Reese has cushings, again, at 12 1/2

[reesehascushings?]

Hi, my name is Randy and we are from NY. We have an amazing female, 12 1/2 year old yorkie, who is the love of our lives. In February of 2012 we went through an entire battery of tests because I had noticed that Reese was losing her hair, mainly on her back. It was quite minamal but being the neurotic I am and obviously wanting the best for reese I immediately took her to my vet. They did several tests, blood, tyhroid panel and didn't really see anything remarkable. We took her to florida to visit my mom and I continued to notice that she had a balding appearance so we went to another vet, who was highly recommended. He did various tests, the creatin/cortisol ratio urine test, a low dose dex test etc and they all came back with inconclusive results... they just werent' sure if she definitely had it or not. After many visits to my new and old vet, and many conversations with the University of Tenn when she had an ACTH done she was deemed to have atypical cushings. An xray of her stomach area was also done but didn't show evidence of anything. I was then told to start treating her with melatonin, 3mg twice daily. Her hair almost immediately started to grow back. That was really the only sign of cushings she had. She was basically born with a ravinous appetite..she basically will eat anything as long as it isnt styrofome and she always had a pot belly, buddah belly we named it, from the time she was nine weeks old and home with us. She never urinated frequently and never really drank a lot. She was always a couch potatoe and much preferred to go on shopping trips and be picked up than running and playing in a yard. We always thought that was Princess Reese's personality. She never climbed more than two steps and we had to force her to walk for more than two minutes on her leash... she much prefers a walk in a stroller. For 12 1/2 years she has lived very contently, more as a human baby than as a dog.

Fast forward to almost three years later this february, I again start seeing hair loss on her back and neck. I brought her back to my vet, who was not the same vet as either from three years ago. In fact my current vet never was convinced that Reese positively had cushings. When I brought her in the vet definitely saw a large amount of hair loss and I had also noticed that she was urinating and drinking much more than she always had been. She also has a new habit of "mixing" her water bowl as she drinks. We have yet to figure out what this is. She mixes the bowl and splashes all the water and then continues to drink at least three to four times per drink. She also has a lot of new growths, small wart like growths in various colors and forms but my vet seemed to think these are normal warts, growths which can be removied as I have in the past (about four in various places) but wouldn't guarantee that they wouldn't come back.She now has about eight in different places. She is due for a dental, which I fear and always have feared due to the anestesia part of it as well as she now has a bump under the skin on the bridge of her nose. I cannot even remember when I first noticed it but I believe it has been there for several months to a year. When I asked my vet about it, she was pretty unsure as to what it is, other than being a very hard and solid bump which she would xray, after we decide what to do with all her other issues.. .HELP!!!

At this point, Reeses hair is definitely very thin but other than that her urine frequency is about 6 times daily, not too much more than it had been her entire life. She gets up at 8 am makes a flood, a week or two ago she would eat and drink and then urinate again, although that hasn't happened continuously. If we are home she will go every 2 hours and then when she goes to sleep which is usually about 8 she will wait until 730 am in the morning without asking to go. Occassionally the past week she has asked to come out of her bed at 11 to urinate and drink and then go back to sleep until 730 or 8 am without a problem. She is always very laid back so I cant really tell if her activity level has gotten worse or if I am getting more paranoid. I keep thinking she looks very sad and even asked the vet if she is in any pain. She doesn't cry or limp but she seems to be a little slower than she has been.

Reese also had a lot of hip and knee issues but never had surgery and always seemed to be perfectly happy due to her "desired activity level".

Sorry for all of the details but there is now so much.. so why am I now totally confused and fearful. First of all the thought of going down this testing road, again, and putting her through all of those tests totally unnerves me and I will also admit, why must we go through a new thyroid panel, ultrasound, low dex test, acth, etc etc. It is more than obivous through her blood results that we gave her last week, that she has cushings. May I ask why I cant just start her off on the recommended dose of one of the meds and see how she does. I will also add that I put her back on HMR lingnans that U tenn had recommended if the melatonin back in 2012 didn't work as well as my former vet. I just do not understand why when she clearly is showing more evidence of having cushings why I need to have her go through all of the tests to prove that she has it. I understand in regulating some of the drugs I will have to start with a loading dose and then monitor through acth tests, but does she really need to have thyroid, ultrasound, low dex, possible hormone panels, creatin ration tests etc etc? I will list her blood and urine results and would greatly appreciate any advice all can give me on this matter.

We again adore our reese and treat her as if she is one of our human daughters but just cannot see putting her through all of those tests again, and very honestly spending the thousands of dollars it cost us in 2012 to basically do what was the normal protocal and what worked for almost three years. Of course I want to do what is best for her but honestly believe that since we already went through this it is pretty clear that the disease has unfortunately progressed. with all of her other issues I would like to eliminate all of the unnecessary tests and try to treat her symptoms while monitoring her carefully.. please let me know what all of you think, who have far more experience than we do. Thank you.

Blood work performed on 12/13/2014

I will only list the numbers that were off.. every other number if not mentioned was within normal range.

ALT (SGOT) high 130 12-118

ALK Phosphatase 1592 5-131 How crazy is that???

GGTP 14 1-12

Urea Nitrogen 36 6-31

BUN/Creatinine Ratio 72 4-27

Potassium 5.9 3.6-5.5

Cholesterol 426 92-324

Triglycerides 853 29-291 alarmingly high but is this an
indication of a bad diet vs
cushings or a combination of
both?

Platelet count 594 170-400

T4 0.6 0.8-3.5

Protein 3+ high but negative

All else was either within the normal range or urine which was clear and all negative for all else.

Does the T4 reading mean that she might have a separate problem with the thyroid or is this indicative of cushings?

Please do not misunderstand me, if tests need to be done to properly diagnose and then treat, that is fine but just to do tests to get the "different pieces of the puzzel" which can be established in separate tests of one or two, why not go forward on those?

Please do let me know what you would recommend for us and once again I appreciate all of the help.

I would like to bring up one issue that will hopefully help you understand our questioning of doctors rush to test/do surgery.. when Reese was about seven months old we noticed that she squealed when we were picking her up. Being a new mom to a puppy I ran to our vet and before we knew it she had a diagnosis of Legg Perthes, which is a congenital defect of the hips, common in yorkies. I was told to go to a specialist and have a battery of tests performed.. xrays etc. After tons of tests and recommendation through the specialist (who is with a highly regarded speciltists office) they wanted to perform double hip surgery on the spot. I panicked and ran out of there with a three page estimate in hand. We had the xrays sent to a friend who had his own vet practice whereby he examined her and said he didn't think she had legg perthes. He then forwarded all of her paper work and tests to a friend at Cornell who got back to him with an inconclusive result, doubting she had legg perthes and told us to leave her alone until gd forbid she became lame... 12 years later and she never went lame!

About two years ago she tore her acl.. to what degree we don't know... xrays were done and once again surgery was recommened. I was nervous about her age etc and putting her through that as well as the recuperation and started doing a lot of research. I found an article that said if we reduced her activity and monitored her completely for 12 weeks, she could heal just as well, if not better than having surgery. I was fortunate enough to be at home and was able to watch over her endlessly. Every day she strengthened her leg and went back to normal. In fact I took a video of her walking (surprise surprise, for reese with or without a torn acl) on her leash which even my vet was surprised over. Unfortunately a year later she fell up a step in my home and tore the other back leg.. with time and patience we all once again nursed her back without having surgery. My point is as fast as I want to see results and take care of my baby, I do not want to put her through unnecessary surgeries and procedures which could end up doing more harm. I felt with my heart of hearts that putting her through acl surgery would be way too much for her and we would have the same monitoring and recouperation period after surgery, as we would without it.

AGain, I apologize for my long winded and poorly written post (novella) but would very much appreciate hearing from as many people as possible. Thank you all again and I am very glad that I have found this site and will be staying up quite late reading all of the wonderful information available to us, here.

[reesehascushings?]

I realize how long my post is and how no one will have the time or desire to read through such a ridicuously long post but if anyone can go through my nonsense and make some sense out of her numbers and what to do next I would be extremely grateful. Thank you.

[Dixie'sMom]

Hey Randy and welcome to you and Reese! I'm glad you found us. Reese sounds like such a precious baby and I'm so sorry she is having problems. It's obvious you love her very much and have taken excellent care of her. Unfortunately, I am fairly new to having a Cushpup myself so I can't advise you. Others with more expertise will be along soon to share their thoughts. I will say that if Reese has transitioned from Atypical Cushings to a full blown Cushings, more testing will be in order. It also appears that her thyroid may need to be explored further as well. Endocrine disorders are very tricky and with treatment, you are seeking a perfect balance to achieve optimal control. That often requires time, and unfortunately, money. You are doing a great job so far by seeking help. The experts will be along shortly and will help guide you thru the medical maze that is Cushings. Hang in there Mom!

Oh, and no worries. We don't mind novellas. :)

[Harley PoMMom]

Hi Randy!

Welcome to you and Reese! Gosh I am sorry that Reese is having some issues, and hopefully, once we all put our heads together we will be able to figure out what's going with your sweet girl.

Thank you so much for your informative post, we love, love details, we're able to provide better feedback when more information is given so you did an excellent job. ;) Although we will probably be asking more questions :eek::)

Cushing's is a low graded disease and moves at a snail's pace which enables a pet parent to get a confirmed diagnosis of Cushing's for their furbaby. Since Cushing's shares many symptoms with other illnesses, it is often misdiagnosed. The tests for Cushing's are not 100% accurate at diagnosing it so that is why multiple tests are done to validate a diagnosis of Cushing's. Also, if a dog has any illness this could cause its system to produce extra amounts of cortisol.

The two drugs generally prescribed for Cushing's are Lysodren/Mitotane and Trilostane/Vetoryl. These are very strong medications and should not be given unless a diagnosis of Cushing's is confirmed.

Although Reese's abnormal blood-work is commonly seen in dogs with Cushing's she really doesn't display the common clinical symptoms of Cushing's. Dog's with Cushing's usually drink bucket and buckets of water, urinate rivers, and have an ravenous appetite. Does her skin look thin? Does she seek out cool places to lay versus warm?

I was wondering if you could post the results from her UTK adrenal panel for us? Also, are you just now introducing the HMR lignans? And is Reese getting the melatonin, and if so, is her dose of 3mg of melatonin once or twice a day?

Regarding her hair loss have allergies or mites been ruled out as a culprit?

Please know we will help in any way we can so do not hesitate to ask all the questions you want. ;)

Hugs, Lori

[molly muffin]

Hello and welcome to the forum. I just had a chance to quickly look through your post. A couple of the things that pop out is test results that need to be looked into further like the liver ggt and alt. Trig needs to come down do lower fat diet. Don't like the protein in urine. Is her urine dilute? Has she been checked for a uti? Aldo how about a UPC? Urine test to check urine protein ratio.
I'd do these first before Cushing's as you don't want false positives due to something else going on.

Welcome again. We completely understand that Reese is an important member of your family just like any other. We all pretty much are the same. :)

[reesehascushings?]

Hi again and thank you for responding. After typing away for ten minutes I clicked on the wrong key and my entire post vanished. I think I need to type my responses in email first and then transfer them.. ugh!!

Reese was never even clearly diagnosed with atypical cushings after all of the tests she went through back in february of 2012.

She was given MELATONIN TWICE DAILY AT 3 MG EACH. Amazingly and I mean amazingly her hair started filling in almost immediately. New soft blackish hair (her original color, she is now more grey) started to come in and filled out completely. I had tried giving her lignans HMR with that a little while after but my first vet told me to stop them to see if the melatonin continued to work on its own and it really did.

Reese always had a huge appetite from day one at nine and 1/2 weeks old She would literally eat 100 pounds of food in one sitting and die over food, if we let her. She will eat anything but dust, dirt and poop. She always had a pot belly for whatever reason and looked and acted like she was born with cushings with those three symptoms, pot belly, ravinous appetite, thin coat (not balding or losing) some panting. Obviously they didn't think she was born with it.

Reese had been on many different diets but for the past three years she is on prescription Royal canine select protein PR, rabbit based food. She was given this because she went through a long stage where she constantly licked her paws at night and we thought she was allergy prone. She had been on raw diets, gd knows how many other diets and weight loss prescription food too since she can be anywhere from 8 to over 12 pounds. She is now at 10 pounds and she could lose a bit more. She just LOVES her food. We do not give her many snacks other than her kibble but I will admit to adding some no salt turkey to her food and we added soft wet food of her kind to her food for pills. I do on occasion give her cheese, I know probably terrible especially now, with her pills or just as an extra bonus in her food. I will also give her some chicken and rice when her stomach hurts but thankfully she really doesnt have stomach issues. I shouldnt put the whammy on it.

She has NEVER been active and I mean never. She never loved playing with toys, running, going on walks, playing with other dogs etc. I guess it is a combination of us overly spoiling her and she thinking she is a person. She adores children and loves to play with them and adores all people and will constantly lick them. For years we have suspected she is NOT so loving, especiallly to strangers, but is dying to steal the crumbs off of them.

She is now urinating about two to three hours from 8 till about 6 and then will wake us up at about 10 or 11 PM to take her in for water and to urinate. In the past she would go to bed at 7 or 8 (yes we go to sleep pretty early due to my husbands work schedule) and not get up until 7 or 8 to eat or urinate. She is drinking far more than she ever did and has a new habit of kicking out tons of the water inbetween of gulping it down. WE have no idea why she is doing this. Literally will take her front paw and stir the bowl and kick it out of the bowl then go back to drinking and do it about three or four times while drinking. Any ideas of what this is? I used to think she was doing this to find food, but I doubt that is it.

She barely pants but when nervous she will. So my question is WHY should we put her through all of these tests, thyroid panel, ultrasound, low dex, acth when she is not in any pain that we can tell, isn't driving me crazy with accidents on the floor, if the drugs will only treat the symptoms? Yes, her baldness on her back and neck is very upsetting but do you treat a dog with chemo for hair loss?

I do want to do all I can for her but please understand my family and I are just coming off my mothers passing. We were extremely close and she developed MDS a blood cancer that was incurable. The chemo given to her was to try to keep the cancer from moving faster therefore reducing her blood levels to dangerous levels. Well it worked for a month or two with little discomfort to my mom but then BAM...the chemo started sending her blood levels way down south, she needed endless transfusions of all types and went to the hospital in patient and out endlessly. My mom survived 11 months from diagnosis and she spent ( or her health insurance spent) thousands and thousands of dollars and for what???? Believe me I would have paid anything to keep my mom alive the way she was prior to being diagnosed, and we did, but for what? We watched my gorgeous and amazing mom deteriorate and go through hundreds of tests and meds and lose over 40 pounds if not more, for what?

Now I will stop with my personal story but I want the truth. We know that cushings cannot be cured, so what are we doing if a baby like mine, right now is not in discomfort, I do not mind bringing her in and out of my room or any room to urinate more often and to get water, her hair loss is so upsetting but it is cosmetic and maybe I will begin to get more clothes for her.. what will this disease do to reese?
Will we lose her if we do not give her chemo, faster? Will her organs deteriorate faster without the drugs than with them? Please help me to understand this crazy disease better.

Could she have a thyroid problem vs cushings? Could she have liver cancer and will an ultrasound show that vs cushings? I have a call into my vet for tomorrow because I need to know these things.

I will be honest, I do not wish to put reese, through unnecessary tests, nor put mysellf through them if not warranted. I also will admit that with three adult daughters and a huge mortgage I am not in the position to do ten more tests and then start treatment on my reese who is 12 1/2 if she has months to live?

I am sorry if I sound harsh and that we don't love reese but I can assure you reese has been the star of our home. We do not vacation without her.. she has never been left with anyone else, she has always gone with us, regardless of where the vacation is. I take her every day possible with me, with the exception of food stores and target where I got escorted out for having her.. I have more pictures of her on my phone and facebook than I have of my husband and beautiful three daughters but I want to do what I can do for reese to have her live a wonderful life for as long as possible without going through millions of tests on a disease that is so tricky to deal with costs a small fortune.

So once again I am sorry for the long post but I would like to know how one can tackle this disease in the most direct (without cutting necessary corners) way possible to have my reese do better. I just do not see the necessity for all of these tests when it seems pretty clear that reese indeed has most if not all of the standard cushings symptoms. Why not do a low dose the compounded or loading dose of one of the drugs to see if that helps. Can it hurt her if given in a small dose? Does it matter if it is in the adrenal or pituartary gland. I must be honest again, if she has tumors I am NOT going to put her through surgery to remove them. She is too small and probably too old to deal with the surgery and the aftermath.

I panic when I have to put her under anestesia for teeth cleaning let alone for tumor removal.

So please do not take offense by my questions and maybe my naivity but I have been down this route and spent thousands and I mean thousands almost three years ago to end up putting her on a ten dollar supplement, which dont get me wrong I am so thankful that it did in fact work for almost three years.

Please let me know what we can do to give Reese the best quality of life in the position we are now in and please do refer to her blood and urine tests.

Thank you all with all of my heart.

I forgot to mention.. .her urine was clear and no inidication of any utis nothing was off with her urine except that high protein.

Her blood work was NOT done on a fast.

[Harley PoMMom]

Oh Randy,

I am so sorry to hear about the loss of your Mother, and my heart goes out to you and your family.

Your love and devotion to Reese is evident and we do see that you have her best interest at heart.

Treatment for Cushing's is only to abate the symptoms, which usually bothers the pet parent more than the furbaby. So, your decision to treat or not is totally up to you, we are not here to judge any one, ok? ;)

Since Reese's symptoms are manageable along with her age, if she were my dog, I would probably forgo all the Cushing's tests too. With senior dogs, there are pros and cons to treating a dog with Cushing's. When a dog has Cushing's their system is producing too much cortisol, that's where all those clinical symptoms come from.

I'm including a post from one of our Administrators, Marianne, with her response to another member regarding treating an elder dog:
Dear Lisa,

Welcome to you and Pepper, and WOW you've done a great job of keeping your girl healthy and happy up to age 17! First off, even though folks here do give various supplements to support healthy body functioning, there are no nonprescription drugs that will address the root cause of Cushing's and lower cortisol sufficiently to control the disease. So it really will take treatment with either trilostane (or Lysodren, the other Rx option) to control the Cushing's, assuming it truly is the cause of her symptoms. Having said that, at age 17, you may want to consider pluses-and-minuses of Cushing's treatment before rushing in to treat Pepper.

Cushing's is typically a slowly progressive disease but it does have have the potential to cause systemic damage over time (from high blood pressure, vulnerability to pancreatitis and infections, high cholesterol, kidney damage, liver inflammation, etc.). So for a younger dog, I'd certainly recommend effective treatment so as to eliminate some of these risks, improve longterm quality of life, and allow the dog to live out his/her normal lifespan. However, for a dog of Pepper's age, immediate quality of life issues seem of paramount importance to me. And there are some trade-offs to treatment, especially for an arthritic dog since the arthritis may actually worsen as the cortisol level drops, necessitating the introduction of additional drugs to better manage the discomfort. Also, especially at the beginning, there can be numerous vet visits and blood draws which can be less than pleasant for a dog who's nervous at the vet (and also hard on the owner's pocketbook :o).

I don't tell you any of this to dissuade you from treating if you and your vet agree this is the best path forward for Pepper. But I do think you are the best judge as to how uncomfortable her current symptoms are to you both, and if they are not bothering Pepper all that much -- as I say, you may want to hold off on treating for the time being.

First things first, though -- as Lori says, it'll be great if we can take a look at those test results.

Marianne

Regarding an ultrasound, they are expensive but they also can be a useful diagnostic tool. An ultrasound can provide so much info and an "inside look" at all the internal organs and it may show any abnormalities with them. As we like to say around here, you get a lot of bang for your buck with an ultrasound.

I hope I have helped. :o

Hugs, Lori

[reesehascushings?]

Thanks so much Lori, I appreciate all of your time and kind words. I again would like you to please expand on one important comment of many you stated. I am confused over the fact of meds only treating symptims not curing the cushings. I basically get that but you and others did mention of gine untreated the cushings can increase blood pressure, increase cholesterol, cause liver and kidney damage. That is why I am so concerned if I choose to not medicate reese. What damage will I do. Right now her numbers are very high and there is obviously something going on even if it is not the cushings. If we medicate will her numbers get better? Will we prolong the possibility gd forbid of kidney failure or further liver damage? I
Sorry for my ignorance but I don't get the other posters comments about what could happen if she doesn't medicate pepper when all are in agreement that cushings cannot be cured but some of the symptims such as hair loss, panting, frquent urinatuon, excessive drinking and even energy level can be normalized. Please explain that further and I was thinking of doing the uktrasound first to see if possibly something else was wrong with Reese's organs unrelated to cushings. I still don't know if I should start at the thyroid pAnel, instead. Yes, I am once again driving myself and everyone else crazy. I am an over thinker and just want to choose the best path for all invilved. Unfortunately with this disease I don't know if anyone knows what is the best choice to make and it just seems like no one test can tell the story and several have to be fone and even over and over again. Please let me know about the progression of existing problems and/or possibly the addition of other illnesses or complete failure due to choosing not to medicate. Thanks again. Best to all, randy

[Harley PoMMom]

There are three types of Cushing's: adrenal dependent hyperadrenocorticism (ADH) which is caused by a tumor on the adrenal gland; pituitary dependent hyperadrenocorticism (PDH) where a tumor is on the pituitary gland, and sometimes, although rarely, a tumor can grow on both at the same time; the last one is known as iatrogenic, this is when Cushing's is caused by an extended exposure to steroids.

The medications, Vetoryl/Trilostane and Lysodren/Mitotane aid only in lowering that cortisol to therapeutic ranges. If the dog has an adrenal tumor, surgery is a cure and is the first treatment of choice if the dog is an acceptable surgical candidate. Unfortunately surgery to remove a pituitary tumor is not a widely available option here in the U.S., as of yet.

Approximately 85% of dogs have pituitary dependent disease and 15% have an adrenal tumor. Treatment for pituitary dependent Cushing's is with either of the drugs listed above. Now, these tumors generally grow slowly and this is what causes a dog's system to produce extra amounts of cortisol. And over a period of time that excessive cortisol will eventually harm a dog's internal organs. However here lies the catch 22, we are now learning that Cushing's medications can sometimes hasten pituitary tumor growth due to disruption of the ACTH feedback loop.

Regarding Reese's high ALP value, approximately 80% - 90% of dogs have a steroid induced isoenzyme of ALP so if a dog does have Cushing's you may see anywhere from a mild to severe increase in ALP. These increases are not because the excess steroids are killing liver cells, it's because the steroids are causing an abnormal accumulation of fat in the liver and it is having to work a bit harder. And like I mentioned before, that abundance of uncontrolled cortisol will cause systemic damage.

I hope I haven't confused you more, if you have any questions please do ask them. ;)

Hugs, Lori

[Squirt's Mom]

If you are concerned about your baby's health and want to make sure everything is ok, I would do further testing NOT related to Cushing's. I have to assume you at least wonder about his health even tho you don't want to treat right now or you wouldn't have taken the time to post about him. ;) I would have the gall bladder and kidneys check regardless.


BUN/Creatinine Ratio 72 4-27

That took my breath away! Are the BUN and CREA listed on the lab report?

IF, IF, IF Reese did actually have Cushing's it would be difficult to trust the test right now in my mind anyway without investigating the liver, gall bladder, and kidneys first. Any illness or stress will affect the cush tests. A tumor on the spleen caused my Squirt to test positive for PDH on five different tests. A simple UTI can do the same thing. ;) So I would focus on those areas myself right now.

Just an FYI - treating Atypical with melatonin only won't do the trick. It is the combination of lignans and melatonin that work on the intermediate hormones involved in Atypical. Melatonin would help with hair growth, and nail growth, tho.

Also, to keep long posts from getting lost -

http://www.k9cushings.com/forum/showthread.php?t=1329

Hugs,
Leslie and the gang

[reesehascushings?]

Thanks again for all who took the time to read my posts and respond. I just spoke with my vet this morning and she wants to do all tests mentioned. Another piece to this puzzle is that I recently noticed a very hard bump or lump on the bridge of her nose. My vet now feels that this would trump all other tests since if this is a cancerous bump that needs to be addressed furst. I am beside myself over all of this but feel that we probably need to start with aspirating her nose and the thyroid panel and as the vet now told me her blood pressure. Then a day or two later to do uktrasound, low dex, and I can't even remember what else. Help??? Now I was told that aspirating the nose and or an X-ray won't even tell the story. My vet does not feel that reese has liver damage as I just asked because she felt she would be showing other signs such as vomiting pancreatitis and other issues which thankfully she is not. The vet never mentioned checking the fall bladder or kidneys and she definitely did not have utis.
Reese was not on lignans with the melatonin for the three years. If I recall correctly u of tenn protocol wAs to try melatonin first and then add lignans if symtoms did not improve. We saw amazing hair growth results and at that time she didn't have any other problems. Please let me know if the nose needs to be checked first and which test would be the best and if doing the thyroid and blood pressure would or should be done with that this week. Then what??? Low dex and uktrasound? My vet does not believe in doing the acth now but doing it again for dosing and several required blood tests after diagnosis of cushings is confirmed to begin and monitor treatment. Does this sound appropriate? Thanks again. If I didn't mention numbers such as bun creatin they were normal. Thanks again

[Squirt's Mom]

I would NOT have an LDDS, HDDS, ACTH or UTK panel done right now. If I were you, I would do all the other tests looking at gall bladder, kidneys, nose, etc FIRST. Why? Because if Reese has a problem that has nothing to do with Cushing's, the cortisol will probably be high from the "other" and could cause false positives on the tests for Cushing's. These tests can only tell us IF the cortisol is high but not WHY. Cortisol will elevate in response to any stress, internal or external. A dog who is extremely stressed just going to the vet can have skewed results. So eliminate ALL other possibilities, then look at those tests for Cushing's.

As I said, that tumor on Squirt's spleen caused all five tests to be positive for PDH. BUT once it was removed, her cortisol returned to normal. ;)

[reesehascushings?]

Thanks so much sgain. Not to sound totally naive but what tests would be done for kidneys fall bladder etc? The vet wants to aspirate her nose but she also said that aspiration doesn't always tell them if a lump is canceroud? In conjunction with the aspiration she would need an X-ray.. Does this sound right? Thanks again.

[Harley PoMMom]

I agree with Leslie, since there is something going on I would not pursue any tests for Cushing's right now.

A fine needle aspiration is generally done first, and is the xray for the chest?

If this were me, I would consider having an ultrasound done, this is take a look at her internal organs. However, not all ultrasounds are created equal. A good quality ultrasound/interpretation depends on a few things; the tool used, the technician performing it, and the physician interpreting it. Is it a human grade (Phillips, GE, Siemens) machine? My gen. vet has an ultrasound machine that just doesn't have the power to capture crisp, high-resolution images. The technician, most likely, will perform their own and therefore, it should be those most experienced with capturing good windows and images. That would be a board cert. radiologist or board cert. Internal Med Spec. Likewise the one interpreting it should be the most experienced as well, and that's generally one of the 2 above.

With my boy, Harley, his first ultrasound showed that he had pancreatitis, Harley never had signs of pancreatitis and after that ultrasound a spec cPL test was performed which did confirm his pancreatitis, his results were 528 with normal ranges being 0-200! :eek::eek:

[reesehascushings?]

Hi Lesli and thank you for your reply. The bun/creatin level is 72 the normal range is 4-27. For the last three years I only had reese on the melatonin and it did seem to "normalize" her. Hair came back and she had no other symptoms. Just recently her coat starting really thinning and that led us to do a new blood workup. That is when we saw all of her high levels on a NO FAST blood test.

Her urinalysis was done at that time too and protein level was elevated at 3+. Also her plat level was high at 594 normal being (170 to 400)
Also her T4 was low0.6 normal range being 0.8 to 3.5. They noted that this could be hypothyroidism on the report.

Thank you again.

[reesehascushings?]

Hi again.. I am sorry reese has so much going on that it is hard to keep my posts straight, especially when I go on and on.

I had noticed a bump under the skin on the bridge of her nose. That was why the vet said that I should probably only do an aspiration of that bump on her nose, before anything else for cushings and do a thyroid panel. I am not even sure if I should do the thyroid panel at this time until we know what we are dealing with on her nose. I noticed this for a few months but thought it was a bone but it is a little off to one side and seemed suspicious. She does seem to be snorting more and breathing a little harder but that could be my mind on overtime, as usual, imagining that.

I woulld just like to know all of your expert opinions on where to go next... so many tests have been thrown on us and I am not sure which shouldl be done first and which will hopefully give us the most accurate results.

Nose aspiration.. unrelated to cushings or thyroid for suspicious under the skin hard bump/lump.

thyroid panel

Blood pressure test

Low dex supression test


ultrasound on abdomen

Then I presume ACTH after medication to monitor dosage if that is where we need to go...

I was also thinking of taking Reese to Dr. Mark Peterson in NYC/Westchester since he is an expert in the field and called but they are not taking any new cushings canine patients, at this time.

If all can continue to post suggestions I would very much appreciate it. I know I am throwing in so much info and no one has the time to read my babbling posts but if you can skim my posts and give me a direct path, or the best indirect path, since I know cushings is a very tough disease to tackle but once we diagnose her properly I hope to get on the right track to stabilize her.

Thanks so much to all!!

[Squirt's Mom]

I noticed this for a few months but thought it was a bone but it is a little off to one side and seemed suspicious. She does seem to be snorting more and breathing a little harder but that could be my mind on overtime, as usual, imagining that.

This comment got my attention, and not in a good way. A friend had a JRT who started panting and snorting - much like your description above. It progressed and worsened as months passed. She had several tests including a nasal scope after a while which found nothing. Months later, the pup ended up in the hospital on prednisone and suddenly started to display neurological signs. An MRI a week or so later showed a tumor that had started in the nasal passage and had grown into the brain. I don't recall any mention by my friend of any visible changes, tho. But because of what my friend when thru and your statement above, I would have the nose and nasal passages thoroughly investigated. The neurologist told my friend that the type of tumor her baby had wasn't usually found until it was too late and it had grown into the skull cavity, causing obvious neurological signs. The GP vet they used was not very proactive but my friend pushed him to do all she could think of to find the cause of her baby's breathing issues and it was never found til it was too late. So no question in my mind where to start. ;)

[reesehascushings?]

Thank you. I am going to call my vet now and take reese hopefully today or tomorrow for her nose issues. Thank you soooo much for posting. As I type reese is lying next to me snoring in a very different way than usual.

I very much appreciate your concern and will keep all posted. Thanks again!!

[reesehascushings?]

We took reese to our get and she was an angel. We decided to do the nose aspiration and truly hope it will work being that the lump is so hard. She had the thyroid panel done amd is being sent to Michigan. We also checked her blood pressure ( which was high) and rightfully so after all the stress she experienced. She seems in good spirits and osh resting comfortably in her crib. Thank you again for your suggestiond. We are praying that she will be alright!!! Any other siggestiond will be welcomed. ThNk you for your time and happy and healthy holidays to one and all!! Xoxo

[Squirt's Mom]

Glad you got those things done and hope the reports are positive when they come in! Enjoy the next few days with Reese, family, and friends forgetting all about this for a bit.

Happy Holidays to you and yours!

[reesehascushings?]

Thank you so much. We will try to keep this journey out of our minds for now. She is doing fine now and will hopefully hear from my vet on Friday or monday regarding the nose lump and probably in about two weeks on the thyroid panel.

A very happy and healthy holiday to all, especially to those who took to the time to go through my ridicuously long posts.

Best,

Randy and Reese

[molly muffin]

Wishing you all the best this holiday season.

[reesehascushings?]

Thanks to all and hope your holiday was relaxing and wonderful.

We did get our first results back (unrelated to cushings) on her nose aspiration and it was inconclusive. I am a little upset since the head vet had told my vet that there would probably be little chance of getting any cells or anything for that matter from her nose aspiration. We are back to square one regarding the bump on her nose but $200 later. This bump has nothing to do with the cushings but my vet felt that if the large bump on the bridge of her nose is cancerous that treatment for that would be due ahead of the cushings. We also took the thyroid panel but am waiting for the results to come back. The vet felt that this too should be done prior to any of the cushings tests but does feel that Reese probably has both a hypothyroid and cushings.

Along with her hair coat loss, somewhat of an increase of urination and drinking Reese seems to be doing okay. She is definitely more tired now and really doesn't want to do too much.

On top of all of this I am trying to treat her wart like growths. She has developed many on different areas of her body which have also been checked out by the vet. I had read that using campho oil mixed with very warm water three times a day can shrink them and even cause them to fall off. I am attempting this on two of hers.

Reese is still on the lignans and melatonin but that doesn't appear to be helping this time. In fact the head vet felt that for the past three years the melatonin probably wasn't helping reese at all and that the hair growth was a coincidence. I dont know if I really agree with that but I suppose we will never know.

Hope all others are doing well. I just feel very sad that we are on this path again and feel the worst for reese. I am also nervous about the finances involved in all of these tests and haven't even started them. We have already spent close to 900 dollars on various preliminary tests (for other issues) and haven't even touched the surface of cushings. Will update when we finally get the thyroid panel back and then it will probably be the low dex and the ultrasound.

We also did her blood pressure which seemed a little silly after taking her thyroid panel blood and doing the nose aspiration and after examining her. Would anyone think her pressure would be low? My vet came back and said Reese started to get very upset by the time they did the blood pressure and it was high..(you think?) Reese has a dislike of anything with velcro and although we didn't see it I would presume the bloodpressure cuff had her favorite material, velcro that makes a sound she really does not like.

Thanks again for listening (reading), I almost feel that this is therapy for me, in itself. We did not hear from Dr. Peterson's office, he is the NY endocronoligist that is unfortunately not taking in any new patients. This seems to be getting more and more difficult and extremely emotional for all of us, especially my poor Reese.

EAch of you enjoy your day and hope all of your furbabies are doing well.

[Renee]

Hi there,

I wonder if you could post a few pictures of the bump on Reese's nose and the warty growths? Also, please describe them. Are they flaky, are there tiny black spots? Do they crack open? Do they bleed? Have any of them healed and gone away? Are they spreading? Does she have them along the trunk or spine?

I am concerned that this may be CC you are dealing with, and your vets just don't know it. An aspiration would come back inconclusive when it's CC, because the lab would not know what to look for, and the cells aren't remarkable. The best, and only true way, to diagnose CC is to do a punch biopsy. Getting CC on the nose (or is it the bridge of the nose?) is not common, but who the heck can say -- cushings, and especially CC, can be unpredictable.

If you are dealing with CC, then this may change your gameplan.

[reesehascushings?]

hi again.. please forgive me again for my ignorance. I do not know what CC is? I can take pictures but reese has a variety of many different bumps and warts in a variety of colors and sizes. I will post pictures of them since I wanted them anyway for the "before and after" my oil treatments. The under the skin bump on the bridge of her nose does not show anything. It is just that a very hard bump that I noticed one day several months ago. I am embarrassed to say as much as we all cuddle and touch her endlessly, I can't say if she always had it or not. It feels like a bone but is slightly off center on the bridge of her nose. I can't even take a picture because no one can see it. The others are very typical in the way they look. some are pinkish and hanging or flat and a couple (some which she has had for years and the vets have told me they are nothing more than warts, skin tags etc) and are black. I just did read in an article that black means cancer, but yet two vets over the years told me they are nothing. Reese is so greasy now from my "oil treatments" which causes her to look like she is even balder than usual. I was going to bathe her but wanted to wait the week to see if these camphor treatments will even work. Being that she gets stressed when I bathe her I wanted to do it less often these days. I will try to upload the two or three pictures I took of the whitish pink growths on the side of her face/neck and her right neck, to see what you think. Thanks again!!

[flynnandian]

cc= short for calcinosis cutis.
use the search function on this forum and you can find threads and pictures.
look for; e.g.
renee
dawn anderson and
jed's mom.
they are all dealing with it.

[reesehascushings?]

Thank you. I made an album of pictures of reese from one year ago and a few days ago. Unfortunately, none really show how bad her hair loss is but you definitely get an idea of how big her belly looks and how discolored it is. She doesn't have any hanging growths on her belly, most are on her neck or head. My vet definitely did not mention CC. I will look at the search link you provided. Thanks again. Please do look at my album of reese. I will probably bathe her tomorrow and take additional pictures since right now she is sleeping with my husband and I don't want to disturb either of them. Thanks again.

[reesehascushings?]

I just quickly looked at various articles and pictures and I am in shock. I feel as if you are probably right about Reese. She looks exactly like many of the pictures I saw on various websites. For some reason when I searched on this site I only brought up my thread and one other on a dog whose name began with a K.

Is this an entirely separate issue from cushings? I saw that this disease can obviously cause major hair loss but can it cause other issues, similarly to cushings? I suppose again what I am trying to ask if this is a completely different disease that could have given the same symptoms as cushings or is this on top of cushings and on top of a possible tumor on the bridge of her nose, on top of a problem with her thyroid?

[reesehascushings?]

I added a picture of a dog who has CC and I am beginning to believe you are right. Although the puppy featured has a far more advanced case it certainly looks like Reese is starting to show the same type of skin condition. Now that I am thinking about this many many years ago we were having issues with Reese having black rashes on her vaginal area. No one was able to tell me what was going on. I keep her very clean and she barely touches the ground outside. They all threw their arms up and just gave me some special shampoos or ointments. It seemed to go away. Then a few years ago she was constantly getting yeast infections in her vaginal area and ears. We were fighting them constantly with antibiotics. Finally as fast as they came, they left. This just seems to be another weird part of Reeses latest problems. I tried calling my vet but didn't realize how late it was. I will definitely call her in the morning. Thanks so much once again.

[molly muffin]

Caliconosis cutis, where hard calcium deposits push up through the skin causing sores, which can become infected and spread, is most often, as in, you can pretty much guarantee that the first thing to look for is cushings. It's caused by the high cortisol. To get rid of it you have to bring down the post cortisol levels.
The only way to know for sure if it is caliconosis cutis is to have a skin scrapping done to test for it.
If you suspect it, then have your vet do the test for it. It's the only way to know for sure.

[Renee]

CC is calcinosis cutis - of which I am very familiar, having been battling it, so to speak, for a good year. If you will look at my photo album, you can see some well documented pictures of my pug's CC.

Sharlene, I do not believe a skin scraping will give the diagnosis, as the cells are unremarkable. Some experienced vets are okay with diagnosing it by examination and skin scrape, but the best and surest way is to do a biopsy and make sure the receiving lab knows what they are looking for. That's not to say a biopsy is a must, just the method I chose, and I believe Jed's mom did the same, as well as Dawn Anderson.

Also, search for my thread, there is a lot of discussion on CC and it's various stages.

[molly muffin]

I completely defer to Renee when it comes to cc as she has been in a battle with it and gone through the testing. So biopsy it is!

Talk to your vet about it.

[reesehascushings?]

Can someone please comment on reeses belly rash and let me know if you think it could be cc and her other growths primarily in the neck and chest area. Although reese is greasy from her oil treatment this morning (by me) I will take pictures of her back coat hair loss. Thanks again.

[Renee]

Okay, I looked at the pictures... and, honestly, many of those growths do NOT look like CC to me. The thing about CC - it comes up and out of the skin, never, ever on top of the skin. A lot of those growths appear to be on top of Reese's skin (like skin tags) and they are fleshy. And, CC is not a rash, so the belly rashes may indeed be caused by cushings (likely), but they are not CC.

Now, as for the hard bump on the bridge of the nose, that could indeed be CC, but I would be surprised it has not broken through the skin yet. Has it been there a few weeks?

I really think a biopsy is the best and surest way to know... but, I hesitate to do something like that on the bridge of the nose. That's a tough choice.

Thanks Sharlene! I hope I didn't come off as bossy or know-it-all!

[reesehascushings?]

Hii Charlene:

You didn't come off bossy or knnow it all, at all! Thank you for responding. We are just going so crazy here trying to figure this all out. The bump under the skin on the bridge of her nose is extremely hard and the size of at least a marble. I think we are just going to watch that now.

The next thing is we are waiting for the thyroid panel and then on to the low dex and ultrasound, I presume. I am trying that holistic approach to her skin tags/warts and not seeing such a great improvement although, like i said, I am making her extremely greasy.

The rash on her belly is pretty bad and I dont know what that reddish purple lesion type new thing is on her upper chest. Her hair unforunately is not changing at all, since we added the lignans to her melatonin, but that is it, so far.

She has slowed down tremendously, even more so than our little couch potatoe has been so it is very disheartening. Hopefully I will get some answers soon and proceed.

Thanks again Charlene and all who responded, I hope you all have a very happy and healthy New Year, and to your pups too.

[reesehascushings?]

Latest update on the cushings road...

I received a call from my vet on monday that reeses thyroid is absolutely fine. I was told to check this out first since they felt something was suspicious in her blood work and wanted to deal with this prior to cushings tests. As I said her nose aspiration was inconclusive (something that was also done since that would possibly require treatement before the cushings, if serious).

Now we progressed quickly to urinating in her sleep on my bed. I thought it was a one time accident and then this morning woke up to her sopping wet in her bed and all of her bedding drenched.

I had asked the vet the other day since reese was diagnosed with atypical cushings three years ago, which tests can we now pass on. She is hesitant to pass on any but finally said she would possibly pass on the low dose test and just do an ultrasound to see how all of her organs are and then start on the drug, I believe she uses lysodren. Reese is about 10 to 10.5 lbs and I just wanted to know how much my vet should be starting her with and when we do the acth test to monitor her.

My husband and I are due to go down to florida with reese and wondered if I should start this treatment now or wait until we get back.
We are leaving on 1/17 and don't know if I will have enough time to get her on the right dose and then of course will only have phone access to my vet.

Any thoughts... I also hate the idea of waiting until we get home since I will be at my moms going through her things and it will be difficult enough without reese having accidents on the plane and in my moms home. I haven't been back to her home since she has passed away so I hope all understand that I am not being selfish it will just be a very difficult time and we have always traveled with reese and I would never board her, especially how she is feeling now.

Thanks for your input.

Randy

[Harley PoMMom]

Until Reese has a confirmed diagnosis for Cushing's, meaning at least two tests that point to Cushing's, I wouldn't start any kind of treatment.

When treatment is initiated, I believe it is best if someone could be home with her. Does Reese get nervous, stressed or agitated while on the plane? If so that would be another reason to not begin treatment.

Here's a handy link with info regarding Lysodren: Lysodren loading Instructions and related tips (http://www.k9cushings.com/forum/showthread.php?t=181)

Hugs, Lori

[labblab]

I have looked back through your thread and I apologize if I am missing something, but nowhere am I seeing mention of the actual test results that accounted for the diagnosis of "Atypical Cushing's." From our experience here, that would have meant that Reese's cortisol levels were normal on her UTK testing but other adrenal hormones were elevated.

If cortisol was not elevated then and you have no blood tests to establish that cortisol is elevated now, I think it would be dangerous to proceed with a full Lysodren load right now and it worries me greatly if your vet is considering doing that. Perhaps she is instead suggesting starting a lower maintenance dose of Lysodren? The problem is that an ultrasound alone is insufficient to establish a Cushing's diagnosis -- you definitely need corroboration from a diagnostic blood test (either LDDS or ACTH). And the appropriate Lysodren dosing approach will depend upon the presence or absence of elevated cortisol at this time. I do think you truly need updated blood results before starting a drug as powerful as Lysodren so that you know exactly what you are dealing with and how best to proceed. I do understand how all this complicates your trip, and I do not take that additional stress on you lightly. But for Reese's safety, I do not think you are yet ready to begin treatment.

Marianne

[Squirt's Mom]

DITTO to everything Marianne said. ;)

[reesehascushings?]

Hello all, I had been here several months ago regarding my 12 1/2 year old yorkie, Reese. We finally did receive a confirmation through an ultrasound that Reese has full blown cushings. In my prior posts I believe I had explained that three years ago Reese was diagnosed with "atypical cushings". I was told to start 3 mg twice daily and believe it or not it seemed to correct her one main issue, hair loss. After three years to almost the day, her coat is thinning quite a bit and she has additional classic symptoms of cushings, enormous water intake, frequent urination, panting etc. We finally decided with our vet that since we had been down this road before and did quite a bit of testing we would just go with an ultra sound and sure enough it showed two enlarged adrenal glands, some minor issues with the gall bladder so she will be placed on ursodiol, as well.
My vet recommended lysodren twice daily as a loading dose of 107 mg each. Reese is approximately ten pounds. I was given a prescription and told that for 20 pills it will cost us $55 dollars for ten days. I hadn't realized that this treatment will cost us $155 dollars per month without any of the other tests. I did look on 1800 pet meds but they only sell 500 mg capsules. Can anyone suggest another way of getting the pills cheaper than $2.75 per pill for her dosage. I was told if we order more in the future it will go down to $1.75 but wondered if there is any way to purchase the pills in the NY Area or anyone who ships for much less? Alsowith all of the information I received today I dont even know if I was told yet, if this dosage remains as an ongoing dosage or does it eventually get used less times per day or per week. I know I am jumping the gun since we didn't even start the med yet but curious to know if it does get less expensive down the road. Also any suggestions on Lysodren vs trilostren.. spelling? My vet believes in lysodren and seems to only use that. I am sorry I am all over the place but very nervous and upset over this diagnosis again, when she had been doing so well. Thank you all who can help us out in any way possible.

[reesehascushings?]

I apologize that I posted in another location by accident (how to area)for some reason I didn't see the new post icon. In any case Reese was diagnosed with cushings ( I wont go back into full details) but wanted to ask if the normal loading dose for a 10 pound dog of lysodren would be 107 mg per pill twice daily?

I also wanted to know where if any place would we be able to purchase this capsule at hopefully a reduced rate. Our vet has quoted us about $155 per month. We were told that if we order more quantity it would go down to about $1.75 per pill instead of our 10 day supply of $2.75. We are in the New York area.

I was also wondering prior to reading all of the information on this forum if members can tell me their thoughts regarding lysodren vs Triolostren.. (spelling)? My vet will only use Lysodren.

We did not get too far into the future but wanted to also ask if the 2x daily regiment remains or do they taper off? This is an expensive med for us on top of her many others plus bloods and all other follow up work that is required.

Can someone please advise since I am very nervous over the entire situation and want to make sure I am doing the right thing by medicating at three years into cushings. As I previously stated Reese was diagnosed with atypical cushings almost three years ago and was only being treated with melatinin twice daily at 3mg. She was doing extremely well (or so we thought) until she had tremendous hair loss again, frequent and increased urination, panting and excessive water drinking. Her only symptom in the past was the hair loss which responded to the melatonin wonderfully, until now.

Her ultra sound today confirmed two large adrenal glands, her blood work previously confirmed cushings as well as all of her classic symptoms. Now that we are getting into a much more intense medication journey, I just want to hear as many suggestions as possible and what seems to work best. I know that every dog responds differently (as humans do) but hoped for the overall opinion.

What is the average life expectancy for a dog with cushings and being medicated vs not being medicated? And how would I even consider Reese since she definitely had either a very minor case initially (three years ago) or in fact did have an atypical case. Would I still consider her having cushings for three years and now that I know nothing can cure this type of cushings but help with the side effects of the disease, what can we expect. In addition to all of this how dangerous is Lysodren and what do I have to watch out for other than the obvious signs of vomiting, diareah etc. My vet told me to monitor her carefully and as soon as I see a decline in her food intake I should call her since that should be the right amount etc? Please help, I apologize for not making any sense but we are obviously very concerned as I suspect most of you were at the beginning too.

Thank you so much for letting me ramble, as usual.

[Squirt's Mom]

MODERATOR NOTE: I have merged your two most recent posts into Reese's original thread. We normally like to keep all posts about each pup in a single thread as it makes it easier for members to refer back to the pup's history when needed. Thanks!

[Squirt's Mom]

The dosing process for Lysodren is two part. The first part is called induction, or loading. During this part the dog takes the med twice a day until you see signs the load has been achieved. Then you stop giving the med, call the vet and schedule an ACTH. If the numbers are where they should be, then you start part 2.

In part 2, or maintenance, the dog gets the med 2-4 times a WEEK and not daily. So the cost usually goes down quite a bit here. ;)

You will do just fine. We are here to help you thru the whole thing. In no time you will be an old pro and telling someone else how to do it! :) Here is a link on Lysodren loading that has some great tips. Read it and have it handy during the load in case you feel the need to refer to it.

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

[Harley PoMMom]

In any case Reese was diagnosed with cushings ( I wont go back into full details) but wanted to ask if the normal loading dose for a 10 pound dog of lysodren would be 107 mg per pill twice daily?

Yep, 107 mg twice a day sounds right, the loading dose is calculated at 50mg/per kg of a dog's weight. So for Reese's weight of 10 lbs, to find her weight in kg you divide the 10 lbs by 2.2, and get 4.54 kg, now take that 4.54 kg and times it by 50 which = 227 mg. So her loading dose should be 227 mg, split, and given twice a day, so you see, that 107 is pretty close, now, that is going to be compounded, right? Cause as far as I know, Lysodren only comes in 500 mg pills.


I also wanted to know where if any place would we be able to purchase this capsule at hopefully a reduced rate. Our vet has quoted us about $155 per month. We were told that if we order more quantity it would go down to about $1.75 per pill instead of our 10 day supply of $2.75. We are in the New York area.

Many of our members use Diamondback pharmacy: http://www.diamondbackdrugs.com/

Does your vet use Cortrosyn as the stimulating agent in those ACTH stimulation tests? If so, than here's another cost savings idea, which is found on Dr Peterson's blog: How to Extend Your Supply of Cortrosyn and Lower the Cost of ACTH Stimulation Testing (http://endocrinevet.blogspot.com/2011/03/how-to-extend-your-supply-of-cortrosyn.html) Your vet might not be aware of this so I would copy this out and give it to him/her.


I was also wondering prior to reading all of the information on this forum if members can tell me their thoughts regarding lysodren vs Triolostren.. (spelling)? My vet will only use Lysodren.

I believe one it no safer than the other, both Trilostane/Vetoryl and Lysodren/Mitotane can be used with great success. Both are strong drugs and only unsafe in the hands of an ignorant vet who doesn't follow protocol and an ignorant pet owner who takes absolutely no active participation in their dog's treatment.


We did not get too far into the future but wanted to also ask if the 2x daily regiment remains or do they taper off? This is an expensive med for us on top of her many others plus bloods and all other follow up work that is required.

During the loading phase the Lysodren is given twice a day until the dog is loaded. Than a maintenance regimen is started which is usually giving the Lysodren 2-3 times a week.


What is the average life expectancy for a dog with cushings and being medicated vs not being medicated? And how would I even consider Reese since she definitely had either a very minor case initially (three years ago) or in fact did have an atypical case. Would I still consider her having cushings for three years and now that I know nothing can cure this type of cushings but help with the side effects of the disease, what can we expect. In addition to all of this how dangerous is Lysodren and what do I have to watch out for other than the obvious signs of vomiting, diareah etc. My vet told me to monitor her carefully and as soon as I see a decline in her food intake I should call her since that should be the right amount etc? Please help, I apologize for not making any sense but we are obviously very concerned as I suspect most of you were at the beginning too.

Thank you so much for letting me ramble, as usual.

Dog's with Cushing's and that are successfully being treated can live out their normal life span.

The majority of dogs with Cushing's have a ravenous appetite, if Reese does not have this kind of appetite I would hesitate to start her on Lysodren because any hesitation or a slight pause in eating is the best gauge in deciding if the dog is loaded. In this case, Trilostane/Vetoryl would probably be the better choice for treatment.

The best advice I can give to you is to make sure you educate yourself so that you don't have to take anybody's word for what is best for your girl. You can find some great reference material in our Helpful Resources sub-forum to help you understand the steps in diagnosing a dog, the treatments used, adverse reactions to those drugs and even a great deal of information on concurrent diseases like diabetes and hypothyroidism. Use this link: http://www.k9cushings.com/forum/forumdisplay.php?f=10

Hugs, Lori

[reesehascushings?]

Thank you all so much!!! You do not know how grateful I am to gain all of this wonderful information from such a knowledgeable group. Reese's appetite since she was 9 1/2 weeks has been ravenous plus! We always say that if a bag of food or anything for that matter short of plastic she would finish it all. My vet did tell me that I must closely monitor her and the first sign of reduction of her food intake I must call her. I am going to contact the pharmacy my vet gave me for the first ten days and then I will contact the less expensive one who you had suggested (much appreciated). Her 107 mg is a compounded dose that is from a NY area pharmacy who my vet uses. I feel so much better now. Unfortunately last night we had a lot of stomach issues with Reese, which is somewhat unsual. She was having diareah and vomiting issues as well as Peeing issues and accidents. I asked my vet if she was given anything to sedate her for the ultrasound but was told no. She was extremely cooperative during the imaging. But, I was informed that she would not eat, drink or even go to the bathroom and was there from 8am until I picked her up at 3. My vet feels it was pancreatitis (sp) which I was surprised since she has only had a few problems with her stomach over her 12 1/2 years. Yesterday was a horror show. Thankfully we put her on flagyl from my regular drug store (vet called it in) and she slept great and all seems to be already resolved. I had lightly fed her some rice and boiled chicken. So we are back on the road again and will order her lysodren today and start on a week from tomorrow. My vet had asked me to start on a Sunday. Thank you all so much and I will be on consistently once she starts her loading does, for sure!!

[judymaggie]

Hi, Randy and Reese! I am a Lysodren mom with my beagle, Abbie, and my first Cush pup, Maggie, had atypical Cushing's which transitioned into "regular" Cushing's. I wanted to add my support to your journey with Reese. I am concerned about a couple of things which I wanted to mention. I don't see that the results of the UTenn tests were posted. If the non-cortisol hormones were elevated initially and no cortisol tests have been performed since (and I don't see any results since Lori and Marianne asked about this in January), then I would be concerned that Reese continues to have atypical Cushing's. If her cortisol is now elevated along with the other hormones, then UTenn's usual recommendation is to add a maintenance dose of Lysodren (without any loading) to the melatonin/lignans treatment.

If I were in your shoes, I would seek a re-test via UTenn which would include an ACTH test before embarking on any Lysodren loading. I would look to our in-house experts for their thoughts on this.

[Harley PoMMom]

After rereading Reese's thread, just like Judy and Marianne (whose post is included), I too am now a bit concerned with starting Reese on the Lysodren. Even though her ultrasound showed bilaterally enlarged adrenal glands, other illnesses besides Cushing's can cause enlargement of the adrenal glands.

Having an ACTH stimulation or LDDS test, I believe, is needed to validate a Cushing's diagnosis.



I have looked back through your thread and I apologize if I am missing something, but nowhere am I seeing mention of the actual test results that accounted for the diagnosis of "Atypical Cushing's." From our experience here, that would have meant that Reese's cortisol levels were normal on her UTK testing but other adrenal hormones were elevated.

If cortisol was not elevated then and you have no blood tests to establish that cortisol is elevated now, I think it would be dangerous to proceed with a full Lysodren load right now and it worries me greatly if your vet is considering doing that. Perhaps she is instead suggesting starting a lower maintenance dose of Lysodren? The problem is that an ultrasound alone is insufficient to establish a Cushing's diagnosis -- you definitely need corroboration from a diagnostic blood test (either LDDS or ACTH). And the appropriate Lysodren dosing approach will depend upon the presence or absence of elevated cortisol at this time. I do think you truly need updated blood results before starting a drug as powerful as Lysodren so that you know exactly what you are dealing with and how best to proceed. I do understand how all this complicates your trip, and I do not take that additional stress on you lightly. But for Reese's safety, I do not think you are yet ready to begin treatment.

Marianne

[reesehascushings?]

Hi all... I was very involved with starting reese's treatment and my daughters pregnancy that I haven't made it back until now. I appreciate all of your comments.

We have started Reese (a week ago yesterday, sunday) on 107 mg. capsule 2 times daily) and have seen ZERO changes. I am unsure if this is good or bad. Good in the respect that she is tolerating the drug without any known side effects but bad in the respect that nothing seems to have changed, externally, anyway.

Reese's appetite has NOT decreased in any way what so ever. She is just as barky when we are eating, gobbles her food down in a matter of seconds (not lifting her head to look at me, breathe or even swallow, she inhales as she has done her entire life, since 9 1/2 weeks old. Her water consumption might be a tad less but she still seems to gulp her water down at least two to three times a day without picking her head or mouth up to breathe either. Her urination frequency doesn't seem to have decreased at all either but I do have to tell her more "to go" (she is wee wee pad trained and does not go out to make especially in this NY weather) so that she does not have the accidents she had been having. She has only had one accident when I went out to my garage and closed the door she immediately watched me leave and then urinated on my dining room floor. I know dogs do not do these things on spite, or at least that is what I have been told, but it seemed like she was nervous that I was leaving her or just annoyed she was not coming with me. Her accidents have definitely lessened but I honestly believe it is because I am monitoring her so consistently and "bossing" her around to go to urinate so I save my floors. I know that is probably totally wrong since it is not giving me a true read on how she is doing and what her Now normal frequency would be on the drug. I will curtail my constant watch. When I do leave her she does go on the paper and seems to be a normal amount.

She does seem happy, I wouldn't say totally energetic but she was always a couch potato from day one. We never knew if it was just her personality or for whatever reason she just didn't want to interact like other dogs. She preferred to be held and interact with children rather than dogs. We always laughed that she thinks she is a human and not a dog. She doesn't seem to have any pain and definitely does not have diareah, vomiting, or anything negative.

Now for the questions.. what does this mean? Is lysodrol just not working for her? Is the dose too low? What damage can this drug be doing to her internally?

I read a couple of late posts quickly since we are running off to get the ACTH test to see what is going on but must reiterate that my vet took her off of the melatonin and lignans. The only thing I noticed about this and it could be a coincidence is she seems to get up a little earlier but she sleeps very peacefully and well. She will settle in as early as 8 PM and not wake until 630 AM now. She used to sleep until 8 am or later. I do not even know if melatonin has the same sleep affects on dogs as it does on people but it doesn't seem to have bothered her at all, being off of it. When I asked my vet if she should stay on the two supplements she said to wean her off and that the likelihood of them having any affect on her getting better, was probably slim to none.

So ladies and gents, what do you think is happening here? It is now 8 days of full dosage and her morning dose this morning and thankfully she is happy as can be but no significant change in her symptoms. I certainly did not expect her coat to grow so quickly, she is extremely thin on her trunk and neck and her neck is so tiny now and her skin appears to be very wrinkled, like elephant skin. She has her assortment of skin tags and growths (which I would love to have removed, but they certainly are not the priority now).

I have reordered another 20 pills, as per my vet, by the way at $2.75 per 107 mg compounded pill.. ugh, and will see what her blood work shows today and report back. Since reese is my velcro girl and came back from her ultrasound and various other tests with a horrible case of diareah and vomiting (probably from nerves of being at the vet all day) my vet agreed to do the acth and then have me come back I believe in an hour to check or whatever they have to do then. Reese is by no means a cage girl and would much prefer to be with me for her waiting time, which I am grateful for instead of keeping her in a cage with other barking or crying dogs. Hopefully she will not be as nervous today.

Wish us luck and please do tell me what you think. I am now nervous about seeing that Utenn recommends keeping on the melatonin and lignans and not a loading dose but a maintnence amount... could this be doing damage to her and should I mention this to my vet. As it is my vet seems to get upset when I voice my own layperson opinions and get second guess her treatment plan but I have been through too many human illnesses where I feel it is extremely important for us to be our own advocates and especially our dogs who cannot speak and stand up for themselves.

Please let me know your feelings. I am due to leave at about 930 am. Thanks all.

[reesehascushings?]

Hello, we are back but will not have any results until tomorrow. I am worried now after reading a couple of the last posts but did not bring that up to my vet today. If anyone can give me any other information regarding reese's case I would appreciate it. I will again post her ACTH number tomorrow. Thank you all.

[Harley PoMMom]

I can only reiterate what I have posted before: After rereading Reese's thread, just like Judy and Marianne (whose post is included), I too am now a bit concerned with starting Reese on the Lysodren. Even though her ultrasound showed bilaterally enlarged adrenal glands, other illnesses besides Cushing's can cause enlargement of the adrenal glands.

Having an ACTH stimulation or LDDS test, I believe, is needed to validate a Cushing's diagnosis.


I have looked back through your thread and I apologize if I am missing something, but nowhere am I seeing mention of the actual test results that accounted for the diagnosis of "Atypical Cushing's." From our experience here, that would have meant that Reese's cortisol levels were normal on her UTK testing but other adrenal hormones were elevated.

If cortisol was not elevated then and you have no blood tests to establish that cortisol is elevated now, I think it would be dangerous to proceed with a full Lysodren load right now and it worries me greatly if your vet is considering doing that. Perhaps she is instead suggesting starting a lower maintenance dose of Lysodren? The problem is that an ultrasound alone is insufficient to establish a Cushing's diagnosis -- you definitely need corroboration from a diagnostic blood test (either LDDS or ACTH). And the appropriate Lysodren dosing approach will depend upon the presence or absence of elevated cortisol at this time. I do think you truly need updated blood results before starting a drug as powerful as Lysodren so that you know exactly what you are dealing with and how best to proceed. I do understand how all this complicates your trip, and I do not take that additional stress on you lightly. But for Reese's safety, I do not think you are yet ready to begin treatment.

Marianne

If this is her 8th day of her loading dose than an ACTH HAS to be performed now.

Hugs, Lori

[reesehascushings?]

Reese did have her ACTH today and will get the results tomorrow... just feel weird about the whole thing. Wondering why she hasn't had any signs of it taking affect but again at least she isn't have negative affects that I know of, YET. Hopefully she will show a normal range tomorrow and then can reduce her to a maint level. Thanks for help if anyone else has any comments please let me know. I am very nervous about this.

[reesehascushings?]

Also, it was pretty much determined that she has cushings from blood work and the ultrasound and all of her symptoms. I was told she is a classic case of cushings. Her numbers of the blood were off the charts all confirming cushings. Nothing wrong with her thyroid and not diabetic. Her liver looked slightly enlarged but not too bad which my vet said she expected with cushings. She was constantly getting yeast ear and vaginal infections as well as urinary tract infections. I will update tomorrow and hope that all will go well. Again, I never spoke with my vet about a maintenence dosage of lysodrol added to her melatonin and lignans but I will ask her tomorrow. I am sure she will be thrilled with my playing Doctor again, but I feel I must be her advocate and continue to stay on top of as much information as I can receive so thank you so much for your concern and interest.

[reesehascushings?]

Sorry to post so many times but I thought of another question. Does anyone know the average cost of an ACTH test after the initial loading dose. My husband and I are both shocked that I was charged about 410.00. That included the ACTH test and cortisol injection or something. I am shell shocked over all of this. I also do not have insurance and was ahead of the game prior to this cushing diagnosis three to four years ago.

We are in the NY area so I am quite certain it is higher than the average but so high? I am going to have the results tomorrow so I am pretty sure this is done right in the office. Please give me some idea of whether or not this "NORMAL".

[Harley PoMMom]

You can save money on the acth stimulation tests if your vet is open to cooperating. There is no reason why s/he shouldn't so make sure you talk to him/her about splitting the vial of cortrosyn, which is the stimulating agent used in the acth stim test. It is the cost of this agent that makes the stim test so darned expensive. Those members with small dogs can capitalize on this savings. You and your vet can read about this on another Dr. Mark Peterson's blog found here: http://endocrinevet.blogspot.com/2011/03/how-to-extend-your-supply-of-cortrosyn.html

I know this sounds odd but dogs that do not have Cushing's are resistant to Lysodren and are much less likely to experience adverse reactions than a dog with cushing's that is extremely sensitive to the drug. For this reason, a misdiagnosis is always a possibility when a dog seems to be resistant to the effects of Lysodren.

A confirmed diagnosis of Cushing's should not be based on just abnormalities on a CBC/chemistry panel and enlarged adrenal glands from an ultrasound,. Multiple testing is required to validate a diagnosis of Cushing's; when obvious clinical Cushing's symptoms are seen, an ACTH stimulation and/or LDDS test should be performed too.
Lori

[reesehascushings?]

Thank you lori. In fact I attempted to make an appointment with Dr. Peterson but was told he no longer sees new canine patients with cushings. Reese had tests done like the low dose etc this time around too and it was confirmed she had cushings.

Although I neglected to get her numbers from the ACTH test yesterday my vet did call to tell me that her numbers are now within normal range. She is reducing her to 107 mg capsule once daily 2x per week.

I suppose I will have to wait and see if there are any clear indications that reeses symptoms have changed. Like I had said Reese had a ravonous appetite from the time she was a baby and I doubt that was cushings related. She now seems to be just as hungry as ever, maybe a slight reduction. She is definitely not urinating as much as she was a few weeks ago to months ago, she does not have any panting and her drinking this past week has definitely tapered off between yesterday and today. I will see if that remains the case.

I am going to call for her numbers and details of the test but so far that is all my vet had indicated to me. She told me that we should start seeing a regrowth in her hair hopefully in several weeks to a few months. Thank you for the article.

Best again,

Randy

[Harley PoMMom]

Hi Randy,

If you would get a copy of that ACTH stimulation test and post the results here for us that would be great. We have seen many members post that their vet stated that their dog's results were within the therapeutic ranges, and unfortunately there were not.

Please do keep us updated ;)

Hugs, Lori

[reesehascushings?]

I will certainly do that. Thanks so much.

[molly muffin]

$410. seems a bit high to me, but it does depend on area of course, but I have seen lower in NY, posted in our ACTH Cost thread: http://www.k9cushings.com/forum/showthread.php?t=1148

I think I would call around and get pricing and then take that to your vet and see if they would match it or something. Seems to me that you are being charged for a full bottle of the stimulating agent and not likely using it all. Is there a break down on your invoice that would show you what the charges are for?

I do hope that the numbers come back in the normal range (definitely post them here) and that then you won't be testing so often.

[reesehascushings?]

Hi Sharlene... thank you so much for responding.I still have the invoice in my car but I know the only breakdown I saw was an ACTH test for about 200 something and then the cortisol.. sorry cortisine..?pretty new to the testing/etc., for about 100 plus. I was shocked to say the least. I know that we will have to do this quite often until she is hopefully stabilized at her maintenence dose. 400 plus dollars is a bit much considering we just spent about $1300 last week on various other tests. The main thing is Reese seems to be doing great. I do not know if much of this is in my head (positive thinking) or if it is truly accurate. Obviously after only 9 days of being on the lysodrol, her coat is still extremely thin but her drinking, urination and panting have reduced substantially if not gone totally away (panting). Her energy level is about the same.. but Reese from puppyhood was a couch potato..so I cannot judge any change. My husband also said that he will be totally surprised if her eating habits change since from 9 1/2 weeks she ate like there was no tomorrow. She still calls me into the kitchen quite a few times per day and stares at her food jars and her old (treat closet) with sad eyes. Since she has always battled the bulge we have been keeping a strict eye on her food intake, way before this last cushings road. She now only gets kibble as a snack a couple times per day if she is very upset over hunger.

I just hope that she will increasingly seem better and that nothing will become a problem. One thing I had noticed over the past week is that she was licking her paws a lot. She had done that over the years at certain times, usually bedtime but it had tapered off substantially after a change in diet and shampoos. Now for the past week she is licking her front paws with a vengence. She also has bad gas every now and then, usually at night, which was rarely an issue for her. When I spoke with my vet she didn't think that either was due to lysodrol.. any opinions on that?

I will get more information regarding her numbers and the cost breakdown next post. Thanks so much again and for the cost too of the tests. I will mention this to my vet, as well. They are definitely NOT one of the least expensive around but which vet really is??
Have a great day, all and continue to wish us luck, please! xoxoxoxo

[reesehascushings?]

I did receive the results from Reese's last ACTH test or I should say first after being on lysodrol for eight days.

I have no idea what it means so if you can please let me know I would appreciate it. All I was told that after her loading dose of 107mg 2x daily each for eight days we were told she is within the normal range and can now drop her dose down to 107 mg 1x per 2 days a week. Does this seem to make sense.

The update I do have is, I am going to watch her even closer but she did wake up once to get water in the middle of the night, about 1am (unusual for her to begin with) and then woke up very early for her at 530 to again drink and urinate. She didn't want to eat, which is pretty normal for her since she doesn't eat until around 7. 630 am she rewoke and wanted to eat, drink and urinate again, not as much as at 530.

It seems as if she is reverting back and I probably should call my vet today. She also had a pee accident yesterday afternoon for no reason in my bedroom.. she had just been in her room drinking, eating, etc. She has only been off her regular dose since this past tuesday when I gave her one pill in the morning and then again on Friday morning.

The following are her results.. I know this sounds silly but I was expecting a lot more of a substantial report than what I received but I suppose all the necessary infomation, is hopefully here.

This was performed at IDEXX labs

PRE ACTH CORTISOL 2.3 REFERENCE RANGE UG/DL

POST-ACTH CORISOL 4.7 REFERENCE RANGE UG/DL

THEIR REFERENCE RANGE

CANINE 2 -6 PRE ACTH CORTISOL
CANINE 6-18 POST ACTH CORTISOL

CANINE 18-22 EQUIVOCAL POST ACTH CORTISOL
CANINE >22 POST ACTH CORTISOL CONSISTENT WITH HYPERADRENOCORTICISM
CANINE <2 POST ACTH CORTISOL CONSISTENT WITH HYPOADRENOCORTICISM
CANINE 1-5 DESIRED PRE AND POST ACTH CORTISOL ON LYSODREN THERAPY

It does go on to describe different percentages since in various dogs if needed I can add those,. as well.

Can anyone please comment and let me know if this seems "normal" for a cushings dog on lysodren.

Thank you for all of your time.

[Harley PoMMom]

The following are her results.. I know this sounds silly but I was expecting a lot more of a substantial report than what I received but I suppose all the necessary infomation, is hopefully here.

This was performed at IDEXX labs

PRE ACTH CORTISOL 2.3 REFERENCE RANGE UG/DL

POST-ACTH CORISOL 4.7 REFERENCE RANGE UG/DL

THEIR REFERENCE RANGE

CANINE 2 -6 PRE ACTH CORTISOL
CANINE 6-18 POST ACTH CORTISOL

CANINE 18-22 EQUIVOCAL POST ACTH CORTISOL
CANINE >22 POST ACTH CORTISOL CONSISTENT WITH HYPERADRENOCORTICISM
CANINE <2 POST ACTH CORTISOL CONSISTENT WITH HYPOADRENOCORTICISM
CANINE 1-5 DESIRED PRE AND POST ACTH CORTISOL ON LYSODREN THERAPY



I have just a moment to post, those reference ranges I boldfaced are the ones for a dog on Lysodren. So Reese's stim numbers are within the therapeutic ranges, however, if she is still showing symptoms of Cushing's she may need her cortisol to run a bit lower. Now having said that, it is quite possible that she has what is called renal medullary washout. To simplify things, it means all the stuff (solute) her kidneys need to concentrate her urine has been washed out for a very long time so the kidneys will take some time to recover. And in some dogs the increased drinking/urinating may never return to normal.

Hugs, Lori

[reesehascushings?]

Thanks so much Lori... could this also mean that she needed to be on the loading dose longer? Or does she need a higher maint dose than 107 2x per week once daily?

I am afraid to ask but will I probably need to put her through another ACTH next week to see where her numbers now are, being that she was on a much lower dose after her loading dose? Is this what I need to expect for possibly weeks to come to tweak her dose.

I know this seems crazy and I am unsure if I even mentioned it or not but her hair seems to be thinning even more. Of course my husband said no, but I definitely see a decrease in hair around her neck and back and she has that wrinkled skin.. I presume that the muscle mass has been compromised.

Would what you had said about the kidneys have shown up in any of the blood work or any other test? I just know that my vet didn't think that her kidneys were in bad shape but unsure if what you had stated would easily show up in any tests.

I must call my vet on monday and see where she goes with this next. I greatly and I mean greatly appreciate your help. I must admit I am getting very nervous about Reese's prognosis and the continued cost of these tests. All my bill states is Cortosyn injection quantity one at $228.80.. we can't forget about the .80 and then ACTH stimulation quantity 1 $167.41. If that is going to be a weekly cost that is a huge monthly expense.

Hope to hear back from you and others and thank you so much for taking time away from your weekends. xoxoxo

[molly muffin]

Once you get her stable on a good dose, the tests don't happen nearly as often. Maybe she just needs to be around 3 post on the test, would could just require a tiny maintenance tweak. Eventually you'll be seeing months without any acth testing required, so that will be good.

How are the symptoms doing? any change?

hmm, I would think that something would show up on a kidney test, but I'm not familiar with what Lori mentioned so I'd leave that to her to respond to.

[reesehascushings?]

Hi all,

I haven't posted in a while but I am at a complete loss. We had started Reese on lysodron back in march. All was going pretty well. Her hair grew back as if it was gorgeous silky black puppy hair on her torso and her eating habits seemed to finally be controlled after 13 years. Her drinking went back to normal and her pot belly which she had since she was a puppy even seemed to be less bloated. Her yeast infections, ear infections and urinary tract infections all seemed to clear up.. she seemed great until last month. She had a horrible night of bloody diarrhea and vomiting. My vet ordered every regular test under the sun.. hence a 950 dollar bill for a three to four hour stay with Iv fluids, cbc, etc. For the first time in reeses life her liver numbers were extremely elevated. When she was stabilized we went home armed with amoxy and flagil and she seemed to come back to herself shortly after. She has now been on those meds for three weeks straight. We are going back tomorrow for another CBC. Her second one about ten days ago still showed an elevated liver level. We have now noticed that her hair looks like it is thinning considerably again and she is just not herself. She is so boney.. her spine is sticking out and has lost so much weight and body mass. She is very listless and went through a bout of not eating at all which started from her resistence after ten years of pill taking to not take her pills which was a vitamin, proin for incontinence which she probably didn't even need anymore.. melationin which I had been giving prior to the lysodrol and a new liver pill which she refused to take even when disguised under various foods. She has again had a horrible bloody stool, which I was not home to see, but my family members said it looked like her insides were falling out.. a jelly like bloody stool. After that she bled droplets of basically black blood. now once again she is basically back to herself after calling my vet who told me to just reduce her diet to only chicken and rice. She basically has not eaten any dog food for weeks and will only eat chicken turkey and rice. We thought we were losing her a couple of times and although the bleeding has now stopped since Sunday she still feels so boney and fragile and sleeps a lot. Does anyone know if Lysodrol would cause elevated liver numbers and if it can cause bloody stools? My vet does not believe that it is the lysodrol since this happened many months after the initial introduction of it. She just seems to be deteriorating and I don't know if this is due to the drug or a combination of the cushings finally taking over or something else entirely. I do have another vet appointment tomorrow when they are supposed to do another cbc and probably will discuss another ACTH. She had an acth about three months ago and all levels were great. Help.. we are so sad and see such a difference in her behavior. She seems so sad and weak and I truly wonder if she is in pain and wants to just give up or is already. When we have my three daughters and grandson over she seems to enjoy all and is part of the family and is eating very nicely again.. even barking to eat as she did for 12 years of her life but most of the time she seems weak and depressed. Can someone please help we are all feeling so scared and sad. We obviously do not want to lose her but do not want to force her to live in pain. Like I said she will not take any of her arthritis vitamins and seems to be in pain from that too. Please help. thanks so much.

[reesehascushings?]

Instead of reading my long winded posts can someone please tell me if lysodren can cause intestinal bleeding after being on it for about nine months? Reese seems to be deteriorating very rapidly I do not know if it is just age related or if the lysodren has become more toxic to her than helpful. She has had a few bloody stools and seems to have lost an excessive amount of weight, very boney (especially her spine) seems to be limping more than usual (she has had problems with arthritis and bad knees, hips, past torn acls). Hair loss is definitely back. Any helpful information would be greatly appreciated. Thank you.

[labblab]

I am so sorry that Reese is doing so poorly, and also sorry that I cannot give you definitive info re: Lysodren as a contributing factor other than to acknowledge that the drug can cause GI upset (and especially if cortisol has dropped too low). However, if cortisol is not being oversuppressed, the severity of Reese's decline would lead me to guess that there is śomething else going on. One thing I just Googled is "Hemorrhagic Gastroenteritis"; I don't know whether these symptoms seem to fit Reese.

http://www.vcahospitals.com/main/pet-health-information/article/animal-health/hemorrhagic-gastroenteritis-in-dogs/764

Have you considered an abdominal ultrasound? The imaging might be able to give you a better sense as to whether there is a tumor or other internal abnormality that would account for these problems. I believe that might be a very helpful diagnostic. And as far as cortisol, at a minimum, I would also at least check Reese's baseline cortisol. If it is higher than 2.0, that would make adrenal oversuppression seem less likely.

Marianne

[reesehascushings?]

Thank you so much Marianne. I believe I will be asked to do numerous tests on Reese tomorrow. I was just wondering if anyone seemed to go through this say situation, when theirs is on lysodren. I can't help myself from wondering if I shouldn't have treated her but I know that she was prone to numerous other setbacks when the cushings was left untreated. I just feel in my heart that she suddenly is unable to tolerate the drug. thanks again for all of your information. xoxo

[molly muffin]

When on any Cushing meds and things start going wrong an ACTH is the first thing that needs to be done as levels can change over time. It's not a given that is the problem but it's a first that should be checked to ripple it out. So definitely do the ACTH. Did she just have a CBC? That should be checkd to. Then next an ultrasound if you still don't have the answers.

[reesehascushings?]

Hi all,

I will try to be brief, which as most know is difficult for me. Reese has taken a major turn for the worse. Upon starting the mitotane 107 mg twice weekly she did amazingly well. Most of her hair grew in beautifully and thick in her puppy color black, her numbers were normalized on about three or even four acth tests.. then suddenly after several months she is totally lethargic, depressed, weak, sleeping 90 to 95% of the day, barely eating most times and had episodes of horrible bloody diarrhea and vomiting. About two months ago she was put on amoxly and flagil and it seemed to do wonders for her.. by the way her acth and blood levels had been more normal than they ever had been. Perfect numbers, yet about a month ago she started losing a lot of her hair again, has no muscle mass (very boney spine and even more tired... I have to try to entice her to eat daily. Again, her numbers on the ACTH were extremely normal and it was not that she was getting too much of the drug that it was causing addisons. She seems to be getting worse and worse.

My vet again wants to do blood, urinalysis. liver bile tests, ultrasounds etc etc etc. When do you stop? Where do you stop? Reese is 13.5 years old and seems to be a shell of herself. I know this will upset many of you but we are not in the financial position to keep up these monthly tests at over 1000 or more on top of normal expenses and her other drugs and the milotane etc. The emotional roller coaster is also heart wrenching. I commute four days out of the week to care for my new grandson with Reese and I think that too is taking a toll on her. I by no means will leave her home by herself from 5am when I leave until 7 or 8 pm when I get home.

I do not feel that my vet has enough experience with cushings or at least not when things are no longer going well and wondered if anyone knows of a highly experienced doctor who deals with canine cushings in the ny metropolitan area. I reached out to Dr. Mark Peterson but unfortunately he no longer sees dogs, just cats. I am nervous that a regular internist will not be familiar enough with the disease either and hate to take giant steps backwards.

Can someone please recommend a Ny or Ny area specialist who could hopefully help Reese and us out and also tell me if anyone experienced the same results while using mitotane.

Reese is 13.5 used to weigh 10 to 11 pounds even reached 12 at one point and now if we are lucky she is 7 1/2. She had a huge appetite from the time she was a puppy and was born with a pot belly and retained it until recent months... Please help. She seems confused and often walks around her pad ten times before she urinates and just does not seem to even resemble herself.

Last question do we need to wean her off of mitotane if we decide to stop it and how many of you would stop it.. I know if we then decide to go back we begin the entire road again of tests and loading dose etc. What would be your next move? Thank you so much.

[labblab]

I am surely sorry that Reese is doing so poorly. Before we move onward with any other suggestions, can you please provide us with the exact numbers and dates for any monitoring ACTH tests performed within the past year?

Thanks so much,
Marianne

[reesehascushings?]

I unfortunately do not have copies of her tests ( very lax of me) since most of the time they call the results into me and just tell me things are fine or not. I am going to call my vet now and find out if they can email me all from at least just prior to the start of the mitotane since this has been going on since she was 9 1/2 at various degrees. Thank you and I will post asap.

[reesehascushings?]

I did receive her records dating back to 2014

from latest tests

12/13/2015
ACTH stimulation
Pre ACTH cortisol 1.3
Post ACTH cort 1.4

CHEM 27 W/SDMA
alp 116 5-160
alt 55 18-121
ast 30 16-55
Creatine Kinase 226 (high) 10-200
GGt 2 1-13
amylase 840 337-1469
lipase 851 (high) 138-755
albumin 2.8 2.7-3.9
total protein 5.7 5.5-7.5
globulin 2.9 2.4-4.0
total bilirubin <0.1 0.0-0.3
bilirubin conjugated 0.1 0.0-0.1
bun 17 9-31
creatinine 0.8 0,5-1.5
cholesterol 180 131-345
glucose 107 63-114
calcium 9.3 8.4-11.8
phosphorus 4.5 2.5-6.1
tc02 (bicarbonate) 24 13-27
chloride 106 (low) 108-119
potassium 4.9 4.0-5.4
sodium 148 142-152
alb/glob ratio 1 0.7-1.5
bun/creatinine ratio 21.3
bilirubin unconjugated 0 0.0-0.2
hemolysis index 1
annion gap 23 11-26
sdma 10 0-14

both sdma and creatinine are within the reference interval which indicates kidney funicition is likely good.

[reesehascushings?]

11.02/15

urinealysis
collection method not given
color dark yellow
claririty cloudy
specific gravity 1.0
glucose negative
bilirubin 1 high
ketones negative
blood trace high
ph 6
protein 3+ 300 to 500 mg/dl
wbc 0-2 0-5 HPF
RBC 0-2 0-5
Bacteria None seen hpf
epi cell 2+ HPf
mucus none seen
casts none seen
crystals none seen
urobilinogen normal

Reticulocyte panel
% Reticulocyte 1.2
reticulocyte 73 10-110

chem 27 W/sdma

alp 1537 HIGH
alt 992 HIGH
ast 520ch
creatine kinase 209 HIGH
GCT 13
amylase 1112
lipase 295
albumin 2.5 low
total protein 6.2
globulin 3.7
total bilirubin 0.3
bilirubin conjugated 0.2 high
bun 24
creatinine 0.8
cholesterol 277
glucose 80
calcium 9
phosphorus 5
tco2 bicarbonte 22
chloride 102 low
potassium 3.9 low
sodium 144
alb/glob ratio 0/7
bun/creatinine ratio 30
bilirubin unconjugated 0.1
na/k ratio 37
hemolysis index n
lipemia index N
anion gap 24
sdma 10

WBC 15.1 4.9-17.6
rbc 6.05 5.39-8.70
hgb 15.9 13.4 -20/7
hct 45.7 38.3-56.5

Please note i believe Reese had a virus when these were taken.

Please note on the other tests in December REese was taking amoxyl and flagil for several weeks. Could being on the antibiotics produce false test results? thank you.

[labblab]

Can you give us the previous ACTH results so that we can see what the cortisol trending has been? Theoretically, the desired therapeutic range for a dog taking Lysodren is for both the pre and post results to fall between 1-5 ug/dL. So Reese's December numbers fall within that range, but there is minimal difference between the pre and the post numbers which indicates that Reese has little cortisol reserve available to help her cope with physical or emotional stress. It may be the case that, for her, the Lysodren is suppressing her cortisol below a level that is healthy for her and it may be causing problems for her, or compromising her ability to respond to other problems. It will help us to see the big picture and to find out whether her cortisol has consistently been running this low.

[reesehascushings?]

904/2015 ACTH stimulation test

Pre acth cort 2.2
Post ACTH cort 2.4


5/23/2015

Pre ACTH cort 2.5
Post ACTH cort 3.7

ACTH stim test 4/14/2015

Pre ACTH Cort 2.3
Post ACTH Cort 4.7


I feel as if I am missing information.. please let me know if I should ask for anything else.. I have many more blood test and urinalysis but I must leave now.. these are the most recent tests. Please advise

[reesehascushings?]

do the previous numbers help? I am sorry I am so confused by this disease and the treatments etc that I feel like a complete fool. Normally I am so on top of situations and obviously I did not do enough research. I also neglected to state Reese is going after me now, which she NEVER did. She is so afraid of me and if I so much as go near her to pick her up she has a new squeal and yelp and goes to bite my hands off. I believe this is from me giving her medications for so long. She used to take them easily in small pieces of bread, turkey or cheese but then after so many years of meds decided she was NOT going to take them. I then made the mistake of putting them in her food, then she stopped eating. We have been through the mill with these meds. She is now down to the mitotane twice weekly which I literally have to hide in one of those pill pockets and then hold her down and literally shove it in her mouth. No one else from my family ever took on her bathing, feeding, med care etc, so she naturally hates me now. I now grind up her food in a processor with a few of her meds and vitamins and then add plain chicken, carrots, string beans.. all low salt or low salt turkey. She will eat very selectively and sparingly. She now went from a HUGE PIGLET, eating everything with the exception of dust to dirt to now sifting through her food and I mean sifting.. she eats so slowly and spits out the pieces that she doesn't care for. The mats or floor is a mess and she barely eats at all. Since she woke up with the smelliest BM today and then bright yellow bile, I gave her chicken and rice which she barely ate. HELP..I feel as though I wished for my baby to eat normally to totally having to force her to eat. It is really heartbreaking. I do not know how much of this is the cushings, the so called treatment for cushings, Old age or something entirely different. What stumps me is why would her hair grow in so beauitfully and then start falling out again so badly? The whole journey has been extremely frustrating to say the least. Now she honestly has changed so drastically... for the first time in our lives I am afraid to even touch her, afraid to have others touch her and she also seems to be losing her mind.. seriously.. As I said she circles around on her pad and seems to forget why she went into her room.. sounds familiar, since I am 57 and going through a similar stage, but it is far more upsetting watching Reese. Please help.. this is not my girl and I would love to see her make a comeback but doesn't seem to be possible.

[labblab]

OK, so aside from anything else that may be going on, her cortisol level has been consistently dropping ever since starting on the Lysodren last spring. It was down to 1.3/1.4 in mid-December and may be even lower by now. It is good that her potassium and sodium levels were within normal range on this most recent blood test, but since many of her symptoms could be attributed to low cortisol, I am concerned that her adrenal glands' ability to produce natural cortisol has become compromised and is insufficient to sustain her. This insufficiency may be temporary or it may be permanent.

I am not a vet, but as poorly as she is doing right now, if she were mine, I would discontinue the Lysodren and ask the vet for some supplemental prednisone to see whether she responds favorably to a higher steroid level in her body. Given her weight of 7 pounds, she would only need a tiny dose of prednisone, maybe just 1 mg. (the typical "rescue" formula for replacing lost cortisol is approx. 0.25 mg per kg.). Under the circumstances, I really think you have little to lose by giving this a try, and I hope your vet will agree.

Marianne

[labblab]

We were posting at the same time. But in answer to your question as to why she was initially doing better -- her cortisol level was at the higher end of the therapeutic range when she was first treated. Since that time, it has consistently been dropping. That may explain the change.

[reesehascushings?]

I have pred in the house which was immediately given to me in case she ran into trouble with the lysodren. I have a call into my vet and will ask her if I can do that. She now threw up again, yellow vomit with the rice that she obviously didnt digest from her breakfast and had a loose mucusy stool. The last dose I gave her of the lysodren was her 107 on wednesday evening. I am supposed to give her her next dose on Sunday which I will not give, if I do not have to wean her off. Is this the case, to your knowledge. I believe she might have to be put on antibiotics now too since she has the loose bm and the vomiting. Hope my vet calls back soon.. in fact I think they might have closed without calling me back. Thank you so much for your response and I will definitely ask my vet about prednisone and stopping the mitotane. I then worry as to what if anything they will be able to treat her with. I appreciate your help so much. Do you know of any NY area specialists other than Dr. Peterson, or if anyone else does please let me know. I did a search on here but nothing is coming up and googled but nothing either.. Dr. Petersons name keeps coming up. Thanks again.

[labblab]

No, she does not need to be weaned off the Lysodren and I absolutely would not give tomorrow's dose as sick as she is. As tiny as she is, I am really, really worried about dehydration with the nausea and vomiting. Do you have an ER vet where you can take her if need be? Oral meds of any sort may not be an option due to the vomiting. She may need IV hydration and medication at this point, depending upon what is actually wrong. I would call your vet back immediately and tell them how sick she is. If they have closed, I would be trying to locate an ER vet near you. I am very worried for Reese!

P.S. I have sent a message to a member whose dog has been treated by a NYC specialist. I will let you know if I can get the contact info for you.

[reesehascushings?]

Hello all.. I spoke with my vet who informed me that she did not think she needed the pred, although I am beginning to wonder. She slept most of the day/night and did not eat, although I tried a couple of times to give her plain chicken. She is drinking in a very limited way. I was told to get her pepcid for the vomiting and to give the flagil twice daily. I will be taking her off of the mitotane and will test her again in two weeks and see if anything has changed. Hopefully she will regain her strength and feel better in the morning. Thanks for your responses. If anyone does know of a specialist again, please do let me know. Thank you.

[Squirt's Mom]

Sweetheart, your vet is wrong. For the sake of Reese's life, get him to another vet for the pred if his will not give you some...and do that TODAY. This is nothing to play around with. Levels as low as Reese's can be life-threatening and this is not a "wait and see" situation. Please demand pred from his current vet or take him to another one. I realize it is Sunday which means an ER visit but this is serious and must be done.

[My sweet Ginger]

Omg! I just have come across reading your last few posts.

PLEASE, STOP LYSODREN AND GIVE REESE PREDNISONE LIKE YESTERDAY !!!

Her adrenals are not producing any reserve cortisol and she needs supplemental prednisone to SURVIVE. Looking at her results of ACTH tests they started flatlining since Sept. so it's kind of amazing that Reese hasn't gone into Addisonian crisis for this long at very low blunted numbers.

Please, give her pred (1mg sounds right as Marianne suggested) for a few days and watch how Reese responds.
To me your vet sounds very inexperienced in treating Cushings and I hope you give her pred right now as Reese's probably suffering unnecessarily and before this becomes even more serious.

Btw, my pup had gone through a similar situation a couple of yrs ago. Song

PS: I know of a very good specialist where I live who treated my pup but it's 2-3 hrs away from NY as we live in CT. Please let me know if you are still interested in seeing this IMS.

[molly muffin]

Just spoke to one of our members in NYC.

Try The Animal Medical Center. http://www.amcny.org/endocrinology

Maybe Blue Pearl. http://bluepearlvet.com/locations/newyork/newyork-hospitals/midtown/

Lysodren erodes the outer cortex of the adrenal gland. It doesn't just get better. Prednisone is a must and electrolytes must be checked and fluids given if needed.

I agree with Leslie and song. See a specialist even at emergency clinic.

[labblab]

I'm so glad Sharlene could give you those referral suggestions! Honestly, I'm pretty much stunned that your vet will not OK the prednisone on a trial basis. There really is so little to lose and so much to possibly gain. If you do take Reese in to another vet, definitely take all those medical records with you for them to copy. In terms of her cortisol, though, here's the key info. This is her ACTH testing history since starting the Lysodren:

4/14/15: (Pre) 2.3 (Post) 4.7

5/23/15: (Pre) 2.5 (Post) 3.7

9/04/15: (Pre) 2.2 (Post) 2.4

12/13/15: (Pre) 1.3 (Post) 1.4

1/09/16: Even lower?????

Your vet has left her Lysodren dose unchanged even though her cortisol has continued to steadily drop throughout time. This shows the problem of looking at a single test result in isolation rather than tracking the trend. As long as Reese was looking healthy and well, any of these results, in isolation, would probably be OK -- even the December posting since the desired therapeutic range for dogs treated with Lysodren can dip as low as 1.0. But it's the trend that's the worry -- Reese's cortisol keeps dropping, dropping, dropping. The Lysodren dose should have been lowered, too, along the way in order to prevent the cortisol from ever dropping too low.

I don't know for certain that Reese's problems now are actually being caused by low cortisol. But as sick as she is, I truly don't understand why your vet isn't even considering that to be a possibility. I am baffled! I really, really hope you can get her in to be seen for a second opinion ASAP.

Marianne

[reesehascushings?]

Hello and thank you for all of your comments. I am shaking as I read this. I had a call into my vet at 12 and the voicemail said that she will call back in five minutes still have not heard. Reese had two loose bowel movements last night and then a bit this morning. I gave her the flagil and 5 mg pepcid since she threw up bile this morning. She has urinated and is drinking but is sleeping quite a bit.

Please let me know how much exactly of the pred to give. I do have it here and will give it to her but please give me the smallest and safest amount that will help her. Thank you for your time and help.

I care for my 15 week grandson in manhattan and there is a big animal hospital there on the east side I will contact them tomorrow to get an appointment... Please let me know the correct dosage for the pred I am getting it now.

[reesehascushings?]

Hi I have my bottle of pred.. it says 5 mg on the bottle, I have three pills and it says to give her 1/2 a pill if crisis.

Should I give her half the pill? Is this the right amount please let me know. The vet has not called me back and at this point I am beyond hysterical. As I said Reese is drinking and did urinate but is sleeping quite a bit. Please let me know how much pred asap. Thank you all.

[reesehascushings?]

Hi, second call into vet and no return. Obviously I need to find a new vet. Since I am in Manhattan quite a bit now I will probably move to one there if not only a specialist and a new vet here on Long Island.

As I said found the pred and the bottle states 5 mg and three pills. The vets instructions was to give Reese 1/2 of a pill, if goes into crisis?

Just checking that I do give her half today or should I give her a little less. I will wait a few more minutes and then just give her a little less than half. If I was wrong and I should have given her half I will after someone with far more experience than me, lets me know.

Please post a response. She is still drinking fine.. not interested in eating anything at all.. just wanted to see if she would take white meat chicken pieces and no interest. She is not panting, not whining, moaning and her eyes look good. Thank you

[labblab]

I just wanted to let you know I'm here and I am in the process of typing a longer reply...

[My sweet Ginger]

First take a deep breath, a few times.
I'd give her 1/4 tab to start off. I think that's a safe dosage for her weight of 7 lbs.
The bottle says 1/2 pill but I'd go with 1/4 pill for now and go from there and let's see what other members would say, k?
Deep breaths.

[reesehascushings?]

Thank you!!! I called AMC NY that is the animal hospital right near my daughters apartment. I asked for any appointment tomorrow with a Dr. Palmer or any of the internists but they will not give me an appointment. I will call the office tomorrow to try to get one then. If I need to walk in they will allow me to do that but I will not see a specialist. Do the internists have enough experience with Cushings? Right now she seems to be resting comfortably but I would like to give her the pred. Please understand that I am not usually comfortable in not following my doctors instructions but I believe in this case I must go with my gut and the experience of all of you.

Thank you and I am waiting to confirm the dosage.

[reesehascushings?]

Thank yoiu soooo much!!!! I am waiting but very much appreciate your post. I am trying to breath but I am beyond shock that my vet of so many years is not calling back. Deeply saddened and in disbelief that knowing all we are going through and have gone through, she is ignoring my calls for over an hour.

I am not naive when it comes to people and businesses but I truly believed that this doctor sincerely cared about Reese and her well being. I have certainly given them enough money but must admit I do question most moves made by them when it comes to her care. If this is offensive and out of line I suppose I have to move on since I feel we all have to be our own advocates and certainly the advocates for our pups. Thanks again and waiting with pred right near me....

[labblab]

OK, here I am again. I'm guessing the prednisone dosage was calculated back when Reese weighed closer to twice as much. So even though the "official" rescue dose calculation would be closer to 1 mg., it is probably easier to just give her the half pill rather than cutting it down even more and risking it crumbling. The excess pred shouldn't really hurt her on a limited basis.

This is my dilemma in advising you about this, though. I am not a vet, and I am not even sure that low cortisol is Reese's problem. We are all guessing on the basis of what you've described. I do not believe the prednisone will hurt her and I hope it will help. But I am just a layperson who is telling you this and it infuriates me that your own vet is ignoring you today. The safest thing would be for Reese to be evaluated by a vet, and that would be my preference, because with all the vomiting and diarrhea, her blood chemistries may be thrown off now, too, in addition to, or even instead of, low cortisol.

If getting her to the vet today is not an option, though, if she were mine -- I would give her the prednisone and then take her in tomorrow to be seen.

Good luck, OK? And please keep updating us!

[molly muffin]

It is not out of line. Maybe your vet didn't get the message or something? Perhaps the 5 minute reply is a standard one for during the week?
There are a lot of possibilities about the vet, so lets see what happens there.

Did AMC say why they wouldn't give an appointment? Is that just a weekend thing where everything is considered an emergency basis? If so, I'd think an internist would at least have access to a specialist if they need to? Did they say they Only have internist in on the weekend?

[labblab]

Thank you!!! I called AMC NY that is the animal hospital right near my daughters apartment. I asked for any appointment tomorrow with a Dr. Palmer or any of the internists but they will not give me an appointment. I will call the office tomorrow to try to get one then. If I need to walk in they will allow me to do that but I will not see a specialist. Do the internists have enough experience with Cushings? Right now she seems to be resting comfortably but I would like to give her the pred. Please understand that I am not usually comfortable in not following my doctors instructions but I believe in this case I must go with my gut and the experience of all of you.

Thank you and I am waiting to confirm the dosage.
Under the circumstances, I think it will be worth it to have Reese evaluated by anybody at the clinic tomorrow. I feel confident that whichever vet sees her will confer with colleagues there on-site in the event that they feel they need additional feedback. Really, at this point you are just wanting basic blood chemistries to be rechecked along with Reese's cortisol level so that supplemental treatment can be administered if it is necessary. Once you know she is not in immediate danger, then you can schedule a follow-up appointment with a specialist for long-term care management.

One very important note, however. The prednisone you give Reese today will artificially elevate an ACTH test result for at least 24 hours (the test can't distinguish between natural cortisol and prednisone). So you will definitely want to note the time you give her the pred and tell that to the vet so that, if possible, they can wait to recheck her cortisol until after the prednisone has left her system in order to get an accurate reading of her natural adrenal function.

Also, an internist IS a specialist. So if they can schedule a visit with an internist, that's who you are wanting to see. Different internists have different areas of special interest, so it would be nice to get somebody who has an interest in endocrinology. But any internist ought to be able to handle what you need to have done tomorrow.

[reesehascushings?]

Hi.. My vet called and said I can give her 1/4 of the five mg.pill once a day. She does not feel that she necessarily needs it but said no harm in trying..I gave it to her and I am to continue with the pred. 5 mg daily and the flagyl. forgive my spelling twice a day.

I will be taking her into manhattan with me along with our records and will attempt to get an appointment with one of the specialists tomorrow if not hoepfully tuesday.

If she still does not pop back in the next several hours I will contact my vet again. She did seem concerned but felt that it might just be a stomach bug or something other than the cortisol. In any case we are home monitoring her every move or lack of... she is still resting comfortably and taking water every half hour. I am taking her in. Hopefully she will have an appetite by later or tomorrow..with her stomach being off I really do not want to push the food. She has been through this before (stomach upsets) and she will hopefully bounce back and gain her appetite and especially with the aid of the pred. Thank you so much ladies and will keep all updated. xoxoxo

[reesehascushings?]

I just saw additional messages. Yes, her dosage was calculated when she was probably closer to 9 - 10 pounds. My vet adjusted that and told me to give her a little less than 1/4 of the 5 mg pill. I thought the pred will interfere with the acth so I will mark that down. They do not have appointments with the internist avaiable tomorrow but maybe I will go in as a walk in just to see whoever I can and then take it from there. I will see if she improves today (wishful thinking) and if she does eat, drink and has more energy etc I will hold off until hopefully tuesday to get an appt with one of the three internists. If she does not improve I will go as a walk in with baby in tow and then take it from there.. just to check her vitals etc.

Thank you so much ladies!!!!! I cannot tell you how much I appreciate all of your expertise. It is a comfort knowing that I have this forum to speak to others in the same boat with far more experience than I have. This has been a rocky 4 1/2 years with Reese. We have been very spoiled since until her cushings diagnosis and even at the early stages we were blessed to have a pretty healthy and very happy little girl. the past six months to a year have been a far different story. Hopefully we will get things back under control now.

Everyone enjoy the rest of your weekend and know how much you have helped Reese and my entire family. Xoxoxo

[labblab]

I think that sounds like a good plan! Good job, Mom!!

[reesehascushings?]

Thank you soooo much!! You have all been wonderful. I am thankful that I had found this forum. Hope all have a great day and I will keep you posted.

[My sweet Ginger]

I like you plan too. Would you let us know how she's doing later today? I think the pred should help her. Try to stay calm and just love her.

[reesehascushings?]

Hi Everyone!!! Thank you Thank you and Thank you a million more times. Reese spent most of the day in her crib, yes crib, sleeping and I was very worried even after the pred at about 130 2PM. At about 5 PM our girl was a NEW girl. I wont be overly positive since I do not want to jinx this but she got up took water, urinated, was even running okay skipping around.. .Reese from the time she was a puppy never ran, never climbed stairs, never jumped off furniture etc. She was so perky and started barking for food. I still went very conservative and gave her a small amount of rice and boiled white chicken. She ate beautifully and urinated again, drank just a minute ago and happily went back on my bed to sleep. She seems sooo much better. She is walking better, which could also be the pred for her arthritis and bad knees, hips.. she is just wonderful! Hopefully this is an upward trend. I will contact the internist tomorrow to see if I can get her in on tuesday and will follow through with her new protocol based on her six month trend.

I again have to say if all of you did not post your messages I probably would have just waited and I now know the results could have and more like would have been deadly. I am ashamed at myself because I often wondered why we werent possibly lowering her dose since she seemed to be going to the Addison side of the spectrum. I no longer had my piglet who barked every second for food but the reverse who was basically starving herself was not who we wanted either. I will have to see where we go from here but I will NOT put her back on the lysodren until someone assures me they will monitor her carefully and know when to adjust the dosages.

Thank you again so many times over and I will update all. I am definitely following through and will keep you all posted. I am off from my grandma duties on Wednesday so I will definitely post then, if not before. Everyone have a fantastic week since I certainly am far happier... guarded happiness but she looks like she will be doing far better. xoxoxoxo

[molly muffin]

Oh we are so happy to see this update.

Hopefully this trend continues far far into the future.

Finally a smile at the end of the day

[My sweet Ginger]

I'm sooo glad Reese has perked up and making you so happy by eating and running around. There is nothing like seeing your pup being happy again. It's such a relief.

She now has to take pred for as long as her body needs it which she will tell you with her clinical signs. Hopefully it won't be too long although my pup stayed on pred for months and months after her Lysodren overdose while we were slowly trying to lower her dose to a minimum.

It makes me really upset that you and Reese have suffered so much for so long so unnecessarily when all your vet had to was lowering her dosage according to the results of ACTH tests. I'm not a fan of your vet right now and wouldn't go back to her for Cushings treatment.

Now you know it wasn't that Reese hated you when she tried to bite your hand. It was because you were forcing food down in her throat when she didn't have any appetite and her low cortisol was causing a lot of pain in her joints and body. She was feeling miserable and in a lot of pain. My heart aches for you and Reese for having to go through all that suffering so unnecessarily.
From here on I hope you and Reese will have many many happy days together. Hugs, Song.

[labblab]

:) :) :) :) :) :) :) :) :) :)

As Song says, I would give the pred again tomorrow if Reese will not be seeing the vet until Tuesday. If you do arrange a Tuesday appointment, I would not give the pred on Tuesday until after the appointment so that the vet can perform an ACTH test without interference from the pred.

[My sweet Ginger]

I know every vet or specialist treats their patient differently on a similar matter but this is how I remember in my pup's case when she was suffering from a blunted case of ACTH 2 years ago.
Two reasons why we didn't do ACTH test at that time. One was she didn't want to stop the pred because she needed it to survive and the second was we knew her cortisol was low as long as she needed pred so we never had ACTH test to see where her cortisol was and I was totally comfortable with her decision. We had one ACTH test many months after but only to see whether her adrenal glands were stimulating or not which showed they were.
Probably they will want to do an ACTH when they see Reese by Tues. but I agree with our IMS and think it's too early for that test yet going by how much the pred is helping her right now. That tells me her cortisol is still pretty low. I'm curious to see how they want to treat her.

[labblab]

Dexamethasone does not interfere with ACTH testing in the same manner that prednisone does. So if going without a steroidal supplement is perceived to be a risk, dexamethasone can be substituted on the day of testing or beforehand in order to still proceed with an accurate test. If you are worried about waiting to dose Reese with pred until after she is examined, you can ask the vet about giving her dexamethasone instead.

Marianne

[My sweet Ginger]

We in fact talked about switching pred with dexamethasone for that exact reason if we needed to get an ACTH test but we just didn't see enough value of having an ACTH test while Ginger's body was clearly responding to supplemental steroids. We both agreed it'd be a waste of money and an unnecessary stress on Ginger at the time.

Yes, we were going to have an ACTH once she starts showing Cushings symptoms again for the treatment purpose but she didn't show them therefore no ACTH tests were done except for the one to check on the stimulation factor as I mentioned earlier.

Based on our own experience this is what I'd like to do if I were you.
Since she's responding to pred so well right now I'd keep giving her daily pred 1/4 tab of 5mg until she's seen by a specialist and let them take this pred factor into consideration in treating Reese under their own protocol. I don't think her cortisol will rise so rapidly to a dangerous point in a couple of days. I will just enjoy her being herself again in a long time.

[labblab]

If Reese continues to look good, I don't disagree at all with giving the pred and holding off on the appointment until later in the week when you can actually see the specialist you want.

In terms of overall treatment, though, I do think Ginger's case was somewhat unusual. In no way am I saying it wasn't appropriate for her specific situation, especially given her multiple heath issues. But I doubt that many vets would want to wait so long, generally, to retest adrenal function in a dog suffering from Addisonian symptoms secondary to Lysodren treatment.

First, the eroded adrenal cortex may begin to rejuvenate sooner rather than later and waiting to reassess until clinical symptoms have actually reappeared may mean that cortisol is once again so high that you would have to begin all over with a full loading regimen. Secondly, if a dog is given supplemental steroids continuously over a lengthy time period, the natural cortisol production can be suppressed regardless of the underlying health or state of the adrenal glands. The dog can end up dependent upon the steroid instead of producing natural cortisol. A dog who is permanently Addisonian will always require this supplementation, but there may be some middle-ground in which some rejuvenation occurs and the same amount or frequency of pred is not necessary.

Neither of these issues should be a concern on a short-term basis for Reese. But my best guess is that the specialist will want to get a sense of her natural adrenal function relatively sooner rather than later. It may not be immediately, but I wouldn't think he/she would want to wait longer than a couple of weeks or so.

[labblab]

How is Reese doing? Fingers crossed that she's continued to improve!

Marianne

[molly muffin]

Checking in to see how Reese is. Did you take him to the specialist?

Oh I remember now, you said you might not be able to update till Wed. It's almost wednesday, does that count? :)

[reesehascushings?]

Hi All.... I am sorry I havent been here but as I said I commute into manhattan from Long Island very early in the morning to care for my 17 week old grandson with Reese in tow. She is doing very well and I have been speaking with my vet regularly. We stopped giving her pred on Sunday (weaned her off) and as of now she is doing GREAT!!! She has more energy than she has had in many years and is urinating regularly and drinking normally. She is not panting and eating great. She is barking for her meals... which I never thought I would be thankful for but I am sooo thankful. If some do not recall from the time reese was a puppy she had an enormous appetite and would eat almost anything short of dust or dirt etc. She would bark constantly and finally responded to a glass with coins. which we used when we had meals to stop her when food was around.

I have the specialists appointment on the 26th to see what he believes I should be doing now. My vet wants to see her back in two weeks (if no other concerns prior) I presume to do an ACTH and other cushings related tests to see where her numbers are at now. Her stomach has been fine since she had the initial problem and does not vomit at all.. thankfully!!! She has been fabulous and is even great with the baby... barking when he wakes up or is crying. I still will not let her too close to him and probably never will.

She seems to be putting on weight which also leads me to another question. Reese was on a prescription dry food for allergies, grain free, rabbit based and was doing pretty well. She had stopped licking her paws over the past year. I now ran out of my food and had asked my vet what I can use instead.. she said any good quality food should be fine. I am not knocking the vets I have used but most do not seem to be as experienced in nutrition and seem to be unfamiliar with the various brands. Over the years I had tried raw and various others but would like her on a very healthy food, rabbit based since the itching has stopped and grain free. Does anyone know of something. I have been grinding her food up with salt free chicken broth some carrots and string beans, low salt and some fresh chicken at times or beef chopped meat plain that I cook. At times I do add a little rice (which she dislikes) and I blend in her vitamin which she had stopped taking, mainly for her arthritis and when I spoke with a dr from University of Tennessee he had suggested that I give her the melatonin I had given to her for many years when she had atypical cushings.. he said it cant hurt and maybe her hair will come back again. By the way the vet at UT did not think she was necessarily in need of pred or that her lysodrol was too much but I will find out from the specialist next week. He also felt that my dr did not have to reduce her dosage (even though I was seeing significant bad signs) I was stumped over that.
If anyone can recommend a great food.. I know I contradicted myself about the allergies to chicken and beef, but for years we stayed away and even though every now and then I would add fresh chicken or beef in her itichiness didnt' seem to return. I know I am all over the board right now, as usual, but would like your thoughts and comments on as many as you have time for, especially the food issue since it would be great to remain local to purchase her food vs going several towns away for her prescription food. Thank you all so much and sorry I didn't get back sooner. I seriously feel if it wasn't for all of you Reese would have been in major danger!!! Thank you!!!!!

[Harley PoMMom]

Thanks so much for the update and what a wonderful one it is!!!!! To be honest, with Reese's allergies and since she is doing well on her prescription dry food I'd be leery to change it.

Fromm and Primal are two brands that I have used for my dogs and I see from searching that Primal does make a rabbit formula: http://www.primalpetfoods.com/product/detail/c/7/id/46

Let us know what the IMS says, please!

Hugs, Lori

[molly muffin]

Yea I don't know if I'd change food either if it is working well now for Reese. I always have ups and downs when I try changing food, which I'm going to have to do since the one I am using is no longer being made. ugh!

Sounds like Reese is doing good now. Yay!

[reesehascushings?]

Hi everyone... I had to cancel my last appointment with Dr. Palmer in Manhattan due to the baby being sick and do not have one until February 19th. I am unsure if I can even wait until then. Things have been going okay but not too great. I had Reese back at my vet for a total CBC and urinalysis and a couple of other tests (blood). If you can believe all came back FINE!!! Her liver enzymes were a little on the lower side now, when typically hers were starting to get very high. She is still not eating too great and now my vet told me that even if her livers are on the lower of normal they still might not be normal???? In fact it can be more indicative of the liver shutting down? Help I am so confused and if normal low and normal high or down right high were going to show and not give an answer why did I spend close to 300 dollars on all of these tests. A tiny bit of protein in her urine but nothing remarkable. She has lost so much weight and continues to do so. She is very picky and will only eat $40 per pound briskett and barely eats that. Today she refused all food. She seems to be drinking much more and is so tired and doesn't want to be bothered. Yesterday she ate nicely and was with me caring for the baby and was even a little energetic. I didn't ask for a copy of her labs but will as soon as I finish typing this. After I received her report over the phone I asked my vet if we should do an ACTH and she said NOT necessary. The last was done in December and she felt like that was normal and Reese was still having some of these issues..NOTHING as bad as NOW. What if she does have Addisons? Could she now be dealing with that? When she was put on the pred for that week or less she seemed to do far better. My vet said of course she would when put on pred but that she shouldn't be on it now. I am goiing out of my mind thinking I am sitting back and killing her. She is down to 6 pounds 9 ounces. She was 7.5 at her last visit and probably nine something prior to starting the lysodren. I feel as if the dose was way too high for her even though her numbers seemed to be within normal range.. maybe not for HER. As some of you had pointed out to me her tests kept showing a downward fast trend. What should I do now.. Please help. What also shocked me was when my daughter and I brought her on Saturday after calling to tell them I didn't like how she was acting.. no energy sleeping so much.. barely eating .. the vet didn't even see her.. she just sent her to the back for blood and urine tests.. I know I am very sensitive now but that seems horrible. I had to ask for her to be weighed. Something does not seem right and again I feel as if am letting her die.

Please offer some suggestions as to what to do now. Dr Palmers office said they cannot get her in any sooner and it doesn't seem to make sense to bring her in as emergency to see just anyone there, they said Dr Palmer would not be brought on to her case.

Please help is there anyone else in the NY area that I can go to. I have begged the specialist whose name escapes me now to at least speak with me that I would pay him for a phone consult and the nurse said NO... Help please.. Thank you.

[reesehascushings?]

Hello all again... I just was lucky enough to change reese's appointment to friday of this week at 4. I hope she will even be okay till then. Obviously if anything horrible does happen I will run to the emergency room. She is resting comfortably now in my bed. I had given her a little pepcid, recommended by my vet in the past couple of weeks for vomiting and gave her some tilen (spelling) powder since her stool was a little loose last night.

If anyone has heard of Dr Palmer please advise and if you have another recommendation for someone who truly specializing in cushings please let me know, as well. I will run anywhere. Thanks so much for your help.

[Squirt's Mom]

"12/13/2015
ACTH stimulation
Pre ACTH cortisol 1.3
Post ACTH cort 1.4"

If this test is what your vet is calling "normal" they are wrong. If you can afford to have the ACTH done and her electrolytes checked I would INSIST those tests be done TODAY. If your vet refuses, find another vet asap. The signs you are describing could certainly be attributed to low cortisol and if the levels go too low or stay too low for too long, that is life threatening, something her vet either doesn't understand or simply can't be bothered to care about, something I am sorry to have to say. This is YOUR baby and she cannot speak for herself - you must stand firm for her and demand these tests be done now.

[reesehascushings?]

I am so confused and I apologize. If that test in december was NOT normal how can she tell me there is no need for it and that they were normal. I have asked her ten times already, including on Monday why we wouldn't test her again.. she said NO NEED!! "her tests in december were normal". I am beside myself. Can she be in an Addison crisis? Why is my vet looking for other possibilities and not dealing with the given? Why wouldn't she think if the ACTH goes is lower yet again that there is a PROBLEM with the meds that caused this.. whether too much or whatever.. that it just didn't agree with Reese. Why is she searching for other things.. such as a problem with her liver????

I am shaking and just do not know what to do at this point and now all of a sudden she is watching my money by telling me the acth is an expensive test and no need now? But all of this other garbage is??? And a test that shows lower normal range livers but she still doesn't think it is necessarily normal so lets do liver bile blood tests on saturday?

I can only get her in on an emergency basis into the city and don't even know where to take her for an acth stim today. She I demand that my vets office does it? Her associate is in who also doesn't think I should be questioning them so much.

[Joan2517]

This is scaring the crap out of me!! If you can't trust your own vet, what are you supposed to do??? They are the ones who are supposed to know all of this....we rely on them.

[labblab]

So you just had blood work done on Saturday that included liver results? If so, that would have been a chemistry panel that undoubtedly would have already included the potassium and sodium, as well (the electrolytes we are most concerned with). But as Leslie says, that still leaves a big question mark about the cortisol.

Your vet's comment about the prednisone makes absolutely no sense to me. If "of course" it helped before, how can she possibly know that Reese doesn't still need it now without rechecking the cortisol. You know, I would be tempted to go ahead and give her some pred today in order to see whether it helps her again now, just as it did then. You are still 48 hours away from the Friday vet appointment, so it will be out if her system by then and can't compromise testing. Or, in the alternative, go ahead and take her in now for cortisol testing as an emergency in advance of that appointment with Dr. Palmer. He will then have that result already in hand when you do finally see him.

[labblab]

Hi, we were typing at the same time. Personally, I would stop taking Reese to the old vet for anything, period. I would try giving her the prednisone today and see whether that helps, and I would then take her to see Dr. Palmer on Friday. If the pred does not help and she worsens even more, then an ER visit tomorrow seems to be your best option.

[reesehascushings?]

I called my vet and believe it or not are all out with an emergency surgery and said they do not think they can do it today. I called the city animal hospital and although Dr. Palma cannot see us until friday they said I can bring her in tomorrow as emergency. I am not thrilled with that but if necessary I will do it. She just urinated but still will not take any water.
For the past several weeks she seems to be confused goes around in circles on her pee pad and then goes to drink or pee or back and forth.

She doesn't seem to be stable on her legs and just does not seem to be herself. In fact I have been stating this since December. She has been off of the mitotane for several weeks now if not a full month but does not seem to be getting any better.

I will watch her a bit longer and then possibly even run her back into Manhattan.

Any additional advice please? I even told my vets receptionist that I feel bad that I am trying to be a dr but do not like how she seems and also would like the ACTH because gd knows how low her numbers are now. I feel as if we are chasing other things, the liver etc when the answer can be right under our noses. While I appreciate my dr trying to save me the close to 300 dollars on the acth, I would have preferred that than the 300 I just paid on a cbc and urine and other test that seemed to have proved NOTHING... and now a liver bile for another $140. I will wait to hear from her and continue to monitor reese.

By the way her stomach is gurgling a lot too.. any ideas of what that is. She does seem to be having a lot of stomach issues as well the past few months.. Thanks again.

[reesehascushings?]

Unfortunately I do not have any pred left. I had given her a couple of weeks ago when things were bad and then slowly weaned her off. The receptionist told me they will call me back and I will ask for more pred. I do not want it to affect her for fridays appointment though.. will she have enough time for it to get out of her system. The appointment is for friday at 4 with dr palma but I could bring her in to their emergency room any time tomorrow without any guarantee of them evening consulting with Dr.Palma.

I am at a loss at this point. It is 1230 here I will wait another hour and monitor her and then hopefully the vet will be back to give her the acth. Yes, I have lost total faith in them and very upset about this entire situation. I had asked if they could call U of tenn. to ask what could possibly be going on. Why she had done so well at the initiation of the lysodron but then had gotten so bad and lost the beautiful new hair she had grown back.. lost her appetite and therefore lost so much weight but they never called. I did call and spoke with whomever they allow you to, as a patient, and can't say that he gave me too much info. I am quite sure my vet would have gotten to speak with someone who would have offered much more information. Thanks again and will be back soon. Please let me know what you think. I really cant get into the city today for the animal hospital emergency room but if that is my only choice I will get on a train.

[labblab]

So you went through a second course of prednisone again a couple of weeks ago and that again helped her, or are you referring only to the original course of pred?

The last we had heard was that in mid-January she was doing well and the pred was discontinued. Did you start and stop the pred again after that?

And yes, if your vet can actually do an ACTH today, then that would probably be best. Then you can go ahead and give pred afterwards without worrying about it interfering with the Friday appointment. However, if there is at least 24-36 hours between the pred and subsequent ACTH testing, you should be OK. Or the other, perhaps even better, option is to ask for dexamethasone instead of pred, because it won't interfere with the testing at any time.

[reesehascushings?]

She was on one week of pred.. a little less than a week since she was weaned off by doing every other day for last three days. That was it. Ideally I was wishing I could get her in to see Dr. Palma today or tomorrow the latest but all the begging did not get me anywhere. She is doing okay, when I say that I mean.. resting not having any difficulty breathing and not vomiting, no diareah..wagging her tail as most as she usually does, but seems to have that constant confusion and lack of stability on her feet. She slept great, until she didn't eat her brisket this morning I wouldn't have known there was another problem. her lack of drinking is concerning me although she is not a huge drinker and never was, even with cushings.. that wasn't one of her symptoms.

I am just at a total loss and my mind is running all over thinking strange thoughts. Wishing in a way that she never went on the med. If she woudn't have been getting tons of infections like ear, vaginal, I highly doubt I would have put her on the mitotane. Her worst symptom was her loss of hair. I just feel all around guilt with this and cannot believe how much she used to eat and how food was her main love and now how things have drastically changed. We used to fight for her to lose weight and not bark during meals and now I would do anything to have her eat. She was always a tea pot yorkie.. pudgy as can be and now she has NO muscle mass, is so boney and only weighs 6 lbs 9 ounces and used to come close to 11. I am so sad and annoyed with myself for not taking her to a specialist earlier in this horrible game. She has been battling atypical or regular cushings since she was 9 1/2 and is now 13 1/2. I again wish I would have had her with a very experienced doctor such as Dr Peterson years ago. We live and surely learn the hard way. Thanks again for helping me so much...

[labblab]

Do you think your vet will give you some dexamethasone today without performing an ACTH? If so and given what you've said, I think I would ask your vet for an appropriate dose of Dex to try giving Reese today and tomorrow, and then wait until Friday to let Dr. Palma oversee any additional testing, including an ACTH. If the Dex helps her, that will aid the overall diagnostics and won't skew the testing. If it doesn't help, then it will look as though something other than low cortisol is at play.

[reesehascushings?]

I went to reeses vet and they didn't even look at her just whisked her off for the ACTH that I basically forced them into giving her. Results tomorrow and $300 later. They refused to give me the pred until they received the results back tomorrow. I still have the friday at 4 pm appointment with dr Palma and we will see how the results come back. I did ask for a copy of her cbc and urine tests from saturday and all and I mean all were normal with the exception of a little protein in her urine. I do not understand this since I would think that there has to be something going on if a dog goes from 9 lbs which was even low for reese about six months ago to now a mere 6lbs 7 ounces.. she was six pounds 9 on saturday but didn't even want to ask about that.. it might be a different scale or being that she hadn't eaten anything since about 5 pm last night. She did eat a bit of food tonight.. humam food of chicken and some brisket. Not a lot but at least she took something and appeared hungry (for reese these days) and drank and urinated. That was close to 90 minutes or more ago and she is thankfully holding it down. I am so sad, confused and paranoid at this point that I cant even begin to think somewhat rationally. She is resting/sleeping comfortably on my bed and we will see what tonight brings. Thanks again for guiding me.. if it wasn't for all of you I dont know what I would be doing or where reese would be. Thanks again. Will check back later or tomorrow.

[reesehascushings?]

Sorry I overlooked the dex suggestion. I am pretty naive with the names of the drugs and I originally thought it was another type of pred. I didn't even know to ask for that and the partner at the vets office didn't suggest it. I had only asked for pred which I was told not to give until they had the results. Other than that the vet (main partner since my vet was not in) said nothing but Hi to me. I guess my expectations might be unrealistic but I would have thought that both partners would have wanted to physically evaluate her. Neither looked at her or asked me any questions at all. I am so disappointed and completely saddened since I honestly believed that her vets really did have a love for Reese and all of their patients. I am more than sure they are annoyed with me since I question everything and try to get to the bottom of things without giving reese every single test under the sun. I am aware that it is very difficult when dealing with cushings to first diagnose and the treatment could be tricky but I really thought when things got hairy they would be there and would try to get to the bottom of what was going on. The intial hair regrowth was great, her "normal" appetite vs her unusually high one was fantastic but when those numbers starting plummeting I think they should have discussed cutting back a bit. I have no idea why she would suddenly lose her hair again... it just doesn't seem to make sense and even while off the med her appetite continues to decrease as obviously her weight now. I hope the acth will give some answer but I am beginning to think it might be back up again since she was on pred for that week and she hasnt been on the mitotane for quite some time now. Will let you all know.. thanks again and again.

[molly muffin]

You said originally her liver numbers where low normal? or lower than normal? You have a copy of the testing done the other day right? What about sodium, posttasium, etc? are they low or high end of normal or right in the middle?

I'm just trying to get an idea of what might be going on with Reese .

The think is that those ACTH test, are on the low side and can definitely be affecting appetite.

[reesehascushings?]

Her liver numbers from this past sat were on the low normal side,according to my vet. She said if reese was acting fine she would not be concerned. The past few cbcs always indicated high liver numbers. These were her latest livers
Alp. 48. Normal range v5 to 160. In the past she had crazy high numbers in the triple and quadrupol levels
Alt. 28. Normal range. 18-121 again past were high
Ast. 29. Normal range. 16-55
Creating. 134. Normal 10 -200

Do you want the others. Most with one exception were all in the normal range. Only thing high was lipase 851 normal 138- 755
I also just received her acth stim taken yesterday. I received it quickly and asked for a copy to be emailed but it was 1.8 1.9. Unsure of pre and post but very close. The last ones taken in dec were 1.3 1.4.

I was told that bring off the mitotane and the pred did raise it is this high enough being she has been off of the drug for at least a month?!they did now prescribe pred. My concern is her stomach is gurgling with horrible gas fumes. Any idea of what might be going on. Thank you

[Harley PoMMom]

I am glad to see her ACTH stim numbers have risen...phew that is a relief. I am quite surprised to see that her liver enzyme levels have come down to with in the normal limits so fast, which is a good thing.

Does it seem to bother her if you touch her tummy? Is her appetite still off? If so, than with the tummy gurgling it may be that she has pancreatitis. Generally with pancreatitis those liver enzymes would be elevated but you never know. So, if this were me I would have a spec cPL test performed to see if the pancreas is inflamed. Here's a link to info about the spec PL test: http://www.idexx.com.au/pdf/en_au/smallanimal/reference-laboratories/spec-cPL-brochure-aus.pdf

Hugs, Lori

[labblab]

I absolutely think it is essential for you to keep the appointment with Dr. Palma tomorrow and to have Reese's test results available to give him. Given the fact that a full month has passed since Reese was treated with the mitotane, coupled with her behavior, I am not happy to see her ACTH results still at a level that is technically below normal for a disease-free dog ("pre" and "post" both less than 2 ug/dl), and still so "flat" (meaning such little difference between the "pre" and "post" number). I believe these results would signal an Addisonian condition for a dog who is not currently being treated with a Cushing's drug and since Reese has now been off the mitotane for a full month, I would have hoped to have seen a larger rebound if her adrenal function had significantly rejuvenated subsequent to the mitotane. So my personal opinion is that she is still suffering from at least some degree of oversuppression of her adrenal function and may very well be in need of some supplemental prednisone to make up for her lack of cortisol reserve. I really don't know what to make of the liver results.

Please, please, please keep that appointment tomorrow and let an expert evaluate her test results, her appearance, and her behavior!

Marianne

[reesehascushings?]

Hello All.. Thanks so much for your reponses.

We did see Dr. Palma yesterday and he does not feel that Reese has addisones but feels that her numbers are fine. I was shocked but he does not feel that the numbers are bad at all and in fact said that he feels that they are well within normal ranges and that she responded well to the mitotane when on it. He feels that what she is now experiencing is completely unrelated to cushings or the meds.

He is pretty sure that she has IBD and needs to be treated with Steroids (heavy duty steroid amounts) to hopefully control her diareah, vomiting, lack of appetite etc) He feels she is malnurished and wanted to do a lot of other tests such as ultrasounds, xrays, endoscopy etc down the road. To be honest, I asked if we can now skip all of those tests and just go with his thought of IBD and treat that condition. If she responds then great and that is what we were dealing with, if she does not they then feel that she probably has a tumor that is cancerous (anywhere in her body). Now you might ask why don't I want to know or seemed concerned about cancer and my answer is that if a cancer was found at 13 1/2 years and her current condition I would NOT put her through any type of surgery or chemo treatment. Therefore I would not be using that diagnostic information to any benefit, other than knowing. Under most instances I am the type of person that needs to know everything but at this point and based on her condition I will know soon enough if she does not respond to the high doses of pred. If not we will have to make her comfortable and analyze her quality of life and then probably make a horrific decision. If I found out it was cancer tomorrow (Gd forbid) I would do pallative care and then probably have to make the decision even quicker because again for us, surgery is out of the question.
Some might be horrified with our feelings but I cannot help that. Having lived through both my parents dying from terminal illnesses and all of the treatments we did and then had to stop I will never be led to feel that our decisions are selfish or wrong in any way. Reese is truly the love of our lives but I feel I know when to put a stop on all of the treatments, tests and possible surgeries. I can only pray now that the high doses of pred will help her to feel better, to regain her ravenous old appetite and to increase her energy level.
Dr. Palma does not believe that it is liver failure or damage and feels pretty confident that the pred should help her and again No addisons

I am concerned that we spent over four years trying to control the cushings and now we are giving her a drug (pred) that basically causes cushings. We were told to expect the same side effects of the cushings.. hair loss, panting, increased urination etc, but that we MUST treat the underlying cause of her feeling so poorly now, with the pred and hopefully we will be able to wean her off of the pred after two weeks of very high doses.

I appreciate all that everyone here has done for me and I will keep you all updated. I am very sad and very scared but will do all that we can to over come this latest obstacle. Reese has had a wonderful life, as we all have with her and I only hope that we can extend that for as long as possible and make her as comfortable as possible.

So if anyone knows what we can safely feed her that might fatten her up, since she has lost so much muscle mass and is only weighing in at 6 lbs 7 ounces, we would appreciate it. We will be cooking our own brisket today and hope she likes it as much as the local delis as well as cooking chicken and rice (which she has really lost interest in) I will try a sweet potatoe and have pumpkin as well, but unsure if these things are good for her stomach issues.

I am waiting for Dr. Palmas assistant to call me so I will go over other options and suggestions. Reese refuses to eat her dog food so I am worried about her not getting necessary nutrients (although I never had much faith in the quality of dog foods) hopefully Dr. Weatherson will make suggestions for supplements or something that I neglected to ask about last night.

Please let me know if any of you have dietary ideas and if you have any comments on her latest diagnosis etc. Thank you a million times over.

Randy
xoxoxoxo

[Joan2517]

Hi Randy,

Personally, I would do the same. I would not put my Lena through surgery at this late stage in her life, or do anything to make her uncomfortable for whatever time she has left. We will deal with the Cushing's and hope for more time, but if it gets to the point where she is not doing well, I will have to make that awful choice. I love her more than anything and I hope I will be strong enough to let her go when the time comes. I wish she could be with me forever.....

Joan

[My sweet Ginger]

Is Dr. Palmas a GP or an IMS? With all due respect, a lot of GP vets do not have enough depth in Cushings knowledge or experience. And sadly even not all IMSs are the same either from my personal experience.

Briefly skimming through your recent posts if she were mine I'd put Reese on a therapeutic dose of prednisone before moving on to any other tests and watch her progress. My thinking is that your vet may be putting her/his ego above the safety of Reese's and usually it's almost second to impossible for them to admit their mistakes.

Maybe not alone but together ACTH pre and post numbers of 1.8 and 1.9 are not really ideal at all, at least not to me. I feel like I'm constantly repeating myself but with numbers such as her's there is no stimulation in her cortisol therefore her system can't not function as it normally should. My pup's pre and post were 2.9 and 2.9 and still she suffered a functional Addison's state for a long, long time. She needed prednisone waaay beyond a week or two. It was more than a full year.
No one knows for sure what's really going on with Reese right now but if I were you I'd try prednisone before anything else although not at that high dose of what they prescribed going by what you wrote. What's the dosage they prescribed for her?

Also I'd put her on appetite stimulant for her poor appetite and Tylan solution for her IBD. The daily dose of liquid Tylan was the only thing that was able to control my sweet baby's (miss her too much) chronic IBD to the end. We had to compound her Tylan solution from Diamondback because the powder form (capsule) was too HUGE for her to swallow at 6 lbs.

[Harley PoMMom]

I believe I, too, would be inclined in trying a therapeutic dose of prednisone for a period of time. Although Reese's ACTH stimulation numbers are within Dechra's ranges for a dog being treated with Trilostane it could be that Reese needs her numbers to be higher in order for her to feel and function better, all dogs are different and have different reactions to medications, so this is why I would let her numbers run higher and see if she perks up.

Adding carbs to her diet may aid in gaining weight; potatoes, pasta...etc. You could also try feeding her baby food, with no onions or onion powder listed in the ingredients.

[labblab]

Well, I have been pushing you to see Dr. Palma, but now I am questioning his game plan, too. :o

It is certainly possible that there is something else/additional going on with Reese such as IBD. But I remain puzzled that he is happy with her adrenal function when it is "flat" and low-normal at best, after a full month off the mitotane and while not taking any Cushing med whatsoever. Even if Dr. Palma does not think Reese is technically Addisonian by the numbers, I still wonder whether she is able to muster enough of a cortisol reserve to adequately respond to daily stresses. But giving her high doses of prednisone will certainly offset any problem with low cortisol if there is such a problem, and perhaps it will indeed help if she has some other inflammatory process going on like IBD.

But correct me if I'm wrong -- wasn't Reese pretty much back to normal, including appetite, during the week she was receiving only the lower dose pred back in January? Does Dr. Palma know that the lower dose pred helped her significantly? If so, I don't understand why he wouldn't want to at least give that a try again first, before launching into massive steroids. That part of the equation puzzles me...

Marianne

[Squirt's Mom]

I am very disappointed in Dr. Palma and am beginning to wonder if there are ANY vets in your area that understand this disease? Yes, 1.9ug/dl is within the acceptable range for a Lyso pup BUT combined with the pre number and her signs, it is pretty clear to me this is a situation of the adrenal glands not producing enough cortisol - an Addison crisis, hopefully not Addison's disease, tho. I'm not a vet but this makes much more sense than IBD. It is your baby of course but I would want a third opinion OR tell him that first I was going back to the low dose of pred that she was on for a week that made her feel better and see if that didn't do the trick. I am just so sorry you and she are having to go thru this. :(

[molly muffin]

I'm on board with the others and trying a therapeutic dose of prednisone for a period of time.

I do think there is a very good chance that with maintenance dosing of prednisone it could be beneficial.

[molly muffin]

Okay. I spoke with someone I know in Manhatten finally and whose dog has both Cushing's and diabetes and eye problems and got the name of her specialist whom she really likes.

It's the Animal Medical Center on East 62nd Street Dr.Appleman. She is head or co-head of internal medicine. She said to ask for her specifically when you make an appt or at minimum a Staff Doctor. Do not let them give you Dr. Daniel Chan. She didn't care for him but said you will like Dr. Appleman and she knows her stuff.

Bio here: http://www.amcny.org/about-amc/veterinarian-specialists/beth-appleman-dvm

I'm sorry it took so long to get this info to you but maybe we vpcan get Reese seeing a good specialist and team and on track.

[Budsters Mom]

You typos/dictation errors always crack me up Sharlene. Thanks for the laugh!:D;):D


got the name of her socialist

[molly muffin]

I really need to turn off autocorrect. It always thinks it knows what word I m going to use Grrrrrrrrr.
Fixed it. Don't care if the specialist is a socialist. ROFLMAO thanks Kathy lol

[labblab]

Sharlene, Dr. Palma is an internist at The Animal Medical Center. :o

[molly muffin]

oh dear. Didn't realize that. Well. They aren't all created equal. I've seen 3 IMS at the place I go to.

[labblab]

That is certainly true!

[reesehascushings?]

Hi All... thanks for your responses and the information about the specialist. Dr. Palma is an internest. I only have a brief time to type but will be back later. Reese is taking 1 ml of pred for a week and then 1/2 in morning and 1 ml at night for the following week. They feel they can combat any IBD issues she might have and also bring up her numbers for the possible lysodren problems. She is NOT taking lyso and has been off for over a month now.

Since her appointment on Friday and the pred started on Sat she is basically a different dog. She is eating great.. possibly a little too hungry but now as long as she doesn't vomit or have diarreah my goal is to have her gain weight. So far she is at about 7lbs 4 vs her 6 lbs 7 last wed. I would say that is a good start. Although dr. Palma and staff told me that she will have the cushings symptoms the only thing I have noticed is the appetite increase, which I am happy about. She might drink a little bit more and might urinate a drop more, due to probably eating and drinking more. They told me her coat would worsen and of now it looks the same as it had gotten recently if not a little better. She is not sleeping as much and is running around or far more quicker than she has in a long time.

I know how dangerous pred can be but I think there is a great time and place for it, if monitored correctly. After contacting my vet yesterday, they told me to cut back on the pred to 3/4 of the initial dose. I then happened to speak with a director there, Dr. Goldstein who recommended that I leave things as initially written by their team. That is the difficulty I guess in working with your vet and an internist. I am going to stay with the internists recommendation unless I notice anything out of the ordinary. I must leave for an appointment but I will come back late afternoon. AGain I appreciate all of your recommendations and will keep you posted.

Unless it is my imagination I really feel that Reeses muscle mass has improved greatly in a very short time. She even feels far heavier than the 7lbs 4 ounces she is. I am just very relieved about her bouncing back but again remain cautiously optimistic. I am always afraid that pred will be a quick fix but then cause far more problems later down the road. Their goal is to wean her off after two weeks, so I suppose they will take a new cbc other blood work and the ACTH stim. I better get a job other than only caring for my grandson... salary free!!! Thanks so much and hope to hear from others later.

Best,

Randy and Reese

[reesehascushings?]

I have to add one thing... Dr. Palma was referred to me by Dr. Feldmans office. The doctor who has worked with cushing dogs and cats for many years. I felt that if their office was recommending him to me, how could we go wrong. He seemed to be very qualified and extremely nice, just do not know why all haven't put too much emphasis on the lysodren causing the problems.

[molly muffin]

I use the specialist for my molly and my vet only for things like vaccinations (when she must have them), another vet for BP (since the primary vet doesn't have a BP machine) but really her specialist deal with everything that relates to her overall health including her blood panels, urinalysis, UPC, etc.
I'd rather have them doing the overall, so there is no conflicting back and forth as to what we should be doing, so cushings, completely in the specialist hands.
I think that would probably be advantageous for you to as your vet might say one thing and the specialist another. Take that out of the equation and it becomes much easier to have her care in one departments hands. Just my thoughts.

[labblab]

Randy, I can't tell you how happy I am to hear about Reese's improvement! Such great news! :)

And yes, prednisone can be a wonder drug in lots of situations. Out of curiosity, can you clarify Reese's dose? You mentioned 1 ml., which makes it sound like a liquid suspension. Can you tell us how many mg. of prednisone are in each ml.? The dosage ought to be written out somewhere, either on the bottle or an accompanying box or label.

Marianne

[reesehascushings?]

Hi all again... I have decided to stay with the animal medical center and Dr. Palma in Manhattan, for now. We are going back for a follow up on Friday. The dose is quite high, according to my vet. It is a suspension of 15 mg/5ml solution 1 ML two times daily for 7 days and then 1ML in the morning and 1/2 ml in the evening for the next 7 days then a recheck which is scheduled for this coming friday.

Reese's hair loss continues, as expected by all vets, urination is slightly increased but not to an unmanageable rate, drinking slightly increased again not too unmanageable, appetite definitely increased.. thank GD, even eating her dog food mixed with all kinds of healthy things, but definitely has subsided a bit when the pred was reduced.

BMs are regular, slightly loose..slight foul odor.. wished they were a little healthier looking and smelling.. sorry to get too graphic.

Today was the first day I heard of belly gurgle a little.
She definitely gained some weight, over 7 lbs now thank gd.. she was on a huge downward swing.

Just to be clear though.. Dr. Palma is not sure that the pred will be a permanent fix. He is still unsure as to whether or not the IBD is the main issue. I was the one who has stopped the sonos, xrays etc to look for any possible tumors, Cancer. As I had said I would NOT do any surgery or even chemo to destroy any possible Cancer so for once in my life I did not feel that I needed that information. If the drs were willing to try prednisone without the additional tests that was the route I wanted to take. I only hope they feel positive about the past two weeks and see where we go with it now. I would presume that once she stops the pred and we wait a bit they will do an ACTH stim to see how badly she is affected by the pred and then I suppose a decision will be made whether or not to reintroduce the mitotane or not.

I will check back again on Saturday or friday evening with hopefully good news. She definitely seems better to me.. wakes up a few times during the night since she sleeps on our bed and cannot go inside to her pads or water by herself but I really do not mind that. I will be more than happy to continue doing that for many years to come, if given that gift. She is a little nervous/skiiddish, more than she ever was but I noticed that prior to the pred. I attributed it to her age and the meds but I need to further discuss that with the drs on friday. Thanks again and hope all of your babies are doing well. Have a great evening.

[molly muffin]

So good to hear that Reese is putting a bit of weight back on and I hope that the medication helps her long term too, as I know you do.

I think, as I've said before, having a main specialist dealing with Reese's issues will work out better. They become more invested in figuring it out and Knowing Reese. That is a huge part of any vet/pet relationship. So, I'm very hopeful that Reese and Dr. Palma will having a bonding experience. :) :)

[reesehascushings?]

Thanks so much! Hopefully we will get a good report tomorrow. I will check back here again in the evening or sat morning. Again I am so grateful to have found all of you on this forum. Enjoy your evening. xoxoxo Randy and Reese

[molly muffin]

Okay. Will be looking forward to see what he says about Reese

[Cushingheartbreak]

Good morning all. I would prefer not to go into years of details today but my 14 year old Yorkie has cushings. She was on mitotane and it caused severe stomach problems, lethargy etc and she had to be taken off and put on prednisone. She is seeing an internist and is on long term low dose pred. I know this is not a good situation but she was also diagnosed with ibd. We had to treat that situation. My question is she has lost excessive weight does not have an appetite and we are now taking her for another uktrasound. Her blood work believe it or not is almost perfect. Some levels are slightly elevated probably due to the pred use. She is also on anipryl (sp) for signs of dementia which seems to have really helped. She has lost tons of hair obviously due to the pred and cushings. Her urination, panting and other older symptoms are fine. She is now going on an appetite stimulant beginning with an m( a human antidepressant to hopefully increase her appetite. Marza somethkng. I didn't pick it up yet and also started cyclosporin to prevent inflammation from the pred and possible other helpful things. I hate all of these Meds but at this point her energy level is far better and she is not having any vomiting or bloody stools as she had been I also had been giving her melatonin twice daily which always seemed to just calm her and at that point helped with the hair loss ( prior to pred)
It has been very difficult and heartbreaking for her but she is mostly happy and energetic. If it was good for her to eat vats of ice cream to fatten her up we would give it. I am making a lot of her food trying to mix with dog food because I feel she needs regular fig food. The internist feels human food is her worst enemy yet he cannot recommend a good food and wants me to speak with a nututuonksy who makes human diets. I don't get that. I also think she would have to be placed on supplements. So finally it brings me to what high quality low fat dog food could someone recommend. She was eating leak chopped meat or chicken rice at times carrots or string beAns and literally picks the pieces out she by no means is getting enough food or nutrients. Any suggestions would be appreciated. She doesn't like eating until mid day and then several times a day. Small meals at least three to four times. Her regular vet said he does not feel any tumors and she doesn't exhibit pain on her visits but he is running ultrasounds to see if she has cancer. Help!!! Any tasty food canned or dry that you can tell me about I would be so grateful. Thank you all so much.

[Cushingheartbreak]

Sorry for the lengthy post but very desperate

[DoxieMama]

Welcome to you and your girl! I only have a moment but wanted to let you know that your posts have come through and I'm sure others will be by today to provide feedback.

One of the canned foods I've seen mentioned is Fromm brand. Here's a link to another site that has helpful info. http://www.dogfoodadvisor.com/best-dog-foods/suggested-low-fat-dog-food/

I'll try to stop by again tonight and add more thoughts.

Shana

[labblab]

Hello and welcome from me, too! I just wanted to let you know that I've moved your thread to our main discussion forum where it will be seen more readily by all our members. ;)

Marianne

[Harley PoMMom]

Hi and welcome to you and your sweet girl!

I am sorry that you and your precious girl have been going through so much and we will help in any way we can.

I'm including a post from me to another member whose dog has lost his appetite:
It's so worrisome when your furbaby becomes a finicky eater and it gets frustrating finding something that they will eat on a regular basis. My boys (cat and dog) eat Fromm dry food. If your looking for toppers usually for a dog the stinkier the better :eek::D some that I have used are tripe, grated parmesan cheese, yogurt, warm meat broth, boiled potatoes. Also carbs are a good filler such as pasta, oatmeal, barley, and quinoa.

I searched for food toppers and found this: http://www.flavoredspray.com/about.html

Here's a link to the dogfood advisor where you can search for dog food and see their ratings: http://www.dogfoodadvisor.com/dog-food-reviews/dry/

Hope this helps.

Hugs, Lori

Primal is a dog food that I have tried with success, also Freshpet is another one I would recommend, it is usually sold in regular grocery stores and is kept in a refrigerator.

Here's a link to Primal: http://www.primalpetfoods.com/

Freshpet: https://freshpet.com/our-foods/our-brands/

Just one question I have, or maybe two ;) When was her last stim test and what were those results? And have her electrolytes been checked recently?

Oh, forgot something :o I have used baby food in the past for some of my picky eaters but make sure it doesn't contain any onion or onion powder.

Hugs, Lori

[Cushingheartbreak]

Thank you all!!! I am having her records sent from last vet but her acts was within normal ranges throughout. The internist said there wouldn't be a point now since she is on pred and it would definitely have an impact on the results. He is treating the ibd that he believes she now has which was causing the vomoting and the bloody stools. He feels that the cushings will now have to take a back seat. He definitely cleared up the vomoting and the stool issues. Her stool is perfect with a slight foul odor that she never really had. The major problem now is the weight loss. She was at 9 and change when we started treatment and now is down to 6.4. Her muscle mass is almost all lost and her hair loss is far worse. I knew that the hair loss and even other symptoms of cushings would worsen due to the pred. The dr has now increased her dosage of pred to .5 twice a day due to her poor appetite and increased weight loss. She was down to .5 once daily and he felt this would be a life long treatment. Oddly enough other than the hair loss increasing she isn't having urinary issues, panting or other cushings symptoms. If she wasn't losing so much weight I wouldn't even care about the hair loss as long as she felt well. Now we have another uktrasound I would think to rule out cancer. Like I said her blood was near perfect with a few slightly elevated levels Thst were to be expected. Temporarily I am cooking her chopped lean beef chopped chicken and some rice and trying to mix in the natural balance limited ingredients canned that she was on. I would like to find a quality food and cut out the human food. I am not supplementing with anything so worried about that too. Thank you again and any suggestions would be very helpful. At a loss and not ready to let my sweet girl go.

[Harley PoMMom]

Maybe this will help:
Some recipes for Satin Balls, and other food ideas, designed to help pups gain weight -


Satin Balls - (Cat's recipe)

1 lb ground lamb, turkey or venison (or combination)

1 8 oz package of ricotta cheese

2 ounces almond butter

2 ounces coconut oil

4 ounces ground flaxseed

1 dozen egg yolks

2 cups rice cereal cooked

Other things to try include green tripe, sardines(canned in water and
drained) scrambled eggs, novelty meats like ostrich and rabbit, and certain
types of baby food. Baked treats can be good too, if the meat content is high
enough to get them interested. Don't OD on protein (as you know) with
Cushing's.

Kathy’s recipe
TO ADD WEIGHT - SATIN BALLS

20 pounds ground 70/30 beef or lamb
2 pounds beef or chicken livers pureed in the blender (gross I know)
12 eggs pureed in the blender
1-pound bag of cranberries pureed in the blender with the eggs
2 containers high fat ricotta cheese
2 cans jack mackerel or Salmon - drained
2 big cans spinach drained
1 box total cereal
1 jar wheat germ
1 big round box oatmeal
1 can of pumpkin
2 cups unsweetened applesauce
Bake at 350 like a meatloaf.


I should have let you know that Satin Balls are pretty high in fat content, as I'm sure you can easily see, and should not be given very often. A sudden increase in fats can trigger pancreatits and a steady diet can lead to a chronic condition there as well as other problems we don't want to add to the mix. So if you decide to try the balls, use them sparingly. These recipes were designed for dogs who have difficulty maintaining weight but who are otherwise fairly healthy.

Hugs,
Leslie and the gang

[Cushingheartbreak]

Thank you so much!!!

[Harley PoMMom]

Hi Randy!

I have taken the liberty of merging your thread into your preexisting thread, this way all information regarding Reese is in one place.

Lori

[reesehascushings?]

Thank you for all of your help

[reesehascushings?]

Hi I posted earlier but have no idea where it posted. Without going into tons of details we seem to be beating the end with Reese. I am taking her to the animal medical center to see dr Palma but it seems as if Reese is wasting away. We have done blood work which continues to look pretty normal some elevation in her liver numbers but that was expected. She is off the mitotane and they are treating her for ibd first and foremost she had lost almost half is her weight and mainly all of her hair on her trunk. She is on prednisone for her stomach which has helped. She is also on appetite stimulants as well as flagyl when needed she is on Prilosec twice daily too.bi give her hurricane twice daily to try to get someone calories in her. She sleep amoxy of the day any ideas and is this the end of her life. Definitely not ready to lose her yet. She has had bloods done and all pretty normal. Uktrasound of her stomach and surrounding areas. Normal. Chest X-ray normal. Help please

[Joan2517]

I'm so sorry...I wish I could help.

[Squirt's Mom]

I hope the vet has some insight along with a plan to help her feel better.

I take it the Lyso was stopped because she started having a lot of diarrhea? If that is the case, were the cortisol and electrolytes checked or did they go straight to IBD? Of course, the Lyso and Pred combined would be sort of in left field (tho I have known of vets who use the two together) and if the pred is helping then that is what I would choose to give her, too.

Has she been checked for diabetes recently? If not, I would be sure they do that today.

Let us know what you learn and I pray you come home with some help for her.
Hugs,
Leslie and the gang

[Harley PoMMom]

Stopping the Lysodren was definitely the right thing to do and now the focus will be in getting her to eat and gain some weight. Sometimes IBD can inflame that darn pancreas and if that is the case than pancreatitis will make her lose her appetite. Has the vet mentioned testing her for pancreatitis with the spec cPL test?

Maybe adding a food supplement would help in the weight gain, I've seen advertisements for PetAg DogSure Food Supplement.

Hopefully by the time you read this Reese will be feeling much better, keeping you both in my thoughts and prayers.

Hugs, Lori

[molly muffin]

Oh I'm so sorry that Reese isn't doing well right now. I agree, getting to her to eat and feel better is first and foremost and I do hope the specialist has some insight into this.

[reesehascushings?]

Hi thanks for your responses. Reese unfortunately is not doing great. She has her good days and bad and today wasn't too great. I spoke with the humane society get at 62nd and second avenue in Manhattan to see his take on this. He had ordered the ultrasound. He didn't think it was a gall bladder problem either, as dr Palma thought. At this point I think he feels that she has reached the end of her life. He did not agree with a feeding tube as dr Palma has suggested. He also served to agree that it reaches a point where we have to decide whether or not we stop searching for an answer. If we do a brain scan and we find a tumor will Reese at this point under six pounds ( usually 10 on average) make it through the scan and would she make it through a surgery if needed. How long will she live after that? She is pure skin and bone. You see every bone on her body since she has no hair on her back. At all!! I think I am in a complete state of shock and so devastated. We always know their lives aren't too long but no one especially me wants to let go of her. The dr at the humane society is going to give her ad as a try but there is little hope she will eat it. I have basically been giving her anything and everything human, mainly ahd she turns her nose up to most. Today again she had a huge appetite kept barking and running into the kitchen for more but barely ate any. I give her a line up of plates of different foods, it looks like a buffet well it is a buffet. He feels like this is probably she related and end of life and that her good and bad days could be neurological issues too. All I know is I am in complete shock and already can't stop crying. Still I am thinking of bringing her to my fourth opinion and looking for top internal medicine vets. I still can't find one. All I have spoken with tell me what a genius dr Palma is. At this point I am questioning ad to why he didn't just tell me what is probably the truth instead of testing and testing and retesting. Thanks for listening and for all concern

[LittleArfinAnnie]

After I read your last post, I found myself thinking about you and Reese for a very long time this evening, hon . . . So much so that sleep just wasn't possible. So I got out of bed, made myself a cup of coffee ( I know . . . stupid move . . . ) and logged back in to this site.

Because I have just recently experienced the devastating feelings that you've described so well, I thought I would share a bit of my story with you.

Please understand that I am in NO WAY giving you advice or making any suggestions here.

I just want you to know, first of all, that you are not alone. All of us here know only too well the anguish and desperation that seem to go hand-in-hand with loving a Cush-baby so deeply. That is a GIVEN.

As my beloved miniature Dachshund, Annie, really began to manifest symptoms that affected her quality of life, I, too, frantically sought medical advice and treatment protocols that I hoped would restore that feisty little girl to me.

Nothing seemed to be working in spite of ACTH numbers that were - and I quote - "the most beautiful numbers that we've seen in over a year".

If her Cushing's is being appropriately controlled, thought I, why is she so obviously not feeling well ?

I subjected that stoic, little soul to MANY tests and procedures . . . spent a small fortune . . . ate a LOT of Kraft Dinner . . . ( independently wealthy, I'm NOT ) tried different foods . . . even cooked for her myself for about six months . . . gently bathed her to try to keep ahead of the opportunistic skin infections that had begun to develop . . . took her to a canine physiotherapist to try to restore some muscle tone and strength to those wobbly, little back legs . . . bought about three thousand fans ( okay, mild exaggeration there ) so that she could always stay cool . . . and basically adjusted my daily routines so that her comfort and dignity remained a priority.

In spite of everything, in spite of my unwavering dedication and heroic measures, in spite of all the vet appointments, tests and treatments, she just was NOT rallying.

What WAS happening, though, was that Annie was just getting more and more tired . . . in other words, she really wasn't having fun anymore. Her quality of life had become virtually non-existent.

One day, in the midst of all of these heroic measures on my part, I began to realize that I was frantically pursuing these "possible" solutions more for ME than for my beloved Annie. She HATED being separated from me during some of those lengthy testing sessions and would always be trembling and quite obviously unhappy whenever I picked her up.

I couldn't put her through any of that anymore.

All I could do was love her with all of my heart and put my energy and effort into making sure that I could maintain her comfort and dignity for as long as possible.

It became all about peace and serenity . . . more for HER than for me. I consciously committed myself to giving her the calmness and love with which she had blessed me for over ten years.

And I continued to watch her closely . . . and take my cues from her, too.

I gently invite you to think about what I have shared with you, sweetheart. You need to be very proud of yourself for all of the effort you are putting into loving and nurturing your beloved Reese. I understand this completely because I, too, have walked in your footsteps. I understand the devastation that you feel because I, too, have felt it. I understand the depth of the bond that you have with your little one because I, too, was blessed with such a deep connection.

But as soon as I became aware of the fact that I was possibly traumatizing Annie by continuing to subject her to my well-intentioned heroic measures, I just KNEW that I loved her too much to make her miserable even one more time. After all, it was also my sacred duty to protect her . . .

Please know that all of us here are holding both you and Reese very close to our hearts . . .

[Joan2517]

Nicely said. I know that if Lena hadn't died in the emergency clinic that night, I would have dragged her to every doctor I could to try to keep her with me...and it would have been the worst thing to do to the dog I loved with all my heart.

She was so tired and we hadn't been on the Cushing's journey long. She was almost 15 and probably had it for a few years, but we didn't know until this past December. Just the couple of months of treatment, going in for the blood tests, changing the dose, the constant monitoring, wore her out. I wish I had just let her be and enjoyed whatever time we had left together. She only wanted to be home, with her brothers, sister, Dad and me.

[Squirt's Mom]

Hey Randy,

I came to the same place with my Squirt as LittleArfin did with Annie - Squirt deserved to enjoy as much as possible whatever time she had left. And she did not enjoy going to the vet - she so deplored those trips that she came to see the vehicle as a whole undesirable when there was a time she loved to ride. All those vet visits destroyed her love of traveling. So I promised her no more pokes or prods.

The focus for me changed from finding those answers to making every moment as comfortable, painless, and love-filled as I possibly could for however long we had. Her taste changed often, sometimes daily, so I was constantly offering this food then that food then the other food - but eventually she would accept something. For so long I had focused on what she needed to eat - but at this time it became about what she WOULD eat and it didn't matter what that was as long as she was eating. If she enjoyed it enough to eat it, she got it. Whatever brought her joy, she got.

We talked about everything. I would hold her and walk around the areas she had loved to explore. She had never been a lap dog - much too independent for that! ;) But during this time, she often sat in my lap on the porch watching the sun rise or set. We gobbled every minute we could for as long as we could.

Then that day came when she told me she had had enough. One the hardest things I have ever done but she was my Beloved, my Sweet Bebe, and she deserved her freedom. She was tired; we could win no more battles. So I did as I had promised. I still miss her terribly and cry for her almost daily but I know it was the right time. You will know as well.

I'm not telling you what to do - that is between you and Reese. I just wanted to share with you and let you know there are many here who understand how you are feeling. And we will be with you all the way. Talk all you need to, cry, scream - we understand.

Hugs,
Leslie

There are a couple of poems I read often during that time. Here is one of them - I talked to this Guardian Angel often during those walks, maybe it will help you as well...

Guardian Angel of Pets

Hello. I've been expecting you for quite some time.
Here, come sit beside us for a while .
and let me tell you about this old friend of mine.
She might look tattered or maybe old
But I won't say goodbye until you've been told.
She had the brightest eyes I had ever seen,
And wore a beautiful fur coat that would out shine a queen .
She was never prissy but walked with an aire ......
And oh so polite, you could take her most anywhere.
She could run like the wind and could catch anything she chased
But she protected and sat with me when I had problems to face.
You could not find a friend nearly so dear.
Because no matter the trouble she always stayed near...
She has never asked for much from me;
Just to love and respect her and I think you'll agree .
To give her a good meal plus a nice warm bed is not much to ask
When she has given me all her love and to her this was no task.
Now I understand you have a schedule to keep.
But I have a small favor before she nods off to sleep.
Please fold your wings around her and let her feel young while in no pain.
Dear Guardian Angel of Pets,
please keep her safe and happy until I see her again.

By Ginger Patton