Down the Cushings Road Again -- Abbie, 15 year old beagle is now at peace

[judymaggie]

Hi, all! As much as I think you are all wonderful, I really didn't want to come back here. As some of you may recall, in 4/2009 my beagle, Maggie, passed away after a two year struggle with both atypical Cushings and "regular" Cushings.

I didn't remember that I had posted when I adopted Abbie but then saw her picture in my profile and reference in my signature. Here is a brief summary: Abbie was 7 years old when I adopted her in 5/2010 after being treated for heartworm . Two weeks after I adopted her she had to have a bilateral mastectomy, then another surgery due to infection from the internal stitches, followed a few months later by bladder surgery. To the surprise of my vet, during the bladder surgery, he discovered she had never been spayed in spite of two shelters saying she was! Since her last surgery she has been in good health with the exception of reoccurring ear infections and UTIs . Abbie was a "street dog" for an unknown period of time before being picked up by animal control. She then made her way to a beagle rescue. She is very loving, particularly towards children and infants, and was house-trained when I adopted her so I do think she had been with a family with children.

This summer Abbie had periods of lethargy which I chalked up to the very hot and humid Florida weather. She was treated for a UTI about a month ago and then she started guzzling water and this was a dramatic change for her as she used to barely drink any. After discussions with my vet (the same wonderful one who helped me with Maggie) we decided that it was time to run a full blood panel and urinalysis. I also asked that a UC:CR be run as red flags had started to pop up for me.

The UC:CR was positive and her liver enzymes were elevated (which had always been in normal range previously). We scheduled an ACTH for Tuesday at which time I will get copies of her lab results. If ACTH is positive for Cushings, I will ask for an ultrasound to be scheduled at our local hospital where Maggie's internist is now CEO.

Of course I am hoping the UC:CR was a false positive but there are those darn red flags and Abbie continues to guzzle water (and trips outside to pee every two hours -- last night was the first nocturnal trip at 1:00 a.m....).

I think my vet likes to do a LDDS before the ultrasound. I will do some refresher reading but would appreciate your thoughts on the need for the LDDS at that point.

[labblab]

Hi Judy, and welcome back (although we were perfectly content to let you just be a veteran visitor...:o). FWIW, if it were me, I believe I'd move straight on to the ultrasound if the ACTH is positive. In view of the excessive thirst/urination, elevated liver enzymes, and positive UC:CR, I wouldn't feel the need to add a LDDS as well. Since the ACTH is the more "specific" test of the two for Cushing's, a positive on the ACTH is actually a more reliable indicator than is a positive on the LDDS (meaning the LDDS is more easily also elevated by other, nonadrenal illness). And even if the LDDS was negative, you would probably still advance to the ultrasound, anyway, due to all the other indicators. So if it were up to me, I'd probably save my money for other diagnostics/treatment.

Marianne

[Harley PoMMom]

Hi Judy,

It is so nice to hear from you although I wish it were under better circumstances.

Reoccuring ear infections, lethargy, and elevated liver enzymes can be attributed to hypothyroidism, has her thyroid level been checked recently? Usually this is checked when a senior blood panel is done and noted as T4, do you see this noted on her chemistry blood panel?

Hugs, Lori

[judymaggie]

Hi, Lori & Marianne! I, too, wish I was just coming by to say "hello" but so very appreciative that this forum is alive and well. I don't think I would have gotten through Maggie's ordeal without all of you.

Abbie's thyroid has been consistently normal, including the most recent check last week.

She continues to drink excessively and I decided to measure the actual amount today. I know I read somewhere what is typical but can't remember where that was. Interestingly, two of my neighbors have commented in the last week that Abbie's belly had gotten quite large. I honestly hadn't thought it had but I guess I have a different perspective, seeing her every day. She has not gained any weight so another "red flag". We go to the vet every five weeks to get her glands expressed -- will have to ask the head tech who sees her if she thinks her abdomen has expanded.

In addition to other things Abbie has had intermittent diarrhea for the last two months and is now on another round of Flagyl and Forti-flora. It has been controlled when on both and then she has a bout of liquid diarrhea. I am definitely going to use the Forti-flora long term. I am supposed to go to once daily Flagyl tomorrow (after one week of twice daily) but her noon-time bowel movement today was liquid. Will talk to the vet tomorrow when I drop off Abbie for her ACTH.

I have added a pic to Abbie's photo album (also below -- feel free to delete it if it is too large for this forum) that was taken in April on our road trip up to north Georgia to visit with friends -- Abbie hates having her picture taken so it was nice to have someone else take a photo while I was nearby.
http://www.k9cushings.com/forum/picture.php?albumid=193&pictureid=7143

[Squirt's Mom]

Oh she is beautiful, Judy!

[labblab]

I'm so sorry about the diarrhea on top of everything else, Judy. If Abbie is in the midst of some sort of inflammatory flare, it does raise some concern in my mind about proceeding with the ACTH since nonadrenal illness can also elevate cortisol levels. However, I do realize you're in somewhat of a tough spot if the episodes of diarrhea have been going on for a couple of months now -- will there ever be a really good time to test? The GI issues may be totally unrelated to Cushing's, or they may be connected in some way. My Cushpup, Barkis, had intermittent diarrhea at the time of diagnosis, too, and my IMS told me that elevated cortisol levels can cause certain types of inflammatory GI responses (even though that sounds paradoxical since steroids function as anti-inflammatory agents). I had hoped that Barkis would improve after we started Cushing's treatment, but he pretty much remained the same. So I never really knew whether the two were actually connected in any way for him.

Anyway, Abbie's picture is adorable and thanks for posting it! And good luck tomorrow with whatever the appointment brings.

Marianne

[judymaggie]

Marianne -- it never occurred to me that an increase in cortisol could be related to gi problems. I found the following that was directed toward humans but, as we all know, our pups mimic so many of our issues:


Cortisol activates the sympathetic nervous system, causing all of the physiologic responses previously described. As a rule, the parasympathetic nervous system must then be suppressed, since the two systems cannot operate simultaneously. The parasympathetic nervous system is stimulated during quiet activities such as eating, which is important because for the body to best use food energy, enzymes and hormones controlling digestion and absorption must be working at their peak performance.

Imagine what goes on in a cortisol-flooded, stressed-out body when food is consumed: Digestion and absorption are compromised, indigestion develops, and the mucosal lining becomes irritated and inflamed. This may sound familiar. Ulcers are more common during stressful times, and many people with irritable bowel syndrome and colitis report improvement in their symptoms when they master stress management.5 And, of course, the resulting mucosal inflammation leads to the increased production of cortisol, and the cycle continues as the body becomes increasingly taxed.4

I do think today's problem might have been related to missing one dose of Forti-flora. A neighbor helped out yesterday with "pee trips" and dinner -- she was used to Abbie's regular dinner regimen and I didn't want to add showing her how to mix in the Forti-flora. Tonight was back to pretty firm ... definitely a delicate balance!

[judymaggie]

Folks: I just dropped off Abbie for her ACTH test. Normal bowel movements last night and this morning so no reason to postpone.

I did pick up copies of the recent labs. Here are the abnormal levels (with reference ranges):

Superchem(10/07/14)
ALKP - 220 High (5-131)
Total Bilirubin - 0.5 High (0.1-0.3)
Cholesterol - 661 High (92-324)
Triglycerides - 471 High (29-291)

Urinalysis(10/07/14)
Specific Gravity - 1.012 Low (1.015-1.050)
Protein - 2+ High (was 3+ on 9/19)
Blood - 3+ High

UC:CR (10/07/14)
Ratio - 18 High (^13 consistent with Cushings)

Both the vet and I continue to be concerned that there is blood in her urine. Assuming we proceed with ultrasound next, I am hoping that will ease any concerns about her bladder.

[Harley PoMMom]

The blood in her urine is worrisome to me as well, this usually points to an UTI, has an urine culture and sensitivity test been performed? This type of test will be able to tell you exactly what bacteria is causing the infection and the proper antibiotic that can kill that bacteria.

[judymaggie]

Hi -- Abbie was treated for a UTI after a cystocentesis showed bacteria and blood in her urine. The cysto was done because she had a crusty discharge that would have contaminated a free flow sample. After 10 days on Clavamox a repeat cysto showed no bacteria but continued to show blood. Since there was no longer any bacteria, we decided there was no need for a urine culture. The urinalysis results from 10/7 were from a third cysto -- again no bacteria but an increase in the blood. My vet explained that there is occasionally a slight bit of blood contamination from the cysto process but level would still be normal or below if that were the cause. We will decide how to proceed with this aspect after ACTH results are in.

Question: I didn't think it was possible for Abbie to drink any more than she had been but, since being home after the ACTH, she is, indeed, drinking even more. Is this due to the increase in cortisol associated with the test?

[molly muffin]

Yes, exactly the ACTH dumps that cortisol into their bodies and sometimes for 48 hours or so, it could be less, they eat, drink, pee, run around like crazy. This should go back to normal soon though. Give it a couple days.

Has their been consistent protein in her urine? If so the vet might want to address that with UPC and moving to a lower protein food.

The other option and not very common, is if the cysto's have caused any problems with the bladder. It is quite common to get some blood in the urine when they do a direct draw, but this should go away and the next free catch urines shouldn't show any blood if that is what it was from.

What about crystals or a stone, those can also cause blood in the urine.

Just throwing thoughts out there for consideration.

Abbie sure is adorable.

Sharlene and molly muffin

[judymaggie]

Thanks for quick reply! I think she is cute, too. :D Effects of ACTH make sense. Abbie hasn't had the "zoomies" (how we describe crazy running around on a beagle forum I participate in) but that may be due to having to give her melatonin this afternoon for thunderstorms anxiety.

I thought that high protein in the urine was a fairly common finding in Cushings dogs so was thinking that was just one more indicator. I feed Abbie prescription Purina DCO mixed with prescription Royal Canin low-fat canned food. It was a very long process to find a food that had the right amount of fiber and the DCO finally worked. Not familiar with UPC abbreviation ...

There haven't been any crystals in the urine but stones are a possibility. We have kind of put that on the back burner until getting through the current tests.

[judymaggie]

Well, Abbie is officially a Cush pup! :( I will get copy of ACTH and post numbers. Her vet is calling Maggie's IMS tomorrow to see if he can see Abbie next week for an ultrasound. Meanwhile, due to continuing gi issues, will be adding pepcid and going back to twice daily flagyl. The vet is concerned that the Cushings may be irritating Abbie's stomach lining. Abbie's symptoms do seem to be increasing very quickly. She definitely has a pot belly and cries for food two hours before dinner time!

I know it is premature but ... if we end up treating with Lysodren (my vet has treated with both Lysodren and Vetoryl but has more experience with Lysodren), are there guidelines to using a slower loading phase due to already existing gi problems? Would we just use the lower end of the range?

[labblab]

Hi Judy, well, we welcome little Abbie into the fold even though ours is a club that does not recruit members other than honorary ones! :o

I think Abbie's ACTH results may have some bearing on the treatment decision -- how highly elevated her cortisol seems to be at this time. Our staffer Addy's Zoe had pre-existing IBD at the time of diagnosis, so faced some of the same issues as you and Abbie. However, Zoe was not as classically symptomatic with Cushing's. Addy corresponded with NY endocrinological expert Dr. Mark Peterson in addition to her home vets, and this is a recent summary that Addy wrote re: their situation (in reply to a dog without GI issues, however -- Sharlene's Molly).



Zoe started out without the classic Cushings symptoms, even in her blood work. Dr. Peterson told me not all Cush pups will have the elevations we normally see. Her main problems were skin/coat issues. Dr.Peterson felt her cortisol was too high for a maintenance dose of Lysodren to work and that her IBD would not tolerate the higher Lysodren doses of a load. He opted for starting at a low dose of Trilostane.

I think if it were me, I would ask if a maintenance dose of Lysodren would hurt Molly and how and if her cortisol is not sky high, perhaps a maintenance dose would be enough to bring it down. Dr. Oliver did tell me he had dogs that did respond to a maintenance dose without a load.
Zoe's GI issues were an ongoing challenge, and I'm hoping Addy will have a chance to stop by at some point to share her experience with you.

Marianne

[judymaggie]

Hi, Marianne! I just picked up a copy of Abbie's ACTH results. If I did a correct conversion (ug/dl to nmol/l), she is swimming in cortisol!

10/14/14

Cortisol Sample 1: 3.8 ug/dl (reference range 1.0-5.0)
Cortisol Sample 2: 26.0 ug/dl (reference range 8-17 with note that any number above 20 is indicative of HAC)

If I converted correctly, 26.0 ug/dl would equal 717.34 nmol/l. From what I have read most Cushing's pups have above 600 nmol/l in post-ACTH.

If we decided to treat with Lysodren (again premature thinking before ultrasound), I am figuring Abbie's loading dose would be 580 mg., divided and given twice a day. At her last weigh-in she weighed 25.6 lbs.; converting that to 11.6 kg and multiplied by 50 would be 580 mg. of Lysodren. Still looking for literature discussing doing loading with less than 50 mg/kg. although, thankfully, no diarrhea yesterday or today.

[addy]

Hi Judy,

I am sorry to read about Abbie’s problems. I am glad Marianne provided the text I wrote t and she is right that Zoe’s IBD was on going. She took a small dose of Metronidazoe usually every day as it continued. Here on the forum, part of the problem we have seen with using a lower dose to load is that it can prolong the time to load. Dr. Peterson did tell me I if I went ahead with the load, I could also give Zoe prednisone during the load.
The other thing Dr. Peterson mentioned was that he felt Zoe would be better off on Vetoryl because if she had flare ups we could start and stop the drug. With Lysodren, he said we would not be able to do that without losing the load.

Hang in there

[judymaggie]

Hi, Addy! Thanks for your input. I was really surprised to read that Dr. Peterson suggested giving Zoe prednisone during the loading phase. I don't think that would work with Abbie as she has an extreme reaction to prednisone with a significant increase in drinking/urinating. Also, since that is her most pronounced Cushing symptom, I would be concerned that I would miss any changes in that area during loading.

The IMS wasn't in today and the staff told my vet that the next available appointment is on 11/3. My vet is going to call back on Monday to speak to the IMS directly and see if he can fit Abbie into his schedule for next week as we really don't want to wait until November for the ultrasound.

Thank goodness I am retired and can work my schedule around letting Abbie out to pee at least every two hours!

[addy]

I was surprised too at the recommendation, especially after everything I read here, but he did say it was possible to do. I wasn't thrilled with the idea of it.

Zoe's IBD flared even on the low dose of Vetoryl in the beginning. So in the end, it was the better drug her Zoe's IBD though I don't know that I am sure it was the best drug for her Cushings.

It is hard sometimes to have it all work out the way we hope.

[molly muffin]

Ugh, I hate it when they give you "next appt" that are far out. Same thing happened with me in August/September.

There is someone else I know who did a loading phase of prednisone and lysodren, per Dr. Petersons instructions. They did it and it worked out fine for them. I think everything depends on the dog though and how they react.

Sharlene and molly muffin

[Dixie'sMom]

I just wanted to say "Hello" and tell you that Abbie is a doll! I have a weak spot for hound dogs. So precious and such a sweet little face! Thank you for rescuing her.

I'm sorry that you are both going thru this. I think the Creator must know who to give these pups to because everyone on this forum is exceptional parents. For you to be given a second Cush pup means you must be a great Mom!

I too am home during the day which is really a blessing because my girl is like Abbie and goes out about every 2 hours as well and unfortunately still does even with medication. I think sometimes its just become habit now. LOL. She's learned how to boss me around very well.

I do remember reading on this forum where small amounts of canned pumpkin can help firm up the bowels. I just can't remember how much to give... and the warning was that too much could cause diarrhea. That may also be something to try and see if it helps Abbie's GI symptoms. Hopefully someone will pop in and give you the exact amount.

Dixie (my doxie Cush Pup), Buttons (beagle, doxie and lord knows what else) and I are rooting for you and Abbie. I'll be following along with the others to see how things are going.

[judymaggie]

Hi, all! First, thanks for everyone's support! My vet was able to schedule an appointment for this morning with the IMS so was very happy we didn't have to wait until November.

The IMS's report says that Abbie was "bright and alert". I loved the "alert" part -- during my initial conversation with the IMS her eyes kept closing due to the melatonin I had given her earlier in the day although she did definitely let go with a few "aro-o-o-s" when she came back to me after the ultrasound. :D

Ultrasound showed:


a coarse liver, bilateral adrenomegaly and age related changes with the kidneys with no other significant findings.

Her blood pressure was in the upper end of normal but no need for any medications at this time. The IMS and I discussed trilostane vs. mitotane and he said he was comfortable with either one based on his findings and Abbie's history. Abbie weighed exactly 25 lbs. today; the IMS said he would load at 500 mg. per day, split into two doses. He said that he always recommends having prednisone on hand.

Closing comment on the report was that "Abbie was a good sport" during her visit!

I will call my vet tomorrow and schedule a meeting time to review everything and get meds. Since he is more comfortable with mitotane, I am going to go that route. Since I have no appointments the first week in November, I am thinking about starting loading on the 1st. My vet takes Wednesdays off so thought the timing would be okay.

[molly muffin]

Whoo hooo, so glad you got in today! Awesome and very good ultrasound report over all. Go Abbie!

hugs
Sharlene and molly muffin

[judymaggie]

Hi, folks! I met with Abbie's vet this afternoon to work out a treatment plan. I walked in with a pile of papers from posts and resources here -- he is used to me having a list for all of Abbie's appointments so he wasn't surprised. He asked me if I wanted to start with my notes or have him describe his usual practice. We went with his routine and there were only a few deviations from what I have learned here.

We are going to go with Lysodren as that is what he is most familiar with -- Abbie, who weighs 25 lbs., will be on 500 mg./day for loading, split into two doses. He said that his experience is that loading takes 7-10 days. When I mentioned a quicker loading period, he said he has never seen that. I think one of the reasons for this is that he leans towards more significant changes in drinking/eating before stopping. He also said that he does the ACTH the day after the last loading dose (as opposed to 48 hours recommended by Dr. Feldman). He also wants me to start on a Monday (as opposed to a Sunday).

If it turns out that the ACTH is done after less than 48 hours, do you think that is going to produce inaccurate results?

I did find the best price for Lysodren at Sam's ($5.50/one 500 mg. tablet) and my vet called in a prescription for 10 tablets with a refill and also added a prescription for prednisone. He also gave me his cell phone number and said I could certainly call him if I need him after hours. I am giving Abbie pepcid once a day now and the vet said to cut the pill in half so I can give it to her with each dose of Lysodren.

Overall, I was pleased with visit. Since I have a couple of appointments next week, I am going to start the Lysodren on 11/3.

[Harley PoMMom]

We are going to go with Lysodren as that is what he is most familiar with -- Abbie, who weighs 25 lbs., will be on 500 mg./day for loading, split into two doses. He said that his experience is that loading takes 7-10 days. When I mentioned a quicker loading period, he said he has never seen that. I think one of the reasons for this is that he leans towards more significant changes in drinking/eating before stopping. He also said that he does the ACTH the day after the last loading dose (as opposed to 48 hours recommended by Dr. Feldman). He also wants me to start on a Monday (as opposed to a Sunday).

The loading dose sounds good, however I am a bit worried about the vet's opinion with loading as there is not a set timeframe for loading a dog. During the loading phase any subtle change that the dog makes, especially while eating, can be a sign that the dog is fully loaded and if the loading were to continue an Addison's crisis is very likely.



If it turns out that the ACTH is done after less than 48 hours, do you think that is going to produce inaccurate results?

Lysodren continues to work for 48 hours after the dose is given, so this HAS to be taken in consideration when interpreting ACTH stimulation test results done in an earlier timeframe. As an example, if the ACTH test is done 24 hours after the last dose of Lysodren was given and those results show that the post number is 2 ug/dl, Lysodren will continue to work thereby causing that post number to drop even further and it could even drop too low.

Hugs, Lori

[labblab]

Hi Judy, I just wanted to add a comment about the 48-hour testing delay. I have not even had a chance to talk about this with Lori yet, but after always having cited this very same info, myself, I am now questioning whether it is really important to wait. I believe all we staffers have been giving this same recommendation for years, but a member recently questioned me about the source. And dang if I didn't have a really hard time coming up with citations and clinicians who feel it is important to wait to test. I think Glynda has found a study that suggested the opposite of what we had previously been led to believe -- that the cortisol level may actually be higher after 48 hours rather than lower. So for some folks, that might be a reason to wait to see whether enough dosing has actually occured. But for me personally, the bottom line is that it seems as though the majority of clinicians do not seem to think it is significantly important to wait, and go ahead and test as soon as there is a suspicion that the loading may be complete.

Marianne

[judymaggie]

Lori & Marianne -- thanks for quick replies! I am comfortable stopping loading as soon as I see subtle changes. I was going to ask for an article with the 48 hour reference because I couldn't find one anywhere ...

I did remember after I posted that my vet also said that I could give the Lysodren to Abbie inside her Royal Canin canned low fat food (which is how I am giving her meds now). I mentioned to him that everything I read has said to give it inside a fatty food. I don't want to use peanut butter because Abbie has a mild choking issue (mostly with water) and I am concerned that the peanut butter (and Lysodren) would get stuck in her throat. Would something like American cheese work?

[Harley PoMMom]

Hi Judy,

I apologize for the misinformation on my part regarding that 48 hour window, I've been out of sorts here latley, personal issues have been taking up my time and obviously my mind :eek:

I am glad Mariann caught my error and has corrected it (and me!) ;)

I know some members have hid the Lysodren pill in cream cheese, would that work for Abbie?

Hugs, Lori

[judymaggie]

Lori--absolutely no need to apologize! You have always been here for everyone and you really do need to take care of yourself.

I saw the mention of cream cheese in a post but couldn't figure out how that would adhere to the pill. We don't know why Abbie is having a choking issue and, because it is not severe, finding out why is taking a back seat to starting Cushing's treatment. (The IMS believes that she probably has the very early stages of tracheal collapse.) That said, I really need to make sure that the Lysodren goes easily down her throat. She does so well with her meds in her canned food that I wish that could be used.

[labblab]

Judy, I may be missing the boat here, but as long as there is at least some amount of fat in the canned food I think you should be OK. In other words, you do want to make sure there is some fat in the stomach at the same time the Lysodren is being digested but I don't think the pill literally has to be wrapped in fat. It is recommended that you feed a meal prior to giving the Lysodren in order to assess any decrease in appetite prior to dosing. So even if the canned food is low-fat, there still will be some fat present to support the pill's digestion in the stomach. The biggest worry is to not give the Lysodren on an empty stomach that is devoid of any fat.

But having said that, I think American cheese would be fine to use in addition. That's exactly what I use for my Peg's phenobarb -- the soft processed American cheese slices. I tear off a little square and then smoosh the cheese nicely around the pill so as to make a tiny pill sandwich and she swallows it with delight. ;)

Marianne

[molly muffin]

Is the canned food of a consistency that you can scoop it and shape it around the pill? I do that for molly to get her to take her pills. (she is not a fan of pills usually, but quite the fan of her canned food). Now if you rattle a pill bottle, she knows she'll get some canned food so she'll come running. Right past the dry food bowl, with food left in it.
They do have their own ways about them. That might help Abbie to be able to swallow the pill too.

Just throwing out thoughts here :)
hugs
Sharlene and molly muffin

[judymaggie]

Sharlene--I do use the canned food with Abbie's current meds. Like Molly, Abbie loves her canned food--she will sit by the frig to remind me to take it out! :D

I am going to use it with the Lysodren. Marianne's logic re the fat issue made me go "duh"! Even though it is a low fat food, it certainly does have some fat as does her dry food.

Picked up Lysodren this morning so am all set except for being nervous about being able to pick up on subtle changes.

[Dixie'sMom]

You can do it Judy! Nobody knows your baby like you do, so you will pick up on things that the vet would even overlook. When it first happens, it's kind of a "wow" moment. And you think "The medicine is really working." My baby is on Vetoryl, but I'm sure it happens the same way... that wow moment. That first time that they can walk by the water or food bowl and not eat or drink.

You got this girl! Go for it.

[molly muffin]

Okay, it's Monday night. Did you start Abbie on the lysodren? How's it going? Was she able to take it with the canned food?
I started the trilostand on Sunday, all good.
I know that with lysodren, the loading phase is always the most worrying part, I think you'll know even minute changes just because you're going to be watching that little girl like a hawk. I know it!! LOL

Let us know how it's going.
Hang in there, you been down this road before and you Can do this!
hugs

[judymaggie]

Sharlene--I really appreciate you checking on us but I am not starting Lysodren until next Monday. I had two appointments already set for this week that I couldn't change and I really want to stick close to home during loading. My experience with Maggie's Cushing's was so different from Abbie's that this seems very new to me.

I did order Denamarin which will arrive tomorrow so can start that this week. I always prefer to make one change at a time so will have a chance to see how Abbie does on this before starting the Lysodren. It was very expensive so not sure I will be continuing her on it after bottle of 75 is gone.

About to try to wake Abbie up and convince her to go out to pee--when I can get her to do that, we both get to sleep through the night. I'm glad all went well at your end with the trilostane--hugs to Molly!

[molly muffin]

Hi Judy, oops, guess I got a head start on you then. :)

I know it feels new and it is with Abbie, every dog is different as we all well know.

hmm, Denamarin, did you check it out on Amazon? Not sure what the price is there, but anything with sam-e and milk thistle, should do the trick. I actually do them separately right now as can't get something with both ingredients in it for some reason here in Canada and I was ordering from Amazon, but was very expensive to do that, especially with the exchange rate right now. So, I get that.
I'll check it out for you, S-Adenysol 100 has both in it, so do a couple others I think. I used that one for a bit.

I've had to wake molly a few times to go out. Not always her favorite thing if it is cold, wet or just dark and she is sleepy. :) Good luck though, it's nice to sleep through the night!

hugs

[judymaggie]

Sharlene--I just checked out prices for S-Adenysol (225 for Abbie's weight) and it is definitely less expensive than Denamarin. Lowest price was on Amazon. Thanks so much for recommendation!

[judymaggie]

Hi, all! First day of loading marked by my elevated blood pressure but Abbie seemed fine! :) I gave her the Lysodren inside a spoonful of canned food and she had no problem swallowing it. She did have a soft poop mid-day but it was normal tonight. She only ate 1/2 of the Denamarin tablet; she hasn't been too thrilled with them since I started them a few days ago. I am thinking I might just split it in half and tuck the halves into her canned food. Let me know if you think that eating a chewable tablet this way effects the benefit.

I measured water intake today and it was actually lower that previous measures -- in my mind it is way too soon for the Lysodren to be the reason but I will certainly continue to measure. She did have to go out to pee just as frequently as previously noted.

On to day 2 ...

[molly muffin]

I have given the sam-e inside dog food before. I think it is fine.

It can be nerve wrecking can't it. Hold on tight to something, at blood pressure can be a bumpy ride during loading!

hugs

[judymaggie]

Hi, all! Am confused ... it is now the end of day 2 of Lysodren loading and Abbie's drinking has significantly decreased. She is now below the "60 ml/kg" indicated on Dr. Feldman's protocol sheet. 22 oz. was that mark for Abbie and, so far, she has only had 18 oz. and had fewer outings to pee. Nothing else has changed either in terms of affect or eating. Her poops are normal.

Feldman's protocol says:


the occurrence of any of these signs (in reference to reduction of appetite, polydipsia, etc.) strongly indicates that the end point in induction therapy has been achieved

but later says:


if food is rapidly consumed (with or without polydipsia), medication is warranted

and then:


usually the initial loading phase is complete when a reduction of appetite is noted or after water intake approaches or falls below 60/ml/kg/day.

I am trying to make sense out of this -- it seems to me that loading, after only 2 days, would be exceptionally rare. That said, we do believe that we were able to get a diagnosis very early in the disease process so maybe a quick loading is possible. Since my vet is off tomorrow, I am leaning towards continuing loading and touching base with my vet on Thursday. Since Abbie has always scarfed down her food as well as been a scavenger outside (primarily for her favorite of crispy worms and frogs), I'm not sure that is going to change.

I would greatly appreciate your thoughts!

[Harley PoMMom]

Hi Judy,

Cushing's can get so confusing :confused: I think you are correct in judging Abbie's load based on water consumption especially since beagles are known for their zestful appetite. And it is not common for a dog to load in 2 days but all dogs are different and react differently so loading in such a short time could be possible, however, the only way to know for sure is to have an ACTH stimulation test done. How are Abbie's stools, any diarrhea, any loose stools?

[labblab]

Oh gosh, Judy, I'm so sorry nobody noticed your question on Tuesday!! What ended up happening, and how is Abbie today?

I agree with the advice that Lori just gave you...

Marianne

[judymaggie]

Hi, Lori & Marianne! Absolutely no need to apologize--being an administrator of an on line beagle forum, I know what it is like trying to keep up with everyone & this forum is a lot more active than ours.

Love the word "zestful" to describe a beagle's appetite! I gave Abbie her pepcid ten minutes ago and she has been "talking" at me for the entire time, trying to convince me that it is dinner time. Tuesday her water intake went back up and fluctuated around the 25 oz. mark until today when it drpped to 19 oz. The only other change I see is that she is sleeping very deeply. Her appetite is still strong. Her stools are normal--I was concerned about the Lysodren bothering her stomach but the pepcid, flagyl and probiotics seem to be working.

My vet called Tuesday night and I left a message for him yesterday that all was the same. I called this evening and asked tech to find out if vet wanted to do ACTH tomorow or Monday. Tech called back to say he wanted to wait until Monday to see if appetite lessened. I am okay with that as I will definitely stop the Lysodren if I see any more changes. Vet wants her fasting which I think will raise her stress level but I couldn't find anything technical to back me up.

Question: after ACTH, do I stop Lysodren until results are back? Results took 2 days last time. Vet takes Wednesdays off so will have to ask him to have someone else call me with numbers.

[Harley PoMMom]

The "norm" is to stop the Lysodren until the ACTH stim results are known, the maintenance dose is dependent on: the loading dose, how long it took the dog to load, and the ACTH stim test results.

Regarding the fasting, according to Dr Peterson, a dog does not need to be fasted:
Preparing for the ACTH stimulation test: Does the animal need to be fasted?


The dog or cat does not have to be fasted overnight, and lipemia does not appear to “clinically’ affect serum cortisol values. However, having a nonlipemic sample may be better in some situations, especially if serum cholesterol or triglycerides are being measuring on same sample.


What's the Best Protocol for ACTH Stimulation Testing in Dogs and Cats? (http://endocrinevet.blogspot.com/2011/03/whats-best-protocol-for-acth.html)

[judymaggie]

Thanks, Lori! I'm going to make one more attempt tomorrow to change my vet's mind.

[molly muffin]

Ugh, I wish I had more knowledge when it comes to lysodren, but I think you definitely know more about it than I do. :) So, I'll just offer my full support.

hugs

[Squirt's Mom]

The simple fact of the matter is, you can tell the vet when you will bring Abbie in for the ACTH. This is YOUR baby and YOUR money and YOUR stress to deal with. ;)

[judymaggie]

Leslie: I know you are right. I woke up at 5 this morning, worried about Abbie's treatment. That said, my vet has been there for me during years of Maggie's very complicated medical road and has gotten Abbie through significant surgeries since I adopted her. I would much rather work things out together with him. I am going to print out a copy of Dr. Peterson's blog and drop it off at the vet along with a note that I want to bring Abbie in after her normal routine is completed, including breakfast, in order to reduce her stress as much as possible for the best possible test results.

Thanks to you and everyone for your support!

[judymaggie]

Success! :D I talked with the office manager/head tech with whom I have become friends with over the past 10+ years. I gave her the print-out with my note on it and explained my thought process. She said she would be happy to discuss with the vet and would call me. I got back home from our mid-day walk and there was a message from her -- vet says fine to not fast and that a 10:00 arrival would also be okay (which is what I asked for). I am feeling much better!

After I wrote last night's post, Abbie ended up guzzling down some more water and ended up at 23.5 oz. for the day (with 22 oz. being the "Feldman" cut-off). She is about at the same pace today and definitely no change in eating -- she enjoyed a couple of crispy worms on our recent walk!

Thanks again to everyone -- you helped boost my confidence!

[molly muffin]

Aww, that is great! Having an established relationship with the vet and team certainly makes things a bit easier when in the midst of cushings.

So, she is probably doing okay on the load right now, as water food intake would suggest anyhow.

Doing good!
hugs

[Dixie'sMom]

I'm so glad to know that someone else's pup likes crispy worms and frogs. :) Hoping to see some good numbers from the vet visit Monday! :) I'm glad Abbie is feeling good.

[judymaggie]

Thanks for your replies, Sharlene & Suzi! Abbie continues to feel good. She is a really good girl--I was even able to convince her to wake up from a deep sleep at 10:30 last night to go out and pee in the rain! Getting her out at that hour eliminates a middle of the night event.

Suzi--I learned the hard way to never try to take a dead frog out of Abbie's mouth. She was experiencing freedom from the dreaded cone of shame after one of her surgeries and grabbed a very large crispy frog. I had previously taken various things out of her mouth and this frog, even though quite petrified, was very large. I pried open her mouth and stuck my finger in to get the frog. Abbie proceeded to chomp down and her incisor tooth went through the frog and my finger! :eek: To make a long story short, cellulitis set in and, after many weeks of heavy duty antibiotics, my finger survived. About six months later I was able to move the joints. The doctors told me that they rarely see infected dog bites and, even though the frog was dead, that that was probably the cause of the infection. Abbie even has a "rap sheet" with Animal Control! :D

[jas77450]

wow, glad you healed, something for all to think about:)

[Dixie'sMom]

O.M.G.! :eek: I can't help but giggle a little but that is awful about your finger! There are always a few small frogs that live on my carport during the summer eating bugs and stuff from the lights and Dixie always wants to get at them. I know shes "tasted" them when she starts sneezing and shaking her head. There are always some that end up flattened and we battle over them with me saying "drop it, drop it, drop it" and her giving me the stink eye. I know if she gets in the house with them, up under my bed to her hoarder's cave that stinky frog will go. So far I've managed to not let her get in the house with them. And the worms too. Lord, the dried up worms on the car port all end up in her belly. These cush babies will eat anything!

[judymaggie]

My vet has assured me that the dead worms are just extra protein! ;) We have frogs here in Florida that emit a poisonous liquid so I am glad that Abbie has no interest in the live ones. She will even spit out the worms if they are not crispy enough! I have always thought that Abbie probably developed her palate because she was a "street dog" for an unknown period of time.

[Dixie'sMom]

I'm sure you are right Judy. Abbie learned to survive and if it had to be crispy worms and flat frogs then I'm glad she ate them. I'll bet that dried frog she bit you over was her filet mignon during her street days! :)

Dixie doesn't have a good excuse. She's just a piglet!

[judymaggie]

Hi, all! Abbie had her ACTH this morning and I am trying not to be too optimistic but she actually walked away from her breakfast this morning after eating about half of her food. She did go back to finish up but it was definitely a change! The cortisol injection really made her a wild girl and, on her first walk back at home, I could definitely see that her worm/frog compulsion had been greatly reduced over the past few days while on the Lysodren. My back and arms are aching from trying to drag her away from the road kill! Unfortunately, she has gained 1 1/2 lbs. during the last three weeks so her big belly is definitely not all due to the Cushings. I think part of the gain is that I am wrapping all her meds in her canned food. I need to get that weight off but am sure she won't be happy about a reduction in her food!

I don't expect to get results until Wednesday so keep your fingers crossed for us!

[molly muffin]

Awesome, it does sound like she is loaded. Now just to wait for the test results and hopefully smooth sailing ahead on maintenance dosing. Crossing my fingers.

I know they are something after that injection and cortisol dump aren't they!!

hugs
Sharlene and molly muffin

[Dixie'sMom]

Crossing fingers and paws for great test results. We do that drill (ACTH) Wednesday and then the wild dog will be my little one. *sigh* I'm sure glad I have you folks to discuss things with. The friends with "normal" dogs just don't get it, do they?

[jas77450]

paws crossed. That's so funny about the hoarders cave. I would find all kinds of things under the bed, his favorite were undergarments:)

[judymaggie]

Hi, folks! I just got off the phone with the vet who had great news: Abbie is loaded!! :D I am very glad that I stopped the Lysodren when I did as her numbers were at the low end of the range:

Pre #: 1.8 ug/dL
Post #: 1.9 ug/dL.

Abbie has really been a "textbook case" which has made it so much easier for me to deal with. I will be keeping her on the 500 mg. of Lysodren a week, split into two doses, one on Thursday morning and one on Monday morning. Unless she has any increase in symptoms, we scheduled her next ACTH for 12/12.

The vet said that he is not concerned about Abbie's weight gain and to keep everything the same in terms of food and meds (pepcid, flagyl, Denemarin and Fortiflora). It is our hope that her on-going digestive issues will even out after a few weeks of treatment.

Questions: 1) Do you usually re-check liver enzymes at the 30 day mark? 2) Do you continue to measure daily water intake?

Thanks for your finger crossing -- it worked!

[molly muffin]

Yes I think at the 30 day mark and then if that is good, you get a nice break of a few months, like 3 and then recheck again.

Wonderful news!

hugs

[Harley PoMMom]

I wouldn't recheck her liver enzymes levels until her chemistry blood panel is due to be done. For some reason there are dogs whose liver levels never do normalize, so don't be alarmed if this happens with Abbie. Also, I wouldn't bother measuring her water consumption, I feel certain that you would be able to pick up on any signs that Abbie's cortisol is dropping too low.

The ACTH recheck on 12/12 sounds perfect to me, however, if Abbie would show any adverse signs of her cortisol dropping too low than an ACTH stim test would be needed ASAP, I'm sure you already know this but thought it was worth repeating . ;)

GREAT JOB JUDY!!!!!

Hugs, Lori

[judymaggie]

Thanks for guidance! I was thinking I would be keeping an eye out for an increase in cortisol, i.e., increase in water/food, and had not considered symptoms indicating a drop in cortisol. With low normal numbers on ACTH, a drop in cortisol does seem more of a risk.

Abbie's post-ACTH wildness was significantly less by this morning. We had a good 30 minute walk; I take her to an area nearby where lots of folks walk their dogs so Abbie is more interested in smells than eating worms. Interestingly, she has always been very wary of large dogs and tries to act aggessively when seeing them. This reaction had dramatically increased over the last few months and then diminished when we started the Lysodren. I am thinking that the changes in cortisol level influenced her behaviorally. Curious if others have seen similar types of changes ...

[Dixie'sMom]

Great News! I had faith that you could do this and you did it perfectly! Go Abbie! Sounds like it will be significantly easier from here on out.

Cosmo's mom - oh yes. Underwear is a staple for the hoarder's cave. hahaha!

[molly muffin]

I think the aggression thing can certainly be part of the cortisol package deal, as we have heard that before.

hugs

[jas77450]

Good job Judy and Abbie!:)

[beaglemom3]

Hi Judy :) Abbie is sooo pretty! I hope her illness is easily controlled, I do not know much about Cushings my beagles have pheos :( so I am not knowledgeable on advice for Cushings but will keep Abbie in my thoughts and prayers for all to go smoothly with her treatment.
arooooooooooooo! from my beagle boys Snuggles(turned15 years old in August) and Brando (will be 15 in March God willing)

[judymaggie]

Thanks, Vicki! It boggles my mind that no one came looking for Abbie in the kill shelter but I definitely ended up with a wonderful girl. So far, she is handling the Lysodren maintenance dose without any issues -- probably better than I do. I still watch her like a hawk on the days she gets a dose!

[molly muffin]

Amazing isn't it that someone wouldn't come looking for her. She's such a sweetie and so pretty.
Course our Molly came from a high kill shelter in Quebec, and that still boggles my mind all these years later.
I figure they just don't any of them know what they missed and in the end it is us that wins, as we have them in our lives each and every day.

Huggers,

[judymaggie]

Hi, all! I gave Abbie her Lysodren maintenance dose this morning. She was coughing a bit after swallowing it and I am wondering if the canned food wrap didn't stay on long enough to prevent irritation. I wrap all of Abbie's pills in her canned food and, since she was used to that, decided to do the same with the Lysodren. She has became adept at eating the food and spitting the pill out--at least she didn't do that with the Lysodren. Also, Abbie's first poop was normal but then had a small soft one and a third one with just liquid (all after Lysodren). I will definitely be keeping track of that. This was Abbie's 4th maintenance dose and she has been fine with other doses.

I know that some of you wrap pills in peanut butter or cream cheese but I think Abbie could easily unwrap those. Has anyone used pill pockets for Lysodren or Vetoryl? I am thinking that the pill would stay enclosed all the way down.

[judymaggie]

Hi, all! I try to only be away from the house for short periods of time on dosing days (Mondays and Thursdays) and am thinking ahead to Thanksgiving next Thursday. Would there be any problem with changing Abbie's dose to Friday? I realize this would shorten the time frame until the next dose the following Monday but I will be out for a longer time frame on Thursday.

(Note: I did see a reference to using pill pockets on another thread; will be trying that out tomorrow. I got the larger capsule size just to make sure it was big enough.)

[Squirt's Mom]

I don't think that would be an issue, Judy. As long as Abbie is getting the correct weekly dose and it's spread out a bit she should be fine. ;)

[judymaggie]

Thanks, Leslie! Using a pill pocket this morning was a fiasco. :( Abbie thought it was meant to be chewed. As she was chewing away, the Lsysodren popped out. Abbie beat me to it, picked it up and swallowed it! She seems none the worse for it and the pill pockets went in the garbage. Back to wrapping in her canned food ...

[jas77450]

pill pockets worked great with Cosmo until he quit eating altogether. I only used half so he would just swallow and not chew. Good luck.

[molly muffin]

molly would eat the pill pocket and spit out the pill.

hugs

[addy]

Could you wrap it in a piece of cheese? I know some members did that.

[judymaggie]

Addy--my concern is that Abbie will try to chew the cheese ball also. I think I'll go back to using her canned food and just make sure I use enough to surround the pill.
I am really pleased with Abbie's response to treatment. She definitely has more energy (and our cooler temps help in that regard). She is also much less obsessive about food and has actually passed right by some crunchy worms on our walks. Definitely drinking less water; I am going to measure tomorrow just to get an accurate read. No soft stools at all the last couple of days.

[molly muffin]

The key is to have another very small piece of cheese in your hand that she sees. This makes her swallow the first piece so she can get the next one. Usually works with anything she really likes the taste of.

Hugs

[judymaggie]

Sharlene--great idea! You are very clever. :D

[addy]

I'm impressed Abbie passed on crunchy worms- that's like us passing on chocolate:):):):):):)

Good to hear things are coming along.

[Dixie'sMom]

It made me smile really big to hear that Abby is doing so well. Such a relief, isn't it? And no crunchy worms? Well, it sounds like our little girl is getting a more refined palate with her treatment. haha! She may just turn into a diva like Addy's Zoe and Sharlene's Molly. :)

I stick Dixie's pill into a piece of raw hotdog. Not the healthiest choice, but she looks forward to it and the pill always goes down and doesn't fall out. Cheese, hotdogs, peanut butter... whatever works. I figure if pill time can be treat time all the better for their attitude. :)

[judymaggie]

Folks: Abbie is doing good but I need some guidance for a possible Cushing's pup on my beagle forum. The owner is about to start Lysodren after positive uc:cr and positive LDDS. I was not able to get specific numbers. He reports some symptoms but normal labs. The latter raised a red flag for me and, a short while ago, he posted that his beagle has been on Rimadyl for a few months. He has opted not to have an ultrasound.

Question: can Rimadyl skew the uc:cr and LDDS tests?

I could do some searching here but thought you might be able to point me in the right direction, particularly if there is some literature from any of the veterinary experts that I can share. I have encouraged this owner to join here but he seems quite content with his vet and plans to go forward.

[molly muffin]

I don't know of Rimadyl causing increased cortisol production, but what was the Rimadyl given for? Things like arthritis that causes pain, can cause cortisol go up sometimes as a reaction to the pain.
Not every dog has high liver values, but I'd say that most do. There is an exception to everything though.

Perhaps give him the link to what to watch for with lysodren loading:

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

Sometimes if they are going to do what they are going to do, the best we can do is make it as safe an experience as we can.

Glad to hear that Abbie is doing so well.
Happy Thanksgiving

hugs

[judymaggie]

Thanks, Sharlene! I have e-mailed our member the Feldman protocol and member notes. As you said, at least I know he is armed with info! He said that his beagle had shoulder pain that resulted in being put on Rimadyl. No mention of a specific diagnosis. I personally wouldn't recommend Rimadyl to any dog -- way too many bad reactions -- but I know many vets still use it. Mine does prescribe it but is very amenable to other options when Abbie has needed it.

[judymaggie]

Hi, all! Question: has anyone thought that lower cortisol can lower body temp? The reason I ask is that it was cold here this morning (as in cold for Florida ...) and Abbie was shivering outside. She has never done that before, even when we have had freezing temps (and it was not even close to that this morning). I put on a coat on her for the next walk and she was fine. Maintenance has been going fine -- she does have ups and downs in energy levels but nothing else noteworthy. One month ACTH is this Friday.

(FYI, beagle forum member's dog loaded in 7 days and first ACTH showed good levels. He said his doctor is following the Feldman protocol which I had e-mailed him.)

[Harley PoMMom]

Hi, all! Question: has anyone thought that lower cortisol can lower body temp?

I would think so, when a dog has elevated cortisol usually one or more of their hormones can be high which can cause them to pant more often and it seems they have a warmer body, so when using Lysodren that cortisol is lowered and generally so are those hormones and it would make sense that this would lower body temp.

[judymaggie]

Hi, all! I am in need of guidance re Lysodren maintenance. I got Abbie's 30 day ACTH numbers today:

Pre # 5.6
Post # 12.7.

The numbers from her post-loading ACTH were pre--1.8 and post--1.9 so definitely a significant increase this time around. Because her first numbers were low with little stimulation, we opted to start maintenance at her loading dose of 500 mg. (she weighs 25 lbs.).
According to Feldman's protocol, the choice now is between increasing her weekly dose or repeat loading dose for 5-10 days. She is definitely drinking less water and her hunger is now back to typical "beagle hunger".

I got the numbers this evening from the head tech as my vet wasn't available. I am actually glad to have this short window to get input before I speak with him tomorrow. Thoughts on which route you think is better would be appreciated.

My inclination is to increase her dose since she had such a significant response to the loading the first time. How do you decide what the increase should be? I have 500 mg. pills which could be quartered -- not sure if pharmacies around here have any other dosage available. If we do go with an increase, would the next ACTH be in another 30 days (of course, before that if any negative changes)? If I am reading the Feldman protocol correctly and the repeat loading is following by an ACTH and a subsequent increase in dose, then I don't really see the purpose of the re-loading option.

Thanks!

[Squirt's Mom]

The maintenance dose is typically the same as the loading dose, just spread out over a week's time. So if she loaded on 500mg a day, the maintenance would typically be 500mg a week. The dosing for maintenance is 25-50mg/kg/week. The adrenals can and do regenerate, in some pups pretty quickly if the maintenance dose isn't high enough or given often enough. You want the maintenance high enough to keep that level achieved with the load....or you have to start all over eventually.

With that post, I would look at the strength of her returning signs compared to prior to starting treatment. IF the signs are almost as strong now as they were then, redo the load. If they are just starting to come on, try an increased maintenance dose being aware that a reload is quite possible regardless.

Just because I am lazy :D - how much does Maggy weigh and what loading dose did she take?

[judymaggie]

Leslie--thanks for your reply. Abbie (my Maggie is prancing at the bridge ;)) weighs 25 lbs. and loaded in 7 days at 500mg which we continued as her maintenance dose. As I mentioned, her ACTH levels after loading were low (1.8 and 1.9).

I have not seen any return of pre-loading symptoms and was surprised her current numbers were high.

How do we decide how much of an increase?

P.S. One thing that I thought was odd--Abbie was a wild dog with tons of energy after her last ACTH. This time around she was pretty quiet the rest of the day. I took her with me to friends' home Friday evening and she was a perfect guest. I really thought that the extra cortisol would have had more effect.

[Harley PoMMom]

Judy, do you think it's a possibility that those most recent ACTH numbers got switched somehow, meaning that the pre is 12.7 and the post is 5.6? Just grabbing at straws here :o

Hugs, Lori

[Squirt's Mom]

Oh my gosh! I am so sorry for that gaff! :o:(

[judymaggie]

Lori--I don't think the head tech would have read them incorrectly but , of course, we all make mistakes. If the numbers were switched, what would a high pre dropping to a lower post mean?

(Leslie--don't beat yourself up--all my neighbors call Abbie "Maggie"!)

[My sweet Ginger]

If you decide to reload Abby I don't think you want to load Abby a second load of 5-10 days. Maybe a mini load, like 2-4 days since she seems to be quite susceptible to lysodren and 12 isn't a really high mumber to bring down.

[judymaggie]

I like the idea of a mini-load. Would we have to do an ACTH after the mini-load? Or do another after a subsequent month of maintenance? I am assuming that I wouldn't be looking for any change in symptoms with the mini-load---that it would serve as kind of a jolt to the cortisol levels.

[My sweet Ginger]

Most definitely you have to do an ACTH test after a mini load each time.

[Squirt's Mom]

And you look for the same signs of loading just like the first time - the only difference is the anticipated load time. Abbie may reload in 36 hours. ;) So you watch just like the first time, stop the med and call for the ACTH just like the first time, and bring her back 2 weeks after restarting maintenance just like first time....ie it's just like the first time only shorter and the testing schedule starts over. So much fun the first time ya'll decided to try it again, huh? :D

[judymaggie]

Thanks--any thoughts about increasing her weekly dose rather than re-loading? My main concern about the increase option is how to decide how much to increase. I do have a compounding pharmacy nearby that I used for Maggie's meds.

Abbie had ACTH after a month on maintenance, not two weeks. Did we err?

With the mini-load, would we do the ACTH after 4 days even if no changes?

Sorry for all the questions--just trying to gather as much info as possible before speaking with vet.

[My sweet Ginger]

It could vary by who your vet is but when we did our mini loads the days were already determined by the vet before the start of each mini loads so I think I wasn't really looking for any changes other than possible adverse reactions and I really didn't see changes in her demeanor by then.

[Harley PoMMom]

If the numbers were switched, what would a high pre dropping to a lower post mean?



There's really not a worry when the pre is higher than the post, this can happen when a dog is very anxious, stressed and/or nervous when the pre blood draw was done.

Hugs, Lori

[labblab]

Hi Judy,

Yup, I agree with Lori that stress can definitely affect baseline cortisol testing values. But regardless, I don't think you would normally expect a "pre" ACTH draw to significantly exceed the "post" under a normal testing situation. This is a reply given by Dr. Mark Peterson to a vet who was treating a dog with Vetoryl. However, I think the information would also be accurate for a Lysodren patient, as well.


Question: I recently rechecked a dog on Vetoryl. The post-ACTH stimulated cortisol concentration was lower than the pre-value. What does this mean?

Answer: There are several explanations for discordant results, i.e., those in which the baseline cortisol is greater than the post-ACTH value. These include laboratory error, mislabeling of samples in the clinic, interference by exogenous steroids, and use of an ineffective ACTH product...

So for what it's worth, I'm guessing those were the true results for Abbie.

Marianne

[judymaggie]

Hi, all! Talked with the vet this evening -- numbers I got previously were accurate (5.6 pre; 12.7 post). We discussed a mini-load vs. an increase in her weekly dose and it was his preference for the increased dose with the next ACTH scheduled for 30 days out (unless earlier if symptoms warrant). Rather than increase the two doses she is getting now, we are adding a third dosing day so will be giving her 250 mg., 3x a week. I mentioned that Abbie has not consistently wanted to go on walks and we both think that the arthritis she has in her back left knee is bothering her more now that her cortisol levels have decreased. Being a stubborn beagle (definitely an oxymoron), I let her dictate how far she walks.

Thanks to everyone for your input!

[molly muffin]

I don't know as much as most of the other pros here about lysodren, but I do want to know I'm keeping up with you and Abbie. Hoping this increase does the trick!

hugs

[judymaggie]

Thanks, Sharlene--with everything going on with your family and Molly and also tracking everyone here, you are definitely a super extraordinaire multi-tasker! :D

[molly muffin]

Merry Christmas Judy and Abbie and Angel Maggie!!

Hoping you have a wonderful Christmas and Holiday Season and that Abbie continues to do so well in the new year.

hugs

[judymaggie]

Hi, folks! I have posted some new pics of Abbie thanks to beagle forum friends who visited on Wednesday -- they spend all their free time taking pictures of shelter dogs with the goal of helping them get rescued. Husband, Jason, is the primary photographer and he has become quite skilled.

[molly muffin]

Love the pictures. They are very good and Abbie looks wonderful.

Hugs

[molly muffin]

Happy new year Judy and Abbie.
Wishing you all the best in the new year

Hugs

[judymaggie]

Hi, all! Had discouraging message from vet this morning. Abbie had a one month (after Lysodren increase to 750 mg a week from 500) ACTH yesterday. I was really, really hoping that her numbers had come down but that was not the case. Numbers were:

Pre- is 5.6 (same as one month ago before increase)
Post- is 14.3 (was 12.7 a month ago).

Vet will be calling me back to discuss options (mini-load vs. another increase). He also wants to find out if Abbie's symptoms have abated. He is leaning towards a 5-7 day mini-load. Abbie has lost weight (glad but not sure why that happened) so need to talk about what would be her loading dose. She now weighs 24 lbs. (down from 25). Abbie is definitely drinking less water. She still wants to go out to pee after every nap but no accidents in the house. She still hoovers down her meals (doubt this will ever change-she is a beagle ...) but is not as ravenous outside (dead worm and frog hunting is less). Her pot belly has tightened up a bit. This past week we have had cooler weather and Abbie has been much more willing to go on walks. This morning she walked for 40 minutes.

I am assuming Abbie will have to have another ACTH after mini-load. I am definitely going to ask the vet to waive the $34 eval and $29 half-day hospitalization fees!

[molly muffin]

Well dang! Not what you wanted to hear obviously. I'd keep an eye on the weight if that is a concern. You said she normally weighs 25lbs and has dropped a pound. Does she seem more active over all? Maybe eating or wanting less treats?

hugs

[judymaggie]

Sharlene -- will keep an eye on weight although, as long as weight loss isn't indicative of any disease process, it would be nice to get Abbie back to her ideal weight of 23 lbs.

Spoke with the vet this afternoon -- will start a mini-load today. He wants to load her with 500 mg./day which will be less than what her weekly dose has been this past month. His rationale for that is that Abbie's numbers are not super high and he does not want to push a huge dose of daily cortisol into her system. I am okay with that -- just hope it works. I will speak with him on Tuesday unless sooner is necessary. Depending on how she is doing, next ACTH will be on Thursday or Friday with Friday being the preference. He agreed to waive $34 eval fee but not $29 hospitalization fee for Friday's test. Every little bit helps! Abbie does have a new lump on her left shoulder which I don't think moves (like other lipomas she has); vet will check it on Friday.

So back to being hyper-vigilant ...

[Dixie'sMom]

Well fooey. I hate you have to do a mini-load. I know they are scary. (Or they would be scary for me anyway). Hopefully this will work and you can get Abbie's numbers down where you want them. Could the swelling in her shoulder be muscular? or arthritis?

I know you will get to the bottom of it. You are a great Mom. :)

[judymaggie]

Folks: I was just reading the latest posts about Grace on Kenny's thread. I am wondering if I should reconsider using Abbie's low fat canned food to wrap the Lysodren. Since she responded so well to the first loading, I really thought that the canned food wasn't an issue. Is it possible that, on maintenance, she isn't absorbing enough Lysodren to keep her adrenals from regenerating between doses? Abbie has never tasted peanut butter but am sure she would love it. This is going to sound silly but am concerned that it would stick to the roof of her mouth and Lysodren wouldn't make it down her throat with the peanut butter.

[molly muffin]

How about cream cheese? What did you use during loading? I don't think it would make that big of a difference she is eating her food right afterwards right? So should get enough fat from that for it to be absorbed? Maybe some of the lysodren peeps will have an idea.

[My sweet Ginger]

Lol. She's got to be the only dog in America who hasn't tasted PB.:D
Then again maybe she's before she came to you, right?:p
How about testing it out? Wrap a small piece of carrot or pea with PB and see if she gets them down. And you will also know whether she likes PB or not.;)

[judymaggie]

Song--you are absolutely right! Who knows what she ate the first seven years of her life--most of her molars were rotten and had to be pulled when she came to me. She loves to have her teeth brushed so all has been good for the last few years. I will do a peanut butter trial with her Benedryl and see how it goes. I fully expect she will love the taste. I have to go pick up more Lysodren at Target tomorrow and they sell those single serve peanut butter packs. Don't have any in the house--I don't eat it either! :D

Sharlene--I used the canned food during loading and her numbers were low. Her numbers on all subsequent ACTHs have been too high so just trying to figure out what is causing that. She gets the Lysodren after she eats, not before. Her dry food is a prescription food for diabetic dogs (after trying several different foods, it was the only one that didn't cause diarrhea) so it is pretty low in fat and I mix it with the low fat canned food.

[Dixie'sMom]

LOL@Song. I think we have the same twisted sense of humor. ;)

How about a mini peanut butter sandwich so it wont stick to the roof of her mouth. :)

Sorry....
(>>>>bows head and walks away)

[labblab]

I've probably mentioned this before, but I am a huge fan of using processed American cheese slices to mold pill pockets around tablets or capsules because those slices are usually so soft and pliable. You can buy the full-fat variety, tear off a square, and completely encase the pill by molding around it. It is not so sticky nor squishy (nor messy) as PB or cream cheese, and the pill will not easily fall out or be torn out if you've totally molded it inside.

So there you have it (and no, I do not own stock in Kraft! ;) :p).

Marianne

[judymaggie]

I think I have created a peanut butter monster! :eek: I tried it with her metronidazole after she had her Lysodren. The pill and every speck of the peanut butter was consumed. Then she started jumping up and down to see if there was more coming her way.

[My sweet Ginger]

I think she's missed her favorite treat for years and finally enjoyed it immensely. :D

[Poppy'sDad]

Hi Judy,
As you have been a huge help to me with Poppy, and even though I am new hear I thought I would chime in. Like Marianne, I have been using the American cheese singles, whole fat, for his Lysodren. Not Kraft but Bordens:)
Even when Poppy crashed and wouldn't look at his food this was how I got his Prednisone down. He didn't take my hand off as he would before the crash and becoming loaded, but no matter how crummy he felt he still took the cheese!
Although it seems you may have found a favorite in the PB.....good luck and I hope it works out!

Greg

[judymaggie]

Hi, all! Abbie's second loading is over. About an hour after her breakfast and morning dose, she had liquid diarrhea. She is fine otherwise but I left a message for her vet that I am not going to give her the evening dose. She was already scheduled for an ACTH tomorrow morning.

Her numbers after her first loading were quite low with little stimulation but then she couldn't maintain a good range. I am going to switch to using peanut butter with her Lysodren when maintenance starts again just in case absorption was the reason for high numbers during previous maintenance.

[ScottieBoo]

Hi, all! Abbie's second loading is over. About an hour after her breakfast and morning dose, she had liquid diarrhea. She is fine otherwise but I left a message for her vet that I am not going to give her the evening dose. She was already scheduled for an ACTH tomorrow morning.

Her numbers after her first loading were quite low with little stimulation but then she couldn't maintain a good range. I am going to switch to using peanut butter with her Lysodren when maintenance starts again just in case absorption was the reason for high numbers during previous maintenance.

I hope you get great results for Abbie. I use Peanut Butter to give my Scottie his Vetoryl. Yet I only chose to do that because He LOVES Peanut Butter and I want him to feel like its a treat.!

[Squirt's Mom]

Let us know! You're a great mom!

[molly muffin]

Well I am glad it is over and hopefully this time she will hold it.

Great indeed!

[addy]

Well, good to read Abbie is loaded again. Good job Mom:)

[judymaggie]

So glad that I didn't give Abbie her evening dose last night--she walked away from a half-eaten breakfast this morning and then spit out her metronidazole, including the canned food it was wrapped in!

I should be getting her ACTH numbers tomorrow. Her vet will not be in tomorrow as well as all of next week so we chatted when I picked up Abbie after her test. Unless Abbie's numbers are below 1 (which I doubt will happen), he wants me to start back up on Monday with the same maintenance dose (250 mg. 3x a week). I did mention that I was going to start wrapping it in peanut butter, hoping that might help with better absorption to keep her cortisol level low during maintenance. He kind of pooh-poohed that idea but it might work and Abbie will love it!

[Dixie'sMom]

I think I have created a peanut butter monster! :eek: I tried it with her metronidazole after she had her Lysodren. The pill and every speck of the peanut butter was consumed. Then she started jumping up and down to see if there was more coming her way. :D

LOL! I loved reading this. I could picture it perfectly. Both my girls love peanut butter and cheese. Buttons has "off" days when she will turn her nose up at everything and those are my 2 test foods. If she won't eat either of them, then I really worry.

I'm glad Miss Abbie is loaded. I hope her tests put her right where you want her and she holds this load. Go Abbie!

[judymaggie]

Hi, folks! Unfortunately, no numbers yet. I'm not sure if my regular vet calls the lab for the numbers so I get them the next day but his assistant vet (who is taking all calls in his absence) didn't have anything back yet so won't have them until Monday.

Abbie was not interested in her food again this morning and again spit out her flagyl and this time I wrapped it in peanut butter! Since she is fine a couple of hours later, I think she is nauseous first thing in spite of having had pepcid. I asked the assistant vet to let me know if I could increase her pepcid dose from 5 mg. twice a day but her response was to give Abbie a little bit to eat before she goes to sleep rather than adjust her meds. Since she already has a treat at 8:30, I honestly don't think this would help. I think the vet (who is relatively young and has never seen Abbie) is probably not comfortable changing anything in the regular vet's absence.

I did a google search for pepcid AC dosing for dogs and everything I read said not to give more than 1 mg. per lb. Abbie weighs 25 lbs. and she is now getting a total of 10 mg. a day. Does anyone think it would be a problem to give her 10 mg. in the morning and then 5 mg. before her dinner? That would still be under the max. I do wait 20 minutes after dosing to give her anything to eat.

Second question: is there any issue with giving Abbie her maintenance dose with her evening meal instead of morning meal? I am thinking that, if she continues to be nauseous in the mornings, she would have a better chance of eating a full meal before her Lysodren and also, hopefully, wouldn't spit it out.

[Harley PoMMom]

I did a google search for pepcid AC dosing for dogs and everything I read said not to give more than 1 mg. per lb. Abbie weighs 25 lbs. and she is now getting a total of 10 mg. a day. Does anyone think it would be a problem to give her 10 mg. in the morning and then 5 mg. before her dinner? That would still be under the max. I do wait 20 minutes after dosing to give her anything to eat.

I don't think I would raise the Pepcid ac dose, but I am such a worry wart. My Harley started to get nauseated after being on Pepcid ac for a while, I then switched him to slippery elm bark (SEB) which he did well on. One caution note with SEB, it may interfere with the absorption of other medications so it is advised to give it at least a hour before other medications. Here's a link to info about SEB: http://www.littlebigcat.com/health/slippery-elm/


Second question: is there any issue with giving Abbie her maintenance dose with her evening meal instead of morning meal? I am thinking that, if she continues to be nauseous in the mornings, she would have a better chance of eating a full meal before her Lysodren and also, hopefully, wouldn't spit it out.

I really don't see why giving her Lysodren in the evenings would be a problem, but I would still ask the vet about it.

Hoping for excellent numbers for Abbie, and hoping she is feeling better real soon.

Hugs, Lori

[judymaggie]

Hi, folks! The Lysodren roller coaster is alive & well! The assistant vet called early this morning with Abbie's numbers:

Pre <1
Post <1

She said that she wanted me to start prednisone and then Lysodren again in two weeks. I was non-committal. This vet only has four years of experience and has never seen Abbie. She didn't ask me how Abbie was doing but just that the Cushing's dogs she has seen that have low numbers are treated as she described. I did ask that she leave a note for Abbie's vet to call on Thursday when he returns to the office.

Abbie's affect, activity level, peeing, pooping and appetite are all normal. The only change I have seen is that she doesn't want to eat the flagyl pill (wrapped in dog food or peanut butter) after breakfast. This is a split pill and can be very bitter. She willingly takes it in dog food after her post-walk chicken.

I don't see any reason to give her prednisone. The Feldman protocol says to give prednisone "as needed". Agree?

The protocol also says to recheck via ACTH in 3-4 weeks and then restart maintenance if appropriate and at a lower dosage. Does the re-check time line depend on seeing increased water intake, peeing, etc.?

It also says to check Na/K. Is this necessary if there are no signs of Addison's?

Not what I was hoping for but not super surprised since the numbers after her first loading were low with little stimulation.

[Harley PoMMom]

For me, those numbers are too low and if this were me, I would give the prednisone.

[Squirt's Mom]

Those numbers make me a tad bit nervous as well even tho her behavior does not support low cortisol. You know her best so if you are comfortable not giving the pred right now, ok, but keep a very close eye on her for the next few days. Remember the Lyso stays in the body a long time and our Abbie seems to be uber sensitive to it so it may stay with her and work on her longer than the norm even. So keep a close eye and keep the pred handy just in case.

As for when to start the maintenance, that is typically within a few days to a week when the post number is within range - Abbie's is below range so I wouldn't be starting it now for anything. Normal range for a Lyso pup is 1-5 ug/dl. Her's just says less than 1 so we don't really know what it actually is. The pre is the same, meaning there was no stimulation of the glands.

After a crash, yes you wait to see signs again and have an ACTH showing elevated cortisol. That may take days or weeks or even months.

[judymaggie]

Lori & Leslie -- thanks for getting back to me so quickly. I, too, am concerned about the numbers. With regards to the pred, how would I know when to stop it if Abbie is not now showing any signs of low cortisol/crash? It is my understanding that the pred would be given to reverse lethargy/vomiting/diarrhea/lack of appetite, etc.

She went for a 30 minute walk this morning which she wasn't even doing very often when on Lysodren. After I was out for a bit this morning, she came running to say "hello" when I came back in the house. She just now went with me to take a neighbor's dog out and walked with us and pooped normally. (Her only episode of diarrhea was last Thursday.)

Still perplexed why her numbers bounce back up into the teens during maintenance when she obviously hits bottom during loading.

Since we are now 84 hours post-Lysodren (her last dose being on Thursday morning), I would think there wouldn't still be any in her system.

[Squirt's Mom]

That sure doesn't sound like low cortisol, huh? :D I probably wouldn't give the pred with that behavior but would still keep an eye on her. As for maintenance, I'm just not sure but you don't want to lose the load any more than you want her to crash. What dose will she be taking and how often?

[Harley PoMMom]

According to this Lysodren flow chart from IDEXX, if a dog's ACTH stimulation test result is <1 ug/dl
Discontinue mitotane.
If dog is listless or ill, administer maintenance prednisone in tapering dose for two weeks.
If dog is clinically healthy, do not start prednisone, but start low maintenance dose of mitotane in two week

https://ca.idexx.com/pdf/en_ca/smallanimal/snap/cortisol/cortisol-mitotane-protocol.pdf

Judy, you are right in that the prednsione need not be started since Abby is acting/feeling ok.

Hugs, Lori

[judymaggie]

Lori -- thanks so much for link as the IDEXX flow chart that I have been referring to is slightly different than the one you posted -- maybe the one I have is an older version. The one you posted does have a reference to what the new maintenance dosage should be, i.e., 25% reduction and refers to the two week waiting period (which is what the vet said this morning although she never asked what "crash" symptoms Abbie was experiencing).

I feel like we are going in circles ... at Abbie's weight of 25 lbs. her initial loading dose would have been 568 mg. We rounded down to 500 mg. since her diagnostic ACTH wasn't sky-high and her symptoms weren't extreme. Also, it is impossible to divide the pills into more than quarters. Here is what followed:

Initial Loading, 11/3-9/14 at 500 mg/day
11/10 ACTH, pre 1.8, post 1.9
11/13 maintenance, 250 mg./2x week (total of 500 mg./wk)
12/12 ACTH, pre 5.6/post 12.7
12/15 maintenance, 250 mg./3x week (total of 750 mg./wk)
1/9/15 ACTH, pre 5.6, post 14.3
Loading, 1/10-15 at 500 mg/day
1/16 ACTH, pre <1, post <1

If we reduce maintenance by 25%, it would be 563 mg. -- really back to what her initial loading would have been if we used exact conversion. I have no idea how I would divide the pills into doses to equal that weekly amount; add to that the fact that Abbie hasn't been able to sustain a higher dose during maintenance. I am stumped! :(

[Harley PoMMom]

You can get it compounded, I did that for my boy, Harley.

[Squirt's Mom]

You might think about 125mg 4x a week, too. ;)

[judymaggie]

Thanks, guys! I do have a compounding pharmacy nearby which I used for some of Maggie's meds. Not sure I want to go back to 500 mg. since Abbie didn't hold her cortisol level at that maintenance dose although she was only getting it twice a week. If we end up going with something closer to the 563 mg. I am wondering if the compounding pharmacy would be willing to save me some money by using the $100 worth of 500 mg. Lysodren tablets that I just purchased. I am also going to definitely use peanut butter to wrap to help with absorption.

Meanwhile, I will definitely keep an eye on my Abbie -- right now she is barking at me to get her dinner ready! :D

[judymaggie]

Hi, all! My vet called tonight after returning from the Orlando conference. He said I did the right thing in not giving Abbie prednisone since her only issue was with her breakfast.

Leslie, he is definitely on the same wavelength as you although starting a bit more conservatively. If Abbie continues to feel well, he wants me to give her 125 mg.on Monday. If no negative reaction, then another 125 mg.on Thursday. If she handles that, then add a third dose the following week. He doesn't want to wait the full two weeks to restart because he is concerned that she might lose the load again.

Abbie is not yet eating her regular breakfast but we are working towards it. This morning she ate canned food with a little dry mixed in. She did swallow the flagyl covered in canned food afterwards. Eating the rest of the day continues to be normal as is activity level and affect. She is still showing arthritis symptoms but I don't want to add anything else to her regimen at this point.

[beaglemom3]

prayers for sweet Abbie to start eating her regular breakfast but I am happy to hear she ate canned mixed with dry, and took her meds!
HUGS to your precious girl.

[Dixie'sMom]

I think Miss Abbie and Miss Molly Muffin are co-authoring a book called "How to Confound Cush Parents and DVMs".

I'm so glad she has felt well during the low numbers. I can't remember, is Abbie on the Flagyl permanently, or will you be stopping that medicine at some point in time. A friend of mine had to take it for an infection and she talked about how hard it was on her stomach. I bet that is causing Abbie's nausea and she knows it so that's why she spits it out if she can detect it at all.

[judymaggie]

I think we can add Kenny's Gracie as a co-author! :D After taking her pepcid and benedryl without any reluctance, Abbie was not enthusiastic about breakfast and wouldn't have anything to do with the flagyl. We went for a good walk followed by chicken after which she gobbled up the flagyl. She definitely is finicky!

I did ask the vet last night if there was any problem with Abbie taking flagyl continuously--he said "no" but agreed we do want to try to wean her off of it at some point. When we have tried that before, the diarrhea returns. Hopefully, if we can get Abbie's cortisol lowered on a consistent basis, her digestive issues will resolve. Abbie has had chronic, intermittent diarrhea ever since I adopted her. I am always glad to see good poops! :D

I am going by the vet's office a little later to pick up ACTH copies--will ask him if he agrees with me giving Abbie the Lysodren after dinner when we start back next week. I will worry less about her refusing it.

[SasAndYunah]

Hi Judy,

you have been (and still are) on quite the journey with Abbie, I sure hope you will sort it all out (I'm sure you will down the road) :) But what an exceptionally gentle and sweet face does she have...wow :) Peanut butter monster or not...she's a total darling ;)

All the best to you and her...will keep on checking in,

Saskia and Quincy :)

[judymaggie]

Saskia--thanks so much for taking the time to read about my Abbie. She is a cuddle bug!

Started back on Lysodren after dinner--she eagerly took her peanut butter "treat". She has been wanting to go out to pee very often today. Not sure if that is related to the 10 day Lysodren break (in spite of her drastically low test numbers) or she has another UTI. Will see how she does the next couple of days.

[addy]

I used metronidazole (flaygl) with Zoe. I tried to keep her on the lowest possible dose without losing control of her IBD once a day because I was always worried about the neurological toxic side effects although our IMS assured me she was not concerned about it:


Adverse effects in dogs and cats include neurologic disorders, lethargy, weakness, neutropenia, hepatotoxicity, hematuria, anorexia, nausea, vomiting and diarrhea.

Neurotoxic effects include encephalopathy, cerebellovestibular signs and periopheral neuropathy.

Neurotoxicity following prolonged therapy is most often related to cumulative dose and duration of treatment.

Most canines who develop neurologic signs secondary to metronidazole administration have received weeks to months of therapy, but toxicity after short-term therapy at relatively low dosages (<60 mg/kg/day) has been reported.


I had to wean Zoe's dose down very slowly. When she had a flare up, I would up the dose and then carefully wean back down. The last two years of her life she took a small dose once a day, every day.

Hugs

[Renee]

Have you tried switching to slippery elm bark? Also, do you add probiotics?

[judymaggie]

Hi! I do want to wean Abbie off of the flagyl but don't want to introduce anything new, i.e., slippery elm bark, until we can get her on a Lysodren maintenance dose that keeps her in the right range on ACTH. She does get probiotics (Forti-flora) once a day on her dinner.

Renee -- what brand of slippery elm bark do you use? The least expensive one I have seen on line is the "Honest Kitchen Perfect Form Supplement".

Abbie has had a good day today -- no apparent negative effects from yesterday's Lysodren.

[Renee]

I would always advocate The Honest Kitchen products, because I love them! Perfect Form and ProBloom are great products they make for upset bellies.

I actually don't use any SEB, but I do add probiotics to all the meals for my pugs. I use B Natural's ultra probiotic powder. We also have some of the ProBloom which we give as a treat.

[addy]

I had good luck with Arc Naturals Gentle Digest, and I totaaly agree that you should not change anything until Abbie is stable on the Lysodren.

I'm a huge fan of Honest Kitchen as well. The Zeal really helped Zoe.

[judymaggie]

Hi, all! Just wanted to give an update on Miss Abbie -- she is doing really good (saying that quietly -- I got jinxed with Maggie as every time I said she was doing good, she would have a major medical event!). The vet and I talked at noon today to discuss how she was doing and what Lysodren dose to use next week. When he asked how she was, I said the best word to describe her is "perky"! :D She has energy (we went for a 45 minute walk this morning), she has normal poops and her water intake is definitely reduced. Last week we started her back on Lysodren with 250 mg. (two doses of 125 each). This week she is getting 375 mg. (three doses of 125 each). She gets her dose after dinner in a peanut butter ball which, of course, she loves! I have been dosing her every third day to try and keep her Lysodren at an even level.

Since she is doing so well, we are going to keep her on the current dose rather than increase it next week. Her next ACTH is on 2/24/15. It will be very interesting to see what her numbers are. Still a mystery why she never showed any symptoms of low cortisol after her last mini-load/ACTH which was <1 on both pre and post.

The vet and I agreed that a full chemistry panel, CBC and urinalysis should be done in April (6 months since last labs). I also told him I wanted a UPC run as well as a blood pressure check. Her last two urine tests have had 2+/3+ protein and her last BP check was at 160. Is there anything else that would be recommended?

[Harley PoMMom]

Judy, looks like you have a well thought out plan. Just wanted to let you know that when having the UPC test done that you want the urinalysis to be done first to make sure there aren't any contaminants, sediment, bacteria, etc in the urine, if these things are found in the urine they can falsely raise those UPC results.

Glad to hear our Abbie is doing great, give her some hugs and kisses from her Auntie Lori.

[beaglemom3]

Wonderful to hear that Abbie is doing well. Thanks for the update and her beagle cousins Snugs and Bran send Abbie hugs, kisses and a huge arooooooooooo!

[molly muffin]

Whoo hoooo go Abbie! She is a little trooper isn't she. So glad she continues to do well and yea, 6 months sounds like a good time to recheck bloods. I do that with molly too. Love it when they feel good and act like they are on top of the world. hmm, in fact, I hear what sounds like molly getting into the shoes right now!

hugs!

[judymaggie]

Hey, Sharlene--so glad you are feeling better!

In order to consistently give Abbie 375 mg. a week, I've gone to a Monday, Wednesday, Friday dosing schedule. I have noticed that Abbie is a bit duller the day after she gets a dose--just not as alert. She perks up on the second day. She is definitely drinking less (didn't even have to refill bowl today) and peeing less.

Wondering if I shouldn't go back to every third day even if that means she won't get 375 mg. in a seven day period. On the three day schedule she wouldn't get a dose the day before her next ACTH test which would be a different scenario than her previous tests. Neither the vet nor I had a calendar in front of us when we talked about the three day schedule ...

[molly muffin]

Could you change the date of the ACTH test so it is the day after her dose if you want to change the schedule? Do you think changing the schedule will make her not be as dull after her dose?

I mean you could certainly try it and see if it changes anything.

[judymaggie]

Hi, folks! This may sound like a strange question but here it goes ...

Is it possible that Lysodren could exacerbate nightmares? Abbie has had very infrequent nightmares since I adopted her -- she will be sound asleep and, all of a sudden, jump up in a very startled state, i.e., run around looking very scared. It takes her a while to calm down and usually doesn't want to go back to sleep in the same spot. Over the past few weeks these episodes have greatly increased in frequency. From personal experience I have had nightmares when given certain types of pain medications after surgeries. I adopted Abbie when she was seven but she didn't have any signs of having been abused but, of course, one never knows with a rescue.

(Sharlene -- I've decided to pretty much stick to the every 3 day dosing schedule. Will switch things a bit the week before her test on the 24th. I want to stick with that day for testing because the techs who do the best job with her glands and nails will both be at work that day. Abbie's glands are "unusual" and the head tech has figured out how to empty them completely. They do the glands/nails after she has had the blood draws so as to not stress Abbie out even more.)

[molly muffin]

Well that makes perfect sense to me and I'd stick with the schedule that gets you the good techs that can do Abbie too.

Interesting, I've not heard of nightmares being worse on lysodren, but anything is possible, as with the cortisol lower, the fight/flight instinct doesn't have that cushion of cortisol adrenaline to get them through it. I know molly is much more jumpy since her cortisol has been coming down. I thought she was going to go into attack mode and take out a sign that was flapping in the wind this evening on our walk. She refused to budge I had to pick her up and then she snapped at me too until she realized that I wasn't backing down and the sign was off limits to her.

[judymaggie]

Hi, all! Well, we are still on the Lysodren roller coaster. Abbie had another ACTH on Tuesday. Her numbers are: pre of 5.7 and post of 13.7. This is pretty much back to where she was before the mini load the week of January 10th. As a reminder, the numbers on the ACTH after the mini load were both below 1.

Abbie's water intake and urinating frequency continue to be normal. Her belly has gotten larger (no weight increase) and, most days, is not interested in going for long walks (pees/poops and back home). Poops are normal--I have started to wean Abbie very slowly off the flagyl. I forgot to mention the slippery elm to the vet.

The vet and I agree that another load would not make sense at this point. We decided on giving her 125 mg. every other day (increased from every third day). Going to hold off doing another ACTH for a while unless drinking/peeing increases. We still plan on running lab tests, etc. in April.

I said that maybe it was time to try Vetoryl--there was a long silence on the phone followed by a laugh--I said it might be a good learning experience for us both (he has never used Vetoryl).

I had a portrait done of Abbie--I'll add it to her photo album tomorrow when I'm on the computer.

[Squirt's Mom]

Well bless both your hearts! She really has had a time getting regulated, poor baby. I hope the increase in maintenance helps!

[molly muffin]

Who would have thought you'd be back again with the cortisol. Abbie is certainly the contrary one when it comes to her cortisol.

Hope this adjustment helps.

[Dixie'sMom]

Oh my goodness. I tend to agree with you that maybe the Vetoryl would give more consistent control with the everyday dosing versus trying to figure out how to get consistent results with the Lysodren dosing. I am confident that you can teach your Vet to use it. :D :D

Hopefully the current Lyso dose will work and you won't have to make any changes. Hugs to you and sweet Abbie.

[judymaggie]

Hi, all! Thanks for your support. In typical Abbie style, she eagerly walked for 30 minutes this morning -- so much for her being sluggish the day after a dose. I, too, am hopeful that Abbie's current dosing schedule will even things out but I am going to print out some of the Vetoryl literature from the Resources forum for my vet. Maybe I can challenge him to try something new!

I posted Abbie's portrait in her photo album -- hoping to get it framed this weekend and hang it proudly next to Maggie's.

[molly muffin]

Oh that is a lovely picture. It will look so nice framed with Maggie's

Glad to hear that she is back to her perky self. :)

[judymaggie]

Hi folks! Abbie's back legs have been very stiff yesterday and today. She is not interested in walks, had a hard time squatting this morning to poop and won't jump up on the ottoman to get to the bed. I just gave her 25 mg. of Tramadol and will give her same dose this evening. Abbie's vet is on vacation this week (although always reachable by cell phone); the other vet in his practice told me this morning that I could give her 50mg. twice a day if needed. I've never had to give her the higher dose and, hopefully, won't have to now.

I'm trying to think positively in that this all probably means that the every other day of Lysodren is successful in lowering her cortisol levels. Such a balancing act!

[molly muffin]

It is a juggle isn't it. You are probably right that the cortisol has dropped enough that she is now feeling stiff and achy.
I wish they had a cortisol meter like a blood sugar meter. Then we could easily find out what the base cortisol level is that they feel the best at.

hugs

[judymaggie]

Sharlene -- you're brilliant -- a "cortisol meter"!!! Not sure if you get to see "Shark Tank" in Canada but that would be a great invention for them to invest in! :D

As an aside, a strange thing happened when I lifted Abbie up on the bed. As I usually do when I have to lift her, I put one hand on her behind and the other on her chest. As I lifted her up, she screamed. I realized that I had my hand up too high and it was pressing on her throat. As I think I have mentioned in earlier posts, Abbie chokes when she drinks water. I have elevated her water bowl but it doesn't really help that much. The vet has thought it might either be allergies or possibly her throat muscles weakening with age. Now I am back to thinking that there might be something else going on. She has her comprehensive visit with the vet mid-April so will add this to the list. I would rather the vet press her throat area and get her upset than me!

[molly muffin]

Yea we get Shark Tank and Dragons Den, have the Canadian version with much the same people on it up here. Cool show. Now if only I knew where to start with developing it. hmmmmm

Oh gosh, okay, maybe something going on with the larynx, they have ruled out a collapsed larynx? or partial collapse maybe.. hmmm

hugs

[judymaggie]

Would a partial collapse cause pain if pressed? Since she doesn't choke when eating, don't think it could be a total collapse. Will have to do some reading ... (what did we do before the internet existed -- well, you were probably not born yet but I certainly was!) I will do a search here as well as I do recall someone mentioning their dog having this issue.

I have also noticed that, when I wipe Abbie's eyes (she has yucky discharge from allergies), I have to be careful not to put my hand on her throat to hold her or she flinches. Didn't really connect that to anything until she screamed out today.

[molly muffin]

Well I'd think a partial Could cause pain if the pressure was just at the right spot. The other option is for something more dire going on and we don't even want to think about that unless we need to.

Yep, research is definitely needed. My husband is telling me that dinner is definitely needed to. hahahaha

hmm, yep, I remember when there was no internet, or if there was I didn't know about it. :) :) When I started working for the military, we still used the ball printers with special ones for high secure messages, and everything was stored on 3 1/4 floppies. Instead of email, I had a drop in tray and notes left on my desk. Funny to think of that now.

Hugs

[Squirt's Mom]

Judy and Sharlene, I'm putting you in charge of getting this cortisol meter in the works! Ok? OK! That would be the coolest thing since sliced bread!

[SasAndYunah]

Sure hope the throat will turn out to be nothing serious... About picking up a dog, well, at least the smaller to midsized ones, I was taught by an orthopedic surgeon that the best way to pick up a dog (again...depending on the size) was to place one fore arm between the front legs (the dogs muzzle is facing your elbow) and support the chest with that hand and to "scoop up" the dogs behind with your other fore arm/elbow area (almost as if the dog sits on your fore arm/in your elbow area) Maybe you could try this approach? :) Don't try this if you have a Lab or similar size dog :p

Saskia and Quincy :)

[Harley PoMMom]

My Bear had a collapsed trachea, the slightest pressure and he would cough which sounded like a goose "honking." He never seemed to be in pain with it, but all dogs are different.

Hoping Abbie's throat issue turns out to be something minor and resolves itself quickly.

Hugs, Lori

[judymaggie]

Thanks for your support! I was up at 4:30 this morning worrying about Abbie and trying to decide what the next best step is, i.e., have her seen by my vet or see how soon I can get her in to see her internist. I decided to see if the vet could see her tomorrow which is his only day in the office this week. If she does need to see the internist, my vet can help me get a quicker appointment and it would be best if he had actually seen Abbie. I called the vet's office and explained what was going on and asked if the vet could fit her in tomorrow or, as an alternative, call me early in the day. The tech said she would call the vet and get back to me later. She called back in about 10 minutes to tell me that I should bring her in at 10:00 tomorrow. It will most likely be a long wait as they are fitting her in but obviously the vet is concerned about her.

Abbie was definitely not feeling good this morning. After much encouragement she finally got out of bed-- she walked outside with me but just sat on the driveway and wouldn't pee. Just turned around and walked back to the door. I put her pepcid in some canned food which is what I do every morning and she wouldn't take it off the spoon. I put it on my finger and tried to get it in her mouth but she spit everything out. A while later, just as I took out the emergency prednisone, she came up to me obviously looking for food!

I tried another pill first and she eagerly took it. After the 20 minute wait she gobbled up her breakast (although I gave her a smaller amount). I gave her more tramadol and she laid down to rest. I tried a couple more times to get her out to pee/poop before leaving for tai chi but she would not go out. When I came home she went out to pee but wouldn't go for a walk. She has since been sleeping off and on.

I did, of course, do some research last night and the majority of veterinarian produced articles listed Cushing's as one of the possible causes of acquired trachea problems. Abbie has been gagging when she drinks water for about a year and a half so am wondering if she wasn't starting down the Cushing's road at that time.

Saskia -- I appreciate your guidance on how to pick up a dog. I think I have been doing as you indicated but will definitely ask the vet to show me tomorrow how to pick up Abbie when necessary. I have limited flexibility due to fibromyalgia so picking her up has always been more challenging.

Sorry about the long post ...

[molly muffin]

I'm glad you got an appt with the vet. It rather seems like her cortisol has dropped again doesn't it. Abbie seems to fall right in the middle of too much vs too little.

Hmmm, well it does make sense that cushings could affect the trachea as it weakens muscles..Tendons and ligaments can be affected.

[Dixie'sMom]

Awww... poor Abbie. I hate it when they feel bad and aren't themselves. I hope you can get some answers tomorrow about her throat and hopefully it is nothing serious. I hope she has a better day tomorrow.

You're such a good mom. :)

[judymaggie]

Hi, all! We are back from the vet and, considering the possibilities, I am feeling good. Abbie's pain is coming from her spine, not her throat. The vet did a very thorough examination -- absolutely no discomfort when he pressed all up and down her throat. However, as he worked his way down her spine, she flinched and her back sunk down. She has had issues with the upper part of her spine before but not the current section.

We talked about treatment options, agreeing that it is more than likely that a lowered cortisol level is the reason that the current problems are more evident. The vet suggested: 1) adding a small dose of prednisone to her every other day Lysodren dose; 2) lowering her Lysodren dose; and, 3) trying an NSAID for 5-7 days. I opted for #3. My preference was Deramaxx but he didn't have any so he chose Metacam. Abbie got her first dose at the vet.

She also was showing some allergy symptoms (dripping nose, discharge from eyes). Because Abbie has been on benedryl for a long time, we decided to switch her to generic zyrtec.

I dropped Abbie off at home and went to buy the zyrtec. When I got home, Abbie was much more alert than she has been and even started barking when I told her it was lunchtime (she gets a little piece of bread crust ...). After lunch she went for her first walk in several days. The insert with the Metacam did say that there might be dramatic improvement and I would have to say there was! I am to call the vet next week (or sooner if necessary) to let him know how Abbie is feeling. Hopefully, we are on an up trend!

I also got out the steps that I had used previously with Abbie -- she was great about using them to get in and out of the car. She used them to get up on the bed but only after a great deal of coaxing. Not sure she will use them if I am not with her but every little bit helps.

[molly muffin]

Oh poor baby. When that happened to molly last winter, I had to keep her from running around or jumping for 6 weeks. I too got steps and put them at the window seat, her favorite spot.

Hopefully she'll feel better soon.

Hugs,

[judymaggie]

Hi, all! Abbie continued to feel well yesterday but today was a setback. When she did walk, her head was down and again no vocalizing at all. I gave her some tramadol a couple of hours ago and she is sleeping heavily now. I probably should have given her some earlier but just didn't think of it.

My neighbor came over to look at Abbie's framed portrait (it came out really nice :D) and, when she saw all of Abbie's meds on the counter, she asked how on earth I could keep everything straight! I bet most of us have similar-looking counters. :rolleyes:

[molly muffin]

How is she doing Judy? I'm hoping no more setbacks. :(

[judymaggie]

Sharlene--thanks for checking on Abbie. I gave her tramadol (3 doses of 25 mg.) yesterday and today in addition to the meloxicam. She is feeling much better on the meds (although she snapped at the neighbor's min pin who tried to hump her ...). I left a message for the vet to call but didn't hear back--know he must be swamped after being out a week. I am going to cut back the tramadol to two doses tomorrow and see how she does.

Allergies seem much better on the zyrtec--not nearly as nasally and snoring decreased. We have piles of oak pollen all over--the landscapers come tomorrow which should help (both of us!).

[judymaggie]

Hi, all! Question: any thoughts on having Abbie on a very low dose of prednisone (concurrent with Lysodren dose) to alleviate arthritic pain/inflammation?

Abbie's vet is encouraging me to try a trial of this combination to try and find that balance between controlling the Cushing's symptoms and making her more comfortable. Abbie is still quite stiff in the mornings and gradually is better as the day goes on. Her last dose of meloxicam is tomorrow. The vet and I agreed, for now, to continue her on one dose of tramadol in the mornings. Abbie's Cushing's symptoms are completely controlled at this point (in spite of ACTH numbers to the contrary).

[molly muffin]

I know of a couple dogs who have been on the combinations and I currently know one person who is on this regiment.

It isn't the normal maybe, but it has possibilities. I can find out some further information. I think it is a very low dose of prednisone.

hugs

[molly muffin]

Okay I checked in with Wendy and her Katie is 11lbs on lysodren and gets 1/2 mg of pred. Dr. Peterson told her 1/2 to 1mg. So it is a very small dose, but has worked well for them so far. Katie is 16 years. :)

[judymaggie]

Sharlene--thanks so much for your feedback. Abbie's vet was suggesting 2 mg. so that is consistent with Katie's dose as Abbie weighs 24 lbs. I am assuming that Katie's vet is "the" Dr. Peterson and that is very reassuring.

[molly muffin]

Yes it is The Dr. Peterson. Sounds about right and I don't think it will hurt to try it. We all thought it was wonky at the time but she has done well. He does tend to think outside the box I guess and go with what he thinks is best for the animals. I doubt she is the only one he has done this with.

[judymaggie]

My vet is very much a "quality of life" type of vet so is much like Dr. Peterson in that respect. He and I had so many of those discussions about Maggie as her health deteriorated--I am totally confident that he has Abbie's best interests in mind.

Abbie gets Lysodren every other day. Do you happen to know (or could ask Wendy) if Katie gets the pred every day or just on the days she gets Lysodren?

[Harley PoMMom]

To me it just seems counterintuitive to give a cushdog prednisone. Maybe letting her cortisol run a bit higher would be enough, because mainly that is somewhat the same as giving pred? :confused: Some members do use adequan for arthritis, and I've read where fish oil can help too.

[judymaggie]

Lori--my reaction was the same as yours. That's why I didn't agree to the pred at this point. I was surprised that Dr. Peterson has used this approach for Wendy's Katie and that has caused me to give it more weight. One of my concerns about the pred is that, on the rare occasions when Abbie had to have some, she had an exaggerated reaction to it with regard to thirst and urinating. Now that her Cushing's symptoms are controlled, I would hate to go backwards. From noon on Abbie is alert and active -- it is the morning hours when she has a dull affect and has no interest in moving, not even to pee/poop.

I had forgotten about the Adequan. Maggie responded really well to her shots; she only needed three shots and no subsequent booster shots. The vet asked me to call him on Monday and I will mention the Adequan to him. Today was her last dose of meloxicam so she will have five days of once a day tramadol which will be a good trial. I don't have too much confidence that it will help as she has been on it along with the meloxicam and is still having rough mornings.

Because of Abbie's many months of diarrhea/soft stools, I am hesitant to try fish oil. I am almost done with weaning her off of the flagyl and her stools remain normal.

[molly muffin]

Arggh, I thought i had posted but looks like I didn't, Katie gets her pred every day.

Yes, Abbie has a profound reaction to pred, then not sure you want to go this route, but it is an option.

I know Lori and you can bet, we all questioned it, but Katie has done well on it.

I'd try the shots though Judy! Easy enough to see if that will work and won't have to mess with cortisol levels to do it.

[judymaggie]

Hi, folks! Abbie's morning stiffness has not improved and, this morning, her back legs were very close together when she first walked which I didn't like seeing. I called the vet this afternoon to discuss upping her tramadol dose to 50 mg. in the morning and to get his thoughts on the feasibility of adequan shots. I also reiterated that I wasn't comfortable with giving her prednisone -- used the word "counterintuitive" (thanks, Lori!).

"Yes" to both 50 mg and shots! I will give Abbie the 50 mg. every morning (and can give 25 mg. in the evening if she is uncomfortable) and we go in Tuesday for her first shot. The vet wants to do a shot once a week for six weeks. Tuesday is her standing every 5 week appointment for expressing her glands -- she may not tolerate being held for that so it may just be a shot appointment.

[Harley PoMMom]

Keeping fingers and toes crossed that the extra tramadol and adequan shots will help.

Hugs to you both, Lori

[molly muffin]

I think that is an excellent plan Judy.

I don't know that pred would necessarily be the answer for Abbie, but if all else fails, the tramadol and the shots, thats when I would look further.

So, I'm crossing everything here too.

hugs

[judymaggie]

Thanks, ladies! Your support means so much to me. Abbie is going to be 12 soon -- it is hard not to compare her health with Maggie's at this age who started to go downhill at this point. I just want to do what is best for Abbie and keep her feeling good! I have been working with her re using the steps--she's been doing really good with me as her cheerleader! :D

Going to talk with the vet on Tuesday about the shot schedule. Novartis' pamphlet for the Adequan refers to a loading regimen of two shots a week for a maximum of four weeks as the effects of each shot last 72 hours.. Not sure why my vet prefers the one shot a week ( which is how Maggie got them).

[molly muffin]

I'd follow the recommended plan for shots unless your vet has a reason that makes sense. Something he might think related to Abbie specifically.

[judymaggie]

Hi, folks! Abbie had her first Adequan injection today. They are going to be given every five days for a total of eight shots. I also decided I wanted to start acupuncture and asked the vet if he thought I should wait until the shots were completed. He thought it would be a good idea to have them done during the same period. I located a certified acupuncture vet only minutes from my house so will give her a call tomorrow to set up the first appointment. If the acupuncturist needs back x-rays done, my vet will do them and put them on a disc for me to give to her.

Abbie tolerated having her glands expressed but we didn't bother with her nail trimming. Her glands were full so glad we could get that done.

[molly muffin]

So what did the vet have to say about a shot schedule today?

How Abbie doing?

huggers

[molly muffin]

Oh I see that we were typing around the same time. Okay I opened the page, ran to the store, then came back and posted. ROFL!

So how is Abbie doing? Glad she got her first shot and hopefully it'll help her soon. We've had others use acupuncture too that has had good results.

hugs

[Harley PoMMom]

Adding the acupuncture sounds like a really great idea, let us know how it goes.

Hugs, Lori

[judymaggie]

Abbie was exhausted from her trip to the vet--probably more from being upset than anything else. As soon as she realizes that we are going to the vet (the car ride is longer than it takes to get to our walking trail), Abbie starts shaking and panting. She walked into the waiting room with her head down and tail between her legs and looked really pitiful. :( I had to drag her down the hallway to the room ...

Back home she went right to sleep, then woke up for dinner and perked up quite a bit to go for a walk. I'm sure it was much too early for any effects from the injection but it was nice to see her feeling better. Wait until she finds out we have to go back on Saturday ...

[molly muffin]

Poor baby, sorry I had to laugh when I read the "Wait until she finds out we have to go back on Saturday..." sentence.

Molly doesn't thrill to the whole going on a car ride to the vets either, but she doesn't like going anywhere in a vehicle. However, she is quite happy to jump towards the open door and be picked up to go on the seat, strange, but then she doesn't actually want to go anywhere or be there. She's a funny one.

I do hope that this has helped Abbie and who knows, maybe the first shot Has helped her. We'll take it either way, now or later.

[judymaggie]

Hi, folks! Abbie had her first acupuncture treatment yesterday. I was very impressed with the vet who is a Chi certified acupuncturist. She was very gentle with Abbie and did a thorough examination. She gave me so much information that I was on overload! Treatment consisted of about 20 needles, two of which were attached to electrodes. Abbie tolerated the needles except for the one that the vet attempted to insert on the bottom of her right foot. Vet tried to inject an aquapuncture in the right rear leg (which is the most stiff) but Abbie would have none of that. Vet hopes that, as the inflammation and pain decreases, she will be okay with it. We also got "Di Gu Pi" biscuits which are an herbal blend that is supposed to help with arthritis and joint pain. They were very expensive so not sure we will continue with those.

We were there about an hour and a half so we were both tired afterward! Fortunately, the clinic is five minutes from my house so very convenient.

Interestingly, the vet was very curious why Abbie was being treated with Lysodren instead of Vetoryl. I told her that my vet was not familiar with Vetoryl -- she said she no longer prescribes Lysodren. She did seem very knowledgeable about Cushing's.

Abbie gets her third Adequan injection tomorrow. I'm sure Abbie will be thrilled to go. :rolleyes:

[molly muffin]

Hope the acupuncture kicks in soon and helps her.

Wow that was some visit you had. Good that she is knowledgable about cushings too.

Some vets have gone to vetroyl, but not all. Lysodren still works just fine as it always has for cushings and really not all dogs do well on vetroyl, so you need, I think, to have other options.

huggers,

[judymaggie]

Hi, all! A new twist -- Abbie's peeing and drinking have increased. We are not back to pre-Lysodren levels but definitely more than last week. We will have a urinalysis and culture done at her 4/14 semi-annual check-up. If those are clear, I will schedule another ACTH which we had decided would be done only if symptoms reappeared. If her cortisol levels have increased, I really am not sure what I would want to do since her arthritis is already affecting her quality of life. Just trying to do keep things simple which is very hard to do with this disease!

[Harley PoMMom]

Oh crap, is she still peeing/drinking more than usual?

I just read your reply on Freida and Dixie's thread, and I am so glad to read that Abbie is doing so well with her Adequan treatment...YAAA!!

[molly muffin]

yep, we need an Abbie update in her thread. :)

I'm back and will become a nag!!! ROFL

How is the peeing? What schedule of shots have you gotten to now?
How is she tolerating the heat now that it is getting warmer where you are?

:)

hugs,

[judymaggie]

Hi, Lori! Abbie's peeing/ drinking is more than a month ago but definitely not pre-Lysodren levels. It feels like summer here in Florida instead of spring--high temps and humidity so that may be contributing factor.

That said, our two hour (!) vet appointment today included getting urine sample to run urinalysis and culture. If sample is clean, also requested UPC. Half of today's appointment was spent calming Abbie down enough to get valid blood pressure readings. Average reading was 168 which is the same it was six months ago so was pleased with that. Abbie also got her vaccines, heartworm check and fecal check. Add to that a lot of blood drawn for complete panels as well as thyroid tests.

My main concern has been Abbie's dull/listless affect. Of course she didn't display any of that at the vet! She had a good morning before we left so I was kind of expecting that. We scheduled an ACTH for 4/28 (a date we already had set for glands). After we get all of her test results back, we'll try to figure out the reason/s for Abbie's changes in behavior.

Thursday is another acupuncture visit and Friday is the last of the initial series of Adequan shots. Abbie is definitely more comfortable and I encourage others to try these alternative treatments when the lowered cortisol increases arthritic pain.

P.S. Hi, Sharlene! I expect you are trying to get back into pre-wedding routines. We missed you and love your nagging! I think I answered your questions.

[molly muffin]

Why yes you did Judy! Thank you. I think those shots can be great. Not sure if they work for all dogs or not, but definitely is worth a try if you encounter those kind of issues.

hmmm, hopefully the test results all come back okay, but then not sure what would be causing the listlessness sometimes.

[judymaggie]

Hi, folks! Abbie has had a setback in terms of pain level--even had trouble handling the acupuncture needles in her back this afternoon. The acupuncture vet suggested a consult with a chiropractor who works with humans and dogs! She travels throughout the surrounding counties and does treatments at vets' offices or at clients' homes. The acupuncture vet said she has seen good responses from the adjustments. I am willing to try it and a session is not very expensive--she was coming to the vet's office on Monday for another dog so will see Abbie afterwards. Should be very interesting!

I expect that some of the lab results will come in tomorrow. I am really leaning towards thinking that Abbie's listlessness is pain-based. It was cooler/less humid this evening and Abbie readily went for a walk--also might have gotten boost from B12 shot and/or acupuncture helped in spite of discomfort during session.

[molly muffin]

Oh no, poor Abbie. Sorry to hear she is having so much pain.

You might be right, it could be the pain that is causing her listlessness. Does that mean the shots aren't working? :( Hoping that something can be found to help her. Crossing fingers for monday.

hugs

[judymaggie]

Sharlene--since we are doing acupuncture simultaneously with the Adequan shots, it is impossible to tell which is responsible for the days/hours when she is moving more comfortably. Whenever I'm adding new meds, I always go with making just one change at a time. I just thought that the two treatments would increase the chances of making her more comfortable. It was discouraging to see Abbie flinch so hard when the vet tried to insert the needles in her back. I've had acupuncture myself and the needles barely penetrate the skin. I think she just didn't like being touched when she didn't feel good.

[molly muffin]

Maybe it was an off day for her and she didn't feel like being messed with? Just in general if she is having some soreness.

[LtlBtyRam]

Just got through reading your thread. I too am treating my cush pup with acupuncture. Although it does help with her ability to move around we also get needles to support the treatment for the Cushing's. Are you getting these needles as well? I am glad we found her Chinese vet. She practices both western and the Chinese medicine so I am thrilled to have her treating my baby. I will be following Abbie's thread now. I hope your girl is feeling better soon. I also looked through your pic I love the one where she is licking her nose.

Angela & Shasta & Family

[judymaggie]

Angela -- thanks for the compliment on Abbie's pic! The acupunturist is putting in needles for both inflammation and Cushing's related areas (kidneys, liver, etc.). Like your vet, she practices both Western and Eastern medicine and seems quite knowledgeable about Cushing's.

Abbie has been quite perky yesterday and today -- she had both acupuncture and an Adequan shot last week so could be either/both accounting for energy lift. This is the first time in a very long time that I have had seen an increase in energy/interest lasting more than a few hours so will quietly celebrate!

[LtlBtyRam]

I am glad to hear she is having a good day, gotta love those. I will follow your lead and quietly celebrate with you. I don't think I'd still have my girl without the support the acupuncture/herbal supplements give her western treatment.

Angela & Shasta & Family

[judymaggie]

Hi, all! Abbie had her first visit with the chiropractic vet this morning. She very quickly put Abbie at ease which was nice to see -- the treats helped! :D After getting her history from me, she was able to zero in on the specific area on her back that is causing Abbie pain -- every time she pressed it, Abbie let out a loud howl.

The vet first tried a mechanical adjustment; Abbie jumped quite a bit, both from the noise and the pain. Then she did manual adjustments for about 15 minutes. Abbie visibly relaxed as the time went on -- it was great to see. Then she tried the mechanical adjustment again and Abbie didn't mind it at all. She showed me exactly where I could do massage with her at home.

We have a follow-up appointment on 4/30. The vet said she rarely does more than three visits -- either the dog responds positively in that time or the adjustments don't help. I mentioned that Abbie didn't tolerate the last acupuncture treatment very well and that I wasn't going to schedule any more if she had the same reaction on Wednesday. She said that the acupuncture vet would come to that decision as well.

She expected Abbie to rest the remainder of the day and, if the adjustments helped, to see improvement in a day or two. Abbie has been pretty comfortable all day and wanted to go for a short walk this afternoon. Overall, definitely a positive experience!

[Harley PoMMom]

Oh Judy, that is great news to hear that the chiropractic visit went well for Abbie! Hope this trend continues.

Hugs, Lori

[judymaggie]

Thanks for the encouragement, Lori! Abbie actually played with me in the house tonight--a very welcome change! :D

[judymaggie]

Hi, folks! Just got off the phone with my vet -- I will pick up copies of all the labs next week but biggest concern is a startingly high UPC. It was 5.0 (with <1.5 normal). Abbie will be starting on 5 mg. of enalapril with a recheck of both blood pressure and UPC in 3-4 weeks. My vet did consult with an IMS with regard to treatment.

A HUGE thank you to those folks here who have discussed the need for UPC testing, especially Sharlene! Were it not for these discussions, I never would have known to ask my vet to include this testing with the other tests that were run last week.

Question -- Abbie's last ultrasound was in October 2014. At that time "age-related changes to kidneys" were the only notation about them. Our plan was to repeat the ultrasound this coming October. What are your thoughts about an earlier ultrasound in light of the recent findings? Would it offer any useful information in terms of treatment?

[molly muffin]

I don't think that there is going to be much show up different on the ultrasound. Often it seems that what you see if the protein loss is the "age - related changes to kidneys" as already noted. It is what we have seen on our ultrasound too. You might want to think about having it this summer though as an option.

I wonder how many dogs actually have protein loss via kidneys as a result of age and not necessarily a result of cortisol or if they are a combined risk. Is her BP good now? Mollys is somewhat controlled with the amoldipine (BP med)
I am fighting a battle to get her UPC down below 2.1 or 2.7 where it seems to want to ride at.

You'll need to keep an eye on the protein and phosphorus amount in her food. Going low, while keeping a moderate fat content and not a high fat content, hello risk of pancreatis, is a tough one I've found.

I'm so sorry that this has shown up in Abbie too. Dang these things are hard to juggle all together. How is her cortisol doing?

Is she still feeling chipper today?

hugs

[judymaggie]

Hi, Sharlene! Yes, like many of us here, I do feel like I am juggling lots of issues. Abbie's blood pressure when tested last week was 168 (average of five readings). From what I have read, this is considered hypertensive. This is a bit higher than readings done in October. Abbie is scheduled for an ACTH next Tuesday.

Abbie is now eating Purina Prescription DCO (diabetes/colitis) dry food mixed with Royal Canin gastrointestinal low fat canned food. This combination seems to provide the right amount of fiber needed to control Abbie's chronic diarrhea. The Purina has 21% protein and 10% fat.

Abbie actually left the driveway this morning to walk to the corner -- something she hasn't done in the morning for a very long time. She has been just going out to pee and sitting in the driveway checking out the neighborhood activities. She is not quite as chipper as yesterday but still better than she has been. I massaged her back this morning which she tolerated -- I even got a snuggle!

[Harley PoMMom]

168 is a bit high but sometimes dogs get that "white coat syndrome" and it can make their BP a bit on the high side, was she nervous at the vets when they were taking her BP? And if her BP is running a high the enalapril may bring it down.

The one thing with those UPC tests, they can be falsely elevated due to any kind of infection, bladder stones, IBD...What I have read is that if 3 samples taken at different times are high that intervention needs to be started, was this Abbie's first PC test?

So glad to hear that Abbie is feeling better!!!!!

[judymaggie]

Hi, Lori! I think the BP average was pretty accurate. They do the pressure readings in a darkened room -- she was there with her favorite tech and they took about an hour to do five readings.

This was her first UPC -- there were no signs of infection in any of her other labs. Because it was so high, the IMS and my vet wanted to get her started on enalapril now. Hopefully, the next one done in 3-4 weeks will be lower.

Abbie went on her "regular" long walk after dinner! :D

[LtlBtyRam]

So glad to hear she is doing well.

[molly muffin]

Yay for long walks Abbie. How is she today?

[judymaggie]

Hi, Sharlene! She was having a good day until we went for acupuncture. I almost cancelled but decided to go since it was scheduled already. Abbie was extremely resistant to having any needles inserted and howled before the vet even touched her! The acupuncture vet agreed that we needed to end our sessions. She was very pleased that the visit with the chiropractor went so well. I was concerned that the visit would set Abbie back but, after taking a long nap, she was back to feeling good and went for a good walk a short while ago. :D

[LtlBtyRam]

I'm glad Abbie is doing well. Did the acupuncturist have her on any herbal supplements (I don't remember and am being lazy not wanting to go back through your thread ;)) If so are you going to keep her on them or just go with what you are now doing?

I don't think Shasta would do well with a Chiropractor, but then again we have never tried. I hope she continues doing well.

Angela

[judymaggie]

Hi, Angela! The only supplements I got from the acupuncture vet were herbal treats (can't remember the name) but, every time I gave them to Abbie, her soft stools returned so I had already stopped them.

I think Abbie might have been expecting to see the chiropractor today--she was amazingly calm in the waiting room. Then she had such a negative reaction to the needles. I wasn't sure what Abbie's reaction would be to the chiropractic treatment but it was certainly worth trying it. Does Shasta like massage? I've been using massage with Abbie for a long time (nothing formal although I have read the t-touch book) and she loves it.

[LtlBtyRam]

I don't think she'd like massage either. She is quite the personality. We call her a cat dog in our house. Even though she is a toy breed Pom she just doesn't act like what you think she would. She never has been a cuddler or one for a lot of petting. When she wants attention she will let you know then let you know she is done. When she was younger and before her first seizure (these are not common) I think she would have preferred a dog house and lived outside. She is just extremely independent, aloof, and haughty. I am surprised she tolerates the needles, but once they are in she doesn't mind them at all. Most of the time she doesn't really mind them going in either, but sometimes there are some she balks at. Especially the ones in her paws and legs. The supplements she is on just make such a big difference on her ability to get around and help keep her stable.

I'm happy you found a treatment Abbie has taken to.

[judymaggie]

Hi, all! I spoke with Abbie's vet this afternoon to discuss the results of her ACTH run on Tuesday. Her numbers are:

Pre: 2.1
Post: 13.0

(compared to 2/25/15 results of pre of 5.7 and post of 13.7).

In light of Abbie's back issues, we have decided to keep her Lysodren dosing unchanged. She is drinking more water (although not as much as pre-Lysodren days) -- this may be due to kidney issues.

I got copies of her 4/15/15 lab results. Here are current abnormal levels (prior results are from 10/14/14):

ALK 386 (range 5-131)(220, same range)
Potassium 5.7 (range 3.6-55)(within range previously)
Cholesterol 654 (range 92-324)(661, same range)
Triglycerides 505 (range, 29-291)(471, same range)
Protein/urine 3+ (2+ previously)

and, as reported previously, UPC of 5.0 (range <=0.5).

We have scheduled a follow-up UPC for 5/21/15. The vet confirmed that the reason treatment with enalapril was started immediately (rather than waiting until after three consecutive high UPCs) was that the current result was so high. He is not concerned with present potassium level but we will repeat a renal panel in a couple of months.

Abbie had another chiropractic treatment yesterday -- she still had pain in several areas along her spine so I have scheduled another appointment for next week. She has been a bundle of energy today!

P.S. Abbie is going to be 12 in a few days -- almost time to change the heading!

[molly muffin]

Almost 12! Good girl Abbie. :)

I probably wouldn't change anything either with the lysodren considering her pain and back and leg issues. However, having said that, I know one of the reasons they want to get molly's cortisol down to a lower range is hoping it will help with the kidney issues. So, you will want to see how that is working on her protein loss and hopefully that will come down significantly too.

Crossing fingers!!

Hope Abbie is feeling good for her birthday.

[judymaggie]

Hi, Sharlene! As I mentioned, Abbie's water intake has increased significantly -- am now beginning to think it is nearing pre-Lysodren levels. I am going to start measuring again tomorrow. For the first time in months, Abbie woke me up during the night (1:20 a.m.!) to go out to pee. I had been taking her out at 10:30 p.m. to avoid the middle of the night pees but was able to stop that. If she wakes me up again tonight, I will go back to that routine. Because of the kidney issues, the increased drinking worries me even more than before.

She is also increasingly obsessed with eating worms -- this had diminished also. Maybe I just got used to her ignoring them when she was feeling so lousy. Her stools have been soft (and sometimes "pudding poop") the last several days -- am thinking this is related to increased worm intake!

Maybe we do need to increase the Lysodren ... so hard to decide what to do!

[molly muffin]

Maybe tweak the maintenance dose a bit and see if that will help.

I know that I'm seeing molly, not waking me up so much as when she wakes up, she has to go out right then and it feels like she is crossing her legs till she can get out. I am not seeing any increase in water consumption, and that to me is worrying as with the kidney issues and the cortisol they need more water, since they pee more, so we're just the opposite, worrying about dehydration.

It is a continuous balancing act trying to address the issues they have and get them all in acceptable levels without messing up another one. Cortisols, BP, Kidneys, pain

Some days it is exhausting, and harder than others.

[judymaggie]

Today is my girl, Abbie's, 12th birthday and the celebration of her adoption!! I love you very much, pretty girl! :D

[Squirt's Mom]

happy 12th birthday, abbie!

[Harley PoMMom]

Happy 12th Birthday, sweet Abbie!!!

I took the liberty and updated her Thread title to reflect her true age, hope that was ok.

[molly muffin]

Happy birthday Abbie!!!!!

[judymaggie]

Thanks, ladies! We had a nice, quiet day. Since I can't really do treats, I did the next best thing--a good massage and extra hugs!

[labblab]

Happy Belated Birthday wishes coming from me, too!! :) :) :)

And I personally think a birthday massage is even better than treats! ;) :D

Good job, Mom, and best wishes, Abbie Girl!
Marianne

[molly muffin]

That sounds like a perfect day Judy. I'm putting I an order for a birthday massage too. Lol.

[judymaggie]

Hi, all! The vet and I spoke for a while this evening. Due to Abbie's continued increased drinking/peeing as well as the increased worm obsession (really the only marker for an increase in hunger) and continued high ACTH post number, we have decided to tweak her Lysodren dose by adding another 125 mg. One week she will get 500 mg. with the next week at 625. As has been her pattern, Abbie starts maintenance doing well but then slides back. If her symptoms abate, we will do another ACTH a month after improvements.

I do have a question about what would be considered a controlled drinking level. Would the amount be the same even after treatment has started? I have been going by what Dr. Feldman references in his loading protocol, i.e., below 60 mg/kl/day of water, which for Abbie would be 22 oz./day. My vet says less than 26 oz.-- not sure how he figures that amount.

Abbie has started to demonstrate a couple of concerning neurological symptoms---her right back foot occasionally knuckles under and twice I have seen her back legs cross over each other. The crossing happened this morning when we were leaving the chiropractor. The vet manually crossed her legs and Abbie was slow in straightening them, indicating slowed reflexes. The acupuncturist had previously noted that her pulses are not as strong in the right leg. I mentioned all this to the vet tonight--we agreed that I needed to keep a close eye on these things with a neurology consult a possibility.

[Harley PoMMom]

Generally, a dog normally drinks at least one ounce of water for each pound of body weight per day. I did a quick scan of your thread and found that Abbie weighs around 25 lbs, right? With 25 lbs that would mean that Abbie's water consumption would be approx. 25 ounces.

Hope the Lysodren tweaking does the trick, and so sorry to hear of dear Abbie's recent issue with her legs :(

Hugs, Lori

[labblab]

Gosh, Judy, I'm sure sorry to hear about these new issues in addition to the rebounding Cushing's symptoms. I know we've talked about this in the past, but remind me again as to why your vet does not wish to consider a switch to trilostane. Has your vet actually had bad experiences with it, or is it instead that she just has not had occasion to prescribe it? You've been playing around with the Lysodren for such a long time now, and it just does not seem as though Abbie is responding to it appropriately. It's paradoxical, because I am going to recommend the reverse to another member whose dog doesn't seem to be easily regulated on trilostane. But it does seem to be the case that different dogs do better or worse on different medications. And gosh, for as long as you have been trying to tweak Abbie, maybe it would be worth all that's involved in trying a switch.

I'm also so sorry about this new problem with her legs. Maybe you might want to hold up on further chiropractic appointments for a while, though, until you can see what develops with the leg crossing. Especially since the crossing started right after this last adjustment, I might wonder whether the treatment actually aggravated something. I know that even in the best of circumstances, sometimes physical therapy of any kind can have unintended or unexpected consequences. I have a friend who is rehabbing from knee replacement, and she is having to alter her therapy regimen because what she had been doing which was supposed to be good apparently now has caused tendonitis for her.

I'm so sorry Abbie has shifted from enjoying her birthday celebration to having these problems. But darn it, we are all gonna focus our energy on her healing!

Marianne

[judymaggie]

Lori -- thanks for input re water consumption. Abbie now weighs 24 lbs. so my vet agrees with you (he had figured her consumption based on 25 lbs.).

Marianne -- my vet has "0" experience with Vetoryl/trilostane. When I have mentioned it in the past, he has shied away from the discussion. If this current increase does not reduce symptoms/lower her numbers, I will broach the subject again and provide him with some articles to read. I am more than willing to work with him -- this would give him an option if he has another patient who isn't well controlled with Lysodren. In light of the high UPC, I think it is more important than ever that we get good cortisol control -- maybe not down to ideal levels because of inflammatory disc issues but lower than it is now.

Good point about holding off on the chiropractic treatment -- it was the second time I had seen the leg crossing but could definitely have been triggered by manipulation. Next appointment is on 6/1 -- I can easily cancel so will see how the next few weeks go.

Thankfully, Abbie is still her cheery self!

[molly muffin]

Hopefully the next few weeks go really well and Abbie continues to be her normal happy little self.

Just like with people, sometimes when they do the alignments, things can get tweaked, so have to be super careful with that if she shows signs of the back leg problems after appointments.

[judymaggie]

Hi, all! I wanted to update Abbie's various issues. She had a repeat UPC last week and, unfortunately, the last level of 5.0 barely moved after a month on once daily enalapril -- just down to 4.7. The vet and I spoke tonight and we are going to try three weeks on twice daily dosing. The UPC will be repeated after that period along with a blood pressure check and renal panel.

Since we added one more dose of Lysodren (now gets one week with 500 mg. followed by one week with 625 mg.), Abbie is doing well with regard to energy level, including consistently wanting to go on walks (even in the terribly hot and humid Florida weather) and she actually has been playful in the house a few times. Her water intake has dropped down to 17-18 oz. a day (from 22-23) with fewer times out to pee in between walks. I think her belly looks much smaller and she has maintained her weight at 24 lbs. Next ACTH is scheduled for 6/9.

Abbie has no pain in her back -- I still try to encourage her to use the steps in the bedroom but sometimes she just leaps right over them! We had another chiropractic visit scheduled for next week but I canceled it -- always know that I can take Abbie to see her if anything flares up.

Now if we could just get that darn proteinuria under control ...

[molly muffin]

Molly gets twice a day dosing for her kidneys and it has helped. She take 7.5mg morning and evening of benazepril. It is an equal dosage as using enalapril.

Glad she is feeling pretty good. Sometimes they just think they can fly over those steps. :)

[judymaggie]

Hi, all! Abbie is continuing to confound me and her vet ... very disappointing ACTH results from 6/9:

Pre 5.4 (up from 2.1 on 4/29)
Post 15.6!!! (up from 13.0 on 4/29)

She continues to have all symptoms under control so results were unexpected.

Because of the increasing cortisol levels and the proteinuria which is not under control yet, we have decided to make the switch to Vetoryl. Some of you may recall that Abbie's vet is the one who was adamant about not wanting to try Vetoryl. He made the switch with the dog of a friend of mine and wasn't following any standard protocols. The dog has been very sick ... Abbie will be the third dog he is going to treat with Vetoryl. I couldn't say anything to him about his treatment of my friend's dog but, now that Abbie will be directly impacted, you can bet that we will be following protocols. I have read all the abstracts as well as the Dechra documents but I still have some questions for all of you Vetoryl experts.

The first sticking point was that my vet did not believe that a wash-out period is necessary. I told him that I definitely wanted a wash-out and he said that it was possible Abbie's symptoms would return. From my reading, this is exactly what you want to see during the wash-out period. The other thing you want to see is a ACTH post of 9.1 or higher. Since Abbie's is already higher than that, the only issue is symptoms. Question: once symptoms return, is it necessary to wait the full 30 days in light of her already high cortisol level?

Second area is dose. My vet wants Abbie to start on 30 mg. a day. Abbie weighs 24.4 lbs. so it is my thinking that 25 mg. would be a better starting dose. Problem is that the Vetoryl only comes in 10 or 30 mg. doses. I do believe that I want to start with name brand to ensure quality. Question: do you think it would be better to start with two 10 mg., i.e., 20 mg., a day rather than start with the higher 30 mg. dose?

One of the papers I read is that dogs switching from Lysodren may be more sensitive to Vetoryl. Abbie is on Enalapril for proteinuria. (She has another UPC and blood pressure curve on 6/16 along with a renal panel.) I have read that both Enalapril and Vetoryl can lower aldosterone so am thinking that may be another reason to go with the lower 20 mg. a day.

Question: what dictates having the first ACTH at 10 days versus waiting until 14th day?

Question: should a full chemistry panel be run with the first ACTH?

My vet said that, if Abbie's cortisol levels are still high with the first ACTH, then her dose would be raised to 30 mg. twice a day ... I think I gasped but didn't say anything. I know that we would wait a full month on the initial dose (assuming no negative effects) and then do another ACTH and, even if high at that point, definitely not double the dose. I really wonder who is providing him with guidance.

Questions: I know this is anticipatory but, if Abbie's numbers are still high after a month on the 20 mg. a day (assuming we go with that as the starting point), what kind of increments are used for increases? Since the next Vetoryl dose is 30 mg., is a 10 mg. increase too much?

Curious if you think it would be a good idea to e-mail Dr. Peterson or Dr. Bruyette with questions.

Sorry for the length but was up at 5:00 this morning with thoughts running through my head ... just needed to get them out!

[labblab]

Gosh, Judy, I'm so sorry about these disappointing results. I'm also sorry to hear that your vet seems to be so poorly informed (or resistant?) when it comes to recommended trilostane treatment protocol. That is really puzzling to me, especially if he's had a bad experience with other patients. Dechra's technical staff is willing and anxious to talk to vets about specific patient issues. Given the complexity of Abbie's situation, I absolutely think that is the best place to start -- for you and your vet to talk to Dechra. You may want to place the first call, so as to give them a preview of the situation from your perspective as the owner. It may be a bit frustrating for you, because any direct recommendations they will pobably want to defer to a conversation with your vet. But at least you can get a file started on Abbie, and have a point of contact. With that in mind, let's turn to your questions.

Question: once symptoms return, is it necessary to wait the full 30 days in light of her already high cortisol level?

Absolutely this needs to be discussed with Dechra. Their own literature contains the warning about the lingering physiological effects of Lysodren. So I would want their feedback about Abbie's specific situation.

Question: do you think it would be better to start with two 10 mg., i.e., 20 mg., a day rather than start with the higher 30 mg. dose?

This is just my personal opinion, but I agree with your thinking -- given both the Lysodren and Enalapril, I would want to start lower rather than higher. Plus, just from a practical standpoint, you can always combine or subtract 10 mg. capsules easily. With 30 mg. capsules, they are useless to you if you start with them but need to decrease Abbie's dose. I would start lower and work up.

Question: what dictates having the first ACTH at 10 days versus waiting until 14th day?

Nothing in particular that I am aware of. Probably scheduling convenience as much as anything else.

Question: should a full chemistry panel be run with the first ACTH?

I think a lot of vets may fudge on that, but given the Enalapril and possible combined effects on aldosterone, I think I would want to make sure the sodium and potassium levels are balanced even at the first check. But you could try to opt for the cheapest, most stream-lined chem panel that contains those values.

Questions: I know this is anticipatory but, if Abbie's numbers are still high after a month on the 20 mg. a day (assuming we go with that as the starting point), what kind of increments are used for increases? Since the next Vetoryl dose is 30 mg., is a 10 mg. increase too much?

I think the size of the increase will all depend on the actual test results and symptom profile. Just no way to judge that yet.

If you want more feedback in addition to Dechra, you can indeed email Dr. Bruyette directly. He has told us he is fine with having our members write to him with questions. I don't know that Dr. Peterson will respond to personal emails; I believe posting questions to his internet blog is his preferred mode of communication.

Marianne

[judymaggie]

Marianne -- thanks so much for making your way through my long post and providing your always valuable input. I will contact Dechra on Monday. I will be at the vet's Tuesday for Abbie's next round of tests so am hoping to get a few minutes of his time then to touch on a couple of areas and see if he is willing to talk with Dechra staff. I printed out some of the Dechra documents as well as Dr. Bruyette's DVM360 interview and the vetsonline notice.

I checked around for prices and California Pet Pharmacy was considerably less expensive than anywhere else (10 mg. were $41.95 for 30). Vet has had no problem calling in prescriptions to Target and Sam's so, once a firm decision about dose is made, I am hoping he will not have an issue with contacting the California pharmacy.