 something.

Molly is now on Florinef 8 pills 0.8 mg and 15 mg prednisone. She still has twitching that I worry about but the vets didn't seem concerned.
Molly was hospitalized for 3 days before coming home. We have had her electrolytes checked already and the numbers looked good to the vets.

I am on the addisons message board (yahoo) much more difficult to follow than this one. They seem to think Molly's drug dosing should be adjusted. Not enough Florinef and too much prednisone. The doctor agreed to let us go to 10 mg of prednisone but that still seems high from everything I am reading. She is more hungry (if possible) then with cushings.

I am going on vacation at the end of the month so I am keeping Molly on Forinef until I get home and then possibly switching to a 25 (28) day shot of Percoten. Our regular vet will write prescriptions for us so we can give her meds at home once dosage is figured out. My husband will have to give Molly the shots because I faint (out cold smelling salt needed) from needles. When my daughter now 23 was 5 all of the preschoolers were getting ears pierced for their birthdays. She was sitting in the chair with me facing away dizzy while they used the earring gun yup I am a whimp.

So far I am pleased with Tufts. Anytime I have emailed or called they have responded. The addison boards seem to think Molly will not go back to cushings based on her electrolyte numbers but only time will tell. I have decided to keep all of the medications for now. I still have 43 Lysodren pills, I am hoping the animal shelters can use them once we figure out if Molly will stay addisons.

Even though I haven't been posting I have been reading all of the boards. I have gotten so much help and information from here.

You have all given me so much encouragement, support, and love with everything Molly and I have gone through.

[molly muffin]

Quite often when they go Addisons from Lysodren, they do tend to stay Addisons, but I understand holding on to the medication for now.
The shots from what I understand work very well for Addisons and most seem to find it easy enough to give them. I'm not sure I'd be able to, but then it's always amazing what we find we are able to do when it necessary for helping others. Glad you're husband will be able to do it.

That is great that Tufts is doing so well for Molly.